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"Introduction: Hemodialysis is an essential treatment in patients with stage 5 chronic kidney disease (CKD) or End-Stage Renal Disease (ESRD). The maturity of arteriovenous fistulas determines the success of hemodialysis. FAV maturity depends on preoperative preparation. The study aims to examine the preoperative and intraoperative peak systolic velocity (PSV) of the radial artery as a predictor of the successful maturation of the radiocephalic FAV. Method: This study used an analytic cross-sectional design to obtain the relationship of FAV maturation with preoperative and intraoperative PSV. Subjects were those who will undergo radiocephalic FAV surgery with preoperative ultrasound mapping. Shortly after anastomosis, PSV was measured. After 6 weeks, FAV was assessed for its maturity. Results: As many as 71 patients were undergone radiocephalic FAV surgery and followed for six weeks. The mean preoperative PSV of mature fistula was significantly higher than immature (54.6 ± 11.7 cm/s and 26.7 ± 7.7 cm/s; p <0.001). The mean intraoperative PSV of mature fistula was significantly higher than immature (57.9 + 12.6 cm/s and 27.1 + 8.1 cm/s; p <0.001). The mean PSV difference in mature fistulas was significantly higher than immature (3 cm/s and 0 cm/s; p <0.001). Preoperative PSV with a cut-off of 40 cm/s, intraoperative with a cut-off of 2 cm/s, and a difference of PSV with a cut-off of 42 cm/s all had 92.9% accuracy as a predictor of FAV maturation compared to “rule of 6” as a reference standard."

"Proporsi penyakit hipertensi di Depok tahun 2002 adalah 57,4%. Puskesmas telah melakukan terapi terhadap penyakitini dengan memberikan antihipertensi. Selain obat yang biasa diberikan dokter (konvensional), ternyata banyak pasienmengkonsumsi tanaman yang berkhasiat obat (obat bahan alam). Penelitian ini bertujuan untuk mengevaluasi efekterapi antihipertensi kombinasi konvensional-bahan alam terhadap tekanan darah pada pasien hipertensi di 5 Puskesmasdi Depok. Penelitian yang didesain kohort retrospektif ini menggunakan sampel pasien hipertensi yang datang kePuskesmas. Pasien yang bersedia ikut penelitian sebanyak 123 pasien, dan dikelompokkan dalam kelompok terapikonvensional (74 orang) dan terapi kombinasi konvensional-bahan alam (49 orang). Sebagian besar pasien hipertensiyang datang ke Puskesmas wilayah Depok adalah perempuan, usia 50-59 tahun, menikah, berasal dari suku Betawi,berpendidikan rendah, tidak bekerja/ibu rumah tangga, berpenghasilan rendah dan menderita hipertensi tahap II.Penurunan tekanan darah diastolik pada kelompok terapi kombinasi konvensional-bahan alam lebih baik dibandingankelompok terapi konvensional, sebaliknya penurunan tekanan darah sistolik lebih baik pada kelompok terapikonvensional dibandingkan kelompok terapi kombinasi konvensional-bahan alam. Namun tidak ada perbedaanbermakna antara keduanya (p>0,05). Kontinuitas penggunaan obat mempengaruhi tekanan darah sistolik (p<0,05).Penelitian ini menunjukkan bahwa belum terlihat jelas pengaruh penggunaan obat bahan alam yang digunakanbersamaan dengan obat konvensional dalam menurunkan tekanan darah.Evaluation on Conventional Antihypertension Use and Natural-Conventional Combination on Patient withHypertension. The proportion of hypertensive disease in Depok city was 57.4% in 2002. Primary health centers hadgiven antihypertensive medication. In addition to the drugs commonly given by a doctor (conventional), many patientstook medicinal plants (natural medicine). This study aimed to evaluate the effects of combination therapy ofconvensional-herbal on blood pressure in hypertensive patients in five primary health centers in Depok. Thisretrospective cohort study used samples of hypertension patients who came to primary health centers. Patients who werewilling to join the study were 123 patients and grouped in to conventional therapy group (74 people) and combinationof conventional-herbal therapy group (49 people). The majority of hypertensive patients who came to the health centersarea of Depok were women, aged 50-59 years old, married, came from ethnic Betawi, less educated, unemployed/housewives, low income and suffering from hypertension stage II. Combination therapy of convensional-herbal hadbetter effect on diastolic and convensional therapy had better effect on systolic. However, no significant differencebetween them (p>0.05). The continuity of treatment affected systolic blood pressure (p<0.05). This study showed thathad not seen clearly influence of herbal that is used combination with conventional drugs in lowering blood pressure."

"Tujuan penelitian ini adalah mengetahui prevalensi hipertensi sistolik terisolasi (HST) pada populasi berusia 40 tahun ke atas di Indonesia serta faktor-faktor risiko yang ada.Metode : Desain penelitian adalah potong lintang; subyek diperoleh dari pasien yang berobat ke dokter dan keluarga atau pengantar mereka. Dokter terpilih secara acak dari 11 kotamadya dan 11 kabupaten yang terpilih secara acak (systematic random sampling assignment) dari lima pulau besar Indonesia dan satu kepulauan Maluku. Nilai pengukuran tekanan darah menggunakan nilai baku dari 3NC VII tahun 2003.Hasil : Subyek yang terkumpul adalah 4436 orang dan HST terdapat pada 316 subyek. Faktor yang berpengaruh terhadap HST adalah umur (OR 1,06 ; 95%CI 1,06 - 1,07), riwayat DM (OR 1,44 ; 95%CI 1,04 - 2,02) , dan riwayat gagal ginjal (OR 1,71 ; 95%CI 0,99 - 2,94). Pada subyek yang merokok, rerata lama merokok yang menderita HST adalah 28,78±14,45 bulan sedangkan yang tidak menderita HST adalah 22,33±11,80 bulan (p = 0,003).Kesimpulan : Prevalensi HST adalah 7,12%. Terdapat hubungan antara umur, riwayat DM dan gagal ginjal dengan HST. Pada penelitian ini tidak terdapat hubungan antara merokok, riwayat keluarga dengan hipertensi dan indeks massa tubuh dengan HST. Pada subyek yang merokok, ternyata lama merokok berbubungan dengan kejadian HST.Daftar pustaka: 37 (1994-2003).

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Isolated Systolic Hypertension in Indonesia, Prevalence and Risk FactorsObjective of this study was to examine the prevalence of isolated systolic hypertension (ISH) amongst Indonesia people at the age of 40 years and over with its associated risk factors.

Methods: Cross sectional study; subjects were collected from persons who visited their doctors or their families. Doctors participated in this study were randomly assigned from 11 cities and 11 district area at five big islands and archipelago also in a systematic random sampling assignment. Measurement of blood pressure were using the standard procedure stated in INC VII (2003).

Results: Of the 4436 subjects, 316 persons met the criteria of ISH. Factors associated with ISH were age (OR 1.06 ; 95%CI 1.06 - 1.07), history of DM (OR 1.44 ; 95%CI 1.04 - 2.02) , and history of renal failure (OR 1.71 ; 95%CI 0.99 - 2.94). Amongst subjects who were smoking, mean duration of smoking in ISH persons was 28.78±14.45 months while in non-ISH persons was 22,33±11,80 months ( p = 0.003).

Conclusion: The prevalence of ISH was 7.12%. Age, history of DM and history of renal failure were associated with ISH. There were no association between smoking, family history of hypertension and body mass index with ISH in this study. Amongst smoking subjects, the duration of smoking was associated with ISH.

References: 37 (1994-2003)"

"Latar belakang: Hemodialisis merupakan salah satu tatalaksana penting yang dilakukan pada pasien dengan penyakit ginjal kronik (PGK) stadium 5 atau penyakit ginjal stadium akhir. Komplikasi akses hemodialisis lebih rendah pada penggunaan akses hemodialisis autogen dibandingkan dengan penggunaan akses prostetik. Maturitas fistula arteriovena sangat menentukan keberhasilan suatu akses vaskular untuk hemodialisis. Maturitas fistula arteriovena tergantung dengan persiapan pre operasi pembuatan fistula arteriovena. Penelitian ini diharapkan pemeriksaan peak systolic velocity pada arteri radialis preoperatif dan intraoperatif dapat memprediksi keberhasilan maturasi dari fistula arteriovena radisefalika. Subjek dan Metode: Subjek adalah pasien-pasien yang akan dibuat FAV radiosefalika dengan USG mapping sesuai standar. Sesaat setelah anastomosis diukur peak systolic velocity dengan USG Doppler probe linear. Penelitian ini menggunakan desain potong lintang analitik untuk mendapatkan hubungan maturasi FAV dengan peak systolic velocity preoperatif dan intraoperatif. Hasil: FAV radiosefalika (n=71) pada 71 pasien dibuat dan dievaluasi dalam 6 minggu. Rerata PSV preoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (54,6+11,7 cm/s dan 26,7+7,7 cm/s; P<0,001). Rerata PSV intraoperatif pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (57,9+12,6 cm/s dan 27,1+8,1 cm/s; P<0,001). Rerata selisih PSV pada fistula yang matur secara signifikan lebih tinggi dibandingkan yang tidak matur (3 cm/s dan 0 cm/s; P<0,001).  PSV preoperatif dengan nilai cut-off sebesar 40 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. PSV intraoperatif dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas 91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Selisih PSV dengan nilai cut-off sebesar 42 cm/s memiliki sensitifitas  91,7%; spesifisitas 95,6%; akurasi 92,9%; positve predictive value 97,8%; dan negative predicvtive value 84,6%. Kesimpulan: PSV preoperatif >40 cm/s dan PSV intraoperatif >42 cm/s memiliki nilai prediktor yang baik untuk maturasi FAV radiosefalika,sehingga dapat menjadi acuan menentukan perlu tidaknya penilaian lebih lanjut dan tindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angka kegagalan maturasi fistula arteriovenous.

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Background: Hemodialysis is one of the important treatments in patients with stage 5 chronic kidney disease (CKD) or end-stage renal disease. Complications of hemodialysis access are lower in the use of access to autogenous hemodialysis compared to the use of prosthetic access. The maturity of arteriovenous fistula greatly determines the success of a vascular access to hemodialysis. The maturity of arteriovenous fistula depends on the preoperative preparation of arteriovenous fistula making. This study is expected to examine the peak systolic velocity of radial arteries in the preoperative and intraoperative to predict the successful maturation of radiocephalic arteriovene fistulas. Subjects and Methods: Subjects are patients who will be made radiocephalic FAV with ultrasound mapping according to the standard. Shortly after anastomosis, a peak systolic velocity is measured with a linear ultrasound Doppler probe. This study uses a cross-sectional analytic design to obtain the relationship of FAV maturation with preoperative and intraoperative peak systolic velocity. Results: Radiosefalic FAV (n = 71) in 71 patients was made and evaluated in 6 weeks. The mean of preoperative PSV in mature fistulas was significantly higher than those who were immature (54.6 + 11.7 cm / s and 26.7 + 7.7 cm / s; P <0.001). The mean intraoperative PSV in mature fistulas was significantly higher than that which was immature (57.9 + 12.6 cm / s and 27.1 + 8.1 cm / s; P <0.001). The mean difference in PSV in mature fistulas was significantly higher than that of immature (3 cm / s and 0 cm / s; P <0.001). Preoperative PSV with a cut-off value of 40 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The intraoperative PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. The difference in PSV with a cut-off value of 42 cm / s has a sensitivity of 91.7%; specificity 95.6%; 92.9% accuracy; positve predictive value 97.8%; and negative predictive value of 84.6%. Conclusions: Preoperative PSV> 40 cm / s and intraoperative PSV> 42 cm / s have a good predictor value for radiocephalic FAV maturation, so that it can be a reference in determining whether or not further assessment and revision actions are intraoperative, which is ultimately expected to reduce the number failure of maturation of arteriovenous fistulas.

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"Latar belakang: Histerektomi merupakan tindakan operasi non-obstetrik terbanyak dengan prevalensi menurut CDC tahun 2011-2015 sebesar 3,2% pada perempuan usia <45 tahun. Uterus berperan baik secara langsung ataupun tidak langsung dalam produksi prostasiklin. Prostasiklin yang dihasilkan bersifat sebagai agen vasodilator pembuluh darah yang bersifat kardioprotektif. Prosedur histerektomi dengan atau tanpa konservasi ovarium mempengaruhi kadar konsentrasi prostasiklin secara sistemik sehingga meningkatkan risiko penyakit kardiovaskular. Oleh karena itu prosedur histerektomi khususnya pada perempuan usia <45 tahun perlu dipertimbangkan.Tujuan: Penelitian ini bertujuan untuk mengetahui perubahan tekanan darah sistolik, diastolik dan mean arterial pressure (MAP) pasca prosedur histerektomi.Metode: Studi ini merupakan studi kohort prospektif terhadap pasien yang dilakukan prosedur histerektomi total dengan atau tanpa konservasi ovarium di RSCM selama Juli 2018-Juli 2020. Data klinis diambil melalui rekam medis, wawancara dan pemeriksaan fisik pada pasien. Sampel kemudian dikelompokkan menjadi kelompok pasien histerektomi total (HT) atau dengan konservasi ovarium (HTSOU) dan kelompok pasien histerektomi salfingo-ooforektomi bilateral (HTSOB), dan dibagi menjadi kelompok usia <40 tahun dan 40-45 tahun. Setelah itu data karakteristik pasien disajikan dalam bentuk karakteristik, sedangkan uji bivariat dilaksanakan menggunakan uji t-tes berpasangan apabila data tersebar normal dan uji Wilcoxon apabila data tersebar secara tidak normal.Hasil: Dari jumlah sampel 80 pasien, didapatkan peningkatan bermakna dalam 12 bulan pasca tindakan pada kelompok pasien HT/HTSOU terhadap tekanan darah sistolik (p=0.012), diastolik (p=0.004), MAP (p=0.002) , sedangkan peningkatan bermakna sudah dapat dilihat dalam 6 bulan pada kelompok pasien HTSOB (sistolik p=<0.001, diastolik p=<0.001, MAP p=<0.001). Pada kelompok usia <40 tahun , didapatkan peningkatan bermakna dalam 12 bulan pasca tindakan pada kelompok pasien HT/HTSOU terhadap tekanan darah sistolik (p=0.006), diastolik (p=0.023), MAP (p=0.01) sedangkan pada kelompok HTSOB peningkatan bermakan sudah terlihat dalam 6 bulan (sistolik p=0.001, MAP p=0.032).Simpulan: Didapatkan peningkatan bermakna tekanan darah sistolik, diastolik dan MAP pada kelompok pasien HTSOB dalam 6 bulan dan kelompok HT/HTSOU dalam 12 bulan.

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Background: Hysterectomy is the most common non-obstetric surgery in adult, reproductive age women. Hysterectomy with or without ovarian conservation is known to increase the risk of cardiovascular disease. However, only a few studies regarding its immediate and short-term effect on hypertension are available. This study aimed to determine changes in blood pressure after a hysterectomy procedure.

Methods: This study is a prospective cohort study of patients who underwent a total hysterectomy procedure with or without ovarian conservation at Cipto Mangunkusumo Hospital, Indonesia, from July 2018 to July 2020. Samples were grouped into patients with total hysterectomy only or hysterectomy with ovarian conservation (HT/HTSOU) and bilateral salpingo-oophorectomy hysterectomy (HTSOB). Statistical analysis was done using paired t-test and Wilcoxon test.

Results: There were 80 patients included in this study (40 for each group). A significant increase in all blood pressure components was observed at 12 months after the procedure in the HT/HTSOU patient group (p < 0.05), while a significant increase was already observed at 6 months after the procedure in the HTSOB group (p < 0.05).

Conclusion: There was a significant increase in all blood pressure components in the HTSOB group at 6 months and the HT/HTSOU group at 12 months following hysterectomy.

Keywords : diastolic, Hysterectomy, mean arterial pressure, Hypertension, systolic"

"Pada organisme aerob, oksigen direduksi sempurna menjadi air di akhir rantai pernafasan di mitokondria yang menyediakan energi untuk menjaga fungsi normal set. Tetapi di dalam mitokondria ada molekul oksigen yang direduksi sebagian membentuk superoksida. Superoksida adalah radikal bebas, senyawa kimia yang mempunyai elektron tidak berpasangan. Radikal bebas sangat penting untuk banyak proses biologi seperti untuk melawan mikroorganisme yang patogen. Namun radikal bebas dapat merusak bila tidak dikontrol dan menyebabkan stres oksidatif.Stres oksidatif terjadi pula di jantung saat direoksigenasi setelah hipoksia, cedera yang terjadi disebut reperfusion injury. Jantung akan kehilangan fungsinya terutama kontraktilitasnya.Penelitian ini bertujuan untuk mengetahui efek kurkumin pada cedera reperfusi. Kurkumin adalah antioksidan yang mempunyai 2 cincin fenol. Kurkumin diduga' dapat mencegah ceders reperfusi setelah hipoksia jantung yang dilakukan pads model the isolated working heart. Penelitian ini menggunakan marmut jantan yang terbagi menjadi 3 kelompok, yaitu kelompok kontrol, kelompok kurkumin 0,25 1.tM, clan kelompok kurkumin 0,5 µM. Efek proteksi kurkumin dilihat dengan mengukur aliran darah koroner, aliran darah aorta, tekanan sistolik dan pengamatan histopatologi jantung.Aliran darah koroner meningkat selama reoksigenasi setelah 60 menit hipoksia, dengan kurkumin aliran darah koroner cenderung menurun. Aliran darah aorta dan tekanan sistolik menurun selama reoksigenasi setelah hipoksia 60 menu, dan cenderung meningkat setelah pemberian kurkumin. Histopatologi jantung yang direoksigenasi setelah hipoksia 60 menit memperlihatkan perubahan pada sel jantung. Kurkumin dosis 0,25 p.M cenderung iebih balk clan pada dosis 0,5 p.M dalam memproteksi jantung selama reoksigenasi setelah hipoksia 60 menit.

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The Effect of Curcumin Toward Coronary Flow, Aortic Flow, And Systolic Pressure in Hypoxia and Reoxygenation Isolated Working Heart Guinea PigIn aerobic organisms oxygen is converted to water at the end of the respiratory chain in mitochondria which provide the energy needed to maintain normal body function and metabolism. However, in the same mitochondrial respiratory chain, oxygen is "partially reduced" to form super oxide. Super oxide is a free radical, a chemical species with an unpaired electron. Free radicals are essential for many normal biological processes, i.e., they are essential in the response of tissue to invading microorganisms. However, they can be destructive if they are not tightly controlled.The oxidative stress also changes the heart in reoxygenation after hypoxia, which is called as reperfusion injury. The heart loses its function, especially contractility.The present study was conducted to find out the effect of curcumin in reoxygenation injury. Curcumin is an antioxidant, a symmetrical compound with two phenyl rings. It is hypothesized that curcumin is active to reduce reperfusion injury after hypoxia in the heart, assayed by the working guinea pig heart model. Three groups of male guinea pigs were used in this study, consisting of control group, curcumin 0, 25 µM, and curcumin 0,5 pM groups. The protective effect of curcumin was investigated by measuring coronary flow, aortic flow and systolic pressure, and by observing the histopathology of the heart.Reoxygenation of the heart after 60 minutes of hypoxia resulted in increased coronary flow, and curcumin decreased the coronary flow. Aortic flow and systolic pressure decreased during reoxygenation after 60 minutes of hypoxia, and curcumin increased aortic flow and systolic pressure. histopathology of the heart after reoxygenation and 60 minutes of hypoxia showed changes of the myocardium. Curcumin 0,25 µM was better than curcumin 0,50 p.M as a protective agent during reoxygenation after 60 minutes of hypoxia."

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Latar Belakang: Steal syndrome yang terjadi karena akses vaskular adalah komplikasi yang paling ditakutkan setelah pembuatan suatu fistula arteriovena, untuk itu perlu dikembangkan suatu bentuk pemeriksaan untuk deteksi awal. Hand ischemia questionnaire dan pengukuran peak systolic velocity arteri radialis dan arteri ulnaris merupakan bentuk pemeriksaan subyektif dan obyektif yang dipakai untuk mendeteksi steal syndrome

Tujuan: Untuk mengetahui korelasi antara hand ischemia questionnaire dengan peak systolic velocity pada arteri radialis dan arteri ulnaris pada pasien hemodialisa dengan akses fistula native lengan atas untuk mendeteksi gejala steal syndrome.

Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Maret hingga Mei 2019 pada pasien yang menjalani hemodialisis dengan menggunakan akses native fistula lengan atas dengan atau tanpa gejala iskemia pada tangan, metode pengisian kuesioner dengan cara wawancara termpimpin, kemudian dilanjutkan dengan pengukuran peak systolic velocity arteri radialis dan arteri ulnaris distal dari fistula arteriovena.

Hasil: Total sampel 80, sampel terbanyak berjenis kelamin wanita 43 (53,8%) sedangkan pria sebanyak 37 orang (46,2%). Sebanyak 91,2% sampel dengan FAV BC Sinistra, dengan median usia 53 tahun. Total skor HIQ yang didapat, minimum 0, maksimum 70, dengan nilai median 3. Nilai PSV arteri radialis minimum 20 cm/detik, maximum 79 cm/detik, median 40 cm/detik. Nilai PSV arteri ulnaris minimum 16 cm/detik, maksimum 70 cm/detik, median 41 cm/detik. Terdapat korelasi yang bermakna (p<0,001) antara hand ischemia questionnaire dengan peak systolic velocity arteri radialis dan arteri ulnaris pada pasien dengan native fistula lengan atas, namun setelah dilakukan uji diagnostik didapatkan sensitivitas hanya sebesar 15% dan spesifisitas 100%

Simpulan: Terdapat korelasi yang signifikan antara hand ischemia questionnaire dengan nilai peak systolic velocity arteri radialis dan arteri ulnaris pada pasien dengan native fistula lengan atas, namun karena didapatkan sensitifitas yang rendah sehingga hand ischemia questionnaire tidak dapat digunakan sebagai pemeriksaan awal untuk mendeteksi steal syndrome pada pasien dengan tanpa gejala iskemia tangan sebelumnya.

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Background: Dialysis access steal syndrome is the most feared complication after making arteriovenous fistulas, for which a form of examination for early detection needs to be developed. Hand ischemia questionnaire and measurement of peak systolic velocity of the radial artery and ulnar artery distal of the arteriovenous fistula are forms of subjective and objective examination used to detect steal syndrome

Objective: To determine the correlation between hand ischemia questionnaire with peak systolic velocity in the radial artery and ulnar artery in hemodialysis patients using native upper arm arteriovenous fistula to detect symptoms of steal syndrome.

Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period March to May 2019 in patients undergoing hemodialysis using native upper arm arteriovenous fistula access with or without symptoms of ischemia in the hand, the method of filling in the questionnaire by guided interview, then followed by measurements of the radial and ulnar artery peak stystolic velocity distal to the arteriovenous fistula

Results: The total sample was 80, the most samples were female 43 (53.8%) while men were 37 (46.2%). 91.2% of the samples had av fistula BC Sinistra, with a median age of 53 years. The total HIQ score obtained is  with a minimum value of 0, a maximum of 70, with a median value of 3. The radial arterial PSV value is with a minimum value of 20 cm/second, a maximum of 79 cm/second, a median of 40 cm/second. The ulnar arterial PSV value is at least 16 cm/second, maximum 70 cm/second, median 41 cm/second. There was a significant correlation (p <0.001) between the hand ischemia questionnaire and the peak systolic velocity of the radial and ulnar artery in patients with native upper arm arteriovenous fistula, but after a diagnostic test the sensitivity was only 15% with 100% specificity.

Conclusion: There was a significant correlation between the hand ischemia questionnaire and the value of the peak systolic velocity of the radial and ulnar arteries in patients with native upper arm fistula, but because of the low sensitivity that the hand ischemia questionnaire could not be used as an initial examination to detect steal syndrome in patients without previous symptoms of hand ischemia.

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"Latar belakang: Penyakit kardiovaskular sangat umum ditemukan dan berakibat fatal pada pasien dengan usia lanjut. Disfungsi sistolik ventrikel kiri yang asimptomatik atau subklinis sering kali mendahului penyakit ini. Deteksi dini terhadap disfungsi sistolik ventrikel kiri dapat mengurangi morbiditas dan mortalitas akibat penyakit kardiovaskular. Salah satu metode deteksi dini adalah dengan penilaian global longitudinal strain (GLS). Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui nilai rerata GLS pada pasien usia lanjut dengan frailty maupun non frailty dan mengetahui faktor-faktor yang berhubungan.Metode: Penelitian potong lintang dilakukan pada pasien usia lanjut diatas 60 tahun di poliklinik geriatri dan kardiologi Ilmu Penyakit Dalam RSCM. Data diperoleh dari wawancara, rekam medik dan pemeriksaan ekokardiografi transtorakal. Variabel penelitian berupa usia, frailty, hipertensi, penyakit jantung koroner, dislipidemia, dan diabetes melitus dianalisis sebagai determinan penurunan GLS. Analisis univariat terhadap masing-masing variabel. Analisis bivariat menggunakan uji chi kuadrat dengan tingkat signifikan p<0,25 dan interval kepercayaan (IK) sebesar 95%. Analisis multivariat menggunakan uji regresi logistik.Hasil: Sebanyak 194 subjek yang memenuhi kriteria pemilihan diikutkan dalam penelitian, rerata usia 66 tahun dengan 118 (60,8%) di antaranya perempuan. Penelitian ini mendapatkan beberapa determinan yang memiliki nilai p<0,25 yaitu frailty, hipertensi, dislipidemia, dan diabetes melitus dengan hasil analisis multivariat, frailty memiliki OR sebesar 2,002 (95% IK 1,042-3,925), dan diabetes melitus memiliki OR sebesar 2,278 (95% IK 1,033-5,025).Simpulan : Nilai median GLS pada usia lanjut secara umum adalah sebesar -21,6% (minimal -5,3% sampai dengan maksimal -29,9%). Faktor yang mempengaruhi penurunan GLS adalah frailty dan diabetes melitus.

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Background: Cardiovascular disease is very common and can be fatal in elderly patients. It is often preceded by asymptomatic or subclinical left ventricular systolic dysfunction (LVSD). Early detection of LVSD can reduce morbidity and mortality due to cardiovascular disease. One method used in the early detection of LVSD is an assessment of global longitudinal strain (GLS).Objective: To determine the mean value of GLS and GLS-related factors.Methods: This cross-sectional study was conducted among elderly patients aged > 60 years in the geriatric and cardiology polyclinic, Internal Medicine, CMH Hospital. Data were obtained from interviews, medical records, and transthoracic echocardiography examination. The variables of age, frailty, hypertension, coronary artery disease, dyslipidemia, and diabetes mellitus were analyzed as the determinants of a decrease in GLS. Univariate analysis was conducted for each variable. Bivariate analysis was conducted using the chi-square test with a significance level of p<0.25 and confidence interval (CI) of 95%, and multivariate analysis used a logistic regression test.Results: A total of 194 patients were admitted according to the study criteria, with a mean age of 66 years. The proportion of women was 60.8%. The study revealed that the determinants with p<0.25 are frailty, hypertension, dyslipidemia, and diabetes mellitus, with multivariate analysis frailty having an OR of 2.002 (95% CI 1.042-3.925) and diabetes mellitus having an OR of 2.278 (95% CI 1.033-5.025).Conclusions : The median value of GLS in elderly is -21,6% (minimum value -5,3% and maximum value 29,9%). The factors that influence the decrease of GLS are frailty and diabetes mellitus."

"Introduction: Steal syndrome that occurs due to vascular access is one of the most feared complications after making a fistula arteriovenous (FAV). It is necessary to develop an assessment for early detection. Hand ischemia questionnaire (HIQ) and measurement of peak systolic velocity (PSV) of the radial artery and the ulnar artery are a form of subjective and objective examinations used to detect steal syndrome. The aim is to determine the correlation between HIQ and PSV of the radial artery and ulnar artery in hemodialysis patients with upper arm’s native FAV to detect symptoms of steal syndrome. Method: This is a cross-sectional study conducted in Cipto Mangunkusumo National Hospital from March to May 2019. Patients undergoing hemodialysis using upper arm native access FAV with or without symptoms of ischemia in the hands were included. Patients were asked to fill HIQ by interview, and then continued with measurement of PSV of the radial arteries and distal ulnar arteries from the hands with FAV. Results: A total of 80 samples were taken with 43 were women (53.8%), and 37 were men (46.2%). About 91.2% of the samples were FAV at the brachiocephalic level. The median age of the samples was 53 years. From the total HIQ score obtained, the results were a minimum of 0, maximum of 70, and a median value of 3. PSV of radial artery were minimum of 20 cm/s, maximum of 79 cm/s, and median 40 cm/s. The minimum PSV of the ulnar artery was 16 cm/s, the maximum was 70 cm/s, and the median was 41 cm/s. There was a significant correlation between the hand ischemia questionnaire and the peak systolic velocity of the radial artery and the ulnar artery in patients with native upper arm FAV (p <0.001), but after diagnostic testing, it was found that sensitivity was only 15% and specificity was 100%. Conclusion: There was a significant correlation between hand ischemia questionnaire and peak systolic velocity of the radial artery and ulnar artery in patients with upper arm native FAV, but due to the low sensitivity, the hand ischemia questionnaire cannot be used as an initial examination to detect steal syndrome in patients with no symptoms of hand ischemia."