The Role of AT1R A1166C Gene Polymorphism in Coronary Slow Flow Phenomenon of Undergoing Coronary Angiography Patients

BACKGROUND: The presence of gene polymorphisms in the renin-angiotensin-aldosterone system associated with an impaired endothelial function that causes atherosclerosis and also myocardial fibrosis such as the polymorphism of the angiotensin-converting enzyme gene and the angiotensin I receptor (AT1R) gene. AIM: This research was aimed to explore the role of AT1R A1166C gene polymorphism in the incidence of coronary slow flow phenomenon (CSFP) in the Malay population, South Sumatra, Indonesia. METHODS: This study is a comparative analysis using a case-control study design to analyze the effect of the AT1R A1166C gene polymorphism on the incidence of slow flow phenomenon in patients undergoing elective coronary angiography at Mohammad Hoesin Hospital Palembang, Indonesia. Examination of AT1R gene polymorphism was carried out with several steps starting from deoxyribonucleic acid extraction, polymerase chain reaction process, followed by restriction fragment length polymorphism stages with Ddel restriction enzymes and visualization. RESULTS: Thirty-two patients participated in these study-baseline characteristics between homogeneous coronary regular flow groups and homogeneous coronary slow flow groups. There is no difference between genotype distribution, allele frequency, and genotype between the CSFP and the coronary standard flow group. CONCLUSION: There is no influence of AT1R A1166C gene polymorphism on the CSFP in patients undergoing coronary angiography

Potential of Omega-3 Supplementation on Muscle Mass, Muscle Strength, and Physical Performance in Elderly Community

BACKGROUND: Geriatric problem characterized by reduced functional ability and impaired adaptation function caused by the decline in various body systems, as well as increased vulnerability to various kinds of stressors, which reduce a person’s functional performance. AIM: This study was aimed to explore the effect of omega-3 supplementation on muscle mass, muscle strength, and physical performance in the elderly community in Palembang, Indonesia. METHODS: This study is an open clinical trial, to assess the potential of omega-3 supplementation on muscle mass, handgrip strength, and physical activity of elderly community. Omega-3 is given as much as 1.2 g once a day for 12 weeks orally. Muscle strength was assessed using Bioelectrical Impedance Analysis. Meanwhile, the muscle strength was assessed with a muscle dynamometer. RESULTS: Omega-3 supplementation has only shown potent efficacy in improving muscle strength in geriatrics patients (before omega-3 supplementation 25.1 + 5.11; after omega-3 supplementation 26.2 + 5.16; p < 0.05). Omega 3 supplementation did not show significant improvement in muscle mass and gait ability in elderly patients. CONCLUSIONS: Omega-3 supplementation improves handgrip strength but does not increase muscle mass and physical performance for geriatrics

The Effect of Angiotensin-Converting Enzyme Gene Polymorphisms in the Coronary Slow Flow Phenomenon at South Sumatra, Indonesia Population

BACKGROUND: The coronary slow flow phenomenon (CSFP) is believed to be affected by endothelial dysfunction ruled by renin, angiotensin, aldosterone, and the angiotensin-converting enzyme (ACE). The gene of ACE has been characterized in humans by a major insertion (I)/deletion (D) polymorphism. Serum ACE levels were associated with I/D polymorphism in the ACE-encoding gene. AIM: This study explored and analyzed the role of ACE gene polymorphism risk factors with the incidence of CSFP in the population of South Sumatra, Indonesia. METHODS: This study was a cross-sectional analytic observational study. A total of 112 CSFP and non- CSFP patients participated in this study. Blood was obtained from the study subjects then processed. Angiotensin I and aldosterone levels were examined using the enzyme-linked immunosorbent assay. The Judkins method was used in the assessment of coronary angiography, which was carried out through the femoral artery. For the examination of ACE I/D polymorphisms, genome deoxyribonucleic acid was extracted from blood cells (leukocytes), using the Wizard’s purification system and examined using the polymerase chain reaction method. All data were evaluated through the Chi-square test, two samples t-test, and Mann–Whitney U-test. All tests used two-sided significance and p < 0.05 was considered statistically significant. RESULTS: ACE I/D gene polymorphism possessed a significant effect in increasing the risk of CSFP. Genotype II polymorphism increased the risk of CSFP as much as 6.9 times compared to individuals with ID/DD genotype. The existence of allele I increased the risk of CSFP 5.7 times compared to allele D. Levels of angiotensin I and aldosterone were increased significantly in patients with CSFP. CONCLUSION: ACE I/D gene polymorphism possessed a significant effect in increasing the risk of CSFP. Genotype of II was the risk factor for the development of CSFP in population of South Sumatra, Indonesia

Correlation of Serum Sclerostin Levels with Carotid Intima Media Thickness in Chronic Kidney Disease Hemodialysis

Chronic kidney disease is associated with a high mortality rate, especially cardiovascular disease associated with mineral and bone disorders. Sclerostin is an inhibitor of Wnt signaling which has the effect of increasing the occurrence of vascular calcification in patients with chronic kidney disease. There are several studies that show different results. Carotid intima media thickness ultrasound examination is a tool to identify atherosclerosis which is part of vascular calcification. The aim of this study is to look at the correlation of sclerostin with carotid intima media thickness (CIMT) in patients with chronic kidney disease undergoing hemodialysis. In this cross section, the concentration of sclerostin was measured by examination of enzymed linked immunosorbent assay. CIMT measurement by ultrasound mode B examination. There were 40 patients in this study. The mean sclerostin level was 256.68 ± 127.76 pg / ml. Sclerostin levels are declared high if above 162 pg / ml there are 30 people. CIMT thickening was present in 11 patients. There was no significant correlation of serum sclerostin with CIMT in patients with chronic kidney disease undergoing hemodialysis (r-0.32 p0,847). In multivariate linear regression, hemodialysis duration is an independent factor that is significantly significant with CIMT. There was no significant correlation of serum sclerostin with CIMT in patients with chronic kidney disease undergoing hemodialysis

The Effect of Vitamin D Supplementation on the Increase in CD4 count of HIV/AIDS Patients Receiving Antiretroviral Therapy

Introduction. Vitamin D plays a role in health overall, but hypovitaminosis D stilloccurs throughout the world. HIV/AIDS patients are prone to suffer fromhypovitaminosis D because of the infection itself and the side effects of antiretroviraltherapy. Various effort have been tried to improve the immune status of HIV/AIDSpatients, one of them is by adding vitamin D. Vitamin D acts as an antiinflammatoryso that it can prevent apoptosis of CD4 T cells and increase CD4 cell count.Methods. This is a randomized control trial add on a study that aims to determinethe effect of vitamin D to increase in CD4 counts of HIV / AIDS patients who havereceived antiretroviral drugs. Subjects were HIV / AIDS patients who had receivedantiretroviral drugs. A total of 20 subjects were divided randomly into two groups;one group received vitamin D (calcitriol 0.5 mcg per day) for eight weeks, and theother group that received a placebo. Each group was measured of CD4 cell countbefore and after treatment. Results. There was a significant increase in the CD4 cellcount of the vitamin D group (p = 0.046), but not in the CD4 cell count of bothgroups (p = 0.985). The comparison of mean CD4 cell counts between groups beforetreatment was not significantly different (p = 0.057), but after treatment, it becamesignificantly different (p = 0.040). Conclusion. Vitamin D has been successful inincreasing CD4 cell count in the vitamin D group, and it is recommended to giveHIV / AIDS patients to increase CD4 cell count

The Role of High-sensitivity C-reactive Protein Serum in Assessing Troponin T in Acute Myocardial Infarction

BACKGROUND: The incidence of acute myocardial infarction (AMI) is increasing worldwide. Inflammation plays an essential role in the initiation and progression of atherosclerosis and the pathogenesis of acute cardiovascular events. C-reactive protein (CRP) has been shown to have prognostic value in patients with acute coronary syndrome, but the most promising use of CRP has been used for primary use. AIM: This study was aimed to explore the sensitivity of high-sensitivity CRP (hs-CRP) in assessing troponin T in AMI. METHODS: The study design was an observational study to assess the sensitivity and specificity of hsCRP against troponin T in patients with AMI with ST-elevation and without ST-elevation. This research was conducted in Palembang, Indonesia. The study subjects were 56 patients with an acute myocardial infusion that met the inclusion and exclusion criteria. RESULTS: The sensitivity of hs-CRP to troponin-T is 93.7%. The specificity of hs-CRP to troponin T was 37.5%. The positive suspected value is 0.9, the estimated negative value is 0.5, the positive likelihood ratio is 1.49, and the negative likelihood ratio is 0.16. CONCLUSION: hs-CRP is quite sensitive in assessing troponin-T but not specific enough in assessing troponin-T activity

The Role of Percutaneous Ventricular Restoration Therapy in Heart Failure After Myocardial Infarction

The process of ventricular remodeling has a major role in the pathogenesis of heart failure in patients with myocardial infarction. Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), antialdosterone diuretics, and beta receptor blockers are drugs that have been widely accepted as anti-remodeling agents. However, sometimes the efficacy of these drugs is inadequate, or their use is constrained by low blood pressure. Percutaneous ventricular restoration therapy is an action that aims to exclude segments of the myocardium that have akinetic or aneurysms by implanting a ventricular partitioning device percutaneously. This technique is expected to prevent the progression of ventricular remodeling through a procedure with a lower risk of intraprocedural mortality than the surgical approach

Role of Fibroblast Growth Factor-23 in Coronary Slow Flow Phenomenon Pathogenesis

The phenomenon of angina chest pain without significant epicardial coronary artery stenosis, but accompanied by a slowdown in coronary blood flow is often found in patients with symptoms of acute coronary syndrome who undergoing invasive coronary angiography. This phenomenon of slow coronary blood flow is then called the coronary slow flow phenomenon (CSFP). The pathogenesis mechanism of CSFP remains unclear. The pathogenesis of CSFP is thought to be multifactorial. Endothelial dysfunction, small vessel disease, inflammation, renin system angiotensin aldosterone, atherosclerosis are thought to be involved in the pathogenesis of CSFP. Cardiovascular disease incidence and death were associated with elevated levels of Fibroblast growth factor-23 (FGF-23). High levels of FGF-23 can lead to formation of blood vessel calcification, left ventricular hypertrophy, arterial stiffness, endothelial dysfunction, increased inflammatory markers and elevated levels of angiotensin II. It is suspected that FGF-23 has a role in this event other than as a regulator of bone and mineral metabolism. This literature review aims to determine the relationship between fibroblast growth factor-23 and the pathophysiology of CSFP. Based on the broad role of FGF-23, it is possible that FGF-23 is involved in the pathogenesis of CSFP