International Journal of Human Capital Management (IJHCM)
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Chronic Inflammation in Colorectal Carcinogenesis: Role of Inflammatory Mediators, Intestinal Microbes, and Chemoprevention Potency
No full textColorectal carcinogenesis is a multi-factorial process which involves accumulation of genetic defect, protein modification, and cell interaction with matrix in colonic epithelial cells. Chronic inflammation is suspected to play role in carcinogenesis by inhibiting apoptosis, impairing DNA, and chronically stimulating mucosal proliferation. Alteration in intestinal microbes’ population, either in one particular species or in overall composition, may also cause chronic inflammation which increase the risk of developing adenoma or carcinoma.Inflammatory mediators and intestinal microbes have diverse effect in colorectal carcinogenesis. Several may increase host anti-tumor immunity, while the others may increase tumor growth. Various ways of interactionshave just started to be partially understood. In addition, colorectal cancer chemoprevention is a promising and important knowledge due to limited success of current available therapy. Chemopreventive agents are currentlybeing studied and have different success rate.Keywords: inflammation, microbes, chemoprevention, carcinogenesis, colorectal cance
Role of Digestive Tract Hormone in Functional Dyspepsia
No full textDyspepsia is a complaint commonly found in daily practice. Functional dyspepsia is considered if the organic cause of dyspepsia is not found. The pathophysiology of functional dyspepsia has not been fully understood.However there are three main pathophysiology, which are: motility disturbance, non-motility disturbance, and psychosocial factor. Several digestive tract hormones are ghrelin, motilin, cholecystokinin (CCK), peptide YY (PYY), somatostatin, glucagon-like-peptide 1 (GLP), are thought to play role in the pathophysiology of functional dyspepsia, particularly in the regulation of digestive tract motility. Currently, a new paradigm in digestive tract disturbance treatment is developing, such as motilin receptor agonist therapy (for example mitemcinal) and ghrelin receptor agonist therapy, which is used as one of the new modalities in treatment of dyspepsia.Keywords: dyspepsia, functional dyspepsia, motilin, ghrelin, cholecystokinin, motilin receptor agonist, ghrelin receptor agonis
The Use of Balanced Scorecard to Support Achievement of Business Plan in Digestive Endoscopy Center, 2013
No full textBackground: Digestive Endoscopy Center, Cipto Mangunkusumo Hospital was established in 2011 in which the concept was developed as center of excellence (CoE). The business plan was created based on safety and patient satisfaction, fast, accurate, quality and one stop services. 2013 is the 2nd year in Digestive Endoscopy Center business plan development and it is expected to increase in many aspects. The aim of this study is to measure the performance of business plan in Digestive Endoscopy Center.Method: This study was conducted from April-December 2013 with quantitative method and cross sectional studies on 76 subjects and also used secondary data from endoscopy’s reports. The balanced scorecard contains 4 measurements, such as financial approach, customer approach, internal process approach, and learning and growth approach. Results: The financial approach resulted that income from 2 types of patients (cash and insurance) were increased in 2013. The customer approach resulted a high satisfaction rate with mean 4.69 of 5 for patient satisfaction and the employee satisfaction increased in 2013 (mean: 3.88 of 5) and in 2010 (mean: 3.64 of 5). Internal process approach was measured using facilities and infrastructure discovered is increased too. Learning and growth approach resulted that accumulation of trainings, achievement of target of the trainings was increased.Conclusion: The achievement of bussiness plan has been evaluated using balanced scored card and showed that there is a balance on the financial approach, customer approach, internal process approach, and learning and growth approach.Keywords: business plan, digestive endoscopy center, balance scorecard
Portal Hypertensive Gastropathy: the Twilight Zone
No full textAs one of the major complication of liver cirrhosis, portal hypertensive gastropathy (PHG) should be an interesting topic to study. Until now the exact mechanism on how this phenomenon happened is yet, not clear.1 The occurrence of PHG is quite high in patient liver cirrhosis and some relationship occurred between PHG and portal hypertension. In liver cirrhosis patients, PHG may be closely associated with hepatic vein pressure gradient(HVPG).2 However, PHG may not be directly associated with portal pressure because the mucosal damage not linearly correlated with portal hypertension, hence other mechanism involved in the etiopathogenesis of PHG. In this regards, the most important factor related to PHG is the pressure in the splanchnic vasculature. Based on histopathology study in PHG, vascular congestion resulted from increased portal pressure reduced oxygen for gastric mucosa, hence exposed mucosal layer to irritants.2 Moreover, the congestion somehow increased the production of nitric oxide, either through the shearstress locally or as the result of increase production of splanchnic vasculature due to portal hypertension
The Role of Various Laboratory Parameters and Imaging Associated with Obstructive Jaundice in Cholangiocarcinoma
No full textCholangiocarcinoma is the second most common primary liver malignancy with a global increase ofincidence and mortality. The mean age at presentation is 50 years. Patients with cholangiocarcinoma usuallywill have symptoms of obstructive jaundice followed with supporting laboratory and imaging findings. Thepredominant clinical feature of extrahepatic cholangiocarcinoma is biliary obstruction resulting in jaundice; while intrahepatic cholangiocarcinoma causes symptoms of intrahepatic mass including abdominal pain in right upper quadrant and other tumor-related symptoms such as cachexia and malaise. The diagnosis and stagingof cholangiocarcinoma require multidisciplinary approaches including laboratory, radiological, endoscopicapproaches and analysis on pathology. This case report describes a patient with a cholangiocarcinoma based on results of endoscopic retrogradecholangiopancreatography (ERCP) imaging. In addition to a diagnosis tool, ERCP can also be a therapeuticmodality for placing stent to reduce symptoms of cholestasis. There were supporting laboratory findings suchas increased bilirubin level, alkaline phosphatase (ALP) and gamma glutamyltransferase (GGT) levels as wellas increased level of tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9and cytological examination.Keywords: cholangiocarcinoma, jaundice, obstructive, ERCP ABSTRAKKolangiokarsinoma merupakan keganasan hati primer kedua yang paling umum, dimana insiden danmortalitasnya meningkat secara global. Usia rata-rata timbulnya gejala adalah 50 tahun. Pasien dengankolangiokarsinoma pada umumnya mengalami gejala ikterus obstruktif disertai dengan hasil laboratoriumdan pencitraan yang mendukung. Gambaran klinis yang predominan dari kolangiokarsinoma ekstrahepatik adalah obstruksi bilier yang menyebabkan ikterus, sedangkan kolangiokarsinoma intrahepatik menimbulkan gejala adanya massa intrahepatik yang menyebabkan nyeri kuadran kanan atas abdominal dan gejala terkaittumor lainnya yaitu kakeksia dan malaise. Diagnosis dan staging kolangiokarsinoma memerlukan pendekatanmultidisipliner antara lain laboratorium, radiologis, endoskopi dan analisis patologi.Pada kasus berikut ini seorang pasien didiagnosa kolangiokarsinoma yang ditegakkan berdasarkan pencitraanendoscopic retrograde cholangiopancreatography (ERCP). Selain untuk diagnosis, ERCP menjadi modalitasterapi dengan dilakukan pemasangan stent untuk mengurangi gejala kolestasis. Pemeriksaan laboratoriumyang mendukung antara lain peningkatan bilirubin, alkalin fosfat dan gamma glutamil transferase (GGT),peningkatan penanda tumor seperti carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, dan pemeriksaan sitologi.Kata kunci: kolangiokarsinoma, ikterus, obstruktif, ERC
Management of Inflammatory Bowel Disease
No full textInflammatory bowel disease (IBD) is an inflammatory disease, which involves the digestive tract with still unknown definite etiology. IBD cases are frequently underdiagnosed or even overdiagnosed. Delay in diagnosis often happen due to the unspecific intermittent symptoms. Principally, treatment of IBD is targeted to acute episodes and maintenance of therapy during remission phase. First line therapy drugs include 5-acetil salicylic acid (5-ASA) and corticosteroids are systemic and topical. If failed, then second line therapy, which has immunosuppressive characteristic, is given such as: 6-mercaptopurine, azathioprine, cyclosporine, methotrexate, and anti-TNF (infliximab). Efforts to prevent recurrent inflammation in IBD are to maintain the remission phase as long as possible. Surgery management may be considered if conservative of pharmacological treatment fails or complication happens. Keywords: inflammatory bowel disease, management, treatmen
The Effect of Zinc Supplementation in Adult Patients with Acute Diarrhea
No full textBackground: Acute diarrhea is a common problem in developing country such as Indonesia with quite high morbidity andmortality rate. It was revealed that the level of zinc deficiency in adult acute diarrhea patients in several hospitals in Jakarta was 69.3%. Although zinc has been proven to be beneficial in the treatment of acute diarrhea in pediatric patients, the effect of zinc supplementation is not fully understood. The objective of this study was to discover the effectiveness of zinc supplementation as an adjuvant therapy in acute diarrhea for adult patients.Method: A double blind randomized controlled trial was done to discover the effect of zinc supplementation to the duration, signs and symptoms on acute diarrhea in hospitalized adults patients in Pertamina Central Hospital, Jakarta from January to December 2013. The data was analyzed using Chi-square test to compare the duration of diarrhea and general linear model (GLM) to assess changes of the symptoms accompanying diarrhea.Results: Data analysis from 84 patients, 30 males (19 zinc, 11 placebo) and 54 females (23 zinc, 31 placebo) with p = 0.111 showed that zinc supplementation significantly reduced the duration of acute diarrhea (p = 0.027) and nausea (p = 0.032). In addition there is a tendency of improvement in several acute diarrhea associated symptoms.Conclusion: Zinc supplementation significantly reduces the duration of diarrhea, nausea, as well as improving some symptoms accompanying acute diarrhea. Keywords: zinc supplementation, acute diarrhea, adult patien
Correlation between Quantitative HBsAg and HBV-DNA in Chronic Hepatitis B Infection
No full textBackground: Methods used to diagnose and monitor chronic hepatitis B (CHB) by quantitation of hepatitis B virus-deoxyribonucleic acid (HBV-DNA) levels is expensive. Cheaper laboratory test as an additional markeris needed, thus we studied serum quantitative HBsAg to be used as surrogate marker in CHB patients. This study was aimed to investigate correlation between serum quantitative HBsAg and HBV-DNA in CHB patients.Method: In this cross-sectional study, we enrolled 62 CHB patients between January 2010 and December 2012 who had quantitative HBsAg and HBV-DNA assays in a private laboratory at Denpasar. HBV-DNA was measured by real-time polymerase chain reaction and quantitative serum HBsAg was measured by chemiluminescent microparticle immunoassay (CMIA). Stastistical analysis was performed by Mann-Whitney and Spearman’s correlation.Results: Of 62 patients, most subjects were males (82.26%). Mean HBsAg titer of CHB in HBeAg positive and negative patients were 281,000 and 4,900 IU/mL, respectively; while mean HBV-DNA in HBeAg positiveand negative patients were 59,000,000 and 7,530,000 IU/mL, respectively. We found that quantitative HBsAg and HBV-DNA in HBeAg positive and HBeAg negative patients were statistically signi cant (p = 0.0001, p = 0.0001, respectively). Signi cant correlation was found between serum quantitative HBsAg and HBV-DNA (r = 0.737; p= 0.000). Quantitative HBsAg was signi cantly correlated with HBV-DNA in HBeAg-positive subgroup (r = 0.717; p = 0.0001); and signi cant correlation was also found in HBeAg-negative subgroup (r = 0.443; p = 0.006) although the correlation was weak. Conclusion: Quantitative HBsAg has signi cant correlation with HBV-DNA in CHB patients. Keywords: quantitative HBsAg Assay, HBV-DNA, HBeAg, chronic hepatitis B infectio