International Journal of Human Capital Management (IJHCM)
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Proportion and Factors Associated with Zinc Deficiency in Acute Diarrhea Patients
No full textBackground: Zinc may affect the intestinal immune response. No data has been available on zinc deficiency in adult patients with diarrhea, especially for Indonesian population. Zinc metabolism, etiologies, pathogenesis and clinical course of diarrhea may have various effects on zinc concentration in different population. This study aimed to determine the proportion of zinc deficiency in patients with acute diarrhea, including its associated factors. Method: A cross-sectional study was conducted in patients with acute diarrhea at outpatient clinics and emergency wards of four hospitals between August 2010 and March 2011. A serum zinc concentration of < 10.7 µmol/L was set as cut-off value for zinc deficiency. Data was analyzed by using Chi-square test. Results: There were 101 subjects, 54.5% were female, the median age was 26 years, median duration of acute diarrhea was 5 days, and the median frequency was 6 times/day. About 95% patients had nutritional status of subjective global assessment (SGA) A and the mean value of body mass index was 19.3 ± 0.70 kg/m2. Approximately 88.1% patients had severe infective diarrhea based on hydration status. About 69.3% patients were zinc deficient with the mean serum zinc concentration of 9.26 ± 2.95 µ mol/L. We found a significant correlation between the severity of diarrhea and zinc deficiency in patients with acute diarrhea. Conclusion: The proportion of zinc deficiency in acute diarrhea patients was quite large although the mean serum zinc level was still below the National Health and Nutrition Examination Survey (NHANES) reference value. The severity of diarrhea has been proven to be significant that affects zinc deficiency in acute diarrhea patients. Keywords: zinc deficiency, acute diarrhea, adul
Dysphagia as an Early Presenting Symptom in Dermatomyositis
No full textDermatomyositis is a systemic disorder that frequently affects the esophagus, lungs, and the heart. Dermatomyositis diagnostic criteria involve evaluation of proximal muscle weakness, elevation serum levels of muscle enzyme, characteristic features of electromyography, typical muscle biopsy and classical skin rash of dermatomyositis. The prevalence of dysphagia in patients with dermatomyositis varied from 10-73%. A 40-year-old male was admitted to Cipto Mangunkusumo hospital with chief complaint of difficult in swallowing. He had been well until he began to have muscle weakness, myalgia, fatigue, and obstructive symptom in his upper digestion tract. Physical examination showed general weakness and symmetrical rash on the face, chest and back. Laboratory examination revealed anemia, thrombocytopenia, and elevated transaminase serum level. Antinuclear antibody was positive. Esophagogastroduodenoscopy showed severe esophagitis. The gastric mucosa biopsy revealed non-active chronic gastritis, antral lymph atrophy, and non-dysplastic. Biopsy of esophageal mucosa showed Barret’s esophagus with squamous epithelial cell and hard dysplasia focus. The electromyography result was suspected to a dermatomyositis. The deltoid muscle biopsy demonstrated dystrophy. Dysphagia may be an initial presenting symptom and especially prevalent in patients with dermatomyositis or other inflammatory myopathy. Dysphagia associated with these myopathies primarily affects the skeletal muscle–activated oropharyngeal phase of swallowing. It may precede weakness of the extremities or present as the sole symptom. Recommended treatments used to treat inflammatory myopathy associated dysphagia are combination of medical, rehabilitation, and interventional. Dysphagia associated with nutritional deficits, aspiration pneumonia, decreased quality of life, and poor prognosis. Patients with inflammatory myopathy and dysphagia are reported to have a 1-year mortality rate of 31%. Keywords: dysphagia, dermatomyositis, inflammatory myopath
Characteristic Profiles of Parasitic and Fungal Infections in Acute Diarrhea
No full textBackground: Diarrhea has been widely encountered in developing countries, including Indonesia. This study aimed to investigate the incidence of parasites and fungal infections, which also constitutes the etiologies of acute diarrhea. Method: A cross-sectional study was performed involving 93 patients. Patients with chief complaint of acute diarrhea were recruited at five hospitals in Jakarta, Indonesia during the period of November 2008 until May 2009. Acute diarrhea was defined as passing watery or soft stools with frequency of more than three times per day, weighted more 200 g per day, and occurred in less than 15 days duration. They were asked to collect their stool to the laboratory for further parasites and fungal detection. Results: This study showed that 41 out of 93 patients (44.09%) were found to be infected with parasites or fungi. The most common microorganism found was Candida albicans in 18 (19.35%) patients. Other parasites encountered in the stool samples were Blastocystis hominis, Entamoeba histolytica, Entamoeba coli, Giardia lamblia. The presenting clinical symptoms of the patients were fever (44.87%), bloating (41.03%), nausea (39.74%), oliguria (39.74%), cephalgia (35.90%), vomiting (24.36%), and tenesmus (19.23%). Conclusion: The incidence of parasitic and fungal infections in patients with acute diarrhea constitutes nearly half of all cases of infection-caused diarrhea. The most commonly encountered microorganism is Candida albicans. Keywords: parasites, fungi, acute diarrhe
Diagnostic Problems in Crohn's Disease: A Case Report
No full textCrohn’s disease is marked by transmural inflammation of the digestive tract and is categorized into inflammatory bowel disease (IBD). In Indonesia, Simadibrata et al, reported 20% from 107 patients who experienced non-infective chronic diarrhea, actually suffered from IBD. A 33-year old male patient complained of watery stool since 3 months before hospital admission. He experienced stabbing stomachache and loss of body weight. Physical and laboratory examination results were within normal limits. Faecal analysis revealed intestinal infection caused by gram-negative bacteria and intestinal maldigestion. Colonoscopy examination exhibited the presence of hyperemic mucosa, edematous, and positive cobblestone appearance in the terminal ileum. Additionally, the histological evaluation showed the impression of chronic ileitis usually found in IBD. Meanwhile, moderate pangastritis was obtained in the esophagoduodenoscopy examination. results of histological biopsy of the antrum showed absence of Helicobacter pylori infection. An active lesion in chronic ileitis was found in immunohistochemistry examination. Acid fast bacterial culture was also performed to the ileum tissue and revealed negative results in clinical microbiology examination. From the examinations conducted, patient was diagnosed as Crohn’s disease and treated with budesonide capsule 3 mg and mesalazine tablet 1,000 mg twice daily. Later, he felt improvement of the complains. This case illustrated Crohn’s disease which is rarely found in Indonesia. This is because diagnosis requires supporting examinations which could only be done in tertiary health care facilities. However, possibility of other diagnosis should be considered, particularly intestinal tuberculosis and infective colitis. Early diagnosis and prompt treatment may improve patient’s prognosis and quality of life. Keywords: IBD, Crohn’s disease, positive cobbleston
Intestinal Amebiasis in Children with Bloody Diarrhea
No full textBackground: Amebiasis affects more than 50 million people each year, resulting in 100,000 deaths. Entamoeba histolytica (E. histolytica) is clearly pathogenic causing intestinal infection that varies from asymptomatic to fulminant colitis. Appropriate diagnosis and treatment of amebiasis in children is important to avoid serious complication, such as hepatic abscesses. Bloody diarrhea is a classic symptom, which is often used as screening for intestinal amebiasis. This study aimed to know the prevalence of intestinal amebiasis and other clinical and laboratory characteristics in children with bloody diarrhea who visited Harapan Kita Women and Children Hospital, Jakarta. Method: This was a retrospective descriptive study. Data was obtained by evaluating medical records at Harapan Kita Women and Children Hospital Jakarta, from January 2009 to December 2010. The data included age, sex, morphology of E. histolytica, blood hemoglobin level and leukocyte count, as well as fecal leukocytes and erythrocytes. Diagnosis was confirmed by finding trophozoites in 3 consecutive stool specimens. Statistical analysis was performed using SPSS program. Results: Trophozoite forms were found in 58/889 (6.5%) children with bloody diarrhea. There were 40 (58.8%) boys, and 27 (39.7%) children were ≤ 1 years old. Fourteen (20.6%) children had anemia, 49 (72.1%) children had fecal leukocytes > 10 and 51 (75%) children had fecal erythrocytes > 5; however, only 21 (30.9%) children with blood leukocytes count > 14,000 u/L. Conclusion: Intestinal amebiasis is common in children with bloody diarrhea, especially infants. Increased fecal leukocytes and erythrocytes are often found in intestinal amebiasis; however, blood leukocyte count may not increase. Keywords: children, intestinal tract, amebiasi
Management of Autoimmune Hepatitis
No full textAutoimmune hepatitis (AIH) is a necroinflammatory liver disease of unknown etiology. Although the pathogenetic mechanism of AIH is still unknown, an underlying genetic predisposition and the association of the disease with certain human leukocyte antigens (HLAs) have been suggested. The molecular mimicry has been proposed as a pathogenetic mechanism for AIH. The diagnosis of AIH is based on a constellation of clinical, serological, and histopathological findings. The International Autoimmune Hepatitis Group (IAIHG) proposed diagnosis criteria in 1993, which were revised in 1999. In 2008, the IAIHG decided to devise a simplified scoring system for wider applicability in routine clinical practice. Based on clinical and serological parameters, AIH cases have been categorized into three subtypes: type-1 AIH, type-2 AIH and type-3 AIH. The therapeutic guidelines of AIH include immunosuppressive agent with corticosteroid and usually in combination with azathioprine. Starting dose of prednisone monotherapy is 60 mg daily, which should be tapered slowly over a 1 week period to a maintenance dose of < 20 mg daily. The other regimen is used in combination with azathioprine, prednisone dose is started at 30 mg and tapered 10 to 5 mg every week until a maintenance dose of 10 mg is achieved. Azathioprine is given at the dose of 50 mg daily. In the very few patients that do not tolerate or have significant side effects to gold standard therapy, alternative immunosuppressive drugs should be given. Other powerful immunosuppressive drugs and molecular interventions are being developed based on recent insights into pathogenic pathways, emerging pharmacologic agents, and new technologies. Keywords: autoimmune hepatitis, pathogenesis, diagnosis, managemen
Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis
No full textBackground: It has not been clear about how often the patient should have esophago- gastroduodenoscopy (EGD) screening for esophageal varices (EV) detection and there is only some data that demonstrates the correlation between the degree of EV and non-endoscopic variables. It is assumed that the presence of EV detected though examination of serum albumin level may trim down the unnecessary endoscopy. This study was aimed to recognize the correlation between albumin level and the degree of EV in patients with liver cirrhosis. Method: A retrospective analysis was performed for 61 patients with liver cirrhosis who had EGD at Sanglah hospital between January and December 2008. Spearman test was used to analyze the correlation between albumin level and the degree of EV. Results: There were 61 patients of 45 (73.8%) male and 16 (26.2%) female. The range age of patients was 13–77 years (average 49.98 ± 1.62 years). Serum albumin level ranged between 1.10-3.60 mg/dL, the average value was 2.21 ± 0.451 mg/dL. We also found 8 (13.1%) patients without EV, 14 (23.0%) patients with EV grade I, 21 (34.4%) patients with grade II and 18 (29.5%) patients with grade III. A negative correlation was found between serum albumin level and the degree of EV (r = - 0.587; p = 0.000, p < 0.01). Conclusion: Serum albumin level can predict the presence and the degree of EV in patients with liver cirrhosis. Keywords: albumin, degree of EV, liver cirrhosi
Effect of Intravenous Polyunsaturated Fatty Acids Administration on Gastric Mucosal Integrity in Pig-tailed Macaques with Obstructive Jaundice
No full textBackground: Acute gastric mucosal injury commonly occurs in patients with obstructive jaundice. We studied the effect of intravenous polyunsaturated fatty acids (PUFA) administration on gastric mucosal integrity in pig-tailed macaques (Macaca nemestrina) with obstructive jaundice by ligating common bile duct (CBD). Method: The study was conducted between February 2009 and May 2010 at the Primate Research Center, Bogor Agricultural Institute. Eight selected male pig-tailed macaques with 6.625 ± 0.83 kg of body weight were used and divided into two groups. In both groups, laboratory examination, including liver function tests and upper gastrointestinal endoscopy were performed before CBD ligation and every two weeks after ligation. In the first group, intravenous PUFA with the dose of 2 g/day was administered every day since four weeks post-ligation up to four weeks later, and in the second group, intravenous PUFA was administered since before ligation up to eight weeks later. Results: In both groups, increased total bilirubin, direct bilirubin, indirect bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and gamma glutamyl transpeptidase were obviously found, meanwhile decreased albumin level was detected and the cholinesterase level of both groups remained unchanged. Ulcer formation occurred among the first group during 4 weeks after CBD ligation, and these ulcers showed obvious healing within four weeks after intravenous PUFA administration. In the second group, there was no significant ulcer formation within eight weeks after CBD ligation. Conclusion: The potential appearance of acute gastric mucosal injury which reflected by ulcer formation in pig-tailed macaques with obstructive jaundice was significantly decreased by intravenous PUFA administration. We also have successfully developed animal model of obstructive jaundice by CBD ligation, based on the result of liver function tests. Keywords: acute gastric mucosal injury, intravenous PUFA administration, obstructive jaundice, pig- tailed macaque
Levels of Adiponectin and Soluble Tumor Necrosis Factor-α Receptor 2 (sNFαR2) in Obese Males with or without Fatty Liver
No full textBackground: Increased lipolysis in obese patients will cause elevated free-fatty acid level leading to insulin resistance. There are varied inflammatory cytokines (sTNFαR2) and anti-inflammatory cytokines (adiponectin) in obese patients, with and without fatty liver (FL). The aim of this study was to determine sTNFαR2 and adiponectin levels in obese patients with and without fatty liver. Method: This study was an observational study with cross-sectional approach, which was conducted between September 2008 and August 2009. The patients were 94 obese male with waist circumference ≥ 90 cm based on criteria of the International Diabetes Federation. Fatty liver was detected by ultrasonography; while adiponectin and sTNFαR2 levels in blood were analyzed by using ELISA Method and blood examination at the clinical laboratory. Results: Levels of adiponectin and sTNFαR2 were different between obese patients with and without FL. The adiponectin level was 3.10 ± 1.14 in patients with FL and was 3.52 ± 1.07 in patients without FL; while the sTNFαR2 were 23.92 ± 6.00 (FL) and 20.61 ± 5.29 (without FL). In patients with low adiponectin level ( 21.78 pg/dL), there was relatively higher occurrence of fatty liver compared to the other patients. Conclusion: Obese patients with fatty liver have higher sTNFαR2 level than patients without fatty liver. Moreover, obese patients with fatty liver have lower adiponectin level compared to patients without fatty liver. Patients with low adiponectin level and high sTNFαR2 level have higher incidence of fatty liver than subjects with high adiponectin level and low sTNFαR2 level. Keywords: adiponectin, soluble tumor necrosis factor α receptor 2 (sTNFαR2), obese, fatty live
Clinical Profile and Outcome of Non-Variceal Upper Gastrointestinal Bleeding in Relation to Timing of Endoscopic Procedure in Patients Undergoing Elective Endoscopy
No full textBackground: Endoscopy is the most accurate method for diagnosing the source of upper gastrointestinal bleeding. This study was aimed to evaluate the correlation between the timing of elective endoscopy and the length of hospital stay, the amount of transfusion given and incidence of recurrent bleeding or patient mortality. Method: A retrospective study was conducted in all patients with non-variceal upper gastrointestinal bleeding who had experienced elective endoscopy at Cipto Mangunkusumo Hospital between January 2007 and August 2008. Identification of clinical risk using clinical Rockall score was performed at the emergency room. Persistent bleeding, recurrent bleeding, surgical treatment and death were the outcome variables. Statistical analysis was performed using Chi-square/fisher exact test and linear regression. Results: There were 40 eligible cases with mean age of 53 ± 13 years; the greatest occurrence was at the age group of 50-59 years (12%), male (52.5%) and those who had clinical symptom of melena (52.5%). Twenty seven (67.5%) patients had Rockall score of 1-3 points and 13 (32.5%) had 4-6 points. There was only one patient who had adherent clots (Forrest grade II B). Endoscopy results revealed that the most common cause of bleeding was gastric ulcer, which occurred in 12 (30%) patients. There was no correlation between the timing of endoscopic procedures and outcome variable; however the length of hospital stay had a significant correlation with timing of endoscopic procedures. Conclusion: Elective endoscopy does not affect the variables of mortality and recurrent bleeding; however, it affects the length of hospital stay. Further prospective studies are required to find causal relation between them. Keywords: non-variceal upper gastrointestinal bleeding, Rockall score, elective endoscopy, outcome variable