MNJ (Malang Neurology Journal)

CASE STUDY OF A TARLOV CYST IN A SYRIAN PATIENT

Hala Salman — 2023-12-27

Tarlov cyst is a rare disease that affects the nervous system, which is a vesicle filled with spinal cord fluid, the cyst surrounding the nerve are fluid-filled sacs that greatly affect the nerve root and are detected by magnetic resonance in some cases the bag expands and put pressure on the affected nerve root. Several treatment methods have been used, including pharmacological and non-pharmacological methods such as cortisone injections and surgery. As a result of the multiplicity of information about Tarlov’s cyst disease, a questionnaire was conducted for the project to prove the views of its being a rare disease and to find out the extent of awareness in society in differentiating between symptoms associated with Tarlov’s cyst and other neurological diseases, we found that 86.4% of people who contributed in our questionnaire were not able to identify the disease, so we found its important to study the Tarlov cyst case that was diagnosed in 2019 which belongs to a 20-year-old girl.

X-ray and MRI were used to diagnose Tarlov's Cyst after one year of the first visit to the doctor. After treating the cyst with muscle relaxants and cortisone for one year the pain persisted and surgery was carried out in 2021. Late diagnosis is common and the degree of knowledge of the disease is low even among medical practitioners. Therefore, we concluded that awareness must be spread through increased research and scientific seminars to introduce it, especially with regard to the medical branches.

A RARE CAUSE OF ENCEPHALOPATHY IN CHILDREN: PRES SYNDROME

Demet Tosun — 2023-12-27

Background: Major clinical symptoms of posterior reversible encephalopathy syndrome include headache, mental status changes, visual disturbances, seizures, especially in the posterior cerebral region, and radiographic findings of vasogenic edema, especially in the posterior cerebellar region.

Case Report: We present our 6-year-old patient with chronic renal failure. admitted to our pediatric emergency department with an acute hypertensive crisis. Generalized tonic-clonic seizures and mental status changes were accompanied in the follow-up of the patient whose GCS was 11; With symptomatic treatment, regression in both clinical complaints and imaging findings of our patient is consistent with Posterior reversible encephalopathy syndrome (PRES).

Conclusion: It is imperative to consider PRES syndrome as a differential diagnosis when pediatric patients exhibit symptoms of acute encephalopathy. It is crucial to emphasize the critical nature of early diagnosis and treatment, as well as the potential for complete recovery without sequelae.

THYMOMA REMISSION WITH STEROID THERAPY IN MYASTHENIA GRAVES WITH GIANT THYMOMA

Fatma Şimşek — 2023-12-27

The thymoma is an uncommon neoplasm. It is detected incidentally in some patients. Myasthenia gravis (MG) is an autoimmune disease and closely related to thymoma. Between 10% and 20% of patients with MG have thymoma and 30%–50% of patients with thymoma have MG. Thymectomy is part of the treatment for MG patients. However, the patient must be stabilized before thymectomy. We present a 26-year-old male case with giant thymoma. In the initial evaluation of the patient, a giant-sized thymoma was observed, which was thought to cause vascular invasion. Interestingly, the introduction of corticosteroid therapy for MG symptom management resulted in unexpected significant remission of giant thymoma. After steroid treatment, thymectomy was performed. This case demonstrated that steroid therapy was effective and well tolerated for the treatment of both thymoma and MG. Therefore, steroid therapy should be continued for a while for thymoma remission before surgery in MG patients with giant thymoma. Treatment is arranged according to the clinical findings of the patient. Each patient's response to treatment and duration of treatment may differ from each other. After thymectomy, long-term follow-up is required for the possibility of thymoma becoming malignant.

HIV-RELATED CEREBRAL TOXOPLASMOSIS TREATED WITH ANTIMALARIA MEDICINES: A CASE REPORT

Andi Kurnia Bintang — 2023-12-27

Background: Cerebral toxoplasmosis is a central nervous system disease caused by infection of intracellular parasite (Toxoplasma gondii) which happened due to activation of dormant form inside brain tissue in immunodeficient patients, especially in people living with HIV/AIDS (Human Immunodeficiency Virus/ Acquired Immunodeficiency Syndrome) or PLWHA.

Case Presentation: A 36-year-old man with subacute headache, fever, changing personal behaviour and confusion that persisted for one month. He also had white spot in mouth, history of significant weight loss, meningeal signs, and motoric disturbance. His non contrast head CT scan shown presumptive cerebral toxoplasmosis appearance. We treated the patient with combined antimalaria drugs consists of Pyrimethamine-Sulfadoxin.

Conclusion: Early diagnosis by available and rationale empiric treatment, then repeated cranial study is recommended which can dramatically reduce the high mortality and morbidity associated with this disease.

HYPERDENSE BASILAR ARTERY SIGN IN ISCHEMIC STROKE PATIENT WITH COVID-19: A CASE REPORT

Neoniza Eralusi Asrini — 2023-12-27

Background: Coronavirus disease 2019 (COVID-19) can cause coagulopathy, leading to thromboembolism disease such as ischemic stroke. Ischemic stroke due to basilar artery occlusion (BAO) is rare condition, which is hard to diagnose and has high mortality especially if accompanied by COVID-19.

Objective: To evaluate the presence of infarction in the basilar area in COVID-19 patients and prevent complications that arise due to misdiagnosis

Methods: 41 year old male patient came to the emergency unit with left-side weakness, slurred speech, vertigo, and nausea 7 hours before admission. He also had mild fever, cough, and fatigue a week before admission. Patient had full consciousness, blood pressure 180/100, left hemiparesis (motoric 3/5), dysarthria, dysphagia. His National Institutes of Health Stroke Scale (NIHSS) score was 7.

Results: From laboratory examination, neutrophil lymphocyte ratio (NLR) was increased to 3.60, he tested positive for SARS-CoV-2 rapid antigen and Polymerase Chain Reaction (PCR) with cycle threshold (CT) value 28.66, and D-dimer was increased to 4000 ng/mL. Bronchovascular markings increased on chest X-ray and hyperdense bacillary artery sign found on head CT-scan suggesting vertebrobasilar infarct. Acute stroke ischemic due to large vessel occlusion in COVID-19 found more often in young men with mild symptoms or asymptomatic COVID-19. Prodromal symptoms and stroke onset in BAO can be atypical and variable. Hyperdense bacillary artery sign on head CT scan was a specific sign and can support the diagnosis of BAO.

Concussion: Patient’s condition got better progressively and was allowed to discharge from hospital after 6 days. BAO patients with younger age, lower NIHSS scores, early diagnosis, and prompt treatment had better prognosis.

ANGIOPLASTIC STENOSIS IN SPONTANEOUS BILATERAL CAROTIC ARTERY DISSECTION: A CASE REPORT

Subandi Subandi — 2023-12-27

Case: A 28-years-old woman presented with sudden right extremities weakness, right sided facial droop, and not being able to speak. On examination, the patient had upper motor neuron (UMN) hemiplegia and motor aphasia. On blood laboratory, we found D-dimer level of 1068 ng/dl. A non-contrast head CT-scan and CT-angiography showed left cerebral hemisphere infarction, and bilateral carotid artery stenosis. Further investigation with transcranial Doppler demonstrated partial stenosis of internal carotid artery (ICA). On cerebral digital subtraction angiography (DSA), we observed pseudoaneurysm on the right ICA and flame-shaped appearance on the left ICA, both are common radiological finding of ICA dissection. Then we performed stenting angioplasty on bilateral ICA to provide recanalization, and aspirin 80mg q.d. and clopidogrel 75mg q.d. was initiated.

Conclusion: Spontaneous dissection of the carotid artery can occur on young adults. DSA is considered as the gold standard for vascular examination, and stenting with angioplasty was performed for recanalization to prevent the progression to severe stroke.

DIFFUSION WEIGHTED IMAGING IN WILSON’S DISEASE

Tushar Kalekar — 2023-12-26

Background: Wilson’s disease is a disorder affecting metabolism of Copper resulting in its accumulation in various organs and thereby various manifestations. Neurologic involvement in Wilson’s disease is well diagnosed using Magnetic Resonance Imaging (MRI). Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) sequences aid to the diagnosis of Wilson’s disease.

Objective: To assess the role of Diffusion-Weighted Imaging (DWI) in Wilson's disease and investigate its application in the clinical course of the disease and to study its demographic distribution.

Methods: A prospective observational study on 25 patients diagnosed to have Wilson's disease with or without any neurological manifestations was done performing MRI of brain with Diffusion-weighted imaging (DWI). A follow-up of the patients was performed at end of 6 months eliciting their clinical history.

Results: In 25 patients studied, 24% patients showed diffusion restriction, corresponded with a poor prognosis as compared to the other 76% with Wilson's disease. Follow-up study after 6 months on these patients revealed that even after having good adherence with de-coppering therapy, these patients showed progressive neurological deterioration. Most of the patients were between the age group 11-20 years accounting for 44% and majority of the patients were males, accounting for 72%.

Conclusion: Diffusion restriction imaging can be effective in determining neurological involvement in Wilson's disease. Patients having diffusion restriction can be considered at high risk for neurological deterioration. It is prudent to obtain diffusion restriction imaging at baseline in all patients diagnosed or suspected to have Wilson's disease.

A SIX-MONTH STUDY OF CLINICAL SYMPTOMS, IMAGING AND OUTCOMES OF PATIENTS DIAGNOSED WITH CEREBRAL VENOUS SINUS THROMBOSIS (CVST)

Ghasem Fatahzadeh Ardalani — 2023-12-27

Background: One of the unusual cause of headache and stroke is CVST with very diverse clinical manifestation. Onset of focal headache, headache with seizures, papilledema, or focal defect are some of important clinical features. Consideration of risk factors, especially the use of hormonal drugs, recent pregnancy, coagulation disorders, as well as recent infections and systemic inflammation, can lead to clinical suspicion of CVST. For early and accurate detection we can use modern MR imaging.

Objective: To evaluate the clinical symptoms and imaging findings of patients with a diagnosis of CVST during 6-months follow-up.

Methods: This cross-sectional study was used on 56 patients with CVST. Clinical, preclinical, and imaging records of inpatients and also information like age, sex, and underlying diseases were collected at a checklist. After 6 months from the start of treatment, the identified patients were followed up through a telephone interview, and if there were any positive symptoms, they were visited on an outpatient basis in the neurology clinic of Alavi Hospital in Ardabil, and the necessary information was extracted. Collected data were analyzed by statistical methods in SPSS version 21.

Results: Of all patients, 47 (84%) were women. The most common symptom was headache with 87.5% and then nausea and vomiting, sensory and visual symptoms with 57.1%, 51.8% and 44.6%, respectively.

Conclusion: The results of this study showed that, the clinical symptoms of patients are very various and misleading, but the most common clinical symptoms were headache, nausea and vomiting. Women were involved more than men. The results of the study disclosed that CVST had wide range of clinical manifestations and non-specific symptoms at the beginning. For that reason, in especially high risk groups for thrombosis, the diagnosis of CVST should be kept in mind.

EVALUATION OF BRAIN LESIONS BY MAGNETIC RESONANCE SPECTROSCOPY IN TERTIARY HOSPITALS OF FAISALABAD

Abdul Maajid Khokhar — 2023-12-27

Background: One of the most fascinating and intricate organs in the human body is the brain. Infectious and neoplastic lesions in brain tissues can be identified by Magnetic Resonance Imaging (MRI).

Objective: This study sought to determine which Magnetic Resonance Imaging (MRI) sequence is more usually used for differentiating brain lesions and which metabolites are examined by Magnetic Resonance Spectroscopy in Tertiary hospitals of Faisalabad. This study also aimed to check the efficacy and cost-effectiveness of MRI in the detection of various brain lesions.

Methods: A cross-sectional study was conducted in the Radiology Department of different tertiary hospitals in Faisalabad. The data was collected from 25 patients (aged between 25 to 70 years) via a convenient sampling technique. Data was collected by performa and analyzed by SPSS V 20.

Results: Out of 25 patients; 20 were male and 5 were female. 15 patients were diagnosed with a tumor, 5 with tuberculosis infectious lesions, 3 with empyema, and 2 with a heterogenous picture of metabolites. According to the results of MRS, different metabolites are used by different hospitals for the evaluation of various brain lesions. Brain infectious and neoplastic lesions can be distinguished quite effectively using MRS, although some infectious lesions can be difficult to distinguish.

Conclusion: MRI is a non-invasive technique to identify brain tumors and infectious lesions. The main metabolites in H₁MRS are Choline, Creatine, and N-Acetyl Aspartate. A high Cho/Cr ratio indicates brain tumors while a low NAA/Cr ratio indicates infectious lesions. When MRS indicates a tumor, not only a brain ^99mTc scan should be performed, but if necessary surgical removal of brain lesions should be preferred.

WEB OF SCIENCE BASED BIBLIOMETRIC ANALYSIS STUDY: TUBERCULOSIS MENINGITIS FROM 1970 TILL TO PRESENT

Sevil Alkan — 2023-12-27

Background: Tuberculous meningitis (TBM) is the most dangerous and incapacitating type of tuberculous and has a high mortality rate.

Objective: We aimed to reveal the general perspective of tuberculous meningitis, with bibliometric analysis.

Methods: This study included only articles as a document type, searched in the Web of Science database, indexed in ‘‘Science Citation Index Expanded’’ and ‘‘Emerging Sources Citation Index’’ from 1970 to the present.

Results: A total of 2370 publications were reached and 1516 articles were included in the study. 87.401% of them were published in Science Citation Index Expanded and 12.599% in the Emerging Sources Citation Index. The articles were mostly published in English (92.084%) language. Most of the articles (6.266%) were published in 2021. 107 countries contributed to the tuberculous meningitis literature. India, the USA, and South Africa were the countries with the highest number of articles published. Most articles were published in “The International Journal of Tuberculosis and Lung Disease’’ journal. The countries that financially supported tuberculous meningitis studies the most were the USA and the United Kingdom (UK).

Conclusion: TB continues to be an important public health problem globally, especially in low-middle-income countries. In this study, it was observed that there has been a significant increase in publications related to TBM in recent years. It was seen that the USA and UK were the countries that provided the most publications and financial support to the studies, although they were not, particularly the countries where TBM was watched most frequently.

MAGNETIC RESONANCE IMAGING FINDINGS IN SEIZURE PATIENTS WITH NORMAL NEUROLOGICAL EXAMINATION

Ghasem Fatahzadeh Ardalani — 2023-12-27

Background: Imaging plays a critical role in the treatment and diagnosis of individuals experiencing seizures, particularly those whose seizures cannot be explained. In various circumstances, CT scans and MRIs (Magnetic Resonance Imaging) are utilized in tandem.

Objective: The purpose of this research was to evaluate the MRI findings of patients referred to Alavi Hospital with seizures and a normal neurological examination.

Methods: This case-series study examined one hundred patients with epilepsy who underwent normal neurological examinations. All patients' imaging reports were meticulously examined, and any changes were documented in pre-established checklists that comprised of the following: age, gender, family history, EEG (electroencephalogram) results, neurological assessments (including motor, plantar, and tendon reflexes), and MRI findings derived from the patients' files and clinical histories.

Result: In the range of 11 to 58 years, the mean age of patients was 7.46 + 32.62 years. Males comprised forty-six (46%) of the patients. In45% of the cases, a familial history of seizures was documented (n=45). Normal EEG results were obtained in 62 cases (62%). Twenty cases (20%) of abnormalities were detected on MRI, seven of which were tumor lesions, as reported by the radiologist. The imaging of the patient's brain revealed no significant correlation between the pathological findings and variables such as age, gender, or family history. No significant correlation was observed between electroencephalogram results and pathological findings on brain imaging in patients with epilepsy.

Conclusion: brain imaging partially compensates for the false negatives that occur during electroencephalograms, and concurrently employing both modalities enhances the ability to diagnose underlying issues in patients experiencing seizures.

EVALUATION OF THE OPTIC NERVE IN MIGRAINE PATIENTS BY MAGNETIC RESONANCE IMAGING HISTOGRAM ANALYSIS

Turgay Kara — 2023-12-27

Background: Migraine is a chronic, paroxysmal neurovascular primary headache disease seen in approximately 15% of the world. In many studies on migraine, changes in the gray and white matter at the microvascular level have been detected. 90% of patients with aura have visual auras. Histogram analysis is an artificial intelligence application that can detect microscopic pathology in tissues before visual pathology.

Objective: Histogram analysis was utilized in our investigation to ascertain whether or not the optic nerve, which is ordinarily visible on magnetic resonance images, was impacted.

Methods: 120 adult migraine patients and 120 control group were involved. MRI was performed on a Philips 1.5 Tesla Ingenia device. For histogram analysis, optic nerve region of interest (ROI) measurement was performed in the coronal planes from the edges of the intraorbital segment, whose borders can be clearly distinguished, by using the manual drawing tool for both eyes. The data were analyzed through the MatLab program.

Results: The average age of individuals diagnosed with migraine was 37.04 ± 9.57 years, whereas the control group had an average age of 37.8 ± 10.8 years. Between the two groups, 27 distinct parameters computed via histogram analysis were compared. In the control and migraine groups, no statistically significant distinction was observed between the right and left eyes. In contrast to the migraine and control groups, the Mean Local Standard Deviation of the Matrix was found to be The histogram's 5th, 10th, 25th, and 75th percentiles, the average squared, the root sum of squared, the size percent M, the most frequently used value, the median, and the average are all quantified using the root sum of squares. The number of pixels is also indicated. It was determined that ROI values were statistically significant (p0.05).

Conclusion: In migraine patients, alterations in the optic nerve, which are typically discernible on conventional magnetic resonance images, may be identified via histogram analysis.

PNEUMONIA IN ICU HOSPITALIZED NEUROLOGIC PATIENTS: THE RELATIONSHIP BETWEEN C-REACTIVE PROTEIN AND PROCALCITONIN LEVELS WITH THE RESULTS OF BLOOD AND SPUTUM CULTURES

Carolin Tiara Lestari Indah — 2023-12-27

Background: Pneumonia is often experienced by neurology patients, especially in the intensive care unit (ICU). Culture and antibiotic sensitivity tests as the gold standard of pneumonia require a long time, then other examinations are needed, namely C-reactive protein markers (CRP), and procalcitonin (PCT).

Objective: To determine the relationship between CRP and PCT levels with the results of blood and sputum cultures in ICU hospitalized neurologic patients Prof I.G.N.G. Ngoerah General Hospital, Denpasar, Bali.

Methods: A cross-sectional study that includes all neurology patients with pneumonia in the ICU of Prof I.G.N.G. Ngoerah General Hospital in 2018-2022. The required examination data are demographic data, CRP and procalcitonin levels, and blood and sputum culture results. Data analysis using SPSS Version 24 qualitatively.

Results: We identified 121 ICU hospitalized neurologic patients with pneumonia involving 59 blood and 85 sputum culture-positive and 15 isolated pathogens. The leading pathogens were Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeuroginosa, Escherichia coli, Staphylococcus aureus, Candida albican, Streptococcus suis, and Staphylococcus haemolyticus, and other pathogens which were isolated in 31 (19,7%), 25 (15.9%), 20 (12.7%), 11 (7%), 10 (6.4%), 4 (2.5%), 3 (1.9%), and 1 (0.6%) cases, respectively, however Klebsiella pneumoniae has the highest number of resistance cases, especially ESBL. There was a significant relationship between high CRP (>97.9) and blood culture (OR 6.42, p <0.03).

Conclusion: CRP can be considered as a fast and appropriate examination to establish an early diagnosis of pneumonia in patients.

PROFILE OF CHARACTERISTIC, RISK FACTOR, AND CLINICAL SEVERITY OF ISCHEMIC STROKE PATIENTS

Philips Carel Perdana — 2023-12-27

Background: Ischemic strokes account for 87% of all strokes, making them the second leading cause of disability and one of the leading causes of mortality worldwide. Using the National Institutes of Health Stroke Scale (NIHSS), the clinical severity of an ischemic stroke can be assessed.

Objective: The objective of this study is to ascertain the clinical severity, risk factors, and characteristics of patients with ischemic stroke at the neurology department of RSUD Dr. Soetomo Surabaya.

Methods: The participants in this descriptive observational study comprise individuals who sought medical attention at the neurology department of RSUD Dr. Soetomo between January 2019 and December 2020 due to an ischemic stroke. The observed profile comprises the following factors: age, gender, obesity, smoking status, alcohol consumption, physical inactivity, family history of vascular disease, form of infarction, dyslipidemia, hypertension, cholesterol, and diabetes.

Results: In the medical record data collection of 89 ischemic stroke patients, 36 patients were excluded when they first entered the hospital. So a total of 53 ischemic stroke patients were collected. 29 (54.72%) patients are male. The age range is dominated by 48 - 62 years from 29 (54.72%) patients. 44 (83.02%) patients are Javanese. 18 (33.96%) patients had a history of smoking, 1 (1.89%) patient consumed alcohol, and 1 (1.89%) patients were inactive physically. 13 (24.53%) patients have a family history of vascular disease, 45 (84.91%) patients have hypertension, 26 (49.06%) patients have dyslipidemia, and 19 (35.85%) patients have diabetes. 34 (64.15%) patients had moderate strokes, 15 (28.30%) patients had mild strokes, 2 (3.77%) patients had moderate-severe strokes, and 2 (3.77%) patients had severe strokes according to the results of the NIHSS assessment on the first admission.

Conclusion: Ischemic stroke patients were mostly in the age range of 48 – 62 years. Comorbidities such as hypertension, dyslipidemia, hypertriglyceridemia, and diabetes are present in the majority of patients. The NIHSS scoring identified moderate stroke patients as having the most frequent outcomes, followed by patients with mild stroke.

THE EFFECT OF HIGH-INTENSITY FOCUSED ELECTRO-MAGNETIC (HIFEM) THERAPY ON URINARY INCONTINENCE

Besut Daryanto — 2023-12-27

Introduction: Urinary incontinence (UI) is an involuntary leakage of urine, regardless of the amount or frequency, which alters physical, emotional, and social well-being and quality of life. The therapy currently being studied is magnetic stimulation (MS) has been used to stimulate the pelvic floor muscles. It is based on Faraday's law of magnetic induction, where a changing magnetic field over time induces electrical activity that depolarizes nerves and causes contraction of the pelvic floor muscles. However, the research on the effect of High-Intensity Focused Electromagnetic is still minimal, especially in Indonesia, so its effectiveness in overcoming UI in Indonesia is still doubtful.

Method: This study used a prospective cohort design where patients were followed for one month. Patients were followed from when they were first diagnosed until the therapy was completed and evaluated. The variables in this study were as follows: pre and post International Prostate Symptom Score (IPSS), Overactive Bladder Syndrome Score (OABSS), Barhal index, and progress of patient complaints from the first therapy.

Result: This research was conducted for 6 sessions, and significant results were obtained in sessions 1, 4, 5, and 6. From this data, we conclude that the HIFEM therapy had a significant effect from session 4. Furthermore, we found a significant therapeutic effect between sessions 4 and 6, but not between sessions 4 and 5. There was also a significant therapeutic effect between sessions 5 and 6.

Conclusion: HIFEM can improve incontinence and OAB complaints. HIFEM works to strengthen the pelvic floor muscles.

THE CORRELATION BETWEEN NEUTROPHYL-LYMPHOCYTE RATIO AND OPTIC NERVE FUNCTION IN METABOLIC SYNDROME PATIENTS

Seskoati Prayitnaningsih — 2023-12-27

Background: The neutrophil lymphocyte ratio (NLR) is a new biomarker in predicting various cardiovascular disorders and was expected to be a biomarker for Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) in metabolic syndrome (MetS) patients.

Objective: This study aims to determine the correlation between NLR and optic nerve function in MetS patients.

Methods: A cross sectional study involving 42 patients divided into 3 groups, consist of control group(14 patients, 28 eyes), MetS without NAION group(14 patients, 28 eyes) and MetS with NAION group(14 patients, 19 eyes). The study was conducted at Saiful Anwar General Hospital on January-March 2019. Optic nerve function evaluation includes visual acuity (VA) from Snellen chart, Retinal Nerve Fiber Layer(RNFL) from OCT, contrast sensitivity from Pelli Robson test, and visual field defect from Humphrey's perimetry. NLR was calculated and compared among groups using anova test. Then the correlation between NLR and optic nerve function was investigated using Pearson and Spearman test.

Results: The NLR was significantly different among groups (p= 0.009), mean of control, MetS without NAION, and MetS with NAION groups 1.70, 1.86, and 2.40 respectively. There were signifficant negative correlation between NLR and visual field defect (p= 0.001,r= -0.487), contrast sensitivity (p= 0.015,r= -0.372), and VA (p= 0.041,r= -0.316), whereas positive correlation between NLR and RNFL statistically insignificant (p= 0.171, r = 0.215).

Conclusion: There were signifficant negative correlation between NLR and visual field defect, contrast sensitivity, VA, whereas positive correlation between NLR and RNFL statistically insignificant. NLR is expected to be a potential biomarker for screening NAION in MetS patients.

THE CORRELATION BETWEEN ADENOID, TONSIL SIZE, AND BODY MASS INDEX WITH OBSTRUCTIVE SLEEP APNEA SEVERITY IN PEDIATRIC PATIENTS

Mohammad Dwijo Murdiyo — 2023-12-27

Background: Sleep disturbance in pediatrics produce daytime sleepiness and decrease productivity. Obstructive sleep apnea (OSA) was the most common cause of daytime sleepiness in children. Adenoid and tonsil hypertrophy was a major determinant of OSAS in pediatrics, in addition to other disorders such as craniofacial anomalies and obesity. Understanding the correlation between adenoid, tonsil size and body mass index (BMI) can be useful in managing optimal treatment strategies.

Objective: To examine the correlation between adenoid, tonsil size, and BMI with OSA severity in pediatric patient with OSAS.

Methods: The medical records of the Department of Otorhinolaryngology Head and Neck Surgery were utilised for this retrospective cross-sectional study spanning from January 1, 2016 to December 31, 2018. This research comprised a cohort of nineteen patients in total. The medical record was queried for the patient's age, sex, adenoid, and tonsil dimensions. The results of a pre-operative polysomnography to assess the severity of OSA were obtained as part of a routine examination and documented in the patient's medical records.

Results: The correlation between variables showed in crosstabulation and Scatter Plot. A p-value below 0.05 indicated that the correlation coefficient of -0474 between adenoid size and OSA severity was statistically significant. The correlation between tonsil size and the severity of obstructive sleep apnea (OSA) was not statistically significant (R2 < 0.3, p < 0.05). Similarly, the correlation between BMI and OSA severity showed no significancy with p-value > 0.05, respectively.

Conclusion: Adenoid size measured with Cohen and Konak ratio show significant correlation with OSA severity. While tonsil size and BMI showed no significancy in OSA severity.

A GLOBAL SCIENTOMETRIC ANALYSIS OF HERPES ENCEPHALITIS RESEARCH IN THE LAST 50 YEARS

İrem Yildirim — 2023-12-27

Background: Herpes encephalitis is the most common of all encephalitis worldwide and has the highest mortality rate. The aim of this study is to review articles on this topic in order to provide a guide for future herpes encephalitis studies to assess current publishing trends and hotspots on herpes encephalitis research globally.

Objective: People have been affected by the herpes virus for many years, but advances in supportive care and antiviral drugs have only recently made it possible for doctors to treat the most severe types of infections. To the authors' knowledge, however, no bibliometric analysis has been done to rate Herpes encephalitis research. In order to enhance research in this area, this study used a bibliometric analysis to assess current publishing trends and hotspots on herpes encephalitis research globally.

Methods: The Web of Science database was searched for pertinent publications between January 1970 and December 2021. The research points, comprising publishing countries, affiliations, first authors, cited authors, cited references, and their clustering, as well as keyword co-occurence, were analyzed using VosViewer to identify research trends and hotspots.

Results: The results of this study's search methodology revealed that between 1970 and 2021, 2138 documents. Only articles (n=1223) were included the study. 89.37% of the articles were written in English. The first article published in 1970 and most of the articles published in the years 1982, 1988, 2007, 2016, and 2017. The United States of America (USA) (29.109%), England (9.076%), France (7.441%), Japan (7.359%) and Germany (7.032) were the other top ranked countries. The most citation numbers were recorded in the year 2021.

Conclusion: This bibliometric analysis outlined the general overview for Herpes encephalitis research and offered insightful guidance for continuing investigations.

SALTWATER FISH CONSUMPTION AND THE RISK OF STROKE IN COASTAL POPULATION

Abiyyu Didar Haq — 2023-12-27

Indonesia, consisting of tens of thousands of islands, has a rather long coastline with relatively high percentage of it is population that lives in the coastal area. High consumption of saltwater fish in the coastal population is an inevitability. Several studies have observed a relation between saltwater fish consumption and the risk of stroke with contradicting results, protective effect on one side and harmful on the other. The protective effect is mainly mediated by the poly-unsaturated fatty acid (PUFA) content of the saltwater fish while the harmful effect is mediated by the sodium content. PUFA exerts its protective effect through it is antioxidant effect on the endothelial wall, anti-inflammatory effect and the activation of anti-apoptotic pathways in the state of ischemic stroke while sodium increases the risk of hypertension which is the main predisposing factor for stroke and induces anatomical remodeling of the endothelial wall as well as functional abnormalities. Several public health interventions have been carried out to mitigate the harmful effect of the sodium content of saltwater fish yet there hasn’t been a specific intervention for coastal population.

EFFICACY OF NON-PHARMACOLOGICAL APPROACHES TO IMPROVE SLEEP QUALITY INDICES IN POST-STROKE INSOMNIA PATIENTS

Shaffana Hidayat — 2023-12-27

Background: Post-stroke insomnia (PSI) is a highly prevalent complication of stroke. Clinical manifestations of PSI include non-refreshing, non-restorative sleep quality and short sleep duration, leading to stroke recovery impediment, cognitive, emotional, and daytime dysfunction, and poor quality of life in stroke patients. PSI can be treated with medications, but studies have reported various adverse effects of hypnotic drugs in PSI.

Objective: This study explores non-pharmacological treatments for their efficacy to improve sleep quality in PSI patients.

Methods: An electronic search in Medline, Google Scholar, Elsevier, Directory of Open Access Journals (DOAJ), and Semantic Scholar was performed to identify studies examining the efficacy of non-pharmacological approaches to PSI.

Results: A total of ten studies examining the efficacy of non-pharmacological approaches to PSI were reviewed. The characteristics of PSI patients in these studies comprised the older population typically at several months after suffering commonly from ischemic type stroke. The evaluated treatments are EEG biofeedback, acupuncture, cognitive-behavioral therapy (CBT), light therapy, and repeated transcranial magnetic stimulation (rTMS). All treatments successfully improved sleep quality, insomnia symptoms, and quality of life in stroke patients as assessed by various measurements including PSQI and actigraphy. Only mild adverse events were reported following acupuncture, such as local hematoma and hand numbness.

Conclusion: Non-pharmacological approaches can be considered efficacious in improving sleep quality index, insomnia symptoms, and quality of life of PSI patients. Furthermore, they do not cause severe or long-lasting adverse effects, thus deemed safe for stroke patients.