The effect of oral anticoagulant use before visit for patients with COVID-19 on mortality: A meta-analysis

Objectives: Anticoagulants have been used as therapeutic or prophylactic agents in COVID-19 and seem to be more beneficial. However, the advantage of oral anticoagulant (OAC) consumption before visit in lowering mortality in COVID-19 patients remains debatable. This meta-analysis aimed to evaluate the effect of OAC use before visit on mortality using the hazard ratio (HR) to estimate the effect of time-to-event endpoints. Materials and Methods: We conducted a literature search in the PubMed and ProQuest databases for any studies comparing groups consuming OAC to no-OAC before visit for mortality in patients with COVID-19. We calculated the overall HRs and their variances across the studies using the random-effects model to obtain pooled estimates. Results: We included 12 studies which had sample sizes ranging from 70 to 459,402 patients. A meta-analysis comparing OAC therapy and non-OAC consumption in COVID-19 patients before visit revealed no decrease in all-cause mortality (HR = 0.92, 95% confidence interval [CI]: 0.83–1.02, P = 0.12; I2 = 68%). However, subgroup analysis of laboratory-confirmed populations revealed that OAC use before visit had a beneficial effect on mortality (HR = 0.84, 95% CI: 0.73–0.98, P = 0.02; I2 = 56%). Conclusion: The use of OAC before visit had no beneficial effect on all-cause mortality in COVID-19 patients

Modification on acute myocardial infarction model through left anterior descending coronary artery ligation: An experimental study on rats(Rattus norvegicus) using readily available materials

Background and Aim: Several difficulties are involved in creating models for myocardial infarction (MI) in animals, such as low survival rates after acute MI, complicated techniques in creating animal models, complexities in confirming acute MI incidence, and complex surgical tools needed in the process. This study aimed to develop an animal model for acute MI using Wistar rats utilizing simple instruments that are readily available in standard animal laboratories. Materials and Methods: We induced MI in 48 Wistar rats using the left anterior descending coronary artery ligation modification technique without tracheal incision and ventilator. This ligation technique was performed 1-2 mm distal to the left atrial appendage. MI occurrence was evaluated using heart enzyme parameters 24 h post-ligation and histological studies of the infarcted area 6 weeks after the ligation. Rats were divided into the coronary artery ligation group and sham group. Results: Of the 48 rats, 24 (50%) died within 24 h post-ligation, but no further deaths occurred in the next follow-up period of 6 weeks. The average infarct size in six rats within 24 h of ligation was 35%±5.7%. The serum glutamic oxaloacetic transaminase level of the group treated with coronary artery ligation was statistically significantly higher than that of the sham group (p=0.000). Conclusion: We developed an MI rat model with consistent infarction size, in which the long-term death of rats was not observed. Our ligation technique for an MI rat model can be a reference for experimental settings without ventilators for small animals

EFFECT OF HYPERTENSION TO THE POST OPERATIVE OUTCOME IN INTRACEREBRAL HEMORRHAGIC PATIENTS

Intisari:LATAR BELAKANG: Perdarahan intra serebral adalah kondisi serius dan dapat muncul tiba-tiba tanpa peringatan. Kondisi ini disebabkan oleh pecahnya pembuluh intra serebral dan dapat menyebabkan hematoma di otak. Bertindak sebagai benjolan, dapat meningkatkan tekanan intrakranial (ICP) dan akan mengaktifkan autoregulasi, tekanan darah akan meningkat secara otomatis untuk menjaga tekanan perfusi serebral konstan. Kontroversi terus ada apakah tekanan darah tinggi pada pasien perdarahan intraserebral harus dikelola sebelum menjalani perawatan operasi atau tidak. Sementara secara logika mengurangi tekanan darah dapat mengurangi hasil yang buruk, tetapi ada juga mengatakan bahwa cepatnya penurunan MAP, angka kematian yang didapat akan lebih tinggi. Perhatian akhir didasarkan pada kepustakaan medis, dikatakan bahwa daerah sekitar hematom ada di mana aliran darah otak berkurang. Jika benar maka menurunkan tekanan darah dapat meningkatkan kerusakan iskemik. Setiap tahun perdarahan intra serebral terjadi pada sekitar 2 juta orang di seluruh dunia dan kejadian ini merupakan kejadian tertinggi di Asia. Oleh karena itu, Tujuan dari penelitian ini adalah untuk mengetahui pengaruh hipertensi terhadap hasil paska operasi pasien perdarahan intra serebral. Apakah tekanan darah yang tinggi harus dikontrol sebelum menjalani operasi operasi pada pasien perdarahan intra serebral atau tidak untuk mendapatkan yang hasil operasi yang terbaik. Desain penelitian yang digunakan adalah studi kohort retrospektif melibatkan pasien perdarahan intraserebral dengan dan tanpa riwayat hipertensi dan menjalani operasi yang dilakukan oleh dokter spesialis bedah saraf . Penelitian ini akan mengamati pengaruh yang signifikan antara pasien ICH dengan dan tanpa hipertensi pada hasil paska operasi . Hasil paska operasi yang dilihat di sini adalah hasil kondisi paska operasi , apakah operasi ini sukses ( pasien masih hidup ) atau pasien meninggal . TUJUAN: Tujuan dari penelitian ini adalah untuk mengamati efek hipertensi terhadap hasil paska operasi pada pasien perdarahan intra serebral. Apakah hipertensi harus dikontrol sebelum menjalani operasi pada pasien perdarahan intra serebral atau tidak untuk mendapatkan hasil paska operasi yang terbaik . METODE: Desain penelitian ini merupakan penelitian kohort retrospektif yang melibatkan pasien perdarahan intra serebral dengan dan tanpa hipertensi yang menjalani operasi di RSUD Sardjito di 2013-2015 . Penelitian ini akan mengamati pengaruh yang signifikan antara pasien perdarahan intra seebral dengan dan tanpa hipertensi terhadap hasil paska operasi . Operasi akan dilakukan oleh dokter spesialis bedah saraf . The pasca operasi hasil yang kita lihat di sini adalah pos kondisi operasi , apakah operasi ini sukses ( pasien masih hidup ) atau meninggal . HASIL: Tidak ada pengaruh yang signifikan antara hipertensi( MAP > 110 ) dengan hasil paska operasi pada pasien perdarahan intra serebral KATA KUNCI: MAP, Hipertensi, Perdarahan intra serebral, Paska Operasi Abstract:Background: Intracerebral hemorrhage is a serious condition and appears suddenly without warning condition that results from the rupture of an intracerebral vessel leading to the development of a hematoma in the brain. Acting as a mass-producing lesion, can increased intracranial pressure (ICP) and activate the autoregulation , blood pressure will be increased automatically to keep the cerebral perfusion pressure in constant . Controversy continues to exist whether high blood pressure in this intracerebral hemorrhage patients must be managed before undergo operative treatment or not. While logically reducing blood pressure, poor outcome can be decreased, but there is also said that rapid decline MAP, the higher mortality. The final concern is based on medical litterature , it is said that an area around the hematoma exist where cerebral blood flow is reduced. If this true then lowering blood pressure could increase any ischemic damage . Intracerebral hemorrhage (ICH) occurs in an estimated 2 million people worldwide each year and the incidence is highest in Asians. Therefore, The objective of this research is to observe the effect of hypertension to the post operative outcome in intracerebral hemorrhagic patients. Whether high blood pressure should be controlled before undergo operative surgery in intracerebral hemmorhage patient or not to get the best post operative outcome. The study design is retrospective cohort study involving intracerebral hemorrhage patients with and without hypertension who had undergo surgery done by neurosurgeon specialist. This study will observe on any significant effect between ICH patients with and without hypertension to the post operative outcome. The surgery will be done by neurosurgery specialist doctor. The post operative outcome that we see here is the post operative condition, whether the operative is success (patient is alive) or died. Objective: The objective of this research is to observe the effect of hypertension to the post operative outcome in intracerebral hemorrhagic patients. Whether high blood pressure should be controlled before undergo operative surgery in intracerebral hemmorhage patient or not to get the best post operative outcome. Method: The study design is retrospective cohort study design involving Intracerebral Hemorrhagic patients with and without hypertension who undergo surgery in RSUD Sardjito in 2013-2015. This study will observe on any significant effect between ICH patients with and without hypertension to the post operative outcome. The surgery will be done by neurosurgery specialist doctor. The post operative outcome that we see here is the post operative condition, whether the operative is success (patient is alive) or died. Conclusion:There is no significant effect of hypertension(MAP>110) to the post operative result in intracerebral hemorrhagic patients Key Words: MAP, Hypertension, ICH, Post Operativ

Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta-Analysis of a Randomized Trial

Purpose. A previous meta-analysis has conducted nonrandomized trials for mechanochemical ablation (MOCA). Since medium-term follow-up data from randomized clinical trials (RCTs) are becoming available, we chose to perform a meta-analysis of RCTs to assess the efficacy and safety of MOCA for saphenous vein insufficiency. Methods. A systematic search of all RCTs comparing the anatomical success of MOCA for saphenous vein insufficiency to thermal ablation was performed using the PubMed and Cochrane Library databases. We employed the Mantel-Haenszel random-effects meta-analysis of outcomes using RevMan 5.3. Results. Four studies (615 patients) were included in this meta-analysis. The MOCA group had 93.4% and 84.5%, whereas the thermal ablation group had 95.8% and 94.8% of anatomical success rate at 1 month (short-term) and a period of more than 6 months but less than 1-year follow-up (mid-term), respectively. According to intention-to-treat analysis, there were similar anatomical successes in MOCA and thermal ablation groups at the short-term follow-up (low-quality evidence; relative risk RR=0.98 (95% CI, 0.94–1.03); P=0.44; I2=53%). The estimated effect of MOCA on anatomical success showed a statistically significant reduction at the mid-term follow-up (moderate-quality evidence; RR=0.89 (95% CI, 0.84–0.95); P=0.0002; I2=0%). MOCA had fewer incidence of nerve injury, deep vein thrombosis, and skin burns compared to the thermal ablation procedure (low-quality evidence; RR=0.33 (95% CI, 0.09–1.28); P=0.11; I2=0%). Conclusion. MOCA offered fewer major complications but lesser anatomical success at the period of more than 6 months but less than 1-year follow-up than thermal ablation. Trial Registration. This trial is registered with UMIN Clinical Trial Registry (UMIN ID 000036727)

Mechanical Occlusion Chemically Assisted Ablation (MOCA) for Saphenous Vein Insufficiency: A Meta-Analysis of a Randomized Trial

Abstract Purpose: A previous meta-analysis has conducted nonrandomized trials for mechanochemical ablation (MOCA). Since medium-term follow-up data from randomized clinical trials (RCTs) are becoming available, we chose to perform a meta-analysis of RCTs to assess the efficacy and safety of MOCA for saphenous vein insufficiency. Methods: A systematic search of all RCTs comparing the anatomical success of MOCA for saphenous vein insufficiency to thermal ablation was performed using the PubMed and Cochrane Library databases. We employed the Mantel-Haenszel random-effects meta-analysis of outcomes using RevMan 5.3. Results: Four studies (615 patients) were included in this meta-analysis. The MOCA group had 93.4% and 84.5%, whereas the thermal ablation group had 95.8% and 94.8% of anatomical success rate at 1 month (short-term) and a period of more than 6 months but less than 1-year follow-up (mid-term), respectively. According to intention-to-treat analysis, there were similar anatomical successes in MOCA and thermal ablation groups at the short-term follow-up (low-quality evidence; relative risk (RR) = 0.98 (95% CI, 0.94-1.03); P = 0.44; I 2 = 53%). The estimated effect of MOCA on anatomical success showed a statistically significant reduction at the mid-term follow-up (moderate-quality evidence; RR = 0.89 (95% CI, 0.84-0.95); P = 0.0002; I 2 = 0%). MOCA had fewer incidence of nerve injury, deep vein thrombosis, and skin burns compared to the thermal ablation procedure (low-quality evidence; RR = 0.33 (95% CI, 0.09-1.28); P = 0.11; I 2 = 0%). Conclusion: MOCA offered fewer major complications but lesser anatomical success at the period of more than 6 months but less than 1-year follow-up than thermal ablation. Trial Registration. This trial is registered with UMIN Clinical Trial Registry (UMIN ID 000036727)

Modification on acute myocardial infarction model through left anterior descending coronary artery ligation: An experimental study on rats (Rattus norvegicus) using readily available materials

Background and Aim: Several difficulties are involved in creating models for myocardial infarction (MI) in animals, such as low survival rates after acute MI, complicated techniques in creating animal models, complexities in confirming acute MI incidence, and complex surgical tools needed in the process. This study aimed to develop an animal model for acute MI using Wistar rats utilizing simple instruments that are readily available in standard animal laboratories. Materials and Methods: We induced MI in 48 Wistar rats using the left anterior descending coronary artery ligation modification technique without tracheal incision and ventilator. This ligation technique was performed 1-2 mm distal to the left atrial appendage. MI occurrence was evaluated using heart enzyme parameters 24 h post-ligation and histological studies of the infarcted area 6 weeks after the ligation. Rats were divided into the coronary artery ligation group and sham group. Results: Of the 48 rats, 24 (50%) died within 24 h post-ligation, but no further deaths occurred in the next follow-up period of 6 weeks. The average infarct size in six rats within 24 h of ligation was 35%±5.7%. The serum glutamic oxaloacetic transaminase level of the group treated with coronary artery ligation was statistically significantly higher than that of the sham group (p=0.000). Conclusion: We developed an MI rat model with consistent infarction size, in which the long-term death of rats was not observed. Our ligation technique for an MI rat model can be a reference for experimental settings without ventilators for small animals

Modification on acute myocardial infarction model through left anterior descending coronary artery ligation: An experimental study on rats (Rattus norvegicus) using readily available materials

Abstract Background and aim: Several difficulties are involved in creating models for myocardial infarction (MI) in animals, such as low survival rates after acute MI, complicated techniques in creating animal models, complexities in confirming acute MI incidence, and complex surgical tools needed in the process. This study aimed to develop an animal model for acute MI using Wistar rats utilizing simple instruments that are readily available in standard animal laboratories. Materials and methods: We induced MI in 48 Wistar rats using the left anterior descending coronary artery ligation modification technique without tracheal incision and ventilator. This ligation technique was performed 1-2 mm distal to the left atrial appendage. MI occurrence was evaluated using heart enzyme parameters 24 h post-ligation and histological studies of the infarcted area 6 weeks after the ligation. Rats were divided into the coronary artery ligation group and sham group. Results: Of the 48 rats, 24 (50%) died within 24 h post-ligation, but no further deaths occurred in the next follow-up period of 6 weeks. The average infarct size in six rats within 24 h of ligation was 35%±5.7%. The serum glutamic oxaloacetic transaminase level of the group treated with coronary artery ligation was statistically significantly higher than that of the sham group (p=0.000). Conclusion: We developed an MI rat model with consistent infarction size, in which the long-term death of rats was not observed. Our ligation technique for an MI rat model can be a reference for experimental settings without ventilators for small animals

The Relationship of HSP-70 with Calcineurin, Sod and Catalase Post-Acute Myocardial Infarction in Wistar Rats Model

Abstract Background: HSP-70 production increased following myocardial ischemia. HSP-70 helps to reduce infarct area through unclear mechanism. It appears that HSP-70 activates calcineurin and induce antioxidant enzymes such as superoxide dismutase (SOD) and catalase. No work has been done, however, to show correlation between HSP-70 and calcineurin, SOD and catalase post-acute myocardial infarction. In the present study, therefore, we sought to investigate the relationship of HSP-70 with calcineurin, SOD and catalase post-acute myocardial infarction (AMI). Methods: An experimental study involved 24 Wistar rats as models of chronic coronary occlusion. The rats were randomly divided into 4 group: no-intervention after AMI (N), sedentary intervention after AMI (S), exercise intervention after AMI (E), and sham (C). Intervention consisted of 2 weeks of recovery then 4 weeks of sedentary for group S or exercise for group E. HSP-70, calcineurin, SOD, and catalase expression in heart were evaluated the difference among groups. Correlation between HSP-70 to other proteins was analysed also. Results: HSP-70 and calcineurin was higher in group S and E compared to group N and C. HSP-70 (MD=0.97, 95%CI 0.60 to 1.34), calcineurin (MD=1.25, 95%CI 0.68 to 1.82, p< 0.05), catalase (MD= 0.57, 95%CI 0.25 to 0.88, p< 0.05), and SOD (0.42, 95%CI 0.14 to 0.69, p< 0.05) significantly higher in Group E compared to S. Sham group had higher SOD and catalase activity than group E. HSP-70 was correlated with calcineurin (r=0.856, p<0.05). HSP-70 was correlated with catalase and SOD when the analysis included only groups who had intervention. Conclusion: HSP-70 and calcineurin was increased, but catalase and SOD was depleted in post-AMI condition. Exercise improved HSP-70, calcineurin, catalase, and SOD activities post-AMI. HSP-70 expression increased directly calcineurin expression