Eka Widyadharma, MD, M.Sc, PhD | Udayana University Bali Indonesia (original) (raw)

Papers by Eka Widyadharma, MD, M.Sc, PhD

Neuropathic pain (NP) is a result of direct disturbances of somatosensory pathways. Its pathophys... more Neuropathic pain (NP) is a result of direct disturbances of somatosensory pathways. Its pathophysiology includes various mechanisms. Recent studies have reported an important role of microglia in the NP mechanism. There are several chemical molecules which are involved in microglia activation. The activated microglia will, in turn, enhance some receptors expression that can be used as markers of its activation. Though we still need future studies about precise microglia role in NP mechanism, the chemical mediators that initiate microglia activation and the alteration of some receptors in the activated microglia which have been found from previous studies can be the interesting future research materials and the promising target for a new therapy for NP.

Background: Neurocognitive complications in HIV patients are known as HIV-associated neurocogniti... more Background: Neurocognitive complications in HIV patients are known as HIV-associated neurocognitive disorder (HAND)
with incidence rates as much as 51% and the domain most affected is memory (63%). Verbal memory impairment is one of the deficits
that still exists even in the era of antiretroviral use. Memory impairment in HIV patients has an impact on the inability to work,
dependency in activities of daily living and poor adherence to ARV treatment. Objective: To determine the correlation between cognitive
impairment and Rey Auditory-Verbal Learning Test (RAVLT) on HIV patients in Sanglah Hospital Denpasar. Methods: A crosssectional
study was conducted involving 30 patients with HIV in outpatient clinic VCT Sanglah Hospital in the period from June to
August 2016. Cognitive impairment was assessed when the score of Montreal Cognitive Assessment Indonesian version (MoCA-Ina)
<26. Further examination with RAVLT consists of A1-5 trial, distractor, A6 trial (immediate recall), trial 7 (delayed recall) and
recognition. Results: Lambda correlation test between cognitive impairment and immediate recall RAVLT yielded r=0.571, p=0.045 and
delayed recall RAVLT was r=0.615, p=0.011, thus indicating a strong positive, statistically significant correlation (p<0.05).
Furthermore, the recognition RAVLT yielded r=0.429, p = 0.068 which showed a moderate, non-significant correlation (p> 0.05).
Conclusions: HIV patients who experience cognitive impairment had a greater likelihood for impairment of immediate recall and
delayed recall of verbal memory assessed using RAVLT.

Dementia is one of the non-motor symptoms are most common in Parkinson's disease, and often come ... more Dementia is one of the non-motor symptoms are most common in Parkinson's disease, and often come along with worsening of motor symptoms. Parkinson's Disease Cognitive Rating Scale (PD-CRS) is to be accurate to detect dementia as a worsening of cognitive impairment on the PP because it can simultaneously assess disturbances in subcortical and cortical systems. To measure Indonesian version of Parkinson's Disease Cognitive Rating Scale (PD-CRS) reliability as an instrument for screening cognitive impairtment of parkinson's patients in Sanglah Hospital Denpasar. A cross-sectional observational study design. Every inclusion patients have been interviewed by 2 phycicians, with 5 to 10 minutes interval using PD-CRS that has been translated in Indonesian language. Reliability, by means inter-rater agreement valuation and analyzed by using Kappa Cohen coefficient. A total of 20 parkinson's patients as subjects (14 men, 70% and 6 women, 30%) with mean age 62,35 + 6,22 years. The result of inter-rater agreement (Kappa coefficient) of PD-CSRS subscale is 0,800. PD-CRS scale modification in Indonesian demonstrated good reliability with good agreement among the examiners. ABSTRAK Demensia merupakan salah satu gejala non motorik yang paling sering terjadi pada penyakit Parkinson, dan seringkali ikut memburuk bersamaan dengan perburukan gejala motorik. Parkinson's Disease Cognitive Rating Scale (PD-CRS) dikatakan cukup akurat untuk mendeteksi demensia sebagai perburukan dari gangguan fungsi kognitif pada PP karena dapat menilai secara bersamaan gangguan pada sistim subkortikal dan kortikal. Penelitian ini bertujuan untuk menilai kesepakatan skala Parkinson's Disease Cognitive Rating Scale (PD-CRS) dalam Bahasa Indonesia sebagai instrumen pemeriksaan yang reliabel atau dapat dipercaya untuk menyaring gangguan kognitif pada pasien-pasien penyakit parkinson di RSUP Sanglah Denpasar. Penelitian ini menggunakan disain potong lintang. Setiap pasien yang memenuhi kriteria inklusi telah diwawancarai oleh 2 orang dokter, dalam selang waktu 5 – 10 menit. Setiap wawancara menggunakan skala yang telah diterjemahkan dalam bahasa Indonesia. Uji reliabilitas menggunakan koefisien Kappa Cohen. Penelitian ini melibatkan sebanyak 20 penderita penyakit parkinson terdiri dari 14 orang lelaki (70%) dan 6 orang perempuan (30%) dengan usia rata-rata 62,35 + 6,22 tahun. Hasil dari kesepakatan antar pemeriksa (koefisien Kappa) skala PD-CRS modifikasi yaitu sebesar 0,800 (p.0,001). Skala PD-CRS modifikasi dalam Bahasa Indonesia menunjukkan reliabilitas yang baik dengan kesepakatan antar pemeriksa yang sangat baik.

The function of sleep is very important and vital. Disruption in sleep latency, duration, effecti... more The function of sleep is very important and vital. Disruption in sleep latency, duration, effectiveness and satisfaction of sleep is a sign of a person experiencing insomnia. Military personnel in the Health Headquarters of Military Regional (Makesdam) IX / Udayana has the duty burden, both physical and psychological that quite a lot, which is also prone to insomnia. Effect of chronic insomnia can interfere with quality of life, performance and social function. It is important to study the correlation between insomnia on military personnel with their quality of life. Our study purpose is to obtain insomnia correlation with quality of life of military personnel in the Makesdam IX/Udayana. This study is a cross-sectional design. Subject taken by consecutive sampling. Insomnia was measured with a KSPBJ Insomnia Rating Scale questionnaire, and quality of life were measured by 36-Item shortform (SF-36) questionnaire. Correlation between Insomnia with the quality of life using Spearman's test. Statistical analysis using SPSS 20.0 for windows. Result of this study involved 130 subjects, consisting of 110 men (84.6%) and 20 women (15.4%), with a mean age of 41.35±8.138 years. Insomnia as many as 55 (42%) with the distribution of 48 males (87%) and 7 women (13%). Insomnia negatively weakly correlated with quality of life impairment in the dimension of mental health (r =-0.379) shown in the domain limitations due to emotional problems (r =-0.310), energy/vitality (r =-0.372), and mental well-being (r =-0.368), with p < 0.001.There is no correlation between insomnia with quality of life impairment in the dimensions of physical health (p = 0.244). Conclusions in this study, insomnia correlated with the quality of life impairment in mental health dimension.

Dizziness is a very common symptom. It is difficult to evaluate severity of dizziness. Vertigo sy... more Dizziness is a very common symptom. It is difficult to evaluate severity of dizziness. Vertigo symptom scale short form (VSS-SF), a validated and reliable questionnaire has proposed for evaluating the benefit of vestibular rehabilitation treatment. It measure severity of dizziness including of balance and autonomic-anxiety dimensions within the past month. This questionnaire had been translated into Norwegian with good results, but the translation in Indonesian has not been done yet. This is a cross-sectional observational study design to measure reliability of Indonesian version of vertigo symptom scale short form (VSS-SF). A total of twenty patients with dizziness were analyzed by using Kappa Cohen coefficient including of 17 women (85%) and 3 men (15%), mean age 39.1 years (SD 14.03 years) with diagnosis of benign paroxysmal positional vertigo (BPPV) 90% (18 cases) and cervical dizziness 10% (2 cases). The scale showed kappa coefficient of 0.89. Therefore, it has a very good inter rater agreement.

The relationship between low absolute CD4 lymphocyte count and neurological complications is well... more The relationship between low absolute CD4 lymphocyte count and neurological complications is well established in the era preceding highly active antiretroviral therapy (HAART). The aims of this study to assess the proportion of cognitive decline among HIV outclinic patient Sardjito General Hospital Yogyakarta and to determine whether the difference of CD4 count between HIV positive patients with cognitive decline and without cognitive decline. A cross sectional study with consecutive sampling. Subject eligible were 15-50 years of age, without a history of stroke, brain injury, CNS tumor and Parkinson's disease wich devided into 2 groups (CD4 > 200 cel/mm3 and d " 200 cel/mm3). Cognitive function was measured by using MMSE and specified for each domain. Digit span and Trail Making Test B were added to further analyze short term memory and motor processing speed and they perform CD4 count in their blood. Ninety six patients fulfill inclution and exclution criteria. Proportion of cognitive decline was 33.3% among HIV patient. Univariate analysis showed significant difference of CD4 count between HIV positive patients with cognitive decline and without cognitive decline (p=0.02). CD4 count was significantly different in the decline of all cognitive domain on MMSE, also in the decline of short term memory and processing speed. There are high of cognitive decline among HIV outclinic patient Sardjito General Hospital Yogyakarta. CD4 count are difference between HIV positive patients with cognitive decline and without cognitive decline.

Objective: Ruptured saccular aneurysms are a common and serious medical problem. The prevalence o... more Objective: Ruptured saccular aneurysms are a common and serious medical problem. The prevalence of aneurysms is low during the first two decades of life and increases steadily after the third decade. Anterior communicating artery (AComA) aneurysms are regarded as the most complex of all intracranial aneurysms. Methods: Here, we report a case of an aneurysm of AComA patient with the development of microsurgical technique and intraoperative monitoring technique. Results: Permanent clipping was successfully performed in the neck of an aneurysm of AComA. Conclusion: Microsurgical clipping still remains a definitive treatment of ruptured cerebral aneurysms.

Epidural hematoma is 2.7 to 4 percent of all intracranial bleeding with the outcomes tend to be f... more Epidural hematoma is 2.7 to 4 percent of all intracranial bleeding with the outcomes tend to be favorable and the mortality rate is expected to approach zero. Efforts to detect risk factors as early as possible is important to do so that quick action resulted in a better outcome. This research is an observational study with cohort research methods involving 80 patients with post-trepanation EDH hematoma evacuation in June 2015 to June 2016. The risk factors identified, age, GCS, pupillary abnormalities, lucid interval, volume and location of the EDH, midline shift and other focal lesions. Were followed up for 3 months after surgery to determine the risk factors that affect pure outcome. Hubungan between risk factors were analyzed using bivariate and multivariate analysis with 95% CI. In bivariate analysis found five significant risk factors: lucid interval, GCS, pupillary abnormalities, midline shift and the duration of the pre-surgery. After multivariate analysis obtained two risk factors were statistically significant to the outcome of patients EDH post trepanation evacuation of hematoma, namely: GCS (RR 4.553 95% CI 3.846 to 2.340) and duration of pre-surgery (RR 4.655 95% CI 4.470 to 2.473). Patients with GCS less than or equal to 8, and the duration of the pre-operation more than 12 hours was associated with unfavorable outcome of patients after trepanation EDH evacuation of hematoma.

Background: Resident doctors often experience sleep deprivation due to their night shift duty. In... more Background: Resident doctors often experience sleep deprivation due to their night shift duty. In some studies, the night shift duty was correlated with decrease of professional performance, in term of cognitive function and ability. Purpose: To find the effect of partial sleep deprivation in decreased cognitive function in resident doctors of Medical Faculty of Udayana University/Sanglah General Hospital Denpasar. Method: This is an analytic observational prospective cohort conducted in Sanglah General Hospital Denpasar from December 2016 to January 2017, in 88 subjects (44 subjects with partial sleep deprivation and 44 subjects with no sleep deprivation). The measurement of sleep deprivation was taken using ESS, prior to night shift duty and right after night shift duty. Decreased cognitive function was defined as decrease of MoCA-INA score before and after night shift duty. Bivariate analysis was done using mann-whitney U test due to abnormal data distribution. Results: the median of decreased cognitive function score between the partial sleep deprivation and the control group differed significantly, and significantly correlated with decreased cognitive function (median (min-max) 5 (2-11), p<0.001). Conclusion: Partial sleep deprivation significantly correlated with decreased cognitive function in resident doctors of Udayana University/Sanglah General Hospital.

Headache is a pain that is located in orbitomeatal line caused by stimulation of pain structures.... more Headache is a pain that is located in orbitomeatal line caused by stimulation of pain structures. Frequent Episodic tension-type headache is a primary headache that often experienced mainly by medical students. The relationship of sleep disorders and headaches have been known since long ago, but the relationship between them is still not known with certainty. This study aims to prove that poor sleep quality increases the risk of frequent episodic tension-type headache on medical students in Udayana University of Bali. This study was conducted at the Udayana University from December 2016 to February 2017 using a case control design of the 62 study subjects. We found 22 subjects (71%) with poor sleep quality in cases groups and 14 subjects(45.25%) in control groups. Statistical analysis showed that a significant relationship between poor sleep quality and frequent episodic tension-type headache with p = 0.039 and OR = 2.968 (95%CI = 1.039-8.749). Poor sleep quality statistically significant to increase the risk of Frequent Episodic tension-type headache, on the medical students in Udayana University of Bali.

Calcium plays an important role in the pathogenesis of ischemic cell damage. Intracellular calciu... more Calcium plays an important role in the pathogenesis of ischemic cell damage. Intracellular calcium accumulation leads to neuronal damage by triggering the cycle of cytotoxic events, however the relationship of Adjusted serum calcium levels and the pathways involved in ischemic injury is unclear. The aim of this study is to determine whether low Adjusted serum calcium levels can be used as predictor of poor outcome in acute ischemic stroke patient. This is a prospective cohort study of acute ischemic stroke patients admitted to Sanglah General Hospital from December 2016 until February 2017. Adjusted serum calcium level was obtained ≤72 hours from onset. Outcome was classified as poor and good, according to the National Institutes of Health Stroke Scale (NIHSS) score taken on admission and 7 days after the onset. Statistical analysis was performed using using Chi-Square. A total of 60 patients were enrolled and met the criteria. Subject's characteristic described by sex, age, onset, stroke type, serum adjusted calcium level, first and second NIHSS score. Serum adjusted calcium level mean was lower in poor outcome group (8,78 ± 0,07) than subjects in the good outcome (9,05 ± 0,06). Chi-square analysis revealed lower Adjusted serum calcium levels accompanied by poor outcomes statistically significant (RR = 3.2; 95% CI = 1.34 to 7.62; p = 0.007). Multivariate analysis revealed lower Adjusted serum calcium levels as an independent predictor of poor outcome in acute ischemic stroke (RR = 6.47; 95%IC = 1.69 to 24.72; p = 0.006). Low Adjusted serum calcium level is an independent predictor of poor outcomes in patients with acute ischemic stroke.

Low Uric acid serum level can affect and deactivate ROS and RNS substantially that will yield in ... more Low Uric acid serum level can affect and deactivate ROS and RNS substantially that will yield in the cells death of substansia nigra pars compacta which is responsible for the occurrence of Parkinson's Disease (PD). The aim of this study was aimed at testing low serum levels of uric acid increased the risk of PD. A case control was performed as the design of this study. Patients with PD enrolled in the case group and patients without PD as control group. Examination of serum uric acid level in the patient's venous blood held after fasting for approximately 8 hours. Uric acid was stated low when the rate is ≤ 4.68mg/dl. In this study, 44 cases and 44 controls who met the eligibility criteria included as a sample and matched according to age and sex. There were 31 males (70.5%) and 13 females (29.5%) PD patients in this study.Factors associated with an increased risk of PD was a lower level of serum uric acid (OR = 3.40; CI 95%: 1.36-8.53, p = 0.008) and a low purine diet (OR = 3.07; CI 95%: 1.29-7.33, p = 0.01). Only a low purine diet became a significant and independent PD risk factor (OR = 2.86; CI 95% :1.02-8.02, p = 0.046) in multivariate analysis. Low serum uric acid level and low purin diet increased the risk of PD. Efforts need to be made based on dietary adjustments, especially food contained sufficient purine to maintain serum uric acid level within normal limit so that PD can be prevented.

Lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consisting of the pr... more Lipomyelomeningocele (LMMC) is a type of congenital occult spinal dysraphism consisting of the presence of lipomatous tissue attached to the dorsal spinal cord, which protrudes though a spinal defect along with the menings or spinal cord to form a posterior mass under the skin. LMMC is the commonest cause of congenital tethering (tethered cord syndrome) and causes neurological deterioration due to the conus medullaris and root ischemia. Here we presented a 6 year old girl with a lump over the back region since birth. The lump was progressively increasing in size. There was history of urinary and fecal incontinence since birth. Local examination of the lumbosacral region revealed a single lump with no redness over it, spherical in shape, 12×10 cm in size, soft consistency, and fixed. CT Scan of lumbosacral spine was done which revealed soft tissue mass at lumbosacral that connected with defect canal sacral from L5 until S2. We diagnosed patient with lipomyelomeningocele. Surgery was performed and there are no post operative complications and now after 1 month of surgery the symptoms were improved. Lipomyelomeningocele is rare case in our Department. Surgical treatment is indicated because the patient had urinary disturbance. There are no post operative complications and now after 1 month of surgery the symptoms were improved.

We report an old man who has main complaint suddenly first onset of central type vertigo and imba... more We report an old man who has main complaint suddenly first onset of central type vertigo and imbalance with tendency to fall to left side, hearing loss on left ear, numbness of left face and right side of his body, weakness in the left face, dysphagia with nausea and vomitus, dysphonic, tachycardia and difficulties of breath ness with sudden onset. Physical examination found horizontal nystagmus, ptosis and miosis in left eye (Horner syndrome), tachycardia and dyspnea, multicranial nerve palsies in left side, thermanesthesia in right side of body. From all examination, this patient diagnosed as Wallenberg Syndrome. With a proper conservative treatment, patient was discharded from hospital with minimum disabillities

, with mean age 35.72 years old. The result showed correlation between CD4 count (r = -0.348; p =... more , with mean age 35.72 years old. The result showed correlation between CD4 count (r = -0.348; p = 0.018), stadium of HIV (r = 0.358; p = 0.014) and duration of ARV treatment (r = 0.330; p = 0.025) and LANSS score. Factors proven to be correlated with neuropathic pain in HIV/AIDS patients are CD4 count, stages of HIV and duration of ARV treatment.

Background: The increasing of age causes decrease of the sleep period. Sleep disorders and cognit... more Background: The increasing of age causes decrease of the sleep period. Sleep disorders and cognitive function complaints are frequently reported in the elderly. The prevalence of sleep disorders and impairment of cognitive function in the elderly is high (about 67% and 17-34%), but there are only a few of study about cognitive function in elderly who experience sleep disturbances in Indonesia.

DESCRIPTION HOSPITAL BASED STUDY AT SANGLAH GENERAH HOSPITAL, BALI, INDONESIA

Introduction: Pain in peripheral neuropathy were found in many chronical disease including human ... more Introduction: Pain in peripheral neuropathy were found in many chronical disease including human immunodeficiency virus (HIV) infection. It required a simple, accurate, and low cost screening instrument to identify peripheral neuropathy, despite the expensive and invasive procedure for definitive diagnosis. Brief peripheral neuropathy screen (BPNS) has been used in many countries and show a good result but had never been translated into Indonesian Language. Aims: To assess the reliability and validity of BPNS Indonesian version as a reliable and valid instrument examination. Methods: It was a cross-sectional study to HIV/AIDS patients in Sanglah Hospital AIDS Research Center (SHARC), Denpasar. Each eligible patient were evaluated with BPNS by 2 physicians and compared to leeds assessment neuropathic symptoms and sign (LANSS) as the golden standard. Reliability analyzed by using Kappa Cohen coefficient. Validity were analyzed using Chi-Square 2x2 table. Results: This study involved 3...

DESCRIPTION HOSPITAL BASED STUDY AT SANGLAH GENERAH HOSPITAL, BALI, INDONESIA