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DEVELOPMENT AND VALIDATION TEST OF DISINI (DISTAL SYMETRIC NEUROPATHY) IN DIABETES MELLITUS PATIENTS Maharani, Anyelir Dewi; Pinzon, Rizaldy Taslim; S, Sugianto
MNJ (Malang Neurology Journal) Vol. 11 No. 2 (2025): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2025.011.02.06

Abstract

Background: Diabetic neuropathy is a complication of diabetes mellitus that may lead to ulceration and potentially amputation of the feet in affected individuals. This may result in elevated rates of morbidity and mortality. Although certain health care facilities lack access to essential neuropathy screening equipment (e.g., 128 Hz tuning forks, reflex hammers, and monofilaments), alternative methods must be developed to ensure early detection of diabetic neuropathy. Objective: To determine the development and measure the validity of the DISINI (Distal Symmetric Neuropathy) questionnaire in diabetes mellitus patients. Methods: A quantitative cross-sectional analysis was conducted at Bethesda Hospital Yogyakarta utilising secondary data obtained from DISINI and DN4 examinations of 64 individuals diagnosed with diabetes mellitus. Utilising the ROC curve, AUC value, Pearson correlation test, and Spearman rank correlation, the acquired data were analysed. Results: Analysis of the ROC Curve and AUC values showed that the cut off for the DISINI questionnaire was ≥ 3. The diagnostic value of the DISINI questionnaire included sensitivity 91.84%, specificity 60.00%, positive predictive value (NPP) 88.24%, negative predictive value (NPN) 69, 23%, positive likelihood ratio (LR (+)) 2.30, and negative likelihood ratio (LR (-)) 0.14. The correlation test DISINI with DN4 shows that there is a relationship between the scores of the DISINI  and DN4 (p = 0.001). The correlation test between DISINI and DNE shows that there is a relationship between the DISINI and DNE scores (p = 0.013). The correlation test DISINI with DNS shows that there is a relationship between the scores of the DISINI and DNS (p = 0.007). The correlation test DISINI with Monofilament showed that there was no relationship (p = 0.318). Conclusion: The validation test of the DISINI (Distal Symmetric Neuropathy) questionnaire in diabetes mellitus patients had a sensitivity of 91.84% and a specificity of 60.00% using the gold standard DN4 (Douleur Neuropathique en 4 Questions).
Pengembangan dan Validasi Awal dari Algoritma Sederhana untuk Menilai Disabilitas Paska Stroke Pinzon, Rizaldy Taslim; Al Jody, Abraham
Jurnal Kesehatan Vol 13 No 1 (2025): In Press
Publisher : STIKES Bethesda Yakkum

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Abstract

 Stroke menyebabkan kematian dan disabilitas jangka panjang di seluruh dunia, termasuk di Indonesia. Alat ukur derajat disabilitas yang ada memiliki durasi pengerjaan yang lama dan belum disesuaikan dengan konteks budaya lokal. Penelitian ini mengembangkan algoritma cepat untuk menilai disabilitas penyintas stroke di Indonesia. Penelitian potong lintang ini dilaksanakan di RS Bethesda, Yogyakarta, Indonesia. Kami mengumpulkan data demografi dan klinis subyek. Derajat disabilitas dinilai dengan algoritma baru dan modified Rankin Scale (mRS). Validitas criterion dievaluasi melalui perhitungan sensitivitas, spesifisitas, nilai prediktif positif (PPV), dan nilai prediktif negatif (NPV). Kami merekrut 22 subjek. Sebanyak 64% subyek adalah laki-laki dan 73% berusia ≥60 tahun. Dyslipidemia dialami oleh 82% subyek dan fibrilasi atrial pada 9%. Algoritma yang baru memiliki sensitivitas 93,3%, spesifisitas 85,7%, PPV 93,3%, dan NPV 85,7% Algoritma ini memiliki akurasi setara dengan instrumeninstrumen standar. Validasi lanjutan dengan penelitian yang lebih besar, di lebih dari satu tempat penelitian, dan pada pasien dengan disabilitas berat diperlukan sebelum penerapan secara luas.
Hubungan Antara Tingkat Kepatuhan Minum Obat Antiplatelet Aspirin Dengan Kejadian Stroke Iskemik Berulang Di RS Bethesda Yogyakarta Putra, I Dewa Gde Rainey Chrisananta; Pinzon, Rizaldy Taslim; Pramudita, Esdras Ardi
Media Farmasi: Jurnal Ilmu Farmasi Vol. 13 No. 1: Maret 2016
Publisher : Universitas Ahmad Dahlan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.12928/mf.v13i1.5742

Abstract

Stroke menduduki urutan ketiga terbesar penyebab kematian setelah penyakit jantung dan kanker, dengan laju mortalitas 18 % sampai 37 % untuk stroke pertama dan 62 % untuk stroke berulang. Diperkirakan 25 % orang yang sembuh dari stroke yang pertama akan mendapatkan stroke berulang dalam kurun waktu 5 tahun. Stroke berulang merupakan stroke yang terjadi lebih dari satu kali. Ketidakpatuhan minum obat memberikan peluang untuk terjadinya stroke berulang 4,39 kali dibandingkan dengan penderita stroke yang teratur berobat. Tujuan penelitian ini untuk melihat hubungan antara tingkat kepatuhan minum obat anti-platelet aspirin dengan kejadian stroke iskemik berulang digunakan  penelitian analitik dengan metode kasus kontrol. Penelitian menggunakan sampel sebanyak 112 data yang diambil dari data primer pasien. Kelompok kasus sebanyak 56 pasien stroke berulang dan kelompok kontrol sebanyak 56 pasien stroke tidak berulang dengan menanyakan riwayat stroke dan kepatuhan minum obat aspirin tahun 2016 kebelakang. Analisis terhadap 112 subyek yang memenuhi kriteria penelitian menunjukkan bahwa terdapat hubungan antara tingkat kepatuhan sedang dan rendah minum obat anti-platelet Aspirin dengan kejadian stroke iskemik berulang dengan p >0,05 (OR : 28,52, 95%CI: 12,657-88,762, p: < 0,001) Hasil menunjukkan bahwa terdapat hubungan antara tingkat kepatuhan minum obat anti-platelet aspirin dengan kejadian stroke iskemik berulang di Rumah Sakit Bethesda Yogyakarta. Kata kunci : Stroke, kepatuhan minum obat antiplatelet aspirin
PENGGUNAAN EPERISONE HYDROCLORIDE UNTUK MENGURANGI NYERI PASIEN NYERI PUNGGUNG BAWAH AKUT DI RUMAH SAKIT BETHESDA YOGYAKARTA Widyantanti, Maria Atika Sukmana; Pinzon, Rizaldy Taslim
Media Farmasi: Jurnal Ilmu Farmasi Vol 14, No 2 : September 2017
Publisher : Universitas Ahmad Dahlan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.12928/mf.v14i2.11243

Abstract

Nyeri punggung bawah (NPB) akut merupakan keluhan umum yang dirasakan pada punggung bawah, dapat menjalar sampai dengan kaki, terjadi kurang dari 12 minggu atau nyeri timbul kembali setelah 6 bulan bebas nyeri. Obat yang digunakan untuk mengatasi NPB salah satunya eperisone hydrochloride. Tujuan dari penelitian ini mengukur efek eperisone hydrocloride dalam menurunkan rasa nyeri pada pasien NPB akut dilihat dari nilai Visual Analog Scale (VAS). Metode  yang digunakan dalam penelitian ini adalah observasional analitik dengan rancangan penelitian kohort. Subjek penelitian, pasien NPB akut yang dikelompokkan berdasarkan terapi yang digunakan, kelompok eperisone hydrocloride 50 mg dua kali sehari dan non-eperisone hydrocloride. Data diperoleh melalui kuisioner nilai VAS dan wawancara. Hasil penelitian ini didapatkan 45 pasien NPB akut yang terdiri dari 16 laki-laki (35,60%), 29 perempuan (64,40%). Sebanyak 15 pasien masuk kelompok eperisone hydrocloride dan 30 pasien masuk kelompok non-eperisone hydrocloride, dengan rata–rata umur pasien 53,53±14,94 dan 59,53 ±14,0 tahun. Hasil analisis statistik menunjukkan terdapat perbedaan bermakna dari penurunan nilai VAS sebelum dan sesudah menerima terapi pada kelompok eperisone hydrocloride (p=0,004), outcome berupa penurunan rasa nyeri saat beraktivitas (p=0,456) dan juga efek samping yang muncul saat pemberian terapi (p=1,000). Kesimpulan dari penelitian ini adalah eperisone hydrocloride  dapat menurunkan nilai nyeri dan mencapai outcome.
The Profile and Determinant Factors of Quality of Life in Patients with Diabetic Neuropathy Pinzon, Rizaldy Taslim; Adnyana, Kadek Sinthia Grahita; Zalukhu, Marta Lisnawati
Kesmas Vol. 12, No. 1
Publisher : UI Scholars Hub

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Abstract

Neuropati merupakan salah satu komplikasi tersering pada diabetes melitus (DM). Neuropati dapat memengaruhi kualitas hidup, derajat kesehatan, maupun tingkat ekonomi. Oleh karena itu, penting untuk mengetahui kualitas hidup pasien DM dengan neuropati beserta dampak yang ditimbulkannya terlebih dahulu agar mendapatkan penanganan yang tepat demi meningkatkan kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui profil kualitas hidup pasien DM dengan neuropati. Penelitian ini merupakan studi observasional menggunakan Short Form 8 (SF-8) Health Survey Standard Indonesia terhadap pasien diabetes melitus dengan neuropati yang diambil secara konsekutif pada bulan Maret hingga Agustus 2016 di Poli Saraf Rumah Sakit Bethesda, Yogyakarta. Terdapat 57 subjek yang dimasukkan dalam penelitian ini. Sebanyak 52,6 % di antaranya adalah perempuan dengan rerata usia 57,3 ±5,85 tahun. Skor kualitas hidup pasien neuropati DM yang paling rendah terdapat pada kategori kesehatan umum (45,26%) disusul nyeri pada tubuh (57,19%), vitalitas atau energi (69,12%), fungsi fisik (69,82%), fungsi sosial (74,03%), kesehatan mental (78,59%), kemampuan peran dengan masalah kesehatan fisik (80,70%), dan kemampuan peran dengan masalah emosi (81,05%). Jenis kelamin dan usia tidak berhubungan secara signifikan terhadap kualitas hidup pasien DM dengan neuropati. Neuropathy is one of the most common complications in patients with diabetes mellitus (DM). Neuropathy has contributed to some impacts of quality of life (QOL), general health status, and socio-economy level. Therefore, it is important to understand more about this issue, so appropriate treatment could be taken to improve QOL of patients with diabetic neuropathy. This study aimed to measure the profile of a patient’s life quality in DM with neuropathy. This study was a observational study using Short Form 8 (SF-8) Health Survey Standard Indonesia to measure the QOL in patients with diabetic neuropathy that were treated consecutively from March to August 2016 in the Department of Neurology in Bethesda Hospital, Yogyakarta. Fifty seven patients with diabetic neuropathy were enrolled as subjects in this study. Most of them were women (52,6%). The mean age of subjects was 57.3 ± 5.85 years. The lowest QOL score in patients with diabetic neuropathy were observed in general health perceptions category (45.26%), followed by bodily pain (57.19%), vitality or energy (69.12%), physical functioning (69.82%), social role functioning (74.03%), mental health (78.59%), physical role functioning (80.70%), and emotional role functioning (81.05%). Patients with diabetic neuropathy have poor QOL. Sex and age were not significantly related to the QOL in patients with diabetic neuropathy.
Acceleration of Telemedicine Use for Chronic Neurological Disease Patients during COVID-19 Pandemic in Yogyakarta, Indonesia: A Case Series Study Pinzon, Rizaldy; Paramitha, Dessy; Wijaya, Vincent Ongko
Kesmas Vol. 15, No. 5
Publisher : UI Scholars Hub

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Abstract

COVID-19 preventions have cut access to routine medical care, especially for many chronic neurological disease patients. This condition has especially promoted telemedicine use in providing healthcare. This study aimed to review telemedicine use catalyzed by several regulations of the Indonesian Government and review 20 cases from Bethesda Hospital in Yogyakarta providing online consultation services. Perceptions of experience on telemedicine were collected from neurological patients at the hospital who were asked about their impressions of consultations and pharmacy medication services, and their suggestions about the new system in outpatient consultations. The regulations for telemedicine use are relevant because of these patients’ risks related to comorbidities and treatments. Of the 20 respondents involved in this study, 15 (75%) were satisfied with the service, 3 (15%) very satisfied, and 2 (10%) others neutral. Most respondents suggest improvement of reimbursement (80%) and others suggest improvement on medications (10%) and services (10%). System and hospital requirements for telemedicine services for neurological cases have been accelerated due to the pandemic. Telemedicine is a way to provide healthcare needed by patients at high risks for COVID-19 fatality related to comorbidities and treatments. Payment regulations, regulatory structures, state licensing, and credentialing across hospitals for better telemedicine experience need to be enhanced.
Utilization of rehabilitation services for BPJS stroke outpatients in indonesia Sutejo, Mianti Nurrizky; Hafidz, Firdaus; Pinzon, Rizaldy
BKM Public Health and Community Medicine Vol 37 No 08 (2021)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/bkm.v37i08.1752

Abstract

Purpose: JKN has been implemented since 2014; however, there has been no change in the value of access to and utilization of medical rehabilitation services, particularly physiotherapy, in FKRTLs in Indonesia. This research aims to identify the factors that influence the pattern of outpatient physiotherapy services received by stroke patients at BPJS Kesehatan during the treatment period. Methods: This study employs an analytical approach using secondary data from the 2015-2016 BPJS Health Data Sample, with a cross-sectional study design. The data were analyzed using univariable and bivariable analyses with the chi-square test, as well as multivariable analysis with logistic regression, with an α level of 0.05. Results: The analysis of patients with stroke cases yielded only 1,641 participants who visited physiotherapy services, and 3 participants from stroke cases who visited rehabilitation services, out of the total participants of BPJS Health in 2015-2016. Frequency of visits to health services for stroke cases among BPJS Kesehatan participants, based on gender, age, province of residence of the participant, type of participation, type of stroke, stroke comorbidity, type of hospital, and cost of claims. Conclusion: This study showed that only a very small number of stroke patients attend rehabilitation services. The utilization services are related to sex, living area, type of stroke, and comorbidities.
Effects of Switching Dose, Dose Variation, and Warfarin Interaction on the Incidence of Stroke Recurrence in Stroke Patients with Atrial Fibrillation Fauzi, Lailla Affianti; Kristin, Erna; Pinzon, Rizaldy Taslim; Kushartanti, Bernadeta Margareta Wara; Arovah, Novita Intan
Borneo Journal of Pharmacy Vol. 7 No. 3 (2024): Borneo Journal of Pharmacy
Publisher : Institute for Research and Community Services Universitas Muhammadiyah Palangkaraya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33084/bjop.v7i3.6603

Abstract

Atrial fibrillation (AF) significantly increases the risk of stroke, necessitating anticoagulation therapy. Warfarin, a commonly prescribed anticoagulant regimen, requires careful monitoring to ensure patient safety. This study aimed to assess the impact of dose switching, dose variation, and potential interactions with warfarin on the incidence of stroke recurrence in stroke patients with AF. The study retrospectively analyzed the treatment records of stroke patients with AF in outpatient settings over one year. The subjects comprised 314 patients who received warfarin prescriptions at two Indonesian Hospitals from January 1, 2015, to December 31, 2019. Out of these patients, 50 had recorded data regarding dose adjustments, variations, and interactions. They were divided into two groups: a case group (n=11) with stroke recurrence and a control group (n=39) without recurrence. Statistical analysis, including chi-square tests and odds ratio calculations, revealed that both warfarin dose switching (OR=7.6) and dose variation (OR=6.6) significantly influenced the incidence of stroke recurrence. It implies that inconsistencies or alterations in warfarin dosing substantially elevate the likelihood of experiencing another stroke, potentially due to inadequate anticoagulation leading to clot formation. Interestingly, the analysis of drug interactions did not significantly impact stroke recurrence. In summary, the recurrence of stroke in patients with AF is notably influenced by warfarin dose adjustments and variations rather than drug interactions. This study highlights the critical importance of precise dosing strategies and vigilant monitoring to enhance the efficacy of anticoagulant therapy in this high-risk population.
Platelet-To-Lymphocyte Ratio as a Predictor of Disability Prognosis in Acute Ischemic Stroke Patients at Bethesda Hospital Bagaskara, Arya T; Pinzon, Rizaldy; Mitasari, Pradita S
Journal of Medicine and Health Vol 7 No 1 (2025)
Publisher : Universitas Kristen Maranatha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.28932/jmh.v7i1.9809

Abstract

Stroke precipitates a neuroinflammatory response. Platelet-to-lymphocyte ratio (PLR) is an inflammatory biomarker conveying plaque adhesion and infarct volume. A high level of PLR is associated with stroke patient’s poor clinical outcomes. This study highlights PLR's potential as a predictive biomarker for post-stroke disability. This study aims to measure PLR at admission and to investigate its potential as a predictor for post-stroke disability. A retrospective cohort study was designed with 98 subjects from Bethesda Hospital Yogyakarta. ROC/AUC analyzed PLR to find the optimal cut-off value. Risk factors were analyzed to find the correlation and causality. From 98 patients, the optimal PLR cut-off is 146.86. A significant positive correlation was observed between PLR and modified Rankin Scale (mRS) scores (p=0.017), and National Institutes of Health Stroke Scale (NIHSS) scores (p=0.043). A significant mean difference in PLR values was also identified between mRS outcomes (p=0.017). PLR was a predictor for mRS (OR=4.051, p=0.037), although it did not predict NIHSS outcomes. The findings indicate that PLR is predictive of post-stroke disability in cases of ischemic stroke. An elevation in PLR suggests a disequilibrium between inflammatory mediators and neuroprotective factors. In conclusion, PLR has the potential as a predictor for post-stroke disability in ischemic stroke
Recurrent Severe Spasmophylia from Hypocalcaemia: A Case Report Pinzon, Rizaldy Taslim; Sinaga, Ruth Vanessa Gloria
Jurnal Kedokteran Brawijaya Vol. 33 No. 1 (2024)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2024.033.01.12

Abstract

Hypocalcemia can present with a variety of clinical symptoms and indications. In situations of nerve-related hypocalcemia, muscle cramps and tetany are signs of increased excitability in either peripheral nerves or the central nervous system. Here, we described the case of a 58-year-old woman experiencing ongoing pain and cramping in both her upper and lower extremities. Through careful physical, neurophysiological, and radiological examinations, we were able to identify hypocalcemia as the primary cause of her severe muscle spasms and cramps, known as spasmophilia. Further detailed history-taking revealed a past total thyroidectomy. Administration of adequate calcium supplementation successfully relieved the symptoms.
Co-Authors Adnyana, Kadek Sinthia Grahita Agung Endro Nugroho Agung Wiwiek Indrayani Agustinus Rudolf Phyma, Agustinus Rudolf Al Jody, Abraham Al Jody, Abraham Alexxander Alexxander, Alexxander Alfi Yasmina Alfi Yasmina Amboro, Wisnu Anak Agung Gede Sugianthara Angela, Angela Ardiani, Birgitta Lisbethiara Bagaskara, Arya T Basuki, Mudjiani Bisay, Vallentino Ardine Prasetya Budi Harsana, Mary Rose Angelina Bustami, Mursyid Ciptasari, Debora Purwasista Daniel Mahendra Krisna, Daniel Mahendra Desyandri Desyandri Digdoyo, Ananda Dodik Tugasworo Erna Kristin Esdras Ardi Pramudita, Esdras Ardi Fedora, Gusti Ayu Jacinda Amanda Ferdy Firmansyah Firdaus Hafidz As Shidieq Fithrie, Aida Fransiska Theresia Meivy Babang, Fransiska Theresia Meivy Gelgel, Putu Clara Shinta Hakim, Manfaluthy Hardi Astuti Witasari Hariatmoko Hariatmoko, Hariatmoko Hidayat, Muh. Faris I Putu Eka Widyadharma Ida Safitri Laksanawati Ika Puspitasari Iwan Dwiprahasto Jarir At Thobari Jesisca, Jesisca Johan Budiman Kadex Reisya Sita Damayanti Kriswanto Widyo, Kriswanto Kushartanti, Bernadeta Margareta Wara Lailla Affianti Fauzi Laksmi Asanti, Laksmi Lestari, MMA Dewi Lucas Meliala Maharani, Anyelir Dewi Maharani, Regina Vika Marpaung, Refianda Olivia Febrianti Mitasari, Pradita S Mugiono, Iroen Muhammad Hasnawi Haddani Muktiarini, Bernadetha Muslimah Muslimah Nani Kurniani Nathanael, Hanshel Everad Novita Intan Arovah Nugraha, Boya Padma, Radha Govinda Pagan Pambudi Pandita, Felicia Dara Puspitaning Paramitha, Dessy Pratiwi, Woro Rukmi Priskila, Loury Priskila, Loury Purwaka, Barlaam Bagus Purwaka Purwandityo, Ayuningtyas Galuh Purwantiningsih, Purwantiningsih Putra, I Dewa Gde Rainey Chrisananta Ratih Puspita Febrinasari Rendra, Andreas K. Renita Sanyasi, Rosa De Lima Renita Sanyasi, Rosa De Lima Renita, Rosa De Lima Rosa De Lima Renita Sanyasi, Rosa De Lima Renita Setyawan, Irfanianta Arif Sinaga, Ruth Vanessa Gloria Sinulingga, Zenine Charolin Siti Nurhayati Sudharmadji Sugianto Sugianto s Sugianto Sugianto Susanto, Agnes Susi Susanti Sutejo, Mianti Nurrizky Thomas Eko Purwata Tri Murti Andayani Trijayanti, Christiana Vania Rau, Chiquita Putri Veronica, Vanessa Vidyatama, Veren Amoreta Widyantanti, Maria Atika Sukmana Wijaya, Vincent Ongko Wijono, Andre Dharmawan Wuysang, Audry Devisanty Y, Yudiyanta Yacobus Christian Prasetyo Yolanda Dyah Kartika Zalukhu, Marta Lisnawati