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University of Sumatera Utara, Medan, Indonesia.
Jelita Siregar has completed her Master at the age of 32 years and Speciality of Clinical Pathology at the age 33 years from Universitas Sumatera Utara and Medical Doctor studies from Universitas Sumatera Utara. She is the secretary of the clinical pathology at Universitas Sumatera Utara. She has published 3 papers in reputed journals and has been serving as an Co-Author in 2 papers in reputated journals.
Introduction : Diabetes mellitus (DM) is a chronic endocrine disorder characterized by hyperglycemia with impaired metabolism of carbohydrates, fats and proteins resulting from disorders of insulin hormone secretion, insulin function, or both. Hyperglycemia and other metabolic changes can cause interference with the production of nitric oxide (NO). Nitric Oxide is synthesized from L-Arginine by endothelial nitric oxide synthase (eNOS) encoded by the eNOS3 gene on chromosome 7. An important polymorphism described in the literature is that G894T results in accelerated degradation and significantly reduces NO production which contributes to the occurrence of atherosclerosis. Purpose : Proving the relationship between Nitric Oxide gene polymorphism and Nitric Oxide levels in type 2 DM with hypertension in the Bataknese. Method : A Case ontrol study was performed to evaluated the association between polymorphism of G894T Gene and nitric oxide level. 56 consecutiv patients with type 2 diabetes with hypertension and 56 healty controls were recruited. The Genotypes polymorphism were determined by the polumerase chain reacion-restriction fragment length polymorphism (PCR-RFLP) analysis. Result : the Polymorphism of G894T Gene Nitric oxide synthase 3 was found to be assosiated with hypertension in type 2 diabetes in the bataknese population as the patients group had higher frequeny compared with the controls. The nitric oxide levels in type 2 diabetes with hypertension in the Bataknese was lower than controls. Conclusion : The result of this study indicated that the G894T polymorphism in NOS 3 may be genetic susceptibility factor for hypertension in the bataknese population.
Philippine Heart Center, Philippines
Joy Fongayao is currently on her 2nd Year of TCVS Fellowship Training at Philippine Heart Center, Quezon City, Philippines. She finished her 5 years General Surgery Residency Training at Baguio General Hospital and Medical Center, Baguio City, Philippines
INTRODUCTION: Multiple systemic embolisms to the spleen, kidney and extremities caused by complications of infective endocarditis (IE) in a single patient are rare and have fatal outcomes. Management of complications depends on the emergency and medical condition of patient. CASE PRESENTATION: Presented is a case of a 37 year old male with IE diagnosed initially with splenic abscess with multiple consultations and prolonged antibiotic intake. Percutaneous drainage of the abscess revealed heavy growth of Streptococcus sanguinis and blood culture shows growth of Capnocytophaga specie. Laparoscopic Splenectomy was done. During hospital stay patient developed Acute Limb Ischemia (ALI) IIB of the right upper extremity and emergency embolectomy was done. Valve Repair surgery was performed eventually and patient was discharged improved thereafter. DISCUSSION: Reported in this paper is a unique case of IE causing complications of splenic abscesses, renal infarcts and ALI with splenic abscess culture of Streptococcus sanguinis and blood culture of Capnocytophagia specie. Embolic complications occur in 20-50% of cases of IE. They can precede the diagnosis of IE in 25-60% of patients.1 Endocarditis as a result of Capnocytophaga canimorsus infection is extremely rare.2 The incidence of embolization causing ALI is unknown. Approximately 5% of patients with splenic infarction will develop splenic abscess. Current agreement states that IE and splenic abscesses should be treated during the same hospitalization, whether it comes first or after valve operation is still controversial. In our patient, the multiple complications of IE were addressed in same hospitalization stay. CONCLUSION: Management of complications of systemic embolism of IE entails a multidisciplinary and individualized approach. Antibiotic therapy, splenectomy, embolectomy and valve surgery on the same hospitalization can have satisfactory outcomes.
Medical University of Ohio at Toledo, United States
William J. Rowe M.D. FBIS (Fellow British Interplanetary Society), FACN (Fellow American College of Nutrition, Retired Fellow Royal Society of Medicine), is a board certified specialist in Internal Medicine. He received his M.D. at the University of Cincinnati and was in private practice in Toledo, Ohio for 34 years. This triggered a 20 year pursuit of the cardiovascular complications of Space flight. He has published in LANCET that extraordinary, unremitting endurance exercise can injure a perfectly normal heart. Of only 4 space syndromes, he has published 2: "The Apollo 15 Space Syndrome" and "Neil Armstrong Syndrome."
Of 12 moon walkers, James Irwin on day after return from Apollo 15 mission, showed extraordinary bicycle ( B) stress test (ST) hypertension ( 275/125) after 3 minutes exercise; supervising > 5000 maximum treadmill ST, author never witnessed ST- blood pressure approaching this level. Symptom-limited maximum B stress test showed “cyanotic fingernails”; possibly venous blood trapped peripherally, supporting author’s “Apollo 15 Space Syndrome,” postulating that severe fingertip pain during space walks, triggered by plasma fluid, trapped distally; mechanism could be related to endothelial dysfunction, providing “silent ischemia” warning. Neil Armstrong returned to Earth with severe diastolic hypertension ( 160/135), consistent with ischemic left ventricular dysfunction; 50 mm increase in comparison with resting BP 110/85. With inhalation of lunar dust, brought into habitat on space suit, with high lunar iron (I) this dust inhalation, along with reduced (R) space flight- transferrin, R antioxidant, calcium (Ca) blocker - magnesium, conducive to severe oxidative stress, Ca overload with potential endothelial injuries. Using moon walker studies as example, my recent editorials show that I dust, released from brakes, with over 90% of brakes made of I, is a major hypertension factor and may also contribute to myocardial infarctions.
University of Hasanuddin, Makassar, Indonesia
M. Akhiruddin has completed general doctor from Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia. Currently, he is completing specialist education programe in Department of Cardiology and Vascular Medicine, University of Hasanuddin, Makassar, Indonesia
Background: Supraventricular Tachycardia (SVT) are triggered by a reentry mechanism. Atrioventricular reentrant tachycardia (AVRT) is another common form of paroxysmal SVT. Paroxysmal SVT is observed not only in healthy individuals; it is also common in patients with previous myocardial infarction, mitral valve prolapse, chronic lung disease. AVRT results from the presence of 2 or more conducting pathways. The accessory pathways may conduct impulses in an anterograde conduction, a retrograde conduction, or both. Most of these accessory pathways are located between the left ventricle and left atrium or in the posteroseptal area, less often between the right ventricle and right atrium. Management of patients with concealed accessory pathways divided into acute treatment and ongoing management of orthodromic AVRT. In this report, we describe a case of Atrioventricular reentrant tachycardia (AVRT) with history of Coronary Artery Disease two Vessels Disease (CAD 2VD). Case report: A 56-year-old man admitted to the hospital with major complaints of palpitation since 1 day and no chest pain. History of recurrent palpitation since 3 months ago. He has history of smoking and coronary angiography was CAD 2VD. On admission, ECG in ER showed Narrow QRS complex tachycardia with heart rate 180 bpm, regular, ST depression at lead V2-V6, q patologis di lead III,aVF. The laboratory result within normal limit. From echocardiography we found decreased LV systolic function and mild LV diastolic dysfunction. Result of Coronary Angiography showing chronic total occlusion (CTO) in Left Circumflex and Right Coronary Artery. The patient has performed procedure electrophysiological (EP) Study and radiofrequency ablation (RFA). Three quadripolar catheter was inserted and placed in RV apex, His bundle, HRA via femoral vein . One decapolar catheter placed in CS via internal jugular vein. Pacing from RVA showed retrograd conduction and programmed atrial stimulation induced SVT. The SVT have morphology AVRT posteroseptal accesories pathway. Ablation cathether was placed at the posteroseptal accessory pathway and multiple radiofrequency ablation (RFA) were done. After RFA at the accessory pathway and then pacing could not reinduced SVT. The procedure of electrophysiolgy study and ablation is complete without complication. Conclusion: AVRT with CTO in LCX and RCA is a rare case with recurrent palpitation presentation. As physicians, we need to be highly vigilant in clinical evaluation. This Case report a 56 year old Male with atrioventricular reentrant tachycardia (AVRT) and coronary artery disease two vessels disease has performed procedure of electrophysiological (EP) Study and radiofrequency ablation (RFA) by electrophysiologist.