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Navigating the intersection of COVID-19 and lower extremity acute limb ischemia: A retrospective cohort study of clinical characteristics and outcomes at Dr. Cipto Mangunkusumo Hospital Muradi, Akhmadu; Fachriza, Ihza; Pratama, Dedy; Suhartono, Raden; Harunarashid, Hanafiah
Narra J Vol. 5 No. 3 (2025): December 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i3.2557

Acute limb ischemia (ALI), a critical condition threatening limb viability and patient survival, has demonstrated an increased incidence during the COVID-19 pandemic, primarily due to virus-associated thrombotic complications. The pandemic has also led to delays in the diagnosis and treatment of non-COVID conditions, including ALI. The aim of this study was to evaluate the clinical characteristics and outcomes of ALI patients treated at Dr. Cipto Mangunkusumo Hospital between 2018 and 2022, comparing outcomes before and during the COVID-19 pandemic. Patients were categorized into two cohorts: pre-pandemic (n=28) and pandemic (n=53), with March 2020 marking the onset of the pandemic period. Treatment outcomes—revascularization success, re-intervention, and mortality—were assessed using multivariate logistic regression. Among the 81 patients, 34.6% were treated before the pandemic and 65.4% during the pandemic. Revascularization success was significantly higher during the pandemic (relative risk (RR): 2.46; 95% confidence interval (CI): 1.16–5.24; p=0.013), whereas no significant differences were observed in re-intervention or mortality rates (both with p>0.05). A prior history of COVID-19 was not significantly associated with revascularization outcome (p=0.933). The use of fluoroscopic guidance was significantly associated with improved revascularization success (RR: 36.58; 95%CI: 6.54–204.6; p=0.001). Rutherford classification was a significant predictor of re-intervention success (p=0.022), while the presence of dyslipidemia and cardiovascular disease were independently associated with mortality (RR: 0.08–0.76, p=0.0o5, and RR: 2.24–25.18, p=0.001, respectively). In conclusion, fluoroscopy appears to enhance revascularization outcomes in the treatment of ALI. Comorbidities such cardiovascular disease, and COVID-19 history should be taken into account when managing patients with ALI.

Recanalization Rates and Complications of Post-Endovenous Microwave Ablation in Chronic Vein Insufficiency with Large GSV Diameter Herwirastri, Novinda; Muradi, Akhmadu
Jurnal Locus Penelitian dan Pengabdian Vol. 4 No. 8 (2025): JURNAL LOCUS: Penelitian dan Pengabdian
Publisher : Riviera Publishing

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58344/locus.v4i8.4763

Endovenous Microwave Ablation (EMA) is one of the thermal ablation modalities to treat chronic venous insufficiency (CVI). The effectiveness and safety of EMAs in large-diameter saphena magna veins (GSVs) still require further research. This study aimed to compare the rates of recanalization and post-EMA complications in CVI patients with GSV diameters of <8 mm and ?8 mm. This retrospective cohort study used data from 54 patients from a multicenter (January 2023 – May 2025). Statistical analysis was performed with an unpaired t-test and a Chi-square test. The rate of venous occlusion reached 100% in both groups. The recanalization rate at 3 months post-procedure was higher in the GSV group ?8 mm (11.1%) compared to the GSV <8 mm (3.7%), although the difference was not statistically significant (p=0.299). There were no significant differences in complications of ecchymosis, thermal skin injury, and paresthesia. However, pain was reported to be significantly higher in the ?8 mm GSV group (33.3% vs 7.4%; p=0.018). The EMA is effective in achieving occlusion in a wide range of GSV diameters, but patients with a GSV of ?8 mm (especially ?10 mm) have a higher tendency to recanalize and post-procedure pain. Additional strategies are needed to be considered to increase effectiveness and comfort in the group.

Association of Vitamin D Deficiency and Diabetic Foot Ulcer Patients in Dr Mohammad Hoesin General Hospital Palembang Dahlan, Kemas; Yususf, Fahmi Jaka; Irfannuddin, Irfannuddin; Murti, Krisna; Muradi, Akhmadu; Liberty, Iche Andriyani
Jurnal Sehat Indonesia (JUSINDO) Vol. 7 No. 1 (2025): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/jsi.v7i01.149

Vitamin D plays a role in the healing process of diabetic foot ulcers (DFU); it can improve the immune system, regulate inflammation function, and regulate growth factors in diabetes mellitus (DM). The immunomodulatory effects of vitamin D include reduced production of IL-2, IL-6, and TNF-alpha and increased production of IL-10. It also increases the activity of antimicrobial peptides (AMP) such as cathelicidin, and it promotes the differentiation of monocytes into macrophages, phagocytosis, and the production of lysosomal enzymes. Furthermore, vitamin D stimulates growth factors including vascular endothelial growth factor (VEGF) and transforming growth factor beta (TGF-β). In this study, the incidence of DM and DFU in DM patients at RSUP Dr. Mohammad Hoesin Palembang will be compared to serum vitamin D levels. This research uses quantitative methods with an analytical observational design. The Mean vitamin D serum level was 11,727 ng/mL, and there was a significant association between serum vitamin D deficiency and DFU (p-value; 0.036 < 0.05). There was a significant association between serum vitamin D deficiency and DFU occurrence (p-value; 0.036 < 0.05) in Mohammad Hoesin General Hospital Palembang. Based on the results of this study, we proposed that patients with diabetic foot ulcers should have their serum vitamin D levels checked, and that vitamin D should be given to them as part of their therapy.

Navigating the intersection of COVID-19 and lower extremity acute limb ischemia: A retrospective cohort study of clinical characteristics and outcomes at Dr. Cipto Mangunkusumo Hospital Muradi, Akhmadu; Fachriza, Ihza; Pratama, Dedy; Suhartono, Raden; Harunarashid, Hanafiah
Narra J Vol. 5 No. 3 (2025): December 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i3.2557

Acute limb ischemia (ALI), a critical condition threatening limb viability and patient survival, has demonstrated an increased incidence during the COVID-19 pandemic, primarily due to virus-associated thrombotic complications. The pandemic has also led to delays in the diagnosis and treatment of non-COVID conditions, including ALI. The aim of this study was to evaluate the clinical characteristics and outcomes of ALI patients treated at Dr. Cipto Mangunkusumo Hospital between 2018 and 2022, comparing outcomes before and during the COVID-19 pandemic. Patients were categorized into two cohorts: pre-pandemic (n=28) and pandemic (n=53), with March 2020 marking the onset of the pandemic period. Treatment outcomes—revascularization success, re-intervention, and mortality—were assessed using multivariate logistic regression. Among the 81 patients, 34.6% were treated before the pandemic and 65.4% during the pandemic. Revascularization success was significantly higher during the pandemic (relative risk (RR): 2.46; 95% confidence interval (CI): 1.16–5.24; p=0.013), whereas no significant differences were observed in re-intervention or mortality rates (both with p>0.05). A prior history of COVID-19 was not significantly associated with revascularization outcome (p=0.933). The use of fluoroscopic guidance was significantly associated with improved revascularization success (RR: 36.58; 95%CI: 6.54–204.6; p=0.001). Rutherford classification was a significant predictor of re-intervention success (p=0.022), while the presence of dyslipidemia and cardiovascular disease were independently associated with mortality (RR: 0.08–0.76, p=0.0o5, and RR: 2.24–25.18, p=0.001, respectively). In conclusion, fluoroscopy appears to enhance revascularization outcomes in the treatment of ALI. Comorbidities such cardiovascular disease, and COVID-19 history should be taken into account when managing patients with ALI.

Factors Influencing Ulcer Healing in Chronic Limb Threatening Ischemia Patients after Endovascular Angioplasty at Cipto Mangunkusumo General Hospital Suhartono, Raden; Wijaya, Ghany H; Muradi, Akhmadu
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Introduction. Chronic limb–threatening ischemia (CLTI) can cause rest pain in the lower extremities and the formation of ulcers or gangrene. Revascularization, which can be done using open surgery or endovascular procedures, is the first line of treatment in CLTI management. CLTI patients at CMGH usually came with advanced conditions and high re–amputation rates even after revascularization. This study aimed to determine factors associated with the outcome of endovascular angioplasty, especially ulcer healing. Method. A cross–sectional study was conducted at CMGH, enrolling CLTI patients with Rutherford grades 5 and 6 who underwent angioplasty. Age, gender, history of smoking, hypertension, atrial fibrillation, heart failure, chronic kidney disease (CKD), and diabetes mellitus were the independent variables of interest in this study. The dependent variable was ulcer healing, a clinical assessment after angioplasty assessed as complete ulcer epithelialization within four months after the procedure. Results. In 133 study subjects, it was found that 60.9% of patients underwent complete epithelialization. Factors that affect ulcer healing in CLTI patients include gender, hypertension, atrial fibrillation, heart failure, chronic kidney disease, and diabetes mellitus. The factor with the strongest association with ulcer healing after endovascular angioplasty based on the logistic regression test is diabetes mellitus. Conclusion. Factors that have a significant association with ulcer healing in patients with CLTI include gender, smoking, hypertension, atrial fibrillation, heart failure, CKD, and diabetes. The factor that was considered to have the strongest association was diabetes mellitus

D-Dimer and Ultrasonography as the Early-Diagnostic Tools for Lower-Limb Trauma Patients with Deep Vein Thrombosis: A Literature Review Muchtar, Faranita; Muradi, Akhmadu
The New Ropanasuri Journal of Surgery Vol. 8, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Introduction. The mortality of venous thromboembolism increased among trauma patients. Both the D-dimer test and ultrasonography are selected to diagnose venous thromboembolism due to non-traumatic causes but are rarely utilized in emergency trauma settings. Objectives. This literature review comprehensively explains the accuracy of the D-dimer test and ultrasonography for deep vein thrombosis (DVT) diagnosis. This study finding might broaden the diagnostic recommendation for traumatic patients with deep vein thrombosis. Method. This study used articles from four distinct journal databases. Only eight of the 480 articles found during searching proceeded with the screening process. Thus, five articles were included in the review after matching the eligibility criteria. Results. Three articles compared the accuracy of using the D-dimer test and ultrasonography, while others compared the accuracy of conventional ultrasonography to venography or colour duplex ultrasonography. Using three mg/L as the cut-off point, the D-dimer test's pooled sensitivity and specificity were 88,37% and 96,96%. Meanwhile, ultrasonography for DVT resulted in a pooled sensitivity of 59% and specificity of 95%. Conclusion. Using both tools in trauma cases with DVT would give a more accurate diagnosis. A systematic review of this issue would be preferred to support this argument.

Literature Review: Role of Vitamin D in Diabetic Foot Ulcer Wound Healing Kemas Dahlan; Irfanuddin; Krisna Murti; Akhmadu Muradi
Jurnal Penelitian Pendidikan IPA Vol 9 No 10 (2023): October
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v9i10.5135

DFU is a common consequence of DM. Vitamin D has multiple positive effects on DFU. Search data from; Google Scholar, Science Direct, Elsevier, EBSCO, Medline and PubMed. Publication at least ten years (2013 until 2022). Inclusion criteria; full paper in English, Study about vitamin D and DFU in human, exclusion criteria; animal model and invitro study. Results; 27 journals; Seven Randomized Controlled Trial. Vitamin D phase on DFU which one substantially smaller. Severe vitamin D insufficiency known with significance linked for an elevated risk of DFU. Vitamin D supplementation can prevent or improve diabetic foot complications

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