Measurement of Motor Evoked Potential in Acute Ischemic Stroke: Based on Latency, Amplitude, Central Motoric Conduction TIME and Resting Motor Threshold

BACKGROUND: After stroke, there are dynamic changes of motor evoked potential (MEP), including latency, amplitude, central motoric conduction time (CMCT) and resting motor threshold (RMT) in cerebral. However, latency, CMCT, amplitude and RMT have not been clearly shown in acute ischemic stroke patients with motoric function impairment based on Modified Motoric Research Council Scale (MRCs).METHODS: Patients with motoric function impairment after acute ischemic stroke were recruited, scored based on MRCs and grouped. Latency, amplitude, CMCT and RMT (% intensity) was measured using transcranial magnetic stimulation (TMS). Latency, amplitude, CMCT and RMT of subjects based on affected hemisphere (AH) and unaffected hemisphere (UH); stroke onset; and motoric severity; were analyzed and compared statistically.RESULTS: Thirty-seven subjects with complete assessments were selected. Results of MEP size measurement between AH and UH showed that latency, amplitude, CMCT and RMT of AH and UH were significantly different (p<0.05). In accordance to AH and UH results, latency, amplitude, CMCT and RMT of mild, moderate and severe groups based on motoric severity, showed that latency and CMCT were prolonged, RMT was increased, while amplitude was decreased along with severity increment. The amplitude and RMT among the groups were significantly different with p=0.034 and p=0.029, respectively.CONCLUSION: MEP size measurement including latency, amplitude, CMCT and RMT have significant different in AH and UH. In addition, amplitude and RMT were significantly different in MRCs groups, therefore the MEP size measurement could be suggested as prognostic tool

Dynamic Pattern of Interleukin-1beta and -10 in Cerebrospinal Fluid Following Aneurysmal Subarachnoid Hemorrhage

BACKGROUND: Inflammation following aneurysmal subarachnoid hemorrhage (SAH) is associated with patient outcome. This study aimed to analyze the dynamics pattern of the pro-inflammatory interleukin (IL)-1β and anti-inflammatory cytokine IL-10 in the cerebrospinal fluid (CSF) following aneurysmal SAH.METHODS: This is a prospective observational study. The CSF was collected prior to surgery, and on the 2nd, 4th and 6th days after surgery. The CSF was then analyzed for IL-1β and -10 using enzyme-linked immunosorbent assay. Delayed Ischemic Neurological Deficits (DIND) was determined based on new neurological deficits within the first week after surgery. Data was analysed with T test or Wilcoxon Rank-Sum test to evaluate the pattern of biomarkers between DIND and non-DIND groups.RESULTS: There were 33 patients enrolled in this study, 16 patients (48.48%) who experienced DIND and 17 patients (51.52%) were non-DIND. There were significant increase dynamic levels of IL-10 and -1β in DIND patients (p<0.05).CONCLUSION: Significant increase levels of IL-10 and -1β in CSF after aneurysmal SAH are associated with DIND

Effects of Combined Physiotherapy Hold Relax and Glucosamine to the Decrease of COMP through Pain reduction, Increase Muscle Strength and addition of Osteoarthritis of the Knee Joint ROM

The purpose of this study was to determine the effect of a combination of administration Hold Relax (HR) and glucosamine in reducing the levels of COMP through decreased pain, increased muscle strength, and the addition of Osteoarthritis (OA) of the knee joint ROM. This study is a quasi-experimental design with two groups of pre and posttest controlled group design, in which subjects were divided into two groups: Group 1 was given 3 times the treatment of HR within a day and glucosamine one capsule per day for 1 week and Group 2 was given 6 HR treatment time within a day and glucosamine once daily for 2 weeks. Measurements were performed before and after treatment for the time specified by the respective groups to determine the value of the Range of Motion (ROM), VAS, MMT and COMP levels (serum).These results indicate that there is a significant difference in pain reduction (95% confidence level) between the two groups in which the average reduction in pain was higher than Group 2 Group 1. Likewise with measurements of muscle strength showed that there were significant differences (level 95%) between the two groups in which the average increase in muscle strength higher than Group 2 Group 1. In the measurement result ROM, there is a significant (95% confidence level) between the two groups in which the average addition of ROM in Group 2 higher than group 1. Based on the value of COMP, there is a significant difference (95% confidence level) between the two groups in which the average reduction in the levels of COMP in Group 2 was higher than group 1. The result of Pearson correlation test showed that there is a significant correlation between the increase in ROM with a decrease in pain (r = 0.636 or 63.6%). There is also a significant correlation between increased ROM with decreased levels of COMP (r = 0573 or 57.3%). Likewise, there is a significant correlation between reduced levels of COMP with a decrease in pain (r = 0402 or 40.2%). From these results it can be concluded that the combination of physiotherapy HR and glucosamine is effective in towards decreased levels of COMP through decreased pain, increased muscle strength, increase ROM at osteoarthritis knee joint, where the provision of physiotherapy HR 6 times within a day and glucosamine once per day in two weeks more effective than the combination of HR administration physiotherapy 3 times within a day and glucosamine once per day in one week

The Benefits of Temu Mangga (Curcuma Mangga Val) in Cognitive Functions of Elderly

The objective of this study was to investigate the benefit of Temu Mangga extract (Curcuma Mangga Val) with cognitive function test using Montreal Cognitive Assesment- Indonesian version (MoCA-Ina -Registry MoCA-Ina / stroke registry-INA 2012) in Elderly. This Clinical trial study was conducted using a double-blind, randomized controlled trial, pre and post-test group design in 85 female participants from Panti Wreda Nursing Home in Jakarta. A total of 83 participants who followed the study to the end. 43 participants were administered the Temu Mangga Capsule (TM) group 3x500 mg/day for 30 days.  Results: Mean score of MoCA-Ina in TM group increased by 2.37 from 23.93 ± 3.73 to 26.30 ± 3.92 with Wilcoxon test p-value = 0.000, and in the control group with 40 participants increased by 2.55 from 23.58 ± 4.60 to 26.13 ± 4.56 with Wilcoxon test p-value = 0.000. Mann-Whitney test results in both groups p &gt; 0.05. Conclusions: There was an increase in each treatment groups and control groups with significant Moca-Ina values, but between the two groups did not show significant difference changes. Psychological factors such as attention and hope will become healthier are a strong factor in this study

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Cortisol dynamics and endothelin-1/nitric oxide ratio are associated with clinical vasospasme

Background: Cortisol dynamics in serum might be related to clinical vasospasm, also known as delayed ischemic neurological deficits (DIND). Two vasoactive substances that play a role in pathophysiology of DIND are endothelin-1 (ET1) and nitric oxide (NO), both are proved associated with cortisol. This study aimed to know how cortisol play a role on ET1/NO ratio and its relationship to DIND.Methods: This was a prospective cohort study for the first 14 days after aneurysmal subarachnoid hemorrhage (SAH). Patients with inclusion criteria will be enrolled for blood test before surgery, and post-operative day 2, 4, 7, and 10 (between 8:00-9:00 AM). The blood tests were performed for cortisol, ACTH, CBG, NO, and ET1. Free cortisol is calculated with Coolens equation. Logistic regression was used to see the interaction model and its scale. Bivariate analysis (corelation) was used to see the relationship between total cortisol, free cortisol, NO, ET1, and clinical vasospasm (DIND).Results: Forty-four patients are enrolled into this study (20 male; 24 females). Mean age is 52.02 years (52.02 ± 11.23). There were 29 patients (66%) within  DIND group and 15 patients Non-DIND as the control group. The mean of cortisol level shown is significantly higher in DIND group (35.99 ± 14.24) µg/dL compared to Non-DIND group (19.57 ± 6.19) µg/dL, p &lt; 0.001. The mean of free cortisol level was significantly higher in DIND group (2.06 ± 1.094) µg/dL compared to non-DIND group (0.838 ± 0.365 µg/dL; p &lt; 0.001). The Scatter Plot graph show that correlation of cortisol with ET1/NO ratio started increasing on day 4 and became stronger on day 10.Conclusion: Cortisol is associated with DIND following aneurysmal SAH,  probably through its role in keeping the balance between ET1 and NO level. (Med J Indones. 2013;22:161-6. doi: 10.13181/mji.v22i3.585) Keywords: Cortisol dynamics, delayed ischemic neurological deficits, endothelin-1, nitric oxide</p