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All Journal Jurnal Kedokteran Syiah Kuala Althea Medical Journal MNJ (Malang Neurology Journal) Journal of Medicine and Health Jurnal Neuroanestesi Indonesia

Cep Juli

Departemen Neurologi, Fakultas Kedokteran, Universitas Padjadjaran, Jawa Barat, Indonesia

Author-ID : 2499481

Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Articles

Correlation of Glasgow Coma Scale Score at Hospital Admission with Stroke Hemorrhagic Patient Mortality at Hasan Sadikin Hospital Hartanto, Ary Setio; Basuki, Andi; Juli, Cep
Journal of Medicine and Health Vol. 2 No. 4 (2019)
Publisher : Universitas Kristen Maranatha

Stroke is the most common cause of death in Indonesia. Stroke is divided into ischemic and hemorrhagic stroke. Hemorrhagic stroke has a higher risk of death than ischemic stroke. Hemorrhagic stroke can disrupt patient’s consciousness. The Glasgow Coma Scale (GCS) is a scale that is widely used to assess level of consciousness. Accurate predictors can help doctors determine prognosis and treatment for stroke patient. This study was conducted to determine the correlation of GCS scores at the time of hospital admission and mortality of hemorrhagic stroke patients at Hasan Sadikin Hospital. This study is a retrospective cohort analytic study involving 134 subjects. Data were analyzed using Kolmogorov-Smirnov’s and Fisher's analysis test with significance of p <0.05. From the results of the study, the p value was 0.00, subjects with GCS score somnolence (12-14) had six times higher risk in mortality (P = 0.02, RR = 6.38) and subjects with GCS score sopor and coma (3 - 11) had twenty four times higher risk in mortality (P = 0.00, RR = 23.85). We concluded that decreased score of SKG at the time of hospital admission was associated with increased risk of death in hemorrhagic stroke patients at Hasan Sadikin Hospital. Keywords: Glasgow Coma Scale, hemorrhagic stroke, mortality

Diastolic Blood Pressure as a Predictor of Mortality in Intracerebral Hemorrhage Stroke Patients with Hypertension Cep Juli; Uni Gamayani; Nur Atik
Althea Medical Journal Vol 8, No 1 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v8n1.2099

Background: Intracerebral hemorrhage (ICH) stroke contributes to a considerable number of deaths, ranging between 30% and 40% of the overall stroke mortality. The incidence of stroke increases with higher blood pressure. High blood pressure at the onset of ICH stroke is a strong predictor for mortality and morbidity. This study aimed to explore the role of diastolic blood pressure as a predictor of death in ICH stroke patients.Methods: Data on 113 ICH stroke patients with chronic hypertension were collected from the medical records of patients treated in the Neurology ward of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in 2019. Data collected were patient characteristics, hypertension status, systolic and diastolic blood pressures, and patient outcome. Analysis was then performed using the Mann-Whitney test.Results: This study revealed a positive correlation (p=0.031) between diastolic blood pressure and death in ICH stroke patients with chronic hypertension.Conclusion: High diastolic blood pressure is associated with mortality in ICH stroke patients with chronic hypertension.

Comparison of Cognitive Function between Intracerebral Haemorrhage Stroke Patients with and without Hypertensive Crisis Mohammad Arianto Satrio Wicaksono; Cep Juli; Chandra Calista; Uni Gamayani; Aih Cahyani; Paulus Anam Ong
Althea Medical Journal Vol 9, No 1 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n1.2368

Background: Intracerebral haemorrhage (ICH) stroke is characterized by neurological dysfunction, caused by focal collection of blood within the brain parenchyma or ventricular system that is not caused by trauma. Hypertension is one of the main risk factors for intracerebral haemorrhage. Hypertensive crisis, which is a more severe type of uncontrolled hypertension may aggravate the cognitive outcomes. The aim of this study was to compare cognitive function between intracerebral haemorrhage stroke patients with and without hypertensive crisis. Methods: This study was a retrospective comparative analytic study, combined with a case-control study from August to November 2020. All medical records of patients with intracerebral haemorrhage, who were admitted to Dr. Hasan Sadikin General Hospital Bandung in 2019, were collected. The total score of mini-mental state examination (MMSE) which was recorded in the medical record was taken and compared between groups using the Mann-Whitney test. The MMSE was conducted on the day of discharge, and the minimum education level of the patients was elementary school.Results: We found a total of 109 medical records with ICH, 67 of which were with hypertensive crisis. The median MMSE score in the hypertensive crisis group was slightly higher than in the non-hypertensive crisis group. Furthermore, there was no statistical difference in MMSE scores between intracerebral haemorrhage patients with and without hypertensive crisis (p-value=0.439). Conclusion: There is no difference in cognitive function between intracerebral haemorrhage patients with and without hypertensive crisis. Further study is of great value to explore the relation between intracerebral haemorrhage patients with and without hypertensive crisis.

Characteristics of Brain Imaging in Intracranial Tumor Patients at Neurology Ward Dr. Hasan Sadikin General Hospital Bandung 2017–2019 Putri Nur Amalia Dewi; Asep Nugraha Hermawan; Cep Juli; Paulus Anam Ong; Sofiati Dian
Althea Medical Journal Vol 8, No 4 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v8n4.2361

Background: Brain imaging is the main modality in establishing the diagnosis of intracranial tumors. Therefore, by using appropriate imaging modalities, lesions can be identified and this is useful in determining management and monitoring of the therapeutic process. This study aimed to describe the use of imaging modalities and the characteristics of imaging findings in diagnosing intracranial tumor patients.Methods: This cross-sectional descriptive study obtained data from medical resumes at the Neurology Ward of Dr. Hasan Sadikin General Hospital Bandung, collected by total sampling method. Data on patients with intracranial tumors who underwent imaging examinations in January 2017–December 2019 were taken, including demographical and imaging characteristics data, divided by tumor type.Results: Of 206 data, the imaging modalities used were contrast CT scan (45.6%), non-contrast CT scan (34.5%), multimodality imaging (13.6%), contrast magnetic resonance imaging (MRI) (3.9%), non-contrast MRI (2.4%), and magnetic resonance spectroscopy (MRS) (0.5%). The most common primary tumor was a solitary lesion (89.4%) located in the right hemisphere in 38.1% of subjects. Metastatic tumors were found mostly as multiple lesions (63.4%) located in both supratentorial and infratentorial in 25.8% of the subjects. Perifocal edema was found in 75% of patients in both tumor types.Conclusions: Contrast CT scan is the most frequently used imaging modality. The most common radiological finding is perifocal edema. Primary tumors are commonly found in solitary numbers, and are located in supratentorial on the right hemisphere. Metastatic tumors are commonly found in multiple numbers and are located both in supratentorial and infratentorial.

Karakteristik luaran klinis neurologis pasien stroke iskemik berdasarkan NIHSS Tiara - Maharani; Cep Juli; Asep Nugraha Hermawan
Jurnal Kedokteran Syiah Kuala Vol 21, No 3 (2021): Volume 21 Nomor 3 Desember 2021
Publisher : Universitas Syiah Kuala

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24815/jks.v21i3.20646

Stroke adalah salah satu penyebab utama kecacatan dan penurunan kualitas hidup akibat penurunan fungsi neurologis. Salah satu alat yang dapat mengukur penurunan fungsi neurologis adalah National Institute of Health Stroke Scale (NIHSS) dengan cara mengukur luaran stroke secara kuantitatif yang terdiri dari sebelas jenis pemeriksaan. Penelitian ini bertujuan untuk mengetahui karakteristik luaran klinis neurologis pasien stroke iskemik berdasarkan NIHSS. Metode pada penelitian ini yaitu deskriptif retrospektif dengan data subjek stroke iskemik pada periode 2017-2019. Pada penelitian ini didapatkan 97 subjek yang terdiri atas 58 pasien aterotrombotik, 33 pasien stroke tromboemboli dan 6 pasien stroke lakunar. Jenis kelamin terbanyak pada subjek adalah perempuan untuk stroke aterotrombotik dan lakunar dan laki-laki untuk stroke tromboemboli. Dengan rentang usia untuk ketiga stroke yaitu ≤ 60 tahun. Lokasi infark yang dilihat berdasarkan CT scan yang terbanyak terletak di hemisfer kiri. Untuk sistem arteri yang terkena paling banyak yaitu arteri karotis. Faktor risiko yang paling sering terjadi pada penelitian ini yaitu hipertensi. Untuk derajat keparahan berdasarkan NIHSS masuk sebagian besar subjek mempunyai skor NIHSS derajat sedang, yaitu berturut-turut 41.4%, 69,7%, dan 16.7% pada stroke aterotrombotik, tromboemboli, dan lakuner. Pada saat pulang sebagian besar skor NIHSS derajat ringan. Pada stroke aterotrombotik 41 subjek (70,7%), stroke tromboemboli 18 subjek (54,5%) dan stroke lakunar 5 subjek (83,3%). Untuk luaran klinis neurologis pasien paling banyak yaitu kelumpuhan wajah, disartria, defisit neurologis motorik lengan dan defisit neurologis motorik tungkai. Pada penelitian ini stroke aterotrombotik merupakan jenis stroke yang paling sering terjadi.

Faktor Faktor Risiko terjadinya Pneumonia pada Stroke Akut di RSUP Dr Hasan Sadikin Bandung Novi Fatni Muhafidzah; Sobaryati Mansur; Emmy Hermiyanti Pranggono; Yusuf Wibisono; Cep Juli; Uni Gamayani; Suryani Gunadharma; Aih Cahyani
Jurnal Neuroanestesi Indonesia Vol 10, No 3 (2021)
Publisher : https://snacc.org/wp-content/uploads/2019/fall/Intl-news3.html

Latar Belakang dan Tujuan: Pneumonia adalah komplikasi non neurologis paling sering pada stroke akut (22%) yang meningkatkan angka kematian, lama rawat inap dan biaya perawatan. Perlu dilakukan identifikasi faktor-faktor risiko terjadinya pneumonia salah satunya neurogenic pulmonary edema (NPE) agar dapat dilakukan pencegahan dan intervensi dini. Tujuan penelitian ini untuk mengetahui gambaran faktor-faktor risiko terjadinya pneumonia (termasuk NPE) pada pasien stroke akut di RSUP Dr Hasan Sadikin Bandung.Subjek dan Metode: Deskriptif observasional prospektif, metode consecutive sampling, periode September - Oktober 2019, mengumpulkan data primer pasien stroke akut yaitu derajat keparahan stroke, tipe, lokasi dan ukuran lesi stroke, terapi dan tindakan selama perawatan, komorbiditas (termasuk NPE). Pneumonia ditegakkan berdasarkan kriteria Centers for Disease Control and Prevention (CDC), NPE berdasarkan kriteria Davison.Hasil: 30 orang mengalami pneumonia pada pasien stroke akut (28,30%). Kejadian pneumonia, lebih sering ditemukan pada pemakaian Nasogastric Tube (NGT) (90%), disfagia (64,71%), lokasi infark Sirkulasi Anterior Total (SAT) (61,54%), ukuran infark besar (61,54%), GCS 9-12 (50%) dan NIHSS 16-20 (50%). NPE didapatkan pada 6,60% pasien stroke akut, 54,17% diantaranya menjadi pneumonia.Simpulan: Kejadian pneumonia pada pasien stroke akut lebih banyak ditemukan pada pemakaian NGT, disfagia, stroke infark lokasi SAT, ukuran infark besar, GCS lebih rendah dan derajat keparahan stroke lebih berat.Risk Factors of Pneumonia in Acute Stroke at Hasan Sadikin Hospital BandungAbstractBackground and Objective:Pneumonia is the most common non neurological complications in acute stroke (22%) that increase mortality rate, length of stay and hospitalization cost. It is necessary to identified risk factors for pneumonia including neurogenic pulmonary edema (NPE) for better prevention and early intervention. The purpose of this study is to determine risk factors of pneumonia (including NPE) in acute stroke patients at Hasan Sadikin General Hospital Bandung.Subject and Methods: Prospective observational descriptive study, consecutive sampling method, during September – October 2019. Primary data collected from acute stroke patients such as stroke severity, type, location and size of stroke, treatment during hospitalizataion, comorbidities (including NPE). Pneumonia was diagnosed based on Central for Disease Control Prevention (CDC) criteria, NPE based on Davison criteria.Results: 30 patients (28.3%) with pneumonia in acute stroke patients. Pneumonia were commonly found in NGT insertion (90%), dysphagia (64,71%), total anterior circulation infarct (TACI) (61,54%), large infarct size (61,54%), GCS 9-12 (50%) and NIHSS 16-20 (50%). NPE only found in 6,60% acute stroke patients, 57,14% of them developed pneumonia.Conclusions: Pneumonia in acute stroke patients is more often found in NGT insertion, dysphagia, TACI location, large infarct size, lower GCS and more severe stroke degree.

THE DISEASE PATTERN OF ELDERLY PATIENTS ADMITTED IN THE NEUROLOGY WARD OF HASAN SADIKIN GENERAL HOSPITAL Millata Azma Basmala; Cep Juli; Paulus Anam Ong; Nushrotul Lailiyya; Lisda Amalia
MNJ (Malang Neurology Journal) Vol. 9 No. 1 (2023): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2023.009.01.3

Background: As life expectancy continues to increase, the elderly population in Indonesia has significantly doubled in the last five decades, making Indonesia a home to 4th largest population of elderly people in Asia. Unlike other age group, there are more challenges in handling older persons due to their increased mortality, morbidity, and disability risks. Objective: We performed this study to understand the disease pattern in elderly patients admitted in the neurology ward of Hasan Sadikin General Hospital. Methods: This was a descriptive cross-sectional study using data from medical resume. We included medical resume of elderly patients admitted in the neurology ward of Hasan Sadikin General Hospital from January 2015 to December 2019. All incomplete, lost, or inaccessible medical resumes were excluded. Results: Among a total of 400 subjects, 210 (52.5%) were males and 190 (47.5%) were females. Young old (59,5%) presented to be the most observed age group. The most frequent diseases of elderly patients seen in this study were ischemic stroke (55.3%), followed by hemorrhagic stroke (19.5%), subarachnoid hemorrhage (5.3%), and tetanus (4.5%). Atherothrombotic subtype (50,6%) of ischemic stroke was seen to be the most frequent. Conclusion: Noncommunicable diseases were the majority of all cases in the elderly with cerebrovascular diseases, such as stroke and subarachnoid haemorrhage, as the most common conditions. It is important to develop efficient hospital-based management strategies particularly for these diseases and intensify early detection and management of risk factors.

CLINICAL OUTCOME OF STROKE PATIENTS BASED ON THE NATIONAL INSTITUTES OF HEALTH STROKE SCALE (NIHSS) IN A TERTIARY HOSPITAL Liunardo Bintang Pratama; Lisda Amalia; Cep Juli; Uni Gamayani; Asep Nugraha Hermawan
MNJ (Malang Neurology Journal) Vol. 9 No. 1 (2023): January
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2023.009.01.4

Background: Stroke is the second leading cause of death and the third cause of disability globally. Clinical outcomes caused by stroke are varied and influenced by various factors. Objective: This study aims to describe the clinical outcome of stroke patients based on neurological deficit using NIHSS at Dr. Hasan Sadikin General Hospital, Bandung. Methods: This study is a retrospective descriptive, cross-sectional study using secondary data from medical records recruited between January 2019 – December 2019 at the Department of Neurology Dr. Hasan Sadikin General Hospital Bandung with the total sampling method. Variables include demographic data, risk factors, and clinical characteristics. Neurological deficit was assessed using NIHSS. Data were analyzed and presented in the form of tables. Results: There were 202 subjects eligible for this study, including ischemic (71.8%) and intracerebral hemorrhage (28.2%) stroke patients. Most of the subjects were male (53%), aged ≥60 years (50,5%), presenting with onset >6 hours (72.3%), and had hypertension (92,1%). Most of the subjects have a moderate stroke (n=102;50.5%) based on the NIHSS score at admission and mild stroke (n=117;57.9%) based on the NIHSS score at discharge, with a motor deficit as the most common neurological deficit found. Conclusion: The majority of stroke patients presented with a moderate stroke on admission and had a clinical improvement during hospital treatment, with most of the patients experiencing a mild stroke on discharge based on NIHSS score. The motor deficit is the most common neurological deficit that affects clinical outcomes.

Cognitive Outcome of Intracerebral Hemorrhage Patients with and without Pneumonia Carissa Vania Pratama; Cep Juli; Chandra Calista; Suryani Gunadharma; Yusuf Wibisono; Paulus Anam Ong
Althea Medical Journal Vol 9, No 3 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/amj.v9n3.2320

Background: There are high prevalence of cognitive impairment in patients with intracerebral hemorrhage (ICH) that may worsen the patients’ outcomes. Pneumonia, as the significant infection complication in stroke patients, may aggravate the decline in the cognitive outcome of patients. This study aimed to explore the cognitive outcomes among patients with or without pneumonia among patients with intracerebral hemorrhage.Methods: A cross-sectional retrospective analytical comparative numeric study was conducted from September 2020 to February 2021, using secondary data of patients with intracerebral hemorrhage admitted to the Department of Neurology Dr. Hasan Sadikin General Hospital in the year 2019. A total sampling method was employed. Data on pneumonia in stroke patients was retrieved, consisting of patients with pneumonia and without pneumonia. Data on Mini-Mental State Examination (MMSE) scores as the measures of cognitive outcomes were compared using the Mann-Whitney U test.Results: There were 108 patients with intracerebral hemorrhage included. There was a statistically significant difference (p value 0.049) in MMSE scores with median MMSE score for pneumonia patients (n = 27) and non-pneumonia patients (n = 81) were 25 and 21, respectively.Conclusions: Cognitive outcome is worse in patients with pneumonia than those without pneumonia. Early intervention is needed for intracerebral hemorrhage patients who develop pneumonia as a complication to improve the cognitive outcome.

PATTERN OF ANTICOAGULANT THERAPY IN CARDIOEMBOLIC STROKE Reihan Achmad Reza; Lisda Amalia; Nushrotul Lailiyya Dahlan; Cep Juli; Hanna Goenawan
MNJ (Malang Neurology Journal) Vol. 9 No. 2 (2023): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2023.009.02.11

Background: Cardioembolic stroke is a category of ischemic stroke that manifests more severe, is prone to recurrence, and is related to a higher mortality rate than the other categories of ischemic stroke. Anticoagulant therapy is recommended in cardioembolic stroke, both for primary and secondary prevention. Objective: The objective of this study is to understand the pattern of anticoagulant therapy in cardioembolic stroke patients admitted at Hasan Sadikin General Hospital Bandung. Methods: The methodology of this study uses retrospective descriptive cross-sectional and use data from medical records collected during January 2015 to December 2020 at Neurology Department of Hasan Sadikin General Hospital with total sampling method. The inclusion criteria were cardioembolic stroke patients that received anticoagulant therapy. Anticoagulant therapy was stratified into Warfarin and New Oral Anticoagulants (NOACs) which consist of dabigatran, rivaroxaban, and edoxaban. To assess stroke severity outcome between warfarin and NOACs we use the National Institutes of Health Stroke Scale (NIHSS) Score. Results: From the 162 cardioembolic stroke patients, the most common oral anticoagulant used was warfarin (90.12%), followed by dabigatran (4.94%), rivaroxaban (3.70%), and edoxaban (1.23%). Only 1 (0.62%) patient who experienced complications from anticoagulant therapy, the complication was non-major bleeding and occurred in warfarin users. Both warfarin and NOACs mainly had NIHSS on discharge in a moderate category with the mean of NIHSS 7.615 and 7.276 for warfarin and NOACs respectively. Conclusion: Warfarin is the most common oral anticoagulant used for cardioembolic stroke based on this study. Both warfarin and NOACs groups have similar stroke severity outcomes measured by NIHSS on discharge and NOACs have lower incidence of bleeding compared to warfarin group.

Co-Authors Aih Cahyani Andi Basuki, Andi Asep Nugraha Hermawan Asep Nugraha Hermawan Asep Nugraha Hermawan Carissa Vania Pratama Chandra Calista Emmy Hermiyanti Pranggono Hanna Goenawan Hartanto, Ary Setio Lisda Amalia Lisda Amalia Liunardo Bintang Pratama Millata Azma Basmala Mohammad Arianto Satrio Wicaksono Novi Fatni Muhafidzah Nur Atik Nushrotul Lailiyya Nushrotul Lailiyya Dahlan Paulus Anam Ong Paulus Anam Ong Paulus Anam Ong Putri Nur Amalia Dewi Reihan Achmad Reza Sobaryati Mansur Sofiati Dian Suryani Gunadharma Tiara - Maharani Uni Gamayani Uni Gamayani Uni Gamayani Uni Gamayani Yusuf Wibisono Yusuf Wibisono

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