Risks for Peripheral Arterial Disease in the Elderly with Type 2 Diabetes Mellitus : Their Correlation with High Sensitivity C-reactive Protein and Ankle-brachial Index

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p <0.001 for right ABI; r = -0.509, p < 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p <0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p < 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (> 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD

Analysis of Psychological Well-Being in High Grade Elementary School Children

This research outlines an analysis of Psychological Well-Being in children who are in the final stages of primary school. The study used a literature review method with the aim of investigating and analysing a deeper understanding of aspects of psychological well-being in children of this age. Through analysing a number of literature sources, this study identified key factors that play a role in influencing psychological well-being in children in the late primary grades. These factors include, but are not limited to, social interactions at school, social support from family and peers, emotional development, adjustment skills and a supportive learning environment. The results of the analyzes suggest that psychological well-being in high school children is closely related to various psychosocial and environmental factors. Moreover, a better understanding of the relationship between these aspects and children's psychological well-being can provide valuable insights for educators, parents and mental health professionals in developing appropriate strategies and interventions to support positive psychological development in children at the primary school level. In conclusion, this study highlights the importance of a holistic understanding of the factors that influence psychological well-being in children in the upper primary grades. The implications of this study are expected to provide a foundation for the development of educational approaches and interventions aimed at improving the psychological well-being of children at this level

Aqueous Extract of Purple Sweet Potato Tuber Increases Sod And Decreases VCAM-1 Expression By Increasing Nrf2 Expression In The Aortic Endothelia Of Hypercholesterolemic Rabbits

Aqueous extract of purple sweet potato tuber are supposed to prevent oxidative stress and protect endothelial function by unknown mechanisms. The purpose of this study was to prove the ability of purple sweet potato tuber aqueous extract in preventing oxidative stress through increasing superoxide dismutase (SOD) via Nrf2 upregulation and decreasing VCAM-1 expression in rabbit aortic endothelium. This study was experimental laboratoric study, with randomized post-test only control group design. The rabbits were randomized into 3 groups (6 rabbits per group). The control group was treated with standard diet, treatment 1 was treated with high-cholesterol diet, and treatment 2 was treated with high-cholesterol diet plus aqueous extract of purple sweet potato tuber with the dose of 4 mL/kg bw/day. After 12 weeks of treatment, blood samples were obtained for the examination of SOD, MDA and total cholesterol level. The expression of Nrf2, SOD-2 and VCAM-1 in aortic endothelium was evaluated based on immunohistochemical methods. One-way ANOVA  test were applied in data analysis, followed by path analysis. The results demonstrated significantly decreased MDA and increased blood SOD level, accompanied by statistically-significant increase in SOD-2 and Nrf2 expression, and decrease of VCAM-1 expression in the treatment group 2 compared to treatment group 1 (p <0.05). It can be concluded that the purple sweet potato tuber aqueous extract prevents oxidative stress by increasing the expression of SOD-2, via Nrf2 protein up-regulation, resulting in decreased VCAM-1 expression in the aortic endothelia of high-cholesterol diet-fed rabbits. Keywords: Purple sweet potato, oxidative stress, SOD-2, Nrf2, VCAM-1, rabbit aort

Key factors influencing the prescribing of statins: a qualitative study among physicians working in primary healthcare facilities in Indonesia.

Objectives: To elicit key factors influencing physicians’ decision to prescribe statins. Design: A qualitative study using a phenomenological approach within a pragmatism interpretive framework. A combination of purposive and snowball sampling was used to recruit physicians. Data were collected through face-to-face, semi-structured interviews with physicians working in primary healthcare facilities in a capital of a province in Indonesia. We recorded and verbatim transcribed the interviews. Coding was done independently by two researchers and data were analyzed using phenomenological data analyses. Key factors influencing physicians’ decision to prescribe statins were classified into factors at the microlevels, mesolevels and macrolevels according to the structural model by Scoggins et al. Participants and setting: Physicians working in primary healthcare facilities in a capital of a province in Indonesia. Results: Ten physicians were included in the study. Key factors at the microlevel were that physicians knew guidelines in general, but there was uncertainty how to take into account the level of total cholesterol in combination with other cardiovascular risk factors such as diabetes and hypertension. At the macrolevel, the new National Health Insurance system (NHIS) appeared to facilitate the prescription of statins though more clinical information should be integrated in the system’s platform to support appropriate prescribing. Conclusions: The findings indicate lack of awareness of specific details in current guideline recommendations. Appropriate prescribing of statins should be enhanced using the new NHIS

Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali

Background: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence. Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence. Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors

ORAL INTAKE OF SARDINELLA LONGICEPS OIL THE DECREASE OF TNF-α AND IL-6 LEVELS IN ATHEROSCLEROTIC WISTAR RAT

Lifestyle changes to consumption of variegated instant food may be associated several heath hazards, such as obesity, dyslipidemia, and atheroschlerosis. This study was conducted to investigate the effects of orally administered Sardinella longiceps oil as an anti inflammatory agent on the serum levels of TNF-α and IL-6 considered as biomarkers for atherosclerosis. The study design is an true experimental with randomized pretest and posttest control group design, using 50 Wistar rat equaly divided into 5 groups, i.e. placebo control group 0% and 4 treatment groups each treated daily with 10%, 15 %, 20 % and 25 % fish oil respectively for 6 weeks. Before the treatment was started, all rats were orally fed daily with a high cholesterol diet for 13 weeks to induce atherosclerosis. Our study showed that the intake of 20%fish oil had resulted in the significantly greatest decrease of 45,63 % in the TNF-α serum levels,from 28.62 ± 1.25 to 15.56 ± 7.20 рg/mL and similar significant decrease 15,42% in of IL-6 serum levels from 134.64 ± 1.98 to 113.87 ± 4.30 рg/mL. The overall results of our study seemed to imply than in the Wistar rats, oral intake of Sardfinella longiceps oils signifacantly decreased serum levels of TNF-α and IL-6 probably through their anti-inflamatory effects. Futher research to determin the magnitude of effects sardinella longiceps oils on the serum levels TNF-α and IL-6 human.</span

RISKS FOR PERIPHERAL ARTERIAL DISEASE IN THE ELDERLY WITH TYPE 2 DIABETES MELLITUS : Their Correlation with High Sensitivity C-reactive Protein and Ankle-Brachial Index

The Indonesian elderly population has been projected to increase up to about four-fold inthree decades (1990-2020). As a consequence of this population trend, the increased prevalence ofdegenerative diseases would be inevitable; this would include the prevalence of peripheral arterialdisease.This study aims to identify the correlation of diverse risk factors, either traditional or nontraditional,with the ankle-brachial index scores, and the correlation of novel non-traditional riskfactor, e.i. high sensitive C-reactive protein with the prevalence of perioheral arterial disease in theelderly, age 60-80 years old, with type 2 diabetes mellitus.Among the 146 elderly patients with type 2 diabetes mellitus, and based on measurement ofthe ABI score, approximately 30.9% of them had PAD. Some traditional and non-traditional riskfactors having a significant correlation with the ankle-brachial index score, were age (r = -0.396, p &lt;0.001 for right ABI; r = -0.509, p &lt; 0.001 for left ABI), supine systolic blood pressure (r= -0.268, p =0.012 for right ABI; r = -0.267, p = 0.013 for left ABI), 2-hour post-prandial blood glucose (r= -0.252, p = 0.018 for right ABI), and hsCRP (r = -0.280, p = 0.011 for right ABI; r = -0.402, p &lt;0.001 for left ABI); whereas other risk factors like obesity based on waist circumference and BMI,non-supine systolic blood pressure, fasting blood glucose, HbA1C, duration of diabetes, plasma lipidsdid not show statistically significant different odd ratios. After linear regression test for risk factorshaving significant correlations with ABI, age and hsCRP were found to influence the ABI scores.Based on a case-control study, risk factors which, to some extent, had statistically significant valuesas risk factors, include older age (? 70 years old; OR = 7.737 [CI = 2.515-23.805]; p &lt; 0.001),relatively high supine diastolic blood pressure (? 90 mmHg; OR = 6.882 [CI = 0.789-60.060]; p =0.048), and high concentration of hsCRP (&gt; 3 mg/L; OR = 4.420 [CI = 1.287-15.181]; p = 0.013).Among these statistically significant risk factors, after logistic regression test analysis, only the age ofthe patient appeared to have significant influence on the prevalence of PAD.In conclusion, this study demonstrates a negative correlation between hsCRP and ABI score;and high levels of hsCRP appeared to be a risk factor for PAD. The age of the patient, however,appeared to be the strongest risk factor for PAD

HIGH RATIO OF MONOSIT: HIGH-DENSITY LIPOPROTEIN AS A RISK FACTOR OFCHRONIC TOTAL OCCLUSION IN PATIENTS CORONARY ARTERY DISEASE

Objective: Chronic total occlusion (CTO) is frequently found in coronary heart disease (CHD) with multivessel lesions. Patients with CTO are associated with an increased mortality rate. Management CTO requires specialized techniques, more resource utilization, and high cost. The progression of atherosclerosis can be prevented by controlling for risk factors. Monocyte to high-density lipoprotein ratio (MHR) is one of the new biomarkers used to assess the incidence of a major adverse cardiovascular event, the severity of coronary lesions, and the incidence of in-stent restenosis. This study was aimed to determine the role of MHR levels as a risk factor for the occurrence of CTO in CAD patients. Methods: This research is a matched case–control located in Sanglah General Hospital from August 2017 until October 2017. This research consisted of 47 cases with CTO and 47 control without CTO. Case and control samples were adjusted by sex, age, and number of blood vessels involved in CAD. Results: The cutoff value of MHR was also determined by analyzing the receiver operating curve. The optimal cut off point was 14.33 with sensitivity 83% and specificity 80.9%. Bivariate analysis showed high MHR was found strongly associated with the risk of CTO in CHD patients with odds ratio (OR)=61; IK 95% (OR)=3.211–114.15; p≤0.001. Multivariate analysis showed that high levels of MHR were significantly associated with risk of CTO after other traditional risk factors such as hypertension, diabetes mellitus, dyslipidemia, and smoking were controlled with OR=20,306; 95% IK (OR)=6.05–68.05; p≤0.001. Conclusion: High levels of MHR were significantly associated with the risk factor of CTO in CAD patients