bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Protection for Child Development in Crisis: A Review of Evidence and Knowledge Gaps
Authors: Aurino Elisabetta , Giunti Sara
Published: May 2021

Globally, humanitarian needs have reached an historically unprecedented scale, undermining the ability of affected children to survive, grow, and thrive. Social protection holds the promise of addressing acute needs and risks faced by children in crisis contexts, while allowing for human capital investments. We review evidence of the impact of emergency cash, food, and other in-kind transfers implemented by governments or humanitarian actors on child development in different contexts. Compared with development settings, rigorous evidence for crises is limited. Most existing studies focus on either schooling or acute malnutrition, highlighting that transfers can mitigate the detrimental effects of crises on these outcomes. Evidence on linear growth, micronutrient deficiencies, health, labor, learning, psychosocial outcomes, and child protection is limited. Also, most studies are set in contexts characterized by high institutional fragility in which emergency social protection is undertaken by international organizations, while evidence from settings where institutional capacity for shock-responsive social protection exists is scarce. Further gaps relate to the cost-effectiveness of alternative program designs and delivery modalities; heterogeneity by child and household backgrounds; and longer-term effects of interventions. Filling these gaps is critical to support child-sensitive approaches to social protection in crises to effectively pursue Sustainable Development Goal 1.
2. CHARACTERISTICS OF UNCONTROLLED HYPERTENSION AMONG END STAGE KIDNEY DISEASE (ESKD) PATIENTS ON CHRONIC HEMODIALYSIS IN DR. HASAN SADIKIN HOSPITAL BANDUNG
Authors: Setyabudi Yogie , Afiatin
Published: May 2021

Background:

Prevalence of uncontrolled hypertension (UHT) in ESKD patient remained relatively high and increasing in trend nowadays, especially in black and Asian people. There is higher mortality among those people, yet hypertension is a leading cause of morbidity of ESKD. Therefore interdialytic weight gain (IDWG) independently associated with an increased BP, and affect outcomes in ESKD patients.

Objective:

The aim of this study is to determine characteristic among UHT in ESKD patient underwent hemodialysis (HD) in Dr. Hasan Sadikin Hospital Bandung.

Method:

We performed cross-sectional study with all ESKD patients with age > 18 years old, underwent hemodialysis > 3 months. Data collected from medical record. BP examined before each HD (3 times in a row). We used two kind of classification, BP > 140/90 as UHT based on NKF-KDOQI 2014 and BP > 130/80 based on AHA 2017.

Result:

130 patients were included. Based on NKF KDOQI 2014 we found that 97 (74,6%) of the patients had UHT and only 9,3% of them had 3 kinds anti-HT agents compare to 21,2% in the controlled hypertension (CHT) group. Hypertension was the main etiology of ESKD (86,1%). The mean IDWG in UHT was 2,8 kgs compare to 2.6 kgs in CHT group.

Conclusion:

In summary, there were more patients in UHT 74,6% patients and most of them used less than 3 anti-HT agents. The average IDWG higher in UHT group. These could be primary data for analytical studies about correlation of UHT, its risk factor.
24. OMECAMTIVE MECARBIL, A NOVEL THERAPEUTIC AGENT FOR HEART FAILURE WITH REDUCED EJECTION FRACTION: A SYSTEMATIC REVIEW
Authors: Trifitriana Monica , Mulawarman Rido , Felani Muhammad Rizky , Tondas Alexander Edo
Published: May 2021

Background:

At least half of the millions of heart failure patients have heart failure with reduced ejection fraction (HFrEF). There have been many drugs used to treat heart failure, but these drugs don’t directly work on the target pathogenesis of HFrEF. Improving systolic function will prevent neurohormonal activation and ventricular remodeling, which clinically will provide better results from hospitalization and causes of death. Omecamtive mecarbil (OM) is a novel selective cardiac myosin activator, it will improve cardiac function in patients with HFrEF.

Objective:

We aim to assess the latest evidence on the outcome of OM in heart failure patients.

Method:

We performed a comprehensive search on topics that assesses OM outcomes in heart failure patients from inception up until January 2021.

Results:

There were 17.712 HFrEF patients from six studies. Three studies showed the decrease of heart rate, two studies prove that OM increase the stroke volume and systolic ejection time, while each of one study showed increase of left ventricular ejection fraction and decrease left ventricular end systolic volume, left ventricular end diastolic volume, left ventricular fraction shortening, left ventricular end systolic dimension and left ventricular end diastolic dimension from the baseline. The route via intravena maximum tolerated by dose 0,5 mg/kg per h, while via orally start with dose 25 mg twice daily. No significant side effects were found. One randomized controlled trial study also showed a lower risk of a composite heart failure events and cardiovascular death than those who received placebo.

Conclusion:

Omecamtive mecarbil improved cardiac function in heart failure and could be the first in class of a new therapeutic agent. Further controlled studies are warranted for definite conclusion.
25. PRO-INFLAMMATORY MARKERS IN COVID-19 PATIENTS WITH HYPERTENSION
Authors: Andhika Rizky , Supriyadi Rudi , Alisjahbana Bachti
Published: May 2021

Background

: Hypertension is associated with poor outcome in patients with Coronavirus Disease-2019 (COVID-19). Several pro-inflammatory markers, such as Absolute Lymphocyte Count (ALC), Neutrophil-to-Lymphocyte Ratio (NLCR), Monocyte-to-Lymphocyte Ratio (MLCR), C-Reactive Protein (CRP), Procalcitonin (PCT), and Ferritin are associated with poor outcome in COVID-19. Pro-inflammatory markers in COVID-19 patients with hypertension is rarely described.

Objective

: We aimed to explore several pro-inflammatory markers in COVID-19 patients with hypertension.

Methods

We retrospectively analysed confirmed COVID-19 patients between March 1 and August 31, 2020 from Hasan Sadikin General Hospital Bandung. Data were obtained from patient's medical records. Patients with history of hypertension before admission were included in hypertension group. Patients with systolic blood pressure (BP) above 140 mmHg and/or diastolic BP above 90 mmHg on admission, were considered as uncontrolled hypertension. The analysis of data correlation was done using the Pearson correlation, alternative Rank Spearman correlation for non-normal distribution.

Results

: We found 140 patients, in which 40 patients were included in hypertension group. NLCR (5.29 vs. 2.92, p = 0.002), MLCR (0.47 vs 0.31, p = 0.001), and CRP (5.62 vs 0.87, p = 0.004) were significantly higher in COVID-19 patients with hypertension. Meanwhile, ALC was found to be lower (1233.9 vs. 1533.9, p = 0.009). PCT (0.05 vs. 0.02, p = 0.079) and ferritin (329.3 vs 224.1, p = 0.073) were higher, but not statistically significant. There was no difference of NLCR, MLCR, CRP, ALC, PCT, and ferritin level between uncontrolled and controlled hypertension group.

Conclusion

: COVID-19 patients with hypertension have higher pro-inflammatory markers.
27. PREDICTIVE VALUE OF LACTATE DEHYDROGENASE FOR POOR MATERNAL AND PERINATAL OUTCOMES IN PATIENTS WITH PRE-ECLAMPSIA: A META-ANALYSIS
Authors: Josephine Claudia Mary , Nurcahyani  , Multazam Rachmatu Bill , Kamarullah William , Nawing Aqila Ghaezany
Published: May 2021

Background:

A large number of studies have reported the relationships between serum lactate dehydrogenase (LDH) and prognosis of pre-eclampsia. However, the result is still controversial and no consensus has been reached.

Objective:

The aim of the study was to find out the role of serum LDH in prediction of poor maternal and perinatal outcomes in patients with pre-eclampsia.

Methods:

We performed a systematic computerized search for eligible articles from PubMed, Europe PMC, ProQuest, EBSCOhost, and Google Scholar databases from inception to January 2021. The pooled odds ratio (OR) and 95% confidence intervals (CIs) of all events of interest and event-free subjects were obtained to assess the predictive value of serum LDH in predicting composite poor outcomes.

Results:

A total of 11 studies that assessed patients with pre-eclampsia were included. Overall, elevated serum LDH level in pre-eclamptic patients was associated with poor maternal and perinatal outcomes [pooled OR: 7.92 (95% CI = 5.75–10.93); pooled OR: 8.08 (95% CI = 4.40–14.83) respectively]. Subgroup analyses showed that elevated LDH also increased risk of placental abruption, disseminated intravascular coagulation, acute renal failure, eclampsia, and HELLP syndrome. The resulting P-value showed no heterogeneity among articles (P > 0.01). No evidence of asymmetry was shown in the funnel plot, thus no publication bias existed in the included studies.

Conclusions:

This meta-analysis demonstrates that elevated serum LDH level is apparently associated with poor outcomes in patients with pre-eclampsia and serum LDH could be a prognostic biomarker for pre-eclamptic patients.
29. THE ASSOCIATION BETWEEN HYPERTENSION AND DEPRESSION IN AGED NURSING HOME RESIDENTS IN INDONESIA
Authors: Putra Iwan Cahyo Santosa , Tanjung Jennifer Ellen , Dara Maria
Published: May 2021

Background:

Hypertension is one of the most common diseases to affect the elderly. With Indonesia currently facing a demographic shift to an ageing population, the prevalence of high blood pressure within the elderly is steadily increasing. Hypertension has been known to disrupt the psychosocial wellbeing of the elderly and cause depression. Besides the stress of dealing with hypertension, anti-hypertensive drugs reportedly may also cause depression as a side effect. Depression in turn can also cause hypertension through the activation of the Hypothalamic-Pituitary-Adrenal axis.

Objective:

The purpose of this study is to determine the association between hypertension and depression in the elderly.

Method:

This cross-sectional study sampled 138 elderly residents aged 60 years and above from the Tresna Budi Mulia nursing home in Jakarta. The blood pressure of the respondents were measured using a sphygmomanometer and a stethoscope, while depression was evaluated using the Geriatric Depression Scale. The collected data were then analyzed using SPSS version 22.

Result:

Out of the 138 respondents, a total of 21 elderly men and women experienced depression with hypertension. The number of respondents who experienced depression without hypertension was 30 (22%), while the number of respondents who experienced hypertension without depression was also 30 (22%). A chi-squared test was performed to observe the association between the two variables, and the p value obtained was 0.468 (p ≥ 0.05).

Conclusion:

There was no association between hypertension and the occurrence of depression in the elderly residents of the Tresna Budi Mulia nursing home in Jakarta.
32. HYPERTENSION AND DILATED CARDIOMYOPATHY IN PEDIATRIC PATIENT: THE ROLE OF L-CARNITINE
Authors: Jagannatha Gusti Ngurah Prana , Pradnyana Wayan Agus Surya , Kamardi Stanly , Yasmin AA Ayu Dwi Adelia , Yantie Ni Putu Veny Kartika
Published: May 2021

Background:

Carnitine is an essential compound for cellular metabolism, and plays an important role in blood pressure (BP) regulation and cardiac development. Carnitine deficiency is a disorder that relate to pediatric hypertension and dilated cardiomyopathy, with possibilities of rapid reversal after carnitine replacement.

Objective:

This report describes a child suffering from hypertension and dilated cardiomyopathy with suspected carnitine deficiency.

Case description:

A 4-year-old boy came to emergency department on August 2018 with shortness of breath. BP was 140/80 mmHg, electrocardiogram revealed sinus tachycardia 150 bpm, echocardiography demonstrated stretch PFO, moderate TR, mild AR, and dilated cardiomyopathy with EF 31.14%. He was diagnosed with grade II hypertension and congestive heart failure. Antihypertensive and heart failure treatment were administered. There was no vascular disorder found, kidney function test and urinalysis were within normal limit. He was also found to have malnutrition, stunting, and suspected to suffer from carnitine deficiency, hence L-carnitine and vitamin B6 were commenced since day 16. Patient's condition was gradually improved and discharged on the 26th day. Unfortunately, he stopped L-carnitine 1 year afterwards, but still continue to take vitamin B6. The last follow-up evaluation on January 2021 showed improvement of BP control (112/70 mmHg) and reversal of cardiac dysfunction with EF 68.9%.

Discussion:

Carnitine deficiency is a rare but treatable cause of pediatric hypertension and cardiomyopathy. Although previous case reports showed complete improvement within a few months, however that was not happened in this case, that may be caused by L-carnitine withdrawal.
33. CHARACTERISTICS AND COMORBIDITIES OF HYPERTENSIVE PATIENTS IN SANGLAH GENERAL HOSPITAL DURING COVID-19 PANDEMIC
Authors: Pradnyana I Wayan Agus Surya , Jagannatha Gusti Ngurah Prana , Kamardi Stanly , Yasmin AA Ayu Dwi Adelia
Published: May 2021

Background:

Recent evidences suggest that hypertension is the most common underlying comorbid among COVID-19 patients, which often occurs in adults who are at higher risk of being infected with the SARS-CoV-2 virus and experiencing severe symptoms. Hypertension is also commonly accompanied by many comorbidities that will further compromised the clinical presentation of COVID-19 patients. Determination and appropriate management of hypertension and its comorbidities would be an important aspect during the pandemic

Objective:

The aims of this study is to define the characteristics and comorbidities among hypertensive patients in outpatient settings during pandemic era.

Methods:

This descriptive cross-sectional study included 108 medical records of patients with hypertension diagnosis in outpatient cardiology clinic, at Sanglah General Hospital in January 2021.

Result:

Among 108 subjects, there was male predominance (57.4%) with mean of age 54.07 years old. About 23.1% subjects were active smokers and 61.1% were overweight/obese. The most common comorbidities that was found on subjects was Coronary Artery Disease (50%), which was followed by heart failure (27.8%) and Diabetes Mellitus (14.8%). Blood pressure was controlled only in 39.8% patients. The patients most commonly took combination therapy (74.1%), with calcium channel blocker (CCB) was the most used pharmacotherapy (81.5%).

Conclusion:

Hypertension and its comorbidities were important predictors of poor outcome among COVID-19 patients. Therefore, optimal therapy and control for all risk factors during this pandemic are mandatory, regarding the benefit for morbidity and mortality.
35. PREVALENCE OF HYPERTENSIVE CRISIS AS A COMORBID AMONG PATIENTS WITH UNCONTROLLED TYPE 2 DIABETIC MELLITUS IN EMERGENCY DEPARTMENT, KARANGANYAR GENERAL HOSPITAL: A CROSS-SECTIONAL STUDY
Authors: Utomo Muhammad Faisal Putro , Putrinadia Aninditya Verinda , Utami Musrifah Budi , Erawan I Gusti Ngurah Agung Tresna
Published: May 2021

Background:

Although uncontrolled hypertension and type 2 diabetes mellitus (T2DM) has poor prognosis, these cardiometabolic diseases are still considered trivial in rural areas. Moreover, most patients with hypertensive crisis don’t recognize it when it is asymptomatic.

Objective:

This study aimed to explore the hypertensive crisis in T2DM and become a pilot study in rural areas of Central Java, Indonesia.

Method:

This was an analytic cross-sectional study conducted at the emergency department, Karanganyar General Hospital, between October to November 2019. Data were taken using data extraction forms that include history taking, physical examination, and laboratory examination. Complete blood count, random blood glucose, and creatinine serum were documented. Data were analyzed using SPSS with univariate and bivariate analysis.

Result:

Our study involved 171 patients with uncontrolled T2DM in the emergency ward. Around half of the patients were males (59.6%) and above 60 years old (46.8%). Patients with a history of ischemic heart disease, chronic kidney disease, stroke, and diabetic foot were 19.3%, 19.9%, 12.3%, and 21.1%. Patients who arrived with high blood pressure were 53.8%. The hypertensive crisis among uncontrolled T2DM was 10.5% (hypertensive urgency was 5.8%, and hypertensive emergency was 4.7%). There was an association between stroke and diabetic foot towards hypertensive crisis (p < 0.05).

Conclusion:

The proportion of hypertensive crisis in T2DM patients was higher than in the non-T2DM group. Various factors due to complications from diabetes and low treatment compliance of chronic disease may affect the development of hypertensive crisis.
36. ASSOCIATION OF ELECTROCARDIOGRAM PARAMETERS OF ATRIAL AND VENTRICULAR REMODELING WITH INTERSTITIAL FIBROSIS IN HYPERTENSIVE PATIENTS
Authors: Anggraini D.M. , Chandra E. , Aditya B.S. , Tiksnadi B.B. , Achmad C.
Published: May 2021

Background:

Cardiac remodeling is frequently seen in hypertensive patients and one of the causes of its process is interstitial fibrosis. Electrocardiogram (ECG) is a practical tool to detect impulse heterogeneity, reflecting fibrosis.

Objective:

To prove association of ECG parameters with interstitial fibrosis in hypertension which might be used to monitor effectiveness of therapies and prognosis.

Methods:

This is a cross-sectional study whose subjects were diagnosed with hypertension recruited from public healthcare from December 2018 until January 2019. Exclusion criteria were elderly (>65 years old), known coronary artery disease, heart failure, and valvular heart diseases. Association between ECG parameters which reflects atrial remodeling, represented by P-wave Dispersion (PWD), and ventricular remodeling, represented by QT dispersion (QTd), with degree of interstitial fibrosis, represented by soluble ST2 (SST2) from blood serum, which has been proven for detecting myocardial fibrosis, were analyzed using Spearman's correlation. Multivariate analysis was performed to adjust the outcome with age and sex.

Results:

From 36 subjects recruited, 24 (66.7%) subjects were female. The median age was 57 (45-65) years old. There were significant moderate correlations between SST2 with PWD (p 0.001; r 0.498), and QTd (p 0.002; r 0.462). After multivariate analysis, the correlation remains significant for PWD (p 0.001) and QTd (p 0.018). The moderate correlation between ECG parameters and SST2 maybe due to the fibrosis caused by myocardial damage in hypertension is subtler than heart failure.

Conclusion:

There are moderate correlations between ECG parameters of atrial and ventricular remodeling with interstitial fibrosis in hypertensive patients.
52. SUBLINGUAL VERSUS ORAL CAPTOPRIL FOR BLOOD PRESSURE REDUCTION IN HYPERTENSION URGENCY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Ulfiarakhma Dela , Mulawarman Rido , Trifitriana Monica
Published: May 2021

Background:

The use of sublingual captopril has been suggested in hypertension urgency on the assumption of faster absorption and thus more rapid effect on blood pressure than with the oral route. But there are still confusing data regarding the preferential route in literature.

Objective:

This study aimed to compare the effect of sublingual and oral captopril to reduce blood pressure in hypertension urgency patients.

Method:

We systematically searched the relevant studies from date of inception to January 2021. Outcomes of interest were blood pressure reduction at 10, 30, and 60 minutes after 25 mg sublingual and oral captopril administration.

Results:

One RCT and two observational studies comprising 353 patients were included. Systolic blood pressure (SBP) was significantly reduced faster in sublingual group at 10 minutes (mean difference 6.65 [95% CI 1.21, 12.09]; p = 0.02; I
2: 89%) and 30 minutes (mean difference 2.54 [95% CI 0.76, 4.32]; p = 0.005; I
2: 0%) compared to oral group. Mean arterial pressure (MAP) was also reduced more rapidly at 10 minutes (mean difference 3.62 [95% CI 2.78, 4.46]; p < 0.00001; I
2: 0%) and 30 minutes (mean difference 2.12 [95% CI 0.88, 3.36]; p = 0.0008; I
2: 0%) in sublingual group. Our meta-analysis showed no significant difference in blood pressure reduction at 60 minutes between two groups.

Conclusion:

Sublingual captopril can reduce SBP and MAP more rapidly compared to oral captopril in the first 30 minutes after administration, but the effect was similar at 60 minutes.
67. ROLE OF INTERLEUKIN 17A IN POPULATION WITH ELEVATED BLOOD PRESSURE: A SYSTEMATIC REVIEW
Authors: Putra SD , Damaiati NE , Soenarta AA
Published: May 2021

Background:

Around half of population with hypertension are failed to achieve blood pressure target despite optimum medical therapy. This suggests another pathogenesis involved in hypertension through immune response, one of which is interleukin 17A (IL-17A).

Objective:

This study seeks to describe the role of interleukin 17A in population with elevated blood pressure

Methods:

An electronic search of Pubmed, Ebsco and Cochrane on 23 January 2021 was undertaken to identify relevant studies. The search strategy being performed used combination keywords of interleukin 17A and elevated blood pressure. Filters were used to exclude irrelevant studies, such as fulltext, English language, published in last 5 years, and human as a subject. The quality of included studies was assessed independently by two reviewers using Rostom et al.

Results:

In total, three studies comprising 539 subjects in which 268 subjects with elevated blood pressure were eligible. The first two studies showed an increase of IL-17A in both prehypertensive and hypertensive groups compared to those with normotensive. In addition, the other study revealed a significant correlation between IL-17A concentration and hypertension duration in group with non-controlled hypertension.

Conclusion:

IL-17A is associated with elevated blood pressure as well as duration of hypertension suggesting the role of immune response on this. Furthermore, IL-17A can be served as a target therapy for hypertensive patients in the future.
69. RELATIONSHIP BETWEEN AGE AT MENARCHE AND HYPERTENSION IN RSUP PROF. DR. R. D. KANDOU MANADO
Authors: Wowor Ester , Palar Stella , Sugeng Cerelia , Umboh Octavianus
Published: May 2021

Introduction:

The age at menarche (AAM) is the first onset of the menstrual cycle in women, which represents the beginning of the capacity to reproduce, and can affect health later. Previous research has shown that early and late menarches were associated with hypertension. Some studies have shown in group of AAM <11 years and >15 years, the risk of hypertension increased.

Objective:

This study aims to assess the correlation between AAM and hypertension.

Methods:

This was an observational cross-sectional study. The subjects were women aged 18-70 years who were treated in the Internal Medicine ward of RSUP Prof. Dr. R. D. Kandou from December 2020–January 2021. Data was collected through interview, blood pressure examination, and medical record. The data were grouped into AAM <11 years, 11–15 years, >15 years; hypertension and non-hypertension, and were processed using SPSS.

Results:

This study included 65 female subjects, aged 22–66 years old. The mean age was 39.57 years. From 65 subjects, 32 (49.24%) were hypertensive and 33 (50.76%) were non-hypertensive. The mean age at menarches was 13.29 years. The Pearson chi square test showed that there was a correlation between AAM with hypertension (p = 0.004). The odds ratio (OR) (CI 95%) showed the AAM >15 years had higher risk of developing hypertension compared to 11–15 years. There was no difference in risk of hypertension in group of AAM <11 years compared to AAM 11–15 years.

Conclusion:

There is a correlation between AAM with hypertension. AAM >15 years is related to risk of hypertension.
71. THE ASSOCIATION OF HIGHER SYSTOLIC BLOOD PRESSURE AT DISCHARGE AND DETERIORATION OF RENAL FUNCTION IN PATIENTS HOSPITALIZED FOR ACUTE DECOMPENSATED HEART FAILURE
Authors: Pratiwi Indah , Moses Kevin , Pratama Dya , Victoria Alexandra , Hanggadi Bhayu , Soerarso Rarsari
Published: May 2021

Introduction:

Deterioration of renal function over time is associated with worse outcomes in patients with Acute Decompensated Heart Failure. Deterioration of renal function was the long-term consequences of RAAS system activation in ADHF. Higher systolic blood pressure was the most common precipitating factor for the acute heart failure event. Moreover, it was known that higher SBP was the predictor of renal function deterioration. Therefore, we hypothesized that the levels of SBP at discharge would have associations with post-discharge outcomes in hospitalized ADHF.

Method:

The study included 51 patients admitted to our hospital between November 2020 and January 2021 with ADHF event, patients were classified into high creatinine value and normal creatinine value based on creatinine at discharged. SBP at discharge was the primary outcome between two groups.

Result:

We examined changes in creatinine and grouped it into high creatinine value (creatinine level ≥1.5 mg/dl) and normal creatinine value (creatinine level <1.5 mg/dl). Overall, 60.8% (n = 31) of patients with AHDF were having higher creatinine value and 39.2% (n = 20) were having normal creatinine value. On Bivariate analysis, SBP at discharge was associated with higher creatinine value (p < 0.07) and result showed positive correlation between SBP at discharge and high creatinine value (r = 0.306, p = 0.31).

Conclusion:

In patients admitted for ADHF, higher creatinine value was correlated with higher SBP at discharge.
76. ELDERLY AS THE MOST PATIENTS WHO ROUTINELY CONTROL HYPERTENSION IN THE CARDIOLOGY OUTPATIENT CLINIC OF WEST NUSA TENGGARA PROVINCE GENERAL HOSPITAL
Authors: Tsuraya Lina , Pintaningrum Yusra
Published: May 2021

Background:

Hypertension is the number one cause of high mortality rates in Indonesia. Basic Health Research 2018 data shows that the prevalence of hypertension has increased from 25.8% in 2013 to 34.1% in 2018. Chronic hypertension can cause various changes in the structure and function of the heart which is known as hypertensive heart disease.

Objective:

To describe the characteristics of hypertensive patients in the cardiology outpatient clinic of West Nusa Tenggara Province General Hospital period July 2019–December 2020.

Method:

This research is a descriptive-analytical study with a retrospective research design. The sample of this study was all new patients diagnosed with hypertension and registered in the medical records. The data was processed using Microsoft excel.

Result:

A total of 1038 hypertension patients was found with the percentage of male is 56.5% and female is 43.5%. It was found that the elderly group dominated (92.87%). Hypertension with coronary artery disease was 456 patients (43.93%) and hypertension with diabetes mellitus and coronary artery disease were 60 patients (5.78%). Most of the patients with hypertension in this research were located in Mataram (46.91%) and the new case of hypertension decreased from July 2019 to December 2020 probably due to the issue of COVID-19.

Conclusion:

Most patients diagnosed with hypertension are elderly, where percentage of male is almost same with female patients. It was found that both of hypertension and diabetes mellitus are risk factors that play a major role in the development of coronary artery disease.
77. ASSOCIATION OF D-DIMER AND FIBRINOGEN LEVEL WITH MORTALITY OF HYPERTENSIVE COVID-19 PATIENTS
Authors: Damay V. , Sugeng C. , Umboh O. , Moeis E.
Published: May 2021

Background:

Hypertension is the most evident comorbid in Covid-19. Thromboembolism, arguably the most thrilling pathomechanism in Covid-19. D-dimer and fibrinogen are parameters to describe thromboembolism but still need a real-world data about its association with mortality in hypertension.

Objective:

To explore association of D-dimer and fibrinogen level with mortality in hypertensive and non hypertensive Covid-19 patients

Methods:

This is a cross sectional retrospective study. Subjects were confirmed Covid-19 patients above 18 years old in RSUP Prof. Dr. R.D. Kandou Manado within last 5 months with D-dimer and fibrinogen examination. Data were analyzed using Mann-Whitney and Chi-square method.

Results:

There were 178 patients, male 93 (52%), female 85 (47.8%), average 52.71 ± 15.30 years old, 100 (56.2%) hypertensive and 78 (43.8%) non hypertensive patients. Among hypertensive patients, 18 (35.3%) with elevated D-dimer and 14 (28%) with elevated fibrinogen did not survive, compared to 4 (10.3%) and 3 (7.7%) in non-hypertensive patients.

There was significant association between D-dimer and mortality in hypertensive patients (PR = 3.46, 95% CI 1.39–8.59; p = 0.003, Median 1.65) and significant differences of D-dimer and fibrinogen level in hypertensive and non-hypertensive (1.65 IQR 3.13 vs. 0.44 IQR 0.79; p = 0.0001, 560 IQR 302.5 vs. 430 IQR 200; p = 0.0001). There was no significant difference of outcome regarding anti-coagulant injection.

Conclusion:

Mortality was about 3 times higher in hypertensive patients with high D-dimer. This study revealed to us that D-dimer potentially a mortality predictor in hypertensive Covid-19 patients.
Early debridement improves outcome in managing ankle tuberculosis: a systematic review
Authors: Rusdianto Ignatius Angga , Tania Fidia , Siswanto Belinda Azhari , Pitarini Astuti
Published: May 2021

Background:

Extra pulmonary tuberculosis (TB) accounts for 10% of all TB patients. Involvement of the musculoskeletal system accounts for only 3%, with ankle TB less than 1% of all musculoskeletal TB. In Indonesia the prevalence of TB is 660 within 100,000 persons, and data for extrapulmonary TB and musculoskeletal TB are unknown. Diagnosis of TB infection in a joint is difficult. Untreated ankle TB and diagnostic delay may result in local cartilage destruction, functional disability, and poorer prognosis.

Methods:

EBSCO, Proquest, Pubmed, ScienceDirect, and Google Scholar were searched using the terms “ankle”, “tuberculosis”, “arthroscopic*”, “debridement” and “open.” English language studies with surgical management of ankle TB by arthroscopy or open debridement that were published between 2004 and 2019 were included. Studies of arthrodesis and multi-drug resistant TB were excluded.

Results:

After an initial search of 60 studies, 28 were excluded, and 20 were duplicates. Twelve studies (six case-control studies, four case series, and two cohort) were included. In total, 103 patients with a mean age of 43.8 (7 to 90) years were treated for ankle TB with arthroscopy debridement, open debridement, and synovectomy. The mean time to surgery was 10.9 (1 to 80) months, and a mean postoperative treatment of 35.5 (1.5 to 260) months. All patients had a mean treatment time of 10 (4 to 21) months with rifampicin, isoniazid, pyrazinamide, and ethambutol. No patients were lost to follow-up.

Conclusions:

Early debridement is recommended to improve outcome in managing ankle TB. This review is limited by the lack of high evidence level studies from high-quality randomized controlled trials, lack of control groups, heterogenous outcomes reporting, small sample sizes, and no objective scoring were used to report the outcomes. However, larger sample sizes with long-term follow-up data were not found.

Level of Evidence:

Level IV.
Injury incidence is higher on artificial turf compared with natural grass in high school athletes: a retrospective cohort study
Authors: Paliobeis Andrew , Sivasundaram Lakshmanan , Knapik Derrick M. , Labelle Mark W. , Olson Matthew , Karns Michael R. , Salata Michael J. , Voos James E.
Published: May 2021

Background:

Prior investigations have demonstrated increased injury risk on artificial turf at the collegiate and professional levels. However, no prior study has examined this risk among high school athletics beyond football. The purpose of this study was to compare injury incidences on artificial versus natural playing surfaces among high school athletes.

Methods:

Data collected from 26 high schools was analyzed to compare injury incidences on artificial turf versus natural grass based on sport. Analyses were also performed to compare injury incidence by injury location (upper extremity, lower extremity, torso), sport, level of competitive play (freshman, junior varsity, varsity), and practice versus competition.

Results:

We identified 953 injuries, with 61% (n=585) occurring on turf and 39% (n=368) on grass. Athletes were 58% more likely to sustain injuries on artificial turf than natural grass relative risk ratio [RR] 1.5897, confidence interval [CI]: 1.4062 to 1.7971, P<0.0001). Lower extremity (RR 1.9597, CI: 1.6169 to 2.3752, P<0.0001), torso (RR 1.8636, CI: 1.1123 to 3.1225, P=0.0181), and upper extremity (RR 1.4494, CI: 1.1104 to 1.8919, P=0.0063) injuries were significantly more likely to occur on artificial turf. Football (RR 1.4572, CI: 1.2726 to 1.6687, P<0.0001), girls soccer (RR 1.7073, CI: 1.1857 to 2.4583, P=0.0040), boys soccer (RR 1.8286, CI: 1.2296 to 2.7194, P=0.0029), and rugby (RR 23.0000, CI: 3.1998 to 165.3244, P=0.0018) had higher injury incidences on artificial turf.

Conclusions:

Athletes were 58% more likely to sustain an injury on artificial turf. Football, soccer, and rugby athletes were at a significantly greater injury risk on artificial turf. Upper and lower extremity and torso injuries also occurred with higher incidence on artificial turf.

Level of Evidence:

Level IV.
Identifying patterns of utilization of single-use video laryngoscopy and supraglottic airway devices to reduce waste
Authors: Baerg Tim , Klapman Seth , Cloyd Benjamin , Hovord David , Edelman Tony , Healy David , Schechtman Samuel
Published: May 2021

Introduction:

Lean management, a systematic method of reducing waste in manufacturing, is an approach that has led to quality improvement and cost reduction in health systems. Utilization of single-use airway equipment, such as videolaryngoscope (VL) blades and supraglottic airways (SGAs) has helped reduce the risk of cross-contamination and the time and cost associated with reprocessing and sterilization.

Methods:

We examined the efficiency of single-use VL blades and SGAs within our tertiary care health system. Purchasing data were reviewed and compared with device utilization within the electronic medical record to determine the amount of waste of disposable airway equipment. Direct observations (Gemba walks) were made in the operating rooms to assess device utilization. For SGAs, a diagnostic questionnaire was sent to providers regarding approaches to use.

Results:

We found the total cost of opened but unused VL blades equaled $29,267. For SGAs, we found that devices were often opened before use and that there is a 16.67% first-time failure rate for placement of SGAs.

Conclusions:

Through education and organizing device setup, and streamlining communication, there is a possibility to reduce future waste.
Bone health in diabetes: Indian perspective
Authors: Pal Rimesh , Bhadada Sanjay Kumar
Published: May 2021

Purpose of review

Despite estimated 77 million people having diabetes, bone health in Asian Indians with diabetes is largely unknown. This review summarizes the published literature on fracture risk and factors affecting it in Asian Indians with diabetes.

Recent findings

Data on fracture prevalence in diabetes is limited; one study showed that diabetes was associated with a significantly higher number of fractures compared with subjects without diabetes (4% vs. 2.4%, P < 0.05). The prevalence of osteoporosis in Asian Indians with type 2 diabetes mellitus (T2D) varies from 35.5 to 49.5%. Studies have shown an increased, similar or lower areal bone mineral density (BMD) at the lumbar spine and/or hip in patients with T2D compared to controls without diabetes. On the contrary, the BMD in patients with type 1 diabetes mellitus (T1D) is modestly low compared to age- and sex-matched healthy controls without diabetes. Recent studies have shown compromised mechanical, material and compositional properties of trabecular bone in Asian Indians with T2D suggesting deteriorated bone quality as one of the contributors of high fracture risk.

Further research is needed to generate evidence-based guidelines to prevent and manage bone fragility in Asian Indians with diabetes.
Veterans’ Use of Veterans Health Administration Primary Care in an Era of Expanding Choice
Authors: Hynes Denise M. , Edwards Samuel , Hickok Alex , Niederhausen Meike , Weaver Frances M. , Tarlov Elizabeth , Gordon Howard , Jacob Reside L. , Bartle Brian , O’Neill Allison , Young Rebecca , Laliberte Avery
Published: May 2021

Background:

The Veterans Choice Program (VCP), aimed at improving access to care, included expanded options for Veterans to receive primary care through community providers.

Objectives:

The objective of this study was to characterize and compare Veterans use of Veterans Health Administration (VA) primary care services at VA facilities and through a VA community care network (VA-CCN) provider.

Research Design:

This was a retrospective, observational over fiscal years (FY) 2015–2018.

Subjects:

Veterans receiving primary care services paid for by the VA.

Measures:

Veteran demographic, socioeconomic and clinical factors and use of VA primary care services under the VCP each year.

Results:

There were 6.3 million Veterans with >54 million VA primary care visits, predominantly (98.5% of visits) at VA facility. The proportion of VA-CCN visits increased in absolute terms from 0.7% in 2015 to 2.6% in 2018. Among Veterans with any VA-CCN primary care, the proportion of VA-CCN visits increased from 22.6% to 55.3%. Logistic regression indicated that Veterans who were female, lived in rural areas, had a driving distance >40 miles, had health insurance or had a psychiatric/depression condition were more likely to receive VA-CCN primary care. Veterans who were older, identified as Black race, required to pay VA copayments, or had a higher Nosos score, were less likely to receive VA-CCN primary care.

Conclusion:

As the VA transitions from the VCP to MISSION and VA facilities gain experience under the new contracts, attention to factors that impact Veterans’ use of primary care services in different settings are important to monitor to identify access barriers and to ensure Veterans’ health care needs are met.
County-level Predictors of Growth in Community-based Primary Care Use Among Veterans
Authors: Gordon Sarah H. , Beilstein-Wedel Erin , Rosen Amy K. , Zheng Tianyu , Kelley Alan Taylor , Cook James , Zahakos Sarah S. , Wagner Todd H. , Vanneman Megan E.
Published: May 2021

Background:

The 2014 Choice Act expanded the Veterans Health Administration’s (VA) capacity to purchase services for VA enrollees from community providers, yet little is known regarding the growth of Veterans’ primary care use in community settings.

Objectives:

The aim was to measure county-level growth in VA community-based primary care (CBPC) penetration following the Choice Act and to assess whether CBPC penetration increased in rural counties with limited access to VA facilities.

Data and Sample:

A total of 3132 counties from VA administrative data from 2015 to 2018, Area Health Resources Files, and County Health Rankings.

Analysis:

We defined the county-level CBPC penetration rate as the proportion of VA-purchased primary care out of all VA-purchased primary care (ie, within and outside VA). We estimated county-level multivariate linear regression models to assess whether rurality and supply of primary care providers and health care facilities were significantly associated with CBPC growth.

Results:

Nationally, CBPC penetration rates increased from 2.7% in 2015 to 7.3% in 2018. The rurality of the county was associated with a 2–3 percentage point (pp) increase in CBPC penetration growth (P<0.001). The presence of a VA facility was associated with a 1.7 pp decrease in CBPC penetration growth (P<0.001), while lower primary care provider supply was associated with a 0.6 pp increase in CBPC growth (P<0.001).

Conclusion:

CBPC as a proportion of all VA-purchased primary care was small but increased nearly 3-fold between 2015 and 2018. Greater increases in CBPC penetration were concentrated in rural counties and counties without a VA facility, suggesting that community care may enhance primary care access in rural areas with less VA presence.
Comparing Outcomes of Flap-Based Salvage Reconstructions in the Radiated Breast
Authors: Patel Ashraf A. , Arquette Connor P. , Rowley Mallory A. , Borrelli Mimi R. , Lee Gordon K. , Nazerali Rahim S.
Published: May 2021

Introduction

Chest wall irradiation significantly decreases the strength and quality of breast tissue supporting prostheses, increasing the risk of skin breakdown and implant or tissue expander extrusion. Autologous tissue, including the latissimus dorsi (LD) or abdominal-based flaps, including the muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps, may be used to salvage reconstructions. However, data comparing outcomes of the two flap options remains limited. We compare postoperative outcomes from both flap types after autologous salvage reconstruction in irradiated breasts.

Methods

Charts were retrospectively reviewed from patients who underwent either chest wall radiation or postmastectomy radiation therapy followed by salvage autologous reconstruction with either a LD and an implant or an abdominal-based flap (muscle-sparing transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flaps). Patients with a history of tissue expander or implant failure requiring autologous salvage as part of 2-staged or delayed-immediate breast reconstruction that were operated on between January 2005 and November 2015 were included. Basic demographics, comorbidities, and recipient site complications (infection, wound dehiscence, seroma, hematoma, fat necrosis, and flap failure) were collected.

Results

A total of 72 patients met the inclusion criteria which included 72 flaps; 35 LD and 37 abdominally based flaps. Demographics and comorbidities did not vary significantly between patient groups. Mean follow-up was 767.6 weeks, and all reconstructions were unilateral. Nineteen (26.4%) patients had at least one complication, most commonly minor infections (9.7%). Overall complication rates were not significantly different between flap groups (P = 0.083). Wound dehiscence was significantly higher in the abdominal group (P = 0.045), and fat necrosis also trended higher in this group (P = 0.085). Major infection trended higher in the latissimus group (P = 0.069).

Conclusions

When comparing outcomes of salvage flap-based reconstruction in radiated breast tissue, overall complication rates were similar when comparing postoperative outcomes between the LD- and abdominal-based flaps. Wound dehiscence was significantly higher when salvage reconstruction used an abdominal flap. Understanding the complications after salvage procedures can help inform decision making and optimize patient care to improve outcomes after breast reconstruction in the radiated breast.
Preoperative Music Listening in Pelvic Reconstructive Surgery: A Randomized Trial
Authors: Chen Yufan Brandon , Barnes Hayley , Westbay Lauren , Wolff Birte , Shannon Megan , Adams William , Acevedo-Alvarez Marian , Mueller Elizabeth R. , Pham Thythy T.
Published: May 2021

Objectives

We aimed to investigate the effect of music listening on preoperative anxiety compared with usual care in patients undergoing pelvic reconstructive surgery.

Methods

Patients scheduled for pelvic reconstructive surgery were enrolled on the day of surgery. Participants were randomized to either the usual care (control group) or to music listening on headphones (music group) before their surgery. Participants completed the Spielberg State-Trait Anxiety Inventory form Y1 to measure baseline state anxiety levels before surgery and again after 30 minutes of usual care or music listening. The primary outcome was the change in state anxiety score as measured by the State-Trait Anxiety Inventory form Y1.

Results

Sixty-nine women completed the study (35 assigned to the control group and 34 assigned to the music group). Analysis of the primary outcome included 66 participants (34 in the control group and 32 in the music group). Improvement in state anxiety was significantly better for patients assigned to music listening (−6.69; SD, 6.98) than for patients assigned to the control group (−1.32; SD, 8.03; P = 0.01). Six weeks postoperatively, patients in the music group (n = 29) reported higher overall satisfaction when compared with those in the control group (n = 31, P = 0.03).

Conclusion

Patients undergoing pelvic reconstructive surgery present with moderate anxiety on the day of surgery. Allowing patients to listen to their preferred music is a simple intervention that may lower preoperative anxiety and improve satisfaction in this patient population.
Adaptation at different points along antibiotic concentration gradients
Authors: Lagator Mato , Uecker Hildegard , Neve Paul
Published: May 2021

Antibiotic concentrations vary dramatically in the body and the environment. Hence, understanding the dynamics of resistance evolution along antibiotic concentration gradients is critical for predicting and slowing the emergence and spread of resistance. While it has been shown that increasing the concentration of an antibiotic slows resistance evolution, how adaptation to one antibiotic concentration correlates with fitness at other points along the gradient has not received much attention. Here, we selected populations of
Escherichia coli
at several points along a concentration gradient for three different antibiotics, asking how rapidly resistance evolved and whether populations became specialized to the antibiotic concentration they were selected on. Populations selected at higher concentrations evolved resistance more slowly but exhibited equal or higher fitness across the whole gradient. Populations selected at lower concentrations evolved resistance rapidly, but overall fitness in the presence of antibiotics was lower. However, these populations readily adapted to higher concentrations upon subsequent selection. Our results indicate that resistance management strategies must account not only for the rates of resistance evolution but also for the fitness of evolved strains.
A simple criterion to design optimal non-pharmaceutical interventions for mitigating epidemic outbreaks
Authors: Angulo Marco Tulio , Castaños Fernando , Moreno-Morton Rodrigo , Velasco-Hernández Jorge X. , Moreno Jaime A.
Published: May 2021

For mitigating the COVID-19 pandemic, much emphasis is made on implementing non-pharmaceutical interventions to keep the reproduction number below one. However, using that objective ignores that some of these interventions, like bans of public events or lockdowns, must be transitory and as short as possible because of their significant economic and societal costs. Here, we derive a simple and mathematically rigorous criterion for designing optimal transitory non-pharmaceutical interventions for mitigating epidemic outbreaks. We find that reducing the reproduction number below one is sufficient but not necessary. Instead, our criterion prescribes the required reduction in the reproduction number according to the desired maximum of disease prevalence and the maximum decrease of disease transmission that the interventions can achieve. We study the implications of our theoretical results for designing non-pharmaceutical interventions in 16 cities and regions during the COVID-19 pandemic. In particular, we estimate the minimal reduction of each region’s contact rate necessary to control the epidemic optimally. Our results contribute to establishing a rigorous methodology to design optimal non-pharmaceutical intervention policies for mitigating epidemic outbreaks.