The Association Between Cardiovascular Risk and Elevated Triglycerides

BACKGROUND: The association between elevated triglycerides and cardiovascular risk has been extensively studied. The elevated level of triglycerides occurs through abnormalities in hepatic very low-density lipoprotein (VLDL) production and intestinal chylomicron synthesis, dysfunctional lipoprotein lipase (LPL)-mediated lipolysis or impaired remnant clearance.CONTENT: Hypertriglyceridemia (HTG) commonly leads to a reduction in high-density lipoprotein (HDL) and increase in atherogenic small dense low-density lipoprotein (LDL) cholesterol, called the atherogenic dyslipidemia (AD). Triglycerides may also stimulate atherogenesis by mechanisms, such excessive release of free fatty acids, and production of pro-inflammatory cytokines, fibrinogen, coagulation factors and impairment of fibrinolysis. Genetic studies strongly support hypertriglyceridemia (HTG) and high concentration of triglyceride-rich lipoprotein (TRL) as causal risk factors for cardiovascular disease. Therefore, lipid management is crucial in reducing cardiovascular risk. Combination of lipid lowering drug therapy may be needed to achieve both LDL and non-HDL cholesterols treatment goal for cardiovascular disease prevention in patients with elevated triglyceride levels, particularly those with triglyceride ≥500 mg/dL.SUMMARY: LDL and non-HDL cholesterol can be a promising target therapy in HTG. Additional clinical outcomes data are needed to provide a more evidence-based rationale for clinical lipid management of hypertriglyceridemic patients

Hubungan Tim Dinamis Dengan Kemampuan Perawat Igd Melakukan Cpr Di Rumah Sakit Rujukan Pertama Nusa Tenggara Barat

Latar Belakang Peran penting perawat dalam penanganan cardiac arrest dan kemampuan kemampuan melakukan high quality CPR adalah kemampuan yang wajib dimiliki oleh perawat.Tujuan penelitian ini adalah untuk mengetahui hubungan antara tim dinamis dengan kemampuan perawat IGD dalam melakukan CPR. Metode observasional analitik dengan pendekatan cross sectional menggunakan purposive sampling. Jumlah sampel 52 perawat IGD dari tiga rumah sakit rujukan pertama di NTB. Alat ukur lembar observasi dan manequin GD/CPR180S, untuk mengetahui kemampuan CPR dan parameter tim dinamis. Hasil penelitian menunjukkan bahwa rata-rata responden hanya melakukan 4 hal dari indikator CPR yang berkualitas dan 5 dari 6 indikator tim dinamis dalam proses CPR. Hasil analisa bivariat dengan menggunakan korelasi pearson menunjukkan Pv 0,000 dan r 0,637. Tim dinamis mempunyai hubungan yang erat dengan kemampuan perawat melakukan CPR. Berdasar dari penelitian ini, sebaiknya pelatihan CPR dilakukan dengan pendekatan tim

Peningkatan Kesintasan Pasca Henti Jantung-Di Luar Rumah Sakit Memerlukan Alat Baru

Saat ini, identifikasi pasien kandidat ICD masih sulit. Memperbaiki keluaran resusitasi merupakan satu–satunya cara untuk menurunkan kematian karena henti jantung mendadak. Salah satu caranya adalah memperpendek selang waktu antara henti jantung dan defibrilasi antara lain dengan alat deteksi henti jantung yang secara otomatis memperingatkan orang sekitar dan EMS. Merancang algoritma deteksi dengan positive predictive accuracy yang tinggi akan menjadi tantangan teknis tersendiriPotential ICD candidate is still difficult to be identified. The only method to lower sudden cardiac death is to improve the outcome of resuscitation; i.e by reducing the time-lag between cardiac arrest and defibrillation attempt through the use of automatic detector that can alert EMS and surrounding people. There is still a challenge to set up an algorithm with high positive predictive accuracy

The Differences of Food Compositions in Adolescent Metabolic Syndrome in Malang

BACKGROUND: Obesity, especially obesity in adolescent, is a worldwide health problem needing much of our attention because it can continue to be obesity in adulthood. About 50% obese adolescents grew up to be obese adults. It was a concern since it is one of risk factor associated with cardiovascular events including hypertension, dyslipidemia, insulin resistance and stroke. Visceral obesity is correlated with diabetogenic, atherogenic, prothrombotic, pro-inflammation, and abnormal metabolism. The objective of this study was to assess the prevalence of obese adolescents in Malang and to identitfy the differences in food compositions between metabolic syndrome and non-metabolic adolescents.METHODS: Prevalence of obesity was determined by assessing BMI in 20 Senior and Junior High Schools. Metabolic syndrome was diagnosed using IDF criteria; waist circumference of >80cm and >90cm for female and male, respectively, and increased triglyceride and decreased HDL concentration levels. The food composition was assessed using food recalls, and then regression linier test was done to define the correlation between food intake and the components of metabolic syndrome.RESULTS: The prevalence of adolescent obesity in Malang had reached 3.32%, with the prevalence of obesity in male subjects higher than in female subjects, i.e. 54.1% compared to 45.9%. The boys had higher mean for height and weight than the girls did, however, the BMI was higher in girls rather than boys. The difference of fat in food composition was significantly higher for the metabolic groups (p=0.031), but the carbohydrate did not significantly differ between the two groups (p=0.407).CONCLUSIONS: The prevalence of adolescent obesity in Malang had reached 3.32%, with the prevalence of 54.1% in male and 45.9% in female. From the statistics test, fat intake showed a significant difference between metabolic syndrome and non-metabolic syndrome groups, but other food compositions didn\u27t

Karakteristik Pasien Gagal Jantung di RS BUMN di Kota Malang

Penelitian ini merupakan studi observatif deskriptif dengan purposive sampling sejak Februari 2017 hingga Oktober 2017 di RS BUMN di Kota Malang. Data diperoleh dari wawancara, pemeriksaan klinis, pemeriksaan penunjang pada pasien IGD RS dengan diagnosis gagal jantung oleh spesialis jantung. Jumlah responden sebanyak 33 orang. Hasil: Dari 33 pasien, 19 (57,6%) pria. Kelompok usia terbanyak <60 tahun (17 - 51,5%). Sumber pembiayaan terutama asuransi pemerintah (BPJS) (27 - 82%). Sejumlah 24 (72,7%) pasien memiliki riwayat penyakit jantung, 14(42,4%) memiliki riwayat merokok, 7 (21,2%) memiliki riwayat konsumsi alkohol, 10 (30,3%) memiliki riwayat diabetes mellitus, dan 20 (60,6%) memiliki riwayat rawat inap akibat gagal jantung. Rehospitalisasi terutama <6 bulan (10 - 30,3%). Penyebab terbanyak kardiomiopati terdilatasi (13 - 39,4%). Sebanyak 15 pasien (45,4%) datang dengan NYHA III dan gejala fisik terutama edema perifer (22 - 66,7%). Kardiomegali pada x-ray dada didapat pada 31(93,9%), irama sinus pada elektrokardiogram pada 28 (84,9%). Pada ekokardiografi, 17 pasien (51,5%) memiliki ejeksi fraksi ≥40%. Simpulan: Sebagian besar responden pria, berusia < 60 tahun, kardiomiopati terdilatasi merupakan penyebab paling banyak gagal jantung.A descriptive observational study with purposive sampling was done at BUMN hospital in Malang city. Data were collected from interview, clinical examination and diagnostics on 33 patients diagnosed as heart failure in ER by cardiologist from February 2017 to October 2017. Results: Of all 33 patients recorded, 19 (57.6%) were men, dominant age group was <60 years old (17/33 - 51.5%). The largest source of funding is government insurance (BPJS) (27/33 - 82%). Previous heart disease found in 24/33 (72.7%) patients, 14/33 (42.4%) had smoking history, 7/33 (21.2%) had history of alcohol consumption, 10/33 (30.3%) had diabetes mellitus, and 20/33 (60.6%) had family history of heart failure. Rehospitalization within <6 months was in 10/33 (30,3%) patients. The most common cause of heart failure was dilated cardiomyopathy (13/33 - 39.4%); 15/33 (45.4%) came with NYHA III. Most patients had peripheral edema (22/33 - 66.7%). Cardiomegaly findings in chest x-ray was in 31/33 (93.9%) patients and 28/33 (84.9%) had sinus rhythm in electrocardiogram. On echocardiography, 17/33 (51.5%) had an ejection fraction of ≥40%. Conclusion: The majority of respondents were male, less than 60 years old with dilated cardiomyopathy

Aloe Gel Enhances Angiogenesis in Healing of Diabetic Wound

BACKGROUND: Diabetic micro and macroangiophathy lead to the incident of diabetic foot ulcers characterized by an increased number of circulating endothelial cells (CECs) and decreased function of endothelial progenitor cells (EPCs). This fact is correlated with ischemia and diabetic wound healing failure. Aloe vera gel is known to be able to stimulate vascular endothelial growth factor (VEGF) expression and activity by enhancing nitric oxide (NO) production as a result of nitric oxide synthase (NOS) enzyme activity. Aloe vera is a potential target to enhancing angiogenesis in wound healing.OBJECTIVE: The objective of this study was to explore the major role of Aloe vera gel in wound healing of diabetic ulcers by increasing the level of EPCs, VEGF, and endothelial nitric oxide synthase (eNOS), as well as by reducing the level of CECs involved in angiogenesis process of diabetic ulcers healing.METHODS: The experimental groups was divided into five subgroups consisting of non diabetic wistar rats, diabetic rats without oral administration of aloe gel, and treatment subgroup (diabetic rats) with 30, 60 and 120 mg/day of aloe gel doses for 14 days. All subgroups were wounded and daily observation was done on the wounds areas. Measurement of the number of EPCs (CD34), and CECs (CD45 and CD146) was done by flowcytometry, followed by measurement of VEGF and eNOS expression on dermal tissue by immunohistochemical method on day 0 and day 14 after treatment. The quantitative data were analyzed by One-Way ANOVA and Linear Regression, with a cofidence interval 5% and significance level (p<0.05) using SPSS 16 software to compare the difference and correlation between wound diameters, number of EPCs and CECs as well as the levels of VEGF and eNOS.RESULTS: The results of this study showed that aloe gel oral treatment in diabetic wistar rats was able to accelerate the wound healing process. It was shown by significant reduction of wound diameter (0.27±0.02); the increased number of CECs (0.42±0.57), respectively (p<0.05). On the other hand, the wound diameter and eNOS indicators showed significant differences at the dose of 60 mg, while the number of EPCs and CECs and the level of VEGF showed significantly different results at a dose of 120 mg. Aloe gel oral therapy showed a positive indication of wound healing acceleration at the optimum dose range 60-120 mg a day.CONCLUSIONS: Aloe gel is potential to be a herbal therapy candidate for diabetic wound healing through enhancing EPCs homing, decreasing the CECs number, and stimulating the increase of VEGF and eNOS levels,hence proving to be a dominant factor in the angiogenesis process