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.

Metabolic syndrome and Framingham risk score in obese young adults.

Background: The increase number of the metabolic syndrome (MetS) among young adults was mostly caused by obesity. MetS increases the risk of coronary heart disease (CHD) which can be estimated by Framingham risk score (FRS). The study was aimed to know the prevalence of MetS and FRS in obese young adults and to associate them with the components of MetS. Methods: A total of 70 male and female students aged 18 to 25 years with BMI ≥ 25 kg/m2 in Faculty of Medicine Universitas Indonesia were selected consecutively. The blood samples used to test fasting blood glucose, total cholesterol, high-density lipoprotein, and triglyceride were examined in Department of Clinical Pathology, Cipto Mangunkusumo Hospital after fasting for 14 to 16 hours. International Diabetes Federation (IDF) definition was used to diagnose MetS. Univariate and bivariate analysis were done. Results: The prevalence of MetS based on IDF definition was 18.6% among obese young adults. The most associated MetS components was hypertriglyceridemia (OR 12.13; 95% CI 2.92-50.46; p = 0.001), followed with high blood pressure (OR 9.33; 95% CI 2.26-38.56; p = 0.001), low-HDL (OR 8.33; 95% CI 2.17-32.05; p = 0.003), and impaired fasting glucose (p = 0.03). Four subjects had FRS ≥ 1% and 66 subjects had risk < 1%. Increased FRS was not associated with MetS (p = 0.154). There was no component of MetS associated with increased FRS. Conclusion: Prevalence of MetS in obese young adults was similar with obese children and adolescents. Although no association of MetS and FRS was found, they are significant predictors for CHD which should not be used separately.

Ende Diabetes Study: diabetes and its characteristics in rural area of East Nusa Tenggara.

Background: There are only few studies about diabetes in rural area in Indonesia. Epidemiological study are needed to formulate health policy of disease management in specific area. The aim of this study was to find the prevalence of diabetes and knowledge of diabetes among the community in Nangapanda Village, Ende District, East Nusa Tenggara. Methods: A cross-sectional study “Ende Diabetes Study” was conducted in Nangapanda Village. This study use cluster random sampling method to a total number of 19756 residents in Nangapanda village. From the sampling frame of 1800 adult subjects who underwent screening with glucometer in 2008 and 2009, 125 subjects have been diagnosed as diabetes or impaired fasting glucose (IFG). All of the subjects who were diagnosed as diabetes or IFG from the previous screening and 218 subjects from control (normal subjects in the 2008 and 2009 screening) were included in the present study. Each subject underwent general anamnesis, nutritional interview, complete physical examinations, and laboratory test (blood and urine). The data were analyzed using SPSS 13.0. Ressult: There were 343 subjects in this study. The prevalence of diabetes in Nangapanda using blood glucose criteria (using fasting and post-glucose load values) was 2%; using post glucose load criteria, the prevalence of DM was 1.56%; while with HbA1c criteria, the prevalence was 2.83%. The prevalence of impaired glucose tolerance (IGT) was 2.2%, and IFG was 6.2%. A number of 71.1% Nangapanda residents have sufficient knowledge about diabetes. Conclusion: Prevalence of diabetes in Nangapanda (using fasting and post-glucose load criteria) was 2% and 1.56% (using post-glucose load values). As much as 71.1% of Nangapanda residents have sufficient knowledge about diabetes.

Prevention of endothelial dysfunction in streptozotocin-induced diabetic rats by Sargassum echinocarpum extract.

Aim This study aimed to elicit the protective effect of Sargassum echinocarpum extract on endothelial dysfunction in thoracic aorta of streptozotocin-induced diabetic rats. Methods The animals were divided into 5 groups. The first was normal, the second was diabetic non treated animals. The third to fifth groups were the diabetic animals which given Sargassum echinocarpum extract (150; 300, and 450 mg kg-1 body weight, respectively) by oral gavage and extract treatment was given for 12 weeks. Diabetes was induced by single administration of streptozotocin (45 mg kg-1, i.p.), dissolved in freshly prepared 0.1 M citrate buffer, pH 4.5. Diabetes was confirmed ten days latter in streptozotocin induced animals showing blood glucose levels > 200 mg dL-1 (11.1 mmol L-1) as monitored in the blood from tail vein using glucometer. After the treatment period, the blood serum acquired was used for antioxidant enzymes assays and the thoracic aorta was used for vasorelaxation assay. Results There was a significant decrease in the activity of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GSH-px) in diabetic rats (3.31+ 0.12;67.17 + 0.62;35.10 + 0.83) comaped to control rats (9.97 + 0.12;185.31 + 0.23;116.38 + 0.88). Administration of Sargassum extract increased the activity of SOD, CAT, and GSH-px. The diabetic rats exhibit endothelial dysfunction as shown by loss of vasodilatory response to acethylcholine (ACH). This was restored by administration of Sargassum extract. Conclusion Sargassum echinocarpum extract ameliorates oxidative stress and reverses the endothelial dysfunction associated with diabetes. This effect appears to be due to its antioxidant properties.

The Sensitivity and Specifi city of a new Scoring System Using High Resolution Computed Tomography to Diagnose Lung Cancer.

Aim To find a non-invasive diagnostic method for lung cancer with the results almost as accurate as histopathological examinations using HRCT scoring system. Method This study was conducted from December 2006 until March 2008. A total of 55 persons, comprised of 40 male and 15 female patients suspected of having lung cancer, underwent high resolution computed tomography with and without contrast as well as CT-guided transthoracic needle aspiration to obtain cytology specimens. Results Histopathological examinations revealed the existence of lung cancer in 43 patients (78%) and benign lesions in 12 patients (22%). A scoring system was then made based on the similarities of fi ndings from CT and histopathologic examinations. In the the age group of 49 years and above, tumor volume of more than 68 cm3, HU of more than 21, spicula positive, angiogram positive and lymph node positive had a value of respectively 20, 19, 10, 24, 18, and 17 (total score 108). Conclusion This new method to diagnose lung cancer is constantly as accurate as histological findings with a sensitivity of 97.7% and a specifi city of 83,3% and a cut-off score of 35. According to this system, a score of less than 35 indicates that the lesions were benign while a score higher than 35 is suggestive malignant.

The effect of non-surgical periodontal therapy on systemic immune response and blood glucose level of NIDDM patients.

Periodontal inflammation is a periodontal disorder of high prevalence in the population. Chronic periodontitis is associated with the accumulation of plaque and calculus as local factors, and systemic factors such an diabetes mellitus (DM) and HIV infection. Cytokine, especially IL-1β as inflammatory mediator for periodontal disease, may directly stimulated iNOS (inducible nitric oxide synthase) expression and NO (nitric oxide) production by β-cells, resulting in NO-mediated β-cell damage. The leucotoxin and proteases produced by periodontal pathogens will induce chemotactic and phagocytotic defect; therefore causing decreased PMN phagocytotic function. Hyperglicemia which occurs in diabetic patients increases calcium influx to the cell, resulting in the increased cytosol’s calcium ([Ca 2+]i) level and; therefore, resulting in dysfunction of PMN and impaired PMN phagocytotic function. Advanced glycosilation endproduct in NIDDM binds to monocytes resulting in the increase of pro-inflammatory cytokines (IL-1, TNFα) and produces activation of macrophages and osteoclasts. Hyperglicemia activates diacyl glycerol (DAG)-protein kinase C (PKC), thus increasing PGE2 and cytokine expression that induce inflammation and periodontal tissue destruction processes. Studies on the effect of scaling to remove calculus disposition on blood glucose control and cellular immune response in DM patient has never been carried out. The aim of the study was to analyze the effect of scaling as non-surgical periodontal therapy on immune response (IL-1β level and PMN phagocytotic function) and blood glucose level of type 2 diabetic patients. Subjects were diabetic patients, 60 controlled-DM (CDM) and 60 uncontrolled-DM (UCDM), in Metabolic-Endocrinology Clinic of Ciptomangunkusumo Hospital, aged 40-60 years. The subjects were divided into treatment (scaling) and control group, and cellular immune response and diabetic status, before and 6 weeks after treatment were evaluated. Statistical analysis (t test) were done using Stata 7.0 software, to compare the parameters before and after scaling in CDM and UCMD subjects. The results showed that scaling decreased IL-1β level and increased phagocytotic function significantly (P<0.05). Scaling decreased fasting and 2 hours post-prandial blood glucose levels and HbA1c level, but the decrease were not significant statistically (P>0.05), except for the decrease in HbA1c level in uncontrolled DM (P=0.00).

Correlation between left ventricular mass and visceral fat thickness in obese women.

AIM: This study was aimed to measure left ventricular mass, which partly determines the function of the left ventricle, in obese women. METHODS: The total number of study subjects was 90, which consisted of 45 obese women (BMI >or= 25 Kg/m2) and 45 non-obese women (BMI < 25 Kg/m2) as control group. They were evaluated by M mode echocardiography and abdominal CT to measure visceral fat, blood pressure, insulin resistance and waist circumference. Correlation was assessed for both groups. RESULTS: There were significant differences in the left ventricular mass of the obese and non-obese group (P= 0.000), systolic blood pressure (P = 0.000), diastolic blood pressure (P = 0.006), waist circumference (P = 0.000), visceral fat (P = 0.000), and HOMA-IR (P = 0.000). With bivariant analysis, it is concluded that there are significant correlations between left ventricular mass and visceral fat (r = 0.67, P = 0.000); between BMI and left ventricular mass (r = 0.67, P = 0.000); between waist circumference and left ventricular mass (r = 0.72, P = 0.000); and also between HOMA-IR and left ventricular mass (r = 0.57, P = 0.000). CONCLUSION: There are significant correlations between increased left ventricular mass and visceral fat, BMI, waist circumference and HOMA-IR among Indonesian women. So far, this study has shown a correlation between obesity and high cardiovascular risk.

The correlation between hs C-reactive protein and left ventricular mass in obese women.

Plasma C-reactive protein (CRP) concentrations are increased in obese individuals. In this study, we examined the correlation between hsCRP and left ventricular mass (LV mass). Fourty five healthy obese women and fourty five healthy non obese women as the controls group were studied by echocardiography and hsCRP. There was no significant correlation between hsCRP and left ventricular mass in obese women (r = 0.29, p 0.06). There was a significant correlation between hs CRP and body mass index (r = 0.46, p 0,002), and also hsCRP and visceral fat (r= 0.33, p 0.03).

The correlation between insulin resistance and left ventricular systolic function in obese women.

AIM: To determine the correlation between insulin resistance and left ventricular systolic function in obese women. METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiograms were undertaken in our echocardiographic laboratory following standard methods. The homeostasis model was used to assess insulin resistance (HOMA IR). RESULTS: Ejection fraction (p =0.22) and fractional shortening (p= 0.58) were not difference between obese women and the normal group. There was no correlation between insulin resistance and left ventricular systolic function. CONCLUSION: There was no correlation between insulin resistance and left ventricular ejection fraction.

Left ventricular diastolic dysfunction in obese women.

AIM: To determine the direct effect of obesity on echocardiographic indices of diastolic left ventricular function METHODS: 44 obese (BMI > or =25 kg/m2) and 45 normal weight women were studied. They had no other pathological conditions. Echocardiographic indices of diastolic function were obtained, and dysfunction was assumed when at least two values differed by > or =2 SD from the normal weight group. RESULTS: In obese subjects, the values of maximum velocity of active mitral filling (A) were increased and pulmonary diastolic velocity was decreased significantly (p< 0,01); all other diastolic variables were unchanged. Subclinical diastolic dysfunction tend to be more prevalent among obese subjects but it was not significantly different from non obese (p= 0.11), being present in nine obese (20.5%) and 4 normal (8.9%) subjects. CONCLUSION: Subclinical left ventricular diastolic dysfunction is present in obese women.

Left ventricular diastolic dysfunction in type 2 diabetes mellitus patient without cardiovascular disease: the association with microalbuminuria.

Twenty-eight cases of type 2 diabetes mellitus (DM) without any cardiovascular disease were recruited from the Department of Metabolic-Endocrine, Faculty of Medicine, University of Indonesia / Dr. Cipto Mangunkusumo General Hospital, Jakarta. Recruitment of the study began in October 2001 and was completed by December 2001. Participants were examined for echocardiography and microalbuminuria urinary examination. Diastolic dysfunction was found in 73.7% of type 2 diabetic patients without microalbuminuria and 66.7% in type 2 diabetic patients with microalbuminuria. Neither type 2 diabetic groups with nor without microalbuminuria indicated any significant association to the occurrence of diastolic dysfunction.

Correlation between cortisol levels and myocardial infarction mortality among intensive coronary care unit patients during first seven days in hospital.

AIM: To measure cortisol level, its relationship with myocardial infarction, and to determine the correlation of elevated cortisol levels with the outcome of myocardial infarction. METHODS: This study was designed as a pre and post study. The diagnosis of myocardial infarction was established based on the WHO criteria. The patients were followed for seven days. Blood specimens were collected on day 1, 3, 5 and 7. RESULTS: Thirty six patients with myocardial infarction were studied. Four patients (11.1%) died and 32 patients (88.9%) survived. Nineteen patients (52.7%) had large infarcts and 23 patients (63.9%) had myocardial complications. The deceased patient's cortisol level differed significantly from those tht survived (65.68 + 29.07 vs 21350 + 15.82 microg/dl, p < 0.05). The groups with large infarcts and myocardial infarct complications had higher cortisol levels, but the difference was not significant compared with the group with small infarcts and patients without complications. Six patients (16.6%) who received thrombolytic therapy had significantly lower cortisol levels as compared to patients without thrombolytic therapy. The duration of elevation cortisol elevation in the deceased patient was longer than that among those who survived. Similar findings were also true for those with large infarcts when compared to those with small infarcts, as well as myocardial infarct patients with complications when compared to those without. However, the duration of cortisol elevation was shorter among patients who received thrombolytic therapy. CONCLUSION: Cortisol level can be used as a prognostic marker for myocardial mortality.