Effect of enhanced external counterpulsation therapy on myeloperoxidase in lowering cardiovascular events of patients with chronic heart failure.

Background: Chronic heart failure (CHF) is a slowly progressive disease with high morbidity and mortality; therefore, the management using pharmacological treatments frequently fails to improve outcome. Enhanced external counterpulsation (EECP), a non-invasive treatment, may serve as alternative treatment for heart failure. This study was aimed to evaluate the influence of EECP on myeloperoxidase (MPO) as inflammatory marker as well as cardiac events outcome. Methods: This was an open randomized controlled clinical trial on 66 CHF patients visiting several cardiovascular clinics in Manado between January-December 2012. The subjects were randomly divided into two groups, i.e. the group who receive EECP therapy and those who did not receive EECP therapy with 33 patients in each group. Myeloperoxidase (MPO) as inflammatory marker was examined at baseline and after 6 months of observation. Cardiovascular events were observed as well after 6 months of observation. Unpaired t-test was use to analyze the difference of MPO between the two groups, and chi-square followed by calculation of relative risk were used for estimation of cardiovascular event outcomes. Results: MPO measurement at baseline and after 6 months in EECP group were 643.16 ± 239.40 pM and 422.31 ± 156.26 pM, respectively (p < 0.001). Whereas in non EECP group, the MPO values were 584.69 ± 281.40 pM and 517.64 ± 189.68 pM, repectively (p = 0.792). MPO reduction was observed in all patients of EECP group and in 13 patients (48%) of non-EECP group (p < 0.001). Cardiovascular events were observed in 7 (21.21%) and 15 (45.45%) of patients in EECP and non-EECP groups, respectively (p = 0.037). Conclusion: EECP therapy significantly decreased the level of MPO as inflammatory marker and this decrease was correlated with the reduction of cardiovascular events in CHF patients.

Hypertension in Indonesian air force pilots.

Background: To investigate the association between aircraft noise and blood pressure. Methods: A nested case-control study was conducted on Indonesian Air Force pilots doing annual medical check-ups at the Saryanto Institute for Aviation and Aerospace Health (LAKESPRA) from 2003 – 2008. The data extracted from medical records were age, total flight hours, type of aircraft, fasting blood glucose and cholesterol levels, waist circumference, height and weight (Body Mass Index), and blood pressure. Results: There were 549 pilots, 49 were found to be hypertensive, with SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg. Helicopters pilots were at an almost 2 fold risk of hypertension compared to pilots of the fixed wing aircrafts. Pilots with more than 1400 hours of flight had more than 2 fold risk of being hypertensive compared to those with 1400 flight hours or less. Conclusion: The type of aircraft, which is related to the noise generated, may be a risk factor for developing hypertension in pilots. Increased total flight hours also increased the risk of hypertension.

High intensity interior aircraft noise increases the risk of high diastolic blood pressure in Indonesian Air Force pilots.

Aim: To analyze the effects of aircraft noise, resting pulse rate, and other factors on the risk of high diastolic blood pressure (DBP) in Indonesian Air Force pilots. Methods: A nested case-control study was conducted using data extracted from annual medical check-ups indoctrination aerophysiologic training records at the Saryanto Aviation and Aerospace Health Institute (LAKESPRA) in Jakarta from January 2003 – September 2008. For analysis of DBP: the case group with DBP ≥ 90 mmHg were compared with contral group with DBP < 79 mmHG. One case matched to 12 controls. Results: Out of 567 pilots, 544 (95.9%) had complete medical records. For this analysis there were 40 cases of high DBP and 480 controls for DBP. Pilots exposed to aircraft noise 90-95 dB rather than 70-80 dB had a 2.7-fold increase for high DBP [adjusted odds ratio (ORa) = 2.70; 95% confi dence interval (CI ) = 1.05-6.97]. Pilots with resting pulse rates of ≥ 81/minute rather than ≤ 80/minute had a 2.7-fold increase for high DBP (ORa = 2.66; 95% CI = 1.26-5.61). In terms of total fl ight hours, pilots who had 1401-11125 hours rather than 147-1400 hours had a 3.2-fold increase for high DBP (ORa = 3.18; 95% CI = 1.01-10.03). Conclusion: High interior aircraft noise, high total flight hours, and high resting pulse rate, increased risk for high DBP. Self assessment of resting pulse rate can be used to control the risk of high DBP.

The impact of β-hCG on placental angiogenesis in pre-eclampsia.

Numerous factors, such as VEGF and intra-placental oxygenation, can influence placental angiogenic activity. Early in the normal gestation period, β-hCG enhance VEGF activity to induce angiogenesis. The aims of this study were to identify the correlation between β-hCG concentration in placental culture and placental angiogenic activity in pre-eclampsia. Ten placenta samples from women with pre-eclampsia and l0 from controls (normal pregnancy) were collected. All subjects agreed to participate in this study and signed an informed consent form. β-hCG concentration in supernatant of placental culture was measured by Microparticle Enzyme Immunoassay (MEIA) and placental angiogenic activity was measured by endothelial cell migration toward placental explant (score 0-4). The results showed that the median score of placental angiogenic activity in pre-eclampsia was significantly higher than in normal pregnancy (p<0.05). Concentration of β-ahCG in pre-eclampsia was significantly higher than in normal pregnancy (p<0.001). hCG concentration in placental culture was positively correlated to placental angiogenic activity both in pre-eclampsia (r=+0.50) and in normal pregnancy (r=+0.57). Althouglt the correlations were weak, β-hCG is considered one of the factors that influence placental angiogenic activity.

Combined traditional medicine and pharmacological antihypertensive drugs in a rural community of West Java, Indonesia.

Some hypertensive subjects in Indonesia consume traditional herbal medicines in addition to the usual pharmacological drugs. This paper studied the relationship between several traditional herbal medicines, such as morinda, star fruit, garlic, or jamu, believed to control hypertension and the risk of current pharmacological antihypertensive drug users in subjects with stage 1 and 2 hypertension in a rural community West Java, Indonesia. The data were obtained from 3 field studies by the second year medical students of the Faculty of Medicine, University of Indonesia conducted in 2001, 2002, and 2003 in a subdistrict of the Bogor regency. The subjects were selected randomly from neighborhood clusters. Interviews and blood pressure measurements were conducted at the houses of the subjects by specially trained second year medical students supervised by faculty members. There were 496 subjects with stage 1 or 2 hypertension, with 11.5% under current antihypertensive drugs. Compared with the hypertension stage 1 subjects, hypertension stage 2 subjects were 5.4 times more likely to be currently taking pharmacological antihypertensive medication (adjusted odds ratio = 5.44; 95% confidence interval = 2.64-11.27). The combined of current antihypertensive medication with traditional medicines were cucumber which being the most dominant followed by star fruit and morinda. Reasons for this were probably the strong influence of culture, the limited medical facilities, and high cost of the antihypertensive drugs. It was concluded that in a rural Indonesia, it was common for hypertensive subjects to take pharmacological drugs as well as traditional medicine for antihypertensive therapy.