Bertahannya Bangsawan Bone Di Tengah Perubahan Rezim, 1811-1946

The implementation of the autonomy Law in the early 2001 in Indonesia haslead to the emergence of petty kings in several regions. However, the diversityof the local political history will be influenced or influence the ways in whichregional autonomy are practiced by local elites. By taking the political historyof Bone from 1811 to 1946 as a case study, this dissertation shows that thecurrent petty kings have long been maintained by decendants of aristocraticelite in Bone. There are three interrelated factors that make the aristocratsin Bone are able to survive in maintaining their power until now; namelypolitical marriages, social networks, and patron-client relationship.The colonial government failed to understand three important factors embedded in the long political history of Bone. This lack of knowledge about history and political culture of Bone has led to ongoing conflict between Bone'saristocrats and the colonial government. By using local sources,Lontara andcolonial sources, the dissertation attempts to provide balanced analysis of thedynamics of local political structures of Bone from the period 1811 to 1946

The Comparative and Usefulness of Platelet Distribution Width in Acute Coronary Syndrome

BACKGROUND: Identifying risk factors for acute coronary syndrome (ACS) is important for both diagnostic and prognostic purposes. Abnormal platelet parameters, mainly platelet count (PC), mean platelet volume (MPV) and platelet distribution width (PDW) are thought to be among these risk factors because platelet activation plays a pivotal role in ACS. PDW is a more specific marker of platelet activation, since it does not increase during simple platelet swelling. In this study, the comparison of risk factors along with the PDW between Non ST-Elevation ACS (NSTEACS) and ST-Elevation ACS (STEACS) were investigated.METHODS: This is a cross-sectional study, patients with ACS that admitted at dr.Wahidin Sudirohusodo General Hospital Makassar since December 2014 to March 2015 who undergo coronary angiography were enrolled. All data variables were taken according to the medical record. PDW was taken on first blood examination at hospital admission. Data was significant if p-value <0.05 and wasprocessed with SPSS version 16.RESULTS: A total of 63 patients were enrolled. There were significantly higher PDW (p=0.047) in STEACS group (13.7±2.0 fL) than in NSTEACS group (12.6±2.3 fL). There were a significant positive correlation between PDW value and SYNTAX scores (Pearson, r=0.552, p=0.000). Cardiovascular risk factors such as history of ACS before (p=0.049 & OR=10.216) and dyslipidemia (p=0.049 & OR=3.915) along with PDW (p=0.003 & OR=1.733) were significant predictor of the incidence of multivessel disease in patient with ACS.CONCLUSION: An increased PDW may predicting more severe disease in ACS based on incidence of STEACS and multivessel disease more often and higher SYNTAX score

Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia

Background: Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods: ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results: Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions: Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients

Clinical Cardiology in South East Asia: Indonesian Lessons from the Present towards Improvement

Although cardiovascular care has improved in the last decade in the low- and middle-income countries (LMICs) in South-East Asia Region; these countries, particularly Indonesia, are still encountering a number of challenges in providing standardized healthcare systems. This article aimed to highlight the current state of cardiology practices in primary and secondary care, including the novel cardiovascular risk factors, recommendations for improving the quality of care, and future directions of cardiovascular research in limited settings in South-East Asia. We also provided the most recent evidence by addressing our latest findings on cardiovascular research in Indonesia, a region where infrastructure, human, and financial resources are largely limited. Improving healthcare policies to reduce a nations' exposure to CVD risk factors, providing affordable and accessible cardiovascular care both at primary and secondary levels, and increasing capacity building for clinical research should be warranted in the LMICs in South-East Asia

Adherence to guideline recommendations for coronary angiography in a poor South-East Asian setting: Impact on short- and medium-term clinical outcomes

In South-East Asian populations and particularly in Indonesia, access to coronary angiography (CAG) is limited. We aimed to assess the adherence for undergoing CAG for indicated patients, according to the guideline recommendations. We then examined whether this adherence would have an impact on patients’ short- and medium-term mortality and morbidity. We consecutively enrolled 474 patients with acute and stable coronary artery disease who had indication for CAG at Makassar Cardiac Center, Indonesia from February 2013 to December 2014. We found that adherence to CAG recommendation in poor South-East Asian setting is low. Of 474 recommended patients, only 273 (57.6%) underwent the procedure. Factors for not undergoing CAG were: older age, female gender, low educational and socio-economic status, and insurance type. While reasons for patients refusing CAG and subsequent intervention included fear, symptoms reduction, and lack of trust concerning the procedure benefit. During follow-up (median 19 (IQR 6–39.3) months), 155 (32.7%) patients died, and 259 (54.6%) experienced at least one adverse event. Adherence to CAG recommendation was associated with a significantly lower short- and medium-term mortality, independent of revascularization and other potential confounders. In sub-group analysis, adhered patients “with revascularization” had significantly better outcomes compared to the “non-revascularization” and “not adhere” groups

Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting

Objective To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting. Methods From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality. Results From hospital admission, patients were followed over a median of 18 (IQR 6-36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88). Conclusions Patients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival

Characteristics and the average 30-day and 6-month clinical outcomes of patients hospitalised with coronary artery disease in a poor South-East Asian setting: The first cohort from Makassar Cardiac Center, Indonesia

Objective To provide a detailed description of characteristics at hospital admission and clinical outcomes at 30-day and 6-month follow-up in patients hospitalised with coronary artery disease (CAD) in a poor South-East Asian setting. Design Prospective observational cohort study. Setting From February 2013 to December 2014, in Makassar Cardiac Center, Indonesia. Participants 477 patients with CAD (acute coronary syndrome and stable CAD). Outcome measures All-cause mortality and major adverse cardiovascular events (MACE). Results Out of 477 patients with CAD, the proportion of young age (<60 years) was 53.9% and 72.7% were male. At admission, 44.2% of patients were diagnosed with ST-segment elevation myocardial infarction (STEMI), 38.6% with diagnosis or signs of heart failure and 75.1% had previous hypertension. Out of 211 patients with STEMI, only 4.7% had been treated with primary percutaneous coronary intervention (PCI) and 6.2% received thrombolysis. The time lapse from symptom onset to hospital admission was 26.8 (IQR 10.0-48.0) hours, and 19.1% of all patients had undergone either PCI or coronary artery bypass graft. The survival rate at 6 months was 78.9%. The rates of all-cause mortality at 30 days and 6 months were 13.4% and 7.3%, respectively; the rate of composite MACE at 30 days was 26.2% and 18.0% at 6 months. Conclusions Patients with CAD from a poor South-East Asian setting present themselves with predominantly unstable conditions of premature CAD. These patients show relatively severe illness, have significant time delay from symptom onset to admission or intervention, and most do not receive the guidelines-recommended treatment. Awareness of symptoms, prompt initial management of acute CVD, well-established infrastructures and resources both in primary and secondary hospital for CVD should be improved to reduce the high rates of 30-day and 6-month mortality and adverse outcomes in this population

In-hospital mortality of patients with acute coronary syndrome (ACS) after implementation of national health insurance (NHI) in Indonesia

Abstract Background The National Health Insurance (NHI) was implemented in Indonesia in 2014, and cardiovascular diseases are one of the diseases that have overburdened the healthcare system. However, data concerning the relationship between NHI and cardiovascular healthcare in Indonesia are scarce. We aimed to describe changes in cardiovascular healthcare after the implementation of the NHI while determining whether the implementation of the NHI is related to the in-hospital mortality of patients with acute coronary syndrome (ACS). Methods This is a retrospective comparative study of two cohorts in which we compared the data of 364 patients with ACS from 2013 to 2014 (Cohort 1), before and early after NHI implementation, with those of 1142 patients with ACS from 2018 to 2020 (Cohort 2), four years after NHI initiation, at a tertiary cardiac center in Makassar, Indonesia. We analyzed the differences between both cohorts using chi-square test and Mann-Whitney U test. To determine the association between NHI and in-hospital mortality, we conducted multivariable logistic regression analysis. Results We observed an increase in NHI users (20.1% to 95.6%, p < 0.001) accompanied by a more than threefold increase in patients with ACS admitted to the hospital in Cohort 2 (from 364 to 1142, p < 0.001). More patients with ACS received invasive treatment in Cohort 2, with both thrombolysis and percutaneous coronary intervention (PCI) rates increasing more than twofold (9.2% to 19.2%; p < 0.001). There was a 50.8% decrease in overall in-hospital mortality between Cohort 1 and Cohort 2 (p < 0.001). Conclusions This study indicated the potential beneficial effect of universal health coverage (UHC) in improving cardiovascular healthcare by providing more accessible treatment. It can provide evidence to urge the Indonesian government and other low- and middle-income nations dealing with cardiovascular health challenges to adopt and prioritize UHC