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Introduction: A subsequent headache that appears within seven days of a head injury is referred to as a post-traumatic headache (PTHA) (or after regaining consciousness after the head trauma). If a post-traumatic headache lasts longer than three months after the injury, it is referred to as chronic or chronic post-traumatic headache (CPTHA). Case Report: A 17-year-old male comes to the neurology outpatient clinic with complaints of headache. The headache has been felt since 3 months ago, 3 days after the patient suffered a blow to his left head from falling from a chair. At that time, the patient fainted about 15 minutes later; the patient regained consciousness and had no complaints. Pain is felt on the left side of the head, throbbing, mild-moderate intensity, and feels heavier when there is a loud sound or seeing a too-bright light. Discussion: Like other primary headaches, post-traumatic headache is diagnosed clinically. Laboratory and routine diagnostic imaging studies are unnecessary and have minimal clinical utility. Brain MRI did not reveal any structural changes in patients with PTHA following injury. Conclusion: Chronic post-traumatic headaches often occur after brain injury, especially after minimally traumatic brain injury. The clinical picture is variable and may be similar to tension-type headaches and/or migraines.

Background/aim: Good sleep quality affects the body's metabolism, which impacts a person's physical and psychological condition. Patients with nasopharyngeal cancer who receive radiotherapy are reported to experience a lot of poor sleep quality, which will affect the success of treatment, increase treatment costs and decrease quality of life, which will cause social problems in the community future. Rate C-Reactive Protein (CRP) serum in nasopharyngeal cancer patients with radiotherapy increased significantly after radiotherapy. This study to Proving rate of CRP is a risk factor for poor sleep quality in nasopharyngeal cancer patients with radiotherapy Method: This is a statistical analytical study with a case-control design in nasopharyngeal cancer patients with radiotherapy at Prof. Dr. IGNG Ngoerah Hospital Denpasar, Bali, from December 2020 to April 2021. Data analysis using SPSS for Windows. Results: There were 120 respondents, 77.5% male, mean age ± SD 52.85 ± 6.35, high CRP levels on average with poor sleep quality 16.95 ± 6.95 mg/L. Bivariate analysis using Chi-square obtained OR = 9.33 (95% CI 2.18-39.9; p = 0.003). The results of multivariate analysis showed that the CRP level variable had p=0.003. There is a significant relationship between high CRP levels and poor sleep quality. Conclusion: High CRP levels increase the risk of poor sleep quality nine times in nasopharyngeal cancer patients with radiotherapy Keywords: poor sleep quality, CRP, nasopharyngeal cancer, radiotherapy

Introduction: A subsequent headache within seven days of a head injury (or after regaining consciousness after the head trauma)is referred to as a post-traumatic headache (PTHA); it is referred to as chronic or chronic post-traumatic headache (CPTHA) if it lasts longer than three months after the injury. Case : A 17-year-old male with headache since 3 months ago, 3 days after suffered a blow to his left head from falling from a chair. At that time, the patient fainted for about 15 minutes but had no complaints after regained consciousness. Pain is felt on the left side of the head, throbbing, mild-moderate intensity, and feels heavier with a loud sound or a too-bright light. Discussion: Post-traumatic headache is clinically diagnosed. Laboratory and routine diagnostic imaging studies are unnecessary and have minimal clinical utility. Conclusion: Chronic post-traumatic headaches often occur, especially after minimally traumatic brain injury. The clinical picture is variable and may be similar to tension-type headaches and/or migraines. Pendahuluan: Nyeri kepala dalam tujuh hari setelah cedera kepala atau setelah sadar kembali dari trauma kepala disebut nyeri kepala pasca-trauma (post-traumatic headache/PTHA); disebut sakit kepala pasca-trauma kronis atau kronis (CPTHA) jika berlangsung lebih dari tiga bulan setelah cedera. Kasus: Seorang laki-laki berusia 17 tahun dengan keluhan nyeri kepala sejak 3 bulan, 3 hari setelah kepala kiri terbentur karena jatuh dari kursi. Saat itu, pasien pingsan sekitar 15 menit, tidak ada keluhan setelah sadar. Nyeri dirasakan di sisi kiri kepala, berdenyut, intensitas ringan-sedang, terasa lebih berat jika ada suara keras atau cahaya terlalu terang. Diskusi: Nyeri kepala pasca-trauma didiagnosis secara klinis. Laboratorium dan studi pencitraan diagnostik rutin tidak diperlukan dan memiliki utilitas klinis minimal. Simpulan: Nyeri kepala pasca-trauma kronis sering terjadi, terutama setelah cedera otak traumatis minimal. Gambaran klinisnya bervariasi dan dapat mirip nyeri kepala tipe tegang dan/atau migrain

The neuropathology of Alzheimer's dementia (AD) is characterized by the buildup of amyloid beta peptide plaques and tau protein in the brain that causes cognitive deficits. The mammalian protein kinase target of rapamycin (mTOR) plays an essential role in controlling the balance of protein synthesis and degradation through autophagy. This study was conducted to determine the role of purple sweet potato water extract in activating autophagy through the mTOR pathway. The study used a randomized posttest-only control group design where 20 male Wistar rats were randomized into the treatment group, and the control group was then induced with d-galactose 100mg/kg BW/day for four weeks. The treatment group was given an aqueous extract of purple sweet potato at 200mg/kg BW/day while the control group was given aquabidest solution for six weeks. The independent t-test showed that the mean mTOR expression in the treatment group (30.30±4.42) was significantly higher (p

Background & Objective: Stroke is one of the leading causes of death and disability worldwide. The incidence of ischemic stroke in the anterior circulation is greater in the middle cerebral artery (MCA) distribution. A high level of platelet to lymphocyte ratio (PLR) has been widely studied as a predictor of poor outcomes in various conditions, such as cardiovascular disease and malignancy. However, the significance of PLR as a predictor of outcome in stroke patients, especially the ischemic type, are still uncertain. This study aimed to determine whether increased PLR was a risk factor for poor outcomes in acute ischemic stroke patients. Methods: This is a single-center case-control study. The data of acute ischemic stroke patients in MCA territory admitted from January 2019 to April 2020, who met the inclusion and exclusion criteria, were collected. The stroke outcome was defined by NIHSS upon discharge. The Control group was those with NIHSS

Preventive medicine is appropriate for the majority of patients, including migraine patients, since migraine is considered a chronic condition that causes debilitating headaches that impair quality of life. Oral migraine preventive medications are available, but their use is restricted owing to their side effects and the fact that they are not specifically intended for migraine prevention. The currently available monoclonal antibodies (all have been approved by the Federal Drug Administration (FDA)) were developed specifically for the prevention of migraine and specifically targeted the CGRP peptide, which plays a critical role in the migraine mechanism. Thus, we discussed the breakthrough in migraine prevention in this article, with a particular emphasis on the role of monoclonal antibodies. Keywords: migraine prevention, monoclonal antibodies, CGRP.

Introduction: Spinal metastases constitute 90% of spine tumors. Primary tumors originate from a variety of malignancies. However, there are no data on the characteristics of spinal metastases in the local population. This study collected data from one of the Tertiary hospitals in Bali to be used as a reference for the initial description regarding the characteristics of spinal metastases.Methods: A cross-sectional descriptive study was conducted by collecting medical record data of patients with spinal metastases at the Sanglah General Hospital for a year (January–December 2019) by total sampling.Results: This study obtained 39 samples. Most primary cancers that metastasize to the spine were lung cancers (30.77%), followed by multiple myeloma (10.26%), prostate cancer (7.69%), and colorectal cancer (5.13%). There were also contributions from breast, cervix, bladder, thyroid, lymphoma, nasal cavity, acute myeloid leukemia, and plasmacytoma. There were 25.64% cases where the primary cancer was unknown. Most of the metastases were in the thoracic segment (35.90%), followed by the lumbar region (28.21%) and the cervical region (12.82%). There were still many lesions that were less visible or unclear (38.46%). Patients generally experienced sensory (94.87%) and motor (92.31%) deficit. Sensory disturbances include paresthesia, hypesthesia and pain. Meanwhile, motor deficit include parapharesis, paraplegia, and tetrapharesis depending on the location of the lesion. Other disorders were related to the autonomic nerves (56.41%) such as defecation and urination problem.Conclusion: Most of the patients aged ?60 years and male. Spinal metastases frequently found in lung cancer patient. There was a high percentage cases with unknown primary origin. In general, the lesions were found in the thoracic and lumbar segments. There were many lesions which unclear or less visible in location. Almost all patients had sensory and motor deficit and only about half of patients had autonomic disorders. Pendahuluan: Metastasis tulang belakang merupakan 90% kasus tumor pada tulang belakang. Tumor primer dapat berasal dari berbagai keganasan. Akan tetap, belum ada data karakteristik metastasis tulang belakang di populasi lokal. Penelitian ini mengumpulkan data dari salah satu rumah sakit Tersier di Bali untuk dapat menjadi acuan gambaran awal terkait karakteristik metastasis tulang belakang.Metode: Penelitian deskriptif potong lintang dilakukan dengan mengumpulkan data rekam medis pasien dengan metastasis tulang belakang di Rumah Sakit Umum Pusat Sanglah selama satu tahun (bulan Januari - Desember 2019) secara total sampling.Hasil: Penelitian ini mendapatkan 39 sampel. Kanker primer terbanyak yang bermetastasis ke tulang belakang adalah kanker paru (30,77%), lalu disusul dengan multiple myeloma (10,26%), kanker prostat (7,69%), dan kanker kolorektal (5,13%). Terdapat pula kontribusi dari kanker payudara, serviks, buli, tiroid, limfoma, cavum nasi, leukemia myeloid akut, dan plasmasitoma. Terdapat 25,64% kasus tidak ditemukan lokasi kanker primernya. Lokasi metastasis paling banyak pada segmen thorakal (35,90%) kemudian regio lumbal (28,21%) dan regio servikal (12,82%). Masih banyak lesi yang kurang terlihat atau tidak jelas (38,46%). Pasien secara umum mengalami gangguan sensorik (94,87%) dan motorik (92,31%). Gangguan sensorik termasuk parestesia, hipestesia, dan rasa nyeri. Sedangkan gangguan motorik termasuk paraparesis, paraplegia, dan tetraparesis tergantung dari letak lesi. Gangguan lainnya yaitu gangguan pada saraf otonom (56,41%) dengan kelainan seperti gangguan buang air besar dan berkemih.Simpulan: Sebagian besar pada pasien usia ?60 tahun dan berjenis kelamin laki-laki. Metastasis tulang belakang cenderung lebih sering pada penderita kanker paru. Selain lokasi primer tersebut, terdapat persentase tinggi dimana tidak ditemukannya dari lokasi kanker primer. Pada umumnya hasil lesi terdapat pada segmen thorakal dan segmen lumbal. Masih banyak pula lesi ini masih kurang terlihat atau tidak jelas lokasinya. Pada umumnya pasien memiliki gangguan sensorik dan motorik serta hanya sekitar setengah pasien mengalami gangguan otonom.

Fresh-cut mangosteen is a minimally processed product that is currently popular due to the requirement for fresh produce, quality, convenience, and minimal preparation. The process of skin removal causes fast deterioration in fresh-cut mangosteen. The nano edible coating of aloe vera gel or nano-ecogel can be applied to delay physicochemical changes in fresh-cut mangosteen. This study is intended to determine the effect of nano-ecogel concentration and immersion time to maintain the physicochemical characteristics of fresh-cut mangosteen. The effects of the concentration of nano-ecogel (100%, 75%, 50%, and 25%, v/v) and immersion time (1, 2, and 3 min) of fresh-cut mangosteen on acidity, vitamin C, water content, total dissolved solids, weight loss, texture and browning index were evaluated for nine days of cold storage. The concentration of nano-ecogel, immersion time, and interaction affected the acidity, water content, total dissolved solids, weight loss, and browning index of fresh-cut mangosteen. The best treatment was immersion in 50% nano-ecogel for 1 min.

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.

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.

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.

Migraine still causes a high rate of disability and is reported to increase the risk of cardiovascular and cerebrovascular diseases. Endothelial dysfunction is considered to be one of the underlying mechanisms linking migraine and vascular disorders. Investigation of endothelial function in migraine includes a variety of examinations including biomarkers and ultrasonography-based studies. Several proposed biomarkers for endothelial dysfunction are endothelial progenitor cells (EPCs), von Willebrand factor (vWF), nitric oxide (NO), tissue-type plasminogen activator antigen (tPA antigen), C-reactive protein (CRP), endothelin-1 (ET-1), and vascular endothelial growth factor (VEGF). Brachial flow-mediated dilatation (FMD) is quite commonly used to reflect systemic endothelial dysfunction, while cerebral endothelial function can be assessed using breath holding index (BHI) on transcranial Doppler (TCD). The results of most studies in migraine sufferers indicate that endothelial dysfunction is found locally in the cerebral circulation, especially at the posterior circulation, while evidence for endothelial dysfunction in the systemic circulation remains controversial.

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.

Objective: Two of the most frequently elderly's health-associated problems are balanced disorder and cognitive decline. One of the solutions to prevent cognitive decline in the elderly is via performing brain vitalization gymnastics. According to these facts and arguments, the authors were interested in studying the effects of brain vitalization gymnastics performed twice every week for four weeks upon cognitive function in the elderly. Methods: This was a randomized pretest-posttest control group design study involving 38 elderly subjects who were registered in the geriatric subgroup of West Denpasar primary health care clinic. The subjects were equally divided into two groups, i.e., those who performed brain vitalization gymnastics and elderly gymnastics. Montreal Cognitive Assessment Indonesian Version(MoCA-Ina) score as tested with paired t-test among brain vitalization gymnastics and elderly gymnastics groups. Results: both groups before and after the exercise increased by 1.53 and 0.11 points, respectively. Furthermore, the brain vitalization gymnastics group had a statistically significant higher MoCA-Ina score as opposed to the elderly gymnastics group (p=0.047). Conclusion: This study had shown that brain vitalization gymnastics was more effective in increasing elderly's MoCA-Ina score as opposed to elderly gymnastics.

Introduction: This case report aims to describe the diagnostic strategy and optimal management of pregnancy with Myasthenia Gravis and Myasthenic Crisis.Case Description: A 27-years-old pregnant female with Myasthenia Gravis complicated by Myasthenic Crisis was hospitalized six times during her pregnancy. Two initial hospitalizations due to acute exacerbation treated with plasmapheresis, and two other hospitalizations complicated with myasthenic crisis treated with massive Therapeutic Plasma Exchange in the Intensive Care Unit. Managing myasthenia gravis in pregnancy, from early pregnancy until delivery, is challenging. Furthermore, the myasthenic crisis in pregnancy is a rare case that requires airway and ventilation support and treatment with plasmapheresis.Conclusion: Myasthenic crisis in pregnancy is a rare condition. Therefore, a guideline about the prenatal, antenatal, delivery plan, exacerbation, and myasthenic crisis management in pregnancy and pregnancy planning women are urgently needed.

Background: Stroke is affected by several factors, age, infection during treatment, obesity, and total cholesterol (TC) levels. Objective: The study aimed to prove low TC serum levels as an unfortunate outcome predictor for intracerebral hemorrhage stroke. Methods : This study is a prospective cohort design. The research did in the Stroke Unit of Sanglah Hospital, Denpasar, from July 1st, 2018 to January 31th, 2019. The study involved patients with hemorrhage strokes with low TC serum levels and aged 40-95 years. Depending on variable divided into two groups with low TC serum levels ( 180mg/dL). Independent variable is The National Institutes of Health Stroke Scale (NIHSS) as an outcome. The processing of data analysis using Mac for SPSS version 23. Result : This study used 70 subjects. The age characteristics of the study subjects with a median value of 62 years in for low TC levels, and 57 years for normal TC levels, dominant in male (60% ), working (71.5%), not obese (58.6%), stroke-related infections (51.4%), and mean arterial blood pressure (MABP) £130mmHg (90%). Subjects with low TC had a risk of 64 times experiencing adverse outcomes (RR = 64: CI 95% = 14.06-291.32: p

Introduction: Headache among medical students is common. The study from the population estimated that the prevalence of headache reached as many as 12 to 18%, depending on the type of the study. Migraine was frequently found among medical students and related to academic underachievement and limiting daily activity. We would like to identify the prevalence and nature of headache among medical students in Udayana University Denpasar, as well as its impact on their quality of life as a whole.Methods: This was an analytical cross-sectional study, involving medical students of second and sixth semester, Faculty of Medicine Udayana University. The study participants were randomized using random number generator and asked to fill in the multiple questionnaires of various parameters of headache profiles, as well as HIT6 score. All data analysis was conducted using SPSS version 20.Results: According to HIT6 questionnaire results, more than half of study participants experienced a certain impact of their headache in their life, with more than 10% of subjects felt substantial and severe implications. More than 80% of study participants experienced headache during the past one year and approximately 67% of them experienced headache within the past 1 to 3 months. The majority (50.8%) of subjects reported headache of pulsating in nature and 78% experienced headache recurrence for up to 5 times a month. Almost half of them (41.3%) experienced impaired activity to a certain extent. More than half (55%) of subjects found their headache so debilitating that they took sick leave of at least one day.Conclusion: Headache was prevalent among medical students, regardless of their age, gender, and socio-economic status. Although generally mild in intensity, given the nature of its recurrency and debilitating painful quality, medical students often took a leave of absence from class for one or more days, thus potentially impairing the quality of life and academic performance to a certain extent.

Cardiac cephalalgia merupakan nyeri kepala seperti migraine, umumnya namun tidak selalu diperberat dengan aktivitas fisik, timbul selama peristiwa myocardial ischaemia, membaik dengan pemberian nitroglycerine. Cardiac cephalalgia merupakan kasus nyeri kepala yang jarang namun dapat mempengaruhi aspek biopsikososial dan kualitas hidup penderita. Berdasarkan The Internasional Classification of Headache Disorder (ICHD), cardiac cephalalgia digolongkan ke dalam nyeri kepala sekunder yang terkait dengan kelainan homeostasis. Artikel ini membahas pengetahuan terbaru mengenai cardiac cephalalgia terkait definisi, epidemiologi, patofisiologi, gambaran klinis, penegakan diagnosis, diagnosis banding, serta pilihan terapinya dengan melakukan pencarian, review dan telaah serta menyimpulkan berbagai literatur terbaru terkait hal tersebut. Cardiac cephalalgia sering ditemukan pada usia dekade lima. Penegakkan diagnosis berdasarkan nyeri kepala yang berkaiatan dengan adanya myocardial ischaemia, dan berespon baik dengan pemberian nitroglycerine. Penatalaksanaan cardiac cephalalgia menitikberatkan pada penanganan myocardial ischaemia. Nitroglycerine merupakan pilihan utama untuk nyeri kepala Kata Kunci : Cardiac Cephalalgia, Nyeri Kepala Sekunder, Myocardial Ischaemia

Streptococcus suis is a zoonotic pathogen that can infect humans, especially meningitis. S. suis meningitis has been commonly diagnosed in Bali, which is associated with the consumption of raw pork. We reported case of S. suis meningitis that could have occurred due to the ingestion of undercooked pork during a traditional ceremony, which also involved two more patients with similar symptoms. A 62-year-old male was brought to the emergency unit because of decreased consciousness (Glasgow coma scale 14/15) in the last 8 hours before admission. He also had a headache, high fever, and stiff neck. Examination of cerebrospinal fluid revealed the presence of S. suis infection and was confirmed by polymerase chain reaction. The patient was administered ceftriaxone and showed a clinical improvement on the third day without any hearing problem.

Kebutuhan jagung di dalam negeri meningkat setiap tahun seiring dengan bertambahnya jumlah penduduk serta berkembangnya industri pangan dan pakan. Salah satu upaya untuk memenuhi kebutuhan jagung adalah meningkatkan produksi nasional melalui penggunaan varietas unggul jagung hibrida. Penelitian ini bertujuan untuk mengetahui kelayakan finansial dan tingkat pendapatan usaha tani jagung hibrida serta faktor yang mempengaruhi sehingga dapat mendorong minat para petani menggunakan varietas unggul jagung hibrida. Penelitian dilakukan pada tahun 2019 di Nusa Tenggara Barat dan Sumatera Utara dengan melibatkan 115 responden. Hasil penelitian menunjukkan usaha tani jagung hibrida layak secara finansial. Tingkat R/C ratio petani kooperator adalah 1,48 dan B/C ratio 0,48, sedangkan petani nonkooperator memiliki tingkat R/C ratio 1,34 dengan B/C ratio 0,34. Pendapatan usaha tani petani kooperator mencapai Rp23.699.300/ha, lebih besar 3,8% dibandingkan dengan petani nonkooperator Rp22.810.400/ha. Tingkat keuntungan usaha tani petani kooperator adalah Rp7.735.700,00/ha, lebih besar 33,1% dibandingkan dengan petani nonkooperator Rp5.814.200,00/ha. Model regresi menunjukkan variabel produktivitas, harga jual, dan biaya pascapanen jagung berpengaruh positif terhadap peningkatan pendapatan usaha tani. Sebaliknya, pendapatan usaha tani akan menurun sejalan dengan biaya yang dikeluarkan untuk pembelian pupuk urea. Upaya yang` perlu dilakukan ke depan sebagai implikasi kebijakan diantaranya 1) subsidi input produksi; 2) pendampingan secara intensif bagi para petani, terutama pada tahap pascapanen dengan memanfaatkan penyuluh pertanian; dan 3) peningkatan penggunaan varietas unggul hibrida untuk meningkatkan produktivitas usaha tani jagung.

Background: The aging process can increase the incidence of neurodegenerative diseases such as dementia. Dementia is characterized by a gradual loss of cognitive performance for locomotor activity in exploring new environments. Research on dementia in mice was carried out by administering d-galactose to induce mitochondrial dysfunction, oxidative stress, inflammation and apoptosis of neurons.Objective: The purpose of this study was to determine differences in locomotor activity in rats induced by oral d-galactose and intraperitoneal injection.Methods: An experimental study with a posttest control group design. The subjects were male Wistar rats aged 12-14 weeks with weighing 200-300gram obtained from the Animal Laboratory of the Pharmacology Unit of the Faculty of Medicine, Udayana University. The study was conducted for 8 weeks, from June to August 2019. A total of 20 rats induced d-galactose dose of 100 mg/kg/day orally and intraperitoneal injection. The use of animals was carried out after obtaining ethical clearance from the ethical committee of the Faculty of Medicine, Udayana University. Y maze test is conducted for 5 minutes at the end of week 8.Results: There was a decrease in locomotor activity in both groups. The average locomotor activity in the oral group was 6.5+0.268, and the injection group was 5.5+0.341. Bivariate analysis with unpaired t-test showed significant differences in locomotor activity between groups given oral d-galactose compared to the intraperitoneal injection group with p=0.034 (Conclusion: Alzheimer's dementia induced d-galactose mice to have a different locomotor activity after administration by oral or intraperitoneal injection of d-galactose. This study supports the results of previous studies that the administration of d-galactose can cause impaired locomotor activity.

BackgroundCOVID-19 infection can show various manifestation, including neurologic manifestations, such asanosmia,ageusia, ordysgeusia, and causes the neurologic disorder such as stroke, Guillain-Barre syndrome, encephalopathy, and many more.AimTo briefly review neurologic manifestation in COVID-19 infection in the Asia region (South East Asia and the Western Pacific Region).Material and methodsThis review uses the PRISMA statement and checklist. The source for reviewed article was performed in PubMed that were published between December 2019 to September 2020 with the latest 1 year of publication. Study titles were first screened, then reviewed by title and abstract and then the last review, we tested full text and applied eligibility criteria.ResultsWe found a total of 9 retrieved articles from the electronic database. Among these 9 articles, 5 of them are case report, 1 case series, 1 prospective multi-center cohort study, 1 retrospective multi-center study, and 1 retrospective observational study. All articles reported confirmed COVID-19, confirmation by positive swab test using the real-time RT-PCR method, with neurologic manifestations, disorder, or syndrome on presentation or found during hospital stay. In case of neurologic disorder or syndrome, the studies reported encephalitis and ADEM, acute cerebrovascular disease, acute symptomatic seizure, and Guillain-Barré syndrome with acute cerebrovascular disease as the most common neurologic disorder associated with COVID-19 infection, followed by encephalitis.ConclusionCOVID-19 also affects the brain, which may result in a global or focal neurologic manifestation. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient’s outcome.Guillain-Barre syndrome, encephalopathy, and many more. This review will briefly review neurologic manifestation in COVID-19 infection in the Asian region (South East Asia and the Western Pacific Region. A total of 9 retrieved articles from the electronic database reported confirmed COVID-19, confirmation by RT-PCR method, with neurologic manifestation, disorder, or syndrome on presentation or found during hospital stay. Healthcare provider treating patient with COVID-19 infection should also be aware of neurologic manifestation associated with COVID-19 infection to improve patient’s outcome.

BACKGROUND: Studies have shown the effects of music toward improved cognitive function due to changes in molecular production and signaling through increased messenger secretion, including hormones, neurotransmitters, and growth factor proteins. Most of the studies used Western classical music as an intervention. AIM: We would like to investigate whether traditional Balinese flute musical composition entitled can improve cognitive function as well as brain-derived neurotrophic factor (BDNF) and interleukin (IL)-6 levels, on par with the Western classical composition. METHODS: This was a prospective intervention trial involving 40 participants recruited from Primary Health Clinic 2 in West Denpasar, Bali, and divided into two groups. Participants were asked to listen to either “Morning Happiness” by Mr. Agus Teja Sentosa, S. Sn (treatment), or Vivaldi’s composition of “Spring” (control group) for 20 min each day for 21 days. Cognitive evaluation was performed using Montreal Cognitive Assessment (MoCA)-INA and blood sample was withdrawn during the 1st day for BDNF and IL-6 levels measurement. All statistical analyses were conducted using IBM SPSS Statistics 20. RESULTS: There was a significant difference between initial and endpoint MoCA-INA test results among treatment and control group (p < 0.001), but there was no significant difference between control and treatment (p = 1.00). BDNF levels differed significantly between initial and endpoint BDNF levels among control group (p < 0.001), but did not differ significantly between control and treatment groups (p = 0.534). There was no significant difference between initial and endpoint IL-6 levels between the control group, but there was a close to statistical difference between of initial and endpoint IL-6 levels among the treatment group (p = 0.052). There was a significant difference in the memory domain between the control and treatment groups (p = 0.01) as measured using MoCA-INA questionnaire. CONCLUSION: Balinese traditional flute composition was proven to be non-inferior when compared with Western classical composition as it improved mainly memory domain accompanied by increasing BDNF and decreased IL-6 levels.

Pendahuluan: Mikroalbuminuria merupakan salah satu indikator kerusakan endovaskular sistemik yang berkaitan dengan kerusakan endotel. Mikroalbuminuria menjadi salah satu faktor risiko penting terhadap prediktor risiko dan prognosis penyakit serebrovaskular. Namun hubungan antara mikroalbuminuria dan prognosis stroke iskemik akut masih belum jelas, terutama kaitannya dengan komorbiditas yang lain. Tujuan: Penelitian ini bertujuan untuk membuktikan mikroalbuminuria sebagai prediktor luaran buruk penderita stroke iskemik akut di RSUP Sanglah Denpasar. Metode: Penelitian ini merupakan kohort prospektif pada penderita stroke iskemik akut yang dirawat di RSUP Sanglah Denpasar mulai bulan Oktober hingga Desember 2018. Seluruh peserta yang memenuhi kriteria inklusi dan eksklusi dan bersedia berpartisipasi dalam penelitian ini diikutsertakan ke dalam studi. Mikroalbuminuria diukur dengan metode pengukuran rasio albumin kreatinin dengan kadar 30-300 mcg/mg. Luaran stroke dikelompokan menjadi baik dan buruk berdasar perbandingan nilai National Institutes Health Stroke Scale (NIHSS) awal saat pasien masuk dan NIHSS akhir pada hari ketujuh sejak awitan. Analisis statistik dilakukan secara bivariat dan multivariat. Hasil: 60 orang memenuhi kriteria eligibilitas. Mikroalbuminuria meningkatkan risiko luaran buruk pada pasien stroke secara bermakna (RR 5,47; IK 95% 2,17 – 13,8; p=

BACKGROUND: Nurses are one of the many jobs that use the shift work system. Nurses work lovingly, requiring high attention when working. Sleep disorders are often experienced by nurses who work shifting outside of normal working hours. Long sleep disorders can cause cognitive function disorders. AIM: This study aims to determine the effectiveness of exposure to blue light in improving cognitive function and serum orexin levels compared to exposure to white light. METHODS: An experimental study with a pre-test-post-test control group design. Subjects were divided into treatment groups (exposure to blue light) and the control group (exposure to white light) equally. Both groups assessed cognitive function scores using the MoCA-INA and examined serum orexin levels before and after light exposure. RESULTS: The mean increase in the cognitive function score of the treatment group (5.00; p < 0.001) was greater than the control group (0.417; p = 0.054) and the mean increase in serum orexin levels in the treatment group (1068, 244; p < 0.001) was greater than the control group (336,706; p = 0.052), the increase in the treatment group was found to be statistically significant. CONCLUSION: Exposure to blue light before carrying out night shift can increase cognitive function scores 5 times greater and increase serum orexin levels higher than exposure to white light on nurses.

Metastasis otak menempati tumor intrakranial yang paling sering terjadi yang insidensinya melebihi tumor otak primer. Hingga kini metastasis otak masih memiliki tingkat morbiditas dan mortalitas tinggi. Sebagian besar metastasis merupakan lesi massa parenkimal makroskopis dengan edema di sekitarnya, dan terjadi pada gray-white matter junction. Metastasis otak tipe milier merupakan kondisi yang jarang dijumpai dengan prognosis yang umumnya buruk. Pasien laki-laki, 51 tahun, dirawat dengan keluhan kesadaran menurun sejak 1 minggu sebelum ke rumah sakit. Pasien didiagnosis dengan adenokarsinoma paru EFGR positif sejak bulan Maret 2019 dan sejak April 2019 memulai pengobatan dengan gefitinib 200mg tiap 24 jam. Pasien juga mengalami nyeri kepala yang hilang timbul disertai dengan muntah. Pemeriksaan MRI kepala kontras ditemukan adanya lesi punktat multipel-milier menyebar pada hampir seluruh bagian otak, mengesankan suatu metastasis tipe milier. Pemeriksaan lanjutan terhadap mutasi EGFR T790M menunjukkan hasil yang positif Metastasis otak tipe milier merupakan kondisi yang jarang dijumpai dengan prognosis yang umumnya buruk. Kemoterapi dan radioterapi hasilnya tidak memuaskan. Pola metastasis tipe milier harus dipertimbangkan dalam diagnosis diferensial pasien dengan demensia progresif dan lesi multipel dikarenakan beberapa penyakit mempunyai gambaran hasil CT scan kepala yang mirip. Hingga kini belum terdapat regimen terapi standar untuk metastasis otak tipe milier namun hasil penelitian menunjukkan kombinasi whole brain radiotherapy dan EGFR tyrosine kinase inhibitor dipandang dapat memberi efek yang menguntungkan. Harapan hidup pada kasus-kasus ini berkisar antara 14 hari sampai 24 bulan. Kata kunci: Adenokarsinoma, otak, paru, metastasis, tipe milier

BACKGROUND: The aging process can increase the incidence of dementia, such as spatial memory impairment to remember space, recognize shapes and distances. Research on dementia in mice was carried out by administering d-galactose through intraperitoneal injection, while oral d-galactose administration had not received enough attention. AIM: This study aims to prove the differences in the occurrence of spatial memory impairment in rats induced by d-galactose through two different routes, oral and intraperitoneal injection. METHODS: This study is an experimental study using a post- test control group design. The sample criteria were 20 male Wistar rats aged 12–14 weeks, weighing 200–300 g divided into two groups which are the oral and intraperitoneal injection. Spatial memory assessment based on spontaneous alternation using the Y-maze test was carried out at the end of week 8. RESULTS: In this study, the average spatial memory score after d-galactose administration in the injection group (51.572±4.388) was lower compared to the oral group (66.058±1.551). The Shapiro–Wilk normality test shows that the data are normally distributed with p > 0.05. Independent t-test showed a significant difference in the incidence of spatial memory disorders between the injection and oral groups with p = 0.010 (p < 0.05). CONCLUSION: The conclusion of this study is that d-galactose administration by oral route or intraperitoneal injection causes a decrease in spatial memory in mice. Spatial memory in the injection group was lower than in the oral group. This might be related to the decrease in synaptophysin in the hippocampus of mice due to d-galactose administration by intraperitoneal injection.

CHRONIC ORGANOPHOSPHATE EXPOSURE AS A RISK FACTOR OF NEUROCOGNITIVE IMPAIRMENT THROUGH HIGH LEVEL OF PHOSPHORYLATED TAU SERUMABSTRACT Introduction: Chronic organophosphate exposure is predicted related to decreased of neurocognitive function, but the mechanism is still unclear. One possible mechanism is abnormal tau protein metabolism as measured in the serum. Aims: To measure the role of chronic organophosphate exposure causing neurocognitive impairment through high serum levels of phosphorylated tau protein (p-tau).Methods: This case control study was conducted in Penarukan Village, Tabanan, Balifrom July 2018 to January 2019. This study involved farmers aged 40-60 years who used organophosphates pesticide for at least the last 2 years and did not wear any personal protective equipment during pesticide use. Neurocognitive function was evaluated using Mini Cog Test. The level of p-tau was measured by taking a 2 mililiters of blood sample and analyzed using enzyme-linked immunosorbent assay (ELISA) method.Results: Sixty six(case = 33; control = 33) subjects were enrolled.Exposure to pesticides for ≥10 years had a higher risk for neurocognitive impairment than

HIGH SUBSTANCE P SERUM LEVELS AS RISK FACTOR FOR CHRONIC TENSION TYPE HEADACHE AMONG MEDICAL STUDENT FACULTY OF MEDICINE UDAYANA UNIVERSITYABSTRACTIntroduction: Several studies revealed that serum substance P (SP) levels increase in people with headache, particularly chronic tension-type headache (CTTH). One of the examples of population at risk of CTTH is medical students because of their stressful academic load. Aim: To determine whether high serumSP levels are the risk factors of CTTH among medical students.Methods: A case-control study was conducted to medical students, aged 19 to 21, of the Faculty of Medicine, Udayana University from December 2018 to January 2019. Subjects were classified into case group (with CTTH) and control group (without CTTH). SP serum levels were measured on both groups. Analyses included univariate, bivariate with Fisher's test to calculate relative risk (RR), and multivariate logistic regression analysis.Results: Sixty-two subjects, predominantly female (51.6%), were involved in this study. In the case group, most of the subjects had mild depression (71%), mild stress (93.5%), pericranial tenderness (61,3%), and elevated SP serum levels (83.9%). From the multivariate analysis, a high level of SP serum (≥ 349,06ng/L) was the risk factor of CTTH (adjusted Odds ratio 9.9; 95% CI 1.06-93.16). Besides that, other factors, for example, mild stress, mild anxiety, mild depression, pericranial tenderness, and sleep disturbances, were related to the prevalence of CTTH(p=0.001).Discussion: This study concluded that high serum SP levels significantly increased the risk of CTTH occurrence among medical students.Keywords: Chronic tension-type headache (CTTH), medical student, SP serum levelsABSTRAKPendahuluan: Beberapa penelitian menunjukkan kadar substasi P (SP) serum meningkat pada penderita chronic tension type headache (CTTH). Salah satu populasi yang rentan mengalami CTTH adalah mahasiswa kedokteran karena beban akademik relatif tinggi yang diduga berkaitan dengan stres psikologis.Tujuan: Mengetahui apakah kadar SP serum merupakan salah satu faktor risiko CTTH pada mahasiwa kedokteran.Metode: Studi kasus kontrol dilakukan terhadap mahasiswa Fakultas Kedokteran Universitas Udayana berusia 19-21 tahun pada bulan Desember 2018 hingga Januari 2019. Subjek dikelompokkan ke dalam kelompok kasus (dengan CTTH) dan kontrol (tanpa CTTH), kemudian seluruhnya diperiksakan kadar SP serum. Analisis data dilakukan secara univariat, bivariat dengan uji Fisher untuk menghitung risiko relatif (RR), dan analisis regresi logistik multivariat.Hasil: Sebanyak 62 subjek yang mayoritas perempuan (51,6%) ikut serta dalam studi ini. Pada Pada kelompok kasus, sebagian besar mengalami depresi ringan (71%), stres ringan (93,5%), nyeri tekan perikranial (61,3%), dan memiliki kadar SP serum yang tinggi (83,9%). Berdasarkan analisis multivariat, kadar SP serum tinggi (≥ 349,06ng/L) merupakan faktor risiko CTTH (adjusted rasio Odds 9,9; IK 95% 1,06-93,16). Selain itu, faktor depresi ringan, stres ringan, ansietas ringan, nyeri tekan perikranial, dan gangguan tidur masing-masing berhubungan dengan kejadian CTTH (p=0,001).Diskusi: Kadar SP serum tinggi merupakan faktor risiko terjadinya CTTH pada populasi mahasiswa kedokteran.Kata kunci: Chronic tension type headache (CTTH), mahasiswa kedokteran, substansi P

Streptococcus suis is a zoonotic pathogen that can infect humans, especially meningitis. S. suis meningitis has been commonly diagnosed in Bali, which is associated with the consumption of raw pork. We reported case of S. suis meningitis that could have occurred due to the ingestion of undercooked pork during a traditional ceremony, which also involved two more patients with similar symptoms. A 62-year-old male was brought to the emergency unit because of decreased consciousness (Glasgow coma scale 14/15) in the last 8 hours before admission. He also had a headache, high fever, and stiff neck. Examination of cerebrospinal fluid revealed the presence of S. suis infection and was confirmed by polymerase chain reaction. The patient was administered ceftriaxone and showed a clinical improvement on the third day without any hearing problem.

BACKGROUND: Human infection of Streptococcus suis in Indonesia was increasing in the following years. Many cases presented with meningitis and sepsis, but in the current case, we presented a rare case of meningitis S. suis infection with spondylodiscitis. CASE REPORT: A 60-year-old man, Balinese, presented with the 3-day onset of fever, headache, and nausea. Three-hour before admission, he became agitated and decreased of consciousness. He had a history of pork consumption 4 days before admission. He was subsequently diagnosed with acute bacterial meningitis and sensorineural hearing impairment. In the next 2 weeks, he developed low back pain, confirmed as spondylodiscitis from magnetic resonance imaging, a less common presentation of S. suis infection. After 4-week intravenous ceftriaxone treatment, he improved significantly with only hearing impairment remaining. CONCLUSION: Meningitis suis is a systemic infection which can manifest in any organ. The clinician should suspect any low back pain as spondylodiscitis in a patient who had S. suis meningitis.

This study aims to determine anthocyanin antioxidant performance with a dose of 2 cc/day based on the expression of apoptotic cells on ischemic stroke rats cerebellum. Research was conducted using ischemic stroke rats ( Rattus no rvegicus ) that prepared by ligated for 3 h on the Common Carotid Artery (CCA) and External Carotid Artery (ECA) followed by reperfusion that commonly known as MCAO (Middle Cerebral Artery Occlusion). The anthocyanin extract was characterized by LC-MS and its IC 50 was measured by DPPH method. The rats were divided into five groups 1) negative control; 2) reperfusion 1 h; 3) reperfusion 72 h; 4) reperfusion 24 h, with anthocyanin therapy; 5) reperfusion 72 h, with anthocyanin therapy. The results of LC-MS showed that anthocyanin from purple sweet potato extracts contained Petunidin-3,5-O-diglucoside (Pt-DG) with an IC 50 value of 22.16 μg/mL, categorized as very strong antioxidant. The results showed that apoptotic cells expression of cerebellum decreased significantly ( p

BACKGROUND: Ischemic stroke occurs due to the abrupt occlusion in the brain which leads to neuronal death. Neuronal death in ischemic stroke is due to increase production of reactive oxygen species (ROS). Neuronal death occurs via necrosis and apoptosis mechanisms. Apoptosis can either occur via extrinsic or intrinsic pathway. Meanwhile, the intrinsic pathway can be caspase-dependent or independent. Anthocyanin is a natural pigment with antioxidant, anti-inflammatory, anti-cancer, and neuroprotective properties. Balinese cultivate of purple potato extract contains a high level of anthocyanin and has been proven for its antioxidant activity. AIM: Antioxidant effect of Balinese cultivates purple potato extract has not been studied on an animal model with ischemic stroke. Accordingly, we would like to study the effect of antioxidant properties from Balinese cultivate of purple potato extract by assessing the neurological score, BNDF concentration, and caspase-independent apoptosis by measuring AIF concentration on Wistar rats with ischemic stroke. METHODS: This was an experimental study using male Wistar rats age between 12-14 weeks weigh between 200 to 250 g. RESULTS: This study demonstrated a significant difference of neurological score on day 3 among control versus treatment groups. Balinese cultivate of purple potato extract markedly reduced AIF, increased BDNF, and suppressed apoptosis among treatment group when compared with the control group. CONCLUSION: We have proven the efficacy of antioxidant activity of anthocyanin derived from Balinese cultivar of purple sweet potato by elevated AIF levels, lower apoptosis rate, improved neurological score on day-3 to day-7 post-stroke, as well as increased BDNF levels.