IntroductionDespite being the current most accurate risk scoring system for predicting in-hospital mortality for patients with acute coronary syndrome (ACS), the Global Registry of Acute Coronary Events (GRACE) risk score is time consuming due to the requirement for electrocardiography and laboratory examinations. This study is aimed to evaluate the association between modified shock index (MSI), as a simple and convenient index, with in-hospital mortality and revascularization in hospitalized patients with ACS.MethodsA single-centered, retrospective cohort study, involving 1,393 patients with ACS aged ≥ 18 years old, was conducted between January 2018 and January 2022. Study subjects were allocated into two cohorts: high MSI ≥ 1 (n = 423) and low MSI < 1 group (n = 970). The outcome was in-hospital mortality and revascularization. The association between MSI score and interest outcomes was evaluated using binary logistic regression analysis. The area under the curve (AUC) between MSI and GRACE score was compared using De Long’s method.ResultsModified shock index ≥ 1 had 61.1% sensitivity and 73.7% specificity. A high MSI score was significantly and independently associated with in-hospital mortality in patients with ACS [odds ratio (OR) = 2.72(1.6–4.58), p < 0.001]. However, ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) patients with high MSI did not significantly increase the probability of revascularization procedures. Receiver operating characteristic (ROC) analysis demonstrated that although MSI and GRACE scores were both good predictors of in-hospital mortality with the AUC values of 0.715 (0.666–0.764) and 0.815 (0.775–0.855), respectively, MSI was still inferior as compared to GRACE scores in predicting mortality risk in patients with ACS (p < 0.001).ConclusionModified shock index, particularly with a score ≥ 1, was a useful and simple parameter for predicting in-hospital mortality in patients presenting with ACS.

Vitiligo is the most common hypopigmentation disorder; however, until now there iss no comprehensive epidemiological-clinical study of vitiligo in Indonesia. A descriptive study using a questionnaire among vitiligo patients in Dr. Hasan Sadikin General Hospital Bandung was conducted to determine the clinical findings, sociodemographic factors, coexisting autoimmune disorders, and severity of disease. All vitiligo patients were recruited during the period of February 2012 to April 2014 from the Dermatology Outpatient Clinic of Dr. Hasan Sadikin General Hospital Bandung, as well as from the Endocrinology and Rheumatology Clinic Department of Internal Medicine; Endocrinology and Allergy and Immunology Clinics Department of Child Health; and Department of Nuclear Medicine the same hospital. We collected data on socio-demographic profiles, clinical profile, and severity of vitiligo based on Vitiligo European Task Force (VETF). Out of 242 patients, female patients made up the majority of the patients (66.12%). In addition, most patients wereunder 20 years (33.47%) and experienced onset of vitiligo highest in the first decade of life (29.34%). About 19.42% had positive family history of vitiligo and only 6.2% had history of autoimmune diseases. The majority of patients (77.27%) had vulgaris type of vitiligo with head-neck (35.36%) asthe most frequent initial site of onset. Based on VETF, the skin affected was mostly below 10% of body surface area (82.23%), i.e. staging score of between 0-5 (57.44%), and spreading score of between >0-(+5) or 68.18%. It is concluded that vitiligo most commonly occurs in females with the highest onset of under 10-years old and strong relationship with genetic predisposition.T he affected area was relatively small, despite the high spreading score. [MKB. 2017;49(2)

Pulmonary hypertension (PH) encompasses several heterogeneous groups of multiple diseases characterized by abnormal pulmonary arterial blood pressure elevation. Unrepaired atrial septal defect (ASD) may be associated with pulmonary arterial hypertension (PAH), indicating pulmonary vascular remodeling. Furthermore, unrepaired ASD could also be associated with other conditions, such as left heart disease or thromboembolism, contributing to the disease progression. We present a case of a 61-years-old woman with complex PH comprising several etiologies, which are PAH due to unrepaired Secundum ASD, mitral regurgitation caused by mitral valve prolapse as a group 2 PH, pulmonary embolism (PE) which progress to chronic thromboembolism PH (CTEPH) and post-acute sequelae of SARS Cov-2. We highlighted the importance of diagnostic investigation in PH, which is crucial to avoid misdiagnosis and inappropriate treatment that could be detrimental for the patient.