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"Latar belakang : Neuropati perifer merupakan salah satu efek samping kemoterapi yang sering ditemui. Beberapa gejala neuropati perifer berupa rasa nyeri yang hebat, perubahan sensoris dan kelemahan. Gejala tersebut menyebabkan keterbatasan dalam beraktivitas sehari-hari, menyebabkan pengurangan dosis, perubahan protokol kemoterapi atau bahkan penghentian obat kemoterapi tersebut. Sehingga meningkatkan angka morbiditas dan mortalitas pasien dengan keganasan.Tujuan: Mengetahui insidensi neuropati perifer pada anak yang mendapat kemoterapi dengan obat alkaloid vinka dan/atau platinum serta faktor risikonya.Metode: Penelitian kohort prospektif pada anak di bagian hematologi onkologi kiara RSCM yang mendapat obat vinkristin dan platinum (sisplatin dan atau karboplatin) dalam pengamatan 12 minggu. Pemeriksaan neuropati perifer dilakukan dengan metode pemeriksaan kecepatan hantar saraf (KHS).Hasil: Sebanyak 55 subjek diikutkan dalam penelitian ini, Insiden neuropati perifer adalah 50,9%. Faktor risiko yang bermakna pada penelitian ini adalah obat vinkristin (p=0.001), dengan risiko 3 kali lebih tinggi untuk kejadian neuropati perifer. Hasil lain yang bermakna adalah kombinasi kemoterapi (p=0,01) dan dosis kumulatif vinkristin 9 mg/m2 (p=0,027). Usia dan status gizi tidak didapatkan bermakna.Kesimpulan: Pada penelitian ini faktor risiko yang bermakna dengan neuropati perifer adalah jenis obat kemoterapi (vinkristin), kombinasi obat, dan dosis kumulatif vinkristin 9 mg/m2.

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Background: Peripheral neuropathy is one of the frequently encountered side effects of chemotherapy. Symptoms of peripheral neuropathy include severe pain, sensory changes, and weakness that cause limitations in daily activities, leading to dose reduction, changes in chemotherapy protocols, or even discontinuation of the chemotherapy drug. This can increase the morbidity and mortality of patients with malignancy.

Objective: To determine the incidence of peripheral neuropathy in children receiving chemotherapy with vinca alkaloids and/or platinum and the risk factors.

Methods: Prospective cohort study of children in the hematology-oncology department at Kiara RSCM who received vincristine and platinum drugs (cisplatin and/or carboplatin) for 12 weeks of observation. Peripheral neuropathy was assessed using the nerve conduction velocity examination.

Results: A total of 55 subjects were included. The incidence of peripheral neuropathy was 50.9%. A significant risk factor in this study was the type of chemotherapy drug, which is vincristine (p=0.001). Patients who received vincristine had a 3 times higher risk of developing peripheral neuropathy. The combination of chemotherapy (p=0.01) and the cumulative dose of vincristine of 9 mg/m2 (p=0.027) also appears to become significant risk factors. Age and nutritional status were not significant risk factor.

Conclusion: The significant risk factors for peripheral neuropathy were the type of chemotherapy drug (vincristine), drug combination, and the cumulative dose of vincristine of 9 mg/m2."

"ABSTRAKSindrom terowongan karpal (STK) merupakan penyakit yang menjadi beban bagi banyak negara di seluruh dunia, dengan berbagai macam pilihan terapi dari medikamentosa hingga pembedahan yang memiliki efek samping yang menurunkan kualitas hidup. Akupunktur telah terbukti dapat menangani nyeri dan memperbaiki saraf, dan salah satu modalitas akupunktur terbaru adalah laser acupuncture. Studi serial kasus ini bertujuan menilai efektivitas laser acupuncture dengan jumlah sampel 6 pergelangan tangan, dengan luaran yang dinilai adalah kuesioner Boston (BCTQ), visual analogue scale (VAS), tes Tinned, Tes Phalen, dan pemeriksaan kecepatan hantar saraf (KHS). Titik yang digunakan adalah PC6, PC7, EXUE9, dan LI4. Hasil studi menunjukkan 3 pergelangan tangan mengalami penurunan derajat KHS, seluruh pergelangan tangan mengalami perbaikan skor BCTQ, nilai VAS mengalami penurunan, tetapi tidak terlihat perbaikan tes Tinel dan Phalen yang bermakna. Disimpulkan bahwa laser acupuncture dapat digunakan sebagai pilihan terapi dalam tatalaksana sindrom terowongan karpal.

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ABSTRACTCarpal tunnel syndrome (CTS) is disease that gives burdens for many countries, with a number of choices for the management such as drugs or surgery, each has side effects that decrease the quality of life. Acupuncture is proven to be an effective treatment for pain and can restore nerve functions, and laser acupuncture is one of the modalities. This study aims to asses the effectiveness of laser acupuncture with 6 wrists and the outcomes are Boston questionnaire (BCTQ), visual analogue scale (VAS), Tinel sign, Phalen sign, and nerve conduction study (NCS). Acupuncture points used here are PC6, PC7, EXUE9, and LI4. The results show a decrease in NCS grades for 3 wrists, all wrists have BCTQ score improvements, VAS also decreases, but no significant improvement in Tinel and Phalen signs. The conclusion is that laser acupuncture can be used as a treatment for the management of carpal tunnel syndrome."

"Thalassemia merupakan salah satu kelainan genetik paling umum di seluruh dunia. Tanpa managemen yang adekuat, komplikasi akan terjadi pada berbagai organ, termasuk sistem saraf. Tujuan penelitian ini adalah untuk menentukan proporsi abnormalitas Brain Auditory Evoked Potentials (BAEP), elektroensefalografi (EEG), dan elektroneurografi (ENG) pada anak thalassemia mayor dan hubungannya dengan faktor risiko terkait. Metode: Penelitian ini merupakan studi potong lintang deskriptif analitik yang dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM) Jakarta dan Rumah Sakit M Djamil (RSMDJ) Padang. Kriteria inklusi adalah anak thalassemia mayor berusia 12-18 tahun yang kontrol teratur minimal dalam 1 tahun terakhir. Pasien dengan epilepsi, palsi serebral, gangguan pendengaran, dan gangguan neurodevelopmental dikeluarkan dari penelitian. Pemeriksaan BAEP, EEG, dan ENG dilakukan pada semua subyek dan diinterpretasikan oleh konsultan neuropediatri. Dilakukan pencatatan usia onset, durasi transfusi, rerata hemoglobin (Hb) pra-transfusi, kadar feritin serum, saturasi feritin, dan kepatuhan konsumsi obat kelasi besi. Hubungan antar variabel dinilai menggunakan analisis bivariat dengan nilai p < 0,05 dikatakan bermakna. Hasil: Sebanyak 64 anak dengan rerata usia 15,1 tahun memenuhi kriteria penelitian, terdiri atas 29 anak laki-laki dan 35 anak perempuan. Rerata Hb pra transfusi, kadar feritin serum, dan saturasi transferin berturut-turut adalah 8,36 g/dL, 4495,3 ng/mL, dan 87,3%. Abnormalitas EEG ditemukan pada 28 (43,8%) subyek dan berhubungan bermakna dengan rerata Hb pra-transfusi < 9 g/dL (p=0,011, rasio prevalensi 3,014, interval kepercayaan 1,04-8,71). Abnormalitas BAEP ditemukan pada 4 (4,6%) subyek dan berhubungan bermakna dengan kadar feritin serum yang lebih tinggi (p=0,007). Hasil ENG abnormal hanya ditemukan pada 1 orang subyek. Tidak terdapat hubungan antara faktor risisko lainnya dengan masing-masing pemeriksaan neurofisiologi. Kesimpulan: Abnormalitas EEG ditemukan pada 43,8% anak thalassemia mayor dan berhubungan dengan rerata Hb pra-transfusi <9 g/dL, sedangkan abnormalitas BAEP ditemukan pada 4% subyek dan berhubungan dengan kadar feritin serum yang lebih tinggi.

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Thalassemia is among the most common genetic disorders worldwide. Without adequate management, complications occur in various organs as well as neurology system. The aim of the study was to determine the proportion of abnormal electroencephalography, brain auditory evoked potentials (BAEP), and nerve conduction study (NCS) in children with thalassemia major and its association with related risk factors. Methods: This was a descriptive-analytic cross sectional study conducted in Cipto Mangunkusumo Hospital and M Djamil Hospital in January to March 2019 All children with thalassemia major aged 12 to 18 years were eligible for the study. Children with epilepsy, palsy cerebral, hearing disorder, or neurodevelopmental problems were excluded. Electroencephalography, BAEP, and NCS were performed in all subjects. Age of onset, transfusion duration, mean pre-transfusion hemoglobin, serum ferritin, transferrin saturation, and compliance to chelating agents therapy were recorded. Bivariate analysis was performed to determine the relationsip between variables with p < 0,05 was considered significant. Results: As many as 64 children with mean age 15,1 years fulfilled the study criteria during the study period, consisting of 29 boys and 35 girls. Mean pre-transfusion hemoglobin, serum ferritin, and transferrin saturation was 8,36 g/dL, 4495,3 ng/mL, and 87,3% respectively. Abnormal EEG was found in 28 (43,8%) subjects and significantly associated with mean Hb below 9 g/dL (p = 0,011; prevalence ratio 3,014; confidence interval 1,04 - 8,71). Abnormal BAEP was found in 4 (4,6%) subjects and significantly associated with higher serum ferritin (p=0,007). Only 1 subject showed abnormal NCS. No association was found between other risk factors with each neurophysiology study. Conclusion: Abnormal EEG was found in 43,8% thalassemia major children and significantly associated with lower pre-transfusion hemoglobin level. Abnormal BAEP was found in 4% subjects and significantly associated with higher serum ferritin."

"ABSTRACTThis paper presents the small-signal modeling of a Single-Ended Primary Inductor Converter power stage operating in discontinuous conduction mode using the sampled-data modeling technique. In addition, two algebraic manipulating features are revealed; the simpler periodic solution determination by the concept of Volt-Second and Capacitor-Charge balance, and the replacement of the expression involving the singular matrix by the equivalent function with the s-domain matrix. Four pulse transfer functions are derived from the model: the smallsignal input-to-output voltage pulse transfer function, the small-signal duty duration-to-output voltage pulse transfer function, the input-to-output voltage pulse transfer function, and the duty duration-to-output voltage pulse transfer function. The model verification is analyzed by the simulation results. The response sequences from the pulse transfer functions oscillate by the same phase and frequency to the one from the simulation with slightly peak amplitude differences, confirming the validity of the acquired pulse transfer functions."

"Latar belakang: Pengukuran luas penampang lintang nervus ulnaris menggunakan USG siku pada populasi dewasa normal pada posisi ekstensi dan fleksi telah banyak dilakukan, tetapi belum banyak penelitian yang menyatakan apakah ada perbedaan bermakna antara kedua posisi tersebut. Bila ditemukan perbedaan yang bermakna, maka pengukuran harus memperhatikan posisi siku karena memiliki rerata normal yang berbeda. Selain itu, hingga saat ini belum ada publikasi maupun data mengenai luas penampang lintang nervus ulnaris pada populasi dewasa normal menggunakan USG siku di Indonesia, khususnya pada posisi ekstensi dan fleksi.Metode: Penelitian ini menggunakan desain deskriptif dan desain potong lintang komparatif dengan data primer. Total sampel 61 nervus ulnaris normal yang dibuktikan dengan pemeriksaan kecepatan hantaran saraf (KHS) dan dilanjutkan dengan pemeriksaan USG pada level terowongan kubital serta 2 cm proksimal dan distalnya, kemudian dilakukan pengukuran luas penampang lintang nervus ulnaris di ketiga level tersebut. Analisis statistik dilakukan dengan uji T 2 kelompok berpasangan, dan perbedaan dianggap bermakna apabila p kurang dari 0,05.Hasil: Rerata luas penampang lintang nervus ulnaris di level 2 cm proksimal dari terowongan kubital, terowongan kubital, dan 2 cm distalnya secara berurutan pada posisi ekstensi adalah 6,0 ± 0,7 mm2, 6,3 ± 0,9 mm2, dan 5,9 ± 0,7 mm2; pada posisi fleksi juga secara berurutan adalah 5,7 ± 0,8 mm2, 5,2 ± 0,9 mm2, dan 5,7 ± 0,7 mm2. Rerata luas penampang lintang nervus ulnaris pada posisi ekstensi lebih besar secara bermakna (p < 0,001) dibandingkan posisi fleksi di ketiga level tersebut pada populasi dewasa normal.Kesimpulan: Rerata luas penampang lintang nervus ulnaris di siku pada posisi ekstensi lebih besar secara bermakna dibandingkan posisi fleksi, sehingga posisi siku subjek perlu diperhatikan pada saat pengukuran karena masing-masing posisi memiliki nilai normal yang berbeda signifikan.

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Background: There are many cross sectional area measurement of ulnar nerve ultrasound of the elbow in extended and flexed position the normal adult population that have been done, but but not many studies have stated whether there are significant differences between the two positions. If significant differences are found, then the measurement must pay attention to the elbow position because it has a different normal mean value. In addition, until now there has been no publication or data on the cross-sectional area of the ulnar nerve in the normal adult population using elbow ultrasound in Indonesia, especially in the position of extension and flexion.

Methods: This study used descriptive design and comparative cross-sectional study design with primary data. A total of 61 normal ulnar nerve samples were proven by nerve conduction velocities examination (NCV) and continued with ultrasound examination at the level of the cubital tunnel and 2 cm proximal and distal, then the cross sectional area of the ulnar nerve at all three levels were measured. Statistical analyses were performed using paired sample t test, and the difference was considered significant if p was less than 0.05.

Results: The mean cross sectional area of the ulnar nerve at the level of 2 cm proximal to the cubital tunnel, cubital tunnel, and distal distal 2 cm in the extension position were 6.0 ± 0.7 mm2, 6.3 ± 0.9 mm2, and 5.9 ± 0.7 mm2, respectively; in the flexion position, they were 5.7 ± 0.8 mm2, 5.2 ± 0.9 mm2, and 5.7 ± 0.7 mm2, respectively as well. The mean cross sectional area of the ulnar nerve in the extension position was significantly greater (p <0.001) than the flexion position at all three levels in the normal adult population.

Conclusion: The mean cross sectional area of the ulnar nerve at the elbow at the extension position was significantly greater than the flexion position, so the elbow position of the subject needs to be considered at the time of measurement because each position has a significantly different normal value."

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