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All Journal journal of internal medicine INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Medical Journal of Indonesia MNJ (Malang Neurology Journal) Indonesian Journal of Cardiology Heart Science Journal Narra J Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Anwar Santoso
Faculty of Medicine Udayana University, Denpasar
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Proatherogenic or antiatherogenic high density lipoprotein type in acute coronary syndrome and healthy male person Kaniawati, Marita; Yusuf, Irawan; Bakri, Syakib; Santoso, Anwar
Medical Journal of Indonesia Vol 19, No 4 (2010): November
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (42.308 KB) | DOI: 10.13181/mji.v19i4.407

Abstract

Aim: To make proatherogenic/antiatherogenic HDL type criteria using Apolipoprotein A-I (ApoA-I), Paraoxonase-1 (PON-1), Neopterin and HDL-cholesterol levels, which may be useful in clinical practice.Methods: This was a case control study recruiting 52 subjects with Acute Coronary Syndrome (ACS) and 30 control healthy subjects. HDL type was classifi ed into antiatherogenic and  proatherogenic based on the levels of ApoA-I, PON-1, Neopterin and HDL-cholesterol. Concentrations of ApoA-I was measured by immunoturbidimetry method, PON-1 was measured by colorimetric method, Neopterin was measured by ELISA, and HDL-C was determined by homogenous method. Univariate logistic regression analysis was done using ACS as a dependent variable and levels of ApoA-I, PON-1, Neopterin andHDL-cholesterol as independent variables. Proatherogenic/ antiatherogenic HDL type was determined by using ApoA-I, PON-1, Neopterin and HDL-cholesterol cut off and odd ratios.Results: Patient’s age was 50.89 + 12.63 year, HDL-C was 39.82 + 9.84 mg/dL, Apo A-1 was 119.77 + 32.05 mg/ dL, PON-1 was 41.26 + 18.19 kU/L, Neopterin was 16.22 + 38.10 nmol/L. Cut offs of ApoA-I, PON-1 and Neopterin successively were 124.5 mg/dL, 40.8 kU/L, and 7.016 nmol/L. On univariate logistic regression analysis showed that OR of ApoA-I, PON-1 and Neopterin respectively were 29.759 (95% CI : 4.074 – 217.382), 1.647 (95% CI : 0.412 – 6.586), 4.317 (95% CI : 1.098 – 16.977). Using scoring system, we concluded that total score > 18 was proatherogenic HDL type, and total score < 18 was antiatherogenic HDL type. With this scoring we found 78.85% had proatherogenic HDL type in ACS population.Conclusions: Dysfunctional HDL or proatherogenic/anti atherogenic  HDL type can be predicted by using ApoA-I– PON-1–Neopterin–HDL-cholesterol scoring system. Those with score of 18 are supposed to have antiatherogenic HDL type, and those with score of > 18 were having proatherogenic HDL type. (Med J Indones 2010; 19:228-34)Keywords: ApoliproteinA-I (ApoA-I), HDL-cholesterol, neopterin, paraoxonase-1 (PON-1), proatherogenic/antiatherogenic HDL
Risk factors of sepsis after open congenital cardiac surgery in infants: a pilot study Fakhri, Dicky; Busro, Pribadi W.; Rahmat, Budi; Purba, Salomo; Mukti, Aryo A.P.; Caesario, Michael; Christy, Kelly; Santoso, Anwar; Djauzi, Samsuridjal
Medical Journal of Indonesia Vol 25, No 3 (2016): September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (402.46 KB) | DOI: 10.13181/mji.v25i3.1450

Abstract

Background: Postsurgical sepsis is one of the main causes of the high mortality and morbidity after open congenital heart surgery in infants.  This study aimed to evaluate the role of cardiopulmonary bypass duration, thymectomy, surgical complexity, and nutritional status on postsurgical sepsis after open congenital cardiac surgery in infants.Methods: A total of 40 patients <1 year of age with congenital heart disease, Aristotle Basic Score (ABS) ≥6 were followed for clinical and laboratory data before and after surgery until the occurrence of signs or symptoms of sepsis or until a maximum of 7 days after surgery. Bivariate analyses were performed. Variables with p≤0.200 were then included for logistic regression.Results: Duration of cardiopulmonary bypass ≥90 minutes was associated with 5.538 increased risk of postsurgical sepsis in comparison to those ≤90 minutes (80% vs 25%, RR=5.538, p=0.006). No association was observed between the incidence of postsurgical sepsis with poor nutritional status (86% vs 84%, RR=1.059, p=1.000), thymectomy (and 50% vs 76%, RR=0.481, p=0.157), and Aristotle Basic Score (p=0.870).Conclusion: Cardiopulmonary bypass time influences the incidence of sepsis infants undergoing open congenital cardiac surgery. Further studies are needed to elaborate a number of risk factors associated with the incidence of sepsis in this population.
Targeting pro-protein convertase subtilisin kexin-9 as a novel therapy of hypercholesterolemia Dwiputra, Bambang; Santoso, Anwar; Poh, Kian K.
Medical Journal of Indonesia Vol 26, No 2 (2017): June
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (365.092 KB) | DOI: 10.13181/mji.v26i2.1443

Abstract

Reducing low density lipoprotein (LDL) cholesterol level is an established primary and secondary prevention strategy for coronary heart disease. However, not all patients are able to achieve their LDL targets as recommended by the guidelines. Over the last 10 years, high plasma LDL level is known to be associated with a higher level of pro-protein convertase subtilisin kexin-9 (PCSK-9). Loss-of-function mutations in the PCSK-9 gene is associated with lower plasma LDL level and cardiovascular risk. Since its discovery in 2003, PCSK-9 has triggered many researchers to design a PCSK-9 inhibitor to reduce LDL cholesterol through competitive inhibition of this molecule. Some phase III clinical trials have showed promising results of PCSK-9 inhibitor efficacy in lowering LDL level and improving clinical outcome. This article aims to discuss the role of PCSK-9 in LDL metabolism and the efficacy of PCSK-9 inhibitor in reducing plasma LDL level.
KORELASI ANTARA BRACHIAL-ANKLE PULSE WAVE VELOCITY DAN PROFIL LIPID PADA KARYAWAN RUMAH SAKIT SANGLAH DENPASAR Arsana, Gede Putu; -, Kambayana; Santoso, Anwar; Suastika, Ketut
journal of internal medicine Vol. 8, No. 2 Mei 2007
Publisher : journal of internal medicine

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Abstract

Brachial-ankle pulse wave velocity (baPWV) is an indicator of limb arterial stiffness. Dislipidemia is a major risk factorof atherosclerosis and may worsen baPWV by increasing the blood viscosity. This study aims to study the correlations betweenbaPWV and the lipid profile among employees of Sanglah Hospital. Cross sectional analytic study was performed in Sanglahhospital. Pulse wave velocity was measured using an automatic device (Fukuda VS 1000). Lipid profile were taken as well. Datawas expressed in mean + SD, analyzed by t-test compare mean and Pearson correlation by using SPSS 13.0. There were 85patients involved, all subjects were male, age all between 40-56 (mean 47.23 + 5.16) years old. Cholesterol total, LDL-C, HDLC,and triglyceride concentrations varied subject, range (means + SD) as (205.05 + 39.40) mg/dL, (144.26 + 36.85) mg/dL,(45.94 + 8.98) mg/dL, and (151.94 + 64.56) mg/dL, respectively. BaPWV on the right limbs were between (13,31 + 2,14 ) m/sec,on the left limbs were (15,05 + 2,33 ) m/sec. Significant correlations were found between total cholesterol concentration and theleft baPWV (r = 0.222, p = 0.41), while a significant correlation were found on the right side (r = 0.234, p = 0.031). Brachialanklepulse wave velocity is positively correlation with total cholesterol concentration.
HUBUNGAN ANTARA OBESITAS SENTRAL DENGAN ADIPONEKTIN PADA PASIEN GERITARI DENGAN PENYAKIT JANTUNG KORONER Gotera, Wira; Suastika, Ketut; Santoso, Anwar; Kuswardhani, Tuty
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Obesity is rapidly becoming a global problem not only in developed countries but also in developing countries such asIndonesia. Visceral obesity (central obesity) is an importance risk for cardiovascular disease and recognition that adipose tissuecan be regarded as a large endocrine organ that secreted inflammatory and anti inflammatory molecules (adiponectin). This studyaims to know the correlation between central obesity and adiponectin in geriatric coronary heart disease (CHD) patients. Thisstudy was cross sectional analytic study of geriatric CHD at out and in patients in Sanglah hospital. Data are presented as groupmean ± SD and analyzed by t-test, chi-square, and Pearson correlation with SPSS 12 software. Forty five patients (35 males and10 females), 23 patient unstable angina pectoris, 14 patient acute myocardial infarction, and 8 patient stable angina pectoris wererecruited and examined. There was high prevalence of central obesity 51.1% (23 patients). Mean of log adiponectin weresignificantly difference between central obese and non central obese (1.80 ± 0.61 vs 1.09 ± 0.41 with p). Central obesity increasedrisk of hypoadiponectinemia 5 times than non central obesity (p=0.011, CI 95% 1.4-17.8). Waist circumference has negativecorrelation with log plasma adiponectin (R=-0.663, p<0.001). There was high prevalence of central obesity in geriatric coronaryheart disease patients. Central obesity increased risk of hypoadiponectinemia 5 times than non central obesity. Waistcircumference has negative correlation with plasma adiponectin. Increased of waist circumference will decrease of adiponectin(cardioprotective protein) and will increase risk of acute coronary syndrome in geriatric patients.
EFEKTIFITAS OBAT PENURUN KOLESTEROL 'STATIN' DALAM MENURUNKAN KEJADIAN KARDIOVASKULER PADA SINDROM KORONER AKUT -, Sajinadiyasa; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Acute coronary syndromes (ACS) is usually caused by atherosclerotic process in coronary artery. Clinical manifestation of ACS is unstable angina pectoris, acute miocard infarc ( non-Q-wave and Q-wave) and sudden death. ACS develop have various degrees of coronary artery occlusion. ACS is caused by rupture of plaque with a thin cap. Inflammation is also plays the pathogenesis these syndromes. Stable plaque is imfortance condition in prevent cardiac event and statin drug lowering cholesterol can made stable plaque and as antiimplammation.
HUBUNGAN ADIPONEKTIN DENGAN GAGAL JANTUNG KONGESTIF Agung Budiyasa, Dewa Gde; Santoso, Anwar
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Adipose tissue synthesis several protein involved in the regulation of insulin action and lipid metabolism. Among theprotein adipocytokines, adiponectin is the most abundant and exerts profound anti-diabetic, anti-atherogenic, and anti-inflammatoryroles. Adiponectin may contribute to the regulation of vascular hemostasis by its ability to affect several signaling pathwaysin the vessel wall and modulate excess inflammatory responses. In the heart, adiponectin serve as a regulator of cardiacinjury through modulation of pro-survival reaction, cardiac energy metabolism, and inhibition of hypertropic remodelling. Manyeffect of adiponectin in the cardiovascular system correlate with the activation of both AMPK and Cox-2.Adiponectin levels may influence the development of CHF, but the epidemiological data are somewhat complex. This isdue in part to the fact that while higher body mass indices are a risk factor for heart failure, obesity is a predictor of improveprognosis in patients with establish CHF because wasting is strongly associated with the increased risk of death in the final stageof this disease. In this regard, high adiponectin levels are a predictor of mortality in patients with heart failure. Presumably, thisparadoxical relationship exist because high body mass, hence low protein, favors survival in endstage heart failure. Therefore,further studies should examine adiponectin levels in patients with stable heart failure
GAGAL JANTUNG Mariyono, Harbanu H; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Heart failure were the end stage of all heart disease and the cause of the increasing morbidity andmortality among patient. Almost five percent from all inhospital patient were heart failure. Heart failure hasbeen defined as the failure of the heart to pump blood to systemic. It can be classify into acute, acutedecompensated and chronic heart failure. New York Heart Association, Stevenson, Forrester have madeclassification based on the clinical symptoms. All cardiac problems can ended into heart failure, thepathogenesis was very complex including renin-angiotensin-aldosteron system, neurohormonal, sympatic nervesystem, nattriuretic peptide, and others. Twelve leads ECGs, echocardiography, chest x-rays, blood chemistries,catheterisation can help us diagnose patient with heart failure. Management of heart failure consist ofmanagement of acute and chronic heart failure, non drugs management, drugs and even an invasive treament.
RELATIONSHIP BETWEEN METHYLENE TETRA HYDRO FOLATE REDUCTASE (MTHFR) GENE POLYMORPHISM AND HYPERHOMOCYSTEINEMIA IN STROKE Raka Widiana, I Gde; -, Tianing; Santoso, Anwar; Ketut Budiarsa, Gusti Ngurah
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Cardiovascular disease is a major cause of mortality in Indonesia. Hyperhomocysteinemia (hyper-hcy) isan independent cardiovascular risk factor, which may be due to methylene tetrahydrofolate reductase (MTHFR)deficiency, frequently linked to MTHFR gene mutation. This case-control study examined the relationshipbetween homocysteine (hcy), folate, and vitamin B12 plasma concentrations with C677T mutation of MTHFRgene among 20 haemorrhagic and non-haemorrhagic stroke patients aged 18-55 years, in Sanglah Hospital,Denpasar. 10 age-matched controls were selected via random sampling of 1 of 4 neighbours; all subjects wereBalinese. Hyper-hcy (X2: 5.4; PR: 1.8; 95% CI: 1.0-2.7; p=0.03), hypertension (X2: 13.12; PR 2.66; 95%CI1.41 to 5.02; p=0.00) were associated with increased risk of stroke. There were no significant correlationbetween plasma hcy levels and plasma folate and vitamin B12 levels as co-factors of hcy metabolism. Lowplasma vitamin B12, smoking, alcohol drinking, and hypertension tend to be determinant factors of hyper-hcy.This study found no mutation on 677 from C to T (C677T), however there were substitution in nucleotidesamong stroke and controls, with or without producing chances of amino acids, including: 1) G659A substitutionthat caused changing in amino acid from glutamine to glycine found in 1 stroke patients with hyper-hcy; 2)A660G substitution that cause changing in amino acid from glutamine to glycine found among all controlsubjects and among 3 stroke patients, one of whom had hyper-hcy; and 3) A661G substitution that causechanging in amino acid from lysine to glutamine found in one stroke patients with normo-hcy. Some variationswere also found in nucleotide 659 and 660, however, did not produce changing in amino acid. Whether thissubstitution is a kind of polymorphism that specific to Balinese ethnicity needs a further study to answer.
AKURASI PULSE OKSIMETRI UNTUK MENDETEKSI DILATASI VASKULAR INTRAPULMONER (DVIP) PADA PASIEN SIROSIS HATI Sujana, I Ketut; Wibawa, I Dewa Nyoman; Santoso, Anwar
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Hepatopulmonary syndrome (HPS) is a complication of liver cirrhotic in the lung. This clinicalsyndrome has three components; liver disease, intrapulmonary vascular dilatation (IPVD), and a defect inoxygenation. Transthoraxic echocardiography with contras enhancement (CE-TTE) is a gold standart methodbut still expensive and difficult to detect IPVD because it needs expertise. Therefore, a simple non-invasivemethod to detect IPVD would be desirable. In this study pulse oximetry was evaluated as predictor foridentification of IPVD in patient with liver cirrhotic.Objective of ythis study is to determine the diagnostic accuracy of pulse oxymetry in detection IPVDcompared with CE-TTE as a gold standart. The diagnostic test was perfomed with pulse oxyimetry in 49consecutive patient with liver cirrhotic of >17 years old without primary cardiopulmonary diseases. Oxygensaturation (SO2) was determined using a pulse oximeter in supine and upright position. The IVPD measured byCE-TTE as gold standard. Measurement of predictor and effect variables were singgle blinded which mean thedifferent examiner, each of them does not know the result of others. Sensitivity, specificity, positif predictivevalue, negative predictive value, accuracy, and likelihood ratio was calculated with computer programmed.Eight patients (16.3%) had IPVD and fourty (83.7%) without IPVD. The cut off SO2 95.5 % in supineposition can predict IPVD with sensitivity 97.6% (CI 95% 72.8;100.0), specificity 87.5% (CI95% 93.2;100.0),positif predictive value 87. 0% (CI95% 78.2;96.7) negative predictive value 100% (CI95% 72.8;100.0),accuracy 95% (CI95% 75.8;100.0), positif likelihood ratio 7.8, and negatif likelhood ratio 0.3. The cut off SO293.0 % in upright position can predict IPVD with sensitivity 100% (CI95% 94.2;100.0), specificity 87.5%(CI95% 78.2;96.7), positif predictive value 100% (CI95% 94.2;102.2), negative predictive value 97.6 %(CI95% 93.4;100.0), accuracy 97.5%(94.1;100.0), positif likelihood ratio 8, and negatif likelhood ratio 0. Thecut off slope oxygen saturation from supine to upright position ( SO2) 2.5% can predict IPVD with sensitivity100% (CI95% 97.2;100.1), specificity 95.1% (CI95% 89.1;100.0), positif predictive value 80% (CI95% 52.0;100.0), negative predictive value 100 %, accuracy 100% (97.1;100.0), positif likelihood ratio 20.4, andnegatif likelhood ratio 0. Pulse oxymetry is accurate predictor to detect of IPVD in liver cirrhotic patientwithout primary cardiopulmonary disease.
Co-Authors AAG Budhitresna Ambari, Ade Meidian Aria Kekalih Asrory, Virna Dwi Oktariana Bambang Budi Siswanto Bambang Widyantoro Basuni Radi Budi Rahmat Busro, Pribadi W. Christy, Kelly Desandri, Dwita Rian Dewa Gde Agung Budiyasa Dicky Armein Hanafy Dicky Fakhri Dwiputra, Bambang Dwiputra, Bambang Gede Kambayana Gede Putu Arsana Harahap, Alida R. Harahap, Alida Rosita Harbanu H Mariyono Hermanto, Dony Yugo I Dewa Nyoman Wibawa I Gde Raka Widiana I Gede Ketut Sajinadiyasa I Gusti Ngurah Ketut Budiarsa I Ketut Suastika I Ketut Sujana I NYOMAN MANTIK ASTAWA Irawan Yusuf Katsukawa, Hajime Liastuti, Lies Dina Listyaningsih, Erlin Marita Kaniawati Michael Caesario Mukti, Aryo A.P. Nusanti, Synthia Poh, Kian K. Pritazahra, Armalya Purba, Salomo R. A.T. Kuswardhani Renan Sukmawan Rezeki, Arindya Rossimaria, Vienna Rossimarina, Vienna Samsuridjal Djauzi Seskoati Prayitnaningsih Simbolon, Jessica Putri Natalia Siska Suridanda Danny Sunu Budhi Raharjo Syakib Bakri Tambunan, Tresia Fransiska Ulianna Tambunan, Tresia FU. Teuku Heriansyah, Teuku Tianing - Triangto, Kevin Wira Gotera Yoga Yuniadi