Background. Amnestic Mild Cognitive Impairment (aMCI) often progresses to Alzheimer's disease. There are clinical markers and biomarkers to identify the degenerative process in the brain. Objectives. To obtain the diagnostic values of olfactory test, pupillary response to tropicamide 0.01%, BDNF plasma level, and APOE ε4 in diagnosing aMCI. Methods. Cross-sectional, comparative analysis. Results. There were 109 subjects enrolled (aMCI: 51, normal cognition: 58) with age 64 ± 5.54 years. For diagnosing aMCI, cut-off point for the olfactory score was <7 out of 10 and >22% for pupil dilatation response. Low BDNF plasma level was related significantly with olfactory deficits and aMCI (P < 0.05). Four of five subjects with homozygote e4 presented with multiple-domain aMCI. This group displayed the lowest means of olfactory score and the highest means of pupillary hypersensitivity response (P < 0.0001). Combination of olfactory deficit and pupillary hypersensitivity response in detection of aMCI was beneficial with Sp 91% and PPV 87%. In conjunction with clinical markers, BDNF plasma level and presence of APOE e4+ improved Sp and PPV. Conclusions. Combination of olfactory test and pupillary response test was useful as diagnostic tool in aMCI. In conjunction with clinical markers, low level of BDNF plasma and presence of APOE e4 improved the diagnostic value.

Lower limb neuropathic pain in HIV patients is a common manifestation of sensory neuropathy (HIV-SN), but can be seen in patients who do not meet standard definitions of HIV-SN. The drug stavudine is a risk factor for HIV-SN, but some patients treated without stavudine experience HIV-SN, and the prevalence and risk factors influencing neuropathic pain in this setting are unknown. A cross sectional study at Cipto Mangunkusumo Hospital Jakarta tested 197 HIV patients treated for >12 months without stavudine. HIV-SN was defined using the AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Test (ACTG-BPNST). A validated Indonesia translation of Douleur Neuropathique en 4 (DN4) questionnaire was used to assess lower limb neuropathic pain. Nerve conduction studies assessed large nerve fiber function and Stimulated Skin Wrinkle (SSW) tests were performed to assess small nerve fibers. The prevalence of neuropathic pain was 6.6%. BPNST + HIV-SN was diagnosed in 14.2% of the cohort and 38.5% of patients with pain. Use of protease inhibitors and ART duration <2 years associated with neuropathic pain in univariate (p=0.036, p=0.002, resp.) and multivariable analyses (model p<0.001). SSW tests were abnormal in 53.8% of subjects with neuropathic pain and only 25.5% without pain (p=0.05). Patients with pain without BPNST + HIV-SN had begun ART more recently than those with both diagnoses. Overall this preliminary study showed that neuropathic pain associated with protease inhibitors and a shorter duration of ART in Indonesian HIV patients, and may be an early symptom of small fiber neuropathy in this context.

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AbstrakTujuan Kadar plasminogen activator inhibitor-1 Hasil Kadar PAI-1 yang tinggi ditemukan lebih sering pada penderita stroke iskemik daripada subjek kontrol (21.1% vs. 7.9 % dengan OR 3.1;. Analisa terhadap semua subjek yang diteliti menunjukkan adanya hubungan negatif yang lemah namun bermakna antara kadar PAI-1 dengan usia (r = -0.4; P = 0.000). Kadar PAI-1 yang tinggi ditemukan lebih sering pada subjek berusia muda (40 -58 tahun) daripada subjek berusia lebih tua ( 60 -84 tahun) (20 vs. 9 .8 %) (P = 0.004). Kesimpulan Dari hasil penelitian pendahuluan ini diduga ada hubungan antara kadar PAI-1 dengan stroke iskemik pada usia muda. Penelitan lebih lanjut dengan jumlah subjek yang lebih besar diperlukan untuk memastikan keadaan ini. (Med J Indones 2010; 19:158-63) AbstractAim Recently, increased plasminogen activator inhibitor-1 (PAI-1) has been known a risk factor for ischemic heart disease. However, the association of increased PAI-1 level with ischemic stroke remains unclear. The aim of this study was to analyze the association of PAI-1 level with ischemic stroke.Methods By case control design we involved 38 ischemic stroke and 38 risky-matched control subjects who fulfilled the criteria. The PAI-1 level was determined by ELISA method using Asserachrom PAI-1 from Stago. ResultsHigh PAI-1 level was found more frequent in ischemic stroke subjects than in control subjects (21.1% vs. 7.9 % with OR 3.1; 95 % CI 0.757 -12.790). The analysis of all studied subjects showed that there was a weak negative correlation between PAI-1 level and age (r = -0.4; P = 0.000). High PAI-1 level was found more frequent in younger (40 -58 years old) than in the older subjects (60 -84 years old) (20% vs. 9.8 %) (p=0.004). ConclusionThe result of this preliminary study suggested an association between PAI-1 level and ischemic stroke in younger age. Further study with larger subjects is recommended to confirm this association. Stroke is the second most common cause of death in the world, with almost 5.1 million people died annually due to stroke. In an attempt for stroke prevention, stroke risk factors should be recognized and controlled.1 In the last decade several conditions associated with stroke Have revealed that plasminogen activator inhibitor-1 (PAI-1) was suspected to play a role in stroke incidence. 2Plasminogen activator inhibitor-1 is the main physiologic regulator in fibrinolytic system since it can inhibit the activity of plasminogen activator. Increased PAI-1 level results in decreased fibrinolytic activity and, therefore, increases the risk of thrombosis.2 It was reported that PAI-1 may influence the progression of atherosclerosis. Increased PAI-1 level causes atherosclerotic lesion susceptible to thrombotic complication. [3][4][5][6] Increased PAI-1 level has been found in some myocardial infarct cases. 7 The risk for myocardial infarction is 3.35 times higher in subjects with high level of PAI-1 compared to those with the normal level of PAI-1. 8 The properties of vasculature in the heart and brain are diff...

AbstrakLatar belakang: Terdapat kaitan antara stroke dengan protein S100B dan glial fibrillary acidic protein (GFAP) yang terlepas saat iskemia. (OR = 3,9; p < 0,001) . Nilai median kadar GFAP didapatkan lebih tinggi bermakna pada subyek yang masuk dengan NIHSS berat (nilai median 0,374 ng/mL) daripada yang masuk dengan NIHSS ringan (nilai median 0,047 ng/mL) dan sedang (nilai median 0,043 ng/mL) (p < 0,05). Kesimpulan: Kadar protein S100B semakin tinggi bermakna seiring dengan semakin beratnya NIHSS, sedangkan kadar GFAP yang tinggi bermakna baru didapatkan pada kasus dengan NIHSS AbstractBackground: S100B protein and glial fibrillary acidic protein (GFAP) released during ischemia have been associated with stroke. This study aimed to know whether there was a correlation between the concentration of these markers with the severity of neurological deficit in ischemic stroke.

Latar belakang: Implan koklea merupakan pilihan utama untuk habilitasi pendengaran dan berbicara pada anak tuli sensorineural berat bilateral. Pengaturan comfortable dan threshold level berdasarkan nilai evoked compound action potential (ECAP) direkam dengan neural responses imaging (NRI) saat pemetaan. Tujuan: Memperoleh nilai ECAP sebagai acuan pemetaan berdasarkan jarak elektroda intrakoklea ke modiolus, jarak terpanjang elektroda nomor satu dengan elektroda berhadapan, jarak marker dengan lubang kokleostomi dan faktor lainnya. Metode: Anak tuli sensorineural usia 2-10 tahun, menggunakan implan koklea dengan desain contour atau straight terdiri dari 16 elektroda, 120 channel sebagai subjek penelitian. Subjek penelitian sebanyak 46 telinga (39 anak), terpasang implankoklea diperoleh secara konsekutif dengan desain potong lintang. Perekaman ECAP elektroda 3-5, 8-10, 13-15 mewakili daerah apeks, medial dan basal. Hasil tomografi komputer resolusi tinggi koklea dengan program OsiriX dilakukan rekonstruksi 3D untuk menilai posisi dan jarak elektroda. Analisis data diawali dengan univariat dan uji korelasi Spearman ‘s pada bivariat. Kandidat faktor yang berperan disertakan pada regresi ganda untuk mendapatkan faktor determinan ECAP. Comfortable zone untuk populasi diperoleh dari analisis area pada distribusi normal menggunakan comfortable level. Hasil: Diperoleh persamaan yaitu: (rerata ECAP)=-21,19+5,87 rerata jarak elektroda ke modiolus (mm)+1.31, rerata threshold level (cu)+0.48 lama penggunaan implan koklea (bulan). (R square=0.60). Comfortable zone diperoleh dengan ECAP yang berada pada variasi 84-87,5% comfortable level. Kesimpulan: Jarak elektroda ke modiolus, lama penggunaan implan koklea dan t level merupakan faktor determinan ECAP. Nilai ECAP dapat digunakan untuk mengidentifikasi penyimpangan jarak elektroda dan memperoleh comfortable zone.Kata kunci : ECAP, implan koklea, lokasi elektroda, tuli sensorineuralABSTRACT Background: Currently cochlear implant remains a preferred choice in hearing and speechhabilitation in children with bilateral profound SNHL. Comfortable and threshold level setting based on ECAP value is recorded by NRI during mapping. Purpose: To obtain ECAP value as mapping guidance based on the distance between electrode to modiolus, the longest distance between electrode number one with the ones it faces, the distance between marker and cochleostomy and other factors. Methods: Research subject were children with SNHL, between 2-10 years old using CI with 16 electrodes, 120 channels. There were 46 ears (39 children) with CI chosen consecutively by cross sectional design. Using NRI, ECAP was recorded on electrode 3-5, 8-10, 13-15 that represent the apex, medial and basal area. Their cochlears were examined with HRCT then 3D reconstruction with OsiriX programto determine the electrode position and calculate the distance. Data analysis started with univariat 1 and bivariat with Spearman’ correlation. Candidates’ factor were analysed with multiregression test to gain ECAP determinant factor. Comfortable zone for population was gained from area analysis in normal distribution using comfortable level. Results: The equation found were: y (average ECAP)=21.19+5.87 the average electrodes to modiolus distance (mm)+1.31, threshold level (cu)+0.48 CI length use (months). (R square=0.60).Comfortable zone was acquired with ECAP between 84-87,5% comfortable level variation. Conclusion: The electrode to modiolus distance, duration of CI use and t level are ECAP determinant factor. The value of ECAP can be used as guidance to identify electrode distance deviation and to gain comfortable zone.Keywords: cochlear implant, ECAP, electrode location, sensoryneural hearing loss

BACKGROUND: Differential diagnosis between hemorrhagic and ischemic stroke, which determine how to treat the patients, was performed by CT-Scan. CT-Scan is not always available in all Indonesian health care facility. Other alternative using biochemical markers needed to be studied.METHODS: In total of 44 stroke patients consist of 25 ischemic and 19 hemorrhagic strokes according to CTScan, participated in this study. S100B Protein, NSE, MBP and H-FABP concentration in the blood of each stroke patient was determined.RESULTS: Among the biochemical markers used, only MBP at cut off point 0,712 ng/ml could be used for diagnosing hemorrhagic from ischemic stroke for serum samples obtained until 72 hours after onset of the stroke. If samples could be obtained within 24 hours, S100B Protein and MBP could be used for diagnosing hemorrhagic from ischemic stroke. If both markers increased (S100B Protein >7.55 pg/ml and MBP >0.109 ng/ml) sensitivity and specificity would be 77.8% and 84.6% respectively.CONCLUSIONS: MBP and S100B Protein are promising markers for differential diagnosis of hemorrhagic from ischemic stroke. Using serum samples obtained within 24 hours after onset and multiple markers (MBP and S100B Protein) will improved diagnostic performance of the test.KEYWORDS: Stroke, S100B Protein, Neuron Specific Enolase, Myelin Basic Protein, and Heart-Type Fatty Acid Binding Protein

BACKGROUND: Patient with larger ischemic lesion will suffer more severe neurogical deficit. The utility of MRI for lesion size measurement is still limited, therefore additional approach was pursued through examination of markers released by damaged brain cell, GFAP and S100B protein. The aim of this study is to know whether both markers are associated with the neurological deficit of anterior circulation ischemic stroke. METHODS: This observational prospective study enrolled 74 patients with anterior circulation ischemic stroke diagnosis. GFAP and S100B protein were measured with ELISA using blood collected at 48 to 72 hours after onset. The neurological deficit was assessed with NIHSS ad discharged.RESULTS: There was a significant association between GFAP level and discharged NIHSS (p=0.008) with 100% sensitivity and 100% negative predictive value. S100B protein also showed a significant correlation with discharged NIHSS (r=0.488; p=0.000) and this correlation could be described with an equation (OR=1.009; 95% CI=1.0003-1.0188; p=0.044). S100B protein at 78.3215 ng/L would give true prediction as 73.9% (95% CI=62.7%-85.2%, p=0.001). CONCLUSIONS: GFAP and S100B protein that were measured at 48 to 72 hours after onset were significantly associated with NIHSS at discharge. KEYWORDS: GFAP, S100B protein, discharged NIHSS, ischemic stroke