Edukasi Penggunaan Monofilament dalam Deteksi Dini Neuropati Sensori Diabetes Mellitus Tipe 2 Pada Kader di Tengah Pandemi Covid-19 Kelurahan Kolo Kota Bima

ABSTRAKNeuropati atau sering disebut sebagai gangguan sensasi merupakan salah satu komplikasi yang sering ditemukan pada pasien diabetes Mellitus tipe 2. Kejadian neuropati sering tidak disadari oleh pasien sehingga mengakibatkan munculnya Diabetic Foot Ulcer. Deteksi dini neuropati diabetic sangat penting pada pasien dengan DM karena pencegahan bisa menurunkan morbiditas dan mortalitas.. Metode yang dilakukan meliputi tahap persiapan, tahap pelaksanaan, monitoring dan evaluasi. strategi pelaksanaan dengan melakukan pre test sebelum kegiatan dilaksanakan, kemudian membagikan modul dan video penggunaan alat pengecekan gula darahdan penggunaan monofilament test, setelah itu di evaluasi dengan post test. Hasil yang didapatkan 90% kader yang hadir mememahami dan bisa mempraktekan cara pengecekan gula darah secara mandiri dan menggunkan monofilament tes. Sedangkan kegaiatan dengan 50 penyandang diabetes 40% mengalami gangguan neuropati sensori, maka dapat disimpulakan adanya peningkatan pengetahuan dan keterampilan para kader tentang deteksi dini neuropati pada pasien diabetes mellitus tipe 2 yang meliputi, pengertian DM, tanda dan gejala, penatalaksanaan, komplikasi, tanda gangguan neuropati dan cara mendeteksinya, ditandai dengan kemampuan kader dan penyandang diabetes mampu menjawab dan mempraktikan pertanyaan dari pengabdi. Kata Kunci: Edukasi, Pelatihan, Monofilament tes, Neuropati. ABSTRACT Neuropathy or often referred to as impaired sensation is one of the complications that are often found in patients with type 2 diabetes mellitus. Early detection of diabetic neuropathy is very important in patients with DM because prevention can reduce morbidity and mortality. The methods used include the preparation stage, implementation stage, monitoring and evaluation. the implementation strategy was to do a pre test before the activity was carried out, then distribute modules and videos on the use of blood sugar checking tools and the use of monofilament tests, after which they were evaluated with a post test. The results obtained were 90% of the cadres who attended understood and could practice how to independently check blood sugar and use the monofilament test. While activities with 50 people with diabetes 40% experiencing sensory neuropathy disorders, it can be concluded that there is an increase in knowledge and skills of cadres about early detection of neuropathy in patients with type 2 diabetes mellitus which includes understanding of DM, signs and symptoms, management, complications, signs of neuropathic disorders. and how to detect it, is marked by the ability of cadres and people with diabetes to be able to answer and practice questions from the servants. Keywords: Education, Training, Monofilament test, Neuropathy

Hubungan Lama Menderita Dengan Kejadian Neuropati Diabetikum Pada Pasien Diabetes Melitus

Organisasi Internasional Diabetes Federation (IDF) memperkirakan terdapat 463 juta orang pada usia 20-79 tahun di dunia menderita diabetes mellitus (DM) tahun 2019 atau setara dengan angka 9,3% dari total penduduk pada usia yang sama. Berdasarkan jenis kelamin, IDF memperkirakan prevalensi DM tahun 2019 yaitu 9% pada perempuan dan 9,65% pada laki-laki. Prevalensi diabetes meningkat seiring penambahan umur menjadi 19,9% atau 111,2 juta orang (umur 65-79 tahun). Angka diprediksi meningkat hingga 578 juta di tahun 2030 dan 700 juta di tahun 2045. Pusat Data dan Informasi PERSI (Perhimpunan Rumah Sakit Indonesia), prevalensi penderita DM dengan komplikasi neuropati sebesar lebih dari 50%. Tujuan untuk mengetahui hubungan lama menderita dengan kejadian neuropati diabetikum pada pasien diabetes melitus Metode secara deskriptif analitik dengan pendekatan cross sectional dan tehnik pengambilan sampel menggunakan purposive sampling sejumlah 84 responden/ pasien diabetes melitus tipe 1 dan tipe 2. Instrumen menggunakan kuesioner dan monofilament test dan data dianalisa dengan uji statistik chi-square. Hasil didapatkan 71 responden (84,5 %) yang lama menderita DM < 5 tahun, 46 responden (54,8%) mengalami neuropati diabetikum dan nilai Asymp Sig 0,942 (P-value = 0,005). Karena nilai 0,942 > 0,005, maka disimpulkan tidak ada hubungan yang signifikan antara lama menderita dengan kejadian neuropati diabetikum.Kata kunci : diabetes melitus; lama menderita; neuropati diabetikumThe Relationship Of Long Suffering With The Event Of Diabetic Neuropaty In Diabetes Mellitus PatientsAbstractThe International Diabetes Federation (IDF) estimates that there are 463 million people aged 20-79 years in the world suffering from diabetes mellitus (DM) in 2019, equivalent to 9.3% of the total population at the same age. Based on gender, IDF estimates that the prevalence of DM in 2019 is 9% in women and 9.65% in men. The prevalence of diabetes increases with increasing age to 19.9% or 111.2 million people (aged 65-79 years). The figure is predicted to increase to 578 million in 2030 and 700 million in 2045. According to the PERSI Data and Information Center (Indonesian Hospital Association), the prevalence of DM sufferers with neuropathic complications is more than 50%. The purpose of this study was to determine the relationship between length of stay and the incidence of diabetic neuropathy in patients with diabetes mellitus. Descriptive analytical method with a cross sectional approach and sampling technique used purposive sampling with a total of 84 respondents/patients with type 1 and type 2 diabetes mellitus. The instrument used a questionnaire and monofilament test and data. analyzed by chi-square statistical test. The results showed that 71 respondents (84.5%) had long suffered from DM < 5 years, 46 respondents (54.8%) had diabetic neuropathy and the Asymp Sig value was 0.942 (P-value = 0.005). Because the value is 0.942 > 0.005, it is concluded that there is no significant relationship between the length of suffering and the incidence of diabetic neuropathy.Keywords: diabetes mellitus; long suffering; diabetic neuropathy

Clinical outcomes of the oblique V-Y advancement pulp flap for repair of lateral fingertip injuries

We report the use of obliquely oriented V-Y advancement pulp flaps to reconstruct 17 consecutive, lateral oblique fingertip traumatic defects over a 2-year period. All flaps survived completely with no bone protuberance, prominent scar or neuroma evident at an average follow-up of 11 months (range 7 to 19). Although there was no incidence of severe hook nail deformities, there were two patients who had residual mild hook nails, two with pulp/nail asymmetries and one with an ingrown nail. The mean static two-point discrimination was 3.6 mm (range 3 to 8) and the mean Semmes–Weinstein monofilament test score 3.9 g (range 2.44 to 4.56). No correlation was found between the flap obliquity angle and sensory test results. We recommend the obliquely oriented V-Y pulp flap as a reliable reconstructive option for the cover of lateral oblique fingertip defects. Level of evidence: IV

Diagnostic accuracy of monofilament test to detect diabetic neuropathy

Background Diabetic peripheral neuropathy (DPN) is a significant independent risk factor for diabetic foot, and an effective screening instrument is required to diagnose DPN early to prevent future ulceration and amputation. This study aims to determine the diagnostic accuracy of monofilament test to detect diabetic peripheral neuropathy. Methods This cross-sectional study was conducted in National Academy of Medical Sciences, Bir hospital, Mahabouddha, Kathmandu from February 2016 to January 2017. A total of 96 diabetic patients attending inpatient and outpatient Department were selected. Diabetic peripheral neuropathy was assessed by measurement of loss of protective sensation (LOPS) by monofilament test and compared with vibration perception threshold by standard biothesiometer. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were calculated. Results The prevalence of diabetic peripheral neuropathy was 26%. The sensitivity, specificity, positive predictive value and negative predictive value of monofilament test were found to be 92.0%, 95.8%, 88.5% and 97.1% respectively. There was strong association between LOPS by monofilament and vibration perception threshold by biothesiometer. Conclusion This study showed a strong diagnostic accuracy of monofilament test to detect DPN when compared with biothesiometer. As monofilament test is a cheap, easily available, and portable, it can be used in the periphery where biothesiometer is not available.

Validity and Reliability of the Semmes-Weinstein Monofilament Test and the Thumb Localizing Test in Patients With Stroke

Background: Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself.Objective: We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis.Methods: Fifty patients with chronic stroke (median time after onset of stroke, 848 [474–1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated.Results: Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83–0.95)/ 0.75 (0.60–0.91) and 0.80 (index finger, 0.67–0.93)/0.79 (0.66–0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71–0.95)/ 0.83 (0.73–0.92), 0.90 (navel level distal space, 0.85–0.96)/ 0.80 (0.69–0.90), 0.80 (shoulder level proximal space, 0.68–0.92)/ 0.77 (0.65–0.89), and 0.87 (shoulder level distal space, 0.80–0.93)/ 0.80 (0.68–0.92) (P &lt; 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94–2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item (r = 0.65, p &lt; 0.001), as did the TLT with the SIAS position sense item (r = −0.70–0.62, p &lt; 0.001 each space).Conclusions: The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.

Iliac Crest Autograft Harvesting by Mosaicplasty Technique

INTRODUCTION: The aim of this study to present the results of patients with iliac wing autograft using the mosaicplasty method in order to reduce donor site morbidity and pain, which are two of the most common complications. METHOD: Between 2011-2018, 35 patients (19 men,16 women) who were harvested autograft from the iliac wing were included in the study.The average age of patients was determined to be 42 (10-64) years, the mean follow-up was 39.9 months (12-101). All patients were operated on for pseudoarthrosis surgery.The same orthopedic surgeon harvested all autografts. The patients were evaluated at post-op 15th day, the first month, and the sixth month. Patients were evaluated in their last follow-up (at sixth month) and monofilament test, two-point discrimination test, visual analog scale (VAS), pain duration, numbness, gait problems, major pain area, cosmetic satisfaction were questioned. RESULTS: The mean of the monofilament test was 4.16 (2.83-6.65). The mean two-point discrimination test was 36.5 mm (9-100 mm). The mean VAS was found to be 2.94 (1-4). In the post-op period, the duration of pain was determined as one month in 21 patients, two months in 5 patients, and four months in 2 patients, while seven patients did not complain of pain at all. It was observed that ten patients complained of numbness in the thigh region (28.5%), and 11 patients complained of gait problem and limping (31.4%). Fifteen patients used an assistive walking device after surgery (42.8%). Only two patients complained of pain in the graft area when the major pain region was questioned after surgery (5.7%). Twenty-one patients were found to be cosmetically satisfied (60%) following the surgery scar in the graft region. CONCLUSİON: We believe that iliac autografts taken with the mosaicplasty technique can be used safely in suitable patients with low complication rates and high patient satisfaction

A STUDY OF MUTUAL INTERPLAY OF MICRONUTRIENTS AND SPECTRUM OF DIABETIC PATIENTS

Persistent uncontrolled hyperglycaemia in Diabetes Mellitus causes permanent structural and functional damage to tissues, which leads to micro and macro vascular complications causing increased mortality and morbidity. Magnesium and Calcium are required for Insulin secretion, Iron is essential for cell functioning and zinc forms the structure of insulin. 90 subjects were enlisted in the study after obtaining written informed consent and divided into 3 groups of pre-diabetic, diabetic and diabetic with micro and macro vascular complication. A brief history with relevant clinical examinations using monofilament test and ophthalmoscopic examination were done to evaluate for diabetic neuropathy and retinopathy respectively. Blood samples for serum zinc, calcium, magnesium and iron were collected and analysed with respect to age, gender and duration since diabetes was diagnosed. With increase in duration of diabetes and HbA1c, serum zinc, iron, and magnesium levels decreased, while calcium levels increased. Till date very few studies have been conducted to study micronutrients deficiency in pre-diabetics. Detection of micronutrients deficiency early in the course of diabetes, may delay the development of complications with their supplementation. Hence, this study is being done to study micronutrients in diabetics and pre-diabetic patients.

Efektifitas buku panduan uji sentuh ipswich dalam meningkatkan keterampilan kader kesehatan mendeteksi neuropati diabetik

The ipswich touch test manual book in improving skills for health cadre members in detecting diabetic neuropathyBackground: Complications of diabetes can affect all organs of the body, especially the ends of the feet as diabetic foot. But this will not occur if diabetes treatment in properly and regularly. The early detection on nerve damage can do immediately to find neuropathy symptoms, which is a decrease in the sensitivity of the feet, by using a monofilament test. However, this tool is rarely available in health care units. Currently, a simple method for detecting neuropathy by the Ipswich Touch Test (IpTT). This technique can perform by health cadres, but it needs written instructions such as a guide or manual book.Purpose: Knowing of the skills for health cadre members in detecting diabetic neuropathy by using ipswich touch test manual book.Methods: The pretest-posttest quasi-experimental design with population was health cadre members taken by cluster sampling from Giri Roto and Dibal villages, Ngemplak District, Boyolali Regency. The sample divided by 2 groups and each a group of 60 participants of cadres. The evaluation by observing of the skills each health cadre members in detecting diabetic neuropathy before and after using ipswich touch test manual book.Results: Based on data analysis using the chi-squared test, the p-value was 0.000 (<0.005). This means that the research hypothesis accepted which states that there are differences in the skills on each health cadre members in detecting diabetic neuropathy before and after using ipswich touch test manual book.Conclusion: There is improving in skills on each health cadre member in detecting diabetic neuropathy by using ipswich touch test manual book.Keywords: Ipswich touch test; Diabetic neuropathy; Skills; CadrePendahuluan: Komplikasi diabetes dapat menyerang seluruh organ tubuh khususnya ujung kaki berupa diabetic foot. Tetapi hal tersebut tidak akan muncul apabila perawatan diabetes dilaksanakan dengan baik, dan teratur. Sehingga terjadinya kerusakan saraf yang dapat segera terdeteksi seperi Neuropati yaitu penurunan sensitivitas rasa kaki. Neuropati dapat dideteksi dengan menggunakan monofilament test. Akan tetapi alat ini belum tentu tersedia di unit pelayanan kesehatan. Saat ini telah dibuat sebuah cara mendeteksi neuropati pada pasien diabetes yang sederhana tanpa alat dinamakan Ipswich Touch Test (IpTT). Teknik ini bahkan dapat dilakukan oleh non profesional antara lain kader kesehatan namun perlu instruksi tertulis seperti buku panduan.Tujuan: Mengetahui perbedaan peningkatan keterampilan kader kesehatan dalam mendeteksi neuropati diabetik menggunakan buku panduan Ipswich Touch Test di Kecamatan Ngemplak Kabupaten BoyolaliMetode : Desain kuasi eksperimen pretest-posttest with control group sebagai populasi adalah kader kesehatan di Kecamatan Ngemplak Kabupaten Boyolali. Pengambilan sampel dilakukan cluster sampling sebanyak 2 kelompok kader yaitu kader di desa Giri Roto dan Dibal masing masing sebanyak 60 orang. Evaluasinya dengan melihat keterampilan kader sebelum dan sesudah menggunakan buku panduan uji sentuh ipswichHasil: Berdasarkan analisis data menggunakan uji Chi-Squared diperoleh hasil p-value 0.000 (< 0,005). Hal ini berarti Hipotesis penelitian diterima yang menyatakan bahwa terdapat perbedaan keterampilan kader dalam mendeteksi neuropati menggunakan buku panduan antara kader desa Dibal dan kader desa Giri Roto.Simpulan: Terdapat peningkatan keterampilan setelah menggunakan buku panduan IpTT pada kader desa Dibal dan desa Giri Roto.

Evaluation of Event Time of Neuropathy in Type 2 Diabetic Patients: Application of Surrogate Endpoints Method

Background: Diabetic neuropathy is the most common complication of diabetes, the effective control of which requires accurate diagnosis of neuropathy on a regular basis. The present study aimed to investigate the factors affecting the event time of neuropathy using the Clayton copula model in type 2 diabetic patients in the presence of a surrogate response variable. Methods: The data of all the people whose diabetes test results were negative in the 2006 screening by the health centers in Fereydun Shahr, Isfahan, but their diabetes re-tests were positive in 2007, and were at least 30 years of age were collected, and their neuropathy status was followed up for at least 10 years. To investigate the factors affecting the event time of neuropathy in the patients, the Clayton copula model as well as the true variable, ten-point monofilament test and surrogate variable, and Michigan questionnaire including interviews and examinations by a trained physician were used. All the statistical analyzes were performed using the R software (version 3.6.2) and tests were done with an error of 0.05. Results: Of the total of 371 diabetic patients studied, 114 (30.7%) were male and their mean age was 63.93 (±0.568) years. According to the Clayton copula model, the individuals with a family history of diabetes and Hemoglobin A1c of >=8.1, BMI of >=35, HDL of <54, and under treatment with oral and insulin injections would develop neuropathy more quickly. Conclusion: In this study, using the survival ROC curve, was shown that the Copula model was more efficient than the surrogate model, so it is suggested that the Copula model be used to predict the occurrence of neuropathy for patients who do not have access to the monofilament test. Keywords: Type 2 Diabetes, Neuropathy, Michigan Questionnaire, Monofilament Test