Cipto Mangunkusumo National Hospital Research Articles

The significance of pulsatility indices in the middle cerebral, internal carotid, and common carotid arteries for small vessel disease in the brain: A retrospective cross-sectional study

Background and objectives. The pulsatility index (PI) indicates the resistance in distant blood vessels and the stiffness of major arteries outside the brain. For cerebral small vessel disease (CSVD), our aim is to enhance our comprehension of the Pulsatility Index (PI) in the common carotid artery (CCA), internal carotid artery (ICA), and middle cerebral artery (MCA). Materials and methods. This study is a cross-sectional retrospective research, which was conducted between January 2020 and June 2020 at the Dr. Cipto Mangunkusumo National Hospital, Indonesia. Patients were divided into groups with CSVD and without CSVD. Univariate and bivariate analyses, along with Spearman correlation and multivariate regression, were conducted to assess the mean difference. The overall score for CSVD was determined based on findings from brain MRI scans. Results. The median age of the 79 participants was 60 years (49-66). CSVD made up 54.4% of the total. The median (interquartile range) PI values for the CCA, ICA, and MCA in cases of CSVD were 1.48 (1.3-1.68), 1.12±0.3, and 1.11 (0.95-1.38), respectively. Despite this, no significant differences in PI were observed between the groups. In cases of total stroke, the PI of the CCA showed a moderate correlation with the PI of the MCA (B 0.4, p=0.001) and the PI of the ICA (B 0.34, p=0.005). However, no correlation was found between PI and either the burden of CSVD or the total score for small vessel disease. Conclusions. The pulsatility indices for the CCA, ICA, and MCA generally rise in cases of CSVD, indicating heightened resistance in distal blood vessels and increased stiffness in the large arteries outside the skull. This highlights the potential use of PI measurement as a promising adjunctive screening and evaluation tool in CSVD.

Correlation of Grading and Number of Ear Subunits With Auditory Brainstem Response Findings in Children With Microtia.

The association between microtia severity and hearing function has been thoroughly investigated. This study examined the relationship between microtia grade, number of ear subunits (i.e., helix, antihelix, scapha, triangularis fossa, concha, lobule, tragus, and antitragus) with auditory brainstem response (ABR) findings in children with microtia. A retrospective chart review was employed in this study. We analyzed the ABR test results and photographs of 22 children with 30 microtia ears at Dr. Cipto Mangunkusumo National Hospital, Jakarta. The ABR test results were acquired using click (air conduction only) and 500-Hz tone burst stimuli (air- and bone-conduction). Ear photographs were overlaid with a template of a normal ear to determine the number of ear subunits present and the subsequent microtia grade. Number of ear subunits and ABR results were analyzed using the chi-square, Mann-Whitney U, and Spearman's correlation tests. ABR thresholds for click and 500-Hz tone bursts air-conduction were significantly poorer for ears with a subunit < 5 compared to ears with a subunit ≥ 5. No significant difference was observed in 500 Hz bone-conduction ABR thresholds between these groups. Correlation analysis showed a significant negative correlation between increased ear subunits and click ABR thresholds. No significant correlation was found between ear subunits and 500-Hz air- and bone-conduction ABR thresholds. A higher number of ear subunits are associated with a lower hearing threshold, as assessed using ABR with click stimuli. Therefore, the number of ear subunits and microtia grades can be used to examine the hearing level thresholds in infants and children with microtia. https://doi.org/10.23641/asha.25669440.

Detection of Enteropathogens in Human Immunodeficiency Virus and Non-Human Immunodeficiency Virus-Infected Children with Acute Diarrhea in an Indonesian Tertiary Hospital Using Multiplex Real-Time Polymerase Chain Reaction.

Diarrhea is one of the leading causes of mortality in children living in developing countries. The etiology of acute diarrhea in each healthcare center varies depending on place, time, and population. This study aimed to identify pathogen patterns in human immunodeficiency virus (HIV)-infected and non-HIV children suffering from acute diarrhea, using multiplex real time reverse transcriptase polymerase chain reaction (RT-PCR), in an Indonesian tertiary hospital. This cross-sectional study was conducted at Dr. Cipto Mangunkusumo National Hospital from March 2019 to April 2020. The study showed that multiplex RT-PCR results were positive in 58.9% of the specimens, with more positive results in HIV-infected children than in non-HIV-infected children (70% vs. 54.7%). Altogether 72 enteropathogens were detected from all specimens. Enteropathogens in non-HIV children with acute diarrhea consisted of bacteria (70.6%) and viruses (29.4%) with a predominance of enteroaggregative Escherichia coli (25.4%), followed by Campylobacter spp. (11.8%), enteropathogenic E. coli (9.8%), Norovirus GII (7.8%), and Clostridium difficile (7.8%). Enteropathogens in HIV-infected children consisted of viruses (57.1%), bacteria (28.6%), and parasites (14.3%) comprising Norovirus GII (24%), Cryptosporidium spp. (14.3%), Campylobacter spp. (14.3%), Norovirus GI (14.3%), and Astrovirus (14.3%). Cryptosporidium spp. was the only parasite found in this study and was found only in HIV-infected children. In non-HIV children with acute diarrhea, most pathogens were invasive bacteria, while in HIV-infected children, more viral and parasite infections occurred, primarily caused by opportunistic pathogens. The pattern of enteropathogens can help clinicians determine further examinations and appropriate empirical antimicrobial therapy for the patient.

The correlation of anxiety and depression with C3 and C4 Levels and systemic lupus erythematosus activity

BackgroundAnxiety and depression are psychosomatic disorders that are frequently observed in chronic conditions such as systemic lupus erythematosus (SLE). Anxiety and depression can be induced by immunological and neurotransmitter dysregulation, which is characterized by hypothalamic–pituitary–adrenal (HPA) axis dysfunction, production of proinflammatory cytokines, and activation of complement in the blood, such as C3 and C4. The causes of anxiety and depression in SLE are complex, ranging from neuropsychiatric involvement to drug adverse effects. Detecting anxiety and depression symptoms in SLE patients is critical to preventing disability from impacting quality of life.ObjectiveTo assess the relationship between anxiety and depression symptomatology, SLE disease activity with levels of C3 and C4 in Cipto Mangunkusumo National Hospital.MethodsThis study used a cross-sectional design. The study included 120 SLE patients from Cipto Mangunkusumo National Hospital, aged 18 to 60 years. All patients were requested to complete a Hospital Anxiety and Depression Scale (HADS) questionnaire to assess their anxiety and depression symptoms. Subjects with anxiety and depression were assessed for disease activity using the Mexican Systemic Lupus Erythematosus Systemic Disease Activity (Mex-SLEDAI), and blood samples were collected to test complement C3 and C4 levels. Spearman's correlation test was used to examine the relationship between HADS scores, Mex-SLEDAI, and C3 and C4 levels.ResultsThe results of the study showed a very weak statistically significant negative correlation between anxiety symptoms based on HADS and C3 levels (r = -0.189; p = 0.038) and a weak correlation between anxiety symptoms and C4 levels (r = -204; p = 0.026). Depressive symptoms based on HADS revealed a very poor connection and no statistical significance with levels of C3 (r = -0.056; p = 0.546) and C4 (r = -0.068; p = 0.461). Anxiety (r = 0.06; p = 0.173) and depression (r = 0.031; p = 0.753) symptoms have a weak and insignificant positive connection with SLE activity.ConclusionC3 and C4 serum levels appeared to decrease when the presence of anxious symptoms increased. There was no significant correlation in SLE disease activity between anxious and depressed patients.

N-acetylcysteine vs placebo as adjunctive treatment in paediatric leukaemia: A single blind, randomized controlled trial

Background: Acute lymphoblastic leukaemia (ALL) accounts for about 25% of all cancer types in children. Many chemotherapeutic agents have been shown to be related to increased oxidative stress and hepatotoxicity which affect the survival rate. N-acetylcysteine (NAC) has been used as adjunctive treatment in malignancy. Objectives: To analyse the effect of NAC administration towards blood oxidant, transaminase enzyme, and bilirubin level in ALL children undergoing induction phase of chemotherapy. Method: This is a single-blind placebo-controlled randomized clinical trial carried out from August to December 2020 in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia. Subjects were randomized consecutively into 2 groups treated with NAC or placebo. Inclusion criteria were newly diagnosed ALL-standard risk (SR) children undergoing chemotherapy induction. Exclusion criteria were subjects contraindicated to NAC, already diagnosed with liver dysfunction, and already taken antioxidants. Data were analysed using SPSS 21. Normality test was conducted followed by data analysis with unpaired t-test. Results: A total of 18 subjects were included in study and 2 of them were excluded. Malondialdehyde levels showed an increase of 0.17nmoL in the NAC group and a decrease of 0.19nmoL in the placebo group. Aspartate transaminase (AST) level increased in mean of 11.40 U/L in the NAC group compared to placebo group 5.67 U/L. Alanine transaminase (ALT) level in the NAC group showed an increase in mean of 23.24 U/L compared to placebo group which showed a decrease in mean of 3.5 U/L. Bilirubin level in the NAC group showed an increase of 0.7 mg/dL compared to placebo group 0.17 mg/dL. There was no significant difference in MDA levels, AST, ALT, and bilirubin levels in the 2 groups (p=0. 186; p=0.638; p=0.164; p=0.352, respectively). Conclusions: Higher malondialdehyde level was shown as a trend in subjects in both groups before chemotherapy was done. N-acetyl cysteine administration showed no significant difference in reducing MDA levels, transaminase enzymes, and bilirubin levels in ALL-SR patients compared to placebo.

Predictors of major adverse cardiac events during 7-days period in acute coronary syndrome patients who had percutaneous coronary intervention in Cipto Mangunkusumo National Hospital, Jakarta

Link of Video Abstract: https://youtu.be/YDWnVBBGC0Q Background: Major adverse cardiac events (MACE) increase the morbidity and mortality of patients with acute coronary syndrome (ACS). Data are lacking on MACE occurrence in patients with ACS after percutaneous coronary intervention (PCI). This study aims to find out the predictors of MACE during 7 days in ACS patients who had PCI. Methods: The study design was unmatched case-control. The study included 461 patients with ACS who were hospitalized in the intensive cardiology care unit in Cipto Mangunkusumo Hospital from January 1st, 2015 until November 30th, 2017. Age, female sex, diabetes mellitus, hypertension, heart failure, kidney function disorder, cardiogenic shock, ejection fraction ≤ 40%, left main (LM) coronary artery stenosis, arrhythmia, 3-vessel coronary artery stenosis, and left anterior descending (LAD) artery stenosis were included in the analysis as predictors of MACE. Results: Cardiogenic shock (OR = 10.65, p = 0.001), LAD stenosis (OR = 15.23, p = 0.02), ejection fraction ≤ 40% (OR = 10.8, p = 0.00), 3-vessels or more coronary artery stenosis (OR 3.47, p = 0.01), heart failure (OR = 3.1, p = 0.02), and renal function disorder (OR 4.76, p = 0.00) were proven as predictors of MACE during 7-days period in ACS patients who had PCI. Female sex, cardiogenic shock, LAD stenosis, and ejection fraction ≤ 40% were independent predictors of MACE in ACS patients who had PCI, with OR values of 6.33 (95%CI 1.32- 30.50), OR 17.56 (1.85-167.06), OR 26.61 (1.38-513.81), and OR 7.6 (1.86-31.09), respectively. Conclusion: Cardiogenic shock, LAD stenosis, ejection fraction ≤ 40%, ≥ 3 vessels stenosis, heart failure, and renal function disorder were predictors of MACE during 7 days in ACS patients who had PCI.

Exploring the self-efficacy and self-care-based stroke care model for risk factor modification in mild-to-moderate stroke patients.

The worldwide burden of stroke is projected to grow unless proper stroke education is implemented. Information alone cannot promote patient self-efficacy and self-care and reduce risk factors. This trial aimed to test self-efficacy and self-care-based stroke education (SSE) on changes in self-efficacy, self-care, and risk factor modification. This study is a single-center, double-blinded, interventional, two-arm randomized controlled trial with a 1- and 3-month follow-up in Indonesia. Between January 2022 and October 2022, 120 patients were prospectively enrolled from Cipto Mangunkusumo National Hospital, Indonesia. Participants were assigned using a computer-generated random number list. SSE was given before discharge from the hospital. Self-care, self-efficacy, and stroke risk score was measured 1 month and 3 months after discharge. Modified Rankin Scale, Barthel Index, and blood viscosity was measured at 1 month and 3 months after discharge. A total of 120 patients (intervention n = 60; standard care n = 60) were randomized. In the 1st month, the intervention group showed a more significant change in self-care (4.56 [95% CI: 0.57, 8.56]), self-efficacy (4.95 [95% CI: 0.84, 9.06]), and stroke risk (-2.33 [95% CI:-3.19, -1.47]) compared to the controlled group. In the 3rd month, the intervention group also showed a more significant change in self-care (19.28 [95% CI: 16.01, 22.56]), self-efficacy (19.95 [95% CI: 16.61, 23.28]), and stroke risk (-3.83 [95% CI: -4.65, -3.01]) compared to the controlled group. SSE may boost self-care and self-efficacy, adjust risk factors, enhance functional outcomes, and decrease blood viscosity. ISRCTN11495822.

Presepsin as a promising biomarker for early detection of post-operative infection in children.

Post-operative systemic inflammation response syndrome (SIRS) is an event that results from surgical trauma, white blood cells contact activation, and intra-surgical bacterial translocation, which is difficult to distinguish from sepsis. Presepsin is a novel biomarker that is increased since the early stages of bacterial infection and can be used to confirm the diagnosis of post-operative infectious complications. This study aimed to investigate the diagnostic performance of presepsin for post-operative infectious complications compared to other well-known biomarkers. This cross-sectional study included 100 post-operative patients admitted to Cipto Mangunkusumo National Hospital and Bunda Hospital in Jakarta, Indonesia. The objective was to identify the optimal cutoff and trend of plasma presepsin concentration on the first and third day after surgery and to compare them with other biomarkers. Plasma presepsin level was higher in the infection group compared to the non-infection group (median 806.5 pg/ml vs. 717 pg/ml and 980 pg/ml vs. 516 pg/ml on the first and third day, respectively). Presepsin levels tended to increase on the third post-operative day (median + 252 pg/ml) in children with infection. The opposite trend was observed in the non-infection group from the first to the third day (median -222.5 pg/ml). Presepsin delta, a three-day difference between the first and third post-operative day, had the best diagnostic performance compared to other biomarkers (Area Under the Curve 0.825). The optimal cutoff for presepsin delta to diagnose post-operative infection was +90.5 pg/ml. Serial assessments of presepsin levels on the first and third days post-surgery and their trends are helpful diagnostic markers for clinicians to detect post-operative infectious complications in children.

Central Facial Soft-Tissue Defect Following Surgical Resection: An Algorithm for Reconstruction

Background: Central facial soft tissue defect poses a unique challenge for the reconstructive surgeon. The three-dimensional properties of the aesthetic facial subunit and its related function are the goals for reconstruction. Considering the prominent social role of the face, the procedure to achieve a good quality of life for patients may cost more than a single surgery. This single-center study presents an algorithm of treatment for central facial soft tissue defect and it’s proposed classification according to the authors’ experiences. Methods: A retrospective review of medical records and photos of patients who underwent central facial soft tissue defect reconstruction in Cipto Mangunkusumo National Hospital, Jakarta, Indonesia, from 2009 to 2019. Patients who underwent free flap reconstruction were followed up, and the primary outcomes were assessed using the FACE-Q head and neck cancer (FACE-Q H&amp;N) scale. A classification system for central facial soft tissue defect with seven subtypes (1–7) based on the facial subunit and its treatment was proposed. Results: Twenty-five patients were included. The malignant tumor was the main etiology (88%), with basal cell carcinoma being the primary cancer pathology (64%). The average defect size was 120 cm2 (32-416 cm2) and most defects fell into subtype 6 of the classification (32%). Anterolateral thigh free flap (ALT) was the main flap of choice (64%), followed by radial forearm free flap (36%), with 92% of flaps succeeding rate from this series. All of the patients underwent at least one ancillary procedure following the reconstruction, while the average was 2 (1-6) procedures. FACE-Q H&amp;N outcomes, especially on the appearance and appearance distress scale, showed a low to moderate score with a 72% response rate. Conclusions: Central facial soft-tissue defect continues to challenge reconstructive surgeons. While the advances in free tissue transfer might improve the general outcomes, the numerous and costly secondary procedures do not usually end up in the best appearance. This study displayed the need for modern reconstruction modalities that provide high satisfaction in aesthetic and functional outcomes with fewer secondary procedures. Vascularized Composite Allotransplantation (VCAT) might be the future choice.

Combination of electroacupuncture and pharmacological treatment improves insulin resistance in women with polycystic ovary syndrome: Double-blind randomized clinical trial.

BackgroundAcupuncture is a nonpharmacological treatment which has been known to improve ovulatory function in polycystic ovary syndrome (PCOS) women. Acupuncture modulates the somatic and autonomic nervous systems, which regulate endocrine and metabolic functions to impact ovulatory functions.ObjectiveTo investigate the effectiveness of electroacupuncture (EA) and pharmacological combination therapy on improving insulin resistance in women with PCOS.Materials and MethodsThis double-blind, randomized clinical trial was performed on 44 participants from March to September 2018 at Cipto Mangunkusumo National hospital, Jakarta, Indonesia. Participants were randomly allocated to treatment (true EA + medication) and control group (sham EA + medication) in a 1:1 ratio using a web-based computer random-number generator. Randomization was carried out by an independent project manager. Both groups received 12 sessions of acupuncture therapy and metformin as pharmacological therapy.ResultsThis study showed a significant decrease in the Homeostatic Model Assessment for Insulin Resistance index in the true EA + medication group before and after therapy (p = 0.014).ConclusionThe combination of EA and pharmacological therapy effectively improves insulin sensitivity in women with PCOS.

Intrauterine device translocation: Case series and management algorithm

Intrauterine devices (IUDs) are the most commonly used long-term contraception due to their 98–99% effectiveness in preventing pregnancy. There are two types of IUD available in Indonesia, a copper-containing IUD and levonorgestrel-releasing IUD. IUD causes chronic inflammatory changes in the endometrium and fallopian tubes that inhibit fertilization and make a hostile environment for implantation. The increased number of endometrial leukocytes is fatal for sperm. In addition, levonorgestrel will inhibit ovulation. The use of an IUD is associated with side effects and complications. The most commonly met complications are IUD expulsion, displacement, translocation, and pregnancy. The average IUD translocation prevalence is 1.3/1000 which mainly occurs during insertion. Translocated IUD may further cause perforation of the bladder or intestines, intestinal obstruction, fistula formation, abscess, adhesion, undesired pregnancy, and chronic pelvic pain. Regardless of the type and location, the WHO recommends removal of the translocated IUD due to its potentially severe complications. Here, we present four cases of IUD translocation at Cipto Mangunkusumo National Hospital from 2020 to 2021, focusing on how to diagnose and the management to remove it.

Evaluation of Traumatic Corneal Rupture Treatment Outcome in dr. Cipto Mangunkusumo Hospital: Two Years Retrospective Study

Open globe injury is an injury that requires prompt treatment which could predict the final outcome. This study evaluates the characteristics and outcome of corneal rupture management in dr. Cipto Mangunkusumo National Hospital’s emergency room. We conducted a retrospective study based on the patient’s medical record between January 2016 – December 2017. Data regarding patients’ demographic, clinical characteristics according to Birmingham Eye Trauma Terminology Score (BETTS) criteria, duration of trauma to surgery, use of early topical steroid, one month visual function result, and risk of endophthalmitis were collected. A repeated ANOVA test with posthoc Bonferroni was used to compare the mean of a paired numeric variable. A total of 163 patients with corneal rupture were recorded, consisted of mostly male (92%) and median age of 27 years old. We found 36.8% cases occurred in the household, 71% cases in the zone I, 62.6% penetrating cases, and mostly came with 4/200-light perception visual acuity (VA) for all zones, mostly caused by inorganic materials and 50.9% cases involved lens. Endophthalmitis was higher in inorganic causes (69.2% vs 30.8%, p=0.33). A total of 95.2% of cases performed surgical treatment in &lt; 24 hours. In post-operative follow up, 53.3% of cases did not need re-operation or proceeding surgery. Several risk factors might affect the treatment outcome of eye injury. Most rupture occurred at zone I. Administration of topical steroids directly post-surgery was not associated with the incidence of endophthalmitis.

The Role of Neutrophil Lymphocyte Ratio , Vitamin D, and NGAL as Cardiovascular Disease Marker in Chronic Kidney Disease

Chronic kidney disease (CKD) patients have higher risk to develop cardiovascular disease (CVD) than non-CKD patients. Neutrophil lymphocyte ratio (NLR) in CKD patients reflects inflammation status and role as complementary prognostic marker to evaluate cardiovascular risk in stage 3 to 5 CKD. High prevalence of vitamin D deficiency commonly found in CKD patients, leads to endothelial dysfunction and increase inflammation. NGAL is used as renal injury biomarker but nowadays NGAL has been known plays important role in CVD pathophysiology. CVD identification in CKD patients is necessary to obtain CVD risk and to stratify mortality earlier in CKD patients. This study aimed to obtain the differences and continued to obtain cut off of NLR, vitamin D and NGAL in CKD patients undergoing hemodialysis (HD) with and without CVD if the differences was significantly. A cross-sectional study was conducted in dr. Cipto Mangunkusumo National Hospital Jakarta, in December- February 2020. Total subjects were 83, consists of two groups with and without the CVD. There were no significant differences of NLR and vitamin D in CKD patients undergoing hemodialysis (HD) with and without CVD. The significant difference was found only in NGAL with cut off 5.64 ng/ml. NLR was lower, meanwhile vitamin D and NGAL were higher in CKD patients undergoing HD with and without CVD.

P121: PREVALENCE OF VERTEBRAL COMPRESSION FRACTURE AND HYPOVITAMINOSIS D IN CHILDREN WITH THALASSEMIA MAJOR

Background: Thalassemia major has various complications that can increase morbidity and mortality. Osteoporosis is a common complication in thalassemia major and has a multifactorial pathogenesis. Osteoporosis can cause vertebral compression fractures and lead to disability. In TIF recommendation, a DEXA-scan is used to measure bone density in thalassemia patients. However, most patients in Indonesia could not afford the DEXA-scan examination because it is not covered by insurance. The 2019 ISCD Pediatric Positions Task Forces stated that the diagnosis of pediatric osteoporosis included the presence of a nontraumatic vertebral compression fracture (VF), without the need for BMD criteria. In Indonesia, there has been no study for the prevalence of hypovitaminosis D and vertebral compression fractures in children with thalassemia major and its correlation. Objective: To describe the prevalence of VF and hypovitaminosis D in children with thalassemia major. Methods: A cross-sectional study design was conducted in children with thalassemia major aged 7–18 years at the Thalassemia Center at Cipto Mangunkusumo National Hospital. Detection and evaluation techniques for vertebral fractures were using plain radiograph from Siemens Healthineers – Ysio Max – X-ray. The classification is based on Global Consensus Recommendations on Prevention and Management of Nutritional Rickets, whereas <30 nmol/L or <12 ng/mL are deficient, 30–50 nmol/L or 12–20 ng/mL are insufficient. Results: This study obtained 165 subjects (50,1% boys, 66% homozygous beta-thalassemia). Fifty-two subjects (31,5%) have VF, and three of them have both thoracal and lumbar fractures. The most common sites of VF were lumbar five and thoracic 11–12. The youngest subject who has VF is seven years old. Osteopenia was found in 67,3% of patients. There were no subjects with fractures who had complaints of pain or a history of previous trauma. Vitamin D levels [25(OH)D] were measured in 122 subjects, and hypovitaminosis D occurred in 77,9% of the subject (32,8% deficiency, 45,1% insufficiency). Our study found no significant relationship between vitamin D levels on the incidence of vertebral compression fractures (p>0,05). Conclusion: To our knowledge, this is the highest prevalence of VF among various studies that have been conducted. Vertebral X-ray is beneficial to detect bone density from osteopenia to fracture in children with thalassemia major. Hypovitaminosis D is common in thalassemia, requiring regular vitamin D administration. Further research is needed to consider the other contributing factors.

The association between 24-h blood pressure variability and major adverse cardiac events (MACE) in hospitalized patients with acute myocardial infarction: a retrospective cohort study

BackgroundAcute myocardial infarction (AMI) is major cardiovascular disease that causes high morbidity and mortality. In AMI, ischemia and necrosis affected some cardiomyocytes leading to a decrease in myocardial contractility which is followed by an acute proinflammation reaction and increased sympathetic tone. Meanwhile, high blood pressure variability (BPV) causing an increased left ventricular workload, heart rate, myocardial oxygen demand and induces proinflamations and endothelial dysfunction. Therefore a high BPV and its associated pathological effects are likely to aggravate the physiological function of the heart and affect the emergence of acute cardiac complications in AMI patients. This study aims to investigate the association’s between short-term BPV and major adverse cardiac events (MACE) in AMI patients. This retrospective cohort study used simple random sampling to identify AMI patients who were hospitalized at Cipto Mangunkusumo National Hospital between January 2018 and December 2019. Mann Withney was performed to investigate the association between BPV and MACE.ResultsThe average systolic BPV value which was calculated as standard deviation (SD) and average real variability (ARV) was higher in the MACE group than in the non-MACE group. Systolic SD and systolic ARV in the MACE group were 13.28 ± 5.41 mmHg and 9.88 ± 3.81 mmHg respectively. In the non-MACE group, systolic SD and systolic ARV were 10.76 (4.59–26.17) mmHg and 8.65 (3.22–19.35) mmHg respectively. There was no significant association between BPV and MACE. However, there were significant differences between systolic SD and systolic ARV in patients with hypertension who experienced MACE and patients without hypertension who experienced MACE.ConclusionsThe BPV of AMI patients who experience MACE was higher than that of non-MACE AMI patients. There was no significant association between BPV ​​and MACE during the acute phase of AMI.

The risk of coronavirus disease (COVID-19) transmission to health workers in the neurology medical service at Dr. Cipto Mangunkusumo National Hospital, Jakarta

Background and Aims COVID-19 transmission in the hospital environment is a serious threat to the patients and health or non-healthcare workers. Previous research identified changes in patients' status to COVID-19 positive during the treatment period reached 10.06%; indicated the high risk of transmission, including in neurology treatment area. This study aims to identify COVID-19 risk factors in the neurology medical service of Cipto Mangunkusumo General Hospital.

Multidimensional Symptom Burden among Patients with Hemodialysis in Indonesia

Patients with hemodialysis commonly experience multiple symptoms. Most of the previous studies analyzedthe symptoms as one dimension such as the severity dimension. Conducting the comprehensive symptomassessment among patients with hemodialysis is necessary to gain a better understanding of the symptom burden.The aim of this study was to identify symptom burden among patients with hemodialysis comprehensively.This study was a descriptive study. A convenience sample of 320 patients undergoing hemodialysis was recruitedfrom the dialysis units at two referral hospitals in Indonesia (Fatmawati Hospital and Cipto MangunkusumoNational Hospital). Indonesian Version of Chronic Kidney Disease – Symptom Burden Index (CKD-SBI) wasused. For the data analysis, descriptive analysis was used. Total 320 subjects were collected. This study foundthat lack of energy was the highest physical symptom burden under 4 dimensions: occurrence 269 (84.0%),severity (mean = 4.28, SD = 3.08), distress (mean = 4.42, SD = 3.09), and frequency (mean = 4.41, SD = 3.27).Furthermore, decreased interest in sex was the highest psychological symptom burden under for dimensions:occurrence 210 (65.6%), severity (mean = 3.39, SD = 3.38), distress (mean = 2.92, SD = 2.99), frequency(mean = 3.70, SD = 3.65). Lack of energy and decreased interest in sex were consistently the highest symptomburden among patients with hemodialysis. Creating appropriate interventions and managing the symptomsexperienced by patients with hemodialysis comprehensively is very important to improve their quality of life.

Neuromuscular Junction Disorders (NMJ) O-NJ001. Electrodiagnostics profile in Myasthenia gravis

Introduction . Repetitive Nerve Stimulation (RNS) has a sensitivity of 50-80% in predicting Myasthenia Gravis (MG). This wide range is affected by type and severity of MG, muscle tested, frequency of stimulation and exercise. There has been a previous study describing these factors but did not confirmed it with the result of Single Fiber (SF) and Acetylcholine Receptor antibody (AChR). Methods . This was a cross-sectional study. Data was from RNS results of MG patients in Electromyography laboratories, Cipto Mangunkusumo National Hospital January to December 2019. Muscle tested on RNS were abductor digiti minimi (ADM) muscle, trapezius (Tr) muscle and orbicularis occuli (OrbOc) muscle. Slow RNS used 3, 5, 7 and 10 Hz stimulation followed by 3 Hz stimulation immediate, 1 minute (min) and 2 min post exercise. Decrease of Compound Muscles Action Potential (CMAP) amplitude > 10% is considered as positive RNS. Results . As much as 47 patients were included in this study. The average age of patients is 43 years old. As much as 44.7% had a positive RNS test, and 70% of the case was positive from OrbOc, followed by Tr (60%) and ADM (30%). Frequency of stimulation that obtained the positivity the most is at 5 Hz, and the 4th wave revealed the lowest point of decreament, followed by the 5th wave. Single Fiber was positive in 57.4% of the case, and AChR was positive in 51.1%. There are 11 patients (23.4%) that has a mismatch results between SF and AChR. Conclusion . RNS without confirmation of SF and AChR may yield a false negative result. Orbicularis Oculi shows the most sensitive muscle tested in RNS, with stimulation of 5 Hz and the 4th waveform the lowest decrement. SF and AChR are still important in confirming strong suspicion patients with MG despite negative results in RNS.

The value of anal swab RT-PCR for COVID-19 diagnosis in adult Indonesian patients

ObjectiveThis study will test the performance of the anal swab PCR test when compared with the nasopharyngeal swab PCR test as a diagnostic tool for COVID-19.DesignAn observational descriptive study which...

Comparison of Eustachian tube ventilation function between cleft palate and normal patients using sonotubometry

ObjectiveTo compare Eustachian tube ventilation function between cleft palate subjects and normal subjects using sonotubometry. MethodA comparative cross-sectional study was conducted at the Department Otolaryngology-Head and Neck Surgery of Ciptomangunkusumo National Hospital, Universitas Indonesia, Jakarta, from June 2013 to January 2014.There were 31 subjects with cleft palate and 62 healthy subjects aged ≤18 years, and both groups were matched according to age. Each subject underwent ear, nose, and throat examination with Veau classification and sonotubometry, a new assembly test in Indonesia. The results of the sonotubogram (the number of Eustachian tube openings, amplitude enhancement in dB, and the duration of Eustachian tube opening in ms) were then analyzed with SPSS using chi-square and Mann–Whitney tests. ResultsSubjects with cleft palate had lower Eustachian tube function than healthy subjects using three sonotubometry parameters (p < 0.001). The proportion of Eustachian tube dysfunction based on the Veau classification was significant (p < 0.001). In multivariate analysis, several determinant factors of Eustachian tube dysfunction were found, such as adenoid hypertrophy (risk factor6.46), the number of Eustachian tube openings (risk factor 36.21), and higher Veau classification (risk factor 10.41). ConclusionSonotubometry could be used to assess parameters of Eustachian tube function. Subjects with cleft palate have a higher risk of having Eustachian tube dysfunction, as do subjects with adenoid hypertrophy.