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Pendahuluan.Pencegahan dan pengendalian hiperlipoproteinemia tipe LDLsangat penting untuk mencegah terjadinya penyakit kardiovaskuler. Pemeriksaan laboratorium dari serum darah menjadi baku emas penegakan diagnosis hiperlipoproteinemia tipe LDL, namun harganya yang mahal dan tidak tersedia di semua layanan kesehatan. Penelitian ini bertujuan untuk mengembangkan indikator rasio lingkar pinggang terhadap tinggi badan (LP/TB) sebagai alat untuk deteksi dini hiperlipoproteinemia tipe LDL di Indonesia. Metode.Penelitian ini menggunakan data Riskesdas 2013 dengan desain potong lintang. Subyek penelitian adalah seluruh penduduk Indonesia yang berusia 15 tahun ke atas. Subyek dengan riwayat penyakit jantung koroner, stroke, hipertiroid, sedang hamil, atau menggunakan kontrasepsi oral diekslusi. Total subyek penelitian sebanyak 29.536 orang. Variabel independen adalah rasio LP/TB, usia, jenis kelamin, adanya hipertensi, diabetes mellitus tipe 2, aktivitas fisik, pola diet, kebiasaan merokok, dan stress. Variabel dependen adalah ada tidaknya hiperlipoproteinemia tipe LDL (LDL ≥100 mg/dl). Hasil. Prevalensi hiperlipoproteinemia tipe LDLdi Indonesia sebesar 73,48%. Dari analisis ROC didapatkan area under curve (AUC) rasio LP/TB untuk mengidentifikasi hiperlipoproteinemia tipe LDLsebesar 0,6355. Titik potong rasio LP/TB sebesar 0,45 pada laki-laki dan 0,49 pada perempuan menghasilkan sensitivitas sebesar 70,15%. Tidak terdapat perbedaan bermakna antara AUC rasio LP/TB dengan AUC indeks massa tubuh (IMT) dan lingkar pinggang. Namun dengan menggunakan titik potong standar di Indonesia, sensitivitas IMT dan lingkar pinggang lebih rendah untuk mendiagnosis hiperlipoproteinemia tipe LDL (sensitivitas IMT: 31,27%, sensitivitas lingkar pinggang 30,16%). Variabel yang menjadi faktor risiko hiperlipoproteinemia tipe LDL adalah usia (POR: 1,03; 95% CI 1,030-1,034), wanita (POR: 1,12; 95% CI 1,05-1,19), hipertensi (OR: 1,34% 95% CI 1,12-1,59), dan diabetes mellitus tipe 2 (POR:1,75; 95% CI 1,37-2,23).Faktor protektif hiperlipoproteinemia tipe LDL menurut indikator rasio LP/TB adalah stress psikis (POR: 0,88, 95%CI: 0,08-0,98). Kesimpulan. Rasio LP/TB ≥0,45 pada laki-laki dan ≥0,49 pada perempuan dapat digunakan untuk menjadi alat deteksi dini hiperlipoproteinemia tipe LDLdengan sensitivitas yang baik. Usia, wanita, diabetes mellitus tipe 2, dan hipertensi merupakan faktor risiko hiperlipoproteinemia tipe LDL.

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Introduction. Detection of LDL type hyperlipoproteinemia is important for the prevention of cardiovascular diseases. Serum lipid testing as gold standard for LDL type hyperlipoproteinemia remains expensive and not available in every districts in Indonesia. We aimed to develop waist to height ratio (WTHR) as simple test to identify LDL type hyperlipoproteinemia among Indonesians. Methods. This was a cross sectional study using data from Indonesia?s Basic Health Research (Riset Kesehatan Dasar) in 2013. A total of 19.536 participants aged 15 and above were included. Subject with history of stroke, ischaemic heart disease, hyperthyroid, in pregnancy, or using oral contraceptive were excluded. Dyslipidemia was defined as LDL≥100 mg/dl. Body weight, height, and waist circumference were measured following standard procedure. We compare validity of WTHR with body mass index (BMI) and waist circumference (WC) for identifying dyslipidemia, with serum lipid testing as gold standard. We also analyze whether age, sex, hypertension, type 2 diabetes, diet, physical activity, smoking habit, and physicological stress were associated with LDL type hyperlipoproteinemia. Data were analysed using logistic regression and areas under the receiving operating characteristic curves. Results. Prevalence of LDL type hyperlipoproteinemia in Indonesia is 73,48%. AUC of WTHR is 0,6355. Wthr at cut off 0,45 in male and0,49 in female gives 70,15% sensitivity. There were no significant difference in AUCs of WTHR, BMI, and WC. But with standard cut-off point of BMI and WC, their sensitivity is lower than WTHR (sensitivity of BMI is 31,27%, sensitivity of WC is 30,16%). Risk factors of of LDL type hyperlipoproteinemia were age (POR: 1,03; 95% CI 1,030-1,034), female (POR: 1,12; 95% CI 1,05-1,19), hypertension (POR: 1,34% 95% CI 1,12-1,59), and type 2 diabetes (POR:1,75; 95% CI 1,37-2,23).Protective factor was physiological stress (POR: 0,86, 95%CI: 0,78-0,96). Conclusions. WTHR≥0,45 in male and ≥0,49 in female may be used as tool for of LDL type hyperlipoproteinemia screening. Age, female, hypertension, type 2 diabetes were risk factors of of LDL type hyperlipoproteinemia.

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Latar Belakang: Human immuno deficiency virus/ Acquired Immune Deficiency Syndrome HIV/AIDS merupakan masalah global yang menunjukkan adanya keterkaitan antara kasus HIV/AIDS dengan adanya kejadian aterosklerosis sebagai pemicu terjadinya kasus Penyakit Jantung Koroner PJK . Pemberian Antiretroviral ARV tersebut juga berisiko untuk kejadian PJK melalui mekanisme dislipidemia, lipodistrofi, resistensi insulin dan gangguan hati, yang juga bisa menyebabkan penebalan tunika intima media.Tujuan: Mendapatkan korelasi perubahan kadar CD 4, kadar viral load dan Indeks Massa Tubuh terhadap perubahan ketebalan tunika intima media arteri karotis pada pasien HIV yang mendapat ARV lini pertama selama 12 bulanMetode: Penelitian ini merupakan studi uji korelasi terhadap 54 pasien HIV yang menggunakan data sekunder penelitian JACCANDO PROJECT. Data yang digunakan adalah data USG doppler arteri karotis, hasil CD 4, hasil viral load dan hasil Indeks Massa Tubuh IMT .Hasil: Median CD 4 sebelum pemberian ARV ialah 68 sel/ l, sedangkan median CD 4 sesudah pemberian ARV 286,5 sel/ l. Median kadar viral load sebelum ARV sebesar 1.79 log10 copy/ml, sedangkan median viral load sesudah ARV yaitu 0 log10 copy/ml. Median IMT sebelum ARV 19.6, sedangkan median sesudah 12 bulan ARV 19.72. Rerata tunika intima media arteri karotis kiri sebelum dan sesudah pemberian ARV selama 12 bulan ialah 0.58 dan 0.63 dengan p-value 0.031. Korelasi perubahan kadar CD 4 dengan ketebalan tunika intima media arteri karotis kanan r= 0.08, p=0,58 , dan kiri r= 0.01, p=0,965 . Korelasi perubahan kadar viral load dengan ketebalan tunika intima media arteri karotis kanan r= 0.09, p=0,54 dan arteri karotis kiri r= 0.06, p=0,66 . Korelasi perubahan kadar IMT dengan perubahan ketebalan tunika intima kanan r= - 0.11, p=0,37 dan kiri r= -0.18, p=0,19 .Simpulan: Ketebalan tunika intima mengalami peningkatan antara sebelum dan sesudah pengobatan antiretroviral, namun tidak didapatkan korelasi antara kadar CD4, Viral load dan indeks massa tubuh dengan ketebalan tunika intima arteri karotis. ...... Background Human immuno deficiency virus Acquired Immune Deficiency Syndrome HIV AIDS is currently a global issue related with coronary artery disease. The effects of antiretroviral ARV is accompanied with some negative features such as dyslipidemia, lipodystrophy, insulin resistance and liver dysfunction which all contribute to increasing tunima intima thickness.Objective To acquire correlation between level of CD4, viral load, and Body Mass Index BMI with changes in tunica intima of carotid artery thickness in HIV patients receiving first line ARV for 12 monthsMethods This study is a correlation study involving 54 HIV patients using secondary data from the JACCANDO PROJECT research data such as Doppler ultrasound of the carotid artery, CD4 values, viral load as well as BMI.Results Median CD before antiretroviral treatment was 68 cells l, median CD 4 after ARV 286.5 cell l. The median viral load rate before ARV was 1.79 log10 copy ml, while median viral load after ARV was 0 log10 copy ml. The median BMI before ARV was 19.6, while median after 12 months of ARV was 19.72. The mean of the left artery carotid artery intima media before and after ARV administration for 12 months was 0.58 and 0.63 with p value 0.031. Correlation of changes in CD4 levels with the thickness of tunica intima medium of right carotid artery r 0.08, p 0,58 , and left r 0.01, p 0,965 . Correlation of changes in viral load levels with the tunica thickness of the right carotid artery medium r 0.09, p 0,54 and left carotid artery r 0.06, p 0.66 . Correlation of changes in BMI levels with changes in thickness of the right tunica intima r 0.11, p 0.37 and left carotid artery r 0.18, p 0.19 .Conclusion The thickness of intima tunica increased after antiretroviral treatment, but no correlation found between CD4, viral load and BMI level with the thickness of the intima tunica carotid artery.

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Penelitian ini bertujuan untuk mengetahui pengaruh pemberian minuman teh hijau setelah konsumsi makanan tinggi lemak dalam bentuk makanan cepat saji, terhadap perubahan kadar TNFα serum sebagai penanda inflamasi postprandial dibandingkan dengan air putih. Penelitian ini merupakan studi eksperimental dengan desain cross over, alokasi acak, tersamar tunggal yang dilakukan pada individu sehat berusia 18?24 tahun di FKUI Jakarta, bulan Maret hingga April 2013. Sebanyak 20 orang menjadi subyek penelitian setelah melalui proses seleksi dan pemilihan subyek dengan simple random sampling, 1 orang subyek drop out, sehingga 19 orang subyek mengikuti penelitian hingga selesai. Data yang diperoleh meliputi usia, jenis kelamin, asupan energi dan lemak dengan metode food record 3x24 jam, serta kadar TNFα serum pada keadaan baseline dan 2 jam postprandial dengan menggunakan metode ELISA. Didapatkan sebagian besar subyek penelitian berjenis kelamin perempuan (57,9%), dengan median usia subyek adalah 20 tahun (19 ? 22 tahun). Persentase konsumsi lemak harian adalah sebesar 32,46 ± 5,2 persen lemak dan rerata asupan lemak sebesar 58,59 ± 15,21 gram per hari. Pada kedua kelompok perlakuan terdapat penurunan kadar TNFα serum postprandial yang signifikan, yaitu sebesar 15,8% dengan median -0,16 (- 0,48 ? 0,38) pg/mL pada kelompok teh hijau dan sebesar 6,9% dengan median - 0,07 (-1,02 ? 0,1) pg/mL pada kelompok air putih. Tidak didapatkan perbedaan perubahan kadar TNFα serum yang bermakna antara subyek yang diberi minuman teh hijau dengan air putih setelah pemberian makanan tinggi lemak (p=0,533).

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ABSTRACT
The objective of this study is to know the effect of green tea consumption after high fat meal on the difference (delta) of serum TNFα as the marker of postprandial inflammation, compared to water consumption. This is an experimental, randomized, single blind, cross over study on healthy adult 18?24 years of age in FKUI Jakarta, March to April 2013. Twenty people become the subjects of this study after the selection and simple random sampling process. One subject was dropped out from the study, so 19 subjects completed the study. Data collected in this study are age, sex, energy and fat intake using 3x 24 hours food record, and serum TNFα baseline and 2 hours postprandial using ELISA method. Most of the study subject are female with the percentage of 57,9%, and the median age is 20 years old (19?20 years old). Daily fat consumption of the study subjects is 32,46 ± 5,2 % , with the mean of 58,69 ± 15,21 grams fat per day. In both study group, there are significant decreasing serum TNFα level, as much as 15,8% with median -0,16 (-0,48 ? 0,38) pg/mL in green tea group and 6,9% with median -0,07 (-1,02 ? 0,1) pg/mL in water group. There is no significant difference on serum TNFα level between two groups (p=0,53

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Backgrounds : There was a two-fold increase in cardiovascular-related mortality in rheumatoid arthritis (RA). Postprandial triglyceride (PPTG) related to increased risk of ischemic heart disease, myocardial infarction, ischemic stroke, mortality and elevated level of adhesion molecules. Increased endothelial adhesion molecules was a sign of endothelial activation, an early process in the development of atherosclerotic lesion. There was no study evaluating the role of NTG in cardiovascular risk assessment in RA patients. Aim : This study observed the relationship between PPTG and sICAM-1 and sE-selectin, as markers of endothelial activation. Methods : This was a cross-sectional study of fifty consecutively-recruited RA patients. Lipid profiles, sICAM-1, and sE-selectin were measured postprandially. Further analysis using multiple regression was performed. Results : There was no correlation found between PPTG and sICAM-1, nor NTG and sE-selectin. Level of sICAM-1 was influenced by HDL (R2=0,087) while sE-selectin was influenced by DAS-28 (R2=0,174), body mass index (R2=0,125), and postprandial glucose (R2=0,138). Conclusion : PPTG did not correlated with sICAM-1 and sE-selectin in RA patients.

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Backgrounds : There was a two-fold increase in cardiovascular-related mortality in rheumatoid arthritis (RA). Postprandial triglyceride (PPTG) related to increased risk of ischemic heart disease, myocardial infarction, ischemic stroke, mortality and elevated level of adhesion molecules. Increased endothelial adhesion molecules was a sign of endothelial activation, an early process in the development of atherosclerotic lesion. There was no study evaluating the role of NTG in cardiovascular risk assessment in RA patients. Aim : This study observed the relationship between PPTG and sICAM-1 and sE-selectin, as markers of endothelial activation. Methods : This was a cross-sectional study of fifty consecutively-recruited RA patients. Lipid profiles, sICAM-1, and sE-selectin were measured postprandially. Further analysis using multiple regression was performed. Results : There was no correlation found between PPTG and sICAM-1, nor NTG and sE-selectin. Level of sICAM-1 was influenced by HDL (R2=0,087) while sE-selectin was influenced by DAS-28 (R2=0,174), body mass index (R2=0,125), and postprandial glucose (R2=0,138). Conclusion : PPTG did not correlated with sICAM-1 and sE-selectin in RA patients.

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Hipertrofi ventrikel kiri atau Left ventricle hypertrophy (LVH) adalah faktor risiko independen terjadinya gagal jantung pada pasien hipertensi. Diagnosis dini LVH diperlukan untuk mencegah kerusakan lebih lanjut pada otot jantung. Cardiotropin-1 (CT-1) diproduksi oleh kardiomiosit dan fibroblas, yang kadarnya dilaporkan meningkat pada pasien hipertensi primer. Tujuan : Membuktikan manfaat CT-1 serum untuk mendeteksi LVH pada pasien hipertensi primer. Metode : Penelitian uji diagnostik dilaksanakan di RSCM Jakarta periode Februari s/d Maret 2013. Subyek penelitian adalah 75 pasien hipertensi primer dengan atau tanpa LVH. Diagnosis LVH dilakukan dengan ekokardiografi sebagai baku emas dan elektrokardiografi/EKG (kriteria Sokolow Lyon voltage, Cornell voltage dan Cornell product). Kadar CT-1 serum diperiksa dari sampel darah vena dengan metode ELISA. Hasil : Berdasarkan ekokardiografi 46 orang (61,3%) LVH dan 29 orang (38,7%) tidak LVH. Kadar CT-1 subyek LVH adalah 82,96 ± 351,843 pg/mL dan subyek tanpa LVH 4,55 ± 1,281 pg/mL (p=0,01). Korelasi CT-1 dengan LVMI adalah tidak bermakna (p=0,1). Luas area dibawah kurva ROC CT-1 untuk diagnosis LVH adalah 0,67 (p=0,01). Nilai cut-off CT-1 adalah 4,45 pg/mL. Uji diagnostik CT-1: Sensitifitas 54,4%, spesifisitas 75,9, NDP 78,1%, NDN 51,2 dan akurasi 61,3%. Uji diagnostik kombinasi CT-1 dan EKG (salah satu kriteria positif LVH): sensitifitas 67,4%, spesifisitas 72,4% , NDP 79,5%, NDN 58,3% dan akurasi 69,3%. Simpulan. CT-1 kurang sensitif namun cukup spesifik untuk diagnosis hipertrofi ventrikel kiri (LVH). Kombinasi CT-1 dengan EKG meningkatkan nilai diagnostik pemeriksaan untuk deteksi LVH pada pasien hipertensi primer.

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Left ventricle hypertrophy (LVH) is independent risk factor of heart failure on hypertension patients. Early detection of LVH is necessary to prevent extensive damage of heart muscle. Cardiotropin-1 (CT-1) is produce by cardiomyosite and fibroblast, that the level of CT-1 has been reported increase on primary hypertension patients. Aim : To prove the benefit of CT-1 serum to detect LVH on primary hypertension patients. Methods : A diagnostic study has been conducted on RSCM Jakarta on the periode of February to March 2013. Research subjects were 75 primary hypertension patients with and without LVH. LVH diagnosis was performed by echocardiography examination as gold standard and electrocardiography/ECG (Sokolow Lyon voltage, Cornell Voltage and Cornell product criterias). CT-1 level was measured by ELISA method from vein blood sample. Results : Based on echocardiography examination 46 patients (61.3%) were diagnosed as LVH and 29 patients (38.7%) without LVH. The level of CT-1 of patients with LVH was 82.96 ± 351.843 pg/mL and 4.55 ± 1.,281 pg/mL on patients without LVH (p=0.01). Correlation between CT-1 and Left Ventricular Mass Index was not significant (p=0.1). Area under the ROC curve was 0.67 (p=0.01). The cut-off of CT-1 level for diagnosis of LVH was 4.45 pg/mL. Diagnostic test yield the sensitivity of CT-1 for diagnosis of LVH was 54.4%, specificity 75.9%, PPV 78.1%, NPV 51.2% and accuracy was 61.3%. Diagnostic test of combination CT-1 and ECG (positive LVH by one or more ECG’s criteria) yield sensitivity 67.4%, specificity 72.4% , PPV 79,5%, NPV 58.3% and accuracy 69.3%. Conclusion. CT-1 examination was not sensitive but specific for LVH diagnosis. Combination of CT-1 and ECG examination was improve diagnostic value of CT-1 for detection of LVH on primary hypertension patients.

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Latar belakang: Sindrom Koroner Akut (SKA) merupakan manifestasi penyakit jantung koroner yang dapat menyebabkan kematian mendadak. SKA kebanyakan terjadi pada usia di atas 45 tahun, Namun beberapa tahun terakhir ini angka kejadian infark miokard usia muda meningkat. Tujuan: Mengetahui perbedaan karakteristik angiografi koroner pada pasien SKA usia ≤45 tahun dengan pasien SKA usia > 45 tahun. Metode: Beratnya stenosis pembuluh darah diukur dengan Vessel Score (jumlah pembuluh darah koroner yang sakit dengan stenosis ≥ 70%) dan Stenosis Score. Hasil: Diteliti sebanyak 322 pasien SKA yang telah menjalani angiografi koroner di ICCU RSUPN Cipto Mangunkusumo Jakarta mulai Januari 2008 sampai Desember 2012. Pasien dibagi kedalam dua kelompok. Kelompok satu adalah pasien usia ≤45 tahun dan kelompok kedua pasien usia>45 tahun. Ditemukan 322 pasien SKA (72 kasus ≤45 tahun dan 250 kasus >45tahun). Distribusi jumlah pembuluh darah yang sakit (vessel score) 1 VD (single vessel diseases) terbanyak pada usia ≤ 45 tahun (43.1 % vs 26.0 % ), sedangkan 3 VD (triple vessel diseases) terbanyak pada usia > 45 tahun (31.6 % vs 18,1 %). Hasil skor stenosis menunjukkan lebih rendah pada usia ≤ 45 tahun dibandingkan usia  45 tahun (median skor stenosis 4 vs 8) dengan perbedaan yang bermakna (p<0,001). Pembuluh darah yang mengalami aterosklerosis yang terbanyak adalah Left Anterior Descending baik kelompok usia ≤ 45 tahun dan usia  45 tahun (65.3% and 74.0%). Pembuluh darah Left Circumflex dan Right Coronary Artery lebih sedikit pada usia ≤ 45 tahun dan bermakna secara statistik (26,4% dan 31,9% vs 46,4% dan 57,2%, p=0,002 dan 0,001). Simpulan: Jumlah pembuluh darah koroner yang sakit (vessel score) dan skor stenosis lebih kecil pada usia ≤ 45 tahun dibanding usia > 45 tahun

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Background: Acute Coronary Syndrome (ACS) is the manifestation of coronary heart disease which can cause sudden death. ACS mostly occurs at the age > 45 years, but recently the incidence of myocardial infarction increases in yong ages. Objective: To determine compared between coronary angiography of acute coronary syndrome patients age ≤ 45 years with acute coronary syndrome patients age > 45 years. Methods: The severety of coronary stenosis was determined by Vessel score and Coronary score. Significant vessel score was defined as stenosis of angiography of more or equal to 70% lumen stenosis by eyeball examination Results :A total of 322 ACS patients who undergone coronary angiography in ICCU Cipto Mangunkusumo from January 2008 to December 2012. Patients were divided into two groups. One patient group is less or equal to the age of 45 years (72 cases) and the second group of patients over the age of 45 years (250 cases). Distribution of number of blood vessels disease 1 VD (single vessel diseases) highest in the age group ≤ 45 years (43.1 % vs 26.0 % ), while 3 VD (triple vessel diseases) highest in the age group > 45 years (31.6 % vs 18,1 %). stenosis score was lower at age ≤ 45 years to compare age > 45 years (median stenosis score 4 vs 8) with statistical significant difference (p < 0.001 ). The Left Anterior Descending Artery significant lesion was found high at the both age groups (65.3% and 74.0%). But the significant stenosis lesion was less found in Left Circumflex and Right Coronary Artery at the age ≤ 45 years (26,4% and 31,9% vs 46,4% and 57,2%, p=0,002 and 0,001). Conclusion :The number of coronary arteries diseases (Vessel score) and Stenosis score is lower at the age ≤ 45 years compared to patients age > 45 years.

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Latar Belakang: Penurunan tekanan pada kabin pesawat dapat mencetuskan gejala hipoksia pada penderita Penyakit Paru Obstruktif Kronik (PPOK). Saat ini belum ada laporan mengenai profil gejala hipoksia saat penerbangan dan gambaran penilaian kelaikan terbang berdasarkan kemungkinan kejadian hipoksia saat penerbangan pada jemaah haji dengan PPOK. Tujuan: Mengetahui profil pasien PPOK yang mengalami gejala hipoksia saat penerbangan dan penilaian kelaikan terbang tanpa menggunakan oksigen berdasarkan fungsi faal paru, saturasi oksigen dan aktifitas berjalan lebih dari 50 meter pada jemaah haji dengan PPOK. Metode: Studi kohort prospektif yang dilakukan pada jemaah haji Embarkasi Jakarta dengan PPOK saat pelaksanaan ibadah haji tahun 2011. Hasil: Pada studi ini didapatkan 36 subyek jemaah haji dengan PPOK. Pada penilaian pra-keberangkatan didapatkan 33 subyek yang dinilai laik terbang tanpa menggunakan oksigen. Saat penerbangan didapatkan tiga subyek mengalami gejala hipoksia. Dua orang berasal dari kelompok yang dinilai laik terbang tanpa menggunakan oksigen dan satu orang dari kelompok yang dinilai laik terbang dengan menggunakan oksigen. Karakterisitik subyek yang mengalami gejala hipoksia didapatkan pada perokok aktif (10,5%), tidak terdiagnosis PPOK sebelumnya (8,8%), PPOK derajat sedang (9,5%), usia lebih dari 60 tahun (5,3%) dan adanya komorbiditas (4,2%). Kesimpulan: Sebagian besar penderita PPOK dapat melakukan penerbangan tanpa menggunakan oksigen.

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Background: The decreased pressure in aircraft cabins may cause hypoxia symptoms in patients with Chronic Obstructive Pulmonary Disease (COPD). Currently, there is no publication known to have reported the profile in-flight hypoxia symptoms and pre-flight medical screening to predict the need for oxygen supplementation in COPD pilgrims. Objective: To obtain profile of in-flight hypoxia and pre-flight assessment for fitness to fly without oxygen supplementation based on pulmonary function test, oxygen saturation, and the ability to walk more than 50 meters among pilgrims with COPD. Methods: This is a cohort-prospective study which was conducted during pilgrimage season during hajj year of 2011. Results: Thirty three COPD patients were identified and subsequently recruited to this study. Pre-flight medical assesment concluded that 33 subject were fit to fly without supplemental oxygen. Nevertheless, three subject developed in-flight hypoxia symptoms i.e. two of them were fit to fly without supplemental oxygen, while another subject was recommended to have supplemental oxygen. Characteristics of subjects with in-flight hypoxia were as follows: (10.5%) current smokers, (8.8%) not known to have COPD prior to health examination, (9.5%) moderate COPD category, (5,3%) above 60 years of age, and (4,2%) with comorbidity. Conclusion: Most pilgrims with COPD were fit to fly without oxygen supplementation.

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Latar belakang Pada pasien diabetes melitus (DM) dengan penyakit jantung koroner 3 pembuluh darah (PJK 3PD) hasil revaskularisasi akan lebih baik dengan bedah pintas koroner (BPK) dibanding intervensi koroner perkutan (IKP) atau medikamentosa. BPK tidak selalu menjadi prosedur yang dikerjakan meskipun sudah direkomendasikan sesuai Skor Syntax, dan tidak semua pasien bersedia menjalani BPK atau IKP. Perlu diketahui apakah pilihan revaskularisasi tersebut mempengaruhi kesintasan 5 tahun. Tujuan Mengetahui perbedaan kesintasan 5 tahun pasien PJK 3PD DM yang menjalani bedah pintas koroner (BPK), intervensi koroner perkutan (IKP), dan medikamentosa di RSCM. Metode Penelitian ini merupakan studi kohort retrospektif dengan pendekatan analisis kesintasan untuk meneliti kesintasan 5 tahun pasien PJK 3PD DM yang menjalani tindakan BPK, IKP, atau medikamentosa. Penelitian dilakukan dengan menggunakan data sekunder 126 pasien PJK 3PD DM yang menjalani BPK, IKP, maupun medikamentosa di RS Cipto Mangunkusumo (RSCM) pada tahun 2006-2007 dan diikuti sampai dengan tahun 2011-2012 dengan dilihat adakah kejadian meninggal. Hasil Kesintasan terbaik pada kelompok BPK (93.5%). Proporsi kematian terbesar pada kelompok medikamentosa (36.1%). Kesintasan BPK paling baik secara bermakna dibandingkan IKP dan Medikamentosa. Kelompok IKP memiliki kesintasan yang lebih baik dibanding medikamentosa (69.5% vs 63.9%). Meskipun tidak bermakna secara statistik, namun pada kelompok IKP proporsi keluhan yang ditemukan setelah tindakan lebih sedikit dibanding kelompok medikamentosa (52% vs 38%). Skor Syntax yang berperan menilai kompleksitas stenosis ikut menentukan kesintasan (p 0,039). Kesimpulan Kesintasan 5 tahun pasien PJK 3PD dengan DM yang paling baik didapatkan pada kelompok yang menjalani Bedah Pintas Koroner. Kesintasan 5 tahun pasien PJK 3PD dengan DM yang menjalani IKP lebih baik dibanding Medikamentosa namun secara statistik tidak bermakna. Faktor yang berpengaruh pada kesintasan 5 tahun pasien PJK 3PD adalah kompleksitas stenosis yang dilihat dengan menggunakan skor Syntax.

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ABSTRACT
Background In patients with diabetes mellitus (DM) with coronary artery disease involving 3 vessels (CAD 3VD) revascularization results will be better with coronary artery bypass surgery (CABG) compared with percutaneous coronary intervention (PCI) or medical therapy. CABG is not always done despite being recommended in accordance with Syntax Score, and some patients prefer not to go through CABG or PCI . This trial determined whether the choice of revascularization affect 5-years survival. Objectives Knowing the difference in 5-years survival of CAD 3VD DM patients who underwent coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI) or medical therapy at Cipto Mangunkusumo Hospital. Methods This study was a retrospective cohort study with survival analysis approach to examine the 5-years survival rate of CAD 3VD DM patients undergoing CABG, PCI, or medical therapy. The study was conducted using secondary data of 126 CAD 3VD DM patients who underwent CABG, PCI, or medical therapy at Cipto Mangunkusumo Hospital in 2006-2007 and followed up to 2011-2012 if there any incident died. Results Best survival in the CABG group (93.5%). The largest proportion of deaths in the medical therapy group (36.1%). The CABG survival was significantly better than the IKP (p=0.01) and medical therapy (p=0.001). PCI group had better survival than medical therapy (69.5% vs. 63.9%). Although not statistically significant, but the proportion of complaints after revascularization in PCI group were found less than medical therapy group (52% vs. 38%). Syntax score that assesses the complexity of stenosis had a significant association with survival (p 0.039). Conclusion 5-years survival of CAD 3VD DM patients is best obtained in the group that underwent CABG. 5-year survival of CAD 3VD DM patients who underwent PCI better than medical therapy but was not statistically significant. Factor that affect the 5-years survival is the complexity stenosis viewed by the Syntax score.

Abstrak :
Transplantasi ginjal dapat memperbaiki fungsi jantung Penelitianeksperimental pada binatang membuktikan bahwa peningkatan kadar hormoneritropoetin memperbaiki fungsi jantung namun secara klinis masih menjadi bahanperdebatan Tujuan: Untuk menilai hubungan peningkatan kadar eritropoetin dengan perbaikanfungsi jantung pada pasien gagal ginjal yang menjalani transplantasi Metoda: Penelitian Kohor prospektif pada pasien gagal ginjal yang menjalanitransplantasi di RSCM Jumlah subyek 21 orang yang dikumpulkan dalam kurunwaktu Maret September 2013 Pengambilan data ekokardiografi dan kadareritropoetin dilakukan sebelum dan 3 bulan sesudah transplantasi ginjal Analisisstatistik dengan uji korelasi Pearson atau Spearman Hasil: Penelitian ini menunjukkan peningkatan bermakna kadar eritropoetin 7 58 2 56 mlU ml menjadi 18 1 6 4 mlU ml Terdapat hubungan peningkatan kadareritropoetin dengan LVEDD r 0 56 p0 05 Kesimpulan: Terdapat hubungan peningkatan kadar eritropoetin dengan perbaikanLVH LVEDD pada pasien gagal ginjal yang menjalani transplantasi Tidak ada hubungan peningkatan kadar eritropoetin dengan perbaikan LVEF ......Kidney transplantation improved cardiac function Based on animaltrials elevated levels of erythropoietin hormone can improved cardiac function butin clinically still debate Aim: To determine association between elevated levels of erythropoietin andimprovement cardiac function on renal failure who underwent transplantation Methods: Prospective cohort study on renal failure who underwent kidneytransplantation at Cipto Mangunkusumo Hospital The study include 21 subjects whocollected it from Marct to September 2013 Data of echocardiography anderythropoietin level were collected at time prior to kidney transplantation and repeat 3months there after The association between elevated levels of erythropoietin andcardiac function was analyzed using Pearson correlation and Spearman test Results: The study showed a significantly elevated levels of erythropoietin from7 58 2 56 to 18 1 6 4 mlU ml There was statistically significant association between elevated levels of erythropoietin and LVEDD r 0 56 p Conclusions: There was association elevated levels of erythropoietin and improvement of LVH, LVEDD on renal failure who underwent transplantation, however, there was no association of elevated levels of erythropoietin level and improvement of LVEF.

Abstrak :
Latar Belakang: Peningkatan kadar high sensitivity C-reactive protein ( hsCRP ) dan kekakuan arteri berhubungan dengan peningkatan insiden kejadian kardiovaskular dan peningkatan mortalitas akibat penyakit jantung koroner pada pasien diabetes melitus tipe 2. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara kadar hsCRP dan kekakuan arteri pada pasien diabetes melitus tipe 2. Metode : Melalui studi cross-sectional, dilakukan pemeriksaan kadar hsCRP dan derajat kekakuan arteri karotis pada 40 pasien dengan diabetes melitus tipe 2. Kekakuan arteri karotis kommunis diperiksa dengan doppler echotracking system untuk menentukan pulse wave velocity (PWV) atau kekakuan arteri karotis lokal (carotid-PWV). Hasil : Nilai median hsCRP pada penelitian ini adalah 4,5 (0,2 - 18,9) mg/L dan nilai rata-rata kekakuan arteri karotis adalah 8,8 ±1,7 m/detik. hsCRP berkorelasi kuat dengan karotid-PWV (r = 0,503, P = 0,001). Korelasi hsCRP dengan karotid-PWV ini tetap terlihat setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure (r = 0,450, P = 0,005). Kesimpulan : Setelah dilakukan koreksi terhadap umur, indeks masa tubuh dan mean arterial pressure, hsCRP berkorelasi positif cukup kuat dengan kekakuan arteri pada pasien diabetes melitus tipe 2. ......Background: The elevated level of high-sensitivity C-reactive protein (hsCRP) and arterial stiffness are associated with higher incidences of cardiovascular events and with increased mortality from coronary heart disease in type 2 diabetic patients. Aim: The aim of this study was to investigate the relationship between hsCRP and arterial stiffness in type 2 diabetic patients. Methods: A cross-sectional study was conducted to assess the plasma levels of high sensitive C-reactive protein and carotid arterial stiffness among 40 patients with type 2 diabetes mellitus. The common carotid artery was studied by a doppler echotracking system to determine the local carotid pulse wave velocity (carotid-PWV). Results: The median value of hsCRP in this study was 4.5 (0.2 to 18.9) mg/L and the average value of local carotid stiffness was 8.8 ± 1.7 m/sec. hsCRP showed a strong correlation with carotid-PWV (r = 0.503, P = 0.001). Levels of hsCRP were independently associated with carotid-PWV after adjusting for age, body mass index, and mean arterial pressure (r = 0,450, P = 0,005). Conclusion: After adjusting for age, body mass index, and mean arterial pressure, hsCRP was strongly positively correlated with arterial stiffness in patients with type 2 diabets mellitus.