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Case Report: COVID-19 and Ischemic Stroke in A 16-Years-Old Patient Cynthia; Kumalawati, July
Magna Neurologica Vol. 2 No. 2 (2024): July
Publisher : Department of Neurology Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20961/magnaneurologica.v2i2.1140

Background: Recent reports show an increasing trend of ischemic stroke at a young age. Diseases associated with ischemic stroke at a young age, namely hereditary hypercoagulable conditions. Case: In this case a 16-year-old boy with clinical complaints of sudden weakness of the right hand and leg, numbness, loss of appetite, nausea and vomiting. Laboratory tests showed results of increased levels of hemoglobin, hematocrit, erythrocyte count, platelet count, leukocyte count and NLR. The neutrophil-to-lymphocyte ratio (NLR), calculated as a simple ratio between the neutrophil and lymphocyte counts measured in peripheral blood. CT scan examination showed acute infarction in the medial left temporal lobe and old infarction in the left frontal lobe (medial gyrus). Thoracic CT Scan examination showed the results of bilateral pneumonia suggestive of viral. The patient encountered COVID-19. The patient experienced cough and shortness of breath and showed abnormal ABG results, namely respiratory alkalosis, decreased oxygen saturation, fever, increased procalcitonin and increased cardiac markers. Discussion: This case report prompts discussions on various aspects of ischemic stroke in young patients, including the role of COVID-19, hypercoagulable states, hematological abnormalities, and diagnostic challenges, with implications for patient management and future research directions. Conclusion: SARS CoV-2 can affect the nervous system through several mechanisms that cause persistent infection, resulting in neurological diseases, including stroke. Young ischemic stroke is usually hypercoagulable and the most common cause is APS. In this patient, polycythemia was occured,that causes blood flow slows and oxygen supply to the brain is reduced. This can cause ischemic stroke.

Pengembangan Model Pendidikan Islam Berbasis Literasi Digital Untuk Generasi Alpha Di Indonesia Sudirman, Sudirman; Leli Hasanah Lubis; Ali Sadikin Ritonga; Khoirun Nisak; Cynthia
Tarbiyah bil Qalam : Jurnal Pendidikan Agama dan Sains Vol. 9 No. 2 (2025): Volume IX Edisi II ( Juli-Desember In-Press)
Publisher : Sekolah Tinggi Ilmu Tarbiyah Al-Bukhary Labuhanbatu

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

Generasi Alpha, yang lahir sejak tahun 2010 ke atas, tumbuh dalam era digital dengan kemampuan teknologi yang tinggi dan gaya belajar visual-interaktif. Mereka memiliki kecepatan dalam mengakses informasi, namun juga menghadapi tantangan seperti rentang perhatian yang pendek dan risiko paparan konten digital tanpa bimbingan moral. Literasi Islam pada generasi ini menjadi perhatian utama karena mudah terpapar konten yang tidak sesuai dengan nilai-nilai Islam, sementara media pembelajaran Islam berbasis teknologi masih sangat terbatas. Kurangnya pendampingan dari orang tua dan keterbatasan kompetensi guru dalam penggunaan teknologi semakin memperburuk kondisi ini. Penelitian ini bertujuan untuk memahami fenomena rendahnya literasi Islam di kalangan Generasi Alpha serta merancang model pendidikan Islam berbasis teknologi yang efektif dan relevan dengan karakteristik mereka. Metode kualitatif deskriptif digunakan dengan teknik pengumpulan data berupa wawancara mendalam, observasi, dan studi dokumentasi pada guru Pendidikan Agama Islam, orang tua, dan siswa di tingkat Sekolah Dasar dan Madrasah Ibtidaiyah. Hasil penelitian menunjukkan perlunya pengembangan media pembelajaran digital interaktif, peningkatan kompetensi guru dalam teknologi, serta sinergi antara sekolah, orang tua, dan lingkungan sosial digital untuk meningkatkan literasi Islam secara efektif dan berkelanjutan.

Pharmacological and Non-Pharmacological Strategies for Sedation and Analgesia in Critically Ill Children: A Systematic Review and Narrative Synthesis Andreas Eric; Cynthia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1383

Background: The management of pain and agitation in the Pediatric Intensive Care Unit (PICU) is critical for patient comfort and preventing adverse outcomes. A wide array of sedation and analgesia strategies exists, but a synthesized appraisal of contemporary evidence is needed to guide clinical practice. This systematic review evaluates the efficacy and safety of various pharmacological and non-pharmacological interventions for sedation and analgesia in critically ill children. Methods: A systematic search was conducted in PubMed, Embase, Cochrane CENTRAL, and CINAHL for studies published between January 2020 and December 2024. Following the PRISMA 2020 guidelines, two independent reviewers screened studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool for Randomized Controlled Trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: From 4,366 identified records, five studies (two RCTs, three observational) involving 875 patients met the inclusion criteria. Study 1, an RCT (n=120), found that adjunctive ketamine significantly reduced mechanical ventilation duration by a mean of 2.1 days (95% CI: 1.2-3.0, p=0.001) compared to standard care. Study 3, a prospective cohort study (n=350), linked continuous sedation to longer PICU stays (median 9 vs. 6 days, p<0.001) and a higher incidence of iatrogenic withdrawal syndrome (45% vs. 18%, p<0.001) compared to intermittent sedation. Study 4, an RCT on music therapy (n=85), demonstrated a significant reduction in postoperative pain scores. Observational studies supported the opioid-sparing effects of multimodal analgesia (Study 5) and noted differences in recovery profiles between midazolam and propofol (Study 2). Conclusion: This review highlights the benefits of a multimodal, goal-directed approach to pediatric sedation and analgesia. Adjunctive ketamine and non-pharmacological interventions show promise in reducing opioid reliance and improving clinical outcomes. Protocols favoring intermittent sedation may reduce length of stay and withdrawal incidence. These findings support a paradigm shift away from deep, continuous sedation towards more nuanced, patient-centered strategies.

Pharmacological and Non-Pharmacological Strategies for Sedation and Analgesia in Critically Ill Children: A Systematic Review and Narrative Synthesis Andreas Eric; Cynthia
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 9 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i9.1383

Background: The management of pain and agitation in the Pediatric Intensive Care Unit (PICU) is critical for patient comfort and preventing adverse outcomes. A wide array of sedation and analgesia strategies exists, but a synthesized appraisal of contemporary evidence is needed to guide clinical practice. This systematic review evaluates the efficacy and safety of various pharmacological and non-pharmacological interventions for sedation and analgesia in critically ill children. Methods: A systematic search was conducted in PubMed, Embase, Cochrane CENTRAL, and CINAHL for studies published between January 2020 and December 2024. Following the PRISMA 2020 guidelines, two independent reviewers screened studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool for Randomized Controlled Trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for observational studies. Results: From 4,366 identified records, five studies (two RCTs, three observational) involving 875 patients met the inclusion criteria. Study 1, an RCT (n=120), found that adjunctive ketamine significantly reduced mechanical ventilation duration by a mean of 2.1 days (95% CI: 1.2-3.0, p=0.001) compared to standard care. Study 3, a prospective cohort study (n=350), linked continuous sedation to longer PICU stays (median 9 vs. 6 days, p<0.001) and a higher incidence of iatrogenic withdrawal syndrome (45% vs. 18%, p<0.001) compared to intermittent sedation. Study 4, an RCT on music therapy (n=85), demonstrated a significant reduction in postoperative pain scores. Observational studies supported the opioid-sparing effects of multimodal analgesia (Study 5) and noted differences in recovery profiles between midazolam and propofol (Study 2). Conclusion: This review highlights the benefits of a multimodal, goal-directed approach to pediatric sedation and analgesia. Adjunctive ketamine and non-pharmacological interventions show promise in reducing opioid reliance and improving clinical outcomes. Protocols favoring intermittent sedation may reduce length of stay and withdrawal incidence. These findings support a paradigm shift away from deep, continuous sedation towards more nuanced, patient-centered strategies.

Causes of Microbleeding in Alzheimer's: Role of Cerebral Amyloid Angiopathy and Factor Xa Inhibitors Cynthia; Nugraha, Jusak; Hamdan, Muhammad; Lumempouw, Silvia; Dharma, Rahajuningsih
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 32 No. 1 (2025)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v32i1.2388

This case report aims to analyze factors that may contribute to the pathophysiological mechanisms underlying microbleeding in Alzheimer’s disease (AD) patients with Deep Vein Thrombosis (DVT), thereby paving the way for appropriate therapeutic interventions and improved patient outcomes. An 80-year-old Indonesian woman, diagnosed with AD and DVT, was admitted to the neurobehavioral clinic on May 16, 2023. Microbleeding was detected in the right cerebellum, right occipital lobe, left caudate nucleus, and left-right frontal cortex based on the Brain MRI. The patient had been treated with factor Xa inhibitors once a day since April 17, 2018, due to DVT. The diagnosis of mild cognitive impairment with bilateral knee osteoarthritis was made on June 13, 2017. Laboratory findings on November 21, 2023, revealed an e-GFR of 36 mL/min/1.73m2, indicating a moderate to severe decline in kidney function. Alzheimer's dementia can cause Cerebral Amyloid Angiopathy (CAA), which can result in clot formation in the brain tissue and around cerebral arteries. This process deteriorates blood flow and impairs the clearance of amyloid beta-peptide (Aβ), leading to Aβ accumulation, microglia activation, synaptic dysfunction, and neuronal death. Decreased cerebral blood flow leads to hypoperfusion, cerebral microvascular infarctions, and microhemorrhages (also known as microbleeds). In elderly patients with Alzheimer's dementia, immobilization often leads to DVT, which is treated with factor Xa inhibitors. However, drug accumulation can occur due to decreased kidney function, potentially causing further microbleeds in the brain. Microbleeding found in this patient might be a consequence of Alzheimer’s pathology and or adverse effects of factor Xa inhibitors.

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