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All Journal Indonesian Journal of Medicine Neurona Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute Folia Medica Indonesiana
Ramdinal Aviesena Zairinal
Departemen Neurologi FK Universitas Indonesia/RSUPN Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience Public Health

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TERAPI HIPEROSMOLAR SEBAGAI TATA LAKSANA EDEMA SEREBRI PASCACEDERA KEPALA: LAPORAN KASUS BERBASIS BUKTI Ramdinal Aviesena Zairinal; Irma Savitri Madjid; Yetty Ramli; Diatri Nari Lastri; Adre Mayza
NEURONA Vol 36 No 1 (2018)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v36i1.49

Abstract

    HYPEROSMOLAR THERAPY FOR CEREBRAL EDEMA POST TRAUMATIC BRAIN INJURY: AN EVIDENCE-BASED CASE REPORTABSTRACTMannitol is an agent widely used to treat hyperosmolarity in cases of increased intracranial pressure after acute traumatic brain injury (TBI). Hypertonic saline is an alternative agent in such cases but is still not well-recognized in daily practice. Thus, a literature searching was conducted to see whether mannitol is more effective and safer than hypertonic saline in reducing intracranial pressure in patients with cerebral edema post TBI. The results of literature searching using PubMed, Google Scholar, and Cochrane Database of Systematic Review showed that there is no clear evidence suggesting mannitol is better than hypertonic saline, and vice versa. Therefore, hypertonic saline should be considered as an alternative treatment for hyperosmolarity besides mannitol.Keywords: Cerebral edema, hyperosmolar therapy, hypertonic saline, mannitol, traumatic brain injuryABSTRAKManitol sebagai agen terapi hiperosmolar untuk menurunkan tekanan intrakranial (TIK) pascacedera kepala telah digunakan secara luas. Sementara pilihan lainnya, yaitu larutan salin hipertonik, masih jarang diaplikasikan pada praktik sehari-hari. Oleh karena itu, dilakukan pencarian literatur untuk menilai efektivitas dan keamanan manitol dibandingkan larutan  salin  hipertonik  dalam  menurunkan  tekanan  intrakranial  berdasarkan  kasus  pasien  yang  mengalami  edema serebri pascacedera kepala. Hasil pencarian di PubMed, Google Scholar, dan Cochrane Database of Systematic Review menunjukkan belum ada bukti ilmiah yang secara tegas menyimpulkan manitol lebih efektif dan aman daripada larutan salin hipertonik maupun sebaliknya. Oleh karena itu, larutan salin hipertonik dapat dijadikan alternatif terapi hiperosmolar selain manitol.Kata kunci: Cedera kepala, edema serebri, manitol, salin hipertonik, terapi hiperosmolar
PERAN MAGNETIC RESONANCE IMGAGING DALAM DIAGNOSIS DAN PROGNOSIS CEDERA MEDULA SPINALIS AKUT Reyhan Eddy Yunus; Taufik Budianto; Trifonia Pingkan Siregar; Thariqah Salamah; Ramdinal Aviesena Zairinal; Mohammad Triadi Wijaya
NEURONA Vol 37 No 4 (2020)
Publisher : PERDOSNI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52386/neurona.v37i4.179

Abstract

Spinal cord injury is a common type of injury that can be highly fatal. Clinically, spinal cord injury can be assessed using standardized physical examination scoring from International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients, which is the American Spinal Injury Association (ASIA) impairment scale or often called as AIS. The results of this scoring will then be combined with magnetic resonance imaging (MRI) examination to determine the diagnosis and prognosis. In this case, we report a 20-year-old male complaining weakness in four extremities after traffic accident while driving a motorcycle. Based on neurological examination, the patient can barely feel a touch sensation and cannot move both his arms and legs at all. Cervical X-ray examination showed dislocation fracture on C5 level. Further MRI examination showed edema and spinal cord hemorrhage around fracture area. The findings of edema and spinal cord hemorrhage on MRI examination are useful in diagnosing and predicting the outcome of patient with spinal cord injury. Keywords: AIS score, MRI, spinal cord injury
KEJADIAN STROKE ISKEMIK PADA PASIEN POSITIF COVID-19 TERKONFIRMASI DI RUMAH SAKIT UNIVERSITAS INDONESIA Rakhmad Hidayat; Gemia Clarisa Fathi; Ramdinal Aviesena Zairinal; Raden Rara Diah Handayani; Mohammad Kurniawan; Taufik Mesiano; Al Rasyid; Salim Harris
NEURONA Vol 38 No 2 (2021)
Publisher : PERDOSNI

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Abstract

Coronavirus disease 2019 (COVID-19) is not only disrupts the respiratory system, it can disrupt various organ systems, one of which is the central nervous system. Indonesia still has a little literature that discusses COVID-19 and its relation to ischemic stroke. This study aims to report the course of ischemic stroke cases in patients who have been confirmed positive for COVID-19. A 56 year old man presented with confirmed COVID-19, the patient had a history of type 2 diabetes mellitus and also a history of dyslipidemia. At initial presentation the patient did not complain of neurological symptoms, but after 12 days of treatment the patient complained of weakness in the left side of the upper leg. The CT scan of the head with contrast revealed an infarction in the peripheral area, perfusion CT found that the patient was hypoperfused in the right cerebral hemisphere area without the presence of a large core infarction or a clear perfusion mismatch defect. CT angiography did not reveal stenosis or occlusion of the large vessels. It can be concluded that ischemic stroke in COVID-19 patients can occur due to various underlying factors, one of which is hypercoagulability. Keywords: COVID-19, Stroke, Universitas Indonesia Hospital
The Role of Hypertonic Saline in Managing Malignant Cerebral Edema Due to Large Vessel Occlusion Stroke: A Case Report Zairinal, Ramdinal Aviesena; Malutfi, Chandrika Najwa; Hidayati, Diah Balqis Ikfi
Indonesian Journal of Medicine Vol. 9 No. 3 (2024)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/theijmed.2024.9.3.738

Abstract

Background: Malignant cerebral edema (MCE) is a complication of large vessel occlusion stroke mainly treated by decompressive craniectomy. The aim of this case report is to demonstrate the efficacy of providing hypertonic saline (3% NaCl) as an alternative treatment for reducing intracranial pressure (ICP) in an MCE patient who refuses surgery. Case Presentation: A 66-year-old man went to the emergency department with unconsciousness, right-sided hemiplegia, and global aphasia for 4.5 hours before admission. His National Institutes of Health Stroke Scale (NIHSS) score was 12. The patient’s brain magnetic resonance imaging (MRI) revealed a large infarction on the left frontotemporoparietal lobe which caused a subfalcine herniation 1.4cm to the right side. He also suffered hyponatremia (115mmol/L). The family refused decompressive craniectomy. The patient received 200ml of 3% NaCl drip intravenous as an initial dose over 20 minutes every 6 hours. Subsequent administration is gradually reduced every 25ml with a distance adjusted to the patient’s condition up to 50ml as the last dose. The patient’s 90-day modified Rankin Scale (mRS) score was 4. Results: The patient with MCE in this case who was administered 3% NaCl as conservative therapy had satisfactory outcomes, as demonstrated by the improvement of the clinical neurological condition. Conclusion: In patients who decline surgery, 3% NaCl might be given as a conservative treatment option to reduce ICP while maintaining serum sodium levels under control. This case revealed a positive clinical result without complications.
Characteristics of Neurophobia Among Medical Students: A Single-Centre Study In Indonesia Zairinal, Ramdinal Aviesena; Hidayati, Diah Balqis Ikfi
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.246

Abstract

Backgrounds: Neurophobia is a fear of neurology among medical students. Early detection is necessary for prevention and further treatment because neurophobia will have a negative impact on patient care. The objective of this study is to investigate the occurrence of neurophobia among medical students. Methods and Materials: A cross-sectional study using the validated NeuroQ questionnaire was distributed to Faculty of Medicine, University of Indonesia (FMUI) students. Inclusion criteria are age ≥18 years, pre-clinical and clerkship students, able to read, understand, speak Indonesian and answer questions independently, and willing to participate in research. Exclusion criteria are questionnaire data that is not filled in completely. Descriptive and comparative tests were carried out to analyze variables. Results: A total of 89 FMUI students completed the questionnaire with an average NeuroQ score of 17.22 (SD 1.999). Most of the students (73 students; 82%) had a NeuroQ score ≥16 points, 32 students (36%) had neurophobia, and 41 students (46%) had marked neurophobia. Gender was not related to the total NeuroQ score (p=0.815). There was no significant difference between pre-clinical and clerkship students with the total NeuroQ score (p=0.246). Conclusions: Most students experience neurophobia. New strategies are needed to change students' perceptions of neurology.
Traumatic Brain Injury Patients in the Emergency Unit of a Tertiary Hospital Zairinal, Ramdinal Aviesena; Malufti, Chandrika Najwa; Ramli, Yetty; Lastri, Diatri Nari; Mayza, Adre; Prawiroharjo, Pukovisa
Folia Medica Indonesiana Vol. 59, No. 3
Publisher : Folia Medica Indonesiana

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Abstract

Highlights: 1. The main focus of this study was to underscore the importance of exploring the characteristics of traumatic brain injury (TBI) patients, which have not been extensively investigated, to help establish effective clinical procedures and decisions. 2. Three out of every four trauma patients in the emergency unit had mild TBIs, and those who did not survive showed a significant trend of rapid deterioration. 3. It is crucial to consistently conduct a thorough and comprehensive head-to-toe examination for all trauma patients. Abstract Traumatic brain injury (TBI) is a prevalent neurological condition in emergency units. TBI cases are frequently diagnosed with severe conditions. Underdiagnosis is common in mild TBI cases. As a result, physicians have an uncomprehensive understanding of the patients' characteristics in their daily practice. This study aimed to discuss the characteristics of trauma patients who were diagnosed with TBIs in an emergency unit. We conducted a retrospective cohort observational study to examine the adult population of TBI patients from April 2022 to March 2023. This study collected several data points, including demographics, clinical characteristics, surgical procedures, and disposition distribution. All variables were compiled and summarized using descriptive statistics and analyzed by calculating frequencies and percentages. During the period of this study, 483 trauma patients were admitted to the emergency unit. A total of 361 (74.7%) of these cases were identified as TBIs. Most of the traumatic brain injuries occurred in men (75.6%), with the predominant age range being 18–22 years (22.4%). Mild TBI cases (74.5%) were the most prevalent, followed by moderate (20.2%) and severe (5.3%) TBI cases. The average score from the Glasgow Coma Scale assessment was 15. Most patients (80.9%) had no hypotension, while a greater number of patients (98.1%) did not exhibit hypoxia as a comorbidity. The Injury Severity Score revealed that the highest percentage of TBIs was categorized as minor (62.3%). It was found that 53.5% of the patients were discharged, while 36% of the patients were hospitalized. However, 7 patients (1.9%) passed in the emergency unit, and 30 patients (8.3%) opted to be discharged against medical advice. Only 21 patients (5.8%) received neurosurgical management. As the most prevalent trauma, TBI necessitates careful management to handle the implications of clinical decision-making. It is crucial to investigate the underlying risk of mortality in TBI cases because the majority of patients do not require neurosurgical intervention.
Relationship between Emergency Department Triage Data and 24- and 48- Hour Mortality in an Academic Teaching Hospital Aviesena Zairinal, Ramdinal; Amanah, Salma Rizqi
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 9 No. - (2025): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v9i-.319

Abstract

Introduction: Triage data plays an essential role in the initial assessment and prioritization of emergency patients. However, the association between triage parameters and short- term mortality remains underexplored. Evaluating 24-hour and 48-hour mortality may serve as an indicator of the effectiveness of triage and early resuscitation efforts. Objectives: To determine the relationship between emergency department triage parameters and short-term mortality (24-hour and 48-hour) among patients treated at an academic teaching hospital. Methods: A retrospective cohort study was conducted on all patients admitted to the emergency department from January to February 2024. Demographic and clinical data obtained during triage were analyzed. Bivariate and multivariate binary logistic regression analyses were performed to identify factors associated with 24-hour and 48-hour mortality. Results: A total of 1,976 patients were included. The 24-hour and 48-hour mortality rates were 1% and 5%, respectively. Significant predictors of 24-hour mortality were triage category (OR = 4.42; 95% CI 1.93–10.09), respiratory rate (OR = 1.09; 95% CI 1.02–1.16). Predictors of 48-hour mortality included age (OR = 1.02; 95% CI 1.008–1.036), triage category (OR = 3.23; 95% CI 2.23–4.67), respiratory rate (OR = 1.08; 95% CI 1.03–1.13), systolic blood pressure (OR = 0.98; 95% CI 0.97–0.99), and mental status (OR = 3.58; 95% CI 2.11–6.07). Conclusion: Several routinely collected data during initial admission to the emergency unit are independently associated with both 24-hour & 48-hour mortality. These results highlight that triage data can serve as meaningful predictors of early mortality and may support rapid risk stratification, resource allocation, and operational decision-making in the Emergency Department.
Co-Authors Adre Mayza Adre Mayza Adre Mayza Al Rasyid Amanah, Salma Rizqi Ariarini, Ni Nengah Rida Chandrika Najwa Malufti Diafiri, Dinda Gemia Clarisa Fathi Hidayati, Diah Balqis Ikfi Imran, Darma Irma Savitri Madjid Kurniawan, Mohammad Lastri, Diatri Nari Malufti, Chandrika Najwa Malutfi, Chandrika Najwa Mohammad Triadi Wijaya Pukovisa Prawiroharjo Pukovisa Prawiroharjo, Pukovisa Raden Rara Diah Handayani Rakhmad Hidayat Reyhan Eddy Yunus Salim Harris Sinthia, Novita Ayu Sitorus, Freddy Sofyan, Henry Riyanto Taufik Budianto Taufik Mesiano THARIQAH SALAMAH, THARIQAH Tiara Aninditha Tiara Aninditha Trifonia Pingkan Yetty Ramli