Hasil Pencarian  ::  Simpan CSV :: Kembali

Abstrak :
ABSTRAK
Stroke adalah gangguan neurologis yang merupakan penyebab utama kecacatan dan penyebab kematian ke dua di dunia. Sebanyak 87 kasus stroke yang terjadi merupakan stroke iskemik. Salah satu komplikasi yang ditimbulkan oleh stroke adalah hemiparesis. Hemiparesis yang tidak tertangani dapat menurunkan kualitas hidup klien pasca perawatan stroke. Intervensi keperawatan terhadap klien stroke iskemik dengan hemiparesis dilakukan dengan memberikan latihan ROM Range of Motion aktif dan pasif yang bertujuan untuk meningkatkan rentang pergerakan sendi, meningkatkan fungsi dan kekuatan otot, dan mencegah kontraktur. Karya ilmiah ini bertujuan untuk memberikan gambaran implementasi asuhan keperawatan melalui pendekatan Keperawatan Kesehatan Masyarakat Perkotaan pada klien stroke iskemik dengan hemiparesis. Intervensi ROM dilakukan selama 5 hari, setiap hari dilakukan selama 15 menit sebanyak 2 kali. Hasil evaluasi menunjukkan adanya peningkatan rentang pergerakan sendi, peningkatan kekuatan otot, peningkatan keseimbangan tubuh, dan kemampuan melakukan ADL Activity Daily Living . Oleh karena itu, intervensi ROM sangat penting dan direkomendasikan untuk diterapkan oleh perawat kepada klien stroke dengan hemiparesis.

---

ABSTRACT
Stroke is a neurological disorder that is the leading cause of disability and the second leading cause of death in the world. As many as 87 of cases are ischemic stroke. One of the complications caused by stroke is hemiparesis. Untreated hemiparesis can reduce the quality of life of clients after stroke treatment. Nursing orders for ischemic stroke clients with hemiparesis are performed by providing active and passive ROM Range of Motion exercise aimed to increase the range of joint movement, improve muscle function and strength, and prevent contractures. This paper aimed to provide an overview of the implementation of nursing care through the Urban Health Nursing approach on ischemic stroke clients with hemiparesis. ROM intervention was done for 5 days, twice a day, as much as 15 minutes. Evaluation results show an increased range of joint movement, increased muscle strength, increased body balance, and ability to perform ADL Activity Daily Living . Therefore, ROM intervention is very important and recommended to be applied by nurses to stroke clients with hemiparesis.

Abstrak :
Tujuan Penelitian Untuk mendapatkan data perubahan kadar vitamin C plasma dan faktor-faktor yang berhubungan pasien stroke iskemik Tempat Penelitian Ruang rawat inap B Rumah Sakit Umum Pusat Nasional Dr. Cipto Mangunkusumo Desain Penelitian Penelitian dengan desain cross sectional dilakukan pada 29 pasien stroke iskemik dengan onset kurang dari 48 jam. Pengambilan subyek penelitian dengan Cara consecutive sampling. Pemeriksaan vitamin C dengan metode spektrofotometri. Data yang dikumpulkan meliputi: karakteristik demografi, faktor risiko, pola makan, asupan nutrisi berdasarkan recall I x24 jam, food frequency amount (FFA) dan food record, pemeriksaan antropometri (BB, TB), pemeriksaan klinis dengan National Institutes of Health Stroke Scale (NIHSS) Subyek Penelitian Jumlah subyek penelitian 29 orang (22 laki-laki dan 7 perempuan). Rerata usia 60 ± 10,1 tahun. Sebanyak 56,7% mempunyai pola makan kurang. Asupan vitamin C selama observasi di bawah angka yang dianjurkan (55,8 ± 15,4 mg/dL ; 54,2 ± 14,2 mg/dL ; 56,1 ± 15,6 mg/dL ; 53,8 ± 16,7 mgldL) Berdasarkan FFA dan recall terdapat korelasi positif bermakna antara kadar vitamin C plasma dengan asupan vitamin C (r:1,42 - 0,43, p<0,05). Berdasarkan food record terdapat korelasi positif cukup antara kadar vitamin C plasma dengan asupan energi (r--0,33 - 0,35 p>0,05 ), dan asupan protein (r3,32 - 0,35, p>0,05)_ Korelasi positif bermakna antara kadar vitamin C plasma dengan asupan vitamin C (r- 0,39 - 0,43, p<0,05). Kadar vitamin C plasma perokok lebih rendah dibandingkan non perokok. Perubahan kadar "vitamin C plasma tidak berbeda menurut jenis kelamin (p-0,05). Demikian pula kadar kadar vitamin C plasma menurut usia (p > 0,05). Tidak terdapat perubahan bermakna nilai NIHSS ( 9,8 ± 6,9 ; 9,8 ± 7,1 ; 9,5 ± 7,1 ; 9,3 ± 7,6 ). Antara kadar vitamin C plasma dengan nilai NIHSS terdapat korelasi negatif (r 0,28 - -0,34, p>0,05). Hasil Penelitian Penelitian ini menunjukkan terdapat perubahan kadar vitamin C plasma pasien stroke iskemik. Penurunan bermakna kadar vitamin C plasma Mari ke 3 dan 5 terhadap kadar vitamin C plasma hari pertama. Persentase asupan energi, protein, serat dan vitamin C masih di bawah kebutuhan. Terdapat korelasi negatif antara kadar vitamin C plasma dengan nilai NIHSS.

---

Objective To investigate the changes of vitamin C plasma level and associated factors in stroke ischemic paitents. Place IRNA B, Cipto Mangunkusumo General Hospital, Jakarta Methods A cross sectional study was carried out among 29 patient with ischemic stroke of recent onset (< 48 hours). Consecutive sampling method was used to obtain the subject. Plasma vitamin C level was measured using spectrofotometry. Data collected were demographic characteristics include, risk factors, pattern food, nutrition intake using 24 hours recall, FFA and food record food, antropometri assessment, neurology examination using NIHSS. Result The subject consist of 29 patients (20 males and 6 females) with mean of age was 60 ± 10,1 years. There were 56,7% have less dietary profile. Vitamin C intake during observation was under recommendation (55,8 ± 15,4 mg/di. ; 54,2 + 14,2 mg/dL ; 56,1 ± 15,6 mg/dL ; 53,8 f 16,7 mg/dL). Based on FFA and recall, there was significant positive correlation between vitamin C plasma level with intake of vitamin C (r = 0,42 - 0,43 p<0,05). Based on record, there was positive correlation between the level of vitamin C plasma level with energy intake (r = 0,33 - 0,35 p50,05 ), and protein intake (r=0,32 - 0,35 p>0,05). There was significant correlation between level of vitamin C plasma with vitamin C intake (r=0,39 - 0,43, p<0,05) The plasma vitamin C Ievel of smoker lower than non smoker patients. There was no relationship between vitamin C plasma level and sex (p>0,05), age (p>0,05). During the observation there were no significant difference in score of NIHSS (9,8 ± 6,9 ; 9,8 ± 7,1 ; 9,5 ± 7,1 ; 9,3 ± 7,6 ). There was negative correlation between the level of vitamin C plasma and NIHSS score, as follows (r = -0,28 - -0,34, p>0,05). Conclusion This study showed that there were changes in the level of the vitamin C plasma of ischemic stroke patient. There was significant decrease in plasma vitamin C level between the third and fourth days and at admission The percentage of energy, protein, fiber and vitamin C intake under the recommendation. There was negative correlation between NIHSS and vitamin C plasma level.

Abstrak :
Introduksi: Iskemia yang terjadi di suatu lokasi di tubuh mengakibatkan kerusakan pada lokasi yang berjauhan; kondisi ini dikenal dengan sebutan cedera reperfusi. Vili intestinal merupakan satu target organ terjadinya kerusakan pada cedera reperfusi dan menjadi motor kegagalan multi organ sistemik. Hipotermia yang ditakuti pada syok justru menunjukkan keuntungan karena bersifat proteksi terjadinya kerusakan vili. Penelitian ini bertujuan membandingkan efek protektif hipotermia dan pre-conditioning pada iskemia. Metode. Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (hipotermia dan pre-conditioning). Dilakukan ligasi a. iliaca communis selama 4 jam, hipotermia sedang (28°C), dan iskemia pre-conditioning pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Setelah dekapitasi, diambil sampel ileum untuk pemeriksaan histopatologi. Hasil: Dari 18 kelinci eksperimental, 1 mengalami drop out karena infeksi. Dilakukan skoring kerusakan vili intestinal berdasarkan kriteria Pusponegoro yang dimodifikasi dengan nilai minimal 4 dan maksimum 12. Kelompok perlakuan pre-conditioning mengalami kerusakan paling minim (= 6,2 ) diikuti kelompok hipotermia (= 7,1). Konklusi: Pre-conditioning menunjukkan kerusakan paling minim; dengan kata lain memberi efek proteksi lebih baik dibandingkan dengan kelompok lainnya. ...... Introduction: Ischemia occurring in a location in the body results in damage to distant locations; this condition is known as reperfusion injury. Intestinal vilia is a target organ of the occurrence of damage to reperfusion injury and a motor failure of multi-organ systemic. The dreaded hypothermia in shock actually shows an advantage because it protects the occurrence of villous damage. This study aimed to compare the protective effect of hypothermia and pre conditioning on ischemia. Methods: Experimental studies were conducted on New Zealand White rabbit (n = 18) with one control group (ischemia) and two treatment groups (hypothermia and pre-blocking). Conducted ligation a. iliaca communist for 4 hours, moderate hypothermia (28°C), and preconditioning ischemia in each group. Then the rabbit is left alive for 8 hours. After decapitation, ileum samples were taken for histopathologic examination. Results: Of the 18 experimental rabbits, 1 had dropped out due to infection. Scores of villus intestinal damage were performed based on modified Pusponegoro criteria with a minimum score of 4 and a maximum of 2. The pre-treatment group experienced the least damage (=6.2) followed by the hypothermia group (=7,1). Conclusion: Pre conditioning shows the least damage; in other words gives a better protective effect compared to other groups.

Abstrak :
Latar Belakang: Acute Limb Ischemia (ALI) merupakan kondisi yang mengancam fungsi tungkai hingga keberlangsungan hidup seseorang. Corona Virus Disease of 2019 (COVID-19), telah menjadi pandemi sejak diumumkan oleh World Health Orgazination (WHO) pada Maret 2020, berdampak dalam penundaan diagnosis dan penanganan penyakit termasuk penyakit non COVID-19. Trombosis merupakan salah satu etiologi ALI diketahui meningkat kejadiannya sebagai komplikasi COVID-19. Namun, studi terkait karakteristik pasien ALI terkait pandemi COVID-19 tidak banyak dilakukan, terutama di Indonesia. Metode: Studi kohort retrospektif karakteristik pasien ALI di Rumah Sakit Cipto Mangunkusumo, Jakarta pada tahun 2018-2022. Seluruh pasien kemudian dibagi menjadi kelompok sebelum pandemi dan selama pandemi dengan batas Maret 2023. Keluaran yang dianalisis adalah keberhasilan revaskularisasi, re-intervensi, dan mortalitas saat perawatan. Analisis data menggunakan SPSS for Mac versi 25 secara bivariat dan multivariat. Hasil: Sebanyak 81 pasien menjadi subjek penelitian terdiri dari 28 (34,6%) pasien pada periode sebelum pandemi dan 53 (65,4%) pasien pada periode selama pandemi COVID-19. Pada periode selama pandemi COVID-19 didapatkan bahwa lebih banyak pasien rujukan (p = 0,001). Terdapat perbedaan bermakna antara kedua periode pandemi terhadap keberhasilan revaskularisasi (p = 0,013) tapi tidak pada keluaran re-intervensi dan mortalitas saat perawatan. Pada periode selama pandemi COVID-19, didapatkan 13 pasien yang memiliki riwayat/terkonfirmasi COVID-19 dengan keluaran yang secara deskriptif sebanding. Pada analisis multivariat, penggunaan fluoroskopi dan trombektomi memengaruhi keluaran keberhasilan revaskularisasi; klasifikasi Rutherford memengaruhi keluaran re-intervensi; dislipidemia, penyakit jantung, dan fluoroskopi memengaruhi keluaran mortalitas saat perawatan. Kesimpulan: Terdapat perbedaan keluaran tatalaksana pasien ALI sebelum dan selama pandemi COVID-19 pada keluaran keberhasilan revaskularisasi. Terdapat beberapa faktor yang memengaruhi keluaran pasien ALI sebelum dan selama pandemi COVID-19 ......Background: Acute Limb Ischemia (ALI) is a condition that threatens limb function and the survival of a patient. Corona Virus Disease of 2019 (COVID-19), has become a pandemic since it was announced by the World Health Organization (WHO) on March 2020, causing delays in the diagnosis and treatment of diseases including non-COVID-19 diseases. Thrombosis is one of the etiologies of ALI known to increase its incidence as a complication of COVID-19. However, there are not many studies regarding the characteristics of ALI patients related to the COVID-19 pandemic, especially in Indonesia. Methods: A retrospective cohort study of the characteristics of ALI patients at Cipto Mangunkusumo Hospital, Jakarta in 2018-2022. All patients were then divided into groups before the pandemic and during the pandemic with a deadline of March 2023. The outcomes analyzed were revascularization success, re-intervention, and mortality during treatment. Data analysis used SPSS for Mac version 25 in bivariate and multivariate ways. Results: A total of 81 patients were the subjects of the study consisting of 28 (34.6%) patients in the pre-pandemic period and 53 (65.4%) patients in the period during the COVID-19 pandemic. During the period during the COVID-19 pandemic, it was found that there were more referral patients (p = 0.001). There was a significant difference between the two pandemic periods on revascularization success (p = 0.013) but not on re-intervention outcomes and on-hospital mortality. During the period during the COVID-19 pandemic, there were 13 patients who had a history/confirmed COVID-19 with outcomes that were descriptively comparable. In multivariate analysis, the use of fluoroscopy and thrombectomy influenced the outcome of successful revascularization; Rutherford's classification influenced re-intervention outcomes; dyslipidemia, heart disease, and fluoroscopy affect the outcome of in-hospital mortality. Conclusion: There are differences in the outcome of the management of ALI patients before and during the COVID-19 pandemic in the outcome of revascularization success. There are several factors that influence patient outcomes for ALI before and during the COVID-19 pandemic.

Abstrak :
ABSTRAK Tujuan : Mengetahui perubahan kadar vitamin A plasma dan hubungannya dengan keadaan klinis penderita stroke iskemik Metodologi : Penelitian dengan desain potong lintang dilakukan pada 26 pasien stroke iskemik dengan onset kurang dari 48 jam. Pengambilan subyek penelitian dilakukan dengan cara consecutive sampling. Pemeriksaan kadar vitamin A dengan metode high performance liquid chromatography (HPLC), dilakukan pada saat pasien masuk, hari kedua, ketiga dan kelima perawatan. Data yang dikumpulkan meliputi : karakteristik demografi, faktor-faktor risiko, asupan nutrisi dengan metode recall 1 x 24 jam, food frequency questionnaire (FFQ) semik antitatif dan selama dirawat dg food record, indeks massa tubuh (IMT) serta penilaian klinis dengan National Institutes of Health Stroke Scale (NIHSS). Hasil : Jumlah subyek penelitian 26 orang (20 laki-laki dan 6 perempuan) dengan rerata usia 60.58 + 9.36 tahun. Faktor risiko terbanyak adalah hipertensi yaitu 80.1%. Berdasarkan WIT, 53.9% subyek masuk dalam kategori berat badan lebih. Tidak didapatkan hubungan yang bermakna antara asupan vitamin A, lemak dan vitamin E dengan kadar vitamin A plasma Rerata kadar vitamin A plasma masuk dalam kategori nominal dan menunjukkan peningkatan yang bermakna pada hari kelima perawatan (p: 0,035). Perjalanan klinis penyakit berdasarkan NIHSS menunjukkan perbaikan yang bermakna (p: 0,045 - 0,005). Terdapat korelasi negatif dan bermakna antara peningkatan kadar vitamin A plasma dengan penilaian NIHSS pada hari kelima perawatan (r:0,391, p: 0,049). Kesimpulan : Terdapat perbedaan yang bermakna antara kadar vitamin A plasma pada hari pertama dengan hari kelima perawatan. Terdapat perbedaan yang bermakna pada penilaian NIHSS selama lima hari perawatan. Terdapat korelasi negatif bermakna antara kadar vitamin A plasma dengan penilaian NIHSS pada hari kelima perawatan. Kata kunci : Vitamin A, stroke iskemik

---

ABSTRACT Levels Of Vitamin A In Ischemic Stroke Patients Objective : The purpose of this study was to investigate the time course of plasma vitamin A changes and its relation with clinical state in ischemic stroke patients. Metodology : A cross sectional study was carried out among 26 patients with ischemic stroke of recent onset (< 48 hours). Consecutive sampling method was used to obtain the subject. Plasma vitamin A level was measured using high performance liquid chromatography (HPLC) on admission, and days 2, 3, and 5. Data collected were demographic characteristics, risk factors of stroke, nutrient intake using 24 hours recall, semi quantitative food frequency questionnaire (FFQ) and food record method when hospitalized, body mass index (BMI), and clinical condition using National Institutes Health Stroke Scale (NIHSS). Result, : The subjects consist of 26 patients (20 males and 6 females) with a mean of age 60.58 + 9.36 years. Hypertension was the most modifiable risk factors (80.1%) that found. Based on SMI, 53.9% subjects had overweight. There were no relationship between nutrient intake (vitamin A, fat and vitamin E) and plasma vitamin A level. Plasma vitamin A level was still in the normal range and gradually increased in the following days, it showed a significant increase on day 5 since admission (p: 0.035). The score of NIHSS was significantly decreased along hospitalized (p: 0.045 - 0.005)_ A significant negative correlation between plasma vitamin A levels and NIHSS score on day 5 was found (r: -0.391, p: 0.049). Conclusion : There was significant difference in plasma vitamin A level between day 5 and at admission. Scores of NIHSS were significantly different in the following days. A significant negative correlation between plasma vitamin A levels and scores of NIHSS on day 5 was found.

Abstrak :
Latar Belakang. Cedera Reperfusi Iskemia merupakan eksaserbasi paradoks mengakibatkan disfungsi dan kematian sel setelah aliran darah direstorasi ke jaringan yang sebelumnya iskemia. Pada iskemia tungkai akut, reperfusi menimbulkan reaksi kompleks melibatkan inflamasi lokal maupun sistemik dengan dampak lokal sindroma kompartemen dan dampak sistemik berupa disfungsi hingga kegagalan multi organ. Platelets activating factors (PAF) sebagai mediator inflamasi pospholipid mempunyai efek fisiologis yang poten dan beragam, sehingga meningkatkan respon inflamasi pada cedera reperfusi iskemik. Berbagai upaya untuk mencegah dan memperingan cedera reperfusi iskemik, antara lain penggunaan prosedur ischemic preconditioning, antioksidan dan terapi anti-sitokin telah diteliti namun hasil dan manfaat klinisnya belum memuaskan. PTX, phosphodiesterase nonspesifik derivat xanthine, memperlihatkan efek penekanan inflamasi dan menghambat interaksi lekositendotel yang menjanjikan dalam mencegah cedera reperfusi. Namun hasil penelitian mengenai peran pentoxifylinne dalam menekan reaksi inflamasi melalui penekanan PAF pada iskemia tungkai akut tidak konsisten. Sehingga penelitian ini bertujuan untuk menilai peran PTX dalam mengurangi cedera reperfusi melalui penekanan mediator inflamasi PAF pada hewan coba kelinci dengan Reperfusi Iskemia tungkai akut. Metodologi. Dilakukan tindakan iskemik tungkai kiri selama 3 jam yang diikuti 2 jam periode reperfusi pada 10 ekor kelinci New Zealand White jantan yang dibagi menjadi 2 kelompok (kelompok pentoksifin dan kelompok kontrol) secara acak. Pada kelompok perlakuan diberikan PTX 30 menit sebelum reperfusi dengan dosis initial bolus 40 mg/kgBB diikuti dengan dosis rumatan 1 mg/kg BB/jam hingga 3 jam periode reperfusi. Pada kelompok kontrol diberikan cairan garam fisiologis dengan kecepatan dan volume yang sebanding. Tindakan Iskemik dilakukan dengan oklusi arteri iliaka komunis sinistra mengunakan klem selama 3 jam kemudian dilanjutkan dengan restorasi aliran darah. Pengambialn sampel untuk pemeriksaan kadar PAF dilakukan pada 2,5 jam iskemik dan pada 2 jam reperfusi. Hasil. Pada periode Iskemik dua jam tiga puluh menit tidak mengakibatkan perbedaan bermakna (p=0,754), kadar rerata PAF pada kelompok PTX 13,09 ± 0,41 pg/mL dan kelompok kontrol I3,38 ± 0,28 pg/mL. Pada jam ke dua tindakan reperfusi ditemukan perbedaan bermakna (p=0,009) kadar rerata PAF dari kelompok PTX menurun menjadi 11,36±0,78 pg/mL dan kelompok kontrol meningkat menjadi 25,5±0,78 pg/dL. Kesimpulan. PTX menurunkan kadar PAF plasma kelinci dengan cedera reperfusi iskemikia tungkai akut.

---

Background. Ischemic reperfusion injury is a paradoxical exacerbation of cell dysfunction and death following the restoration of blood flow to previously ischemic tissue. Restoration of blood flow is essential to salvage ischemic tissue, however reperfusion itself paradoxically causes further damage to the ischemic tissue, threatening function and viability both organ local and distal through the inflammation response. In Acute limb ischemia, there are essentially two components: a local component that can result in increasing the regional damage from ischemia inflammatory responses which may result in local syndrome, compartment syndrome, and systemic syndrome, multi organ dysfunction and failure. Several method and attempt had been studied and performed to prevent and attenuate reperfusion injury such as, ischemic preconditioning, antioxidant, and anti-cytokine therapy, but their clinical benefit were not satisfactory. Pentoxifylline has emerged as an agent that may attenuate inflammation response through several mechanisms. However, studies on PTX and its function to prevent and attenuate inflammation response through attenuating PAF in acute limb ischemic were not consistent. In this study the role of PTX and its function to prevent and attenuate inflammation response through attenuating PAF in acute limb ischemic was investigated. Methods. Acute limb ischemia in the left lower limbs of 10 New Zealand White male rabbit were performed for 3 hour followed by 2 hours period of ischemia. The rabbits were randomly separated into 2 groups of five (group pentoxifylinne and group control). The Pentoxifylline group was given PTX 40 mg/kg bolus half an hour prior to reperfusion followed by maintenance dose 1 mg/kg/hour until 2 hour post reperfusion, while the control group was given normal saline solution with comparable volume and rate administration. Acute limb Ischemic procedure was performed by direct occlusion of the left femoral artery using non traumatic clamp and followed by releasing the clamp after 3 hours of occlusion. Level of PAF were measured after 2.5 hour of ischemic period and after 2 hours of reperfusion period. Results. After 2.5 hours of ischemic period, the mean PAF levels did not show any significant difference (p=0.754). The mean PAF level of pentoxifylline group 13.09f0.41 pg/mL, while the mean PAF level of control group 13.38±0.28 pg/mL, After 2 hours period of reperfusion, there were significant differences of mean PAF level between the two groups (p=0.009). The mean PAF level in the control group increase by 12.1 110.79 to became 25.5±0.78 pg/dL, while the mean PAF level of the PTX group decrease by 1.73f1.1 pg/mL and became 11.36±0.78 pg/m L. Conclusion. PTX decreased the PAF level in rabbits with acute limb ischemic reperfusion injury.

Abstrak :
Latar Belakang : Pada penelitian sebelumnya terdapat korelasi yang positif antara kemampuan deformabilitas, jumlah eritrosit dan shear rate yang rendah yang berakibat terhadap perfusi otak yang akhirnya akan mempengaruhi perburukan pasien stroke iskemik. Hal ini bisa dilihat dengan pemeriksaan Laju Endap Darah (LED). LED merupakan metode yang mudah dan merupakan petunjuk tidak langsumg terhadap deformabilitas eritrosit. Jika ada kondisi yang meningkatkan kadar fibrinogen atau makroglobulin lainnya akan menyebabkan eritrosit mengendap lebih cepat. Dengan melihat konsep ini kami melakukan penelitian untuk mengeksplorasi korelasi antara komponen eritrosit dengan keluaran klinis stroke iskemik. Obyektif : Apakah LED ini mempunyai nilai prognostik klinis. Desain dan Metode: Potong Lintang sesuai kriteria seleksi dan dieksplorasi apakah intensitas respon fase akut terdapat informasi keluaran klinis jangka pendek dengan melakukan uji korelasi antara LED pada pasien dalam 72 jam sejak onset stroke dengan keluaran Minis 7 hari kemudian yang diukur dengan National Institute of Health Stroke Scale (N1HSS). Hasil: 51 pasien stroke iskemik akut ,dalam 72 jam dari onset klinis. semua pasien dilakukan neuroimejing and pemeriksaan darah rutin, tennasuk LED. 28 pasien (54,9%) terdapat peningkatan LED. LED meningkat (Laki-laki >13 dan wanita > 20) sebanding dengan penigkatan NIHSS. Dengan uji korelasi Spearman Koefisien korelasinya moderat (r=0,642) dan berhubungan bermakna (p < 0,001).

---

Background: In the recent study, there is a positive correlation among deformability, the amount of erythrocyte and low shear rate which impact to cerebral perfusion. By reducing the cerebral perfusion could increased the infarct size and clinical manifestation worse. The erythrocyte sedimentation rate (ESR) is a simple method and an indirect marker of erythrocyte deformability. If any conditions that increased the amount of fibrinogen and other macroglobulin will increase the ESR. By this concept we did the research to explore the correlation between erythrocyte component and the outcome of ischemic stroke. Objective: To evaluate whether the ESR can be used as a clinical prognostic value. Design and Methods: Consecutive Cross sectional study and explore the intensity of the acute-phase response by the correlation test between the ESR within 72 hour from the onset of stroke and the out come at day 7 measured by National ?Institute of Health Stroke Scale (NIHSS) and whether provided further information concerning the short term out come. Results: 51 acute ischemic stroke, within 72 hours from clinical onset. All patients had neuroimaging and routine blood tests, including erythrocyte sedimentation rate (ESR). 28 patients (54,9%) had increased ESR. The ESR was increased (men >13 and woman > 20) as the NIHSS was high. With Spearman Correlation test the coefficient correlation is moderate (r4,642) and was significant correlated (p < 0,001). Conclusion: The ESR is a predictor of short term stroke outcome. These findings might be indicative the amount of fibrinogen, hyperviscosityand the erythrocyte deformability changes. Key Words : ischemic stroke ; erythrocyte sedimentation rate ; prognosis.

Abstrak :
Latar Belakang. Komplikasi tindakan revaskularisasi pasca suatu periode iskemik mulai menjadi perhatian kalangan medis sejak awal abad ke-20. iskemik tungkai akut merupakan masalah kegawatan kardiovaskular dan tindakan reperfusi terhadap jaringan yang iskemik ternyata sexing memperburuk cedera jaringan yang ada, bahkan sampai dilakukan amputasi. Pada ceders reperfusi iskemik (R-1) terjadi perubahan sifat hemoreologi darah (hematokrit, viskositas, dan deformitas set darah merah). Pentoksifilin (PTXF) mempunyai kemampuan memperbaiki cedera reperfusi dengan meningkatkan aliran darah perifer, memperbaiki deformitas sel darah merah, menurunkan viskositas darah, dan menekan agregasi platelet. Tujuan Penelitian. Untuk mengetahui pengaruh pemberian PTXF terhadap faktor hemoreologi darah pada cedera R-I tungkai akut. Metode. Penelitian dilakukan pada kelinci jantan ras New Zealand White Rabbit (NZW) yang berasal dari 1 galur sebanyak 10 ekor usia 5 bulan dengan berat badan rata-rata 2,5-3 kg. Kemudian hewan coba dibagi dalam 2 kelompok, yakni 5 ekor kelinci kelompok perlakuan diberi PTXF dengan dosis 40 mglkgBB yang diikuti dosis rumatan 1 mglkgBBljam dan 5 ekor kelinci sebagai kontrol diberi cairan NaCl 0,9% dengan kecepatan yang sama seperti kelompok perlakuan. Dilakukan oklusi arteri iliaka komunis sinistra dan setelah 2,5 jam iskemik diambil darah untuk pemeriksaan hematokrit dan viskositas, setelah itu segera diberikan PTXF. Pada jam ke-3 dilakukan reperfusi (membuka oklusi) dan 2 jam setelah reperfusi diambil darah untuk pemeriksaan hematokrit dan viskositas. Data hasil pemeriksaan dianalisis dengan statistik program SPSS 13 dengan menggunakan uji parametrik General Linear Model (GLM) untuk pengukuran berulang. Hasil. Nilai rerata hematokrit kelompok PTXF fase iskemik 37,06+3,88% dan fase reperfusi 34,20+1,90% dengan delta penurunan 2,86%. Nilai rerata hematokrit kelompok nonPTXF fase iskemik 35,88+5,31% dan fase reperfusi 32,90+4,61% dengan delta penurunan 2,98%. Antara pengukuran pertama dan kedua, baik kelompok PTXF dan nonPTXF tidak terdapat perbedaan bermakna (per, i 9 dan p=0,37). Analisis statistik nilai rerata hematokrit antara kelompok PTXF dan nonPTXF tidak terdapat perbedaan bermakna (p=0,74). Nilai rerata viskositas kelompok PTXF fase iskemik 5,25+0,77 ep dan fase referfusi 4,69+0,70 cp dengan delta penurunan 0,558 cp. Nilai rerata viskositas kelompok nonPTXF fase iskemik 4,54+0,48 cp dan fase reperfusi 4,48+1,31 cp dengan delta penurunan 0,066 cp. Antara pengukuran pertama dan kedua, baik, kelompok PTXF dan nonPTXF tidak terdapat perbedaan bermakna secara statistik (p~,26 dan p=0,92). Analisis statistik pada nilai rerata viskositas antara kelompok PTXF dan nonPTXF tidak terdapat perbedaan bermakna (p=0,53). Kesimpulan. Pemberian PTXF pada kelompok perlakuan memperlihatkan hasil tidak bermakna dalam menurunkan nilai hematokrit dan viskositas darah dibanding kelompok kontrol pads keadaan ceders R-I tungkai akut.

---

Background: Complications of revascularization after an ischemic period has attract attention from clinicians since the beginning of 20th century. Acute limb ischemia is an emergency cardiovascular problem and revascularization procedures of ischemic tissue has been documented to worsen tissue damage to the extend of a need for limb amputation. In ischemic reperfusion injury, changes in blood hemorheology occurs (hematocrit, viscosity and eryhtrocyte deformities). Pentoxifylline (PTXF) has the ability to repair reperfusion injury by increasing peripheral blood flow, repairing eryhtrocyte deformities, decreasing blood viscosity dan suppressing platelet agregation. Objectives: To investigate the effect of pentoxifylline administration toward hemorheology changes in acute limb ischemic reperfusion injury. Methods: We studied 10 pure strain New Zealand White Rabbit (NZW) age 5 months with mean weight of 2.5-3 kg. The subjects were divided in two groups; 5 of the experimental rabbit were given PTXF 40 mg/kg body weight followed by a maintenance dose of 1 mg/kg body weight/hour, while subjects in the control group received a similar administration of NaCl 0.9%. We performed occlusion of the left common iliac artery and after an ischemic period of 2.5 hours blood samples were taken for hematocrit and viscosity measurement. PTXF were given soon afterward. On the third hour the artery occlusion were opened and after another two hours blood samples were again taken for hematocrit and viscosity measurement. Data analysis were performed by SPSS 13, using parametric test with general linear model (GLM) for repeated measurements. Results: The mean hematocrit value for the PTXF group in the ischemic period were 37.0613.88%, and in the reperfusion period were 34.2011.90%, with a decrease of 2.86%. The mean hematocrit value for the control group in the ischemic and reperfusion period were 35.8815.31% and 32.90±4.61% , respectively, with a decrease of 2.98%. There were no significant difference between the first and second hematocrit measurements both in the experimental and control group (p-0.19 and p=0.37). Statistical analysis of mean hematocrit value between the two groups also showed no significant difference (p=0.74). The mean viscosity value for the PTXF group in the ischemic period were 5.2510.77 cp and in the reperfusion period were 4.6910.70 cp with a difference of 0.558 cp. The mean viscosity value for the control group in the ischemic and reperfusion period were 4.54±0.8 cp and 4.4811.31 cp, respectively, with a decrease of 0.066 cp. There were no statistically significant difference between the first and second viscosity measurements both in the experimental and control group (p=0.26 and p=0.92). Statistical analysis of mean viscosity value between the two groups also showed no significant difference (p=0.53). Conclusion: PTXF administration in the experimentally induced acute limb ischemic reperfusion injury in rabbits have no benefits to decrease hematocrit and viscosity values compared to control group.

Abstrak :
Stroke adalah penyebab kematian kedua serta penyebab kecacatan ketiga di dunia. Penatalaksanaan yang menjadi standar baku emas pada stroke iskemik akut adalah trombolisis. Angka tindakan trombolisis masih rendah, bawah standar yang diharapkan sebesar 12% (Hoffmeister et al., 2016). Kondisi ini terjadi secara global, baik negara maju maupun negara berkembang. Oleh karena itu, perlu dilakukan penelitian mengenai penyebab rendahnya cakupan tindakan trombolisis pada penderita stroke di berbagai negara di dunia. Penelitian ini merupakan systematic review dengan melakukan analisis faktor konfirmatori. Penelusuran dilakukan pada basis data dari PubMed, EMBASE, SpringerLink, dan ScienceDirect dari tahun 2012 sampai dengan 2022. Dilakukan juga penelusuran pada Google Schoolar dan Pusinfokesmas FKM UI serta Universitas Indonesia Library. Pelaporan systematic review ini menggunakan panduan PRISMA. Pada hasil penelusuran berdasarkan kata kunci dan kriteria yang sudah ditetapkan didapatkan total 4971 jurnal didapatkan dari berbagai negara di dunia. Setelah dilakukan skrining terdapat 101 jurnal, kemudian setelah diteliti, terdapat 26 studi terpilih yang diekstraksi dan disintesis. Analisis faktor yang diteliti mengikuti kerangka kerja Donabedian yang mengevaluasi pelayanan kesehatan. Pada hasilnya didapatkan bahwa pada komponen struktur pelayanan trombolisis terdapat beberapa hal yang menjadi penyebab rendahnya trombolisis pada pasien stroke iskemik di berbagai negara yaitu kurangnya penggunaan telemedisin pada lokasi yang jauh dari pusat stroke, belum optimalnya pelayanan EMS sehingga meningkatkan door to needle time, tim stroke belum berkompeten dan berpengalaman, faktor pembiayaan dari mahalnya biaya pelayanan dan kurang mendukungnya penjaminan dari asuransi, tipe rumah sakit yang belum mendukung, SOP rumah sakit yang belum sempurna, kurangnya pelatihan, kultur organisasi rumah sakit yang belum mendukung, serta faktor dari pasien sendiri. Proses trombolisis dilakukan di beberapa tempat, antara lain di pusat stroke di rumah sakit besar, maupun di rumah sakit kecil dengan telestroke. output dari pelayanan trombolisis yaitu cakupan pemberian trombolisis pada pasien stroke akut di rumah sakit dimana pada penelitian ini ditemukan memiliki angka yang masih relatif kecil. Disarankan kepada manajemen rumah sakit dan otoritas kesehatan setempat untuk meningkatkan kesadaran masyarakat mengenai stroke dan langkah yang harus dilakukan saat terjadi stroke. Rumah sakit juga perlu untuk meningkatkan kapabilitas tim stroke dengan pelatihan dan simulasi, menyempurnakan prosedur pelayanan melalui hospital by law, meningkatkan kemampuan EMS sehingga door to needle time berkurang, dan mencoba menerapkan berbagai metode trombolisis seperti telestroke untuk pasien yang lokasinya jauh, metode Helsinki dan drip and ship yang terbukti menurunkan penundaan pemberian trombolisis ......Stroke is the second leading cause of death and the third cause of disability in the world. The gold standard treatment for acute ischemic stroke is thrombolysis. The rate of thrombolysis is still low, below the expected standard of 12% (Hoffmeister et al., 2016). This condition occurs globally, both developed and developing countries. Therefore, it is necessary to conduct research on the causes of the low coverage of thrombolysis in stroke patients in various countries in the world. This is a systematic review research by conducting confirmatory factor analysis. Searches were conducted on databases from PubMed, EMBASE, SpringerLink, and ScienceDirect from 2012 to 2022. A search was also carried out on Google Schoolar and the FKM UI's Pusinfokesmas and the University of Indonesia Library. This systematic review report uses PRISMA guidelines. In the search results based on keywords and predetermined criteria, a total of 4971 journals were obtained from various countries in the world. After screening there were 101 journals, then after being researched, there were 26 selected studies that were extracted and synthesized. The factor analysis studied followed the Donabedian framework that evaluates health services. In the results, it was found that in the structural component of the thrombolysis service there are several things that cause low thrombolysis in ischemic stroke patients in various countries, namely the lack use of telemedicine at locations remote from the stroke center, not optimal EMS services that increasing door to needle time, the stroke team has not competent and experienced, the financing factor is the high cost of service and the lack of support for insurance coverage, the type of hospital that does not supported, the hospital SOP is not perfect, the lack of training, the organizational culture of the hospital is not supportive, as well as factors from the patients themselves. The thrombolysis process is carried out in several places, including in stroke centers in large hospitals, as well as in small hospitals with telestroke. The output of thrombolysis services is the coverage of thrombolysis in acute stroke patients in hospitals, which in this study were found to have relatively small numbers. It is recommended to the hospital management and local health authorities to increase public awareness about stroke and the action that must be taken when a stroke occurs. Hospitals also need to improve stroke team capabilities with training and simulations, improve service procedures through hospital by law, improve EMS capabilities so that door-to-needle time is reduced, and try to apply various thrombolysis methods such as telestroke for patients who are placed remotely, the Helsinki method and drip and ship which has been shown to reduce delays in thrombolysis.

Abstrak :
ABSTRAK
Sitikolin adalah neuroprotektor yang paling banyak digunakan untuk memperbaiki kerusakan neurologis pada penderita stroke iskemik, namun efektivitas sitikolin masih diperdebatkan berdasarkan penelitian ilmiah karena memberikan hasil yang heterogen. Penelitian bertujuan untuk mengetahui pengaruh terapi sitikolin terhadap fungsi neurologis yang dinilai dengan The National Institute of Health Stroke Scale (NIHSS) dan kemampuan fungsional yang dinilai dengan Barthel Index. Penelitian pada pasien stroke iskemik berdasarkan terapi sitikolin yang dilakukan di 18 rumah sakit di Indonesia yang berkontribusi dalam registri penyakit stroke. Desain studi penelitian ini adalah kohort retrospektif menggunakan data registri stroke Indonesia. Penilaian perbaikan fungsi neurologis berdasarkan perubahan nilai NIHSS sebesar > 2 poin dan penilaian kemampuan fungsional berdasarkan perubahan nilai Barthel Index sebesar > 20 poin yang diukur pada saat masuk dan keluar rumah sakit. Pasien stroke iskemik yang mendapat terapi sitikolin memiliki peluang perbaikan fungsi neurologis sebesar 1,34 kali (CI 95% 1,058-1,658) dibanding pasien yang tidak mendapat terapi sitikolin setelah dikontrol variabel neurorestorasi. Peluang perbaikan kemampuan fungsional pasien stroke iskemik yang mendapat terapi sitikolin sama dengan pasien yang tidak mendapat sitikolin setelah dikontrol dengan neurorestorasi dengan relative risk 1,07 (CI95% 0,879-1,293; p=0,53).

---

ABSTRACT
Citicoline is the most widely used neuroprotective to repair neurological deficit in ischemic stroke patients, however the effectiveness of citicoline is still controversial and raise arguments against scientific research because it provided heterogeneous results.The objectives of the study are to identify citicoline effect on neurological function improvement using The National Institute of Health Stroke Scale (NIHSS) and functional ability improvement using Barthel Index (BI) in the treatment of ischemic stroke patients at 18 hospitals involved in Indonesia stroke registry. The design of this study is retrospective cohort study using stroke registry data. Improvement of neurological function assessed by changes of NIHSS score >2 and improvement of functional ability assesed by changes of Barthel Index score > 20 as measured at the time of admission and discharge of the hospital.The result shows that the probability of functional neurological improvement on citicoline treatment group is higher than no citicoline treatment group with adjusted RR by neurorestoration is 1,34 (95% CI 1.058 to 1.658, p=0,0014). There is no difference of functional ability improvement between citicoline and no citicoline treatment group, with adjusted RR by neurorestoration is 1.07 (CI95% 0.879 to 1.293; p=0,53).