International Journal of Human Capital Management (IJHCM)
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Effect of Conjugated Hyperbilirubinemia on the Prognosis of Patients Hospitalized in Intensive Care Unit at Kariadi Hospital Semarang
No full textBackground: In critically-ill patients, liver dysfunction plays a significant role on patient’s morbidity and mortality in the intensive care unit (ICU). Metabolic, hemodynamic and inflammatory factors also contribute in liver damage. Bilirubin is one of clinical markers for liver dysfunction. Some literatures indicated that patients with hyperbilirubinemia have higher mortality rate. The aim of this study was to assess the death prognosis of critically-ill patients with hyperbilirubinemia. Method: This study was an observational, prospective, and cohort study. All patients at the ICU of Kariadi hospital with hyperbilirubinemia were consecutively recruited over 8-month period from May 1st 2008 to January 31st 2009. Hyperbilirubinemia was defined as serum bilirubin levels ≥ 1.3 mg/dL for at least 72 hours and no hyperbilirubinemia was observed when the patients were admitted to the hospital. Results: Of 79 subjects who fulfilled inclusion criteria, the incidence of hyperbilirubinemia in critically-ill patients was 39.2%. About 56 subjects were enrolled in the study. Among them, 28 subjects showed hyperbilirubinemia and the other 28 subjects were included in the control group. There was no significant difference regarding the baseline characteristics of hyperbilirubinemia group and non- hyperbilirubinemia group. At the end of the study, the mortality rate in hyperbilirubinemia patients were 60.7% and 21.3% in the non-hyperbilirubinemia patients. The relative risk (RR) of death was 2.8; (95% CI = 1.3 - 6.1; p = 0.003). Conclusion: The incidence of hyperbilirubinemia was high in critically ill-patients hospitalized in the ICU of Kariadi hospital. The incidence of death between non-hyperbilirubinemia and hyperbilirubinemia subjects was significantly different. The significant relative risk of death indicates that hyperbilirubinemia may have influences on the mortality rate of critically-ill patients hospitalized in the ICU. Keywords: liver dysfunction, hyperbilirubinemia, deat
Cardiac Tamponade Due to Liver Amebiasis Rupture
No full textAmebiasis is common cases in Asia, Africa, and South Africa. Liver amebiasis has become a serious problem worldwide especially in health and social aspect. The protozoa named Entamoeba histolytica was easily found in area with poor sanitation, low socioeconomic status, and poor nutrition status. The incidence of amebiasis in several hospitals in Indonesia is 5-15% per year. Epidemiological observation showed the comparison of incidence among male and female population and it was approximately 3 : 1 until 22 : 1 with male predominance. The potential age suffered from amebiasis is around 20 - 50 years old. The route of infection spread to oral-fecal and oral-anal-fecal. The most common complication is abscess rupture (5-15.6%). Rupture may be located in pleural cavity, pericardial cavity, lung, bowel, intraperitoneal, and skin. Rupture of liver amebias spread to pleural and pericardial cavity is a rare case and frequently under reported. This case report illustrates a 40-year-old male with cardiac tamponade due to rupture of liver amebiasis. Patient’s was admitted with chief complaint of shortness of breath, positive Beck’s triad, hepatomegaly, pleural effusion, liver abscess on sonography and swinging of heart on echocardiography. This patient was treated with metronidazole as a drug of choice, and pericardiocentesis for the cardiac tamponade.Keywords: cardiac tamponade, Entamoeba histolytica, oral-anal-fecal, metronidazole, pericardiocentesi
Risk Factors for the Occurrence of Erosive Esophageal in Patients with Dyspepsia
No full textBackground: The prevalence of erosive esophagitis tends to increase recently. It induces higher medical expense, loss of working time, and decreases quality of life. However the study on risk factors of erosive esophagitis scarcely reported in Indonesia. This study aimed to find the association between age, sex, smoking, alcohol drinking, body mass index, hiatal hernia, the use of non steroidal anti-inflammatory drugs (NSAID), and drugs that decrease lower esophageal sphincter (LES) tone with the occurrence of erosive esophagitis in dyspeptic patients. Method: A case-control study was conducted on patients with dyspepsia who underwent upper gastrointestinal endoscopy procedure and had been interviewed to determine risk factors for erosive esophagitis in July - September 2008. The association between risk factors and the occurrence of erosive esophagitis were analyzed using Chi-square, which subsequently revealed p < 0.25, this variable included in multivariate analysis. Result: There were 135 patients fulfilled criteria; 45 patients as cases and 90 patients as controls. The association was found between the occurrence of erosive esophagitis in dyspeptic patients and smoking more than 15 cigarette/day (OR 15.43; p = 0.00; CI 95% 4.77-49.88), the use of NSAID (OR 9.49; p = 0.00; CI 95% 2.77-32.53) and the consumption of drugs that decrease LES tone (OR 3.56; p = 0.02; CI 95% 1.26-10.02). Conclusion: Smoking more than 15 cigarettes/day, use of NSAID and drugs that decrease LES tone is a risk factors for the occurrence of erosive esophagitis. Keywords: erosive esophagitis, NSAID, smoking, drugs that decrease LES ton
Diagnosis and Management Pancolitis in Patient with Ulcerative Colitis
No full textABSTRACT Ulcerative colitis (UC) is a form of inflammatory bowel disease (IBD) that usually affects the rectum and part of the colon, which spreads continuously with no skip area. Pancolitis occurs in 20% of patients with UC. Patients with chronic UC, especially pancolitis, have a higher risk of colon cancer. In patients with pancolitis, the risk of cancer increases by 0.5-1% per year after having 8-10 years of disease. A 72-year-old man came with complaint of bloody-mucus diarrhea associated with abdominal cramps. The colonoscopic appearance of colitis was observed in whole lumen throughout colon. Histopathological analysis demonstrated dense infiltrates of granulocytes and macrophages formed by severe inflammation. Normal appearances were observed in the remaining epithelial cells. No parasites, specific process, or malignancy were found. Moreover, no acid-resistant bacteria were found. However, atypical cells were found in one of the biopsy specimens. The patient was diagnosed with extensive type of severe UC. The initial management of treatment included improvement of his general condition along with antibacterial therapy of metronidazole and ciprofloxacin. Specific treatment of sulphasalazine and prednisone were given after pancolitis appearance was revealed, which has similar clinical manifestations in accordance with UC. Keywords: pancolitis, ulcerative colitis, chronic diarrhea, inflammatory bowel diseas
Imaging of the Biliary Tract
No full textImaging is central to the investigation and diagnoses of biliary tract disease. Upper abdominal pain, jaundice and abnormal liver function test are common symptoms and signs and imaging of the biliary tract should be performed to make an exact diagnosis of the disease. There are many options in the field of imaging from simple to more sophisticated examinations. Several imaging techniques are obsolete namely oral cholecystography, Intravenous cholangiography and biliary scintigraphy, and should therefore be omitted. These imaging techniques are expensive and we should choose one or two options. Abdominal ultrasound is less expensive and can be performed rapidly without special preparation or contrast agent. It is the imaging of choice in the initial evaluation to evaluate patients with hepatopacreaticobiliary diseases. From the Result of abdominal ultrasound examination we can choose further the right imaging technique that can disclose the diagnoses of the disease.Keywords: biliary tract, diseases, imagin
Result Comparison of Fecal Occult Blood Test between FOBT Hb and FOBT Hb tambah Tranferrin in Detecting Upper Gastrointestinal Tract Bleeding
No full textBackground: Immunological fecal occult blood test (FOBT) using anti human hemoglobin (Hb) has a low sensitivity in detecting upper gastrointestinal (GI) bleeding, due to Hb degradation. Transferrin (Tf) is more stable in stool when compared to Hb, provides an alternatives on diagnosing upper GI bleeding. This study aim to determine the advantage of FOBT Hb + Tf in detecting upper GI bleeding compared with FOBT Hb alone. Method: This study was conducted by comparing the diagnostic value of Rapid Immunochromatographic FOBT that use anti-human Hb alone, with the one using combination of anti human Hb & Tf simultaneously in detecting upper GI bleeding. Stool sample from 48 patients with upper GI bleeding and 29 controls (without any upper GI bleeding) were collected then tested with both FOBT Methods. Endoscopy study was used as gold standard endoscopy to determine test’s diagnostic value. Result: In detecting upper GI bleeding, the sensitivity of FOBT Hb + Tf (85.42%) was higher than FOBT Hb (29.17%). The specifity of both Methods were accurate at 89.66% and 93.10% respectively. Positive predictive values (PPV) for both Methods were also good at 93.18% and 87.50% while negative predictive value (NPV) FOBT Hb + Tf (78.79%) were higher than FOBT Hb (44.26%). Conclusion: Between these two test Methods on detecting upper GI bleeding, FOBT Hb + Tf has higher sensitivity, PPV and NPV value compared to FOBT Hb. It is advisable to use FOBT Hb + Tf for upper GI bleeding screening. Keywords: FOBT, immunochromatography, hemoglobin, transferrin, upper GI bleedin
Dyspeptic Syndrome in Urban Population of Jakarta
No full textBackground: Dyspeptic syndrome is experienced by many patients who visit general practitioners and gastroenterologist. In Indonesia, a small number of epidemiological data about dyspeptic syndrome are available. The aim of this study was to obtain data on prevalence, characteristics and factors/lifestyle associated with dyspeptic syndrome in urban population of Jakarta. Method: The study was conducted by interview to 1,645 respondents representing the population of Jakarta in the year 2007 using the Steps WHO version 1.4 instruments. The selection of respondents was performed by multistage cluster random sampling, i.e. each municipality is represented by one district and each was represented by a number of villages and respondents interviewed at random. Dyspeptic syndrome is defined whenever there is one or more complaints of nausea, vomiting, belching, epigastric pain, no appetite, early satiety, bloating. Scoring was performed for each category of questions using wstep1 method prior to the analysis. Data analysis was performed with Chi-square test or t-test. Results: Of the 1,645 respondents, the prevalence of dyspeptic syndrome was 58.1%. The most apparent clinical complaint ranges consecutively, i.e. nausea 30.1%, epigastric pain 28.7%, bloating 23.8%, etc. Dyspeptic syndrome is significantly more often experienced by female respondents (p < 0.001). Dyspeptic syndrome were more common in respondents who have less/no fruit (p < 0.001) and vegetables (p = 0.049) intake. Dyspeptic syndrome is more common in respondents with anxiety and depression (p < 0.001) also in respondents who consume non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.001). Conclusion: Prevalence of dyspeptic syndrome in Jakarta urban population is 58.1%. Dyspeptic syndrome was more common in female, respondents who have less / no fruit and vegetables intake, in respondents who experienced anxiety and depression and respondents who consume NSAIDs. Keywords: dyspeptic syndrome, Jakarta, urban population, prevalenc
Colitis Tuberculosis
No full textTuberculosis (TB) is a significant public health problem worldwide. Indonesia is a country with the third highest prevalence of TB in the world after China and India. TB infection can attack all organs of the human body. TB in digestive system is one of the extrapulmonary TB manifestations and comprises of 3- 16% of all extrapulmonary TB cases. This type of TB may affect digestive system, peritoneum, mesentery lymphatic glands, liver, and spleen. Digestive system is affected in 66-75% of patients with abdominal TB. The ileocaecal region is most commonly affected. The manifestation of abdominal TB is not specific. Precise diagnostic approach and supporting results are needed to determine final diagnosis. However, there is no single examination adequate enough to diagnose abdominal TB. If the diagnosis can be established early, this disease could then be managed with conventional anti-TB drugs. Treatment for both 6-9 months period and 18-24 months period has been proven effective in management of extrapulmonary TB. In countries with high abdominal TB prevalence, initiation of anti-TB therapy is allowed if there are the clinical features present. Diagnosis can be determined when the patient has therapeutic response against the the anti-TB treatment. Keywords: tuberculosis, colitis, extrapulmonary, antituberculosis drug
Factors Found on the First Variceal-Bleeding Episode in Liver Cirrhosis Patients with Portal Hypertension
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