Tjokorda Gde Dalem Pemayun
Bagian Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Diponegoro/RSUP Dr. Kariadi, Jl. Dr. Sutomo 16-18 Semarang

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Hiperglikemia dan Aterosklerosis Arteri Karotis Interna pada Penderita Pasca Stroke Iskemik Agus Darmawan; Dodik Tugasworo; Tjokorda Gde Dalem Pemayun
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 1 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

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ABSTRACTHyperglycemia and atherosclerosis of internal carotid artery in post ischemic stroke patientBackground: Atherosclerosis is the primary cause of death in stroke. Marker of atherosclerosis in carotid artery is intima media thickness (IMT) of artery walls. One of trigger atherosclerosis is hyperglycemia. The objective of the study is to investigate the association between hyperglycemia to atherosclerosis of internal carotid artery in post ischemic stroke patient.Methods: A cross sectional design study, patients post ischemic stroke admitted outpatient clinic of neurology department at Dr. Kariadi General Hospital Semarang, start at May 2010 until July 2010. Analysis of atherosclerosis using carotid duplex ultrasound, analysis of hyperglycemia with fasting blood glucose levels, two-hour postprandial glucose levels and also HbA1c levels using bloodvenous in the laboratory of clinical pathology department at Dr. Kariadi General Hospital. Descriptive statistic and logistic regression test were performed to analyze the data.Result: The mean of fasting blood glucose (FBG) levels were 113.93 (SD 42.2) mg/dL, two-hours postprandial glucose (2hPPG) levels were 182.4 (SD 76.5) mg/dL, HbA1c levels were 6.4 (SD 1.5)%. The mean of intima media thickness of internal carotid artery was 1.2 (SD 1.9) mm. No significance difference  between FBG, 2hPPG and A1c (95% CI, p>0.05) to atherosclerosis of internalcarotid artery in post ischemic stroke patient.Conclusion: There are no significant association between hyperglycemia and atherosclerosis of internal carotid artery in post ischemic stroke patient.Keywords: Hyperglycemia, atherosclerosis, post ischemic stroke ABSTRAKLatar belakang: Aterosklerosis merupakan penyebab kematian utama pada stroke. Petanda aterosklerosis di arteri karotis adalah ketebalan tunika intima media intima media thickness (IMT) di arteri tersebut. Salah satu pemicu aterosklerosis adalah hiperglikemia. Tujuan penelitian ini adalah membuktikan pengaruh hiperglikemia terhadap aterosklerosis arteri karotis interna pada penderita pasca stroke iskemik.Metode: Desain penelitian adalah cross sectional, pada penderita pasca stroke iskemik yang kontrol di Poliklinik Saraf RSUP Dr. Kariadi Semarang mulai Mei 2010 sampai Juli 2010. Analisis aterosklerosis menggunakan USG Karotis Duplex, analisis hiperglikemia dengan menganalisis kadar glukosa darah puasa, kadar glukosa darah 2 jam postprandial dan kadar HbA1c menggunakan darah vena di Laboratorium Patologi Klinik RSUP Dr. Kariadi. Data dianalisis dengan statistik deskriptif dan uji regresi logistik.Hasil: Rerata kadar glukosa darah puasa (GDP) 113,9 (SB 42,2) mg/dL, kadar glukosa darah 2 jam postprandial (GD2PP) 182,4 (SB 76,5) mg/dL dan kadar HbA1c 6,4 (SB 1,5)%. Rerata ketebalan tunika intima media arteri karotis interna 1,2 (SB 1,9) mm. Tidak ada hubungan bermakna antara GDP, GD2PP dan HbA1c (95% CI, p>0,05) terhadap aterosklerosis arteri karotis interna pada penderita pasca stroke iskemik.Simpulan: Tidak ada hubungan hiperglikemia dengan aterosklerosis arteri karotis interna pada penderita pasca stroke iskemik.
Homosistein Plasma dan Perubahan Skor Fungsi Kognitif pada Pasien Pasca Stroke Iskemik Agus Yudawijaya; Endang Kustiowati; Tjokorda Gde Dalem Pemayun
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 1 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (119.104 KB)

Abstract

ABSTRACTPlasma homocysteine and cognitive function score change in post ischemic stroke patients Background: Increase of total homocysteine level is a strong risk factor for cerebrovascular disorder and is correlated with decrease of performance in sort of cognitive tests, including mini mental state examination (MMSE) and clock drawing test (CDT). The aim of this study was to prove the correlation between plasma homocysteine level and change in cognitive function score in postischemic stroke patients. Methods: The design was cross-sectional. The subjects were post-ischemic stroke patients, treated at B1-ward Dr. Kariadi Hospital Semarang from January-June 2010. Plasma homocysteine levels were measured on the first week post onset of ischemic stroke using venous blood at GAKI Laboratory Dr. Kariadi Hospital and cognitive function score was examined using MMSE and CDT on the first and 12th week post onset. Datas were analyzed using descriptive analysis and Spearman’s rho correlation test. Results: Of 30 patients, there were 13 patients with homocysteinemia (43.3%) and 17 with hyperhomocysteinemia (56.7%). There was significant difference of MMSE and CDT score decrease in the first and 12th post onset, with p=0.000 and p=0.001 respectively. Spearman’s rho showed correlation between plasma homocysteine level and cognitive function score based on MMSE with r=-0.837; p=0.000, and based on CDT with r=-0.655; p=0.000. Conclusions: There is strong negative correlation between plasma homocysteine level and change in cognitive function score on the first week post onset of ischemic stroke. Keywords: Homocysteine level, cognitive function score, post-ischemic stroke   ABSTRAK Latar belakang: Peningkatan kadar homosistein plasma merupakan faktor risiko kuat terjadinya penyakit  serebrovaskuler dan dihubungkan dengan penurunan performa sederet tes-tes kognitif, termasuk MMSE (mini mental state examination) dilengkapi oleh CDT (clock drawing test). Tujuan penelitian ini adalah membuktikan hubungan antara homosistein plasma dengan perubahan skor fungsi kognitif pada pasien pasca stroke iskemik. Metode: Desain penelitian adalah cross sectional, pasien pasca stroke iskemik dirawat di Bangsal B1 Saraf RSUP Dr. Kariadi Semarang mulai Januari 2010 sampai Juni 2010. Pemeriksaan homosistein plasma dilakukan pada I minggu pasca onset stroke iskemik menggunakan darah vena di Laboratorium GAKI RSUP Dr. Kariadi dan pemeriksaan skor fungsi kognitif dengan tes MMSE dan CDT dilakukan pada I dan XII minggu pasca onset stroke iskemik. Data di analisis dengan statistik deskriptif dan uji korelasi Spearman’s rho.  Hasil: Didapatkan homosisteinemia pada 13 orang (43,3%) dan hiperhomosisteinemia pada 17 orang (56,7%). Terdapat perbedaan bermakna penurunan skor MMSE dan CDT pada I dan XII minggu pasca onset stroke iskemik dengan nilai p=0,000 dan p=0,001. Uji korelasi Spearman’s rho, menunjukkan koefisien korelasi homosistein plasma dengan skor fungsi kognitif berdasarkan MMSE adalah r=-0,837; p=0,000, sedangkan berdasarkan skor CDT adalah r=-0,655; p=0,000. Simpulan: Didapatkan adanya hubungan kuat dan negatif antara homosistein plasma dengan perubahan skor fungsi kognitif pada I minggu pasca onset stroke iskemik.