AKSONA

In Silico Analysis of Pongamia pinnata to Inhibit Neuronal Apoptosis after Ischemic Stroke via NMDAR and Caspase-3

Muhammad Ja'far Shodiq, Farmindo Hartono, Siti Khaerunnisa, Abdulloh Machin — Mon, 31 Jul 2023 00:00:00 +0700

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The potential of Pongamia pinnata as an inhibitor of apoptosis in ischemic stroke has never been evaluated before.
Pongamia pinnata has potential to inhibit neuronal apoptosis via NMDAR and Caspase-3 in ischemic stroke.
Karanjachromene has the best binding interaction to inhibit NMDAR.

ABSTRACT

Introduction: One of the cardiovascular diseases with the highest mortality rate is stroke. Stroke is the second-leading cause of death worldwide. Each year, 12.2 million new cases of stroke occur, of which 7.6 million are ischemic strokes. In ischemic stroke, there are several pathways that cause neuronal apoptosis. The activity of NMDAR and caspase-3 is one of the pathways. Pongamia pinnata phytochemicals have a neuroprotective function against neurological disorders. However, its use as an inhibitor of apoptosis in ischemic stroke has never been evaluated before. Objective: This research was designed to evaluate the phytochemicals of Pongamia pinnata as inhibitors of neuronal apoptosis in ischemic stroke using an in silico study. Methods: This study used four main phytochemicals of Pongamia pinnata, namely Karanjin, Karanjachromene, Pongapin, and Pongachromene. The protein targets for neuronal apoptosis were NMDAR and caspase-3. The molecular docking processes were ligand preparation, protein preparation, grid box determination, molecular docking, and visualized molecular docking. Results: In silico results showed that at NMDAR target proteins, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -5.12, -5.83, -5.03, and -5.13 kcal/mol. At protein targets, Caspase-3, Karanjin, Karanjachromene, Pongapin, and Pongachromene have binding energies of -4.87, -4.98, -4.88, and -5.08 kcal/mol. Conclusion: The phytochemicals of Pongamia pinnata have the potential to inhibit neuronal apoptosis via NMDAR and caspase-3 in ischemic stroke. The binding of Karanjachromene to NMDAR demonstrated the compound's best interaction.

HDL Cholesterol and Functional Scale Measured by the NIHSS in Acute Thrombotic Stroke Patients

Rahayu Nofita Sari, Hanik Badriyah Hidayati, Jusak Nugraha — Mon, 31 Jul 2023 00:00:00 +0700

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Stroke is one of the leading causes of death and disability in the world.
There is correlation between HDL cholesterol in acute thrombotic patients and the functional degree of the NIHSS.
The lower rate of HDL cholesterol is related to the higher NIHSS score or the higher level of stroke severity.

ABSTRACT

Introduction: Stroke is one of the world’s leading causes of death and disability. Acute thrombotic stroke accounts for 87% of all stroke cases. The study of the correlation between high-density lipoprotein (HDL) cholesterol levels and acute thrombotic stroke is still limited, especially on the relationship between HDL levels and the degree of functional stroke. Objective: This study aimed to prove a correlation between HDL cholesterol and the functional scale measured by the NIHSS (National Institutes of Health Stroke Scale) in acute thrombotic stroke. Methods: The design study was cross-sectional, with sampling by consecutive admission based on inclusion and exclusion criteria in the neurological ward (Seruni A) at Dr.Soetomo General Academic Hospital, Surabaya. The NIHSS was used to determine the degree of functional scale, and HDL levels were measured by enzymatic endpoint methods. Results: From the 40 subjects studied, 16 (40%) had normal HDL levels of ≥ 40 mg/dL with an NIHSS score between 0–10, and 24 (60%) had lower HDL levels of ≤ 40 mg/dL with an NUHSS score between 0–20. There were significant results in this study (r = 0.391 and p = 0.013). Conclusion: There was a negative correlation between HDL cholesterol levels and the functional scale measured by the NIHSS in acute thrombotic stroke patients.

Intracerebral Hemorrhage Score as a Prognosis Prediction of Spontaneous Intracerebral Hemorrhage at RSI Surabaya Jemursari

Mon, 31 Jul 2023 00:00:00 +0700

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Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia.
The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral.
The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die.

ABSTRACT

Introduction: Spontaneous intracerebral hemorrhage, or hemorrhagic stroke, is one of the leading causes of mortality and disability in Indonesia. Objective: The intracerebral hemorrhage (ICH) score is a widely used predictive tool for the prognosis of death 30 days after spontaneous intracerebral hemorrhage, but the intracerebral hemorrhage-grading scale (ICH-GS) score has a more specific interval to assess prognosis prediction after intracerebral hemorrhage. Methods: The type of research used was observational-retrospective research. The population included all patients with spontaneous intracerebral hemorrhage hospitalized at RSI Jemursari Surabaya in 2017–2019. Results: The results revealed that there were 110 spontaneous intracerebral hemorrhage patients with complete data in medical e-records during 2017–2019; 65.5% (72 patients) were male and 34.5% (38 patients) were female. The data showed that 20% (22 patients) had an ICH-GS score of 8 and 0.9% (1 patient) had an ICH-GS score of 12. Conclusion: The higher the total score, the more likely it is to have a poor outcome. The results of this study indicate that patients with a high total score did not always die.

D-Dimer Levels as a Predictor of Clinical Outcome and Mortality in Acute Ischemic Stroke Patients: A Systematic Review and Meta-Analysis

Pearl Dhodik Wirasman, Abdulloh Machin, Jenar Harumi — Mon, 31 Jul 2023 00:00:00 +0700

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An increase in the D-dimer level indicates activation of the coagulation system through thrombus formation and fibrinolysis.
The meta-analysis found a significant relationship between elevated d-dimer levels and worsening clinical outcomes and increased mortality.
The D-dimer level can be used as a predictor for predicting clinical outcomes and mortality in acute ischemic stroke patients at each duration of follow-up.

ABSTRACT

Introduction: In ischemic stroke, high D-dimer levels are frequently found, indicating coagulation with ongoing thrombus formation and fibrinolysis. Objective: The purpose of this study was to analyze the role of D-dimer in predicting clinical outcomes and mortality in acute ischemic stroke patients. Methods: A systematic literature search was conducted using the PRISMA method through the PubMed, Science Direct, and Google Scholar databases. The quality of the article was assessed using the Newcastle-Ottawa Scale (NOS) and statistically analyzed using Review Manager software version 5.4.1. Results: Eight articles had good quality according to NOS and matched the criteria for the literature search. Elevated D-dimer levels and worsened clinical outcomes have a significant result when discharged from the hospital: OR 2.37 (95% CI 1.68–3.35); I² = 45% p < 0.00001; 1-month: OR 1.75 (95% CI 1.38–2.23), I²= 47% p < 0.00001; 3-months: OR 2.43 (95% CI 2.00–2.95), I² 0% p < 0.00001; 6-months: OR 2.64 (95% CI 1.92–3.63), I²= 0% p < 0.00001; and 12-months: OR 1.92 (95% CI 1.31–2.82), I² = 62% p < 0.0008. Elevated D-dimer level and increased mortality have a significant result with OR 2.25 (95% CI 1.78–2.85), I² = 45% p < 0.00001. Conclusion: D-dimer can be used as a predictor of clinical outcome and mortality in acute ischemic stroke.

Cerebral Salt Wasting Syndrome in Traumatic Epidural Hematoma and Subarachnoid Hemorrhage: A Case Report

Mon, 31 Jul 2023 00:00:00 +0700

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CSWS is a rare case of hyponatremia in central nervous system disorders.
The correct diagnosis of CSWS is very important because it has a different treatment strategy from other diseases so that patients will get a good outcome.

ABSTRACT

Introduction: Electrolyte imbalance is common in patients with neurologic disease, including traumatic brain injury. The most common type is hyponatremia, a condition in which serum sodium <135 mmol/L. High morbidity and mortality rates are associated with hyponatremia, especially if the underlying causes are misdiagnosed and improperly treated. One such condition that comes to mind is cerebral salt wasting syndrome (CSWS), which is treated primarily with volume resuscitation and sodium replacements and is characterized by hyponatremia, elevated urine sodium, and hypovolemia. Case: A 21-year-old man was hospitalized for a traumatic brain injury due to a traffic accident. He suffered from an epidural hematoma (EDH) and a subarachnoid hemorrhage (SAH). He underwent an emergency decompression craniotomy and hematoma evacuation. The operation went well, as expected. During hospitalization, the patient developed agitation, restlessness, and polyuria with hyponatremia in serum but elevated in urine. We identified that CSWS was the underlying cause and administered isotonic, hypertonic, and hydrocortisone treatments to the patient. The patient showed progressive improvement. His condition tends to be stable, and he has a normal electrolyte level. Conclusion: Cerebral salt wasting syndrome (CSWS) is an important but underrecognized cause in hyponatremic patients with central nervous system disorders.

Preoperative Endovascular Embolization of Intracranial Hemangioma: A Case Report

Gilbert Tangkudung, Jeffry Foraldy, Yovanka Manuhutu — Mon, 31 Jul 2023 00:00:00 +0700

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Preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success
Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection.

ABSTRACT

Introduction: Hypervascular tumors of the head, neck, and central nervous system are associated with a high risk of bleeding during surgery. Hemangioma is a benign neoplasm that tends to grow rapidly, bleed, and have a high recurrence rate, especially after partial resection. Considering that hemangioma is a type of tumor with high vascularity, preoperative tumor embolization was performed to reduce intraoperative risk and maximize resection success. Case: A 33-year-old female came with the chief complaint of chronic progressive headaches and vision loss in the last 5 years. She got a lump on her forehead and had a visual acuity of 1/∞ in both eyes. She had already been diagnosed with hemangioma at a secondary regional hospital, where she bled profusely on the operating table, causing the resection to be discontinued. She was referred to our hospital for preoperative embolization. She underwent an endovascular embolization procedure with PVA particles to seal the feeder artery to the tumor. After embolization, angiography showed a complete devascularized tumor lesion. A total resection was done three days later with minimal bleeding compared to the first surgery. After a three-month follow-up, there was no new neurological deficit, and her headache was resolved completely, although her vision still did not improve. Conclusion: Endovascular embolization has developed into an important and effective adjuvant in tumor management before a surgical resection. Advances in catheter-based techniques, in conjunction with the development of the neurointervention field, are expected to raise the number of perioperative embolization procedures performed.

A Rare Case of Dural Tail Sign in the Patient with Glioblastoma Multiforme: A Case Report

Mon, 31 Jul 2023 00:00:00 +0700

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A dural tail sign was found in T1W1-MR-images with contrast of a patient with glioblastoma multiforme.
Glioblastoma multiforme as a grade IV malignancy of the astrocytes' glioma, the dura mater can be infiltrated and shown as DTS, although rarely reported.

ABSTRACT

Introduction: The dural tail sign (DTS), which is rarely seen in patients with glioblastoma multiforme (GBM), is reported here. This sign is generally found as a manifestation of meningioma due to the reactive changes of the tumor’s invasion. Case: A 61-year-old Javanese man presented with a gradually worsening headache two months prior to hospital admission. He also suffered from paralysis of his right extremities. His complete blood tests and clinical chemistry were within normal limits. A head CT scan showed a large mass near the convexity of the brain in the left parietal lobe, along with edema and a shift of the midline structures to the right. This was confirmed on the T1W1 MR images with contrast, where DTS was clearly shown. Following surgical resection and tumor excision, histopathology analysis revealed GBM with malignant cell infiltration to the dura in the vicinity of the neoplasm. Conclusion: Here we showed a DTS in GBM as a malignant infiltration marker into the dura

Case Series: Gamma Knife Radiosurgery in Brain Arteriovenous, Is It Good Enough?

Yohan Budi Hartanto, Debora Sharon Rory, Jesisca Jesisca — Mon, 31 Jul 2023 00:00:00 +0700

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Brain AVMs are a special concern due to their inherent high risk of bleeding.
Gamma Knife radiosurgery (GKRS), as one of the modality treatments, is intended to induce progressive occlusion of an AVM by using high-dose targeted radiation
The result of Gamma Knife radiosurgery (GKRS) can be full obliteration, with complications because adverse radiation effects.

ABSTRACT

Introduction: Brain arteriovenous malformations (AVMs) are relatively uncommon. Gamma Knife radiosurgery (GKRS) is one of the AVM’s therapeutic interventions, with both advantages and disadvantages. Here, we report the results of two cases of brain AVM after GKRS.

Cases:

Case 1: Non-contrast head MRI imaging of a 45-year-old man with persistent left-sided headaches revealed a 1.4 x 2.5 x 2.28 cm AVM nidus in the left parasagittal frontal lobe. After a single GKRS with a 25-Gy marginal dose, the MRI contrast showed complete obliteration, with persistent perifocal edema and headache.

Case 2: A 25-year-old woman with a history of generalized seizures. The angiograms revealed an AVM nidus with a diameter of 32.58 mm on her right posterior frontal lobe. After a single GKRS with a 22-Gy marginal dose, the MRI contrast showed full obliteration with large edema. The patient had presented with hemiparesis.

Conclusion: In these cases, the results after GKRS were full obliteration with complications of edema, headache, and hemiparesis. We also found that complications appear to be associated with adverse radiation effects.