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"Latar Belakang: Penyakit arteri perifer (PAP) merupakan salah satu komplikasi makrovaskular pada penyandang diabetes melitus tipe 2 (DMT2) yang menimbulkan tingkat morbiditas dan mortalitas yang tinggi. Hingga saat ini, belum ada telaah sistematis dan komprehensif mengenai faktor risiko kejadian PAP pada penyandang DMT2.Tujuan: Mengetahui efek estimasi kumulatif dari berbagai faktor risiko kejadian penyakit arteri perifer pada penyandang diabetes melitus tipe 2.Metode: Telaah sistematis dan mata-analisis ini disusun berdasarkan standar PRISMA.Penelusuran literatur secara sistematis dan komprehensif dilakukan pada PubMed/MEDLINE, ProQuest, dan EMBASE, untuk mencari studi kohort dan kasus kontrol yang melaporkan faktor risiko PAP pada DMT2. Selain itu kami juga melakukan penelusuran terhadap grey literature. Risiko bias tiap studi yang diinklusi dinilai menggunakan the Newcastle-Ottawa Scale. Data dianalisis menggunakan RevMan versi 5.4 untuk mencari efek estimasi kumulatif dari tiap faktor risiko.Hasil: Didapatkan 10 studi yang dimasukkan ke dalam telaah sistematis ini, dengan total 73.834 pasien DMT2. Semua studi memiliki kualitas baik berdasarkan Newcastle-Ottawa Scale. Hubungan yang bermakna secara statistik terhadap kejadian PAP pada DMT2 didapatkan pada kelompok dengan usia ≥ 70 tahun (OR 3.44; IK 95% 2.11, 5.62), durasi diabetes ≥ 5 tahun (OR 1.81; IK 95% 1.24, 2.64), riwayat penyakit jantung koroner (OR1.55; IK 95% 1.30, 1.83), hipertensi (OR 1.43; IK 95% 1.10, 1.86), dan peningkatan LDL (OR 2.51; IK 95% 1.38, 4.56). Semua bukti temuan memiliki tingkat keyakinan moderate (GRADE rating)Kesimpulan: Usia ≥ 70 tahun, durasi diabetes ≥ 5 tahun, riwayat penyakit jantung koroner, hipertensi, dan peningkatan LDL merupakan faktor risiko kejadian PAP pada DMT2

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Background: Peripheral arterial disease (PAD) is one of the macrovascular complications of type 2 diabetes mellitus (T2DM), which cause serious rate of

morbidities and mortality. To date, there have not been any systematic and comprehensive review regarding the risk factors of incidence of PAD in T2DM populations.

Objective: Our study aims to analyze the pooled effect estimates of each risk factors of PAD incidence in T2DM populations. factors of PAD incidence in T2DM populations.

Methods: This systematic review and meta-analysis was conducted using the PRISMA standard. A systematic and comprehensive literature searching was conducted in

PubMed/MEDLINE, ProQuest, and EMBASE database, to obtain any cohort or casecontrol studies reporting the risk factors of PAD incidence in T2DM populations. We also

conducted searching on gray literature and hand-searching. We assessed risk of bias using

Newcastle-Ottawa Scale assessment tool. The pooled effect estimates of each risk factors was analyzed using RevMan version 5.4.

Results: Ten studies were included in this review comprising 73834 T2DM patients in total. All the studies had good quality based on Newcastle-Ottawa Scale. Significant association with the incidence of PAD in T2DM was found in the group of age ≥ 70 years

old (OR 3.44; 95% CI 2.11, 5.62), diabetes duration ≥ 5 years (OR 1.81; 95% CI 1.24, 2.64), coronary artery disease history (OR 1.55; 95% CI 1.30, 1.83), hypertension (OR

1.43; 95% CI 1.10, 1.86), and increased LDL (OR 2.51; 95% CI 1.38, 4.56). All the evidence has moderate certainty (GRADE rating).

Conclusion: Age ≥ 70 years old, diabetes duration ≥ 5 years, coronary artery disease history, hypertension dan increased LDL are significant risk factors of PAD incidence in T2DM population."

"Diabetes melitus merupakan penyakit metabolik kronis dengan prevalensi yang terus meningkat setiap tahunnya. Pasien diabetes melitus berisiko mengalami komplikasi mikrovaskular dan makrovaskular. Salah satu komplikasi makrovaskular pada pasien diabetes melitus adalah penyakit arteri perifer (PAD) yang berkontribusi pengembangan penyakit ulkus kaki diabetik. Latihan fisik sebagai salah satu manajemen non farmakologi pada Penyakit arteri perifer. Buerger allen exercise (BAE) merupakan latihan yang bertujuan untuk meningkatkan perfusi perifer ke kaki. Buerger allen exercise diterapkan dalam dua kali sehari selama lima hari perawatan dan dilakukan rutin pada pasien untuk mengatasi masalah keperawatan perfusi perifer tidak efektif. Evaluasi dari latihan ini adalah pengukuran ankle-brachial index untuk menilai perfusi pada kaki. Hasil yang didapatkan terdapat kenaikan ankle-brachial index pada kaki kanan 0.88 menjadi 1.03 dan untuk kaki kiri 0.87 menjadi 1.01. Kesimpulan dari hasil penerapan intervensi buerger allen exercise dapat mengatasi masalah perfusi perifer tidak efektif dibuktikan dengan peningkatan pada nilai ankle brachial index.

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Diabetes mellitus is a chronic metabolic disease with a prevalence that continues to increase every year. Diabetes mellitus patients are at risk of experiencing microvascular and macrovascular complications. One of the macrovascular complications in diabetes mellitus patients is peripheral arterial disease (PAD), which contributes to the development of diabetic foot ulcers. Physical exercise as a non-pharmacological management of peripheral arterial disease. Buerger Allen Exercise (BAE) is an exercise that aims to increase peripheral perfusion to the feet. The Buerger Allen exercise is applied twice daily for five days of treatment and is carried out routinely on patients to overcome the problem of ineffective peripheral perfusion nursing. The evaluation of this exercise is the measurement of the ankle-brachial index to assess perfusion in the foot. The results showed an increase in the ankle-brachial index for the right leg from 0.88 to 1.03 and for the left from 0.87 to 1.01. The conclusion from the results of implementing the Buerger Allen Exercise intervention can overcome the problem of ineffective peripheral perfusion as evidenced by an increase in the ankle-brachial index value."

"[ABSTRAKLatar 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) stabilMetode : 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.

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ABSTRACTIntroduction : 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.]"

"Latar Belakang : Penyakit arteri perifer PAP ekstremitas bawah merupakan salah satu komplikasi makrovaskular DM tipe 2 yang memiliki angka morbiditas dan mortalitas yang tinggi. Proses inflamasi telah diketahui berperan dalam terjadinya PAP pada penyandang DM tipe 2. Rasio neutrofil limfosit atau neutrophil lymphocyte ratio NLR telah digunakan sebagai penanda inflamasi kronik. Sejauh penelusuran kepustakaan yang dilakukan, belum didapatkan studi yang meneliti hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Tujuan : Mengetahui hubungan antara NLR dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2. Metodologi : Penelitian ini menggunakan desain potong lintang dengan subjek penyandang DM tipe 2 yang menjalani pemeriksaan ankle brachial index ABI di poliklinik divisi Metabolik Endokrin RSCM periode Oktober 2015 ndash; September 2016. Didapatkan 249 subjek penelitian yang memenuhi kriteria inklusi dan eksklusi. Dilakukan pengambilan data sekunder dari rekam medis mengenai data ABI, NLR, data demografik serta faktor perancu. Subjek dinyatakan menderita PAP ekstremitas bawah jika memiliki nilai ABI le; 0,9 dengan pemeriksaan probe Doppler. Data NLR kemudian dikategorikan berdasarkan median nilai NLR dan dicari hubungan nilai NLR dengan kejadian PAP ekstremitas bawah. Uji chi square digunakan untuk analisis bivariat dan regresi logistik digunakan untuk analisis multivariat. Hasil : Penyakit arteri perifer ekstremitas bawah ditemukan pada 36 subjek 14,5. Didapatkan nilai median NLR total sebesar 2,11. Nilai median NLR didapatkan lebih tinggi pada kelompok PAP daripada tanpa PAP 2,46 vs 2,04. Terdapat hubungan yang bermakna antara nilai NLR ge; 2,11 dengan kejadian PAP ekstremitas bawah pada penyandang DM tipe 2 PR 2,46, 95 IK 1,23 ndash; 4,87; p=0,007. Dengan menggunakan uji regresi logistik, diketahui bahwa hipertensi merupakan variabel perancu. Simpulan : Terdapat hubungan antara rasio neutrofil limfosit dengan kejadian penyakit arteri perifer ekstremitas bawah pada penyandang DM tipe 2.

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Background : Lower extremity peripheral artery disease PAD is one of diabetic macrovascular complication which has high rate of morbidity and mortality. Chronic inflammation has been known to have a role in the pathogenesis of PAD in diabetic patient. Recently, neutrophil lymphocyte ratio NLR has been used as a marker of chronic inflammation. To the best of our knowledge, there are no prior studies about the relationship between NLR and PAD in type 2 diabetic patients.

Aim : To determine the relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patient.

Methods : This was a cross sectional study on 249 patients with type 2 diabetes mellitus who underwent ankle brachial index ABI examination at Metabolic and Endocrinology Divison in Cipto Mangunkusumo Hospital between October 2015 ndash September 2016. The data were retrospectively collected from medical record. Lower extremity peripheral artery disease was defined as having ABI value le 0,9 by probe Doppler. Neutrophil lymphocyte ratio were categorized based on the median value and the relationship with lower extremity PAD were determined. Chi square test was used for bivariate analysis and logistic regression was used for multivariate analysis against confounding variables.

Result : Lower extremity peripheral artery disease was found in 36 subject 14,5. Median of NLR was 2,11. The median value of NLR was found higher in subjects with lower extremity PAD than without PAD 2,46 vs 2,04. There was an association between NLR value ge 2,11 and lower extremity PAD in type 2 diabetic patient p 0,007 PR 2,46 and 95 CI 1,23 ndash 4,87. By using logistic regression, it was known that hypertension was the confounding variable.

Conclusion : There is a relationship between neutrophil lymphocyte ratio and lower extremity peripheral artery disease in type 2 diabetic patients."

"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

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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"

"Hiperglikemia dan gangguan metabolisme pada diabetes melitus (DM) berhubungan dengan komplikasi penyakit arteri perifer (PAP). Pada pasien DM dengan PAP, disbiosis mikrobiota usus mengakibatkan penurunan produksi short-chain fatty acid (SCFA) sehingga memicu inflamasi nonspesifik dan aterogenesis. Penelitian ini bertujuan untuk mengidentifikasi hubungan kadar SCFA feses dengan berbagai parameter pemeriksaan vaskular pada pasien DM dengan PAP.Metode: Penelitian ini adalah studi potong lintang yang mengidentifikasi hubungan SCFA total, asetat, propionat, butirat, dan valerat feses dengan ankle-brachial index (ABI), toe pressure, diameter, plak, peak systolic velocity (PSV), volume flow (VF), spektrum aliran, dan derajat PAP arteri ekstremitas bawah pada pasien DM dengan PAP di sebuah sentra pelayanan kesehatan tunggal.Hasil: Sebanyak 37 subjek DM dengan PAP dianalisis. Terdapat hubungan negatif bermakna antara nilai asetat absolut dan diameter arteri femoralis communis (CFA) (r = -0,4; p =0,016) serta nilai propionat relatif dengan diameter arteri dorsalis pedis (DPA) (r =-0,376; p =0,04). Terdapat hubungan positif bermakna nilai asetat relatif dengan diameter DPA (r =0,381; p =0,038) serta nilai valerat relatif dengan PSV CFA (r =0,364; p = 0,029). Kelompok dengan plak CFA memiliki nilai asetat absolut yang lebih tinggi (p =0,039) dibandingkan kelompok yang tidak memiliki plak aterosklerotik. Kelompok dengan plak arteri poplitea (POPA) memiliki nilai butirat absolut yang lebih tinggi (p =0,046) dan nilai SCFA total yang lebih tinggi (p =0,046) dibandingkan kelompok yang tidak memiliki plak. Tidak terdapat hubungan bermakna SCFA dengan ABI, volume flow, dan derajat PAP.Kesimpulan: Nilai SCFA feses yang lebih tinggi cenderung berhubungan dengan diameter arteri perifer ekstremitas bawah yang lebih kecil dan PSV yang lebih tinggi. Nilai SCFA feses yang lebih tinggi juga cenderung didapatkan pada kelompok dengan plak arteri di atas lutut. Perlu dilakukan penelitian lanjutan untuk mengevaluasi efek sebab-akibat antara SCFA dan parameter-parameter vaskular pada pasien DM.

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Chronic hyperglycemia and metabolic abnormalities in diabetes mellitus are associated with peripheral arterial disease (PAD). Additionally, in diabetics with PAD, gut microbiota dysbiosis may lead to reduction in short-chain fatty acid (SCFA) production, prompting nonspecific inflammation and atherogenesis. This study aims to identify the association between SCFA and various vascular clinical and laboratory parameters in patients with diabetes and PAD.

Methods: This cross-sectional epidemiological study aims to identify the association of fecal total SCFA, acetate, propionate, butyrate, and valerate on ankle-brachial index (ABI), toe pressure, diameter, atherosclerotic plaque, peak systolic velocity (PSV), volume flow (VF), flow profile, and the degree of PAD of the lower extremity arteries in patients with diabetes and PAD in a single center.

Results: A total of 37 subjects with diabetes and PAD were analyzed. There were negative correlations of absolute acetate levels with common femoral artery (CFA) diameter (r = -0,4; p =0,016) and relative propionate levels with dorsal pedal artery (DPA) diameter (r =-0,376; p =0,04). There were positive correlations of relative acetate levels with DPA diameter (r =0,381; p =0,038) and relative valerate levels with PSV CFA (r =0,364; p = 0,029). Higher absolute acetate levels were found in group with CFA plaques (p =0,039). Higher absolute butyrate levels were found in group with popliteal artery (POPA) plaques (p =0,046), as was higher total SCFA levels (p =0,046). No significant association was found between SCFA and ABI, volume flow, and the degree of PAD.

Conclusion: Higher fecal SCFA levels were associated with smaller vascular diameters and higher PSV in lower extremity arteries. Higher SCFA levels were also more likely to be found in groups with above-knee atherosclerotic plaques. Further research is warranted to confirm the cause-effect relationship between SCFA and various vascular parameters in patients with diabetes and PAD."

"Latar belakang:Kondisi hiperglikemia pada diabetes melitus (DM) yang tidak terkontrol dan berlangsung lama dapat menimbulkan dampak negatif. Salah satu konsekuensi dari DM adalah munculnya penyakit arteri perifer (PAP) dan neuropati perifer diabetik (NPD). NPD merupakan komplikasi diabetes yang menunjukkan tanda dan gejala gangguan motorik dan sensorik, sementara PAP adalah kondisi aterosklerosis yang berkembang perlahan pada pembuluh arteri. Kedua penyakit ini menunjukkan gejala kelainan motorik dan sensorik yang saling tumpang tindih.Tujuan:Penelitian ini bertujuan untuk mengetahui hubungan stenosis arteri yang dinilai menggunakan arteriografi terhadap gangguan saraf yang dinilai menggunakan pemeriksaan kecepatan hantar saraf (KHS) pada pasien DM tipe 2 dengan PAP dan NPD.Metode:Penelitian ini merupakan penelitian potong lintang yang mengambil data sekunder dari data penelitian sebelumnya yang dilakukan pada Juli 2018 hingga Juni 2021 RSUPN Cipto Mangunkusumo. Subjek penelitian ini adalah penyandang DM yang memiliki NPD dan PAP yang memenuhi kriteria inklusi dan tidak memenuhi kriteria eksklusi. Subjek penelitian kemudian menjalani pemeriksaan arteriografi untuk menilai stenosis pada A. Peroneal, A. Tibialis Anterior dan A. Tibialis Posterior. Subjek penelitian juga menjalani pemeriksaan kecepatan hantar saraf (KHS) pada N. Peroneal Communis, N. Peroneal Superficialis, N. Tibialis dan N. Suralis. Korelasi antar kedua variabel kemudian diuji dengan Uji Korelasi Spearman.Hasil:Hasil menunjukkan bahwa stenosis A. Peroneal memiliki korelasi negatif derajat sedang (r = - 0.420) dengan KHS sensorik N. Peroneal Superficialis yang bermakna secara statistik (p = 0.023). Sementara itu, hubungan stenosis dan gangguan KHS pada A. Peroneal dengan N. Peroneal Communis, A. Tibialis Anterior dengan N. Tibialis dan A. Tibialis Posterior dengan N. Suralis memiliki korelasi yang tidak bermakna secara statistik (p >0.05). Hal ini dapat dijelaskan oleh kemungkinan kolateral yang dapat muncul pada penyandang PAP, struktur anatomi vaskular terhadap syaraf, dan jumlah sampel yang kecil.Kesimpulan:Terdapat korelasi negatif derajat sedang antara derajat stenosis A. Peroneal dan KHS sensorik N. Peroneal Superficialis. Namun hasil yang tidak bermakna ditemukan pada hubungan A. Peroneal dengan N. Peroneal Communis, A. Tibialis Anterior dengan N. Tibialis dan A. Tibialis Posterior dengan N. Suralis.

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Background:

The condition of hyperglycemia in uncontrolled and prolonged diabetes mellitus (DM) can have negative impacts. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). DPN is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. Both diseases exhibit overlapping symptoms of motor and sensory abnormalities.

Objective:

This study aims to determine the correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN.

Methods:

This is a cross-sectional study that takes secondary data from previous research data conducted from July 2018 to June 2021 RSUPN Cipto Mangunkusumo. The subjects of this study were people with DM who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. The research subjects then underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery and posterior tibial artery. Research subjects also underwent nerve conduction velocity (KHS) examinations in the Peroneal N. Communis, N. Peroneal Superficialis, N. Tibialis and N. Suralis. The correlation between the two variables was then tested using the Spearman Correlation Test.

Results:

The results showed that the Peroneal Artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the Superficial Peroneal Nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the Peroneal Nerve with the Common Peroneal Nerve, Anterior Tibial Nerve with Tibialis Nerve and Posterior Tibial Nerve with Sural Nerve had a correlation that was not statistically significant (p > 0.05). This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples.

Conclusion:

There is a moderate negative correlation between the degree of stenosis of the Peroneal nerve and the sensory NCV of the Peroneal Superficialis. However, insignificant results were found in the correlation between Peroneal Artery with Common Peroneal Nerve, Anterior Tibialis Artery with Tibial Nerve and Posterior Tibial Artery with Sural Nerve."

"Latar Belakang: Prevalensi penyakit arteri perifer PAP pada pasien dengan penyakit ginjal kronik PGK terlihat meningkat sejak stadium 3. Alat diagnostik nilai indeks ankle brachial ABI cukup akurat dalam mendeteksi PAP pada populasi normal. Pada PGK yang sering terjadi kalsifikasi pembuluh darah dimana nilai ABI dapat menjadi normal atau tinggi meski sudah ada stenosis pembuluh darah. Kalsifikasi pada ibu jari jarang terjadi membuat pemeriksaan nilai indeks toe brachial TBI mempunyai kelebihan dalam menilai PAP pada PGK.Tujuan: Untuk mendapatkan proporsi PAP berdasarkan nilai ABI dan TBI serta informasi mengenai profil PAP pada PGK predialisis dan faktor yang diduga berhubungan. Metode: Penelitian potong lintang pada pasien PGK di poliklinik Ilmu Penyakit Dalam, poliklinik Ginjal Hipertensi, poliklinik Kardiologi dan poliklinik Kardiologi Pusat Jantung Terpadu RSCM periode Oktober 2015-Maret 2016. Data didapatkan dari hasil wawancara, pemeriksaan fisik, nilai ABI dan TBI, serta pemeriksaan laboratorium. Studi deskriptif dilakukan dengan melihat proporsi PAP berdasarkan nilai ABI dan TBI, proporsi variabel dan penentuan nilai rerata dan median. Hasil: Terdapat 75 pasien yang memenuhi kriteria penelitian. Proporsi PAP berdasarkan nilai ABI dan TBI 60 IK 95 49 -; 71. Nilai ABI. 0,9 dan TBI. 0,7 digunakan sebagai cut off dalam diagnosis PAP. Proporsi PAP pada tiap stadium ginjal mulai terlihat besar. Pasien dengan PAP lebih banyak laki-laki 51,1 dan rerata IMT 23,57 3,5 kg/m2. Median usia pasien 64 tahun 33-74 tahun. Nilai median ABI 1,04 0,7-1,26 dan TBI 0,61 0,31-0,74. Sebagian besar tidak merokok 53,3, mempunyai komorbiditas hipertensi 84, diabetes melitus 64, penyakit jantung koroner 57 dan dislipidemia 40. Nilai median laju filtrasi glomerulus 31,6 6,3-57,6, nilai median albuminuria 153 mg/g kreatinin 7,9-10767,3, nilai median kalsium. mg/dL 7,2-9,8 mg/dL, nilai median fosfat 3,9 mg/dL 1,9-5,7 mg/dL, rerata nilai produk CaxPO4 33,7 6,5 mg2/dL2 dan nilai median hsCRP 1,3 mg/L 0,1-19,19 mg/L. Proporsi pasien dengan hipertensi lebih besar pada pasien dengan PAP. Sementara proporsi DM tidak terkontrol lebih besar dibandingkan yang terkontrol 44. 20. Simpulan: Proporsi PAP pada pasien PGK predialisis berdasarkan nilai ABI dan TBI sebesar 60. PAP pada PGK predialisis lebih banyak pada subjek dengan komorbiditas, diabetes melitus yang tidak terkontrol, stadium. klasifikasi Fontaine dan kecenderungan albuminuria yang meningkat.

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Background The prevalence of peripheral artery disease PAD in chronic kidney disease patients is increasing in CKD stage. or higher. Ankle brachial index is an accurate diagnostic tool in population without CKD. Higher prevalence of arterial calcification in CKD can lead to. normal or high ABI in stenotic vessel. Toe vessels are less susceptible to calcification, therefore toe brachial index TBI measurement can be more useful for PAD assessment in CKD population.

Objectives: The aim of the study is to determine the profile of PAD based on ankle brachial index and toe brachial index in predialysis CKD patients.

Methods: cross sectional study was conducted in outpatient clinics of Dr. Cipto Mangunkusumo hospital from October 2015 to March 2016. The data were obtained by interview, ABI and TBI measurement, and analyzing the laboratories values.

Results: In 75 patients ABI and TBI measurement were conducted simultaneously. ABI 0.9 and or TBI 0.7 had been used as cut off values for diagnosing PAD. PAD proportion based on ABI and TBI in CKD predialysis is 60 IK 95 49 - 71. PAD proportion in every CKD stage are high. Most of the subject are male 51.1 and the mean body mass index value is 23.57 3.5 kg m2. The age median is 64 year old 33 74 year old. The median value of ABI is 1.04 0.7 1.26 and TBI 0.61 0.31 0.74. Most of the patients are non smoker 53.3, had hypertension 84, diabetic 64, coronary artery disease 57 and dyslipidemia 40. Median value of glomerulus filtration rate is 31.6 ml menit 1.73 m2 6.3 57.6 ml menit 1.73 m2, median value of albuminuria 153 mg. kreatinin 7.9 10767.3 median value of calcium. mg dL 7.2 9.8 mg dL, median value of phosphate 3.9 mg dL 1.9 5.7 mg dL, mean value of CaxPO4 product is 33.7 6.5 mg2 dL2 and median value of hsCRP 1.3 mg. 0.1 19.19 mg.. Most patient with PAD had. greater proportion of hypertension. The proportion of uncontrolled diabetes are higher in patient with PAD 44 vs 20.

Conclusion PAD proportion based on ABI and TBI is 60 IK 95 49 - 71. Most of the patients with PAD in CKD predialyis are with uncontrolled diabetes, stage II of Fontaine classification, increased albuminuria. "