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Uji Validitas dan Reliabilitas Kuesioner Sindrom Terowongan Karpal Boston Versi Bahasa Indonesia Fitri Octaviana; Yoga Putra; Ahmad Yanuar Safri; Winnugroho Wiratman; Luh A. Indrawati; Manfaluthy Hakim
eJournal Kedokteran Indonesia Vol 10, No. 1 - April 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (325.424 KB) | DOI: 10.23886/ejki.10.132.18-25

Abstract

Kuesioner Sindrom Terowongan Karpal Boston (KSTK-B) merupakan kuesioner dalam dikembangkan dalam Bahasa Inggris untuk menilai derajat keparahan dan status fungsional pada Sindrom Terowongan Karpal(STK). Penelitian ini bertujuan untuk mendapatkan kuesioner KSTK-B versi bahasa Indonesia yang valid danreliabel. Dilakukan adaptasi dan penerjemahan transkultural KSTK-B ke bahasa Indonesia, dilanjutkan ujivaliditas menggunakan uji korelasi Pearson dan uji reliabilitas menggunakan nilai alpha Cronbach. Penelitiandilakukan pada bulan Juli 2018 hingga September 2018. Subjek penelitian didapatkan sebanyak tiga puluhlima pasien dewasa dengan STK yang datang ke Poli Rawat Jalan Neurologi terdiri dari 31 perempuan, usiaberkisar antara 45 - 71 tahun dengan 32 subyek berusia = 50 tahun. Pada uji validitas domain derajat keparahangejala pada uji pertama nilai r antara 0,484-0,781; r pada uji kedua 0,482-0,760; untuk domain status fungsionaldidapatkan nilai r 0,495-0,825; dan 0,615-0,783 pada uji kedua. Hasil uji reliabilitas, domain derajat keparahangejala nilai alfa Cronbach 0,876 pada uji pertama dan 0,874 pada uji kedua, untuk uji reliabilitas domain statusfungsional pada uji pertama sebesar 0,857 dan 0,854 pada uji kedua. Kuesioner KSTK-B versi Bahasa Indonesiavalid dan reliabel dalam mengevaluasi keluhan serta gejala pada penderita dengan STK.
HUBUNGAN KADAR ANTIBODI RESEPTOR ASETILKOLIN DENGAN DERAJAT KEPARAHAN PENYAKIT MIASTENIA GRAVIS DI RS CIPTO MANGUNKUSUMO Manfaluthy Hakim; Fika Tiara; Ahmad Yanuar; Winnugroho Wiratman; Luh Ari Indriawati; Astri Budikayanti; Fitri Octaviana
NEURONA Vol 37 No 3 (2020)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i3.164

Abstract

Introduction: Acetylcholine receptor (AChR) antibody is main antibody in pathogenesis of myasthenia gravis (MG). AChR antibody is an important diagnostic tests. Myasthenia gravis clinical features can be divided into ocular, generalized and bulbar MG. Severity of MG can be assessed based on MG composite score (MG-cs). Aim: To evaluate association between level of AChR antibody and MG severity based on MG severity in Cipto Mangunkusumo Hospital. Methods: This was a descriptive-analytic cross-sectional study which were done at Cipto Mangunkusumo Hospital during January to November 2017. Inclusion criteria were MG patients aged 18-75 years old. Assessment of MG composite score and blood withdrawal were performed at the same time. The level of AChR antibody was measured by ELISA method. Results: There were 72 subjects met inclusion criteria. Mean age was 43 years old (SD 12.56) with proportion higher in women (2.5:1). Ocular MG was the most initial symptom (79.2%) and early onset was the most common(77.8%). There were 59.7% subject who had seropositive AChR antibody. There was no significant association between seropositive AChR antibody and gender, age of onset, MG type, MGFa classification, immunotherapy. There was no association between level of AChR antibody and MG-cs(p=0.727). Discussion: There wasn’t any association between level of AChR antibody and MG severity based on MG-cs. Keywords: AChR antibody, MG composite score, MG severity
UJI VALIDITAS DAN RELIABILITAS KUESIONER THE 15-ITEM MYASTHENIA GRAVIS QUALITY OF LIFE SCALE VERSI BAHASA INDONESIA (MG-QOL15 INA) Fitri Octaviana; Ahmad Yanuar Safri; Fikry Syahrial; Luh Ari Indrawati; Winnugroho Wiratman; Manfaluthy Hakim
NEURONA Vol 37 No 4 (2020)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i4.176

Abstract

Introduction: Myasthenia gravis (MG) is a chronic autoimmune disease in the neuromuscular junction characterized with fluctuating weakness symptoms. Advance in the diagnosis and management of MG cases increases the patient’s life expectancy therefore the evaluation of therapeutic success is no longer based solely on coping with the symptoms, but also in evaluating the quality of life of patients. The 15-item Myasthenia Gravis Quality of Life scale (MG-QOL15) is a questionnaire utilized today to evaluate the quality of life of MG patients. Aims: To obtain a valid and reliable Indonesian version of MG-QOL15 instrument. Methods: Forty four MG patients at the Cipto Mangunkusumo Neurology outpatient clinic who met the inclusion criteria were included in this cross sectional study. Patients filled in the MG-QOL15 questionnaire twice at two days interval. The concept used for the validity test of MG-QOL15 INA is cross-cultural validation according to World Health Organization (WHO) method. Reliability test was assessed using Cronbach alpha value. Results: We performed WHO cross-cultural validation on MG-QOL15 INA and obtained Spearman correlation coefficient values ranging from 0.568-0.789 at the first examination and 0.574-0.763 at the retest. Cronbach’s alpha value at the first examination was 0.917 and 0.909 for the retest. Discussion: MG-QOL15 INA is valid and reliable to be used as an instrument in evaluating the quality of life of MG patients. Keywords: Myasthenia gravis, MG-QOL15, quality of life
PENDEKATAN DIAGNOSIS DAN TATA LAKSANA MULTIDISIPLIN JANGKA PANJANG PADA NEUROPATI HEREDITER: CHARCOT MARIE TOOTH Putri Widya Andini; Manfaluthy Hakim; Fitri Octaviana; Luh Ari Indrawati; Winnugroho Wiratman; Triana Ayuningtyas; Ahmad Yanuar Safri
NEURONA Vol 38 No 1 (2020)
Publisher : PERDOSNI

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Abstract

Hereditary neuropathy is the most common inherited neuromuscular diseases, with Charcot Marie Tooth being the most common form. It is characterised by degeneration of peripheral sensory and motor nerves due to axonal degeneration or demyelination. The diagnosis of hereditary neuropathy requires comprehensive history taking including family history to determine the mode of inheritance, clinical and neurophysiological examination, and genetic testing. This review provides a diagnostic approach and long-term multidisciplinary management in patients with suspected hereditary neuropathy. Keywords: Charcot Marie Tooth, genetics, neuropathy
UJI DIAGNOSTIK ICE PACK TEST DAN REPETITIVE NERVE STIMULATION SERTA KOMBINASINYA PADA MIASTENIA GRAVIS Winnugroho Wiratman; Bazzar Ari Mighra; Fitri Octaviana; Astri Budikayanti; Luh Ari Indrawati; Triana Ayuningtyas; Ahmad Yanuar Safri; Manfaluthy Hakim
NEURONA Vol 38 No 3 (2021)
Publisher : PERDOSNI

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Abstract

Introduction: Diagnosis of myasthenia gravis (MG) is based on clinical symptoms, physical examination and supporting examination; so far, no examination has become the primary standard in the enforcement of MG. Supporting examinations that are fast, non-invasive and easy to do are ice pack test (IPT) and repetitive nerve stimulation (RNS). Aims: To find the sensitivity and specificity of the IPT, RNS examination, and the combination of both in enforcing the diagnosis of MG. Methods: This study was conducted with a cross-sectional design using primary data and medical records of suspicious MG patients with ptosis in Cipto Mangunkusumo General Hospital between July-November 2019. Results: Of the 38 subjects with ptosis, 35 subjects were confirmed MG with positive SF-EMG/AChR antibodies/response therapy. The ice pack test was positive in 29 subjects (76.3 %). The diagnostic test results of the ice pack test have sensitivity 80%, Specificity 66.67%, area under the curve (AUC) value of 73.3%, the RNS has a sensitivity of 60%, specificity 100%, AUC value 80%, while the combination test has sensitivity 94.28%, specificity 66.67% and AUC value 80.5%. Discussion: The combination of IPT and RNS has good diagnostic value so it can be used as a supporting examination to the diagnosis of MG. Keywords: diagnostic test; ice pack test; myasthenia gravis; ptosis; RNS
SINDROM PIRAMIDAL BILATERAL MENYERUPAI KLINIS SINDROM GUILLAIN-BARRE Putri Auliya; Ahmad Yanuar Safri; Taufik Mesiano; Winnugroho Wiratman; Fitri Octaviana; Manfaluthy Hakim
NEURONA Vol 38 No 4 (2021)
Publisher : PERDOSNI

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Abstract

A 35-year-old man came with weakness in all four limbs with ascending paralysis. The patient experienced a weakness in the right leg initially, followed by the left leg within three hours and involved both arms within one day. The patient was taken to the emergency room afterwards, and within four days, the patient developed tetraplegia, experienced weaknesses of the vocal cord and must be assisted by the ventilator. Lumbar puncture and plasmapheresis were performed, but no improvement was seen. Subsequently, the patient underwent magnetic resonance imaging (MRI) and obtained a picture of subacute infarction on bilateral medulla oblongata pyramidal seen in ????heart shape????. Patients were rehabilitated and given secondary stroke preventive therapy. Clinical findings in this patient were very similar to the clinical findings in Guillain-Barre Syndrome as this cause delayed diagnosis and therapy of the stroke. Both of these two syndromes can be life-threatening because respiratory failure can occur. Keywords: Bilateral pyramidal syndrome, GBS, Guillain-barre syndrome, stroke
FAKTOR-FAKTOR YANG MEMENGARUHI LUARAN THERAPEUTIC PLASMA EXCHANGE PADA KRISIS MIASTENIA DI RSUPN CIPTO MANGUNKUSUMO Manfaluthy Hakim; Triana Ayuningtyas; Ahmad Yanuar; Nadia Ayu Mulansari; Winnugroho Wiratman; Luh Ari Indrawati; Astri Budikayanti; Fitri Octaviana
NEURONA Vol 38 No 4 (2021)
Publisher : PERDOSNI

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Abstract

Introduction: Myasthenic crisis (MC) occurs due to worsening symptoms of myasthenia gravis (MG) characterized by acute respiratory failure, prolonged post-thymectomy intubation or bulbar weakness causing dyspnoea. Therapeutic Plasma Exchange (TPE) has been accepted as first-line therapy for MC. The management of TPE is not quite ideal according to the American Society of Apheresis (ASFA) recommendations. Aim: To determine the factors that in????uenced the outcomes of MC patients who underwent TPE Methods: This study was a cross-sectional design by taking secondary data on MC cases that received TPE at RSUPN Cipto Mangunkusumo from January 2014 to September 2018. The diagnosis of MC is based on clinical examination. Bivariate analysis was carried out on factors that infuenced TPE outcomes in MC. Results: A total of 38 cases met the inclusion criteria. Good outcomes after undergoing TPE are found in 60.5% of cases. The onset of MG (p=0.039) and type of MG (p= 0.001) have a significant relationship with TPE outcome on MC. Early-onset MG and ocular to generalized MG show good outcomes. Antibody specificity variables showed a strong trend in infuencing TPE outcome in MC (p=0.055). Patients with MC who underwent TPE according to ASFA showed faster clinical improvement than those who underwent TPE not according to ASFA. Discussion: Early-onset MG and ocular to generalized MG are factors that can affect the excellent outcome of TPE in MC. Patients who undergo TPE, according to ASFA, show faster clinical improvement. Keywords: ASFA, myasthenic crisis, therapeutic plasma exchange
The Relationship Between Shift Work Patterns and Cognitive Function Disorders in Health Workers at Hospital X, West Java, Indonesia Malau, Bintang Leonard; Amilya Agustina; Pukovisa Prawiroharjo; Winnugroho Wiratman; Retno Asti Werdhani
Sriwijaya Journal of Neurology Vol. 2 No. 2 (2024): Sriwijaya Journal of Neurology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjn.v2i1.105

Abstract

Introduction: Jobs with shift work patterns, especially irregular ones, can disrupt circadian rhythms and sleep quality, which then impacts cognitive function. Despite its importance, research on cognitive domain vulnerabilities related to shift work patterns is still limited. Sleep quality and cognitive function are critical in the context of hospital health services, where decisions and actions must be taken quickly and precisely to support patient safety. Methods: This research is a cross-sectional observational analytical study to determine the relationship between shift work patterns and impaired cognitive function. To measure sleep quality, the Pittsburgh Sleep Quality Index Indonesian (PSQI-Ina) is used, while cognitive function and cognitive domains were measured using Oxford Cognitive Screen (OCS) Indonesian (OCS-Ina), a cognitive instrument for stroke patients, which has been validated. The minimum sample size in this study was 72 samples. Correlation, principal component analysis, demographic analysis, and regression were used to characterize the relationship between PSQI-Ina, OCS-Ina, and other research variables. Results: A total of 83 health workers met the inclusion criteria and were included in the research. The results showed that 16 respondents (19.3%) experienced impaired cognitive function in the Attention domain and 2 respondents (2.4%) experienced impairment in 2 cognitive domains (Attention and Number Management). The results of statistical analysis showed a significant relationship with health workers who had part-time jobs having a 12.8-fold risk (OR 12.8; 95% CI 1.7-91; p = 0.011) of experiencing cognitive impairment. Then health workers who experience poor sleep quality (with a PSQI value >5) have a 40.3 times greater risk (OR 40.3; 95% CI 2.2-708.1; p = 0.011) of experiencing cognitive impairment. Likewise, health workers with irregular shift work patterns have a 5.4 times risk of experiencing cognitive impairment (OR 5.4; 95% CI 0.1-26.6; p = 0.036). Conclusion: There is a relationship between shift work patterns and impaired cognitive function in the workplace. Hospitals should prioritize ergonomic shift work schedules, emphasizing speed and clockwise rotation, to support the well-being of their healthcare workers.
Association between CYP2C9 and CYP2C19 Polymorphism, Metabolism, and Neurotoxicity after Administration of Phenytoin: A Systematic Review Mardhiani, Rizka; Harahap, Yahdiana; Wiratman, Winnugroho
Keluwih: Jurnal Kesehatan dan Kedokteran Vol. 5 No. 1 (2023): Keluwih: Jurnal Kesehatan dan Kedokteran (December)
Publisher : Direktorat Penerbitan dan Publikasi Ilmiah, Universitas Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24123/kesdok.V5i1.6010

Abstract

Abstract—Phenytoin is an antiepileptic drug (AED) metabolized by cytochrome P450 enzymes, especially by CYP2C9 (90%) and CYP2C19 (10%), where both enzymes are polymorphic so that they can undergo polymorphism and it can change the metabolic rate of the drug. Phenytoin is one of the drugs whose risk of side effects may increase due to its narrow therapeutic window of 10-20 µg/mL if the metabolism is slow. The main literature was taken from publications through the library databases in 2017 – 2021. Studies and reviews describing the metabolism, CYP2C9 and CYP2C19 polymorphisms, and neurotoxicity of phenytoin were included, and unrelated research were excluded. There were 18 of 853 articles describing CYP2C9 and CYP2C19 polymorphisms, metabolism, and neurotoxicity events associated with phenytoin used. The authors conclude that based on the results from various literature, there is an association between CYP2C9 and CYP2C19 polymorphism, metabolism, and neurotoxicity after Phenytoin administration with CYP2C9*2 and CYP2C9*3 types of polymorphisms for CYP2C9 and CYP2C19*2 and CYP2C19*3 types for CYP2C19*3 enzymes which can slow down the phenytoin metabolism and increase its concentration in serum so that the risk of causing neurotoxicity. Keywords: CYP2C9, CYP2C19,metabolism, neurotoxicity, phenytoin Abstrak—Fenitoin merupakan obat antibangkitan yang dimetabolisme oleh enzim sitokrom P450 terutama oleh CYP2C9 (90%) dan CYP2C19 (10%), dimana kedua enzim tersebut bersifat polimorfik sehingga dapat mengalami polimorfisme dan dapat mempengaruhi laju metabolisme obat. fenitoin merupakan salah satu obat yang risiko efek sampingnya dapat meningkat jika metabolismenya lambat karena jendela terapeutiknya yang sempit, yaitu 10-20 µg/mL. Literatur utama diambil dari publikasi melalui database perpustakaan tahun 2017 – 2021. Penelitian dan ulasan yang menggambarkan metabolisme, polimorfisme CYP2C9 dan CYP2C19, dan neurotoksisitas fenitoin, dan penelitian yang tidak terkait dikeluarkan. Terdapat 18 dari 853 artikel yang menjelaskan polimorfisme CYP2C9 dan CYP2C19, metabolisme, dan kejadian neurotoksisitas terkait dengan fenitoin yang digunakan. Peneliti menyimpulkan bahwa berdasarkan hasil dari berbagai literatur, terdapat hubungan antara polimorfisme, metabolisme, dan neurotoksisitas CYP2C9 dan CYP2C19 setelah pemberian fenitin dengan jenis polimorfisme CYP2C9*2 dan CYP2C9*3 untuk CYP2C9 dan CYP2C19*2 dan CYP2C19*3 jenis enzim CYP2C19*3 yang dapat memperlambat metabolisme fenitoin dan meningkatkan konsentrasinya dalam serum sehingga berisiko menyebabkan neurotoksisitas. Kata kunci: CYP2C9, CYP2C19, fenitoin, metabolisme, neurotoksisitas
FENOMENA OTOT POSITIF PADA KELAINAN NEUROMUSKULAR Angelita, Michelle Cancera; Indrawati, Luh Ari; Hakim, Manfaluthy; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Fadli, Nurul; Harsono, Adrian Ridski
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 40 No 2 (2024): Vol 40 No 2 (2024): Volume 40, No 2 - Maret 2024
Publisher : PERDOSNI

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Abstract

Positive muscle phenomena arise due to various forms of spontaneous muscle hyperactivity originating from motor neurons or the muscle itself. The presence of this phenomenon can constringe the possible diagnosis to be more specific, so if presence it is necessary to be identified in patients with potential neuromuscular disease. However, the presence of positive muscle phenomena is often overlooked. This gap in our knowledge regarding definitions, clinical findings, electrodiagnostic findings, and pathophysiological mechanisms hampers effective diagnosis and treatment. In this article, we review the clinical characteristics approach to diagnosis of various positive muscle phenomena originating from the lower motor neuron (LMN) and muscle, including tetany, cramps, fasciculations, myokymia, neuromyotonia, rippling muscle, percussion induced rapid contractions (PIRCs), myoedema, and contractures. Keywords: fasciculation, muscle phenomena, hyperactivity, myotonia, rippling muscle