International Journal of Human Capital Management (IJHCM)
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Alterations in Blood Ammonium Level and Psychometric Test in Patients with Liver Cirrhosis after a Tempe Diet
No full textBackground: Hepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non- ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion. Study aim: To determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet). Method: This is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group is given a tempe diet, while the second (control) group is given liver diet II/III (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT). Results: In the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories. Conclusion: A 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test. Keywords: lever cirrhosis, hepatic encephalopathy, tempe diet, numeric connection test, child-pugh criteri
The Efficacy of Trimethoprim-sulfamethoxazole Compared to Ciprofloxacin in The Treatment of Spontaneous Bacterial Peritonitis in Cirrhotic Patients with Ascites
No full textBackground: The incidence of spontaneous bacterial peritonitis (SBP) is 7 to 23%, and the associated mortality rate is 25 to 40% (Rimola 1992). The aim of this study was to evaluate the efficacy of trimethoprim-sulfamethoxazole compared to ciprofloxacin in the treatment of SBP in cirrhotic patients with ascites. Materials and Method: This prospective randomized double blind study included 43 cirrhotic patients with ascites (25 males, 18 females, ages 23-75 years, one female patient died prior to laboratory evaluation) enrolled between May 1999 and June 2000, at the Department of Internal Medicine of Mohammad Hoesin General Hospital /the Medical Faculty of Sriwijaya University of Palembang, South Sumatera. Twenty-three patients (53.4%) with SBP were eligible for the study, all were randomized. Patients were divided into 2 groups (13 in group I, and 10 in group II), those receiving trimethoprim- sulfamethoxazole 960 mg once daily for 10 days and those receiving ciprofloxacin 1000 mg once daily for 10 days. Statistically, there was no significant difference in the characteristics of the 2 groups. Results: The incidence of SBP in our study was 53.4% (23 patients out of 43 cirrhotic patients with ascites). The Results of the study demonstrate that trimethoprim-sulfamethoxazole and ciprofloxacin are both effective (91.6% and 90%) in the treatment of SBP. There was a significant decrease in ascitic fluid PMN count after 10 days treatment with both of the drugs (p=0.001 and p=0.000). There was no statistically significant difference (t-test) between the two groups in decreasing the ascitic fluid PMN count after the treatment (p=0.664). Conclusion: Trimethoprim-sulfamethoxazole and ciprofloxacin has similar efficacy in the treatment of spontaneous bacterial peritonitis in cirrhotic patients with ascites. Keyword: Trimethoprim-sulfamethoxazole, ciprofloxacin, spontaneous bacterial peritonitis
Primary Lymphoma of The Gastrointestinal Tract
No full textChronic hepatitis due to hepatitis B virus (HBV) or hepatitis C virus (HCV) is still a major problem in terms of progressive liver damage, prevention and therapy in most parts of the world. Unfortunately, to date, there is still no specific and effective therapy for HBV. No therapy can be given to carrier, non- replicative and asymptomatic patients of chronic HBV infection. Lamivudine or alpha-interferon can be used for treatment of compensated, chronic hepatitis B infection with significant increase of aminotransferase. Approximately 40 % of patients can have seroconversion with this form of therapy. Chronic hepatitis D virus infection can be treat with alpha-interferon and in the final stage, may undergo liver transplantation. For chronic hepatitis C virus infection, alpha-interferon with ribavirin have been shown to have a better efficacy than alpha-interferon alone where the efficacy can reach 39 – 49 %. Keywords: hepatitis, interferon, lamivudin,ribaviri
Study of Transaminases in Heroin Addicts
No full textA recent increase in the number of drug users particularly of heroin has been noted in the community. A cross-sectional study on the level of transaminases as a representation of liver damage in drug users was done in privated hospital in Jakarta. Exclusion criteria were fever, serious illness or the multiple use of addictive drugs based on a urinary test. The hepatitis B surface antigen (HBsAg) was examined using reverse passive hemaglutination assay (RPHA) and the antibody of hepatitis C virus core-protein (anti- HCV) with dipstick anti-HCV. AST and ALT levels were determined using an automatic chemical analyzer. Of 132 patients who fulfill the criteria, 83.5 % were injection drug users (IDU). Means AST and ALT were significantly higher in IDU. Anti-HCV positive patients with increased AST and ALT were significantly higher compared to anti-HCV negative. The increase of transaminase was also consistent in injection drug users although no viral marker could be detected. In conclusion, the examination of transaminases in drug users especially IDU is important besides tests for hepatitis viral markers because there is often an increase with or without viral infection and this can be associated with hepatocellular damage. Key words: Transaminase, heroin addicts, hepatiti
Non-Surgical Biliary Drainage on Biliary Obstruction due to Malignancy
No full textSurgery is still the golden standard of curative therapy for malignant biliary obstruction, but only 10- 20% of cases considered resectable. Therefore, palliative therapy to relieve pain, cholestasis, and biliary obstruction, is the main treatment for most patients. The development of percutaneous transhepatic biliary drainage and endoscopic biliary drainage had brought about minimally invasive treatment for malignant biliary obstruction, which had lower morbidity and mortality than surgical drainage. The choice of drainage technique depends on type of tumor, site of obstruction, also the available expert and instrumentation. Keywords: malignant biliary obstruction, percutaneous transhepatic biliary drainage, therapeutic endoscopic retrograde cholangiopancreatograph
Colonic Tuberculosis and Chronic Diarrhea
No full textWe describe that often colonic tuberculosis remains unsuspected prior to surgery. We therefore draw attention to pitfalls in the diagnosis and review the literature on the diagnostic modalities available to diagnose the disease. Today, the prompt diagnosis of an unknown gastroenteritis process involves colonoscopy. Using a fiberscope, a procedure with instantaneous return can be carried out. Patients with clinical presentation suggestive of colonic tuberculosis should have had either an aggressive diagnostic work out using high-yield tests or anti tuberculosis therapy. Key words: Colonic tuberculosis, chronic diarrhea, colonoscop
The Role of Gastric Acidity and Lower Esophageal Sphincter Tone on Esophagitis in Patients with Dyspepsia
No full textBackground: Esophagitis implies an organic damage of the esophagus due to several pathophysiologic factors, predominantly: (1) degree of gastric acid secretion (gastric pH), whereabouts are rapidly or slowly to be mucosal breaks onto esophagus were under the influenced by: (a) gastric pH £ 4 and (b) the contact of gastric acid into esophageal mucosal. (2) Lower esophageal sphincter (LES) as a important factor for antireflux mechanisms, which antireflux mechanism cannot serve as a barrier system whenever tone of LES comes down until £ 10 mmHg that causes feeble resting LES pressure. Esophageal injuries are recognized endoscopically by the presence of the Savary-Miller’s classification (1985), but there are not definitely which ones principally to pathophysiologic factor.Methods: This was a consecutive non-random sampling cross sectional study. Thirty subject from 127 patients with dyspepsia undergoing elective upper-endoscopic examination with collecting of the gastric juice and biopsies of lower esophageal mucosal, also esophageal manometric examination. Before that, clinical inclusive and exclusive criterias until laboratory examination were performed. Significant interval was 95%. Analyzing data with Fisher’s Exact Test One-Tail to correlate between gastric pH and hypotonic LES into esophagitis. Results: Esophagitis prevalence was 22.8%. Fisher’s Exact Test One-Tail to correlate esophagitis with gastric pH £ 4 was significant (p=0.013798), but with hypotonic LES (tones of LES £ 10 mmHg) was not (p=0.60269). The combined roles of gastric pH and tones of LES into esophagitis are included: (1) Frequency of roles of pH £ 4 and hypotonic LES are 48.2%. (2) Frequency of role of pH £ 4 without hypotonic of LES are 33.3%. (3) Frequency of role of hypotonic LES without pH £ 4 are 11.1% and (4) Frequency of esophagitis without roles of pH £ 4 and hypotonic of LES are 7.4%. Conclusions: The sum of gastric pH £ 4 and hypotonic of LES together are more than each separate factor. Onto statistically was significant between esophagitis and gastric pH, but there is no correlation with tones of LES. So, gastric pH plays a more important role than LES. Key words: gastric pH, tones of LES, roles of pH and tones of LES, esophagiti