International Journal of Human Capital Management (IJHCM)
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S-Index and APRI Score to Predict Liver Fibrosis Chronic in Hepatitis B and C Patients
No full textBackground: A great interest has been dedicated to the development of non invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. The aim of this study was to comparethe accuracy between S-index and aspartate aminotransferase to platelet ratio index (APRI) to FibroScan for predicting liver fibrosis in chronic hepatitis B and C patients.Method: A cross-sectional study was conducted in 40 patients with chronic hepatitis B and C between January 2010 - May 2011 at Division of Gastroentero-hepatology, Department of Internal Medicine, Adam Malik Hospital, Medan. Patients underwent laboratory examination and FibroScan, then used predictive values to assess the accuracy of S-index scores and APRI compared to FibroScan. The analysis was performed using SPSS 15.0.Results: S-index identified significant fibrosis in 87.5% patients with sensitivity (Se) 87.5% and specificity (Sp) 100%. About 67.5% of 40 patients could be identified correctly. S-index also could accurately predict the absence or presence of cirrhosis in 87.5% of the total 40 patients, with NPV 91.7% and PPV 81.25%, respectively. APRI for significant fibrosis has Se 85.7%, Sp 88%, PPV 88.8%, NPV 69.2%; while Se 53%, Sp 88%, PPV 72.7%, NPV 75.8% for liver cirrhosis. AUROC value for S-index was higher than APRI in predicting significant fibrosis and cirrhosis, i.e. 0.938 vs. 0.917 and 0.873 and 0.707, respectively.Conclusion: The S-index has a higher accuracy than APRI in predicting significant fibrosis and cirrhosis in patients with chronic hepatitis B virus and hepatitis C virus infection.Keywords: S-index, APRI score, FibroScan, chronic hepatitis B and
Comparison between Intermittent Propofol Bolus Techniques and Target-Controlled Infusion in Patients Underwent Gastrointestinal Endoscopy
No full textBackground: Nowadays, the use of propofol for sedation during gastrointestinal endoscopic procedure has become more popular, either by intermittent-bolus (IB) technique or target-controlled infusion (TCI). Theaim of this study was to compare the outcomes of both techniques including the total consumption of propofol, consumption per minute, total cost, side effects and its recovery time.Method: This study was a single-blinded randomized clinical trial conducted at Digestive Endoscopy Center, Cipto Mangunkusumo Hospital, Jakarta between October and November 2013. There were fifty patients with pre-operative American Society of Anesthesiologist (ASA) Physical Status Classification I-III, aged 18-65 years, body mass index 18-30 kg/m2 who were randomized to obtain sedation with IB propofol or TCI after having a premedication with 1 μg/kgBW fentanyl. The outcomes including the duration of sedation, total dose, propofol consumption per minute, the total cost, the incidence of hypotension, the incidence of desaturation, and recovery time were then evaluated using SPSS version 21.0.Results: Duration of procedure between two groups was not significantly different (p = 0.718). Total dose of propofol, its consumption per minute and total cost were higher in TCI group (p = 0.010; p = 0.004; p = 0.001). The incidence of hypotension, desaturation and recovery time were not significantly different (p = 0.248; p = 0.609; p = 0.33) in both groups.Conclusion: IB technique is more efficient in terms of total propofol dose, consumption per minute and total cost compared to the TCI technique. The incidences of hypotension, desaturation and recovery time profiles were comparable between the two groups.Keywords: gastrointestinal endoscopy, intermittent bolus, propofol, sedation, TC
Role of Lamivudine as Preemptive Therapy in Cancer Patients with Hepatitis B undergoing Chemotherapy
No full textPatients diagnosed with hematology malignancy and solid tumor who underwent chemotherapy, frequently encountered hepatitis B reactivation. Patients with blood cancer, including lymphoma, had higher risk of reactivation compared to those with solid tumor. Steroid and immunosuppressant drugs contained in chemotherapy regimens were responsible for those events. Hepatitis B reactivation during chemotherapy treatment could contribute to acute liver failure and increase mortality. Administration of analog nucleoside therapy in this group of patient prior to the initiation of chemotherapy could prevent reactivation of hepatitis B.A 43 year-old male patient were diagnosed with diffuse large B cell non-Hodgkin lymphoma stadium II BE (oropharynx) under chemotherapy and had hepatitis B. In this evidence based case report, we reported a critical appraisal of the role of lamivudine as preemptive therapy in blood cancer and solid tumor.Keywords: chemotherapy, hepatitis B reactivation, malignanc
Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia
No full textBackground: Upper gastrointestinal (UGI) malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI malignancy. This study was aimed to determine the prevalence of UGI malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age > 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age >45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI malignancy.Keywords: dyspepsia, alarm symptoms, upper GI malignancy, clinical prediction mode
Gastrointestinal Problems in HIV/AIDS Patients
No full textBackground: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital.Keywords: gastrointestinal, HIV/AIDS, oral candidiasis,CD
Impaired Glucose Metabolism in Liver Cirrhosis
No full textBackground: Approximately 30% of patients who suffer cirrhosis maybe diabetic, called hepatogenous diabetes (HD). Insulin resistance seems to be the pathophysiologic basis for HD. Aims of this study were to evaluate the glucose metabolism disorders in liver cirrhosis patients and to observe the insulin resistance in HD.Method: This study was conducted from February-July 2013 in Koja Hospital Jakarta. In the first phase, with observational design, inclusion criteria were liver cirrhosis and exclusion was an acute complication. We recorded their oral glucose tolerance test (OGTT). Patients who met the HD criteria were continued to the second phase, using analytic design, and were compared with type 2 diabetes mellitus (T2DM) patients as control. Mean differences of 2-hours postprandial plasma glucose/fasting plasma glucose (2hPPG/FPG) ratio, as well as fasting insulin levels between both groups were assessed.Results: Twenty four patients were included in our study. Normal glucose tolerance test were noted in 7 (29%) patients, impaired glucose tolerance (IGT) in 6 (25%) patients and HD in other 11 (46%) patients. In the second phase, we obtained the ratio of 2hPPG/FPG in HD was 2 ± 0.5 and T2DM was 1.5 ± 0.4 (p = 0.01). Mean fasting insulin levels in HD was 10.8 ± 4.2 μIU/mL, while T2DM was 9.3 ± 5.3 μIU/mL (p = 0.5). The ratio of 2hPPG/FPG was higher in HD compared to T2DM, assuming the role of insulin resistance in HD.Conclusion: There were impaired glucose metabolism in liver cirrhosis patients, as well as hepatogenous diabetes. Insulin resistance and hyperinsulinemia appeared to play role in HD.Keywords: hepatogenous diabetes, type 2 diabetes mellitus, 2hPP/FPG ratio, fasting insulin leve
Liver Disorders in Type 2 Diabetes Mellitus
No full textBackground: Patients with type 2 diabetes mellitus (T2DM) are frequently diagnosed with some abnormal liver features. These liver abnormalities are suggested to be correlated with insulin resistance. The aim of thisstudy was to evaluate liver abnormalities and fasting insulin levels in patients with T2DM.Method: This study was conducted in Koja Hospital from February to July 2013. Study design was analytical study. Data for sex, age, complication, body mass index (BMI), liver function, liver enzyme, and fasting insulinlevel were collected. Univariate and bivariate statistical analyses were done using SPSS 20.Results: Twenty eight patients were included in this study, 71.43% of them were female. The age group of 40-60 years was the highest among the patients (64.28%). Highest complication was neuropathy, BMI of mostpatients were obese. Liver abnormalities were documented in 35.8% patients, liver enzyme increased in 21.4% patients. Non alcoholic fatty liver disease (NAFLD) were noted in 46.6% patients, and one patient was positive for hepatitis B. Mean fasting insulin in T2DM with NAFLD were higher than in T2DM without NAFLD. However, it was not statistically significant (40.08 ± 36.8 μU/mL vs. 54.3 ± 37.1 μU/mL; p = 0.27).Conclusion: Liver abnormalities found in T2DM patients were elevated liver enzyme, decreased albumin and increased of bilirubin. Through ultrasound, NAFLD and liver cirrhosis were found. Fasting insulin levelwas higher in T2DM with NAFLD but it was not statistically significant.Keywords: type 2 diabetes mellitus, non alcoholic steato-hepatitis, fasting insuli
Pharmacological and Non-Pharmacological Treatment in Non-Alcoholic Fatty Liver Disease
No full textNon-alcoholic fatty liver disease (NAFLD) is a spectrum of liver disease, from steatosis to liver cirrhosis in individual who does not consume alcohol in significant amount. The prevalence of NAFLD in Indonesia was estimated around 30%, this condition related to the increased incidence of metabolic disorders. Current understanding of NAFLD pathogenesis is the third-hit theory, in which insulin resistance resulting in free fatty acid accumulation that triggers inflammation causing fibrosis and hepatocyte death, and these conditions are not followed by adequate hepatocyte proliferation.Treatment of NAFLD requires both non-pharmacologic and pharmacologic interventions. Life style intervention includes restricting calories, low saturated fat and low sugar diet, and also physical activity. Bariatricsurgery remains controversial since in several study participants had experienced deterioration of disease. There are no definitive treatment for NAFLD currently. Treatment is aimed to improved insulin sensitivity, decreased oxidative stress and inflammation. Several agents use for treatment of NAFLD are insulin sensitizer (metformin and glitazones), statin, omega-3, vitamin E, ursodeoxycholic acid, orlistat, pentoxyphylline, and losartan.Keywords: NAFLD, treatment, pharmacologic, non-pharmacologi
The Profil of Esophagogastroduodenoscopy for Elderly Patients at Kariadi Hospital Semarang
No full textBackground: The hospitalization and mortality rate for gastroduodenal ulcer in the elderly remain very high. It may be attributed to increase prescriptions for gastroduodenal damaging drugs, including the non-steroidal anti inflammatory drugs (NSAIDs). The aim of this study was to determine the profile of elderly patients’ characteristics who had undergone esophagogastroduodenoscopy (EGD) at Kariadi Hospital. Method: A cross sectional study was conducted in elderly patients with non-variceal EGD at Kariadi Hospital, Semarang between Januari 2009 and December 2010. Analysis statistic was performed using chi-square test, with SPSS version 19. Results: Among records for a total of 164 cases of eldery patients who had undergone EGD, 90 patients were enrolled in this study. There were 64 (71.1%) male patients and the most chief complaint was hematemesis (22.2%). The most common indication for EGD was upper gastrointestinal tract bleeding (55.6%). EGD results demonstrated that the most common finding was mild abnormalities (56.7%). Gastric ulcer was found in EGD results in 38.0% cases with upper gastrointestinal bleeding (PR = 5.5; 95% CI = 1.7-17.9; p = 0.002). Moreover, the gastric ulcer was also found in 42.3% among NSAIDs users (PR = 3.2; 95% CI = 1.2-8.6). Conclusion: Upper gastrointestinal tract bleeding is the most common indication for EGD in elderly patients at Kariadi Hospital, Semarang. The most EGD image was only mild abnormalities followed by gastric ulcer. In the study, upper gastrointestinal bleeding is associated with high incidence of gastric ulcer, which also correlated with high incidence of NSAIDs utilization. Keywords: elderly, esophagogastroduodenoscopy, co-morbiditie