Myocardial edema is one of the most common complications of coronary artery bypass grafting (CABG) that is linearly related to many coronary artery diseases. Myocardial edema can cause several consequences including systolic dysfunction, diastolic dysfunction, arrhythmia, and cardiac tissue fibrosis that can increase mortality in CABG. Understanding myocardial fluid balance and tissue and systemic fluid regulation is crucial in order to ultimately link how coronary artery bypass grafting can cause myocardial edema in such a setting. The identification of susceptible patients by using imaging modalities is still challenging. Future studies about the technique of imaging modalities, examination protocols, prevention, and treatment of myocardial edema should be carried out, in order to limit myocardial edema occurrence and prevent complications.
Aims Preoperative risk prediction models have important role in heart valve surgery management. Changing in patient characteristics and surgical facilities over time, might affect the predicting value of those scoring system. This study aimed to compare the validation of EuroSCORE II, Ambler score and Harapan Kita score in predicting in hospital mortality at patients underwent heart valve surgery Methods Cohort restrospective study was performed at 416 patients who underwent heart valve surgery from November 2018 to December 2019. Data was taken from the medical records by consecutive sampling method. The calibration and discrimination value of EuroSCORE II, Ambler score and Harapan Kita score were obtained. Results Observed in hospital mortality was 6.7%. EuroSCORE II, Ambler score and Harapan Kita score have good calibration (Hosmer-Lemeshow test p = 0.065, p = 0.233 and p = 0.314). The discriminative value of these three scores predicting in hospital mortality for EuroScore II AUC 0.763 (95% CI; 0.660-0.867), Ambler score AUC 0.748 (95% CI; 0.655-0.841) and Harapan Kita score AUC 0.694 (95% CI; 0.584-0.804) Conclusion EuroSCORE II, Ambler score and Harapan Kita score have fairly good validation. Those scoring system have good calibration with Harapan Kita score calibration relatively better than EuroSCORE and Ambler score, meanwhile Harapan Kita score has less discrimination value than EuroScore II and Ambler score.
Methylenetetrahydrofolate Reductase (MTHFR) C677T gene polymorphism is associated with decreased MTHFR enzyme activity that leads to hyperhomocysteinemia and hypertension. The MTHFR C677T polymorphism is also associated with lower affinity and faster unbinding of flavin adenine dinucleotide, a riboflavin-derived cofactor for MTHFR enzyme. Natuna is a district which once reported has the highest prevalence of hypertension in Indonesia, based on a national basic health research. Therefore, this study aims to investigate the association between MTHFR C677T polymorphism and riboflavin intake with hypertension in the Natuna district population. An analytic cross-sectional population study was conducted in the region. Data of demographic, physical examination, and food recall, as well as MTHFR genotyping from blood samples of study subjects were collected. The subjects were 268 adults, among which 128 (45.9%) had hypertension, 49 (17.5%) had mutant allele of MTHFR genotype (CT or TT), and 158 (56.4%) had low daily riboflavin intake. There was association between MTHFR C677T polymorphism and hypertension [OR 3.387 (1.724 – 6.654), p = 0.001]. Post-hoc analysis showed that group of mutant MTHFR C677T genotype with low riboflavin intake showed strong association with hypertension [OR 19.320 (4.498–82.980), p<0.01]. Meanwhile, group with mutant MTHFR C677T genotype and normal riboflavin intake did not show a significant association with hypertension. As a conclusion, there was association between interaction of riboflavin intake and MTHFR C677T polymorphism with hypertension. This suggests possibility of riboflavin supplementation in population with high prevalence of hypertension especially those with MTHFR C677T gene polymorphism
Background Heart failure is a leading cause of hospitalisation and mortality with high incidence and ever-increasing prevalence in the world. Although novel methods in management of acute decompensated heart failure (ADHF) have been developed, mortality and rehospitalisation rates remain high. Loop diuretics have been shown to be effective in relieving congestion and have been recommended in many heart failure guidelines. Continuous use of loop diuretics may cause complications in the form of diuretics resistance. The prevalence of diuretic resistance ranges from 20–35% in the heart failure population and has been shown to be a predictor of mortality and an increased incidence of hospitalisation. Until now there are debates in determining the clinical indicators of diuretic resistance. However, the clinical characteristics of patients with acute decompensated heart failure that predict the development of diuretic resistance have not been widely studied and previous studies have shown different results from one another. Purpose This study aims to identify factors that influence the occurrence of diuretic resistance in ADHF patients based on clinical profiles, medical histories, and laboratory findings. Methods This was a retrospective cohort study on patients treated due to ADHF from January-December 2019. Diuretic resistance was defined as a diuresis response less than 1400 ml in the first 24 hours after administration of 40 mg of intravenous furosemide. Results Data from 535 patients were analysed. The prevalence of diuretic resistance in this study was 68%. Independent predictors obtained from multivariate logistic regression analysis were Type II Diabetes Mellitus (p=0.013), history of prior iv loop diuretics >6 days (p=0.002), history of oral loop diuretic dose >80 mg/day (p=0.006), LVEF ≤49% (p=0.002), BUN ≥21 mg/dL (p<0.001) and serum chloride <98 mmol/L (p<0.001). In addition, a scoring system has been generated from the final model with AUC 0.749. Conclusions Independent predictors for diuretic resistance obtained from this study were DM, history of prior iv loop diuretics >6 days, history of oral loop diuretic dose >80 mg/day, LVEF ≤49%, BUN ≥21 mg/dL and serum chloride <98 mmol/L. Funding Acknowledgement Type of funding sources: None.
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