Wound Healing in Diabetic Foot Ulcer Patients Using Combined Use of Platelet Rich Fibrin and Hyaluronic Acid, Platelet Rich Fibrin and Placebo: An Open Label, Randomized Controlled Trial.

BACKGROUND: Autologous platelet-rich fibrin (A-PRF) is an adjunctive method for diabetic foot ulcer (DFU) in addition to glycaemic control and debridement. This study aimed to evaluate the role of A-PRF + hyaluronic acid (HA), A-PRF and sodium chloride 0.9% (control) in DFU wound healing. Nowaday, the use of  PRF autologous consider as adjuvant therapy in DFU treatment. METHODS: This open-label randomized controlled trial was conducted at Koja District Hospital and Gatot Soebroto Hospital from July 2019 to April 2020. DFU patients with wound duration of three months, Wagner-2, and ulcer size < 40 cm2 were recruited and randomly assigned into A-PRF + AH, A-PRF and control group. On day-0, day-3 and day -7, samples and photographs were taken. Samples were analysed with ELISA and photographs were analysed with ImageJ to calculate granulation index (GI). Statistical analysis was performed using SPSS version 20. RESULTS: Topical therapy with A-PRF + AH was associated with a significant increase in VEGF from day 0 (232.8 pg/mg) vs day 7 (544.5 pg/mg) compared to A-PRF on day 0 (185.7 pg/mg) vs day 7 (272.8 pg/mg), and the controls on day 0 (183.7 pg/mg) vs day 7 (167.4 pg/mg). On evaluation  of VEGF swab, there is increasing significantly in A-PRF+HA group compare others group in day -3 ( p=0.022) and day -7 (p= 0.001).In the A-PRF + AH group, there was a significant decrease in IL-6 from day 0 (106.4 pg/mg) vs day 7 (88.7 pg/mg) compared with PRF on day 0 (91.9 pg/mg) vs day 7 (48,8 pg/mg). IL-6 was increased in the control group from day 0 (125.3 pg/mg) vs day 7 (167.9 pg/mg). On evaluation  of IL-6 swab, there is decreasing significantly in A-PRF+HA group compare others group in day -7 (p= 0.041). CONCLUSION: The PRF + HA combination increased angiogenesis and reduced inflammation in DFUs and may represent a new DFU therapy.

The role of VEGF, PDGF and IL-6 on diabetic foot ulcer after Platelet Rich Fibrin + hyaluronic therapy.

BACKGROUND: Current standard management of diabetic foot ulcers (DFUs) consists of surgical debridement followed by soak NaCl 0.9% gauzes tight infection and glycaemic control. Nowadays the use of advanced platelet-rich fibrin (A-PRF) has emerged as an adjunctive method for treating DFUs. This study was conducted to demonstrate the ability of combine A-PRF + HA as a complementary therapy in DFUs healing related with angiogenesis,inflammation and granulation index process. METHODS: This open label randomized controlled trial was conducted in Koja District Hospital and Gatot Soebroto Hospital Jakarta, Indonesia on July 2019-April 2020. DFUs patients with wound duration of three months, Wagner-2, with size of ulcer less than 40 cm2 were included in the study. The number of subjects was calculated based on the rule of thumb and allocated randomly into three groups, namely topical A-PRF + HA, A-PRF and Sodium Chloride 0.9% as a control, for each of 10 subjects. A-PRF made by 10 mL venous blood, centrifuge 200 G in 10 min, meanwhile A-PRF + HA though mix both them with vertex machine around 5 min. Biomarker such as VEGF, PDGF and IL-6 examined from DFU taken by cotton swab and analysis using ELISA. Granulation Index was measured using ImageJ. Biomarkers and granulation index were evaluated on day 0, 3, 7 and 14. Data were analysed using SPSS version 20 with Anova and Kruskal Wallis test to compare the angiogenesis and inflammation effect between the three groups. RESULT: In topical dressing A-PRF + HA, there is an increase in delta VEGF on day-3 (43.1 pg/mg protein) and day-7 (275,8 pg/mg protein) compared to A-PRF on day-3 (1.8 pg/mg protein) and day-7 (104.7 pg/mg protein), also NaCl (control) on day-3 (-4.9 pg/mg protein) and day-7 (28.3 pg/mg protein). So that the delta VEGF of A-PRF + HA group increase significantly compared with others on day-3 (p = 0.003) and day- 7 (p < 0.001). Meanwhile A-PRF + AH group, there is also a decrease in delta IL-6 after therapy on day-3 (-10.9 pg/mg protein) and day-7 (-18.3 pg/mg protein) compared to A-PRF in delta IL-6 on day- 3 (-3.7 pg/mg protein) and on day-7 (-7.8 pg/mg protein). In NaCl (control) group there is a increase delta IL-6 on day-3 (4.3 pg/mg protein) and on day-7 (35.5 pg/mg protein). So that the delta IL-6 of A-PRF + HA group decrease significantly compared with others only on day- 7 (p = 0.015). In PDGF le level analysis, A-PRF + HA group increase significantly (p = 0.012) only in day -7 compare with other group (5.5 pg/mg protein). CONCLUSION: The study shows the superior role of combined A-PRF + HA in the treatment DFU though increase angiogenesis and decrease inflammation pathway. The advantage of using A-PRF + HA is that it accelerates wound healing by increasing granulation tissue compared to A-PRF alone.

Correlation Between Vitreous Advanced Glycation End Products, and D-dimer with Blood HbA1c Levels in Proliferative Diabetic Retinopathy.

BACKGROUND: proliferative diabetic retinopathy (DR) is an advanced form of DR that eventually could lead to blindness. Levels of vitreous advanced glycation end products (AGEs) and D-dimer may reflect the pathological changes in the retina, but only few studies have assessed their correlation with blood hemoglobin A1C (HbA1c) levels. This study aimed to find the association between blood HbA1c levels with vitreous AGEs and D-dimer levels in patients with proliferative DR. METHODS: an analytical cross-sectional study was performed in subjects with proliferative DR who underwent vitrectomy. Subjects were divided into 2 subgroups, i.e. uncontrolled (HbA1c >7%) and controlled (HbA1c <7%) groups. Vitreous AGEs and D-dimer levels were assessed; the levels were compared between uncontrolled and controlled hyperglycemic patients. Statistic correlation tests were also performed for evaluating blood HbA1c, vitreous AGEs, and D-dimer levels. RESULTS: a total of 47 patients were enrolled in this study and 32 (68.1%) of them were women. Median vitreous AGEs level was 11.0 (3.0 - 48.0) µg/mL; whereas median vitreous D-dimers level was 5,446.0 (44.0 - 37,394.0 ) ng/mL. The median vitreous AGEs levels was significantly higher in patients with uncontrolled vs. controlled hyperglycemia (14.0 vs. 4.0 mg/mL; p<0.001). There was a significant positive correlation with moderate strength between blood HbA1c level and vitreous AGEs level (r=0.524; r2=0.130; p=0.0001). Blood HbA1c level could be used to predict vitreous AGEs level by using the following calculation: vitreous AGEs = -1.442+ (1.740xblood HbA1c). Vitreous D-dimer levels were not significantly different between uncontrolled and controlled hyperglycemia (median 4607.5 vs. 5701.6 ng/mL; p = 0.458). There was a positive significant correlation between blood HbA1c and vitreous D-dimer levels (r = 0.342; p = 0.019); however the correlation was weak. Vitreous AGEs level had a positive significant correlation with vitreous D-dimer levels (r = 0.292; p = 0.046) and the correlation strength was also weak. CONCLUSION: median vitreous AGEs levels were significantly higher in proliferative DR patients with uncontrolled than those with controlled hyperglycemia. Blood HbA1c level can be used to assess vitreous AGEs level in patients with proliferative DR by using the following calculation: vitreous AGEs = -1.442+(1.740 x HbA1c). However, the blood HbA1c level can not be used to predict vitreous D-dimer level in patients with proliferative DR.

Predictors of five days mortality in diabetic ketoacidosis patients: a prospective cohort study.

AIM: to determine the role of serum lactate and diabetic ketoacidosis (DKA) severity as predictors for five-days mortality in DKA patients. METHODS: a prospective cohort study was conducted in DKA patients admitted to emergency department (ED) at Cipto Mangunkusumo Hospital, Jakarta, Indonesia, during 2007-2008 periods. Predictors for 5 days mortality in DKA patients in this study including serum lactate and DKA severity (plasma glucose, arterial blood pH, serum bicarbonate, osmolality, anion gap, and alteration in sensorium) at admission. Cox's Proportional Hazard Regression Analysis was used to determine independent predictors for 5-days mortality among study population. RESULTS: sixty patients with diabetic ketoacidosis were enrolled in the study; in which 24 (40%) patients were died within 5 days after admission. In the multivariate analysis, the lactate level 4 mmol/L (HR, 3.09; 95% CI, 1.36-7.05) and altered in sensorium stuporous/comatose (HR, 3.38; 95% CI, 1.45-7.87) were identified as independent predictors for 5-days mortality in DKA adult patients. CONCLUSION: lactate level 4 mmol/L and altered in sensorium stuporous/comatose can be used to predict 5-days mortality in adult patients with DKA.

Enhancing Diagnostic Accuracy of aMCI in the Elderly: Combination of Olfactory Test, Pupillary Response Test, BDNF Plasma Level, and APOE Genotype.

Background. Amnestic Mild Cognitive Impairment (aMCI) often progresses to Alzheimer's disease. There are clinical markers and biomarkers to identify the degenerative process in the brain. Objectives. To obtain the diagnostic values of olfactory test, pupillary response to tropicamide 0.01%, BDNF plasma level, and APOE ε 4 in diagnosing aMCI. Methods. Cross-sectional, comparative analysis. Results. There were 109 subjects enrolled (aMCI: 51, normal cognition: 58) with age 64 ± 5.54 years. For diagnosing aMCI, cut-off point for the olfactory score was <7 out of 10 and >22% for pupil dilatation response. Low BDNF plasma level was related significantly with olfactory deficits and aMCI (P < 0.05). Four of five subjects with homozygote e4 presented with multiple-domain aMCI. This group displayed the lowest means of olfactory score and the highest means of pupillary hypersensitivity response (P < 0.0001). Combination of olfactory deficit and pupillary hypersensitivity response in detection of aMCI was beneficial with Sp 91% and PPV 87%. In conjunction with clinical markers, BDNF plasma level and presence of APOE e4+ improved Sp and PPV. Conclusions. Combination of olfactory test and pupillary response test was useful as diagnostic tool in aMCI. In conjunction with clinical markers, low level of BDNF plasma and presence of APOE e4 improved the diagnostic value.

Association of TSH receptor antibody, thyroid stimulating antibody, and thyroid blocking antibody with clinical activity score and degree of severity of Graves ophthalmopathy.

AIM: to evaluate the association between TSH receptor antibody (TRAb), thyroid stimulating antibody (TSAb), and thyroid stimulation blocking antibody (TBAb) and TSAb/TBAb ratio with clinical activity score (CAS) and degree of severity of GO. METHODS: this was a cross sectional study involving 75 consecutive Graves' disease patients admitted at Cipto Mangunkusumo hospital between December 2009 until January 2011. Bartley criteria were used as clinical criteria for GO. In addition to clinical criteria, orbital CT scan and measurement of extraocular muscle thickness and increment of retroorbital fat volume were carried out. Furthermore, TSH, FT4, FT3 and TRAb were measured using ELISA method, TSAb and TBAb using RIA method. Clinical activity of GO was measured using clinical activity score (CAS). Degree of severity of GO was measured using Eckstein modified NOSPECS system. RESULTS: subjects consisted of various different ethnic groups in Indonesia, with the range of age between 20-63 years old. There were 28 (37%) and 61 (83.6%) GO subjects with clinical-based and CT scan-based respectively. Among all GD subjects, the proportion of TSAb were 70 (93.3%) and TBAb were 13 (17.3%). There was no correlation between TRAb and CAS nor the severity of GO, either clinical-based and CT scan-based GO. There was also no correlation between TSAb and CAS. No correlation between TSAb and severity of CT scan-based GO, but significant correlation between TSAb and severity of clinical-based GO (r=0.274; p=0.009) was noted. There was no correlation between TBAb and severity of GO. We also found no correlation between TBAb and CAS of clinical-based GO, but we found strong negative correlation with CAS CT scan-based GO (r=-0.565; p=0.035). The TSAb/TBAb ratio was also strongly correlated with all parameters evaluated, CAS of clinical-based GO (r=0.730; p=0.031), CAS of CT scan-based GO (r=0.607; p=0.024), degree of severity of clinical-based GO (r=0.563; p=0.023), and degree of severity of CT scan-based GO (r=0.762; p=0.001). CONCLUSION: TRAb was not correlated with CAS and degree of severity of clinical-based and CT scan-based GO, while TSAb was correlated with degree of severity of GO. There was negative correlation between TBAb and CAS of clinical-based GO, whereas TSAb/TBAb ratio was correlated with CAS and degree of severity of both clinical-based and CT scan-based GO.

Disturbance of B-vitamin status in people with type 2 diabetes in Indonesia--link to renal status, glycemic control and vascular inflammation.

BACKGROUND: Diabetes is associated with mishandling of thiamine in the kidney and development of diabetic nephropathy. The aim of this study is to assess the disturbance of thiamine and other B-vitamin status of patients with type 2 diabetes in Indonesia. METHODS: One hundred and fifteen patients with type 2 diabetes with and without microalbuminuria or albuminuria and 39 healthy people were recruited. After a 2-month washout period for B-vitamin supplementation, markers of vitamins B(1), B(6), B(9) and B(12), were determined. RESULTS: Fractional excretion of thiamine (22.8 versus 33.5%; P<0.05) and urinary excretion of the vitamin B(6) degradation product 4-pyridoxic acid (0.081 versus 0.133 µmol/g creatinine, P<0.001) was increased in patients with type 2 diabetes with respect to healthy controls. There was also increased total plasma cobalamin (398 versus 547 pmol/l, P<0.001) and holotranscobalamin (74 versus 97 pmol/l, P<0.001) in patients with type 2 diabetes. In multiple regression analysis these were linked to HbA1c, duration of diabetes and systolic blood pressure, and fasting plasma glucose, folate and C-reactive protein, respectively. CONCLUSIONS: There was renal mishandling of thiamine, increased degradation of vitamin B(6) and cytosolic metabolic resistance to vitamin B(12) in patients with type 2 diabetes in Indonesia.

The role of allergic risk and other factors that affect the occurrence of atopic dermatitis in the first 6 months of life.

BACKGROUND: Atopic dermatitis (AD) is a chronic inflammation of the skin that often appears in early childhood. The manifestation is related to the tendency towards T helper 2 cytokine immune responses (interleukin (IL)-4, IL-5). Genetic factors are suggested to play important roles in AD, and it can be transmitted to newborns, increasing their risk of developing allergies. OBJECTIVE: To determine the association between cord-blood cytokine levels (IL-5, interferon (IFN) γ), cord-blood total immunoglobulin E (IgE) level, perinatal environmental exposure, and the risks of allergy as well as the development of AD in the first 6 months of life. METHODS: A 6-month cohort study with a nested case-control within was conducted on newborns in Jakarta from December 2008 until May 2009. After the umbilical cord blood samples were taken and stored, subjects were followed up monthly until 6 months old. The occurrence of AD and lifestyle or environmental exposures were recorded. The allergic risk was determined using a modified pediatric allergy immunology work groups scoring system based on allergic history (allergic rhinitis, asthma, AD) in the family. The levels of IL-5 and IFN-γ were measured using ELISA and total IgE by CAP system FEIA. Multivariate analysis was used to evaluate risk factors. RESULTS: This study was conducted on 226 subjects. The incidence of AD was 16.4%; of those, 59% had low risk allergy, 38.5% moderate, and 2% high risk. AD mostly occurred at the age of 1 month (57%). Cord blood samples were examined in 37 subjects with AD and 51 without AD; of those, 25% showed high levels of total IgE (>1.2 IU/µL), and 51% showed normally-distributed high absorbance IL-5 values (≥0.0715, absolute value was undetected). The increased level of IL-5 was directly proportional to IgE. High absorbance IFN-γ values (≥0.0795, absolute value = 18.681 pg/µL) were observed in 52% of subjects. CONCLUSION: The associations between the risk of allergy in the family, cord-blood total IgE, IL-5, IFN levels, and some perinatal environmental exposure with AD in the first 6 months of life have not been established.

Adiponectin levels and its role in insulin resistance among adult women with metabolic syndrome.

AIM: To identify the proportion of low adiponectin level and to evaluate the role of low adiponectin level, age, body mass index, and waist circumference on the occurrence of metabolic syndrome in women with insulin resistance. METHODS: The study was done by a cross-sectional survey on adult women aged 30-60 years. The study was conducted at Fatmawati Hospital-Jakarta from January to March 2008 with a total sample of 33. The sample was selected consecutively based on the presence of metabolic syndrome according to the IDF 2005 criteria. The examination of plasma adiponectin level was done by ELISA method. Insulin resistance was defined if HOMA IR > or = 2 (calculated by fasting insulin (microU/mL) x Fasting blood sugar (mmol/L) divided by 22.5). Association of low adiponectin level with insulin resistance was evaluated by calculating the Odds Ratio. RESULTS: Seventeen of 33 subjects with metabolic syndrome have insulin resistance, in which 7 of them (41.18%) show low adiponectin level. While in 16 subjects without insulin resistance, only one subject (6.25%) has low adiponectin level. From 8 subjects with low adiponectin level, 7 of them (87.5%) have insulin resistance. In other words, low adiponectin level is associated with increased risk of insulin resistance (Odds Ratio 10.5, P = 0.040 (CI 95% : 1.12-98.91). CONCLUSION: Low adiponectin concentration increases the risk of developing insulin resistance much more than normal adiponectin level.

Prevalence of metabolic syndrome using NCEP/ATP III criteria in Jakarta, Indonesia: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of MetS in Jakarta, as a capital city of Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. We use The WHO Step Wise in collecting data. We also collected blood sample for total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride level. The ATP III modified Asian criteria require the presence of 3 or more of the following: 1. Abdominal obesity (waist circumference ≥ 90 cm in men and ≥ 80 cm in women; 2. A high triglyceride level (≥ 150 mg/dL); 3. A low HDL-cholesterol level < 40 mg/dL for men and < 50 mg/dL for women); 4. High blood pressure (systolic ≥ 130 mmHg or diastolic ≥ 80 mmHg; and 5. A high fasting plasma glucose concentration (≥ 110 mg/dL). RESULTS: Among 1,591 subjects, there are 641 men (40.3%) and 950 women (59.7%). The crude prevalence of MetS using the ATP III modified Asian criteria is 28.4% with prevalences in men and women are 25.4 and 30.4% respectively. The prevalences of MetS in NGT, prediabetes, and diabetes group are 16.4, 35.1, and 73.4% respectively. The prevalences of MetS and central obesity in prediabetes group and diabetes group are higher significantly than those in normal glucose tolerance group (p<0.01). The most common component of MetS in men is hypertension (84.7%), followed by hypertriglyceridemia (83.4%), central obesity (75.5%), hyperglycemia (50.9%) and low HDL-cholesterol (43.6%). While in women, the most common component is central obesity (84.1%), followed by hypertension (84.1%), hypertriglyceridemia (66.1%), low HDL-cholesterol (57.8%), and hyperglycemia (50.2%). CONCLUSION: The prevalence of MetS in this study is 28.4%. The most component found in men is hypertension while in women is central obesity.

The pre-diabetic epidemiological study in Depok, West Java.

OBJECTIVE: To recognize the prevalence of impaired fasting glucose level (IFG) and impaired glucose tolerance (IGT) in general population of Depok Area, West Java. METHODS: the study was conducted in a population with age > or = 25 years, in Depok Area, West Java, which was selected by using two stage random sampling. Data were collected by using the Step Wise Approach of WHO. Subjects without previous diabetes history were categorized as diabetes if their fasting blood glucose level > or = 126 mg/dL, and or the 2-hour-after 75 gram glucose load > or = 200 mg/dL. While pre-diabetes was defined as IFG when the fasting blood glucose > or = 100 mg/dL to < 126 mg/dL or IGT when the 2-hour-after 75 gram glucose load level > or = 200 mg/dL (ADA 2003). RESULTS: of 1200 participants, there were 975 participants who fulfilled the invitation and there were 969 eligible participants to be evaluated. Among the participants aged > or = 25 years, there were 40 (4.13%) subjects with isolated IFG and 234 (24.25%) subjects with isolated IGT, 55 subjects (5.68%) with mixed IFG/IGT. CONCLUSION: the prevalence of isolated impaired fasting blood glucose in population with age > or = 25 years is 4.13%; while the prevalence of isolated impaired glucose tolerance is 24.25%. Mixed IFG/IGT is 5.68%. The total prevalence of pre-diabetic patients is 33.96%.

Dyslipidemia in newly diagnosed diabetes mellitus: the Jakarta primary non-communicable disease risk factors surveillance 2006.

AIM: To obtain the prevalence of dyslipidemia and other cardiovascular risk factors in subjects with undiagnosed DM in Jakarta, Indonesia. METHODS: Data were obtained from surveillance of primary non-communicable disease in five regions in Jakarta, Indonesia, conducted in 2006. Targeting for 1,800 samples, we performed a purposive and simple random sampling of subjects within the age range of 25-64 years old in selected sampling areas, and stratified random sampling by adjusting to age and sex within those selected sampling areas. DM was diagnosed according to WHO criteria after an oral glucose test, i.e fasting blood glucose > or = 126 mg/dL or post loading blood glucose > or = 200 mg/dL and subjects had no history of DM. Dyslipidemia was diagnosed if triglyceride > or = 150 mg/dL, HDL-cholesterol in men < 40 mg/dL or < 50 mg/dL in women and total cholesterol > or = 200 mg/dL. RESULTS: From 1,591 subjects, comprising 640 men and 951 women, the prevalence of newly diagnosed DM is 8.4%. Among this subjects, the prevalences of hypercholesterolemia, hypertriglyceridemia and low HDL-cholesterol are 66.1 (OR 2.28; P=0.004), 54.3 (OR 3.02; P= 0.0001) and 38.6% (OR 2.27; P=0.009) respectively. The prevalence of dyslipidemia in subjects with newly diagnosed DM remains higher among all age groups than that in subjects without DM. CONCLUSION: the prevalence of dyslipidemia among subjects with newly diagnosed DM is higher than that in subjects without DM.

Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis.

OBJECTIVE: PAD-SEARCH was the first international study to investigate the prevalence of peripheral arterial disease (PAD) in Asian type 2 diabetic patients and to demonstrate the relationships between putative risk factors and PAD. SUBJECTS AND METHODS: In total 6625 type 2 diabetic patients aged 50 and older were enrolled and determined ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) in Korea, China, Taiwan, Hong Kong, Indonesia, Thailand and the Philippines. RESULTS: Mean patient age was 63.7+/-8.2 years and mean duration of diabetes was 10.3+/-8.0 years. One thousand one hundred and seventy-two (17.7%) subjects were diagnosed as PAD by ABI (< or =0.9). PAD subjects had a significantly longer duration of diabetes, hypertension, higher HbA1c, and a significantly lower mean BMI than non-PAD subjects. In terms of lipid profiles, triglyceride was the only significant variable. Notably, mean ABI and baPWV in females were significantly poorer than age matched males in subjects with a normal ABI. However, mean ABI and baPWV in males were significantly poorer than in age matched females in subjects with PAD. CONCLUSIONS: These findings suggest that PAD is a common complication in Asian type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for Asian diabetic patients with high risk factors.

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.

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.

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.

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.