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Forns index as a useful noninvasive predictor of esophageal varices in liver cirrhosis Siregar, Rizqi Arini; Dairi, Leonardo Basa; Siregar, Gontar Alamsyah
Universa Medicina Vol 35, No 3 (2016)
Publisher : Faculty of Medicine, Trisakti University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2016.v35.199-205

Abstract

BackgroundRupture and bleeding from esophageal varices are major complications of portal hypertension and associated with a high mortality rate. Non-invasive serum markers of liver fibrosis could be used as predictors of esophageal varices in cirrhotic patients. The objective of this study was to assess the performance of Forns index as a noninvasive predictor in diagnosing esophageal varices.MethodsA cross-sectional study was done in 51 cirrhotic patients who were admitted to Adam Malik hospital, Medan. Demographic and clinical data were recorded and laboratory tests were performed, so that Forns index could be calculated. The difference between Forns index and size of esophageal varices as determined by endoscopy was tested by independent-t and Mann-Whitney analysis. The diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, likelihood ratios and areas under the receiver operating characteristic curves (AUROC). ResultsOf the 51 patients with esophageal varices included in this study, the size of esophageal varices comprised F2 (37.3%), F3 (33.3), and F1 (29.4%). Most patients were of Child-Plug C type (52.6%). There was a significant difference between Forns index and grade of esophageal varices. The AUROC for Forns index was 0.717 (95% CI: 0.561 - 0.872) and the cut-off >7.92 was highly predictive to diagnose large esophageal varices with a sensitivity of 63.9%, specificity of 73.3%, PPV of 85.2%, NPV of 45.8% and accuracy of 71.7%.ConclusionForns index was significantly increased in large esophageal varices. Forns index is a good noninvasive predictor of esophageal varices in cirrhotic patients.
Association Between Degree of Gastritis and Malondialdehyde Level of Gastritis Patients at Adam Malik General Hospital Medan Darmadi Darmadi; Gontar Alamsyah Siregar; Leonardo Basa Dairi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 2 (2017): VOLUME 18, NUMBER 2, AUGUST 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (400.333 KB) | DOI: 10.24871/182201780-85

Abstract

Background: The main pathogenesis of gastritis is inflammation which process can not be separated from the role of free radicals. Malondialdehyde (MDA) is a free radical biomarker and which increases in gastritis patients. However, studies on MDA were generally performed on experimental animals or examined MDA in gastric mucosa. The aim of this study is to determine the association of histopathological degrees of gastritis (the degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia) with plasma MDA level.Method: Cross-sectional study of 40 consecutive gastritis patients who came to endoscopic unit of Adam Malik General Hospital Medan, from January to May 2017. Assessment for the severity of chronic inflammation, neutrophil activity, atrophy, and intestinal metaplasia refers to Updated Sydney System. Plasma MDA levels were examined using an HPLC MDA kit. Univariate and bivariate (Chi-square and fisher exact test) analysis were performed with SPSS version 22.Results: A total of 26 patients (65%) were men with an average age of 49.25 years. Lymphocyte infiltration was observed in 100% of specimens, neutrophil infiltration in 37.5%, atrophy in 22.5%, and intestinal metaplasia in 22.5%. There was a significant association between degree of lymphocyte infiltration with MDA level (p = 0.014; PR = 8.667; 95% CI: 1.52-89.52). There was a significant association between degree of neutrophil activity with high MDA level (p = 0.002; PR = 11.33; 95% CI: 2.64-48.74). There was a significant association between degree of atrophy with high level of MDA (p 0.001; PR = 14; 95% CI: 3.4–57.648). There was a significant association between degree of intestinal metaplasia with high MDA level (p = 0.001; PR = 12.5; 95% CI: 3.76-24).Conclusion: There were significant associations between degree of lymphocyte infiltration, neutrophil activity, atrophy, and intestinal metaplasia with high level of MDA.
The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital Herryanto Lumbantobing; Leonardo Basa Dairi; Juwita Sembiring; Mabel Sihombing; Betthin Marpaung; Sri Maryuni Sutadi; Lukman Hakim Zain
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/121201134-37

Abstract

Background: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study. Keywords: upper gastrointestinal endoscopy, profile, indications, endoscopic diagnosis
The Comparison of Tnf α (Tumor Necrosis Factor α) Serum Levels Between Cytotoxin - Associated Gene A (Caga) Positive and Negative in Patients with Gastritis Helicobacter pylori Fitri Armanti Karo; Leonardo Basa Dairi; Gontar Alamsyah Siregar
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (190.925 KB) | DOI: 10.24871/1832017148-152

Abstract

Background: Helicobacter pylori (H. pylori) infection is the common cause of chronic gastritis in the world that is around 80% in addition to other causes such as autoimmune diseases, drugs, idiopathic and others. The pathogenesis of H. pylori associated with virulence factors consisting of cytotoxin - associated gene A (CagA) and vacuolating cytotoxin A (Vaca). In the case of gastritis occurred acute and chronic inflammatory responses and activation cytokines that cause inflammation of mucous which TNF-α levels increased in patients gatritis H. pylori. Levels of serum TNF-α was found higher in patients infected with H. pylori with CagA positive. The purpose of this study is to investigate the comparison between TNF-α serum level in H. pylori gastritis patients with Cag A (+) and CagA (-).Method: The study was conducted with a cross-sectional design in 30 patients with dyspepsia, using PADYQ score. We performed gastroscopy, biopsy, and CLO test to prove the existence of H. pylori. Furthermore, we used PCR to assess CagA (+) and CagA (-), and ELISA method to measure TNF-α serum level.Results: From 30 subjects, 18 men (60%), 12 women (40%), and the mean age was 53.5 years, the majority of the ethnic was Bataknese  (53.3%), patients with H. pylori gastritis with CagA (+) were 21 (70%) and patients with H. pylori gastritis with CagA (-) were 9 (30%). We found the mean serum levels of TNF-α was higher (3.48) in H. pylori gastritis with CagA (+) than the CagA (-) (1.29) with p value was 0.001.Conclusion: We found increased serum levels of TNF-α in patients with CagA (+) compared to Cag A (-) H. pylori gastritis.
Hubungan Rasio Neutrofil-Limfosit (RNL) dengan Derajat Keparahan Pasien COVID-19 di Rumah Sakit Martha Friska Medan Tahun 2021 Sipahutar, Nathalia Elizabeth Rouli; Dairi, Leonardo Basa; Sibarani, Joseph Partogi; Sihombing, Jenny Ria
Nommensen Journal of Medicine Vol 9 No 1 (2023): Nommensen Journal of Medicine: Edisi Agustus
Publisher : Universitas HKBP Nommensen

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36655/njm.v9i1.688

Abstract

ABSTRACT Background: COVID-19 is a disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which is rapidly transmitted in humans. Systemic inflammation will cause changes in leukocytes in the circulation which can lead to neutrophilia and lymphocytopenia. In COVID-19, the neutrophil-lymphocyte ratio (NLR) can be used as a predictor of disease severity in the early stages. An increase in NLR can reflect an increased inflammatory process and can predict severity. This study aims to determine relationship between NLR and the severity of COVID-19 patients at Martha Friska Hospital Medan in 2021. Methods: The design of this research is observational analytic with cross sectional method. Samples was taken from medical records of COVID-19 patients at Martha Friska Hospital Medan from January-March 2021 with consecutive sampling method and obtained 74 samples. This research was done in November 2021. The analysis of the data processed by the univariate frequency distribution table and the SPSS version 25 program was carried out bivariately using the Chi Square test. Results: From 74 COVID-19 patients, RNL <3.13 obtained 29 people (93%) with mild severity, 2 people (7%) moderate severity and no patients with severe-critical severity. COVID-19 patients with RNL 3.13 is 6 people (14%) with mild severity, 20 people (46%) with moderate severity, 17 people (40%) with severe-critical severity. This study showed there was a relationship between NLR and the severity of COVID-19 patients (p=0.000). Conclusion: There is a relationship between NLR and the severity of COVID-19 patients. Keywords : COVID-19 severity, neutrophil-lymphocyte ratio ABSTRAK Latar Belakang : COVID-19 adalah suatu penyakit yang disebabkan oleh Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) yang bersifat cepat menular sesama manusia. Peradangan yang terjadi secara sistemik dapat menyebabkan perubahan leukosit dalam sirkulasi yang dapat membuat perubahan pada neutrofilia dan limfositopenia. Rasio neutrofil-limfosit (RNL) pada pasien COVID-19 dapat digunakan sebagai prediktor keparahan penyakit pada fase awal infeksi penyakit. RNL yang meningkat dapat diartikan sebagai proses peningkatan inflamasi. Penelitian ini bertujuan untuk mengetahui hubungan antara RNL dengan derajat keparahan pasien COVID-19 di Rumah Sakit Martha Friska Medan tahun 2021. Metode : Penelitian ini memiliki desain analitik observasional dengan metode cross sectional. Sampel penelitian diambil dari data rekam medik pasien COVID-19 di Rumah Sakit Martha Friska Medan dari Januari-Maret 2021 dengan metode consecutive sampling dan didapatkan 74 sampel. Penelitian dilakukan pada bulan November 2021. Analisis data yang diolah dengan tabel distribusi frekuensi secara univariat dan dengan program SPSS versi 25 dilakukan secara bivariat menggunakan uji Chi Square. Hasil : Dari 74 pasien COVID-19, nilai RNL 3,13 didapatkan 29 orang (93%) dengan derajat keparahan ringan, 2 orang (7%) derajat keparahan sedang dan tidak didapatkan pasien dengan derajat keparahan berat-kritis. Pasien COVID-19 dengan RNL 3,13, sebanyak 6 orang (14%) derajat keparahan ringan, 20 orang (46%) dengan derajat keparahan sedang, 17 orang (40%) derajat keparahan berat-kritis. Penelitian ini menunjukkan terdapat hubungan antara RNL dengan derajat keparahan pasien COVID-19 (p=0,000). Kesimpulan : Terdapat hubungan antara RNL dengan derajat keparahan pasien COVID-19. Katakunci : Derajat keparahan COVID-19, rasio neutrofil-limfosit