Incidental durotomy or postoperative cerebrospinal fluid leak after elective surgery for degenerative spinal disorders causes significantly higher health care costs.

EFFECTS OF REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION (r-TMS) TOWARDS PAIN INTENSITY IN PATIENTS WITH CENTRAL POST-STROKE PAIN (CPSP)ABSTRACTIntroduction: About 2,7% patients have experienced central post-stroke pain (CPSP) after stroke attack. Repetitive transcranial magnetic stimulation (r-TMS) is a nonpharmacological method to overcome CPSP.Aims: To determine the effectiveness of r-TMS to reduce pain intensity in patients with CPSP.Methods: Randomized-controlled trial in Wahidin Sudirohusodo hospital and Inggit clinic from December 2017 until May 2018. Subjects were divided to 2 groups; control, who received standard therapy for CPSP, and treatment, who received standard therapy for CPSP and r-TMS. Repetitive transcranial magnetic stimulation was done using 2000 pulse and 10Hz frequency. Pain intensity was measured with Numerical Pain Rating Scale (NPRS) at baseline, after r-TMS until day 10. Data analysis was done by Mann-Whitney test.Results: As much as 30 subjects were divided into 2 groups (15 control and 15 treatment). The difference in NPRS score after 10 days of treatment was statistically higher in the treatment group compared to the control (6,67 vs 4,67, p=0,002).Discussion: There was a significant reduction in pain intensity in the group given r-TMS for 10 cycles.Keywords: Central pain, NPRS, r-TMS, strokeABSTRAKPendahuluan: Sebanyak 2,7% pasien mengalami central post-stroke pain (CPSP) setelah serangan. Efektivitas repetitive transcranial magnetic stimulation (r-TMS) merupakan salah satu metoda nonfarmakologis untuk mengatasi CPSP.Tujun: Mengetahui efektivitas repetitive transcranial magnetic stimulation (r-TMS) terhadap penurunan intensitas nyeri pada penderita CPSP.Metode: Uji klinis terandomisasi di RSUP Dr. Wahidin Sudirohusodo dan Klinik Inggit dari Desember 2017 hingga Mei 2018. Subjek dibagi menjadi 2 kelompok, kelompok kontrol yang mendapat terapi standar dan kelompok perlakuan yang ditambahkan r-TMS. Repetitive transcranial magnetic stimulation dilakukan sebanyak 2000 pulse dengan frekuensi 10Hz. Nyeri diukur dengan Numerical Pain Rating Scale (NPRS) sebelum dan pascaterapi hingga hari ke-10. Analisis data dilakukan dengan uji Mann-Whitney.Hasil: Didapatkan 30 subjek yang dibagi menjadi 2 kelompok (15 kontrol dan 15 perlakuan). Selisih skor NPRS setelah sepuluh hari terapi lebih besar secara signifikan pada kelompok perlakuan dibandingkan dengan kontrol (6,67 vs 4,67, p=0,002).Diskusi: Terdapat penurunan intensitas nyeri yang signifikan pada kelompok yang diberikan r-TMS selama 10 siklus.Kata kunci: Central pain, NPRS, stroke, r-TMS

This study aimed to evaluate the effect of Makassar folk music on cerebral hemodynamics using transcranial doppler (TCD). This was an experimental study with a pre- and post-test design. The study was conducted on 30 subjects at the Sonology clinic of Wahidin Sudirohusodo Hospital, Makassar from August to September 2019. The subjects listened to either rock, classical, or Makassar folk music and cerebral hemodynamic parameters before and after listening were assessed using TCD. The results of the study show that there were significant changes in both the left and the right middle cerebral artery (MCA) mean flow velocity (MFV) after listening to three genres, with a p-value < 0.0001 for each genre. There was no significant difference between the changes observed in left MFV MCA compared to the one on the right side. The value of MFV change was not significantly different across genres. The results indicate that Makassar folk music has the same effect on increasing cerebral hemodynamics as classical music and rock music.

DIAGNOSTIC VALUE OF DAVE UNHAS STROKE SCORE IN CARDIOEMBOLIC ISCHEMIC STROKE PATIENTS WITH ATRIAL FIBRILLATIONABSTRACTIntroduction: It is important to diagnose cardioembolic ischemic stroke quickly especially in the absence of CT scan/MRI, besides having a poor prognosis, cardioembolic ischemic stroke also has high disability and death rates.Aim: To investigate the diagnostic value of Dave Unhas Stroke Score (DUSS) in cardioembolic ischemic stroke patients with atrial fibrillation (AF).Methods: This was a diagnostic test research on cardioembolic ischemic stroke sufferers with AF and without cardioemboli in Wahidin Sudirohusodo Hospital and its networking hospital in Makassar from September 2018 to March 2019. DUSS consists of 5 variables: blood pressure (BP), activity at onset, headache, vomiting, and level of consciousness were assessed in both groups. DUSS cut off point was determined by receiver operating characteristics (ROC). The test results are considered as statistically significant if the p value <0.05.Results: There were 80 subjects consisting of 40 subjects each in the cardioembolic and noncardioembolic ischemic stroke groups. The research results showed diagnostic value of DUSS in cardioembolic ischemic stroke patients due to atrial  fibrillation with cut off point 10 had a sensitivity of 95.0%, specificity 97.5%, positive predictive value 97.4%, negative predictive value 95.1%, and accuracy 96.2%. The results of this calculation shown area under curve (AUC) on the ROC curve that is 99.6% with a very significant p value (p <0.001) which means DUSS can be used to distinguish between cardioembolic ischemic stroke due to AF (score >10) from noncardioembolic ischemic stroke (score <10).Discussion: DUSS 10 cut off point can distinguish cardioembolic ischemic stroke due to AF and noncardioembolic.Keywords:  Dave Unhas  Stroke  Score, cardioembolic ischemic stroke patients with atrial fibrillation, noncardioembolic ischemic stroke, diagnostic value, cut-off pointABSTRAKPendahuluan: Mendiagnosis stroke iskemik kardioemboli dengan cepat penting dilakukan terutama pada keadaan tidak tersedianya CT scan/MRI, selain karena memiliki prognosis yang buruk, juga memiliki angka kecacatan dan kematian yang tinggi.Tujuan: Mengetahui nilai diagnostik Skor Stroke Dave Unhas (SSDU) pada penderita stroke iskemik kardioemboli akibat fibrilasi atrium (FA).Metode: Penelitian uji diagnostik terhadap penderita stroke iskemik kardioemboli dengan FA dan nonkardioemboli di RS Wahidin Sudirohusodo dan jejaringnya di Makassar pada bulan September 2018-Maret 2019. Dilakukan penghitungan SSDU berdasarkan 5 variabel: tekanan darah (TD), aktivitas saat serangan, nyeri kepala, muntah, dan tingkat kesadaran pada kedua kelompok serta cut off point SSDU yang optimal menggunakan receiver operating characteristics (ROC). Hasil uji statistik signifikan jika nilai p<0,05.Hasil: Didapatkan 80 subjek yang terdiri dari masing-masing 40 subjek pada kelompok stroke iskemik kardioemboli dan nonkardioemboli. Hasil penelitian menunjukkan nilai diagnostik SSDU pada penderita stroke iskemik kardioemboli akibat FA dengan cut off point 10 memiliki sensitivitas 95,0%, spesifisitas 97,5%, nilai prediksi positif 97,4%, nilai prediksi negatif 95,1%, dan akurasi 96,2%.  Hasil perhitungan ini menunjukkan area under curve (AUC) pada kurva ROC, yaitu 99,6% dengan nilai p yang sangat signifikan (p<0,001) yang berarti SSDU dapat digunakan untuk membedakan antara SIkardioemboli akibat FA (skor >10) dengan stroke iskemik nonkardioemboli (skor <10).Diskusi: Diperoleh cut off point SSDU 10 yang dapat membedakan stroke iskemik kardioemboli akibat FA dan nonkardioemboli.Kata kunci: Fibrilasi atrium, kardioemboli, nonkardioemboli, nilai diagnostik, stroke iskemik, Skor Stroke Dave Unhas

This study aimed to evaluate the effect of Makassar folk music on cerebral hemodynamics using transcranial doppler (TCD). This was an experimental study with a pre- and post-test design. The study was conducted on 30 subjects at the Sonology clinic of Wahidin Sudirohusodo Hospital, Makassar from August to September 2019. The subjects listened to either rock, classical, or Makassar folk music and cerebral hemodynamic parameters before and after listening were assessed using TCD. The results of the study show that there were significant changes in both the left and the right middle cerebral artery (MCA) mean flow velocity (MFV) after listening to three genres, with a p-value < 0.0001 for each genre. There was no significant difference between the changes observed in left MFV MCA compared to the one on the right side. The value of MFV change was not significantly different across genres. The results indicate that Makassar folk music has the same effect on increasing cerebral hemodynamics as classical music and rock music.