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A retrospective study of spontaneous intracranial hemorrhage


Spontaneous intracerebral hemorrhage (SICH) is a serious disease despite progressing medical knowledge. SICH appears suddenly without warning, unlike ischemic strokes that are often preceded by a transient ischemic attack. Outcome is determined by the initial severity of the bleeding; mortality and morbidity of SICH are high. The aim of this study was to describe the characteristics of type, location, and outcome of SICH. A retrospective review was conducted on the records of 2042 cases admitted to a private hospital in Karawaci, Tangerang, between 1 January 1996 to 31 December 2008. Analysis was done on type, location, and the final outcome measures by the Glasgow Outcome Scale (GOS). The results of the study showed that the most prevalent type of SICH was hypertensive stroke, amounting to 1698 cases (83.1%), and the least commonly encountered type was dural fistula totaling 5 cases (0.3%). SICH due to hypertensive stroke frequently occurred in the basal ganglia (50.8%) comprising the putamen, caudate nucleus and globus pallidus. On average, the outcome at the time of dismissal was good, where 105 cases (88.2%) were GOS 4 and 5. SICH requires prompt and appropriate management. Therefore the signs and symptoms of intracranial hemorrhage should be promptly recognized and followed by appropriate ancillary examinations in order to promptly determine the management required, including possible surgical interventions.

Keywords : Spontaneous intracranial hemorrhage, hypertensive stroke, arteriovenous malformations, prognosis

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Waist circumference as a predictor for blood glucose levels in adults


Anthropometric indexes such as body mass index (BMI), waist circumference (WC), hip ciucumference (HC), and waist–hip ratio (WHR), are all useful anthropometric measurements to provide important information on blood glucose concentrations. The aim of this study was to determine different anthropometric measurements, in particular BMI, waist circumference, hip circumference and waist-to-hip ratio, in their ability to predict the blood glucose levels in men and women 40 to 60. A cross-sectional study was conducted on a sample of 44 men and 127 women aged 40 to 50 who lived in Cipete Selatan subdistrict, South Jakarta. Blood glucose levels was assessed and anthropometric measurements comprising BMI, WC, HC, WHR were collected. Multiple linear regression analysis was used to determine the best predictor for blood glucose levels. The study showed that the prevalence of DM type 2 was 25.7% and the prevalence was higher in men (40.9%) compared to women (23.5%). The significant predictive variables in the simple regression analysis were age and waist circumference. Multiple linear regression showed that after adjustment for age, WC was positively associated with blood glucose levels. Standardized a value was 0.172 (p=0.026). WC predict blood glucose levels, beyond that explained by traditional diabetic risk factors and BMI. These findings provide support for the recommendation that WC be a routine measure for identification of diabetes mellitus type 2 in men and women aged 40 to 60 years.

Keywords: Anthropometric indexes, blood glucose levels, diabetes mellitus type 2

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Effectiveness of Piper betle leaf infusion as a palpebral skin antiseptic


The goal of an antiseptic is to eliminate or greatly reduce the number of microorganisms in the surgical field at the time of the surgery. The objective of this study was to verify the effectiveness of 20% Piper betle leaf infusion as an antiseptic solution in pre-surgery cataract patients. A clinical trial with partner-matching design was conducted on 31 pairs of eyelids. From each pair of eyelids, one eyelid was asigned to the Piper betle infusion group and the opposite one to the povidone-iodine group. The microorganisms were collected by swab from the patient’s palpebral skin, inoculated on nutrient agar, and incubated at 37oC for 20 hours. The antiseptic effectiveness was measured by counting the microbial colonies before and after administration of the antiseptic solutions. This study demonstrates that the mean colony counts after application of 20% Piper betle leaf infusion showed a significant reduction of 27-100% compared with those before administration (p=0.001). Mean colony counts after 10% povidone-iodine administration showed a significant reduction of 88-100% compared with the mean counts before the solution was applied (p=0.000). The 20% Piper betle infusion has an antiseptic potential. Nevertheless, the 10% povidone-iodine solution has more effective antiseptic capability. .

Keywords: Antiseptic, palpebral skin, Piper betle leaf infusion, povidone-iodine

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Musculoskeletal pain and posture decrease step length in young adults


Pain of the musculoskeletal system, especially low back pain, is one of the most frequent problems with a high risk of disability. The aim of this research study was to determine the existence of an association between low back pain on one hand, posture and step length on the other. This cross-sectional study was conducted on 77 healthy young adult subjects. Step length was measured with the Biodex Gait Trainer 2 (230 VAC). The study results indicate that 62.3% of the young adult subjects had suffered from low back pain. There was no significant association between gender and pain. In male subjects no significant association was found between pain on one hand and mean difference in step length and posture on the other. However, in female subjects with abnormal posture, there was a highly significant difference in left step length between subjects with back pain and those without (p=0.007). The results of a multiple regression analysis indicate that posture has the greatest influence on left step length (B=4.135; 95% Confidence Interval 0.292-7.977). It is recommended that in the examination of low back pain an assessment be made of posture, step length and difference in step lengths.

Keywords: Musculoskeletal pain, posture, step length, young adults

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Gastrointestinal symptoms and sleep disturbance in female nurses


Sleep disturbance is a common symptom in the general population. An association between sleep disturbances and functional gastrointestinal (GI) disorders has been reported by several investigators. GI symptoms are more common among people with sleep disturbance in female nurses. To explore this issue further, a study using a cross sectional design was conducted to determine whether unexplained GI symptoms are more common in female nurses with self-reported sleep disturbance. This study was conducted from February through April 2007 in Hospital X in Central Jakarta. A total of 152 female nurses participated in this study. A questionnaire consisting mainly of items concerning sleep disturbance was distributed to the subjects. Significant associations were observed between gastrointestinal symptoms such as anorexia and constipation and sleep disturbance. Constipation was significantly more common in female nurses with sleep disturbance (prevalence ratio=6.1;95% C.I. 1.76 – 20.56), but the association between shift work and sleep disturbance was not statistically significant (prevalence ratio=1.67;95% C.I. 0.53-5.24). Both constipation and anorexia are more prevalent in female nurses with self-reported sleep disturbance. Further research to understand the associations between GI symptoms and sleep disturbance is warranted.

Keywords: Gastrointestinal symptoms, sleep disturbance, female nurses

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Homocysteine and cognitive function in the elderly


Dementia is prevalent among elderly people, and projections show that the number of affected might triple over the next 50 years, because of a large increase in the oldest segment of the population. The objective of this study was to investigate the relationship between cognitive function and serum homocysteine level. This study was a cross-sectional study carried out in Mampang district, South Jakarta. A total of 94 elderly people was recruited for this study consisting of 44 females and 50 males. In this study serum homocysteine level was assessed by fluorescent polarization immunoassay and cognitive function with the mini mental state examination (MMSE). In elderly women MMSE scores for plasma homocysteine concentrations of <11.7 mmol/L, 11.7-14.9 mmol/L and >14.9 mmol/L were 24.00 ± 3.68, 23.80 ± 6.51, and 20.80 ± 9.00 respectively, with p=0.000. In elderly men the MMSE scores for plasma homocysteine concentrations of <11.7 mmol/L, 11.7-14.9 mmol/L and >14.9 mmol/L were respectively 27.66 ± 2.06, 26.33 ± 3.79 and 24.03 ± 5.52 with p=0.008. Homocysteine concentrations of >14.9 mmol/L were more commonly found in males (66%) than in females (22.70%). The results of a regression analysis indicated that the factors influencing cognitive function were level of education (p=0.001) and age (p=0.035), whereas gender and homocysteine concentration did not affect cognitive function (p=0.554 and p=0.714, respectively). Plasma homocysteine concentration was inversely related to cognitive function. The most important factors affecting cognitive function were level of education and age.

Keywords : Plasma homocysteine, cognitive function, elderly

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Pleiotropic effects of statins in stroke prevention


Cardiovascular disease is the leading cause of death and disability, and contributes substantially to healthcare budgets. The lipid-lowering drugs, 3-hydroxy-3-methylgulutaryl-coenzyme A (HMG-CoA) reductase inhibitor or statins, reducing mortality and cardiovascular morbidity in patients with established cardiovascular disease. Statins therefore have a place in the secondary prevention of cardiovascular disease. Recent experimental and clinical studies suggest that statins may exert vascular protective effect beyond cholesterol reduction. The cholesterol-independet or “pleiotropic” effects of statin include the upregulation and activation of endothelial nitric acid synthase (eNOS) that can increase nitric oxide (NO) production. Augmentation of NO production increases cerebral blood flow, which can lead to neuroprotection during brain ischaemia. By inhibiting mevalonate synthesis, statins prevent the formation of several isoprenoids (including farnesylpyrophosphate and geranylgeranylpyrophosphate). Inhibiting geranylgeranylation of RhoA small G proteins increases the stability of eNOS mRNA through the remodeling of endothelial actin microfilamens. Moreover, statins directly increase eNOS activity within minutes by activating the pathway involving phosphoinositide 3-kinase and protein kinase B. In the secondary prevention of stroke, the use of statins reduces the incidence of either recurrent stroke or other major vascular events and treatment should be initiated soon after the event. The use of statins does not increase hemorrhagic stroke or cancer and may also favor atherosclerotic plaque regression.

Key words: Statin, endothelial nitric synthase stroke ischemic

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A 55 year old man with progressive neurologic deficits


At least 50 percent of the decline in functional abilities associated with the elderly is caused by neurological conditions, particularly vascular dementia, such as occurs in Binswanger disease. Binswanger disease is a rare condition, characterized by acute strokes with symptoms and signs compatible with lacunar infarction. The disease onset is commonly between 55 and 75 years. The majority of patients with Binswanger disease have chronic hypertension and other putative factors including diabetes mellitus, polycythemia, thrombocytosis, hyperlipidemia, hyperglobulinemia and pseudoxanthoma elasticum, increased fibrinogen levels and the antiphospholipid antibody syndrome. We report the case of a 55 year-old man, who suffered from involuntary movements of his right arm, slight hemiparesis on the right side, and also had dementia. He had a history of high blood pressure and laboratory tests showed that he had diabetes mellitus. The brain magnetic resonance imaging showed irregular white matter abnormalities with multiple lacunar infarcts in the basal ganglia and pons. The clinical picture is characterized by acute strokes, followed by involuntary movements and also dementia. Therefore we decided to diagnose it as Binswanger disease. After discharge from hospital, the patient has not returned for follow-up.

Keywords: Binswanger disease, irregular white matter abnormalities, multiple lacunar infarcts

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