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Bhattacharjee S, Ghosh C, Sen A, Lala M. Characterization of Firmiana colorata (Roxb.) leaf extract and its silver nanoparticles reveal their antioxidative, anti-microbial, and anti-inflammatory properties. INTERNATIONAL NANO LETTERS 2023; 13:1-13. [PMID: 36683730 PMCID: PMC9838539 DOI: 10.1007/s40089-023-00392-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Nanotechnology is the integrative science in the field of physics, chemistry and biology. For the synthesis of silver nanoparticles, a simple approach was applied using Firmiana colorata (Roxb.) aqueous leaf extract. During the synthesis of this silver nanoparticle, the solution color changes from green to deep brown due to the reduction of silver. The phytocompounds present in the Firmiana colorata (Roxb.) leaf extract acts as a reducing as well as a capping agent. Identifying the presence of bioactive compounds responsible for the reduction of silver was extensively characterized by UV-Vis spectrophotometer, FTIR, SEM, and EDX. Moreover, to know the efficacy of the silver nanoparticles (AgNps) antioxidant and antimicrobial studies were evaluated against the human pathogenic bacteria. Furthermore, GC-MS analysis of the leaf extract of Firmiana colorata has been done followed by the in-silico molecular docking against the Anti-inflammatory and oxidative protein. Here within this study, a comparative evaluation was done among the Firmiana colorata (Roxb.) leaf extract and the synthesized silver nanoparticles. Results indicate that ethnomedicinally lesser known Firmiana colorata (Roxb.) and AgNps have the potency to act as anti-inflammatory, antioxidative, and antimicrobial agents.
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Affiliation(s)
- Soumita Bhattacharjee
- Molecular Cytogenetics Laboratory, Department of Botany, University of North Bengal, Darjeeling, 734013 India
- Laboratory of Tea Taxonomy and Ecology, Department of Tea Science, University of North Bengal, Siliguri, Darjeeling, 734013 India
| | - Chandra Ghosh
- Laboratory of Tea Taxonomy and Ecology, Department of Tea Science, University of North Bengal, Siliguri, Darjeeling, 734013 India
| | - Arnab Sen
- Molecular Cytogenetics Laboratory, Department of Botany, University of North Bengal, Darjeeling, 734013 India
| | - Mousikha Lala
- Molecular Cytogenetics Laboratory, Department of Botany, University of North Bengal, Darjeeling, 734013 India
- Genetics Laboratory, Department of Botany, Acharya Brojendra Nath Seal College, Cooch Behar Panchanan Barma University, Cooch Behar, 736101 India
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Dharma S, Dakota I, Firdaus I, Danny SS, Zamroni D, Yudha A, Susanto A, Siswanto BB. Performance of Primary Angioplasty for STEMI during the COVID-19 Outbreak. Int J Angiol 2021; 30:148-154. [PMID: 34054273 DOI: 10.1055/s-0041-1727133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
There has been concern whether the declining cases of ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) outbreak associate with primary angioplasty performance. We assessed the performance of primary angioplasty in a tertiary care hospital in Jakarta, Indonesia, by comparing the door-to-device (DTD) time and thrombolysis in myocardial infarction (TIMI) flow after angioplasty between two periods of admission: during the outbreak of COVID-19 (March 1 to May 31, 2020) and before the outbreak (March 1, to May 31, 2019). Overall, there was a relative reduction of 44% for STEMI admission during the outbreak ( n = 116) compared with before the outbreak ( N = 208). Compared with before the outbreak period ( n = 141), STEMI patients who admitted during the outbreak and received primary angioplasty ( n = 70) had similar median symptom onset-to-angioplasty center admission (360 minutes for each group), similar to radial access uptake (90 vs. 89.4%, p = 0.88) and left anterior descending infarct-related artery (54.3 vs. 58.9%, p = 0.52). The median DTD time and total ischemia time were longer (104 vs. 81 minutes, p < 0.001, and 475.5 vs. 449 minutes, p = 0.43, respectively). However, the final achievement of TIMI 3 flow was similar (87.1 vs. 87.2%), and so was the in-hospital mortality (5.7 vs. 7.8%). During the COVID-19 outbreak, we found a longer DTD time for primary angioplasty, but the achievement of final TIMI 3 flow and in-hospital mortality were similar as compared with before the outbreak. Thus, primary angioplasty should remain the standard of care for STEMI during the COVID-19 outbreak.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Isman Firdaus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Siska Suridanda Danny
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dian Zamroni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ardi Yudha
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Agus Susanto
- Catheterization Laboratory Nurse Manager, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Amoras TSG, Rodrigues TB, Menezes CR, Zaninotto CV, Tavares RDS. Door-to-balloon Time in Cardiovascular Emergency Care in a Hospital of Northern Brazil. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20190104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dakota I, Dharma S, Andriantoro H, Firdaus I, Danny SS, Zamroni D, Radi B. "Door-In to Door-Out" Delay in Patients with Acute ST-Segment Elevation Myocardial Infarction Transferred for Primary Percutaneous Coronary Intervention in a Metropolitan STEMI Network of a Developing Country. Int J Angiol 2020; 29:27-32. [PMID: 32132813 PMCID: PMC7054060 DOI: 10.1055/s-0039-3401046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care. Objective We evaluated the door-in to door-out (DI-DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network. Patients and Methods We retrospectively analyzed the DI-DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019. Correlation analysis between DI-DO times and total ischemia time was performed using Spearman's test. Logistic regression analyses were used to find variables associated with a longer DI-DO time. Results Median DI-DO time was 180 minutes (25th percentile to 75th percentile: 120-252 minutes). DI-DO time showed a positive correlation with total ischemia time ( r = 0.4, p < 0.001). The median door-to-device time at the PCI center was 70 minutes (25th percentile to 75th percentile: 58-88 minutes). Multivariate analysis showed that women patients were independently associated with DI-DO time > 120 minutes (odds ratio 1.55, 95% confidence interval 1.03 to 2.33, p = 0.03). Conclusion The DI-DO time reported in this study has not reached the guideline recommendation. To improve the overall performance of primary PCI in the region, interventions aimed at improving the DI-DO time at the initial hospitals and specific threat for women patients with STEMI are possibly the best efforts in improving the total ischemia time.
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Affiliation(s)
- Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Isman Firdaus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Siska Suridanda Danny
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Dian Zamroni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Basuni Radi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
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Irawati S, Dharma S, Taxis K, Nguyen T, Nursyarofah N, Wilffert B, Hak E. Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country. Glob Heart 2020; 15:8. [PMID: 32489781 PMCID: PMC7218801 DOI: 10.5334/gh.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background and aims Acute ST-elevation myocardial infarction (STEMI) is a potentially fatal presentation of coronary artery disease (CAD). Evidence of the impact of acute pharmacological interventions in non-reperfused STEMI patients on subsequent events is limited. We aimed to assess the association between adherence to guideline-recommended preventive medications and in-hospital mortality among this high-risk patient population. Methods We conducted a cohort study using data obtained from the Jakarta Acute Coronary Syndrome (JAC) Registry database from a tertiary care academic hospital in Indonesia. We included 1132 of 2694 patients with STEMI recorded between 1 January 2014 and 31 December 2016 who did not undergo acute reperfusion therapy. Adherence to guideline-recommended preventive medications was defined as the combined administration of aspirin, clopidogrel, anticoagulants and statins after hospital admission. The main outcome measure was in-hospital mortality. Results Overall, 778 of 1132 patients (69%) received the combination of preventive medications. The guideline non-adherent group had significantly more patients with earlier onset of STEMI, higher Killip class and thrombolysis in myocardial infarction (TIMI) score. After adjustments for measured characteristics using logistic regression modeling, exposure to the combination of preventive therapies was associated with a statistically significant lower risk for in-hospital mortality (adjusted odds ratio: 0.46, 95% confidence interval: 0.30-0.70). Conclusions Adherence to guideline-recommended preventive medications was associated with lower risk of in-hospital mortality in non-reperfused STEMI patients. The predictors of not receiving these medications need to be confirmed in future research.
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Affiliation(s)
- Sylvi Irawati
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
- Center for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, ID
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, ID
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, ID
| | - Katja Taxis
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, VN
| | - Nunung Nursyarofah
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, ID
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
- University of Groningen, Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, NL
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
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Herawati T, Keliat BA, Waluyo A. Perceptions of self-care readiness among STEMI patients following primary PCI. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dharma S, Mahavira A, Haryono N, Sukmawan R, Dakota I, Siswanto BB, Rao SV. Association of Hyperglycemia and Final TIMI Flow with One-Year Mortality of Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI. Int J Angiol 2019; 28:182-187. [PMID: 31452586 DOI: 10.1055/s-0039-1691811] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The association of hyperglycemia at admission and final thrombolysis in myocardial infarction (TIMI) flow with 1-year mortality of patient with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not much been explored. We evaluated the association of hyperglycemia and final TIMI flow with 1-year mortality in patients with acute STEMI who underwent primary PCI. We retrospectively analyzed 856 patients with STEMI who underwent primary PCI in a tertiary care academic center between January 2014 and July 2016. Based on the receiver operating characteristics curve, the cutoff used for hyperglycemia in this study was greater than or equal to 169 mg/dL. Cox proportional hazard model was used to determine the association of hyperglycemia and TIMI flow with 1-year mortality. Compared with patients with lower blood glucose level (<169 mg/dL; n = 549), a greater proportion of patients who presented with hyperglycemia (≥169 mg/dL; n = 307) had final TIMI flow 0 to 1 (3.3 vs. 0.5%; adjusted odds ratio = 5.58, 95% confidence interval [CI] 1.30-23.9, p = 0.02). Hyperglycemia was associated with an increased risk for 1-year mortality (adjusted hazard ratio [HR]= 2.0, 95% CI: 1.13-3.53, p = 0.017). Multivariable Cox regression showed that the interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an elevated risk for 1-year mortality (adjusted HR= 9.4, 95% CI: 2.34-37.81, p = 0.002). A higher proportion of patients with acute STEMI who presented with hyperglycemia had final TIMI flow 0 to 1 after primary PCI. The interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an increased risk for 1-year mortality. This study suggests that aggressive control of hyperglycemia prior to primary PCI may facilitate better angiographic and clinical outcomes after primary PCI. Clinical Trial Registration Clinicaltrials.gov Identifier number: NCT02319473.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Andi Mahavira
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Nur Haryono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, North Carolina
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Dharma S, Andriantoro H, Dakota I, Sukmawan R, Firdaus I, Danny SS, Zamroni D, Siswanto BB, Rao SV. Hospital outcomes in STEMI patients after the introduction of a regional STEMI network in the metropolitan area of a developing country. ASIAINTERVENTION 2018; 4:92-97. [PMID: 36483994 PMCID: PMC9706728 DOI: 10.4244/aij-d-17-00048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/23/2018] [Indexed: 06/17/2023]
Abstract
AIMS Data on the long-term outcomes of STEMI patients treated via a network in Asian countries are very limited. We aimed to evaluate the characteristics and outcomes of STEMI patients at two different periods, before and five years after the establishment of a regional STEMI network in Jakarta, Indonesia. METHODS AND RESULTS Out of 6,291 patients with STEMI admitted to hospital between January 2008 to January 2016, we compared the characteristics and outcomes of STEMI patients from two different periods, January 2008 to July 2009 (before instalment of the STEMI network, N=624), and from January 2015 to January 2016 (five years after the start of the network, N=1,052). The PCI hospital is an academic tertiary care cardiac hospital and initiated the regional STEMI network in 2010. Logistic regression was used to determine the adjusted association between treatment in the latter period and mortality. Compared with data from 2008/2009, in the 2015/2016 period, more primary PCI procedures were performed (N=589 [56%] vs. N=176 [28%], p<0.001), fewer patients did not receive reperfusion therapy (37% vs. 59%, p<0.001), and median door-to-device (DTD) times were shorter (82 vs. 94 minutes, p<0.001). Overall in-hospital mortality decreased from 9.6% to 7.1% (adjusted odds ratio 0.72, 95% CI: 0.50 to 1.03, p=0.07). CONCLUSIONS Half a decade after the implementation of the STEMI network in Jakarta, Indonesia, the result is better and faster care for patients with STEMI and this has been associated with lower in-hospital mortality.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Isman Firdaus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Siska Suridanda Danny
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dian Zamroni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Bambang Budi Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC, USA
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Schröders J, Wall S, Hakimi M, Dewi FST, Weinehall L, Nichter M, Nilsson M, Kusnanto H, Rahajeng E, Ng N. How is Indonesia coping with its epidemic of chronic noncommunicable diseases? A systematic review with meta-analysis. PLoS One 2017; 12:e0179186. [PMID: 28632767 PMCID: PMC5478110 DOI: 10.1371/journal.pone.0179186] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/07/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Chronic noncommunicable diseases (NCDs) have emerged as a huge global health problem in low- and middle-income countries. The magnitude of the rise of NCDs is particularly visible in Southeast Asia where limited resources have been used to address this rising epidemic, as in the case of Indonesia. Robust evidence to measure growing NCD-related burdens at national and local levels and to aid national discussion on social determinants of health and intra-country inequalities is needed. The aim of this review is (i) to illustrate the burden of risk factors, morbidity, disability, and mortality related to NCDs; (ii) to identify existing policy and community interventions, including disease prevention and management strategies; and (iii) to investigate how and why an inequitable distribution of this burden can be explained in terms of the social determinants of health. METHODS Our review followed the PRISMA guidelines for identifying, screening, and checking the eligibility and quality of relevant literature. We systematically searched electronic databases and gray literature for English- and Indonesian-language studies published between Jan 1, 2000 and October 1, 2015. We synthesized included studies in the form of a narrative synthesis and where possible meta-analyzed their data. RESULTS On the basis of deductive qualitative content analysis, 130 included citations were grouped into seven topic areas: risk factors; morbidity; disability; mortality; disease management; interventions and prevention; and social determinants of health. A quantitative synthesis meta-analyzed a subset of studies related to the risk factors smoking, obesity, and hypertension. CONCLUSIONS Our findings echo the urgent need to expand routine risk factor surveillance and outcome monitoring and to integrate these into one national health information system. There is a stringent necessity to reorient and enhance health system responses to offer effective, realistic, and affordable ways to prevent and control NCDs through cost-effective interventions and a more structured approach to the delivery of high-quality primary care and equitable prevention and treatment strategies. Research on social determinants of health and policy-relevant research need to be expanded and strengthened to the extent that a reduction of the total NCD burden and inequalities therein should be treated as related and mutually reinforcing priorities.
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Affiliation(s)
- Julia Schröders
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Stig Wall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Mohammad Hakimi
- Centre for Reproductive Health, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Fatwa Sari Tetra Dewi
- Department of Health Behaviour, Environment and Social Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Lars Weinehall
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
| | - Mark Nichter
- School of Anthropology, College of Social and Behavioral Sciences, The University of Arizona, Tucson, United States of America
| | - Maria Nilsson
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Hari Kusnanto
- Department of Family Medicine, Community Medicine and Bioethics, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ekowati Rahajeng
- Center for Public Health Research and Development, National Institute of Health Research and Development (NIHRD), Ministry of Health, Jakarta, Republic of Indonesia
| | - Nawi Ng
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Centre for Demographic and Ageing Research, Umeå University, Umeå, Sweden
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Martínez-Sánchez C, Arias-Mendoza A, González-Pacheco H, Araiza-Garaygordobil D, Marroquín-Donday LA, Padilla-Ibarra J, Sierra-Fernández C, Altamirano-Castillo A, Álvarez-Sangabriel A, Azar-Manzur FJ, Briseño-de la Cruz JL, Mendoza-García S, Piña-Reyna Y, Martínez-Ríos MA. Reperfusion therapy of myocardial infarction in Mexico: A challenge for modern cardiology. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:144-150. [PMID: 28169119 DOI: 10.1016/j.acmx.2016.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/21/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022] Open
Abstract
Mexico has been positioned as the country with the highest mortality attributed to myocardial infarction among the members of the Organization for Economic Cooperation and Development. This rate responds to multiple factors, including a low rate of reperfusion therapy and the absence of a coordinated system of care. Primary angioplasty is the reperfusion method recommended by the guidelines, but requires multiple conditions that are not reached at all times. Early pharmacological reperfusion of the culprit coronary artery and early coronary angiography (pharmacoinvasive strategy) can be the solution to the logistical problem that primary angioplasty rises. Several studies have demonstrated pharmacoinvasive strategy as effective and safe as primary angioplasty ST-elevation myocardial infarction, which is postulated as the choice to follow in communities where access to PPCI is limited. The Mexico City Government together with the National Institute of Cardiology have developed a pharmaco-invasive reperfusion treatment program to ensure effective and timely reperfusion in STEMI. The model comprises a network of care at all three levels of health, including a system for early pharmacological reperfusion in primary care centers, a digital telemedicine system, an inter-hospital transport network to ensure primary angioplasty or early percutaneous coronary intervention after fibrinolysis and a training program with certification of the health care personal. This program intends to reduce morbidity and mortality associated with myocardial infarction.
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Affiliation(s)
- Carlos Martínez-Sánchez
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Alexandra Arias-Mendoza
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico.
| | - Héctor González-Pacheco
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | | | - Jorge Padilla-Ibarra
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Carlos Sierra-Fernández
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | | | | | | | | | - Salvador Mendoza-García
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Yigal Piña-Reyna
- Unidad Coronaria, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
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Dharma S, Andriantoro H, Purnawan I, Dakota I, Basalamah F, Hartono B, Rasmin R, Isnanijah H, Yamin M, Wijaya IP, Pratama V, Gunawan TB, Juwana YB, Suling FRW, Witjaksono AMO, Lasanudin HF, Iskandarsyah K, Priatna H, Tedjasukmana P, Wahyumandradi U, Kosasih A, Budhiarti IA, Pribadi W, Wirianta J, Lubiantoro U, Pramesti R, Widowati DR, Aminda SK, Basalamah MA, Rao SV. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry. BMJ Open 2016; 6:e012193. [PMID: 27580835 PMCID: PMC5013359 DOI: 10.1136/bmjopen-2016-012193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. DESIGN Retrospective cohort study. SETTING Emergency department of 56 health centres. PARTICIPANTS 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. MAIN OUTCOME MEASURE Characteristics of reperfusion therapy. RESULTS The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). CONCLUSIONS In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI-DO time along with improvement of DTD time at PCI centres. TRIAL REGISTRATION NUMBER NCT02319473.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ismi Purnawan
- Chairman, Indonesian Heart Association, Jakarta Branch, Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Beny Hartono
- Binawaluya Cardiac Center, East Jakarta, Indonesia
| | - Ronaly Rasmin
- Budhi Asih General Hospital, East Jakarta, Indonesia
| | | | - Muhammad Yamin
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta, Indonesia
| | - Ika Prasetya Wijaya
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta, Indonesia
| | - Vireza Pratama
- Department of Cardiology, Gatot Soebroto Army Central Hospital, Central Jakarta, Indonesia
| | - Tjatur Bagus Gunawan
- Department of Cardiology, Dr Mintohardjo Hospital, Indonesian Naval Hospital, Central Jakarta, Indonesia
| | | | - Frits R W Suling
- Department of Cardiology, Christian University of Indonesia General Hospital, East Jakarta, Indonesia
| | - A M Onny Witjaksono
- Department of Cardiology, St Carolus General Hospital, Central Jakarta, Indonesia
| | | | | | | | | | | | | | | | - Wisnoe Pribadi
- Esnawan Antariksa Indonesian Air Force Hospital, East Jakarta, Indonesia
| | | | | | - Rini Pramesti
- Fatmawati General Hospital, South Jakarta, Indonesia
| | | | | | | | - Sunil V Rao
- Section Chief, Department of Cardiology, Duke University Medical Center, Durham VA Medical Center, Durham, North Carolina, USA
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Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, Yamin M, Bagus T, Hartono B, Ratnaningsih E, Suling F, Basalamah MA. Organisation of reperfusion therapy for STEMI in a developing country. Open Heart 2015; 2:e000240. [PMID: 26019883 PMCID: PMC4442233 DOI: 10.1136/openhrt-2015-000240] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022] Open
Abstract
Objective Routine evaluation of performance measures for the system of care for patients with ST-elevation myocardial infarction (STEMI) is needed to improve the STEMI network. We sought to evaluate the current status of reperfusion therapy for STEMI in the capital city of a developing country where a STEMI network was introduced in 2010. Methods Data were obtained from a local registry. A total of 28 812 patients admitted to the emergency department of a national cardiovascular hospital in three different periods (2007, 2010 and 2013) were retrospectively analysed; there were 2703 patients with STEMI. Results In 2013 compared with 2007, there was a major increase in the number of primary percutaneous coronary interventions (PCIs) (35% vs 24%, p<0.001), and the proportion of non-reperfused patients fell (62.8% vs 67.7%, p<0.001). An improvement in the overall STEMI mortality rate was also observed (7.5% vs 11.7%, p<0.001). Conclusions Implementation of a regional system of care for STEMI may improve utilisation of primary PCI. Future organisation of reperfusion therapy in a developing country such as Indonesia strongly calls for a strategy that focuses on prehospital care to minimise delay from the first medical contact to reperfusion therapy, and this may reduce the proportion of non-reperfused patients. These strategies are in concordance with guideline recommendations and may reduce or eliminate gaps in healthcare in developing countries, particularly the underutilisation of evidence-based therapies for patients with STEMI. Trial registration number NCT 02319473, Clinicaltrials.gov.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Ismi Purnawan
- Chairman, Indonesian Heart Association, Jakarta Branch , Indonesia
| | - Vireza Pratama
- Department of Cardiology, Gatot Soebroto Army Central Hospital, Central Jakarta , Indonesia
| | - Herawati Isnanijah
- Department of Cardiology and Vascular Medicine , Pasar Rebo General Hospital , East Jakarta , Indonesia
| | - Muhammad Yamin
- Integrated Cardiovascular Services, Cardiology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta , Indonesia
| | - Tjatur Bagus
- Department of Cardiology, Dr Mintohardjo Hospital, Indonesian Naval Hospital, Central Jakarta , Indonesia
| | | | - Endang Ratnaningsih
- Department of Cardiology and Vascular Medicine , Tarakan General Hospital , Central Jakarta , Indonesia
| | - Frits Suling
- Department of Cardiology and Vascular Medicine, Christian University of Indonesia General Hospital, East Jakarta, Indonesia
| | - M Abas Basalamah
- Department of Cardiology and Vascular Medicine, Persahabatan Hospital, East Jakarta, Indonesia
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