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All Journal Paediatrica Indonesiana Journal of Pain, Vertigo and Headache
Bulain, Stanley
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Health Professions Medicine & Pharmacology Neuroscience

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A RARE CASE OF ISCHEMIC STROKE IN A YOUNG WOMAN WITH AUTOIMMUNE DISEASE: DIAGNOSIS AND THERAPY CHALLENGES Bulain, Stanley; Atalia, Arila; Lestari, Hotma; Pamarta, Trisna Belani; Rakhmatiar, Rodhiyan
Journal of Pain, Headache and Vertigo Vol. 6 No. 2 (2025): September
Publisher : PERDOSNI (Perhimpunan Dokter Spesialis Neurologi Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jphv.2025.006.02.02

Abstract

Introduction: Stroke is a leading cause of death and disability worldwide and is considered a disease of the elderly. However, recent trends indicate an increase in stroke cases in young adults due to autoimmune causes. Stroke in young adults directly impacts health, productivity, society, the economy, and the health system. Case: A 30-year-old woman presented with sudden, intermittent weakness of one half of her body for 2 days. Physical examination revealed mild paralysis of the right 7th and 9th nerves, hemiparesis, hemihypesthesia, hemiparesthesia, increased physiological reflexes, and positive Hoffman and Tromner reflexes in the right extremity. A CT scan was normal, and the ANA test was positive. The patient was hospitalized for 7 days and given citicoline 500 mg once, azathioprine 50 mg twice, hydroxychloroquine 1200 mg once, acetylsalicylic acid 200 mg once, and pulse methylprednisolone 125 mg four times. She gradually improved. The patient was referred to the RSSA for MRI and MRA, which revealed a chronic infarction extending from the corona radiata to the left lentiform nucleus and no visible ACA segment A1 structure. The patient experienced a generalized tonic-clonic seizure lasting 2 minutes during the DSA. Diazepam 7.5 mg, Metamizole 1 g, and Nicardipine 3 mg/hour were administered, and the patient subsequently regained consciousness. The DSA results showed total occlusion of the ACA segment A1. The patient was diagnosed with CVA infarction with total occlusion of the ACA segment A1, with suspected autoimmune disorder. The patient was discharged three days later and planned for observation. Conclusion: Ischemic stroke in young adults with autoimmune disorders is a serious condition that requires special attention. Antiphospholipid antibody-related hypercoagulability and vascular complications such as vasculitis are the main mechanisms of stroke in this population. Further evaluation for underlying autoimmune disease is necessary for further treatment decisions.
Diagnostic performance of digital and traditional stethoscopes for detecting pneumonia-associated crackles in pediatric pneumonia patients Udin, Muchammad Fahrul; Anggarkusuma, Michelle Vanessa; Pareira, Raymundus Florentino Mariano; Sajidah, Farah; Raziq, Muhammad Abdul; Bulain, Stanley; Amar, Nasim; Lestari, Hotma; Yusuf, Muhammad; Olivianto, Ery; Mulia, Rizki Hari
Paediatrica Indonesiana Vol. 65 No. 4 (2025): July 2025
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi65.4.2025.331-6

Abstract

Background Advancements in healthcare technology have enabled the development of digital stethoscopes, enhancing auscultation in telemedicine practices. By remotely capturing and transmitting respiratory sounds, these devices improve physical examinations as well as the diagnosis and monitoring of respiratory diseases, particularly in remote or underserved areas. Objective To evaluate the sensitivity and specificity of a piezoelectric sensor-based digital stethoscope compared to a conventional stethoscope in detecting crackles associated with pediatric pneumonia. Methods This prospective comparative study involved 30 randomly selected pediatric pneumonia patients. Two pediatric pulmonologists independently assessed breath sounds in six lung areas using both digital and conventional stethoscopes. Findings were compared to evaluate the digital stethoscope’s sensitivity and specificity in detecting crackles, with the conventional stethoscope serving as the reference standard. Results The digital stethoscope demonstrated high sensitivity (>90%) and specificity (>90%) in detecting crackles, comparable to the conventional stethoscope. Examiner 1 achieved a sensitivity of 93.16%, a specificity of 97.10%, and an accuracy of 94.62%, while Examiner 2 achieved a sensitivity of 90.43%, a specificity of 91.55%, and an accuracy of 90.86%. The study highlights the potential of digital stethoscopes in telemedicine applications, particularly for pediatric respiratory assessments. Conclusion The digital stethoscope shows good diagnostic performance and may be a viable tool for remote auscultation. Its use may improve access to diagnostics in underserved areas or when in-person exams are difficult.
Co-Authors Amar, Nasim Anggarkusuma, Michelle Vanessa Atalia, Arila Ery Olivianto Lestari, Hotma Muchammad Fahrul Udin, Muchammad Fahrul Muhammad Yusuf Mulia, Rizki Hari Pamarta, Trisna Belani Pareira, Raymundus Florentino Mariano Rakhmatiar, Rodhiyan Raziq, Muhammad Abdul Sajidah, Farah