PurposeThe aim of this study was to analyze the association of the carotid intima-media thickness (CIMT) with various parameters in patients on maintenance hemodialysis (mHD).MethodsA cross-sectional study was conducted, enrolling 68 subjects (41 men, 27 women) on mHD in the Hemodialysis Unit, Sanglah Hospital, Denpasar, Indonesia. CIMT was measured with B-mode ultrasonography using a USG Sonoace 8000 and a 7.5 MHz linear transducer.ResultsCIMT was higher in subjects with cardiovascular disease (CVD) compared with those without CVD (0.6494 vs 0.7288 mm; P=0.026), and in men compared with women (0.7056 vs 0.6141 mm; P=0.003). CIMT was correlated with age (R=0.607; P<0.001), plasma albumin (R=−0.291, P=0.016), serum phosphate (R=−0.294, P=0.015), calcium-phosphate product (R=−0.284, P=0.011), and plasma high-sensitivity C-reactive protein (R=0.279, P=0.030). However, after multiple linear regression testing, only age consistently had a role in determining the CIMT value (β=0.452, P<0.001).ConclusionSubjects with CVD have higher CIMT than those without CVD and men had higher CIMT than women. In addition, older age, higher high-sensitivity C-reactive protein, and lower albumin, phosphate, and calcium-phosphate product levels were correlated with higher CIMT. Age was the most important marker for CIMT in subjects on mHD.

It has been known that carotid stiffness is a predilection for stroke. Strain elastography (SE) ultrasound (US) is one of the new modalities which can evaluate carotid artery stiffness by obtaining its tunica intima media strain value. There were no studies that show the carotid artery SE US value in stroke patients, hence become the underlying reason this study was conducted. The aim of this study was to provide an evaluation of carotid artery SE US values in stroke patients.A pair-matched case-control study was conducted on 40 case subjects and 40 controls which met all inclusion and exclusion criteria. Carotid arteries SE US value was obtained through the average of 3 region of interest (ROI) on each intima media layer of 3 level carotid arteries assessed on both sides. Diagnostic accuracy study was analysed to determine the cut off value between stiff and not stiff. Subsequently, bivariate and multivariate analyses were performed.There were 65% male on both groups with mean age 56.7 ± 13.0 on the case group and 53.8 ± 11.8 on the control group. ROC curve analysis showed that all measurement locations were reliable with high numbers (91.03-97.8%). The cut of value of carotid artery stiffness was ≥0.9333 (97.5% sensitivity and 90% specificity). Carotid artery stiffness is a major risk factor of stroke with OR 351 (p value 0.000). Multivariate analysis showed that carotid artery stiffness remained a strong risk factor of stroke (OR 467.89, p value 0,000). Other radiologist can repeat this technique with good interobserver (r = 0.782-0.985) and intraobserver reliability (r = 0.802-0.954).Carotid artery stiffness is a strong risk factor for stroke, with carotid artery stiffness SE US cut off values of ≥0.9333.

Introduction: Cerebral edema could be caused by mild or moderate traumatic brain injury. The primary modality for cerebral edema is head computed tomography (CT), however the interpretation could be different between radiologists which could be due to subjectivity. The purpose of this study is to determine the radiologist interobserver and intraobserver reliability in the interpretation of cerebral edema on head CT of mild and moderate traumatic brain injury in Sanglah General Hospital, Denpasar, Bali.Methods: Retrospective study design with interobserver and intraobserver reliability test of two radiologists in interpreting cerebral edema on head CT of patients with mild and moderate traumatic brain injuryResults: 35 head CT scans of patients with clinical history of mild or moderate traumatic brain injury, shows that significant differences (bias) intraobserver and interobserver in the interpretation of cerebral edema.Conclusion: Head CT scan could not be reliable to determine cerebral edema in patients with mild and moderate traumatic brain injury due to high subjectivity between radiologists.

Background: Total Knee Artrhoplasty (TKA) is the final therapeutic choice for osteoarthritis (OA) if conservative therapy fails. However, some studies show that about 50% of patients undergoing TKA complain on anterior knee pain postoperatively. One of the most common causes of knee pain comes from the patellofemoral components. Some interesting potential risk factors needing investigations include patellar maltracking, pseudo patella baja, and patellar tilt. By knowing the relationship between these potential risk factors and patellofemoral pain after TKA, it is hoped that further modifications can be made intraoperatively to maximalize the functional outcomes of these patients.Methods: This is a Case Control study to investigate the factors affecting patellofemoral pain after TKA without patellar resurfacing, including patellar maltracking, pseudopatella baja, and patellar tilt, compared to those who don’t experience patellofemoral pain. The study was conducted at Sanglah Hospital, Denpasar, Bali in September-December 2019. Clinical and radiographic data were obtained secondarily from patient medical records.Results: Chi Square Test for Maltracking patella test showed a value of P = 0,000 (P <0.05), indicating a significant difference between the group with patellofemoral pain and those without. Chi Square Test for Pseudopatella Baja showed a value of P = 1,000 (P> 0.05), indicating no significant difference. While the Chi Square Test for Patellar Tilt showed a value of P = 0.045 (P <0.05), indicating a significant difference.Conclusion: Patellar maltracking and patellar tilt are proven to be risk factors for higher NRS values compared to those without, in post-TKA patients patellar resurfacing. Whereas Pseudopatella Baja was not proven to be a risk factor for higher NRS values. Latar Belakang: Total Knee Artrhoplasty (TKA) merupakan pilihan terapi tahap akhir dari osteoartritis (OA) lutut bila manajemen konservatif gagal. Walaupun demikian, beberapa studi menunjukan bahwa pasca operasi TKA, sekitar 50% pasien justru mengeluhkan nyeri pada bagian depan lutut. Salah satu penyebab tersering nyeri lutut pada pasien-pasien OA pasca TKA berasal dari komponen patellofemoral. Beberapa faktor risiko yang menarik untuk diteliti sebagai peyebab nyeri patellofemoral pasca TKA antara lain maltracking patella, pseudo patella baja, dan patellar tilt. Dengan mengetahui keterkaitan antara faktor-faktor risiko potensial tersebut dengan nyeri patellofemoral pasca TKA, diharapkan lebih lanjut dapat dilakukan modifikasi saat operasi guna mengurangi insiden nyeri patellofemoral pada pasien-pasien pasca TKA, sehingga dapat meningkatkan keluaran fungsional pasien-pasien tersebut.Metode: Penelitian ini merupakan penelitian Case Control untuk mengetahui faktor risiko terjadinya nyeri patellofemoral pasca TKA tanpa mengganti komponen patella pasien-pasien dengan OA lutut, terkait dengan yang memiliki faktor maltracking patella, pseudopatella baja, dan patellar tilt, dibandingkan dengan yang tidak memiliki faktor tersebut. Penelitian dilakukan di RSUP Sanglah, Denpasar, Bali selama bulan September-Desember 2019. Data klinis dan radiografis didapat dari data sekunder dari rekam medis penderita.Hasil: Uji Chi Square Maltracking patella menunjukkan nilai P = 0,000 ( P < 0,05), menandakan perbedaan yang signifikan antara kelompok yang nyeri dan tidak nyeri. Uji Chi Square Pseudopatella Baja menunjukkan nilai P = 1,000 ( P > 0,05), menandakan tidak adanya perbedaan yang signifikan. Sedangkan Uji Chi-square Patellar Tilt menunjukkan nilai P = 0,045 ( P < 0,05), menandakan perbedaan yang signifikan.Simpulan: Maltracking patella dan patellar tilt merupakan faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa maltracking patella pada pasien-pasien pasca-TKA tanpa mengganti komponen patella. Sedangkan Pseudopatella Baja tidak terbukti sebagai faktor risiko terhadap nilai NRS yang lebih tinggi dibandingkan tanpa pseudopatella Baja pada pasien-pasien pasca-TKA tanpa mengganti komponen patella.