Rheumatic heart disease is a late complication of valvular inflammation caused by rheumatic fever. Studies have shown that the differentiation of valvular interstitial cells (VIC) into fibroblasts plays an important role in valvular remodeling and fibrosis. Various strategies to minimize valvular fibrosis has increased recently. This study aims to analyze the effect of dexamethasone, olmesartan, and its combination in inhibiting TGF-β1-induced VIC differentiation into myofibroblast. In vitro laboratory experimental-posttest only control group design was conducted. Isolated VIC of Oryctolagus cuniculus was pretreated using 2,5 ng/mL of TGF-β1 and divided into groups of dexamethasone (0.1 uM/L), olmesartan (100 nmol/L), and its combination. Inhibition of myofibroblast differentiation was quantified by the expression of α-SMA levels detected by immunofluorescence. Dexamethasone, olmesartan, and its combination administration were significantly reduced TGF-β1-induced VIC differentiation into myofibroblast expressed by α-SMA levels (dexamethasone 6823 ± 1735.3, olmesartan 6683.7 ± 2795.05). Combination of dexamethasone and olmesartan exhibit the most potent inhibition compared to control (5051.87 ± 1612.210 vs 22286.73 ± 2780.2; p < 0.000). In conclusion, dexamethasone, olmesartan, and the combination can significantly reduce the differentiation of VIC into myofibroblasts. The greatest potential is the combined effect of dexamethasone and olmesartan, while dexamethasone and olmesartan have the same potential.
Acute Coronary Syndrome (ACS) is one of the highest causes of death globally, with the number of deaths reaching more than 9 million people in 2016. Therefore, a fast and accurate ACS diagnosis is needed. This study aimed to determine the relationship between the neutrophil-lymphocyte ratio, the number of coronary artery lesions evaluated by angiography, and troponin I in ACS patients Material and Methods: This research is an analytic observational with a retrospective cross-sectional design. Sampling was carried out using a total sampling technique and obtained 87 samples that met the inclusion and exclusion criteria for the 2019-2020 period at Dr. Soetomo Regional General Hospital Surabaya. The correlation between the number of coronary artery lesions and the neutrophil-lymphocyte ratio to troponin I levels were respectively analyzed using chi-square and spearman-rho with SPSS ver. 25. Results: The results showed a moderately significant correlation between the neutrophil-lymphocyte ratio and troponin I levels (p =0.003, rs = 0.319). While the correlation analysis between the number of coronary artery lesions and the vessel score on troponin I showed insignificant results (p = 0.525), which means that the number of coronary artery lesions was not correlated with troponin I. Conclusion: This study concludes a significant correlation with moderate correlation between the neutrophil-lymphocyte ratio and troponin I. However, there is no significant correlation between the number of coronary artery lesions assessed by the Sullivan and troponin I levels.
Background Takotsubo cardiomyopathy (TC) presents as a result of catecholamine surge. There are increase of TC among COVID-19 patients, which is induced by cytokine storm. TC is previously known as a self-limiting and benign cardiac manifestation, but it has been uncovered that TC can be associated with fatal cardiac outcome due to cardiogenic shock and life-threatening arrhythmia. Clinical Presentation A 54-year-old woman presented to the emergency department with a fever since 9 days before admission accompanied by DOE, PND, and fatigue that worsened since 5 days before admission. Fifteen days before her complaints, she experience bereavement from his son death from motorcycle accident. She was referred from regional hospitals due to respiratory failure necessitating ventilator support. Physical examination revealed normal blood pressure and desaturation. ECG shows tachycardia with global ST-elevation. CXR shows cardiomegaly (CTR 62%) and pneumonia. The laboratory demonstrated increased Neutrophil to Lymphocyte Ratio (NLR), C-Reactive Protein, Troponin, and positive PCR COVID-19 swab. An echocardiography presented regional wall motion abnormality with apical ballooning appearance and reduced systolic function with LVEF of 51% resembling Takutsubo cardiomyopathy. Despite maximal ventilatory and pharmacology, she experienced malignant ventricular tachycardia not responding to defibrillation and expired in only 6 hours Discussion The presence of cardiac arrhythmia followed by cardiac arrest in COVID-19 patient complicated by TC can be a direct effect of catecholamine surge and myocardial injury or indirect effect from QT-prolongation and inflammatory process. Concurrent COVID-19 pneumonia and TC may progress with dismal prognosis, so that in need of prompt referral system.
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