Kumara Tini
Departemen Neurologi, FK Universitas Udayana/RS Universitas Udayana, Bali, Indonesia

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COVID-19 and cerebrovascular diseases: neuroanatomy and neuropathophysiology overview Ida Ayu Sri Indrayani; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Nyoman Angga Krishna Pramana; Kumara Tini
Bali Anatomy Journal Vol 4 No 1 (2021): Bali Anatomy Journal (BAJ)
Publisher : Department of Anatomy, Medical Faculty, Universitas Udayana, Bali-Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36675/baj.v4i1.55

Abstract

Background: COVID-19 has expanded globally and has become a health burden for the entire world's population. SARS-CoV-2 as the causative virus, currently does not only cause respiratory disorders, it also involves other organs, including the cerebrovascular system, causing manifestations in the central and peripheral nervous systems. Review: SARS-CoV-2 is classified under the β-coronavirus genus of the Coronaviridae family, and 1 of 4 major protein of its structures, known as spike (S) glycoprotein acts as an important role in promoting the viral invasion process. Olfactory and trigeminal nerves are suggested to be the entry point of SARS-CoV-2 to central nervous system, and promote the disruption of brain cells and vasculatures. Conclusion: Manifestations of cerebrovascular disease are becoming more intense, where there is a dysregulation of the ACE2 receptor to perform its main tasks due to the SARS-CoV-2 invasion. SARS-CoV-2 viruses cause various impairments to cerebrovascular endothelial cells, promote hypercoagulation and increasing the risk of thrombosis, downregulate the host immune cells and cause hyperinflammation as well as cytokine storm, lead to brain damages and further complications.
Characteristics, comorbidities, and outcomes of acute ischemic stroke cases treated with thrombolysis in Sanglah General Hospital Bali: A case series Ida Ayu Sri Indrayani; Valentina Tjandra Dewi; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Nyoman Angga Krishna Pramana; Kumara Tini; I Made Oka Adnyana
Bali Anatomy Journal Vol 4 No 1 (2021): Bali Anatomy Journal (BAJ)
Publisher : Department of Anatomy, Medical Faculty, Universitas Udayana, Bali-Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36675/baj.v4i1.56

Abstract

Background: Intravenous recombinant tissue plasminogen activator (IV rt-PA) in eligible patient groups is the main therapy for acute phase ischemic stroke within 4.5 hours of symptom onset which can significantly improve functional outcome. However, not all patients who underwent thrombolysis had a good outcome. Case: We report a series of seven patients cases undergoing IV thrombolysis from 2019-2020 at Sanglah General Hospital with varying baseline conditions and outcomes. Most cases benefit from IV rt-PA administration. There was one case with a poor outcome and one case with a rare anaphylactic reaction following alteplase administration. Conclusion: The number of thrombolysis procedure which is the main treatment of acute ischemic stroke is quite small. It is necessary to increase public education and understanding regarding the rapid response to acute stroke symptoms. Most of the cases yielded good outcomes while several cases had unfavorable outcomes related to variable factors. Hemorrhagic transformation does not directly associate with poor outcome. Clinicians also need to increase awareness of allergic reactions risk to rt-PA and provide prompt treatment.
KARAKTERISTIK KLINIS PASIEN EPILEPSI DI POLIKLINIK SARAF RSUP SANGLAH PERIODE JANUARI – DESEMBER 2016 Izzati Shoba Maryam; Ida Ayu Sri Wijayanti; Kumara Tini
Callosum Neurology Vol 1 No 3 (2018): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (332.632 KB) | DOI: 10.29342/cnj.v1i3.29

Abstract

Latar Belakang: Jumlah kasus epilepsi di Indonesia cukup tinggi dengan prevalensi 8,2 per 1.000 penduduk dan insiden 50 per 100.000 penduduk. Data demografi dapat digunakan sebagai pertimbangan klinisi dalam mendiagnosis serta menentukkan penanganan lanjutan yang tepat. Tujuan: Mengetahui karakteristik klinis pasien epilepsi di Poliklinik Saraf Rumah Sakit Umum Pusat (RSUP) Sanglah periode bulan Januari hingga Desember 2016. Metode Penelitian: Penelitian deskriptif observasional menggunakan data rekam medis pasien epilepsi yang berobat di Poliklinik Saraf RSUP Sanglah bulan Januari hingga Desember 2016. Hasil: 70 pasien epilepsi memiliki rerata usia 35 tahun dengan laki-laki sebanyak 55,7%. Rerata usia awitan bangkitan 29 tahun. Jenis bangkitan terbanyak adalah bangkitan umum dan mayoritas etiologinya simtomatik. 77,1% pasien menggunakan monoterapi dan 72,9% berobat kurang dari dua tahun. Fenitoin merupakan OAE utama dalam monoterapi maupun sebagai kombinasi dengan OAE yang lain. Simpulan: Kasus epilepsi didominasi oleh pasien laki-laki dengan rerata usia 35 tahun. Awitan bangkitan ditemukan pada dekade kedua. Bangkitan umum merupakan gejala paling banyak ditemukan dengan fenitoin sebagai OAE utama. Kata Kunci: Karakteristik, Epilepsi, Obat Anti Epilepsi
TATA LAKSANA PEMERIKSAAN NEUROLOGIS VIRTUAL DI ERA PANDEMI CORONA VIRUS DISEASE 2019 Ni Made Susilawathi; Kumara Tini; Ida Ayu Sri Wijayanti; Putu Lohita Rahmawati; Putu Gede Sudira; Dewa Putu Wisnu Wardhana; Dewa Putu Gde Purwa Samatra
Callosum Neurology Vol 3 No 3 (2020): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v3i3.119

Abstract

Latar Belakang: Pandemi Corona Virus Disease 2019 (COVID-19) dengan penularannya yang sangat cepat di seluruh dunia berdampak terhadap perubahan pelayanan kesehatan di bidang neurologi sebagai upaya mendukung program pengendalian penyakit ini. Tujuan: Merumuskan rekomendasi panduan pemeriksaan neurologis untuk pelayanan teleneurologi.   Diskusi: Penyesuaian dalam pelaksanaan pelayanan neurologi perlu segera dilakukan dengan mengadopsi metode pelayanan dengan telemedicine terutama dalam tata cara pemeriksaan pasien dengan pembatasan fisik dan sosial sebagai salah satu langkah pencegahan infeksi SARS-CoV-2. Simpulan: Layanan teleneurologi perlu dikembangkan dalam pelayanan neurologi termasuk pengembangan prosedur pemeriksaan neurologis secara virtual. Kata kunci: COVID-19, Pemeriksaan Neurologi, Pemeriksaan Virtual, Pembatasan Fisik
PROFIL SKRINING INFEKSI COVID-19 DAN KADAR D-DIMER PADA PASIEN STROKE DI RSUP SANGLAH DENPASAR Ida Ayu Sri Indrayani; Ida Bagus Kusuma Putra; I Gusti Ngurah Ketut Budiarsa; Anak Agung Bagus Ngurah Nuartha; Angga Krishna; Kumara Tini; I Made Odie Lastrawan; Putu Ngurah Arya Darmawan; Eric Hartono Tedyanto; Aurelia Vania
Callosum Neurology Vol 4 No 1 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i1.157

Abstract

Pendahuluan: Coronavirus Disease 2019 (COVID-19) diumumkan sebagai pandemi oleh World Health Organization (WHO) pada tanggal 11 Maret 2020. Studi menemukan stroke dapat merupakan salah satu manifestasi neurologi COVID-19. Studi mengenai karakteristik pasien stroke pada masa pandemi COVID-19 dipublikasi untuk menunjang data mengenai COVID-10 pada pasien stroke sehingga mendukung penyusunan pedoman tatalaksana stroke yang lebih baik di masa pandemi COVID-19 Tujuan: Untuk mengetahui karakteristik pasien stroke selama pandemi COVID-19 di RSUP Sanglah Kota Denpasar Metode: Studi ini merupakan studi deskriptif dengan kriteria inklusi pasien yang didiagnosa stroke di RSUP Sanglah pada periode Juni-Agustus 2020. Subjek dipilih menggunakan teknik consecutive sampling Hasil Penelitian: Studi melibatkan 69 pasien stroke dengan laki-laki sebanyak 62,3% dan perempuan 37,7%. Stroke non-hemoragik didapatkan sebanyak 67,7% dan stroke hemoragik 33,3%. Dari skrining Rapid Test ditemukan 7,2% hasil reaktif dan 92,8% non-reaktif. Pemeriksaan PCR pada tes swab menunjukkan hasil 10,1% positif, negatif 11,6%, dan yang tidak diperiksa sebanyak 78,3%. Hasil pemeriksaan rontgen thorax menunjukkan gambaran pneumonia sebanyak 23,2%, tidak pneumonia sebanyak 75,4%, dan TB 1,4%. Hasil pemeriksaan D-Dimer ditemukan 62,3% normal dan 37,7% meningkat. Dari pasien yang memiliki hasil swab test positif (7 orang), didapatkan 7 orang dengan hasil D-Dimer meningkat Simpulan: COVID-19 dapat ditemukan sebagai penyebab atau penyakit penyerta pasien stroke pada masa pandemi ini. Kadar D-dimer yang tinggi dapat menjadi marker gangguan koagulasi pada COVID-19 yang merupakan salah satu mekanisme penyebab stroke pada infeksi SARS-CoV-2 ini Kata Kunci: COVID-19, D-dimer, Karakteristik, Stroke
Faktor – faktor yang berhubungan dengan luaran klinis pasien tetanus di RSUP Sanglah pada bulan Januari 2018 – Oktober 2019 Tu Bagus Adnan Angga Prawira; Ni Putu Witari; Kumara Tini
Intisari Sains Medis Vol. 11 No. 3 (2020): (Available online: 1 December 2020)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (305.281 KB) | DOI: 10.15562/ism.v11i3.697

Abstract

Introduction: Tetanuseis anwacute diseasedthat attacks thewperipheral nervousgsystem, causedebyfthe tetanospamin toxinvproducedbbymthe bacterium Clostridiumbtetani. Tetanusfcan be lifecthreatening andgis stillra healthgproblem forxdevelopingvcountries, includingvIndonesia. Thisfstudy aimsbto determinekthe characteristicskand relationships of age, incubation period, tetanus degree, and complications of the clinical outcome of tetanus patients in Sanglah Hospital Denpasar in January 2018 - October22019.Method: Thissstudy is accross-sectionall studyeof 333samples thatfwere takenxfrom secondaryddata infthe formvof medicalbrecords atvSanglah HospitalcDenpasar.rDatalwerekanalyzeduusing SPSS software version 23.Result: Tetanusfpatients with age <60 years found in 19 people, >60 years found in 14 people. The incubation period <7 days was found in 7 people, >7 days was found in 26 people. TetanussAblett I / mild scores was found in 1 person, II/moderate in 18 people, III/severe in 9 people, IV/very severe in 5 people. Cardiovascular complications was found in 16 people, respiratory system in 11 people, no complications in 6 people. Good clinical outcomes (survive) in 19 people, death in 14 people.Conclusion: There is no relationship between age and incubation period on clinical outcomes Theregis afstrong relationshiptbetween thebdegree of tetanusvand complicationsvwith clinicalboutcomes with significantgvalues respectively of p=0.008i (correlationbcoefficient = 0.443) and p=0.004 (correlationfcoefficient = 0.487).  Latar Belakang: Tetanusrrmerupakant tpenyakit akutr yangr menyerangr susunany sarafhtepi, disebabkanlloleh toxin tetanospamin yangfdihasilkan oleh bakteri Clostridiummtetani. Penyakitrtetanus dapatbmengancam nyawabdan masihbmerupakan masalahxkesehatan bagiz negara-negara berkembang, termasukkkIndonesia. Penelitiannnini bertujuanf funtuktt mengetahui karakteristike dan hubunganefaktorrusia, masa inkubasi, derajat tetanus, dan komplikasi terhadap luaran klinis pasien tetanus di RSUP Sanglah Denpasar pada bulan januari 2018 – Oktoberr2019.Metode: Penelitiangini merupakanvpenelitian potongslintang pada233 sampeltyang diambilhdari datacsekunder berupazrekam medisddi RSUPCSanglahcDenpasar.wData dianalisisjmenggunakanrsoftware SPSSsversi 23.Hasil: Pasien tetanus dengan usia < 60 tahun dijumpai 19 orang, > 60 tahun sebanyak 14 orang. Masa inkubasi < 7 hari dijumpai pada 7 orang, > 7 hari dijumpai pada 26 orang. Tetanus skoreAblett I/ringan dijumpai 1 orang, II/sedang sebanyak 18 orang, III/berat sebanyak 9 orang, IV/sangat berat sebanyak 5 orang. Komplikasi kardiovaskular dijumpai 16 orang, sistem pernafasan 11 orang, tidak ada komplikasi pada 6 orang. Luaran klinis yang bertahan hidup = 19 orang, meninggal = 14 orang.Simpulan: Tidak terdapat hubungan antara faktor usia dan masa inkubasi terhadap luaran klinis. Terdapat hubungan yang kuat antara derajat tetanus dan komplikasi dengan luaran klinis dengan nilai signifikan berturut-turut sebesar p=0,008 (koefisienckorelasi 0,443) dan p=0,004 (koefisientkorelasi 0,487).
CHARACTERISTICS OF ACUTE ISCHEMIC STROKE PATIENTS DUE TO SMALL VESSEL OCCLUSION Richard Suherlim; Nyoman Angga Krishna Pramana; Kumara Tini; Ida Bagus Kusuma Putra; Ida Ayu Sri Indrayani
MNJ (Malang Neurology Journal) Vol. 9 No. 1 (2023): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2023.009.01.5

Abstract

Background: Ischemic stroke account for about 87% of all stroke cases. This study will focus on ischemic stroke due to small vessel occlusion as one of the subtypes based on TOAST (trial of ORG 10172 in acute stroke treatment). Objective: To determine the characteristics of ischemic stroke patients caused by small vessel occlusion and are expected to be used as a basis for further research. Methods: A descriptive observational retrospective study regarding the characteristics of acute ischemic stroke patients due to small vessel occlusion at Sanglah Hospital. Secondary data were obtained from patient medical records. Results: The total number of cases of small vessel occlusion was 338. The majority of the sample were men (64.5%) between 40-60 years old (53.6%). Most of the samples were patients who had experienced an ischemic stroke for the first time (75.1%) with NIHSS (National Institute of Health Stroke Scale) scores showing mild (48.2%) and moderate (51.5%) symptoms. Around half of them had a history of hypertension (60.1%), dyslipidemia (59.5%), and diabetes mellitus (44.1%). The most common location of infarction was in the anterior circulation (77.5%) with almost the same ratio of right and left hemisphere locations. Conclusion: Ischemic stroke due to occlusion of small vessels at Sanglah Hospital Denpasar for 3 years was 35.2% of the total ischemic stroke cases. Half of the total sample had classic vascular risk factors. Further research is needed to determine another effective treatment strategy other than just secondary prevention such as life style moderation to prevent recurrency.
Headache in healthcare workers related to personal protective equipment use in COVID-19 referral hospital Ida Ayu Sri Wijayanti; Ni Putu Ayu Putri Mahadewi; Putu Gede Sudira; Kumara Tini; Ni Made Susilawathi; I Made Oka Adnyana
Universa Medicina Vol. 42 No. 1 (2023)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2023.v42.52-60

Abstract

BackgroundStudies show that wearing personal protective equipment (PPE) for long periods of time can lead to discomfort such as headaches, which could affect the performance of healthcare workers. The aim of this study was to determine the prevalence and risk factors of headaches related to PPE in healthcare workers at a COVID-19 referral hospital. MethodsA cross-sectional study was conducted involving 174 healthcare workers in a COVID-19 referral hospital in Bali. We conducted interviews using a questionnaire that consisted of three main parts: characteristics of the subjects, PPE usage, and PPE-associated headaches. A multiple logistic regression was used to analyze the data. ResultsThe analysis results showed that the PPE-associated headaches had a prevalence of 63.8% and were gradual in onset, pressure-like in quality (46%), and mild in intensity (80.1%). PPE level III-associated headache was the most common type. The majority of the participants had headaches up to 6 hours after using the protective gear, but improving within 15-30 minutes of removal and/or after pharmacotherapy. A Chi-squared analysis showed a statistically significant association between duration of PPE use, working units, and PPE levels (p<0.05). A logistic regression analysis found a significant relationship between PPE level and headache occurrence (OR=4.826;95%CI: 2.433-9.572; p<0.001). ConclusionThe frequency of PPE-associated headache was high and the PPE level was a risk factor of headache among healthcare workers. Better strategies are needed to reduce the duration of PPE exposure so that the work performance and quality of life of healthcare workers are not significantly affected.
The Synergistic Impact of Astrocyte Reactivity and Vitamin D Deficiency on Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis Patricia; Anak Agung Ayu Putri Laksmidewi; Kumara Tini
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1449

Abstract

Background: Post-stroke cognitive impairment (PSCI) is a common, debilitating outcome of ischemic stroke. Glial Fibrillary Acidic Protein (GFAP), marking astrocyte reactivity, and Vitamin D, a neuro-immunomodulatory steroid, are independently linked to PSCI. This study aimed to quantify the synergistic impact of elevated serum GFAP and concurrent Vitamin D deficiency on PSCI risk. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted for prospective cohort studies (2015-2025) assessing acute serum GFAP, 25-hydroxyvitamin D (25(OH)D), and subsequent cognitive outcomes in ischemic stroke patients. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of seven studies (n=3,850) was performed using a random-effects model to calculate pooled odds ratios (ORs) for PSCI across four biomarker-defined groups. A formal test for synergistic interaction was conducted by assessing the departure from additivity of effects on the log-odds scale. Results: Seven high-quality studies were included. Compared to the reference group (Normal GFAP/Sufficient Vitamin D), the pooled OR for PSCI was 2.18 (95% CI: 1.85-2.57) for high GFAP alone and 1.95 (95% CI: 1.65-2.30) for Vitamin D deficiency alone. For the dual-biomarker group (High GFAP/Deficient Vitamin D), the pooled OR was 4.75 (95% CI: 3.98-5.67). This observed risk was significantly greater than the 3.13 OR expected from a purely additive model (p for interaction < 0.001), confirming a significant synergistic effect. Sensitivity analysis showed the effect was most pronounced in patients with moderate-to-severe strokes (NIHSS > 5). Conclusion: Elevated serum GFAP and Vitamin D deficiency synergistically increase the risk of PSCI, particularly in patients with more severe strokes. The interplay between acute astroglial injury and compromised systemic neuroprotection appears to be a critical determinant of cognitive outcomes. While confounding by patient frailty requires further study, this dual-biomarker profile identifies a high-risk subgroup and highlights a key pathophysiological interaction.
The Synergistic Impact of Astrocyte Reactivity and Vitamin D Deficiency on Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis Patricia; Anak Agung Ayu Putri Laksmidewi; Kumara Tini
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 12 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i12.1449

Abstract

Background: Post-stroke cognitive impairment (PSCI) is a common, debilitating outcome of ischemic stroke. Glial Fibrillary Acidic Protein (GFAP), marking astrocyte reactivity, and Vitamin D, a neuro-immunomodulatory steroid, are independently linked to PSCI. This study aimed to quantify the synergistic impact of elevated serum GFAP and concurrent Vitamin D deficiency on PSCI risk. Methods: Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted for prospective cohort studies (2015-2025) assessing acute serum GFAP, 25-hydroxyvitamin D (25(OH)D), and subsequent cognitive outcomes in ischemic stroke patients. Quality was assessed using the Newcastle-Ottawa Scale. A meta-analysis of seven studies (n=3,850) was performed using a random-effects model to calculate pooled odds ratios (ORs) for PSCI across four biomarker-defined groups. A formal test for synergistic interaction was conducted by assessing the departure from additivity of effects on the log-odds scale. Results: Seven high-quality studies were included. Compared to the reference group (Normal GFAP/Sufficient Vitamin D), the pooled OR for PSCI was 2.18 (95% CI: 1.85-2.57) for high GFAP alone and 1.95 (95% CI: 1.65-2.30) for Vitamin D deficiency alone. For the dual-biomarker group (High GFAP/Deficient Vitamin D), the pooled OR was 4.75 (95% CI: 3.98-5.67). This observed risk was significantly greater than the 3.13 OR expected from a purely additive model (p for interaction < 0.001), confirming a significant synergistic effect. Sensitivity analysis showed the effect was most pronounced in patients with moderate-to-severe strokes (NIHSS > 5). Conclusion: Elevated serum GFAP and Vitamin D deficiency synergistically increase the risk of PSCI, particularly in patients with more severe strokes. The interplay between acute astroglial injury and compromised systemic neuroprotection appears to be a critical determinant of cognitive outcomes. While confounding by patient frailty requires further study, this dual-biomarker profile identifies a high-risk subgroup and highlights a key pathophysiological interaction.