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"Mortalitas 30 hari pascaoperasi CABG di RSCM mencapai 13,96%. Angka ini jauh lebih besar dari mortalitas di Amerika Serikat 2% dan Pakistan 3,4%. Perbedaan yang besar ini menimbulkan pertanyaan adakah prediktor mortalitas lain selain yang terdapat pada EuroSCORE dan STS yang dapat menjadi prediktor mortalitas 30 hari pascaoperasi CABG di Indonesia. Penelitian ini berusaha mengetahui peran determinan praoperasi seperti yang terdapat pada EuroSCORE dan STS, determinan intraoperasi, dan pascaoperasi terhadap mortalitas 30 hari pascaoperasi CABG. Penelitian ini merupakan penelitian retrospektif menggunakan data sekunder rekam medis pasien berusia > 18 tahun yang menjalani operasi CABG di Pusat Jantung Terpadu, Rumah Sakit Dr. Cipto Mangunkusumo tahun 2012-2015. Analisis dilakukan secara multivariat regresi Cox untuk mendapat model akhir hubungan antara deteminan pra-, intra-, pasca-, dan perioperasi dengan mortalitas pascaoperasi CABG. Penelitian ini menunjukkan bahwa Terdapat hubungan antara disfungsi neurologi, disfungsi ginjal, disfungsi ventrikel kiri, lama klem aorta, durasi operasi, trombositopenia pasca operasi dan pemasangan IABP pasca operasi dengan HR (IK 95%) berturut-turut: 5,63 (2,18-14,49); 3,49 (1,30-9,42); 3,07 (1,30-7,23); 4,00 (1,62-9,88); 3,03 (1,08-8,49); 3,37 (1,40-8,14) dan 9,56 (4,03- 22,67). Di samping prediktor praoperasi yang sudah standar, lama klem aorta, durasi operasi, trombositopenia pascaoperasi dan pemasangan IABP pascaoperasi merupakan determinan yang perlu dipertimbangkan dalam memprediksi mortalitas 30 hari pascaoperasi CABG.

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Thirty-day mortality after CABG surgery in dr. Cipto Mangunkusumo Hospital is 13.96%, higher than in the US (2%) and Pakistan (3.4%). This huge difference suggests that there are other predictors beside those included in EuroSCORE dan STS. This research aimed to determine the role of preoperative, intraoperative, postoperative, and perioperative determinants of CABG surgery in 30-day mortality after the procedure. This was a retrospective study using secondary data from medical record of patients who underwent CABG in Comprehensive Heart Care Centre, dr. Cipto Mangunkusumo General Hospital in 2012-2015. Data were analysed using regresi Cox multivariate. This research showed that age, neurological dysfunction, renal dysfunction, left ventricle dysfunction, aortic clamp time, surgery duration, low platelet after surgery, and IABP support after surgery were associated with 30-day mortality after CABG with HR (95% CI) : 5,63 (2,18-14,49); 3,49 (1,30-9,42); 3,07 (1,30-7,23); 4,00 (1,62-9,88); 3,03 (1,08- 8,49); 3,37 (1,40-8,14) and 9,56 (4,03-22,67). In conclusion, besides scoring model determinants, low platelet count and administration of IABP after surgery should be considered as predictors of 30-day mortality after CABG."

"Latar Belakang: Acute Respiratory Distress Syndrome (ARDS) merupakan salah satu komplikasi progresivitas pneumonia, dengan risiko mortalitas dan kebutuhan ventilasi mekanik yang sangat tinggi. Identifikasi risiko tinggi kejadian ARDS sangat penting untuk meningkatkan kewaspadaan tenaga medis dan upaya pencegahan yang optimal. Tujuan: Mengetahui insidens ARDS pada pasien pneumonia dan mengetahui apakah hipoalbuminemia dapat memprediksi kejadian ARDS dalam 14 hari perawatan. Metode: Studi kohort prospektif pasien pneumonia yang dirawat ruang rawat inap RSPUN dr. Cipto Mangunkusumo dalam periode 1 Agustus-31 Desember 2015. Hipoalbuminemia didefinisikan sebagai kadar albumin admisi < 2,5 g/dL. Kejadian ARDS dinilai berdasarkan pemenuhan kriteria Berlin dalam 14 hari perawatan. Hasil: Subjek pada penelitian ini sebanyak 120 pasien. Insidens kumulatif ARDS sebesar 17,5% (IK95% 10,7%-24,3%). Analisis bivariat menunjukkan hipoalbuminemia dapat memprediksi peningkatan risiko ARDS dalam 14 hari perawatan (RR 3,455; IK 95% 1,658-7,200). Terdapat hubungan bermakna antara sepsis saat admisi dan keseimbangan cairan dengan kejadian ARDS dalam 14 hari perawatan. Analisis multivariat menunjukkan RR hipoalbuminemia setelah penyesuaian adalah 3,274 (IK 95% 1,495-5,528), dengan variabel perancu sepsis saat admisi. Simpulan: Insidens ARDS pasien pneumonia dalam 14 hari perawatan adalah 17,5%. Hipoalbuminemia dapat memprediksi peningkatan risiko kejadian ARDS dalam 14 hari perawatan pasien pneumonia.

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Background: Acute Respiratory Distress Syndrome (ARDS) is one of complication for pneumonia progression, it is associated with higher risk of mortality and increased need for mechanical ventilation. Identification of patients with high risk of developing ARDS is essential to increase physician alertness and ensure optimal prevention.

Purpose: To obtained information about incidence of ARDS in pneumonia diagnosed patients, and if hypoalbuminemia can predict occurrence of ARDS in 14 days after diagnosed pneumonia.

Method: Prospective cohort study in pneumonia diagnosed patients admitted in August until 31 December 2015, with 14 days of observation, all patient is being treated in medical ward unit of Cipto Mangunkusumo Hospital. Hypoalbuminemia is defined as albumin level below 2,5 g/dL and ARDS is defined by Berlin criteria.

Result: The study has enrolled 120 patient. Cumulative incidence of ARDS is 17,5% (IK95% 10,7%-24,3%). Bivariate analysis showed hypoalbuminemia could predict increased risk of ARDS in 14 days after diagnosed pneumonia (RR 3,455; IK 95% 1,658-7,200). There is significant relationship between sepsis at time of admission and mean fluid balance. Multivariate analysis shows adjusted RR 3,274 (IK 95% 1,495-5,528), with sepsis at time of admission as a confounder.

Conclusion: Cumulative incidence of ARDS in pneumonia diagnosed patient after 14 days is 17,5%. Hypoalbuminemia could predict increased risk of ARDS in 14 days of treatment in pneumonia diagnosed patients."

"Latar Belakang. Walaupun pasien HIV mendapat terapi antiretroviral yang efektif, penurunan fungsi fisik sering ditemukan lebih awal dan menimbulkan masalah baru berupa penuaan dan frailty.Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan prefrail dan frail pada pasien HIV dalam terapi antiretroviral.Metode. Desain studi potong lintang pada pasien HIV usia ≥30 tahun dalam terapi ARV minimal 6 bulan. Pasien yang memenuhi inklusi dilakukan pencatatan demografis, penyakit komorbid, faktor terkait HIV seperti lama terdiagnosis, lama ARV, dan CD4, pengukuran antropometri seperti indeks massa tubuh, penilaian depresi dengan Indo BDI-II, dan penilaian frailty dengan kriteria Fried. Pasien dengan riwayat infeksi otak, kanker, dan oportunistik aktif dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.Hasil. Terdapat 164 pasien yang dianalisis. Proporsi prefrail sebanyak 51,2% (84 pasien) dan frail 3,7% (6 pasien), dengan komponen dominan pada kelemahan genggam. Pasien laki-laki sebanyak 72% dengan median usia (IQR) 40,5 (36-47) tahun, dan median CD4 nadir (IQR) 53 (21-147) sel/mm3, median CD4 awal (IQR) 77 (32 - 206) sel/mm3. Hepatitis C menjadi faktor komorbid terbanyak. Depresi berhubungan dengan prefrail dan frail dengan OR 2,14 (IK95%: 1,034-4,439) dan p = 0,036. Tidak terdapat hubungan faktor usia ≥50 tahun, ≥2 penyakit komorbid, lama terdiagnosis HIV ≥5 tahun, lama ARV ≥5 tahun, CD4 <200 sel/mm3, indeks massa tubuh ≥25 kg/m2, dan pendapatan rendah dengan prefrail dan frail.Kesimpulan. Terdapat proporsi prefrail sebanyak 51,2% dan frail 3,7%. Depresi merupakan salah satu faktor yang terbukti berhubungan terhadap prefrail dan frail pada pasien HIV dalam terapi ARV.

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Background. Although HIV patients receive effective antiretroviral therapy, decrease in physical function is often found earlier and creates new problems in the form of aging and frailty

Aim. to determine the proportion and factors associated with prefrail and frail in HIV patients on antiretroviral therapy.

Method. A cross-sectional study design in HIV patients aged ≥30 years who were on ARV therapy for at least 6 months. Patients who fulfilled the inclusion were recorded demographically, comorbid diseases, HIV-related factors such as length of diagnosis, duration of ARV, CD4, anthropometric measurements such as body mass index, depression assessment with Indo BDI-II, and frailty assessment with Fried criteria. Patients with a history of brain infection, cancer, and active opportunists were excluded. Bivariate and multivariate analysis was carried out on these factors.

Results. There were 164 patients analyzed. The proportions of prefrail and frail were 51.2% and 3.7% respectively, with the dominant component in muscle weakness. Male patients were 72% with median age (IQR) 40.5 (36-47) years, median baseline CD4 (IQR) 77 (32 - 206) cell/mm3, and median nadir CD4 (IQR) 53 (21-147) cells/mm3. Hepatitis C is the most comorbid factor. Depression is related to prefrail and frail with OR 2.14 (95%CI: 1,034-4,439) and p = 0,036. There was no correlation between factors such as age ≥50 years, ≥2 comorbid diseases, length of diagnosis of HIV ≥5 years, duration of ARV ≥5 years, CD4 cell count <200 cells/mm3, body mass index ≥25 kg/m2, and low income with prefrail and frail.

Conclusion. The proportions of prefrail and frail are 51.2% and 3.7% respectively. Depression is one of the factors that is proven to be related to prefrail and frail in HIV patients in ARV therapy."

"ABSTRAKTujuanPenelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasijantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan halyang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasilpenilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapatmenentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkanParsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktorrisiko apa saja yang dapat mempengaruhi mortalitas perioperatif.Pasien dan MetodeDari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yangtelah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dantelah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson ChiSquare, dan uji Anova, keduanya juga dianalisis dengan kurva ROCHasilAngka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksimortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitassebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORElebih mendekati angka kematian riil bila dibandingkan Parsonnet score .KesimpulanEuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksiEuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukuryang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katupmitral

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ABSTRACTObjectiveThe use of risk stratified mortality studies for analyzing surgical outcome in cardiacsurgery is obviously a developing area. Unfortunately, outcomes research in valverepair surgery has been relatively limited. The risk stratification in the assessment ofcardiac surgical results is inevitable. Surgeons and hospitals need availability of riskassessment result which may influence decision-making. Without risk stratification,surgeons and hospitals treating high-risk patients will appear to have worse resultsthan others. Our purpose was to compare the performance of risk stratification models,Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)in our patients undergoing mitral valve repair (MVr) and predict the risk factors thatinfluence inhospital mortality .Patient and methodsFrom January 2010 to December 2012, 96 consecutive patients have undergone MVrusing cardiopulmonary bypass and scored according to Parsonnet score andEuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, crosstabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.ResultsOverall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it wasstatistically significant for the Parsonnet score and EURO score . Parsonnet Score hasa higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC forParsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with theParsonnet score of subjectivity, inclusion of many items not associated with mortality,and the overprediction of mortality have been highlighted. Pre operative NYHA class,age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet scoreduring mitral valve repair were statistically significant for affecting inhospitalmortality risk.ConclusionsThe EuroSCORE is more reasonable overall predictor of hospital mortality in ourpatients undergoing MVr compared to Parsonnet score."

"Latar belakang: Angka morbiditas dan mortalitas meningkat pada pasien fibrilasi atrium (FA) yang mengalami gagal jantung akut. Pada pasien irama sinus, left atrial volume index (LAVI) dan heart rate variability (HRV) merupakan prediktor kuat terjadinya komplikasi kardiovaskular. Penelitian LAVI dan HRV pada pasien FA hingga saat ini belum konklusif.Tujuan: Mengetahui hubungan LAVI dan HRV dengan kejadian gagal jantung akut pada pasien FAMetode: Studi kohort retrospektif dengan populasi terjangkau pasien dewasa FA di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) 1 Januari 2020 hingga 31 Desember 2021 yang berasal dari registri Optimal INR measures for Indonesians (OPTIMA). Data sekunder LAVI diukur dengan ekokardiografi dan parameter HRV terdiri dari standar deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), rasio low frequency dan high frequency (LF/HF) diukur menggunakan alat HRV portabel. Pasien diikuti hingga 30 Januari 2023, luaran dinilai dengan melihat catatan medik atau melalui telepon.Hasil: Dilakukan analisis pada 144 sampel. Proporsi kejadian gagal jantung akut sebesar 15,3%. Tidak terdapat hubungan antara SDNN dengan kejadian gagal jantung akut (RR 1,75; IK95% 0,260 – 11,779, p=0,565). Tidak terdapat hubungan antara LF/HF dengan kejadian gagal jantung akut (RR 2,865; IK 95% 0,765 – 10,732, p=0,118). Terdapat hubungan antara LAVI dengan kejadian gagal jantung akut (adjusted RR 2,501; IK 95% 1,003 – 6,236, p=0,049). Diabetes melitus dan hipertensi merupakan faktor perancu pada penelitian ini.Kesimpulan: Peningkatan LAVI berhubungan dengan kejadian gagal jantung akut pada pasien FA. HRV tidak berhubungan dengan kejadian gagal jantung akut pada pasien FA.

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Background Morbidity and mortality rates increase in patients with atrial fibrillation (AF) who experience acute heart failure. In patients with sinus rhythm, left atrial volume index (LAVI) and heart rate variability (HRV) are strong predictors of cardiovascular complications. Research on LAVI and HRV in AF patients has so far not been conclusive.

Objectives: To determine the relationship between LAVI and HRV and the incidence of acute heart failure in AF patients.

Methods: A retrospective cohort study was conducted with an accessible population of adult AF patients at RSCM from January 1, 2020, to December 31, 2021, originating from the Optimal measures INR for Indonesians (OPTIMA) registry. LAVI was measured by echocardiography, and HRV parameters consist of the standard deviation of NN intervals (SDNN), the root mean square of successive differences (RMSSD), and the ratio of low frequency and high frequency (LF/HF) measured using a portable ECG device. Patients were followed until January 30, 2023, and outcomes were assessed by looking at medical records or by telephone.

Result: A total of 144 subjects were analysed. The proportion of acute heart failure is 15.3%. There was no relationship between SDNN and the incidence of acute heart failure (RR 1.75; 95% CI 0.260–11.779, p=0.565). There was no relationship between LF/HF and the incidence of acute heart failure (RR 2.865; 95% CI 0.765–10.732, p=0.118). There is a relationship between LAVI and the incidence of acute heart failure (adjusted RR 2.501; 95% CI 1.003–6.236, p = 0.049). DM and hypertension were confounding factors in this study.

Conclusion: The elevation of LAVI is associated with the incidence of acute heart failure in AF patients. HRV is not associated with the incidence of acute heart failure in AF patients."

"Latar Belakang. Walaupun pasien HIV mendapat terapi antiretroviral yang efektif, penurunan fungsi fisik sering ditemukan lebih awal dan menimbulkan masalah baru berupa penuaan dan frailty.Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan prefrail dan frail pada pasien HIV dalam terapi antiretroviral.Metode. Desain studi potong lintang pada pasien HIV usia ≥30 tahun dalam terapi ARV minimal 6 bulan. Pasien yang memenuhi inklusi dilakukan pencatatan demografis, penyakit komorbid, faktor terkait HIV seperti lama terdiagnosis, lama ARV, dan CD4, pengukuran antropometri seperti indeks massa tubuh, penilaian depresi dengan Indo BDI-II, dan penilaian frailty dengan kriteria Fried. Pasien dengan riwayat infeksi otak, kanker, dan oportunistik aktif dieksklusi. Analisis bivariat dan multivariat dilakukan pada faktor-faktor tersebut.Hasil. Terdapat 164 pasien yang dianalisis. Proporsi prefrail sebanyak 51,2% (84 pasien) dan frail 3,7% (6 pasien), dengan komponen dominan pada kelemahan genggam. Pasien laki-laki sebanyak 72% dengan median usia (IQR) 40,5 (36-47) tahun, dan median CD4 nadir (IQR) 53 (21–147) sel/mm3, median CD4 awal (IQR) 77 (32 – 206) sel/mm3. Hepatitis C menjadi faktor komorbid terbanyak. Depresi berhubungan dengan prefrail dan frail dengan OR 2,14 (IK95%: 1,034–4,439) dan p = 0,036. Tidak terdapat hubungan faktor usia ≥50 tahun, ≥2 penyakit komorbid, lama terdiagnosis HIV ≥5 tahun, lama ARV ≥5 tahun, CD4 <200 sel/mm3, indeks massa tubuh ≥25 kg/m2, dan pendapatan rendah dengan prefrail dan frail.Kesimpulan. Terdapat proporsi prefrail sebanyak 51,2% dan frail 3,7%. Depresi merupakan salah satu faktor yang terbukti berhubungan terhadap prefrail dan frail pada pasien HIV dalam terapi ARV.

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Background. Although HIV patients receive effective antiretroviral therapy, decrease in physical function is often found earlier and creates new problems in the form of aging and frailty

Aim. to determine the proportion and factors associated with prefrail and frail in HIV patients on antiretroviral therapy.

Method. A cross-sectional study design in HIV patients aged ≥30 years who were on ARV therapy for at least 6 months. Patients who fulfilled the inclusion were recorded demographically, comorbid diseases, HIV-related factors such as length of diagnosis, duration of ARV, CD4, anthropometric measurements such as body mass index, depression assessment with Indo BDI-II, and frailty assessment with Fried criteria. Patients with a history of brain infection, cancer, and active opportunists were excluded. Bivariate and multivariate analysis was carried out on these factors.

Results. There were 164 patients analyzed. The proportions of prefrail and frail were 51.2% and 3.7% respectively, with the dominant component in muscle weakness. Male patients were 72% with median age (IQR) 40.5 (36-47) years, median baseline CD4 (IQR) 77 (32 - 206) cell/mm3, and median nadir CD4 (IQR) 53 (21–147) cells/mm3. Hepatitis C is the most comorbid factor. Depression is related to prefrail and frail with OR 2.14 (95%CI: 1,034-4,439) and p = 0,036. There was no correlation between factors such as age ≥50 years, ≥2 comorbid diseases, length of diagnosis of HIV ≥5 years, duration of ARV ≥5 years, CD4 cell count <200 cells/mm3, body mass index ≥25 kg/m2, and low income with prefrail and frail.

Conclusion. The proportions of prefrail and frail are 51.2% and 3.7% respectively. Depression is one of the factors that is proven to be related to prefrail and frail in HIV patients in ARV therapy."

"Latar belakang.Kardiomiopati terimbas kemoterapi berbasis antrasiklin memiliki dampak signifikan terhadap pasien kanker. Pemantuan fungsi jantung berbasis fraksi ejeksi, yang saat ini menjadi standar, tidak dapat mengetahui kerusakan secara awal dan bila ditemukan kardiomiopati maka kerusakan sudah terlambat. Penggunaan biomarker dan teknik pencitraan ekokardiografi dengan strain dipikirkan dapat memberi gambaran kejadian kardiomiopati awal. Oleh karena itu, perlu dilakukan aplikasi dari penggunaan troponin dalam memprediksi kejadian kerusakan jantung pada pasien yang menjalani kemoterapi berbasis antrasiklin.

Tujuan. Untuk mengetahui hubungan antara peningkatan kadar high sensitivity troponin I dengan kejadian kardiomiopati subklinis pada pasien kanker yang yang menjalani kemoterapi berbasis antrasiklin

Metode. Studi kohort prospektif dilakukan pada Januari-September 2023. Pasien kanker berusia diatas 18 tahun yang mendapatkan kemoterapi berbasis antrasiklin di Rumah Sakit Cipto Mangunkusumo dan Rumah Sakit Kanker Dharmais direkrut untuk penelitian. Pemeriksaan high sensitivity troponin dilakukan pada 6 titik waktu pra dan pascasiklus pertama, kedua, dan ketiga. Pemantauan Global longitudinal strain dilakukan sebelum kemoterapi, pascakemoterapi siklus ke 2,  siklus ke 4 dan siklus ke 6.  Kardiomiopati subklinis didefinisikan sebagai penurunan GLS >15% dari data dasar. Dibuat kurva ROC dari nilai titik potong high sensitivity troponin I  terhadap kejadian kardiomiopati subklinis.  

Hasil. Dari 61 subjek, didapatkan insiden kardiomiopati subklinis sebesar 29,4% (95% IK 9,4-18,6). Tidak didapatkan titik potong dari perubahan high sensitivity troponin I dalam memprediksi kardiomiopati subklinis.

Kesimpulan. Tidak didapatkan hubungan antara kadar high sensitivity troponin I dengan kejadian kardiomiopati subklinis pada pasien kanker yang yang menjalani kemoterapi berbasis antrasiklin.

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Background. Chemotherapy based anthracycline induced cardiomyopathy has a significant impact on cancer patients. Monitoring heart function based on ejection fraction, which currently is the standard, cannot detect damage early and by the time cardiomyopathy is detected, the damage is already advanced. The use of biomarkers and echocardiographic imaging techniques with strain is thought to provide insight into early cardiomyopathy occurrences. Therefore, there is a need to apply troponin usage in predicting heart damage events in patients undergoing anthracycline-based chemotherapy.

Aim. To determine the relationship between an increase in high sensitivity troponin I levels and subclinical cardiomyopathy incidence in cancer patients undergoing anthracycline-based chemotherapy.

Method. A prospective cohort study was conducted from January to September 2023. Cancer patients over 18 years of age receiving anthracycline-based chemotherapy at Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital were recruited for the research. High sensitivity troponin examinations were conducted at 6 pre- and post-cycle time points (first, second, and third cycles). Global longitudinal strain monitoring was performed before chemotherapy, after the second cycle, fourth cycle, and sixth cycle. Sublinical cardiomiopathy is defined as a reduction in GLS > 15% from baseline. An ROC curve was generated for the high sensitivity troponin I cutoff values against subclinical cardiomyopathy occurrences.

Results. Out of 61 subjects, incidence of subclinical cardiomyopathy was found to be 29.4% (95% CI 9.4-18.6). No cutoff point was found for changes in high sensitivity troponin I in predicting subclinical cardiomyopathy.

Conclusion. There was no relationship found between high sensitivity troponin I levels and subclinical cardiomyopathy occurrences in cancer patients undergoing anthracycline-based chemotherapy."

"Latar belakang: Pemberian albumin hiperonkotik intravena lazim dilakukan pada pasien hipoalbuminemia berat (kadar albumin plasma ≤2,5 g/dl). Walaupun demikian, hingga ini, berbagai referensi menunjukkan hasil yang inkonklusif terkait manfaat "koreksi" kadar albumin pada pasien, terutama dalam menurunkan mortalitas dan morbiditas.Metode: Penelitian ini menilai karakteristik pasien hipoalbuminemia berat dan pola penggunaan albumin intravena hiperonkotik di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo. Analisis kesintasan dilakukan dengan variabel bebas berupa pemberian albumin intravena, penyakit dasar, kadar albumin saat admisi dan sebelum pemberian, serta durasi hingga temuan hipoalbuminemia berat. Data deskriptif ditampilkan terkait pemberian albumin, yaitu mencakup jumlah yang diberikan dan respons terhadap pemberian albumin.Hasil dan Diskusi: Mayoritas pasien (79,19%) dengan kadar albumin ≤2,5 g/dl diberikan albumin hiperonkotik intravena. Insidens mortalitas 30 hari pada pasien hipoalbuminemia berat adalah 47,20%. Pemberian albumin intravena didapatkan tidak memiliki hubungan bermakna dengan kesintasan 30 hari (HR 0,902; IK 95% 0,598-1,361; p=0,624). Faktor yang berhubungan bermakna dengan kesintasan 30 pada pasien hipoalbuminemia berat adalah sepsis, syok hipovolemik, keganasan padat, serta temuan kadar albumin sebelum pemberian ≤2,0 g/dl.Kesimpulan: Pemberian albumin hiperonkotik intravena pada pasien rawat inap tidak berhubungan dengan kesintasan 30 hari.

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Introduction: Intravenous hyperoncotic albumin administration is a common practice to be done to patients with severe hypoalbuminemia (plasma albumin level ≤2.5 g/dl). However, until now, many references has shown inconclusive results associated with "correction" of albumin level in patients, especially in reducing mortality and morbidity.

Method: This study assessed severe hypoalbuminemia patients' characteristics and pattern of use from hyperoncotic albumin intravenously in Cipto Mangunkusumo National Hospital. Survival analysis was done with independent variables including: intravenous albumin administration, underlying diseases, albumin level during admission and before albumin administration, as well as time duration from admission to severa hypoalbuminemia detection. Descriptive data was also shown associated with albumin administration consisted of amount of albumin given and response after albumin administration.

Result and Discussion: Majority of subjects (79.19%) with albumin level ≤2.5 g/dl was given hyperoncotic albumin intravenously. Incidences of 30-day mortality in severe hypoalbuminemia patients is 47.20%. There as no association between intravenous albumin administration and 30-day survival (HR 0.902; 95 CI% 0,598-1.361; p=0.624). Factors which were found associated with 30-day mortality are sepsis, hypovolemic shock, solid malignancy, and findings of albumin level ≤2.0 g/dl before albumin administration.

Conclusion: Hyperoncotic intravenous albumin administration didn't associate with 30-days survival."

"ABSTRAKLatar BelakangTrakeostomi merupakan tindakan yang umum dilakukan di unit perawatan intensif. Tindakan trakeostomi dapat menurunkan hambatan udara jalan napas, memiliki potensi untuk menurunkan obat sedasi dan pneumonia terkait ventilator sehingga diharapkan dapat menurunkan mortalitas dan morbiditas pasien di unit perawatan intensif. Namun batasan waktu untuk melakukan trakeostomi pada pasien kritis yang diprediksikan akan memerlukan bantuan ventilasi jangka panjang hingga saat ini masih dalam perdebatan karena berbagai penelitian terdahulu menunjukkan hasil yang berbeda-beda.TujuanMengetahui hubungan antara saat trakeostomi dengan mortalitas perawatan unit intensif. Mengetahui insiden mortalitas antara trakeostomi dini dan lanjut pada pasien perawatan unit intensif dengan ventilasi mekanik.MetodologiPenelitian dengan desain kohort retrospektif, dilakukan terhadap 162 pasien kritis dengan ventilasi mekanik yang menerima tindakan trakeostomi selama perawatan intensif di RSUPN Dr. Cipto Mangunkusumo pada kurun waktu Januari 2008-Desember 2012. Data saat untuk melakukan trakeostomi, klinis, laboratorium, dan radiologis dikumpulkan. Pasien diamati untuk melihat kejadian mortalitas selama perawatan intensif. Analisis hubungan antara saat trakeostomi dengan mortalitas perawatan intensif menggunakan tes X2. Analisis multivariat dengan regresi logistik digunakan untuk menghitung adjusted odds ratio (dan interval kepercayaan 95%) antara kelompok trakeostomi dini dan lanjut untuk terjadinya mortalitas perawatan intensif dengan memasukkan variabel-variabel perancu sebagai kovariat.HasilTerdapat hubungan yang tidak bermakna antara trakeostomi dini dan lanjut dengan mortalitas unit perawatan intensif pada uji X2 (p=0,07) dengan RR 0,67 (IK95% 0,51-1,05). Insiden mortalitas pada trakeostomi dini dan lanjut sebesar 28,4% dan 42%.KesimpulanKelompok trakeostomi dini cenderung untuk memiliki insiden mortalitas yang lebih rendah dibandingkan dengan trakeostomi lanjut. Namun saat trakeostomi tidak berhubungan dengan mortalitas unit perawatan intensif secara statistik.

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ABSTRACTBackgroundTracheostomy is a common procedure in the intensive care unit . Tracheostomy can reduce airway resistance, the usage of sedation and ventilator-associated pneumonia. Based on these advantages, tracheostomy can potentially reduce ICU mortality and morbidity . But the timing to perform a tracheostomy in critically ill patients who are predicted to require long-term ventilatory support is still under debate, because previous studies showed different results.ObjectiveInvestigating the association between tracheostomy timing with intensive care unit mortality. Knowing the incidence of ICU mortality between early and late tracheostomy in patients with mechanical ventilation in intensive care unit.MethodsRetrospective cohort study design was conducted on 162 critically ill patients in mechanical ventilation. These patients also underwent tracheostomy procedure during intensive care treatment in Cipto Mangunkusumo during period from January 2008-December 2012. The timing to tracheostomy, clinical, laboratory, and radiological data were collected . Patients were observed for the incidence of mortality during intensive care. Chi Square test was used to analyze the relationship between tracheostomy timing with intensive care unit mortality. Multivariate analysis with logistic regression was used to calculate adjusted odds ratios ( and 95% confidence intervals ) between early and late tracheostomy group to the intensive care mortality by including confounding variables as covariates .ResultsThere is no significant association between early and late tracheostomy with the intensive care unit mortality ( p = 0.07 ) with a risk ratio (RR) of 0.67 ( CI 95 % 0.51 to 1.05 ) . The incidence of mortality in early and late tracheostomy was 28.4 % and 42 % .ConclusionEarly tracheostomy group tended to have a lower mortality incidence compared with late tracheostomy. Association between timing to tracheostomy with the intensive care unit mortality was not statistically significant."

"Latar Belakang. Keluarga derajat pertama (first degree relatives/FDR) dari Diabetes Melitus tipe 2 (DMT2) memiliki kecenderungan untuk memiliki gangguan metabolik dan vaskular lebih dini tanpa melaui resistensi insulin (RI) sebagai perantaranya seperti lebih tebalnya tunika intima media karotis. Penyakit perlemakan hati non-alkoholik (non-alcoholic fatty liver disease/NAFLD) adalah penyakit hati kronik yang banyak ditemukan pada pasien DMT2 yang dependen terhadap RI. Studi tentang hubungan FDR DMT2 dengan NAFLD masih sangat terbatas dan inkonklusif. Hubungan tersebut masih belum jelas apakah kejadian NAFLD pada FDR DMT2 dependen terhadap RI atau karena kerentanan genetik FDR DMT2. Tujuan. Untuk mengetahui hubungan antara FDR DMT2 dengan NAFLD. Metode. Sebanyak 118 dewasa muda (19-39 tahun) dengan toleransi glukosa normal (59 subjek FDR DMT2 dan 59 subjek non-FDR dengan matching usia dan jenis kelamin) diikutsertakan dalam penelitian potong lintang ini. Pengukuran antropometri (tinggi, berat badan, indeks massa tubuh (IMT) dan lingkar perut) dan analisis laboratorium (glukosa darah puasa, HbA1c, profil lipid, serum glutamic pyruvic transaminase (SGPT)), serum glutamic oxaloacetic transaminase (SGOT)) diperiksa pada penelitian ini. Perlemakan hati didiagnosis dengan ultrasonografi (USG) menggunakan kriteria standar. Hasil Penelitian. Dua puluh enam subjek (22,03%) dengan NAFLD terdeteksi dengan USG dalam penelitian ini dengan proporsi yang sama pada kedua kelompok. Pada kelompok FDR DMT2 didapatkan jumlah subjek dengan angka HDL rendah dan sindrom metabolik lebih tinggi dibandingkan dengan kelompok tanpa FDR. Kesimpulan. Pada penelitian ini tidak didapatkan hubungan antara FDR DMT2 dengan NAFLD.

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Background. First degree relatives (FDR) of type 2 diabetes mellitus (T2DM) predisposes individuals to have earlier metabolic and vascular disorders independent of insulin resistance (IR) such as thicker carotid intima media thickness than that of non-FDR. Non-alcoholic fatty liver disease (NAFLD) is the most commonly found chronic liver disease in T2DM which is IR dependent. Studies about NAFLD in FDR of T2DM populations are very limited and inconclusive. It is unclear whether the occurrence of NAFLD in FDR of T2DM is IR dependent or due to genetic vulnerability.

Aim. to determine the association between NAFLD and FDR of T2DM.

Method. A total of 118 young adults (19-39 years old) with normal glucose tolerance (59 FDR of T2DM and age-sex matched 59 non-FDR subjects) were included in this cross-sectional study. Anthropometric measurement (height, weight, BMI and waist circumference) and routine laboratory analysis (fasting blood glucose, HbA1c, lipid profile, alanine aminotransferase (ALT), aspartate transaminase (AST)) were examined. Fatty liver was diagnosed by ultrasonography (US) using standard criteria.

Result. Twenty-six (22,03%) subjects with NAFLD were detected by US with similar proportion for each group. Low HDL level and metabolic syndrome were found higher in FDR group.

Conclusion. we couldn`t prove the association between FDR of T2DM and NAFLD in this research."