Profile of Upper Extremities Function among Stroke Outpatients in Dr. Hasan Sadikin General Hospital, Bandung

Background: Stroke is one of the leading causes of death and disabilities worldwide. Among all types of disabilities, disturbance in upper extremities functions is at the highest percentage. This study aimed to determine the profile of upper extremities function among stroke outpatients in Dr. Hasan Sadikin General Hospital as an initial step to provide a better follow up and management.Methods: The design of this study was a descriptive study, conducted from April to October 2014 among stroke outpatients in the Department of Physical Medicine and Rehabilitation Dr Hasan Sadikin General Hospital, Bandung based on a consecutive sampling method. The function of upper extremities was tested by Chedoke Arm and Hand Integrated version 9 (CAHAI-9).Result: In total, 42 patients were included, consisting of a male (n=25) and a female (n=17). Nine tasks were performed with dependently by the patients such as open the coffee jar (n22; 52%), call 118 (n24;57%), draw a line with a ruler (n22;52%), pour a glass of water (n33;79%), wring out washed cloth (n26;62%) do up five-button (n31;74%), dry back with the towel (n25;60%), put toothpaste on a toothbrush (n25;60%), and cut medium resistance putty(n32;76%).Conclusions: The majority of stroke outpatients in the sub-acute phase still have a dependent function of upper extremities. Better patient management and interventions focusing on this function need to be enhanced for a better outcome.

Gratitude Cognitive Behavior Therapy Untuk Meningkatkan Harga Diri Remaja Korban Perceraian

Penelitian menyebutkan bahwa anak dari orang tua yang bercerai memiliki harga diri yang lebih rendah dari pada orang tua yang tidak bercerai. Terapi kebersyukuran diprediksikan dapat membantu mengubah persepsi negatif remaja tentang dirinya menjadi persepsi yang positif sehingga evaluasi dirinya menjadi baik, dengan demikian harga dirinya akan meningkat. Tujuan penelitian ini adalah untuk mengetahui keefektifan terapi kebersyukuran dengan pendekatan cognitive behavior therapy (G-CBT) untuk meningkatkan harga diri pada remaja korban perceraian. Metode pada penelitian ini adalah menggunakan kuasi eksperimen dengan desain penelitian single case A-B-A-B Penelitian ini menggunakan metode analisis data secara kuantitatif dengan melihat perubahan skor hasil pengukuran berdasarkan waktu pengukuran. Hasil dari penelitian ini menunjukkan bahwa skor harga diri partisipan meningkat setelah diberikan terapi Gratitude Cognitive Behavior Therapy (G-CBT) dan pengaruh dari terapi ini masih berdampak selama 2 minggu setelah diberi perlakuan. Setelah terapi dihentikan skor harga diri tidak mengalami penurunan atau kembali seperti pada pengukuran awal

Clinical and Cerebrospinal Fluid Abnormalities as Diagnostic Tools of Tuberculous Meningitis

Background: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculous (TB) disease and remains difficult to diagnose. The aim of the study was to determine the diagnostic value of clinical and laboratory findings of cerebrospinal fluid (CSF) examinations for diagnosing TBM using bacterial culture result as the gold standard.Methods: A prospective cross sectional study was carried out to 121 medical records of hospitalized TBM patients in neurological ward at Dr. Hasan Sadikin General Hospital Bandung, from 1 January 2009–31 May 2013. The inclusion criteria were medical records consisted of clinical manisfestations and laboratory findings. The clinical manisfestations were headache and nuchal rigidity, whereas the laboratory findings were CSF chemical analysis (protein, glucose, and cells) and CSF microbiological culture. Validity such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for clinical and laboratory findings were calculated, using bacterial culture result as the gold standard.Results: The most clinical findings of TBM was nuchal rigidity and it had the highest sensitivity value, but the lowest spesificity value. Decreased of CSF glucose had the highest sensitivity value compared to other laboratory findings, but the value was low.Conclusions: The clinical manisfestations and the laboratory findings are not sensitive and specific enough for diagnosing TBM. [AMJ.2016;3(1):132–6] DOI: 10.15850/amj.v3n1.72

Glasgow Outcome Scale Assessment in Patients with Cerebral Toxoplasmosis

Background: Cerebral toxoplasmosis is a Toxoplasma gondii infection affecting the brain. Assessment of the functional outcome after treatment is needed as an evaluation for therapeutic management. One of the instruments used is the Glasgow Outcome Scale (GOS). This study aimed to assess the functional outcome of cerebral toxoplasmosis patients using GOS.Methods: A Cross-sectional descriptive study with total sampling method was conducted. Medical records were retrieved from patients with cerebral toxoplasmosis registered at the Department of Neurology, Dr. Hasan Sadikin General Hospital, Bandung during year 2017–2019. Inclusion criteria were patients with cerebral toxoplasmosis aged >18 years and had a positive HIV serological test. The GOS was assessed and presented in frequency, using Microsoft Excel and SPSS software ver. 25.0.Results: Of 87 patients, 68% had somnolent on admission to the hospital, 51% had hemiparesis/hemiplegia, and 76% had GOS 3, indicating severe disability. Almost one third (28%) of patients died during hospitalization with non-neurological complications as the most common cause of death (63%). On discharge from the hospital, 82% of the survivors were fully alert, 40% had hemiparesis/hemiplegia, and 33% had GOS 4 (mild disability).Conclusions: Most of the cerebral toxoplasmosis patients come to the hospital with severe disability. During the treatment, one third of patients died, and those who survived had mild disability. GOS has improved after hospitalization, suggesting that GOS is useful for assessment of therapeutic management.

Predictor of Mortality in Acquired Immunodeficiency Syndrome Patients with Central Nervous System Opportunistic Infections

Background: Indonesia’s increase of acquired immunodeficiency syndrome (AIDS) cases is one of the fastest. Mortality cases of AIDS also increase per year. Central nervous system (CNS) opportunistic infection is one of the most likely manifestations on advanced stage of Human immunodeficiency virus (HIV)/AIDS patients. Common CNS opportunistic infections are toxoplasma infection and tuberculous meningitis (TBM). The study aimed to analyze the predictor of mortality in AIDS patients with CNS opportunistic infections.Methods: This study reviewed 151 medical records from AIDS patients with CNS opportunistic infection admitted to the Department of Neurology, Dr. Hasan Sadikin General Hospital Bandung from 2007-2012. This study was conducted from April to November 2013. Patients’ clinical manifestations (seizure, headache, altered consciousness), laboratory examination (CD4+ level count) and treatment history (antiretroviral or ART and cotrimoxazole) were collected. Chi-square and logistic regression test were used to determine the mortality predictor in patients.Results: Mortality rate was 37.7%. Clinical manifestations from patients were seizure 29.8%, altered consciousness 66.2%, and headache 88.7%. Patients had cotrimoxazole treatment 44.4% and 38.4% patients had ART. CD4+ level count data from 86 patients were obtained, 94% had CD4+ level count ≤200. Bivariate analysis showed altered consciousness had significant mortality predictor (Odd ratio (OR): 29.944; 95% Confidence interval (CI) 6.9–129.945; p<0,0). Multivariate analysis showed ART had highest predictive mortality value (OR: 2.968; 95% CI 1.236–7.126; p=0.015).Conclusions: Altered consciousness and no antiretroviral treatment are mortality predictors in AIDS patients with CNS opportunistic infections. [AMJ.2016;3(4):577–82] DOI: 10.15850/amj.v3n4.94

Clinical and Cerebrospinal Fluid Abnormalities as Diagnostic Tools of Tuberculous Meningitis

Background: Tuberculous meningitis (TBM) is the most severe form of extrapulmonary tuberculous (TB) disease and remains difficult to diagnose. The aim of the study was to determine the diagnostic value of clinical and laboratory findings of cerebrospinal fluid (CSF) examinations for diagnosing TBM using bacterial culture result as the gold standard.Methods: A prospective cross sectional study was carried out to 121 medical records of hospitalized TBM patients in neurological ward at Dr. Hasan Sadikin General Hospital Bandung, from 1 January 2009–31 May 2013. The inclusion criteria were medical records consisted of clinical manisfestations and laboratory findings. The clinical manisfestations were headache and nuchal rigidity, whereas the laboratory findings were CSF chemical analysis (protein, glucose, and cells) and CSF microbiological culture. Validity such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) for clinical and laboratory findings were calculated, using bacterial culture result as the gold standard.Results: The most clinical findings of TBM was nuchal rigidity and it had the highest sensitivity value, but the lowest spesificity value. Decreased of CSF glucose had the highest sensitivity value compared to other laboratory findings, but the value was low.Conclusions: The clinical manisfestations and the laboratory findings are not sensitive and specific enough for diagnosing TBM. [AMJ.2016;3(1):132–6] DOI: 10.15850/amj.v3n1.72

Characteristics and Risk Factors of Patients with Acute Ischemic Stroke in Dr. Hasan Sadikin General Hospital Bandung, Indonesia

Background: Stroke is the second most common cause of death globally and the third most common cause of disability. The prevalence of stroke is increasing despite managing various stroke risk factors that have improved considerably. Ischemic stroke is the most prevalent type, and about 90% of stroke events are attributable to modifiable risk factors. This study aimed to explore the characteristics and risk factors of patients with acute ischemic stroke in Dr. Hasan Sadikin General Hospital.Methods: A descriptive cross-sectional study was conducted retrospectively in October 2020, using a total sampling method on medical records of acute ischemic stroke patients in Dr. Hasan Sadikin General Hospital year 2019. Medical records with incomplete and missing data were excluded. Demographic and known risk factors data were collected and presented in the table.Results: Of the 355 subjects, male patients (n=69, 76.7%) were predominant, with the age range of 55–64 years old (36.1%). The majority of the subjects had an ischemic stroke of large-artery atherosclerosis (68.2%) with carotid system involvement (93.2%). As much as 305 subjects (85.9%) had hypertension as the risk factor, followed by dyslipidemia (47.3%), heart disease (39.4%), previous stroke history (33.8%), smoking (25.6%), diabetes mellitus (24.5%), hyperuricemia (12.1%), and blood disorders (2.3%).Conclusions: Males in the older age group have a higher risk of getting acute ischemic stroke with ischemic stroke of large-artery atherosclerosis and carotid system involvement, and hypertension has the highest prevalence