Neuromyelitis Optica Spectrum Disorder: A Case Report of Effective Combination Immunosuppressant, Corticosteroids, and Therapeutic Plasma Exchange

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. The symptoms can occur simultaneously or separated by a variable period. NMOSD is associated with serum aquaporin antibodies 4 immunoglobulin G (AQP4-IgG). CASE PRESENTATION: We report a case of a 22-year-old male with complaints of weakness of all four limbs, impaired vision, urinary incontinence, and dyspnea. The Expanded Disability Status Scale (EDSS) was nine. Spinal magnetic resonance imaging (MRI) showed longitudinal extensive transversal myelitis. The brain MRI showed a normal impression, whereas the brain magnetic resonance spectroscopy (MRS) examination showed a description of the mild demyelination process. The serum antibody AQP4 (AQP4-IgG) results were seronegative, the cerebrospinal fluid examination was normal, and the oligoclonal band was negative. The ophthalmoscopic examination found bilateral papillary atrophy but optical coherence tomography (OCT) was still normal. Somatosensory evoked potential and visual evoked potential examinations were abnormal. The patient was diagnosed with NMOSD and was given combination immunosuppressant therapy, corticosteroids, and therapeutic plasma exchange. The patient experienced significant improvement with EDSS decreased to six. CONCLUSION: In the case of relapsing NMOSD patient, combination therapy of immunosuppressants, corticosteroids, and TPE was used. There were significant improvements from EDSS nine to six

Efektivitas Masase Abdomen terhadap Pencegahan Konstipasi pada Pasien Stroke

This study aims to identify the effectiveness of abdominal massage in preventing constipation in stroke patients. The method used is a quasi-experimental two-group pretest-posttest. The sampling technique was conducted by consecutive sampling using the Constipation Assessment Scale (CAS) instrument. The results showed an effect of abdominal massage on the prevention of constipation in stroke patients (p = 0.001) and after the procedure (p = 0.001). In conclusion, abdominal massage is effective in preventing constipation. Keywords: Abdomen, Constipation, Massage, Strok

Penerapan Teknologi Virtual Reality terhadap Perilaku Nyeri Pasien Pasca Bedah ORIF Fraktur Ekstremitas Bawah Saat Penggantian Balutan Luka

This study aims to identify the effect of applying virtual reality technology on pain behavior in postoperative ORIF patients with lower extremity fractures during dressing changes. The type of research used is a quasi-experimental nonequivalent control group pretest-posttest design. The sample in this study amounted to 50 patients after ORIF surgery for lower extremity fractures who underwent a wound dressing replacement procedure with a consecutive sampling technique. The research instrument consisted of a demographic data questionnaire, virtual reality devices and media and the Behavioral Pain Scale-Non Intubated (BPS-NI). The results showed that as many as 22 respondents (88%) who received virtual reality intervention when changing wound dressings did not show any pain, while the other 3 respondents experienced mild pain (12%). The results of the statistical test analysis Wilcoxon-Signed Ranked and Mann Whitney obtained a p-value <0.05. In conclusion, there is an effect of applying virtual reality technology in reducing pain as indicated by changes in pain behavior of patients after ORIF surgery for lower extremity fractures when changing wound dressings. Keywords: Change of Wound Bandage, Pain Behavior, Virtual Realit

Barriers to diagnosis and management of CNS infections in Indonesia

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