NORMAL PLANTAR FASCIA THICKNESS IN ADULT

Background: Plantar fasciitis is a common problem caused by thickening of the plantar fascia. The normal plantar fascia thickness ranged between 2-3 mm and it was generally accepted that value more than 4mm was considered pathologic. Objective: to identify normal plantar fascia thickness in adults using ultrasonography. Methods: This is a cross sectional study measuring the thickness of plantar fascia in 145 subjects with no history of heel pain. Plantar fascia thickness was measured in both feet using an ultrasound. Age, height and weight were recorded and analysed. Results: As much as 145 subjects were included in this study. Male to female ratio was 0.7. Mean age was 44 and body mass index (BMI) was mostly within normal range. Plantar fascia thickness in male was 2.71 ± 0.48 mm in right foot, and 2.74 ± 0.47 mm in left foot. Fascia thickness in female was 2.55 ± 0.50 mm in right foot, and 2.57 ± 0.45 mm in left foot. There was a significant plantar fascia thickness difference between male and female (p = 0.035 in right foot, and p=0.04 in left foot). Age, weight and BMI had a significant correlation towards plantar fascia thickness. In multivariate analysis, age and BMI revealed to have a linear correlation to plantar fascia thickness Conclusion: Age and BMI were found to be the best predictive factor of plantar fascia thickness.

THE ROLE OF INTRAOPERATIVE NEUROPHYSIOLOGIC MONITORING TO ENHANCE SUCCESSFUL ORTHOPEDIC SURGERY

One of the main advance in orthopaedic surgery domain has a goal to investigates the safest and harmless method in surgical procedures. Less complications means a better outcome of surgery. One of the commonest risks at orthopaedic surgery is central and peripheral nerve injury. The modality of Intraoperative Neurophysiologic Monitoring (IONM) which act to limit the risk of nerve injury during operative procedure through the evaluation of nerve integrity and function enable the surgeon to decrease injury to the nerve associated with orthopaedic surgical procedure in the operating room. This article aims to explain and describe the latest modality of IONM, its basic concept and its function at surgery. The last part of the article discussed about orthopaedic surgical techniques which use IONM. The authors hope that this article will enhance the knowledge of all the readers about IONM. This article was written based on literature study searched at Google Scholar, Medline and PubMed. The references were taken from a relatively up to date study ranging from 2013-2018. The article was selected according to the authors inclusion criteria and six articles was chosen as the references for this review. As a conclusion, IONM has an important role to increase successful rate of surgery through minimizing nerve injury risk during surgical procedure.

PROFILE OF HISTORY OF FEBRILE SEIZURE IN PATIENTS WITH EPILEPSY

Background: Febrile seizure is convulsions with fever (temperature ³38°C) with no central nervous system infection that commonly found in children (6-60 months). Febrile seizures do not always mean the child has epilepsy. However, febrile seizures can be a possible long-term risk factor for epilepsy. Objective: The objective of this study is to know the profile of febrile seizure in patients with epilepsy. Methods: A retrospective descriptive study on 23 patients with epilepsy in the EEG Department of Neurology, Dr. Soetomo General Hospital, Surabaya, Indonesia in the period 2018-2019 based on inclusion and exclusion criteria. The total number of epilepsy patients is 849 patients, 216 of whom had a history of febrile seizure. Among 216 epilepsy patients who had a history of febrile seizures, 23 of them were qualified as the sample. The sampling technique used was total population sampling. The instrument of this research is the patients’ medical record. Data analysis is carried out descriptively. Results: The characteristics of the history of febrile seizures that found in patients with epilepsy are more patients are male, have the age of onset on less than 2 years old, have the body temperature more than 38.3°C, have the seizure duration less than 15 minutes, have focal seizures, have recurrent seizures in 24 hours, have a history of more than one febrile seizure, have accompanying neurological disorders, and have no family history of epilepsy. Conclusion: Febrile seizure is still becoming a concern because there is a possibility that it may develop into epilepsy. Even though, not all children who experience febrile seizure will generate epilepsy.

INDIRECT CEREBRAL REVASCULARIZATION ON OPTHALMIC ARTERY BY USING A DRUG-ELUTING BALLON FOR SUSPECTED MOYAMOYA DISEASE

Moyamoya disease (MMD) is a rare idiopathic progressive vaso-occlusive disease causing multiple occlusion of cerebral vessels lead to ischemic stroke. Asian population is the most common race to be affected. We present a male patient 33-years old with suspected MMD with right hemiparesis and neurocognitive changes. On digital substraction angiography (DSA) there was appearance of ‘puff of smoke’ on his right hemisphere, stenosis middle cerebral arteries M1 bilaterally, stenosis of right opthalmic artery (OA), stenosis of left anterior cerebral artery (ACA) and aplasia of right ACA. Ballon angioplasty was performed on right OA that supply the contralateral symptomatic stenosis area (left A1) indirectly through anterior ethmoidal artery and anterior falcine artery (OA-ACA collateral). While no guidelines for the management of MMD, cerebral revascularization by using drug-eluting ballon (DEB) in right opthalmica artery is potentially effective treatment that could allow the brain to have good blood supply (gives good collateral to both ACA), reduces burden of the fragile moya-moya vessels to be ruptured followed by improvement of clinical results. Patient’s selection by understanding the stage, its progressivity and collateral formation are crucial before decision is made.

A COMPREHENSIVE APPROACH INTO STEREOSCOPIC VISION

Stereopsis (or stereoscopic) vision is the ability to see depth of perception, which is created by the difference in angle of view between both eyes. The first process is known as simultaneous perception. Objects will fall on each corresponding retina and there will be a process of fusion of the two images into one. Then, the brain initiates three-dimensional perception in visual cortex, creating stereoscopic vision. Stereoscopic vision will rapidly develop, especially at the age of 6-8 months of life. Stereoscopic is important in daily activities. There are many stereoacuity tests to evaluate stereoscopic vision. Stereoscopic examinations are based on the principle of haploscope, anaglyph, or polaroid vectograph. There are qualitative and quantitative examination methods to assess stereoscopic vision. Qualitative examinations such as Horizontal Lang Two Pencil test and Synoptophore. Quantitative examination including Contour stereopsis test and Clinical random dot stereopsis test. The inability of the eye to see stereoscopic can be called stereoblindness. This can be affected by amblyopia, decreased visual acuity, or the presence of ocular misalignment. Inability to achieve stereoscopic vision will impact an individual to perform some daily life activities, and lead to an increase in difficulty interacting in the world.

COMPARISON OF COGNITIVE FUNCTION BETWEEN FIRST ISCHEMIC STROKE AND RECURRENT ISCHEMIC STROKE PATIENTS

Background: Cognitive impairment is a common condition that may affect up to 50% of stroke patients. Post stroke cognitive impairment is associated with reduced quality of life, which may increase the number of dependency. Recurrent stroke may happen in approximately 25% patients and they have higher rates of cognitive impairment. Objective: The aim of this study is to examine the comparison of cognitive function between first ischemic stroke and recurrent ischemic stroke patients in Hasan Sadikin Hospital, Bandung. Methods: This study is a retrospective, cross-sectional study using the data recruited between the year 2012 - 2016 at the Department of Neurology at the Hasan Sadikin Hospital Bandung. The data collected in this study were demographic data, including age, level of education, and residence, and the clinical data as well. Cognitive function was assessed using Mini-Mental State Examination (MMSE). The comparison between the cognitive function between both groups were analyzed using the Mann-Whitney U test. Results: There were 428 subjects eligible for this study, with 207 subjects categorized as first ischemic stroke group and 221 subjects categorized as recurrent ischemic stroke group. There was a statistically significant difference in MMSE scores between the first ischemic stroke patients (24.90 ± 4.64) and recurrent ischemic stroke patients (22.85 ± 4.64 ) with a p value of 0.002. Conclusion: Recurrent ischemic stroke patients had lower MMSE scores than the first ischemic stroke patients. Clinicians should be more aware in detecting early cognitive impairment in stroke patients and in preventing the incidence of recurrent stroke.

EFFECT OF DATE FRUIT (PHOENIX DACTYLIFERA L.) EXTRACT ON TNFα LEVELS AND BRAIN WEIGHT OF ALZHEIMER’S MODEL RATS

Background: Alzheimer's disease (AD) is a neurodegenerative disorder marked by brain inflammation resulted in structural damage and brain dysfunction. Tumor necrosis factor α (TNFα) is a cytokine that plays an important role in inflammation. Dates fruit may help to fight oxidative stress and inflammation in the brain. Objective: To determine the effect of date fruit extracts on blood TNFα levels and brain weight of alzheimer’s model rats. Methods: This research is a laboratory experimental study by post-test only with control group design using alzheimer model rats. This study used 6 treatment groups with simple randomization. Each treatment group was represented by 8 Sprague Dawley rats. The normal control group (KN) was not induced by Hcy and was not given date palm extract, the negative control group (K-) was the Alzheimer's experimental rats which was not given the date palm extract, the positive group was the Alzheimer's experimental rats which was given the Donepezil (K+). Groups P1, P2, P3 were Alzheimer's experimental rats that were given date palm extract at a dose of 200, 400,800 mg / kgBW / day. The effect of date palm extract dosage on TNFα levels and brain weight were analyzed using the One Way Anova test followed by Tukey's post hoc test. Results: The difference in TNFα levels between groups showed a significant difference (p = 0.00). Meanwhile there was no significant difference in brain weight among all groups (p > 0,05). Conclusion: Date palm extract at doses of 200, 400, 800 mg / kgBW can decrease blood TNFα levels of Alzheimer’s model rats.

CLOSING THE GAP FOR PHARMACOLOGICAL TREATMENT OF PAINFUL DIABETIC NEUROPATHY : THE POTENTIAL ROLE OF VITAMIN D

Painful neuropathic pain is a challenging chronic pain to treat. It is heterogeneous in symptoms and could be resistant to the available treatments regimen. Current pharmacological treatments fail to achieve adequate pain relief in a most patients. The previous review showed that only less than 50% of patients can achieve good pain reduction with standard adjuvant treatment. The available adjuvants analgesic only focus in the symptom control, and do not interfere with the progressing damage of the nerve. Vit D insufficiency is quite frequent in type 2 diabetes patients.diabetes, particularly those with symptoms of DPN. The studies also showed that low serum vitamin D levels are an independent predictor of DPN development. Vitamin D supplementation is necessary for diabetic neuropathy patients since it promotes the synthesis of neurotrophins and neurotransmitters. Additional vitamin D therapy have big role in nerve growth factor and the regulation of neurotrophin and Ca2+ homeostasis in neurons, and provides protection for neurons in the peripheral nervous system. In this review, we do systematically search the studies about Vitamin D for the treatment of painful diabetic neuropathic condition. We used PubMed, Cochrane, Clinical Key, and search Google Scholar for papers that used vitamin D phrases. and painful diabetic neuropathy as our major database for this review and we make a systematic table to explain our review. However, there is still an unmet need in the management of neuropathic pain. The unmet needs maybe caused by the gap between pharmacological treatmnet in pain reduction in painful diabetic neuropathy patients. Therefore, in this review we discuss about the potential use of vitamin D as an add-on therapy to closing the gap in the management of neuropathic pain.

STUDY OF SIGNIFICANCE OF PHASE MASK IMAGE IN ACUTE STROKE PATIENTS

Background: Phase images contains information regarding local susceptibility changes between the tissues, which can help measure the iron and other content which changes the local field. Typically, this information is ignored before looking at console. Susceptibility weighted imaging (SWI) is a magnetic resonance (MR) technique detects an early hemorrhagic transformation within the infarct to provide insight into cerebral hemodynamics following the stroke. Objective: Significance of “phase mask imaging in differentiation of hemorrhage and calcifications” in acute stroke patients. Methods: An observational non-interventional study carried out on 100 patients with stroke and headache symptoms. MRI Brain Stroke Profile with FLAIR, DWI, ADC, SWAN, and Phase mask sequences, done on 3T GE MRI scanner. Results: All patients underwent MRI study with SWI sequence. Of 183 cases, 33%(n=60) patients had microbleeds, 5%(n=10) patients had granulomas, 32%(n=58) patients had arterial thrombus with infarct, 11%(n=20) patients had falx calcifications, 11%(n=20) patients had intraparenchymal haemorrhage, and 8%(n=15) patients had infarcts with haemorrhagic transformation. The sensitivity of phase imaging in the detection of calcification was 90%. Conclusion: Phase mask imaging plays an important role to detect intracranial calcifications and chronic microbleeds. Phase mask imaging acts as a supplement tool in acute stroke patients, which guides further management.

DECREMENTAL RESPONSE ON PROLONGED EXERCISE TEST IN A PATIENT WITH THYROTOXIC PERIODIC PARALYSIS

Paralysis of acute onset often presents a diagnostic challenge for the assessing physician because of a large number of differential diagnosis and overlap of clinical features among them. Thyrotoxic periodic paralysis is an uncommon cause of acute weakness. In addition to serological tests, electromyography findings during prolonged exercise test are very helpful in confirming the diagnosis. Only a few case reports of thyrotoxic periodic paralysis have been published from Middle East and none of them have described this specific electrophysiological data. A man in his 20s presented to us with acute onset weakness in both legs which was evaluated further and found to have hypokalemia. The work up for the etiology revealed thyrotoxic status and a final diagnosis of thyrotoxic periodic paralysis was established. The prolonged exercise test performed in this patient showed typical progressive decremental respsonse with nadir at 40 minutes after the exercise.