Background: Coronavirus disease-19 (COVID-19) is an infectious disease with high morbidity and mortality rates. Indonesia had reported a 2.8% of mortality rate up to June 2021. A strategy to control the virus spreading is by vaccination. The Indonesian Food and Drug Monitoring Agency had approved the use of CoronaVac, an inactivated virus vaccine developed by Sinovac. Most adverse events following immunization (AEFI) for CoronaVac are mild, and the most common symptoms are injection-site pain, headache, and fatigue. Neurovascular adverse events, including thrombosis or ischaemic stroke after receiving CoronaVac have not previously been reported. Correspondingly, we reported three patients with an Acute Ischaemic Stroke (AIS) after the administration of CoronaVac in our hospital.
ObjectiveEvaluating the TBI incidence during the COVID-19 pandemic era compared with similar period in previous year.BackgroundThe emergence of SARS-CoV2 influenced the evolution of governmental and hospital policy worldwide, which might eventually impact many aspects. The incidence of many diseases in the Emergency Department (ED), especially traumatic brain injury (TBI), has been an area of interest.Design/MethodsRetrospective study comparing TBI incidence before and during COVID-19 pandemic era starting from the declaration of national pandemic date (March 16, 2020) until June 14, 2020 with the comparison of the same period in the previous year.ResultsThere was an increase in admission rate due to TBI during COVID-19 pandemic compared with the previous year (157/752 (20.9%) vs 106/766 (13.8%), p < 0.001, respectively). While the range of age was similar between COVID-19 and non-COVID-19 era (37.9 ± 14.8 vs 38.6 ± 15.4 years, p = 0.712), male was higher in percentage to experience the injury (131/157 (83.4%) vs 67/106 (63.2%), p < 0.001). During the pandemic era, road traffic injury (97/157 (61.8%) vs 56/106 (52.8%), p = 0.149) as well as moderate-to-severe brain injury tended to increase (30/157 (19.1%) vs 17/106 (16.0%) p = 0.524) albeit statistically insignificant. Although the mortality rate was similar (12/157 (7.6%) vs 9/106 (8.5%), p = 0.804), higher hospitalization rate was observed in the pandemic era (81/157 (51.2%) vs 37/106 (34.9%) p = 0.008).ConclusionsTBI incidence remained increasing despite entering the COVID-19 era. These phenomena required further investigation and analysis that may possibly be unrelated with the COVID-19, but due to the change of the government policy and its impact, such as the more quiet road after national social distancing.
Background COVID-19 increases the risk of acute ischemic stroke. The objective of this study is to identify the risk factors, comorbidities, and outcomes in COVID-19 patients with acute ischemic stroke at University of Indonesia Hospital. Results The clinical condition of COVID-19 patients with ischemic stroke is more severe for patients older than 55 years (p < 0.05), patients at the critical COVID-19 clinical stage, and patients with atrial fibrillation (p < 0.05). The level of C-reactive protein (CRP) more than 60 mg/L correlated with the outcome of the patient as well. Conclusion The study concluded that, age, COVID-19 clinical degree, and atrial fibrillation significantly affect the outcome in COVID-19 patients with stroke.
Cedera atau trauma medula spinalis merupakan salah satu jenis cedera yang sering ditemui dan dapat berakibat fatal. Secara klinis, cedera medula spinalis dapat dinilai dengan pemeriksaan fisis terstandar dari International Standards for Neurological and Functional Classification of Spinal Cord Injury Patients yaitu panduan American Spinal Injury Association (ASIA) impairment scale atau biasa disebut AIS. Hasil pemeriksaan dari skor AIS yang dihubungkan dengan pemeriksaan MRI untuk menegakkan diagnosis dan menetukan prognosis pasien. Pada kasus ini akan dilaporkan pasien laki-laki usia 20 tahun datang ke IGD rumah sakit dengan keluhan kelemahan keempat anggota gerak setelah mengalami kecelakaan lalu lintas saat sedang mengendarai sepeda motor. Pada pemeriksaan neurologis pasien masih dapat merasakan sedikit sentuhan namun tidak menggerakkan keempat ekstremitas sama sekali. Pemeriksaan X-ray servikal menunjukkan adanya fraktur dislokasi setinggi C5. Pemeriksaan MRI menunjukkan fraktur dislokasi setinggi C5 disertai edema dan perdarahan medula spinalis. Temuan edema dan perdarahan medula spinalis pada pemeriksaan MRI bermanfaat dalam proses diagnosis serta menentukan prognosis pasien dengan cedera medula spinalis akut. Kata kunci: Cedera medula spinalis, MRI, skor AIS
HYPEROSMOLAR THERAPY FOR CEREBRAL EDEMA POST TRAUMATIC BRAIN INJURY: AN EVIDENCE-BASED CASE REPORTABSTRACTMannitol is an agent widely used to treat hyperosmolarity in cases of increased intracranial pressure after acute traumatic brain injury (TBI). Hypertonic saline is an alternative agent in such cases but is still not well-recognized in daily practice. Thus, a literature searching was conducted to see whether mannitol is more effective and safer than hypertonic saline in reducing intracranial pressure in patients with cerebral edema post TBI. The results of literature searching using PubMed, Google Scholar, and Cochrane Database of Systematic Review showed that there is no clear evidence suggesting mannitol is better than hypertonic saline, and vice versa. Therefore, hypertonic saline should be considered as an alternative treatment for hyperosmolarity besides mannitol.Keywords: Cerebral edema, hyperosmolar therapy, hypertonic saline, mannitol, traumatic brain injuryABSTRAKManitol sebagai agen terapi hiperosmolar untuk menurunkan tekanan intrakranial (TIK) pascacedera kepala telah digunakan secara luas. Sementara pilihan lainnya, yaitu larutan salin hipertonik, masih jarang diaplikasikan pada praktik sehari-hari. Oleh karena itu, dilakukan pencarian literatur untuk menilai efektivitas dan keamanan manitol dibandingkan larutan salin hipertonik dalam menurunkan tekanan intrakranial berdasarkan kasus pasien yang mengalami edema serebri pascacedera kepala. Hasil pencarian di PubMed, Google Scholar, dan Cochrane Database of Systematic Review menunjukkan belum ada bukti ilmiah yang secara tegas menyimpulkan manitol lebih efektif dan aman daripada larutan salin hipertonik maupun sebaliknya. Oleh karena itu, larutan salin hipertonik dapat dijadikan alternatif terapi hiperosmolar selain manitol.Kata kunci: Cedera kepala, edema serebri, manitol, salin hipertonik, terapi hiperosmolar
Edisi kali ini ditandai dengan artikel menarik mengenaik cedera otak traumatik. Kecelakaan lalu lintas masih menjadi penyebab utama cedera otak traumatik di negara berkembang seperti Indonesia. Hal ini berbeda dengan negara-negara maju yang menunjukkan bahwa peristiwa jatuh (fall) menduduki peringkat pertama penyebab cedera otak traumatik. Fakta tersebut juga didukung dengan penggunaan obat-obat antikoagulan, terutama oleh pasine lanjut usia. Berbeda halnya dengan di Indonesia, yang sebagian besar pasien cedera otak traumatik merupakan laki-laki usia produktif. Akibatnya, selain disabilitas yang bisa terjadi, terdapat dampak sosial ekonomi yang serius. Pasien tersebut menjadi kesulitan bekerja dan mencari nafkah untuk dirinya dan keluarganya. Secara definisi, segala jenis gangguan fungsional atau struktural di otak akibat proses trauma berupa energi dari luar tubuh termasuk dalam cedera otak traumatik. Hal ini menekankan bahwa terminologi cedera kepala sudah kurang tepat lagi digunakan dalam praktik sehari-hari karena fokus dari masalahnya adalah otak secara spesifik, bukan kepala. Dengan demikian, penilaian klinis pada pasien cedera otak traumatik tidak hanya sebatas abnormalitas pada radiologi, tetapi jauh yang lebih penting juga pada fungsi otaknya. Pada beberapa kasus, hasil CT scan tidak menunjukkan lesi struktural yang bermakna, tetapi pasiennya mengalami nyeri kepala kronik, sulit berkonsentrasi, mudah lelah, atau gangguan mood. Hal lain yang menarik dari cedera otak traumatik adalah mekanisme trauma yang dialami oleh pasien dan hubungannya dengan gangguan yang didapat. Hal ini yang disebut sebagai biomekanisme penting untuk diketahui oleh para klinisi yang merawat pasien karena seringkali data anamnesis dari pasien atau orang lain tidak selalu akurat. Lebih jauh daripada itu, bisa jadi ada kepentingan tertentu dari dari pihak pasien atau lainnya untuk memanipulasi mekanisme trauma. Oleh sebab itu, dengan menguasai pengetahuan ini, dan didukung kemampuan klinis yang adekuat, klinisi bisa mengambil langkah bila terdapat ketidaksesuaian antara mekanisme trauma dengan cedera yang didapat.
Edisi ini merupakan edisi perdana yang sepenuhnya melalui format sistem Open Jurnal System (OJS). Hal ini diperlukan untuk keperluan akreditasi jurnal. Semoga semua pihak yang terlibat dalam jurnal ini bisa beradaptasi dengan sistem baru ini. Beberapa artikel menarik terdapat dalam edisi kali ini. Salah satunya adalah mengenai chorea pada pasien diabetes mellitus (DM) tipe 2 yang mengalami komplikasi hiperglikemia hiperosmolar nonketotik. Pendekatan klinis yang seksama, termasuk menyingkirkan adanya penyebab struktural di otak yang bisa menyebabkan chorea, menjadi hal yang penting untuk dilakukan. Selain itu, terdapat laporan kasus juga mengenai perubahan status mental pasien yang dirawat awalnya dengan Covid-19. Fenomena ini memang tidak jarang bisa ditemukan pada pasien perawatan di ruang isolasi. Seperti halnya artikel chorea, pada kasus ini juga perlu langkah untuk mengeksklusi kemungkinan etiologi infeksi lain, di samping virus SARS-CoV-2, yang menyebabkan perubahan status mental pasien, misalnya dengan melakukan analisis cairan otak. Kedua artikel tentang komplikasi DM tipe 2 dan Covid-19 menunjukkan bahwa terdapat hubungan antara kondisi sistem lain di tubuh kita, dalam hal ini sistem endokrin, respirasi, dan infeksi, dengan manifestasi neurologis. Hal sebaliknya juga bisa terjadi, bahwa lesi struktural di otak bisa berdampak pada sistem lain. Misalnya, pasien perdarahan subaraknoid bisa mengakibatkan kelainan pada elektrokardiografi (EKG) dan keluhan sesak akibat edema paru neurogenik. Dengan demikian, pemahaman mengenai interaksi otak dengan sistem lain di tubuh kita adalah hal yang penting dikuasai.
Introduction: Awake craniotomy in pediatric group is challenging. Its success depends on maintaining a good rapport with the child, careful titration of anesthetic agents, and managing intraoperative challenges.Methodology/Description: An awake craniotomy with neurophysiological monitoring was planned for this 10-year-old girl with lesion at the right motor cortex. After adequate counseling, she was acquainted to the environment with repeated visits to the perioperative suite. She was also familiarized with the motor function testing during surgery. Under standard monitoring, propofol infusion at 100 to 150 μg/kg/min and fentanyl infusion at 0.5 μg/kg/h were initiated after a bolus dose of 15 μg of fentanyl. A 22-gauge cannula was inserted in the right radial artery for blood pressure monitoring. Scalp block was performed with mixture of 2% lignocaine with adrenaline and 0.5% ropivacaine (7 mL each). Sedation was continued during painful procedures like pin fixation, insertion of needle electrodes, and all steps of craniotomy. Throughout the procedure oxygen was given through nasal prongs and her respiration was monitored with the chest leads used for ECG. Propofol infusion was stopped after exposure of duramater. She was comfortable throughout the procedure and co-operated for motor assessment of limbs. Careful titration of sedatives helped in electrophysiological assessment like cortical and subcortical mapping and ECoG. Propofol infusion was restarted after dural closure. No significant complications occurred and the patient recovered without any motor deficits.Conclusion: Our case report illustrates that with proper planning and careful titration of anesthetics, awake craniotomy along with intraoperative neurophysiological monitoring is safe and feasible in pediatric age group. Introduction: Patients with an acute increase in intracranial pressure (ICP) due to cerebrovascular accident (CVA) or traumatic brain injury (TBI) undergo decompressive craniectomy. The surviving patients then undergo cranioplasty procedure in future for rehabilitation by having a positive effect on the cerebrospinal fluid (CSF) dynamics. A high rate of perioperative complications is associated with this procedure. We conducted a retrospective analysis of the cranioplasty surgeries which took place in our center. KeywordsMethodology/Description: After taking permission from the Institute Review Board, data was collected from the Anesthesia and Neurosurgery registers from June 2016 to June 2017. A retrospective analysis was performed.Results: The overall complication rate found was 6.6%. Cranioplasties were done post craniectomies for TBI in 60% of cases and post-CVA in 40% of cases. Sixty-six percent of cranioplasties were with acrylic, 20% with autologous bone, and 13.3% with titanium plates. The only complication encountered intraoperatively was seizure in one patient. No deaths were noted. One patient developed deterioration in the Glasgow Coma Scale on the third postoperative day and had to undergo removal of the acrylic bone. The...
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