Failure to use routine prevention of disability (POD) assessment resulting In permanent disability
| Main Authors: | Erika Zoulba, Emmy Soedarmi Sjamsoe, Sri Linuwih Menaldi, Melani Marissa, Yudo Irawan |
|---|---|
| Format: | application/pdf Journal |
| Bahasa: | eng |
| Terbitan: |
Universitas Indonesia
, 2016
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| Online Access: |
http://jgenprodvi.ui.ac.id/index.php/jdvi/article/view/34 |
Daftar Isi:
- Abstract Disability is one of problems in leprosy or Morbus Hansen (MH), which can cause the patient loose his autonomy and may affect his social relationship with family and community. Disability occurs due to neurological inflammation that can manifest as silent neuritis (which develops without any pain). Silent neuritis can be recognized early with a routine prevention of disability (POD) assessment. A 19-year-old male patient was referred from a District General Hospital with a history of numbness and stiffness of his 4th and 5th fingers of his left hand since 1 month before admittance. The patient was refered by Community Health Center (CHC or PUSKESMAS) after a one year treatment and RFT. During his treatment at the CHC, no assessment of peripheral nerve or POD had ever been performed. The POD assessment at our hospital demonstrated sensory deficit at some points of assessment on both palms and reduced muscle strength of the first and 5th fingers in both hands. Nerve conduction velocity (NCV) performed at the outpatient of Neurology Department, showed multiple mononeuropathy MH with irreversible damage. Nerve damage is still considered reversible when it occurs less than 6 months. In this case, the silent neuritis was not detected early and there was delayed treatment; as showed by NCV which revealed a manifestation of irreversible nerve damage. Routine POD assessment may detect the condition and appropriate treatment may overcome the nerve damage. Keywords: Morbus Hansen, silent neuritis, prevention of disability assessment Abstrak Kecacatan merupakan salah satu masalah pada penyakit kusta atau Morbus Hansen (MH) yang dapat menyebabkan pasien kehilangan kemandirian serta memengaruhi hubungan sosial dengan keluarga dan masyarakat. Kecacatan terjadi akibat proses inflamasi pada saraf, yang dapat bermanifestasi sebagai silent neuritis (timbul tanpa nyeri). Silent neuritis dapat diketahui sejak awal dengan pemeriksaan prevention of disability (POD) secara teratur. Seorang laki-laki19 tahun, dikonsulkan dari Rumah Sakit Umum Daerah (RSUD) dengan rasa baal dan kaku pada jari ke-4 dan 5 tangan kiri sejak 1 bulan yang lalu. Satu tahun yang lalu, pasien berobat di Puskesmas sampai dinyatakan release from treatment (RFT). Selama di Puskesmas tidak pernah dilakukan pemeriksaan saraf tepi, maupun POD. Hasil pemeriksaan POD di Rumah Sakit terdapat gangguan sensoris pada titik-titik pemeriksaan di kedua telapak tangan dan penurunan kekuatan otot jari ke-1 dan 5 kedua tangan. Hasil pemeriksaan kecepatan hantar saraf (KHS) di Poliklinik saraf didapatkan gambaran mononeuropati multipleks pada MH dengan kerusakan yang ireversibel Kerusakan saraf dianggap masih reversibel apabila terjadi kurang dari 6 bulan. Pada kasus ini silent neuritis tidak diketahui sejak awal dan terjadi keterlambatan tatalaksana, sehingga pada pemeriksaan KHS telah didapatkan gambaran kerusakan saraf yang ireversibel. Hal ini dapat dicegah dengan pemeriksaan POD secara teratur dan pemberian terapi yang sesuai. Kata kunci: Morbus Hansen, silent neuritis, POD