International Journal of Human Capital Management (IJHCM)
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Randomized Double-blind Controlled Trial: Benefits of Lactobacillus reuteri in Chronic Functional Constipation Patients
Get PDFBackground: Chronic functional constipation is a common problem that affects between 15-25% of the population and cause symptoms and disorders that creates discomfort, morbidity, and high costs for health care. Recently, the consumption of probiotics in treating chronic constipation in adults have been investigated. However, there are still limited and controversial evidences available from controlled trials. The aim of this study was to evaluate the effects of Lactobacillus reuteri (L. reuteri) in improving the Agachan constipation score, the number of L. reuteri in the feces and the fecal pH in the patients with chronic functional constipation.Method: A double-blind, placebo randomized controlled trial (RCT) was conducted in 40 adults (12 males/28 females with mean age 45.95 ± 16 years) affected by chronic functional constipation according to Rome III criteria. Patients were randomly assigned to receive a supplementation of L. reuteri or placebo for 4 weeks.Results: At week 4, the decrease in Agachan constipation score was from 17.00 to 8.00 with p < 0.001, the increase number of L. reuteri was from 6.80 x 107 to 2.12 x 108 with p < 0.001 and the decrease of pH feces was from 5.44 (SD 0.70) to 4.78 (SD 0.56) with p < 0.001 in the L. reuteri group, otherwise in the placebo group there were no significant results in Agachan constipation score, the number of L. reuteri and fecal pH assessed.Conclusion: L. reuteri is more effective than the placebo group in improving the Agachan constipation score, increasing the number of L. reuteri in the feces and decreasing the fecal pH in adult with chronic functional constipation.
The Difference of Gastric pH in Dyspepsia Patients With or Without Type 2 Diabetes Mellitus
No full textBackground: Dyspepsia syndrome often experienced by patients with diabetes mellitus (DM). Gastric acid is one of the aggressive factors of syndrome dyspepsia and peptic ulcers. This study aims to find the difference of gastric pH in dyspepsia patients with DM and without DM, and also to determine whether there is any correlation between gastric pH with proteinuria and hemoglobin A1c (HbA1c).Method: Two groups of patients consisted of 30 patients with DM and 30 patients without DM. Basal gastric pH of each group counted. Basal gastric pH was measured by inserting electrode catheter into the stomach for 30 minutes and then recorded on PH Metri brand Digitrapper pH-Z. Complication of DM was measured by microalbuminuria, while blood sugar control was measured by HbA1c. Chi-square test was done to look for difference of gastric pH between the diabetic patients group and non-diabetic patients group, by first determining the point of intersection with receiver operating characteristic (ROC) analysis. Correlation test between basal gastric pH with microalbuminuria and HbA1c were done.Results: Basal gastric pH in dyspepsia patients with DM vs. dyspepsia patients without DM was 2.30 ± 0.83 vs. 2.19 ± 0.52. With the Chi-square test, there is a significant difference between the diabetic patients group and non-diabetic patients group. With the correlation test between gastric pH and microalbuminuria was found r = 0.47 and p 0.05.Conclusion: There is a significant difference between basal gastric pH in diabetic dyspepsia patients and non-diabetic dyspepsia patients. There is a correlation between basal gastric pH and microalbuminuria, whereas there is no correlation between basal gastric pH and HbA1c
Success Rate of Liver Stiffness Measurement Using Transient Elastography in Non-alcoholic Fatty Liver Disease Patients with Obesity and Its Influencing Factors
Get PDFBackground: Percentage of patients who had liver stiffness measurement failure using transient elastography varied between 2-10%; mainly caused by obesity. XL probe is expected to increase the success rate of liver stiffness measurement in patients with obesity. The objective of this study is to evaluate the success of liver stiffness measurement using M and XL probes and its influencing factors.Method: Patients who fulfilled the inclusion criteria were included in this study. Examination results were then analysed using statistical analysis unpaired t-test or Mann-Whitney and McNemar statistical tests.Results: From 92 NAFLD patients with obesity who were studied, the proportion of success in measuring liver stiffness using M probe was 57.6%, while that of XL probe was 88.0%. This difference was statistically significant (p < 0.001). BMI, SCD, and thoracic circumference were associated with success in measuring liver stiffness using M probe, with p value of 0.007, 0.001, and 0.001 respectively. The results of Mann-Whitney statistical test revealed median value of BMI and SCD of patients who had liver stiffness measurement failure using M probe were 32.7 kg/m2 and 2.6 cm respectively. T-test results showed that the mean value of thoracic circumference of patients who had liver stiffness measurement failure using M probe was 97.8 cm.Conclusion: Proportion of success in measuring liver stiffness in NAFLD patients with obesity using XL probe was better compared to the M probe. BMI, SCD, and thoracic circumference were associated with the success of measuring liver stiffness using M probe. The same variables were not associated with XL probe
Infection and Colorectal Neoplasm
Get PDFColorectal cancer is a major cause of cancer-related morbidity and mortality. Colorectal cancer is the third most common malignancy and the 4th most common cause of cancer mortality worldwide. A number of infectious agents are considered to be cancer risk factors due to the hypothesis-generating and supportive evidence accumulated to date. It has been estimated that one fifth of all cancer is caused by some infectious agent(s). Infections from certain bacteria, such as Helicobacter pylori (H. pylori), Streptococcus bovis (S. Bovis), viruses, such as human papillomavirus (HPV), human cytomegalovirus (HCMV), and parasites may increase the risk of colorectal cancer. More studies are needed to learn the association of infectious agents with the incidence of colorectal cancer.Keywords: colorectal cancer, infectious agents, malignancy, neoplasm
Recurrent Upper Gastrointestinal Bleeding Caused by Gastric Angiodysplasias
No full textGastric angiodysplasia, a typical discrete lesion with flat and bright-red color in gastric mucosa and submucosa, is one of the cause of recurrent upper gastrointestinal bleeding. Mostly, angiodysplasia found as multiple lesion in different location. Melena, hematemesis, and chronic anemia is a consequence of untreated gastric angiodysplasia. Sometimes, it is hard to diagnose, because of its similarities with another gastric mucosa lesion and an inadequate gastric distention during endoscopic procedure. Both pharmacological and non-pharmacological therapy were used to treat this condition in daily clinical practice, one of them is argon plasma coagulation as thermal modalities during endoscopy procedure. This therapy promise an effective angiodysplasia therapy to stop upper gastrointestinal bleeding and further complication.Gastric angiodysplasias causing recurrent gastrointestinal bleeding were found in a 73-year old man. He had been hospitalized for several times in the last two years in various hospitals in his home country as well as abroad, because of hematemesis and/or melena. The previous repeated gastroscopic examination by experienced endoscopists revealed erosive gastritis. After receiving blood transfusions, gastroscopy was performed and showed multiple small, flat bright-red mucosal lesions in different size in the stomach. The lesions were succesfully treated with argon plasma coagulation (APC). During a follow-up period of more than 18 months no further recurrent bleeding was observed
Management of Recurrent Cholangitis in Patient with Iatrogenic Bile Duct Stricture
Get PDFIatrogenic bile duct stricture is the most common causes of benign bile duct stricture. Several studies reported that approximately 80% of benign strictures occur following injury during a cholecystectomy. Strictures of the biliary tract have a broad spectrum of manifestations, ranging from mild elevation of liver enzymes to life-threatening infections such as cholangitis, liver abscess, and biliary cirrhosis. Moreover, due to its indolent course with subtle clinical manifestations, diagnosis is often delayed and most patients present with a protracted, complicated course. We reported a case of 26 years old female with recurrent cholangitis due to iatrogenic bile duct stricture. Biliary drainage through endoscopic approach followed by surgical procedure was selected as strategic management for the patient
Molecular Diagnostics in Colorectal Cancer
Get PDFColorectal cancer (CRC) presents in one of three patterns: sporadic colorectal cancer in those without a family history (65-85%); those with a family history (familial CRC) 10-25% of cases; inherited CRC accounting for less of 10% cases and presents as well-characterized cancer predisposition syndromes including Lynch syndrome (hereditary non-polyposis colorectal cancer/HNPCC) which comprises about 1-5% of all colorectal cancer, and multiple polyps CRC, which includes familial adenomatous polyposis (FAP,1%), rare CRC syndrome < 0.1 %). Many efforts have been made to discover the genetic and molecular features of CRC, and there is more evidence that these features determine the prognosis and response to treatment. Colorectal cancer (CRC) is a heterogeneous disease, with three known major molecular groups. The most common is the chromosomal instability group, characterized by an accumulation of mutations in specific oncogens and tumor suppressor genes. The second is the microsatellite instability group, caused by the dysfunction of deoxyribonucleic acid (DNA) mismatch repair genes leading to genetic hypermutability. The CpG island methylation phenotype (CIMP) is the third group, distinguished by hypermethylation. In this review we would like to provide an up-to-date overview of molecular genetic aspects of CRC that are currently important and should guide clinical practice in colorectal cancer in the diagnosis and selection of therapy
Relationship Between Vascular Endothelial Growth Factor and Severity of Hepatocellular Carcinoma
Get PDFBackground: Severity of hepatocellular carcinoma (HCC) that is assessed using Barcelona Clinic Liver Cancer (BCLC) classification is a main prognostic factor of hepatocellular carcinoma. Assessment of the serum level of Vascular Endothelial Growth Factor (VEGF) is considered to reflect the severity of HCC. However, there is still no fundamental basis of the association of severity of HCC with the serum VEGF level. The objective of this study is to know the relationship between serum VEGF levels with the severity of HCC by assessing the average difference of serum VEGF level in various severity of HCC.Method: This study was a cross sectional study to identify the association between serum VEGF levels with the severity of HCC based on BCLC classification. This study was performed in Cipto Mangunkusumo Hospital between January and May 2015. Statistical tests used to evaluate the association between serum VEGF level with BCLC classification was one-way ANOVA analysis, and continued with post hoc Tukey Schaffe analysis.Results: A total of 61 subjects with HCC were included into this study. In this study, we did not find subjects with stage 0 BCLC. The average of serum VEGF level in stage A BCLC was 288.26 ± 156.6 pg/mL; stage B BCLC: 434 ± 164.8 pg/mL; stage C BCLC: 785.57 ± 194.25 pg/mL; stage D BCLC: 1537.97 ± 660.62 pg/mL. One-way ANOVA analysis showed significant difference (P < 0.001) between serum VEGF level and HCC severity based on BCLC classification. Post hoc Tukey Schaffe analysis showed the presence of significant difference between stage A and C BCLC (p < 0.05) and stage A and D BCLC (p < 0.001), stage B and D BCLC (p < 0.001), and stage C and D BCLC (p < 0.001). There was no significant difference between stage A and B BCLC, and between stage B and C BCLC.Conclusion: It was found that serum VEGF level increased in accordance to the HCC severity based on BCLC classification, particularly for stage B BCLC and above
Administration of Methotrexate in Rheumatoid Arthritis Patients with Chronic Hepatitis B
No full textAim: To identify if methotrexate (MTX) may be given to chronic hepatitis B patients and to evaluate the necessity of antiviral prophylaxis administration.Method: Literature search procedure to answer this clinical problem was performed by exploring the literature online using PubMed, Highwire Stanford University, NUS Library, and MD Consult search engines. With this searching method, we found 20 articles in English. From those 20 articles, there were two articles relevant based on the title and abstract (studies by Tamori et al and Mori).Results: From 45 patients without HbsAg from Tamori et al study, only one from 3 patients receiving disease-modifying antirheumatoid drug/DMARD (including MTX) experienced reactivation. Those three patients did not receive anti-TNF-α therapy. Study by Mori concluded that DMARD was relatively safe to be given to most RA patients with the history of HBV infection, although they were not given anti HBV prophylaxis therapy.Conclusion: MTX is not recommended for patient in this case because it is contraindicated to be given in HBV infected patient with any given Child Pugh score. If MTX is still given, it is recommended to give antiviral prophylaxis therapy.
Mirizzi’s Syndrome
Get PDFMirizzi’s syndrome was an obstruction caused by gallstone located in gallbladder neck (or cystic duct) or outside gallbladder that caused a dilatation of gallbladder and narrowing of adjacent duct, sometimes with the presence of cholecystocholedochal fistula. Mirizzi’s syndrome was a rare complication of gallbladder stone. We reported a 42 years old woman complained progressive icteric sclera. Patients also complained dark urine and light stool. During physical examination, we found an icteric sclera, pain in right upper quadrant (visual analogue scale/VAS 3), and generalized icterus (greenish yellow). Complete examination revealed a Mirizzi’s syndrome