Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
Latar Belakang. Stratifikasi risiko merupakan bagian integral dari managemen pasien sindrom koroner akut (SKA). Identifikasi pasien yang berisiko tinggi menjadi sangat penting untuk meningkatkan kewaspadaan sekaligus mengurangi tindakan berlebih terhadap pasien dengan risiko rendah. Meskipun TIMI pada STEMI dan UAPINSTEMI merupakan skor risiko yang baik dan telah divalidasi dan dipergunakan secara luas, tetapi penelitian mengenai perfonnanya belum pernah dilakukan di Indonesia. Adanya perbedaan karakteristik antara pasien SKA di Indonesia dengan populasi di negara maju dapat mempengaruhi prognosis pasien sehingga perlu dilakukan penelitian mengenai perfonna dari kedua sistem skoring tersebut. Tujuan. Menilai perfonna kalibrasi dan diskriminasi skor TIMI dalam memprediksi mortalitas 30 hari pasien STEMI dan 14 hari pasien UAPINSTEMI di Indonesia Metodologi. Studi kohort retrospektif menggunakan data rekam medis pasien SKA yang dirawat di IeeU RSeM 2003-2010 dengan metode pengambilan sampel konsekutif. Perfonna kalibrasi skor TIMI dinyatakan dengan plot kalibrasi dan uji Hosmer-Lemeshow sedangkan perfonna diskriminasi dinyatakan dengan nilai AUe. Hasil. Selama penelitian terkumpul 714 pasien STEMI dan 787 pasien UAPINSTEMI yang dirawat di IeeU RSeM. Skor TIMI STEMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dengan plot kalibrasi 0,98, uji Hosmer-Lemeshow 0,93 dan nilai AUe 0,801 (Kl 95% 0,759-0,844). Perfonna kalibrasi dan diskriminasi skor TIMI UAPINSTEMI juga cukup baik dengan plot kalibrasi mencapai 0,88, uji Hosmer lemeshow 0,86 dan nilai AUe 0,727 (KI95% 0,668-0,786). Simpulan. Skor TIMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas pasien SKA di Indonesia. ......Background. Risk Stratification in acute coronary syndrome patients is an integral part in the management of patients. Risk stratification is important to avoid overtreatment in high risk patients, as well as undertreatment in low risk patients. Although TIMI STEMI and TIMI UAiNSTEMI are scores that have been validated and used widely, but to date no study of its appicability has been done in Indonesia. Differences in characteristic of acute coronary syndrome patients in Indonesia compared to developed countries can have influence on the prognostic of the patient hence a study is needed regarding performance of TIM I scoring system. Objectives. To obtain the calibration dan discrimination performance of TIMl risk score to predict 30 day dan 14 day mortality in STEMI and UAPINSTEMI patients in Indonesia Methods. A retrospective cohort study with consecutive sampling was done in ACS patients hospitalized in the ICCU Cipto Mangun Kusumo Hospital between the period 2003 until 2010. Calibration performance of TIM I risk score was evaluated by calibration plot and Hosmer-Lemeshow test while discrimination performance was done with A Uc. Results. A total of 714 STEMI patients and 787 UAPINSTEMI patients entered the study. TIMI STEMI risk score have a good calibration and discrimination performance with calibration plot of 0, 98, Hosmer-Lemeshow test 0,93 and AUC 0,801 (CI95% 0,759-0,844). A good calibration and discrimination performance of TIMI UAPINSTEMI risk score was observed with calibration plot of 0,88, Hosmer-Lemeshow test 0,86 and AUC 0,73 (CI 95% 0,668-0,786). Conclusion. TIM! risk score has a good calibration and discrimination performance in predicting mortality of ACS patients in Indonesia.

Abstrak :
Latar Belakang : Fistula arteriovena (FAV) merupakan akses vaskular yang paling banyak digunakan oleh pasien-pasien Penyakit Ginjal Tahap Akhir (PGTA) yang menjalani hemodialisis rutin di Indonesia. FAV dapat mengalami disfungsi sebelum digunakan untuk inisiasi hemodialisis, yang disebut kegagalan primer. Klopidogrel merupakan antiagregasi trombosit yang dilaporkan dapat mengurangi kejadian kegagalan primer pada FAV dibandingkan antiagregasi trombosit lainnya. Hingga saat ini belum ada panduan yang merekomendasikan penggunaan klopidogrel karena kurangnya bukti ilmiah. Tujuan: Mengetahui pengaruh pemberian klopidogrel terhadap kejadian kegagalan primer FAV dan risiko perdarahan pada pasien-pasien PGTA. Metode: Penelusuran literatur Randomized Control Trial pada pangkalan data Medline / Pubmed, EbscoHost, Embase, Proquest, Scopus dan Cochrane Library berdasarkan kriteria eligibilitas sesuai PICO tanpa batasan bahasa sejak tahun 1987. Penilaian risiko bias menggunakan aplikasi Risk of Bias 2 Cochrane. Hasil: Penelitian ini melibatkan 3 penelitian Randomized Control Trial berdasarkan kriteria yang telah ditentukan. Ketiga penelitian mendapatkan hasil bahwa pemberian klopidogrel dapat mengurangi risiko kegagalan primer FAV. Meta-analisis tidak dapatdilakukan karena adanya heterogenitas klinis dan metodologis. Penilaian risiko bias dengan Risk of Bias 2 Cochrane mendapatkan 2 literatur berisiko bias ringan, dan 1 berisiko sedang. Penilaian dengan uji regresi Egger ( p = 1,00) dan uji korelasi Rank (p = 0,446) tidak terdapat indikasi bias publikasi. Prevalensi perdarahan tidak berbeda pada kelompok perlakuan dibandingkan kelompok kontrol. Simpulan: klopidogrel dapat mengurangi kejadian kegagalan primer FAV dengan kejadian perdarahan yang tidak berbeda dengan kelompok kontrol. ......Background: Arteriovenous fistula (FAV) is the most widely used vascular access for end-stage renal disease also called end-stage kidney disease or kidney failure (CKD) patients undergoing routine hemodialysis in Indonesia. However, FAV can become dysfunctional before it is used for the initiation of hemodialysis, a condition known as primary failure. Clopidogrel is an anti-platelet aggregation that has been reported to reduce the incidence of primary failure in FAV compared to other anti-platelet aggregation agents. To date, the guideline does not suggest the use of clopidogrel monotherapy for prevention arteriovenous fistula primary failure due to low quality of evidence. Objective: To assess the association of clopidogrel to the incidence of primary FAV failure and the risk of bleeding in End Stage Kidney Disease patients. Methods: A literature search was carried out to obtain Randomized Control Trial studies conducted since 1987 from Medline / Pubmed, EbscoHost, Embase, Proquest, Scopus, and Cochrane Libraries without language restrictions. Risk of bias assessment was performed with the Cochrane Risk of Bias 2 application. Results: This study involved 3 studies based on determined criteria. The risk of bias assessment with Cochrane's Risk of Bias 2 obtained a mild degree. All of the studies found that clopidogrel may reduce the risk of primary AVF failure. Meta-analysis was not performed due to clinical and methodological heterogeneity. Risk of bias assessment found 2 literature with mild risk bias and 1 literature with low risk bias. Assessment with Egger regression test (p = 1.00), and Rank correlation test (p = 0.446) showed no indication of publication bias. In addition, the prevalence of bleeding did not differ between the treatment and control groups

Abstrak :
Latar Belakang: Penyakit jantung merupakan penyebab kematian nomor satu dari kelompok Penyakit Tidak Menular (PTM) dan berdasarkan studi epidemiologi di Asia Tenggara, prevalensi gagal jantung di Asia Tenggara memiliki presentase yang lebih tinggi dibandingkan dengan negara lainnya. Gagal Jantung Dekompensasi Akut (GJDA) menjadi indikasi utama terjadinya admisi pada pasien dengan gagal jantung, khususnya gagal jantung dengan fraksi ejeksi rendah. Adanya kondisi hiponatremia dan hipokloremia pada pasien fraksi ejeksi rendah diharapkan dapat meningkatkan kewaspadaan bagi klinisi sebagai prediktor admisi akibat GJDA. Metode : Studi kohort retrospektif dengan menelusuri rekam medis pasien GJDA pada populasi fraksi ejeksi rendah berusia>18 tahun yang dirawat inap di RSUPN Cipto Mangunkusumo sejak tahun 2020 sampai dengan tahun 2023, dan menelusuri data elektrolit 90 hari sebelum admisi pasien dengan diagnosis GJDA pada pasien dengan fraksi ejeksi rendah. Dilakukan analisis bivariat dan juga multivariat prediktor admisi dengan diagnosis GJDA pada pasien dengan fraksi ejeksi rendah. Hasil : Dari total 265 subjek penelitian yang diletiti, analisis bivariat yang menunjukkan hiponatremia dan hipokloremia dapat menjadi prediktor admisi akibat GJDA pada pasien dengan fraksi ejeksi rendah, dengan analisis multivariat menunjukkan keduanya tetap merupakan prediktor yang baik secara statistik terkait admisi akibat GJDA pada pasien dengan fraksi ejeksi rendah dengan RR hiponatremia 1,729 (IK95% 1,367-2,179) dengan nilai P<0,001 dan OR hipokloremia 1,181 (IK95% 1,064-1,311) dengan nilai P 0,002. Kesimpulan : Hipontaremia ataupun hipokloremia pada pasien gagal jantung dengan fraksi ejeksi rendah dapat menjadi prediktor admisi akibat GJDA. ......Background : Cardiovascular disease remains the foremost cause of mortality within the spectrum of Non-Communicable Diseases (NCDs). Epidemiological studies within Southeast Asia have illuminated a notably elevated prevalence of heart failure compared to other global regions. Acute Decompensated Heart Failure (ADHF) serves as a primary catalyst for hospital admissions, particularly among patients exhibiting diminished left ventricular ejection fraction. The identification of hyponatremia and hypochloremia in individuals with reduced ejection fraction holds promise in enhancing clinicians' vigilance as predictive markers for ADHF admissions. Methodology : This retrospective cohort study delved into the medical records of individuals with ADHF within the low left ventricular ejection fraction cohort, aged >18 years, admitted to Dr. Cipto Mangunkusumo National Central General Hospital from 2020 to 2023. Electrolyte profiles from the 90-day period preceding ADHF diagnosis among patients with reduced ejection fraction were scrutinized. Both bivariate and multivariate analyses were conducted to delineate predictors of ADHF admissions in this subgroup. Results : Among the 265 subjects scrutinized, bivariate analysis revealed that both hyponatremia and hypochloremia could function as robust predictors for ADHF admissions in patients displaying diminished ejection fraction. Multivariate analysis solidified their statistical significance as predictors of ADHF admissions in individuals with reduced ejection fraction. Hyponatremia exhibited an relative risk (RR) of 1.729 (95% CI 1.367-2.179) with a P-value of <0.001, while hypochloremia demonstrated an RR of 1.181 (95% CI 1.064-1.311) with a P-value of 0.002. Conclusion : The presence of hyponatremia and hypochloremia in patients with heart failure and reduced left ventricular ejection fraction stands as a clinically significant predictive factor for ADHF admissions.

Abstrak :
Latar Belakang. Prevalensi penyakit arteri perifer (PAP) pada pasien diabetes melitus lebih tinggi dibandingkan populasi umum. Penyakit arteri perifer dapat meningkatkan mortalitas dan morbiditas terutama akibat penyakit kardiovaskular pada pasien diabetes melitus tipe 2 (DM tipe 2). Tidak semua pasien dengan PAP dapat terdeteksi dengan pengukuran ankle brachial index (ABI) istirahat, sehingga diperlukan pemeriksaan ABI treadmill. Pemeriksaan ABI treadmill dapat mendeteksi PAP pada fase awal, sehingga profil pasien pada kelompok ini berbeda dengan klompok PAP yang dideteksi dengan ABI istirahat. Diketahuinya profil pasien PAP ini penting untuk membantu meningkatkan kewaspadaan pasien, khususnya pasien DM tipe 2. Tujuan. Mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Metode. Penelitian dengan desain potong lintang dilakukan di Poliklinik Metabolik Endokrin dan Kardiologi, Departemen Ilmu Penyakit Dalam, Rumah Sakit Cipto Mangunkusumo pada Februari sampai April 2016 dengan metode sampling konsekutif. Subjek dengan nilai ABI istirahat normal/ perbatasan menjalani treadmill dengan protokol Bruce yang digunakan juga sebagai protokol uji latih jantung treadmill. Diagnosis PAP ditegakkan bila terdapat penurunan nilai ABI lebih dari 20% dibandingkan ABI istirahat. Hasil. Sebanyak 92 subjek dianalisis untuk mengetahui profil pasien DM tipe 2 dengan PAP yang dideteksi dengan ABI treadmill. Lima belas subjek (16,3%) didiagnosis PAP. Kelompok PAP memiliki persentase subjek dengan durasi diabetes ≥ 10 tahun sebanyak 53,3%; dislipidemia sebanyak 73,3%; penyakit ginjal kronik (PGK) sebanyak 33,3%; perokok sebanyak 40%; komplikasi neuropati sebanyak 53,3%; albuminuri sebanyak 53,3%; retinopati sebanyak 40%; dan respons iskemia jantung positif/sugestif positif sebanyak 40% subjek. Sedangkan kelompok tanpa PAP memiliki subjek dengan durasi diabetes ≥ 10 tahun sebanyak 33,8%; dislipidemia sebanyak 57,1%; PGK sebanyak 19,5%; perokok sebanyak 32,5%; komplikasi neuropati sebanyak 37,7%; albuminuri sebanyak 26,4%; retinopati sebanyak 28,6%; respons iskemia jantung positif/sugestif positif sebanyak 28,5% subjek. Kesimpulan. Prevalensi PAP yang dideteksi dengan ABI treadmill pada pasien DM tipe 2 adalah 16,3% (IK 95%: 8-23%). Kelompok PAP yang dideteksi dengan ABI treadmill memiliki subjek dengan durasi DM ≥ 10 tahun, dislipidemia, perokok, PGK, neuropati, albuminuria, retinopati dan respons iskemia jantung positif/sugestif positif lebih banyak daripada subjek tanpa PAP. ...... Background. The prevalence of peripheral arterial disease (PAD) among diabetes patients was higher compared to general population. PAD increases morbidity and mortality, especially due to cardiovascular disease, in type 2 diabetes mellitus patients (T2DM). Not all patients having PAD could not be detected by resting ankle brachial index (ABI) measurement, hence it is required treadmill ABI examination. The examination enable to detect PAD in the earlier phase, therefore patients profile would different with PAD patient detected from resting ABI examination. The profiles are important to raise the awareness of T2DM patients. Aim. To identify profile T2DM patients with PAD detected by treadmill ABI. Methods. A cross-sectional study was carried out in Metabolic Endocrine and Cardiology Outpatient Clinic, Internal Medicine Department, Cipto Mangunkusumo Hospital during February-April 2016. The study used consecutive sampling method. Subject having normal or borderline resting ABI value is examine using Bruce protocol treadmill. The protocol is also used as a cardiac treadmill exercise test protocol. The patients diagnose as PAD if there is a reducing ABI value more than 20% compared to resting ABI. Result. The profile of PAD patients detected by treadmill ABI were obtain from 92 subjects. Fifteen subjects (16,3%) were diagnosed having PAD. In the group with PAD, the percentage of subject with diabetes duration ≥ 10 years was 53,3%; dyslipidemia was 73.3%; chronic kidney disease (CKD) was 33.3%; smokers was 40%; complications of neuropathy was 53.3%; albuminuri was 53.3%; retinopathy was 40%; positive / positive suggestive cardiac ischemia response was 40% . Meanwhile the group without PAD, the percentage of subjects with diabetes duration ≥ 10 years was 33.8%; dyslipidemia was 57.1%; CKD was 19.5%; smokers was 32.5%; complications of neuropathy was 37.7%; albuminuri was 26.4%; retinopathy was 28.6%; positive / positive suggestive cardiac ischemia response was 28.5%. Conclusion. The prevalence of PAD that detected by treadmilll ABI in T2DM patients is 16,3% (95% CI: 8-23%). The Group with PAD detected by ABI treadmill which have duration of diabetes ≥ 10 years, dyslipidemia, smokers, CKD, neuropathy, albuminuria, retinopathy, and the positive result on treadmill exercise test have more subjects than group without PAD.

Abstrak :
Latar belakang: Sindrom koroner akut SKA merupakan penyebab utama peningkatan morbiditas dan mortalitas di seluruh dunia. Mortalitas SKA dari berbagai studi di luar negeri diketahui berhubungan dengan kadar kalium serum saat admisi. Penelitian mengenai hubungan kadar kalium serum dengan mortalitas pada SKA masih perlu dilakukan karena adanya kemajuan dalam terapi kardiovaskular yang cukup pesat terutama pada era PCI saat ini dan adanya hasil yang bertolakbelakang antara studi terbaru dengan panduan yang ada. Tujuan: Menilai hubungan antara kadar kalium serum saat admisi dengan mortalitas selama perawatan pasien SKA in-hospital mortality. Metode: Data kadar kalium dan kematian diperoleh dari rekam medis dengan desain studi kohort retrospektif terhadap 673 pasien SKA yang dirawat dengan sindrom koroner akut di RSUPN Cipto Mangunkusumo. Keluaran utama yang diamati berupa mortalitas selama perawatan. Analisis bivariat dengan Pearson Chi-square dan multivariat menggunakan regresi logistik dilakukan untuk menentukan hubungan antara kadar kalium serum abnormal dengan kematian pada sindrom koroner akut. Hasil dan Pembahasan: Subjek yang datang dengan kadar kalium serum yang abnormal K < 3,50 mEq/L atau > 5,0 mEq/L saat admisi sebesar 24,22 163 pasien , sedangkan grup dengan kalium normal sebesar 510 subjek 75,78. Dari analisis regresi logistik, setelah adjustment terhadap faktor perancu eGFR, didapatkan hubungan yang bermakna antara kadar kalium serum abnormal saat admisi dengan mortalitas selama perawatan dengan nilai p = 0,04 adjusted RR 2,184; 95 CI: 1,037-4,601. Terjadi peningkatan risiko mortalitas pada subjek dengan kadar serum kalium 4,0- ...... Background: Acute coronary syndrome ACS is the leading cause of increased morbidity and mortality across the globe. This mortality was known to be associated to the serum potassium level on admission. More studies are still needed due to rapid advancement in cardiovascular medicine especially in the era of interventional cardiology and also the conflicting results that exist between recent studies and established guidelines. Aims: To determine association between serum potassium levels on admission of subjects with acute coronary syndrome and in-hospital mortality. Methods: Included in the study were 673 acute coronary syndrome patients hospitalised in Indonesian National Cipto Mangunkusumo Hospital. The outcome of the study was all-cause in-hospital mortality. Logistic regression models adjusted for risk factors, hospital treatment, and co-morbidities were constructed. Results: Total of 163 patients 24,22 with abnormal serum potassium K < 3,50 mEq/L or > 5,0 mEq/L and 510 subjects with normal serum potassium 75.78. Logistic regression analysis after adjustment of the confounder eGFR shows significant association between serum potassium level on admission and in-hospital mortality with p value of 0,04 adjusted RR 2.184; 95 CI: 1.037-4.601. The risk of dying for patients with serum potassium of 4.0-.

Abstrak :
[ABSTRAK
Latar Belakang : Atherosklerosis adalah suatu proses penyakit yang difus, dengan adanya satu pembuluh darah yang rusak akan memprediksikan adanya kelainan pada pembuluh darah lain. Ankle Brachial Indeks (ABI) dan Toe Brakhial Indeks (TBI) adalah test non invasif terbukti sensitive dan spesifik untuk mendeteksi beratnya penyakit arteri perifer. Tujuan : Mengetahui hubungan derajat Penyakit Arteri Perifer (PAP) Asimtomatis dengan beratnya Penyakit Jantung Koroner (PJK) stabil Metode : Dilakukan studi potong lintang pada tujuh puluh tiga pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri coroner dinilai dengan skor Gensini > 40 (berat) dan < 40 (ringan-sedang). PAP dinilai dengan pemeriksaan ABI dan TBI dengan metode Oscillomtreic. Analisis menggunakan uji Spearman correlation test dan uji Pearson correlation test. Hasil : Proporsi PAP asimtomatis pada PJK stabil 47 pasien (64,4%). Nilai median ABI adalah 1,07 (kisaran 0,57-1,27), nilai rerata TBI adalah 0,57 (SB 0,155) dan nilai rerata skor Gensini adalah 46,60 (SB 33,64). Analisis bivariat ABI dengan skor Gensini menunjukkan tidak terdapat korelasi (r=-0,099, p 0,407) dan analis bivariate TBI dengan skor Gensini juga menunjukkan tidak terdapat korelasi (r= -0,153, p= 0,196) Simpulan : ABI dan TBI dengan metode Oscillometric tidak berkorelasi dengan derajat stenosis arteri koroner berdasarkan skor Gensini. ABI dan TBI tidak memiliki kemampuan yang baik untuk membedakan pasien PJK ringan-sedang dan berat berdasarkan skor Gensini.

---

ABSTRACT
Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores., Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease. Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD) Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables. Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.]

Abstrak :
ABSTRAK
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.

Abstrak :
Pendahuluan: Neuropati diabetik merupakan komplikasi diabetes yang paling sering ditemukan dalam praktik sehari-hari. Gejala terutama dikeluhkan rasa nyeri atau baal pada kedua tungkai. Penyakit arteri perifer (PAP) juga merupakan komplikasi diabetes dengan manifestasi nyeri pada tungkai. Adanya neuropati dan PAP akan mempengaruhi gejala satu sama lain sehingga umumnya pasien akan datang dalam keadaan yang lebih berat. Penelitian ini bertujuan untuk mengetahui gambaran klinis dan hasil pemeriksaan elektrodiagnostik neuropati diabetik dengan atau tanpa PAP. Metode: Studi ini bersifat deskriptif dengan metode potong lintang pada pasien diabetes melitus tipe 2 dengan neuropati berdasarakan Toronto clinical neuropathy score (TCNS). Pasien kemudian dilakukan pemeriksaan elektrofisiologi (Kecepatan hantar saraf (KHS) dan sympathetic skin response (SSR)) untuk membuktikan adanya neuropati serta pemeriksaan ankle brachial index (ABI) dan toe brachial index (TBI) untuk mendiagnosis adanya PAP. Hasil: Sebanyak 46 subjek penelitian yang terdiri dari 22 laki-laki dan 24 perempuan. Rerata usia subjek penelitian adalah 63,09 (±9,98) tahun dengan rerata lama menderita diabetes 13,57 (±10,43) tahun. Kebanyakan pasien memiliki kontrol glikemik yang kurang baik dengan median HbA1C of 7,35 (min-max: 5,6-12,2). Didapatkan sebanyak 22 orang terdiagnosis PAP berdasarkan pemeriksaan TBI. Berdasarkan analisis bivariat didapatkan kemaknaan secara statistik antara adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten serta riwayat penyakit jantung koroner dengan adanya PAP (masing-masing p < 0,05). Kesimpulan: Adanya keluhan nyeri, rasa kram, lokasi nyeri, klaudikasio intermiten, serta riwayat penyakit jantung koroner dapat menunjukkan adanya kemungkinan PAP pada pasien neuropati diabetik. Kata kunci: neuropati diabetik, penyakit arteri perifer, kecepatan hantar saraf, respon kulit simpatetik

---

Background: Diabetic neuropathy (DN) is a common complication of diabetes. Symptoms can be tingling, pain or numbness in the leg.(1) Peripheral arterial disease (PAD) is also a complication of diabetes which can cause pain in the leg. The presence of DN and PAD affect each other, resulting in worse patient condition. The aim of this study to evaluate clinical characteristics and electrodiagnostic findings in diabetic neuropathy with and without PAD. Method: a descriptive cross-sectional study in type 2 diabetes mellitus patient with neuropathy based on Toronto clinical neuropathy score (TCNS). Patients were evaluated with electrodiagnostic study (nerve conduction study (NCS) and sympathetic skin response (SSR)) to confirm neuropathy and also ankle brachial index (ABI) and toe brachial index (TBI) to evaluate PAD. Results: a total of 46 subjects consisted of 22 male and 24 females include in this study. The mean age of the study population was 63,09 years (±9,98). The mean duration of diabetes in the study population was 13,57 years (±10,43). Most of the patients had poorly controlled diabetes with a median HbA1C of 7,35 (min-max: 5,6-12,2). Ten patients have PAD based on TBI examination. From bivariate analysis, there is statistically significant association between pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease with the presence of PAD (p < 0,05). Kesimpulan: The presence of pain, cramp, pain location, intermittent claudication, and history of coronary arterial disease can predict the presence of PAD in DN patients. Keywords: diabetic neuropathy, peripheral arterial disease, nerve conduction study, sympathetic skin response

Abstrak :
Latar belakang : Pasien gagal jantung kronik memerlukan evaluasi pemeriksaan ekokardiografi. Berbagai metode pemeriksaan digunakan dalam pemeriksaan ekokardiografi, diantaranya pemeriksaan LAEF, LAVI, dan LVEF yang terkait dengan penelitian ini. Metode pemeriksaan LAEF dan LAVI memiliki peran dalam menilai remodelling atrium kiri, sedang LVEF terkait dengan fungsi sistolik ventrikel kiri. Tujuan : Penelitian ini bertujuan menilai korelasi nilai LAEF dan LAVI dengan nilai LVEF pada < 40% dan ≥ 40%. Metode : Studi potong lintang pada 150 pasien gagal jantung kronik yang dilakukan pemeriksaan ekokardiografi trans-torakal di eko-lab PJT RSCM.Pemeriksaan ekokardiografi metode LAEF dengan metode area length (2 dimensi) pada minimal 2 view eko, sedangkan LAVI dengan metode 2 dimensi. Pemeriksaan LVEF dengan metode Simpson. Hasil : Pada penelitian didapatkan 150 subjek dengan nilai median LAVI 30,9mL/m2 (RIK 22,08-40,80), nilai median LVEF 55,75 % (RIK 40,75-61,85), nilai LAEF median 31,8 % (RIK 23,98-38,30). Korelasi nilai LAEF dengan nilai LVEF pada LVEF < 40% dengan hasil korelasi positif sedang bermakna (r = 0,614; p <0,001), pada LVEF ≥ 40% dengan hasil korelasi positif sedang bermakna (r =0,580 ; p < 0,001). Korelasi nilai LAVI dengan nilai LVEF pada LVEF < 40% dengan hasil berkorelasi negatif lemah dan tidak bermakna (r = -0,093; p = 0,722), sedangkan pada LVEF ≥ 40% dengan hasil berkorelasi negatif lemah bermakna (r = -0,299; p < 0,001). Dilakukan sub-analisis pada LVEF 40-50%, didapatkan nilai LAEF dan nilai LVEF berkorelasi positif lemah bermakna (r = 0,492; p <0,001). Lalu sub-analisis pada LVEF ≥ 50%, didapatkan korelasi nilai LAEF dan nilai LVEF positif lemah tidak bermakna (r = 0,205; p = 0,063). Kesimpulan : Terdapat korelasi positif nilai LAEF dengan nilai LVEF pada pasien gagal jantung kronik baik pada HFrEF (LVEF < 40%) dan LVEF ≥ 40%, sehingga nilai LAEF pada cut-off nilai LVEF 40% dapat menjadi salah satu marker menilai proses remodelling atrium kiri. Sedangkan nilai LAVI dengan LVEF pada pasien gagal jantung kronik ditemukan korelasi lemah atau tidak adanya korelasi. ......Background : Patients with chronic heart failure require echocardiographic evaluation. Various examination methods were used in echocardiographic examinations, including LAEF, LAVI, and LVEF examinations related to this study. LAEF and LAVI examination methods have a role in assessing left atrial remodeling, while LVEF is related to left ventricular systolic function. Objective : This study aims to assess the correlation between LAEF and LAVI values with LVEF values at LVEF < 40% and LVEF 40%. Methods : A cross-sectional study of 150 patients with chronic heart failure who underwent transthoracic echocardiography at the RSCM PJT eco-lab. Echocardiographic examination using the LAEF method with the area length method (2 dimensions), in at least 2 eco views, while the LAVI using the 2-dimensional method. LVEF examination by the Simpson method. Results : The study found 150 subjects with a median LAVI value of 30.9 mL/m2 (IQR 22.08-40.80), a median LVEF value of 55.75% (IQR 40.75-61.85), a median LAEF value of 31 ,8% (IQR 23.98-38.30). The correlation between the LAEF value and the LVEF value at LVEF < 40% has a moderately significant positive correlation (r = 0.614; p < 0.001), while at LVEF ≥ 40% has a moderately significant positive correlation (r = 0.580 ; p < 0.001). The correlation between the LAVI value and the LVEF value at LVEF < 40% has a weak and insignificant negative correlation (r = -0.093; p = 0.722), while at LVEF ≥ 40% has a weak negative significant correlation (r = -0.299; p < 0.001). Sub-analysis was performed on LVEF 40-50%, and the LAEF value and LVEF value were positively and significantly correlated (r = 0.492; p < 0.001). Then the sub-analysis at LVEF > 50%, it was found that the correlation between the LAEF value and LVEF value were weak positive and not significant correlated (r = 0.205; p = 0.063). Conclusion : There is a positive correlation between LAEF values and LVEF values in chronic heart failure patients both at HFrEF (LVEF < 40%) and LVEF ≥ 40%, so that the LAEF value at the cut-off LVEF 40% can be one of the markers to assess the left atrial remodeling process. While the value of LAVI with LVEF in patients with chronic heart failure found a weak correlation or no correlation.

Abstrak :
ABSTRAK
Latar Belakang: Aterosklerosis merupakan penyakit sistemik, bisa terjadi di seluruh pembuluh darah. Pada arteri karotis terjadi penebalan tunika intima yang dapat dideteksi menggunakan penunjang non invasif yaitu dengan ultasound. Pada tungkai dapat dilakukan pemeriksaan non invasif yaitu Ankle-Brachial Index (ABI) dan Toe-Brachial Index (TBI) untuk mengetahui adanya penyakit arteri perifer, dengan asumsi bahwa adanya penurunan ABI atau TBI menunjukkan sudah ada stenosis. Berdasarkan hal ini diduga terdapat hubungan antara ABI dan TBI dengan Carotid Intima Media Thickness (CIMT). Tujuan: Mendapatkan hubungan antara ABI dan TBI dengan CIMT. Metode: Dilakukan studi potong lintang pada 36 pasien diabetes tipe II. Dilakukan pemeriksaan ABI dan TBI bila memenuhi kriteria Penyakit Arteri Perifer, dilanjutkan dengan pemeriksaan ultrasound untuk mengetahui ketebalan tunika intima karotis. Hubungan antara ABI dan TBI dengan CIMT dihitung dengan Spearman. Hasil: Rerata ABI yang diperoleh adalah 0,97 ± 0,15, rerata TBI 0,56 ± 0,1. Nilai tengah CIMT 0,96 (0,77 - 3,60). Tidak terdapat hubungan antara ABI dengan CIMT (r=-259, p=0,127) dan terdapat hubungan negatif bermakna antara TBI dengan CIMT (r=-0,47, p=0,004). Simpulan: Tidak terdapat hubungan antara ABI dengan CIMT. Terdapat hubungan negatif bermakna antara TBI dengan CIMT.

---

ABSTRACT
Background: Atherosclerosis is a systemic disease that can be found in all arteries. Carotid Intima Media Thickness can be measure with ultrasound. Peripheral Artery Disease can be assessed with Ankle Brachial Index (ABI) And Toe Brachial Index (TBI). Low ABI or TBI can detect stenosis on the lower extremity arteries. Objective:To determine correlation between Ankle Brachial Index And Toe Brachial Index With Carotid Intima Media Thickness Methods: A cross sectional study on type II diabetic patients. Peripheral artery were assessed with Ankle Brachial Index and Toe Brachial Index. Carotid Intima Media Thickness measured with ultrasound. Correlation between ABI and TBI with CIMT were calculated with Spearman correlation test. Results: Mean Ankle Brachial Index were 0,97 ± 0,15, mean Toe Brachial Index 0,56 ± 0,1. Median of Carotid Intima Media Thickness 0,96 (0,77 - 3,60). Correlation between ABI with CIMT (r=-259, p=0,127) and TBI with CIMT (r=-0,47, p=0,004) Conclusions:There were no correlation between Ankle Brachial Index with Carotid Intima Media Thickness. There were negative correlation between Toe Brachial Index with Carotid Intima Media Thickness.