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"Kondisi hipertiroidisme berkorelasi dengan kejadian atherosclerosis cardiovascular disease (ASCVD). Hal ini dapat terjadi melalui jalur resistensi insulin, metabolisme lipid, dan inflamasi yang dapat menyebabkan disfungsi endotel. Sebaliknya, pemberian obat antitiroid seperti propiltiourasil (PTU) atau metimazol memiliki potensi untuk memperbaiki disfungsi endotel yang terjadi. PTU memiliki keunggulan dibandingkan metimazol dalam hal menghambat migrasi dan proliferasi otot polos vaskular. Studi ini bertujuan untuk mempelajari peran hormon tiroid dan pengobatannya pada pasien Graves terhadap penanda dini aterosklerosis.Studi ini merupakan uji klinis tersamar tunggal yang dilakukan di RSUPN Dr. Cipto Mangunkusumo (RSCM) pada pasien Graves baru yang diberikan PTU atau metimazol selama 3 bulan. Kedua kelompok diperiksakan HOMA-IR,LDL-R, NF-kB, sICAM-1, sVCAM-1 dan sE-selektin serta pulse wave velocity (PWV) dan carotid intima media thickness (cIMT) saat sebelum terapi, setelah terapi 1 bulan dan 3 bulan. Dilakukan uji Pearson atau Spearman untuk menilai korelasi antar variabel. Perubahan variabel dalam 3 bulan dinilai dengan uji repeated ANOVA. Perbedaan pada kelompok PTU dan metimazol dinilai dengan uji general linear model.Selama bulan Juli 2019 hingga Agustus 2020, didapatkan 36 pasien Graves baru. Pada uji korelasi didapatkan konsentrasi T4 bebas berkorelasi dengan sICAM-1(r = 0,41; p = 0,013) dan sVCAM-1 (r = 0,458; p = 0,005), begitu juga T3 total berkorelasi dengan sICAM-1 (r = 0,513; p = 0,001) dan sVCAM-1 (r = 0,567;p < 0,001). Pada tindak lanjut 3 bulan, didapatkan 24 subjek (13 kelompok PTU dan 11 kelompok metimazol) yang menyelesaikan pemeriksaan dan mencapai eutiroid. Pada kelompok PTU, didapatkan penurunan LDL-R (p = 0,017),sICAM-1 (p = 0,001), sVCAM-1 (p < 0,001) dan sE-selektin (p = 0,045). Pada kelompok metimazol terjadi penurunan hanya pada LDL-R (p = 0,011) dan sVCAM-1 (p = 0,001). Namun pada perbandingan kedua kelompok tidak berbeda bermakna. Parameter PWV dan cIMT juga tidak berbeda bermakna.Simpulan: Pada penelitian ini kondisi hipertiroid pasien Graves berkorelasi dengan peningkatan sICAM-1 dan sVCAM-1 sebagai penyebab aterosklerosis. Pemberian obat antitiroid dapat menurunkan LDL-R, sICAM-1, sVCAM-1 dan sE-selektin. PTU memiliki mekanisme yang berbeda dari metimazol dalam patofisiologi aterosklerosis. Akan tetapi, belum didapatkan bukti pada perubahan PWV dan cIMT

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Hyperthyroidism is correlated with atherosclerosis cardiovascular disease (ASCVD). The basic mechanisms are through insulin resistance, lipid metabolism, and inflammation resulted in endothelial dysfunction. On the other hand, antithyroid drugs such as propiltiourasil (PTU) or methimazole have the potential to improve the endothelial dysfunction. PTU is believed to have a better profile than methimazole in reducing smooth muscle cells migration and proliferation. This study aims to investigate the effect of thyroid hormone and its treatment in Graves’ disease to early marker of atherosclerosis.

This study is a single-blinded clinical trial conducted in dr. Cipto Mangunkusumo General Hospital (RSCM) to newly diagnosed Graves’ patient treated with PTU or methimazole for 3 months. Both groups were examined for LDL-R, NF-ĸB, sICAM-1, sVCAM-1, sE-selectin, pulse wave velocity (PWV) and carotid intima media thickness (cIMT) at baseline, after 1 month and 3 months treatment. Pearson or Spearman test was done to analyze correlation between tested variables. Repeated ANOVA test was done to analyze the changes in those variables during 3 months treatment. Difference between PTU and methimazole groups was analyzed with general linear model test.

From July 2019 to August 2020, 36 newly diagnosed Graves’ patients were included in the study. Correlation test showed free T4 concentration correlated to sICAM-1 (r = 0.41; p = 0.013) and sVCAM-1 (r = 0.458; p = 0.005), and total T3 also correlated to sICAM-1 (r = 0.513; p = 0.001) and sVCAM-1 (r = 0.567; p < 0.001). After 3 months follow up, 24 subjects (13 from PTU group and 11 from methimazole group) reached euthyroid state and included in the analysis. In PTU group, we found reduction in LDL-R (p = 0.017), sICAM-1 (p = 0.001),

sVCAM-1 (p < 0.001) and sE-selectin (p = 0.045). While in methimazole groups, we only found reduction in LDL-R (p = 0.011) and sVCAM-1 (p = 0.001). However, after comparing both groups, the differences were not statistically significant. We found no significant changes in PWV and cIMT parameter.

In conclusions, this study found that hyperthyroidism in Graves’ patient correlated with increase in sICAM-1 and sVCAM-1, which are the early markers of atherosclerosis. Antithyroid drugs can lower LDL-R, sICAM-1, sVCAM-1 and sE-selectin. PTU had a different mechanism in pathophysiology of atherosclerosis compared to methimazole. However, we found no evidence in PWV and cIMT changes"

"Latar Belakang: Penyakit vaskular aterosklerotik merupakan penyebab penting morbiditas dan mortalitas pasien penyakit ginjal kronik PGK, terutama penyakit ginjal tahap akhir PGTA yang menjalani dialisis. Perbedaan potensial antara tindakan hemodilisis HD dengan Continuous Ambulatory Peritoneal Dialysis CAPD dapat memberi efek berbeda terhadap faktor risiko penyakit kardiovaskular PKV dan dalam mempengaruhi timbulnya PKV. Salah satu faktor yang mendorong timbulnya PKV pada pasien PGTA ialah retensi produk toksin uremik, di antaranya Beta-2 mikroglobulin b2M yang dihubungkan secara independen dan bermakna dengan PKV pada pasien aterosklerosis asimtomatik. Ketebalan tunika intima-media karotis KIMK merupakan petanda aterosklerosis pada pasien PGK. Tujuan: Mengetahui perbedaan kadar b2M serum dan KIMK antara pasien HD dibandingkan pasien CAPD, dan korelasi antara kadar b2M serum dengan KIMK. Metode: Penelitian dilakukan secara potong lintang. Subjek adalah pasien PGTA yang rutin menjalani HD atau CAPD dan memenuhi kriteria penelitian, dilakukan pengumpulan data berupa karakteristik subjek, pemeriksaan fisik, pemeriksaan kadar b2M serum dan pemeriksaan KIMK dengan ultrasonografi. Dilakukan perbandingan rerata kadar b2M serum, rerata KIMK kanan, rerata KIMK kiri antara kelompok pasien HD dan CAPD dengan uji t tidak berpasangan dan uji Mann Whitney, serta uji korelasi Pearson antara kadar b2M serum dengan KIMK. Hasil: Dari 62 subjek penelitian yang terdiri 36 pasien HD dan 26 pasien CAPD, didapatkan kadar b2M serum pasien HD lebih tinggi tetapi tidak bermakna p 0,167; IK95 2,041-11,508, KIMK kanan lebih tebal bermakna pada pasien CAPD p 0,006, KIMK kiri lebih tebal tetapi tidak bermakna p 0,770, dan tidak didapatkan korelasi antara kadar b2M serum dengan KIMK kanan maupun kiri r 0,085 p 0,514 ; r 0,082 p 0,529. Kesimpulan: Kadar b2M serum tidak berbeda bermakna antara pasien HD dengan CAPD, KIMK kanan lebih tebal bermakna pada pasien CAPD, KIMK kiri tidak berbeda antara pasien HD dengan CAPD, tidak didapatkan korelasi antara kadar b2M serum dengan KIMK.

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Background: Atherosclerotic vascular disease is a main cause of morbidity and mortality in chronic kidney disease patients, especially end stage renal disease undergoing dialysis. Potensial difference between hemodialysis HD and continuous ambulatory peritoneal dialysis CAPD treatment could have a different effect on cardiovascular risk factors and may differentially influence the risk of developing CVD. One of the risk factors can induce CVD is uremic toxin retention. Beta 2 microglobulin b2M is a middle molecule uremic toxin independently and significantly related to CVD in patients with asymptomatic carotid atherosclerosis. Carotid intima media thickness CIMT is a surrogate marker of atherosclerosis in chronic kidney disease patients.

Objectives: To know the difference of serum b2M level and CIMT in HD patients group compared to CAPD patients group, and to determine correlations between serum b2M level with CIMT.

Methods: We conducted a cross sectional study. Subjects were ESRD patients undergoing HD or CAPD which fulfilled study criteria were included in study. Data collection included subjects characteristics, physical examination, laboratory examination of serum b2M level, and measurement of CIMT by Doppler ultrasound. We used non pair student t test and Mann Whitney test to compare the mean of serum b2M level and the mean of left and right CIMT between HD group and CAPD group, and Pearson correlation test to serum b2M level and CIMT.

Results: Of 62 subjects, consisted of 36 HD patients and 26 CAPD patients, we found non significant higher serum b2M level in HD patients p 0,167 95 CI 2,041 11,508, significant thicker right CIMT in CAPD patients p 0,006, non significant thicker left CIMT in HD patients p 0,770, and there was no correlation between serum b2M level with right or left CIMT r 0,085 p 0,514 r 0,082 p 0,529.

Conclusions: Serum b2M level was not significant different between HD and CAPD patients, right CIMT was thicker in CAPD patients, left CIMT was not different between HD and CAPD patients, and no correlation between serum b2M level and CIMT."

"Aim: to develop a scoring system and measure the diagnostic added value of albuminuria to estimate CIMT. Methods: cross-sectional study was done in Endocrine Outpatient Clinic Cipto Mangunkusumo Hospital between March-May 2012 in T2DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking. Bivariate analysis and multivariate (logistic regression) analysis was done, followed by developing the scoring system. Results: from 71 subjects, there were 67.6% with increased CIMT and 73.3% with albuminuria. From 48 subjects with increased CIMT, 87.5% had albuminuria. Albuminuria measurement had high sensitivity (87.5%).Adding albuminuria measurement will increase the AUC as 2.3%. Estimation score for duration of DM, hypertension, dyslipidemia were as follows 1, 2, 1 respectively. Probability score of increased CIMT for score <2, 2, and >2 was as follows 15%, 57%, and 90%. Conclusion: albuminuria measurement increase the diagnostic value of CIMT. Scoring system can be used as a screening tool to estimate the increased of CIMT in type 2 DM patients without history of cerebrocardiovascular event, CKD stage ≥ III, and smoking.

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Tujuan: mengembangkan sistem skor dan menentukan nilai tambah diagnostik albuminuria dalam mengestimasi carotid intima-media thickness (CIMT).

Metode: studi potong lintang dilakukan di poliklinik endokrin RSCM bulan Maret-Mei 2012 pada pasien DMT2 tanpa komplikasi serebrokardiovaskular, penyakit ginjal kronis (PGK) stadium ≥ III, dan tidak merokok. Kami melakukan analisis statistik yang dilanjutkan dengan pembuatan sistem skor.

Hasil: dari 71 subjek, didapatkan CIMT dan albuminuria masing-masing sebesar 67,6% dan 73,3%. Dari 48 subjek dengan CIMT, sebanyak 87,5% mengalami albuminuria. Pemeriksaan albuminuria memiliki sensitivitas sebesar 87,5%. Penambahan nilai albuminuria akan meningkatkan AUC sebesar 2,3%. Skor estimasi untuk variabel lama terdiagnosis DM, hipertensi, dislipidemia berturut-turut sebesar 1, 2, 1. Skor probabilitas CIMT pada skor <2, 2, dan >2 sebesar 15%, 57%, dan 90%. Kesimpulan: pemeriksaan albuminuria meningkatkan nilai tambah diagnostik CIMT. Sistem skor dapat digunakan sebagai alat skrining terhadap CIMT pada pasien DM tipe 2 tanpa komplikasi serebrokardiovaskular, PGK stadium ≥ III, dan tidak merokok."

"Latar Belakang. 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 petanda 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. Tujuan. Menentukan faktor-faktor determinan yang bermakna dan nilai tambah diagnostikpemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Metodologi. 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, kemudian ditentukan nilai tambah pemeriksaan OPG dalam mendeteksi penebalan TIM karotis pada pasien DM tipe 2. Hasil dan Pembahasan. Dari 70 subyek penelitian, didapatkan jumlah subyek dengan peningkatan OPG dan penebalan TIM karotis adalah sebesar 45,7 % dan 70 %. Dari 49 subyek dengan penebalan TIM karotis, didapatkan 61,2 % subyek 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. Kesimpulan. 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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Background. Vascular calcification measured by carotid intima-media thickness

(CIMT) in type 2 diabetes mellitus (DM) patient is a predictor for cerebrocardiovascular

event. Osteoprotegerin (OPG) as a marker for endothelial dysfunction

can be used as a predictor for increased CIMT. Applicability of carotid ultrasonography

(USG) in Indonesia is still limited, therefore other diagnostic method that is more cost

effective is needed.

Objective. To determine the significant determinant factors and the diagnostic added

value of OPG to detect increased CIMT in type 2 DM patient.

Methods. Cross sectional study was conducted in Metabolic Endocrine and Internal

Medicine outpatient clinic Cipto Mangunkusumo Hospital between April and June 2012

in type 2 DM patient without history of cerebro-cardiovascular event, without history of

chronic kidney disease (CKD) stage III – V and without smoking. Bivariate analysis and

multivariate analysis were performed to variables duration of DM, hypertension,

dyslipidemia, HbA1c and OPG, followed by determining the diagnostic added value of

OPG to detect increased CIMT in type 2 DM patient.

Results. From 70 subjects, there were 45,7 % subject with increased OPG and 70 %

subject with increased CIMT. From 49 subject with increased CIMT, 61,2 % subject had

increased OPG. Duration of DM (OR 26,9; IK 95 % 2 – 365,6), hypertension (OR 22;

IK 95 % 2,3 – 207,9), dyslipidemia (OR 85,2; IK 95 % 3,6 – 203,6) and OPG (OR 12,9;

IK 95 % 1,4 – 117,3) were correlated significantly to increased CIMT. OPG

measurement had high specificity and positive predictive value (90,5 % and 84 %).

Diagnostic added value of OPG was only as 2,3 % to detect increased CIMT in type 2

DM patient.

Conclusion. The significant determinant factors for detection of increased CIMT in

type 2 DM patient were duration of DM, hypertension, dyslipidemia and OPG. The

diagnostic added value of OPG was 2,3 % to detect increased CIMT in type 2 DM

patient."

"[ABSTRAKLatar belakang : Penyebab kematian nomor tiga di Indonesia adalah Penyakit Jantung Koroner (PJK). PJK dapat dievaluasi dengan menilai skor Coronary Artery Calcium (CAC) menggunakan modalitas radiologi CT cardiac. Permasalahan saat ini adalah modalitas CT cardiac tidak tersedia di semua institusi kesehatan, sehingga dibutuhkan modalitas lain yang berguna untuk skrining skor CAC menggantikan modalitas CT cardiac. Dari 4 modalitas yang dapat mendeteksi skor CAC,pemeriksaan USG Doppler arteri karotis komunis merupakan modalitas terpilih untuk melakukan skrining.Tujuan : Menilai apakah terdapat korelasi antara skor CAC dengan nilai CIMT dan RI arteri karotis komunis menggunakan modalitas USG Doppler arteri karotis komunis.Metode : Penelitian cross sectional ini menggunakan data primer dari pasien yang menjalani pemeriksaan CT cardiac dengan temuan skor CAC. Subjek penelitian yang masuk ke dalam kriteria penerimaan kemudian dilakukan pemeriksaan USG Doppler arteri karotis komunis bilateral dan dilakukan pengukuran terhadap nilai CIMT dan nilai RI.Hasil : Jumlah subjek penelitian adalah 27 orang, dengan hasil terdapat korelasi positif bermakna dengan nilai korelasi sedang antara skor CAC dan nilai CIMT maksimum dengan persamaan : skor CAC = -85.51 + 199.82 x nilai CIMT maksimum. Terdapat korelasi positif bermakna dengan nilai korelasi sedang antara skor CAC dan nilai RI arteri karotis komunis dengan persamaan : skor CAC = -503.53 + 849.00 x nilai RI.Kesimpulan : Modalitas USG Doppler arteri karotis komunis pengukuran nilai CIMT dan nilai RI dapat digunakan sebagai modalitas skrining untuk memperkirakan skor CAC pada pasien.

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ABSTRACTBackground : Coronary artery disease (CAD) known as the third cause of morbidity in Indonesia. CAD can be evaluated using CAC scoring from CT cardiac. Nowadays the issue related to its availability, not all health institution has this modality. We need other modality imaging that can replace CT cardiac for screening CAC scoring. From 4 modalities imaging that can evaluated CAC scoring, common carotid artery Doppler ultrasonography is the modality of choice for screening.Purpose : To evaluate correlation value between CAC scoring and carotid intima media thickness (CIMT) and resistive index common carotid artery using Doppler ultrasonography.Method : Cross sectional research using primary data CAC scoring from CT cardiac. All subject that met research?s criteria will have bilateral common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value.Result : Total subject is 27 people. There is a positive correlation with medium correlation value between CAC scoring and maximum CIMT using this approach : CAC scoring = -85.51 + 199.82 x maximum CIMT value. There is also a positive correlation with medium correlation value between CAC scoring and common carotid artery resistive index value using this approach : CAC scoring = -503.53 + 849.00 x resistive index value.Conclusion : Common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value is a promising screening modality to predict patient?s CAC scoring., Background : Coronary artery disease (CAD) known as the third cause of morbidity in Indonesia. CAD can be evaluated using CAC scoring from CT cardiac. Nowadays the issue related to its availability, not all health institution has this modality. We need other modality imaging that can replace CT cardiac for screening CAC scoring. From 4 modalities imaging that can evaluated CAC scoring, common carotid artery Doppler ultrasonography is the modality of choice for screening.Purpose : To evaluate correlation value between CAC scoring and carotid intima media thickness (CIMT) and resistive index common carotid artery using Doppler ultrasonography.Method : Cross sectional research using primary data CAC scoring from CT cardiac. All subject that met research’s criteria will have bilateral common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value.Result : Total subject is 27 people. There is a positive correlation with medium correlation value between CAC scoring and maximum CIMT using this approach : CAC scoring = -85.51 + 199.82 x maximum CIMT value. There is also a positive correlation with medium correlation value between CAC scoring and common carotid artery resistive index value using this approach : CAC scoring = -503.53 + 849.00 x resistive index value.Conclusion : Common carotid artery Doppler ultrasonography measurement of CIMT and common carotid artery resistive index value is a promising screening modality to predict patient’s CAC scoring.]"