Internal Medicine Commons^™

Dual-Functional Phosphorene Nanocomposite Membranes For The Treatment Of Perfluorinated Water: An Investigation Of Perfluorooctanoic Acid Removal Via Filtration Combined With Ultraviolet Irradiation Or Oxygenation, Joyner Eke, Lillian Banks, M. Abdul Mottaleb, Andrew J. Morris, Olga V. Tsyusko, Isabel C. Escobar

Internal Medicine Faculty Publications

Nanomaterials with tunable properties show promise because of their size-dependent electronic structure and controllable physical properties. The purpose of this research was to develop and validate environmentally safe nanomaterial-based approach for treatment of drinking water including removal and degradation of per- and polyfluorinated chemicals (PFAS). PFAS are surfactant chemicals with broad uses that are now recognized as contaminants with a significant risk to human health. They are commonly used in household and industrial products. They are extremely persistent in the environment because they possess both hydrophobic fluorine-saturated carbon chains and hydrophilic functional groups, along with being oleophobic. Traditional drinking water …

A Patient With Combined Metformin-Induced Lactic Acidosis And Euglycemic Diabetic Ketoacidosis, Kamil Sardarli, Russell Leong, Inayat Gill, Sami S. Zarouk

Conference Presentation Abstracts

Introduction: Metformin is a small, non-protein-bound molecule that can cause lactic acidosis in 6 out of 100,000 patients with a mortality rate of 30-50%. Concurrent euglycemic diabetic ketoacidosis (DKA) from sodium-glucose co-transporter-2 (SGLT2) inhibitor has been reported in one case. We report a unique case of a patient with acute kidney injury (AKI) in the setting of metformin-induced lactic acidosis and osmotic diuresis due to euglycemic DKA complicated by celecoxib use. Case Description: A 66-year-old female with a past medical history of type 2 diabetes mellitus for 21 years on metformin 1000 mg twice daily and empagliflozin 25 mg daily …

Diagnosis Of Early Delayed Graft Function (Dgf) Using Timp-2*Igfpb-7 Product In Transplant Recipients: Preliminary Results, Russell Leong, Cassandra Rodd, Kellyann M. Gomes, Solomiia Savedchuk, Paul S. Kellerman

Conference Presentation Abstracts

Background: DGF is acute kidney injury (AKI) defined as need for dialysis within one week of renal transplant. AKI is defined by a change in serum creatinine (SCr), however early recognition is limited by delay in creatinine rise. Accurate early biomarkers may lead to prevention or treatment of established AKI. The product of two novel biomarkers of cell cycle arrest, tissue Inhibitor of metalloproteinase-2 (TIMP-2) and insulin-like growth factor binding protein (IGFBP-7) have shown promise in predicting AKI. In prior studies, TIMP-2*IGFPB-7 ≤0.3 had high negative predictive value, and ≥2 high positive predictive value for AKI. Aims - 1) Investigate …

Opioid Use Disorder: The Timeline For Medication Assisted Therapy, Alexander Cristofori

Capstone Showcase

Opioid Use Disorder is patterns of opioid use leading to withdrawal, giving up important life events in order to use opioids, and excessive time spent using opioids, to name a few diagnostic criteria. The clinical progression of the disorder involves periods of acute exacerbation and remission that are cyclic in nature. Treatment is most effective when it includes both pharmacological and psychosocial modalities, referred to as medication assisted therapy (MAT). Three drugs used commonly in MAT-based treatment for OUD from oldest to newest include Methadone, Buprenorphine-naloxone, and Naltrexone. Treatment program models that prioritize total abstinence from the addictive substance attached …

Management Of Refractory Ventricular Fibrillation With Double Sequential Defibrillation, Kaitlyn A. Brown

Capstone Showcase

Patients experiencing cardiac arrest are treated according to ACLS protocols, however current protocols lack recommendations for the treatment of refractory Ventricular Fibrillation which persists after more than 3 cycles of CPR and defibrillation. One potential intervention for these cases that is being researched is the use of simultaneous or sequential activation of two defibrillators. This literature review analyzed the results of several studies to determine if double sequential defibrillation (DSD) is a viable treatment to achieve return of spontaneous circulation (ROSC) and improved patient survival. The results of the studies were mixed with some showing positive outcomes, and others showing …

Antibiotic Stewardship In Skin And Soft Tissue Infections, Shah Z. Ali, Jose Campo Maldonado

MEDI 9331 Scholarly Activities Clinical Years

Antibiotic use during inpatient hospitalizations have a significant impact on both patient care and healthcare costs. Using data collected over a one month period in 2019 from inpatient hospitalizations, we aim to determine the most common indicated uses for vancomycin and piperacillin-tazobactam, along with the average days of therapy for their use in treating skin and soft tissue infections.

Evaluating The Use Of Telehealth To Manage Hypertension In Primary Care, Alexandra M. Wiesner

DNP Projects

Background: Hypertension remains one of the most common chronic conditions in the United States leading to several health complications and immense financial burdens, yet it remains grossly undertreated despite the availability of evidence-based treatment options. The 2017 guidelines from the American College of Cardiology and American Heart Association recommended the use of home blood pressure monitoring with a telehealth component as an adjunct to regular hypertension treatment; however, implementing this into practice can be difficult depending on the setting, available resources, and the knowledge and skills of the providers. Aims: The purpose of this investigation is to evaluate patient adherence …

A Rare Case Of Solid Pseudopapillary Neoplasm Of The Pancreas, Steven Michael, Nadeem Kassam, Aidan Njau, Omar A. Sherman, Harrison Chuwa, Salim Surani

General Surgery, East Africa

Solid pseudopapillary neoplasm of pancreas (SPN) is a rare entity. It is almost exclusively seen in females within the second and third decades of life with only small minority affecting children. Due to the paucity of the number of cases seen, the natural history of the disease is not fully understood. SPN tumors of the pancreas are usually found incidentally and usually have an excellent prognosis. We herein present a case of a 33-year-old lady diagnosed with SPN, who presented with abdominal fullness, two weeks post cesarean sectio

Anorectal Malformation, Associated With Colon Atresia And Intestinal Malrotation, A Case Report, Allyzain Ismail, Lazaro Mboma, Victor Ngotta, Masawa Nyamuryekung'e

Internal Medicine, East Africa

Introduction and importance: In this case report from Muhimbili National Hospital, Dar es salaam, Tanzania, we present the unexpected findings of anorectal malformation, colonic atresia, and intestinal malrotation in a 2-day old neonate. This combination is exceedingly rare, with only case reports published in the literature. We describe the challenges in diagnosis and offer our insights based on this experience and review of the literature.

Case presentation: Our patient was a male born at term, weighing 2600 g, diagnosed clinically with a high anorectal malformation. He was planned for colostomy, and we unexpectedly found a collapsed descending colon. Exploration revealed …

Covid-19 And Teleneurology In Sub-Saharan Africa: Leveraging The Current Exigency, Philip Adebayo, Olusegun John Oluwole, Funmilola Tolulope

Internal Medicine, East Africa

Africa has over 1.3 billion inhabitants, with over 60% of this population residing in rural areas that have poor access to medical experts. Despite having a ridiculously huge, underserved population, very few African countries currently have any form of sustained and organized telemedicine practice, and even fewer have dedicated tele-neurology services. The ongoing COVID-19 pandemic has proved to be one of the most significant disruptors of vital sectors of human endeavor in modern times. In the healthcare sector, there is an increasing advocacy to deliver non-urgent care via telemedicine. This paper examined the current state of tele-neurology practice and infrastructural …

Determining Risk Factors That Affect Progression In Patients With Nonproliferative Diabetic Retinopathy, Dalbert J Chen, Jacky C Kuo, Alex J Wright, Alice Z Chuang, Wenyaw Chan, Robert M Feldman, Eric L Crowell

Faculty, Staff and Student Publications

PURPOSE: to determine risk factors that affect nonproliferative diabetic retinopathy (NPDR) progression and establish a predictive model to estimate the probability of and time to progression in NPDR.

RESULTS: Two hundred thirty patients were included. Initially, 65 eyes (28.3%) had no retinopathy; 73 (31.7%) mild NPDR; 60 (26.1%) moderate NPDR; and 32 (13.9%) severe NPDR. Patients were followed for a mean of 5.8 years (±2.0 years; range 2.1-9.4 years). 164 (71.3%) eyes progressed during the follow-up. Time-independent risk factors affecting progression rate were age (hazard ratio (HR) = 0.99,

CONCLUSION: HbA1c level is a significant modifiable risk factor in controlling …

Prevalence And Factors Associated With Mental Health Symptoms In Adults Undergoing Covid-19 Testing, Ikponmwosa Osaghae, Linh K Nguyen, Tong Han Chung, Olivia Moffitt, Yen-Chi L Le, Mark B Suh, Pooja N Prasad, Eric J Thomas, Christine D Gordon, Kevin O Hwang

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: Understanding the mental health impact of the COVID-19 pandemic on persons receiving COVID-19 testing will help guide mental health interventions. We aimed to determine the association between sociodemographic factors and mental health symptoms at 8 weeks (baseline) after a COVID-19 test, and compare prevalence of mental health symptoms at baseline to those at 16-week follow-up.

MATERIALS AND METHODS: Prospective cohort study of adults who received outpatient COVID-19 testing at primary care clinics. Logistic regression analyses were used to assess the association between sociodemographic characteristics and COVID-19 test results with mental health symptoms. Mental health symptoms reported at …

Clonidine For The Treatment Of Agitation After Dexmedetomidine Discontinuation In Pediatric Patients: A Retrospective Cohort Study, Thao L Nguyen, Weng Man Lam, Hillary Orr, Brian Gulbis, Riza Mauricio, Eric Tom, Vinai M Modem, Alvaro Coronado-Munoz

Faculty, Staff and Student Publications

OBJECTIVE: Dexmedetomidine has become a widely used drug in PICUs for sedation. We aim to determine the effects of clonidine on pediatric patients after dexmedetomidine use.

METHODS: This was a retrospective cohort study that evaluated all pediatric patients admitted to a tertiary PICU who received dexmedetomidine infusion for >48 hours. Outcomes in patients exposed to clonidine (CLON) were compared with those of patients who were not exposed (NoCLON).

RESULTS: A total of 216 patients were included in this study (43 CLON and 173 NoCLON). The primary outcome, agitation, was less in the CLON cohort (9.3%) than in the NoCLON cohort …

Prevalence And Factors Associated With Mental Health Symptoms In Adults Undergoing Covid-19 Testing, Ikponmwosa Osaghae, Linh K Nguyen, Tong Han Chung, Olivia Moffitt, Yen-Chi L Le, Mark B Suh, Pooja N Prasad, Eric J Thomas, Christine D Gordon, Kevin O Hwang

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: Understanding the mental health impact of the COVID-19 pandemic on persons receiving COVID-19 testing will help guide mental health interventions. We aimed to determine the association between sociodemographic factors and mental health symptoms at 8 weeks (baseline) after a COVID-19 test, and compare prevalence of mental health symptoms at baseline to those at 16-week follow-up.

MATERIALS AND METHODS: Prospective cohort study of adults who received outpatient COVID-19 testing at primary care clinics. Logistic regression analyses were used to assess the association between sociodemographic characteristics and COVID-19 test results with mental health symptoms. Mental health symptoms reported at …

Prevalence And Factors Associated With Mental Health Symptoms In Adults Undergoing Covid-19 Testing, Ikponmwosa Osaghae, Linh K Nguyen, Tong Han Chung, Olivia Moffitt, Yen-Chi L Le, Mark B Suh, Pooja N Prasad, Eric J Thomas, Christine D Gordon, Kevin O Hwang

Faculty, Staff and Student Publications

BACKGROUND AND OBJECTIVE: Understanding the mental health impact of the COVID-19 pandemic on persons receiving COVID-19 testing will help guide mental health interventions. We aimed to determine the association between sociodemographic factors and mental health symptoms at 8 weeks (baseline) after a COVID-19 test, and compare prevalence of mental health symptoms at baseline to those at 16-week follow-up.

MATERIALS AND METHODS: Prospective cohort study of adults who received outpatient COVID-19 testing at primary care clinics. Logistic regression analyses were used to assess the association between sociodemographic characteristics and COVID-19 test results with mental health symptoms. Mental health symptoms reported at …

Restoration Of Cardiac Function After Myocardial Infarction By Long-Term Activation Of The Cns Leptin-Melanocortin System, Fabio N Gava, Alexandre A Da Silva, Xuemei Dai, Romain Harmancey, Sadia Ashraf, Ana C M Omoto, Mateus C Salgado, Sydney P Moak, Xuan Li, John E Hall, Jussara M Do Carmo

Faculty, Staff and Student Publications

Heart failure has a high mortality rate, and current therapies offer limited benefits. The authors demonstrate that activation of the central nervous system leptin-melanocortin pathway confers remarkable protection against progressive heart failure following severe myocardial infarction. The beneficial cardiac-protective actions of leptin require activation of brain melanocortin-4 receptors and elicit improvements in cardiac substrate oxidation, cardiomyocyte contractility, Ca

Racial Disparities In Systemic Sclerosis: Short‐ And Long‐Term Outcomes Among African American Participants Of Sls I And Ii, Elizabeth R Volkmann, Virginia Steen, Ning Li, Michael D Roth, Philip J Clements, Daniel E Furst, Shervin Assassi, Dinesh Khanna, Grace-Hyun J Kim, Jonathan Goldin, Robert M Elashoff, Donald P Tashkin

Faculty, Staff and Student Publications

OBJECTIVE: To evaluate short- and long-term outcomes of African American (AA) participants of Scleroderma Lung Studies (SLS) I and II.

METHODS: SLS I randomized 158 participants with systemic sclerosis-interstitial lung disease (SSc-ILD) to 1 year of oral cyclophosphamide (CYC) versus placebo. SLS II randomized 142 participants with SSc-ILD to 1 year of oral CYC followed by 1 year of placebo versus 2 years of mycophenolate (MMF). Joint models compared the course of forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DLCO) between AA and non-AA, and Cox proportional hazard models assessed long-term morbidity and mortality outcomes.

RESULTS: In …

Restoration Of Cardiac Function After Myocardial Infarction By Long-Term Activation Of The Cns Leptin-Melanocortin System, Fabio N Gava, Alexandre A Da Silva, Xuemei Dai, Romain Harmancey, Sadia Ashraf, Ana C M Omoto, Mateus C Salgado, Sydney P Moak, Xuan Li, John E Hall, Jussara M Do Carmo

Faculty, Staff and Student Publications

Heart failure has a high mortality rate, and current therapies offer limited benefits. The authors demonstrate that activation of the central nervous system leptin-melanocortin pathway confers remarkable protection against progressive heart failure following severe myocardial infarction. The beneficial cardiac-protective actions of leptin require activation of brain melanocortin-4 receptors and elicit improvements in cardiac substrate oxidation, cardiomyocyte contractility, Ca

Mir-9-1 Suppresses Cell Proliferation And Promotes Apoptosis By Targeting Uhrf1 In Lung Cancer, Cheng-You Jia, Wei Xiang, Ji-Bin Liu, Geng-Xi Jiang, Feng Sun, Jian-Jun Wu, Xiao-Li Yang, Rui Xin, Yi Shi, Dan-Dan Zhang, Wen Li, Zavuga Zuberi, Jie Zhang, Gai-Xia Lu, Hui-Min Wang, Pei-Yao Wang, Fei Yu, Zhong-Wei Lv, Yu-Shui Ma, Da Fu

Faculty, Staff and Student Publications

Lung cancer is listed as the most common reason for cancer-related death all over the world despite diagnostic improvements and the development of chemotherapy and targeted therapies. MicroRNAs control both physiological and pathological processes including development and cancer. A microRNA-9 to 1 (miR-9 to 1) overexpression model in lung cancer cell lines was established and miR-9 to 1 was found to significantly suppress the proliferation rate in lung cancer cell lines, colony formation in vitro, and tumorigenicity in nude mice of A549 cells. Ubiquitin-like containing PHD and RING finger domains 1 (UHRF1) was then identified to direct target of miR-9 …

Helping Healthcare Teams Save Lives During Covid-19: Insights And Countermeasures From Team Science, Allison M Traylor, Scott I Tannenbaum, Eric J Thomas, Eduardo Salas

Faculty, Staff and Student Publications

As the COVID-19 pandemic has ravaged the United States, health care teams are on the frontlines of this global crisis, often navigating harrowing conditions at work, such as a lack of personal protective equipment and staffing shortages, and distractions at home, including worries about elderly relatives or making childcare arrangements. While the nature and severity of stressors impacting health care teams are in many ways unprecedented, decades of psychological research exploring teamwork in extreme contexts can provide insights to understand and improve outcomes for teams in a crisis. This review highlights the psychological principles that apply to teams in a …

Interscalene Block For Analgesia In Orthopedic Treatment Of Shoulder Trauma: Single-Dose Liposomal Bupivacaine Versus Perineural Catheter, Andrzej P Kwater, Nadia Hernandez, Carlos Artime, Johanna Blair De Haan

Faculty, Staff and Student Publications

BACKGROUND: Interscalene brachial plexus block is frequently utilized to provide perioperative analgesia to patients undergoing shoulder surgery to optimize recovery, minimize opioid consumption, and decrease overall hospital length of stay. The use of an indwelling perineural interscalene catheter provides extended analgesia and is efficacious in managing severe postoperative pain following major shoulder surgery. Currently, the only alternative to perineural catheters for extended analgesia with interscalene block involves the perineural infiltration of liposomal bupivacaine. However, there is limited published data regarding the overall analgesic effectiveness of using interscalene liposomal bupivacaine in the setting of shoulder surgery.

METHODS: We performed a retrospective …

Influenza Vaccination For The Prevention Of Cardiovascular Disease In The Americas: Consensus Document Of The Inter-American Society Of Cardiology And The Word Heart Federation, Álvaro Sosa Liprandi, María Inés Sosa Liprandi, Ezequiel José Zaidel, Gabriel M Aisenberg, Adrián Baranchuk, Eduardo Costa Duarte Barbosa, Gabriela Borrayo Sánchez, Bryce Alexander, Fernando Tomás Lanas Zanetti, Ricardo López Santi, Ana Girleza Múnera-Echeverri, Pablo Perel, Daniel Piskorz, Carlos Enrique Ruiz-Mori, Jorge Saucedo, Osiris Valdez, José Ramón González Juanatey, Daniel José Piñeiro, Fausto J Pinto, Fernando Stuardo Wyss Quintana

Faculty, Staff and Student Publications

BACKGROUND: Cardiovascular mortality is decreasing but remains the leading cause of death world-wide. Respiratory infections such as influenza significantly contribute to morbidity and mortality in patients with cardiovascular disease. Despite of proven benefits, influenza vaccination is not fully implemented, especially in Latin America.

OBJECTIVE: The aim was to develop a regional consensus with recommendations regarding influenza vaccination and cardiovascular disease.

METHODS: A multidisciplinary team composed by experts in the management and prevention of cardiovascular disease from the Americas, convened by the Inter-American Society of Cardiology (IASC) and the World Heart Federation (WHF), participated in the process and the formulation of …

Profile Of Patients Neutropenia Fever Unrelated To Chemotherapy In Dr. Cipto Mangunkusumo General Hospital, Gantira Danasasmita, Lie Khie Chen, Robert Sinto, Pringgodigdo Nugroho

Jurnal Penyakit Dalam Indonesia

Introduction. The condition of neutropenia increases the risk of infection. The causes of neutropenia are widely discussed as side effects of chemotherapy, but patients with neutropenia who are not due to side effects of chemotherapy are increasing in number. This study aims to provide an overview of the characteristics of neutropenic fever population unrelated to chemotherapy. Method. The study was conducted retrospectively on the medical records of neutropenic fever patients who were not chemotherapy-related in the National Hospital Dr. Cipto Mangunkusumo in January 2018-November 2019. Variables studied included demographic, clinical characteristics, classification of multinational association of supportive care in cancer …

Correlation Of The Quality Of Antibiotic Usage By Utilising Gyssens Flow And The Success Of Treatment In Negative Gram Mdr Sepsis In Tertiary Hospital, Soroy Lardo, Lie Khie Chen, Widayat Djoko Santoso, Cleopas Martin Rumende

Jurnal Penyakit Dalam Indonesia

Introduction. Multi Drug Resistance (MDR) antibiotics have become a global health threat to the community. The use of appropriate antibiotics makes preventive and curative measures very important for the success of overcoming MDR and intervening the complexity of resistance, at least slowing the rate of occurrence of MDR. This study aimed to identify the difference in the quality of antibiotic use quality of use using gyssens flowchart and the success in sepsis patients’ treatment due to gram-negative MDR bacteria with non-MDR bacterial infections in tertiary hospitals. Methods. A retrospective cohort study was conducted using secondary data from patient with age …

Validity And Reliability Test Of European Organization For Research And Treatment Of Cancer Quality Of Life Questionnairebreast 23 In Breast Cancer Patient On Treatment, Mizanul Adli, Hamzah Shatri, Noorwati Sutandyo, Suhendro Suwarto

Jurnal Penyakit Dalam Indonesia

Introduction. Improved survival of breast cancer patients are not necessarily followed by improvement of quality of life. According to the European Organization for Research and Treatment of Cancer (EORTC), cancer patients’ quality of life are very important to be evaluated. In Indonesia, breast cancer patients cannot be assessed their quality of life accurately because there is no valid and reliable questionnaire. This study aims to prove that the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Breast 23 (EORTC QLQ-BR23) is a valid and reliable measuring instrument to be used in Indonesia. Methods. This study was a …

Fever-Induced Brugada Syndrome In An Acute Gastroenteritis Patient: A Case Report, Rio Yansen Cikutra, Irwin Irwin

Jurnal Penyakit Dalam Indonesia

Brugada syndrome (BS) is a disease caused by autosomal dominant sodium channel mutation in the heart. The prevalence of BS worldwide is estimated to be 1-5/10,000 population and the highest prevalence is in Southeast Asia which is >5/10,000 population. Brugada syndrome is a dangerous condition because it predisposes to malignant arrhythmias (ventricular tachycardia/VT and ventricular fibrillation/VS) and sudden cardiac death (SCD). Fever is a trigger for malignant arrhythmias, syncope, or SCD in BS. This article discusses about a case of 64-year-od man patient with complaint of syncope, preceded by chest pain and palpitation. The patient also had a fever and …

Peran Penting Pengendalian Resistensi Antibiotik Pada Pandemi Covid-19, Robert Sinto

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Selection Of Oral Antidiabetic Drugs In Type 2 Diabetes Mellitus Patients With High Risk For Cardiovascular Events, Derlin J. Leander, Dicky L. Tahapary

Jurnal Penyakit Dalam Indonesia

Type 2 diabetes mellitus (DMT2) patients are associated with an increased risk of cardiovascular events. Prior to the era of cardio-vascular trial outcome (CVOT) evidence on the efficacy of old oral diabetes (OAD) drugs such as metformin, sulfonylurea, thiazolidindion, glinid, and alpha glucosidase inhibitors in reducing the risk of cardiovascular events was very limited. Since 2008, all OADs must have CVOT data. DPP-4 inhibitors are neutral against the risk of cardiovascular events while SGLT-2 inhibitors are reported to significantly reduce the risk of cardiovascular events. This finding even helped to change the DMT2 management guidelines issued by American Diabetes Association …

Level Of Disability And Limitation Of Shoulder Motion In Post Mastectomy At Hasan Sadikin Hospital Bandung In 2019, Nadya Rachmawati, Tertianto Prabowo, Fathurrachman Fathurrachman

Jurnal Penyakit Dalam Indonesia

Introduction. Post-mastectomy complications in breast cancer patients can be a long-term disabilities such as limitation of shoulder function that only appears after several months to years after surgery and may remain for the rest of the patient’s life. This study aims to describe the level of disability and limitation of the shoulder joint’s range of motion in breast cancer patients following mastectomy at Hasan Sadikin Hospital, Bandung 2019. Methods. This research was conducted by using descriptive method with cross-sectional study design. Sampling technique using consecutive sampling method during one-month study period. Samples were post-mastectomy breast cancer patients who came to …

The Impact Of “Code Stemi” Program Implementation On Door To Balloon Time And Major Adverse Cardiac Events Of Patients With St Elevation Myocardial Infarction, Prijander L B Funay, Ika Prasetya Wijaya, Eka Ginanjar, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Delay in the management of ST Elevation Myocardial Infarction (STEMI) patients is a cause of high mortality and the incidence of major adverse cardiac events (MACE). Efforts that can be made in health facilities with primary percutaneous coronary intervention (PCI) capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementation the CODE STEMI program. This study aimed to determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing primary PCI. Methods. This was a retrospective cohort study …