Dysphagia as presenting symptom of myasthenia gravis: a case series of successful outcome in multidisciplinary approach

Dysphagia can be caused by mechanic or neurologic disorders. Neurologic dysphagia is commonly related to cerebrovascular disease, parkinson disease, amyotropic lateral sclerosis, tardive dyskinesia, and myasthenia gravis (MG). About 15-40% dysphagia occurred in MG generalized type. Only 6% MG with dysphagia were reported as a single symptom. The case reports aimed to demonstrate the role of otolaryngologist in multidisciplinary approach of the MG management. Two cases of MG were reported. First case was a 33 years old woman with moderate MG generalized type with ocular, dysphagia, and disarthria symptoms and second case was a 46 years old man with acute severe MG with crisis. Management therapy was applied according to onset and severity of MG. Acetylcholinesterase (AChE) and corticosteroid were administered for the first case, whereas therapeutic plasma exchange (TPE) for second case. In conclusion, disfagia in MG can be accompanied with other symptom, therefore its management should be based on the severity in order to give a positive result

The Effect of Nigella Sativa on Clinical Improvement of Laryngopharyngeal Reflux Patients

Background : Laryngopharyngeal Reflux (LPR) decribes as retrograde reflux from gaster into the laryngopharynx because of the premature relaxation upper esophageal sphincter. The management of LPR patients includes lifestyle and dietary arrangements, medical therapy and surgical management. Nigella sativa (NS) / black cumin  has anti-inflammatory, anti-oxidant and gastroprotective effects that are expected to provide clinical improvement in LPR patients.Objective : The purpose of this study was to determine the effectiveness of NS on the clinical improvement of LPR patients.Methods : This research is an intervention study using pre and post test design methods of 34 LPR patients in Dr. Kariadi, hospital and 2 affiliated hospital  from November 2019 - March 2020.Result : 24 patients with complete data while 10 patients were unable to evaluate RFS because of a pandemic. The treatment group (15 patients) were given  omeprazole 20 mg / 12 hours plus NS 1000 mg / 12 hours orally and control group (9 patients) were given omeprazole 20 mg / 12 hours orally and placebo. Data were tested by Shapiro Wilk test, followed by the appropriate parametric test, and Fisher's exact test. There were no differences in clinical improvement in LPR based on RSI and RFS values between groups given additional NS and groups without NS, p 0.105.Conclusion : there were no significant differences in clinical improvement between groups given additional NS and groups without NS

Effectivity of alkaline water on the clinical improvement in laryngopharyngeal reflux

Laryngopharyngeal reflux (LPR) is the reflux of gastric acid through theupper oesophageal sphincter causing mucosal damage of the larynx, thegastrointestinal tract, and the upper airway. Alkaline water has the ability towithstand acidic conditions in the body, the formation of carbonic anhydrase,and reepithelization. This study aimed to investigate the effect of alkaline wateron the clinical improvement in LPR patients. A randomized control trial withpre-test and post-test control group design on LPR patients aged 18 to 60 y.o.was conducted at the ENT-HS outpatient clinic of Dr Kariadi Central Hospital,Semarang, Central Java, Indonesia. Thirty subjects were recruited and dividedinto two group with 15 subjects in each group. In the control group, the subjectswere given standard therapy and mineral water. In the treatment group, thesubjects were given standard therapy and alkaline water. The diagnosis ofLPR was made if the reflux scoring index (RSI) was ≥13, and the reflux findingscore (RFS) was >7. ,After two weeks of intervention, the clinical improvementswere evaluated by reassessing the RSI score. The data were analyzed usingthe Shapiro-Wilk test and independent t-test. The results showed that the mostcommon main complaint was throat clearing [11 subjects (37%)]. Based on theRSI score, there were clinical improvements in both the control (p <0.001) andthe treatment groups (p <0.001). However, there was no significant differencein the RSI score before and after the intervention in the control (p = 0.058)and the treatment groups (p = 0.322). In conclusion,tbe d there is an effect ofalkaline water on the clinical improvement of LPR patients. However, there isno significant difference in the clinical improvement between the control andthe treatment groups

The association of risk factors with psychiatric symptoms and quality of life in laryngopharyngeal reflux disease patients

Background: Risk factors for laryngopharyngeal reflux (LPR), such as age, gender, BMI, smoking history and dietary habit affect the severity of LPR. These risk factors have a clinical impact on both social and emotional aspects, which can reduce the quality of life. Thus led the researchers to analyse association between these risk factors with psychiatric symptoms and quality of life for LPR sufferers.Methods: Analytical descriptive research with cross-sectional approach to LPR patients in ENT clinic RSUP Dr. Kariadi Semarang. Sixty six samples aged 18-60 years and met the criteria of the researcher were measured using the DASS 21 questionnaire and the RQS questionnaire. Statistical analysis used the chi-square test.Results: Obtained 66 subjects with a mean age of 45.1 years, there were more women than men (75.8%). Analysis of risk factors associated with depression found gender (p=1.000), age (p=1.000), duration of symptoms (p=1.000), BMI (p=0.132), smoking (p=0.452), and diet (p=1.000). Analysis of risk factors with anxiety obtained gender (p=0.340), age (p=0.743), duration of symptoms (p=0.085), BMI (p=0.322), smoking history (p=1.000), and diet (p=1.000). Analysis of risk factors with stress obtained gender (p=0.798), age (p=0.088), duration of symptoms (p=0.324), BMI (p=0.276), smoking history (p=0.606) and diet (p=0.538). Analysis of the gender association related to the quality of life LPR patients (p=0.032).Conclusions: Duration of symptoms, age, BMI, smoking history and diet were not associated with psychiatric symptoms and quality of life in LPR sufferers. Gender is not associated with psychiatric symptoms but is related to quality of life

Factors Associated with Hearing Loss in Helicopter Aircrew of Indonesian Army Aviation Center, Semarang

Introduction: Hearing loss and tinnitus may occur in pilots due to exposure of the high noise level (ranges from 104-110 dB) generated by aircraft/helicopters. In addition, flying time, acoustic trauma, diabetes mellitus, hypertension and smoking are risk factors of hearing loss. Objective: to identify the factors associated with hearing loss in the crew of the Indonesian Army Aviation Center, SemarangMethods: in the cross-sectional research, 114 military helicopter aircrews aged 20-58 years, working for the Army Aviation Center in Semarang were included. The exclusion criteria were history of previous ear surgery, infection of the outer and middle ear, the use of ototoxic drugs (kanamycin, cisplatin and carboplatin). The level of hearing loss and tinitus was assessed by otoscopy and audiometry. Whereas, tinnitus was obtained from the history taking. Data were analyzed using chi-square test and fisher's exact and Yates’s correction.Results: One hundred and fourteen subjects (mean age of 26.54 + 4.72) were included. Several factors such as flight time (p = 0.698), acoustic trauma (p = 0.151), diabetes mellitus (p = 0.596), smoking (p = 0.222), hypertension (p = 0.356) were not associated with sensorineural hearing loss. Several factors such as flight time (p = 0.706), acoustic trauma (p = 0.5160), diabetes mellitus (p = 0.789), smoking (p = 0.495), hypertension (p = 0.112) were not associated with tinnitus.Conclusion: There is no association between flight time, acoustic trauma, diabetes mellitus, hypertension, and smoking and hearing loss

Tatalaksana Laringomalasia Kongenital Derajat Sedang pada Bayi

Latar belakang: Laringomalasia merupakan kelainan laring kongenital yang paling sering. Gejala khas laringomalasia adalah stridor inspirasi. Penatalaksanaan laringomalasia dengan non medikamentosa, medikamentosa dan operatif. Tujuan penulisan kasus ini adalah melaporkan tatalaksana laringomalasia kongenital derajat sedang pada bayi dengan aspirasi rekuren, sehingga angka morbiditas dan mortalitas menurun.Laporan kasus: Bayi perempuan, usia 2 bulan, konsulan dari bangsal anak RSUP Dr. Kariadi Semarang dirawat dengan assesment bronkopneumonia riwayat aspirasi rekuren, gizi buruk perawakan normal, dan anemia mikrositik normokromik. Diagnosis Bagian THT adalah laringmalasia kongenital derajat sedang disertai pneumonia aspirasi. Tatalaksanan dengan diit lewat NGT, medikamentosa, fisioterpi, stimulus oromotor. Evaluasi 1minggu mengalami perbaikan, dipulangkan terpasang NGT, diberi obat, edukasi, fisioterapi dan latihan stimulus oromotor Bayi. usia 6 bln NGT di lepas. Evaluasi saat pasien berusia 8 bulan, tidak sesak nafas, minum susu dengan dot dan tidak tersedak. Pembahasan : Laringomalasia dibagi menjadi derajat ringan, sedang dan berat. Laringomalasia derajat sedang perlu perbaikan gejala dengan memasang NGT untuk diit dan cegah aspirasi. 70% bayi mengalami perbaikan setelah 12 bulan. 28% laringomalasia derajat sedang dapat menjadi laringomalasia derajat berat. Bayi dengan laringomalasia derajat sedang dan saturasi oksigen rata-rata ≤ 91% memerlukan terapi operatif (supraglottoplasti). Kasus ini terdiagnosis laringomalasia derajat sedang dengan terapi konservatif membaik dan tidak ada indikasi untuk dilakukan tindakan operatif.Kesimpulan :. Bayi perempuan 2 bulan terdiagnosis laringomalasia derajat sedang disertai aspirasi pneumonia. Di berikan tatalaksana konservatif mengalami perbaikan klinis. Usia 8 bulan tidak sesak, dapat minum dengan baik.

The effect of Nigella sativa and zinc on IgE and IL-5 serum levels, the experimental study in ovalbumin induced BALB/C mice

Background: Allergy is a hypersensitivity reaction due to induction of specific IgE binding to allergens on the surface of mast cells. Interleukin-5 is an important marker of hypersensitivity inflammation reactions.  Nigella sativa, contain active substance thymoquinone, can reduce inflammatory mediators. Zinc as anti-inflammatory by inhibit releasing mediators from mast cells. Objective was to determine the effect of Nigella sativa (NS) and zinc on IgE and IL-5 serum levels on ovalbumin-induced BALB/C mice.Methods: The study design was a true experiment with post-test only control group using BALB/C mice. The study was conducted at Sultan Agung Islamic University’s laboratory on March-June 2020. Inclusion criteria were female BALB C mice, 6-8 weeks, 22-25 grams, and healthy. Thirty mice were divided randomly into 5 groups; negative control, positive control, NS group, zinc group, and NS + zinc group. All groups treated for 28 days. Allergic reactions tested by skin test with OVA, intervention response assessed by IgE and IL-5 serum levels.Results: At the end of study completed, obtained 6 negative controls, 6 positive controls, 6 NS groups, 5 zinc groups, and 5 NS+zinc groups. Two mice s died before intervention completed. Serum IgE and IL5 levels were significantly difference between treatment groups (Kruskal Wallis test; p=0.007 and One-way ANOVA test; p=0.020). The result of logistic regression test, IgE levels was the most significant in the NS+zinc group (p=0.006) and IL-5 levels was the most significant in the zinc group (p=0.002)Conclusions:  Nigella sativa, zinc, and its combination can reduce IgE and IL-5 serum levels of ovalbumin-induced BALB / C mice

Pengaruh Suplementasi Koenzim Q10 terhadap Kadar Laktat Dehidrogenase Penderita Limfoma Non-hodgkin yang Menjalani Kemoterapi di Rsup Dr.kariadi Semarang

LATAR BELAKANG : Peningkatan kadar LDH dikenal sebagai penanda tumor yang menggambarkan aktivitas tumor termasuk tumor sel germinal, sarkoma dan LNH. Koenzim Q10 bekerja sebagai kofaktor dalam Siklus Krebs yang berperan dalam mengatasi kondisi kekurangan ATP dalam sel melalui reaksi reduksi dan oksidasi. TUJUAN : Membuktikan pengaruh pemberian koenzim Q10 terhadap kadar LDH penderita LNH yang mendapat kemoterapi di RSUP Dr.Kariadi, Semarang. METODE : Penelitian intervensi dengan desain randomized pre and post test double blind control group design. Subyek yang ditentukan sebanyak 34 orang. Subjek penelitian adalah penderita LNH yang mendapat kemoterapi dengan pemberian terapi selama 21 hari. Kelompok penelitian dibagi menjadi 2, yaitu kelompok perlakuan (penderita LNH yang mendapat kemoterapi, dan koenzim Q10 100mg/hari) sebanyak 17 orang, serta kelompok kontrol (penderita LNH yang mendapat kemoterapi dan plasebo) sebagai sisanya. Analisis data dengan deskriptif dan uji hipotesis HASIL :&nbsp; Terdapat perbedaan signifikan sebelum dan setelah intervensi, dimana terjadi penurunan kadar LDH pada kelompok perlakuan sedangkan pada kelompok kontrul justru terjadi peningkatan kadar LDH. KESIMPULAN : Kadar LDH pada pasien LNH yang diberikan koenzim Q10, lebih baik dibandingkan tanpa pemberian koenzim Q10. Terdapat perbedaan bermakna secara statistik pada penelitian ini Kata Kunci : Limfoma Non-Hodgkin (LNH); Lactate Dehidrogenase (LDH); Koenzim Q10, prognosi