Search

Introduction: Following an acute rheumatic fever infection brought on by an inflammatory reaction to streptococcal bacteria, rheumatic heart valve disease results in valve degeneration. Elements of the immune system play an important role, in facilitating myofibroblast transdifferentiation and clearing damaged tissue of apoptotic cells. Myelofibrosis arising in valve components is the main cause of valve dysfunction. Valve myelofibrosis showed a significantly increased collagen, proteoglycan, and elastin content in myofibrotic valves compared to healthy valves. Objective: To establish curcumin’s capacity to prevent rabbit valve interstitial cells (VIC) from differentiating into myofibroblasts after being stimulated by TGF-1 by comparing the results to controls. Method: This study uses a posttest-only control group design for an in-vitro laboratory experiment. Heart VIC of a New Zealand rabbit were isolated (Oryctolagus cuniculus), and induced fibrosis by administration of TGF-β1 5 ng/mL. VIC pretreated with TGF-β1 were treated with low-dose curcumin (20 nanoM/L) and high-dose curcumin (50 nanoM/L). The immunocytochemical method based on SMA expression observed the inhibition of myofibroblastic differentiation. Statistical significance was analyzed by Kruskal-Wallis statistical test with a p-value < 0.05 as the limit of significance. Result: Administration of curcumin with low doses (20 nanoM/L) and high doses (50 nanoM/L), significantly decreased TGF-β1-induced myofibroblastic differentiation of VIC, which was characterized by decreased SMA expression in all low-dose curcumin treatment groups (20 nanoM/L) (1.40 ± 6.30) and high-dose curcumin (50 nanoM/L) (1.40 ± 8.30). Conclusion: Curcumin potentially prevent the development of SMA-expressing VIC into myofibroblasts.

Prosthetic valve endocarditis (PVE) accounts for 20.1% of all infective endocarditis cases. We report a case of PVE complicated by arrhythmias, embolic phenomenon, and sepsis. A 64-year-old female with history of mitral valve replacement presented to the hospital with febrile episode and malaise. Echocardiography showed vegetation at paravalvular area, and Staphylococcus aureus was found on blood culture. Aggressive intravenous antibiotic cover and hemodynamic support were initiated. The management of PVE remains a challenge due to its malignant course and heterogenous complications. Citation: Suwanto D, Lefi A, Chandra E, Putra TS, Mulia EPB. Paravalvular vegetations in prosthetic valve endocarditis with a malignant course: a case report. Anaesth. pain intensive care 2022;26(5):723-726. DOI: 10.35975/apic.v26i5.2012

Acute Coronary Syndrome (ACS) is one of the highest causes of death globally, with the number of deaths reaching more than 9 million people in 2016. Therefore, a fast and accurate ACS diagnosis is needed. This study aimed to determine the relationship between the neutrophil-lymphocyte ratio, the number of coronary artery lesions evaluated by angiography, and troponin I in ACS patients Material and Methods: This research is an analytic observational with a retrospective cross-sectional design. Sampling was carried out using a total sampling technique and obtained 87 samples that met the inclusion and exclusion criteria for the 2019-2020 period at Dr. Soetomo Regional General Hospital Surabaya. The correlation between the number of coronary artery lesions and the neutrophil-lymphocyte ratio to troponin I levels were respectively analyzed using chi-square and spearman-rho with SPSS ver. 25. Results: The results showed a moderately significant correlation between the neutrophil-lymphocyte ratio and troponin I levels (p =0.003, rs = 0.319). While the correlation analysis between the number of coronary artery lesions and the vessel score on troponin I showed insignificant results (p = 0.525), which means that the number of coronary artery lesions was not correlated with troponin I. Conclusion: This study concludes a significant correlation with moderate correlation between the neutrophil-lymphocyte ratio and troponin I. However, there is no significant correlation between the number of coronary artery lesions assessed by the Sullivan and troponin I levels.

Rheumatic heart disease is a late complication of valvular inflammation caused by rheumatic fever. Studies have shown that the differentiation of valvular interstitial cells (VIC) into fibroblasts plays an important role in valvular remodeling and fibrosis. Various strategies to minimize valvular fibrosis has increased recently. This study aims to analyze the effect of dexamethasone, olmesartan, and its combination in inhibiting TGF-β1-induced VIC differentiation into myofibroblast. In vitro laboratory experimental-posttest only control group design was conducted. Isolated VIC of Oryctolagus cuniculus was pretreated using 2,5 ng/mL of TGF-β1 and divided into groups of dexamethasone (0.1 uM/L), olmesartan (100 nmol/L), and its combination. Inhibition of myofibroblast differentiation was quantified by the expression of α-SMA levels detected by immunofluorescence. Dexamethasone, olmesartan, and its combination administration were significantly reduced TGF-β1-induced VIC differentiation into myofibroblast expressed by α-SMA levels (dexamethasone 6823 ± 1735.3, olmesartan 6683.7 ± 2795.05). Combination of dexamethasone and olmesartan exhibit the most potent inhibition compared to control (5051.87 ± 1612.210 vs 22286.73 ± 2780.2; p < 0.000). In conclusion, dexamethasone, olmesartan, and the combination can significantly reduce the differentiation of VIC into myofibroblasts. The greatest potential is the combined effect of dexamethasone and olmesartan, while dexamethasone and olmesartan have the same potential.

Recent studies revealed that differentiation of valvular interstitial cell (VIC) into myofibroblasts played an important role in valvular remodeling and fibrosis. Study was performed on in vitro cultured of VIC from New Zealand rabbit (Oryctolagus cuniculus). Isolated VIC was pretreated using 5 ng/mL of TGF-β1 and divided into groups of olmesartan (100 nanomol/L) as short 30 minutes exposure duration and as continuous 72 hours exposure duration. Inhibition of myofibroblast differentiation was quantified by the expression of α-SMA levels detected by immunofluorescence staining. Olmesartan administration either, as short 30 minutes exposure duration or as continuous 72 hours exposure duration, were significantly reduced TGF-β1-induced VIC differentiation into myofibroblast expressed by α-SMA levels compared to control (short 30 minutes exposure duration: 9.18 ±2.25, as continuous 72 hours exposure duration: 10.13 ±0.69, and control 22.29 ±2.78; p < 0.001), but without significant difference between the two treatment groups (p 0.403). Olmesartan both on short and continuous exposure can inhibit the differentiation of valve interstitial cells into myofibroblasts based on the expression of αSMA, but without a significant difference in the inhibitory effect.

Aortic dissection (AD) is a relatively rare but dreadful illness, often accompanied by severe, sharp (or 'tearing') back pain or anterior chest pain, as well as acute hemodynamic compromise. Painless dissection has also been reported in rare cases. Echocardiography has become the most commonly used imaging test for evaluating cardiovascular disease and, thus, plays an important role in aortic disease diagnosis and follow-up.This paper presents the case of a 63-year-old female presenting a chronic cough for more than 30 days, accompanied by chest pain radiating to the left scapula, a history of chronic hypertension, and recent chest x-ray findings of mediastinal mass on the upper left of the aortic knob. Transthoracic echocardiography (TTE) shows a clear image of a dissection flap on the ascending aorta and abdominal aorta, with a false lumen that is larger than the true lumen and filled with intramural thrombus. A transesophageal echocardiography (TOE) examination performed later shows a clear entry tear near the sinuses of Valsalva directly above the ostium of the right coronary artery (RCA). The patient was diagnosed with AD Stanford A de Bakey Type 1. Computed tomography (CT) focusing on the thoracoabdominal aorta and coronary artery was ordered upon suspicion of RCA ostium obstruction by the dissection flap and to further direct the surgical management. However, later on, the patient refused to undergo surgery, opting instead for conservative medical therapy.The diagnosis of AD is challenging. Our case emphasizes the vital role of TTE in diagnosing AD, particularly in patients with atypical symptoms in which the diagnosis of AD might not be considered. Such missed AD diagnoses can lead to precarious outcomes.

In COVID-19 patients, Interleukin-6 (IL-6) will increase, and the production of antigens will be excessive, which will cause excessive inflammation of the tissues, especially the respiratory tract, which causes fibrosis in the lungs and can lead to death.To analyze IL-6 expression of lung tissue in COVID-19 patient severity.The study is an observational analytic design from July to December 2020. COVID-19 patient severity who died was examined for IL-6 expression on lung tissue. The lung tissue sampling uses the core biopsy method.The total number of samples obtained was 38 samples. Characteristics of patients with a mean age of patients were 48 years, male, the most common chief complaint was shortness of breath, mean symptom onset was 5 days, patient length of stay was 10 days, the most common cause of death was a combination of septic shock and ARDS and the most common comorbid diabetes mellitus. There is an increased WBC, neutrophils, platelets, procalcitonin, CRP, BUN, creatinine serum, AST, ALT, and D-dimer. In this study, the average tissue IL-6 expression was 72.63, with the highest frequency of strong positive 47.4%.An increase in IL-6 expression on lung tissue showed the severity of COVID-19 infection.

Introduction. Recent studies revealed that differentiation of valvular interstitial cell into myofibroblasts played an important role in pathological valve remodeling in rheumatic valvular disease. Objective. To investigate effects of atorvastatin, olmesartan, and resveratrol on Transforming Growth Factor β1-induced fibrosis. Methods. Valvular interstitial cell was isolated from 12-weeks male New Zealand rabbit (Oryctolagus cuniculus). Culture cells was divided into 4 groups, control group, group I (0.5 mg/mL Atorvastatin), group II (100 nmol/L Olmesartan), group III (50 μM/L Resveratrol) and group IV (combinations). All group were exposed to 100 nM Transforming Growth Factor β1 for 24 hours. Results. Immunochemical staining demonstrated that cells were completely differentiated into myofibroblasts with mean expression of α-smooth muscle actin 24522.64±4566.994. Atorvastatin, olmesartan, resveratrol, and its combination significantly reduced α-smooth muscle actin expression (6823±1735.3, 6942.7±2455.9, 14176.2±3343.3, 5051.8±1612.2 respectively (pConclusion. Our data showed atorvastatin, olmesartan, resveratrol, and its combination significantly reduce Transforming Growth Factor β1-induced valvular fibrosis.

Hyperglycemia state is harmful to body’s homeostasis. Uncontrolled hyperglycemic patients, especially patients with diabetes mellitus have a higher mortality risk of heart disease 2 to 4 times compared to non-hyperglycemic patients. Vascular endothelial impairment always been observed and found as a key feature of hyperglycemia state, which is correlated with reduced numbers and dysfunction of endothelial progenitor cells (EPCs). Objective: This paper aims to investigate the effect of hUCB-MSCs derived secretome treatment on the EPCs migration under hyperglycemia state. Materials and Methods: EPCs were isolated and cultured from peripheral blood samples and cultured for three days. Cultured EPCs were cultivated in 6-well plates until confluence and incubated with high glucose for 5 days, then placed in the modified Boyden chamber at the upper chamber with basal media. The lower chamber was supplemented with basal media and secretome at 2%, 10%, and 20% concentration and VEGF treated group as a control. EPCS migration was evaluated using a Boyden chamber assay. Statistical analysis was performed using SPS 25.0. Results: EPCs migration were significantly higher when hUCB-MSCs-derived secretome was given in high glucose concentrations compared to the and control group (79.80 ± 5.07 vs 51.00 ± 5.15, p

Background Great diversity among public hereditary variants may play a role in the susceptibility and severity of acute rheumatic fever (ARF)/rheumatic heart disease (RHD). Cytokine gene polymorphisms may contribute to the disease-associated cytokine imbalance. However, to the best of our knowledge, there is no existing meta-analysis concerning an association of the cytokine gene functional polymorphisms with the susceptibility / severity of ARF/RHD. Aims To investigate the potential association between cytokine gene functional polymorphisms of TNF-α, TGF-β, IL-10, IL-6 and IL-1β and the susceptibility and severity of ARF/RHD. Methods Comprehensive and structured search on Pubmed/Medline, Embase, EBSCO, and Cochrane Central Register of Controlled Trials was performed. Statistical analyses were performed using STATA. First, we performed direct pairwise meta-analysis. Then, a network meta-analysis was performed with the consistency model to compare the genetic models of different cytokine gene polymorphisms. Results Evidence derived from the meta-analysis of 24 retrospective cohort and case-control studies identified that elevated serum levels of TNF-α have been observed in ARF cases, occurring as a result of a SNP (-308G>A) in the promoter site of the TNF-α gene. Our results also suggest that IL-1β (-511) C/T polymorphism, TGF-β1 [rs1800469], and IL-1β [rs2853550] single nucleotide polymorphisms (SNPs) contributed to the susceptibility of ARF/RHD. Egger’s test did not demonstrate significant asymmetry in the dominant. Conclusion In summary, the polymorphism model increased the risk of RHD in the dominant genetic model, recessive genetic model, homozygote model and allelic genetic model among non-Asians while, recessive genetic model and homozygote model among Asians.

Objective: To determine the relationship of coronary heart disease traditional risk factors to the number of lesioned coronary arteries and calculate the relative risk. Methods: This study used an analytical research design with a retrospective cohort study design using patient catheterization report data. Data analysis was performed using the chi square test and relative risk in 449 individuals. Results: Based on the analysis results obtained p value 0.05 indicating no relationship between risk factors for coronary heart disease with the number of coronary arteries the lesions based on sex, history of hypertension and history of smoking. Conclusion: There is a relationship between age, history of diabetes mellitus, history of dyslipidemia and the number of coronary arteries that are lesions in patients with coronary heart disease and there is no relationship between sex, history of hypertension and smoking history with the number of coronary arteries that are lesions in patients with coronary heart disease. Keywords: single vessel disease; multivessel disease; coronary artery disease; risk factors CAD

Background: There is a lot of research on the importance of exercise but studies on the effective time of exercise regarding regulation of blood glucose levels are not clearly known. Objective: This study aimed to determine the comparison of changes in blood glucose levels before and after moderate intensity physical exercise in the morning and evening. Materials and Methods: Healthy men (n=34), age between 17-22 years, Body Mass Index (BMI) between 18.5-22.9 kg/m2 (normal Asia Pacific), participating in the morning (8.00 am) or evening group (20.00 pm) are asked to do moderate intensity physical exercise (55-70% of maximum heart rate) using ergocycle for a total of 40 minutes. Blood glucose levels 2 hours post prandial capillaries were taken before exercise and blood glucose levels after exercise were taken acutely. Results: The mean decrease in blood glucose levels in the morning group was ± 8.353 ± 9.16 mg/dL and in the evening group was ± 6.294 ± 10.10 mg/dL. Blood glucose levels decreased significantly for the morning group (p=0.002) and the evening group (p=0.021). The comparison of changes in blood glucose levels between the morning and evening groups was not significant (p=0.538). Conclusion: There was no difference between morning or evening exercise related to changes in blood glucose levels.

Background: There is a lot of research on the importance of exercise but studies on the effective time of exercise regarding regulation of blood glucose levels are not clearly known. Objective: This study aims to determine the comparison of changes in blood glucose levels before and after moderate intensity physical exercise in the morning and night. Material and method: Healthy men (n=34), Age between 17-22 years, Body Mass Index (BMI) between 18.5-22.9 kg/m2 (normal Asia Pacific), participating in the morning group (8.00 am) or the night group (20.00 pm) are asked to do moderate intensity physical exercise (55-70% of maximum heart rate) using ergocycle for a total of 40 minutes. Blood glucose levels 2 hours post prandial capillaries are taken before exercise and blood glucose levels after exercise are taken acutely. Result: The mean decrease in blood glucose levels in the morning group was -8.353±9.16 mg/dL and in the night group was -6.294±10.10 mg/dL. Blood glucose levels decreased significantly for the morning group (p=0.002) and the night group (p=0.021). The comparison of changes in blood glucose levels between the morning and night groups was not significant (p=0.538). Conclusion: There is no difference between morning or night exercise related to changes in blood glucose levels.

Carotid intima-media thickness (CIMT) is frequently utilized for detection of subclinical atherosclerosis. This study aims to investigate the association between the CIMT values and demographic characteristics, cardiovascular disease (CVD) risk factors, lipid biochemistry profiles, and high-sensitivity C-reactive protein (hs-CRP) levels among the Indonesian population. Subjects who had two or more CVD risk factors but were not receiving lipid-lowering therapy were recruited from six hospitals of Indonesia. Measurements of CIMT are obtained by ultrasonography of 12 sites within the common carotid artery. CVD risk factors, lipid and glucose profiles, and hs-CRP values were analyzed with respect to distribution of CIMT. The mean–max CIMT was 0.805 ± 0.190 mm (minimum, 0.268 mm; maximum, 1.652 mm) and the mean–mean CIMT was 0.614 ± 0.190 mm (minimum, 0.127 mm; maximum, 1.388 mm). Multivariate analyses confirmed an independent association between increasing CIMT and increasing age (regression coefficient = 0.004; p = 0.004). Our data show normative mean–mean CIMT data for Indonesian subjects with two or more CVD risk factors who are not receiving lipid-lowering therapy, which may guide CVD risk stratification of asymptomatic individuals in Indonesia.

Introduction : Until now, cardiovascular complications are still the highest cause of death and disability in DM patients. Hypomagnesemia in DM accelerate atherosclerosis and can cause instability and plaque rupture which can lead to acute coronary syndrome. M ethods : Design of this study was observational analytic using a "case control" study involved 76 samples of DM patients, consisting of 38 samples with SKA (+) and 38 samples with SKA (-). Subjects of this study were all DM patients in the period July-December 2018 in the Emergency Room (ER) and Outpatient Installation of Endocrine at the RSUD Dr. Soetomo Surabaya, which fulfills the criteria for inclusion and exclusion. Demographic data and clinical characteristics are presented descriptively. If data is normally distributed then an unpaired t test is carried out and if the data is not normally, distributed with Mann Whitney test is performed. The statistical test was stated to be significant if p