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Skor ICH-GS untuk Prediksi Prognosis Pasien Stroke Perdarahan Intraserebral di Rumah Sakit Islam Jakarta Pondok Kopi Pandhita S, Gea; -, Samino; Bustami, Mursyid
Cermin Dunia Kedokteran Vol 44, No 12 (2017): Neurologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1113.965 KB) | DOI: 10.55175/cdk.v44i12.686

Abstract

Latar Belakang dan Tujuan. Prediksi prognosis yang akurat pada kasus stroke perdarahan intraserebral (PIS) sangat penting untuk menentukan pilihan terapi. Penelitian ini bertujuan menguji manfaat klinis skor ICH-GS untuk memprediksi prognosis pasien stroke PIS selama rawat inap di Rumah Sakit Islam Jakarta Pondok Kopi (RSIJPK). Metode. Seluruh pasien rawat inap yang tercatat di bagian rekam medis RSIJPK dengan diagnosis stroke PIS pada periode Januari-Desember 2013 diikutkan dalam penelitian ini. Diagnosis stroke PIS ditegakkan berdasarkan gambaran klinis defisit neurologis mendadak dan memiliki gambaran perdarahan intraserebral berdasarkan pemeriksaan CT scan kepala. Skor ICH-GS diukur pada semua subjek penelitian saat di Instalasi Gawat Darurat (IGD). Skor tersebut kemudian dievaluasi untuk memprediksi angka mortalitas pasien stroke PIS selama rawat inap di rumah sakit. Hasil. Terdapat 47 pasien stroke PIS yang dianalisis dalam penelitian ini. Kisaran skor ICH-GS yang didapatkan adalah 5-12. Angka mortalitas keseluruhan selama rawat inap adalah 34%. Makin tinggi skor ICH-GS, makin tinggi mortalitasnya. Mortalitas pasien stroke PIS dengan skor ICH-GS 7-9 lebih rendah pada kelompok pasien yang mendapat terapi operatif dibandingkan kelompok pasien yang mendapatkan terapi non-operatif. Sebaliknya, mortalitas pasien stroke PIS dengan skor ICH-GS 10-11 lebih tinggi pada kelompok operatif dibandingkan kelompok non-operatif. Pasien stroke PIS dengan skor ICH-GS 6 pada kedua kelompok memiliki mortalitas yang sama. Simpulan. Skor ICH-GS dapat digunakan untuk memprediksi prognosis sehingga diharapkan dapat membantu tenaga medis dalam menentukan pilihan strategi terapi operatif atau non-operatif.Background. Accurate prediction of outcome after primary ICH is necessary to distinguish patients who will benefit from particular therapeutic strategies. The aim of the present study was to test the clinical usefulness of the ICH-GS score in predicting the prognosis of ICH patients in PK-JIH. Methods. Patients diagnosed with ICH between January to December 2013 were screened and enrolled in this study. ICH-GS score was evaluated to predict in-hospital mortality. Results. A total of 47 patients were included in the final analysis. Craniotomy was performed in 26% patients (surgery group). In-hospital mortality rates for patients with ICH-GS scores of 5 to 12 were 0%, 0%, 20%, 29%, 33%, 40%, 86%, and 100%, respectively. In the adjusted analysis, in-hospital mortality rates for patients with ICH-GS scores of 7-9 were lower in surgery group (p<0,05). Among patients with ICH-GS scores of 10-11 in-hospital mortality rates were higher in surgery group (p<0,05). In-hospital mortality rates for patients with ICH-GS scores of 6 in surgery group were equal to patients in non-surgery group. Conclusion. ICH-GS is a simple scale for predicting in-hospital mortality. ICH-GS can give a simple overview to distinguish patients who would benefit from specific therapeutic strategies.
Gambaran Quantitative Electroencephalography (QEEG) Anak Laki-laki Penderita Attention-Deficit Disorder (ADD) Pandhita S, Gea; Sutarni, Sri
Sanus Medical Journal Vol. 2 No. 1 (2021)
Publisher : Universitas Muhammadiyah Prof. Dr. Hamka (UHAMKA Press)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22236/sanus.v1i1.6610

Abstract

Background. The Diagnostic and Statistical Manual of Mental Disorders (DSM) grouping the types of ADD is based on the clinical symptoms of neurobehavioral disorders, regardless of the possible underlying etiology. This means that the same ADD type group may have a different etiology of functional brain disorders. Meanwhile, QEEG has been known to describe the possible etiology that underlies an ADD event. This study aims to identify differences in QEEG features in the same ADD type group. Methods. Subjects consisted of 40 boys with ADD. QEEG was recorded from 21 sites, and Fourier transformed to provide estimates for relative power in the delta, theta, alpha, and beta bands in the frontotemporal and central regions. These data were converted to Z-scores based on the normal value data; afterward, they were subjected to cluster analysis. Independent sample t-tests were used to determine how the total ADD group and the ADD cluster subgroups differed from the normal value. Results. The total ADD group had increased relative delta (Z-score-frontotemporal region = 3,26 ± 1,59; Z-score-central region = 4,04 ± 1,71), decreased relative alpha (Z-score-frontotemporal region = -2,78 ± 1,29; Z-score-central region = -2,86 ± 1,36), decreased relative beta (Z-score-frontotemporal region = -5,33 ± 1,61; Z-score-central region = -6,19 ± 1,86), increased rasio teta/alpha (Z-score-frontotemporal region = 2,806 ± 1,41; Z-score-central region = 2,59 ± 1,26), and increased rasio teta/beta (Z-score-frontotemporal region = 4,36 ± 1,69; Z-score-central region = 4,94 ± 1,46). Two distinct QEEG clusters subgroups were found. The first cluster was characterized by increased central relative delta (Z-score-central region = 3,02 ± 1,17), decreased relative beta (Z-score-frontotemporal region = -4,29 ± 0,73; Z-score-central region = -5,06 ± 1,19) and increased rasio teta/beta (Z-score-frontotemporal region = 3,83 ± 1,91; Z-score-central region = 4,94 ± 1,96). The second cluster was characterized by increased relative delta (Z-score-frontotemporal region = 4,71 ± 1,02; Z-score-central region = 5,72 ± 0,98), decreased relative alpha (Z-score-frontotemporal region = -3,92 ± 1,12; Z-score-central region = -4,24 ± 0,69), decreased relative beta (Z-score-frontotemporal region = -7,08 ± 1,06; Z-score-central region = -8,09 ± 0,99), increased rasio teta/alpha (Z-score-frontotemporal region = 3,08 ± 1,04; Z-score-central region = 2,86 ± 1,02), and increased rasio teta/beta (Z-score-frontotemporal region = 5,23 ± 1,16; Z-score-central region = 5,71 ± 1,35) Conclusions. These results indicate that boys with ADD do not constitute a homogenous group in QEEG profile terms. Two distinct QEEG clusters were found. The first cluster was typified by a cortically hypoaroused, while the second cluster was typified by a maturational-lag in central nervous system development. This difference in possible etiology may have implications for studies of the utility of QEEG in the diagnosis of ADD and the differences in therapeutic response between the two groups.
PENATALAKSANAAN KOMPREHENSIF LANSIA DENGAN PENURUNAN FUNGSI KOGNITIF DAN DEMENSIA Pandhita S, Gea; Laksmi, Purwita W; Marfianti, Erlina
Sanus Medical Journal Vol. 2 No. 2 (2021)
Publisher : Universitas Muhammadiyah Prof. Dr. Hamka (UHAMKA Press)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22236/sanus.v2i2.7430

Abstract

Pasien Geriatri mempunyai karakteristik yang khusus, berbeda dengan karakteristik pasien pada golongan usia yang lain. Pasien geriatri antara lain ditandai dengan karakteristik memiliki multi-morbiditas atau multi-penyakit, kapasitas fisiologis yang menurun, manifestasi klinis penyakit yang tidak khas, status fungsional menurun, dan malnutrisi. Kondisi ini akan menimbulkan masalah kesehatan spesifik yang lazim ditemui pada pasien geriatri, yaitu: Frailty, Sarkopenia, Delirium, Jatuh, Gangguan Tidur, Dizziness, Syncope, Ulkus Dekubitus, Inkontinensia, dan Elder mistreatment. Beberapa masalah kesehatan yang sering dialami oleh pasien geriatri adalah Instability, Immobility, Infection, Incontinence, Intellectual impairment (Mild/Vascular Cognitive Impairment, Dementia), Impairment of hearing & vision, Impaction (konstipasi), Isolation (depresi), Inanition (malnutrisi), Impecunity (kemiskinan), Iatrogenic, Insomnia, Immune deficiency, dan Impotence. Berbagai syndrome geriatri ini saling berinteraksi secara kompleks. Oleh karena itu perlu pendekatan khusus dalam penilaian dan penatalaksanaan kasus geriatri,. Pendekatan ini sering dikenal sebagai Comprehensive Geriatric Assessment (CGA).
Kejadian Delirium pada Pasien Penderita Covid-19 dan Kemungkinan Perburukannya menjadi Gejala Demensia Pandhita S, Gea; Abdul Gofir
Sanus Medical Journal Vol. 2 No. 2 (2021)
Publisher : Universitas Muhammadiyah Prof. Dr. Hamka (UHAMKA Press)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22236/sanus.v2i2.7452

Abstract

Delirium merupakan suatu sindrom neurobehavioral (perubahan perilaku terkait gangguan neurologis) yang disebabkan oleh gangguan sementara aktivitas neuron (sel saraf otak) sebagai akibat sekunder dari gangguan sistemik. Prevalensi delirium pada pasien yang dirawat inap di rumah sakit cukup tinggi. Kejadian delirium lebih tinggi pada pasien dengan kasus kritis dan pada pasien penderita Covid-19. Kejadian delirium pada pasien dengan kasus kritis yang dirawat di rumah sakit adalah sekitar 31,8%. Angka kejadian ini meningkat menjadi sekitar 55% pada penderita Covid-19. Beberapa penelitian menunjukkan bahwa terdapat mekanisme patofisiologi delirium pada pasien penderita Covid-19 yang serupa dengan kejadian delirium pada pasien non-Covid-19. Bukti epidemiologi menunjukkan keterkaitan kejadian delirium pada pasien non-Covid-19 dengan kejadian demensia beberapa periode waktu setelahnya (Probabilitas sekitar 30%). Bukti radiologis dan patologi anatomi juga menunjukkan adanya proses patologis di otak akibat Covid-19 yang dapat mengakibatkan gangguan saraf otak ireversibel dan berkontribusi pada penurunan kognitif jangka panjang. Hal-hal tersebut menunjukkan kemungkinan besar dapat terjadi keterkaitan antara kejadian delirium yang dialami pasien penderita Covid-19 dengan kejadian demensia di masa mendatang.