Background: Left ventricular hypertrophy (LVH) is a preclinical manifestation of cardiovascular disease and a strong predictor of cardiovascular morbidity and mortality. The electrocardiogram (ECG) is an easily available, easy to use and cost effective tool to evaluate LVH. Peguero – Lo Presti criteria is a newcriteria to diagnose LVH from ECG that has higher sensitivity than the other ECG criteria.Aims: To assess the ability of Peguero – Lo Presti criteria to diagnose LVH and obtain new cut-off point criteria to more accurately diagnose LVH in patients with hypertension in Adam Malik Hospital.Methods: A cross sectional study was conducted on patients with hypertension in cardiac centre Adam Malik Hospital Medan. Electrocardiographic examination was performed to obtain Peguero – Lo Presti point in blinded fashion. LVH was assessed using M-mode method with Cube formula. The analysis of Peguero – Lo Presti criteria was based on the calculation of the deepest S wave in any precordial lead (deepest S wave,SD) and S wave in lead V4 (SV4). A SD + SV4 ≥ 28 mm in male and ≥ 23 mm in female subjects were considered positive for LVH. LVH was defined as left ventricular mass index > 115 gr/m2 in male and > 95 gr/m2 in female subjects.Results: Peguero – Lo Presti criteria had 54.8% sensitivity, 97.6% specificity, 55.4% NPV and 97.6% PPV to diagnose LVH. Lowering the cut-off point of Peguero – Lo Presti criteria to 26 mm in male and 22 mm in female subjects improved the sensitivity from 54.8% to 67.1% with 90.5% specificity, 61.3% NPV and 92.5% PPV to diagnose LVH.Conclusion: Peguero – Lo Presti criteria on ECG could be used to diagnose LVH in patients with hypertension in Adam Malik Hospital Medan.
Background: Acute Coronary Syndrome (ACS) is a term used to describe symptoms caused by Acute Myocardial Infarction (AMI). At present, risk stratification is carried out with the use of a Global Registry of Acute Coronary Events (GRACE) score as a validated predictor for cardiovascular events among ACS patients. Mean platelet volume (MPV) is an accurate marker of platelet size and can be considered that to be added to the GRACE score to increase the predictive value of the occurrence of major cardiovascular events (MACE). This study aims to seek the comparison between GRACE score independently and GRACE score with the addition of MPV values in predicting major cardiovascular events during in-hospital care in ACS patients. Methods: This study was ambispective cohort study of 219 ACS patients from November 2017 to November 2018. GRACE scores and MPV values were calculated and mace was observed during hospital treatment. An analysis was performed to see the role of MPV addition to GRACE scores in predicting MACE. Results: MPV values and GRACE scores were found to be increased in patients with MACE compared with those who did not. Area under curve (AUC) on the ROC curve obtained 0.786 (95% CI: 0.717-0.855, p<0.001) when the GRACE score was calculated independently, and increased to 0.810 (95% CI: 0.620-0.775, p<0.001) with addition MPV which indicates a combination of MPV and GRACE score increases predictive value. Conclusion: The addition of the MPV value to the GRACE score provides a higher predictive value in predicting MACE in ACS patients in hospital care.
BACKGROUND: The histopathological grades identification is unquestionably essential to determine the most effective approach in oncologic management, specifically in breast cancer (BC) as the most common malignancy diagnosed worldwide. Complex and micro-level alterations of coagulation function of the host may occur at some point since the reactivity of the tumor cells byproduct will dysregulate its physiologic function; as represented by the higher rate of fibrinolysis which in turn increase the D-dimer level.
AIM: The study aims to provide the correlation between the level of d-dimer and histopathological grades in BC patients.
METHODS: A total of 111 females with confirmed BC were included in this study, which was conducted from March to September 2021 at the teaching hospital of Universitas Sumatera Utara. After thorough clinical information analysis, the histopathological examination (HPE) was conducted to confirm the malignancy and graded based on the Bloom-Richardson grading system; therefore, the HPEs were classified into slow/moderate or poorly differentiated. The D-dimer value of >0.5 mg/L was indicated as an elevated level.
RESULTS: From the 102 eligible patients to be included in the final evaluation, it was observed that 46.1% and 52.9% of the participants were presumed with elevated D-dimer level and high-grade carcinoma, respectively. The elevated D-dimer level results percentage was substantially more common in high-grade BC (72.3%, the positive predictive value analysis. Other parameters, for example, sensitivity (63.0%), specificity (72.9%), and negative predictive value (63.6%) were found to be statistically accurate (p < 0.001).
CONCLUSION: The influence of tumor cells differentiation toward coagulation system or fibrin metabolism dysfunction is observable in this study. Hence, the role D-dimer level measurement should be investigated further to assist the BCs’ grading determination workup.
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