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The production of food-grade salt from crude solar salt has been examined through a techno-economic evaluation. This study aimed to investigate a salt factory to analyze its technical and economic aspects to determine the precise parameters for improving the quality of food-grade salt. The primary process of this factory involves grinding, washing, draining, drying, and fortification, supported by equipment like brine management, conveyors, sieves, and packaging. The proposed salt plant, designed for a 3-ton daily output over 15 years, requires 30 months for construction and a 4-month startup. The total capital outlay is USD 1,921,000, with USD 310,000 for technology and equipment. Economic indicators, including a Net Present Value (NPV) of USD 7,862,000, an Internal Rate of Return (IRR) of 46.48%, payback in 1.56 years, and a Return on Investment (ROI) of 64.28%, demonstrate feasibility. Establishing a salt plant in Indonesia supports food-grade salt production, stabilizes solar salt prices and enhances the welfare of traditional salt farmers. Ultimately, the results of this study can provide valuable insights for evaluating the feasibility of establishing a food-grade salt production plant in Indonesia.

Abstract This meta-analysis was conducted to clarify the role of klotho and fibroblast growth factor 23 (FGF-23) in human arterial remodeling across recent studies, in terms of arterial calcification, thickness, and stiffness. A systematic literature search was conducted on five databases for articles up to December 2023. Arterial calcification, thickness, and stiffness were determined using the calcification score and artery affected, carotid intima–media thickness (CIMT), and pulse wave velocity (PWV), respectively. Sixty-two studies with a total of 27,459 individuals were included in this meta-analysis. Most studies involved chronic kidney disease patients. Study designs were mostly cross-sectional with only one case–control and nine cohorts. FGF-23 was positively correlated with arterial calcification (r = 0.446 [0.254–0.611], p

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. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

Summary: The presence of calcified nodule (CN) is a significant characteristic of atherothrombosis in acute coronary syndrome (ACS). However, its characteristics continue to be understudied. This review aimed to further investigate these characteristics. This study found that CN was a distinctive feature of an atheromatous plaque, representing 6.3% of ACS. CN was more common in NSTE-ACS than in STEMI patients (9.4% vs. 6.6%). CN was also chiefly observed in the left anterior descendant artery (48%), followed by the right coronary (40.4%) and left circumflex (14.5%) arteries. Higher prevalence of hypertension (78.8%), diabetes mellitus (50.8%), multivessel disease (71.7%), and kidney disease (26.43%) were noted in CN compared to non-CN patients. CN-associated ACS also 6-fold increased the risk of target lesion revascularization compared to those without CN.

Cardiovascular disease (CVD) is a growing burden in Indonesia, making primary prevention of utmost importance. High sensitivity cardiac troponin I (hsTnI) has been known as one of the biomarkers of choice for diagnosing acute myocardial infarction. Nonetheless, recent studies indicate that hsTnI assay has potential as a predictor of cardiac risk in asymptomatic individuals. An advisory board consisting of renowned cardiologists from the Indonesian Heart Association was convened in Jakarta in March 2023. The meeting aimed to explore the appropriate use of hsTnI for cardiovascular (CV) risk stratification in apparently healthy adults in Indonesia. The board reviewed relevant literature and developed key consensus statements, including hsTnI cut-off for identifying high-risk asymptomatic patients, the proposed algorithm, and monitoring after aggressive risk factor control. This article presents the resulting consensus statements to provide clinicians with a practical tool for planning primary prevention strategies. Furthermore, it is expected to raise awareness and advocacy among stakeholders in the healthcare infrastructure regarding the use of hsTnI as a guide for assessing CV risk in Indonesia.

Abstract Background The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). Case presentation A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. Conclusion We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits.

Heart disease is a heart condition that sometimes causes a person to die suddenly. One indication is a rhythm disorder known as arrhythmia. Multi-class Arrhythmia Detection has followed: QRS complex detection procedure and arrhythmia classification based on the QRS complex morphology. We proposed an edge device that detects QRS complexes based on variance analysis (QVAT) and the arrhythmia classification based on the QRS complex spectrogram. The classifier uses two-dimensional convolutional neural network (2D CNN) deep learning. We use a single board computer and neural network compute stick to implement the edge device. The outcomes are a prototype device cardiologists use as a supporting tool for analysing ECG signals, and patients can also use it for self-tests to figure out their heart health. To evaluate the performance of our edge device, we tested using the MIT-BIH database because other methods also use the data. The QVAT sensitivity and predictive positive are 99.81% and 99.90%, respectively. Our classifier's accuracy, sensitivity, predictive positive, specificity, and F1-score are 99.82%, 99.55%, 99.55%, 99.89%, and 99.55%, respectively. The experiment result of arrhythmia classification shows that our method outperforms the others. Still, for r-peak detection, the QVAT implemented in an edge device is comparable to the other methods. In future work, we can improve the performance of r-peak detection using the double-check algorithm in QVAT and cross-check the QRS complex detection by adding 1 class to the classifier, namely the non-QRS class.

Abstract Background Cardiac myxoma is the most common type of primary cardiac tumor, with the majority located in the atrial wall. The tumor is attached to valvular structures in a few cases, of which the pulmonary valve is the least affected. Pulmonary valve myxoma may have different clinical manifestations from the more common cardiac myxomas because of its vital position. A misdiagnosis of these types of cardiac myxoma may be detrimental to the care and well-being of patients. Therefore, this systematic review aims to define the clinical characteristics of pulmonary valve myxoma and how this differs from a more common cardiac myxoma. Methods Employed literature was obtained from PubMed, ScienceDirect, Scopus, Springer, and ProQuest without a publication year limit on August 23, 2022. The keyword was “pulmonary valve myxoma.” Inclusion criteria were as follows: (1) case report or series, (2) available individual patient data, and (3) myxoma that is attached to pulmonary valve structures with no evidence of metastasis. Non-English language or nonhuman subject studies were excluded. Johanna Briggs Institute checklists were used for the risk of bias assessment. Data are presented descriptively. Results This review included 9 case reports from 2237 articles. All cases show a low risk of bias. Pulmonary valve myxoma is dominated by males (5:4), and the patient’s median age is 57 years with a bimodal distribution in pediatric and geriatric populations. The clinical manifestation of pulmonary valve myxoma is often unspecified or asymptomatic. However, systolic murmur in the pulmonary valve area is heard in 67% of cases. Echocardiography remains the diagnostic modality of choice in the majority of cases. Tumor attached to the pulmonary cusps or annulus and extended to adjacent tissues in all cases. Therefore, valve replacement or adjacent tissue reconstructions are required in 77% of cases. The recurrence and mortality are considerably high, with 33% and 22% cases, respectively. Conclusions Pulmonary valve myxoma is more common in males with a bimodal age distribution, and its outcomes seem worse than usual cardiac myxomas. Increasing awareness of its clinical symptoms, early diagnosis, and complete myxoma resection before the presence of congestive heart failure symptoms are important in achieving excellent outcomes. A firm embolization blockade is needed to prevent myxoma recurrence.

Some patients presenting with acute coronary syndrome may have had nonobstructive coronary arteries. Nevertheless, a lot of people are not aware that, as of the fourth universal definition of myocardial infarction, Takotsubo syndrome is no longer categorized as myocardial infarction with non-obstructive coronary arteies group. This can lead to diagnostic delays, the use of unnecessary examination, and harmful medical intervention. We present a 68-year-old woman with typical chest pain for 6 h. She had a history of hypertension, transient ischemic attack, and diabetes mellitus. She was diagnosed first with acute coronary syndrome but was later found to have takotsubo syndrome, based on high international takotsubo diagnostic score and transthoracic echocardiography findings of systolic apical ballooning. Within 5 days, she makes a gradual recovery.

Myocarditis is distinguished by a wide array of nonspecific symptoms, including chest pain, dyspnea, and palpitations. These symptoms are accompanied by electrocardiographic abnormalities that exhibit similarities to those observed in myocardial infarction. However, the results of coronary angiography frequently, though not consistently, show normal findings. Therefore, the clinical diagnostic procedure often encounters difficulties and is susceptible to the misdiagnosis of myocardial infarction with nonobstructive coronary arteries. The signs of poor cardiac contractility are a common manifestation of myocarditis and can be evaluate with bedside echocardiography. Two-dimensional speckle tracking echocardiography bestows a precise left ventricle (LV) global and regional dysfunction . We present a case of a 40-year-old man with typical chest pain for 8 hours, and dyspnea. He had no significant medical history. This patient was first diagnosed with high lateral ST-elevation myocardial infarction (STEMI) with cardiogenic shock. Angiography examination revealed no significant obstruction of coronary vessels. However, serial left ventricle global longitudinal strain supports the diagnosis of myocarditis. After receiving the treatment for myocarditis, the patient makes a full recovery within 7 days.

Context: Inflammatory factors and oxidative stress were discovered to play significant roles in the progression of chronic kidney disease (CKD). There is, however, no research on the direct impact of high plasma angiotensin converting enzyme (ACE) and interleukin (IL)-6 levels on CKD prognosis, particularly in non-hemodialysis patients. Aims: To investigate the potential role of plasma ACE and IL-6 levels in CKD prognosis. Methods: A total of 75 non-dialysis CKD patients participated in this cross-sectional study. The estimated glomerular filtration rate (e-GFR) and albuminuria were used to determine the prognosis of CKD. The plasma ACE and IL-6 levels were measured using an enzyme-linked immunoassay (ELISA). Spearman’s rank correlational analysis was used to examine the relationship between ACE and IL-6 plasma levels with the prognosis of CKD. Results: The result showed a statistically significant correlation between age and plasma ACE (p = 0.038, r = 0.241), serum creatinine, and urine albumin-creatinine ratio with CKD prognosis (p

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of death in patients with chronic kidney disease (CKD). Klotho expression was reduced in patients with CKD, leading to vascular calcification, endothelial dysfunction, and atherosclerosis. We investigated the role of the klotho G395A gene polymorphism and plasma klotho level in the ten-year risk of atherosclerotic cardiovascular disease (ASCVD) and CVD mortality in CKD patients. METHODS: We used the PCR-CTPP assay method to genotype klotho G395A single nucleotide polymorphism (SNP) in 72 non-dialysis CKD patients. The klotho level was determined using the enzyme-linked immunoassay (ELISA) method. Path analysis was used to determine the relationship between the klotho G395A SNP, plasma klotho level, ASCVD risk score, and CVD mortality risk score. RESULTS: Our results showed that the GA genotype had lower plasma klotho levels than the GG genotype (path coefficient=-0.185, p=0.000). There was a significant negative correlation between plasma klotho level and the ASCVD risk score (r=-0.243, p=0.040), but no significant correlation was found between plasma klotho level and the CVD mortality risk score (r=-0.145, p=0.225). Path analysis showed that plasma klotho level had a significant negative direct effect on ASCVD risk score (path coefficient=-0.272, p=0.000) and an indirect effect on CVD mortality risk score (path coefficient=0.187, p=0.005). CONCLUSION: Klotho G395A SNP might reduce lower plasma klotho levels, which increased ASCVD and CVD mortality risk scores in non-dialysis CKD patients. However, other risk factors such as age, CKD stages, hypertension, and smoking should be taken into consideration. Therefore, large-scale genetic association studies with adjusted variables could be conducted in various ethnic groups for a more robust result. KEYWORDS: klotho, single nucleotide polymorphism, cardiovascular disease, chronic kidney disease

Background: The shock index (SI) ratio serves as a straightforward predictor to identify patients who are either at risk of or experiencing shock. COVID-19 patients with shock face increased mortality risk and reduced chances of recovery. This review aims to determine the role of SI in the emergency department (ED) to predict COVID-19 patient outcomes. Methods: The systematic search was conducted in PubMed, ProQuest, Scopus, and ScienceDirect on June 16, 2023. We included observational studies evaluating SI in ED and COVID-19 patient outcomes. Random-effect meta-analysis was done to generate odds ratios of SI as the predictor of intensive care unit (ICU) admission and mortality. The sensitivity and specificity of SI in predicting these outcomes were also pooled, and a summary receiver operating characteristics (sROC) curve was generated. Results: A total of eight studies involving 4557 participants were included in the pooled analysis. High SI was found to be associated with an increased risk of ICU admission (OR 5.81 [95%CI: 1.18–28.58], p = 0.03). Regarding mortality, high SI was linked to higher rates of in-hospital (OR 7.45 [95%CI: 2.44–22.74], p = 0.0004), within 30-day (OR 7.34 [95%CI: 5.27–10.21], p 0.7 yielded improved sensitivity (95%CI: 78.0% [59.7%–89.4%]) and specificity (95%CI: 76.8% [41.7%–93.9%]) in predicting overall mortality. Conclusion: SI in emergency room may be a simple and useful triage instrument for predicting ICU admission and mortality in COVID-19 patients. Future well-conducted studies are still needed to corroborate the findings of this study.

Vaccination is significant to control, mitigate, and recover from the destructive effects of coronavirus disease 2019 (COVID-19). The incidence of myocarditis following COVID-19 vaccination has been increasing and growing public concern; however, little is known about it. This study aimed to systematically review myocarditis following COVID-19 vaccination. We included studies containing individual patient data of myocarditis following COVID-19 vaccination published between January 1, 2020 and September 7, 2022 and excluded review articles. Joanna Briggs Institute critical appraisals were used for risk of bias assessment. Descriptive and analytic statistics were performed. A total of 121 reports and 43 case series from five databases were included. We identified 396 published cases of myocarditis and observed that the majority of cases was male patients, happened following the second dose of mRNA vaccine administration, and experienced chest pain as a symptom. Previous COVID-19 infection was significantly associated (p < 0.01; OR, 5.74; 95% CI, 2.42–13.64) with the risk of myocarditis following the administration of the first dose, indicating that its primary mechanism is immune-mediated. Moreover, 63 histopathology examinations were dominated by non-infective subtypes. Electrocardiography and cardiac marker combination is a sensitive screening modality. However, cardiac magnetic resonance is a significant noninvasive examination to confirm myocarditis. Endomyocardial biopsy may be considered in confusing and severe cases. Myocarditis following COVID-19 vaccination is relatively benign, with a median length of hospitalization of 5 days, intensive care unit admission of

Abstract Background True isolated posterior myocardial infarction is an uncommon finding of acute coronary syndrome, with an incidence rate of 3–7%. The prevalence rates of isolated posterior myocardial infarction in men and women are 72% and 28%, respectively. This uncommon finding may be attributed to multiple factors, such as unremarkable changes on 12-lead electrocardiography, a lack of awareness or knowledge, and an absence of diagnostic consensus, which leads to reperfusion delay and poor clinical outcomes. Case summary Herein, we report three cases of acute myocardial infarction presenting as isolated ST-segment elevation in the posterior leads (V7–V9): Asian men aged 57, 62, and 53 years, who presented with ST-segment depression in V1–V3 that resolved gradually. Coronary angiography revealed a total/critical occlusion of the proximal circumflex coronary artery in all three cases. Routine and accurate interpretations of 15-lead electrocardiography (12-lead with additional V7–V9) resulted in a better sensitivity for isolated posterior myocardial infarction diagnoses, followed by a timely and opportune primary percutaneous coronary intervention. Conclusions Isolated posterior myocardial infarction is a rare but potentially fatal event that is often accompanied by atypical and subtle changes on 12-lead electrocardiography (especially in the V1–V3 precordial leads) and may remain undetected by physicians. Therefore, the comprehensive and routine application of posterior leads is a crucial addition to the standard diagnosis and management of acute coronary syndrome in patients with subtle ST-segment changes who do not fulfill the criteria for ST-elevation myocardial infarction.

Seperti yang sudah kita alami bersama, ponsel pintar saat ini sudah menjadi bagian hidup sehari-hari. Pengguna ponsel pintar di Indonesia pada tahun 2021 diperkirakan mencapai 191,6 juta orang (70,1% populasi). Durasi penggunaan yang cenderung lama akan memberikan efek yang pada tubuh. Hal ini berhubungan dengan paparan radiasi sinar biru yang dihasilkan layar ponsel pintar. Penggunaan teknologi Light Emitting Diode (LED) menjadi semakin terkenal luas pada layar ponsel pintar. Walaupun terlihat berwarna putih, namun cahaya yang dipancarkan dari layar ponsel pintar memiliki panjang gelombang 400 – 490 nm, yang tergolong dalam kategori sinar biru. Dua saran umum yang dapat dilakukan untuk mengurangi paparan radiasi sinar biru yaitu pengurangan cahaya tingkat tinggi yang tidak perlu di malam hari dan redaman komponen panjang gelombang pendek dari spektrum. Namun, masih banyak pengguna yang tidak menyadari bahwa ponsel pintar mereka memiliki fitur filter sinar biru. Spektrum sinar biru dari layar ponsel dapat diamati menggunakan spektrometer. Saat ini, spektrometer sangat murah telah dikembangkan untuk dapat dirakit sendiri, misalnya papercraft spectrometer dari Public Lab. Artikel ini akan berfokus pada analisis reduksi sinar biru dari layar ponsel pintar berjenis LED. Terdapat tiga ponsel pintar yang diamati, yaitu masing-masing satu unit ponsel berjenis layar AMOLED, OLED dan Super AMOLED. Pengamatan dilakukan ketika fitur filter sinar biru bawaan ponsel diaktifkan atau tidak. Hasil analisis spektrum menunjukkan bahwa terdapat perbedaan nilai intensitas ketika filter sinar biru tidak diaktifkan dan diaktifkan. Ketika filter sinar biru bawaan dari ponsel diaktifkan, maka intensitas yang dihasilkan dari layar lebih rendah dibandingkan tanpa mengaktifkan filter. Berdasarkan perhitungan reduksi intensitas sinar biru, didapatkan bahwa rata-rata filter dari ketiga ponsel yang diamati mampu mereduksi sinar biru antara 52,79% - 68,78%. Ponsel pintar dengan layar Super AMOLED memiliki performansi reduksi spektrum sinar biru lebih baik dibandingkan dengan ponsel dengan layar OLED dan AMOLED.

Pengguna perangkat seluler di Indonesia semakin meningkat dari tahun ke tahun. Pada tahun 2022, tercatat lebih dari 370 juta pengguna seluler, melebihi total populasi negara. Penggunaan gawai yang semakin intens dapat meningkatkan risiko gangguan kesehatan, khususnya terhadap organ penglihatan. Salah satu potensi bahaya dari perangkat seluler portabel yang dapat menyebabkan risiko kesehatan mata adalah paparan radiasi sinar biru dari layar gawai. Filter sinar biru, yang sudah disematkan oleh pabrikan gawai pada produk seluler terkini, dapat menjadi salah satu solusi yang bisa dimanfaatkan oleh pengguna untuk meminimalkan risiko tersebut. Namun, masih banyak pemilik perangkat yang belum menyadari keberadaan fitur ini. Selain itu, penggunaan sejumlah fitur pada gawai diprediksi akan meningkatkan konsumsi daya baterai. Artikel ini akan menyajikan hasil survei pengguna terkait pengetahuan mereka tentang fitur filter sinar biru. Lebih lanjut, pengukuran konsumsi baterai menggunakan aplikasi Accubattery juga dilakukan terhadap penggunaan filter sinar biru untuk beberapa aktivitas daring. Hasil survei menunjukkan bahwa lebih banyak pengguna yang belum mengetahui tentang filter sinar biru pada gawai yang mereka miliki. Hasil pengukuran daya baterai menunjukkan bahwa penggunaan filter dapat meningkatkan konsumsi baterai perangkat dengan peningkatan terbesar didapatkan untuk aktivitas menonton video secara daring, yaitu hampir dua kali lipat. Berdasar hasil perhitungan selisih konsumsi daya ketika filter diaktifkan dan tidak, pengguna direkomendasikan untuk mengaktifkan filter saat aktivitas rapat daring dan belajar daring, karena konsumsi daya dari kedua kegiatan tersebut tidak mengalami kenaikan yang signifikan.

IntroductionPeripartum cardiomyopathy (PPCM) is a potentially life-threatening pregnancy-related heart disease. Genetic roles such as gene polymorphisms may relate to the etiology of PPCM. This study analyzes the association between single nucleotide gene polymorphism (SNP) guanine nucleotide–binding protein beta-3 subunit (GNB3) C825T and insertion/deletion (I/D) of the angiotensin-converting enzyme (ACE) gene with the incidence of PPCM.MethodsAn analytic observational study with a case–control design was conducted at the Integrated Cardiac Service Center of Dr. Soetomo General Hospital, Surabaya, Indonesia. PPCM patients of the case and control groups were enrolled. Baseline characteristic data were collected and blood samples were analyzed for SNP in the GNB3 C825T gene and for I/D in the ACE gene by using the polymerase chain reaction, restriction fragment length polymorphism, and Sanger sequencing. We also assessed ACE levels among different ACE genotypes using a sandwich-ELISA test.ResultsA total of 100 patients were included in this study, with 34 PPCM cases and 66 controls. There were significant differences in GNB3 TT and TC genotypes in the case group compared with that in the control group (TT: 35.3% vs. 10.6%, p = 0.003; TC: 41.2% vs. 62.5%, p = 0.022). The TT genotype increased the risk of PPCM by 4.6-fold. There was also a significant difference in the ACE DD genotype in the case group compared with that in the control group (26.5% vs. 9.1%, p = 0.021). DD genotypes increased the risk of PPCM by 3.6-fold. ACE levels were significantly higher in the DD genotype group than in the ID and II genotype groups (4,356.88 ± 232.44 pg/mL vs. 3,980.91 ± 77.79 pg/mL vs. 3,679.94 ± 325.77 pg/mL, p

Abstract Background Electrocardiogram (ECG) is a widely accessible diagnostic tool that can easily be obtained on admission and can reduce excessive contact with coronavirus disease 2019 (COVID‐19) patients. A systematic review and meta‐analysis were performed to evaluate the latest evidence on the association of ECG on admission and the poor outcomes in COVID‐19. Methods A literature search was conducted on online databases for observational studies evaluating ECG parameters and composite poor outcomes comprising ICU admission, severe illness, and mortality in COVID‐19 patients. Results A total of 2,539 patients from seven studies were included in this analysis. Pooled analysis showed that a longer corrected QT (QTc) interval and more frequent prolonged QTc interval were associated with composite poor outcome ([WMD 6.04 [2.62‐9.45], P = .001; I2:0%] and [RR 1.89 [1.52‐2.36], P

Hypertension is one of the most common morbidities in COVID-19. Previous studies demonstrated that hypertension increases composite poor outcomes in patients with COVID-19. Beta-blockers is widely used as one of the most common antihypertensive agents. Beta-blockers may hold potential benefits in COVID-19 treatment, with current evidence of the potential mechanism of beta-blockers remains scarce. However, several mechanisms were suggested, including decreasing RAAS pathway activity and lowering the ACE2 levels, reducing cytokine storms, and may be beneficial in reducing mortality in ARDS related COVID-19. Further large-scale randomized clinical trials should be conducted before a definite recommendation can be drawn.

The quality of education in Indonesia is still far from being expected. It is different from Taiwan. The government and people realize that a strong commitment to build and develop a national education system is a key determinant of the success of the state to maintain students’ achievement. The purpose of this study is to respond the correlation of teacher teaching experience (TTE) and instructional delivery on teacher’s competence (TCC), classroom curriculum (CC), and personal competencies (PC) by examining teachers in the primary schools from Taiwan and Indonesia. This study explores the differences between Taiwan and Indonesia cohort in TCC, CC, PC and correlation between TTE and TCC, CC, PC to bring learners` achievement. The results shown that the TCC, CC, PC are different from Taiwan and Indonesia. Then, TEE is statistically significant on TCC, CC, and PC. The techno teaching of each country is compiled by the ministry of education, and then the primary school is given the authority to develop techno teaching or students’ achievement in accordance with the conditions of each region and students’ demand in Indonesia which includes a teacher’s competencies that are supported to succeed the education especially in primary school.

Abstrak — Sarana dan prasarana (sarpras) kampus merupakan aset yang digunakan sebagai penunjang kegiatan belajar mengajar. Sarpras kampus tidak hanya untuk digunakan tetapi perlu dijaga kebersihannya. Namun pada kenyataannya sarpras kampus sering terabaikan dari segi kebersihannya. Terabaikannya kebersihan sarpras tersebut disebabkan oleh beberapa hal seperti kurangnya pengawasan oleh bagian sarpras, sulitnya melakukan pengecekan sarpras dikarenakan jumlahnya yang banyak serta terletak di area yang cukup luas, dan terbatasnya petugas kebersihan. Untuk menangani permasalahan hal tersebut maka dirancang sebuah aplikasi monitoring kebersihan sarana dan prasarana kampus. Pada perancangan aplikasi ini menggunakan metode System Development Life Cycle (SDLC), tahapan-tahapannya adalah perencanaan, analisis, perancangan, implementasi, uji coba, dan penggunaan. Aplikasi yang akan dibangun merupakan aplikasi responsif yang berbasis web dengan platform sistem operasi android. Responsif yang dimaksud adalah salah satu teknik yang digunakan pada pengembangan aplikasi berbasis web agar aplikasi yang dijalankan menyesuaikan pada layar perangkat yang digunakan. Bahasa pemrograman yang digunakan adalah PHP dan MySql dipadukan dengan framework CSS yaitu bootstrap. Aplikasi yang dibangun dilengkapi fasilitas feedback yang dapat digunakan oleh pimpinan berupa komentar dan juga ratting pada setiap laporan kebersihan dari masing-masing unit dan lokasi. Komentar dan rating yang diberikan pimpinan ini dapat memberikan pengaruh secara moral kepada penanggung jawab kebersihan secara langsung. Pada akhirnya perancangan aplikasi ini bermanfaat untuk membantu memudahkan bagian sarana prasarana dan pimpinan dalam memonitoring kebersihan sarana sehingga mampu meningkatkan mutu kebersihan sarana prasarana kampus dan memperlancar proses kegiatan belajar mengajar. Kata kunci : Aplikasi Monitoring, Kebersihan, Responsif.

The purpose of this research is to develop a learning package for Sciences Subject that can improve the critical thinking skill of the Elementary School Students. Therefore, in general, it can be categorized into a research and development. It can be done because of learning material with process skill to practice it not available. The learning package was developed by using 4-D model; defining, designing, developing, distributing. The subject in this study was learning material that will be tested in student of SD Raden Patah Surabaya. The result showed that learning material was valid, enforceability get good category with 100%. Student activites by using process get good too. The improvement of students’ critical thinking is consistent on 3 classes (IVA, IVB, and IVC), the significant and high improvement with the average of N-Gain of 0,75. The data of students’ responses showed that most of students (98,09%) are happy to the process skill based learning. Based on the results and findings of the research, it can be concluded that the developed learning package can be stated as a valid, practical, and effective learning package. The implication of the research is that the process skill based Sciences learning can improve students’ critical thinking skill.

This article discusses the influence of the ISO 9001:2008 quality management system and compensation for teacher performance in SMA Darul Ulum 2 Unggulan BPPT Jombang. The purpose of this research is: to know the influence of SMM 9001:2008 implementation to the teacher performance; to know the influence of the compensation for teacher performance; to find out the influence of the SMM ISO 9001:2008 implementation and the compensation simultaneously on the teacher performance. This is a correlational research with an expost facto approach. The population of this study are all teachers in SMA Darul Ulum 2 Unggulan BPPT Jombang that amounted to 92 people. The methods of data collection in this study using questionnaires. Based on the research conducted, it was concluded that the implementation of ISO 9001:2008 quality management system and the the compensation either apart or together are very closely related to the teacher performance in Darul Ulum 2 SMA Unggulan BPPT Jombang.

Acute pericarditis is a common disorder caused by inflammation of the pericardium and can occur as an isolated entity or as a manifestation of an underlying systemic disease. The diagnosis of acute pericarditis is established when a patient has at least two of the following symptoms or signs: chest pain consistent with pericarditis, pericardial friction rub, typical ECG changes, or a pericardial effusion of more than trivial size. Systemic Lupus Erythematosus (SLE) is a chronic autoimmune systemic disorder with unknown etio-pathogenesis. Upon the susceptible genetic, hormonal and abnormal immunologic background, the environmental factors may play role as trigger to permit disease development. Cardiovascular complications occur in more than half of the patients with SLE. Pericarditis is the most studied cardiovascular manifestation, although often not evident clinically, and it is included in the American College of Rheumatology (ACR) classification criteria for SLE. We report a clinical case of initially unremarkably findings which progressed to SLE complicated by full-blown acute pericarditis. A brief review of acute pericarditis, including etiology, clinical presentation, ECG criteria, echocardiographic manifestation, and treatment is presented. Abstrak Perikarditis akut adalah penyakit yang disebabkan oleh inflamasi dari perikard, dapat terjadi sebagai entitas penyakit primer maupun sekunder sebagai manifestasi dari penyakit sistemik yang mendasarinya. Diagnosis perikarditis akut ditegakkan saat pasien mengalami setidaknya dua dari tanda atau gejala berikut: nyeri dada spesifik perikarditis, pericardial friction rub, perubahan EKG tipikal, atau adanya efusi perikard dengan ukuran lebih dari trivial. Lupus Eritematosus Sistemik (LES) adalah penyakit autoimun sistemik kronis dengan etiopatogenesis yang belum diketahui. Adanya kepekaan genetik, latar belakang imunologis abnormal dan hormonal, serta faktor lingkungan memegang peran sebagai pemicu perkembangan penyakit. Komplikasi kardiovaskular terjadi pada lebih dari setengah pasien dengan SLE. Perikarditis merupakan manifestasi kardiovaskular yang paling sering dijumpai, meskipun jarang ditemukan patognomonis secara klinis, dan termasuk dalam kriteria klasifikasi LES menurut American College of Rheumatology (ACR). Berikut kami laporkan kasus dengan presentasi klinis febris dan takikardia yang kemudian mengarah pada LES dengan komplikasi perikarditis akut. Kami sertakan juga ulasan tentang perikarditis akut, termasuk etiologi, presentasi klinis, kriteria EKG, manifestasi ekokardiografis, dan terapi.

Background: Uremic patients are in a pro-oxidant state and show an increased level of asymmetric dimethylarginine (ADMA), which is due to increased PRMT1 activity and reduced dimethylarginine dimethylaminohydrolase (DDAH) as degradation enzymes. Reactive oxidant species may play an important role in increasing the action of PRMT1 and in inhibiting the action of DDAH. Albuminuria and ADMA are closely correlated with progression of cardiovascular disease in chronic kidney disease (CKD) patients as well as indicators for decreasing renal function. Although ACEIs and/or ARBs reduced albuminuria in CKD patients, the results are still conflicting. Several factors in these patients may play important roles in the mechanism of albuminuria such as oxidative stress. The antioxidant N-acetylcysteine may prove to have beneficial therapeutic effect, because it can reduce oxidative stress as shown by evidence in humans, and subsequently increase ADMA. The objective of the present study is to explore the contribution of the antioxidant N-acetylcysteine (NAC) to the decrease of ADMA and albuminuria in non-diabetic CKD patients. Material and Methods: Patients with non-DM CKD stage 1–4 with albuminuria were randomized to receive ACEI and/or ARB alone (control group) or with antioxidant NAC 600 mg orally twice a day (treatment group). Observations were performed for 3 months to measure ADMA and albuminuria before and after-treatment. 80 patients in total 40 in the control group and 40 in the treatment group were used. Results: After oral treatment with NAC, the plasma level of ADMA in the treatment group increased from 0.604 µmol/l to 0.689 µmol/l, whereas ADMA level in the control group exhibited a higher increase from 0.561 µmol/l to 0.743 µmol/l. The increases in these groups were significantly different (p < 0.02). Moreover, the level of albuminuria was reduced from 148.12 µg/mg • cr to 132.7 µg/mg • cr in the treatment group, and from 75.25 µg/mg • cr to 71.85 µg/mg • cr in the control group. The difference was significant (p < 0.001). Conclusion: The anti-oxidant N-acetylcysteine can be used as adjuvant therapy to inhibit the progression of CKD in patients by decreasing the ADMA level and albuminuria.

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. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

The prevalence of hepatitis C virus (HCV) infection has been as high as approximately 80% in patients with maintenance hemodialysis in public hospitals in Indonesia. However, the prevalence in private hospitals has not been examined yet. The aim of this study was to investigate the prevalence of anti-HCV antibody and the subtype distribution in patients with hemodialysis in a private hospital in Surabaya, Indonesia. Sera were obtained from 41 hemodialysis patients in a private hospital in Surabaya. The positive prevalence of anti-HCV antibody was carried out by the enzyme-linked immunosorbent assay (ELISA). Anti-HCV-positive sera were subjected to reverse transcription-PCR (RT-PCR) to detect HCV RNA and then direct sequencing. The HCV subtype was examined by phylogenetic analysis. Twenty five patients (61%) out of 41 were positive for anti-HCV antibody, and HCV-RNA was detected in 19 patients. The positive prevalence of anti-HCV antibody was 7.7% (one out of 13 patients) among patients who had undergone hemodialysis for less than one year, whereas it was 85.7% (24 out of 28 patients) among patients who had undergone hemodialysis for over one year. Phylogenetic analysis revealed HCV-1a (52.6%) was the most common subtype, followed by 1b (15.8%), 1c (15.8%), 2a (5.3%), and 3k (5.3%). In conclusion, the prevalence of HCV infection among hemodialysis patients in a private hospital was as high as that in general hospitals. The predominant subtype was HCV-1a, which is in accordance with the previous studies in general hospitals in Surabaya, Indonesia.

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. Electrocardiograms changes were suggestive of type A Wellens syndrome. Nitroglycerin was administrated, the patient's chest pain disappeared, and we planned an early invasive strategy. He had a previous documented electrocardiogram before he went for catheterization and based on the second electrocardiogram changes were suggestive of an ST-elevation. As the result of the invasive strategy, it was found that there was single-vessel disease, critical occlusion in the middle of the left anterior descending artery coronary artery with collateral from the right coronary artery. After two days of observation in the Intensive Cardiovascular Care Unit, the patient improved and was transferred to Low Care Unit. Conclusions The case highlights Wellens syndrome in acute critical occlusion with collateral artery.

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.

Energy access is crucial for rural development in developing countries, as electrification drives economic growth, creates employment opportunities, and enhances the quality of life for rural communities. This study aims to determine the feasibility of powering a remote community with a hybrid energy system (HRS) combining solar photovoltaic, wind, and biogas to generate electricity and meet the energy needs of the rural area. West Waru Village was selected as the case study area due to its abundance of renewable energy sources. The HOMER tool was employed to model and optimize the HRS, providing a detailed analysis of its technical, economic, and environmental aspects. Furthermore, the study's findings were analyzed through a sensitivity analysis, considering uncertainty factors such as village load consumption, solar radiation, wind speed, and biomass availability. The best configuration for an on-grid scheme included a 2,284 kW photovoltaic (PV) system, 388 unit vertical axis wind turbine (VAWT), and a 500 kW biogas generator, resulting in a net present cost (NPC) of $8,506,090, a cost of energy (COE) of $0.054/kWh, and a payback period of 5.79 years. This configuration also reduced carbon dioxide (CO2) emissions by 67.2% compared to grid electricity. The optimal configuration for an off-grid scheme consisted of a 5,491 kW PV system, 954 VAWT, a 500 kW biogas generator, and 4,850 batteries, with an NPC of $20,162,390 and a COE of $0.1601/kWh, reducing CO2 emissions by 99.993%. These findings can serve as a baseline for the government to develop renewable energy systems in West Waru. [ABSTRACT FROM AUTHOR]

Background: Management of systemic lupus erythematosus (SLE) and lupus nephritis (LN) in pregnancy has been improving in recent decades. However, SLE can still lead to adverse pregnancy outcomes if not appropriately treated. Optimal dose of steroids, as one of the most commonly used for the treatment of SLE and LN in pregnancy is still a subject of debate. In this review, we determine the pregnancy outcomes in SLE and LN patients treated with low vs high doses of steroids. Methods: ProQuest, Pubmed, Science Direct, Scopus, and Web of Science were carefully searched for relevant studies published in English. A total of 2,596 studies were reviewed. We extracted the data from previous studies showing the use of steroids treatment in high-dose and low-dose related to pregnancy outcomes. We provide larger data about maternal (preterm rupture of membrane, fetal loss, pre-eclampsia, and flare up) and fetal outcomes (prematurity, small gestational age, low birth weight) receiving high vs low steroid in patients with SLE and LN in this systematic review and meta-analysis. Results: A total of 13 studies were included. Of these, one study discussed a group with LN and 12 other studies discussed SLE with related maternal and fetal outcomes. Maternal outcome in the group with low-dose steroid showed a lower risk of fetal loss (odds ratio (OR): 1.93; 95% confidence interval (CI) 1.01-3.70), but there were no differences in other maternal outcomes. The low-dose steroid group showed a better fetal outcome, with a lower risk of prematurity (OR: 3.06; 95% CI 1.98-4.71), small gestational age (OR: 2.63; 95% CI 1.15-6.00), and low birth weight (OR: 2.43; 95% CI 1.23-4.79). Conclusions: In pregnant patients with SLE or LN, high-dose steroids are associated with the high risk of fetal loss during pregnancy, preterm birth, small gestational age, and low birth weight.

Background: Several aspects of chronic kidney disease (CKD) such as the incidence rate and mortality rate are concerning. Oxidative stress contributes to progression and mortality in patients with CKD; however, a specific correlation between several markers of oxidative stress and the estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) in the Indonesian population has not been sufficiently described yet. Methods: This study was an analytic observational study with a sample of 56 patients with CKD in Universitas Airlangga Hospital, Surabaya, Indonesia, from December 2019 – March 2020. The markers for oxidative stress investigated were urinary 8-hydroxy-2 deoxyguanosine (8-OHdG), serum symmetric dimethylarginine (SDMA) and asymmetric dimethylarginine (ADMA). The correlations between each variable of oxidative stress and CKD were analyzed using Pearson analysis. Results: There was a positive correlation between 8-OHdG and eGFR (p=0.00, r=0.51); however, there was a negative correlation between 8-OHdG and ACR (p=0.025, r=-0.30). SDMA and eGFR showed a negative correlation (p=0.00, r=-0.648), while SDMA and ACR showed a positive correlation (p=0.03, r=0.349). ADMA showed a negative correlation with eGFR (p=0.00, r=-0.476). There were significantly decreased 8-OHdG but increased ADMA and SDMA as the CKD stage progressed (p=0.001, p=0.00, and p = 0.00, respectively). Higher urine 8-OHdG was detected in patients without history of hemodialysis, whereas ADMA and SDMA showed higher value in patients with hemodialysis (p=0.00, p=0.00, and p=0.004, respectively), patients with history of diabetes mellitus (DM) had higher mean 8-OHdG (p 0.000) yet lower serum ADMA and SDMA (p=0.004 and p=0.003, respectively). Conclusions: In patients with CKD in Indonesia, the markers for oxidative stress 8-OHdG, SDMA, and ADMA are correlated with eGFR and ACR levels. There were also significant difference in 8-OHdG, SDMA, and ADMA levels among CKD stages, between dialysis vs non dialysis, and DM vs non DM patients.