International Journal of Human Capital Management (IJHCM)
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National Consensus on the Use of Sedation Drugs in the Gastrointestinal Endoscopic Procedures
Get PDFGastrointestinal endoscopy is rapidly developing and several gastrointestinal endoscopy equipment are available for both diagnostic and therapeutic purposes. Proper sedation is critical in performing endoscopic procedures, both for patients and physicians. This consensus is used as a guideline and not as a legal standard in performing endoscopic services. This consensus explained the definition, indication, contraindication, and complication prevention during sedation. Factors affecting the need of sedation is patient factors, procedure factors, and sedation level. Diagnostic or therapeutic upper gastrointestinal tract endoscopy which not complicated can be performed with minimal sedation or moderate sedation, while deep sedation can be considered for longer and more complex procedures. Furthermore, assessment and selection of sedation was explained, followed by the guide to choose pharmacological sedation and analgesics. Currently, diazepam, midazolam, propofol, fentanyl, and pethidine is the most likely used sedation during gastrointestinal endoscopy, with midazolam as the preferred medication of choice. This consensus also explained the antidote of each drug and the recovery after procedure. This consensus aimed to improve gastrointestinal endoscopic procedure services in Indonesia.
Hepatitis B Reactivation in Immunosupressed Patients, Prophylaxis and Management
Get PDFHepatitis B virus (HBV) reactivation is a clinical problem associated with high morbidity and mortality rates. Currently, this incidence seems to be increasing around the world. The reactivation commonly developes in immunosuppressed individuals, although it may also occur spontaneously. Individuals who develop malignancy with chronic hepatitis B virus infection are at high-risk for hepatitis B virus reactivation, since they are closely related to immunosuppression, especially when undergoing chemotherapy. The loss of immune control in these patients may results in the reactivation of HBV replication within hepatocytes. This review article will focus on HBV reactivation related to immunosuppressed patients, immunosuppressive drug classes and corresponding risk estimates of hepatitis B virus reactivation, screening test recommended before getting this drugs, choice of antiviral drugs for prophylaxis, and duration of prophylaxis treatment based on EASL, AASLD and APASL guidelines
Primary Hepatic Lymphoma in a 32-year-old Male
No full text A 32-year-old male came with right upper abdominal pain with a mass increasing in size since the last 6 months, with no other typical symptoms. The physical findings revealed right upper abdominal mass, rubbery consistence, irregular surface, rounded edge, unclear border, immobile, without any tenderness. Other physical examination revealed normal findings, without any lymphadenopathy at another site. The laboratory findings revealed non-reactive hepatitis B and C markers, normal AFP, slightly increased LDH. Plain chest X-ray showed elevated right hemidiaphragm, and a large mass sized ± 14.18 x 8.56 x 12.56 cm compressing the liver. We’ve done biopsy with ultrasound guiding on the mass, and the histological examination revealed that it was lymphoma with negative CD20. The diagnosis was established as primary hepatic lymphoma and the patient was then given chemotherapy
The Prevalence, Profile, and Risk Factor of Patients with Ulcerative Colitis at Dr. Saiful Anwar Malang General Hospital
Get PDFBackground: The prevalence ulcerative colitis (UC) in RSCM Jakarta in 1991-1995 is 2.5%. The disease affects men and women at similar rates or slightly more common in women than in men. Age of onset follows a bimodal pattern, with a peak at 15-25 years and a smaller one at 55-65 years, although the disease can occur in people of any age. The precise etiology of UC is not well understood. UC is precipitated by a complex interaction of environmental (cigarretes, diet, non-steroidal anti-inflammatory drug/NSAID, etc), genetic, and immunoregulatory factors. This study aimed to identify the prevalence, profile and risk factor of ulcerative colitis in Dr. Saiful Anwar General Hospital Malang.Method: This is a retrospective survey analysis from medical record which was taken from 2170 patients who underwent colonoscopy in Dr. Saiful Anwar General Hospital Malang from January 2010 to December 2014. Demographic setting (sex, age), clinical features, lifestyle, diagnosis based on colonoscopy were analyzed as the variables.Results: Total patients with UC was 176 patients. The prevalence of UC during 2010-2014 was 8.2% at Dr. Saiful Anwar General Hospital. There was a similar prevalence of sex between male and female patients, in which 95 (53.4%) were male and 81 (46.6%) were female. The average age of patients with UC was 41,6 years. Most patients were presented with abdominal pain (32.90%) and weight loss (42.1%). The diagnosis based on colonoscopy were pancolitis (36%), proctosigmoiditis/proctitis (31.81%), and left-sided colitis (21.9%). The risk factors of UC identified in this study were current smoker, use of NSAIDs/traditional herbs/potion and fiber diet. Majority of ulcerative colitis study samples were non-smoker (75%), not consuming herbal treatment/NSAID (60.22%), and rarely consuming fiber (36.93%). There is a significan correlation between frequency of fiber diet and UC (r = -0.106, p = 0.000).Conclusion: The prevalence of UC was 8.2% in our hospital with men and women were equally affected, and average age was 41.6 years. Patients presented with various clinical symptoms, most are abdominal pain and weight loss. The most frequent diagnosis were pancolitis, proctosigmoiditis/proctitis, and leftside colitis. There is a significant correlation between frequency of fiber diet and UC (r = -0.106, p = 0.000).Keywords : ulcerative colitis, prevalence, profile, risk factor
Accuracy of Liver Fibrosis Degree Based on King’s Score to FibroScan in Chronic Hepatitis B
Get PDFBackground: A great interest has been dedicated to the development of non-invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. Cross et al proposed King’s score, age (years) x aspartate aminotransferase/AST (IU/L) x [international normalized ratio (INR)/platelets (109/L)]. This study aims to investigate the accuracy of King’s score for predicting liver fibrosis in patients with chronic Hepatitis B.Method: From February until July 2013, sixty two patients confirmed chronic Hepatitis B, underwent FibroScan in Division of Gastroenterology and Hepatology at Haji Adam Malik Hospital, Medan. Serum obtained and analyzed for AST, INR, and pancreolauryl test (PLT) activity, and the King’s score was computed. Liver fibrosis pathology was staged according to a defined system on a scale of F0 to F4 in FibroScan. We used predictive values to assess the accuracy of King’s score.Results: King’s score greater than or equal to 12,3 in predicted significant fibrosis has 48.1% sensitivity, 88.6% specificity, 76.5% positive predictive value (PPV), 68.9% negative predictive value (NPV). King’s score greater than or equal to 16,7 in predicted cirrhosis has 83.3% sensitivity, 85.7% specificity, 38.5% positive predictive value (PPV), 98% negative predictive value (NPV). The validation set confirmed the utility of this index, area under receiver operating characteristic curves for each non-significant and cirrhosis was 0,684 (95% CI: 0,545-0,822; p = 0,014) and 0,845 (95% CI: 0,664-1,027; p = 0,006), respectively.Conclusion: The King’s score predicts cirrhosis (grade-4 fibrosis) in patients with chronic Hepatitis B with a high degree of accuracy, potentially decreases the need for liver biopsy
Choledocholithiasis during Pregnancy: Multimodal Approach Treatment
Get PDFPregnancy is an important risk factor for growth of choledochal stones. Since choledocholithiasis encountered during pregnancy, which is also a possible cause of pancreatitis and cholangitis, may be the reason for serious morbidity and mortality both for the mother and the fetus, it should be treated. In this article, the results and reliability of endoscopic retrograde cholangiopancreatography (ERCP) application on a pregnant woman accompanied with percutaneous biliary procedures are presented. We report a case of 33-year-old woman at 19th week of gestation with cholestatic jaundice due to a common bile duct (CBD) stone managed by endoscopic retrograde cholangiopancreatography (ERCP). The patient had post ERCP pancreatitis which resolved with medical management. Percutaneous cholecystostomy was also performed to control source of infection in the gallbladder. ERCP is the first procedure that will be preferred in the treatment of choledocholithiasis in pregnancy with the right indications provided that proper precautions have been taken. Possible harmful effects of ionized radiation on fetus during fluoroscopy should be minimalized by giving in short periods and low doses.Keywords:
Achalasia: A Review of Etiology, Pathophysiology, and Treatment
Get PDFAchalasia was a condition marked by peristaltic movement absent in lower esophageal sphincter and segment that hypertonic result in imperfect relaxation during food ingestion. Achalasia incidence did not differ between men and women, account for 1 in 100.000 people every year with prevalence of 10 in 100.000 people, unrelated specifically with ethnic, and has its highest incidence on 30-60 age group.Based on its etiology, it was divided into primary and secondary Achalasia, while based on its motility, it was into hypermotil, hypomotil, and amotil Achalasia. Until present, several therapeutic modalities were available to treat Achalasia, among them was pharmacology therapy, botulinum toxin injection via endoscopy, pneumatic dilatation, Heller myotomy surgery, and Per Oral Endoscopy Myotomy (POEM)
Comparison of Helicobacter pylori Detection Using Immunohistochemistry and Giemsa and Its Association with Morphological Changes in Active Chronic Gastritis
Get PDFBackground: Gastritis is an inflammation of the gastric mucosa as a response to infection or irritation of the gaster. The most common aetiology of chronic gastritis is Helicobacter pylori (H. pylori) infection. Presence of H. pylori is associated with the occurrence of inflammation, atrophy, and intestinal metaplasia. In terms of morphology, H. pylori is known in 2 forms, which are rod-shaped and coccoid-shaped. Coccoid-shaped bacteria are difficult to detect using Giemsa staining. Therefore, immunohistochemistry staining of H. pylori and evaluation of the sensitivity of coccoid-shaped of H. pylori are needed.Method: Cross-sectional study on 90 biopsy tissues of chronic gastritis patients in year 2015 and 2014, which included 30 Giemsa cases with positive H. pylori, 30 cases of active chronic gastritis with negative H. pylori but coccoid-shaped was found, and 30 non-active chronic gastritis, were subsequently stained with immunohistochemistry staining of H. pylori.Results: Expression of coccoid-shaped H. pylori in active chronic gastritis was significantly different (p < 0.05) in immunohistochemistry staining. There was a significant difference between active chronic gastritis with positive H. pylori and negative H. pylori in immunohistochemistry staining with degree of inflammation. Sensitivity and specificity test between Giemsa and immunohistochemistry staining showed sensitivity of 65% and specificity of 100%.Conclusion: Immunohistochemistry staining in active chronic gastritis was more sensitive compared to Giemsa staining in detecting H. pylori, particularly the coccoid-shaped bacteria
Nutritional Management in Acute Pancreatitis
Get PDFAcute pancreatitis induce a catabolic stress that increase systemic inflammatory response with worsening nutritional status. Current approach in acute pancreatitis therapy was still symptomatic because of no definitive therapy yet to prevent any inflammatory and proteolytic cascade. One of the most important thing to consider in acute pancreatitis therapy was nutritional management. “Pancreatic rest” concept that formerly used have been known to increase cost, sepsis incidence due to catheter use, and also metabolic and electrolyte disorder. Nowadays, “gut rousing” concept was preferable compared to “pancreatic rest” concept, support that nutritional management was needed to stimulate and generate intestinal function. Enteral nutrition administration have to consider patient’s hemodynamic status. Necrosis incidence, respiratory failure, intensive care, and mortality was found to be lower in patients given enteral nutrition in first 48 hours compared to after 48 hours. Nutrition administration via nasogastric tube or nasojejunal tube was still in doubt while several studies showed that nasogastric tube administration was safe and tolerated, otherwise could be evaluated in larger population sample study. Nutrition and metabolic monitoring was also an important part to reach nutritional goals and reduce complications