Khazanah Riset

KHAZANAH RISET RSPAD GATOT SOEBROTO HIGH RELIABILITY ORGANIZATION HOSPITAL RESEARCH UNIVERSITY Editor: Soroy Lardo Handrianto Setiajaya Nani Iriani Muhamad Tolib Kata Pengantar Mayjen TNI dr. Bambang Dwi Hasto, Sp.B., FInaCS., M.Si. THIAMSI The Indonesia Army Medical Science Institute i

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Pengantar Editor Penelitian itu merupakan akarnya kehidupan, karena memuat penjalaran kolateral yang mengisi sumbu tanah dengan oksigenisasi, mekanisme biokimiawi dan mekanik untuk membuat tanah tersebut tetap subur. Proses ini „bak‟ salah satu elemen amal jariah ilmu yang dimanfaatkan. Penelitian itu bertaut dengan spirit dan inovasi, menjadi cermin besar untuk memancarkan energi terbarukan, mengisi relung ide, sehingga menjadi brain memory base, bahwa progresifitas dari keilmuan akan menukik menjadi akar yang kuat, mengalirkan cahaya diatas cahaya. Riset kehidupan menjadikan gulungan akar tersebut sebagai penopang kuat inovasi pohon keilmuan diatasnya Pemahaman terhadap spirit inovasi menjadi penting bagi setiap peneliti di rumah sakit yaitu: (1) Spirit inovasi menjadi wajah dan cerminan awal rumah sakit dalam menerapkan mutu penelitian berbasiskan pelayanan (translational research) (2) Spirit inovasi menjadi sanggul untuk menjaga ilmu yang dimiliki disetiap kepala peneliti tetap terjaga dan terpelihara. (3) Spirit inovasi menjadi ransel yang melekat pada setiap peneliti untuk menguatkan tulang belakangnya, sehingga tulang menjadi penguat untuk meningkatkan kompetensi keilmuan. (4) Spirit inovasi menjadi barometer lingkungan rumah sakit, yaitu terbentuknya budaya meneliti dengan tidak melupakan pelayanan pasien secara maksimal. (5) Spirit inovasi menjadi wahana berjalannya pembentukan karakter peneliti, untuk memiliki kemandirian jiwa juang menjalani penelitian berikutnya (6) Spirit inovasi menegakkan keyakinan terhadap setiap peneliti untuk membangun nilai nilai reliabilitas dan validitas dalam proses menjadi pelayan pasien yang terbaik. Sehingga nilai keilmuan yang dipelajari harus senantiasa dijaga dan dipertahankan. iii

Alhamdulillah, sekelumit buku kecil ini merupakan perjuangan panjang dari sejarah riset RSPAD Gatot Soebroto yang sudah terbentuk sejak awal berdirinya rumah sakit ini. Melekatkan satu penelitian dengan penelitian lain menjadi kerangka besar khazanah riset, sungguh bukanlah pekerjaan yang mudah. Berkat ketekunan dan kerjasama semua pihak ,buku ini terwujud sebagai wajah cerah RSPAD Gatot Soebroto masa depan. Terima kasih kepada Kolonel CKM dr Nana Sarnadi, Sp. OG Dirbang dan Riset yang memfasiltasi penerbitan buku ini. Ketua Tim Editor Kolonel CKM Dr.dr.Soroy Lardo, Sp.PD FINASIM iv

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KATA PENGANTAR Puji dan syukur kita panjatkan kehadirat Tuhan Yang Maha Esa atas segala rahmat dan karuniaNya, sehingga kita masih diberikan kesempatan dan kemampuan untuk memberikan kontribusi positif bagi organisasi RS Kepresidenan RSPAD Gatot Soebroto. Saya menyambut gembira atas terbitnya kumpulan abstrak yang terangkum dalam Khazanah Riset RSPAD Gatot Soebroto yang bertepatan dengan HUT ke-70 RS Kepresidenan RSPAD Gatot Soebroto. Pada kesempatan kali ini RSPAD berhasil membukukan penelitian yang telah dilakukan oleh peneliti internal yang selanjutnya dibuatlah dalam bentuk kumpulan abstrak Khasanah THIAMSI. THIAMSI atau The Indonesia Army Medical Science Institute merupakan wadah bagi tim peneliti RSPAD Gatot Soebroto untuk meningkatkan kemampuan riset yang selanjutnya diharapkan dapat memberi dampak terhadap pelayanan kesehatan di rumah sakit kebanggan kita. Fase ke depan, rumah sakit rujukan memerlukan dukungan unit/ institusi riset yang kuat. Perlu saya ingatkan bahwa penelitian harus menjadi komitmen dan tanggungjawab setiap komponen di RSPAD Gatot Soebroto sesuai dengan bidang keahliannya masing-masing, sehingga rumah sakit ini kedepannya tidak hanya sekedar mempertahankan akreditasinya, tetapi menjadi rumah sakit yang mewujudkan pelayanan prima bagi penggunanya dan menjadi rumah sakit kelas dunia (World Class Hospital) Sebelum mengakhiri sambutan, atas nama pribadi dan Kepala RS Kepresidenan RSPAD Gatot Soebroto, saya menyampaikan ucapan terimakasih kepada semua pihak yang telah berpartisipasi aktif atas penerbitan ini. Saya mengucapkan Selamat Ulang Tahun ke-70 RS Kepresidenan RSPAD Gatot Soebroto. Semoga Tuhan Yang Maha Esa selalu memberi taufiq dan hidayah-Nya kepada kita semua dalam melaksanakan tugas dan pengabdian kepada bangsa dan Negara yang kita cintai, Aamiin. Dirgahayu RS Kepresidenan RSPAD Gatot Soebroto Jakarta, 26 Juli 2020 Kepala RSPAD Gatot Soebroto dr. Bambang Dwi Hasto, Sp.B., FInaCS., M.Si. Mayor Jenderal TNI vi

Sekapur Sirih Menteri Kesehatan Riset di rumah sakit rujukan adalah mata rantai penting untuk menumbuhkan kekuatan pelayanan unggulan sehingga memberikan suatu optimalisasi terukur sendi-sendi pelayanan yang diterapkan. Rumah sakit kepresidenan RSPAD Gatot Soebroto memiliki unit pelayanan cerebrovaskuler dan cell cure, saat ini menjadi „trade mark‟yang diharapkan berdiri di depan mengembangkan kegiatan penelitian di bidang cerebrovaskuler. RSPAD Gatot Soebroto tidak hanya bergerak di satu bidang unggulan, namun sejak sepuluh tahun terakhir telah bergerak dinamis multidisiplin keilmuan menampilkan performance di bidang penelitian, diantaranya stem cell, tropik infeksi, infertifilitas, onkologi dan satu lagi yang tidak dilupakan adalah unit kedokteran militer, sebagai karakter rumah sakit militer. RSPAD Gatot Soebroto adalah rantai rujukan tertinggi evakuasi prajurit terutama dalam transformasi pertempuran. Pembentukan THIAMSI (The Indonesia Army Medical Science Institute) adalah upaya untuk menampilkan wajah RSPAD Gatot Soebroto ke depan dengan semangat tidak hanya rumah sakit pelayanan, tetapi spirit memajukan riset yang kelak digawangi perwira periset muda kesehatan militer yang sekarang sedang tumbuh. Sekali lagi, mohon dijaga THIAMSI dan terus kembangkan menjadi World Class Medical Institute. Saya ucapkan terima kasih kepada Tim Editor yang sudah berjuang mengumpulkan satu persatu abstrak penelitian yang dirangkum dalam satu buku khazanah riset. Suatu pekerjaan yang tidak mudah. Buku ini kelak menjadi salah satu saksi sejarah kelak RSPAD Gatot Soebroto menjadi Hospital Research University. Jakarta, 26 Juli 2020 Menteri Kesehatan Dr.dr.Terawan Agus Putranto, Sp.Rad. (K) RI Letnan Jenderal TNI (Purn.) vii

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Sekapur Sirih Kepala Staf Angkatan Darat Tentara Nasional Angkatan Darat adalah gerbang pertahanan nasional menghadapi setiap Ancaman, Tantangan, Hambatan dan Gangguan (ATHG) yang mengganggu sendi dan elemen kebangsaan. Menyikapi hal ini, tidak semata dengan memperkuat satuan tempur, bantuan tempur dan teritorial. Konsep yang penting saat ini adalah menguatkan kemampuan akademik personil TNI AD sebagai kekuatan intelektual bangsa. Peran akademisi sebagai intelektual bangsa merangkum secara koheren dinamisasi masa depan yang terus berkembang yang ditujukan terhadap citra masa depan kesehatan bangsa terhadap kecenderungan pendekatan intuitif, spekulatif, utopis dan imajinatif, menuju pendekatan yang memiliki proyeksi, bahwa konsep tersebut berada dalam batas yang relevan, bermakna kebijaksanaan dan alternatif yang dapat menuntun masyarakat menuju cita-cita yang diharapkan. Intelektualiatas dalam perspektif kebangsaan mengembangkan beberapa prinsip kecendekiawaannya yaitu: (1) Prinsip ketahanan bangsa terhadap interelasi, interaksi dan koneksivitas keseimbangan potensi energi bangsa, (2) Analisis mikro dan makro terhadap masalah dan isu masa kini dan masa depan konsep kesehatan bangsa, sebagai nilai kreativitas menuju bangsa yang berdaulat. Peran Akademisi TNI AD yang dalam beberapa dekade ini terjadi peningkatan dalam menempuh pendidikan S2 dan S3, tentunya memiliki kontribusi besar untuk mengakselerasi pembangunan di masyarakat melalui peran TNI AD. Mengingat tantangan kedepan adalah sejauh mana sistem teknologi pertahanan dapat menjembatani berbagai kompleksitas masalah yang terkait dengan kondisi sosial ekonomi di masyarakat. Akademisi TNI AD dengan berbagai institusi TNI dan jejaring pendidikan, penelitian dan pengembangannya diharapkan dengan kapasitas dan kompetensinya. Salah satu bidang untuk memperkuat peran akademisi TNI AD adalah memperkuat riset sebagai titik tumpu untuk memperkuat transformasi pertempuran dan teritorial. RSPAD Gatot Soebroto melalui THIAMSI (The Indonesia Army Medical Science Institute) telah melaksanakan penelitian yang melibatkan multidisiplin. Melalui Buku Khazanah Riset ini membuktikan RSPAD Gatot Soebroto kelak dengan bangga menjadi Military Hospital Research University. Terima kasih kepada Tim Editor dan Selamat Ulang Tahun. Kepala Staf Angkatan Darat Andika Perkasa ix Jenderal TNI

DAFTAR ABSTRAK PENGANTAR EDITOR .............................................................................iii KATA PENGANTAR ............................................................................... vi SEKAPUR SIRIH MENTERI KESEHATAN .......................................... viiii SEKAPUR SIRIH KEPALA STAF ANGKATAN DARAT ....................... ix DAFTAR ABSTRAK ................................................................................. x CHAPTER I :CEREBROVASCULAR CENTER & CELL CURE 1 1. Critical Care Medicine; Intra-Arterial Heparin Flushing Improve Cerebral Blood Perfusion in Ischemic Stroke Patients: A Report from Cerebrovascular Center Indonesia Army Central Hospital Gatot Soebroto (RSPAD)...................................................................... 3 Terawan Agus Putranto ,Tugas Ratmono , Andri Hidayat , Bayu Putera, Joko Widodo , Lucia Hermiwati, Mulyana Mulyana, Grace Chandra, Gatot S Lawrence Lao 2. Introducing The Tolerogenic Macrophage Therapy as An Alternative Approach to Manage Systemic Lupus Erythematosus: A Case Series ....................................................................................... 4 Terawan Agus Putranto, Djoko Wibisono , Nyoto Widyo Astoro , Martina Lily Yana , Endra Tri Prabowo , Denny Irwansyah , Nurhadiyanta , Yudo Rantung , Taruna Ikrar , Fred Fandrich 3. Intraarterial Heparin Flushing Effect on Motor Evoked Potentials in Chronic Ischemic Stroke Patients..................................................... 5 Terawan Agus Putranto, Tugas Ratmono, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya 4. Neurology: Transcranial Magnetic Stimulation (TMS) Improve Motoric Function in Post-Ischemic Stroke Patients, Indonesia Army Central Hospital Gatot Soebroto (RSPAD)................................. 6 Tugas Ratmono, Terawan A Putranto, Andri Hidayat, Bayu Putera, Joko Widodo, Lucia Hermiwati, Mulyana Mulyana, Gatot S Lawrence Lao 5. Intra Arterial Heparin Flushing Increases Cerebral Blood Flow in Chronic Ischemic Stroke Patients......................................................... 7 Terawan Agus Putranto, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya x

6. Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient ........................................................................ 8 Terawan Agus Putranto, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya 7. Introduction to Dendritic Cell Vaccines Immunotherapy for Glioblastoma Multiforme: A Novel Approach ....................................... 9 Terawan Agus Putranto , Djoko Wibisono , Nyoto Widyo Astoro , Martina Lily Yana , Yudo Rantung , Ida Bagus Amertha Putra Manuaba 8. Intra Arterial Heparin Flushing Effect on Motor Evoked Potentials in Chronic Ischemic Stroke Patients................................................... 10 Terawan Agus Putranto, Tugas Ratmono, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya 9. The Effect of Intraarterial Heparin Flushing to Autism Symptoms When Used to Treat The Concomitantcerebral Venous Thrombosis: A Case Series ............................................................... 11 Erwin Setiawan, Ristaniah Soetikno , Nelly Amalia Risan , Shelly , Tugas Ratmono , Ardianto Pramono, Rachmanto Heryawan Surya Adiputra , Terawan Agus Putranto 10. Measuring Motor Evoked-Potentials in Children with Autism Spectrum Disorders Accompanied with Cerebral Vein Thrombosis Following Intraarterial Heparin Flushing ........................ 12 Erwin Setiawan , Ristaniah Soetikno , Nelly Amalia Risan , Shelly , Tugas Ratmono , Terawan Agus Putranto , Ardianto Pramono 11. Utilization of Modified Digital Subtraction Angiography in A Child with Cerebral Venoussinus Thrombosis Presenting with Autism Spectrum Disorder Symptoms: A Novel Approach................ 13 Ardianto Pramono , Ristaniah Soetikno , Achmad Hussein Sundawa Kartamihardja , Tinni Trihartini Maskoen , Terawan Agus Putranto , Erwin Setiawan 12. The Safety of Modified Digital Subtraction Angiography in RSPAD Gatot Soebroto: A Comprehensive Outlook ......................... 14 Terawan Agus Putranto, Nyoto Widyo Astoro,Basuki Rachmad, Erwin Setiawan, Ardianto Pramono, Djuwita, Taruna Ikrar 13. Headaches and Patent Foramen Ovale as A Risk Factor for Stroke Detected by Transcranial Doppler in Indonesia Army Soldiers................................................................................................ 15 Rita xi

14. Correlation of The Level and The Protrusion of Lumbar Disc Herniation with Severity of Radicular Pain in Lumbar Disc Herniation Patients. Clinical Aspect, Levels of TNF-α and IL-1β in Serum as A Predictor of Pain ............................................................. 16 Agus Yunianto 15. The Effect of The Lipid Nutrient Supplement (LNS) Treatment on The Level of Brain Derived Neurotrophic Factor (BDNF) and The Motor Development of the Child Aged 6 – 23 Months in South Central Timor Regency, East Nusa Tenggara Province ......... 18 Rita, Suryani As’ad, Veni Hadju, and Jumraini Tammasse 16. Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Departement of Hasan Sadikin Bandung Hospital................................................................................ 19 Lisda Amalia, Andi Basuki, Ridwan Siswanto CHAPTER II : METABOLIC 21 17. Evaluation of Drug Related Problems in Diabetes Mellitus Disease and Cellulitis in Hospital Center of Army (RSPAD) Gatot Soebroto Jakarta................................................................................. 23 Samir, Rahmatillah, Diana Laila, Efi Aprilita Rinayanti 18. Peripheral Blood Mesenchymal Stem Cells Isolated from Indonesia Long Tailed Monkey (Macaca fascicularis) ....................... 24 Agus Harsoyo, Dondin Sajuthi, Arief Boedion ,Yoga Yuniadi , Irma H. Suparto 19. Differentiation and Identification of Cardiomyocyte and Cardiac Conduction Systems Connexin from Bone Marrow Mesenchymal Stem Cells Macaca nemestrina .......................................................... 25 Agus Harsoyo 20. Association Between Diagnosis of Hypertension and Findings of Cardiac Catheterization in Army Personnel Undergoing Medical Check-Up............................................................................... 27 Emir Yonas, Raymond Pranata, Veresa Chintya, Bambang Pamungkas, Vireza Pratama, Bayu Arif Permana, Dina Evalina Syahlul, Agus Harsoyo xii

21. Left Ventricular Hypertrophy in Army Personnel Undergoing Medical Check-Up: Is Hypertension The Cause of LVH?.................. 28 Emir Yonas, Raymond Pranata, Veresa Chintya, Bambang Pamungkas, Vireza Pratama, Bayu Arif Permana, Dina Evalina Syahlul, Agus Harsoyo 22. Profile of Cardiovascular Risk Factors of Army Personnel Undergoing Medical Check-Up........................................................... 29 Raymond Pranata, Emir Yonas, Veresa Chintya, Bambang Pamungkas, Vireza Pratama, Bayu Arif Permana, Dina Evalina Syahlul, Agus Harsoyo 23. Association Between Diagnosis of Hypertension and Hypertensive Response During Treadmill in Army Personnel Undergoing Medical Check-Up, How Influential Is It? ....................... 30 Raymond Pranata, Emir Yonas, Veresa Chintya, Bambang Pamungkas, Vireza Pratama4, Bayu Arif Permana, Dina Evalina Syahlul, Agus Harsoyo 24. Hydrogels as An Alternative Treatment for Callus Formation in Diabetes Foot Ulcers: A Case Series .......................... 31 Siti Anisah 25. Rifampicin-Induced Acute Pancreatitis .......................................... 32 Trian Satrio, Deka Larasati, Ruswhandi 26. Grazoprevir Plus Elbasvir in Routine Hemodialysis Patients with Chronic Hepatitis C Virus Infection and Factors Associated with Sustained Virological Response ................................................. 34 Dwi Edi Wahono, Aida Lydia, Irsan Hasan, and Ikhwan Rinaldi 27. Study of Bone Turnover in Premenopausal Women Type 2 Diabetes Mellitus: Levels of Serum Tumor Necrosis Factor-α and Sclerostin............................................................................................. 35 Sugiarto, Bambang Setiyohadi, Dyah Purnamasari, Hamzah Shatri 28. Incidence of Acute Kidney Injury and Use of Renal Replacement Therapy in Intensive Care Unit Patients in Indonesia............................................................................................. 36 Jonny , Moch Hasyim , Vedora Angelia , Ayu Nursantisuryani Jahya, Lydia Permata Hilman , Venna Febrian Kusumaningrum and Nattachai Srisawat xiii

29. A Simple Tenckhoff Catheter Placement Technique for Continuous Ambulatory Peritoneal Dialysis (CAPD) Using The Bandung Method................................................................................. 37 Jonny , Rudi Supriyadi, Rully Roesli, Goh Bak Leong, Lydia Permata Hilman, and Fidelisa Cita Arini 30. Metabolic Syndrome in HIV Patients on Antiretroviral Therapy .... 38 Nyoto Dwi Astoro, Soroy Lardo, Jimmy 31. Unusual Case of Acute Liver Dysfunction Associated with Drug-Induced Rhabdomyolysis and Acute Kidney Injury................... 39 Fatwiadi Apulita Ginting Munte, Deka Larasati, Eny Ambarwati, Ruswhandi 32. The Hypoglicemic Effect of Andrographis paniculata Extract Capsules as Additional Therapy on Type 2 Diabetes Mellitus at The Army Central Hospital Gatot Soebroto, Jakarta, Indonesia........ 40 Yaman Nizmawardini, Hanani Endang, Ruray Djunaidi, Santi Purna Sari 33. Positive Correlation of ECG Dispersion Mapping (Heartvue™) in Prediabetic Patients Internal Medicine Polyclinic of RSPAD Gatot Subroto ...................................................................................... 41 Acil Aryadi, Djoko Wibisono 34. Positive Correlation of ECG Dispersion Mapping (HeartVue ™) in DMT2 Patients in Endocrine and Metabolic Clinic of Central Army Hopital Gatot Soebroto.............................................................. 42 Sidhi Laksono, Susi Setyowati, Djunaidi 35. Prevalence of Atrial Fibrillation in Chronic Kidney Disease Patients with Hemodialysis in Gatot Soebroto Army Center Hospital................................................................................................ 44 Shahab F. I, Wibisono D. 36. Effectiveness Comparison of Metformin-Sulfonylurea and Metformin-Acarbose on The Glycemic Parameters of Type 2 Diabetes Mellitus Patients: A Retrospective Cohort Study at Gatot Soebroto Army Hospital Jakarta ......................................................... 45 Wafa, Rani Sauriasari, Renni Septini 37. Relation Between Peripheral to Central Pulmonary Artery Diameter Ratio with Chronic Obstructive Pulmonary Disease Severity................................................................................................ 46 Vininta Fazharyasti Ilyas, Aziza G, Icksan, Retno Wihastuti, Joedo Prihastono xiv

38. The Correlation Between LVEF Gated-SPECT with Hemodialysis, Calcium-Phosphorus Products and Parathyroid Hormone in Patients with Chronic Kidney Disease............................ 47 Djoko Nariman, Eko Purnomo 39. Artery Diameter Ratio with Chronic Obstructive Pulmonary Disease Severity ................................................................................. 49 Vininta Fazharyasti Ilyas, Aziza G. Icksan, Retno Wihastuti., Joedo Prihartono 40. Six-month Survival of Patients with Malignant Distal Biliary Stricture Following Endoscopic Biliary Stent Procedure and Its Associated Factors.............................................................................. 50 Luki Kusumaningtyas , Dadang Makmun , Ari F. Syam , Siti Setiati 41. The Influence of Lemuru Oil (Sardinella longiceps) in The Removeling Process of The New Zealand White Rabbit Alveolaris Moved by Ortodontics ......................................................................... 51 Puji Hartono 42. Acute Kidney Injury Prevalence and Renal Replacement Therapy in Intensive Care Unit Patients in Indonesia........................ 53 Jonny, Moch Hasyim, Vedora Angelia, Ayu Nursantisuryani Jahya, Lydia Permata Hilman, Venna Febrian Kusumaningrum, Nattachai Srisawat 43. Recurrent Bilateral Staghorn Stones as A Manifestation of Normocalcemic Primary Hyperparathyroidsm.................................... 54 Bellinda Magdalena, Susie Setyowati 44. One Year Commemoration of Endoscopic Retrograde Cholangio- Pancreatography (ERCP) of Obstructive Jaundice In Gatot Soebroto Central Army Hospital – Jakarta............................... 55 Syafruddin A.R. Lelosutan, Ruswhandi Martamala 45. Hepatocyte Inflammatory Profile in Patients with Chronic Hepatitis in Gatot Soebroto Central Army Hospital Jakarta............... 57 Syafruddin A.R. Lelosutan, Ruswhandi Martamala, Untung Sudomo, Ardiana, Shinta Soraya 46. Endoscopy Description of Bronchial Astma Patients with Gastroesofageal Reflux Disease Symptoms...................................... 58 Syafruddin A.R. Lelosutan, Agus Dwi Susanto, Ruswhandi Martamala xv

47. The Effect of Ketogenic Diet in Seizure Control and Improving Children Cognitive Functions With Lennox Gastaut Syndrome......... 59 Wisvici Y Samin, Indah K Murni, Endy Paryanto P 48. Pattern of Heart Failure in Children with Left to Right Shunt Congenital Heart Disease in Sardjito Hospital Yogyakarta ............... 61 Wisvici Y Samin, Indah K Murni, Endy Paryanto P 49. Diagnostic Value of NT-proBNP for Diagnosing Pulmonary Hypertension in Left To Right Shunt Congenital Heart Disease ....... 62 Wisvici Yosua Samin, Indah Kartika Murni, Endy Paryanto Prawirohartono 50. Sleep Problems in 0-36 Months Old Indonesian Children with Atopic Dermatitis ................................................................................. 63 Irwanto, Hapsari W. Ningtiar, Taufiq Hidayat, Azwin M. Putera, Zahrah Hikmah, Anang Endaryanto 51. Determinant Factors of The Degree of Depression in Beta Major Thalassemia Children ............................................................... 64 Hapsari Widya Ningtiar, Ahmad Suryawan, Irwanto, IDG Ugrasena 52. The CDC PNU-1 Criteria for Diagnosis of Ventilator - Associated Pneumonia ....................................................................... 65 Hapsari Widya Ningtiar, Dwi Putri Lestari, Neurinda Permata Kusumastuti, Arina Setyaningtyas, Retno Asih Setyoningrum, Ira Dharmawati, Abdul Latief Azis 53. Study to Evaluate The Efficacy and Safety of EASYEF® in Acute Wound (Split-Thickness Skin Graft Donor Site) ...................... 66 Anastasia Dessy Harsono 54. Survivor Characteristics of Congenital Malformations of The Gastrointestinal Tract Post Surgical Correction in Army Central Hospital Jakarta.............................................................................. 67 Marissa Anggraeni, Diana Chaidir, Carina E. Jacobs, Catur S. Sutisna, Irhamni, Windhi Kresnawati, Yenny Kumalawati, Yenny 55. Clinical and Hemodynamic Effect of Endothelin Receptor Antagonists on Eisenmenger Syndrome Patients ........................ 68 Emir Yonas, Raymond Pranata, Muhammad Yamin, Nuvi Nusarintowati, Siti Elkana Nauli, Hafil Budianto Abdulgani, Bambang Budi Siswanto xvi

56. Cartilage Regeneration on Donor Site Defect with One Sided Perichondrial Auricular Cartilage Graft : An Experimental Rabbit Model................................................................................... 70 Nurardhilah Vityadewi, Kristaninta Bangun CHAPTER III : INFECTIOUS DISEASE 73 57. The Worsening Factors of Dengue Hemorrhagic Fever (DHF) Based on Cohort Study with Nested Case-Control in A Tertiary Hospital................................................................................................ 75 Soroy Lardo, M H N E Soesatyo, Juffrie and S R Umniyati 58. The Effect of A Unique Propolis Compound (Propoelixtm) on Clinical Outcomes in Patients with Dengue Hemorrhagic Fever....... 76 Lardo Soroy, Sulistyo Bagus, Iswandi Purnama Yongkie, Wibisono Djoko 59. Association of Initial Intracellular Signalling Pathway and Cytokine Level with Early Mortality in Severe Sepsis Patients.......... 78 KC Lie, D Widodo, S Lardo, Eppy & R Sinto 60. Sepsis Pulmonary Embolism Following Appendectomy Surgery ................................................................................................ 79 Soroy Lardo, Anna Ariane, Khie Chen 61. Concurrent Infections of Dengue Viruses Serotype 2 and 3 in Patient with Severe Dengue from Jakarta, Indonesia........................ 80 Soroy Lardo, Yaldiera Utami, Benediktus Yohan, Seri MMU, Tarigan, Widayat Djoko Santoso, Leonardo Nainggolan, R. TedjoSasmono 62. Preliminary Study of Safety and Toxicity of Cempedak Capsules as An Alternative Complementary Drug for Malaria Prophylaxis at Nanga Badau, Kalimantan.......................................... 81 Soroy Lardo, A. Widyawaruyanti, I. Tantular, W. Budiman, B. Sulistyo, A. Fakhrizal, A. F. Hafid, D. Rusdianto, B. Y. Rimba and Nasronudin 63. A Clinical Profile of Hepatitis A Patients in Jakarta, Indonesia ..... 83 Randy Adiwinata, Andi Kristanto, Timoteus Richard, Daniel Edbert, Frida Angelina, Soroy Lardo, Erni J Nelwan 64. The Autoimmune Mechanism in Degue Hemorrhagic Fever ........ 84 Soroy Lardo, Marsetyawan HNE Soesatyo, Juffrie, Sitti R. Umniyati xvii

65. Adult-Onset Still‟s Disease as A Differential Diagnosis in Prolonged Fever: Diagnosis and Treatment Experience ................... 85 Felix F. Widjaja, Diah Martina, Soroy Lardo, Suryo A. K. Wibowo 66. Plasmodium Ovale Infection After One Year Mefloquine Prophylaxis in A Young Indonesian Soldier ....................................... 86 Frans Liwang, Dewi M. Ratih, Soroy Lardo 67. Diagnostic Validity of Blue Plasma Lymphocyte for Dengue Infection Diagnosis.............................................................................. 87 Yongkie Iswandi Purnama 68. Factors Related to ODHA in Carrying Out ARV Therapy in RSPAD Gatot Soebroto Central Jakarta ............................................ 88 Antonius Ivan Priyono Saputro 69. Factors That Influence Survival of Antiretroviral (ARV) Theraphy Patients in One Hospital in Jakarta 2007-2017 ................. 89 Fauziah Hasani 70. Analysis of Biological Factors Affecting The Quality of Life of ODHA Patients in HIV Polyclinics RSPAD Gatot Soebroto Ditkesad 2014 ..................................................................................... 90 Jaemi 71. Relationship Prediction of Mortality and Vulnerability in HIV- Infected Indonesian Army Period in 2018 .......................................... 91 Deka Larasati 72. Integrated System of Monitoring and Evaluation of TB HIV Collaboration in The Gatot Soebroto Central Army Hospital ............. 92 Elisabeth Sri Lestari Handayani 73. Increases Quality of Life HIV AIDS Patient with Pressure Ulcer... 93 Siti Anisah 74. Difference of Procalcitonin Levels in Gram-Positive and Gram- Negative Bacterial Sepsis Patients of Indonesia Army Central Hospital Gatot Soebroto in 2016 ........................................................ 94 Nindy Handayani, Soroy Lardo, Nunuk Nugrohowati xviii

75. The Relationship Between APACHE II SCORE and the Mortality of Sepsis Patients in the Intensive Care Unit (ICU) of Indonesia Army Central Hospital Gatot Soebroto January - December 2013 ..................................................................................................... 95 Hendra Leofirsta , Soroy Lardo, Sri Wahyuningsih, Hartono, Dis Bima Purwaamidjaja 76. The Diagnostic Test of Nelwan Score Towards Tubex Tf Titer (Anti-Salmonella IgM) to Diagnose Typhoid Fever at RSPAD Gatot Soebroto in 2014-2015 ............................................................. 96 Mochammad Hargo, Soroy Lardo, Sri Wahyuningsih 77. Anti – NS1 Antibody in Dengue Hemorrhagic Fever: Role as Predictor for Severity and Protective Function................................... 97 78. Therapeutic Response of Grazoprevir Plus Elbasvir in Chronic Hepatitis C Infection Patients on Maintenance Hemodialysis and Associated Factors.............................................................................. 99 Dwi Edi Wahono, Aida Lydia, Irsan Hasan, Ikhwan Rinaldi 79. Therapeutic Response of Grazoprevir Plus Elbasvir in Routine Hemodialysis Patients with Chronic Hepatitis C Virus Infection and Factors Associated with Sustained Virological Response........ 101 Dwi Edi Wahono, Aida Lydia, Irsan Hasan, and Ikhwan Rinaldi 80. The Correlation of Inappropriate Antibiotic Prophylaxis with Post Laparatomy Surgical Site Infection at Gatot Soebroto Army Central Hospital Year 2014 to 2017 ................................................. 103 Yuliarna Sari dewi, Asri Adisasmita, Syahrizal Syarif, Soroy Lardo 81. Association Between Opportunistic Infection and CD4+ T Lymphocyte Counts Among HIV-Infected Patients Taking Antiretroviral Therapy in Gatot Soebroto Central Army Hospital ..... 104 Fatia A Ramadhana, Elisabeth Handayani, Soroy Lardo, Yongki Iswandi Purnama, Sri Wahyuningsih, Alexander K Ginting 82. Patterns of Sepsis Based on Representation of Multiple Organ Dysfunction Syndrome (MODS), Kind of Microorganism, Antibiotic Combination and Mortality Rate in ICU of Paviliun Kartika Indonesia Army Central Hospital Gatot Soebroto................ 105 Dessy Krissyena, Yongki Iswandi Purnama Soroy Lardo, Cut Fauziah, Dis Bima Purwaamidjaja xix

83. Sofa Score Value and Infection Source Description in Sepsis Patients Who Run in Hospital in General Care Indonesia Army Central Hospital Gatot Soebroto....................................................... 106 Kemal Fariz Kalista, Yongki Iswandi Purnama, Soroy Lardo, Khie Chen 84. Drug Eruption Pattern in HIV / AIDS Patients at The Voluntary Counseling and Testing (VCT) Clinic Indonesia Army Central Hospital Gatot Soebroto.................................................................... 107 Iin Rahmania Inayatillah, Dyani Taher, Elizabeth Handa, Yongki Iswandi Purnama, Soroy Lardo, Alexander Ginting 85. Odontogenic Acute Rhinosinusitis ............................................... 108 Mulyaningrum Moerseto 86. The Frequency of TB in Patients with DM Treated in General Care RSPAD Gatot Soebroto ........................................................... 109 Sutami Abdullah, Susi Setiowaty, Syafruddin ARL 87. Comparison Study on : The Effectivity of Oral Hygiene Using Piper Betle Boiled Water and Povidine Iodine 1% on The Number of Candidiasis and Level of Comfort in Patients with HIV/AIDS ...... 110 Elly Nurachmah, Dewi Gayatri, Siti Anisah, Soroy Lardo 88. Esophageal Stricture Caused by Fungal Infection in HIV Patient ............................................................................................... 112 Iin Indra Pertiwi, Nia Noviyanti Siregar, Deka Larasati, Diany Taher, Soroy Lardo 89. Encephalopathy Dengue with Obesity and Melena.................... 114 Nur Chandra Bunawan, Andreas Pekey,Deka Larasati, Soroy Lardo 90. Eradication of Thypoid Carrier ..................................................... 115 Pradipto Utomo, Andreas Pekey, Deka Larasati, Soroy Lardo 91. A Case of Deep Vein Thrombosis in Patient with Human Immunodeficiency Virus Infection: Diagnostic and Treatment Approach ........................................................................................... 116 Jeremia Immanuel Siregar, Ariska Sinaga, Soroy Lardo, Deddy Zaelani 92. Correlation of CD4 Counts, Adherence and Opportunistic Infection Toward Mortality Status of People with HIV/AIDS Treated with Antiretroviral Therapy in Gatot Soebroto Central Army Hospital .................................................................................... 118 Sariputri Deviana, Soroy Lardo, Suciati Yuli xx

93. The Outcomes of Infants with HIV Infected Mother in A Tertiary Hospital in Indonesia ........................................................... 119 Hapsari Widya Ningtiar, Leny Kartina, Dwiyanti Puspitasari, Dominicus Husada, Parwati Setiono Basuki, Ismoedijanto 94. Infective Endocarditis Due to Burkholderia Cepacia in A Neonate ............................................................................................. 120 E. Yonas, R. Pranata, and N. Nusarintowati CHAPTER IV : ONCOLOGY & DIAGNOSTIC 123 95. Asian Pacific Association for the Study of The Liver Consensus Recommendations on Hepatocellular Carcinoma ........ 125 Masao Omata, Laurentius A. Lesmana, Ryosuke Tateishi, Pei-Jer Chen, Shi-Ming Lin, Haruhiko Yoshida, Masatoshi Kudo, Jeong Min Lee, Byung Ihn Choi, Ronnie T. P. Poon, Shuichiro Shiina, Ann Lii Cheng, Ji-Dong Jia, Shuntaro Obi,Kwang Hyub Han, Wasim Jafri, Pierce Chow, Seng Gee Lim, Yogesh K. Chawla, Unggul Budihusodo, Rino A. Gani, C. Rinaldi Lesmana, Terawan Agus Putranto, Yun Fan Liaw, and Shiv Kumar Sarin 96. Office Hysteroscopy and Outpatient Transvaginal Endoscopy in Low Resource Minimal Setting ..................................................... 126 Ardianto Pramono , Ristaniah Soetikno, Achmad Hussein Sundawa Kartamihardja, Tinni Trihartini Maskoen , Terawan Agus Putranto, Erwin Setiawan 97. Overview of Chromogranin A Screening in IBS Patients and Suspected Patients GEP-NET.......................................................... 126 Endra Tri Prabowo, Murdani Abdullah, Ina S Timan, Arini Setiawati, Terawan Agus Putranto, Taruna Ikrar 98. The Features of Multi-Drug Resistant Organisms in Tertiary Hospital in Indonesia : A One-Year Hospital Based Study.............. 128 Febria Asterina, Martina L Yana, Febria Asterina, Endra T Prabowo, Joko Widayanto, Soroy Lardo 99. Adenocarcinoma Esophagus in Asymptomatic Barret Esophagus ........................................................................................ 130 Trian Satrio, Deka Larasati, Diany N. Taher, El Nissi xxi

100. The Progress of The Implementation of Hospital Transfusion Reaction Reporting and Investigation System ................................. 131 Febria A Said 101. Molecular Detection of N Gene Measles Virus with Conventional PCR and Reverse Transcriptase Real-Time PCR for Diagnosis of Measles Disease ................................................... 133 Muhamad Tolib, Vivi Setiyawati, Daniel Djoko W 102. High Dose 50 mCi or 100 mCi Nal-131 for Preventive Thyroablation of Thyroid Remnant in Patients with Differentiated Thyroid Cancer.................................................................................. 134 Djoko Nariman, Eko Purnomo 103. Importance of Dental and Facial Records in Forensic Dental Identification Indonesia Army............................................................ 134 Iwan Dermawan 104. Our Experience in The Application of P-32 for Palliative Treatment of Painful Disseminated Bone Metastases ..................... 137 Eko Purnomo, Ratna D., Yusuf, Firdaus S. Sohar, Wahid Ibrahim D. 105. Automated Bone Scan Index as Predictors of Survival in Prostate Cancer ................................................................................ 138 Joko Wiyanto, Djoko Nariman, Eko Purnomo, Budi Darmawan, Basuki Hidayat and A. Hussein S. Kartamihardja 106. The Effect of Mechanical Bowel Preparation with NaP and MgSO4 to The Colonic Mucosa in Vivo Experimental Study in Rabbit ................................................................................................ 139 Ahmad Zumaro, Ignatius Riwanto, Andy Maleachi 107. Condom Added for Overtube The Experiences and Innovative Idea for Endoscopic Foreign Body Extraction .................................. 140 Ahmad Zumaro, Kunsemedi Setyadi, Andy Maleachi 108. The Difference of The Incidence of Surgical Site Infection Between Lichtenstein Repair with Macroporous Monofilament Mesh and Shouldice Repair in Incarcerated Hernia ........................ 141 Ahmad Zumaro, Ignatius Riwanto, Andy Maleachi, Edy Dharmana, Tjahyono xxii

109. Surgical Embolectomy for Submassive Pulmonary Embolism in Young Adult Patient : A Case Report Themes: Adult Cardiac Surgery .............................................................................................. 142 Arya Utama, Wijoyo Hadi Mursito, Andreas Andri lensoen, Arief Widya Taufiq 110. Compatibility Between Chest Ultrasound with Chest X-Ray, Chest Ultrasound with Clinical Diagnosis, and Chest X-Ray with Clinical Diagnosis in Cases of Pediatric Pneumonia ....................... 143 Sophia Utami, Eddy Sudijanto, Hesti Gunarti 111. Conventional and Conformal Technique of External Beam Radiotherapy in Locally Advanced Cervical Cancer: Dose Distribution, Tumor Response, and Side Effects ............................. 145 N Mutrikah, H Winarno, T Amalia and M Djakaria 112. Progesterone Receptor Relationship with The Formation of Kalvaria Hyperostosis on Meningioma ............................................. 146 Handrianto Setiajaya 113. Hürthle Cell Carcinoma: A Rare Case with Unique Morphological Features .................................................................... 147 Familia Bella Rahadiati, Agnes Stephanie Harahap and Maria Fransiska Ham 114. Proton Therapy for Defence and Resilience of The Indonesia Health Sector..................................................................................... 148 Muhamad Tolib 115. Modified Rapid Urease Test for The Detection of Helicobacter pylori from Gastric Biopsies in Patients With Dyspepsia ................. 149 Angky Budianti, Mardiastuti, Lisa Yuliantiningsih, Ardiana Kusumaningrum and Ari Fahrial Syam 116. Topical Nitroglycerin is Associated with A Reduced Mastectomy Skin Flap Necrosis-Systematic Review and Meta- Analysis ............................................................................................. 150 Rachel Vania, Raymond Pranata, Denny Irwansyah, Budiman 117. Viability of Cartilage Grafts with Perichondrium Attachment: Experimental Study........................................................................... 151 Maria Valentine, Prasetyanugraheni Kreshanti 118. Bunionplasty in Plastic Surgery Point of View ............................. 152 Maria Valentine, Budiman xxiii

CHAPTER V : NURSING 154 119. Nursing Managemet of Chronic Wound....................................... 156 Siti Anisah 120. The Impacts of Kaizen Concepts Application in Management on Safety of Nurses from Injuries Caused by Needlestick in Hospital: Library Research ............................................................... 157 Siti Anisah 121. Workshop Methode Krabby Patty, Make Quality Implementation and Safety Patients are Beautiful In 2018.............. 158 Susilowati, Didin Syaefudin, Desnita Fitri 122. Disorders Case Analysis of Neurology System Using Approach Roy Adaptation Theory in RSPAD Gatot Soebroto Jakarta............................................................................................... 160 Dyah Untari CHAPTER VI : MANAGEMENT & HEALTH LAW 162 123. Legal Protection of Hospital Business Actors for Indications of Malpractices ...................................................................................... 164 Iwan Dermawan 124. The Factors That Affect Performance of Clinical Case Manager in The Implementation The Standard Assessment of Patients at The IRNA RSPAD Gatot Soebroto ............................................................................................ 165 Desnita Fitri 125. The Experience of Elderly Living in Elderly Residental House (PSTW) A Phenomenology Study .................................................... 166 Septirina Rahayu xxiv

126. Patients Safety Round, Extremely Bullets, General (A Study on The Analysis of The Influence of Patient Safety Culture, Leadership Style, Teamwork Through Patient Safety Rounds to Increase Reporting of Patient Safety Incidents at The Army Central Hospital In 2019) .................................................................. 167 A.Budi Sulistya, Abraham Arimuko, Susilowati 127. Small, Beautiful But Great Impact (A Study of The Effectiveness and Efficiency of Accreditation Exhibition Activities in The Implementation of International Accreditation Standards at The Central Army Hospital in 2016) ................................................. 169 Susilowati 128. Relationship Analysis of Patient Satisfaction on Quality of Health Services to Interest in Re-Use of Inpatient Services at The Gatot Soebroto Army Central Hospital In 2015................................ 170 Ponco Agus Prasojo, Susilowati 129. Determinants Associated with The Clinical Performance of Health Workers in The Implementation of Patient Safety In Inpatient Gatot Subroto Army Hospital In 2015 ............................... 170 Prihadi Estu Widodo, Susilowati 130. Determinants Related to The Work Behavior of Doctors at The Gatot Soebroto Army Central Hospital in 2015......................... 173 Hardjanto, Susilowati 131. Evaluate The Skills of Health Workers in Basic Life Assistance Actions, Fire Fighting and Hand Hygiene According to The Educational Qualification Standards and Staff of The JCI Accreditation Standards at The Gatot Soebroto Army Hospital in 2015................................................................................................... 174 Made Astiya, Susilowati 132. Determinants Related to Doctor's Visit Compliance According to The Hospital Minimum Service Standards at The Gatot Soebroto Army Central Hospital in 2017 .......................................... 175 Donny Aldian, Susilowati 133. The Medicolegal Aspects of Hymen Examination of Rape in RSUP Dr. Hasan Sadikin Bandung ................................................. 178 Purwanto Panji Sasongko; Noorman Herryadi; Andri Andrian Rusman xxv

134. Characteristics of The Corpse Which Management Based on Specific Emerging Infections in Gatot Soebroto Indonesia Army Central Hospital................................................................................. 180 Purwanto Panji Sasongko, Muhamad Tolib CHAPTER VII : CASE REPORT 183 135. Successful Treatment of Adult Pleomorphic Rhabdomyosarcoma in The Posterior Left Femur: A Case Report .185 Barlian Sutedja, Abdul Muthalib, Ikhwan Rinaldi, Terawan Agus Putranto, Tjondro Setiawan, Diah Rini Handjari, Jubilate Edward I. Tambun, Reza Adiwidjaja 136. Fractional Flow Reserve: Nurturing A Functional Perspective in Angioplasty (Case Report)............................................................ 186 E. Hindoro, V. Pratama, BA. Permana, I. Purnawan, R. Pranata, G. Fonda 137. Routine Thrombus Aspiration in Primary Percutaneous Coronary Intervention: Is It Still Necessary? (Case Report)............ 187 R. Pranata, V. Pratama, I. Purnawan, E. Hindoro, G. Fonda 138. A Case Report of Primary Percutaneous Coronary Intervention on Multivessel Disease ST Elevation Myocardial Infarct: Why Not CABG After?...................................................................................... 188 Abraham Fatah, Wendy Wiharja, Raymond Pranata, Sunanto Ng 139. Congenital Hernia Diaphragmatica Presenting in A 14- Day- Old Infant : A Case Report................................................................ 189 Catur Suzantra Sutisna,Valerie Viola, Sri wahyuni 140. Intestinal Malrotation with Midgut Volvulus In Infancy: A Case Report................................................................................................ 190 Catur Suzantra Sutisna ,Valerie Viola ,Sri wahyuni 141. Combination of Fosfomycin and Levofloxacin for Multidrug- Resistant Pseudomonas aeruginosa Sepsis A Case Report .......... 191 Soroy Lardo, Imelda M. Loho, Indra Wijaya, Khie Chen Lie 142. The Effectiveness of NaI-131 Therapy for Hyperthyroidism (RSPAD Gatot Soebroto case report) .............................................. 193 Eko Purnomo, Djoko Nariman, Ratna D., Yusuf xxvi

143. Gingival Depigmentation in Former Smoker Patient, A Case Report................................................................................................ 194 Firlina Azrini 144. Late Onset Type 1 Diabetes Mellitus: A Case Report................. 195 Bellinda Magdalena, Susie Setyowati 145. Helcobacter pylori Infection in Siblings : A Case Report............. 196 Mardiastuti H.Wahid, Lisa Yuliantiningsih, Rike Syahniar, Ari Fahrial Syam, Andi Yasmon, Ening Krisnuhoni, Ardiana Kusumaningrum and Angky Budianti 146. Case Report : Plasma Convalescent Therapy in Severe Patient Covid-19................................................................................ 197 Basuki Rachmad 147. Modification Technique in Post-Myocardial Infarction Ventricular Septal Defect Closure: A Case Report .......................... 198 Sheilla Giusti, Aulia Rahman, Aswin Nugraha, Andreas Andri Lensoen, Wijoyo Hadi Mursito, Arief Widya Taufiq 148. Malaria and Co-Infection Among Traveller in A Refferal Hospital: A Case Series ................................................................... 199 Soroy Lardo, Hadiki Habib, Rahmat Cahyanur, Donnie LG 149. Prolonged Severe Thrombocytopenia as Complication of African Vivax Malaria Resembled Immune Thrombocytopeniepurpura................................................................ 201 Soroy Lardo, Laurentius A Pramono, Nikko Darmindro, Jerry Nasaruddin, Mala Hayati, Bhanu Kumar, Prima Yuriandro, Rizki Y Pradwipa, Nyoto W Astoro 150. A Re-Positive Covid-19 Patient.................................................... 202 Yongkie Iswandi Purnama, Soroy Lardo 151. Case Report of Baby Born with Goltz Syndrome ........................ 203 Diana Chaidir, Fransiskus Aditya Kristianto, Catur Suzantra Sutisna, Irhamni, Anastasia Dessy Harsono, Sri Dharmayanti, Rita Maria, Yenny Purnama, Yenny Kumalawati Santoso, Windhi Kresnawati xxvii



CHAPTER I CEREBROVASCULAR CENTER & CELL CURE 1

2

Critical Care Medicine; Intra-Arterial Heparin Flushing Improve Cerebral Blood Perfusion in Ischemic Stroke Patients: A Report from Cerebrovascular Center Indonesia Army Central Hospital Gatot Soebroto (RSPAD) Terawan Agus Putranto ,Tugas Ratmono , Andri Hidayat , Bayu Putera, Joko Widodo , Lucia Hermiwati, Mulyana Mulyana, Grace Chandra, Gatot S Lawrence Lao Abstract Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80- 85% of the total cases. Conventional ischemic stroke management has indicated some major obstacles in the stroke management program; therefore an approach using intra-arterial heparin fi ushing method has been used to overcome the above limitations. Controversy has been around for sometimes, therefore 2 groups of scientifi c forum have been established InaCVF (Indonesia CerebroVascular Forum) and InaDOCAR Prevent (Indonesia DOCAR Prevent) to fi nd out the scientifi c rational in the management of ischemic stroke using intra-arterial heparin fi ushing. The objective of this approach is for recovering the cerebral blood perfusion at the optimal time. Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fi ushing guided with digital subtracted angiography (3D-DSA). Prior to the heparin-fi ushing procedure, all patients are undergone functional MRI test and the patients are carefully selected for the optimal result. Post procedure, the patients undergone functional MRI. The pre and post functional MRI results are compared to determine the change of cerebral blood perfusion. Results: Of 2146 ischemic stroke patients, undergone intra-arterial heparin fi ushing, none of the patients had severe complication. Sixty-six percent, 32%, and 2% have signifi cant moderate and little improvement respectively. Further biochemical parameters is still under investigation to elucidate the pathomechanism. Conclusions: Intra-arterial heparin fi ushing in patient with ischemic stroke is a promising and effective modality. 3

Introducing The Tolerogenic Macrophage Therapy as An Alternative Approach to Manage Systemic Lupus Erythematosus: A Case Series Terawan Agus Putranto, Djoko Wibisono , Nyoto Widyo Astoro , Martina Lily Yana , Endra Tri Prabowo , Denny Irwansyah , Nurhadiyanta , Yudo Rantung , Taruna Ikrar , Fred Fandrich Abstract Introduction: Systemic Lupus Erythematosus (SLE) has been quite an enigma in medicine. The possibility of the host own defense mechanism attacking itself is still quite difficult to understand. Patients who suffer from this disease tend to have a problem in their qualities of life, especially as the majority affect female in their productive ages. Conservative therapy to manage this disease is widely developed and implemented. Since the known therapies have several side effects and limitation, a need to develop a new strategy that can re-establish the “tolerance” mechanism of our immune system is increasingly needed. Immunotherapy is already a promising field in the strategy against autoimmune cases. In our facility, we developed immunotherapy called ToM (Tolerogenic Macrophage) which similar to Mreg (Regulatory Macrophage) inorder to utilise the “tolerance” ability of this immune apparatus. Case: In this study, we present 2 cases of female patients who suffer from SLE, which underwent ToM Therapy in our Cellcure facility in RSPAD Gatot Soebroto Jakarta-Indonesia. After the procedure the patient was monitored one month and one year. Clinical and control parameter such as ANA (IF) and ANA profile was examined again in both patients to measure the effect of this therapy. The ANA titer and the titer of specific antibodies such as dsDNA, Nucleosomes and Histones results show significant reduction, accompanied by the improvement of the symptoms. Conclusion: ToM Therapy seems to have a good efficacy as immunotherapy for SLE. Further study needed to establish this approach. Keywords: Tolerogenic Macrophage, Systemic Lupus Erythematosus, Immunotherapy 4

Intraarterial Heparin Flushing Effect on Motor Evoked Potentials in Chronic Ischemic Stroke Patients Terawan Agus Putranto, Tugas Ratmono, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya Abstract Background: Stroke has always been a complicated disease which affects not only the patient quality of life but also the patient family. In ischemic stroke patients, one of the most complicated outcomes was the disruption of motor function. Increased motor function is a visible positive outcome of stroke patients. Aim: This study aims to measure the motor evoked potentials values which the results might give us more insights into how this disease affects the motor neuron pathway. Methods: This study was an experimental pre-posttest study involved 75 patients diagnosed with chronic ischemic stroke (onset of more than 30 days). The MEPs value was measured by adjusting the IAHF procedure in 2015. Results: There was no significant difference between motor evoked potential value (amplitude, latency, central motor conduction time) pre and post intraarterial heparin procedure (IAHF) (p>0.05). Occasionally, there was a significant difference in latency value in lacunar, subcortical, and cortical-subcortical area after IAHF (p<0.05). Conclusion: This study shows that the size and localization of the affected area might determine the results of IAHF. Keywords: IAHF, MEPs, amplitude, latency, CMCT, ischemic stroke 5

Neurology: Transcranial Magnetic Stimulation (TMS) Improve Motoric Function in Post-Ischemic Stroke Patients, Indonesia Army Central Hospital Gatot Soebroto (RSPAD) Tugas Ratmono, Terawan A Putranto, Andri Hidayat, Bayu Putera, Joko Widodo, Lucia Hermiwati, Mulyana Mulyana, Gatot S Lawrence Lao Abstract Indonesian Basic Health Research Study (RISKESDAS) indicate that prevalence of stroke is 12.1%; and is considered as one of the major cause of death in Indonesia. It has been reported that ischemic stroke shown about 80- 85% of the total cases, that continues to be the leading cause of long term disability worldwide. Primarily due to a loss of motor abilities and subsequent impairment in activities of daily living. Transcranial magnetic stimulation (TMS) is a non invasive tool that has been used in addition to other existing diagnostic tools to investigate motor pathophysiology in stroke patients. It has been shown to quantify the corticomotor excitability properties of clinically affected and unaffected muscles. Therefore, the objective of the study is to determine the usefulness of the device to rehabilitate the motoric function of the post-ischemic stroke patients Methods: March 2013 - March 2014, there has been 4380 cases of ischemic stroke, and only 2146 (48.9%) undergone intra-arterial heparin fl ushing guided with digital subtracted angiography (3D- DSA). Prior and post heparin-fl ushing procedure, all patients are undergone functional MRI test and assessment of the motoric function using TMS to examine the resting motor threshold (RMT), the amplitude (A), the latency (L), as well as Central Motoric conduction Time (CMCT) at the lesion and non lesion areas. Results: 2146 ischemic stroke patients, the RMT are 55.60±11.75 to 54.40±8.93 (p=0.52), and 52.78±10.59 to 52.22±8.59 (p=0.794); Amplitude are 1.57±1.76 to 1.7±1.72 (p=0.44), and 1.21±1.36 to 1.8±1.67 (p=0.005); Latency 23.76±4.51 to 23.51±4.36 (p=0.555) and 22.85±3.37 to 22.45±3.95 (p=0.104); and RMT 9.69±3.36 to 9.20±3.78 (p=0.238) and 8.87±2.92 to 8.02±2.58 (p=0.002) at the non lesion and lesion areas respectively. Conclusions: TMS provide a convincing evidence as new modality for post stroke rehabilitation. 6

Intra Arterial Heparin Flushing Increases Cerebral Blood Flow in Chronic Ischemic Stroke Patients Terawan Agus Putranto, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya Abstract Background: Recently, stroke therapy is focused on reperfusion therapies for restoring cerebral blood flow (CBF) and minimizing the undesired effects of neuron ischemia. However, the thrombolytic therapy to restore CBF was restricted with narrow time window. On the other hands, not many patients can reach the treatment immediately after the onset of stroke. A wider time window therapy that might increase CBF would probably helpful. This study aims to investigate the CBF improvement after intra arterial heparin flushing (IAHF) therapy in chronic stroke patients. Methods: A clinical trial was conducted with time sampling. We collected chronic ischemic stroke subjects (with stroke onset ≥30 days) within periods FebruarySeptember 2015. We investigated CBF before and after IAHF treatment in 75 chronic stroke patients. The difference before and after IAHF treatment in subgroup which is classified with infarct size and lesion area was tested. CBF was measured using MRI Quality Arterial Spin Labeling (qASL) with region of interest around infarct lesion. Results: We found a significant CBF improvement (p<0.05). around infarct area after IAHF treatment with average 10.39mL/100g/min raised. CBF improvement was found in lacunar infarct (p<0.001) nd non lacunar (p<0.001), also in infarct in cortical (p<0.05) subcortical (p<0.05) and both area (p<0.05). Conclusion: IAHF is associated with increased CBF around infarct area and IAHF probably offers some benefit for chronic stroke. Keywords: IAHF, CBF, chronic stroke, ischemic, lacunar, non lacunar, cortical lesion, subcortical lesion. 7

Intra Arterial Heparin Flushing Increases Manual Muscle Test – Medical Research Councils (MMT-MRC) Score in Chronic Ischemic Stroke Patient Terawan Agus Putranto, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya Abstract Background: Muscle strength impairment in stroke patient affect the patient daily life, especially when it occurs on the extremities muscles. Manual Muscle Testing (MMT) is an examination method to measure muscle strength using standardized scoring. Objective: To find possible improvement of Manual Muscle Test (MMT) Score after administration of Intra Arterial Heparin Flushing in chronic ischemic stroke patient. Method: This is an experimental study using pretest-posttest group design, with randomized controlled clinical trial, conducted among patients in Cerebrovascular Center Unit in Army Central Hospital Gatot Soebroto starting from February 2014. With 75 patients included in this study. The examination of muscle strength was done by trained physicians. The MMT score were taken before and after the IAHF procedure is conducted. Results: This study found higher score of MMTMRC scoring system on chronic stroke patient with IAHF procedure (mean MMT-MRC Score = 6,05 point. With p<0,05). Indicating that IAHF procedure is associated with better muscle strength improvement shown with higher MMT-MRC score on stroke patient, which will have better prognostic outcome in their recovery. Conclusions: Intra Arterial Heparin Flushing have significant effect on chronic stroke patient with decreased muscle strength, which shows a significant increase of MMTMRC score Keywords: Intra Arterial Heparin Flushing, Manual Muscle Test, Chronic Ischemic Stroke 8

Introduction to Dendritic Cell Vaccines Immunotherapy for Glioblastoma Multiforme: A Novel Approach Terawan Agus Putranto , Djoko Wibisono , Nyoto Widyo Astoro , Martina Lily Yana , Yudo Rantung , Ida Bagus Amertha Putra Manuaba Abstract Background: The modality of therapy in this era is quite sophisticated. The mortality rate of patients diagnosed with glioblastoma multiforme is still high. It might be due to the late diagnosis of the tumors since most in the early stages some tumors do not show any significant symptoms or the symptoms usually misdiagnosed with another disease. Nowadays there is an uptrend of therapeutic methods called immunotherapy which declared as the fourth approachment for glioblastoma multiforme (GBM). In RSPAD Gatot Soebroto Jakarta, the author starts this approach using dendritic cell vaccines in the specialized department called the Indonesia Army Cell Cure Center. Aim: The report aims to describe a case of GBM treated by dendritic cell vaccines. Case Report: A 52-year-old woman had weakness in her left extremities and visual impairment in the left eye since 2016. The patient was brought to RSPAD in August 2016 with a history of cerebral hemorrhage, then already underwent a craniotomy at the right temporoparietal region. After biopsies and tissues examination, the patient later diagnosed with GBM. As for judging the natural history of the diseases, the team decided to counsel the patient and her family conducting a new treatment strategy for GBM, immunotherapy. The immunotherapy approach performed in RSPAD was the dendritic cell (DC) vaccines therapy. As regard to post-DC vaccines therapy, the patient showed a significant improvement in her clinical condition (Karnofsky performance status increased from 30% to 60%). Also, the patient surpassed the average survival rate. Thus, the patient still scheduled for a routine follow up and a round of examinations to preserve the patient improved condition. Conclusion: The patient who has immunotherapy strategy especially dendritic cell vaccines therapy has shown an improved clinical status and survival rate for GBM, more than the average survival rates. These findings might give us more insights into how dendritic cell vaccines therapy can be involved as the fourth therapeutic strategies on treating patients with GBM. Keywords: dendritic cell therapy, glioblastoma multiforme, immunotherapy 9

Intra Arterial Heparin Flushing Effect on Motor Evoked Potentials in Chronic Ischemic Stroke Patients Terawan Agus Putranto, Tugas Ratmono, Irawan Yusuf, Bachtiar Murtala, Andi Wijaya Abstract Background: Stroke has always been a complicated disease which affects not only the patient quality of life but also the patient family. In ischemic stroke patients, one of the most complicated outcomes was the disruption of motor function. Increased motor function is a visible positive outcome of stroke patients. Aim: This study aims to measure the motor evoked potentials values which the results might give us more insights into how this disease affects the motor neuron pathway. Methods: This study was an experimental pre-posttest study involved 75 patients diagnosed with chronic ischemic stroke (onset of more than 30 days). The MEPs value was measured by adjusting the IAHF procedure in 2015. Results: There was no significant difference between motor evoked potential value (amplitude, latency, central motor conduction time) pre and post intraarterial heparin procedure (IAHF) (p>0.05). Occasionally, there was a significant difference in latency value in lacunar, subcortical, and cortical-subcortical area after IAHF. Keywords: IAHF, MEPs, amplitude, latency, CMCT, ischemic stroke 10

The Effect of Intraarterial Heparin Flushing to Autism Symptoms When Used to Treat The Concomitantcerebral Venous Thrombosis: A Case Series Erwin Setiawan, Ristaniah Soetikno , Nelly Amalia Risan , Shelly , Tugas Ratmono , Ardianto Pramono, Rachmanto Heryawan Surya Adiputra , Terawan Agus Putranto Abstract Introduction: There are still no definite therapeutic strategies for Autism Spectrum Disorder (ASD) other than behavioural interventions and few FDA approved behaviour control drugs. In this study, we found a co- existence medical condition of ASD & Cerebral Vein Thrombosis (CVT) in the paediatric population. Based on these findings, a new therapeutic approach, a catheter-directed anticoagulant therapy termed as IAHF (Intra Arterial Heparin Flushing) was performed on this population of patients. Methods: This paper aims to describe a series of 10 cases of IAHF procedure performed to treat CVT on children with ASD from 2018 through 2019 at Cerebrovascular Center RSPAD Gatot Soebroto Jakarta- Indonesia. The children diagnosed with ASD by the multidisciplinary team but also had CVT findings on their brain magnetic resonance imaging studies when performed as the series of comprehensive diagnostic examination. IAHF were conducted by delivering heparin through a modified DSA technique into the occluded vessels. Subject Autism status was assessed with the Childhood Autism Rating Scale (CARS) before and one month after IAHF procedures. Results: The measurement of CARS Score after IAHF shows a relatively positive result. Eight patients showed a decreased in total CARS Score after the procedure, while only two patients had no improvement. One subject shows a decrease of nine points, the most significant changes, and improved the status from moderate to mild autism. Conclusion: In children who have ASD and also accompanied by CVT findings in their imaging studies, IAHF treatment showed clinical improvement of the autism symptoms. Keywords: Childhood Autism Rating Scale, Autism Spectrum Disorder, Cerebral Venous Thrombosis, Intraarterial heparin flushing 11

Measuring Motor Evoked-Potentials in Children with Autism Spectrum Disorders Accompanied with Cerebral Vein Thrombosis Following Intraarterial Heparin Flushing Erwin Setiawan , Ristaniah Soetikno , Nelly Amalia Risan , Shelly , Tugas Ratmono , Terawan Agus Putranto , Ardianto Pramono Abstract Background: The use of the term “Autism Spectrum Disorder” has led to confusion over this substance. Prior to DSM-V criteria, symptoms of Autism Spectrum Disorder (ASD) refers to the problems in brain vasculature and brain chemistry most likely affect the children behavior, whereas the authors‟ findings suggest such problems depicting a similar anomaly in cerebral vein thrombosis case (CVT). Recently, the evoked potentials, that demonstrated in CVT, have a possible prognostic value on patients suffering from ASD. This study purposes to measure the motor evoked potentials (MEPs) on patients following the intervention of intraarterial heparin flushing (IAHF). Methods: A descriptive study was conducted on 17 patients admitted in Cerebrovascular Center of RSPAD Gatot Soebroto, Jakarta, diagnosed with ASD presenting CVT. The MEPs value was measured by conforming the IAHF procedure. Results: The MEPs value (amplitude, latency, CMCT) pre and postIAHF showed an increasing value. Meanwhile, there was a lowering value of latency and CMCT in left cortical participants after IAHF. Conclusion: The group tends to perform more expected positive MEPs changes after IAHF. Keywords: MEPs, ASD, CVT, IAHF, amplitude, latency, CMCT 12

Utilization of Modified Digital Subtraction Angiography in A Child with Cerebral Venoussinus Thrombosis Presenting with Autism Spectrum Disorder Symptoms: A Novel Approach Ardianto Pramono , Ristaniah Soetikno , Achmad Hussein Sundawa Kartamihardja , Tinni Trihartini Maskoen , Terawan Agus Putranto , Erwin Setiawan Abstract Background: The limited number of case reports about Cerebral Venous Sinus Thrombosis (CVST), especially in the pediatric population who also present with Autism Spectrum Disorders (ASD) symptoms, prompted the authors to be the pioneer in reporting of pediatric CVST with ASD symptoms case in Indonesia. In this study, we would like to report a case of an 8-year-old patient with ASD who was diagnosed with CVST after undergoing Magnetic Resonance Imaging (MRI) examination. After the diagnosis was established, the patient underwent a modified Digital Subtraction Angiography (DSA) method, which was later termed as Intra Arterial Heparin Flushing (IAHF) as its treatment option. Case presentation: An 8-year-old-boy was brought by his parents to Gatot Soebroto Hospital with speech and communication problems, and also cognitive and behavioral problems such as the inability to count, read words, follow orders and maintain emotional stability. After a thorough standard examination by the attending physician, further examination using Magnetic Resonance Imaging with MR perfusion was suggested to establish a diagnosis. The imaging results showed a decrease in blood flow in the transverse sinus and straight sinus, and also in the internal jugular vein. The patient was diagnosed with CVST. The patient underwent anticoagulation therapy, which was administered through a modified DSA method, which was later termed as IAHF procedure, to increase the cerebral blood flow. Conclusion: After the patient underwent the IAHF procedure, good clinical outcomes were immediately seen, even at six months follow up. The parents reported that there were improvements in the patient‟s cognitive and behavioral status. Keywords: autism spectrum disorder, cerebral venous sinus thrombosis, digital subtraction angiography, intra arterial heparin flushing 13

The Safety of Modified Digital Subtraction Angiography in RSPAD Gatot Soebroto: A Comprehensive Outlook Terawan Agus Putranto, Nyoto Widyo Astoro,Basuki Rachmad, Erwin Setiawan, Ardianto Pramono, Djuwita, Taruna Ikrar Abstract Introduction: There are no recent estimates of the complication rate associated with Intra Arterial Heparin Flushing (IAHF). The purpose of this study was to estimate the rate of complication occurring during and after Intra Arterial Heparin Flushing. Method: This report is a descriptive study based on analysis of interventional radiology database. The study involved patients who underwent IAHF procedure started from January 2018 until December 2018 in Rumah Sakit Pusat Angkatan Darat Gatot Soebroto (Indonesian Army Central Hospital). Subjects were assessed for their age, sex, medical history, diagnosis, intra-procedural complication, and postprocedural complication. Result: All IAHF procedures were performed via transfemoral catheterisation and using a vascular closure device to help achieve homeostasis. Our population included 1223 (70,57%) male and 510 (29,43%) Female, with age ranging from 21 to 80 years old. The majority of the subject was in 51-60 years old age group (35,31%). All IAHF were technically successful. No intraprocedural complication was noted, there was no occurrence of iatrogenic vessel injury (dissection) and no neurological deficit secondary to IAHF procedures. There was some local complication after IAHF procedure such as hematoma 44 persons (2,54%), oedema around the puncture site six patients (0,35%), and bleeding at the puncture site three patients (0,17%). Beside local complication, there were several systemic complications such as allergy in 10 persons (0,58%). No neurological complication was reported after IAHF. CONCLUSION: We concluded that IAHF has a relatively low rate of acute complication. Most complications were related to local hemostasis control, and no severe sequelae were found Keywords: Digital Subtraction Angiography, Intra Arterial Heparin Flushing, Vascular Closure Device, Manual Compression, Complication, Interventional Radiology 14

Headaches and Patent Foramen Ovale as A Risk Factor for Stroke Detected by Transcranial Doppler in Indonesia Army Soldiers Rita Abstract Migraine head pain is a chronic disability condition that is about 6% of men and 15%-18% of women. Migraine are one of the risk factors for stroke. The study aims to analyze the relationship of head pain and patent the foramen ovale as the wrong source of the potential cause of stroke. The research design is observational with a case-control approach. The selection of the subject uses consecutive sampling involving 300 subjects since March – November 2018. A total of 256 of the 300 subjects included in the study consisted of 76 cases of migraine headaches and 80 non- migraine cases that were netted in the neural polyclinics of RSPAD Gatot Soebroto and Ridwan Meureksa Hospital. The and 100 subjects were the control groups recruited from the Indonesia Army soldiers, civil servant, family and relatives of the subject, the students, staff and doctors of RSPAD Gatot Soebroto and Ridwan Meureksa Hospital. Information on head pain is obtained through anamnesa and using questionnaires. Then conducted diagnostic evaluation for PFO using TCD. The results of the study obtained majority of migraine headaches are female 58 (76.3%). Risk factors that are meaningless associated with migraine are age, gender, hypertension and dyslipidemia (P < 0.05). Test analysis using Chi-Square shows the prevalence of PFO in migraine sufferers significantly higher than control (25.3% vs 9.0%; OR = 3.61 (CI) 1.54-8.49; C < 0.05). The prevalence of PFO in non-migraine sufferers is more descriptive than the control (13.8% vs 9.0%; OR-1.61 (CI) 0.63-4.11; p = 0,442), but statistically meaningless. PFO degrees are being found more in migraine headaches than non-migrents (30.0% vs 18.2%; OR = 0.48 (CI) 0.08-2.95; p = 0,721). 15

Correlation of The Level and The Protrusion of Lumbar Disc Herniation with Severity of Radicular Pain in Lumbar Disc Herniation Patients. Clinical Aspect, Levels of TNF-α and IL-1β in Serum as A Predictor of Pain Agus Yunianto Abstract Background: Radicular pain is a condition characterized by a compression of the radix that can be cause a lumbar disc herniation ( LDH ). Symptomatic herniations present as lumbar radiculopathy from both mechanical and chemical irritation of the nerve root. Pain is the most common complaint among the patients with symptomatic LDH, follow with paresthesia, motor disturbance and otonomic failure. Porpuse: To assess the expression of inflammatory respons were correlated with the severity of radicular pain in LDH patients that underwent microdiscectomy. Methods: An observational prospective study of the 33 patients with LDH, age range 20-60 years old with single level unilateral LDH and agree to follow the study. The pain score pre and post operatively were measured using Japannesse Orthopaedic Association ( JOA ) score and the level of TNF-α and IL-1β in serum. We analyzed TNF-α, IL-1β, sex, age, level of LDH, annulus pre and post operatively and correlated them with pain score ( JOA ) before surgery, 10 days after surgery, first month, second month and third month postoperatively. Results: We evaluated 33 patients with mono level and unilateral LDH and performed microdiscectomy in Gatot Soebroto Central Army Hospital Jakarta. Radicular pain were correlated significantly with sex ( p < 0,001 ), level ( p = 0,108 ), annulus ( p = 0,075 ), onset < 1 month ( p = 0,060 ) and not significantly with age ( p = 0,953 ) and position ( p = 0,657 ). The level of IL-1β pre and postoperative decrease significantly ( p = 0,304 ) and in acute condition with onset less than 1 month the level of IL-1β decrease most significant ( p = 0,109 ). Whereas the level of TNF-α pre and post operative in acute onset < 1 month increase but not significant ( p = 1 ), in sub acute the level decrease but not significant ( p = 0,799 ) and in chronic also decrease but not significant 9 p = 0,841 ). 16

Conclusions: Radicular pain in LDH correlated with sex, level, annulus and onset but there is no correlation with age and position of the LDH. In acute condition with onset less than 1 month the level of IL-1β as a predictor the severity of pain. Keywords. LDH. Radicular pain. IL-1β. TNF-α. Microdiscectomy. 17

The Effect of The Lipid Nutrient Supplement (LNS) Treatment on The Level of Brain Derived Neurotrophic Factor (BDNF) and The Motor Development of The Child Aged 6 – 23 Months in South Central Timor Regency, East Nusa Tenggara Province Rita, Suryani As’ad, Veni Hadju, and Jumraini Tammasse Abstract This research aimed to assess the effect of the LNS treatment on the BDNF levels and the motor development of the children aged 6 – 23 months. Children were treated with LNS of 2 sachets of @50 gr/day for 90 days. Before and after the LNS consumption, the levels of BDNF and motor development were assessed using Denver II. The statistical analysis was performed using the t-independent test, t-paired test, Wilcoxon test and Mc.Nemar test. The research results revealed that there was a significant increase in the mean value of BDNF concentration after the consumption of LNS (0,848 ± 1,724 vs 4,592 ± 2,211) ng/ml (p = 0,000) compared to the control group, mean diff (3,744 ± 3,045 vs 3,031 ± 3,082). Wilcoxon and Mc. Nemar tests indicated that there was a significant increase in the motor development of the LNS group compared to the control group, Z-score (- 4,025 vs -4,642). The t-independent test indicated that there was a significant correlation between the mean BDNF concentration and the motor development. Keywords: LNS, BDNF, motor development 18

Clinical Characteristics of Cerebral Venous Sinus Thrombosis (CVST) Patients in Neurology Departement Hasan Sadikin Bandung Hospital Lisda Amalia, Andi Basuki, Ridwan Siswanto Abstract Background: CVST is an entity caused by intracranial vein, including cerebral sinuses, cortical vein and proximal part of the jugular vein. A delay in diagnosing and treating can result in brain infarct with hemorrhagic transformation, even death. The goal of this study is to learn the clinical characteristics of patients with CVST that had been confirmed by DSA. Method: the study is a retrospective observastional descriptive study. The subjects of this study are patients diagnosed as CVST in Neurology department Hasan Sadikin Hospital from june 2015 to November 2017, the data used in this study came from the hospital medical record. Results: there was 33 subjects with most (22 patient/66.7%) being women between 40-49 years old. In this study the most frequently found risk factor was infection in 8 subjects(24.2%), prothorombotic conditions in 6 subjects (18.2%). The clinical manifestations were mainly headache in 27 subjects (81,8%) and motoric weakness in 11 subjects ( 33.3%). The sinus most often involved was the transverse sinus (28 subjects), and cavernous sinus (5 subjects) with the clinical manifestation being headache. D-dimer levels were also increased with mean 1.21 mg/dl. Consclusion: CVST patients are mostly at the midle age of decade, with infection being the most frequent risk. Headache and hemiparesis were the most frequent clinical manifestation. Location of thrombosis were more often found on the transverse sinus and D- Dimer level was increased from laboratory examination in the study subject. Keywords: CVST, DSA, clinical characte ristic 19

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CHAPTER II METABOLIC 21