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All Journal Majalah Kedokteran Bandung Althea Medical Journal Jurnal Kesehatan Prima
Ahmad Rizal Ganiem
Universitas Padjadjaran
Health Professions Medicine & Pharmacology Nursing Public Health

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Journal : Althea Medical Journal

 1 
Glasgow Outcome Scale Assessment in Patients with Cerebral Toxoplasmosis Brigitta Berlianty; Sofiati Dian; Ahmad Rizal Ganiem
Althea Medical Journal Vol 9, No 1 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n1.2290

Abstract

Background: Cerebral toxoplasmosis is a Toxoplasma gondii infection affecting the brain. Assessment of the functional outcome after treatment is needed as an evaluation for therapeutic management. One of the instruments used is the Glasgow Outcome Scale (GOS). This study aimed to assess the functional outcome of cerebral toxoplasmosis patients using GOS.Methods: A Cross-sectional descriptive study with total sampling method was conducted. Medical records were retrieved from patients with cerebral toxoplasmosis registered at the Department of Neurology, Dr. Hasan Sadikin General Hospital, Bandung during year 2017–2019. Inclusion criteria were patients with cerebral toxoplasmosis aged >18 years and had a positive HIV serological test. The GOS was assessed and presented in frequency, using Microsoft Excel and SPSS software ver. 25.0.Results: Of 87 patients, 68% had somnolent on admission to the hospital, 51% had hemiparesis/hemiplegia, and 76% had GOS 3, indicating severe disability. Almost one third (28%) of patients died during hospitalization with non-neurological complications as the most common cause of death (63%). On discharge from the hospital, 82% of the survivors were fully alert, 40% had hemiparesis/hemiplegia, and 33% had GOS 4 (mild disability).Conclusions: Most of the cerebral toxoplasmosis patients come to the hospital with severe disability. During the treatment, one third of patients died, and those who survived had mild disability. GOS has improved after hospitalization, suggesting that GOS is useful for assessment of therapeutic management. 
Outcomes of Tuberculous Meningitis Patients with Hydrocephalus with or without Cerebrospinal Fluid Diversion Nabila Chantikarizky Hasanah; Akhmad Imron; Ahmad Rizal Ganiem
Althea Medical Journal Vol 8, No 4 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v8n4.2300

Abstract

Background: Hydrocephalus is a common complication in tuberculous meningitis patients and is a poor predictor with high mortality and morbidity rates. Therefore, early diagnosis, detection, and treatment of hydrocephalus are important. Cerebrospinal fluid diversion is the process used to drain accumulated fluid in the brain and spinal cord. This study aimed to explore the outcome of tuberculous meningitis patients with hydrocephalus who underwent cerebrospinal fluid diversion and who did not.Methods: This was a retrospective cross-sectional descriptive study, including tuberculosis meningitis patients with hydrocephalus, admitted at the Department of Neurology Dr. Hasan Sadikin Bandung General Hospital during the period 2018. Functional outcomes were grouped based on the Glasgow Outcome Scale.Results: Of the 55 patients, only 14 (25.5%) underwent cerebrospinal fluid diversion. The outcome of patients with cerebrospinal fluid diversion was 8 of 14 good, 1 of 14 poor, and 5 of 14 died. The outcome of patients without cerebrospinal fluid diversion was 13 of 41 good, 2 of 41 poor, and 26 of 41 died. Most tuberculous meningitis patients with hydrocephalus, with or without the cerebrospinal fluid diversion procedure were at an advanced stage with a high mortality rate. Conclusion: The proportion of good functional outcomes in patients with cerebrospinal fluid diversion is higher than in patients without the cerebrospinal fluid diversion. 
Visualization of Carotid Doppler in Patients with Ischemic Stroke at Dr. Hasan Sadikin General Hospital Bandung Year 2016-2019 Olivia Olivia; Ahmad Rizal Ganiem; Syarief Hidayat
Althea Medical Journal Vol 8, No 3 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v8n3.2285

Abstract

Background: Various pathological changes in both the intra and extracranial arteries that supply the brain can cause disturbance of cerebral blood flow and perfusion leading to cerebral dysfunction. Doppler ultrasound is able to assess these changes. This study was performed to evaluate the anatomical and physiological changes found in the carotid arteries of patients with ischemic stroke using Doppler ultrasound.Methods: The cross-sectional descriptive study design with total sampling method was conducted on the medical records of ischemic stroke patients who had carotid Doppler ultrasound at the Department of Cardiology and Vascular Medicine Dr. Hasan Sadikin General Hospital Bandung from 2016 to 2019. Demographic data, such as stroke diagnoses and plaque characteristics recorded in the Doppler reports were collected.Results: There were 38 data sets collected. The distribution and characteristics of atherosclerotic plaques were similar between the two carotid systems, with the same percentage of plaque being found in the right (31.6%) and left (36.8%) carotid system. The most common type of plaque found was type III and was located in the common carotid artery. Thrombus was absent in all patients. Intimal media thickening was found in 13.2% right system and 15.8% left system. Stenosis was present in 34.2% of patients, and most had <50% stenosis. Peak systolic velocity increased (>125 cm/s) in 5.3% of the right system and 7.9% of the left system of the internal carotid artery.Conclusions: Most of the atherothrombotic and thromboembolic type of ischemic stroke patients in this study have normal carotid Doppler ultrasound features. Further study on the presence of plaque in ischemic stroke patients in Indonesia is needed.
Prevalence of Opportunistic Infection in Central Nervous System among Patients with HIV/AIDS at Dr. Hasan Sadikin General Hospital Bandung, Indonesia Dinda Sayyidah Laela Fatimatuzzahra; Ahmad Rizal Ganiem; Aih Cahyani; Suryani Gunadharma; Sofiati Dian
Althea Medical Journal Vol 9, No 2 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n2.2298

Abstract

Background: The low coverage of diagnosis and treatment in patients with human immunodeficiency virus (HIV) infection in Indonesia increases the risk of opportunistic infections that affects various organs, including the central nervous system (CNS). This study aimed to determine the prevalence of opportunistic infections in the CNS among hospitalized patients with HIV/acquired immune deficiency syndrome (AIDS) at Dr. Hasan Sadikin General Hospital Bandung, Indonesia.Methods: In this cross-sectional study with a total sampling method, data were collected from HIV/AIDS patients who were diagnosed with CNS opportunistic infection and hospitalized in the neurology ward during the period 2015–2019. Data were presented as median (interquartile range) and percentage frequency.Results: Among the 2,606 HIV/AIDS patients registered, 219 (8.4%) were accompanied by CNS opportunistic infections. The highest number was cerebral toxoplasmosis (58.9%; n=129) followed by tuberculous meningitis (33.3%; n=73) and cryptococcal meningitis (7.8%; n=17). Most of the patients admitted for unconsciousness (64.4%; n=141), with unknown HIV-infection status (61.2%; n=134). Among patients with positive HIV-infection status, only 50.6% (43/85) patients were taking antiretroviral therapy (ART) and 24.7% (21/85) patients dropped out ART before being diagnosed with CNS opportunistic infections. The CD4+’s median value was 21 cells/mm3 (IQR 9-61.25), with mortality during hospitalization was 36.5% (80/219). Conclusions: The prevalence of CNS opportunistic infections among HIV-infected patients is 8.4%, dominated by cerebral toxoplasmosis, and laboratory result showed very low CD4+ levels. The diagnosis of HIV infection is shortly made before hospitalization, and those who has been diagnosed have low compliance with ART. The mortality rate during hospitalization is high.
Outcomes of Tuberculous Meningitis Patients with or without Hydrocephalus from a Tertiary Hospital in West Java, Indonesia Nubella Citresna Zakiyyah; Suryani Gunadharma; Ahmad Rizal Ganiem
Althea Medical Journal Vol 9, No 4 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n4.2304

Abstract

Background: Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis. One of the most common complications of TBM is hydrocephalus, with a higher risk of mortality. This study aimed to evaluate the outcome among TBM patients with or without hydrocephalus.Methods: This study was a retrospective cross-sectional comparative analytical study. A total sampling was employed based on the number of traceable resumes of TBM patients treated at the Department of Neurology Dr. Hasan Sadikin General Hospital, Bandung, Indonesia in 2018. Results: Of the 127 data of TBM patients, 55 (43.3%) had hydrocephalus, and 72 (56.7%) did not. The median age of TBM patients with and without hydrocephalus was 34 years (IQR 26–45) and 35 years (IQR 24–44), respectively. Decreased consciousness dominated the clinical symptoms for 94.5% in the hydrocephalus group and 84.7% in the non-hydrocephalus group. Hospital-acquired pneumonia occurred mainly in the hydrocephalus group (29.1%), whereas urinary tract infections mainly occurred in without hydrocephalus group (18%). There was a significant difference between the outcome of hydrocephalus and non-hydrocephalus (p=0.005). Mortality was higher in patients with hydrocephalus compared to those without hydrocephalus.Conclusions: The outcome of TBM patients with hydrocephalus is worse than those without hydrocephalus, as reflected by a higher grade of TBM, higher mortality rate, and lower good recovery upon treatment administration. Therefore, prompt diagnosis and treatment are needed to improve the outcome and survival among TBM patients with hydrocephalus.
Co-Authors Aih Cahyani Akhmad Imron Amanda Widayanti Beny Hasan Purwara Brigitta Berlianty Dinda Sayyidah Laela Fatimatuzzahra Fathul Huda Herliana Riska Ida Parwati Iin Pusparini Nabila Chantikarizky Hasanah Nubella Citresna Zakiyyah Nushrotul Lailiyya Olivia Olivia Siti Aminah Sobana Sofiati Dian Suryani Gunadharma Syarief Hidayat Tri Hanggono Achmad Uni Gamayani Yunia Sribudiani Yusuf Wibisono