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"ABSTRACTAtrial septal defect is one of the most common forms of congenital heart disease. Although various M-mode and two-dimensional echocardiographic characteristics of atrial septal defect have been described, these criteria lack sensitivity and specificity. By allowing visualization of blood flow, the demonstration of right-toleft or left-to-right shunting is possible with contrast echocardiography(11-16). The purpose of the first part of this study was to verify the utility of this technique for evaluating patients with atrial septal defect.We observed that contrast echocardiographic shunts may persist long after closure of an atrial septal defect. The aim of the second part of' this study was to determine whether this indicates unsuccessful repair or a hemodynamically important residual shunt.Peripheral venous injection of echocardiographic contrast allows the visualization of blood flow through the right sided cardiac cavities. The purpose of the third part of the study was to determine whether the technique may aid to the diagnosis of some right heart abnormalities by the demonstration of specific blood flow patterns.The patterns of echo contrast appearance in the inferior vena cava after upper extremity injection may be related to right heart hemodynamics(17,18). The purpose of the fourth part of the study was to determine the utility of contrast echocardiography of the inferior vena cava for the assessment of right heart hemodynamics. Since the technique can be used to detect tricuspid regurgitation( 9-21), we also studied whether estimation of its severity is possible,. because this would have important therapeutic and prognostic implications.An intriguing potential .future application of contrast echocardiography is the study of myocardial perfusion. The technique would offer many advantages over the other imaging modalities such as radionuclide techniques, contrast-enhanced computerized transmission tomography, positron emission tomography and nuclear magnetic resonance. Contrast echocardiographic. myocardial perfusion imaging would have a good spatial and temporal resolution and allows direct and simultaneous assessment of both the perfusion and function of the myocardium. It is also much less expensive. However, a good and safe echocardiographic contrast agent for such application in humans is not yet available. "

"ABSTRAKLatar Belakang. Media kontras dapat memberikan efek toksik pada sel tubulus ginjal, menyebabkan suatu kondisi dinamakan contrast induced nephropathy (CIN), yang berhubungan dengan peningkatan morbiditas dan mortalitas, dan memiliki efek yang sama pada pasien dengan gagal ginjal kronik maupun pasien risiko rendah (Laju Filtrasi Glomerolus (LFG) ≥ 60, skor Mehran sebelum tindakan ≤ 5). Dari beberapa penelitian mengenai rasio volume kontras dengan laju filtrasi glomerulus (V/LFG) untuk memprediksi CIN belum ada yang dikhususkan untuk pasien risiko rendah.Metodologi. Penelitian ini merupakan studi potong lintang yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular FKUI/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) dengan mengambil data dari rekam medis dan ruang kateterisasi. Durasi data yang diambil adalah Agustus 2015 - April 2016. Hasil penelitian dianalisis dengan prosedur Receiver Operating Characteristic (ROC) dari rasio V/LFG. Akan dianalisis nilai Area Under Curve dan mencari titik potong yang direkomendasikan sebagai nilai prediktor optimal dengan sensitivitas dan spesifisitas yang terukur.Hasil. Dari 223 data yang terkumpul lengkap dan sesuai dengan kriteria inklusi dan eksklusi didapatkan jumlah pasien yang mengalami CIN adalah sebesar 11 pasien (4,9%). Didapatkan perbedaan bermakna pada kedua jenis kelompok yaitu pada variabel jenis tindakan (P = 0,04), volume kontras (P = 0,02), dan rasio V/LFG (P = 0,032). Dari kurva ROC didapatkan bahwa rasio V/LFG mempunyai nilai AUC 0,69 (IK 95% 0,53 - 0,86). Dari kurva ROC ditentukan nilai potong yang bermakna dari rasio V/LFG ≥ 1,0 (Sensitifitas 55%, Spesifisitas 78%, Akurasi 77%, Nilai Prediksi Positif 12%, Nilai Prediksi Negatif 97%, P = 0,022). Dengan menggunakan rasio V/LFG ≥ 1 didapatkan insidensi CIN adalah 12% dibandingkan 3% pada pasien dengan V/LFG < 1 (OR 4,33; IK 95% 1,27 - 14, 83); P = 0,022).Kesimpulan. Rasio V/LFG ≥ 1,0 dapat memprediksi kejadian CIN pada pasien risiko rendah yang menjalani tindakan angiografi atau intervensi koroner perkutan elektif

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ABSTRACT

Background: Contrast media could give toxic effect to renal tubulus, creatining a condition named contrast induced nephropathy (CIN) and is associated with increased morbidity and mortality, and has the same effect in patient with chronic kidney disease or in low risk patients (estimated Glomerolus Filtration Rate (eGFR) ≥ 60, Mehran Score before procedure ≤ 5). From several studies concerning ratio of contrast volume to creatinine clearance (V/CrCl) to predict CIN, there were not any study yet focusing in low risk patients.

Methods: This is a cross-sectional study conducted in Cardiology and Vascular Medicine Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita (NCCHK). The data were retrieved from medical records and catheterization room, since August 2015 -- April 2016. Receiver Operating Characteristic (ROC) is used to analyze the data, and by using Area Under Curve will gives the optimal cut-off for contrast volume to creatinine clearance ratio with measured sensitivity and specificity.

Results: From 223 patients the incidence of CIN is 11 patients (4,9%). There is a significant difference from both groups in types of procedure (P = 0,04), contrast volume (P = 0,02), and V/CrCl ratio (P = 0,032). From ROC curve we found that V/CrCl ratio have an AUC 0,69 (CI 95% 0,53 - 0,86). From ROC curve the significant cut-off ratio of V/CrCl is ≥ 1,0 (Sensitifity 55%, Specificity 78%, Accuracy 77%, Positive Predictive Value 12%, Negative Predictive Value 97%, P = 0,022). Using V/CrCl ratio ≥ 1,0 the incidence of CIN is 12%, compared to 3% in patients with V/LFG < 1,0 (odds ratio 4,33; CI 95% 1,27 - 14, 83); P = 0,022).

Conclusions: V/CrCl ratio ≥ 1,0 could predict CIN in low risk patients undergoing angiography or percutaneous coronary intervention."

"The main target of clinical and academic cardiology activities is to optimize the patient's management and ultimately their welfare. Professionals manage patients according to their own understanding of disease process; clinicians concentrate on alleviating the symptoms and echocardiographers on identifying the disease. This book helps to 'cross the barrier' and describes the common ground between physiologic disturbances and their management which should ideally form the shared basis for understanding and managing all cardiac problems.A practical review of the many uses of echocardiography in clinical practice, Clinical Echocardiography is designed to integrate and refine the investigation of cardiac disorders within the framework of the pathologic, physiologic and surgical appearances of heart disease. It has been common to consider echocardiographic findings separately from the more physical aspects of heart disease. However, with the development of new imaging modalities such as three- and four-dimensional echocardiography, it has become necessary to consider this imaging as a window on the heart. "

"SBRT adalah salah satu metode dalam radioterapi dengan menggunakan fraksi yang sedikit namun memiliki efek samping berpotensi menghasilkan wilayah hostpsot. Diusulkan volume target baru, yaitu Definie Target Volume (DTV). DTV memiliki probabilitas tinggi dimana jaringan target berada. DTV ditentukan melalui probabilitas okupansi dan kontraksi margin. DTV akan menjadi target prioritas dan PTV-crop diberlakukan seperti PTV pada perencanaan klinis. Optimisasi DTV dilakukan dengan eksplorasi dosis secara maksimum namun dengan membatasi dosis ke bagian OAR. Berdasarkan perencanaan, pada volume DTV kasus HCC, peningkatan 𝐷𝑚𝑎𝑥 tertinggi mencapai 187,3% dengan rata-ratanya 124,98% ± 29,02%. Untuk volume PTV-crop, rata-rata peningkatan 𝐷𝑚𝑒𝑎𝑛 adalah 103,84% ± 4,69%. Peningkatan 𝐷𝑚𝑎𝑥-DTV kasus serviks mencapai 138,49% dan rata-ratanya 116,80% ± 13,19%. Pada PTV-crop, rata-rata peningkatan 𝐷𝑚𝑒𝑎𝑛 serviks 101,89% ± 5,58%. Pemberian dosis yang besar pada target DTV akan berkaitan dengan peningkatan pada OAR. Peningkatan dosis OAR-HCC sebesar 106,93% ± 5,57% dan OAR-serviks sebesar 101,18% ± 1,87%. Hasil penelitian ini didapatkan dosis pada target DTV mengalami peningkatan yang cukup tinggi namun target PTV-crop mempunyai peningkatan dosis yang masih sesuai dalam standar untuk klinis. Selain itu OAR sekitar target meskipun dosis rata-ratanya meningkat, namun tidak terlalu signifikan dan masih dibawah konstrain.

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SBRT is a method in radiotherapy using a small fraction but has side effects that have the potential to produce a host site. A new target volume is proposed, namely the Define Target Volume (DTV). DTV has a high probability of where the target network is. DTV is determined through the probability of occupancy and the contraction margin. DTV will be a priority target and PTV-crop is treated like PTV in clinical planning. Optimization of DTV is carried out by exploring the maximum dose but by limiting the dose to the OAR. Based on the plan, on the DTV volume of HCC cases, the highest 𝐷𝑚𝑎𝑥 reached 187.3% with an average of 124.98% ± 29.02%. For PTV-crop volume, the average 𝐷𝑚𝑒𝑎𝑛 increase to 103.84% ± 4.69%. The dose escalation in 𝐷𝑚𝑎𝑥-DTV for cervical cases reached 138.49% and the average was 116.80% ± 13.19%. In the PTV-crop, the average escalation in cervical 𝐷𝑚𝑒𝑎𝑛 was 101.89% ± 5.58%. Prescription of large doses to target DTV will be associated with an increase in OAR. The increase in the dose of OAR-HCC was 106.93% ± 5.57% and OAR-cervix was 101.18% ± 1.87%. The results of this study obtained that the dose on the DTV target had increased quite high, but the PTV-crop target had an increased dose that was still according to clinical standards. In addition, the OAR is around the target, although the average dose has increased, it is not very significant and is still under constraints."

"Latar belakang: Metode loop-mediated isothermal amplification (LAMP) merupakan metode sederhana yang dapat mengamplifikasi DNA/RNA menggunakan empat sampai dengan enam primer dalam bentuk ?pasangan? dari sekuens conserved gen. Penelitian ini bertujuan untuk mengoptimasi LAMP dalam menegakkan diagnosis kasus TB di Indonesia.Metode: Setelah uji optimasi, metode LAMP kemudian diujikan pada 122 DNA Mycobacterium tuberculosis (Mtb) sampel tersimpan, yang merupakan spesimen sputum pasien TB dengan BTA positif yang dikumpulkan dari 13 provinsi di Indonesia pada tahun 2008 untuk studi genotipe dan merupakan koleksi Pusat Biomedis dan Teknologi Dasar Kesehatan (PBTDK), Balitbangkes. Uji optimasi meliputi uji sensitifitas dan uji spesifisitas sejumlah pasangan primer LAMP terhadap larutan serial DNA Mtb H37Rv dan 12 spesies Mycobacteria. Uji LAMP dilakukan menggunakan tiga jenis instrumen yaitu LAMP turbidemeter, pelat pemanas dan penangas air. Hasil pengujian beberapa pasang primer dan instrument ini kemudian diterapkan untuk uji LAMP pada isolat spesimen klinik Indonesia, yaitu menggunakan pasangan primer dari gen gyrB, Hasil amplifikasi dideteksi dengan lampu UV.Hasil: Uji sensitivitas menunjukkan bahwa pasangan primer gen 16S rRNA dan gyrB memberikan hasil terbaik yaitu mampu mendeteksi 10.0 fg - 1.0 pg genomik DNA Mtb H37Rv. Uji spesifisitas menunjukkan bahwa pasangan primer gen gyrB merupakan pasangan primer paling spesifik. Hasil pengujian pasangan primer gyrB pada isolat klinis Indonesia didapatkan positivity rate 94,2% (114/121).Kesimpulan: Metode LAMP berpotensi untuk digunakan dalam diagnosis kasus TB di Indonesia.

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AbstractBackground: Loop-mediated isothermal amplification (LAMP) is a method already claimed as a simple technique to amplify DNA/ RNA using four to six primers as ?a set? from conserved sequence of target gene. In this study we optimize the use of LAMP for detection of Mycobacterium tuberculosis in clinical isolates from Indonesia.Methods: Procedures to perform LAMP were optimized, then the method was applied to 122 archieved samples of DNA?s Mtb from clinical TB patients with Acid Fast Bacilli (AFB) smears positive. The samples were obtained in 2008 from 13 provinces in Indonesia for genotyping study, which then become collections of Center for Biomedical and Basic Technology of Health (CBBTH), NIHRD Indonesia. The optimization tests include sensitivity and specificity tests of several sets primers, which were evaluated using 10-fold serially diluted DNA of Mtb H37Rv and 12 species of Mycobacteria. Three equipments consisted of LAMP turbidimeter, heating block and water bath were compared for its ability in DNA amplification. Detection of M. tuberculosis from clinical isolates used set primers specific for gyrB gene, amplicon was detected with UV fluorescence system.Results: The results showed that the highest sensitivity was obtained using the set primers specific for 16S rRNA and gyrB which could detect 10.0 fg to 1.0 pg genomic DNA of Mtb H37Rv. The set primers specific for gyrB gene was the most specific primers. Application of LAMP using gyrB set primers on Indonesian clinical isolates showed 94.2% (114/121) positivity rate.Conclusion: LAMP method is potentially used in TB diagnosis in Indonesia."

"Laboratory Medicine is an essential text for medical students and residents studying clinical pathology, medical technology students, and for practitioners working in a clinical setting. By selecting the appropriate tests and interpreting the results correctly, physicians using this book should be able to optimize patient outcomes and reduce the cost of achieving a diagnosis.This full-color guide features an easy-to-follow, consistent presentation for each disease discussed. Chapters begin with a brief description of the disorder followed by a discussion that includes tables detailing the laboratory evaluation of specific disorders, and coverage of diagnosis, baseline tests to exclude diagnostic possibilities, and clinical indications thatwarrant further screening and special testing."

"Tujuan: Mengetahui efek pemberian suplemen vitamin A penderita DVA dalam meningkatkan fungsi sensitivitas kontras, pemeriksaan sensitivitas kontras dapat menjadi alat deteksi penderita DVA dan perbedaan dosis vitamin A mengakibatkan peningkatan fungsi sensitivitas kontras.Metode: Merupakan penelitian uji klinis tersamar ganda pada anak usia 6-9 tahun yang sudah dapat membaca di desa Suwug Kecamatan Sawan Kabupaten Buleleng,, Bali. Pengambilan subyek penelitian berdasarkan kadar vitamin A serum yang menurun (0,35-<0,70 µmol/lt) dan pemeriksaan sensitivitas kontras (<1,75 log unit). Pemberian suplemen vitamin A dibagi menjadi 2 kelompok yaitu dosis 200.000 IU dan 100.000 IU pada hari 1,2,14. Evaluasi kadar serum vitamin A dilakukan pada hari ke-21 dan sensitivitas kontras pada hari ke-8,9, dan 21.Hasil: Sejumlah 36 (19%) anak dari 190 anak SD menderita DVA subklinis dengan sensitivitas kontras menurun. Pemeriksaan sensitivitas kontras sangat sensitive untuk diagnosa DVA subklinis (100%) terapi tidak begitu spesifik (80,5%). Didapatkan hubungan yang bermakna (p=0,00) antara sensitivitas kontras dengan kadar serum vitamin A dan didapatkan hubungan korelasi yang positif. Efek suplemen vitamin A terhadap kadar serum vitamin A dan sensitivitas kontras bermakna (p=0,00) dan tidak didapatkan perbedaan percepatan peningkatan fungsi sensitivitas kontras antar dua kelompok (p<0,05).Kesimpulan: Pemberian suplemen vitamin A dapat meningkatkan fungsi sensitivitas kontras, dengan dosis 100.000 IU sudah mencukupi terapi penderita DVA subklinis. Pemeriksaan sensitivitas kontras merupakan alat yang sensitif untuk menditeksi DVA subkluus.

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Purpose: To evaluate the effect of vitamin A supplementation in increasing contrast sensitivity function of vitamin A deficiency patients. Contrast sensitivity examination can be used as a tool to detect vitamin A deficiency and the vitamin A dose variation can accelerate of sensitivity contrast function increase.Method: The study is double blind clinical trial conducted in elementary school able to read students, aged between 6-9 years old in Suwug village, Sawan, Buleleng, district of Bali. Subject were collected based upon decreased of vitamin A serum level (0,35-<0,70 µmol/lt) and decrease function of contrast sensitivity (<1,75 log unit). The intervention of vitamin A supplementation is divided into 2 doses, 200.000 IU and 100,000 IU in day 1,2 and 14. On day 21 vitamin A serum level were evaluated and contrast sensitivity on day 8.9.21.Result: Thirty six (19%) students from 190 were detected to be subclinical vitamin A deficiency with decreasing contrast sensitivity function. Contrast sensitivity is very sensitive to diagnose subclinical vitamin A deficiency (100%) but quite sensitive (80,5%). There was positive significant correlation (p=0,00) between contrast sensitivity with vitamin A serum level. The effects of vitamin A supplementation on vitamin A serum level and contrast sensitivity were significant (p=0,00). There were no difference in acceleration of contrast sensitivity increase between two groups (p<0.05).Conclusion: Vitamin A supplementation may increase contrast sensitivity function with 100.000 IU dose is enough for subclinical vitamin A deficiency therapy. Contrast sensitivity examination is a sensitive tool to detect subclinical vitamin A deficiency patients."