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"Tujuan: Mendapatkan alat (Mikrokapiler Digital/MD) untuk mengukur viskositas darah dan plasma yang mempunyai presisi dan akurasi yang baik. Mengetahui peran viskositas darah dan plasma yang diukur dengan MD, faktor risiko dan determinan terhadap prognosis stroke iskemik akut berdasarkan National Institute of Health Stroke Scale (NIHSS), Modified Rankin Score (mRS), Interleukin 6 (IL-6), dan neuron-specific enolase (NSE). Penelitian tahap pertama meliputi uji presisi dan akurasi, sedangkan tahap kedua adalah uji prognosis. Subjek penelitian: Subjek untuk uji presisi adalah 40 dewasa sehat yang melakukan Medical Check Up (MCU). Subjek untuk uji akurasi dan prognosis adalah 135 pasien stroke iskemik akut onset ≤ 3 hari, usia 35 – 74 tahun. Pengukuran dan intervensi: Presisi dinilai dengan coefficient of variation (CV), interrater variability Cronbach Alpha dan coefficient of reliability Bland Altman. Akurasi dinilai dengan uji diagnostik. Uji prognosis meliputi analisis bivariat dilanjutkan dengan analisis multivariat cox proportional hazards regression. Hasil: Dari penelitian tahap pertama, didapatkan CV sebesar 0,04, nilai interrater variability Cronbach Alpha dan mean difference Bland Altman adalah baik. Sensitivitas dan spesifisitas MD untuk viskositas darah adalah 88,9 % dan 88,9 %, sedangkan untuk viskositas plasma adalah 100 % dan 84 %. Rumus prediksi untuk konversi viskositas darah MD ke satuan poise adalah y = 0,846x + 0,614, dan untuk viskositas plasma adalah y = 1,072x + (-0,160). Pada uji tahap kedua, didapatkan faktor determinan antara lain: fibrinogen merupakan faktor determinan perubahan viskositas darah dan plasma; viskositas darah merupakan faktor determinan perburukan kondisi klinis (National Institute of Health Stroke Scale/NIHSS dan modified Rankin Scale/mRS); viskositas darah dan diabetes melitus (DM) merupakan faktor determinan prognosis stroke iskemik akut berdasarkan interleukin 6 (IL-6); dan HDL merupakan faktor determinan prognosis stroke iskemik akut berdasarkan neuron specific enolase (NSE). Simpulan: MD memiliki presisi dan akurasi yang baik. Viskositas darah merupakan faktor determinan perburukan kondisi klinis baik akut maupun pasca perawatan.

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Objectives: To design a simple and portable instrument (Digital Microcapillary) for measuring blood and plasma viscosity values with high precision and accuracy. To assess the roles of these values, the risk and determining factors in predicting the outcome of acute ischemic stroke assessed using National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), interleukin 6 (IL-6), and neuron specific enolase (NSE). The first stage of this study included precision and accuracy tests, while the second stade was the prognostic test.

Research subjects: 40 healthy adults admitted for Medical Check Up (MCU) were recruited for the precision test while the subjects for accuracy and prognostic tests were 135 acute ischemic stroke patients, either inpatients or outpatients, aged 35 - 74 years old, with up to 3 days stroke onset.

Measurement and intervention: The precision was assessed by calculating coefficient of variation (CV), Cronbach Alpha interrater variability, and Bland Altman coefficient of reliability, while the accuracy was assessed using diagnostic test. The prognostic test included bi- and multivariate analyses using Cox proportional hazards regression.

Results: The results of the first stage study were that the CV was 0.04; Cronbach Alpha interrater variability and Bland Altman mean difference values were excellent. The prediction formula used to convert blood viscosity value measured with digital microcapillary to poise unit was y = 0.846x + 0.614, and the formula for plasma viscosity was y = 1.072x + (-0.160). The sensitivity and specificity of Digital Microcapillary for blood viscosity measurement were 88.9 % and 88.9 %, respectively and for plasma viscosity measurement were 100 % and 84 %, respectively. The second stage of the study showed that the variables proven to be the determinants were: fibrinogen as the determinant of blood and plasma viscosity, blood viscosity as the determinant of clinical outcome (NIHSS and mRS), blood viscosity and diabetes mellitus as the determinants of acute ischemic stroke outcome indicated by blood IL-6 level, and HDL as the determinant of acute ischemic stroke outcome indicated by NSE level.

Conclusions: Digital Microcapillary has high precision and accuracy. Blood viscosity is a determining factor in the ischemic stroke outcome, both acute and one month after hospital discharge."

"Stroke merupakan manifestasi klinis berupa defisit neurologis yang bertahan selama minimal 24 jam, menunjukkan keterlibatan fokal sistem saraf pusat, yang disebabkan oleh gangguan aliran darah otak. Prevalensi stroke di Indonesia mencapai 0,8% dan menjadi salah satu penyebab kematian terbanyak. Stroke juga dapat menimbulkan kecacatan permanen, namun pengobatan untuk kesembuhan sempurna belum ditemukan. Oleh karena itu, perlu dicari strategi untuk mencegah dampak yang ditimbulkan oleh stroke. Tujuan penelitian ini adalah untuk mengidentifikasi efek neuroprotektif ekstrak akar Acalypha indica Linn dalam mencegah kerusakan inti sel saraf hipokampus tikus pascahipoksia.Penelitian ini merupakan studi eksperimental menggunakan ekstrak akar A. indica Linn, diberikan kepada tikus Sprague Dawley yang dibagi menjadi tiga kelompok perlakuan, yaitu kontrol negatif yang mendapat akuades, kelompok ekstrak akar A. indica Linn dosis 400 mg/kgBB dan kelompok ekstrak dosis 500 mg/kgBB. Setelah diberi perlakuan selama 7 hari, tikus diberi perlakuan hipoksia dengan oklusi arteri karotis komunis bilateral selama satu jam. Jaringan hipokampus tikus kemudian diambil dan diamati perubahan inti selnya.Hasil analisis dengan uji statistik One Way Anova dilanjutkan dengan uji Post Hoc menunjukkan ekstrak akar A. indica Linn dosis 400 mg/kgBB (p=0,029) dan 500 mg/kgBB (p=0,035) memiliki efek neuroprotektif terhadap inti sel saraf area CA3 hipokampus dibandingkan dengan kontrol negatif. Namun, efek neuroprotektif dosis 500 mg/kgBB tidak berbeda bermakna dibandingkan dengan dosis 400 mg/kgBB.

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Stroke is a syndrome characterized by acute onset of neurologic deficit that persists for at least 24 hours, reflects focal involvement of the central nervous system, and is the result of disturbance of the cerebral circulation. Stroke prevalence in Indonesia is 0,8% and it becomes one of the leading cause of death.

Stroke can also cause permanent disability, but cure for complete recovery hasn?t been found. Therefore, a strategy to prevent the damage caused by stroke becomes focus of today?s research. Aim of this study is to identify the neuroprotective effect of Acalypha indica Linn root extract to prevent hypoxia-induced damage on nucleus of hippocampal neuron in rats.

This research is an experimental study performed on fifteen rats (Sprague-Dawley) that divided into three groups receiving three different treatments for 7 days, i.e. negative control group receiving aquades, group receiving extracts 400 mg/kgBW/day, and group receiving extract 500 mg/kgBW/day. Then, rats underwent hypoxia by occlusion of the bilateral common carotid arteries for one hour. The hippocampus tissue was obtained and was observed to be identified its structural changes.

Results from one-way ANOVA and Post Hoc analysis showed that root extract of A. indica Linn dose of 400 mg/kgBW (p=0,029) and 500 mg/kbBW (p=0,035) have neuroprotective effect on neuron of CA3 hippocampus compared with negative control. However, the analysis showed that root extract of A. indica Linn dose 500 mg/kgBW has no significant difference with dose 400 mg/kgBW."

"Pada tahun 2007, stroke menyebabkan kematian sebanyak 135.952 jiwa di dunia dan merupakan penyebab kematian nomor tiga di Amerika Serikat (AS). Di Indonesia, stroke menyerang 35,8% penduduk usia lanjut dan 12,9% penduduk usia produktif. Setelah sembuh dari stroke, 70% pasien menderita gejala sisa, seperti hemiplegia, kesulitan bicara, dll. Untuk mengatasi gejala sisa, biasanya diberikan agen nootropik yaitu pirasetam. Di samping harganya mahal, pirasetam memiliki berbagai efek samping seperti gelisah, vertigo, gangguan pola tidur, serta gangguan aliran darah. Salah satu terapi alternatif yaitu dengan menggunakan tanaman herbal (Acalypha indica Linn dan Centella asiatica). Tujuan penelitian ialah untuk mengetahui efek neuroterapi dari kombinasi ekstrak akar kucing (Acalypha indica Linn) dan ekstrak pegagan (Centella asiatica) pada neuron hipokampus tikus Sprange Dawley pascahipoksia. Penelitian ini dilakukan dengan menggunakan desain eksperimental dengan 5 kelompok perlakuan yaitu (1) kontrol negatif (akuades); (2) kontrol positif (pirasetam); (3) 150 mg ekstrak akar kucing (AK)+150 mg ekstrak pegagan(P); (4) 200 mg ekstrak AK+150 mg ekstrak P; (5) 250 mg ekstrak AK+150 mg ekstrak P. Setelah itu, dilakukan penghitungan 500 buah jumlah sel pada girus dentatus eksternal berdasarkan kategori sel normal, kondensasi, dan piknotik. Hasilnya diuji dengan menggunakan One Way Anova karena variabel bebas (kelompok perlakuan) berjenis kategorik dan variabel terikat (jumlah sel) berjenis numerik. Hasil uji One Way Anova menunjukkan bahwa terdapat perbedaan bermakna diantara kelompok sel normal (p=0.001), sel kondensasi (p=0.002), serta sel piknotik (p=0.043). Berdasarkan uji Post Hoc, kombinasi 200 mg AK+150 mg ekstrak P memiliki efek yang hampir sama dengan pemberian pirasetam (p=0.001).

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Stroke is the third leading causes in USA. In Indonesia, stroke attacked 35.8% elderly and 12.9% productive age population. Recovering from stroke, 70% of patients suffered from sequel symptoms such as hemiplegic, speech difficulty, etc. To overcome these symptoms, giving nootropic agent (piracetam) is recommended. Apart from expensive price, piracetam have several side effects namely anxiety, vertigo, sleeping pattern disorder, and also bloodstream disorder. One of alternative therapy used herbal medicine (Acalypha indica Linn dan Centella asiatica). This research is conducted to obtain neural therapy effect of extract Acalypha indica Linn 200 mg mixed with extract Centella asiatica 150 mg on improvement Sprange Dawley rat’s hippocampus neuron after hypoxia. This experimental study used five treatment groups: (1) negative control (aquadest); (2) positive control (piracetam); (3) extract Acalypha indica Linn (AI) 150 mg + extract Centella asiatica (CA) 150 mg; (4) extract AI 200 mg + extract CA 150 mg; (5) extract AI 250 mg + extract CA 150 mg. Afterwards, we performed calculation on 500 cells consisted of normal, condensation cells, and pyknotic cells along external dentatus gyrus. The results were tested using One Way Anova due to independent variables (treatment groups) is categorical type and dependent variables (cells count) is numerical type. The test resulted that there are significant difference between normal cells (p=0.001), condensation cells (p=0.002), and pyknotic cells (p=0.043). Post hoc test revealed that combinations of extract AI 200 mg with extract CA 150 mg have similar effect showed by piracetam (p=0.001)."

"ABSTRAKKondisidisuse osteoporosispada pasien hemiparesis dapat menyebabkan morbiditas yang signifikan. Penelitian ini bertujuan untuk menilai pengaruh faktor-faktor klinis tersebut terhadap status kepadatan massa tulang. Sebanyak34 subjek direkrut dalam penelitian ini. Rerata nilai BMD (g/cm2) wrist sisi sehat dan sakit adalah 0,8 ±0,15 dan 0,74 ± 0,15; hipsisi sehat dan sakit adalah 0,83 ± 0,15 dan 0,77 ± 0,16; serta spine adalah 1,005 ± 0,20. Terdapat perbedaan bermakna antara BMD sisi sehat dengan sisi sakit baik pada hip maupun wrist (p<0,001). Didapatkan korelasi positif yang kuat antara awitan hemiparesis dengan delta BMD wrist dan hip (r= 0,779 p=0,001 dan r=0,791 p=0,001). Terdapat juga hubungan yang secara statistik bermakna antara delta BMD dengan usia dan kekuatan motorik. Pada uji multivariat didapatkan bahwa usia dan awitan hemiparesis merupakan faktor prediktor utama terhadap delta BMD (aR2 wrist= 0,486, aR2 hip= 0,614). Usia, kekuatan motorik ekstremitas, awitan hemiparesis, dan kepatuhan rehabilitasi mempengaruhi penurunan nilai BMD. Selain itu, usia dan awitan hemiparesis menjadi faktor prediktor utama terhadap penurunan nilai BMD. Faktor-faktor ini sebaiknya menjadi salah satu pertimbangan utama dalam manajemen diagnostik dan tatalaksana disuse osteoporosis pada pasien stroke

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ABSTRACTDisuse osteoporosis in hemiparetic patients often results in significant morbidity and decreased quality of life. This study aims to investigate the effect of these csinical factors on bone mineral density. A total of 34 subjects were recruited for this study. The mean BMD value (g / cm2) of the healthy and paretic side of the wrist was 0.8 ± 0.15 and 0.74 ± 0.15; healthy and paretic hip was 0.83 ± 0.15 and 0.77 ± 0. 16); and the spine was 1.005 ± 0.20. There was a significant difference between the healthy and paretic side of BMD of both hip and wrist (p <0.001). Multivariate analysis demonstrated that the onset of hemiparesis was a strong predictor of delta BMD (aR2 wrist = 0.486, aR2 hip = 0.614). Age, limb strength, the onset of hemiparesis, and rehabilitation compliance are associated with the decreased BMD among patients with post-stroke neuromuscular deficit. In addition, age and the onset of hemiparesis are major predictors of accelerated BMD loss, which can be used to calculate delta BMD score. These factors should perhaps become the main issues addressed in the diagnosis or treatment of disuse osteoporosis among stroke patient."

"Hipoksia merupakan kondisi inadekuat suplai oksigen menyebabkan peningkatan radikal bebas perusak organ, contohnya otak. Radikal bebas dinetralisir antioksidan endogen dan eksogen. Acalypha indica dan Centella asiatica memiliki efek antioksidan. Pewarnaan AgNOR mengukur derajat kerusakan sel. Penelitian bertujuan membuktikan efek pemberian kombinasi ekstrak etanol akar Acalypha indica dan Centella asiatica pada histopatologi neuron korteks serebrum tikus pascahipoksia pewarnaan AgNOR. Penelitian mendapat sediaan dari 26 ekor tikus Spraque-Dawley, terbagi dalam 6 kelompok: kontrol normal; kontrol negatif (hipoksia+aquades); hipoksia+kombinasi 1; hipoksia+kombinasi 2; hipoksia+tunggal 2; kontrol positif (hipoksia+vit C). Induksi hipoksia selama 7 hari dengan mengalirkan O2 10% dan N2 90% bertekanan 1 atm. Setelah 7 hari, dilakukan Analisis Gas Darah, reoksigenasi 1 jam, dilanjutkan pemberian perlakuan aquades; (AI200+CA150); (AI250+CA100); CA150 dan vitamin C selama 7 hari. Pada akhir studi dilakukan euthanasia, organ otak diambil untuk pemeriksaan histopatologi dengan pewarnaan AgNOR. Hasil: Pemberian esktrak kombinasi 2, tunggal 2, dan kombinasi 1 berbeda bermakna dibandingkan kontrol negatif (p=0,000; p=0,005; p=0,023). Kesimpulan: Kombinasi ekstrak etanol (AI250+CA100) memiliki efek terbaik untuk mengurangi kerusakan neuron korteks serebrum secara histopatologi.

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Hypoxia is inadequate conditions of oxygen causes increasing free radicals destroying organs, e.g. brain. Free radicals neutralized by endogenous and exogenous antioxidants. Acalypha indica and Centella asiatica have antioxidant effects. AgNOR staining measures degree of damaged cell. The aim of this study was to prove the effect of the combination of ethanol extract on the roots of Acalypha indica and Centella asiatica on the histopathology of cortical neurons in cerebrum of rats after hypoxia in AgNOR staining. The study of 26 Spraque-Dawley rats, divided into 6 groups: normal control; negative control (hypoxia + aquades); hypoxia + combination 1; hypoxia + combination 2; hypoxia + single 2; positive control (hypoxia + vit C). Induction of hypoxia for 7 days by flowing 10% O2 and 90% N2 with 1 atm pressure. After 7 days, Blood Gas Analysis, 1 hour re-oxygenation, followed by treatments; distilled water; (AI200 + CA150); (AI250 + CA100); CA150 and vitamin C for 7 days. At the end of study, euthanasia was carried out, brain organs were taken for histopathology examination with AgNOR staining. The combination 2, single 2 and combination 1 extracts were significantly different compared to negative control (p = 0,000; p = 0.005; p = 0.023). The combination of ethanol extract (AI250 + CA100) has the best effect to reduce damage to cerebral cortical neurons histopathologically."

"Disertasi ini membahas algoritme neuromuscular taping terhadap manifestasi klinis gangguan mikrosirkulasi pada kaki dabetik. Tahapan riset meliputi kajian literatur, faktor risiko neuropati kaki diabetik, uji diagnostik, standarisasi perawatan pencegahan neuropati kaki diabetik, standarisasi NMT FANI pada perawatan neuropati kaki diabetik dan pembentukan algoritme. Desain penelitian uji diagnostik dengan cross sectional, sedangkan uji efek NMT FANI terhadap kelembapan, suhu, kapiler lipatan kuku dan nyeri neuropati dengan desain eksperimental. Instrument menggunakan moisture meter skin, thermometer infrared, capiloroscopy, biothesiometer dan LANSS. Hasil uji diagnostik menunjukan moisture meter skin (sensitifitas, spesifisitas dan akurasi 74%); capilaroscopy (sensitifitas, spesifisitas dan akurasi 73%) baik dalam mendeteksi neuropati kaki diabetik. Uji thermograph menunjukan sensitifitas 73.07% dalam mendeteksi kelainan neuropati, spesifisitas 56.42% dan akurasi 59.03%. Uji thermometer gun menunjukan sensitifitas 56.66%, spesifisitas 53.67% dan akurasi 54.21% kurang baik dalam mendeteksi neuropati kaki diabetik. NMT FANI berpengaruh secara signifikan terhadap kelembapan kulit, kapiler lipatan kulit kuku dan derajat nyeri neuropati pada kaki diabetik (p value < 0.05), sedangkan pada suhu kaki tidak berpengaruh secara signifikan (p value > 0.05). Hasil akhir algoritme tersusun dari pengkajian awal dari hasil anamnesis faktor risiko, pemeriksaan fisik dan diagnostik serta tatalaksana NMT FANI. Indikator kelembapan kulit, perubahan struktur kapiler lipatan kuku kaki dan intervensi NMT FANI perlu dimasukan dalam tatalaksana kaki diabetik.

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This dissertation discusses the neuromuscular taping algorithm against the clinical manifestations of microcirculation disorders in the diabetic foot. The research stages included a review of literature, risk factors for neuropathy of diabetic foot, diagnostic tests, standardization of preventive treatment of diabetic foot neuropathy, standardization of NMT FANI in the treatment of diabetic foot neuropathy, and algorithm formation. The study design was a cross-sectional diagnostic test, while an experimental design was employed for the NMT FANI effect test on skin moisture, temperature, nail fold capillaries, and neuropathic pain. The instruments used were a skin moisture meter, infrared thermometer, capillaroscopy, biothesiometer, and LANSS. The diagnostic test results showed that the SC skin moisture meter (sensitivity, specificity, accuracy 74%) and capillaroscopy (sensitivity, specificity, accuracy 73%) were good at detecting diabetic foot neuropathy. The thermograph test shows a sensitivity of 73.07% in detecting neuropathic disorders, a specificity of 56.42% and an accuracy of 59.03%. The thermometer gun test showed a sensitivity of 56.66%, a specificity of 53.67%, and an accuracy of 54.21% that was not good at detecting diabetic foot neuropathy. NMT FANI had a significant effect on skin moisture, nail fold capillaries, and the degree of neuropathy pain in diabetic foot (p value < 0.05), while foot temperature did not significantly influence (p value > 0.05). The end result of the algorithm is composed of a preliminary assessment of the results of the history of risk factors, physical examination, diagnostic and management of NMT FANI. Indicators of skin moisture, changes in the capillary structure of the nail folds and NMT FANI interventions need to be included in the management of diabetic foot."