The Application of Coronary Contrast Emptying Time in Diagnosing Coronary Slow Flow Phenomenon: A Serial Case Report.

The Coronary Slow Flow Phenomenon doesn't achieve as much attention as its counterpart Coronary Arterial Disease because it is considered a rather benign entity. But now it is proven that coronary slow flow phenomenon can also manifest as an acute coronary syndrome, myocardial ischemia, malignant arrhythmia, and even sudden cardiac death.This entity is usually diagnosed from coronary angiography study when a delayed coronary contrast filling time is found without the presence of significant epicardial narrowing of the related arteries. But, in our center's years of experience, we frequently found cases in which myocardial ischemia or infarction was suggested or proven clinically, on the other hand, angiography study showed no significant epicardial coronary artery narrowing neither delayed coronary contrast filling time. Furthermore, we observed that this group of patients exhibited a rather prolonged coronary contrast emptying time instead.In this serial case report, we presented some of our cases where microvascular disorders were suspected. We demonstrated that not all coronary contrast filling times in ischemic or infarction-related arteries were prolonged, on the other hand, prolongation of coronary contrast emptying time showed a more consistent result.

The Association of ß2-Microglobulin and Fibroblast Growth Factor 23 with Major Adverse Cardiac Event in Acute Coronary Syndrome Patients with Chronic Kidney Disease.

BACKGROUND: chronic kidney disease (CKD) increases the severity and risk of mortality in acute coronary syndrome (ACS) patients. The role of ß2-M as a filtration and inflammation marker and FGF23 as a CKD-MBD process marker might be significant in the pathophysiology in ACS with CKD patients. This study aims to determine the association of ß2-M and FGF23 with major adverse cardiac event (MACE) in ACS patients with CKD. METHODS: we used cross sectional and retrospective cohort analysis for MACE. We collected ACS patients with CKD consecutively from January until October 2018 at Dr. Cipto Mangunkusumo General Hospital. Data were analyzed using logistic regression and Cox's Proportional Hazard Regression. RESULTS: a total of 117 patients were selected according to the study criteria. In bivariate analysis, ß2-M, FGF23, and stage of CKD had significant association with MACE (p = 0.014, p = 0.026, p = 0.014, respectively). In multivariate analysis, ß2-M - but not FGF 23- was significantly associated with MACE (adjusted HR 2.16; CI95% 1.15-4.05; p = 0.017). CONCLUSION: ß2-M was significantly associated with MACE, while FGF23 was not so. This finding supports the role of inflammation in cardiovascular outcomes in ACS with CKD patient through acute on chronic effect.

Serum Albumin as Prognostic Marker for Older Adults in Hospital and Community Settings.

Serum albumin, known for its multifaceted role in health, is hypothesized to serve as a prognostic marker for older adults, both in hospital and community settings. Nine studies were included in the review, revealing consistent associations between low serum albumin levels and increased mortality risk in hospitalized older individuals. In community settings, low serum albumin levels were linked to higher mortality rates compared to those with normal levels. The synthesis of evidence underscores the potential of serum albumin as a prognostic marker for older adults, offering valuable insights for risk stratification and targeted interventions. While robust evidence supports its utility in hospital settings, further research is warranted in community settings to address current limitations and enhance the applicability of serum albumin as a prognostic tool. This review merges existing knowledge of the prognostic significance of serum albumin in older adults across hospital and community settings. The findings emphasize the importance of serum albumin as a potential prognostic marker, urging continued research efforts to refine its application in diverse healthcare contexts and improve outcomes for the aging population.

Ophiocephalus striatus Extract Supplementation Decreases Serum IL-6 Levels in Older People with Sarcopenia-A Single-Center Experience.

Sarcopenia, a condition characterized by muscle loss and decreased function in older adults, is a growing public health concern. This study aimed to investigate the effects of Ophiocephalus striatus extract on insulin-like growth factor-1 serum, interleukin-6 serum levels, and sarcopenia-related parameters in older adults with sarcopenia. This double-blind randomized controlled trial included 80 older adults with sarcopenia. Participants were randomly assigned to receive Ophiocephalus striatus extract or a placebo for two weeks. The IGF-1 serum and IL-6 serum levels were assessed as primary outcomes. The Ophiocephalus striatus extract intervention resulted in a significant reduction in serum IL-6 levels. Although the IGF-1 levels did not show significant changes, there was an increase for the intervention group. This study demonstrated that a 2-week intervention with Ophiocephalus striatus extract positively impacted the serum IL-6 levels in older adults with sarcopenia. While the IGF-1 levels did not change significantly in this short intervention period, the observed improvements in IGF-1, calf circumference, muscle mass, and muscle strength are promising. The findings suggest that Ophiocephalus striatus extract may offer a valuable intervention for managing sarcopenia, particularly in regions with abundant Ophiocephalus striatus production, such as South Sumatera. This study was registered with trial number NCT05869383.

Is T-Wave Alternans a Repolarization Abnormality Marker in COVID-19? An Investigation on the Potentialities of Portable Electrocardiogram Device.

Background: Cardiac arrhythmias are significantly associated with poor outcomes in coronavirus disease 2019 (COVID-19) patients. Microvolt T-wave alternans (TWA) can be automatically quantified and has been recognized as a representation of repolarization heterogeneity and linked to arrhythmogenesis in various cardiovascular diseases. This study aimed to explore the correlation between microvolt TWA and COVID-19 pathology. Methods: Patients suspected of COVID-19 in Mohammad Hoesin General Hospital were consecutively evaluated using Alivecor® Kardiamobile 6L™ portable electrocardiogram (ECG) device. Severe COVID-19 patients or those who are unable to cooperate in active ECG self-recording were excluded from the study. TWA was detected and its amplitude was quantified using the novel enhanced adaptive match filter (EAMF) method. Results: A total of 175 patients, 114 COVID-19 patients (polymerase chain reaction (PCR)-positive group), and 61 non-COVID-19 patients (PCR-negative group) were enrolled in the study. PCR-positive group was subdivided according to the severity of COVID-19 pathology into mild and moderate severity subgroups. Baseline TWA levels were similar between both groups during admission (42.47 ± 26.52 µV vs. 44.72 ± 38.21 µV), but higher TWA levels were observed during discharge in the PCR-positive compared to the PCR-negative group (53.45 ± 34.42 µV vs. 25.15 ± 17.64 µV, P = 0.03). The correlation between PCR-positive result in COVID-19 and TWA value was significant, after adjustment of other confounding variables (R2 = 0.081, P = 0.030). There was no significant difference in TWA levels between mild and moderate severity subgroups in patients with COVID-19, both during admission (44.29 ± 27.14 µV vs. 36.75 ± 24.46 µV, P = 0.34) and discharge (49.47 ± 33.62 µV vs. 61.09 ± 35.99 µV, P = 0.33). Conclusions: Higher TWA values can be observed on follow-up ECG obtained during discharge in the PCR-positive COVID-19 patients.

The role of ACE gene polymorphism on pathogenesis of ischemic stroke.

AIM: to describe the role of ACE gene polymorphism on pathogenesis of ischemic stroke in patients with the history of hypertension. The study was conducted in a population of Palembang city. METHODS: approximately 3 ml of peripheral blood samples were obtained by using venipuncture on antecubital vein. The samples were collected in tubes that contained ethylene diamine tetraacetic acid (EDTA) for DNA analysis. The DNA was extracted from leukocytes according to the standard DNAzol® Extraction Protocol. Samples were stored at -80°C until the analysis. Template DNA was then amplified by using a pair of sense oligonucleotide primer of 5'-CTGG AGACC ACTCCCATCCTTTCT-3' and antisense primer 5'-GATGGTGGCCATCAC ATTCGTC AGAT-3', 10 pmol of each primer. The PCR mixture contained 20 ng of genomic DNA, 3 mM MgCl2, 50 mM KCl, 10 mM Tris-HCl pH 8.4, 5% dimethyl-sulphoxide (DMSO), each of 0,5 mM deoxyribonucleoside triphosphate (dNTPs) and 1 unit of Taq polymerase in a final volume of 50 µL. The DNA was amplified by 30 cycles; denaturation at 940C for 1 min, annealing at 580C for 1 min, and extension at 720C for 2 min, followed by a final extension at 720C for 4 min by using PCR Thermal (Icycler, Biorad, USA). PCR products were separated by electrophoresis on a 2% agarosa gel, and identified by ethidium bromide (0.1%) staining, and finally visualized by ultraviolet light. They were documented by using the geldoc (Biorad, USA). The PCR product is a 190 bp fragment in the absence of insertion (D) and a 490 bp fragment in the presence of insertion (I). RESULTS: ischemic stroke with hypertension or with the history of hypertension was found more frequently in male (70%) and ≥ 55 year old subjects (60.0%). The study showed that the frequency of II genotype was higher than DI and DD. Moreover, the frequency of I allele was higher than D allele. In healthy normotensive group, the results remained the same. However, different results were found in infarct-stroke group with hypertension history in which the frequency of DI genotype was higher than in II genotype and the DD. The study showed that there was no significant correlation (p=0.188) between ACE gene polymorphism and infarct stroke in subjects with the history of hypertension. ACE gene just has approximately 5% role in developing ischemic stroke. CONCLUSION: there is no significant correlation between ACE gene polymorphism and the development of ischemic stroke in patients with history of hypertension of the population in Palembang. However, the study showed that there is a different pattern of genetic control on ACE compared to previous studies ever done in Caucasians.

The Association between the Activin A Serum Level and Carotid Intima-Media Thickness in Chronic Kidney Disease Patients.

INTRODUCTION: Chronic kidney disease (CKD) is associated with high mortality rates, mainly as a result of cardiovascular complications. Meanwhile, recent studies have suggested a role of a homodimer protein called activin A in chronic kidney disease-mineral and bone disorder (CKD-MBD) conditions that may exist in the vascular calcification and osteolytic process. Ultrasound examination of the carotid intima-media thickness (cIMT) is a noninvasive method to assess vascular calcification. This study aimed to analyze the relationship between the activin A serum level and cIMT in patients with CKD at Mohammad Hoesin Hospital, Palembang, Indonesia. METHODS: We conducted a hospital-based, cross-sectional study of consecutive CKD patients at the Department of Internal Medicine, Mohammad Hoesin Hospital, from July to November 2019. The level of activin A was measured by enzyme-linked immunosorbent assay. Meanwhile, cIMT measurements were collected by B-mode ultrasound imaging. RESULTS: A total of 55 patients with CKD were included in this investigation. The median serum activin A level in these patients was 236.17 (116.33-283) pg/mL, while the median cIMT was 0.8 (0.6-1.45) mm. A relationship between the serum activin A level and cIMT (r = 0.449; p = 0.001) was observed. During multivariate analysis with linear regression, triglyceride (p = 0.049), phosphate (p = 0.005), and activin A (p = 0.020) serum levels were factors associated with cIMT. CONCLUSION: In this study, a relationship between the activin A serum level and cIMT in patients with CKD was identified. Vascular calcification should be screened for in all CKD patients by the measurement of cIMT.