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All Journal E-Jurnal Medika Udayana Universa Medicina The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Pamungkas, Kadek Mercu Narapati
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Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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KARAKTERISTIK FUNGSI KELENJAR TIROID PASCA TIROIDEKTOMI TOTAL PADA PASIEN NODUL TIROID DI RSUP SANGLAH Pamungkas, Kadek Mercu Narapati
E-Jurnal Medika Udayana Vol 11 No 1 (2022): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2022.v11.i01.P15

Abstract

ABSTRACT The thyroid nodule is an enlargement because of the impact of TSH stimulation in order to produce thyroxine. The thyroid nodule is a case of benign and malignant neoplasm with a prevalence rate of 5-10%. The thyroid nodule causes obstruction and cosmetic disturbance so that these need thyroid gland surgery or thyroidectomy. Thyroidectomy is categorized into two methods which are partial and total thyroidectomy. After thyroidectomy procedure is performed, it needs subsequent examination post thyroidectomy in order to check the thyroid gland functions (hypothyroid, euthyroid and hyperthyroid). Such examination consists of the examination of TSH and FT4 levels. This study aims to understand the characteristics in terms of age, sex, classification and thyroid gland post total thyroidectomy. This study is of a descriptive research type with cross-sectional design towards thyroid nodule patients in RSUP Sanglah from November 2018 until November 2019. This study uses secondary data in the form of thyroid nodule patients’ medical records to get the characteristics in terms of age, sex, classification and thyroid gland post total thyroidectomy. In this study, it was found that 59 patients’ medical records with highest category which is with the age 50-59 years (30.5%); thyroid nodule cases are suffered more by female patients (84.7%) and was found more to be malignant (59.3%) which the domination of papillary thryroid carcinoma (45.8%). The thyroid gland function characteristics which are with the most cases are hypothyroid (44.1%), as followed by hyperthyroid (37.3%) and euthyroid (18.6%). It can be concluded that the thyroid nodule cases happen most in 50-59 years old with case with more prevalence in female patients. The thyroid nodule is found more to be in malignant classification. The thyroid gland function post thyroidectomy being found to be with most prevelence is hyperthyroid. Keywords : Thyroid nodule, thyroidectomy, thyroid function
Renal Safety of Tenofovir Alafenamide versus Tenofovir Disoproxil Fumarate for the Treatment of Chronic Hepatitis B Patients: An Evidence-based Case Report Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024368

Abstract

ABSTRACTBackground: Treatment modalities for chronic hepatitis B infection (CHB) are interferon and antiviral. The most commonly used antiviral is tenofovir disoproxil fumarate (TDF), however it is known to have nephrotoxicity. Recently, a new antiviral tenofovir alafenamide (TAF) has been developed, which also inhibits hepatitis B virus (HBV). This study aimed to compare the renal safety of TAF and TDF.Method: Literature searching was conducted in PubMed/Medline and Cochrane databases, with modified keywords as “chronic hepatitis B”, “tenofovir alafenamide”, “tenofovir disoproxil fumarate”, “renal” with BOOLEAN logic. The articles obtained will be selected and will be carried out for critical appraisal about validity, importance, and applicability.Results: Four studies of double-blind randomized-clinical trials (RCT) were obtained for analysis. The antiviral effects of TAF and TDF groups were not significantly different. The increase in serum creatinine of TAF group was significantly smaller than TDF group in three studies (p 0.05). While one study showed no significant difference (p = 0.32). The decrease in eGFR (estimated-Glomerular Filtration Rate) in the TAF group was smaller than TDF in three studies (p 0.001), whereas one study found an increase in eGFR in the TAF group (p = 0.00034). There were no severe side effects found in both study groups.Conclusion: Based on the scientific evidence obtained, TAF has more renal safety than TDF. Although the antiviral effect is not significantly different.  Keywords: chronic hepatitis B, tenofovir alafenamide, tenofovir disoproxil fumarate, renal function
Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation Dewi, Ni Nyoman Gita Kharisma; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202427-33

Abstract

BackgroundCirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.Aim of StudyEvaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.MethodWe conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical recordResultOf the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosisConclusionIn addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.
Low albumin-to-creatinine ratio: a novel predictor of 90-day mortality in hepatocellular carcinoma with liver cirrhosis Pamungkas, Kadek Mercu Narapati; Dewi, Putu Itta Sandi Lesmana; Dewi, Ni Luh Putu Yunia; Dewi, Ni Nyoman Gita Kharisma; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
Universa Medicina Vol. 43 No. 3 (2024)
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2024.v43.313-320

Abstract

BackgroundDespite recent advances in the treatments of hepatocellular carcinoma (HCC), the prognosis of HCC patients remains controversial. Lowered serum albumin in hepatocellular carcinoma, an advanced stage of liver cirrhosis, indicates a worsening condition. Hepatorenal syndrome, marked by increased serum creatinine, is a key mortality indicator. The aim of this study was to determine the serum albumin-to-creatinine ratio (sACR) as a predictor of mortality in patients with HCC and liver cirrhosis. MethodsThis retrospective cohort study included 37 patients with HCC and liver cirrhosis. Patient characteristics, sACR, model of end-stage liver disease (MELD) score, and Child-Turcotte-Pugh (CTP) score were obtained from medical records. The optimal cut-off point for the sACR was determined using receiver operating characteristic (ROC) analysis to evaluate its predictive ability for 90-day mortality. Survival analysis was conducted using the Kaplan-Meier method with a log-rank test, and Cox regression was employed to obtain hazard ratios (HR) to estimate the patient’s prognosis. ResultsA low sACR cut-off of 2.32 was identified. Kaplan-Meier analysis confirmed that sACR met the proportional hazard assumption. sACR <2.32 was a significant predictor of 90-day mortality (HR 6.52; 95% CI 1.80-23.63; p=0.004), comparable to MELD 40 (HR 41.3; 95% CI 1.98-862.90; p=0.016) and CTP category (HR =2.19;95%CI: 0.79-6.06;p=0.131). Conclusion The sACR is a novel predictor of 90-day mortality in HCC patients with liver cirrhosis. Lower sACR is associated with overall survival and may help to design strategies to personalize management approaches among patients with HCC and liver cirrhosis.
Hepatic Encephalopathy Scoring Model in Hepatic Cirrhosis Based on Clinical and Laboratory Parameter Pamungkas, Kadek Mercu Narapati; Lesmana Dewi, Putu Itta Sandi; Dewi, Ni Luh Putu Yunia; Kharisma Dewi, Ni Nyoman Gita; Sindhughosa, Dwijo Anargha; Mariadi, Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/253202416-23

Abstract

Background: Hepatic Encephalopathy (HE) is a serious complication with a wide spectrum of clinical symptoms, from minimal changes to profound coma. HE is hard to diagnose without advanced laboratory parameters such as ammoni. This study aims to develop a scoring model to diagnose HE using clinical and laboratory parameters. Methods: An analytical cross-sectional study collected data from 96 hospitalized patients with liver cirrhosis from November 2021 to January 2022. Employing multivariate logistic regression analysis, the study aimed to identify autonomous factors associated with HE. Each significant variable was used to calculate patient probabilities. The score for each variable was computed utilizing the (B/SE)/lowest(B/SE) formula, demonstrating robust discriminatory capability. The scoring model was formulated and evaluated based on its sensitivity and specificity.Results: Nineteen point eight percent, equivalent to ninenteen patients, were admitted with HE. The scoring model was crafted based on nineteen variables. There were four significant variables in this model: Aspartate Aminotransferase (AST) (p=0.01), Total Bilirubin (p=0.007), Fibrosis-4-Index (FIB-4) (p=0.014), and Ascites (p=0.016). Each variable was scored as 1 for AST, -1 for total bilirubin, 1 for FIB-4-index, and 1 for Ascites. The probability was 2%, 14.2%, 57%, 91.4%, and 50%, following the total score of -1, 0, 1, 2, and 3, respectively. The sensitivity and specificity of the scoring model were 68.4% and 85.3%, respectively (AUC=84.7%).Conclusion: Daily laboratory and clinical manifestations related to hepatic cirrhosis could give a clue to diagnosing hepatic encephalopathy. 
Co-Authors Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Putu Itta Sandi Lesmana Dwijo Anargha Sindhughosa, Dwijo Anargha I Ketut Mariadi Kharisma Dewi, Ni Nyoman Gita Lesmana Dewi, Putu Itta Sandi Mariadi, Ketut