Risks for Peripheral Arterial Disease in the Elderly with Type 2 Diabetes Mellitus : Their Correlation with High Sensitivity C-reactive Protein and Ankle-brachial Index

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p <0.001 for right ABI; r = -0.509, p < 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p <0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p < 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (> 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD

The Lactate/Pyruvate Ratio of Metabolic Modulation Using Glucose Insulin Kalium and Lactate Solution and Their Effect on Functional Mechanical Recovery of the Isolated Perfused Heart

Metabolic modulation with Glucose Insulin Kalium (GIK) solution has beenreally well known in their capacity to improve post ischemic heart function. In this regardGIK intervention on post operative Coronary Artery Bypass Graft (CABG) can improveheart function recovery on reperfusion period (Goldhaber dan Weiss, 1992; Atwell et al.,1997). Post operative CABG intervention with GIK will produce a beneficial effect onthe elevation of heart energy to prevent ionic homeostasis disturbance and reactiveoxygen species (ROS) production that become the basis of reperfusion injury (Silvermandan Stern, 1994; Cross et al., 1995; Taegtmeyer et al., 1997; Opie, 1999; Lazar, 2002;Doenst et al., 2003; Trence et al., 2003).Many efforts have been made to clarify how exactly GIK works to improve postischemic heart function as in CABG. This is crucially done in order to be able to modifythe solution concerned. Although this solution has been clearly proved to improve postischemic heart function, it is not totally free from its adverse effect. Its main side effect isthat it can provoke hyperglycemic state, which contrasts with the tight glucose control incontinuously normal range for the patients who are critically ill.In this study lactate and pyruvate level in the coronary effluent were measuredfrom the isolated heart directly perfused with GIK and lactate. It was shown that thepreischemic lactate level was low and then clearly elevated as soon as the reperfusiontook place due to anaerobic metabolism. In accordance with reperfusion time lactate leveldecreased gradually. In relation with pyruvate level, this substrate evolution looked likethe appearance of lactate but its value was lower if compared with lactate.The recovery in functional mechanical activity of the post ischemic heart seems tobe much more related to the pattern of the evolution of logarithmic lactate/pyruvate ratio(L/P ratio). Logarithmic value of L/P ratio in GIK group increased since the earlyreperfusion period (+40%, p < 0.05), followed by improvement in recovery ofmechanical activity in this group which was significantly higher if compared with thecontrol group. Similar fashion was found in lactate group in regard to the evolution of thelogarithmic value of L/P ratio in this group, where its value was significantly highercompared with the control group. The logarithmic evolution pattern on L/P ratio for thisgroup increased along the reperfusion time (+34% p < 0.05).From the present study, it can be concluded that the recovery of functionalmechanical activity of the post ischemic heart perfused with GIK is through modificationon cellular lactate metabolism

High Serum Concentration of Interleukine-6 and Rank-ligand as Risk Factors for Osteoporosis in Estrogen Deficiency Post-menopausal Women

Osteoporosis in post-menopausal women is not merely due to deficient estrogenhormone production. The development of osteoporosis is due to increased boneresorption by osteoclasts. The osteoclast\u27s number and activity is controlled by activatingfactors such as IL-6 and RANK-L. The objective of this study was to determine that highIL-6 and RANK-L serum concentrations are risks for osteoporosis in estrogen deficientpost-menopausal women. The serum concentration of ß-CrossLaps (CTx) was measuredto determine bone resorption rate. This is an observational analytical study using case andcontrol design conducted at Sanglah General Hospital of Denpasar. The sample size wascalculated using the paired case-control study formula. There were 41 osteoporotic and41 non-osteoporotic (control) estrogen deficient post-menopausal women involved in thestudy.Data were analyzed by using the t-paired and McNemar tests. Mean serumconcentration of IL-6 among the osteoporotic women was significantly higher ascompared to that of the controls (3.47±1.75 pg/ml vs 2.51±1.13 pg/ml, p = 0.001). Meanserum concentration of RANK-L among the osteoporotic women was also significantlyhigher as compared to that of the controls (320.66±122.44ng/ml vs 249.94±82.41 ng/ml,p = 0.002). To qualify as risk factors for osteoporosis, the cut-off point for IL-6 was 2.17pg/ml (OR = 4, CI 95%: 1.23-14.24; p = 0.032); the cut-off point for RANK-L was275.165 ng/ml (OR = 8, CI 95%: 1.84-34.79; p = 0.001). Analysis of both high serumconcentration of IL-6 and RANK-L was associated with an odd ratio of 9 (CI 95%: 4,27-18,96, p=0,000). CTx concentration in the osteoporotic women was significantly higherthan in the controls (0.60±0.22ng/ml vs 0.46±0.16ng/ml, p = 0.004).We found that the high IL-6 and RANK-L serum concentrations were risk factorsin estrogen deficient post-menopausal women. CTx being a marker for osteoclastic boneresorption activity, increased in concentration higher in osteoporotic than in nonosteoporoticwomen. The high serum concentrations of IL-6 and RANK-L could be usedas predictors for osteoporosis in estrogen deficient post-menopausal women

Impact of Medical Waste Socialization on Medical Waste Management in Health Services Facilities

It is important to disseminate information about medical waste in health care facilities to provide knowledge and skills for paramedics, patients and the general public so that medical waste generated from each service facility can be managed properly and in accordance with applicable laws. When viewed from the amount of medical waste originating from health facilities, it is estimated that it will increase over time. The reason is that the number of hospitals, health centers, treatment centers, medical laboratories and health clinics is increasing. Thus, the purpose of writing this article is to determine the impact of socialization of medical waste on the handling of medical waste in health care facilities. The method used is Literature Review in a way that is used to collect data or sources related to a particular topic that can be obtained from various sources of English-language international journals sourced from the PubMeb database, Google Schola, Semantic Scholar, Emerald Insight. Search results with keywords Socialization, Medical Waste, Handling, Health Service Facilities found 50 journals that match these keywords. A total of 37 journals from journals found according to the search keywords were then screened, 10 journals were excluded because full text articles were not available. Journals that meet the inclusion range of 5 full text journals are reviewed. So the conclusion is that the dissemination of information in health care facilities is very important in providing knowledge and skills for medical professionals, patients and the general public in managing medical waste

Force, support, and endorsing factors of early marriage in adolescent Sasak (Sasak Ethnic) in Central Lombok

Projection of Indonesian teenager 2000-2025 years of age 10-24 years is reach 64 million or 28.64% of the total population of Indonesia. West Nusa Tenggara with a population growth rate around 1.49% exceeds the national population growth rate 1.1% with fertility during adolescence (early marriage) of 48 / 1,000 children who were born between 15-19 years reached 8359 people. Figures of early marriage on the teen have an impact on social inequalities in the high school dropout rate, premarital sex, divorce and high epidemics of sexually transmitted infections (STIs) as well as the explosion of the population. The research objective was to determine the amplifier, enabling factors and drivers of early marriage in adolescents Sasak in Central Lombok Regency. The research design is a "cross-sectional". Samples of the research 582 people, taken using systematic random sampling method from 2,574 population. The dependent variable of early marriage in adolescents, while teens knowledge about reproductive health, adolescent attitude about early marriage, pregnancy Unwanted (KTD), culture, peer pressure, media exposure information, the role of parents as the independent variable

Benefits of Medical Waste Management in the Facility Health Services

Medical waste is all waste generated from hospital activities in the form of solid, liquid, and gas. The hospital, as a health service facility, is a gathering place for sick and healthy people and can be a source of disease transmission and allows environmental pollution and health problems, also producing waste that can transmit disease. According to the World Health Organization (WHO), waste generated by health service activities includes various kinds of materials, from used needles to soiled sanitary napkins, body parts, diagnostic samples, blood, chemicals, drugs, medical devices, and radioactive materials. To avoid these risks, it is necessary to manage waste in hospitals to protect patients, health workers, visitors, and the community around the hospital from the spread of infection and injury. The aim is to find out the benefits of medical waste management in health care facilities. The method used in writing this article is a literature review by identifying, evaluating, and synthesizing the works of research results and ideas that have been produced by researchers and practitioners. The results of the search process were only taken 27 articles that met the inclusion criteria, namely articles published in the period 2012-2021 and had discussions related to "the benefits of medical waste management in health care facilities and English. Medical waste management is getting rid of and utilizing general waste for other purposes. For general waste, the handling is identical to other domestic waste. Recycling is implemented wherever possible at every opportunity. Uninfected sharps must be properly packaged and will not harm handling workers and can be disposed of like general waste, while infected sharps are treated as hazardous waste

Force, support, and endorsing factors of early marriage in adolescent Sasak (Sasak Ethnic) in Central Lombok

Projection of Indonesian teenager 2000-2025 years of age 10-24 years is reach 64 million or 28.64% of the total population of Indonesia. West Nusa Tenggara with a population growth rate around 1.49% exceeds the national population growth rate 1.1% with fertility during adolescence (early marriage) of 48 / 1,000 children who were born between 15-19 years reached 8359 people. Figures of early marriage on the teen have an impact on social inequalities in the high school dropout rate, premarital sex, divorce and high epidemics of sexually transmitted infections (STIs) as well as the explosion of the population. The research objective was to determine the amplifier, enabling factors and drivers of early marriage in adolescents Sasak in Central Lombok Regency. The research design is a "cross-sectional". Samples of the research 582 people, taken using systematic random sampling method from 2,574 population. The dependent variable of early marriage in adolescents, while teens knowledge about reproductive health, adolescent attitude about early marriage, pregnancy Unwanted (KTD), culture, peer pressure, media exposure information, the role of parents as the independent variable