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Disebabkan cepatnya perkembangan teknologi yang terjadi, secara tidak langsung mempengaruhi banyak bidang, salah satunya dalam bidang pendidikan. Untuk membuat sistem pembelajaran menjadi lebih interaktif, dibuatlah sebuah aplikasi dengan mengimplementasikan teknologi Mixed Reality (MR), yang merupakan hasil kombinasi Virtual Reality (VR) dengan Augmented Reality (AR). Penelitian ini mengimplementasikan teknologi Mixed Reality untuk media edukasi tentang jenis serta karakteristik bioma berbasis android yang memanfaatkan teknologi 3D sebagai objek pembelajarannya. Pengguna dapat berinteraksi dengan objek virtual, dan untuk memunculkan objek virtual dibutuhkan sebuah marker sebagai penanda dari objek virtual. Algoritma FAST Corner Detection akan memindai marker untuk menentukan titik tengah gambar pada marker. Agar mendapatkan hasil yang lebih nyata dan interaktif digunakan metode Occlusion Detection, sehingga objek virtual dapat berinteraksi langsung dengan pengguna aplikasi. Aplikasi telah diuji pada perangkat dengan versi sistem operasi android yang berbeda-beda, yaitu Nougat (7.0) hingga R (11.0) dimana hasil pengujian jarak terhadap marker bervariasi, mulai dari jarak terdekat sebesar 10 cm hingga terjauhnya yaitu 240 cm hingga 300 cm. Juga hasil pengujian sudut kemiringan terhadap marker, batas maksimal sudut kemiringan marker dapat dipindai adalah sebesar 80°. Waktu respon Mixed Raeality pun diuji dengan cara menghitung lama waktu munculnya objek virtual saat pertama kali kamera memindai marker, yang menghasilkan waktu 0,5 detik.

Metacognition and reading comprehension skills are believed to influence students' academic success. However, many studies report that students' understanding of texts is still low even though they have been able to read fluently. This study aims to investigate and describe students' metacognitive awareness in reading comprehension learning activities and the effect of metacognition on reading comprehension skills. The research method used is a mixed-method by utilizing the descriptive and quantitative correlational analysis results. The research subjects involved were 280 students and eight Indonesian language teachers from eight senior high schools. The research data was obtained from the observations of reading learning activities, interviews, distributing questionnaires, and reading skills tests. The results showed that most students did not know the right reading strategy for themselves. Overall, students have not been able to conclude the goals and benefits of learning to read comprehension for their lives, behave passively in learning, and have not been able to identify solutions to face reading comprehension difficulties according to their characteristics. Based on the results of correlational calculations, metacognition was positively correlated with students' reading comprehension skills. This study recommends that teachers and curriculum designers emphasize the components of metacognitive awareness activity for improving students' reading comprehension skills.

Susu kedelai terbuat dari hasil ekstraksi kedelai. Susu kedelai memiliki komposisi yang mirip dengan susu sapi yaitu 3,5% protein, 2% lemak, dan 2,9% karbohidrat, sehingga susu kedelai dapat digunakan sebagai pengganti susu sapi bagi orang yang alergi terhadap protein hewani. Masalah yang dihadapi UKM mitra (pengusaha susu kedelai) yaitu pada proses pengolahan, pendinginan dan pengemasan. Selama ini proses pengadukan dilakukan secara konvensional yaitu menggunakan pengaduk manual sehingga karyawan mudah capek dan tangan terasa panas karena terkena uap panas. Selain itu, suhu yang digunakan harus tepat (80-90 oC) karena jika suhunya >90 oC maka susu kedelai akan pecah dan jika suhunya < 80 oC maka susu kedelai akan menggumpal. Masalah berikutnya yaitu pada proses pendinginan membutuhkan waktu yang lama (30 menit) dan kurang higenis karena dibiarkan di udara terbuka. Sedangkan untuk proses pengemasan memerlukan 2 orang sehingga waktu yang diperlukan untuk mengemas juga relatif lebih lama (60 menit). Tujuan dalam kegiatan PKMT ini yaitu meningkatkan efektivitas produksi susu kedelai dengan indikator: proses pengadukan dilakukan mesin dengan penggerak motor listrik, proses pendinginan menjadi 5 kali lebih cepat, dan proses pengemasan menjadi 2 kali lebih cepat. Metode pelaksanaan dalam kegiatan ini yaitu merancang, manufaktur, assembly, ujicoba mesin, serah terima mesin, pelatihan pengoperasian dan perawatan mesin serta pemantauan secara berkala. Hasil penerapan mesin pengolah dan pengemas susu kedelai semi otomatis diperoleh bahwa proses pengadukan menjadi lebih praktis karena dilakukan mesin dengan penggerak motor listrik, mempercepat proses pendinginan menjadi 4 menit, dan mempercepat proses pengemasan menjadi 21 menit maka dapat disimpulkan bahwa permasalahan UKM mitra dapat teratasi karena proses pengolahan, pendinginan dan pengemasan dapat dilakukan dalam satu mesin.

Abstract Aims Peripartum cardiomyopathy (PPCM) may result in a number of detrimental adverse cardiovascular events, notably persistent left ventricular ejection fraction (LVEF) reduction or even mortality. Imaging parameters on cardiac magnetic resonance (CMR) and their prognostic implications have rarely been perused in PPCM. We aimed to describe CMR's prognostic value in predicting poor left ventricular (LV) function recovery using late gadolinium enhancement (LGE) and T2‐weighted or T2 mapping. Methods and results PubMed, Europe PMC, and ScienceDirect were screened for studies on late gadolinium enhancement (LGE) and myocardial oedema using CMR and PPCM. The outcome of interest was poor LV function recovery, with a follow‐up period of at least 6 months. Comparisons between groups with the presence of LGE, myocardial oedema, and recovered against non‐recovered patients were pooled. A random‐effects model was employed to calculate the effect size. All pooled results were expressed as risk ratios (RRs) and 95% confidence intervals (CI). The area under the curve (AUC) was generated to test overall prognostic accuracy. Six cohort studies with 162 patients were included. The mean age of participants in this study was 30.6 years, and the majority of patients were diagnosed with PPCM after delivery. LGE was associated with a higher risk of poor LV function recovery, particularly when conducted at a later stage of disease (≥2.8 months) [RR = 2.83 (95% CI = 1.25–6.40); P = 0.001]. On the contrary, CMR conducted early (

Abstract Background This case highlights the management of concomitant acute myocarditis and congenital long QT syndrome with electrical storm and incessant Torsade de Pointes. Case presentation An 18 years-old Southeast Asian para 1 abortus 0 (P1A0) postpartum patient with cesarean section owing to severe preeclampsia, acute lymphocytic myocarditis, and prolonged QT interval owing to long QT syndrome. She has incessant Torsade de Pointes treated with beta-blocker, lidocaine, overdrive pacing with a temporary transvenous pacemaker, left cardiac sympathetic denervation per video-assisted thoracoscopic surgery, and implantable cardioverter-defibrillator implantation. We initially used bisoprolol, then switched to propranolol and finally to carvedilol, which reduced the Torsade de Pointes frequency. The longest QTc interval was 696 ms, and the shortest was 624 ms, 2 months after initial corticosteroid administration and left cardiac sympathetic denervation. Device interrogation at 9 months follow up showed three episodes of ventricular fibrillation, 2 spontaneously resolved and one necessitates shock. Conclusion Management of concomitant acute myocarditis and congenital long QT syndrome with incessant Torsade de Pointes requires beta-blockers, anti-inflammatory drugs, autonomic modulation, and short-term measures, such as overdrive pacing with deep sedation. Implantable cardioverter-defibrillator is vital to prevent sudden cardiac death.

Background: Right ventricular pacing may lead to deterioration of left ventricular (LV) function. Recent guideline suggests the use of conduction system pacing (CSP) with either his bundle pacing (HBP) or left bundle branch area pacing (LBBAP). This study aimed to investigate the difference of LV function between HBP and LBBAP. Methods: This is a prospective cohort study enrolling patients age >18 years requiring CSP implantation from June 2020 to January 2024 in Hasan Sadikin General Hospital, Bandung. Data regarding QRS duration and several echocardiography parameters were obtained at baseline and during follow up within 1 year after CSP implantation. Results: From 66 patients, 35 were included in the HBP group. There was no difference in QRS duration at baseline between both groups with higher left ventricular ejection fraction (LVEF) in HBP group (51.2 ± 13.9% vs 45.6 ± 11.1%, p=0.078). During follow up, HBP group showed narrower QRS duration (113.40 ± 17.06ms vs 120.81 ± 12.12ms, p=0.029). LV function was preserved in HBP group while there was a trend of LV function improvement in LBBAP group (53.1 ± 11.7% in LBBAP vs 53.9 ± 11.5% in HBP group, p=0.536). Further analysis in 33 patients with LV dysfunction showed a trend of LVEF improvement in both groups (35.3 ± 7.9% to 44.6 ± 11.28% in HBP and 38.7 ± 6.9% to 51.4 ± 13.1% in LBBAP group). Conclusion: HBP resulted in narrower QRS complex. However, both HBP and LBBAP showed a trend of LV function improvement in patients with LV dysfunction.

Abstract Background One of the downsides of percutaneous coronary intervention (PCI) is stent failure which could be related to stent underexpansion. Hence, PCI based on an accurate coronary artery size obtained from intracoronary imaging is tremendously important. Until now, there is no data about all coronary artery dimensions in the Southeast Asian population performed by intravascular ultrasound (IVUS). The coronary artery size of 153 patients with chronic coronary syndrome (CCS) in acute or chronic settings who underwent percutaneous coronary intervention (PCI) with IVUS was examined. The mean artery size and its predictors were analyzed. Results There were 153 patients with 633 coronary artery segments: the mean left main (LM) external elastic membrane (EEM) diameter and cross-sectional area (CSA) were 5.02 ± 0.43 mm and 19.93 ± 3.48 mm2, proximal left anterior descending artery (LAD) 4.25 ± 0.42 mm and 14.34 ± 2.85 mm2, the mid-LAD 3.86 ± 0.39 mm and 11.70 ± 2.24 mm2, the distal LAD 3.32 (2.83–4.30) mm and 8.77(6.23–14.99) mm2, the proximal left circumflex artery (LCX) 3.91 ± 0.42 mm and 12.07 ± 2.53 mm2, the distal LCX 3.51 ± 0.47 mm and 9.90 (5.09–14.20) mm2, the proximal right coronary artery (RCA) 4.50 ± 0.48 mm and 16.14 ± 3.43 mm2, the mid-RCA 4.16 ± 0.420 mm and 13.74 ± 2.72 mm2, the distal RCA 3.81 ± 0.41 mm and 11.59 ± 2.46 mm2, respectively. Body surface area (BSA) is an independent predictor for the majority of epicardial coronary arteries with a positive linear relationship. Conclusions The mean artery size of the Indonesian population was comparable with previous studies. The knowledge of coronary artery size will help the clinician to have a reference for intervention, especially when no intravascular imaging is available.

Abstract Background Atrial septal defects (ASD) are the most common type of adult congenital heart disease (ACHD) associated with a high risk developing of pulmonary arterial hypertension (PAH). ASD closure is not recommended in patients with PAH and Pulmonary Vascular Resistance (PVR) ≥ 5 Wood Unit (WU). Noninvasive methods have been proposed to measure PVR; however, their accuracy remains low. Right Ventricle (RV) - Pulmonary Artery (PA) coupling is defined as the ability of the RV to adapt to high-resistance conditions. Tricuspid Annular Plane Systolic Excursion (TAPSE)/estimated pulmonary artery systolic pressure (ePASP) calculation using echocardiography is a noninvasive technique that has been proposed as a surrogate equation to evaluate RV-PA coupling. Currently, no research has demonstrated a relationship between RV-PA coupling and PVR in patients with ASD. Methods The study participants were consecutive eligible patients with ASD who underwent right heart catheterization (RHC) and echocardiography at Hasan Sadikin General Hospital, Bandung. Both the procedures were performed on the same day. RV-PA Coupling, defined as TAPSE/ePASP > 0.31, was assessed using echocardiography. The PVR was calculated during RHC using the indirect Fick method. Results There were 58 patients with ASD underwent RHC and echocardiography. Among them, 18 had RV/PA Coupling and 40 had RV/PA Uncoupling. The PVR values were significantly different between the two groups (p = 0.000). Correlation test between TAPSE/ePASP with PVR showed moderate negative correlation (r= -0.502, p = 0.001). TAPSE/ePASP ≤ 0.34 is the cutoff point to predict PVR > 5 WU with sensitivity of 91.7% and specificity 63.6%. Conclusion This study showed a moderate negative correlation between TAPSE/ePASP and PVR. TAPSE/ePASP ≤ 0.34 could predict PVR > 5 WU with good sensitivity.

BackgroundThis study aimed to systematically evaluate the efficacy and safety of atherectomy followed by drug-coated balloon angioplasty (A-DCB) in comparison with drug-coated balloon (DCB) angioplasty alone for the treatment of lower extremity artery disease (LEAD).MethodsSystematic literature search was performed using several online databases including MEDLINE (via PubMed), Europe PMC, and ScienceDirect databases from inception until February 21st, 2024. We included all studies comprised three main variables including A-DCB, DCB, and LEAD. The primary outcomes were primary patency and target lesion revascularization (TLR). Whereas secondary outcomes were all-cause mortality, post-procedural complications, and clinical characteristics.ResultsA total of 15 studies (10 cohort studies and 5 randomized controlled trials studies) consisting of 1,385 participants with mean age 68.7 ± 8.9 were included. In comparison with DCB alone, A-DCB was significantly associated with a higher risk of primary patency [RR = 1.16 (95% CI = 1.07–1.26); P

Engaging first-time voters in the 2024 General Election is vital for a healthy democracy. The General Election Commission of Yogyakarta City is concerned that many new voters lack understanding of democratic processes, which might lead to lower turnout. To address this, the Commission is running educational programs in schools and universities. This research looks at these efforts and their impact on first-time voters. It shows that effective political education can increase awareness and participation among young voters. The findings suggest that these educational programs help first-time voters get involved in the election, making the process more effective and inclusive. The research highlights the importance of ongoing political education to strengthen democratic participation.

Objective: To assess the cardioprotective effects of Carvedilol in preventing subclinical left ventricular dysfunction (SLVD) in breast cancer patients after completing FAC chemotherapy. Methods: This prospective study employed a quasi-experimental clinical trial conducted from September 2018 to May 2019. Breast cancer patients receiving FAC chemotherapy were divided into two groups: intervention (IG) and control (CG). The IG received Carvedilol 6.25 mg b.i.d., which was increased every three weeks until reaching a tolerated dose. The study evaluated changes in left ventricular global longitudinal strain (GLS) and the incidence of SLVD (GLS reduction ≥15% and GLS >-18%) 24 weeks after initiating the FAC regimen. Result: Of the 81 women enrolled in the study, 31 were in the IG. No significant changes in GLS were observed during or after completing FAC chemotherapy in the IG, whereas the CG showed contradictory results. At the end of the follow-up period, the delta GLS reduction was lower in the IG (0.7; 95% CI -0.60, 3.60) compared to the CG (3.00; 95% CI -2.16, 4.19), with a p-value of 0.035. Similarly, the percentage reduction in GLS was 3.6% in the IG and 14.29% in the CG, resulting in a p-value of 0.05. The incidence rate of SLVD (GLS reduction ≥15% and GLS > -18%) was lower in the IG (41.9% and 25.8%) than in the CG (58% and 48%). Conclusion: Carvedilol may have a cardioprotective effect in preventing the incidence of SLVD, as evaluated by GLS reduction and changes, in women with breast cancer after completing a full cycle of the FAC regimen.

Abstract Background Preeclampsia is one of the leading causes of death in childbearing women worldwide. Hemodynamic changes in preeclampsia can trigger cardiac remodeling as indicated by increase of soluble-ST2 (sST2). Global longitudinal strain were able to detect systolic dysfunction better than the ejection fraction. This study aims to evaluate the correlation between serum levels of sST2 towards GLS in patients with early-onset preeclampsia. Methods This is a cross-sectional observational study with correlation analysis. Subjects were patients with severe preeclampsia with gestational age before 34 weeks at Dr. Hasan Sadikin Central General Hospital Bandung and Bandung Kiwari Regional General Hospital from June to August 2022. Examination of sST2 was carried out through blood samples using the ELISA method. sST2 was measured using Presage ST2 Assay reagent. GLS examination was carried out using speckle tracking technique with EchoPAC. Correlation analysis was conducted using the Pearson test if normally distributed, otherwise Spearman’s correlation was conducted. Correlation analysis was followed by linear regression. Results A total of 30 patients met the inclusion criteria. The mean age was 30.83 ± 7.09, with 17 (56.7%) multiparous patients. The median sST2 was 145.75 ng/mL, and the median GLS was − 17.4%. Spearman correlation analysis showed that there was a significant positive correlation with moderate strength between sST2 and GLS (r = 0.583; p

BackgroundConcerns regarding restenosis after treatment with drug-coated balloons (DCB) remain. We aimed to identify the incidence of target lesion revascularization (TLR) and explore clinical, procedural, and other factors influencing it.MethodsSingle-center retrospective analysis of a prospective cohort PCI registry study included 80 patients (100 lesions) who underwent successful DCB angioplasty between January 2020 and October 2023 and follow-up angiography within 2 years of either planned or unplanned reason. Incidence and factors associated with TLR were analyzed.ResultsAngiographic evaluation was conducted within a median of 151 days (interquartile range: 109 days). During index procedure, 54% were complex lesions. Intravascular imaging (IVI) was performed in 80% of lesions. TLR occurred in 11% of the lesions and was less frequent in the IVI group compared to the angiography-alone group [6.3 vs. 54.5%; odds ratio: 0.156, 95% confidence interval (CI): 0.042–0.580; p = 0.002]. No association was found between baseline and lesion characteristics, lesion complexity, plaque morphology, pre-dilatation procedure balloon type, maximal inflation pressure, or length of DCB between the groups (p > 0.05). Multivariate analysis revealed that IVI utilization was independently associated with a lower TLR rate (adjusted odds ratio: 0.116, 95% CI: 0.020–0.669; p = 0.016).ConclusionIn DCB angioplasty, only IVI use exhibited a significant difference in the TLR rate among baseline lesion characteristics and lesion preparation and was independently associated with a lower TLR rate.

Universalists argue that human rights as laid out by current human rights law embodies universal ideals and rights that are universally relevant and applicable to all people. However, some relativists have questioned this idea, pointing out that ethical systems should evolve in the context of local cultures and not assume its universal applicability. It arises a question whether human rights indeed a universal concept that should be assumed to all nations irrespective of its cultural differences. Especially in the context of most developing nations that have their own cultural philosophies and societal conducts, it is intriguing to assess how does the "universal applicability" of human rights fare within the local enforcement of human rights treaties. This research will be normative legal research as it will analyze the legal aspect of relativism in the perspective of developing nations in its relation to the enforcement of human rights within the existing treaty that encompasses of Universal Declaration of Human Rights, and Convention on the Elimination of All Forms of Discrimination against Women. This article argues that "consent" of the intended groups that the human treaties wanted to protect matters to bridge the difference between the two concepts.

Background: Several technical limitations exist in angiography procedures, including suboptimal visualization of a particular location and angiography only providing information about the contour of the vascular lumen, while intravascular ultrasound (IVUS) provides information regarding wall composition on coronary vascular lesions. With recent trials demonstrating IVUS benefits over standard angiography, our meta-analysis aimedto evaluate and summarize the current evidence on whether IVUS-guided drug-eluting stent (DES) placement resulted in better outcomes than the angiography-guided DES placement in patients with left main coronary artery (LMCA) disease. This meta-analysis aimed to analyze the current evidence on the IVUS-guided and angiography-guided drug-eluting stent (DES) placement in patients with LMCA disease. Methods: Literature searching was performed using Scopus, Embase, PubMed, EuropePMC, and Clinicaltrials.gov using PRISMA guidelines. The intervention group in our study are patients undergoing IVUS-guided percutaneous coronary intervention (PCI) and the control group are patients undergoing angiography alone-guided PCI. Cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis were compared between the two groups. Results: There were 11 studies comprising 24,103 patients included in this meta-analysis. IVUS-guided PCI was associated with lower cardiovascular mortality (hazard ratio (HR) 0.39 [95% CI 0.26, 0.58], p < 0.001; I2: 75%, p < 0.001) and all-cause mortality (HR 0.59 [95% CI 0.53, 0.66], p < 0.001; I2: 0%, p = 0.45) compared to angiography alone guided PCI. The group receiving IVUS guided PCI has a lower incidence of myocardial infarction (HR 0.66 [95% CI 0.48, 0.90], p = 0.008; I2: 0%, p = 0.98), target lesion revascularization (HR 0.45 [95% CI 0.38, 0.54], p < 0.001; I2: 41%, p = 0.10) and stent thrombosis (HR 0.38 [95% CI 0.26, 0.57], p < 0.001; I2: 0%, p = 0.50) compared to the control group. Conclusions: Our meta-analysis demonstrated that IVUS-guided DES placement had lower cardiovascular mortality, all-cause mortality, target lesion revascularization, myocardial infarction, and stent thrombosis than angiography-guided DES implantation.

Warfarin (WF) is an anticoagulant commonly used for thromboembolism-related diseases.This study aims to assess the pharmacokinetic profile of WF. The stereospecific interaction of S-and R-WF requires quantification of the enantiomer to determine the pharmacokinetic profile. The analysis method of the enantiomers in plasma is developed using an HPLC fluorescence detector with a Chiralcel OD-RH column (4.6 mm × 150 mm i.d., 5 m) and a Chiralcel OD-RH guard column (4.0 mm × 10 mm, 5 m). The separation is conducted using isocratic with acetonitrile mobile phase: Phosphate buffer, pH 2.00 (40:60 v/v), column temperature 40°C, flow rate 1 mL/min, injection volume 50 L. WF is measured at an excitation wavelength of 310 nm and emission of 350 nm. This method results in limit of detection (LOD) values of 18.6 ng/mL and limit of quantitation (LOQ) of 62.01 ng/mL for R-WF and LOD values of 18.61 ng/mL and LOQ of 62.04 ng/mL for S-WF. The results showed a linearity in concentration between 100 and 2500 ng/mL with r2 = 0.9969 and r2 = 0.9991 for R-and S-WF. The validation requirements of selectivity, accuracy, and precision for within and between run with a value of

Aim: This study aims to evaluate: the difference of soluble suppression of tumorigenicity 2 (sST2) level, a biomarker for cardiac remodeling and echocardiography parameters value prior to and 1 month after implantation; and the association between pacemaker parameters and pacemaker mode along with delta sST2 levels. Materials & methods: This prospective cohort study enrolled all symptomatic bradycardia patients aged >18 years with preserved ejection fraction who underwent permanent pacemaker (PPM) implantation. Results: A total of 49 patients were included in this study. The sST2 level (ng/ml) were significantly different between prior and 1 month following PPM implantation (23.4 ± 28.4 vs 39.9 ± 63.7; p = 0.001). Conclusion: The early cardiac remodeling has occurred within 1 month after PPM implantation as indicated by increasing delta sST2 level.

Smoking is related to vascular aging. However, the hazardous effect of e-cigarette is often debatable, with limited studies available. In contrast, moderate-intensity aerobic exercise is well known to decrease aortic stiffness. We provide novel research to determine the effect of e-cigarette and aerobic moderate-intensity exercise on the aortic structure of Wistar rats. A total of 26 male Wistar rats (Rattus norvegicus) 8 weeks aged, 200-250 g b.w., were randomly divided into 4 groups, namely, K0 (normal rats), K1 (rats were given moderate-intensity aerobic exercise by animal treadmill 20 m/30 min), K2 (rats were given e-cigarette with 6 mg nicotine, 40% propylene glycol, and 60% vegetable glycerine 30 min for 5 days/week), and K3 (rats were given e-cigarette and moderate-intensity aerobic exercise). After exposure for 6 weeks, all animals were sacrificed to isolate the aorta for histopathological analysis with hematoxylin-eosin stain to evaluate the elastic fiber layer and intimal-medial thickness. The Verhoeff-Van Gieson staining was done for quantification elastic lamina fragmentation. Our study found that the e-cigarette group had the highest elastic lamina fragmentation among groups (8.14±2.85). The exercise only group showed the lowest elastic lamina fragmentation (2.50±1.87). Fragmentation in the e-cigarette and exercise group was higher than in the exercise only group (5.83±0.753 vs. 2.50±1.87, p=0.002). There is a significant difference of NO serum between four groups. The result of post hoc analysis using LSD showed that there is a significant difference of NO serum between K0 and K2, K0 and K3, K1 and K2, and K1 and K3. Therefore, our research demonstrated that the most injury of aorta elastic lamina was in the group that was exposed to e-cigarette that leads to vascular aging while exercise is not yet proven to reverse this effect.

Background Blood pressure (BP) and heart rate (HR) have been studied extensively to predict unfavourable outcomes in patients suffering from an acute myocardial infarction (AMI). Shock index (SI) and modified shock index (MSI) are two new emerging parameters that incorporate BP and HR into their calculations, thereby improving the predictive value of each HR and BP alone in AMI patients. Thus, our aim was to determine the prognostic utility of SI and MSI in AMI patients. Methods We searched PubMed, ProQuest, EBSCO Host, and Europe PMC from conception to May 2022. Studies were eligible if they evaluated the relationship of SI and MSI with all-cause mortality and major adverse cardiac events. Results A total of 16 studies involving 80,195 participants met the inclusion criteria and were included in this meta-analysis. Our study revealed significantly higher all-cause mortality risk for patients with high SI and MSI compared to patients with low indices, regardless of the periods of outcomes, study population, or diverse cut-off values. Moreover, both increased SI and MSI also predicted higher major adverse cardiac event rates. Conclusions According to our findings, both SI and MSI in the emergency department can predict all-cause mortality and major adverse cardiac events in patients with acute myocardial infarction. Given this growing body of evidence, as well as the fact that SI and MSI are very simple objective indices derived from two readily available vital signs, they should be used in daily clinical practice to risk stratify patients presenting with acute myocardial infarction. PROSPERO registration CRD42022329558.

Background Blood pressure (BP) and heart rate (HR) have been studied extensively to predict unfavourable outcomes in patients suffering from an acute myocardial infarction (AMI). Shock index (SI) and modified shock index (MSI) are two new emerging parameters that incorporate BP and HR into their calculations, thereby improving the predictive value of each HR and BP alone in AMI patients. Thus, our aim was to determine the prognostic utility of SI and MSI in AMI patients. Methods We searched PubMed, ProQuest, EBSCO Host, and Europe PMC from conception to May 2022. Studies were eligible if they evaluated the relationship of SI and MSI with all-cause mortality and major adverse cardiac events. Results A total of 16 studies involving 80,195 participants met the inclusion criteria and were included in this meta-analysis. Our study revealed significantly higher all-cause mortality risk for patients with high SI and MSI compared to patients with low indices, regardless of the periods of outcomes, study population, or diverse cut-off values. Moreover, both increased SI and MSI also predicted higher major adverse cardiac events rates. Conclusions According to our findings, both SI and MSI in the emergency department can predict all-cause mortality and major adverse cardiac events in patients with acute myocardial infarction. Given this growing body of evidence, as well as the fact that SI and MSI are very simple objective indices derived from two readily available vital signs, they should be used in daily clinical practice to risk stratify patients presenting with acute myocardial infarction. PROSPER registration CRD42022329558.

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.

Coronary Artery Bypass Grafting (CABG) is aimed to improve the quality of life among post-CABG patients, there exist a large number of patients having a low level of quality of life. The study aimed to analyze factors that influenced the quality of life among post-CABG patients. The descriptive study was conducted using cross-sectional analysis with a consecutive sampling of 80 post CABG patients in Hasan Sadikin Hospital from 20 May-30 June 2019. Data were analyzed using multivariate linear regression. The independent variables in this study included age, gender, education level, pain, mental health, social support, spiritual well-being, and cardiac rehabilitation. The data were collected using three questionnaires which included Short-Form 36 (SF-36) to measure patient-reported pain, mental health, and the quality of life; Multidimensional Scale of Perceived Social Support (MSPSS) to provide information about the role of social support; and Spirituality Index of Well Being (SIWB) designed to measure the spiritual well-being of the patients. The results showed four factors had significantly influenced the quality of life among patients after CABG. The factors included age (p-value0,001; r=0,521), pain level (p-value0,001; r=0,666), mental health (p-value0,001; r=0,426), and social support (p-value0,001; r=0,345). Pain factor had the most significant effect on the patients (r=0,497). Pain could cause a stress response that influenced the recovery stage which eventually impacted the quality of life. This study implies that the management of post-CABG patients could be performed by applying pain and stress management in discharge planning.

ABSTRAK Pengamatan parameter kualitas air, tanah, kesehatan dan pertumbuhan merupakan hal yang penting untuk dilakukan dalam budidaya udang vaname. Keterkaitan antar parameter tersebut perlu untuk diketahui dan dianalisis lebih lanjut. Penelitian ini bertujuan untuk melihat keterkaitan antara berbagai parameter kualitas air, kualitas tanah, koefisien teknis budidaya dan parameter kesehatan udang dalam kegiatan budidaya udang dengan nilai sedimen redok potensial yang berbeda. Penelitian ini dilakukan dengan perbedaan nilai sedimen redok potensial yaitu 69,33 ± 14,5 mV, 151,00 ± 8,89 mV, dan 210,00 ± 17,32 mV dengan empat ulangan. Udang sebanyak 25 ekor dengan bobot rata rata 1,37 ± 0,04 g dan padat tebar 144 ekor/m2 digunakan dalam penelitian selama 30 hari. Selama penelitian parameter yang diamati meliputi parameter kualitas air, kesehatan dan pertumbuhan. Parameter kualitas air tidak menunjukkan perbedaaan nyata antar perlakuan kecuali nilai pH dan oksigen terlarut. Pada nilai redok potensial yang rendah nilai pH air cenderung lebih tinggi sedangkan pada nilai redok potensial yang lebih tinggi nilai oksigen terlarut lebih tinggi. Parameter kualtias air yang menunjukkan keterkaitan berdasarkan analisis komponen utama (PCA) dan klaster adalah konduktivitas dan TDS sedangkan parameter kualitas tanah yang saling berkaitan adalah total P, total Fe, total Mn dan total S. Adapun parameter pertumbuhan dan kesehatan udang tidak memenuhi syarat untuk diuji lanjut dengan PCA. Kata kunci: kualitas air, PCA, redok potensial, sedimen, udang putih.

Pulmonary hypertension (PH) encompasses several heterogeneous groups of multiple diseases characterized by abnormal pulmonary arterial blood pressure elevation. Unrepaired atrial septal defect (ASD) may be associated with pulmonary arterial hypertension (PAH), indicating pulmonary vascular remodeling. Furthermore, unrepaired ASD could also be associated with other conditions, such as left heart disease or thromboembolism, contributing to the disease progression. We present a case of a 61-years-old woman with complex PH comprising several etiologies, which are PAH due to unrepaired Secundum ASD, mitral regurgitation caused by mitral valve prolapse as a group 2 PH, pulmonary embolism (PE) which progress to chronic thromboembolism PH (CTEPH) and post-acute sequelae of SARS Cov-2. We highlighted the importance of diagnostic investigation in PH, which is crucial to avoid misdiagnosis and inappropriate treatment that could be detrimental for the patient.

Background: Preeclampsia is associated with intense inflammatory response in pregnancy, and soluble ST2 (sST2) is pathologically increased in this condition. No data exist regarding maternal sST2 levels in normal pregnancy versus preeclampsia in areas of southeast Asia with an ethnic Malay predominance. Materials and Methods: Patients were sorted into normal pregnancy or preeclampsia. Patients with a history of allergic, inflammatory, or malignant disease were excluded. One sample was taken per patient; all samples were taken during the third trimester of pregnancy. Thirty samples from each group were enrolled in the study, totaling 60 samples. Soluble ST2 levels in maternal plasma were measured using the Presage® ST2 Assay according to manufacturer instructions, and data was analyzed using SPSS 23. Results: Patients in the preeclampsia group were significantly older than those in the normal pregnancy group (p = 0.01). Most patients with preeclampsia presented as early-onset (n = 23). Both systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly higher (p 63.66 ng/ml has sensitivity 50% and specificity 93.3%, with AUC of 0.78 [95% CI 0.66 – 0.90], p 63.66 ng/ml has an OR of 14.0 [95% CI 2.82 – 69.6], p

Coronary artery diseases (CAD), also known as coronary heart disease (CHD), are the world’s leading cause of death. The basis of coronary artery disease is the narrowing of the heart coronary artery lumen due to atherosclerosis. The use of electronic cigarettes has increased significantly over the years. However, harmful effects of electronic cigarettes are still not firm. The aim of this article is to review the impact of electronic cigarette and its role in the pathogenesis of atherosclerosis from recent studies. The results showed that several chemical compounds, such as nicotine, propylene glycol, particulate matters, heavy metals, and flavorings, in electronic cigarette induce atherosclerosis with each molecular mechanism that lead to atherosclerosis progression by formation of ROS, endothelial dysfunction, and inflammation. Further research is still needed to determine the exact mechanism and provide more clinical evidence.

Purpose: There is uncertainty as to which anticoagulant should be used in non-valvular atrial fibrillation (AF) with valvular heart disease. This systematic review and meta-analysis aimed to assess the efficacy and safety of direct-acting oral anticoagulants (DOACs) compared with warfarin in patients with non-valvular AF with valvular heart disease.Methods: We performed a comprehensive literature search using PubMed, Scopus, Embase, and Clinicaltrials.gov from the inception of databases up until August 2, 2021, and the search was updated and finalized on October 17, 2021. The intervention group was DOACs and the control group was warfarin. The primary outcome was systemic embolism and stroke (SSE), and the secondary outcome was major bleeding and intracranial hemorrhage. The pooled effect estimate was reported as the hazard ratio (HR) and odds ratio (OR).Results: There were 21,185 patients from seven studies included in this systematic review and meta-analysis. Stroke and systemic embolism were lower in patients receiving DOACs [HR 0.76 (95% CI 0.67, 0.87), p < 0.001; I2: 5%] compared with warfarin. The subgroup analysis on RCTs showed the significant reduction of SSE in the DOACs group [HR 0.73 (95% CI 0.60, 0.89), p = 0.002; I2: 16%]. There was no significant difference in terms of major bleeding [HR 0.89 (95% CI 0.75, 1.05), p = 0.18; I2: 69%]. Intracranial hemorrhage [HR 0.42 (95% CI 0.22, 0.80), p = 0.008; I2: 73%] were lower in the DOAC group.Conclusion: This meta-analysis indicates that DOACs were associated with a lower risk of SSE and intracranial hemorrhage compared with patients receiving warfarin. There was no significant difference between the two groups in terms of major bleeding.

In this study, we reported the construction of Gold Nanospike (AuNS) structures on the surface of screen-printed carbon electrode (SPCE) used for non-enzymatic electrochemical detection. This modification was prepared with a one-step electrodeposition method by controlling the electrodeposition parameters, such as applied potential and deposition time, via Constant Potential Amperometry (CPA). Those parameters and precursor solution concentration were varied to investigate the optimum electrodeposition configuration. The results confirmed that AuNS were homogenously deposited and well-dispersed on the working electrode surface of SPCE. The AuNS-modified SPCE was implemented as a non-enzymatic sensor toward dopamine and could enhance the electrocatalytic ability compared with the bare SPCE. Further examination shows that the sensing performance of the AuNS-modified SPCE produced an increase in electrochemical surface area (ECSA) at 17.25 times higher than the bare electrode, a sensitivity of 0.056 µA mM−1 cm−2 with a wide linear range of 0.2–50 µM and a detection limit of 0.33 µM. In addition, AuNS-modified SPCE can selectively detect dopamine among other interfering analytes such as ascorbic acid, urea, and uric acid, which commonly coexist in the body fluid. This work demonstrated that AuNS-modified SPCE is a prospective sensing platform for non-enzymatic dopamine detection.

The correlation between metalloproteinase-9 (MMP-9) level and neutrophil-lymphocyte count ratio (NLCR) in AMI patients has not been studied despite the fact that they are both known to predict ventricular remodeling. This study aimed to evaluate the correlation between the MMP-9 level and NLCR in patients with acute myocardial infarction. A cross-sectional study was conducted by recruiting acute coronary syndrome patients (onset within 24 hours) who were admitted to the emergency department in several hospitals around Bandung during October-December 2012. The relationship between the MMP-9 level and NLCR was analyzed using Pearson correlation test. Linear regression analysis was used to measure the strength of NLCR in MMP-9 level prediction. Thirty seven patients aged 55.8 + 11 years old were included in this study with mostly male patients (78%). Seventy-six percents of the sample were ST-elevation myocardial infarct (STEMI) patients with the onset of symptoms of 6 (3-14) hours. The mean lymphocyte-neutrophil ratio was 5.24 (1σ±2.4) and the MMP-9 plasma concentration was 370 (240-530) ng/mL. One-sided Pearson correlation showed a positive correlation between the two variables (r=0.44, p=0.003). The linear regression analysis conceived the formula of MMP-9 = 40.87 (NLCR) + 211.3 which was used to show the relationship between the MMP-9 level and lymphocyte-neutrophil ratio. There was a positive moderate correlation between the MMP-9 level and NLCR in patients with AMI. Linear regression analysis shows that NLCR is the only independent variable to predict the MMP-9 plasma level. Key words: Acute myocardial infarct, left ventricular remodeling, matrix metalloproteinase (MMP)-9, neutrophyl-lymphocyte count Ratio (NLCR)

Background: Prolonged pacing of the right ventricle (RV) is associated with left ventricular (LV) systolic dysfunction. Several studies have shown that the RV pacing location, pacing burden (percentage), and paced QRS duration may affect LV systolic function. Subclinical LV dysfunction may occur early after implantation of a permanent pacemaker (PPM). Therefore, this study aims to detect early subclinical LV systolic dysfunction measured by global longitudinal strain (GLS) using speckle tracking echocardiography (STE) at one month after PPM implantation. Methods: A single-center, prospective cohort study was conducted, and all patients indicated for PPM implantation with preserved LV systolic function were included. Data of RV pacing location (RV apical vs right ventricular outflow tract (RVOT), pacing burden (percentage) (≤40% vs >40%), and paced QRS duration (≤150 ms and >150 ms) were obtained. The change of GLS was also measured before and one month after PPM implantation (delta GLS). Results: 37 patients were enrolled in this study, which demonstrated significant difference between GLS before (-20.30 SD 3.38) and after (-16.93 SD 3.47) PPM implantation (p=150ms ((1.70 (0.30–8.30) vs 3.45 (0.0–10.5)), p=0.266). Meanwhile, there was a significant difference of delta GLS between patients with pacing burden ≤40% vs >40% (Mean 1.92 SD 1.37 vs 3.98 SD 3.04), p=0.007). Further analysis found that pacing burden only affected the delta GLS in group with apical RV pacing (≤40% (1.58 SD 0.59) vs > 40% (4.67 SD 3.47), p = 0.008) and did not affect the delta GLS in group with RVOT pacing (≤40% (2.32 SD 1.98) vs > 40% (3.29 SD 2.48), p = 0.446). Conclusion: The pacing parameter, particularly pacing burden > 40% may induce the subclinical LV systolic dysfunction after one month of pacemaker implantation as shown by decline of GLS, especially when the RV pacing location was placed on apical.

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.

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.

The rise of LGBT case in Indonesia, attracted the attention of researchers to see how the view of psychology about LGBT. This study is a literature review research using relevant reference theories and publications in the field of Psychosexual, Islamic Psychology, and Biopsychology. According to the psychosexual perspective, humans are inherently bisexual. A person to be able to express himself as LGBT or heterosexual is when he is in phallic phase, where the point of pleasure is in the genitals. Based on the Islamic psychology, LGBT behavior is a type of ammara personality; dominated by lust 55%, assisted by 30% of mind power, and 15% of qalbu. While based on biopsychological point of view, LGBT behavior is not influenced by hormones but occurs due to changes in brain structure caused by experience and environment called plasticity, where the behavior of a person is able to change the shape of the human brain itself. From the results of the literature review above shows that LGBT is an abnormality of sexual orientation that is influenced by one's experience and environment.