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Abstrak :
Latar belakang: Tromboemboli vena (TEV) dapat bermanifestasi sebagai trombosis vena dalam (TVD) ataupun emboli paru (EP). EP sebagai komplikasi TVD dapat berakibat fatal. TVD umumnya terjadi disebabkan multipel faktor risiko seperti penyakit penyerta (komorbid), faktor provokasi, gangguan hemostasis dll. Gangguan fungsi hemostasis berupa keadaan protrombotik sudah dimulai dari awal stadium penyakit ginjal kronik (PGK). Menurunnya laju filtrasi glomerulus berkolerasi dengan peningkatan TEV. Mekanisme pasti bagaimana terjadinya TVD pada penderita PGK sampai saat ini masih belum jelas. Tujuan: Untuk mengetahui profil hemostasis dan faktor risiko yang berhubungan dengan TVD pada pasien PGK. Metode : Penelitian potong lintang retospektif dengan memakai data sekunder pada pasien PGK stadium 3-5 yang dirawat inap selama 1.5 tahun antara Oktober 2011- April 2013. Faktor risiko TVD yang diteliti meliputi DM, CHF, stroke iskemik, faktor provokasi, usia lanjut dan penurunan LFG. Analisis bivariat dan multivariat dilakukan dengan regresi logistik untuk mendapatkan faktor risiko yang paling berhubungan dengan terjadinya TVD pada pasien PGK. Adanya perbedaan proporsi pada kedua kelompok dinilai dengan analisis bivariat. Hasil: Proporsi TVD kasus baru yang telah dikonfirmasi dengan USG Doppler ditemukan sebesar 8% (91 dari 1115 pasien). Subyek penelitian sebanyak 160 pasien terdiri atas kelompok TVD 75 orang dan kelompok Non TVD 85 orang, subyek juga terbagi dalam kelompok Dialisis 77 orang dan Non Dialisis 83 orang. Pada pemeriksaan hemostasis ditemukan persentase rasio APTT <0.8 (1.9%), rasio PT <0.8 (0%), INR <0.8 (0%), fibrinogen >400 mg/dl (56.2%) dan D-Dimer >500 μg/l (87.5%) pada keseluruhan pasien PGK. Kadar fibrinogen lebih tinggi pada kelompok TVD daripada Non TVD. Tidak ada perbedaan hemostasis antara kelompok Dialisis dan Non Dialisis. Dari beberapa faktor risiko TVD yang diteliti, DM merupakan faktor risiko yang bermakna sesuai p <0.001, OR 4.5 (95% KI 2.3-8.8). Kesimpulan: Sebagian besar pasien PGK cenderung mengalami hiperkoagulasi. Pasien PGK dengan DM berisiko untuk mengalami TVD. DM bersama faktor risiko lain dapat menjadi predisposisi terjadinya TVD pada PGK. ......Background: Venous thromboembolism (VTE) may manifest as deep vein thrombosis (DVT) or pulmonary embolism (PE). PE as a major complication of DVT and can lead to potentially fatal. DVT can occur as the result of multiple risk factors such as comorbidities, provoked factors, abnormal hemostasis functions and others. Chronic kidney disease (CKD) is typically associated with a prothrombotic tendency in the early stages of the disease. The declining of glomerular filtration rate (GFR) is correlated with increasing of VTE. The exact mechanism of how DVT develops in CKD patients remains unclear. Aim: To determine the hemostasis profiles and risk factors associated with DVT in CKD patients. Methods: Retrospective cross sectional study was hold by review the medical records from stage 3-5 CKD patients that hospitalized during 1.5 years (October 2011 - April 2013). Multiple risk factors for TVD such as CHF, stroke ischemic, provoked factors, elderly and decreasing of eGFR were examined. Bivariate and multivariate analysis with logistic regression performed to obtain the most risk factors associated with the occurrence of TVD in CKD patients. The differences of proportion between both groups were assessed by bivariate analysis. Results: The proportion of first DVT confirmed by doppler ultrasound was 8% (91 of 1115 patients). 160 patients were divided into groups. 75 and 85 patients comprised the group with DVT-Non DVT as well as 77 and 83 patients comprised the group with Dialysis-Non Dialysis. We found the APTT ratio <0.8 (1.9 %), PT ratio <0.8 (0 %), INR <0.8 (0 %), fibrinogen level >400 mg/dl (56.2 %) and DDimer level >500 μg/l (87.5 %) in all CKD patients. The level of fibrinogen was higher when DVT group compared to Non DVT group. There was no significant differences of hemostasis functions between Dialysis and Non Dialysis group. Multivariate analysis demonstrated that diabetes mellitus (p<0.001, OR: 4.5; 95% CI: 2.3 to 8.8) was associated with DVT in CKD patients among all risk factors. Conclusion: Most CKD patients tend to have hypercoagulation. Diabetes was associated with DVT risk in CKD patients. Diabetes with other risk factors could be as predispotition factors for DVT in CKD in this study.

Abstrak :
Pendahuluan: Keganasan berhubungan erat dengan keadaan hiperkoagulasi dan berisiko empat kali lipat untuk terjadinya trombosis. Magnetic resonance imaging (MRI) dan magnetic resonance venography (MRV) merupakan metode diagnostik bersifat tidak invasif dan memiliki dengan sensitifitas dan spesifisitas serta akurasi yang tinggi untuk menilai vena serebral dan parenkim otak, three dimensional contrast enhanced (3D-CE) MRV merupakan metode yang mendekati baku emas untuk diagnosis trombosis vena serebral. TVS. Sampai saat ini belum ada penelitian di Indonesia yang membandingkan hasil pemeriksaan MRI serebral rutin dibandingkan dengan pemeriksaan 3D-CE-MRV dalam diagnosis trombosis vena serebra pada penderita keganasan. Metode: Penelitian diagnostik dengan pendekatan potong lintang menggunakan studi prospektif untuk mengetahui tingkat sensitivitas dan spesifisitas MRI serebral rutin dibandingkan dengan 3D-CE-MRV dalam mendeteksi TVS penderita keganasan. Hasil: MRI serebral rutin dalam menilai TVS pada penderita keganasan dibandingkan 3D-CE-MRV mempunyai nilai sensitivitas 90%, spesifisitas 50%, nilai duga positif 95% dan nilai duga negatif 75% serta nilai akurasi yang mencapai 95%, sehingga pemeriksaan MRI serebral rutin dapat dijadikan modalitas alternatif untuk diagnosis TVS. Lokasi trombosis yang tersering pada sinus sagitalis superior 63%, kemudian disusul oleh sinus transversus dan sinus rektus sebesar 31,7%, sinus kavernosus 27%, vena kortikal 25%, sinus sigmoid 12,7%, sinus sagitalis inferior 7,9%, sinus confluence 3,2% dan vein of Galen 1,6%. MRI serebral sekuens T1 kontras mempunyai sensitivitas mencapai 94,7% dan nilai spesifisitas 50%, terutama dalam evaluasi sistem vena superfisial, seperti sinus sagitalis superior dan vena kortikal dan terbatas pada sistem vena dalam. Kesimpulan: MRI serebral rutin dapat dijadikan modalitas alternatif untuk diagnosis TVS. ......Introduction: Malignancy closely associated with a hypercoagulable state and four-fold risk for thrombosis. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) is a non-invasive diagnostic method and has the sensitivity and specificity as well as high accuracy for assessing cerebral venous and brain parenchyma, three-dimensional contrast enhanced (3D-CE) MRV is a method that approached the gold standard for the diagnosis of cerebral venous thrombosis (CVT). Until now there has been no research in Indonesia, which compared the results of routine cerebral MRI with 3D-CE-MRV in the diagnosis of cerebral venous thrombosis in patients with malignancy. Methods: The study was cross-sectional diagnostic approach using a prospective study to determine the level of sensitivity and specificity of routine cerebral MRI compared with 3D-CE-MRV in detecting CVT patients with malignancy. Results: Routine cerebral MRI with contrast in assessing CVT in patients with malignancy compared examination 3D-CE-MRV has a sensitivity value of 90% , specificity value of 50%, positive predictive value of 95% and negative predictive value 75% and as well as the accuracy rate reaches 95%, so the routine examination of cerebral MRI with contrast can be used as an alternative modality for the diagnosis of CVT. Thrombosis location are common in the superior sagittal sinus 63%, followed by the transverse sinus and straight sinus of 31.7%, cavernous sinus 27%, cortical veins 25%, sigmoid sinus 12.7%, inferior sagittal sinus 7.9%, confluence sinus of 3.2% and 1.6% vein of Galen. Cerebral MRI sequences T1 contrast has reached 94.7% sensitivity and specificity values of 50%, especially in the evaluation of the superficial venous system, such as the superior sagittal sinus and cortical veins and limited the deep venous system. Conclusion: Routine cerebral MRI can be used as an alternative modality for the diagnosis of CVT.

Abstrak :
Pendahuluan: Deep Vein Thrombosis (DVT) memiliki kecenderungan terus meningkat dengan koinsidensi mortalitas jangka pendek dan morbiditas jangka panjang. COVID-19 dapat menyebabkan hypercoagulable state dan menjadi predisposisi terjadinya DVT. Penelitian ini bertujuan untuk menganalisis hubungan kadar fibrinogen, D-Dimer, dan dosis heparin teraupetik berdasarkan kadar APTT dengan adanya COVID-19 pada pasien DVT. Metode: Desain penelitian komparatif dan kohort prospektif digunakan untuk membandingkan kadar fibrinogen, D-Dimer, dan dosis heparin terapeutik antara pasien COVID-19 dan non COVID-19 yang menderita DVT di RSPN Cipto Mangunkusumo pada bulan Maret 2020 – Maret 2022. Penegakan diagnosis DVT dilakukan dengan pemeriksaan ultrasonografi dan/atau computed tomography angiography (CTA) fase vena. Data variabel utama dan lainnya diperoleh dari rekam medis pasien. Uji T independen atau Mann-Whitney digunakan untuk menganalisis perbedaan nilai variabel antara kedua kelompok. Hasil: Dari total 253 sampel, tidak terdapat perbedaan karakterisitik awal antara kelompok DVT COVID-19 (n=44) dan DVT non COVID-19 (n=209), kecuali pada parameter Wells Score. Kelompok DVT COVID-19 memiliki kadar Fibrinogen, D-Dimer, dan aPTT yang lebih tinggi daripada kelompok DVT non COVID-19, baik sebelum terapi maupun sesudah terapi heparanisasi (semua nilai p =0,000). Pada akhir pengamatan, didapatkan dosis heparin terapeutik pada kelompok DVT COVID-19 lebih tinggi dibanding pada kelompok DVT non COVID-19 (30,00 (20,00-40,00)x103 U vs. 25,00 (20,00-35,00)x103 U, p=0,000). Kesimpulan: Kadar fibriongen, D-Dimer, dan dosis heparin terapeutik pada pasien DVT yang menderita COVID-19 lebih tinggi dibandingkan pada pasien DVT yang tidak menderita COVID-19. Inisiasi pemberian dosis heparin terapeutik dosis tinggi dapat dipertimbangkan pada pasien DVT dengan komorbid COVID-19 dan dipandu oleh hasil pemeriksaan biomarker koagulasi darah. ......Introduction: Deep Vein Thrombosis (DVT) has an increasing trend with a coincidence of short-term mortality and long-term morbidity. COVID-19 can cause a hypercoagulable state and predispose to DVT. This study aims to analyze the relationship between fibrinogen levels, D-Dimer, and therapeutic heparin doses based on APTT levels in the presence of COVID-19 in DVT patients. Methods: A comparative study design and a prospective cohort were used to compare levels of fibrinogen, D-Dimer, and therapeutic heparin doses between COVID-19 and non-COVID-19 patients suffering from DVT at Cipto Mangunkusumo Hospital in March 2020 – March 2022. Diagnosis of DVT was performed by ultrasound examination and/or computed tomography angiography (CTA) venous phase. The primary variable data and others were obtained from the patient's medical record. An Independent T-test or Mann-Whitney was used to analyze the differences in variable values between the two groups. Results: Of 253 samples, there was no difference in initial characteristics between the DVT COVID-19 (n=44) and non-COVID-19 DVT groups (n=209), except for the Wells Score parameter. The COVID-19 DVT group had higher levels of fibrinogen, D-Dimer, and aPTT than the non-COVID-19 DVT group, both before and after heparinization therapy (all p-values = 0.000). At the end of the follow-up period, the therapeutic dose of heparin in the COVID-19 DVT group was higher than in the non-COVID-19 DVT group (30.00 (20.00-40.00)x103 U vs. 25.00 (20.00-35.00)x103 U, p-value=0.000). Conclusion: The levels of fibrinogen, D-Dimer, and therapeutic doses of heparin in DVT patients who have COVID-19 are higher than in DVT patients who do not have COVID-19. Initiation of a higher therapeutic dose of heparin can be considered in DVT patients with comorbid COVID-19 and guided by the results of blood coagulation biomarkers.

Abstrak :
LATAR BELAKANG: Keganasan meningkatkan risiko trombosis vena sekitar 2-7 kali. Insideni trombosis vena pada tumor ganas ovarium dilaporkan berkisar antara 5-29 . Berbagai faktor yang terkait dengan kondisi pasien usia, indeks massa tubuh, komorbid , karakteristik tumor ukuran, stadium, histologi, ascites dan terapi kemoterapi, lama pembedahan, jumlah perdarahan di laporkan dapat menjadi prediktor trombosis vena dalam TVD namun penelitian mengenai model prediksi TVD khususnya untuk populasi Indoensia masih terbatas. TUJUAN: Mengetahui faktor ndash; faktor prediktor trombosis vena dalam pada tumor ganas ovarium. DESAIN DAN METODE: Penelitian cohort prospektif ini dilakukan di RSUPN Cipto Mangunkusumo, Jakarta dan merekrut 116 pasien dengan dugaan tumor ganas ovarium yang akan menjalani operasi. Berbagai variable lain yang diduga sebagai prediktor TVD seperti kadar pra-terapi trombosit, D-Dimer, fibrinogen, usia, indeks massa tubuh IMT , komorbid, stadium, diameter, histologi, bilateralitas tumor, adanya ascites, metastasis jauh diukur dan dicatat. Pasien diikuti untuk gejala dan tanda TVD. Pasien yang memiliki gejala dan tanda klinis TVD dilakukan pemeriksaan Ultrasonografi Duplex vascular. HASIL: Seratus tiga pasien tumor ganas ovarium diikutkan dalam analisis. Insideni TVD adalah 16.5 dan 88.2 kejadian TVD terjadi sebelum pembedahan. Tidak ditemukan kejadian TVD selama perawatan pasca operasi dengan rata rata lama perawatan 8.8 hari. Kombinasi beberapa variable menghasilkan model prediksi kejadian TVD pada tumor ganas ovarium yang mencakup metastasis jauh OR 28,99; IK 95 3,83-219,52, IMT ge; 22,7 kg/m2 OR 15,52, IK 95 2,24-107,37 , kadar D-Dimer ge; 1700 mg/ml OR 13,30, IK 95 2.40-73,84 , stadium lanjut OR 6,66; IK 95 1,05-42,27 , histologi epithelial OR 6,5; IK 95 0,34-125,75 , diameter tumor ge; 18,25 cm OR 2,36, IK 95 0,48-11,54 , adanya komorbid OR 2,49, IK 95 0,53-11,66. Skor prediksi kejadian TVD adalah skor 3 untuk metastasis jauh, IMT ge; 22,76 kg/m2, D dimer ge; 1700 mg/dl, skor 2 untuk stadium lanjut, skor 1 untuk komorbid, diameter tumor ge; 18,25 cm, histologi epitelial dan skor 0 jika tidak ditemukan factor risiko atau nilai variable dibawah titik potong. Skor ge; 8 dari 14 adalah skor minimum dengan nilai prediksi TVD yang baik dengan AUC 0,92 IK 95 0,86-0,98, probabilitas 86,46, sensitivitas 64.7, spesifisitas 90.7. KESIMPULAN: Model prediksi kejadian TVD dapat membantu memprediksi pasien tumor ganas ovarium yang berisiko tinggi untuk mengalami TVD sehingga dapat dipertimbangkan pencegahan TVD selektif. ......BACKGROUND: Malignancy increase the risk of venous thromboembolism around 2 7 fold. Its incidence in ovarian malignancy ranged within 5 29 . Various characteristics related to patients age, body mass index, comorbid , tumor stage, tumor diameter, histology, ascites, distant metastasis or treatment length of surgery, bleeding, transfusion were found as predictor of venous thromboembolism. Predictor model of DVT occurrence in ovarian malignant tumor especially in Indonesian population is still limited. OBJECTIVE: To evaluate the prediction model of deep vein thrombosis DVT in ovarian malignant tumor. METHOD: This prospective cohort study enrolled 116 patients with suspected ovarian malignant tumor. Suspected risk factors of venous thromboembolism such as age, body mass index BMI , comorbid, pretreatment D dimer, fibrinogen, thrombocyte level, tumor diameter, staging, presence of distant metastasis, ascites, tumor histopathology, length of surgery, intraoperative blood loss and blood transfusion were measured and recorded. Patient who had symptoms and signs of DVT was confirmed with Doppler ultrasonography. RESULT: Incidence of symptomatic DVT was 16.5 and 88.2 cases occurred before surgery. No case of symptomatic DVT was observed during post operative hospitalization with mean length of stay 8.85 days. Predictor factor of DVT were distant metastasis OR 28,99 95 CI 3,83 219,52, BMI ge 22,7 kg m2 OR 15,52, 95 CI 2,24 107,37 , D Dimer ge 1700 mg ml OR 13,30, 95 CI 2.40 73,84, advanced stage OR 6,66 95 CI 1,05 42,27 , epithelial tumor OR 6,5 95 CI 0,34 125,75, tumor diameter ge 18,25 cm OR 2,36, 95 CI 0,48 11,54, comorbid OR 2,49, 95 CI 0,53 11,66. Prediction score of DVT were score 3 for distant metastasis, BMI ge 22,7 kg m2, D Dimer ge 1700 mg ml, score 2 for advanced stage, score 1 for tumor diameter ge 18,25 cm, comorbid, epithelial tumor and score 0 for the absence of variables or value of variable was less than the cut off. Total score ge 8 of 14 is the least score which has a good predictive value for DVT ocurence with AUC 0.92, 95 CI 0.86 0.92, probability 86,46, sensitivity 64.7, specificity 90.7. CONCLUSION: Prediction model of DVT may help to predict the patient with malignan ovarian tumor who had high risk of DVT therefore can consider selective DVT prevention.

Abstrak :
Latar Belakang: Sindrom pascatrombosis (PTS) diestimasikan terjadi pada 20-50% pasien dengan jarak beberapa bulan hingga 1-2 tahun pasca trombosis vena dalam DVT. Insidensi PTS akan lebih tinggi pada DVT yang ditatalaksana konservatif. Tatalaksana DVT pada COVID-19 selama ini hanya konservatif. Sampai saat ini belum ada penelitian mengenai evaluasi terjadinya sindrom pascatrombosis pada pasien DVT dengan COVID- 19. Metode: Desain penelitian yang digunakan adalah desain desain kohort retrospektif. Penelitian dilakukan di Divisi Bedah Vaskular dan Endovaskular, Departemen Medik Ilmu Bedah, Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo, Jakarta. Waktu penelitian akan berlangsung selama 6 bulan, yaitu dari bulan Desember 2022 sampai dengan Mei 2023. Dilakukan uji bivariat dan multivariat pada data yang didapat. Hasil: Didapatkan insidensi terjadinya PTS pada pasien DVT dan COVID-19 adalah 59.3%. Variabel yang meningkatkan risiko terjadinya PTS dan secara statistik bermakna menurut uji bivariat adalah riwayat DVT ipsilateral (p = 0.000), lokasi trombus Iliaka Femoral Popliteal (p = 0.000), dan derajat COVID-19 sedang berat (p = 0.000). Dari uji multivariat didapatkan y = -2.965 + 2.545X1(riwayat DVT ipsilateral) + 2.110X2 (lokasi trombus Iliaka Femoral Popliteal) + 2.679X3 (Derajat COVID-19 sedang berat). Kesimpulan: Insidensi terjadinya PTS pada pasien DVT dengan COVID-19 yang dilakukan terapi konservatif lebih meningkat. Faktor risiko yang memengaruhi terjadinya sindrom pascatrombosis secara uji statistik bivariat bermakna menurut uji bivariat adalah adanya riwayat DVT ipsilateral, lokasi trombus Iliaka Femoral Popliteal, dan derajat COVID-19 sedang berat. Dari uji multivariat didapatkan derajat COVID-19 sedang berat sebagai faktor risiko terbesar PTS sebesar 14.5X, riwayat DVT ipsilateral sebagai faktor risiko terbesar PTS sebesar 12.7X dan lokasi trombus Iliaka Femoral Popliteal sebagai faktor risiko sebesar 8.2x. ......Background: Post-thrombotic syndrome (PTS) is estimated to occur in 20-50% patients several months to 1-2 years after DVT. The incidence of PTS will be higher in DVT which is managed conservatively. So far, the management of DVT in COVID-19 has only been conservative. To date, there have been no studies regarding the evaluation of the occurrence of postthrombotic syndrome in DVT patients with COVID-19. Methods: The design used for this research was a retrospective cohort design. The study was conducted at the Division of Vascular and Endovascular Surgery, Department of Medical Surgery, dr. Cipto Mangunkusumo, Jakarta. The research time will last for 6 months, from December 2022 to May 2023. Bivariate and multivariate tests were carried out. Results: The incidence of PTS in DVT and COVID-19 patients was 59.3%. Variables that increasing the risk of PTS and were statistically significant according to bivariate tests were history of ipsilateral DVT (p = 0.000), Popliteal Iliac Femoral thrombus location (p = 0.000), and moderate to severe COVID-19 severity (p = 0.000). From the multivariate test, y = -0.596 + 2.545X1 (ipsilateral DVT history) + 2.110X2 (popliteal Iliac Femoral thrombus location) + (-2.679)X3 (moderate to severe COVID-19 severity). Conclusion: The incidence of PTS in DVT patients with COVID-19 who are undergoing conservative therapy is increasing. The risk factors that influence the occurrence of postthrombotic syndrome in statistically significant bivariate tests are history of ipsilateral DVT, the location of the Iliac Femoral Popliteal thrombus, and the moderate to severe COVID-19 severity. From the multivariate test, moderate to severe COVID-19 severity was found as the biggest risk factor for PTS by 14.5-fold, history of ipsilateral DVT as risk factor for PTS by 12.7-fold and the location of the Iliac Femoral Popliteal thrombus as a risk factor for 8.2-fold.

Abstrak :
Udara di tulang temporal mempunyai fungsi yang bervariasi, terutama sebagai cadangan udara telinga tengah. Gangguan fungsi tuba Eusthacius akan menyebabkan udara di tulang temporal berfungsi sehingga tidak terbentuk tekanan negatif yang disebabkan penyerapan udara oleh mukosa telinga tengah. Hal ini mencegah terjadinya perubahan mukosa telinga tengah dan mencegah terjadinya otitis media. Tujuan penelitian ini adalah untuk menilai kesesuaian klasifikasi pneumatisasi mastoid berdasarkan struktur sinus sigmoid terhadap volume akurat sel-sel udara mastoid menggunakan MSCT Scan Spiral di Rumah Sakit Cipto Mangunkusumo berupa 158 mastoid dari 78 pasien (40 laki-laki dan 38 perempuan) dengan rentang umur 18 sampai 60 tahun tanpa kelainan atau malformasi pada gambaran CT Scan. Data sekunder diambil dari raw data yang telah direkonstruksi menggunakan pesawat CT scan Somatom spiral scanner (Siemens Medical Systems) dengan tebal irisan 2,0 mm, Filter Kernel H 70 very sharp, mastoid window (window width 4.000 HU, window level 600 HU), densitas antara ? 1.000HU sampai dengan +70HU di dalam Compact Disc. Klasifikasi pneumatisasi mastoid ditentukan berdasarkan tiga garis paralel dengan kemiringan 45◦ yang diletakkan pada posisi garis melewati bagian paling anterior dari sinus sigmoid pada persimpangannya dengan tulang petrosus, bagian paling lateral di sepanjang bidang transversal sigmoid groove dan paling posterior dari sinus sigmoid. Statistik deskriptif (SPSS 17.0) disajikan berupa analisis volume sel-sel udara mastoid berdasarkan kelompok pneumatisasi menggunakan uji Kruskal Wallis dilanjutkan analisis Post Hoc dengan hasil rerata volume sel-sel udara masingmasing kelompok pneumatisasi berbeda bermakna dengan kelompok lainnya, dengan batas kemaknaan (α) 0,05, dan ROC (Receiver operator curve) menunjukkan bahwa masing-masing kelompok pneumatisasi mempunyai sensitivitas dan spesifisitas tinggi.

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The air in the temporal bone has various functions. In particular, it serves as the air reservoir of the middle ear. When the function of the Eustachian tube deteriorates, the air in the temporal bone acts to prevent negative pressure from developing due to absorption of air by the middle ear mucosa, and thus prevents changes of the middle ear mucosa, as well as progression of otitis media. The aim of this paper is to evaluate The Conformity Classification of Mastoid Pneumatization in Normal Adult based on Sigmoid Sinus with the Mastoid Air Cells Volume using Spiral MSCT Scan in Cipto Mangunkusumo Hospital of One hundred and fifty six mastoids of 78 subjects (40 males and 38 males) ranged in age from 18 years to 60 years without impairment or malformation of temporal bone CT scan were eligible for enrolment in this study. Secondary data drawn from raw data in Compact Disc that has been reconstructed using Somatom spiral scanner (Siemens Medical Systems) with 0,2 cm slice thickness, filter Kernel very sharp and mastoid window (window width 4.000HU and window level 600HU). We used -1.000 to + 70 HU. Classification of mastoid pneumatization is determined based on three parallel lines angled at 45◦ in the anterolateral direction which each line crossed the most anterior point of the sigmoid sinus at the junction with the petrous bone, the most lateral aspect along the transverse plane of the sigmoid groove, and the most posterior point of the sigmoid sinus, respectively. Descriptive statistics (SPSS 17.0) are presented in the form of air cells mastoid volume based on Classification of mastoid pneumatization using Kruskal Wallis test and followed by Post Hoc analysis with the volume of the mastoid air cells of each group differ significantly with other groups, significance limit of 0.05, and ROC (Receiver operator curve) showed that each group has a high sensitivity and specificity.

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ABSTRAK
Latar Belakang: Perlunya stratifikasi risiko dan evaluasi terapi berkala pada sindrom koroner akut (SKA) terkait mortalitas dan morbiditas di kemudian hari. Petanda biokimia ST2 praktis dan lebih murah, serta tidak dipengaruhi oleh usia, jenis kelamin dan fungsi ginjal. Kadarnya dapat berbeda antar ras, namun belum ada data yang menyajikan profil kadar ST2 awal dan penurunan pasca terapi definitif di Indonesia. Metode: Studi deskriptif longitudinal pada 40 subjek yang diperiksan kadar ST2 secara ELISA saat awal dan setelah terapi definitif. Hasil: Didapatkan proporsi kadar ST2 awal <35 ng/mL lebih dominan ( 52,5% vs. 47,5%). Kadar ST2 awal tertinggi didapatkan pada IMA-NST, yaitu 46,79 ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) yang memiliki awitan terlama (48 jam). Hipertensi memiliki proporsi tertinggi (91,7%) dan usia berbanding lurus dengan kadar ST2. Proporsi kadar ST2 yang tidak mengalami penurunan sebesar 30%, terutama APTS (41,7%) dengan usia rerata 3 tahun lebih tua (58 tahun vs. 55 tahun). Simpulan: Didapatkan kadar ST2 <35 ng/mL pada sebagian besar subjek, tertinggi pada IMA-NST. Lama awitan, hipertensi dan usia diduga berhubungan dengan kadar ST2 awal tinggi. Kadar ST2 pasca terapi menurun pada sebagian besar subjek.ABSTRACT
Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. A new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t influenced by age, gender, and kidney function. The ST2 value are different in due to race among countires. There is no data available regarding ST2 baseline and after definitive treatment profile in Indonesia. Method: It is a longitudinal descriptive study that conducted prospectively on 40 subjects. The value of ST2 was examined using ELISA methods at baseline and after definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79 ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the longest onset of chest pain (48 hours). Hypertension had the highest proporsion (91,7%) and age were proportional to the ST2 value. The proportion of the ST2 value that didn?t decreased after therapy were lesser than the decrease (30% vs. 70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years old). Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level were found in NSTEMI-ACS. Onset of angina, hypertension and age were found to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. A new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t influenced by age, gender, and kidney function. The ST2 value are different in due to race among countires. There is no data available regarding ST2 baseline and after definitive treatment profile in Indonesia. Method: It is a longitudinal descriptive study that conducted prospectively on 40 subjects. The value of ST2 was examined using ELISA methods at baseline and after definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79 ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the longest onset of chest pain (48 hours). Hypertension had the highest proporsion (91,7%) and age were proportional to the ST2 value. The proportion of the ST2 value that didn?t decreased after therapy were lesser than the decrease (30% vs. 70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years old). Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level were found in NSTEMI-ACS. Onset of angina, hypertension and age were found to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. A new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t influenced by age, gender, and kidney function. The ST2 value are different in due to race among countires. There is no data available regarding ST2 baseline and after definitive treatment profile in Indonesia. Method: It is a longitudinal descriptive study that conducted prospectively on 40 subjects. The value of ST2 was examined using ELISA methods at baseline and after definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79 ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the longest onset of chest pain (48 hours). Hypertension had the highest proporsion (91,7%) and age were proportional to the ST2 value. The proportion of the ST2 value that didn?t decreased after therapy were lesser than the decrease (30% vs. 70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years old). Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level were found in NSTEMI-ACS. Onset of angina, hypertension and age were found to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment. ;Background: Acute coronary syndrome been a burden for causing high mortality and morbidity, therefore risk stratification and therapy evaluation are needed. A new biomarker ST2 is practice and less expensive for daily usage and it also doesn?t influenced by age, gender, and kidney function. The ST2 value are different in due to race among countires. There is no data available regarding ST2 baseline and after definitive treatment profile in Indonesia. Method: It is a longitudinal descriptive study that conducted prospectively on 40 subjects. The value of ST2 was examined using ELISA methods at baseline and after definite treatment. Result: The proporsion of baseline ST2 <35 ng/mL are dominan (52,5% vs. 47,5%). The highest of ST2 baseline value are found in NSTEMI-ACS it?s 46,79 ng/mL (kuartil-1 3,67 ng/mL, dan kuartil-3 102,41 ng/mL) and it also had the longest onset of chest pain (48 hours). Hypertension had the highest proporsion (91,7%) and age were proportional to the ST2 value. The proportion of the ST2 value that didn?t decreased after therapy were lesser than the decrease (30% vs. 70%), especially UAP (41,7%) that had 3 years older ages (58 years old vs. 55 years old). Conclusion: Proportion of baseline of ST2 value <35 ng/mL groups were higher than ST2 level ≥35 ng/mL (52,5% vs. 47,5%), and the highest baseline ST2 level were found in NSTEMI-ACS. Onset of angina, hypertension and age were found to be dominant in patient with early ST2 level ≥35 ng/mL. The ST2 value were decreasing in most of the subject after treatment.

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Latar belakang: Trombosis vena dalam (deep vein thrombosis/DVT) dapat menyebabkan komplikasi jangka panjang berupa sindrom pasca thrombosis (Post Thrombotic Syndrome/PTS) yang menurunkan kualitas hidup pasien. Tujuan: mengetahui proporsi dan faktor risiko PTS pada DVT ekstremitas bawah. Metode: Penelitian ini merupakan studi kohort retrospektif sejak Juli 2014 hingga September 2015 di RS Cipto Mangunkusumo Jakarta. Subjek adalah pasien dengan DVT pada tungkai bawah yang dibuktikan melalui USG (ultrasonografi) doppler dalam waktu 3 bulan sebelum penelitian. Gejala dan tanda PTS dinilai dengan menggunakan skala Villalta. Hasil: Penelitian ini melibatkan 91 subjek dengan median hari saat diagnosis DVT sampai dengan pemeriksaan PTS didapatkan 748 hari. Gejala dan tanda PTS yang paling banyak didapatkan adalah rasa berat (63,9%) dan hiperpigmentasi kulit (77,5%). PTS didapatkan pada 49 subjek (53,8%) dan mayoritas didapatkan dengan PTS derajat ringan (69,3%). Jenis kelamin perempuan (RR 1.48, IK 95% 0,97-2.42) dan letak trombus proksimal-distal meningkatkan risiko terjadinya PTS (RR 1.35, IK 95% 0.85-2.13), akan tetapi tidak signifikan secara statistik. Kesimpulan: Proporsi PTS pasca 3 bulan pasca terjadinya DVT ekstremitas bawah sebesar 53,8 %. Jenis kelamin perempuan dan lokasi trombus proksimaldistal meningkatkan risiko terjadinya PTS.

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Latar belakang. Risiko Venous Thromboembolism (VTE) yang terkait dengan keganasan adalah 4,1 kali lipat lebih besar dibandingkan dengan pasien tanpa keganasan. Pasien keganasan memiliki risiko perdarahan yang lebih besar dengan terapi antikoagulan yang umum digunakan. Inferior Vena Cava Filter (IVCF) telah direkomendasikan sebagai alternatif yang kontroversial. Tujuan. Untuk menemukan bukti ilmiah tertinggi dalam keamanan, manfaat, dan dampak klinis IVCF untuk mengelola VTE terkait keganasan. Metode. Sesuai dengan pedoman PRISMA, pada situs berbasis data Cochrane, PubMed, dan ClinicalKey dicari menggunakan kata kunci ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). Artikel-artikel ini ditinjau dan dinilai. Hasil. Ada 10 artikel yang ditinjau (1.191 partisipan). Komplikasi IVCF yang ditemukan: migrasi filter (0,9%), trombosis vena cava (3,7%), PE berulang (2,8%); fraktur filter (0,9%); dan penetrasi IVCF (0,9%). Tidak ada kematian yang ditemukan pada pasien karena komplikasi karena penyisipan filter (LOE 2). Penyisipan IVCF dapat mengurangi tingkat PE tetapi dengan peningkatan jumlah DVT (DVT: dengan filter vs tanpa filter: 35,7% vs 27,5%; HR 1,52; CI95 % 1,02–2,27; p = 0,042; PE: 6,2% vs. 15,1 %; HR 0,37; 95% CI 0,17–0,79; p = 0,008). Enam studi tidak menemukan peningkatan yang signifikan secara statistik dalam mortalitas terkait PE. Kesimpulan. IVCF aman dan bermanfaat untuk pengelolaan VTE terkait keganasan, terutama pada pasien dengan kontraindikasi antikoagulan (LOE 2, 3 dan 4). ......Background. The risk of venous thromboembolism (VTE) associated with malignancy is 4.1-fold greater compared to patients without malignancy. Malignancy patient have greater risk of bleeding with the commonly used anticoagulant therapy. Inferior Vena Cava Filter (IVCF) have been recommended as an controversial alternative. Objective. To find the highest evidence in the safety, benefit, and clinical outcome of the IVCF for managing VTE associated with malignancy. Method. Aligning with PRISMA guidelines, online databases Cochrane, PubMed, ScienceDirect and ClinicalKey were searched using keywords ("Inferior Vena Cava Filter" or "IVCF") and (“Anticoagulant”) and ("Cancer" or "Malignancy") and ("Venous Thromboembolism" or "VTE" or "Pulmonary Embolism" or "Deep Vein Thrombosis") and ("Safety" or "Benefit" or "Complication" or "Recurrence" or "Survival Rate" or "Mortality"). These articles were reviewed and appraised. Results. There were 10 articles reviewed (1,191 participants). Complication of IVCF found: filter migration (0.9%), vena cava thrombosis (3.7%), recurrent PE (2.8%); filter fracture (0.9%); and IVCF penetration (0.9%). No mortality was found in patients due to complications due to filter insertion (LOE 2). IVCF insertion can reduce PE rates but with an increase in the number of DVT (DVT: with filter vs without filters: 35.7% vs 27.5%; HR 1.52; CI95 % 1.02–2.27; p = 0.042 ; PE: 6.2% vs. 15.1%; HR 0.37; 95% CI 0.17–0.79; p = 0.008). Six studies found no statistically significant increase in PE-related mortality. Conclusion. IVCF is safe and beneficial for the management of malignancy-associated VTE, especially in patients with contraindications to anticoagulants (LOE 2, 3 and 4).

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Latar Belakang: COVID-19 menyebabkan respon inflamasi sistemik dan ganguan koagulasi yang memperberat disfungsi endotel dan destablisasi plak intrakoroner yang berhubungan dengan beban trombus tinggi sehingga menyebabkan morbiditas dan mortalitas yang tinggi. Pasien dengan COVID-19 dengan infark miokard akut dengan elevasi segmen ST (IMAEST) yang memiliki beban trombus tinggi dihubungkan dengan mortalitas jangka pendek yang lebih besar namun pengaruhnya terhadap mortalitas dengan waktu yang lebih lama masih belum jelas. Tujuan: Mengetahui hubungan COVID-19 dengan mortalitas 6 bulan pada pasien IMAEST dengan beban trombus tinggi (BTT) intrakoroner yang menjalani intervensi koroner perkutan (IKPP). Metode: Terdapat 124 pasien dengan IMAEST yang memiliki BTT intrakoroner yang menjalani IKPP pada periode April 2020 hingga November 2021 dianalisis secara retrospektif. BTT intrakoroner berdasarkan kriteria TIMI. Status COVID-19 positif atau negatif berdasarkan pemeriksaan laboratorium dan variabel lainnya dilihat hubungannya terhadap mortalitas 6 bulan dengan analisis kesintasan dan cox regresi. Hasil: Terdapat mortalitas tinggi pada pasien COVID-19 positif (31%) dibanding pasien COVID-19 negatif (4,2%) sampai dengan 6 bulan sejak admisi rumah sakit. Pasien dengan COVID-19 cenderung meninggal lebih besar dalam 6 bulan dibanding pasien tanpa COVID-19 (HR 8.45 IK95% 2.6- 27.5). Pada model akhir multivariat analisis, status COVID-19 positif merupakan prediktor independen terhadap kematian 6 bulan sejak admisi (HR 12,89 ; IK95%:3,34 – 49,76 ; p ≤ 0,001). Status COVID-19 positif pada pasien IMAEST dengan BTT intrakoroner yang menjalani IKPP ini juga mempengaruhi level kesintasan (survival rate) yang lebih rendah dalam 6 bulan. Kesimpulan: Terdapat hubungan antara COVID-19 dengan mortalitas 6 bulan pada pasien dengan IMAEST dengan BTT intrakoroner yang menjalani IKPP. ......Background: COVID-19 causes systemic inflammatory response and disturbance in coagulation function which might give detrimental effect on endothelial dysfunction and instability of coronary plaque leading to high thrombus burden and affecting morbidity and mortality. Patients with COVID-19 with ST Elevation Myocardial Infarction (STEMI) that have Intracoronary High Thrombus Burden (IHTB) is reported to have higher intrahospital mortality but its impact on long-term mortality is still not known. Objective: To determine whether COVID-19 is affecting 6 months mortality in STEMI patients with IHTB who undererwent Primary Percutanoeus Coronary Intervention (PPCI). Methods: There were 124 patients with STEMI with IHTB who underwent PPCI form April 2020 to November 2021 from retrospective analysis. IHTB were classified according TIMI thrombus grade. COVID-19 status (positive or negative) were obtained according to laboratory results and other variables were analysed with cox regression analysis and survival analysis. Results: Higher 6 months mortality rate from admission was found among COVID 19 patients compared to COVID-19 negative patients (31% vs 4,2%). The risk of death within 6 months from admission was higher in COVID-19 positive patients compared to COVID-19 negative patients ( HR 8.45 CI95% 2.6 -27.5, p < 0.001). In multivariate analysis, COVID-19 positive was independent predictor for 6 months mortality from admission ( HR 12.89 CI95% 3.34- 49.7 , p ≤ 0,001). Patients with COVID-19 positive were also had lower survival rate within 6 months from admission. Conclusion: COVID-19 is associated with 6 months mortality from admission in patients with STEMI with IHTB who underwent PPCI.