Injeksi Cairan Dekstrosa Hipertonik (Proloterapi) pada Osteoarthritis Lutut Kronis

Pendahuluan: Proloterapi juga dikenal sebagai terapi injeksi regeneratif atau skleroterapi adalah terapi yang menggunakan zat kimia atau biologi untuk kondisi nyeri muskuloskeletal kronis, termasuk osteoartritis lutut. Osteoartritis(OA) lutut adalah bentuk paling umum dari osteoarthritis kronis di seluruh dunia serta merupakan penyebab utama nyeri dan kecacatan dalam beberapa tahun terakhir, hasilbeberapa uji klinis yang dipublikasikan telah menunjukkan efek positif proloterapi pada osteoartritis lutut. Kasus: Wanita,51 tahun dengan nyeri lutut kanan sejak 1 tahun lalu, semakin memberat dalam 3 bulan. Numeric Rating Scale (NRS) adalah 7. Didapatkan tenderness, krepitasi, dan range of movement (ROM) normal tanpa adanya deformitaslutut kanan. Dari pemeriksaan radiologis didapatkan osteoarthritis femorotibial joint grade 1 dan osteoarthritis femoropatellar joint kanan. Injeksi dekstrosa hipertonik 25% dilakukan setiap 2 minggu. Sebelumnya pasien mendapat injeksi steroid intraartikuler (triamsinolon) namun nyeri kembali muncul setelah tiga minggu. Nilai Numeric Rating Scale (NRS) menurun menjadi 4 setelah dilakukan injeksi dekstrosa hipertonik yang keempat. Kesimpulan: Injeksi dekstrosa hipertonik (proloterapi) dapat dijadikan sebagai modalitas terapi alternatif yang menghasilkan perubahan klinis pada osteoarthritis lutut dengan resiko minimal, biaya terjangkau dan penggunaan yang mudah

Azathioptrine in Refractory Tolosa-Hunt Syndrome: Two Case Report

Introduction: Tolosa-Hunt syndrome (THS) is an inflammatory disease with painful ophthalmoplegia and unilateral periorbital headache as detailed by the International Classification of Headache Disorders, 3rd edition (ICHD-3). Azathioprine has been suggested as a second-line treatment in refractory THS when oral corticosteroid only gives a partial response. Case: Two cases of THS, 45-year-old and 41-year-old women with unilateral headache, drooping of the left upper eyelid, and diplopia. They presented with complete ophthalmoplegia and ophthalmic division of trigeminal nerve disturbance. Magnetic resonance imaging (MRI) showed thickening of the left cavernous sinus, suggesting THS, while the other was normal. Corticosteroid (prednisone 1-1,5 mg/day) was given orally for the first two weeks, and according to the Numeric Pain Rating Scale (NPRS), pain intensity was reduced from severe to moderate. As a second-line treatment, azathioprine (2 mg/kg/day) was given afterward, with a significant reduction in pain intensity and remission of ophthalmoplegia within seven days. Azathioprine was used as an immunosuppressive agent and was continued for another three months without any deterioration in neurological deficits. The levels of complement 3, 4 (C3, C4), and C-reactive protein (CRP) were normal in both patients, with a slight increase in erythrocyte sedimentation rate (ESR) and equivocal values on antinuclear antibody (ANA) results. Other differentials of THS were eliminated from history-taking, physical examination, and proper investigations. Conclusion: Azathioprine as a second-line treatment can be used instead of an oral corticosteroid for refractory cases of THS with fewer side effects. Complete remission of ophthalmoplegia and a significant reduction in pain intensity was obtained

Difference of pain intensity in tension type headache patients focusing on the personality

Tension-type headache (TTH) is the most common headache disorders. The association between headache and psychiatric disordershas received considerable attention. Reasons for examining personality in persons with headache disorders include determining ifpersonality characteristics predispose one to develop headache disorders, if personality disturbance is a consequence of theheadache disorder, or if an underlying (or comorbid) causal mechanism exists producing both conditions concurrently. The purposeof this study was to determine the difference in pain intensity focusing on personality type in patients with TTH. Cross-sectionalanalytic study using consecutive sampling method has been applied. Respondents were recruited from Neurologic outpatient clinic ofDr. Soetomo General Hospital, Surabaya, since September 2012-February 2013. Pain intensity was measured using Visual AnalogScale (VAS), while Minnesota Multiphasic Personality Inventory-2 (MMPI-2) was used to determine the personality traits of theparticipants. Data was displayed descriptively. SPSS 17 was used to analyze the data. Sixty patients were enrolled in this study,female has higher TTH prevalence than male (68.3% : 31.7%). The mean age was 36.35 ± 10.050 years. VAS mean score was 5.608± 1.8765. Chronic episode of TTH was the most common clinical feature (61.7%). From the linear regression analyses,hypochondriasis was statistically significant with VAS score (p<0.05) than depression and hysteria. VAS score have significancieswith hypochondriasis personalities

Perbaikan Klinis Signifikan Pasien Spondilitis Tuberkulosis yang Mendapatkan Regimen Obat Anti Tuberkulosis: Laporan Kasus Serial

Spondilitis tuberkulosis, yang dikenal sebagai penyakit Pott, adalah bentuk paling umum dari tuberkulosis muskuloskeletal. Regimen obat anti tuberkulosis masih menjadi terapi dasar atau dikombinasikan dengan pembedahan pada kasus tertentu. Kasus: Kami melaporkan dua kasus spondilitis tuberkulosis, laki-laki 53 tahun dan wanita 26 tahun dengan nyeri punggung hebat. Kedua pasien mengalami hipoestesia kedua tungkai bawah dan gangguan kencing. Kelemahan tungkai gradual terjadi sejak 4 minggu dengan skala medical research council (MRC) 1 pada kasus pertama, sedangkan pada kasus kedua kelemahan terjadi sejak 2 minggu dengan skala MRC 3. Magnetic resonance imaging (MRI) spinal menunjukkan spondilitis tuberkulosis pada vertebra thorakal 5–6 dengan kompresi medula spinalis pada kasus pertama dan spondilodiscitis tuberkulosa pada vertebra thorakal 2–3, gibbus, abses paravertebral dengan kompresi medula spinalis derajat sedang pada kasus kedua. Kedua pasien dipersiapkan menjalani operasi elektif. Regimen obat anti tuberkulosis meliputi Isoniazid, Pirazinamid, Rifampisin, dan Streptomisin selama 1–2 bulan, diikuti Isoniazid dan Rifampisin selama 9–12 bulan diberikan sebagai terapi lini pertama. Didapatkan peningkatan kekuatan otot signifikan dengan skala MRC 5, tidak didapatkan defisit otonom, dan nyeri derajat ringan yang dinilai dengan numeric pain rating scale (NPRS) setelah satu tahun follow up. Kesimpulan: Regimen obat anti tuberkulosis tetap dapat diandalkan dan mampu menunjukkan perbaikan klinis yang signifikan pada terapi pasien spondilitis tuberkulosis

Evaluasi Status Fungsional Pasien Stroke Iskemik Di Ruang Rawat Inap Saraf RSUD Dr. Soetomo Menggunakan Instrumen Functional Independence Measure (FIM)

Introduction: Stroke is a sudden and acute functional focal and global brain disorder that lasts more than 24 hours due to brain blood circulation disorders. Strokes can influence several aspects of life including ADL. Aim: To analyze the patients with ischemic stroke in Neurology Department of RSUD Dr. Soetomo by Functional Independence Measure (FIM) scale at the times of admission to hospital, discharge, and one month after follow-up. Methods: The design of study was cohort. Sample was 60 patients that suitable with the inclusion criteria and was selected by consecutive sampling. Patient’s age, sex, length of stay, nutritional intake, compliance of drugs intake, and the ability of physical activity were recorded. After that, motor assessment and daily activities skills were evaluated by FIM scale. Data was collected by interview and examination for 5 months. Data was analyzed by t-test. Results: A sum of 60 patients are studied. Most frequent genders are male (53,3%), age ranging from 60-69 years old (36,7%), length of stay mostly less than a week (88,3%), nutritional intake is mostly balanced (31,7%), most of the patients take their drugs regularly (66,7%), and most of the patients are only need supervision (45%). The FIM score at admission ranged between 54-71 (40%), at discharged ranged between 72-89 (46,7%), and after one month follow-up ranged between 72-89 (48,3%). There were significant change at p=0,001 between FIM Score at discharged and admission and also between FIM score after one month follow-up and discharged. Conclusion: All patients’ FIM scores were improved. There was a correlation between patient’s length of stay and FIM score at admission and also the ability of physical activity. Significant correlation was found between patient’s age and the ability of physical activity with the FIM score at discharge. Patient’s age, length of stay, and the ability of physical activity have significant correlation with The FIM score after one month follow-up

Chronic Cluster Headache in Woman: A Case Report

Background and objective: Cluster headache is the most frequent trigeminal autonomic headache syndromes, with high morbidity due to its pain severity. Chronic cluster headache, comprised of 10-20% patients, can be more difficult to control, mandates for efficient prophylactic therapy for the patient. We present a woman with chronic cluster headache with successful verapamil prophylactic treatment. Case report: A 53 years old woman, admitted in neurology outpatient clinic, complained of 2 years severe left periorbital pain in temporal region with Numeric Pain Rating Scale (NPRS) 10, accompanied by autonomic symptoms (conjunctival injection, tearing, nausea, hyperhidrosis), lasting 45 minutes – 2 hours (if untreated), twice a day especially at night, improved with oxygen therapy during acute attack. Neurological examination and head computed tomography (CT) scan with contrast were normal. Due to her worsening periodicity for the past 2 weeks, prophylactic treatment with verapamil 80 mg twice daily was commenced which give an excellent remission of symptoms and reduced pain intensity within 14 days (NPRS was reduced to 0 with no cluster attack for one month follow up). Conclusions: Verapamil 80 mg twice daily can be used as prophylactic treatment for chronic cluster headache with good result and less side effect. It gives significant reduction on pain intensity followed by no cluster attack

Correlation between Blood and Cerebrospinal Fluid (CSF) Neutrophil-Lymphocyte Ratio with Bacterial Meningitis Prognosis Patient

Abstract Bacterial Meningitis is a bacterial infection of the central nervous system’s protective membranes called the meninges. Bacterial Meningitis has a high disability and case fatality rate. This inflammatory process not only manifests in CSF but also systemically. The neutrophil-lymphocyte ratio(NLR) can be a predicting factor of severity and prognosis in systemic inflammation. Only a few studies in Indonesia evaluate the neutrophil-lymphocyte ratio as a predictor of mortality in adult bacterial meningitis. This study also aimed to compare neutrophil-lymphocyte ratio in LCS and systemic as a predictor of mortality in patients with adult bacterial meningitis. This is an analytic cross-sectional study in Dr. Soetomo's general hospital—a total sample of 44 bacterial meningitis patients from the inpatient ward of Dr. Soetomo General Hospital Surabaya. The blood Neutrophil- Lymphocyte ratio, Glasgow Coma Scale upon admission, and Absolute lymphocyte count were significant with bacterial meningitis outcome with p-value less than 0.05. Early detection of bacterial meningitis patient prognosis could alert the healthcare provider to give careful monitoring and aggressive treatment

Correlation between Blood and Cerebrospinal Fluid (CSF) Neutrophil-Lymphocyte Ratio With Bacterial Meningitis Prognosis Patient

Abstract Bacterial Meningitis is a bacterial infection of the central nervous system’s protective membranes called the meninges. Bacterial Meningitis has a high disability and case fatality rate. This inflammatory process not only manifests in CSF but also systemically. The neutrophil-lymphocyte ratio(NLR) can be a predicting factor of severity and prognosis in systemic inflammation. Only a few studies in Indonesia evaluate the neutrophil-lymphocyte ratio as a predictor of mortality in adult bacterial meningitis. This study also aimed to compare neutrophil-lymphocyte ratio in LCS and systemic as a predictor of mortality in patients with adult bacterial meningitis. This is an analytic cross-sectional study in Dr. Soetomo's general hospital—a total sample of 44 bacterial meningitis patients from the inpatient ward of Dr. Soetomo General Hospital Surabaya. The blood Neutrophil- Lymphocyte ratio, Glasgow Coma Scale upon admission, and Absolute lymphocyte count were significant with bacterial meningitis outcome with p-value less than 0.05. Early detection of bacterial meningitis patient prognosis could alert the healthcare provider to give careful monitoring and aggressive treatment

Correlation between Blood and Cerebrospinal Fluid (CSF) Neutrophil-Lymphocyte Ratio With Bacterial Meningitis Prognosis Patient

Abstract Bacterial Meningitis is a bacterial infection of the central nervous system’s protective membranes called the meninges. Bacterial Meningitis has a high disability and case fatality rate. This inflammatory process not only manifests in CSF but also systemically. The neutrophil-lymphocyte ratio(NLR) can be a predicting factor of severity and prognosis in systemic inflammation. Only a few studies in Indonesia evaluate the neutrophil-lymphocyte ratio as a predictor of mortality in adult bacterial meningitis. This study also aimed to compare neutrophil-lymphocyte ratio in LCS and systemic as a predictor of mortality in patients with adult bacterial meningitis. This is an analytic cross-sectional study in Dr. Soetomo's general hospital—a total sample of 44 bacterial meningitis patients from the inpatient ward of Dr. Soetomo General Hospital Surabaya. The blood Neutrophil- Lymphocyte ratio, Glasgow Coma Scale upon admission, and Absolute lymphocyte count were significant with bacterial meningitis outcome with p-value less than 0.05. Early detection of bacterial meningitis patient prognosis could alert the healthcare provider to give careful monitoring and aggressive treatme

Performance of Antibiotic Used in Stroke Patients at Dr Soetomo Academic Hospital Surabaya

Background: The prevalence of stroke in 2018 in Indonesia is 10.9 per mil. Decreased immunity in stroke complications can occur due to bacterial infections. Antibiotics are a treatment modality for bacterial infections that are regulated and monitored for their use to inhibit bacteria that are resistant to antibiotics. Objective: To find out the pattern of antibiotic use in stroke patients at Dr Soetomo Academic Hospital Surabaya. Methods: This is a retrospective study of medical records to determine patterns of antibiotic used based on DDD and DDD/100 patient-days in stroke patients in Seruni room at Dr Soetomo Academic Hospital Surabaya with sampling method is purposive sampling. The sample population is all stroke patients in the Seruni room at Dr Soetomo Academic Hospital Surabaya Indonesia for the period of July – December 2021. Result: The total sample in this study was 166 stroke patients, which were 33.13% taking antibiotics. Pneumonia had the highest frequency of infectious cases affecting stroke patients, accounting for 44 cases (25.6%). The most route of administration was parenteral (92.7%). The most widely used antibiotic was Ceftriaxone with 27.4% (95.5 DDD or 6.04 DDD/100 patient-days). The total value of antibiotic use was 392.17 DDD or 24.8 DDD/100 patient-days and the highest DDD value was Levofloxacin (138 DDD or 8.73 DDD/100 patient-days). Conclusion: Pneumonia became the most of infectious cases found, accounting for 44 cases (25,6%). As many as 33.13% of 166 stroke patients received antibiotic treatment. The most route of administration was parenteral (92.7%). The most widely used antibiotic was Ceftriaxone (27.4% or 95.5 DDD or 6.04 DDD/100 patient-days). The highest DDD value was Levofloxacin (26% use or 138 DDD or 8.73 DDD/100 patient-days)