GAMBARAN KLINIS SINDROM KORONER AKUT BERDASARKAN STATUS GULA DARAH DI RSUD Dr. SOETOMO SURABAYA

Sindrom Koroner Akut (SKA) merupakan penyebab utama morbiditas dan mortalitas di dunia, termasuk Indonesia. SKA merupakan kumpulan gejala akibat iskemia miokardium karena terdapat penyumbatan pada arteri koronaria. Penyumbatan tersebut sebagian besar disebabkan oleh terbentuknya plak aterosklerosis. Salah satu faktor risiko terbentuknya plak aterosklerosis adalah gangguan metabolisme glukosa. Di sisi lain, gangguan metabolisme glukosa dapat terjadi pada penyakit akut dan kritis, sindroma koroner akut adalah salah satu dari antaranya. Tujuan penelitian ini adalah untuk mengetahui karakteristik penderita SKA berdasarkan kadar gula darah acak ketika masuk rumah sakit RSUD Dr. Soetomo Surabaya. Penelitian ini menggunakan data rekam medis penderita SKA yang masuk rumah sakit pada periode Januari - Desember 2013 di Intensive Cardiac Care Unit (ICCU) RSUD Dr. Soetomo Surabaya. Metode sampling yang digunakan adalah total sampling, dimana jumlah sampel yang diperoleh yaitu 62 sampel. Data yang diperoleh kemudian dianalisis dengan metode statistik deskriptif. Dari penelitian dapat disimpulkan bahwa 72,6% penderita SKA mengalami hiperglikemia. Hiperglikemia terjadi pada penderita berjenis kelamin laki-laki dan berusia lebih dari 55 tahun. Gejala nyeri dada spesifik lebih banyak dikeluhkan pada penderita hiperglikemik (66,7%) daripada normoglikemia (47,1%). Diagnosa akhir ST-Elevation Myocardium Infarction (STEMI) lebih banyak daripada Non ST-Elevation Myocardium Infarction (NSTEMI) baik pada hiperglikemia (97,8% banding 2,2%) maupun normoglikemia (82,4% banding 17,6%). Riwayat penyakit diabetes mellitus tipe 2 lebih banyak didapatkan pada penderita SKA dengan hiperglikemik (53,3%) daripada normoglikemia (11,8%). Komplikasi ketika perawatan lebih banyak terjadi pada penderita SKA dengan hiperglikemia (1,2 komplikasi/penderita) daripada normoglikemia (1,17 komplikasi/penderita), dengan komplikasi organ jantung yang paling banyak terjadi, yaitu 64,4% pada hiperglikemia dan 58,8% pada normoglikemia. Lama rawat penderita SKA dengan hiperglikemia lebih lama daripada normoglikemia (7,81 ± 2,71 hari banding 6,67 ± 1,03 hari). Penderita SKA dengan hiperglikemia lebih banyak yang meninggal daripada penderita SKA normoglikemia

THE SIMILAR CHANGES OF GLUCOSE LEVELS BEFORE AND AFTER MODERATE INTENSITY EXERCISE ACUTELY IN THE MORNING AND EVENING

Background: There is a lot of research on the importance of exercise but studies on the effective time of exercise regarding regulation of blood glucose levels are not clearly known. Objective: This study aimed to determine the comparison of changes in blood glucose levels before and after moderate intensity physical exercise in the morning and evening. Materials and Methods: Healthy men (n=34), age between 17-22 years, Body Mass Index (BMI) between 18.5-22.9 kg/m2 (normal Asia Pacific), participating in the morning (8.00 am) or evening group (20.00 pm) are asked to do moderate intensity physical exercise (55-70% of maximum heart rate) using ergocycle for a total of 40 minutes. Blood glucose levels 2 hours post prandial capillaries were taken before exercise and blood glucose levels after exercise were taken acutely. Results: The mean decrease in blood glucose levels in the morning group was ± 8.353 ± 9.16 mg/dL and in the evening group was ± 6.294 ± 10.10 mg/dL. Blood glucose levels decreased significantly for the morning group (p=0.002) and the evening group (p=0.021). The comparison of changes in blood glucose levels between the morning and evening groups was not significant (p=0.538). Conclusion: There was no difference between morning or evening exercise related to changes in blood glucose levels

Comparison of Serum Magnesium Level in Diabetes Mellitus (DM) Patients with or without Acute Coronary Syndrome (ACS)

Introduction: Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome. Methods: Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p <0.05. The association between hypomagnesemia and the incidence of ACS a multivariate logistic regression test was performed, the risk number was in the form of odds ratios (OR). Results: This study involved 76 subjects with diabetes mellitus with SKA and non SKA 38 subjects. The mean serum magnesium level in the ACS group was lower than non ACS (1.9 mg / dL vs. 2.1 mg / dL), hypomagnesemia cut-off of <2.08 mg / dL. In this study hypomagnesemia as a risk factor for the incidence of ACS in DM patients with OR 2.8 (CI 1.1-7.6; p = 0.039). Conclusion: Magnesium levels in the ACS group were lower than the non ACS group. Hypomagnesemia Increase The Incidence of Acute Coronary Syndrome in Diabetes Mellitus Patients

Human Umbilical Cord Blood-derived Secretome Enhance Endothelial Progenitor Cells Migration on Hyperglycemic Conditions

Hyperglycemia state is harmful to body’s homeostasis. Uncontrolled hyperglycemic patients, especially patients with diabetes mellitus have a higher mortality risk of heart disease 2 to 4 times compared to non-hyperglycemic patients. Vascular endothelial impairment always been observed and found as a key feature of hyperglycemia state, which is correlated with reduced numbers and dysfunction of endothelial progenitor cells (EPCs). Objective: This paper aims to investigate the effect of hUCB-MSCs derived secretome treatment on the EPCs migration under hyperglycemia state. Materials and Methods: EPCs were isolated and cultured from peripheral blood samples and cultured for three days. Cultured EPCs were cultivated in 6-well plates until confluence and incubated with high glucose for 5 days, then placed in the modified Boyden chamber at the upper chamber with basal media. The lower chamber was supplemented with basal media and secretome at 2%, 10%, and 20% concentration and VEGF treated group as a control. EPCS migration was evaluated using a Boyden chamber assay. Statistical analysis was performed using SPS 25.0. Results: EPCs migration were significantly higher when hUCB-MSCs-derived secretome was given in high glucose concentrations compared to the and control group (79.80 ± 5.07 vs 51.00 ± 5.15, p<0.000). This study also showed that hUCB-MSCs-derived secretome increase EPCs migration under high glucose concentrations in a dose-dependent manner (p<0.05). Conclusion: hUCB-MSCsderived secretome enhances EPCs migration under hyperglycemic state. This result may be of relevance for cell-free and regenerative therapeutic modality for a diabetic patient with coronary artery disease (CAD)

Clinical Characteristics and Number of Valve Lesion in Rheumatic Heart Disease Severity

Rheumatic heart disease (RHD) occurs due to sequelae in the form of damage to the heart valves from the failure of acute rheumatic fever (ARF) therapy. Heart valve damage can cause various complications such as congestive heart failure, arrhythmias, pulmonary hypertension, atrial fibrillation, endocarditis, which can cause death. The study aimed to assess the association between clinical characteristics and valve lesion and rheumatic heart disease severity. The study was an analytic observational with a cross-sectional design of 73 patients with definite RHD from September 2019 to March 2020 in Dr. Soetomo Regional General Hospital. The majority of patients were female (80%, p=0.235) 30–39 years old (34%, p=0.157). The mean age was 42.08±12.16 years. The majority of patients have low socioeconomic status (78%, p=0.025) and rural dwelling location (70%, p=0.138) over three-quarters of patients living with more than four people in the same house (75%). Multivalvular lesions (90%, p=0.003) and severe RHD (77%) were present predominantly. In conclusion, low socioeconomic status and multivalvular lesions are associated with rheumatic heart disease severity.   KARAKTERISTIK KLINIS DAN JUMLAH LESI KATUP PADA DERAJAT KEPARAHAN PENYAKIT JANTUNG REUMATIK Penyakit jantung reumatik (PJR) adalah penyakit yang terjadi akibat gejala sisa berupa kerusakan katup jantung dari kegagalan terapi demam reumatik akut (DRA). Kerusakan katup jantung pada PJR dapat menimbulkan berbagai komplikasi seperti gagal jantung kongesti, aritmia, hipertensi pulmonal, atrial fibrilasi, dan endokarditis yang dapat menyebabkan kematian. Penelitian ini bertujuan mencari hubungan karakteristik klinis dan jumlah lesi katup dengan derajat keparahan PJR. Penelitian ini merupakan analitik observasional menggunakan pendekatan cross-sectional. Sampel penelitian ini adalah pasien yang terdiagnosis definitif PJR berdasar atas ekokardiografi pada bulan Sepetember 2019–Maret 2020 di RSUD Dr. Soetomo Surabaya. Didapatkan 73 pasien sesuai dengan kriteria inklusi. Mayoritas pasien berjenis kelamin perempuan (80%; p=0,235), dengan kelompok usia 30–39  (34%; p=0,157). Usia rerata 42,08±12,16 tahun. Sebagian besar pasien berstatus sosial ekonomi rendah (78%, p=0,025) dan lokasi tinggal pedesaan (70%; p=0,138). Lebih dari tiga perempat pasien tinggal dengan ≤4 orang di satu atap (75%). Lesi multivalvular (90%; p=0,003) dan PJR berat (77%) ditemukan secara dominan. Simpulan, status sosial ekonomi rendah dan lesi katup multivalvular berhubungan dengan derajat keparahan penyakit jantung reumatik

PERAN IL-17, IFN-, TNF-, LTF, IL-4, IL-35 DAN TGF- SEBAGAI PREDIKTOR TERHADAP SPEKTRUM VALVULITIS REMATIK

Pro- and anti-inflammatory cytokines are important secondary signals in rheumatic valvulitis and may related with extension of valvular damage (spectrum of rheumatic valvulitis). Hence, the study aimed to determine whether serum marker of pro- Interleukin-17 (IL-17), Tumor Necrosis Factor- (TNF-), Interferron- (INF-) and lactoferrin (LTF) and anti-inflammation cytokine Interleukin-4 (IL-4), Interleukin-35 (IL-35) and Transforming Growth Factor- (TGF-) impact on the spectra (extention) of rheumatic valvulitis. Methods: Patients were subdivided according to the extent of left-sided valvular involvement. Based on echocardiographic examination, patient with only of mitral valve disease were enrolled as on the univalvular group, while those with involvement of both mitral and aortic valves were allocated to the multivalvular group. Serum level of IL-4, IL-17, IL-35, TNF-, TGF-, INF- and LTF were determined by flow cytometri. Results: The study included seventy-two patients with RHD (mean age 37.22±9.84 yrs, male: female 28:44) and, 36 age and sex-matched unrelated healthy volunteers (normal control). Patients were classified according to univalvular rheumatic (n=36, mean age 37.61±10.98 yrs), multivalvular rheumatic (n=36, mean age 36.83±8.70 yrs) and normal control (n=36, mean age 33.08±8.48 yrs). Serum level of pro-inflammation cytokine (IL-17, TNF-, INF- and LTF) and anti-inflammation cytokine (IL-4, IL-35 and TGF-) was significantly elevated in RHD (both univalvular and multivalvular rheumatic groups) compared with control group. Both univalvular and multivalvular groups have statistically significant association with IL-4, IL-17 and INF- but no significant association with TNF-, TGF- and LTF. IL-35 significantly increased serum level of IL-17 and INF-, IL-17 (b=0.253, p=0.000), INF- (b=0.577, p=0.000). IL-17 have greater risk for multivalvular rheumatic (OR=1.065; [95% CI: 1.027 – 1.104]; p=0.001) and univalvular rheumatic (OR=1.055; [95% CI: 1.018 – 1.094] ; p=0.003) then their matched controls. IL-4 have greater protection for univalvular rheumatic (OR=0.964; [95% CI: 0.937 – 0.992] ; p=0.011) and multivalvular rheumatic (OR=0.961; [95% CI: 0.934 – 0.989] ; p=0.007) then their matched controls. INF- have greater risk for multivalvular rheumatic (OR=1.070; [95% CI: 1.024 – 1.118] ; p=0.002) and univalvular rheumatic (OR=1.065; [95% CI: 1.020 - 1.112] ; p=0.004)

Relationship Between Risk Factors of Coronary Heart Disease on The Amount of Lesioned Coronary Artery

ABSTRACT Objective: To determine the relationship of coronary heart disease traditional risk factors to the number of lesioned coronary arteries and calculate the relative risk. Methods: This study used an analytical research design with a retrospective cohort study design using patient catheterization report data. Data analysis was performed using the chi square test and relative risk in 449 individuals. Results: Based on the analysis results obtained p value 0.05 indicating no relationship between risk factors for coronary heart disease with the number of coronary arteries the lesions based on sex, history of hypertension and history of smoking. Conclusion: There is a relationship between age, history of diabetes mellitus, history of dyslipidemia and the number of coronary arteries that are lesions in patients with coronary heart disease and there is no relationship between sex, history of hypertension and smoking history with the number of coronary arteries that are lesions in patients with coronary heart disease

Comparison of Serum Magnesium Levelin Diabetes Mellitus (DM) Patientswith or without Acute Coronary Syndrome (ACS)

Introduction: Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome. Methods: Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p <0.05. The association between hypomagnesemia and the incidence of ACS a multivariate logistic regression test was performed, the risk number was in the form of odds ratios (OR). Results: This study involved 76 subjects with diabetes mellitus with SKA and non SKA 38 subjects. The mean serum magnesium level in the ACS group was lower than non ACS (1.9 mg / dL vs. 2.1 mg / dL), hypomagnesemia cut-off of <2.08 mg / dL. In this study hypomagnesemia as a risk factor for the incidence of ACS in DM patients with OR 2.8 (CI 1.1-7.6; p = 0.039). Conclusion: Magnesium levels in the ACS group were lower than the non ACS group. Hypomagnesemia Increase The Incidence of Acute Coronary Syndrome in Diabetes Mellitus Patients

Human Umbilical Cord Blood-derived Secretome Enhance Endothelial Progenitor Cells Migration on Hyperglycemic Conditions

Abstract: Hyperglycemia state is harmful to body’s homeostasis. Uncontrolled hyperglycemic patients, especially patients with diabetes mellitus have a higher mortality risk of heart disease 2 to 4 times compared to non-hyperglycemic patients. Vascular endothelial impairment always been observed and found as a key feature of hyperglycemia state, which is correlated with reduced numbers and dysfunction of endothelial progenitor cells (EPCs). Objective: This paper aims to investigate the effect of hUCB-MSCs derived secretome treatment on the EPCs migration under hyperglycemia state. Materials and Methods: EPCs were isolated and cultured from peripheral blood samples and cultured for three days. Cultured EPCs were cultivated in 6-well plates until confluence and incubated with high glucose for 5 days, then placed in the modified Boyden chamber at the upper chamber with basal media. The lower chamber was supplemented with basal media and secretome at 2%, 10%, and 20% concentration and VEGF treated group as a control. EPCS migration was evaluated using a Boyden chamber assay. Statistical analysis was performed using SPS 25.0. Results: EPCs migration were significantly higher when hUCB-MSCs-derived secretome was given in high glucose concentrations compared to the and control group (79.80 ± 5.07 vs 51.00 ± 5.15, p<0.000). This study also showed that hUCB-MSCs-derived secretome increase EPCs migration under high glucose concentrations in a dose-dependent manner (p<0.05). Conclusion: hUCB-MSCsderived secretome enhances EPCs migration under hyperglycemic state. This result may be of relevance for cell-free and regenerative therapeutic modality for a diabetic patient with coronary artery disease (CAD