International Journal of Human Capital Management (IJHCM)
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Candida Esophagitis: A Retrospective Study of Upper Gastrointestinal Endoscopic Grading and the Characteristic Profile
No full textBackground: Candida esophagitis is a common abnormality found on esophagogastroduodenoscopy (EGD) procedure in patients with recognizable risk factors. However, the finding is frequently incidental as most of them are asymptomatic. There has been no study on the characteristics of Candida esophagitis in Indonesia. The aim of this study was to describe the degree of Candida esophagitis and its characteristics in patients who underwent EGD procedure at Cipto Mangunkusumo Hospital. Method: A retrospective study was conducted on all EGD procedures at the Gastroenterology Procedure Room, Internal Medicine Department, Cipto Mangunkusumo Hospital, between January 2007 and December 2009 with a total of 2,311 samples. The study was carried out by visually examining all endoscopic procedures and grading them according to the Kodsi severity grading (1976), and evaluating medical records. Data analysis was performed using Microsoft Excel 2007. Results: During the study period, Candida esophagitis was found in 2.6% patients with predominant male (68.9%) and the average age was 49.8 ± 15 years. The chief complaints found were dyspepsia (34.4%), melena (21.3%) and dysphagia (4.9%) and 32.8% patients were asymptomatic. The most frequent risk factors were age ≥ 60 years old (28.3%), proton pump inhibitor or H2 receptor antagonist user (26.4%), and antibiotics (17.0%). Grade II Kodsi candidiasis was the most prevalent degree in this study (44.3%). Conclusion: Candida esophagitis was one frequent finding in endoscopy based on the complaint of dyspepsia in patients with certain risk factors. However, the results of this study still need further validation in prospective studies. Keywords: Candida esophagitis, esophagogastroduodenoscopy, risk factors, gradin
The Future of Acid Inhibition
No full textThere are many unmet needs with current gastric acid suppression with proton pump inhibitors (PPIs). Recommended prescription of one standard morning dose for all patients and for all medical conditions must be scientifically inappropriate and far from individualized personal medicine. For several diseases, especially gastroesophageal reflux disease and Barrett esophagus, more intense, more prolonged diurnal acid suppression is indicated. Especially inhibition of nocturnal acid secretion with our current delayed-release PPIs turns out to be difficult. This overview summarizes the actual attempts to improve the control of acid secretion, which is necessary to adapt the degree of acid inhibition to the individual patient needs. To be discussed are: immediately release PPIs, extended PPI formulations, PPIs with a much longer half-life, potassium competitive acid blockers, gastrin antagonists, etc. Future studies have to proof that those novel drug approaches indeed contribute to reduce the unmet needs. Keywords: acid secretion, PPI, nocturnal acid secretio
Idiopathic Portal Hypertension: A Rare Cause of Recurrent Hematemesis Melena
No full textIdiopathic portal hypertension (IPH) known as non-cirrhotic portal fibrosis (NCPF) is a constellation of liver disorders, in which liver cirrhosis is not present and the main clinical and pathological findings are encountered in the portal venous system. Patients usually come to hospital with esophageal varices and upper gastrointestinal bleeding; however, it is often misdiagnosed as liver cirrhosis. Its etiology is still unknown, but some evidences and epidemiological studies suggest that it is a multifactorial disease with genetic basis. The laboratory evaluation in IPH reveals only mild and subtle abnormalities predominantly related to hypersplenism. The major complications of IPH are esophageal varices and hypersplenism. Endoscopic sclerotherapy or band ligation, shunt surgery, and transjugular intrahepatic portosystemic shunt (TIPS) are modalities to treat the complications of IPH. The case report reported about diagnosis and treatment of a 20-year-old male with idiopathic portal hypertension. Keywords: idiopathic portal hypertension, non-cirrhotic portal fibrosis, diagnosis, treatmen
Total Lymphocyte Count as a Nutritional Parameter in Hospitalized Patients
No full textBackground: Nowadays, there are still many malnourished patients during hospitalization, which comprises around 45-50% patients. Malnutrition is related to increased mortality and morbidity rate; therefore, nutritional state should be assessed in hospitalized patients. Total lymphocyte count (TLC) is related to decreased body function in malnutrition and it is a means of nutritional assessment. Until now, there is no data showing association between malnutrition and TLC in hospitalized patients in Indonesia. The objective of this study was to identify the association between malnutrition and TLC < 1,200 cell/mm3 in hospitalized patients. Method: This study was a cross-sectional study. Subjects were new patients hospitalized at internal medicine ward of Cipto Mangunkusumo Hospital. Patients were collected by consecutive sampling. We conducted the study between April and May 2008. Fifty four patients were assessed for malnutrition by the subjective global assessment (SGA) and they also had undergone complete blood count. TLC was numbered with routine complete blood count test. Patients were classified into malnutrition according to SGA. TLC was classified with cut-off point of 1,200 cell/mm3. Statistical analysis included Chi-square test, which was used to compare proportion. Results: There were 52% malnourished patients, 33% patients with TLC < 1,200 cell/mm3, 57% patients with malnutrition and TLC < 1,200 cell/mm3. This study showed that there was an association between malnutrition and TLC < 1,200 cell/mm3 (p = 0.001). Moreover, there was also significant association between severe malnutrition (SGA C) with TLC < 900 cell/mm3 (p = 0.02). Conclusion: There is an association between malnutrition and TLC < 1,200 cell/mm3. Keywords: malnutrition, total lymphocyte count, body mass index, subjective global assessmen
The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital
No full textBackground: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study. Keywords: upper gastrointestinal endoscopy, profile, indications, endoscopic diagnosi
Cytokeratin 7 and Cytokeratin 19 Expressions in Oval Cells and Mature Cholangiocytes as Diagnostic and Prognostic Factors of Cholestasis
No full textBackground: The activity of liver progenitor cells as bipotent liver stem cells, such as the oval cells, has been observed. The presence of oval cells and mature cholangiocytes forming hepatobiliary ductules may be applied to distinguish extrahepatic and intrahepatic cholestasis of the infants. Method: This cross sectional study was performed on 40 paraffin-embedded sections consisting of 2 groups of 20 cases with extrahepatic and intrahepatic cholestasis of the infants from histophatological examination in Cipto Mangunkusumo hospital Jakarta between January 2000 and September 2011. The liver fibrosis grading was reevaluated by hematoxylin and eosin and also trichrome staining. The specimens were tested by immunohistochemical staining for cytokeratin (CK) 7 and CK 19 expressions in oval cells and mature cholangiocytes. The correlation between CK7/CK19 expressions in oval cells and liver fibrosis were analyzed by Spearman’s correlation test. Results: Expressions of CK7 and CK 19 on oval cells and mature cholangiocytes performed in hepatobiliary ductules, were significantly higher in extrahepatic than intrahepatic cholestasis with p < 0.05. CK7 and CK19 expressions in oval cells showed strong correlation with the degree of liver fibrosis with r = 0.793; p < 0.05 for CK 7 and r = 0.827; p < 0.05 for CK 19. Conclusion: Expressions of CK7 and CK19, in oval cells and mature cholangiocytes, were higher at extrahepatic than intrahepatic cholestasis. Expressions of CK7 and CK19 in oval cells were directly proportional to the degree of liver fibrosis in cholestasis of the infants. Keywords: cholestasis, oval cell, cholangiocytes, fibrosis, CK7, CK1
Prevalence of Crohns Disease in Endoscopic Unit Cipto Mangunkusumo Hospital
No full textBackground: The cumulative number of inflammatory bowel disease patients in Asia has raised three times since early 1990s, although Crohn’s disease is still less common than ulcerative colitis. The objective of this study was to provide clinical and demographic data of Crohn’s disease patients seen in Endoscopic Unit Cipto Mangunkusumo Hospital and compare the Results with other Asian countries. Method: This study was done retrospectively cross-sectional descriptive from medical records of all patients underwent colonoscopy at Endoscopic Unit, Cipto Mangunkusumo Hospital, and histological evaluation in the Department of Anatomical Pathology, Faculty of Medicine, University of Indonesia, between 2007 and 2008. Data was analyzed using SPSS version 17. Results: Of 921 patients who underwent colonoscopy, 19 (2.1%) patients were diagnosed with Crohn’s disease. There was no sex preponderance. The mean age was 47.7 years with a peak age at presentation between 51 and 60 years. The main clinical complaints were diarrhea (42.1%), lower gastrointestinal bleeding (36.8%), abdominal pain (10.5%) and upper gastrointestinal bleeding (5.3%). Colonoscopic findings were hyperemia in 94.7%, edema in 57.9%, erosions in 63.2%, ulcerations in 89.5%, pseudopolyp in 31.6%, fragile lesion in 10.5%, stenosis, fistulation, and cobblestone appearance in 5.3%. Involvement of isolated left colon was 26.3%; other manifestations were isolated right colon (10.5%), pancolitis (57.9%), ileitis (5.3%), ileocolitis (36.8%) and skip lesion (5.3%). Conclusion: The prevalence of Crohn’s disease in this study was similar to the findings in previous studies in Asian countries, with diarrhea as the main clinical complaint, and pancolitis as the dominant finding in colonoscopy examination. Keywords: Crohn’s disease, prevalence, clinical complaints, colonoscopy descriptio
Pancreatic Cancer: Review of Etiology, Clinical Features, Diagnostic Procedures, Treatment and Mesothelin Role
No full textPancreatic cancer is one with high mortality cancer in the world. Ninety percent of pancreatic cancer is pancreatic adenocarcinoma. Various factors is associated with an increased risk of pancreatic cancer including age, sex, race, genetic, history of chronic pancreatitis, diabetes mellitus, gallstone, obesity, Helicobacter pylori infection, smoking, diet, and polution exposure. A lot of cases were diagnosed in late stadium due to non-specific early clinical symptoms, and also, until now, there is no examination tool that may screen pancreatic cancer in the earliest stage. Total surgery resection is the therapy of choice in the early stadium of pancreatic cancer, and other therapy modalities are chemotherapy, radiotherapy. Combination of these modalities is frequently used in order to increase the effectiveness of therapy. Mesothelin, a surface glycoprotein on normal mesothelial cells, is overexpressed in pancreatic cancer; therefore, although it is not a cancer specific antigen, it can be used in diagnostic and treatment of pancreatic cancer. Several studies about mesothelin application in pancreatic cancer have been performed; however, more studies are needed to improve the application of mesothelin on pancreatic cancer. Keywords: pancreatic cancer, risk factor, therapy, mesotheli