High Dose Allicin with Vitamin C Improves EPCs Migration from the Patient with Coronary Artery Disease

Endothelial Progenitor Cells (EPCs) have an important role in endothelial dysfunction repairment through neovasculogenesis and cardiac myocytes regeneration. However, EPCs migration is greatly reduced in the patient with Coronary Artery Disease (CAD). Allicin and Vitamin C are hypothesized to improve EPCs migration due to its antioxidant properties. Objective: To investigate the effect of Allicin and its combination with Vitamin C in EPCs migration of CAD patients. Material and Method: Mononuclear cells were isolated from CAD patients and cultured on fibronectin-coated plates with colony-forming unit Hill medium. The cells were divided into untreated (control), Allicin treatment (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ ml), and each dose of Allicin combined with 250 mcg/mL of Vitamin C. EPCs migration was assessed with Transwell Migration Assay Kit and evaluated by using statistical tests. Results: This research shows that EPC migration was significantly higher in the treatment. Allicin at all dose (dose 100 mcg/ml, 200 mcg/ml, 400 mcg/ml) and its combination with 250 mcg/mL of vitamin C compared to untreated group (p<0.05). Allicin increase EPCs migration in a dosedependent manner. However, the only combination of 400 mcg/ml Allicin with 250 mcg/mL of vitamin C which has significantly higher EPCs migration compared to Allicin treatment alone. Conclusion: Allicin improves EPCs migration in a dose-dependent manner. Improvement of the migration only observed on the Allicin dose 400 mcg/ml with Vitamin C

EFEK PEMBERIAN ALLICIN TERHADAP MIGRASI ENDOTHELIAL PROGENITOR CELL PADA DARAH TEPI PENDERITA PENYAKIT JANTUNG KORONER STABIL

Latar Belakang: Kerusakan endotel adalah tahap awal dari atherosklerosis yang berperan dalam proses terjadinya penyakit jantung koroner (PJK). EPC mampu memperbaiki fungsi endotel serta memicu neoangiogenesis. Beberapa penelitian menunjukkan menurunnya jumlah dan fungsi EPC pada pasien PJK. Allicin adalah suatu organosulfur yang biasa didapatkan dari bawang putih. Studi terdahulu menunjukkan bahwa Allicin memiliki efek antiatherosklerosis serta dapat meningkatkan proliferasi dan fungsi EPC secara in vitro. Karena itu dalam penelitian ini akan diteliti mengenai potensi efek Allicin terhadap migrasi EPC secara in vitro. Tujuan: Untuk menganalisis efek pemberian Allicin terhadap migrasi EPC pada darah tepi penderita PJK stabil Metode: Penelitian ini merupakan laboratory experimental posttest only control group design. Sel mononuklear diisolasi dari darah tepi penderita penyakit jantung koroner stabil dan dilakukan kultur dalam medium basal selama 3 hari. EPC dibagi menjadi kelompok Allicin 100 μg/mL, 200 μg/mL, 400 μg/mL), dan kelompok kontrol kemudian diinkubasi selama 48 jam. Migrasi EPC dievaluasi dengan menghitung jumlah sel yang berpindah dari rongga atas menuju membran yang menghadap rongga bawah Transwell migration assay setelah 20 jam menggunakan mikroskop cahaya dengan pewarnaan giemsa. Data dianalisis dengan uji statistik ANOVA. Hasil: Semua dosis Allicin dapat meningkatkan migrasi EPC secara bila dibandingkan dengan kontrol. Kelompok dosis Allicin 400 μg/mL memberikan efek peningkatan migrasi yang lebih besar dibandingkan dosis yang lebih rendah (100 μg/mL dan 200 μg/mL). Tidak didapatkan perbedaan bermakna antara kelompok yang mendapat perlakuan Allicin 100 μg/mL dan 200 μg/mL, namun secara umum terdapat tren peningkatan jumlah migrasi EPC dengan penambahan dosis Allicin. Kesimpulan: Allicin dapat meningkatkan migrasi EPC pada darah tepi penderita penyakit jantung koroner stabil secara dose dependent

Rapid Atrial Fibrillation in the Emergency Department

Atrial fibrillation (AF) is the most common rhythm disorder seen in doctors’ offices and emergency departments (EDs). In both settings, an AF holistic pathway including anticoagulation or stroke avoidance, better symptom management, and cardiovascular and comorbidity optimization should be followed. However, other considerations need to be assessed in the ED, such as haemodynamic instability, the onset of AF, the presence of acute heart failure and pre-excitation. Although the Advanced Cardiovascular Life Support guidelines (European Society of Cardiology guidelines, Acute Cardiac Care Association/European Heart Rhythm Association position statements) and several recent AF publications have greatly assisted physicians in treating AF with rapid ventricular response in the ED, further practical clinical guidance is required to improve physicians’ skill and knowledge in providing the best treatment for patients. Herein, we combine multiple strategies with supporting evidence-based treatment and experiences encountered in clinical practice into practical stepwise approaches. We hope that the stepwise algorithm may assist residents and physicians in managing AF in the ED