International Journal of Human Capital Management (IJHCM)
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In Searching of Colorectal Cancer Screening Tools Suitable for Resource-limited Countries
No full textHBeAg and Anti HBe Status in Patients with Chronic Hepatitis B Infection
No full textBackground: Data on HBeAg and anti HBe status in patients with chronic hepatitis B infection are not yet available in Indonesia. This study was done to acquire data on HBeAg and anti HBe status in patients with hepatitis B chronic infection. Method: The material of this study was sera, collected from 105 patients with chronic hepatitis B infection from June to November 2007, divided into four groups of hepatoma, liver cirrhosis, chronic hepatitis B and asymptomatic HBsAg carriers. All sera were examined for HBsAg, HbeAg, anti HBe aside from liver function examinations. The sera consisted of 23 sera of patients with hepatoma, 27 with liver cirrhosis, 12 with chronic hepatitis B, and 43 with HBsAg asymptomatic carriers. Results: From 105 samples, only 18.1% samples were in replicative phase, as shown with the positivity of HBeAg and the negativity of anti-HBe. Sera with negative HbeAg and positive anti-HBe were mainly found in liver cirrhosis (70.73%) and least in chronic hepatitis B (50.00%) Conclusion: The high frequency of HBeAg negative and anti-HBe positive in this study might indicate the possible high frequency of pre core mutation. A study using quantitative HBV DNA should be done to confirm it. Keywords: HBeAg, anti HBe, chronic hepatitis
Endoscopic Feature of Upper Gastrointestinal Bleeding Patient in Soedarso General Hospital Pontianak
No full textBackground: Gastrointestinal tract hemorrhage is an emergency condition most commonly caused by rupture of the esophageal varices with a mortality rate between 25-30% of cases. Gastrointestinal endoscopy is an accurate diagnostic used modality to identify lesions and locate bleeding in the upper gastrointestinal tract. The aims of this study were to determine the endoscopic features of upper gastrointestinal bleeding patients and distribution based on age and sex. Method: Retrospective study of endoscopic Results of upper gastrointestinal bleeding patients in Soedarso hospital, Pontianak, between January - June 2008. Results: There were 114 patients consisting of 75 (65.79%) male and 39 (34.21%) female. The findings from endoscopic examination were 46 (40.35%) cases of gastric ulcers, 23 (20.17%) cases of esophageal varices, 20 (17.54%) cases of errosive gastritis, 17 (14.91%) cases of duodenal ulcer, and 4 (3.5%) cases of esophageal mass/gastric mass. Conclusion: In this study the most common cause of upper gastrointestinal bleeding is gastric ulcer and it occurs more often in males compared to females. Keywords: endoscopic feature, upper gastrointestinal, gastric bleedin
The Efficacy of L-Ornithine L-Aspartate Granules and Normal Protein Diet in Minimal Hepatic Encephalopathy with Malnutrition
No full textBackground: The dietary protein restriction that was commonly recommended to hepatic encephalopathy (HE) patients, often leads to malnutrition, whereas malnutrition can deteriorate cirrhosis prognosis. The aims of this study were to find out encephalopathy improvement that was measured by critical flicker frequency (CFF) test and nutritional status by measuring prealbumin level after L-Ornithine L-Aspartate (LOLA) treatment with adequate calories and protein intake in patients with HE. Method: Patients with liver cirrosis who visited Cipto Mangunkusumo hospital on June-October 2009 was evaluated by CFF test using HEPAtonormTM device. Encephalopathy was defined when CFF < 39 Hz. Nutritional status was measured by the mid-arm muscle circumference (MAMC) and was stated as malnutrition when the MAMC was below the 15th percentile. Patients had been treated by 3 x 6 mg LOLA granules for 2 weeks, and adequate calories and protein intake with branched-chain amino acid (BCAAs) substitution. The change of encephalopaty was evaluated by the CFF test and the nutritional status by measuring prealbumin blood level. Results: There were 17 patients with liver cirrhosis who fulfilled the inclusion criteria. The mean CFF Result increased from 34.1 ± 2.5 Hz to 36.5 ± 2.9 Hz after LOLA treatment with the adequate calories and protein intake including BCAAs substitution, which was statistically significant (p < 0.001) compared to before treatment. The prealbumin level also increased significantly compared before treatment, i.e. from 5.4 ± 2.1 mg/dL to 6.4 ± 2.6 mg/dL, p = 0.008. Conclusion: HE patients with malnutrition could be given adequate calorie and protein with BCAAs substitution to improve their nutritional status, and LOLA granules for the improvement of HE. Keywords: minimal hepatic encephalopathy, malnutrition, CFF, LOLA, prealbumin, BCAA
The Knowledge Level of Primary Care Physicians in Surabaya Primary Health Care Center Concering Hepatitis B
No full textBackground: One of physician’s functions at primary health care center (PHC) is the ability to diagnose some diseases especially that contribute to high morbidity and mortality. Until now, hepatitis B virus infection has become a major health problem worldwide. The aim of this study was to identify the knowledge level of primary care physicians concerning hepatitis B in Surabaya. Method: The present study was a cross-sectional study that performed by investigators through interviews with primary care physicians in Surabaya to fill questionnaires for measuring their knowledge level. The questionnaires were modified from questionnaire survey in Tur Key performed by Peksen et al. It reflected the level of knowledge of the physicians including their comprehension, application and analysis. Validity and reliability test were performed on the Result of those questionnaires. The knowledge level was categorized as follows: > 75 (excellent), 70.0–74.9 (very high), 65.0–69.9 (high), 60.0–64.9 (medium), 55.0–59.9 (moderate), 47.5–54.9 (nearly moderate), 40.0-47.4 (less moderate), < 40 (low). Results: Based on validity test, we obtained 14 items of 17 question items with correlation coefficient 0.287–0.561 and alpha reliability index 0.639; therefore, the instrument can be used to measure the knowledge level. The results of mean score conversion included comprehension, which was 84.878 ± 16.499 (excellent category); application, which was 47.556 ± 31.870 (nearly moderate category) and analysis, which was 14.634 ± 35.562 (low category). Statistically, the mean value of the knowledge level scale, which was the combination of comprehension, application and analysis, was obtained at 49.023 ± 19.085 including the nearly moderate category. Conclusion: By using a valid and reliable instrument, the knowledge level of primary care physician in Surabaya concerning hepatitis B can be categorized as nearly moderate. Keywords: hepatitis B, liver cirrhosis, hepatom
The Role of Fecal Occult Blood Test in Screening of Colorectal Cancer and Inflammatory Bowel Disease
No full textColorectal cancer (CRC) and inflammatory bowel disease (IBD) are a quite common colon disease in the world. The World Gastroenterology Organization (WGO) recommends screening test to detect colorectal cancer, i.e. fecal occult blood test (FOBT) and colonoscopy. Diagnosis of CRC is established based on a good history taking, clinical manifestation, physical examination and laboratory examination. Other supporting laboratory tests include routine laboratory test of hemoglobin for detecting anemia, examination of bleeding stool either macroscopically or microscopically. Radiographic examination, either colon in loop or colonoscopy (if such modalities are available), shall be performed to confirm the occurrence of cancer mass in the colon. Moreover, biopsy examination is carried out to obtain the histopathological feature of tumor mass or the type of cancers. WGO has made a guideline for CRC screening, which consists of 6 cascades, which depend on the risk of colorectal cancer and local facilities available. There are several kinds of FOBT, but the most frequently used include three methods, i.e.: the FOBT guaiac base/traditional, the fecal immunochemical test (FIT) and the FOB + transferrin rapid test (OT 102c & OT 103c). FIT and FOB + transferrin rapid test have a quite high sensitivity and specificity in detecting the lower gastrointestinal tract bleeding caused by colorectal cancer and IBD. Keywords: FOBT, colorectal cancer, IB
Frequency Scale for the Symptoms of GERD Score for Gastroesophageal Reflux Disease in Koja Hospital
No full textBackground: The frequency scale for the symptoms of GERD (FSSG) was a specific questionnaire to gastroesophageal reflux disease (GERD), which has been validated against the endoscopic findings in Japan. The high score FSSG is one of the factors related to failure of proton pump inhibitor (PPI) mono therapy. The purpose of this study is to determine FSSG score in patients with GERD at Koja hospital, in order to predict the need for combination therapy of PPI with pro- kinetic drug or PPI only. Method: Dyspeptic patients which had have heartburn and/or regurgitation were collected in the period of March until July 2010. The FSSG score was obtain containing 12 questions which consisted of seven questions for reflux symptoms and five questions for dysmotility/dyspeptic symptoms. Results: There were 129 patients, 51 (39.5%) males and 78 (60.5%) females, mostly in the age group of < 40 years (55.8%), body mass index of most patients (66.6%) were normal, only 12.4% were overweight. FSSG score revealed the mean of total score of 17.6 ± 6.9. From 129 dyspepsia patients who complained heartburn and or regurgitation, obtained 121 (94%) met criteria for GERD with cutoff eight. The mean of reflux score was 7.4 ± 4.6 while the mean of dyspeptic/dysmotility score was 10.1 ± 4. Thus from 129 patients studied, the symptoms of dyspeptic/dysmotility more dominant than symptoms of reflux Conclusion: GERD patients in Koja hospital have a high mean FSSG score, whereas dysmotility symptoms was proved to be more dominant than acid reflux Keywords: GERD, FSSG, dyspeptic/dysmotility score, reflux scor
Diagnosis and Management of Klatskin Tumor
No full textKlatskin tumor is a cholangiocarcinoma in bifurcatio areas and related to poor prognosis. Surgery is the only curative method, but endoscopy also has a role in diagnostic as well as therapeutic measures. This report shall discuss a case of Klatskin tumor in which to establish diagnosis, multimodal imaging using ultrasonography, computed tomography, endoscopic retrograde cholangiopancreatography (ERCP), and tumor markers were used. For palliative therapeutic measures in this case, placement of plastic stents by ERCP was performed. The procedure ERCP with stents placement can be an option in the management of Klatskin tumor, in which surgery is not possible to be conducted. Keywords: Klatskin tumor, ERCP, stent, diagnosis, managemen
Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment
No full textBackground: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices. Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxi
