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Article ; Online: Hyperactive Delirium Management Due to Electrolyte Imbalance in Geriatric Patients

Putu Juni Wulandari / R.A. Tuty Kuswardhani

International Journal of Medical Reviews and Case Reports, Vol 6, Iss 2, Pp 35-

2022 Volume 40

Abstract: Delirium is a serious and common acute neuropsychiatric syndrome in the elderly, characterized by disturbances in consciousness, memory, orientation, perception, thought, and behaviour, fluctuating course and acute onset. The etiologies of delirium are ... ...

Abstract	Delirium is a serious and common acute neuropsychiatric syndrome in the elderly, characterized by disturbances in consciousness, memory, orientation, perception, thought, and behaviour, fluctuating course and acute onset. The etiologies of delirium are multifactorial and diverse and often reflect the consequences of acute medical conditions, disease complications or drug intoxication. Delirium can have a variable presentation and need instruments that can improve detection and diagnosis. Understanding the aetiology, assessment, and systematic detection and treatment programs appear to be beneficial for the elderly. We present the case of female 70 years old with altered mental status after her family noted a change in the patient's behaviour. For the past few days, the patient's appetite waned, and she became agitated. Previously the patient had experienced diarrhoea for several days. After a comprehensive evaluation, the patient was diagnosed with hyperactive delirium due to electrolyte disturbances (hyponatremia and hypokalemia). Treatment is done by improving sodium and potassium levels and administering haloperidol. We discuss the presentation and management of this patient and review the treatment options of hyperactive delirium due to hyponatremia and hypokalemia.
Keywords	delirium ; treatment ; hyponatremia ; elderly ; Medicine ; R
Subject code	616
Language	English
Publishing date	2022-01-01T00:00:00Z
Publisher	Bulgarian Association of Young Surgeons
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Factors Related to the Severity of Delirium in the Elderly Patients With Infection.

Kuswardhani, R A Tuty / Sugi, Yosef Samon

Gerontology & geriatric medicine

2017 Volume 3, Page(s) 2333721417739188

Abstract: Objective: ...

Abstract	Objective:
Language	English
Publishing date	2017-11-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2844974-5
ISSN	2333-7214 ; 2333-7214
ISSN (online)	2333-7214
ISSN	2333-7214
DOI	10.1177/2333721417739188
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Addition of Active Stretching to Balance Strategy Exercise is the Most Effective as a Home-Based Exercise Program in Improving the Balance of the Elderly.

Vittala, Govinda / Sundari, Luh Putu Ratna / Basuki, Nur / Kuswardhani, R A Tuty / Purnawati, Susy / Muliarta, I Made

Journal of mid-life health

2022 Volume 12, Issue 4, Page(s) 294–298

Abstract: Background: The decreased balance in the elderly increases the risk of falling. An effective type of exercise is needed to improve balance for the elderly.: Aims: The purpose of this study was to determine the difference in the effectiveness of ... ...

Abstract	Background: The decreased balance in the elderly increases the risk of falling. An effective type of exercise is needed to improve balance for the elderly. Aims: The purpose of this study was to determine the difference in the effectiveness of adding active stretching with dynamic stretching to balance strategy exercise as a home-based exercise program in improving the balance for the elderly. Participants and methods: This research was a randomized control trial. The participants were 36 elderly selected based on the inclusion and exclusion criteria, divided into three groups. Group 1 was given dynamic stretching exercises to balance strategy exercises, Group 2 was assigned active stretching exercises to balance strategy exercise, and Group 3 was given balance strategy exercise only as a control group. Each group was given different exercises three times a week for 6 weeks. The balance ability of the elderly is measured using a Berg balance scale (BBS). Results: The mean difference scores of BBS before and after exercise with paired sample Conclusion: According to the results, the addition of active stretching exercise to the balance strategy exercise as a home-based exercise program is the most effective in improving balance for the elderly.
Language	English
Publishing date	2022-01-20
Publishing country	India
Document type	Journal Article
ZDB-ID	2595412-X
ISSN	0976-7819 ; 0976-7800
ISSN (online)	0976-7819
ISSN	0976-7800
DOI	10.4103/jmh.jmh_184_21
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis.

Tuty Kuswardhani, R A / Henrina, Joshua / Pranata, Raymond / Anthonius Lim, Michael / Lawrensia, Sherly / Suastika, Ketut

Diabetes & metabolic syndrome

2020 Volume 14, Issue 6, Page(s) 2103–2109

Abstract: Background and aims: The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. ... ...

Abstract	Background and aims: The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. Charlson Comorbidity Index (CCI) is a validated, simple, and readily applicable method of estimating the risk of death from comorbid disease and has been widely used as a predictor of long-term prognosis and survival. Methods: We performed a systematic review and meta-analysis of CCI score and a composite of poor outcomes through several databases. Results: Compared to a CCI score of 0, a CCI score of 1-2 and CCI score of ≥3 was prognostically associated with mortality and associated with a composite of poor outcomes. Per point increase of CCI score also increased mortality risk by 16%. Moreover, a higher mean CCI score also significantly associated with mortality and disease severity. Conclusion: CCI score should be utilized for risk stratifications of hospitalized COVID-19 patients.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/therapy ; Comorbidity/trends ; Hospitalization/trends ; Humans ; Prospective Studies ; Retrospective Studies ; Risk Assessment/trends
Keywords	covid19
Language	English
Publishing date	2020-10-28
Publishing country	Netherlands
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2273766-2
ISSN	1878-0334 ; 1871-4021
ISSN (online)	1878-0334
ISSN	1871-4021
DOI	10.1016/j.dsx.2020.10.022
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients

Tuty Kuswardhani, R.A. / Henrina, Joshua / Pranata, Raymond / Anthonius Lim, Michael / Lawrensia, Sherly / Suastika, Ketut

Diabetes & Metabolic Syndrome: Clinical Research & Reviews

A systematic review and meta-analysis

2020 Volume 14, Issue 6, Page(s) 2103–2109

Keywords	Internal Medicine ; Endocrinology, Diabetes and Metabolism ; General Medicine ; covid19
Language	English
Publisher	Elsevier BV
Publishing country	us
Document type	Article ; Online
ZDB-ID	2273766-2
ISSN	1878-0334 ; 1871-4021
ISSN (online)	1878-0334
ISSN	1871-4021
DOI	10.1016/j.dsx.2020.10.022
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Bone marrow-derived stem cells as an adjunctive treatment for acute myocardial infarction: a systematic review and meta-analysis.

Kuswardhani, R A Tuty / Soejitno, Andreas

Acta medica Indonesiana

2011 Volume 43, Issue 3, Page(s) 168–177

Abstract: Aim: to confirm the beneficial effect of BMCs therapy over placebo in AMI patients with inclusion only to the randomized double blind placebo-controlled trials.: Methods: we searched multiple database (MEDLINE, CENTRAL, CINAHL) through January 2011 ... ...

Abstract	Aim: to confirm the beneficial effect of BMCs therapy over placebo in AMI patients with inclusion only to the randomized double blind placebo-controlled trials. Methods: we searched multiple database (MEDLINE, CENTRAL, CINAHL) through January 2011 for randomized, double-blind, placebo-controlled trials evaluating the efficacy and safety of BMCs for the treatment of AMI. We subsequently performed a random-effect meta-analysis to assess the eligible studies included related to the primary outcomes (mean LVEF, LVESV, and LVEDV changes from baseline) and secondary outcomes (all-cause mortality, recurrent MI, rehospitalization for HF). Results: ten RCTs (total=906 patients) were included. BMCs therapy was proven superior to placebo regarding mean LVEF change (2.07%; 95% CI, 0.55% to 3.59%; [I2=57%; p=0.008]), LVESV (5.52 mL; 95% CI, -7.68 mL to -3.36 mL; [I2=16%; p<0.00001]), and LVEDV (3.08 mL; 95% CI, -5.57 mL to -0.58 mL; [I2=23%, p=0.02]) from baseline. BMCs therapy showed no difference with regards to mortality events when compared to placebo (OR 1.01; 95% CI, 0.35 to 2.94; [I2=0%; p=0.98]), but exerts protective effects toward recurrent MI (OR 0.45; 95% CI, 0.09 to 2.16; [I2=8%; p=0.32]) and rehospitalization for HF (OR 0.39; 95% CI, 0.08 to 1.85; [I2=0%; p=0.24]). All outcomes were sustained for a long period of time (up to 5 years). Conclusion: the resulting meta-analysis concluded that BMCs therapy consistently improves cardiac performance parameters (LVEF, LVESV, and LVEDV) when compared to placebo, even after the establishment of primary intervention. It is also safe to use and prevents the development of recurrent MI and HF.
MeSH term(s)	Bone Marrow Transplantation ; Humans ; Myocardial Infarction/physiopathology ; Myocardial Infarction/therapy ; Stem Cell Transplantation ; Stroke Volume ; Ventricular Function, Left
Language	English
Publishing date	2011-07
Publishing country	Indonesia
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2474707-5
ISSN	2338-2732 ; 0125-9326
ISSN (online)	2338-2732
ISSN	0125-9326
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Older Age and Worse Nutritional State Were Related with Impaired Inflammatory Response in Elderly Patients

R.A. Tuty Kuswardhani / Gede Sukrawan / Ketut Suastika

Bali Medical Journal, Vol 5, Iss 2, Pp 316-

2016 Volume 321

Abstract: ... revealed that age has a moderately negative correlation with both of plasma IL-2 and serum CRP levels (R ... 0.305, p=0.009; and R= -0.413, p=0.005, respectively). Plasma IL-2 levels were positively correlated ... with several variables like body mass index (R=0.282, p=0.016), mini nutritional assessment (R=0.237, p=0.045), biceps ...

Abstract	Background : Ageing process is related with multisystem disorders. One of them is immune response impairment. It is imperative to evaluate the association between age and related nutritional status with inflammatory response in elderly patient. Methods : A cross sectional study to evaluate inflammatory response among elderly patients (≥60 years) at Geriatric Out-patient Clinic, Sanglah Hospital was conducted. Seventy-two patients were enrolled in the study. Age, nutritional states (body mass index and mini nutritional assessment), and inflammatory markers (interleukin-2 [IL-2] and C-reactive protein [CRP]) and other anthropometric as well as laboratory parameters were measured in the study. Results : In the study it was revealed that age has a moderately negative correlation with both of plasma IL-2 and serum CRP levels (R= -0.305, p=0.009; and R= -0.413, p=0.005, respectively). Plasma IL-2 levels were positively correlated with several variables like body mass index (R=0.282, p=0.016), mini nutritional assessment (R=0.237, p=0.045), biceps skin fold (R=0.291, p=0.013), and triceps skin fold (R=0.258, p=0.028). While serum CRP levels has positive correlation with lying diastolic blood pressure (R=0.345, p=0.020) and negative correlation with calf circumference (R=-0.312, p=0.037). No significant associations were found between diabetes and hypertension with inflammatory markers. Conclusion : This study concluded that older age and worse nutritional state were related to worse inflammatory response in the elderly patients.
Keywords	elderly ; nutritional state ; inflammatory response ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	610 ; 616
Language	English
Publishing date	2016-07-01T00:00:00Z
Publisher	DiscoverSys
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: High Interleukin-6 Level Increases Depression Risk on Geriatric Population in Denpasar, Bali-Indonesia

Cokorda Agung Wahyu Purnamasidhi / R.A. Tuty Kuswardhani

Bali Medical Journal, Vol 5, Iss 3, Pp 395-

2016 Volume 399

Abstract: Background : High interleukin-6 (IL-6) serum level was responsible in inflammatory regulation through the interaction within macrophage, glial melatonin production and regulation of methyl CpG-binding protein 2 (MeCP2) and influenced neuro-inflammation ... ...

Abstract	Background : High interleukin-6 (IL-6) serum level was responsible in inflammatory regulation through the interaction within macrophage, glial melatonin production and regulation of methyl CpG-binding protein 2 (MeCP2) and influenced neuro-inflammation process, thus, it increased the risk of depression. The aim of this study was to determine whether high interleukin-6 serum level increased the risk of depression in geriatrics. Methods : A case control was performed as the design of this study. Geriatric populations with depression enrolled as the case group and without depression as control group. Assessment of IL-6 serum level was conducted by the patient’s venous blood. The IL-6 serum> 10 pg/ml was categorized as high. Results : In this study, 30 cases and 30 controls who met the criteria included as samples. There were 20 males (66.7%) and 10 females (33.3%). Factors associated with an increased risk of depression in geriatric were a high level of serum interleukin-6 (OR=3.60; CI95%: 1.22-10.64, p=0.018) and a marital status (OR=3.50; CI95%: 1.11-11.02, p=0.028). High level of interleukin-6 was a significant and an independent risk factor of depression in geriatric (OR=3.60; CI95%: 1.22-10.64, p=0.021) in multivariate analysis. Conclusion : This study concluded that high IL-6 serum level increased the risk of depression in geriatric.
Keywords	serum interleukin-6 level ; risk ; depression in geriatric ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2016-09-01T00:00:00Z
Publisher	DiscoverSys
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Safety Comparison between Amitriptyline versus Gabapentin on Neuropathic Pain Therapy in Geriatric with Type II Diabetes Mellitus

Made Krisna Adi Jaya / R.A. Tuty Kuswardhani

Bali Medical Journal, Vol 5, Iss 3, Pp 479-

2016 Volume 483

Abstract: Background: Neuropathy in diabetes mellitus is a disorder that occurs in the peripheral nervous system. Diabetic neuropathy is more prevalent in elderly (44%) compared to adult (24%). The most commonly used agent in diabetic neuropathy are Amitriptyline ... ...

Abstract	Background: Neuropathy in diabetes mellitus is a disorder that occurs in the peripheral nervous system. Diabetic neuropathy is more prevalent in elderly (44%) compared to adult (24%). The most commonly used agent in diabetic neuropathy are Amitriptyline and Gabapentin, mostly to treat the neuropathic pain. However, there were variations in the results of the studies that have been done related to safety between both drugs. Thus, further research is needed to confirm the safety of both drugs in diabetic neuropathy treatment especially in geriatrics patients. Objective: The aim of this study was to compare the safety of Amitriptyline versus Gabapentin administration for diabetic neuropathic pain in geriatric. Methods: A prospective cohort study involving 70 elderly were observed during 4 weeks. The outcome targets were incidence of side effect and comparison incidence of side effect between both drugs. Non-parametric Mann Whitney U, Chi-Square, and Fisher’s Exact test were used to analyze the outcome. Result: Most side effects have appeared in the group Amitriptyline is a dry mouth followed by sedation / drowsiness, fatigue, dizziness, and constipation. In the group of Gabapentin the incidence of adverse events that most often arises is sedation (sleepiness) followed by dizziness, dry mouth, and fatigue. Low doses administration showed that Amitriptyline has significantly greater adverse effects (p < 0.05) compared with Gabapentin. However, no significant differences were found in therapeutic dose (p > 0.05). Conclusion: The incidence of adverse events was more common in geriatric patients receiving Amitriptyline compared to Gabapentin.
Keywords	diabetes neuropathic pain ; side effect ; amitriptyline ; gabapentin ; geriatric ; Medicine ; R ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2016-10-01T00:00:00Z
Publisher	DiscoverSys
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis

Tuty Kuswardhani, R A / Henrina, Joshua / Pranata, Raymond / Anthonius Lim, Michael / Lawrensia, Sherly / Suastika, Ketut

Diabetes Metab Syndr

Abstract: BACKGROUND AND AIMS: The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. ... ...

Abstract	BACKGROUND AND AIMS: The ongoing COVID-19 pandemic is disproportionately affecting patients with comorbidities. Therefore, thorough comorbidities assessment can help establish risk stratification of patients with COVID-19, upon hospital admission. Charlson Comorbidity Index (CCI) is a validated, simple, and readily applicable method of estimating the risk of death from comorbid disease and has been widely used as a predictor of long-term prognosis and survival. METHODS: We performed a systematic review and meta-analysis of CCI score and a composite of poor outcomes through several databases. RESULTS: Compared to a CCI score of 0, a CCI score of 1-2 and CCI score of ≥3 was prognostically associated with mortality and associated with a composite of poor outcomes. Per point increase of CCI score also increased mortality risk by 16%. Moreover, a higher mean CCI score also significantly associated with mortality and disease severity. CONCLUSION: CCI score should be utilized for risk stratifications of hospitalized COVID-19 patients.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #915414
Database	COVID19

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