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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Preeclampsia is an obstetric problem that cannot be resolved comprehensively in the world&#44; likewise in Indonesia&#46; Major complications in pregnancy are due to hypertensive disease in pregnancy&#44; including gestational hypertension&#44; preeclampsia &#40;PE&#41;&#44; and eclampsia&#44; and accounted for 14&#37; of maternal mortality<span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Preeclampsia is a particular symptom in pregnancy marked with high blood pressure and proteinuria after 20 weeks&#44; occurring in 8&#37; of pregnant women<span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The cause of preeclampsia until now is not known&#46; Severe preeclampsia experienced by pregnant women does not occur by itself&#46; Many risk factors can affect the incidence of severe preeclampsia&#58; Mother&#39;s age&#44; parity&#44; gestational age&#44; number of children&#44; the number of ANC visits&#44; and the History of Hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Protective effects for preeclampsia are probably best if vitamin L-arginine and antioxidants are added before the 24-week gestation age&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> Vitamin D mother is low during pregnancy&#44; and preeclampsia incidence suggests that vitamin deficiency can be an independent risk factor for preeclampsia&#46; The damage or dysfunction of endothelial cells appears to be the basic pathophysiological event of the maternal vascular system in women with preeclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies reported statistical significance between L-arginine supplementation and nitric oxide levels in women with preeclampsia&#46; The study also showed an increase in nitric oxide levels in the blood after L-arginine supplementation&#44; and these women had a lower chance of developing preeclampsia than those who did not receive L-arginine supplementation&#46; This study demonstrated the specificity of nitric oxide as a marker of the development of preeclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Several studies have found that vitamin D is associated with preeclampsia as evidenced by research<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Low maternal and placental calcium levels in preeclampsia&#46; These changes may be associated with some dysfunction in the mother and placental compartment&#44; including deregulation of the immune system&#44; characterized by high levels of pro-inflammatory cytokines in preeclampsia&#46; Therefore&#44; vitamin D supplementation has been suggested to reduce the incidence of preeclampsia&#46; Therefore&#44; the background of this research is still rarely found in publications in Indonesia&#46; Therefore&#44; based on the above problems&#44; it is necessary to research the analysis of serum L-arginine levels and serum 25-hydroxyvitamin D levels as predictors of survival for mothers and infants with severe preeclampsia and compare serum levels of L-arginine and 25-hydroxyvitamin D in the mother group&#46; Normal pregnancy&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research is a secondary data study &#40;medical record data&#41;&#46; In this study&#44; the researchers wanted to analyze serum levels L-arginine and 25-hydroxyvitamin D as a predictor of survival of severe preeclampsia mothers&#46; In addition&#44; it also analyzed comparisons of serum levels L-arginine and serum levels of 25-hydroxyvitamin D in normal pregnant women&#44; severe preeclampsia&#44; and preeclampsia with complications&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Research time and place</span><p id="par0030" class="elsevierStylePara elsevierViewall">Medical records were taken from June 2019&#8211;August 2019&#46; The research was conducted in 4 hospitals in Makassar&#44; including Dr&#46; Wahidin Sudirohusodo General Hospital&#44; Hasanuddin University Education Hospital&#44; Sitti Khadijah 1 Mother and Child Hospital&#44; Sitti Fatimah maternal and child health hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data collection techniques</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study is a descriptive retrospective study using medical record data by reviewing patient characteristics&#44; treatment rooms&#44; and supplements&#46; In addition&#44; other supporting data are serum levels L-arginine and 25-hydroxyvitamin D in a sample group of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46; The data were analyzed using statistical analysis with survival analysis statistics test and one-way Anova test&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The number of samples in this study was 72 samples&#46; The serum l-arginine level in severe preeclampsia was greater than the significance level of 0&#46;799 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; which means that the serum l-arginine level had no significant effect on the survival time of the mother with severe preeclampsia&#46; While the serum level of 25-hydroxyvitamin D has a value that is smaller than the significance level of 0&#46;024 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; so that the serum level of 25-hydroxyvitamin D affects the survival duration of severe preeclampsia &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In contrast&#44; the comparison of L-arginine and 25-hydroxyvitamin D serum levels in normal pregnant women &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; severe preeclampsia&#44; and severe preeclampsia with complications showed results where the <span class="elsevierStyleItalic">P</span> value &#62;0&#46;05 with the conclusion that there was no significant difference between the three sample groups with serum levels of L-arginine and 25-hydroxyvitamin D&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Arginine is considered an unnecessary amino acid in many species&#44; including humans&#46; However&#44; in specific physiological &#40;growth&#44; pregnancy&#41; or pathophysiological conditions with certain conditions&#44; arginine is required in preterm birth&#59; sepsis and diabetes can cause arginine to be necessary&#46; Usually&#44; these conditions can benefit from exogenous arginine supplementation because this amino acid is required for NO&#44; creatine&#44; polyamine&#44; and protein synthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">L-arginine is categorized as a semi-essential amino acid&#59; under normal circumstances&#44; the body can meet its needs by synthesizing L-arginine&#44; but in pregnant conditions&#44; the need for L-arginine will increase&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> L-arginine is the most important source in the regulation of nitric oxide so that in pregnancy&#44; there will be a period of increased deposition in maternal and fetal tissues so that increased NO synthesis is needed to be a major contributor to maternal vascular expansion in pregnancy and blood flow to the placenta&#46; This makes the need for L-arginine to be an essential amino acid in pregnant women&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Vitamin D is a fat-soluble vitamin that plays a significant role in bone mineralization&#46; However&#44; low levels of vitamin D have been linked to osteoporosis and coronary artery disease&#44; diabetes&#44; obesity&#44; and cancer&#46; In pregnancy&#44; vitamin D status is important for the health of both mother and fetus&#46; Low serum vitamin D during pregnancy results in poor fetal bone mineralization at 19 weeks gestation&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In pregnancy&#44; vitamin D is needed by the body&#46; In general&#44; the need for vitamin D is not only for pregnant women but also for the general population&#44; namely &#8805;50<span class="elsevierStyleHsp" style=""></span>nmol&#47;L &#40;or 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; Pregnant women who have decreased levels of vitamin D<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>nmol&#47;L serum 25-&#40;OH&#41; D have the potential to experience hypertension&#44; immunological disorders &#40;regulation of cytokines and immunoglobins&#41;&#44; and differentiation of proliferative cells &#40;gene regulation&#41;&#44; which underlie the occurrence of preeclampsia&#44; namely if there is a decrease in placental growth factor concentrations and there is endothelial dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">During pregnancy&#44; deficiencies of vitamins and minerals&#44; collectively known as micronutrients&#44; can have significant adverse effects on maternal and birth outcomes&#46; Evidence-based nutrition interventions could make a difference and could potentially avoid this outcome&#46; Iron supplementation has been shown to increase the average hemoglobin concentration of the mother over a period of time and reduce the risk of anemia&#46; Zinc supplementation has been shown to result in small but significant reductions in preterm birth&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Meanwhile&#44; this study is in line with the research &#40;Amran and Faruk&#44; 2015&#41; with the research title Non-parametric survival model in Diarrhea Patient Hospital Data at Indralaya Public Health Center&#44; and this study is looking for an estimate of the survival function and the estimation of the hazard function&#44; the results are obtained&#46; On the 4th day&#44; the lowest hospitalization was h &#40;4&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0357&#44; while the highest chance was on the 15th day&#46; Two types of testing were carried out in this study&#44; namely simultaneous covariate contribution testing and partial testing&#46; Based on the simultaneous test&#44; if all covariates are entered together&#44; the effect on the survival time of all covariates is not significant&#46; Meanwhile&#44; in the partial test&#44; when the other covariates were deemed not influential&#44; only the covariate of private occupation and moderate-severe disease status had a significant effect on survival time&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; this research is also in line with research from Qomaria&#44; Fatekurohman&#44; and Qomaria <span class="elsevierStyleItalic">et al&#46;</span> &#40;2019&#41; with the research title Cox Proportional Hazard Model Application for Stroke Patients at RSD Balung&#44; Jember Regency using the compilation of a proportional hazard cox model preceded by a proportional hazard assumption test and followed by selecting the best model using backward elimination and selecting the model that has the smallest AIC value&#46; Finally&#44; the hazard ratio interpretation is carried out from the best model&#46; The result&#58; Increasing age&#44; the risk of death will increase by 1&#46;2094 times&#46; Patients who do not have comorbidities with DM have a risk of death 0&#46;6175 times less than patients who have DM comorbidities&#46; Patients with hemorrhagic stroke had a risk of death 3&#46;0178 times greater than patients with ischemic stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Serum L-arginine level does not affect the survival duration of severe preeclamptic mothers&#44; while serum 25-hydroxyvitamin D levels affect the survival duration of severe preeclamptic mothers&#46; There was no significant difference between serum levels of L-arginine and 25-hydroxyvitamin D in each group with normal pregnancy status&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46; However&#44; the mean low serum L-arginine levels were found in severely preeclamptic women with complications&#44; while insufficient serum 25 hydroxyvitamin D levels were found in the group of normal pregnant women&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to analyze serum levels of L-arginine and 25-hydroxyvitamin D as predictors of survival in severely preeclamptic women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study is a retrospective descriptive study using medical record data from June to August 2019 and has received a recommendation for ethical approval with the protocol number UH20070290&#46; The study was conducted in 4 hospitals in Makassar&#58; Dr&#46; General Hospital&#46; Wahidin Sudirohusodo&#44; Hasanuddin University Teaching Hospital&#44; Siti Fatimah Regional Mother and Child Health Hospital&#44; and Sitti Khadijah 1 Mother and Child Hospital&#46; The samples of this study were mothers who gave birth with a diagnosis of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Serum l-arginine level did not affect the survival of severe preeclamptic mothers&#46; It was shown at <span class="elsevierStyleItalic">p</span>-value 0&#46;799<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Meanwhile&#44; serum levels of 25-hydroxyvitamin D affect the predictors of maternal preeclampsia where the <span class="elsevierStyleItalic">p</span>-value is 0&#46;024<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; In comparing serum levels of L-arginine and 25-hydroxyvitamin D&#44; there was no significant difference in groups of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Serum level of 25-hydroxyvitamin affects the survival of severe preeclamptic mothers&#46;</p></span>"
        "secciones" => array:4 [
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    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 3rd International Nursing&#44; Health Science Students &#38; Health Care Professionals Conference&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">B&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Wald&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col">Exp&#40;B&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">L-Arginine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">25-Hydroxyvitamin D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;741&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;024&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum Levels L-Arginine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;61&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;54&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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Analysis of serum levels L-arginine and 25-hydroxyvitamin D as a predictor of survival of severe preeclampsia mothers
Dwi Wahyuningsiha, Andi Nilawati Usmana,
Autor para correspondencia
, Prihantonob
a Department of Midwifery, Graduate School, Hasanuddin University, Makassar, Indonesia
b Department of Oncology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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    "titulo" => "Analysis of serum levels L-arginine and 25-hydroxyvitamin D as a predictor of survival of severe preeclampsia mothers"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Preeclampsia is an obstetric problem that cannot be resolved comprehensively in the world&#44; likewise in Indonesia&#46; Major complications in pregnancy are due to hypertensive disease in pregnancy&#44; including gestational hypertension&#44; preeclampsia &#40;PE&#41;&#44; and eclampsia&#44; and accounted for 14&#37; of maternal mortality<span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Preeclampsia is a particular symptom in pregnancy marked with high blood pressure and proteinuria after 20 weeks&#44; occurring in 8&#37; of pregnant women<span class="elsevierStyleInf">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">2</span></a> The cause of preeclampsia until now is not known&#46; Severe preeclampsia experienced by pregnant women does not occur by itself&#46; Many risk factors can affect the incidence of severe preeclampsia&#58; Mother&#39;s age&#44; parity&#44; gestational age&#44; number of children&#44; the number of ANC visits&#44; and the History of Hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Protective effects for preeclampsia are probably best if vitamin L-arginine and antioxidants are added before the 24-week gestation age&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> Vitamin D mother is low during pregnancy&#44; and preeclampsia incidence suggests that vitamin deficiency can be an independent risk factor for preeclampsia&#46; The damage or dysfunction of endothelial cells appears to be the basic pathophysiological event of the maternal vascular system in women with preeclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Several studies reported statistical significance between L-arginine supplementation and nitric oxide levels in women with preeclampsia&#46; The study also showed an increase in nitric oxide levels in the blood after L-arginine supplementation&#44; and these women had a lower chance of developing preeclampsia than those who did not receive L-arginine supplementation&#46; This study demonstrated the specificity of nitric oxide as a marker of the development of preeclampsia&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">6</span></a> Several studies have found that vitamin D is associated with preeclampsia as evidenced by research<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> Low maternal and placental calcium levels in preeclampsia&#46; These changes may be associated with some dysfunction in the mother and placental compartment&#44; including deregulation of the immune system&#44; characterized by high levels of pro-inflammatory cytokines in preeclampsia&#46; Therefore&#44; vitamin D supplementation has been suggested to reduce the incidence of preeclampsia&#46; Therefore&#44; the background of this research is still rarely found in publications in Indonesia&#46; Therefore&#44; based on the above problems&#44; it is necessary to research the analysis of serum L-arginine levels and serum 25-hydroxyvitamin D levels as predictors of survival for mothers and infants with severe preeclampsia and compare serum levels of L-arginine and 25-hydroxyvitamin D in the mother group&#46; Normal pregnancy&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This research is a secondary data study &#40;medical record data&#41;&#46; In this study&#44; the researchers wanted to analyze serum levels L-arginine and 25-hydroxyvitamin D as a predictor of survival of severe preeclampsia mothers&#46; In addition&#44; it also analyzed comparisons of serum levels L-arginine and serum levels of 25-hydroxyvitamin D in normal pregnant women&#44; severe preeclampsia&#44; and preeclampsia with complications&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Research time and place</span><p id="par0030" class="elsevierStylePara elsevierViewall">Medical records were taken from June 2019&#8211;August 2019&#46; The research was conducted in 4 hospitals in Makassar&#44; including Dr&#46; Wahidin Sudirohusodo General Hospital&#44; Hasanuddin University Education Hospital&#44; Sitti Khadijah 1 Mother and Child Hospital&#44; Sitti Fatimah maternal and child health hospital&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Data collection techniques</span><p id="par0035" class="elsevierStylePara elsevierViewall">This study is a descriptive retrospective study using medical record data by reviewing patient characteristics&#44; treatment rooms&#44; and supplements&#46; In addition&#44; other supporting data are serum levels L-arginine and 25-hydroxyvitamin D in a sample group of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46; The data were analyzed using statistical analysis with survival analysis statistics test and one-way Anova test&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">The number of samples in this study was 72 samples&#46; The serum l-arginine level in severe preeclampsia was greater than the significance level of 0&#46;799 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; which means that the serum l-arginine level had no significant effect on the survival time of the mother with severe preeclampsia&#46; While the serum level of 25-hydroxyvitamin D has a value that is smaller than the significance level of 0&#46;024 &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; so that the serum level of 25-hydroxyvitamin D affects the survival duration of severe preeclampsia &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; In contrast&#44; the comparison of L-arginine and 25-hydroxyvitamin D serum levels in normal pregnant women &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> and <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; severe preeclampsia&#44; and severe preeclampsia with complications showed results where the <span class="elsevierStyleItalic">P</span> value &#62;0&#46;05 with the conclusion that there was no significant difference between the three sample groups with serum levels of L-arginine and 25-hydroxyvitamin D&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0045" class="elsevierStylePara elsevierViewall">Arginine is considered an unnecessary amino acid in many species&#44; including humans&#46; However&#44; in specific physiological &#40;growth&#44; pregnancy&#41; or pathophysiological conditions with certain conditions&#44; arginine is required in preterm birth&#59; sepsis and diabetes can cause arginine to be necessary&#46; Usually&#44; these conditions can benefit from exogenous arginine supplementation because this amino acid is required for NO&#44; creatine&#44; polyamine&#44; and protein synthesis&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">L-arginine is categorized as a semi-essential amino acid&#59; under normal circumstances&#44; the body can meet its needs by synthesizing L-arginine&#44; but in pregnant conditions&#44; the need for L-arginine will increase&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> L-arginine is the most important source in the regulation of nitric oxide so that in pregnancy&#44; there will be a period of increased deposition in maternal and fetal tissues so that increased NO synthesis is needed to be a major contributor to maternal vascular expansion in pregnancy and blood flow to the placenta&#46; This makes the need for L-arginine to be an essential amino acid in pregnant women&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Vitamin D is a fat-soluble vitamin that plays a significant role in bone mineralization&#46; However&#44; low levels of vitamin D have been linked to osteoporosis and coronary artery disease&#44; diabetes&#44; obesity&#44; and cancer&#46; In pregnancy&#44; vitamin D status is important for the health of both mother and fetus&#46; Low serum vitamin D during pregnancy results in poor fetal bone mineralization at 19 weeks gestation&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In pregnancy&#44; vitamin D is needed by the body&#46; In general&#44; the need for vitamin D is not only for pregnant women but also for the general population&#44; namely &#8805;50<span class="elsevierStyleHsp" style=""></span>nmol&#47;L &#40;or 20<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; Pregnant women who have decreased levels of vitamin D<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>nmol&#47;L serum 25-&#40;OH&#41; D have the potential to experience hypertension&#44; immunological disorders &#40;regulation of cytokines and immunoglobins&#41;&#44; and differentiation of proliferative cells &#40;gene regulation&#41;&#44; which underlie the occurrence of preeclampsia&#44; namely if there is a decrease in placental growth factor concentrations and there is endothelial dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">During pregnancy&#44; deficiencies of vitamins and minerals&#44; collectively known as micronutrients&#44; can have significant adverse effects on maternal and birth outcomes&#46; Evidence-based nutrition interventions could make a difference and could potentially avoid this outcome&#46; Iron supplementation has been shown to increase the average hemoglobin concentration of the mother over a period of time and reduce the risk of anemia&#46; Zinc supplementation has been shown to result in small but significant reductions in preterm birth&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Meanwhile&#44; this study is in line with the research &#40;Amran and Faruk&#44; 2015&#41; with the research title Non-parametric survival model in Diarrhea Patient Hospital Data at Indralaya Public Health Center&#44; and this study is looking for an estimate of the survival function and the estimation of the hazard function&#44; the results are obtained&#46; On the 4th day&#44; the lowest hospitalization was h &#40;4&#41;<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0357&#44; while the highest chance was on the 15th day&#46; Two types of testing were carried out in this study&#44; namely simultaneous covariate contribution testing and partial testing&#46; Based on the simultaneous test&#44; if all covariates are entered together&#44; the effect on the survival time of all covariates is not significant&#46; Meanwhile&#44; in the partial test&#44; when the other covariates were deemed not influential&#44; only the covariate of private occupation and moderate-severe disease status had a significant effect on survival time&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition&#44; this research is also in line with research from Qomaria&#44; Fatekurohman&#44; and Qomaria <span class="elsevierStyleItalic">et al&#46;</span> &#40;2019&#41; with the research title Cox Proportional Hazard Model Application for Stroke Patients at RSD Balung&#44; Jember Regency using the compilation of a proportional hazard cox model preceded by a proportional hazard assumption test and followed by selecting the best model using backward elimination and selecting the model that has the smallest AIC value&#46; Finally&#44; the hazard ratio interpretation is carried out from the best model&#46; The result&#58; Increasing age&#44; the risk of death will increase by 1&#46;2094 times&#46; Patients who do not have comorbidities with DM have a risk of death 0&#46;6175 times less than patients who have DM comorbidities&#46; Patients with hemorrhagic stroke had a risk of death 3&#46;0178 times greater than patients with ischemic stroke&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0080" class="elsevierStylePara elsevierViewall">Serum L-arginine level does not affect the survival duration of severe preeclamptic mothers&#44; while serum 25-hydroxyvitamin D levels affect the survival duration of severe preeclamptic mothers&#46; There was no significant difference between serum levels of L-arginine and 25-hydroxyvitamin D in each group with normal pregnancy status&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46; However&#44; the mean low serum L-arginine levels were found in severely preeclamptic women with complications&#44; while insufficient serum 25 hydroxyvitamin D levels were found in the group of normal pregnant women&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to analyze serum levels of L-arginine and 25-hydroxyvitamin D as predictors of survival in severely preeclamptic women&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study is a retrospective descriptive study using medical record data from June to August 2019 and has received a recommendation for ethical approval with the protocol number UH20070290&#46; The study was conducted in 4 hospitals in Makassar&#58; Dr&#46; General Hospital&#46; Wahidin Sudirohusodo&#44; Hasanuddin University Teaching Hospital&#44; Siti Fatimah Regional Mother and Child Health Hospital&#44; and Sitti Khadijah 1 Mother and Child Hospital&#46; The samples of this study were mothers who gave birth with a diagnosis of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Serum l-arginine level did not affect the survival of severe preeclamptic mothers&#46; It was shown at <span class="elsevierStyleItalic">p</span>-value 0&#46;799<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; Meanwhile&#44; serum levels of 25-hydroxyvitamin D affect the predictors of maternal preeclampsia where the <span class="elsevierStyleItalic">p</span>-value is 0&#46;024<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; In comparing serum levels of L-arginine and 25-hydroxyvitamin D&#44; there was no significant difference in groups of normal pregnant women&#44; severe preeclampsia&#44; and severe preeclampsia with complications&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Serum level of 25-hydroxyvitamin affects the survival of severe preeclamptic mothers&#46;</p></span>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">SE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Wald&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Df&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Sig&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Exp&#40;B&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#46;0&#37; CI Exp&#40;B&#41;</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lower&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Upper&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">L-Arginine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;0&#46;138&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;541&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;065&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;799&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25-Hydroxyvitamin D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;1&#46;741&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;770&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;110&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;175&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;039&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;793&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2781719.png"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Survival analysis &#40;cox proportional hazard regression model&#41;&#46;</p>"
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      1 => array:8 [
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        "tipo" => "MULTIMEDIATABLA"
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            "identificador" => "at2"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#42; One-way ANOVA test&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum Levels L-Arginine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>-<span class="elsevierStyleItalic">value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;99<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;54&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe pre-eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;12<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>75&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe preeclampsia with complications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#42; One-way ANOVA test&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Serum Levels 25-Hydroxyvitamin D&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P-value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#46;52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;12&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Severe pre-eclampsia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">112&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>34&#46;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Severe preeclampsia with complications&nbsp;\t\t\t\t\t\t\n
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