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All Journal Keluwih: Jurnal Kesehatan dan Kedokteran The Indonesian Journal of Community and Occupational Medicine eJournal Kedokteran Indonesia Sriwijaya Journal of Neurology Neurona Acta Neurologica Indonesia
Winnugroho Wiratman
Departemen Neurologi Fakultas Kedokteran Universitas Indonesia
Agriculture, Biological Sciences & Forestry Biochemistry, Genetics & Molecular Biology Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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The Effectiveness of Plasmapheresis Compared to Intravenous Immunoglobulin in Guillain-Barre Syndrome Patients Mustika, Alyssa Putri; Hakim, Manfaluthy; Sari, Waode Satriana; Octaviana, Fitri; Budikayanti, Astri; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Indrawati, Luh Ari; Fadli, Nurul; Harsono, Adrian Ridski; Savitri, Irma
Acta Neurologica Indonesia Vol. 2 No. 02 (2024): Acta Neurologica Indonesia
Publisher : Departemen Neurologi Fakultas Kedokteran Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69868/ani.v2i02.24

Abstract

Introduction : Guillain-Barré syndrome (GBS) is the second most common cause of acute and subacute general paralysis. The management is symptom-adjusting, but plasmapheresis (plasma exchange/PE) and intravenous immunoglobulin immunotherapy (IVIG) can be administered to accelerate the return of neurological function. This study aim to determine PE's effectiveness compared to IVIG in GBS patients and the side effects or complications that may arise. Method : The literature study is carried out on four databases. Selection is carried out using inclusion and exclusion criteria. The articles were screened and extracted independently by two investigators. Results : The literature study obtained three systematic review studies. In the first study, shows the outcomes in the form of improved Hughes Score (OR 1.9; 95% CI 1.11-3.28) and mortality (OR 0.8; 95% CI 0.31-2.29) against IVIG. The second study, outcomes shown in the form of improved disability scores (WMD -0.02, p: 0.83), and secondary outcomes such as mortality or relapse (p >0.05, respectively). The third study showed that IVIG had higher efficacy (OR 1.6, p: 0.067, 95% CI 0.972-2.587), shorter duration of hospitalization, 38 days, compared to 49-day PE therapy (SMD -3.389, 95% CI -11.601-4.824; p: 0.419), however, had higher side effect (OR 0.8, p: 0.430, 95% CI 0.389-1.495). Conclusion : PE efficacy is generally lower than IVIG, as indicated by disability scores/motor ability scores in various studies, as well as the duration of hospitalization. The safety of therapy is assessed by the side effects that appear and appear-more-often in IVIG therapy rather than PE.
Carpal Tunnel Syndrome and Associated Factors Among Workers in Blacksmithing Industry in Java, Indonesia Maha Putra, I Gede; Isbayuputra, Marsen; Wiratman, Winnugroho; Hidayat, Rakhmad; Soemarko, Dewi Sumaryani
The Indonesian Journal of Community and Occupational Medicine Vol. 5 No. 2 (2025): ijcom
Publisher : ILUNI MKK FKUI and PRODI MKK FKUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53773/ijcom.v5i2.173.66-72

Abstract

Introduction: Carpal Tunnel Syndrome (CTS) is one of the most common work-related musculoskeletal disorders, particularly in the informal sector such as traditional blacksmithing industries. Objective. This study aims to determine the prevalence and associated factors of CTS among blacksmith workers in Mekarmaju Village, Bandung Regency. Methods: Using a cross-sectional design, data were collected from 100 male workers through questionnaires, work observations, and physical examinations (Phalen and Tinel tests). Result:The results showed a CTS prevalence of 68%, with the majority of cases being bilateral. Bivariate analysis revealed several factors associated with CTS, including body mass index, age, dominant hand, and type of work. However, multivariate analysis identified only work duration (>3 years) as a significantly associated factor (aOR = 0.03; 95% CI: 0.01–0.92; p = 0.045), indicating that newer workers are more vulnerable to CTS. Conclusion: These findings highlight the importance of early ergonomic interventions and health screening at the beginning of employment to prevent CTS in the informal labor sector.
ATTRv MIMICKING CIDP: INSIGHTS FROM TWO GENETICALLY CONFIRMED PATIENTS IN A NATIONAL TOP REFERRAL HOSPITAL Indrawati, Luh Ari; Hadiweijaya, Antonia; Wiguna, Fikry Ichsan; Parindra, Cakra; Safri, Ahmad Yanuar; Wiratman, Winnugroho; Fadli, Nurul; Harsono, Adrian Ridski; Hakim, Manfaluthy; Octaviana, Fitri
Majalah Kedokteran Neurosains Perhimpunan Dokter Spesialis Saraf Indonesia Vol 42 No 1 (2025): Volume 42, No 1 - Desember 2025
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v42i1.803

Abstract

ATTRv is a treatable autosomal dominant hereditary devastating disease caused by pathogenic variants in TTR gene leading to amyloid deposition in peripheral nerves. TTR stabilizer or gene silencing drugs are able to reduce amyloid formation. It can mimic chronic inflammatory demyelinating polyneuropathy (CIDP) but does not respond to immunotherapy, highlighting the importance of accurate diagnosis. We present two Indonesian male patients initially misdiagnosed with CIDP. The first case developed progressive distal weakness, sensory loss, profound autonomic dysfunction including orthostatic hypotension, erectile dysfunction and significant weight loss. Nerve conduction studies revealed demyelinating sensory neuropathy with mixed motor involvement and autonomic testing showed absent SSR and abnormal HRV. The patient received supportive care, including fludrocortisone for orthostatic hypotension. The second case experienced distal sensory-motor neuropathy with additional features of erectile dysfunction, urinary and fecal incontinence and recurrent painless heel blisters. Nerve conduction studies showed axonal sensorimotor polyneuropathy, and autonomic testing along with SSEP confirmed widespread autonomic and sensory pathway involvement. Serum protein electrophoresis in both cases revealed elevated gamma globulin without monoclonal spikes. Whole exome sequencing in both cases revealed the same pathogenic TTR variant (c.148G>A, p.Val50Met), confirming the diagnosis of ATTRv. CIDP lacks specific biomarkers and can mimic various neuropathies. In this case, distal predominant weakness and profound autonomic dysfunction were red flags for alternative diagnosis, such as ATTRv. Progressive sensory-motor neuropathy, atypical CIDP with autonomic involvement and unexplained weight loss warrant suspicion of ATTRv. Differential diagnoses should include diabetic neuropathy, autoimmune nodopathy, MAG neuropathy and monoclonal gammopathy-associated neuropathies.
Co-Authors Ahmad Yanuar Ahmad Yanuar Amilya Agustina Andhika Rachman Angelita, Michelle Cancera Aninditha, Tiara Astri Budikayanti Bazzar Ari Mighra Dewi Sumaryani Soemarko Fadli, Nurul Fika Tiara Fikry Syahrial Fitri Octaviana Fitri Octaviana Fitri Octaviana Fitri Octaviana Fitri Octaviana Fitri Octaviana Fitri Octaviana Hadiweijaya, Antonia Hakim, Manfaluthy Harsono, Adrian Ridski Indrawati, Luh Ari Isbayuputra, Marsen Luh A. Indrawati Luh Ari Indrawati Luh Ari Indrawati Luh Ari Indrawati Luh Ari Indrawati Luh Ari Indriawati Maha Putra, I Gede Malau, Bintang Leonard Manfaluthy Hakim Mardhiani, Rizka Mustika, Alyssa Putri Nadia Ayu Mulansari, Nadia Ayu Parindra, Cakra Pratiwi, Astri Dewina Pukovisa Prawiroharjo Putri Auliya Putri Widya Andini Rakhmad Hidayat Ranakusuma, Teguh A. S Retno Asti Werdhani Rini Andriani Safri, Ahmad Yanuar Sari, Riska Nanda Sari, Waode Satriana Savitri, Irma Sofyan, Henry Riyanto Taufik Mesiano Tiara Aninditha Triana Ayuningtyas Triana Ayuningtyas Triana Ayuningtyas Wiguna, Fikry Ichsan Yahdiana Harahap Yesnuar Safri, Ahmad Yoga Putra