The roles of trimethylamine-N-oxide in atherosclerosis and its potential therapeutic aspect: A literature review

Current research supports the evidence that the gut microbiome (GM), which consist of gut microbiota and their biologically active metabolites, is associated with atherosclerosis development. Trimethylamine-N-oxide (TMAO), a metabolite produced by the GM through trimethylamine (TMA) oxidation, significantly enhances the formation and vulnerability of atherosclerotic plaques. TMAO promotes inflammation and oxidative stress in endothelial cells, leading to vascular dysfunction and plaque formation. Dimethyl-1-butanol (DMB), iodomethylcholine (IMC) and fluoromethylcholine (FMC) have been recognized for their ability to reduce plasma TMAO by inhibiting trimethylamine lyase, a bacterial enzyme involved in the choline cleavage anaerobic process, thus reducing TMA formation. Conversely, indole-3-carbinol (I3C) and trigonelline inhibit TMA oxidation by inhibiting flavin-containing monooxygenase-3 (FMO3), resulting in reduced plasma TMAO. The combined use of inhibitors of choline trimethylamine lyase and flavin-containing monooxygenase-3 could provide novel therapeutic strategies for cardiovascular disease prevention by stabilizing existing atherosclerotic plaques. This review aims to present the current evidence of the roles of TMA/TMAO in atherosclerosis as well as its potential therapeutic prevention aspects

Myocarditis and coronavirus disease 2019 vaccination: A systematic review and meta-summary of cases

Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42–13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of <12%, and mortality of <2%. The majority was treated with nonsteroidal anti-inflammatory drugs, colchicine, and steroids. Surprisingly, deceased cases had characteristics of being female, older age, non-chest pain symptoms, first-dose vaccination, left ventricular ejection fraction of <30%, fulminant myocarditis, and eosinophil infiltrate histopathology

PENGARUH LAMA WAKTU PENYIMPANAN AIR SUSU IBU DARI IBU BAYI PRETERM PADA SUHU 4O C TERHADAP PERTUMBUHAN BAKTERI SELAMA 0, 24 DAN 48 JAM

1. Rerata jumlah bakteri pada jam ke-0, 24 dan 48 berturut-turut adalah 92, 79 dan 63. 2. Penyimpanan ASI dari ibu bayi preterm pada suhu 4o C selama 24 dan 48 jam mengurangi rerata jumlah koloni bakteri (CFU) dalam ASI

The Comparison of Breast milk from Mother with Preterm Infant at 4 C Temperature in 0, 24 and 48 Hours on Bacterial Growth

Introduction: Preterm and fullterm breast milk has different leukocyte and bioactive concentration, which affect it’s bactericidal activity and storage duration. The preterm breast milk potentially has longer storage duration than fullterm breast milk The research and guideline about the acceptable of storage duration of preterm breast milk at 4o C was limited. The objective of this study was to assess the correlation of storage duration of preterm breast milk preterm baby at 4o C temperature on bacterial growth. Methods: The study design was experimental using pre-post control groups design. We used 9 samples of breast milk which met the inclusion criteria divided into 3 groups. The first, second and third groups was storage in 4o C for 0, 24 and 48 hours respectively before the inoculation to the culture media. Results: FAfter the samples were kept at 4o C temperature for 0, 24 and 48 hours, the mean bacterial colony forming unit for each group were 92 (±SD 112), 79 (±SD 97) and 63 (±SD 73) CFU respectively. Compared to the first group, the second and third group has lower bacterial colony forming unit but no significant differences statistically (P= 0.214 and P=1.39 respectively). Likewise there was no significant bacterial colony forming unit between second and third group (P=0.086). Conclusion: Storage of preterm breast milk in 4o C for 24 and 48 hours show no change in total bacterial colony count (TBCC)

Long-term systolic blood pressure variability independent of mean blood pressure is associated with mortality and cardiovascular events:A systematic review and meta-analysis

The association between long-term systolic blood pressure variability (SBPV) and cardiovascular (CV) outcomes after being adjusted with mean blood pressure (BP) is questionable. This systematic review aims to evaluate the associations between mean BP adjusted long-term SBPV and CV outcomes. A systematic search was conducted on PubMed, Scopus, and Science Direct on January 4, 2023. A total of 9,944,254 subjects from 43 studies were included in this meta-analysis. Long-term SBPV increased the risk of all-cause mortality (HR 1.21 [95%CI 1.16-1.25], I2=100%), CV mortality (HR 1.10 [95%CI 1.07-11.4], I2 = 90%), MACE (HR 1.10 [1.07-1.13], I2 = 91%), cerebrovascular stroke (HR 1.22 [1.16-1.29], I2=100%), and myocardial infarction (HR 1.13 [95%CI (1.07-1.19)], I2=91%). European populations generally had higher risk compared to other continents. In conclusion, long-term SBPV is associated with all-cause mortality, CV mortality, MACE, MI, and stroke. Poor outcomes related to long-term SBPV seem more dominated by cerebrovascular than coronary events.</p

Long-term systolic blood pressure variability independent of mean blood pressure is associated with mortality and cardiovascular events:A systematic review and meta-analysis

The association between long-term systolic blood pressure variability (SBPV) and cardiovascular (CV) outcomes after being adjusted with mean blood pressure (BP) is questionable. This systematic review aims to evaluate the associations between mean BP adjusted long-term SBPV and CV outcomes. A systematic search was conducted on PubMed, Scopus, and Science Direct on January 4, 2023. A total of 9,944,254 subjects from 43 studies were included in this meta-analysis. Long-term SBPV increased the risk of all-cause mortality (HR 1.21 [95%CI 1.16-1.25], I2=100%), CV mortality (HR 1.10 [95%CI 1.07-11.4], I2 = 90%), MACE (HR 1.10 [1.07-1.13], I2 = 91%), cerebrovascular stroke (HR 1.22 [1.16-1.29], I2=100%), and myocardial infarction (HR 1.13 [95%CI (1.07-1.19)], I2=91%). European populations generally had higher risk compared to other continents. In conclusion, long-term SBPV is associated with all-cause mortality, CV mortality, MACE, MI, and stroke. Poor outcomes related to long-term SBPV seem more dominated by cerebrovascular than coronary events.</p

Clinical characteristics and surgical outcomes of cardiac myxoma:A meta-analysis of worldwide experience

Cardiac myxoma is the most common primary cardiac tumor. However, existing literature mainly consists of single-center experiences with limited subjects. This systematic review aimed to provide data on clinical characteristics and surgical outcomes of cardiac myxoma. We performed a thorough literature search on May 23, 2023 on PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science. The inclusion criteria were English full-text, observational studies, and included &gt;20 subjects. From the search, 112 studies with a total of 8150 patients were included in the analysis. The mean age was 51 years (95 % confidence interval [95%CI] = 49.1–52.3), and the majority were females (64.3 % [95 % CI = 62.8–65.8 %]). The most common clinical manifestation was cardiovascular symptoms. Echocardiography can diagnose almost all cases (98.1 % [95 % CI = 95.8–99.6 %]). Cardiac myxoma was mostly prevalent in left atrium (85.3 % [95%CI = 83.3–87 %]) and predominantly with pedunculated morphology (75.6 % [95%CI = 64.1–84.3 %]). Post-tumor excision outcomes were excellent, with an early mortality of 1.27 % (95 % CI = 0.8–1.8 %), late mortality rate of 4.7 (95 % CI = 2.5–7.4) per 1000 person-years, and recurrence rate at 0.5 (95 % CI = 0.0–1.1) per 1000 person-years. Tumor excision is warranted in a timely manner once the cardiac myxoma diagnosis is established.</p

Clinical characteristics and surgical outcomes of cardiac myxoma:A meta-analysis of worldwide experience

Cardiac myxoma is the most common primary cardiac tumor. However, existing literature mainly consists of single-center experiences with limited subjects. This systematic review aimed to provide data on clinical characteristics and surgical outcomes of cardiac myxoma. We performed a thorough literature search on May 23, 2023 on PubMed, ProQuest, ScienceDirect, Scopus, and Web of Science. The inclusion criteria were English full-text, observational studies, and included &gt;20 subjects. From the search, 112 studies with a total of 8150 patients were included in the analysis. The mean age was 51 years (95 % confidence interval [95%CI] = 49.1–52.3), and the majority were females (64.3 % [95 % CI = 62.8–65.8 %]). The most common clinical manifestation was cardiovascular symptoms. Echocardiography can diagnose almost all cases (98.1 % [95 % CI = 95.8–99.6 %]). Cardiac myxoma was mostly prevalent in left atrium (85.3 % [95%CI = 83.3–87 %]) and predominantly with pedunculated morphology (75.6 % [95%CI = 64.1–84.3 %]). Post-tumor excision outcomes were excellent, with an early mortality of 1.27 % (95 % CI = 0.8–1.8 %), late mortality rate of 4.7 (95 % CI = 2.5–7.4) per 1000 person-years, and recurrence rate at 0.5 (95 % CI = 0.0–1.1) per 1000 person-years. Tumor excision is warranted in a timely manner once the cardiac myxoma diagnosis is established.</p

National Health Insurance-Based Telemedicine Implementation For Hypertension Management In Primary Centres

Hypertension nowadays still becomes one of the severe problems in Indonesia, with a prevalence of 34% in 2018. The complication of hypertension causes the most deaths and disabilities in Indonesia and cost 75% of The Social Security Organizing Agency (BPJS) budget or IDR 15 trillion in 2019. This problem was probably caused by patients' lack of knowledge and limited personnel at the primary health centre (PHC). Telemedicine is a health care provider without any direct contact, which has various methods. Today, telemedicine in Indonesia is growing rapidly along with technology and legal regulation in its implementation, increasing users by 700% in the first year of 2020. Despite the rise of those numbers, telemedicine in PHC is still limited. Recently, the Ministry of Health and various organizations have issued telemedicine regulations at primary level health facilities in collaboration with The Social Security Organizing Agency. This review aims to discuss the current implementation and the potential future of telemedicine-based hypertension management in collaboration with the Social Security Organizing Agency in PHC