Genetic Polymorphism in Peripartum Cardiomyopathy

Abstract and Figures Peripartum cardiomyopathy (PPCM) is a rare type of cardiomyopathy. PPCM is a potentially life-threatening pregnancy-associated disease that typically arises in peripartum period and is marked with left ventricular (LV) dysfunction and heart failure. The cause of PPCM remain unclear, but several mechanisms have been proposed ehich indices a potentially multi-factorial etiology. Early case reports identified overlap between familial dilated cardiomyopathy (DCM) and PPCM, although the degree of overlap is largely unknown. Many evidence supporting a contribution from gene mutations in PPCM includes genome-wide association studies, familial occurrence, variable prevalence among different regions and ethnicities, and more recent investigations of panels of genes for mutations among women with PPCM. Although the true incidence of genetic cardiomyopathy is not yet known among women with PPCM, there is substantial evidence demonstrating that genetic contribution to their condition

THE PROFILE OF CORONARY HEART DISEASE PATIENTS IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL, SURABAYA, INDONESIA

Background: Coronary heart disease is a deadly disease for human. The incidence of coronary heart disease is different, so that this research reported the profile of coronary heart disease patients in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Objective: To analyze the profile of CHD patients in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia from February to September 2018. Materials and Methods: A descriptive research based on the medical records. Results: There were 65 male patients and 20 female patients. There were 58% patients aged 50-60 years old, 24% patients aged more than 60 years old, and 18% patients are under 50 years old. The patients’ occupations were as follows: 42% civil servants, 36% private employees, 9% housewives, 5% retirees, 3% entrepreneurs, 1% for teacher, driver, fisherman, priest, and merchant. The complaints included chest pain (40%), shortness of breath (23.5%), PCI (4.6%), thump chest (1.2%), lower right abdominal pain (1.2%), right leg pain (1.2%), nausea (1.2%), vomitting (1.2%), cough (1.2%), dysentry (1.2%), and no complaint (23.5%). CHD patients in Dr. Soetomo General Academic Hospital, Surabaya, Indonesia had the history of hypertension (30.6%), heart disease (22.6%), diabetes mellitus (21.9%), smoking (5.6%), COPD (0.8%), and no history of disease (12.9%). Sixty-one percent of the patients had blood sugar level of  ≥100 mg/dl, 19% patients had blood sugar level of <100 mg/dl, 20% patients did not have data. Conclusion: There were 85 patients, predominantly males of 50-60 years old. The most common occupation of the patients was civil servant and they came with major complaint of chest pain with the history of hypertension

The anatomical snuffbox for transradial access in arteriovenous fistula intervention: Case report and brief review of the literature

Abstract Left distal transradial artery (dTRA) access in the anatomical snuffbox is a relatively novel technique and is considered beneficial when left TRA access is required. This technique offers essential advantages, including improved patient comfort and lower vascular complications. dTRA may provide an entry site for retrograde recanalization of the radial artery. We presented a case of a 65-year-old man with 5-stage chronic kidney disease (CKD) and had left a radio-cephalic arteriovenous fistula (AVF) for routine hemodialysis. There was obstruction of AVF a month after creation. The vascular intervention has been performed using left dTRA access for retrograde recanalization. Angiogram showed cephalic vein obstruction and non-significant stenosis of the proximal radial artery. Percutaneous transluminal angioplasty was successful in improving cephalic vein flow. Hemostatic performed without a hemostatic device. This case report highlights the dTRA access approach in the anatomical snuffbox to recanalize AVF occlusion in the wrist in a patient with CKD

Association between arteriovenous access flow and ventricular function:A cross-sectional study

Background: Permanent hemodialysis access comes with a myriad of problems on top of the well-known benefits; flow disturbances, risk of infection and revision being among them. All of these could eventually lead to impaired cardiac function. Even so, the relationship between impaired cardiac function due to arteriovenous access in patients undergoing hemodialysis has not been clearly described. This study aimed to analyze the relationship of flow in an artificial arteriovenous access with left and right ventricular function in patients with chronic kidney disease (CKD) undergoing hemodialysis at a referral hospital in Indonesia.Material and methods: This was a cross sectional study with consecutive sampling technique. Samples were patients with CKD undergoing hemodialysis at Dr. Soetomo General Hospital from December 2021to January 2022. A total of 47 patients who met the inclusion criteria underwent Doppler ultrasound to assess arteriovenous access flow and transthoracic echocardiography to assess left and right ventricle function.Results: From 47 patients, 26 (55.3%) had high arteriovenous access flow. The clinical characteristics of the patients between the high and low arteriovenous access flow groups were not significantly different. We found that the value of left ventricular ejection fraction in the non-high-flow access group was significantly higher than the high-flow access group (p < 0.05). Other than that, the median right ventricle fractional area changes in the non-high-flow access group was also higher than the high-flow access group (p < 0.05).Conclusion: Arteriovenous access flow as measured by Doppler ultrasonography has a significant relationship with impaired left and right ventricular functions based on systolic function parameters from echocardiography

Carotid Artery Segmentation on Ultrasound Image using Deep Learning based on Non-Local Means-based Speckle Filtering

Abstract: Cardiovascular disease (CVD) causes significant deaths worldwide, of which 17.3 million deaths per year are due to CVD. The use of Ultrasound is necessary to see the abnormalities. The study will segment Carotid Artery segmentation on the Ultrasound image by using the U-Net-based architecture of non-local means-based speckle filtering (NLMBSF). The images will use NLMBSF to reduce speckles, and the data set will be divided into two parts, namely the dataset, which using NLMBSF and not NLMBSF. After that, doing training to create a U-net model, the training data model results will be searched with the best Accuracy. The obtained result of the study is an accuracy value of 97.74%, dice value is 87.22%, and a loss of 0.0107 on data that does not use NLMBSF. Still, it got different data results using NLMBSF, namely 97.6% accuracy, dice value is 84.06% and 0.0138 value loss

The effect of the endothelial nitric oxide synthase on hypoxia-induced factor-1 alpha level in a state of endothelial dysfunction after hyperbaric oxygen therapy

Abstract Aim: This research aims to know the effect of eNOS on hypoxia-induced factor-1 alpha (HIF-1α) levels in endothelial dysfunction after hyperbaric oxygen therapy (HBOT). Materials and Methods: The design of this study was experimental research; the study sample consisted of 30 Sprague Dawley (Rattus norvegicus) white rats and divided into three groups p1, p2, and p3; p1 rats with a standard diet, p2 rats with a high-cholesterol diet, and p3 rats with a high-cholesterol diet continued HBOT at 2.4 ATA with 98% O2 for three sessions with a duration of 30 min/session, and air brakes for 5 min between each session for 10 consecutive days. eNOS and HIF-1α were examined using the enzyme-linked immunosorbent assay method. Results: From the results of testing the significance of the regression model, the results showed that there was a relation of HIF-1α on eNOS levels (P = 0.009) after treatment with HBO 2,4 ATA with 98% oxygen for three sessions with the duration of 30 min/session, and air brake for 5 min between each session for 10 days consecutively. Conclusion: The effect of eNOS on HIF-1α levels in HBOT shows that HBO can significantly affect the levels of HIF-1α through endothelial nitric oxide synthase (eNOS) level

Factor Xa inhibitor for venous thromboembolism management in patient with cancer: a systematic review and meta-analysis

Background: An earlier systematic review reported no differences in the incidence of recurrent venous thromboembolism and major bleeding between factor Xa inhibitors and standard anticoagulation. The present meta-analysis aimed to assess the effectiveness of factor Xa inhibitors for the management of venous thromboembolism (VTE), specifically in patients with cancer, as there were more randomized clinical trials (RCTs) available. Methods: The PubMed and Cochrane Library databases were systematically screened for all RCTs assessing factor Xa inhibitor efficacy for VTE management in cancer patients. Using RevMan 5.3, we performed a Mantel–Haenszel fixed-effects meta-analysis of the following outcomes: recurrent VTE, VTE events, and major bleeding rates. Results: We identified 11 studies involving 7,965 patients. Factor Xa inhibitors were superior in preventing VTE recurrence, compared to low-molecular-weight heparin (LMWH) (OR 0.60; 95% CI 0.45–0.80; P < 0.01) and vitamin K antagonists (VKA) (OR 0.51; 95% CI 0.33–0.78; P < 0.01). As prophylaxis, factor Xa inhibitors had a similar rate of VTE compared to VKAs (OR 1.08 [95% CI 0.31–3.77]; P = 0.90) and a lower rate compared to placebo (OR 0.54 [95% CI 0.35–0.81]; P < 0.01). Major bleeding rates were higher with factor Xa inhibitors than with LMWHs (OR 1.34 [95% CI 0.83–2.18]; P = 0.23), but significantly lower than VKAs (OR 0.71 [95% CI 0.55–0.92]; P < 0.01). Conclusions: Factor Xa inhibitors are effective for VTE management in patients with cancer; however, they are also associated with an increased bleeding risk compared to LMWH, but decreased when compared to VK

Elevated fibrinogen and fibrin degradation product are associated with poor outcome in COVID-19 patients: A meta-analysis

Abstract Introduction: COVID-19 is a systemic infection with a significant impact on coagulation which manifests in thromboembolism. There is an unknown relationship of which coagulation profile parameter at presentation has an association with poor outcome in COVID-19. Objective: This meta-analysis aimed to determine the relationship between fibrinogen and FDP with poor outcome in COVID-19 patients. Methods: A systematic search of all observational studies or trials involving adult patients with COVID-19 that had any data fibrinogen or FDP on admission was carried out using the PubMed, Science Direct, Scopus, ProQuest, and MedRxiv databases. We assessed the methodological quality assessment using the NIH Quality Assessment Tool. We performed random-effects inverse-variance weighting analysis using mean difference (MD). Results: A total of 17 studies (1,654 patients) were included in this meta-analysis. It revealed a higher mean of fibrinogen levels on admission in patients with severe case compared to those with non-severe case (MD = 0.69, [95% CI: 0.44 to 0.94], p < 0.05; I2 = 72%, p < 0.05). Non-survivor group had a pooled higher mean difference of fibrinogen values on admission (MD = 0.48 [95% CI: 0.13 to 0.83], p < 0.05; I2 = 38%, p = 0.18). Higher FDP on admission was found in poor outcome (composite of severity, critically ill, and mortality) compared to good outcome (4 studies, MD = 4.84 [95% CI: 0.75 to 8.93], p < 0.05; I2 = 86%, p < 0.05). Conclusion: Elevated fibrinogen and FDP level on admission were associated with an increase risk of poor outcome in COVID-19 patients

Elevated fibrinogen and fibrin degradation 1 product are associated with poor outcome in 2 COVID-19 patients: A meta-analysis

INTRODUCTION: COVID-19 is a systemic infection with a significant impact on coagulation which manifests in throm11 boembolism. There is an unknown relationship of which coagulation profile parameter at presentation has an association with poor outcome in COVID-19. OBJECTIVE: This meta-analysis aimed to determine the relationship between fibrinogen and FDP with poor outcome in COVID-19 patients. METHODS: A systematic search of all observational studies or trials involving adult patients with COVID-19 that had any data fibrinogen or FDP on admission was carried out using the PubMed, Science Direct, Scopus, ProQuest, and MedRxiv databases. We assessed the methodological quality assessment using the NIH Quality Assessment Tool. We performed random-effects inverse-variance weighting analysis using mean difference (MD). RESULTS: A total of 17 studies (1,654 patients) were included in this meta-analysis. It revealed a higher mean of fibrinogen levels on admission in patients with severe case compared to those with non-severe case (MD= 0.69, [95% CI: 0.44 to 0.94], p < 0.05; I2 = 72%, p < 0.05). Non-survivor group had a pooled higher mean difference of fibrinogen values on admission (MD= 0.48 [95% CI: 0.13 to 0.83], p < 0.05; I2 = 38%, p = 0.18). Higher FDP on admission was found in poor outcome(composite of severity, critically ill, and mortality) compared to good outcome (4 studies, MD= 4.84 [95% CI: 0.75 to 8.93], p < 0.05; I2 = 86%, p < 0.05). CONCLUSION: Elevated fibrinogen and FDP level on admission were associated with an increase risk of poor outcome in COVID-19 patients