This study aimed to determine the relationship between ankle brachial index (ABI) and the severity of ulcer using Wagner classification among patients with diabetic foot in Prof. Dr. R. D. Kandou Hospital Manado. This was an observational study with a cross-sectional design conducted at the Department of Surgery and Department of Internal Medicine of Prof. Dr. R.D. Kandou Manado Hospital from January to June 2015. The results showed that there were 38 patients with diabetic foot ulcers. The highest proportion was the group of patients with Wagner grade 4 (10 patients - 26.3%), followed by grade 1 (9 patients - 23.7%), grade 2 and 3 (each of 8 patients - 21.05%), and grade 5 (3 patients - 7.9%). There were 22 patients (57.9%) with normal ABI values, followed by moderate ischemia in 8 patients (21.1%), mild ischemia in 7 patients (18.4%), and only 1 patient (2.6%) with severe vascular obstruction. The Spearman test showed a P value of 0.008 which meant that there was a significant correlation between ABI and the severity of ulcer. The lower the ABI value, the more severe the ulcer of diabetic foot cases Conclusion: ABI value had a significant relationship with the severity of ulcers of diabetic foot patients.Keywords: ABI, diabetic footAbstrak: Penelitian ini bertujuan untuk mengetahui hubungan Ankle Brachial Index (ABI) dengan derajat keparahan ulkus pada penderita dengan kaki diabetik yang dirawat di RSUP Prof. Dr. R. D. Kandou Manado. Penelitian berupa studi observasional dengan desain potong lintang yang dilakukan di Bagian Bedah dan Bagian Penyakit Dalam RSUP Prof. Dr. R. D. Kandou Manado selama periode Januari sampai Juni 2015. Hasil penelitian mendapatkan 38 penderita kaki diabetik dengan proporsi terbanyak yaitu penderita dengan ulkus Wagner grade 4 sebanyak 10 pasien (26,3%), diikuti grade 1 sebanyak 9 pasien (23,7%), grade 2 dan 3 masing-masing sebanyak 8 pasien (21,05%), dan terakhir ulkus Wagner grade 5 sebanyak 3 pasien (7,9%). Nilai ABI normal didapatkan paling banyak yaitu pada 22 pasien (57,9%), diikuti oleh obstruksi vaskular sedang sebanyak 8 pasien (21,1%) dan iskemi ringan sebanyak 7 pasien (18,4%), dan hanya 1 pasien (2,6%) dengan obstruksi vaskular berat. Hubungan ABI dan keparahan ulkus diuji dengan analisis koefisien koreksi Spearman dan mendapatkan nilai P = 0,008 yang menunjukkan makin rendah nilai ABI maka nilai keparahan ulkus semakin besar. Simpulan: Nilai ABI memiliki hubungan bermakna dengan keparahan ulkus penderita kaki diabetik.Kata kunci: ABI, kaki diabetik

Introduction: Percutaneous transluminal angioplasty (PTA) is the gold standard in the management of AVF dysfunction. On the other hand, the management of stenosis with PTA induces an acceleration of neointimal hyperplasia with the occurrence of restenosis. The aim of this study was to assess the increase of quick of blood (Qb) hemodialysis (HD) patients after venoplasty with AVF dysfunction and its patency within 3 months post procedure, and examine the factors associated with venoplasty failure to maintain optimal Qb. Method: This study used a quasi-experimental design, in which all subjects received the treatment under study without a control group, due to ethical issues; because venoplasty is the standard protocol for AVF dysfunction in the place of this study. Qb measurements were made before and after HD, and 3 months thereafter, to evaluate AVF patency. Result: There were 25 cases that included 23 patients with 2 patients had to be re- venoplasty. An increase in Qb averaged 221.3−196.7 mL / min or about 25 mL / min in the 3-month period after venoplasty with significant results (p = 0.044). The location of stenosis in juxta anastomosis has a 14 times greater chance of venoplasty failure (p = 0.037) than stenosis in the area of draining vein or central vein. Diabetes Mellitus (DM) increased the odds of venoplasty failure 12 times greater (p = 0.038) than cases without this comorbid.. Conclusion: This study proves the increase in Qb of hemodialysis patients after venoplasty for AVF dysfunction, and it was found that the location of juxta anastomosis stenosis and the presence of DM are the two main factors that have the potential to increase the chance of venoplasty failure.

American National Kidney Foundation (2002) states that end-stage kidney disease is an indication for renal replacement therapy, one of which is hemodialysis. Vascular access comprises a fundamental component of hemodialysis therapy (HD), facilitating the patient’s blood flow to the dialyzer. However, there are some factors affecting the maturity of an arteriovenous fistula (AVF), inter alia the patient, comorbidities, and anatomical and functional conditions of the blood vessels involving the blood flow rate (BFR). This study was aimed to establish the differences between intra-operative BFR and BFR six weeks after surgery as well as any correlations between intraoperative BFR, venous diameter, and skin to vein distance with maturity of brachiocephalic AVF. This was prospective cohort study conducted at the Department of Surgery, Prof. Dr. R. D. Kandou General Hospital Manado. Subjects were 41 CKD patients who underwent brachiocephalic AVF surgery. The vein diameter, skin to vein distance, and BFR were measured immediately as intra-operative data using a Doppler USG and all were re-measured at six-week-follow-up examination as six-week-postoperative data. The results showed that there was a significant increase in BFR at six weeks postoperation compared to intraoperation (t=-19.215; P <0.0001). Bi-serial point correlation analysis revealed that there was a significant correlation between intraoperative venous diameter and maturity (rpb=0.276; P=0.04) as well as a significant correlation between intraoperative BFR and maturity (rpb=0.615; P=0.002). No significant correlation was observed between intra-operative skin to vein distance and maturity (rpb=0.093; P=0.281). Conclusion: There was a significant difference in BFR between intraoperation and 6 weeks postoperation in the mature AV fistula. There was a significant relationship between intraoperative BFR and maturity as well as between intraoperative venous diameter and maturity, while no significant relationship between skin-vein distance and maturity was found.Keywords: brachiocephalic AVF, BFR, maturityAbstrak: American National Kidney Foundation (2002) menyatakan bahwa penderita dengan penyakit ginjal tahap akhir diindikasikan untuk dilakukan terapi pengganti ginjal, salah satunya hemodialisis (HD). Akses vaskular merupakan komponen penting pada terapi HD karena melalui akses vaskular darah dari tubuh pasien dapat dialirkan menuju dialyzer. Terdapat banyak faktor yang memengaruhi maturitas suatu arteriovenous fistula (AVF), yaitu pasien itu sendiri, komorbid, serta keadaan anatomi dan fungsional pembuluh darah termasuk nilai blood flow rate (BFR). Penelitian ini bertujuan untuk mengetahui perbedaan BFR intraoperasi dan BFR enam minggu pascaoperasi serta adanya korelasi antara BFR intraoperasi, diameter vena, dan jarak kulit-vena dengan maturitas AVF brakiosefalika. Penelitian ini dilaksanakan di Bagian Bedah RSUP Prof. Dr. R. D. Kandou Manado dengan desain kohort prospektif. Subyek penelitian ialah 41 pasien PGK yang menjalani operasi pembuatan AVF brakiosefalika. Setelah selesai operasi dihitung diameter vena, jarak kulit-vena, dan BFR sebagai data intraoperasi menggunakan USG Doppler. Penghitungan dilakukan kembali 6 miggu pascaoperasi. Hasil penelitian mendapatkan peningkatan BFR yang sangat bermakna pada enam minggu pascaoperasi dibandingkan intraoperasi (t =-19,215, P<0,0001). Dengan analisis korelasi point biserial didapatkan hubungan bermakna antara diameter vena intraoperasi dengan maturitas (rpb=0,276; P=0,04), tidak terdapat hubungan bermakna antara jarak kulit-vena intraoperasi dengan maturitas (rpb=0,093; P=0,281), dan terdapat hubungan bermakna antara BFR intraoperasi dengan maturitas (rpb=0,615; P=0,002). Simpulan: Terdapat perbedaan bermakna antara BFR intraoperasi dan BFR 6 minggu pascaoperasi pada AVF matur. Terdapat hubungan bermakna antara BFR intraoperasi dan diameter vena intraoperasi dengan maturitas namun tidak terdapat hubungan bermakna antara jarak kulit-vena dengan maturitas.Kata kunci: AVF brakiosefalika, BFR, maturitas

The prevalence of diabetes mellitus (DM) is increased globally every year, especially in developed countries. In Indonesia, the prevalence of diabetic ulcers is amounted to 15%. Mortality and amputation are as high as 32.5% and 23.5% and are the most common cause of diabetic patient care in the hospital. This study was aimed to compare the sensitivity of diabetic ulcers’ bacteria to PHMB gel with 0.9% saline gel. This was a descriptive analytical study. Subjects were 57 patients of diabetic ulcer associated with infection. Pus samples obtained from the diabetic ulcers were cultured and were further evaluated for the sensitivity test to PHMB gel and saline gel. Data were analyzed by using the ƻ test. The results showed that the proportion of bacteria’ sensitivity to PHMB was significantly different (P <0.05) meanwhile to 20% saline gel was not significantly different (P <0.05). Conclusion: Application of PHMB gel could improve the process of wound healing of diabetic ulcer with infection.Keywords: PHMB gel, Na Cl gel, diabetic ulcer with infectionAbstrak: Prevalensi penyandang diabetes melitus (DM) secara global semakin meningkat setiap tahunnya terutama di negara berkembang. Di Indonesia, prevalensi ulkus diabetik pada penyandang DM sebesar 15%. Angka kematian dan amputasi sangat tinggi yaitu sebesar 32,5% dan 23,5% yang merupakan penyebab terbanyak perawatan di rumah sakit. Penelitian ini bertujuan untuk mendapatkan pola kuman pada ulkus diabetik serta membandingkan kepekaan kuman terhadap PHMB gel dan NaCl gel. Jenis penelitian ialah deskriptif analitik. Subyek penelitian ialah 57 pasien dengan ulkus diabetik disertai infeksi. Sampel pus dari ulkus diabetik dibuat kultur kemudian dilanjutkan dengan uji kepekaan kuman terhadap PHMB gel dan NaCl gel. Data dianalisis menggunakan uji ƻ. Hasil uji statistik mendapatkan perbedaan proporsi kepekaan kuman terhadap PHMB yang bermakna (P < 0,05) sedangkan perbedaan proporsi kepekaan kuman terhadap NaCl gel 20% tidak bermakna (P >0,05). Simpulan: Pemberian PHMB gel dapat meningkatkan proses penyembuhan luka pada penyandang DM dengan ulkus yang disertai infeksi.Kata kunci: PHMB gel, Na Cl gel, ulkus diabetik dengan infeksi

Diabetic foot ulcer is still a major health problem worldwide due to its increasing prevalence. This study was aimed to prove the correlation between PEDIS score and vascular Doppler examination performed on dorsalis pedis and posterior tibial arteries of patients with diabetic foot ulcers. This was an observational study with a cross sectional design. The results showed that during the period of August 2017 until January 2018, there were 62 patients with diabetic foot ulcers at the wards of Surgery Department and Internal Medicine Department of Prof. Dr. R. D. Kandou Hospital Manado. Most patients were in the age group of 60-69 years, had leukocytosis (74.1%), poor blood sugar control (70.9%), and hypoalbuminemia (98.3%). Moreover, smoking history in 20.9% of patients; hypertension in 35.4% of patients; and dyslipidemia in 20.9% of patients. The Doppler examination resulted in biphasic waveform in posterior tibial artery (40.3%) as well as in dorsalis pedis artery (41.9%). Perfusion score showed 50% of subjects had PAD. Most subjects (90.3%) had ulcers of >3 cm2 and were infected superficially in the subcutaneous area (56.4%). Most subjects (58%) suffered from severe infection with high leucocyte counts, however, only 29% of subjects had lost of sensoric ability. The correlation Spearman test obtained r = -0.486 and P = 0.000 in the posterior tibial artery; and r = -0.281 and P = 0.0027 in the dorsalis pedis artery. Conclusion: There was a significant correlation between vascular Doppler result and PEDIS score. The higher the PEDIS score, the worse the vascular Doppler result.Keywords: diabetic foot ulcer, PEDIS score, vascular DopplerAbstrak: Ulkus kaki diabetik masih merupakan masalah kesehatan utama sedunia dengan prevalensi yang terus meningkat. Penelitian ini bertujuan untuk membuktikan apakah terdapat hubungan antara skor PEDIS dan pemeriksaan spektral Doppler vaskuler pada arteri poplitea, dorsalis pedis, dan tibialis posterior pada pasien dengan ulkus kaki diabetik. Jenis penelitian ialah observasional dengan desain potong lintang. Hasil penelitian mendapatkan 62 pasien dengan ulkus kaki diabetik di bangsal Bagian Bedah dan Penyakit Dalam RSUP Prof. Dr. R. D. Kandou Manado selama periode Agustus 2017 sampai Januari 2018. Ukus diabetik tersering ditemukan pada kelompok usia 60-69 tahun dengan rerata usia 58,5 tahun. Sebagian besar pasien mengalami leukositosis (74,1%), kontrol gula darah buruk (70,9%), dan hipoalbuminemia (98,3%). Riwayat merokok didapatkan sebesar 20,9%; hipertensi 35,4%; dan dislipidemia 20,9%. Hasil pemeriksaan Doppler bifasik pada arteri tibialis posterior (40,3%) dan arteri dorsalis pedis (41,9%). Skor perfusi menunjukkan 50% subyek mengalami penyakit arteri perifer (PAD). Sebagian besar (90,3%) subjek memiliki ulkus >3 cm2 luas area. Infeksi sebagian besar superfisial di subkutan (56,4%), selebihnya menderita infeksi hingga fasia, otot, dan tendon. Sebagian besar subyek penelitian menderita infeksi berat (58%) dengan angka leukosit tinggi. Hanya 29% dari subjek penelitian mengalami kehilangan kemampuan sensorik. Hasil uji korelasi Spearman mendapatkan pada arteri tibialis posterior: r = -0,486 dengan P = 0,000 dan pada arteri dorsalis pedis: r = -0,281 dengan P = 0,0027. Simpulan: Terdapat hubungan bermakna antara hasil pemeriksaan spektral Doppler dan skor PEDIS. Semakin tinggi skor PEDIS semakin buruk hasil spektral Doppler.Kata kunci: ulkus kaki diabetik, skor PEDIS, Doppler spektral vaskular