BackgroundIn developing countries, even electrocardiography (ECG) hasn’t been used widely in most health-care centers. The ability of physicians to refer to chronic kidney disease (CKD) patients for ECG, often collide with several barriers and costs. Therefore, we need to formulate the simplest and most efficient model to predict when CKD patients need to be referred due to potential ECG abnormalities.ObjectiveThe aim of this study was to develop several clinical and laboratory parameters as a predictor of any ECG abnormalities.Materials and MethodsA retrospective cross-sectional study design held at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia. Subjects were hospitalized patients with CKD between 1 January to 31 December 2019. 198 CKD patients (101 males) were enrolled for the study. All patients had demographic information, detailed clinical profile, resting 12-lead ECG recording, complete blood count, serum electrolyte and renal function test profile during admission and results were interpreted blindly by two cardiologists. Statistical analysis was done by SPSS 17.0.ResultsA total of 198 patients were included in this study. Mean ages were 52.2±11.8 years old and fifty-one percent were males. Eighty-eight percent of patients from 198 patients had ECG abnormality. AUC of hemoglobin level to discriminate poor R wave progression, pathological Q wave, non-spesific ST-T changes, and frontal axis deviation were 0.532, 0.641, 0.556 and 0.693, respectively. In multivariate logistic regression analysis, only higher systolic blood pressure was determined as an independent predictor of abnormal ECG finding in CKD patients, as systolic blood pressure increase by one unit, the odds of having abnormal ECG is increased 1.02 times (95% CI: 1.00 – 1.02, p=0.042).ConclusionThe ECG abnormalities can be found in hospitalized CKD patients. Fragmented QRS and long QTc were the highest prevalent ECG abnormalities in our study. Serum creatinine and hemoglobin could predict peaked T wave and prolonged QTc among hospitalized CKD patients. Systolic blood pressure could predict prolonged QTc and fragmented QRS in CKD patients.

Background Department of Cardiology and Vascular Medicine created a virtual education series about dietary guideline that refers to DASH by adapting the local wisdom of the Surabaya community. Aims We aimed to evaluate the impact of Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series towards knowledge, attitude, practice, and reduction of blood pressure in the primary care setting during COVID-19 pandemic. Methods This type of online action research is quantitative with a quasi-experimental design that designs using one group pretest-posttest, when this study was conducted in October-December 2020. The population in this study were all patients with hypertension who were treated in Mojo primary health care setting. A purposive sampling technique were done to receive 110 participants using online questionnaire. Results A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation, the only parameter that showed significant improvement were knowledge and attitude (p<0 .001). There is no significant change in the skill parameters (p=0.131) and blood pressure parameters (p=0.433) . Conclusion Airlangga Comprehensive Anti-Hypertensive Diets Virtual Education Series implementation in our study population seems to be effective to improve knowledge and attitude of participants, however, this program seems to be ineffective to improve skill and blood pressure reduction in participants. Future study with longer durations and more comprehensive programme needs to be done to scrutinize the clinical impact of this program nationwide.

Background: It is important and challenging to distinguish between acute myocardial infarction and Wellens syndrome due to its time to intervention. Difficulties in differentiating between subtypes could mean the patients are overtreated or receive undertreatment. Case report: A 57-year-old man was referred to our emergency ward with acute onset of chest pain. Electrocardiographic (ECG) changes were suggestive of Wellens syndrome type A. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented ECG before he went for catheterization and based on the second ECG changes were suggestive of an ST elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, near total occlusion in the middle of the left anterior descending artery (LAD) with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit (ICCU), the patient improved and was transferred to the Low Care Unit. Conclusions: The case highlights Wellens syndrome in acute total occlusion with collateral artery.

BACKGROUND One of the efforts to reduce hypertension rates in the community is through an educational campaign that refers to the NIH's National Heart, Lung, and Blood Institute curricula or abbreviated as NHLBI. However, during the coronavirus disease 2019 (COVID-19) pandemic, one of the hardest hit areas is health promotion, and there is a significant obstacle regarding the most effective way to transfer knowledge, attitude and practice towards society without transmitting the virus. AIM To evaluate the impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and the practice of hypertension management in the primary care setting during the COVID-19 pandemic. METHODS An online action research with a randomized crossover-controlled trial using a pretest-posttest control group design. The study was conducted in October 2020-April 2021. The population in this study were patients with hypertension who were treated in the Mojo primary health care setting. A purposive sampling technique was done to receive 110 participants using an online questionnaire and invitation letter. RESULTS A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Virtual Anti-Hypertensive Educational Campaign implementation, the only parameter that showed significant improvement was knowledge and attitude ( P < 0.001). There is no significant change in the practice parameters ( P = 0.131). CONCLUSION The Virtual Anti-Hypertensive Educational Campaign implementation in our study population seems to be effective to improve knowledge and attitude of participants, nevertheless, this program seems to be ineffective to improve the practice of hypertension management aspect in participants. Future study with longer durations and more comprehensive programs need to be done to scrutinize the clinical impact of this program nationwide.

Background Great diversity among public hereditary variants may play a role in the susceptibility and severity of acute rheumatic fever (ARF)/rheumatic heart disease (RHD). Cytokine gene polymorphisms may contribute to the disease-associated cytokine imbalance. However, to the best of our knowledge, there is no existing meta-analysis concerning an association of the cytokine gene functional polymorphisms with the susceptibility / severity of ARF/RHD. Aims To investigate the potential association between cytokine gene functional polymorphisms of TNF-α, TGF-β, IL-10, IL-6 and IL-1β and the susceptibility and severity of ARF/RHD. Methods Comprehensive and structured search on Pubmed/Medline, Embase, EBSCO, and Cochrane Central Register of Controlled Trials was performed. Statistical analyses were performed using STATA. First, we performed direct pairwise meta-analysis. Then, a network meta-analysis was performed with the consistency model to compare the genetic models of different cytokine gene polymorphisms. Results Evidence derived from the meta-analysis of 24 retrospective cohort and case-control studies identified that elevated serum levels of TNF-α have been observed in ARF cases, occurring as a result of a SNP (-308G&gt;A) in the promoter site of the TNF-α gene. Our results also suggest that IL-1β (-511) C/T polymorphism, TGF-β1 [rs1800469], and IL-1β [rs2853550] single nucleotide polymorphisms (SNPs) contributed to the susceptibility of ARF/RHD. Egger’s test did not demonstrate significant asymmetry in the dominant. Conclusion In summary, the polymorphism model increased the risk of RHD in the dominant genetic model, recessive genetic model, homozygote model and allelic genetic model among non-Asians while, recessive genetic model and homozygote model among Asians.