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AIM: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. METHODS: a cohort study (February - October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). RESULTS: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. CONCLUSION: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing.

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AIM: to examine the effect of A.paniculata on pancreatic b-cells. METHODS: sixty minutes incubation of BRIN-BD11 in Modified Kreb-Ringer Solution containing 16.7 mM glucose (KRB-3) + 0.625 - 2.5 mg/mL A.paniculata evoked 1.7 - 3.73 fold of insulin secretion compared to 16.7 mM glucose only (p = 0.003 - p < 0.001). RESULTS: compared to the effect of 100 mM glibenclamide, 60 minutes incubation of BRIN-BD11 in KRB-3 containing 1.25 and 2.5 mg/mL A. paniculata evoked 1.5 fold (p=0.034) and 2.3 fold (p=0.001) insulin secretion. Twenty minutes incubation of BRIN-BD11 in KRB-3 + 0.625-5 mg/mL A.paniculata, evoked 1.4 - 4.7 fold (p = 0.002 - p < 0.001) of insulin secretion compared to 16.7 mM glucose only. Twenty minutes incubation of BRIN-BD11 in KRB-1 containing 1.11 mM glucose + 0.625 - 10 mg/mL A.paniculata, evoked 1.3 - 3.7 fold (p = 0.019 - p < 0.001) of insulin secretion compared to 16.7 mM glucose only. CONCLUSION: this study conclude that A.paniculata was a very strong, dose dependent insulinotropic agent, glucose dependent and independent insulin secreting agent. This study also conclude that A.paniculata affected one of the membrane receptors, mostly ATP-dependent potassium channels (K+ATP).

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AIM: to evaluate the effects of curcumin on total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride in acute coronary syndrome patients. METHODS: this study were conducted at Dr. Cipto Mangunkusumo General Hospital (RSUPN-CM), Persahabatan Hospital, MMC Hospital and Medistra Hospital, Jakarta. The study started from 1 May 2005 to 5 May 2006. Study Design was an interventional study which was a randomized double blind controlled trial to evaluate the effects of curcumin administration at escalating doses (low dose 3 times 15 mg/day, moderate dose 3 times 30 mg/day, and high dose 3 times 60 mg/day) on total cholesterol level, LDL cholesterol level, HDL cholesterol level, and triglyceride level in ACS patients. RESULTS: a 75 ACS patients undergoing randomization participated in randomized controlled trial (RCT). Of the 75 ACS patients participating in that RCT, 67 received care at RSCM, 6 at Persahabatan Hospital, and 2 at MMC Hospital. As many as 63 patients were able to participate in the RCT up to its conclusion. There was no significant difference in age, sex, risk factor of dyslipidemia, DM, smoking, hypertension, CHD history in family, height, body weight and body mass index, waist circumference, systolic blood pressure, diastolic blood pressure in the four groups of patients. This showed that the randomization performed was reasonably good. There was no significant difference in laboratory parameters, such as total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride, fasting blood glucose, blood glucose 2 hours PP, glyco Hb, triglyceride, Hb, Ht, leukocyte, thrombocyte, ureum, creatinine, SGOT, SGPT, in the four groups. There was no significant difference in types of ACS and locations of ACS in the four groups as well. There was no significant difference in statin medicatios (simvastatin), aspirin ACE inhibitor, and DM medications in the four groups. No patient used tiazolidindion. No significant difference was found in the percentage of compliance in the four groups of patients. The effects of curcumin on total cholesterol level and LDL cholesterol level, there was a trend that the lower the dose of curcumin, the higher the effect of reduction. For HDL cholesterol level, there was also a trend that the lower the dose of curcumin, the higher the effect of increase in HDL cholesterol level. However, for triglyceride the pattern was not the same, and the group of moderate-dose curcumin shoed the minimal effect of increase, followed by the low-dose curcumin and finally the high-dose curcumin that showed the highest effect of increase. CONCLUSION: the administration of low-dose curcumin showed a trend of reduction in total cholesterol level and LDL cholesterol level in ACS patients.

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AIM: this study aimed to observe whether the interleukin-6 level in acute coronary syndrome (ACS) patients were higher than those in coronary heart disease (CHD) patients. In addition, we would like to observe the cut off point of interleukin-6 level in ACS. METHODS: this cross sectional study were conducted at Dr. Cipto Mangunkusumo General Hospital (RSUPN-CM), Persahabatan Hospital, MMC Hospital and Medistra Hospital, Jakarta. The study started from 1 May 2005 to 5 May 2006. RESULTS: in this observational study, as many as 62 CHD patients were collected and 84 ACS that met the study criteria. Demographic analysis showed that there was no difference in ages among the two groups (ACS and CHD). The risk factors of dyslipidemia, hypertension and lipid profile in the two groups did not differ significantly. Waist circumference and IMT, systolic and diastolic blood pressures in the two groups did not also differ significantly. Smoking was more prevalent in the groups of ACS than in the groups of CHD. In this study the IL-6 level in ACS (mean 40.85 pg/mL, SD 41.71, CI 95% 25.63-42.08 was higher than that in CHD (mean 4.58 pg/mL, SD 9.61, CI 95% 2.14-7.02). To identify the IL-6 level as the predictor for the occurrence of ACS, sensitivity and specificity were calculated at various cut-off points of IL-6 level. At cut-off point of IL-6 4.43 pg/mL the highest sensitivity (89.95%) and highest specificity (77.42%) were found with ROC of 0.87. CONCLUSION: it could be concluded that the IL-6 level in ACS were higher that those in CHD. The IL-6 level 4,43 pg/mL could differentiate the acute condition (ACS) and stable condition (non-ACS) with sensitivity of 89.95% and specificity of 77.42%, and ROC of 0.87.

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BACKGROUND AND PURPOSE: There have been few reports on the efficacy and safety of statins in the Asian population. The study objectives were to compare the efficacy and safety of atorvastatin and simvastatin in Asian people. MATERIALS AND METHODS: This was a 16-week, double-blind, double-dummy, randomized, multicenter study involving eight medical centers in six Asian countries or areas. After a 6-week, diet-controlled, placebo lead-in period, 157 patients with low-density lipoprotein cholesterol (LDL-C) of between 160 and 250 mg/dL and serum triglyceride (TG) of less than 400 mg/dL were randomized to receive 10 mg of either atorvastatin (n = 79) or simvastatin (n = 78). After 8 weeks of treatment, all patients had the dose of study medication increased to 20 mg, irrespective of LDL-C concentration. Data obtained by monitoring lipid profiles, adverse events, and laboratory tests during the 16 weeks of study were used to assess the efficacy and safety of both treatments. RESULTS: After 8 weeks of treatment, LDL-C concentrations were reduced by 42.5% from baseline in patients receiving atorvastatin and 34.8% in those receiving simvastatin (p = 0.0006). Patients treated with atorvastatin also had a significantly greater reduction in very-low-density lipoprotein cholesterol (VLDL-C), TG, and total cholesterol (TC) after 8 weeks of treatment. The significantly greater reductions in LDL-C, VLDL-C, TG, and TC from baseline achieved with atorvastatin were still observed after an additional 8 weeks of treatment with 20 mg study medication. Both drugs increased high-density lipoprotein cholesterol (HDL-C) concentrations after 16 weeks of treatment, with no significant difference between the two treatments. After 16 weeks of treatment, 93% of atorvastatin and 85% of simvastatin patients had achieved their National Cholesterol Education Program LDL-C goals. No deaths occurred in the study population and the incidence of treatment-emergent adverse events was the same in the two groups (28%). Only one patient who was treated with simvastatin had a transaminase or creatine phosphokinase concentration that was more than three-fold the upper limit of normal. CONCLUSIONS: Asian people with primary hypercholesterolemia treated with atorvastatin had lower LDL-C, VLDL-C, TG, and TC after 8 weeks and 16 weeks of treatment than those treated with simvastatin. Both drugs demonstrated acceptable safety profiles.

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