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All Journal Jurnal Penyakit Dalam Indonesia
Sally Aman Nasution, Sally Aman
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Medicine & Pharmacology

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Validity of Simple Risk Index and Evaluation of Methods andManagement of Acute Coronary Events to Predict Mortality inAcute Coronary Syndrome Patients in Intensive Coronary CareUnit Cipto Mangunkusumo Hospital Meutia, Rahmah Safitri; Nasution, Sally Aman; Makmun, Lukman H
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
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Introduction. Risk stratification is an important part in the management of patients with an Acute Coronary Syndrome (ACS) to avoid overtreatment or undertreatment. Although Simple Risk Index (SRI) and Evaluation of Methods and Management of Acute Coronary Events (EMMACE) have been validated in other countries, no study of its applicability has been performed in Indonesia with different patients’ characteristics. This study aims to obtain the calibration and discrimination performance of SRI and EMMACE to predict 30 days mortality in ACS patients in ICCU of Cipto Mangunkusumo Hospital. Methods. A retrospective cohort study with consecutive sampling was conducted in ACS patients hospitalized in the ICCU Cipto Mangunkusumo hospital between the period of 2003 up to 2010. Data analyzed performed by SPPS program for Windows Version 17. The discrimination performance was explained using a value of area under the receiver-operator curve (AUC) while calibration performance was evaluated using hosmer lemeshow and plot calibration. Results. A total of 922 patients were included in this study consisted of 453 STEMI patients, 234 NSTEMI patients and 235 UAP patients. Simple Risk Index (SRI) score for STEMI had presentable discrimination and calibration performance (AUC= 0,92; R2 = 0,98; and p value= 0,01). Simple Risk Index (SRI) score for overall ACS also showed sufficient performance and calibration discrimination (AUC= 0,87; R2 = 0,99; and p value= 0,52). Meanwhile, EMMACE score in ACS patients showed satisfactory performance discrimination (AUC= 0,87), but the calibration perfomance was not as satisfactory as the SRI score with the calibration plot (R2 )= 0,54 (p value= 0,52). Conclusions. Simple Risk Index (SRI) score shows a satisfactory discrimination and calibration performance both in STEMI and overall ACS patients in predicting mortality of ACS patients in ICCU Cipto Mangunkusumo Hospital. Evaluation of Methods and Management of Acute Coronary Events (EMMACE) score, nonetheless, displays sufficient discrimination performance, but poor performance of calibration.
The Role of Duke Treadmill Score as a Predictor of CoronaryArtery Disease in Patients with Positive Treadmill Test Results Ikhsan, Muhammad; Nasution, Sally Aman; Wijaya, Ika Prasetya; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 2
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Introduction. Coronary Artery Disease (CAD) is one of the disease entity that leading cause of morbidity and mortality in worldwide. Treadmill test is part of the diagnostic modality which readily available to assess possibility of narrowing coronary artery and guiding us whether we need for the further investigation. Despite of that, treadmill test has limitation in diagnostic accuracy. Duke Treadmill Score (DTS) was also tested as a diagnostic score, and shown to predict significant CAD better than the ST-segment response alone. Methods. This is a cross-sectional study performed in adult patients with stable CAD that underwent treadmill test and coronary angiography in outward patient clinic of the Integrated Cardiac Service in Cipto Mangunkusumo Hospital between January 2011 and December 2013. Results. A total of 103 patients in this study, thirty nine patients (37,9 %) had significant CAD in coronary angiography. Briefly, mean age was 54,71 years and 55 patients (53,4 %) were females. The most common CAD risk factor was hypertension (51,5 %). A mean of DTS score was -3.53, which mostly categorized as intermediate risk (89,3 %). Based on DTS results, cut-off point was determined by using Receiver Operator Curve (ROC) method, in which value of -8,85 considering as a cut-off point. Sensitivity and specificity value of DTS were 28 % (CI 95 %: 17 % to 44 %), and 95 % (CI 95 %: 87 % to 98 %). Positive and negative predictive value were 79 % (CI 95 %: 52 % to 92 %) and 69 % (CI 95 %: 58 % to 77 %). Positive and negative likelihood ratio were 6.02 and 0.75. Conclusions. DTS has a good performance in predicting significant CAD at cut-off point -8,85 in patients with positive treadmill test.
Pendekatan Diagnosis dan Tatalaksana Infark Ventrikel Kanan HS, R Fidiaji; Nasution, Sally Aman
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
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Fungsi optimal jantung merupakan hasil interaksi dari berbagai bagian jantung, baik ventrikel kiri maupun ventrikel kanan. Namun, perkembangan diagnosis dan tatalaksana kegawatan jantung umumnya berpusat pada disfungsi ventrikel kiri. Perkembangan keilmuan saat ini memperlihatkan bahwa disfungsi ventrikel kanan juga mengakibatkan gangguan hemodinamik yang signifikan dan membutuhkan tatalaksana yang berbeda dengan tatalaksana disfungsi ventrikel kiri. Infark ventrikel kanan umumnya bukan merupakan suatu kasus tunggal, namun seringkali menyertai infark ventrikel kiri. Identifikasi infark ventrikel kanan pada kondisi tersebut, dapat mempengaruhi tatalaksana yang dilakukan pada suatu sindrom koroner akut.
Retraction: Correlation of Serum Uric Acid Levels with The Severity Of Coronary Artery Stenosis in Patients with Acute CoronarySyndrome: Meta-Analysis Study Prasetyo, Diding Heri; Nasution, Sally Aman; Alwi, Idrus; Abdullah, Murdani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. The relationship between serum uric acid (SUA) level and ischemic heart disease abides controversial and still has not been established as a cardiovascular risk factor. The cooperative interaction between those two factors is not fully understood. Prior epidemiological evidences of the causal relationship is still argumentative. There were various studies using the same methods yet the outcome were different. This study aims to conduct a meta-analysis to synthesize the results of recent studies in order to obtain data quantitatively and also accurately. Methods. This study protocol was registered with PROSPERO (CRD42020210948), and conducted according to PRISMA guidelines, tracing studies published in vulnerable periods from January 2010 to May 2020. The Cochrane Library, EBSCO, Medline/PubMed, ProQuest and Science Direct are sources of published studies. Meta-analysis was conducted to synthesize the associations between SUA level and severity of coronary artery stenosis, using random effect model to account for possible study heterogeneity. Heterogeneity was assessed using I2 , and the meta-analysis was performed using comprehensive meta-analysis version 3 (CMA3) software. Results. Five studies (n = 601 patients) identified a correlation between serum uric acid levels and Gensini scores (r = 0.548; p <0.001) in ACS patients. Heterogeneity bias was found in the analysis, whereas publication bias was not found. There was a moderate positive correlation between serum uric acid levels and the severity of coronary artery stenosis, with a correlation coefficient of 0.548 (p value <0.001).
Correlation of Haemoglobin Platelet Ratio (HPR) and LeukocytePlatelet Ratio (LPR) with SYNTAX-2 Score in STEMI Patients Ikhsan, Muhammad; Nasution, Sally Aman; Rachman, Andhika; Muhadi, Muhadi
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. Various studies have concluded the association between various markers of inflammation with the clinical outcome in STEMI patients. However, most of these markers are quite expensive and not available in healthcare facilities. Hence, we aim to study the correlation between haemoglobin platelet ratio (HPR) and leucocyte platelet ratio (RPL) and the clinical outcomes of STEMI patients. Methods. This is a cross-sectional study performed in adult patients with STEMI who were hospitalized in Intensive Coronary Care Unit Cipto Mangunkusumo Hospital between January 2016 and October 2020. The data was analyzed by testing the correlation between HPR and LPR with SYNTAX-2 score. Results. There were 114 subjects in this study, with a mean age was 53.87 years and dominated by male (86.8%). We found no correlation between HPR and LPR with SYNTAX-2 Score. From the sub-group analysis, there was a moderate positive correlation between HPR and SYNTAX-2 score (r = 0.587; p= 0.005) and a strong positive correlation between LPR and SYNTAX-2 score (r = 0.606; p = 0.004) in subjects with normal body mass index (BMI). Additional results obtained a strong negative correlation between neutrophil lymphocyte ratio (NLR) with SYNTAX-2 score (r = -0.738; p= 0.0037) and a very strong negative correlation between platelet lymphocyte ratio (PLR) with SYNTAX-2 score (r= -0,857; p= 0,007) in subjects with low BMI. Conclusion. There is no correlation between HPR and LPR with SYNTAX-2 Score
Cardiotoxicity Complication of Radiotherapy Wisman, Beta Agustia; Nasution, Sally Aman; Panggabean, Marulam M
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
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Radiation is an important modality in the management of malignancy. Some cases of malignancy requiring radiotherapy in the chest include breast cancer, Hodgkin's lymphoma, or lung cancer.Cardiotoxicity due to radiotherapy can occur within 3 to 29 years after radiotherapy, mostly in the second or third decade after therapy. Some cardiovascular complications resulting from radiotherapy may affect pericardial, myocardial, vascular, heart valves and conduction disturbances. Symptomatic cardiotoxicity may occurs 10% in patients undergoing radiotherapy in the chest area. It is important for clinicians to understand the cardiotoxicity of radiotherapy for educational purposes, therapeutic and dosing considerations, treatment monitoring and early detection. Early detection and post-radiation monitoring have an important role to reduce morbidity and mortality due to cardiovascular disease after radiotherapy and comprehensive management is necessary
Right Ventricular Systolic and Diastolic Function Profile inPatient with Stable Chronic Obstructive Pulmonary Disease Oktavia, Dina; Nasution, Sally Aman; ZN, Anna Uyainah; Rumende, C Martin
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
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Introduction. Right ventricular dysfunction is one of the common complication of chronic obstructive pulmonary disease (COPD). Right ventricular assessment is importance, since it related with exercise intolerance and poor prognosis. Methods. Thirty stable COPD men (mean age: 65 ± 6 yr) underwent spirometry. In addition to conventional echocardiographic parameters, TAPSE, right heart chambers, and trans tricuspid inflow were determined. Results. The mean value of FEV1 was 28 ± 8% of the predicted value. There was no subject with mild airflow limitation, 57% subjects were with very severe airflow obstruction. All of pulmonary function test showed mixed restrictive-obstructive pattern. Mean of right chamber was in normal limit. Forty percent of the patients suffered right ventricular diastolic dysfunction. Means of TAPSE was 16.96 ± 96 mm. Sixty percent of the patients suffered right ventricular systolic dysfunction. There was no significant difference in TAPSE between groups with moderate-severe flow obstruction and very severe airflow obstruction. There was no significant correlation between FEV1 % prediction and TAPSE, so the cut-off value between the two variables cannot be determined. Conclusions. The proportion of right ventricular systolic dysfunction was 60% and diastolic dysfunction was 40%. There was no correlation between FEV1 % prediction and TAPSE. The cut-off value between the two variable in stable COPD patients cannot be determined.
Faktor-Faktor yang Memengaruhi Kualitas Hidup Pasien Gagal Jantung Kronik Fraksi Ejeksi Terjaga (HFpEF) Rawat Jalan di RSUPN Dr. Cipto Mangunkusumo Pratama, Derin Anugrah; Nasution, Sally Aman; Muhadi, Muhadi; Mansjoer, Arif; Alwi, Idrus; Purnamasari, Dyah; Lydia, Aida; Tahapary, Dicky Levenus
Jurnal Penyakit Dalam Indonesia Vol. 11, No. 1
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Introduction. The prevalence of heart failure in Indonesian adults is 1.5%, at least half of which categorized as heart failure with preserved ejection fraction (HFpEF). Quality of life assessment plays an important role in the management of heart failure, one of the tools widely used is the Minnesota Living with Heart Failure (MLHF) questionnaire. In Indonesia, there is still no data regarding risk factors that affect the quality of life of HFpEF patients. This study aimed to determine the quality of life profile of HFpEF patients and the relationship between the risk factors (age, hypertension, DM, smoking, and obesity) on the quality of life of HFpEF patients. Methods. A cross-sectional study was conducted. Data was collected from adult HFpEF (based on echocardiography in the last 6 months) patients (>18 years old) who visited the Cardiology Clinic at Cipto Mangunkusumo Hospital from January 2022 to December 2023. Quality of life was measured using the MLHF questionnaire. Bivariate analysis was performed to find the relationship between risk factors (age, gender, hypertension, DM, smoking, and obesity) and patients’ quality of life. Multivariate analysis was performed for hypertension, DM, gender, and age variables. Results. Out of 206 subjects, 72.33% of patients were dominant in the physical domain items, and 27.67% of patients were dominant in the emotional domain items. The majority of patients dominant in physical items had overall good quality of life. The majority of patients dominant in emotional items also had good quality of life. No significant relationship was found between the dominant domain item and the quality of life in HFpEF patients. We also found that there was no significant relationship between socio-demographic factors and risk factors for dominant domain items. However, there was a significant relationship between age (p=0.005), gender (p=0.001), and smoking history (p=0.001) with the quality of life in HFpEF patients. Adult patients had a poorer quality of life compared to elderly patients (OR= 0.33 [95% CI 0.17-0.66]). No significant relationship was found between hypertension, diabetes mellitus, dyslipidemia, and obesity with the quality of life in HFpEF patients. Conclusions. There is a statistically significant relationship between age, gender, and smoking history with the quality of life in HFpEF patients. Meanwhile, there is no significant relationship between hypertension, diabetes mellitus, and obesity with the quality of life in HFpEF patients.
Kesintasan Pasien Karsinoma Hepatoselular: Sebuah Studi Komprehensif tentang Pengaruh Awitan Dini versus Lambat dan Faktor Determinannya Achmad, Ibrahim; Jasirwan, Chyntia Olivia Maurine; Rajabto, Wulyo; Abdullah, Murdani; Nababan, Saut Horas H.; Nasution, Sally Aman; Koesnoe, Sukamto; Sari, Nina Kemala
Jurnal Penyakit Dalam Indonesia
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Introduction. The prognosis for patients with Hepatocellular Carcinoma (HCC) is generally poor because most cases are diagnosed at an advanced stage. Several studies indicate that HCC is more prevalent and has a worse prognosis among younger individuals. This study aims to identify and compare the variations in survival rates between early and late-onset HCC patients at Cipto Mangunkusumo Hospital and investigate the factors that impact survival outcomes in both groups. Methods. Retrospective cohort study of HCC patients registered in HCC registry 2015-2022. Survival was visualized using Kaplan-Meier curves. Prognostic factor variables in the Cox Proportional Hazard Regression analysis by backward method in the final model became independent prognostic factors for overall survival. Results. There were 896 subjects. Patients with early onset had a median survival of 2.0 months (95% CI 1.0-2.9), while late-onset patients had a median survival of 4.0 months (95% CI 3.4-4.5) (p=0.021). During the observation period, the incidence of death in early onset was found to be higher compared to late onset (92.9% vs. 87.7%, p 0.032). In the multivariate analysis for early onset, hypertension comorbidity and lack of hepatitis treatment were prognostic factors increasing the risk of death with [HR 3.7 (95% CI: 1.0-12.7)] and [HR 2.4 (95% CI: 0.9-6.2)] (p=0.053). In the multivariate analysis for late onset, prognostic factors increasing the risk of death include AFP levels ≥200 ng/mL [HR 1.2 (95% CI: 1.0-1.5)], liver cirrhosis [HR 1.2 (95% CI: 1.0-1.3)], AJCC stage 4 as the most advanced stage [HR 4.5 (95% CI: 2.2-8.9)], supportive therapy [HR 5.2 (95% CI: 3.9-6.8)], and palliative therapy [HR 1.6 [95% CI: 1.2-2.2)]. Conclusion. The median survival of early-onset HCC patients is lower compared to late-onset ones because the majority are not given curative treatment. Independent prognostic factors in early-onset are hypertension and hepatitis treatment, while in late-onset AFP levels, liver cirrhosis, AJCC stage, and therapy are given.
Co-Authors A.A. Ketut Agung Cahyawan W Achmad, Ibrahim Aida Lydia, Aida Andhika Rachman Anna Uyainah Arif Mansjoer Beta Agustia Wisman, Beta Agustia C Martin Rumende Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Dicky Levenus Tahapary Diding Heri Prasetyo Dina Oktavia Dyah Purnamasari Esthika Dewiasty, Esthika HS, R Fidiaji Idrus Alwi Ika Prasetya Wijaya Lukman H Makmun Marulam M Panggabean, Marulam M Muhadi Muhadi, Muhadi Murdani Abdullah Nababan, Saut Horas H. Pratama, Derin Anugrah R. Fidiaji H Santoso, R. Fidiaji H Rahmah Safitri Meutia, Rahmah Safitri RR. Ella Evrita Hestiandari Sari, Nina Kemala Sukamto Koesnoe Wulyo Rajabto ZN, Anna Uyainah