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All Journal e-CliniC JURNAL BIOMEDIK KESMAS Universa Medicina Jurnal Kedokteran Klinik Jurnal Sinaps Medical Scope Journal (MSJ) Eduvest - Journal of Universal Studies Jurnal Kedokteran Meditek Malahayati International Journal of Nursing and Health Science Indonesian Journal of Public Health and Community Medicine Journal of Neurointervention and Stroke (JNeViS)
Warouw, Finny
Fakultas Kesehatan Masyarakat Universitas Sam Ratulangi Manado
Aerospace Engineering Biochemistry, Genetics & Molecular Biology Computer Science & IT Dentistry Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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Effectiveness of non-invasive transcranial magnetic stimulation therapy as a therapy for post-stroke visuospatial impairment: A meta-analysis Lapian, Albertus Theo; Warouw, Finny; Momole, Ansye Grace Nancy; Pertiwi, Junita Maja; Tangkudung, Gilbert
Malahayati International Journal of Nursing and Health Science Vol. 8 No. 2 (2025): Volume 8 Number 2
Publisher : Program Studi Ilmu Keperawatan-fakultas Ilmu Kesehatan Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/minh.v8i2.552

Abstract

Background: Visuospatial disorders refer to deficits in attention, exploration, and interaction with the contralateral side of space that cannot be attributed to primary sensory or motor dysfunction. These disorders are usually caused by lesions in the right hemisphere due to cerebral circulation disorders, such as stroke. Transcranial Magnetic Stimulation (TMS) has emerged as a noninvasive treatment option for addressing visuospatial deficits. Purpose: To evaluate the effectiveness of TMS as a therapy for visuospatial disorders in post-stroke patients. Method: This study was conducted using randomized controlled trials (RCTs) comparing TMS with sham treatment for post-stroke visuospatial impairment identified through searches in Google Scholar, PubMed/Medline, Clinical Key, Wiley Online, Science Direct, ResearchGate, and Neurona. A meta-analysis was conducted to assess the efficacy of TMS therapy for improving visuospatial deficits in post-stroke patients. Results: A total of 189 studies on TMS were identified with four homogeneous articles finally included in the meta-analysis. The analysis combined visuospatial assessments using the Motor-Free Visual Perception Test (MVPT), ​​Star Cancellation Test (SCT), Albert Test (AT), and Line Bisection Test (LBT). The meta-analysis revealed significant findings for the MVPT, with a weighted mean difference (WMD) of 2.43 (95% CI: 1.86 to 3.01, p < 0.001). For LBT, WMD was 2.69 (95% CI: 2.04 to 3.34, p = 0.020). Conclusion: The improvements in visuospatial function observed in participants undergoing TMS suggest that TMS may serve as a potential therapeutic option for post-stroke patients with visuospatial impairment.
Effectiveness of medium-chain triglyceride diet and low glycemic index therapy in drug-resistant childhood epilepsy: a systematic review, meta-analysis, and meta-regression Wiradarma, Elbert; Khosama, Herlyani; Warouw, Finny; Wariki, Windy M. V.; Jehosua, Seilly Yunita; Pertiwi, Junita Maja
Universa Medicina Vol. 44 No. 2 (2025)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2025.v44.245-256

Abstract

Background Drug-resistant epilepsy (DRE) challenges clinical management, with many patients failing to find relief. Medium-chain triglyceride diet (MCTD) and low glycemic index therapy (LGIT) are emerging variants of the ketogenic diet. MCTD and LGIT show promise but lack clear efficacy data. The purpose of this systematic review was to evaluate and compare the efficacy of MCTD and LGIT in the management of pediatric patients with DRE. Methods Four databases were searched (PubMed, Embase, Scopus, and Cochrane Library) from November 2024 to February 2025. Two independent reviewers meticulously screened titles, abstracts, and full texts, ensuring adherence to predefined criteria.  Data extraction encompassed study characteristics, participant demographics, intervention details, and outcomes, including seizure frequency, percentage reduction, and adverse events. Statistical analyses were performed using R 4.2.2 software, assessing heterogeneity with Cochrane Q and I² and utilizing random-effects and common-effects models. Results From 1489 articles found, 487 duplicates were removed, 897 were excluded based on title and abstract screening, and of the 47 full-text articles assessed for eligibility, 31 articles were excluded, resulting in 16 articles (9 MCTD and 7 LGIT) included in this review. The pooled estimates for the proportion of children achieving seizure freedom, ≥90% seizure reduction, and ≥50% seizure reduction following the intervention were comparable between the MCTD and LGIT groups. Based on the random-effects model, the overall success proportion of MCTD in reducing seizure frequency was 0.20 [95 % Confidence Interval (CI), 0.14-0.27] (p<0.01). Meanwhile, in the LGIT group, the overall success proportion was 0.27 [95% CI,0.14- 0.45] (p<0.01). Conclusion Both MCTD and LGIT demonstrate comparable efficacy, and no definitive conclusion can be drawn regarding the superiority of one diet over the other.
Korelasi antara Tingkat Distres dengan Early-Onset Dementia pada Narapidana LPP Kelas IIB Manado Pua, Yohanes A.; Pertiwi, Junita M.; Warouw, Finny
e-CliniC Vol. 14 No. 2 (2026): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v14i2.65855

Abstract

Abstract: Female inmates in correctional institutions are vulnerable to psychological distress, including depression, anxiety, and stress. High levels of distress are associated with an increased incidence of early-onset dementia (EOD), which refers to dementia occurring before the age of 65. This study aimed to determine the correlation between distress levels and EOD among female inmates. This was an analytical observational study with a cross-sectional design, conducted at the Manado Class IIB Women’s Correctional Institution from August to November 2025. Sampling was carried out using the stratified random sampling technique, with DASS-21 and MoCA-Ina questionnaires as research instruments. The results obtained a total of 59 female inmates participated in this study. Most inmates had normal distress levels, including normal depression (59,3%), anxiety (49,2%), and stress (59,3%). Based on EOD assessment, the majority (62.7%) showed cognitive impairment. The Spearman’s correlation test indicated a significant relationship between distress levels and early-onset dementia (p=0.000). In conclusion, there is a significant correlation between distress levels and early-onset dementia among female inmates at the Manado Class IIB Women’s Correctional Institution. Keywords: distress levels; early-onset dementia   Abstrak: Narapidana perempuan di lembaga pemasyarakatan rentan mengalami distres, seperti depresi, kecemasan, maupun stres. Tingginya tingkat distres berdampak pada angka kejadian early-onset dementia (EOD), yang merujuk pada demensia di rentang usia <65 tahun. Penelitian ini bertujuan untuk mengetahui korelasi antara tingkat distres dengan EOD pada narapidana LPP Kelas IIB Manado. Jenis penelitian ialah observasional analitik dengan desain potong lintang. Penelitian ini dilakukan di LPP Kelas IIB Manado selama bulan Agustus-November 2025, dengan teknik pengambilan sampel menggunakan stratified random sampling. Instrumen penelitian menggunakan lembar kuesioner DASS-21 dan MoCA-Ina. Jumlah sampel penelitian ini sebanyak 59 narapidana perempuan. Hasil penelitian menunjukkan bahwa mayoritas narapidana perempuan berada pada tingkat distres normal, dengan sebaran tingkat depresi normal (59,3%), tingkat kecemasan normal (49,2%), dan tingkat stres normal (59,3%). Berdasarkan penilaian EOD, mayoritas narapidana perempuan mengalami gangguan kognitif (62,7%). Hasil uji korelasi Spearman mendapatkan nilai signifikansi p<0,01 (p=0,000) yang menunjukkan terdapat korelasi bermakna antara tingkat distres dengan EOD. Simpulan penelitian ini ialah terdapat korelasi bermakna antara tingkat distres dengan early-onset dementia pada narapidana LPP Kelas IIB Manado. Kata kunci: tingkat distres; early-onset dementia
Anatomical Profile of Vertebrobasilar System Based on Angiographic Studies Tangkudung, Gilbert; Warouw, Finny; Yoesdyanto, Kennytha; Hartoyo, Vinson
Journal of Neurointervention and Stroke Vol. 1 No. 1: MAY 2025
Publisher : Neurointervention Working Group of Indonesian Neurological Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63937/jnevis-2025.11.9

Abstract

Highlight: Anatomical variations in blood vessels can significantly affect circulatory hemodynamics These variants also pose a risk of developing intracranial pathologies such as aneurysms Early detection can help prevent further complications ABSTRACT Introduction: Variations of cerebral vasculature in vertebrobasilar system (VBS) occur during embryogenesis and may contribute to cerebrovascular events. These anatomical variants occur in approximately 7% of cases with a 91% prevalence noted in the symmetrical caudal fusion variant. Cerebral angiography remains the most sensitive method for diagnosing these anomalies. Objective: This study aimed to identify angiographic variations in the VBS.  Method: This descriptive observational study used a cross-sectional approach, analyzing secondary data from stroke patients who underwent angiographic procedures between December 2017 and August 2020 at Prof. dr. R. D. Kandou Hospital, Manado. The sample size included the total population of stroke patients who met the inclusion criteria. Data were processed using SPSS version 32. Result:  A total of 277 samples were analyzed. The most commonly observed variations were symmetric cranial fusion (81.50%) and asymmetric caudal fusion (15.42%). One case of symmetric caudal fusion had a basilar tip aneurysm. While most patients exhibited normal anatomy, variants of the posterior cerebral artery (PCA) were also observed, including absence (6.17%) and hypoplasia (7.48%). The superior cerebellar artery (SCA) was absent in 1.76% of cases. Absence of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) was observed in 13.56% of cases; however, these were compensated by complex vascular formations involving collateral sources (21.58%). Conclusion: This study concludes that anatomical variations in cerebral vasculature, including perforators and anastomoses, can be effectively observed through angiographic studies.Careful patient selection is essential to rule out secondary causes of hemifacial spasm and to identify underlying neurovascular contacts.
Pengaruh Pemberian Kafein terhadap Luaran Klinis Penyakit Parkinson Skor UPDRS Adinata, Daniel N.; Sekeon, Sekplin A. S.; Warouw, Finny
e-CliniC Vol. 14 No. 2 (2026): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v14i2.66057

Abstract

Abstract: Parkinson’s disease is the second most common neurodegenerative disorder worldwide and still lacks of a disease-modifying therapy. Caffeine, an A2AR antagonist, may provide neuroprotection and modulate the dopaminergic system, potentially improving both motor and non-motor symptoms of this disease. This study aimed to evaluate the association of caffeine administration with Unified Parkinson’s Disease Rating Scale (UPDRS) score changes in patients with Parkinson’s disease through a meta-analysis of clinical trials. This meta-analysis showed that caffeine was associated with a statistically significant reduction in UPDRS III scores at enam weeks with moderate certainty, statistically insignificant reductions on UPDRS I, II, III (beyond six weeks), and IVFluctuations with moderate certainty, and statistically insignificant increases in UPDRS IVDyskinesia with low certainty. All UPDRS subscale changes might not be clinically meaningful. In conclusion, caffeine likely reduces UPDRS I, II, III, and IVFluctuation scores and may increase UPDRS IVDyskinesia, but may not be clinically meaningful. Nonetheless, caffeine remains a potential adjuvant candidate warranting further trials incorporating drug holidays to prevent tolerance Keywords: Parkinson’s disease; caffeine; Unified Parkinson’s Disease Rating Scale    Abstrak: Penyakit Parkinson merupakan penyakit neurodegeneratif kedua tersering di dunia dan masih belum memiliki terapi yang dapat memodifikasi progresifitasnya. Kafein, antagonis A2AR, diduga memiliki efek neuroprotektif dan modulasi sistem dopaminergik yang berpotensi memperbaiki gejala motorik maupun non-motorik penyakit ini. Penelitian ini bertujuan untuk menilai hubungan pemberian kafein terhadap perubahan skor Unified Parkinson’s Disease Rating Scale (UPDRS) pada pasien penyakit Parkinson melalui meta-analisis uji klinis. Hasil meta-analisis menunjukkan bahwa pemberian kafein secara statistik bermakna menurunkan skor UPDRS III durasi intervensi enam minggu dengan keyakinan sedang, tidak secara statistik bermakna menurunkan skor UPDRS I, II, III (selain durasi intervensi enam minggu), dan IVFluktuasi dengan keyakinan sedang, serta tidak secara statistik bermakna meningkatkan skor UPDRS IVDiskinesia dengan keyakinan rendah. Semua perubahan luaran subskala UPDRS mungkin tidak bermakna secara klinis. Simpulan penelitian ini ialah pemberian kafein kemungkinan besar menurunkan skor UPDRS I, II, III, dan IV bagian fluktuasi, serta mungkin meningkatkan skor UPDRS IVDiskinesia, tetapi mungkin tidak bermakna secara klinis. Meskipun demikian, terdapat potensi kafein sebagai adjuvan yang masih memerlukan penelitian lanjutan dengan drug holiday untuk mencegah toleransi. Kata kunci: penyakit Parkinson; kafein; Unified Parkinson’s Disease Rating Scale
Co-Authors Adinata, Daniel N. Akili, Rahayu H, Andika Surya Atmadja Anes, Brenda Militsia Christi Rosalina Angelina Stevany Regina Masengi Anthonius Kurniadi Assa, Winly Yuliana Birang, Meirani F. Budi Ratag, Budi Budi Setiawan Chesya P.R. Salindeho Christoffel M. Memah Daniel Febrian Sengkey Deeng, Gracia V. Y. Desy . Doda, Diana V.D. Edward Nangoy, Edward Frans Wantania Gampu, Agrisia Garusu, Ratna Santika Hartoyo, Vinson Harvani Boky, Harvani Herlyani Khosama Hugo Dwiputra Jehosua, Seilly Yunita Jimmy Posangi Jootje M.L Umboh Junita Maja P.S Junita Maja Pertiwi Kamae, Sitti Ramlia Kawatu, Paul A.T Kumayas, Putri Elshadai Labagow, Elisa Lantang, Christina Lapian, Albertus Theo Laura Wulandary Kaeng Lengkong, Erlika Lihu, Tutin R. M.L, Jootje Maddusa, Sri Seprianto Maja Pertiwi, Junita Mamahit, Juliet Merry Eva Mambo, Christi Diana Manabung, Apriliani R. Maranatha, Armando Vengo Subito Lewi Marthen Theogives Lasut, Marthen Theogives Melke J. Tumboimbela Mieke A. H. N. Kembuan Mieke A.H.N Kembuan Momole, Ansye Grace Nancy Mutiara Toreh Nike Gledis Monintja Oddi R Pinontoan Odi Pinontoan Odi Roni Pinontoan Paendong, Winner Hiskia George Paul A.T. Kawatu Pertiwi, Junita M. Pertiwi, Junita Maja Pua, Yohanes A. Purbawijaya, Poek Denny Rahayu H. Akili, Rahayu H. Ratumbanua, Fralen Julio Rianna J Sumampouw Ricky C. Sondakh Rizal Tumewah Sekplin A. S. Sekeon, Sekplin A. S. Sengkey, Aprilia Sengkey, Omega Prisilia Soeratinoyo, Dewi K. Sugiarto, Natanael E. Sumigar, Cindy Keren Suoth, Lery F. Tangkudung, Gilbert Tewuh, Syeri Oktaviani Theresia Runtuwene Togelang, Mega Rossita Umboh, Jootje Marthen Luther Umboh, Jotje M.L Vriska V. Rambing Walewangko, Sarah Alni Wariki, Windy M. V. Wello, Novita L. L. Wiradarma, Elbert Woodford B. S. Joseph Woodford B.S. Joseph, Woodford B.S. Wowor, Ribka Yantu, Sintia Salmawati Yoesdyanto, Kennytha Yonathan Andrian Yulianty Sanggelorang