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Reperfusion Arrhythmia in Acute Myocardial Infarction Setiadi, Teguh; Taufik Indrajaya; Ali Ghanie; Ferry Usnizar; Erwin Sukandi; Syamsu Indra; Erwin Azmar; Rukiah Chodilawati; Imran Soleh; Yudhie Tanta
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 7 No. 12 (2023): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v7i12.894

Management of reperfusion in acute myocardial infarction is an important component of myocardial cell survival to minimize the area experiencing infarction and improve patient clinical outcomes. However, this reperfusion also contributes to myocardial injury which is preceded by the ischemic process. One of the injuries related to the ischemia-reperfusion process in the myocardium is reperfusion arrhythmia. Reperfusion arrhythmias from several studies can begin to occur in the first minutes after restoration of obstructed coronary flow. The features of reperfusion arrhythmia can include accelerated idioventricular rhythm, ventricular tachycardia, ventricular fibrillation, and other arrhythmias. The mechanism of reperfusion arrhythmia can be excess calcium in the cells, oxidative stress due to an increase reactive oxygen species, energy metabolism disorders, and neutrophil accumulation. Excessive intracellular calcium and other mechanisms cause a delay in the depolarization of previously ischemic cells. This reperfusion arrhythmia requires special attention because it can disrupt hemodynamics and patient outcomes after reperfusion procedures. Knowledge of the mechanisms of reperfusion arrhythmias will guide clinicians to provide better management during and after reperfusion procedures.

Novel Insights into the Pathophysiology of Coronary Slow Flow Phenomenon: The Role of Triglycerides-Glucose Index and Electrocardiogram Risk Score in Subclinical Atherosclerosis Kusuma, Singgih; Erwin Sukandi; Taufik Indrajaya; Ferry Usnizar; Irfannuddin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1228

Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed distal coronary vessel opacification without significant epicardial coronary stenosis. The underlying mechanisms of CSFP remain unclear, but subclinical atherosclerosis is a likely contributor. This study investigated the relationship between the Triglycerides-Glucose Index (TyG), Electrocardiogram Risk Score (ERS), and carotid intima-media thickness (CIMT) in CSFP patients. Methods: This cross-sectional study involved 31 patients diagnosed with CSFP at Dr. Mohammad Hoesin General Hospital Palembang. CSFP was determined based on coronary blood flow slowdown on angiography. Data collection included anamnesis, physical examination, laboratory tests, echocardiography, and CIMT measurement. Statistical analysis was performed using SPSS 27. Results: The majority of CSFP patients were male (51.6%) with a mean age of 50.87 ± 13.94 years. Dyslipidemia was the most prevalent risk factor (77.4%), followed by hypertension (35.5%), smoking (22.6%), and diabetes mellitus (6.5%). Statistical analysis revealed significant positive correlations between TyG index and CIMT (r = 0.445, p = 0.012), and between ERS and CIMT (r = 0.476, p = 0.007). Conclusion: TyG and ERS indices are positively correlated with CIMT in CSFP patients. These indices may be useful tools for cardiovascular risk evaluation and early identification of high-risk patients for subclinical atherosclerosis and potential CSFP.

The Shadow of Deficiency: Vitamin D Status as a Critical Determinant of Antithyroid Drug Efficacy in Graves’ Disease – Insights from an Indonesian Cohort Ratna Maila Dewi Anggraini; Intan Fajrin Karimah; Eddy Yuristo; Yulianto Kusnadi; Erwin Sukandi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1356

Background: Graves' disease (GD), an autoimmune hyperthyroid condition, presents significant management challenges, particularly concerning variable remission rates with antithyroid drugs (ATDs). Vitamin D, with its established immunomodulatory properties, is hypothesized to influence autoimmune processes, including those in GD. However, its precise impact on ATD treatment outcomes in diverse populations, especially in regions like Indonesia with high vitamin D deficiency prevalence, remains insufficiently elucidated. Methods: This retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, analyzing data from 73 newly diagnosed adult GD patients (diagnosed January 2022 - December 2023). Patients had confirmed GD based on hyperthyroidism with orbitopathy or positive TRAb and were followed until May 2025. Baseline serum 25-hydroxyvitamin D [25(OH)D], free T4 (fT4), and TSH levels were recorded. Vitamin D deficiency (VDD) was defined as <20 ng/mL. The primary outcome was non-remission after ATD therapy, defined as failure to achieve stable euthyroidism for ≥6 months on minimal ATD doses. Multivariate Poisson regression was used to assess predictors of non-remission. Results: Of 73 patients (mean age 36.2 years; 62% female), 55 (75.3%) exhibited VDD. Multivariate analysis identified VDD as a significant independent predictor of non-remission (adjusted Relative Risk [aRR] 11.81; 95% CI 1.88–74.20; p=0.008). Elevated baseline fT4 levels (≥5 ng/dL; aRR 4.61; 95% CI 1.13–18.70; p=0.032) and older age (>48 years; aRR 0.078; 95% CI 0.06–0.95, indicating a protective effect of older age against non-remission) were also significant predictors. Conclusion: Baseline vitamin D deficiency is a potent independent risk factor for non-remission in Indonesian Graves' disease patients receiving antithyroid drug therapy. These findings underscore the potential importance of assessing and addressing vitamin D status in the management of Graves' disease to optimize therapeutic outcomes.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

The Shadow of Deficiency: Vitamin D Status as a Critical Determinant of Antithyroid Drug Efficacy in Graves’ Disease – Insights from an Indonesian Cohort Ratna Maila Dewi Anggraini; Intan Fajrin Karimah; Eddy Yuristo; Yulianto Kusnadi; Erwin Sukandi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1356

Background: Graves' disease (GD), an autoimmune hyperthyroid condition, presents significant management challenges, particularly concerning variable remission rates with antithyroid drugs (ATDs). Vitamin D, with its established immunomodulatory properties, is hypothesized to influence autoimmune processes, including those in GD. However, its precise impact on ATD treatment outcomes in diverse populations, especially in regions like Indonesia with high vitamin D deficiency prevalence, remains insufficiently elucidated. Methods: This retrospective cohort study was conducted at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia, analyzing data from 73 newly diagnosed adult GD patients (diagnosed January 2022 - December 2023). Patients had confirmed GD based on hyperthyroidism with orbitopathy or positive TRAb and were followed until May 2025. Baseline serum 25-hydroxyvitamin D [25(OH)D], free T4 (fT4), and TSH levels were recorded. Vitamin D deficiency (VDD) was defined as <20 ng/mL. The primary outcome was non-remission after ATD therapy, defined as failure to achieve stable euthyroidism for ≥6 months on minimal ATD doses. Multivariate Poisson regression was used to assess predictors of non-remission. Results: Of 73 patients (mean age 36.2 years; 62% female), 55 (75.3%) exhibited VDD. Multivariate analysis identified VDD as a significant independent predictor of non-remission (adjusted Relative Risk [aRR] 11.81; 95% CI 1.88–74.20; p=0.008). Elevated baseline fT4 levels (≥5 ng/dL; aRR 4.61; 95% CI 1.13–18.70; p=0.032) and older age (>48 years; aRR 0.078; 95% CI 0.06–0.95, indicating a protective effect of older age against non-remission) were also significant predictors. Conclusion: Baseline vitamin D deficiency is a potent independent risk factor for non-remission in Indonesian Graves' disease patients receiving antithyroid drug therapy. These findings underscore the potential importance of assessing and addressing vitamin D status in the management of Graves' disease to optimize therapeutic outcomes.

The Impact of Intravascular Imaging (IVUS/OCT) Guidance on Preventing In-Stent Restenosis and Improving Long-Term Clinical Outcomes in Complex PCI: A Meta-Analysis Lian Lanrika Waidi Lubis; Taufik Indrajaya; Ferry Usnizar; Erwin Sukandi; Syamsu Indra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1369

Background: Percutaneous coronary intervention (PCI) in patients with complex coronary artery disease is associated with a higher risk of adverse events, including in-stent restenosis (ISR). Intravascular imaging, using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT), has been proposed to optimize stent implantation and improve outcomes, but its definitive role requires comprehensive evidence synthesis. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs). Major electronic databases (PubMed, EMBASE, Cochrane CENTRAL) were searched from January 2014 to May 2025 for RCTs comparing intravascular imaging-guided PCI with angiography-guided PCI in patients undergoing complex procedures. The primary efficacy endpoint was Major Adverse Cardiovascular Events (MACE), a composite of cardiac death, target-vessel myocardial infarction, and clinically-driven target lesion revascularization. The key secondary endpoint was angiographic ISR. A random-effects model was used to calculate pooled Risk Ratios (RRs) and 95% Confidence Intervals (CIs). Results: Seven RCTs, enrolling a total of 9,150 patients, met the inclusion criteria. The median follow-up was 24 months. Intravascular imaging guidance was associated with a significant reduction in the risk of MACE (RR: 0.66; 95% CI: 0.55-0.79; p<0.0001) compared to angiography guidance, with moderate heterogeneity (I²=52%). The risk of angiographic ISR was also significantly lower in the imaging-guided group (RR: 0.49; 95% CI: 0.38-0.63; p<0.0001). Furthermore, imaging guidance led to a significant reduction in cardiac death (RR: 0.55; 95% CI: 0.38-0.80) and clinically-driven target lesion revascularization (RR: 0.54; 95% CI: 0.42-0.69). Conclusion: This meta-analysis provides definitive evidence that the use of intravascular imaging (IVUS or OCT) to guide complex PCI significantly reduces the incidence of long-term major adverse cardiovascular events and in-stent restenosis. These findings support the routine adoption of intravascular imaging as the standard of care to optimize outcomes in this high-risk patient population.

Premature Rupture of Membranes in a Pregnant Patient with Systemic Lupus Erythematosus and Lupus Carditis: A Case Report Wardani, Anisa Karamina; Nova Kurniati; Norman Djamaludin; Erwin Sukandi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 10 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i10.1093

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease associated with significant maternal and fetal risks, especially during pregnancy. Lupus carditis and premature rupture of membranes (PROM) pose additional challenges in managing such pregnancies. Case presentation: A 21-year-old woman with a history of SLE and lupus carditis presented at 34 weeks gestation with premature rupture of membranes. Her medical history was notable for regular follow-up and treatment for SLE manifestations, including mucocutaneous involvement and microcytic hypochromic anemia. Physical examination revealed characteristic signs of SLE, and echocardiography confirmed dilated cardiomyopathy. Following a multidisciplinary approach, a cesarean section was performed, resulting in the successful delivery of a healthy neonate. Conclusion: This case highlights the importance of a coordinated multidisciplinary approach in managing complex pregnancies involving SLE, lupus carditis, and PROM. Early diagnosis, close monitoring, and timely intervention are crucial for optimizing maternal and fetal outcomes in such cases.

Premature Rupture of Membranes in a Pregnant Patient with Systemic Lupus Erythematosus and Lupus Carditis: A Case Report Wardani, Anisa Karamina; Nova Kurniati; Norman Djamaludin; Erwin Sukandi
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 10 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i10.1093

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease associated with significant maternal and fetal risks, especially during pregnancy. Lupus carditis and premature rupture of membranes (PROM) pose additional challenges in managing such pregnancies. Case presentation: A 21-year-old woman with a history of SLE and lupus carditis presented at 34 weeks gestation with premature rupture of membranes. Her medical history was notable for regular follow-up and treatment for SLE manifestations, including mucocutaneous involvement and microcytic hypochromic anemia. Physical examination revealed characteristic signs of SLE, and echocardiography confirmed dilated cardiomyopathy. Following a multidisciplinary approach, a cesarean section was performed, resulting in the successful delivery of a healthy neonate. Conclusion: This case highlights the importance of a coordinated multidisciplinary approach in managing complex pregnancies involving SLE, lupus carditis, and PROM. Early diagnosis, close monitoring, and timely intervention are crucial for optimizing maternal and fetal outcomes in such cases.

Novel Insights into the Pathophysiology of Coronary Slow Flow Phenomenon: The Role of Triglycerides-Glucose Index and Electrocardiogram Risk Score in Subclinical Atherosclerosis Kusuma, Singgih; Erwin Sukandi; Taufik Indrajaya; Ferry Usnizar; Irfannuddin
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 3 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i3.1228

Background: Coronary slow flow phenomenon (CSFP) is characterized by delayed distal coronary vessel opacification without significant epicardial coronary stenosis. The underlying mechanisms of CSFP remain unclear, but subclinical atherosclerosis is a likely contributor. This study investigated the relationship between the Triglycerides-Glucose Index (TyG), Electrocardiogram Risk Score (ERS), and carotid intima-media thickness (CIMT) in CSFP patients. Methods: This cross-sectional study involved 31 patients diagnosed with CSFP at Dr. Mohammad Hoesin General Hospital Palembang. CSFP was determined based on coronary blood flow slowdown on angiography. Data collection included anamnesis, physical examination, laboratory tests, echocardiography, and CIMT measurement. Statistical analysis was performed using SPSS 27. Results: The majority of CSFP patients were male (51.6%) with a mean age of 50.87 ± 13.94 years. Dyslipidemia was the most prevalent risk factor (77.4%), followed by hypertension (35.5%), smoking (22.6%), and diabetes mellitus (6.5%). Statistical analysis revealed significant positive correlations between TyG index and CIMT (r = 0.445, p = 0.012), and between ERS and CIMT (r = 0.476, p = 0.007). Conclusion: TyG and ERS indices are positively correlated with CIMT in CSFP patients. These indices may be useful tools for cardiovascular risk evaluation and early identification of high-risk patients for subclinical atherosclerosis and potential CSFP.

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