International Journal of Human Capital Management (IJHCM)
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Evaluation and Management of the Pediatric Patients with Suspected Gastroesophageal Reflux Diseases
No full textGastroesophageal reflux is a normal physiologic process occurring in healthy infants. Symptoms due to gastro-esophageal reflux diseases (GERD) are troublesome when they have adverse effects on the well- being of the patient. A thorough history and physical examination is generally sufficient to establish a clinical diagnosis of uncomplicated infant with gastroesophageal reflux. Poor weight gain is a warning sign. Irritability and regurgitation are associated with a wide range of physiologic and pathologic conditions. Heartburn or substernal burning is a reliable indicator for GERD in adolescents. Barrett esophagus does occur in children with severe chronic reflux. GERD is commonly cited as a cause of dysphagia; however, there are no strong pediatric data demonstrating this relationship. An etiologic role for reflux in reactive airways disease, such as asthma, has not been established. No test can determine whether reflux is causing recurrent pneumonia. Data showing the correlation between reflux and upper airway disease is weak, consisting mainly of case descriptions. Sandifer syndrome is an uncommon, but specific manifestation of GERD. Children with cerebral palsy are at particularly high risk of GERD. Similarly, children with certain genetic syndromes such as Cornelia de Lange and Down syndrome are prone to GERD. A higher prevalence of GERD and its complications has been reported in patients with a variety of chronic respiratory disorders including bronchopulmonary dysplasia and cystic fibrosis. GERD treatment is frequently administered to premature infants. However, the true prevalence of GERD is unknown. Keywords: gastroesophageal reflux diseases, infants, childre
Evaluation of Increased Serum Aminotransferase Level in Asymptomatic Patient
No full textLiver test abnormalities are commonly found in ambulatory patients. The liver function tests are routinely included in chemistry panels. According to the American Gastroenterological Association (AGA), 1-4% of the asymptomatic population may have elevated serum liver chemistry. The majority of asymptomatic patients with liver test abnormalities have no evidence of liver disease. Unfortunately, abnormal Results for liver function are often not adequately investigated, missing an important chance of identifying treatable chronic liver disease. Potential causes of liver aminotransferase elevation are originated from hepatic causes (viral hepatitis, alcohol use, medication use, steatosis and non-alcoholic steatosis hepatitis, autoimmune hepatitis, hemochromatosis, Wilson’s disease, α-antitrypsin deficiency) and non hepatic causes. In the majority patients (92%) with chronically elevated aminotransferase tests, etiologies of the liver disease could be diagnosed through close clinical approach, which includes: history taking, physical examination, and blood tests. If elevation persists after an appropriate period of observation, further testing may include ultrasonography and other serum studies. In about 8% of patients with chronic abnormal alanine aminotransferase levels no cause is found. So, if liver test abnormalities cannot be explained by other findings, liver biopsy examination can help to exclude serious liver disease or disclose the nature and severity of liver disease. Keywords: elevated liver transaminase, asymptomatic patients, chronic liver diseas
Effect of L-ornithine-L-aspartate Therapy on Low-Grade Hepatic Encephalopathy in Patients with Liver Cirrhosis
No full textBackground: Minimal hepatic encephalopathy (MHE) is an abnormal condition of psychometric testing before hepatic encephalopathy (HE) condition reducing quality of life and survival rate. Impractical instrument, the psychometric hepatic encephalopathy score (PHES), has been recommended in diagnosing MHE. The new critical flicker frequency (CFF) has good precision and accuracy for diagnosing MHE. Oral L-ornithine-L-aspartate (LOLA) may increase ammonia detoxification. The aim of this study was to recognize the effect of oral LOLA on low-grade HE by investigating the mean value of CFF. Method: We included 31 patients with liver cirrhosis and low-grade HE (MHE, HE grade 1 and 2) at the outpatient clinic of hepatology, Cipto Mangunkusumo hospital between November 2009 and March 2010. It was a double-blind, randomized, placebo-controlled clinical trial. Oral LOLA was administered in a dose of 18 g/day, 3 times daily for 14 consecutive days. At the end of the study, there were 27 cirrhotic patients with CFF value < 38 Hz; 14 patients had received LOLA and 13 patients had placebo. Statistic analysis was performed by using the Mann-Whitney U test. Results: The mean value of CFF in LOLA group after treatment (39.3 Hz) was significantly different than the placebo group (36.04 Hz); (p = 0.027). Ammonia level decreased in LOLA group from 118.7 into 109.1 µ mol/L. In placebo group, it increased from 106.9 into 147.5 µ mol/L with p = 0.275 (before); p = 0.052 (after). Conclusion: Oral LOLA may improve the value of CFF and is likely to decrease blood ammonia level in patients with low-grade HE. Keywords: low-grade hepatic encephalopathy, oral LOLA, CFF improvement, ammonia detoxificatio
Selecting Treatment Modality for Small Hepatocellular Carcinoma: Radiofrequency Ablation, Percutaneous Alcohol and Acetic Acid Injection
No full textHepatocellular carcinoma (HCC) is the most common primary hepatic malignancy worldwide and is the leading cause of death in patients with cirrhosis. In early-stage tumors, potential curative therapies have been used including ablative therapies using percutaneous ethanol injection (PEI), percutaneous acetic acid injection (PAI) or radiofrequency ablation (RFA); surgical resection and liver transplantation. RFA is more effective and safer than other local ablative therapy modalities. RFA should be considered as the first-line treatment for patients with small HCC, i.e. sized less than 5 cm; preferably less than or equal to 3 cm since they are not suitable for liver resection or liver transplantation. RFA should also be compared with transarterial embolization, which currently has been considered as the standard HCC therapy in some countries. It has been reported that the combination of RFA and embolization treatment may reduce the early and late recurrence rate. Keywords: hepatocellular carcinoma, percutaneous ethanol injection, acetic acid injection, radiofrequency ablatio
Correlation between Apolipoprotein B (Apob) Level and Non Alcoholic Fatty Liver in Type 2 Diabetes Mellitus with Metabolic Syndrome
No full textBackground: Non-alcoholic fatty liver disease (NAFLD) is a liver disorder commonly found in the majority of patients with metabolic risk factors, such as obesity and type 2 diabetes. Apolipoprotein B (apoB) is the moiety of low density lipoprotein (LDL) and clinical interest that provides a relative accurate estimation of circulating LDL particle. The aim of this study was to know the relationship between apoB level and occurrence of fatty liver in type 2 diabetes mellitus (DM) with metabolic syndrome. Method: A cross sectional study was conducted in patients suffered from type 2 DM with metabolic syndrome at Internal Medicine Outpatient Clinic in Moewardi Hospital Surakarta between April and May 2011. Thirty two patients with type 2 DM and metabolic syndrome were enrolled to this study and categorized into two groups; consisting of 16 patients with fatty liver and 16 patients without fatty liver. Student t-test was used in the analysis of this study. Results: Of 32 patients who fulfilled this study criteria, patients type 2 diabetes mellitus and metabolic syndrome with non-alcoholic fatty liver diseases (NAFLD) had higher apoB level than patients type 2 diabetes mellitus and metabolic syndrome without NAFLD (p = 0.013). Conclusion: NAFLD group had significantly higher apoB level than without NAFLD group in type 2 DM with metabolic syndrome patients. Keywords: apolipoprotein B, non-alcoholic fatty liver disease, type 2 DM, metabolic syndrom
Non-invasive Markers for Diagnosis of Liver Cirrhosis in Chronic Hepatitis B
No full textBackground: Indonesia is an endemic country for hepatitis B viral infection. Thus, early diagnosis of cirrhosis is important to be established with regard to prompt treatment and to determine the patients’ prognosis. Liver biopsy which is a gold standard in diagnosing liver cirrhosis has several limitations, such as expensive and invasive. The objective of this study was to identify the accuracy of non-invasive markers: aspartate/alanine transaminase ratio (AAR), age-platelet index (API), aspartate transaminase to platelet ratio index (APRI), spleen to platelet ratio index (SPRI), and age-spleen-platelet ratio index (ASPRI) in predicting cirrhosis in chronic hepatitis B patients. Methods: A diagnostic study was performed in Division of Hepatology and Hepatology Outpatient Clinic, Depatment of Internal Medicine, Cipto Mangunkusumo Hospital between January 2009 and July 2010, with the participation of 71 chronic hepatitis B patients who had undergone liver biopsy consecutively. Stage of fibrosis was determined based on the METAVIR scoring system. Five non-invasive markers: AAR, API, APRI, SPRI, and ASPRI were compared with liver biopsy Results. Statistical analysis was performed by using T-test and Spearman correlation test using SPSS version 13. Results: API, APRI, SPRI, and ASPRI had significant correlation with the incidence of liver cirrhosis in hepatitis B infection (p < 0.05). However, AAR had no correlation with the incidence of cirrhosis. Using the cut-off point of 1.19, APRI was the best marker with area under curve (AUC) 0.91, sensitivity 83.3%, and specificity 89.2%. Conclusion: Non-invasive markers were suitable in predicting cirrhosis and have the potential to decrease the number of liver biopsy in chronic hepatitis B patients. Keywords: non-invasive markers, chronic hepatitis B, liver cirrhosi
Nosocomial Clostridium difficile Diarrhea in Patient with Malignancy
No full textClostridium difficile (C. difficile) is the main pathogen causing antibiotics associated diarrhea and colitis. This bacterium increases with hospitalization with incidence of 20-60 cases per 100,000 patients/day. C. difficile is gram positive bacilli which produce toxins in 2,700 cases in every 100,000 exposures to particular antibiotics, such as clindamycin, cephalosporin, and ampicillin. These antibiotics disrupt the intestinal normal flora and predispose to colonization of C. difficile. This case described a 53-year old male patient with squamous cell carcinoma in his left ear who came to Department of Internal Medicine, Cipto Mangunkusumo Hospital, with the complain of diarrhea since two weeks after one month hospitalization in Department of Ear, Nose, and Throat. The characteristics of the diarrhea were 10 times per day ± 100 mL, watery consistency, green yellowish in color, and no blood in the feces. Additionally, the patient also complained of pain in all parts of his stomach, especially in the epigastric area. Earlier, patient was given ceftazidime for 30 days of hospitalization. The serology examination of C. difficile in the feces showed positive result (titer = 0.790 and control = 0.190). During the colonoscopy examination, pancolitis was found and the pathologic anatomy result was found appropriate for infective colitis. Thereafter, antibiotic administration was ceased and metronidazole was administered intravenously three times a day. The diarrhea stopped after seven days and the patient was discharged. Keywords: Clostridium difficile, nosocomial diarrhea, malignanc
Non-endoscopic Examination as Predictor of Varices Degree in Liver Cirrhosis Patients Who have Experienced Esophageal Variceal Bleeding
No full textBackground: Standard diagnosis for determining the degree of varices is by endoscopy. However, sometimes there are obstacles in the implementation of endoscopy. Based on the factors, we need to know the parameters of non-endoscopic examination which include ascites, splenomegaly, thrombocytopenia, Child-Pugh, portal vein diameter as a predictor of the degree of liver cirrhosis patients with varices who have experienced esophageal variceal bleeding. Method: The study design was cross-sectional study. The study was conducted on hospitalized patients in Cipto Mangunkusumo hospital, Gatot Subroto hospital, and Kraton hospital from September 2008 to November 2009. The patients were liver cirrhosis patients with history of upper gastrointestinal bleeding, no present bleeding, and hemodynamically stable. Examination of predictor factors in the patients such as ascites, splenomegaly, thrombocytopenia, Child-Pugh and portal vein diameter were done. Statistical analysis was performed with student’s t-test, Mann-Whitney test, and stepwise multivariable logistic regression. Results: The study involved 44 patients with liver cirrhosis who have esophageal variceal bleeding. Based on the results of endoscopic examination, large varices (F3) were found in 21 (47.73%) patients, small varices (F1 & F2) in 23 (52.27%) patients, located on the distal esophagus extending to the medial (86.4%), with red color sign present (54.5%). Results of non-endoscopic examination such as splenomegaly, ascites, thrombocytopenia, portal vein diameter and Child-Pugh score was known not to be associated with the degree of esophageal varices (p > 0.05). Conclusion: Non-endoscopic examination was not related to the degree of varices in liver cirrhosis patients who have experienced esophageal variceal bleeding. Keywords: esophageal variceal bleeding, liver cirrhosis, predictor factors, endoscopic criteri
Preventing NSAID-induced Gastropathy: The Role of Mucus Cells to Prevent Aspirin-Induced Acute Gastric Mucosal Damage
No full textBackground: Mucus is pre-epithelial gastric layer that may prevent damages due to direct contact between aspirin and gastric epithelial cells. The integrity of gastric mucosa and mucous cellular reaction may serve as primary and secondary prevention of extended aspirin-induced gastric mucosal damage. The aim of this study was to prove the function of mucus as defensive factor in rats. Method: The study was conducted in twenty white rats of the Sprague-Dawley strain at Department of Pathology and Clinical Reproduction, Bogor Agricultural University, between January and December 2008. The rat in the treatment group were given 400 mg aspirin diluted in aqua bidest through intra- gatric canules; while the control group received aqua bidest only once daily for 3 days. Necropsies, macroscopic and microscopic observation were performed by counting the number of Alcian blue- periodic acid Schiff-stained mucous cells at fundus/corpus and antrum/pylorus regions. Data analysis was performed using ANOVA and Duncan test. Results: The number of mucous cells with positive lesions in the treatment group was significantly different from the control group at both regions. There was no significant difference of negative lesions between treatment and control group at both regions. At antrum/pylorus region, there was no difference of negative lesions between treatment and control groups; however, both groups demonstrated significant difference of positive lesions in treatment group. Conclusion: In primary prevention for gastric mucosal lesions, there is no increasing number of mucous cells in normal mucosa. Increasing number of mucous cells is a secondary prevention against extended aspirin-induced gastric mucosal damage. Keywords: NSAIDs/ASA, mucus cells, gastric mucosal lesion, ra