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.

APPLICATION OF FORENSIC ACCOUNTING TECHNIQUES AS ANTIDOTE FOR CURBING FRAUD IN NIGERIA BUDGET IMPLEMENTATION ADEGBIE

Budgeting is a fiscal policy used by the government to grow and develop the economy to ensure performance, stability and sustainability. Studies have shown that diversion of budgeted allocated funds, misappropriation of funds, fraud and uncompleted capital and developmental projects are major challenges facing budgetary system in Nigeria public sector. Studies further revealed that various strategies used to resolve the problem have not been successful. This study evaluated the impact of the applying forensic accounting techniques in curbing fraud in Nigeria budget implementation. The study employed survey cross-sectional research design. The population consisted of 195 staff of federal government establishments connected with budgetary system and fiscal policy. With the use of total enumeration, 195 copies of the questionnaire were administered with a retrieval rate of 150 copies (77%).The study adopted descriptive and inferential statistics to analyze the data. The findings showed that Investigative and Audit Support Service have strong impact on fraud and misappropriation of budgeted allocation funds β=0.342,F (1,149)=10.587,p-value=.002.The result also showed that Investigative and Audit Support Service has significant impact on uncompleted capital and developmental projects.β=0.745,F(1,149)=249.621,p-value=.003.The study concluded that the application of forensic accounting techniques have positive effect on curbing fraud in budget implementation. The study recommended that the federal government should make a policy to incorporate forensic accounting in Nigeria budgetary system

A STUDY ON IMPACT OF COVID-19 ON TEACHING

“Be the change you want to see in the world.” The petrifying and severe impact of COVID-19 has shaken the world to its core. Later, most of the Governments around the world have temporarily closed educational institutions in an attempt to stop the spread of the COVID-19 pandemic. In India, 320 million students have been affected by COVID-19 school closures, and though the government quickly recommended shifting to “online teaching.” Many of the government institutions are lacking of facilities to conduct online classes. Many teachers are to be updating them to challenge this situation otherwise leads to job threat. This paper with an objective to study out whether the faculties are ready to face challenges due to online teaching and to identify who among male and female are feeling more threat for their jobs due to online teaching.

COMPARISON OF INSULIN LIKE GROWTH FACTOR-1 LEVELS IN CHRONIC MYELOCYTIC LEUKEMIA PATIENTS RECEIVING IMATINIB AND NILOTINIB THERAPY WITH HEALTHY POPULATIONS

Introduction. CML is the most common form of chronic leukemia in Indonesia, whereas in Western countries it is more commonly found in the form of chronic lymphocytic leukemia (CLL). Chronic myelocytic leukemia (CML) is a chronic myeloproliferative disease with clonal abnormalities due to genetic changes in stem cell pluripotence. This disease is characterized by proliferation of granulocyte series without differentiation disorders. On the CML, the Philadelphia chromosome (Ph1 chr) is found in a reciprocal translocation 9.22 (t9; 22). Insulin-like Growth Factor-1 is a natural polypeptide in the human body that has similarities with insulin. IGF-1 plays an important role in the growth and development of tissues. As such, several studies have shown an association between IGF-1 and -2 circulation rates. IGF-1 plays an important role in terms of stimulating cell proliferation and inhibition of apoptosis. This affects the regulation of the body's physiological growth as well as pathological growth such as cancer. Until now there has been no research on IGF-1 levels in CML patients with imatinib and nilotinib treatment. Methods. This research is a cross-sectional study, by observing the status of exposure and simultaneous disease in individuals from a single population, in one period. The study was conducted in December 2019 at the Outpatient Clinic of H Adam Malik General Hospital Medan with the approval of the North Sumatera University Research Ethics Commission. Data were analyzed using SPSS where p <0.05 was considered significant. Results. This study showed that there were no differences in IGF-1 levels between CML patients who received imatinib and nilotinib therapy. The mean IGF-1 results were obtained in the imatinib group 107.43±19.70 and nilotinib 107.43±18.09. While the healthy population is 138.60±52.85. Conclusion. No significant differences were found in IGF-1 levels between CML patients receiving imatinib and nilotinib therapy with healthy populations.