International Journal of Human Capital Management (IJHCM)
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Gallstones and Choledocolithiasis with Severe Cholestatic Jaundice in beta-Thalasemia Intermedia Patient
No full textGeographically, b-thalassemia can be found in many countries including in Indonesia. Thalassemia intermedia referred to patients as being ‘too haematologically severe to be called minor, but too mild to be called major’. Patients with thalassemia intermedia usually present themselves to medical attention in later childhood or even adulthood and are sustainable without the need for regular transfusion therapy. Three main factors are responsible for the clinical sequele of thalassemia intermedia: chronic anemia, ineffective erythropoiesis, and iron overload.There are many complications related to b-thalassemia intermedia such as gastroentero-hepatology diseases (splenomegaly, gallstones, choledocolithiasis, predispose patients to liver fibrosis and cirrhosis), vascular, endocrine and bone diseases. About 55-63% thalassemia intermedia patients suffer from gallstone with 68–85% of these patients undergo cholecystectomy, and 67-90% patients undergo splenectomy. Therefore, ultrasound examination is required to be performed regularly during illness and before patient underwent surgery or splenectomy to detect the presence of gall stones. In this case report a patient with gallstones and choledocholithiasis was reported. Severe cholestatic jaundice in b-thalassemia intermedia was diagnosed six months before hospitalization. The patient underwent open cholecystectomy and exploration common bile duct stones. Keywords: beta-thalassemia intermedia, gallstones, choledocolithiasis, iron overloa
Soy Infant and Extensively Hydrolyzed Formula as Therapeutic Formula for Cow’s Milk Protein Allergy
No full textCow’s milk protein allergy (CMPA) is a food allergy mostly suffered by children aged < 3 years that can be mediated by IgE or non-IgE or both. The prevalence of CMPA in children is heterogeneous between populations. Meta-analysis study showed that the prevalence was 2-3% in infants and < 1% in children aged < 6 years. Although the prevalence is quite small but proper management is very important because it affects the quality of life of children and to avoid the risk of anaphylactic reaction that threatens life. Therapy for CMPA is to avoid cow's milk protein and its derivatives; it is also recommended for breast-feeding mothers to do the same. Therapeutic milk formulas that can be given is extensively hydrolyzed formula (eHF) or soy infant formula (SIF). The selection of formula became adebate, especially about the safety, effectiveness and cost. Keywords: cow milk protein allergy, soy infant formula, extensively hydrolyzed formul
Role of Proton Pump Inhibitor in the Management of Acid-Related Disorders
No full textProton pump inhibitor (PPI) is the strongest inhibitor to gastric acid secretion. PPI is effective in all gastricacid disorders, such as: peptic ulcer, gastroesofageal reflux disease, non steroid anti inflammatory drugs (NSAIDs)gastropathy, and Zollinger-Ellison syndrome. Several studies comparing one PPI to another. Although somedifferences have been reported, there are small differences with unclear clinical importance.PPI has side effects that may be related to diarrhea due to Clostridium difficile, pneumonia, hip fracture, vitamin B12 deficiency, and IgE mediated allergic reaction. Several studies revealed strong association but havelimitation in design and sampel size. PPI therapy should be according to indication, dose, and appropriate period.Keywords: proton pump inhibitor, gastric acid disorder, indication, dose, period ABSTRAKPenghambat pompa proton (PPP) adalah inhibitor paling kuat terhadap sekresi asam lambung. PPPefektif untuk terapi semua gangguan asam lambung termasuk ulkus peptikum, penyakit gastroesofageal reflux,gastropati karena obat anti inflamasi non steroid (OAINS), dan sindrom Zollinger-Ellison. Beberapa penelitianmembandingkan beragam PPP satu dengan yang lainnya. Walaupun dilaporkan ada beberapa perbedaan,namun besaran perbedaannya kecil dan tidak jelas kepentingan klinisnya.PPP kemungkinan berkaitan dengan efek samping diare karena Clostridium difficile, pneumonia, frakturpanggul, defisiensi vitamin B12, dan reaksi alergi yang dimediasi IgE. Beberapa penelitian menunjukkanhubungan yang kuat namun memiliki keterbatasan desain dan besaran sampel. Terapi PPP harus sesuai denganindikasi, dosis, dan jangka waktu yang tepat.Kata kunci: penghambat pompa proton, gangguan asam lambung, indikasi, dosis, jangka wakt
Alpha-1 Acid Glycoprotein Cut-off Value as Diagnostic Biomarker in Hepatocelular Carcinoma with Liver Cirrhosis
No full textBackground: Hepatocellular carcinoma (HCC) remains a major problem throughout the world, especially in diagnostic and therapeutic management. Previous studies stated that alpha-1 acid glycoprotein (AAG) was a potensial biomarker in diagnostic of HCC. This study assessed the best cut-off value of AAG as a diagnostic biomarker of HCC with liver cirrhosis.Method: This was a cross-sectional, diagnostic study, conducted from January to October 2013 in Cipto Mangunkusumo Hospital. The subjects were HCC with liver cirrhosis patients and as control were liver cirrhosis patients. Abdominal ultrasonography (USG), abdominal 3 phase contrast computerized tomography (CT) scan, and liver biopsy, if necessary, were done. All patients were having AAG examination, then the result was analyzed using receiver operating characteristic (ROC) curve and assessment of some cut-off values was done.Results: There were 25 HCC with liver cirrhosis patients and 37 liver cirrhosis patients as control included in this study. HCC with liver cirrhosis patients were 92% male and 8% were female, over 50 years old (72%). HBV infection was the most common etiology and most of the patients had multiple nodules in the liver (80%). ROC curve showed the area under the curve (AUC) was 81.44%.Conclusion: The best cut-off value of AAG to be aware of HCC with liver cirrhosis was 61 mg/dL and as a diagnostic was 136 mg/dL. Keywords: hepatocelullar carcinoma, alpha-1 acid glycoprotein, cut-off
Blood Transfusion Strategy in Gastrointestinal Tract Bleeding: Liberal or Restrictive
No full textGastrointestinal tract bleeding is an emergency problem, which is frequently found. The manifestations of gastrointestinal tract bleeding vary, ranging from massive bleeding which is life threatening until occult bleeding that is not sensed by the patient. One of the main objectives in the management of gastrointestinal tract bleeding is stabilizing patient’s hemodynamic, either by using infusion of crystalloid, colloid, or even with the administration of blood transfusion. In massive gastrointestinal tract bleeding, administration of red blood cells transfusion may be life saving. However, in cases where bleeding is not profuse, the safest and most effective blood transfusion strategy is still controversial. Until now, there is no trial that gives information regarding safety and effectiveness of liberal or restrictive transfusion strategy in lower gastrointestinal tract bleeding. However, for most patients with gastrointestinal bleeding, with or without portal hypertension, it is better to postpone blood transfusion until the hemoglobin level decrease to less than 7 g/dL.Keywords: gastrointestinal tract bleeding, blood transfusion, liberal, restrictiv
Demographical Distribution on the Incidence of Helicobacter pylori Infection in Jakarta: Obtaining Samples from 5 Municipalities
No full textBackground: Currently, the hospital-based studies on Helicobacter pylori (H. pylori) have demonstrated that the incidence of H. pylori infection tends to decline in Indonesia. On the other hand, no population-based study has ever been conducted. Therefore, our study was performed to evaluate the true incidence of H. pylori found among the population.Method: This study was a surveillance using cross-sectional design. The samples used in our study were randomly selected from 1,645 samples including those from five municapalities of Special Capital Region of Jakarta in 2006. Immunochromatographic test (ICT) was utilized to establish the diagnosis of H. pylori infection. The test has demonstrated high sensitivity and specificity for Indonesian populationResults: The seroprevalence of H. pylori infection among 310 patients was 52.3% (162 out of 310 patients) with mean age of 43.48 + 10.45 years. There was no difference regarding seroprevalence in both groups of 40 years of age (52.3% and 52.2%). The highest prevalence of H. pylori infection was found in West Jakarta (66.1%); while the lowest prevalence was found in South Jakarta (41.0%). The incidence of H.pylori infection between those who were alcoholic was equal to those who were not alcoholic (46.2% vs. 52.5%).Similar result was also found between smokers and non-smokers (53.8% vs. 51.8%).Conclusion: In this study, we found that H. pylori seroprevalence remains high in the population. Various seroprevalence of H.pylori infection were found among five municipalities in Jakarta.Keywords: Helicobacter pylori, Jakarta, seroprevalenc
Clinical Characteristics and Microbiological Profiles of Community-Acquired Intra-Abdominal Infections
No full textBackground: Intra-abdominal infections (IAIs) have different aspects to consider. One important aspectis the microbiological analyses, especially in the era of broad spread of resistant microorganisms. The studywas designed to describe the clinical characteristics and microbiological profiles of community acquired IAIs. Method: An observational study was performed on medical records of 12 months period (January toDecember 2013) in a General Hospital, Karawaci, Tangerang. Adult patients undergoing surgery for IAIs with positive microbiological culture and identification of microorganisms were included. Data collected were clinical characteristics and microbiological profiles and wereanalyzed statisticallyusing the SPSS version 17. Results: In 12 months period of study, 17 patients of IAIs with a total of 17 intra peritoneal specimens were collected. A total of six microorganisms were cultured. All the IAIs were monomicrobial, with aerobicmicroorganism dominantly Gram-negative bacilli. The dominant microorganism was Escherichia coli (E.coli), found in 58.8% of IAIs. The most common site was appendix (41.2%), and none from small intestine. Thesusceptibility test found that piperacillin tazobactam, tigecycline, meropenem and amikacin were the most activeantimicrobial against E. coli. Multi-drug resistant (MDR) E. coli in this study was 40%. The MDR E. coli had66.6% resistance to levofloxacin and ciprofloxacin, 66.6% susceptibility to ceftriaxone and ceftazidime, and100.0% susceptibility to amikacin. Conclusion: The most common site of community-acquired IAIs was appendix (41.2%). E. coli is still adominant microorganism with the MDR E. coli proportion of 40%.Keywords: intra-abdominal infections, clinical characteristics, microbiological profile
Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis
No full textBackground: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector
The Use of Immunochemical Fecal Occult Blood Test as Colorectal Cancer Screening Tool in Asymptomatic Population in Indonesia
No full textBackground: Colorectal cancer is the fourth leading cause of cancer-related mortality worldwide. Earlydetection of colorectal cancer is necessary in term of increasing survival. Immunochemical fecal occult bloodtest (I-FOBT) is one of the simple and inexpensive screening modality that can be used widely. No data has been available yet regarding the usage of I-FOBT in Indonesia. This study is a prevalence study of I-FOBT in asymptomatic population in Indonesia. Method: A cross sectional study was conducted in asymptomatic population visiting five public health service centers in Depok district, West Java, Indonesia. This study was performed from January to March 2012. Casereport form and I-FOBT kit were used to assess and screen the patients. Statistic analysis was performed usingChi-square test. Results: The prevalence of positive I-FOBT was almost equally distributed among age group. Femaledominated whole patients 202 (72.7%). Most of them had middle to low education level 116 (41.7%). As manyas 50.7% patients had normal body mass index. We had 11 (4%) patients with positive result of I-FOBT. Conclusion: Prevalence of positive result of I-FOBT in asymptomatic population in Indonesia was 4%.Further studies were needed to confirm sensitivity and specifity of I-FOBT in Indonesia.Keywords: colorectal cancer, immunochemical fecal occult blood test (I-FOBT), early detectio
Prevention of Hepatitis B Virus Transmission in Pregnancy
No full textChronic hepatitis B virus infection is a serious health problem in many countries, particularly in developing countries. In Asia-Pacific region, vertical transmission from mother to child is the main endemicity factor of hepatitis B virus (HBV) infection. Almost 50% cases of hepatitis B virus infection happen during perinatal and neonatal period, including vertical transmission from mother to child during pregnancy.World Health Organization (WHO), World Gastroenterology Organization (WGO) and many countries have recommended immunoprophylaxis by the administration of hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) to prevent transmission from mother to child. However, there are approximately 10-15% babies born from mother with hepatitis B infected by HBV through intrauterine transmission. Incidence of intrauterine transmission is accounted for around 43-50% if DNA of HBV in the mother is more than 107 copies/mL, although passive and active immunization to the baby has been administered. Therefore, administering antiviral drugs in pregnant women with chronic hepatitis B accompanied by immunoprophylaxis is effective in preventing hepatitis B infection transmission during pregnancy, particularly in decreasing the number of virus and administering active or even passive immunization to neonates. Keywords: hepatitis B, pregnancy, prevention, transmissio