rosa sanyasi - Academia.edu (original) (raw)

Papers by rosa sanyasi

Cermin Dunia Kedokteran, Jul 1, 2017

Latar Belakang: Depresi merupakan gangguan suasana perasaan yang sering ditemukan. Banyak pasien ... more Latar Belakang: Depresi merupakan gangguan suasana perasaan yang sering ditemukan. Banyak pasien depresi tidak memberikan respons baik terhadap terapi anti-depresan standar. Celecoxib, obat golongan penghambat COX 2, dapat digunakan sebagai terapi add-on. Tujuan: Mengetahui manfaat celecoxib sebagai terapi add on pada depresi. Pembahasan: Depresi memiliki kaitan erat dengan proses inflamasi, yang ditunjukkan dengan peningkatan kadar CRP dan sitokin pro-inflamasi, khususnya IL-6, IL-1, serta TNF-α. Celecoxib bekerja menghambat sintesis PG, sehingga tidak terbentuk metabolit aktif PG, yaitu PGE 2, yang berperan dalam patofisiologi depresi. Celecoxib juga dapat meningkatkan neurotransmiter serotonin dan noradrenalin di SSP dan menekan aktivitas berlebih aksis HPA. Celecoxib sebagai terapi add on mengurangi skor HDRS, menurunkan kadar IL-6 serum, menunjukkan tingkat respons dan remisi lebih baik daripada anti-depresan tunggal atau plasebo. Dosis celecoxib yang paling sering digunakan untuk efek anti-depresan adalah 400 mg/hari selama 6 minggu. Celecoxib dapat ditoleransi dengan baik pada mayoritas pasien. Simpulan: Celecoxib efektif menurunkan gejala depresi, menurunkan konsentrasi sitokin pro-inflamasi dalam darah, menurunkan skor HDRS, dan dapat ditoleransi dengan baik.

Peran Channelopathy pada Tatalaksana Nyeri

Cermin Dunia Kedokteran, Dec 1, 2017

Cermin Dunia Kedokteran

Pendahuluan: Sindrom Mona Lisa (SM) merupakan paralisis nervus fasialis idiopatik pada wanita ham... more Pendahuluan: Sindrom Mona Lisa (SM) merupakan paralisis nervus fasialis idiopatik pada wanita hamil atau wanita post partum. SM sering terkait dengan hipertensi gestasional, superimposed preeklamsia, preeklamsia, dan sindrom HELLP. Faktor risiko independen SM adalah hipertensi kronik dan obesitas. Beberapa hipotesis patofisiologi SM meliputi: kondisi immunocompromised, reaktivasi virus herpes, edema interstisial yang memicu edema perineural dan kompresi nervus fasialis di kanal fasialis os temporal, dan hiperkoagulasi yang memicu trombosis pembuluh darah yang mensuplai nervus fasialis, Tanda dan gejala SM sama dengan Bell’s palsy (BP). Tatalaksana meliputi penggunaan tetes air mata artifisial atau penutup mata, kortikosteroid, dan/atau antiviral. Prognosis SM baik, khususnya pada kasus inkomplit.Background: Mona Lisa Syndrome (MS) is an idiopathic facial nerve paralysis in pregnancy and post partum. MS is correlated to gestational hypertension, superimposed preeclamsia, preeclamsia,...

Journal of Pharmaceutical Sciences and Community, 2017

Oral fingolimod has been recently accepted as a treatment for relapsing Multiple Sclerosis (MS) b... more 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.

Journal of the Medical Sciences, 2019

Neuropathic pain (NP) is type of chronic pain that is common and often difficult to treat. Clinic... more 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 i...

Terapi Intra-Arterial Heparin Flushing Pada Stroke Iskemik Kronik

Terapi reperfusi dapat dibedakan menjadi dua, yaitu terapi intravena (IV) dan terapi intra-arteri... more Terapi reperfusi dapat dibedakan menjadi dua, yaitu terapi intravena (IV) dan terapi intra-arteri (IA). Terapi IA dapat menjadi pilihan pada pasien yang memiliki kontraindikasi terapi IV. Terapi IA pada pasien dengan stroke iskemik kronik belum banyak dilakukan khususnya di Indonesia. Tujuan dari penulisan telaah ini adalah untuk mengetahui manfaat pemberian intra-arterial heparin flushing (IAHF) pada pasien stroke iskemik kronik. Pencarian dilakukan pada PubMed dan Cochrane dengan kata kunci antara lain “ intra-arterial heparin flushing ”, “ intra-arterial therapy in chronic ischemic stroke ”, dan “ heparin in ischemic stroke ”. Penelitian yang dilibatkan dalam telaah ini adalah penelitian yang dilakukan pada pasien stroke iskemik kronik yang memperoleh terapi IAHF. Terdapat dua penelitian yang membahas terapi IAHF pada pasien dengan stroke iskemik. Kedua penelitian tersebut dilakukan pada 75 subjek. Luaran yang dinilai adalah MMT dan CBF. Hasil dari kedua penelitian tersebut menun...

The Progressivity of Carotid Intima-Media Thickness Changes with The Angiotensinogen M235T Gene Variants in Post-Ischemic Stroke Patients

Analysis of total 72 samples showed 37 (51.4%) AGT M235T CT gene variant, 35 (48.6%) AGT M235T TT... more Analysis of total 72 samples showed 37 (51.4%) AGT M235T CT gene variant, 35 (48.6%) AGT M235T TT gene variant, and no AGT M235T CC gene variant. Among the three variants, there was no relationship between the M235T variant and cIMT, either 6 months or 1 year after onset (p>0.05).

A Systematic Review of Evolocumab for Stroke Prevention in Patients with Dyslipidemia

Introduction: Evolocumab is a human monoclonal immunoglobulin G2 (IgG2) directed against human pr... more Introduction: Evolocumab is a human monoclonal immunoglobulin G2 (IgG2) directed against human proprotein convertase subtilisin/kexin type 9 (PCSK9). By inactivating PCSK9, evolocumab upregulates low-density lipoprotein receptor (LDLR) causing increased catabolism of low-density lipoprotein cholesterol (LDL-C) and the consequent reduction of LDL-C levels in the blood. Objective: This systematic review aimed to identify the effectiveness of evolocumab for stroke prevention in patients with dyslipidemia. Method: PubMed and Cochrane Library were searched to identify relevant studies. The keywords were the combination of the following words: evolocumab, PCSK9, stroke, and dyslipidemia. The inclusion criteria of the study i.e : patients with dyslipidemia, was a randomised controlled trial (RCT), published within ten (10) years (from 2008 to 2018), concerned on evolocumab and compared to other pharmacologic agents for the management of dyslipidemia or placebo. The quality of selected stud...

Jurnal Kedokteran dan Kesehatan Indonesia, 2018

Backround: It is very important to know and detect various stroke symptoms because stroke is an e... more 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. Subjects' 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. Latar Belakang: Sangat penting untuk mengetahui dan mendeteksi gejala stroke dengan segera karena penanganan stroke berpacu dengan waktu. Kurangnya pengetahuan mengenai gejala stroke akan mengakibatkan keterlambatan dalam penanganan stroke. Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui perbandingan gejala klinis dan faktor risiko pada pasien stroke iskemik dan stroke hemoragik. Metode: Penelitian ini menggunakan desain penelitian kasus kontrol. Subjek dalam penelitian ini adalah pasien stroke iskemik dan stroke hemoragik yang tergister elekronik di Rumah Sakit Bethesda, Yogyakarta. Hasil: Gejala klinis yang paling sering muncul pada kedua grup adalah kelemahan anggota gerak (76.4% vs 71.4%), sedangkan gejala klinis yang paling jarang adalah wajah perot (2% vs 3.6%). Hipertensi merupakan faktor risiko stroke yang paling sering dijumpai pada kedua grup (48% vs 71.4%), sedangkan atrial fibrilasi paling jarang dijumpai. Penelitian ini tidak menemukan adanya gejala khusus yang

Journal of thee Medical Sciences (Berkala Ilmu Kedokteran), 2020

A new coronavirus disease called COVID-19 was declared by World Health Organization (WHO). The CO... more 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.

Universa Medicina, 2017

BackgroundStroke is the main cause of disability and death in many countries. The high incidence ... more BackgroundStroke 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.MethodsThis 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. ResultsThe 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 complication...

Asian Journal of Pharmacy and Pharmacology, 2018

Background: is commonly known as turmeric constituents include the three curcuminoids: curcumin, ... more Background: is commonly known as turmeric constituents include the three curcuminoids: curcumin, Curcuma longa demethoxycurcumin, and bisdemethoxycurcumin. Curcumin has anti-inflammatory and analgetic action. It is a promising medication to alleviate pain among arthritic patients. : This systematic review aimed to identify Objective the benefit of in arthritis pain. : Systematic research was conducted by using Curcuma longa Materials and Methods PubMed and Cochrane with following terms to search: " ", "curcumin", and "turmeric". The quality of Curcuma longa randomized controlled trial (RCT) study is assessed by using the Jadad score and the selected studies were reviewed by using PRISMA checklist as the guidance. : There were 98 studies related to and arthritis pain. Results Curcuma longa After screening and checking for the eligibility, remains 7 studies. All studies have a good quality indicated by Jadad score of 3. The subjects in most studies were osteoarthritis (OA) patients and compared curcumin with placebo. ≥ Subjects in all studies dominated by female. VAS is the most common scale to assess the degree of pain. Curcumin was considered to be safe in patients with arthritis. It also improves the intensity of pain in all studies. : Conclusion Curcuma longa proved to be effective to reduce pain among arthritic patients. It is also found to be safe without any serious adverse event.

Berkala Ilmiah Kedokteran Duta Wacana, 2017

Pendahuluan : Bunuh diri adalah suatu tindakan yang disengaja untuk mengakhiri hidup diri sendiri... more Pendahuluan : Bunuh diri adalah suatu tindakan yang disengaja untuk mengakhiri hidup diri sendiri. Tindakan bunuh diri dipicu oleh berbagai faktor. Sangat sedikit literatur yang membahas kasus bunuh diri di Indonesia, terlebih faktor yang memicu gantung diri. Tujuan : Tujuan dari penelitian ini adalah untuk mengetahui berbagai faktor yang memicu gantung diri di wilayah Panekan. Metode : Penelitian ini menggunakan metode penelitian deskriptif. Terdapat 7 subjek yang terlibat dalam penelitian ini. Informasi mengenai subjek diperoleh melalui wawancara mendalam dengan responden. Hasil : Subjek penelitian didominasi oleh jenis kelamin laki-laki (57.14%), berusia ≥50 tahun (85.71%), berpendidikan rendah (100%), bekerja sebagai petani (85.71%), dan menikah (100%). Terdapat 4 pemicu utama yang teridentifikasi dalam penelitian ini, yaitu: masalah sosial, masalah ekonomi, penyakit kronik, dan gangguan mental yang lama tidak tertangani. Ada satu subjek yang tidak teridentifikasi pemicu utamany...

Berkala Ilmiah Kedokteran Duta Wacana, 2018

Pendahuluan: Leptospirosis merupakan penyakit zoonosis yang disebabkan oleh bakteri Leptospira sp... more Pendahuluan: Leptospirosis merupakan penyakit zoonosis yang disebabkan oleh bakteri Leptospira sp. Lepstospirosis banyak dijumpai di negara tropis dan negara berkembang, termasuk Indonesia. Timbulnya atau meningkatnya kejadian kesakitan dan atau kematian yang bermakna secara epidemiologi pada suatu daerah dalam kurun waktu tertentu dan merupakan keadaan yang dapat menjurus pada terjadinya wabah disebut sebagai kejadian luar biasa (KLB). Selama ini belum pernah terdapat kasus leptospirosis yang dijumpai di Magetan, Jawa Timur. Tujuan: Laporan kasus ini bertujuan untuk menjabarkan kronologi KLB leptospirosis di Magetan, Jawa Timur. Hasil dan Pembahasan: Pasien perempuan berusia 40 tahun datang ke Puskesmas Panekan, Magetan, Jawa Timur dengan keluhan demam sejak 6 hari sebelumnya disertai dengan mual, muntah, nyeri di perut sebelah kanan, nyeri pada kedua betis, sesak nafas, dan mata berubah menjadi berwarna kuning. Pasien menjalani rawat inap di Puskesmas. Dari hasil pemeriksaan darah...

Asian Journal of Medical Sciences, 2020

Background: Chronic kidney disease (CKD) patients often have a high homocysteine level Hyperhomoc... more Background: Chronic kidney disease (CKD) patients often have a high homocysteine level Hyperhomocystinemia considered as one of cardiovascular disease risk factor in CKD patients. Studies concern on the proportion of hyperhomocysteinemia in patients with CKD in Indonesia are very limited. Aims and Objectives: The main objective was to identify the proportion of hyperhomocysteinemia in CKD patients. Materials and Methods: This was a cross sectional study. Subjects in this study were CKD patients with routine hemodyalisis two times per week. Five mililiters venous blood was collected before the first hemodyalisis. The blood was stored into tubes contain clot activator. Homocysteine level higher than 15.39 μmol/L considered as hyperhomocysteine. Results: Total of 122 subjects included at this study. Subjects dominated by male with mean age of 51.7 years. Anemia (86.9%) and hypertension (86.1%) were the common comorbidities. Co-treatment assessed in this study i.e.: folic acid, calcium ...

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

Journal of Drug Delivery and Therapeutics, 2020

Background: Chronic kidney disease (CKD) patients often have a chronic fatigue and lower QoL, thu... more 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 week...

Asian Pacific Journal of Health Sciences, 2018

This study was a cross-sectional study. This study conducted at Bethesda Hospital, Yogyakarta, fr... more This study was a cross-sectional study. This study conducted at Bethesda Hospital, Yogyakarta, from March to May 2017. Subjects' data were obtained from medical record and electronic stroke registry. Study Subjects and Sampling Calculation The subjects were post-ischemic stroke patients. The inclusion criteria, i.e., (1) age >18 years, (2) suffered from ischemic stroke within 6 months, and (3) agreed to be a study subject. Ischemic stroke diagnosis was confirmed by neurologist supported by computed tomography (CT) scan examination. Every subject was given an informed consent before performed the tests. The exclusion criteria, i.e., (1) subjects with incomplete data, (2) subjects with a history of Alzheimer, Parkinson, dementia before time to hospital, epilepsy, head trauma, meningoencephalitis, delirium, motoric disorder on dominant side, visual impairment, PSCI includes all forms of cognitive decline that develops after stroke [5] includes executive function, memory, language, visuospatial ability, visuoconstructional ability, or global cognitive function. [6] PSCI may interfere with the quality of life in stroke survivor. [7] Cognitive impairment constitutes a substantial world health burden that is likely to increase with ageing populations and emphasize the critical need for effective treatments. [8] The study in PSCI epidemiology and contributing factor(s) is limited in Indonesia. The combination of Montreal Cognitive Assesment-Indonesian Version (MoCA-INA) and clock drawing test (CDT) as the diagnostic tools for PSCI in Indonesia is not

Global Journal of Medical Research, 2019

Background: Chronic pain is the major complaint in subjects with osteoarthritis (OA). Non-steroid... more Background: Chronic pain is the major complaint in subjects with osteoarthritis (OA). Non-steroid anti-inflammatory drug (NSAID) is still the drug of choice in Indonesia to treat OA patients. The prolonged consumption of NSAID may lead to many adverse events (AE). Some previous studies showed the extract of Curcuma longa and Boswellia serrata is a promising potential as therapeutic interventions against OA. Objective: This study aimed to evaluate the effectiveness and safety of CB extract to relieve symptoms in patients with OA. Study Design: This was a randomized controlled trial (RCT) in OA patients. The treatment used in this trial were CB extract (350 mg of Curcuma longa and 150 mg Boswellia serrata) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium). Subjects were randomized to 3 different groups (Group 1: CB extract and NSAID; group 2: CB extract; group 3: NSAID). Each medication was taken two times per day for four weeks. Paracetamol tablet 500 mg gave to each subject as...

Asian Journal of Pharmacy and Pharmacology, 2018

Background: Low back pain (LBP) is the main cause of disability. Eperisone is a centrally acting ... more Background: Low back pain (LBP) is the main cause of disability. Eperisone is a centrally acting muscle relaxants. It is often used to alleviate musculoskeletal pain including LBP. This systematic review aimed to identify the Objective: effectiveness of eperisone in LBP. Systematic research was conducted by using PubMed and Cochrane with Methods: following terms to search: "eperisone", "low back pain and eperisone", "low back pain and muscle relaxant', "low back pain and antispasmodic", "randomized controlled trial eperisone", and "randomized controlled trial muscle relaxant". The quality of randomized controlled trial (RCT) study is assessed by using the Jadad score by and he selected studies t were reviewed by using PRISMA checklist as the guidance. There were 1389 citations from PubMed and Results: Cohcrane. After screening for title and abstract, irrelevant topic, availability of full text, duplication, the final result was 6 RCT. All studies have a great quality. Subjects in all study were patients with LBP. Eperisone in these study compared to eperisone with different dosage, tizanidine, thiocolchicoside, diazepam, or placebo. Thiacolchicoside was the most common comparison. Visual Analogue Scale (VAS) and Finger to Floor Distance (FFD) were the most common outcome measurement. Eperisone represents a good efficacy to treat LBP and has a better tolerability. Conclusion:

Asian Journal of Pharmacy and Pharmacology, 2018

Background: Vertigo is the subtype of dizziness and impair patients' health-related quality of li... more Background: Vertigo is the subtype of dizziness and impair patients' health-related quality of life. Betahistine is generally well-tolerated as an anti-vertigo drug. This systematic review aimed to identify the effectiveness Objective: of betahistine in vertigo patients Systematic research was done by using PubMed and Cochrane. with. Methods: following terms to search: "vertigo medication", "betahistine", "betahistine dihydrochloride", "betahistine mesilate", and "betahistine in vertigo". The quality of randomized controlled trial (RCT) study is assesed by using Jadad score by and he selected studies were reviewed by using PRISMA checklist as the guidance. There were 2669 citation t Results: from PubMed and Cohcrane. After adjusting for inclusion and exclusion criteria, the final result was a total 6 RCT studies included in this review. One study was discarded because lack of quality as an RCT study, thus remained 5 studies. All selected studies were RCT published in English within the last 10 years, involved subjects with vertigo. Each study was compared betahistine to: different dose of betahistine, diuretics, promethazine, dietary salt restriction, or Semont's maneuver. Among 5 studies, 4 studies prove betahistine is an effective drug in vertigo Conclusion: treatment.

Cermin Dunia Kedokteran, Jul 1, 2017

Latar Belakang: Depresi merupakan gangguan suasana perasaan yang sering ditemukan. Banyak pasien ... more Latar Belakang: Depresi merupakan gangguan suasana perasaan yang sering ditemukan. Banyak pasien depresi tidak memberikan respons baik terhadap terapi anti-depresan standar. Celecoxib, obat golongan penghambat COX 2, dapat digunakan sebagai terapi add-on. Tujuan: Mengetahui manfaat celecoxib sebagai terapi add on pada depresi. Pembahasan: Depresi memiliki kaitan erat dengan proses inflamasi, yang ditunjukkan dengan peningkatan kadar CRP dan sitokin pro-inflamasi, khususnya IL-6, IL-1, serta TNF-α. Celecoxib bekerja menghambat sintesis PG, sehingga tidak terbentuk metabolit aktif PG, yaitu PGE 2, yang berperan dalam patofisiologi depresi. Celecoxib juga dapat meningkatkan neurotransmiter serotonin dan noradrenalin di SSP dan menekan aktivitas berlebih aksis HPA. Celecoxib sebagai terapi add on mengurangi skor HDRS, menurunkan kadar IL-6 serum, menunjukkan tingkat respons dan remisi lebih baik daripada anti-depresan tunggal atau plasebo. Dosis celecoxib yang paling sering digunakan untuk efek anti-depresan adalah 400 mg/hari selama 6 minggu. Celecoxib dapat ditoleransi dengan baik pada mayoritas pasien. Simpulan: Celecoxib efektif menurunkan gejala depresi, menurunkan konsentrasi sitokin pro-inflamasi dalam darah, menurunkan skor HDRS, dan dapat ditoleransi dengan baik.

Peran Channelopathy pada Tatalaksana Nyeri

Cermin Dunia Kedokteran, Dec 1, 2017

Cermin Dunia Kedokteran

Pendahuluan: Sindrom Mona Lisa (SM) merupakan paralisis nervus fasialis idiopatik pada wanita ham... more Pendahuluan: Sindrom Mona Lisa (SM) merupakan paralisis nervus fasialis idiopatik pada wanita hamil atau wanita post partum. SM sering terkait dengan hipertensi gestasional, superimposed preeklamsia, preeklamsia, dan sindrom HELLP. Faktor risiko independen SM adalah hipertensi kronik dan obesitas. Beberapa hipotesis patofisiologi SM meliputi: kondisi immunocompromised, reaktivasi virus herpes, edema interstisial yang memicu edema perineural dan kompresi nervus fasialis di kanal fasialis os temporal, dan hiperkoagulasi yang memicu trombosis pembuluh darah yang mensuplai nervus fasialis, Tanda dan gejala SM sama dengan Bell’s palsy (BP). Tatalaksana meliputi penggunaan tetes air mata artifisial atau penutup mata, kortikosteroid, dan/atau antiviral. Prognosis SM baik, khususnya pada kasus inkomplit.Background: Mona Lisa Syndrome (MS) is an idiopathic facial nerve paralysis in pregnancy and post partum. MS is correlated to gestational hypertension, superimposed preeclamsia, preeclamsia,...

Journal of Pharmaceutical Sciences and Community, 2017

Oral fingolimod has been recently accepted as a treatment for relapsing Multiple Sclerosis (MS) b... more 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.

Journal of the Medical Sciences, 2019

Neuropathic pain (NP) is type of chronic pain that is common and often difficult to treat. Clinic... more 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 i...

Terapi Intra-Arterial Heparin Flushing Pada Stroke Iskemik Kronik

Terapi reperfusi dapat dibedakan menjadi dua, yaitu terapi intravena (IV) dan terapi intra-arteri... more Terapi reperfusi dapat dibedakan menjadi dua, yaitu terapi intravena (IV) dan terapi intra-arteri (IA). Terapi IA dapat menjadi pilihan pada pasien yang memiliki kontraindikasi terapi IV. Terapi IA pada pasien dengan stroke iskemik kronik belum banyak dilakukan khususnya di Indonesia. Tujuan dari penulisan telaah ini adalah untuk mengetahui manfaat pemberian intra-arterial heparin flushing (IAHF) pada pasien stroke iskemik kronik. Pencarian dilakukan pada PubMed dan Cochrane dengan kata kunci antara lain “ intra-arterial heparin flushing ”, “ intra-arterial therapy in chronic ischemic stroke ”, dan “ heparin in ischemic stroke ”. Penelitian yang dilibatkan dalam telaah ini adalah penelitian yang dilakukan pada pasien stroke iskemik kronik yang memperoleh terapi IAHF. Terdapat dua penelitian yang membahas terapi IAHF pada pasien dengan stroke iskemik. Kedua penelitian tersebut dilakukan pada 75 subjek. Luaran yang dinilai adalah MMT dan CBF. Hasil dari kedua penelitian tersebut menun...

The Progressivity of Carotid Intima-Media Thickness Changes with The Angiotensinogen M235T Gene Variants in Post-Ischemic Stroke Patients

Analysis of total 72 samples showed 37 (51.4%) AGT M235T CT gene variant, 35 (48.6%) AGT M235T TT... more Analysis of total 72 samples showed 37 (51.4%) AGT M235T CT gene variant, 35 (48.6%) AGT M235T TT gene variant, and no AGT M235T CC gene variant. Among the three variants, there was no relationship between the M235T variant and cIMT, either 6 months or 1 year after onset (p>0.05).

A Systematic Review of Evolocumab for Stroke Prevention in Patients with Dyslipidemia

Introduction: Evolocumab is a human monoclonal immunoglobulin G2 (IgG2) directed against human pr... more Introduction: Evolocumab is a human monoclonal immunoglobulin G2 (IgG2) directed against human proprotein convertase subtilisin/kexin type 9 (PCSK9). By inactivating PCSK9, evolocumab upregulates low-density lipoprotein receptor (LDLR) causing increased catabolism of low-density lipoprotein cholesterol (LDL-C) and the consequent reduction of LDL-C levels in the blood. Objective: This systematic review aimed to identify the effectiveness of evolocumab for stroke prevention in patients with dyslipidemia. Method: PubMed and Cochrane Library were searched to identify relevant studies. The keywords were the combination of the following words: evolocumab, PCSK9, stroke, and dyslipidemia. The inclusion criteria of the study i.e : patients with dyslipidemia, was a randomised controlled trial (RCT), published within ten (10) years (from 2008 to 2018), concerned on evolocumab and compared to other pharmacologic agents for the management of dyslipidemia or placebo. The quality of selected stud...

Jurnal Kedokteran dan Kesehatan Indonesia, 2018

Backround: It is very important to know and detect various stroke symptoms because stroke is an e... more 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. Subjects' 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. Latar Belakang: Sangat penting untuk mengetahui dan mendeteksi gejala stroke dengan segera karena penanganan stroke berpacu dengan waktu. Kurangnya pengetahuan mengenai gejala stroke akan mengakibatkan keterlambatan dalam penanganan stroke. Tujuan Penelitian: Penelitian ini bertujuan untuk mengetahui perbandingan gejala klinis dan faktor risiko pada pasien stroke iskemik dan stroke hemoragik. Metode: Penelitian ini menggunakan desain penelitian kasus kontrol. Subjek dalam penelitian ini adalah pasien stroke iskemik dan stroke hemoragik yang tergister elekronik di Rumah Sakit Bethesda, Yogyakarta. Hasil: Gejala klinis yang paling sering muncul pada kedua grup adalah kelemahan anggota gerak (76.4% vs 71.4%), sedangkan gejala klinis yang paling jarang adalah wajah perot (2% vs 3.6%). Hipertensi merupakan faktor risiko stroke yang paling sering dijumpai pada kedua grup (48% vs 71.4%), sedangkan atrial fibrilasi paling jarang dijumpai. Penelitian ini tidak menemukan adanya gejala khusus yang

Journal of thee Medical Sciences (Berkala Ilmu Kedokteran), 2020

A new coronavirus disease called COVID-19 was declared by World Health Organization (WHO). The CO... more 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.

Universa Medicina, 2017

BackgroundStroke is the main cause of disability and death in many countries. The high incidence ... more BackgroundStroke 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.MethodsThis 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. ResultsThe 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 complication...

Asian Journal of Pharmacy and Pharmacology, 2018

Background: is commonly known as turmeric constituents include the three curcuminoids: curcumin, ... more Background: is commonly known as turmeric constituents include the three curcuminoids: curcumin, Curcuma longa demethoxycurcumin, and bisdemethoxycurcumin. Curcumin has anti-inflammatory and analgetic action. It is a promising medication to alleviate pain among arthritic patients. : This systematic review aimed to identify Objective the benefit of in arthritis pain. : Systematic research was conducted by using Curcuma longa Materials and Methods PubMed and Cochrane with following terms to search: " ", "curcumin", and "turmeric". The quality of Curcuma longa randomized controlled trial (RCT) study is assessed by using the Jadad score and the selected studies were reviewed by using PRISMA checklist as the guidance. : There were 98 studies related to and arthritis pain. Results Curcuma longa After screening and checking for the eligibility, remains 7 studies. All studies have a good quality indicated by Jadad score of 3. The subjects in most studies were osteoarthritis (OA) patients and compared curcumin with placebo. ≥ Subjects in all studies dominated by female. VAS is the most common scale to assess the degree of pain. Curcumin was considered to be safe in patients with arthritis. It also improves the intensity of pain in all studies. : Conclusion Curcuma longa proved to be effective to reduce pain among arthritic patients. It is also found to be safe without any serious adverse event.

Berkala Ilmiah Kedokteran Duta Wacana, 2017

Pendahuluan : Bunuh diri adalah suatu tindakan yang disengaja untuk mengakhiri hidup diri sendiri... more Pendahuluan : Bunuh diri adalah suatu tindakan yang disengaja untuk mengakhiri hidup diri sendiri. Tindakan bunuh diri dipicu oleh berbagai faktor. Sangat sedikit literatur yang membahas kasus bunuh diri di Indonesia, terlebih faktor yang memicu gantung diri. Tujuan : Tujuan dari penelitian ini adalah untuk mengetahui berbagai faktor yang memicu gantung diri di wilayah Panekan. Metode : Penelitian ini menggunakan metode penelitian deskriptif. Terdapat 7 subjek yang terlibat dalam penelitian ini. Informasi mengenai subjek diperoleh melalui wawancara mendalam dengan responden. Hasil : Subjek penelitian didominasi oleh jenis kelamin laki-laki (57.14%), berusia ≥50 tahun (85.71%), berpendidikan rendah (100%), bekerja sebagai petani (85.71%), dan menikah (100%). Terdapat 4 pemicu utama yang teridentifikasi dalam penelitian ini, yaitu: masalah sosial, masalah ekonomi, penyakit kronik, dan gangguan mental yang lama tidak tertangani. Ada satu subjek yang tidak teridentifikasi pemicu utamany...

Berkala Ilmiah Kedokteran Duta Wacana, 2018

Pendahuluan: Leptospirosis merupakan penyakit zoonosis yang disebabkan oleh bakteri Leptospira sp... more Pendahuluan: Leptospirosis merupakan penyakit zoonosis yang disebabkan oleh bakteri Leptospira sp. Lepstospirosis banyak dijumpai di negara tropis dan negara berkembang, termasuk Indonesia. Timbulnya atau meningkatnya kejadian kesakitan dan atau kematian yang bermakna secara epidemiologi pada suatu daerah dalam kurun waktu tertentu dan merupakan keadaan yang dapat menjurus pada terjadinya wabah disebut sebagai kejadian luar biasa (KLB). Selama ini belum pernah terdapat kasus leptospirosis yang dijumpai di Magetan, Jawa Timur. Tujuan: Laporan kasus ini bertujuan untuk menjabarkan kronologi KLB leptospirosis di Magetan, Jawa Timur. Hasil dan Pembahasan: Pasien perempuan berusia 40 tahun datang ke Puskesmas Panekan, Magetan, Jawa Timur dengan keluhan demam sejak 6 hari sebelumnya disertai dengan mual, muntah, nyeri di perut sebelah kanan, nyeri pada kedua betis, sesak nafas, dan mata berubah menjadi berwarna kuning. Pasien menjalani rawat inap di Puskesmas. Dari hasil pemeriksaan darah...

Asian Journal of Medical Sciences, 2020

Background: Chronic kidney disease (CKD) patients often have a high homocysteine level Hyperhomoc... more Background: Chronic kidney disease (CKD) patients often have a high homocysteine level Hyperhomocystinemia considered as one of cardiovascular disease risk factor in CKD patients. Studies concern on the proportion of hyperhomocysteinemia in patients with CKD in Indonesia are very limited. Aims and Objectives: The main objective was to identify the proportion of hyperhomocysteinemia in CKD patients. Materials and Methods: This was a cross sectional study. Subjects in this study were CKD patients with routine hemodyalisis two times per week. Five mililiters venous blood was collected before the first hemodyalisis. The blood was stored into tubes contain clot activator. Homocysteine level higher than 15.39 μmol/L considered as hyperhomocysteine. Results: Total of 122 subjects included at this study. Subjects dominated by male with mean age of 51.7 years. Anemia (86.9%) and hypertension (86.1%) were the common comorbidities. Co-treatment assessed in this study i.e.: folic acid, calcium ...

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

Journal of Drug Delivery and Therapeutics, 2020

Background: Chronic kidney disease (CKD) patients often have a chronic fatigue and lower QoL, thu... more 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 week...

Asian Pacific Journal of Health Sciences, 2018

This study was a cross-sectional study. This study conducted at Bethesda Hospital, Yogyakarta, fr... more This study was a cross-sectional study. This study conducted at Bethesda Hospital, Yogyakarta, from March to May 2017. Subjects' data were obtained from medical record and electronic stroke registry. Study Subjects and Sampling Calculation The subjects were post-ischemic stroke patients. The inclusion criteria, i.e., (1) age >18 years, (2) suffered from ischemic stroke within 6 months, and (3) agreed to be a study subject. Ischemic stroke diagnosis was confirmed by neurologist supported by computed tomography (CT) scan examination. Every subject was given an informed consent before performed the tests. The exclusion criteria, i.e., (1) subjects with incomplete data, (2) subjects with a history of Alzheimer, Parkinson, dementia before time to hospital, epilepsy, head trauma, meningoencephalitis, delirium, motoric disorder on dominant side, visual impairment, PSCI includes all forms of cognitive decline that develops after stroke [5] includes executive function, memory, language, visuospatial ability, visuoconstructional ability, or global cognitive function. [6] PSCI may interfere with the quality of life in stroke survivor. [7] Cognitive impairment constitutes a substantial world health burden that is likely to increase with ageing populations and emphasize the critical need for effective treatments. [8] The study in PSCI epidemiology and contributing factor(s) is limited in Indonesia. The combination of Montreal Cognitive Assesment-Indonesian Version (MoCA-INA) and clock drawing test (CDT) as the diagnostic tools for PSCI in Indonesia is not

Global Journal of Medical Research, 2019

Background: Chronic pain is the major complaint in subjects with osteoarthritis (OA). Non-steroid... more Background: Chronic pain is the major complaint in subjects with osteoarthritis (OA). Non-steroid anti-inflammatory drug (NSAID) is still the drug of choice in Indonesia to treat OA patients. The prolonged consumption of NSAID may lead to many adverse events (AE). Some previous studies showed the extract of Curcuma longa and Boswellia serrata is a promising potential as therapeutic interventions against OA. Objective: This study aimed to evaluate the effectiveness and safety of CB extract to relieve symptoms in patients with OA. Study Design: This was a randomized controlled trial (RCT) in OA patients. The treatment used in this trial were CB extract (350 mg of Curcuma longa and 150 mg Boswellia serrata) and NSAID (400 mg ibuprofen or 50 mg diclofenac sodium). Subjects were randomized to 3 different groups (Group 1: CB extract and NSAID; group 2: CB extract; group 3: NSAID). Each medication was taken two times per day for four weeks. Paracetamol tablet 500 mg gave to each subject as...

Asian Journal of Pharmacy and Pharmacology, 2018

Background: Low back pain (LBP) is the main cause of disability. Eperisone is a centrally acting ... more Background: Low back pain (LBP) is the main cause of disability. Eperisone is a centrally acting muscle relaxants. It is often used to alleviate musculoskeletal pain including LBP. This systematic review aimed to identify the Objective: effectiveness of eperisone in LBP. Systematic research was conducted by using PubMed and Cochrane with Methods: following terms to search: "eperisone", "low back pain and eperisone", "low back pain and muscle relaxant', "low back pain and antispasmodic", "randomized controlled trial eperisone", and "randomized controlled trial muscle relaxant". The quality of randomized controlled trial (RCT) study is assessed by using the Jadad score by and he selected studies t were reviewed by using PRISMA checklist as the guidance. There were 1389 citations from PubMed and Results: Cohcrane. After screening for title and abstract, irrelevant topic, availability of full text, duplication, the final result was 6 RCT. All studies have a great quality. Subjects in all study were patients with LBP. Eperisone in these study compared to eperisone with different dosage, tizanidine, thiocolchicoside, diazepam, or placebo. Thiacolchicoside was the most common comparison. Visual Analogue Scale (VAS) and Finger to Floor Distance (FFD) were the most common outcome measurement. Eperisone represents a good efficacy to treat LBP and has a better tolerability. Conclusion:

Asian Journal of Pharmacy and Pharmacology, 2018

Background: Vertigo is the subtype of dizziness and impair patients' health-related quality of li... more Background: Vertigo is the subtype of dizziness and impair patients' health-related quality of life. Betahistine is generally well-tolerated as an anti-vertigo drug. This systematic review aimed to identify the effectiveness Objective: of betahistine in vertigo patients Systematic research was done by using PubMed and Cochrane. with. Methods: following terms to search: "vertigo medication", "betahistine", "betahistine dihydrochloride", "betahistine mesilate", and "betahistine in vertigo". The quality of randomized controlled trial (RCT) study is assesed by using Jadad score by and he selected studies were reviewed by using PRISMA checklist as the guidance. There were 2669 citation t Results: from PubMed and Cohcrane. After adjusting for inclusion and exclusion criteria, the final result was a total 6 RCT studies included in this review. One study was discarded because lack of quality as an RCT study, thus remained 5 studies. All selected studies were RCT published in English within the last 10 years, involved subjects with vertigo. Each study was compared betahistine to: different dose of betahistine, diuretics, promethazine, dietary salt restriction, or Semont's maneuver. Among 5 studies, 4 studies prove betahistine is an effective drug in vertigo Conclusion: treatment.