Profile of Pediatric Rheumatic Heart Disease Patients with Mitral Regurgitation Receiving Angiotensin-Converting Enzyme Inhibitor in dr. Saiful Anwar General Hospital Malang

AbstractBackground : Rheumatic heart disease (RHD) remains the leading cause of heart failure in children worldwide. Long-term consequences and sequelae of acute rheumatic fever may further contributes to isolated mitral regurgitation (MR), unless promptly treated, may develop to extensive fibrosis and calcification leading to mitral stenosis.  ACE inhibitor through reverse remodeling mechanisms may encounter secondary LV changes due to rheumatic MR. Studies in the field of RHD remain limited, particularly in Indonesia. Method : This observational descriptive study recruited 69 pediatric patients diagnosed with RHD who went to Pediatric Cardiology Clinic of dr. Saiful Anwar General Hospital during November 2018 to June 2019. A total of 22 patients were excluded due to incomplete data or showing no MR during echocardiography. The remaining samples (47 patients) were divided into two groups i.e: captopril and no captopril group. Data regarding profile of baseline characteristics, parameter of LV remodeling (dimension, mass and geometry), and grading of MR  were collected then tabulated using descriptive statistical analysis. Results : In general, from total 47 of sample population, female sex was found to predominate (68%), with mean age of 12.1 years and body mass index (BMI) 17.2 kg/m2. Proportion of distribution among captopril and no captopril group demonstrated no significant difference (p>0.05). Captopril group revealed younger age, higher BMI and longer time of initial RHD diagnosis compared to no captopril group. Evaluation of LV remodeling parameter demonstrated that captopril group had smaller LVIDd, lower LVMI, higher fractional shortening (FS) and higher LVEF. LVPWd dan RWT were found to be relatively similar among both groups. Evaluation of MR grade revealed that captopril group showed lower value of MR VC, MR EROA and MR regurgitant volume. Conclusion : Profile of pediatric RHD patients with MR who had been receiving captopril for at least 12 months in dr. Saiful Anwar General Hospital during period of 2018-2019 demonstrated younger age, higher BMI, smaller LVIDd, lower LVMI, lower MR grade, higher FS and higher LVEF compared to patients who had not. Keywords: rheumatic heart disease, mitral regurgitation, ACE inhibitor, captopril, left ventricle remodelin

Poor Adherence to Secondary Prophylaxis is Associated with More Severe Rheumatic Valve in Pediatric Patients: A Cross-Sectional Study

Background : Rheumatic heart disease (RHD) contributed to a large number of proportion amoung cardiovascular problems in developing county, especially Indonesia. Secondary prophylaxis method using intramuscular injection of Benzathin Penicillin-G (BPG) has been known as the most effective strategy in the prevention of RHD. However, whether this prevention method also resulting in prevention of disease severity in Indonesian patients remained to be examined.Objectives : This study aimed to assess the difference of rheumatic valve severity in Indonesian pediatric patients between adequate and poor adherence to secondary prophylaxis by using intramuscular BPG injection.Methods : This cross-sectional study was conducted at Pediatric Cardiology Department of Saiful Anwar General Hospital from November 2018 to June 2019. Patients with documented history of RHD were included. Frequency of intramuscular BPG injection during the last one year was recorded. Adherence was measured using the proportion of days covered (PDC) and adequate adherence was defined as PDC ≥0.90. The severity of RHD was assessed based on the severity of the mitral and / or aortic valve using echocardiography. Bivariate analysis and multivariate logistic regression analysis was used to identify characteristics associated with rheumatic valve severity.Results : A significant difference of rheumatic mitral and/or aortic valve severity was observed between adequate adherence compared to poor adherence group (p = 0.016). Rheumatic mitral and/or aortic valve were found to be more severe in patients who has one or more episode of ARF recurrence (p = 0.003). Multivariate logistic regression analysis demonstrated that adherence to secondary prophylaxis within the last 1 year has the strongest influence on the severity of rheumatic mitral and/or aortic valve (p = 0.049; OR 7.20).Conclusion : The adherence to secondary prophylaxis has the strongest related the rheumatic valve severity compared to other factors

Pengaruh Asosiasi Merek, Loyalitas Merek, Kesadaran Merek dan Citra Merek terhadap Ekuitas Merek Nike Di Media Sosial Pada Kalangan Konsumen Muda

The purpose of this research is to test and analyze the influence of brand associations, brand loyalty, brand awareness and brand image on brand equity on young consumers. The samples in this study were 137 students of the University of Veteran Bangun Nusantara, University of Sebelas Maret Surakarta and University of Muhammadiyah Surakarta. The sampling method used in this study is nonprobability sampling, while the technique used is purposive sampling. The results of data from 137 respondents were analyzed using descriptive statistical testing and multiple linear regression using the Stastitular Package for Social Science Computer Progamme (SPSS) version 21. Results through multiple linear regression analyses, showed that brand associations and brand loyalty had an effect on Nike brand equity on social media among young consumers while brand awareness and brand image, had no effect on Nike brand equities on social media among young consumers.  Keywords: brand associations, brand loyalty, brand awarenes