CLINICAL STUDY OF JAMU FORMULA FOR GENU OSTEOARTHRITIS

The uses of conventional drug for osteoarthritis treatment has been shown to give serious side effects. The use of jamu as a natural product for treatment of osteoarthritis needs a scientific evidence especially efficacy and safety evidence. This research is a quasi experiment pre post test design study that was conducted at Klinik Saintifikasi Jamu B2P2TOOT from March until December 2011. The giving of jamu formula that which consisted of 15 gram temulawak rhizome (Curcuma xanthorrhiza), 7 gram meniran herb (Phylanthus niruri), 15 gram kunyit rhizome (Curcuma domestica), 5 gram adas seed (Foeniculum vulgare), 5 gram rumput bolong herb (Equisetum debile), and 5 gram kumis kucing leaves (Orthosiphon stamineus) for2 months could improve clinical symptoms such as joint paint, swollen joints, movement disorders and tingling. Objectively the jamu formula decresed the joint paint with measurements of visual analogue scale. This formula in terms of safety did not interfere with liver and kidney function

Association between Soluble Intercellular Adhesion Molecule-1 and Soluble Vascular Cell Adhesion Molecule-1 Levels and Left Atrial Thrombosis Gradation in Mitral Stenosis

Background. The relationship between inflammation and coagulation has been widely described, which adhesion molecules play important role in inflammation. Soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) seem to be related to thrombosis in few previous studies. The level of those molecules were increased in mitral stenosis (MS), however their relationship with left atrial thrombosis gradation is still unknown. Methods. Patients with moderate-severe MS (without any significant mitral regurgitation) who underwent transesophageal echocardiography were recruited consecutively in September-October 2013. They were divided into 3 categories of left atrial thrombosis gradation: non-thrombus without dense left atrial spontaneous echo contrast (LASEC) group, and non-thrombus with dense LASEC group, and thrombus group. Results. A total of 39 subjects were enrolled in the study with a mean age of 40.979.61 year. Moreover, 71.8% of them were female and 67.7% of them had atrial fibrillation (AF). Evaluation on left atrial thrombosis gradation as mentioned above showed that sICAM-1 levels were 284.74 (218.79-321.00) ng/mL, 346.86 (125.68-698.12) ng/mL, and 395.93 (171.44-1021.53) ng/mL, consecutively (p=0.280). While sVCAM-1 levels gradually increased based on those groups consecutively: 729.01 (543.93-967.80) ng/mL, 1066.00 (581.36-2470.60) ng/mL, and 1158.00 (668.66-2498.30) ng/mL (p=0.016). Multivariate analysis showed that AF and mitral valve area (MVA) influence thrombosis gradation. Conclusion. Difference in sVCAM-1 levels were found among left atrial thrombosis gradation groups in mitral stenosis, but its effect on thrombosis gradation was influenced by AF and MVA

“Endovascular Stent Graft” pada Diseksi Aorta Tipe B

Pada tahun 1970, Nicholls, seorang dokter kerajaan Inggris, melakukan otopsi terhadap King George II yang mengalami kematian mendadak. Ternyata penyebab kematian sang Raja adalah efusi masif perikardium, rongga perikard dipenuhi bekuan darah, akibat robekan dinding aorta. Hirs dkk (1958) pernah membuat penelusuran terhadap 505 penderita dengan gejala klinis serupa, ia memperlihatkan tingginya angka kematian serta sulitnya menegakkan diagnosis, sehingga pasien umumnya meninggal. Kemajuan modalitas pencitraan berperan sangat penting dalam mendiagnosis diseksi akut aorta secara dini, dan kemajuan teknik terapi akhirnya mampu meningkat-kan harapan hidup pasien dengan kelainan ini

Hubungan Durasi QRS Awal Dengan Derajat Reperfusi Miokard Setelah Angioplasti Koroner Perkutan Primer

Background.Reperfusion therapy in acute myocardial infarction aims at early and sustained reperfusion of the myocardium at risk. However, even when TIMI flow 3 is achieved, some patients have less optimal reperfusion at myocardial tissue level. QRS duration before reperfusion therapy was showed as a predictor of myocardial reperfusion after fibrinolytic therapy, but currently there is no data showing relationship between QRS dura-tion at admission with myocardial reperfusion after primary percutaneous coronary intervention (primary PCI).Methods.A case control study was conducted to study the relationship between QRS duration at admission with myocardial reperfusion after pri-mary PCI. Myocardial reperfusion was assessed by myocardial blush grade (MBG), and was grouped as optimal reperfusion (MBG 2-3) and impaired reperfusion (MBG 0-1).Results.There were 41 patients fulfilling study criteria. Thirty one patients had optimal reperfusion and 10 patients had impaired reperfusion. Impaired reperfusion group had longer QRS duration (103 +14 vs 91 +12 ms; p = 0,013) and were older (63,9 +12,2 vs 53,7 +10,3 years, p = 0,023). The two groups were similar in terms of gender, diabetes, hypertension, dyslipidemia, smoking status, pain-to-door time, pain-to-balloon time, infarct-related artery location, and TIMI flow. Multivariate analysis showed that longer QRS duration was associated with impaired reperfusion after primary PCI (OR: 21.7, p = 0.014). QRS duration of more than 105 ms was a predictor of impaired reperfusion after primary PCI, with 84% sensitivity and 62% specificity.Conclusions.Longer QRS duration at admission is a predictor of impaired myocardial reperfusion after primary PCI. Patients with STEMI who have QRS duration of more than 105 ms should be considered to be at higher risk of impaired reperfusion after primary PCI.Latar Belakang. Terapi reperfusi pada infark miokard akut bertujuan untuk memperoleh reperfusi miokard yang segera dan menetap. Namun walaupun TIMI flow3 tercapai, sebagian pasien memiliki reperfusi yang tidak optimal pada jaringan miokard. Durasi QRS awal telah ditunjukkan sebagai prediktor reperfusi miokard setelah terapi fibrinolitik, namun sampai saat ini belum ada data yang menunjukkan hubungan antara durasi QRS awal dengan reperfusi miokard setelah angioplasti primer.Metode.Penelitian kasus kontrol dilakukan untuk menilai hubungan antara durasi QRS awal dengan reperfusi miokard setelah angioplasti primer. Reperfusi miokard dinilai dengan myocardial blush grade(MBG), dan dikelompokkan menjadi reperfusi optimal (MBG 0-1) dan reperfusi tidak optimal (MBG 2-3).Hasil.Ditemukan 41 pasien yang memenuhi kriteria penelitian; 31 memiliki reperfusi yang optimal dan 10 reperfusi tidak optimal. Kelompok reperfusi tidak optimal memiliki durasi QRS awal yang lebih panjang (103 +14 vs 91 +12 milidetik; p = 0,013) dan usia yang lebih tua (63,9 +12,2 vs 53,7 +10,3 tahun, p = 0,023). Kedua kelompok memiliki karakteristik yang sama dalam hal jenis kelamin, diabetes, hipertensi, dislipidemia, status merokok, pain-to-door time, pain-to-balloon time, lokasi infarct-related artery, dan TIMI flow. Analisa multivariat menunjukkan bahwa durasi QRS yang lebih panjang berhubungan dengan reperfusi yang tidak optimal setelah angioplasti primer (OR: 21.7, p = 0.014). Durasi QRS awal lebih dari 105 milidetik memiliki sensitivitas 84% dan spesifisitas 62% untuk memprediksi reperfusi yang tidak optimal setelah angioplasti primer.Kesimpulan. Durasi QRS awal yang lebih panjang dapat menjadi prediktor dari reperfusi miokard yang tidak optimal setelah angioplasti primer. Pasien STEMI dengan durasi QRS awal yang lebih panjang atau sama dengan 105 milidetik mungkin memiliki risiko yang lebih tinggi untuk terjadinya reperfusi yang tidak optimal setelah angioplasti primer

The Protective Effect of Vitamin E for Reducing Intra-Hospital Mortality in Acute Limb Ischemia Patients

Background Management of acute limb ischemia (ALI) is still a huge challenge. Current advances of endovascular therapeutic approach in management of ALI have decreased the overall amputation rate, nevertheless, mortality rate remains high which may be caused by metabolic consequences of reperfusion injury. Aim To understand the role of vitamin E to intra-hospital and 30-day mortality among acute limb ischemia patients. Methods This retrospective cohort study included all patients with ALI between 2015 to 2018. Vitamin E 2x400 mg orally for seven days was given based on physician preference after ALI diagnosis was confirmed. Data were collected from Vascular Registries of National Cardiovascular Center Harapan Kita (NCCHK), Jakarta, Indonesia. Univariate analysis and logistic regression models were used to explore factors that contribute to intra-hospital and 30-day mortality. Results                                        A total of 160 patients with ALI involving 192 limbs were admitted to our hospital. Mostly were male (63.1%) and mean age were 56±13 years old. Majority of the patients had unilateral lesion (80%), and were diagnosed with Rutherford stage IIA (36.3%), followed by stage IIB (33.8%), stage I (20%), and stage III (10%) respectively. Intra-hospital and 30-day mortality were 28.1% and 36.9%, respectively. Low treatment of vitamin E increased intra-hospital mortality (HR 5,6 95%CI 1.7-18.3), however, it did not affect 30-day mortality. Other factors including IABP insertion, arrhythmia, bleeding requiring transfusion and acute renal failure were associated with higher intra-hospital and 30-day mortality. In addition, menopause (HR 3.2; CI 1.16-8.85) was also a predictor of 30-day mortality. Conclusion Vitamin E administration reduced intra-hospital mortality but not on 30-day mortality in acute limb ischemia patients. Keywords: Acute Limb Ischemia, vitamin E, mortality, reperfusion injur

Association between Soluble Intercellular Adhesion Molecule-1 and Soluble Vascular Cell Adhesion Molecule-1 Levels and Left Atrial Thrombosis Gradation in Mitral Stenosis

Background. The relationship between inflammation and coagulation has been widely described, which adhesion molecules play important role in inflammation. Soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) seem to be related to thrombosis in few previous studies. The level of those molecules were increased in mitral stenosis (MS), however their relationship with left atrial thrombosis gradation is still unknown. Methods. Patients with moderate-severe MS (without any significant mitral regurgitation) who underwent transesophageal echocardiography were recruited consecutively in September-October 2013. They were divided into 3 categories of left atrial thrombosis gradation: non-thrombus without dense left atrial spontaneous echo contrast (LASEC) group, and non-thrombus with dense LASEC group, and thrombus group. Results. A total of 39 subjects were enrolled in the study with a mean age of 40.979.61 year. Moreover, 71.8% of them were female and 67.7% of them had atrial fibrillation (AF). Evaluation on left atrial thrombosis gradation as mentioned above showed that sICAM-1 levels were 284.74 (218.79-321.00) ng/mL, 346.86 (125.68-698.12) ng/mL, and 395.93 (171.44-1021.53) ng/mL, consecutively (p=0.280). While sVCAM-1 levels gradually increased based on those groups consecutively: 729.01 (543.93-967.80) ng/mL, 1066.00 (581.36-2470.60) ng/mL, and 1158.00 (668.66-2498.30) ng/mL (p=0.016). Multivariate analysis showed that AF and mitral valve area (MVA) influence thrombosis gradation. Conclusion. Difference in sVCAM-1 levels were found among left atrial thrombosis gradation groups in mitral stenosis, but its effect on thrombosis gradation was influenced by AF and MVA

Right Ventricular Dysfuction In Subject With Obstructive Sleep Apnoea

An analytical design study on the systolic right ventricle (RV) function was done in Obstructive Sleep Apnea (OSA) patients who underwent polisomnography procedure and compare it with normal subject. The assessment of the RV function was performed using the Speckle tracking echocardiography method. Other RV function parameters such as TAPSE, Tissue Doppler Imaging (TDI), dan Myocardial Performance Index (MPI) were also measured. The results showed RV dysfunction in OSA patients compared with normal subject, the decrease of RV function was significantly different between the two groups. Factors that contributed to RV dysfunction in OSA patients were higher Apnea-Hypopnea Index (AHI) and Nocturnal Oxygen Desaturation

Correlation of Brachial Flow Mediated Dilation with Severity of Coronary Artery Disease

Background. Endothelial dysfunction precedes the development of morphological changes and contributes to atherosclerotic lesion development and progression. Evaluation using non invasive method such as brachial FMD (flow mediated dilation) has given inconsistent information for extension and coronary atherosclerotic severity regarding endothelial dysfunction. This research will evaluate the correlation between brachial FMD and severity of coronary artery disease (CAD) stenosis. Methods. It was a cross sectional study. Evaluations were performed in 85 patients who had followed elective coronary angiography and fulfilled inclusion criteria in National Cardiovascular Center Harapan Kita since January until October of 2012. Correlation between brachial FMD and severity of CAD stenosis (Gensini score) was evaluated using linear regression analysis. Results. Brachial FMD had negative correlation with Gensini score (R= -0,227; P= 0,037). Hypertension had negative correlation with brachial FMD (R= -0,235; P= 0,032). Male gender had positive correlation with brachial FMD (R= 0,220; P= 0,040). Conclusion. There was weak negative correlation between brachial FMD and Gensini score

Estimasi Tekanan Atrium Kanan Dengan Rasio Gelombang E/Ea Katup Trikuspid

Background. Right atrial pressure is one of hemodynamic parameter that can guide therapy for patients in intensive care unit. Right atrial pressure is also needed for calculation of other hemodynamic parameter such as pulmonary pressure and systemic vascular resistance. Estimation of right atrial pressure using E/Ea ratio is not much studied until now. There were only three studies with different result. This study objective is therefore to asses the correlation and agreement of estimation right atrial pressure by using ratio E wave (spectral doppler) and Ea wave (tissue doppler imaging) from tricuspid valve. Methods.This is a diagnostic test with cross sectional design study in patients in Cardiovascular Care Unit (CVCU) who had been inserted central venous pressure line (CVP line). E wave was taken from tricuspid inflow with pulsed wave spectral doppler and Ea wave was taken from the lateral tricuspid annulus with tissue doppler imagingat at early diastolic filling. Correlation analysis was performed to assess the correlation of E/Ea ratio with right atrial pressure from CVP line. The result of E/Ea ratio liner regrresion is analyzed with bland altman plot to asses agreement between E/Ea ratio and invasive methods of CVP line. Data was analyzed using SPSS 15.0.Results.There were 50 from 16 sample. As many as 20 data was also also measured by second observer for interobserver variability. There was a good precision for inter and intraobserver with ICC > 0,8. There was good correlation between E/Ea ratio with right atrial pressure, r = 0.728, p < 0,001. Cut off point E/Ea >3,95 could predict right atrial pressure = 10 mmHg (sensitvity 73,1% and specificity 70,8% and positive predictive value 73% and negative predictive value 73,9%). The agreement between E/Ea ratio and CVP line for measuring right atrial prssure was poor, with Intra-class Correlation(ICC) 24% and percentage error more than 30%. Based on this agreement right atrial pressure estimated by E/Ea ratio could have difference as much as 0,01 +3,53 mmHg. Conclusion.There were good correlation but poor agreeement for right atrial pressure estimation by using E/Ea ratio.Latar belakang.Tekanan atrium kanan merupakan salah satu parameter hemodinamik yang penting untuk membantu pemberian terapi yang sesuai khususnya pada pasien yang dirawat di ruang rawat intensif. Selain itu tekanan atrium kanan diperlukan untuk pengukuran hemodinamik lain seperti tekanan a. pulmonal dan resistensi vaskular sistemik. Estimasi tekanan atrium kanan dengan rasio E/Ea belum banyak diteliti. Hanya ada tiga penelitian dengan hasil yang cukup berbeda. Penelitian ini bertujuan menguji kembali korelasi dan kesesuian estimasi tekanan atrium kanan dengan cara ekokardiografi yaitu dengan memakai rasio gelombang E (spektral Doppler) dan gelombang Ea (tissue Doppler Imaging) dari katup trikuspid.Metode.Penelitian ini merupakan uji diagnostik dengan desain potong lintang yang dilakukan pada pasien yang dirawat di Cardiovascular Care Unit(CVCU) yang dipasang kateter vena sentral. Gelombang E diambil di ujung katup trikuspid dengan pulsed wave spectral dopplersedangkan gelombang Ea diambil dari anulus katup trikuspid dengan pulsed wave tissue doppler imaging pada saat fase diastolik awal. Uji korelasi dilakukan untuk melihat korelasi rasio E/Ea dengan tekanan atrium kanan dari kateter vena sentral. Hasil regresi linear E/Ea akan dianalisa lagi dengan plot bland altman untuk menguji kesesuaian antara rasio E/Ea dengan metode invasif kateter untuk estimasi tekanan atrium kanan. Data diolah oleh SPSS 15.0Hasil.Terdapat 50 data dari 16 sampel yang diteliti. Sebanyak 20 data diperoleh dari pengamat kedua untuk pengamatan interobserver. Didapatkan presisi yang baik inter dan intraobserver dengan ICC > 0,8. Terdapat korelasi yang baik antara rasio E/Ea dengan tekanan atrium kanan dengan r = 0,728 p < 0,001. Titik potong E/Ea >3,95 dapat memprediksi nilai tekanan atrium kanan =10 mmHg (sensitifitas 73,1% dan spesifisitas 70,8% dan positive predictive value73% dan negative predictive value 73,9%. Kesesuaian rasio E/Ea dengan pengukuran invasif hasilnya tidak begitu baik dengan Intra-class Correlation(ICC) 24% dan percentage errormelebihi 30%. Berdasarkan dengan analisa kesesuaian ini tekanan atrium kanan yang diestimasi dengan rasio E/Ea mempunyai perbedaan 0,01 +3,53 mmHg. Kesimpulan.Terdapat korelasi yang baik namun kesesuaian yang kurang baik antara pemeriksaan rasio E/Ea untuk estimasi tekanan atrium kanan

Korelasi Kekakuan Arteri Dengan Kadar Endothelin-1 Plasma pada Laki-laki Obesitas

Background.Obesity is associated with increase arterial stiffness and el-evated plasma endothelin-1 concentration. However, there is still conflict-ing data regarding the effect of obesity on arterial stiffness and plasma endothelin-1 concentration.Objective.The purpose of the current study was to assess this effect and analyze whether there was correlation between arterial stiffness indices and plasma endothelin-1 concentration.Methods.The design of the study was cross sectional study that compare and correlate arterial stiffness and plasma endothelin-1 concentration be-tween obesity group (n=40) and normoweight group (n=40). Obesity was defined as body mass index = 25 kg/m2. Arterial stiffness was as-sessed by measuring carotid-femoral pulse wave velocity (PWV) dan ß stiffness index (ß) non-invasively using ultrasound method. Endothelin-1 was measured by ELISA.Results.There was no significant difference regarding PWV between obesity and normoweight group (mean ± SD: 809.44 ± 137.77 versus 850.96 ± 211.60 cm/s, p=NS), but ßwas significantly higher in obese group (8.79 ± 3.15 versus 7.28 ± 1.96, p=0.012). PWV and ßcorre-lated significantly with age (PWV: r=0.446, p<0.001, ß: r=0.354, p=0.001), but only ßcorrelated with body mass index (r=0.282, p=0.011) and waist circumference (r=0.312, p=0.005). There was no significant difference between obesity and normoweight group regard-ing plasma endothelin-1 concentration (0.94 ± 0.26 versus 0.95 ± 0.18 pg/dl, p=NS). There are no significant correlations between PWV/ßand plasma endothelin-1 concentration.Conclusions.These findings suggest that the effect of obesity on arterial stiffness is not uniformly seen throughout all arterial region. Obesity im-pact on carotid artery is greater than its impact on aorta, and this impact on arterial stiffness is not mediated by endothelin-1.Latar belakang.Obesitas dihubungkan dengan peningkatan kekakuan arteri dan kadar endothelin-1 plasma, namun masih terdapat kontroversi mengenai efek obesitas terhadap kedua hal ini. Tujuan penelitian ini untuk melihat efek obesitas terhadap kekakuan arteri dan kadar endothelin-1 plasma serta melihat apakah terdapat korelasi antara kekakuan arteri dan kadarendothelin-1 plasma.Metode.Desain penelitian adalah penelitian potong lintang yang membandingkan dan mengkorelasikan kekakuan arteri dan kadar endothelin-1 plasma antara kelompok obesitas (n=40) dengan kelompok berat badan normal (n=40). Obesitas didefinisikan sebagai indeks massa tubuh = 25 kg/m2. Kekakuan arteri dinilai dengan mengukur carotid-femoral pulse wave velocity(PWV) dan ß stiffness index(ß) secara non invasif dengan ultrasonografi. Endothelin-1 diperiksa menggunakan metode ELISA.Hasil.Tidak terdapat perbedaan PWV bermakna di antara kelompok obesitas dan berat badan normal (mean ± SD : 809.44 ± 137.77 versus 850.96 ± 211.60 cm/detik, p=NS), namun terdapat perbedaan ßyang bermakna di antara kedua kelompok (8.79 ± 3.15 versus 7.28 ± 1.96, p=0.012). Baik PWV maupun ßberkorelasi positif dengan usia (PWV: r=0.446, p<0.001, ß: r=0.354, p=0.001), namun hanya ßyang berkorelasi dengan indeks massa tubuh (r=0.282, p=0.011) dan lingkar perut (r=0.312, p=0.005). Tidak terdapat perbedaan bermakna kadar endothelin-1 plasma pada kelompok obesitas dan berat badan normal (0.94 ± 0.26 versus 0.95 ± 0.18 pg/dl, p=NS). Tidak terdapat korelasi antara PWV dan ßdengan kadar endothelin-1 plasma.Kesimpulan.Hasil penelitian ini menunjukkan bahwa efek obesitas pada kekakuan arteri tidak tersebar secara uniform pada seluruh region arteri. Obesitas memberikan dampak yang lebih besar pada arteri karotis dibandingkan aorta, dan tampaknya efek obesitas pada kekakuan arteri tidak dimediasi oleh endothelin-1