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All Journal Damianus Journal of Medicine MNJ (Malang Neurology Journal) KESANS : International Journal of Health and Science HEALTHY: Jurnal Inovasi Riset Ilmu Kesehatan
Arimbawa, I Komang
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Chemistry Health Professions Medicine & Pharmacology Neuroscience Physics Public Health

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LOW TOTAL CHOLESTEROL SERUM LEVELS AS A POOR OUTCOME PREDICTOR FOR INTRA-CEREBRAL HEMORRHAGE STROKE Ariswanda, I Gusti Agung Gede; Adnyana, I Made Oka; Widyadharma, I Putu Eka; Nuartha, A A B N; Laksmidwei, A A A Putri; Arimbawa, I Komang
MNJ (Malang Neurology Journal) Vol. 6 No. 2 (2020): July
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

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Abstract

Background: Stroke is affected by several factors, age, infection during treatment, obesity, and total cholesterol (TC) levels.  Objective: The study aimed to prove low TC serum levels as an unfortunate outcome predictor for intracerebral hemorrhage stroke. Methods: This study is a prospective cohort design. The research did in the Stroke Unit of Sanglah Hospital, Denpasar, from July 1st, 2018 to January 31th, 2019. The study involved patients with hemorrhage strokes with low TC serum levels and aged 40-95 years. Depending on variable divided into two groups with low TC serum levels (<180 mg/dL) and normal TC serum levels (>180mg/dL). Independent variable is The National Institutes of Health Stroke Scale (NIHSS) as an outcome. The processing of data analysis using Mac for SPSS version 23. Result: This study used 70 subjects. The age characteristics of the study subjects with a median value of 62 years in for low TC levels, and 57 years for normal TC levels, dominant in male (60% ), working (71.5%), not obese (58.6%), stroke-related infections (51.4%), and mean arterial blood pressure (MABP) £130mmHg (90%). Subjects with low TC had a risk of 64 times experiencing adverse outcomes (RR = 64: CI 95% = 14.06-291.32: p <0.001). Multivariate analysis showed a low TC serum level as an independent variable.Conclusion: Low TC serum levels as an independent predictor having a poor outcome in intracerebral hemorrhage stroke
Characteristics of Electrodiagnosis in Drop Foot Patients at Neurological Polyclinics Elsye Anita Umsina Nauw, Haya; Arimbawa, I Komang; Dwita Pratiwi, Ni Made
Jurnal KESANS : Kesehatan dan Sains Vol 3 No 7 (2024): KESANS: International Journal of Health and Science
Publisher : Rifa'Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.54543/kesans.v3i7.293

Abstract

Introduction: Drop foot is the inability to lift the front leg due to the dorsoflexion weakness of the foot, which causes an unsafe gait and potentially results in a fall. This weakness is often caused by compression neuropathy of the peroneal nerve and can result from injuries at various levels of the nervous system. Other causes include metabolic diseases such as diabetes mellitus as well as neurodegenerative, neuromuscular, and inflammatory conditions. The gold standard for diagnosing peroneal neuropathy is electrodiagnostic testing, including nerve conduction studies and needle electromyography, which are useful for detecting lesions and differentiating the degree of lesion in the nervous system. Objective: This study aims to determine the characteristics of drop foot patients who undergo electrodiagnostic examinations, especially the results of Compound Muscle Action Potential (CMAP) and Sensory Nerve Action Potential (SNAP), at the Neurological Polyclinic of Professor IGNG Ngoerah Hospital Denpasar, Bali. Method: This study used a cross-section descriptive study. Data was collected from the medical records of patients who underwent electrodiagnostic examinations at the neurological polyclinic of Professor IGNG Ngoerah Hospital. Data analysis was conducted to evaluate the characteristics of CMAP and SNAP in patients with drop foot complaints. Result and Discussion: the study showed that as many as 80% of drop foot patients were male, electrodiagnostic examination, in CMAP assessed the peroneal and tibial nerves, the motor nerve transmission there were 100% lesions on the peroneal nerve at all levels of lesion location.  Meanwhile, different results can be seen from the assessment of SNAP function where what is assessed is the surreal nerve in each different lesion group. Conclusion: Electrodiagnostic examinations, particularly CMAP and SNAP analysis, are effective in identifying peroneal neuropathy as the cause of foot drop. This study supports the importance of electrodiagnostic examination to determine the location of the lesion and plays a role in the treatment and prognosis of patients with drop foot complaints in the neurological polyclinic
MYASTHENIA GRAVIS WITH FEATURES OF ACUTE PONS INFARCTION: A RARE CASE REPORT Kencana Dewi, Ni Luh Diah; Arimbawa, I Komang; Dwita Pratiwi, Ni Made
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
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.2024.010.02.19

Abstract

Background: Myasthenia gravis (MG) is an antibody-mediated autoimmune disease at neuromuscular synaptic transmission. The clinical sign of a myasthenia gravis is the presence of weakness that affects vision (ocular), bulbar and proximal skeletal muscles and also myasthenia gravis can resemble vascular disorders or any infectious diseases. Case: A 48-year-old Balinese male patient came to the emergency department of  Prof I.G.N.G Ngoerah Central General Hospital complaining of shortness of breath. Shortness of breath is said to have occurred since one month ago. Shortness of breath improves slightly when the patient rests. Another complaint felt by the patient is that the right eyelid drops, especially during the daytime, will improve in the afternoon. The patient denied any weight loss or a history of malignancy. The patient about three months ago had fallen from a motorcycle and felt numbness in his right cheek until now. The patient has been undergoing treatment at the District General Hospital and he was diagnosed with myasthenia gravis and took Mestinon. CT scan of the head showed an acute infarction of the left pons accompanied by a suspicion of acute meningoencephalitis. Discussion: From the results of the RNS (Repetitive nerve stimulation) in this patient, it was found that the neuromuscular junction lesion was supportive of the description of the myasthenia gravis case. Conclusion: Myasthenia gravis is a disease of the nervous system with various manifestations. Good clinical examination and supporting examination are very necessary to confirm the diagnosis.
LAPORAN KASUS: PERAN KOLABORATIF PSIKIATRI DALAM TATALAKSANA GANGGUAN PSIKIATRIK PADA PENDERITA MIASTENIA GRAVIS KAPITA, RAMBU K. B. F.; WAHYUNI, A A SRI; DINIARI, N K SRI; ARYANI, L N ALIT; ARIMBAWA, I KOMANG
HEALTHY : Jurnal Inovasi Riset Ilmu Kesehatan Vol. 4 No. 1 (2025)
Publisher : Pusat Pengembangan Pendidikan dan Penelitian Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51878/healthy.v3i4.4356

Abstract

Myasthenia Gravis (MG) is an autoimmune disorder affecting the neuromuscular junction, leading to impaired muscle contraction that worsens with activity and improves with rest. It commonly affects bulbar and skeletal muscles, severely impairing the patient's ability to perform daily activities and requiring long-term therapy. The chronic nature of the disease can lead to psychiatric disorders, which may exacerbate MG symptoms, and vice versa. Psychiatric disorders in this context are not merely psychological responses to the disease but can also be biologically explained. This case report discusses the role of psychiatry in managing psychiatric disorders in MG patients, focusing on measurable therapy outcomes using the quality of life instrument MG-ADL (Myasthenia Gravis Activities of Daily Living), compared with psychiatric disorders such as depression and anxiety using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). The case involves a 31-year-old female patient with a severe MG crisis, presenting with psychiatric disorders such as depression and anxiety, which were managed through an integrated approach between psychiatry and medical MG management. The use of MG-ADL as a clinical measure showed significant improvement in the patient’s daily functioning following neurological interventions, including definitive MG therapy and psychiatric adjunctive care. Furthermore, BDI and BAI results indicated a significant reduction in scores, correlating with the improvement in MG condition, as monitored through MG-ADL. This case study highlights the importance of collaborative roles between psychiatry and other specialists in managing MG. This collaboration leads to better physical and psychological functioning. The implications of this case report strengthen the argument for a holistic approach to MG management, where psychiatric aspects should not be neglected in efforts to achieve optimal therapeutic outcomes. ABSTRAKMiastenia gravis merupakan gangguan autoimun pada neuromuscular junction menyebabkan gangguan kontraksi otot yang semakin parah dengan aktivitas dan membaik dengan istirahat, sering terjadi pada otot bulbar dan gerak, serta menyulitkan penderita dalam berbagai aspek aktivitas keseharian dan membutuhkan terapi jangka waktu lama. Kondisi penyakit kronis dapat menimbulkan suatu gangguan psikiatri dimana kehadirannya dapat memperparah kondisi MG demikian sebaliknya. Kehadiran Gangguan psikiatrik bukan sebagai suatu respon psikologik semata dalam menghadapi penyakit, melainkan dapat dijelaskan secara biologik. Laporan kasus ini mengulas peran psikiatri dalam manajemen gangguan psikiatri pada pasien MG, dengan fokus pada peningkatan hasil terapi yang terukur menggunakan kualitas hidup dengan instrument MG-ADL (Myasthenia Gravis Activities of Daily Living) dibandingkan dengan gangguan psikiatrik berupa depresi dan kecemasan menggunakan instrument BDI (Beck Depression Inventory) dan BAI (Beck Anxiety Inventory). Kasus melibatkan seorang pasien wanita 31 tahun, dengan krisis MG (gejala berat) yang mengalami gangguan psikiatri seperti depresi dan kecemasan, yang diatasi dengan pendekatan terintegrasi antara psikiatri dan manajemen medis MG. Penggunaan MG-ADL sebagai pengukur klinis menunjukkan perbaikan signifikan dalam fungsi harian pasien setelah intervensi neurologis yaitu terapi definitif MG dan adjuvan psikiatri dilakukan. Selain itu, hasil BDI dan BAI menunjukkan penurunan skor yang signifikan sejalan dengan perbaikan kondisi MG yang terpantau dengan MG-ADL. Studi kasus ini menyoroti pentingnya peran kolaboratif antara psikiatri dan spesialisi lainnya dalam menangani MG. Hal ini mengarah pada perbaikan fungsi fisik dan psikologis yang lebih baik. Implikasi dari laporan kasus ini memperkuat argumen untuk pendekatan holistik dalam manajemen pasien MG, di mana aspek psikiatri tidak boleh diabaikan dalam upaya mencapai hasil terapi yang optimal.
Prediktor Klinis dan Pencitraan Hematoma Subdural Kronik pada Pasien Lanjut Usia di Instalasi Gawat Darurat Vania, Aurelia; Arimbawa, I Komang; Laksmidewi, Anak Agung Ayu Putri; Putra, Ida Bagus Kusuma; Widyantara, I Wayan
Bahasa Indonesia Vol 23 No 3 (2024): Damianus Journal of Medicine
Publisher : Atma Jaya Catholic University of Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25170/djm.v23i3.5416

Abstract

Pendahuluan: Subdural hematoma kronik (cSDH) merupakan salah kasus emergensi neurologi yang sering terjadi yang lebih sering terjadi pada lansia. Diagnosis cSDH memiliki kesulitan tersendiri pada pasien lansia. Studi ini bertujuan untuk mempelajari karakteristik klinis pasien lansia yang dapat menjadi prediktor adanya cSDH dan derajat keparahan gambaran cSDH yang ditemukan pada hasil CT-scan kepala. Metode: Penelitian ini merupakan studi kasus-kontrol yang dilakukan di Instalasi Gawat Darurat Neurologi RSUP Prof. dr. I.G.N.G. Ngoerah dalam periode 3 tahun. Studi melibatkan 85 pasien lansia cSDH dan 85 kontrol yang terbukti tidak ada perdarahan intrakranial dari data imaging. Pengumpulan dan pengolahan data yang dilakukan meliputi variabel karakteristik demografi, faktor risiko, presentasi klinis, dan karakteristik cSDH pada gambaran computed-tomography scan (CT-scan) kepala. Hasil: Studi ini menemukan pasien cSDH dengan rata-rata usia 72,9±8.1 tahun dan 75,3% laki-laki. Penurunan kesadaran dan defisit fokal merupakan presentasi klinis yang paling sering ditemukan dengan median onset 3 hari (rentang 1-30 hari). Usia lebih tua, laki-laki (RO=2,84, 95% IK 1,45-5,45, p=0,001), hipertensi (RO=3,66, 95% IK 1,89-7,06, p=0,000), dan gangguan ginjal kronik (RO=2,77, 95% IK 1,34-5,72, p=0,005) merupakan faktor risiko terjadinya cSDH yang signifikan. Efek massa dan Glasgow Coma Scale (GCS) yang rendah lebih sering terjadi pada cSDH dengan midline shift (MLS) >5mm. Simpulan: Adanya cSDH perlu dipertimbangkan pada pasien lansia yang datang dengan onset manifestasi neurologis akut-subakut terutama pasien laki-laki, mengalami penurunan kesadaran dengan atau tanpa defisit fokal, disertai adanya komorbid hipertensi dan gangguan ginjal. Penurunan GCS dan efek massa dapat memperkirakan adanya MLS pada CT-scan kepala.
Co-Authors Anak Agung Ayu Putri Laksmidewi Anak Agung Bagus Ngurah Nuartha Ariswanda, I Gusti Agung Gede ARYANI, L N ALIT DINIARI, N K SRI Dwita Pratiwi, Ni Made Elsye Anita Umsina Nauw, Haya I Made Oka Adnyana I Putu Eka Widyadharma I WAYAN WIDYANTARA KAPITA, RAMBU K. B. F. Kencana Dewi, Ni Luh Diah Laksmidwei, A A A Putri Putra, Ida Bagus Kusuma Vania, Aurelia Wahyuni, A A Sri