International Journal of Human Capital Management (IJHCM)
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Pancreatic Exocrine Insufficiency in Chronic Diarrhea
No full textBackground: One of the causes of chronic diarrhea is pancreatic exocrine insufficiency. Chronic diarrhea cases are commonly encountered in Indonesia. Materials & methods: All patients with chronic diarrhea at hospitals in Jakarta were included in this study and dyspeptic patients were used as control subjects. The study and control subjects must submit their stool for fecal pancreatic elastase-1 examination at a private laboratory in Jakarta. Mild/moderate pancreatic exocrine insufficiency was defined if the concentration was between 100 - 200 mg E1/g stool. Severe pancreatic exocrine insufficiency was defined if the concentration was below 100 mg E1/g stool. The data was analyzed using Fisher or Kruskal-Wallis tests. Results: There were 32 chronic diarrhea patients with a male to female ratio of 19/13 (59.38%/40.62%). The most frequent age range was 50-59 years old (39.5%). The characteristics (sex, age and race) of chronic diarrhea patients were matched with the characteristics of dyspeptic patients as control subjects (p > 0.05). The fecal elastase-1 results in chronic diarrhea displayed greater pancreatic exocrine insufficiency ( 200 mg E1/g stool, p < 0.001). The mean fecal elastase-1 Result in chronic diarrhea and in dyspepsia were 316.29 + 195.44 vs. 475.93 + 65.33 mg E1/g stool (p < 0.001). Six patients (18.74%) were established as having severe pancreatic exocrine insufficiency. Seven patients (21.88%) were found with mild/moderate pancreatic exocrine insufficiency. Conclusion: Pancreatic exocrine insufficiency was found frequently in chronic diarrhea Keywords: pancreatic exocrine insufficiency, chronic diarrhea, fecal pancreatic elastase-
Gastroduodenal Mucosal Integrity and Influencing Factors
No full textGastroduodenal mucosal integrity has important role in the pathogenesis of gastroduodenal ulcer. It depends on imbalance between aggressive and defensive factors. However, many experts believe that defensive factors has more dominant role. Maintenance of gastrointestinal endothelial integrity appears to define the “cytoprotection” phenomenon and, as discussed below, is a critical component of NSAID- induced GI injury and a potential target for therapeutic intervention. Keywords: mucosal integrity, aggressive factors, defensive factor, cytoprotectio
Non Cirrhotic Portal Fibrosis
No full textDiagnosis of non cirrhotic portal fibrosis was considered when the following criteria were fulfilled evidence of portal hypertension (oesophageal varices, hypersplenism, ascites, or increased hepatic venous pressure gradient), Doppler ultrasound showing patent portal and hepatic veins, and liver biopsy showing sign of cirrhosis. Non cirrhotic portal fibrosis clinically characterized by splenomegaly, anemia, portal hypertension, and histopathological examination portal tract showing fibrosis and sclerosis. Portal hypertension are most caused by a cirrhotic liver (85%), there are only a few reports on non cirrhotic portal hypertension, mostly in Japan and India. We reported a case of non cirrhotic portal fibrosis in young male. The clinical complications of portal hypertension are variceal bleeding and pancytopenia due to hypersplenism. Variceal band ligation and splenectomy were performed. The patient showed good clinical response. Keywords: portal hypertension, non cirrhotic portal fibrosis, young mal
Helicobacter pylori Infection in Idiopathic Chronic Urticaria
No full textHelicobacter pylori (Hp) infection is the most common chronic bacterial infection in human. The role of Hp infection in various GI disorders had been widely accepted. However, further studies have found new extragastrointestinal involvement such as urticaria. Chronic urticaria is a common disorder that has complex pathophysiologic mechanism. As mater of fact, etiology remains unclear in most of the cases. This condition is called Idiopathic Chronic Urticaria. Several studies had shown high prevalence of Hp infection in patients with ICU and improved symptoms after eradication therapy of Hp. This observation had suggested that Hp has important role as etiologic factor in some cases of ICU. The presence of Hp infection and its role in ICU should be proven before initiating eradication therapy, so that irrational used of drugs and antibiotics resistance can be prevented. Keywords: Helicobacter pylori, Idiopathic Chronic Urticari
Emerging Cases of Hepatitis C Virus and Human Immunodeficiency Virus Co-infection Among Narcotics Abusers in Pondok Indah Hospital, Jakarta
No full textBackground: Narcotics and psychoactive substances abuse, particularly by intravenous route, currently is a major health problem affecting young Indonesian people. Consequently, there is an increasing incidence of blood-borne viral diseases, including hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections. This study was aimed to investigate the prevalence of HCV and HIV co-infection among narcotics abusers in Pondok Indah Hospital, Jakarta. Method: This was a cross-sectional study in Pondok Indah Hospital, Jakarta using patients’ medical records. Data from patients with the diagnosis of mental and behavioral disorders due to various psychoactive substances and HIV-related diseases were retrieved to obtain demographic characteristics, history of drug abuse and serological testing. Patients were excluded if there were another organic mental disorders found or a history of blood transfusion prior to infection. Results: There were 157 cases of drug abuse collected between January 2000 and May 2005, 85.4% were men and their median age was 24 years old. The peak age group was 21-25 years old. Injection drug users (IDUs) were found in 72% of cases. Anti-HCV total antibody was found in 45.2% cases, including 2 non-IDUs, while anti-HIV antibody and combined anti-HCV/anti HIV antibodies were found in 13.4% and 7.6% cases, respectively. Anti-HCV positive patient are significantly younger than anti- HCV negative patients (27.9 + 8.2 vs. 23.7 + 4.4 years, p < 0.001), while the duration of use was not significantly correlated with HCV infection. Neither age nor duration of use was statistically significant with the presence of anti-HIV antibody. However, there is a significant correlation between the duration of drug abuse with HCV and HIV co-infection (6.0 + 3.0 vs. 4.1 + 2.8 years, p = 0.027). Conclusion: The prevalence of HCV and HIV co-infection among narcotics abusers in Pondok Indah Hospital was 7.6%. The emerging cases of hepatitis C and HIV infections during the last several years was significantly related to the increasing numbers of narcotics abusers. Keywords: hepatitis C virus, human immunodeficiency virus, co-infection, injection drug user
Intestinal Amebiasis: Diagnosis and Management
No full textIntestinal amebiasis is an infection due to Entamoeba Histolytica and has the highest prevalence in tropical countries, including Indonesia. Amebiasis is responsible for approximately 70,000 deaths annually every year. High prevalence is found especially in endemic area which had poor hygiene and sanitation or crowded population. Human is the main reservoir, while the disease can be transmited by mechanical vector such as cokckroach and flies. Making diagnosis of intestinal amebiasis sometimes can be a problem. Clinical presentation and disease severity may be varied. Complication due to late management of the disease can be fatal. Lifestyle education, early diagnosis and proper management of amebiasis are very important measures to promote by health workers. Keywords: intestinal amebiasis, diagnosis, managemen
Correlation between Branched Chain Amino Acids to Tyrosine Ratio and Child Pugh Score in Liver Cirrhosis Patients
No full textBackground: The determination of branched chain amino acids (BCAA) to tyrosine ratio (BTR) was available in making differentiation of chronic hepatitis from liver cirrhosis, because there was a strong association between BTR and staging (fibrosis) scores. Branched chain amino acids to tyrosine ratio have a correlation with Fischer ratio and the examination is easier because it can be done by enzymatic assay. Materials and Methods: To evaluate the correlation between BTR and Child-Pugh score, we examined the amino gram of 52 liver cirrhosis patients consisted of 26 Child-Pugh A, 19 Child-Pugh B, and 7 Child-Pugh C. The examination of amino gram was done by High Pressure Liquid Chromatograph (HPLC) analyzer. Branched chain amino acids to tyrosine ratio were compared to Child-Pugh score, albumin, ammonia level, number connection test to Fischer ratio. Results: Significant differences in BTR among Child-Pugh A, B, C were observed (Child-Pugh A 7.75 + 1.2; Child Pugh B 6.0 + 1.23 and Child Pugh C 4.38 + 3.14 (p = 0.000)). Branched chain amino acids to tyrosine ratio had a weak correlation with albumin (r = 0.292; p = 0.036), ammonia level (r = 0.376; p = 0.006) and strong correlation with Fischer ratio (r = 0.818; p = 0.000). There was no significant correlation between BTR and number connection test. Conclusion: These results showed that the determination of the molar ratio of branched chain amino acids to tyrosine well reflected the severity of liver cirrhosis and it can be used as a substitute of Fischer ratio. Keywords: Branched chain amino acids, tyrosine, liver cirrhosi
Management of Constipation
No full textConstipation is the most ignored complaint by doctors and unfortunately, it requires urgent management due to the decreased quality of life. Most cases are functional constipation but there is also a great number of constipation due to organic abnormalities. In an attempt to manage the patient properly, we should put our emphasis on excellent knowledge of pathophysiology of constipation.By using the colonic transit time test, we could determine the type of constipation, which would have an effect on therapy. In most cases, constipation has a good response to high fiber diet and additional laxative medication and surgical therapy is seldom required unless complications have occurred. There is also a suggestion for preventing constipation may be caused by opioid usage. Keywords: Constipation, colonic transit time test, high fiber diet, laxative
The Causes of Upper Gastrointestinal Bleeding in the National Referral Hospital: Evaluation on Upper Gastrointestinal Tract Endoscopic Result in Five Years Period
No full textBackgrounds: Gastrointestinal bleeding such as hematemesis or melena are common conditions in clinical practice and endoscopic service. The mortality rate due to gastrointestinal bleeding is relatively high. In this study, we evaluate the causes of hematemesis melena for the last 5 years and the factors associated with the bleeding. Methods: The study was done retrospectively. We obtained data from medical record of patients that performed endoscopy of upper gastrointestinal tract in Division of Gastroenterology, Department of Internal medicine, Cipto Mangunkusumo hospital (Jakarta, Indonesia) during the period of 2001 to 2005. Results: Of 4.154 patients who underwent upper gastrointestinal tract endoscopy from 2001 to 2005, we found that 837 patients (20.1%) were due to upper gastrointestinal bleeding. They were 552 male (65.9%) and 285 female patients (34.1%). Mean age of male patients was 52.7 ± 15.82 years, while for female patients was 54.46 ± 17.6 years. Of 837 patients who came due to hematemesis were 150 patients (17.9%), melena were 310 patients (37.8%), both melena and hematemesis were 371 patients (44.3%), 557 cases (66.5 %) due to non varices. Endoscopic results showed that 280 cases (33.4%) were due to esophageal varices. In general, this study had demonstrated that esophageal varices was the most frequent cause of upper gastrointestinal bleeding. We found 229 cases of esophageal varices were coincidence with portal hypertensive gastropathy. While ulcer was found in 225 cases (26.9%) and most of them were gastric ulcer (51.1%). Of gastrointestinal bleeding caused by esophageal varices, most were grade III in 138 cases (49.3%). The incidence of bleeding of bleeding were found more frequently in patients age group of 40 - 60 years (389 cases; 46.5%), > 60 years (305 cases; 36.2%), 60 years, most were caused by ulcer (37.4%). In this study, we also found that cancer as the cause of gastrointestinal bleeding in 26 cases (3.1%). Gastrointestinal cancer comprised of gastric cancer in 15 cases (57.7%), duodenal cancer in 7 cases (26.9%), and esophageal cancer in 4 patients (15.4%). Conclusion: The most frequent cause of upper gastrointestinal bleeding was esophageal varices and usually had reached stage III. The non variceal cause of bleeding was gastric cancer. Upper gastrointestinal malignancy was also found to be the etiology of bleeding in this study. Keywords: upper gastrointestinal bleeding, endoscop
Colorectal Cancer in Young Patient: A Distinguished Disease Entity?
No full textBackground: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients (< 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher’s exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients < 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p < 0.05 was considered as significant. Results: Sixteen young aged (< 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p < 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habits Keywords: Young aged colorectal cancer patients, cross sectional analysis, clinical and histological differenc