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Cardiovascular/ heart disease is still the highest cause of death due to metabolic diseases. Factors that can be changed as well as unchangeable variables may contribute to the development of cardiac disease. A healthy lifestyle, including dietary habits, exercise routines, smoking habits, and alcohol consumption—factors that can be changed or modified—all contribute to an increased risk of cardiac disease by increasing blood pressure, body cholesterol, blood sugar levels, and other risk factors for diabetes and obesity.1,2 prevalence of the cardiac disease is increasing every year. The increase in cardiac disease is also influenced by the increasing incidence of metabolic diseases which are risk factors and have been mentioned previously.1

In cardiac disease, inflammation, and oxidative stress reactions produced by the body are part of the severity of cardiac disease experienced by sufferers. Cardiac disease can be reduced in severity and even prevented by a number of risk factors that, if correctly managed, can be modified. Maintaining cholesterol levels, blood sugar levels, blood pressure, and the health of the cardiac itself through behavioral changes and the use of nutritional supplements are all risk factors that can be managed.2

In some patients with metabolic diseases that can be controlled without drugs, olive extract, and lifestyle changes are the options for the management of these metabolic diseases.1,2 In addition, there are many different diet strategies that are now well known. According to the Mediterranean diet, giving olive extract plays a role in the diet plan and offers positive effects on the body's metabolism, particularly for cardiac health.1 The Mediterranean Diet is an eating plan that puts an emphasis on plant-based meals, includes seafood and uses olive extract. It has been demonstrated that the Mediterranean diet and olive oil consumption have positive effects on the body.1,3

Olive Extract on Cardiac Health

The leaves of olive plants are abundant in polyphenols, which have several health advantages. Many olive extracts are currently used in a wide range of foods and dietary supplements. According to research, the compounds in olives have cardiac-protective, antioxidant, anti-inflammatory, and anticancer properties.3,4 Oleuropein, Tyrosol, and Hydroxytyrosol, three compounds contained in olive trees, are believed to be responsible for the health effects of olives. Olive extract has been shown in numerous studies to have positive effects on cardiac health and lower the risk of coronary cardiac disease. Olive extract is now extensively used in a variety of dietary supplements, and according to studies, it also has positive effects on cholesterol metabolism, blood pressure, sugar metabolism, and body fat levels.1,3,4

The mechanism of action of the olive extract itself is still being researched, but several effects have been proven through research on glucose metabolism, this olive extract influences peripheral glucose uptake thereby reducing the buildup of blood sugar, increasing post-meal insulin secretion to be able to control blood sugar levels after eating, and stimulation of secretion of glucagon-like peptide-1 (GLP-1), which is a hormone in the body's satiety-hunger system.  Olive oil has an antioxidant impact on fat metabolism, which lowers the body's overall fat storage. While HDL cholesterol and lipids weren't changed significantly, it was discovered that olive extract was helpful for lowering total cholesterol and LDL cholesterol in the metabolism of cholesterol.  The good benefits obtained from olive extract on sugar and cholesterol metabolism can reduce the risk of cardiac disease.1-5

In addition to its benefits on sugar and fat metabolism, olive extract is also beneficial in reducing blood pressure and can have a significant impact on patients suffering from hypertension.2 Hypertension is still the biggest risk factor for the cardiovascular system which can have an impact on various diseases, such as cardiac disease, chronic kidney disease, and cerebrovascular disease/stroke, and still causes many deaths in sufferers. Blood pressure control, both systolic blood pressure and diastolic blood pressure, can reduce the risk of cardiac attack by 20-25% and reduce the risk of cardiac failure by as much as 50%.3 Olive extract controls blood vessel resistance, stabilizes blood flow within blood vessels, and helps to maintain blood pressure within the body. Cardiovascular advantages include lowering systolic blood pressure and controlling pulse rate. The cardiac is said to receive enough nutrients to be able to pump blood throughout the body, which also lowers the risk of cardiac attack and cardiac failure. The presence of a stable blood flow received from the olive extract is also said to have a positive impact on the health of the cardiac itself.1,2,4

Conclusion

The olive tree, or Olea europaea, is considered to have several positive effects on human health. The olive plant itself has a wealth of anti-inflammatory, anti-hypertensive, antioxidant, and cardioprotective compounds in its leaves. Oleuropein, Hydroxytyrosol, and other polyphenolic compounds are substances that are designed for and found in many of the leaves of the olive plant. Olive oil regulates blood pressure, sugar metabolism, and bodily cholesterol in order to keep cardiac health. Giving olive oil has been shown to have cardioprotective effects in addition to lowering cardiac disease risk factors.1-6

Referensi

1. Steves Y, Winkens B, Jonkers D, Masclee A. The effect of olive leaf extract on cardiovascular health markers: a randomized placebo-controlled clinical trial. Eur J Nutr. 2021; 60(4): 2111-2120

2. Razmpoosh E, Abdollahi S, Mousavirad M, Clark CCT, Soltani S. The effects of olive leaf extract on cardiovascular risk factors in the general adult population: a systematic review and meta-analysis of randomized controlled trials. Diabetology & Metabolic Syndrome. 2022; 14:151.

3. Ismail MA, Norhayati MN, Mohamad N. Olive leaf extract effect on cardiometabolic profile among adults with prehypertension and hypertension: a systematic review and meta-analysis. PeerJ. 2021; 9

4. Menezes R, Peres KK, Costa-Valle MT, Faccioli LS, Dallegrave E, Garavaglia J, et al. Oral administration of oleuropein and olive leaf extract has cardioprotective effects in rodents: A systematic review. Portuguese Society of Cardiology. 2022; 41(2): 167-175.

5.Huang C, Sumpio B. Olive oil, the Mediterranean Diet, and Cardiovascular Health. Journal of the American College of Surgeons. 2008; 207(3): 407-416.

6. Esquius L, Garcia-Retortillo S, Balague N, Hristovski R, Javierre C. Physiological- and performance-related effects of acute olive oil supplementation at moderate exercise intensiy. Journal of the International Society of Sports Nutrtion. 2019; 16:12.

Both mother and fetus need sufficient nutrition. The first 1000 days of life is a crucial period in pregnancy and nutrition plays a significant influence on the growth and development of a child in this period. Good nutrition can be obtained from sufficient macronutrients and micronutrients in the body. Micronutrients can be obtained from minerals and vitamins contained in food and supplements. Micronutrient deficiency still becomes a serious issue for women of reproductive age, especially pregnant women. This issue is quite common in developing countries. One of the micronutrient deficiencies is vitamin D. 1,2

Vitamin D is a fat-soluble vitamin that can be obtained from some food sources including milk, fish, and eggs, but only in small amounts.1 Vitamin D is also produced and activated in the body through exposure to sunlight.1,2 Generally, vitamin D mostly can be obtained from vitamin D3 supplements. Vitamin D is divided into vitamin D2 (Ergocalciferol) which is found in many foods, vitamin D3 (Cholecalciferol) which is a measurable form to increase body vitamin D levels obtained from supplements, Calcidiol or serum 25-hydroxyvitamin-D ( 25-OH-D) which is a measured parameter of vitamin D levels in the body, and calcitriol which is the active form found in blood plasma.1,2  The main mechanism of action of vitamin D is the metabolism of calcium and phosphorus which are beneficial for bone mineralization. However, vitamin D has receptors spread almost throughout the body. Therefore, besides calcium and phosphorus metabolism, vitamin D also has an important role in the immune system. A deficiency of vitamin D can cause various health problems such as allergies, autoimmune, and cancer. 1,2,3

The measurement of Vitamin D levels can be through serum concentrations of 25-OH-D as an indicator of vitamin D status in the body. A minimum vitamin D level of 20 ng/ml is needed to avoid bone disorders, but with various metabolic interactions in the body, it is considered to be deficient in vitamin D if the serum 25-OH-D level is lower than 32 ng/ml. Currently, vitamin D deficiency still becomes a global issue and is mostly experienced by pregnant women.1,3 Vitamin D deficiency in pregnancy mostly occurs in a population with high risk such as vegetarians, women who rarely sunbathe or have limited access to sunlight, and are black race. 4 Pregnant women need vitamin D as Vitamin D levels in newborns depend on vitamin D levels during pregnancy. Thus, if pregnant women have a low Vitamin D level, it can also affect the fetus or baby 3,4

Vitamin D deficiency is associated with various disorders and health problems considering that vitamin D receptors are found in almost all parts of the body such as the reproductive tract, ovaries, endometrium, and placenta.5 Serum levels of vitamin D in pregnant women have decreased during pregnancy due to the increased physiological needs of the fetus. Vitamin D levels will be needed more along with the age of the gestation period. In the 2nd and 3rd trimesters of pregnancy, the need for vitamin D will increase.3,4,5

In pregnancy, vitamin D deficiency is associated with various problems in both the mother and fetus. For mothers, this can increase the risk of hypertension in pregnancy, premature birth, and diabetes in pregnancy, while for the fetus, it can increase the risk of low birth weight, and bone mass abnormalities which can lead to several diseases such as rickets and fractures in newborns, attention deficit hyperactive disorder behavior (ADHD) and autism. 3,4

The recommended dose of vitamin D is different for each person. However, adults in general can regularly consume 1000-4000 IU per day. 2,4,6 Pregnant women are recommended to get vitamin D supplements of 400 -600 IU per day. The administration of vitamin D at a dose of 1000-4000 IU per day is considered safe and has an effect.2-7 Research conducted states that consumption of vitamin D at a dose of 4000 IU per day for 6 months in pregnant women is considered safe and provides good benefits. Indeed, consuming vitamin D should be done by checking the initial serum vitamin D level in the body and checking it periodically within 3 months to see changes in the body's vitamin D levels for adjustment.1-7 Routine vitamin D administration is safe since early pregnancy. Clinical studies reveal that no toxicity occurs with the use of 30,000 IU of vitamin D3 per day as long as the serum vitamin D level is below 200 ng/ml.1,3

Conclusion

Vitamin D supplementation at a dose of 1000-4000 IU per day for pregnant women is considered safe and can provide good benefits to both the pregnant woman and the fetus or child. [1] The provision of vitamin D supplements in pregnancy has been proven to improve fetal growth and reduce the risk of low birth weight, hypertension in pregnancy, premature birth, and gestational diabetes. Besides, pregnant women with sufficient levels of vitamin D contribute to the reduced incidence of enamel defects in their babies as well as a reduced risk of attention deficit hyperactive disorder (ADHD) and autism.1-7

References

1. Bi WG, Nuyt AM, Weiler H, Leduc L, Santamaria C, Wei SQ. Association between vitamin D supplementation during pregnancy and offspring growth, morbidity, and mortality: A Systematic Review and Meta-analysis. JAMA Pediatr. 2018

2. Mousa A, Naqash A, Lim S. Macronutrient and Micronutrient Intake during Pregnancy: An Overview of Recent Evidence. Nutrient. 2019; 11(2).

3. Lopez P, Faustino R, Stefan P, Peter C. Vitamin D supplementation during pregnancy: an overview. Current Opinion in Obstetrics and Gynecology. 2020; 32(5):316-321

4. ACOG Committee. Vitamin D: Screening and supplementation during pregnancy. Obstet Gynecol. 2011; 118(1): 197-198.

5. Franasiak JM, Lara E, Pellicer A. Vitamin D in human reproduction. Current Opinion in Obstetrics and Gynecology. 2017; 29(4):189-194.

6. Mithal A, Kalra S. Vitamin D supplementation in pregnancy. Indian J Endocrinol Metab. 2014; 18(5): 593-596.

7. Sass L, Vinding RK, Stokholm J. Pregnancy and Neurodevelopment in Childhood. JAMA Netw Open. 2020; 3(12)

A condition in which the number of platelets in your body decreases. A decrease in the number of platelets can cause various cases such as dengue hemorrhagic fever, autoimmune disease (ITP), including some types of cancer, chemotherapy treatment, or kidney disease.

Normal platelet count 150000 - 400000.

• If your platelet count is 50,000, you are at risk of bleeding
• If your platelet count is 20,000, you have a high risk of bleeding. Your doctor will tell you if you need a transfusion.
• If the platelet count is low then a transfusion is needed, before the surgical procedure.

What should you do if you have a low platelet count:

• Ask for help if you are unable to stand or walk on your own
• Do not do sports where the possibility of injury is very large
• Not allowed to do manicures, pedicures, waxing, tattoos
• Eat soft food
• Keep lips moist
• Brush your teeth slowly using a soft toothbrush
• Do not use toothpicks, dental floss
• Avoid coughing too hard

Call your doctor if:

• Vomiting blood (hematemesis)
• Stomach pain
• Cough with red phlegm
• Blurred vision
• Severe headache
• Blood in the urine (hematuria)
• Gum bleeding
• Prolonged menstruation
• Red spots (Petechiae)

Hemophilia is a genetic disorder of the blood caused by a deficiency of blood clotting factors (Factor VIII or Factor IX). Hemophilia patients have difficulty in blood clotting so that bleeding takes longer than normal people or in severe cases spontaneous bleeding (without injury). This can be prevented if it gets the right treatment.

Hemophilia can occur in all groups, races, ethnicities, or socioeconomics. Hemophilia occurs in about 1:10000 males. Generally, those who suffer from hemophilia are men, because this disease is inherited through the X chromosome, while women are only carriers of the trait.

• Hemophilia A: deficiency of Factor VIII
• Hemophilia B: Factor IX deficiency

The main symptom of hemophilia is bleeding that is difficult to stop. Bleeding can be external (outside the body) or internal (bleeding inside the body). The most common bleeding is internal bleeding in the joints and muscles, especially the knee joints and thigh muscles.

Based on the degree of severity, hemophilia is divided into:

1. Mild hemophilia

• FVIII/FIX levels 5% - 40%.
• Bleeding is rare.
• May bleed if there is severe trauma or the patient undergoes major surgery.
• If the patient has never experienced major trauma or major surgery, he or she may not know that he or she has mild hemophilia.

2. Moderate hemophilia

• FVIII/FIX levels 1% - 5%.
• Bleeding if there is minor trauma or minor surgery such as tooth extraction, circumcision, and others.
• Spontaneous bleeding may occur, although this is rare.

3. Severe hemophilia

• FVIII/FIX levels are less than 1% (<1%).
• Frequent spontaneous bleeding.
• Even if you experience minor trauma or minor surgery, it can be fatal.

Signs and symptoms

Symptoms of hemophilia vary depending on the amount of clotting factors you have and the location of the bleeding.

External bleeding is easily visible. Children are more likely to experience external bleeding such as cuts in the knees, exposed to scissors, bitten tongue or missing teeth.

Internal bleeding is difficult to identify if there are no known signs. These include bruising (especially bruising that is accompanied by swelling), redness of sites especially muscles or joints (such as the knee). Children with hemophilia can usually report internal bleeding. Sometimes they say there is a "bubble" at the site of bleeding, for example in a joint. The site of bleeding usually provides a sensation of pain, stiffness and warmth.

Babies with hemophilia can't say what they're feeling, but can give signs. When they start to crawl, parents should be reminded of the increased occurrence of sores on the abdomen, chest, buttocks and back. Signs of internal bleeding include:

• Red or tea-colored urine (hematuria)
• Black or bloody stools (melena)
• Vomiting with blood (hematemesis)
• After head trauma, headache, vomiting, weakness and convulsions occur

Knee joint bleeding

Bleeding under the skin (hematoma)

Diagnosis

If there is no family history of hemophilia, hemophilia is usually diagnosed from the symptoms that arise. Some infants with severe hemophilia are diagnosed with hemophilia in the first 6 months of life because they are prone to trauma that can cause bleeding.

In older, active children, doctors suspect hemophilia if the child is prone to bruising, bleeding profusely at the time of the trauma, or swelling with joint pain that occurs for no apparent reason.

In patients suspected of having hemophilia, laboratory tests are carried out in the form of screening tests for blood clotting which include platelet count, bleeding time, clotting time, PT, and APTT. Hemophilia patients have abnormalities in the APTT, where the APTT is longer than normal (normally 30-35 seconds). After finding a prolonged APTT, factor VIII levels were checked. If there is a deficiency, the patient is diagnosed as hemophilia (depending on the level, it can be mild, moderate, or severe). If the FVIII level is normal, the FIX level is checked. If there is a deficiency, it is diagnosed as hemophilia B.

Hemophilia treatment

Treatment of hemophiliacs requires adequate administration of Factor VIII or Factor IX, for life and periodically so that they can achieve a normal life expectancy and live like a normal person. However, hemophilia can be managed properly if it is known how to handle if there is bleeding and routine treatment by replacing the missing clotting factors.

Handling hemophilia is grouped into two, namely to prevent bleeding (prophylaxis) and treatment when bleeding occurs (on-demand). To prevent bleeding, patients are usually given injections of Factor VIII (for hemophilia A) or Factor IX (for hemophilia B) in certain doses regularly 2-3 times per week. If bleeding can be prevented, complications of permanent damage can be avoided.

For treatment in the event of bleeding, given Factor VIII or IX as soon as possible with a dose according to the location and severity of bleeding. The more severe and the longer the bleeding is controlled, the more Factor VIII or IX needed. And if the bleeding is more frequent and the longer it is treated, permanent damage to the bleeding joint can occur. In addition, blood clotting factor levels that are left low increase the risk of severe bleeding in the event of minor trauma or even life-threatening brain hemorrhage. Therefore, the optimal management is to prevent bleeding and if there is bleeding, it should be treated immediately.

Home care

Patients usually recognize the early signs of bleeding. Stopping bleeding at this stage causes less damage and less Factor VIII or IX is needed. Treatment measures that can be done at home to reduce pain when there is active bleeding in the joints are as follows:

RICE (Rest, Immobilization, Compression, Elevation)

1. rest

• Rest the joint in a comfortable position.
• Usually in a flexed position (the joint is slightly bent)

2. Immobilization

• To prevent excessive bleeding, the affected joint should not be moved.
• If bleeding is in the elbow joint, you can use a sling (arm support), if bleeding is in the knee joint or in the leg muscles, you can use crutches (cane) or a wheelchair.

3. Compression

• The affected joint is compressed using ice.
• Use immediately, continued for at least the first 12 hours.

4. Elevation

• The affected joint is elevated so that it is higher than the heart.
• Detained by using pillows/other tools.

Analgesics or pain relievers that are safe for hemophilia patients are paracetamol or mefenamic acid. Aspirin should not be given, because it will further interfere with the blood clotting process. Administration of Desmopressin (DDAVP) can increase factor VIII levels quite high in mild to moderate hemophilia A.

External bleeding treatment

In some children with hemophilia, sores can occur every day and can be treated with simple first aid measures. The most important thing is how we provide good treatment (by giving clotting factor medication).

In superficial wounds:

• Wash the wound with clean running water
• Clean all the stuck clots
• Dry with sterile gauze
• Close the wound

If the bleeding does not stop then treatment with clotting factors is needed

Prevention of bleeding in hemophilia patients

Parents of children with hemophilia can prevent the occurrence of hemophilia with the following healthy habits:

• Exercise regularly. Swimming is a good sport for children with hemophilia, because this sport can move all the muscles without putting heavy pressure on the joints.
• Maintain weight. Weight gain can lead to an increased risk of bleeding.
• Dental hygiene. Make sure children brush their teeth twice a day and have regular check-ups with the dentist.
• Avoid activities that involve physical contact, such as martial arts, football, or sports that have a high risk of accidents, such as motorcycle or car racing, rock climbing, and others.

When to visit the doctor

Some bleeding requires special attention. Call your doctor if:

• Signs and symptoms of joint bleeding
• Bruises all over the body
• Fever occurs because it is a sign of infection
• Trauma to the head, neck, stomach, or back
• Bleeding that can't be stopped
• Stomach pain that won't go away
• Urine that is red or like the
• Black or bloody stools
• Headache accompanied by vomiting and loss of consciousness