bluuebunny/crossref_metadata_2025 huggingface dataset:
Produktivitas dan rendemen kayu gergajian pada perusahaan IUIPHHK PT. Katingan Timber Celebes
Authors: Uar Ningsie Indahsuray
Published: September 2018

Kayu gergajian merupakan bahan baku untuk memproduksi berbagai jenis sortimen, ketersediaannya sangat berperan dalam Produktifitas serta kelancaran produksi guna pencapaian target yang direncanakan. Penelitian ini bertujuan untuk mengetahui : (1) Mengetahui persediaan bahan baku kayu bulat dan kayu gergajiaan pada perusahaan IUIPHHK PT. Katinga Timber Celebes (2) Mengetahui Produktivitas Kayu gergajian pada Perusahaan IUIPHHK PT. Katingan Timber Celebes (3) Mengetahui Rendemen dan Limbah Kayu gergajian Perusahaan IUIPHHK PT. Katingan Timber Celebes. Metode yang digunakan dalam penelitian kuantatif dan mengunakan analisis Regresi linieer sederhana, Berdasarkan data penerimaan bahan baku kayu gergajian, maka dapat disusun nilai trend penerimaan bahan baku kayu gergajian. Dari perhitungan penerimaan bahan baku kayu gergajian didapatkan nilai stok awal per 3 tahun dibagi dengan tiga puluh enam bulan mendapatka hasil 30.3081. Hubungan searah atau positif yang terjadi ditunjukan oleh nilai koefisien korelasi penerimaan bahan baku kayu gergajian tersebut. Persediaan bahan baku kayu bulat pada PT.KTC sebanyak 1.967,01 M3 dimana pasokan tertinggi terjadi pada tahun 2016 sebesar 641,78 M3, dan penerimaan kayu olahan gergajian sebanyak 1.091,09 M3 dimana input terbesar pada tahun 2014 sebesar 719.6105 hal ini menujukan produktifitas pada PT. KTC tidak stabil atau tidak memenuhi target yang ada. Rata-rata produktivitas industri kayu gergajian pada PT. Katingan Timber Celebes di Kecamatan Fena Leisela Desa Wamlana Kabupaten Buru sebesar 30,31 M3/Bulan selama 3 tahun atau 1,17 M3 /hari dan Rata-rata rendemen sebesar 58,18 % per 3 tahun, rata-rata limbah industri kayu gergajiaan sebesar 44,86%.
Analisis kualitas air sungai yang bermuara di Perairan Teluk Kao Halmahera Utara
Authors: Husen Azis
Published: September 2018

Penelitian ini bertujuan menganalisis dan menentukan tingkat pencemaran merkuri (Hg) di perairan Teluk Kao Halmahera Utara. Metode yang digunakan adalah metode survei observasi wawancara dan pengambilan sampel air dengan cara purposive sampiling sedangkan untuk analisis air dan sedimen mengunakan alat spektrofotometer penyerap atom (atomic absorption spectrophotometer, AAS). Analisis kualitas air sungai, air laut di perairan Teluk Kao Halmahera Utara untuk pagi dan sore dengan nilai sebesar 0,004 mg/L - 0,0038 mg/L. Sedangkan kandungan merkuri (Hg) untuk sedimen pagi dan sore dengan nilai 0,0032, mg/L - 0,0076 mg/L. Berdasarkan dari hasil tersebut bahwah mutu air sungai Kobok dan Taolas di perairan Teluk Kao Halmahera Utara sudah tidak bisa dikonsumsi sesuai Peraturan Pemerintah Pengelolaan air minum secara konvensional (kelas 1), 0,001 ppm, (kelas 2 dan 3), 0,002 ppm dan (kelas 4). 0,005 ppm dengan demikian mutu air sungai Teluk Kao sudah tidak aman untuk di konsumsi bagi masyarakat Teluk Kao. Sedangkan untuk sedimen sungai Kobok dan Taolas Teluk Kao sudah tidak lagi memenuhi Standar Bahan Baku Mutu sesuai Peraturan Pemerintah No. 82 Tahun 200 kelas I. 0,001 mg/L kelas II. 0,002 mg/L kelas III. 0,002 mg/L kelas IV 0,005 mg/L
Intercultural Communication in EFL Classrooms
Authors: Girik Allo Markus Deli
Published: September 2018

Intercultural communication is an important aspect in EFL classrooms since EFL classrooms are one of the learners’ environments to learn the culture and intercultural communication. The researcher employed the quantitative research with survey design. This study investigated the place of culture and intercultural communication in Torajan EFL classrooms and Torajan students’ perceptions on Imperatives for studying Intercultural Communication. It is found that: Students needed for the new cultural and intercultural knowledge in EFL classrooms and hoped that curriculum can meet their needs on intercultural communication competence, and students are aware and hope to institutional and EFL lecturers to create intercultural environment and encourage effective intercultural dialogue in EFL classrooms in order to achieve: pedagogical, personal development, peace, economic, demographic, and ethical imperatives of intercultural communication.
The Power of Speech by Medicine Vendor
Authors: Musfirah Musfirah
Published: September 2018

The speech of medicine vendor contains power to convince the costumers. This study is aimed at investigating the linguistics features used in the in the speech of medicine vendor. This study is descriptive qualitative in analyzing and displaying the data. The techniques of analyzing data were transcribing the utterances, translation the data into English by applying morpheme by morpheme translation and idiomatic translation, and identifying the linguistics features of medicine vendors’ speech. The result of this study revealed that parallelism is one of the linguistics features used in the speech to build a power.
Effectiveness of ABA Therapy for Children with Special Needs of Autism: A Study of Psycholinguistics View
Authors: Ithriyah Siti
Published: September 2018

The background of this study is the recognition of an expert consultant psychiatrist named dr. Suzy Yusna SpKJ, who stated in our interview that based on the experience of practice before the 1990's the number of patients who were diagnosed as a child with autistic disorder in a year is only about five people. However, at this time of day can be diagnosed, three new patients. This shows a significant increase in autism. This study aims to describe (1) the effectiveness of Applied Behavioral Analysis (ABA) therapy model to increase autistic children's language; and (2) language development of children with autism after acquiring learning methods ABA therapy. This research method is descriptive research. The study takes its source data from children with special needs at Rumah Autis Bogor. Five children were selected as the research participants. We conclude that Lovaas’ ABA method to prove the effectiveness of these therapies through phases and methods. Therapists who are experts in this field also helped determine the success in measuring the response level of language learning for children with autism. Thus, effective ABA therapy model applied in improving the language of children with autism. Before the ABA method is applied, the average child's ability to speak to one type of vocabulary requires learning four to five times (four and five days) with bad judgment and poor. However, after being given an action, then the average language skills of children with autism increased by only one or two lessons (one and two days) with the excellent score.
Penilaian Fungsi Ventrikel Kanan (2)
Authors: Soesanto Amiliana M
Published: September 2018

Pada edisi sebelumnya telah dibicarakan beberapa cara penilaian praktis dan sederhana terhadap fungsi ventrikel kanan. Selanjutnya pada dalam artikel ini akan diuraikan kembali cara pengukuran funfsi ventrikel kanan yang agak lebih "advanced" yang mungkin hanya terbatas penggunaannya untuk kepentingan kasus khusus atau penelitian. Artikel ini dimaksudkan bukan untuk menjelaskan tentang teori dan latar belakang.
Clinical Implication of Early Repolarization
Authors: Octavianus Reza , Yuniadi Yoga , Setianto Budhi
Published: September 2018

Early repolarization described as J-point elevation with concaved ST segment, notch or slurred at terminal QRS complex on surface electrokardiography. This electrokardiography pattern that usually exists in young male population, for about 60 years has been concluded as benign normal variant electrokardiography. Klatsky in 2002, has strengthed this issues with his study with 1000 elecrokardiographies with early repolarization which were followed for 12 years. There was no significant case for hospitality or malignant ventricular arrhythmias among population with early repolarization comparared with normal elektrokardiography without early repolarization.But, recent studies with larger samples, show different thing, which is there was a correlation between early repolarization and malignat ventricular arrhythmias. So the issue is, whether we can still consider this early repolarization as a normal variant or not. And how about the management of asymptomatic population with early repolarization such as syncope or evidence of malignant ventricular arrhythmias.T-wave Alternans is a difference at amplitude or morphology of ST segment and T wave in every other heart beat. T-wave Alternans measurement is a non-invasive method to value cardiac cells hererogeneity. This examination has been proven to be useful as a risk stratification for malignant ventricular arrhythmias events in large studies. Higher T-wave Alternans value accompanied with higher risk for developing these arrythymias. T-wave Alternans measurement has been approved in the guideline for management of wide QRS complex tachyarrythmias for detection ventricular arrhythmias with I and IIa class of recommedantion. The more practical Modified Moving Average technicque which can be performed in healthy subjects with early repolarization is useful for risk stratification. Large studies have approved the use of Modified Moving Average for measure T-wave Alternans in these arrhythmias risk stratification.
Elevasi Segmen ST Varian Normal
Authors: Yuniadi Yoga
Published: September 2018

Elevasi segmen ST selalu menimbulkan dugaan adanya infark miokard akut. Walaupun sebenarnya tidak semua elevasi segmen ST berkaitan dengan adanya oklusi arteri koroner karena ada gambaran elevasi segmen ST yang hanya merupakan varian normal. Tulisan ini akan menyegarkan kembali pengetahuan tentang elevasi segmen ST varian normal.
Perioperative Management of Single Ventricle
Authors: Cintyandy Riza , Boom Cindy E
Published: September 2018

Single Ventricle (SV) was a terminology for a condition when one of theventricles is hypoplastic or absent. These patients often require a seriesof procedures to provide effective palliation. Surgical therapy commitsthe single ventricle to the delivery of oxygenated blood to the systemiccirculation and deoxygenated blood is directed to the pulmonary circulationbypassing the ventricle. There are three phases of palliation procedures: (1)placement of shunt, (2) Bidirectional Glenn Shunt and (3) Fontan procedure.There are different physiologies in each phase. With improved surgicaltechniques and medical care, SV patients are living longer. Many SV patientsappear in need of anesthesia for routine general and obstetric procedures.Anesthesiologists, general practitioners, and subspecialists alike increasinglymay encounter the patient with SV physiology.
Pencitraan Resonansi Magnetik Kardiovaskular pada Penyakit Jantung Bawaan
Authors: Lilyasari Oktavia
Published: September 2018

Pencitraan merupakan suatu hal yang fundamental dalam diagnosis Penyakit Jantung Bawaan (PJB). Pencitraan Resonansi Magnetis Kardiovaskular (Cardiovascular Magnetic Resonance/CMR) menjadi teknik penting dalam diagnosis dan tatalaksana penyakit kardiovaskular. Data contagious 3D yang merupakan kekuatan CMR sangat efektif memberikan gambaran lengkap patologi anatomi PJB sederhana ataupun kompleks. CMR dapat menyajikan gambar tiga dimensi dengan resolusi tinggi dan memungkinkan untuk rekonstruksi visualisasi kelainan jantung yang kompleks.Saat ini pencitraan dengan menggunakan CMR menjadi tekhnik penting dan adekuat dalam menilai fungsi ventrikel, aliran dinamis intra kardiak, termasuk regurgitasi dan stenosis katup, aliran pembuluh darah besar, karakterisasi anatomi kelainan bawaan yang kompleks, terutama yang berhubungan dengan vena sistemik dan pulmonal, hubungan antar ruang jantung (atrioventricular connection, ventriculo-arterial connection). CMR juga dapat mengurangi jumlah prosedur kateterisasi diagnostik untuk evaluasi pre dan post tindakan intervensi bedah maupun non bedah, sehingga dapat meminimalisasi efek radiasi yang ditimbulkan oleh prosedur kateterisasi.Beberapa kesulitan timbul saat melakukan pemeriksaan CMR pada anak yang kecil. Diperlukan beberapa penyesuaian untuk menghasilkan kualitas gambar yang optimal, karena ukuran struktur jantung yang lebih kecil, frekuensi nadi yang lebih cepat, kesulitan atau ketidakmampuan untuk mengikuti komando tahan nafas dan kurangnya kerjasama pasien.Penggunaan klinis CMR tergantung dari usia dan kondisi klinis pasien. Pencitraan Resonansi Magnetik Kardiovaskular menjadi teknik utama terutama pada anak-anak yang cukup besar, remaja atau dewasa pada kelainan anatomi yang kompleks, dan evaluasi post operasi.
Circulating Endothelial Progenitor Cells is a predictor in Atherosclerosis: Is it really a promising candle?
Authors: Santoso Anwar
Published: September 2018

Circulating endothelial progenitor cells (CEPC) are supposed to be a subset of bone marrow-derived peripheral blood mononuclear cells (PBMC), revealing immature surface markers common to hematopoietic stem cells, such as CD 34 and CD 133 and endothelial lineage markers. These cells can be isolated from peripheral, umbilical cord, and bone marrow blood. CD 34 represents a marker of immature stem cells that is commonly used to characterize CEPC together with other surface antigens. Though, as CD 34 is also expressed at lower levels on mature endothelial cells, most recent studies used CD 133, a marker of more immature hematopoietic stem cells that is now considered the best surface marker to define, identify and isolate the CEPC1. CD 133 (also known as AC 133 or prominin) is highly conserved antigen with unknown biological activity. It would be expressed on hematopoietic stem cells, but not on mature endothelial cell and monocytes. In order to reflect the endothelial cells, there is general agreement for the use of at least one additional marker, such as vascular endothelial growth factor receptor-2 (VEGFR-2 or KDR), while others are platelet-endothelial cells adhesion molecules-1 (PECAM-1), von Willebrand factor, c-kit, Tie-2, vascular endothelial-cadherin and VEGFR-12.
Interpretasi Hasil Pemeriksaan MRI Kardiak pada Penyakit Jantung Koroner
Authors: Wicaksono Sony Hilal , Muslim Fachmi Ahmad , Rossimarina Vienna
Published: September 2018

Seorang pasien dapat didiagnosis penyakit jantung koroner (PJK) melalui empat cara: kematian jantung mendadak, sindrom koroner akut, angina pektoris stabil paska revaskularisasi, dan hasil diagnostik noninvasif (Computed Tomography scan/CT scan koroner, Single Photon Emission Computed Tomography Myocardial Perfusion Imaging/SPECT MPI nuklir atau Magnetic Resonance Imaging/MRI)1. Pemeriksaan noninvasif memegang peranan penting, yaitu sebagai satu-satunya cara mendiagnosis PJK asimtomatik. Oleh sebab itu, pemahaman mengenai interpretasi hasil pemeriksaan noninvasif seperti CT scan koroner, SPECT MPI nuklir atau MRI kardiak dimasukkan dalam kompetensi dasar program pendidikan spesialis jantung dan pembuluh darah menurut Kolegium PERKI.
Alcohol Septal Ablation of Hyperthropic Obstructive Cardiomyopathy Patient with Respiratory Failure
Authors: Endang Jusuf , Haryadi H , Suridanda Siska , S Andika , Christian Roy , Irmalita I , Raharjo Sunu Budi , Yuniadi Yoga
Published: September 2018

Hypertrophic Obstructive Cardiomyopathy (HOCM) prevalence is about 1 among 500 population. It is caused by genetic malformation. Dyspnoe, angina pectoris and syncope are clinical manisfestation. Pharmacological and non-pharmacological treatments can be performed to relieve the obstructive symptoms. Recently alcohol septal ablation has been proven improve haemodynamic and functional status.We report a case of HOCM patient with refractory lung oedema and intubated due to respiratory failure that was immediatelly improved afterseptal ablation.
Coronary Intervention for Stable Angina Pectoris: The use of Fractional Flow Reserve as a decision making tool for Coronary Angioplasty
Authors: Martha Januar Wibawa
Published: September 2018

Coronary angioplasty is a definitive, percutaneous intervention to improve myocardial oxygen supply. The benefit of coronary angioplasty for stable angina pectoris is still a controversy. The COURAGE trial had shown that angioplasty for stable angina pectoris gave no additional benefit compared with optimal medical therapy, while the recently done FAME II trial showed the opposite. FAME II trial proved that angioplasty could reduce MACEs in stable angina pectoris patients. The conflicting results from COURAGE and FAME II trials is due to the difference in decision making methodology used for angioplasty. COURAGE used plain angiogram while FAME II utilized Fractional Flow Reserve (FFR) as a tool to decide whether a lesion should undergo angioplasty. The result of FAME II demonstrate FFR is far more reliable to determine coronary lesion which cause ischemia, hence a better decision making tool for angioplasty. The specificity of FFR is proven high, while angiography has an excessive false positives. The use of FFR before angioplasty is still low although there is a considerable evidence that FFR is a better decion making tool for angioplasty compared to angiography. Health economic analysis displayed the use of FFR for stable angina pectoris is cost effective in the long term.
Only Single Pacing On Dual Chamber Pacemaker
Authors: Yuniadi Yoga
Published: September 2018

EKG merupakan pemeriksaan penunjang yang sangat penting untuk evaluasi pasien pemakai alat pacu jantung menetap. Melalui EKG fungsi pemacuan dan fungsi sensing alat pacu jantung menetap dapat ditentukan dengan cukup akurat. Dengan mengantongi informasi jenis alat pacu jantung menetap yang digunakan, EKG bagi seorang kardiolog akan memberikan informasi adanya fenomena undersensing, oversensing, loss of capture, loss of output, dan sebagainya.
Pemeriksaan Hemodinamik Ekokardiografi pada Kasus Kegawatan dan Kritikal Jantung Seri III: Penilaian Hemodinamik Jantung Kanan
Authors: Soesanto Amiliana M
Published: September 2018

Walaupun sering terabaikan, fungsi jantung kanan dan sirkulasi pulmoner mempunyai peranan penting dalam keseluruhan sistem sirkulasi. Tidak jarang kasus-kasus kritikal disebabkan karena kegagalan sirkulasi jantung kanan. Pada seri III forum ekokardiografi ini akan dibahas penilaian hemodinamik jantung kanan dengan ekokardiografi untuk kasus-kasus kritikal sehingga akan diutamakan cara pemeriksaan yang praktis, sederhana, dan cepat.
Correlation of Brachial Flow Mediated Dilation with Severity of Coronary Artery Disease
Authors: Mulia Erwin , Sunu Ismoyo , Joesoef, Andang H , Harimurti Ganesja M
Published: September 2018

Background. Endothelial dysfunction precedes the development of morphological changes and contributes to atherosclerotic lesion development and progression. Evaluation using non invasive method such as brachial FMD (flow mediated dilation) has given inconsistent information for extension and coronary atherosclerotic severity regarding endothelial dysfunction. This research will evaluate the correlation between brachial FMD and severity of coronary artery disease (CAD) stenosis.Methods. It was a cross sectional study. Evaluations were performed in 85 patients who had followed elective coronary angiography and fulfilled inclusion criteria in National Cardiovascular Center Harapan Kita since January until October of 2012. Correlation between brachial FMD and severity of CAD stenosis (Gensini score) was evaluated using linear regression analysis.Results. Brachial FMD had negative correlation with Gensini score (R= -0,227; P= 0,037). Hypertension had negative correlation with brachial FMD (R= -0,235; P= 0,032). Male gender had positive correlation with brachial FMD (R= 0,220; P= 0,040).Conclusion. There was weak negative correlation between brachial FMD and Gensini score.
Seeing the Inner from Outer
Authors: Yuniadi Yoga
Published: September 2018

Since Furchgott et al1 showed that acetylcholine requires the presence of endothelial cells to induce vasodilation, the importance of the endothelial cell layer for vascular homeostasis has been increasingly appreciated. Endothelial dysfunction was initially identified as impaired vasodilation to specific stimuli such as acetylcholine or bradykinin. A broader understanding of the term would include not only reduced vasodilation but also a proinflammatory and prothrombic state associated with dysfunction of the endothelium.2 Figure 1 describe regulation function of endothelium during normal and dysfunction condition.3 In human, endothelial dysfuntion was first described in forearm of hypertensive patient.4 Dysfunction of the endothelium has been attributed to the pathophysiology of different forms of cardiovascular disease, including hypertension, coronary artery disease, chronic heart failure, peripheral artery disease, diabetes, and chronic renal failure.2
Relationships mean platelet volume dengan miocardial quantitative blush-est ima patients undergoing primary percutaneous coronary intervention
Authors: Murdiati Sri , Yuniadi Yoga
Published: September 2018

Background. Mean platelet volume is a marker of platelet, size and activation functions. Increased mean platelet volume showed a large and active platelet release more thromboxane A2 than smaller ones. A simple marker was detected using a fast and functional techniques will help approaches to inflammation caused by platelets. Thus MPV is an important examination of effective simple, easy, and low cost to be used and explored extensively, particularly in developing countries such as Indonesia, to predict the likelihood of complications to come.Methods and Results. Seventy-two patients (age minimum 30 years and maximum 80 years who came to the hospital with a presentation IMA-EST onset less than 12 hours were included in this study. Following primary percutaneous intervention coroner examined myocardial blush with Qube and see the relationship with the value mean platelet volume (MPV) in assessing myocardial flow. End point of this study is the lack of correlation between MPV values in the assessment of myocardial blush Qube post-reperfusion.Conclusion. MPV values in this population as the initial entry no relationship with Qube in assessing the value of post-reperfusion myocardial blush
Analgetic Sedation for Electrical Cardioversion in Emergency Room
Authors: Yuwono Kurniawan Agung
Published: September 2018

General practitioner assigned in emergency room must have ability to do electrical cardioversion either in emergency, urgent or elective setting. Analgetic sedation is mandatory to avoid severe pain during electrical cardioversion. Limited number of anesthesiologist and emergency setting that need prompt electrical cardioversion warrant of selecting and using of analgetic sedation agents by doctor in emergency room. Characteristics of those agents must have strong analgesic effect and rapid onset and offset, minimize pain and anxiety and maximize amnesia with minimal adverse effect. This paper reviews some randomized control trial of those agents.
Takikardia QRS lebar dengan hemodinamik tidak stabil
Authors: Yuniadi Yoga
Published: September 2018

KasusSeorang laki-laki, 56 tahun datang ke UGD RS daerah di Jawa Tengah dengan keluhan lemas yang sudah dirasakan sejak seminggu sebelum masuk RS. Pasien juga mengeluh berdebar dan muntah-muntah. PPemeriksaan fisik didapatkan TD 90/60, RR 24 kpm dengan laju nadi sulit dihitung karena terlalu cepat. Tanda fisik lain tidak menonjol kecuali terdapat edema di kedua tungkai. Rekaman EKG diperlihatkan pada gambar 1. Bagaimana bersikap terhadap keadaan klinis pasien ini?Gambar 1. Rekaman EKG 12 sadapan. Takikardia QRS lebar dengan gelombang P bebas (anak panah)
Sindroma Pre Eksitasi Asimtomatik: Ablasi Versus Konservatif
Authors: Munawar Dian Andina , Yuniadi Yoga
Published: September 2018

Wolff-Parkinson-White (WPW) is a sporadic and familial abnormality. Epidemiologicaldata indicate that 0.1% to 0.3% of the general populationhave ECG findings suggesting that during sinus rhythm. The risk of suddencardiac death is around 0.25%. Patients with WPW syndrome is oftensymptomatic because of cardiac arrhythmias. Sometimes the arrhythmiacan be life-threatening, and leads to sudden cardiac death. However, thereis still controversy in management of individuals with asymptomatic WPWpattern. Despite radiofrequency catheter ablation remains the first linetherapy of the WPW syndrome, the risk of complications of this procedureis almost the same as the risk of sudden cardiac death in asymptomaticWPW. Therefore, an algorithm to determine the appropriate managementof asymptomatic WPW patients is needed.
Nilai Prediktif Mri Kardiak Pasca Stemi Peran Late Enhancement
Authors: I Irnizarifka , Wicaksono Sony Hilal , Kuncoro Ario Soeryo , Kasim Manoefris
Published: September 2018

Forum Pencitraan Kardiovaskular edisi sebelumnya membahas tentang peran Magnetic Resonancec Imaging (MRI) kardiak pada kasus Penyakit Jantung Koroner dalam kondisi akut maupun kronik. Dalam forum kali ini, kami sajikan contoh kasus penggunaan MRI kardiak pada pasien pasca Infark Miokard Akut Elevasi ST (IMAEST) yang dilakukan pemeriksaan MRI kardiak saat perawatan sebagai stratifikasi risiko pasien pasca IMAEST. Penyakit kardiovaskular masih menjadi penyebab morbiditas dan mortalitas tertinggi di dunia, dengan penyakit arteri koroner (PAK) sebagai manifestasi utamanya.1 Dengan semakin berkembangnya manajemen serangan jantung akut, setidaknya 70% pasien yang dirawat di rumah sakit dengan infark miokard akut (IMA) berhasil melewati fase akutnya. Namun, konsekuensi jangka panjang pasca serangan akut tetap dapat terjadi meskipun intervensi fase akut telah dilakukan. Dengan demikian, ketepatan waktu dalam mendiagnosis IMAEST menjadi sangat penting.
Tips Dan Trik: Mengenali Tamponade
Authors: Ariani Rina , Soesanto Amiliana M
Published: September 2018

Tamponade merupakan kondisi klinis mengancam jiwa dimana fungsi jantung terganggu oleh penekanan dari ruang pericardium, baik oleh cairan, massa, bekuan darah, ataupun kombinasi antara ketiganya. Fisiologi tamponade terjadi akibat terganggunya hemodinamik akibat peningkatan tekanan intra pericardium sehingga mengganggu pengisian ruang jantung. Tamponade dapat terjadi akibat adanya volume efusi yang cukup besar atau terbentuknya efusi dalam waktu yang singkat. Perlu diingat bahwa efusi yang besar dapat tidak menimbulkan tamponade bila terakumulasi bertahap sehingga memungkinkan rongga perikard meregang dan beradaptasi. Harus pula digaris bawahi diagnosis tamponade merupakan diagnosis berdasarkan klinis namun ekokardiografi seringkali dapat mengenali adanya tamponade dengan lebih dini.
Symptomatic Myocardial Bridging Treated by Coronary Stenting
Authors: Winata Johan , Reppi Eben , Budiono Bambang , Lefrandt Reggy L
Published: September 2018

Background : Myocardial bridging is a congenital coronary anomaly withmostly benign course throughout life. However, several pathological clinicalmanifestations may accompany myocardial bridging, such as arrhythmia,angina, depressed left ventricular function, myocardial stunning, myocardialinfarction, and sudden death. Symptomatic management with anti anginalagents should be adequate in most cases. Stenting, surgical resection ofthe bridge (myotomy), and coronary bypass surgery are only reserved forthe rare patient with severe symptoms.Case Report : A 44 year old man was admitted to the hospital because ofthe recurrent episodes of palpitations, syncope and chest pain. ECG showedsinus rhythm with bigeminy ventricular extra systoles. Echocardiographyshowed no regional wall motion abnormalities with normal ejection fraction.Coronary angiography showed myocardial bridging in mid LAD withno associated atherosclerotic coronary disease.Recurrent episodes of angina and non-sustained VT were detected duringobservation in ICCU, despite anti-arrhytmic drug treatment and Kaliumcorrection. Decision was made to perform PCI to cover bridging segmentusing drug eluting stent (DES). Post stent angiography showed no subsequentmilking effect of systole with improvement in the occurrence ofarrhythmia. Holter monitoring which was done 1 week after PCI showedno ventricular extrasystole found. Clinical evaluation and treadmill test at3 months after the procedure demonstrated good clinical condition andthe patient remained free of symptoms.Conclusion : A successful coronary stenting to mid LAD due to myocardialbridging with persistent symptoms despite medial therapy. A thorough followup should be done to identify the possibility of luminal narrowing causedby intimal proliferation or stent fracture due to external compression.
Right Ventricular Dysfuction In Subject With Obstructive Sleep Apnoea
Authors: Santoso Rony M , Rahajoe Anna U , Sunu Ismoyo
Published: September 2018

An analytical design study on the systolic right ventricle (RV) functionwas done in Obstructive Sleep Apnea (OSA) patients who underwentpolisomnography procedure and compare it with normal subject. Theassessment of the RV function was performed using the Speckle trackingechocardiography method. Other RV function parameters such as TAPSE,Tissue Doppler Imaging (TDI), dan Myocardial Performance Index (MPI)were also measured.The results showed RV dysfunction in OSA patients compared with normalsubject, the decrease of RV function was significantly different betweenthe two groups. Factors that contributed to RV dysfunction in OSA patientswere higher Apnea-Hypopnea Index (AHI) and Nocturnal OxygenDesaturation.
Sindrom Bradi-Takiaritmia
Authors: Yuniadi Yoga
Published: September 2018

Seorang perempuan usia 67 tahun datang ke poli Aritmia dengan keluhan sering lemas dan berdebar. Tidak ada riwayat pingsan atau nyeri dada. Pemeriksaan fisik dalam batas normal. Pemeriksaan laboratorium tidak menunjukkan kelainan yangbermakna. Pemeriksaan holter 24 jam menunjukkan gambaran di bawah ini (Gambar 1).
The Need for National Registry
Authors: Yuniadi Yoga
Published: September 2018

Currently medical outcomes research has generally been conducted with 3 sources of data: randomized clinical trials, administrative claims databases, and data registries. Each of these data sources has a unique set of applications, data quality issues, and requirements.1 In United State, clinical trials is part of the pharmaceutical and device pre-approval process thus it has highly regulated requirements for source document verification.2 In contrast, quality control of administrative data is primarily limited to fields directly related to claims adjudication. Thus, administrative claims data are significantly limited for the purposes of performing healthcare research.3 Like administrative claims data, registries are nonrandomized, observational datasets that can be generalized to real-world practice, depending on the representativeness of participants and the completeness of enrollment.4 However, as with the data collected in randomized clinical trials, registries include detailed clinical data using standardized data definitions.
Coronary CT Angiography untuk deteksi plak rapuh, sebagai bagian dari usaha pencegahan Sindrom Koroner Akut
Authors: Wicaksono Sonny Hilal
Published: September 2018

Tindakan Primary Percutaneous Coronary Intervention (PPCI) untuk pasien sindrom koroner akut (SKA) dengan ST elevasi (STEMI=ST elevation myocardial infarction) telah berjasa banyak dalam menurunkan mortalitas. Namun kerusakan jaringan miokard pasca PPCI tetap terjadi, akibat iskemia yang telah berlangsung sebelum reperfusi berhasil, atau kerusakan jaringan miokard akibat cedera reperfusi. Hal tersebut menimbulkan konsekuensi morbiditas akibat SKA berupa gagal jantung. Sehingga dikhawatirkan bila SKA tidak dicegah, di masa yang akan datang akan timbul epidemi gagal jantung. Oleh sebab itu strategi pencegahan terjadinya SKA perlu menjadi pengetahuan dasar bagi seluruh dokter spesialis jantung dan pembuluh darah (SpJP) agar epidemi gagal jantung dapat dicegah.Strategi pencegahan SKA tetap memegang 5 prinsip:1. Health Promotion2. Primary Prevention3. Early Detection and Prompt Treatment4. Secondary Prevention5. RehabilitationPoin pertama dan kedua dilakukan langsung ke tengah masyarakat di luar klinik atau rumah sakit, mulai dari poin ke-tiga, yaitu deteksi dini, dilakukan dalam praktek klinik.
Fibrilasi Atrial dengan Takikardia QRS Lebar
Authors: Yuniadi Yoga
Published: September 2018

Seorang pria Bngladesh, 65 tahun datng ke UGD dengan keluhan mau pingsan. Pasien adalah pasien lama dengan 3VD yang sudah dilakukan revaskularisasi lengkap dengan pemasangan stent. Riwayat medis sebelumnya adalah rawat inap berulang karena ADHF. Hasil ekokardiografi menunjukkan suatu disfungsi ventrikel kiri berat, fraksi ejeksi (EF) 35%, dimensi end diastolik ventrikel kiri (EDD) 66 mm dan dimensi atrium kiri (LAD) 52 mm. Pemeriksaan fisik dalam batas normal.
Temuan Gambaran CT Napkin Ring Sign Pada Pasien Asimtomatik
Authors: Wicaksono Sony Hilal
Published: September 2018

KasusSeorang laki-laki usia 56 tahun datang ke poliklinik rawat jalan untuk memeriksakan kesehatannya saat dalam keadaan tanpa keluhan atau asimtomatik. Keluhan selama ini tidak ada yang memiliki karakteristik angina atau sesak napas. Pasien memiliki riwayat penyakit jantung koroner dikeluarganya, yaitu dua orang kakak kandungnya (laki-laki) yang telah menjalani operasi jantung dan dipasang ring.Pasien pernah memeriksakan faktor risiko kardiovaskular dengan hasil terdapat peningkatan kadar kolesterol dalam darah yaitu LDL setinggi 150 mg/dL. Selain itu pasien juga dengan hipertensi grade 1 tekanan darah sistolik berkisar 140-150mmHg. Hasil EKG menunjukkan kesimpulan normal sinus ritme, tidak ditemukan kelainan pada setiap gelombang PQRST maupun setiap segmen PR dan ST.Karena gambaran EKG masih normal, dengan faktor risiko usia jenis kelamin dan riwayat keluarga serta dislipidemia, maka kami menganjurkan deteksi aterosklerosis kepada pasien dengan metode CT coronary angiography (CTCA).
Secretory Phospholipase A2 Tipe II (SPLA II) In Cardiovascular Disease
Authors: Sargowo Djanggan
Published: September 2018

Inflammatory reactions contribute to the pathogenesis of cardiovascular conditions such as atherosclerosis and ischemic damage in acute myocardial infarction (AMI). Among the mediators involved in inflammation are secretory phospholipase A2 group II (sPLA2-II) enzymes. Though some cells constitutively express Spla2-II, the synthesis by cells such as hepatocytes is typical for an acute-phase reactant. Recent literature suggest multiple roles for sPLA2-II in cardiovascular disease. In this review we discuss the role of sPLA2-II in included that sPLA2-II appears to be an inportant inflammatory mediator of cardiovascular disease.
Varicose Vein
Authors: Septiani Putri , Sulastomo Heru
Published: September 2018

Varicose vein is a common problem in vein. It is a dilated, elongated, and tortuous vein. It used to be a cosmetic problem, but nowadays it has become a more serious problem, since it can affect quality of life. It usually occurs in the inferior extremities. The venous system is divided into superficial vein, deep vein, perforator vein, and intramuscular sinus venosus. Pathological conditions that usually occur in the vein system are obstruction and valve incompetence. The risk factors of varicose vein are: elderly, history of family with varicose vein, pregnancy, occupation that requires long standing, sedentary life style, and obesity. Ultrasonography (USG) duplex is the most recommended modality to diagnose varicose vein. The classification of this disease is based on chronic venous disease classification, the CEAP (Clinical, Etiology, Anatomy, Pathophysiology) classification. The management for varicose vein includes intervention (sclerotherapy, endovenous ablation, and surgery) and non-intervention (education, compression stocking, and pharmacology) therapy.
Polysaccharide Peptide: A promising Anti Inflammation and Anti Oxidant in Atherosclerosis
Authors: Prasetya Indra , Ashriyah Ria , Setyawati Ira , Hermawan Joko , Mahargo Widyo , Leksono Yunita , Andri W. Titin , Heriansyah Teuku , Aris W. Muhammad , Sargowo Djanggan
Published: September 2018

Background : Heart disease is the leading cause of death for both men and women, but heart disease is preventable and controllable. Ganoderma lucidum is widely used as traditional medicine for centuries particularly in China, Japan, and Korea. Previous study showed antioxidative activity of polysaccharide peptide (PsP) from Genoderma lucidum.Objective : This study was aimed to evaluate anti-inflammatory and antioxidant effect of polysaccharide peptide (PsP) from Ganoderma lucidum in atherosclerotic rats.Methods : The atherosclerotic rats were randomly divided into four groups (5 rats each group) : atherosclerotic model with high-fat diet, low dose PsP treated group (50 mg/kgBW), medium dose PsP treated group (150 mg/kgBW), high dose PsP treated group (300 mg/kgBW), with normal mice used as a control group. Parameters measured were the level of MDA, SOD, IL - 6 , IL - 10, hsCRP, TNF - ?, lipid profile and foam cell.Results : After PsP therapy for 5 weeks, the levels of MDA (p=0.01), hsCRP (p=0.018) in rats model of atherosclerosis decrease significantly. PsSP can reduce levels of IL - 6 (p=0.933) and increase levels of SOD (p=0.28) descriptively at PsP doses 150 mg/kgBW. While the levels of TNF-? (p=0.894) and IL-10 (p=0.98) was not affected by administration of PsP. PsP improve the lipid profile by increasing HDL (p=0.002) and lowering total cholesterol (p=0.04). The formation of foam cells (p=0.024) as a marker of atherogenesis significantly decreased by administration of PsP .Conclusion : PSP can be useful to reduce inflammatory processes and oxidative stress to prevent the process of atherogenesis.
Trimetazidine Effects on Neutrophils Count in Patients Post PPCI
Authors: Mehi Taka , Yuniadi Yoga , Haryono Nur
Published: September 2018

The incidence rate of ST-Elevation acute Myocardial Infarct (STEMI) keeps increasing. Currently, myocardial reperfusion, either with thrombolytic or Primary Percutaneous Coronary Intervention (PPCI), is the main treatment. However, mortality rate of STEMI patients undergoing PPCI is still high which is 6% to 14%. The main purpose of PPCI is to restore the patency of infarcted epicardial artery and to establish microvascular reperfusion as soon as possible so that it can reduce enlargement of irreversible necrotic myocardial tissue. In the other hand, restored patency of infarcted epicardial artery does not indicate sufficient reperfusion to microvascular. Such phenomenon is called no-reflow or microvascular obstruction (MVO). Specific pathogenic component of MVO is reperfusion injury. Reperfusion injury involves some mediator and mechanisms, one of which is the process of thrombolysis and angioplasty. Mediator that play a certain role is inflammatory neutrophil which is activated and accumulated. Trimetazidine is an anti-ischemic agent which selectively inhibits end stage activation of oxidation pathway of 3-ketoacyl coenzyme Athiolase. Trimetazidine has an ability to reduce the accumulation of neutrophil
Optimization of Hypertension Treatment using Fixed-Dose Combination of Perindropril/Amlodipine
Authors: Hindoro Evan , Karlina Arlis
Published: September 2018

A lot of hypertensive patients require two or more antihypertensive drugs to control and maintain normal blood pressure. Combination of antihypertension is recommended either as first or second line treatment. Among available antihypertension medications, combination of renin-angiotensinaldosteron (RAAS) inhibitor with calcium channel blocker or diuretics are more recommended as they have sinergistic clinical and biomolecular effects.Furthermore, single pill dosage is associated with higher patients compliants and lower faults incidence in medication. Severeal fixed-dose combinations are currently available in the market to give easier hypertension control and patients compliants. This short review focus on combination of perindropril and amlodipine
The Role of Cardiac Computed Tomography in Tetralogy of Fallot and Pulmonary Atresia
Authors: Lilyasari Oktavia
Published: September 2018

Congenital heart disease (CHD) occurs in about 6 to 8 of 1000 live births with the increasing prevalence can be attributed to major improvements in diagnosis and treatment. Imaging has an important role in diagnosis of CHD. It outlines anatomy and physiology, helps to refine management, evaluates the consequences of interventions and helps guide prognosis. However, no single available imaging modality fulfills these roles for all patients and diseases. Therefore, assessment for CHD must involve multimodalities that can be used in a complementary fashion, and that together are sensitive, accurate, reproducible, and cost effective, whilst minimizing harm.In previous years, the diagnosis and the treatment of congenital malformations have often depended on cardiac catheterization. In many institutions, cardiac catheterization still remains the gold standard against which other modalities are measured. In the past decade, however, imaging methodologies have increasingly shifted toward the use of less invasive and noninvasive techniques. Although echocardiography is the most commonly used imaging modality for diagnosis and follow-up of subjects with CHD, the evolution of cardiovascular magnetic resonance (MR) imaging and increasingly computed tomography (CT) does offer new ways to visualize the heart and the great vessels.
Catheter-Directed Thrombolysis in Patient with Acute Limb Ischemia Grade IIB
Authors: Indrayana Yanna , Sargowo Djanggan
Published: September 2018

Acute limb ischemia was defined as sudden decrease in limb perfusion of less than 14 days duration, resulting in variable ischaemic clinical manifestation and potential risk of limb loss. We reported a case female 64 years old with sudden onset of right leg pain in last 3 days with history of hipertension, Diabetes Mellitus and heart failure. From physical examination of lower extremity was found pulselessness, pallor, paresthesi, poikilothermia, paralysis, and pain at the level of A. Poplitea dextra. Diagnosis was confirmed with Duplex Ultrasonography. From arteriography we found thrombus with subtotal occlusion at proximal a. Femoralis dextra and diffuse stenosis at the distal. Operation was not carried out as the request of the patient and it was decided to performed Catheter-directed Thrombolysis. In evaluation there was flow improvement at a. Femoralis dextra but it did not reach peripheral perfussion due to reperfussion injury.
Gagal Jantung Kongestif dan Fibrilasi Atrium: Apa Terapi Terbaik?
Authors: Yuniadi Yoga
Published: September 2018

Gagal jantung bukan menurun bahkan meningkat prevalensinya.1 Terapi sindrom koroner akut yang lebih baik dan makin banyaknya populasi manula ditengarai sebagai penyebab peningkatan tersebut. Gagal jantung sistolik menimbulkan peningkatan tekanan akhir diastolik ventrikel kiri yang akhirnya akan meningkatkan pula tekanan atrium kiri sehingga terjadi remodeling atrium yang kemudian menyebabkan terjadinya fibrilasi atrium (FA). Sebaliknya FA dengan respon ventrikel yang cepat dan tidak terkontrol juga akan menyebabkan remodeling ventrikel yang berujung pada gagal jantung. Selain itu FA juga meningkat pada manula, sejalan dengan peningkatan kejadian gagal jantung.
Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus
Authors: Sakasasmita Sylvie , Harimurti Ganesja M. , Fakhri Dicky , Venty Venty
Published: September 2018

Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.
Takikardia Qrs Lebar: Apa Mekanismenya?
Authors: Yuniadi Yoga
Published: September 2018

Seorang pria, 60 tahun sedang dirawat di ruang rawat intensif pasca operasi bedah pintas koroner (BPAK) dengan episode takikardia QRS lebar berulang. Pasien masih dalam keadaan terintubasi dan mendapat obat-obat vasokonstriktor/inotropik. Sebelum operasi BPAK irama jantung irama sinus normal, tetapi pasca BPAK mengalami fibrilasi atrium. Terjadi penurunan lebih lanjut tekanan darah pada saat takikardia dengan QRS lebar. Pemberian amiodarone drip tidak dapat ditoleransi karena menyebabkan tekanan darah turun, sehingga diberikan xylocard drip.Apakah mekanisme takikardia QRS lebar? Apakah xylocard obat yang tepat?
Fragmented QRS Complex as a Predictor of Multivessel Disease in Acute Coronary Syndrome
Authors: Mappangara Idar , Alkatiri Abdul Hakim , Hendyanto Stefan
Published: September 2018

Background: The incidence of multivessel disease in acute coronary syndrome (ACS) is expected to be identified as early as possible in order to perform optimal management. The presence of multivessel disease can lead to ischemia or myocardial infarction. Fragmented QRS complex (fQRS) is a new electrocardiography (ECG) parameter that has been proven to be caused by ischemia or myocardial infarction.Methods: A cross-sectional study. Patients with ACS that admitted at Dr. Wahidin Sudirohusodo Makassar since December 2014 - March 2015 who are eligible were enrolled in this study.Presence of fQRS evaluated on first 12-lead ECG at hospital admission. Presence of multivessel disease based on coronary angiography. Data were analyzed by logistic regression. Data was significant if the p-value<0.05.Results: There are 63 subjects (56 men and 7 women) included in this study. Older age, history of ACS before, presence of dyslipidemia, and presence of fQRS were significantly more often in group with multivessel disease. After analyzed with logistic regression, the fQRS was the only significant predictor of multivessel disease with p value 0.003 and odds ratio 13.28.Conclusion: Presence of fQRS in the first 12-lead ECG when admitted to the hospital was an independent predictor of multivessel disease in patients with ACS.