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Hubungan Derajat Berat Disfagia dengan Perbaikan Derajat Stroke pada Pasien Stroke Iskemik Akut di RSUD Dr. Moewardi Surakarta Ira Ristinawati; OS Hartanto; Hari Wujoso; Subandi Subandi
Smart Medical Journal Vol 4, No 2 (2021): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v4i2.42116

Abstract

Pendahuluan: Stroke masih merupakan penyebab mortalitas dan morbiditas yang tinggi di seluruh dunia. Pasien stroke sering mengalami disfagia terutama pada fase akut. Prosedur penilaian yang mudah diterapkan untuk menilai disfagia pada pasien stroke penting dilakukan untuk mencegah komplikasi yang bisa terjadi akibat disfagia, yaitu dengan menggunakan skor GUSS (Gugging Swalowing Screen).Metode: Penelitian ini adalah penelitian kuantitatif analitik observasional dengan pendekatan cross sectional, dengan populasi sampel pasien stroke iskemik akut yang rawat inap pada periode bulan Januari-Maret 2020, didapatkan jumlah subjek penelitian 33 yang sesuai dengan kriteria inklusi dan eksklusi yang telah ditentukan. Uji korelasi pearson dan spearman digunakan untuk menganalisis data dalam penelitian ini.Hasil: Terdapat hubungan yang signifikan secara statistik antara disfagia dengan perbaikan derajat stroke pada pasien stroke iskemik akut dengan nilai p=0,002 (p<0.05) yang mempunyai korelasi sedang (r=0,530) di RSUD Dr.Moewardi Surakarta. Selain itu juga terdapat hubungan yang signifikan secara statistik antara keparahan disfagia dengan pneumonia dengan nilai p=0.001 (p<0.005)Kesimpulan: Terdapat hubungan antara disfagia dengan perbaikan derajat stroke pada pasien stroke iskemik akut di RSUD Dr.Moewardi Surakarta. Kata Kunci: stroke iskemik akut, disfagia, NIHSS, skor GUSS, perbaikan derajat stroke.Introduction: Stroke has high mortality and morbidity rates in the world. Stroke patients often experience dysphagia, especially in the acute phase. An easy assessment procedure applied to assess dysphagia in stroke patients is important to prevent complications that can occur due to dysphagia, namely by using a GUSS (Gugging Swalowing Screen) score.Methods: This study was a quantitative observational analytic study with a cross sectional design, with a sample population of acute ischemic stroke patients who were hospitalized in the period January-March 2020, obtained the number of subjects 33 in accordance with the specified inclusion and exclusion criteria. Pearson and Spearman correlation tests were used to analyze the data in this study.Results: There was a statistically significant relationship between dysphagia and stroke improvement in patients with acute ischemic stroke with p value = 0.002 (p <0.05) which had a moderate correlation (r = 0.530) in Dr.Moewardi Hospital Surakarta. There was also a statistically significant relationship between the severity of dysphagia and pneumonia with p value = 0.001 (p <0.005)Conclusion: There is a relationship between dysphagia and improvement in the degree of stroke in patients with acute ischemic stroke in RSUD Dr.Moewardi Surakarta. Keywords: acute ischemic stroke, dysphagia, NIHSS, GUSS score, stroke improvement.
Long-COVID neurological symptoms are associated with D-dimer levels in COVID-19 patients Diah Kurnia Mirawati; Pepi Budianto; Rivan Danuaji; Subandi Subandi; Ira Ristinawati; Hanindia Riani Prabaningtyas
Universa Medicina Vol. 41 No. 2 (2022)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2022.v41.169-175

Abstract

Background Coronavirus disease 2019 (COVID-19) is a disease designated as a global pandemic by the WHO that can manifest clinically as neurological disorders that can occur in the acute phase or after the acute phase (long COVID-19), such as headache, myalgia, anosmia, and cognitive impairment. These neurological disorders as symptoms of long COVID-19 are presumably caused by hypercoagulable conditions characterized by an increase in D-dimer level. This study aims to determine the correlation of long COVID-19 neurological symptoms with hypercoagulable conditions and the role of D-dimer as a biomarker of long COVID-19 neurological symptoms. MethodsThis was a cross-sectional study involving 31 patients with long COVID-19 symptoms. Admitted long COVID-19 cases with recorded D-dimer levels and definitive outcomes were included consecutively. Long COVID-19 neurological symptoms were collected. D-dimer level was measured using immunofluorescence assay and reported in fibrinogen equivalent units (ìg/mL). The correlation between D-dimer levels and neurological clinical manifestations was assessed by using ordinal regression analysis. The p-value of <0.05 was considered statistically significant. ResultsThe mean age of the subjects was 38.81 ± 11.58 years and 18 (58.06%) were female. Long COVID neurological symptoms comprised myalgia, anosmia and cephalgia, and most subjects complained of myalgia (80.65%). On multivariable analysis, long-COVID-19 neurological symptoms were significantly correlated with D-dimer [odds ratio (OR) = 1.05; p=0.020]. ConclusionThe number of neurological long COVID symptoms were significantly correlated with level of D-Dimer. Ultimately, more clarity is needed on the neurological impact of COVID-19, its diagnosis, and its treatment.
Efektivitas Pelatihan Manajemen Disfagia terhadap Pengetahuan Tenaga Kesehatan RSUD Dr. Moewardi Ira Ristinawati; Raden Andi Ario Tedjo; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Hanindia Riani Prabaningtyas; Muhammad Hafizhan; Stefanus Erdana Putra
Smart Society Empowerment Journal Vol 2, No 3 (2022): Smart Society Empowerment Journal
Publisher : Fakultas Kedokteran UNS

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (409.782 KB) | DOI: 10.20961/ssej.v2i3.67279

Abstract

Pendahuluan: Disfagia atau kondisi kesulitan menelan makanan dari rongga mulut ke lambung merupakan salah satu komplikasi dari stroke. Disfagia merupakan komplikasi yang sangat mempengaruhi luaran klinis pasien stroke. Adanya kesulitan menelan akan memperumit kondisi neurologis pasien stroke. Manajemen disfagia merupakan hal yang sangat penting untuk dipahami oleh tenaga kesehatan sehingga dapat meningkatkan kualitas hidup pasien.Metode: Pelatihan manajemen disfagia dilakukan dengan metode presentasi yang dilanjutkan dengan sesi diskusi bersama pemateri. Untuk menilai pengetahuan peserta mengenai manajemen disfagia, peserta menjalani pretest dan posttest. Hasil pretest dan posttest kemudian dibandingkan dengan uji T-berpasangan untuk mengetahui efektivitas pelatihan terhadap pengetahuan tenaga kesehatan mengenai manajemen disfagia pasca strokeHasil dan pembahasan: Pelatihan ini diikuti oleh 72 orang tenaga kesehatan di RSUD Dr Moewardi yang terdiri dari 27 (37.5%) orang perawat, 22 (30.5%) orang dietisien, dan 23 (32.0%) orang fisioterapis. Hasil uji korelasi menunjukkan perbedaan yang signifikan antara nilai pretest dan posttest perawat (r=0.812, p=0.021), nutrisionis (r=0.792, p=0.038), dan fisioterapis (r=0.649, p=0.002)Kesimpulan: Terdapat peningkatan pengetahuan tentang manajemen disfagia pada tenaga kesehatan di RSUD Dr. Moewardi.Kata Kunci: disfagia, stroke, tenaga kesehatan, pelatihan
Pelatihan Pengisian Mini Mental State Examination (MMSE) dan Eight-item Informant Interview to Differentiate Aging and Dementia (AD8) untuk Deteksi Dini Demensia Alzheimer bagi Tenaga Kesehatan di Fasilitas Kesehatan Tingkat Pertama Ira Ristinawati; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Hanindia Riani Prabaningtyas; Raden Andi Ario Tedjo; Stefanus Erdana Putra; Muhammad Hafizhan
SEMAR (Jurnal Ilmu Pengetahuan, Teknologi, dan Seni bagi Masyarakat) Vol 11, No 2 (2022): November
Publisher : LPPM UNS

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/semar.v11i2.66400

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Kegiatan ini bertujuan untuk  untuk meningkatkan pengetahuan dan kesadaran para tenaga kesehatan di fasilitas kesehatan tingkat pertama (FKTP) tentang pentingnya cara pengisian kedua instrumen tersebut dalam rangka deteksi dini demensia Alzheimer. Kegiatan ini juga bertujuan mengarahkan para tenaga kesehatan di FKTP untuk melakukan skrining pada pasien yang memiliki faktor risiko mengalami demensia Alzheimer sehingga tatalaksana dini yang lebih baik dapat diterapkan pada penderita demensia Alzheimer yang tentunya dapat meningkatkan kualitas hidup pasien tersebut. Target yang dicapai adalah peningkatan pemahaman dan informasi terkait cara pengisian MMSE dan AD8 dan manfaat skrining demensia Alzheimer. Metode pelaksanaan kegiatan pemberdayaan dan pengabdian masyarakat pada mitra berupa pemetaan demografi tenaga kesehatan FKTP potensial yang dilanjutkan dengan koordinasi dan kolaborasi dengan bagian Diklit RSUD Dr. Moewardi Surakarta untuk promosi dan pelaksanaan pelatihan daring. Selanjutnya, peneliti melakukan pelatihan dengan cara menjelaskan cara pengisian MMSE dan AD8 serta manfaat skrining demensia Alzheimer, simulasi interaktif cara pengisian MMSE dan AD8 dengan probandus, diskusi dan tanya jawab, serta evaluasi. Hasil pengabdian ini menunjukkan bahwa para tenaga kesehatan memiliki pemahaman yang meningkat dibandingkan sebelum pelatihan tentang cara dan manfaat pengisian MMSE dan AD8 dalam skrining demensia Alzheimer, sehingga meningkatkan kesadaran para tenaga kesehatan di FKTP akan dampak buruk peningkatan kejadian demensia Alzheimer yang dapat timbul akibat keterlambatan diagnosis. Kata kunci: demensia Alzheimer; pelatihan; tenaga kesehatan; MMSE; AD8
Comparison of Cognitive Function Examination Using Montreal Cognitive Assessment (MOCA-INA) with Telephone Moca (T-MOCA) Ira Ristinawati; Azmi Farah Fairuzya
Smart Medical Journal Vol 5, No 3 (2022): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v5i3.66435

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Introduction: The prevalence of dementia tends to increase over time. MOCA assessment tool is a cognitive function screening test that has high sensitivity. Telephone-based MOCA assessment has potential of detection and monitoring dementia which can be widely applied.Methods: This is an observational study with cross-sectional approach in the Neurology Outpatient Department RSUD Dr. Moewardi. The aim of this study is to compare the effectiveness of MOCA-INA assessment tool with the T-MOCA.Results: There were 424 patients who underwent MOCA-INA examination during January-June 2022. After screening, 185 patients were able to complete the study. Subjects consisted of 67 males (36.2%) and 118 females (63.8%); aged 65-74 years (44.9%), 75-84 years (25.9%), and 85 years (29.2%). It was found that the conformity diagnosis of MOCA-INA to T-MOCA was 82.3% in the conversion test. There were significant differences between normal patients and MCI patients in age (p=0.000), education level (p=0.000), MOCA-INA score (p=0.000), and T-MOCA score (p=0.000). The relationship between MOCA-INA and T-MOCA has a strong positive correlation (p = 0.000; r = 0.789). Subsequent correlation test between MOCA-INA and T-MoCA showed a strong significant relationship in the direction of gender (p = 0.000; r = 0.438) and education level (p = 0.000; r = -0.323)Conclusion: Both MOCA-INA and T-MOCA could significantly determine the level of cognitive function with a strong correlation between the two assessments.
Efektifitas Promosi Kesehatan Menggunakan Video Senam Rehabilitasi Vestibuler untuk Mengurangi Keluhan Vertigo di Masa Pandemik Diah Kurnia Mirawati; Raden Andi Ario Tedjo; Pepi Budianto; Hanindia Riani Prabaningtyas; Ira Ristinawati; Subandi Subandi; Rivan Danuaji; Muhammad Hafizhan; Stefanus Erdana Putra
SEMAR (Jurnal Ilmu Pengetahuan, Teknologi, dan Seni bagi Masyarakat) Vol 12, No 2 (2023): November (Article in Press)
Publisher : LPPM UNS

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/semar.v12i2.68328

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Vertigo merupakan sensasi gerakan atau rasa gerak dari tubuh seperti sensasi berputar namun tanpa adanya sensasi berputar yang sebenarnya. Vertigo paling sering disebabkan oleh disfungsi pada sistem vestibular dari lesi perifer maupun sentral. pada masa pandemi COVID-19 sebagian besar pasien vertigo mengalami kesulitan untuk rutin memeriksakan diri di rumah sakit. Oleh karena itu, dicari alternatif berupa perawatan non farmakologis agar pasien bisa tetap mengontrol keluhan penyakitnya di masa pandemi ini. Senam rehabilitasi vestibular melatih otak melalui petunjuk visual dan proprioseptif alternatif untuk menjaga keseimbangan. Penelitian ini dibuat untuk mengetahui efektifitas promosi kesehatan menggunakan video senam rehabilitasi vestibuler untuk mengurangi keluhan vertigo. Penyelenggaran penyuluhan pada anggota posyandu lansia ANTHURIUM, Kelurahan Tegalrejo yang diikuti sebanyak 47 orang. Sebelum dan sesudah penyuluhan dilakukan evaluasi terkait pengetahuan peserta mengenai vertigo melalui pretest dan posttest. Data hasil evaluasi menunjukkan adanya perbaikan pengetahuan peserta dari skor rata rata awal 62.4 menjadi 83.7.
Hematomyelia Akibat Traumatic Lumbar yang Menyebabkan Syok Spinal: Sebuah Laporan Kasus Raden Andi Ario Tedjo; Lawly Arrel Dionnie Greatalya; Vivienne Tjung; Muhammad Hafizhan; Stefanus Erdana Putra; Suroto Suroto; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Yetty Hambarsari; Baarid Luqman Hamidi; Hanindia Riani Prabaningtyas; Ervina Arta Jayanti Hutabarat; Ira Ristinawati; Teddy Tejomukti
Jurnal Keperawatan Padjadjaran Vol. 11 No. 3 (2023): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v11i3.2352

Abstract

Background: Spinal cord hemorrhage or hematomyelia can arise from trauma or non-trauma causes, adverse effect of anticoagulation therapy and ruptured vascular malformation. Bleeding in epidural space is common and complications such as acute spinal cord syndrome can arise due to the compression and destruction of the spinal cord. Symptoms of hematomyelia might be varied depending on location of the lesion, often accompanied with acute radicular pain. In this case study, we reported a case of spinal shock after traumatic lumbar hematomyelia. Case: A 13-year-old girl presented to Dr. Moewardi General Hospital with inferior paraparesis, bladder and bowel incontinence, a day after falling on her gluteus. Physical examination revealed reduced motoric and sensory function below 12th thoracal dermatome, with no patellar and reduced Achilles reflexes. Conventional X-ray was unremarkable and further investigation with MRI showed a hematoma on thoracal 10 to 12 vertebrae. Motor and sensory functions were improved after 12 days administration of corticosteroids and further improvement was seen almost immediately after decompression surgery. Objective: To describe a case of spinal shock caused by traumatic lumbar hematomyelia Method: This is a case report study describing spinal shock which improved after administration of corticosteroid and decompression surgery. Conclusion: Spinal shock could be caused by traumatic lumbar hematomyelia, which is characterized by loss of motor, sensory, and bladder function, and decompression surgery improved the prognosis.
Correlation between Neutrophil/Lymphocyte Ratio (NLR), lipid profile, lesion location and vascular cognitive impairment in acute ischemic stroke patients Ira Ristinawati; Kenneth Tan; Benedictus Benedictus; Muhammad Hafizhan; Stefanus Erdana Putra; Suroto Suroto; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Yetty Hambarsari; Baarid Luqman Hamidi; Hanindia Riani Prabaningtyas; Ervina Arta Jayanti Hutabarat; Teddy Tejomukti; Raden Andi Ario Tedjo
Jurnal Keperawatan Padjadjaran Vol. 12 No. 2 (2024): Jurnal Keperawatan Padjadjaran
Publisher : Faculty of Nursing Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24198/jkp.v12i2.2526

Abstract

Background: Stroke is the leading cause of long-term disability with significant clinical and socioeconomic impact worldwide. Hyperlipidemia and inflammation play major roles in ischemic stroke. This research focuses on the correlation of three factors, namely Neutrophil-Lymphocyte Ratio (NLR), lipid profile, and lesion location, with Vascular Cognitive Impairment (VCI). These factors may serve as potential predictors for VCI. Purpose: This research aims to study the correlation between NLR, lipid profile, and lesion location with vascular cognitive impairment. Besides, this research aims to explore those potential biomarkers as predictors of vascular cognitive impairment. Methods: This was a cross-sectional study which included 107 patients diagnosed with ischemic stroke from February 2022 to January 2023 with a history of admission to the hospital within 72 hours. After signed an informed consent form, every patient had history taking, physical exam, lipid profile, routine blood test, Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Indonesian Version (MoCA-Ina) on the first hospital day. Statistical tests were done with Spearman correlation method. Results: The data distribution was not normal for INR and MoCA-INA values (p<0.05).  Total cholesterol was insignificantly (p=0.092) correlated with MoCA-INA score with low correlation value (r=-0.293). HDL was significantly (p=0.035) correlated with MoCA-INA score with moderate correlation value (r=0.461). LDL was significantly (p=0.028) correlated with MoCA-INA score with low correlation value (r=-0.387). Triglycerides was insignificantly (p=0.440) correlated with MoCA-INA score with very weak correlation value (r=-0.137). NLR was significantly (p=0.015) correlated with MoCA-INA score with moderate correlation value (r=-0.412). Conclusions: Lipid profile is correlated with cognitive impairment in post stroke patients, with HDL being a protective factor, and LDL as risk factor. NLR was associated with worse cognitive function and LDL was directly proportional to NLR. Lesion location reporting was highly heterogeneous and more uniformed reporting is recommended for future research.
ANGIOPLASTIC STENOSIS IN SPONTANEOUS BILATERAL CAROTIC ARTERY DISSECTION: A CASE REPORT Subandi, Subandi; Danuaji, Rivan; Suroto, Suroto; Mirawati, Diah Kurnia; Budianto, Pepi; Hambarsari, Yetty; Hamidi, Baarid Luqman; Prabaningtyas, Hanindia Riani; Hutabarat, Ervina Arta Jayanti; Ristinawati, Ira; Tejomukti, Teddy; Tedjo, Raden Andi Ario; Santosa, Novian Anindito; Putra, Stefanus Erdana; Hafizhan, Muhammad
MNJ (Malang Neurology Journal) Vol. 10 No. 1 (2024): 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.2024.010.01.20

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Case: A 28-years-old woman presented with sudden right extremities weakness, right sided facial droop, and not being able to speak. On examination, the patient had upper motor neuron (UMN) hemiplegia and motor aphasia. On blood laboratory, we found D-dimer level of 1068 ng/dl. A non-contrast head CT-scan and CT-angiography showed left cerebral hemisphere infarction, and bilateral carotid artery stenosis. Further investigation with transcranial Doppler demonstrated partial stenosis of internal carotid artery (ICA). On cerebral digital subtraction angiography (DSA), we observed pseudoaneurysm on the right ICA and flame-shaped appearance on the left ICA, both are common radiological finding of ICA dissection. Then we performed stenting angioplasty on bilateral ICA to provide recanalization, and aspirin 80mg q.d. and clopidogrel 75mg q.d. was initiated. Conclusion: Spontaneous dissection of the carotid artery can occur on young adults. DSA is considered as the gold standard for vascular examination, and stenting with angioplasty was performed for recanalization to prevent the progression to severe stroke.
Patient with Foreign Accent Syndrome in Post Infarct Thrombotic Stroke: A Case Report Tiffany, Firstiafina; Ristinawati, Ira; Nur Hanifa, Shafira
Magna Neurologica Vol. 2 No. 1 (2024): 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.v2i1.894

Abstract

Background: Stroke is the second leading cause of death in the world and is the leading cause of disability worldwide. One of the disabilities is language disorder. Foreign Accent Syndrome (FAS) is a clinical condition associated with a noticeable change of accent, that could affect verbal communication and social interaction skills. By identifying this case earlier, we hope that the patient’s activity daily living is less disrupted. Case: A 54-year-old woman presented with right limb weakness and tingling, along with a change in speech accent from Javanese to Madurese, despite no prior exposure to Madurese. Neurobehavioral examination revealed language and memory disturbances, and MRI showed cerebral infarction in the bilateral hippocampi, small vessel ischemia in the bilateral frontal lobes, and corona radiata. Discussion: The accent change, known as FAS that was experienced by the patients are thought to be due to neurological causes, which was stoke. In a study using a lesion network mapping approach concluded that the lesion causing accent disorder was located within a single network in the bilateral frontal lobe. In line with the existing theory, the MRI results in this patient showed ischemia in the blood vessels of the bilateral frontal lobes. Conclusion: Clinical symtoms related to stroke depending on the location of the lesion. The accent change in this patient, known as Foreign Accent Syndrome (FAS), is believed to be caused by stroke affecting the bilateral frontal lobes. Early recognition of FAS can help reduce disruptions in communication and social interactions.