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"Pendahuluan: Deep Vein Thrombosis (DVT) memiliki kecenderungan terus meningkat dengan koinsidensi mortalitas jangka pendek dan morbiditas jangka panjang. COVID-19 dapat menyebabkan hypercoagulable state dan menjadi predisposisi terjadinya DVT. Penelitian ini bertujuan untuk menganalisis hubungan kadar fibrinogen, D-Dimer, dan dosis heparin teraupetik berdasarkan kadar APTT dengan adanya COVID-19 pada pasien DVT. Metode: Desain penelitian komparatif dan kohort prospektif digunakan untuk membandingkan kadar fibrinogen, D-Dimer, dan dosis heparin terapeutik antara pasien COVID-19 dan non COVID-19 yang menderita DVT di RSPN Cipto Mangunkusumo pada bulan Maret 2020 – Maret 2022. Penegakan diagnosis DVT dilakukan dengan pemeriksaan ultrasonografi dan/atau computed tomography angiography (CTA) fase vena. Data variabel utama dan lainnya diperoleh dari rekam medis pasien. Uji T independen atau Mann-Whitney digunakan untuk menganalisis perbedaan nilai variabel antara kedua kelompok. Hasil: Dari total 253 sampel, tidak terdapat perbedaan karakterisitik awal antara kelompok DVT COVID-19 (n=44) dan DVT non COVID-19 (n=209), kecuali pada parameter Wells Score. Kelompok DVT COVID-19 memiliki kadar Fibrinogen, D-Dimer, dan aPTT yang lebih tinggi daripada kelompok DVT non COVID-19, baik sebelum terapi maupun sesudah terapi heparanisasi (semua nilai p =0,000). Pada akhir pengamatan, didapatkan dosis heparin terapeutik pada kelompok DVT COVID-19 lebih tinggi dibanding pada kelompok DVT non COVID-19 (30,00 (20,00-40,00)x103 U vs. 25,00 (20,00-35,00)x103 U, p=0,000). Kesimpulan: Kadar fibriongen, D-Dimer, dan dosis heparin terapeutik pada pasien DVT yang menderita COVID-19 lebih tinggi dibandingkan pada pasien DVT yang tidak menderita COVID-19. Inisiasi pemberian dosis heparin terapeutik dosis tinggi dapat dipertimbangkan pada pasien DVT dengan komorbid COVID-19 dan dipandu oleh hasil pemeriksaan biomarker koagulasi darah.

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Introduction: Deep Vein Thrombosis (DVT) has an increasing trend with a coincidence of short-term mortality and long-term morbidity. COVID-19 can cause a hypercoagulable state and predispose to DVT. This study aims to analyze the relationship between fibrinogen levels, D-Dimer, and therapeutic heparin doses based on APTT levels in the presence of COVID-19 in DVT patients. Methods: A comparative study design and a prospective cohort were used to compare levels of fibrinogen, D-Dimer, and therapeutic heparin doses between COVID-19 and non-COVID-19 patients suffering from DVT at Cipto Mangunkusumo Hospital in March 2020 – March 2022. Diagnosis of DVT was performed by ultrasound examination and/or computed tomography angiography (CTA) venous phase. The primary variable data and others were obtained from the patient's medical record. An Independent T-test or Mann-Whitney was used to analyze the differences in variable values between the two groups. Results: Of 253 samples, there was no difference in initial characteristics between the DVT COVID-19 (n=44) and non-COVID-19 DVT groups (n=209), except for the Wells Score parameter. The COVID-19 DVT group had higher levels of fibrinogen, D-Dimer, and aPTT than the non-COVID-19 DVT group, both before and after heparinization therapy (all p-values = 0.000). At the end of the follow-up period, the therapeutic dose of heparin in the COVID-19 DVT group was higher than in the non-COVID-19 DVT group (30.00 (20.00-40.00)x103 U vs. 25.00 (20.00-35.00)x103 U, p-value=0.000). Conclusion: The levels of fibrinogen, D-Dimer, and therapeutic doses of heparin in DVT patients who have COVID-19 are higher than in DVT patients who do not have COVID-19. Initiation of a higher therapeutic dose of heparin can be considered in DVT patients with comorbid COVID-19 and guided by the results of blood coagulation biomarkers."

"Latar belakang :Tesis ini membahas tentang analisis kasus kematian pada pasien Aneurisma aorta abdominal di RSUP Fatmawwati yang menjalani operasi elektif. Sampel dan Metode : Data pasien diambil periode 2013 sampai April 2018. Semua pasien yang meninggal dari operasi elektif aneurisma aorta abdominal akan di data. Penelitian ini ditampilkan dalam bentuk deskriptif, dengan data kualitatif dan kuantitatif. Data kualitatif didapatkan dengan melakukan wawancara dengan tim operasi, operator, tim anestesi dan paramedis instrumen. Data kuantitatif didapatkan dengan telusur rekam medis. Hasil : Terdapat 27 kasus, selama periode 2013 sampai April 2018. Hanya 15 kasus yang rekam medis lengkap, 5 kasus hidup, 2 kasus meninggal pada operasi emergency dan 8 kasu meninggal pada operasi elektif. Dari 8 kasus ini, 5 kasus disertai anemia dan trombositopenia yang menetap sampai pada tahap postoperasi, 2 kasus dengan gangguan ginjal dan 1 kasus dengan penyebab yang belum jelas. Pada 8 kasus kematian, lama operasi berkisar dari 4 jam 20 menit sampai 8 jam 10 menit. Jumlah perdarahan berkisar dari 750 cc sampai 7.000 cc. Kadar creatinin preoperasi, berkisar dari 1,0 sampai 4,3 mg/dL. Kadar creatinin postoperasi berubah dari 1,0 sampai 4,5 mg/dL. Kadar hemoglobin postoperasi berkisar 5,9 sampai 9,4 g/dL. Kadar trombosit, berkisar 45.000 sampai 108.000/uL. Rata rata jumlah perdarahan adalah 3.156 cc. Kesimpulan : Penelitian ini menyimpulkan bahwa kasus dengan hasil akhir kematian, sebagian besar disertai oleh jumlah perdarahan yang masif. Perbaikan yang dilakukan untuk resusitasi komponen darah tidak mencapai hasil yang optimal.

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Background : The aim of this study is to confirm the factors that affect the mortality following open elective abdominal aortic aneurysm repair. Subject and Methode : This study was a retrospective study. Qualitative and quantitave data were collected from interviewing the team in charge and from the hospital database medical record. The data were collected for five years, from 2013 until April 2018. Data will be displayed in descriptive. Result : Twentyseven cases were hospitalized during the periode of 2016 until April 2018. Ten cases were not availlable to analyze, medical record were missing. Out of two case from these fivteen cases, was an emergency case. Five cases were alive when they discharge from the hospital. The other eight were elective cases and were able to analyze. Five cases, out of this eight, were accompanied by anemia and thrombositopenia, which last until they all move from the surgery room to the ICU. Two cases with renal disfunction, and one case with unclear cause of death. Duration of surgery in all this elective cases, ranged from 4 hours 20 minutes until 8 hours 10 minutes. Bood loss during surgery, estimated from 750 cc to 7.000 cc. Preoperative creatinin level, ranged from 1,0 to 4,3 mg/dL. Postoperative cretainin level, ranged from 1,0 to 4,5 mg/dL. Postoperative hemoglobin level, ranged from 5,9 to 9,4 g/dL. Postoperative platelet count , ranged from 45.000 to 108.000/uL. Mean blood loss during surgery was 3.156 cc. Conclusion : This study concluded that most of the death case was accompanied by massive bleeding. And all those attempt to improve by blood rescusitation, was not promptly worked."

"Latar Belakang: Akses vaskular (AVF) adalah jalur kehidupan bagi pasien hemodialis jangka panjang dan merupakan pilihan utama. Nyatanya kegagalan maturasi AVF yang tinggi merupakan masalah bagi pasien penyakit ginjal tahap akhir (PGTA). Penilaian faktor prediktor kegagalan maturasi yang mudah digunakan memberi informasi prediksi dalam menentukan prognosa.  Sistem penilaian ini mencoba menerjemahkan faktor inflow, outflow dan conduit (IOC) menjadi angka yang membantu menilai secara kuantitatif hasil akhir resiko maturasi. Penelitian ini bertujuan untukmenggabungkan penilaian IOC untuk memprediksi outcome, dan mengembangkan sistem skoring IOC-Score pada prediksi maturasi AVF.Metode: Didapatkan 177 pasien AVF brachiocephalica dengan studi kohort retrospektif pada pasien PGTA sepanjang tahun 2020-2021 yang memenuhi kriteria iklusi. Penilaian karakteristik pasien dan AVF memberi gambaran demografi, dan analisa regresi logistik mendapatkan kemaknaan statistik pada faktor prediktor yang signifikan.Hasil: Delapan signifikan faktor komponen IOC: diameter arteri ³3.85mm, diameter vena ³2.45mm. Peak Systolic Velocity (PSV) arteri ³ 72.35, Volume Flow (VF) arteri ³ 72.35, VF vena ³291.9, Intima Media Thickness (IMT) <0.29, stenosis draining vein dan stenosis vena central (masing-masing 1poin). Skor IOC (maksimal 8 poin) signifikan memprediksi keberhasilan maturasi AVF (p<0.001). Skor IOC di dapatkan titik potong ³4.5 menghasilkan risk rasio 62.85 (Interval kepercayaan/CI 95%: 23.31-169.48; p<0.001) dan probabilitas 96.8% untuk skor maksimal.  Kesimpulan: Inflow, Outflow dan Conduit meningkatkan prediksi outcome pada maturasi AVF, dinyatakan dalam skor prognostic IOC yang akurat, mudah, applikatif dan terpercaya. 

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Background: Vascular access (AVF) as  a “lifeline” on long term hemodialysis is still the primary choice. Fact there is still high rate of failure of arteriovenous fistula procedure is one of the obstacles in treatment of chronic kidney disease. Easy-to-use scoring inform physician to predict and help to decide the management. Scoring system attempts to translate inflow, outflow dan conduit (IOC) into a score, thereby allows quantification of maturation. Purpose of this study is to combine IOC factors to predict the outcome, and develop easy-to-use risk scoring system predict fistula maturation; IOC-Score.

Methods: Total 177 consecutive brachiocephalic fistulae were identified cohort retrospectively on 2020-2021. Numerous patient-and fistula-related demographics were noted. Cox regression analysis was used to identify significant factors predictive of fistula maturation, and significant variables weighted according to their hazard ratio.

Results: Eight significant factor IOC component: arterial diameter ³3.85mm, vein diameter  ³2.45mm, arterial Peak Systolic Velocity (PSV) ³ 72.35, arterial Volume Flow (VF)³ 72.35, vein VF³291.9, Intima Media Thickness (IMT)<0.29, stenosis draining vein and central vein stenosis (each 1poin). The IOC-Score (maximum 8 points) significantly predict fistula maturation (p<0.001). Cut of point IOC-Score ³4.5 with risk ratio 62.85 (Confidence Interval/CI 95%: 23.31-169.48; p<0.001) dan probability 96.8% for maximum score.  

Conclusion: Combination Inflow, Outflow and conduit improves the prognostic of  outcome on fistula maturation, formulated in IOC-Score which is accurate, simple, applicable and reliable. "

"Pengantar. Penelitian ini dilakukan dengan tujuan untuk membedakan efektifitas dan keamanan single balloon angioplasty (SBA) dengan akses arterial inflow dan vena outflow pada pasien PGK yang menjalani hemodialisis dengan disfungsi radiocephalic AVF.Metode. Penelitian ini dilaksanakan pada bulan April-Juni 2022 dengan desain observasional retrospektif, di Unit Rekam Medis RS Cipto Mangunkusumo, RS Hermina Bekasi, dan RS Prof. Dr. R.D. Kandou Manado. Semua pasien dengan penyakit ginjal kronis stadium akhir (pada terapi hemodialisis) yang memiliki fistula arteriovenosa disfungsional radiosefalik (AVF). Variabel terikat dalam penelitian ini adalah keberhasilan AVF setelah terapi endovaskular (SBA) yang dinilai berdasarkan kriteria KDOQI NKF, patensi AVF, dan komplikasi pada pasien setelah terapi endovaskular.Hasil. Sebanyak 178 pasien dengan disfungsi AVF radiosefalik dilibatkan. Tingkat keberhasilan untuk SBA ditemukan lebih tinggi pada kelompok aliran arteri, dengan rasio odds (OR) 2,539 (95% CI 1,100-5,858). Tingkat patensi pada 3 dan 6 bulan setelah SBA dengan akses aliran arteri ditemukan lebih tinggi dibandingkan dengan akses aliran keluar vena (p 0,05). Tidak ada pengaruh jenis akses ini pada patensi 12 bulan setelah prosedur SBA (p = 0,991). Tidak ada perbedaan yang signifikan dalam tingkat komplikasi SBA dengan akses ke aliran masuk arteri dan aliran keluar vena pada pasien CKD dengan disfungsi AVF.Simpulan. Tingkat keberhasilan, patensi 3 bulan, dan SBA 6 bulan pasca operasi ditemukan lebih tinggi dengan akses aliran masuk arteri.

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Introduction. This study was conducted with the aim of differentiating the effectiveness and safety of single balloon angioplasty (SBA) with access to arterial inflow and venous outflow in CKD patients on hemodialysis with radiocephalic AVF dysfunction.

Methode. This research was conducted in April-June 2022 with an observational retrospective design, at the Medical Record Unit of Cipto Mangunkusumo Hospital, Hermina Hospital Bekasi, and Prof. Hospital. Dr. R.D. Kandou Manado. All patients with end-stage chronic kidney disease (on hemodialysis therapy) who have a radiocephalic dysfunctional arteriovenous fistule (AVF). The dependent variable in this study was the success of AVF after endovascular therapy (SBA) which was assessed based on the KDOQI NKF criteria, AVF patency, and complications in patients after endovascular therapy.

Results. A total of 178 patients with radiocephalic AVF dysfunction were included. The success rate for SBA was found to be higher in the arterial inflow group, with an odds ratio (OR) of 2.539 (95% CI 1.100–5.858). The rate of patency at 3 and 6 months after SBA with arterial inflow access was found to be higher than with venous outflow access (p 0.05). There was no effect of this type of access on the patency of 12 months after the SBA procedure (p = 0.991). There was no significant difference in the complication rate of SBA with access to arterial inflow and venous outflow in CKD patients with AVF dysfunction.

Conclusion. The success rates, 3-month patency, and 6-month postoperative SBA were found to be higher with arterial inflow access."

"Latar Belakang: Akses vaskular sebagai jalur kehidupan pasien gagal ginjal kronik yang menjalani hemodialisis dapat mengalami disfungsi. Stenosis merupakan salah satu penyebab disfungsi akses vaskular yang dapat menurunkan kualitas hemodialisis. Terapi endovaskular seperti angioplasty adalah salah satu solusi efektif untuk mengatasi masalah ini, tetapi tindakan ini memerlukan biaya yang cukup tinggi. Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang mempengaruhi keberhasilan tindakan single balloon angioplasty, yang merupakan alternatif dari tindakan angioplasty standar, pada penderita stenosis vena sentral.Metode: Penelitian ini merupakan studi kohort retrospektif analitik yang menilai faktor-faktor yang berpengaruh terhadap keberhasilan tindakan single balloon angioplasty di RSCM, RS Hermina Bekasi, RSUP Fatmawati dan RSUD Tangerang pada periode Januari 2018 sampai Desember 2020. Analisis dilakukan untuk mengidentifikasi hubungan lokasi stenosis, riwayat pemasangan kateter vena sentral, panjang lesi dan stenosis awal dengan keberhasilan tindakan single balloon angioplasty berdasarkan stenosis residual dan adekuasi hemodialisis pascatindakan.Hasil: Terdapat 109 pasien yang diinklusi dalam penelitian ini, dengan rerata usia 55,17±11,51 tahun. Dari jumlah tersebut, 58 subjek (53,2%) adalah laki-laki; 96 subjek (88,1%) memiliki komorbid hipertensi dan 38 subjek (34,9%) menderita komorbid diabetes. Pasien dengan panjang lesi >2 cm memiliki proporsi keberhasilan sebesar 21,1%, lebih rendah dibandingkan kelompok panjang lesi ≤2 cm (78,9%) (p<0,001). Derajat stenosis inisial >80% juga lebih banyak ditemukan memiliki stenosis residual ≥30% (p<0,001). Pasien dengan panjang stenosis ≤2 cm memiliki peluang keberhasilan 5,089 kali (IK 95%, 2,103–12,31) lebih tinggi dibandingkan pasien dengan panjang stenosis >2 cm. Pasien dengan derajat stenosis 50–80% memiliki peluang keberhasilan 31,62 kali (IK 95%, 7,00–142,83) lebih tinggi dibandingkan pasien dengan derajat stenosis inisial >80%. Patensi vena sentral pada 3 bulan pertama didapatkan pada 59 pasien (54,1%) dan berkurang menjadi 28,4% pada bulan ke-6 dan 9,2% pada bulan ke-12.Kesimpulan: Terdapat hubungan antara panjang lesi dan derajat stenosis inisial dengan keberhasilan tindakan single balloon angioplasty

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Background: Vascular access is the lifeline of a hemodialysis patient. Hemodialysis vascular access dysfunction is a major cause of morbidity and mortality in the hemodialysis population. Venous stenosis may result in access dysfunction, which impairs dialysis quality. Endovascular intervention such as angioplasty is an effective solution to treat this condition; however, the cost of this procedure is unacceptably high for most patients.  This study aims to identify factors affecting the success of single balloon angioplasty, which is a modification of standard angioplasty technique, for patients with central venous stenosis.

Methods: This is a retrospective analytic cohort study identifying factors affecting the success rate of single balloon angioplasty procedure in dr. Ciptomangunkusumo, Hermina Bekasi, Fatmawati, and Tangerang General Regional hospitals from January 2018 to December 2020. Statistical analysis was conducted to identify the correlation between stenosis location, previous history of central venous catheter placement, lesion length, and initial stenosis with the success rate of single balloon angioplasty according to residual stenosis and hemodialysis adequacy postoperatively.

Results: There were 109 patients included in this study, with an average age of 55.17±11.51 years. Of the 109 subjects, 58 (53.2%) were men; 96 subjects (88.1%) suffered from chronic hypertension, while 38 were diabetics. Patients with lesion length of >2 cm had a 21.1% lower success rate compared with those with lesion length of ≤2 cm (78.9%) (p<0.001). Patients with an initial stenosis of >80% was more likely to have residual stenosis of ≥30% (p<0,001). Patients with stenosis length of ≤2 cm had a 5.089-times (95% CI, 2.103–12.31) higher success rate compared with those with stenosis length of >2 cm. Patients with a degree of stenosis 50–80% had a 31.62-times (95% CI, 7.00–142.83) higher success rate compared with patients with an initial stenosis of >80%. Central venous was patent in 59 patients (54.1%) in the first 3 month and decreased to 28.4% and 9.2% in the 6th and 12th month, respectively.

Conclusion: Lesion length and the degree of initial stenosis were significantly correlated with the success rate of single balloon angioplasty."

"Latar Belakang: Deep Vein Thrombosis (DVT) adalah salah satu penyakit penyebab mortalitas jangka pendek dan morbiditas jangka panjang. Kasus DVT akan meningkat seiring bertambahnya usia. Pada pasien dengan keganasan, risiko DVT meningkat hingga 4,1 kali lipat karena kondisi hiperkoagulasi. Penatalaksanaan DVT antara lain pemberian antikoagulan dan kompresi eksterna. Penelitian ini bertujuan membandingkan luaran antropometrik tungkai pasien DVT dengan keganasan dan non-keganasan yang diterapi heparin.Metode: Kohort retrospektif menggunakan rekam medis di RS Cipto Mangunkusumo. Variabel bebas adalah status keganasan pada pasien DVT sedangkan variabel terikatnya adalah pengukuran antropometrik lingkar tungkai sebelum terapi heparin, 4 hari, dan 7 hari. Analisis statistik menggunakan SPSS versi 25, nilai p<0,05 menunjukkan kemaknaan secara statistik.Hasil: Sebanyak 63 subjek penelitian, didapatkan subjek DVT dengan keganasan sebanyak 33 subjek (52,4%) dan DVT non keganasan sebanyak 30 subjek (47,6%). Pada awal terapi, tidak terdapat perbedaan ukuran antropometrik antara DVT keganasan dan non keganasan. Pada hari ke-4 dan ke-7 terapi, terdapat perbedaan perbaikan ukuran antropometrik di mid femur, distal femur, dan mid cruris, dimana perbaikan klinis lebih tampak pada DVT non keganasan (p<0,05). Subjek DVT keganasan memiliki dosis heparin maintenance teraputik yang lebih tinggi (p=0,000), dan mencapai waktu kadar APTT terapeutik yang lebih lama (p=0,000).Kesimpulan: Subjek DVT keganasan menunjukkan perbaikan klinis yang lebih kecil dibandingkan DVT non keganasan. Selain itu, memerlukan dosis heparin maintenance terapeutik yang lebih tinggi, dan mencapai waktu kadar APTT terapeutik yang lebih lama.

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Background: Deep Vein Thrombosis (DVT) is a disease that causes short-term mortality and long-term morbidity. DVT cases will increase with age. In patients with malignancy, the risk of DVT increases up to 4.1-fold due to the hypercoagulable state. Treatment for DVT includes anticoagulants and external compression. This study aims to compare the anthropometric outcomes of the limbs of DVT patients with malignancy and non-malignancy treated with heparin.

Method: Retrospective cohort study using medical records at Cipto Mangunkusumo Hospital. The independent variable is malignancy status in DVT patients while the dependent variable is anthropometric measurements of leg circumference at first day, 4 days and 7 days heparin therapy. Statistical analysis using SPSS version 25, p<0.05 showed statistical significance.

Results: Of the 63 study subjects, 33 subjects (52.4%) had DVT with malignancy and 30 subjects (47.6%) had non-malignant DVT. At the start of therapy, there was no difference in anthropometric measures between malignant and non-malignant DVT. On the fourth and seventh days of therapy, there were differences in anthropometric size improvement in the mid femur, distal femur, and mid cruris, whereas clinical improvement was more evident in nonmalignant DVT (p<0.05). Malignant DVT subjects had higher therapeutic maintenance heparin doses (p=0.000), and achieved longer therapeutic APTT levels (p=0.000).

Conclusion: Malignant DVT subjects showed less clinical improvement than non-malignant DVT. In addition, it requires higher therapeutic maintenance heparin doses, and achieves a longer therapeutic APTT level time."

"Tujuan. Penelitian ini dibuat untuk mengetahui faktor-faktor yang berhubungan patensi satu tahun Single Balloon Angioplasty (SBA) pada Stenosis Draining Vein Fistula Arteriovenosa (FAV) RadiosefalikaMetode. Penelitian ini merupakan studi kohort retrospektif, yang dilakukan di RSUPN Cipto Mangunkusumo Jakarta, RSUP Fatmawati, dan RS Hermina Bekasi pada bulan Juli-November 2022. Pasien ≥ 18 tahun yang pertama kali didiagnosis stenosis juxta dan draining vein FAV radiosefalika diinklusi dalam penelitian. Variabel yang diteliti adalah lama pembuatan FAV hingga terjadi stenosis, karakteristik stenosis (jumlah, panjang, derajat, dan diameter), serta peningkatan flow dan sisa residual stenosis pasca angioplasti. Bila pada analisis bivariat didapatkan p<0,25 maka akan dilanjutkan ke analisis multivariat menggunakan regresi logistik.Hasil. Peneliti menginklusi 110 pasien disfungsi FAV radiosefalika pada draining vein yang menjalani tindakan SBA, dengan median usia 59 (30–82) tahun. Patensi FAV radiosefalika pasca tindakan SBA pada bulan ke-3, bulan ke-6, dan bulan ke-12, masing-masing sebesar 87,3, 74,5%, dan 42,7%. Faktor-faktor yang ditemukan berhubungan dengan patensi adalah riwayat diabetes (aOR=26,610, IK95% 2,992–236,681), jumlah stenosis (aOR=17,329, IK95% 2,204–136,242), panjang stenosis ≥ 2 cm (aOR=14,993, IK95% 1,808–124,351), durasi FAV < 6 bulan (aOR=86,094, IK95% 7,729–959,044), diameter stenosis ≥ 2,685 mm (aOR=8,900, IK95% 1,515–52,287), dan residual stenosis ≥30% (aOR=250,241, IK95%, 6,129–10.216,612).Simpulan. Angka patensi 1 tahun tindakan SBA pada pasien dengan FAV radiosefalika yang mengalami stenosis draining vein adalah sebesar 42,7%. Residual stenosis ≥30% pasca tindakan merupakan faktor yang paling berpengaruh dalam menentukan patensi FAV 12 bulan pasca tindakan

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Aim. This study aimed to determine the factors related to one year patency of Single Balloon Angioplasty (SBA) in Radiocephalic Arteriovenous Fistula Draining Vein Stenosis (FAV).

Methods: This is a retrospective cohort study, which was conducted at Cipto Mangunkusumo, Fatmawati, and Hermina Bekasi Hospital General Hospital in July–November 2022. Patients aged ≥ 18 years who were firstly diagnosed with juxta and draining vein FAV radiocephalics stenosis were included in the study. The variables studied were the duration of FAV placement until stenosis occurred, the characteristics of the stenosis (number, length, degree, and diameter), as well as increased flow and residual stenosis after angioplasty. If the bivariate analysis obtained p <0.25 then it will be continued to multivariate analysis using logistic regression.

Results: We included 110 patients with radiocephalic FAV dysfunction in the draining vein who underwent SBA, with a median age of 59 (30–82) years. The patency of radiocephalic FAV after the SBA procedure at the 3rd, 6th, and 12th months, were 87.3, 74.5%, and 42.7%, respectively. Factors associated with patency were history of diabetes (aOR=26.610, CI95% 2.992–236.681), number of stenoses (aOR=17.329, CI95% 2.204–136.242), length of stenosis ≥2 cm (aOR=14.993, CI95% 1.808) –124.351), duration of FAV <6 months (aOR=86.094, CI95% 7.729–959.044), diameter of stenosis ≥2.685 mm (aOR=8.900, CI95% 1.515–52.287), and residual stenosis ≥30% (aOR=250.241, CI95 %, 6,129–10,216,612).

Conclusion: The 1-year patency rate for SBA in patients with radiocephalic FAV who have stenosis of the draining vein is 42.7%. Residual stenosis ≥30% postoperatively is the most influential factor in determining FAV patency 12 months postoperatively."

"Latar belakang. Berbagai studi telah berhasil menemukan faktor-faktor yang mempengaruhi penyembuhan luka khususnya terkait fungsi ginjal dan albumin. Akan tetapi, belum terdapat studi yang mengevaluasi hubungan fungsi ginjal dan albumin terkhusus pada penyembuhan luka pasca amputasi pasien luka diabetik.Metode. Penelitian ini merupakan studi kohort retrospektif, yang dilakukan pada bulan Oktober–Desember 2022. Pasien ulkus kaki diabetik yang telah mendapatkan tindakan amputasi di RSUPN Cipto Mangunkusumo, yang mana keputusan amputasinya diambil berdasarkan skor WIfI [berada pada zona merah (risiko amputasi tinggi) skor WIfI yang dipetakan berdasarkan derajat luka, iskemia, dan infeksi] diinklusi ke dalam penelitian. Variabel yang diteliti meliputi kadar albumin, ureum, kreatinin, laju filtrasi glomerulus (LFG), kesembuhan luka, usia, status gizi, terapi insulin, merokok, hipertensi, durasi penyakit DM, dan onset luka.Hasil. Peneliti mengikutsertakan 61 pasien luka kaki diabetik yang menjalani tindakan amputasi di RSUPN Dr. Cipto Mangunkusumo, yang terdiri dari 23 (37,7%) pasien laki-laki dan 39 (63,9%) pasien dengan status gizi berlebih. 65,6% pasien mengalami reepitelisasi sempurna dalam 28 hari pasca tindakan amputasi. Kadar albumin, ureum, dan kreatinin pasien ditemukan sebesar 2,56 (1,11–4,98) g/dL, 71,00 (0,56–210) U/L, dan 1,40 (0,50– 11,50) U/L. LFG ditemukan sebesar 52,60 (4,10–117,30) mL/menit. Kadar albumin yang lebih tinggi (≥ 2,605 g/dL) dan kadar ureum yang lebih rendah (< 71,6 U/L) ditemukan berhubungan dengan probabilitas penyembuhan luka yang lebih tinggi (p < 0,050).Simpulan. Kadar albumin ditemukan lebih tinggi, sementara kadar ureum ditemukan lebih rendah pada kelompok luka sembuh pasien luka kaki diabetik 28 hari pasca amputasi.

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Background. Various studies have succeeded in finding factors that affect wound healing, especially related to kidney function and albumin. However, there have been no studies evaluating the relationship between kidney function and albumin, especially in post-amputation wound healing in diabetic wound patients.

Methods. This is a retrospective cohort study, conducted in October–December 2022. Diabetic foot ulcer patients who have received an amputation procedure at Cipto Mangunkusumo Hospital, where the decision to amputation is made based on the WIfI score [is in the red zone (high risk of amputation) WIfI scores charted according to degree of injury, ischemia, and infection] were included in the study. The variables studied included albumin, urea, creatinine, glomerular filtration rate (GFR), wound healing, age, nutritional status, insulin therapy, smoking, hypertension, duration of diabetes mellitus, and onset of injury.

Results. We included 61 patients with diabetic foot injuries who underwent amputation at RSUPN Dr. Cipto Mangunkusumo, which consisted of 23 (37.7%) male patients and 39 (63.9%) patients with excess nutritional status. 65.6% of patients experienced complete re-epithelialization within 28 days after the amputation. The patient's albumin, urea, and creatinine levels were found to be 2.56 (1.11–4.98) g/dL, 71.00 (0.56–210) U/L, and 1.40 (0.50–11 ,50) U/L. GFR was found to be 52.60 (4.10–117.30) mL/minute. Higher albumin levels (≥ 2.605 g/dL) and lower urea levels (< 71.6 U/L) were found to be associated with a higher probability of wound healing (p < 0.050).

Conclusion. Albumin levels were higher, while urea levels were lower in the group of healed wounds of patients with diabetic foot ulcer in 28 days following the amputation surgery."

"Hiperglikemia dan gangguan metabolisme pada diabetes melitus (DM) berhubungan dengan komplikasi penyakit arteri perifer (PAP). Pada pasien DM dengan PAP, disbiosis mikrobiota usus mengakibatkan penurunan produksi short-chain fatty acid (SCFA) sehingga memicu inflamasi nonspesifik dan aterogenesis. Penelitian ini bertujuan untuk mengidentifikasi hubungan kadar SCFA feses dengan berbagai parameter pemeriksaan vaskular pada pasien DM dengan PAP.Metode: Penelitian ini adalah studi potong lintang yang mengidentifikasi hubungan SCFA total, asetat, propionat, butirat, dan valerat feses dengan ankle-brachial index (ABI), toe pressure, diameter, plak, peak systolic velocity (PSV), volume flow (VF), spektrum aliran, dan derajat PAP arteri ekstremitas bawah pada pasien DM dengan PAP di sebuah sentra pelayanan kesehatan tunggal.Hasil: Sebanyak 37 subjek DM dengan PAP dianalisis. Terdapat hubungan negatif bermakna antara nilai asetat absolut dan diameter arteri femoralis communis (CFA) (r = -0,4; p =0,016) serta nilai propionat relatif dengan diameter arteri dorsalis pedis (DPA) (r =-0,376; p =0,04). Terdapat hubungan positif bermakna nilai asetat relatif dengan diameter DPA (r =0,381; p =0,038) serta nilai valerat relatif dengan PSV CFA (r =0,364; p = 0,029). Kelompok dengan plak CFA memiliki nilai asetat absolut yang lebih tinggi (p =0,039) dibandingkan kelompok yang tidak memiliki plak aterosklerotik. Kelompok dengan plak arteri poplitea (POPA) memiliki nilai butirat absolut yang lebih tinggi (p =0,046) dan nilai SCFA total yang lebih tinggi (p =0,046) dibandingkan kelompok yang tidak memiliki plak. Tidak terdapat hubungan bermakna SCFA dengan ABI, volume flow, dan derajat PAP.Kesimpulan: Nilai SCFA feses yang lebih tinggi cenderung berhubungan dengan diameter arteri perifer ekstremitas bawah yang lebih kecil dan PSV yang lebih tinggi. Nilai SCFA feses yang lebih tinggi juga cenderung didapatkan pada kelompok dengan plak arteri di atas lutut. Perlu dilakukan penelitian lanjutan untuk mengevaluasi efek sebab-akibat antara SCFA dan parameter-parameter vaskular pada pasien DM.

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Chronic hyperglycemia and metabolic abnormalities in diabetes mellitus are associated with peripheral arterial disease (PAD). Additionally, in diabetics with PAD, gut microbiota dysbiosis may lead to reduction in short-chain fatty acid (SCFA) production, prompting nonspecific inflammation and atherogenesis. This study aims to identify the association between SCFA and various vascular clinical and laboratory parameters in patients with diabetes and PAD.

Methods: This cross-sectional epidemiological study aims to identify the association of fecal total SCFA, acetate, propionate, butyrate, and valerate on ankle-brachial index (ABI), toe pressure, diameter, atherosclerotic plaque, peak systolic velocity (PSV), volume flow (VF), flow profile, and the degree of PAD of the lower extremity arteries in patients with diabetes and PAD in a single center.

Results: A total of 37 subjects with diabetes and PAD were analyzed. There were negative correlations of absolute acetate levels with common femoral artery (CFA) diameter (r = -0,4; p =0,016) and relative propionate levels with dorsal pedal artery (DPA) diameter (r =-0,376; p =0,04). There were positive correlations of relative acetate levels with DPA diameter (r =0,381; p =0,038) and relative valerate levels with PSV CFA (r =0,364; p = 0,029). Higher absolute acetate levels were found in group with CFA plaques (p =0,039). Higher absolute butyrate levels were found in group with popliteal artery (POPA) plaques (p =0,046), as was higher total SCFA levels (p =0,046). No significant association was found between SCFA and ABI, volume flow, and the degree of PAD.

Conclusion: Higher fecal SCFA levels were associated with smaller vascular diameters and higher PSV in lower extremity arteries. Higher SCFA levels were also more likely to be found in groups with above-knee atherosclerotic plaques. Further research is warranted to confirm the cause-effect relationship between SCFA and various vascular parameters in patients with diabetes and PAD."

"ABSTRAK Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakanpenyebab utama perawatan di rumah sakit. Kegagalan maturitas merupakan hambatan utamapenggunaan arteriovenous fistula. Tujuan dari penelitian ini adalah untuk mengkaji korelasi peaksistolik velocity arteri brakialis dan volume flow draining vein intraoperatif denganmenggunakan ultrasonografi doppler untuk memprediksi maturasi AVF. Uji statistik yangdigunakan adalah uji Mann Whitney dan uji Chi Squere. Hasil yang didapatkan tidak ditemukankorelasi antara PSV arteri brakialis dengan maturitas. Rerata nilai titik potong volume flowdraining vein intraoperatif 259,43 ml/min dan paska operatif 679,22 ± 65,36 ml/mindihubungkan dengan maturitas, ini dapat menjadi acuan menetukan perlu tidaknya melakukantindakan revisi saat intraoperatif, yang pada akhirnya diharapkan dapat menurunkan angkakegagalan maturasi AVF. ABSTRACT Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure.;Hemodialisis as treatment for renal replacement often patient chronic renal disease grade 5.Vascular access for hemodialysis its associated problems is the leading cause for hospitaladmission and morbidity.Maturation failure is impeded by issues of maturation. The result fromthis study showed that correlation peak sistolik velocity brakial artery and bloodflow ratemeasured using Doppler ultrasonogaphy right creation of the brachiocephalic fistula can predictAVF maturation. Statistic analisis use Mann Whithey and Chi Squere. Result no correlation PSVwith maturation, The intraoperative Bloodflow rate 259,43 ml/min and post operative 6 week679,22 ± 65,36 ml/min, maybe used as a guide to decide whether or not a corrective procedurewas needed to repair the brachiochephalic and consequently help in reducing the rate of AVFmaturation failure."