Muchtaruddin Mansyur

Genetic polymorphism in postoperative sepsis after open heart surgery in infants.

Background Sepsis is one of the complications following open heart surgery. Toll-like receptor 2 and toll-interacting protein polymorphism influence the immune response after open heart surgery. This study aimed to assess the genetic distribution of toll-like receptor 2 N199N and toll-interacting protein rs5743867 polymorphism in the development of postoperative sepsis. Methods A prospective cohort study was conducted in 108 children <1-year old who underwent open heart surgery with a Basic Aristotle score ≥6. Patients with an accompanying congenital anomaly, human immunodeficiency virus infection, or history of previous open heart surgery were excluded. The patients’ nutritional status and genetic polymorphism were assessed prior to surgery. The results of genetic polymorphism were obtained through genotyping. Patients’ ages on the day of surgery and cardiopulmonary bypass times were recorded. The diagnosis of sepsis was established according to Surviving Sepsis Campaign criteria. Results Postoperative sepsis was observed in 21% of patients. There were 92.6% patients with toll-like receptor 2 N199N polymorphism and 52.8% with toll-interacting protein rs5743867 polymorphism. Conclusions Toll-like receptor 2 N199N polymorphism tends to increase the risk of sepsis (odds ratio = 1.974; 95% confidence interval: 0.23–16.92; p = 0.504), while toll-interacting protein rs5743867 polymorphism tends to decrease the risk of sepsis (odds ratio = 0.496; 95% confidence interval: 0.19–1.27; p = 0.139) in infants <1-year old undergoing complex open heart surgery.

The role of apolipoprotein E polymorphism in improving dyslipidemia in obese adolescents following physical exercise and National Cholesterol Education Program Step II intervention.

Abstract Background: Lifestyle changes are important factors for managing dyslipidemia before considering blood lipid-lowering drugs. However, genetic factors can influence the response outcome. Objective: We aimed to determine a dyslipidemia management strategy in obese adolescents. Patients and methods: A total of 60 dyslipidemic obese adolescents received physical exercise and the NCEP step II diet for 28 days. Apolipoprotein E (apo E) genotypes and blood lipid levels were compared before and after interventions. Results: The apo E3/E3 genotype was found to be common in all subjects. Mean levels of total cholesterol, triglyceride, and low-density lipoprotein-cholesterol (LDL-C) improved in subjects with the E3 allele after the intervention, but not the E2 allele. Total cholesterol and LDL-C, but not triglyceride levels, improved in subjects with the E4 allele. Discussion: Apo E alleles might influence improvement in lipid profiles after diet and exercise interventions. These results could inform personalized dyslipidemia management in obese adolescents, to determine which subjects would benefit from blood lipid-lowering drugs.

1459 The effect of below exposure noise threshold limit value to acute stress

Introduction This study aims to examine the possibility of the effect of noise with intensity below the threshold value to stress. Method The study is a quasi-experimental involved 108 subjects divided into 6 noise exposure groups of control, 0 dBA, 70 dBA, 75 dBA, 80 dBA and 85 dBA in 15 min exposure. Research subjects consisted of healthy males, aged 18–39 years and met the study criteria. Assessment of stress include physical stress index (PSI), the total power (TP) and low frequency/high frequency ratio (the ratio of LF/HF) measured using the test heart rate variability (HRV), adrenaline and cortisol blood levels measured before and after treatment. Result Research subjects who qualify as many as 102 people a year aged 23.99±4.77 years. Research subjects have equal characteristics between treatment groups according to the socio-demography. There is no different of PSI value, the ratio of TP and LF/HF, Adrenaline between exposure groups. Cortisol levels were positively correlated with higher levels of adrenaline (r=0.35, p<0.01) while adrenaline levels and cortisol levels were strongly positively correlated (r=0.53, p<0.01). PSI values weakly positively correlated with cortisol levels (r=0.2, p<0.05) and the ratio LF/HF were positively correlated weakly with cortisol (r=0.2, p<0.05). Discussion Effect of noise on the stress intensity visible starting at Laeq, 65 dBA and Laeq 8 hour, 8 hour 70 dBA. Correlation parameter values autonomic balance system with adrenaline and cortisol levels demonstrate the potential use of HRV as a psychophysiological assessment instruments due to noise disturbance.

1636b Mining workers, administrative task, obesity, hypertriglyceridemia, and young workers increased risk liver function elevation among indonesian male workers

Introduction Mining workers have potential risks to be exposed by many toxicants. Due to the majority of toxicants metabolised through the liver this may be high risk of the liver function alteration due to occupational and non-occupational health hazards exposures. The purpose of this study was to explore the risk of mining worker to have liver function elevation (LFE) adjusted by other risk factors. Methods A comparative cross sectional study was conducted to examine the secondary data of 2016 annual medical examination results of 5634 workers from six various industries in Indonesia. The data subjects consisted of 447 of those who had a LFE compared with 1341 subjects were randomly chosen from those data whose were normal in liver function enzyme. Liver function elevations were considered on the basis of serum aspartate aminotransferase and/or alanine aminotransferase level more than 5 points above reference levels. The risk of mining workers to have liver function elevation were calculated using Odds Ratios and adjusted by Type of Task, Chemical Exposure History, Age, Body Mass Index, Medical History and Triglyceride Level. Result This study analysed 1781 male workers (31.0±7.4 year). No significant associations were observed between outcome and medical history of diabetes mellitus and liver disease as well as alcohol consumption, smoking, physical exercise, and chemical exposure history. Risk factors associated with LFE were identified including obesity (OR 4.0, 95% CI: 3.1 to 5.0), work in mining sector (OR 2.0, 95% CI: 1.6 to 2.6), role as administrative worker (OR 1.4, 95% CI: 1.0 to 1.8), age <35 years (OR 1.4, 95% CI: 1.1 to 1.9), and hypertriglyceridemia (OR 1.6, 95% CI: 1.3 to 2.1) respectively. Discussion Attributed risk factors of LFE among worker were identified including occupational, individual and modifiable metabolic risk. Further research is needed to explain the role of occupational exposures in LFE among miners.

Early Exercise Program for Patients with Heart Failure after Hospital Discharge

Background: The exercise program (EP) demonstrated beneficial effects on survival and morbidity of patients with chronic and stable heart failure (HF), but there were no evidence of safety and benefit when the EP was implemented early. Objectives: This study aimed to investigate the effects of early EP for patients with HF. Methods: We randomly recruited 48 patients with systolic HF early after acute HF hospitalisation, with ejection fraction <40%, age <65 years, resting heart rate <100 bpm, and able to walk more than 100 meters as the intervention group (IG). They participated in in-hospital, low-to-moderate intensity, symptom-limited EP for 1 month. Meanwhile, 65 patients with similar characteristic or refused to be recruited to the IG were allocated as control group (CG) underwent usual care. Pre and post study measurement of 6-minutes walking test (6MWT) distance, NTproBNP level, quality of life parameters (Minnesota Living with Heart Failure Questionnaire and SF-36), and first major adverse cardiac event (mortality, rehospitalisation or clinical worsening) within 1 month study period. Results: Both groups had similar baseline characteristics. The patients in IG initiated the early EP on day 5.1+3.5 from hospital discharge. Major adverse cardioascular events were experienced by 9 (18.8%) of the IG and by 26 (40%) of the CG (p=0.016). At the end of study, the 6MWT distance of IG was higher than that of CG: 398.9 (95% CI: 383.8-414.0) versus 352.7 (95% CI: 318.4-387.0) meters, p=0.016. Mean NT-proBNP level did not change in IG (from 3774 to 3563 pg/mL, p=0.568) nor in CG (from 3784 to 4931 pg/mL, p=0.150). Quality of life parameters improved in IG, but not in CG. Conclusion: Early EP for patients with HF was safe and effective in improving physical fitness level and quality of life and it did not harm the myocardium.

Correcting of pronated feet reduce skeletal muscle injury in young women with biomechanical abnormalities.

Biomechanical abnormalities of pronated feet accompanied by functional leg length disparity may increase the risk of skeletal muscle injury. Objective of the study is to prove that correction of pronated feet by the foot orthoses will reduce the creatine kinase-MM (CK-MM) concentrations as the muscle injury indicator. The design study was double blind randomized clinical trials with control. Research subjects were divided into two groups, group 1 used the foot orthoses while group 2 did not used the foot orthoses. The whole subject examined the concentrations of the CK-MM enzyme before, and 24–72 hours after the walking test. The walking test was conducted 15 minutes with maximum speed. The concentration of the CK-MM enzyme before walking test on treatment group was 70.07±15.33 International Unit (IU), similar with the control group was 69.85±17.03 IU (P=0.971). The increased in CK-MM enzyme concentrations 45 hours after the walking test was lower in the treatment group (7.8±9 IU) than the control group (22.0±11.5 IU) (P=0.001). The CK-MM enzyme concentrations continued to decline in the treatment group after the second walking test (77.21±17.47 IU), and after the third walking test (69.86±11.88 IU) (P=0.018). The foot orthoses for correcting the pronated feet on the young women with biomechanical abnormalities is able to reduce the degree of the skeletal muscle injury after walking activity.