HEADACHE PROFILE OF BRAIN TUMOR PATIENTS IN MOHAMMAD HOESIN HOSPITAL PALEMBANG

Background: Headache is one of the most common complaint in population while a serious causative of underlying disease is very rare. Although headaches are rarely the result of a brain tumor, brain tumors are frequently associated with headaches. The challenges to the physician are to determine the specific feature of headache related to brain tumor.Methods: This is cross sectional study involved primary and metastatic brain tumor patient admitted in neurology ward of Mohammad Hoesin hospital from April 2018 to June 2019. The inclusion criteria including age > 18 years old and there was symptom of headache based on anamnesis. All were interviewed about their personal details (age, gender). The characteristic of headache was obtained based on questionnaire designed in our department. Various neurological symptoms related to the tumor were also recorded. Information of the tumor was obtained from the patient’s chart (histopathology of the tumor) and from characteristic of neuroradiological finding (magnetic resonance imaging or computed tomography). Headache and tumor characteristics were compared between primary and metastatic tumor by contrasting frequencies. We also analysed the correlation between tumor characteristics (location, hidrocephalus, vasogenic edema and tumor type) with headache intensity.Results: A total of 95 of 199 patients (48%) with headache symptom were studied in this series. Most patients were complained of chronic headache. Headache was mostly throbbing in both primary and metastatic brain tumors.  Progressively headache was dominant in this study and more than half patients report the quality of headache as moderate at the onset. In 35,8% patients, headache was the patient’s first complaint.  Headache as the isolated symptom of brain tumor was found in only 3,2% and only 28,4% of patients ful?lled the three ‘classic criteria’ of the brain tumor headache. A great localizing value of the headache was found in 63 cases of 95 patients. Of the 61 patients with single tumor and unilateral side, the unilateral headache was on 48 cases (78,8%). Of the 26 patients with strictly bilateral headache, 10 cases (38,5%) had bilateral sided tumors. Conclusion: The incidence of brain tumor headache in this study is similar to previous reports although the classic brain tumor headache features was found in a small portion of the patients.

Profile of Coagulation Marker and The Influence Factors in Central Nervous System Tumor

Brain tumors have the highest percentage of thrombosis compared to other types of malignancies. Hypercoagulation is a risk for thromboembolic events in patients with malignancy. Hypercoagulation conditions are frequentlyfound in patients with malignancy arising from the aptitudeof tumor cells to activate the coagulation system. This condition can be detected through coagulation markers in the blood. This marker isPT, APTT, INR, Fibrinogen and D-Dimer.This research is a descriptive analytic study using secondary data from medical records of patients with central nervous system (CNS) tumors. The inclusion criteria were CNS tumor patients> 18 years old and had been diagnosed with CNS tumor. Coagulation markers are recorded based on the results of the initial laboratory examination upon entering the hospital, consisting of D-Dimer, PT, APTT, Fibrinogen, INR.There were 124 researchsubjects, consisting of 60 men and 64 women. Most research subjects are in the age range of 40-49 years (54.8%). Hypercoagulation conditions were found in 92.74% of study subjects. The most common accompanying conditionwas hypertension (22.6%). There were no significant differences in the hypercoagulable conditions in groups with and without accompanying conditions.Hypercoagulation was found in most research subjects. There are no factors that influence the hypercoagulation condition in this study

Profile of Coagulation Marker and The Influence Factors in Central Nervous System Tumor

Brain tumors have the highest percentage of thrombosis compared to other types of malignancies. Hypercoagulation is a risk for thromboembolic events in patients with malignancy. Hypercoagulation conditions are frequently found in patients with malignancy arising from the aptitude of tumor cells to activate the coagulation system. This condition can be detected through coagulation markers in the blood. This marker is PT, APTT, INR, Fibrinogen and D-Dimer. This research is a descriptive analytic study using secondary data from medical records of patients with central nervous system (CNS) tumors. The inclusion criteria were CNS tumor patients > 18 years old and had been diagnosed with CNS tumor. Coagulation markers are recorded based on the results of the initial laboratory examination upon entering the hospital, consisting of D-Dimer, PT, APTT, Fibrinogen, INR. There were 124 research subjects, consisting of 60 men and 64 women. Most research subjects are in the age range of 40-49 years (54.8%). Hypercoagulation conditions were found in 92.74% of study subjects. The most common accompanying condition was hypertension (22.6%). There were no significant differences in the hypercoagulable conditions in groups with and without accompanying conditions. Hypercoagulation was found in most research subjects. There are no factors that influence the hypercoagulation condition in this study

PAIN CHARACTERISTICS OF CENTRAL NERVOUS SYSTEM TUMOR IN MOHAMMAD HOESIN GENERAL HOSPITAL

Pain is one of the cardinal symptom in tumor patient, especially in Central Nervous System (CNS) tumor. It often impacts patient’s quality of life. The incidence and characteristic of pain have rarely been reported in Palembang, Indonesia. This observational study was planned to investigate the clinical presentation and epidemiology of CNS tumor firstly diagnosed in ward throughout July to December 2018. 99 patients recently diagnosed with CNS tumor were enrolled. From 99 patients, we found 34 patients with tumor associated pain. We further evaluated the information of pain linked with brain tumors via questionnaire and medical record. Of all 34 subjects, the age ranged from 43 to 79 years old with female : male ratio 3:1. Pain was present 100% in spinal tumor and 54% in brain tumor. Clinical characteristics of pain found in brain tumor were typically in ipsilateral lesion (92%), pulsating (76%), moderate intensity (60%), recurrent (84%), not radiating (80%), with frequency of 3-4 times in a week (48%). On the other hand, pain in spinal tumor was generally felt on the site of the lesion (100%), radiating (77.8%), electrical type of pain (44.4%), high intensity (77.8), and constant (88.9%). From this study we conclude that tumor locations can show some different pain characteristics. Therefore careful pain assessment is compulsory to have better understanding and more appropriate management

THE COMPARISON OF EFFECTIVENESS AND SAFETY BETWEEN WARFARIN AND RIVAROXABAN IN HYPERCOAGULATED CENTRAL NERVOUS SYSTEM TUMORS

Abstract:                                                                                                                                           Background: Central nervous system (CNS) tumors originate from the brain and spinal cord, and have complications, such as hypercoagulation. The administration of anticoagulants (warfarin and rivaroxaban) has been able to reduce hypercoagulation-related morbidity and mortality, however, the effectiveness and safety of their use has not been well studied. This study aims to compare the effectiveness and safety of anticoagulant drugs between warfarin and rivaroxaban in hypercoagulated CNS tumors. Methods: This was a randomized clinical trial study, double-blinded, conducted on CNS tumor patients from September-November 2020 at Mohammad Hoesin Hospital. The patients were given warfarin and rivaroxaban for 3 weeks. Coagulation status was measured before and after. Data were analyzed using SPSS ver.24. Results: The mean age of 20 patients was 42.70+8.14 years and majority were female (80%), with tumor characteristics were primary (80%), single (85%), and located in the brain (95%). In the warfarin group (n=10), there were significant improvements in PT (p 0.008), INR (p 0.013), Fibrinogen (p 0.041), and D-Dimer (p 0.008) value, also the rivaroxaban group (n=10) in PT (p 0.013), APTT (p 0.012), INR (p 0.028), Fibrinogen (p 0.047), D-Dimer (p 0.032), and Anti Fxa (p 0.028). However, there was no significant difference between groups, except when comparing the Anti Fxa delta (p 0.041). There was 1 person with major bleeding using warfarin, and 1 person (excluded) with GIT bleeding using rivaroxaban. Conclusion: There was a significant improvement of coagulation value in both groups, also side effects were seen as well. Keyword: CNS Tumor, Hypercoagulation, Warfarin, Rivaroxaba

KARAKTERISTIK TUMOR SISTEM SARAF PUSAT DI RSUP DR. MOHAMMAD HOESIN PALEMBANG

Angka kejadian tumor susunan saraf pusat (SSP) semakin meningkat. Data epidemiologi mengenai kejadian tumor SSP di Indoensia masih terbatas.  Penelitian ini bertujuan untuk mengetahui karakteristik tumor SSP di RSUP Dr. Mohammad Hoesin Palembang. Penelitian ini merupakan studi deskriptif yang dilakukan di Rumah sakit Mohammad Hoesin dengan subjek penelitian adalah pasien tumor primer dan metastasis SSP berusia di atas 18 tahun yang memenuhi kriteria inklusi dan eksklusi dari tahun 2015 sampai 2019. Variabel yang diteliti antara lain karakteristik demografis, distribusi tumor, serta karakteristik tumor primer dan metastasis SSP. Dari 289 kasus tumor primer SSP, terbanyak adalah meningioma (77,1%) diikuti astrositoma (13,1%) dengan derajat terbanyak adalah WHO derajat I (79,2%). Perbandingan perempuan dan laki-laki 3:1 dengan rerata usia 44 tahun (20-69 tahun). Nyeri kepala merupakan keluhan utama terbanyak (36,0%). Mayoritas lesi berada di intrakranial dimana supratentorial merupakan lokasi terbanyak. Sedangkan dari 103 kasus tumor metastasis SSP, terbanyak dilaporkan berasal dari keganasan paru (53,4%) yang lebih sering dijumpai pada laki-laki, diikuti payudara (23,2%) dengan rentang usia terbanyak 41-60 tahun. Penurunan kesadaran merupakan keluhan utama tersering (34,1%). Lesi metastasis terbanyak merupakan lesi multipel (37,8%), terletak di parenkim otak. Mayoritas tumor primer SSP yang merupakan meningioma dan derajat terbanyak adalah WHO derajat I. Keganasan paru dan payudara merupakan penyebab tersering tumor metastasis SSP masing-masing pada laki-laki dan perempuan

The Concordance of Recursive Partitioning Analysis (RPA) Class Stratification with Survival of Brain Metastases Patients in Mohammad Hoesin Hospital, Palembang, Indonesia: The concordance of RPA, Diansari et al

A B S T R A C TIntroduction: Recursive Partitioning Analysis is one of prognostic scores, has beenvalidated to any different setting. Objective: To identify the concordance of RecursivePartitioning Analysis stratification in survival with brain metastases patients.Methods: Retrospective study was performed on brain metastases patients fromJanuary 2017 until Desember 2019 based on medical record. The follow up timestarted from the first diagnosis of brain metastases to death or last follow up. TheKaplan Meier was used to plot survival curves and the log-rank test was used toanalyse differences between groups Results: Mean overall survival time was 4,67months with 1,14 months for median survival for all patients. According to scoring,mostly (80,8%) patients were in group 3. The median survival time was 7 monthsand 2 months for group 2 and 3. Conclusion: It has shown relatively congruitysurvival in BM patients with stratification of Recursive Partitioning Analysis in ourinstitution

Does Electroencephalography Result Affect the Success of Treatment for Epilepsy Patients ?

A B S T R A C TIntroduction: Approximately there is 50 million people with epilepsy in the world.Currently, pharmacological management is the most therapeutic option. However,about 30% of patients will develop drug-resistant epilepsy. Many factors arethought to affect the treatment success. This study was conducted to determinethe relationship between electroencephalographic results and epilepsy treatmentsuccess. Methods : This is cross sectional observational study. Inclusion criteriawas epileptic patients aged > 18 years and had received epilepsy treatment for atleast 1 year. The chi-square test is performed to see the relationship betweenresearch variables. Results: EEG results has an effect on the success of therapy(p 0.027). The most common type of epileptiform abnormality is sharp waves. Themost epileptiform amplitude and location were 80 microvolts and in the temporallobe. Conclusion: There is a significant relationship between EEG abnormalitiesand the epilepsy treatment success