RESUMEN
Pseudoaneurysms are false aneurysms that mostly occur at the site of arterial injury. Pseudoaneurysm is the most frequent complication after catheter-associated interventions and occurs because of an insufficient closure of the puncture site. However, there are several reported cases of patients with pseudoaneurysm without a prior history of vascular intervention. We described a case of ruptured giant abdominal aortic pseudoaneurysm in a patient with no prior history of vascular intervention, with an initial complaint of abdominal pain. The patient successfully received EVAR therapy using a kissing graft.
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Aneurisma Falso , Aneurisma de la Aorta Abdominal , Humanos , Aneurisma Falso/etiología , Aneurisma Falso/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/complicaciones , Masculino , Rotura de la Aorta/cirugía , Rotura de la Aorta/etiología , Rotura de la Aorta/diagnóstico por imagen , Dolor Abdominal/etiología , Rotura Espontánea , Procedimientos Endovasculares , Aorta Abdominal/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Implantación de Prótesis Vascular , Persona de Mediana EdadRESUMEN
BACKGROUND: Post-thrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) and affects 20-40% of DVT subjects. The risk factor of PTS after DVT is difficult to determine. We aimed to evaluate the incidence of PTS after 3 months of DVT diagnosis and to determine the risk of PTS. METHODS: A retrospective cohort study of subjects who developed DVT confirmed by Doppler ultrasound in Cipto Mangunkusumo Hospital from April 2014 until June 2015. The presence of PTS was assessed after 3 months of completed DVT treatment using the Villalta score. Risk factors for PTS were evaluated from medical records. RESULTS: There were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms. RESULTS: There were 91 subjects with DVT with mean age of 58 years. 56% were female. It was dominated by subjects aged ≥ 60 years (45.1%). Hypertension (30.8%) and diabetes mellitus (26.4%) were the major comorbidities in this study. Deep vein thrombosis occurred commonly in unilateral side (79.1%), proximal localization (87.9%), and unprovoked DVT (47.3%). The cumulative incidence of PTS after DVT was 53.8%, 69% of subjects had mild PTS. Heaviness of the leg (63.2%) and edema (77.5%) were the most common symptoms. Significant risk factors for PTS were unprovoked DVT (adjusted RR 1.67; 95%CI: 1.17-2.04; p = 0.01) and female gender (adjusted RR 1.55; 95%CI: 1.03-1.94; p = 0.04). Age, body mass index, thrombus location, immobilization, malignancy and surgery was not associated with PTS. CONCLUSION: We conclude that 53.8% of subjects suffered PTS after 3 months of DVT. Unprovoked DVT and female gender were significant risk factors for PTS.
RESUMEN
The increasing rate of central vascular access use especially for hemodialysis access in Indonesia carries risk of retention of the guidewire to the heart resulting in a condition known as heart foreign bodies. We described a case of mislocation of double-lumen catheter guidewire to the right atrium in a patient planned to perform hemodialysis. The patient complained of dyspnea and swelling of extremities but the symptoms had already appeared before the insertion of the catheter due to the patient's underlying kidney disease arising conclusion that the foreign bodies itself are asymptomatic. The wire was found on chest x-ray and then confirmed on fluoroscopy during the retrieval procedure. Loop-wire was used to snare the guidewire. The wire was successfully evacuated and the patient was stable. The rare nature of the condition could become a challenge in recognizing the condition. Percutaneous retrieval is the preferred management of the condition.
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Catéteres , Cuerpos Extraños , Humanos , Catéteres/efectos adversos , Fluoroscopía , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/terapia , Cuerpos Extraños/etiología , Atrios Cardíacos/diagnóstico por imagen , IndonesiaRESUMEN
BACKGROUND: Arteriovenous fistula (FAV) is the most widely used vascular access for end-stage renal disease (ESRD) patients undergoing routine hemodialysis in Indonesia. However, FAV can become dysfunctional before it is used for the initiation of hemodialysis, a condition known as primary failure. Clopidogrel is an anti-platelet aggregation that has been reported to reduce the incidence of primary failure in FAV compared to other anti-platelet aggregation agents. Through this systematic review, we aimed to assess the role of clopidogrel to the incidence of primary FAV failure and the risk of bleeding in ESRD patients. METHODS: A literature search was carried out to obtain randomized Control Trial studies conducted since 1987 from Medline / Pubmed, EbscoHost, Embase, Proquest, Scopus, and Cochrane Central without language restrictions. Risk of bias assessment was performed with the Cochrane Risk of Bias 2 application. RESULTS: All of the three studies involved indicated the benefit of clopidogrel for the prevention of AVF primary failure. However, all of the studies have substantial differences. Abacilar's study included only participants with diabetes mellitus. This study also administered a combination of clopidogrel 75 mg and prostacyclin 200 mg/day, while Dember's study gave an initial dose of clopidogrel 300 mg followed by daily dose 75 mg and Ghorbani's study only gave clopidogrel 75 mg/day. Ghorbani and Abacilar started the intervention 7-10 days before AVF creation, while Dember started 1 day after VAF creation. Dember gave treatment for 6 weeks with an assessment of primary failure at the end of week 6, Ghorbani's treatment lasted for 6 weeks with an assessment at week 8, while Abacilar gave treatment for one year with an assessment at weeks 4 after AVF creation. In addition, the prevalence of bleeding did not differ between the treatment and control groups. CONCLUSION: Clopidogrel can reduce the incidence of primary FAV failure without significant increase of bleeding events.
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Fístula Arteriovenosa , Derivación Arteriovenosa Quirúrgica , Fallo Renal Crónico , Humanos , Clopidogrel/uso terapéutico , Derivación Arteriovenosa Quirúrgica/efectos adversos , Fallo Renal Crónico/complicaciones , Fallo Renal Crónico/terapia , Diálisis Renal , Hemorragia/inducido químicamente , Hemorragia/prevención & control , Fístula Arteriovenosa/tratamiento farmacológico , Fístula Arteriovenosa/etiología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: The Arrhythmia-Specific Questionnaire in Tachycardia and Arrhythmia (ASTA) was developed in Sweden using English which may pose cultural and language barriers for Indonesian patients. As such, we aimed to translate the original ASTA into Indonesian, then assess its validity and reliability. METHODS: Translation of the ASTA from English to Indonesian was done using forward and backward translation. The final version was then validated with the Short Form-36 (SF-36) questionnaire. Test-retest reliability study was done in a 7-14-day interval. RESULTS: The Indonesian version of ASTA was deemed acceptable by a panel of researchers with Cronbach's α of 0.816 and Intraclass Correlation Coefficient (ICC) ranging from 0.856-0.983. In a comparison to the SF-36, the medication utilization domain was poorly correlated with role limitations due to physical health (r:0.384; p<0.01) and pain (r:-0.317; p<0.05). The arrhythmia-specific symptoms domain was poorly correlated with role limitations due to emotional problems (r:0.271; p<0.05). In addition, the health-related quality of life (HRQOL) domain was poorly correlated with role limitations due to physical health (r:0.359; p<0.01) and emotional problems (r:0.348; p<0.01), also total SF-36 score (r:-0.367; p<0.01). The ASTA total score was poorly correlated with role limitations due to physical health (r:0.37; p<0.01), and emotional problems (r:0.376; p<0.01), also total SF-36 score (r:-0.331; p<0.01). CONCLUSION: The Indonesian version of ASTA has good internal and external validity as well as good reliability. Both the physical and mental domains of ASTA are correlated with role limitations due to emotional problems and SF-36 total score.
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Arritmias Cardíacas , Calidad de Vida , Humanos , Calidad de Vida/psicología , Reproducibilidad de los Resultados , Indonesia , Arritmias Cardíacas/diagnóstico , Taquicardia/psicología , Encuestas y CuestionariosRESUMEN
AIM: To identify the correlation between hsCRP and arterial stiffness in type-2 diabetic patients. METHODS: A cross-sectional study was conducted to assess the plasma levels of hsCRP and carotid arterial stiffness in 40 patients with type-2 diabetes mellitus. The common carotid artery stiffness was evaluated using radio frequency echo-tracking system to determine the local carotid pulse wave velocity (carotid-PWV). RESULTS: Median value of hsCRP in this study was 4.5 (0.2 to 18.9) mg/L and the average value of local carotid stiffness was 8.8±1.7 m/sec. High sensitive CRP showed a strong correlation with carotid-PWV (r=0.503, P=0.001). hsCRP level was independently associated with carotid-PWV after adjustment for age, body mass index, and mean arterial pressure (r=0.450, P=0.005). CONCLUSION: Hs-CRP has moderate positive correlation with arterial stiffness in patients with type-2 diabets mellitus.
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Proteína C-Reactiva/análisis , Arteria Carótida Común/diagnóstico por imagen , Diabetes Mellitus Tipo 2/fisiopatología , Análisis de la Onda del Pulso , Rigidez Vascular/fisiología , Adulto , Factores de Edad , Presión Sanguínea/fisiología , Índice de Masa Corporal , Arteria Carótida Común/fisiopatología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
AIM: to investigate the association among ACE gene polymorphism, serum ACE level and atherosclerotic lesion in offspring of type 2 diabetes in Jakarta, Indonesia. METHODS: a cross sectional study was conducted among 73 nondiabetic and normotensive offspring of type 2 diabetes subjects. Each subject underwent medical history taking, physical examination, laboratory examination (oral glucose tolerance test, lipid profile, ace gene polymorphism, serum ace level) and atherosclerotic lesions (carotid intima media thickness or atherosclerosis plaque) examination using B-mode USG. RESULTS: among 73 subjects, the proportions of genotype DD, ID and II are 10, 38, and 52% respectively. There is association between ACE gene polymorphism and serum ACE level (p=0.000). Among 3 genotypes, II has the lowest value of serum ace level which is statistically significant. The prevalence of atherosclerotic lesion in this study is 45.2%. There is no correlation between ACE gene polymorphism and atherosclerotic lesion. CONCLUSION: the insertion/deletion (I/D) polymorphism of the ACE gene was associated with serum ACE level but not with atherosclerotic lesion in carotid arteries among offspring of type 2 diabetes subjects.
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Aterosclerosis/genética , Enfermedades de las Arterias Carótidas/genética , Diabetes Mellitus Tipo 2/genética , Peptidil-Dipeptidasa A/sangre , Peptidil-Dipeptidasa A/genética , Adulto , Análisis de Varianza , Glucemia , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Femenino , Genotipo , Prueba de Tolerancia a la Glucosa , Humanos , Masculino , Linaje , Polimorfismo Genético , Estado Prediabético/sangre , Factores de RiesgoRESUMEN
Background: Rheumatoid arthritis (RA) is one of the most common autoimmune diseases, characterized by systemic inflammation, joint destruction and disability. Methotrexate (MTX) is used as the primary treatment for RA patients. However, the response to MTX therapy is highly varied and difficult to predict. This study sought to determine the role of MTX by measuring the MTX polyglutamate 3 (MTX-PG3) levels and the disease activity score 28 based on C-reactive protein (DAS28-CRP) of RA patients. Method: A prospective cohort study was conducted at the Rheumatology Polyclinic of Dr. Cipto Mangunkusumo General Hospital. Thirty-four patients with RA were included and followed up to 12 weeks. The RA patients were treated with MTX 10 mg per week and an increased dose of 5 mg per week every month. DAS28-CRP and MTX-PG3 level were assessed at week 8 and 12. Multivariate logistic regression analysis was used to determine the correlation between MTX-PG3 and DAS28-CRP. Result: A total of 34 RA patients were followed and the MTX was well tolerated in which no increase of serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT) and glomerular filtration rate (GFR) were observed. The mean scores of DAS28-CRP decreased following the MTX-treatment: 3.93, 3.22 and 2.82 at week 0, 8 and 12, respectively. In contrast, the median concentration of MTX-PG3 increased from week 8 to week 12 followed by increasing the dose of MTX. Our analysis suggested there was a moderate positive correlation between MTX-PG3 levels and DAS28-CRP score at week 8 and week 12 post-MTX treatment. Conclusion: The level of MTX-PG3 is correlated with DAS28-CRP score suggesting that MTX-PG3 could be used as an indicator to assess the disease activity in RA patients. Nevertheless, a prospective study with a higher number of patients is needed to confirm this finding.
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Antirreumáticos , Artritis Reumatoide , Antirreumáticos/uso terapéutico , Artritis Reumatoide/tratamiento farmacológico , Proteína C-Reactiva/metabolismo , Proteína C-Reactiva/uso terapéutico , Humanos , Metotrexato/uso terapéutico , Ácido Poliglutámico/uso terapéutico , Estudios ProspectivosRESUMEN
BACKGROUND: Chronic limb ischemia (CLI) is strongly associated with increased mortality in diabetes patients. OBJECTIVE: The aim of this study was to evaluate factors affecting mortality within 1 year after endovascular revascularization in CLI patients. METHODS: This retrospective cohort study was based on medical records from the Integrated Cardiovascular Centre of Dr. Cipto Mangunkusumo National General Hospital, a tertiary care hospital in Jakarta, Indonesia. The study included 199 CLI patients with type 2 diabetes mellitus (T2DM) who underwent endovascular revascularization from January 2008 to June 2018. The patients were followed up for 1 year after endovascular revascularization. Kaplan-Meier and Cox proportional hazard analysis was used to analyze the data. RESULTS: 1-year survival probability was 58.8%. Cox proportional hazard analysis showed that duration of diabetes (HR 3.52; 95% CI 1.34-9.22), anemia (HR 2.59; 95% CI 1.47-4.56), and smoking (HR 2.49; 95% CI 1.46-4.27) were significantly associated with mortality within 1 year after endovascular revascularization. CONCLUSIONS: In T2DM patients with CLI, duration of diabetes, anemia and smoking were associated with a higher risk of mortality within 1 year post endovascular revascularization.
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Anemia , Diabetes Mellitus Tipo 2 , Procedimientos Endovasculares , Amputación Quirúrgica , Anemia/complicaciones , Isquemia Crónica que Amenaza las Extremidades , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Isquemia/complicaciones , Isquemia/cirugía , Estimación de Kaplan-Meier , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Female, 55 year old with history of long standing hypertension and diabetes, came to ER in a hospital with decreased consciousness. The pulse was irregular and ECG showed recurrent Ventricular Tachycardia (VT). After immediate intervention, she was finally survived and admitted to Intensive coronary care Unit (ICCU). Cardiac troponin was positive. She was considered to have acute coronary syndrome. The Brain CT showed ischemic lesion. During hospitalization, coronary angiography was performed. It showed left dominant coronary artery and very small right coronary artery (RCA) with no RCA ostial at the aorta. There was 50% stenosis in Left Descending Artery (LAD) and 30% in Left Circumflex (LCX). Total occlusion caused by thrombus at the RCA ostial was suspected. The cardiac MSCT was then performed to confirm the result. The MSCT showed no ostial of RCA at aorta and suspected total occlusion in proximal RCA. The RCA arises from LCX and its vessel was small in diameter less than 2 mm.