International Journal of Human Capital Management (IJHCM)
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Detection of HBV-DNA and Its Correlation with the HBeAg/Anti-HBe Serological Status in HBsAg-positive Patients
No full textBackground: In the past years, HBeAg and anti-HBe status in individuals with positive HBsAg were often correlated to viral replication. This study was aimed to find correlation between the HBV viremia and HBeAg/anti-HBe serological status in HBsAg-positive individuals. Method: An observational-analytic design was performed in this study. The sera of all positive HBsAg patients at Biomedika Hospital Laboratory were collected and examined for HBeAg and anti-HBe using immunochromatography technique between January and April 2012. The sampling method was purposive sampling. Afterwards, the sera were examined for HBV-DNA by polymerase chain reaction (PCR). Results: Sufficient amount of sera were collected from 44 patients consisting of 33 males and 11 females. The mean age was 15-68 years. Positive HBeAg and negative anti-HBe status was found in 11 (42%) patients. Negative HBeAg and positive anti-HBe was found in 26 (59.1%) patients. Both HBeAg and anti-HBe were negative in 7 (16.3%) patients. HBV-DNA was detected in all 11 (100%) patients with positive HBeAg and negative anti-HBe. HBV-DNA was also detected in 11 (42%) patients with negative HBeAg and positive anti-HBe. However, there was only one patient (14.3%) with both negative HBeAg and anti-HBe status, who had detectable HBV-DNA. Conclusion: Positive HBeAg can be used as an indicator of viremia, but negative HBeAg cannot be used as an indicator of the absence of viremia without further HBV-DNA testing. Patients with negative HBeAg and positive HBV-DNA were suspected for having pre-core mutant. Keywords: HBV-DNA, positive HBsAg, HBeAg, anti-HBe, pre-core mutan
Proximal Jejunal Diverticle: Cause of Upper Gastrointestinal Bleeding
No full textFive percents of patient presenting with gastrointestinal (GI) bleeding, the etiology of bleeding could not be found by upper endoscopy and colonoscopy. Almost 75% of which, the abnormality is detected in small bowel. One of the etiologies in small bowel bleeding is jejunal diverticle. In this paper, we reported a female, 38 years old, came with upper GI bleeding since one month ago. She had undergone several diagnostic procedures, such as abdominal ultrasound, abdominal computed tomography scan (CT-scan), upper and lower endoscopy, but there were no conclusion to explain the cause of bleeding. However, barium follow through examination found a diverticle, pouch-like shape, at jejunal proximal projection. Then, she underwent surgical treatment. Small intestine bleeding is best investigated by capsule endoscopy and double balloon enteroscopy. However, in limited conditions, small bowel follow through can be used to screen the source of bleeding in small intestine. The specific diagnosis of small intestine diverticle is possible by radiologic contrast study using various form of barium. Small bowel diverticle does not require surgical treatment, unless refractory symptoms or complications occur. Jejunal diverticle is one of sources in small intestinal bleeding. Small bowel follow through can still be used to diagnose jejunal diverticle. Keywords: diverticle, proximal jejunal, upper gastrointestinal bleeding, barium follow throug
Paradigm on Chronic Constipation: Pathophysiology, Diagnostic, and Recent Therapy
No full textABSTRACTChronic constipation is a medical gastrointestinal problem which can degrade patient’s quality of life. So far, the shifting pathophysiologic mechanism to colonic neuropathology has not been supported by diagnostic facility and therapy. Target therapy for chronic constipation related to enteric nervous system is still limited to study. Currently, the discovery of neurotrophin-3 has not shown any significant development needed in daily clinical practice. Until now study related to endoscopic full-thickness biopsy has not been done in human and waiting for its applications in daily practice. Targeted therapy for chronic constipation which is related to enteric nervous system is still limited to study. The discovery of neurotrophin-3, although currently on clinical trial phase II, still not showing any significant contribution in daily clinical practice. New pathophysiologic mechanism shifting the ‘idiopathic’ paradigm or ‘functional’ to colonic neuropathology has not been met with diagnostic modalities and therapy based on this knowledge. Study regarding endoscopic full-thickness biopsy to help revealing this novel mechanism has not been done in human. Henceforth, until now applied studies pertinent to this subject are longing in order for enteric neuron etiology can be firmly established Thus, in the future, translational study is demandingly needed for a firm establishment of diagnostic and therapeutic modalities to its currently evolving pathophysiology. Keywords: chronic constipation, colon, enteric nervous system, neurotophin-
Upper Gastrointestinal Endoscopic and Histopathological Findings in Patients with Dyspepsia
No full textBackground: Dyspepsia is a syndrome located in the epigastric area. Upper gastrointestinal (UGI) tract endoscopy and histopathological examination are important diagnostic tools for dyspepsia. This study aimed to evaluate the pattern of dyspepsia in patients who underwent endoscopy examination at Koja Hospital, Jakarta. Method: All patients with dyspepsia who visited Koja Hospital from January until December 2011 were evaluated in this observational study. The data taken was age, gender, clinical symptoms, risk factors, alarm symptoms, body mass index, UGI tract endoscopic and histopathological findings. Data was analyzed using descriptive statistical analysis. Results: Of 1,279 patients with dyspepsia symptoms, 148 patients underwent UGI tract endoscopy. The main symptom was epigastric pain (91.2%). The most common risk factor was female (60.1%). The most common finding of alarm symptoms was history of UGI bleeding (21.6%). The most frequent result of UGI tract endoscopy was gastritis (79.7%). The most widely found of gastritis type was moderate antral gastritis (56%). The most common gastritis histopathological finding was non-active, non- atrophic, non-dysplastic chronic moderate gastritis (56%). All biopsy results included those with gastritis as well as gastric ulcer, which revealed negative results of Helicobacter pylori (H. pylori). Conclusion: The pattern of dyspepsia at Koja Hospital includes female predominant, most patients had alarm symptom history of UGI bleeding, gastritis on endoscopic findings, but H. pylori was not found in histopathological results. Keywords: dyspepsia, symptoms, risk factors, endoscopy, histopathologica
FSSG Scale System in Comparison with GERD Questionnaires in Predicting Endoscopic Findings with Reflux Esophagitis
No full textABSTRACTBackground:Gastroesophageal reflux diseases(GERD) frequently manifests in varied symptoms other than its classics (heartburn and regurgitation), this variation might hinder its diagnostic effort. Several questionnaires based on symptoms filled by the patients themselves may help in diagnosing GERD without previous endoscopic examination. This study objects to compare endoscopic findings in patients which previously asked to fill the questionnaires (frequency scale for the symptoms of GERD (FSSG)) and GERD questionnaire (GerdQ) in pursuit of reliable and valid instrument to detect GERD before endoscopic approaches. Methods: This study was conducted in cross-sectional design involving 72 patients in Adam Malik Hospital, Medan with symptomps of upper abdominal pain or discomfort with or without heartburn/regurgitation. Subjects were asked to fill both FSSG and GerdQ and underwent endoscopy. Diagnoses made were classified as reflux esophagitis, functional dyspepsia, or other diagnoses. Subsequently we conduct a comparison analysis of both questionnaires’ specificity and accuracy using receiver operator curve (ROC) by analyzing the area below the curve. Results: According to endoscopic findings from 72 subjects, we ascertained the following results: 52.8% gastritis, antral ulcer, and esophageal hiatal hernia, 37.5% functional dyspepsia, and reflux esophagitis in 9.7% cases. GerdQ is concluded to be superior in terms of specificity and accuracy compared with FSSG with the following percentages in terms of sensitivity, specificity, accuracy, and p value, respectively: 100%, 23.1%, 61.5%, 0.318 vs. 100%, 73.8%, 86.9%, 0.001. Conclusion: GerdQ is superior compared to FSSG in diagnosing GERD based on clinical symptoms in daily practice.Keywords: reflux esophagitis, GERD, FSSG, GerdQ, endoscopy, Los Angeles classification, heartburn.
The Effect of Pediococcus pentosaceus on Stool Frequency, TNF-α Level, Gut Microflora Balance in Diarrhea-induced Mice
No full textBackground: Enteropathogenic Escherichia coli (EPEC) are pathogenic microorganisms causing inflammation and imbalanced gut microflora that may result in diarrhea. Pediococcus pentosaceus (P. pentosaceus) isolated from “dadih” (milk curd) are used as probiotics containing lactic acid bacteria (LAB), which are useful to improve the balance of intestinal microflora and inhibit the growth of pathogenic microorganisms. This study was aimed to recognize the effect of P. pentosaceus supplementation on stool frequency, tumor necrosis factor-α (TNF-α) and gut microflora balance in experimental mice with EPEC-induced diarrhea. Method: The study was conducted in 60 white mice (Mus muscullus) at Biomedical Laboratory, Biotechnology/Production and Animal Husbandry Technology Institute, University of Andalas, Padang in April 2012. The frequency of stool, TNF-α level and microflora balance of the mice were measured before and after the EPEC-induced diarrhea and following the administration of antibiotics. Statistical analysis was performed using ANOVA and Duncan test. Results: The highest mean stool frequency was found in positive control group, i.e. 55 times, which was reduced significantly after 12-hour P. pentosaceus supplementation in a dose of 2 x 108 cfu/g into 18 times. The mean TNF-α level in positive control group was 128.17 pg/mL that lowered significantly to 48.0 pg/mL. The highest mean total number of LAB was 97.0 x 107 cfu/g, which was significantly different from positive control group of 7 x 107 cfu/g. Conclusion: P. pentosaceus supplementation in a dose of 2 x 108 cfu/g may reduce the stool frequency, lower TNF-α and improve the gut microflora balance following 12-hour supplementation in diarrhea-induced mice. Keywords: Pediococcus pentosaceus, TNF-α, diarrhea, EPEC, gut microflor
Histopathology of Helicobacter pylori in Chronic Dyspepsia Patients
No full textABSTRACTBackground: Helicobacter pylori (H. pylori) are the most common infection found in dyspepsia cases. This infection is almost always found in digestive tract inflammation and commonly develops into chronic gastritis. Meanwhile, chronic gastritis is a condition assumed as the early event in pathological abnormalities of the stomach which finally may develop into carcinoma of the gaster. In Indonesia, data describing the incidence of H. pylori infection based on the histopathological appearance, location of specimen collection, inflammatory degree, and age of chronic dyspepsia patients is not yet available. The aim of this study is to determine the incidence of H. pylori based on histopathology appearance in chronic dyspepsia patients in Moewardi Hospital Surakarta.Method: This study is a cross sectional descriptive study by performing endoscopy-biopsy and histopathology examination to chronic dyspepsia patients who came to Gastroenterohepatology Clinic, Department of Internal Medicine, Moewardi Hospital, Surakarta on 1 January 2009 - 31 December 2010.Results: More than 90% subjects were > 40 year old with the distribution of majority patients were 46-55 year old (32.43%). The most commonly found endoscopic appearance in subjects with positive H. pylori was superficial chronic gastritis (81.08%) with mild inflammatory degree (64.86%) and majority located in the antrum 97.3%.Conclusion: The proporsion of H. pylori infection in male and female was almost equal and was mostly found in the age group of 46-55 year old. This infection frequently happens in chronic dyspepsia who has histopathologic appearance of superficial chronic gastritis with mild inflammatory degree in the antrum area. Keywords: Helicobacter pylori, superficial chronic gastritis, ag
Identification and Stenting of Malignant Obstructive Jaundice : Determining the Success Rates of ERCP
No full textBackground: Malignant and benign lesions may cause obstructive jaundice. The treatment of these conditions includes biliary stenting drainage, percutaneous transhepatic biliary drainage (PTBD), or surgical procedures. In advanced malignant jaundice, stent placement often turns out to be difficult. The aim of this study was to determine the success rates of malignant obstructive jaundice detection utilising endoscopic retrograde cholangiopancreatography (ERCP) and its stent placement procedure. Method: We conducted a retrospective study in 139 patients who undergone ERCP in Cipto Mangunkusumo Hospital between October 2004 and July 2008. Data was analyzed descriptively with SPSS version 17.0. Results: Of 139 study subjects, 131 (94.2%) of them had clinical obstructive jaundice (direct bilirubin > indirect bilirubin level). There were 73 (55.7) male patients, with age range of 20-84 years. Among 114 patients with identified cause of obstruction, 57 (50%) patients had undergone stent placement; however, only 32 (56.1%) patients had successful stent placement. Our descriptive analysis showed that age and sex did not affect the stent success rates, and malignancy was showed to be a factor of stent failure. Conclusion: ERCP appears to be reliable enough for identifying the cause of obstructive jaundice in most patients. In this study, the achieved success rate of stent placement is more than 50%. Moreover, such rate is lower in the malignant obstructive jaundice than the non-malignant counterparts. Papillary carcinoma is the most frequent cause of malignant obstructive jaundice. Keywords: ERCP, obstructive jaundice, stenting, malignanc
Acupuncture in the Management of Functional Dyspepsia
No full textDyspepsia is an uncomfortable sensation or pain in the upper abdomen which is persisting or recurring. Dyspepsia can be classified into functional and organic dyspepsia. Functional dyspepsia is more commonly found compared to the organic type, approximately 60%. Pharmacologic therapy in the management of functional dyspepsia has not shown optimal results, with the multifactorial etiology of functional dyspepsia as the main challenge. Therefore, the management of functional dyspepsia is widened and involves variety treatment modalities, acupuncture being one of them. Acupuncture is a way of treatment by puncturing needles to particular area on the skin to eliminate pain and treat particular diseases. Acupuncture affects stomach motility and gastric acid secretion in functional dyspepsia patients. Two acupuncture points commonly used in functional dyspepsia are ST 36 and PC 6. Acupuncture can restore gastric motility in patients with functional dyspepsia, who have gastric emptying disturbance. Besides, functional dyspepsia complaints, such as epigastric pain, nausea, vomiting, anorexia, burning sensation, and bloating were found to improve after acupuncture therapy. Side effects of acupuncture are not life threatening with low incidence rate. The effectiveness of acupuncture therapy compared to standard medication shows varies results. Further studies are needed to determine the characteristics of functional dyspepsia patients which could have optimal results through acupuncture therapy. Keywords: epigastric pain, gastric motility, ST 36, PC