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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Jurnal Penyakit Dalam Indonesia Magna Neurologica Academic Hospital Journal Neurona Indonesian Journal of Biomedicine and Clinical Sciences
Satiti, Sekar
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Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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Abnormal electroencephalographyas predictor of mortality in meningoencephalitis Tama, Whisnu Nalendra; Satiti, Sekar; Asmedi, Ahmad
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 1 (2020)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (796.225 KB) | DOI: 10.19106/JMedSci005201202004

Abstract

Although the incidence of meningoencephalitis has decreased,howeverits mortality remainshigh. Electroencephalography (EEG) has an important role in the management of meningoencephalitis although the imaging modalities have replaced its position. Abnormality in EEG may appear earlier than in imaging so it is expected to predict mortality.The study aimed to investigate the prognostic role of EEG results in predicting mortality of meningoencephalitis.This was an observational prospective cohort study involvingmeningoencephalitis patients in Dr. Sardjito General Hospital,Yogyakartafrom July 2016 to January 2017 who underwent EEG examination.The patients who met the inclusion and exclusion criteria were divided into abnormal and normal EEG groups. The outcomewas the mortality during hospitalization. Furthermore, the type of EEG abnormalities associated with mortality were evaluated.Thirty-eight patients with the mean age was 33.61±20.37 yearwere involved in this study. Twenty-eight patients (73.7%) had abnormal EEG result and 10 patients (26.3%) death.Bivariate analysis showed that abnormal EEG result (p =0.028) and Glasgow Coma Scale (GCS) score (p =0.005) were significantly associated with mortality. Analysis for the type of EEG abnormalities found that only diffuse slowing (p =0.001) was significantly associated with mortality. Multivariate analysis showed either abnormal EEG result or GCS score were independently predictor of mortality. Abnormal EEG and GCS score were interrelated in affecting mortality.In conclusion, abnormal EEG resultin meningoencephalitis, diffuse slowing in particular, is predictor of mortality during hospitalization
Meningoensefalitis Manifestation in Wegener’s Granulomatosis with Anca Negative: Case Report Sudibyo, Triyanti Kurniasari Ananta Putri; Mulya, Deshinta Putri; Budiono, Eko; Satiti, Sekar; Rosalia, Levina Prima
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 3
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Wegener’s granulomatosis is a vasculitis that affects small to medium blood vessels, generally occurring at the age of 64- 75 years with an incidence of 8-10 / 1,000,000 people. Meningoencephalitis manifestations are rarely found in Wegener’s granulomatosis with the incidence only in the range of 0-7%. Anti-neutrophil cytoplasmic antibody (ANCA) is often used in diagnosing Wegener’s granulomatosis, but negative ANCA can be found in 10-20% of cases. A 30-year-old man came with a decrease in consciousness. His anamnesis and physical examination showed signs that led to Wegener’s granulomatosis, despite negative ANCA examination results. After getting therapy according to the management of the Wegener’s granulomatosis there is a clinical improvement in the patient. This case is raised because it is a rare case and needs sharpness in establishing a diagnosis. Wegener’s granulomatosis can cause very bad progress, but if handled properly, complete remission can be achieved.
High-sensitivity C-reactive protein/albumin (hs-CRP/albumin) ratio as a predictor of deterioration of clinical outcome in central nervous system infections Hayati, Hanifah Fajarisna; Satiti, Sekar; Paryono, Paryono; Intansari, Umi; Sutarni, Sri; Subagya, Subagya; Indarwati, Indarwati; Setyopranoto, Ismail
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 4 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005504202306

Abstract

Central nervous system (CNS) infections such as encephalitis, meningitis, or myelitis have high morbidity and mortality in Indonesia. High sensitivity C-reactive protein (hs-CRP) is a sensitive marker of acute inflammation, while albumin is the most abundant protein component in plasma and cerebrospinal fluid (CSS). Infection triggers an inflammatory response so that an increase in the hs-CRP/albumin ratio (CAR) can be a predictor of worsening clinical outcome in patients with CNS infections. However, studies examining the predictor value of serum and CSF CAR on worsening clinical outcomes of patients are limited, particularly in CNS infections. The purpose of this study was to prove the CAR as a predictor of worsening clinical outcome in patients with CNS infections.  It was an observational study using a prospective cohort design. Fifty subjects recruited until October 2021 at Dr. Sardjito General Hospital were involved.  The multivariate regression analysis showed that serum CAR (OR=3.604; 95%CI=1.487-8.736; p =0.005) could be a single predictor. However, by combining three variables, namely serum CAR, CSF CAR, and decreased consciousness at admission, could be a stronger predictor of worsening clinical outcome in patients with CNS infection (AUC = 97.1%; 95%CI = 0.929-1.00; p <0.001). The optimal cut-off value for serum CAR was 1.35 (Youden index = 0.88, sensitivity = 96%, specificity = 92%) while for CSF CAR was 0.14 (Youden index = 0.60, sensitivity = 76%, specificity = 84%). In conclusion, a combination predictive model of three variables, namely serum CAR, CSF CAR, and awareness at admission can be a stronger predictor of clinical outcome in patients with CNS infection than serum CAR alone.
Differences in the clinical presentations of anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis with status epilepticus: a retrospective case series Sejahtera, Desin Pambudi; Satiti, Sekar; Mukhtar, Ishana Nafeeza; Andatu, Roshynta Linggar; Khairani, Atitya Fithri
Indonesian Journal of Biomedicine and Clinical Sciences Vol 56 No 3 (2024)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v56i3.15917

Abstract

Literature on anti-NMDAR (anti-N-methyl-D-aspartate receptor) encephalitis is limited in developing countries, including Indonesia. This retrospective observational case series explored the impact of early diagnosis and treatment on patient outcomes in four distinct cases of anti-NMDAR encephalitis with status epilepticus, and other related conditions, of patients referred to Dr. Sardjito General Hospital, Yogyakarta. Clinical data from May 2021 to August 2023 were collected through the review of medical records, encompassing demographic information, clinical presentation, history, laboratory results, imaging studies, EEG reports, interventions, and the progression of the disease. Four cases were reported, three of whom were diagnosed with anti-NMDAR and one with bacterial encephalitis, each presenting a variety of neuropsychiatric clinical symptoms, leading to hospitalization, extensive testing, and interventions to establish the definitive diagnosis. Cases 1 and 4 have a childhood history of seizures. The cases analyzed factors including the impact of childhood versus adulthood onset and the adherence to taking medicine regularly leading to exacerbation symptoms and relapses. Distinguishing anti-NMDAR encephalitis from related conditions, such as bacterial encephalitis, was further complicated in patients with varied neuropsychiatric presentations (seizures, hallucinations, irritable behavior, headaches) and responses to the treatment. Supporting investigation finds positive NMDAR testing and abnormal CT, MRI, and EEG results, contributed to definitive diagnoses. It could be concluded that comprehensive diagnostic investigations are important for prompt recognition of clinical characteristics, and early initiation of immunomodulatory therapy in managing anti-NMDAR encephalitis and related conditions in Yogyakarta, Indonesia.
Vitamin D Deficiency in Relapsing Anti-NMDAR Encephalitis Presenting with Acute Cognitive Impairment: A Case Report Luthffia, Audiza; Cempaka Thursina Srie Setyaningrum; Amelia Nur Vidyanti; Desin Pambudi Sejahtera; Satiti, Sekar
Magna Neurologica Vol. 3 No. 1 (2025): January
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v3i1.1740

Abstract

Background: Anti N-methyl-D-aspartate Receptor (NMDAR) encephalitis is an autoimmune disease characterized by neuropsychiatric symptoms caused by autoantibodies against NMDAR. It is a treatable disease, but approximately 12-25% of  patients experience relapse. Vitamin D has several immunomodulatory effects and its deficiency is associated with systemic and neurologic autoimmune disease. Case:A 21-year-old woman presented with acute cognitive impairment, followed by status epilepticus during hospitalization. Two years ago, she was diagnosed with anti-NMDAR encephalitis and completely recovered after immunotherapy. During relapse, magnetic resonance imaging (MRI) showed chronic lacunar infarct on the right basal ganglia, and electroencephalography (EEG) showed diffuse slowing, identical to findings from the first event. Laboratory testing during relapse indicated vitamin D deficiency, which was normal before relapse onset. Symptoms improved following intravenous methylprednisolone, plasma exchange, vitamin D supplementation, and symptomatic treatment. Discussion: Inadequate immunotherapy has been suggested as a major risk factor for relapse, while other determinants have not been well recognized. Vitamin D inhibits proliferation of B cells, an important immunomodulator in anti-NMDAR encephalitis. Previous study revealed vitamin D levels were reduced in anti-NMDAR encephalitis patients and it is also thought to influence response to therapy. On the other hand, vitamin D also influence neurotransmitter activities and synaptic formation involved in cognitive and memory functioning. Conclusion: Anti-NMDAR encephalitis is a treatable autoimmune disease but still has the possibility of relapse. Vitamin D deficiency may be related with relapse of anti-NMDAR encephalitis. Routine screening for vitamin D deficiency can be considered in relapsed patients or during maintenance therapy.
Penurunan Kesadaran dan Kejang Berhubungan dengan Peningkatan Mortalitas pada Pasien Covid-19: Studi Retrospektif di Rumah Sakit Umum Dr. Sardjito Yogyakarta Satiti, Sekar; Edyanto, Abdullah Syafiq; Pambudi Sejahtera, Desin; Nalendra Tama, Whisnu; Yuli Firlando, Afdhal; Vidyanti, Amelia Nur
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 39 No 4 (2023): Vol 39 No 4 (2023)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v39i4.381

Abstract

Introduction: Coronavirus infection has been associated with neurologic manifestations. Aim: The aim of this study was to investigate the predictors of mortality based on neurological manifestations among hospitalized COVID-19 patients. Methods: This was a retrospective study on COVID-19 patients hospitalized at Dr. Sardjito General Hospital Yogyakarta, Indonesia from March 9, 2020 to January 28, 2021. Demographic characteristics, medical history, symptoms, and clinical signs were extracted from medical records. Factors associated with the mortality were analysed using multivariate logistic regression analysis. Results: A total of 421 medical records were examined. Among them, 114 individuals died during hospitalization (27.08%). Several baseline characteristics were associated with mortality including age (OR: 1.05, 95%CI: 1.03-1.07, p = 0.000), history of diabetes mellitus (DM) (OR: 3.1, 95%CI: 1.95-4.95, p= 0.000), history of hypertension (OR: 1.88, 95%CI: 1.22-2.92, p= 0.004), and history of renal insufficiency (OR: 3.73, 95%CI: 2.2-6.32, p= 0.000). Neurological manifestation that associated with mortality were loss of consciousness (OR= 34.70, 95%CI: 12.67-95.05, p= 0.000), delirium (OR= 21.01, 95%CI: 3.85-114.51, p= 0.000), and seizure (OR= 31.01, 95%CI: 3.82-251.69, p= 0.001). On the multivariate analysis, loss of consciousness (OR: 33.10, 95%CI: 12.00-91.33, p= 0.000), and seizure (OR: 22.75, 95%CI: 2.16 to 239.81, p= 0.009) were independent predictive factors for mortality. Discussion: Loss of consciousness and seizure were neurological manifestations served as independent predictive factors for mortality in COVID-19 patients. Keywords: COVID-19, loss of consciousness, mortality, neurological manifestations, seizure
SKOR ISAN SEBAGAI PREDIKTOR IN-HOSPITAL MORTALITY PADA PASIEN DENGAN STROKE-ASSOCIATED PNEUMONIA Mara Ditta, Adist Azizy; Gofir, Abdul; Satiti, Sekar; Hanif, Faishal
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 2 (2024): Vol 40 No 2 (2024): Volume 40, No 2 - Maret 2024
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v40i2.497

Abstract

Introduction: Stroke-associated pneumonia (SAP) is attributed as the most common cause of death in acute stroke. ISAN score is a potential tool for predicting SAP in acute stroke care since it is easy to use. Several clinical risk such as age and pre-stroke disability has been proposed to contribute mortality in SAP patients. Aims: This study aims to determine the relationship between ISAN score and in-hospital mortality in acute stroke patients at RSUP Dr. Sardjito. Methods: This study is an analytic observational study with a retrospective cohort design using data from the stroke registry of the Stroke Unit of RSUP Dr. Sardjito from 2021 - 2023. Patients who were clinically diagnosed with SAP at the time of acute phase stroke treatment were included in the study. ISAN scores were divided into 0-5, 6-10, 11-14, and >14 with the interpretation of low, medium, high, and very high respectively. The data was analysed using SPSS v22.. Results: A total of 147 stroke patients with SAP (55% male, mean age 64.9 ± 13.4 years) were included in this study. Death occurred in 61 study subjects and was more prevalent in the high ISAN group (n=30). On bivariate analysis, mortality was significantly associated with ISAN score (p=0.002), gender (p=0.003) and NIHSS score (p=0.002). High ISAN scores have been associated with mortality of stroke patients with SAP, according to multivariate analysis. (aOR=3.94, IK95% 1.31-11.84, p=0.015). Discussion: A high ISAN score at admission is significantly associated with mortality of stroke patients with SAP. Keywords: Pneumonia, stroke, mortality, acute stroke, ISAN score
Breaking Bad News: Flipped Calendar as a Patient Information Provision Education Media Using the Spikes Method a Universitas Gadjah Mada Academic Hospital Wirastuti, Fita; Effendy, Christantie; Adnan, Nur Fatimah; Satiti, Sekar
Academic Hospital Journal Vol 7, No 2 (2025)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v7i2.104337

Abstract

Background: The quality of Breaking Bad News (BBN) communication has a significant impact on patient treatment adherence, emotional condition, understanding, and satisfaction with medical care. Effective communication skills and appropriate communication techniques are essential for providing optimal care. The SPIKES protocol is a communication protocol used as a standard and strategy for delivering difficult patient communication, comprising several stages: setting up, perception, invitation, knowledge, emotions, strategy, and summary.Objective: This study aimed to determine the effect of using the BBN flip chart calendar as educational media, combined with the SPIKES method, at Universitas Gadjah Mada Academic Hospital (UGM Academic Hospital). The specific research objectives were: (a) to understand the perceptions and expectations of doctors and nurses when providing education related to BBN, and (b) to determine the effect of using the BBN flip chart calendar educational media on patients.Method: This study was an experimental investigation to assess the effectiveness of using the BBN flip chart calendar as educational media in conjunction with the SPIKES protocol. The type of research was a quantitative study to understand the implementation of the BBN flip chart educational media at UGM Academic Hospital.Result:  The intervention group and the control group do not show statistically significant differences. The primary reason for these outcomes could be that behavioral changes are difficult to modify with a single communication practice. Continuous evaluation and feedback are needed on the effectiveness of BBN to improve the quality of health workers.
Co-Authors Abdul Gofir Abdullah Syafiq Edyanto Adnan, Nur Fatimah Ahmad Asmedi Amelia Nur Vidyanti Andatu, Roshynta Linggar Cempaka Thursina Srie Setyaningrum Christantie Effendy Deshinta Putri Mulya Desin Pambudi Sejahtera Eko Budiono Hanif, Faishal Hayati, Hanifah Fajarisna Indarwati Indarwati Ismail Setyopranoto Khairani, Atitya Fithri Luthffia, Audiza Mara Ditta, Adist Azizy Mukhtar, Ishana Nafeeza Nalendra Tama, Whisnu Pambudi Sejahtera, Desin Paryono Rosalia, Levina Prima Sejahtera, Desin Pambudi Sri Sutarni Subagya Subagya, Subagya Sudibyo, Triyanti Kurniasari Ananta Putri Tama, Whisnu Nalendra Umi S. Intansari Ida Savitri Laksanawati Wirastuti, Fita Yuli Firlando, Afdhal