International Journal of Human Capital Management (IJHCM)
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Diseases in Chronic Non-infective Diarrhea
No full textBackground: Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea. Methods: We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray. Result: Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn’s disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc. Conclusion: The most frequent abnormality found in chronic non-infective diarrhea was maldigestion. Keywords: Chronic diarrhea, non-infectiv
The Role of Specific Cellular Immune System in Chronic Hepatitis C
No full textHepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune respons
A Comparison of Efficacy between Rebamipide and Omeprazole in the Treatment of NSAIDs Gastropathy
No full textBackground: Gastropathy represent a disparity of gastric mucosal characterized by sub-epithelial bleeding and erosion. Gastropathy can be induced by non steroidal anti-inflammatory drugs (NSAIDs), alcohol, stressor, and chemical agents with various sign and symptoms. NSAIDs-induced gastropathy is the second most common etiology of gastric ulcer and variceal haemorrhages. Aims: To investigate the effectivity of rebamipide compare with omeprazole in treatment of NSAIDs- induced gastropathy. Method: This triple blind randomized study was enrolled from January to June 2004 with 38 subjects who were recruited from outpatient and inpatient clinic in M Hoesin Hospital in Palembang. Subject was divided into two groups. Endoscopic examination was performed in every patients. Results: There was an improvement of symptom in rebamipide group (78.9%) and omeprazole group (79.0%) after treatment but it didn’t have significant difference statistically. Improvement of NSAIDs induced gastropathy after treatment between two groups have significant difference (P = 0.02), and improvement of gradation of gastropathy after treatment has significant difference (P = 0.007).There was no side effect of administration of rebamipide and omeprazole in each group. Conclusion: Rebamipide as effective as omeprazole in improvement of symptom. Omeprazole is more effective than rebamipide in improvement of NSAIDs induced gastropathy and is as safe as rebamipide in the treatment of NSAIDs induced gastropathy. Keywords: Gastropathy, NSAIDs, rebamipide, omeprazol
Prolonged QTc-Interval in Liver Cirrhotic Patient: Prevalence and Its Relationship with Severity of Liver Dysfunction
No full textBackground: The aim of the study was to determine the prevalence of prolonged QTc -interval and it’s relationship with the severity of liver dysfunction in liver cirrhotic patient in the outpatient clinic of Hepatology, Dr. Cipto Mangunkusumo General National Hospital Methods: cross sectional study. Eighty one subjects was recruited and being followed as a consecutive non random sampling. The patient was divided according to the modified Child-Pugh classification and undergo to the ECG examination (with minimal 2 leads have measured QT-interval; one of these is II, aVL, V2 or V3 lead). Result: The prolonged QTc-interval prevalence in liver cirrhotic patient was found in 55 subjects (67,9%) with the mean 448.6 msec (SD = 28,9; 95% CI = 442.2 - 454.8). Using the Forward Stepwise Method in multivariate analysis to the independent variables (p < 0.05) was found only the modified Child-Pugh classification had strongly correlation with the prolonged QTc-interval (OR = 11.2; 95% CI = 3.57-35.47; p = 0.000) Conclusion: The prolonged QTc-interval prevalence in liver cirrhotic patient is 67.9%. The prolonged QTc-interval were strongly associated with the severity of liver dysfunction. Keywords: The prolonged QTc-interval, liver dysfunction, liver cirrhosi
Irritable Bowel Syndrome: Diagnosis and Treatment
No full textIrritable bowel syndrome (IBS) is the most common functional disorder of the gastrointestinal tract. As a result of the lack of specific diagnostic testing and absence of circumscribed biology markers of the disease, its diagnosis is based on a myriad of symptoms. The term irritable bowel syndrome was probably first coined in 1944 by Peters and Bargen. In 1849, Cumming described the clinical manifestations of Irritable Bowel Syndrome. Irritable bowel syndrome is defined on the basis of the recently modified Rome criteria as the presence of at least 12 weeks (not necessarily consecutive) of abdominal discomfort or pain in the preceding 12 months that cannot be explained by structural or biochemical abnormalities, and that has at least two of the following three features: pain relieved with defecation, an onset associated with a change in the frequency of bowel movements (diarrhea or constipation), or an onset associated with a change in form of stool (loose, watery, or pellet-like). The syndrome can be divided into three subcategories according to the Modified Rome criteria II; those with a predominant symptom of diarrhea, constipation, or constipation alternating with diarrhea. There are several criteria for irritable bowel syndrome, one of which is the Manning criteria, applied in many epidemiological and clinical studies to identify irritable bowel syndrome. However, many investigators disagree with this criteria due to a seemingly poor validity in men. In an attempt to bring order to the specialty, consensus-based approach is adopted by a group of international experts, which led to the development of the Rome criteria for irritable bowel syndrome (Table 1). Extra-intestinal symptoms, including headache, backache, urinary and gynecologic symptoms, and fatigue, are more common in the constipation-predominant subgroup
Impact of Low Fiber Diet on Gastrointestinal Disorders
No full textFiber is not digested or absorbed in the small intestine. The main site of action of fiber is in the colon. In the colon, fiber will increase stool output and frequency, increase stool water, dilute the colonic content, reduce the toxins, bile acid, increase colonic fermentation and also stimulate probiotic growth. Some meta-analysis of observational epidemiologic and case control studies have found a protective effect of dietary fiber against colon cancer that increase with intake. Therefore, the high fiber diet is healthy recommendation to prevent various gastrointestinal disorders. Keywords: dietary fiber - colon cancer - constipatio
The Role of Sclerotherapy in Children
No full textIntroduction: Endoscopic sclerotherapy to control variceal bleeding in adults has been proven to be useful. Complications from this procedure that have been reported include esophageal stricture, perforation, mediastinitis and recurrent bleeding. This procedure has increasingly been used in pediatric patients, thus increasing the incidence of its complications. The purpose of this study: To report the effect of sclerotherapy in variceal bleeding Method: All patients that underwent sclerotherapy since 1989 were included in the study and were followed up until December 1999. We recorded the frequency of injections, recurrent bleeding, and gastropathy. Results: During the last ten years, we have used sclerotherapy in 26 patients. The varices were secondary to intrahepatic portal hypertension. The average age at initial sclerotherapy was 7 years (ranging from 1-12 years). Two patients died following initial sclerotherapy. Nine patients could not be followed up and 17 patients were under monitoring for 2-10 years. Four patients died after 2-8 years of follow up due to the underlying diseases. Complete obliteration of all varices was obtained in 12 cases, minimal residual varices in four and 1 case was unfavorable for injection. Six patients (35.3%) suffered from recurrent bleeding; 4 patients had minimal residual varices (1 year follow up), and 2 patients had complete obliteration (3 years follow up). Gastropathy was found in 6 patients after 12 to 32 sessions of injection. Complications such as perforation or stricture were not found. Conclusions: Sclerotherapy is a very useful technique to control variceal bleeding in children. We found recurrent bleeding and gastropathy in 35.3% patients. Other complications were not found. Keywords: Sclerotherapy, children, endoscopy varices esophagu
A Randomized Trial Comparing The Effect of Soy Protein Diet Supplement Versus Hospital Standard Supplement on Clinical and Laboratory Parameters in Malnutrition Patients
No full textBackground: Studies have shown that soy protein diet may improve clinical nutrition status of malnutrition patients. Soybeans itself are unique foods because of their rich nutrient content. The complete nutrient in soybean is important and also offers many health benefits especially in malnutrition patient during hospitalization. Objective: The objective of this study was to assess the effect of soy protein supplement and hospital standard supplement (animal protein) on anthropometries and laboratory findings in malnutrition patients during hospitalization. Method: Forty-eight patients with malnutrition (confirmed by Body Mass Index < 20 kg/m2) aged 14- 70 years old were recruited from Internal Medicine wards in Cipto Mangunkusumo hospital, Jakarta, Indonesia. The study design was randomized controlled trial. The subjects were randomly divided into 2 groups were fed supplement diet contained soy protein supplement diet (40 g/d) or hospital standard supplement (40 g/d) for 2 weeks. Body weight was measured in the first day (base line data), 7-dayand 14-day after intervention. Blood and urine was collected at baseline, 7-day and 14-day for measuring transferin, prealbumin and nitrogen balance. The intake of supplement, gastrointestinal symptoms and others adverse event were noted every day. Result: From 48 subjects, there were only 32 patients that completed the study during 2 weeks. In the base line data there were no significant different for intake diet calculation, anthropometrics and laboratory parameters in study group and control group. A total of patients 32 consist of 20 (62,5 %) female and 12 (37,5%) male with a mean age 31,8 + 12,9 years old. Anthropometrics evaluation after 1 week and 2 weeks intervention in soy protein supplement showed significantly increased every week in 2 weeks. In control group, significantly increased showed only after two weeks intervention. But there was no significantly increased of BMI of two groups. Serum transferin concentration increased from 1,489 ± 0,502 at base line to be 1,600 ± 0,502 at week 1 and to bel, 695 ± 0,402 in study group. But this increasing was no significantly between two groups. No significant differences were found between two groups for prealbumin level after 1 week and 2 weeks intervention. Nitrogen balance improved significantly (p<0,05) more with soy protein supplement than hospital standard supplement (animal protein). In this study, there was no side effect in soy protein supplement diet and 1 case with diarrhea and nausea in hospital standard supplement (animal protein) Conclusion: Soy protein supplement diet improved both of nutrition parameter: anthropometrics and laboratory parameter. There were no significantly different in anthrometrics and laboratory parameter berween soy protein supplements tahan hospital standar supplement (animal protein). But nitrogen balance improved significantly in study group than control group. Substitution of soy protein for animal protein has the potential role for the patient with malnutrition Keywords: Soy protein diet, Malnutritio
Clinical Approach to Chronic Pancreratitis
No full textChronic pancreatitis is still considered an uncertain process with an undetermined pathogenesis and ill defined treatment. Chronic pancreatitis is distinguished from acute pancreatitis based on structural and functional differences. In acute pancreatitis, the gland is normal prior to the attack, and returns to normal after an acute attack, while in chronic pancreatitis, the gland is already in an abnormal state prior to or following an attack or prior to and following an acute attack. The most common local complication of chronic pancreatitis is the formation of pseudocysts. Psedocysts are usually formed due to passage obstruction of the pancreatic tract (retention cyst) or due to recurrent acute exacerbation Several pancreatic abnormalities, such as stones, ductal stricture, fluid collection, and functional sphincter abnormality, could be treated using endoscopy. Adjuvant treatment for biliary duct abnormality such as biliary stricture due to pancreatitis, and stent insertion in cases of duodenal obstruction, could also be performed via endoscopy Keywords: Chronic pancreratitis, tropical pancreatitis, treatmen
Abnormalities of the Small Bowel in Chronic Non-Infective Diarrhea: A Histopathological Study
No full textBackground: The incidence of chronic non-infectious diarrhea cases is increasing in line with the developments of medical technology and science. The objective of this study was to uncover the histopathologic abnormalities of the small bowel in cases of chronic non-infectious diarrhea. Methods: All chronic non-infectious diarrhea patients in Cipto Mangunkusumo Hospital from 1996 until 2000 were included in this study. For the control group, we used 37 endoscopically-normal patients with functional dyspepia with the same characteristics (sex and age). All of the patients underwent gastroduodeno-jejunoscopic and ileocolonoscopic examinations. Patients with infection were excluded from this study. Biopsies were taken from the duodenal bulb, descending duodenum, jejunum near the Treitz ligament, terminal ileum, and colon. Histopathological tests were performed on all of the biopsies. Result: Histopathological examination was carried out on 31 patients and 37 control patients. In the duodenal bulb, the width of villi, lymphocyte infiltration, eosinophil infiltration, stage of inflammation, and polymorphonuclear cells infiltration were all lower in the chronic non-infectious diarrhea group than in the control group (p < 0.01). In the descending part of duodenum and jejunum, lymphocyte infiltration, the stage of inflammation, and polymorphonuclear cell infiltration were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Within the terminal ileum, lymphocyte infiltration, the stage of inflammation and lymphoid follicle hyperplasia were found to be higher in the chronic non-infectious diarrhea group than in the control group (p< 0.01). Conclusion: Histopathologically, increased lymphocyte infiltration, inflammation and lymphoid follicle hyperplasia were discovered in specified areas of small intestine in chronic non-infectious diarrhea patients. Keywords: Histopathological examination, chronic non-infectious diarrhea, lymphocyte infiltration, mucosal inflammation, lymphoid follicle hyperplasi