Although HIV is still uncommon in the general population in Indonesia, its prevalence among adult meningitis cases already seems high. Mycobacterium tuberculosis and Cryptococcus neoformans are the main causes of meningitis in this setting, and mortality is very high, especially in HIV-infected patients. Our data suggest that adult meningitis cases in Indonesia should be screened routinely for HIV infection. Further studies are needed to address the high mortality.

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

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.

Background: Low back pain is discomfort presented below the margin of the 12th thoracic rib and above the inferior gluteal fold with or without leg pain. It is also a major cause of disability. Several risk factors have been identified for contributing low back pain. It is important to determine whether body mass index (BMI) can affect the disability in patients with chronic low back pain. Oswestry disability index (ODI) questionnaire has been used to measure the severity of disability. Thus, the focus of study was to determine correlation between BMI and disability in patients with chronic low back pain. Methods: Sixty two patients aged 18 years old or more who were clinically diagnosed as having low back pain at least 3 months participated in this study in the period of October to November 2015 in the Department of Physical Medicine and Rehabilitation of Dr. Hasan Sadikin General Hospital Bandung. Total sampling method was used. Gender, age, weight, height, BMI and disability were recorded using ODI questionnaire. This analytical study was cross sectional study and the ordinal variable was analyzed using linear regression analysis. Results: Females had higher proportion (77). Chronic low back pain patients were equally distributed on normal weight and overweight categories. Patient with chronic low back pain had higher chances of developing moderate disability. There were positive correlation between BMI and disability. Nevertheless, there was no statistically analysis difference between model 1 and 2. Conclusions: The BMI affects the disability in patients with chronic low back pain. [AMJ.2016;3(4):624-8]

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AbstrakPada stroke iskemik terjadi kerusakan neuronal serta penurunan glikolisis aerob akibat menurunnya kadar glukosa. Neuron specific enolase (NSE) yang terdapat pada jaringan neuronal banyak tidak terpakai sehingga kadarnya meningkat. Pada kerusakan neuronal serta gangguan membran sel, sawar darah otak terganggu sehingga NSE berdifusi kedalam ekstraselular dan cairan serebrospinal. Peningkatan kadar NSE serum juga berhubungan dengan volume infark dan luasnya kerusakan otak. Penelitian ini bertujuan untuk mengetahui peningkatan kadar NSE pasien stroke infark aterotrombotik akut, serta korelasinya dengan derajat keparahan stroke dan luaran fungsional. Rancangan penelitian adalah observational analytic dengan pendekatan kohort. Pasien stroke infark aterotrombotik fase akut sebagai kasus, sedangkan kontrolnya orang sehat. Penelitian dilakukan di Rumah Sakit Dr. Hasan Sadikin Bandung, mulai Februari sampai Agustus 2008. Pemeriksaan kadar NSE serum dan penilaian tingkat keparahan stroke berdasarkan National Institutes of Health Stroke Scale (NIHSS) dilakukan saat masuk rumah sakit, sedangkan luarannya dinilai pada hari ketujuh dengan indeks Barthel. Analisis yang digunakan adalah analisis bivariat dengan uji statistik Mann-Whitney dan uji Pearson. Dari 43 kasus dan 43 kontrol, didapatkan perbedaan kadar NSE serum yang bermakna rata-rata=11,41 [5,07] ng/mL berbanding 8,93 [3,03] ng/mL (p=0,019). Terdapat korelasi yang bermakna peningkatan kadar NSE serum dengan derajat keparahan yang dinilai berdasarkan skala NIHSS (p= 0,024), juga dengan luaran fungsional (p=0,012). Nilai akurasi paling tinggi terdapat pada kadar NSE serum 12 ng/mL, dengan sensitivitas 42% dan spesifisitas 84%. Kesimpulan dari penelitian ini adalah kadar NSE serum berkolerasi dengan derajat keparahan serta keluaran fungsional penderita stroke infark. [MKB. 2010;42(2):62-8]. Kata kunci: Kadar neuron specific enolase,stroke infark, NIHSS, Indeks Barthel Correlation of Serum Neuron Specific Enolase with Severity and Functional Outcome in Acute Atherothrombotic Infarction Stroke Patients AbstractNeuronal damage and decreasing aerobic glicolysis process in ischaemic stroke are caused by lowering level of blood glucose. The amount of neuronal intrasitoplasmic glicolytic enolase enzyme, also known as neuron specific enolase, increases in blood circulation because it is not used anymore in damage neuron. So the mechanism failure in blood-brain barrier, as result of neuronal and cell membrane damage, causes NSE diffusion to extracellular and cerebrospinal fluid, then NSE level increases in blood serum and cerebrospinal fluid in acute cerebral infarction. Elevating NSE level is also connected with infarct volume and the extent of brain damage. The aim of this study was to evaluate connection between upgrading NSE serum level in acute atherothrombotic-stroke infarction patients, level of stroke incompatibility, and functional outcome. The method of study was observational analytic with kohort study. Subjects of study were divided into case group consisted of ...

Background and objective: The Clinical GBS Severity Evaluation Scale (CGSES) was developed to determine immunotherapy of GBS patients more objectively. GBS Disability Scale (SDSGB) describes severity of GBS and assesses effectiveness of immunotherapy. Purpose of this study was to measure difference of CGSES and GBSDS in GBS patients with and without immunotherapy and to compare the suitability of subjective decisions with CGSES. Subject and Methods: This is a comparative cross-sectional analytic observational study retrospectively in GBS patients from January 2015-March 2020 hospitalized at Dr Hasan Sadikin Hospital, Bandung. Results: There were 92 subjects (35 with and 57 without immunotherapy). Mean age was 41.5 years, and male:female ratio was 57.6%:42.4%. There were no differences in demographics and physical examination between two groups, except for cranial nerve paresis (62.9% vs. 33.3%; p=0.006). There was a difference in mean length of stay with and without immunotherapy (29.5 ± 34.4 vs. 11.4 ± 4.1 days, p=0.0001). Results of the CGSES assessment with and without immunotherapy had a significant difference (p=0.035). There were significant differences in GBSDS at admission and discharge with (p=0.007) and without immunotherapy (p=0.025). There was a discrepancy between subjective decisions and CGSES value (Kappa value 0.117; 95% CI 0.021-0.213). Conclusion: There were differences in CGSES and GBSDS in group of GBS patients with and without immunotherapy. There was a discrepancy between subjective assessment of decision to give immunotherapy with CGSES scoring.

CORRELATION ANALYSIS OF TOTAL SYMPTOM SCORE, PAIN, AND QUALITY OF LIFE POST HIGH DOSE VITAMIN B1, B6, DAN B12 TREATMENT IN PERIPHERAL NEUROPATHYABSTRACTIntroduction: Peripheral neuropathy (PN) is a clinical condition in which nerves of the peripheral nervous system are damaged and is associated with various symptoms affecting the patients’ quality of life (QoL).Aims: To understand the  effect of Vitamin B1, B6, and B12 combination in mild to moderate PN.Methods: This is a prospective, open label, multicenter, single arm observational study involved 399 subjects with PN of different etiology. Subjects received the vitamin B1, B6, and B12 combination tablet orally once daily and were observed for 3 months. Total symptom score (TSS), visual analog score (VAS) and QoL were assessed, and the correlation between these parameters was analyzed.Results: Clinically significant reductions were observed from baseline to subsequent visits for TSS and VAS. Positive correlation  was observed between TSS and components of VAS. The study treatment was associated with a significant improvement in QoL parameters. Inverse correlation was observed between QoL and TSS as well as QoL and components of VAS. The study treatment was found to be well tolerated.Discussion: The correlation  analysis between different outcome measures demonstrated the beneficial effect of combination of vitamin B1, B6, and B12 in relief from symptoms and improvement in QoL of PN.Keyword: Correlation analysis, peripheral neuropathy, SF-8, TSS, VAS, vitamin B1, B6, and B12ABSTRAKPendahuluan: Neuropati perifer (NP) merupakan kondisi klinis akibat kerusakan pada sistem saraf tepi yang memengaruhi kualitas hidup (quality of life/QoL) pasien.Tujuan: Mengetahui efek pemberian kombinasi vitamin B1, B6, and B12 pada NP ringan hingga sedang.Metode: Penelitian observasional dan prospektif secara open label, multisenter, dan single arm, yang melibatkan 399 subjek penderita neuropati perifer dengan etiologi yang berbeda-beda. Subjek mengonsumsi tablet kombinasi vitamin B1, B6, and B12 secara oral satu kali sehari dan diamati selama 3 bulan. Dilakukan penilaian skor gejala total (total symptom score/TSS), visual analog scale (VAS), dan QoL, serta korelasi antara parameter-parameter tersebut.Hasil: Terdapat penurunan TSS dan VAS yang bermakna secara klinis antara baseline (awal) dengan kunjungan berikutnya. Terdapat korelasi yang positif antara TSS dengan komponen-komponen VAS. Pemberian perlakuan dalam penelitian berkorelasi secara bermakna dengan perbaikan parameter dalam QoL. Teramati juga adanya hubungan terbalik antara QoL dengan TSS serta QoL dan komponen VAS. Pengobatan pada penelitian ini juga terbukti dapat ditoleransi dengan baik.Diskusi: Analisis korelasi antara berbagai macam metode pengukuran yang berbeda menunjukkan manfaat dari pemberian kombinasi vitamin B1, B6, and B12 dalam mengurangi gejala dan perbaikan QoL pada pasien PN.Kata kunci: Analisis korelasi, neuropati perifer, kualitas hidup, SF-8, TSS, VAS, vitamin B1, B6, and B12