International Journal of Human Capital Management (IJHCM)
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Measuring HBsAg and HBV DNA Levels in Cilegon
No full textBackground: Implication of measuring HBsAg level is still not recognized well. The aim of this study to recognize the correlation of serum HBsAg level and serum HBV DNA level between in HBeAg positive patients and HBeAg negative patients. Method: Quantitative serum HBV DNA were collected retrospectively between January 2006 and May 2009. We stratified the patients into four groups, that were; HBeAg positive and (a) ALT > 2 x upper limited normal (UNL) (group A),( b) ALT 2 x UNL (group C) (b) ALT 20,000 IU/mL. In group B, C and D the accuracy to predict serum HBV DNA level were not so good . Conclusion: There were positive correlation between HBsAg titers and HBV DNA levels in HBeAg positive and HBeAg negative patients as demonstrated in the three group stratification; however, the correlation was negative in group HBeAg positive and ALT 2 x UNL with HBsAg cut-off level 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL; while in other groups, the correlation were not so good. Keywords: serum HBsAg level, serum HBV DNA level, hepatitis B, correlatio
Ileal Endometriosis
No full textEndometriosis at the ileum site is a rare case and among the difficult cases of endometriosis. Intestinal endometriosis may cause obstructing symptoms, which is difficult to be distinguished from malignant or inflammatory disease. We report a case of 33-year-old woman, who admitted to the hospital because of sub-ileus intestinal obstruction. She underwent one session laparoscopy and laparatomy operation. Her ileum showed obstruction because of stenosis and adhesion with an ovarian brown cyst. She experienced terminal ileal resection, ileocaecostomy anastomosis, followed by laparatomy ovarial cystectomy and appendectomy. Microscopic evaluation of the intestine revealed vascular congestion, lymph nodes inflammation, and typical endometrial glands in the muscle layer of ileum. There was no sign of malignancy. These findings led to the diagnosis of ileal endometriosis. The ovarian cyst was actually the endometrial cyst of the ovary. Keywords: sub-ileus obstructive, ileal endometriosis, endometrial cys
Upper Gastrointestinal Malignancy among Dyspepsia Patients in Cipto Mangunkusumo Hospital Jakarta
No full textBackground: Upper gastrointestinal (GI) malignancy was still a health problem in all over the world. The prevalence of the upper GI malignancy vary among Asian countries. Data from Indonesia was scarcely reported. The aim of this study is to determine the frequency of upper GI malignancy among dyspepsia patients who underwent esophagoduodenoscopy (EGD) procedure. Method: This is a retrospectives study from subject with dyspepsia that had underwent upper GI endoscopy at the Department of Internal Medicine Cipto Mangunkusumo hospital from January 2005 to December 2007. All complete data from medical report and histopathology appearance will be recorded. Results: Out of 2,116 subjects underwent endoscopy due to dyspepsia, 110 (5.19%) subjects was diagnosed as cancer. This upper GI malignancy consisted of gastric cancer in 63 (2.97%) cases, esophageal cancer 32 (1.51%) and duodenal cancer 15 (0.71%). The mean ages of the subjects was 53.36 ± 10.97 years, age less than 45 years was 20 (18.20%) subjects, more than 45 years was 90 (81.18%), male 71 (64.50%) subjects, female 39 (35.50%). Most of them had alarm signs 96 (87.30%). Histopathology finding showed adeno-carcinoma in 75 (68.20%) cases, signet ring cell carcinoma in 14 (12.70%), squamous cell carcinoma in 8 (7.30%), others in 13 (11.80%). Out of 59 gastric cancer, 48 (76.20%) cases was located at distal part while the rest 11 (17.50%) cases was located at the proximal gaster, and 4 (6.30%) in diffuse. By the ethnics founded Javanese 37 (33.60%) subjects, Betawinese 22 (20.00%), Sundanese 12 (10.90%) and Batak 13 (11.80%). Conclusions: Upper GI malignancy was found in five percent of subjects with dyspepsia who undergo colonoscopy. The three most frequent malignancies were gastric carcinoma, esophageal carcinoma, and duodenal carcinoma respectively. Most of gastric adenocarcinoma was located at distal stomach. Keywords: upper gastrointestinal malignancy, dyspepsia, endoscopy, alarm sign, histopatholog
Efficacy and Safety of In-Asia-manufactured Interferon alpha-2b in Combination with Ribavirin for Therapy of Naïve Chronic Hepatitis C Patients: A Multicenter, Prospective, Open-Label Trial
No full textBackground: An open-label, multi center and non-comparative study was conducted to evaluate the efficacy and safety of a more affordable in-Asia-manufactured interferon á-2b product in combination with ribavirin to treat naïve chronic hepatitis C patients. Method: Thirty chronic naïve hepatitis C patients were treated with in-Asia-manufactured interferon a-2b subcutaneously 3 MIU thrice weekly and ribavirin 800-1,200 mg daily for 48 weeks. Follow-up was done until 24 weeks after the end of treatment. Efficacy was assessed by examining serologic and biochemical parameters at pre and post-treatment. Safety was assessed by evaluating clinical symptoms and laboratory parameters. Results: The virological response and sustained virological response rates of all Hepatitis C Virus (HCV) genotypes were 83.3% and 76.7% respectively. Post-treatment, 80% patients had significant alanine transaminase (ALT) decreased into normal level and remained normal in 76.7% patients at 24th week follow up period. At that time, the ALT level and sustained virological response were lower in HCV genotypes 1 and 4 than in non-1 and non-4 genotypes. The most frequent adverse event was flu-like syndrome. Conclusion: The efficacy and safety study on combination therapy of in-Asia-manufactured interferon a-2b and ribavirin has shown a good result based on the current standard of interferon alpha and ribavirin combination therapy. Keywords: interferons, combination drug therapy, chronic hepatitis C, treatment efficacy, safet
Serum Zinc Level and Urinary Zinc Excretion in Liver Cirrhotic Patient
No full textBackground: Zinc deficiency is commonly found in liver cirrhotic patient, and it is usually caused by excessive urinary excretion that is exaggerated by diuretic agents. The objective of this study is to know the differences of zinc serum concentration according to the Child-Turcotte-Pugh (CTP) score and clinical factors that influence zinc serum level and 24-hour urinary zinc excretion. Method: The design of this study was cross-sectional. In adult patients with liver cirrhosis, blood samples were collected after patients had fasted for at least 8 hours. Zinc levels were measured by the flame atomic absorption spectrophotometry method. Correlation test was performed among numeric variables, as well as Mann-Whitney U test to measure mean differences of zinc serum concentration and of 24-hours urinary zinc excretion according to clinical factors. The level of significance was p 550 µg/24 hour. The results of mean difference test of zinc serum concentration between CTP score B and C showed no statistical significance (p = 0.052). Urinary zinc excretion correlated to urine volume (r = 0.638, p = 0.000), and it was higher in hospitalized patients compared to outpatients. It also was higher in men compared to women. There were no statistically significant differences in zinc serum level, zinc urinary level, and urinary zinc excretion on the administration of diuretic agents. Conclusion: There were no significant differences of fasting zinc serum concentration in cirrhotic patients between the CTP scores B and C. In liver cirrhotic patients, urinary zinc excretion positively correlates to urine volume. Keywords: liver cirrhosis, serum zinc level, urinary zinc excretio
Hemobilia after 49-days Accidental Hepatic Trauma and Twice Perihepatic Packing
No full textHemobilia occurs in only 1.2–5% of patients with accidental liver trauma. Clinical presentation of hemobilia include one symptom and two signs known as the classic Quinke triad, upper abdominal pain, upper gastrointestinal bleeding and jaundice. This report describes a case of patient with hemobilia that had been diagnosed 49 days after accidental hepatic trauma and twice perihepatic packing. A 29-year old man with hematemesis melena came to the hospital with the history of hepatic accidental trauma and had already received twice perihepatic packing treatment. At first, the esophagogastroduodenoscopy could only find gastritis and duodenal ulcer. Subsesquently, the ultrasonography revealed liver hematoma. Diagnosis of hemobilia was made when bleeding exiting from the ampulla of Vater which then was confirmed by the second esophagogastroduodenoscopy. Surgery had been planned but the patient and his family had refused the procedure. Hemobilia should be considered in patients presenting with gastrointestinal blood loss after liver injury. The diagnosis is confirmed by esophagogastroduodenoscopy and angiography. Modalities used to stop bleeding include angiography with embolization, surgical intervention, observation, and electro- coagulation or photocoagulation. Keywords: hematemesis, melena, liver injury, hemobilia, esophagogastroduodenoscop
Seroprevalence Study of HbsAg positive in Entrant Candidates of Specialist Doctoral Program at Dr. Kariadi Hospital Semarang
No full textBackground: Hepatitis B Virus (HBV) infection is one of main diseases that infects human kind and constitutes a serious health problem in community. As a consequence of their job, health personnel have gained higher risk to HBV infection. Medical personnel (doctors) are determined as one of the high-risk group of the HBV infection through blood transmission.The objective of this study was to determine the prevalence of HBsAg positive in doctors who were entrant candidates of medical specialist program at Dr. Kariadi hospital. Method: The study was conducted retrospectively by reviewing medical record of 1,145 doctors who were entrant candidates of medical specialist program at Dr. Kariadi hospital since April 2000 to October 2004. The HBsAg assay as a marker of HBV infection was analyzed by EIA (Enzyme Immuno Assay) Method. Results: Among the 1,145 doctors examined , the range of age was 29.34 ± 3.04 years, and more than 3-year work period as doctor was 64% (733/1,145), and less than 3-year work period as doctor was 36% (412/1,145). The prevalence of HBsAg positive in population was 3.9% (45/1,145). The seropositive of HBsAg in the group of doctors with more than 3-year work period was significantly higher than the group with less than 3-year work period (5.1% (38/73) vs. 1.6% (7/412) with p < 0.05. Conclusion: The prevalence of HBsAg positive in doctors who were entrant candidates of specialist doctoral program at Dr. Kariadi hospital was 3.9%. The prevalence of infection was higher in the group of doctors with more than 3-year work period. Keywords: prevalence, HBsAg, docto
Problems in Diagnosis Approach for Carcinoma of Pancreatic Head
No full textIncidences of pancreatic cancer worldwide have been known to be increased. It is the fifth leading cause of death in United State of America. Seventy percent occurs in the head of the pancreas. Major risk factors are related to age, black race, smokers, high-fat diet, chronic pancreatitis, diabetes mellitus and alcohol consumption. Some clinical symptoms such as jaundice, abdominal pain, unexplained weight loss or ascites can occur early or even late in the course of disease. Diagnosing pancreatic cancer sometimes can be difficult, regarding to discrepancy between clinical symptoms and radiological findings. It is important to take good history of the patient, thorough examination, and combine several modalities in diagnosing tumor of pancreatic head. In this case report, a 54 year-old female, came to the hospital with abdominal swelling and jaundice. Physical examination revealed liver and spleen enlargement and edema on both lower extremities. The laboratory result showed increment in Carcinoembryonic Antigen (CEA) and carbohydrate antigen 19-9 (CA19–9) level, without marked increase in bilirubin level. Dilatation of the pancreatic duct was found in this patient, without any sign of bile stone. Endoscopic Retrograde Cholangiopancreatography (ERCP) in this patient was failed to have significant result. Keywords: carcinoma of pancreatic head, papilla vater carcinoma, diagnosis, ERCP, jaundiceH
The Absence of Urease Enzymatic Activity of Helicobacter pylori Coccoid Form
No full textBackground: Helicobacter pylori (H. pylori) is a gram negative and pleomorphic bacteria that able to change its morphology according to the environment. The objective of the study was to determine the biochemical and some genetic characteristic of coccoid form of H. pylori induced by starvation, aerobiosis and antibiotic. Method: The material of the study is an isolate of spiral form of CagA positive H. pylori grown from gastric biopsy specimen of a patient with chronic gastritis. The CagA positive isolate was subcultured in liquid media containing the sheep sera. The sample was divided into three groups each group consist of 27 tube. Each tube contained 109 CFU of H. pylori bacteria/ml in 4 ml liquid media. So the experiment was performed in 3 replicates. In the first group of sample, coccoid form was induced by a prolonged culture under microaerophilic condition without the addition of fresh media, in the second group by aerobiosis, while in the third group by addition of 0.1 µg amoxycillin/ml cultured in microaerophilic condition. Periodic sampling was done every day to calculate the percentage of coccoid form, to observe the possibility to regrow the spiral form and for serial electron microscopic observation. One tube is picked up in every periodic sampling. In tubes containing antibiotic the periodic sampling was done one hourly. Detection of cagA and ureA gene was done by Polymerase Chain Reaction (PCR) with appropriate primers. Results: The time needed for the development of coccoid form: Length of time from the start of the experiment needed to reach 100% coccoid form was: 49 days in microaerophilic with starvation, 28 days in aerobiosis with starvation, and 13.5 days in antibiotic. result of biochemical test: Urease enzymatic activity was only positive in spiral form. All samples of coccoid form due to all the 3 stressors did not show any urease enzymatic the activity. PCR of ureA gene: All samples of spiral and coccoid form showed positive band of ureA gene and cagA gene. Western blot of protein CagA, urease A and urease B: Western blot analysis showed that in spiral form and all coccoid form band of urease A and urease B is clearly seen,while cagA in Western blot only clearly seen in spiral form but it is absent in cocoid form. Conclusion: Troughout the cycle of coccoid form the urease gene responsible for the production of urease and cagA gene responsible for virulence was in intact condition. However, despite the presence of urease protein in coccoid form the urease enzymatic activity was absent. This fact has several diagnostic and clinical implications. Keywords: urease enzymatic activity, coccoid form, Helicobacter pylor
A 17-Years Old Man of Colitis Tuberculosis with Fistula Perianal
No full textTuberculosis (TB) remains to be one of the most common problems in developing countries such as Indonesia. It can involve many organs including gastrointestinal tracts. Colonic tuberculosis is an ancient disease and has long been recognized. However, it is sometimes difficult to make early diagnosis due to its nonspecific signs and symptoms. Perianal granulomas or perianal fistula presents some degree of diagnostic difficulty. A spectrum of diseases can produce granulomas in perianal region and perineum. Most are infectious or inflammatory diseases. Standard histological diagnosis often less significant to clarify the etiology and treatment will vary from one to another disease entity. In this report, we present a case 17-years old man with colitis TB and fistula perianal, in which the initial diagnostic workup suggested Crohn’s disease. Mantoux test, Acid Fast Bacilli test on fecal examination and polymerase chain reaction analysis revealed negative result. The chest X-ray was normal; while the fistulography X-ray: revealed 2 orifices in rectosigmoid area. The colonoscopy revealed mucosa edema with ulceration in rectosigmoid and pedincular polyp in the caecum. Initial colonoscopy diagnosis was Crohn’s disease with differential diagnosis colitis ulcerative, colitis TB, colitis infection. results of direct or post homogenizes examination (Ziel–Nielsen staining) revealed that no acid-fast bacilli was found. Multiple biopsies were done, which indicated mucosa edema with ulceration in rectosigmoid area, pedincular polyp in the caecum, and surrounded by fistula perianal; while histopathological examination showed inflammatory-caseating-epithelioid-granulomas and giant cells (Langhans datia cell) caused by tuberculosis. It highlights the need for awareness of intestinal TB along with the differential diagnosis of chronic intestinal disease. Standard regimen of antituberculosis treatment was given and the patient showed good clinical response. Keywords: Crohn’s disease, caseating epithelioid granuloma, giant cell, colitis TB, perianal fistul