The Mechanism of Coronary Artery Calcification in Centrally Obese Non-Diabetic Men: Study on The Interaction of Leptin, Free Leptin Index, Adiponectin, hs-C Reactive Protein, Bone Morphogenetic Protein-2 and Matrix Gla Protein

Background: The calcium in the artery was thought to be the result of the imbalance or dysregulation of the promoter and inhibitor cytokines influenced by various subclinical and clinical conditions. This study aimed to investigate the interaction between central obesity, as an early subclinical condition, also known as a chronic low grade inflammation condition and coronary artery calcium (CAC) in non-diabetic population including the underlying pathomechanisms of a CAC in the early stage of atherosclerosis.Materials and Methods: This was a cross-sectional pathway analysis study enrolling 60 central obesity non-diabetic men that underwent coronary calcium score scan, anthropometrics and biomarker assays.Results: There was a positive correlation between increasing free leptin index/adiponectin (FLI/A) ratio and CAC (r=0.297; p<0.05). There was a positive correlation between increasing FLI/A ratio and plasma high sensitive C-reactive protein (hs-CRP) (r=0.318; p<0.05). Plasma hs-CRP and bone morphogenetic protein-2 (BMP-2)-matrix gla protein (MGP) dysregulation were positively correlated (r=0.221; p<0.05) after adjusted to risk factors including insulin resistance, hypertension, age, and dyslipidemia.Conclusion: The study found that one of the pathways involved in CAC in the centrally obese non-diabetic male is might be due to an increase of free leptin and decrease of adiponectin. The free leptin and adiponection ratio also increased hs-CRP, which partially correlated to the dysregulation of BMP-2 and MGP.Keywords: coronary artery calcification, central obesity, adipokines, bone regulator protein, pathomechanis

Subacute Toxicity Test of (Scaevola taccada Gaertn.) Roxb Leaf Extract on Kidney and Liver Function in Rats (Rattus norvegicus)

Beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb has pharmacological effects such as anti-inflammatory, analgesic, antioxidant, antidiabetic and anticancer. Although beruwas laut leaf have many advantages, safety is the main requirement that herbal medicine must have. This research was aimed to prove sebacute of beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb.) about the function of kidney and liver. This research used 20 rats were devided into 4 groups. Group 1 as a control group and groups 2,3, and 4 as an experimental group by administration of beruwas laut leaf extract with dose 200 mg/kgBB, 400 mg/kgBB, and 600 mg/kgBB. The extract was made using maceration and sebacute toxicity testing was carried out for 14 days. After giving the extract, some of rats had diarrhea. The results showed significant effect to increase levels of ureum and CGT after administration of dose 400mg/kgBB. Moreover, administration of dose 600 mg/kgBB caused significant effect in liver biomarkers and kidney (GGT and ureum). It was concluded that ethanol extract of beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb.) with dose 200mg/kgBB showed safe but toxic to kidney and liver with dose 600mg/kgBB.Beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb has pharmacological effects such as anti-inflammatory, analgesic, antioxidant, antidiabetic and anticancer. Although beruwas laut leaf have many advantages, safety is the main requirement that herbal medicine must have. This research was aimed to prove sebacute of beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb.) about the function of kidney and liver. This research used 20 rats were devided into 4 groups. Group 1 as a control group and groups 2,3, and 4 as an experimental group by administration of beruwas laut leaf extract with dose 200 mg/kgBB, 400 mg/kgBB, and 600 mg/kgBB. The extract was made using maceration and sebacute toxicity testing was carried out for 14 days. After giving the extract, some of rats had diarrhea. The results showed significant effect to increase levels of ureum and CGT after administration of dose 400mg/kgBB. Moreover, administration of dose 600 mg/kgBB caused significant effect in liver biomarkers and kidney (GGT and ureum). It was concluded that ethanol extract of beruwas laut leaf (Scaevola taccada (Gaertn.) Roxb.) with dose 200mg/kgBB showed safe but toxic to kidney and liver with dose 600mg/kgBB

Which Biology Marker Can be a Predictor for Higher Syntax Score?

BACKGROUND: Syntax score is a lesion-based angiographic scoring system, originally devised to grade the anatomic complexity of coronary artery disease (CAD) and thereby facilitate consensus in the study of a diagnostic angiogram between surgeons and interventional cardiologists. Suitable biology marker to predict the severity of CAD and to have a treatment decision for revascularization by percutaneous coronary intervention (PCI) or bypass surgery, is still unknown. Which biology marker can be a predictor for higher Syntax score remains unknown as well.METHODS: Severity of 105 patients who underwent coronary angiography, were evaluated with Syntax score. Laboratory tests were conducted for routine blood test, serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), high-sensitivity C-reactive protein (hs-CRP), total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, kidney function, creatinine and hemoglobin A1c (HbA1c).RESULTS: Ureum had significant correlation with Syntax score, p=0.016 and 95% confidence interval (CI)=0.05-0.55. Result of logistic regression analysis showed that HDL and haematocrit had significant correlation with Syntax score, with cut off point 34 (p=0.02, p=0.0033, respectively). Based on multi-variate analysis, Syntax score 34 = 16 (HDL ≤40 + Ureum ≥23) + 10 (Neutrophil/Lymphocyte ≥3.789) +10 (HbA1c ≥7 ) + 13 ( monocyte ≥9%).CONCLUSION: HDL cholesterol, ureum, neutrophil-lymphocyte ratio, HbA1c and monocyte altogether can predict the higher Syntax score.KEYWORDS: syntax, neutrophil, lymphocyte, HDL, cholesterol, ureum, HbA1c, monocyt

Six-minute walking test distance predicts readmission in hospitalized heart failure patient in integrated cardiac centre, Makassar, Indonesia

Background: Assessment of functional capacity prior to discharge can help identify patients at risk for readmissions in heart failure patients. This research aims to conduct a study in order to assess the distance traveled in the six-minute walk test (6-MWT) as a predictor of readmission rates in patients with congestive heart failure.Methods: This type of research is a quantitative correlational study with a prospective cohort study experimental design. Data were collected when the patient was treated at the Integrated Cardiac Center of Wahidin Sudirohusodo Hospital with a diagnosis of heart failure. The research was conducted from June 2019 to December 2019 after obtaining clearance from the institutional ethical committee. 6-MWT measures the distance that a patient can quickly walk on a flat, hard surface in a period of 6-MWD. To see the correlation between the components of 6-MWT the readmission using one-way anova. To determine the cut-off point, sensitivity and specificity of each component of the 6-MWT to rehospitalization using the receiver operating characteristic (ROC) curve. Statistical analysis was carried out using SPSS and SAP programs.Results: Out of the 93 samples, the 6-MWD has a significant p<0.001 for the readmission incidence≤30 days, meaning that the higher the 6-MWT value, it correlates with the decrease in the number of readmission incidents. In the ROC curve analysis for the 6-MWD parameter, it was found that the 6-MWD had a good predictability of readmission events in≤30 days (C=0.781, p<0.001).Conclusions: 6-MWD can be used to predict readmissions in≤30 days in heart failure patients. The lower the 6-MWD with a cut off of 183 meters, the higher the risk of readmission in≤30 days of heart failure patients. By knowing the cut off value, 6-MWD can be used as a reference to create a comprehensive treatment flow for heart failure patients to prevent increased readmission rates. In the end, it can reduce the burden of treatment costs on heart failure patients. 

Comparison Between Carotid Intima-Media Thickness and Coronary Artery Calcification in the Prediction of Atherosclerosis in Diabetic Patients

BACKGROUND: Cardiovascular disease is one of the atherosclerosis etiologies that can lead to death. Diabetes mellitus increases the risk of atherosclerosis. Screening tool is very beneficial for detecting atherosclerotic plaque, especially in subclinical atherosclerotic cases. Carotid intima-media thickness (CIMT) and coronary artery calcification score (CACS) are two kinds of tools that are widely used, and each of these tools has its own superiority. This study was aimed to investigate the sensitivity and specificity of both of these tools as screening tools.METHODS: The study was conducted with a cross sectional design involving 43 diabetic and 68 non-diabetic male subjects aged above 45 years old. All subjects fulfilled inclusion criteria. Carotid artery ultrasonography and CACS measurement were performed.RESULTS: Fischer exact test was used to show a significant correlation between CIMT and CACS (p<0.05). Diagnostic test was used to assess the sensitivity of CIMT toward CACS in above 75 percentile. The left common carotid artery (LCCA) showed the highest sensitivity either in diabetic (76.4%) or non-diabetic male subjects (90%).CONCLUSION: CIMT has the same sensitivity with CACS. CIMT can be used as the preferred screening tool for high risk patients and as a substitution tool to CACS for low risk patients in subclinical atherosclerosis detection

PENGARUH MADU TRIGONA TERHADAP STRESS OKSIDATIF PADA TIKUS PUTIH (Rattus norvegicus) YANG DIINDUKSI STATIN UNTUK MENCEGAH MIOTOKSISITAS

Tujuan penelitian ini adalah mengetahui pengaruh madu trigona terhadap stress oksidatif pada tikus putih yang diinduksi statin untuk mencegah miotoksisitas melalui pengukuran kadar kreatin kinase (CK), malondialdehid (MDA), dan aktivitas superoksida dismutase (SOD). Penelitian ini menggunakan 30 ekor tikus jantan yang dibagi menjadi 6 kelompok, terdiri dari 5 ekor tiap kelompok. Kelompok 1 merupakan kontrol yang hanya diberikan NaCMC 0,5%; kelompok 2 (induksi atorvastatin 20 mg/kgBB selama 3 minggu dan dilanjut dengan 40 mg/kgBB selama 2 minggu); kelompok 3 (diberi madu 4,5 ml/kgBB); kelompok 4, 5, dan 6 (diberi madu 1,5 ml; 3 ml; 4,5 ml/kgBB, berturut-turut selanjutnya selang waktu 2 jam diinduksi atorvastatin). Hasil penelitian menunjukkan bahwa kadar CK sebelum dan setelah perlakuan selama lima minggu pada tikus yang diinduksi atorvastatin mengalami peningkatan secara signifikan (p&lt;0.05), sedangkan kadar CK pada kelompok tikus yang lainnya tidak menunjukkan perubahan yang bermakna. Kadar MDA setelah perlakuan pada tikus yang hanya diinduksi atorvastatin menunjukkan kadar yang relatif tinggi, namun secara statistik tidak menunjukkan perbedaan bermakna dengan kelompok tikus yang lainnya.  Demikian pula dengan aktivitas SOD pada tikus yang hanya diinduksi atorvastatin tidak menunjukkan perbedaan bermakna dengan kelompok tikus yang diberi madu sebelum induksi atorvastatin

HUBUNGAN FIBRILASI ATRIUM DENGAN GANGGUAN KOGNITIF

Fibrilasi atrium dan gangguan kognitif merupakan masalah kesehatan utama, patomekanisme secara pasti belum jelas dan penelitian sebelumnya menemukan hubungan yang bermakna. Penelitian ini bertujuan untuk mengetahui hubungan fibrilasi atrium dengan gangguan kognitif dengan menggunakan tes Montreal Cognitive Assessment versi Indonesia ( MoCA-Ina). Desain penelitian adalah Cross Sectional Study, pada 60 subjek penderita dengan masing-masing 30 subjek dengan fibrilasi atrium dan 30 subjek tanpa fibrilasi atrium di Poli Kardiologi dan Poli Saraf Rumah Sakit Wahidin Sudirohusodo di Makassar, dari bulan Maret hingga Mei 2013. Pada kelompok penelitian dilakukan pemeriksaan fungsi kognitif menggunakan instrument tes MoCA-Ina. Hasil penelitian menunjukkan rerata usia penderita dengan fibrilasi atrium dan tanpa fibrilasi atrium (55.00 SB 7.17 vs 52.03 SB 5.73 tahun) dan jenis kelamin laki-laki lebih banyak dibanding perempuan pada penderita fibrilasi atrium (56.7% vs 43.3%). Gangguan kognitif dijumpai 86,7% pada subjek penderita dengan fibrilasi atrium dan 6,7% pada penderita tanpa fibrilasi atrium, dengan nilai p 0.000 dengan OR 91,00% dan IK 95%. Unsur kognitif yang paling banyak terganggu adalah memori tertunda dan atensi. Penelitian ini menerangkan terdapat hubungan fibrilasi atrium dengan gangguan kognitif

OUTCOME JANGKA PENDEK PASIEN PENYAKIT JANTUNG KORONER MULTIVESSEL STABIL KANDIDAT UNTUK OPERASI CORONARY ARTERY BYPASS GRAFTING DENGAN GAMBARAN EKG NORMAL

Pendahuluan: Berbagai studi sebelumnya yang melihat outcome pada pasien PJK multivessel stabil baik yang menjalani CABG, PCI, maupun yang hanya mendapat terapi obat tidak mempertimbangkan gambaran EKG yang mungkin berpengaruh pada outcome. Studi ini bertujuan untuk melihat outcome jangka pendek pasien PJK multivessel stabil kandidat untuk operasi CABG dengan gambaran EKG normal. Metode: Studi Kohort. Outcome primer yang dinilai berupa angina berulang, kejadian SKA, stroke dan kematian karena berbagai sebab dalam 6 bulan. Data dianalisis menggunakan SPPSS versi 16. Data dinyatakan signifikan jika nilai p&lt;0.05. Hasil: Didapatkan 79 pasien (69 pria dan 10 wanita) dikelompokkan pada kelompok yang menjalani CABG(n=13), PCI (n=12), maupun terapi obat (n=54). Kejadian bebas SKA dalam 6 bulan pada kelompok CABG sebanyak 100%, kelompok PCI sebanyak 75%, dan kelompok terapi obat sebanyak 85.1%. Dalam ikutan selama 6 bulan, kejadian bebas angina pada kelompok CABG sebanyak 87.4%, kelompok PCI sebanyak 67% dan kelompk terapi obat sebanyak 42.9% (p=0.015 &amp; OR=7.413). Kesimpulan: Terapi obat untuk PJK multivessel berhubungan dengan kejadian SKA yang lebih rendah dibandingkan PCI dalam 6 bulan. CABG lebih superior dibandingkan terapi obat dalam menghilangkan gejala angina. Ketiga strategi terapi berhubungan dengan tingkat kematian yang rendah dalam 6 bulan

High sensitivity C-reactive protein, left ventricular mass, and systolic function in obese adolescents

Background Obesity has been associated with structural and functional cardiac muscle defects. High sensitivity C-reactive protein (hs-CRP) has been utilized as an independent predictor of future cardiovascular disease. Objective To assess for correlations between hs-CRP, left ventricular mass, and systolic function in obese adolescents. Methods This cross-sectional study was conducted from August 2013 to February 2014. Subjects were obese adolescents aged 13-18 years with a body mass index (BMI) >95th percentile, according to the 2000 Centers for Disease Control and Prevention Growth Chart. Subjects underwent laboratory testing of serum hs-CRP levels, as well as left ventricular mass and function measurements by echocardiography. Descriptive analysis was performed on patients’ characteristics and correlation analysis was done by Pearson’s test with a significance level of P<0.05. Results Subjects were 40 obese adolescents. There was no statistically significant correlation between hs-CRP and left ventricular mass (r=0.083; P=0.305). There was a moderate correlation between hs-CRP with ejection fraction (EF) (r=0.372 and P=0.009 ) and fractional shortening (FS) of the left ventricle (r=0.420 and P=0.003). Conclusion In obese adolescents, we find no correlation between hs-CRP and left ventricular mass. However, hs-CRP is moderately correlated with left ventricular EF and FS

Neck Circumference Correlates to Coronary Calcification Better Than BMI and Waist Circumference in Insulin Resistance Obese Subjects

The association of obesity, insulin resistance, and chronic low-grade inflammation has been evident for years. Neck circumference (NC), a parameter of subcutaneous fat, is a unique storage depot and allegedly has an additional role for cardiovascular risk beyond the effect of abdominal circumference. Vascular calfication is identified at early stage of atherosclerosis and associated with cardiovascular events. The degree of calcification associated with local vascular inflammation and progression of atherosclerosis, however, there is no study linking NC independently to coronary calcification, an established parameter of subclinical atherosclerosis. This study carried out 60 obese non-diabetes men, consisted of 30 insluin-resistant (IR) and 30 non insulin-resistant (NIR) subjects. In IR subjects, there was a significant positive correlation between CAC score with NC, but none between CAC score with body mass index (BMI) or waist circumference. A significant correlation was found between hs-CRP with CAC score or NC in IR subjects, but none in NIR subjects. Interestingly, the correlation between NC and CACA score in IR subjects remained significant after each of BMI, hs-CRP, HOMA-IR, leptin or adiponectin being adjusted, lead to suggestion of another mechanisms might invlolve in the patho-mechanisms of coronary calcification in upper body obesity subjects. We concluded, in non-diabetic beyond the effect of BMI, low-grade inflammation, the degree of insulin resistance and adipokines such as leptin and adipocnetin