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Abstrak :
Cedera otak pada perdarahan intraserebral spontan (PIS) terdiri dari cedera primer kerusakan struktural karena proses mekanis dan cedera sekunder akibat respons patofisiologis subklinis mencakup inflamasi, stress oksidatif dan sitotoksik terhadap komponen serta produk degradasi darah. Proses subklinis PIS yang sedang berlangsung tersebut masih belum terpantau secara lengkap, sehingga penelitian ini ditujukan untuk mengidentifikasi perjalanan proses subklinis cedera otak sekunder perdarahan intraserebral spontan dan pengaruhnya terhadap perubahan luaran respons klinis kasus (LRK) PIS pasca-intervensi bedah saraf. Penelitian ini menggunakan desain observasional prospektif, mulai Agustus 2016-April 2018 terhadap 20 subjek yang baru pertama kali mengalami perdarahan intraserebral spontan yang disertai perdarahan intraventricular dan menjalani intervensi bedah saraf external ventricular drainage (EVD). Data tercatat mencakup skor Full Outline of UnResponsiveness (SF), TIK, dan kadar hari ke-1 dan hari ke-7 Tumor Necrosis Factor alpha (TNFα), Superoxide Dismutase (SOD) dan zat besi dalam LSS. Analisis bivariat menggunakan uji Ttak berpasangan atau uji Mann-Whitney. Data skala kategorik diuji dengan Chisquare atau Fisher's exact test, dan untuk data kategorik berpasangan dengan uji McNemar. TIK pasca-intervensi semua subjek menurun secara gradual menjadi normal dan ada lima subjek yang tidak mengalami perbaikan LRK SF hari 1-7. Semua subjek kelompok 'tanpa perbaikan' mempunyai kadar TNFα LSS hari ke-1 tinggi, sebaliknya yang kadarnya normal mengalami perbaikan LRK (P=0,003). Selisih nilai peningkatan TNFα hari 1-7 juga lebih besar bermakna pada yang 'tanpa perbaikan' (P=0,005). Kadar SOD LSS hari ke-1 dan perubahannya tidak terbukti berbeda bermakna antara kedua kelompok. Pengamatan klinis memperlihatkan 80% subjek 'perbaikan', mempunyai kadar zat besi LSS hari ke-1 normal dalam status saturasi transferin < 50%. Semua subjek yang mempunyai kadar zat besi hari ke-1 tinggi dalam status saturasi transferin ≥ 50% mengalami LRK 'tanpa perbaikan'. Terdapat perbedaan bermakna dari selisih peningkatan status saturasi transferin antara kedua kelompok subjek. (P=0,05). Penelitian ini menyimpulkan bahwa subjek PIS dengan kadar TNFα LSS hari ke-1 tinggi dan/atau zat besi LSS tinggi dalam status saturasi transferin ≥ 50%, mempunyai LRK 'tanpa perbaikan'. Semakin besar peningkatan kadar TNFα LSS pada hari ke-7 dan/atau kadar zat besi yang disertai peningkatan saturasi transferrin, mempunyai LRK 'tanpa perbaikan'. Kadar SOD hari ke-1 dan perubahan kadar hari 1-7 belum dapat dimanfaatkan sebagai penanda prognosis dan proses subklinis PIS.

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Brain injury of spontaneous intracerebral hemorrhage caused by primary injury of structural damage due to mechanical processes and secondary injuries resulting from subclinical pathophysiological responses of inflammation, oxidative stress and cytotoxicity to components and blood degradation products including iron. The subclinical pathophysiology processes still cannot be monitored explicitly. This study is aimed at identifying the course of ICH subclinical secondary brain injury process and finding its relations with the days 1-7 trend of clinical response outcomes after neurosurgical intervention. This study is a prospective observational designed study done from August 2016 until April 2018. Twenty subjects were diagnosed as spontaneous intracerebral hemorrhage and underwent neurosurgical intervention external ventricular drainage (EVD). Recorded data consist of everyday Full Outline of UnResponsiveness (FOUR) score, intracranial pressure, and cerebro-spinal fluid (CSF) Tumor Necrosis Factor alpha (TNFα), Superoxide Dismutase (SOD), iron and transferrin saturation at day-1 and day-7. Bivariate analysis performed with unpaired T-test or Mann-Whitney test. Unpaired categorical scale data tested by Chi-square or Fisher's exact test, and McNemar test for paired categorical data. All 'unimproved' subjects had high levels of day-1 CSF TNFα, whereas all subjects with normal TNFα have clinical improvement response (P=0.003). Subsequently those subjects had significantly greater increasing levels (P=0.005). No significant difference of CSF SOD between of 'unimproved' and 'improved' group. Clinical observation clearly showed that 80% of 'improved' subjects have normal day-1 iron levels in controlled by transferrin saturation < 50%. There will be no improvement of those high iron levels with transferrin saturation ≥ 50%. A significant difference results were also noted of increasing transferrin saturation status (P=0,05). This study concluded that SICH with high level of day-1 CSF TNFα and/or high CSF iron with transferrin saturation ≥ 50%, would have an 'unimproved' trend of clinical response outcome. Greater increasing level of those biomarkers in days 1-7, tend to have an unimproved outcome. CSF SOD could not to be use as a significant clinical prognostic and process biomarker.

Abstrak :
Latar Belakang: Cedera Otak Traumatik (COT) mempengaruhi jutaan orang di seluruh dunia setiap tahunnya. Penelitian ini bertujuan untuk mengetahui hubungan temuan radiologi TBI dengan angka kecacatan dan kematian di RSUPN dr. Cipto Mangunkusumo. Metode: Penelitian ini merupakan penelitian deskriptif analitis, dilakukan secara retrospektif dengan menggunakan data sekunder yang diambil dari rekam medis dan arsip pasien yang disediakan oleh Departemen Neurologi FKUI-RSCM yang telah didiagnosis menderita COT sedang dan berat di RSUPN dr. Cipto Mangunkusumo dari Januari hingga Desember 2021. Hasil CT diklasifikasikan menggunakan skor CT Rotterdam. GOSE digunakan sebagai outcome prediktor dimana penilaian dilakukan pada hari ke 14, 30, dan 90. Analisis bivariat akan dilakukan dengan menggunakan uji Chi-square dan uji Mann-Whitney. Hasil: TBI sedang menjadi dominan (88,5%) dan SAH menjadi kelainan CT paling umum di RSCM (57,6%). Usia ditemukan menjadi faktor signifikan dalam perkembangan hasil yang lebih buruk pada hari ke-14 pasca-trauma (p= 0,026). Keparahan juga ditemukan sebagai faktor yang signifikan terlepas dari kapan skor GOSE diambil (hari ke-14 p= 0,004, hari ke-30 p= <0,001, hari ke-90 p=<0,001). SAH merupakan prediktor hasil yang signifikan pada hari ke-14 (p=0,030), hari ke-30 (p=0,010), dan hari ke-90 (p = 0,009). DAI (p= 0,048) dan edema serebral (p=0,009) memainkan peran penting terhadap hasil pada hari ke-90. Skor CT Rotterdam memiliki hubungan yang signifikan terhadap prediksi hasil pada hari ke-14 (p=0,009), hari ke-30 (p <0,001), dan hari ke- 90 (p <0,001). Kesimpulan: Tingkat keparahan COT, SAH, DAI, dan edema serebral mempunyai peran penting dalam prediksi hasil akhir penelitian. ......Introduction: TBI affects millions of individuals around the world. This research aims to explore the relationship between radiological findings of TBI and the disability and mortality rate in Cipto Mangunkusumo Hospital Methods: This is a descriptive analytical research, done in a retrospective way by the usage of secondary data extracted from medical records of patients that had been diagnosed with TBI in Cipto Mangunkusumo hospital in 2021. GOSE was used as an outcome predictor in which assessment was done at the 14th, 30th, and 90th day. Analysis was done using Chi-square test and Mann-Whitney test Results: Moderate TBI to be predominant (88.5%) and SAH to be the most prevalent CT abnormality in Cipto Mangunkusumo hospital (57.6%). Age was found to be a significant factor in the development of worse outcomes in the 14th day post-trauma (p= 0.026). Severity was found to be a significant factor also regardless of when the GOSE score was taken (14th day p= 0.004, 30th day p= <0.001, 90th day p=<0.001). SAH was a significant predictor of outcome at the 14th day (p=0.030), 30th day (p=0.010), and 90th day (p = 0.009). DAI (p= 0.048) and cerebral edema (p=0.009) played a significant role on the outcome at the 90th day. Rotterdam CT score had a significant association in outcome prediction at the 14th day (p=0.009), 30th day (p < 0.001), and 90th day (p < 0.001). Conclusion: Severity, Rotterdam CT score, SAH, DAI, and cerebral edema had a significant role in prediction of outcome at the end of the study.

Abstrak :
ABSTRAK
Latar Belakang : Cedera Kepala masih menjadi masalah medis sekaligus masalah sosial-ekonomi di Indonesia. Angka mortalitas dan morbiditasnya enderung meningkat. Proses Neuroinflamasi dan Stres Oksidatif berperan dalam proses cedera kepala sekunder setelah trauma. Iskemia otak menjadi pencetus proses ini yang berujung pada kematian sel saraf.

Penelitian ini bertujuan untuk menentukan hubungan antara proses neuroinflamasi dan stres oksidatif dengan prognosis pasien cedera kepala dan hubungannya dengan prosedur bedah saraf dengan neuroinflamasi dan stres oksidatif.

Metode: Desain Studi penelitian ini adalah prospektif terhadap 40 pasien cedera kepala yang dilakukan tindakan bedah saraf. Dilakukan pemeriksaan serum antibodi terhadap NR2A dan serum glutahion (GSH) sebelum dan satu hari paska operasi pada pasien cedera kepala, kenudian dinilai hubungannya dengan parameter kesaddaran (GCS) dan fungsi (GOS) serta kaitannya dengan tindakan bedah saraf.

Antibodi terhadap NR2A diukur dengan metode ELISA. Sementara kadar Glutathion (GSH) serum diukur bekerjasama dengan departemen biokimia dan moekuler Fakultas Kedokteran Universitas Indonesia.

Hasil : Dari 40 sampel, sebagian besar adalah lelaki (77,5%) dengan rerata usia 30,78 tahun. Pasien dengan GCS>8 sebanyak 57,5 % sementara dengan GCS < 8 sebanyak 4,7 %. Terdapat peningkatan GCS pada hari ke-7 paska operasi. Diketahui pula terdapat peningkatan GOS pada bulan ke-3 dibandingkan bulan-1 paska operasi.

Kadar serum antibodi NR2A menunjukkan kecenderungan penurunan dibandingkan kadar preoperasi (perbedaan median -1,34 ng/dl).

Tidak terdapat kaitan ntara antibodi NR2A dan GSH serum dengan GCS,GOS dan tindakan bedah saraf.

Kesimpulan : Pemeiksaan kadar antibodi NR2A serum sebaiknay dilakukan secara serial. Kadar antibodi NR2A masih mungkin memiliki nilai prognostik pada pasien cedera kepala.

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ABSTRACT
Background: Head Injury still a medical and socioeconomic problem in Indonesia. Mortality and morbidity rate tends to increase. Neuroinflamation dan oxidative stress play role in secondary brain damage after head trauma. Brain ischemia causing this process into happenand leads to neuronal death. This study aims to determine the association between neuroinflamation and oxydative stress with prognosis of brain injury patients and the association between neurosurgical procedure with neuroinflamation and oxydative stress.

Method: The Study design is a prospective observation of 40 brain-injured patients who underwent surgery. NR2A antibodies and GSH (glutathione )level of pre- and 1 day post operation on brain injury patients were measured, and their association with GCS, GOS and neurosurgical proedures were analyzed.

NR2A antibodies serum level were measured by ELISA. GSH (glutathione) serum level were measured in collaboration with department of Biochemistry and molecular Bioloy, Faculty of Medicine, University of Indonesia.

Result: From 40 patients most are male (77,5%) with mean age 30,78 years. Patient present with favorable GCS (GCS>8) was 57,5 %, while unfavorable GCS (GCS<8) was 42,7%. There was an increase of GCS on day-7 post operation. There was also an increase on patients' GOS on month 3 compared to month-1 post operation.

The postoperative NR2A antibody serum level showed a downward trend compared to preoperative value ( median difference -1,34 ng/dl). There is no significant association of NR2A antibody and GSH serum level with GCS, GOS and neurosurgical procedure.

Conclusion : Serial postoperative NR2A antibody serum level need to be measured in serial manner. NR2A antibody serum may have prognostic values in brain -injured patient.

Abstrak :
ABSTRAK
Latar Belakang. Pasien pasca cedera kepala seringkali mengalami gangguan kognitif. Instrumen komputer “Stimulasi Kognitif” (STIMKOG) adalah salah satu bentuk intervensi terapetik kognitif eksternal yang dapat diberikan pada pasien cedera kepala. STIMKOG memiliki tujuh stimulus yang mencakup lima domain kognitif. Tujuan dari penelitian adalah mengetahui fungsi kognitif pada pasien cedera kepala setelah distimulasi dengan STIMKOG.

Metode. Penelitian menggunakan desain eksperimental. Subyek penelitian adalah pasien cedera kepala ringan-sedang yang dibagi atas kelompok intervensi dan kelompok kontrol. Kelompok intervensi diberikan latihan STIMKOG selama 12 hari berturut-turut sedangkan kelompok kontrol hanya diberikan di hari 1, 6 dan 12. Evaluasi perubahan fungsi kognitif menggunakan pemeriksaan neuropsikologi Skrining tes Luria Nebraska.

Hasil. Sebanyak 60 subyek ikut dalam penelitian, terbagi atas 30 subyek di tiap kelompok. Rasio jumlah laki-laki dan perempuan adalah 2:1. Usia dari subyek penelitian berkisar antara 17-45 tahun, sebagian besar berusia 20-40 tahun (63.3%). Berdasarkan tingkat pendidikan, sebagian besar berpendidikan tamat SMU (51.6 %). Sebanyak 80% subyek adalah cedera kepala sedang sedangkan 20% adalah cedera kepala ringan. Perbaikan nilai STIMKOG kelompok intervensi lebih besar dari kelompok kontrol pada kecepatan waktu, keberhasilan, kegagalan dan persentase jawaban benar. Pada Skrining Tes Luria Nebraska di awal penelitian terdapat gangguan terutama pada tes Kalkulasi 3, Abstraksi dan Bahasa, Working Memory, New Learning Ability, Immediate memory dan atensi. Pasca latihan STIMKOG terjadi penurunan jumlah subyek yang mengalami gangguan kognitif pada kelompok intervensi sebesar 46.7% lebih besar dibandingkan kelompok kontrol (23.3%).

Kesimpulan. Instrumen STIMKOG dapat meningkatkan fungsi kognitf pada pasien cedera kepala ringan-sedang.

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ABSTRACT
Background. Patients with traumatic brain injury were frequently had cognitive disfunction. Computer instrument “Stimulasi Kognitif” (STIMKOG) is one of external therapeutic intervention which can be applied to traumatic brain injury patients. STIMKOG has seven stimulus which include five cognitive domains. The objectives of the study were to obtain cognitive function in traumatic brain injury patients after being stimulated by STIMKOG.

Method. An experimental study was conducted. Participants were mild-moderate traumatic brain injury patients which classified into intervention and control group. Intervention group were trained for 12 days consecutively whereas the control group only in day 1, 6 and 12 with level of difficulty 2. Cognitive evaluation was conducted using neuropsychology examination Screening Test Luria Nebraska.

Result. A total of 60 subjects participated in this study, divided into 30 subjects in each group. The ratio of man and woman was 2:1. The age of the subjects was between 17 and 45 years, with age majority between 20-40 years (63,3%). Based on level of education, 51.6% subjects were secondary high school graduates. The subjects consisted of 80% moderate traumatic brain injury and 20% mild traumatic brain injury. The improvement of STIMKOG score in intervention group was greater than control group in time response velocity, success rate, failure rate and correct answer persentage. Post STIMKOG training, number of subjects with cognitive disfunction had decreased 46,7% in intervention group greater than control group (23,3%).

Conclusion. STIMKOG instrument could improve cognitive function in light-moderate traumatic brain injury patients.

Abstrak :
ABSTRAK
Tujuan : Mengetahui hubungan kadar protein S100 pada pasien cedera otak ringan dan sedang yang diukur secara bertahap pada saat pasien tiba di rumah sakit, beberapa jam pasca trauma, dan sekian hari perawatan di rumah sakit, sehingga dapat digunakan sebagai petanda kerusakan otak.

Latar belakang : Cedera otak menjadi masalah kesehatan masyarakat di seluruh dunia karena dapat menyebabkan kecacatan dan kematian. Diagnosis cedera otak ditegakkan berdasarkan pemeriksaan klinis neurologi, dan CT scan atau MRI untuk melihat kerusakan anatomi. Pemeriksaan kadar protein S100 pada pasien cedera otak ringan dan sedang dengan menggunakan bahan serum diperlukan untuk mendeteksi dan dapat untuk mengevaluasi adanya kerusakan otak pasca traumatik.

Metode : Subyek penelitian adalah orang sehat dan pasien cedera otak ringan dan sedang berdasarkan nilai SKG, pemeriksaan klinis neurologi, dan CT scan, yang diambil darahnya untuk pemeriksaan kadar protein S100 pada saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan. Pemeriksaan kadar protein S100 dalam serum menggunakan Elecsys S100 dengan prinsip ECLIA.

Hasil : Terdapat perbedaan bermakna (p = 0,001) pada semua kadar protein S100 yang diukur saat tiba di rumah sakit, 6 jam pasca trauma, 24 jam pasca trauma, dan hari terakhir perawatan, baik pada pasien cedera ringan maupun sedang. Puncak kadar protein S100 tercapai pada 6 jam pasca trauma pada pasien cedera otak ringan dan sedang. Kadar protein S100 pada pasien cedera otak sedang saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan pasien cedera otak ringan (median 0,259 μg/L rentang 0,207 – 0,680 μg/L vs median 0,150 μg/L rentang 0,051 – 0,289 μg/L, p = 0,001) dan kadar protein S100 pasien cedera otak ringan saat tiba di rumah sakit lebih tinggi secara bermakna dibandingkan kadar protein S100 orang sehat (median 0,150 μg/L rentang 0,051 – 0,289 μg/L vs rerata 0,065 ± 0,017μg/L, p = 0,001).

Kesimpulan : Pada pasien cedera otak ringan dan sedang saat tiba di rumah sakit sudah terdapat peningkatan kadar protein S100 secara bermakna dibandingkan dengan orang sehat. Protein S100 dapat digunakan sebagai petanda untuk deteksi dan evaluasi kerusakan otak pasca traumatik.

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ABSTRACT
Objective: To identify the relation of protein S100 level in mild and moderate brain injury patient, which is measured repeatedly at admission, few hours post trauma, and few days of hospitalization, thus it can be used as brain injury biomarker.

Background: Brain injury becomes worldwide public health issue since it may cause disability and mortality. The diagnosis of brain injury is made based on clinical neurology examination, and CT scan or MRI, to observe anatomical impairment. Serum S100 protein examination in mild and moderate brain injury patients is needed to detect and evaluate the presence of post traumatic brain injury.

Method: This research subject is healthy people and patients with mild and moderate brain injury, based on their GCS grade, clinical neurologic examination, and CT scan. On these patients, the blood for S100 protein examination is taken at admission, 6 hours post trauma, 24 hours post trauma, and last day of hospitalization. Examination of a serum S100 protein is conducted using Elecsys S100 with ECLIA method.

Result: There is significant difference (p = 0,001) in mild or moderate brain injury patients in all serum S100 protein which is measured at admission, 6 hours post trauma, 24 hours post trauma, and the last day of hospitalization. The peak level of serum S100 protein reached at 6 hours post trauma. Serum S100 protein in moderate brain injury patients at admission is significantly higher than the mild ones (median 0, 259 μg/L range 0,207 – 0,680 μg/L vs median 0,150 μg/L range 0,051 – 0,289 μg/L, p = 0,001), and serum S100 protein in mild brain injury patients is also significantly higher than healthy people (median 0,150 μg/L range 0,051 – 0,289 μg/L vs mean 0,065 ± 0,017μg/L, p = 0,001).

Conclusion: In mild and moderate brain injury patients, serum S100 protein is already significantly increased at admission, compared to healthy people. Serum S100 protein can be used as brain injury biomarker to detect and evaluate the presence of post traumatic brain injury.

Abstrak :
ABSTRAK
Klien stroke yang dirawat di rumah sakit sekitar 30-40% mengalami kondisi depresi. Depresi disebabkan karena kondisi fisik klien yang mengalami perubahan akibat penyakit stroke. Penelitian ini bertujuan untuk mengetahui pengaruh terapi kognitif dan psikoedukasi terhadap kondisi depresi, ketidakberdayaan dan kemampuan mengubah pikiran negatif pada klien stroke di Rumah sakit Cipto Mangunkusumo Jakarta. Desain penelitian ini quasi experimental pre and post test with control group dengan jumlah sampel sebanyak 87 orang yang dipilih menggunakan teknik consecutive sampling dimana 29 orang mendapat terapi kognitif dan psikoedukasi keluarga, 29 orang hanya mendapat terapi kognitif dan 29 orang tidak mendapatkan terapi. Uji analisis yang digunakan yaitu uji anova dan pair t-test. Hasil penelitian menunjukkan penurunan kondisi depresi dan ketidakberdayaan serta peningkatan kemampuan mengubah pikiran negatif pada klien stroke yang mendapat terapi kognitif dan psikoedukasi keluarga lebih besar bermakna (Pvalue < 0,05) dibanding kelompok yang hanya mendapat terapi kognitif dan yang tidak mendapatkan terapi. Faktor yang berkontribusi terhadap kondisi depresi pada klien stroke adalah usia. Terapi Kognitif dan psikoedukasi keluarga direkomendasikan pada klien stroke yang mengalami depresi dan ketidakberdayaan.

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ABSTRACT
Stroke patients who were take care in the hospital 30-40% in depression condition. Depression was cause by physical condition patients that were changed due to stroke illness. This research aim was to determine the effect of cognitive therapy and psycho Education for depression, helplessness, and ability to change negative thoughts for stroke patients at Cipto Mangunkusumo Hospital in Jakarta. This research design was quasi experimental pre and post test with control group with a total of sample 87 person with 29 persons are given cognitive therapy and family psychoeducation therapy, 29 persons are given only cognitive therapy and 29 persons are not given therapy. Analysis by anova test and Pair t-test. The result of research show a decrease in depression and helplessness condition and increase the ability to change negative thoughts of stroke clients whom received cognitive therapy and family psychoeducation group larger than whom just only receive cognitive therapy and the group without therapy (p value <0,05). There was factor that contribute depression condition of stroke client is age. Cognitive therapy and Family Psychoeducation are recommended for stroke klien who got depression and helplessness.

Abstrak :
Introduction: Traumatic Brain Injury (TBI) is a common non-infectious disease. It is so common that it is dubbed as the “silent pandemic”. It is also the main contributor of the overall disability and mortality rates in the overall injuries caused by trauma. Studies have found that the annual worldwide TBI occurrence is 295 occurrences for every 100,000 people. Another study found that around 10 million people suffer from TBI which requires hospitalization or with lethal consequences annually worldwide. Several factors can influence the overall outcome of TBI in patients. This study aims to elucidate the influence some of these factors may have; including age, sex, severity, amount of lesion, and brain region affected. Methods: This research is an analytical research using retrospective methods as medical records from the archives of the Department of Neurology of FKUI-RSCM is used. Statistical analysis is done using SPSS with Chisquared and Kruskal-Walis as the main method of statistical tests used; appropriate to data type. Results: Age was found to be a significant factor in the development of worse outcomes in the 14th day post-trauma (p= 0.026). Severity was found to be a significant factor also regardless of when the GOSE score was taken (14th day p= 0.004, 30th day p= <0.001, 90th day p=<0.001). Injuries in multiple brain regions was also a significant factor (14th day p= 0.003, 30th day p= 0.037, 90th day p= 0.008). The parietal region was found to be the only significant predictor (14th day p= 0.013, 30th day p= 0.011, 90th day p= 0.044). Conclusion: Age, severity, amount of brain region affected, and injury in the parietal region is a significant outcome predictor. ......Introduksi: Cedera Otak Traumatik (COT) adalah penyakit non-infeksius yang umum ditemui. Sangat sering hingga dianggap sebagai “pandemi diam-diam”. COT juga merupakan kontributor Tingkat Disabilitas dan Mortalitas utama dari semua cedera traumatik lainnya. Satu studi telah menemukan bahwa kejadian COT tahunan pada seluruh dunia adalah 295 kejadian untuk setiap 100.000 orang. Study lain menemukan sekitar 10 juta orang menderita COT yang memerlukan perawatan di rumah sakit atau berakibat fatal tiap tahunnya di seluruh dunia. Ada beberapa faktor yang dapat mempengaruhi keluaran keseluruhan pasien COT. Studi ini bertujuan untuk menjelaskan pengaruh dari beberapa faktor tersebut; termasuk umur, jenis kelamin, keparahan, jumlah lesi, dan area otak yang terpengaruhi. Methode: Penelitian ini adalah penelitian analitik dengan metode retrospektif dengan menggunakan rekam medis yang tersedia pada arsip Departemen Neurologi FKUI-RSCM. Analisis statistik dilaksanakan menggunakan SPSS dengan metode Chi-Squared dan Kruskal Walis sebagai metode statistik utama yang dipakai dan sesuai dengan tipe data juga. Hasil: Umur ditemukan sebagai faktor yang signifikan dalam perkembangan hasil kurang baik pada hari ke-14 sehabis trauma (p=0.026). Keparahan juga ditemukan sebagai faktor yang signifikan pada tiap titik waktu skor GOSE diambil (hari ke-14 p= 0,004, hari ke-30 p= <0,001, hari ke-90= <0,001). Cedera pada lokasi multipel pada otak juga ditemukan sebagai faktor yang signifikan (hari ke-14 p= 0.003, hari ke-30 p= 0.037, hari ke-90 p= 0.008). Daerah parietal juga ditemukan sebagai prediktor yang signifikan (hari ke-14 p= 0,013, hari ke-30 p= 0,011, hari ke-90 p= 0,044). Konklusi: Umur, keparahan dan jumlah daerah otak yang terpengaruhi dan cedera pada daerah parietal adalah prediktor hasil yang signifikan.

Abstrak :
Background: This study aims to determine the association between neuroinflammation and oxidative stress with prognosis of brain injury patients and the association between neurosurgical procedure with neuroinflammation and oxidative stress condititons. Methods: The study design is a prospective observation of 40 brain injury patients who underwent surgery. IL-6, uric acid, MDA, NR2A antibodies and GSH serum level of pre- and 1 day post-operation on brain injury patients were measured, and their association with GCS, GOS and neurosurgical procedures were analyzed. Results: The post-operative IL-6 serum level showed a downward trend compared to pre-operative value (mean decrease: -190.61 pg/mL). The post-operative IL-6 level was significantly associated with GCS 7 days post-operation (p = 0.006), with OR 24. The post-operative IL-6 serum level was significantly associated with GOS 3 months post-trauma (p = 0.016) with OR 11.6. The post-operative uric acid serum level showed a downward trend compared to pre-operative value (mean decrease: -0.26 mg/dL). There was a significant difference between the mean value of post-operative uric acid serum level in patients with 7 days post-trauma with GCS ≤ 8 (mean: 4.16 mg/dL) and GCS > 8 (mean: 2.71 mg/dL), (p = 0.042). The post-operative MDA serum level showed a downward trend compared to pre-operative value (mean decrease: -0.08 nmol/mL). There is no significant association between MDA serum level, GCS and GOS and no significant association of NR2A antibody and GSH serum level with GCS, GOS and neurosurgical procedure. From the multivariate analysis, the most important neuroinflammatory variable associated with GCS and GOS is IL-6. Conclusion: Neuroinflammation and oxidative stress may have prognostic values in brain-injured patients, in particular IL-6. Neurosurgical procedures may decrease the neuroinflammation process.

Abstrak :
Anterior traumatic injury could be caused by many functional disturbances, such as mastication, speech, and esthetic. This condition can be repaired by paying attention to the aspects. Reposition can be done with any appliance but if the reposition must focus on the esthetic aspect, it will require special attention. In this case, it shows that fixed and removable appliance with prosthetic function can be used as alternative treatment for children who suffer traumatic injury.

Abstrak :
Brain plasticity is the focus of a growing body of research with significant implications for neurorehabilitation. This state-of-the-art volume explores ways in which brain-injured individuals may be helped not only to compensate for their loss of cognitive abilities, but also possibly to restore those abilities. Expert contributors examine the extent to which damaged cortical regions can actually recover and resume previous functions, as well as how intact regions are recruited to take on tasks once mediated by the damaged region. Evidence-based rehabilitation approaches are reviewed for a range of impairments and clinical populations, including both children and adults.