A report of two cases of type 2 diabetes mellitus (T2DM): happy and longevity

Chronic hyperglycemia in patients with type 2 diabetes mellitus (T2DM) isassociated with the development of complications and the increase of risk ofmortality. Patients with T2DM have a shorter life expectancy than non-diabeticpopulation. It is attributed to cardiovascular disease, stroke, renal disease,and infection. Depression secondary to T2DM worsens the quality of life. Onthe contrary, positive emotions correlated strongly with long life expectancy.A number of mechanisms might explain this correlation. We reported twogeriatric patients over 80 y.o. with T2DM comorbidity for more than 20 years.Discussion point of these cases is the subject’s longer life span compared to theaverage diabetic patient’s life expectancy and great quality of life despite thedisease burden of chronic hyperglycemia in T2DM and cardiovascular risk

THE CORRELATION OF TRANEXAMIC ACID USED AS ANTIFIBRINOLYTIC THERAPY TO GLASGOW COMA SCALE FOR THE FIRST 7 DAYS IN HAEMORRHAGIC STROKE PATIENTS

Objective: Treatment of haemorrhagic stroke using tranexamic acid is still used in some hospitals, to prevent the occurrence of the complication called rebleeding. Rebleeding is an important cause of bad outcomes that result loss of consciousness and even death. The administration of the antifibrinolytic tranexamic acid in patients with haemorrhagic stroke can reduce the occurrence of rebleeding but it also can increase poor outcome caused by cerebral ischemia that can worsen the patient's condition.Methods: This study used observational study design, cohort, prospective, and multicenter. The purpose of this study was to determine the effectiveness of the use of tranexamic acid in patients with haemorrhagic stroke. Statistical testing is done by analyzing the Glasgow Coma Scale (GCS) score on day 1st, day 3rd, and day 7th between the treatment groups haemorrhagic stroke patients who received tranexamic acid therapy as antifibrinolytic therapy in Bethesda Hospital for 23 patients compared with a control group of patients haemorrhagic stroke who did not receive therapy as tranexamic acid antifibrinolytic therapy in the Dr. Sardjito Hospital for 23 patients.Results: The statistical analysis of the independent t-test showed that there was no significant difference between the average GCS score of day 1st (P=262), day 3rd (P=0.293), and day 7th (P=0.648) between treatment group and control group. The statistical analysis of the Mann-Whitney showed that there was not significant difference comparing the difference between the pre and post GCS score at treatment group and control group (P=0.158).Conclusion: Administration of tranexamic acid in patients with haemorrhagic stroke (treatment group) gives the same clinical response compared to the patients who did not receive tranexamic acid therapy (control group) based on assessment of the Glasgow Coma Scale (GCS) score.Â

ADHERENCE TO SECONDARY STROKE PREVENTION THERAPIES IN ISCHEMIC STROKE PATIENTS AT TEACHING HOSPITAL IN CENTRAL JAVA INDONESIA

Objective: Patients who survive from the first stroke have risk factors to be recurrent. Based on American Heart Association/American Stroke Association and PERDOSSI (Indonesian Neurologist Association), medications which are prescribed to reduce the risk of recurrent stroke as secondary stroke prevention therapies include antiplatelet/anticoagulant as well as antihypertensive and lipid lowering agent. Patients' adherence to the secondary stroke prevention therapies is important to reduce the recurrent stroke. Methods: This is a quantitative research and the data was collected retrospectively. The number of subjects of this study were 165 respondents. The participants were interviewed by researchers about their adherence to secondary stroke prevention by Modified Morisky Adherence Scale 8 (MMAS-8) questionnaire. Patients' adherence was stated as low (MMAS-8 score < 6); moderate (MMAS-8 score = 6-7) and high (MMAS-8 = 8). This research was taken at a teaching hospital in Central Java Indonesia.Results: Of 165 participants, 48 participants (29%) were categorized to have low adherence, 43 participants (26%) had moderate adherence, and 74 participants (45%) had high adherence to secondary stroke prevention therapies. The reasons for not adhering to the medications were felt better (34.1%), forgetfulness (18.7%), boredom (16.5%), lack of family support (8.8%), lack of time (6.6%), felt worse (5.5%), concern about side effects (3.3%), preference to Complementary Alternative Medicines (3.3%), and cost (3.3%).Conclusion: The number of patients who has high adherence to secondary stroke prevention was 45% and the most common reason why participants did not adhere to therapy was because they felt better (34.1%).  Â

The Association between Pesticide Exposure and Neurological Signs and Symptoms in Farmers in Magelang District, Central Java, Indonesia

BACKGROUND: Excessive use of pesticides is known to cause neurotoxicity. Chronic effects of pesticide poisoning include neuropathy and tremors. AIM: This study aimed to determine the association between pesticide exposure and the occurrence of neurological signs and symptoms, especially neuropathy and tremor, in farmers. METHODS: This was a cross-sectional study. The study location was Seloprojo Village, Ngablak District, Magelang Regency, Central Java Province. Farmers as subjects were recruited to determine neuropathy using Diabetic Neuropathy Symptom (DNS) and Diabetic Neuropathy Examination (DNE) scoring. Tremor events were measured with Tremor Rating Scale (TRS). Cholinesterase levels were examined using venous blood samples to determine the level of pesticide poisoning. RESULTS: Of the 120 farmers studied, 68.3% experienced pesticide poisoning with cholinesterase levels below normal values. Weakness of the upper limb was found in 10 subjects (8.33%), while weakness of the lower limbs was found in 6 subjects (5%). There were 59.2% farmers who met the neuropathy criteria from the DNS score and those who met the neuropathic criteria from the DNE score were 6.7%. Tremor symptoms were found in 71.7% of the farmers. There was no significant association between cholinesterase levels and DNS score (p = 0.737), but there were significantly lower levels of cholinesterase (p = 0.046) in the neuropathy group measured with DNE score. There was no significant association between cholinesterase levels and TRS (p = 0.204). CONCLUSION: Cholinesterase levels were significantly associated with neuropathy incidence measured with DNE criteria but statistically not related to tremors in farmers exposed to pesticides

Blood Cholinesterase Level is Associated with Cognitive Function in Indonesian School-age Children Exposed to Pesticides

BACKGROUND: Pesticides are known as depressors of acetylcholinesterase (AChE) activity, resulting in the nervous system toxicity. The previous studies have described associations between AChE, a stable marker of pesticide poisoning, and cognitive performance in children. AIM: This study aimed to identify the association between blood AChE level and cognitive function in children exposed to pesticides in the Magelang Regency, Indonesia. METHODS: A cross-sectional study involving school-age children with a history of pesticide exposure in Ngablak, Magelang Regency, Central Java, Indonesia, was conducted. Blood AChE level was evaluated, and the Modified Mini–Mental State Examination for Children (MMMSEC) was used to analyze the cognitive function of the children. RESULTS: In total, 56 subjects aged between 9 and 11 years were included in this study. Median blood AChE level was 9.64 kIU/L, and 24 subjects (42.9%) had low blood AChE levels. Median MMMSEC score was 33. Eleven subjects (19.6%) were found to have abnormal cognitive function. Bivariate analysis showed that blood AChE level was associated with MMMSEC score (r = 0.343, p = 0.010). Multiple linear regression showed that blood AChE level had a positive association with cognitive function in children, assessed using the MMMSEC score (β = 0.360; p = 0.006). Further analysis showed that the attention and orientation (memory function) domains of the MMMSEC were significantly associated with blood AChE level (β: 0.371 and 0.297, respectively, p < 0.05). CONCLUSIONS: Blood AChE level, a stable marker of pesticide poisoning, was positively associated with cognitive function in children, as assessed using the MMMSEC score. In particular, the orientation and attention domains of the MMMSEC were associated with blood AChE level

Tatalaksana stroke dan penyakit vaskuler lain

Buku ini diharapkan menjadi pemicu belajar bagi para pembaca, yang menyajikan berbagai macam kasus stroke dan penyakit vaskuler lain yang jarang dijumpai di praktik klinik. Penulis menyajikan kasus dari berbagai dimensi yang disertai dengan analisis penanganannya.x, 196 hlm.: 23 c

Farmakoterapi dalam neurologi

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Buku pintar kasus neurologi

Buku ini ditulis sebagai cara belajar kasus neurologi secara kontekstual. Banyak sekali kasus neurologi yang dapat ditegakkan. Diagnosisnya tidak cukup dengan berdasarkan anamnesis dan pemeriksaan neurologi saja, tetapi perlu dilengkapi dengan pemeriksaan penunjang medis, utamanya, ada kasus-kasus yang membutuhkan gold standard untuk diagnosis dengan pemeriksaan penunjang yang mutakhir

FARMAKOTERAPI DALAM NEUROLOGI

211 hlm