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Abstrak :
ABSTRACT Rheumatoid arthritis (RA) is an autoimmune disease which has recently been recognized to manifest as not only intraarticular events, presented either subclinically or clinically, were discovered more in AR patients. Atherogenic inflammatory mediator in AR including interleukin-6 (IL 6) was thought tobe one of nontraditional cardiovascular risk factor contributing to increase the endothelial dysfunction biomarker such as e selectin.

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ABSTRAK
Pendahuluan: Kalsifikasi vaskular yang ditandai dengan penebalan tunika intima-media (TIM) karotis pada pasien diabetes melitus (DM) tipe 2 merupakan faktor prediktor terhadap kejadian serebro-kardiovaskular. Osteoprotegerin (OPG) merupakan penanda disfungsi endotel yang dapat digunakan sebagai prediktor terhadap penebalan TIM karotis. Penggunaan ultrasonografi (USG) karotis untuk menilai ketebalan TIM karotis masih terbatas di Indonesia sehingga diperlukan metode diagnostik lain yang lebih cost effective. Penelitian ini dilakukan untuk menentukan faktor-faktor determinan yang bermakna dan nilai tambah diagnostik pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Metode: Studi potong lintang dilakukan di poliklinik Metabolik Endokrin dan poliklinik spesialis Ilmu Penyakit Dalam RS Cipto Mangunkusumo (RSCM) pada bulan April-Juni 2012 pada pasien DM tipe 2 tanpa komplikasi serebro-kardiovaskular, tanpa komplikasi penyakit ginjal kronik (PGK) stadium III-V dan tidak merokok. Pada penelitian ini dilakukan analisis bivariat dan multivariat pada variabel lama menderita DM, hipertensi, dislipidemia, HbA1c, dan OPG. Selanjutnya, ditentukan nilai tambah pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Analisis data dilakukan dengan menggunakan program SPSS versi 17.0. Hasil: Dari 70 subjek penelitian, didapatkan jumlah subjek dengan peningkatan OPG dan penebalan TIM karotis adalah sebesar 45,7% dan 70%. Dari 49 subjek dengan penebalan TIM karotis, didapatkan 61,2% subjek dengan peningkatan OPG. Lama menderita DM (OR 26,9; IK 95% 2-365,6), hipertensi (OR 22; IK 95% 2,3-207,9), dislipidemia (OR 85,2; IK 95% 3,6-203,6) dan OPG (OR 12,9; IK 95% 1,4-117,3) berhubungan secara bermakna dengan penebalan TIM karotis. Pemeriksaan OPG mempunyai spesifisitas dan nilai duga positif tinggi (90,5% dan 84%). Nilai tambah diagnostik OPG hanya sebesar 2,3% dalam mendeteksi penebalan TIM karotis. Simpulan: Faktor-faktor determinan yang bermakna untuk mendeteksi penebalan TIM karotis pada pasien DM tipe 2 adalah lama menderita DM, hipertensi, dislipidemia dan OPG. Nilai tambah diagnostik dari pemeriksaan OPG adalah sebesar 2,3% dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2.

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ABSTRACT
Background: to identify other factors other than the TIMI scores that can be used as predictors of 30-day mortality in STEMI patients by including variables of left ventricle ejection fraction (LVEF) and glomerulus filtration rate (GFR) at Cipto Mangunkusumo National Central General Hospital. Methods: a retrospective cohort study was conducted in 487 STEMI patients who were hospitalized at RSUPN Cipto Mangunkusumo between 2004 and 2013. Sample size was calculated using the rule of thumbs formula. Data were obtained from medical records and analyzed with bivariate and multivariate method using Coxs Proportional Hazard Regression Model. Subsequently, a new scoring system was developed to predict 30-day mortality rate in STEMI patients. Calibration and discrimination features of the new model were assessed using Hosmer-Lemeshow test and area under receiver operating characteristic curve (AUC). Results: bivariate and multivariate analyses showed that only two variables in the new score system model were statistically significant, i.e. the Killip class II to IV and GFR with a range of total score between 0 and 4,6. Thirty-day mortality risk stratification for STEMI patient included high, moderate and low risks. The risk was considered high when the total score was >3,5 (46,5%). It was considered moderate if the total score was between 2,5 and 3,5 (23,2%) and low if the total score was <2,5 (5,95%). Both variables of the score had satisfactory calibration (p > 0,05) and discrimination (AUC 0,816 (0,756-0,875; CI 95%). Conclusion: There are two new score variables that can be used as predictors of 30-day mortality risks for STEMI patients, i.e. the Killip class and GFR with satisfactory calibration and discrimination rate.

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Background: some studies show fragmanted QRS (fQRS) as a marker of myocardial scar, ventricular arrhythmia, ventricular remodelling and worse coronary collaterals flow, which can increase the incidence of major adverse cardiac event (MACE) after infarction. This study aimed to identify the role of fQRS as one of the risk factors for MACE (cardiac death and reinfarction) in acute coronary syndrome patients within 30 days observation. Methods: a cohort retrospective study was conducted using secondary data of acute coronary syndrome patients at Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital from July 2015 to October 2017. Multivariate analysis were done by using logistic regression with GRACE score (moderate and high risk), low eGFR (< 60 ml/min), low LVEF (< 40%), diabetes mellitus, age more than 45 years and hypertension as confounding factors. Results: three hundred and fifty three (353) subjects were included. Fragmented QRS was found in 60,9 % subjects. It was more frequent in inferior leads (48.8% ) with mean onset of 34 hours. Major adverse cardiac events were higher in fQRS vs. non-fQRS group (15.8% vs. 5.8 %). Bivariate analysis showed higher probability of 30 days MACE in fQRS group (RR 2.72; 95%CI 1.3 -5.71p=0.08). Multivariate analysis revealed adjusted RR of 2.79 (95% CI: 1.29 - 4.43, p<0.05). Low eGFR was a potential confounder in this study. Conclusion: persistent fQRS developed in ACS during hospitalization is an independent predictor of 30 days MACE cardiac death and re-infarction.

Abstrak :
ABSTRACT
Cardiovascular disease (CVD) remain a leading cause of death globally. The concept of acute myocardial infarction in young adults was uncommon. Atherosclerosis is the leading cause of CVD, including myocardial infarction, stroke, heart failure and peripheral artery disease. This condition is initiated early in childhood and progressive in nature. CVD risk factors includes hypertension, dyslipidemia and obesity play a role in the development of atherosclerosis and components in insulin resistance syndrome. One of many risk factors for insulin resistance in healthy individuals is a first-degree relative (FDR) of Type 2 Diabetes Mellitus (T2DM) patients. This group shows a higher risk of insulin resistance and pancreatic beta cells disruption even in adolescence, although they often remains asymptomatic. Clinical manifestations of metabolic disorders and atherosclerosis will appear earlier in the FDR T2DM group who have sedentary lifestyles and obesity, when compared to the non-FDR group. Several studies have attempted to detect metabolic disorders and subclinical atherosclerosis that might occur; therefore an early prevention can be carried out in these high-risk groups. Unfortunately, factors that affect the onset and the severity of the prospective clinical manifestations from the previous studies remained inconclusive.