Introduction Carotid artery disease in geriatric is one of the important etiologies of stroke, which topped the cause of mortality in Indonesia. Specific prevention should be done as early as asymptomatic disease occurred. Initial assessment can be performed using ultrasound by measuring the intima-media thickness (IMT) of carotid artery, which can evaluate earlier progression of the atherosclerosis process. Unfortunately, we do not have risk factors categorization that show us which geriatric population fall under high-risk stratification to be screened. Method Study was done to Indonesian geriatric population. Asymptomatic carotid disease was tested positive if IMT was > 0.9 mm without any previous neurological symptoms. Correlation of the result was statistically tested with risk factors of atherosclerotic process, such as sex, body mass index, presence of hypertension, diabetes mellitus, and hypercholesterolemia Results Study obtained 104 subjects and showed the prevalence of asymptomatic carotid disease was 37.5%. Two risk factors: diabetes mellitus and hypercholesterolemia were statistically significant (p = 0.01) with odds ratio (OR) 3.56 (1.31–9.64, 95% confidence interval [CI]) and OR 2.85 (1.25–6.51, CI 95%), respectively. Logistic regression showed the risk was 69.2% by having two of these comorbidities, 47.2 or 42.5% if diabetes mellitus or hypercholesterolemia was present. Conclusion As diabetes mellitus and hypercholesterolemia were proved to be significant risk factors for asymptomatic carotid artery disease, we recommend performing ultrasound screening to measure carotid artery IMT for geriatric population who had diabetes mellitus and/or hypercholesterolemia for asymptomatic carotid artery disease to be diagnosed and further treated.

Introduction: The vascular access modality that is often used to perform regular hemodialysis (HD) measures in children with kidney failure is a tunneled double lumen catheter (TDLC), which has increased its use from 60% in 2011 to 78% in 2014 in Indonesia. The incidence of blockage caused by thrombosis is around 50%. These conditions can occur within the first 24 hours after TDLC, and usually develop within two weeks, causing early catheter dysfunction. Alteplase (rt-PA) is a thrombolytic choice for TDLC dysfunction and heparin, streptokinase, and urokinase. This study aims to determine the factors of thrombus formation in early catheter dysfunction and the effectiveness of alteplase as a therapeutic modality. Method: This study was a case-control study with children aged 0-18 years and suffering from stage 4-5 chronic kidney disease (CKD) who underwent regular HD at Cipto Mangunkusumo National Hospital. Statistical analysis using Mann-Whitney, Chi-square, Fisher’s exact, linear regression, and receiver operating characteristic (ROC) statistical tests. The test was carried out using SPSS version 20 for Windows software. Results: During the period of January 2016 to November 2017, 111 subjects met the criteria. A total of 65 subjects (58.6%) were male, and 46 subjects (41.1%) were female. Analysis showed that each albumin level <3.5 g/dL, hemoglobin (Hb) <10 g/dL, and creatinine> 5 mg/dL were risk factors for early catheter dysfunction that improved with rt- PA (p<0, 05). In multivariate analysis, only albumin levels <3.5 g/dL were associated with early catheter dysfunction. Receiver operating characteristics (ROC) curves show that early catheter dysfunction is at risk of albumin levels with a cutoff of ≤3.71 g/dL (sensitivity of 90.9% and specificity of 52.5%) and Hb levels with a cutoff of ≤8.58 g/dL (sensitivity 54.5% and specificity 77.5%). Rt-PA therapy successfully improves the condition of early catheter dysfunction in 20/22 (90.9%) cases. There were no significant side effects on the use of rt- PA in this study. Conclusion: In children undergoing regular HD with TDLC, hypoalbuminemia <3.5 g/dL, Hb <10 g/dL, and creatinine >5 mg/dL were risk factors for early catheter dysfunction. Alteplase may be useful as a safe therapeutic option. Keywords: tunneled double lumen catheter in children, early catheter dysfunction, rt-PA

Introduction: The most common cause of the peripheral arterial disease (PAD) is atherosclerosis. PAD is associated with other atherosclerotic diseases such as renal artery stenosis (RAS). Life expectancy decreases in patients with RAS, especially those whose stenosis is above 60% but has not reached the stage of chronic kidney failure. This study aims to determine the prevalence of RAS in PAD patients, the relationship between angiographic scoring system (ANGIO Score), history of hypertension, and diabetes mellitus with the degree of RAS. Method: This research was a cross-sectional study conducted at Cipto Mangunkusumo Hospital from February to May 2019. Patients with a diagnosis of lower extremity PAD and had been assessed with CT angiography examination, were included in this study. The degree of RAS and ANGIO Score were calculated. Sampling was done by the total sampling method. Results Most patients were women 33 (50.8%), while men were 32 (49.2%). 90.8% of the patients had diabetes, while 61.5% of the sample had hypertension. Grade 1 RAS was the most found. There was no correlation between ANGIO Score on age, sex, and diabetes mellitus, but there was a significant relationship with hypertension. There was a relationship between RAS with age and hypertension, but there was no relationship with diabetes mellitus and gender. ANGIO Score and RAS had a significant relationship (p <0.001). Conclusion: There was a relationship between the ANGIO Score and the severity of RAS. The cut-off score of 9 for the ANGIO Score had a sensitivity of 85.7% and a specificity of 61.4% for predicting RAS. Keywords: peripheral arterial disease, angiographic scoring system, renal artery stenosis, CT angiography