Background and Aims Hyponatremia is often observed in patients with heart failure. The proposed pathophysiology of hyponatremia in heart failure is due to increase of arginine vasopressin activity that elevates renal water reabsorption, thereby diluting sodium content in plasma. Hyponatremia has been identified as a factor that worsens heart failure patients' prognosis, including cardiovascular morbidity and mortality. Thus, this study was conducted to investigate the impact of hyponatremia in heart failure patients on rehospitalisation within thirty days. Methods and Results This is a single-centre prospective cohort study. A total of 205 acute decompensated heart failure patients admitted to National Cardiovascular Center Harapan Kita from July 2018 to March 2019 were included into the study. The study population was then divided into two groups based on predischarge sodium level. In this study, hyponatremia was defined as serum sodium level less than 135 mEq/l. Among the study population, 58 patients (28.3%) had hyponatremia at discharge. The data was analyzed using chi-square test. There were 19 patients who were readmitted within 30 days and 52.9% of them had hyponatremia at discharge. The effect of hyponatremic status at discharge to 30-day readmission rate was statistically significant (p = 0.03, OR = 3.19 95%CI 1.22-8.33). Conclusion Hyponatremia in heart failure patients at discharge is associated with increased risk of 30-day readmission.

Introduction: Doxorubicin (DOX) is an anthracycline that is used for a wide range of malignant conditions. However its off-target effect causes cardiotoxicity. Dexrazoxane (DEX) is the only clinically approved cardioprotective agent against anthracycline toxicity. Its activity has been attributed to its iron-chelating effects. The aim of this project was to assess the protective effect of DEX against DOXinduced toxicity in an HL-1 cardiomyocyte model, and to investigate an early stage marker involved in cellular damage by DOX. Methods: HL-1 cardiomyocytes were cultured for the purpose of bioactivity studies. The half maximal inhibitory concentration (IC-50) of DOX was established. Then the ability of DEX to recover damaged cells was assessed using measures of cell viability. A variety of DEX concentrations with HL-1 s were studied in vitro. Finally, an early stage marker involved in cellular damage by DOX was examined. An assay kit was used for the study of dsDNA breaks through the detection of γ-H2AX -a phosphorylated histone historically proven as a highly specific and sensitive molecular marker for dsDNA damage detection. Results: The IC-50 of DOX was 3 μM. When DEX was combined, there was an additional toxic effect on HL-1 s. The inhibitory effect of DEX on cell viability ceased at 10 μM. The γ-H2AX assay showed decreased dsDNA breaks in cells treated with DEX compared with those treated with DOX alone. The dsDNA breaks were increased in cells treated with DOX alone compared with control (cells alone) (P < 0.05), and dsDNA breaks were increased in cells treated with DOX alone versus those treated with combined DOX and DEX (P < 0.05). Discussion: DEX was found to abolish the DNA damage signal γ-H2AX caused by DOX in HL-1 s as demonstrated in the γ-H2AX assay, suggesting an alternative mechanism of cardioprotective action of DEX.

Enterocutaneous fistula (ECF) management is a challenge that requires a multidisciplinary team approach in achieving optimal clinical output. Nutrition as a component of management plays a vital role in determining the prognosis, both as a predictor of morbidity and mortality. Malnutrition can also occurs as a preceeding situation or complication of ECF caused by the underlying disease, decreased food intake, increased protein requirements associated with systemic inflammation, and increased nutrient loss associated with the amount of fistula output. Thus, nutrition management can act as prevention, therapy, or both. Nutritional medical therapy in ECF cases aims to adequately estimate nutritional needs, maintain fluid and electrolyte balance, and stimulate spontaneous ECF closure whenever possible. To achieve optimal outcome, nutrition needs analysis must be done individually by considering the etiology, anatomical location of the fistula, and the amount of output. In the following article, we will discuss a comprehensive step-by-step nutrition treatment, both from the nutritional routes consideration, macronutrient and micronutrient requirements, specific nutrients, pharmacotherapy, and monitoring and evaluation that need to be done to achieve optimal clinical outcomes.

Aims Acute coronary syndrome (ACS) is responsible for high rates of hospital admission with high cost burden. Knowing patients with projected prolonged length of stay (LOS) could enable clinicians to do early interventions and better preparations. This study aims to identify factors associated with prolonged LOS in ACS patients at the time of admission. Method and Result We included 237 ACS patients admitted to Kediri General Hospital and Bogor General Hospital between January and June 2020. Patients who died during hospitalization or discharged by their own will were excluded. Data were collected retrospectively and analyzed using SPSS v25. Prolonged LOS was defined as LOS more than 6 days. The mean age was 57.5±0.7 years, majority was male (65.8%) and had diagnosis of NSTE-ACS (56.5%). The median LOS was 5 days (2-23), and the prevalence of prolonged LOS was 18.1%. On bivariate analysis, factors associated with prolonged LOS were high risk age (men &gt; 40 years and women &gt; 50 years) (p = 0.01), hypotension (p &lt; 0.01), decreased consciousness (p = 0.004), sign of shock (p = 0.002), tachycardia (p = 0.001), and higher Killip class (p = 0.002). After multivariable adjustment and stepwise elimination, hypotension was found to be significant independent predictor for prolonged LOS (OR 38.512 [95% CI 4.5-328], p = 0.001). The area under the receiver operating characteristic curve (AUC) was 0,704 (95% CI 0.614-0.794) which showed acceptable discrimination, and calibration was good (Hosmer-Lemeshow test: p = 0.96). Conclusion Hypotension was found to be strong independent predictor for prolonged LOS in ACS patients.