Perbaikan Gejala Neuropati Pada Pemberian Kombinasi Vitamin B Untuk Pasien Neuropati Diabetikum

Neuropati diabetikum (ND) adalah komplikasi utama yang sering muncul pada pasien diabetes mellitus (DM). Penelitian ini bertujuan untuk menilai efektivitas vitamin B kombinasi terhadap gejala klinis ND dan QoL (kualitas hidup/quality of life) pada pasien DM. Metode yang digunakan dalam penelitian ini adalah metode penelitian one group pre and post test design pada pasien DM dengan ND. Setiap subjek mendapatkan kombinasi vitamin B yang terdiri dari: vitamin B1, vitamin B6, dan vitamin B12 dengan dosis masing-masing secara berurutan: 100 mg, 100 mg, 5000 mcg. Gejala klinis ND diukur dengan menggunakan Total Symptom Score (TSS). Angka QoL diukur dengan menggunakan kuesioner SF-8. Penilaian gejala dilakukan sebanyak 5 kali, dari penilaian awal hingga 3 bulan. Ada 104 subjek pada awal penelitian. Tujuh subjek tidak dapat mengikuti penelitian sampai selesai, sehingga tersisa 97 subjek pada akhir penelitian. Ada perbaikan gejala ND, yang meliputi sensasi nyeri tertusuk, sensasi nyeri terbakar, kesemutan, dan rasa kebas/baal, setelah pemberian kombinasi vitamin B. Perubahan tersebut bermakna secara statistik (p<0,0001). Hasil serupa juga tampak pada QoL. Ada perbaikan QoL dari awal penelitian hingga akhir penelitian. Perbedaan tersebut bermakna secara statistik (physical component summary dengan p<0,0001 dan mental component summary dengan p=0,0001). Kombinasi vitamin B efektif untuk memperbaiki gejala klinis dan meningkatkan kualitas hidup pada pasien ND

Ischemic stroke in coronavirus disease 19 (COVID-19) positive patient: a case report

A new coronavirus disease called COVID-19 was declared by World Health Organization (WHO). The COVID-19 may complicated into many other conditions, including neurologic. One among this neurologic complication is stroke. This paper aimed to report a case of ischemic stroke in COVID-19 positive patient in Yogyakarta, Indonesia. A male patient, 42 years old, came to emergency department with weakness in his right arm for two days as his main complain. He also had face drop on the right side, cough, and shortness of breath. He had a history of hyperthyroid and type II diabetes mellitus. The brain CT Scan showed a lacunar infarct in the left lentiform nucleus. Patient had nasopharynx and oropharynx swab to be checked for the presence of COVID-19 and the result was positive.The pathophysiology of stroke in COVID-19 include the hyperactivation of inflammatory factors that causes a fatal inflammatory storm. It also cause a damage of coagulation system which causing the D-dimer and platelet abnormalities, hypercoagulability from critical illness and cardioembolism from virus-related cardiac injury. Moreover, COVID-19 may cause a direct role in viral infection in central nervous system. In conclusion, ischemic stroke can be present along with COVID-19.

Critical appraisal of neuropathic pain guidelines in Asia

Neuropathic pain (NP) is type of chronic pain that is common and often difficult to treat. Clinicians may be guided by a number of published guidelines and algorithms for the management of neuropathic pain. It is important for every clinician to know the quality of guidelines. The availability of current guideline in Asian countries is not well understood. Critical appraisal of NP guidelines in Asia has not performed, yet. The aim of this study was to appraise the quality of pharmacological treatment from neuropathic pain guidelines in Asia. Systematic searches were conducted by using combination of keywords i.e NP, Asia, and guideline. Guidelines evaluation was using appraisal of guidelines for research & evaluation II (AGREE II) instrument. The result interpreted as (i) a strongly recommended for use in practice if most domains scored above 50%; (ii) recommended for use with some modification if most domains scored between 30% to 50%; or (iii) not recommended for use in practice if most domains scored below 30%. After matched to inclusion and exclusion criteria there were 5 guidelines left: a guideline from Philippines, China, South Korea, Malaysia and Middle East. All of guidelines are recommended for use with some modification. The guidelines mention that first line treatment for NP are tricyclic antidepressants, selective norepinephrine reuptake inhibitor (SNRI) and alpha 2-delta ligand calcium channel blocker (CCB). Most of the evidences come from peripheral NP. There were limited evidences for the treatment of central neuropathic pain (central post stroke pain and pain after spinal cord injury). All the existing guideline mention, that the first line treatment for neuropathic are the tricyclic antidepressants, SNRI and alpha 2-delta ligand CCB

AGE-RELATED FACTORS OF EPILEPSY AND ITS IMPACT ON QUALITY OF LIFE: A CROSS-SECTIONAL STUDY IN BETHESDA HOSPITAL YOGYAKARTA

Introduction: Epilepsy is a neurological disorder that negatively impacts quality of life (QOL). There are limited studies on the QOL of people living with epilepsy in Indonesia. Aim: The purpose of this study was to evaluate the association between age-related factors (age, age at onset, and duration of epilepsy) and QOL. Methods: This cross sectional study was conducted in the Department of Neurology, Bethesda Hospital, Yogyakarta, Indonesia from November 2017 to February 2018.&nbsp; Patients with epilepsy aged 18 years and above were recruited in the study. QOL was measured using the Short Form 8 (SF-8). Results: A total of 27 patients were eligible for the study. The QOL of patients aged ≥ 60 years was significantly lower in the following aspects: physical functioning (42.44±8.243), general health (40.04±7.641), role emotional (39.60±7.638), mental health (43.50±10.347), and mental component score (42.04±10.282). Patients with age at onset ≥ 55 years had significant effects in lower role emotional (40.54±7.245) and mental component score (42.98±10.155). There was no significant difference in the QOL scores and duration of epilepsy. Conclusion: This study demonstrated that age and age at onset&nbsp;influence the QOL in patients with epilepsy.&nbsp; &nbsp; &nbsp; Keywords: Epilepsy, age-related factors, quality of life, Short Form 8 Health Survey

The Benefit and Safety of Vitamin B Combination to Reduce Fatigue and Improve Quality of Life in Chronic Kidney Disease Patients

Background: Chronic kidney disease (CKD) patients often have a chronic fatigue and lower QoL, thus may increase morbidity and mortality in CKD patients. Objective: The objective was to identify the benefit and safety of administration of intravenous vitamin B combination to reducing fatigue, measure the prevalence of fatigue and QoL in CKD patients. Method: This study was an observational non control study for 4 weeks in CKD patients with routine hemodyalisis 2 times/week. Every subject has a routine administration of intravenous vitamin B combination, consist of 100 mg vitamin B1, 100 mg vitamin B6, and 5000 mcg vitamin B12, after each hemodyalisis. Visual analogue scale (VAS) used to measure the degree of fatigue. QoL measured using SF-8 questionnaire, consist of total, physical (PCS), and mental component (MCS). Results: The prevalence of fatigue is high. The mean VAS score was 3.4±2.1 at baseline and there were 46.7% subjects with VAS score above the mean VAS score. After 4 weeks administration of vitamin B combination intravenously, the mean VAS score was decreasing from 3.4 to 2.7. The prevalence of fatigue was decreasing from 46.7% to 41%. This shifting was statistically significant (p:0.008). There was a score reduction in total component (20.19±4.8 to 19.29±4.9), PCS (13.44±3.1 to 12.99±3.5), and MCS (6.75±2.1 to 6.31±1.9). This score reduction indicated a better QoL. However, the reduction was not statistically significant. Conclusion: The prevalence of fatigue is high. Intravenous vitamin B combination considered to be effective and safe to reducing the degree of fatigue in CKD patients. Keywords: chronic kidney disease, fatigue, hyperhomocysteinemia, vitamin B combination, quality of lif

Clinical symptoms and risk factors comparison of ischemic and hemorrhagic stroke

Backround: It is very important to know and detect various stroke symptoms because stroke is an emergency condition. Lack of knowledge about stroke symptoms leads to delay on stroke treatment. Objective: The aim of this study is to compare clinical symptoms and risk  factors between ischemic and hemorrhagic stroke. Methods: This study was a case control study. The subjects in this study were ischemic and hemorrhagic stroke patients. Subject data were recorded in electronic stroke registry at Bethesda Hospital, Yogyakarta. Results: The most common clinical symptoms in both groups were limb weakness (76.4% vs 71.4%), whereas the rarest was face drooping (2% vs 3.6%). Hypertension was the most common risk factor in both group (48% vs 71.4%), whereas atrial fibrillation was the rarest. This study did not find the specific correlation between any clinical symptoms to ischemic stroke incidence, however, decrease a level of consciousness was significant to hemorrhagic stroke incidence (OR: 2.738, 95% CI: 1.503-4.990, p: 0.001). Previous stroke (OR: 2.413, 95% CI: 1.314-4.433, p: 0.005) and dyslipidemia (OR: 4.862, 95% CI: 2.613-9.045, p: 0.000) were significant increasing risk of ischemic stroke. Hypertension was only the significant increasing risk of hemorrhagic stroke (OR: 3.680, 95% CI: 2.086-6.492, p: 0.000). Conclusion: Decrease level of consciousness has a significant correlation to hemorrhagic stroke incidence, but there is no specific symptom correlate to ischemic stroke incidence. Previous stroke and dyslipidemia are significant risk factors for ischemic stroke, whereas hypertension is the only significant risk factor for hemorrhagic stroke

The benefit of Curcuma longa and Boswellia serrata to improve quality of life in osteoarthritis patients: a randomized controlled trial

Background: Quality of life (QoL) can be affected by chronic pain in osteoarthritis (OA). Previous studies showed that combination of Curcuma longa (CL) and Boswellia serrata (BS) extract (CB extract) are promising for alternative treatment for pain in OA. This study aimed to measure the benefit of CB extract to improve QoL in patients with OA.Methods: This was a randomized controlled trial (RCT) in OA patients. Subjects were randomized to 3 different group (Group 1: CB extract (350 mg of CL and 150 mg BS) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium); group 2: CB extract; group 3: NSAID). Each medication was taken two times per day for 4 weeks. QoL measured using 5Q-5D-5L that include five dimensiones in 5Q-5D: mobility, self-care, usual activities, pain/discomfort, anxiety/depression, with 5 levels of severity.Results: There were 105 subjects at baseline. After 4 weeks of study, remained 95 subjects. The most common problem in group 1, 2, and 3 was pain (n=23, n=8, n=15 respectively). The improvement of level of severity in group 1 after 4 weeks of treatment was significant in mobility problems (p=0.002), pain/discomfort (p&lt;0.001), and anxiety/depression (p=0.008). A significant improvement was only seen in usual activity problems (p=0.013) in group 2. The decrease of level of severity in usual activity problems (p=0.034), pain/discomfort (p=0.005), and anxiety/depression (p=0.018) in group 3 were also statistically significant.Conclusions: CB extract was beneficial to improve QoL in OA patients with a less side effect compared to NSAID

MANFAAT PEMBERIAN VITAMIN B KOMBINASI UNTUK MENURUNKAN KADAR HOMOSISTEIN PADA GAGAL GINJAL KRONIK

Pendahuluan: Pasien gagal ginjal kronik (GGK) sering mengalami hiperhomosisteinemia. Berbagai penelitian terdahulu menunjukkan hubungan yang bermakna antara hiperhomosisteinemia dengan peningkatan kejadian stroke. Tujuan: Tujuan dari penelitian ini adalah untuk mengetahui proporsi hiperhomosisteinemia, kemanjuran, serta keamanan pemberian vitamin B kombinasi intravena dalam menurunkan kadar homosistein pada pasien GGK. Metode:&nbsp;Penelitian ini adalah penelitian intervensional yang dilakukan pada pasien dengan GGK yang menjalani hemodialisis rutin 2 kali/minggu dan telah rutin memperoleh vitamin B kombinasi intravena (100mg vitamin B1, 100mg vitamin B6, dan 5000mcg vitamin B12). Setelah penghentian pemberian vitamin B kombinasi selama 1 minggu, pemeriksaan kadar homosistein dilakukan 3 kali: kunjungan awal, 2 minggu, dan 4 minggu setelah kunjungan awal. Vitamin B kombinasi kembali digunakan saat kunjungan awal. Hiperhomosisteinemia didefinisikan sebagai kadar homosistein &gt;15,39µmol/L. Hasil: Terdapat 122 subjek yang terlibat dalam penelitian ini. Subjek didominasi oleh pria dengan usia rata-rata 51,7 tahun. Asam folat merupakan salah satu obat yang sering dikonsumsi oleh para subjek. Prevalensi hiperhomosisteinemia adalah sebesar 89,3% dari total subjek. Meskipun sebagian besar subjek mengonsumsi asam folat (86,1%), angka kejadian hiperhomosisteinemia masih tinggi. Penurunan kadar homosistein tampak setelah penggunaan vitamin B kombinasi intravena selama 4 minggu (rata-rata 23.43±8.39µmol/L pada kunjungan pertama menjadi 12.24±4.41µmol/L pada kunjungan ketiga, p:0.0008).&nbsp;Terdapat 2 kejadian tidak diharapkan (KTD) selama penelitian ini. Pada investigasi lebih lanjut tidak ada korelasi antara KTD tersebut dengan penggunaan vitamin B kombinasi intravena. Kesimpulan:&nbsp;Hiperhomosisteinemia adalah kondisi yang sering dijumpai pada pasien dengan GGK yang menjalani hemodialisis rutin. Pemberian vitamin B kombinasi intravena terbukti aman dan efektif dalam menurunkan kadar homosistein. Kata Kunci: Gagal Ginjal Kronik, Hiperhomosisteinemia, Penyakit Kardiovaskular, Strok

Complications as important predictors of disability in ischemic stroke

Background Stroke is the main cause of disability and death in many countries. The high incidence of disability in stroke survivors requires special attention to determine various predictive factors of disability. This study aimed to identify the various predictive factors of disability in ischemic stroke. Methods This study was a cross sectional study on 4510 ischemic stroke patients. Each patient’s data had been recorded in the electronic stroke registry of Bethesda Hospital. Ischemic stroke diagnosis was confirmed by brain CT scan, which was interpreted by a neurologist and a radiologist. Disability was assessed using the modified Rankin scale. Predictors of disability were assessed. Multiple logistic regression analysis was used to analyse the data. Results The subjects were predominantly males, >60 years of age, and suffered stroke for the first time. The incidence of disability was 31.5% (1420/4510). Multiple logistic regression analysis showed that the presence of complications (OR: 6.43; 95% CI: 4.74-8.73; p60 years (OR: 1.55; 95% CI: 1.35-1.79; p<0.001) were independent predictive factors of disability. Conclusion We demonstrated that a substantial proportion of patients with ischemic stroke become disabled. And the presence of complications was the most predictive factor of disability in ischemic stroke

CRITICAL APPRAISAL OF EFFECTIVENESS OF ORAL FINGOLIMOD ON RELAPSING MULTIPLE SCLEROSIS

Oral fingolimod has been recently accepted as a treatment for relapsing Multiple Sclerosis (MS) by the Indonesian Food and Drug Administration. The number of MS patients is increasing in Indonesia. There is a critical need of systematically reviewing the new medication for both efficacy and safety. This review aimed to appraise the clinical evidences of oral fingolimod for the effective treatment of relapsing MS. We searched in Pubmed database. We limited our search to only articles that were in full text, published within the last 10 years, and in English. We used the Jadad scale to measure the quality of the evidences. We only found 3 trials, all conducted with randomized and double blind design. The three trials were: the FREEDOMS I, FREEDOMS II, and TRANSFORMS studies. The FREEDOMS studies compared with placebo, and the TRANSFORMS study compared with injectable interferon. All of the studies have good quality in methodology (Jadad scale >3). The results of the three studies showed the benefit of oral fingolimod in reducing MS relapse compared with placebo with relative risk reduction range from 48% to 54%, and also in reducing new lesions in T2 brain MRI with relative risk reduction range from 35% to 74%. Our critical appraisal found that oral fingolimod improved clinical outcomes. The availability of oral fingolimod in Indonesia makes it one of the options in treatment of MS relapse in Indonesia and has been demonstrated to be effective and safe with relatively small risk