International Journal of Human Capital Management (IJHCM)
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The Effect of Branched Chain Amino Acids and L-Ornithine L-Aspartate Combination as The Late Evening Snacks on Nutritional Status and Minimal Hepatic Encephalopathy in Liver Cirrhosis
No full textABSTRACTBackground:Minimal hepatic encephalopathy (MHE) in liver cirrhotic patients is critical manifestation of low grade hepatic encephalopaty (HE), is caused quality of life decrease and risk of deteriorating into distinct HE. The study was conducted to asses the effect of combination of branched-chain amino acids (BCAA) and L-ornithine L-aspartate (LOLA), which was given late evening, on nutritional status and degree of HE.Method: This single-blind randomized study was conducted on liver cirrhotic outpatients in hepatology clinic of Cipto Mangunkusumo Hospital period June 2011-June 2012. The study subjects were divided into two groups, group of late evening snack (LS) and day snack (DS). Each group was supplemented with combination of milk of BCAAs and LOLA (3.7 g/serving). Evaluation based on history, physical examination, laboratory tests and critical flicker frequency (CFF) was performed one month after the intervention. Data were statistically analyzed with SPSS 15.Results: Thirty-two patients whose the inclusion criteria were divided into 16 subjects for each group, LS and DS. After one month of the intervention, the average level of prealbumin for DS group was increased statistically significant (p < 0.001), but not significant for LS group (p = 0.259). The increase of average body weight,mid-arm muscle circumference (MAMC) and CFF test result in both groups. There was no improvement on subject global assessment (SGA) score after one month intervention in both groups.Conclusion: This study proved that giving combination of BCAAs and LOLA may improve the condition of MHE, however for nutritional status can not be assessed. Keywords: minimal hepatic encephalopathy, BCAAs, LOLA, prealbumin, SGA score, nutritional statu
Improvement of Nutritional Status in Liver Cirrhotic Patients with Adequate Dietary Feeding and High Branched-chain Amino Acids Supplementation
No full textBackground: There is still a high prevalence of malnutrition among liver cirrhotic patients despite the fact that it deteriorates their prognosis. Pre-albumin can be used as a parameter to evaluate short-term nutritional status. This study was conducted to find out the overall outcome of calories and protein diet, and substitution of branched-chain amino acids (BCAA) to enhance pre-albumin serum level in cirrhotic patients with malnutrition. Method: This was a quasi-experimental study conducted in liver cirrhotic patients who visited Koja Hospital between April and September 2009. Mid-arm muscle circumference (MAMC) was used to evaluate nutritional status. Those with MAMC below the 15th percentile were considered as malnourished. Diet of adequate calories and protein with the substitution of 2 x 4 scoop (± 60 g) BCAA milk powder in 200 mL warm water twice daily (± 7.3 g BCAA) was given for two weeks. Pre-albumin serum level was subsequently monitored (before and after intervention) to see if there were any nutritional status changes. Data was analyzed using dependent student T-test with SPSS version 15.0. Results: There were eligible 16 patients. The average pre-albumin level after diet intervention for two weeks was significantly higher than those before the intervention; i.e. from 5.8 (2.2) mg/dL to 6.8 (2.1) mg/dL, with p = 0.004. Conclusion: Diet of adequate calories and branched-chain amino acid can improve the pre-albumin serum level in liver cirrhotic patients with malnutrition. Keywords: cirrhosis, malnutrition, pre-albumin, BCA
The Prevalence and Factors Associated with Drug-induced Hepatitis in HIV-positive Tuberculosis Patients
No full textIntroduction: Tuberculosis (TB) have demonstrated a global increase since 1990 along with the increase of world’s population and the transmission of human immunodeficiency virus (HIV). Anti- tuberculosis drugs are very effective, but it may cause drug-induced hepatitis (DIH). The aim of this study was to assess the prevalence and association of several risk factos with the occurence of drug-induced hepatitis in HIV-positive tuberculosis patients. Method: We conducted a retrospective case-control study based on medical records of HIV-positive TB patients who seek medical attention to HIV Referral Center at Cipto Mangunkusumo Hospital between July 2008 and December 2010. Overall, we enrolled 168 medical records with 42 cases and 126 controls. Chi-square and logistic regression test analysis were conducted for analyzing risk factors of drug-induced hepatitis in HIV-positive tuberculosis patients. Results: Drug-induced hepatitis were found in 42 (8.04%) patients.The prevalence of DIH was highest among 35 (25.2%) male patients, aged < 35 years old in 32 (26.0%) patients, with albumin level < 3.5 g% in 10 (11.2%) patients, body mass index (BMI) < 18.5 kg/m2 in 14 (18.4%) patients, CD4+ count < 100 cells/mm3 in 29 (24.4%) patients, and those who received rifampicin (R), isoniazid (H), and pirazinamid (Z) regiments for their anti-tuberculosis drugs 24 (31.2%) patients. No risk factors were found to have statistically significant association with DIH. Conclusion: The prevalence of DIH is quite high. Although no risk factor was found statistically significant, but evaluation and liver biochemical examination should be carried out regularly in patients with DIH risk factors. Keywords: drug-induced hepatitis, tuberculosis, human immunodeficiency viru
Etiology Profile of Lower Gastrointestinal Bleeding
No full textBackground: Lower gastrointestinal bleeding (LGIB) is still a significant health problem since the unknown etiology had not existed until now. Similar condition occurs at Adam Malik Hospital. No data about the etiology of LGIB has been defined. Therefore, this study was aimed to recognize the etiology profile of LGIB at Adam Malik Hospital, Medan. Method: A retrospective descriptive study was conducted on medical records of patients who had undergone lower gastrointestinal tract endoscopy (colonoscopy) at Adam Malik Hospital, Medan between January 2009 and December 2010 based on their complaint of hematochezia. Data was analyzed using SPSS version 19. The data was categorized based on subjects’ age, sex and etiology of their hematochezia. Results: There were 116 patients consisted of 61 (52.6%) males and 55 (47.4%) females with mean age of 50.52 (17-84) years. The colonoscopy revealed 52 (44.7%) cases of hemorrhoidal varices, 17 (14.7%) cases of rectal carcinoma, 17 (14.7%) normal endoscopic results, 8 (6.9%) cases of sigmoid carcinoma, 8 (6.9%) of proctitis, 6 (5.1%) cases of colitis, 4 (3.5%) cases of colon carcinoma, and 4 (3.5%) cases of rectosigmoid carcinoma. Conclusion: This study found that hemorrhoidal varices is the most common etiology of LGIB. Keywords: LGIB, colonoscopy, hemorrhoid
Microscopic Colitis in Patients with Diarrhea of Unknown Etiology: Diagnosis and Treatment
No full textChronic diarrhea is a common reason for referral to a gastroenterologist. Microscopic colitis (MC) is fairly common cause of chronic non-bloody diarrhea. Microscopic colitis which was previously regarded rare, now has emerged as a common cause of chronic diarrhea. The condition is characterized clinically by chronic non bloody diarrhea, a macroscopically normal or near-normal colonic mucosa, but microscopic examination of mucosal biopsies reveals diagnostic histopathological changes. Microscopic colitis mainly includes two diseases, collagenous colitis (CC) and lymphocytic colitis (LC). In CC the most characteristic feature is thickening of the sub-epithelial collagen layer (SCL) beneath the basal membrane intra-epithelial lymphocyte (IEL) infiltration although not asprominent as in LC. The diagnosis of LC relies on a characteristic increase of IELs, which exceeds 20 IEL/100 surface epithelial cells compared with < 5 IEL/100 surface epithelial cells in normal colonic mucosa. Randomized controlled trials (RCTs) assessing therapies for microscopic colitis have been performed. A previously published review showed that budesonide was effective in producing both clinical and histological responses in patients with collagenous colitis. This review will focus on epidemiology, clinical features and treatment of MC. Keywords: chronic diarrhea, microscopic colitis, lymphocytic and collagenous coliti
Zinc Supplementation in Children with Acute Diarrhea of Invasive Bacterial and Non-bacterial Infection
No full textBackground: Diarrhea is one of the manifestations of gastrointestinal disorder. In Indonesia, diarrhea is still one of the leading causes of death in infants and children. Diarrhea requires a rational and comprehensive management to deliver an optimal result. This study was aimed to assess the effectiveness of zinc supplementation in children with acute diarrhea of invasive bacterial infection. Method: A cross-sectional study was performed in 74 children aged 2-14 years with acute diarrhea, who visited the Outpatient Clinic, Pasar Rebo Hospital Jakarta, between January and June 2011. The inclusion criteria were patients had suffered diarrhea for 1-7 days. Based on fecal analysis Results, subjects were divided into group A (non-infectious) and group B (infectious). All children received zinc supplementation. Results: The mean value of subject age was 46.6 months in group A and 81.3 months in group B. The mean frequency of diarrhea prior to zinc supplementation was 7.5 times/day in group A and 7.8 times/day in group B. Duration of diarrhea before zinc supplementation was 52.6 hours in group A and 45.4 hours in group B. On the seventh day, there was no subject of both groups who still suffered from diarrhea. Although the duration of diarrhea in group A was shorter than group B, no significant difference was found (62.4 hours vs 66.8 hours, p = 0.07). Conclusion: Zinc supplementation shows similar efficacy in children with acute diarrhea caused by invasive bacterial infection and those without bacterial infection as well. Keywords: acute diarrhea, invasive diarrhea, zinc supplementatio
Helicobacter pylori Infection in Superficial Gastritis, Erosive Gastritis and Gastric Ulcer
No full textBackground: Helicobacter pylori (H. pylori) infection leads to inflammation of the gastric mucosa. It damages the gastric epithelium and related to the risk of developing gastric cancer. Over time, it may develop into the development of glandular atrophy and intestinal metaplasia. This study was aimed to evaluate the histological features of gastric mucosa, including H. pylori infection in patients with endoscopically found superficial gastritis, erosive gastritis and gastric ulcer. Method: Subjects with abdominal complaints who underwent consecutive upper gastrointestinal endoscopy were prospectively selected at Tugurejo Hospital between November 2004 and December 2010. Eligible subjects were those with endoscopic diagnosis of superficial gastritis, erosive gastritis or gastric ulcer. The biopsy specimens were taken from the corpus, angulus and antrum of all the patients. Giemsa and hematoxylin-eosin staining were used for the histological diagnosis H. pylori and gastric mucosa inflammation. Results: The overall prevalence of H. pylori infection in superficial gastritis, erosive gastritis and gastric ulcer were 24.3%. There was significant difference between H. pylori infection rate in antrum of patients with superficial gastritis 19.4%, erosive gastritis 26.3%, and gastric ulcer 34.7%. The positivity rate of glandular atrophy and intestinal metaplasia of superficial gastritis with H. pylori- positivity was 12.5%, 14.0%; erosive gastritis 26.3%, 16.6%; and of gastric ulcer 38.9%, 29.3%; respectively. However, there was no significant difference. Conclusion: Patients with gastric ulcer have H. pylori infection, atrophic gastritis and metaplasia intestinal more than superficial gastritis and erosive gastritis. Progression of the gastric ulcer to atrophic gastritis and intestinal metaplasia is related to H. pylori infection. Keywords: Helicobacter pylori infection, superficial gastritis, erosion and ulce
Management of Nutrition in Gastric Emptying Preparation before Medical Procedures
No full textPatient preparation before medical procedures, for example in elective surgery, abdominal ultrasonograhy (USG), endoscopy, intubation, etc., is by emptying the stomach. Attempt in emptying stomach is by fasting since the night before medical procedure with the intention to decrease the risk of aspiration. Management of nutrition guidelines in preparation of medical procedures currently refers to pre- surgery fasting which is recommended by American Society of Anaesthesiologist (ASA) and the Canadian Anaesthetists Society (CAS). In Indonesia, pre-surgery fasting guideline is suggested by Indonesia Society of Anesthesiology and Intensive Care. However, in various unit of service, fasting the patient since the night before is still performed. Development of nutrition management in medical procedures has experienced many changes, such as surgery which is aimed to restore organ normal function and to accelerate the healing of patients. Various studies on nutrition are developed in conjunction with the programs development to optimize pre-surgery preparation. Keywords: nutrition management, pre-surgery nutrition, aspiratio
Non-alcoholic Fatty Liver Disease Related to Metabolic Syndrome: a Case-control Study
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is a benign condition, but it can go for years and progress to liver cirrhosis or eventually to liver cancer. Metabolic syndrome (MS) is a condition associated with NAFLD. This study was aimed to know the risk factors of NAFLD related to metabolic syndrome. Method: A case-control study was performed in NAFLD patients with or without MS and healthy individuals. All subjects were recruited from population that underwent routine medical check-up at Sardjito Hospital, Jogjakarta, during March 2007–August 2008. Diagnosis of NAFLD is defined based on clinical and liver ultrasound findings. Diagnosis of MS is defined by International Diabetes Federation on criteria for the diagnosis of MS. Data were analyzed by using T-test, ANOVA and linear regression. Odds ratio (OR) (95% CI and p < 0.05) was calculated by cross-tab analysis. Results: There were 84 patients enrolled in the study (group I = 30 NAFLD + MS subjects; group II = 26 NAFLD patients; group III = 28 healthy). The data showed statistically significant Results in waist circumference, systole blood pressure, fasting glucose, triglyceride, high density lipoprotein (HDL) cholesterol level, homeostasis models assessment index ratio (HOMA-IR), free fatty acid (FFA), and adiponectin. The ANOVA and linear regression test among NAFLD groups showed significant difference only on HDL-cholesterol and FFA level. The lowest OR was 1.674 for HDL-cholesterol and highest OR was 13.571 for triglyceride. Conclusion: The independent factors of NAFLD related to metabolic syndrome are FFA and HDL- cholesterol level, even though a decreasing of HDL-cholesterol level has a lowest risk of NAFLD. Keywords: NAFLD, metabolic syndrome, FFA, adiponectin, HDL-cholestero