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Optimizing Postoperative Pain Management After Endoscopic Sinus Surgery in Indonesia: A Comparative Study of Analgesic Regimens Nabila Saraswati; Made Swastika; Zahra Amir; Husin Sastranagara; Bernadette Wilson
Sriwijaya Journal of Otorhinolaryngology Vol. 1 No. 2 (2023): Sriwijaya Journal of Otorhinolaryngology
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjorl.v1i1.33

Abstract

Introduction: Endoscopic sinus surgery (ESS) is a frequently performed procedure for chronic rhinosinusitis in Indonesia. Effective postoperative pain management is vital for patient comfort, early recovery, and minimizing healthcare expenses. This study compared the efficacy of different analgesic regimens in managing postoperative pain after ESS in an Indonesian population. Methods: This prospective, randomized controlled trial involved 120 patients undergoing ESS at a tertiary hospital in Indonesia. Patients were randomly allocated to one of three groups: Group A received intravenous patient-controlled analgesia (PCA) with morphine, Group B received a combination of intravenous ketorolac and oral paracetamol, and Group C received oral paracetamol alone. Pain intensity was evaluated using the Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours postoperatively. The requirement for rescue analgesia and the occurrence of adverse effects were also documented. Results: Group A (PCA with morphine) exhibited significantly lower VAS scores at all time points compared to Group B (ketorolac and paracetamol) and Group C (paracetamol alone) (p<0.001). Group B showed lower VAS scores than Group C at 2 and 6 hours postoperatively (p<0.05). The need for rescue analgesia was significantly higher in Group C compared to the other groups (p<0.001). The incidence of nausea and vomiting was higher in Group A, while constipation was more frequent in Group B. Conclusion: Intravenous PCA with morphine provided superior postoperative pain control after ESS compared to other analgesic regimens. However, the increased incidence of nausea and vomiting should be taken into account. A combination of intravenous ketorolac and oral paracetamol presented a suitable alternative with a more favorable side effect profile. Further investigation is necessary to optimize pain management protocols for ESS in the Indonesian population.
Transcranial Magnetic Stimulation for the Treatment of Chronic Dizziness: A Randomized Controlled Trial in Bandung, Indonesia Zahra Amir; Nabila Saraswati; Made Swastika; Zainal Abidin Hasan; Aisyah Andina Rasyid; Hasrita Soleiman; Bernadette Wilson
Sriwijaya Journal of Neurology Vol. 2 No. 1 (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.v1i2.90

Abstract

Introduction: Chronic dizziness is a debilitating condition with limited treatment options. Transcranial magnetic stimulation (TMS) has shown promise in treating various neurological conditions. This randomized controlled trial investigated the efficacy and safety of TMS in treating chronic dizziness in Bandung, Indonesia. Methods: Participants with chronic dizziness (≥ 3 months) were randomly assigned to receive either active TMS or sham TMS for 10 sessions over two weeks. The active TMS group received 1 Hz stimulation over the right dorsolateral prefrontal cortex (DLPFC), while the sham group received placebo stimulation. The primary outcome was the change in Dizziness Handicap Inventory (DHI) score from baseline to four weeks post-intervention. Secondary outcomes included changes in Vertigo Symptom Scale (VSS) scores, Hospital Anxiety and Depression Scale (HADS) scores, and quality of life measures. Safety was assessed through monitoring of adverse events. Results: A total of 60 participants completed the study (30 in each group). The active TMS group showed a significantly greater improvement in DHI scores compared to the sham group (p < 0.001). Significant improvements were also observed in VSS, HADS, and quality of life measures in the active TMS group. No serious adverse events were reported. Conclusion: This study provides evidence for the efficacy and safety of TMS in treating chronic dizziness in the Indonesian population. TMS may be a valuable therapeutic option for patients with chronic dizziness who have not responded to conventional therapies.
In Vitro and In Vivo Efficacy of a Novel Strontium-Doped Bioactive Glass Hydrogel for Dentin-Pulp Complex Regeneration Rinna Azrida; Bryan Helsey; Bernadette Wilson; Mohammad Yoshandi
Crown: Journal of Dentistry and Health Research Vol. 3 No. 1 (2025): Crown: Journal of Dentistry and Health Research
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/crown.v3i1.236

Abstract

Introduction: The regeneration of the dentin-pulp complex is a major challenge in vital pulp therapy. This study aimed to develop and evaluate a novel injectable hydrogel composed of strontium-doped bioactive glass (Sr-BG) in a methacrylated gelatin (GelMA) matrix to promote dentin-pulp complex regeneration. Strontium was added for its dual therapeutic effects of enhancing odontogenic differentiation and inhibiting bacterial activity. Methods: We synthesized Sr-BG nanoparticles using a sol-gel method and characterized them with X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). The nanoparticles were then incorporated into a GelMA hydrogel. We assessed the material's physical properties, including its swelling ratio, degradation rate, and ion release profiles (Si, Ca, P, Sr). We also evaluated its in vitro biocompatibility and odontogenic potential using human dental pulp stem cells (hDPSCs), assessing cell viability (MTT assay), alkaline phosphatase (ALP) activity, and the expression of odontogenic markers (DSPP, DMP-1, RUNX2) via RT-qPCR. We tested its antibacterial properties against Streptococcus mutans. For the in vivo evaluation, the hydrogel was used as a pulp capping agent in the mechanically exposed molars of Wistar rats. After 4 and 8 weeks, we assessed tissue regeneration using histological analysis (H&E and Masson's trichrome staining) and micro-computed tomography (micro-CT). Results: The synthesized Sr-BG nanoparticles were amorphous with a particle size of about 80-120 nm. The Sr-BG/GelMA hydrogel exhibited controlled swelling and degradation, along with a sustained release of therapeutic ions. In vitro, the hydrogel demonstrated excellent biocompatibility and significantly upregulated ALP activity and the expression of DSPP, DMP-1, and RUNX2 in hDPSCs compared to the control group (p < 0.05). The material also showed significant antibacterial activity against S. mutans. In vivo, histological analysis revealed the formation of a thick, continuous, and well-organized tertiary dentin bridge with minimal inflammation in the Sr-BG/GelMA group at 8 weeks. Micro-CT analysis confirmed a significantly greater volume and density of newly formed mineralized tissue compared to control groups treated with calcium hydroxide. Conclusion: The novel strontium-doped bioactive glass hydrogel showed significant potential for dentin-pulp complex regeneration. Its combined osteoinductive, angiogenic, and antibacterial properties make it a promising biomaterial for advanced vital pulp therapy, offering a superior alternative to traditional pulp capping agents.