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CORRELATION BETWEEN BLOOD LIPID LEVELS AND SEVERITY OF DIABETIC PERIPHERAL NEUROPATHY IN WAHIDIN SUDIROHUSODO HOSPITALABSTRACTIntroduction: Blood lipid levels play a role in the etiopathogenesis of diabetic neuropathy and have a significant relationship to the severity of diabetic neuropathy in patients with diabetes mellitus (DM).Aim: To assess the correlation between blood lipid levels and the severity of diabetic peripheral neuropathy (DPN) based on nerve conduction study (NCS).Methods: A cross-sectional study at Wahidin Sudirohusodo General Hospital, Makassar, consecutively from December 2018 to March 2019 on type 2 DM patients with DPN based on screening for diabetic neuropathy symptoms. HbA1C and blood lipid levels were examined, and DPN severity based on NCS was assessed using electromyoneurography (ENMG) with England criteria. One-way ANOVA was used for correlation analysis.Results: There were 56 subjects with an average age of 60.25 years old, the majority was women (51.8%) with DM duration ≥5 years (62.5%), HbA1C levels of patients ≥7% (55.4%), dyslipidemia (76.8%), and experienced severe DPN (55.4%). There was a significant relationship between blood lipid levels and the severity of DPN (p<0.05), especially in subjects with a patient’s HbA1C level <7%.Discussion: High lipid level plays a role in etiopathogenesis of diabetic neuropathy.Keywords: Blood lipid levels, diabetic peripheral neuropathy, HbA1CABSTRAKPendahuluan: Kadar lipid darah berperan dalam etiopatogenesis neuropati diabetik dan memiliki hubungan signifikan terhadap derajat keparahan neuropati diabetik pada pasien diabetes melitus (DM).Tujuan: Menilai hubungan kadar lipid darah dengan derajat keparahan neuropati diabetik perifer (NDP) berdasarkan Nerve Conduction Study (NCS).Metode:  Penelitian  potong  lintang  di  RSUP  Wahidin  Sudirohusodo,  Makassar,  secara  konsekutif  periode Desember 2018-Maret 2019 terhadap pasien DM tipe 2 yang mengalami NDP berdasarkan skrining diabetic neuropathy symptoms. Dilakukan pemeriksaan kadar HbA1C dan lipid darah, serta penilaian derajat keparahan NDP berdasarkan KHS menggunakan alat elektromioneurografi (ENMG) dengan kriteria England. Analisis hubungan menggunakan uji one-way ANOVA.Hasil: Didapatkan 56 subjek dengan rerata usia 60,25 tahun, mayoritas perempuan (51,8%) dengan durasi DM ≥5 tahun (62,5%), kadar HbA1C pasien ≥7% (55,4%), dalam keadaan dislipidemia (76,8%), dan mengalami NDP berat (55,4%). Terdapat hubungan bermakna antara kadar lipid darah dan derajat keparahan NDP (p<0,05), terutama pada subjek dengan kadar HbA1C pasien <7%.Diskusi: Tingginya kadar lipid darah akan memperberat derajat keparahan NDP.Kata kunci: HbA1C, kadar lipid darah, neuropati diabetik perifer

Takayasu's arteritis is one of the causes of ischemic stroke at a young age, but the occurrence is still rarely reported in Indonesia. Here we report the case of a 19-year-old Indonesian female who was admitted to the Wahidin Sudirohusodo Hospital with a sudden onset of right-sided hemiplegia. Other features of Takayasu’s arteritis were observed, including a discrepancy of more than 10 mmHg between the left and right arm systolic blood pressure, claudication of the extremities, and decreased brachial artery pulse. Left hemisphere cerebral infarction was confirmed on the computed tomography (CT) scan. Angiogram abnormalities were also present, showing occlusion of the left proximal inner carotid artery after branching at the aortic arch, and occlusion of the left subclavian artery. Although no fever was observed on presentation, the patient had an elevated erythrocyte sedimentation rate (ESR) of 44 mm/hour. In conclusion, Takayasu’s arteritis should be considered as a potential cause of ischemic stroke in young adults.

THE EFFECT OF LOCAL STEROID INJECTION ON DISTAL SENSORY AND MOTOR LATENCY IN PATIENTS WITH CARPAL TUNNEL SYNDROMEABSTRACTIntroduction: Carpal tunnel syndrome (CTS) is the most common type of neuropathy found in upper extremities. The syndrome can cause disability and leads to the decrease in productivity. Local steroid injection can help alleviate the symptoms, delay operation, and improve electrophysiologic parameter in a concise period.Aims: To determine the effect of steroid injection on distal sensory and motor latency in patients with CTS.Methods: Clinical trial with non-randomized paralel group design on patients in dr. Wahidin Sudirohusodo Hospi- tal from March to August 2017. Patients were divided into two groups, treatment group who were injected with intracanal steroid (n=20) and control who were treated with oral steroid (n=20). Electroneuromyography (ENMG) evaluation was done on the first day and one week after steroid injection. Statistical analysis was done with Statistical Packages for Social Sciences (SPSS) version 22. Wilcoxon sign-ranked and Mann-Whitney U test were used to analyze the difference between the treatment and control groups.Results: Distal sensory and motor latency improved significantly in both groups. Distal sensory latency after steroid were improved in both groups. But the improvement was more significant in steroid injection group compared to control group in sensory (0,30mSec vs 0,06mSec), and also motor distal latency (0,53mSec vs 0,09mSec).Discussion: Steroid injection improves distal sensory dan motor latency in patients with carpal tunnel syndrome.Keywords: Carpal tunnel syndrome, distal motor latency, distal sensory latency, steroid injectionABSTRAKPendahuluan: Sindrom terowongan karpal (STK) adalah jenis neuropati yang paling sering terjadi pada ekstremi- tas atas. Sindrom ini menyebabkan disabilitas dan menurunkan produktivitas. Injeksi steroid lokal (intrakanal) dapat mer- ingankan gejala, menunda operasi, dan memperbaiki parameter elektrofisiologi dalam jangka pendek.Tujuan: Mengetahui pengaruh injeksi steroid terhadap latensi distal sensorik dan motorik pada pasien dengan STK.Metode: Uji klinis dengan desain grup paralel terhadap pasien dengan STK yang berobat di RSUP Dr. Wahidin Sudirohusodo dari bulan Maret hingga Agustus 2017. Subjek dibagi menjadi kelompok perlakuan yang diberi injeksi ste- roid (lokal) intrakanal (n=20) dan kelompok kontrol yang diberikan steroid oral (n=20). Pemeriksaan elektroneuromiografi (ENMG) dilakukan pada hari pertama subjek datang ke RS dan satu minggu pascaterapi steroid. Analisis statistik dilaku- kan dengan program Statistical Packages for Social Sciences (SPSS) versi 22. Uji Wilcoxon signed-rank dan Mann-Whitney U digunakan untuk meneliti hubungan antar kelompok injeksi steroid lokal dan oral.Hasil: Terdapat pemendekan latensi distal sensorik dan motorik secara signifikan pasca pemberian steroid pada kedua kelompok. Namun pemendekan tersebut terjadi lebih besar dan lebih signifikan pada kelompok injeksi steroid lokal dibandingkan oral, baik pada latensi distal sensorik (0,30mdet vs 0,06mdet), maupun pada latensi distal motorik (0,53mdet vs 0,09mdet).Diskusi: Injeksi steroid intrakanal memperpendek latensi distal sensorik dan motorik pada pasien dengan sindrom terowongan karpal secara bermakna.Kata kunci: Injeksi steroid, latensi distal motorik, latensi distal sensorik, sindrom terowongan karpal