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"Latar Belakang Malformasi arteri-vena (MAV) adalah kondisi di mana arteri dan vena terhubung langsung tanpa pembuluh kapiler. MAV otak memiliki risiko tinggi untuk perdarahan yang berpotensi fatal. Insiden MAV otak berkisar antara 1.12 hingga 1.42 kasus per 100,000 orang per tahun, dengan tingkat mortalitas sekitar 10-15%. Tujuan penelitian ini adalah untuk menyediakan hasil studi mengenai perbaikan pasien MAV otak pasca SRS di RSUPN Dr. Cipto Mangunkusumo, Jakarta. Harapannya, dapat memberikan wawasan yang berharga dalam memperlancar penanganan kondisi ini. Metode Penelitian ini adalah penelitian observasional deskriptif dengan jenis studi kuantitatif. Pasien yang diteliti adalah pasien yang dirawat dengan SRS di RSCM, dan terdata dalam kurun tahun 2018-2023. Waktu follow-up pasien adalah 3 tahun. Luaran klinis yang dinilai adalah sefalgia dan kejang. Luaran lainnya adalah radiologis, dan komplikasi pasca-tindakan SRS. Hasil Penelitian dilakukan pada 41 pasien (63.4% laki-laki, 36.6% perempuan, rerata usia 25.7 tahun; usia minimum 5 tahun, dan usia maksimum 72 tahun). Seluruh pasien (41 orang) mengalami sefalgia sebagai manifestasi awal, dan seluruh pasien mengalami perbaikan pada masa follow-up 1 tahun. Kejang merupakan manifestasi terbanyak kedua (15 orang), dan perbaikan kejang mencapai 86.7% pada masa follow-up 1 tahun. Manifestasi lainnya adalah defisit motorik, gangguan bahasa, gangguan memori, dan gangguan lapang pandang. Komplikasi pasca-tindakan yang terjadi pada pasien adalah edema serebri dan perdarahan. Kesimpulan Seluruh pasien (41 orang) MAV otak mengalami perbaikan sefalgia, hal ini tercatat pada masa follow-up 1 tahun. Pada masa follow-up 2 tahun, 86.7% pasien mengalami perbaikan kejang dari total 15 pasien MAV dengan manifestasi kejang. Semakin kecil volume nidus MAV, maka semakin besar obliteration rate. Komplikasi terbanyak yang dialami oleh pasien MAV otak yang ditatalaksana dengan SRS di RSCM adalah perdarahan, dengan angka 9.8% (4 orang).

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Introduction Arteriovenous malformation (AVM) is a condition where arteries and veins are directly connected without capillaries. Brain AVM carries a high risk for potentially fatal bleeding. The incidence of BAVM ranges from 1.12 to 1.42 cases per 100,000 people per year, with a mortality rate of approximately 10-15%. The aim of this study is to provide the results of a study on the improvement of cerebral MAV patients after SRS at Dr. Cipto Mangunkusumo Hospital, Jakarta. Hopefully, it can provide valuable insights in expediting the management of this condition. Method This study is a descriptive observational study with a quantitative study type. The patients studied were patients who were treated with SRS at RSCM, and were recorded in the period 2018-2023. Patient follow-up time was 3 years. The clinical outcomes assessed were cephalgia and seizures. Other outcomes were radiological, and post-treatment complications of SRS. Results The study was conducted on 41 patients (63.4% male, 36.6% female, mean age 25.7 years; minimum age 5 years, and maximum age 72 years). All patients (41 people) had cephalgia as the initial manifestation, and all patients had improvement at the 1-year follow-up period. Seizures were the second most common manifestation (15 patients), and seizure improvement was 86.7% at 1-year follow-up. Other manifestations included motor deficits, language impairment, memory impairment, and visual field impairment. Post-operative complications that occurred in patients were cerebral edema and hemorrhage. Conclusion All patients (41 people) with cerebral MAV experienced improvement in cephalgia, this was noted at the 1-year follow-up period. At the 2-year follow-up period, 86.7% of patients had seizure improvement out of a total of 15 MAV patients with seizure manifestations. The smaller the MAV nidus volume, the greater the obliteration rate is. The most common complication experienced by brain MAV patients who were treated with SRS at RSCM was hemorrhage, with a rate of 9.8% (4 people)."

"Latar Belakang : Peningkatan resistensi vaskular paru (RVP) pasien stenosis mitral (SM) disebabkan oleh proses reaktif hipertensi pulmoner (HP) sehingga mempengaruhi luaran klinis pascabedah katup mitral. Endotelin-1 (ET-1) sebagai mediator vasoaktif berperan penting pada HP reaktif. Belum ada penelitian yang menghubungkan kadar ET-1 vena pulmoner (VP) dengan RVP. Tujuan Penelitian : Menilai korelasi kadar ET-1 VP terhadap RVP sebelum dan sesudah pembedahan katup mitral pada pasien SM dengan HP. Metode : Penelitian ini merupakan studi potong lintang pada 28 pasien SM berat dengan HP sedang dan berat yang menjalani pembedahan katup mitral di Pusat Jantung Nasional Harapan Kita dari bulan April hingga November 2014. Dilakukan analisa statistik untuk mencari korelasi antara kadar ET-1 VP dengan RVP sebelum dan sesudah pembedahan katup mitral. Hasil Penelitian : Terdapat korelasi antara kadar ET-1 VP dengan RVP prabedah (r=0,49, p=0,008), sedangkan dengan RVP pascabedah tidak berkorelasi bermakna (r=0,204, p=0,32). Analisa regresi linear antara kadar ET-1 VP dengan RVP prabedah setelah disesuaikan dengan variabel perancu hipertensi, diabetes melitus tipe 2, fibrilasi atrial, penggunaan penyakat beta dan diuretik didapatkan r=0,5 koefisien β 1,04 dengan interval kepercayaan (IK) 95% (0,401-1,691) p=0,003, sedangkan dengan RVP pascabedah setelah disesuaikan dengan variabel perancu hipertensi, penghambat ACE/ARB, penyakat beta, vasodilator, waktu cross clamp didapatkan r=-0,08 koefisien β -0,2 dengan IK 95 % (-0,99-0,5) p=0,5. Kesimpulan : Terdapat korelasi positif bermakna dengan kekuatan sedang antara kadar ET-1 VP dengan RVP prabedah, Peningkatan kadar ET-1 VP sebesar 1 pg/ml, akan meningkatkan RVP prabedah sebasar 1,04 WU. Kadar ET-1 VP tidak memiliki korelasi bermakna terhadap RVP pascabedah.

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Background : The increased of Pulmonary Vascular Resistance (PVR) in mitral stenosis (MS) patient occurs in reactive pulmonary hypertension, and it affects clinical outcome after mitral valve surgery. Endothelin-1 (ET-1) as vasoconstrictive agent have important role in reactive pulmonary hypertension so far there is no study that corelate pulmonary vein (PV) ET-1 with PVR in MS.

Objectives : To study the correlation of PV ET-1 level with PVR measured by echo before and after mitral valve surgery in patient MS with pulmonary hypertension.

Methods : Twenty eight MS patients with moderate and severe pulmonary hypertension who underwent mitral valve surgery at National Cardiovascular Centre Harapan Kita from April to November 2014. Statistical analysis was done to see the correlation of PV ET-1 level with PVR before and after mitral valve surgery. Blood sample was taken from VP in the operating room and analyzed with Quantikine® ELISA ET-1 Immunoassay. PVR was measured by PVR-AMS formula by echocardiography.

Result : There was a correlation between PV ET-1 and PVR pre surgery (r=0,49, p=0,008), whereas, there was no significant correlation with PVR post surgery (r=0,204, p=0,32). Linear regression analysis was performed, PV ET-1 and PVR pre surgery were adjusted to confounding variables hypertension, diabetes mellitus, atrial fibilation, use of beta blocker and diuretic; r=0,5 β coefisien level 1,04 with confidance interval (CI) 95 % (0,401-1,691), p=0,003. PVR post surgery was adjusted to confounding variables hypertension, dislipidemia, use of ACE-I/ARB, beta blocker, vasodilator, cross clamp time, r=-0,08 β coefisien level -0,2 with CI 95 % (-0,99-0,5), p=0,5.

Conclusion : There was a moderate positive correlation between PV ET-1 with PVR pre surgery, the increased of PV ET-1 level 1 pg/ml, would increase PVR level 1,04 WU. There was no significant correlation between PV ET-1 with PVR post surgery."

"Penyakit TB lebih berkembang pada masyarakat dengan status sosial ekonomi yang rendah, kelompok terpinggirkan dan populasi rentan lainnya. Salah satu yang termasuk populasi rentan adalah komunitas penderita kusta. Penyakit TB dan kusta banyak ditemukan di daerah beriklim tropis dengan kelembapan udara tinggi, tingkat sosial ekonomi penduduk yang rendah serta status gizi dan higienitas yang buruk. Infeksi kedua penyakit ini dapat terjadi bersamaan pada satu individu dan biasanya terjadi pada pasien imunokompromais. Koinfeksi TB paru pada penderita kusta dapat meningkatkan mortalitas.Penelitian ini bertujuan untuk mengetahui proporsi TB Paru pada penderita kusta yang berobat di Poliklinik Kulit dan Kelamin RSUPN Dr. Cipto Mangunkusumo serta mengetahui faktor risiko yang dapat memengaruhi. Desain penelitian adalah cross sectional dengan jenis penelitian deskriptif analitik berdasarkan hasil pemeriksaan laboratorium, foto toraks dan kuesioner. Penelitian dilakukan di Poliklinik Kulit dan Kelamin serta Poliklinik Penyakit Dalam – Pulmonologi RSUPN Dr. Cipto Mangunkusumo pada tahun 2022. Sampel penelitian ini adalah pasien kusta baik sedang dalam pengobatan multi drugs therapy (MDT) maupun telah dinyatakan release from treatment (RFT) yang memenuhi kriteria penelitian dan bersedia untuk berpartisipasi dalam penelitian. Besar sampel yang diperlukan untuk penelitian ini adalah 105 orang. Data yang diperoleh diolah dan dianalisis secara univariat, bivariat dan multivariat dengan perangkat lunak SPSS.Dari total 109 subjek, terdapat 3 orang (2,75%) yang didiagnosis TB paru yang mencakup 1 orang TB paru bakteriologis terkonfirmasi TCM dan 2 orang TB paru klinis. Mayoritas subjek dengan TB paru berusia kurang dari 40 tahun (66,7%), didominasi laki-laki (66,7%) dan seluruhnya berpendidikan rendah. Dari subjek yang memberikan informasi, sebanyak 50% memiliki pendapatan kurang dari 3,5 juta per bulan. Seluruh subjek dengan TB paru mengaku tidak pernah mendapat vaksinasi BCG dan mayoritas mengaku memiliki riwayat merokok (66,7%). Sebanyak 66,7% mengaku tidak ada riwayat kontak fisis, tidak pernah menggunakan barang dan berbincang dengan penderita TB paru. Hanya 33,3% penderita koinfeksi TB paru pada kusta yang memiliki status gizi kurang. Seluruh penderita TB paru pada kusta didiagnosis kusta tipe multibasiler. Dari hasil analisis bivariat, faktor pendidikan memiliki hubungan yang bermakna dengan luaran TB paru. Namun pada analisis multivariat tidak dapat mengeluarkan hasil.

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TB disease develops more in communities with low socio-economic status, marginalized groups, and other vulnerable populations. One of the vulnerable populations is the leprae community. TB and leprosy are often found in tropical climates with high air humidity, low socio-economic levels of the population, and poor nutritional and hygiene status. Infection with these two diseases can occur simultaneously in one individual and usually occurs in immunocompromised patients. Pulmonary TB coinfection in leprosy sufferers can increase mortality.This study aims to determine the proportion of pulmonary TB in leprosy sufferers who seek treatment at the Skin and Venereology Polyclinic, RSUPN Dr. Cipto Mangunkusumo, and the risk factors that can influence it. The research design was cross-sectional with a descriptive analytical research type based on the results of laboratory examinations, chest x-rays, and questionnaires. The research was conducted at the Skin and Venereology Polyclinic and the Internal Medicine- Pulmonology Polyclinic, RSUPN Dr. Cipto Mangunkusumo, in 2022. The sample for this study was leprosy patients who were either undergoing multidrug therapy (MDT) or had been declared released from treatment (RFT) and who met the research criteria and were willing to participate in the research. The sample size required for this research is 105 people. The data obtained was processed and analyzed univariately, bivariately, and multivariately with SPSS software.Of the total 109 subjects, there were 3 people (2.75%) who were diagnosed with pulmonary TB, including 1 person with bacteriological pulmonary TB confirmed by TCM and 2 people with clinical pulmonary TB. The majority of subjects with pulmonary TB were less than 40 years old (66.7%), dominated by men (66.7%), and all had low education. Of the subjects who provided information, 50% had an income of less than 3.5 million per month. All subjects with pulmonary TB admitted that they had never received BCG vaccination, and the majority admitted to having a history of smoking (66.7%). As many as 66.7% admitted that they had no history of physical contact, had never used items, or talked to pulmonary TB sufferers. Only 33.3% of people with pulmonary TB co-infection with leprosy have poor nutritional status. All patients with pulmonary TB in leprosy were diagnosed with multibacillary-type leprosy. According to the results of the bivariate analysis, educational factors have a significant relationship with pulmonary TB outcomes. However, multivariate analysis could not produce results."

"Latar belakang. Abnormalitas fungsi vena terkait inflamasi dan hipertensi vena merupakan dasar patofisiologi insufisiensi vena kronik. Pembuktian hubungan faktor inflamasi lokal pada jaringan vena dengan fungsional vena menjadi penting ketika vena yang diteliti akan menjadi konduit vena pada Bedah Pintas Arteri Koroner (BPAK) dan evaluasi patensinya berpengaruh pada mortalitas dan morbiditas pasien Penyakit Jantung Koroner (PJK). Metode. Penelitian ini merupakan studi potong lintang dari 35 sampel jaringan vena saphena magna pasien PJK yang diambil untuk konduit vena pada BPAK dan telah diperiksa IVK menggunakan Duplex Ultrasound (DUS) dengan parameter time refluks, periode bulan September sampai November 2014 di Pusat Jantung Nasional Harapan Kita. Untuk analisa hitung jumlah leukosit dilakukan pewarnaan Hematoxyllin eosin pada jaringan vena oleh ahli patologi anatomi. Analisis statistik dilakukan untuk mencari hubungan antara hitung jumlah leukosit jaringan vena dengan time refluks vena saphena magna. Hasil. Analisa statistik dengan Chi square didapatkan perbedaan bermakna peningkatan jumlah leukosit jaringan vena pada pasien insufisiensi vena kronik dibandingkan normal (52,63 % vs 18,755) dengan nilai P 0,039. Analisa lebih lanjut dengan rasio odd, dimana pasien dengan peningkatan jumlah leukosit jaringan vena memiliki 4 kali lipat kemungkinan menderita insufisiensi vena kronik (Crude OR 4,81; CI 95% 1.02 - 22.57; P value 0.046), dan setelah dianalisa menggunakan variabel perancu usia, jenis kelamin, Diabetes mellitus, Hipertensi, Perokok, Dislipidemia, adjusted OR bertambah menjadi 6 kali lipat (Adjusted OR 6,66; CI 95% 1.16 - 38.31; P value 0.033). Kesimpulan. Terdapat hubungan antara nilai inflamasi lokal dengan parameter hitung jumlah lekosit jaringan vena dengan fungsi vena pada pasien insufisiensi vena kronik dengan parameter time refluks yang diperiksa dengan DUS.

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Background: Venous function abnormality associated with inflammation and venous hypertension is the main pathophysiology of Chronic Venous Insufficiency (CVI). Proving the relationship between local inflammation factors in venous tissue and its function became an important point because the veins studied are used as a conduit for Coronary Artery Bypass Graft (CABG) procedure, and its patency evaluation will affect the mortality and morbidity rate in Coronary Artery Disease (CAD).

Methods: This is a cross-sectional study, evaluating 35 Great Saphenous Veins (GSV) tissues taken as conduit for CABG procedure from CAD patients that have been previously examined using Duplex Ultrasound (DUS) for GSV reflux time from September-November 2014 at National Cardiac Centre Harapan Kita. Vein tissue samples were stained with Hematoxylin-Eosin and the vein tissue leucocyte count were evaluated by an independent anatomical pathologist. Reflux time and vein tissue leukocyte count results were then grouped into 2 categories each and analysed with chi-square test to assess the relationship between the two variables

Result: There was significant difference of elevated leukocyte count evaluated in patients with CVI according to DUS reflux time (52,63%) compared to normal ones (18.75%) (p=0.039). The risk for patients with elevated total leukocyte count to develop CVI was 4 times greater than those who have normal count (crude OR 4.81; 95% CI 1.02 to 22.57; p=0.046) and after adjusted for confounding factors, such as age, sex, and history of diabetes, hypertension, smoking, and dyslipidaemia, the risk was increased into 6 times (adjusted OR 6.66; 95% CI 1.16 to 38.31; p=0.033).

Conclusion: There is significant relationship between local inflammatory factors, evaluated using total leukocyte count, with venous functions, evaluated using DUS reflux time, in CVI patients."

"Latar Belakang: Fibrosis ventrikel kanan merupakan respons adaptif sekaligus maladaptif terhadap kelebihan beban di ventrikel kanan. Peranan fibrosis ventrikel kanan pada populasi hipertensi pulmonal (HP) akibat defek septum atrial (DSA) sekundum belum banyak diketahui.Tujuan: Membandingkan derajat fibrosis ventrikel kanan pada pasien DSA sekundum yang sudah dan belum terjadi penyakit vaskular paru (PVP) serta menilai korelasi parameter fibrosis berdasarkan magnetic resonance imaging (MRI) dengan nilai pulmonary arterial resistance index (PARi), flow ratio (FR) dan rasio pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) dari kateterisasi jantung.Metode: Penelitian ini merupakan studi potong lintang pada pasien DSA sekundum dengan HP berusia 318 tahun yang menjalani kateterisasi jantung kanan dan pemeriksaan MRI untuk menilai fibrosis ventrikel kanan.Hasil: Terdapat total 63 pasien yang ikut serta dalam penelitian. Sebanyak 92.1% pasien memiliki gambaran late gadolinium enhancement (LGE) di regio right ventricular insertion point dan 66.7 % di septum interventrikular. Kelompok yang sudah mengalami PVP memiliki skor LGE, nilai native T1 dan extracellular volume (ECV) yang lebih tinggi dibanding kelompok yang belum (berturut-turut, 3 [1-4] vs. 2 [0-4]; p = 0.001, 1192 [1043-1407] ms vs. 1118 [1019-1191] ms; p <0.001, 43.7 ± 5.5% vs. 38.1 ± 4.6%; p <0.001). Skor LGE memiliki korelasi sedang terhadap PARi (r = 0.581, p <0.001), PVR/SVR (r = 0.561, p <0.001) dan FR (r = -0.490, p <0.001). Nilai native T1 memiliki korelasi kuat terhadap PARi (r = 0.679, p <0.001) dan PVR/SVR (r = 0.627, p <0.001) serta korelasi sedang terhadap FR (r = -0.589, p <0.001). Nilai ECV memiliki korelasi sedang terhadap FR (r = -0.440, p <0.001), serta korelasi lemah terhadap PARi (r = 0.398, p = 0.001) dan PVR/SVR (r = 0.382, p = 0.001).Kesimpulan: Pasien DSA sekundum yang sudah mengalami PVP memiliki derajat fibrosis ventrikel kanan yang lebih berat serta terdapat korelasi bermakna antara fibrosis ventrikel kanan dengan parameter kateterisasi jantung.

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Background : Right ventricular (RV) fibrosis is both adaptive and maladaptive response to the overloaded RV. Its role in pulmonary hypertension (PH) caused by secundum atrial septal defect (ASD) is not well known.

Aim(s): This study aims to compare RV fibrosis in patients with secundum ASD who have and have not experienced pulmonary vascular disease (PVD) and to determine the correlation of RV fibrosis with pulmonary arterial resistance index (PARi), flow ratio (FR), and pulmonary vascular resistance/systemic vascular resistance (PVR/SVR) ratio.

Method(s): This is a cross-sectional study on patients aged ≥18 years with secundum ASD and PH, who underwent right heart catheterization (RHC) and cardiac magnetic resonance imaging (MRI) to assess RV fibrosis.

Result(s): There were a total of 63 patients participating in this study. The majority of patients showed late gadolinium enhancement (LGE) in the region of RV insertion point (92.1%) and interventricular septum (66.7%). The PVD group had higher LGE scores, native T1, and extracellular volume (ECV) (3 [1-4] vs. 2 [0-4]; p = 0.001, 1192 [1043- 1407] ms vs. 1118 [1019-1191] ms; p <0.001, 43.7 ± 5.5% vs. 38.1 ± 4.6%; p <0.001, respectively). LGE scores had a moderate correlation with PARi (r = 0.581, p <0.001), PVR/SVR ratio (r = 0.561, p <0.001), and FR (r = -0.490, p <0.001). RV native T1 showed a strong correlation with PARi (r = 0.679, p <0.001) and PVR/SVR (r = 0.627, p <0.001), and a moderate correlation with FR (r = -0.589, p <0.001). RV ECV had a moderate correlation with FR (r = -0.440, p <0.001), and weak correlations with PARi (r = 0.398, p = 0.001) and PVR/SVR (r = 0.382, p = 0.001).

Conclusion: Secundum ASD patients with PVD showed significantly higher degree of RV fibrosis. There is a significant correlation between RV fibrosis and hemodynamic parameters obtained from RHC."