Sleep problems are commonly found in stroke patients. The risk for stroke is higher in patients with sleep disorders. Sleep-awake disorders prevalence is 20-40% among stroke patients. Sleep quality could influence the level of severity of stroke. In Indonesia, there is limited publication about the influence of sleep quality to the severity of acute stroke. This study aimed to obtain the relationship between sleep quality before stroke and the severity of acute stroke. This was a cross-sectional study. All stroke patients treated in Neurological wards were selected with inclusion and exclusion criteria. Sleep quality was measured with Pittsburgh Sleep Quality Index (PSQI). Levels of severity of acute stroke were determined with NIHSS score. Univariate data were descriptively analysed. Bivariat data were conducted to compare sleep quality (good/poor) and level of severity (mild/moderate/severe). Chi square test was applied with a p<0.05 of significancy level. The results showed that of 102 patients, the average age was 59.4 year (SD 11.6), age range was 28-87 years old. Male patients were 55% of all cases. The average of GCS score was 13.31 (SD 2.6). Based on PSQI criteria, we found 21.8% of patients with good sleep quality and 78.2% with poor sleep quality. Based on NIHSS score we found 25.5% of patients with mild, 58.8% with moderate, and 15.7% with severe disability. The chi-square test showed a p value 0.762 (>0.05). Conclusion: There was no significant relationship between sleep quality and the severity of acute stroke.Keywords: sleep quality, NIHSS, acute strokeAbstrak: Stroke merupakan masalah besar bagi kesehatan masyarakat. Risiko terkena stroke lebih besar terjadi pada pasien dengan gangguan tidur. Prevalensi gangguan tidur-bangun dilaporkan sebesar 20-40% pada pasien yang terkena stroke. Kualitas tidur memengaruhi keparahan dan prognosis stroke. Di Indonesia, masih sedikit data yang dipublikasi mengenai pengaruh kualitas tidur terhadap keparahan stroke akut. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas tidur sebelum stroke dengan tingkat keparahan stroke akut. Desain penelitian ini ialah potong lintang. Seluruh pasien yang dirawat di seluruh ruang Neurologi dijadikan subyek penelitian dengan kriteria inklusi dan eksklusi. Kualitas tidur diukur dengan Pittsburgh Sleep Quality Index (PSQI). Tingkat keparahan stroke akut dinilai dengan skor NIHSS. Metode statistik deskriptif dikerjakan pada data-data univariat. Analisis bivariat dilakukan untuk mendapatkan hubungan kualitas tidur (baik/buruk) dengan derajat defisit neurologi (ringan/sedang/berat). Digunakan uji Chi square dengan acuan signifikansi p<0.05. Hasil penelitian memperlihatkan rerata usia pasien 59,46 tahun (SD 11,6) dengan kisaran usia 28-87 tahun. Pasien laki-laki ditemukan sebesar 55%. Rerata GCS 13,31 (SD 2.6). Pada pengukuran kualitas tidur menurut kriteria PSQI didapatkan kualitas tidur baik sebesar 21,8% dan kualitas tidur buruk sebesar 78,2%. Berdasarkan derajat defisit neurologik menurut nilai NIHSS didapatkan defisit neurologik ringan sebesar 25,5%, sedang 58,8%, dan berat 15,.7%. Uji Chi-square menunjukkan nilai p 0,762 (>0.05). Simpulan: Tidak ditemukan hubungan bermakna antara kualitas tidur sebelum stroke dengan tingkat keparahan stroke akut.Kata kunci: kualitas tidur, NIHSS, stroke akut
Vaccination is considered as the most effective solution for the SARS-COV-2 pandemic problem. Therefore, an understanding of the effectiveness of vaccination is now very important, both to design a better response to SARS-CoV-2, as well as to provide education for prospective vaccination participants. This study was aimed to obtain the description of specific antibody in SARS-CoV2 vaccinated individuals. This was a cohort-design study. SARS-CoV-2 specific antibody was measured wiht the Electro Chemiluminescence Immunoassay (ECLIA) method. This study was carried out at Prof. Dr. R. D. Kandou Hospital with 28 subjects; all were examined three times with an interval of three weeks. The first antibody examination revealed antibody formation (IgG) with a range of 3.6-1825 AU/mL with a median of 418.3 AU/mL and a mean of 525.6 AU/mL. In the second and third examinations, the median antibody titer value in the elderly group was recorded at 482.9 AU/mL and 631.3 AU/mL respectively, which were higher than the group of non-elderly subjects who were recorded to have a median of 391.9 AU/mL in the second examination and 401.6 AU/mL in the third examination. In conclusion, vaccination causes specific immunity, and the effectiveness of vaccination for the formation of specific antibodies (IgG) in the elderly group is good, although it takes a longer time compared to the non-elderly group. Moreover, the antibody formed after 63 days from the first vaccination in the elderly group is higher than in the non-elderly group.Keywords: SARS-COV-2; antibody; vaccination Abstrak: Penanggulangan pandemi SARS-COV-2 yang dianggap paling efektif hingga saat ini ialah vaksinasi, yang dilengkapi dengan penerapan protokol kesehatan. Pemahaman tentang efektivitas vaksinasi saat ini menjadi amat penting, baik untuk merancang penanggulangan SARS-CoV-2 yang lebih baik, maupun untuk memberikan edukasi bagi calon peserta vaksinasi. Penelitian ini bertujuan untuk mendapatkan gambaran antibodi spesifik yang terbentuk pada penerima vaksinasi SARS-CoV2 menggunakan desain cohort. Pengukuran antibodi spesifik SARS-CoV-2 menggunakan metode Electro Chemiluminescence Immunoassay (ECLIA). Penelitian dilaksanakan di RSUP Prof. Dr. R. D Kandou dengan jumlah subjek 28 orang, masing-masing diperiksa tiga kali dengan jeda waktu tiga minggu. Pada pemeriksaan antibodi pertama ditemukan pembentukan antibodi (IgG) dengan range 3,6-1825 AU/mL dengan median 418,3 AU/mL dan rerata 525,6 AU/mL. Pada pemeriksaan kedua dan ketiga, nilai median titer antibodi pada kelompok lanjut usia, berturut-turut tercatat 482,9 AU/mL dan 631,3 AU/mL pada pemeriksaan ketiga, lebih tinggi dibanding dibanding kelompok subjek non lansia yang tercatat memiliki median 391,9 AU/mL pada pemeriksaan kedua dan 401,6 AU/mL pada pemeriksaan ketiga. Simpulan penelitian ini ialah vaksinasi menimbulkan imunitas spesifik, dan efektivitas vaksinasi untuk pembentukan antibodi spesifik (IgG) pada kelompok lanjut usia baik, walau membutuhkan waktu yang lebih panjang dibanding kelompok non lanjut usia. Antibodi yang terbentuk pasca vaksinasi 63 hari setelah pemberian vaksinasi pertama pada kelompok lanjut usia lebih tinggi dibanding kelompok non usia lanjut.Kata kunci: SARS-CoV-2; antibodi; vaksinasi
Background: Adherence to medication is an important component of successful epilepsy treatment. However, the disease’s long-term treatment makes it difficult to achieve good adherence. This study aimed to assess the adherence level of anti-epileptic drugs (AEDs) among adult epilepsy patients in Indonesia and its associated factors.Methods: We reviewed the medical records of epilepsy patients in a tertiary public hospital between September 2018 and August 2019. Subjects were patients who were electro-clinically diagnosed with any type of epilepsy, have been taken at least one AED for at least three months, have a record of Morisky medication adherence scale 8 items (MMAS-8) score, and aged 20 years old and above. The level of adherence was measured by the MMAS-8 Indonesian version.Results: We found 97 eligible subjects and the majority were males (56.7%), unemployed (69.1%), and aged ≥30 years old (55.7%). Most subjects (41.2%) showed a high adherence level. The remaining 30.9% and 27.8% had a moderate and low adherence level respectively.Conclusions: This study reveals that high AEDs adherence is associated with being male, younger than 30 years of age, received monotherapy instead of polytherapy, and no memory impairment. A further investigation related to the reason why these factors play roles in the Indonesian setting is important to design appropriate strategies to improve AEDs adherence of epilepsy patients.
Chronic pain is one of the clinical manifestations that is frequently reported in post-Covid-19 patients. This condition may be triggered by specific psychosocial or biological stressors in some organs previously affected by the infection. This study aimed to obtain the incidence of chronic pain in post-Covid-19 patients and its pathomechanisms. This was a literature review study using two databases, PubMed and Science Direct, with the modified Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) method for literature review. The results showed that there were 504 articles according to the keywords and 10 articles that matched the criteria. Chronic pain was experienced by 36.5%-62.5% of patients. Most literatures associated post-Covid-19 chronic pain with systemic tissue injury leading to increased production of proinflammatory cytokines and the presence of somatization due to psychosocial and emotional distress. Infections experienced by post-Covid-19 patients affected the sensitivity of nociceptors as recipients of pain stimuli and nerve hypersensitivity so that patients can experience chronic pain for a long time. In conclusion, the incidence of chronic pain in post-Covid-19 patients is high. Post-Covid-19 chronic pain with systemic tissue injury leads to increased production of proinflammatory cytokines and the presence of somatization due to psychosocial and emotional distress.Keywords: chronic pain; post-Covid-19; pathomechanism Abstrak: Nyeri kronis merupakan salah satu manifestasi klinis yang mulai banyak dilaporkan pada pasien post-Covid-19. Kondisi ini mungkin dipicu oleh stresor psikososial atau biologis spesifik pada beberapa organ yang sebelumnya terdampak infeksi. Penelitian ini bertujuan untuk mendapatkan angka kejadian nyeri kronis pada pasien post-Covid-19 dan patomekanisme melalui telaah literatur menggunakan dua pangkalan data yaitu PubMed dan Science Direct dengan metode Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) yang dimodifikasi untuk telaah literatur. Hasil penelitian mendapatkan 504 artikel sesuai kata kunci dan terdapat sepuluh artikel yang sesuai dengan tujuan penelitian. Nyeri kronis dialami oleh 36,5% - 62,5% pasien. Sebagian besar literatur menghubungkan nyeri kronis post-Covid-19 dengan jejas jaringan sistemik yang menyebabkan peningkatan produksi sitokin proinflamasi serta adanya somatisasi akibat distres psikososial dan emosional. Infeksi yang pernah dialami oleh pasien post-Covid-19 memengaruhi sensitivitas nosiseptor sebagai penerima rangsangan nyeri serta hipersensitivitas saraf sehingga pasien dapat mengalami nyeri kronis secara berkepanjangan. Simpulan penelitian ini ialah angka kejadian nyeri kronis pada pasien post-Covid-19 cukup tinggi. Nyeri kronis post-Covid-19 terjadi karena adanya jejas jaringan secara sistemik yang menimbulkan peningkatan produksi sitokin proinflamasi serta adanya somatisasi akibat distres psikososial dan emosional. Kajian lanjut dan berulang perlu dilakukan mengingat adanya dinamika perkembangan kasus infeksi maupun varian.Kata kunci: nyeri kronis; post-Covid-19; patomekanisme
Background: Pain is one of the global public health challenges. Pain is not only contributing to physical complaint but also mental and personality dimension as well as productivity issues. Severity of pain is affected by multiple factors, including biological, psychological, and social factors. The objective of the study was to analyse whether there is difference of severity level of pain among several demographical and clinical characteristics of patients with pain.Methods: A hospital-based observational study was conducted with cross-sectional design for six months period. Population of research were patients with pain as the chief complaint treated at the neurology outpatient clinic. Eligible sample were obtained through consecutive total sampling technique. The difference of severity of pain (mild/moderate/severe) and 6 characteristics of patients (age group, sex, number of morbidities, body area of pain, onset and working diagnosis) were analysed. Chi square statistical analysis with SPSS version 17.0 was employed with p value <0,05 were regarded as significant level.Results: Majority of patients were female (58.8%), in the 51-60 age group, at senior high school level and living in urban area. Almost half of the patients with pain have no history of comorbidity (45.9%), which relatively almost equal with patients with single comorbidity. Three mostly affected body areas were shoulder, wrist, and lower back. Majority of patients admitted with moderate level of pain. The onset of pain was mostly above 6 months before visiting the clinic. During the study period, the most frequently working diagnosis were carpal tunnel syndrome and osteoarthritis knee. In bivariate analysis, we found that among 6 demographical and clinical characteristics, body area of pain and working diagnosis have significant difference associated with severity of pain (p value<0.05).Conclusions: There is significant difference of severity of pain based on body area of pain and working diagnosis. We could not detect significant difference of severity of pain based on age group, sex, number of comorbidity and onset of pain.
Osteoarthritis (OA) is calcification of the joint associated with severe painful sensation caused by joint instability. This joint instability is affected by destruction of cartilage that protects the bones. Osteoarthritis can be caused by various factors such as age, genetic as well as vigorous exercise or activity. As the cartilage destruction progresses, the unprotected bone will rub on the other bone in the joint which can lead to osteoarthritis. Management of OA consists of a variety of treatments, such as pharmacological, non-pharmacological, non-pharmacotherapy, and surgery treatments. Due to the development of science and technology, various modalities have emerged that can support the treatment of OA inter alia prolotherapy. Prolotherapy or regenerative injection could influence the recovery of the destructed area directly and relief the painful sensation through the actions of inflammatory cells, macrophages, immune cells, and cytokines, therefore, the improvement of the destructed areas could occur faster. It was reported that knee osteoarthritis could be treated with prolotherapy successfully. In conclusion, since prolotherapy influences the body to repair the destructed areas, hence it could be used as the new osteoarthritis treatment, especially knee osteoarthritis.Keywords: prolotherapy, knee osteoarthritis, chronic pain Abstrak: Osteoartritis (OA) merupakan pengapuran sendi yang disertai nyeri hebat, disebabkan oleh karena adanya ketidakstabilan sendi yang dipengaruhi oleh rusaknya tulang rawan yang berperan untuk melindungi tulang. Osteoartritis dapat disebabkan oleh berbagai faktor seperti usia, jenis kelamin, genetik, aktivitas maupun olahraga berat. Saat tulang rawan rusak, maka tulang yang tidak dilindungi dapat saling bersinggungan di sendi sehingga sendi hancur dan berujung pada OA. Pengobatan untuk OA terdiri dari beragam pengobatan baik farmakologi, non-farmakologi, non-farmakoterapi, maupun tindakan operasi. Seiring berjalannya perkembangan ilmu pengetahuan dan teknologi, maka muncul berbagai modalitas yang dapat menunjang pengobatan OA, antara lain proloterapi. Proloterapi atau injeksi regeneratif memengaruhi dan memberi dampak penyembuhan secara langsung pada area yang mengalami cedera maupun nyeri melalui kerja sel-sel radang, makrofag, sel-sel imun, dan sitokin sehingga dapat bekerja lebih cepat untuk perbaikan daerah yang cedera. Telah dilaporkan hasil bermakna dalam peng-gunaan proloterapi pada osteoartritis lutut. Simpulan penelitian ini ialah proloterapi merangsang tubuh untuk memperbaiki daerah yang cedera sehingga merupakan solusi terbaik yang dibutuhkan dalam pengobatan OA dewasa ini terutama pada OA lutut.Kata kunci: proloterapi, osteoartritis lutut, nyeri kronik
Background: Stroke is one of the major public health problem worldwide. Data from several hospital in Indonesia showed that stroke is the leading cause of mortality among adults in Indonesia. Stroke patients experience diminishing quality of life. This study aimed to determine the effect of ageing on weakening social cohesion among stroke patients in Manado. Subjects and Method: This was an analytic observational study with cross sectional design. This study was conducted in Manado, North Sulawesi. A sample of 42 ischemic stroke patients were selected for this study from several hospitals in Manado by stratified random sampling. The dependent variable was social cohesion. The independent variable was age. The sample patients were divided into 2 age groups: <60 years old (non-geriatric patients) and ≥ 60 years old (geriatric patients). The data were collected by questionnaire. Data on stroke diagnosis was obtained from the medical record. The data were analyzed using Odd Ratio and Chi Square. Results: Mean (SD) age of stroke patients was 57.6 years (12.0 years). Proportion of geriatric stroke patients (aged ≥ 60 years old) was 38.1%. Female patients were 57.1%. Patients with ≥ high school attainment or higher were 42.9%. Patients belonging to Minahasa ethnic was 76.2%. The proportion of poor social cohesion was 37.5% among geriatric patients and 11.5% among non-geriatric patients. Ageing was associated with poorer social cohesion (OR= 4.60; 95% CI=0.95 to 22.16; p= 0.046). Conclusion: Ageing is associated with poorer social cohesion among ischemic stroke patients.
Lack of information and knowledge from the youth students about sexually transmitted disease (STD) can lead to increment to the numbers of the sexually transmitted disease among the youth. SMP Negeri I Talawaan is one of the schools located in North Minahasa. Presenting the education or information related to sexual issues si still considered toboo and trigger pros-cons among the society in the village of Talawaan, Kecamatan dimembe. Thus, the information about the education and the risk of sexually transmitted disease is necessary to improve he knowledge of the students about STD so that the students can prevent STD in early stage. This is a quasi-experiment with One Group Pretest Posstest approach that have been held in August 2019. The sample used was a total of 78 students at SMP Negeri I Talawaan 7 th grade and 8 th grade. Data collecting on this research by using questionnaire. Knowledge level about the STD before the socialization which categorized as good knowledge category is 21 respondents amounted to (26.92%), fair knowledge category is 49 respondents (62.82%), and less knowledge category is 8 respondents (10.25%). Whereas upon receiving the socialization, the knowledge level improved where number of respondent in good knowledge category is 69 respondents (88.46%), fair knowledge category is 9 respondents (11.53%), in other words respondent with less knowledge category is none.
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