International Journal of Human Capital Management (IJHCM)
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The Pathogenic Triad of Chronic Cough: Postnasal Drip Syndrome, Asthma, and Gastroesophageal Reflux Disease
No full textChronic cough, lasting for 3 weeks or more, is one of the most common symptoms for which adult patients seek medical attention. The pathogenic triad of chronic cough is Postnasal Drip Syndrome (PNDS), Asthma, and Gastroesophageal Reflux Diseases (GERD) are the vast majority etiology of chronic cough in non-smoker adult with normal chest X-ray. The clinical investigations that should be performed are spirometry pre-post bronchodilator and bronchoprovocation testing for asthma; plain sinus radiograph and or computed tomographic imaging of the sinus for PNDS due to sinusitis; gastro-intestinal investigation 24 hours oesophageal pH monitoring and upper gastrointestinal endoscopy for GERD. Keywords: chronic cough, postnasal drip syndrome, asthma, gastroesophageal reflux diseas
Eosinophilic Esophagitis
No full textThe frequency of eosinophilic esophagitis (EE) cases is increasing along with increased understanding among doctors about EE. In the beginning, EE is mostly found in children population. It was first reported in adults by Landres on 1978. The prominent EE symptoms in adults are dysphagia and solid food impaction. Endoscopic examination reveals mucous ring of esophagus, white plaque on the mucosa. The diagnosis is supported by positive result of eosinophils, which forms infiltration on the mucosaof > 20 eosinophils/ high power field in the distal or middle esophagus. Treatment by using diet and corticosteroid, either topical or systemic, shows adequate results. Immunomodulator treatment is promising, but it needs further investigation with larger sample. No consensus have been reached for EE, therefore it may affect the diagnosis, treatment and epidemiology data. Keywords: esophagus, eosinophil, dysphagia, ring of esophagu
The Detection of H pylori In Gastric Mucosal Biopsy Specimens by PCR Using Primers Derived From Ure C Gene in Patients with Dyspepsia
No full textBackground: The detection of Helicobacter pylori (H. pylori) in gastric biopsy specimens can be done using CLO (Campylobacter Like Organism) test and histopatological examination, but the sensitivity of both Method is influenced by the density of the bacteria in the sample. Beside that, the coccoid form is detected with difficulty by histology and need immunohistochemical stain to confirm. PCR can be used for the detection of both spiral and coccoid form of the bacteria. Objective: To detect the genome of H. pylori by Polymerase Chain Reaction (PCR) using primers derived from ureC gene of the bacteria in gastric biopsy specimen from patients with dyspepsia. Methods: Gastric biopsy specimen from 179 patients with dyspepsia in the endoscopic unit Mataram hospital. The biopsy was taken from antrum and corpus and put into sterile saline for the culture of H. pylori and put into 70% ethanol solution for the PCR. The specimen for bacterial culture was carried soon to microbiology laboratory and plated into the appropriate media and grown in microaerophilic condition in CO2 incubator. The PCR was done using primers derived from ureC. Result: The H. pylori genome was detected in 79 of 179 biopsy sample (44.13%). The bacterial culture was positive for H. pylori in 22 (12%). The PCR result was positive in 10/35 of patient with normal endoscopy (28.57%). From 22 patients with duodenal ulcer without gastric ulcer the PCR was positive in 15 (68.18%). In patient with gastric ulcer without duodenal ulcer the PCR was positive in 9 patients (42.08%). From 7 patient with combined gastric and duodenal ulcer the PCR was positive in 5 (71.43%), in 3 patient with gastric cancer the PCR was positive in 1 (33.33%). Conclusion: The study showed that 44.13% of patient with dyspepsia in Mataram hospital was positive for H. pylori by PCR. Keywords: detection of Helicobacter pylori, gastric mucosal biopsy specimen, polymerase chain reaction, ureC gen
Normal Histological Appearances of the Duodenum Jejunum and Terminal Ileum in Indonesian People
No full textBackground: There is no literature specifically on the normal appearance of small bowel mucosa amongst Indonesians. Diseases of the small bowel can cause chronic diarrhea. Chronic diarrhea is common in Indonesia. Methods: Thirty seven patients with normal stomach and small bowel on endoscopic and histopathologic examination were included in this study. Biopsies were taken from the duodenal bulb, descending part of duodenum, jejunum and terminal ileum. The scoring Method for the inflammatory cells (lymphocytes, plasma cells and eosinophil cells) was carried out using the symbols 0 (negative), +, ++, and +++. Results: The mean height of the villi of the duodenal bulb was 265.00 ± 81.89 mm, the mean height of the crypts of the duodenal bulb was 196.67 ± 56.01 mm, the mean width of the villi were 59.14 ± 74.14 mm. The mean height of the villi of the duodenum pars descendens was 317.27 ± 99.66 mm and the mean height of the crypts was 218.79 ± 84.66 mm. The mean height of the villi of the jejunum was 341.76 ± 76.06 mm and the mean height of the crypts was 189.41 ± 58.15 mm. The mean height of the villi of the terminal ileum was 235.41 ± 73.32 mm, and the mean height of the crypts was 186.22 ± 64.09 mm. Conclusion: Histologically, the mean height of the villi of the normal small bowel was between 235.41 ± 73.32 to 341.76 ± 76.06 mm and the mean height of the crypts of the normal small bowel was between 186.22 ± 64.09 to 218.79 ± 84.66 mm. Keywords: normal, duodenum, jejunum, terminal ileum, histological appearances, villous height, villous width, crypt heigh
Management of Esophageal Foreign Body
No full textForeign body ingestion is a common clinical problem. Objects such as coin, safety pin, meat bolus, bone, denture, etc. are often ingested. They lodge in certain part of esophagus, which may be asymptomatic or develop some symptoms of esophagus or respiratory tract. Plain radiography is indicated for every patient with a known or suspected foreign body. It may appear as radiopaque or radiolucent images. A number of methods can be used to remove esophageal foreign bodies, including: observation, endoscopy, rigid esophagoscopy, Foley catheter extraction, bougienage and sometimes administration of LES relaxant or surgery. Application of those strategies is selected based on the type and location of foreign bodies. Five cases had been managed by different strategies, i.e. two cases were successfully managed by endoscopy; a case was managed through careful observation; another case was managed by pushing object into stomach using endoscopic approach; and the other case was fail when it was managed by Foley catheter but then it was successfully managed by rigid esophagoscopy at ENT Department. All of cases had been managed without any complication. Keywords: esophageal foreign body, foreign body ingestion, procedure remova
Prevalence and Distribution of Anemia Risk Factor in Patient with Chronic Hepatitis C who Has Combination therapy of Interferon Alpha and Ribavirin
No full textBackground: Interferon alfa and ribavirin combination therapy is one of effective standard therapy for chronic hepatitis C (CHC.) However, anemia is a common side effect of this therapy that patients have to reduce or discontinue ribavirin therapy. But ribavirin dose reduction or discontinuation can reduce the effectivity of the therapy. Hence, it is important to know the prevalence of anemia and to determine the factors associated with anemia. Objective: To know the prevalence of anemia and some risk factors associated with anemia caused by the combination therapy in chronic hepatitis C. Method: Sixty one of CHC patients who received combination therapy were included in this study. The study used cross sectional design and data were obtained by measured complete blood count on 8th week of therapy. Result: Subjects 47 (77%) were males, 14 (23%) were females with mean age 38.9 years. Subjects had genotype 1 and 4 were 23 (71.9%) and 44 (72.1%) subjects received 1,000 mg ribavirin. Prevalence of anemia was found to be 52.5%. On multivariate analysis, only pretreatment hemoglobin concentration 50 years or female were not found to be the risk factor of anemia but patient with these risk factors should be carefully monitored. Intervention to prevent anemia should be considered to these patients. Eight subjects from 32 anemia patients had ribavirin dose reduction, and no patient had discontinuation treatment on 8th week of therapy. Keywords: chronic hepatitis C, IFN-alfa- RIB combination therapy, risk factors of anemi
Immunocompetent Expression of CD4+ T Cell and CD8+ T Cell, TNF-alpha and INF-gamma in Patient with Chronic Hepatitis C
No full textAim: To investigate the expression CD4+ T cell and CD8+ T cell as well as TNF-a and INF-g level on chronic hepatitis C. Methods: This is a cross-sectional study. Forty patients with chronic hepatitis C based on laboratory examination, who were collected from blood transfusion centers at Dr. M. Djamil Hospital. The control group used forty healthy samples. Results: There were 40 chronic hepatitis C cases satisfying the inclusion criteria. We found that CD4+ T cells count 50.35 ± 3.18%; CD8+ T cells count 59.37 ± 3.52%; TNF-a level 22.03 ± 3.72 pg/ml and INF-g level 4.47 ± 1.47 pg/ml. Conclusion: The chronic infection hepatitis C virus have given the effects on the immunocompetent cells which increased of CD4+, CD8+, TNF-a level and INF-g level. Keywords: hepatitis C virus, CD4+ T cell, CD8+ T cell, cytokines TNF-a, INF-
Relationship between serum zinc concentration and neutrophil phagocytic function in liver cirrhosis patients
No full textBackground: Liver cirrhosis patients are susceptible to infection. The incidence of infections depends on several factors. One of the factors is decreasing immune system i.e. the deterioration of neutrophil phagocytic function. The deterioration of neutrophil phagocytic function is caused by complement deficiency, bowel endotoxemia, decreasing tuftsin activity, and zinc deficiency. Zinc deficiency is caused by impairment of bowel absorption and increasing zinc excretion by urine. Zinc influences the specific and non specific immune system. Aim: To determine whether there is relationship between serum zinc concentration with neutrophil phagocytic function in liver cirrhosis patients. Subject & Method: This was a cross-sectional study from August 2004 until September 2005. Study population are ambulatory liver cirrhosis patients and in patient liver cirrhosis. Correlation analysis was done to asses relationship between zinc concentration and neutrophil phagocytic function, which used Nitro Blue Tetrazolium (NBT) dye reduction test. Result: There were 58 subjects fulfilled the criteria. The mean of serum zinc concentration was 114 mmol/L. The mean of NBT was 3.4 ± 3.1%. The coefficient correlation between zinc serum concentration and neutrophil phagocytic function was 0.13, p= 0.58. Conclusion: There was a weak and non significant positive correlation between serum zinc concentration with neutrophil phagocytic function in liver cirrhosis patients. Keywords: zinc, neutrophil phagocytic function, liver cirrhosi
Candidiasis in Malignancy
No full textEsophageal candidiasis presents with a range of clinical findings and is rarely found among immunocompetent patient without predisposing factors. Between 20-50% of patient may be asymptomatic. One of predisposing factor of candidiasis is immunocompromised condition due to malignancy. Dysphagia is the most frequently presented feature of esophageal carcinoma. We demonstrated a case of esophageal candidiasis as one of early clinical presentation in patient with esophageal carcinoma. Keywords: esophageal candidiasis, esophageal carcinom
Laboratorium Diagnosis of Clostridium difficile Infection
No full textClostridium difficile is the most important cause of antibiotic associated diarrhea, and pseudomembranous colitis, a severe infection of the colon. Strain Clostridium difficile produce two potent toxin, toxin A (enterotoxin) and toxin B (cytotoxin). These two toxins are both responsible for the diarrhoea and inflammation seen in patients treated due to infection, especially the broad spectrum antibiotics. Direct detection of Clostridium difficile cytotoxin from faecal specimen using mammalian tissue culture lines is considered the standard diagnostics test of Clostridium difficile infection. This test is very sensitive but requires a minimum two days to complete. In order to improve the threshold of diagnosis and treatment, a number of enzyme immunoassay Methods have been used, with a reported sensitivity to either toxin A or toxin B. Keywords: Clostridium difficile, cytotoxin, diarrhea, enzyme immunoassa