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All Journal Acta Interna : The Journal of Internal Medicine Journal of the Medical Sciences (Berkala Ilmu Kedokteran) JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Jurnal Gizi Klinik Indonesia Budapest International Research and Critics Institute-Journal (BIRCI-Journal): Humanities and Social Sciences Journal of Innovation in Management, Accounting and Business The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Journal of Mandalika Literature

Neneng Ratnasari

Division Of Gastroenterology And Hepatology, Department Of Internal Medicine, Faculty Of Medicine, Gadjah Mada University-Sardjito General Hospital, Yogyakarta

Author-ID : 2968414

Religion Arts Humanities Biochemistry, Genetics & Molecular Biology Economics, Econometrics & Finance Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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

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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 Â± 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-AÂ 0.7 - 0.97 mg/L, CP-B 0.7 - 0.49 mg/L, and CP-C 0.7 â 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. Â Key words: Liver Cirrhosis â Child Pugh score - Cystatin CÂ

Relationship between plasma fi brinogen levels with model of end stage liver disease score in patients with liver cirrhosis Nasir, Moch. Abdul; Ratnasari, Neneng; Bayupurnama, Putut
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTIntroduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis.The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis.Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r).Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 Â± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 Â± 102, 89 mg/dl, and mean of the MELD score was 17,05 Â± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010).Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting.Keywords: liver cirrhosis, fi brinogen, MELD score

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

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

Relationship between plasma fi brinogen levels with model of end stage liver disease score in patients with liver cirrhosis Moch. Abdul Nasir; Neneng Ratnasari; Putut Bayupurnama
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

ABSTRACTIntroduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis.The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis.Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r).Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 ± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 ± 102, 89 mg/dl, and mean of the MELD score was 17,05 ± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010).Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting.Keywords: liver cirrhosis, fi brinogen, MELD score

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

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

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.

Correlation Between Neutrophil To Lymphocyte Ratio With Child Turcotte Pugh In Liver Cirrhosis Patients Wiwiek Probowati; Putut Bayupurnama; Neneng Ratnasari
Acta Interna The Journal of Internal Medicine Vol 6, No 1 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Background: Neutrophil to lymphocyte ratio (NLR) is an index that iswidely used these days. RNL has been widely studied as a predictor of poor survival and outcome in patients with liver cirrhosis, hepatocellular carcinoma, coronary heart disease, rheumatoid arthritis, sepsis and malignancy.Objective: To determine whether there is a correlation between NLR with a score of Child turcotte pugh (CTP) in patients with liver cirrhosis in Dr. Sardjitogeneral Hospital.Methods :The study design was cross-sectional study. The study began in December 2014 until the number of samples are met. The subjects of this study were patients with liver cirrhosis at affordable populations undergoing inpatient and outpatient care in the Dr. Sardjito Hospital that meet the inclusion and exclusion criteria. Venous blood test to measure neutrophils,lymphocytes, albumin, total bilirubin, INR (Internationale normalized ratio). Data presented in the form of descriptive analysis of the characteristics of the study subjects such as the mean and standard deviation values of lymphocyte and neutrophil ratio scores CTP. For analyze the correlation between NLR with CTP scores Spearman nonparametric analysis p <0.05.Results : There are 33 subjects in the study. Based on the results of this study found a positive significant correlation between the ratio of neutrophils to lymphocytes CTP with r = 0.749 andp= <0.0001 and obtained the formula Y = 7.797 + 0,067x. Thus increasing of neutrophils to lymphocytes ratio positive correlated with the severity of liver cirrhosis.Conclusion. There are positive correlation between the neutrophil to lymphocyte ratio with CTP scores in patients with liver cirrhosis.

Overlap in Patient with Functional Dyspepsia and Unspecified Functional Anorectal Pain Suharjo B Cahyono; Neneng Ratnasari; Siti Nurdjanah
Acta Interna The Journal of Internal Medicine Vol 6, No 2 (2016): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Functional gastrointestinal disorders (FIGD) represent a common and important class of disorders within gastroenterology. FIGD are a cause of great anxiety, distress and morbidity. FIGD disorders maybe manifest as overlapping syndrome. Patients with functional dyspepsia (FD) show frequent overlapping of other gastrointestinal disease, such as functional anorectal pain. These overlap patients have more frequent or more severe symptoms, poor health related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. These disorders were diagnosed according Rome III criteria and excluded structural diseases. Multimodalities approach should be used during treatment patient with FGID. It was reported a male patient with functional dyspepsia and unspecified functional anorectal pain overlap. Keywords: Functional gastrointestinal disorders, functional dyspepsia, functional anorectal pain

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

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.

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

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

Co-Authors . Suharno Agus Siswanto Arif Nur Widodo Arif Rohman Hakim Aulia, Nisma Catharina Triwikatmani Deshinta Putri Mulya Didik Setyo Heriyanto Dite Ari Prapti Dwijayanti, Hervina Eko Budiono Endro tanoyo Fahmi Indrarti Farida, Yeni Firman Wahyudi Fita Rahmawati Fita Rahmawati Fujawati, Eli Hakim, Suharno Hasanah Mumpuni Hemi Senorita Hervina Dwijayanti I Dewa Putu Pramantara Jamhari Jamhari Juwita Raditya Lina Tjandra Marcellus, Marcellus Moch. Abdul Nasir Muhammad Arif Muhammad Eko Cahyanto Mulyani, Tuty Nanda Qoriansas Nugraha, Adityansyah Irendra Nur Signa Gumilas Nurdjanah S Nurdjanah S, Nurdjanah Probowati, Wiwiek Puji Lestari Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama Putut Bayupurnama RA Aditya Adhi Puruhita Rachmad Aji Saksana Renovaldi, Dede Retno Ambarukminingsih Riska Humardewayani Adie SATRIYAS ILYAS Siti Maryani SITI MARYANI Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Siti Nurdjanah Sofia Mubarika Haryana Suhara, Ade Suhara Suharjo B Cahyono Suharjo B Cahyono Suharjo B Cahyono Suharjo Broto Cahyono Suharno Hakim Suryo Taroeno Susetyowati Susnita, Tia Aprilia Sutanto Maduseno Sutanto Maduseno Sutanto Maduseno Tri Murti Andayani Tuty Mulyani Wiwiek Probowati Yeni Farida Zagoto, Agnes Dina Irene Dorithy

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