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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

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

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

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.

Spinocerebellar Ataxia 3 (SCA3) Patient with Peripheral Neuropathy Siti Aminah Sobana; Iin Pusparini; Nushrotul Lailiyya; Ahmad Rizal Ganiem; Uni Gamayani; Yusuf Wibisono; Fathul Huda; Yunia Sribudiani; Tri Hanggono Achmad
Majalah Kedokteran Bandung Vol 54, No 1 (2022)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v54n1.2394

Spinocerebellar ataxia (SCA) 3 is a neurodegenerative disease which involves cerebellum and extra cerebellum. Neuropathy in SCA3 manifests in various ways, including axonal and demyelination lesions in sensory and motor nerves. There has not been any study that describes the peripheral neuropathy characteristics of SCA3 patients in Indonesia at the time of this publication. This paper reports a case of a 43-year-old male with known spinocerebellar ataxia 3 presented with hereditary ataxia and mild numbness in both palms since two years before. No abnormalities were found during the sensory examination. The NCS showed severe axonal demyelinating sensorimotor peripheral neuropathy. In magnetic resonance imaging (MRI), an atrophy in the cerebellum with cerebral multiple lacunar infarction was identified. Electrophysiological results revealed profound axonal lesion in peripheral nerves. To conclude, peripheral neuropathy in SCA3 represents the dominance of axonal lesions in motor nerves.

Hubungan Persentase Sel Leukosit Polimorfonuklear dalam Cairan Serebrospinal dan Luaran Pasien Meningitis Tuberkulosis di RSUP Dr. Hasan Sadikin Bandung Amanda Widayanti; Ahmad Rizal Ganiem; Ida Parwati
Majalah Kedokteran Bandung Vol 52, No 4 (2020)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15395/mkb.v52n4.1563

Tuberculous (TB) meningitis is the most severe type of extrapulmonary TB with high morbidity and mortality rates. Many factors affect patient outcome, including the intracranial inflammation process. In acute inflammation, recruitment of a high number of polymorphonuclear (PMN) cells can cause edema which may eventually increase the intracranial pressure. This increase in intracranial pressure may lead to functional decline, disability, and even death. This study aimed to explore the association between the PMN percentage in cerebrospinal fluid (CSF) and TB meningitis patient outcome as measured by the Glasgow Outcome Scale at Dr. Hasan Sadikin General Hospital Bandung, which is a tertiary hospital in Indonesia. This was a retrospective cohort study using patient medical record data from 2017. All TB meningitis patients over 18 years old were included. Patients with missing PMN results in medical record were excluded, which led to a total 88 subjects participating in this study. Variables analyzed were PMN percentage in CSF and patient outcome that were categorized as poor, moderate, and good. Analysis were performed using theKruskal-wallis test. An increase in PMN median as the patient outcome declined were observed, but the association between the PMN percentage in CSF and patient outcome was insignificant (p=0.186). Hence, no association between PMN percentage in CSF and TB meningitis patient outcome was identified in this study. Hubungan Persentase Sel Leukosit Polimorfonuklear dalam Cairan Serebrospinal dan Luaran Pasien Meningitis Tuberkulosis di RSUP Dr. Hasan Sadikin BandungMeningitis tuberkulosis (TB) merupakan merupakan jenis TB ekstraparu paling berat dengan morbiditas dan mortalitas tinggi. Berbagai faktor memengaruhi luaran pasien, salah satunya proses inflamasi intrakranial. Pada inflamasi akut, terjadi peningkatan sel polimorfonuklear (PMN) dan bila dalam jumlah tinggi dapat menimbulkan efek edema yang meningkatkan tekanan intrakranial. Peningkatan tekanan intrakranial ini menyebabkan penurunan fungsi otak, disabilitas, bahkan kematian. Penelitian ini bertujuan mengetahui hubungan persentase PMN dalam cairan serebrospinal (CSS) dan luaran Glasgow Outcome Scale pada pasien meningitis TB di RSUP Dr. Hasan Sadikin Bandung. Penelitian ini merupakan studi retrospektif cohort menggunakan data rekam medik tahun 2017. Kriteria inklusi adalah pasien terdiagnosis meningitis TB dan berusia ≥18 tahun. Kriteria eksklusi adalah data rekam medik yang tidak lengkap untuk hasil PMN. Variabel yang diteliti adalah persentase PMN dan luaran pasien yang dikategorikan menjadi GOS buruk, sedang, dan baik kemudian dianalisis dengan uji Kruskal-wallis. Didapatkan 88 subjek yang memenuhi syarat. Terdapat peningkatan median PMN seiring derajat perburukan luaran namun hasil analisis menunjukkan tidak terdapat hubungan yang bermakna antara PMN dan luaran GOS pasien (p=0,186). Simpulan, tidak terdapat hubungan antara persentase PMN dalam CSS dengan luaran GOS pasien meningitis TB.

Pengaruh Virtual Reality Dalam Menurunkan Kecemasan Menghadapi Persalinan Pada Primigravida Herliana Riska; Beny Hasan Purwara; Ahmad Rizal Ganiem
Jurnal Kesehatan Prima Vol 13, No 1 (2019): FEBRUARI
Publisher : poltekkes kemenkes mataram

Kehamilan adalah suatu peristiwa yang melibatkan perubahan fisiologis, psikologis dan sosial yang sering disertai kecemasan. Apabila tidak dikelola dengan baik, kecemasan dalam kehamilan dapat berkembang menjadi keadaan patologis yang akan berdampak negatif terhadap luaran persalinan yang tidak menguntungkan. Virtual reality(VR) merupakan salah satu teknologi canggih yang memungkinkan seseorang dibawa ke dalam dunia maya. Penggunaan VR dalam membangun pengalaman melahirkan belum pernah dilakukan sebelum ini. Tujuan penelitian ini adalah untuk menganalisis pengaruh virtual reality terhadap penurunan kecemasan menghadapi persalinan pada primigravida. Penelitian ini menggunakan rancangan penelitian eksperimen semu (quasi experiment) dengan desain pre post non equivalent control group design. Enam puluh ibu hamil primigravida,kehamilan yang diinginkan, usia kehamilan 36 minggu yang memeriksakan kehamilannya di puskesmas PONED kota Bandung dibagi menjadi 2 kelompok secara random, kelompok perlakuan mendapatkan dua kali VR, sedangkan kelompok kontrol mendapat pelayanan standar. Skor kecemasan dinilai menggunakan modifikasi Pregnancy-Related Anxiety Questionnaire (PRA-Q), pemberian dilakukan sebelum dan sesudah perlakuan, untuk menilai penurunan skor kecemasan setelah pemberian VR yang kedua. Pengujian statistik menggunakan analisis non parametrik dengan menghitung besarnya risiko dengan RR dan 95% interval konfidensi. Nilai p pada penurunan skor kecemasan setelah perlakuan <0,001, dengan RR 2,178, selang kepercayaan 95% IK(1,356– 6,172). Nilai median kecemasan sebelum perlakuan pada kelompok VR adalah 23. Nilai median kecemasan pada kelompok VR setelah perlakuan turun menjadi 14. Nilai median kecemasan sebelum perlakuan pada kelompok kontrol adalah 23,50. Nilai median kecemasan pada kelompok kontrol setelah perlakuan turun menjadi 18. Persen penrunan median pada kelompok VR adalah 36,4% sedangkkn pada kelompok kontrol adalah 24,0%. Ibu hamil yang tidak diberikan intervensi VR memiliki risiko kecemasan 2,89 kali lebih tinggi dibandingkan dengan kelompok VR.

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

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

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.

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