International Journal of Human Capital Management (IJHCM)
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Multimodality Treatment of Bile Duct Stone
No full textGallstone and bile duct stone is a common disease and affects people from every society, race, age and gender. Advance in medicine has led us to a new paradigm of bile duct stone treatment. Endoscopic procedures for bile duct stone by means of Endoscopy Retrograde Cholangio-pancreatography (ERCP), sphincterotomy, balloon dilation, basket extraction, and lithotripsy, and even using laser as well as the shockwave-has brought a lot of novel innovation with high success rate. Appropriate indication and the ability to recognize various risk factors of complication are the keys to successful treatment, in order to decrease morbidity and mortality rate. Multimodality treatment of bile duct stone includes endoscopy, surgery, and drugs are a treatment approach which has always to be carried out in bile duct stone management. Difficult bile duct stone cases such as large stone, impacted stone, biliary stone in pregnancy, and recurrent stone can be treated by endoscopy with excellent success rate particularly if it is accomplished using multimodality treatment. Keywords: bile duct stone, endoscopy, ERCP, sphincterotomy, mechanical lithotripsy, laser lithotripsy, shockwave, cholecystectomy laparoscopy, precut sphincerotom
Diarrhea in HIV Infection
No full textDuring the last decade, there has been an increase of immunocompromized patients all around the world; that mostly due to pandemic of Human Immunodeficiency Virus (HIV) infection. Chronic diarrhea as one of common symptoms in patients with HIV infection has different etiology compared to immunocompetent patients. Initial approach of diarrhea in HIV infection may be conducted by evaluating the temporal relationship between the development of diarrhea and the administration of antiretroviral, especially the protease inhibitor agents; which is then followed by fecal analysis/examination for pathogenic bacteria and protozoa as well as endoscopy examination. Biopsy examination of intestinal mucosa is necessary for HIV enteropathy or diarrhea due to microsporidia, which is confirmed further by electron microscopy. The etiology of chronic diarrhea in HIV patients may also different, depend on the cluster of differentiation count value of all patients. Based on such differences, it is necessary to have adequate approach, recognition and understanding in the management of chronic diarrhea, especially for HIV patients. Keywords: diarrhea, infection, H
Abdominal Disturbances among Dengue Fever Patients
No full textBackground: Abdominal disturbances are common symptoms found in approximately 40% of patients with dengue fever, which frequently cause significant morbidity. This study was developed as an attempt to understand the effect of plasma leakage in dengue hemorrhagic fever; particularly on ab dominal problems. Method: The study was conducted in hospitalized patients who were diagnosed with dengue fever and dengue hemorrhagic fever (based on the 1997 WHO criteria for DHF) at Fatmawati hospital, Jakarta, Indonesia. Abdominal ultrasonography (USG) was done on the fourth to sixth day in every patient and when necessary, endoscopy was done. Data were analyzed by Chi-square test. Results: Fifty-three (54.6%) patients had abdominal pain, 81 (83.5%) patients had nausea, 45 (46.4%) patients had excessive vomiting and 28 (28.9%) patients had diarrhea. Forty-seven (48.4%) patients had their aspartate aminotransferase (AST) elevated more than two fold of the Upper Normal Limit (UNL) level; 19 (20%) patients had their alanine aminotransferase (ALT) level elevated two fold higher than the UNL. Amylase was found to be two fold higher than the UNL only in 2 (2%) patients. Lipase level elevated two fold higher than the UNL in 11 (11.3%) patients. USG imaging showed that thickening of the gallbladder wall (over 3 mm) were observed in 83 (85.6%) patients. Endoscopic procedures showed erosive features particularly in the antrum, including edema of the gastric mucosa and widening of the gastric mucosa folding in four patients, while 4 (4.12%) patients had melena. Conclusion: Abdominal disturbances such as abdominal pain, vomiting, melena, liver enlargement and abnormal liver function as well as thickening of the gallbladder wall more than five mm are significantly high in patients with dengue hemorrhagic fever. Keywords: abdominal disturbances, plasma leakage, dengue hemorrhagic feve
The Discrepancy of Colonoscopical and Histopathological Findings in Infectious Colitis: Focus on Amebic Colitis
No full textBackground: Result of colonoscopic examination in infectious colitis was varying. The aim of this study was to recognize the correlation between colonoscopical and histopathological findings in patients with infectious colitis at Cipto Mangunkusumo hospital, Jakarta. Method: A cross-sectional study had been conducted. There were 227 patients with infectious colitis with unidentified etiology and 17 patients with amebic colitis. In both groups, several variables had been studied including sex, age group and indication of colonoscopy by using Chi-square test. The relationship between hematochezia and amebic colitis event was also studied by using Chi-square test. To recognize the ability of colonoscopy test in diagnosing amebic colitis, we conducted diagnostic test by searching the sensitivity and specificity. Result: In both groups of infectious colitis, we found male more frequent than female. There was a significant difference mean of age in both group of infectious colitis (p = 0.04). The mean age of amebic colitis group was younger (35.86 ± 14.36 years) than the other infectious colitis group (45.34 ± 15. 90 years). The incidence of amebic colitis was more frequent in hematochezia than in non -hematochezia (p < 0.001). The sensitivity and specificity of colonoscopy in diagnosing amebic colitis were 35% and 97%, respectively. Conclusion: There was a tendency of developing amebic colitis in patients with hematochezia than non-hematochezia. In diagnosing the presence of amebic colitis, colo noscopy examination has lo w sensitivity and high specificity. Keywords: discrepancy, infectious colitis, amebic colitis, colonoscopy, histopathological findin
Effects of BCAA Enteral Nutrition to the Change of Nutritional Status and Hepatic Encephalopathy Parameters in Liver Cirrhosis Patient with Hepatic Encephalopathy
No full textBackground: This study was also conducted to determine the effects of high-branched chain amino acid (BCAA) enteral supplementation on altered nutritional status parameters (including plasma prealbumin) and hepatic encephalopathy parameters in liver cirrhosis patients with hepatic encephalopathy. Method: Our study was a randomized, single-blinded experimental study comparing between control group of liver cirrhosis patients with standard hospital liver diet (40 kcal/kgBW/day for male and 35 kcal/kgBW/day for female; protein 1.25 g/kgBW/day) and experimental group of liver cirrhosis patients with liver diet modification high in BCAA supplementation, which had similar protein and calorie calculation as the control group. Results: Subclinical hepatic encephalopathy prevalence was 32%. In the experimental group, prealbumin plasma, arm circumference, body weight and body mass index (BMI) increased; whereas in the control group, prealbumin plasma, arm circumference, body weight and BMI decreased (p < 0.05). In experimental group, the ammonia level significantly decreased (p < 0.01). Clinical hepatic encephalopathy, flapping tremor, the number connection test (NCT) did not show significant changes between the two groups. However, there was worsening trend in the control group. Level of albumin, bilirubin, AST, ALT did not show any significant difference between both groups. Conclusion: High-BCAA enteral supplementation which is administered to liver cirrhosis patients with hepatic encephalopathy for 14 days could improve plasma prealbumin level, arm circumference, body weight, BMI and could decrease the plasma ammonia level. However, it does not improve Fischer ratio, psychometric test and electroencephalography Keywords: malnutrition, liver cirrhosis, BCAA, Fisher rati
The Result Discrepancies between Histological and PCR Method for Detecting Helicobacter pylori in Patients with Dyspepsia due to Inappropriate Preparation before Endoscopy
No full textBackground: False negative result of Helicobacter pylori (H. pylori) detection in gastric tissue can be due to inappropriate preparation before endoscopy. The objectives of this study is to compare the result of H. pylori detection in gastric biopsy by histological method and ure C polymerase chain reaction (PCR) in patients with dyspepsia who underwent upper gastrointestinal (GI) endoscopy without preparations other than six hours fasting before endoscopy. Method: We obtained 156 paraffin blocks of gastric endoscopic biopsy samples, taken from antrum and corpus of patients with dyspepsia who underwent endoscopic examination at the Endoscopy Unit of Biomedika hospital, Mataram. All biopsy samples were stained with Hematoxylin and Eosin for tissue diagnosis and Giemsa stain for detecting H. pylori Ure C PCR were done on all blocks. Cag PCR were performed on all Ure C PCR positive samples. Results: Of 156 paraffin blocks, only 17 blocks (10.9%) were positive for H. pylori by histological examination. All of the 17 samples showed positive results on PCR method. Of 156 paraffin blocks, positive results were found in 73 patients (45.9%) by ure C PCR method. The PCR method has increased the positivity rates of H. pylori more than four times compared to histological method. This study showed that the rate of cag a was 63.0%. Conclusion: Ure C PCR is superior to histological examination in patients who did not stop consuming acid supressor drug and antibiotic two weeks prior to endoscopy. This phenomenon can be explained by the change of spiral form into coccoid form of H. pylori, which is hardly detected using Giemsa stain. Keywords: Helicobacter pylori, histology, ureC, Cag a, PC
Multiple Lesion of the Colon and Ileocaecal Valve in Patient with Colitis Tuberculosis with Positive Bacilli Examination in the Stool
No full textIt is sometimes hard to establish the diagnosis of colon tuberculosis because the ulceration features on ileocaecal valve and caecum are not specific. Moreover, biopsy of lesion area can only provide 60-80% detection. The lesions usually include linear or transversal ulcer, nodule, abnormal form of ileocaecal valve and caecum, inflammatory polyp and irregular multiple fibrous bands. We report a case of colon tuberculosis in a 32-years-old woman with giant ulcer and pseudopolyps at ileus terminalis and ileocaecal junction detected by colonoscopy, in addition to multiple ulcers along the colon, starting from rectum to ascending colon. By fecal examination, positive Acid Fast Test (AFT) result was found and by chest X-ray, tuberculosis features were also found. Keywords: tuberculosis colitis, multiple ulcers in colon, giant ulcer, pseudopolyp, fecal AFT, colonoscop
Level of Gastrin Serum and Ulcer Size on Gastric Ulcer Correlated to Helicobacter pylori Infection
No full textBackground: Previously has been defined that peptic ulcer has strongly correlated to Helicobacter pylori (H. pylori) infection. But it hasn’t determined about correlation of gastrin serum level to the ulcer severity on H. pylori infection. The aims of this study were to find the percentage of H. pylori infection on peptic ulcer cases and its correlation to the gastrin serum level. Method: This is analytic cross sectional study in 50 patients with gastric ulcer who came to Adam Malik hospital from February to October 2007. The correlation between gastrin serum level and the size of ulcer with positive and negative Urea Breath Test (UBT) group was analyzed by unpaired student t- test. The correlation between gastrin serum level and ulcer size were investigated with Pearson correlation test and linier regression. Result: Fifty eligible patients, 33 (66%) had positive UBT and 17 (34%) were negative. There were statistically significant difference on gastrin serum level in positive UBT and negative respectively (p = 0.017). There were also significant difference between mean of ulcer size in positive UBT and negative respectively (p = 0.025). There were correlation between gastrin serum level and ulcer size (r = 0.315; p = 0.026). It can predict the increasing ulcer size in 0.012 mm every 1 pg/mL of gastrin serum elevated. Conclusion: Patients with positive UBT has greater ulcer size and higher gastrin level as compared to the negative group. There were positive correlation between gastrin serum level to the size of ulcer in peptic ulcer patients and increase of ulcer size followed with elevated of gastrin serum level. Keywords: Helicobacter pylori infection, gastrin serum level, ulcer siz
Serial Cases of Combining ESWL and ERCP Procedures in Management Chronic Pancreatitis and Difficult Bile Duct Stones
No full textExtracorporeal shock wave lithotripsy (ESWL) has an established role in the management of pancreaticductalcalculiandasfurthertreatmentmodalityforlargeordifficultcomplicatedcommon bile duct(CBD)stones. Combinedwithminimally invasive endoscopic procedure suchasendoscopic retrogradecholangio-pancreatography(ERCP),it has replaced open surgeryas theinitial form of therapy. ESWL has also proved to bean effective therapyin treating intrahepaticstones that are refractory toroutine endoscopic extraction.Inthese serialcaseswe presentthree caseswhichusing combinedESWLandERCP procedurestotreatchronicpancreatitispainandgiantCBDstonethat presentinggoodresultsonfollowupwithoutanycomplication. Keywords:ESWL, ERCP,chronicpancreatitis, CBDston