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Nearly catastrophe coronary perforation: Is it second drug-eluting stent effective? Munirwan, Haris; Hadi, Tjut F.; Purnawarman, Adi; Latief, Muhammad H.; Wattanasiriporn, Wittawat; Yusrizal, Teuku
Narra J Vol. 4 No. 1 (2024): April 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i1.637

Abstract

Coronary artery perforation (CAP) is an uncommon yet serious complication. Although severe perforations (Ellis III) have become more frequent, the overall mortality rate associated with perforations (7.5%) has decreased in recent years. Unfortunately, our medical facility cannot always access a cover stent. The aim of this case report was to demonstrate the effectiveness of using a second drug-eluting stent as an alternative and successful treatment approach in a CAP patient. This is the case of a 67-year-old female with stable angina pectoris Canadian Cardiovascular Society classification III (CCS III), three-vessel coronary artery disease (CAD), who declined CABG (Syntax score of 44) and had type II diabetes mellitus. The patient underwent elective percutaneous coronary intervention (PCI), and we identified diffuse stenosis in the proximal to distal portions of the left anterior descending artery (LAD) with extensive calcification. Furthermore, there was a chronic total occlusion (CTO) in obtuse marginal (OM) 2, as well as critical stenosis in OM3, 80% stenosis in the proximal part of right coronary artery (RCA), 90% stenosis in the middle of the RCA, 90–95% in the distal RCA, and diffuse stenosis ranging from 70–80% in the distal posterolateral. During the procedure to alleviate the stenosis in the left circumflex artery (LCx), we encountered a coronary perforation classified as Ellis type III while using a 2.5/20 mm NC balloon inflated to 12 atm for 12 seconds. In response, we performed stent placement from the proximal LCx to OM2 using the Xience Xpedition drug-eluting stent (DES) measuring 2.5/28 mm. Subsequently, we conducted extended balloon inflation (intermittent) for five minutes. Despite these efforts, the coronary perforation, still classified as Ellis type III, persisted. We decided to employ intrastent stenting (a second DES strategy) with the Coroflex Isar DES measuring 2.5/28 mm, followed by prolonged balloon inflation. The outcome revealed no remaining perforation, Thrombolysis in Myocardial Infarction (TIMI) III flow, and no complications such as pericardial effusion after 48 hours of monitoring. The implantation of a second DES proved to be a practical approach for managing a significant CAP.
Tackling the ST elevation in leptospirosis: A double-edged sword between bleeding and thrombosis – A case report Dewi, Ivana P.; Damayanti, Kadex RS.; Anggitama, Andreas M.; Bagaskara, Arya T.; Dewi, Kristin P.; Yusrizal, Teuku
Narra J Vol. 5 No. 2 (2025): August 2025
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v5i2.1978

Abstract

Although leptospirosis is a well-recognized zoonotic disease, the occurrence of ST-segment-elevation myocardial infarction (STEMI)-mimicking leptospiral myocarditis, accompanied by subsequent bleeding and thrombocytopenia is an exceptionally rare finding. The dual risks of bleeding and thrombosis further complicate the management of anticoagulation and thrombolytic therapy amidst competing risks. The aim of this study was to present leptospirosis complicated by myocarditis, which mimicked STEMI, followed by bleeding and thrombocytopenia. A 61-year-old male patient was referred from a community health center to the hospital with primary complaints of chest discomfort and diaphoresis, which had started 11 hours prior to admission. These symptoms were associated with a 12-day history of intermittent fever, nausea, and vomiting. Upon physical examination, the patient appeared lethargic, with a blood pressure of 86/63 mmHg, heart rate of 107 bpm, respiratory rate of 22 breaths per minute, and temperature of 39.8°C. Electrocardiography revealed widespread ST-segment elevation. Echocardiography showed global hypokinesia with a reduced ejection fraction of 48%. Laboratory tests confirmed the presence of IgM and IgG anti-Leptospira antibodies, along with elevated high-sensitivity cardiac troponin levels. The patient was diagnosed with Weil's disease (Faine's score 32), with leptospiral myocarditis and STEMI considered as differential diagnoses. Initial management involved a loading dose of dual antiplatelet therapy (aspirin 320 mg and clopidogrel 300 mg) due to the suspected diagnosis of STEMI. However, it was later discontinued on the second day of admission due to the development of severe thrombocytopenia and minor bleeding manifestations. Following the administration of ceftriaxone 2 g every 12 hours and doxycycline 100 mg every 12 hours, the patient's condition improved. This case highlights the importance of recognizing leptospirosis as a potential cause of myocarditis and thrombocytopenia, especially when clinical signs resemble those of STEMI. Early diagnosis and careful management, including the suspension of dual antiplatelet therapy and initiation of targeted antibiotic therapy, were pivotal in preventing further complications and improving the patient's outcomes.
Penerapan Pemurnian Air Darurat Pasca Banjir Bandang dengan Pelatihan Masyarakat untuk Peningkatan Ketahanan Lokal di Aceh, Indonesia Ersa, Nanda Savira; Yusrizal, Teuku; Gustami, Heri; Akmal, Ajmir; Najmuddin, Najmuddin; Herdianti, Wenny; Prayogo, Wisnu
Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM) Vol 9, No 4 (2026): Volume 9 Nomor 4 (2026)
Publisher : Universitas Malahayati Lampung

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jkpm.v9i4.25352

Abstract

ABSTRAK Banjir bandang di Aceh sering merusak infrastruktur air minum sehingga masyarakat terdampak kehilangan akses terhadap air yang aman. Pemulihan cepat layanan air bersih yang disertai peningkatan kapasitas operasional masyarakat menjadi krusial untuk mencegah dampak kesehatan lanjutan. Artikel ini bertujuan menyajikan model terintegrasi antara penerapan teknologi pemurnian air darurat dan pelatihan teknis berbasis masyarakat pada konteks pascabanjir bandang di Aceh, Indonesia. Program dilaksanakan melalui pendekatan partisipatif dan bertahap yang meliputi asesmen kebutuhan cepat, commissioning unit pemurnian air bergerak tipe skid-mounted, pelatihan operator, serta pemantauan rutin. Hasil pengujian kualitas air menunjukkan penurunan parameter fisik-kimia dari air baku menuju air hasil olahan hingga air minum, yang mengindikasikan peningkatan kualitas air secara konsisten selama periode operasional, dengan tren stabilitas parameter yang menunjukkan efektivitas sistem dalam berbagai kondisi kualitas air baku lapangan yang berfluktuasi. Selain itu, evaluasi kepuasan masyarakat menunjukkan mayoritas responden menyatakan puas terhadap aspek layanan, kinerja sistem, serta dampak program terhadap kesehatan dan kebutuhan dasar air, dengan tingkat kepuasan yang tinggi pada indikator aksesibilitas, keandalan sistem, dan kemudahan operasional di tingkat pengguna lokal. Unit yang diterapkan mampu memulihkan akses air yang lebih aman bagi masyarakat terdampak serta menjaga stabilitas operasional dalam kondisi lapangan yang fluktuatif. Selain itu, pelatihan meningkatkan kompetensi operator lokal dan memperkuat praktik penanganan air yang aman di tingkat rumah tangga. Model integrasi antara teknologi pemurnian non-kimia dan pemberdayaan masyarakat ini menunjukkan pendekatan yang praktis dan replikatif untuk penyediaan air minum darurat pascabanjir, dengan menekankan pengendalian risiko rekontaminasi dan keberlanjutan operasional berbasis komunitas. Kata Kunci: Banjir Bandang, Pemurnian Air Darurat, Pelatihan Masyarakat, Air Minum Aman, Respons Bencana.  ABSTRACT Flash floods in Aceh frequently damage drinking water infrastructure, resulting in the loss of access to safe water for affected communities. Rapid restoration of clean water services, combined with strengthening community operational capacity, is essential to prevent further public health risks. This article aims to present an integrated model that combines the deployment of emergency water treatment technology with community-based technical training in a post-flash flood context in Aceh, Indonesia. The program was implemented through a participatory and phased approach, including rapid needs assessment, commissioning of a skid-mounted mobile water treatment unit, operator training, and routine monitoring. Water quality assessment results indicate a consistent reduction in physico-chemical parameters from raw water to treated water and final drinking water, demonstrating stable performance of the system under fluctuating field conditions. In addition, community satisfaction evaluation shows that most respondents expressed high satisfaction with service delivery, system performance, and program impact on health and basic water needs, particularly in terms of accessibility, system reliability, and operational ease at the local user level. The deployed unit successfully restored access to safer water for affected communities while maintaining operational stability under variable field conditions. Furthermore, the training program improved local operator competence and strengthened safe water handling practices at the household level. This integrated approach, combining non-chemical water treatment technology and community empowerment, provides a practical and replicable model for post-flood emergency drinking water supply, emphasizing recontamination risk control and community-based operational sustainability. Keywords: Flash Flood, Emergency Water Purification, Community Training, Safe Drinking Water, Disaster Response.