Endothelial dysfunction in diabetes mellitus

Diabetes mellitus is associated with an increased risk of cardiovascular disease, even in the presence of intensive glycemic control. Substantial clinical and experimental evidence suggest that both diabetes and insulin resistance cause a combination of endothelial dysfunctions, which may diminish the anti-atherogenic role of the vascular endothelium. Both insulin resistance and endothelial dysfunction appear to precede the development of overt hyperglycemia in patients with type 2 diabetes. Therefore, in patients with diabetes or insulin resistance, endothelial dysfunction may be a critical early target for preventing atherosclerosis and cardiovascular disease. Microalbuminuria is now considered to be an atherosclerotic risk factor and predicts future cardiovascular disease risk in diabetic patients, in elderly patients, as well as in the general population. It has been implicated as an independent risk factor for cardiovascular disease and premature cardiovascular mortality for patients with type 1 and type 2 diabetes mellitus, as well as for patients with essential hypertension. A complete biochemical understanding of the mechanisms by which hyperglycemia causes vascular functional and structural changes associated with the diabetic milieu still eludes us. In recent years, the numerous biochemical and metabolic pathways postulated to have a causal role in the pathogenesis of diabetic vascular disease have been distilled into several unifying hypotheses. The role of chronic hyperglycemia in the development of diabetic microvascular complications and in neuropathy has been clearly established. However, the biochemical or cellular links between elevated blood glucose levels, and the vascular lesions remain incompletely understood. A number of trials have demonstrated that statins therapy as well as angiotensin converting enzyme inhibitors is associated with improvements in endothelial function in diabetes. Although antioxidants provide short-term improvement of endothelial function in humans, all studies of the effectiveness of preventive antioxidant therapy have been disappointing. Control of hyperglycemia thus remains the best way to improve endothelial function and to prevent atherosclerosis and other cardiovascular complications of diabetes. In the present review we provide the up to date details on this subject

Inflammatory cytokines and atrial fibrillation: current and prospective views

Atrial fibrillation (AF) is the most common sustained arrhythmia and a challenging clinical problem encountered in daily clinical practice. There is an increasing body of evidence linking inflammation to a broad spectrum of cardiovascular conditions including AF. Historical evidence supports an association between AF and inflammation and is consistent with the association of AF with inflammatory conditions of the heart, such as myocarditis and pericarditis. AF has been associated with myocardial oxidative stress, and antioxidant agents have demonstrated antiarrhythmic benefit in humans. Increased plasma interleukin (IL)-6, C-reactive protein (CRP), and plasma viscosity support the existence of an inflammatory state among “typical” populations with chronic AF. These indexes of inflammation are related to the prothrombotic state and may be linked to the clinical characteristics of the patients (underlying vascular disease and comorbidities), rather than simply to the presence of AF itself. It has been suggested that inflammation may have a role in the development of atrial arrhythmias after cardiac surgery, and that a genetic predisposition to develop postoperative complications exists. Cytokines can have a prognostic significance; IL-6 levels, CRP, and other cytokines may have prognostic value in AF. Cytokine lowering therapies, statins, angiotensin converting enzyme inhibitors and other anti-inflammatory agents may have a role in the treatment of AF. The present article provides an overview of the evidence linking inflammatory cytokines to AF and their therapeutic and prognostic implications

Gambaran Kebiasaan Minum Air Putih pada Ibu Hamil dan Ibu Menyusui di Poli BKIA RS Bhakti Rahayu

Poor fluid intake can cause either mild or chronic hypovolemia for pregnant mothers. This will certainly complicate the delivery process. On the other hand, for breastfeeding-mothers, in addition to normal fluid loss through urination, evaporation (sweat), and defecation (stool), mothers also loss a lot of water from breastfeed. Consequently, hydration has become essential for both pregnant and breastfeeding mothers. There are many types of fluids that can be consumed by pregnant and breastfeeding mother. Water has the most dominant contribution in hydration process compared to other types of liquids. However, preliminary studies among the majority of pregnant and breastfeefing mothers shows that they have a habit of consuming lesser water, due to myths. Taking this further, this study aims to see a general picture of water consumption among pregnant and breastfeeding mothers. This research uses quantitative approach and descriptive method with qualitative method (in depth interview) as complemented data. This study takes the sample of pregnant women and breastfeeding mothers in RS Bhakti Rahayu Surabaya with total of 50 mothers, 25 mothers each. The sampling technique used is simple random sampling. The result shows that both pregnant and breastfeeding mothers have a good water consumption habit, although there are still few, who have poor level of water consumption habit.This may be due to high levels of exposure to external information, particularly health, given that the majority of mothers are active social media users and often use the platform as an information portal

STRATEGI KEPALA MADRASAH DALAM MENINGKATKAN MUTU PENDIDIKAN PADA MIN BUENGCALA KECAMATAN KUTA BARO KAB ACEH BESAR

Abstract: Strategies of principal is an important factor in determining the success of the improvement of school quality. This study aimed to describe the strategies of principal from the planning, implementation, supervision, and obstacles in improving education quality. To achieve the goal, this study used qualitative approach and descriptive method. Data collection through observation, interview, and documentation study. Data analysis procedure were data reduction, data display, and data verification. Subjects of this study were principal, vice principal, and teachers. The results of the study showed that (1) The strategies of principal in improving learning effectiveness conducted by teachers with the suggestion that teachers’ discipline should be improved and teachers should prepare lesson plan, (2) The strategies of principal in improving teacher potential by conducting various trainings and technical guidance, and teacher have to equip themselves with quality reading, (3) There was no obstacle in the condition of school staff/personnel and teachers but there were obstacles in facility and infrastructure especially the classrooms condition which were inadequate, the school did not have multipurpose building, and the school environment condition was plagued by inconvenient vehicles and public transportations. Keywords: Strategies of Principal and Education Quality. Abstrak: : Strategi kepala madrasah merupakan faktor yang penting dalam menentukan keberhasilan peningkatan mutu dimadrasah. Penelitian ini bertujuan mendesripsikan strategi kepala madrasah dari perencanaan, pelaksanaan, pengawasan dan hambatan dalam meningkatkan mutu pendidikan. Untuk mencapai tujuan tersebut, penelitian ini menggunakan pendekatan kualitatif dengan metode deskriptif. Teknik pengumpulan data dilakukan melalui Observasi, Wawancara dan Studi Dokumentasi. Prosedur analisis data adalah Reduksi Data, Penyayian Data, dan Verifikasi. Sedangkan subjek penelitian adalah Kepala Madrasah, Wakil Kepala Madrasah, dan Guru. Hasil penelitian menunjukkan bahwa: (1) Strategi kepala madrasah dalam meningkatkan efektivitas pembelajaran yang dilaksanakan guru dengan anjuran kedisiplinan guru harus ditingkatkan serta perangkat pembelajaran harus di miliki oleh setiap guru (2) Strategi kepala madrasah dalam meningkatkan potensi guru dengan melakukan berbagai pelatihan dan bimtek serta guru membekali diri dengan bacaan yang bermutu (3) Kendala yang dihadapi kepala madrasah dalam implementasi strategi kepala madrasah dalam meningkatkan mutu pendidikan tidak memiliki kendala bila dilihat dari kondisi staf/karyawan madrasah, kondisi guru di madrasah tetapi masih terkendala dengan sarana dan prasana terutama ruang kelas yang belum memadai serta gedung serbaguna yang belum ada sama sekali, sedangkan kondisi lingkungan madrasah terkendala dengan ketidak nyamanan kendaraan dan sarana transportasi pemerintah.Kata kunci : Strategi Kepala Madrasah, dan Mutu Pendidika

Elevated serum leptin levels in patients with acute myocardial infarction; correlation with coronary angiographic and echocardiographic findings

BACKGROUND: To assess the relationship between serial serum leptin levels in patients with acute myocardial infarction (AMI) who received thrombolysis and the degree of coronary atherosclerosis, coronary reperfusion, echocardiographic findings, and clinical outcome. 51 consecutive patients presenting with AMI were studied. Clinical characteristics including age, sex, body mass index (BMI) and cardiovascular risk factors were recorded. Serial serum leptin levels at the time of admission and subsequently at 0, 6, 12, 24, 36, 60 hours afterwards were obtained. Coronary angiography was performed in 34 patients; the relation between serum leptin levels and evidence of coronary reperfusion as well as the extent of coronary atherosclerosis according to the coronary artery surgery study classification (CASS) were evaluated. Echocardiographic evaluation was performed in all patients. 36 matched patients were enrolled as control group who had serum leptin level 9.4 ± 6.5 ng/ml. RESULTS: The patients mean age was 50.5 ± 10.6 years. There were 47 males and 3 females. 37.1% were diabetics, 23.5% were hypertensive, 21.6% were dyslipidemic and 22.7% were obese (BMI ≥ 30). Leptin concentrations (ng/ml) increased and peaked at the 4th sample (36 hrs) after admission (mean ± SD) sample (1) =9.55 ± 7.4, sample (2) =12.9 ± 8.4, sample (3) =13.8 ± 10.4, sample (4) =18.9 ± 18.1, sample (5) =11.4 ± 6.5, sample (6) =10.8 ± 8.9 ng/ml. There was a significant correlation between serum leptin and BMI (r = 0.342; p = 0.03). Leptin levels correlated significantly to creatine kinase level on the second day (r = 0.43, p ≤ 0.01). Significant correlation of mean serum leptin with the ejection fraction (P < 0.05) was found. No difference in timing of peak serum leptin between patients who achieved coronary reperfusion vs. those who did not (p = 0.8). There was a trend for an increase in the mean serum leptin levels with increasing number of diseased vessels. There was no correlation between serum leptin levels and outcome neither during the hospitalization nor at 9 months follow up. CONCLUSION: Serum leptin levels increase after myocardial infarction. Serum leptin level may be a predictor of the left ventricular ejection fraction and the degree of atherosclerosis but not of coronary reperfusion

Strategi Kepala Madrasah Dalam Meningkatkan Mutu Pendidikan Pada Min Buengcala Kecamatan Kuta Baro Kab Aceh Besar

: Strategies of principal is an important factor in determining the success of the improvement of school quality. This study aimed to describe the strategies of principal from the planning, implementation, supervision, and obstacles in improving education quality. To achieve the goal, this study used qualitative approach and descriptive method. Data collection through observation, interview, and documentation study. Data analysis procedure were data reduction, data display, and data verification. Subjects of this study were principal, vice principal, and teachers. The results of the study showed that (1) The strategies of principal in improving learning effectiveness conducted by teachers with the suggestion that teachers' discipline should be improved and teachers should prepare lesson plan, (2) The strategies of principal in improving teacher potential by conducting various trainings and technical guidance, and teacher have to equip themselves with quality reading, (3) There was no obstacle in the condition of school staff/personnel and teachers but there were obstacles in facility and infrastructure especially the classrooms condition which were inadequate, the school did not have multipurpose building, and the school environment condition was plagued by inconvenient vehicles and public transportations

Nano-Fe3O4/O2: Green, Magnetic and Reusable Catalytic System for the Synthesis of Benzimidazoles

Magnetic nano-Fe3O4 was applied in the presence of atmospheric air as a green, efficient, heterogeneous and reusable catalytic system for the synthesis of benzimidazoles via the reactions of o-phenylenediamine (1 eq) with aryl aldehydes (1 eq) in excellentyields (85–97 %) and short reaction times (30–100 min) with a proposed mechanism.Keywords: Benzimidazole, benzene-1,2-diamine, aldehyde, nano-Fe3O4, heterogeneous catalyst, magnetite, O

Economics bridge between theory and practice of Sustainable built environment: a case for marginal benefit and marginal cost

Common economic gauges that validate Sustainable Built Environment (SBE) in households may cause for such projects to be shelved especially when the result of commercial feasibility study does not favour the stakeholders. It is a fact that the capital cost of Energy Efficient (EE) equipment and Renewable Energy (RE) system are more expensive than the conventional methods. However, SBE is now necessary and the gap between theory and practical of SBE in relation to economics aspect must be narrowed. The economics of SBE must not only assert the environmental implication but also make tangible its benefit to the household for championing the cause. In Economics, Marginal Cost (MC) and Marginal Benefits (MB) measure additional benefits of every additional costs of investment at a specific level of production and consumption; and Economists suggests that effective gain and loss must be compared to the status quo, i.e., Relative Position (RP). These Economics theories of MC, MB and RP are adapted to measure the progression of SBE with regards to lighting requirements in a living/dining area simulated to represent two types of houses: with and without Passive Architecture (PA) design strategies. Both are applied with conventional incandescent light bulbs and EE light fittings as well as RE in lieu of the mains electricity supply. The comparative approach shows the value of MB and MC at every stage of the SBE progression and this enables the household to make informed decision at a margin. The result suggests that the value of MB is more than MC when both cases use EE light fittings, i.e., approximately RM2 gain for every RM1 cost. It is also found that RE benefits the household more in PA case. This approach makes economic sense in so far encouraging household to opt for SBE