PARENTS' BEHAVIOR IN GIVING DRUG IN CHILDREN WITH TUBERCULOSIS IN POLYCLINIC CHILDREN RSUD. DR. PIRNGADI MEDAN

Lung tuberculosis (TB) is one of the diseases that need special attention in Indonesia; this is because Indonesia is ranked third after the world of India and China with patients about 10% of the total number of TB patients in the world. This research aims to identify the picture of behavior parents in the provision of drugs in children with TB in Children Polyclinic RSUD. Dr. Pirngadi Medan. This study uses descriptive design with the number of samples of 42 respondents. Samples were taken using consecutive sampling technique. The data were collected using a knowledge, attitude, and action questionnaire. The data collected were analyzed using descriptive statistics, then the result of data analysis is presented in frequency distribution table and percentage. The result of this research indicates that the majority of respondents have good knowledge as much as 85.7%, and the majority of respondents have good attitude of 76.2% while the majority of respondents have an adequate action of 52.3%. The results of this study can be used as information and reference for child and community nurses in providing nursing care, especially health education and monitoring of treatment for patients with pulmonary TB in undergoing treatment

Montessory Method in Training Development of Health Protocol Ambassadors Facing the Post COVID-19 Pandemic Era at SD Muhammadiyah 01 Medan

Along the decline COVID-19 cases in Indonesia, the implementation of Limited Face-to-face Learning (PTM) in education units was again carried out by observing the implementation of strict health protocols by education units. In the implementation, various problems were found, such as the lack of awareness of students in implementing health protocols. The solutions offered by the Community Service team to support preventing the spread of COVID-19 and improving healthy lifestyles include developing a health protocol ambassador program through a peer teaching program with the Montessori method. This activity was carried on August 8, 2022 with assistance and monitoring carried out until August 22, 2022 at SD Muhammadiyah 01 Medan with a total sample of 60 people. The results showed an increase before and after the activity, before the activity was carried out as many as 31 (51.7%) respondents were at a moderate level of knowledge, 37 (61.7%) positive attitudes and 32 (53.3%) good behavior respondents. After the activities were carried out, 47 (78.3%) respondents had high knowledge, 60 (100%) positive attitudes and 46 (76.7%) good behavior. Therefore, this method is effective in increasing the knowledge, attitudes and behavior of students' awareness about health protocols and prevention of COVID-19 transmission

MRI-Based Computational Torso/Biventricular Multiscale Models to Investigate the Impact of Anatomical Variability on the ECG QRS Complex

Aims:Patient-to-patient anatomical differences are an important source of variability in the electrocardiogram, and they may compromise the identification of pathological electrophysiological abnormalities. This study aims at quantifying the contribution of variability in ventricular and torso anatomies to differences in QRS complexes of the 12-lead ECG using computer simulations. Methods:A computational pipeline is presented that enables computer simulations using human torso/biventricular anatomically based electrophysiological models from clinically standard magnetic resonance imaging (MRI). The ventricular model includes membrane kinetics represented by the biophysically detailed O’Hara Rudy model modified for tissue heterogeneity and includes fiber orientation based on the Streeter rule. A population of 265 torso/biventricular models was generated by combining ventricular and torso anatomies obtained from clinically standard MRIs, augmented with a statistical shape model of the body. 12-lead ECGs were simulated on the 265 human torso/biventricular electrophysiology models, and QRS morphology,duration and amplitude were quantified in each ECG lead for each of the human torso-biventricular models. Results:QRS morphologies in limb leads are mainly determined by ventricular anatomy,while in the precordial leads, and especially V1 to V4, they are determined by heart position within the torso. Differences in ventricular orientation within the torso can explain morphological variability from monophasic to biphasic QRS complexes. QRS duration ismainly influenced by myocardial volume, while it is hardly affected by the torso anatomyor position. An average increase of 0.12±0.05 ms in QRS duration is obtained for eachcm3of myocardial volume across all the leads while it hardly changed due to changes in torso volume. Conclusion:Computer simulations using populations of human torso/biventricular models based on clinical MRI enable quantification of anatomical causes of variability in the QRS complex of the 12-lead ECG. The human models presented also pave theway toward their use as testbeds in silico clinical trial

Analysis of Community Behavior in Coronavirus Disease-19 Prevention in Medan

BACKGROUND: Coronavirus (Co V) is a type of virus that can cause interference with the respiratory tract. The development of COVID-19 is happening fast in the world, especially in Indonesia. In Medan, the highest number of COVID-19 cases was spread in the Medan Selayang sub-district. One of the steps taken by the government to reduce transmission of COVID-19 is by implementing prevention and social distancing behavior. Community behavior is influenced by various factors such as age, sex, physical nature, level of education, socioeconomic to culture. AIM: To find out the factors that influence the community behavior of Medan Selayang people in the effort to prevent COVID-19 METHOD: This cross-sectional study was conducted on 102 respondents. Data collection methods, in the form of primary data, are carried out by distributing and filling out questionnaires through the Google form media. RESULTS: from 102 respondents were found that 90.2% of respondents had good behavior in COVID-19 prevention efforts. In the multinomial logistic regression, found sig. (P) on the variables of gender, age, education level and employment status respectively of 0.360; .772; 0.860; and 0.878 (p value> 0.05). CONCLUSION: In this study, no significant relationship was found between sex, age, education level, and employment status on COVID-19 preventive behavior Keywords: COVID-19, Behavior, Prevention Measures &nbsp

Human-based approaches to pharmacology and cardiology: an interdisciplinary and intersectorial workshop

Both biomedical research and clinical practice rely on complex datasets for the physiological and genetic characterization of human hearts in health and disease. Given the complexity and variety of approaches and recordings, there is now growing recognition of the need to embed computational methods in cardiovascular medicine and science for analysis, integration and prediction. This paper describes a Workshop on Computational Cardiovascular Science that created an international, interdisciplinary and inter-sectorial forum to define the next steps for a human-based approach to disease supported by computational methodologies. The main ideas highlighted were (i) a shift towards human-based methodologies, spurred by advances in new in silico, in vivo, in vitro, and ex vivo techniques and the increasing acknowledgement of the limitations of animal models. (ii) Computational approaches complement, expand, bridge, and integrate in vitro, in vivo, and ex vivo experimental and clinical data and methods, and as such they are an integral part of human-based methodologies in pharmacology and medicine. (iii) The effective implementation of multi- and interdisciplinary approaches, teams, and training combining and integrating computational methods with experimental and clinical approaches across academia, industry, and healthcare settings is a priority. (iv) The human-based cross-disciplinary approach requires experts in specific methodologies and domains, who also have the capacity to communicate and collaborate across disciplines and cross-sector environments. (v) This new translational domain for human-based cardiology and pharmacology requires new partnerships supported financially and institutionally across sectors. Institutional, organizational, and social barriers must be identified, understood and overcome in each specific setting

Metabolic profiling of aortic stenosis and hypertrophic cardiomyopathy identifies mechanistic contrasts in substrate utilization

Aortic stenosis (AS) and hypertrophic cardiomyopathy (HCM) are distinct disorders leading to left ventricular hypertrophy (LVH), but whether cardiac metabolism substantially differs between these in humans remains to be elucidated. We undertook an invasive (aortic root, coronary sinus) metabolic profiling in patients with severe AS and HCM in comparison with non‐LVH controls to investigate cardiac fuel selection and metabolic remodeling. These patients were assessed under different physiological states (at rest, during stress induced by pacing). The identified changes in the metabolome were further validated by metabolomic and orthogonal transcriptomic analysis, in separately recruited patient cohorts. We identified a highly discriminant metabolomic signature in severe AS in all samples, regardless of sampling site, characterized by striking accumulation of long‐chain acylcarnitines, intermediates of fatty acid transport across the inner mitochondrial membrane, and validated this in a separate cohort. Mechanistically, we identify a downregulation in the PPAR‐α transcriptional network, including expression of genes regulating fatty acid oxidation (FAO). In silico modeling of β‐oxidation demonstrated that flux could be inhibited by both the accumulation of fatty acids as a substrate for mitochondria and the accumulation of medium‐chain carnitines which induce competitive inhibition of the acyl‐CoA dehydrogenases. We present a comprehensive analysis of changes in the metabolic pathways (transcriptome to metabolome) in severe AS, and its comparison to HCM. Our results demonstrate a progressive impairment of β‐oxidation from HCM to AS, particularly for FAO of long‐chain fatty acids, and that the PPAR‐α signaling network may be a specific metabolic therapeutic target in AS

Metabolic profiling of aortic stenosis and hypertrophic cardiomyopathy identifies mechanistic contrasts in substrate utilization

Open Access via the Wiley Agreement UKRI | Medical Research Council (MRC), Grant/Award Number: MR/ P011705/1, MC_UP_A090_1006 and MR/S010483; British Heart Foundation (BHF); NIHR | NIHR Oxford Biomedical Research Centre (OxBRC)Peer reviewe

The interplay between metabolic alterations, diastolic strain rate and exercise capacity in mild heart failure with preserved ejection fraction

Background: Heart failure (HF) is characterized by altered myocardial substrate metabolism which can lead to myocardial triglyceride accumulation (steatosis) and lipotoxicity. However its role in mild HF with preserved ejection fraction (HFpEF) is uncertain. We measured myocardial triglyceride content (MTG) in HFpEF and assessed its relationships with diastolic function and exercise capacity. Methods: 27 HFpEF (clinical features of HF, left ventricular EF >50%, evidence of mild diastolic dysfunction and evidence of exercise limitation as assessed by cardiopulmonary exercise test) and 14 controls underwent 1H-magnetic resonance spectroscopy (1H-MRS) to measure MTG (lipid/water, %), 31P-MRS to measure myocardial energetics (phosphocreatine-to-adenosine triphosphate - PCr/ATP) and feature-tracking magnetic resonance imaging for diastolic strain rate. Results: When compared to controls, HFpEF had 2.3 fold higher in MTG (1.45±0.25% vs. 0.64±0.16%, p=0.009) and reduced PCr/ATP (1.60±0.09 vs. 2.00±0.10, p=0.005). HFpEF had significantly reduced diastolic strain rate and maximal oxygen consumption (VO2 max), which both correlated significantly with elevated MTG and reduced PCr/ATP. On multivariate analyses, MTG was independently associated with diastolic strain rate while diastolic strain rate was independently associated with VO2 max. Conclusions: Myocardial steatosis is pronounced in mild HFpEF, and is independently associated with impaired diastolic strain rate which is itself related to exercise capacity. Steatosis may adversely affect exercise capacity by indirect effect occurring via impairment in diastolic function. As such, myocardial triglyceride may become a potential therapeutic target to treat the increasing number of patients with HFpEF.This work was supported by Chest Heart and Stroke Association, Scotland. MM acknowledges support from the National University of Malaysia and Ministry of Higher Education Malaysia. SN and OR acknowledge support from the Oxford NIHR Biomedical Research Centre and the Oxford British Heart Foundation Centre of Research Excellence. JES is a Senior BHF Basic Science Research Fellow (FS/11/50/29038). CTR is funded by a Sir Henry Dale Fellowship from the Wellcome Trust and the Royal Society [098436/Z/12/Z/B]. OR is a BHF Clinical Intermediate Research Fellow FS/16/70/32157