Background. Stroke remains one of the most common noncommunicable diseases among Indonesian populations. This study aimed to identify the prevalence of stroke and its associated risk factors in the Sleman District of Yogyakarta Special Region, Indonesia. Method. This study was a secondary analysis of community-based data collected by the Sleman Health and Demographic Surveillance System (HDSS) in 2016. Basic demographic and socioeconomic data were collected. Additional questions about history of stroke and other chronic diseases were interviewed as a self-reported diagnosis. History of hormonal contraceptives use and dietary patterns were also collected. We examined the association between the prevalence of stroke and risk factors, namely, age, gender, self-reported history of chronic diseases, hormonal contraceptives use, and high-risk dietary patterns. Results. The survey included 4,996 households composed of 20,465 individuals. Data regarding stroke incidents were available from 13,605 subjects aged ≥20 years old. Among them, a total of 4,884 subjects also have data regarding stroke risk factors. The overall prevalence of stroke in Sleman District was 1.4% (0.5% men and 0.90% women). The prevalence increased with additional decades of age (p<0.001). In a multivariable model, increasing age, self-reported history of hypertension (OR=8.37, 95%CI: 4.76 to 14.69), and self-reported history of diabetes mellitus (OR=2.87, 95%CI: 1.54 to 5.35) were significantly associated with stroke. Conclusions. A community-based survey in Indonesia showed a high prevalence of stroke which was associated with increasing age, hypertension, and diabetes mellitus. These findings suggest that preventive actions against the aforementioned modifiable risk factors should be prioritized.

Background: Caregivers play a central role in post-stroke patients' care. However, the role of and problems managed by caregivers have not been widely studied, particularly in Indonesia. This study aims to explore the roles and problems of caregivers in post- stroke patients’ care. Method: This was a qualitative study. Seven caregivers of post-stroke patients from the homecare clinic of Dr Sardjito General Hospital were purposely selected during January 2017 to June 2018. Focus group discussions were conducted to explore the roles and problems of caregiving. Results: Themes related to caregivers’ roles were: connecting patients with medical personnel and other family members, maintaining patients’ health conditions by fulfilling basic needs and assisting rehabilitation, as well as maintaining patients’ psychological conditions by encouraging conversation, telling jokes, or recreation. On the other hand, themes related to caregivers’ problems were: lack of knowledge caused by education inadequacy, underappreciated and unconcerned family, suboptimal service including limited physiotherapy and pharmacy resource, unthorough administration, lack of communication, physical limitations, and burnout, as well as uncooperative patients. Conclusions: Caregivers play essential roles as communicators and help to maintain patient's health conditions. Common problems are related to a lack of knowledge about strokes and a lack of attention from family. Further research to study the effects of these findings on the quality of life of both patient and their caregiver, as well as how to handle the caregiver issues should be investigated.

The pathophysiology of vascular cognitive impairment (VCI) is associated with chronic cerebral hypoperfusion (CCH). Increased high-mobility group box protein 1 (HMGB1), a nonhistone protein involved in injury and inflammation, has been established in the acute phase of CCH. However, the role of HMGB1 in the chronic phase of CCH remains unclear. We developed a novel animal model of CCH with a modified bilateral common carotid artery occlusion (BCCAO) in C57BL/6 mice. Cerebral blood flow (CBF) reduction, the expression of HMGB1 and its proinflammatory cytokines (tumor necrosis factor-alpha [TNF-α], interleukin [IL]-1β, and IL-6), and brain pathology were assessed. Furthermore, we evaluated the effect of HMGB1 suppression through bilateral intrahippocampus injection with the CRISPR/Cas9 knockout plasmid. Three months after CCH induction, CBF decreased to 30–50% with significant cognitive decline in BCCAO mice. The 7T-aMRI showed hippocampal atrophy, but amyloid positron imaging tomography showed nonsignificant amyloid-beta accumulation. Increased levels of HMGB1, TNF-α, IL-1β, and IL-6 were observed 3 months after BCCAO. HMGB1 suppression with CRISPR/Cas9 knockout plasmid restored TNF-α, IL-1β, and IL-6 and attenuated hippocampal atrophy and cognitive decline. We believe that HMGB1 plays a pivotal role in CCH-induced VCI pathophysiology and can be a potential therapeutic target of VCI.

Background. The global burden of stroke is still high, particularly in developing countries, with hypertension serving as the main risk factor. The awareness of stroke among hypertensive patients is crucial for stroke prevention. This study was aimed at identifying the awareness of being at risk of stroke and its determinant factors among hypertensive patients in Banyumas, Indonesia. Methods. This was a cross-sectional study conducted in Primary Health Centers (PHCs) in Banyumas Regency, Indonesia, from April to August 2019. A simple random sampling technique was used to select the representatives’ PHCs. Hypertensive patients who came regularly to the PHCs were consecutively recruited. Data were collected through a self-reported questionnaire and medical records. The main outcome was the level of participants’ awareness of being at risk of stroke. Multivariate logistic regression analysis was performed to measure determinant factors associated with the level of awareness. Results. Out of 457 patients investigated, 77.46% had a low level of awareness. Low knowledge of hypertension, low income, and no history of previous stroke were associated with a low-level of awareness (odds ratio (OR) 1.942, 95% CI 1.195-3.158, 0.007; OR 2.321, 95% CI 1.326-4.064, 0.003; and OR 6.033, 95% CI 2.450-14.858, , respectively). Conclusion. Majority of hypertensive patients were unaware of being at risk of stroke. Knowledge of hypertension, income, and history of previous stroke are factors that may influence the awareness of being at risk of stroke among them. This emphasizes the need to provide better campaigns and education programs to raise the awareness of stroke in a community setting, particularly for the population at risk.

Context: Radiofrequency therapy is a medical procedure mainly used to reduce pain with a low complication rate (less than 1%), ease of application, and low cost. This review’s objective was to (1) evaluate the pulsed radiofrequency (PRF) effectiveness in treating radicular pain and (2) assess the PRF procedure’s safety in managing radicular pain in lumbar herniated nucleus pulposus (HNP). Methods: A systematic review and meta-analysis. A tertiary care center and an academic medical center. Six full articles with the following features were selected for this review: (1) Articles published in English; (2) studies on the PRF effect on radicular pain in lumbar HNP; and (3) randomized control trials. Results: The studies showed that the PRF group had a reduction in pain scores at each evaluation. In four of the studies, the PRF group showed a more significant reduction in pain scores than the control, and in two of the studies, the reduction in pain scores was not significant in the PRF group compared to the control. An adverse effect was reported in one patient experiencing increased radicular pain after PRF. Lack of data required for statistical analysis, and lack use of a uniform duration for the PRF procedure by all the studies. Conclusions: PRF can be used as a promising clinical recommendation for pain management with minimally invasive radicular pain techniques due to lumbar HNP.

Background: Caregivers play a central role in post-stroke patients care. However, the role of and problems managed by caregivers have not been widely studied, particularly in Indonesia. This study aims to explore the roles and problems of caregivers in post- stroke patients’ care. Method: This was a qualitative study. Caregivers of post-stroke patients from the homecare clinic of Dr Sardjito General Hospital were purposely selected during January 2017 to June 2018. Focus group discussions were conducted to explore the roles and problems of caregiving. Results: Themes related to caregivers’ roles were: connecting patients with medical personnel and other family members, maintaining patients’ health conditions by fulfilling basic needs and assisting rehabilitation, as well as maintaining patients’ psychological conditions by encouraging conversation, telling jokes, or recreation. On the other hand, themes related to caregivers’ problems were: lack of knowledge caused by education inadequacy, underappreciated and unconcerned family, suboptimal service including limited physiotherapy and pharmacy resource, unthorough administration, lack of communication, physical limitations, and burnout, as well as uncooperative patients. Conclusions: Caregivers play essential roles as communicators and help to maintain patient's health conditions. Common problems are related to a lack of knowledge about strokes and a lack of attention from family. Understanding the roles and problems of caregivers may help facilitate better management and increase the quality of life for both patients and their caregivers.