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Background: Chemotherapy with fluorouracil, adriamycin, and cyclophosphamide (FAC) regimen in breast cancer patients may cause myocardial injury and necrosis, thereby attenuating global and regional longitudinal strain (GLS and RLS). It is unclear whether the first chemotherapy cycle would cause GLS and RLS reduction and which segment would be most affected by the chemotherapy. The purpose of the study was to investigate the effect of the first chemotherapy cycle on GLS and RLS reduction. Methods: This was a prospective single-center cohort study of patients with breast cancer who underwent the first chemotherapy cycle with a FAC regiment. The GLS and RLS were measured using speckle tracking echocardiography and left ventricular ejection fraction (LVEF) measured with Simpson's biplane. The echocardiography was performed before and 3 weeks after the first chemotherapy cycle. We compared the value of GLS, RLS, and LVEF before and after chemotherapy using paired t -test analysis. Results: Thirty-six breast cancer patients were enrolled in the study. The GLS and RLS were reduced significantly at 3 weeks compared to baseline. The RLS of the basal anteroseptal, basal anterolateral, mid anterolateral, mid inferolateral, and all apical segments declined significantly from baseline. The largest RLS decline was detected in the apicoanterior segment. The post-chemotherapy GLS but not LVEF was significantly lower than that before treatment. Conclusion: The GLS and RLS of patients who underwent first cycle chemotherapy with FAC declined significantly than that before treatment, especially at the apicoanterior segment. LVEF was not altered after first cycle chemotherapy. Cardiol Res. 2021;12(4):238-243 doi: https://doi.org/10.14740/cr1229

BACKGROUND: This study aimed to investigate whether the active prescription of low-dose aspirin during or prior to hospitalization affects mortality in patients with coronavirus disease 2019 (COVID-19). Aspirin is often prescribed for secondary prevention in patients with cardiovascular disease and other comorbidities that might increase mortality, and may therefore falsely demonstrate increased mortality. To reduce bias, only studies that performed an adjusted analysis were included in this review. METHODS: A systematic literature search of PubMed, Scopus, Embase and Clinicaltrials.gov was performed, from inception until 16 April 2021. The exposure was active prescription of low-dose aspirin during or prior to hospitalization. The primary outcome was mortality. The pooled adjusted effect estimate was reported as relative risk (RR). RESULTS: Six eligible studies were included in this meta-analysis, comprising 13,993 patients. The studies had low-to-moderate risk of bias based on the Newcastle-Ottawa Scale. The meta-analysis indicated that the use of low-dose aspirin was independently associated with reduced mortality {RR 0.46 [95% confidence interval (CI) 0.35-0.61], P < 0.001; I2 = 36.2%}. Subgroup analysis on in-hospital low-dose aspirin administration also showed a significant reduction in mortality [RR 0.39 (95% CI 0.16-0.96), P < 0.001; I2 = 47.0%]. CONCLUSION: Use of low-dose aspirin is independently associated with reduced mortality in patients with COVID-19, with low certainty of evidence.

BACKGROUND: Cardiac injury is frequently encountered in patients with coronavirus disease 2019 (COVID-19) and is associated with increased risk of mortality. Elevated troponin may signify myocardial damage and is predictive of mortality. This study aimed to assess the prognostic value of troponin above the 99th percentile upper reference limit (URL) for mortality, and factors affecting the relationship. METHODS: A comprehensive literature search of PubMed (MEDLINE), Scopus and Embase was undertaken, from inception of the databases until 16 December 2020. The key exposure was elevated serum troponin, defined as troponin (of any type) above the 99th percentile URL. The outcome was mortality due to any cause. RESULTS: In total, 12,262 patients from 13 studies were included in this systematic review and meta-analysis. The mortality rate was 23% (20-26%). Elevated troponin was observed in 31% (23-38%) of patients. Elevated troponin was associated with increased mortality [odds ratio (OR) 4.75, 95% confidence interval (CI) 4.07-5.53; P < 0.001; I2 = 19.9%]. Meta-regression showed that the association did not vary with age (P = 0.218), male gender (P = 0.707), hypertension (P = 0.182), diabetes (P = 0.906) or coronary artery disease (P = 0864). The association between elevated troponin and mortality had sensitivity of 0.55 (0.44-0.66), specificity of 0.80 (0.71-0.86), positive likelihood ratio of 2.7 (2.2-3.3), negative likelihood ratio of 0.56 (0.49-0.65), diagnosis odds ratio of 5 (4-5) and area under the curve of 0.73 (0.69-0.77). The probability of mortality was 45% in patients with elevated troponin and 14% in patients with non-elevated troponin. CONCLUSION: Elevated troponin was associated with mortality in patients with COVID-19 with 55% sensitivity and 80% specificity.

OBJECTIVE This systematic review and meta-analysis aimed to evaluate whether the absence of electrocardiographic (ECG) left ventricular hypertrophy (LVH) was associated with poor outcome in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS We performed systematic review search on PubMed, Embase, and Scopus up until January 22, 2021. The key exposure was the absence of ECG LVH, defined as the absence of LVH by electrocardiographic criteria. The outcome of interest was composite poor outcome, which is a composite of mortality and/or rehospitalization after TAVR. The effect estimate was reported as hazard ratio (HR). In addition, we generate sensitivity and specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), and area under curve (AUC). RESULTS There are four studies comprising of 827 patients included in this systematic review and meta-analysis. The prevalence of poor outcome in this pooled analysis was 30%. The absence of ECG LVH was associated with increased poor outcome in patients undergoing TAVR (HR: 1.86, [1.34, 2.57], p

Background: Sympathetic hyperactivity is one of the several factors that influence left ventricular dyssynchrony post anthracycline. Cardiovascular risk factors affect the acceleration of left ventricular dyssynchrony. The purpose of this study is to assess the difference in correlation coefficient between HRV and mechanical dispersion in breast cancer patients with and without cardiovascular risk factors after anthracycline administration.Method: This was a cross sectional study with linear regression analysis conducted at Hasan Sadikin General Hospital Bandung between July-October 2018. Subjects were breast cancer patients who had received 6 cycles of FAS and were divided into 2 groups. Group I was patients with breast cancer who have cardiovascular risk factors and group II was without cardiovascular risk factors. Sympathetic hyperactivity was assessed using HRV baseline frequency with minimum duration of recording and left ventricular dyssynchrony was assessed using MD method by echocardiography.Result: This study involved 66 patients. Group I (n=34, age 50.3±6.3 years) and group II (n=32, age 48.5±9 years). The median of LF/HF ratio was 2.7 ms2 (group I) and 1.9 ms2 (group II). MD value in group I and group II was 52.2±13.6 ms and 45.7±8.8 ms, respectively. The result of linear regression analysis showed positive correlation between the LF/HF ratio and MD in group I (r=0.546, p=0.001) and group II (r=0.423, p=0.016) after adjusting three confounding factors (systolic blood pressure, cumulative dose of Doxorubicin, and age).Conclusion: Correlation coefficient of HRV with mechanical dispersion in post anthracycline breast cancer patients in those with cardiovascular risk factorswas worse compared to those without cardiovascular risk factors but was not statistically significant.

Background: Preoperative left atrial remodeling as Postoperative atrial fibrillation (POAF) predisposing factors could be measured by left atrial volume index (LAVI) and P-wave dispersion. Aim: This study aimed to assess P-wave dispersion and LAVI as preoperative predictors of POAF among patients who underwent Coronary Artery Bypass Graft (CABG). Methods: An analytical retrospective cohort study was performed on patients who underwent CABG. The P-wave dispersion and POAF were evaluated based on documented ECG results. LAVI size was collected from echocardiographic reports. Hazard ratios of P-wave dispersion and LAVI for POAF were analyzed using Cox proportional hazard model. Result: A total of 42 subjects (57±1 years) were included in this study. POAF occurred in 28.6% of patients at a median of 2 days after CABG. P-wave dispersion was significantly longer in patients in whom AF was developed (53.03±3.82ms vs. 44.01±1.98ms, p:0.028), while LAVI difference was not significant. The Cox proportional hazard model showed a significant association between P-wave dispersion and risk of POAF (HR 1.05, CI95%, 1.001-1.103;p=0.048). There was no association between LAVI and risk of POAF (HR1.003, CI 95%, 0.965-1.044;p=0.864). Conclusion: P-wave dispersion is a predictor of POAF in patients who underwent CABG. Risk stratification using P-wave dispersion enables clinicians to identify high-risk patients before CABG surgery.

Background: This systematic review and meta-analysis aimed to assess whether low serum 25-hydroxyvitamin D (25-OHD) level is associated with susceptibility to COVID-19, severity, and mortality related to COVID-19.Methods: Systematic literature searches of PubMed, Scopus, and Embase database up until 9 December 2020. We include published observational prospective and retrospective studies with information on 25-OHD that reported main/secondary outcome. Low serum 25-OHD refers to participants with serum 25-OHD level below a cut-off point ranging from 20 to 30 ng/mL. Other cut-off values were excluded to reduce heterogeneity. The main outcome was mortality defined as non-survivor/death. The secondary outcome was susceptibility and severe COVID-19.Results: There were 14 studies comprising of 999,179 participants. Low serum 25-OHD was associated with higher rate of COVID-19 infection compared to the control group (OR = 2.71 [1.72, 4.29], p < 0.001; I2: 92.6%). Higher rate of severe COVID-19 was observed in patients with low serum 25-OHD (OR = 1.90 [1.24, 2.93], p = 0.003; I2: 55.3%), with a sensitivity of 83%, specificity of 39%, PLR of 1.4, NLR of 0.43, and DOR of 3. Low serum 25-OHD was associated with higher mortality (OR = 3.08 [1.35, 7.00], p = 0.011; I2: 80.3%), with a sensitivity of 85%, specificity of 35%, PLR of 1.3, NLR of 0.44, and DOR of 3. Meta-regression analysis showed that the association between low serum 25-OHD and mortality was affected by male gender (OR = 1.22 [1.08, 1.39], p = 0.002), diabetes (OR = 0.88 [0.79, 0.98], p = 0.019).Conclusion: Low serum 25-OHD level was associated with COVID-19 infection, severe presentation, and mortality.

Hypersensitive pneumonitis (HP), also known as extrinsic allergic alveolitis, is a complex pulmonary syndrome mediated by the immune system and caused by inhalation of various antigens that have previously been sensitized by the individual. The pathobiology of this disease is not fully understood, but in addition to the triggers that initiate the disease, genetic factors tend to be necessary, because only a small proportion of people are exposed to HP. Because of the lack of standard diagnostic standards, the diagnosis of HP is not directly established and depends on several factors, including the history of exposure, antibodies present in specific antigens, clinical features, bronchoalveolar lavage (LAB), and radiological and pathological features. However, in proper management, high suspicion is significant and can negate the need for more invasive tests. Clinical manifestations and allergic history vary greatly. Corticosteroids may be useful in acute episodes to relieve symptoms or chronic progressive disease, but their long-term effects have never been validated in prospective clinical trials. We conduct a systematic review of published journals about HP. The search uses the Pubmed database using the medical term (MeSH) until January 2020. A total of 13 journals and one textbook were identified.

Background: Hypertension is a global health problem, with the prevalence increasing by 30% from 2013 to 2018 in Indonesia. Furthermore, obesity, a major risk factor for hypertension, has also escalated by 50%. Hence, the incidence of Obstructive Sleep Apnoea Syndrome (OSAS), which is strongly associated with hypertension and obesity, is expected to increase. OSAS is part of the complex sleep disorder breathing syndrome, but there is a lack of data regarding its prevalence and association with hypertension. Objective: To investigate the prevalence of OSAS and its association with hypertension in Jatinangor, West Java, Indonesia. Methods: A cross-sectional study was conducted from September to October 2018 of subjects from two villages in Indonesia selected by purposive sampling. Fifteen neighbourhoods were chosen by the cluster random sampling method, with a total of 1,308 respondents included in this study. Inclusion criteria were age > 17 years old and resident in the village for more than one year. OSAS was determined by a 4-variable screening tool questionnaire (4-V) and hypertension was measured by a standardised method (average of three measurements in each session with a one-minute break using a digital device); both measurements were performed by trained health cadres. All results were statistically analysed using chi-square and logistic regression. Results: Of the total of 1308 respondents included in this study, 33 (2.5%) had OSAS and 299 respondents (22.8%) had hypertension. In the population with OSAS, 18 respondents (54.5%) had hypertension, significantly higher (pp = 0.000). Conclusion: The prevalence of OSAS in the Jatinangor district of Indonesia is 2.5% and it is significantly associated with hypertension.

Background : Cardiovascular disease has very high morbidity and mortality, therefore, prevention of this disease becomes a national priority in the health programs. Health cadres, as an agent in community primary prevention, should have a good health condition. This study aimed to describe the cardiovascular risk profile in health cadresin Jatinangor, West Java. Methods : This was a cross-sectional study, conducted in Cilayung Village, Jatinangor, in September 2018. Consecutive sampling was performed on 20 health cadres aged 25 - 64 years old who did not have previous cardiovascular events such as coronary heart disease or stroke. Clinical data were collected consisting of blood pressure, body mass index (BMI), random blood glucose, history of diabetes mellitus, physical activity and active smoking habits. Cardiovascular risk was assessed using Jakarta cardiovascular scores and European Relative Risk Score. Results : Only 17 of 20 health cadres fulfilled the inclusion criteria with a systolic and diastolic blood pressure of 133.5±27.8 mmHg and 81.1±14.8 mmHg, respectively, and BMI of 27.4±5.3 kg/m2.The risk of cardiovascular disease in healthy cadres was at low (47.1%), moderate (41.2%) and high risk (11.7%). The average of the European Relative Risk score was 1.88±0.9. BMI >30 has a 40% high risk of cardiovascular disease. Conclusions : Most of the health cadres in Jatinangor, West Java have a low and moderate risk of cardiovascular disease, even though there is a small percentage that is at a high risk. The awareness for prevention and management programs for risk factors needs to be raised among health cadres. .

BACKGROUND: In this systematic review and meta-analysis, we aimed to compare the level of von Willebrand Factor (vWF) antigen in patients with poor outcome compared to those without. Additionally, we also explored factors that may affect the difference in terms of vWF antigen between the two groups. METHODS: A comprehensive literature search was performed using the PubMed, Embase, and Scopus databases from inception up until 7 April 2021. The main outcome was poor outcome, which is a composite of mortality and severe COVID-19. RESULTS: There are 10 studies comprising of 996 patients included in this systematic review and meta-analysis. vWF antigen was higher in patients with poor outcome (standardized mean difference [SMD] 0.84 [0.45, 1.23], p

Background: This meta-analysis aimed to assess the prognostic value of hyponatremia in patients with COVID-19.Methods: We performed a systematic literature search on PubMed, Scopus, ScienceDirect, and Wiley up until January 26, 2021. The key exposure was hyponatremia, defined as sodium level below the reference level. The outcome of interest was poor outcome, which was a composite of mortality, severe COVID-19, and prolonged hospitalization. Severe COVID-19 was defined severe CAP or needing ICU care or IMV. The pooled effect estimate was odds ratio (OR). Sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), diagnostic OR (DOR), and area under curve (AUC) were generated.Results: There were 11,493 patients from eight studies included in this systematic review and meta-analysis. The incidence of hyponatremia was 24%, and incidence of poor outcome was 20%. Hyponatremia was associated with poor outcome in COVID-19 (OR 2.65 [1.89, 3.72], p < 0.001; I2: 67.2%). Meta-regression analysis showed that the association between hyponatremia and poor outcome was reduced by age (OR 0.94 [0.90, 0.98], p = 0.006) and hypertension (OR 0.96 [0.93, 0.94], p < 0.001). Hyponatremia has a sensitivity of 0.37 [0.27, 0.48], specificity of 0.82 [0.72, 0.88], PLR of 2.0 [1.5, 2.7], NLR of 0.77 [0.69, 0.87], DOR of 3 [2, 4], and AUC of 0.62 [0.58, 0.66] for predicting poor outcome. In this pooled analysis, hyponatremia has a 33% posttest probability for poor outcome, and absence of hyponatremia confers to a 16% posttest probability.Conclusion: Hyponatremia was associated with poor outcome in patients with COVID-19.Systematic Review Registration: PROSPERO, CRD42021233592.

BACKGROUND AND AIMS: Creatine kinase (CK), a marker of muscle damage, is potentially associated with a more severe COVID-19. In this systematic review and meta-analysis, we aim to evaluate the association between the elevated CK and severity and mortality in COVID-19. METHODS: We performed a systematic literature search on PubMed, Scopus, and Embase up until January 26, 2020. The main outcome was poor outcome, a composite of mortality and severe COVID-19. RESULTS: There are 2471 patients from 14 studies included in this systematic review and meta-analysis. The incidence of elevated CK in this pooled analysis was 17% (11%, 22%) and the incidence of poor outcome in this pooled analysis was 27% (19%, 34%). Elevated CK was associated with poor outcome in patients with COVID-19 (OR 3.01 [2.21, 4.10], p

BackgroundThis systematic review and meta-analysis aimed to assess whether ventricular longitudinal strain can be used as a prognostication tool in patients with coronavirus disease 2019 (COVID-19).MethodsSystematic literature searches of PubMed, Embase, and EuropePMC databases were performed on 16 November 2020. Left ventricular global longitudinal strain (LV-GLS) refers to LV contraction measurement using the speckle tracking-based method refers to the mean of strain values of the RV free wall (three segments) measured using echocardiography. The main outcome was poor outcome, defined as a composite of mortality and severe COVID-19.ResultsSeven studies comprising of 612 patients were included in meta-analysis. Six studies have mortality as their outcome, and 1 study has severity as their outcome. Patients with poor outcome have lower LV-GLS (SMD 1.15 (0.57, 1.72),p< 0.001;I270.4%). Each 1% decrease in LV-GLS was associated with 1.4x increased risk of poor outcome (OR 1.37 (1.12, 1.67),p= 0.002;I248.8%). Patients with poor outcome have lower RV-LS (SMD 1.18 (0.91, 1.45),pI20%). Each 1% decrease in RV-LS was associated with 1.3x increased risk of poor outcome (OR 1.25 (1.15, 1.35),pI211.8%). Subgroup analysis showed that for every 1% decrease in LV-GLS and RV-LS is increased mortality with OR of 1.30 (1.12, 1.50) and OR of 1.24 (1.14, 1.35), respectively.ConclusionThis study shows that lower LV-GLS and RV-LS measurements were associated with poor outcome in patients with COVID-19.Trial registrationPROSPEROCRD42020221144

Sphyngomonas paucimobilis (S. paucimobilis) is a low-pathogenicity, gram-negative bacilli (GNB) that are previously known as an opportunist microorganism. Recent studies have shown that S. paucimobilis is an emerging pathogen causing various infections. Multidrug-resistant GNB has emerged as a major clinical and therapeutic dilemma in various hospital-associated infections. Although rare, S. paucimobilis could be associated with infective endocarditis (IE). Prosthetic valve endocarditis (PVE) is the most severe type of IE, which has high mortality rates despite diagnostic and treatment advances. We report a fatal case of early PVE associated with multidrug-resistant (MDR) - S. paucimobilis complicated with perivalvular abscess, complete heart block, valve detachment, and septic arthritis.

Background: We aimed to assess the dose-response relationship between Triglyceride-Glucose (TyG) Index and Major Adverse Cardiovascular Events (MACE) in patients with Acute Coronary Syndrome (ACS). Methods: A systematic literature search was performed using PubMed, Scopus, and Embase for records published from the inception up until 7 February 2021. Studies that fulfilled all of these criteria were included: 1) prospective or retrospective observational studies reporting patients with ACS and 2) assessing the impact of TyG index on MACE with at least three quantitative classifications. The outcome of interest is MACE across the TyG index intervals. MACE was a composite of all-cause mortality, myocardial infarction, unstable angina pectoris, target vessel revascularization, cerebrovascular accidents, and heart failure. The effect estimates were reported as relative risks (RRs). Results: There are 13,684 subjects from 4 studies included in this meta-analysis. This meta-analysis showed that the highest category of TyG index was associated with twofold MACE (RR 2.09 [1.59, 2.76], p

Background: Myocardial necrosis may occur due to anthracycline (doxorubicin/adriamycin) chemotherapy usage. Furthermore, myocardial necrosis can affect the heterogeneity of heart conduction system and lead to repolarization abnormalities. The aim of this study was to investigate the effect of cardiotoxicity caused by anthracycline to repolarization abnormalities measured by T peak to T end (TpTe) interval. Methods: This was a single center prospective cohort study with linear regression from October 2018 to May 2019. The subjects of the study were breast cancer patients after completing administration of chemotherapy with fluorouracil, adriamycin and cyclophosphamide (FAC) regimen (containing anthracycline) for 6 months. Myocardial necrosis was assessed by high sensitive (hs)-troponin I, and the heterogeneity of repolarization was measured by TpTe interval. Results: This study involved 25 breast cancer patients after chemotherapy in the 6-month FAC regimen. The mean age is 46 ± 7 years, and the cumulative dose of anthracycline is 591 ± 52 mg/m 2 . The mean level of hs-troponin I is 90.5 ± 44.7 ng/L and the TpTe interval is 108.2 ± 10 ms. The results of linear regression analysis showed a positive correlation between hs-troponin I and TpTe interval (r: 0.421, P: 0.036) after controlling for one confounding variable (cumulative dose of anthracycline). Conclusions: Cardiotoxicity caused by accumulative dose of anthracycline may lead to myocardial necrosis which was shown by elevated hs-troponin I levels. This process may lead to heterogeneity conduction system that affect the repolarization phase of cardiac cycle which was shown by increased TpTe interval. Cardiol Res. 2020;11(5):305-310 doi: https://doi.org/10.14740/cr1052

Background: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise. Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if > 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression. Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR. Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.

Anti Inflamasi Non Steroid (AINS) merupakan golongan obat untuk nyeri dan inflamasi yang banyak digunakan di masyarakat. Tujuan penelitian ini adalah mengidentifikasi karakteristik responden, pola penggunaan AINS, dan tingkat pengetahuan masyarakat di kelurahan Sungai Besar. Penelitian ini adalah penelitian noneksperimental dengan metode observasional deskriptif dengan teknik pengumpulan sampel menggunakan teknik quota sampling. Sampel penelitian yang memenuhi kriteria inklusi dan ekslusi berjumlah 96 responden. Instrumen penelitian berupa lembar kuesioner yang sudah dilakukan uji validitas dan reliabilitas. Hasil penelitian menunjukkan masyarakat kelurahan Sungai Besar yang menggunakan AINS adalah berjenis kelamin perempuan (56,25%), berumur 26–45 tahun (59,38%), berpendidikan SMA/SMK (43,75%), dan bekerja sebagai Ibu Rumah Tangga (36,64%). Pola penggunaan AINS meliputi jenis AINS yang digunakan adalah asam mefenamat (73,95%), waktu terakhir menggunakan obat 1 bulan terakhir (83,33%), cara memperoleh obat tanpa resep dokter (78,12%), tempat pembelian obat di apotek (83,33%). Tujuan pengobatan untuk mengurangi rasa nyeri (73,96%), bentuk sediaan obat yang digunakan sediaan tablet (100%), cara penggunaannya langsung diminum (100%), dan aturan pakai 3 x sehari (84,38%), responden tidak mengalami efek samping selama penggunaan AINS (83,33%), serta responden (96,87%) tidak memiliki kondisi penyakit lain/riwayat penyakit dalam penggunaan AINS. Tingkat pengetahuan responden terkait penggunaan AINS tinggi (77,08%). Kesimpulan dari penelitian ini responden memiliki tingkat pengetahuan tinggi tentang penggunaan obat AINS.Kata Kunci : AINS, Pola Penggunaan, Tingkat PengetahuanNon-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a class of drugs for pain and inflammation that are widely used in the community. The aim of this study was to identify the characteristics of the respondents, the pattern of using NSAIDs, and the level of knowledge of the people in the Sungai Besar village who had used NSAIDs. This research is a non-experimental research with descriptive observational method with quota sampling technique. The research sample that met the inclusion and exclusion criteria was 96 respondents. The research instrument is a questionnaire that has been tested for validity and reliability. The results showed that the Sungai Besar community who used AINS were female (56.25%), aged 26–45 years (59.38%), had a high school education (43.75%), and worked as housewives ( 36.64%). The pattern of NSAID use includes the type of NSAID used is mefenamic acid (73.95%), the last time using the drug in the last 1 month (83.33%), get medicine without a doctor's prescription (78.12%), buy medicine at the pharmacy (83 ,33%). The purpose of treatment is to reduce pain (73.96%), the dosage form of the drug used is tablet (100%), how to use it directly to drink (100%), and the rule of use 3 times a day (84.37%), respondents do not experience side effects during the use of NSAIDs (83.33%), and respondents (96.87%) did not have other disease conditions/history of disease in the use of NSAIDs. The level of knowledge of respondents related to the use of NSAIDs is high (77.08%). The conclusion of this study is that respondents have a high level of knowledge about the use of NSAIDs.

Pasien yang menjalani operasi Bedah Pintas Koroner (BPK) atau coronary artery bypass grafting (CABG) memiliki risiko terjadinya komplikasi pasca operasi yang berakibat pada hari rawat yang lama bahkan kematian. Intervensi berupa rehabilitasi jantung fase I diperlukan untuk membantu mempercepat proses pemulihan pasca operasi serta mencegah terjadinya komplikasi pasca operasi BPK. Meskipun penelitian terkait rehabilitasi jantung sudah banyak dilakukan, namun perlu dilakukan telaah lebih lanjut dari artikel penelitian mengenai intervensi yang dapat dilakukan dalam program rehabilitasi jantung yang aman dan mudah dilakukan pada pasien pasca operasi BPK. Tujuan penelitian ini adalah untuk melihat intervensi yang aman dan efektif dilakukan dalam rehabilitasi jantung fase I pada pasien yang menjalani operasi BPK. Studi literatur ini dibuat dengan melakukan analisis terhadap atikel-artikel ilmiah minimal penelitian retrospektif yang dipublikasi tahun 2008 sampai 2018 dan berbahasa Inggris. Data didapat dari database meliputi Google Scholar, PubMed, DOAJ, dan Proquest dengan kata kunci cardiac rehabilitation phase I, coronary artery bypass grafting, early ambulation, early mobilization, education pre operative, dan physical exercise . Hasil studi literatur ini didapatkan 13 artikel yang sesuai dengan kriteria inklusi dan eksklusi. Hasil telaah ditemukan bahwa pelaksanaan rehabilitasi jantung fase I pada pasien yang menjalani operasi BPK dimulai dari fase praoperasi dan dilanjutkan pasca operasi sampai pasien akan pulang. Intervensi rehabilitasi jantung fase I, baik pre maupun pasca operasi, terdiri dari edukasi dan konseling, latihan/ aktivitas fisik, latihan bernapas, latihan batuk efektif, inspiratory muscle training , fisioterapi dada, dan respiratory muscle stretch gymnastics . Oleh karena itu, hasil telaah literatur ini dapat menjadi dasar dalam menentukan standar prosedur operasional terhadap pelaksanaan rehabilitasi jantung fase I untuk rumah sakit yang menyediakan pelayanan operasi BPK. Kata Kunci: ambulasi dini, coronary artery bypass grafting , mobilisasi dini, rehabilitasi jantung fase I Abstract Cardiac rehabilitation phase I in patient undergoing coronary artery bypass grafting surgery. A p atient undergoing coronary artery bypass grafting CABG surgery ha s a risk of post operative complication, which can cause prolonged length of stay and even mortality. Th e patient necessarily needs to do intervention cardiac rehabilitation phase I to help the recovery process after surgery and prevent post operative complications. The articles related to cardiac rehabilitation have been carried out. However, it is necessary to review research articles about the effectiv e and safe intervention of cardiac rehabilitation phase I for patients undergoing CABG surgery. The aim of this study was to explore the effectiv e and safe intervention of cardiac rehabilitation phase I. This literature review was conducted by analyzing articles including randomized control trial until retrospective design which published between 2008 to 2018 with English language articles. Data w as searched through Google Scholar, PubMed, DOAJ, and Proquest. The keyword wa s early ambulation, coronary artery bypass grafting, preoperative education, physical exercise, early mobilization, and cardiac rehabilitation phase I or inpatient cardiac rehabilitation. The finding in this literature review was 13 articles corresponding with the inclusion and exclusion criteria. The result of this study found that the intervention in cardiac rehabilitation phase I in patient who undergoing coronary artery bypass grafting surgery was started from preoperative and continued postoperative phases until the patient will leave the hospital. Interventions in cardiac rehabilitation phase I consisted of education and counseling, physical exercise/ activity, breathing exercises, effective cough exercises, inspiratory muscle training, chest physiotherapy, and respiratory muscle stretch gymnastics. Therefore, the result of this literature review can be the basis to determine standard operational procedure for the implementation of the cardiac rehabilitation phase I for the hospitals that provide CABG surgery. Keywords: cardiac rehabilitation phase I, coronary artery bypass grafting, early ambulation, early mobilization

Body mass index (BMI) and cardiorespiratory fitness are considered risk factors for cardiovascular disease. Chronic inflammation associated with adiposity as well as the hemodynamic changes that occur when there is an increase in BMI suggests a possible association between BMI and cardiorespiratory fitness. This study aims to analyze the relationship between BMI and cardiorespiratory fitness. A cross-sectional study was conducted using weighted cardiac training test results for the period January 1st, 2014 to December 31, 2019, from the Non-Invasive Diagnostic Division, the Department of Cardiology and Vascular Medicine, Dr. Hasan Sadikin Bandung. Subjects included in the study were those who achieved the maximum estimated heart rate based on age or less than 10 beats per minute, and/or the exercise test was stopped due to fatigue with a Borg 17 scale. Patients with multiple conditions were excluded from the study (taking beta-blockers, having a history of heart failure and diabetes mellitus, currently undergoing cardiac rehabilitation), along with patients with incomplete data. The maximum oxygen consumption in the form of the metabolic equivalent of tasks (METs) was estimated based on the speed and inclination of the stage reached during the treadmill training test using the Bruce protocol. The percentage of fitness is obtained by comparing the METs achieved with the estimated maximum METs based on age and gender. The relationship between BMI and percentage of fitness was analyzed using the Pearson correlation test. The total number of subjects included in the study was 51 subjects. The mean BMI of the subjects was 25.65 ± 3.22 kg / m2. The mean fitness percentage was 107.29 ± 23.89. Analysis of the relationship between BMI and fitness showed a negative but insignificant relationship (r = -0.135, p = 0.345). An increase in body mass index has a tendency to be associated with a decrease in cardiorespiratory fitness.

Background Despite its efficacy, FAC regimen may cause fatal cardiotoxicity. Carvedilol may also exert additional antioxidant effects. This study aimed to assess the effect of carvedilol in preventing decline of left ventricular function in breast cancer patients receiving FAC regimen chemotherapy. Methods The study was a quasi-experimental study. The study subjects were consisted of breast cancer patients currently receiving post-first cycle FAC chemotherapy regimen in period of March – May 2019. The study subjects were divided into 2 groups: control and intervention group. In intervention groups, the patients consumed up titrated carvedilol with initial dose of 2 × 6.25 mg daily, follow-up echocardiography was performed for the patients in order to assess GLS score of left ventricle. Result Eighty patients were enrolled to the study, with each group consisted of 40 patients. Patient baseline characteristics were not significantly different between both groups. Left ventricular function was assessed using speckle tracking echocardiography and assessing the change of GLS score. Decrease of GLS score was higher in the intervention group compared to the control group, although the decrease was not statistically significant (0.767 ± 0.355 vs. 0.897 ± 0.526; p = 0.838). Percentage wise, similar findings were reported, albeit no significant (3.34 ± 1.65 vs. 3.46 vs. 2.58; p = 0.968). Conclusions Carvedilol was not able to prevent the decline of subclinical left ventricular function after such chemotherapy cycle. However, it maybe more likely that the benefits appear in patients whose given larger cumulative dose of anthracycline and have multiple risk factors.

Background: Triglycerides (TG) as a risk factor for coronary artery disease (CAD) is still a matter of controversy but when used as a single ratio with high density lipoprotein (HDL) the predictive value for CAD is better. The TG/HDL ratio is also associated with the presence of small dense LDL (sdLDL) in the body. SdLDL is a more atherogenic LDL subfraction and has been proven to be associated with CAD progression.Aims: This study aims to find the correlation between the TG/HDL ratio and the degree of coronary lesion severity based on the Gensini score in stable non diabetic angina pectoris patients.Methods: This study was a cross sectional study conducted at Dr. Hasan Sadikin Hospital and Hasna Medika Palimanan Hospital. Subjects were non diabetic stable angina pectoris patients ≥18 years old who underwent elective coronary angiography. Blood collection for TG and HDL examination was performed after coronary angiography. Gensini scoring system was used to assess the severity of coronary lesions. The relationship between the TG/HDL ratio and the Gensini score was analyzed using multiple linear regression tests against confounding variables.Results: This study involved 60 patients with stable angina pectoris with a mean age of 60±8 years. The mean TG/HDL ratio is 2.56 ± 1.04. The average Gensini score was 51 ± 36. The TG/HDL ratio was significantly associated with the Gensini score (R = 0.637; p

Background: Thorax expansion used to measure respiratory function. Data of thorax expansion for healthychildren is still limited. Thorax expansion is caused by breathing. This influences cardiovascular functionbecause anatomically the heart is located within the thorax cavity. The aim of this study is to determine themeasurement of thorax expansion using the measurement tape method. Factors influencing thorax expansionare sex and age; and correlates with heart rate and blood pressure in school age children.Methods: Ninety-six children were included in this study both male and female and were aged 6 to 15years. They were in Elementary School and Junior High School in Jatinangor. The study were conductedfrom September-November 2013 by adopting a random selection cross sectional method. The examinationsperformed after written informed consent and questionnaire form from their parents.Results: The results showed that upper thorax has lower mean expansion than middle and lower thoraxexpansion respectively (2.96±0.64cm; 3.82±1.04cm; 5.01±1.15cm). There was significant difference betweengroups of age (p

Background: Obesity is one of the global health problems with increasing prevalence, and the complication is related to the alteration of the left ventricle. An obese person without symptoms has impaired diastolic function compares to a normal population, but the mechanism is still unclear. One of the evolving theories is caused by chronic inflammation, characterized by the increase of proinflammatory adipocytokines in an obese person. Leptin is a chronic inflammatory marker which is synthesized by all adipose tissues and has a positive correlation with the body mass index. Leptin level are influenced by age except young adult group. The aim of this study is to investigate the correlation between leptin level and diastolic function of the left ventricle in youngadult obese.Method: This study was conducted in a single centre with cross-sectional design. The subject of this study consists of all young adult obese, worked in Dr. Hasan Sadikin General Hospital, between June-August 2018. The diastolic function of the left ventricle was measured by examining the ventricle relaxation (E/mean e’) by tissue doppler imaging method. The examination of leptin level was done by sandwich-ELISA testmethod. Pearson correlation test was done to assess the correlation between those two.Result: This study consisted of 38 patients with the mean of age 30.75±7.25 years old, 68% were males. The mean score of E/mean e’ was 6.49±3.02 ng/mL and the median of leptin was 13.95 (9.1–25.4) mg/L. After data log transformation of leptin was done, there was a significant positive correlation (r= 0.5892, p

Infark miokardium akut merupakan penyebab utama kematian di dunia. Perbedaan jenis kelamin berperan terhadap mortalitas jangka panjang pascainfark miokardium yang menunjukkan gambaran pola fisiologi regenerasi miokardium yang spesifik. Kematian setelah infark miokardium lebih tinggi pada perempuan. Remodeling ventrikel kiri merupakan proses penyembuhan luka pascainfark miokardium yang menjadi petunjuk keadaan gagal jantung maupun kematian. Proses ini berpengaruh penting pada fungsi ventrikel dan prognosis survival yang dapat didiagnosis dengan pemeriksaan ekokardiografi. Terdapat kontroversi berkaitan dengan peranan androgen pada proses remodeling jantung. Walaupun masih terdapat perdebatan, androgen memiliki peran terhadap remodeling ventrikel kiri dan bersifat protektif terhadap proses fibrosis yang maladaptif. Dilakukan penelitian observasional analitik yang bersifat prospektif untuk mengkaji peranan testosteron terhadap remodeling ventrikel kiri pada pasien infark miokardium akut di RSUP Dr. Hasan Sadikin Bandung selama Maret–Oktober 2015. Penelitian dilakukan pada 60 orang laki-laki usia 40–77 tahun penderita infark miokardium akut. Pemeriksaan ekokardiografi, pengukuran kadar testosteron total, testosteron bebas, dan testosteron bioavailabel dilakukan sebanyak dua kali. Pemeriksaan pertama dilakukan saat pasien didiagnosis infark miokardium akut dan pengulangan 4–6 minggu kemudian. Usia rata-rata penderita 56,16±8,48 tahun. Bila dibanding dengan pemeriksaan pertama dan kedua, tampak peningkatan kadar testosteron total yang signifikan (785,00±661,76 ng/dL vs 822,33±365,64 ng/dL; p=0,004), penurunan kadar testosteron bebas (24,66±17,91 ng/dL vs 19,00±15,24 ng/dL; p=0,067), dan penurunan kadar testosteron bioavailabel (475,21±353,10 ng/dL vs 394,98±314,85 ng/dL; p=0,166). Analisis korelasi rank Spearman memperlihatkan korelasi bermakna antara testosteron bebas dan relative wall thickness ( p=0,019), serta testosteron bioavailabel dengan relative wall thickness (p=0,014). Simpulan, testosteron berperan pada proses remodeling ventrikel kiri pascainfark miokardium akut yang diperlihatkan dengan peningkatan kadar testosteron total serta penurunan kadar testosteron bebas maupun testosteron bioavailabel yang memiliki afinitas yang kuat dengan kardiomiosit. CORELLATION BETWEEN TESTOSTERONE LEVEL AND LEFT VENTRICULAR REMODELING PROCESS IN ACUTE MYOCARDIAL INFARCTION PATIENT Myocardial infarction (MCI) is a leading cause of death worldwide. Gender differences in long term mortality after MCI lead to a specific physiologic pattern of myocardial regeneration. Moreover mortality after MCI was reported to be higher in women. Left ventricular remodeling is cardiac wound healing after MCI indicate a high risk of heart failure and death. This remodeling can importantly affect the function of the ventricle and prognosis for survival which can be diagnosed by echocardiography. Controversial information excert about the role of androgen in cardiac remodeling. Even the evidence still debatable, androgen has a role in left ventricular (LV) remodeling and protect heart from maladaptive fibrosis. A prospective analytical observational study was conducted to evaluate the role of testosterone in LV remodeling in acute myocardial infarction patients. The study comprised 60 men aged 40–77 years with acute myocardial infarction in Dr. Hasan Sadikin Hospital during March–October 2015. Echocardiographyc study and the level of total, free, and bioavailable testosterone were measured twice. The first measured when they diagnosed acute myocardial infarction and the second after 4–6 weeks. The age of patient was 56.16±8.487 years old. Comparing the first and the second measure indicate that total testosterone significantly increased (785.00±661.76 ng/dL vs 822.33±365.64 ng/dL, p=0.004), free testosterone decreased (24.66±17.91 ng/dL vs 19.00±15.24 ng/dL, p=0.067), and bioavailable testosteron decreased (475.21±353.10 ng/dL vs 394.98±314.85 ng/dL, p=0.166). Correlation analysis by rank Spearman showed significantly correlation between free testosterone with relative wall thickness (p=0.019), and bioavailable testosterone with relative wall thickness (p=0.014). It is concluded that testosterone has a role on LV remodeling process after myocardial infarction showed by increasing of total testosterone and decreasing of free and bioavailable testosterone which have great affinity with cardiomyocyte.