Association between angiotensin-converting enzyme (ACE) gene I/D polymorphism with the risk of knee OA: A systematic review, meta-analysis, and meta-regression

Background

Previous studies have linked genetics to knee osteoarthritis. Angiotensin-converting enzyme (ACE) gene I/D polymorphism may cause OA. However, evidence remains inconsistent. This study examines knee OA risk and ACE gene I/D polymorphism.

Methods

We explored Europe PMC, Medline, Scopus, and Cochrane Library using keywords. Three assessment bias factors were assessed using the Newcastle-Ottawa Scale (NOS). Criteria for inclusion: (1) Split the study population into knee OA patients and healthy controls; (2) Analysed the ACE gene I/D polymorphism; (3) Case-control or cross-sectional surveys. Studies with non-knee OA, incomplete data, and no full-text were excluded. The odds ratio (OR) and 95% confidence intervals (95% CI) were calculated using random-effect models.

Results

A total of 6 case-control studies consist of 1,226 patients with knee OA and 1,145 healthy subjects as controls were included. Our pooled analysis revealed that a significant association between ACE gene I/D polymorphism and risk of knee OA was only seen in the dominant (DD + ID vs. II) [OR 1.69 (95% CI 1.14 - 2.50), p = 0.009, I2 = 72%], and ID vs. II [OR 1.37 (95% CI 1.01- 1.86), p = 0.04, I2 = 43%] genotype models. Other genotype models, including recessive (DD vs. ID + II), alleles (D vs. I), DD vs. ID, and DD vs. II models did not show a significant association with knee OA risk. Further regression analysis revealed that ethnicity and sex may influence those relationships in several genotype models.

Conclusions

Dominant and ID vs. II ACE gene I/D polymorphism models increased knee OA risk significantly. More research with larger samples and different ethnic groups is needed to confirm our findings. After ethnicity subgroup analysis, some genetic models in our study showed significant heterogeneities, and most studies are from Asian countries with Asian populations, with little evidence on Arabs.

Evaluation of Blended Learning in Terms of the Perceptions of Medical Students: A Mixed Method Study

Introduction

The ongoing 4.0 industrial evolution, characterized by the rise of digital technology, has had a massive impact on human lifestyles worldwide. Faculty members in medical school are expected to respond to this industrial revolution by implementing teaching strategies, one of which is Blended learning as a suitable solution to overcome the limitations of space and time in the teaching process. For effective utilization of blended learning, it is important to conduct extensive studies on its implementation. The aim of this study was to assess the effectiveness and efficiency of implementing blended learning in the faculty of medicine in Hasanuddin University from the students' perspective.

Methods

This study used a sequential explanatory mixed method approach, combining quantitative and qualitative methods. The quantitative part involved 782 undergraduate medical students from the first, second, and third years. Data were collected through a questionnaire survey distributed among the students. The qualitative part of the research was conducted through focus group discussions involving 13 students based on the questionnaire scores, representing both high and low scores. The results of the quantitative and qualitative research were collected and integrated.

Results

Based on the results, the majority of students agreed that blended learning provided many advantages to their learning (Mean±SD: 3.79±0.78). Also, they reported e-learning platform significantly contributed to their learning process (Mean±SD: 3.88±0.67). The workload of blended learning method was still considered quite heavy by students, and good time management was highly needed (Mean±SD: 3.45±0.84). As for qualitative part, some positive results were obtained; they reported that it increased motivation for learning, enhanced the efficiency of learning and gaining adaptability, while the negative opinions were the network error in e-learning, erratic e-learning display, and video quality problem.

Conclusion

Most of the students expressed positive opinions about the advantages of blended learning; according to them, learning was more efficient and effective, it enhanced learning motivation, and it provided comprehensive accessible learning materials.

Factors Influencing the Implementation of Interprofessional Collaborative Practice in Teaching Hospital Setting: A Mixed-Method Study

Introduction

Health service in the current global era requires health workers to provide qualified service, this also applies to teaching hospitals. Collaboration between several professions involved (doctors, nurses, and pharmacists) in an interprofessional collaboration system is needed in providing such service. Factors influencing interprofessional collaboration is unique to each health care center. The purpose of this study was to determine the factors that influence the implementation of interprofessional collaborative practice among health workers in Dr. Wahidin Sudirohusodo General Hospital.

Methods

This is a mixed-method explanatory sequential design study, utilizing quantitative and qualitative data. Quantitative data were obtained from the Indonesian-validated Collaborative Practice Assessment Tool (CPAT) questionnaire. CPAT in Indonesian language has been validated in previous research by Findyartini, et al. in 2019 in Indonesian population. The questionnaire was internally validated with the study population with Cronbach alpha of 0.812. All health care professionals meeting the selection criteria were enrolled for the quantitative study. The questionnaire was given to 152 health professionals enrolled as research subjects, including nutritionists, nurses, doctors, pharmacists, and medical rehabilitation specialists serving in Dr. Wahidin Sudirohusodo Hospital for >3 years. Five participants with highest and lowest CPAT score from each profession were invited for FGD entitled "Exploring factors involved in interprofessional collaboration in Wahidin Sudirohusodo General Hospital" and divided into 2 groups according to the CPAT score. The score from each subscale in the questionnaire is obtained for each research subjects and the median is compared among each profession group using Kruskall-Wallis test significant to a p value of <0.05. Qualitative data as recording transcript is acquired from FGD; the transcript was then coded into several general themes by 2 of the authors and was discussed using thematic analysis using MaxQDA.

Results

Research subjects were predominantly women (121 respondents (79.6%)), 32.9% were nurses, and most of the healthcare professional (81 subjects (55.1%)) have been working for >10 years. Among profession groups (Doctors, Pharmacists, Medical Rehabilitation Specialists, Nutritionists, and Nurses), difference in score distribution (p<0.05) was found in relationships among team members (40 vs 39 vs 39.5 vs 36 vs 42, p<0.001), barriers to team collaboration (10 vs 18.5 vs 14 vs 18 vs 10, p<0.001), and leadership (20 vs 20 vs 23 vs 20 vs 20, p 0.045). From the FGD, factors influencing interpersonal collaborative practice are leadership factors, system/rule factors, and personal factors.

Conclusion

This research showed that personal, system/organizational and leadership factors influence the implementation of interprofessional collaboration. In this study, there is a different perception regarding relationships among team members, barriers to team collaboration, and leadership among profession group.

Comparison between Neutralization Capacity of Antibodies Elicited by COVID-19 Natural Infection and Vaccination in Indonesia: A Prospective Cohort

BACKGROUND

To fight the COVID-19 pandemic, immunity against SARS-CoV-2 should be achieved not only through natural infection but also by vaccination. The effect of COVID-19 vaccination on previously infected persons is debatable.

METHODS

A prospective cohort was undergone to collect sera from unvaccinated survivors and vaccinated persons-with and without COVID-19 pre-infection. The sera were analyzed for the anti-receptor binding domain (RBD) titers by ELISA and for the capacity to neutralize the pseudovirus of the Wuhan-Hu-1 strain by luciferase assays.

RESULTS

Neither the antibody titers nor the neutralization capacity was significantly different between the three groups. However, the correlation between the antibody titers and the percentage of viral neutralization derived from sera of unvaccinated survivors was higher than that from vaccinated persons with pre-infection and vaccinated naïve individuals (Spearman correlation coefficient (r) = -0.8558; 95% CI, -0.9259 to -0.7288), p < 0.0001 vs. -0.7855; 95% CI, -0.8877 to -0.6096, p < 0.0001 and -0.581; 95% CI, -0.7679 to -0.3028, p = 0.0002, respectively), indicating the capacity to neutralize the virus is most superior by infection alone.

CONCLUSIONS

Vaccines induce anti-RBD titers as high as the natural infection with lower neutralization capacity, and it does not boost immunity in pre-infected persons.

Dynamic interaction of obesity, age, MCP-1 Level, and ACE-1 gene with the severity of knee osteoarthritis: a cross-sectional study

The risk factors most strongly associated with knee osteoarthritis (OA) are old age and obesity. However, few studies have evaluated the interaction between aging and obesity in conjunction with inflammatory markers and knee OA severity as part of a complete assessment of knee OA management. Therefore, this study aims to evaluate the interaction between obesity, age, inflammation [including the I/D polymorphism of angiotensin converting enzyme-1 (ACE-1)], and the severity of knee OA.

METHODS

A total of 80 knee OA patients were included in this cross-sectional study. The severity of knee OA was determined based on the Kellgren-Lawrence system. All patients underwent physical and radiological examination; monocyte chemoattractant protein 1 (MCP-1) markers were measured. The parameters of the ACE-1 gene were examined with sequencing DNA.

RESULTS

There was a significant relationship between age and severity of knee OA (P=0.007), with subjects aged greater than or equal to 65 having a 3.56-fold higher risk of developing moderate to severe OA than subjects aged less than 65. There was a significant difference between body weight and knee OA severity (P=0.026), in which subjects weighing greater than or equal to 60 kg had 3.14 times the risk of experiencing severe knee OA. Multivariate regression analysis indicated that age was the strongest independent variable for knee OA severity compared with body weight. MCP-1 levels were significantly higher in mild knee OA than in moderate to severe knee OA. The DD genotype of the ACE-1 gene increases the risk of severe knee OA by four times in subjects aged greater than or equal to 65 compared to subjects aged less than 65. However, the DD genotype of the ACE-1 gene does not increase the risk of severe knee OA in subjects weighing greater than or equal to 60 kg.

CONCLUSION

While obesity and age were found to be associated with the severity of knee OA, age emerged as the independent risk factor for knee OA severity. Furthermore, MCP-1 levels were significantly higher in cases of mild knee OA compared to severe knee OA. It was observed that the DD genotype of the ACE-1 gene increases the risk of severe knee OA in individuals aged 65 years or older.

The level of ratio between matrix metalloproteinase-1 (MMP-1) and tissue inhibitor matrix metalloproteinase-1 (TIMP-1) after prolotherapy intervention and the functional outcome in patient with frozen shoulder: A randomized controlled trial

OBJECTIVE

To determine the effect of prolotherapy on functional outcome changes, along with ratio of matrix metalloproteinase-1 (MMP-1)/tissue inhibitor matrix metalloproteinase-1 (TIMP-1) as an indicator of tissue repair in the glenohumeral joint in frozen shoulder patients.

DESIGN

Single-blinded randomized controlled trial.

SUBJECTS/PATIENTS

Participants with frozen shoulder.

METHODS

The prolotherapy group is the study group, and the normal saline (NS) group is the control group. Each group was given injections at weeks 0, 2, 4, and 6. Level of biomarker levels was measured at week 6 and week 12 after there. Functional outcomes were measured at weeks 0, 6, and 12.

RESULTS

A significant difference in week 6 and week 12 was demonstrated in the ratio of MMP-1/TIMP-1 level between the prolotherapy group and the normal saline group (P value = .002). Both groups performed well regarding the Numerical Rating Scale score and functional outcome. Compared to the normal saline group, prolotherapy changed the mean range of motion in flexion and internal rotation.

CONCLUSION

Prolotherapy is considered to play a role in repairing cartilage based on biomarker assessment, particularly the ratio of MMP-1/TIMP-1-prolotherapy effectiveness in improving functional outcome and Numerical Rating Scale score.

Seroprevalence of Chikungunya in an Asymptomatic Adult Population in North and South Sulawesi, Indonesia

Chikungunya (CHIK) is an emerging and reemerging infectious disease of public health importance in Indonesia. Information on the asymptomatic and true burden of CHIK virus (CHIKV) infections is limited. We assayed 1,092 healthy population samples, collected in North and South Sulawesi between 2019 and 2020, for antibodies against CHIKV. Blood samples were screened by IgM and IgG ELISAs and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) assay. CHIKV IgG seroprevalence in North and South Sulawesi was 53.2% and 53.9%, respectively. The overall prevalence of anti-CHIKV IgM antibody was 12.9%. Molecular testing of blood donors revealed 0.66% (2/300) were positive for CHIKV qRT-PCR. Our study provides new insights into the CHIKV endemicity situation in the eastern part of Indonesia and warrants the need for further systematic surveillance considering there is no treatment or vaccine for CHIK infection.

A Case Series: Effect of Comorbidities on the Outcomes of Prolotherapy Injection for Frozen Shoulder Patients

Frozen shoulder (FS) is a disease caused by an inflammatory condition that causes severe pain and decreased range of motion by loss of glenohumeral mobility. Frozen Shoulder restricts daily life's functional aspect, increasing morbidity. Hypertension and diabetes mellitus are risk factors that make an FS poor prognosis during treatment because of the diabetes glycation process and hypertension-enhanced vascularization. Prolotherapy injects an irritant solution into the tendon, joints, ligaments, and joint spaces to release growth factors and collagen deposition, reducing pain, restoring joint stability, and increasing the quality of life. We report 3 cases of patients with confirmed FS. Patient A with no comorbidity, patient B with diabetes mellitus, and patient C with hypertension, with all patient's chief complaints of shoulder pain and limited ROM, and symptoms affected the general quality of daily life. This patient was provided injection with Prolotherapy treatment combined with physical therapy intervention. Patient A had significantly improved ROM to maximum after 6 weeks with relieved pain and improved shoulder function. Patients B and C showed increased ROM, still tiny, decreased pain, and improved shoulder function. In conclusion, prolotherapy demonstrated a beneficial effect in a patient with FS with comorbidities, although not to the maximum extent in patients without comorbidity.

Effectiveness of Prolotherapy Combined with Physical Therapy Versus Physical Therapy Only for Frozen Shoulder: A Case Report

Case series

Patients: Male, 66-year-old • Male, 65-year-old

Final Diagnosis: Frozen shoulder

Symptoms: Limited range of motion of shoulder • pain radiating into the neck and elbows • shoulder pain

Medication: —

Clinical Procedure: Injection of prolotherapy • physical therapy

Specialty: Rehabilitation

Combination of thyroid ultrasound examination (TIRADS) and survivin gene mRNA expression to determine the type of thyroid nodule

Background: Ultrasound plays a significant role in determining the diagnosis of thyroid nodules. The thyroid ultrasound examination is operator dependent, so the Thyroid Imaging Reporting and Data System (TIRADS) method were developed. However, until now TIRADS has not been able to replace the Fine Needle Aspiration (FNA) examination in determining the type of benign or malignant thyroid nodule, so it is necessary to find alternative biomarkers that can be used to increase the sensitivity and specificity of TIRADS. In this study, the mRNA expression of the survivin gene in thyroid nodules was examined in combination with TIRADS so that it is expected to increase the diagnostic value. Method: This study is a diagnostic test with a cross sectional design on 51 patients with thyroid nodules in 5 hospitals on the island of Lombok. Subjects who met the inclusion and exclusion criteria were subjected to TIRADS examination using an ultrasound machine and mRNA expression of the survivin gene using cubital vein blood samples with polymerase chain reaction (PCR). Result: The characteristics of the research subjects were dominated by female sex with age 40 years, TIRADS 3 and histology of benign thyroid nodules. Analysis using the ROC curve obtained TIRADS has a sensitivity of 94.4%, specificity 39.4%, accuracy 58.82%, Positive Predictive Value (PPV) 45.9%, Negative Predictive Value (NPV) 92.9%. While Survivin has 100% sensitivity, 60.6% specificity, 58.1% accuracy, 58.1% PPV, 100% NPV. In the serial combination of TIRADS and survivin, there was an increase in the diagnostic value, namely sensitivity 94.4%, specificity 75.8%, accuracy 82.35%, PPV 68%, NPV 96.2%. Conclusion: The combination of TIRADS and survivin can increase the diagnostic value in determining the type of thyroid nodule

Macro- and Micronutrient of Junk Food and Preeclampsia on Pregnant Women

BACKGROUND: Preeclampsia (PE) is still a global public health issue in developed and developing countries. It is a major contributor to maternal and fetal morbidity and mortality. The pathophysiology of preeclampsia during pregnancy is unclear, but the WHO reported that PE is higher in developing countries than developed ones due to lifestyle and nutritional status. AIM: This study aimed to describe the influence of macro- and micronutrients of junk food on PE. METHODS: This case–control study was carried out on 148 samples, including pregnant women with preeclampsia (n = 74) and normal pregnant women (n = 74) with gestational age > 20 weeks. Data on junk food intake were collected using the SQ-FFQ form and then estimated using the Nutri Survey. Data were analyzed in SPSS version 17 using descriptive statistics. Pearson correlation coefficient was used to observe the correlation between variables with p < 0.05 and 95% confidence interval. RESULTS: Binary logistic regression revealed that the intake of fat (p = 0.005), vitamin C (p = 0.002), and sodium (p = 0.036) contained in the junk food were significantly associated with PE. The frequency of consumption of junk food also had a significant effect on the incidence of preeclampsia (p = 0.013). CONCLUSION: Intake of fat, vitamin C, and sodium were associated with PE, and they were risk factors of PE. The frequency of consuming junk food gave more risk to have PE.

The Effect of Trehalose Supplementation on Macrovascular Inflammation Biomarker in Old Rats by Assessing NFκB-p65 Expression

Background: Vascular inflammation is one of contributing factors to the pathogenesis of arterial aging. Age-related activation of the inflammatory process can lead to various macro-and microvascular pathologies. The pro-inflammatory microenvironment generated in the vascular wall can lead to the pathogenesis of vascular diseases due to an increase in vascular dysfunction. Trehalose is a disaccharide that has several functions, protecting against stressors (one of them is reactive oxygen species/ROS) and preventing the inflammatory responses induced by endotoxic shock. Objectives: To analyze the effect of trehalose supplementation on macrovascular inflammatory processes related to the aging process. Methods: The experimental study used 28 male Wistar rats (Rattus novergicus) which were divided into 4 groups, young control group (Group A), old control group (Group B), 2% sucrose group (Group C), and 2% trehalose group (Group D); were then observed for 8 weeks. Results: The results showed that there were no significant differences in aortic tissue NFκB-p65 expression between old and young subjects (p=0.247). The 2% trehalose group had 40% lower aortic tissue NFkB-p65 expression compared to the old control group (p=0.012); while the group given 2% sucrose solution had a 30% higher aortic tissue NFkB-p65 expression compared to the trehalose group (p=0.018). Conclusion: Trehalose has a good effect on aging-associated vascular inflammatory processes that can be seen from the low aortic tissue NFκB-p65 expression in old rats.

The Effect of Trehalose Sugar on Insulin Resistance in Old Rats by Assessing HOMA-IR (Homeostasis Model Assessment-Insulin Resistance)

Background: Insulin resistance is a condition in which insulin cannot take up glucose, increasing blood glucose. Elderly people are more exposed to insulin resistance, requiring dietary interventions that extend longevity. Trehalose, a naturally occurring sugar, showed potentially reduce insulin resistance which can be measured using the HOMA-IR index. Objectives: This study aimed to assess HOMA-IR levels as a parameter of insulin resistance in old rats after giving trehalose sugar. Methods:  Experimental research with 28 male Wistar rats (Rattus novergicus) was separated into 4 groups, the control group of young rats (Group A), the control group of old rats (Group B), a group of old rats that were given 2% Trehalose solution (Group C), and a group of old rats that given 2% sucrose solution (Group D) that observed for 8 weeks. Results: The results showed differences in HOMA-IR levels (p<0.001) between old and young subjects. The intervention in Group C was optimal in reducing levels of HOMA-IR (p<0.001) by 18.2% compared with the old control, while Group D increased levels of HOMA-IR by 14.3% (p<0.001) compared with the old control. The age of the subjects with HOMA-IR level is positively correlated (p<0.001; r=0.721) and the weight of subjects with the HOMA-IR level is also positively correlated (p<0.001; r=0.698), indicating that the older and the greater weight of subject resulting in the bigger of HOMA-IR value. Conclusion: Trehalose is effective in reducing HOMA-IR levels as a parameter of insulin resistance in old rats.

Perbandingan Efektivitas BAE dengan Senam Kaki Terhadap Sirkulasi Darah Perifer dan Kadar Glukosa Darah pada Penderita Diabetes Melitus Tipe 2

Hiperglikemia dalam jangka panjang dapat menyebabkan aterosklerosis, penebalan membran basalis dan perubahan pada saraf perifer. Hal ini menyebabkan gangguan perfusi perifer yang menimbulkan beberapa komplikasi serius seperti ulkus, gangren hingga beresiko amputasi. Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas antara buerger allen exercise dengan senam kaki terhadap sirkulasi darah perifer dan kadar glukosa darah puasa pada penderita diabetes melitus tipe 2. Desain penelitian ini adalah analitik komparatif dengan sampel 32 orang pasien diabetes melitus tipe 2. Kelompok responden dibagi menjadi dua, masing-masing kelompok terdiri dari 16 responden. Kelompok pertama, responden yang diberikan perlakuan latihan buerger Allen exercise dan kelompok kedua, responden yang diberikan latihan senam kaki. Berdasarkan hasil uji analisis paired t-test pada kelompok perlakuan yang diberikan latihan buerger Allen exercise dibandingkan dengan kelompok yang diberikan latihan senam kaki, didapatkan hasil yang signifikan, p=0,001 (p<0.05), yang berarti ada pengaruh terhadap peningkatan nilai ankle brachial index (ABI) dan penurunan kadar glukosa darah puasa (GDP), dan 2 jam post prandial (PP). Selanjutnya, dari Hasil uji independent t-test diperoleh perbedaan yang signifikan antara kelompok responden yang diberikan latihan buerger Allen exercise dan kelompok responden  yang diberikan latihan senam kaki P<0.05. ( p=0.001 untuk nilai ABI, p = 0.004 untuk GDP dan p = 0.037 untuk 2 jam PP). Kesimpulan penelitian ini adalah buerger allen exercise lebih efektif dibandingkan senam kaki terhadap peningkatan nilai ABI, dilain pihak senam kaki lebih efektif dibandingkan dengan buerger allen exercise terhadap penurunan kadar glukosa darah.

Perbandingan Otago, Basic Exercise, dan Kombinasi Keduanya Terhadap Kekuatan Otot dan Fungsional Berjalan Penderita Osteoarthritis

Osteoarthritis (OA) adalah penyakit sendi yang paling umum yang mengurangi kualitas hidup. Ini sering dikaitkan dengan gangguan mobilitas karena rasa sakit dan kelemahan otot, sehingga menjadi faktor risiko jatuh. Penelitian ini bertujuan untuk membandingkan pengaruh latihan otago, latihan dasar, dan kombinasi keduanya terhadap perubahan kekuatan otot dan kemampuan fungsional berjalan pada pasien OA lutut. Penelitian ini merupakan penelitian analitik komparatif dengan jumlah peserta 60 orang yang dibagi menjadi tiga perlakuan. Jumlah peserta dalam setiap perlakuan sebanyak 20 orang. ANOVA ulangan digunakan sebagai uji statistik dengan signifikansi p 0,05. Hasilnya, terdapat perbedaan yang signifikan antara ketiga kelompok perlakuan dalam hal perubahan kekuatan otot (p=0,003) dan kemampuan fungsional berjalan (p=0,036). Hasil post hoc menunjukkan bahwa kelompok latihan otago dan latihan dasar memiliki perbedaan kekuatan otot dan kemampuan fungsional berjalan yang signifikan dibandingkan kelompok latihan otago dan latihan dasar. Penelitian ini menyimpulkan bahwa kombinasi latihan otago dan latihan dasar lebih efektif daripada latihan otago atau latihan dasar hanya dalam meningkatkan kekuatan otot dan kemampuan fungsional berjalan.

Antenatal care parameters that are the risk factors in the event of preeclampsia in primigravida

OBJECTIVE

This study aimed to analyze the parameters of antenatal care, which becomes a risk factor against the incidence of preeclampsia in primigravidae in Kolaka.

METHODS

The study uses case-control studies (case-control), which use a retrospective approach. The population in this study were all primigravida pregnant women recorded in the medical records at the BLUD Hospital. HM Djafar Harun as many as 5796 women and BLUD Benyamin Guluh Hospital as many as 5065 women. The sample in this case group is the primary mother Gravida, who suffered from preeclampsia from January 2014 to September 2018, and the control group was primigravida mothers who did not suffer from preeclampsia in the same period.

RESULTS

The results showed that the age of primigravida mothers 14-28 years had a risk of 1.581 times more significant for having preeclampsia than the age group 29-49 years with CI (1.186-2.108), the incidence of hypertension in trimester 1 in primigravida mothers had a risk of 3.405 times greater for preeclampsia than mothers without a history of hypertension in trimester 1 with CI (2.164-5.358), irregular antenatal visits are 1.095 times more likely to develop preeclampsia than regular antenatal visits with CI (0.799-1.539), weight gain primigravida maternal body 1-10kg 1.540 times greater risk of developing preeclampsia than 10-20kg of weight gain with CI (1.074-2.207), pregnancy checks according to Antenatal Care non-compliant care standards are 1.333 times more likely to develop preeclampsia than primigravida mothers who obediently do the inspection antenatal care with CI (0.970-1.831).

CONCLUSION

Variables that are very risky with preeclampsia in primigravida mothers based on multivariate analysis are the hypertension incidence in the first trimester with an OR: 3.363 with a CI value of 2.126 and a lower value of 5.318.

Learning media based on augmented reality (AR) increased the skill of physical examination of the integumentary system of pregnant women in midwifery students

OBJECTIVE

This research was to analyze the correlation of AR-based Learning Media to improving the physical examination of the integumentary system of pregnant women in midwifery students.

METHOD

The research method used Quasi-experimental with Non-Equivalent Control Group Design. The sample of 92 students was selected by a purposive sample, divided into two intervention and control groups. The intervention group was 62 students, and the control group was 30 students. Data collection was performed using a checklist to assess the skill of the physical examination of the integumentary system of pregnant women. To test the differences of skill before and after treatment in control and intervention groups used the Mcnemar test, whereas to know the differences in skill from time to time Cochran test was used.

RESULT

The results showed differences in the measurement of skills improvement in the control and intervention groups before and after the intervention was given. A more significant increase in skills occurred in the intervention group with a p-value <0.001 contributing after 1week of giving a demonstration, and application-based (AR) skills increased by 66.1%. After two weeks it increased by 93.5%, and after two weeks it increased by 100%. So it could be concluded statistically that AR-based learning media was significant in improving the physical examination skills integumentary systems in pregnant women.

Effectiveness of Augmented Reality (AR) based learning media on increasing the physical examination system of pregnant women urinary system

OBJECTIVE

This study aims to analyze the effectiveness of learning media based on Augmented Reality (AR) on improving the physical examination skills of the urinary system of pregnant women.

METHOD

This type of research is an experimental study with a quasi-experimental non-equivalent control group design conducted in January-February 2020 at the Midwifery Polytechnic Laboratory of the Ministry of Health Gorontalo. A sample of 92 students was selected by purposive sampling and met the inclusion criteria. Then the sample was divided into two groups: a control group that was given material through lecture and demonstration methods totaling 30 respondents and an intervention group that was given material through AR learning media and a method of demonstration totaling 62 respondents. Data collection was performed using a checklist to assess student skills improvement. Data were analyzed using the Cochran test to determine differences in skills over time.

RESULTS

There was an increase in skills in the control and intervention groups with a statistically significant P<0.001 (P<0.05). However, the results showed that the mean improvement in skills in the week I of the study in the intervention group who were given AR learning media was higher in the percentage of skill improvement (72.6%) when compared to the control group who were given the lecture method and the demonstration method (36.7%). Likewise, the mean increase in skills in week II of the study in the intervention group was higher in the percentage of skill improvement (91.9%) compared to the control group given the lecture and demonstration method (66.7%), although in the third week all respondents in the control group and group the intervention becomes skilled at carrying out a physical examination of the urinary system of pregnant women.

CONCLUSION

AR media is more effective in improving student skills.

Mean arterial pressure and the endothelin-1 levels in preeclampsia

OBJECTIVE

This study aims to determine the correlation between Endothelin-1 levels and mean arterial pressure (MAP) with preeclampsia so that their combination can be used as the predictor of PE in early pregnancy.

METHOD

This study used a cross-sectional study with a case-control design carried out in February to June 2020 in several hospitals and health centers in Makassar city, namely Dr. Wahidin Soedirohusodo General Hospital, Hasanuddin University State University Hospital, health center Bara Baraya, health center Mamajang, and health center Antang. Respondents in this study were divided into 37 pregnant women with preeclampsia and 53 pregnant women with normotension. This study's criteria for respondents were 20-35 years old, single pregnancy with > 20 weeks gestational. Data collected included education, body mass index (BMI), parity, the interval of pregnancy, and gestational age. ET-1 levels were determined using th ET-1 Elisa Kit with the ELISA method, and MAP was collected by measuring blood pressure when pregnant women came to health facilities.

RESULTS

The mean serum ET-1 levels in the preeclampsia were highest than normotensive with a significant p-value of 0.001 (p<0.05). The MAP in the preeclampsia was highest than normotensive too, with a significant value of p-value 0.001 (p<0.05), and there is a positive correlation between ET-1 and MAP with r=0.34 and p-value 0.001 (p<0.05).

CONCLUSION

The combination of ET-1 and MAP can be considered as a prognostic factor to detect PE in early pregnancy.

Comparison of nitric oxide levels, roll over test value, and body mass index in preeclampsia and normotension

OBJECTIVE

The study aims to compare levels NO, the ROT, and BMI values in preeclampsia and normotension.

METHOD

This study was an observational analytical study that combined the draft case-control study and a cross-sectional study (hybrid method) conducted in February-June 2020. This study was conducted in the Hospital Dr. Wahidin Sudirohusodo Makasar, Antang Health Center, Barabaraya Health Center, and Mamajang Health Center. Respondents in this study were pregnant women divided into two groups, 108 mothers with normal pregnancies and 42 mothers with preeclampsia. The criteria of the study respondents were single pregnancies, pregnancy of more than 20 weeks, and the gestational age of 20-35 years old. Data collected includes age, parity, gestational age, pregnancy interval, body mass index (BMI), and education. In addition, Nitric oxide levels are determined using Elisa Kit, and roll over test is collected by performing blood pressure measurements at two different positions.

RESULTS

The mean serum NO levels in the preeclampsia 176.43±50.8 and 152.75±51.3 in normotension, and there is a meaningful relationship p=0.012. Mean value of ROT in preeclampsia 23.21±8.54 and 19.63±8.85 in normotension p=0.026. There is a meaningful difference in IMT with preeclampsia p=0.003.

CONCLUSION

NO, ROT and BMI are significantly higher in pregnant mothers with preeclampsia than in normal pregnancies.

Exercise adaptations and TGF-β1 levels in recreational cyclists

Background

Cycling is a physical exercise that is widely performed to improve physical fitness. Regular physical exercise will lead to adaptations to exercise. This adaptation is useful in suppressing the production of reactive oxygen stress (ROS) generated in response to cellular metabolism that uses oxygen. Transforming growth factor beta-1 (TGF-β1) plays a role in increasing the production of ROS, thus, when the concentration is low, it would lead to an improvement in physical fitness. This study aims to compare levels of TGF-β1 between recreational cyclists and sedentary groups. In addition, this research also compares several other parameters, which are fasting blood sugar levels and lipid profiles (triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol) between cyclists and sedentaries.

Methods

This was an observational analytical study with a cross-sectional design. The research subjects consisted of 2 groups, each consisting of 21 participants, namely the recreational cyclist and the sedentary group. Anthropometric examinations were carried out, including body weight, height, body mass index, waist circumference, and body fat percentage. Fasting blood glucose concentration and lipid profile (Triglyceride – TG, Total Cholesterol – Total C, HDL Cholesterol – HDL-C, and LDL Cholesterol – LDL-C) were determined by the enzymatic colorimetric methods, and TGF-β1 levels were determined using the fluorescence of specific antibodies for TGF-β1 (pg/ml) using ELISA method. Statistical analysis was performed using IBM SPSS v. 25.

Results

The anthropometric variables, other than body height, did not differ significantly between the two groups, so did the fasting blood glucose concentration. Nevertheless, the lipid profile (TG, Total C, HDL-C and LDL-C) were found to be significantly better in the cyclist group (p < 0.05).

The mean level of TGF-β1 in recreational cyclists was 8, 908.48 pg/ml, lower than the control group, 10, 229.28 pg/ml. The results of the unpaired t-test showed significant mean differences between the two groups, (p = 0.001; p < 0.05).

Conclusion

The levels of TGF-β1 in the recreational cyclist group were lower than the sedentary group. Regular physical exercise will trigger exercise adaptations that can suppress latent TGF-β1 activation.

•

This study aims to compare levels of TGF-β1 between recreational cyclists and sedentary groups

•

The research subjects consisted of 2 groups, each consisting of 21 participants, namely the recreational cyclist and the sedentary group.

•

Anthropometric examinations were carried out, including body weight, height, body mass index, waist circumference, and body fat percentage

•

The levels of TGF-β1 in the recreational cyclist group were lower than the sedentary group

Expert consensus on the minimum clinical standards of practice for Nigerian physiotherapists working in intensive care units: A modified Delphi study

BACKGROUND

Management of patients in intensive care units (ICUs) needs staff with a recommended level of expertise and experience owing to the life-threatening nature of illnesses, injuries and complications that these patients present with. There are no specific guidelines governing physiotherapy practice in ICUs in Nigeria. Hence, there is a need to have expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs as a first step to proposing/developing guidelines in the future.

OBJECTIVES

To assess the expert consensus on the minimum clinical standard of practice for physiotherapists working in ICUs in Nigeria.

METHODS

Physiotherapists with working experience in Nigerian ICUs were purposively recruited into the present study using a modified Delphi technique. A questionnaire comprising 222 question items on the role of physiotherapy in critical care was adopted and administered to the participants over three rounds of Delphi procedure (online). Participants checked either 'essential', 'not essential' or 'unsure' for each question item. For each question item to be considered 'essential' or 'not essential', a consensus agreement ≥70% had to be met. Questions without consensus were further modified by providing definition or clarification and presented in subsequent rounds. Data were analysed descriptively.

RESULTS

We recruited 26 expert physiotherapists who consented to the study and completed the first round of the study. The majority of the physiotherapists (n=24) remained in the study after the third round. A total of 178 question items were adjudged to be 'essential' after the first round, and a further 15 and three additional items were subsequently adjudged to be as 'essential' after modifying the outstanding question items during the second and third rounds, respectively. No consensus was reached for 24 items. None of the question items were ranked as 'not essential' after all the rounds.

CONCLUSION

Expert consensus was achieved for a substantial number of question items regarding knowledge and skills for assessment, condition and treatment items of the questionnaire by experienced critical care physiotherapists in Nigeria.

Effect of Artificial Carbon Dioxide-Rich Water Immersion on Peripheral Blood Flow in Healthy Volunteers: Preliminary Study about Artificial Carbon Dioxide-Rich Water

BACKGROUND: Peripheral blood circulation disorder is one of the global health problems. Balneotherapy that uses CO2 springs may be one of the complementary treatment options. The device to produce artificial CO2-rich water is needed to achieve an improvement effect, at least almost like the improvement effect of natural balneotherapy. AIM: This study aims to investigate the effect of artificial CO2-rich water immersion on peripheral blood flow using Bicarbonated JesC CREA BC-2000. METHODS AND MATERIALS: Thirty-nine healthy volunteers participated in this study. Each subject immersed both of their legs in a mixed solution from water and CO2 at temperature 38°C. This solution was mixed using a device, namely, “Bicarbonated JesC CREA BC-2000”. Peripheral blood flow was measured for 5 min before immersion (in this study, we denoted it as the mean basal blood flow), 10 min during immersion, and 5 min after immersion using pocket JMS laser Doppler flowmetry MBF-IIA. Repeated analysis of variance was used for statistical analysis. RESULTS: There is the difference in peripheral blood flow among before, during, and after immersing the legs into artificial CO2-rich water using Bicarbonated JesC CREA BC-2000 (p < 0.001). CONCLUSION: Bicarbonated JesC CREA BC-2000 may be used as the device to produce an artificial CO2-rich water bath that may affect peripheral blood flow in healthy volunteers.

Physicochemical Characteristics of Chicken Eggshell Flour Produced by Hydrochloric Acid and Acetic Acid Extraction

Backgrdound: Several previous researchers have prepared chicken eggshell flour using hydrochloric acid (HCl) and acetic acid (CH3COOH) solvents. However, the results of the physicochemical characteristics still very diverse. This study aims to produce chicken eggshell flour using two different types of solvents (4% HCl and CH3COOH 2N) and determine the proper solvent to obtain better physicochemical characteristics. Method: This type of research was descriptive quantitative. The research stages initiated by preparing chicken eggshell samples by maceration using 4% HCl and CH3COOH 2N. Afterward, chemical characteristics (moisture content, ash, calcium carbonate, calcium, and phosphorus) and physical characteristics (yield) of eggshell flour were determined. Processing and data conducted by using the IBM SPSS statistic program Result: The higher levels of calcium, calcium carbonate, phosphorus, ash, yield, and lower water content of the eggshell powder were generated by extraction using 4% HCl than 2N acetic acid (CH3COOH). Conclusion: The physicochemical characteristics of the eggshell powder extracted from the 4% HCl were better than the 2N acetic acid (CH3COOH)

Changes in levels of cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen in subjects with knee osteoarthritis after dextrose prolotherapy: A randomized controlled trial

Objective

To assess the effects of dextrose prolotherapy in patients with knee osteoarthritis on the levels of serum cartilage oligomeric proteinase and urinary C-terminal telopeptide of type II collagen, and on the Western Ontario McMaster Universities Index and numerical rating scale score for pain.

Methods

A randomized controlled trial, in which participants were randomly allocated into 2 groups, receiving injections of either hyaluronic acid or dextrose prolotherapy. The hyaluronic acid group received 5 injections, 1 each on weeks 1, 2, 3, 4 and 5, and the dextrose prolotherapy group received 3 injections, 1 each on weeks 1, 5 and 9. Serum cartilage oligomeric proteinase, urinary C-terminal telopeptide of type II collagen, Western Ontario McMaster Universities Index score, and numerical rating scale score for pain were measured at baseline and 3 weeks after the last injection. Comparative analysis was conducted using Wilcoxon test within groups and analysis of covariance (ANCOVA) test between groups.

Results

A total of 47 participants (21 allocated to hyaluronic acid, 26 allocated to dextrose prolotherapy) completed the protocol. Both interventions resulted in significant improvements in numerical rating scale scores for pain, total Western Ontario McMaster Universities Index scores, and its subscales score. However, the dextrose prolotherapy outperformed hyaluronic acid in numerical rating scale score for pain and level of urinary C-terminal telopeptide of type II collagen, with score changes differences of 0.93 (p = 0.042) and 0.34 (p = 0.048), respectively. No significant changes in level of serum cartilage oligomeric proteinase were found in either group.

Conclusion

Dextrose prolotherapy is an alternative injection therapy for knee osteoarthritis, which was found to be associated with a significant reduction in urinary C-terminal telopeptide of type II collagen compared with hyaluronic acid injection. Neither injection method resulted in reduced serum cartilage oligomeric proteinase.

The serum contents of glutathione peroxidase in umbilical cord blood of low born bodyweight babies and normally born bodyweight babies

OBJECTIVE

The research aimed at investigating the diversity of the enzymatic antioxidant serum contents of the glutathione peroxidase in the umbilical cord blood of the low born bodyweight babies and normal born bodyweight babies. This was the cross-sectional study research.

METHODS

Samples were taken using the purposive sampling techniques namely the low born body weight baby group and normal born body weight baby group. Each group comprised 20 samples who were then taken blood sample of the umbilical cords having been cut off led to the placenta as much as 3cc. The examination of the enzymatic antioxidant contents of the glutathione peroxidase serum used ELISA method. The research was conducted for 3 months. The data analysis used Chi-Square test and Mann-Whitney U test.

RESULTS

The research results indicated that there is the significant diversity of the enzymatic antioxidant serum contents of the glutathione peroxidase between the low born bodyweight babies and normal born bodyweight babies with p value 0.001<0.05, in which the measurement of the glutathione peroxidase serum content of the low born body weight baby group is 17.24±SD 1.52ng/mL, whereas the normal born body weight baby group is 20.30±SD 3.64ng/mL.

CONCLUSION

It can be concluded that the average glutathione peroxidase serum content on the low born bodyweight babies is lower than the normal born bodyweight babies.

699 Pre-Operative Screening and Investigation of Patients with Suspected Non-Alcoholic Fatty Liver Disease Among Bariatric Surgery Patients

Introduction

Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent. The investigations used to diagnose NAFLD include FIB-4 score, NAFLD score and AST/ALT ratio (AAR). Gold-standard for diagnosis is liver biopsy. Bariatric surgery reduces steatosis and fibrosis in NAFLD patients. However, in undiagnosed NAFLD, it can lead to worsening fibrosis and decompensation of cirrhosis, causing complications.

The aim is to identify how well bariatric patients are being screened for NAFLD pre-operatively.

Method

Database analysis was conducted in the bariatric clinics at Royal Derby Hospital and analysed using SPSS.

Results

392 patients’ data (Overall group) were analysed and compared with those who had an AAR&gt;1 (Abnormal group). Abnormal group had a higher mean AAR, NAFLD and FIB-4 scores. Surprisingly, ALT and AST levels were higher in Overall group compared to Abnormal. Generally, patients were not pre-operatively checked sufficiently (81.9% LFTs, 62.2% ASTs).

Conclusions

A large number of patients could have undiagnosed NAFLD due to the lack of LFT/AST checks as ALT scores alone would miss fibrosis. Using AAR&gt;1 and FIB-4 would allow clinicians to detect fibrosis earlier to carry out non-invasive diagnostic measures, avoiding unnecessary biopsies. Early diagnosis means patients undergoing bariatric surgery with possible cirrhosis will not experience decompensation and associated complications.

Body mass index as the most influential factor of high-sensitivity C-reactive protein in non-diabetic adults

BACKGROUNDHigh-sensitivity C-reactive protein (hsCRP) has been widely accepted as a predictor of future cardiovascular risk that reflects a microinflammatory state. Obesity linked to microinflammation increases the prevalence of metabolic disorders and cardiovascular diseases. This study aimed to determine the association between several obesity indices namely body mass index (BMI), waist circumference (WC), body fat percentage (fat), and visceral fat (VF) with hsCRP in non-diabetic adults. METHODSThis was a cross-sectional study performed on 80 non-diabetic adults with ages ranging from 20-40 years. The obesity indices BMI, WC, body fat percentage, and VF were measured. We then measured the hsCRP levels using an immunoturbidimetric method. Simple and multiple linear regression tests were used to analyze the association between obesity indices and hsCRP levels. RESULTSMean of log BMI, log WC, and log VF was 1.41 ± 0.08 kg/m2, 1.93 ± 0.06 cm, and 0.95 ± 0.27 units, respectively. Simple linear regression tests showed that log BMI (â=3.506; p<0.001), log WC (â=3.672; p<0.001), log VF (â=0.833; p<0.001), and log systolic blood pressure (â=3.739; p=0.024) had a significant positive correlation with log hsCRP levels. Further multiple linear regression test showed that log BMI (â=3.772; Beta=0.674; p<0.001) had the greater effect on log hsCRP levels compared to other indices. CONCLUSIONS    BMI had a greater influence on hsCRP levels compared to other obesity indices in non-diabetic adults. Body mass index can be used as a better index in predicting hsCRP levels compared to other indices.

Invasion of human microvascular endothelial cells by Mycobacterium leprae through Mce1A protein

In patients with lepromatous leprosy, Mycobacterium leprae is often observed inside the human microvascular endothelial cells (HMVEC) surrounding Schwann cells (SC) at the site of lesions in the peripheral nerves. Based on this observation, it is considered that the nasal mucous may be the invasion pathway for M. leprae and HMVEC serve as an important reservoir for the bacteria before they invade SC. In light of previous research which revealed that Mce1A protein mediates bacterial invasion into nasal epithelial cells and HMVEC, we conducted a study to determine whether the invasion of M. leprae into HMVEC can be suppressed by blocking the Mce1A protein. In this study, we analyzed bacterial invasive activity by adding recombinant Escherichia coli, which express the active region (InvX:72 a.a.) of Mce1A protein on their external membrane, into cultured HMVEC, using the adhesin involved in the diffuse adherence mechanism. The number of bacteria that invaded into the cells was then measured by a colony counting method. The active region of Mce1A was divided into four sections, and hyperimmune antisera was prepared for each section for analyzing the inhibitory effect against invasion. The invasive activity was suppressed by antibodies against InvX regions 1-24 a.a., 25-46 a.a. and 58-72 a.a. This suggests that the InvX regions 1-24 a.a., 25-46 a.a. and 58-72 a.a. of Mce1A protein play an important role in the invasion of M. leprae into HMVEC and that it may be possible to suppress entry of M. leprae in HMVEC with antibodies against these regions.

The rise of circulatory endothelin (ET)-1 and endothelin receptors (ETA, ETB) expression in kidney of obese wistar rat

BACKGROUND

Endothelin (ET)-1, a circulatory protein, and its receptors (ET_A and ET_B) in various organs were reported to play a pivotal role in many diseases, including obesity. However, the changes of ET_A and ET_B expression in ventricle and kidney in obesity was less reported. The study is designed to observe the level of circulatory ET-1 and expression of ET_A/ET_B in ventricle and kidney of obese, as compared to non-obese, Wistar rats.

METHODS

Groups of obese 14 and 34 weeks Wistar rats were compared to non-obese controls at similar ages. The obesity status was achieved by feeding the with high calories protein diet CP 551 + milk powder, while the control group was fed with a standard calorie protein AD II diet. The concentration of circulatory ET-1, ET_A and ET_B of ventricle and kidney were measured by Enzyme Linked Immunosorbent Assay (ELISA) technique after the termination of both groups at 14^th and 24^th weeks.

RESULTS

The level of circulatory ET-1, expression of ET_A and ET_B in kidney, and LDL of obese rats were significantly higher than control rats (T-Test, P<0.05) in the elder groups, while no differences of the ET_A and ET_B were found in the ventricle. No differences of the levels of circulatory ET-1, ET_A and ET_B expression were found between obese and control groups of younger rats (P>0.05). HDL levels were under normal value for both groups.

CONCLUSION

Obesity in elder obese rats leads to dysregulation of kidney vessels through activity of ET-1 and ET_A/ET_B.

The unique tropism of Mycobacterium leprae to the nasal epithelial cells can be explained by the mammalian cell entry protein 1A

Leprosy is a chronic infection where the skin and peripheral nervous system is invaded by Mycobacterium leprae. The infection mechanism remains unknown in part because culture methods have not been established yet for M. leprae. Mce1A protein (442 aa) is coded by mce1A (1326 bp) of M. leprae. The Mce1A homolog in Mycobacterium tuberculosis is known to be associated with M. tuberculosis epithelial cell entry, and survival and multiplication within macrophages. Studies using recombinant proteins have indicated that Mce1A of M. leprae is also associated with epithelial cell entry. This study is aimed at identifying particular sequences within Mce1A associated with M. leprae epithelial cell entry. Recombinant proteins having N-terminus and C-terminus truncations of the Mce1A region of M. leprae were created in Escherichia coli. Entry activity of latex beads, coated with these truncated proteins (r-lep37 kDa and r-lep27 kDa), into HeLa cells was observed by electron microscopy. The entry activity was preserved even when 315 bp (105 aa) and 922 bp (308 aa) was truncated from the N-terminus and C-terminus, respectively. This 316-921 bp region was divided into three sub-regions: 316-531 bp (InvX), 532-753 bp (InvY), and 754-921 bp (InvZ). Each sub-region was cloned into an AIDA vector and expressed on the surface of E. coli. Entry of these E. coli into monolayer-cultured HeLa and RPMI2650 cells was observed by electron microscopy. Only E. coli harboring the InvX sub-region exhibited cell entry. InvX was further divided into 4 domains, InvXa-InvXd, containing sequences 1-24 aa, 25-46 aa, 47-57 aa, and 58-72 aa, respectively. Recombinant E. coli, expressing each of InvXa-InvXd on the surface, were treated with antibodies against these domains, then added to monolayer cultured RPMI cells. The effectiveness of these antibodies in preventing cell entry was studied by colony counting. Entry activity was suppressed by antibodies against InvXa, InvXb, and InvXd. This suggests that these three InvX domains of Mce1A are important for M. leprae invasion into nasal epithelial cells.

Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting

Objective

To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting.

Methods

From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality.

Results

From hospital admission, patients were followed over a median of 18 (IQR 6-36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88).

Conclusions

Patients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.

Correlation Between Onset of Diabetes Mellitus and Nitric Oxide Levels in Patient with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (DM) is associated with increased risk of endothelial dysfunction if it lasts a long time without control. This study aims to connect the Onset of Diabetes Mellitus (DM) with Nitric Oxide levels in patients of type 2 diabetes mellitus. The study used cross-sectional study method. The samples were 86 subjects, consisting of 38 subjects of Type 2 DM controlled and 48 subjects of Type 2 DM uncontrolled. The results of the Kruskal-Wallis statistical test showed no significant difference between the Onset of DM and Nitric Oxide levels in the categories of 4-6 years (19.4 ± 10.1), 7-9 years (17.3 ± 9.3) and 10-12 years (13.3 ± 8.5) (p=0.06). Furthermore, the Spearman correlation test revealed a negative correlation between the Onset of DM and Nitric Oxide level in patients with Type 2 DM with and without control (r =-0.217). The level of Nitric Oxide (NO) can consider as a predictor of long-term complication in patients with type 2 DM.

Premixed vs basal-bolus insulin regimen in Type 2 diabetes: comparison of clinical outcomes from randomized controlled trials and real-world data

AIM

To evaluate the concordance between data derived from randomized controlled trial (RCT) and real-world estimates of HbA_1c and weight change after 24 weeks of initiation of a basal-bolus compared with a premixed insulin regimen in people with Type 2 diabetes.

METHODS

Data eight RCTs were pooled after a systematic review of studies examining basal-bolus (n = 1893) or premixed (n = 1517) regimens. Real-world data were extracted from the UK primary care dataset for people on basal-bolus (n = 7483) or premixed insulin regimens (n=10 744). The mean differences between HbA_1c and weight from baseline were calculated using t-tests, while analysis of variance was used to compare the two treatment regimens. Linear regression analyses were used to determine the predictors of this change.

RESULTS

Both insulin regimens were associated with HbA_1c reductions (real-world data -0.28%; RCT data, -1.4%) and weight gain (real-world data, +0.27 kg; RCT data, +2.96 kg) but there were no significant differences between basal-bolus and premixed insulin. Discordances in the pattern of treatment response were observed, however, between real-world and RCT data for both insulin regimens. For any given baseline HbA_1c concentration, the change in HbA_1c in the RCTs was greater than in real-world conditions and for those with baseline weight above ~60 kg, RCT data showed overall weight gain in contrast to slight weight loss in the real-world population. Lastly, for both randomized controlled trial and real-world populations, while greater baseline weight was associated with reduced response to treatment, the association was much steeper in the RCT than in the real-world population. In addition, greater baseline weight was associated with greater weight reductions in both premixed insulin and basal-bolus insulin regimens, although to a lesser extent with the latter.

CONCLUSION

These results highlight specific discrepancies in the HbA_1c reduction and weight change in insulin regimen between real world versus RCT populations; with greater reduction in HbA_1c and greater increase in weight observed in the RCT population than in the real-world population. Also, the basal-bolus regimens in both real-world and RCT populations showed greater reduction in HbA_1c compared to the premix regimen (though more marked in RCTs), while the premix regimen showed greater increase in weight in real-world, as against basal-bolus in the RCT population.

Continuous subcutaneous insulin infusion (CSII) therapy at Derby Teaching Hospitals: sustained benefits in glucose control

AIM

In the short term, continuous subcutaneous insulin infusion (CSII) has been associated with improved glycaemic control, reduced hypoglycaemia and improved quality of life (QOL). However, limited data are available on its long-term benefits, particularly in the UK. We aimed to assess the impact of CSII on longer term outcomes.

METHOD

Patient-level data were obtained for CSII users at Derby Teaching Hospitals, UK. Patient confidence and satisfaction questionnaires using the Likert scale were used to assess confidence in self-management. Comparative statistics were conducted using Pearson's chi-square and Student's t-tests.

RESULTS

Some 258 CSII users were identified (60.1% female, mean age 43.9 ± 13.4 years). Overall, there was significant decrease in HbA_1c from 78 mmol/mol (9.3 ± 2.0%) at baseline, to 69 mmol/mol (8.5 ± 1.3%) at 6 months [mean difference (md): -0.64; 95% confidence interval (95% CI): -0.91 to -0.37; P < 0.0001]; which was sustained at 6 years of follow-up (HbA_1c : 66 mmol/mol, 8.2 ± 1.3%; md: -1.07%; 95% CI: -1.45 to -0.69; P < 0.0001). One hundred and twenty-one patients (47%) responded to the survey, of whom 95 (78.5%) reported a reduction in the frequency of hypoglycaemia; 102 (84.3%) were satisfied with the quality of care received in the insulin pump service.

CONCLUSION

CSII therapy led to a sustained long-term improvement in glycaemic control in addition to a reduction in self-reported hypoglycaemia.

Comparison of cardiovascular and metabolic outcomes in people with type 2 diabetes on insulin versus non-insulin glucose-lowering therapies (GLTs): A systematic review and meta-analysis of clinical trials

OBJECTIVES

To compare the cardiovascular and metabolic outcomes of Insulin versus non-insulin glucose lowering therapy (GLT).

METHODS

We included randomised control trials (RCTs) which randomised patients aged >18years with Type 2 Diabetes (T2D) to insulin vs non-insulin GLT. We used risk ratios (RR), risk difference (RD) and odds ratios (OR) with 95% confidence interval (95%CI) to analyse the treatment effects of dichotomous outcomes and mean differences (with 95% CI) for continuous outcomes.

RESULTS

We included 18 RCTs with 19,300 participants. There was no significant difference in the risk of all-cause mortality and CV events between the groups (RR=1.01; 95%CI: 0.96-1.06; p=0.69). In 16 trials, insulin showed greater efficacy in glycaemic control (mean diff=-0.20; 95%CI: -0.28 to -0.11) but the proportion achieving HbA1c level of either ⩽7.0% or 7.4% (53 or 57mmol/mol) was similar in both (OR=1.55; 95%CI=0.92-2.62). The non-insulin group had a significant reduction in weight (mean diff=-3.41; 95%CI: -4.50 to -2.32) and an increase in the proportion of adverse events (54.7% vs 45.3%, p=0.044), but the insulin group showed an (RR=1.90; 95%CI: 1.44-2.51) increased risk of hypoglycaemia.

CONCLUSION

There was no difference in the risk of all-cause mortality and adverse cardiovascular (CV) events between Insulin and non-insulin GLTs. Insulin was associated with superior reduction in HbA1c; least reduction in weight and higher risk of hypoglycaemia. Both showed similar proportion of patients achieving HbA1c target. Non-insulin GLTs were associated with a higher risk in reported adverse drug events.

Relationship between HbA1c and cancer in people with or without diabetes: a systematic review

AIM

To identify the relationship between HbA1c and cancers in people with or without diabetes.

BACKGROUND

Cancer is a major public health problem, accounting for 8.2 million deaths worldwide in 2012. HbA1c level has been associated with the risk of developing certain cancers, although the existing evidence is conflicting.

METHODS

EMBASE, MEDLINE, CINAHL and the Cochrane Library were searched. Eligible articles included randomized controlled trials, cohort studies, case-control studies, systematic reviews and meta-analyses. Participants of either sex, with or without Type 1 or 2 diabetes, were included. The studies were assessed using the Scottish Intercollegiate Guidelines Network (SIGN) criteria by two independent assessors. No meta-analysis was performed because of the heterogeneity of results.

RESULTS

A total of 19 studies from 1006 met the inclusion criteria, of which 14 were cohort studies and five were nested case-control studies. Eight studies investigated outcomes for all cancer sites. Four of these studies reported that higher HbA1c levels were associated with higher incidence and/or mortality risk for all cancers. One study observed a U-shaped relationship between HbA1c and cancer incidence and mortality. Increasing HbA1c levels were associated with increasing risk of developing colorectal, pancreatic, respiratory and female genital tract cancers. No increased risk was observed for breast cancer, gastrointestinal or urological malignancies.

CONCLUSION

HbA1c appears to be associated with cancer incidence and/or cancer mortality, but further studies are needed to fully understand the complex relationship between HbA1c and cancer.

Promoting health and reducing costs: a role for reform of self-monitoring of blood glucose provision within the National Health Service

AIM

To determine the cost-effectiveness of all options for the self-monitoring of blood glucose funded by the National Health Service, providing guidance for disinvestment and testing the hypothesis that advanced meter features may justify higher prices.

METHODS

Using data from the Health and Social Care Information Centre concerning all 8 340 700 self-monitoring of blood glucose-related prescriptions during 2013/2014, we conducted a cost-minimization analysis, considering both strip and lancet costs, including all clinically equivalent technologies for self-monitoring of blood glucose, as determined by the ability to meet ISO-15197:2013 guidelines for meter accuracy.

RESULTS

A total of 56 glucose monitor, test strip and lancet combinations were identified, of which 38 met the required accuracy standards. Of these, the mean (range) net ingredient costs for test strips and lancets were £0.27 (£0.14-£0.32) and £0.04 (£0.02-£0.05), respectively, resulting in a weighted average of £0.28 (£0.18-£0.37) per test. Systems providing four or more advanced features were priced equal to those providing just one feature. A total of £12 m was invested in providing 42 million self-monitoring of blood glucose tests with systems that fail to meet acceptable accuracy standards, and efficiency savings of £23.2 m per annum are achievable if the National Health Service were to disinvest from technologies providing lesser functionality than available alternatives, but at a much higher price.

CONCLUSION

The study uncovered considerable variation in the price paid by the National Health Service for self-monitoring of blood glucose, which could not be explained by the availability of advanced meter features. A standardized approach to self-monitoring of blood glucose prescribing could achieve significant efficiency savings for the National Health Service, whilst increasing overall utilisation and improving safety for those currently using systems that fail to meet acceptable standards for measurement accuracy.

Reclamation from palm oil mill effluent using an integrated zero discharge membrane-based process

This research emphasizes eloquently on membrane technology for treatment of palm oil mill effluent (POME) as it is the Malaysia’s largest and most important agro based industry. Findings established significant quality improvement with an efficient recovery of water from palm oil mill via innovative membrane application. Conventional bio-methods, whilst adhering to the Department of Environment’s (DOE) discharge regulations, produces brownish liquid which pales in comparison to the crystal clear water obtained through membrane treatment. The pre-treatment process consists of coagulation-flocculation using green environmental coagulant bases such as Moringa oleifera (MO) seeds. The ultrafiltration polyvinylidene difluoride (PVDF) and thin film composite (TFC) reverse osmosis were vital for the membrane processes. The system gave 99% suspended solids reduction in suspended solid and 78% of water present was successfully recovered. This technology guarantees water recovery with drinking water quality; meeting the US Environmental Protection Agency (USEPA) standard or could be recycled into the plant with sludge utilization for palm oil estates, thus enabling the concept of zero discharge to be executed in the industries. In addition, green and healthy antioxidants such as oil and beta-carotene can be recovered from POME further demonstrate. Silica gel showed better performance in separation of carotenes from oil at temperature 40°C using adsorption chromatography with 1154.55 ppm. The attractiveness of this technology, enabling the utilization of reuse of agricultural waste into potentially value added products.

Drug-Induced Diabetes Mellitus: Evidence for Statins and Other Drugs Affecting Glucose Metabolism

Abnormalities of glucose metabolism and glucose tolerance, either because of a reduction in tissue sensitivity to insulin (e.g., in liver, skeletal muscle, and adipose tissues) and/or a reduction in pancreatic insulin secretion, are associated with a number of unwanted health outcomes. Even small increases in circulating glucose levels (often described as dysglycemia or prediabetes) may confer an increased risk of cardiovascular (CV) disease and progression to overt type 2 diabetes. A number of drug therapies, many of them used long term in chronic disease management, have adverse effects on glucose metabolism, diabetes risk, and glycemic control among patients with preexisting diabetes. In this study, we review the evidence, underlying mechanisms, and the clinical significance of drug-related adverse effects on glucose metabolism.

Semianalytical approach to criteria for ignition of excitation waves

We consider the problem of ignition of propagating waves in one-dimensional bistable or excitable systems by an instantaneous spatially extended stimulus. Earlier we proposed a method [I. Idris and V. N. Biktashev, Phys. Rev. Lett. 101, 244101 (2008)] for analytical description of the threshold conditions based on an approximation of the (center-)stable manifold of a certain critical solution. Here we generalize this method to address a wider class of excitable systems, such as multicomponent reaction-diffusion systems and systems with non-self-adjoint linearized operators, including systems with moving critical fronts and pulses. We also explore an extension of this method from a linear to a quadratic approximation of the (center-)stable manifold, resulting in some cases in a significant increase in accuracy. The applicability of the approach is demonstrated on five test problems ranging from archetypal examples such as the Zeldovich-Frank-Kamenetsky equation to near realistic examples such as the Beeler-Reuter model of cardiac excitation. While the method is analytical in nature, it is recognized that essential ingredients of the theory can be calculated explicitly only in exceptional cases, so we also describe methods suitable for calculating these ingredients numerically.