International Journal of Human Capital Management (IJHCM)
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Palliative Stenting With or Without Radiotherapy for Inoperable Esophageal Carcinoma
Get PDFAim: to evaluate the comparison of palliative treatment using esophageal stenting alone or in combination with radiotherapy.Method: Patient/problem, intervention, comparison, and outcome (PICO) system were used. We conduct a searching in PubMed site. The next process was selection by reading all articles (10 articles). There were 9 articles excluded from analysis. We finally choose one randomized trial study written by Javed A, Pal S, Dash NR, Ahuja V, Mohanti BK, Vishnubhatla S, et al goes to the critical appraisal step.Results: The result of this study showed that dysphagia scores improved significantly in both groups, in patients with inoperable esophageal cancer treated with esophageal stenting alone (group I) and a combination of esophageal stenting and radiotherapy (group II) following stent insertion. However, dysphagia relief was more sustained in Group II than in Group I (7 vs. 3 months, p = 0.002).Conclusion: In this evidence-based case report (EBCR), we reported a man who suffered from dysphagia caused by inoperable esophageal carcinoma. Based on the critical appraisal of the randomized trial collected previously from PubMed with specific criterias, we conclude that a combination of esophageal stent and radiotherapy effectively prolongs duration of dysphagia relief and improves the overall survival, without increasing the incidence of complications
Diagnosis and Treatment of Small Intestinal Bacterial Overgrowth
Get PDFSmall Intestinal Bacterial Overgrowth (SIBO) is a clinical condition, in which excess amounts of bacteria are found in small intestine. SIBO occurred when normal homeostatic mechanism which control enteric bacteria population disrupted. Elderly patients are more vulnerable to SIBO which can be caused by two conditions, which are gastric acid reduction and disproportionately drugs consumption which then caused hypomotility. There are several methods to diagnose SIBO, but diagnose often begin with suspicion and history of risk factors of SIBO. There are two most frequent tests in SIBO diagnostic, which are bacterial culture examination and breath test. Treatments of SIBO are: (1) Treatment of underlying disease and improvement of medical condition; (2) Eradication of excess bacterial growth; (3) Resolve nutritional deficiencies which related to SIBO
Diagnostic Approach to Gastroesophageal Reflux Disease: The Role of GERD Questionnaire and PPI Test
Get PDFGastroesophageal Reflux Disease (GERD), according to American College of Gastroenterology (ACG), is symptoms or mucosal damage produced by abnormal reflux of gastric contents into the esophagus. In most patients with GERD, showed no abnormalities in the endoscopic picture. This is what underlies the importance of a diagnostic tool in the form of assessment for the degree of severity of the disease based on symptoms, response to therapy and effect on the patients’ quality of life. This diagnostic tool is then formulated in the form of a questionnaire (GERD Questionnaire). Response to treatment with proton pump inhibitor (PPI) drugs is also often used to support the diagnosis of this disease.DIAMOND study is a large study which aim to assess the accuration of the questionnaire and use of PPI test. Diagnostic method with questionnaire modality and followed by PPI test have sensitivity and specificity value, which are relatively similar to the symptoms-based diagnoses performed by general practitioners or gastroenterologist, as well as when compared to endoscopy and esophageal pH monitoring. Although the diagnosis by methods of questionnaires and PPI test is not the most ideal test in term of accuracy, but these tests are not expensive, readily available and worked mainly on primary health care. These test methods are favored compared to other tests.
Palliative Surgery for Biliary Drainage in an Unresectable Pancreatic Cancer
Get PDFPancreatic cancer, known for its rapid progression and poor prognosis, usually presents with obstructive jaundice. Biliary drainage can be achieved by various techniques and approaches, with endoscopic drainage as the preferred method. However, open drainage of the biliary tree is indicated when unresectable tumor is found during resection surgery. This is a case of biliary drainage with a double bypass biliodigestive construction, which could be performed in patients with unresectable cancer in the head of the pancreas presenting with obstructive jaundice and gastric outlet obstruction.
The Role of M2 Pyruvate Kinase in the Screening of Bowel Inflammation
Get PDFBackground: This is a study to determine if M2 Pyruvate Kinase (M2-PK) can be used to screen the presence of bowel inflammation.Method: The study design being used is diagnostic test. In this study, we recruited 76 participants and performed colonoscopy examination as a gold standard and faecal M2-PK as the examined procedure.Results: From the result of this study, we identified the important role of M2-PK to screen the presence of bowel inflammation with the cut-off point of 1.05 U/mL compared to colonoscopy as gold standard with the sensitivity of 86.2%, specificity 81.8%, positive predictive value 96.6%, and negative predictive value 50%.Conclusion: From the result of this study, we suggested M2-PK examination to screen bowel inflammation in patients with lower gastrointestinal tract problems.
Upper Gastrointestinal Endoscopy as Diagnostic Test for Detection of Gastric Malignancy in Sanglah Hospital Denpasar
Get PDFBackground: Gastric malignancy is the third most common cause of cancer-related death in the world. Upper gastrointestinal (UGI) endoscopy for detection of gastric malignancy has been used widely in Indonesia. This study aimed to determine the prevalence of gastric malignancy and diagnostic value of UGI endoscopy in detection of gastric malignancy in Sanglah Hospital, Denpasar.Method: A retrospective study on patients undergoing UGI endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between January 2012 and December 2014 was conducted. Endoscopical and histological diagnosis were documented. The diagnostic test of endoscopic diagnosis were conducted by showing its sensitivity, specificity, positive predictive value, negative predictive value, and accuracy.Results: One thousand and sixty eight patients with upper gastrointestinal symptoms were subjected to endoscopy between January 2012 and December 2014. Of the 1068 cases, 39 patients were suspected for gastric malignant lesions on UGI endoscopy. During the study period, histopathologically-confirmed gastric malignancy was found in 2.72% patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of UGI endoscopic diagnosis for these neoplastic lesions were 100%, 99.04%, 74.36%, 100%, and 99.06%, respectively.Conclusion: The prevalence of gastric malignancy was higher compared to western countries. Endoscopy is important as diagnostic tool in patients with suspicion of gastric malignancy. Greater suspicion in clinical judgment and carefulness in excluding malignancy through one histopathology negative findings need to be done to reduce the number of misdiagnoses of gastric malignancy
Diagnosis and Treatment of Refractory Gastroesophageal Reflux Disease (GERD)
No full textGastroesophageal reflux disease (GERD) was a damage in mucosal layer caused by gastric acid reflux. GERD was found about 10-20% in Western Countries and less in Asia, about 2,6-6,7%. Among different type of GERD, refractory GERD was a problem found in daily clinical practice. This terminology was used in patients with regurgitation and heartburn symptoms which is not responsive to 8 weeks proton pump inhibitor (PPI) therapy. There were several mechanisms underlying the etiology and pathophysiology of refractory GERD. In general, refractory GERD diagnosis was based on clinical findings, objective endoscopic examination, ambulatory reflux monitoring, and response to antiacid-secretion therapy. Reevaluation of patients compliance should be the first step in refractory GERD management. A further treatment strategies could be started, consist of medical and surgical therapies. A basic clinical knowledge of refractory GERD would help clinician in deciding the best approach for diagnosis and therapy.
Effect of Coconut Milk Supplementation to Nutritional Status Parameters in Liver Cirrhosis Patients
Get PDFBackground: Liver cirrhosis is on of health problems in Indonesia. Decreasing number of liver cells in cirrhosis cause some complications, one of which is malnutrition. In Indonesia, coconut milk is one of nutrients sources which quite popular. Coconut milk is thought to have hepatoprotective effect and be able to be eliminated by cirrhosis patients. A study about effect of coconut milk supplementation to nutritional status parameters in liver cirrhosis patients is really needed.Method: This study is a randomized controlled trial with parallel design. This study is conducted in Cipto Mangunkusumo Hospital Jakarta from February to March 2014. Patients are given late night snack (LNS) in form of agar that contained 25 grams of sugar and additional 50 cc coconut milk in group I (experimental group) and additional drink that contained 25 grams of sugar in group II (control group). Variables that measured to look changes in nutritional status between the two groups are triceps skinfold thickness (TSF), mid arm muscle circumference (MAMC), body mass index (BMI), body fat mass (BFM), prealbumin levels and serum albumin levels.Results: A total of 35 patients with liver cirrhosis in this study to the completion. There are three parameters of nutritional status that increasing better in the group receiving a LNS from combination of carbohydrates and coconut milk, compared to group receiving carbohydrates alone. Those three parameters are mean (SD) MAMC with amount of 9.41 (6.43) mm in group I and 4.68 (5.76) mm in group II, p = 0.028. Median (range) BFM changes 0.67 (-2.47-3.80) kg in group I and 0.21 (-4.96-1.99) kg in group II, p=0,373. Mean (SD) serum albumin level change 0.17 (0.31) g/dL in group I and 0.07 (0.41) g/dL in group II, p = 0,426. There is an increase in the TSF measurement in all subjects after one month of LNS supplementation, but not found any significant differences of TSF changes between the two groups. While the measurement of BMI and serum prealbumin did not show any significant changes after treatment in all subjects research.Conclusion: One month LNS 200 kkal supplementation with combination of carbohydrates and coconut milk have a better effect on the improvement of nutritional status in patients with liver cirrhosis, compared to carbohydrates alone. This shown by the better parameters of MAMC, BFM and increased serum albumin in group I, compared to group II
Maximum Tolerated Volume and Plasma Acylated Ghrelin Levels after Drink Tests in Patients with Functional Dyspepsia
No full textBackground: Impaired gastric accommodation and visceral hypersensitivity are major pathophysiological mechanism in functional dyspepsia (FD). Ghrelin, as gut hormone, may play a pathophysiological role in functional dyspepsia. Nutrient drink test was developed to assess impaired gastric accommodation in FD patients. The aims of this study are to compare maximum tolerated volume, postprandial symptoms and acylated ghrelin levels between dyspepsia functional patients and healthy subjects as controls.Method: A cross sectional study was conducted from July 2014 to November 2014, at Sardjito General Hospital, Yogyakarta. Twenties functional dyspepsia patients and 20 healthy subjects ingested nutrient drink tests (Ultra Milk contain 0.6 kcal/mL). The maximum tolerated volume was recorded. After ingested maximal tolerated volume, nausea, bloating and pain were rated using visual analogue scales (VAS) with 100 mm lines. The levels of acylated ghrelin was recorded before and 30 minutes after maximal drinking.Results: The demographic characteristics (age, sex, and body mass index) between dyspepsia patients and healthy subjects were compared. Patients with functional dyspepsia ingested 600 (350–1000) mL and healthy subjects ingested 1375 (1000–1900) mL (p < 0.001). The total symptom scores were higher in dyspepsia patients compared healthy subjects; 215 (110–350) vs. 75 (50–120) (p < 0,001). The fasting plasma levels of acylated ghrelin (20.65 : 2 – 31.37 pg/mL) in FD patients were significantly lower than healthy subjects (30.61 : 2 – 251.19 pg/mL) ( p = 0.012). Conclusion: Patients with functional dyspepsia ingested significantly lower volume and significantly have higher score symptoms than healthy subjects. The fasting plasma levels of acylated ghrelin in functional dyspepsia patients were significantly lower than healthy subjects.