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"Tuberkulosis masih menjadi masalah di dunia terutama di Indonesia sebagai negara ke-3 terbesar penyumbang penderita tuberkulosis baru. Etambutol merupakan salah satu jenis obat yang dipakai dalam pengobatan tuberkulosis di Indonesia. Etambutol memiliki efek samping gangguan fungsi mata yaitu neuropati etambutol. Diagnosis neuropati etambutol sulit ditegakkan karena sebagian besar anatomi fundus yang normal dan sering terdiagnosis terlambat sehingga kerusakan permanen dapat terjadi. Mengingat besarnya dampak yang ditimbulkan toksisitas etambutol, diperlukan upaya mendeteksi kelainan ini sedini mungkin. Pemeriksaan pERG dan mfERG dilaporkan pada beberapa studi bermanfaat dalam mengkonfirmasi kasus toksisitas etambutol okular setelah terdapat gangguan secara klinis. Belum diketahui diantara pemeriksaan pERG dan mfERG yang dapat menunjukkan perubahan terlebih dahulu untuk mendeteksi toksisitas etambutol sebelum terjadi gangguan klinis. Penelitian ini menggunakan metode uji klinis prospektif pada 40 sampel mata dianalisis dengan uji T berpasangan dan Wilxocon. Pemeriksaan dilakukan dengan pemeriksaan Snellen chart, HRR Richmond Plates, Pelli Robson, pattern ERG dan multifokal ERG pada pasien yang terdiagnosis tuberkulosis kategori 1 selama 2 bulan pertama. Visus, sensitifitas warna dan kontras tidak berubah pada seluruh pasien selama follow-up 2 bulan. Terdapat penurunan waktu implisit P50 sebesar -1,27± 4,71 mS (p=0,049) dan amplitudo gelombang N95 sebesar -0,93± 4,49 μV (p=0,038) yang bermakna secara statistik pada pemeriksaan pERG. Tidak terdapat perubahan bermakna pada gelombang N1 dan P1 pada pemeriksaan mfERG. Pemeriksaan gelombang pERG lebih dahulu mengalami perubahan dibandingkan mfERG.

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Tuberculosis (TB) are world health problem, especially in Indonesia as 3rd biggest leading for the new emerge patient TB. Ethambutol is included one of the standard therapy that still used to treat TB patient in Indonesia. Ethambutol have side effect that related with eye disease called neuropathy ethambutol. Neuropathy ethambutol is hardly to diagnose due to most cases have normal fundus anatomy and therefore frequently delayed to detect, permanent damage could happen in this situation. As we know that damage could happen from ethambutol toxicity, it necessary to detect this disease as soon as possible. Examination pattern electroretinography (pERG) and multifocal electroretinography (mfERG) is reported has an advantage to detect and to confirm ocular toxicity by ethambutol after the clinical problem had emerge. It is not yet known neither pERG nor mfERG could detect any changes to detect ethambutol ocular toxicity before the clinical problem emerge.

This study use prospective clinical trial to 40 eye sample and analyzed with paired t and wilcoxon test. The examination use Snellen chart, HRR Richmond Plates, Pelli Robson, pERG and mfERG in tuberculosis category 1 patient with 2 months follow-up. Visual acuity, sensitivity in color and contrast are normal to whole patient for 2 months follow-up. In pERG examination we found mean implicit time wave P50 are shorten by -1,27± 4,71 mS (p=0,049) and mean of amplitude wave N95 are reduced by -0,93± 4,49 μV (p=0,038) and both are statistically significant. In mfERG examination we did not find any statistically significant changes in both wave N1 and P1. Pattern ERG had earlier changes compare to mfERG."

"[ABSTRAKLatar Belakang: Kusta merupakan penyakit infeksi penyebab neuropati perifer paling sering. Neuropati otonom merupakan salah satu neuropati perifer yang perlu dideteksi dini dengan pemeriksaan sederhana untuk mencegah kecacatan lebih lanjut karena memiliki gejala subklinis. Tujuan: Menguji sensitivitas dan spesifisitas pemeriksaan Stimulated Skin Wrinkle (SSW) terhadap Sudoscan dalam mendeteksi neuropati otonom pada kusta multibasiler. Metode penelitian: Penelitian menggunakan uji diagnostik pemeriksaan SSW terhadap Sudoscan pada penderita kusta multibasiler yang telah didiagnosis di poliklinik Kulit dan Kelamin RS Cipto Mangunkusumo, Jakarta. Penelitian dilakukan selama tiga bulan (Maret-Mei 2015). Anamnesis, pemeriksaan fisik, SSW dengan krim Eutectic mixture of local anesthetic (EMLA), dan Sudoscan dilakukan pada setiap subjek penelitian. Hasil dianalisis untuk mendapatkan nilai sensitivitas dan spesifisitas. Hasil: Diperoleh 70 subyek penelitian. Prevalensi gangguan otonom berdasarkan pemeriksaan SSW, Sudoscan dan klinis berturut-turut sebesar 64.3%, 32.9% dan 85.7%. Berdasarkan kurva ROC pemeriksaan SSW terhadap Sudoscan, didapatkan nilai AUC sebesar 0,779. Setelah diuji dengan tabel 2x2 didapatkan nilai sensitivitas 95.7%, spesifisitas 51.1%, nilai prediksi positif 48.9% dan nilai prediksi negatif 96%. Kesimpulan: Pemeriksaan SSW dapat menjadi pemeriksaan penyaring yang sederhana dalam mendeteksi neuropati otonom pada kusta tipe multibasiler, dengan sensitivitas yang tinggi.

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ABSTRACTBackground: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.;Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity., Background: Leprosy is the commonest infectious disease causes peripheral neuropathy. Autonomic neuropathy is a peripheral neuropathy that is important to detect with a simple examination to prevent further disability because the subclinical manifestation. Objective: Examine the sensitivity and specificity of Stimulated Skin Wrinkle (SSW) examination against Sudoscan to detect autonomic neuropathy in multibacillary leprosy. Method: The study consists of diagnostic test of SSW examination upon Sudoscan among multibacillary leprosy patients previously diagnosed in the Dermatology & Venerealogy Clinic in Cipto Mangunkusumo Hospital, Jakarta. The study was conducted in three months (March-May 2015). History, physical examination, SSW with Eutectic mixture of local anesthetic (EMLA) cream, and Sudoscan was performed upon every subject. Results are analyzed to obtain sensitivity and specificity level. Results: There are 70 subjects participated. Prevalence of autonomic disturbance by SSW, Sudoscan and clinical are 64.3%, 32.9% and 85.7% respectively. Based on ROC curve of the SSW examination against Sudoscan, the obtained AUC value is 0.779. After testing with chi-square, the following values were obtained: sensitivity 95.7%, specificity 51.1%, positive predictive value 48.9%, and negative predictive value 96%. Conclusion: SSW examination is a simple screening test that can detect autonomic neuropathy among multibacillary leprosy, with high sensitivity.]"

"ABSTRAKLatar Belakang: Neuropati perifer merupakan komplikasi neurologis tersering pada pasien HIV. Stavudin, yang dikaitkan dengan risiko neuropati perifer, mulai ditinggalkan sebagai pilihan pertama terapi antiretroviral. Penelitian ini bertujuan untuk mengetahui angka kejadian neuropati pada pasien HIV dalam terapi antiretroviral non stavudin menggunakan multimodalitas pemeriksaan, dan faktor risiko yang berhubungan.Metode Penelitian: Penelitian berdesain potong lintang menggunakan data sekunder dari penelitian JakCCANDO ditambah dengan data primer dari pasien HIV dalam terapi antiretroviral non stavudin minimal 12 bulan yang berobat di Unit Pelayanan Tepadu (UPT) HIV Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo (RSUPNCM). Anamnesis dan penelusuran data faktor risiko, skrining klinis Brief Peripheral Neuropathy Screen (BPNS), elektroneurografi, dan Stimulated Skin Wrinkling (SSW) dengan krim lidokain:prilokain 5% dilakukan pada setiap subjek penelitian. Data dianalisis dengan SPSS 17.0.Hasil: Angka kejadian polineuropati simetris distal (PSD) pada 68 subjek penelitian berdasarkan BPNS, elektroneurografi, SSW, dan kombinasi ketiga modalitas ialah 16,2%, 25%, 29,4%, dan 52,9%. Subjek dengan CD4 nadir kurang dari 50 sel/l memiliki risiko PSD sebesar 2,85 kali lebih tinggi dibandingkan kelompok subjek dengan CD4 nadir yang lebih tinggi (IK 95% 1,99-8,29). Subjek yang memiliki tinggi badan lebih dari sama dengan 170 cm (p<0,03) dan viral load lebih dari sama dengan 35.000 kopi/ml (p<0,05) memiliki rerata kecepatan hantar saraf sensorik tungkai bawah lebih rendah dibandingkan subjek dengan tinggi badan dan viral load yang lebih rendah.Kesimpulan: Angka kejadian neuropati perifer pada pasien HIV masih cukup tinggi yaitu 52,9% dari subjek penelitian, meskipun stavudin tidak lagi digunakan. Penggunaan multimodalitas pemeriksaan memberikan kemampuan deteksi neuropati lebih banyak dibandingkan modalitas pemeriksaan tunggal. Subjek dengan CD4 nadir kurang dari 50 sel/l, 2,85 kali lebih berisiko mengalami PSD. Penelitian ini juga menunjukkan adanya hubungan antara tinggi badan lebih dari sama dengan 170 cm dan viral load lebih dari sama 35.000 kopi/ml terhadap abnormalitas parameter elektroneurografi saraf sensorik tungkai bawah.

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ABSTRACT

Background: Peripheral neuropathy was a common neurologic complications in HIV patients. Stavudine, which was often associated with neuropathy risk, is no longer used as first line HAART. This study was aimed to determine prevalence of neuropathy in HIV patients receving HAART without stavudine using multi modalities examination, and associated risk factors.

Materials and Method: A cross-sectional study was undertaken using secondary data from JakCCANDO study subjects and primary data from HIV patients receiving antiretroviral therapy without stavudine for minimum 12 months in Integrated HIV Outpatient Clinics of Cipto Mangunkusumo General Hospital. All subjects were performed history taking, Brief Peripheral Neuropathy Screen (BPNS), electroneurography, and Stimulated Skin Wrinkling (SSW) using lidocaine:prilocaine 5% cream. Data analysis was done using SPSS 17.0.

Results:Prevalence of symmetric distal polyneuropathy (DSP) from 68 study subjects based on BPNS, electroneurography, SSW, and combination of three modalities were 16,2%, 25%, 29,4%, and 52,9%. Subjects with nadir CD4 less than 50 cells/l were at increased risk of DSP 2,85 times larger than subjects with higher nadir CD4 (CI 95% 1,99-8,29). Subjects with a height of equal or more than 170 cm (p<0,03) and viral load of equal or more than 35.000 copies/ml (p<0,05) had significantly decrease mean of lower extremities sensory nerve conduction velocities based on electroneurography compared to subjects with lower height and viral load.

Conclusions: Peripheral neuropathy remained a numerous neurological complication, as much as 52,9% of study subjects, even when stavudine was no longer used. Multiple diagnostic tools used in this study gave higher neuropathy number compared to single diagnostic modality. Subjects with nadir CD4 less than 50 cells/l had 2,85 times higher risk of having DSP. There were also correlation between height equal or more than 170 cm and viral load equal or more than 35.000 copies/ml with electroneurographic parameter abnormalities of sensory nerve in lower extremities."

"Terdapat sekitar 1.400 ton merkuri dilepas ke lingkungan global dari penggunaan merkuri di sektor Pertambangan Emas Skala Kecil (PESK). Pemakaian merkuri dalam pengolahan emas yang kurang memperhatikan lingkungan memungkinkan media lingkungan tercemar dan menyebabkan masyarakat di sekitar pertambangan ikut terpajan merkuri dan berdampak pada kesehatan. Neuropati perifer merupakan salah satu gangguan kesehatan yang terjadi karena terganggu atau rusaknya sistem saraf sensorik dan atau motorik akibat akumulasi merkuri di dalam tubuh. Penelitian ini bertujuan menentukan hubungan antara kadar merkuri dalam rambut terhadap gangguan neuropati pada masyarakat di wilayah PESK Kecamatan Cimanggu Kabupaten Pandeglang Banten. Penelitian ini menggunakan desain studi cross sectional dengan teknik total sampling. Terdapat hubungan yang signifikan dan substansi antara kadar merkuri dalam rambut dengan gangguan neuropati perifer setelah di kontrol oleh variabel umur dan status merokok yaitu dengan p value 0,001 dimana responden dengan kadar merkuri dalam rambut yang tinggi 2/g) mempunyai risiko 29,98 kali lebih besar untuk mengalami gangguan neuropati perifer dibandingkan dengan responden dengan kadar merkuri dalam rambut 2/g setelah dikontrol variabel umur variabel status merokok. Diperlukan adanya upaya yang kompherensif untuk meminimalisir penggunaan merkuri sehingga dapat mengendalikan kejadian dampak kesehatan yang disebabkan oleh pajanan merkuri."

"Latar Belakang : Sektor pertanian merupakan sektor yang paling banyak menyerap tenaga kerja. Semakin meningkatnya usaha sektor pertanian juga menyebabkan peningkatan penggunaan pestisida. Kenyataannya, umumnya masyarakat tidak menyadari gejala gangguan kesehatan yang dialaminya merupakan keracunan pestisida karena gejala tidak spesifik, namun secara kronis dapat menimbulkan penyakit, salah satunya gangguan neurologi. Penelitian ini bertujuan untuk mengetahui gangguan neurologi yang disebabkan karena pajanan kronis pestisida dan faktor-faktor yang mempengaruhinya pada petani.Metode :Penelitian menggunakan desain cross sectional dengan besar sampel 119 orang yang diambil dengan cluster random sampling. Penelitian di Desa Cibeurem, Kecamatan Kertasari, Kabupaten Bandung, Provinsi Jawa Barat yang dilaksanakan dari bulan Mei 2016 sampai Juli 2016. Pengambilan data dilakukan melalui wawancara, anamnesis dan pemeriksaan fisik. Tugas kerja, penggunaan alat pelindung diri, hygiene perorangan, keluhan petani, pemeriksaan kekuatan otot, pemeriksaan sensibilitas dan pemeriksaan refleks adalah variable yang diteliti.Hasil :Prevalensi neuropati perifer sebesar 56,3 . Proporsi petani dengan nilai intensitas pajanan tinggi sebesar 50,4 . Intensitas pajanan pestisida pada petani tidak berhubungan secara bermakna terhadap neuropati perifer. Faktor-faktor lain yang meningkatkan risiko terhadap neuropati perifer yaitu : usia OR : 2,05, IK95 0,98-4,29 , status gizi p = 0,131 , tingkat pendidikan OR : 0,67, IK95 0,32 ndash;1,38 . Faktor lain seperti diabetes mellitus, penyakit jantung dan penyakit hipertensi tidak dapat dianalisis.Kesimpulan dan saran :Intensitas pajanan tinggi terhadap pestisida berisiko lebih tinggi dibanding intensitas pajanan rendah terhadap neuropati perifer walau tidak berhubungan secara statistik. Bila menemukan keluhan neuropati yang diduga berhubungan dengan pestisida, petani diharapkan segera memeriksakan diri ke fasilitas kesehatan terdekatKata Kunci :Neuropati perifer, intensitas pajanan pestisida, skoring Sulistomo

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Background The agricultural sector is the most demanding labour. Pesticides are used simultaneously by the increasing of the agricultural production. The fact in the community all this time is generally not aware of the health problems they experienced symptoms of pesticide poisoning because the symptoms are not specific , but in chronic can cause serious illness , one of that is neurological disorders . This study aims to determine the neurological disorder caused by chronic exposure to pesticides and the factors that influence the farmers.Method: This study was designed as a cross sectional study with 119 farmers as the respondents taken by cluster random sampling. The study was conducted since May to July 2016 in Cibeureum village, Kertasari subdistrict, Bandung district, West Java province. Data was collected by interview and physical examination. Variables studied were work tasks, personal protective equipments usage, habitual personal hygiene, complaints of farmers, muscle strength examination, examination of sensibility and reflex examination.ResultsTotal prevalence of peripheral neuropathy event was 56,3 . The proportion of the farmers with high intensity of pesticide exposure was 50,4 . The intensity of pesticide exposure was not significantly related peripheral neuropathy event. Other factors that increase the risk for peripheral neuropathy were age OR 2,05, IK95 0,98 4,29 , nutritional status p 0,131 , level of education OR 0,67, IK95 0,32 - 1,38 . The other factor like, dibates mellitus, heart disease, hypertension can not be analyzed.Conclusion High intensity of pesticide exposure increased the risk of peripheral neuropathy event, even was not significantly related peripheral neuropathy event. When you find the alleged complaint neuropathy associated with pesticides, farmers are expected to immediately went to the nearest health facility Key words peripheral neuropathy, intensity of pesticide exposure, Sulistomo scoring"

"ABSTRAKNeuropati diabetika merupakan salah satu komplikasi dari diabetes melitus yang dapat menurunkan kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui efek terapi kombinasi laserpunktur dan medikamentosa dibandingkan dengan laserpunktur sham dan medikamentosa pada penderita neuropati diabetika. Uji klinis acar tersamar ganda dengan kontrol dilakukan terhadap 36 pasien. Tindakan laserpunktur dilakukan pada titik telinga MA-IC3 endokrin, ST36 Zusanli, ST40 Fenglong, dan SP6 sanyinjiao bilateral dua kali seminggu selama dua belas kali, sedangkan kelompok kontrol dilakukan terapi laserpunktur dengan laser dimatikan. Hasil penelitian menunjukkan perbedaan bermakna rerata sebelum dan sesudah antara kelompok laserpunktur dan medikamentosa dengan kelompok laserpunktur sham dan medikamentosa terhadap peningkatan kadar Interleukin 10 0,05 -0,08-0,66 dan -0,075 -1,40-0,56 , p=0,032 dan peningkatan kecepatan hantaran saraf motorik tibialis kiri 0,00 -3,20-13,0 dan -2,35 -14,5-8,30 , p=0,007. Kesimpulan : terapi kombinasi lasepunktur dan medikamentosa efektif meningkatkan kadar Interleukin 10 dan memperbaiki kecepatan hantaran saraf motorik tibialis kiri pada penderita neuropati diabetika.

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ABSTRACTDiabetic neuropathy is one of the complications of diabetes mellitus is characterized that can degrade the quality of life of patients. This study aims to determine the effect of combination therapy Laserpuncture and medication compared with sham Laserpuncture and medication in patients with diabetic neuropathy. Double blind randomized clinical trials with the controls carried out on 36 patients. Laserpuncture action performed at the ear point MA IC3 endocrine, ST36 Zusanli, ST40 Fenglong, and SP6 Sanyinjiao bilateral twice a week for twelve times, while the control group therapy with the laser turned off. The results of the study assessed the levels of Interleukin 10 and nerve conduction study before treatment and after treatment twelve times. The results showed a significant difference before and after between the Laserpuncture and medication groups compared with sham Laserpuncture and medication to increased levels of Interleukin 10 0,05 0,08 0,66 and 0,075 1,40 0,56 , p 0,032 and an increase in velocity of the left tibial motor nerve conduction 0,00 3,20 13,0 and 2,35 14,5 8,30 , p 0,007. Conclusion the combination therapy of lasepuncture and medication effectively increasing the levels of Interleukin 10 and improve velocity of the left tibial motor nerve conduction in patients with diabetic neuropathy."

"ABSTRAK Neuropati diabetika ND adalah penyakit sistem saraf yang menyebabkan kematian rasa, rasa tebal, nyeri, dan ketidakmampuan untuk merasakan panas dan dingin. Komplikasi diabetes ini merupakan kelainan progresif dan berkaitan pula dengan menurunnya kualitas hidup penderita. Berbagai pilihan pengobatan seperti medikamentosa dan non medikamentosa digunakan untuk menangani keluhan ini. Namun pengobatan yang ditujukan untuk mengganggu proses-proses patologis telah dibatasi oleh efek samping dan kurangnya efektifitas. Penelitian ini bertujuan untuk mengetahui efek terapi kombinasi laserpunktur dan medikamentosa dibandingkan laserpunktur sham dan medikamentosa pada penderita neuropati diabetika di ekstremitas inferior. Uji acak tersamar ganda dengan kontrol dilakukan pada 32 pasien ND yang dialokasikan kedalam kelompok kasus n=16 dan kelompok kontrol n=16 . Tindakan laserpunktur dilakukan pada titik telinga MA-IC3 endokrin, ST36 Zusanli, ST40 Fenglong, dan SP6 Sanyinjiao bilateral dua kali seminggu selama dua belas kali. Skor VAS, kadar IL6, dan QOL digunakan untuk mengukur keluaran penelitian. Terdapat perbedaan bermakna secara statistik pada perbedaan rerata selisih skor VAS sebelum dan sesudah antara kelompok kasus -4,12 1,204 dan kelompok kontrol -1,37 0,718 dengan nilai p"

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""ABSTRACT" Diabetic neuropathy is a nervous system disease that causes numbness, thick flavor, tenderness, and inability to feel heat and cold. Complications of diabetes is a progressive disorder and also related to the declining quality of life of the patient. Various treatment options like medical treatment and non pharmacological are used to treat this problem, but a treatment that is intended to disrupt the pathological processes have been limited by side effects and lack of effectiveness. This study aims to determine the effect of combination therapy laserpuncture and medical compared with sham laserpuncture and medical in patients with diabetic neuropathy in the lower extremities. A randomized double blind controlled trials with controls carried out on 32 patients with DN, they were allocated into case group n 16 and control group n 16 . Laserpuncture action performed at bilateral the ear point MA IC3 endokrin, ST36 Zusanli, ST40 Fenglong, and SP6 Sanyinjiao twice a week for twelve times. VAS score, IL6 levels, and QOL are used to measure the output of the study. There are statistically significant in the mean difference of VAS score before and after treatment between case group 4.12 1.204 and control group 1.37 .718 with a p value "

"Seorang pekerja laki-laki 38 tahun mengalami gejala gangguan saraf tepi dan di diagnosis neuropati perifer. Pekerja tersebut memiliki riwayat bekerja sebagai operator mesin Spinning di pabrik pembuatan rayon selama 10 tahun dengan riwayat paparan CS2 melebihi nilai ambang batas secara inhalasi. Tujuan dari laporan kasus berbasis bukti ini adalah untuk mendapatkan jawaban yang tepat tentang hubungan antara paparan karbon disulfida kerja melalui inhalasi dengan neuropati perifer di antara pekerja industri rayon. Pencarian artikel dilakukan melalui PubMed, Scopus, Medline, Embase dan handsearching. Kriteria inklusi adalah Tinjauan Sistematis, Meta-Analisis, Studi Kohort, Studi Kasus-kontrol, Studi potong lintang, pekerja dengan paparan CS2 secara inhalasi di lingkungan kerja, hasil diagnosis neuropati perifer atau hasil tes konduktifitas saraf sebagai alat diagnostik baku neuropati perifer ( MNCV dan SNCV ). Kemudian ditelaah secara kritis menggunakan kriteria CEBM oxford untuk studi etiologi . Dari hasil pencarian artikel didapatkan 4 jurnal penelitian. Terdapat satu artikel studi kohort prospektif dan tiga artikel studi potong lintang. Hasil telaah kritis 4 studi penelitian belum cukup kuat menunjukkan hubungan antara paparan CS2 inhalasi dengan neuropati perifer. Namun nilai penurunan konduktivitas saraf tepi dikatakan bermakna jika kecepatan konduktivitas saraf tepi ekstremitas atas < 50 m/s dan ekstremitas bawah jika < 40 m/s.

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Carbon disulfide (CS2) is widely used in various industries as a raw material for the manufacture of goods such as rayon, cellophane, and carbon tetrachloride. Currently, the largest user of this chemical is the rayon fibre industry. This evidence-based case report aims to obtain precise answers regarding the relationship between occupational carbon disulfide exposure through inhalation and peripheral neuropathy among rayon industry workers. A 38-year-old male worker had peripheral nerve disorder symptoms and was diagnosed with peripheral neuropathy. The worker had a history of working as a spinning machine operator in a rayon manufacturing factory for 10 years with a history of exposure to CS2 exceeding the threshold value through inhalation. An article search was conducted through PubMed, Scopus, Medline, Embase, and manual searching. The articles were then critically appraised using Oxford's CEBM criteria for etiological studies. The article searches resulted in one prospective cohort study and three cross-sectional studies. Based on the patient's condition, the findings from the 4 research studies were insufficient to establish a link between inhalation exposure to CS2 and peripheral neuropathy. Further studies with a stronger association level are needed to establish the relationship between inhaled CS2 exposure and peripheral neuropathy."

"Pendahuluan: Prevalensi neuropati sensorik HIV (NS-HIV) di RS Cipto Mangunkusumo (RSCM) pada tahun 2006 adalah 33%, saat seluruh pasien mendapatkan terapi antiretroviral (ARV) stavudine. Walaupun stavudine tidak digunakan lagi, pasien masih mengeluhkan gejala NS-HIV. Penelitian ini bertujuan untuk mengetahui prevalensi dan faktor yang berhubungan dengan NS-HIV dan nyeri neuropatik; kadar kemokin CCL5 plasma dan antibodi IgG CMV pada NS-HIV dan nyeri neuropatik. Tujuan lain adalah untuk mengetahui dan gambaran intra-epidermal nerve fiber density (IENFD) dan makrofag CD14+ perineural pada NS-HIV. Metode: Penelitian potong lintang yang dilakukan di RSCM pada tahun 2015-2017. Didapatkan 197 pasien HIV dalam terapi ARV tanpa stavudin >12 bulan. NS-HIV ditegakkan berdasarkan The AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Tool (ACTG-BPNST/BPNST), sedangkan nyeri neuropatik dinilai menggunakan kuesioner Douleur Neuropathique 4 (DN4). Dilakukan pengambilan darah untuk mengukur hitung sel T CD4+, viral load, CCL5, antibodi IgG CMV. Dilakukan pemeriksaan nerve conduction study (NCS) dan Stimulated SkIin Wrinkle (SSW) test. Biopsi kulit dilakukan pada 9 pasien NS-HIV dan 5 pasien tanpa NS (NS-) untuk menilai intra-epidermal nerve fiber density (IENFD) dan makrofag CD14+ perineural dan dibandingkan kontrol sehat.Hasil: Prevalensi NS-HIV adalah 14,2% sedangkan prevalensi nyeri neuropatik 6,6%. Faktor yang berhubungan dengan NS-HIV adalah viral load >500 kopi/ml dan meningkatnya usia. Faktor yang berhubungan dengan nyeri neuropatik adalah penggunaan ARV Protease Inhibitor (PI) dan durasi ARV< 2 tahun. Kadar CCL5 plasma dan antibody IgG CMV tidak berhubungan terhadap NS-HIV dan nyeri neuropatik. Median IENFD pada pasien NS-HIV lebih rendah dibandingkan pasien HIV tanpa neuropati (3 vs 5,8 /mm2); median IENFD pasien HIV dengan dan tanpa neuropati sensorik lebih rendah dibandingkan kontrol sehat (11,2/mm2). Empat dari lima pasien NS-HIV dengan INEFD rendah mempunyai hitung CD4+ nadir yang rendah. Makrofag CD14+ dapat diidentifikasi perineural pada pasien NS-HIV dan pasien HIV tanpa neuropati sensorik. Kesimpulan: Prevalensi NS-HIV menurun jauh saat stavudin tidak lagi digunakan. Prevalensi nyeri neuropatik lebih rendah dari prevalensi NS-HIV. Meningkatnya usia dan terdeteksinya viral load berhubungan dengan NS-HIV; PI dan durasi penggunaan ARV yang lebih pendek berhubungan dengan nyeri neuropatik. IENFD pasien HIV lebih rendah dibandingkan kontrol sehat. Pasien NS-HIV dengan IENFD rendah memiliki hitung CD4+ nadir yang rendah. Makrofag CD14+ perineural di epidermis dapat diidentifikasi pada pasien HIV dengan dan tanpa neuropati sensorik.

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Introduction: Prevalence of HIV associated sensory neuropathy (HIV-SN) in Cipto Mangunkusumo Hospital (CMH) was 33% in 2006 where all patients used stavudine. Despite stavudine use has been reduced; some patients still complain the symptom of HIV-SN. This study aimed to explore the prevalence and associated factors of HIV-SN and neuropathic pain; to know plasma CCL5 chemokine level and CMV IgG antibody in HIV-SN and neuropathic pain; to study the pattern of intra-epidermal nerve fiber density (IENFD) and perineural CD14+ macrophage in HIV-SN. Method: It was a cross sectional study carried out at CMH from 2015 until 2017. We tested 197 HIV patients who had antiretroviral treatment (ART) without stavudine for >12 months. The AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Tool (ACTG-BPNST/BPNST) and Douleur Neuropathique 4 (DN4) questionnaire were used to assess HIV-SN and neuropathic pain respectively. Nerve conduction study (NCS) and Stimulated Skin Wrinkle (SSW) test were performed. The current CD4+ T-cell counts, viral load, CCL5 and IgG CMV antibidoy were measured. Skin biopsy was performed in 5 HIV-SN and 9 HIV-NoSN to assess IENFD and CD14+ macrophage compare to healthy control subjects.Result: The prevalence of HIV-SN was 14.2% and neuropathic pain was 6.6%. Viral load >500 copies HIV-RNA/ml and increasing age were associated with HIV-SN, while protease inhibitor (PI) and ART duration<2 years were associated with neuropathic pain. CCL5 plasma level and CMV IgG antibody were not associated with HIV-SN and neuropathic pain. IENFDs in HIV-SN were lower than HIV-NoSN (3 vs 5.8/mm2, respectively); IENFDs in HIV patients generally were lower than healthy control (11.2/mm2). Four of 5 HIV-SN patients with low IENFD had low nadir CD4+ T-cell count. CD14+ macrophage can be identified around the nerves of both HIV-SN and HIV-NoSN patients. Conclusion: Prevalence of HIV-SN in the era without stavudine is lower. Prevalence of neuropathic pain is lower than prevalence of HIV-SN. Increasing age and detectable viral load are associated with HIV-SN; PI and shorter duration of ART are associated with neuropathic pain. IENFDs in HIV patients are lower than healthy control. HIV-SN patients with low IENFD tend to have low nadir CD4+ T-cell count. CD14+ macrophage is present in both HIV patients with and without sensory neuropathy."

"[ABSTRAKPenderita neuropati perifer diabetik yang mengalami penurunan sensasi kaki dapatberakibat terjadinya luka diabetik. Penelitian ini bertujuan mengetahui efektivitaskombinasi senam kaki diabetik dan terapi SPA terhadap peningkatan sensasi kakipada pasien dengan neuropati perifer diabetik. Penelitian ini menggunakan kuasiexperimental pretest-posttest design with control group dengan jumlah sample 35orang yang didapat dengan tehnik purposive sampling. Pengukuran sensasi kakidilakukan pada hari pertama minggu ke-1 dan hari terakhir minggu ke-4 perlakuan.Sampel penelitian yaitu pasien neuropati perifer diabetik dengan skor sensasi kakimaksimal 8. Hasil uji mann whitney menunjukkan ada perbedaan reratapeningkatan sensasi kaki yang diberikan kombinasi senam kaki diabetik dan terapiSPA dibandingkan hanya diberikan tindakan senam kaki diabetik (p value < 0.05).Tindakan kombinasi senam kaki diabetik dan terapi SPA lebih efektif dalammeningkatkan sensasi kaki yang akan berpengaruh terhadap menurunnya resikoluka pada pasien DM.

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ABSTRACTDiabetic peripheral neuropathy patients with decreasing in foot sensation willimpact on diabetic ulcers. This study aims to explore the effect of combinationbetween diabetic legs exercise and SPA therapy on foot sensitivity escalationamong patients with diabetic peripheral neuropathy. This study used quasiexperimentalpretest-posttest design with control group with 35 respondents andrecruited by purposive sampling methode. Data were collected from patients withperipheral diabetic neuropathy and had 8 maximum score of foot sensitivity.. Footsensitivity was measured on the 1st day of intervention and end day of intervention.Mann whitney test analysis showed significant differences on foot sensitivity withcombination of diabetic legs exercise and SPA therapy compare to diabetic legsexercise only (p value < 0.05). It can be inferred that combination of diabetic legsexercise and SPA therapy are more effective to increase legs sensitivity. Therefore,combined effect of those therapies may eventually decrease diabetic ulcers risk., Diabetic peripheral neuropathy patients with decreasing in foot sensation willimpact on diabetic ulcers. This study aims to explore the effect of combinationbetween diabetic legs exercise and SPA therapy on foot sensitivity escalationamong patients with diabetic peripheral neuropathy. This study used quasiexperimentalpretest-posttest design with control group with 35 respondents andrecruited by purposive sampling methode. Data were collected from patients withperipheral diabetic neuropathy and had 8 maximum score of foot sensitivity.. Footsensitivity was measured on the 1st day of intervention and end day of intervention.Mann whitney test analysis showed significant differences on foot sensitivity withcombination of diabetic legs exercise and SPA therapy compare to diabetic legsexercise only (p value < 0.05). It can be inferred that combination of diabetic legsexercise and SPA therapy are more effective to increase legs sensitivity. Therefore,combined effect of those therapies may eventually decrease diabetic ulcers risk.]"