CARDIAC CEPHALALGIA

Cardiac cephalalgia merupakan nyeri kepala seperti migraine, umumnya namun tidak selalu diperberat dengan aktivitas fisik, timbul selama peristiwa myocardial ischaemia, membaik dengan pemberian nitroglycerine. Cardiac cephalalgia merupakan kasus nyeri kepala yang jarang namun dapat mempengaruhi aspek biopsikososial dan kualitas hidup penderita.  Berdasarkan The Internasional Classification of Headache Disorder (ICHD), cardiac cephalalgia digolongkan ke dalam nyeri kepala sekunder yang terkait dengan kelainan homeostasis. Artikel ini membahas pengetahuan terbaru mengenai cardiac cephalalgia terkait definisi, epidemiologi, patofisiologi, gambaran klinis, penegakan diagnosis, diagnosis banding, serta pilihan terapinya dengan melakukan pencarian, review dan telaah serta menyimpulkan berbagai literatur terbaru terkait hal tersebut. Cardiac cephalalgia sering ditemukan pada usia dekade lima. Penegakkan diagnosis berdasarkan nyeri kepala yang berkaiatan dengan adanya myocardial ischaemia, dan berespon baik dengan pemberian nitroglycerine. Penatalaksanaan cardiac cephalalgia menitikberatkan pada penanganan myocardial ischaemia. Nitroglycerine merupakan pilihan utama untuk nyeri kepala Kata Kunci : Cardiac Cephalalgia, Nyeri Kepala Sekunder, Myocardial Ischaemi

Musical Therapy with Balinese Flute Increased Cognitive Function, Brain-derived Neurotrophic Factor Serum Levels, and Decreased Interleukin-6 Serum Levels among the Elderly in West Denpasar Primary Health Clinic

BACKGROUND: Studies have shown the effects of music toward improved cognitive function due to changes in molecular production and signaling through increased messenger secretion, including hormones, neurotransmitters, and growth factor proteins. Most of the studies used Western classical music as an intervention. AIM: We would like to investigate whether traditional Balinese flute musical composition entitled can improve cognitive function as well as brain-derived neurotrophic factor (BDNF) and interleukin (IL)-6 levels, on par with the Western classical composition. METHODS: This was a prospective intervention trial involving 40 participants recruited from Primary Health Clinic 2 in West Denpasar, Bali, and divided into two groups. Participants were asked to listen to either “Morning Happiness” by Mr. Agus Teja Sentosa, S. Sn (treatment), or Vivaldi’s composition of “Spring” (control group) for 20 min each day for 21 days. Cognitive evaluation was performed using Montreal Cognitive Assessment (MoCA)-INA and blood sample was withdrawn during the 1st day for BDNF and IL-6 levels measurement. All statistical analyses were conducted using IBM SPSS Statistics 20. RESULTS: There was a significant difference between initial and endpoint MoCA-INA test results among treatment and control group (p < 0.001), but there was no significant difference between control and treatment (p = 1.00). BDNF levels differed significantly between initial and endpoint BDNF levels among control group (p < 0.001), but did not differ significantly between control and treatment groups (p = 0.534). There was no significant difference between initial and endpoint IL-6 levels between the control group, but there was a close to statistical difference between of initial and endpoint IL-6 levels among the treatment group (p = 0.052). There was a significant difference in the memory domain between the control and treatment groups (p = 0.01) as measured using MoCA-INA questionnaire. CONCLUSION: Balinese traditional flute composition was proven to be non-inferior when compared with Western classical composition as it improved mainly memory domain accompanied by increasing BDNF and decreased IL-6 levels

Differences in Spatial Memory Impairment in Mice after Oral D-Galactose Administration and Intraperitoneal Injection

BACKGROUND: The aging process can increase the incidence of dementia, such as spatial memory impairment to remember space, recognize shapes and distances. Research on dementia in mice was carried out by administering d-galactose through intraperitoneal injection, while oral d-galactose administration had not received enough attention. AIM: This study aims to prove the differences in the occurrence of spatial memory impairment in rats induced by d-galactose through two different routes, oral and intraperitoneal injection. METHODS: This study is an experimental study using a post- test control group design. The sample criteria were 20 male Wistar rats aged 12–14 weeks, weighing 200–300 g divided into two groups which are the oral and intraperitoneal injection. Spatial memory assessment based on spontaneous alternation using the Y-maze test was carried out at the end of week 8. RESULTS: In this study, the average spatial memory score after d-galactose administration in the injection group (51.572±4.388) was lower compared to the oral group (66.058±1.551). The Shapiro–Wilk normality test shows that the data are normally distributed with p > 0.05. Independent t-test showed a significant difference in the incidence of spatial memory disorders between the injection and oral groups with p = 0.010 (p < 0.05). CONCLUSION: The conclusion of this study is that d-galactose administration by oral route or intraperitoneal injection causes a decrease in spatial memory in mice. Spatial memory in the injection group was lower than in the oral group. This might be related to the decrease in synaptophysin in the hippocampus of mice due to d-galactose administration by intraperitoneal injection

Dry needling reduces pain in Sanglah General Hospital Denpasar workers with myofascial pain syndrome in the upper trapezius muscle

Background: Myalgia is a common complaint in the general population, but it is underappreciated and often undertreated. Myofascial pain syndrome is a form of myalgia that is characterized by local regions of muscle hardness. The main component of this syndrome is the trigger point that is composed of taut bands. Various invasive and non-invasive procedures are available to inactivate myofascial trigger points. Dry needling involves inserting a filiform needle directly into a trigger point without injection of material. Dry needling is a treatment modality that is minimally invasive, cheap, easy to learn, and carries a low risk for reducing pain. --- Objective: The aim of this study was to test the hypothesis that dry needling could reduce pain in subjects with myofascial pain syndrome in the upper trapezius muscle on Sanglah hospital’s workers. --- Method: Twenty-six subjects with myofascial pain syndrome in upper trapezius muscle were randomly divided into two groups: 13 subjects in the control group received acetaminophen, and 13 subjects in the dry needling group received dry needling and acetaminophen. The numeric rating scale was assessed before, 1 hour, 24 hours, and 7 days after the treatment. Side effects of dry needling were evaluated every day for 7 days follow up. The total amount of acetaminophen was assessed at last day follow up. --- Results: At baseline, the numeric rating scale was same in control versus dry needling group. Reduction in all numeric rating scale at 1 hour, 24 hours, and 7 days after dry needling was significant (p<0,05). --- Conclusion: dry needling could reduce pain and analgetic oral consumption in subjects with myofascial pain syndrome in the upper trapezius muscle. There were no side effects of dry needling reported on this study.peer-reviewe

Instrumental Balinese Flute Music Therapy Improves Cognitive Function and Serum Dopamine Level in the Elderly Population of West Denpasar Primary Health Care Center

BACKGROUND: Musical artwork using Balinese flutes made from bamboo (timing buluh) by Agus Teja Sentosa, S.Sn is a combination of music played with flute as the main instrument which contains certain components resembling music therapy such as in western classical music by Antonio Lucio Vivaldi. AIM: This study aims to determine the improvement of cognitive function and increase in serum dopamine in the elderly after listening to music with Balinese flute as the main instrument. METHOD: The current study allocated 18 subjects in the control group listened to western classical music by Antonio Lucio Vivaldi, while 18 subjects in the intervention group listened to western classical music and music from Balinese flute as the main instrument by Agus Teja Sentosa, S.Sn. MoCA-Ina assessment and examination of serum dopamine levels were carried out initially and 21 days after listening to music intervention. RESULTS: The mean increase in cognitive function score was higher in the intervention group (5.22; p &lt; 0.001) than in the control group (4.67; p &lt; 0.001), this increase was not statistically significant with a value of p = 0.562 (p &gt; 0.005). The mean increase in dopamine levels in the control group (3.60) was greater than in the treatment group (3.56), but the mean increase was not statistically significant (p = 0.085). CONCLUSION: There was a significant relationship between listening to the main instrumental Balinese flute music and the improvement of cognitive function, especially in the memory domain in all study subjects, but the mean increase in cognitive function and serum dopamine level did not reach statistical significance

Neuroprotective Effects of Purple Sweet Potato Balinese Cultivar in Wistar Rats With Ischemic Stroke

BACKGROUND: Purple sweet potato (Ipomoea Batatas L.) is one of the sources for anthocyanin, which promotes the health through antioxidant, anti-inflammatory, anti-cancer, neuroprotection, and anti-apoptosis activities. Oxidative stress has been shown to be the cause of apoptosis in ischemic stroke. AIM: The objective of this research was to delineate the pleiotropic effects of anthocyanin for neuroprotection during an acute stroke event. METHODS: Anthocyanin was extracted from Balinese cultivar of purple sweet potato and subsequently administered to rat models of induced ischemic stroke (labelled as treatment group), as well as a placebo (labelled as a control group). Several parameters were in turn evaluated, i.e. the activities of anti-apoptotic (Bcl-2) as well as pro-apoptotic (cytochrome c, caspase-3) molecules, and apoptosis rate. Bcl-2 levels were determined using the histochemical method, cytochrome c and caspase-3 via ELISA method, while apoptosis rate was measured by TdT-medicated Dutp-Nick End Labeling (TUNEL) assay. RESULTS: Bcl-2 expression demonstrated significantly higher Bcl-2 expression in the treatment compared with control group (median 31.2 vs. 1.1; p = 0.001). Accordingly, pro-apoptotic cytochrome c and caspase-3 levels were also found significantly lower in the treatment as opposed to control group (mean 4.17 vs. 8.06; p = 0.001; mean 3.81 vs. 8.02; p = 0.001). Ultimately, apoptosis rate was found markedly lower among treatment than control groups (mean 3.81 vs. control 21.97; p = 0.003). CONCLUSION: The results of this study indicated a significant neuroprotective effect of anthocyanin derived from Balinese cultivar of PSP. Anthocyanin was able to increase and reduce anti-apoptotic and pro-apoptotic protein levels, respectively, resulting in lesser cellular apoptotic rate when compared with placebo. The potential mechanism was thought mainly due to its anti-oxidant properties

HIGH-INTENSITY LASER THERAPY TO TREAT NEUROPATHIC PAIN IN POST-HERPETIC NEURALGIA

Post-herpetic neuralgia (PHN) is chronic neuropathic pain that is felt for at least 3 months or more at the site of the rash due to herpes zoster infection. Epidemiological studies get a prevalence of 0.49 cases of PHN per 1000 people per year. The clinical manifestation of PHN is chronic pain on the skin lesions due to herpes zoster infection. The therapy that is commonly used as the first line is the provision of pharmacotherapy such as gabapentin or pregabalin. An 83-year-old male patient with a diagnosis of PHN that had been felt for 5 years. He has been taking drugs for 5 years but the pain has not improved. The patient is given high-intensity laser therapy. After 5 treatments with an interval of 1-2 weeks, pain was significantly reduced from an 8/10 scale to 4/10. The frequency of occurrence of severe pain is also reduced from 5 times per day to only 1 time per day. The use of high-intensity laser therapy is not commonly used as a therapy for PHN. Based on its mechanism of action, the use of high-intensity laser therapy is worth considering because of its effectiveness in treating pain in a shorter time than low-intensity laser therapy

Increased Serum Neutrophil Lymphocyte Ratio Raises the Risk for Peripheral Diabetic Neuropathy in Type 2 Diabetes Mellitus Patients

Objective: Peripheral diabetic neuropathy (PDN) is among the most prevalent diabetes mellitus (DM) sequelae. PDN is a severe health issue that represents a huge social and economic burden worldwide, is associated with long-term morbidity, and diminishes the quality of life of those affected. The neutrophil-lymphocyte ratio (NLR) is a mixture of the two primary components of chronic inflammatory diseases (high neutrophils and low lymphocytes) that contribute to the production of PDN. This study aimed to demonstrate high serum NRL levels enhance the risk of PDN in type 2 DM patients. Materials and Methods: This study employed a case-control design, collecting data from the registers and outpatient medical records of Prof. Dr. IGNG Ngoerah General Hospital type 2 DM patients who satisfied the inclusion and exclusion criteria between January 2018 and December 2019. Based on clinical neuropathy and abnormal electrodiagnostic testing, the PDN diagnosis was established. Serum NLR was collected from laboratory tests recorded by a computer. Results: The Receiver Operating Characteristic (ROC) curve approach determined the NLR cut-off value of 2.18. High NLR substantially increased the incidence of PDN (OR 10.36; 95% CI 3.69-29.07; p<0.001). Other characteristics evaluated, including duration of diabetes, usage of anti-diabetic medications, uncontrolled diabetes, obesity, hypertension, and dyslipidemia, were not significantly associated with the incidence of PDN. High serum NLR was an independent risk factor for PDN in type 2 DM patients (adjusted OR=10.36; 95% CI: 3.57-29.07; p<0.001). Conclusion: Based on the findings of this investigation, it was determined that elevated serum NLR increases the risk of PDN events in patients with type 2 DM

Penurunan Fraksi Ejeksi Ventrikel Kiri dalam Enam Bulan Meningkatkan Faktor Resiko Gangguan Kognitif Penderita Gagal Jantung Sistolik

AbstrakGangguan kognitif sering dijumpai pada penderita gagal jantung sistolik dan tidak terdeteksi sejak awal. Hal ini memperburuk kondisi dan luaran klinis penderita. Penelitian ini bertujuan untuk mengetahui adanya peningkatan risiko terjadinya gangguan kognitif pada penderita gagal jantung sistolik dengan penurunan fraksi ejeksi ventrikel kiri dalam enam bulan. Metode penelitian ini adalah kontrol kasus, di Poli Jantung dan Poli Saraf RSUP Sanglah, Denpasar, periode Oktober 2018 hingga Desember 2018. Analisis data dilakukan dengan SPSS versi 22. Penelitian ini menggunakan 76 subjek, dengan rerata usia 50,3 ± 4,5 tahun. Karakteristik yang lebih dominan dijumpai pada jenis kelamin laki-laki 44 orang (57,9%), pendidikan ≥ 12 tahun 40 orang (52,6%), dan pekerjaan formal 40 orang (52,6%) Dari hasil analisis statistik didapatkan persentase penurunan fungsi kognitif pada kelompok kasus sebesar 89,5% sedangkan pada kelompok kontrol didapatkan 13,2%. Analisis bivariat dengan Chi-square, didapatkan nilai OR=56,1; IK 95% 13,844-227,338; p<0,001. Pada analisis multivariat didapatkan penurunan FEVK dalam enam bulan merupakan faktor risiko yang kuat, memiliki risiko mengalami gangguan kognitif pada penderita gagal jantung sistolik dengan adjusted OR=23,1, setelah mengendalikan jenis kelamin, pendidikan dan pekerjaan, OR=23,1; IK 95% 4,7-114,03; p<0,001. Penelitian ini menyimpulkan bahwa penurunan FEVK dalam enam bulan sebagai faktor risiko gangguan kognitif penderita gagal jantung sistolik. Penulis menyarankan para klinisi perlu melakukan pemeriksaan fungsi kognitif pada penderita gagal jantung sistolik .Kata kunci: gangguan kognitif, penurunan FEVK, gagal jantung sistoli

Headache in healthcare workers related to personal protective equipment use in COVID-19 referral hospital

Background Studies show that wearing personal protective equipment (PPE) for long periods of time can lead to discomfort such as headaches, which could affect the performance of healthcare workers. The aim of this study was to determine the prevalence and risk factors of headaches related to PPE in healthcare workers at a COVID-19 referral hospital. Methods A cross-sectional study was conducted involving 174 healthcare workers in a COVID-19 referral hospital in Bali. We conducted interviews using a questionnaire that consisted of three main parts: characteristics of the subjects, PPE usage, and PPE-associated headaches. A multiple logistic regression was used to analyze the data. Results The analysis results showed that the PPE-associated headaches had a prevalence of 63.8% and were gradual in onset, pressure-like in quality (46%), and mild in intensity (80.1%). PPE level III-associated headache was the most common type. The majority of the participants had headaches up to 6 hours after using the protective gear, but improving within 15-30 minutes of removal and/or after pharmacotherapy. A Chi-squared analysis showed a statistically significant association between duration of PPE use, working units, and PPE levels (p<0.05). A logistic regression analysis found a significant relationship between PPE level and headache occurrence (OR=4.826;95%CI: 2.433-9.572; p<0.001). Conclusion The frequency of PPE-associated headache was high and the PPE level was a risk factor of headache among healthcare workers. Better strategies are needed to reduce the duration of PPE exposure so that the work performance and quality of life of healthcare workers are not significantly affected