Broken Heart Syndrome (BHS) is the weakness of the heart muscle due to emotional stress or physical stress called cardiomyopathy. The main etiology is a sudden release of stress hormones (catecholamines), such as norepinephrine, epinephrine, and dopamine. About 90% of BHS patients are female with average age of 67-70"‰ years, most of them are post-menopausal females. The most widely supported pathological theories are catecholamine-induced cardiotoxicity and microvascular dysfunction. The clinical condition resembles that of acute myocardial infarction, consisting of chest pain, electrocardiographic changes, elevated cardiac biomarkers, and abnormalities of heart wall motion. There is transient systolic dysfunction in the apical and/or middle segment of the left ventricle resembling acute myocardial infarction but absence of coronary artery obstructive disease. There are BHS criteria according to Mayo Clinic. Laboratory tests can be performed by examining Natriuretic Peptides, cardio myonecrosis markers (Troponin I and T, creatinine kinase, and myoglobin), and catecholamines. There is no single established biomarker for initial diagnosis of BHS that distinguishes it from STEMI. It was found that the most accurate ratio as a marker capable of differentiating BHS from STEMI in early stages was NTproBNP/TnI ratio. The InterTAK diagnostic score was used to predict the probability of BHS, differentiating it from ACS in an acute stage, prior to coronary angiography. The main differential diagnosis of BHS is ACS, besides acute myocarditis infectious. Patients with BHS should be treated as ACS until proven otherwise. The prognosis for BHS patients is generally very good.
Coronaviruses commonly infect the respiratory tract, leading to severe pneumonia. Respiratory problems cause numerous acid-base disorders in 2019 Coronavirus Disease (COVID-19) patients. Several studies have explored laboratory biomarkers used in the management and prognosis of COVID-19 patients during this pandemic; however, only a few focused on blood gas analysis. Determine the blood gas analysis pattern and its association with the outcome of severe COVID-19 patients treated in the Intensive Care Unit (ICU). This retrospective cohort study used secondary data from patients with severe COVID-19 treated in the ICU of Hasanuddin University Hospital between January and December 2021. There was a higher number of male (58.8%) compared to female patients (41.5%), with a mean age of 62 years. Respiratory alkalosis was the most prevalent blood gas disorder (24.4%). Metabolic alkalosis was a blood gas disorder with the highest number of recovery/improvement outcomes (8 patients). There was no significant relationship between blood gas analysis results and the outcome of severe COVID-19. In addition, no specific pattern was found in the results of blood gas analysis. Respiratory alkalosis was the most frequent blood gas disorder detected in these patients.
Ischemic stroke is the cause of most cases which occur due to obstruction, this pathogenesis can be caused by the formation of thrombus in the cerebrum blood vessels. Platelet aggregation plays a role in the pathogenesis of thromboembolic cerebrovascular disease. Platelets size, measured as Mean Platelet Volume (MPV) is a marker of platelet function and is associated with the indicator of platelet activity. Several studies have found that there was an increased of MPV in acute ischemic stroke while the correlation with the severity and outcome of stroke was still controversial. The aim of study is to determine the MPV and their association with outcomes in acute ischemic stroke patients. A cohort study during May up to July 2010 was carried out, the researchers measured MPV and analyze their correlation with its outcome using modified Rankin scale score 10 days after the onset in 33 acute ischemic stroke patients. The mean of MPV for the first three days of the onset was 8.9 fl, on the 5th day was increased up to 9.4 but at the 10th day of onset the MPV remains the same value as the 5th day. The MPV of first three days and 5th day have a positive correlation, but insignificant with their outcome, with p values 0.158 and 0.06, respectively. From this study can be concluded that the increased of MPV on the fifth day onset did not have any significant correlation with the outcome of acute ischemic stroke illness.
Acute Interstitial Nephritis (AIN) is the main cause of acute renal failure because of hypersensitivity to many antibiotics and otherdrugs that potent to induce allergic response in renal interstitial tissue. Gold standard for AIN diagnosis upheld from clinical sign,laboratory, USG, Gallium renal tests and renal biopsy. A cross sectional study was carried out among 120 (AIN) patients and none (AIN)from the Paediatrics and Internal Medicine Department Wahidin Sudirohusodo hospital from June until September 2008. Eosinophilcount was performed using haematology auto analyser. The data was analyzed by Mann-Whitney test using SPPS for windows. Thetotal 120 samples consisted of 60 samples of AIN and 60 samples Non AIN were included in this study. Mean eosinophil in AIN 4. 9 %and non AIN 3. 1%. There were statistical difference of eosinophil level between AIN and non AIN with p < 0. 00. Eosinophil level canbe used to differentiated between AIN and non AIN in conjunction to the clinical sign.
The limitations of health facilities in diagnosing AMI, especially in remote areas require an easy and inexpensive examination such as Neutrophil Lymphocyte Ratio (NLR) and High-Density Lipoprotein (HDL), which have a positive correlation with hs-Troponin I. The purpose of this study was to analyze the value of NLR, HDL, and hs-Troponin I as diagnostic markers in STEMI and NSTEMI patients. This retrospective study used medical record data for 152 STEMI patients and 93 NSTEMI patients from January to December 2020 at Dr. Wahidin Sudirohusodo. The NLR value was based on the results of routine blood tests using Sysmex XN-10, the results of HDL examinations using the Bio Majesty JCA-BM9010/c instrument, and the results of the hs-Troponin I examination using the Vidas instrument. Statistical tests using the MannWhitney test, the diagnostic value of NLR, and hs-Troponin I was analyzed by ROC to obtain the cut-off. The test result is significant if p <0.05. The sample consisted of 152 samples of STEMI patients and 93 NSTEMI patients. The NLR value in STEMI patients was significantly different from NSTEMI patients (p <0.001), HDL levels were not significantly different in STEMI and NSTEMI patients (p=0.475), while hs-Troponin I levels were significantly higher in STEMI patients than NSTEMI (p <0.001). The ROC curve showed the sensitivity and specificity of NLR, namely 64% and 70% at the cut-off of 4.32, and the sensitivity and specificity of hs-Troponin I was 78% and 60% at the cut-off of 910.5 ng /L. The NLR and hs-Troponin I values was increased in STEMI patients compared to NSTEMI due to the increased inflammatory response and the higher risk of damage to the myocardium. The coordinates of the NLR ROC curve show a cut-off of 4.32 and hs-Troponin I 910.5 ng/L provides optimal sensitivity and specificity. The conclusion of this study is NLR and hs-Troponin I can be used as diagnostic markers in STEMI and NTEMI patients with a cut-off value of NLR 4.32 and hs-Troponin I 910.5 ng/L.
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