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All Journal Acta Interna : The Journal of Internal Medicine MEDICINUS
Endro tanoyo
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Transient Elastography Changes on Patient with Hepatic Cirhossis who were Treated by Simvastatin 20 Mg Compared to Simvastatin 10 mg Endro tanoyo; Neneng Ratnasari; Sutanto Maduseno
Acta Interna The Journal of Internal Medicine Vol 10, No 1 (2020): Acta Interna The Journal of Internal Medicine
Publisher : Faculty of Medicine Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/actainterna.61292

Abstract

Background. Liver cirrhosis is a pathological condition that describes the end stage of liver fibrosis. Fibrosis is currently a two-way process. The process of returning from fibrosis now is a clinical reality. According to Abraldes et al. (2009), administration of simvastatin for one month will increase liver cell regeneration and improve endothelial dysfunction. Liver biopsy is still the gold standard for assessing liver cirrhosis, but this procedure is invasive and has the potential to cause life-threatening complications. Liver biopsy is complicated by sampling errors (reaching 30%) and different abilities between observers. Transient elastography (Fibro scan) is a non-invasive modality for diagnosing liver fibrosis that has high sensitivity and specificity.Aim. The aim of the study was to discover the difference in effect, of simvastatin 20 mg compared to 10 mg for 3 months to improve liver stiffness in patients with liver cirrhosis.Method. The study design used a double blind, randomized clinical trial. The subjects of the study consisted of a group given simvastatin 10 mg / day and the group given simvastatin 20 mg / day for 3 months. Routine medications for cirrhosis were still made according to the original dose. During the study, an initial and final transient elastography examination was carried out and monthly supervision of medication compliance and side effects. Data analysis for statistical tests was carried out by t-test, Mann Whitney test, fisher’s-exact test, and ANOVA test.Result. A total of 21 subjects underwent thorough research and transient elastography. The simvastatin 10mg group (n = 12) experienced a decrease in liver stiffness, with a delta mean of liver stiffness of -4.97+7.09 (p <0.023) compared to the simvastatin 20 mg group (n = 9) with a heart stiffness of -4.09 + 10.06 (p= 0.982). Changed liver stiffness in the two groups were not statistically significant differences. Etiology and confounding drugs showed statistically no significant effect.Conclusion. Both simvastatin 10 mg and 20 mg can reduce liver stiffness. The effect of the two doses of the drug in reducing liver stiffness was not statistically significant different.
Persistent Jaundice in a Tuberculosis Patient After Treatment: A Rare Case of Primary Sclerosing Cholangitis Endro Tanoyo; Fahmi Indrarti; Deshinta Putri Mulya; Nur Rahmi Ananda; Naomi Yoshuantari; Bestari Ariningrum Setyawati
MEDICINUS Vol. 38 No. 8 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/9gdf2175

Abstract

Primary sclerosing cholangitis (PSC) presents diagnostic challenges due to its overlapping features with other conditions. This case report describes a 28-year-old woman with a history of pulmonary tuberculosis who developed jaundice weeks after completing antituberculosis treatment, initially resembling drug-induced liver injury (DILI). In 2021, patient was diagnosed with tuberculous sclerosing cholangitis and showed improvement with antituberculosis therapy. However, in 2022, patient experienced recurrent jaundice, fever, dark urine, and weight loss, without gastrointestinal symptoms. Laboratory tests revealed elevated bilirubin (total 13.8 mg/dl, direct 12.9 mg/dl), increased liver enzymes (SGOT 177 U/l, SGPT 91 U/l), and a positive antinuclear antibody indirect immunofluorescence (ANA IF) test with a centromere pattern. Magnetic resonance cholangiopancreatography (MRCP) and liver biopsy findings supported a diagnosis of PSC, overlapping with tuberculous sclerosing cholangitis. Treatment with ursodeoxycholic acid, methylprednisolone, and mycophenolic acid led to significant improvement in bilirubin and liver enzyme levels, although they remained above the normal range. This case highlights the diagnostic complexity of PSC in tuberculosis patients, particularly in the absence of typical gastrointestinal symptoms. The relationship between tuberculosis and PSC remains unclear, necessitating further investigation. Despite treatment, serum bilirubin and transaminase levels were fluctuated but persisted above the normalrange, highlighting the challenges in managing PSC with concurrent tuberculosis. This report emphasizes the importance of comprehensive diagnostic approaches, including imaging and histopathology, in identifying atypical presentations of PSC.
Co-Authors Bestari Ariningrum Setyawati Deshinta Putri Mulya Fahmi Indrarti Naomi Yoshuantari Neneng Ratnasari Nur Rahmi Ananda Sutanto Maduseno