A Systematic Overview Of Abdominal Aortic Aneurysm (AAA)

An abdominal aortic aneurysm (AAA) is defined as an abnormal dilatation of the abdominal aorta more than 50% of its diameter. The aortic wall continues to weaken and become unable to hold the forces of the luminal blood pressure, resulting in progressive dilatation and rupture. The rupture of the aneurysm wall is influenced by several factors, such as the aneurysm size, expansion rate, continued smoking, and persistent hypertension. The AAA is a common degenerative condition with high mortality in older people. The AAA increases these last two decades. It is occurring in 7-8% of men at the age of over 65 years old. The disease prevalence is six times higher in men than in women. It is also increasing dramatically by the presence of the following factors: age older than 60 years old, smoking, hypertension, and ethnicity. Repair of large or symptomatic AAA by open surgery or endovascular is recommended, but not significant in the small aneurysm

ISOLATION OF POTENTIAL ANTIMICROBIAL METABOLITE FROM ENDOPHYTIC BACILLUS AMYLOLIQUEFACIENS DL06 OF CARNIVOROUS PLANT DROSERA BURMANNII VAHL.

Objectives: Exploitation of bacterial endophytes for production of antimicrobial substances has led to the discovery of novel natural metabolites of diverse chemical nature. The present study focuses attention toward optimization of cultural conditions for production of antimicrobial compound(s) by an endophytic bacterium DL06 followed by its extraction and partial purification. Methods: The leaf endophytic bacterium Bacillus amyloliquefaciens DL06 (GenBank Accession no. MK696415, Microbial Culture Collection Accession no. 4186) isolated from carnivorous plant Drosera burmannii has been identified as a potent producer of antimicrobial metabolite following agar cup assay against several test bacterial and fungal strains. Cultural conditions for production of antimicrobials were optimized by “one variable at a time” method. The active fraction was isolated and purified partially using solvent extraction, thin-layer chromatography, and high performance liquid chromatography (HPLC) analysis. Results: B. amyloliquefaciens DL06 produced maximum antimicrobial compound in tryptic soy broth and Davis–Mingioli’s medium when grown under shake culture. Production of the antimicrobial metabolite has been optimized for the inoculum density, aeration, temperature, pH as well as carbon, and nitrogen sources. The antimicrobial metabolite was extracted from the cell-free culture filtrate in butanol and partially purified by silica gel column chromatography and HPLC. Conclusions: The antimicrobial metabolite, tentatively identified as quercetin showed broad spectrum bioactivity affecting several fungi and a number of Gram-positive and Gram-negative bacteria

A vine copula mixed effect model for trivariate meta-analysis of diagnostic test accuracy studies accounting for disease prevalence

A bivariate copula mixed model has been recently proposed to synthesize diagnostic test accuracy studies and it has been shown that it is superior to the standard generalized linear mixed model in this context. Here, we call trivariate vine copulas to extend the bivariate meta-analysis of diagnostic test accuracy studies by accounting for disease prevalence. Our vine copula mixed model includes the trivariate generalized linear mixed model as a special case and can also operate on the original scale of sensitivity, specificity, and disease prevalence. Our general methodology is illustrated by re-analyzing the data of two published meta-analyses. Our study suggests that there can be an improvement on trivariate generalized linear mixed model in fit to data and makes the argument for moving to vine copula random effects models especially because of their richness, including reflection asymmetric tail dependence, and computational feasibility despite their three dimensionality

COMPLETE REPAIR OF TETRALOGY OF FALLOT (TOF) ON BEATING HEART SURGERY WITHOUT AORTIC CROSS CLAMPING : REPORT OF A CASE

Introduction: Reperfusion injury is a well-known phenomenon that occurred in cardioplegic techniques with cardiopulmonary bypass. Therefore great effort is made to prevent reperfusion injury. Beating Heart Continuous Coronary Perfusion (BHCCP) surgery is one of the alternative techniques to improve an ischemic reperfusion injury in open-heart surgery, either in pediatric or in adult. This technique can be done in complete repair of tetralogy of Fallot (TOF). Purpose: To report our first experience in doing complete repair of TOF using beating heart technique without aortic cross-clamping Case Report: A five-year-old boy came on to ER on January 6th, 2012, with a history of cyanotic since birth. His echocardiography and catheterization concluded a tetralogy of Fallot with a McGoon ratio of 1.95 (the diameter of RPA and LPA were 9.14 mm and 8.79 mm, respectively). A complete repair of TOF was done using beating heart surgery without aortic cross-clamping technique. One month post-surgery evaluation, there weren't any neurological or motor disorders. Echocardiography results showed no residual pulmonary stenosis, but 0.2 mm residual VSD was found. Conclusion: This heart rate technique is an alternative method of myocardial protection in cardiac surgery. In several cardiac centres globally, this technique is relatively safe and can be used during surgery, especially in the total correction of TOF

Acute Limb Ischemia (Ali): An Overview Of Clinical Diagnosis And Treatment

Acute limb ischemia (ALI) is one of vascular emergency. It is defined as a rapid and sudden decrease in limb blood flow due to acute occlusion It is considered to be acute if it occurs within 14 days after the first symptom onset. The incidence of ALI is around 1.5/10.000 people per year. It has reported a mortality rate of 15%-20% in 30 days and high amputation rates 10%-15% if appropriate treatment not administered. The causes of ALI are divided into embolism and thrombosis. Thrombosis can occurred due to atherosclerotic lesion while most cases of embolism are cardiogenic one. Classic features of ALI are known as 6Ps: pain, pallor, paralysis, paraesthesia, pulselessness, poikilothermia. A good history taking and physical examination are needed to assess further treatment needed. Severity of ALI also need to be set based on Rutherford Classification. If the limb was diagnosed as irreversible damage, amputation should be taken as treatment choice without hesitation. ALI can be treated with administered of heparin, endovascular and open surgical. Post treatment follow up also needed to rule out any possible complication such as compartment syndrome and ischemic-reperfusion injury

Adult Cardiac Surgery During Covid-19 Pandemic

Coronavirus Disease 2019 (COVID-19), which is caused by the SARS Coronavirus 2 (SARS-CoV-2), has affected over 200 countries worldwide. First case of COVID-19 wasfound in Wuhan, China, precisely around December 2019. COVID-19, especially in thosewith underlying health conditions or comorbidities, has an increasingly rapid and severeprogression, often leading to death. This virus is a single-strand RNA coronavirus, binding the angiotensin-converting enzyme 2 (ACE2) receptor which enters human cells. Coronavirusdisease has been reported to affect cardiac and vascular organs. cardiomyocyte death andinflammation are results of a direct mechanism that involves viral infiltration into myocardialtissue. Some cardiovascular manifestations of myocardial injuries associated with COVID-19are arrhythmias, myocardial infarction, heart failure, and elevated biomarkers (cardiactroponin I and brain-type natriuretic peptide). Some of this manifestation requires immediate intervention or surgery. Criteria are needed for hospitals or institutions that mostly maintain cardiac surgery services and surgery-urgent patients depending on severity of the disease and hospital resources. These criteria also limit the risk of exposure to patients and healthcare workers and allocate resources appropriately to those in greatest need. This paper aims to share our discussion and give an overview of patients undergoing cardiac surgery, providing clinicians with recommendations to triage and plan these procedures during the COVID-19 outbreak effectively

Thoracic Surgery Preparation, Patient Election, and Its Management During Covid-19 Pandemic: Surabaya Experiences

A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019. It has spread rapidly from China to worldwide. The COVID-19 pandemic of 2020 posed a historic challenge to health care systems around the world, healthcare systems needed to consider providing clinical services to other patients in need. The specialty of general thoracic surgery includes the management of serious diseases such as chest wall congenital anomaly, lung cancers, esophageal cancers, mediastinal tumor, chest wall infection, and trauma. Thoracic surgery is one of high risk procedure in this pandemic, however, a high level of evidence supports the surgical management of potential patients with thoracic disease and anomaly is still lacking. Critical determinants of robust thoracic surgery service provision are pre-existing plans for epidemic response. "Flatten the curve" as an aggressive action is needed. Prioritizations of thoracic surgery cases are needed to differ between elective and emergency cases to limit any contamination. Before surgery, important pre-operative assessments were conducted aims to identify patients' high risk and adjust the procedure. example of a recommendation, if urgent / emergency surgery with symptoms clear clinical pneumonia or rapid test (+). The lessons learned can apply to the other areas during this pandemic, and the world, in preparation for the next one

AN ANIMATED MODELS DEVELOPMENT OF CARDIOVASCULAR SYSTEM IN PHARMACOLOGY LEARNING MODULE FOR MEDICAL STUDENTS

Hypertension is the most known common cardiovascular disease. Based on the Indonesian Competency Standard of Medical Doctors (StandarKompetensiDokter Indonesia or SKDI), the management of essential hypertension is at 4A or the highest level. Therefore, doctors should be able to establish a complete and independent diagnosis and management. The student passing rate in the cardiovascular system at the undergraduate level of medical education of Faculty of Medicine Widya Mandala Catholic University (FK UKWMS) was around 60-70%. This study is an evaluation to develop learning methods that would improve student learning outcomes. The development of this animation model is aimed to increase the engagement process in Pharmacology learning, especially in the cardiovascular system. 98 active students participated in this study, divided into 74 undergraduate students and 24 clinical internship students. The evaluation was carried out using a pre-test and a post-test related to pharmacological animation video exposure. Using the Wilcoxon different test, there was a significant difference between the pre-test and post-test results, especially in the clinical internship program’s students. This animated model was expected to help students to determine the rational determination of hypertension therapy