Background: Epilepsy is a neurological disorder that is still widely found. The main goal of epilepsy therapy is for epilepsy patients to achieve an optimal quality of life with minimal therapeutic side effects. The active compounds in Centella asiatica and Nigella sativa have shown anticonvulsant effects. Objective: To determine the difference in anti-convulsant effects on the administration of Centella asiatica and Nigella sativa extracts in pentylenetetrazole-induced acute epilepsy model. Methods: This experimental study was conducted using 28 male Swiss divided into 7 equally large groups. The study was conducted with CMC Na 0.5% as a negative control and oral Phenitoin 25mg/Kg as a positive control, and 5 treatment groups were given C. asiatica extracts 800mg/Kg and 1000mg/Kg, N. sativa 800mg/Kg and 1000mg/Kg, and a mixture of C. asiatica 400mg/Kg and N. sativa 400mg/Kg orally. On the 7th day, seizure induction with pentylenetetrazole was performed, then measurements were taken. Results: There was significant difference on the seizure onset (p<0.001). In the experimental group, the longest onset we found was in the C. asiatica extract 1000mg/Kg group (99.25 ± 42.96 seconds). There was a significant difference in the total duration of seizure in C. asiatica 1000mg/Kg (p=0.031), N. sativa 800mg/Kg (p= 0.041), and N. sativa 1000mg/Kg (p= 0.030) groups. Conclusion: Administration of C. asiatica 1000mg/Kg and N. sativa 800 and 1000mg/Kg extracts had an anticonvulsant effect on the duration of seizures.
Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder affecting 1–2% of individuals over 60 years old. Beyond motor symptoms, PD is often associated with dementia, especially with advancing age and disease duration. The risk of Parkinson’s Disease Dementia (PDD) increases markedly in older patients, reaching up to 80–90% by age 90. Key risk factors include age, severity of parkinsonism, male gender, psychiatric symptoms, and mild cognitive impairment. PDD differs from Alzheimer’s disease, with more prominent deficits in attention, executive function, and visuospatial skills. Its pathogenesis involves dopaminergic neuronal loss, α-synuclein deposition, inflammation, and oxidative stress. Case Report: A 70-year-old man with a five-year history of worsening hand tremors, gait disturbance, and bradykinesia presented with additional cognitive decline, including forgetfulness and difficulty managing daily tasks. He had a known diagnosis of PD, hypertension, and hearing impairment. Physical exam showed classic PD features, and brain MRI revealed cortical atrophy and an absent swallow tail sign. He was diagnosed with PDD, Hoehn and Yahr stage 3, and treated with pharmacologic therapy and rehabilitation. Discussion: The diagnosis of PDD in this patient was based on the Movement Disorder Society (MDS) criteria, which require pre-existing PD, gradual onset of dementia, and significant cognitive decline affecting daily function, without other identifiable causes. Cognitive testing and MRI findings supported the diagnosis. PDD is associated with neurodegeneration involving dopaminergic and other neurotransmitter systems, particularly affecting executive function and memory. Management aims to address both motor and cognitive symptoms, with cholinesterase inhibitors like rivastigmine shown to improve cognitive outcomes. Conclusion: Patients with PD may experience progression to dementia, marked by both motor and non-motor symptoms. Compared to age-matched individuals without PD, those with PD are at a substantially higher risk of developing dementia.
Background: Obstructive sleep apnea (OSA) is a prevalent global health issue, yet current monitoring methods are often inaccessible or impractical for routine, at-home use. Objective: This study addresses the need for simple, non-invasive tools for sleep quality assessment. Methods: We developed and evaluated a novel, browser-based snoring detection application leveraging TensorFlow.js. A binary classification model was trained on a balanced dataset of snoring and background noise audio. A key feature of the application is its client-side architecture, where all audio processing and model inference occur locally on the user's device, ensuring real-time performance and preserving user privacy. The model's performance was validated on a holdout test set using standard classification metrics. Results: The model demonstrated robust performance, achieving an overall accuracy of 94.12%, a sensitivity of 95.00%, and a specificity of 93.22% in distinguishing snoring from ambient noise. The application successfully generated useful session statistics for users, including total snoring duration, frequency, and the percentage of snoring time during a monitoring session. Conclusion: This study validates the use of a browser-based AI system as a reliable, scalable, and privacy-preserving tool for sleep quality monitoring. While not a diagnostic instrument, the application serves as a highly accessible preliminary screening and awareness tool. This approach represents a significant step toward democratizing sleep health monitoring and empowering individuals to take an active role in managing their well-being.
Background: Parkinsonian syndromes are characterized by progressive motor impairment resulting from nigrostriatal dopaminergic degeneration. Although diagnosis is primarily clinical, early disease stages often overlap with non-parkinsonian disorders, leading to misclassification. Dopamine transporter (DaT) imaging provides an objective biomarker for confirming presynaptic dopaminergic loss. However, the only internationally approved tracer, Iodine-123 ioflupane (DaTscan™), remains unavailable in Indonesia due to the absence of high-power cyclotron facilities and logistical constraints. Technetium-99m TRODAT-1, a generator-based alternative, offers a practical solution for countries with limited nuclear infrastructure. Objective: Two patients with confirmed Parkinson’s disease (A, B) underwent brain SPECT/CT imaging using 99mTc-TRODAT-1. Radiotracer preparation followed standard reconstitution and autoclaving procedures, achieving >95% radiochemical purity. Images acquired four hours post-injection were evaluated visually using the Fabiani scale to assess DaT binding patterns. Results: Patient A demonstrated asymmetric uptake loss in the posterior putamen consistent with mid-stage PD, while Patient B exhibited near-complete absence of striatal binding with increased extra-striatal activity, typical of advanced PD with cognitive decline. Both cases confirm that TRODAT-1 provides reliable visualization of nigrostriatal degeneration and remains technically feasible for local production and distribution. Conclusion: 99mTc-TRODAT-1 represents a viable and diagnostically robust DaT imaging option for Indonesia, offering both clinical accuracy and logistical practicality. Broader implementation could substantially improve diagnostic precision and disease staging in parkinsonian syndromes nationwide.
Background: Upper limb motor impairment is a common and often persistent consequence of stroke, significantly affecting patients' functional independence. Constraint-Induced Movement Therapy (CIMT) and Mirror Therapy (MT) have been widely utilized in post-stroke rehabilitation, yet their comparative effectiveness and neuroplastic mechanisms remains underexplored. Objective: This systematic review aimed to evaluate and compare the efficacy of CIMT, MT, and their combination in improving upper limb motor function among post-stroke patients, with a particular focus on their role in promoting neuroplasticity and neurorestoration Methods: A systematic review based on PRISMA recommendations was conducted on PubMed, ResearchGate, ScienceDirect, and ProQuest, resulting in nine eligible studies. Quality and risk of bias were assessed using the Joanna-Briggs Institute checklist. Results: A total of 248 stroke survivors participated in the reviewed studies. Outcome measures included the Fugl-Meyer Assessment (FMA), Action Research Arm Test (ARAT), Manual Function Test (MFT), and Motor Activity Log (MAL). All three interventions—CIMT, MT, and their combination—resulted in significant improvements in upper limb function compared to conventional therapy. CIMT and its variants (modified-CMIT) consistently showed superior outcomes, particularly in patients with residual voluntary movement. Notably, combined CIMT and MT interventions demonstrated synergistic benefits in several trials. Conclusion: Both CIMT and MT are effective neurorestorative interventions for upper limb recovery after stroke, with CIMT generally producing greater improvements. CIMT primarily promotes cortical reorganization through intensive, task-specific training, whereas MT engages visuomotor and mirror neuron systems to enhance motor network activation. Their integration may provide synergistic neuroplastic benefits.
Background: Neurodegenerative diseases represent a growing global health challenge, with early detection remaining elusive in clinical settings. Recent advances in fluid biomarkers have enabled the identification of molecular changes preceding clinical symptoms, thus offering promising avenues for early diagnosis and personalized management. This review synthesizes current findings on biomarker utility alongside neuroimaging in neurodegenerative disease detection and prognosis Objective: To evaluate the diagnostic accuracy and prognostic value of fluid biomarkers and neuroimaging in the early detection of neurodegenerative diseases, with a focus on Alzheimer’s disease. Methods: This systematic review and meta-analysis, registered in PROSPERO (CRD420251142436), followed PRISMA guidelines. Comprehensive searches across PubMed and Scopus identified peer-reviewed studies from 1985–2025 on neurodegenerative biomarkers and neurobehavioral changes. Standardized mean differences (SMD) along with 95% confidence intervals (CI) were calculated using a random-effects model to address study variability. The degree of heterogeneity was quantified by the I² statistic, while publication bias was assessed qualitatively due to the limited number of included studies. Results: This Meta-analysis reveals heterogeneity in biomarker-MRI correlations, biomarkers demonstrate remarkable accuracy in detecting Alzheimer’s at its earliest stages. This early detection capability for early intervention. No consistent overall effect emerged, underscoring standardization protocols remains a major challenge. Conclusion: Biomarker represent a promising approach for early detection and precise intervention in Alzheimer’s disease. Integrating fluid biomarkers, advanced neuroimaging, and standardized cerebrospinal fluid analysis enhances diagnostic accuracy and enables timely therapy during the prodromal stage. Future research should explore synergies between fluid biomarkers and digital cognitive tools to develop scalable, cost-effective screening protocols.
This letter critiques the article by Kalekar et al. that evaluates the radiological features and extent of mucormycosis, a rare and serious fungal infection, in post-COVID patients using computed tomography (CT) and magnetic resonance imaging (MRI). The letter points out some major flaws and weaknesses in the article, such as the lack of a clear research question and hypothesis, the weak literature review and theoretical framework, the poor study design and methodology, and the superficial discussion and conclusion. The letter suggests some ways to improve the article, such as formulating a specific research question and hypothesis, conducting a comprehensive and critical literature review, describing and justifying the study design and methodology in detail, and discussing the implications and limitations of the study. The letter hopes that the critique will help the authors revise their article and make it more suitable for publication.
Background: Mild head injury (commotio cerebri) due to the direct impact of an impulsive force on the head results in temporary changes in mental status. Post-traumatic amnesia (PTA) plays an important role in predicting cognitive impairment in patients with head injury Objective: This study aimed to assess the relationship between PTA and cognitive function in patients with commotio cerebri at Dr. Zainoel Abidin General Hospital (RSUDZA) in Banda Aceh, Indonesia.. Methods: This cross-sectional observational study recruited 50 patients with mild head injury who were hospitalized in the Neurology Department of RSUDZA between January and March 2025 using consecutive sampling. PTA was assessed using the Galveston Orientation and Amnesia Test-8 (GOAT-8) questionnaire, and cognitive function was evaluated using the Indonesian version of the Montreal Cognitive Assessment (MoCA-INA). Results: The relationship between PTA and cognitive function was assessed using Spearman's correlation test. Statistical significance was set at p<0.05. A strong positive correlation was observed between PTA and cognitive function (p=0.000; r=0.618). Significant relationships existed between commotio cerebri and executive functioning (p=0.000, r=-0.521), naming (p=0.020, r=-0.327), attention (p=0.011, r=-0.357), and memory (p=0.000, r=-0.486). PTA showed significant relationships with memory (p=0.000, r=-0.51), orientation (p=0.000, r=-0.53), abstraction (p=0.011, r=-0.31), and language (p=0.020, r=-0.28). PTA was significantly correlated with cognitive impairment and executive components (p=0.000), attention (p=0.000), and memory (p=0.002). Conclusion: Cognitive impairments after traumatic brain injury include attention deficits, memory loss, and impaired executive functioning. Executive functioning and repetition are the most vulnerable areas in patients with mild head injury. PTA assessments should be conducted immediately after head trauma, as subsequent assessments are inadequate.
Background: This report presents a rare case of TB myelitis with concurrent TBM, emphasizing the importance of early detection and intervention due to its atypical symptoms and high risk of neurological disability. Objective: To report a rare case of tuberculous myelitis occurring concurrently with TBM and to highlight the importance of early recognition, appropriate imaging, and timely therapeutic intervention to improve neurological outcomes. Methods: A clinical case review was conducted involving a 32-year-old male presenting with progressive neurological deficits. Clinical evaluation, neuroimaging, cerebrospinal fluid (CSF) analysis, and treatment response were assessed. Management consisted of anti-tuberculosis therapy, corticosteroids, and intensive rehabilitation, with neurosurgical intervention deferred due to medical instability. Result: he patient initially developed chronic headache, fever, and cough, followed by worsening lower limb weakness, numbness, and urinary retention. Neurological examination revealed paraplegia with sensory level at T4. Imaging demonstrated hydrocephalus and pulmonary tuberculosis, while CSF analysis confirmed TBM. A diagnosis of TB myelitis with concurrent meningitis was established. Following initiation of anti-tuberculosis therapy (2RHZE/10RH), corticosteroids, and rehabilitation, the patient showed gradual neurological improvement despite the postponement of neurosurgical procedures. However, there are still few standardized protocols for diagnosing and treating TB myelitis, which calls for more research. Conclusion: Rapid diagnosis of TB myelitis, a treatable complication of CNS tuberculosis, can significantly improve patient outcomes, necessitating further research and development of new therapeutic approaches.
Background: Diabetic neuropathy (ND) is experienced by more than 50% of people with diabetes and can lead to ulcers and even amputations if not detected early. Fast, accurate, and affordable detection is needed, especially in health facilities with limited equipment, to prevent serious complications due to nerve damage. Objective: The aim of this study was to assess the inter-rater reliability and validity of the Neuropathy Symptom Score (NSS) and the E-Skin Diabetic Simple Test (ESDST) as clinical diagnostic scores for diabetic neuropathy. Methods: The research design used was cross-sectional involving 176 respondents. The selected samples were then assessed for Neuropathy Symptom Score (NSS) and E-Skin Diabetic Simple Test (E-SDST) by two examiners at different times and places. The data obtained were categorized into positive diabetic neuropathy and negative neuropathy. Statistical analysis for reliability testing between examiners with Cohen's Kappa coefficient, while validity with a 2x2 table Results: The reliability value is obtained κ=0.68 with an alpha of 0.00 which means substantial agreement that there is agreement in using this tool from both raters. The results of ESDST validity compared to NSS obtained sensitivity results of 80.1% (high) and specificity 83.3% (high). Conclusion: E-SDST is able to screen people with ND is also capable as a specific diagnostic tool and as a clinical diagnostic tool diabetic neuropathy has moderate/sufficient inter-rater reliability.
Background: Dry Eye Disease (DED) is a multifactorial ocular condition characterized by tear film instability and ocular surface inflammation. The severity of DED is closely related with poorer quality of life. Studies showed that poor sleep quality occurs in more than 40% of patients with DED. This is due to decreased tear secretion and increased tear osmolarity due to poor sleep. Sleep deprivation is associated with higher risk of diseases that have been shown to be associated with an increased risk of dry eye. Objective: This study was conducted to find the relationship between sleep quality and dry eye disease in Indonesia. Methods: This study was an analytic observational study using a cross sectional study design on 240 respondents in Mendalanwangi Village, Wagir District, Malang Regency. The study was conducted by examining Fluorescein TBUT and filling out the DEQ-5 questionnaire to assess DED and the PSQI questionnaire to assess sleep quality among the study subjects. Results: Among participants who experienced DED, 63.9% reported poor sleep quality, whereas only 36.1% reported good sleep quality. Conversely, in the non-DED group, 56.7% had good sleep quality while 43.3% had poor sleep quality. The results of statistical analysis using the chi-square test with a significance value of p = 0.003 (p < 0.05) and OR 2.31 which indicates there is an association between sleep quality and DED. Conclusion: Poor sleep quality increases the risk of DED 2.3 times compared to good sleep quality and affecting person's quality of life, hence increasing morbidity and mortality.
Background: Parkinson’s disease is a chronic and progressive neurodegenerative disorder characterized by both motor and non-motor symptoms that worsen over time, ultimately reducing patients’ quality of life. Objective: This study aimed to describe the clinical characteristics, motor and non-motor complications, and quality of life of Parkinson’s disease patients treated at Arifin Achmad Regional General Hospital, Riau. Methods: This study was a descriptive cross-sectional study conducted at the Neurology Polyclinic of Arifin Achmad Regional General Hospital, Riau, from January to August 2025. Samples were obtained using a total sampling technique. Results: A total of 31 Parkinson’s patients were included. More than half (54.8%) were aged ≥ 60 years, and 51.6% were males. Most had a high school education (32.3%), were unemployed (90.3%), and were not engaged in social activities (61.3%). The majority had no family history of Parkinson’s disease (83.9%) but presented with comorbidities (54.8%). Tremor was the predominant symptom (96.8%), while 67.7% had no motor complications. Cognitive impairment was found in 45.2%, mainly affecting the memory domain (96.8%). Poor sleep quality was common (61.3%), with nocturia as the most frequent disturbance (90.3%). Regarding quality of life, 32.3% of patients were within the acceptable range, with the mobility domain being the most affected (48.4%). Conclusion: Most Parkinson’s patients were elderly males with moderate disease progression. Comprehensive management addressing both motor and non-motor symptoms is essential to improve patients’ overall quality of life.
Background: Short-term memory (STM) is crucial for learning and academic success, particularly in demanding fields, such as medical education. Recent studies have suggested that auditory spiritual interventions, such as listening to Qur’anic recitation, may positively influence cognitive function. However, the evidence specific to Surah Ar-Rahman and its impact on STM among medical students remains limited. Objective: To investigate the impact of listening to Surah Ar-Rahman on the short-term memory performance of medical students. Methods: This quasi-experimental, pre- and post-test controlled study was conducted with 46 second-semester medical students from the Faculty of Medicine and Health Sciences, University of Jambi, Indonesia. Participants were randomly assigned to either an intervention group (listening to Surah Ar-Rahman for 12 min) or a control group (resting quietly for 12 min). Short-term memory was assessed using the digit span test before and after the intervention. Data were analyzed using paired and independent sample t-tests, and effect sizes were calculated using Cohen’s d-. Results: The intervention group showed a significant increase in digit span scores post-intervention (mean difference = 1.48, p < 0.001, Cohen’s d = 0.87), indicating a large effect. No significant changes were observed in the control group. Post-test scores between the groups were significantly different (p = 0.011). Conclusion: Listening to Surah Ar-Rahman had a substantial positive effect on medical students’ short-term memory. This non-pharmacological intervention may be a valuable adjunct to cognitive optimization strategies in medical education.
Background: Neurocritical conditions such as traumatic brain injury, stroke, and brain tumor contribute significantly to mortality. Fluid balance is a key determinant of outcome, as overload can exacerbate brain edema and intracranial hypertension. However, diagnosis-specific evidence remains limited. Objective: To investigate the association between early fluid balance and in-hospital mortality across major neurocritical diagnoses through secondary analysis of a large critical care dataset. Methods: We conducted a secondary analysis using a publicly available dataset from Harvard Dataverse. Adult patients with neurocritical diagnoses were identified, and cumulative fluid balance within the first 72 hours was calculated. Patients were stratified by diagnosis and categorized into positive (>0 mL) or negative fluid balance groups. The primary outcome was in-hospital mortality. Results: A positive early fluid balance was likely correlated with higher mortality across the cohort even without having significant correlation (OR 0.205, 95% CI 0.031–1.301, p=0.093). The effect was strongest for SAH (OR 5.35, 95% CI 0.84–34.12, p=0.036) and for SAH, TBI, ICH, and brain tumor, the interaction terms all approached statistical significance (p=0.036-0.051), suggesting that more positive fluid balance might be associated with an increased risk of death. In contrast, infarct showed no such pattern (p = 0.256). Fluid type could not be distinguished in this dataset, but prior studies suggest composition may further modify outcomes. Conclusion: Early fluid balance shows diagnosis-specific prognostic value in neurocritical care, with fluid overload strongly linked to mortality in SAH, TBI, ICH and Brain tumor. Future studies should integrate fluid type alongside balance to refine individualized strategies.
Background: Insulin resistance is one of the modifiable risk factors for ischemic stroke. Objective: This study aimed to investigate the relationship between treatment success, complications, and the functional status of the patients at 3 months follow up, Triglyceride/Glucose index and Triglyceride/High Density Lipoprotein values in patients who were received intravenous thrombolytic and/or mechanical thrombectomy treatments. Methods: A total of 432 patients aged over 18 years who were treated for acute ischemic stroke were included in the study. The Triglyceride Glucose index was computed using the formula Ln (Fasting Blood Sugar (mg/dl) x Fasting Triglyceride Level (mg/dl)/2) based on blood samples taken on the first day of hospitalization. Etiological evaluation of stroke was performed according to the TOAST classification. Results: Twenty-four hours following intravenous thrombolysis and/or mechanical thrombectomy, patients exhibiting elevated Triglyceride/Glucose index values demonstrated higher NIHSS scores. Moreover, individuals diagnosed with large vessel occlusions had significantly increased Triglyceride/Glucose index and Triglyceride/High Density Lipoprotein ratio levels compared to those with cardioembolic stroke etiology. On the other hand, no meaningful association was identified between Triglyceride/Glucose index and Triglyceride/High Density Lipoprotein values and the duration of hospitalization or modified rankin score outcomes. Conclusion: In this study, no strong evidence was shown regarding the relationship between Triglyceride/Glucose index and Triglyceride/High Density Lipoprotein values and treatment-related complications and functional status at 3-month follow-up in patients who underwent iv thrombolytic and mechanical thrombectomy treatment due to acute ischemic stroke. Prospective studies with longer follow-up of patients are needed on this subject.
Background:Parkinson's disease (PD) is a progressive neurodegenerative disorder, with the main manifestations being tremors, rigidity, bradykinesia, and postural balance disorders, accompanied by a decline in cognitive function. Objective: One of the major challenges in PD is difficulty performing dual tasks, rehabilitation strategies such as dual-task training (DTT) have been proposed to simultaneously target motor and cognitive deficits. In this study, we aimed to assess the impact of dual-task training on cognitive function, balance, gait, and quality of life in patients with Parkinson’s disease. Methods: In this study, 30 patients diagnosed with idiopathic Parkinson’s disease, aged 50–70 years were randomly assigned into experimental group (n=15) receiving dual-task training and control group (n=15) receiving single-task training for 12 sessions (40 minutes each, twice weekly for 6 weeks). Outcome measures included Timed Up and Go test, step length and stride length, fluency test and PDQ-39 measured at baseline, after 3 weeks and after 6 weeks. Results: There was a statistically significant difference was found in PDQ-39 (t= -2.888, p=0. 007), Semantic Fluency test (t=3.391, p=0.002) and phonemic Fluency test (t=2.956, p=0.006) after 6 weeks between experimental and control group. Both groups showed significant improvements in balance, gait parameters after 6 weeks (p<0.05). Conclusion: Both type of training help to improve balance and gait, but dual-task training provided added gains in quality of life and cognition. Incorporating dual-task exercises into rehabilitation may therefore offer superior functional benefits by better reflecting real-world mobility demands.
Background: Glioblastoma multiforme (GBM) is most prevalent and aggressive form of glioma, characterized by a high mortality rate and significant effect on patient's quality of life. The challenges in diagnosing, treating, and predicting prognosis of GBM highlight the need for more reliable biomarkers. Promising characteristics as noninvasive biomarkers have been identified in microRNA (miRNAs) to their critical role in glioblastoma pathogenesis. Objective: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 standards guided implementation of this systematic review and meta-analysis examining diagnostic and prognostic relevance of microRNAs in GBM as non-invasive biomarkers. A total of 9 studies on diagnostic accuracy and 6 studies on prognostic analysis were included. Articles were identified through comprehensive searches in PubMed, EBSCO, and Wiley databases. Availability of diagnostic indicators such as area under curve (AUC), sensitivity, and specificity for miRNA-based diagnosis, along with survival measurements reported as hazard ratios (HRs) or mean survival outcomes, constituted main inclusion requirements for original studies. Results: In meta-analysis, circulating miRNAs achieved notable diagnostic performance, supported by sensitivity and specificity values of 0.86 and 0.92, respectively, along with AUC of 0.93. Subgroup analysis was then performed to assess consistency of accuracy based on ethnicity, sample source, dysregulation category, and miRNA profile mapping. Certain miRNAs also showed promise as prognosis markers as they are involved in glioblastoma progressivity. Conclusion: Circulating miRNAs demonstrate high accuracy as non-invasive biomarkers for GBM diagnosis and prognosis. Their role in glioblastoma progression suggests potential applications in more precise therapeutic approaches.
Background: Acupuncture is an established treatment for peripheral facial nerve paralysis, but optimal management of post-parotidectomy facial nerve paralysis in the geriatric population remains uncertain. Case Report: A 60-year-old man developed right facial nerve paralysis following parotidectomy and received integrated care from a medical acupuncturist, neurologist, and family physician with corticosteroids, mecobalamin, other oral medications, and acupuncture. Electroacupuncture (EA) and manual acupuncture (MA) were given twice weekly for 30-minute sessions (28 sessions), resulting in progressive improvements: lagophthalmos resolved by session 7, mouth symmetry improved by session 20, and eyebrow movement was stored by session 28. Conclusions: House-Brackmann Facial Nerve Grading System (HBFNGS) and nerve conduction velocity (NCV) testing demonstrated functional recovery, suggesting that combined electroacupuncture, manual acupuncture, and pharmacotherapy may be effective for post-parotidectomy facial nerve paralysis.
Background: Stroke is the third leading cause of death globally, and early prediction of in-hospital mortality risk is essential for improving clinical outcomes and optimizing resource allocation. However, no in-hospital mortality system applicable to both ischemic and hemorrhagic stroke currently exists in Indonesia. This study aims to identify significant predictors of in-hospital mortality among stroke patients, to develop an in-hospital mortality prediction score system, and to assess the performance of the score. Methods: This retrospective cohort study included stroke patients hospitalized at Dr. Saiful Anwar Hospital, Malang, Indonesia in January-December 2024, with data obtained from electronic medical records. Multivariate logistic regression with backward stepwise elimination was performed to identify predictors significantly associated with in-hospital mortality. Scoring weights were derived from regression coefficients. Model performance was assessed using accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the curve (AUC). Results: Eight significant predictors were identified: age ≥60 years, male sex, National Institute of Health Stroke Scale (NIHSS) ≥16, leukocytosis, hyperglycemia, hemorrhagic stroke type, pneumonia, and sepsis. These predictors were incorporated into an in-hospital mortality scoring system. The scoring system demonstrated an accuracy of 72.92%, sensitivity 80%, specificity 71.77%, PPV 31.37%, NPV 95.7%, and an AUC of 0.784. Conclusions: Eight out of thirteen proposed predictors were significantly associated with in-hospital mortality among stroke patients. Based on these predictors, a prognostic scoring system for in-hospital mortality was developed, demonstrating fair discriminative performance.
Background: Mobilisation after acute ischemic stroke is commonly practiced, yet the optimal timing and intensity remains uncertain. The AVERT trial (A Very Early Rehabilitation Trial) raised concerns regarding very-early and high-intensity mobilisation, but no prior synthesis has jointly compared timing–intensity strategies. Objective: To compare the effectiveness of mobilisation strategies classified by AVERT timing–intensity criteria and evaluate safety outcomes. Methods: We systematically searched through indexed search engines for randomised controlled trials. The primary outcome was favourable functional recovery at 90 days (modified Rankin Scale 0–2). Risk of bias was assessed using Cochrane RoB-2. A Bayesian random-effects network meta-analysis was performed with treatment ranking using surface under the cumulative ranking curve (SUCRA) and consistency assessed by node-splitting. Safety outcomes (complications and mortality) were summarised using direct comparisons with odds ratios (ORs) and forest plots. Results: Eight trials (n = 813) formed a connected network of six mobilisation strategies. Moderate-intensity mobilisation showed the highest probabilities of favourable outcomes across initiation timings. Also, early–moderate mobilisation was more favorable compared to delayed–moderate mobilisation (OR 2.14; 95% CrI 1.14–4.13). The Surface Under the Cumulative Ranking (SUCRA) curve placed moderate intensity strategies higher. Conclusion: Mobilisation delivered at a moderate intensity (3-6 sessions per day and 20-40 minutes/day) is associated with the highest probability of improved functional recovery at 90 days, when accompanied by careful monitoring and avoidance of very early and high-intensity mobility within the first 24-72 hours. Safety data were heterogeneous and needed standardised adverse-event reporting.
