THE RELATIONSHIP OF NT PRO BNP AND ECHOCARDIOGRAPHIC FEATURES OF RIGHT VENTRICLE DISFUNCTION WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT HAJI ADAM MALIK GENERAL HOSPITAL MEDAN

Background: Cardiovascular complications caused by Chronic Obstructive Pulmonary Disease (COPD) will affect structure and function of heart’s normal anatomy. This study aims to determine the relationship between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular (RV) dysfunction in COPD. Method: A cross-sectional study to assess the association between the abnormality of NT Pro BNP levels and echocardiographic features of right ventricular dysfunction in COPD in the outpatient unit of the Integrated Heart Center H. Adam Malik Hospital Medan. COPD patients were grouped based on GOLD criteria from spirometry examination into severe COPD (GOLD III) and very severe COPD (GOLD IV). Subjects then performed NT pro BNP and echocardiography examination to assess pathological changes in cardiac. Result: NT Pro BNP was higher in GOLD IV. Cut off value of NT Pro BNP > 172 pg/nl is the initial parameter of right ventricular dysfunction. Pulmonary hypertension was found in 93% of cases. The most common cardiac pathological findings were RV hypertrophy (71%), RV dysfunction (86.7%) and pulmonary regurgitation (87.5%). Pathological findings on echocardiography were more common in the GOLD IV group. COPD severity was associated with NT Pro BNP abnormalities (p <0.001) and associated with pathologic echocardiographic findings (p <0.001). Conclusion: Severe COPD is associated with increased NT pro-BNP abnormalities and pathological findings on echocardiography. Echocardiography facilitates early detection of cardiovascular complications in patients with severe and very severe COPD (GOLD III and IV).

KINESIOLOGY TAPING AND NEURAL GLIDING EXERCISE IN CARPAL TUNNEL SYNDROME

Introduction: Carpal Tunnel Syndrome (CTS) is a condition of neuropathy caused by median nerve entrapment, which is related to repetitive injury mostly due to workload. Some people have occupation that require a lot of repetitive wrist movement such as cigarette factory workers. Kinesiology taping and neural gliding exercises are conservative interventions, which can be performed on people with CTS. Case: This case report showed that there was improvement symptom of carpal tunnel syndrome treated with kinesiology taping and neural gliding exercise. The patient was female, 43 years old, a cigarette factory worker. She had complains of tingling sensation on her palms, moreover on finger 1, 2 and 3 since 2 weeks before. The physical examination revealed positive test of carpal tunnel syndrome such as Phalen, Pressure Provocation and Tinel test. Boston Carpal Tunnel Questionnaire (BCTQ) was also performed. The diagnose was confirmed with nerve conduction studies result. Kinesiology taping was applied on this patient and reapplied weekly until 4 weeks. Patient was also taught about neural gliding exercise and was asked to do it every day for 4 weeks. BCTQ was evaluated weekly and improved every week. While nerve conduction studies was evaluated in 4 weeks and there was also improvement in the result. Conclusion: The improved outcome occurring in this case shows that kinesiology taping and neural gliding exercise can be considered as management of carpal tunnel syndrome, but of course further research is needed to prove its significance.

ASSESSMENT OF ADMINISTRATIVE ROLE PERFORMANCES OF HEADMASTERS OF PRIMARY SCHOOLS IN EBONYI STATE SOUTH EAST, NIGERIA

This study was carried out to identify the administrative role performances of headmasters of primary schools in Ebonyi state, southeast Nigeria. The study also identified the challenges faced the headmasters in performing their roles and strategies for handling these challenges. Three research questions were developed in line with the purpose of the study. Three null hypotheses were formulated and tested at 0.05 level of significance. The study adopted descriptive survey design. The population of the study is 1471 headmasters and 10,188 teachers, and the sample comprised 150 headmasters and 1000 primary school teachers from the area of study. This sample was drawn using multi-stage sampling technique. A–21 item instrument termed “Headmasters’ Administrative Role Performance Assessment Questionnaire” (HARPAQ) was used by the researcher for data collection. The instrument was first validated by experts and reliability was determined using Cronbach Alpha Statistics and the reliability got was 0.85. The administration and retrieval of instrument were through direct contact and use of research assistants with the respondents. Data collected were analysed using mean and standard deviation for the research question while z-test statistics were used for testing the null hypotheses. The findings of the study revealed that all the 21 items were accepted by the respondents. Findings on the hypotheses tested revealed that there was no significant difference in the mean responses of headmasters and primary school teachers from Ebonyi state on the items presented. Adequate funding, prudency and accountability in fund management, regular leadership training of headmasters, formation of formidable umbrella union for the headmasters to always interact with government on issues of school funding and management, involving the PTA and community in school management among others were recommended.

HIGH ADMISSION PLASMA OSMOLALITY VALUE AS IN-HOSPITAL MAJOR ADVERSE CARDIOVASCULAR EVENTS PREDICTOR IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION

Background: Elevated blood urea nitrogen (BUN), blood glucose, and alteration sodium levels are common among patients with acute myocardial infarction (AMI). These parameters to be widely investigated to assess the prognosis in AMI patients. However, the combination of these parameters (BUN, blood glucose, and sodium) calculated by a certain formula in the form of plasma osmolality has not been widely studied to assess the prognosis of patients with acute myocardial infarction. This study aims to assess plasma osmolality in predicting hospital major adverse cardiovascular events (MACEs) among AMI patients. Methods: Data were collected from 118 consecutive patients with AMI in Cardiac Centre Haji Adam Malik General Hospital Medan. We measured admission plasma osmolality [1,86 (Na+) + BUN/2,8 + Glucose/18+9]. Then we observed in hospital Major Adverse Cardiovascular Outcomes (MACEs) which consist of cardiovascular mortality, acute heart failure, malignant arrhythmia, and cardiogenic shock. Statistical analysis was performed using mean difference, logistic regression, and receiver operating curve (ROC). Result: Among 118 patients, MACEs were observed in 49 (41.5%) patients with the most common MACEs was acute heart failure (25.4%). Bivariate analysis showed a significant relationship between the plasma osmolality and in hospital MACEs (p < 0.001). The plasma osmolality AUC prediction value was 78.9%. The optimal cut-off value was 279.9 mOsm/kg (sensitivity 81.6%; specificity 75.4%). In multivariate logistic regression analysis, the plasma osmolality was the strongest predictor with an OR value of 10.542 (95% CI 2.694-41.255; p-value <0.001). Conclusions: Among AMI patients, high plasma osmolality value (≥280 mOsm/kg) is a better predictor of in-hospital MACEs than its components separately(BUN, glucose level, sodium).

THE IMPACT OF COGNITIVE IMPAIRMENT AFTER STROKE ON QUALITY OF LIFE AND DAILY LIFE ACTIVITIES

Stroke is a major cause of death and disability worldwide. Cognitive impairment is commonly seen after stroke and might significantly affect the functional outcome. The study aimed to investigate the impact of cognitive impairment after stroke on quality of life and daily life activities. This was a cross-sectional study involving 38 post stroke patients, consisted of 23 males (60.5%) and 15 females (39.5%). All patients underwent neuropsychology examination and assessment of quality of life and activity daily living. The proportion of post-stroke cognitive impairment was 44.7%. Cognitive impairment after stroke affects several domains, including attention, memory, executive function and visuospatial. Cognitive impairment was significantly associated with worse performance in daily life activities

ASSOCIATION BETWEEN CLUSTER OF DIFFERENTIATION 4 COUNT AND THE CLINICAL OUTCOMES OF CEREBRAL TOXOPLASMOSIS IN POSITIVE HIV PATIENTS

Background: About 30% to 40% of HIV patients ultimately will develop cerebral toxoplasmosis. Objectives: To determine the relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients. Methods: This study uses a cross-sectional design. Sampling was conducted at the Integrated Inpatient Room at H. Adam Malik Hospital Medan. The study sample was taken as many as 31 consecutive subjects. CD4 count and KPS (Karnofsky performance score) examinations were performed. CD4 is calculated using the flow cytometry method. The Karnofsky scale is measured to determine the patient's performance status. Data analysis using fisher's exact test. Results: The demographic characteristics of the research subjects were male (93,5%), age range 34,38 ± 7,67 years, marital status (64,5%), high school education level (74,2%), and entrepreneurial work (64,5%). CD4 count < 100 were obtained in 67.7% of subjects with a median value of 25 (2-480). As many as 77.4 % of subjects had a karnofsky scale value of 70 with a median value of 50 (0-80). There is a significant relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients, while CD4 <100 cells / µL can increase clinical risk with a Karnofsky Performance Scale (KPS) score 70 to 1.8 times greater (p = 0.02 and PR = 1.8 and Confidence Interval 95% = 0,95-3,41). Conclusions: There is a significant relationship between CD4 count and clinical outcomes of cerebral toxoplasmosis in HIV positive patients.

ASSOCIATION BETWEEN AGES AND GLUCOCORTICOID-INDUCED DIABETES MELLITUS INCIDENCE IN INTRACRANIAL TUMOR PATIENTS

Background: glucocorticoids are the main therapy for treating peritumoral edema in patients with intracranial tumors. The use of glucocorticoids has side effects, one of which is hyperglycemia or what is called Glucocorticoid-Induced Diabetes Mellitus (GIDM). Hyperglycemia in brain tumor patients is associated with decreased survival, increased recurrence and degeneration to malignancy. Objective: to determine the association between age and the incidence of GIDM in intracranial tumor patients. Method: this study uses a cohort design. Sampling was conducted at Ruang Rawat Inap Terpadu (Rindu) H. Adam Malik General Hospital Medan. Samples were taken as many as 30 subjects consecutively. Blood sugar levels were checked twice a day on days 4 and day 5. Data analysis used the fisher test and eta correlation test. Results: demographic characteristics of the study subjects were an average age of 51 years, high school education level, housewife occupation. As many as 46.7% were primary brain tumors and 53.3% were metastatic brain tumors with the most metastases originating from the lungs (56.3%). There was no difference in the proportion of age groups for the incidence of GIDM (p> 0.05). There was no significant relationship between age and the incidence of GIDM (p> 0.05). Conclusion: there is no difference in the proportion of the age group to the incidence of GIDM and there is no significant association between age and the incidence of GIDM.

THE LEVELS OF FERRITIN SERUM AS A BIOMARKER TO DISTINGUISH BETWEEN ACTIVE AND INACTIVE SYSTEMIC LUPUS ERYTHEMATOSUS

Introduction: The Characteristic recurrence of SLE (Systemic Lupus Erythematosus) patients cannot be predicted. Lack of a reliable parameter that can predict an active clinical phase precludes the way to explore effective preventive strategies for disease relapse, while clinicians should balance the toxicity effect of prolonged use of immunosuppressive therapy. Aim: Knowing the function of serum ferritin as a biomarker to distinguish between active and inactive SLE Methods: Cross-sectional research was conducted at the hospital general of Haji Adam Malik Medan from August to September 2019 in 65 SLE patients. Patients conducted a serum ferritin test and in value by using the MexSledai score. Data analysis using the Mann-Whitney test in SPSS 20th. Result: Median (Min-max) serum ferritin levels of active SLE group 1519 (18.6-2218) ng/mL while inactive SLE Group is 250 (10.5-2000) ng/mL. There are significant differences in serum ferritin levels between active and inactive SLE groups (p = 0,004). ROC curve plot on was found the value of the serum ferritin cutoff can be used to diagnose active SLE. Cutoff value for ferritin levels is (486.0 ng/mL) with a sensitivity value (100.0%) and specificity (90.5%). Conclusion: Serum ferritin levels can be used as a biomarker to distinguish active and inactive SLE.

ASSOCIATION BETWEEN BLOOD PRESSURE VARIABILITY AND EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

Background: Variability in blood pressure is a predictor of stroke severity and causes of poor functional outcome. Blood pressure variability is one of the main predictor of the prognosis acute ischemic stroke. Blood pressure variability were independently and linearly associated with the development of early neurologic deterioration (END) in acute ischemic stroke Objective: To determine the association between blood pressure variability and END in acute ischemic stroke patients. Method: This study uses a cross sectional design. Sampling was conducted at H. Adam Malik General Hospital Medan. Samples were taken as many as 40 subjects consecutively. Blood pressure checks were perform every hour for 72 hours then an assessment of the National Institute of Health Stroke Scale (NIHSS) score at admission and the third day of treatment. Data analysis used fisher’s exact test. Results: The demographic characteristics of the study subjects were an average age of 56-<71 years, high school education level, housewife occupation and Batak ethnicity. The mean of maximum systolic blood pressure (SBP) was 151±12.16 mmHg, minimum SBP 123.15±18 mmHg, delta SBP 25.35±10.66 mmHg, maximum diastolic blood pressure (DBP) 79.7±6.01 mmHg, minimum DBP 61.77±7.32 mmHg and delta DBP 17.97±8.48 mmHg. The NIHSS day 1 score had an average of 9.55±6.73, the NIHSS day 3 score was 11.25±7.93. Most subjects experienced END. There is a significant relationship between blood pressure variability and END with a p of 0.03 (p<0.05). Conclusion: There is a significant relationship between blood pressure variability and END in patients with acute ischemic stroke.

CORRELATION BETWEEN NEUTROPHIL-TO-LYMPHOCYTE RATIO AND HIGH SENSITIVITY C REACTIVE PROTEIN WITH SEVERITY AND OUTCOME IN ACUTE ISCHEMIC STROKE PATIENT

Background: Inflammation plays a role in the pathophysiology of cerebral ischemic and also an initial response to brain injury. Inflammation involving Blood and Brain Barrier disturbance, leukocyte infiltration, endothelial cells activation, oxidant and inflammatory mediator buildups which can develop rapidly within hours and can cause secondary injury to brain tissues Objectives: To determine the correlation between Neutrophil-to-Lymphocyte Ratio (NLR) and High Sensitivity C Reactive Protein (hsCRP) with severity and outcome in acute ischemic stroke patients Methods: This study used a cross-sectional design approach. Sampling was done at H. Adam Malik General Hospital Medan and taken as many as 38 subjects. NLR and hsCRP were examined on the first day of admission. Severity was assessed by using the National Institutes of Health Stroke Scale and the outcome was assessed by using the Modified Ranking Scale on the first and fourteenth day of admission. The data analysis used the contingency coefficient correlation test and gamma test. Results: Demographic characteristics of the subjects are; the average age is 62 years old, the highest educational level is high school graduate, and the most occupation is unemployed. There is a positive, moderate, and significant correlation between NLR and severity of acute ischemic stroke (r=0.511; p=0.001). There is a positive, moderate, and significant correlation between NLR and the outcome of acute ischemic stroke (r=0.463; p=0.001). There is a positive, very strong, and significant correlation between hsCRP and severity of acute ischemic stroke (r=0.896; p=0.001). There is a positive, strong, and significant correlation between hsCRP and outcome of acute ischemic stroke (r=0.624; p=0.001) Conclusions: There is a positive and significant correlation between NLR and hsCRP with severity and outcome in acute ischemic stroke patients.