Paradoxical Hemiparesis from Cerebellopontine Angle Tumor: A Case Report

Objective: To report a vestibular schwannoma in the cerebellopontine angle presenting with paradoxical hemiparesis with the Kernohan-Woltman Notch Phenomenon (KWNP).Methods: A 31-year-old female presented to the neurology clinic at Bhayangkara Hospital TK. I R. Said Sukanto, Indonesia, on 29 November 2021 with loss of balance, hearing, vision, and weakness in her left arm and leg. On physical examination, the patient had reduced left arm and leg muscle strengths against resistance (MRC grade 4), face deviation to the left, abnormal finger-to-nose test, dysdiadochokinesia, and inability to perform tandem gait. She was admitted for a brain MRI but did not return to the hospital for re-evaluation and surgery. Results: The brain MRI showed a mass on the left side of the cerebellum with a size of 4.44x3.93x4.93 cm, suggesting vestibular schwannoma. The mass also caused the obliteration of the ventricle, causing hydrocephalus.Conclusion:KWNP is an unusual finding resulting in a paradoxical hemiparesis, a false-localizing neurologic sign. Physicians should recognize KWNP in patients with hemiparesis, especially in space-occupying lesions. Imaging studies can help localize the lesion to minimize misdiagnosis and optimize patient treatment.

Comparison of Preemptive Post-Intubation 15 Mg/KgBW Paracetamol to 0.35 Mg/KgBW Meperidine in Incidence of Post-Anesthetic Shivering

Post anesthesia shivering (PAS) is a repetitive involuntary movement of one or more muscle groups as a result of a decrease in core body temperature. Pharmacological therapy in preventing PAS may include meperidine and paracetamol. This study compared the effectiveness of paracetamol to meperidine in reducing the incidence of post-anesthesia shivering. This study used an experimental randomized double-blind comparative analytic design on patients underwent exploratory laparotomy surgery under general anesthesia at Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from September 2021 to August 2022. Patients with 50 ASA 1-2 physical status were included and divided into two groups. One group received 15 mg/kg group paracetamol and the other received 0.35 mg/kg meperidine. Data on tympanic membrane temperature and hemodynamics before and after induction and after extubating were collected. Furthermore, data on the results of the assessment of the incidence and grade of shivering in each treatment group were also collected. The results of this study showed that there was a decrease in the frequency of PAS in patients receiving intravenous 15 mg/kg paracetamol (p<0.05), as well as less side effects in the form of nausea and vomiting (p < 0.05). The incidence and degree of shivering after general anesthesia using intravenous 15 mg/kg paracetamol was lower compared to the use of 0.35 mg/kg meperidine. In the meperidine group, the decrease in body temperature was lower than in the paracetamol group, while the incidence of nausea and vomiting in the paracetamol group was lower than in the meperidine group. In conclusion, paracetamol reduces the incidence of post-anesthesia shivering better than meperidine

Perceptions of Medical Students in Bandung towards Online and Offline Learning in the Anatomy Laboratory during the Covid-19 Pandemic

Background: Coronavirus Disease 2019 (COVID-19) that surged throughout the world in 2019 and engulfed Indonesia in 2020 had changed many aspects of people’s activities, significantly when altering the offline anatomy laboratories to online. This study aimed to determine the perspective of medical students in Bandung regarding the learning process in online and offline anatomy laboratories during the COVID-19 pandemic.Methods: This descriptive study had used modified questionnaires in previous research with a Likert scale. The respondents were 184 students from the 2018 or 2019 class of the Faculty of Medicine in Bandung, who participated in both online and offline anatomy laboratory learning methods. Sampling was carried out using the purposive sampling method. The data were presented in a frequency table and calculated by SPSS.  Results: Regarding ‘material understanding’, most students (57.0%) disagreed that online anatomy laboratory activities were better than offline. In terms of ‘facilities and infrastructure’, 38.0% of students disagreed that online anatomy laboratory learning facilities were more adequate than offline. On the aspect of ‘teacher's perception’, most students agreed (39.0%) that teacher’s performance was better in online anatomy laboratory activities.Conclusion: This study shows that medical students prefer to combine online and offline anatomy laboratory activities

Low Bone Mineral Density, Sedentary Lifestyle, and Depression as Risk Factors for Frailty Syndrome at a Home Care Facility in West Jakarta, Indonesia

Background: The life expectancy in Indonesia is increasing. The rising number of the elderly people plays a vital role for a country to achieve development success. However, it has many consequences in the health sector, including a frailty syndrome. This study aimed to explore the association between frailty and related factors.Methods: This cross-sectional study was conducted at a home care facility in West Jakarta between September and October 2019, using a simple random sampling method. Data were analyzed using the chi-square test and multivariate logistic regression. The inclusion criteria were members of the home care aged ≥60 years and had signed a written informed consent.Results: In total, 97 respondents were included. Female gender and bone mineral density (BMD) were associated with frailty syndrome (p=0.018 and p=0.05, respectively). Multivariate logistic regression analysis showed the odds ratio of frailty for the female gender (OR= 3.319; 95% CI 1.045–10.543), low bone mineral density (OR= 4.939; 95% CI 1.516–16.090), depression (OR= 7.622; 95% CI 1.246 – 46.621), and low physical activity (OR = 3.639; 95% CI 1.096 – 12.079).Conclusions: There is a relationship between female gender and bone mineral density with frailty syndrome with the risk factors for frailty syndrome in this study are female gender, low bone mineral density, depression, and low physical activity

Effect of High Fat and Cholesterol Diet on Total Blood Cholesterol Levels in Pregnant Wistar Rats

Hypercholesterolemia during pregnancy is a physiological condition resulting from increased insulin resistance, lipoprotein synthesis, and lipolysis in adipose tissue, which mobilizes lipids as an energetic substrate for fetal growth. Consumption of foods high in fat and cholesterol may lead to an increase in total blood cholesterol levels during pregnancy due to saturated fat and cholesterol contents that will increases the synthesis of lipoproteins in the blood. The objectives of this study were to determine the effects of high fat and cholesterol diet on the total blood cholesterol levels in pregnant Wistar rats. This study was a true experimental research using a randomized post-test-only control group design  conducted from November 2020 to October 2021on fourteen female Wistar rats that were divided into control and intervention groups. Cow brain was provided as the high fat and cholesterol diet and after the rats gave birth, blood was drawn from the heart. The total blood serum cholesterol levels were assessed  using Micro Lab 300 with the CHOD-PAP method and the data were analyzed using an independent t-test. This study showed that the mean total blood cholesterol levels for the control and treatment groups were 80.43±18.512 mg/dL and  142.57±24.786 mg/dL, respectively, which reflected a significant differences in the mean total blood cholesterol level between the control and treatment groups (p-value <0.01). In conclusion, a high fat and cholesterol diet affects the total blood cholesterol level in pregnant Wistar rats

Perbandingan derajat nyeri setelah pemberian Gabapentin dan Amitriptilin sebagai adjuvan analgetik pasien nyeri kanker

Penggunaan opioid tunggal pada nyeri kanker kurang efektif sehingga perlu dikombinasikan dengan analgetik non opioid. Tujuan penelitian adalah membandingkan derajat nyeri pada pemberian gabapentin dengan amitriptilin sebagai adjuvan analgetik pasien nyeri kanker. Desain penelitian ini menggunakan uji klinis acak tersamar ganda, subjek penelitian adalah pasien poli nyeri RSUP H. Adam Malik dengan derajat nyeri berat yang dibagi 3, yaitu kelompok gabapentin, amitriptilin, dan plasebo sebagai adjuvan. Penelitian dilakukan selama periode April–Juni 2022. Sampel dievaluasi derajat nyeri, pain DETECT dan efek samping hari 1 (T1), hari 3 (T2), dan hari 7 (T3). Derajat nyeri berat pengukuran T1 pada grup gabapentin didapatkan 1,8%, amitriptilin 10,5% dan plasebo 7%. Pada T2, T3 tidak didapatkan derajat berat pada semua kelompok. Pemeriksaan pain DETECT dijumpai rerata 29,4±5,3. Pada T1 dan T2 tidak terdapat perbedaan bermakna. Pada T3 terdapat perbedaan bermakna dengan nilai p 0,003 antara penggunaan gabapentin dan plasebo. Pada penelitian ini didapatkan penurunan NRS secara klinis pada penggunaan adjuvan analgetik dibanding dengan plasebo, tetapi tidak terdapat perbedaan bermakna secara statistik. Pada pain DETECT ditemukan perbedaan bermakna setelah pemberian adjuvan gabapentin setelah hari ke-7 dibanding dengan plasebo. Simpulan penelitian ini terdapat penurunan derajat nyeri secara klinis penggunaan adjuvan analgetik dibanding dengan plasebo, tetapi tidak terdapat perbedaan bermakna secara statistik. Nyeri merupakan mekanisme pertahanan tubuh yang membantu untuk memberikan tanda bahwa sedang terjadi kerusakan jaringan atau akan terjadi kerusakan jaringan. Pada keganasan nyeri yang ditimbulkan oleh gangguan pada sistem saraf disebut nyeri neuropatik, tatalaksana nyeri kanker bisa dengan analgetik dan adjuvan, salah satunya Gabapentin dan Amitriptilin. Desain penelitian  ini menggunakan uji klinis acak tersamar ganda, sampel yang digunakan adalah pasien poli nyeri dengan diagnosis keganasan dengan derajat nyeri NRS berat dengan pemberian MST dan Parasetamol sampel di bagi 3 kelompok yaitu kelompok yang diberikan Gabapentin, Aamitriptilin dan placebo sebagai adjuvan. Kemudian sampel akan di evaluasi derajat nyeri,  hari 1 (T1), hari 3 (T2) dan hari 7 (T3). Didapatkan hasil NRS pada grup Gabapentin  pada T1 derajat berat menjadi  1 orang (1.8%), grup Amitriptilin 3 orang (10,5%) dan plasebo 4 orang (7%). Pada T2 tidak di dapatkan NRS derajat berat pada semua kelompok. Pada grup Gabapentin  pada T2 derajat sedang menjadi 15 orang (26,3%), grup Amitriptilin 15 orang (26,3%) dan plasebo 14 orang (24,6%). Pada T3 tidak di dapatkan NRS derajat berat pada semua kelompok. Pada grup Gabapentin  pada T3 derajat sedang menjadi 14 orang (26,3%), grup Amitriptilin 12 orang (21,1%) dan plasebo 15 orang (26,3%).Pada penelitian ini secara klinis didapatkan penurunan NRS secara klinis pada penggunaan adjuvan analgetik dibandingkan Plasebo tetapi tidak terdapat perbedaan bermakna secara statistik. Pada penilaian nyeri neuropatik dengan Pain DETECT ditemukan perbedaan bermakna setelah pemberian adjuvan Gabapentin setelah hari ke-7 dibandingkan dengan Plasebo. Efek samping setelah pemberian obat pada penelitian tidak terdapat perbedaan bermakna

Impact of Severe Preeclampsia on the Incidence of Low-Birth-Weight Babies

Infant birth weight is an important indicator of survival, growth potential, and developmental capacity. Maternal health plays an important role in determining the well-being of newborns. A complicated pregnancy, inclusive of conditions such as preeclampsia, elevates the risk of giving birth to a low birth weight (LBW) baby. This study aimed to compare the impact of severe preeclampsia on the incidence of LBW babies in Dr. Dradjat Prawiranegara General Hospital Serang, Indonesia. This case-control analysis included 148 parturients recruited randomly from June to October 2022. Logistic regression was used as the analytical tool, with P=0.000 considered as demonstrating a significant association. The incidence rates of LBW and severe preeclampsia in 2018 were 19.84% and 14.15%, respectively. The case group recorded LBW within the weight range of 1,000-2,450 g, with 38% of them were Small for Gestation Age (SGA), while 50% and 12% were Appropriate for Gestational Age (AGA), and Large for Gestational Age (LGA), respectively. In contrast, the control group, with birth weights ranging from 2,600-4,500 g, 13.50% were SGA, while 77% and 9.50% were AGA and LGA, respectively. Parity was a confounding factor influencing the incidence of LBW, while maternal age did not present a significant correlation. Pregnancies with severe preeclampsia were found to have a 29-fold increased likelihood of delivering LBW babies compared to the control group when controlling for parity (P=0.000, CI 95%). Hence, women with severe preeclampsia pregnancies have a higher risk for delivering LBW babies of 29 times higher than the control

Outcome of Posterior Cruciate Ligament Avulsion Fractures from Tibial Attachment Treated by Open Reduction and Internal Fixation

Objectives: To analyze the clinical and functional outcomes of posterior cruciate ligament avulsion fractures treated by open reduction and internal fixation from tibial attachment.Methods: This observational study was conducted at the orthopedics department of a tertiary care medical college. Forty adult patients with PCL avulsion fractures were included in this study based on predefined inclusion and exclusion criteria. All patients were treated by open reduction and internal fixation. Patients were followed up for one year. The Lysholm scale and knee society score were used to assess functional outcomes. A p-value less than 0.05 was considered to be statistically significant.Results: Overall, 34 (75 %) males and 6 (15%) females participated in this study with an M: F ratio of 1:0.17. The mean age of affected patients was 37.3 +/- 7.34 years. Out of 40 patients, 29 (72.50%) patients sustained fractures secondary to road traffic accidents, while 7 (17.50%) had sports-related injuries. There was a highly significant improvement in the Lysholm and Knee Society scores from the time of presentation to the final follow-up (P<0.0001). Only 1 (2.5%) patient developed residual joint instability as evidenced by the drawer test result.Conclusion: Patients with posterior cruciate ligament avulsion fracture treated by Open reduction and internal fixation were found to have excellent results in terms of functional outcomes

Perbandingan Mula Kerja Ropivacaine 0,75% dengan Levobupivacaine 0,5% untuk Blokade Peribulbar pada Pasien yang Menjalani Operasi Vitrektomi

Blokade peribulbar merupakan salah satu teknik anestesi regional yang dapat digunakan untuk operasi vitrektomi. Ropivakain dan levobupivakain merupakan anestetik lokal yang memiliki keunggulan durasi kerja yang lama dan tingkat komplikasi lebih rendah dibanding dengan bupivakain. Penelitian ini bertujuan membandingkan mula kerja antara ropivakain dan levobupivakain pada blokade peribulbar. Jenis penelitian ini berupa eksperimental prospektif yang menggunakan desain double blind randomized controlled trial dengan analisis statistik menggunakan uji Mann Whitney. Subjek terdiri dari 34 orang yang menjalani operasi vitrektomi dengan blokade peribulbar. Penelitian dilakukan bulan Maret–April 2022 di di Netra Klinik Spesialis Mata Bandung. Enam belas subjek dilakukan blokade peribulbar dengan ropivakain 0,75% dan 18 subjek mendapatkan levobupivakain 0,5%. Mula kerja rerata pada grup ropivakain 0,75% didapatkan 11,3 menit, sedangkan grup levobupivakain 0,5% rerata 7,78 menit dengan perbedaan bermakna (p<0,05). Volume rerata grup ropivakain 0,75% adalah 8,06±1,44 mL, sedangkan grup levobupivakain 0,5% mendapatkan volume rerata 7,00±1,79 mL. Mula kerja levobupivakain 0,5% lebih cepat dibanding dengan ropivakain 0,75%, hal tersebut kemungkinan berhubungan dengan perbedaan lipid solubilitas, ropivakain 10 kali lebih rendah lipid solubilitasnya dibanding dengan levobupivakain. Simpulan penelitian ini adalah mula kerja levobupivakain 0,5% pada blokade peribulbar lebih cepat dibanding dengan ropivakain 0,75%.  Pendahuluan. Blokade peribulbar merupakan salah satu teknik anestesi regional yang dapat digunakan untuk operasi vitrektomi. Ropivakain dan levobupivakain merupakan anestetik lokal yang memiliki keunggulan durasi kerja yang lama, dan tingkat komplikasi lebih rendah dibanding dengan bupivakain. Penelitian ini bertujuan mencari mula kerja dari ropivakain dan levobupivakain. Metode. Sebanyak 34 subjek dilakukan vitrektomi di Netra Klinik Spesialis Mata Bandung dengan blokade peribulbar. Enam belas subjek mendapatkan ropivakain 0,75% dan delapan belas subjek mendapatkan levobupivakain 0,5% untuk blokade peribulbar. Setelah penyuntikan dilakukan penilaian gerak bola mata untuk menilai akinesia, dinilai Cicendo Akinesia Score (CAS) setiap menit selama 10 menit, blokade tercapai bila skor CAS 2 atau 3. Hasil. Grup ropivakain 0,75% didapatkan mula kerja rerata 11,3 menit, sedangkan grup levobupivakain 0,5% rerata 7,78 menit setelah penyuntikan. Hasil statistik didapatkan nilai p <0,05 yang berarti bermakna dari mulai kerja kedua obat. Volume rerata grup ropivakain 0,75%  8,06±1,44 ml, sedangkan grup levobupivakain 0,5% mendapatkan volume rerata 7,00±1,79 ml.  Diskusi. Mula kerja levobupivakain 0,5% lebih cepat dibanding dengan ropivakain 0,75%, hal tersebut kemungkinan berhubungan dengan perbedaan lipid solubilitas, ropivakain 10 kali lebih rendah lipid solubilitasnya dibanding levobupivakain. Anatomi bola mata diselubungi oleh jaringan lemak, kemungkinan penetrasi ropivakain lebih lambat dibanding dengan levobupvakain. Simpulan. Mula kerja levobupivakain 0,5% lebih cepat dibandingkan dengan ropivakain 0,75% pada blokade peribulbar. Kata Kunci: blokade peribulbar, levobupivakain, ropivakain, vitrektom