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All Journal Medicina INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES E-Jurnal Medika Udayana MNJ (Malang Neurology Journal) Bali Journal of Anesthesiology Callosum Neurology Journal : Jurnal Berkala Neurologi Bali Majalah Kedokteran Neurosains IJAAM (Indonesian Journal of Anti-Aging Medicine) Cermin Dunia Kedokteran
Thomas Eko Purwata
Department Of Neurology, Faculty Of Medicine, Universitas Udayana/ Sanglah General Hospital
Health Professions Medicine & Pharmacology Neuroscience Public Health Other

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PROFIL PASIEN SINDROM TEROWONGAN KARPAL DI POLIKLINIK SARAF RSUP SANGLAH DENPASAR I Komang Arimbawa,* Ni Komang Dewi Mahayani,* I Gusti Ngurah Purna Putra, Thomas Eko Purwata*
NEURONA Vol. 35 No. 3 Juni 2018
Publisher : Neurona Majalah Kedokteran Neuro Sains

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Abstract

INTRODUCTION CARPAL TUNNEL SYNDROME CTS IS THE ENTRAPMENT OF THE MEDIAN NERVE AT THE CARPAL TUNNEL
Characteristics of cervical myofascial pain in medical students Samatra, Dewa Putu Gede Purwa; Widyadharma, I Putu Eka; Haditya, Yogi; Suryamulyawan, Kadek Adi; Devi, Gusti Ayu Putu Giti Livia; Lim, Demetria Jesica; Wijayanti, Ida Ayu Sri; Adnyana, I Made Oka; Purwata, Thomas Eko
Bali Journal of Anesthesiology Vol 3, No 2 (2019)
Publisher : DiscoverSys Inc.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (182.851 KB) | DOI: 10.15562/bjoa.v3i2.188

Abstract

Background: Cervical myofascial pain or neck pain is in the fourth most disease that causes disability after back pain, depression, and other musculoskeletal diseases. Cervical myofascial pain is characterized by pain originating from a trigger point located in the skeletal muscle, commonly referred as myofascial trigger points (MTrPs).Methods: An observational study with a cross-sectional design, conducted on 3 to 9 of December 2018 with research subjects were medical students at Udayana University who undergoing 5th and 6th year in clinical clerkship at Sanglah General Hospital Denpasar. The data was taken using Google Form which was filled in online by the subject and then analyzed using SPSS version 21.Results: From 307 respondents, 62.2% stated experiencing neck pain (196 respondents) with the majority of women 65.4%, the duration of neck pain occurred for <24 hours with the most frequent frequency at least once per month (46.1%), and appeared most often at night (39.8%) and occurs after night shift in 106 subjects (55.5%). The pain was said getting worse by activity in 102 subjects (52.4%) and getting better when resting in 185 subjects (96.9%). Most of the subjects did not use pain relievers to treat neck pain experienced (84.3%). In subjects who use painkillers, Paracetamol is the most often drug of choice to relieve pain (11%). For non-pharmacological treatment, 53.4% of respondents chose to rest or sleep.Conclusion: Most of the respondents who were clerkship reported experiencing neck pain at least once a month and often felt after a night shift. Respondents who reported neck pain were mostly women.
Terapi insulin menurunkan kejadian nyeri neuropati diabetik dibandingkan dengan oral anti-diabetes pada penderita diabetes melitus tipe 2 Lestari, Luh Kadek Trisna; Purwata, Thomas Eko; Putra, IGN Purna
Medicina Vol 47 No 1 (2016): Januari 2016
Publisher : Medicina

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Abstract

Nyeri neuropati diabetik (NND) merupakan salah satu komplikasi yang sering terjadi pada penderita diabetes melitus (DM) tipe 2. Insulin merupakan salah satu terapi DM tipe 2. Insulin memperbaiki status metabolik dengan cepat terutama kadar glukosa darah sehingga kerusakan sel saraf dapat dicegah termasuk kejadian NND. Tujuan penelitian ini adalah untuk mengetahui apakah terapi insulin dapat menurunkan kejadian NND pada pasien DM tipe II dibandingkan dengan oral anti-diabetes (OAD). Subjek penelitian adalah 80 orang penderita DM tipe 2 yang menjalani pengobatan ke Poliklinik Endokrin dan Poliklinik Saraf RSUP Sanglah selama bulan Januari-Maret 2015. Subjek terdiri dari kelompok kasus 40 orang DM dengan NND dan kelompok kontrol 40 orang DM tanpa NND. Adanya NND ditentukan dengan alat bantu douleur neuropathique en 4 questions (DN4). Uji hipotesis menggunakan Chi-square, dan regresi logistik dengan tingkat kemaknaan P<0,05. Hasil penelitian mendapatkan bahwa terapi insulin pada penderita DM tipe 2 menurunkan risiko NND dibanding terapi OAD dengan RO=0,07 (IK95% 0,02 sampai 0,26), P<0,0001. Dari penelitian ini dapat disimpulkan bahwa terapi insulin pada penderita DM tipe 2 dapat menurunkan kejadian NND. Painful diabetic neuropathy (PDN) is one of the most common complications that often occur in diabetes mellitus (DM) patient. Insulin is one of the DM treatment can quickly improve metabolic status, especially blood glucose levels, so prevent damage to nerve cells include NND. The purpose of this study was to determine whether insulin therapy can reduce the risk of NND in patients with type II DM compared to oral anti-diabetic (OAD). Subject of study was 80 samples with type 2-DM underwent treatment to Endocrine and Neurology Outpatient Clinic at Sanglah Hospital from January until March 2015. Subjects consist of 40 subjects in case group with PDN and 40 subjects in control group without PDN. The existence of PDN was determined by douleur neuropathique en 4 questions (DN4) tools. This study found that insulin therapy reduce incidence of PDN on type 2-DM patients compared to OAD therapy with OR=0.07 (95%CI 0.02 to 0.26), P<0.0001. It was concluded that insulin therapy can reduce incidence of PDN in type 2-DM patient.
HIPERTERMI DALAM 72 JAM AWITAN SEBAGAI PREDIKTOR PERBURUKAN KLINIS PENDERITA STROKE ISKEMIK AKUT SELAMA PERAWATAN Adja, Yuliana Monika Imelda Wea Ora; Nuartha, Anak Agung Bagus Ngurah; Purwata, Thomas Eko
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

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Abstract

Stroke merupakan penyebab utama kematian dan kecacatan di dunia yang membutuhkan pengobatandan perawatan jangka panjang. Stroke iskemik akut dengan defisit neurologi yang berat terjadikurang lebih 2-10% dan berhubungan dengan prognosis buruk baik jangka pendek ataupun jangkapanjang. Banyak faktor yang mempengaruhi luaran dan tingkatan perbaikan setelah mengalamistroke iskemik di antaranya peningkatan suhu tubuh. Penelitian ini bertujuan mengetahui hipertermidalam 72 jam awitan yang dihubungkan dengan prediktor perburukan klinis penderita stroke iskemikakut selama perawatan.Penelitian ini merupakan penelitian observasional analitik dengan rancangankohort prospektif. Prediktor perburukan digolongkan atas dua kelompok yaitu prediktor perburukanklinis dan prediktor perbaikan klinis melalui nilai NIHSS pada saat awal dan hari ke tujuh perawatan,dan juga di lakukan pengukuran suhu aurikula dalam 72 jam awitan stroke.Selama periode Januarisampai Maret 2015 didapatkan 88 penderita yang memenuhi kriteria eligibilitas. Data dianalisismenggunakan SPSS 20 for windows dengan menampilkan berbagai karakteristik subyek penelitianmeliputi usia, jenis kelamin, awitan stroke, jenis stroke iskemik, skor NIHSS awal, skor NIHSS harike-7, dan derajat hemiparesis. Hubungan antara hipertermi dengan perburukan klinis penderita diujidengan Chi-square, didapatkan hasil yang bermakna secara statistik (RR= 8,01;IK 95% 3,02 sampai21,25; P <0,0001). Dapat disimpulkan bahwa hipertermi merupakan prediktor perburukan klinispenderita stroke iskemik akut selama perawatan yang diukur dengan skala NIHSS. [MEDICINA2015;46:104-11].Stroke is a leading cause of death and disability in worldwide which need a long term care and treatment.Acute ischemic stroke reveal a severe neurological deficits occur approximately 2-10% in population. Itis associated with poor short and long term prognosis. Many factors influence outcomes and degree ofrepairing after ischemic stroke, in which increasing of body temperature is one of it. This study aim todetermine whether a hyperthermia occur in 72 hours is associated with predictor of clinical deteriorationof ischemic stroke patients during treatment.This was an analytic observational prospective cohortstudy design. Predictors of clinical deterioration measures with NIHSS score at baseline and seventhday of treatment and auricular temperature measured in 72 hours of stroke onset.There was 88 patientswith ischemic stroke during January to March 2015 met the eligibility criteria. Data were analyzedusing SPSS 20 for windows to display the various characteristics of the study subjects including age,sex, stroke onset, type of ischemic stroke, first and seventh day NIHSS score, and the degree ofhemiparesis. The relationship between hyperthermia and clinical deterioration tested with Chi-squaretest. The results obtained were statistically significant (RR= 8.01; 95%CI= 3.02 to 21.25; P<0.0001).Itwas concluded a 72-hour hyperthermia as a predictor of clinical deterioration of acute ischemic strokepatients during treatment measured with NIHSS. [MEDICINA 2015;46:104-11].
THORACIC OUTLET SYNDROME Widiastuti, Priska; Purwata, Thomas Eko
Medicina Vol 46 No 3 (2015): September 2015
Publisher : Medicina

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Abstract

Thoracic outlet syndrome (TOS) adalah kumpulan gejala yang disebabkan oleh penekanan strukturneurovaskular ekstremitas atas saat berjalan di antara kosta pertama dan klavikula menuju keaksila. Penekanan dapat disebabkan oleh kelainan tulang atau jaringan lunak di sekitarnya. GejalaTOS dapat berupa gejala neurologi seperti nyeri lengan atas dan bawah, kesemutan, hilangnya rasaraba, kelemahan motorik, dan gejala vaskular seperti klaudikasio ekstremitas atas selama aktifitas,pucat, dingin, kelainan suplai darah perifer, mikroemboli, dan perubahan warna kulit. Pemeriksaanfoto rontgen, elektromiografi dan arteriografi/venografi dapat digunakan untuk mendukung diagnosisTOS. Terapi TOS berupa terapi konservatif dengan mengontrol nyeri dan udem, memperbaiki posturtubuh, modifikasi gaya hidup, dan terapi pembedahan melalui pendekatan supraklavikular anterior,transaksila, dan subskapular posterior. [MEDICINA 2015;46:174-7].Thoracic outlet syndrome (TOS) is a constellation of symptoms caused by compression ofneurovascular structure of the upper limb as they pass between first rib and clavicle en route to theaxilla. Compression can be caused by bony or soft tissue abnormalities. The symptoms can beneurological symptoms including arm and forearm pain, paresthesia, sensation loss, motor weakness,and vascular symptoms including upper limb claudication during exercise, pallor, coldness, impairedperipheral blood supply, microembolization, and skin colour changes. Rontgen photo, electromyographyand arteriography/venography can be used to diagnose TOS. Thoracic outlet syndrome can be treatedconservatively with pain and edema control, proper posture, life style modification, and surgical therapywith anterior supraclavicular, transaxillary, and posterior subscapular approaches. [MEDICINA2015;46:174-7].
PENURUNAN JUMLAH LEUKOSIT SEBAGAI PREDIKTOR PERBAIKAN KLINIS PENDERITA STROKE HEMORAGIK SELAMA PERAWATAN Harkitasari, Saktivi; Nuartha, Anak Agung Bagus Ngurah; Purwata, Thomas Eko
Medicina Vol 46 No 2 (2015): Mei 2015
Publisher : Medicina

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Abstract

Prognosis penderita stroke hemoragik dipengaruhi oleh banyak faktor, salah satunya adalah jumlahleukosit. Berbagai penelitian menyatakan bahwa peningkatan jumlah leukosit sebagai prediktorperburukan klinis dan kematian pada penderita stroke hemoragik, tetapi sampai saat ini masihbelum jelas apakah penurunan jumlah leukosit setelah terjadi leukositosis dapat sebagai prediktorperbaikan klinis penderita stroke hemoragik. Penelitian ini menggunakan rancangan kohort prospektif.Subjek penelitian adalah penderita stroke hemoragik dengan awitan datang d”24 jam denganleukositosis saat masuk rumah sakit yang dirawat di Sanglah Denpasar. Kelompok yang mengalamipenurunan jumlah leukosit dibandingkan dengan kelompok yang tidak mengalami peningkatan atautanpa perubahan jumlah leukosit. Penilaian luaran klinis menggunakan perubahan skor NIHSS yangdinilai pada hari ketujuh. Total sebanyak 44 subjek dimasukkan dalam penelitian, 19 subjekmeunjukkan perbaikan skor NIHSS. Penurunan jumlah leukosit memiliki hubungan yang signifikandengan perbaikan klinis (RR=5,33; IK95%: 1,81 sampai 15,74; P<0,0001). Hasil penelitianmenunjukkan hanya penurunan jumlah leukosit memiliki hubungan yang independent dengan perbaikanskor NIHSS. Disimpulkan bahwa pada penderita stroke hemorgaik dengan leukositosis, penurunanjumlah leukosit dapat menjadi prediktor perbaikan klinis selama perawatan yang diukur denganskala NIHSS. [MEDICINA 2015;46:92-8].The prognosis of hemorrhagic stroke patients is associated with many factors, leucocyte count is one ofthem. Many studies indicated that elevated leucocyte count is a predictor for bad clinical outcome anddeath in patients with hemorrhagic stroke, however, there is remain unclear whether leucocyte reductionafter leucocytosis could be a predictor for better clinical outcome of patients with hemorrhagic stroke.Thisis a prospective cohort study. Subject were hemorrhagic stroke patients who were arrival time d”24hours onset with leucocytosis admitted in Sanglah hospital Denpasar. Group with leucocyte countreduction were compared with group leucocyte count elevation or without changing. Clinical outcomewere measured with NIHSS score changing at day 7.A total of 44 subjects were recruited, 19 of themhad better NIHSS score. Leucocyte count reduction was significantly associated with better clinicaloutcome (RR=5,33; 95%CI: 1,81 to 15,74; P<0,0001). Leucocyte count reduction was the onlyindependently associated with better NIHSS score. It was concluded that in hemorrhagic stroke patientswith leucocytosis, leucocyte count reduction could be a predictor for better clinical outcome duringhospitalization measured with NIHSS.[MEDICINA 2015;46:92-8].
NYERI KEPALA PADA PERDARAHAN SUBARAKNOID Purwata, Thomas Eko
Medicina Vol 45 No 3 (2014): September 2014
Publisher : Medicina

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Abstract

Perdarahan subaraknoid (PSA) merupakan keadaan darurat medik neurologi dengan morbiditas danmortalitas yang sangat tinggi. Penyebab tersering non-traumatik PSA adalah pecahnya berry (saccular)aneurysms. Gejala  klasik   PSA    adalah nyeri  kepala  akut    yang  sangat hebat  seringkali  disertaidengan penurunan kesadaran. Nyeri kepala ini digambarkan pasien sebagai nyeri yang sangat hebatyang tidak pernah dirasakan sebelumnya, seringkali disertai mual, muntah, dan kejang. Patofisiologinyeri kepala pada PSA diduga karena pecahnya pembuluh darah menyebabkan ekstravasasi darah kedalam ruang subaraknoid dengan  tekanan yang  tinggi yang mengakibatkan peningkatan  tekananintrakranial, kerusakan langsung pada jaringan lokal dan  adanya efek toksik oksi-hemoglobin dapatmenimbulkan iritasi meningen, vasospasme, dan perubahan kesadaran. Luaran PSA dapat diperbaikisecara dramatis dengan penanganan dini yang agresif, tepat dan professional. Manajemen PSA denganpemberian obat-obatan dan tindakan pembedahan. Pencegahan PSA dengan mengendalikan faktorrisiko dan komplikasi lain yang sering menyertai PSA. [MEDICINA 2014;45:165-170].
HIGH PLASMA TNF-? LEVELS AND MONONUCLEAR CELLS iNOS AND TNF-? EXPRESSION AS RISK FACTORS FOR PAINFUL DIABETIC NEUROPATHY Eko Purwata, Thomas; Suastika, Ketut; Raka Sudewi, A. A.; Widjaja, Djoenaidi
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 2 Juli 2010
Publisher : Udayana University

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Abstract

Painful Diabetic Neuropathy (PDN) is one of the most common and annoyingcomplications of diabetes mellitus. The pathogenesis of PDN is complex and still unclear.Recently it has become clear that nitric oxide (NO) and proinflammatory cytokines playan important role in the pathogenesis and maintenance of pain in PDN. Based on thisphenomenon, this study was conducted to investigate whether the cytokine tumornecrosis factor-alpha (TNF-?) and NO, in this case inducible Nitric Oxide Synthase(iNOS), play a role in PDN pathogenesis.The study was carried in two steps. The first step was a cross sectional and thesecond step was a case-control study. The study was performed in 110 type-2 diabeticpatients. The plasma TNF-? levels were determined by ELISA while the expression ofTNF-? and iNOS in mononuclear cells were analyzed immunohistochemically.Of 110 subjects, 59 patients suffered from Painful DN (case) and the remaining51 patients were Painless DN (control). Cross sectionally, plasma TNF-? levels andimmunoreactivity for iNOS and TNF-? were higher in patients with more severe pain inthe Visual Analog Scale (VAS). There were statistically significant differences (p <0.05) between mild and severe pain in regard to TNF-? level (15.24 pg/ml ± 5.42 vs.20.44 pg/ml ± 10.34 ); to iNOS immunoreactivity (9.72 % ± 8.61 vs. 15.6% ± 11.84); andto TNF-? immunoreactivity (13.0 % ± 9. 48 vs. 20.44% ± 11.75).The case control study showed that TNF-? had an odd ratio of 5.053 [CI 95%(2.241-11.392); p < 0.001]. TNF-? immunoreactivity of 4.125 [CI 95% (1.805-9.425); p< 0.001]; and iNOS immunoreactivity of 3.546 [CI 95% (1.613-7.795); p = 0.002]. There were correlations between TNF-? level, TNF-? and iNOS immunoreactivity andVAS with coefficient correlation: 0.330; 0.285 and 0.275 (p < 0.05) respectively.It is concluded that Diabetic Neuropathy patients with high TNF-? levels, iNOSand TNF-? immunoreactivity of mononuclear cells have higher risk for painful DN thanpainless DN. The higher TNF-? level, iNOS and TNF-? immunoreactivity the moresevere was the pain. This supports the hypothesis that TNF-? and iNOS have role inPDN pathogenesis. The results of this research could be applied as a basic for furtherresearch in pursuit of better management of PDN.
POTENTIAL OF ANTHOCYANIN BASED POLY (METHYL METHACRYLATE) NANOPARTICLES SPECIFIC ACTIVATED MICROGLIA IN MANAGEMENT INFLAMMATORY PAIN ON HERNIATED NUCLEUS PULPOSUS: A LITERATURE REVIEW Widyadharma, I Putu Eka; Satyarsa, Agung Bagus Sista; Sanjaya, Feliani; Gitari, Ni Made; Niryana, I Wayan; Purwata, Thomas Eko; Jawi, I Made; Suprapta, Dewa Ngurah; Sudewi, AA Raka
MNJ (Malang Neurology Journal) Vol. 7 No. 1 (2021): January
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.2021.007.01.9

Abstract

Pain is an unpleasant sensory and emotional experience that can affect the quality of life and leads to decreased productivity in patients. Low back pain (LBP) is one of the significant causes of disability worldwide with lifelong incidence. The purpose of this literature review describes the potential of anthocyanin-based Poly (Methyl Methacrylate) (PMMA)   nanoparticles as the management of inflammatory pain in the Hernia Nucleus Pulposus (HNP ). The method used is a literature study by entering the keyword. Of the 77 journals reviewed, 47 journals were found by the topic and used as a reference for this work. The anthocyanin-based PMMA nanoparticles act as anti-nociceptors by inhibiting microglia that produce inflammatory mediators in HNP. Poly (Methyl Methacrylate) nanoparticles have specific targets in microglia. Anthocyanins have the effect of inhibiting inflammatory pain through many destinations. Anthocyanin inhibits the synthesis of nitric oxide (NO ) and prostaglandin E2 (PGE 2) and inhibits the activation of p38 MAPK and NF-kB pathways that express TNF-α and IL-1β genes as anti-nociceptive. The anthocyanin-based PMMA nanoparticles have potential as a novel therapy for inflammatory pain in HNP. There has been no research between these modalities. Therefore, further research is needed to find out the exact potential of anthocyanin-based PMMA nanoparticles.
EFFICACY AND SAFETY OF DULOXETINE IN THE TREATMENT OF CHEMOTHERAPY INDUCED PERIPHERAL NEUROPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS Widyadharma, I Putu Eka; Vania Rau, Chiquita Putri; Pinzon, Rizaldy Taslim; Y, Yudiyanta; Indrayani, Agung Wiwiek; Purwata, Thomas Eko; Nugraha, Boya
MNJ (Malang Neurology Journal) Vol. 7 No. 1 (2021): January
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.2021.007.01.10

Abstract

Background: One of the adverse effects of chemotherapy in the neurological field is chemotherapy-induced peripheral neuropathy (CIPN), it was an adverse effect caused by many chemotherapeutic regimens and a major cause of continuous pain in patients who survived cancer. When the symptoms get worse, survivor’s quality of life is declining and they are often having problems with mental health, insomnia, cognitive functioning, fatigue, physical functioning, and pain. So far the choice of therapy for CIPN is still limited. Now, there was no drug approved to treat pain due to CIPN. Duloxetine are a SNRI (serotonin norepinephrine reuptake inhibitor), which it’s useful in CIPN are highly supported by evidence.Methods: We conducted a systemactic-computer based literature search on January 4, 2019 in PubMed database for article published between 2013 and 2018. We searched for a literature related with used a duloxetine for management of chemotherapy induced peripheral neuropathy.Results: From the 4 studies that included in this review, the total participants are 478 patients with neuropathic pain and already get a chemotherapy regiment. From the meta-analysis showed one study had no effect, two studies had small effect, and one study had medium effect.Conclusion: Duloxetine is a great option for the treatment of CIPN in especially reducing neuropathic pain.  
Co-Authors Adhiyoga Santosa Agung Bagus S. Satyarsa Agung Wiwiek Indrayani Anak Agung Bagus Ngurah Nuartha Astika, Domy Devi, Gusti Ayu Putu Giti Livia Dewa Ngurah Suprapta Dewa Putu Gede Purwa Samatra Djoenaidi Widjaja Domy Astika Dwijo Anargha Sindhughosa Gitari, Ni Made Gondowardaja, Yoanes Haditya, Yogi I Gusti Ngurah Purna Putra I Ketut Suastika I Made Jawi I Made Oka Adnyana I Putu Eka Widyadharma I Wayan Niryana Ida Ayu Sri Wijayanti IGN Purna Putra, IGN Purna Indah Mira Tiaraputri Wijaya Komang Wiswa Mitra Kenwa Lim, Demetria Jesica Luh Kadek Trisna Lestari Nugraha, Boya Priska Widiastuti, Priska Putu Stephanie Apriliana Hardika Raka-Sudewi A. A. Rizaldy Pinzon Saktivi Harkitasari, Saktivi Sanjaya, Feliani Suryamulyawan, Kadek Adi Vania Rau, Chiquita Putri Wimpie I Pangkahila Y, Yudiyanta Yoanes Gondowardaja Yuliana Monika Imelda Wea Ora Adja, Yuliana Monika Imelda Wea Ora