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All Journal Jurnal Penelitian Pendidikan IPA (JPPIPA) Narra J Journal of Medical Science; Jurnal Ilmu Medis Rumah Sakit Umum Daerah dr. Zainoel Abidin, Banda Aceh Indonesian Journal of Case Reports
Adi Purnawarman, Adi
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Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Dentistry Education Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Nursing Physics Public Health

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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.
Association between NT-proBNP level and the number of stents with major advanced cardiovascular events (MACE) in patients with multivessel coronary artery disease treated with percutaneous coronary intervention: A prospective cohort study Subkhan, Muhammad; Heriansyah, Teuku; Munirwan, Haris; Purnawarman, Adi; Dimiati, Herlina
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.v4i1.710

Abstract

Complex revascularization strategies, particularly complete revascularization, are controversial in coronary artery disease (CAD), and data supporting routine revascularization in stable CAD is lacking. The importance of percutaneous coronary intervention (PCI) in CAD and N-terminal pro-brain natriuretic peptide (NT-proBNP), which has been studied as a predictor of major advanced cardiovascular events (MACE) in CAD patients, still requires further research. The aim of this study was to determine the association between NT-proBNP levels and the number of stents with MACE incidence in CAD cases. A prospective cohort study was conducted in both types of CAD (acute coronary syndrome (ACS) and chronic coronary syndrome (CCS)). The NT-proBNP levels were measured pre- and post-PCI using fluorescence immunoassay, while MACE was assessed three months post-PCI. The Student t-test was used to compare the levels of NT-proBNP between pre- and post-PCI and between those who had MACE and did not; both in patients treated with single or multiple stenting groups. A total of 32 CAD patients were recruited, consisting of 20 ACS cases and 12 CCS cases. NT-proBNP levels post-PCI increased significantly in both ACS and CCS patients compared to pre-PCI either among those treated with single and multiple stentings. MACE occurred in 4 (12.5%) out of a total of 32 patients, all of which occurred in ACS patients treated with multiple stentings. Those who had MACE had higher post-PCI NT-proBNP levels compared to those who did not have MACE (23,703.50 vs 11,600.17 pg/mL, p=0.013). This study highlights the association between elevated NT-proBNP levels and multiple stenting with the presence of MACE in CAD patients, particularly in ACS cases.
Immunoexpression of aortic endothelial P-selectin and serum apolipoprotein A-1 levels after administration of arabica (Coffea arabica) and robusta (Coffea canephora) coffee bean extracts: In vivo study in atherosclerosis rat model Ekawati, Wahyu; Heriansyah, Teuku; Kamarlis, Reno K.; Purnawarman, Adi; Sofyan, Hamny; Enitan, Seyi S.
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.794

Abstract

Atherosclerosis is a leading cause of cardiovascular disease-related death worldwide. Some studies suggested that the natural ingredients in coffee may negatively affect cardiovascular diseases, while other studies indicated that coffee contains anti-inflammatory compounds that are beneficial for cardiovascular diseases. The aim of this study was to measure the expression of P-selectin in aortic endothelial cells and the level of serum apolipoprotein A-1 (ApoA-1) in an atherosclerosis rat model after the administration of arabica and robusta coffee bean extracts at mild-moderate and high doses. An experimental study was conducted with a complete randomized design using 36 adult male white rats (Rattus norvegicus) divided into six groups: negative control (NC), positive control (PC), arabica mild-moderate dose (A1), arabica high dose (A2), robusta mild-moderate dose (R1), and robusta high dose (R2). Animals were induced atherosclerosis with atherogenic feed and then were treated with arabica and robusta coffee bean extracts at two different doses for four weeks. The results showed that the expression of P-selectin in the group of rats treated with robusta coffee bean extract was lower than arabica coffee bean extract group. Rats with robusta coffee bean extract mild-moderate dose had the highest ApoA-1 levels compared to other groups significantly (p<0.05). The level of ApoA-1 was higher in both mild-moderate and high dose of robusta coffee groups compared to the negative control group (both with p<0.001). In conclusion, mild-moderate intake of robusta coffee bean extract could reduce aortic P-selectin immunoexpression and increase serum ApoA-1 levels in an atherosclerosis rat model.
Enhancing Early Detection of Alzheimer's Disease through MRI using Explainable Artificial Intelligence Noviandy, Teuku Rizky; Idroes, Ghifari Maulana; Purnawarman, Adi; Imran, Imran; Lestari, Nova Dian; Hastuti, Sri; Idroes, Rinaldi
Indonesian Journal of Case Reports Vol. 2 No. 2 (2024): December 2024
Publisher : Heca Sentra Analitika

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.60084/ijcr.v2i2.255

Abstract

Alzheimer’s disease is a progressive brain disorder that causes memory loss and cognitive decline, affecting millions of people worldwide. Early detection is critical for slowing the disease's progression and improving patient outcomes. Magnetic Resonance Imaging (MRI) is widely used to identify brain changes associated with AD, but subtle abnormalities in the early stages are often difficult to detect using traditional methods. In this study, we used a deep learning approach with a model called ResNet-50 to analyze MRI scans and classify patients into four categories: Non-Demented, Very Mild Demented, Mild Demented, and Moderate Demented. The model was trained using MRI images, achieving an accuracy of 95.63%, with strong sensitivity, precision, and specificity. To make the model’s predictions understandable for healthcare professionals, we applied a technique called Grad-CAM, which highlights areas of the brain that influenced the model’s decisions. These visual explanations help clinicians see and trust the reasoning behind the AI's results. While the model performed well overall, misclassifications between adjacent disease stages were observed, likely due to class imbalance and subtle brain changes. This study demonstrates that explainable AI tools can improve early detection of Alzheimer’s disease, supporting clinicians in making accurate and timely diagnoses. Future work will focus on expanding the dataset and combining MRI with other clinical information to enhance the tool's reliability in real-world settings.
Rancangan Aplikasi Sindroma Koroner Akut Purnawarman, Adi; Herawati, Eka Tlaga; Hasibuan, Syariah; Nazari, Nuri; Bashori, Ahmad
Journal of Medical Science Vol 6 No 1 (2025): Journal of Medical Science
Publisher : LITBANG RSUDZA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55572/jms.v6i1.219

Abstract

Saat ini penyakit jantung masih menjadi penyebab kematian tertinggi di dunia, Indonesia, maupun Aceh. Kurangnya kesadaran tentang gejala awal serangan jantung membuat penanganan menjadi tidak maksimal atau lebih dari 20 menit yang dapat menyebabkan miokardium mengalami nekrosis. Adanya perkembangan penggunaan teknologi saat ini dapat dimanfaatkan untuk mengatasi masalah deteksi dini gejala awal serangan jantung melalui suatu sistem komputerisasi. Oleh karena itu, penelitian ini telah mentransformasikan standar deteksi dini sindrom koroner akut ke dalam Aplikasi Sindroma Koroner Akut RSUDZA yang berbasis android dan dapat diakses oleh seluruh tenaga kesehatan maupun masyarakat Aceh. Hal tersebut bertujuan menurunkan angka kematian sehingga pelayanan kesehatan jantung dapat optimal melalui meningkatnya kecepatan kunjungan pasien serangan jantung ke rumah sakit dalam waktu onset 20 menit – 2 jam. Penelitian ini telah dilakukan selama tiga bulan di RSUD dr. Zainoel Abidin dengan sistem pakar. Daftar pertanyaan faktor risiko serta tanda dan gejala awal sebagai deteksi dini serangan jantung di Aplikasi Sindroma Koroner Akut RSUDZA diperoleh dari Pedoman Tatalaksana Sindrom Koroner Akut. Hasil penelitian dari uji blackbox didapatkan bahwa semua fitur dan fungsi dari sistem berjalan sesuai dengan rancangan aplikasi. Sementara itu, hasil penelitian dari uji user acceptance test pada 100 responden yaitu 97% menyatakan tampilan aplikasi menarik, 100% menyatakan dapat mengakses aplikasi dengan mudah, 100% menyatakan pertanyaan di aplikasi mudah dipahami, 100% menyatakan aplikasi ini cukup bermanfaat, serta 100% menyatakan setuju jika aplikasi ini dipublikasikan ke dalam playstore. Oleh karena itu, Aplikasi Sindroma Koroner Akut RSUDZA dapat digunakan oleh tenaga kesehatan maupun masyarakat.
ARNI vs ACE Inhibitors in Improving Left Ventricular Geometry, Diastolic Function, and Cardiac Power Output in HFrEF Patients: A Prospective Cohort Study among Acehnese, Indonesia Taufiqurrahman; Heriansyah, Teuku; Purnawarman, Adi; Novita; Zulkarnain
Jurnal Penelitian Pendidikan IPA Vol 11 No 4 (2025): April
Publisher : Postgraduate, University of Mataram

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29303/jppipa.v11i4.10593

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a condition associated with high morbidity and mortality. Changes in left ventricular geometry, diastolic function, and cardiac power output (CPO) are key indicators in the management of heart failure. ARNI and ACE inhibitors have been proven effective to treat this condition, but comparative studies on these therapies in the Asian population remain limited. This study was conducted to assess changes in left ventricular geometry, diastolic function, and CPO in heart failure patients following ARNI therapy compared to ACE inhibitors among Indonesian. This observational study employed a prospective cohort design involving 73 heart failure patients divided into two groups: the ARNI group and the ACE inhibitor group. Evaluations were conducted at first admission/recruitment and after three months period of therapy using echocardiography to assess parameters of left ventricular geometry (LVMI and RWT), diastolic function (E/e' ratio), and CPO. The use of ARNI or ACE inhibitors over three months showed a significant reduction in LVMI, accompanied by an improvement in diastolic function marked by a significant decrease in the E/e' ratio (p < 0.05). However, no significant differences were observed between the two groups. CPO values increased in both groups with a p-value < 0.05, where ARNI therapy showed a greater improvement compared to ACE inhibitors (p = 0.048). The use of ARNI and ACE inhibitors in heart failure patients can improve CPO, left ventricular geometry, and diastolic function, with ARNI therapy providing a better enhancement in CPO compared to ACE inhibitors.
Co-Authors BASHORI, AHMAD Dian Lestari, Nova Ekawati, Wahyu Enitan, Seyi S. Hadi, Tjut F. Hamny Sofyan Hasibuan, Syariah Herawati, Eka Tlaga Herlina Dimiati, Herlina Idroes, Ghifari Maulana Imran Imran Kamarlis, Reno K. Latief, Muhammad H. Munirwan, Haris Nazari, Nuri Novita Rinaldi Idroes Solly Aryza Subkhan, Muhammad Taufiqurrahman Teuku Heriansyah, Teuku Teuku Rizky Noviandy Wattanasiriporn, Wittawat Yusrizal, Teuku Zulkarnain