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Kristin Purnama Dewi

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Author-ID : 2970256

Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Systematic Review: Pre-Stroke Use of Angiotensin Receptor Blockers and Stroke Outcomes Ivana Purnama Dewi; Virandra B. Kusmanto; Kristin Purnama Dewi; Rizaldy Pinzon
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 50, No 2 (2018)
Publisher : Journal of the Medical Sciences (Berkala Ilmu Kedokteran)

Background: Hypertension is the major risk factor and the most important modifiable risk factor for stroke. Angiotensin Receptor Blockers (ARB) are widely used in patient at high risk of cardiocerebrovascular events. The objective of this literature review was to determine the efficacy of pre-stroke use of ARB on stroke outcomes.Methods: Major medical databases (PubMed, MEDLINE, Clinical Key, Cochrane Library, EMBASE) were systematically searched using keyword: “hypertension”, “ARB”, “stroke”, and “outcome”. The search were limited to clinical trials published within the last 10 years, written in English, with full-text availability. We used GRADE Working Group to measure the quality of evidence.Results: Four clinical studies, three retrospective studies and one nationwide population-based cohort study met our inclusion criteria with total of 102.644 patients for analysis. The scientific quality of the studies varied from poor (1 study), moderate (1 study), and high quality (2 studies). Generally, the subjects of the studies were acute ischemic stroke patients. Three studies showed pre-stroke use of ARB were significantly associated with better stroke outcomes. Only one study found different result whereas pre-stroke use of ARB did not appear to affect stroke outcomes. Outcome of the studies was explored according to morbidity (severity and functional status upon discharge) and mortality (30-days mortality or in-hospital mortality). Several limitations were present, including non-random treatment assignment, retrospective study design, and lack of data for longitudinal medication exposure in observational studies.Conclusions: This systematic review shows evidence that there is possible benefit of pre-stroke ARB treatment in relation to better ischemic stroke outcomes. However, further studies with better research method quality are still needed. The efficacy of ARB treatment in relation to other type of stroke outcomes also needs to be furtherly examined.Keywords: ARB, pre-stroke, benefit, prognosis Makalah ini dipresentasikan dalam Poster Session 11th Scientific Meeting of Indonesian Society of Hypertension, 24-26 February 2017

PRIMARY MASTITIS TUBERCULOSIS CLINICALLY MIMICKING FIBROADENOMA MAMMAE Kristin Purnama Dewi
Berkala Ilmiah Kedokteran Duta Wacana Vol 3, No 2 (2018): BERKALA ILMIAH KEDOKTERAN DUTA WACANA
Publisher : Faculty of Medicine Universitas Kristen Duta Wacana

Introduction: Breast tuberculosis (mastitis TB) is a rare extrapulmonary presentation of tuberculosis that marked pathologily with involvement extensively mamma lobules, which because of infection of Mycobacterium tuberculosis. Many epidemiology studies stated that the incidence of mastitis TB is more common in developing countries than developed countries. Mastitis TB occurs mainly in reproductive woman. Case: A 32-year-old woman came to Surgery Department with chief complaint right upper quadrant palpable breast lump for 4 months. Mammae dextra physical examination confirmed single nodule, size ± 3cm x 3cm x 2.5cm in superior quadrant, mobile, tender, well defined shape, feel like marble, reddish skin, warm, no skin retraction and no nipple discharge. VAS score 2. Mammosonogram was performed and indicated mastitis in the superior quadrant of mammae dextra. Fine needle aspiration revealed negative malignant cells and granulomatous with suppurative inflammation. The histopathological evaluation from mammae excision confirmed datia langhans cells and indicated granulomatous mastitis. Then patient referred to the Pulmonary Department. On TB pulmonary examination confirmed normal chest x-ray and negative acid fast basil (AFB). Patient was diagnosed with primary mastitis TB. Patient was treated with anti-tuberculosis drug (OAT) and gave good response and no side effects. Discussion: Based on the International Standards for Tuberculosis Care (ISTC) diagnosis of mastitis TB can be confirm by anamnesis, physical examination, and also some additional diagnostic test such as sonomammographic imaging, fine needle aspiration or surgical specimens for pathology examination and culture or AFB with Ziehl-Neelsen staining. In Indonesian National Guidelines for TB Control, mastitis TB was treated with fixed drug combination (FDC), intensive phase in 2 months using 4 FDC and advanced phase in 4 months using 2 FDC. In case followed up in 2 months, patient recovered very well and advised to continue the treatment. Conclusions: TB mastitis is rare even in countries with TB endemic. Diagnosis of primary mastitis TB based on clinical, radiological, pathological and microbiological. Treatment of mastitis TB with FDC for 6 months consists of an intensive phase and an advanced phase in this patient gave good outcome. Keywords: Mastitis tuberculosis, diagnosis, treatment.

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