Peranan ACE-Inhibitor pada penyakit jantung bawaan

Angiotensin-converting enzyme inhibitors have been shown to have the broadest impact of any drug in cardiovascular medicine. Dual role of ACE inhibitors, both preventing and treating cardiovascular disease. ACE inhibitors have an indirect effect on primary prevention by lessening hypertension and decreasing left ventricular hypertrophy, especially in patients with cardiac failure. In children, the causes of cardiac failure are significantly different and many cases are due to congenital malformations, such as left-to-right- shunts. In these patients, the function of both the right and the left ventricles will be affected and these children suffer from high-output cardiac failure. Therefore, in carefully selected patients with congenital heart disease, the response to systemic afterload reduction with ACE inhibitors appears favorable. Nevertheless, a more comprehensive controlled trial to assess the hemodynamic and functional effects of ACE inhibitors in such patients should be undertaken

The Potential Identification of Pulau Belimbing Village for the Development of Halal Tourism in Kampar Regency

Halal tourism is currently an interesting trend to study. The population of Indonesia, amounting to 273.5 people, of which 87.2 percent are Muslim. This is a huge opportunity for the development of halal tourism. Pulau Belimbing Village is one of the villages in Kampar Regency which has tourist destinations that are synonymous with Islamic customs and religions which can be a site to promote Islamic culture. This research is a qualitative descriptive study that describes the existing conditions of the research object. From the results of this study, it was found that Pulau Belimbing Village has the potential to develop into one of the halal tourism destinations in Kampar Regency and Riau Province. Intense support from the local government and various interested parties is needed to realize this halal tourism

Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: One-Year Follow-up.

BACKGROUND AND OBJECTIVES Declines in stroke admission, intravenous thrombolysis, and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the impact of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), intravenous thrombolysis (IVT), and mechanical thrombectomy over a one-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020). METHODS We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, intravenous thrombolysis treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases. RESULTS There were 148,895 stroke admissions in the one-year immediately before compared to 138,453 admissions during the one-year pandemic, representing a 7% decline (95% confidence interval [95% CI 7.1, 6.9]; p<0.0001). ICH volumes declined from 29,585 to 28,156 (4.8%, [5.1, 4.6]; p<0.0001) and IVT volume from 24,584 to 23,077 (6.1%, [6.4, 5.8]; p<0.0001). Larger declines were observed at high volume compared to low volume centers (all p<0.0001). There was no significant change in mechanical thrombectomy volumes (0.7%, [0.6,0.9]; p=0.49). Stroke was diagnosed in 1.3% [1.31,1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82,2.97], 5,656/195,539) of all stroke hospitalizations. DISCUSSION There was a global decline and shift to lower volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared to the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year. TRIAL REGISTRATION INFORMATION This study is registered under NCT04934020