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Abstrak :
ABSTRAK
Prevalensi migren di Indonesia tinggi dan migren menyebabkan disabilitas ketujuh terbanyak di dunia. Diagnosis migren menggunakan kriteria IHS, tetapi angka negatif palsu tinggi 50 . Disfungsi endotel adalah dasar patofisiologi migren, melalui gangguan reaktivitas vasomotor dan inflamasi. Pemeriksaan breath holding index BHI hanya menggunakan stimulus hiperkapnia sementara indeks vaskular migren IVM menggabungkan kombinasi hiperkapnia dan hipokapnia. Akurasi IVM dan peran CGRP serta ICAM-1 dalam patogenesis nyeri kepala migren belum dipahami.Penelitian ini menilai respons vasodilatasi dan vasokonstriksi pembuluh darah intrakranial penderita migren, akurasi alat IVM dibandingkan IHS dan BHI, serta menganalisis perubahan kadar CGRP dan ICAM-1 satu bulan pengobatan.Penelitian menggunakan rancangan potong lintang dan pre-post design. Subjek nyeri kepala primer fase interiktal di Poli Neurologi RSCM yang memenuhi kriteria inklusi dan eksklusi diikutsertakan. Subjek dianamnesis berdasarkan kriteria MS-Q Indonesia, pemeriksaan Doppler transkranial untuk menilai BHI dan IVM pada kedua sisi kepala, dan diberikan obat topiramat dan/atau indometasin sesuai kriteria penelitian. Subjek kontrol 1 bulan untuk menilai respons klinis nyeri kepala. Sampel darah diambil saat awal dan akhir penelitian untuk menilai kadar CGRP dan ICAM-1.Terdapat 104 subjek terkonfirmasi migren dan 24 subjek terkonfirmasi bukan migren. Tidak ada perbedaan karakteristik sosiodemografis: baik usia, jenis kelamin, tingkat pendidikan, dan pekerjaan. Nilai MFV MCA kelompok terkonfirmasi migren lebih rendah bermakna saat menahan napas dibandingkan kelompok terkonfirmasi bukan migren pada sisi ipsilateral dan sisi kontralateral. Pada kelompok terkonfirmasi migren kemampuan vasokonstriksi lebih tinggi bermakna dibandingkan kelompok terkonfirmasi bukan migren pada sisi ipsilateral dan kontralateral.Nilai sensitivitas dan spesifisitas IVM gabungan, BHI serta IHS/MS-Q berturut-turut adalah 94,23 dan 91,67 , 59,63 dan 91,67 , 60,58 dan 95,58 . Tidak ada perbedaan bermakna antara IVM gabungan dengan IVM ipsilateral. Kadar CGRP dan ICAM-1 tidak berbeda bermakna antara kedua kelompok saat awal dan akhir. Pada kelompok terkonfirmasi migren, proporsi kadar CGRP awal tinggi berkorelasi dengan penurunan CGRP akhir. Proporsi kadar CGRP awal tinggi berhubungan bermakna dengan kepositifan IVM.Simpulan: Respons vasodilatasi pembuluh darah MCA penderita migren, lebih rendah dan vasokonstriksi lebih tinggi. IVM terbukti memiliki akurasi baik untuk mendiagnosis gangguan reaktivitas vasomotor pada migren. Kadar CGRP awal tinggi pada migren merupakan prediktor penurunan CGRP dalam 1 bulan. Kata kunci: BHI, CGRP, ICAM-1, IVM, migren, reaktivitas vasomotor

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ABSTRACT
Migraine has a high prevalence in Indonesia and is the seventh cause of disability in the world. Migraine is diagnosed using the IHS criteria, but the false negative rate is high 50 . Endothelial dysfunction is the underlying pathophysiology of migraine causing impairment of the vasomotor reactivity and inflammation. Breath holding index BHI examination only uses hypercapnia stimulus, while the migraine vascular index MVI uses a combination of hypercapnia and hypocapnia stimulus. The accuracy of MVI and the role of CGRP and ICAM 1 in the pathogenesis of migraine is not fully understood.This study is aimed to assess the vasodilatory and vasoconstriction response of intracranial blood vessels of migraine patients, to know the accuracy of MVI compared to IHS and BHI, and to analyze changes in CGRP and ICAM 1 levels after 1 month of therapy.The study used a cross sectional and pre post design approach. Subjects with primary headache interictal phase who came to the neurology out patient clinic at Cipto Mangunkusumo Hospital RSCM , that met inclusion and exclusion criteria were included in the study. Subjects underwent anamnesis based on the Indonesian version of the MS Q criteria, transcranial Doppler examination to assess BHI and MVI on both sides of the head, and was given topiramate and or indomethacin based on the study 39 s criteria. Subjects were then asked to come for a 1 month follow up to assess the clinical response of headache. Blood samples were taken before and after treatment to assess CGRP and ICAM 1 levels.There were 104 confirmed migraine and 24 confirmed non migraine subjects in the study. There were no differences in sociodemographic characteristics between the two groups based on age, gender, education level, and occupation. The MCA MFV value in the confirmed migraine group is significantly lower compare to the confirmed non migraine group on the ipsilateral and contralateral side, where as the vasoconstriction ability is significantly higher in the confirmed migraine group compare to the confirmed non migraine group on the ipsilateral and contralateral side.The sensitivity and specificity of combined MVI, BHI and IHS MS Q respectively are 94.23 and 91.67 , 59.63 and 91.67 , 60.58 and 95.58 . There was no significant difference between combined MVI with ipsilateral MVI. Levels of CGRP and ICAM 1 did not differ significantly between the two groups before treatment and after treatment. In the confirmed migraine group, a high proportion of CGRP levels before treatment was correlated with CGRP decline after treatment. In addition, a high proportion of CGRP levels before treatment was associated with MVI positivity.Conclusions The vasodilatory response is found to be lower, whereas the vasoconstriction response is higher in the MCA of migraine patients. MVI is proven to have good accuracy in diagnosing impairment of vasomotor reactivity in migraine. A high initial CGRP level in migraine patients is a predictor of a decrease in CGRP within 1 month of prophylaxis therapy.Key words BHI, CGRP, ICAM 1, migraine, MVI, vasomotor reactivity

Abstrak :
Tujuan : Mendapatkan perbandingan reaktifitas platelet jam pertama (dengan alat Multiplate) antara ticagrelor dan clopidogrel. Latar Belakang : Ticagrelor memiliki kemampuan inhibisi platelet lebih baik dibandingkan clopidogrel. Penelitian PLATO atau substudi PLATO-platelet, dosis clopidogrel hanya 300 mg, dibandingkan dengan ticagrelor 180 mg pada pasien STEMI. Penelitian ini dilakukan untuk menilai reaktifitas platelet pada jam-1,4 dan 8 antara ticagrelor 180 mg atau clopidogrel 600 mg pada pasien STEMI. Metode : Penelitian random clinical trial, double blind, pasien STEMI dengan naive clopidogrel atau ticagrelor, dilanjutkan tindakan intervensi perkutan primer (PPCI) di RS Jantung Harapan Kita dari April-Juni 2013. Aktifitas platelet diukur jam pertama, jam keempat dan kedelapan dengan alat Multiplate. Hasil : Didapat 22 pasien STEMI nave clopidogrel/ticagrelor, dengan 11 pasien tiap kelompok. Tidak terdapat perbedaan terhadap usia, onset iskemik, BMI, penyakit penyerta Diabetes Melitus serta waktu pengambilan sampel pemeriksaan antara 2 kelompok obat. Didapat nilai reaktifitas platelet tetap tinggi pada kelompok obat clopidogrel dibandingkan ticagrelor pada jam pertama. Hasil kelompok ticagrelor tetap konstan hingga jam ke-8. Dan penurunan rekatifitas platelet kelompok clopidogrel menurun mendekati nilai yang diharapkan hingga jam 8. Kesimpulan : Reaktifitas platelet ticagrelor lebih rendah dibandingkan clopidogrel saat jam pertama pasca loading obat. Terdapat 45% (5 pasien) pada kelompok clopidogrel yang tetap memiliki reaktifitas platelet tinggi pada pemeriksaan jam pertama, keempat dan kedelapan, serta 9% (1 pasien) pada ticagrelor yang memiliki kenaikan nilai reaktifitas platelet pada jam keempat dan kedelapan ......Objectives : This study sought to compare platelet reactivity by180 mg ticagrelor and 600 mg clopidogrel in primary PCI STEMI patients. Background: The ability of ticagrelor in inhibiting platelet functions was more potent than clopidogrel in stable CAD and UAP/NonSTEMI patients. According to the PLATO trial or PLATO-platelet substudy, patients treated with 180 mg ticagrelor had better clinical endpoint and more platelet inhibition compared to 300 mg clopidogrel. The study we conducted was to see the platelet reactivity at 1st, 4th, and 8th hour after ingestion of 180 mg ticagrelor compared to 300 mg clopidogrel in STEMI patients Methods: This is a randomized double blind clinical trial carried out in Department of Cardiology and Vascular Medicine Universitas Indonesia/ National Cardiovascular Center Harapan Kita in April - June 2013. As many as 22 clopidogrel or ticagrelor nave STEMI patients undergoing primary PCI with were recruited. Platelet reactivity (PRU) was assessed by Multiplate at 1,4,8 h after LD. Result : Both nave ticagrelor and clopidogrel goups had 11 patients each. About 45% patients in clopidogrel group have high reactivity platelet at 1h, 4h and 8 h MEA analysis, and 9% patients in ticagrelor group have high reactivity platelet at 4h and 8 h MEA analysis. Conclusion: The action of Ticagrelor in platelet reactivity was lower compared to Clopidogrel in STEMI patients. 45 % patients in clopidogrel group maintained high platelet reactivity at 1st, 4th and 8th hour after LD, while 9% patients in ticagrelor group had high platelet reactivity started at 4th up 8th hour after LD.

Abstrak :
ABSTRAK
Geopolimer sebagai filler dapat digunakan sebagai semen instan yang ramah lingkungan dalam proses reparasi jalan beton. Sampel prekursor sintetis geoplimer dihasilkan melalui metode melt-quench. Analisa melalui XRD dan uji kuat tekan dilakukan untuk mengetahui perbandingan amorfisitas antara prekursor metakaolin sintetis, prekursor abu terbang class F sintetis, prekursor metakaolin alami, dan prekursor abu terbang class F alami dalam lingkup pengaruhnya terhadap reaktivitas geopolimer dalam medium alkali. Sampel dengan struktur prekursor dan struktur geopolimer yang lebih amorf memiliki reaktivitas dan kuat tekan yang lebih tinggi. Komposisi prekursor, sejarah perlakuan, kandungan pengotor, cooling rate, komposisi geopolimer memberi pengaruh signifikan pada struktur yang terbentuk.

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ABSTRACT
Geopolymer as filler can be used in repairing the concrete road for its characteristic as environment friendly instant cement. Synthetic geopolymer precursor was made by melt-quench method. XRD and compressive strength test have been done in order to analyzing the amorphous comparative of synthetic metakaoline precursor, synthetic class F fly ash, natural metakaoline precursor, natural class F fly ash respectively corresponds to reactivity in alkaline medium. Precursor and geopolymer that have more amorphous structure indicate higher reactivity and compressive strength. Precursor composition, treatment history, modifier content, cooling rate, geopolymer composition give significant effect on the structure produced.

Abstrak :
Latar belakang: Polimorfisme genetik dari reseptor P2Y12 dikatakan dapat mempengaruhi aktivasi reseptor P2Y12 atau menghambat aktivasi trombosit. Beberapa polimorfisme nukleotida tunggal dalam gen P2Y12 ditemukan dapat menyebabkan variabilitas antarindividu dalam agregasi platelet. Telah diidentifikasi lima polimorfisme dari gen P2Y12 yaitu T744C, C34T, G52T, ins801A, dan C139T. Salah satunya, polimorfisme C34T adalah salah satu dari polimorfisme yang dikatakan ada kaitannya dengan peningkatan agregasi platelet yang dapat menunjukkan kemungkinan untuk terjadinya modifikasi respon terapi clopidogrel. Namun hingga saat ini belum ada penelitian yang menilai hubungan langsung antara polimorfisme reseptor P2Y12 dengan TIMI-flow beserta faktor-faktor yang mempengaruhinya, termasuk fungsi penghambatan platelet pada pasien IMA-EST yang menjalani IKPP. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan antara polimorfisme nukleotida tunggal pada reseptor P2Y12 dengan TIMI flow beserta faktor-faktor yang mempengaruhinya, termasuk penghambatan fungsi platelet. Metode: Studi potong lintang pada 167 pasien IMA-EST yang menjalani IKPP. dilakukan pemeriksaan polimorfisme C34T reseptor P2Y12 dengan metode Taqman dan pemeriksaan fungsi penghambatan platelet yang diukur dengan VerifyNow P2Y12. Hasil: Dari 167 subjek penelitian, studi polimorfisme mengungkapkan proporsi pasien dengan heterozygous mutan sebanyak 34.1%, dan 1.8% pasien merupakan homozygous mutan. Sisanya adalah homozygous wildtype ditemukan sebanyak 64.1%. 25.7% pasien tergolong non-responder terhadap clopidogrel. Secara keseluruhan tidak terdapat hubungan secara langsung antara polimorfisme C34T dengan TIMI flow < 3, namun terdapat hubungan antara polimorfisme C34T dengan penurunan fungsi penghambatan platelet (OR 2.17, p = 0.046). Kesimpulan: Tidak terdapat hubungan secara langsung antara polimorfisme C34T dengan TIMI flow, namun pasien dengan polimorfisme C34T pada reseptor P2Y12 memiliki risiko untuk mengalami penurunan penghambatan fungsi platelet. ......Background: Genetic polymorphism of P2Y12 receptors is said to have affect of P2Y12 receptor activation or inhibit platelet activation. Several single nucleotide polymorphisms in the P2Y12 gene were found to cause variability between individuals in platelet aggregation. Five polymorphisms have been identified from the P2Y12 gene, namely T744C, C34T, G52T, ins801A, and C139T. One of them, C34T is one of the polymorphisms that is said to be related to increased platelet aggregation which can indicate the possibility for modification of the response of clopidogrel therapy. But until now there has been no research that assesses the direct relationship between P2Y12 receptor polymorphisms and TIMI-flow along with the factors that influence it, including the function of platelet inhibition in STEMI patients undergoing PPCI Objective: This study aims to determine the relationship between single nucleotide polymorphisms at P2Y12 receptors with TIMI flow along with the faktors that influenced it, including inhibition of platelet function. Methods: A cross-sectional study of 167 STEMI patients who underwent PPCI. C34T polymorphism of P2Y12 receptor was evaluated by the Taqman method and the inhibition of platelet function was measured by VerifyNow P2Y12. Results: Among 167 subjects, the heterozygous mutants group were 34.1%, and 1.8% of patients were homozygous mutants. The rest 64.1% was homozygous wildtype. 25.7% of patients were classified as non-responders to clopidogrel. Overall there was no direct relationship between C34T polymorphisms and TIMI flow <3, but there was a relationship between C34T polymorphisms and decreased platelet inhibitory function (OR 2.17, p = 0.046). Conclusion: There is no direct relationship between C34T polymorphisms and TIMI flow, but patients with C34T polymorphisms of P2Y12 receptors have a risk of decreasing platelet function inhibition.