The Effect of Phenytoin Loading Dose to Hepatic Enzyme in Epilepsy Patients

Epilepsy was defined as neurologic abnormality that was characterized with tendency to cause consistent epileptic seizure and neurobiologist, cognitive, psychologist, and social consequences. According to WHO, it was proximately about 50 million people with epilepsy worldwide. Single use of antiepileptic drug (AED) became first choice in starting epilepsy treatment, because most of patients was successfully controlled by first or second single therapy of AED. Phenytoin mostly was used for focal and generalized seizure type and as second line for mixed seizure type (myoclonic and tonic-clonic). Beside its good effectiveness in controlling seizure, phenytoin also caused significant adverse effects. Such as, phenytoin could cause hepatotoxicity with a couple of days until eight weeks onset, which is characterized by elevation of aspartate aminotransferase (AST).with level range of 2-100 times from normal baseline and also elevation of alanine aminotransferase (ALT). Keywords: Epilepsy, Antiepileptic, Phenytoin, Adverse effects

EpCare: Prototipe Sistem Detektor Pre-Iktal Pasien Epilepsi Berbasis Fitur CSI dari Sinyal EKG 1 Kanal Menggunakan AD8232

Kejang epilepsi dapat terjadi di sembarang waktu dan tempat, dan dalam kondisi tertentu dapat menyebabkan cedera fatal. Oleh karena itu, kebutuhan akan perangkat wearable yang dapat mengirimkan peringatan kepada pengguna akan kejang yang akan datang adalah penting. Perangkat ini harus dapat merasakan kelainan pada sinyal biomedis pengguna dan mengirimkan peringatan sebelum kejang. Penelitian ini mengembangkan sistem yang mendeteksi kondisi pre-iktal pasien epilepsi berdasarkan fitur Cardiac Sympathetic Index (CSI) dari sinyal Elektrokardiogram (EKG). Listrik jantung pasien diukur menggunakan 3 elektroda yang dihubungkan ke AD8232 untuk mewakili sinyal 1 kanal. Algoritma Pan-Tompkins diimplementasikan untuk mendapatkan interval RR dari sinyal EKG. Kemudian fitur CSI dihitung berdasarkan nilai RR-interval. Distribusi setiap 100 interval RR dijadikan sebagai dasar untuk menentukan nilai ambang batas CSI. Ketika nilai CSI melebihi ambang batas ini, sistem akan mengirimkan peringatan ke aplikasi seluler, yang disebut EpCare. Eksperimen dilakukan pada dua kelompok data, yaitu kelompok data primer dari non-penderita epilepsi dan kelompok data sekunder dari penderita epilepsi. F-measure dari eksperimen yang menggunakan ambang batas dari orang normal sebesar 0.64, sedangkan F-measures dari eksperimen yang menggunakan ambang batas individual penderita epilepsy sebesar 0.50. AbstractEpileptic seizures may occur at anytime and anywhere, and in certain conditions may lead to fatal injury. Therefore, the need for wearable device that can alert user to an impending seizure is important. This device should be able to sense abnormality in user’s biomedical signals and send alert prior to seizure. This research develops a system that detects pre-ictal condition of epilepsy patient based on Cardiac Sympathetic Index (CSI) feature from Electrocardiogram (ECG) signals. Patient’s heart electricity is measured using 3 electrodes which are connected to AD8232 to represent 1 channel signal. Pan-Tompkins algorithm is implemented to obtain RR intervals of ECG signals. Then, CSI feature is calculated based on the values of RR-intervals. A distribution of every 100 RR-intervals is made as basis to determine a threshold value of CSI. When CSI value exceeds this threshold, system will send alert to a mobile application, called EpCare. Experiments were conducted on two groups of data, which are primary one from non-epileptic persons, and secondary one from epileptic patients. F-measures of experiments used threshold of non-epileptic person is 0.64, while F-measures of experiments used individual threshold of epileptic person is 0.50.

Investigation of the role of sleep quality and sleep duration on fasting blood glucose level in acute ischemic stroke patients: A preliminary study

The aim of this study was to evaluate the association between the sleep quality and sleep duration with the level of fasting blood glucose in patients with acute ischemic stroke. A cross-sectional study was conducted among acute ischemic stroke patients admitted to Dr. Soetomo Hospital and Universitas Airlangga Hospital from May to October 2021. Patients who met the inclusion were enrolled. To assess the sleep quality, Pittsburgh Sleeps Quality Index (PSQI) was applied. To determine sleep duration during the nocturnal period, Fitbit Charge 2 HR device was used. Evaluation of plausible confounders was assessed through physical examination, interviews, and a set of validated questionnaires. A total of 30 acute ischemic stroke patients were included in this study. The mean age of the participants was 56.40±9.77 years and 60% were males. There were 63.3% patients classified as mild stroke and 36.7% moderate-severe stroke. The average PQSI score was 5.57±2.59, while the average sleep duration was 319.8±108.7 minutes. The average fasting blood glucose level was 89.03±14.71 mg/dL. Significant positive correlation was obtained between sleep duration and fasting blood glucose level (r=0.533; p=0.002). Similarly, there was no statistically significant correlation between sleep quality with the level of fasting blood glucose (r=-0.167; p=0.377). To the best of our knowledge, this is the first study assessing the correlation between sleep quality and sleep duration with the level of fasting blood glucose levels in patients with acute ischemic stroke. This study therefore might be of great interest to provide insights on the importance of sleep management in acute ischemic stroke patients

Investigation of the role of sleep quality and sleep duration on fasting blood glucose level in acute ischemic stroke patients: A preliminary study

The aim of this study was to evaluate the association between the sleep quality and sleep duration with the level of fasting blood glucose in patients with acute ischemic stroke. A cross-sectional study was conducted among acute ischemic stroke patients admitted to Dr. Soetomo Hospital and Universitas Airlangga Hospital from May to October 2021. Patients who met the inclusion were enrolled. To assess the sleep quality, Pittsburgh Sleeps Quality Index (PSQI) was applied. To determine sleep duration during the nocturnal period, Fitbit Charge 2 HR device was used. Evaluation of plausible confounders was assessed through physical examination, interviews, and a set of validated questionnaires. A total of 30 acute ischemic stroke patients were included in this study. The mean age of the participants was 56.40±9.77 years and 60% were males. There were 63.3% patients classified as mild stroke and 36.7% moderate-severe stroke. The average PQSI score was 5.57±2.59, while the average sleep duration was 319.8±108.7 minutes. The average fasting blood glucose level was 89.03±14.71 mg/dL. Significant positive correlation was obtained between sleep duration and fasting blood glucose level (r=0.533; p=0.002). Similarly, there was no statistically significant correlation between sleep quality with the level of fasting blood glucose (r=-0.167; p=0.377). To the best of our knowledge, this is the first study assessing the correlation between sleep quality and sleep duration with the level of fasting blood glucose levels in patients with acute ischemic stroke. This study therefore might be of great interest to provide insights on the importance of sleep management in acute ischemic stroke patients

Hubungan Kepatuhan Penggunaan Obat Anti Epilepsi terhadap Kejadian Kejang Pasien Epilepsi Menggunakan Kuesioner ARMS (Adherence Refill Medication Scale)

Epilepsi termasuk penyakit kronis otak yang dikarakterisasi dengan kejang berulang (2 kali atau lebih), dimana terjadi gerakan involunter yang melibatkan sebagian tubuh (partial) atau seluruh tubuh (generale), dan seringkali disertai dengan hilangnya kesadaran dan kontrol fungsi saluran cerna atau saluran kemih. Pengobatan epeilepsi sering menggunakan OAE (Obat AntiEpilpsi). Diketahui 70% anak-anak dan dewasa dengan epilepsi berhasil diterapi dengan obat antiepilepsi. Salah satu ukuran manajemen terapi obat pada penyakit epilepsi adalah menurun atau hilangnya kejang, sehingga adanya kejadian kejang menjadi salah satu ukuran pencapaian end outcome. Kejadian kejang dipengaruhi oleh beberapa faktor diantaranya ada tidaknya faktor pemicu kejang dan kepatuhan konsumsi obat antiepilepsi. Penelitian ini merupakan penelitian observasional cross sectional yang dilakukan di poli neurologi Instalasi Rawat Jalan RSUD dr. Soetomo dan Instalasi rawat Jalan RS Universitas Airlangga. Selama penelitian diperoleh 52 pasien epilepsi yang menggunakan obat antiepilepsi. Padapenelitian ini diamati hubungan kepatuhan terhadap adanya kejang pasien epilepsi dalam penggunaan obat anti epilepsi. Pada penelitian ini diketahui nilai koefisien korelasi/ nilai rho (r) sebesar -0,348 dengan nilai p= 0,011 (p<0,05) atau signifikan secara statistik. Hasil tersebut menunjukkan adanya hubungan antara kategori kepatuhan (menggunakan kuesioner ARMS) dengan kejadian kejang, dimana semakin tinggi skor ARMS (dianggap semakin tidak patuh) berbanding lurus dengan peningkatan kejang