Current research supports the evidence that the gut microbiome (GM), which consist of gut microbiota and their biologically active metabolites, is associated with atherosclerosis development. Trimethylamine-N-oxide (TMAO), a metabolite produced by the GM through trimethylamine (TMA) oxidation, significantly enhances the formation and vulnerability of atherosclerotic plaques. TMAO promotes inflammation and oxidative stress in endothelial cells, leading to vascular dysfunction and plaque formation. Dimethyl-1-butanol (DMB), iodomethylcholine (IMC) and fluoromethylcholine (FMC) have been recognized for their ability to reduce plasma TMAO by inhibiting trimethylamine lyase, a bacterial enzyme involved in the choline cleavage anaerobic process, thus reducing TMA formation. Conversely, indole-3-carbinol (I3C) and trigonelline inhibit TMA oxidation by inhibiting flavin-containing monooxygenase-3 (FMO3), resulting in reduced plasma TMAO. The combined use of inhibitors of choline trimethylamine lyase and flavin-containing monooxygenase-3 could provide novel therapeutic strategies for cardiovascular disease prevention by stabilizing existing atherosclerotic plaques. This review aims to present the current evidence of the roles of TMA/TMAO in atherosclerosis as well as its potential therapeutic prevention aspects.
Background: The association between visit-to-visit systolic blood pressure variability (SBPV) and cardiovascular outcomes after being adjusted with mean systolic blood pressure (SBP) is questionable.Objective: To systematically review studies quantifying the associations of visit-to-visit SBPV adjusted to mean SBP with cardiovascular outcomes.Method: A systematic search in PubMed, Scopus, and Science Direct was conducted on 27 November 2022. We included studies evaluating the association of various SBPV parameters with cardiovascular outcomes. Only clinical trials and cohort studies were included. We included all patients with available data on visit-to-visit SBPV and cardiovascular outcomes. Hemodialysis patients were excluded due to inter-hemodialysis BPV. Different parameters of SBPV (standard deviation, coefficient of variation, variation in mean) were extracted and analyzed as standardized hazard ratios, a log-hazard ratio for each unit of SBPV divided by its standard deviation. Generic inverse variance using random effect meta-analysis was performed to estimate pooled standardized hazard ratio. The QUIPS tool for prognostic study was used for risk of bias assessment.Result: A total of 9,944,254 subjects from 43 studies (21 trials and 22 cohorts) were included in meta-analysis. Increased visit-to-visit SBPV was associated with a risk of all-cause mortality (HR 1.21, CI95%[1.16–1.25]), cardiovascular mortality (HR 1.1, CI95%[1.07–1.14]) cardiovascular events (HR 1.1, CI95%[1.07–1.13]), myocardial infarction (HR1.13, CI95%[1.07–1.19]) and stroke (HR 1.22, CI95%[1.16–1.29]). After sensitivity analysis for studies adjusted to mean SBP, SBPV is still significantly associated with all mentioned cardiovascular outcomes.Conclusion: Systolic blood pressure variability, independent of mean SBP, is associated with all-cause mortality, cardiovascular death, cardiovascular events, myocardial infarction, and stroke.PROSPERO registration number CRD42023389113
Background: Indonesia is one of the fastest-aging countries. The increased elderly population carries the burden of chronic diseases such as hypertension and diabetes mellitus, along with their complications. The reinforcement of lifestyle changes has been promoted in primary healthcare through the Prolanis program to reduce these diseases’ burden, though its effectivity is unknown.Objective: To evaluate the outcome of the Prolanis program in Jatirejo Primary Healthcare.Methods: In this study, 61 patients were recruited from November 2021 – April 2022. Data were obtained from medical records as pre- and post-follow-up in 6 months period. Data pre- and post-follow-up were analyzed using the Wilcoxon and dependent T-test.Results: There were 64.52% patients with systolic hypertension. The median data of pre- and post- follow up showed that: HbA1C was 5.9% (range 3 – 13) and 6.3% (range 5 – 11) (p 0,959); BUN was 15,3 mg/dL (range 10 – 32) and 14,8 mg/dL (range 13 – 25) (p 0,638); serum creatinine was 0,8 mg/dL (range 0,4 – 3,1) and 1,2 mg/dL (range 0,7 – 2,6) (p 0,026); total cholesterol was 183 (range, 123 – 300) and 219 (range 179 – 231) (p 0,008); triglycerides was 133 (range 82 – 326) and 159 (range 135 – 394) (p 0,416); HDL was 40,65 SD ± 2 and 41 SD ± 2,3 (p 0,206); LDL was 117,5 SD ± 35 and 139,7 SD ± 20 (p 0,886); and urine microalbumin was 53 (range 5 – 200) and 63,5 (range 5 – 200) (p 0,721).Conclusion: Improvement in patients’ outcomes has not been shown after Prolanis program. Further study with larger populations and more variables is needed.
Background: The probability of in-hospital death was significantly higher in patients with hypertension, hence increasing the risk for severe clinical presentations of COVID-19.Objective: We aimed to determine whether cardiac examination is correlated with increasing mortality risk among hypertensive COVID-19.Methods: This retrospective cohort study included 406 patients with hypertension and confirmed COVID-19 in referral hospitals in East Java between March 2020 to April 2021. Clinical finding, electrocardiograph (ECG), laboratory and chest x-ray (CXR) findings are examined to predict mortality of the hypertensive COVID-19 patients.Results: The median patient age was 57 years with range 49–64 years old, predominantly men 58.4%. The final model associated with an increase of mortality in hypertensive COVID-19 patients include cardiomegaly (p = 0.036), sinus tachycardia (p = 0.001), ST-segment abnormalities (p = 0.036), right bundle branch block (p = 0.008), left bundle branch block (p = 0.046), left ventricle hypertrophy (p = 0,023)., which were found to be significant predictors of mortality in hypertensive COVID-19 patients after the multivariable regression analysis.Conclusion: We concluded that specific abnormal cardiac examination (cardiomegaly, tachycardia, ST Segment abnormalities, left ventricle hypertrophy, right and left bundle branch block) increase the mortality risk in hypertensive COVID-19 patients. Therefore, complete cardiac examination is important for hypertensive COVID-19 patients to determine prognosis.
Based on the results of interviews with the coordinator of the family planning program at the Puskesmas Songgon, their data collection system was still written manually in the Kohort book which must then be classified and processed further to obtain processed data that describes the situation and conditions of the family planning program application in Songgon District. The aims of this research to determine the effectiveness and efficiency of the family planning program report duration between the use of Google Sheets media and the manual counting method at the Puskesmas Songgon. The implementation of the program were 23 May 2019 at Puskesmas Songgon Hall. This program was designed based on the needs of the field of family planning management at the Puskesmas Songgon. This program was created using a computer, the Google Sheets application, which is an application that resembles Microsoft Excel, but is managed by Google and accessed via a browser. It creates two types of formats, namely forms for data entry and automatic calculation reports. The results of this study, it can be seen that the program used by group 2 is 10 times more efficient in calculating the achievements of the family planning program.
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