Jurnal Sinaps http://jurnalsinaps.com/index.php/sinaps <p>Jurnal bagian Neurologi Fakultas Kedokteran Universitas Sam Ratulangi bekerjasama dengan Perhimpunan Dokter Spesialis Saraf Cabang Manado</p> Neurologi Manado en-US Jurnal Sinaps 2615-2002 GAMBARAN TEKANAN DARAH PADA PASIEN STROKE HEMORAGIK DENGAN DIABETES MELITUS DAN NON DIABETES MELITUS DI BAGIAN SARAF RUMKITAL DR.RAMELAN SURABAYA http://jurnalsinaps.com/index.php/sinaps/article/view/6 <p><strong>Latar Belakang: </strong>Stroke merupakan penyebab kematian terbanyak di Indonesia. Tekanan darah dan diabetes melitus merupakan faktor penyebab terjadinya stroke yang dapat diubah.<strong>Metode: </strong>Penelitian ini menggunakan desain penelitian deskriptif dengan metode studi prevalensi, dengan menggunakan data sekunder yang didapat melalui rekam medis pada bulan Januari-November 2015. <strong>Hasil:</strong> Pada pasien stroke hemoragik dengan diabetes melitus&nbsp; yang tekanan darahnya normal sejumlah 7.14%, prehipertensi sejumlah 7.14%, hipertensi stage 1 sejumlah 21.43%, dan stage 2 sejumlah 64.29%. Sedangkan pada non diabet, tekanan darah normal sejumlah 4.54%, prehipertensi sejumlah&nbsp; 9.09%, hipertensi stage 1 sejumlah 13.64%, dan stage 2 sejumlah 72.73%. <strong>Kesimpulan: </strong>Penelitian ini menyimpulkan bahwa pada pasien stroke hemoragik dengan diabetes mellitus dan non diabetes mellitus di ruang rawat inap Rumkital Dr.Ramelan yang memiliki tekanan darah paling banyak adalah pada kelompok hipertensi stage 2.</p> <p><strong>Kata kunci</strong> :<em>stroke hemoragik, tekanan darah, diabetes melitus</em>.</p> <p>&nbsp;</p> <p><strong><em>ABSTRACT</em></strong></p> <p><strong><em>Background:</em></strong><em> Stroke is the most cause of death in Indonesia. Blood pressure and diabetes mellitus were suggested as the modifiable risk factor of hemorrhagic stroke. <strong>Method:</strong> It is used the descriptive design with prevalence studies method by using secondary data those were taken from the medical record since January until November 2015. <strong>Result:</strong> On hemorrhagic stroke patients with diabetes mellitus who have normal blood pressure were 7.14%, prehypertension&nbsp; were 7.14%, hypertension stage 1 were 21.43%, and stage 2 were 64.29%. Meanwhile on the patients without diabetes mellitus, who have normal blood pressure were 4.54%, prehypertension were 9.09%, hypertension stage 1 were 13.64%, and stage 2 were 72.73%. <strong>Conclusion:</strong> This study shows that hemorrhagic stroke patients with diabetes mellitus or without diabetes mellitus at Neurology wards Dr.Ramelan Navy Hospital Surabaya who have the hypertension stage 2 are the most.</em></p> <p><strong><em>&nbsp;</em></strong></p> <p><strong><em>Keywords</em></strong><em>: hemorrhagic stroke, blood pressure, diabetes mellitus</em></p> Eric Hartono Meilinda Puspitasari Olivia Adam ##submission.copyrightStatement## 2019-02-05 2019-02-05 2 1 IRAMA SIRKADIAN PADA STROKE AKUT http://jurnalsinaps.com/index.php/sinaps/article/view/49 <p><strong>Latar Belakang</strong><strong>: </strong>Irama sirkadian mempengaruhi perilaku dan hampir setiap fungsi fisiologis manusia. Stroke dapat mengganggu irama sirkadian sampai jangka waktu tertentu. <strong>Tujuan:</strong> Mengetahui perubahan pola irama sirkadian pada stroke akut di Manado. <strong>Metode:</strong> Penelitian kohort deskriptif di RSUP Prof. dr. R.D. Kandou, Manado bulan Desember 2015-Februari 2016. Subjek dibagi menjadi kelompok stroke iskemik dan stroke hemoragik. Perubahan irama sirkadian dinilai dengan melihat perubahan tekanan darah sistolik dan diastolik, denyut nadi, dan glukosa darah dalam 72 jam pertama perawatan. <strong>Hasil:</strong> Didapatkan 35 subjek (23 stroke iskemik dan 12 stroke hemoragik). Kenaikan tekanan sistolik dan diastolik pada stroke iskemik dan hemoragik mencapai puncaknya pada pukul 04.00. Tekanan darah sistolik menurun pada pukul 20.00 dan diastolik menurun lebih awal, pada pukul 08.00. Peningkatan rerata denyut nadi mencapai puncaknya pada pukul 16.00 dan menurun pada pukul 00.00 untuk kedua kelompok. Didapatkan peningkatan rerata kadar glukosa darah pada pukul 20.00 yang menurun pada pukul 08.00 untuk kedua kelompok. <strong>Diskusi: </strong>Pola diurnal dan nokturnal irama sirkadian untuk tekanan darah dan kadar glukosa darah masih terlihat tetapi nilai lonjakannya lebih tinggi daripada pola normal. Denyut nadi tidak mengalami perubahan berarti dibandingkan dengan pola normal. Umumnya irama sirkadian kembali normal setelah stroke melewati masa akut.</p> <p><strong>&nbsp;</strong></p> <p><strong><em>Kata</em></strong><em> <strong>kunci</strong> :</em> irama sirkadian, stroke akut,&nbsp; tekanan darah, nadi, glukosa darah.</p> <p>&nbsp;</p> <p><strong><em>ABSTRACT</em></strong></p> <p><strong>Background:</strong> Circadian rhythm affects human behavior and almost all physiological functions. Stroke could disrupt the circadian rhythm until a certain period. Aim To learn the changes of circadian rhythm in acute stroke in Manado. <strong>Method: </strong>Descriptive cohort study conducted in R.D. Kandou hospital in Manado in December 2015-February 2016. Subjects were divided to ischemic stroke and hemorrhagic stroke groups. Changes in circadian rhythm was assessed by measuring the changes in systolic and diastolic blood pressures, heart rate, and blood glucose level within the first 72 hours of admission. <strong>Result:</strong> There were 35 subjects (23 ischemic stroke and 12 hemorrhagic stroke). The increase of systolic and diastolic blood pressures in ischemic and hemorrhagic stroke reached their peak at 04.00 am. Systolic blood pressure decreased at 08.00 pm while diastolic blood pressure decreased earlier at 08.00 am. The increase in average heart rate reached its peak at 04.00 pm and decreased at 00.00 am in both groups. There was an increase in the average blood glucose level at 08.00 pm that decreased at 08.00 am in both groups. <strong>Discussion:</strong> Diurnal-nocturnal pattern of circadian rhythm for blood pressure and blood glucose was still present but the spike was higher than normal. In general, the circadian rhythm returned to normal after stroke surpassed the acute period.</p> <p><strong><em>&nbsp;</em></strong></p> <p><strong><em>Keywords: </em></strong><em>circadian rhythm, acute stroke, blood pressure, heart rate, blood glucose.</em></p> Merry septemi Ekayanti Muhammad Fandy Bachtiar Arthur H.P Mawuntu ##submission.copyrightStatement## 2019-02-05 2019-02-05 2 1 ANALISIS BIAYA SATUAN PASIEN MENINGITIS TUBERKULOSIS YANG DIRAWAT INAP DI RSUP PROF. DR. R. D. KANDOU MANADO http://jurnalsinaps.com/index.php/sinaps/article/view/50 <p><strong>Latar Belakang:</strong>Meningitis tuberkulosis (TB) banyak ditemukan di Indonesia dan perawatan pasiennya memerlukan biaya yang cukup besar. Untuk uji diagnostik awal<em>, World Health Organization</em> merekomendasikan pemeriksaanXpert MTB/Rif cairan serebrospinal. Namun demikian, analisis biaya satuan belum pernah dilakukan untuk kasus ini di RSUP. Prof. dr. R.D Kandou (RS RDK).Kami hendakmengetahui biaya satuan pasien meningitis TB di RS RDK, tanpa dan dengan menggunakan pemeriksaanXpert MTB/Rif. <strong>Metode: </strong>Dilakukan analisis biaya satuan dengan metode satu langkah.Biaya langsung dihitung dengan melihat data rekam medis dan <em>billing system</em> pasien meningitis TB nonoperatif yang dirawat inap di RS RDK tahun 2017.Biaya tidak langsung diestimasi dari hasil wawancara metode <em>semi-structured interview</em> pada responden yang sesuai. Biaya satuan dihitung dari penjumlahan rerata biaya dari setiap komponen biaya yang ditemukan. Dicatat juga biayakomponen tertinggi dan terendah masing-masing. <strong>Hasil: </strong>Didapatkan 25 subjek yang memenuhi kriteria penelitian. Persentase laki-laki 60% dengan rerata usia 46tahun dan rerata lama rawat adalah 12 hari. Biaya satuan langsung adalah Rp.14.779.178 dan biaya satuan tidak langsung Rp. 3.369.767. Biaya pemeriksaan Xpert MTB/Rif di RS RDK ditanggung oleh pemerintah tetapi pemeriksaan dari sampel cairan serebrospinal belum dapat dikerjakan. <strong>Kesimpulan: </strong>Biaya satuan meningitis TB di RS RDK lebih besar dari paket <em>Indonesian Case</em><em>-</em><em>Based Group</em> dengan selisih Rp. 1.564.278. Pemeriksaan Xpert MTB/Rif tidak dikenakan biaya sehingga perbedaannya dapat diabaikan.</p> <p><em>Kata </em><em>k</em><em>unci:</em> Meningitis tuberkulosis, biaya satuan, Xpert MTB/Rif, Manado.</p> <p>&nbsp;</p> <p><strong>ABSTRACT</strong></p> <p><strong>Background:</strong> Tuberculous (TB) meningitis is commonly seen across Indonesia and its treatment requires a huge cost. World Health Organization recommends the utilization of Xpert MTB/Rif from the cerebrospinal fluid as the initial diagnostic test. However, the unit cost analysis for this case has never been done in Kandou Hospital. We intend to find out the unit cost of TB meningitis patient in R.D. Kandou Hospital, without and with the utilization of Xpert MTB/Rif. <strong>Method:</strong> We performed a unit cost analysis using the simple distribution method. Direct cost was calculated from medical record and billing system data of nonsurgical TB meningitis patients admitted in Kandou Hospital in the year 2017. Indirect cost was estimated from the result of interviews using the semi-structured interview method on appropriate respondents. Unit cost was calculated from the sum of average costs from each cost component found. The highest and lowest cost for each cost component were also recorded. <strong>Result:</strong> We found 25 eligible subjects. The male percentage was 60% with average age 46 years old and average length of stay 12 days. The direct unit cost was Rp. 14.779.178 and the indirect unit cost was Rp. 3.369.767. The cost of the Xpert MTB/Rif examination was paid by the government, but the cerebrospinal fluid sample was still unable to be tested. <strong>Conclusion:</strong> The unit cost of TB meningitis in Kandou Hospital was higher than the Indonesian Case-Based Group package with Rp. 1.564.278 cost difference. The Xpert MTB/Rif examination was not charged so the difference is negligible.</p> <p><em>Keywords:</em> Tuberculous meningitis, unit cost, Xpert MTB/Rif, Manado.</p> Anugrah Febriantama Sekplin A.S Sekeon Edward Nangoy Christoffel M.O Mintardjo Arthur H.P Mawuntu ##submission.copyrightStatement## 2 1 19 32 GAMBARAN FUNGSI KOGNITIF PADA LANJUT USIA DI KELURAHAN MAASING KECAMATAN TUMINTING http://jurnalsinaps.com/index.php/sinaps/article/view/51 <p><strong><em>Latar Belakang:</em></strong>Jumlah penduduk lanjut usia yang terus meningkat dapat menimbulkan masalah kesehatan seperti gangguan fungsi kognitif dan dapat di periksa dengan pemeriksaan <em>Montreal Cognitive Assessment</em> versi Indonesia (INA MoCA) dan <em>Trail Making Test</em> (TMT). <em>Tujuan:</em> Mengetahui gambaran fungsi kognitif pada lanjut usia di Kelurahan Maasing Kecamatan Tuminting. <em>Metode:</em>Penelitiandeskriptif dengan metode <em>crosssectional</em>, dilaksanakan bulan Oktober-November 2018 bertempat di Kelurahan Maasing Kecamatan Tuminting.<em>Hasil:</em> Dari penelitian diperoleh 50 orang yang memenuhi kriteria inklusi. Pemeriksaan Ina MoCA menunjukkan 92% lanjut usia mengalami penurunan fungsi kognitif, pada pemeriksaan TMT-A menunjukkan 96% lanjut usia terganggu dan pada TMT-B menunjukkan 100% lanjut usia terganggu. Kelompok lanjut usia yang paling menunjukkan penurunan fungsi kognitif yaitu jenis kelamin laki-laki, usia 60-74 tahun dan 75-90 tahun, jenis pekerjaan nelayan dan IRT, tingkat pendidikan SMA dan SD, lanjut usia dengan riwayat hipertensi menunjukkan penurunan fungsi kognitif&nbsp; 97% dan lanjut usia dengan riwayat diabetes melitus menunjukkan penurunan fungsi kognitif 75% pada Ina MoCA dan 100% pada TMT. <strong><em>Kesimpulan:</em></strong>Dari hasil penelitian menunjukkan 92% lanjut usia mengalami penurunan fungsi kognitif pada pemeriksaan Ina MoCA dan pada TMT-A 96% terganggu, pada TMT-B 100% terganggu.</p> <p><strong>&nbsp;</strong></p> <p><strong>Kata kunci :</strong> Lanjut usia, fungsi kognitif, Ina MoCA, TMT-A, TMT-B</p> <p>&nbsp;</p> <p><strong><em>Abstract</em></strong></p> <p><strong><em>Background: </em></strong><em>The increasing number of elderly people can cause health problems such as impaired cognitive function. Impaired cognitive function can be examined by Montreal Cognitive Assessment Indonesian Version (Ina MoCA) examination and Trail Making Test (TMT). Objective: Knowing overview of cognitive function in elderly at Maasing sub-district Tuminting district. Methods:The descriptive research with cross sectional method, was conducted in October-November 2018 held at Maasing sub-district Tuminting district. Results:From the research gained 50 people who met the inclusion criteria. Ina MoCA examination showed 92% elderly people had decline in cognitive function, on the TMT-A showed 96% elderly people disturbed and on the TMT-B showed 100% elderly people disturbed. The elderly people group showed the most decline in cognitive function that is male gender, age of 60-74 years and 75-90 years, the type of work fishermen and housewives, high school and elementary school level. Elderly people with a history of hypertension showed a decline in cognitive function 97% and elderly people with a history of diabetes mellitus showed a decline in cognitive function 75% on the Ina-MoCA and 100% on the TMT.<strong>Conclusion: </strong>Based on the result showed 92% elderly people had decline in cognitive function on the Ina MoCA and on the TMT-A 96% disturbed, on the TMT-B 100% disturbed.</em></p> <p><em>&nbsp;</em></p> <p><strong><em>Keywords :</em></strong><em>Elderly people, cognitive function, Ina MoCA, TMT-A, TMT-B</em></p> Mutiara Toreh Junita Maja Pertiwi Finny Warouw ##submission.copyrightStatement## 2019-02-05 2019-02-05 2 1 33 42