International Journal of Human Capital Management (IJHCM)
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Acute Cholangitis: An Update in Management Based on Severity Assessment
Full text linkAcute cholangitis (AC) is a biliary tract emergency which causes significant morbidity and mortality. The direct cause of death in AC is sepsis that leads to irreversible shock and multiple organ failure. The most common predisposition are bile duct stones and previous invasive manipulation of the biliary tree. Biliary infection and biliary obstruction are the two main factors in pathophysiology of AC. Gram-negative bacteria are isolated frequently from bile and blood culture in cholangitis. The most common cause of biliary obstruction is gallstone.The Charcot’s triad which commonly has been used to diagnose AC is severely limited and the clinical presentation of the disease has wide spectrum ranging from mild symptoms to severe life-threatening disease. Thus, the use of the most updated Tokyo Guidelines (TG18) is imperative to diagnose the disease and to assess the severity. The TG18 diagnostic criteria is based on the presence of systemic inflammmation, cholestasis, and evidence on imaging studies of biliary tract. The prompt treatment is tailored according to severity assessed by TG18. Initial treatment includes sufficient fluid replacement, hemodynamic control, electrolyte compensation, intravenous antibiotic administration, and intravenous analgesic administration. The definitive treatment which related to the pathophysiology of the disease are biliary drainage and antibiotic administration
Study of the Completion of Follow-up After Helicobacter pylori Eradication Therapy
Full text linkBackground: Because no therapeutic regimens have an eradication rate of 100%, post-treatment evaluation is necessary to ensure that adequate eradication therapy for Helicobacter pylori has been provided. The fact that not all patients are evaluated after eradication therapy is a serious concern for both the medical care system and medical economy.Method: We performed a retrospective study of 411 patients who received first-line H. pylori eradication therapy at Fuyoukai Murakami Hospital from October 1, 2014 to March 31, 2016. We calculated the rate of post-treatment follow-up at 1 year after completing the eradication therapy. In addition, we excluded 76 patients who definitely received post-treatment evaluation because of follow-up appointments with gastroenterologists (n = 29) or return visits to other physicians (n = 47) and included 335 patients in the final study population. We used logistic regression models for identifying the relevant factors contributing to the completion of post-eradication follow-up.Results: The rate of completion of post-eradication follow-up was 78.8% (324/411). Multivariate analysis revealed that the adjusted odds ratios for age (≥ 48 years), gender (female) and preventive measures for gastric cancer (esophagogastroduodenoscopy after radiographic screening for gastric cancer and a desire to be examined for H. pylori infection) were 1.85 [95% confidence interval (CI): 1.11–3.09; p < 0.05], 1.89 [95% CI: 1.07–3.34; p < 0.05] and 4.01 [95% CI: 1.61–10.0; p < 0.01], respectively.Conclusion: Age ≥ 48 years, female gender and preventive measures for gastric cancer were independently related to a higher rate of completion of post-eradication follow-up
Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology
Full text linkBackground: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. Pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p=0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.
Antibiotic Associated Diarrhea in Hospitalized Adult Patients
Full text linkBackground: Antibiotic associated diarrhea (AAD) occurs from the first initiation until 2 months of the end of antibiotic treatment. The aims of this study were to know the incidence of AAD, Clostridium difficile infection and other gastrointestinal symptoms in hospitalized adult patients.Method: The study is a cross sectional study. We studied the antibiotic associated diarrhea (AAD), Clostridium difficile infection and other gastrointestinal symptoms in patients who were admited in Cipto Mangunkusumo Hospital. Inclusion were male or female, age 18-75 years old, Patients started receiving antibiotics maximal 2 x 24 hours prior to hospitalization, gave written informed consent.Results: The incidence of AAD was 11.5%. The incidence of Clostridium difficile infection was 15.4%. The Upper gastrointestinal symptom was present on 20 (38.5%) patients. Lower abdominal symptom was present on 10 (19.2%) patients.Conclusion: The Incidence of AAD and Clostridium difficile infection were 11.5% and 15.4% respectively. The clinical manifestations of AAD were diarrhea, other upper and lower abdominal symptoms.
Advanced Gastric Cancer in a Young Male Patient
Full text linkGastric cancer remains the second most common GI cancer in the world, and is usually found in men, especially those over 50 years of age. Gastric cancer is a multifactorial disease resulting from the interaction between genetic and environmental factors at the stomach mucosa level. The diagnosis is made by endoscopic biopsy. The high frequency of late diagnosis or advanced stages accounts for the overall poor prognosis for this tumor. Surgery is the most frequently employed modality for both cure and palliation. However, most patients present with advanced disease that is incurable.We reported a rare case of young male patient aged 24 years old with advanced gastric adenocarcinoma. The main clinical features were epigastric pain, vomiting, melena and weight loss. An abdominal mass was palpable on physical examination. Endoscopy showed a giant tumor mass causing gastric outlet obstruction, that appear edematous, there were hemorrhagic lesions. The histopathologic examination revealed poorly differentiated adenocarcinoma. Palliative resection could not be performed because the tumor tightly adhered to adjacent structures. Jejunostomy or nasojejunostomy tube were performed to allow enteral nutrition. Best supportive care is very important to improve the quality of life
Dengue Hemorrhagic Fever with Acute Fulminant Hepatitis: A Case Report
No full textDengue virus is estimated to cause over 100 million infections throughout the world annually. Although dengue infections can have a wide range of clinical pictures, atypical manifestations have been described recent years. The liver is a susceptible organ affected in dengue infection. Mild liver dysfunction is common in cases of dengue infection but severe liver function impairment and even encephalopathy are rare. The following is a case report of dengue hemorrhagic fever (DHF) with acute fulminant hepatitis. A 43-year-old woman has fulminant hepatitis on day 3 of treatment. Her AST level increased dramatically from 363 U/L to 3,246 U/L. The causes of other hepatitis infection has been excluded. Her dengue IgM-antibody level was reactive. Level of dengue IgM antibody reactive. Clinical improvement experienced by patient after supportive therapy and administration glisirizin or Stronger Neo-Minophagen-C (SNMC)
Long Term Risks of Proton Pump Inhibitor Administration: A Literature Review
No full textProton pump inhibitor (PPI) has become drug of choice for acid related disease. However, PPI tend to be overprescribed and becoming one of the highest burden for health cost. Some studies showed that PPI are prescribed unnecessarily. Recent evidences showed raised concerns over long term effects of PPI consumption. Several long term side effects such as increased incidence of gastric polyps, micronutrient absorption disorders, infections, and osteoporosis have been yearly discussed. In recent years there has been increased attention to new side effects such as dementia, chronic renal failure, and cardiovascular disorders. Therefore, some health associations had issued warning and guidance regarding long term PPI prescription
Artificial Ascites in Radiofrequency Ablation for Liver Cancer
Full text linkBackground: Radio Frequency Ablation (RFA) is one of the treatment modality for liver tumor either as primary tumor as well as secondary malignancy. Occasionally, a good ablation can’t be performed due to the tumor location. To assists the ablation in this particular case, some fluid can be deposited inside the abdomen which is called as artificial ascites. The aim of this study is to report and evaluate the method of artificial ascites in RFAMethod: This was a case series study consist of 19 consecutive patients that had been treated with ultrasound-guided RFA using artificial ascites from 2014 to 2017.Results: Artificial ascites was successfully performed in all 19 patients (100%) with total of 53 hepatocellular carcinoma (HCC) lesions in 34 RFA’s sessions and tumor size ranges from 10mm to 50mm. Most of the tumors were primary tumor (14/19). 9 patients had single tumor and 10 patients had multiple tumors and most of the tumor were located in segment 5 (14/53). Artificial ascites was performed using 5% dextrose in water (D/W) solution ranging from 500ml to 1500ml. No adverse effect occurred during and after the procedure.Conclusion: Percutaneous RFA using artificial ascites technique was safe and effective for treating HCC
Prevalence of Gastroesophageal Reflux Disease (GERD) in Dyspepsia Patients in Primary Referral Hospital
Full text linkABSTRACTBackground: Gastroesophageal reflux disease (GERD) is caused by reflux of stomach contents into the esophagus and give the typical symptoms as heartburn. The prevalence of GERD was vary around the world. Prevalence of GERD by endoscopy in Jakarta was 22.8%. Limited data exist to determine the prevalence and related factors of gastroesophageal reflux disease (GERD) in the population without alarm symptoms. Validated GERDq questionnaire can be used easily to diagnose GERD in primary health care. This study aims to know the prevalence of GERD and related factors.Method: This cross-sectional study was conducted in adult dyspepsia patients at General Hospital District of Cilincing from January to March 2016. A validated GERDq questionnaire and a single proportion sample size calculation were used. Results: The prevalence of GERD was 49%, in elderly participants the prevalence was 44%. Of the 104 consecutive participants, 33.7% were male and 66.3% were female. The mean age was 47.6 ± 15.4 years old. The rate of GERD was higher in females than in males (53 vs. 40%, p = 0.189), increased as the age of the participants increased (p = 0.059) and also increased as the body mass index (BMI) of the participants increased (p > 0.05). GERD was present in 50% of active or former smokers (p > 0.05), 33.3% of daily coffee drinkers (p > 0.05), 56.2% of active or former alcohol consumers (p > 0.05), and 57.4% of daily tea drinkers (p = 0.049).Conclusion: The prevalence of GERD in dyspeptic patient was still high. There is a relation between GERD and tea consumption.Keywords: gastroesophageal reflux disease (GERD), dyspepsia, GERDq questionnair
Correlation Between TNF- α and Degree of Gastritis
Full text linkBackground: TNF- α is a cytokine that plays an active role in the pathogenesis of gastritis. The correlation of TNF-α levels in the gastric mucosa with the severity of gastritis has long been known. However, few studies have assessed TNF-α levels in serum of gastritis patients. This study aims to evaluate correlation between serum TNF-α level with the degree of gastritis based on histopathology.Method: A cross sectional study on eighty gastritis patients that fulfilled the inclusion criteria underwent serum TNF-α examination, endoscopy, and biopsy. Rapid urease test was used for diagnosis of H. pylori infection. The severity of gastritis based on lymphocyte infiltration, neutrophil infiltration, atrophy, and intestinal metaplasia according to Updated Sydney System. Univariate and bivariate analysis (Chi-square, fisher's exact, spearman correlation, and independent T-test) were done using SPSS version 22.Results: There were 41.25% patients infected with Helicobacter pylori. Serum TNF-α levels in the infected group were significantly higher compared to negative H. pylori (p < 0.05). There was significant positive correlation between serum TNF-α levels and degree of gastritis based on lymphocyte infiltration (r = 0.333; p = 0.003).Conclusion: There was a significant positive correlation between serum TNF-α level with the severity of gastritis based on lymphocyte infiltration