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"Latar Belakang: GERD merupakan penyakit saluran cerna atas yang banyak ditemukan dan prevalensnya semakin meningkat. Pemberian PPI belum memberikan hasil yang memuaskan, dimana 30-42% pasien masih menunjukkan keluhan. Pasien yang masih menunjukkan keluhan dikatakan GERD refrakter. Ansietas dan depresi dipikirkan sebagai salah satu faktor risiko GERD refrakter. Saat ini belum ada data mengenai angka kejadian ansietas dan depresi pada pasien GERD refrakter di Indonesia.Tujuan: Mengetahui perbedaan proporsi kejadian ansietas dan depresi pada subgrup GERD refrakter berdasarkan pemeriksaan pH impedans.Metode: Penelitian ini merupakan studi potong lintang menggunakan data primer yang melibatkan 118 pasien GERD refrakter. Dilakukan analisis dengan membagi pasien berdasarkan EGD dan pH impedans menjadi ERD, true NERD, esofagus hipersensitif dan functional heartburn. Kemudian dilakukan analisis proporsi kejadian ansietas dan depresi pada masing-masing subgrup.Hasil: Sampel berjumlah 118 pasien terdiri dari 41 pasien ERD, 25 pasien true NERD, 8 pasien esofagus hipersensitif dan 44 pasien functional heartburn. Proporsi kejadian ansietas sebesar 41,5% pada kelompok ERD, 60% pada kelompok NERD, sebesar 62,5% pada kelompok esofagus hipersensitif, dan 40,9% pada kelompok functional heartburn. Proporsi kejadian depresi sebesar 41,5% pada kelompok ERD, sebesar 40% pada kelompok NERD dan 40,9% pada kelompok functional heartburn. Tidak ada pasien yang menderita depresi pada kelompok esofagus hipersensitif. Tidak didapatkan perbedaan yang bermakna secara statistik proporsi kejadian ansietas dan depresi pada subgrup GERD refrakter.Simpulan: Tidak terdapat perbedaan proporsi kejadian ansietas dan depresi pada masing-masing subgrup GERD refrakter.

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Background: GERD is a major gastrointestinal disease that is found in the community and the prevalence is increasing. Giving PPI has not given satisfactory results, where 30-42% patients still showing complaints. This patients is referred as refractory GERD. Anxiety and depression is considered as risk factors for refractory GERD. Currently there is no data on the incidence of anxiety and depression correlated with subgroups  of refractory GERD based on pH impedance examination in Indonesia.

Objectives: To determine the proportion differences of anxiety and depression events on each of GERD refractory subgroups based on pH impedance examination.

Methods: This study is a cross-sectional study using primary data involving 118 refractory GERD patients. Analysis were carried out by dividing patients based on EGD and pH impedance examination into ERD, NERD, hypersensitive esophagus and functional heartburn. The proportion of anxiety and depression then analyzed in each of those groups.

Results: 118 patients participated in these study consisting of 41 ERD patients, 25 NERD patients, 8 hypersensitive esophageal patients and 44 functional heartburn patients. The proportion of anxiety events was 41.5% in the ERD group, 60% in the NERD group, 62.5% in the hypersensitive esophageal group, and 40.9% in the functional heartburn group. The proportion of depression events was 41.5% in the ERD group, 40% in the NERD group and 40.9% in the functional heartburn group. There is no patient suffered from depression in the hypersensitive esophageal group. There is no statistically significant difference between the incidence of anxiety and depression in each of those groups.

Conclusions: There is no differences in the proportion of anxiety and depression events in each of GERD refractory subgroup."

"Level rekomendasi penggunaan rutin intra-arotic balloon pump (IABP) pada pasien dengan renjatan kardiogenik diturunkan menjadi level III. Manfaat penggunaan IABP sebelum revaskularisasi belum diinvestigasi secara uji klinis acak. Tujuan studi ini untuk menilai pengaruh penggunaan IABP sebelum revaskularisasi pada pasien infark miokard akut dengan komplikasi renjatan kardiogenik.Uji klinis acak pembanding terbuka dilakukan di Pusat Jantung Nasional Harapan Kita periode januari 2018 hingga Mei 2020. Randomisasi dilakukan pada 69 subjek infark miokard dengan renjatan kardiogenik. Alokasi kelompok kontrol 34 subjek dan perlakuan (IABP sebelum revaskularisasi) 35 subjek. Luaran primer adalah mortalitas rumah sakit dan pasca revaskularisasi hari ke_30. Luaran sekunder perfusi global (bersihan asam laktat jam ke_12), perfusi regional (kreatinin), performa jantung yang dinilai secara ekokardiografi (Global longitudinal strain) dan penanda biologis untuk regangan miokard (NT-proBNP dan ST2). Variabel hemodinamik ekokardiografi dan komplikasi tindakan juga dilaporkan.Setelah drop out, Analisis perprotokol dilakukan pada 18 subjek kelompok kontrol dan 16 subjek kelompok perlakuan. Mortalitas rumah sakit dan 30 hari pasca revaskularisasi, 12 (66,7%) subjek pada kelompok kontrol dan 9 (56,3%) subjek pada kelompok perlakuan, p 0,533. Pada luaran sekunder tidak ditemukan perbedaan bermakna pada kedua kelompok untuk bersihan laktat efektif jam ke-12; pemeriksaan kreatinin, global longitudinal strain, hemodinamik ekokardiografi dan nilai NT-proBNP dan ST2. Pada hari ke_3, kurva kaplan meier berpisah dan mortalitas RS dini pada kelompok kontrol 9 (50%) subjek dan pada kelompok perlakuan 1 (6,25%) subjek, hasil uji fisher p 0,013. Mortalitas RS lanjut berhubungan dengan IABP dan sepsis. Dua patomekanisme diusulkan untuk menerangkan patomekanisme kematian pada kelompok kontrol dan kelompok perlakuanSimpulan: Penggunaan IABP sebelum revaskularisasi pada subjek infark miokard akut dengan komplikasi renjatan kardiogenik tidak memperbaiki mortalitas rumah sakit dan pasca perawatan hari ke-30. Pada kelompok kontrol diusulkan patomekanime mortalitas serangan fisiologis kali satu. Kelompok perlakuan, patomekanime mortalitas diusulkan serangan fisiologis kali dua.

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The guideline recommendation on routine use of Intra Aortic balloon pump (IABP) in cardiogenic shock had been downgraded to level recommendation III. The role of IABP insertion before revascularization has never been investigated in randomized control trial. The aim of this study is to investigate the role of IABP insertion before revascularization in acute myocardial infarction complicated by cardiogenic shock.

Randomized control trial was performed in National Cardiac Center Harapan Kita at the period January 2018–April 2020. We randomly assigned 69 patients cardiogenic shock due to acute myocardial infarction. There are 34 patients assigned to control group (no IABP) and 35 patients assigned to intervention group (IABP before revascularization). Percutaneous Coronary Intervention and medical care were performed according to local protocol. The primary end points were in-hospital mortality and mortality at 30 days post revascularization. The secondary end points were perfusion (lactate clearance, creatinine), cardiac performance (global longitudinal strain), Biomarker for myocardial stretch (NT-proBNP & ST2). Echo hemodynamic and complication variables were also reported.

After drop out, a total of 18 patients in the control group and 16 patients in intervention group (IABP before revascularization were included in per protocol analysis for the primary and secondary end points. The primary end result of in hospital mortality and 30 days post revascularization mortality were identical in 12 patients in the control group (66.7%) and 9 patients in the intervention group (56.3%), p 0,533. There were no significant differences in secondary end points, effective lactate clearance at 12 hour, creatinine, Global Longitudinal Strain, NT-proBNP, ST2 including echo hemodynamic, dose of catecholamine therapy and sepsis. At the third day, Kaplan Meier curve demonstrated early separation with significant difference in mortality 9 patients in the control group (50%) and 1 patients in the intervention group (6,25%), p 0,013. Late in hospital was associated with IABP and sepsis. There was also a trend of greater elevation of NT-proBNP on day 3 in the intervention group. Therefore, pathomechanisms of death for control group and intervention group were proposed.

Conclusion: The use IABP before percutaneous intervention in patient shock cardiogenic due to acute myocardial infarction did not improve clinical outcome in hospital mortality or 30 days post Revascularization. One hit of physiological deterioration model for cardiogenic cardiogenic shock patient and two hit of physiological deterioration model for cardiogenic shock patient treated with IABP before revascularization were proposed. "

"Latar belakang: Rinosinusitis kronik (RSK) merupakan sebuah masalah kesehatan global. Berdasarkan keberadaan polip hidung, RSK dikategorikan menjadi RSK dengan dan tanpa polip hidung. Rinosinusitis yang memiliki gejala persisten walaupun mendapatkan tata laksana yang tepat disebut sebagai rinosinusitis refrakter. Kondisi ini dapat menyebabkan tatalaksana berlebih terkait kegagalan dalam tindakan pembedahan. Terdapat banyak faktor yang berperan dalam patogenesis RSK refrakter, seperti infiltrasi eosinofil, biofilm dan asma.Tujuan penelitian: Mengetahui pengaruh infiltrasi eosinofil, biofilm dan asma terhadap RSK dengan polip hidung bilateral refrakter.Metode: Penelitian ini menggunakan desain cross-sectional dan melibatkan 37 pasien RSK dengan polip hidung bilateral di RSUPN Cipto Mangunkusumo. Data diambil dari rekam medis (jenis kelamin, usia, atopi, dan asma) dan hasil pemeriksaan preparat blok paraffin polip hidung (infiltrasi eosinofil dan biofilm). Analisis data dilakukan menggunakan Statistical Program for Social Science (SPSS) for Windows versi 20.Hasil: Kejadian refrakter ditemukan pada 29 subjek (78,4%). Berdasarkan analisis bivariat, tidak terdapat asosiasi yang bermakna antara infiltrasi eosinofil, biofilm, asma, atopi, usia, dan jenis kelamin dengan kejadian RSK dengan polip hidung bilateral refrakter (p>0,05). Kesimpulan: Tidak terdapat pengaruh signifikan dari infiltrasi eosinofil, biofilm dan asma terhadap RSK dengan polip hidung bilateral refrakter.

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Background: Chronic rhinosinusitis (CRS) is a global health issue. Based on the existence of nasal polyps, CRS is further categorized into CRS with and without nasal polyps. Rhinosinusitis that show persistent symptoms despite suitable treatment is referred to as refractory rhinosinusitis. This condition could cause over-treatment due to failed surgery. There are a lot of factors that contribute towards the pathogenesis of refractory CRS, such as eosinophil infiltration, biofilm, and asthma

Aim: To assess the impact of eosinophil infiltration, biofilm, and asthma towards refractory CRS with bilateral nasal polyps.

Methods: This is a cross-sectional study involving 37 CRS with bilateral polyp nasal patients at Dr. Cipto Mangunkusumo National General Hospital. Data were obtained from medical records (sex, age, atopy, and asthma) and nasal polyp paraffin block examination (eosinophil infiltration and biofilm). Data analysis was performed using Statistical Program for Social Science (SPSS) for Windows version 20.

Results: 29 subjects (78,4%) had refractory CRS with bilateral nasal polyps. Based on bivariate analysis, no significant association was shown between eosinophil infiltration, biofilm, and asthma, age, and sex and refractory CRS with bilateral nasal polyps."

"ABSTRAKLatar belakang: External Counter Pulsation (ECP) dapat diaplikasikan sebagai pilihan terapi pada pasien dengan angina refrakter yang tidak adekuat dikendalikan dengan terapi medis, angioplasti perkutan (IPK) ataupun bedah pintas arteri koroner (BPAK). Hasil bervariasi masih diperoleh pada perbaikan fraksi ejeksi ventrikel kiri pada pasien yang menjalani ECP. Metode 2D-Speckle Tracking Echocardiography (2D-STE) dianggap lebih unggul menilai perbaikan klinis, namun hingga kini belum ada penelitian yang mengevaluasi mekanikal ventrikel kiri dengan menggunakan 2D-STE pada pasien yang menjalani protokol standar ECP (35 sesi).Tujuan: Mengetahui perubahan mekanik ventrikel kiri sesudah dilakukan 35 protokol standar ECP dibandingkan dengan kontrol/sham pada pasien angina refrakter yang tidak ideal menjalani revaskularisasi konvensional (IPK/BPAK).Metode: Pasien dengan angina refrakter yang tidak dapat dilakukan revaskularisasi lebih lanjut secara konvensional (IPK/BPAK) dirandomisasi menjadi 2 kelompok: kelompok terapi standar ECP (300 mmHg) dan kelompok placebo/sham (75 mmHg). Terapi standar ECP diberikan selama 35 sesi, durasi 1 jam/hari/sesi, selama 5 hari/minggu, selama 7 minggu. Data 2D-STE mencakup strain longitudinal dan post systolic index (PSI) diambil sebelum dan sesudah terapi (dengan double-blind).Hasil: Terdapat 46 subjek ikut serta dalam penelitian dan tidak ada subjek yang mengalami drop-out. Tiga pasien dieksklusi karena kualitas ekokardiografi sub-optimal. Dua puluh dua subjek disertakan dalam Grup Terapi ECP dan 21 subjek dalam Grup Kontrol (sham). Karakteristik dasar strain homogen sebelum dilakukan perlakuan baik secara global (Grup Terapi 12,42±4,55 vs Grup Sham 12,00±4,92; p 0,774) maupun secara segmental/regional (Grup Terapi 12,63 (0,01-25,16) vs Grup Sham 12,43 (0,01-27,20); p 0,570). Setelah perlakuan tidak didapatkan perbedaan bermakna secara statistik antar kelompok pada parameter mekanik ventrikel kiri baik secara global (p 0,535) maupun regional (p 0,434). Parameter PSI mengalami perbaikan pada grup Terapi (p 0,049) dan segmen dengan PSI≥20% cenderung mengalami perbaikan strain longitudinal pada grup Terapi dibanding grup Sham (p 0,042).Kesimpulan: Terapi ECP sebanyak 35 sesi tidak memberikan perbaikan mekanik ventrikel kiri secara global maupun regional/segmental pada pasien angina refrakter yang tidak ideal menjalani revaskularisasi konvensional (IPK/BPAK) dibanding sham.

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ABSTRACTBackground: External Counterpulsation (ECP) can be applied as a therapeutic option in patients with debilitating refractory angina inadequately controlled by medical therapy, percutaneous angioplasty (PCI), or coronary artery bypass surgery (CABG). Varied results are still obtained in the improvement of the left ventricular ejection fraction in patients undergoing ECP. The 2D-Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement, but there has been no study evaluating mechanical parameters of the left ventricle using 2D-STE in patients undergoing the standard ECP protocol (35 sessions).Objective: To determine the effect of ECP on left ventricular mechanical parameters changes after performing 35 ECP standard protocols compared with sham (control) in patients with refractory angina who are not ideal for conventional revascularization (PCI/CABG).Methods: We conducted a double-blind randomized control trial. Patients with refractory angina who could not be further revascularized conventionally (PCI/CABG) were randomized into 2 groups: the ECP group (300 mmHg) and the Sham group (75 mmHg). ECP standard therapy was given for 35 sessions, duration of 1 hour/day/session, for 5 days/week, for 7 weeks. 2D-STE data including strain and post systolic index (PSI) were obtained before and after therapy.Results: There were 46 subjects included in the study without any drop-out. Three patients were excluded due to suboptimal echocardiographic images. Twenty-two subjects were included in the ECP group and 21 subjects into the sham group. A homogenous baseline strain was found either globally (ECP group 12.42 ± 4.55 vs Sham group 12.00±4.92; P=0.774) or segmentally/regionally (ECP group 12.63 (0.01-25.16) vs the Sham group 12.43 (0.01-27.20); P=0.570). After treatment, there was no statistically significant improvement between groups in the mechanical function of the left ventricle both globally (P=0.535) or regionally/segmentally (P=0.434). There were improvements in the PSI parameters found in the ECP group (P=0.049) and segments with PSI ≥20% tended to improve longitudinal strains in the Therapy group compared to the Sham group (p 0.042).Conclusion: 35 sessions of ECP therapy did not improve the global nor regional/segmental left ventricular mechanical parameters in patients with refractory angina who were not ideally suited for conventional revascularization (PCI/CABG) compared to Sham."