Joedo Prihartono

Middle Cerebral Artery Pulsatility Index as Predictor of Cognitive Impairment in Hypertensive Patients

Background: Cognitive impairment is a manifestation of cerebrovascular disease regarding hypertension and other degenerative diseases which has become a global health issue due to increased life expectancy. Recently, the gold standard used for diagnosing vascular cognitive impairment (VCI) has required a combination of the neurophysiological approach and magnetic resonance imaging (MRI). The Neurosonological approach, involving measuring the pulsatility index (PI) of the middle cerebral artery (MCA) using Trans Cranial Doppler (TCD), can hopefully be used as an affordable alternative predictor of VCI in patients with hypertension. Methods: A cross-sectional study was conducted at the Outpatient Clinic of the Department of Neurology in Ciptomangunkusumo Hospital, Jakarta. Sixty-six hypertensive subjects with no macrovascular complication were selected and screened using the Montreal Cognitive Assesment-Indonesia version (MoCA-Ina) to determine their cognitive status. Subjects were categorized into two groups; subjects with scores ≥26 were classified as the normal cognitive group, while subjects with scores <26 were classified as the cognitive impairment group. Both groups then underwent TCD examination to determine bilateral MCA PI. Results: There was a significant difference between MCA PI in both groups; it was higher in the cognitive impairment group than normal group (p < 0.001). Subjects with an increased left MCA PI were more likely to suffer cognitive impairment than those with an increased right MCA PI. Conclusion: MCA PI can be used as a predictor for cognitive impairment in hypertensive subjects.

Selected Benefits of Pentoxifylline in Acute Ischemic Stroke Management: Consideration of Risk Factors

Background: The role of pentoxifylline in acute ischemic stroke lacks objective markers of its efficacy. In this study, we used blood viscosity as a specific marker to evaluate the efficacy of pentoxifylline. Objectives: This quasi-experimental study aimed to analyze pentoxifylline as an antihemorrheologic agent in acute ischemic stroke patients with certain risk factors, including age, smoking, hypertension, dyslipidemia, diabetes mellitus, and ischemic heart disease. Method: There were 22 acute ischemic stroke patients with blood hyper viscosity within 72 hours of onset who received pentoxifylline 1.200 mg/day for five days and continued with oral dose 400 mg twice daily for the next twenty-three days. All subjects received the standard treatment for acute ischemic stroke. The risk factors of stroke were recorded including smoking, hypertension, dyslipidemia, diabetes mellitus, and ischemic heart disease. Results: The median of baseline blood viscosity was 6.46 poise (5.20-9.73). The blood viscosity at the seventh and thirtieth day tend to decrease. The mean decrement blood viscosity level was statistically significant in smoking (p=0.009) and dyslipidemia (p=0.006) subjects. Clinical outcomes were assessed using the National Institutes of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and Barthel Index (BI). All subjects had good functional outcome and statistically significant for those who had diabetes mellitus and heart disease. Conclusion: Pentoxifylline is beneficial for acute ischemic stroke patients with risk factors of smoking, dyslipidemia, diabetes mellitus, and heart disease.

Fatty Liver and Its Associated Factors among Breast Cancer Patients in Dharmais Cancer Hospital, Jakarta

Background : Fatty liver is frequently found during ultrasound (US) examination of breast cancer patients. It is not known how the association between breast cancer and fatty liver. This study was aimed to obtaine the prevalence of fatty liver in breast cancer patients and its association with clinical characteristics of the patients. Met h od: This was a cross-sectional study in Dharmais Cancer Hospital, Jakarta. Study subjects were breast cancer patients who came between January 2011 and December 2013. Fatty liver was assessed by using abdominal US and were grouped into mild, moderate, and severe. Clinical characteristics of the patients included age, body mass index (BMI), menopausal status, breast tissue density using Breast Imaging Reporting and Data System (BI-RADS), and immunohistochemical estrogen receptor (ER) status. Results : A total of 72 patients were enrolled during the study period with the mean age of 47.5 years. Fatty liver was found in 68 (94.4%) patients. Sixty (83.3%) patients had moderate-to-severe fatty liver. Patients with moderate-to-severe fatty liver had significantly higher BMI (26.9 ± 5.39 vs. 23.6 ± 4.05 kg/m 2 ; p = 0.005). Fatty liver was not associated with the patient’s age, menopausal status, and breast tissue density. Conclusion : This study showed that the prevalence of fatty liver in breast cancer patients is very high. Fatty liver shows significant association with obesity but is not associated with breast tissue density or estrogen receptor status. Keywords : breast cancer, breast cancer density, fatty liver, estrogen receptor