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CORRELATION BETWEEN CHILD PUGH SCORE AND CYSTATIN C IN LIVER CIRRHOSIS PATIENTS Deshinta Putri Mulya; Siti Nurdjanah; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 1, No 1 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1746.805 KB) | DOI: 10.22146/acta interna.3860

Abstract

ABSTRACTBackground. Renal dysfunction is a serious problem and it provides a poor prognosis for patients with advanced liver cirrhosis, where this condition can progress to kidney failure. This condition is known as hepatorenal syndrome. Cystatin C utilization as a marker of decreased kidney function in patients with liver cirrhosis has been widely proven. Data on how far the severity of liver cirrhosis can affect the decline in renal function has not been widely known. Objective. This study aimed is to verify correlation between the severity degree of the liver (Child Pugh/CP score) with levels of Cystatin C serum. Methods. This study was a cross sectional study. Population studied were patients with liver cirrhosis who visited the clinic of Gastroentero-hepatology and treated in the department of Internal Medicine ward Dr. Sardjito Hospital - Yogyakarta during October 2009 - March 2010. Data were analyzed with a computer; the analyzed of the CP score correlation with increased levels of Cystatin C using Spearman correlation for data not normally distributed. Result. We found 48 research subjects during the month of October 2009 - March 2010. The subjects were 35 male (72.9%) and 13 female (27.1%) with average age 53.1 ± 11.9 years old. Subjects with CP-A were 9 patients (18.8%), CP-B were 14 patients (29.2%) and CP-C were 25 patients (52.1%). The range value of Cystatin C between CP class shows CP-A  0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 – 2.49 mg/L (statistically significant difference with p <0.05). Liver cirrhosis patients who had Cystatin C levels <0.96 mg/L were 22 patients (45.83%) and 26 patients (54.1%), had higher levels of Cystatin C> 0.96 mg/L. Child score was positively correlated to increased levels of Cystatin C (p= 0.000; r= 0.566) linear regression equation with Cystatin was = 0.37 + 0.08 * Child score (r square 0.32). Conclusion. This study concluded that the Child score had a moderate positive correlation with Cystatin C serum level.  Key words: Liver Cirrhosis – Child Pugh score - Cystatin C 
CORRELATION BETWEEN CYSTATIN C TO SEVERITY DISEASE OF CIRRHOSIS BASED ON MODEL OF END STAGE LIVER DISEASE SCORE Heribertus Gunadi; Putut Bayupurnama; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (853.846 KB) | DOI: 10.22146/acta interna.3864

Abstract

ABSTRACTBackground:    Cirrhosis patients  with renal failure  are  at   high   risk  for   death   and  reduced survival   as   compared   with   those   without   renal failure,  and have poor prognosis.  Some studies  have suggested   that  cystatin  C did  more  accurate   than creatinine /0  detect glomerulusfiltration    rate (GFR) in patients  with cirrhosis.  Model  of End Stage  Liver Disease  (MELD)  score  can be used in patients  with cirrhosis  with variously  Widely severity  disease  and etiologies.  Until nmv, there is no study about correlation  between  levels  of cystatin  C to disease severity  in cirrhosis based on MELD score.Objective:  This present  study  was to investigate  the correlation  between levels of cyst at ill C with disease severity  in cirrhosis  based on MELD score.Method:   Study  design  was cross sectional s t u d y,     This      study       was     conducted          at Gastoenterohepatology         outpatient     clinic    and Internal Medicine  ward of Dr Sardjito  General Hospital,     Yogyakarta.    Inclusion     criteria     were patients    with    cirrhosis    diagnosed     by   clinical criteria,  laboratory   and  USG.findillg,   age   >  18 years,   had  complete  medical  record  and  obtained informed consent. Exclusion criteria were chronic kidney  disease,  sepsis,  hepatocellutare   carcinoma, used high doses  of steroid,  had thyroid dysfunction. hypertension  and diabetes mellitus.Result:   The  mean  of cystatin   C based  on categorical    MELD    score   were   MELD    <10   = 0.93±0.19   mgll;   MELD    IO-19=1.08±0.26    mg/l; MELD  20-29   =  1.25±O.27 mgll;  MELD  30-39   = 2.49 mg/l and  MELD  >40  = 2.43 mgll;  0)=0.013; 95%   CI  0.000-0.061).     There   was   a  significant correlation   between  cystatin  C to MELD  score  as demonstrated   byp=O.OOOand r=0.485.Conclusion:     Our  data  suggested    a significant     correlation     with   medium    strength between cystatin  C to severity  disease  of cirrhosis based 011 MELD score. Keywords:  cirrhosis,  cystatin  C, MELD score  
Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention Suharjo Broto Cahyono; Neneng Rasari Neneng Rasari; Putut Bayupurnama; Sutanto Maduseno; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (221.941 KB) | DOI: 10.22146/acta interna.5351

Abstract

ABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogues
Evaluating Indications and Diagnostic Yield of Colonoscopy in Sardjito General Hospital Suharjo Broto Cahyono; Putut Bayupurnama; Neneng Ratnasari; Catharina Triwikatmani; Fahmi Indrarti; Sutanto Maduseno; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 4, No 2 (2014): The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (161.006 KB) | DOI: 10.22146/acta interna.16956

Abstract

ABSTRACTBackground: Colonoscopy is the gold standard procedure which is widely used in the diagnosis and treatment of colonic mucosal disorder. Inappropriate colonoscopy indications increase rate of complications.Aim: The main aims of our study were to evaluate indications, fi ndings and diagnostic yield at colonoscopy.Methods: A retrospective study of all colonoscopy was conducted from January 2012 through August 2013, at Dr. Sardjito General Hospital, Yogyakarta and there were 688 colonoscopy reports. Seven colonoscopy indications were documented and presented: rectal bleeding or hematochezia, chronic diarrhea, abdominal pain, constipation, screening and surveillance for colonic neoplasia, change in bowel habit and anemia. Diagnostic yield was defi ned as the ratio between signifi cant fi ndings detected on colonoscopy and the total number of procedures performed for the indication. In our study, diagnostic yield was established by colonoscopy, not confirmed by biopsy.Results: Overall diagnostic yield was 72.53%. The leading indication for colonoscopies was rectal bleeding or hematochezia (36.19%), followed by chronic diarrhea (23.11%), abdominal pain (14.09%), constipation (13.37%), screening and surveillance (5.66%), change in bowel habit (5.52%) and anemia (2.02%). Diagnostic yields according colonoscopies examination were normal (37.14%), colorectal cancer (19.33%), proctitis (14.24%), infl ammatory bowel disease (12.50%), polyps (11.19%),hemorrhoid (10.03%), and diverticel(3.78%). Colorectal cancers were found in patients with hematochezia (74 patients, 29.71%), chronic diarrhea (34 patients, 21.38%), constipation (13 patients, 14.13%). Of 249 patients presenting with hematochezia were found colorectal cancer (74 patients), hemorrhoid (50 patients), proctitis (30 patients), normal (30 patients). Our study showed that diagnostic yield was far lower in patients below 50 years (38.48%) compared > 50 years (61.52%), especially for colorectal cancer (p < 0.001), polyps (p = 0.004) and diverticular (p < 0.001).Conclusions: Hematochezia was the leading indication for colonoscopy and the diagnostic yield was 72.53%. The leading of colonoscopy fi ndings were normal colonoscopies, followed by colorectal cancer, proctitis,infl ammatory bowel disease, polyps and diverticel. Colonoscopy indications should be based on the available guidelines to minimize as much as possible the number inappropriate procedures and complications.Keywords: Colonoscopy, diagnostic yield, colonic indications, appropriateness of colonoscopy
Maximum Tolerated Volume in Nutrient Drinking Test for Diagnosis of Functional Dyspepsia Suharjo Broto Cahyono; Neneng Ratnasari; Putut Bayupurnama; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 5, No 1 (2015): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (153.71 KB) | DOI: 10.22146/acta interna.22384

Abstract

Background. Methods to evaluate pathophysiology of functional dyspepsia (FD) such as barostat are invasive, expensive and not readily available. Nutrient drink test was developed as noninvasive, safe and low cost means to assess impaired gastric accommodation in FD patients. The aim of this study is to evaluate whether this test could be used for diagnostic tool for FD patients.Method. A cross sectional study was conducted from July 2014 to December 2014, at Sardjito General Hospital, Yogyakarta, Indonesia. Twenty FD patients (according Rome III criteria with normal gastroscopy) were matched by age, gender and body mass index with 20 healthy controls. All of FD patient and healthy controls ingested nutrient drink tests (UltraMilk contain 0.6 kcal /mL). Maximum tolerated volume (MTV) of each subject was recorded. Sensitivity, specifi city, positive predictive value (PPV) and negative predictive value (NPV) were analyzed.Results. Using ≤ 950 mL of maximum tolerated volume as cut off point, sensitivity, specificity, PPV and NPV were 95%, 100%, 100% and 95%.Conclusions. A nutrient drinking test can discriminate between FD patients and healthy controls with high sensitivity and specifi city. This test could be used as objective, safe and non-invasive diagnostic tool for FD patients.
Relationship between the MELD score with severity erectile dysfunction in cirrhotic patients Doddy Afprianto; Siti Nurdjanah; Muhammad Robikhul Ikhsan
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (279.328 KB) | DOI: 10.22146/actainterna.48160

Abstract

Background. Liver cirrhosis is a pathological condition that describes the end stage of hepatic fibrotic which progressively ongoing that signed by distortion from hepar architecture and the formation of the regenerative modulus. Liver cirrhosis causes impairment in most of the liver function including the hormonal balance and metabolism of steroids. In the male patients, liver cirrhosis causes hypogonadism and feminization. Sexual dysfunction in cirrhotic patients is still underestimated and underdiagnosed. The most common sexual dysfunction in male cirrhotic patients is impotence or erectile dysfunction. Erectile dysfunction (ED) is define as a persistence inability to reach and/ or maintain enough erection to satisfy the sexual activity. International Index of Erectile Function 5/IIEF-5 could mark erectile dysfunction. Despite the prevalence of erectile dysfunction is high in patients with liver cirrhosis, only a few studies revealing the relationship between severity of liver cirrhosis and severity of erectile dysfunction.Objective. The purpose of this study is to determine the correlation between MELD score and severity of erectile dysfunction (IIEF-5 score) in cirrhosis patients.Methods. This study is observational with a cross-sectional method. Subjects were patients with liver cirrhosis, male, age 18 to 65 years old, married, have a partner, and agreed participated to this study. We used Pearson the correlation to assess correlation between severity of liver cirrhosis (Child Pugh score) and severity of erectile dysfunction (IIEF-5 score) if the data were distributed normally and Spearman correlation if the distribution is abnormal.Conclusion. There is negative correlation with the moderate strength degree between MELD score (the degreee of severity in liver cirrhosis) with the IIEF-5 score (the degree of erectile dysfunction). Keywords: liver cirrhosis, MELD score, erectile dysfunction, IIEF-5, correlation.
Interleukin-8 expression differences in chronic and active chronic inflammation gastric mucosa biopsy with helicobacter pylori infection Muhammad Arif; Siti Nurdjanah; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.79 KB) | DOI: 10.22146/actainterna.48161

Abstract

Background: Infection with Helicobacter pylori (HP) estimated to occur in 50% of the population in the world. Helicobacter pylori infection causes inflammation of the gastric mucosa and gastric epithelial release of interleukin-1β, interleukin-6, interleukin-8 and tumor necrosis factor α. Interleukin-8 plays a role in the degree of chronic inflammation of the gastric mucosa and gastric cancer risk. There has been no research on differences in the expression of interleukin-8 is based on chronic and chronic active inflammation on biopsy of the gastric mucosa with Helicobacter pylori infection in Hospital Dr. Sardjito.Objective: To prove the differences in the expression of interleukin-8 of chronic inflammation and gastric mucosal biopsy active chronic infection with Helicobacter pylori.Methods: This study used a cross-sectional design. Examined the expression of interleukin-8 on the rest of the biopsy sample HP (+) in August 2009 to March 2014. Classification of chronic inflammatory and chronic active obtained through histopathology report. Categorical numerical data from the two groups, unpaired, the distribution is not normal: Mann-Whitney test. Differences were considered significant if it was obtained p <0.05 with a confidence interval of 95%.Results: There were 41 samples of gastric mucosa biopsy preparations, comprising 9 samples of chronic inflammation and 32 samples of chronic inflammatory active of the gastric mucosa. The median value of the expression of IL-8 eptitel surface on chronic inflammation by 83 (40-94)% and the active chronic inflammation by 82 (19-94). Comparison test with Mann Whitney U test. From the statistical calculations p value = 0.887  with p> 0.05Conclusion: There is no difference in the expression of interleukin-8 in inflammatory chronic active and chronic inflammation of the gastric mucosa with Helicobacter pylori infection.Keywords: Helicobacter pylori, interleukin-8, chronic inflammation and chronic inflammatory active.
Effect of Metformin and Valsartan Toward Homa-IR in Metabolic Syndrome Patient with Non-Alcoholic Fatty Liver Disease (NAFLD) Prasetio Kirmawanto; Siti Nurdjanah; Muhammad Robikhul Ikhsan
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (397.829 KB) | DOI: 10.22146/actainterna.48403

Abstract

ABSTRACTBackground: Insulin sensitizer drugs such as metformin has suggested giving in metabolic syndrome patient and NAFLD, which both pathogeneses were insulin resistance. Angiotensin II receptor blocker (ARB), anti-hypertension drugs, has the similar properties to improve regulation of Proliferator-Activated Receptor Gama (PPARɤ). This aim of the study is to prove the improvement of insulin resistance which examined by HOMA-IR method on metabolic syndrome patient with NAFLD after receiving metformin and valsartan medication.Method: This study was conducted to the patient in Endocrinology Clinic Sardjito General Hospital aged 35-36 years who meet diagnostic criteria for metabolic syndrome based on the IDF in 2006 and NAFLD. Convenience sampling method is done for 11 months (May 2012 – March 2013) and was expected sample size 35. HOMA-IR examination made before and after administration of metformin and valsartan for 12 weeks. Cut off value for HOMA –IR on pathological metabolic syndrome and NAFLD was ≥ 2. Medical and Health Research Ethics Committee (MHREC) Faculty of Medicine Universitas Gadjah Mada approved this study protocol.Result: Subject of study retrieved 15 (43%), six males (40%) and nine females (60%) aged 43-63 years old. Median HOMA-IR baseline was 2.8 (0.6-14.5) and at the end of therapy was 3.8 (1.72-14.1). Eleven (74%) have increased HOMA-IR value and four (26%) experience declined but none of them reach the value below 2. In general clinical improvement occurs in the form of AST and ALT reduction but not statistically significant.Conclusion: This study does not prove that administration of metformin and valsartan in-patient with metabolic syndrome with NAFLD would improve insulin resistance assessed by the HOMA-IR method.Keywords: Metformin, valsartan, metabolic syndrome, NAFLD, HOMA-IR 
Effectiveness Combination of Ginger Extract (Zingiber officinale) and Ranitidine Compared with Combination of Ranitidine and Placebo against Severity of Functional Dyspepsia Dite Ari Prapti; Neneng Ratnasari; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 7, No 1 (2017): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (269.496 KB) | DOI: 10.22146/actainterna.48406

Abstract

ABSTRACTBackground: Efficacy ranitidine as dyspepsia functional treatment was 8-35 % and ginger extracts as a traditional recipe in various countries for generations could be used as a therapy dyspepsia, antinausea, spasm, colic, and other stomach complaints. Ginger therapeutic effectiveness could reach 68-77% in vivo studies (animal models).Objective: To determined how much influence combination of ginger extract and ranitidine could improve severity of dyspepsia compared with combination of ranitidine and placebo in patients with functional dyspepsia.Method: This study was a quasi experimental. The research was conducted from December 2015 until April 2016 with 26 participants.Results: After getting therapy for 2 weeks in group I, mean SODA score in the pain scale decreased (8.4 %) of 29.07 ± 7.29 to 25.08 ± 8.22, statistically significant (p <0.046). Mean SODA score in the pain scale group II decreased (7.2%) of  25.38 ± 6.19 to 24 ± 6.01 (p=0.302). Mean SODA score in the non pain scale in group I decreased (7.7%) of 16.84 ± 2.44 to 15.15 ± 2.64 (p=0.074), while in the group II decreased (1.6%) of 15.77 ± 2.71 to 15.23 ± 2.94 (p=0.470). Mean SODA score in the satisfaction scale in group I increased (19.9%) of 7.77 ± 3.63 to 10.08 ± 3.59 (p=0.053) while in the group II increased (8.4%) of 9.62 ± 2.72 to 10.92 ± 2.46 (p=0.072). Comparison decline of SODA score in the pain scale between group I was 4.31 ± 6.3 and in group II is 1.23 ± 4.91, greater in group I but not significantly (p=0.178) at baseline to week 2nd. Comparison decline of SODA score in the non pain scale between group I was 1.69 ± 3.11 and in group II was 0.54 ± 2.6, greater in group I but not significantly (p=0.316) at baseline to week 2nd. Comparison increasing of SODA score in the satisfaction scale between group I was – 2.31 ± 3.88 and in group II was -1.31 ± 2.39, greater in group I but not significantly (p=0.437).  Conclusion: Combination of ginger extract and ranitidine could decrease pain scale, non pain scale and increase satisfaction scale more effective clinically than plasebo and ranitidine for functional dyspepsia patient, but not statistic significantlyKeywords: ginger extract, severity of dyspepsia, and functional dyspepsia
Relationship between Interleukin-6 Expression with the Progressive and Severity of Ulcerative Arif Nur Widodo; Neneng Ratnasari; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 9, No 1 (2019): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (170.41 KB) | DOI: 10.22146/actainterna.50889

Abstract

Background. Based on international statistics, the incidence of Inflammatory Bowel Disease (IBD) is about 2.2-14.3 cases per 100.000 people per year for Ulcerative Colitis (UC). In Indonesia, there is no epidemiological study of IBD. To assess the degree of severity associated with the ulcerative colitis disease can be used a varietyof tools, including the Truelove Witts score which has sensitivity and specificity that high enough for UC in the phase of active disease. Interleukin-6 (IL-6) is a pro-inflammatory cytokine that plays a very important role in the self-defense mechanism and acts as an acute-phase protein. Serum levels of IL-6 and increased expression in the colonic mucosa of active IBD patients indicate the level of IBD disease activity.Aims. The aim of the study was to determine the relationship between Interleukin-6 expression (IL-6) and the severity of UC disease using Truelove Witts classification.Methods. This study used a cross-sectional method that analyzed the relationship between IL-6 expression and UC weighing based on Truelove Witts classification using colon tissue biopsy results from UC patients who met inclusion and exclusion criteria.Results. Th ere were 26 subjects studied and performed an endoscopic analysis and anatomical pathology. Mean age of research subjects were 52.73 + 11.11 years with men's favored subjects (n = 15). Subjects were severe UC 16 (61.5%), moderate 7 (26.9%) and mild 3 (11.5%). More male subjects in mild UC, 12 vs. 3 and more female subjects in moderate-severe UC, 4 vs. 7 (p 0.032). Signifi cant diff erences in IL-6 expression in defecation were > 4 times/day, IL-6 300 (285-400) versus defecation < 4 times/day, IL-6 295 (212.1-340) p 0.039. Signifi cant diff erence in IL-6 expression between mild UC 295 (212.1-340) with moderate- severe UC 301.66 (235.57-400) with p value 0.032.Conclusion. IL-6 expression in moderate-severe UC subjects was higher than mild UC subjects based on Truelove Witts criteria.Keywords:  Inflammatory Bowel Disease,  Ulcerative Colitis,  Truelove Witts classification,  Interleukin-6.