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Abstract Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating condition of peripheral nerve because of chemotherapeutic agent exposure among cancer patients. Despite its relatively high prevalence, to date, there has been no specific or standardized diagnostic criteria for CIPN and establishing diagnosis can be burdensome with significant time and efforts. Therefore, there is a need for an accurate biomarker to aid in early and objective diagnosis of CIPN. Based on the relevant pathogenesis of CIPN, herein we discussed several potential biomarker candidates to be incorporated in the diagnosis of CIPN, ranging from bodily fluid-based biomarker such as neurotrophic factors and neurofilaments, genetic biomarker such as microRNAs, electrophysiologic biomarker such as quantitative sensory testing, and imaging biomarkers such as high-resolution ultrasound and magnetic resonance neurography. We also discussed the strengths and weaknesses of each biomarker type, and future directions to accelerate its translation into routine use in clinical practice.

Pain is an essential aspect of the body's physiological response to unpleasant noxious stimuli from either external sustained injuries or an internal disease condition that occurs within the body. Generally, pain is temporary. However, in patients with neuropathic pain, the experienced pain is persistent and uncontrollable, with an unsatisfactory treatment effectiveness. The activation of the immune system is a crucial factor in both central and peripheral neuropathic pain. The immune response plays an important role in the progression of the stages of neuropathic pain, and acts not only as pain mediators, but also produce analgesic molecules. Neuropathic pain has long been described as a result of dysfunctional nerve activities. However, there is substantial evidence indicating that the regulation of hyperalgesia is mediated by astrocytes and microglia activation. Mesenchymal stem cells currently hold an optimal potential in managing pain, as they can migrate to damaged tissues and have a robust immunosuppressive role for autologous or heterologous transplantation. Moreover, mesenchymal stem cells revealed their immunomodulatory capabilities by secreting growth factors and cytokines through direct cell interactions. The main idea underlying the use of mesenchymal stem cells in pain management is that these cells can replace damaged nerve cells by releasing neurotrophic factors. This property makes them the perfect option to modulate and treat neuropathic pain, which is notoriously difficult to treat.

Abstract Background Epilepsy initiation involves multifactorial etiologies, including genetic susceptibility, structural anomalies, and glial cell dysregulations, particularly in astrocytes. Despite advancements in understanding various factors, the mechanisms of astrocyte dysregulation in epilepsy, critical for neural homeostasis, remain elusive, requiring comprehensive evaluation of molecular pathways and cellular interactions for future targeted interventions. Methods A systematic search of PubMed, ScienceDirect, and the Cochrane databases up to January 1st 2024 identified relevant studies predominantly from experimental models, forming the basis for an in-depth analysis of astrocytic contributions to epileptic pathophysiology. The aims, subjects, epilepsy induction techniques, assessment methods, and findings of each studies were presented. Results A total of 24 clinical trials met the inclusion criteria and were included in the systematic review. Altered potassium buffering compromises extracellular potassium regulation, fostering hyperexcitability. Aquaporin dysfunction disrupts water homeostasis, aggravating seizure susceptibility. Disturbances in glutamatergic transmission, marked by changes in glutamate transporter function, contribute to excitotoxicity, fueling epileptogenesis. Intricacies in calcium signaling and disruptions in calcium-binding proteins tip intracellular calcium balance towards hyperexcitability. Dysfunctional GABA transporters compromise inhibitory neurotransmission, upsetting excitatory–inhibitory balance. Gap junction protein dysregulation disrupts astroglial networks, impacting neuronal synchronization in epileptogenic circuitry. Compromised BBB allows entry of epileptogenic factors, exacerbating the epileptogenic milieu. Conclusions Collectively, these astrocytic dysregulations unveil intricate contributors to epilepsy onset and progression.

Abstract Background Alzheimer’s disease (AD) stands as a formidable challenge within the realm of neurodegenerative disorders, characterized by its inexorable progression and the profound cognitive impairments it engenders. Despite decades of research, the management of AD remains in a conundrum, with currently available treatments offering only modest symptomatic relief and none that can definitively alter the course of the disease. Objective This investigation seeks to provide a concise overview of the influence of probiotics on the cognitive aspects of AD, drawing upon a compilation of conducted studies. Methods The study was conducted by means of comprehensive searches in MEDLINE, Pubmed, and Google Scholar databases spanning from January 2015 to December 2020. The composition of this review adhered to the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The evaluation of eligibility criteria was guided by the Population, Intervention, Comparator, Outcome, and Study Design (PICOS) framework, a methodology that was systematically applied to each identified research entry. Results Upon the implementation of the search protocol, a total of five articles that satisfied the predetermined inclusion criteria were incorporated into this review. Among these, four encompassed randomized controlled trials (RCTs), while the fifth pertained to an explorative interventional study. AD stands as a progressive neurodegenerative affliction of considerable clinical import. Through the assessment of diverse investigations, compelling evidence has emerged affirming that probiotic microorganisms, acting via the intricate gut–brain axis signaling pathway, harbor the capacity to ameliorate cognitive function in AD. The collective findings across all the studies unequivocally indicate a notable enhancement in cognitive function subsequent to the administration of probiotic supplementation (p

Objective: Morbus Hansen (MH), caused by Mycobacterium leprae, is marked by neuropathic pain. Prior studies link low vitamin D levels to diabetic neuropathic pain, yet research on its role in MH-related neuropathic pain is limited. This study investigates the role of vitamin D deficiency in MH-related neuropathic pain. Materials and Methods: An analytical cross-sectional study was conducted among multibacillary (MB) MH patients at Prof. Dr. I.G.N.G. Ngoerah Hospital, Bali from April to August 2023. Neuropathic pain was assessed using the Douleur Neuropathique 4 (DN4) questionnaire, while serum 25(OH)D levels determined vitamin D status. The cutoff for deficiency was determined via ROC curve analysis. Results: Among 42 participants, those without neuropathic pain exhibited higher mean serum vitamin D levels than those with neuropathic pain (28.69 ± 8.16 vs. 22.11 ± 9.54 ng/ml; p=0.021). The ROC curve identified a cutoff value of 30.25 ng/ml, categorizing participants into vitamin D deficiency (

Abstract Background Stroke is one of the main causes of disability, in which nearly 2/3 of survivors experience disability and interferes with the patient’s daily functional activities. Hypertension, dyslipidemia, obesity, and smoking habits are the main causes of stroke in young adults. Vascular abnormalities are also risk factor for stroke in young adults. Advanced imaging examinations such as cerebral digital subtraction angiography (DSA) can provide a clear picture of the vasculature of the blood vessels of the human brain and provide a real-time picture of the hemodynamic status, blood flow and collateral circulation of the cerebral vessels. Results There were approximately 999 patients who had DSA cerebral examination during the study period. The total young adult population was 147 [92 males (62.4%) and 55 females (37.6%)]. There were 82 patients with ischemic stroke (60.7%). The main etiology of ischemic stroke in this study was intracranial atherosclerotic disease (ICAD) [44 (53.65%)]. The young adult population had 53 hemorrhagic stroke patients (39.3%). The main cause of hemorrhagic stroke is hypertensive vasculopathy (41.5%), followed by a ruptured cerebral arteriovenous malformation (CAVM) (37.7%). There were 12 patients with cerebral sinus venous thrombosis (CSVT). Headache is the main complaint of patients with venous stroke, followed by seizures and hemiparesis. The transverse sinus is the most common site for occlusion (66.7%). Conclusion This study describes the characteristics and prevalence of stroke in young adults based on the results of cerebral DSA examination. Stroke in young adults is not uncommon. Several traditional risk factors in old age are now found in young people. Lifestyle modification is needed to reduce the prevalence of stroke in young adults.

Objective: Vitamin D as an essential nutrient is increasingly being studied and reported to have roles in diabetes and cognitive function through its antioxidant, anti-inflammatory, and neuroprotective functions. This study aimed to investigate vitamin D deficiency as a factor associated with cognitive impairment in Type 2 Diabetes Mellitus patients. Materials and Methods: This case-control study was conducted at the diabetic center and neurology outpatient clinic at Prof. Dr. I.G.N.G Ngoerah Hospital in Denpasar, Indonesia between September and December 2022. Cases had a score of < 26 on the Montreal Cognitive Assessment questionnaire (Indonesian version) controls had a score ≥26. Vitamin D levels were assessed using serum 25-hydroxyvitamin D levels. The cut-off for vitamin D deficiency was obtained through the receiver operating curve characteristic. Results: In total 31 cases and 31 controls were included. The cut-off for vitamin D deficiency was

Background: Segmental zoster paresis (SZP) is a very uncommon complication characterized by localized weakening of the upper or lower limbs. Case report: A 69-year-old man came with complaints of weakness in the right leg two months ago. He had weakness in his right leg after two days of having herpes on his right leg. There was paresthesia and hypesthesia on neurological examination according to the L1-L3 dermatome. Neurophysiology examination revealed a neuropathy in the right femoral nerve. Discussion: Varicella-zoster virus, being a neurotrophic virus, primarily invades and incubates in the dorsal root or cerebral ganglion nerve cells. Etiological investigations in SZP patients have revealed that the anterior root is the most prevalent location of inflammation and degeneration. Conclusion: SZP is a rare complication following VZV infection that can lead to misdiagnosis and overtreatment in clinical practice. The neurophysiological examination is very important in diagnosing segmental zoster paresis.

Objective: Peripheral diabetic neuropathy (PDN) is among the most prevalent diabetes mellitus (DM) sequelae. PDN is a severe health issue that represents a huge social and economic burden worldwide, is associated with long-term morbidity, and diminishes the quality of life of those affected. The neutrophil-lymphocyte ratio (NLR) is a mixture of the two primary components of chronic inflammatory diseases (high neutrophils and low lymphocytes) that contribute to the production of PDN. This study aimed to demonstrate high serum NRL levels enhance the risk of PDN in type 2 DM patients. Materials and Methods: This study employed a case-control design, collecting data from the registers and outpatient medical records of Prof. Dr. IGNG Ngoerah General Hospital type 2 DM patients who satisfied the inclusion and exclusion criteria between January 2018 and December 2019. Based on clinical neuropathy and abnormal electrodiagnostic testing, the PDN diagnosis was established. Serum NLR was collected from laboratory tests recorded by a computer. Results: The Receiver Operating Characteristic (ROC) curve approach determined the NLR cut-off value of 2.18. High NLR substantially increased the incidence of PDN (OR 10.36; 95% CI 3.69-29.07; p

Post-herpetic neuralgia (PHN) is chronic neuropathic pain that is felt for at least 3 months or more at the site of the rash due to herpes zoster infection. Epidemiological studies get a prevalence of 0.49 cases of PHN per 1000 people per year. The clinical manifestation of PHN is chronic pain on the skin lesions due to herpes zoster infection. The therapy that is commonly used as the first line is the provision of pharmacotherapy such as gabapentin or pregabalin. An 83-year-old male patient with a diagnosis of PHN that had been felt for 5 years. He has been taking drugs for 5 years but the pain has not improved. The patient is given high-intensity laser therapy. After 5 treatments with an interval of 1-2 weeks, pain was significantly reduced from an 8/10 scale to 4/10. The frequency of occurrence of severe pain is also reduced from 5 times per day to only 1 time per day. The use of high-intensity laser therapy is not commonly used as a therapy for PHN. Based on its mechanism of action, the use of high-intensity laser therapy is worth considering because of its effectiveness in treating pain in a shorter time than low-intensity laser therapy.

Abstract Background Migraine and stroke are neurovascular diseases that have become a public health problem and a relatively high economic burden. The relationship between migraine and stroke has been described in the literature for a long time. Several studies reveal that migraine can be a risk factor for stroke. Methods We systematically searched PubMed using the PRISMA method and keywords according to MeSH terms to prepare this systematic review. We included published articles discussing migraine as a risk factor for ischemic stroke with a cohort study design and English article and listed the statistical value of the study. Results In our meta-analysis, we found that migraine significantly increases the incidence of ischemic stroke. There were 12 studies included in this systematic review, and a meta-analysis was performed. The results showed a significant association between migraine and ischemic stroke (HR 1.205, 95% CI 1.151–1.262 p = 0.000), migraine with aura and ischemic stroke (HR 1.442, 95% CI 1.241–1.675 p = 0.000), and migraine without aura and ischemic stroke (HR 1.126, 95% CI 1.048–1.211 p = 0.001). The exact mechanism of stroke caused by migraine is still unclear, although, in some theories, several mechanisms have been described that are thought to be the cause of stroke. Several important points of the cause of stroke in migraine are hemodynamic changes, endothelial dysfunction, cervical artery dissection, vascular reactivity, hypercoagulability, and abortive migraine drugs. Conclusions Both migraine with aura and without aura are risk factors for ischemic stroke. Several mechanisms that may cause ischemic stroke in migraine have been described, of which CSD-induced endothelial dysfunction is the primary pathophysiology of ischemic stroke in migraine.

Abstract Background Migraine is a primary headache with a prevalence of 12–20% in the world. Approximately 38% sufferers were indicated for prophylactic therapy, but only a small proportion (3–13%) received prophylactic therapy. The role of melatonin in migraine is to protect the brain against toxins through anti-free radical activity, inhibition of the release of inflammatory factors and neurotransmitters. Results This review uses the PRISMA protocol and uses source from Pubmed. A total of 142 articles were found according to the search strategy. 5 articles were collected with a randomized-controlled trial design that matched the inclusion criteria. Of the 5 articles, there were only 2 articles that proved significant where melatonin gave better results compared to placebo in migraine sufferers, especially in the frequency of attacks, duration, and reduction in the use of other analgesics. Based on the dose and duration of melatonin administration, although most use a dose of 3 mg melatonin with a duration of 2–3 months, this still needs to be investigated further because the available data are not sufficient. In addition, the use of melatonin before going to bed at night is said to be better because it is associated with the majority of side effects that occur, namely sleepiness. Conclusion Studies on melatonin and migraine with a randomized-controlled trial design are still limited so there is not enough evidence to support the administration of melatonin as a treatment for migraine sufferers, including the safety and side effects, especially for a long period of time.

Abstract Treatment goals in bladder pain syndrome (BPS) or interstitial cystitis (IC) focusing on relieving symptoms to improve quality of life and avoiding adverse events (AEs) since curative treatment for BPS/IC is not available. The readily available pharmacologic options for BPS/IC including oral, intravesical, and transdermal therapy. The purpose of this study is to review randomized trial studies over the last 15 years examining the efficacy and safety of oral pharmacological and supplementary therapies for BPS/IC. A systematic search was conducted in PubMed and Medline Library. Only randomized-controlled trials and randomized comparative trials published between 2005 and 2020 on the efficacy and safety of oral therapies for BPS/IC were included. The keywords used were “bladder pain syndrome”, or “interstitial cystitis”, and “random” or “trial”. From 629 articles, nine were included in this review. Oral therapies included consist of cyclosporine A (CyA), amitriptyline, amitriptyline plus alpha lipoic acid (ALA) and omega-3 fatty acids (n-3 PUFA), PD-0299685, sildenafil, pentosan polysulfate sodium (PPS), AQX-1125, and hydrogen-rich water. Among retrieved trials, amitriptyline in combination with ALA and n-3 PUFA, sildenafil, and cyclosporine A proved their efficacy for BPS/IC. Sildenafil was generally well tolerated, while amitriptyline and CyA must be used with caution, the supplementation of ALA/n-3 PUFAs possibly lower dosage of amitriptyline, subsequently reduce its AEs. CyA was superior to PPS but possessed greater AEs. Further studies focusing on etiopathology and phenotype differentiation of this syndrome will greatly contribute to the development of effective therapy.

Background. Herpes zoster is a disease caused by reactivation of endogenous viruses that cause local dermatomal disorders characterized by unilateral radicular pain and vesicular dermatomal eruption. Some of the factors that responsible for reactivation of the herpes zoster virus are older age and low immune status. Case presentation. A 54-years-old presenting with meningitis after consumed a raw pork. Five days later developed herpes zoster. Conclusions. Herpes simplex reactivation in Streptococcus suis infection might relate to low immune system caused by the poor immune response to antibody and the use of high-dose systemic steroid.

Abstract Background Painful diabetic neuropathy is one of the most common complications of type 2 diabetes mellitus, with approximately 30–50% of people will experience diabetic neuropathy. Chronic hyperglycemia will cause an inflammatory process that will trigger an immune response included leukotrienes. Leukotriene B4 is associated with hemoglobin glycation levels. This study aimed to determine high serum leukotriene B4 levels and other factors as a risk factor for painful diabetic neuropathy in type 2 diabetes mellitus patient. Results Forty-two subjects with 22 cases (median age 56.5 ± 4.9 years) and 20 controls (median age 56.5 ± 5.2 years) group were collected. In bivariate analysis, significant factor for high risk PDN was high leukotriene B4 serum level (OR 5.10; 95% CI 1.34–19.4, p 0.014). Meanwhile, insignificant factors were anti-diabetic drugs (OR 2.139; 0.62–7.37; p = 0.226), and duration of diabetes mellitus (OR 2.282; 0.56–9.25; p = 0.315). Independent risk factor was serum leukotriene B4 levels (OR 5.10; 95% CI 1.336–19.470; p = 0.017). Conclusions In this study, high leukotriene B4 serum levels increase the risk of painful diabetic neuropathy among type 2 diabetes mellitus. The leukotriene B4 may consider as a potential biomarker for early detection in high risk for PDN and early treatment.

Stroke has been known as the second greatest cause of mortality and the third cause of disability. Ischemic stroke is more frequent than hemorrhagic stroke. The pathophysiology of ischemic stroke relates with inflammatory process. Neutrophil and lymphocyte are part of that process. Routine peripheral hematological laboratory, which contains information of neutrophil and lymphocyte, is easy, cheap and rapid test. This literature review purposes to explain the modality of neutrophil-lymphocyte ratio (NLR) in predicting the recurrence, disability and mortality of ischemic stroke following acute phase.

Introduction. Cerebral toxoplasmosis is one of the diseases of the central nervous system that can occur in people with AIDS. Cerebral toxoplasmosis occupies third place among fatal diseases that can occur in people with AIDS. Prevalence of toxoplasmosis is about 25-30% of the world’s human population, and in Asia it is as high as 40%. Risk factors for developing cerebral toxoplasmosis is needed to be sought to find out risk factors that triggers and acts as protective factors for toxoplasmosis cerebral in HIV-positive patients. Methods. Two reviewers searched PubMed and Medline to identify cohort, case-control and cross-sectional studies. Two independent reviewers searched the databases, identified studies and extracted data. Inclusion and exclusion criteria were applied for the data screening. Results. Four studies were included. Two prospective cohort studies, one multicenter cohort study and one case control study. Age was not found to have a role as a risk factor. Gender was shown to have significant in one study (Male vs female OR 0.47 95% CI 0.25-0.88, p = 0.02). CD4 100.000 was associated with 5.10 times higher to develop cerebral toxoplasma. Prophylaxis therapy using cotrimoxazole can reduce the risk of cerebral toxoplasmosis. Conclusion. Age, female sex, low CD4 cell count, and high HIV viral load increase the risk of cerebral toxoplasmosis, whereas ART therapy and prophylaxis with cotrimoxazole can reduce the risk.

Objective. Painful diabetic neuropathy (PDN) is a prevalent debilitating consequence of diabetes mellitus with lack of satisfactory therapeutic options. Methylcobalamin (MeCbl) is one of vitamin B12 analogs with known neurotrophic effects. We aimed to determine if MeCbl can relieve PDN. Materials and methods. This was a randomized (1:1) double-blind placebo-controlled trial involving PDN patients. Treatment and control group received daily 12.5 mg oral amitryptiline bid with either 500 µg of intravenous MeCbl or saline injection given on alternating days, respectively, for a 9-consecutive day period. PDN was assessed with douleur neuropathique 4 (DN4) questionnaire. Numeric pain rating scale (NPRS) was used to monitor pain intensity and treatment response. All investigators and patients were kept blinded throughout the study period. Outcomes. 42 patients, 21 on each arm had completed the study. The NPRS reduction can already be observed as early as day 2 post-intervention. Both the treatment and control group demonstrated sustained reduction of NPRS by almost one point per each time point of evaluation in the first three days (p

In some neurological diseases, advanced examinations can be used as diagnostic tools. Several indicators have also been discovered that can be used to assess the severity of neuronal damage and neurological disease progression. Neurofilament light chain (NfL) is a cytoskeleton protein that makes up the structure of neuron axons and is released when a neuron is injured, allowing it to assess neuronal injury severity. NfL was first used to diagnose central nervous system disorders like dementia, multiple sclerosis, and other neurodegenerative diseases. But, NfL levels have also been elevated in peripheral nervous system disorders, like in several neuropathic conditions, including amyloid neuropathy, HIV-associated neuropathy, diabetic peripheral neuropathy, leprosy neuropathy, and other neuropathy, according to various investigations. Theoretically, all abnormalities induced by axonal injury will increase blood NfL levels, allowing NfL testing to be utilized as a measurement tool. NfL levels can also be a predictive indicator to monitor treatment efficacy and peripheral neuropathy progression.

Industrial revolution 4.0 has changed the health industry. Medical treatments derived from the latest technologies are expected to improve health and economic status. The rapid development of technology has influenced the learning and clinical practice of medicine. Virtual Reality (VR) is one of the latest technologies that is currently being implemented as a treatment for neurological disorders. This article seeks to give an overview of the development of VR implementation in neurorehabilitation. The data source of this article is research and studies published in NCBI, PubMed, Cochrane, and other relevant online databases. From this article, it is found that VR can be used as a pain reliever and motor function rehabilitation for patients with balance and gait deficits. VR is used to distract patients’ attention to pain for a short time period. VR also improves motor function recovery in stroke patients. Cybersickness is usually reported as a side effect of using VR and it depends on each individual. The implementation of VR for patients with neurological disorders has showed advantages in reducing pain and improving motor function but still need further research about applicability and authorization of virtual reality in the world of medicine.

The purpose of this paper is to review the effectiveness of citicoline as suggested adjuvant therapy for painful diabetic polyneuropathy based on evidences. Pain is one of the most common symptoms that make patients consult with a doctor, especially chronic pain. One of the examples is painful diabetic polyneuropathy, which prevalence is increasing by global development. Diabetic polyneuropathy is the most common cause of neuropathic pain caused by long-term complications of microangiopathy. Affect not only individual socioeconomic status but also the psychological aspect of the patient. Neuropathic pain is one of the most common causes of long-term disability. Some medicines already recommended as the drug of choice, but not all of them give maximum results. Adjuvant neuroprotector therapy is often considered to help manage painful diabetic polyneuropathy, such as citicoline, which has been proven in some studies. Painful diabetic polyneuropathy is very challenging because of its pathophysiology, which has not fully understood. The different mechanism of pain sensation is still unknown but it is thought that the oxidative stress after microangiopathy triggers the discharge of abnormal load from damaged neurons. Some analgesics have not given the expected result. Conclusion. Citicoline may be suggested as adjuvant therapy based on evidences with animal subject, but further studies with human subject are still needed.

Introduction. A brain abscess is a collection of pus, immune cells, and other materials that are generally caused by bacterial or fungal infection in the brain parenchyma. This disease has a high level of morbidity and mortality, nonetheless, until now there has been no in-depth research on this disease, especially in Bali. Objective. This study aimed to determine the proportion and characteristics of patients with brain abscess at the Sanglah General Hospital, Denpasar, Bali, Indonesia in 2019-2020. Material and methods. This study is an observational study with a cross sectional method. A total of 41 patients with brain abscesses recorded in hospital medical records in 2019-2020 were included in this study. Univariate analysis was performed to obtain the characteristics of patients with brain abscesses. Results. Most of the patients were male (63.4%), aged 20-39 years. The main complaint most often found in patients was decreased consciousness (56.1%), with neurological symptoms in the form of hemiparesis (32.3%). Most of the abscesses were found on the right frontal, right parietal and left parietal with a percentage of 14.06% each. The CT scan results showed a rim contrast enhancement (63.4%), cerebral edema (75.6%), and normal sulcus gyri (51.2%). Up to 50% of patients with a history of surgical procedures underwent a craniotomy. Other disease histories most often found in patients were sinusitis (29.5%), diabetes mellitus (15.3%), and toxoplasmosis (12.5%). Conclusion. There are varying results of the clinical characteristics of patients with brain abscesses, and indicate the natural course of this disease.

Objectives. High levels of non high density lipoprotein cholesterol (non-HDL-C) are known to contribute to an increased risk of ischemic stroke. This systematic review was conducted to identify the relationship between high non-HDL-C levels and the risk of ischemic stroke. Material and methods. This systematic review using PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement guideline, with a pre-determined search strategy. The search was conducted in Pubmed Central (PMC) and Pubmed from 2009 until 2020 with inclusion criteria, patients with a diagnosis of ischemic stroke, age >18 years, with non-HDL-C levels. The title and abstract of these articles were reviewed for relevance, based on inclusion criteria. This systematic review using STROBE to evaluate the quality in individual study which consists of 22 domains. Results. In the final stage, this systematic review identifies six cohort study consisting 166.720 participants. Overall, the quality in individual studies based on STROBE is good. We reported that there are two studies report that high non-HDL-C levels can significantly increase the risk of ischemic stroke. Meanwhile, there are four studies that report there was no significant relationship between high non-HDL-C levels and the risk of ischemic stroke. Conclusions. Overall, this systematic review provides the result about relationship between high levels of non-HDL-C and the risk of ischemic stroke, there are two studies with a larger population support that high levels of non-HDL-C can increase the risk of ischemic stroke. However, further studies is needed with a large population that specifically identify the relationship between non-HDL-C levels and risk of ischemic stroke and makes a better adjustments for confounding variables.

Stroke causes disability with high morbidity and mortality in the world, causes a variety of disabilities and symptoms including disturbances in motor function, sensory, and cognitive. Sensory disability in post stroke patient can be categorized into two group; the one is stimulated by peripheral mechanism which we often called post stroke pain, and another one is stimulated by central mechanism which we called central post stroke pain (CPSP). Pain after stroke is usually underdiagnosed and poorly understood. In 1906, CPSP was called the thalamus pain syndrome by Dejerine and Roussy, but then it is known that CPSP can also developed in extra-thalamic stroke lesion. The prevalence of CPSP is approximately 1-12% in all around the world. CPSP occurs in one-third of overall post-stroke pain cases. In most cases, the onset of CPSP is within 1 month and then the incidence decreases with time. The most common manifestations are allodynia and dysesthesia. The pathophysiology itself remains clearly unknown in detail. Various theories such as central sensitization, disinhibition of medial thalamus, and central imbalance theory thought to be contribute in CPSP pathophysiology. This complexity make CPSP very difficult to manage. Some pharmacotherapies and non-pharmacotherapies have been studied to relieve pain in order to improve the quality life of CPSP sufferers. The aim of this article is to discuss the general view of central post stroke pain to increase the understanding and awareness of health giver in order to give sooner and better management for patient that can affect prognosis of the patient.

Pain is an unpleasant sensory and emotional experience that can affect the quality of life and leads to decreased productivity in patients. Low back pain (LBP) is one of the significant causes of disability worldwide with lifelong incidence. The purpose of this literature review describes the potential of anthocyanin-based Poly (Methyl Methacrylate) (PMMA) nanoparticles as the management of inflammatory pain in the Hernia Nucleus Pulposus (HNP ). The method used is a literature study by entering the keyword. Of the 77 journals reviewed, 47 journals were found by the topic and used as a reference for this work. The anthocyanin-based PMMA nanoparticles act as anti-nociceptors by inhibiting microglia that produce inflammatory mediators in HNP. Poly (Methyl Methacrylate) nanoparticles have specific targets in microglia. Anthocyanins have the effect of inhibiting inflammatory pain through many destinations. Anthocyanin inhibits the synthesis of nitric oxide (NO ) and prostaglandin E2 (PGE 2) and inhibits the activation of p38 MAPK and NF-kB pathways that express TNF-α and IL-1β genes as anti-nociceptive. The anthocyanin-based PMMA nanoparticles have potential as a novel therapy for inflammatory pain in HNP. There has been no research between these modalities. Therefore, further research is needed to find out the exact potential of anthocyanin-based PMMA nanoparticles.

Background: One of the adverse effects of chemotherapy in the neurological field is chemotherapy-induced peripheral neuropathy (CIPN), it was an adverse effect caused by many chemotherapeutic regimens and a major cause of continuous pain in patients who survived cancer. When the symptoms get worse, survivor’s quality of life is declining and they are often having problems with mental health, insomnia, cognitive functioning, fatigue, physical functioning, and pain. So far the choice of therapy for CIPN is still limited. Now, there was no drug approved to treat pain due to CIPN. Duloxetine are a SNRI (serotonin norepinephrine reuptake inhibitor), which it’s useful in CIPN are highly supported by evidence. Methods: We conducted a systemactic-computer based literature search on January 4, 2019 in PubMed database for article published between 2013 and 2018. We searched for a literature related with used a duloxetine for management of chemotherapy induced peripheral neuropathy. Results: From the 4 studies that included in this review, the total participants are 478 patients with neuropathic pain and already get a chemotherapy regiment. From the meta-analysis showed one study had no effect, two studies had small effect, and one study had medium effect. Conclusion: Duloxetine is a great option for the treatment of CIPN in especially reducing neuropathic pain.

Introduction. The most common type of dementia is Alzheimer’s disease (AD). AD is characterized by loss of memory and cognitive impairment. In epidemiological studies, low folate could disturb vitamin B12 absorption, which leads to the inflammatory process, and it explains the association between both vitamins and Alzheimer’s disease. Material and methods. We did a systematic search through PubMed and Embase according to the PRISMA protocol. We included studies published in the last 5 years (from 2015 to June 2020). Data will be extracted by two reviewers. We assess the quality of studies using JADAD Scale for randomized-controlled trials. Results. We found 426 journals in our search strategy. In the end, 2 studies met the eligibility criteria and were included in this review. These two randomized controlled trials revealed that folic acid improved cognitive function in Alzheimer’s disease (p < 0.05) and mild cognitive impairment (p = 0.028). Discussion. In this systematic review, we found that daily folic acid supplements could improve cognitive function in patients with Alzheimer’s disease and mild cognitive impairment. The exact mechanism is unknown, but it is believed that folic acid supplementation improves cognitive function by reducing the levels of peripheral inflammatory cytokines Conclusion. Daily oral folic acid supplemental (400 µg and 1.2 mg) for 6-12 months improves cognitive function in Alzheimer’s disease and mild cognitive impairment.

Abstrak Gangguan kognitif sering dijumpai pada penderita gagal jantung sistolik dan tidak terdeteksi sejak awal. Hal ini memperburuk kondisi dan luaran klinis penderita. Penelitian ini bertujuan untuk mengetahui adanya peningkatan risiko terjadinya gangguan kognitif pada penderita gagal jantung sistolik dengan penurunan fraksi ejeksi ventrikel kiri dalam enam bulan. Metode penelitian ini adalah kontrol kasus, di Poli Jantung dan Poli Saraf RSUP Sanglah, Denpasar, periode Oktober 2018 hingga Desember 2018. Analisis data dilakukan dengan SPSS versi 22. Penelitian ini menggunakan 76 subjek, dengan rerata usia 50,3 ± 4,5 tahun. Karakteristik yang lebih dominan dijumpai pada jenis kelamin laki-laki 44 orang (57,9%), pendidikan ≥ 12 tahun 40 orang (52,6%), dan pekerjaan formal 40 orang (52,6%) Dari hasil analisis statistik didapatkan persentase penurunan fungsi kognitif pada kelompok kasus sebesar 89,5% sedangkan pada kelompok kontrol didapatkan 13,2%. Analisis bivariat dengan Chi-square, didapatkan nilai OR=56,1; IK 95% 13,844-227,338; p

Background. Altered lipid profiles have consistently been linked to cerebrovascular events. Ischemic stroke (IS) was a common comorbid condition established in type 2 diabetes mellitus (T2DM). The apolipoprotein E (ApoE) gene which has a notably critical function in lipoprotein metabolism is believed as one of the potential candidate genes susceptible to IS complications in T2DM. This research aimed to determine the association of apolipoprotein E gene polymorphism with lipid profile and IS risk in T2DM patients. Methods. This case-control study involved a total of 60 diabetic participants divided into two groups with and without IS. ApoE was genotyped using PCR and sequencing analysis. Results. The most predominant genotype observed in 27 participants (45%) was E3/E3. Lower levels of high-density lipoprotein cholesterol (HDL-C) were found in ε2 carriers (p=0.003; 95% CI −23.35–−4.89) and ε4 carriers (p=0.019; 95% CI 1.38–14.55) compared to ε3 homozygotes. Total cholesterol (TC), triglyceride, and low-density lipoprotein cholesterol (LDL-C) levels had no association with ApoE gene polymorphism in this study. ApoE gene polymorphism was not related to IS in T2DM (p=0.06; adjusted OR: 4.71; 95% CI 0.93–23.79). Conclusions. ApoE ε2 and ε4 carriers were associated with lower levels of HDL-C. No association was identified between ApoE gene polymorphism and IS in T2DM patients.

Myasthenia gravis is one characteristic of autoimmune disease caused by the disruption of synaptic transmission at the neuromuscular junction. It is characterized by a progressive weakness and abnormal skeletal muscle used continuously and accompanied by fatigue on exertion. knowledge of normal anatomy and function of the neuromuscular junction is very important for understanding about myasthenia gravis,.Presynaptic membrane (membrane nerve), post-synaptic membrane (membrane of the muscle), and the synaptic gap forming part of the neuromuscular junction. Immunogenic mechanism plays a very important in the pathophysiology of myasthenia gravis, in which the antibody is the product of B cells is precisely against the acetylcholine receptor. Management of myasthenia gravis to do with drugs, thymomectomy or with immunomodulating and immunosuppressive therapy that can provide a good prognosis in the healing myasthenia gravis.