Endang Kustiowati
Faculty of Medicine, Diponegoro University

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Plasmin for Enhanced Improvement in Acute Ischaemic Stroke: A Multicentre Randomized Placebo-Controlled Trial Misbach, Jusuf; Jannis, Jofizal; Kustiowati, Endang; Umbas, David Gunawan; Nurimaba, Nurjaman; Suratno, Suratno; Kotambunan, Siwi; Yamanie, Nizar; Soertidewi, Lyna; Octaviana, Fitri; Khosama, Herlyani
Journal of the Indonesian Medical Association Vol. 59 No. 5 May 2009
Publisher : Journal of the Indonesian Medical Association

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Abstract

Plasmin® (rongshuan jiaonans) is a medicine from China - which has gone through a high technology of biochemical extraction - that has thrombolitic effect, fibrinolytic effect, anticoagulant, antiplatelet and anti-inflamation effect. The purpose of this study was to evaluate Plasmin® in acute ischemic stroke patients in a randomized, double-blind, placebo-controlled trial using some assessments of functional outcome and vascular as well as labarotary parameter such as Barthel Index (BI) and Modified Rankin Scale (MRS), mini mental state examination (MMSE), transcranial Doppler’s (TCD) performance, and measurement of blood analysis including fibrinogen level, INR, platelet aggregation, total cholesterol, HDL cholesterol, LDL cholesterol, and triglyceride level. An 84-day randomized double-blind placebo-controlled study was conducted. Participants were recruited from six academic hospitals that had been diagnosed as ischaemic stroke for the first time after 2 hours and before 2 weeks of onset. Patients were randomly assigned to plasmin® or placebo control (1:1 ratio). Sixty patients of ichaemic stroke who fulfilled inclusion criteria were enrolled in the study over 84 days period, with 44 participants completing the study (21 plasmin and 23 placebo). The increasing of BI score at 84th day compare to 14th day was significantly more in plasmin group than in placebo. Eighteen participants (85.7%) of plasmin showed improvement in MRS score, while in placebo group only 12 participants (52.2%) showed improvement (p =0.018). Motor strength of upper extremity was seen improving significantly in plasmin after 14 days of treatment compare to placebo, while lower extremity was significantly improved after 28 days of treatment. Administration of plasmin® in the acute ischaemic stroke patient between 2 hours and 2 weeks of onset showed significant improvement in motor strength, BI score, and MRS score. Further study with larger number of participants is recommended to confirm the benefit of plasmin® in management of acute ischaemic stroke.Keywords: acute ischaemic stroke, Barthel Index, Modified Rankin Scale, plasmin, randomized controlled trial
HUBUNGAN FAKTOR RISIKO STROKE NON HEMORAGIK DENGAN FUNGSI MOTORIK Axanditya, Bianda; Kustiowati, Endang; Lestari P, Dwi
MEDIA MEDIKA MUDA Vol 3, No 1 (2014): MEDIA MEDIKA MUDA
Publisher : Jurusan Kedokteran Umum, Fakultas Kedokteran, Universitas Diponegoro

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Abstract

Latar belakang: Jumlah pasien stroke setiap tahun selalu meningkat dengan manifestasi terbanyak yaitu gangguan motorik. Stroke memiliki faktor risiko yang beragam seperti usia, riwayat keluarga, hipertensi, diabetus melitus, dislipidemi merokok dan lain lain, tetapi belum banyak studi yang mempelajari faktor risiko stroke dengan fungsi motorik.Tujuan: Menganalisa faktor gangguan funngsi motorik pada pasien stroke non hemoragik.Metode: Desain penelitian ini merupakan penelitian observasional analitik dengan rancangan belah lintang, dengan 27 pasien stroke non hemoragik sebagai subjek. Pengumpulan data menggunakan data rekam medik dan pemeriksaan motor assessment scale for stroke. Data disajikan dalam bentuk tabel dan analisa menggunakan uji fisher exact dan regresi logistik.Hasil: Dari 27 pasien stroke non hemoragik dengan gangguan fungsi motorik yang diperiksa, didapatkan hasil penelitian yaitu tidak adanya hubungan antara faktor – faktor risiko stroke seperti jenis kelamin laki-laki, riwayat keluarga dengan stroke, usia >55 tahun, hipertensi, penyakit jantung, diabetus melitus, dislipidemi dan merokok dengan fungsi motorik (p>0,05). Jumlah faktor risiko stroke terhadap gangguan fungsi motorik juga di dapatkan hasil yang tidak signifikan(p=0,294).Kesimpulan: Jenis kelamin laki – laki, riwayat keluarga dengan stroke, usia >55 tahun, hipertensi, penyakit jantung, diabetus melitus, dislipidemi, merokok tidak berhubungan dengan gangguan fungsi motorik pada pasien stroke non hemoragik.
The Effect of Applying Self- and Family-Oriented Written Education on the Management of Medicamentose, Clinical Exposure, and Quality of Life of Patient with Epilepsy Kustiowati, Endang; Samsudi, Samsudi; Widodo, Joko; Kusumastuti, Kurnia
The Journal of Educational Development Vol 6 No 2 (2018): June 2018
Publisher : The Journal of Educational Development

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15294/jed.v6i2.22412

Abstract

Epilepsy is a brain disorder characterized by a tendency to induce a continuous epileptic recurrence and neurobiological, cognitive, psychological, as well as social consequences. Epilepsy seizures are a series of signs and/or symptoms caused by abnormal neuronal activities in the brain. The purpose of this study was to prove the benefits of applying self- and family-oriented educational management to clinical outcomes, self-management, and impact of epilepsy on family, patient’s quality of life, family support, and the role of doctors and family of the epilepsy patient. This is an experimental research using two groups pre and posttest design. The subjects were 80 epilepsy patients ranging from 18 to 70 years of age. All subjects had never had any epilepsy surgery. The subjects were randomly assigned to treatment and control groups; 40 subjects in the treatment group received treatment and self- as well as family-oriented education while the other 40 subjects in the control group received treatment only. Family-oriented education was conducted using written materials on pathophysiology and epilepsy management, psychological effects of epilepsy, and information about the epilepsy community. All of the subjects answered the questionnaires prior to and 3 months after treatment. The questionnaires include information on seizure frequency and seizure-free status, medication adherence, self-management, epilepsy impact on patient and family, and quality of life. The results show that self- and family-oriented education can improve medication adherence, self-management, and family roles. Family-oriented education reduces the frequency of seizures as well as the impact of epilepsy on patients and families. It was concluded that self- and family-oriented education had a positive effect on medical management, clinical outcomes, self-management, and the quality of life of patients with epilepsy.
HOMOSISTEIN PLASMA DAN PERUBAHAN SKOR FUNGSI KOGNITIF PADA PASIEN PASCA STROKE ISKEMIK Yudawijaya, Agus; Kustiowati, Endang; Pemayun, Tjokorda Gde Dalem
MEDIA MEDIKA INDONESIANA 2011:MMI Volume 45 Issue 1 Year 2011
Publisher : MEDIA MEDIKA INDONESIANA

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Abstract

ABSTRACTPlasma homocysteine and cognitive function score change in post ischemic stroke patients Background: Increase of total homocysteine level is a strong risk factor for cerebrovascular disorder and is correlated with decrease of performance in sort of cognitive tests, including mini mental state examination (MMSE) and clock drawing test (CDT). The aim of this study was to prove the correlation between plasma homocysteine level and change in cognitive function score in postischemic stroke patients. Methods: The design was cross-sectional. The subjects were post-ischemic stroke patients, treated at B1-ward Dr. Kariadi Hospital Semarang from January-June 2010. Plasma homocysteine levels were measured on the first week post onset of ischemic stroke using venous blood at GAKI Laboratory Dr. Kariadi Hospital and cognitive function score was examined using MMSE and CDT on the first and 12th week post onset. Datas were analyzed using descriptive analysis and Spearman?s rho correlation test. Results: Of 30 patients, there were 13 patients with homocysteinemia (43.3%) and 17 with hyperhomocysteinemia (56.7%). There was significant difference of MMSE and CDT score decrease in the first and 12th post onset, with p=0.000 and p=0.001 respectively. Spearman?s rho showed correlation between plasma homocysteine level and cognitive function score based on MMSE with r=-0.837; p=0.000, and based on CDT with r=-0.655; p=0.000. Conclusions: There is strong negative correlation between plasma homocysteine level and change in cognitive function score on the first week post onset of ischemic stroke. Keywords: Homocysteine level, cognitive function score, post-ischemic stroke   ABSTRAK Latar belakang: Peningkatan kadar homosistein plasma merupakan faktor risiko kuat terjadinya penyakit  serebrovaskuler dan dihubungkan dengan penurunan performa sederet tes-tes kognitif, termasuk MMSE (mini mental state examination) dilengkapi oleh CDT (clock drawing test). Tujuan penelitian ini adalah membuktikan hubungan antara homosistein plasma dengan perubahan skor fungsi kognitif pada pasien pasca stroke iskemik. Metode: Desain penelitian adalah cross sectional, pasien pasca stroke iskemik dirawat di Bangsal B1 Saraf RSUP Dr. Kariadi Semarang mulai Januari 2010 sampai Juni 2010. Pemeriksaan homosistein plasma dilakukan pada I minggu pasca onset stroke iskemik menggunakan darah vena di Laboratorium GAKI RSUP Dr. Kariadi dan pemeriksaan skor fungsi kognitif dengan tes MMSE dan CDT dilakukan pada I dan XII minggu pasca onset stroke iskemik. Data di analisis dengan statistik deskriptif dan uji korelasi Spearman?s rho.  Hasil: Didapatkan homosisteinemia pada 13 orang (43,3%) dan hiperhomosisteinemia pada 17 orang (56,7%). Terdapat perbedaan bermakna penurunan skor MMSE dan CDT pada I dan XII minggu pasca onset stroke iskemik dengan nilai p=0,000 dan p=0,001. Uji korelasi Spearman?s rho, menunjukkan koefisien korelasi homosistein plasma dengan skor fungsi kognitif berdasarkan MMSE adalah r=-0,837; p=0,000, sedangkan berdasarkan skor CDT adalah r=-0,655; p=0,000. Simpulan: Didapatkan adanya hubungan kuat dan negatif antara homosistein plasma dengan perubahan skor fungsi kognitif pada I minggu pasca onset stroke iskemik.