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Risk factors of intracranial stenosis among older adults with acute ischemic stroke
Pinzon, Rizaldy;
Asanti, Laksmi;
Sugianto, Sugianto;
Widyo, Kriswanto
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.1-7
Intracranial large artery atherosclerosis is an important cause of stroke worldwide. Previous studies have shown that it is found more commonly in Asians. However, studies of intracranial stenosis in Indonesian stroke patients have been very few in number. The aim of this cross-sectional study was to determine the frequency and risk factors of intracranial stenosis in acute ischemic stroke. The data were obtained from 234 consecutive patients in the transcranial doppler (TCD) registry. Documentation of risk factors was performed systematically and for TCD sonography TD-DOP 9000 equipment with a 2-MHz probe was used for the examination of the intracranial circulation. The criteria of middle cerebral artery (MCA) stenosis used in this study were a peak systolic velocity (PSV) >140 cm/s or mean systolic velocity (MSV) >80 cm/s. For stenosis of the posterior circulation the criteria were PSV > 90 cm/s or MSV >60 cm/s. The data were obtained from 234 patients, and complete examinations were performed in 182 patients (77.7%). Ischemic stroke is the most common indication for performing TCD sonography. Stenosis was present in 38% of cases, with stenosis iof the anterior circulation being the more common. The most frequent risk factors were hypertension, dyslipidemia, and diabetes. Intracranial stenosis is common in stroke patients, in whom the risk factors are hypertension and diabetes.
Restless legs syndrome and impact on work performance
Samara, Diana
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.42-48
Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by unpleasant sensations in the legs and an uncontrollable urge to move them for relief. The RSL prevalence in the general population is 0.1% - 11.5%, and increases with age, with the highest effect of producing a primary sleep disorder (70%-80%). Women appear to be at increased risk, as do individuals with certain chronic conditions, including renal failure and anemia. The pathophysiology of RLS is incompletely understood, but it probably results from derangements in dopamine and iron metabolism, and has a genetic component. RSL could be idiopathic or secondary (usually related with iron deficiency, terminal renal failure, pregnancy, and spinal cord lesions). RLS patients usually have sleep disorders, so the disease can cause difficulties and problems in occupational and social life. Subjects with RLS symptoms appear to experience significantly more daytime problems, including being late for work, making errors at work, or missing work because of sleepiness. The diagnosis of RLS is made by following the criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Pharmacologic RLS therapy, in which dopaminergic drugs constitute the first line, is effective and may have a dramatic effect on symptoms and quality of life. Identifying and treating RLS may improve sleep quality, daytime function and work performance.
Relationship between noise and job stress at a private thread spinning company
Mursali, Andi;
Basuki, Endang;
Dharmono, Suryo
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.8-16
Noise exposure is one of the major occupational hazards in many places, and has several health effects, including hearing loss and psychological effects such as sleep disturbances and mental stress. The objective of this research was to determine the relationship between noise and stress and other risk factors that affect job stress. A cross-sectional comparative design involved a total of 326 workers consisting of 220 workers in high noise conditions and 106 workers in low noise conditions. The data were collected directly from the respondents by filling out the questionnaire on worker characteristics, the stress diagnostic questionnaire, and the symptom checklist 90, through discussions with company management, and by measurement of noise levels. The job stress prevalence in workers in high noise conditions was 55% and in those in low noise conditions 24.5%. The results showed that risk factors such as gender of workers, noise conditions, habitual use of ear plugs, shift work, and work stressors had a significant relationship with job stress. Multivariate analysis indicated that the habit of using earplugs was a dominant risk factor causing job stress. The prevalence of job stress in high noise conditions was higher than that in workers in low noise conditions. Noise conditions have a significant relationship with job stress (OR=2.46; 95% CI 1.33 - 4.55). Workers in high noise conditions who did not always use or never had used ear plugs had a higher chance of experiencing stress than those in low noise conditions who did not need ear plugs (OR=21.76; 95% CI 8.09 - 58.52). This study supported that noise exerts its health effect via stress, since noise often raise stress in various ways.
The role of triptans in the management of migraine
Meiyanti, Meiyanti
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.49-58
Migraine is one of the most prevalent disorders seen in clinical practice today and also a major cause of disability in the workplace. The prevalence of migraine is highest during the years of peak productivity, ie, between the ages of 25 and 55 years. The triptans are a group of selective 5-hydroxtriptamine (HT)1 serotonin receptor agonists that activate the 5-HT1B/1D receptor and possibly also the 5-HT1A dan 5-HT1F receptors. To date 7 subclasses of serotonin receptors have been identified, namely subclasses 5-HT1 to 5-HT7. Triptan causes cranial vasoconstriction, inhibits peripheral trigeminal activity and the trigeminal afferents. With its triple action, triptans can control acute attacks of migraine. Triptan is contraindicated in patients with previous ischemic or coronary artery disease, cerebral or peripheral vascular disease and other cardiovascular disorders. Triptans should be given immediately after an acute attack of migraine. The triptans are useful in the management of an acute migraine, but are not indicated for preventive therapy of migraine. Several new advances in migraine management have been made in regard to the recognition of the disease, the pathogenesis of migraine, and the phenomenon of central sensitization. More treatment options become available to patients and prescribers, the impact of such therapy on worker productivity will become more important in determining the value of such interventions.
Effect of aerobic exercise on blood lipid levels in postmenopausal women
Mawi, Martiem
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.17-24
High blood total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), and low concentrations of high-density lipoprotein cholesterol (HDL-C) are related to risk for coronary heart disease (CHD) development. Growing evidence indicates that physical exercise can prevent at least some of the negative effects on health associated with post. The purpose of this study was to evaluate the effect of regular aerobic exercise for 12 weeks on the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. An experimental study was conducted comprising 62 postmenopausal women, aged 50-70 years, not on hormonal therapy, consuming a regular diet, living in East and South Jakarta, and willing to perform aerobic exercises regularly. The results of this study showed that all four lipid levels differed significantly between the control group and the intervention group, the respective mean levels ± SD for TC being 228.0 ± 39.7 mg/dL vs. 171.6 ± 18.4 mg/dL, (p = 0.000); for LDL-C 149.0 ± 36.9 mg/dL vs. 97.7 ± 17.8 mg/dL, (p = 0.000); for HDL-C 50.9 ± 3.9 mg/dL vs. 71.5 ± 6.7 mg/dL, (p = 0.000); and for triglycerides 150.5 ± 67.5 mg/dL vs. 95.0 ± 37.8 mg/dL (p = 0.000). Thus practitioners recommending exercise for coronary artery disease risk reduction in postmenopausal women.
Imaging of common bile duct stones
A Nurman, A Nurman
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.59-68
The gallbladder serves as the repository for bile produced in the liver. However, bile within the gallbladder may become supersaturated with cholesterol, leading to crystal precipitation and subsequent gallstone formation. Gallstone is one of the most common gastrointestinal diseases in clinical practice. Common bile duct stone may be silent and symptomless; alternatively the stone can cause acute cholangitis with jaundice, pain and fever and acute pancreatitis. Imaging of the gallbladder is typically requested for evaluation of right upper quadrant pain in patients with or without fever and jaundice. Hence,imaging is central to the investigation and diagnoses of choledocholithiasis. There are many options in the field of imaging of choledocholithiasis from a simple to more sophisticated examinations. Ultrasonography (US) has been the traditional modality for evaluating gallbladder disease, primarily owing to its high sensitivity and specificity for both stone disease and gallbladder inflammation. However, US is limited by patient body habitus, with degradation of image quality and anatomic detail in obese individuals. With the advent of faster and more efficient imaging techniques, magnetic resonance (MR) imaging has assumed an increasing role as an adjunct modality for gallbladder imaging. MR imaging allows simultaneous anatomic and physiologic assessment of the gallbladder and biliary tract. Magnetic resonance cholangiopancreatography is excellent for identifying the presence and the level of biliary obstruction. With newer diagnostic imaging technologies emerging, endoscopic retrograde cholangiopancreatography is evolving into a predominantly therapeutic procedure.
Multimicronutrient supplementation and asymptomatic urinary tract infections in the elderly
Boekitwetan, Paul;
Surjawidjaja, Julius E.;
Aidilfit, Mahyunis;
Lesmana, Murad
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.25-33
As human life expectancy continues to increase, developing countries are reporting higher percentages of elderly in their respective populations. The defense mechanisms of the elderly are reduced due to several factors, such as increased susceptibility to infection, specifically urinary tract infection (UTI). A randomised, placebo-controlled, double-blind trial was conducted to assess whether multimicronutrient supplementation is effective in reducing UTIs in older people in the community. A total of 261 elderly who lived in Mampang Prapatan district, South Jakarta, were randomised to daily multimicronutrient supplementation or control groups. The primary outcomes were the incidence of asymptomatic UTI, the organisms responsible for UTIs and the results of sensitivity tests on UTI microorganisms. UTI was defined as culture-positive urine yielding a single species of organisms in numbers greater than 104 cfu/mL urine specimen. At base-line 19.5% of the elderly had UTI, namely 23.7% patients in the MMN group and 16.7% in the control group, but the difference was not statistically significant (p=0.158). Escherichia coli was the most common microorganism, isolated in 20.7% of the MMN group and 17.5% of the control group. After six months of supplementation, UTI in the MMN group decreased by 40.6% compared with only 14.4% in the control group. The numbers of E. coli also declined by 64.3% in the MMN group compared to 37.8% in the control group. This study has confirmed the beneficial effect of multimicronutrient supplementation on UTI in the elderly.
Novel swine origin influenza a (H1N1) virus in humans
Merijanti, Lie T.
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.i-ii
In March and early April 2009, while much of the world was focusing on the threat of avian influenza originating in Asia, intelligence gathering systems were also extracting evidence of an epidemic of acute respiratory infections in Mexico and southern California. Although the exact sequence of events is uncertain, the Centers for Disease Control and Prevention (CDC) had confirmed the presence of a novel reassortment of Influenza A strain H1N1 from avian, swine, and human strains. On 25 April 2009, The World Health Organization (WHO) declared the swine flu outbreak in North America a public health emergency of international concern. On 29 April 2009, the International Health Regulations emergency committee recommended a change from WHO pandemic influenza phase 4 to phase 5. This means that WHO views a pandemic as imminent. WHO and the CDC have confirmed that the new swine flu virus is transmitted between humans.
Body mass index and quality of life among the elderly
Kusumaratna, Rina K.;
Hidayat, Adi
Universa Medicina Vol 28, No 1 (2009)
Publisher : Faculty of Medicine, Trisakti University
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DOI: 10.18051/UnivMed.2009.v28.34-41
Obesity in many countries is a major public health problem. The health problems associated with an increase in the proportion of elderly in the population are further compounded by the increasing prevalence of obesity and overweight in older people. The aimed of this study was to explore any difference of quality of life (QOL) attributable body mass index (BMI) categories using the WHOQOL-BREF instruments. An observational cross-sectional study was conducted in Mampang Prapatan district, South Jakarta. A total of 296 free-living elderly aged 60 years and above were participated in this study. BMI was calculated as the weight (kg) divided by the square of the height (m2). Quality of life was measured by WHOQOL-BREF questionnaire in the Indonesian language version. The results showed that the percentage of overweight subjects was 27.5% in male and 22.2% in female elderly, while the percentage of obese subjects was respectively 8.3 and 13.2.1% respectively. In males, the mean scores on each domain of the QOL were higher compared with females. The significant differences were in social relationship (p=0.000) and environment (p=0018) domains. Among male and female elderly the highest mean scores of each domain of QOL was observed in the environment domain, and mean scores of the environment domain was significantly higher in males compare with females (p=0.018). The results have practical implications for the health of older persons because they show that the overweight have a worse score in two QOL domains, namely psychological health and environment.