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HITUNG ANGKA LEKOSIT SEBAGAI SALAH SATU PREDIKTOR PROGNOSIS FUNCTIONAL OUTCOME DAN LAMA PERAWATAN RUMAH SAKIT PADA STROKE ISKEMIK AKUT Gofir, Abdul; Indera, Indera
Media Penelitian dan Pengembangan Kesehatan Vol 24, No 2 Jun (2014)
Publisher : Badan Penelitian dan Pengembangan Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (382.799 KB)

Abstract

AbstrakLekositosis merupakan petanda klasik inflamasi sistemik. Iskemik serebral akan mencetuskan respons inflamatorik  melalui  akumulasi  granulosit  dan  akhirnya  lekosit  mononuclear  di  sekitar  daerah  infark. Dengan  demikian,  hitung  angka  lekosit  kemungkinan  dapat digunakan  sebagai  indikator  prognosis outcome klinis dan lama rawat inappada stroke iskemik akut. Tujuan studi adalah untuk mengetahui apakah hitung angka lekosit dapat memprediksi severitas prognosis outcome klinis dan lama rawat inap pada stroke iskemik akut. Dalam studi prospektif ini, didapatkan 120 subyek penelitian dengan stroke iskemik akut. Hitung angka lekosit subyek penelitian didapatkan saat awal masuk rumah sakit. Prognosis outcome klinis stroke iskemik akut dinilai menggunakan National Institute of Health Stroke Scale (NIHSS) setelah keluar dari rumah sakit. Lama rawat inap dihitung dari saat masuk sampai keluar rumah sakit. Korelasi antara hitung angka lekosit dengan NIHSS dan lama rawat inap dianalisis untuk menentukan prediktor prognosis stroke iskemik akut. Hasil studi menunjukkan pasien dengan angka lekosit yang tinggi memiliki outcome fungsional neurologis yang berat berdasarkan National Institute of Health Stroke Scale (NIHSS). Lekositosis juga meningkatkan lama masa rawat inap. Angka lekosit menunjukkan  korelasi  yang  sedang  terhadap  outcome  klinis  dan  korelasi  yang  kuat  terhadap  lama rawat inap pada stroke iskemik akut (r = 0.647 dan 0.706) dan bermakna signifikan secara statistik (p < 0.001 untuk keduanya). Kesimpulan yang didapat adalah angka lekosit saat masuk rumah sakit dapat menjadi prediktor outcome fungsional neurologis dan lama masa rawat inap pada pasien stroke iskemik akut.Kata Kunci : Stroke iskemik akut; Hitung angka lekosit; NIHSS; Lama rawat inap; PrognosisAbstractElevated leukocyte count is a classic marker of systemic inflammation. Brain ischemia elicits an inflammatory response with a rapid accumulation of granulocytes and later of mononuclear leukocytes around the infarct zone. Therefore, it is possible that blood leukocyte count might serve as prognostic indicator of functional outcome and length of stay (LOS) in acute ischemic stroke. The aim of the study is to determine whether the leukocyte count can predict prognosis of functional outcome and length of stay in acute ischemic stroke. This study is a prospective study. Leukocyte count of 120 patients with acute ischemic stroke was obtained on admission to the hospital. Prognosis of functional outcome was determined by using National Institute of Health Stroke Scale (NIHSS) after hospital discharge. Length of stay was measured from admission until hospital discharge. Correlation between leukocyte count and functional outcome (as measured by NIHSS) and LOS was analysed to establish predictor of prognosis in acute ischemic stroke. Patients with higher leukocyte count had poor functional neurological outcome based on National Institute of Health Stroke Scale (NIHSS). Higher leukocyte count also increased length of stay (LOS). Leukocyte count showed moderate correlation with clinical outcome and strong correlation with length of stay of acute ischemic stroke (r = 0.665 and 0.706 respectively) and was statistically significant (p < 0.001 for both). The conclusion is that Leukocyte count on admission could serve as a predictor of functional neurological outcome and length of stay in patients with acute ischemic stroke.Keywords : Acute ischemic stroke; leukocyte count; NIHSS; Length of stay; Prognosis
HUBUNGAN DOSIS DAN DURASI PENGGUNAAN WARFARIN TERHADAP TARGET INR (INTERNATIONAL NORMALIZED RATIO) 1,5-2,0 PADA PASIEN STROKE ISKEMIK DENGAN ATRIAL FIBRILASI Dini Khairunnisa; Ika Puspitasari; Abdul Gofir
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 3, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.202

Abstract

Warfarin merupakan salah satu antikoagulan yang biasanya digunakan pada pasien stroke iskemik dengan atrial fibrilasi. Sampai saat ini, penggunaan antikoagulan sebagai terapi pencegahan masih dalam penelitian. Hasil yang diharapkan pada pasien ini terlihat dari peningkatan nilai INR (International Normalized Ratio) dan mencapai target terapi. Jenis penelitian adalah cross sectional. Data diambil secara prospektif dari rekam medik pasien yang dirawat di unit stroke dan bangsal rawat inap Dahlia 2. Subyek penelitian adalah pasien stroke iskemik dengan atrial fibrilasi yang menjalani rawat inap sedangkan objek penelitian meliputi rekam medik pasien yang didalamnya tertera nilai INR (International Normalized Ratio) selama pasien menggunakan warfarin dan didukung pula oleh informasi tambahan mengenai kondisi pasien yang diperoleh dari keluarga pasien dan tenaga medis yang terlibat. Analisis data dilakukan secara deskriptif dan korelatif. Analisa data dilakukan dengan membuat grafik hubungan INR (International Normalized Ratio) pasien dengan durasi penggunaan warfarin dari tiap pasien yang disertai juga dengan dosis warfarin, komorbiditas dan terapi lain yang diperoleh pasien selama berada di rumah sakit sampai tercapai atau tidak tercapainya target INR (International Normalized Ratio). Selain itu, dilakukan juga analisis statistik multiple regression linear untuk mengetahui hubungan antara dosis dan durasi penggunaan warfarin terhadap target INR (International Normalized Ratio) 1,5-2,0 pasien selama menggunakan warfarin dan di rawat dirumah sakit. Hasil penelitian menunjukkan adanya hubungan yang bermakna dengan level signifikansi 0,05 (P<0,05) dari dosis dan durasi warfarin terhadap INR (International Normalized Ratio) pada pasien stroke iskemik dengan atrial fibrilasi.Kata kunci: warfarin, INR (International Normalized Ratio), dosis, durasi, stroke iskemik, atrial fibrilasi
PERBANDINGAN MANFAAT ANTIPLATELET KOMBINASI ASPIRIN DAN KLOPIDOGREL DENGAN ASPIRIN TUNGGAL PADA STROKE ISKEMIK Rismi Fatoni; Abdul Gofir; Sugiyanto Sugiyanto
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 4, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.296

Abstract

Persentase kejadian stroke berulang dalam 30 hari pertama setelah serangan adalah 3-10% dan risiko terjadi pada 6 bulan pertama yaitu 8,8%. Pemberian terapi antiplatelet pada pasien stroke iskemik dapat mencegah kejadian stroke berulang. Hasil penelitian terkait efektivitas pemberian terapi antiplatelet kombinasi aspirin dan klopidogrel dibandingkan dengan aspirin tunggal berbeda-beda. Penelitian ini termasuk penelitian observasional dengan metode kohort retrospektif yang dilakukan di RSUP Dr. Sardjito Yogyakarta. Kelompok pertama adalah pasien stroke iskemik yang mendapatkan terapi antiplatelet aspirin tunggal sebanyak 77 subyek. Kelompok kedua adalah pasien stroke iskemik yang mendapatkan terapi antiplatelet kombinasi aspirinklopidogrel sebanyak 70 pasien. Outcome penelitian ini yaitu kejadian stroke berulang dalam kurun waktu 6 bulan setelah kejadian stroke pertama. Data diperoleh dari data sekunder yaitu rekam medik dan follow-up kejadian stroke berulang sebagian dilakukan dengan menghubungi pasien atau keluarga pasien. Stroke berulang terjadi pada 8,6% pasien stroke yang mendapatkan terapi antiplatelet kombinasi aspirin-klopidogrel dibandingkan 13,0% pasien pada kelompok yang mendapatkan terapi antiplatelet aspirin tunggal (RR 1,22; 95%CI 0,807 – 1,850; p=0,391). Kejadian stroke berulang 6 bulan setelah serangan stroke iskemik pertama di RSUP Dr. Sardjito Yogyakarta, antara pasien yang mendapatkan terapi antiplatelet kombinasi aspirin-klopidogrel dan antiplatelet aspirin tunggal tidak berbeda. Kata kunci: stroke iskemik, antiplatelet, kejadian stroke berulang
SECONDARY PREVENTION TO REDUCE THE OCCURRENCE OF RECURRENT STROKE ON ISCHEMIC STROKE Hidayah Karuniawati; Zullies Ikawati; Abdul Gofir
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 5, No 1
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.23

Abstract

One of the purpose from stroke theraphy is to prevent recurrent stroke using secondary prevention by administering antiplatelet/anticoagulant, antihypertensive, antidyslipidemia, and antihyperglycemic. This study aimed to find the influence of secondary prevention on the occurrence of recurrent stroke and determine the factors that involve in the occurrence of recurrent stroke. This research was conducted with a quantitative approach and retrospective case-control study. The subjects were 165 respondents consisted of 82 respondents in the case group and 83 respondents in the control group. Data were analyzed using bivariate/chi square and logistic regression multivariate test. The result showed that the secondary prevention and patient’s compliance reduced the incident of recurrent stroke. The rate of recurrent stoke was decreased from 68% to 24% by antiplatelet therapy and compliance, from 69% to 23% by antihypertensive and compliance, from 54% to 29% by antidislipidemic and compliance, from 52% to 23% by antihiperglikemic and compliance, and the combination of these four secondary preventions reduced the recurrent stroke from 52% to 13%. Multivariate analysis showed that the several factors involved in determining the rate of recurrent stroke, namely patiens who did not use antihypertensive therapy (P=0,000; OR 9.871), had systolic blood pressure≥140mmHg (P=0,011; OR 3,156), HDL<40mg/dl (P=0,005; OR 3,594), and the lack of exercise (P=0,048; OR 2,365).Keyword: recurrent stroke, secondary prevention, compliance, antihypertensive therapy
EFFECT OF GIVING ANTIHYPERTENSIVE DRUG AGAINST REDUCTION OF BLOOD PRESSURE IN ACUTE ISCHEMIC STROKE PATIENTS WHO HOSPITALIZED IN RSUP DR. SARDJITO YOGYAKARTA Wahyu Sedjatiningsih; Zullies Ikawati; Abdul Gofir
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 2, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.85

Abstract

Incidence of ischemic stroke 10 times more often than haemorrhagic stroke in the the west countries, but haemorrhagic stroke has a higher risk of mortality than ischemic stroke. One focus of acute stroke management is the management of hypertension. Blood pressure reduction in ischemic stroke patients could potentially reduce the risk of brain edema, the risk of hemorrhage, and prevent further vascular damage. However, an aggressive blood pressure reduction can cause a decrease in perfusion pressure to the ischemic area. Most hypertensive patients require two or more antihypertensive medications to achieve blood pressure targets. This study used observational study design with retrospective data collection on medical records of acute ischemic stroke patients and performed in RSUP Dr. Sardjito Yogyakarta period January 2010-December 2010. Data were analyzed with descriptive analysis and chi-square evaluative analysis on the relationship between the type of therapy with a reduction in blood pressure of acute ischemic stroke patients. Initial antihypertensive medication use in patients with acute ischemic stroke in RSUP Dr. Sardjito were 13 types of five classes of antihypertensive drugs. After getting a single antihypertensive medication, patients who experienced a decrease in systolic blood pressure on day-3 was 60%, while 17% fixed and 23% up and after getting a combination of antihypertensive medications, patients who experienced a decrease in systolic blood pressure on day-3 was 75%, while 10% fixed and 15% rise. Antihypertensive drug therapy alone or in combination had the same ability to lower systolic blood pressure (p = 0.260) and diastolic (p = 0.567) in patients with acute ischemic stroke in RSUP Dr. Sardjito Yogyakarta. Keywords: Hypertension, acute ischemic stroke, single antihypertensive drug, antihypertensive drug combinations, RSUP Dr.Sardjito Yogyakarta
HUBUNGAN LEUKOSITOSIS DENGAN LUARAN KLINIS PASIEN STROKE ISKEMIK Rohmania Setiarini; Abdul Gofir
JURNAL KEDOKTERAN Vol 2 No 1 (2016)
Publisher : Fakultas Kedokteran Universitas Islam Al-Azhar

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Abstract

Stroke merupakan penyebab kecacatan dan kematian ketiga di dunia. Leukositosis sering terjadi pada pasien stroke akut dan dicurigai mempunyai efek buruk terhadap luaran klinis pasien stroke. Tujuan penelitian ini adalah ntuk mengetahui adakah hubungan leukositosis dengan luaran klinis pasien stroke iskemik. Penelitian ini merupakan penelitian kohort prospektif pada pasien stroke iskemik di Unit Stroke dan Bangsal Saraf RSUP Dr. Sardjito. Kadar leukosit diambil saat pasien datang, pemeriksaan klinis neurologi dinilai dengan SSGM saat pasien datang dan onset hari ketujuh. Dilakukan analisis kadar leukosit dengan selisih nilai SSGM. Penelitian ini menunjukkan bahwa terdapat hubungan antara leukositosis dengan luaran klinis pasien stroke iskemik bermakna signifikan secara statistik (p 0,026)
A report of two cases of type 2 diabetes mellitus (T2DM): happy and longevity Hemi Sinorita; Sri Sutarni; Abdul Gofir
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 54, No 4 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005404202211

Abstract

Chronic hyperglycemia in patients with type 2 diabetes mellitus (T2DM) is associated with the development of complications and the increase of risk of mortality. Patients with T2DM have a shorter life expectancy than non-diabetic population. It is attributed to cardiovascular disease, stroke, renal disease, and infection. Depression secondary to T2DM worsens the quality of life. On the contrary, positive emotions correlated strongly with long life expectancy. A number of mechanisms might explain this correlation. We reported two geriatric patients over 80 y.o. with T2DM comorbidity for more than 20 years. Discussion point of these cases is the subject’s longer life span compared to the average diabetic patient’s life expectancy and great quality of life despite the disease burden of chronic hyperglycemia in T2DM and cardiovascular risk.
Hypertension as Risk Factor of Poor Functional Outcome in Primary Ischemic Stroke Patients Siti Aisyah Affiati; Astuti Prodjohardjono; Abdul Gofir; Probosuseno Probosuseno; Noor Alia Susanti; Sri Sutarni; Ismail Setyopranoto
Academic Hospital Journal Vol 4, No 1 (2022)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v4i1.62783

Abstract

Survival rate of ischemic stroke has been improving which increases long-term disability in consequences.  GBD 2017 shows stroke as the third most common cause of morbidity. Hypertension is the most common risk factor for ischemic stroke incidence and affecting long-term functional outcome. Therefore, hypertension control in ischemic stroke is expected to improve functional outcome and quality of life. Therefore, this study was conducted to know the role of hypertension as risk factor of poor functional outcome in primary ischemic stroke patients. Study was conducted by observational retrospective cohort from May 2018 until April 2019 in 7 hospitals in D.I. Yogyakarta. Functional outcome of primary ischemic stroke patients was assessed by physician at day 30 by using Barthel Index. Bivariate analysis was analyzed by using Chi-Square with 95% CI and p-value <0.05 indicated statistical significance. Based on the study, there were increased risk for having dependent functional outcome in hypertension (RR=1.12, 95% CI=0.74-1.69), diabetes mellitus (RR=1.041, 95% CI=0.71-1.53) but these results were not statistically significant (p>0.05). From the study it can be concluded that hypertension is one of the most common risk factors of stroke but hypertension has no role in predicting functional outcome.  However, hypertension increases risk for having poor functional outcome in ischemic stroke patients.
Kejadian Delirium pada Pasien Penderita Covid-19 dan Kemungkinan Perburukannya menjadi Gejala Demensia Gea Pandhita S; Abdul Gofir
Sanus Medical Journal Vol. 2 No. 2 (2021): Vol. 2 No. 2 (2021): Sanus Medical Journal
Publisher : Universitas Muhammadiyah Prof. Dr. Hamka (UHAMKA Press)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22236/sanus.v2i2.7452

Abstract

Delirium merupakan suatu sindrom neurobehavioral (perubahan perilaku terkait gangguan neurologis) yang disebabkan oleh gangguan sementara aktivitas neuron (sel saraf otak) sebagai akibat sekunder dari gangguan sistemik. Prevalensi delirium pada pasien yang dirawat inap di rumah sakit cukup tinggi. Kejadian delirium lebih tinggi pada pasien dengan kasus kritis dan pada pasien penderita Covid-19. Kejadian delirium pada pasien dengan kasus kritis yang dirawat di rumah sakit adalah sekitar 31,8%. Angka kejadian ini meningkat menjadi sekitar 55% pada penderita Covid-19. Beberapa penelitian menunjukkan bahwa terdapat mekanisme patofisiologi delirium pada pasien penderita Covid-19 yang serupa dengan kejadian delirium pada pasien non-Covid-19. Bukti epidemiologi menunjukkan keterkaitan kejadian delirium pada pasien non-Covid-19 dengan kejadian demensia beberapa periode waktu setelahnya (Probabilitas sekitar 30%). Bukti radiologis dan patologi anatomi juga menunjukkan adanya proses patologis di otak akibat Covid-19 yang dapat mengakibatkan gangguan saraf otak ireversibel dan berkontribusi pada penurunan kognitif jangka panjang. Hal-hal tersebut menunjukkan kemungkinan besar dapat terjadi keterkaitan antara kejadian delirium yang dialami pasien penderita Covid-19 dengan kejadian demensia di masa mendatang.
C-reactive protein (CRP) and lactate dehydrogenase (LDH) as functional outcome predictors in stroke patients Nadhilla, Nyimas Farisa; Gofir, Abdul; Setyawan, Tommy Rachmat; Farida, Siti; Ar Rochmah, Mawaddah
Indonesian Journal of Biomedicine and Clinical Sciences Vol 56 No 3 (2024)
Publisher : Published by Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/inajbcs.v56i3.15893

Abstract

Stroke is a neurologic disorder with high mortality and disability. Its pathophysiology is associated with vascular inflammation. However, studies between vascular inflammatory markers and stroke outcomes are still limited. This study aimed to investigate the association between inflammatory markers and functional outcomes of stroke. This was a retrospective cohort study involving all stroke patients at the Dr. Sardjito General Hospital, Yogyakarta from October 2020 to August 2021 who meet the inclusion and exclusion criteria. Mann-Whitney was used for bivariate analysis, followed by multivariate analysis. A total of 269 subjects, with 213 infarcts (79.2%) and 56 hemorrhagic (20.8%) strokes. There were 83 subjects deceased (30.9%), with 66 infarct (31%) and 17 hemorrhagic (30.4%) strokes. High CRP levels had significant and independent associations with worse GCS, ADL, IADL, NIHSS, BI, SSGM, MRS, and higher mortality rates (p < 0.05). High LDH levels had a significant and independent association with worse GCS scores and higher mortality rates (p < 0.05). Sub-analysis showed high CRP and LDH had associations with high mortality rates in infarct (p < 0.001), but only CRP (p = 0.029) had associations with high mortality rates in hemorrhagic. There was no significant association between fibrinogen and procalcitonin with stroke outcomes (p > 0.05). Cox-regression analysis showed CRP>24.5 mg/dL and LDH >300U/L associated with hazard ratios of 3.2 (p < 0.001) and 1.65 (p = 0.026). In conclusion. high CRP and LDH levels are associated with mortality rates in stroke patients.