Pendahuluan: Penyakit ginjal kronis (PGK) merupakan penurunan fungsi ginjal secara progresif dan sudah berlangsung lama. Pola terapi pada PGK sangat bervariasi karena PGK memiliki banyak faktor risiko seperti penyakit kardioserebrovaskular sehingga perlu diberikan obat yang sesuai dengan penyakit yang mendasari. Tujuan: Mengidentifikasi profil pola terapi pada faktor risiko penyakit kardioserebrovaskular pasien penyakit ginjal kronis yang menjalani hemodialisis. Metode: Penelitian ini menggunakan rancangan penelitian cross sectional atau potong lintang dengan pendekatan deskriptif. Subjek yang diteliti adalah penderita penyakit Ginjal Kronis yang menjalani hemodialisis di RS Bethesda dan RS Panti Rapih Yogyakarta. Data yang digunakan dalam penelitian ini merupakan data sekunder yang diambil dari data rekam medis. Analisis menggunakan data yang diambil dibuat dalam bentuk tabel. Hasil: Penelitian ini melibatkan 92 pasien penyakit ginjal kronis yang menjalani hemodialisis terdiri dari 60 laki-laki (65,2%) dan 32 perempuan (34,8%) dengan rata-rata usia 50 tahun. Pasien dengan riwayat klinis yang berisiko menjadi penyakit kardioserebrovaskular dan belum mendapat pengobatan 39 orang (42,4%). Faktor risiko kardioserebrovaskular paling banyak adalah hiperhomosisteinemia 91 pasien (98,9%). Obat yang banyak digunakan untuk mengurangi terjadinya penyakit kardioserebrovaskular adalah asam folat dengan jumlah 81 pasien (89%), anti anemia 77 pasien (90,6%), dan anti hipertensi 74 pasien (90,2%). Kesimpulan: Pola terapi yang banyak digunakan adalah asam folat, anti anemia, dan anti hipertensi. Faktor risiko kardioserebrovaskular paling banyak adalah hiperhomosisteinemia.

PREDICTING FACTOR FOR DISABILITY OUTCOME IN PATIENT WITH ISCHEMIC STROKE IN BETHESDA HOSPITAL YOGYAKARTAABSTRACTIntroduction: It is estimated that around 25% to 74% of the 50 million stroke patients who live become independent either need the full or partial assistance due to decreased physical abilities, cognition, and emotions.Aims: The aim of this study is to measure the determinant factors for disability in patients with ischemic stroke.Methods: Cohort retrospective study using stroke registry and medical records on stroke patients in Bethesda Hospital, Yogyakarta, from 2015 to 2017. The inclusion criteria included patients ≥40 years old, that has been diagnosed with ischemic stroke using CT scan, had complete stroke registry data and medical record. For the analysis this study used univariate, Chi–square method for bivariate, and logistic regression method for multivariate analysis.Results: Based on multivariate analysis, muscle strength 0-4 (p=0.023), 3 (p=0.267), 2 (p=0.579), and 1 (p=0.049), 0 (p=0.003), also aphasia (p<0.001), dysphagia (p<0.001), and triglyceride levels (p=0.043) were significant predictors of disability outcomes in patients with ischemic stroke.Discussion: Motor strength, aphasia, dysphagia, and serum triglyceride were significant for disabillity outcome in patient with ischemic stroke.Keywords: Disability, outcome, ischemic strokeABSTRAKPendahuluan: Diperkirakan sampai saat ini sekitar 25% sampai 74% dari 50 juta pasien stroke yang hidup menjadi tidak mandiri baik membutuhkan bantuan seluruhnya atau hanya sebagian akibat penurunan kemampuan fisik, kognisi, dan emosi.Tujuan: Untuk mengetahui faktor yang berpengaruh pada luaran disabilitas pasien dengan stroke iskemik.Metode: Penelitian analitik secara retrospektif berdasarkan data stroke registry dan rekam medis pasien stroke iskemik di RS Bethesda, Yogyakarta, pada tahun 2015-2017. Kriteria inklusi adalah pasien berusia ≥40 tahun yang telah terdiagnosis dengan CT scan kepala, serta memiliki data stroke registry dan rekam medis yang lengkap. Analisis data univariat dan bivariat menggunakan metode Chi-square, serta multivariat dengan metode regresi logistik.Hasil: Berdasarkan hasil multivariat didapatkan bahwa kekuatan otot 0-4 (p=0,023), kekuatan otot 3 (p=0,267), kekuatan otot 2 (p=0,579), kekuatan otot 1 (p=0,049), kekuatan otot 0 (p=0,003), afasia (p<0,001), disfagia (p<0,001), dan kadar trigliserida (p=0,043) merupakan faktor prediktor yang signifikan terhadap luaran disabilitas pasien stroke iskemik.Diskusi: Kekuatan otot pasien saat masuk, gejala afasia, disfagia, dan kadar trigliserida berhubungan dengan luaran disabilitas pada pasien stroke iskemik.Kata kunci: Disabilitas, luaran, stroke iskemik

A new coronavirus disease called COVID-19 was declared by World Health Organization (WHO). The COVID-19 may complicated into many other conditions, including neurologic. One among this neurologic complication is stroke. This paper aimed to report a case of ischemic stroke in COVID-19 positive patient in Yogyakarta, Indonesia. A male patient, 42 years old, came to emergency department with weakness in his right arm for two days as his main complain. He also had face drop on the right side, cough, and shortness of breath. He had a history of hyperthyroid and type II diabetes mellitus. The brain CT Scan showed a lacunar infarct in the left lentiform nucleus. Patient had nasopharynx and oropharynx swab to be checked for the presence of COVID-19 and the result was positive.The pathophysiology of stroke in COVID-19 include the hyperactivation of inflammatory factors that causes a fatal inflammatory storm. It also cause a damage of coagulation system which causing the D-dimer and platelet abnormalities, hypercoagulability from critical illness and cardioembolism from virus-related cardiac injury. Moreover, COVID-19 may cause a direct role in viral infection in central nervous system. In conclusion, ischemic stroke can be present along with COVID-19.

Combination of five clinical data as prognostic factors of mortality after ischemic stroke BACKGROUNDThe mortality rate after ischemic stoke is influenced by various factors. Prognosis after ischemic stroke can be predicted using a scoring system to help the doctor to evaluate patient's condition, neurologic deficits, and possible prognosis as well as make appropriate management decisions. The objective of this study was to identify the factors which determine mortality rates in patients after ischemic stroke and to determine the prognosis of ischemic stroke patients using the predictive mortality score. METHODSThis was a nested case control study using data from the stroke registry and medical records of patients at the Neurology Clinic of Bethesda Hospital Yogyakarta between 2011-2015. Data was analysed using simple and multiple logistic regression analysis. The scoring was analyzed using receiver-operating characteristic (ROC) curve and the cut-off point using area under the curve (AUC). RESULTSMultiple logistic regression analysis showed a significant association between mortality of ischemic stroke patients and age CONCLUSIONSAge, high random blood glucose level, complications, metabolic encephalopathy risk and the use of ventilators are associated with mortality after ischemic stroke. The predictive mortality score can be used to assess the prognosis of patients with ischemic stroke.