Mild cognitive impairment (MCI) is predicted to be a common cognitive impairment in primary health care. Early detection and appropriate management of MCI can slow the rate of deterioration in cognitive deficits. The current methods for early detection of MCI have not been satisfactory for some doctors in primary health care. Therefore, an easy, fast, accurate and reliable method for screening of MCI in primary health care is needed. This study intends to develop a decision tree clinical algorithm based on a combination of simple neurological physical examination and brief cognitive assessment for distinguishing elderly with MCI from normal elderly in pri-mary health care. This is a diagnostic study, comparative analysis in elderly with normal cognition and those presenting with MCI. We enrolled 212 elderly people aged 60.04-79.92 years old. Multivariate statistical analysis showed that the existence of subjective memory complaints, history of lack of physical exercise, abnormal verbal semantic fluency, and poor one-leg balance were found to be predictors of MCI diagnosis (p ≤ 0.001; p = 0.036; p ≤ 0.001; p = 0.013). The decision trees clinical algorithm, which is a combination of these variables, has a fairly good accuracy in distinguishing elderly with MCI from normal elderly (accuracy = 89.62%; sensitivity = 71.05%; specificity = 100%; positive predictive value = 100%; negative predictive value = 86.08%; negative likelihood ratio = 0.29; and time effectiveness ratio = 3.03). These results suggest that the decision tree clinical algorithm can be used for screening of MCI in the elderly in primary health care.

<p>Sejak tanggal 11 Maret 2020, WHO telah mendeklarasikan COVID-19 sebagai pandemi. Gejala COVID-19 yang paling umum adalah demam, malaise, dan batuk kering, namun dapat juga muncul gejala gangguan penghidu atau anosmia. Anosmia pada COVID-19 dapat disebabkan oleh invasi langsung oleh virus melalui epitel hidung dan bulbus olfaktorius pada reseptor ACE2. Anosmia pada COVID-19 ini dapat timbul tiba-tiba atau didahului oleh gejala ringan seperti batuk kering. Tatalaksana anosmia pada COVID-19 masih terus berkembang dan diteliti lebih lanjut.</p><p>Since March 11, 2020, WHO has declared COVID-19 a pandemic. The most common symptoms of COVID-19 are fever, malaise, and dry cough, but there can also be symptoms of olfactory dysfunctions including anosmia. Anosmia in COVID-19 can be caused by direct viral invasion through the nasal epithelium and olfactory bulb at the ACE2 receptor. Anosmia in COVID-19 can spontaneously appear or preceded by mild symptoms such as dry cough. The management of anosmia in COVID-19 is still developing and needs more in-depth research.</p><p> </p>

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Pasien COVID-19 memiliki gejala bervariasi. Saat ini, selain ditemukan gejala pada sistem pernapasan dan pencernaan, gejala di sistem organ lain pun mulai banyak ditemukan, salah satunya pada sistem saraf dengan gejala neurologis yang bervariasi seperti anosmia (sering), stroke, nyeri kepala, kejang, dan penurunan fungsi kognitif. Tata laksana pasien dengan penurunan fungsi kognitif masih diteliti. Beberapa pilihan terapi di antaranya human recombinant erythropoietin, flavonoid, dan terapi imun (IVIg) yang masih kontroversial. COVID-19 patients have varied symptoms. At present, in addition to symptoms in the respiratory and digestive systems, symptoms in other organ systems have begun to be found, one of which is in the nervous system with various neurological symptoms such as anosmia (frequent), stroke, headaches, seizures, and decreased cognitive function. Management of patients with decreased cognitive function is still being studied. Several therapeutic options include human recombinant erythropoietin, flavonoids, and immune therapy (IVIg), which are still controversial.

ASSOCIATION BETWEEN HISTORY OF HEART DISEASE AND SEVERITY OF ACUTE FIRST-EVER ISCHEMIC STROKEABSTRACTIntroduction: History of heart disease such as atrial  fibrillation, angina pectoris, myocardial infarction, heart failure has a role on ischemic stroke severity.Aim: This research aims to find the association between history of heart disease and stroke severity using NIHSS score on acute ischemic stroke patients in Atma Jaya hospital during 2014-2018.Method: This research used cross-sectional method with two-sided fisher’s exact test. With total sampling, samples retrieved from secondary sources in Atma Jaya hospital during 2014-2018 resulting 236 subjects. Stroke severity measured by NIHSS score during admission, categorized with severe stroke (15-42) and non-severe stroke (0-14).Result: There is a significant association between history of AF (p=0.046) on first-ever ischemic stroke severity. Acute first-ever ischemic stroke patients who are  >18 years old with history of AF has a tendency of 5,2 times to have severe stroke compared with patients without AF. Other history of heart disease has no significant association towards stroke severity.Discussion: In accordance with previous research, our findings suggest a significant association between history of atrial fibrillation and acute first-ever ischemic stroke severity in which there is a tendency of more severe stroke compared wth patients without AF. Unlike previous findings, this research shows no significant association between history of heart failure and stroke severity due to limited data characteristic  of ejection fraction preventing us to include patient with ejection fraction below 30%. This limitation may also allow history of angina pectoris and myocardial infarction to be insignificant.Keywords:  Atrial  fibrillation,  heart  failure,  ischemic  stroke,  myocardial  infarction,  National  Institutes  of Health Stroke ScaleABSTRAKPendahuluan: Riwayat penyakit jantung seperti atrial fibrilasi, angina pektoris, infark miokardium, gagal jantung memiliki peran terhadap keparahan stroke iskemik.Tujuan: Mengetahui hubungan riwayat penyakit jantung dengan tingkat keparahan stroke berdasarkan skor NIHSS pada pasien stroke iskemik akut di RS Atma Jaya pada tahun 2014-2018.Metode: Penelitian potong lintang terhadap data sekunder pasien stroke iskemik pertama kali yang dirawat di RS Atma Jaya pada tahun 2014-2018. Keparahan stroke diukur berdasarkan National Institutes of Health Stroke Scale (NIHSS) masuk dengan kategori severe stroke (skor 15-42) dan non-severe stroke (0-14). Dilakukan uji Fisher dua sisi untuk menilai hubungan.Hasil: Terdapat 236 subjek dengan mayoritas hubungan riwayat AF (p=0,046) terhadap tingkat keparahan stroke. Pasien berumur >18 tahun yang mengalami stroke iskemik akut pertama kali dengan riwayat AF akan berpeluang 5,2 kali lebih tinggi untuk mengalami severe stroke dibandingkan jika tanpa riwayat AF. Riwayat penyakit jantung lain tidak memiliki hubungan signifikan terhadap tingkat keparahan stroke.Diskusi: Terdapat hubungan yang signifikan antara riwayat AF terhadap tingkat keparahan stroke, terutama pada subjek dengan severe stroke jika dibandingkan pasien tanpa riwayat AF. Tidak ditemukan hubungan signifikan antara penyakit jantung yang lain dikarenakan keterbatasan data penelitian.Kata kunci: Atrial fibrilasi, gagal jantung, infark miokardium, National Institutes of Health Stroke Scale, stroke iskemik