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The Relationship Between fragmented QRS Complexes (fQRS) and the Severity of Coronary Artery Lesion in Coronary Artery Disease: A Cross-sectional Study

2024-12-14T03:39:13Z

Title: The Relationship Between fragmented QRS Complexes (fQRS) and the Severity of Coronary Artery Lesion in Coronary Artery Disease: A Cross-sectional Study Authors: Prasetya Wijaya, Ika; Ginanjar, Eka; Rachman, Andhika; Aini, M. Hafiz Abstract: Background: The severity of coronary artery lesion is commonly used as a predictor of mortality, major adverse cardiovascular event (MACE), and revascularization in coronary artery disease (CAD). Fragmented QRS complex (fQRS) is used as a marker of myocardial ischemia in patients with CAD. The relationship between the two should be studied further. The objective of this study was to determine the relationship between fQRS and the severity of coronary lesion in patients with CAD. Methods: A cross-sectional study was conducted at Cipto Mangunkusumo Hospital Jakarta. Secondary data were taken from 172 patients with CAD who underwent percutaneous coronary intervention (PCI) from January to June 2018 with total sampling. Patients were divided into two groups based on the existence of fQRS. Demographic, clinical, and corangiography characteristics (Gensini score, total vascular lesion, and vascular lesion significance) were studied. Data were analyzed using agreement test and chi-square. Results: fQRS was present in 94 subjects (54.6%). Bivariate analysis showed a significant difference between fQRS with mild-moderate Gensini score as well as mild-severe Gensini score (kappa = 0.721 and 0.820; p<0.001), fQRS with significant CAD (kappa = 0.670; p<0.001), and fQRS with multivessel CAD (kappa = 0.787; p<0.001). Conclusion: There is a significant relationship between fQRS and the degree of severity of coronary lesion in CAD patients. Keywords: coronary artery disease, fragmented QRS, Gensini score

Risk Factors for Temporary Vascular Access Infection in Patients with End-Stage Renal Disease Undergoing Hemodialysis in Cipto Mangunkusumo Hospital

2024-12-14T03:35:41Z

Title: Risk Factors for Temporary Vascular Access Infection in Patients with End-Stage Renal Disease Undergoing Hemodialysis in Cipto Mangunkusumo Hospital Authors: Susilo, Adityo; Dharma Suryana, Kresna; Nugroho, Pringgodigdo Abstract: Background: Temporary vascular access is used to provide adequate hemodialysis for patients who are initiating dialysis or are awaiting maturation of a more permanent vascular access. However, infection is one of the most frequent complications of using temporary vascular access and is the second leading cause of death in patients undergoing hemodialysis after cardiovascular events. There has been no research on the risk factors for the incidence of infection in patients using temporary vascular access in Indonesia. Methods: This is a retrospective cohort study utilizing secondary data from medical records of 318 subjects aged 18 years and older with end-stage renal disease and undergoing hemodialysis using temporary vascular access at Cipto Mangunkusumo Hospital. Results: Temporary vascular access infection was found in 125 of 318 subjects (39.3%). The risk factors of temporary vascular catheter infection in the multivariate analysis were females (OR 1.731; 95% CI 1.050-2.854; p=0.032), low hemoglobin levels (OR 2.293; 95% CI 1.353-3.885; p=0.002), presence of diabetes mellitus (OR 2.962; 95% CI 1.704-5.149; p<0.001) and duration of catheter insertion (OR 5.322; 95% CI 1.871-15-135; p=0.002). The association between ferritin and catheter insertion site was not analyzed as a risk factor because it was not performed in all subjects. Conclusion: The incidence of infection in patients with end -stage renal disease undergoing hemodialysis using temporary vascular access at Cipto Mangunkusumo Hospital was 39.3%. Female gender, low hemoglobin level, diabetes mellitus, and duration of catheter insertion were risk factors for temporary vascular access infection. Keywords: Risk factors, temporary vascular access infection, end-stage renal disease, chronic kidney disease, hemodialysis

The Association Between Uric Acid and Symmetric Dimethylarginine Levels in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

2024-12-14T03:34:02Z

Title: The Association Between Uric Acid and Symmetric Dimethylarginine Levels in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis Authors: Yaruntradhani Pradwipa, Rizki; Hustrin, Ni Made; Hidayat, Rudy; Shatri, Hamzah Abstract: Background: Uric acid (UA) levels are associated with increased risk of cardiovascular events and mortality in hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) patients. In a study with a population of healthy young adults and HD there was a correlation between high blood uric acid levels and blood symmetric dimethylarginine (SDMA) level. However, in CAPD population, there are still conflicting data on the mechanism of increased risks related to uric acid levels. This study aimed to assess the association between uric acid levels and SDMA in the subjects undergoing CAPD. Methods: This was a cross – sectional study conducted in all the adults who underwent CAPD for at least three months in tertiary hospital in Jakarta, Indonesia. Subjects already on uric lowering therapy, pregnant or lactating women, and those with a history of malignancy were excluded. Uric acid and SDMA level were measured at the same time patients controlled to outpatient clinic. Bivariate analysis was performed using the Mann – Whitney test and multivariate analysis performed using logistic regression test. Results: A total of 55 subjects were included. The median level of UA was 7.30 + 1.59 mg/dl and 33 subjects (60%) had UA levels of 7 mg/dl or higher. The median SDMA level was 633.73 + 231.54 ng/mL. Subjects with UA levels > 7 mg/dl had significantly higher SDMA levels compared to subjects with UA levels < 7 mg/dl (721.58 + 220.57 vs 501.95 + 182; P < 0.001). The cut – off value of SDMA 536 ng/mL was obtained from the receiver operating characteristic (ROC) curve with sensitivity 81.8%, specificity 63.6%, PPV 77.78% and NPV 73.68%. After fully adjusted with the confounders, the determinant factors in this study were diabetes mellitus (OR: 7.844; CI95%: 1.899 – 32.395: P value: 0.004) and dyslipidemia (OR: 6.440; CI95%: 1.483 – 27.970; P value: 0.013) as risk factors. Conclusion: In CAPD patients, UA levels above 7 mg/dl were associated with increased SDMA levels. This study demonstrates the determinant factors regarding association between UA level and SDMA in CAPD patients were diabetes mellitus and dyslipidemia. The cut – off value of SDMA above 536 ng/mL were significant to increased risk of cardiovascular events. Keywords: uric acid, SDMA, CAPD.

Factors Associated with Absolute Neutrophil Count Dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) Chemotherapy Induced Neutropenia During Extended Filgrastim Administration in Breast Cancer Patients

2024-12-14T03:31:45Z

Title: Factors Associated with Absolute Neutrophil Count Dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) Chemotherapy Induced Neutropenia During Extended Filgrastim Administration in Breast Cancer Patients Authors: Ashariati, Ami; Yudho Bintoro, Ugroseno; Savitri, Merlyna Abstract: Background: Myelosuppressive effects of chemotherapy for breast cancer treatment may trigger chemotherapyinduced neutropenia (CIN) and febrile neutropenia (FN). Filgrastim has been widely used as prophylaxis against CIN and FN. However despite filgrastim administration, some study showed FN still occur and cause patient vulnerability to infection. This study aims to evaluate factors associated with Absolute Neutrophil Count (ANC) dynamics and Docetaxel-Adryamicin-Cyclophosphamide (TAC) CIN during extended filgrastim administration in breast cancer patients. Methods: Patients were selected among breast cancer in-patients who fulfilled the eligibility criteria. Patient characteristics data and ANC were collected. The entire patients received 5μg/kg/day filgrastim by subcutaneous injection 24 hours post-chemotherapy. ANC was monitored daily and filgrastim administration was stopped when ANC reached >10000/mm3 or 14 days of administration. Kruskall-Wallis test and Spearman Correlation test was performed to analyze ANC dynamics and CIN-related factors. Results: This study included 42 breast cancer patients. Patient age median was 52 (31-70) years old. ANC nadir could be observed around 5-7 days after chemotherapy and FN occurred in two out of 38 grade 4 neutropenia patients (4.8%). Critical ANC lasted for 1 day, 2 days, and 3 days respectively in 9 (23.7%), 25 (65.8%) and 4 (10.5%) patients. There was no correlation between neutropenia and age. ANC slope and recovery duration did not show a significant difference. However, depth of nadir is inversely correlated with the duration of ANC recovery (>10000/mm3) and the duration during the peak on the 2nd day until reaching nadir both with fair strength, r = −0.489 and r = −0.438 (p <0.05), respectively. No sepsis incidence had manifested. Conclusion: CIN still occurred in breast cancer patient receiving filgrastim primary prophylaxis regardless of age and neutropenia severity. Nadir as the lowest point of ANC should be noted as a pivotal milestone for ANC slope and recovery evaluation. Keywords: breast cancer, cancer, TAC chemotherapy, febrile neutropenia, filgrastim