International Journal of Human Capital Management (IJHCM)
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Fatty Liver and Its Associated Factors among Breast Cancer Patients in Dharmais Cancer Hospital, Jakarta
No full textBackground: Fatty liver is frequently found during ultrasound (US) examination of breast cancer patients. It is not known how the association between breast cancer and fatty liver. This study was aimed to obtaine the prevalence of fatty liver in breast cancer patients and its association with clinical characteristics of the patients.Method: This was a cross-sectional study in Dharmais Cancer Hospital, Jakarta. Study subjects were breast cancer patients who came between January 2011 and December 2013. Fatty liver was assessed by using abdominal US and were grouped into mild, moderate, and severe. Clinical characteristics of the patients included age, body mass index (BMI), menopausal status, breast tissue density using Breast Imaging Reporting and Data System (BI-RADS), and immunohistochemical estrogen receptor (ER) status.Results: A total of 72 patients were enrolled during the study period with the mean age of 47.5 years. Fatty liver was found in 68 (94.4%) patients. Sixty (83.3%) patients had moderate-to-severe fatty liver. Patients with moderate-to-severe fatty liver had significantly higher BMI (26.9 ± 5.39 vs. 23.6 ± 4.05 kg/m2; p = 0.005). Fatty liver was not associated with the patient’s age, menopausal status, and breast tissue density.Conclusion: This study showed that the prevalence of fatty liver in breast cancer patients is very high. Fatty liver shows significant association with obesity but is not associated with breast tissue density or estrogen receptor status. Keywords: breast cancer, breast cancer density, fatty liver, estrogen recepto
Correlation between Severity of Dyspepsia and Helicobacter pylori Infection
No full textBackground: Dyspepsia is a common complaint in clinical practice. Correlation between Helicobacterpylori (H. pylori) and functional dyspepsia had been reported in many studies, but studies that analyzed theseverity of dyspepsia and H. pylori were limited and the results were controversial. This study is about to knowthe correlation between the severity of dyspepsia and H. pylori infection. Method: A retrospective descriptive analysis to patients with dyspepsia at Permata Bunda Hospital, Medan was done in 2010-2014. Simple random sampling was done to get 44 patients with dyspepsia, 22 are H. pylori positive and 22 patients are H. pylori negative. The severity of dyspepsia assessed with Porto Alegre DyspepticSymptoms Questionnaire (PADYQ) scoring instrument. Univariate and bivariate analysis (Chi-square andSpearman correlation) were done using SPSS version 22. Results: Epigastric pain is the most common symptom in dyspepsia patients. There is a correlation betweenulcer type dyspepsia and H. pylori infection (p = 0.030), while dysmotility type and mixed type were not correlated.The severity of epigastric pain has significant positive correlation with H. pylori (r = 0.386; p = 0.01), while theseverity of other symptoms such as nausea, vomit, and abdominal bloating have negative correlation with H.pylori. Dyspepsia total scoring is significantly lower in H. pylori positive than in H. pylori negative (p = 0.033). Conclusion: There is a positive correlation between the severity of epigastric pain and H. pylori infection,negative correlation between the severity of nausea, vomit, and abdominal bloating and H. pylori infection, andcorrelation between lower dyspepsia total scoring and H. pylori infection.Keywords: dyspepsia, Helicobacter pylori, PADYQ, epigastric pai
Cranial Metastasis as Initial Manifestation of Hepatocellular Carcinoma
No full textCranial metastasis from hepatocellular carcinoma (HCC) prior to diagnosis of the primary tumor withoutliver dysfunction is a very rare event. Cranial metastasis may be the sole initial presentation of HCC. Earlydiagnosis is essential in order to treat the primary disease. Cranial metastasis from HCC should be consideredin the differential diagnosis in patients with subcutaneous scalp mass and osteolytic defects on X-ray.A 55 year old female patient without known liver disease, presented with a palpable right occipital scalp mass. On head computed tomography (CT) scan, a tumor on right orbita wall, osteolytic skull and invasion to theright frontal lobe was observed. The histological diagnosis obtained from the biopsy was a poorly differentiatedcranial metastasis adenocarcinoma that was difficult to determine the origin. On positron emission tomography(PET) scan, there was a hypermetabolic mass around intra hepatal bile duct which suspicious primary cancer.The histological diagnosis obtained from the liver biopsy was appropriate with HCC grade II. The metastatictumor was removed via occipital craniectomy. She received a palliative course of external beam radiationtherapy to the right orbit. Then, she received symptomatic treatment and herbal medicine with cassava leavesfor the last three months. Evaluation of bone survey shows lytic lesion at calvaria and compression fractureat vertebrae thoracal 11-12 appropriate with metastasis process. According to Barcelona Clinic Liver Cancer(BCLC) criteria she suffered from HCC terminal stage D with average survival of about 4 months.Keywords: hepatocellular carcinoma, cranial metastasis, palliative treatment ABSTRAKMetastasis kranial dari karsinoma hepatoselular sebelum diagnosis tumor primer dengan hasil tanpa adanyagangguan fungsi hati adalah peristiwa sangat jarang ditemui. Metastasis pada tulang kranial dapat menjadi salah satu presentasi awal dari karsinoma hepatoseluler. Menegakkan diagnosis di awal sangat diperlukan untuk menentukan penatalaksanaan pada penyakit primer. Metastasis pada kranial dari karsinoma hepatoseluler harusdipertimbangkan pada kasus subkutan skalp tumor dan pada pasien dengan defek osteolitik pada gambaranradiologi.Seorang pasien perempuan usia 55 tahun, yang tidak didapatkan riwayat penyakit hati sebelumnya, datangdengan benjolan pada region oksipital kanan. Hasil computed tomography (CT) scan kepala didapatkantumor pada dinding orbita kanan. Dari pemeriksaan histologi menunjukkan metastasis dari adenokarsinomaberdiferensiasi buruk yang sulit ditentukan asalnya. Pada pemeriksaan positron emission tomography (PET)scan, terdapat massa hipermetabolik di sekitar duktus intrahepatik yang diduga sebagai tumor primer. Hasil biopsi menunjukkan karsinoma hepatoselular derajat 2. Dilakukan kraniektomi region oksipital pada penyebaran tumor dan dilanjutkan radioterapi paliatif pada region oksipital kanan. Selanjutnya pasien hanya mendapatkanterapi simtomatik dan daun singkong sebagai terapi herbal selama 3 bulan terakhir. Evaluasi survei tulangsetelah 3 bulan menunjukkan lesi litik pada kalvaria dan fraktur kompresi pada tulang vertebrae thorakal 11- 12. Menurut kriteria Barcelona Clinic Liver Cancer (BCLC) pasien tersebut masuk ke dalam stadium terminalD dengan rata-rata angka harapan hidup 4 bulan setelah terdiagnosis.Kata kunci: karsinoma hepatoseluler, metastasis kranial, terapi paliati
Detection of Hepatitis B Virus Pre-core Mutant by Allele Specific Polymerase Chain Reaction
No full textIntroduction: Mutation in pre-core region is characterized by negative HBeAg and positive anti-HBe despite active replications of the virus. The mutation has diagnostic and prognostic implications. Therefore, detectionof pre-core mutant is important. Standard diagnosis approach for detecting pre-core mutant is through DNA sequencing of hepatitis B virus (HBV) pre-core region. Unfortunately, DNA sequencing is not available in mostcenters. Hence, a simpler diagnostic approach is necessary.Method: An observational-analytic design study was performed. Detection of pre-core mutant was conducted in individuals with positive HBsAg and HBV DNA that had various patterns of HBeAg and anti HBe. HBsAg, HBeAg and anti-HBe was detected using immunochromatography technique. The HBV DNA was evaluated by using qualitative polymerase chain reaction (PCR) testing. PCR was done by three rounds of amplification with primers derived from wild type pre-core and mutant pre-core. Results: Of 25 sera with HBeAg negative, anti-HBe positive and HBV DNA positive, allele specific (AS) PCR pre-core mutant was detected in 20 (80%) sera. Two sera with HBeAg negative, anti HBe negative and HBV DNA positive were negative for pre-core mutant. Of 8 sera with HBeAg positive, anti HBe negative and HBV DNA positive, pre-core mutant was detected in 2 (25%) sera.Conclusion: Most of individuals with HBV DNA positive, HBeAg negative and anti-HBe positive have harbored pre-core mutant. The finding indicated that all patients with HBsAg positive, HBV DNA positive and HBeAg negative, but anti-HBe positive should be examined for the presence of pre-core mutant. Pre-core mutant is also found in HBeAg positive individual. Keywords: HBV, pre-core mutant, polymerase chain reactio
Recent Updates of Helicobacter pylori Infection: from Epidemiology Study to Guideline Issues
No full textHelicobacter pylori (H. pylori) infection is still a big issue in gastroenterology field. Its relationship withgastrointestinal malignancies now is widely known and the extra-gastrointestinal manifestation of this epidemicbring new problems. Although the prevalence is decreasing in developed countries, the resistance rate of somestrains to standard therapy needs more attention and new strategies. Recent epidemiology studies revealed that H. pylori infection is a specific population disease. Many trials and meta analyses revealed new evidences and horizons in the management of this infection. This review updated and highlighted pathophysiology, clinicalaspect, and new epidemiology data on H. pylori infection which is published in the last five years.Keywords: Helicobacter pylori, update, epidemiology ABSTRAKInfeksi Helicobacter pylori (H. pylori) masih merupakan permasalahan besar di bidang gastroenterologi.Hubungannya dengan keganasan saluran cerna saat ini telah dikenal secara luas dan manifestasinya di luarpencernaan pada epidemi ini membawa masalah baru. Meskipun prevalensinya menurun di negara-negara maju,namun tingkat resistensi dari beberapa terapi standar membutuhkan lebih banyak perhatian dan strategi baru.Penelitian epidemiologi baru-baru ini mengungkapkan bahwa infeksi H. pylori didapatkan pada populasi tertentu.Banyak percobaan dan metaanalisis yang mengungkapkan bukti dan wawasan baru dalam penatalaksanaannya.Ulasan ini memperbarui dan menyoroti patofisiologi, aspek klinis, dan data epidemiologi baru pada infeksi H.pylori yang telah dipublikasikan dalam lima tahun terakhir.Kata kunci: Helicobacter pylori, memperbarui, epidemiolog
Imaging Modalities Role inRecurrent Acute Pancreatitis Diagnosis
No full textRecurrent acute pancreatitis (RAP) is a potentially life-threatening pancreatic disorder. Itrequires a combination of medical and interventional skills to diagnose, determine the etiology, and treat the condition. Recurrencesoccur in 25-30% of all acute pancreatitis cases. The most common cause of RAP is gallstone (microlithiasis). Imaging modalities become an important aspect to evaluate multiple microlithiasis. In this case, we report a 52 years oldoverweight female with RAP and fatty liver ofunknown etiology.We suspected gallstone as the cause of RAP. Physical examination considered normal. Ultrasound and abdominal CT scan wasperformed in whichfatty liver were founded. Since the gallstone is not clearly found with radiologic imaging, we decide to undergoEndoscopic Retrograde Cholangiopancreatography(ERCP)procedure to evaluatea possibility of microlithiasis. ERCPresult showed a multiple microlithiasis, thus we evacuate the stones. Clinical outcome post ERCP and evacuationprocedure was good. We concluded that the best imaging modalities to evaluate microlithiasis in RAP with normal ultrasound and abdominal CT scan is ERCP. Keywords:recurrent acute pancreatitis (RAP), microlithiasis, endoscopic retrograde cholangiopancreatography (ERCP)
Risk Factors of Chronic Atrophic Gastritis
No full textBackground: Chronic atrophic gastritis is a well-established precursor of gastric cancer. The development of atrophic chronic gastritis is multifactorial, involving the environment as well as host responses to the Helicobacter pylori (H. pylori) infection. The aim of this study is to determine prevalence and risk factors of chronic atrophic gastritis.Method: The study was a cross sectional study on gastritis patients admitted to endoscopy units at Adam Malik General Hospital and Permata Bunda Hospital, Medan, from May-October 2014. A simple random sampling was performed to obtain 50 patients. Data concerning sociodemographic factors and H. pylori status were collected. H. pylori were considered positive from the positive results of the campylobacter like organism (CLO) test. Univariate and bivariate analyses were performed using the SPSS 22 with 95% confidence interval. Bivariat analysis was performed using a Chi-square test. Results: Prevalence of chronic atrophic gastritis was 40%. There were associations between age and chronic atrophic gastritis (95% CI = 1.05-2.80; p = 0.021; OR = 1.73), body mass index and chronic atrophic gastritis (95% CI = 1.1-3.1; p = 0.011; OR = 1.85), and H.pylori infection and chronic atrophic gastritis (95% CI = 1.23-4.88; OR = 2.45; p = 0.001). There were no associations between gender, ethnicity, or rural-urban classification and chronic atrophic gastritis (p > 0.05).Conclusion: Elderly status, low BMI, and H. pylori infection are risk factors for the development of chronic atrophic gastritis. Keywords: chronic atrophic gastritis, Helicobacter pylori, gastric atrophy, body mass inde
Splanchnic Hypoperfusion and Enteral Feeding
No full textHypoperfusion or decrease in blood flow is may cause organ failure. When the body experiences hypoperfusion, body perfusion is prioritized to brain and heart, which may cause the hypoperfusion of splanchnic organ. Splanchnic hypoperfusion will cause ischemia of the mucosa, disturbance in the barrier, and increased splanchnic permeability, which in further level mayl cause bacterial and endotoxin translocation to systemic circulation.Enteral feeding in hypoperfusion is beneficial to prevent splanchnic hypoperfusion. However, method of enteral feeding needs to be considered, so that it does not cause harmful adverse effects. Early enteral feeding by slow continuous drip method can prevent splanchnic failure in critically ill patients with high risk of hypoperfusion. Keywords: splanchnic hypoperfusion, enteral feeding, continuous slow drip metho
Correlation between Serum Albumin and Fasting Blood Glucose Level in Patients with Liver Cirrhosis
No full textBackground: Liver cirrhosis is a pathological condition describes the end-stage of liver fibrosis. On liver damage may occur impaired glucose metabolism such as insulin resistance and glucose intolerance. The correlation between chronic liver diseases with impaired glucose metabolism has been known as hepatogenous diabetes. Albumin levels were significantly affected by poorly controlled blood glucose seen from the high HbA1c. This study aims to determine correlation of serum albumin level and fasting blood glucose level in patients with liver cirrhosis.Method: This cross-sectional study was conducted in 52 patients with liver cirrhosis in Gastroentero-hepatology Clinic and Inpatients, Hasan Sadikin Hospital. The study was conducted from February to June 2013. History taking, physical examination and laboratory tests including liver function tests and fasting blood glucose were performed. Data were analyzed using Spearman rank test for the correlation.Results: There were 31 (59.6%) males and 21 (40.4%) females with mean age 53.4 ± 12.8 years. The mean serum albumin was 2.7 ± 0.5 g/dL and median fasting blood glucose was 100 (66-195) mg/dL. Etiology of liver cirrhosis was hepatitis B virus infection 28 (51.9%), hepatitis C virus infection 16 (30.8%) and non viral hepatitis B and C infection 9 (17.3%). Severity of cirrhosis scored using child turcotte pugh (CTP) which was 43 (82.7%) of CTP B and 9 (17.3%) of CTP C. There was statistically significant correlation between albumin level and fasting blood glucose with ρ = -0.630 and p < 0.01.Conclusion: In patients with liver cirrhosis have low serum albumin level correlates with high fasting blood glucose. Keywords: cirrhosis, albumin, fasting blood glucos
17 Year Old Female Patient with Systemic Lupus Erythematosus and Ulcerative Colitis
No full textGastrointestinal manifestations are common in systemic lupus erythematosus (SLE). Although the relationshipbetween SLE with ulcerative colitis (UC) rarely obtained, SLE patients with gastrointestinal manifestations shouldpreferably be evaluated for the possibility of an inflammatory bowel disease (IBD). UC prognosis associatedwith SLE is usually good, whereas by proper diagnosis and management, the clinical output and a good life expectancy of patients will be obtainedA young female, 17 years old, who had previously been diagnosed with SLE for 5 years, came with complaintsof abdominal pain and chronic diarrhea. From the results of colonoscopy and biopsy of the intestinal mucosawas noted that in accordance with UC. After receiving treatment for 6 days, she no longer obtained complaintsof abdominal pain and diarrhea. Keywords: systemic lupus erythematosus, gastrointestinal, ulcerative colitis, inflammatory bowel disease ABSTRAKManifestasi gastrointestinal merupakan hal yang sering terjadi pada lupus eritematosus sistemik (LES).Meskipun hubungan antara LES dengan kolitis ulseratif (KU) jarang didapatkan, sebaiknya pada pasien LESdengan manifestasi gastrointestinal dilakukan evaluasi untuk kemungkinan adanya suatu penyakit inflamasiusus besar. Prognosis UC terkait LES biasanya baik, dimana dengan diagnosis dan penatalaksanaan yang tepatakan didapatkan keluaran klinis dan harapan hidup yang baik pada pasien.Seorang perempuan muda berusia 17 tahun yang sebelumnya telah terdiagnosa LES selama 5 tahun, datangdengan keluhan nyeri perut dan diare kronik. Dari hasil pemeriksaan kolonoskopi dan biopsi mukosa ususdidapatkan gambaran yang sesuai dengan KU. Setelah mendapat terapi selama 6 hari, tidak didapatkan lagi keluhan nyeri perut dan diare.Kata kunci: lupus eritematosus sistemik, gastrointestinal, colitis ulseratif, penyakit inflamasi usus besa