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a b s t r a c tPurpose: To find out a novel risk factor for peripheral arterial disease (PAD) in the elderly with Type 2 diabetes mellitus (T2DM). Methods: A cross-sectional study involving 70 out of 146 elderly (!60 years) with T2DM whose ankle ebrachial index (ABI) was measured at the Geriatric Out-patient Clinic, Sanglah Hospital. Results: The overall prevalence of PAD was 30.8% (45 out of 146); in males, it was 25.88% (22 out of 85) and in females, 37.70% (23 out of 61). Only 70 out of 146 subjects who had complete data were further analyzed. By bivariate correlation test, it was found that age (right ABI: r ¼ À0.396, p < 0.001; left ABI, r ¼ À0.509, p < 0.001); lying systolic blood pressure (right ABI: r ¼ À0.268, p ¼ 0.012; left ABI: r ¼ À0.267, p ¼ 0.013); and concentration of 2-hours post-prandial (2-hpp) plasma glucose (right ABI: r ¼ À0.252, p ¼ 0.018) had inverse correlation with ABI, whereas waist circumference, body mass index, sitting and standing systolic and diastolic blood pressures, lying diastolic blood pressure, levels of total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol, triglyceride, fasting plasma glucose, haemoglobin A1C (A1C), and duration of diabetes, had no correlation with ABI. The ages of subjects who had PAD were greater than those without PAD (71.5 years vs. 65.2 years, p < 0.001). Homocysteine tended to be correlated only with left ABI (r ¼ À0.198; p ¼ 0.050), but after assessment on sex factor, it showed that homocysteine had inverse correlation with ABI in males (right ABI: r ¼ À0.371, p < 0.026; left ABI: r ¼ À0.358, p ¼ 0.032). Homocysteine also had a positive correlation with age (r ¼ 0.315, p ¼ 0.004). By multiple regression test, age, LDL cholesterol, and 2-hpp plasma glucose had a role in the PAD event.Conclusions: Some traditional risk factors (age, lying systolic blood pressure, LDL cholesterol, and 2-hpp plasma glucose) were related with PAD in the elderly with T2DM. Homocysteine as a novel risk factor had a correlation with ABI only in the male subjects. Age was the most important risk factor for PAD, either directly or indirectly through homocysteine (only in males).

Background: This research aims to find a cure for anti-inflammation, based on the utilization of red piper crocatum. The research was started with descriptive study to explore active components of red piper crocatum leaf and followed by experimental study to investigate red piper crocatum activity of the leaf extract in anti-inflammation induced Wistar rat. In this research observed three dominant components: caryophyllene bicyclo [5.2.0] none, 2 methylene-4, 8,8-trimethyl-4-vinyl; phytol; 5,9-propano-5H-benzocycloheptene, 6,7,8,9-tetrahydro-7,11-bis(methylene); 4,4-ethynedioxy-2-hexadecen-15-15 olide 1,4,9-trioxaspiro [4,15] eic os-6-en-8-one, 10 methyl; 1H-1,2,4-triazole-5(H)-thione,4-allyl-3-(3-furyl); Benzofuran,2,3-dihydro-2-methyl-7-phenyl which are possibly active to inhibit anti-inflammation to atherosclerosis. Bad eating habits also can cause various health problems, such as obesity, dyslipidemia, inflammation to atherosclerosis. This study was conducted to investigate of red piper crocatum leaves extract as an anti-inflammation through decrease of biochemistry markers TNF-α and IL-6 levels. Method: This is a true experimental with randomized pre-test and post-test control group design, using 50 Wistar rats that are divided

ObjectivesTo elicit key factors influencing physicians’ decision to prescribe statins.DesignA qualitative study using a phenomenological approach within a pragmatism interpretive framework. A combination of purposive and snowball sampling was used to recruit physicians. Data were collected through face-to-face, semistructured interviews with physicians working in primary healthcare facilities in a capital of a province in Indonesia. We recorded and verbatim transcribed the interviews. Coding was done independently by two researchers and data were analysed using phenomenological data analyses. Key factors influencing physicians’ decision to prescribe statins were classified into factors at the microlevels, mesolevels and macrolevels according to the structural model by Scoggins et al.Participants and settingPhysicians working in primary healthcare facilities in a capital of a province in Indonesia.ResultsTen physicians were included in the study. Key factors at the microlevel were that physicians knew guidelines in general, but there was uncertainty how to take into account the level of total cholesterol in combination with other cardiovascular risk factors such as diabetes and hypertension. At the macrolevel, the new National Health Insurance System (NHIS) that appeared to facilitate the prescription of statins though more clinical information should be integrated in the system’s platform to support appropriate prescribing.ConclusionsThe findings indicate lack of awareness of specific details in current guideline recommendations. Appropriate prescribing of statins should be enhanced using the new NHIS.

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