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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."

"ABSTRAKPenyebab PAD yang paling sering adalah atherosclerosis. PAD berhubungan dengan penyakit atherosklerosis lain seperti renal artery stenosis (RAS). Angka harapan hidup menurun pada pasien yang mengalami RAS, terutama yag stenosisnya diatas 60% namun belum sampai ke tahap gagal ginjal kronik. Dengan penatalaksanaan yang holistik diharapkan angka harapan hidup pasien semakin meningkat.Tujuan: Untuk mengetahui prevalensi RAS pada pasien PAD serta melihat hubungan antara Angio Score, riwayat hipertensi dan diabetes melitus terhadap derajat RAS yang terjadi.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN Dr. Cipto Mangunkusumo selama periode Februari hingga Mei 2019. Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dengan diagnosis lower extremity PAD dan dari pemeriksaan CT Angiografi didapatkan stenosis pada pembuluh darah tungkai, serta tampak arteri renalis pada pemeriksaan CTA yang dilakukan pada pasien tersebut. Pengambilan sampel dilakukan dengan metode total sampling.Hasil: sampel terbanyak berjenis kelamin wanita (50,8%) sedangkan pria sebanyak 32 orang (49,2%). Sebanyak 90,8% pasien yang diteliti menderita diabetes sedangkan 61,5% dari sampel menderita hipertensi. RAS derajat 1 merupakan yang terbanyak ditemukan. Tidak ada hubungan ANGIO Score terhadap usia, jenis kelamin dan diabetes mellitus, namun ada terhadap hipertensi. Terdapat hubungan antara RAS dengan usia dan hipertensi, namun tidak terdapat hubungan terhadap diabetes mellitus dan jenis kelamin. ANGIO Score dan RAS terdapat hubungan yang bermakna (p<0,001).Simpulan: Perbandingan ANGIO Score berdasarkan derajat stenosis mendapatkan hasil uji Kruskall Wallis mendapatkan nilai p<0,001 dan dilanjutkan dengan uji Mann Whitney mendapatkan bahwa perbedaan sudah terjadi saat perbandingan derajat stenosis 0 dengan derajat 1 dan seterusnya (p<0,001). Semakin tinggi nilai ANGIO Score (cut off pada score 9), angka spesifitas semakin tinggi.

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ABSTRACTBackground: The most common cause of PAD is atherosclerosis. PAD is associated with other atherosclerosis diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients who experience RAS, especially those with stenosis above 60% but have not yet reached the stage of chronic renal failure. With holistic management, it is expected that the patient's life expectancy will increase.Objective: To determine the prevalence of RAS in PAD patients and to see the relationship between Angio Score, history of hypertension and diabetes mellitus to the degree of RAS that occurred.Method: The design used is a cross-sectional design. This research was conducted at RSUPN Dr. Cipto Mangunkusumo during the period February to May 2019. The study was conducted at RSUPN Dr. Cipto Mangunkusumo with a diagnosis of lower extremity PAD, which obtained an ABI score of <0.9, severe ischemia until both unilateral and bilateral limb necrosis and CT angiography examination found stenosis in the leg veins, and the appearance of the renal artery on CTA examination performed on patients that is. Sampling is done by the total sampling method.Results: the most samples were female (50.8%) while men were 32 (49.2%). As many as 90.8% of patients studied had diabetes while 61.5% of the samples suffered from hypertension. 1st degree RAS is the most found. There is no relationship between ANGIO Score with age, gender and diabetes mellitus, but there is a hypertension. There is a relationship between RAS and age and hypertension, but there is no relationship to diabetes mellitus and gender. ANGIO Score and RAS have a significant relationship (p <0.001).Conclusion: The comparison of ANGIO Score based on the degree of stenosis obtained the results of the Kruskall Wallis test obtained a p value of <0.001 and continued with the Mann Whitney test found that the difference had occurred when the ratio of stenosis degrees was 0 with degrees 1 and so on (p <0.001). The higher the ANGIO score (cut off at score 9), the higher the specificity."

"Latar belakang: Peripheral artery disease (PAD) merupakan penyakit yang menyerang arteri selainpembuluh darah otak dan jantung, dimana penyebab paling sering adalah proses aterosklerosis.Diperlukan tatalaksana yang bersifat komprehensif untuk mengurangi mortalitas dan morbiditas.Diagnosis dini dengan pemeriksaan perfusi distal menentukan prognosis pasien setelah dilakukantindakan baik konservatif atau endovaskular.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian ini dilakukan di RSUPN dr.Cipto Mangunkusumo, Jakarta, Indonesia selama Februari –Mei 2020. Penelitian ini menggunakananalisis bivariat yaitu uji hipotesis analitik korelatif kategorik-numerik untuk melihat outcome berupahasil ABI, AP, dan penyembuhan luka terhadap tindakan PTA dan terapi konservatif. Analisismenggunakan uji Mann Whitney dan Chi Square. Pengujian dilakukan dengan menggunakan pirantilunak SPSS version 20 for Windows.Hasil : Dari penelitian ini didapatkan sebanyak masing-masing 28 subjek yang menjalani PTA dankonservatif. Fakor risiko yang paling adalah DM tipe II yaitu 11 subjek (39,3%) pada kelompok PTAdan 12 subjek (42,9%) pada kelompok konservatif. Sebanyak 24 subjek (85,7%) kelompok PTAmemiliki penyembuhan luka baik dan 4 subjek (14,3%) memiliki penyembuhan luka tidak baik.Sebanyak 13 subjek (46,4%) pada kelompok konservatif memiliki penyembuhan luka baik dan 15subjek (53,6%) memiliki penyembuhan luka tidak baik. Terdapat peningkatan proporsi nilai ABIsebelum dan sesudah tindakan dengan delta ABI 0,09 ± 0,178. Terdapat peningkatan proporsi nilai APsebelum dan sesudah tindakan dengan delta AP8,95 ± 12.183. Tidak terdapat hubungan bermaknaantara perubahan nilai ABI (p=0,878) dan AP (p=0,420) dengan tindakan. Terdapat hubungan yangbermakna antara tindakan pada subjek dengan penyembuhan luka (p=0,002)Kesimpulan: Terdapat peningkatan proporsi nilai AP dan ABI pada kelompok PTA. Tidak didapatkanhubungan yang signifikan secara statistik antara perfusi distal (nilai ABI dan nilai AP) dengan tindakanPTA dan konservatif (p=0,878 dan p=0,420). Terdapay hubungan yang signifikan secara statistikantara penyembuhan luka dengan tindakan PTA dan konservatif (p=0,002)

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Background: Peripheral artery disease (PAD) is a disease that attacks arteries except blood vessels of

cerebral and heart. Atherosclerosis is the most frequent cause. Comprehensive management is needed

to reduce mortality and morbidity. Early diagnosis by distal perfusion examination determines patient's

prognosis after either conservative or endovascular measures.

Methods: A cross sectional study, research subject were PAD with ulcers patients CMGH where the

data were collected from medical record CMGH during Februari-Mei 2020. Statistical analysis with a

categorical-numerical correlative analytic to see corelate ABI, AP, and wound healing with PTA.

Analysis using the Mann Whitney and Chi Square test. The test was carried out using SPSS version 20

for Windows software.

Results: There were 28 subjects each PTA’s group and conservative’s group. The most risk factors

were type II DM; 11 subjects (39.3%) in the PTA’s group and 12 subjects (42.9%) in the

conservatives’s group. There were 24 subjects (85.7%) of the PTA’s group had good wound healing

and 4 subjects (14.3%) had poor wound healing. There were 13 subjects (46.4%) in the conservative’s

group had good wound healing and 15 subjects (53.6%) had poor wound healing. There was an

increase in proportion of ABI before and after therapy with an ABI delta of 0.09 ± 0.178. There was an

increase in proportion of AP before and after therapy with delta AP of 8,95 ± 12,183. There was no

significant relationship between changes in the ABI (p = 0.878) and AP (p = 0.420) with therapy.

There was a significant relationship between therapy with wound healing (p = 0.002)

Conclusion: There was an increase the proportion of AP and ABI in the PTA group. There was no

statistically significant relationship between distal perfusion (ABI and AP) with PTA and conservative

therapy (p = 0.878 and p = 0.420). There was statistically significant relationship between wound

healing with PTA and conservative (p = 0.002)"

"Latar Belakang: Penyakit Kaki Diabetik memiliki prevalensi 6,3% populasi dunia. Angka amputasi mayor 139,97 kasus per 100.000 populasi. Penyakit arteri perifer pada kaki diabetik erat kaitannya dengan arteri femoralis ke distal yaitu arteri femoralis komunis sebagai gambaran inflow dan arteri poplitea sebagai arteri yang berhubungan langung dengan arteri infrapoplitea. Keputusan tatalaksana debridemen dan amputasi sangat penting dan berhubungan dengan biaya, morbiditas dan mortalitas yang salah satunya bisa ditentukan dengan pemeriksaan vaskular. Penelitian untuk mengetahui hubungan antara tekanan sistolik, fasisitas and volume flow pasien kaki diabetik terhadap keputusan debridemen atau amputasi belum banyak dilakukan.Metode: Desain penelitian adalah potong lintang, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan pada bulan Januari 2023 – April 2023.Hasil: Total subyek 38 orang, sebanyak 19 subyek yang dilakukan debridemen, 19 subjek yang dilakukan amputasi. Terdapat hubungan yang bermakna antara gambaran fasisitas bifasik arteri poplitea dengan keputusan amputasi pasien kaki diabetik (p<0,05). Uji Chi-Square menunjukkan hasil pemeriksaan ultrasonografi bifasik memiliki faktor prediksi terhadap keputusan amputasi pada pasien kaki diabetik, didapatkan jumlah subjek yang bifasik dan dilakukan amputasi tiga kali lipat lebih tingi daripada yang dilakukan debridemen. Pada pemeriksaan tekanan sistolik arteri popliteal, fasisitas arteri femoralis komunis, volume flow arteri popliteal dan arteri femoralis komunis tidak didapatkan hubungan yang bermakna terhadap keputusan tatalaksana debridemen atau amputasi pada pasien kaki diabetik.Kesimpulan: Pemeriksaan fasisitas ultrasonografi pada arteri popliteal dapat menjadi prediksi tindakan amputasi pada pasien kaki diabetik.

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Background: Diabetic Foot Disease has a prevalence of 6.3% of the world's population. The major amputation rate is 139.97 cases per 100,000 population. Peripheral arterial disease in the diabetic foot is closely related to the distal femoral artery. Common femoral artery as an inflow feature and the popliteal artery as an artery that is directly related to the infrapopliteal artery. The decision to treat debridement and amputation is very important and is related to costs, morbidity and mortality, one of which can be determined by vascular examination. Research to determine the relationship between systolic pressure, fascisity and volume flow of diabetic foot patients on debridement or amputation decisions has not been carried out much.

Methods: The research design was cross-sectional, conducted at Cipto Mangunkusumo General Hospital. The research was conducted in January 2023 – April 2023.

Results: A total of 38 subjects, 19 subjects underwent debridement, 19 subjects underwent amputations. There was a significant relationship between the description of the popliteal artery biphasic phasicity and the decision to amputation in diabetic foot patients (p<0.05). The Chi-Square test showed that the results of biphasic ultrasound examination had a predictive factor for the decision to amputation in diabetic foot patients. It was found that the number of subjects who were biphasic and had amputation three times higher than those who underwent debridement. On examination of popliteal artery systolic pressure, common femoral artery phasicity, popliteal artery volume flow and common femoral artery found no significant relationship to the decision of debridement or amputation treatment in diabetic foot patients."

"Penyakit Ginjal Kronik (PGK) merupakan kelainan struktur atau fungsi ginjal yang mengalami penurunan selama 3 bulan yang mengalami peningkatan prevalensi kasus. Peningkatan prevalensi kejadian PGK juga akan meningkatkan kebutuhan hemodialisis dan penggunaan arteriovenous fistula (AVF). Maturasi dan keberhasilan AVF dipengaruhi oleh faktor pasien dan struktur vaskular. Latihan isometrik dilaporkan dapat meningkatkan diameter vena, arteri, dan peak systolic velocity (PSV). Tujuan penelitian ini untuk melihat pengaruh latihan isometrik pre operatif terhadap diameter vena cephalica, diameter arteri radialis, PSV, intimal medial thickening (IMT), dan volume flow arteri radialis. Desain penelitian adalah eksperimental pre and post-test study, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan follow up pasien selama 8 minggu latihan isometri. Total subjek penelitian sebanyak 38 orang. Usia median subjek penelitian yaitu 56 tahun dengan rentang usia 20 sampai 71 tahun. Terdapat perbedaan yang signifikan antara diameter vena (p=0,003), PSV (p=0,032), dan volume flow (p=0,030) subjek penelitian pre dan post latihan isometrik. Terdapat perbedaan signifikan antara perubahan diameter vena terhadap komorbid diabetes melitus. Tidak terdapat perbedaan bermakna antara perubahan diameter vena, PSV, dan volume flow paska latihan ismoetrik terhadap kelompok usia, komorbid, dan jenis kelamin (p>0,005). Penggunaan latihan isometrik dapat meningkatkan perubahan diameter vena, PSV dan volume flow pada pasien sebelum pembuatan AVF radiocephalica. Tidak terdapat perubahan signifikan diameter vena pasca latihan isometrik pada penderita diabetes melitus.

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Chronic Kidney Disease (CKD) is a disorder of kidney structure or function that has decreased over 3 months and has an increased prevalence of cases. The increasing prevalence of CKD will also increase the need for hemodialysis and the use of arteriovenous fistula (AVF). AVF maturation and success are influenced by patient factors and vascular structure. Isometric exercise is reported to increase the diameter of veins, arteries, and peak systolic velocity (PSV). Objective: Analyzing the effect of preoperative isometric exercise on the diameter of veins, arteries, PSV, intimal medial thickening (IMT), and volume flow. The research design was an experimental pre and post-test study, conducted at Cipto Mangunkusumo Center National Hospital. The study was conducted to follow up patients for 8 weeks of isometric exercise. The total study subjects were 38 people, with the highest prevalence being men, and comorbid hypertension. The median age of the research subjects was 56 years with an age range of 20 to 71 years. There were significant differences between venous diameter (p=0.003), PSV (p=0.032), and volume flow (p=0.030) in pre and post isometric training subjects. There was significant difference between cephalic vein diameter to diabetes mellitus group. There was no significant difference between changes in radial artery diameter, PSV, IMT, and post-isometric exercise volume flow for the age, comorbid, and sex groups (p>0.005). The use of isometric exercises can increase changes in venous diameter, PSV and volume flow in patients before the making of radiocephalic AVF. There was no significant change in venous diameter after isometric exercise in patient with diabetes mellitus.

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"Latar Belakang: Acute Limb Ischemia (ALI) merupakan kondisi yang mengancam fungsi tungkai hingga keberlangsungan hidup seseorang. Corona Virus Disease of 2019 (COVID-19), telah menjadi pandemi sejak diumumkan oleh World Health Orgazination (WHO) pada Maret 2020, berdampak dalam penundaan diagnosis dan penanganan penyakit termasuk penyakit non COVID-19. Trombosis merupakan salah satu etiologi ALI diketahui meningkat kejadiannya sebagai komplikasi COVID-19. Namun, studi terkait karakteristik pasien ALI terkait pandemi COVID-19 tidak banyak dilakukan, terutama di Indonesia. Metode: Studi kohort retrospektif karakteristik pasien ALI di Rumah Sakit Cipto Mangunkusumo, Jakarta pada tahun 2018-2022. Seluruh pasien kemudian dibagi menjadi kelompok sebelum pandemi dan selama pandemi dengan batas Maret 2023. Keluaran yang dianalisis adalah keberhasilan revaskularisasi, re-intervensi, dan mortalitas saat perawatan. Analisis data menggunakan SPSS for Mac versi 25 secara bivariat dan multivariat. Hasil: Sebanyak 81 pasien menjadi subjek penelitian terdiri dari 28 (34,6%) pasien pada periode sebelum pandemi dan 53 (65,4%) pasien pada periode selama pandemi COVID-19. Pada periode selama pandemi COVID-19 didapatkan bahwa lebih banyak pasien rujukan (p = 0,001). Terdapat perbedaan bermakna antara kedua periode pandemi terhadap keberhasilan revaskularisasi (p = 0,013) tapi tidak pada keluaran re-intervensi dan mortalitas saat perawatan. Pada periode selama pandemi COVID-19, didapatkan 13 pasien yang memiliki riwayat/terkonfirmasi COVID-19 dengan keluaran yang secara deskriptif sebanding. Pada analisis multivariat, penggunaan fluoroskopi dan trombektomi memengaruhi keluaran keberhasilan revaskularisasi; klasifikasi Rutherford memengaruhi keluaran re-intervensi; dislipidemia, penyakit jantung, dan fluoroskopi memengaruhi keluaran mortalitas saat perawatan. Kesimpulan: Terdapat perbedaan keluaran tatalaksana pasien ALI sebelum dan selama pandemi COVID-19 pada keluaran keberhasilan revaskularisasi. Terdapat beberapa faktor yang memengaruhi keluaran pasien ALI sebelum dan selama pandemi COVID-19

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Background: Acute Limb Ischemia (ALI) is a condition that threatens limb function and the survival of a patient. Corona Virus Disease of 2019 (COVID-19), has become a pandemic since it was announced by the World Health Organization (WHO) on March 2020, causing delays in the diagnosis and treatment of diseases including non-COVID-19 diseases. Thrombosis is one of the etiologies of ALI known to increase its incidence as a complication of COVID-19. However, there are not many studies regarding the characteristics of ALI patients related to the COVID-19 pandemic, especially in Indonesia. Methods: A retrospective cohort study of the characteristics of ALI patients at Cipto Mangunkusumo Hospital, Jakarta in 2018-2022. All patients were then divided into groups before the pandemic and during the pandemic with a deadline of March 2023. The outcomes analyzed were revascularization success, re-intervention, and mortality during treatment. Data analysis used SPSS for Mac version 25 in bivariate and multivariate ways. Results: A total of 81 patients were the subjects of the study consisting of 28 (34.6%) patients in the pre-pandemic period and 53 (65.4%) patients in the period during the COVID-19 pandemic. During the period during the COVID-19 pandemic, it was found that there were more referral patients (p = 0.001). There was a significant difference between the two pandemic periods on revascularization success (p = 0.013) but not on re-intervention outcomes and on-hospital mortality. During the period during the COVID-19 pandemic, there were 13 patients who had a history/confirmed COVID-19 with outcomes that were descriptively comparable. In multivariate analysis, the use of fluoroscopy and thrombectomy influenced the outcome of successful revascularization; Rutherford's classification influenced re-intervention outcomes; dyslipidemia, heart disease, and fluoroscopy affect the outcome of in-hospital mortality. Conclusion: There are differences in the outcome of the management of ALI patients before and during the COVID-19 pandemic in the outcome of revascularization success. There are several factors that influence patient outcomes for ALI before and during the COVID-19 pandemic."

"Latar Belakang: Ulkus diabetik merupakan komplikasi diabetes melitus dengan morbiditas dan mortalitas yang tinggi, dengan prevalensi 6,3% populasi dunia dan angka amputasi mencapai 139,97 kasus per 100.000 orang. Pada kasus lanjut, pasien ulkus diabetik dilakukan debridemen atau bahkan amputasi yang sangat mempengaruhi kualitas hidup pasien. Prediksi penyembuhan luka pasca debridemen merupakan suatu penilaian yang sangat penting untuk memberikan pelayanan terbaik bagi pasien. Namun, hingga saat ini, penelitian untuk mengetahui hubungan antara tekanan sistolik, fasisitas dan volume flow pada pasien ulkus diabetik terhadap penyembuhan luka pasca debridemen belum banyak dilakukan.

Tujuan: Mengetahui hubungan antara tekanan sistolik, fasisitas and volume flow pasien ulkus diabetik terhadap penyembuhan luka pasca debridemen.

Metode: Desain penelitian ini adalah potong lintang, dilakukan di RSUPN Cipto Mangunkusumo. Penelitian dilaksanakan pada bulan Agustus 2023 – Oktober 2023.

Hasil: Terdapat 40 subjek penelitian yang memenuhi kriteria inklusi. Profil subjek penelitian  sebagian besar terdiri dari jenis kelamin perempuan dengan rata-rata usia 56,93 tahun. Jumlah pasien yang memiliki riwayat hipertensi adalah 21 orang (52,5%), riwayat dislipidemia adalah 10 orang (25%), dan riwayat merokok adalah 17 orang (42,5%). Analisis bivariat dengan uji Pearson mendapatkan faktor risiko yang berhubungan signifikan terhadap skor DFUAS adalah diabetes melitus (p<0,001), merokok (p<0,001), dan hipertensi (p=0,007). Terdapat hubungan korelasi yang kuat dan signifikan antara nilai ABI yang semakin kecil dengan skor DFUAS yang semakin besar (p<0,001). Selain itu, terdapat juga hubungan korelasi kuat dan signifikan antara fasisitas arteri poplitea bifasik dengan nilai DFUAS yang semakin besar (p<0,001). Sementara itu, tidak terdapat hubungan korelasi yang signifikan antara tekanan sistolik arteri poplitea, fasisitas arteri femoralis komunis, dan volume flow arteri poplitea maupun femoralis komunis terhadap skor DFUAS atau penyembuhan luka.

Kesimpulan: Pemeriksaan ABI dan fasisitas arteri poplitea dengan ultrasonografi dapat menjadi prediksi penyembuhan luka pada pasien ulkus diabetik.

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Diabetic ulcer is a complication of diabetes mellitus with high morbidity and mortality, with a prevalence of 6.3% of the world population and an amputation rate of 139.97 cases per 100,000 people. In advanced cases, diabetic ulcer patients undergo debridement or even amputation which greatly affects the patient's quality of life. Prediction of wound healing after debridement is a very important assessment to provide the best service for patients. However, until now, there has not been much research to determine the relationship between systolic pressure, fascicity and volume flow in diabetic ulcer patients on post-debridement wound healing.

Objective: Knowing the relationship between systolic pressure, fascicity and volume flow of diabetic ulcer patients on wound healing after debridement.

Method: The design of this study was cross-sectional, conducted at Cipto Mangunkusumo Hospital. The study was conducted in August 2023 - October 2023.

Results: There were 40 research subjects who met the inclusion criteria. The profile of the research subjects mostly consisted of female gender with an average age of 56.93 years. The number of patients who had a history of hypertension was 21 people (52.5%), a history of dyslipidemia was 10 people (25%), and a history of smoking was 17 people (42.5%). Bivariate analysis with the Pearson test found that the risk factors significantly associated with DFUAS scores were diabetes mellitus (p<0.001), smoking (p<0.001), and hypertension (p=0.007). There was a strong and significant correlation between a smaller ABI value and a larger DFUAS score (p<0.001). In addition, there was also a strong and significant correlation between biphasic popliteal artery fascicity and greater DFUAS score (p<0.001). Meanwhile, there was no significant correlation between popliteal artery systolic pressure, common femoral artery fascicity, and popliteal or common femoral artery flow volume on DFUAS score or wound healing.

Conclusion: Ankle brachial index examination and popliteal artery fascicity with ultrasonography can be predictive of wound healing in diabetic ulcer patients."

"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. "

"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 dan Conduit improves the prognostic of outcome on fistula maturation, formulated in IOC-Score which is accurate, simple, applicable and reliable. "

"Latar Belakang: DM merupakan salah satu penyebab morbiditas dan mortalitas tertinggi di dunia, dengan 15-25% pasien akan berkomplikasi menjadi DFU. Data pada tahun 2003 di RSCM menunjukkan bahwa angka kematian akibat DFU adalah 16% dan angka amputasi mencapai 25%. Hingga saat ini belum terdapat strategi tatalaksana DFU yang efektif karena patogenesis molekular yang menyebabkan kegagalan penyembuhan luka masih belum sepenuhnya dipahami. Selain itu pengendalian kadar glukosa darah dalam pengobatan DFU masih belum jelas dan menjadi perdebatan dalam berbagai studi.Tujuan: Penelitian ini bertujuan untuk menganalisis hubungan HbA1c dan GDS dengan faktor angiogenesis HIF-1α, sehingga dapat dijadikan dasar dalam melakukan tata laksana yang tepat untuk pasien DFU.Metode: Desain penelitian potong lintang. Subjek penelitian pasien DFU yang berobat ke RSCM, diambil data dasar (jenis kelamin dan usia), pemeriksaan klinis (TB, BB, dan IMT), pemeriksaan laboratorium (GDS, HbA1c). HIF-1α diperiksa dari sampel biopsi jaringan luka DFU saat operasi debridemen dan amputasi dengan pemeriksaan ELISA. Data dilakukan uji normalitas Saphiro-Wilk dan uji normalitas Kolmogorov Smirnov, dilanjutkan uji korelasi Spearman. Pengaruh variabel perancu dianalisa dengan uji mann whitney dan tes regresi linear sederhana.Hasil: Terdapat 64 pasien yang memenuhi kriteria inklusi dan dilakukan pemeriksaan kadar HiF1α dari sampel jaringan biopsi. Data karakteristik didapatkan hasil kelompok dominan perempuan (54.7%) dengan usia rerata 55.7 ± 10.4 tahun, IMT median 24.9 kg/m² (overweight 48.2%, obesitas 34.6%), dan komorbid anemia (84.3%). Karakteristik laboratorium, GDS median 220 (14-705)mg/dL dengan kelompok kondisi hiperglikemik >200 mg/dL sebanyak 54.7%. HbA1c median 7.7(4.1-13.7)% dengan kelompok kontrol gula darah buruk HbA1c >6.5% sebanyak 85.8%. Tidak didapatkan korelasi bermakna antara GDS dengan HIF-1α p 0.523(p>0.05). Tidak didapatkan korelasi yang bermakna antara HbA1c dengan HIF-1α p 0.792(p>0.05). Didapatkan variable perancu yang bermakna pada kondisi derajat luka DFU p 0.03 (p< 0,05).Kesimpulan: Hasil penelitian ini menunjukkan bahwa baik HbA1c atau GDS tidak mempunyai hubungan yang bermakna dengan kadar HiF-1α. Variabel perancu kondisi derajat luka DFU berpengaruh secara signifikan terhadap ekspresi HIF-1α

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Background: DM is one of the leading causes of morbidity and mortality in the world, with 15-25% of patients developing complications of DFU. Results data in 2003 at the RSCM showed that the mortality rate from DFU was 16% and the amputation rate was 25%. There is no effective DFU management strategy because the molecular pathogenesis that causes wound healing failure is still not fully understood. In addition, the control of blood glucose levels in the treatment of DFU is still unclear and has been debated in various studies.

Objective: This study aims to analyze the relationship between HbA1c and GDS with the angiogenesis factor HIF-1α, so that it can be used as a basis for appropriate management of DFU patients.

Methods: The research design was cross sectional. Body mass index, comorbid disease status were recorded. The laboratory parameters GDS, HbA1c and HiF-1a expression examined in the laboratory. Test the normality data by the Saphiro-Wilk test and the Kolmogorov Smirnov test, followed by the Spearman correlation test. The effect of confounding variables was analyzed by Mann Whitney test and simple linear regression test.

Results: There were 64 patients who met the inclusion criteria and were examined for HiF1α levels from biopsy tissue samples. Characteristic data showed that the dominant group was female (54.7%) with a mean age of 55.7 ± 10.4 years, median BMI 24.9 kg/m² (overweight 48.2%, obesity 34.6%), and comorbid anemia (84.3%). Laboratory characteristics, the median GDS of 220 (14-705)mg/dL with the hyperglycemic condition group >200 mg/dL as much as 54.7%. The median HbA1c was 7.7(4.1-13.7)% with the bad blood sugar control group HbA1c >6.5% as much as 85.8%. There was no significant correlation between GDS and HIF-1α p 0.523 (p>0.05). There was no significant correlation between HbA1c and HIF-1α p 0.792 (p>0.05). A significant confounding variable was found in the condition of the degree of wound DFU p 0.03 (p < 0.05).

Conclusion:The results of this study showed that neither HbA1c nor GDS had a significant correlation with HiF-1α . The confounding variable of DFU wound degree had a significant effect on the expression of HIF-1α"