AKSONA

Spontaneous Intracranial Hemorrhage in a 34-Year-Old Male Patient Related to Hypertensive Emergency

Mifta Nurmalasari — 2024-07-31

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Unhealthy lifestyles are believed to be cause of hypertension at a young age.
Untreated hypertension increases cardiovascular disease morbidity and mortality.
The incidence of intracranial hemorrhage associated with hypertension is approximately 60%. It commonly occurs in the deep brain structure, which is considered to have a poor clinical outcome.

ABSTRACT

Introduction: The incidence of hypertension is currently moving toward younger ages. It’s thought that an unhealthy lifestyle serves as a trigger. Hypertension can increase morbidity and mortality related to cardiovascular disease, even at a young age. This case report is intended to report the incidence of spontaneous intracranial hemorrhage in a 34-year-old male patient during a hypertensive emergency. Case: A 34-year-old male patient was rushed to the emergency unit at midnight due to a sudden decrease in consciousness. Headaches and seizures occurred before admission. The patient denied having any history of head trauma. The patient’s habits included excessive caffeine consumption, frequent late-night sleeping, and extensive smoking. At the time of admission, the patient’s vital signs indicated a poor clinical condition: GCS E1V1M1, BP 212/118 mm/Hg, deep irregular rapid breathing, sometimes followed by periodic apnea, RR 28 breath/minute, HR 111 beat/minute, SpO2 50%, T 36.8°C, which gradually developed hyperthermia. Both eyes had constricted and fixed pupils; the light reflexes were negative. A neurological examination revealed the body’s left lateralization. The head CT scan without contrast indicated hemorrhage in the right intracerebral, midbrain, pons, intraventricular, and subarachnoid areas, with estimated total volume of about 31 ml. Conservative treatment was chosen due to the bleeding location in the deep brain structure of GCS 3, which was considered to have a poor outcome. Conclusion: Hypertension in the younger age group is commonly associated with unhealthy lifestyles, which increase morbidity and mortality related to cardiovascular disease.

Bell's Palsy Post COVID-19 Vaccination: An Unwanted Occurence of Coincidence

Indra Pramanasari — 2024-07-31

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The COVID-19 vaccination is one of the methods used to combat the COVID-19 pandemic.
Bell's palsy is one of the unwanted side effects of the COVID-19 vaccination.
The benefits and protective impacts of the COVID-19 vaccine exceed the dangers.

ABSTRACT

Introduction: TOne way to fight the COVID-19 pandemic is through vaccination. Indonesia widely uses a number of vaccines. The inactivated virus vaccine (Sinovac-CoronaVac), the recombinant adenovirus vector vaccine ChAdOx1-S/nCoV-19 (AstraZeneca), the mRNA-1273 vaccine (Moderna), and the BNT162b2 mRNA vaccine (Pfizer-BioNTech) are some of these. The COVID-19 vaccination has reported several cases of acute facial nerve paralysis as an adverse event. Case: A 34-year-old female patient complained of drooping lips to the left side and being unable to close the right eyelid three days after receiving the first dose of the COVID-19 vaccine inactivated virus type (CoronaVac). Physical examination revealed obesity, right lagophthalmos, and right peripheral facial nerve paralysis, but no extremity paresis. The patient was clinically diagnosed with Bell's palsy and received corticosteroid therapy. The patient's complaints improved after 2 weeks of treatment. Reports indicate that several types of COVID-19 vaccines have resulted in acute facial nerve paralysis. The mRNA-type COVID-19 vaccine led to the most widely reported cases of Bell’s palsy. The incidence of Bell's palsy after the COVID-19 vaccine is very rare. Conclusion: Overall, the advantages and protective effects of the COVID-19 vaccine outweigh the risks.

Refractory Hyponatremia due to Systemic Infection: A Systematic Review

Dinda Rifdayani Inayah — 2024-07-31

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Hyponatremia is a potentially life-threatening condition.
Refracter hyponatremia can be seen in patients with systemic infection who have undergone therapy.

ABSTRACT

Introduction: Hyponatremia is a condition in which the sodium serum level is below the normal range. This condition is most common in hospitalized patients receiving systemic infection therapy and can lead to worse outcomes, potentially life-threatening.Objective: This study aimed to summarize the incidence of refractory hyponatremia due to systemic infection therapy. Methods: This was a systematic literature search conducted in October 2023 on the online database PubMed regarding refractory hyponatremia due to systemic. The analysis excluded narrative reviews, non-English studies, and studies that only discussed transient hyponatremia or local infections. Results: A total of 10 case reports of 11 patients were included in the final analysis. The mean age of patients was 46.63 years (SD = 20.79 years), and 63.64% were male. Strongloides stercoralis hyperinfection was the most common cause of systemic infection (54%). It was followed by disseminated Varicella-zoster virus infection (28%), tuberculosis (9%), and systemic nocardiosis (9%). The most common cause of immune compromise is stem cell transplant recipients (28%), followed by miliary tuberculosis (18%). Up to 91% of cases are caused by the syndrome of inappropriate antidiuretic hormone (SIADH), which is the pathophysiology of hyponatremia. Conclusion: Most patients with systemic infections and refractory hyponatremia have conditions that encourage immune compromise. The treatment of systemic infections is a priority since they contribute to hyponatremia.

Chemotherapy-Induced Peripheral Neuropathy: Pathophysiology, Diagnosis, and Treatment

Ica Justitia — 2024-07-31

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Chemotherapy induces neurotoxicity through DNA crosslink, impaired calcium homeostasis, mitochondrial damage, increased reactive oxygen species, pro-inflammatory cascade, axon degeneration, and programmed cell death.
CIPN has a primary impact on the sensory neuron.
CIPN is diagnosed based on the patient's history, chemotherapy history, and neurologic examination. Some pharmacological and non-pharmacological treatments are hypothesized to reduce CIPN symptoms, but only duloxetine is recommended.

ABSTRACT

Chemotherapy-induced peripheral neuropathy (CIPN) is the most common and severe neurological side effect of many commonly used chemotherapy agents. It affects more than 60% of cancer patients. Approximately 30%–40% of patients have persistent symptoms five months or longer after stopping treatment. Even years after completing chemotherapy, some patients still experience CIPN symptoms. CIPN increases the annual cost of healthcare, leads to detrimental dose reduction and even cessation of treatment, and severely affects cancer survivors’ quality of life. Chemotherapy induces neurotoxicity through a variety of mechanisms that lead to neuronal cell damage or cell death. This mechanism of neurotoxicity varies depending on the specific agent. CIPN is characterized predominantly by sensory axonal peripheral neuropathy. Motor and autonomic symptoms may appear, but less frequently. To diagnose CIPN, a thorough patient's history and neurological examination are required. The current approach to CIPN management focuses on managing the symptoms of neuropathic pain and reducing or stopping the chemotherapy agent when CIPN manifests. There is no proven or advised prophylaxis therapy for CIPN. The point of this review was to talk about how some commonly used chemotherapy agents (such as platinum-based compounds, taxanes, vinca alkaloids, bortezomib, and thalidomide) cause CIPN, how to diagnose it, and the newest treatments that are available.

Blood Pressure in Patients Obstructive Sleep Apnea and Resistant Hypertension with Continuous Positive Airway Pressure (CPAP) Therapy: A Systematic Review and Meta-Analysis

Mutiara Rizqia Rivania — 2024-07-31

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CPAP therapy is a medical treatment for individuals suffering from OSA, a condition that is frequently linked to cardiovascular disease and resistant hypertension.
Five studies clearly showed that combining CPAP therapy with standard medications had a big effect on the blood pressure of patients with both obstructive sleep apnea (OSA) and resistant hypertension.
Administering CPAP in conjunction with standard treatment, as per guidelines, has demonstrated the capability to lower both daytime and nighttime blood pressure in individuals affected by OSA and resistant hypertension.

ABSTRACT

Introduction: Obstructive sleep apnea (OSA) is an upper respiratory tract disorder that is often associated with cardiovascular diseases, one of which is resistant hypertension (RH). On the other side, Continuous Positive Airway Pressure (CPAP) is a medical treatment that is often used for patients with OSA and RH. Objective: This meta-analysis aimed to determine the effectiveness of CPAP in patients with OSA and resistant hypertension by measuring systolic and diastolic blood pressure at diurnal, nocturnal, and 24 hours. Methods: We conducted a systematic review using a PRISMA flowchart, utilizing sources such as PubMed, Scopus, Science Direct, and ClinicalTrials.gov with MeSH. We then reviewed these sources for quality studies using RoB2, and analyzed the data using the Revman website version. 5.4.Results: The five studies included in the analysis found that CPAP, while maintaining conventional drugs, significantly affected the blood pressure of patients with OSA and RH. The significant results were made clearer by obtaining data for nocturnal SBP pressure, mean -3.89 mmHg (95% CI: -7.03 to -0.76) with a p-value < 0.02, and then nocturnal DBP obtained a mean of -2.34 mmHg (95% CI: -4.70 to 0.02) with a p-value < 0.05. Meanwhile, the 24-hour results for SBP obtained a mean of -2.97 mmHg (95% CI: -5.88 to -0.06) with a p-value < 0.05, and the 24-hour results for DBP obtained a mean of -2.39 mmHg (95% CI: -4.62 to -0.16) with a p-value < 0.04. Conclusion: CPAP, while maintaining conventional treatment according to indications, can reduce 24-hour and nocturnal blood pressure in patients with OSA and resistant hypertension.

Profile of Meningioma Patients at Dr. Soetomo General Academic Hospital

Natasha Valeryna — 2024-07-31

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Meningioma, the most common primary brain tumor, is typically found in women aged 40-49 years old.
Meningiomas can show distinctive characteristics on clinical, radiological, and histopathological examinations.
There were significant differences in histopathological grading between male and female patients, as well as between homogenous and heterogenous contrast enhancement.

ABSTRACT

Introduction: Meningioma is an intracranial extracranial tumor that arises from arachnoid cells. It is reported to be the most common primary brain tumor (39%). Meningioma is diagnosed based on clinical and radiological findings, but a definitive diagnosis requires histopathology examination. However, the clinical, radiological, and histopathological profile of meningioma is rarely studied in Indonesia. Objective: This study aimed to identify the clinical, radiological, and histopathological profile of meningioma patients at Dr. Soetomo General Academic Hospital Surabaya from 2017 to 2021. Methods: This was a retrospective observational study with a cross-sectional design using secondary data collected from electronic medical records at Dr. Soetomo General Academic Hospital Surabaya in 2017-2021. Results: A total of 256 patients were included in this study. The majority of the patients in this study were female (83.98%), aged 40-49 years old (43.36%), and mostly had the clinical symptom of headache (35.94%). Meningiomas were mostly WHO grade I (85.16%), with a transitional subtype (44.92). Based on the Kruskal-Wallis test, there were differences in histopathological grading between male and female patients (p = 0.000), as well as between homogenous and heterogenous tumor enhancement (p = 0.027). However, there were no differences in histopathological grading between the dural tail findings (p = 0.181) and hyperostosis findings (p = 0.135). Conclusion: Meningioma was found to be more common in females than in males, with the peak occurring in 40-49 years old. The most prevalent clinical symptom was headache, and convexity was the most common location for these tumors, most of which were larger than 3 cm. The majority of meningiomas were WHO grade I with transitional subtype.

Profiles of Patients with Low Back Pain Caused by Disc Herniation in the Neurology Outpatient Clinic of Dr. Soetomo General Academic Hospital Surabaya during the Period of 2021

Bani Agindra — 2024-07-31

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The degenerative process plays a dual role, both protecting from and causing disc herniation.
Men have a quicker degeneration rate at a younger age, while women have a quicker rate at an older age.
Occupational factors such as physical workload, repetition, bending, and sitting periods all contribute to disc herniation.

ABSTRACT

Introduction: Low back pain (LBP) refers to a sensation of pain or discomfort occurring in the region between the lowest costal and gluteal crease, with or without leg pain. Damage to the annulus fibrosus causes disc herniation, allowing the nucleus pulposus to herniate into the spinal canal. In less than 5% of cases, LBP is caused by disc herniation. Objective: This study examined the profiles of individuals with herniated LBP discs and related factors at Dr. Soetomo General Academic Hospital Surabaya. Methods: The study was conducted at Dr. Soetomo General Academic Hospital Surabaya using secondary data from medical records, which was then analyzed using descriptive statistics. Results: Fifty-eight LBP patients with herniated discs were enrolled in this study. The patient sample ranged from 23 to 74 years old, with a mean of 47,98±14,92. The majority of patients (29.3%) were 31–40 years old. Male and female prevalence rates were the same. Employees have the highest percentage of any occupation group, with 56.9%. Conclusion: Some of the findings clarify previous studies. Age, gender, and occupation were all linked to the occurrence of either LBP or disc herniation. However, our data cannot indicate whether or not these factors contribute to the occurrence of LBP and disc herniation. Therefore, more research is required to understand these factors and their relation to disc herniation and LBP.

Profile Patients based on Risk Factors for Ischemic Stroke in the Neurology Inpatient Ward of Dr. Soetomo General Academic Hospital Surabaya during the Period of January to June 2022

Nabila Divandra Kusuma — 2024-07-31

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Some risk factors exhibited incongruent outcomes and went against existing theories.
The age group under 65 years old was the most prevalent modifiable risk factor.
Stage 2 hypertension was the most dominant non-modifiable risk factor.

ABSTRACT

Introduction: Stroke is a major cause of disability and death worldwide. Among the three types of strokes, the ischemic stroke is the most prevalent. Controlling risk factors is a key approach to preventing ischemic stroke. Due to the limited data availability in Indonesia, it is important to research patient profiles focusing on risk factors for ischemic stroke. Objective: To record the patient profiles based on the risk factors for ischemic stroke in the neurology inpatient ward of Dr. Soetomo General Academic Hospital Surabaya for the period of January–June 2022. Methods: This was a descriptive observational study with a retrospective design. This study examined secondary data from ischemic stroke patients’ medical records at the Dr. Soetomo General Academic Hospital’s neurology inpatient ward in Surabaya between January and June 2022. Results: Out of 176 patients, 108 were under the age of 65. Of these, 97 were male. There were 63 patients with a history of ischemic stroke, 58 with diabetes mellitus, 84 with stage 2 hypertension, 77 with dyslipidemia, 59 with impaired kidney function, 52 with diabetes mellitus by lab tests, and 23 who smoked. Conclusion: In this study, some risk factors exhibited discrepancies and contradicted existing theories. The two dominant variables in the patient population were a combination of risk factors that occur more frequently at a certain age and a combination of risk factors in patients with recurrent strokes.