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"Latar belakang: Mekanisme penyebab kematian COVID-19 adalah terjadinya hipoksemia dan ARDS. Salah satu komponen dalam penilaian ARDS adalah hasil Annalisis Gas Darah (AGD) dan nilai perbedaan tekanan parsial oksigen di arteri dan alveolus yang dikenal sebagai AaDO2. Peran nilai analisis gas darah dan AaDO2 pada luaran meninggal COVID-19 perlu di telaah lebih lanjut.Metode penelitian: Analisis deskriptif kohort retrospektif terhadap pasien COVID-19 terkonfirmasi yang dirawat di RSUP Persahabatan secara consecutive sampling dari bulan maret sampai dengan agustus 2020. Kami meninjau 205 rekam medis pasien terkonfirmasi yang telah memenuhi kriteria inklusi.Hasil: Median dan rentang nilai pH, PaCO2, PaO2, HCO3, BE, SaO2, FiO2, SpO2 adalah 7,41(7,01-7,54), 32,1(17,5-87,1), 73,9(22,7-343,7), 21(7,2-38,9), -3,8(-22,2-13,3), 94,9(33,5-99,9), 0,54(0,21-1,00), 95(33,5-99,9) secara berurutan. Terapi oksigen yang digunakan pasien adalah masker oksigen nonhirup ulang sebesar 37,56% diikuti dengan kanula hidung sebesar 32,20%, ventilator mekanis sebesar 16,59%, kanula hidung arus tin ggi sebesar 10,73%, masker sederhana sebesar 0,98% dan masker venturi sebesar 0,49%. Median nilai AaDO2 sebesar 272,58% (40,55-644,17). Derajat penyakit klinis terbanyak memiliki derajat klinis kritis sebesar 93,2%. Gangguan asam basa yang dialami pasien adalah 33,51% mengalami gangguan asam basa campuran, 22% mengalami gangguan asidosis metabolik tidak terkompensasi dan 25% pasien mengalami asidosis repiratorik terkompensasi. Terdapat korelasi parameter PaO2, BE, SaO2, FiO2, PAO2 dan AaDO2 dengan kejadian kematian pasien (p<0,05).

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Background: The cause of death in COVID-19 is hypoxemia in acute respiratory distress syndrome (ARDS). This condition could be assessed through arterial blood gas analysis by determining the alveolar arterial oxygen gradient value (AaDO2). The role of arterial blood gas analysis and AaDO2 to predict mortality in COVID-19 is yet to be explored.

Methods: We performed observational retrospective cohort analysis of COVID-19 confirmed patients treated at Persahabatan Hospital, Jakarta, Indonesia. Subject by means of consecutive sampling were COVID-19 confirmed patients between March and August 2020. We reviewed the medical record of 205 patients whom meet the inclusion criteria.

Results: Median value and range of pH, PaCO2, PaO2, HCO3, BE, SaO2, FiO2, SpO2 were 7.41(7.01-7.54), 32.1(17.5-87.1), 73.9(22.7-343.7), 21(7.2-38.9), -3.8(-22.2-13.3), 94.9(33.5-99.9), 0.54(0.21-1.00) and 95(33.5-99.9). Most of the patients use non-rebreathing mask (37.56%), followed by nasal cannula (32.2%), mechanical ventilator (16.59%), high flow nasal cannula (10.73%), simple mask (0.98%) and venturi mask (0.49%). Median value of AaDO2 was 272.58 (40.55-644.17). Most of the patients were critically ill (93.2%). There were 33.51% patients presented with the mix acid base disorder, 22% with uncompensated metabolic acidosis disorder and 25% with compensated respiratory acidosis disorder. There was a correlatio"

"Pola sirkadian tekanan darah (TD) adalah gambaran TD 24 jam berupa kurva TD yang meningkat pada pagi hari, menurun pada siang / sore hari dan terendah pada malam hari / waktu tidur. 24 hours Ambulatory Blood Pressure Monitoring (24 hrs ABPM) merupakan alat pengukur TD yang lebih akurat dan dapat memperlihatkan pola sirkadian TD 24 jam. Turunnya TD 10 - 20% pada malam hari disebut dipper, jika turun < 10% disebut nondipper. Meningkatnya TD 24 jam dan nondipper merupakan faktor risiko morbiditas dan mortalitas kardiovaskular. Prevalensi hipertensi dan nondipper pada Penyakit Ginjal Kronik Stadium 5 dalam Terapi Dialisis (PGK 5D) masih sangat tinggi. Faktor utama penyebab hipertensi pada PGK 5D adalah menurunnya Laju Filtrasi Glomerulus (LFG) dan meningkatnya cairan ekstraselular. Transplantasi ginjal akan memperbaiki TD dan nondipper dengan membaiknya LFG, meningkatnya produksi urin dan menurunnya cairan ekstraseluler. Namun demikian satu bulan Pasca Transplantasi Ginjal kebutuhan dosis obat imunosupresan masih cukup tinggi yang dapat mengakibatkan hambatan penurunan TD. Tujuan : Mengetahui perbedaan pola sirkadian TD, data dipper / nondipper dan rerata TD 24 jam pada pasien PGK Pra dan satu bulan Pasca Transplantasi Ginjal. Metode Penelitian : Studi Pre experimental dengan before and after design. Subjek penelitian pasien PGK 5D / Pra Transplantasi Ginjal berusia 18 ? 60 tahun, dilakukan di RSCM pada bulan Oktober sampai dengan Desember 2014. Jumlah subjek sebanyak 15 orang. Dilakukan pengumpulan urin 24 jam, pemeriksaan LFG, pengukuran TD 24 jam dengan 24 hrs ABPM, Pra dan satu bulan Pasca Transplantasi Ginjal. Analisis statistik dengan uji McNemar dan uji t dependen. Hasil : Terdapat 12 subjek nondipper dan 3 subjek dipper pada pasien PGK Pra Transplantasi Ginjal. Satu bulan Pasca Transplantasi Ginjal seluruh subjek (15 orang) memperlihatkan keadaan nondipper. Uji McNemar tidak dapat dilakukan karena seluruh subjek PGK satu bulan Pasca Transplantasi Ginjal nondipper (homogen). Terdapat penurunan rerata TD sistolik 24 jam pasien PGK satu bulan Pasca Transplantasi Ginjal yang tidak signifikan (p > 0,05) dan penurunan rerata TD diastolik 24 jam yang signifikan (p < 0,05). Simpulan : Belum terdapat perbaikan nondipper pada pasien satu bulan Pasca Transplantasi Ginjal. Terdapat penurunan rerata TD sistolik 24 jam yang tidak signifikan dan penurunan rerata TD diastolik 24 jam yang signifikan pada pasien satu bulan Pasca Transplantasi Ginjal.

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The circadian pattern of blood pressure (BP) is a 24 hours blood pressure (24hrs BP) curve which increases in the morning, decreases in the afternoon/evening and the lowest state is at night/bedtime. 24 hrs Ambulatory Blood Pressure Monitoring (ABPM) is a BP measuring device that is accurate and can exhibit a circadian pattern of 24 hrs BP. The fall of BP 10-􀀃20% at night is called as a dipper, while less than 10% is called as a nondipper. The increasing of 24 hrs BP and nondipper are the risk factor for cardiovascular morbidity and mortality. The prevalence of hypertension and nondipper in Chronic Kidney Disease stage 5 on Dialysis (CKD 5D) are still very high. The main factors causing hypertension in CKD 5D are decreased Glomerular Filtration Rate (GFR) and increased extracellular fluid. Kidney transplantation will improve BP and nondipper by GFR improvement, increases urine production and decreases extracellular fluid. However, one month after kidney transplantation, the dose of immunosuppressant drugs is relatively high, which is an obstacle to decrease BP.

Aim: To determine differences in the circadian pattern of BP, the data of dipper and nondipper, and the mean of 24 hrs BP in CKD before, and one month after kidney transplantation.

Methods: Design of the study is before and after design. Subjects of the study were patients with CKD 5D before kidney transplantation, aged 18-60 years, were conducted in Cipto Mangunkusumo Hospital during October to December 2014. 15 subjects were included in the study. 24 hrs urine collection, GFR, 24 hrs BP measurement with 24 hrs ABPM were recorded in all subjects, before and one month after kidney transplantation. McNemar test and t dependent test were used in statistical analysis.

Results: Before kidney transplantation, 12 of 15 subjects were nondippers while the others 3 subjects were dippers. After kidney transplantation, all subjects (15 patients) were nondippers. McNemar test can not be used because all subjects one month after kidney transplantation were nondippers (homogeneous). The decreasing of the mean of 24 hrs systolic BP was found in all CKD one month after kidney transplantation, but statistically not significant (p>0.05), while decreasing of the mean of 24 hrs diastolic BP was statistically significant (p<0.05).

Conclusion: There were still no improvement in nondipper patients one month after kidney transplantation. There were a decrease in the mean of 24 hrs systolic BP but statistically not significant and a decrease in the mean of 24 hrs diastolic BP which is statistically significant in patients one month after kidney􀀃transplantation."

"Aliran darah koroner terjadi terutama pada fase diastolik. Stenosis arteri koronaria menimbulkan iskemia miokard. Iskemia miokard dapat menimbulkan gangguan diastolik. Gangguan diastolik mengakibatkan penurunan aliran darah koroner pada sepertiga awal diastolik, baik pada waktu istirahat maupun selama takikardia. Angina pektoris merupakan gejala iskemia miokard. Tujuan penelitian ini untuk membuktikan bahwa ditemukan gangguan diastolik ventrikel kiri, dan angina pektoris akan lebih berat bila disertai dengan gangguan diastolik ventrikel kiri pada pasien stenosis arteri koronaria. Pada penelitian ini dilakukan pemeriksaan variabeI diastolik ventrikel kiri, dengan ali ran mitral gelombang pulsa doppler ekokardiografi saat istirahat, pada pasien yang terbukti mengalami stenosis arteri koronaria dari pemeriksaan angiografi koroner. Pada penelitian ini, yang memenuhi kelima variabel diastolik dan diklasifikasikan sebagai fungsi diastolik normal adalah 3,3%, relaksasi abnormal 10%, sementara 86,7% menunjukkan perubahan beberapa variabel diastolik.

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Coronary blood flow occurs mainly in the diastolic phase. Arterial stenosis The coronary artery gives rise to myocardial ischemia. Myocardial ischemia can cause diastolic disorders. Diastolic disorders result in decreased blood flow coronary in the first third of diastolic, both at rest and during tachicardia. Angina pectoris is a symptom of myocardial ischemia. The purpose of this study to prove that diastolic disorders of the left ventricle, and angina were found Pectoris will be more severe when accompanied by diastolic disorders of the left ventricle in patients with coronary artery stenosis. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, a variabeI examination was carried out diastolic left ventricle, with ali ran mitral pulse wave Doppler echocardiography at rest, in patients who have been shown to have coronary artery stenosis of coronary angiography examination. In this study, which meets all five variables diastolic and classified as normal diastolic function is 3.3%, relaxation abnormal 10%, while 86.7% showed changes in several diastolic variables.

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"Latar belakang: Chronic limb threatening ischemia (CLTI) merupakan bentuk terparah peripheral arterial disease. Pasien kaki diabetik dengan CLTI memiliki risiko amputasi mayor dan mortalitas paska revaskularisasi dan dipengaruhi beberapa faktor seperti usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi. Indonesia belum memiliki data amputasi mayor dan mortalitas kaki diabetik dengan CLTI setelah revaskularisasi dan faktor-faktor yang berpengaruh. Penelitian ini bertujuan mengetahui angka amputasi mayor dan mortalitas satu tahun pasca revaskularisasi beserta faktor-faktor yang memengaruhi di Rumah Sakit Cipto Mangunkusumo (RSCM).Metode: Kohort retrospektif pasien kaki diabetik dengan CLTI setelah revaskularisasi di RSCM Januari 2010 – Desember 2020. Pengambilan data rekam medis. Luaran utama amputasi mayor dan mortalitas satu tahun setelah revaskularisasi. Dilakukan analisis bivariat dengan uji Kai Kuadrat, jika persyaratan tidak terpenuhi maka menggunakan Fischer-exact, variabel bermakna diuji lebih lanjut dengan regresi logistik. Hasil: Penelitian melibatkan 150 subjek. Amputasi mayor dan mortalitas satu tahun setelah revaskularisasi sebesar 27,3% dan 24,7%. Tidak didapatkan hubungan yang bermakna antara faktor-faktor yang diteliti dengan amputasi mayor dan mortalitas satu tahun.Kesimpulan: Didapatkan angka amputasi mayor dan mortalitas 1 tahun pasca revaskularisasi. Usia lanjut, gagal ginjal kronik, komorbid penyakit jantung dan hipertensi bukan merupakan faktor yang memengaruhi angka amputasi dan mortalitas satu tahun.

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Background: Chronic limb threatening ischemia (CLTI) is the most severe form of peripheral arterial disease. Diabetic foot patients with CLTI have major amputation and mortality risk after revascularization and affected by factors such as elderly, chronic kidney disease (CKD), cardiac morbidity and hypertension. In Indonesia there are no data regarding diabetic foot major amputation and mortality with CLTI after revacularization and influencing factors. Study aims to determine one year major amputation and mortality and factors that can affect diabetic foot pastients with CLTI after revascularization.

Methods: Retrospective cohort study on diabetic foot patients with CLTI undergoing revascularization at Cipto Mangunkusumo National Hospital from January 2010 to December 2020. The primary outcome was one-year major amputation and mortality after revascularization. Factors included were age, CKD, cardiac comorbidity and hypertension. We conducted bivariate analysis using Chi Square or Fisher-exact test. Variables were further tested using multivariate test.

Result: 150 subjects were enrolled. One-year major amputation and mortality was 27.3% and 24.7%. There are not significant correlations between factors with major amputation and mortality.

Conclusion: Major amputation and mortality rate one year after revascularization at RSCM are gained. Elderly, CKD, cardiac comorbidity and hypertension are not factors affecting one-year major amputation and mortality."

"The chief complain of chronic peripheral arterial occlusion disease is intermittent clodication, or calf pain during exercise that is relieved by resting. As the disease advances, pain occurs even during resting. The main cause for this disease is atherosclerosis.Clinical evaluation of patients comprise of questionnaire, exploration of atherosclerosis risk factors such as smoking, hyperlipidemia, diabetes mellitus, hypertension, etc. Pulse examination, ankle-brachial pressure index (ABPl) measurements and leg segmenta! blood pressure assessments are integral examinations in such patients. Another important test is functional assessments using the treadmill, or other tests to cause hyperemia.The chief management is to prevent common morbidity and mortality due to atherosclersosis such as coronary heart disease and its complications, as well as cerebrovascular disease and its complications. Management is also targeted towards preventing the progress of peripheral arterial occlusion disease.Specific management for peripheral arterial occlusion disease that is clearly beneficial to improve symptoms is physical exercise. Drugs such as pentoxyphylline, naftidrofuryl, buflomedil, and cilostazol are of little benefit only. Aspirin is useful to prevent cardiovascular, but is useless to improve symptoms.Prior to offering interventional procedures (angiopfasty and for stent insertion) or surgery, the following issues should be contemplated: I) the patient does not respond to physical exercise and risk factor modification, b) there is severe disability, c) there is no longer other disease that limits activity, and d) the morphology of the lesion is in line with the intervention, with a low risk and high probability for initial and long-term success"

"[LATAR BELAKANGPenyebab terbanyak Penyakit Arteri Perifer (PAP) pada usia diatas 40 tahun adalah aterosklerosis. Prevalensi penyakit aterosklerosis perifer meningkat pada kasus dengan diabetes melitus, dislipidemia, hipertensi dan perokok. Critical Limb Ischemia (CLI) merupakan manifestasi dari PAP berat, CLI dikaitkan dengan risiko kehilangan tungkai yang sangat tinggi. Pada pasien CLI tanpa adanya revaskularisasi, pasien biasanya akan dilakukan amputasi dalam hitungan minggu atau bulan. Revaskularisasi secara terbuka memiliki morbiditas yang cukup banyak. Seiring kemajuan teknologi, revaskularisasi secara terbuka perlahan-lahan digantikan dengan adanya intervensi endovaskuler dalam dua dekade terakhir. Revaskularisasi endovaskuler di Departemen Ilmu Bedah RSCM baru mulai dilakukan pada tahun 2012 dan di Indonesia saat ini belum ada studi yang menilai hasil dari tindakan revaskularisasi.METODEMetode yang diambil adalah analitik komparatif berpasangan dengan disain penelitian longitudinal pre-post study. Selama Agustus 2013 hingga Agustus 2014 didapatkan 16 pasien yang masuk kriteria inklusi. Dilakukan pengambilan data nilai ABI sebelum dan sesudah revaskularisasi endovaskuler. ABI digunakan sebagai penilaian efektivitas revaskularisasi.HASILHasil didapatkan nilai mean ABI sebelum tindakan 0,7±0,118 dan nilai mean ABI sesudah tindakan 0,844±0,127. Didapatkan peningkatan nilai ABI sesudah tindakan 0,14. Dari hasil uji T berpasangan didapatkan nilai p=0,001. Secara statististik didapatkan peningkatan yang signifikan antara nilai ABI sebelum tindakan dan sesudah tindakan.KESIMPULANDapat ditarik kesimpulan tindakan revaskularisasi endovaskuler terhadap pasien PAP efektif berdasarkan nilai ABI;BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI, BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI]"

"ABSTRAK Kondisi pasien diabetes mellitus DM tipe 2 dengan peripheral arterial disease PAD yang tidak ditangani dengan tepat dapat memicu terjadinya neuropati, ulkus pedis diabetik, bahkan amputasi. Intervensi latihan ankle range of motion ROM dipercaya dapat mengurangi gejala dan mencegah progresifitas PAD pada pasien DM tipe 2. Namun pada praktiknya, intervensi ini masih jarang dilakukan. Studi kasus dalam Karya Ilmiah Akhir Ners KIAN ini bertujuan untuk mengidentifikasi pengaruh pemberian intervensi ankle ROM pada pasien DM tipe 2 dengan komplikasi PAD. Hasil analisis menunjukkan bahwa terdapat pengurangan gejala PAD dan peningkatan aliran darah ekstremitas yang ditandai dengan peningkatan saturasi oksigen, kekuatan pulsasi, dan penurunan skala nyeri. Edukasi dan pendampingan latihan ankle ROM pada pasien DM tipe 2 dengan PAD diperlukan agar perfusi jaringan perifer pasien dapat tercapai dengan optimal.

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ABSTRACT The conditions of type 2 diabetes mellitus T2DM patient with peripheral arterial disease PAD that is not handled properly can lead to neuropathy, diabetic pedis ulcer, even amputation. Intervention of ankle range of motion ROM exercise is believed to reduce symptoms and prevent the PAD progression. However, in clinical practice, this intervention still rarely done. Therefore, this case report aims to identify the impact of ankle ROM in T2DM patients with PAD complications. The results showed that there was a reduction in PAD symptoms and an increase in limb blood flow characterized by increased oxygen saturation, pulsation, and decreased pain scale. In brief, education and advisory of ankle ROM in T2DM patient with PAD is required to optimize the peripheral perfusion."