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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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Non-alcoholic Fatty Liver Disease Related to Metabolic Syndrome: a Case-control Study Neneng Ratnasari; Hemi Senorita; Riska Humardewayani Adie; Putut Bayupurnama; Sutanto Maduseno; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Non-alcoholic fatty liver disease (NAFLD) is a benign condition, but it can go for years and progress to liver cirrhosis or eventually to liver cancer. Metabolic syndrome (MS) is a condition associated with NAFLD. This study was aimed to know the risk factors of NAFLD related to metabolic syndrome. Method: A case-control study was performed in NAFLD patients with or without MS and healthy individuals. All subjects were recruited from population that underwent routine medical check-up at Sardjito Hospital, Jogjakarta, during March 2007–August 2008. Diagnosis of NAFLD is defined based on clinical and liver ultrasound findings. Diagnosis of MS is defined by International Diabetes Federation on criteria for the diagnosis of MS. Data were analyzed by using T-test, ANOVA and linear regression. Odds ratio (OR) (95% CI and p 0.05) was calculated by cross-tab analysis. Results: There were 84 patients enrolled in the study (group I = 30 NAFLD + MS subjects; group II = 26 NAFLD patients; group III = 28 healthy). The data showed statistically significant Results in waist circumference, systole blood pressure, fasting glucose, triglyceride, high density lipoprotein (HDL) cholesterol level, homeostasis models assessment index ratio (HOMA-IR), free fatty acid (FFA), and adiponectin. The ANOVA and linear regression test among NAFLD groups showed significant difference only on HDL-cholesterol and FFA level. The lowest OR was 1.674 for HDL-cholesterol and highest OR was 13.571 for triglyceride. Conclusion: The independent factors of NAFLD related to metabolic syndrome are FFA and HDL- cholesterol level, even though a decreasing of HDL-cholesterol level has a lowest risk of NAFLD. Keywords: NAFLD, metabolic syndrome, FFA, adiponectin, HDL-cholesterol

Factors that Influence Cecal Intubation Rate in Unsedated Patients during Colonoscopy Suharjo B Cahyono; Putut Bayupurnama; Neneng Ratnasari; Catharina Triwikatmani; Fahmi Indrarti; Sutanto Maduseno; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 1 (2014): VOLUME 15, NUMBER 1, April 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Successful cecal intubation is a primary quality indicator in colonoscopies and the mostimportant factor in detecting abnormal lesion in the colon. There are many factors that influence cecal intubationrate during colonoscopy procedure. The aim of this study is to evaluate the factors that influence cecal intubationrate in unsedated patients during colonoscopy. Method: A retrospective study of colonoscopy performed at Sardjito General Hospital, Jogjakarta, from January 2012 to August 2013. Age, sex, bowel preparation, indication for colonoscopy, colonoscopist, andreasons of incomplete colonoscopy from 564 colonoscopy reports were recorded and analysed. Results: Overall successful cecal intubation rate was 408 (72.34%). Causes of incomplete colonoscopywere patients discomfort or pain 41.66%, looping/redundant 28.85%, poor bowel preparation 18.59%, fixation/adhesion 6.41%, and bleeding risk 4.49%. Female was more unsuccessful in cecal intubation than male (31.50%vs. 24.05%; p = 0.048). The successful cecal intubation rates for gastroenterologists compared to gastroenterology(GI) fellows were 77.92% vs. 49.55%; p 0.001, and poor bowel preparation was more difficult to reach cecalthan good preparation (57.58% vs. 23.69%; p 0.001). Multivariate logistic regression analysis demonstratedthat female and poor bowel preparation were independently associated with lower cecal intubation rate, andgastroenterologists were independently associated less unsuccessful to reach cecal. Conclusion: The overall successful cecal intubation rate was still below the set standard. Several identifiedfactors that may predict lower of cecal intubation rate: the skill and experience of colonoscopists (GI fellows),poor bowel preparation and female.Keywords: cecal intubation rate, colonoscopy, unsedated colonoscopy

Maximum Tolerated Volume and Plasma Acylated Ghrelin Levels after Drink Tests in Patients with Functional Dyspepsia Suharjo B Cahyono; Neneng Ratnasari; Putut Bayupurnama; Nurdjanah S
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 1 (2015): VOLUME 16, NUMBER 1, April 2015
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Impaired gastric accommodation and visceral hypersensitivity are major pathophysiological mechanism in functional dyspepsia (FD). Ghrelin, as gut hormone, may play a pathophysiological role in functional dyspepsia. Nutrient drink test was developed to assess impaired gastric accommodation in FD patients. The aims of this study are to compare maximum tolerated volume, postprandial symptoms and acylated ghrelin levels between dyspepsia functional patients and healthy subjects as controls.Method: A cross sectional study was conducted from July 2014 to November 2014, at Sardjito General Hospital, Yogyakarta. Twenties functional dyspepsia patients and 20 healthy subjects ingested nutrient drink tests (Ultra Milk contain 0.6 kcal/mL). The maximum tolerated volume was recorded. After ingested maximal tolerated volume, nausea, bloating and pain were rated using visual analogue scales (VAS) with 100 mm lines. The levels of acylated ghrelin was recorded before and 30 minutes after maximal drinking.Results: The demographic characteristics (age, sex, and body mass index) between dyspepsia patients and healthy subjects were compared. Patients with functional dyspepsia ingested 600 (350–1000) mL and healthy subjects ingested 1375 (1000–1900) mL (p 0.001). The total symptom scores were higher in dyspepsia patients compared healthy subjects; 215 (110–350) vs. 75 (50–120) (p 0,001). The fasting plasma levels of acylated ghrelin (20.65 : 2 – 31.37 pg/mL) in FD patients were significantly lower than healthy subjects (30.61 : 2 – 251.19 pg/mL) ( p = 0.012). Conclusion: Patients with functional dyspepsia ingested significantly lower volume and significantly have higher score symptoms than healthy subjects. The fasting plasma levels of acylated ghrelin in functional dyspepsia patients were significantly lower than healthy subjects.

Gallstones and Choledocolithiasis with Severe Cholestatic Jaundice in beta-Thalasemia Intermedia Patient Suharjo B Cahyono; Putut Bayupurnama; Neneng Ratnasari; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 2 (2014): VOLUME 15, NUMBER 2, August 2014
Publisher : The Indonesian Society for Digestive Endoscopy

Geographically, b-thalassemia can be found in many countries including in Indonesia. Thalassemia intermedia referred to patients as being ‘too haematologically severe to be called minor, but too mild to be called major’. Patients with thalassemia intermedia usually present themselves to medical attention in later childhood or even adulthood and are sustainable without the need for regular transfusion therapy. Three main factors are responsible for the clinical sequele of thalassemia intermedia: chronic anemia, ineffective erythropoiesis, and iron overload.There are many complications related to b-thalassemia intermedia such as gastroentero-hepatology diseases (splenomegaly, gallstones, choledocolithiasis, predispose patients to liver fibrosis and cirrhosis), vascular, endocrine and bone diseases. About 55-63% thalassemia intermedia patients suffer from gallstone with 68–85% of these patients undergo cholecystectomy, and 67-90% patients undergo splenectomy. Therefore, ultrasound examination is required to be performed regularly during illness and before patient underwent surgery or splenectomy to detect the presence of gall stones. In this case report a patient with gallstones and choledocholithiasis was reported. Severe cholestatic jaundice in b-thalassemia intermedia was diagnosed six months before hospitalization. The patient underwent open cholecystectomy and exploration common bile duct stones. Keywords: beta-thalassemia intermedia, gallstones, choledocolithiasis, iron overload

Alterations in Blood Ammonium Level and Psychometric Test in Patients with Liver Cirrhosis after a Tempe Diet Neneng Ratnasari; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 3, NUMBER 2, August 2002
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/32200233-37

Background: 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 criteria

Ultrasound-Diagnosed Non-Alcoholic Fatty Liver Disease among Medical Check Up Patients Suharjo B Cahyono; Putut Bayupurnama; Neneng Ratnasari; Sutanto Maduseno; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Society for Digestive Endoscopy

Background: Non-alcoholic fatty liver disease (NAFLD) is recognised as one of the most important causes of chronic liver disease and has become an important health issue in many countries. The aim of the study wasto evaluate the prevalence and risk factors of NAFLD patients based on ultrasound diagnosed in medical check up setting.Method: In this study, of 2,105 patients undergoing medical check up in Charitas Hospital, Palembang between January 2011 to August 2013, 115 NAFLD patients and 113 non-NAFLD patients as controls were included. Diagnosis of NAFLD was based on ultrasound appearance, patients did not consume alcohol, with negative HBsAg and hepatitis C virus antibodies.Results: The prevalence of NAFLD in medical check up patients was 7.9% whereas 39% patients had normal body mass index (BMI) ( 25 kg/m2). Patients with NAFLD compared with non-NAFLD patients had higher values of BMI (p 0.001), triglycerides (p = 0.001), aspartate aminostransferase (AST) (p 0.001), alanine aminotransferase (ALT) (p 0.001), fasting glucose (p = 0.002), and lower HDL cholesterol (p = 0.001). Obesity was the strongest associated factor for NAFLD (95% CI = 1.87-7.85; OR = 3.83; p 0.001), followed by high glucose levels (95% CI = 1.38 - 8.31; OR = 3.83; p = 0.008) and hypertriglyceridemia (95% CI = 1.38 - 4.11;OR = 2.38; p = 0.002).Conclusion: About 7.9% patients suffered from NAFLD. Approximately 39% medical check up patients had NAFLD with normal BMI. Obesity, hypertriglyceridemia and high glucose levels were the risk factors for NAFLD.Keywords: non-alcoholic liver disease, body mass index, prevalence, metabolic syndrome

Melanosis Coli Suharno Hakim; Putut Bayupurnama; Neneng Ratnasari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 2 (2016): VOLUME 17, NUMBER 2, August 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Melanosis coli is a brownish discoloration of the colonic mucosa caused by the accumulation of pigment in macrophages of the lamina propria. We reported a 62 years old woman with prolonged constipation since 10 years ago. She underwent haemorhoidectomy when 17 years old. Since 4 years ago she regularly comsumted herbal laxative. On 27 january 2015 underwent colonoscopy at Sardjito hospital Yogyakarta. Colonoscopic examination revealed Melanosis coli.

Colorectal Cancer in Young Patient: A Distinguished Disease Entity? Siti Nurdjanah; Suryo Taroeno; Putut Bayupurnama; Sutanto Maduseno; Neneng Ratnasari
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 6, ISSUE 2, August 2005
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/62200537-41

Background: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients ( 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher’s exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p 0.05 was considered as significant. Results: Sixteen young aged ( 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habits Keywords: Young aged colorectal cancer patients, cross sectional analysis, clinical and histological difference

Endoscopic Sclerotherapy and Band Ligation in Secondary Prophylaxis of Esophageal Variceal Treatment Catharina Triwikatmani; Putut Bayupurnama; Sutanto Maduseno; Neneng Ratnasari; Fahmi Indrarti; Siti Nurdjanah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 3, December 2010
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/1132010121-124

Background: Variceal bleeding is the most severe outcome of portal hypertension. Endoscopic sclerotherapy and band ligation are endoscopic treatment modalities for both active variceal bleeding and secondary prophylaxis. Endoscopic sclerotherapy has been carried out in Sardjito hospital since 1998, while band ligation has only been carried out since 2007 year. The aim of this study was to evaluate the long-term Result of endoscopic sclerotherapy and endoscopic band ligation in secondary prophylaxis of esophageal variceal eradication. Method: This is not a prospective study and is not randomized. The Results of patients who underwent endoscopic sclerotherapy and endoscopic band ligation from July 2003 to June 2009 were compared. Patients were evaluated for re-bleeding and recurrence rates. Results: Two hundred and seventy seven patients underwent endoscopic sclerotherapy and endoscopic band ligation during the period. One hundred and nine patients with varices eradication data; 49 patients who underwent sclerotherapy and 60 patients who underwent band ligation were followed for 1-119 (15.54 ± 20.70) months. The numbers of sessions for eradication were 4.33 ± 1.16 and 2.23 ± 0.59 for endoscopic sclerotherapy and endoscopic band ligation respectively (p 0.001). Re-bleeding and recurrence rates were 38.64% and 84.21% for endoscopic sclerotherapy, and 25.93% and 70% for endoscopic band ligation (p 0.05). Conclusion: Endoscopic band ligation is more effective than sclerotherapy in the eradication of esophageal varices. Keywords: esophageal varices, sclerotherapy, band ligation, secondary prophylaxis

The Role of Insulin Resistance in Diabetic Patients with Chronic Liver Disease Neneng Ratnasari; Siti Nurdjanah; Putut Bayupurnama; Sutanto Maduseno
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 1, April 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/9120081-3

Background: The association between diabetes and chronic liver disease has been well documented. However, the mechanism remains unknown. The aim of this study was to investigate the insulin resistance in chronic liver disease and normal liver in diabetic patient. Method: A total of 31 diabetic, non-alcoholic patients with multiple oral hypoglycemic drugs, either with or without lipid abnormalities were enrolled in this study. Subjects were recruited from outpatient clinic of Department of Endocrine at Dr. Sardjito Hospital, Jogjakarta, Indonesia from May-June 2004. This was a cross sectional study. Fasting insulin and glucose level, liver function test, body mass index, and the presence of fatty liver by ultrasound were examined. Insulin resistance was estimated by calculating fasting insulin and glucose plasma level as the homeostasis model assessment (HOMA) index ratio. Data was described with mean ± SD and analyzed by independent sample t-test. Results: Thirty one patients were enrolled to the study, i.e. 8 patients with normal liver and 23 patients with fatty liver. Only 14 patients agreed to continue the study including 10 patients with fatty liver and 4 patients with normal liver. Mean of age was 59.1 ± 8.7 and mean value of BMI was 24.62 ± 3.05. The liver function test revealed normal Results. Triglyceride, cholesterol, fasting glucose level, and HOMA index (2.77 ± 1.95 vs. 1.66 ± 1.02) in patients with fatty liver were higher than patients with normal liver. No correlation was found between fasting insulin level as well as HOMA index and mean value of BMI (obese and non-obese) as well as hypertension. There was significant correlation between triglyceride level and fasting insulin among fatty liver patients (p = 0.048; CI 95% -7.404; -0.032). Conclusion: The non-alcoholic fatty liver disease in diabetic patients with normal liver enzymes and multiple oral hypoglycemic drugs appear to be related with insulin resistance and hypertriglyceridemia. Keywords: fatty liver, diabetic, insulin resistance

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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