bluuebunny/crossref_metadata_2025 huggingface dataset:
M10. Investigating prognostic value of cardiac biomarkers for predicting mortality in novel coronavirus disease-2019 patients: A meta-analysis of diagnostic test accuracy
Authors: Govardi Ericko , Kamarullah William , Sabrina Adelia Putri , Rocky Marthin Alexander
Published: April 2022

Aims

Cardiac injury is common in novel coronavirus disease-2019 (COVID-19) patients and is associated with an increased risk of mortality. However, the prognostic accuracy of cardiac biomarkers in predicting mortality in COVID-19 patients remains unclear. A meta-analysis of diagnostic test accuracy was conducted to find cost-effective biomarkers, particularly those frequently evaluated to enable risk stratification and sensible resource allocation.

Methods

We systematically searched PubMed, Europe PMC, and SCOPUS for studies published up to June 2021. Studies were enrolled, if they included assessment of the accuracy of predetermined cardiac biomarkers (troponin, lactate dehydrogenase (LDH), creatine kinase, and N-terminal pro-brain natriuretic peptide (NT-proBNP)) in predicting mortality of COVID-19 patients and provided sufficient data to construct a 2 x 2 contingency table.

Results

This meta-analysis showed cardiac troponin was the most reliable biomarker in prognosticating mortality in COVID-19 patients (area under curve (AUC) = 0.79 (0.76–0.83), sensitivity = 0.63 (0.52–0.73), specificity = 0.80 (0.74–0.84)), followed by LDH (AUC = 0.75 (0.71–0.78), sensitivity = 0.72 (0.63–0.80), specificity = 0.65 (0.54–0.75)), NT-proBNP (AUC = 0.73 (0.69–0.77), sensitivity = 0.55 (0.41–0.68), specificity = 0.79 (0.68–0.87)), and creatine kinase (AUC = 0.35 (0.31–0.39), sensitivity = 0.27 (0.19–0.36), specificity = 0.76 (0.49–0.92)).

Conclusion

Increased cardiac injury biomarkers may aid in the identification of individuals who are most at risk, especially cardiac troponin with AUC 0.79, 63% sensitivity and 80% specificity.
M11. Magnesium Sulfate as Atrial Fibrillation Prophylaxis post Coronary Artery Bypass Graft Surgery: A Meta-analysis
Authors: Rismawanti R I , Rachmanadi M B
Published: April 2022

Background and Aims

Arrhythmia, especially atrial fibrillation (AF), is a common complication post coronary artery bypass graft (CABG) surgery and a major source of morbidity and mortality. This meta-analysis aims to evaluate the use of magnesium sulfate (MgSO4) as AF prophylaxis post CABG surgery.

Method and Results

A total of 10 studies enrolled 1,371 patients (1,114 males and 257 females) were retrieved from Pubmed, Cochrane, and Medline until July 2021 to identify studies about the association between MgSO4 and AF occurrence post CABG surgery. All suitable full text must accomplish Jadad score ≥2 for assessing study quality. Data were analyzed using Review Manager 5.3. Mantel-Haenszel formula was used for dichotomous variables to calculate the odds ratio (OR). Our results showed MgSO4 group (n = 711) compared to the placebo group (n = 660) were at decreased odds of having AF post CABG surgery (OR 0.59; 95%CI 0.39 to 0.91; p = 0.03) with AF occurrence in 134 patients and 188 patients, respectively. Data were derived from the random-effects model due to the heterogenous result between studies (Tau2=0.22, Chi2=18.99, df = 9 [p = 0.03], I2 = 53%).

Conclusion

This meta-analysis showed that administration of MgSO4 decreased the occurrence of AF occurrence post CABG surgery. Further research is needed to determine the optimal MgSO4 dose and time of administration.
C6. Acute Limb Ischemia Patient with Covid 19 Progressing to Chronic Limb-Threatening Ischemia: a Case Report
Authors: Wicaksono  , Kurnianingsih N
Published: April 2022

Background

Acute Limb Ischemia (ALI) and Chronic Limb-Threatening Ischemia (CLTI) are manifestations of Peripheral Artery Disease (PAD). The management of ALI and CLTI, apart from optimal medical treatment and lifestyle control, also includes surgery and endovascular revascularization. ALI and CLTI conditions can be a thromboembolic complication of Covid 19.

Case Description

A 58-year-old woman with risk factor Diabetes Mellitus presents with a black leg on the digiti I and digiti II of the right inferior extremity. She also complains of walking pain for 2 months. Previously, She had been treated with complaints of ischemic leg pain 2 months earlier and had performed a Doppler Ultrasound. At that time, she was diagnosed as ALI Grade II-A and was positive for Covid 19, from the laboratory examinations it was found an increase in fibrinogen, 419 mg/dl (Reference value 154.3-397.9) and D-Dimer increased to 0.9 mg/L (Reference value ≤ 0.5), She had undergone a surgical embolectomy procedure. At the time of the last control and based on CT-angiography, she was assessed as CLTI with Fontaine IV, Rutherford V, WIfI 1-1-0 and decided to do endovascular revascularization.

Discussion

The choice of either a surgical procedure or endovascular revascularization depends on grading and the initial assessment. Correct timing of ALI and CLTI treatment will increase limb salvage rate. Covid 19 can also manifest as a condition associated with a hypercoagulable state that can, in turn, lead to both arterial and venous thrombosis.
C15. Biventricular Heart Failure and Pulmonary Hypertension in Systemic Sclerosis: a rare and unusual case report
Authors: Farissa I P , Trisnawan M H , Ahnaf M F , Hellmi R Y
Published: April 2022

Backgrounds

Systemic sclerosis (SSc), chronic multisystem autoimmune disease, characterized by excessive fibrosis and vascular endothelial dysfunction. Cardiovascular involvement may be induced by various pathways, either primary or secondary to pulmonary hypertension or renal involvement.

Case Summary

A 46 years old woman presented to emergency department with cold, dark purplish ulcers in fingertips with progressive worsening pain in upper extremities, claudication intermitten, and dyspneu since 4 months ago. She had a mask-like facial, shiny skin, microstomia, restricted mouth opening, calcinosis cutis, Raynauds phenomenon, and sclerodactyly. There were pansystolic murmur grade III/6 in tricuspid area, and rales in basal lungs. ECG showed sinus rhythm with fragmented QRS, poor R-wave progression. Chest X-Ray revealed pancardiomegaly with pleural effusion and HRCT thorax revealed interstitial lungs disease. The laboratory revealed leucocytosis, increase D-dimer (870 ug/L), negative ANA and ds-DNA test, positive anti SCl test. Echocardiography showed biventricular dysfunction with decreased LVEF 37% (Teichz) and TAPSE 10 mm, RA RV dilatation, severe TR with high probability for PH. Extremities Doppler showed normal arteries and veins system. These findings indicates that primary and secondary cardiac involvement in SSc. Heart failure, pulmonary hypertension, and cyclophosphamide medication were administered

Discussion

Primary cardiac involvement, a direct consequence of SSc, may manifest as fibrosis of the myocardial, conduction system, pericardial and, valvular disease. Furthermore, a secondary phenomenon due to pulmonary arterial hypertension (PAH), and kidney pathology. Though the burden remains low, it may worsen the outcome, consequently, all patients with SSc should undergo screening.
C24. Cardioembolic Stroke due to LV Thrombus : Very High Risk NSTEMI Complication
Authors: Valdy Gerry , Syafri Masrul , Syukri M
Published: April 2022

Background

Ischemic heart disease is the major cause to the high mortality rate. Ischemic heart disease was responsible for 7 million of the 53 million deaths reported in 2010. Left ventricle thrombus that complicates acute myocardial infarction (AMI) is a major cause of cardioembolic stroke.

Case Summary

A 69-year-old man presented with typical of infarction chest pain and shortness of breath since 2 days before admission to the hospital. The patient was diagnosed with NSTEMI TIMI 4/7 GS 177, PVC Frequent and history of VT and was planned for immediate PCI. After cannulation in the left coronary artery, the patient developed VT/VF and therefore CPR was performed. The patient was in ROSC then admitted to the CVCU and had improved. After two days of treatment, the patient experienced weakness in right limbs and difficulty of speaking, followed by decreased consciousness and suspected with ischemic stroke. The patient was then immediately treated for cardioembolic stroke. After 1 day of treatment the patient got worsened and was declared dead.

Discussion

Based on NSTEMI startification, patients was included in very high risk with a major cardiovascular event rate of 40.9%. During the treatment, patients experiencing cardioembolic stroke which causes increased mortality. Management of cardioembolic stroke as soon as possible increases the chances of success in therapy
C43. Eisenmenger Syndrome The Challenge of Untreated Large Ventricular Septal Defect in Pregnant Women: A Case report
Authors: Kalista Yuliet , Djoen Herdianto , Rheza Giovanni
Published: April 2022

Background

Eisenmenger syndrome is a constellation of symptoms that arise from an uncorrected large congenital heart disease that have a reversed shunt to right to left. Eisenmenger syndrome in pregnancy is rare because pregnancy in this patient is not recommendeed due to high mortality for mother and baby. The objective of this case report is to highlight the argument of Eisenmenger syndrome in pregnancy.

Case Summary

A 38-years pregnant woman presented to the emergency room with dyspnea since the third trimester. Reported history of the untreated ventricular septal defect. Central cyanosis, systolic murmur and lower extremity oedema were found. ECG showed a right axis deviation with right ventricular hypertrophy. Cardiomegaly was found from a chest x-ray. Left ventricular diastolic dysfunction, large ventricular septal defect with Right-Left shunt, and pulmonary hypertension were found from echocardiography. Based on characteristic appearance, a diagnosis of Eisenmenger syndrome was made. Caesarean delivery was performed and the baby delivered safely, but the mother passed away.

Discussion

Eisenmenger syndrome in pregnancy comes with high mortality to mother and baby. A ventricular septal defect is a common cause of Eisenmenger syndrome. The choice for medical treatment from Eisenmenger syndrome in pregnancy is still controversial. Both caesarean section and vaginal delivery could be harmful to the patient due to vulnerability to hemodynamic change.
C45. Exercise-Induced Ventricular Tachycardia in Normal Coronary Artery Patient with Incidental Finding of COVID-19 : a case report
Authors: Taim A I , Saleh K , Muzakkir
Published: April 2022

Background

Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation.

Case Description

A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions.

Discussion

Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.
C48. How to handle VT storm in ICD patient : serial case report
Authors: Prismadani M , Julario R
Published: April 2022

Background

Ventricular tachycardia (VT) storm can cause sudden death in patients with trans-venous implantable cardioverter-defibrillator (ICD) and adversely affects prognosis in survivors. Patients with recurrent shocks have a poor quality of life and increased mortality rates. The purpose of this case series was to discuss the available treatment option for VT storm in ICD patients.

Case Summary

We reported two patients with VT storm on ICD. Both patients had palpitation, clinical heart failure, and recurrent shocks from ICD with appropriate rhythms. The first case had hypokalemia with ICD recording showed 45 episodes of VT, 45 antitachycardia pacing (ATP), and 5 shocks therapy. The second case had hypomagnesemia with ICD recording showed 195 episodes of VT, 42 ATP, and 3 shocks therapy. Management approaches to these patients include ICD reprogramming, correcting electrolyte abnormalities, treating heart failure and administering anti-arrhythmic drugs (AADs).

Discussion

VT storm on ICD refers to three or more appropriate therapies for ventricular tachyarrhythmias, including ATP or shocks, within 24 hours. The known triggers must be treated, such as electrolyte disturbance and worsened heart failure. AADs therapy could suppress VT and increased the tachycardia cycle length (TCL) so that the response to ATP is better. ICD reprogramming include higher heart rate treshold, longer detection period, and improving ATP programming. Catheter ablation and cardiac sympathetic denervation (CSD) may be an option if VT storm persists.
C52. Infected Femoral Artery Pseudoaneurysm with Klebsiella pneumoniae Bacteremia in Injected Drug Abuser: A Case Report
Authors: Khairunnisa H , Mardhiyah I , Mahavira A , Pasaribu F Z
Published: April 2022

Background

Injected drug abuse is a significant problem in modern societies today, with increases various vascular complications due to repeated punctures under septic conditions. One of the severe vascular complications is infected pseudoaneurysm. However, no study reported the involvement of Klebsiella pneumonia in infected pseudoaneurysm.

Case Summary

A 40-year-old homeless man, an injected drug abuser, presented to the emergency department with a severe pain lump in the right groin area since three weeks ago. The hemodynamic was unstable and the laboratory examination revealed severe infection. While ultrasonography was suggesting high suspicion of lymphadenitis in the right groin area, the Doppler ultrasonography was showing a pseudoaneurysm in the right common femoral artery. The blood cultures grew Klebsiella pneumonia ESBL. Patient was planned to be referred to vascular surgery center. Unfortunately, before patient got a referral, his condition worsened with a fall of hemoglobin suggesting rupture of pseudoaneurysm that didn’t improve with resuscitation.

Discussion

A tender swollen groin in an injected drug abuser should prompt a high index of suspicion for the presence of pseudoaneurysm. When faced with uncertain diagnosis, further investigation with appropriate imaging is warranted. In this case, diagnosis of infected pseudoaneurysm was confirmed due to the co-incidence of septic condition. Surgical management with controlled infection and resuscitation was required, however, it remained a challenge due to the unstable condition and pseudoaneurysm itself that was prone to rupture. In addition, Klebsiella pneumonia ESBL made bacteria resistant to cephalosporins and monobactams.
C53. Infection of Coronavirus Disease 2019 Reveals Brugada Pattern
Authors: Patriya N A S , Yasa A
Published: April 2022

Background

Coronavirus Disease 2019 (COVID-19) resulted considerable morbidity and mortality worldwide since December 2019. In the other hand, Brugada syndrome had higher risk of sudden cardiac death. Although it was manifested with an electrocardiographic (EGC) abnormalities, the patients with Brugada syndrome were often healthy and unaware of their genetic predisposition.

Case Summary

A 59 years old man without significant medical history was reported a day of fever, productive cough, and shortness of breath. He did not complain any chest pain, palpitation, and episode of syncope. The patient had no family history of sudden cardiac death. On presentation, he was febrile (39,5°C), tachycardia (110 beats/ min), and tachypnea (28 breath/ min). Laboratory findings of the patient were elevated High-sensitivity C-reactive protein (hs-CRP), with normal electrolyte level, and troponin. The Polymerase chain reaction (PCR) test for COVID-19 performed with the positive result. The chest radiograph showed multifocal bilateral interstitial with a normal cardiac silhouette. The ECG revealed Brugada type 2 ECG pattern. A bedside echocardiogram demonstrated with the normal result. His condition continued to improve and the ECG demonstrated complete resolution of the initial Brugada ECG pattern.

Discussion

COVID-19 infection has been described as unmasking Brugada pattern. The most frequently reported symptoms of COVID-19 was fever. Brugada syndrome was a genetic disorder, that was most commonly involving SCN5A gene, which encoded the cardiac sodium channel. Fever caused blockade of sodium channel was being well described provocative trigger that might incite arrhythmia in patient with Brugada syndrome.
C54. Infective Endocarditis with Ventricular Septal Defect and Ruptured Sinus of Valsalva: A Case Report
Authors: Zebua J , Nasution A N , Siregar A A , Hasan H
Published: April 2022

Background

Ventricular Septal Defect (VSD) is the most common congenital heart defect with incidence rate about 50% of all case in children. VSD is often followed by weakness of the wall in the sinus of Valsalva causing aneurysms, where 30-50% of cases of aneurysms in the sinus of Valsalva is associated with VSD. Congenital heart defects also increased risk factors for infective endocarditis (IE) with the risk of infection 15-140 times greater than the general population.

Case Description

A 7-year-old boy was reported with fever and shortness of breath, echocardiography examination showed subaortic VSD, ruptured sinus of Valsalva, multiple vegetation on left ventricular outflow tract, right coronary cusp, and right ventricle, moderate aortic, pulmonal and tricuspid regurgitation with mild pulmonal hypertension. Although there was no growth of bacteria from blood culture but result from kidney ultrasound showed sign of glomerulonephritis, suggesting additional findings in Duke criteria. The patient was treated with broad spectrum antibiotic and heart failure drugs. Then, Heart Team decided to refer the patient to Cardiac Center Harapan Kita for evacuating vegetations and repairing congenital heart defect.

Discussion

Infective endocarditis is one of the most arduous complication that must be treated immediately in patients with VSD. Besides reducing the symptoms that arise from heart defects, the clinicians also have to stop the process of infection. Adequate antibiotics and immediate surgery are the best strategy to evacuate the focus of infection as well as to repair congenital defects.
C57. Left Main Coronary Artery Compression by A Dilatated Pulmonary Artery in Patients with Pulmonary Arterial Hypertension: What Should We Do?
Authors: Jauhari H , Anggrahini D W , Hartopo A B
Published: April 2022

Background

Pulmonary artery hypertension (PAH) is often associated with angina and extrinsic compression of left main coronary artery (LMCA) by a dilatated pulmonary artery is recognized as the cause. The optimal management for pulmonary arterial hypertension with extrinsic LMCA compression has not been clearly established.

Case Summary

We report on 31-year-old female with secundum atrial septal defect and 44 -year-old female with incomplete atrioventricular septal defect complain of progressive typical angina that aggravated with exertion. The electrocardiogram showed right heart strain and chest radiograph showed cardiomegaly involving the right cavities with enlargement of the pulmonary arch. Right heart catheterization showed pulmonary arterial hypertension with the mean pulmonary artery pressure of 61 mmHg and 65 mmHg respectively. Cardiac CT demonstrated compression of proximal LMCA by dilatated pulmonary artery. Although with optimal phosphodiesterase-5 (PDE5) inhibitor and prostacyclin analog therapy, patients still complain of angina.

Discussion

LMCA compression may be associated with additional complications of severe myocardial ischemia, including myocardial infarction, left ventricle dysfunction, arrhythmia, and eventually, sudden death. It may occur in patients with PAH with severely dilated PA and can be identified with either computed tomographic coronary angiography or selective coronary angiography. Furthermore, there are no guidelines recommending optimal management of this disease entity. Optimalization of pharmacologic treatment of PAH may reduce compression-related symptoms. A stent implantation is a promising alternative option for the treatment of LMCA compression and provides an optimal risk-to-benefit ratio, both for symptom relief and for long-term outcomes.
C62. May-Thurner syndrome, a diagnosis and endovascular treatment in adult women with no risk factor: a case report and literature review
Authors: Hidayatullah F N , Pasciolly R M R J
Published: April 2022

May-Thurner syndrome (MTS) is a venous compression syndrome in which the left common iliac vein (LCIV) is compressed between the lower lumbar spine and the right common iliac artery (RCIA). This syndrome is suspected when a patient presents with recurrent or chronic venous insufficiency (CVI) or deep vein thrombosis (DVT) on his/her left lower extremity; although MTS’ clinical presentation varies. A history of recurrent left lower extremity DVT and symptoms associated with chronic venous hypertension, including varicosities, venous ulcers, lower limb swelling, and pain in the inguinal, calf, or upper leg regions suggests MTS diagnosis. We present a case report and conduct a literature review on a patient presenting with painful, numb, and swollen left leg since three months before admission. Intermittent claudication was found. Doppler ultrasonography confirmed no thrombus, yet suggested that the RCIA compressed the LCIV. Doppler’s finding was confirmed using computed tomography (CT) scan, and RCIA compression seemed to cause an obstruction. MTS diagnosis is often missed in patients with lower limb pain because the block is not caused by a thrombus and a clinician often misses to conduct Doppler examination on the iliac artery/vein. This study highlights the importance of considering MTS in a patient with left lower limb pain, and chronic DVT which is unresponsive to pharmacological treatment, hence, endovascular treatment may be warranted.
C70. Performing Percutaneous Coronary Intervention in Dextrocardia: A Case Report
Authors: Syafar R H , Khairat M , Syukri M
Published: April 2022

Background

Dextrocardia is defined as the heart location in the right hemithorax with the apex pointing inferiorly and to the right. Performing percutaneous coronary intervention (PCI) in patient with dextrocardia can be difficult and requires some modification.

Case Summary

A 55-years old male with chest pain 3 hours before admission, apex in right side, a chest X-ray confirm the heart in the right hemithorax, electrocardiogram (ECG) was consistent with dextrocardia and showed inferior ST-segment elevation myocardial infarction (STEMI). We performed primary PCI with femoral access. During coronary angiography, it was a challenge to engage the diagnostic catheter to both of ostium right and left coronary artery. Coronary angiography showed total occlusion in the proximal of right coronary artery (RCA). We inversed the engagement technique and radiological angles for RCA from the left anterior oblique 35º to the right anterior oblique 30º and finally revascularization could be done easier.

Discussion

Performing PCI in patient with dextrocardia can be challenging. Inversion the engagement technique and radiological angles and views will give an advantage to the operator for imaging and doing intervention. Using image reversal technology is also help to get the image like a normal position.
C83. Recurrent Syncope in Isolated Right Ventricular Non-Compaction Cardiomyopathy: A Case Report
Authors: Chandra S , Lukito A A , Hutabarat H , Fernandes R A P
Published: April 2022

Isolated right ventricular non-compaction cardiomyopathy (iRVNC) is a rare disease, and often under diagnosed. The patients might come with right heart failure, ventricular arrhythmias and systemic embolism. A 64 –yo female presented with episodes of recurrent syncope. There is thickened trabecular on apical right ventricular (RV), moderate tricuspid regurgitation and moderate probability of pulmonary hypertension on echocardiography. Furthermore, cardiac MRI on this patient confirned hypertrabeculated and dilatation of RV, spongiform appearance of the RV apical, non-compacted (NC) thickness of the RV was 23.5 mm at the apical level with compacted thickness (C) of 2 mm (NC to C ratio 11,7), hypertrophic moderator band, and dilatation RA and global hypokinetic and decreased function of RV. Hence, the diagnosis was an isolated right ventricular non-compaction cardiomyopathy, without LV involvement. The medication given including sildenafil, nebivolol, spironolactone, digoxin and edoxaban. Lesson learned from this case, syncope might be one of iRVNC symptoms. Multiple modalities could be needed for diagnostic confirmation for patients with syncope. Echocardiography as a diagnostic tool is useful to find prominent trabeculations and when NC/C ratio >2. If the echocardiographic findings were inconclusive, cardiac MRI was could be performed for better discrimination between compact and non-compact inner and outer layers of myocardium with NC/C ratio > 2,3.
C85. Right heart failure due to chronic thromboembolic pulmonary hypertension in systemic lupus erythematosus patient: a case report
Authors: Saputra B M I , Darma K S S
Published: April 2022

Background

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with varying clinical manifestations and high risk of thrombosis. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) as late complication of acute pulmonary embolic sometimes occured in SLE patients and in advanced condition it can manifest as right heart failure.

Case Summary

A female, 29 years old with complaints of bilateral ankle oedema and bloated stomach, as well as dyspneu on effort occurred progressively since approximately 4 months. These complaints were also accompanied by hair loss and redness on both cheeks. Physical examination revealed increased jugular venous pressure, systolic murmur in left lower sternal border, ascites, hepatomegaly, and bilateral ankle oedema. Echocardiography revealed dilated right atrium and right ventricle (RV), decreased RV systolic function, severe tricuspid regurgitation, and distended inferior vena cava. Computed tomography (CT) pulmonary angiography showed filling defect in the left pulmonary artery. Lab examination showed an increase in D-dimer, ANA titer >1: 1000, and lupus anticoagulant ratio 1.59. Diuretics therapy, anticoagulant, corticosteroid, and immunosuppressant were given to this patient. Right heart function was improved following the treatment.

Discussion

The increased risk of thrombosis in this case is related to several factors, including: antiphospholipid antibodies, inflammation and disease activity. CTEPH is formed as a result of poor resolution of the thrombus in the pulmonary arteries, resulting in fibrosis of residual thrombotic material that can impede blood flow. Increased intrapulmonary pressure due to pulmonary vascular obstruction causes RV remodeling and dysfunction.
C86. Secondary Prophylaxis For Rheumatic Heart Disease During The Pandemic Era: A Case Report
Authors: Ramadhan G F , Supriadi E
Published: April 2022

Background

Rheumatic heart disease (RHD) is heart diseases results from recurrent episodes of acute rheumatic fever (ARF). It often occurs in developing countries and its pathogenesis is not clearly understood. RHD can be controlled with prophylaxis that requires patients to visit healthcare facility regularly. However, the current pandemic condition is a challenge for patients to receive routine treatment and evaluation.

Case Summary

A 17-years-old girl comes to emergency room with complaints of shortness of breath with mark limitation of physical activity 3 days prior to admission. The patient also complaint with joint pain and leg swelling. She was diagnosed Rheumatic Heart Disease and received prophylactic penicillin injections every month. However, since the pandemic, She do vice versa. In physical examination was found pansystolic murmur on aortic valve and bilateral lower extremity edema. Echocardiography showed moderate mitral regurgitation and mild aortic regurgitation. This patient was hospitalized and treated with benzathine penicillin G, prednisone, aspirin, furosemide and captopril.

Discussion

Management of ARF includes eradication cause of infection, treat complications, and secondary prevention. Administration of secondary prophylaxis is useful for reduce new bacterial strains that can cause recurrent acute or chronic attacks. First line of secondary prophylaxis for ARF is intramuscular benzathine penicillin G that given per month. In this current pandemic conditions, patients are expected to continue prophylaxis therapy and follow up the disease with using pandemic health protocols.
C94. The characteristics and outcome of pediatric patients with congenital heart disease (CHD) infected by coronavirus disease 2019 (COVID-19) between march 2020 to february 2021 at sanglah hospital: a case series of 12 patients
Authors: Ambara G S , Gunawijaya E , Yantie N P V K
Published: April 2022

Background

Coronavirus disease 2019 (COVID-19) has a complex connection to cardiovascular system. COVID-19 infection has been proven to cause significant dysfunction in lung, heart, and endothelial cells. Therefore, patients with complex congenital heart lesions have a high risk of developing severe complications and worse outcomes. This paper aims to determine the characteristics and outcome of pediatric congenital heart disease (CHD) patients infected by COVID-19 at Sanglah hospital.

Case Summary

Within the period of March 2020 to February 2021, there were 12 cases of pediatric CHD accompanied by COVID-19 infection, which consists of 8 females and 4 males within the age of 6 days to 18 years. Based upon symptomatic CHD classification, there were 4 cyanotic CHD cases and 1 acyanotic case, respiratory problems were reported in all 5 cases. These are pneumonia in 4 cases and respiratory distress caused by hyaline membrane disease (HMD) in 1 case. 2 cases require mechanical ventilation. The outcome of all inpatient cases were favorable.

Discussion

To date, there are only few scientific evidence detailing how COVID-19 affects CHD. We were unable to calculate the correlation analysis since the population sample was too small. The most severe cases that requires mechanical ventilation had comorbidities in the form of malnutrition and down syndrome. From the perspective of pathophysiology, one of the most important factor determining outcome was the severity of CHD itself. Other contributing factors were COVID-19’s destructive effect on heart tissue and co-infection by other microorganism.
C96. The First Percutaneous Transvenous Mitral Commissurotomy guided by Three Dimensional Transesophageal Echocardiography in Haji Adam Malik General Hospital Medan
Authors: Indra R K , Lubis A C , Ardini T W , Hasan H
Published: April 2022

Background

Percutaneous Transvenous Mitral Commissurotomy (PTMC) has become the treatment of choice for patients with mitral stenosis. PTMC guided by three-dimensional Transesophageal Echocardiography (3D-TEE) promise of greater safety and efficacy.

Case Summary

We report a 29-year-old woman who came to our outpatient clinic with shortness of breath as a chief complaint for the past three months. ECG depicted sinus rhythm. Transthoracic Echocardiography (TTE) and 3D-TEE showed severe mitral stenosis with MVA planimetry: 0.8 cm2, MV mean PG 12 mmHg, MV PHT 403 ms, Wilkins score was 4 and no thrombus was found. Therefore, we decided to do PTMC. We successfully done the antegrade transseptal puncture by fluoroscopy guided by two-dimensional (2D) TEE . Then, we used Inoue-balloon catheter No. 24 to dilate the mitral valve. Afterthat, we did 3D-TEE evaluation of the mitral valve area and it showed a significant improvement, with MVA 3D planimetry: 2.0 cm2 and MV mean PG: 4 mmHg and we found moderate mitral regurgitation (MR VC 0.4 cm, MR PISA: 0.3 cm), so we decided to end the procedure.

Discussion

In this case, the PTMC procedure was carried with 2D and 3D-TEE guiding, where process run more easily because interventionist can ensure the targeted site during transeptal puncture, navigation to the mitral valve and post inflation inspection. 3D-TEE guiding can also directly ensure the success of PTMC in real time by evaluating the MVA planimetry (pre and post PTMC) and the mitral regurgitation.
C98. The Role of Echocardiography as a Diagnostic Modality in Pulmonary Embolism in Intensive Care
Authors: Alaydrus S Q , Munirwan H
Published: April 2022

Background

Pulmonary embolism (PE) is the third most frequent cause of death in the world. In epidemiological studies, annual incidence rates for PE range from 39-115 per 100 000 population. Acute PE interferes with both circulation and gas exchange. Right ventricular (RV) failure due to acute pressure overload is considered the primary cause of death in severe PE.

Case Summary

A 70-year-old female patient presents to the emergency room of RSUDZA with complaints of typical chest pain that has been experienced since 3.5 hours before admission. In the emergency department, patients with obesity status with a general condition are weak and agitated. Physical examination found within normal limits. From laboratory test, there were leukocytosis and increasing of D-Dimer. From ECG we found McGinn White Sign. Based on echocardiography, we found RV/LV basal ratio > 1 accompanied by Mc Connel sign and decreased right ventricular systolic function.

Discussion

Echocardiography is one of diagnostic modalities that is very useful for making a diagnosis, where the use of echocardiography is more accessible than computer tomography (CT) as the gold standard. In this case, by using echocardiography especially in intensive rooms, the diagnosis of pulmonary embolism can be established faster in high risk patients. The prognosis of pulmonary embolism is very dependent on the speed at which the diagnosis is made.
C101. Toxoplasmic Myocarditis in Immunocompetent Patient: A Rare Case Report
Authors: Suryawan Willy , Siswanto Bambang Budi , Kurniawan Agnes
Published: April 2022

Background

Toxoplasmosis is the most frequent protozoan infection among human. Primary acquired infections in immuno-competent hosts are usually asymptomatic or may cause only slight, self-resolving and not pathognomonic symptoms. Although often considered as benign, acute infections in young healthy adults can lead to heart inﬂammation, including acute myocarditis.

Case Illustration

A 28-year-old man was admitted to the hospital with a chief complaint of flu-like illness with intermittent fever and sharp chest pain. His physical examination was unremarkable. The electrocardiography showed no significant ST-T changes. His laboratory investigations gave the following results: elevated level of HsTrop T (571 ng/L; reference: <4 ng/dL), SGOT (112 U/L; reference: <41 U/L), SGOT (114 U/L; reference: <41 U/L). The echocardiography showed lateral pericardial thickening with preserved left ventricular function. He underwent cardiac MRI (cMRI). The cMRI showed myocardial edema without ischemic scar. The serological test is positive for recent Toxoplasma infection. Therefore, the patient was diagnosed with acute toxoplasmic myocarditis and subsequently treated with corticosteroid, ACE-I, beta blocker, and a combination of pyrimethamine and clindamycin. His symptoms was improved.

Discussion

We reported a case of an acute toxoplasmic myocarditis in an immunocompetent young man. This case demonstrates the importance of determining the etiology of myocarditis in order to start an appropriate therapy and prevent possible sequeale.
An artificial coculture fermentation system for industrial propanol production
Authors: Hocq Rémi , Sauer Michael
Published: April 2022

Converting plant biomass into biofuels and biochemicals via microbial fermentation has received considerable attention in the quest for finding renewable energies and materials. Most approaches have so far relied on cultivating a single microbial strain, tailored for a specific purpose. However, this contrasts to how nature works, where microbial communities rather than single species perform all tasks. In artificial coculture systems, metabolic synergies are rationally designed by carefully selecting and simultaneously growing different microbes, taking advantage of the broader metabolic space offered by the use of multiple organisms. 1-propanol and 2-propanol, as biofuels and precursors for propylene, are interesting target molecules to valorize plant biomass. Some solventogenic Clostridia can naturally produce 2-propanol in the so-called Isopropanol–Butanol–Ethanol (IBE) fermentation, by coupling 2-propanol synthesis to acetate and butyrate reduction into ethanol and 1-butanol. In this work, we hypothesized propanoate would be converted into 1-propanol by the IBE metabolism, while driving at the same time 2-propanol synthesis. We first verified this hypothesis and chose two propionic acid bacteria (PAB) strains as propanoate producers. While consecutive PAB and IBE fermentations only resulted in low propanol titers, coculturing Propionibacterium freudenreichii and Clostridium beijerinckii at various inoculation ratios yielded much higher solvent concentrations, with as much as 21 g/l of solvents (58% increase compared to C. beijerinckii monoculture) and 12 g/l of propanol (98% increase). Taken together, our results underline how artificial cocultures can be used to foster metabolic synergies, increasing fermentative performances and orienting the carbon flow towards a desired product.
An interolog-based barley interactome as an integration framework for immune signaling
Authors: Velásquez-Zapata Valeria , Elmore James Mitch , Fuerst Gregory , Wise Roger P
Published: April 2022

The barley MLA nucleotide-binding leucine-rich-repeat (NLR) receptor and its orthologs confer recognition specificity to many fungal diseases, including powdery mildew, stem-, and stripe rust. We used interolog inference to construct a barley protein interactome (Hordeum vulgare predicted interactome, HvInt) comprising 66,133 edges and 7,181 nodes, as a foundation to explore signaling networks associated with MLA. HvInt was compared with the experimentally validated Arabidopsis interactome of 11,253 proteins and 73,960 interactions, verifying that the 2 networks share scale-free properties, including a power-law distribution and small-world network. Then, by successive layering of defense-specific “omics” datasets, HvInt was customized to model cellular response to powdery mildew infection. Integration of HvInt with expression quantitative trait loci (eQTL) enabled us to infer disease modules and responses associated with fungal penetration and haustorial development. Next, using HvInt and infection–time–course RNA sequencing of immune signaling mutants, we assembled resistant and susceptible subnetworks. The resulting differentially coexpressed (resistant – susceptible) interactome is essential to barley immunity, facilitates the flow of signaling pathways and is linked to mildew resistance locus a (Mla) through trans eQTL associations. Lastly, we anchored HvInt with new and previously identified interactors of the MLA coiled coli + nucleotide-binding domains and extended these to additional MLA alleles, orthologs, and NLR outgroups to predict receptor localization and conservation of signaling response. These results link genomic, transcriptomic, and physical interactions during MLA-specified immunity.
Effect of High-Intensity Power Training on Cognitive Function in Older Adults With Type 2 Diabetes: Secondary Outcomes of the GREAT2DO Study
Authors: Zhao Ren Ru , Mavros Yorgi , Meiklejohn Jacinda , Anderberg Kylie A , Singh Nalin , Kay Shelley , Baker Michael K , Wang Yi , Climstein Mike , O’Sullivan Anthony , De Vos Nathan , Baune Bernhard T , Blair Steven N , Simar David , Fiatarone Singh Maria A
Published: April 2022

We sought to determine the effects of 12 months of power training on cognition, and whether improvements in body composition, muscle strength, and/or aerobic capacity (VO2peak) were associated with improvements in cognition in older adults with type 2 diabetes (T2D). Participants with T2D were randomized to power training or low-intensity sham exercise control condition, 3 days per week for 12 months. Cognitive outcomes included memory, attention/speed, executive function, and global cognition. Other relevant outcomes included VO2peak, strength, and whole body and regional body composition. One hundred and three adults with T2D (mean age 67.9 years; standard deviation [SD] 5.9; 50.5% women) were enrolled and analyzed. Unexpectedly, there was a nearly significant improvement in global cognition (p = .05) in the sham group relative to power training, although both groups improved over time (p < .01). There were significant interactions between group allocation and body composition or muscle strength in the models predicting cognitive changes. Therefore, after stratifying by group allocation, improvements in immediate memory were associated with increases in relative skeletal muscle mass (r = 0.38, p = .03), reductions in relative body fat (r = −0.40, p = .02), and increases in knee extension strength were directly related to changes in executive function (r = −0.41, p = .02) within the power training group. None of these relationships were present in the sham group (p > .05). Although power training did not significantly improve cognition compared to low-intensity exercise control, improvements in cognitive function in older adults were associated with hypothesized improvements in body composition and strength after power training.
Coping mechanisms and burnout among checkpoint soldiers in the IDF: a salutogenic perspective
Authors: Atias Dor , Machluf-Biton Maayan , Lior Yotam , Ohayon Ofir , Antonovsky Avishai
Published: April 2022

While many military positions are characterized by rigorous routines and long-hour shifts, some positions also require the practice of sensitivity and empathy alongside diligence and attention. Prolonged exposure to such conditions may promote emotional exhaustion, depersonalization and diminished self-accomplishment perception, all part of work-related burnout which may affect soldiers’ ability to practice their duty. The service in the Israel Defense Forces (IDF) checkpoint unit is an example of such conditions due to the soldiers’ constant interaction with civilian population. In this questionnaire-based cross-sectional study which included 404 responders from the IDF checkpoint battalions, we examined the effects of demographical, situational and personal variables on soldiers’ burnout. A hierarchical multivariate linear regression (R2 = 0.47) identified sense of coherence, the core concept in the salutogenic model of health, as the most prominent protective factor, followed by service motivation and perceived well-being (WB). Taken together, the results revealed several factors associated with military work-related burnout. These findings can serve as a base for burnout prevention programs, which may potentially improve not only the soldiers’ WB but also the interfaces between military and civilian populations.
Transfer of Anolis Locomotor Behavior Across Environments and Species
Authors: Foster Kathleen Lois , Selvitella Alessandro Maria
Published: April 2022

Arboreal animals must learn to modulate their movements to overcome the challenges posed by the complexity of their heterogeneous environment, reduce performance failure, and survive. Anolis lizards are remarkable in the apparent ease with which they conquer this heterogeneity, demonstrating an impressive ability to modulate their locomotor behavior to maintain stable locomotion on widely disparate surfaces. Significant progress has been made towards understanding the impact of substrate structure on the behavioral plasticity of arboreal species, but it is unclear whether the same strategies employed to shift between substrates in one context can be employed to shift between those same substrates in a new context. Is the kinematic shift between broad and narrow perches achieved in a similar way on different inclines? Do all species within an ecomorph make similar adjustments? Here, we analyze the limb movements of two trunk-crown Anolis ecomorphs, Anolis carolinensis and Anolis evermanni, running on 6 different surfaces (3 inclinations × 2 perch diameters), from the perspective of Transfer Learning. Transfer learning is that field of machine learning which aims at exploiting the knowledge gained from one task to improve generalization about another, related task. In our setting, we use transfer learning to show that the strategies employed to improve locomotor stability on narrow perches are transferred across environments with different inclines. Further, behaviors used on vertical inclines are shared, and thus transfer well, across perch diameters whereas the relationship between horizontal and intermediate inclines change on different perch diameters, leading to lower transfer learning of shallow inclines across perch diameters. Interestingly, the best incline for transfer of behavior differs between limbs: forelimb models learn best from the vertical incline and hind limb models learn best from horizontal and intermediate inclines. Finally, our results suggest both that subtle differences exist in how A. carolinensis and A. evermanni adjust their behaviors in typical trunk-crown environments and that they may have converged on similar strategies for modulating forelimb behavior on vertical surfaces and hind limb behavior on shallow surfaces. The transfer of behavior is analogous to phenotypic plasticity, which likely plays a key role in the rapid adaptive evolution characteristic of Anolis lizards. This work is an example of how modern statistical methodology can provide an interesting perspective on new biological questions, such as on the role and nuances of behavioral plasticity and the key behaviors that help shape the versatility and rapid evolution of Anolis lizards.