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"Latar Belakang. Multipel sklerosis merupakan penyakit kronik progresif dimana selain dari berbagai gejala neurologis yang ada, gangguan tidur merupakan masalah yang juga memiliki dampak terhadap penyandang penyakit multipel skeloris. Beberapa penelitian telah menunjukkan bahwa prevalensi gangguan tidur ditemukan lebih tinggi pada penyandang penyakit multipel skeloris dibandingkan populasi normal. Penelitian ini bertujuan untuk mengetahui prevalensi serta pola gangguan tidur pada penyandang penyakit multipel sklerosis di Indonesia.Metode. Penelitian ini merupakan studi deskritptif potong lintang. Populasi penelitian merupakan pasien dengan penyakit multiple sklerosis yang berobat di RSCM Jakarta yang memenuhi kriteria inklusi, dan dilakukan pengambilan data klinis dan pengambilan sampel dengan mengisi kuesioner Pittsburgh Sleep Quality Assessment (PSQI) dan STOP-BANG Sleep Apnea Questionnaire, serta The Mini International Neuropsychiatric Interview ICD-10 (MINI ICD-10). Data yang didapat kemudian dilakukan pengolahan dan analisis data.Hasil. Dari empat puluh dua subjek MS yang diikutsertakan pada penelitian ini, 32 (76,2%) subjek berusia kurang dari 35 tahun, 34 (81,0%) berjenis kelamin perempuan, 23 (54,8%) subjek tidak bekerja, 9 (21,4%) mengalami depresi, dan 9 (21,4%) memiliki EDSS 6 ke atas. Insomnia ditemukan pada 32 (76,2%) subjek, dengan proporsi yang lebih besar ditemukan pada subjek berusia 35 tahun ke atas (80% vs 75%, p=0,556), berjenis kelamin laki-laki (87,5% vs 73,5%, p=0,374), kelompok yang tidak bekerja (78,3% vs 73,7%, p=0,504), kelompok dengan depresi (77,8% vs 75,8%, p=0,638), dan kelompok dengan EDSS lebih dari sama dengan 6 (77,8% vs 75,8%, p=0,638). Seluruh subjek memiliki risiko OSA dengan 39 (92,9%) subjek memiliki risiko ringan-sedang dan 3 (7,1%) subjek memiliki risiko berat. Hanya laki-laki yang memiliki risiko terhadap kejadian OSA (37,5% vs 0%, p=0,005), tetapi tidak berkaitan terhadap kejadian insomnia.Kesimpulan. Prevalensi gangguan tidur pada penyandang penyakit multipel skeloris di Indonesia sangat tingi. Untuk itu perlu dilakukan evaluasi dan pemeriksaan lebih lanjut guna menunjang diagnosis.

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Background. Multiple sclerosis (MS) is a chronic progressive disease in which sleep disorder, besides various neurologic manifestations, highly impacts the patients but is often neglected in clinical settings. Several studies had discovered that sleep disorder was more prevalent in MS than general population. This study aimed to investigate the prevalence and characteristics of sleep disorder in MS patients in Indonesia.Methods. A descriptive cross-sectional study involving MS patients was conducted at Dr. Cipto Mangunkusumo National General Hospital Jakarta. In addition to clinicodemographic data collection, data regarding sleep quality, obstructive sleep apnea (OSA), and depression state were assessed using Indonesian previously-validated Pittsburgh Sleep Quality Index, STOP-BANG Sleep Apnea Questionnaire, and The Mini International Neuropsychiatric Interview ICD-10, respectively.Results. Of forty MS participants included in this study, 29 (72.5%) aged less than 35 years, 32 (80.0%) were women, 20 (50.0%) were unemployed, 10 (25.0%) had depression, and 10 (25.0%) had Expanded Disability Scoring Scale (EDSS) of ≥6. Insomnia was found in 33 (82.5%) participants, of which larger proportion were male (100.0% vs 78.1%, p=0.309. Three (7,1%) participants had moderate risk of OSA. Only male had significant risk of OSA (moderate risk 25.0% vs 0%, p=0.036), but it did not associate with insomnia.Conclusion. Sleep disorder in MS patients in Indonesia is prevalent. There was potencies of the risk of OSA in MS, especially in male. Detection of insomnia and risk OSA is important in MS comprehensive care."

"Latar Belakang. Gangguan kognitif dapat terjadi pada multipel sklerosis MS dan berdampak menurunnya kualitas hidup. Brief International Cognitive Assessment for MS BICAMS merupakan instrumen untuk mendeteksi gangguan kognitif penyandang MS. Penelitian ini bertujuan untuk memvalidasi instrumen BICAMS versi bahasa Indonesia BICAMS-INA .Metode. Penelitian potong lintang ini dilakukan di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo Jakarta periode Mei-Juni 2018 pada kelompok MS dan kontrol. Pemeriksaan BICAMS yang terdiri dari; Symbol Digit Modalities Test SDMT , California Verbal Learning Test-II CVLT-II , dan Brief Visuospatial Memory Test Revised BVMTR dilakukan pada 23 kelompok MS dan 66 kelompok kontrol. Kemudian dilakukan retest pada 13 kelompok MS dan 23 kelompok kontrol.Hasil. Rerata SD hasil pemeriksaan BICAMS pada kelompok MS dan kontrol sebagai berikut: SDMT kelompok MS 41,4 15,1; kelompok kontrol 64,9 16,2 p

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Background. Cognitive impairment can occur in multiple sclerosis MS and impact on decreased quality of life. Brief International Cognitive Assessment for MS BICAMS is an instrument to detect cognitive impairment in MS. This study aimed to validate the Indonesian version of BICAMS BICAMS INA .Methods. This cross sectional study was performed in Cipto Mangunkusumo National General Hospital, Jakarta, from May to June 2018 on MS and control group. Consisted of Symbol Digit Modalities Test SDMT , California Verbal Learning Test II CVLT II , and Brief Visuospatial Memory Test Revised BVMTR , this instrument was administered to 23 patients with MS and 66 healthy controls. Retest was performed on 13 patients with MS and 23 healthy controls.Result. The mean SD score of BICAMS in MS and control groups were as follows SDMT in MS vs control group 41.4 15.1 vs 64.9 16.2 p"

"Latar Belakang: Sklerosis multipel (multiple sclerosis/MS) merupakan penyakit inflamasi-demyelinasi sistem saraf pusat yang mengakibatkan atrofi struktur otak penderita. Indeks korpus kalosum (IKK) merupakan salah satu metode pengukuran morfometrik korpus kalosum yang cepat serta dengan reliabilitas interrater yang tinggi. Tujuan: Mengetahui korelasi antara hasil pengukuran IKK dengan volume korpus kalosum, substansi grisea kortikal, substansi grisea subkortikal, dan substansi alba serebri melalui MRI volumetri otak pada penderita MS. Metode : Hasil MRI kepala dari 30 penderita MS dilakukan pengukuran IKK. Nilai IKK kemudian dilakukan analisis korelasional dengan volume korpus kalosum, substansi grisea kortikal, substansi grisea subkortikal, dan substansi alba serebri yang diperoleh menggunakan perangkat lunak FreeSurfer©. Hasil : Terdapat korelasi yang sangat kuat antara IKK dengan volume korpus kalosum (R = 0,797 ; p = 0,001) dan volume substansi alba serebri (R = 0,813 ; p = 0,001). IKK juga berkorelasi kuat dengan volume substansi grisea kortikal (R = 0,642 ; p = 0,001) dan volume substansi grisea subkortikal (R = 0,696 ; p = 0,001). Kesimpulan : Metode pengukuran IKK dapat menjadi parameter morfometrik cepat dan sederhana yang menggambarkan volume korpus kalosum, substansi grisea kortikal, substansi grisea subkortikal, dan substansi alba serebri pada penderita MS.

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Background: Multiple sclerosis (MS) is an inflammatory-demyelinating disease of the central nervous system which results in atrophy of brain structure. Corpus callosum index (CCI) is a method of morphometric measurement of the corpus callosum using midsagittal slice from MRI which does not require additional sequences with fast processing time and high interrater reliability.

Objectives : To determine the correlation between the CCI measurements with corpus callosum, cortical gray matter, subcortical gray matter, and cerebral white matter volume through brain MRI volumetry in MS patients.

Methods : CCI measurements were obtained from head MRI from 30 MS patients according to the method conceived by Figueroa et al. Correlational analysis was carried out between CCI with corpus callosum, cortical gray matter, subcortical gray matter, and cerebral white matter volume obtained using FreeSurfer©.

Results : Very strong correlation was shown between CCI and corpus callosum volume (R = 0.797; p = 0.001) and cerebral white matter volume (R = 0.813; p = 0.001). CCI also shown strong correlation with cortical gray matter volume (R = 0.642; p = 0.001) and subcortical gray matter volume (R = 0.696; p = 0.001).

Conclusion : CCI can be a fast and simple morphometric parameter that describes the corpus callosum, cortical gray matter, subcortical gray matter, and cerebral white matter volume in MS patients."

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ABSTRAK

Latar belakang: Penilaian kualitas hidup pasien multipel sclerosis (MS) belum rutin digunakan di Indonesia karena belum terdapatnya kuesioner spesifik berbahasa indonesia yang valid. Tujuan dari penelitian ini adalah untuk adaptasi lintas budaya dan validasi kuesioner kuesioner MSQOL-54 versi Indonesia (MSQOL-54 INA).

Metode:  Adaptasi lintas budaya dilakukan sesuai dengan metode forward-backward terstandar. Uji psikometri dilakukan dengan menilai reliabilitas (α Cronbach), validitas interna (item internal consistency,  item discriminant validity dan analisis fakorial) dan validitas eksterna dengan menilai korelasi dengan faktor klinis EDSS dan faktor demografis lainnya.

Hasil: Uji reliabilitas α Cronbach menunjukkan konsistensi internal yang baik (>0,7) di setiap domain kecuali domain persepsi kesehatan (0,665) dan fungsi sosial (0,433). Validitas bentuk dengan komputasi koefisien korelasi menunjukkan konsistensi konsistensi internal yang sesuai dengan dimensi MSQOL-54 asli. Berdasarkan analisis faktorial domain energi,  keterbatasan peran akibat masalah emosional, fungsi sosial dan persepsi kesehatan tidak sesuai dengan dimensi asli. Validitas eksternal dengan EDSS menunjukkan korelasi negatif pada semua domain kecuali fungsi seksual, kemaknaan yang signifikan secara statistik ditemukan pada kedua skor komposit.

Kesimpulan: Kuesioner MSQOL-54 INA memilki reliabilitas yang baik dan terbukti valid serta dapat diterima dengan baik oleh pasien MS di Indonesia. Selanjutnya kuesioner ini dapat digunakan oleh klinisi indonesia untuk tata laksana MS yang lebih komprehensif.

 

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ABSTRACT

Background: Quality of life assessment of patients with multiple sclerosis (MS) is not routinely performed in Indonesia due to the unavailability of the validated Indonesian version of a specific instrument. The objective of this study was to transculturally adapt and validate the Indonesian version of the MSQOL-54 (MSQOL-54 INA) questionnaire.

Methods: The transcultural adaptation was conducted by performing a standardized forward-backward method. Psychometric analysis was performed by assessing the reliability (Cronbach α), internal validation (item internal consistency, item discriminant validity and factorial analysis) and external validation by measuring the correlation with a clinical factor such as EDSS and other demographic factors.

Results: Reliability test with Cronbach α showed good internal consistency (>0.7) at each domain, except for health perception (0.665) and social function (0.433). Construct validity using computation of correlation coefficient showed internal consistency in accordance with the original MSQOL-54 standard dimension. Factorial analysis showed that energy, role limitation due to emotional problems, social function and health perception is not in accordance with the original version. External validation with EDSS showed negative correlation on almost all components, except for sexual function, but both composite scores were statistically significant.

Conclusion: MSQOL-54 INA questionnaire has good internal reliability and is proven to be valid and well-accepted by Indonesian MS patients. Therefore, it can be used by Indonesian clinicians for more comprehensive MS management.

 

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"Latar belakang. Penolakan tindakan pungsi lumbal cukup besar. Salah satu faktor yang berperan adalah pengetahuan, pemahaman serta persepsi pasien dan keluarga yang kurang tepat terhadap tindakan pungsi lumbal. Informed consent yang baik diharapkan dapat memperbaiki hal ini. Penelitian ini dilakukan untuk menilai kualitas informed consent pungsi lumbal. Metode penelitian. Penelitian ini dilakukan dua tahap. Tahap 1 penyusunan dan analisis kuesioner. Tahap 2 uji coba dan penilaian reliabilitas. Tahap 1 menggunakan desain uji validasi isi. Populasi adalah dokter spesialis neurologi yang memiliki pengetahuan dan pemahaman pungsi lumbal. Sampel diambil dengan cara intentional sampling. Tahap 2 menggunakan desain potong lintang. Populasinya adalah pasien/wali pasien yang telah mendapakan informed consent pungsi lumbal di IGD, bangsal/poli neurologi RSUPN Dr. Cipto Mangunkusumo  bulan Desember 2022-Januari 2023. Sampel diambil dengan cara consecutive sampling. Hasil. Kuesioner pungsi lumbal 2022 memiliki validitas isi yang baik namun tingkat pemahaman memiliki reliabilitas yang kurang baik. Sebanyak 75% tenaga medis profesional dalam memberikan informed consent pungsi lumbal. Sebanyak 28,12% penerima informasi memahami informasi yang diberikan. Sebanyak 68,8% penerima informasi puas terhadap proses informed consent. Sebanyak 25% proses informed consent pungsi lumbal berkualitas. Kesimpulan. Sebagian besar tenaga medis sudah profesional dalam melakukan informed consent pungsi lumbal meskipun belum seluruhnya penerima informasi memahami informasi yang disampaikan. Sebagian besar penerima informasi puas dengan proses informed consent pungsi lumbal. Kualitas informed consent pungsi lumbal di RSUPN Dr. Cipto Mangunkusumo masih harus ditingkatkan.

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Background: There is quite a number of rejection for lumbar puncture procedure. One of its most contributing factor is inadequate understanding of the procedure itself from the patient or family. A well prepared informed consent is aimed to mitigate this issue. This study was conducted in order to evaluate the quality of informed consent for lumbar puncture in our centre.

Methods. This study is done in 2 phases, on the 1st phase we compose and analyze the questionnaire and on the 2nd phase is to test and evaluate its reliability. Content validation test design was used on the 1st phase. Study population are neurologists who possess the understanding and competency of lumbar puncture. Samples are chosen by intentional sampling. For the 2nd phase, we used the cross-sectional design study. And the population are patients or their family who received lumbar puncture informed consent in ER unit, neurology ward or clinic at RSUPN Dr. Cipto Mangunkusumo, starting from December 2022 to January 2023. Sample was chosen by consecutive sampling.

Results. Lumbar puncture questionnaire is pretty well validated for its content, although it’s not that well defined on how much it can be understood by the patient. As much as 75% of neurologists have given professional informed consent for their patient. But only 28.12% of the patients truly understood the information they received. And 25% of all informed consent was done in a good quality.

Conclusion. Most of neurologists have done their informed consent in a professional manner, even though not all patient could understand the information quite fully. Most of the patients are satisfied with how well the informed consent was explained. The conclusion is there are still ways to improve the quality of lumbar puncture informed consent in RSUPN Dr. Cipto Mangunkusumo "

"Latar Belakang. Sejak laporan pertama ensefalitis antireseptor N-methyl-D-aspartate (NMDA) pada 2007, prevalensi ensefalitis autoimun (EA) serupa dengan ensefalitis infeksi (EI). Sayangnya, heterogenitas klinis EA, serupanya klinis dengan EI, penyakit autoimun seperti neuropsikiatrik lupus eritematosus sistemik, atau penyakit psikiatrik menjadi tantangan deteksi awal dan tatalaksana EA. Keterlambatan berhubungan dengan perburukan luaran, sedangkan kekurang-tepatan menerapi EI sebagai EA dapat mengeksaserbasi infeksi. Studi ini bertujuan mengenali karakteristik EA, khususnya ensefalitis antireseptor NMDA definit sebagai EA tersering, di era keterbatasan ketersediaan penunjang definitif di Indonesia.Metode. Studi kohort retrospektif dengan rekam medis di RSUPN dr. Cipto Mangunkusumo dilakukan pada curiga EA yang menjalani pemeriksaan antireseptor NMDA cairan otak sejak Januari 2015-November 2022. Karakteristik klinis dan penunjang EA, EA seropositif NMDA, dan luarannya dinilai. Analisis univariat dan bivariat dilakukan sesuai kebutuhan.Hasil. Dari 102 subjek yang melalui kriteria inklusi dan eksklusi, terdapat 14 EA seropositif dan 32 seronegatif NMDA. Temuan klinis EA terbanyak adalah gangguan psikiatri dan tidur (85,7%), gangguan kesadaran (78,3%), prodromal (76,1%), dan bangkitan (70,6%). Karakteristik penunjang EA adalah inflamasi sistemik (75,0%), inflamasi cairan otak (69,2%), abnormalitas MRI (57,9%) dominan inflamasi (42,2%), dan abnormalitas EEG (89,5%). Karakteristik klinis EA seropositif NMDA adalah psikosis (76,9% vs 24,1%, p=0,002), delirium (71,4% vs 40,6%, p=0,06), bangkitan (71,4% vs 46,7%, p=0,12), takikardia (55,6% vs 17,6%, p=0,08), dan gangguan otonom lainnya (55,6% vs 23,5%, p=0,19), sedangkan klinis EA seronegatif NMDA adalah somnolen (34,4% vs 7,1%, p=0,07) dan defisit neurologis fokal (31,3% vs 7,1%, p=0,13). Leukositosis dan pleositosis cairan otak dengan dominasi mononuklear secara signifikan lebih ditemukan pada EA seropositif NMDA. Sebanyak 10,9% subjek meninggal.Kesimpulan. Karakteristik klinis EA adalah gangguan psikiatri dan tidur, gangguan kesadaran, prodromal, dan bangkitan. Psikosis, delirium, bangkitan, dan disfungsi otonom cenderung lebih ditemukan pada EA seropositif NMDA. Inflamasi sistemik, cairan otak, MRI, dan abnormalitas EEG sering ditemukan pada EA, terutama seropositif NMDA. 

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Background. Since the first report of N-methyl-D-aspartate receptor (NMDAR) encephalitis in 2007, the prevalence of autoimmune encephalitis (AE) was similar to infectious encephalitis (IE). Unfortunately, heterogenities of EA as well as similarities in the manifestation to IE, other autoimmune diseases including neuropsychiatric systemic lupus erythematosus, or psychiatric diseases compromised the early detection and management of EA. This delay correlated with worse outcome whereas the inaccuracy in treting IE as AE may exacerbate infection. This study aimed to describe the characteristics of EA, particularly definitive NMDAR encephalitis as the most common, in the era of limited availability of definitive ancillary test in Indonesia.

Methods. Retrospective study using medical records at Dr. Cipto Mangunkusumo National Center General Hospital was conducted for suspected EA cases tested for cerebrospinal fluid NMDAR autoantibody test from January 2015 to November 2022. Clinical, ancillary characteristics, and concordance between clinical diagnosis and diagnostic criteria were assessed. Univariate, bivariate, and multivariate analysis were perfomed as needed.

Result. Of 102 subjects following inclusion and exclusion criteria, there were 14 seropositive and 32 seronegative NMDA subject. Clinical characterstics of AE were psychiatric and sleep disorder (85,7%), altered consciousness (78.3%), prodromal (76.1%), and seizure (70.6%). Ancillary characteristics of AE were systemic inflammation (75.0%), cerebrospinal fluid inflammation (69.2%), MRI abnormalities (57.9%) with inflammatory predominance (42.2%), and EEG abnormalities (89.5%). Seropositive NMDA characteristics were psychosis (76.9% vs 24.1%, p=0.002), delirium (71.4% vs 40.6%, p=0.06), seizure (71.4% vs 46.7%, p=0.12), tachycardia 955.6% vs 17.6%, p=-0.08), and other autonomic disorder (55.6% vs 23.5% p=0.19) whereas seronegative NMDA characteristics were somnolence (34.4% vs 7.1%, p=0.07) and focal neurologic deficit (31.3% vs 7.1%, p=0.13). Leukocytosis and cerebrospinal fluid pleocytosis with mononuclear predominance were significantly found in seropositive NMDA AE. The mortality rate was 10.9%.

Conclusion. Clinical characteristics of AE were psychiatric and sleep disorder, altered consciousness, prodromal, and seizure. Psychosis, delirium, seizure, and autonomic dysfunction tended to be found in seropositive NMDA AE. Inflammation in systemic, cerebrospinal fluid, and MRI findings as well as EEG abnormalities commonly occurred in AE, especially seropositive NMDA."

"Latar belakang: Pasien NMOSD cenderung menunjukkan progresifitas/perburukan defisit neurologis pada setiap relaps. Pemberian terapi rumatan pada NMOSD bisa mencegah relaps dan mempertahankan remisi. Hingga saat ini belum ada studi yang meneliti mengenai kepatuhan pengobatan pasien NMOSD. Tujuan dari penelitian ini adalah untuk menilai tingkat kepatuhan pengobatan pasien NMOSD, mengetahui karakteristik serta faktor-faktor yang memengaruhi kepatuhan pengobatan.Metode: Penelitian ini merupakan studi potong-lintang dengan populasi seluruh pasien NMOSD yang berobat di RSCM sejak tahun 2019 hingga Mei 2023. Sampel diambil dengan cara consecutive sampling. Kriteria inklusi yaitu pasien dengan diagnosis NMOSD sesuai kriteria diagnosis IPND tahun 2015, usia ≥ 18 tahun, konsumsi obat untuk NMOSD minimal selama 1 bulan. Kriteria eksklusi yaitu tidak bersedia ikut serta dalam penelitian. Kepatuhan berobat dinilai dengan kuesioner Morisky Medication Adherence Scale 8 versi Bahasa Indonesia (MMAS-8), depresi dinilai dengan kuesioner Beck Depression Inventory versi Bahasa Indonesia (BDI-II), kognitif dinilai dengan kuesioner Montreal Cognitive Assesmenet versi Bahasa Indonesia (Moca-INA), dan persepsi terhadap penyakit dinilai dengan kuesioner Beck Depression Inventory versi Bahasa Indonesia (B-IPQ. Data karakteristik demografi, pengobatan, dan klinis didapatkan dari rekam medis/anamnesis. Hasil: Subjek penelitian ini sebanyak 42 orang dengan rasio pria:wanita= 1: 13. Pasien yang terkategori patuh berobat sebesar 57,1%. Kepatuhan berobat berhubungan dengan status pernikahan (p=0,037), jenis obat saat ini (p=0,033), nilai EDSS (p=0,035), depresi (p=0,018), dan gangguan kognitif (p=0,029). Hasil analisis multivariat mendapatkan bahwa subjek yang tidak depresi 4,60 kali (IK 95% 1,03-20,4) lebih patuh dibandingkan depresi dan setiap kenaikan 1 poin EDSS (perburukan klinis) dapat 1,33 kali meningkatkan kepatuhan pengobatan (IK95% 1,02-1,76). Simpulan: Pada penelitian ini, sebagian besar pasien NMOSD patuh pengobatan. Faktor independen yang mempengaruhi kepatuhan pengobatan pasien NMOSD di RSCM adalah depresi dan derajat disabilitas.

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Background: NMOSD patients tend to show progressive/worsening neurologic deficits in each relapse. Maintenance therapy for NMOSD can prevent relapse and maintain remission. Until now there have been no studies that examined the medication adherence of NMOSD patients. The aim of this study was to assess the level of medication adherence of NMOSD patients, to find out the characteristics and factors that influence treatment adherence.

Methods: We conducted a cross sectional study on NMOSD patients who came to RSCM from 2019 to May 2023. Samples were taken by consecutive sampling. The inclusion criteria were patients with a diagnosis of NMOSD according to the 2015 IPND diagnosis criteria, age ≥ 18 years, consumption of drugs for NMOSD for at least 1 month. Exclusion criteria were not willing to participate in the study. Medication adherence was assessed by the Indonesian version of the Morisky Medication Adherence Scale 8 questionnaire (MMAS-8), depression was assessed by the Indonesian version of the Beck Depression Inventory questionnaire (BDI-II), cognitive was assessed by the Indonesian version of the Montreal Cognitive Assessment questionnaire (Moca-INA), and perceptions of illness were assessed by the questionnaire Beck Depression Inventory Indonesian version (B-IPQ). Data on demographic, treatment, and clinical characteristics were obtained from medical records/anamnesis.

Results: There were 42 subjects in this study with a male:female ratio = 1: 13. Patients who were categorized as adherent to medication were 57.1%. Medication adherence was related to marital status (p=0.037), current type of medication (p=0.033), EDSS score (p=0.035), depression (p=0.018), and cognitive impairment (p=0.029). The results of multivariate analysis found that subjects who were not depressed were 4.60 times (95% CI 1.03-20.4) more adherent than depressed subjects and for every 1 point increase in EDSS (clinical worsening) could be 1.33 times increased medication adherence (95% CI). 1.02-1.76).

Conclusion: In this study, the majority of NMOSD patients adhered to treatment. Independent factors that influence NMOSD patient medication adherence at RSCM are depression and the degree of disorder."

"Latar Belakang. Prevalensi disabilitas pada pasien meningitis tuberkulosis (MTB) hampir setara dengan angka mortalitas mencapai 29-50%. Aspek luaran pasien MTB tidak cukup dinilai berdasarkan angka morbiditas dan mortalitasnya, namun mencakup kesehatan fisik, mental, dan sosial seperti yang didefinisikan oleh World Health Organization (WHO). Penelitian ini bertujuan untuk mengetahui kualitas hidup pasien MTB selesai obat anti-tuberkulosis (OAT) dan faktor-faktor yang memengaruhinya. Metode. Studi potong lintang (cross sectional) dilakukan pada pasien MTB, termasuk tuberkuloma selesai OAT di RSUPN dr. Cipto Mangunkusumo periode Mei 2019-Juni 2023. Karakteristik demografis, klinis, diagnosis, tatalaksana pasien dinilai dari data rekam medis dan wawancara. Luaran kualitas hidup pasien dinilai menggunakan kuesioner SF (Short form)-36. Analisis statistik dilakukan dengan SPSS versi 19.0, yaitu Mann-Whitney dan Kruskal-Wallis untuk data kategorik, Spearman untuk data numerik. Hasil. Dari 53 subjek penelitian dengan median usia 30 (IQR 25,5-39) tahun, didapatkan median skor SF-36 yaitu, 86,5 (IQR 74,9-92,8). Median (IQR) skor pada aspek fisik (PCS) dan mental (MCS) kualitas hidup serupa, yaitu 85 (IQR 69,4-94,85) dan 88,1 (IQR 74,1-95,3). Faktor yang berhubungan dengan kualitas hidup pasien MTB selesai OAT antara lain penghasilan (p=0,033), kejang (p=0,028), kelemahan motorik (p=0,023), dan mRS saat pulang perawatan (p=0,007). Faktor yang berhubungan dengan skor PCS adalah pekerjaan (p=0,012), penghasilan (p=0,007), kelemahan motorik (p=0,024), dan mRS saat pulang perawatan (p=0,01). Faktor yang berhubungan dengan skor MCS adalah usia (p=0,006) dan kejang (p=0,025). Kesimpulan. Kualitas hidup pasien MTB selesai OAT berdasarkan skor SF-36, PCS, dan MCS tergolong baik. Faktor yang memengaruhi kualitas hidup lebih tinggi pada pasien MTB selesai OAT adalah berpenghasilan, tanpa klinis kejang atau kelemahan motorik, dan mRS saat pulang perawatan 0-2. Faktor yang memengaruhi aspek fisik lebih tinggi adalah pekerjaan, berpenghasilan, tanpa klinis kelemahan motorik, dan mRS saat pulang perawatan 0-2, sedangkan aspek mental lebih tinggi adalah usia ≥30 tahun dan tanpa klinis kejang. Kata kunci. Kualitas hidup, meningitis tuberkulosis, selesai OAT, SF-36<

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The prevalence of disabilities among tuberculous meningitis (TBM) patients almost similar with its mortality rate (29-50%). The comprehensive evaluation of long-term outcomes should encompass not only morbidity and mortality rates but also incorporate the dimensions of physical, mental, and social well-being as outlined by the World Health Organization (WHO). This study aimed to assess the quality of life (QoL) among patients with TBM following the completion of anti-tuberculosis treatment (ATT) and investigating the factors that have impacts on this particular aspect. Methods. Retrospective cross sectional study of TBM patients, including tuberculoma upon completion of ATT at dr. Cipto Mangunkusumo National Center General Hospital during May 2019-June 2023. Demographic, clinical, diagnostic, and treatment characteristics were conducted by medical records and interviews. The assessment of QoL in TBM patients was performed using Short form (SF)-36 questionnaire. Statistical analysis was performed with SPSS version 19.0 (Mann-Whitney and Kruskal-Wallis for categorical data, Spearman for numeric data). Result. The study involved 53 participants, with median of age 30 (IQR 25.5-39) years, demonstrated favorable median SF-36 score of 86.5 (IQR 74.9-92.8). Median of physical score (PCS) and mental score (MCS) almost similar, 85 (IQR 69.4-94.85) and 88.1 (IQR 74.1-95.3), respectively. The impact of various factors on QoL was assessed, revealing significant associations with monthly income (p=0.033), presence of seizure (p=0.028), motoric abnormalities (p=0.023), and mRS at discharge (p=0.007). Employment (p=0.012), monthly income (p=0.007), motoric abnormalities (p=0.024), and mRS at discharge (p=0.01) were identified as factors influencing the PCS score. Age (p=0.006) and presence of seizure (p=0.025) found to impact the MCS score. Conclusion. The evaluation of QoL in TBM patients after completing ATT utilizing SF-36 score, PCS, and MCS revealed favorable outcome. Several factors were found to significantly influence higher SF-36 score, including monthly income, absence of seizure and motoric abnormalities, and mRS at discharge of 0-2. Similarly, factors such as employment, monthly income, absence motoric abnormality, and mRS at discharge of 0-2 were associated with higher PCS scores. Furthermore, a higher MCS score was observed in patients aged 30 years or older and those without seizures. Keywords. Quality of life, QoL, tuberculous meningitis, completion ATT, SF-36"

"Latar Belakang: Meningitis tuberkulosis (TBM) memiliki angka kematian yang tinggi khususnya pada kelompok HIV positif. Penelitian ini bertujuan untuk mengetahui karakteristik klinis dan prediktor kesintasan TBM dalam masa perawatan dan 6 bulan berdasarkan status infeksi HIV.Metode: Studi kohort retrospektif menggunakan data Indonesian Brain Infection Study bulan April 2019-September 2021 dengan diagnosis akhir TBM. Analisis faktor yang berhubungan dengan kesintasan masa perawatan dilakukan dengan regresi logistik. Estimasi probabilitas kesintasan 6 bulan dan prediktor yang berperan dinilai menggunakan kurva Kaplan-Meier dan uji regresi Cox.Hasil: Sebanyak 133 subjek TBM dimasukkan ke dalam studi (HIV positif 39,8%, TBM definite 31,6%). HIV positif memiliki temuan TBM definite yang lebih rendah, peningkatan sel dan protein cairan serebrospinal (CSS) yang lebih rendah, penurunan rasio glukosa CSS:serum yang lebih rendah, dan temuan TB milier yang lebih tinggi. Kesintasan dalam masa perawatan secara umum adalah 73,7% (HIV positif 67,9% vs. HIV negatif 77,5%, p=0,2), dipengaruhi oleh TBM probable dan TBM derajat 3. Estimasi probabilitas kesintasan 6 bulan adalah 57,9% (HIV positif 54,7% vs. HIV negatif 60%, p=0,4), dipengaruhi oleh waktu inisiasi obat antituberkulosis (OAT) dan TBM derajat 3. Tidak didapatkan perbedaan prediktor kesintasan masa perawatan dan 6 bulan berdasarkan status HIV.Kesimpulan: Kelompok HIV positif memiliki gambaran inflamasi CSS yang lebih rendah namun cenderung memiliki kesintasan rawat inap dan 6 bulan yang lebih rendah. TBM stadium lanjut berperan pada kesintasan jangka pendek dan panjang, sementara penundaan inisiasi OAT sejak admisi berhubungan dengan kesintasan jangka panjang.

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Background: Tuberculous meningitis (TBM) has a high mortality rate, especially in the HIV positive group. This study aims to define the clinical characteristics, as well as to analyze the inhospital and 6 month-survival and the following predictors of TBM patients with and without HIV infection.

Methods: Cohort retrospective study using Indonesian Brain Infection Study data with final diagnosis of TBM, between April 2019 and September 2021. Logistic regression was used to determine the predictors of inhospital survival. Meanwhile, 6-months probability survival was estimated using Kaplan-Meier curves and Cox regression analysis.

Results: A total of 133 subjects were included in the study (HIV positive 39.8%, definite TBM 31.6%). HIV positive group had less TBM definite, lower cerebrospinal fluids (CSF) cells and protein increases, smaller decrease in CSF:serum glucose ratio, and more miliary TB cases. Overall inhospital survival was 73.7% (HIV positive 67.9% vs. HIV negative 77.5%, p=0.2), with predictors of TBM probable and TBM grade 3. Six-month probability survival estimates was 57.9% (HIV positive 54.7% vs. HIV negative 60%, p-=0,4), with predictors of initiation of TB drug timing and TBM grade 3. We found no significant differences of inhospital and 6-month predictors according to HIV status.

Conclusions: Despite less inflammatory profile, HIV positive group had lower inhospital and 6-month survival. Advanced stage TBM had lower inhospital and 6-month survival, while delayed TB drug initiation was more related to the 6-month survival."

"Latar Belakang: Meskipun kontroversial, hospital readmission (HR) dapat mencerminkan keadaan pasien saat dipulangkan dan sebagai indikator untuk mengevaluasi mutu perawatan rumah sakit (RS). Penelitian ini bertujuan untuk mengetahui insidensi dan faktor risiko HR pada pasien infeksi intrakranial.Metode Penelitian: Studi kohort retrospektif pasien infeksi intrakranial periode April 2019-November 2021, menggunakan data Indonesian Brain Infection Study dan telusur rekam medis. Analisis bivariat menggunakan uji Chi Square dan Mann Whitney, dilanjutkan dengan analisis multivariat regresi logistik.Hasil: Insidensi HR pasien infeksi intrakranial sebesar 28,45%. Mayoritas subjek mengalami HR sebelum 30 hari (64,7%). Penyebab HR terbanyak adalah penyakit lain yang berbeda dengan diagnosis awal (55,9%). Komorbid penyakit ginjal meningkatkan risiko HR (aOR=7,2, IK 95%=2,2-23,8,p=0,000). Gejala klinis saat perawatan awal berupa kelemahan motorik dan kejang juga meningkatkan risiko HR (aOR=2,27,IK 95%=1,28-4,01, p=0,001) dan (aOR=1,93,IK 95%=1,02-3,62, p=0,037). Sedangkan ketersediaan pelaku rawat dapat menurunkan risiko HR (aOR=0,07,IK 95%=0,03-0,45, p=0,002).Kesimpulan: Insidensi HR pada pasien infeksi intrakranial dalam waktu 6 bulan sebesar 28,45%. Penyakit ginjal, gejala klinis kelemahan motorik dan kejang pada perawatan awal merupakan faktor yang dapat meningkatkan risiko HR, sedangkan ketersediaan pelaku rawat merupakan faktor yang dapat menurunkan risiko HR. 

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Background: Although controversial, hospital readmission (HR) can reflect the patient's condition at discharge and as an indicator to evaluate the quality of hospital care. This study aims to determine the incidence and risk factors for HR in intracranial infections.

Method: A retrospective cohort study of intracranial infection patients, in period April 2019-November 2021, using secondary data from the Indonesian Brain Infection Study and tracing medical records. Bivariate analysis using Chi Square and Mann Whitney test, followed by multivariate logistic regression analysis.

Results: The incidence of HR in patients with intracranial infections was 28.45%. The majority of subjects experienced HR before 30 days (64.7%). The most common cause of HR was other diseases that were different from the initial diagnosis (55.9%). Kidney disease comorbidity increased HR risk (aOR=7.2;95%CI=2.2-23.8;p=0.000). Clinical symptoms during initial treatment such as motor weakness and seizures also increased the risk of HR (aOR=2.27;95%CI=1.28-4.01;p=0.001) and (aOR=1.93;95%CI=1.02-3.62;p=0.037). Meanwhile, the availability of caregivers can reduce HR risk (aOR=0.07;CI 95=0.03-0.45;p=0.002).  

Conclusion: The incidence of HR in patients with intracranial infection within 6 months was 28.45%. Kidney disease, motor weakness and seizures are factors that can increase the risk of HR, while the availability of caregivers is a factor that can reduce the risk of HR."