Changes in Life Quality of Chronic Kidney Disease Patients with Hemodialysis Who Are Given Vitamin B1, B6, and B12 Parenterally

Background: Chronic kidney disease (CKD) is a disease that causes a progressive decrease in kidney function, which can end in kidney failure disease and will have an impact on decreasing quality of life. Previous research has shown that by giving vitamins B1, B6, and B12 can improve quality of life. Aim: To measure changes in quality of life in patients with chronic kidney disease who were given vitamins B1, B6, and B12 parenterally. Material and Methods: This study used quasi experimental (one group pre and post test) in 117 patients who were selected in Bethesda Hospital and Panti Rapih Hospital Yogyakarta hemodialysis unit. Patients were given vitamins B Combination injections twice a week in each hemodialysis for 4 weeks. Quality of life was measured by SF-8 questionnaire on the first day of hemodialysis before given vitamins (pre-test) and on the 30th day, after eight injection of vitamins B1, B6, and B12 (post test). Results: The mean age of observed patients were 51.58 ± 12.51 years. From 117 patients, 73 patients (62,4%) were male and 44 patients (37.6%) were female. The improvement in overall quality of life in patients was not significant (p= 0.055). Quality of life improvement was only significant in the male group (p = 0.016). Conclusion: There was no significant difference after 4-weeks-injections of vitamins B Combination to the overall quality of life in chronic kidney disease patients undergoing hemodialysis. But there was found a significant improvement in quality of life in the male patients with chronic kidney disease who had hemodialysis. Keywords : chronic kidney disease, quality of life, vitamins B1, B6, and B12, SF-8 questionnaire

HUBUNGAN HIPERTENSI DENGAN GANGGUAN FUNGSI KOGNITIF PADA PASIEN POST-STROKE ISKEMIK DI RS BETHESDA

Stroke can affect a functional impairment of brain, called cognitive impairment. Incident of cognitive impairment increase three times after stroke, and sometimes involved impairment of visuospatial, memories, language, attention, and executive function.Study was reformed with Cross-Sectional method. The data divided into two types, primary data used Montreal Cognitive Assessment Indonesian version (MoCA-Ina) with Clock Drawing Test (CDT), and secondary data used Stroke Registry (2010-2017 period) with medical record of Bethesda Hospital Yogyakarta. The collected data were analyzing with descriptive analysis (univariate), followed by chi square test (bivariate), and logistic regression for multivariate analysis. The sample that be collected were 110 samples, consist of 72 men (65%) and 38 women (34.5%). Most ages that participate this research are 51-60 years with 36 patients (32.7%). There were 75 patients (68.2%) with cognitive impairment (MoCA 26) and 35 patients (31.8%) without cognitive impairment (MoCA is more than or equal 26). In bivariate analysis, it was found that hypertension (OR: 1.02; CI: 0.70-1.49; p: 0.823) did not affect the occurrence of cognitive impairment in ischemic post-stroke patients. In the multivariate analysis, onset, recurrent stroke, number of lesions, parietal lesions, and temporal lesions are associated with cognitive impairment on post-stroke ischemic patient.There is no correlation between hypertension and cognitive impairment on post-stroke ischemic patien

Dampak Pemberian Vitamin B1, B6, B12 Parenteral terhadap Proporsi Hiperhomosisteinemia pada Pasien Hemodialisis

Banyak pasien gagal ginjal kronis menderita hiperhomosisteinemia yang dapat meningkatkan risiko terjadinya penyakit vaskuler. Dari penelitian sebelumnya ditemukan bahwa pemberian vitamin B dapat mengurangi hiperhomosisteinemia pada pasien yang menjalani hemodialisis. Penelitian ini dilakukan untuk mengukur dampak pemberian vitamin B1, B6, B12 parenteral terhadap proporsi hiperhomosisteinemia pasien gagal ginjal kronik yang menjalani hemodialisis. Penelitian dilakukan dengan desain one group pretest-posttest menggunakan data sekunder rekam medis hasil laboratorium. Data didapatkan dari 117 pasien dengan metode consecutive sampling dan analisis data dilakukan menggunakan SPSS berlisensi dengan uji McNemar. Hasilnya terdapat penurunan proporsi hiperhomosisteinemia yang bermakna setelah pemberian vitamin B selama 2 minggu (70,94%; p=0,000) dan 4 minggu (66,38%; p=0,000), sehingga kesimpulannya, pemberian vitamin B1, B6, dan B12 dalam jangka waktu 2 minggu maupun 4 minggu dapat menurunkan proporsi hiperhomosisteinemia secara bermakna pada pasien gagal ginjal kronis yang menjalani hemodialisis

Herpetic Neuralgia After Inactivated Covid-19 Vaccination : A Case Report

ABSTRACT The COVID-19 pandemic has made prevention procedures against the rapidly spreading infection a top priority. Inactivated COVID-19 vaccines have been developed and authorized for use in some countries including Indonesia, where the Sinovac vaccine has been distributed to health care workers and the elderly. There have been no reports of herpes zoster reactivation after the Sinovac vaccine in Indonesia yet. Advanced age may be a risk factor in reduction of cell-mediated immunity that related to VZV reactivation.However, this article reports an unusual case of varicella zoster virus (VZV) reactivation in a patient who received the COVID-19 vaccine. This is the first case of VZV reactivation following Sinovac COVID‐19 vaccination. It is very difficult  to establish a straightforward relationship between herpes zoster and inactivated COVID‐19 vaccine, immune dysregulation created by the vaccine may play a role in the reactivation of latent VZV infection in the current case. There is a need for further review and studies in the future

The Burden of Atrial Fibrillation as Stroke Risk Factor in Southeast Asia: A Systematic Review

Introduction Stroke is the most burden complication in a patient with atrial fibrillation. Atrial Fibrillation (AF) is the common cardiac arrythmia in stroke patients. The epidemiology study of AF-associated stroke were limited published research in southeast. This study may prove valuable in routine clinical practice. This systematic review aimed to identify the latest evidence on the epidemiology of AF related stroke in southeast Asia regions. Methods: We performed a comprehensive search on prevalence or incidence of atrial fibrillation related stroke from inception up until September 2019 through PubMed and Cochrane Central Database. The keywords were the combination of the following words:  “stroke”, “epidemiology”, “atrial fibrillation”, and was then used with the name of each country in southeast Asia”. The inclusion criteria of the study i.e : patients with stroke, was a original papers with observational study, concerned on AF in stroke patients in southeast Asia. Data on incidence and prevalence were obtained from hospital-based studies and community-based studies. Results: Atrial Fibrillation prevalence data are available in five countries in southeast Asia, a total of the 11 articles identified were from Malaysia, Thailand, Vietnam, Singapore, and Indonesia were also represented. The reported prevalence of AF as a risk factor of stroke patients was 2.6 % until 23.04% based on hospital-based studies. Conclusion: AF is one of risk factors that associated with the stroke. This study also showed that prevalence AF in South East Asia ranged  2.6 – 23.04 % . However, owing to the limited number of studies in southeast Asian countries, further investigation is needed before drawing a definite true of prevalence of AF in the southeast Asia population. Keywords: Atrial Fibrillation, AF-associated Stroke, Epidemiology, Risk Factors

Tuberculosis Related Ischemic Stroke : A Case Report

Tuberculosis (TB) is a widespread infectious disease caused by Mycobacterium Tubercle Bacilli. In 15-20 % cases of active pulmonary TB, infection spreads to extrapulmonary foci, including the nervous system complications. Ischemic stroke related tuberculosis without meningitis is rare. We report a 74-year-old female presented with rapid onset confusion, unconsciousness, and left hemiparesis. She had been recently diagnosed with active TB 3 months ago and treated with combination anti tuberculosis regiment. Her recent acute neurological manifestations began within 24 hours prior to admission in the hospital. The brain CT showed  middle cerebral artery territory infarction. The risk factors tracing found no significant abnormality. The only abnormal finding was high CRP. This report describes rare case of a patient with active TB and who presented with acute ischemic stroke.Tuberculosis (TB) is a widespread infectious disease caused by Mycobacterium Tubercle Bacilli. In 15-20 % cases of active pulmonary TB, infection spreads to extrapulmonary foci, including the nervous system complications. Ischemic stroke related tuberculosis without meningitis is rare. We report a 74-year-old female presented with rapid onset confusion, unconsciousness, and left hemiparesis. She had been recently diagnosed with active TB 3 months ago and treated with combination anti tuberculosis regiment. Her recent acute neurological manifestations began within 24 hours prior to admission in the hospital. The brain CT showed  middle cerebral artery territory infarction. The risk factors tracing found no significant abnormality. The only abnormal finding was high CRP. This report describes rare case of a patient with active TB and who presented with acute ischemic stroke

PENGGUNAAN EPERISONE HYDROCLORIDE UNTUK MENGURANGI NYERI PASIEN NYERI PUNGGUNG BAWAH AKUT DI RUMAH SAKIT BETHESDA YOGYAKARTA

Nyeri punggung bawah (NPB) akut merupakan keluhan umum yang dirasakan pada punggung bawah, dapat menjalar sampai dengan kaki, terjadi kurang dari 12 minggu atau nyeri timbul kembali setelah 6 bulan bebas nyeri. Obat yang digunakan untuk mengatasi NPB salah satunya eperisone hydrochloride. Tujuan dari penelitian ini mengukur efek eperisone hydrocloride dalam menurunkan rasa nyeri pada pasien NPB akut dilihat dari nilai Visual Analog Scale (VAS). Metode  yang digunakan dalam penelitian ini adalah observasional analitik dengan rancangan penelitian kohort. Subjek penelitian, pasien NPB akut yang dikelompokkan berdasarkan terapi yang digunakan, kelompok eperisone hydrocloride 50 mg dua kali sehari dan non-eperisone hydrocloride. Data diperoleh melalui kuisioner nilai VAS dan wawancara. Hasil penelitian ini didapatkan 45 pasien NPB akut yang terdiri dari 16 laki-laki (35,60%), 29 perempuan (64,40%). Sebanyak 15 pasien masuk kelompok eperisone hydrocloride dan 30 pasien masuk kelompok non-eperisone hydrocloride, dengan rata–rata umur pasien 53,53±14,94 dan 59,53 ±14,0 tahun. Hasil analisis statistik menunjukkan terdapat perbedaan bermakna dari penurunan nilai VAS sebelum dan sesudah menerima terapi pada kelompok eperisone hydrocloride (p=0,004), outcome berupa penurunan rasa nyeri saat beraktivitas (p=0,456) dan juga efek samping yang muncul saat pemberian terapi (p=1,000). Kesimpulan dari penelitian ini adalah eperisone hydrocloride  dapat menurunkan nilai nyeri dan mencapai outcome

Characteristic of Red Blood Cell Profile as a Predictor of 30-Day Clinical Outcome in Ischemic Stroke Patients

Ischemic stroke is the most common type of stroke in Indonesia. Measuring inflammatory biomarkers (IL-6) is a way to predict clinical outcomes in ischemic stroke patients. However, the laboratory test is very expensive, so it requires another test that can represent the inflammation, for instance, by measuring RDW and MCV value when hospitalized. Hence, this study aims to measure RDW and MCV value of ischemic stroke patients at admission with a 30-day clinical outcome (disability). This study is a retrospective cohort that used secondary data from medical records of ischemic stroke patients in Bethesda Hospital Yogyakarta and was conducted on 105 subjects. They are divided into two groups by their mRS score in 30-day after onset, (1) the independent group (mRS score of 0- 2), (2) the dependent group (mRS score of 3-6). After that, these two groups are analyzed by an independent t-test. High RDW and low MCV value at admission increased 30-day disability risk. There was a statistically significant RDW value and 30-day clinical outcome (p=0,008), but there was no statistically significant MCV value and 30-day clinical outcome (p=0,277). 30-day clinical outcome in ischemic stroke patients can be predicted by their characteristic of red blood cell profile at admission

THE PREVALENCE AND DETERMINANT FACTORS OF LOW VITAMIN D LEVELS IN PATIENTS WITH PAINFUL DIABETIC NEUROPATHY

Objective: Type 2 diabetes mellitus is a major public health problem. Diabetic neuropathy is one of the major diabetes microvascular complications. The previous study suggests that Vitamin D deficiency plays an important role in the development and progression of diabetes and the data in Indonesia are very limited. This study aims to measure the prevalence of Vitamin D deficiency and its determinant factors in patients with painful diabetic neuropathy (PDN). Methods: This study is a cross-sectional study. The data were obtained from 53 subjects with diabetic peripheral neuropathy. A pre-designed questionnaire was used to collect data on the patient’s age, gender, duration of diabetes, comorbidities, any diabetic complications, and current treatment for diabetes mellitus. The Vitamin D levels were measured by a standardized method in the Prodia Research Laboratory. Results: Study findings showed that from 53 study subjects, most of them were female (79.2%). The mean age of subjects was 57.83±8.79 years. We found a high prevalence of low Vitamin D levels in the Indonesian population as many as 98.11% and only 1.9% has sufficiency Vitamin D levels. Gender (p=0.028), hypertension (p=0.027), and controlled complications (p=0.005) were significantly associated with Vitamin D levels. Conclusion: All patients with PDN in this study had a high prevalence of Vitamin D deficiency. This high prevalence of Vitamin D deficiency also has been reported worldwide. Physician should be aware and continue to treat patients with Vitamin D deficiency

TELAAH KRITIS DOKUMEN CLINICAL PATHWAY APPENDISITIS AKUT, HERNIA INGUNALIS LATERALIS DAN HEMORROIDEKTOMI RUMAH SAKIT BETHESDA YOGYAKARTA

Latar Belakang : Semakin meningkatnya tuntutan pelayanan kesehatan bermutu, bebas dari kesalahan medik, malpraktek dan terhindar dari bahaya (patient safety) dengan biaya yang rendah menjadi latar belakang diterapkannya clinical pathway. Clinical Pathway diharapkan menjadi solusi dalam memberikan proses optimal dalam perawatan, terarah dan memiliki waktu yang tepat.dalam pemberian tindakan oleh tenaga kesehatan terkait diagnosis. Clinical pathway dapat menjadi sebuah alat ukur dalam mengetahui kualitas pelayanan kesehatan dan menjadi acuan pembiayaan sesuai INA-CBGs dimana pembayaran akan dilakuakan berdasarkan diagnosa.Metode : Penelitian ini merupakan studi deskriptif evaluative dengan melihat clinical pathway dan di telaah berdasarkan instrumen ICPAT. Dokumen Clinical Pathway Appendicitis Akut, Hernia Inguinalis Latealis Reponibilis (Herniotomi), dan Hemorroidektomi pada perdarahan per rektal et causa Hemorrhoid  (Hemorroidektomi) di RS Bethesda akan dilihat melalui dua dimensi ICPAT yaitu Dimensi 1 dan 2.Hasil : Dimensi 1 pada instrumen ICPAT seluruhnya terdapat (terjawab ya) pada seluruh Clinical Pathway yang ditelaah. Sedangkan dimensi 2 pada instrumen ICPAT pada clinical pathway Appendicitis akut sebesar 37% (11 pertanyaan) dijawab ya, pada Clinical Pathway Hernia Inguinalis Lateralis dijawab ‘Ya’ adalah sebesar 48 % (13 pertanyaan) dan pada Clinical Pathway Hemorroid sebesar 52 % (14 pertanyaan).Kesimpulan : Berdasarkan instrument ICPAT dokumen ini memang benar adalah sebuah clinical pathway yang baik, namun masih dibutuhkan revisi dan perbaikan untuk menjadikan Clinical Pathway ini sesuai dengan standar ICPAT.