Background: Peripheral neuropathy is a common condition which can have a significant impact on quality of life. It occurs as a component of several common and rare diseases or can be idiopathic and can present with various symptoms.Aims and Objectives: This study is aimed at evaluating the effectiveness and safety of the fixed dose combination of vitamin B1, B6 and B12in mild to moderate peripheral neuropathy of various etiologies in the Indonesian population.Materials and Methods: This was a prospective, open label, multi-center, single arm observational study (Indonesian Clinical Trial Registry No: INA-KPA0DYA). A total of 411 subjects with mild to moderate peripheral neuropathy of various etiologies, who met the eligibility criteria, were included in the study. A subject was considered to have “completed” the study if the study procedures, up to Visit 3 (one month of treatment) were accomplished. Procedural results and 12-week clinical outcomes are reported.Results: Treatment with combination of vitamin B1, B6 and B12 in subjects with symptoms of PN showed significant improvement in overall Total Symptom Score (TSS), within 14 days. The treatment also successfully reduced individual components of TSS from baseline to Visit 5. A significant percentage reduction was also observed for all the Visual Analogue Scale (VAS) parameters at the end of 12 weeks, while the Quality of Life (QoL) scores increased from baseline to the end of treatment.Conclusions: The fixed dose combination of vitamin B1, B6 and B12 was effective and welltolerated in subjects with mild to moderate peripheral neuropathy, of various etiologies.Asian Journal of Medical Sciences Vol.9(1) 2018 32-40

 Introduction: Wound care has also developed rapidly after the dissemination of the concept of TIME (Tissue, Infection, Moisture, and Wound Edge) in modern dressing (MD). The aim of this study was to compare modern dressings (MDs) and classic dressings (CDs) in terms of patient comfort, cost effectiveness and wound healing.Methods: A prospective study design with total of 25 participants. The sampling technique used was consecutive sampling. Patient comfort was assessed through the frequency of wound care and pain scale using the Visual Analogue Scale (VAS). Cost-effectiveness was assessed using direct and indirect costs. Wound healing was assessed using the Bates-Jensen Wound Assessment Tool (BWAT) score. The data was analyzed using the independent t and Mann-Whitney tests.Results: In terms of comfort, the mean for the number of times that wound care was performed and the pain scale in the participants using MD was (3.07 ± 0.88 times and VAS 4.59  ± 0.72, respectively), which is less compared to using CD (4.60  ±  1.84 times each and VAS 5.43  ± 0.75). Referring to the indirect and direct costs, MD (13.67  ± 6.09 and 527.63  ± 84.47, respectively) has the same cost-effectiveness as CD (14.00  ± 7.64 and 482.68 ± 98.08, respectively). In terms of healing, the mean of the BWAT score in MD (31.26  ± 1.69) was better compared to CD (33.07  ± 1.65).Conclusion: The application of MD has the same cost-effectiveness as CD with a more satisfactory outcome for the wounds in terms of comfort and healing.

Peripheral neuropathy (PN) is the most common disorder of the peripheral nervous system in adults, and its prevalence increases with age. Because PN is often poorly documented and strongly underdiagnosed, estimating its prevalence in the general population is difficult. Only few epidemiological studies on the prevalence of PN in the general population are available, mostly from industrialized countries. Especially in developing countries, figures from different sources vary considerably. Available data often focus on certain etiological subgroups-particularly diabetics-or on neuropathic pain (NeP), which contributes to this variation. More epidemiological prevalence studies from the general population are required to gain a better picture on sizes of patient groups and cause patterns. To provide an overview of current prevalence data, we performed a selective literature search in PubMed, Cochrane and Google Scholar and used relevant examples along with comprehensive reviews covering the past 15+ years identified through the use of the authors' own files. These data indicate that PN is frequent and often undiagnosed for a long time.Although diabetes is the number one cause of PN worldwide, there are various causes beyond, making it hard for physicians to gain a clear patient picture and recognize symptoms. Most clinical studies also focus on diabetic PN treatment only; thus, data comparing the treatment of PN of several etiologies are rare, which contributes to the lack of awareness of PN causes. In order to demonstrate that different PN subgroups can benefit from treatment with B vitamins progressively over time-regardless of underlying PN causes, we also present some subgroup results of a recent non-interventional study (Neurobion non-interventional; NENOIN) herein. The NENOIN study showed that treating PN of different etiologies including idiopathic neuropathy is possible with a fixed dose of neurotropic B vitamins. Therefore, we conclude that this is an effective treatment option for different PN subgroups from which even patients with unknown PN causes can benefit.

Barré and Strohl in 1916. Although GBS has a good prognosis (5% mortality rate), about 10% of patients experience serious disability one year after the start of neurological onset. Recent research of GBS shows that the process involves a number of subtypes with different immunological mechanism and a spectrum of clinical syndrome of acute inflammatory neuropathy. Antibodies against peripheral nerve gangliosides and their own complements are recognized as an important mechanism of nerve damage in GBS. Pharmacokinetics of intravenous immunoglobulin (IVIg) therapy and other related factors that influence prognosis has been researched. In order to investigate the possible role of complement inhibition in GBS management, new studies will be conducted. The management of GBS should be provided in appropriate hospital units, with specialist teams, intensive care and rehabilitation facilities as essential parts. This article aims to provide updated management of GBS.Citation: Imelda NC, Baktir F, Fidiana, Hidayati HB, Basuki M. Updates in the management of Guillain Barre Syndrome. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S54-S57

Pendahuluan: Spastisitas adalah gangguan motorik yang sering dijumpai dan muncul setelah stroke. Spastisitas dapat menyebabkan nyeri dan disabililitas pada bagian tubuh yang mengalaminya. Tujuan: mencari hubungan antara rasio H/M yang diukur dengan elektromiografi dengan derajad spastisitas yang terjadi setelah fase akut stroke. Metode: Penelitian ini adalah studi analisis korelatif observasional, dengan 26 sampel. Pasien diukur rasio H/M pada saat stroke akut dan diukur derajad spastisitasnya dengan menggunakan Modified Ashworth Scale setelah 3 bulan. Hasil yang didapatkan dilakukan analisa statistik dengan menggunakan tes korelatif kategorik dari Spearman. Hasil: Pasien yang mengikuti penelitian ini sebanyak 26 orang. Terdapat perbedaaan antara nilai H/M rasio antara sisi parese dengan sisi sehat dan tidak didapatkan hubungan yang bermakna antara nilai rasio H/M yang diukur saat fase akut stroke dengan derajad spastisitas yang diukur dengan Modified Ashworth Scale (MAS) setelah 3 bulan (p = 0,06 ; r = 0, 37). Kesimpulan: Rasio H/M pada pasien stroke akut meningkat pada sisi parese dibanding pada sisi sehat, namun peningkatan ini tidak memiliki hubungan yang signifikan dengan derajad spastisitas pasca stroke yang diukur dengan MAS, sehingga rasio H/M tidak dapat digunakan sebagai prediktor munculnya spastisitas pasca stroke

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Highlight:1. Patients with myasthenia gravis (MG) can have both autoimmune and non-autoimmune comorbidities.2. MG patients were predominantly aged >50 years, females and the commonest comorbidity are hypertension and diabetes mellitus.3. Age and comorbidities were found to have significant correlation among these patients, but not between gender and comorbidities.Abstract:Background:  There are limited studies on the comorbidities of myasthenic crisis (MC) associated with age and gender, specifically from Indonesia. These data might be valuable for treatment to improve the outcome of these patients. Objective: To analyze the correlation between age and gender with the comorbidities amongst the MC patients admitted in the ICU of Dr. Soetomo General Academic Hospital, Surabaya, Indonesia in 2017-2019. Materials and methods:  A retrospective cross-sectional analytic study was conducted on 25 medical records of MC patients who fulfilled the inclusion and exclusion study criteria. Descriptive statistics and Chi-square tests were done to determine the potential correlation between variables (significant level of p<0.05). Results: The age of MC patients was £50 years (80%) and >50 years (20%) while the gender predominantly found were females (68%) with 32% males. A significant correlation was found between age and comorbidities (p=0.002) whilst not between gender and comorbidities (p=0.115). The most common comorbidities observed were hypertension (30%) and diabetes mellitus (20%). Conclusion: There were 40% of patients found with comorbidities. There was a significant association between age and comorbidities found amongst myasthenic crisis patients, whilst no significant association was found between gender and comorbidities.

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