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All Journal Indonesian Journal of Anesthesiology and Reanimation (IJAR) AKSONA JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia
Fardhani, Ichlasul Mahdi
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Health Professions Medicine & Pharmacology Neuroscience Public Health

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Lambert-Eaton Myasthenic Syndrome: A Review of Rare Neuromuscular Disease Related to Paraneoplastic and Autoimmune Fardhani, Ichlasul Mahdi; Graciella, Cindy; Rayyan, Muhammad Isra Rafidin
AKSONA Vol. 5 No. 1 (2025): JANUARY 2025
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/aksona.v5i1.56359

Abstract

Highlight: LEMS is a rare neurological disease with fluctuating symptoms Delays and misdiagnosis of LEMS disease often occur The two main pathophysiologies of LEMS are autoimmune and paraneoplastic.   ABSTRACT A rare condition known as Lambert-Eaton myasthenic syndrome (LEMS) affects the neuromuscular junctions, which are the connections between muscles and nerves. Tumor-associated or autoimmune causes trigger this condition. This mechanism depends on the presence of antibodies that directly attach to voltage-gated calcium channels located on the presynaptic nerve terminals. LEMS disease is divided into non-paraneoplastic or non-tumor LEMS (NT-LEMS) and paraneoplastic LEMS (P-LEMS). NT-LEMS is believed to be caused by an autoimmune process. On the other hand, P-LEMS has an underlying tumor, and LEMS symptoms are paraneoplastic manifestations of the tumor. Clinical signs of LEMS include proximal muscle weakness, autonomic dysfunction, and decreased deep tendon reflexes. The predominant sign of LEMS is weakness of the lower extremities. The defining characteristic of LEMS is a weakness that spreads from caudal to cranial, causing oculobulbar manifestations, and from proximal to distal, potentially involving the feet and hands. The diagnosis of LEMS depends on clinical, electromyographic, and serological findings of anti-VGCC antibodies. Therefore, comprehensive oncologic screening and monitoring should promptly follow a diagnosis of LEMS. The standard approach to treating LEMS symptoms is administering drugs that improve neurotransmission, such as potassium channel blockers and amifampridine. In refractory cases, immunosuppressants or immunomodulator agents, such as a combination of prednisone and azathioprine, are used. If a tumor is detected, oncological therapy should be a priority.  
POLA TUBERKULOSIS PADA RONTGEN DADA SEORANG PEREMPUAN BERUSIA 16 TAHUN DENGAN PNEUMONIA ASPIRASI TERKAIT TENGGELAM DI NEGARA ENDEMIS, INDONESIA: LAPORAN KASUS Athoillah, Nabil; Tias, Ditya Pramudyaning; Fardhani, Ichlasul Mahdi; Kurniawan, Setiadi Drajad
JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol 11 No 2 (2025): JIMKI: Jurnal Ilmiah Mahasiswa Kedokteran Indonesia Vol. 11.2 (2025)
Publisher : BAPIN-ISMKI (Badan Analisis Pengembangan Ilmiah Nasional - Ikatan Senat Mahasiswa Kedokteran Indonesia)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53366/jimki.v11i2.807

Abstract

Background: Aspiration pneumonia is a process of lung infection that occurs after abnormal fluid ingress in the lower respiratory tract. Drowning is one of the most common cause of aspiration pneumonia. The diagnosis of aspiration pneumonia can be confirmed through history taking, physical examination, and supporting examination for appropriate therapy. Here we report a case of aspiration pneumonia due to drowning that had a radiological appearance of fibroinfiltrates resembling pulmonary TB. Case Illustration: A 16-year-old girl presented with symptoms of decreased consciousness, fever, shortness of breath, and haemoptysis after drowning in a river. The patient was diagnosed with aspiration pneumonia based on clinical manifestations, but the patient was suspected of having pulmonary TB from the chest X-ray. The patient was treated according to the management of aspiration pneumonia rather than TB to avoid treatment resistance and side effects. Conclusion: This report shows the importance to assess the symptoms of aspiration pneumonia or TB in children with symptoms of shortness of breath and haemoptysis to avoid inappropriate therapy.
Combined Spinal-Epidural Anesthesia with Isobaric Ropivacaine 0.375% for Inguinal Hernia Surgery in a Heart Failure Patient with Ejection Fraction of 36% Rayyan, Muhammad Isra Rafidin; Ghiffari, Salman Sultan; Hariyanto, Achmad; Winarso, Achmad Wahib Wahju; Darmawan, Haris; Fardhani, Ichlasul Mahdi
Indonesian Journal of Anesthesiology and Reanimation Vol. 6 No. 1 (2024): Indonesian Journal of Anesthesiology and Reanimation (IJAR)
Publisher : Faculty of Medicine-Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ijar.V6I12024.50-57

Abstract

Introduction: Heart failure is a condition caused by myocardial abnormalities that interfere with the fulfillment of the body's metabolism. It is one of the primary causes of high perioperative morbidity and mortality rates, and its management presents a challenge to anesthesiologists. Objective: To demonstrate combined spinal-epidural anesthesia with isobaric ropivacaine 0.375% for inguinal hernia repair surgery in a heart failure patient with an ejection fraction of 36%. Case Report: A 53-year-old man presented with a complaint of a lump on his left groin accompanied by pain with a visual analog scale (VAS) pain score of 3/10 three days before admission. The patient was also known to often complain of shortness of breath and chest palpitations when lying down at night and during strenuous activity. Based on the examination, the patient was then diagnosed with reducible left lateral inguinal hernia and heart failure with LVEF 36%. Subsequently, the patient was scheduled for elective herniotomy-hernioraphy surgery under low-dose combined spinal-epidural anesthesia. Spinal anesthesia was performed with isobaric ropivacaine 0.375% and fentanyl 25 μg in a total volume of 3.5 ml at the L3-L4 intervertebral space. Epidural anesthesia was performed with isobaric ropivacaine 0.375% and fentanyl 25 μg in a total volume of 8 ml at the L2-L3 intervertebral space. After 10 minutes, the sensory block reached the T6 level, but the motor block was only partial (Bromage 1). A continuous infusion of isobaric ropivacaine 0.1875% 1 ml/hour was administered through the epidural catheter to control postoperative pain. During surgery and hospitalization, the patient's hemodynamic condition remained stable. Conclusion: Combined spinal-epidural anesthesia with isobaric ropivacaine 0.375% can provide adequate anesthesia with relatively stable hemodynamics, thus making it safe for inguinal hernia repair surgery in heart failure patients with reduced ejection fraction.
Co-Authors Athoillah, Nabil Darmawan, Haris Ghiffari, Salman Sultan Graciella, Cindy Hariyanto, Achmad Kurniawan, Setiadi Drajad Rayyan, Muhammad Isra Rafidin Tias, Ditya Pramudyaning Winarso, Achmad Wahib Wahju