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Abstrak :
Menjadi kanker terbanyak ke empat yang dialami oleh wanita, diagnosis yang cepat dan tepat diperlukan dalam tatalaksana kanker serviks. Terdapat beberapa cara dalam diagnosis kanker serviks, seperti colposcopy dan biopsi. Namun masih terkendala dengan waktu yang terlalu lama, biaya yang besar, dan interpretasi hasil pada manusia yang kerap kali berbeda. Seriring dengan perkembangan ilmu pengetahuan dan teknologi, kebutuhan akan teknologi baru meningkat untuk mengatasi kendala tersebut. Differential Scanning Calorimetry (DSC) menjadi suatu pilihan dalam mengkarakteristikan nilai profil termogram yang khas ada pada sel kanker serviks mengingat DSC sangat sensitif terhadap perubahan suhu. Penelitian ini menggunakan sampel yang dikelompokkan menjadi sel normal serviks, sel kanker serviks HeLa tanpa perlakuan, dan sel kanker serviks HeLa dengan pemberian doxorubicin. Tiap kelompok memuat 4 sampel. Sel dikultur dan di ekstraksi sebanyak 5 mL dengan konsentrasi 2,5 x 108 /ml. Kemudian sel beserta medium RPMI 1640 diambil 10 μl dan diletakkan kedalam DSC-60 plus series (shimadzu) sebagai pembaca nilai profil termogram. Hasil pembacaan pada DSC berupa grafik yang dianalisis bagian puncaknya untuk mendapatkan komponen nilai profil termogram, yakni titik lebur dan entalpi lebur. Selanjutnya nilai titik lebur dan entalpi lebur dilakukan pengujian dengan uji ANOVA satu arah. Hasil pembacaan DSC menunjukkan adanya 1 puncak transisi pada kelompok sel kanker serviks HeLa tanpa perlakuan. Khususnya pada kelompok sel kanker serviks HeLa dengan pemberian doxorubicin, grafik menunjukkan 2 puncak transisi. Nilai titik lebur dan entalpi lebur pada kelompok sel kanker serviks HeLa tanpa perlakuan adalah 143,12 ± 10,2 oC dan 1,35 ± 0,34 kJ/g Kedua nilai tersebut berbeda bermakna diantara kelompok sel normal serviks serviks dan sel kanker serviks HeLa dengan pemberian doxorubicin. DSC dapat membedakan nilai profil termogram sel kanker serviks HeLa dengan sel normal serviks dan sel kanker serviks HeLa dengan pemberian doxorubicin sehingga DSC diharapkan menjadi pilihan dalam diagnosis dan pemantauan terapi. ...... Being the fourth most cancer experienced by women, a prompt and appropriate diagnosis is needed in the management of cervical cancer. There are several modalities in the diagnosis of cervical cancer cells, such as colposcopy and biopsy. But there is still obstacles such too long time, large costs, interpretation of results in humans that are often different, and procedures that are less comfortable for patients. Along with the development of science and technology, the need for new technologies is increasing to overcome these obstacles. Differential Scanning Calorimetry (DSC) is an option in characterizing typical thermogram profile values in cervical cancer cells because DSC is very sensitive to temperature changes. This study used samples grouped into normal cervical cells, untreated HeLa cervical cancer cells, and HeLa cervical cancer cells with doxorubicin administration. Each group contains 4 samples. Cells were cultured and extracted as much as 5 mL with a concentration of 2.5 x 108/ ml. Then the cell with RPMI 1640 medium was taken 10 µl and placed into DSC-60 plus series (shimadzu) as a reader for the thermogram profile value. The reading results on the DSC in the form of a graph that analyzed the transisional peak to get the thermogram profile value component, which is the melting point and enthalpy change. Furthermore, the value of the melting point and enthalpy changes were tested by one-way ANOVA test. DSC readings showed a transition peak in the HeLa cervical cancer cell group without treatment. Especially in the HeLa cervical cancer cell group with doxorubicin administration, the graph shows 2 transition peaks. Melting point values and enthalpy changes in the HeLa cervical cancer cell group without treatment were 143.12 ± 10.2 oC and 1.35 ± 0.34 kJ/g. Both values were significantly different between normal cervical cell groups and HeLa cervical cancer cells with doxorubicin administration. DSC can differentiate the profile value of the thermogram of HeLa cervical cancer cells with normal cervical cells and HeLa cervical cancer cells by administering doxorubicin so that DSC is expected to be an option in therapeutic diagnosis and monitoring.

Abstrak :
Proporsi PJK menurut SKRT 1995 adalah 26 %, tidak saja menempati urutan pertama pada penyakit Cardin vasculer disease tapi juga meningkat dari tahun ke tahun, hal ini sangat dipengaruhi oleh gaya hidup. Tujuan penelitian ini adalah untuk melihat pengaruh rasio total kolesterol/HDL, HDL, trigliserida terhadap timbulnya PJK. Manfaat aplikatif dari penelitian ini untuk dapat melakukan pencegahan terhadap timbulnya PJK terutama bagi orang orang yang mempunyai risiko tinggi. Metode : Desain penelitian adalah kasus kontrol dengan populasi kasus penderita PJK di RSPP Januari ski Desember 1997 Jakarta Selatan sebanyak 60 kasus yang di diagnosis DSPD atau DSJP, untuk kontrol diambil dari bagian Bedah umum sebanyak 60 orang yang di nyatakan tidak menderita PJK oleh DSPD dan atau DSJP Dengan kekuatan 80 %, dan derajat kepercayaan 95 %. Penentuan cut off point memakai Cara ROC, serta data di analisis dengan analisis logistik regresi. Hasil penelitian : Pada analisis bivariat rasio total kollesterol ? 4,19 mempakan faktor risiko untuk terkena PJK 1,23 kali 95 % CI ( 0,5023-3,0218 ) di bandingkan mereka dengan kadar rasio total kolesterolJHDL kurang dari 4,19 walaupun secara statistik tidak bermakna 1-IDL pada kadar >36 mg/dl meznpunyai risiko rendah untuk terkena PJK yaitu 0,40 kali 95% CI (0,1683-0,9505) secara statistik bermakna, demikian juga trigliserid pada kadar ≥ 106 mg/dl merupakan faktor risiko terkena PJK sebesar 2,63 kali 95% CI ( 1,0748-6,4159 ) secara statistik bermakna. Dari hasil analisis multivariat permodelan akhir rasio total kolesterol/HDL merupakan faktor risiko 1,53 kali untuk terjadinya PJK, 95% Cl ( 0,5407 - 4,3490 ), HDL tinggi merupakan faktor proteksi sehingga risiko untuk terkena PJK rendah yaitu 0,23 kali, 95% CI ( 0,0761- 0,8719 ), hipertrigliserid mempunyai risiko 2,85 kali untuk terkena PJK, 95% C1 ( 1,0352 -7,8240 ), umur mempunyai risiko 1,09 kali untuk terkena PJK, 95% Cl (1,7128-64,3385) body mass index tinggi mempunyai risiko 3,54 kali untuk terkena PJK. Kesimpulan : Rasio total kolesterol/HDL yang tinggi merupakan faktor risiko untuk terkena PJK dengan di kontrol oleh variabel lain walaupun secara statistik tidak bermakna, pada kadar HDL rendah merupakan faktor risiko untuk terkena PJK baik( berdiri sendiri maupun di kontrol oleh variabel lain, demikian juga trigliserid tinggi merupakan faktor risiko untuk terkena PJK baik berdiri sendiri maupun setelah di kontrol oleh variabel lain. ......Proportion of cardio vascular diseases according to SKRT 1995 is 26 %, this not only occupies the top of the list of cardio vascular diseases, but also has been increasing over the years, which is highly influenced by life style. Purpose of this research is to study the ratio effect of total cholesterol/NDL, HDL, triglyceride against emergence of cardio vascular disease. The applicative benefit of this research is in order to be able to carry out preventive measures against emergence of cardio vascular disease, particularly for persons with high risk. Method : Design of research is case control with a population case of cardio vascular disease in Pertarnina hospital centre from January to December 1997 in South Jakarta, totalling 60 cases which were diagnozed by internist or cardiologist. Based on a strength of 80 % and 95 % confidence interval, determination of the cut point was done by using the ROC method, and data being furher analyzed by logistic regression analysis. Research Result : In bivariate analysis, the cholesterol total ratio Z 4.19 constitutes a risk factor to be subjected to cardio vascular disease L23 times 95% Cl ( 0.5023 - 3.0218) compared with those with a total ratio content of chloresterolfHDL of less than 4.19, even though statistically it has no significance_ NDL at the content of z 36 mg/dl has a lower risk to be affected by radio vascular disease, notably 0.40 times 95% Cl ( 0.1683 -- 0.9505 ) by way of reliable statistics, the same goes for triglyceride at the content of z 106 mg/dl constitutes an risk factor 163 times to be affected by cardio vascular disease 95% CI ( 1.0748 - 6,4159 ) by reliable statistics. From results of multivariate analysis of latest total ratio models cholesterolll4DL constitutes a risk factors of 1.53 times to be affected by cardio vascular disease, 95% CI ( 0.5408 - 4.3490 ), high HDL constitutes a protective factor thus resulting the risk to be affected by cardio vascular disease is low, notably 0.23 times, 95% Cl ( 0.0761- 0,8719 ), hypertriglyceride has the risk of 2.85 times to be affected by cardio vascular disease 95% CI ( L0352 -- 7.8240 ), age has the risk factor of 1.09 times to be affected by cardio vascular disease 95% Cl ( 1.0356 --L1643 ), hyperglycemia has the risk of 10.49 times to be affected by cardio vascular disease 95% Cl ( L7128 - 64.3385 ), high body mass index the risk of 154 times to be affected by cardio vascular disease. Conclusion : Total ratio of high CholesterolLHDL constitutes a risk factor to be affected by cardio vascular disease with the control of other variables, even though statistically this is not significant, while a low HDL content constitutes a risk factor to be affevted by cardio vascular disease, both individually as well as under control by other variables, the same is valid for high tiglyceride also constitues a risk factor to be affected by cardio vascular disease, both individually as well after being controlled by other variables.

Abstrak :
Latar belakang: Pasien pascabedah pintas arteri koroner (BPAK) mengalami penurunan fungsi paru akibat inflamasi perioperatif sehingga terjadi ketidakcocokan ventilasi/perfusi dan kelemahan otot pernapasan. Akibatnya saat beraktivitas, terjadi keterbatasan oksigen sehingga terjadi kelelahan otot lebih cepat dan kapasitas fungsional rendah. Latihan pernapasan diharapkan membantu memperbaiki kapasitas fungsional melalui perbaikan fungsi paru. Tujuan: Membuktikan manfaat latihan pernapasan terhadap kapasitas fungsional yang diukur dengan 6 Minutes walk test (6MWT) pada pasien pasca-BPAK yang menjalani rehabilitasi kardiovaskular fase II. Metode: Uji klinis dengan merandomisasi subjek pada kelompok perlakuan yang mendapat adjuvan latihan pernapasan atau menjalani program rehabilitasi standard. Diukur kapasitas inspirasi dan 6MWT pada awal dan akhir rehabilitasi fase II. Hasil: Dua puluh delapan subjek dirandomisasi menjadi 14 kelompok perlakuan dan 14 kelompok standard. Setelah menjalani program rehabilitasi, kelompok perlakuan dan standard mengalami peningkatan jarak 6MWT yang tidak berbeda bermakna (67 ± 62.9 meter VS. 53 ± 65.7 meter; p = 0.556 ) walau kelompok perlakuan mengalami peningkatan kapasitas inspirasi lebih baik daripada kelompok standard (1357 ± 691.4 mL VS 589 ± 411.5 mL; p = <0.001 ). Simpulan: Latihan pernapasan sebagai latihan adjuvan rehabilitasi kardiovaskular fase II pasca-BPAK tidak memperbaiki jarak 6MWT secara bermakna dibandingkan program rehabilitasi standard, hanya mempercepat perbaikan fungsi paru. ......Background : Patients undergoing coronary artery bypass graft (CABG) surgery develop pulmonary dysfunction due to inflammation and respiratory muscle weakness, hence ventilation/perfusion mismatch occurs then leads to low functional capacity. Respiratory training has been identified to improve functional capacity by recovering pulmonary function faster. Objectives : To study respiratory training benefit as adjuvant training in 2 phase of cardiovascular rehabilitation program after CABG for improving functional capacity measured by 6 minutes walk test/6MWT distance. Methods : This single blind clinical trial randomized subjects into intervention group or standard group. Intervention group received respiratory training up to 60% of maximum inspiratory volume (MIV) as an adjuvant to the standard program. Then MIV and 6MWT distance were evaluated. Result : Twenty eight subjects participated, 14 subjects were in intervention group and others were in standard group. Six MWT distance improvement is not significantly different between groups (67 ± 62.9 VS. 53 ± 65.7 meters respectively; p = 0.556 ). However, intervention group experienced better MIV improvement compared to standard group (1357 ± 691.4 VS. 589 ± 411.5 mL; p = <0.001 ). Conclusion : Respiratory training as adjuvant training did not improve 6MWT distance among patients undergoing CABG surgery significantly.

Abstrak :
Latar Belakang. Hipertensi merupakan salah satu masalah kesehatan dunia dan merupakan salah satu faktor risiko penyakit kardiovaskular yang berhubungan dengan proses aterosklerosis dan aterotrombosis. Pengukuran tekanan darah di klinik atau rumah sakit saat ini masih dianggap sebagai metode referensi dalam mendiagnosis dan evaluasi pasien hipertensi, tetapi disebabkan adanya fenomena white-coat terlihat semakin jelas informasi yang diberikan seringkali tidak adekuat tentang status tekanan darah pasien yang sebenarnya. Hipertensi sendiri dikaitkan dengan kerusakan target organ dan salah satu diantaranya ke organ pembuluh darah. Pemeriksaan ketebalan tunika intima media arteri karotis dimaksudkan untuk melihat kerusakan yang terjadi akibat efek fenomena white-coat pada pembuluh darah yang mencerminkan terjadinya proses aterosklerosis dini. Tujuan dari penelitian ini adalah menilai hubungan antara kejadian fenomena white-coat pada pasien hipertensi dalam pengobatan dengan ketebalan tunika intima media arteri karotis. Metode. Studi potong lintang dengan pengambilan pasien hipertensi dalam pengobatan secara konsekutif, mulai bulan Januari - Mei 2014 di poli rawat jalan RS Jantung dan Pembuluh Darah Harapan Kita, Jakarta. Pasien menjalani pemeriksaan OBP saat kontrol dan HBP dilakukan selama 4 hari berturut-turut dengan memakai alat tensimeter osilometri yang tervalidasi. Pemeriksaan ketebalan tunika intima media arteri karotis dilakukan pada semua pasien yang masuk dalam kriteria inklusi untuk mendapatkan nilai rerata ketebalan kompleks tunika intima. Hasil. Didapatkan 219 subyek penelitian yang masuk kriteria inklusi. Uji statistik Mann Whitney digunakan untuk mengetahui hubungan pasien hipertensi yang mengalami fenomena white-coat dengan ketebalan tunika intima media arteri karotis. Hasil yang didapat, tidak terdapat perbedaan rerata yang bermakna secara statistik ketebalan tunika intima media arteri karotis antara pasien hipertensi yang mengalami fenomena white-coat dan yang tidak (A. Karotis kanan 0,7 ± 0,5 vs 0,8 ± 0,4 mm, nilai p = 0,153 ; A. Karotis kiri 0,8 ± 0,4 vs 0,7 ± 0,4 mm, nilai p = 0,900 ; A. Karotis kanan dan kiri 0,7 ± 0,4 vs 0,8 ± 0,3 mm, nilai p = 0,260). Dari hasil uji bivariat terhadap seluruh faktor perancu didapatkan variabel obat antihipertensi golongan enzym penyekat angiotensin dan usia terbukti sebagai perancu dalam penilaian hubungan antara fenomena white-coat dengan rerata ketebalan tunika intima media arteri karotis. Kesimpulan. Penelian ini menunjukkan bahwa tidak terdapat perbedaan rerata yang bermakna secara statistik ketebalan tunika intima media arteri karotis antara pasien hipertensi yang mengalami fenomena white-coat dan yang tidak. ...... Background. Hypertension is one of the most important public health problems worldwide and a major risk factor for all forms of atherosclerotic and atherothrombotic CVD. Office blood pressure monitoring nowadays still considered as a method of reference for diagnosing an evaluating hypertensive patients, but due to white coat phenomenon, the information for the real blood pressure status is unclear. Hypertension itself was related to target organ damage and one of them is vascular damage related to atherosclerosis. Evaluation of carotid intima media thickness can represent early atherosclerotic process that happened in organ vascular caused by white-coat phenomenon. Our objective was to analyze the relationship between white-coat phenomenon in hypertensive patients with carotid intima media thickness. Method. This is a cross sectional, consecutive study. Data was collected from January ? May 2014 in National Cardiac Centre Harapan Kita Hospital Outpatient clinic. Office Blood pressure was measured when patients controlled to the clinic and HBP was measured for 4 consecutive days with the same validated electronic device. B-mode ultrasound of carotid arteries was performed to measured mean of carotid intima media thickness. Results. Two hundred and nineteen hypertensive patients on therapy were enrolled in this study. Mann Whitney statistic test was used to determine the relationship of independent variables in hypertensive patients with white-coat phenomenon with carotid intima media thickness and found that there is no significant difference between hypertensive patients with white-coat phenomenon and no white-coat phenomenon with mean carotid intima media thickness (Right Carotid artery 0.7 ± 0.5 vs 0.8 ± 0.4 mm, p value = 0.153 ; Left Carotid Artery 0.8 ± 0.4 vs 0.7 ± 0.4 mm, p value 0.900 ; Right and left Carotid Artery 0.7 ± 0.4 vs 0.8 ± 0.3 mm, p value 0.260). From bivariate analysis results, obtained on all confounding variables, ACE-inhibitor and age proved as confounding in the assessment of the relationship between hypertensive patients with white-coat phenomenon and mean carotid intima media thickness. Conclusions. This study showed that there is no significant difference of mean carotid intima media thickness in hypertensive patients with white-coat and no white-coat phenomenon.

Abstrak :
Latar Belakang : Cedera reperfusi menyebabkan kerusakan dan kematian sel miokard dan memberikan kontribusi hingga 50% dari luas infark. Pengkondisian iskemia dari luar jantung (remote ischemic conditioning, RIC) dapat menjadi perlakuan non invasif, murah dan mudah untuk membatasi cedera reperfusi. Efek kardioprotektif yang didapatkan dari perlakuan ini antara lain penurunan luas infark dan peningkatan fungsi kontraktilitas ventrikel. 6 MWT merupakan salah satu penilaian luaran klinis dan NT pro BNP menjadi salah satu parameter dari penilaian fungsi miokard dari efek RIC. 6 MWT pada sejumlah studi telah menunjukkan hubungannya dengan luas infark. Dalam studi yang lain pemeriksan NT-pro BNP setelah IMA-EST berkorelasi dengan ukuran infark dan fungsi miokard setelah IMA. Tujuan : Menilai efek perlakuan pengkondisian iskemia ekstremitas pada pasien IMA EST yang menjalani IKPP terhadap 6 MWT dan kadar NT-ProBNP. Metode : Penelitian ini merupakan studi klinis acak tersamar dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Dilakukan perlakuan RIC pada kelompok studi sebelum tindakan IKPP. Pengukuran 6 MWT dan kadar NT-ProBNP dilakukan dalam masa perawatan pada kelompok studi dan kontrol. Hasil : Terdapat 87 subyek yang terbagi dalam 2 kelompok yakni 41 orang mendapat perlakuan RIC dan 46 orang sebagai kelompok kontrol. Didapatkan jarak 6 MWT lebih jauh pada kelompok studi dibandingkan dengan kelompok kontrol namun tidak bermakna secara statistik (316 (±46) vs 289 (±66) meter; p = 0.06). Didapatkan kadar NT-Pro BNP lebih rendah pada kelompok studi dibandingkan dengan kelompok kontrol yang bermakna secara statistik (1073 (328-3974) vs 1514 (205-10696) pg/mL; p = 0.05). Kesimpulan : Perlakuan RIC sebelum tindakan IKPP tidak meningkatkan kapasitas fungsional yang diukur dengan 6 MWT namun dapat menurunkan kadar NT-ProBNP. ...... Background : Reperfusion injury has been recognized to cause cell damage and death. As consequence, it contributes about 50% of infarct size. Remote ischemic condiotioning (RIC) has been identified as a noninvasive, low-cost, and easy to performed method to prevent it, so cardioprotective effect such as reducing infarct size and ventricular contraction improvement could be achieved. Meanwhile, myocardial function can be clinically assessed by measuring 6 minutes walk test (6MWT) and serum NT-proBNP level. Many studies showed association and correlation among 6MWT, NT-proBNP, infarct size and myocardial function. Objectives : To assess remote ischemic conditioning in ST-Elevation Myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) to their 6 MWT distance and serum NT-proBNP level. Methods : Eighty seven subjects were randomly assigned into 2 groups, those receiving RIC intervention (4 to 5 minutes cycles of cuff inflation/deflation on lower extremity) or control (uninflated cuff for 40 minutes) protocols prior to primary PCI. Prior to hospital discharge, all subjects underwent 6MWT and NT-proBNP evaluation. Results : RIC improve 6MWT distance in intervention group, but it was not significantly different compared to control group (316 ±46 meters vs. 289 ± 66 meters). Serum NT-ProBNP level was also lower in RIC group compared to control group (1073 (328-3974) pg/mL vs. 1514 (205-10696) pg/mL ) and the difference was statistically significant. Conclusion : RIC intervention prior to primary PCI improved functional capacity measured by 6MWT but not statistically significant compared to control group, however it improved serum NT-ProBNP significantly.

Abstrak :
ABSTRAK
Latar Belakang: Obesitas merupakan salah satu masalah kesehatan utama yang banyak ditemukan di negara maju maupun negara berkembang. Obesitas menjadi salah satu faktor risiko timbulnya penyakit kardiovaskular. Diketahui bahwa populasi obesitas memiliki kadar plasma BNP yang rendah dibanding kelompok normal. BNP adalah suatu hormon yang disintesis oleh miosit atrium yang berperan dalam meregulasi hemodinamik tubuh. Selain itu BNP memiliki efek anti fibrosis dan anti hipertrofi pada jantung. Dipikirkan bahwa adanya gangguan sintesis BNP di miosit jantung sebagai salah satu penyebab. Maka, penelitian ini bertujuan untuk melihat profil ekspresi mRNA BNP, NPR-A dan NPR-C pada populasi obesitas. Metode: Studi potong lintang dilakukan di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Jaringan miosit tersimpan yang sudah dilakukan ekstraksi RNA dibagi menjadi 2 kelompok berdasarkan IMT, kelompok obesitas (IMT ≥27) dan kelompok normal (IMT <27) dan sesuai kriteria inklusi dan eksklusi. RNA kedua kelompok dilakukan sintesis cDNA, ekstraksi protein dan Real-Time PCR untuk mendapatkan mean ΔCt. Kemudian dilakukan penghitungan menggunakan metode Livak untuk mendapatkan nilai ekspresi relatif mRNA. Data kemudian di analisis statistik menggunakan SPSS 20. Hasil Penelitian: Sebanyak 48 pasien diikutsertakan dalam penelitian ini dengan jumlah kelompok normal 34 orang dan kelompok obesitas 14 orang. Hasil ekspresi mRNA BNP, NPR-A dan NPR-C lebih rendah pada kelompok obesitas dibanding kelompok normal. Namun, tidak didapatkan perbedaan bermakna ekspresi mRNA BNP (p 0,768), NPR-A (p 0,838) dan NPR-C (p 0,768) antara kelompok obesitas dibanding kelompok normal. Kesimpulan: Penelitian ini tidak menemukan perbedaan ekspresi mRNA BNP, NPR-A dan NPR-C yang bermakna antara kelompok obesitas dengan kelompok normal.

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ABSTRACT
Background: Obesity is presenting as a significant health problem across the world. Obesity is a risk factor for cardiovascular diseases. The plasma level of B-type natriuretic peptide (BNP) has been identified to be lower in obese people compare to normal. As we know, BNP is one of the cardiac hormones synthesized by atrial myocyte that plays a role in hemodynamic regulations. In addition, BNP exerts its anti fibrotic and anti hypertrophic effects in the heart. It has been hypothesized that one of the possible mechanism responsible for this inverse relationship is the impaired synthesize of BNP by cardiomyocytes. Therefore, the aim of our study is to evaluate the mRNA expression profile of BNP, Natriuretic peptide receptor type-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C) in cardiomyocytes of obese population. Method: A cross-sectional study was conducted in Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed the RNA extraction proses were divided into 2 groups, Obese group (BMI ≥27) and Normal group (BMI <27), according to BMI and inclusion and exclusion criteria. Synthesize cDNA, protein extraction and Real-Time PCR were performed in order to have the mean of ΔCt. Livak method was used to determine the relative expression mRNA value. SPSS 20 for Windows was used for the purpose of statistical analyses. Results: 48 patients were included in this study that consist of 34 patients in normal group and 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPRC were lower in obese group compared to normal group. However, there was no significant difference between groups. Conclusion: In conclusion, there is no significant difference of mRNA expression of BNP, NPR-A and NPR-C between obese and normal group.;Background: Obesity is presenting as a significant health problem across the world. Obesity is a risk factor for cardiovascular diseases. The plasma level of B-type natriuretic peptide (BNP) has been identified to be lower in obese people compare to normal. As we know, BNP is one of the cardiac hormones synthesized by atrial myocyte that plays a role in hemodynamic regulations. In addition, BNP exerts its anti fibrotic and anti hypertrophic effects in the heart. It has been hypothesized that one of the possible mechanism responsible for this inverse relationship is the impaired synthesize of BNP by cardiomyocytes. Therefore, the aim of our study is to evaluate the mRNA expression profile of BNP, Natriuretic peptide receptor type-A (NPR-A) and Natriuretic peptide receptor type-C (NPR-C) in cardiomyocytes of obese population. Method: A cross-sectional study was conducted in Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK). Cardiomyocytes that have been performed the RNA extraction proses were divided into 2 groups, Obese group (BMI ≥27) and Normal group (BMI <27), according to BMI and inclusion and exclusion criteria. Synthesize cDNA, protein extraction and Real-Time PCR were performed in order to have the mean of ΔCt. Livak method was used to determine the relative expression mRNA value. SPSS 20 for Windows was used for the purpose of statistical analyses. Results: 48 patients were included in this study that consist of 34 patients in normal group and 14 patients in obese group. The mRNA expression of BNP, NPR-A and NPRC were lower in obese group compared to normal group. However, there was no significant difference between groups. Conclusion: In conclusion, there is no significant difference of mRNA expression of BNP, NPR-A and NPR-C between obese and normal group.

Abstrak :
ABSTRAK Latar Belakang : Meskipun manajemen gagal jantung (GJ) semakin maju, prognosis pasien tetap belum membaik. Hal ini disebabkan karena adanya komorbid, terutama perburukan fungsi ginjal yang juga memainkan peran utama dalam patofisiologi GJ. Pada tahun 2015, Putri dkk telah mengembangkan sistim skor VKPP untuk memprediksi perburukan fungsi ginjal pada pasien dengan Gagal Jantung Dekompensasi Akut (GJDA), yang variabelnya terdiri atas jenis kelamin perempuan, Hb < 12,5 mg/dl, kreatinin awal > 2,5 mg/dl, riwayat hipertensi, dan usia > 75 tahun. Nilai diskriminasi sistim skor tersebut 0,682 (95% IK; 0,630 - 0,734). Sampai saat ini, belum ada validasi eksternal pada sistim skor VKPP tersebut, sehingga perlu dilakukan agar dapat diimplementasikan secara klinis. Tujuan : Melakukan validasi eksternal sistim skor Kardio-Renal VKPP pada pasien dengan GJDA yang menjalani rawat inap. Metode : Penelitian merupakan studi kohort retrospektif dengan metode validasi eksternal temporal yang dilakukan di Departemen Kardiologi dan Kedokteran Vaskular Universitas Indonesia/Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, menggunakan data sekunder September 2015 hingga April 2016, yang diambil secara consecutive sampling. Analisis data ditujukan untuk mendapatkan nilai kalibrasi dan diskriminasi. Hasil : Sampel akhir berjumlah 418, dengan kejadian perburukan fungsi ginjal sebesar 20,3%. Odds Ratio (OR) semua variabel sesuai dengan OR pada studi VKPP, kecuali variabel jenis kelamin perempuan yang justru tidak menjadi faktor risiko (OR 0,78; 95% IK 0,43-1,45). Setelah dilakukan penghitungan skor VKPP pada semua sampel studi, didapatkan nilai kalibrasi 0,594 dan diskriminasi/AUC sebesar 0,568 (95% IK; 0,502 - 0,634). Pada studi Validasi, kejadian perburukan fungsi ginjal pada kelompok risiko rendah, sedang, dan tinggi yang dihitung menggunakan skor VKPP berurutan sebesar 18,6%, 21,9%, dan 29,6%. Dengan demikian, hanya kelompok risiko rendah yang berada pada rentang probabilitas prediksi perburukan fungsi ginjal yakni 11-26% (pada risiko sedang dan tinggi sebesar 27-49,5% dan 50-80%). Kesimpulan : Sistim skor VKPP secara eksternal valid untuk memprediksi kelompok risiko rendah, namun masih perlu kajian lebih lanjut pada kelompok risiko sedang dan tinggi.

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ABSTRACT Background : Although the management of Heart Failure (HF) has developed, prognosis of patients still not significantly improved. It is due to comorbidities, especially worsening kidney function, which also plays a major role in the pathophysiology of HF. In 2015, Putri et al have developed a scoring system (VKPP score) to predict worsening of renal function in patients with Acute Decompensated Heart Failure (ADHF), in which predictors are female, Hb < 12.5 mg/dl, admission creatinine > 2.5 mg/dl, history of hypertension, and age > 75 years . This scoring system yields discrimination value of 0.682 (95% CI; 0.630 to 0.734). Until now, there has been no external validation on the VKPP scoring system, therefore it is needed in order to implement them clinically. Objective : To validate externally the VKPP Cardio-Renal scoring system in patients who are hospitalized with ADHF. Methods : This is a retrospective cohort study with temporal external validation method that performed at the Department of Cardiology and Vascular Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, using secondary data from September 2015 until April 2016, which taken by consecutive sampling method. The data analysis is intended to develop the value of calibration and discrimination. Results : The final samples are 418, with 20.3 % incidence of kidney function deterioration. Odds Ratio of all predictors is similar with the result in VKPP study, except female variable which is not a risk factor (OR 0.78; 95% CI; 0,43-1,45). As final, the calibration and discrimination values are 0.594 and 0.568 (95% CI; 0.502-0.634). In the validation study, the incidence of worsening renal function in the low, moderate, and high risk group which are calculated using VKPP consecutively valued 18.6 % , 21.9 % and 29.6 %. However, only the low-risk group who were in the range of probability predictions of worsening renal functions, which is 11-26 % (moderate and high risk valued 27 to 49.5 % and 50-80 %).

Abstrak :
Tujuan : Mendapatkan perbandingan reaktifitas platelet jam pertama (dengan alat Multiplate) antara ticagrelor dan clopidogrel. Latar Belakang : Ticagrelor memiliki kemampuan inhibisi platelet lebih baik dibandingkan clopidogrel. Penelitian PLATO atau substudi PLATO-platelet, dosis clopidogrel hanya 300 mg, dibandingkan dengan ticagrelor 180 mg pada pasien STEMI. Penelitian ini dilakukan untuk menilai reaktifitas platelet pada jam-1,4 dan 8 antara ticagrelor 180 mg atau clopidogrel 600 mg pada pasien STEMI. Metode : Penelitian random clinical trial, double blind, pasien STEMI dengan naive clopidogrel atau ticagrelor, dilanjutkan tindakan intervensi perkutan primer (PPCI) di RS Jantung Harapan Kita dari April-Juni 2013. Aktifitas platelet diukur jam pertama, jam keempat dan kedelapan dengan alat Multiplate. Hasil : Didapat 22 pasien STEMI nave clopidogrel/ticagrelor, dengan 11 pasien tiap kelompok. Tidak terdapat perbedaan terhadap usia, onset iskemik, BMI, penyakit penyerta Diabetes Melitus serta waktu pengambilan sampel pemeriksaan antara 2 kelompok obat. Didapat nilai reaktifitas platelet tetap tinggi pada kelompok obat clopidogrel dibandingkan ticagrelor pada jam pertama. Hasil kelompok ticagrelor tetap konstan hingga jam ke-8. Dan penurunan rekatifitas platelet kelompok clopidogrel menurun mendekati nilai yang diharapkan hingga jam 8. Kesimpulan : Reaktifitas platelet ticagrelor lebih rendah dibandingkan clopidogrel saat jam pertama pasca loading obat. Terdapat 45% (5 pasien) pada kelompok clopidogrel yang tetap memiliki reaktifitas platelet tinggi pada pemeriksaan jam pertama, keempat dan kedelapan, serta 9% (1 pasien) pada ticagrelor yang memiliki kenaikan nilai reaktifitas platelet pada jam keempat dan kedelapan ......Objectives : This study sought to compare platelet reactivity by180 mg ticagrelor and 600 mg clopidogrel in primary PCI STEMI patients. Background: The ability of ticagrelor in inhibiting platelet functions was more potent than clopidogrel in stable CAD and UAP/NonSTEMI patients. According to the PLATO trial or PLATO-platelet substudy, patients treated with 180 mg ticagrelor had better clinical endpoint and more platelet inhibition compared to 300 mg clopidogrel. The study we conducted was to see the platelet reactivity at 1st, 4th, and 8th hour after ingestion of 180 mg ticagrelor compared to 300 mg clopidogrel in STEMI patients Methods: This is a randomized double blind clinical trial carried out in Department of Cardiology and Vascular Medicine Universitas Indonesia/ National Cardiovascular Center Harapan Kita in April - June 2013. As many as 22 clopidogrel or ticagrelor nave STEMI patients undergoing primary PCI with were recruited. Platelet reactivity (PRU) was assessed by Multiplate at 1,4,8 h after LD. Result : Both nave ticagrelor and clopidogrel goups had 11 patients each. About 45% patients in clopidogrel group have high reactivity platelet at 1h, 4h and 8 h MEA analysis, and 9% patients in ticagrelor group have high reactivity platelet at 4h and 8 h MEA analysis. Conclusion: The action of Ticagrelor in platelet reactivity was lower compared to Clopidogrel in STEMI patients. 45 % patients in clopidogrel group maintained high platelet reactivity at 1st, 4th and 8th hour after LD, while 9% patients in ticagrelor group had high platelet reactivity started at 4th up 8th hour after LD.