SULISTIANINGRUM

TEKNIK KARDIOVASKULAR

Subjects and verbs must AGREE with one another in number (singular or plural).
Thus, if a subject is singular, its verb must also be singular; if a subject is plural, its
verb must also be plural.

Subject + [perpositional phrase] + verb

When a sentence begins with there is – there are / here is – here are, the subject and verb
are inverted. After all that you have learned already, you will undoubtedly find this topic a
relatively easy one.
Although each part of the compound subject is singular (ranger and camper), taken
together (joined by and), each one becomes a part of a plural structure and, therefore, must
take a plural verb (see) to agree in the sentence.

Exercise 11 : Subject – Verb Agreement

1. Neither Bill nor Mary (is/are) going to the play tonight.
2. Anything (is/are) better than going to another movie tonight.
3. Skating (is/are) becoming more popular every day.
4. A number of reporters (was/were) at the conference yesterday.
5. Everybody who (has/have) a fever must go home immediately.
6. Your glasses (was/were) on the bureau last night.
7. There (was/were) some people at the meeting last night.
8. The committee (has/have) already reached a decision.
9. A pair of jeans (was/were) in the washing machine this morning.
10. Each student (has/have) answeres the first three questions.
11. Either John or his wife (make/makes) breakfast each morning.
12. After she had perused the material, the secretary decided that everything (was/were)
in order.
13. The crowd at the basketball game (was/were) wild with excitement.
14. A pack of wild dogs (has/have) frightened all the ducks away.
15. The jury (is/are) trying to reach a decision.
16. The army (has/have) eliminated this section of the training test.
17. The number of students who have withdrawn from class this quarter (is/are) appalling.
18. There (has/have) been too many interruptions in this class.
19. Every elementary school teacher (has/have) to take this examination.
20. Neither jill nor her parents (has/have) seen this movie before.
 SULISTIANINGRUM
TEKNIK KARDIOVASKULAR

Ratification Journal Media Medika Muda

PERIODONTAL DISEASE AS A CAUSE OF CORONARY
HEART DISEASE IN RSUP DR. KARIADI SEMARANG

Arranged By :
PRASETYO NUGROHO

ABSTRACT
Background : Cardiovascular disease is a prevalent disease that occured on human
populationin this world. This disease was in second position in the most deadly disease after
infection. One of cardiovascular disease that become prevalent lately in Indonesia was coronary
heart disease. Coronary heart disease have many risk factors, one of them is pathological
condition of artery blood vessel inner wall, that suspected by some doctors can be caused by
bacterial activity from periodontal disease, a disease that most people think harmless. The
previous researchs already suspected that there are relation from this two disease, but none of
them can define the real realtionship, because of to many confound factors. The aim of this
research is to find out wether there any conection beetwen periodontal disease and coronar
heart disease or not.
Methods : This was a descriptive-analytical research with Case-controlapproach, the samples
are 35 coronary heart disease patienst, and 35 others heart diseases patient, all of the samples
were treated in second and third class of Dokter Kariadi Hospital heart ward. The periodontal
index was counted with classification from Russel.
Result : Using Chi square test to analyze the characteristics of samples, it can be concluded
that hipertension and oral health care have significant relation with coronary heart disease. And
using Mann whitney test, it`s concluded that periodontal disease have significant relationship
with coronary heart disease. But, because there are more than one variable that has significant
relationship with coronary heart disease, we`re using Logistic-Regression test to excluded other
confounding factors.
Conclusion : There is a relation from periodontal disease and coronary heart disease, but there
is confounding factor that is more dominant, it is hipertension.
Key words : Coronary heart diseas, periodontal disease
PRELIMINARY
Cardiovascular disease is a disease that is very common in the human population in the
world. This disease is in a position to second in the world's deadliest disease after infection,
which is about 29% of all deaths that occur in the world's population. Atherosclerosis is a major
component of cardiovascular disease about one of four people and cause death in 39% of
patients in the United States.
Coronary heart disease is a heart disease which is mainly caused by the disorder, either
a narrowing or blockage of the coronary arteries of the heart.
While periodontal disease is a wide variety of pathological alteration in the periodontal
tissues. These diseases have developed various changes regarding the theory of etiology. Prior
to 1960 scientists believed that only periodontal disease is caused by deposits of calculus which
acts as a mechanical irritant periodontal tissues. In 1965-1980 scientists found periodontal
disease can occur not only as a result of the calculus, but could also be due to the accumulation
of plaque bacteria in the oral cavity. Based on the results of scientific research of periodontal
disease is not only caused by plaque bacteria alone, the response of the host against plaque
bacteria have an important effect on periodontal tissue damage, oral conditions, habits,
systemic disease, and genetic factors are also a risk factor for periodontal disease.
The general form of periodontal disease is gingivitis and periodontitis, the two diseases
are the most common diseases in the human population in the world. Ginggivitis caused by
plaque gingival disease is most often the case, the severity and duration of the disease is
influenced by the interaction of bacteria - host cells, as well as systemic factors, medication
and nutrition.
Periodontitis is an inflammatory-based infections, which the backers of network gear,
and has the characteristics of tissue damage - the network advocates teeth, and alveolar bone
that can lead to tooth loss. Periodontitis Chronic periodontitis is the type most often occur,
usually occurs in adults, but it can also be about children - children. The severity of chronic
periodontitis comparable to oral health factors and the amount of exposure to pathologic agents
that exist in the oral cavity.
Infection is a risk factor for atherosclerosis and thromboembolic cause. Gram - negative
or similar lipopolysaccharide (endotoxin), when on trial in experimental animals, can induce
inflammatory cell infiltration into the large blood vessels, proliferation of smooth muscle of
blood vessels, degeneration of the layer of fat in blood vessels, and coagulation in blood
vessels.
According to some studies, there is a relationship between periodontal disease and
coronary heart disease, including immunology, namely on inflammatory markers such as C -
reactive protein, fibrinogen, leukocyte count was found in the levels were significantly higher
in patients with severe gingivitis or periodontitis. Moreover, it can also be caused by a variety
of bacteria, such as Streptococcus, Streptococcus β - hemolytic group A can download the
synthesis of hemolysin to menghemolisis erythrocytes either complete or incomplete, while
Streptococcus type A can synthesize pyrogenic exotoxin, exotoxin brings structure lisogenic
and superantigen, then the bacteria Stap hylococcus also produce Toxic shock syndrome toxin
- 1 (TSST - 1) also contains a superantigen toxin that can induce toxic shock syndrome. While
Hujoel et al, in a study concluded that there is no ti Berar relationship between periodontal
disease and coronary heart disease events.
 Of the few studies that have been done in part to the conclusion that the case of
periodontal had a significant role in the incidence of coronary heart disease, but not least
berpendapa t that periodontal disease can not be linked to heart disease 7 Coronary because
there is insufficient study data supporting how this process can occur ,
Besides, in the department of Kariadi far not conducted a similar study, therefore the
authors are interested in doing research on the relationship ihit the two diseases.

RESULTS
Has conducted research to see periodontal index in patients with heart disease who were
treated in the cardiac ward grade 2 and grade 3 in Hospital doctor Kariadi Semarang. L
periodonta index data retrieval performed in the period from April to July 2012. Researchers
using primary data obtained through the measurement of periodontal indices were measured
and calculated based on Russell's periodontal index, the number of sample was 35 patients p
enderita coronary heart disease, and 35 patients heart disease other than coronary heart disease,
as well as using secondary data obtained from a questionnaire given to the subject of research.
Test for normality using the Shapiro - W ilk, and data analysis were used using Chi-square and
Mann Whitney.

DISCUSSION
In a study conducted has obtained data to test the hypothesis, the study sample were 70
people, 35 patients with coronary heart disease, heart disease and 35 patients with non-CHD.
All samples were obtained from hospital cardiac ward doctor Kariadi Semarang class II and
class III, who studied during the period from April to July. From the results, the characteristics
of the study sample. By using Chi - Square knowable factors - fax tors influencing coronary
heart disease. Based on the analysis of data characteristic of sample is known that factors
Gender (p = 0.63), diabetes mellitus (p = 0.290), smoking (p = 0.150), Alcohol (p = 0.205),
family history (p = 0. 526 ) did not have a significant association with the incidence of coronary
heart disease, 11 while hypertension (p = 0.031), and check the teeth (p = 0.048) had a
significant association with coronary heart disease (p <0.05). This may disebaban because, in
individuals who have never done oral health check, of course, will have a mouth situation worse
compared to individuals who routinely check the health of the mouth so the chances of
developing periodontal disease will be higher. Hypertension is a risk factor for coronary heart
disease, indirectly hypertensive role of proinflammatory cause in patients with hypertension,
there will be an increase in angiotensin II, a potent vasoconstrictor, it can memperpa rah
atherosclerosis to the coronary arteries of the heart, and then directly hypertension affect
coronary heart disease through increased peripheral pressure which is a causative factor of
coronary heart disease.
In a study conducted a has obtained data to test the hypothesis, the study sample were
70 people, 35 patients with coronary heart disease, heart disease and 35 patients with non-
CHD. All samples were obtained from hospital ward doctor Jantung Kariadi Semarang class II
and class III, who studied during the period from April to July. From the results, the
characteristics of the study sample. By using Chi - Square knowable factors - factors that
berpengar uh against coronary heart disease. Based on the analysis of data characteristic of
sample is known that factors Gender (p = 0.63), diabetes mellitus (p = 0.290), smoking (p =
0.150), Alcohol (p = 0.205), family history (p = 0526) is not i choose a meaningful relationship
with the incidence of coronary heart disease, whereas hypertension (p = 0.031), and check the
teeth (p = 0.048) had a significant association with coronary heart disease (p <0.05). This may
disebaban because, in individuals who have never done oral health check, of course, will have
a mouth situation worse compared to individuals who routinely check the health of the mouth
so the chances of developing periodontal disease will be higher. Hypertension merupak an risk
factor for coronary heart disease, is 12 not directly hypertension role of proinflammatory cause
in patients with hypertension, there will be an increase in angiotensin II, a potent
vasoconstrictor, it can aggravate atherosclerosis, which may involve the coronary arteries of
the heart, and then directly hypertensive effect coronary heart disease through increased
peripheral pressure which is a causative factor of coronary heart disease. 5 For deases
relationship between periodontal and coronary heart disease, used the method Mann - Whitney,
this is done as an alternative of Paired T - Test for index data obtained are nominal data. The
results of tests carried out based on the data obtained by mel alui research using Mann -
Whitney, significant relationship between periodontal disease and coronary heart disease (p =
0.022), this proves the hypothesis, that there is a relationship between disease period ontal with
coronary heart disease can be accepted.

CONCLUSION
Based on data analysis and discussion that has been done, it can be concluded that there
is a relationship between periodontal disease and coronary heart disease. Thus, the hypothesis
has been proposed is acceptable.

SUGGESTION
Further research is needed with a longer time, the number of more samples, and also
requires special attention to the factors - factors that can affect the periodontal situation.
MINI-TEST 1 : GRAMMAR ITEMS 3 THROUGH 14
1. Buying clothes are often a very time-consuming practice because those clothes that a
A B C
person likes are reraly the ones that fit him or her.
D
2. Because they had spent too many time considering the new contract, the students
A B D
lost the opportunity to lease the apartement.
C
3. These televisions are all too expensive for we to buy at this time, but perhaps we will
A B C D
return later.
4. After she had bought himself a new automobile, she sold her bicycle.
A B C D
5. The next important question we have to decide is when do we have to submit the
A B C D
proposal.
6. George has not completed the assignment yet, and maria hasn’t neither.
A B C D
7. John decided to buy in the morning a new car, but in the afternoon
A B C
he changed his mind.
D
8. Some of the plants in this store require very little care, but this one needs
A B
much more sunlight than the others ones.
C D
9. After George had returned to his house, he was reading a book.
A B C D
10. Many theories on conserving the purity of water has been proposed, but not one has
A B C
been as widely accepted as this one.
D
11. The food that Mark is cooking in the kitchen is smelling delicious.
A B C D
12. After John eaten dinner, he wrote several letters and went to bed.
A B C D
13. The manager has finished working on the report last night, and now she will begin
A B C
to write the other proposal.
D
14. Because Sam and Michelle had done all of the work theirselves, they were
A B C

Unwilling to give the results to Joan.

D
15. Daniel said that if he had to do another homework tonight, he
A B
Would not be able to attend the concert.
C D
16. After to take the medication, the patient became drowsy and more manageable.
A B C D
17. We insist on your leaving the meeting before any further outbursts take place.
A B C D
18. It has been a long time since we have talked to john, isn’t it?
A B C D
19. Henry objects to our buying this house without the approval of our attorney, and
A B C
John does so.
D
20. Rita enjoyed to be able to meet several members of Congress during her vacation.
A B C C
21. After being indicted for his part in a bank robbery, the reputed mobster decided find
A B C D
another attorney.
22. Harry’s advisor persuaded his taking several courses which did not involve
A B C
Much knowledge of mathematics.
D
23. The only teachers who were required to attend the meeting were George, Betty, Jill,
A B C
and me.
D
24. The work performed by these officers are not worth our paying them any longer.
A B C D
25. The president went fishing after he has finished with the conferences.
A B C D
26. Peter and Tom plays tennis every afternoon with Mary and me.
A B C D
27. There were a time that I used to swim five laps every day, but now I do not
A B C
have enough time.
D
28. He was drink a cup of coffee when the telephone rang.
A B C D
29. We called yesterday our friends in Boston to tell them about the reunion that we are
A B C D
planning.
30. The children were playing last night outdoors when it began to rain very hard.
A B C D
31. Those homework that your teacher assigned is due on Tuesday unless you have made
A B C D
 prior arrangements to turn it in late.
32. Please give me a few coffee and some donuts if you have any left.
A B C D
33. There are ten childs playing in the yard near her house, but your child is not
A B C
among them.
D
34. People respected George Washington because he was a honest man, and he turned out
A B C
to be one of our greatest military leaders.
D
35. He isn’t driving to the convention in March, and neither they are.
A B C D
36. Catherine is studying law at the university, and so does John.
A B C D
37. The company has so little money that it can’t hardly operate anymore.
A B C D
38. My cousin attends an university in the Midwest wich specializes in astronomy.
A B C D
39. The students were interested in take a field trip to The National History Museum, but
A B C
they were not able to raise enough money.
D
40. Because they have moved away, they hardly never go to the beach anymore.
A B C D
41. Us students would rather not attend night classes in the summer, but we often have to.
A B C D
42. The policeman ordered the suspect to don’t remove his hands from the hood of the car
A B C D
43. It was him who came running into the classroom with the news.
A B C D
44. My brother doesn’t care how much does the car cost because he is going to buy it
A B C D
anyway.
45. Marry and her sister studied biology last year, and so does Jean.
A B C D
46. Pete had already saw that musical before he read the reviews about it.
A B C D
47. There’s a new Oriental restaurant in town, isn’t it?
A B C D
48. The government has decided voting on the resolution now rather than next month.
A B C D
49. The professor is thinking to go to the conference on aerodynamics next month.
A B C D
50. His father does not approve of him to go to the banquest without dressing formally.
A B C D