A B S T R A C TBackground: Head injuries occur every 15 seconds worldwide, with patientsdying every 12 minutes. The value of the Neutrophil Lymphocyte Ratio (NLR) is afactor that influences the assessment and prognostic value of patients withintracranial hemorrhage and without intracranial hemorrhage in head injury.The aim of this study was to determine the relationship between increased NLRbased on the severity of head injury patients with or without intracranialhemorrhage. Methods: This study is a retrospective cross sectional study of headinjury patients with hemorrhage and without intracranial hemorrhage who weretreated at Dr. M. Djamil Hospital Padang in 2020 from May to December 2020.Data was collected in the Medical Records Department of Dr. M. Djamil HospitalPadang who met the inclusion and exclusion criteria. Results : A total of 92patients were included in the inclusion criteria for this study. The results showedthat the mean NLR value in head injury patients was 11.72 with a variation of7.31. The mean NLR level based on the severity of mild head injury was 10.15with a variation of 6.38. The mean NLR level of moderate head injury severity was12.70 with a variation of 7.09. The mean NLR level of severe head injury, was14.69 with a variation of 9.30. The results showed that there was no difference inthe mean of NLR levels in mild head injury patients with hemorrhage and withoutintracranial hemorrhage. The results showed that there was a significantrelationship between NLR levels in moderate head injury patients withhemorrhage (14.20) and without intracranial hemorrhage (7.20) (p value = 0.029),whereas in severe head injury it could not be assessed because there was nosample without hemorrhage. Conclusion: There is an association betweenincreased NLR and intracranial bleeding in moderate head injury patients
Background: Endoscopic surgery techniques had been advancing in this last two decades. Transsphenoidal approach endoscopic surgery to the skull base provides better visualization of the operation field compared to microscopic surgery, and also brought lower morbidity than other techniques. Purpose: To report a transsphenoidal endoscopic skull base surgery for craniopharyngioma resection. Case Report: A case of craniopharyngioma in a 47-year-old man. The tumor resection was performed with transsphenoidal endoscopic approach, in collaboration with a neurosurgeon. Clinical Question: Is transsphenoidal endoscopic skull base surgery approach, the appropriate surgical procedure for craniopharyngioma management? Review Method: Evidence based literature study of skull base surgery with transsphenoidal endoscopic approach in craniopharyngioma through database Cochrane library, Pubmed Medline, and hand searching. Result: Skull base surgery with transsphenoidal endoscopic approach was minimally invasive with maximally invasion compared to transcranial surgery, and also provided better view, and could reduce complication rate. Conclusion: Skull base surgery with transsphenoidal endoscopic approach offers more advantage in skull base lesion management compared to other techniques. Collaboration between neurosurgeon and otorhinolaryngologist using this technique could reduce complication and morbidity rate. ABSTRAKLatar belakang: Teknik operasi endoskopi mengalami perkembangan pesat dalam dua dekade terakhir. Bedah basis kranii dengan pendekatan endoskopi transfenoid memberikan kualitas visualisasi lapang pandang operasi lebih baik dibanding menggunakan mikroskop, dan juga mengakibatkan morbiditas lebih rendah dibanding teknik lainnya. Tujuan: Melaporkan keberhasilan bedah basis kranii dengan pendekatan endoskopi transfenoid pada kraniofaringioma. Laporan kasus: Seorang laki-laki 47 tahun dengan diagnosis kraniofaringioma yang dilakukan tindakan reseksi tumor dengan pendekatan endoskopi transfenoid berkolaborasi dengan ahli bedah saraf. Pertanyaan Klinis: Apakah bedah basis kranii dengan pendekatan endoskopi transfenoid merupakan teknik operasi yang tepat untuk tatalaksana kraniofaringioma? Telaah literatur: Telaah literatur berbasis bukti mengenai bedah basis kranii dengan pendekatan endoskopi transfenoid pada kraniofaringioma melalui database Cochrane library, Pubmed Medline, dan pencarian manual. Hasil: Bedah basis kranii dengan pendekatan endoskopi transfenoid memberikan akses minimal dengan invasi maksimal, visualisasi lebih baik, dan dapat menurunkan angka komplikasi. Kesimpulan: Bedah basis kranii dengan pendekatan endoskopi transfenoid merupakan teknik operasi lesi basis kranii yang lebih unggul dibandingkan teknik lainnya. Kolaborasi antara ahli bedah saraf dan THT dapat mengurangi angka komplikasi dan morbiditas tindakan ini.
A B S T R A C TBackground: Traumatic brain injury is the main cause of death in the populationunder the age of 45 years, and the fourth leading cause of death in the entire ofpopulation. Based on the degree of traumatic brain injury, it is commonly categorizedbased on the Glasgow Coma Scale (GCS). Post-Concussion Syndrome (PCS) is theset of somatic, emotional / behavioral and cognitive symptoms that occur after atraumatic brain injury. The aim of this study was to find out the prevalence andcorrelation of the degree of traumatic brain injury based on the Glasgow Coma Scale(GCS) and the emersion of Post-Concussion Syndrome (PCS) acute onset in patientswith head injuries Method: This study was a cross-sectional analytic study ofpatients who experienced Post-Concussion Syndrome (PCS) after traumatic braininjury at DR. M. Djamil Hospital Padang in 2020 from June to November 2020. Datawere collected by filling in a questionnaire (The Rivermead Post ConcussionSymptoms Questionnaire) and medical record data of neurosurgical patients thatmet the inclusion and exclusion criteria. Result: : It indicated that 70 patients wereincluded in the inclusion criteria of this study. A total of 38 (54.3) respondents didnot undergo the acute onset of PCS, meanwhile respondents who experienced acuteonset of PCS were 32 (45.7) respondents. The results showed that 25 (67.6%)respondents with mild traumatic brain injury had PCS acute onset, while 4 (17.4%)respondents with moderate degree of traumatic brain injury had PCS acute onset,and 4 (17.4%) respondents had PCS acute onset PCS 3 (30%) respondentsexperienced severe traumatic brain injury with acute onset PCS and statistically thedifference in the proportion of data from each of these variables was significant witha p-value of 0.0001. The results of statistical tests showed that p value> 0.05 on thecorrelation between PCS and GCS, thus, it can be concluded that there was nocorrelation between the direction of the relationship between PCS and GCS.Conclusion There was no correlation between the degree of traumatic brain injurybased on GCS and the incidence of PCS acute onset, either it was unidirectional orvice versa in patients with head injuries at RSUP M. Djamil Padang.
Background: Head injuries occur evry 15 seconds worldwide, with patients dying every 12 minutes. The value of the Neutrophil Lymphocyte Ratio (NLR) is a factor that influences the assessment and prognostic value of patients with intracranial hemorrhage and without intracranial hemorrhage in head injury. Objective: The aim of this study was to determine the relationship between increased NLR based on severity of head injury patients with or without intracranial hemorrhage. Methods: This study is a retrospective cross sectional study of head injury patients with hemorrhage and without intracranial hemorrhage who were treated at Dr. M. Djamil Hospital Padang in 2020 from May to December 2020. Data was collected in the Medical Records Department of Dr. M. Djamil Hospital Padang who met the inclusion and exclusion criteria. Results: The results showed that there was a significant relationship between NLR levels in moderate head injury patients with hemorrhage (14,20) and without intracranial hemorrhage (7,20) (p value = 0.029), whereas in severe head injury it could not be assessed because there was no sample without hemorrhage. Conclusion:There is an association between increased NLR and intracranial bleeding in moderate head injury patients.
Introduction: Diffuse axonal injury is a type of severe head injury. In overall head injury cases, it is estimated that 60% of severe head injuries and 40% of head injury cases were associated with diffuse axonal injury. Diffuse axonal injury is found in secondary brain injury with the occurrence of an ischemic brain. Magnesium sulfate plays a role as a deciphering agent in severe head injury and ischemic brains. This study was conducted to investigate the efficacy of magnesium sulfate administration in patients with diffuse axonal injury. Methods: This research was conducted using a quasi-experimental design for three months, from October to December 2019, involving patients with severe head injury admitted to the emergency room of Dr. M. Djamil General Hospital, Padang. Results: The results showed that magnesium sulfate administration was more effective than conventional therapy in improving the level of consciousness of patients with severe head injuries, but there was no significant difference between the two groups (p > 0.05). The number of patients was equally analyzed between the two study groups using independent t-test analysis on SPSS. Conclusion: Magnesium sulfate administration was more effective than conventional therapy, but the difference was not statistically significant. Age and onset must be considered by researchers to assess the performance of magnesium sulfate therapy in diffuse axonal injury patients.
The correlation between the degree of traumatic brain injury based on the glasgow coma scale (GCS) and the emersion of post concussion syndrome (PCS) acute onset in the patients of post traumatic brain injury at Dr. M. Djamil Hospital Padang Background: Traumatic brain injury is the main cause of death in the population under the age of 45 years, and the fourth leading cause of death in the entire of population. Based on the degree of traumatic brain injury, it is commonly categorized based on the Glasgow Coma Scale (GCS). Post-Concussion Syndrome (PCS) is the set of somatic, emotional / behavioral and cognitive symptoms that occur after a traumatic brain injury. Objective: The aim of this study was to find out the prevalence and correlation of the degree of traumatic brain injury based on the Glasgow Coma Scale (GCS) and the emersion of Post-Concussion Syndrome (PCS) acute onset in patients with head injuries Methods: This study was a cross-sectional analytic study of patients who experienced Post-Concussion Syndrome (PCS) after traumatic brain injury at DR. M. Djamil Hospital Padang in 2020 from June to November 2020. Data were collected by filling in a questionnaire (The Rivermead Post Concussion Symptoms Questionnaire) and medical record data of neurosurgical patients that met the inclusion and exclusion criteria. Results: It indicated that 70 patients were included in the inclusion criteria of this study. A total of 38 (54.3) respondents did not undergo the acute onset of PCS, meanwhile respondents who experienced acute onset of PCS were 32 (45.7) respondents.The results showed that 25 (67.6%) respondents with mild traumatic brain injury had PCS acute onset, while 4 (17.4%) respondents with moderate degree of traumatic brain injury had PCS acute onset, and 4 (17.4%) respondents had PCS acute onset PCS 3 (30%) respondents experienced severe traumatic brain injury with acute onset PCS and statistically the difference in the proportion of data from each of these variables was significant with a p-value of 0.0001. The results of statistical tests showed that p value> 0.05 on the correlation between PCS and GCS, thus, it can be concluded that there was no correlation between the direction of the relationship between PCS and GCS. Conclusion:There was no correlation between the degree of traumatic brain injury based on GCS and the incidence of PCS acute onset, either it was unidirectional or vice versa in patients with head injuries at RSUP M. Djamil Padang.
Background: O6-methylguanine-DNA methyltransferase (MGMT) is a DNA-repair enzyme that correlates with tumor resistance mechanism to chemotherapy. Methylation of the MGMT promoter inhibits the cells from producing MGMT and is useful to predict chemotherapy's effectiveness with alkylating agents. This study aims to evaluate the MGMT promoter methylation of low-grade and high-grade glioma in the Neurosurgery Department of Cipto Mangunkusumo National General HospitalMethods: We evaluated MGMT promoter methylation status using methylation-specific polymerase chain reaction in low and high-grade glioma patients who underwent surgical resection in the Neurosurgery Department of Cipto Mangunkusomo Hospital Jakarta. The result then correlated with age, sex, Karnofsky Performance Scale (KPS), and glioma grading. Data were analyzed using SPSS version 20 for Windows.Results: MGMT promoter methylation was observed more often in patients diagnosed with age more than 40 years old than in patients less than 40 years old (85.7% vs. 50.0%), also more in men than women (77.7% vs. 50.0%). In patients with KPS more than 70 and KPS 70 or less, methylation of MGMT promoter was observed in 70.0% and 57.1%, respectively. Based on tumor grading, MGMT promoter methylation was observed more often in low-grade gliomas (WHO grade II) than high-grade gliomas (WHO grade II and IV) (85.7% vs. 50.0%). There was no significant relationship between gender, age, KPS, malignancy degree, and Overall Survival (OS) to the MGMT promoter methylation (p>0.05).Conclusion: MGMT promoter methylation was observed less in the higher grade of tumors (grade IV), lower KPS, younger age at the time of diagnosis, and female patients, although the differences were not statistically significant. MGMT promoter methylation was observed more often in gliomas with oligodendroglioma components.
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