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"TUJUAN: (1) Mengetahui perubahan fungsi sistolik dan diastolik serta massa ventrikel kin pada remaja dan dewasa muda penderita Talasemia mayor dibandingkan dengan remaja dan dewasa muda normal. (2) Mengetahui hubungan antara kadar feritin serum dan fungsi sistolik dan diastolik ventrikel kiri yang diperoleh dengan pemeriksaan ekokardiografi pada remaja dan dewasa muda penderita Talasemia mayor.TEMPAT PENELITIAN: Divisi Kardiologi dan Divisi Hematologi Anak FK UI/RSCM JakartaSUBYEK PENELITIAN: Remaja dan dewasa muda penderita Talasemia mayor yang menjalani pemeriksaan dan transfusi rutin di Pusat Talasemia RSCM sejak bulan Agustus - Desember 2005.METODOLOGI: Dilakukan penelitian observasional dengan rancang bangun cross sectional. Data meliputi parameter hematologis pasien Talasemma mayor dan parameter fungsi sistolik ventrikel kiri (EF dan FS), fungsi diastolik ventrikel (E, A, rasio E/A, IVRT), serta massa ventrikel kiri (LVDDi, LVDSi, LVMi) dengan menggunakan mesin ultrasonografi Sonas 4500, transduser 8 MHz. Data diolah dengan SPSS versi 10. Dilakukan uji t, analisa regresi liner dan analisa multivariat dengan regresib multiple. Nilai a yang dipakai adalah 0,05. Jumlah subyek minimal yang diperlukan adalah 28.HASIL : Dan 32 subyek Talasemia mayor yang diperiksa, 30 subyek diikutsertakan dalam penelitian. Fungsi sistolik dan diastolik Talasemia mayor lebih rendah dibanding kontrol dan perbedaan ini secara statistik bermakna. Rerata EF Talasemia mayor dan kontrol masing-masing adalah 66,1% (SB 4,9) dan 71,6% (SB 5,6) ; p < 0,0001. Rerata FS 36,0% (SB 3,7) dan 39,8% (SB 5,5) ; p = 0,003. Rerata rasio E!A Talasemia mayor dan kontrol masing-masing 2,14 (SB 0,4) dan 1,83 (SB 0,3); p = 0,002. Massa ventrikel kin Talasemia mayor secara bermakna lebih berat dibanding kontrol. Rerata LVMi (g/m2) Talasemia mayor dan kontrol masing-masing 111,1 (SB 30,8) dan 75,4 (SB 14,5); p < 0,0001. Dengan regresi linier sederhana dan regresi multipel dijumpai hubungan yang cukup kuat dan bermakna antara fungsi diastolik ventrikel kiri (rasio FA) dengan kadar feritin serum (r = 0,71;p < 0,0001).KESIMPULAN: Fungsi sistolik dan fungsi diastolik remaja dan dewasa muda penderita Talasemia mayor telah mulai mengalami perubahan dan abnormalitas. Massa ventrikel kin remaja dan dewasa muda penderita Talasemia mayor lebih berat dari pada orang normal. Semakin tinggi kadar feritin serum semakin besar kemungkinan penderita Talasemia mayor untuk menderita gangguan fungsi diastolik.

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OBJECTIVES: To detect the left ventricular systolic and diastolic functions and mass alteration among adolescents and young adults with Thalassemia major compared to those of normal adolescents and young adults, and to find out the relationship between serum ferritin level and left ventricular functions which are obtained from echocardiography examination.SETTING: Division of Pediatric Cardiology and Hematology Department of Child Health, Medical Faculty, Cipto Mangunkusumo Hospital JakartaSUBJECTS: Adolescents and young adults with Thalassemia major whose got blood transfusion in Thalassemia Center Cipto Mangunkusumo Hospital Jakarta between August to December 2005.METHODS: A cross-sectional study was conducted. The data includes the Thalassemia major patients' hematology data, left ventricular systolic function (EF and FS), and diastolic function (A, E, F/A ratio, IVRT), mass (LVDD1, LVDSi, LVMi) by using an ultrasonography Sonos 4500, transducer 8 MHz. That data were processed with SPSS version 10. The t test, liner regression and multiple regression analysis were performed. Statistical significant was assumed with a 0.05. The minimal number of subjects needed was 28.RESULTS: Out of 32 Thalassemia major patients, 30 were enrolled to study. Left ventricular systolic and diastolic function of Thalassemia major patients were lower than the control and it was statistically significant.[ EF 66.1% (SD 4.9) and 71.6% (SD 5.6); p < 0.0001, FS 36.0% (SD 3.7) and 39.8% (SD 5.5); p = 0.003, E/A 2.14 (SD 0.4) and 1.83 (SD 0.3); p = 0.002], respectively. Left ventricular mass of Thalassemia major patients was greater than control, and it was statistically significant [LVMi (g/m2) 111.1 (SD 30.8) and 75.4 (SD 14.5); p < 0.0001], respectively. Linier and multiple regression analysis showed that there was significant and powerful relation between left ventricular diastolic function (E/A ratio) and serum ferritin ( r = 0.71; p < 0.0001).CONCLUSION: The systolic and diastolic functions of adolescents and young adults with Thlassemia major have started to alter and abnormalities. The left ventricular mass of adolescents and young adults with Thalassemia major more than heavier that of a normal person. The higher the level of serum ferritin is, the more likely it is for Thalassemia major patient to suffer from diastolic abnormalities."

"This study aims to analyze factors in the acceptance and success of theimplementation of SPAN for those who have direct access to it (licensedusers) at the Treasury Office (KPPN) using an integrated model. Thesamples are 160 licensed users in 15 KPPN in Central Java. Thetechnical analysis used in this research is Partial Least Square (PLS)using software SmartPLS version 3.2.3. Based on the result, it was foundthat social factors and facilitating conditions have positive andsignificant effects on user attitudes. In addition, user attitudes also havepositive and significant effects on user satisfaction. Meanwhile, othervariables, such as performance expectations, effort expectations,information quality and systems quality, have no effect on user attitudein using SPAN.Penelitian ini bertujuan untuk menganalisis faktor-faktor yangmempengaruhi penerimaan dan kesuksesan penerapan SPAN bagipara pengguna yang memiliki hak akses (licenced user) SPAN di KPPNdengan menggunakan model integrasi (integrated model).Pengambilan sampel menggunakan metode area sampling dengansampel yang terdiri dari licenced user pada KPPN lingkup JawaTengah (15 KPPN) sebanyak 160 responden. Teknis analisis yangdigunakan adalah Partial Least Square (PLS) dengan pengolahan datamenggunakan perangkat lunak SmartPLS Versi 3.2.3. Berdasarkanhasil analisis, diperoleh kesimpulan bahwa pengaruh sosial dankondisi yang memfasilitasi, berpengaruh positif dan signifikanterhadap sikap pada penggunaan. Sikap pada penggunaan jugaberpengaruh positif dan signifikan terhadap kepuasan pengguna.Sedangkan variabel lain, meliputi ekspektasi kinerja, ekspektasiusaha, kualitas informasi, dan kualitas sistem tidak berpengaruhterhadap sikap pada penggunaan SPAN."

"Latar belakang: Renjatan merupakan masalah utama di ruang emergensi dan rawat intensif anak. Resusitasi cairan pada renjatan hanya memberikan repons pada 50% pasien. Pemberian cairan yang berlebih akan meningkatkan morbiditas dan mortalitas. Indeks dinamis memiliki keterbatasan dalam memprediksi fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) belum banyak diteliti dan dapat mengatasi keterbatasan indeks dinamis.Tujuan: Mengidentifikasi peran LVEDVI sebagai prediktor fluid responsiveness terhadap pemberian cairan resusitasi pada anak dengan renjatan.Metode: Ini adalah penelitian uji diagnostik-potong lintang pada anak dengan renjatan di ruang emergensi dan rawat intensif anak RSUPN Cipto Mangunkusumo Juni hingga November 2018. Pengukuran LVEDVI dilakukan menggunakan USCOM dan dibandingkan dengan peningkatan isi sekuncup ≥15% setelah fluid challenge sebagai kriteria fluid responsive. Sampel dimasukkan ke dalam kelompok fluid responsive dan fluid nonresponsive.Hasil: Dari 40 subyek penelitian, didapatkan 60 sampel fluid challenge. Terdapat 31 sampel di kelompok fluid responsive dan 29 sampel di kelompok fluid nonresponsive. Tidak terdapat perbedaan bermakna rerata LVEDVI pada kedua kelompok (p=0,161). Nilai AUROC LVEDVI 40,9% pada titik potong 68,95 mL/m², dengan sensitivitas 45,16% dan spesifisitas 44,83%.Simpulan: Penelitian ini tidak dapat membuktikan LVEDVI dapat berperan sebagai prediktor fluid responsiveness.

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Background: Shock is a major problem in the Pediatric Emergency and Intensive Care Unit. Fluid resuscitation for shock only provides response in 50% of patients. Excessive fluid administration will increase morbidity and mortality. Dynamic indexes have limitations in predicting fluid responsiveness. Left Ventricular End Diastolic Volume Index (LVEDVI) has not been widely studied and can overcome the limitations of dynamic indexes.Objective: To identify LVEDVI as a predictor of fluid responsiveness in children with shock.Method: This was a cross-sectional diagnostic study in children with shock in the emergency room and pediatric intensive care unit of Cipto Mangunkusumo Hospital RSUPN from June to November 2018. The LVEDVI measurements were performed using USCOM and compared with an increase in stroke volume ≥15% after fluid challenge as fluid responsiveness criteria. Sample then categorized into fluid responsive and fluid nonresponsive group.Results: Of 40 subjects, 60 fluid challenge samples were obtained. There were 31 samples in the fluid responsive group and 29 in the fluid nonresponsive group. There was no significant mean difference of LVEDVI in the two groups (p=0.161). The AUROC of LVEDVI is 40,9% with cut off value of 68,95mL/m². The sensitivity and specificity are 45,16% and 44,83% respectively.Conclusion: This study cannot prove LVEDVI can act as a predictor of fluid responsiveness."

"[ABSTRAKLatar belakang dan tujuan: Menentukan korelasi nilai Ejection Fraction (EF) ventrikel kiri pada echo 2D dan DSCT jantung pada pasien Penyakit Jantung Koroner (PJK) stabil di RSUPN Cipto Mangunkusumo, sehingga nilai EF ventrikel kiri DSCT jantung dapat dijadikan acuan untuk evaluasi, penatalaksanaan dan prognosis pada PJK stabil yang mempunyai indikasi dilakukan CT jantung.Metode: Analisa retrospektif dari 30 pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak waktu ≤ 3 bulan, meliputi penilaian EF ventrikel kiri. Berdasarkan nomor rekam medis yang ada, dilakukan pengambilan data EF ventrikel kiri echo 2D serta data tambahan lainnya. Nilai EF ventrikel kiri secara DSCT di evaluasi kembali pada cardiac workstation (Siemens, Leonardo), kemudian ditentukan bagaimana korelasinya dengan nilai EF ventrikel kiri secara echo 2D. Analisis statistik penelitian ini menggunakan uji SpearmanHasil: Terdapat perbedaan nilai EF ventrikel kiri sebanyak 4% antara echo 2D dengan DSCT jantung. Perbedaan sebanyak 4% ini tidak bermakna signifikan secara klinis namun bermakna secara statistik. Nilai R Spearman yang didapat adalah 0,17 sementara nilai p 0,364 (p > 0,005), artinya tidak terdapat korelasi antara nilai EF ventrikel kiri secara echo 2D dengan DSCT jantung pada pasien PJK stabil yang menjalani pemeriksaan echo 2D dan DSCT jantung dengan jarak ≤ 3 bulan di RSUPN Cipto Mangunkusumo.Kesimpulan: Walaupun pada penelitian ini secara statistik tidak berkorelasi, namun pada keadaan hasil echo yang borderlineatau pada pasien PJK stabil yang mempunyai indikasi dilakukan CT jantung, nilai EF ventrikel kiri pada CT dapat menjadi acuan untuk penatalaksanaan selanjutnya.

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ABSTRACTBackground and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.;Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management., Background and Objectives: to determine the correlation left ventricle Ejection Fraction (EF) between echo 2D and cardiac DSCT in Coronary Heart Disease (CHD) patients at Cipto Mangunkusumo Hospital, so that the value of the left ventricular EF cardiac DSCT can be used as a reference for the evaluation, treatment and prognosis in stable CHD who have an indication of cardiac CT.Methods: A retrospective analysis of 30 patients with stable CHD who underwent 2D echo and cardiac DSCT with interval ≤ 3 months, include assessment of left ventricular EF. Based on the existing medical record number, performed data collection left ventricular EF 2D echo and other additional data. Value of left ventricular EF in DSCT in return on cardiac evaluation workstation (Siemens, Leonardo), then determined how its correlation with left ventricular EF values in 2D echo. Statistical analysis of this study using the Spearman test.Result: There are differences in left ventricular EF value by 4% between 2D echo with cardiac DSCT. The difference of 4% is not clinically significant, but statistically significant. Spearman R value obtained was 0.17 while the p-value 0.364 (p> 0.005), meaning that there is no correlation between the value of the left ventricular EF in 2D echo and cardiac DSCT in patients with stable CHD who underwent 2D echo and cardiac DSCT with distance ≤ 3 month in Cipto Mangunkusumo hospital.Conclusion: Although this study was not statistically correlated, but the results echo borderline or in stable CHD patients who had cardiac CT indications, left ventricular EF values on CT can be a reference for further management.]"

"ABSTRAKLatar belakangPenyakit jantung Koroner (PJK) merupakan penyebab kematian yang tertinggi di dunia dan cenderung meningkat dari tahun ke tahun. Skor TIMI STEMI sudah banyak digunakan dan divalidasi sebagai prediktor kematian pasien STEMI namun belum mencakup komponen fraksi ejeksi ventrikel kiri (FEVK) dan laju filtrasi glomerulus (LFG), dan kurang optimal dalam penggunaanya.TujuanMemodifikasi skor TIMI STEMI dengan memasukkan variabel FEVK dan LFG sebagai prediktor mortalitas pada pasien STEMI dalam 30 hari di RSCM. Metode Studi kohort retrospektif terhadap 487 pasien STEMI yang di rawat di RSUPN Cipto Mangunkusumo pada periode 2004-2013. Data variabel prediktor diperoleh dari penelusuran rekam medis. Data yang didapatkan dianalisis secara bivariat dan multivariat, setelah itu dibuat formulasi baru prediktor mortalitas pasien STEMI dalam 30 hari dan akan diujikan pada seluruh data dan dinilai risiko mortalitasnya serta dibandingkan dengan skor TIMI dengan AUC (area under curve).HasilDari analisis secara bivariat dan multivariat didapat hanya dua variabel yang dapat digunakan dalam formula baru yaitu kelas killips II-IV dan LFG dengan kisaran total skor 0-4.6 Stratifikasi risiko mortalitas dalam 30 hari pada pasien STEMI adalah tinggi (total skor >3,5; 46,5%), sedang (total skor 2,5-3,5;23,2%), dan rendah (total skor <2,5;5,95%). Diskriminasi modifikasi skor TIMI STEMI dengan AUC 0.816; IK 95%; 0.756-0.875.KesimpulanModifikasi skor TIMI STEMI terdiri dari dua variabel yaitu kelas Killip dan LFG. Modifikasi ini memiliki kalibrasi dan diskriminasi yang baik sebagai prediktor mortalitas 30 hari pada pasien STEMI.

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ABSTRACTBackgroundCoronary Heart Disease (CHD) is the leading cause of death in the world and the rate increases every year. TIMI STEMI score has been used and validated as mortality predictor for STEMI patient but unfortunately, it does not involve left ventricle ejection fraction (LVEF) and Glomerulus filtration rate (GFR), thus it is less optimal in clinical setting.ObjectiveTo modify TIMI STEMI score include LVEF and GFR as variables for 30 day mortality predictor STEMI patients in RSUPN Cipto Mangunkusumo Hospital. Methods Retrospective cohort study was done toward 487 STEMI inpatients in RSUPN Cipto Mangunkusumo Hospital in 2004-2013. Predictor variable data was obtained from medical records. The data was analyzed with bivariate and multivariate method using Cox’s Proportional Hazard Regression Model. Subsequently, formulate new predictors for STEMI patient mortality rate in 30 days. In these newly formulated predictors shall be stratified to all data and mortality risk shall be assessed and compared with current TIMI STEMI Score using area under curve (AUC).ResultsFrom bivariate and multivariate analysis, only two variables were found to have significant values for new formulation; Killip class II-IV and GFR which contribute 0.4.6 of total score value. 30 day mortality risk stratification for STEMI patient is high if total score > 3.5;46.5%, moderate if total score 2.5-3.5;23.2% and low if total score < 2.5;5.95%. Modified TIMI STEMI Score has a good discrimination rate with AUC value of 0.816 (0.756-0.875) and confidence interval (CI) 95%.ConclusionModified TIMI STEMI Score has two variables such as Killip Class and GFR. It has good calibration and discrimination for 30 day mortality predictor in STEMI patients."