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All Journal International Journal of Public Health Science (IJPHS) journal of internal medicine Biomolecular and Health Science Journal CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL Narra J The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Titong Sugihartono
Department Of Internal Medicine, Faculty Of Medicine, Universitas Airlangga, Dr. Soetomo Hospital, Surabaya, Indonesia
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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FAKTOR RISIKO TERKAIT PERDARAHAN VARISES ESOFAGUS BERULANG PADA PENDERITA SIROSIS HATI Vidyani, Amie; Vianto, Denny; W, Budi; Kholili, Ulfa; Maimunah, Ummi; Sugihartono, Titong; Purbayu, Herry; Boedi Setiawan, Poernomo; A Nusi, Iswan; Adi, Pangestu
journal of internal medicine Vol. 12, No. 3 September 2011
Publisher : journal of internal medicine

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (70.384 KB)

Abstract

Recurrent esophageal varices bleeding  in  liver cirrhosis  increase  the morbidity and mortality. 50 ! 60% patients with Esophageal Varricess (EV) will experience recurrent bleeding, 30% or one third of them will experience recurrent bleeding one year after diagnosis of EV. Mostly recurrent bleeding will be found at 6 weeks until 6 months after the Þ rst bleeding. Prevention of recurrent bleeding is important for survival. The aim of this research to know the risk factors of recurrent EV bleeding in liver cirrhotic patients and the onset of recurrent bleeding after the Þ rst endoscopy. This is a  cross sectional study. Thirty Þ ve decompensated liver cirrhosis patients that fulÞ ll the inclusion and exclusion criteria participated in this study. After the Þ rst endoscopy, the risk factors are written, consist of sex, age, ascites, degree of varices, history of LVE/STE the severity of liver disease, and history of consuming gastric iritating drugs. The patients followed for six months to evaluated  the occurence of  recurrent bleeding. We used Pearson Chi-Square  test  for statistic analysis  (signiÞ cant  if p < 0.05). SPSS 17 were used to statistic calculation. Statistic analytical showed signiÞ cant correlation (p = 0.006; OR = 8.889; CI: 1.803 ! 43.820). On  the other hand sex, age, degree of EV, history of STE/LVE showed non signiÞ cant correlation. The main risk factor of recurrent EV in liver cirrhosis is the severity of liver disease.
Effect of Pneumatic Balloon Dilation to The Changes of Eckardt Score in Patient With Achalasia Budi Widodo; Iswan Abbas Nusi; Titong Sugihartono
Biomolecular and Health Science Journal Vol. 3 No. 1 (2020): Biomolecular and Health Science Journal
Publisher : Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/bhsj.v3i1.17938

Abstract

Introduction: Achalasia is an esophageal motility disorder, but its pathogenesis remains unclear. The highest incidence is among adults aged 30 – 60 years with the prevalence of 10/100.000 population. Diagnosis of achalasia is based on symptoms and upper endoscopy, barium esophagogram, and esophageal manometry. Pneumatic Balloon Dilation (PBD) is one of the treatment options, whether it is fluoroscopy-guided or direct endoscopy guided. This study aims to analyze the effect of PBD on the changes of Eckardt score among achalasia patients.Methods: An analytical observational study with a retrospective and prospective design was conducted on 18 achalasia patients who performed PBD at Dr. Soetomo General Hospital. Data were then analyzed using t-test. Results: The mean age was 47.8±12.5 years, and the mean achalasia duration was 18.3±5.9 months. There were no differences of achalasia cases between men and women. The mean body weight in the pre and post PBD was 50.9±6.2 vs 53.1±6.5 kg with delta 2.19±1.88 (p <0.0001). The mean BMI in the pre and post PBD was 20.2±2.2 vs 21.1±2.5 kb/m2 with delta 0.89±0.78 (p <0.0001). In addition, the mean Eckardt score in the pre and post PBD was 10.17±1.47 vs 2.5±0.86 (p <0.0001). There were 3 patients with Eckardt score of 4 after PBD and no weight loss after one-month evaluation. Conclusion: There was a significant difference of Eckardt score before and after PBD. The improvement of the Eckardt scores led to the change of weight and body mass index among achalasia patients.
Hepatic Hydrothorax in a Patient with Liver Cirrhosis: a Case Report Martino Handoyo; Titong Sugihartono
Current Internal Medicine Research and Practice Surabaya Journal Vol. 2 No. 2 (2021): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v2i2.28702

Abstract

Hepatic hydrothorax is a transudative pleural effusion which presents in 5-10% patients with liver cirrhosis. Although fairly uncommon, it is associated with higher morbidity and lower survival rate. The mechanism is yet to be understood fully, but the most widely accepted pathogenesis involves the presence of portal hypertension, diaphragmatic defects, and negative intrathoracal pressure, all of which lead to the formation of unidirectional passage of ascitic fluid from peritoneal cavity into pleural space. Due to its origin, the pleural effusion has similar characteristics to ascitic fluid. We herein report the case of a 60-year-old woman with advanced liver cirrhosis and right-sided moderate hepatic hydrothorax. Treatment given to the patient includes diuretics, sodium restriction, and repeated thoracentesis. Subsequent evaluation of the patient revealed improvement both clinically and radiologically.
Gastrointestinal Endoscopy in Patients Receiving Antithrombotic Therapy Supriadi Supriadi; Titong Sugihartono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 22, No 2 (2021): VOLUME 22, NUMBER 2, August 2021
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (650.694 KB) | DOI: 10.24871/2222021134-139

Abstract

Gastrointestinal endoscopy is used as a diagnostic and therapeutic tool. Patients receiving antithrombotic agents are at higher risk for bleeding in this procedure. Regarding its thromboembolic versus bleeding risk, physicians should consider to adjust antithrombotic therapy in patients undergoing gastrointestinal endoscopy. Some important factors including the urgency of the procedure, bleeding risk from the procedure and antithrombotic itself, and the risk of thromboembolic events during endoscopy if antithrombotic is to be stopped need to be considered wisely. Based on recommendations of ASGE, ESGE, and BSG, endoscopic procedures were divided based on the level of emergency, namely elective and urgent. In elective endoscopy with high risk of bleeding and thromboembolism, antithrombotic therapy is given in the minimum duration required and then discontinued before the procedure. In elective endoscopy with low risk of bleeding and thromboembolism, antithrombotic can be continued as usual. In urgent endoscopy due to gastrointestinal bleeding, all antithrombotic should be discontinued. Antithrombotic can be restarted within 48 hours after the procedure if no bleeding is evident
Response Evaluation of Patients Undergoing Transarterial Chemoembolization (TACE) for Hepatocellular Carcinoma with Respect to Tumour Size, Number of Lesion, and Alpha-Fetoprotein (AFP) Level Adaninggar PN; Ulfa Kholili; Ummi Maimunah; Poernomo B Setiawan; Iswan A Nusi; Herry Purbayu; Titong Sugihartono; Budi Widodo; Husin Thamrin; Amie Vidyani
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 1 (2016): VOLUME 17, NUMBER 1, April 2016
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (192.599 KB) | DOI: 10.24871/17120163-9

Abstract

Background: Transarterial chemoembolization (TACE) is widely used as a palliative treatment for unresectable hepatocellular carcinoma (HCC). TACE is also used as bridging therapy before liver transplantation to avoid tumour progression and considered for downstaging to fulfill tumour resection or liver transplantation criterias. This study aimed to evaluate response of TACE in unresectable HCC according to changing of tumour size, number of lesion, and AFP level.Method: Retrospectively, we evaluate 69 HCC patients who underwent TACE in Dr. Soetomo General Hospital in January 2012-June 2015, including their age, sex, aetiologies, and Barcelona Clinic Liver Cancer/BCLC staging. Laboratory examinations such as complete blood count (hemoglobin/Hb, leucocyte, thrombocyte), liver function test (aspartate aminotransferase/AST, alanine aminotransferase/ALT, bilirubin, albumin, international normalized ratio/INR), alpha-fetoprotein/AFP level, and abdominal CT-scan were performed before and 1 month post-TACE. Data was analysed using paired t-test.Results: 69 patients with mean age of 51.81 ± 12.8 years old, predominantly 76.8% males, the most common aetiology was hepatitis B 68.1%, 92.8% BCLC B, 64.3% with stable disease, none achieved complete response, 97.1% had tumour size 5 cm, 69.6% had single tumour, and 55.7% had AFP level 1000 ng/mL. There was a significant increase in tumour size and number of lesions in 1 month post-TACE that were approximately 1.76 cm and 2.33, respectively, and there was no significant difference between AFP level before and 1 month post TACE.Conclusion: In 1 month post TACE evaluation, there was a significant increase of tumour size and number of lesion, but there was no significant alteration in AFP level. TACE might be performed repeatedly with shorter evaluation interval than 1 month to achieve better response.
Clinical Outcome Controversy in Helicobacter pylori Infection Muhammad Miftahussurur; Heasty Oktaricha; Titong Sugihartono
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 21, No 2 (2020): VOLUME 21, NUMBER 2, August 2020
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (302.351 KB) | DOI: 10.24871/2122020146-152

Abstract

H. pylori infection can manifest as intestinal and extraintestinal disease. In this review, we summarize several factors that cause differences in clinical manifestations of H. pylori infection. Host inflammatory response and bacterial virulence are key in determining the pattern of acid secretion and gastritis. The acid level factor that has a greater effect, not H. pylori infection itself. Gastritis predominant in the gastric in the initial phase will produce higher acid and trigger GERD. H. pylori is also the cause of gastric adenocarcinoma. Different vacA genotypes are related to the risk of clinical manifestations such as peptic ulcer or gastric cancer. However, there is variance prevalence in some countries which can be explained through a combination of several factors including age at infection, virulence factors of H. pylori, host genetic profile, and environmental factors. Besides, important differences were found at a locus in CagA H. pylori which resulted in differences in clinical outcomes in the form of gastritis or MALT lymphoma. H. pylori infection alone is not enough to trigger  idiopathic thrombocytopenic purpura (ITP). Additional triggers are needed to obtain an anti-platelet autoimmune response at ITP associated with H. pylori. Therefore, the difference in clinical manifestations of H. pylori infection remains controversial. H. pylori is not only a single cause, but the host and environmental factors also contribute to producing different responses.
Wilson’s Disease: A Review Amie Vidyani; Fauziah Diayu Retnaningtyas; Ulfa Kholili; Titong Sugihartono; Iswan Abbas Nusi; Poernomo Boedi Setiawan; Ummi Maimunah; Budi Widodo; Husin Thamrin; Muhammad Miftahussurur; Herry Purbayu
Current Internal Medicine Research and Practice Surabaya Journal Vol. 4 No. 1 (2023): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v4i1.36428

Abstract

Wilson’s disease is a disease that results from a genetic disorder that causes copper accumulation. Wilson’s disease has presented challenges for physicians during the last century, but it can be diagnosed and treated over time. Diagnosing Wilson’s disease is challenging for doctors because of its wide range of clinical manifestations and complexity. Studies that can help diagnose Wilson’s disease include a 24-hour copper urine examination and neurological tests, such as a CT scan or MRI, and liver function tests. There is also a scoring system to help medical personnel diagnose this disease. Correct diagnosis and adequate therapy can be provided, such as penicillamine, trientine, zinc, and, most rarely, liver transplantation. It is also necessary to monitor the side effects of treatment and its effectiveness of treatment. When receiving therapy, Wilson’s disease has a better prognosis than if it is not treated.
Association between COVID-19 severity with liver abnormalities: A retrospective study in a referral hospital in Indonesia Maimunah, Ummi; Kholili, Ulfa; Vidyani, Amie; Sugihartono, Titong; Tanaya, Willa M.; Wessels, Firda I.; Alshawsh, Mohammed A.; Miftahussurur, Muhammad
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.816

Abstract

Coronavirus disease 2019 (COVID-19) is characterized by an acute respiratory infection with multisystem involvement and the association of its severity to liver function abnormalities is not well characterized. The aim of this study was to assess the association between the severity of COVID-19 patients and liver function abnormalities. This retrospective study included adult patients with confirmed COVID-19, which were classified as non-severe or severe according to World Health Organization guidelines. Liver function test results were compared between the severity groups. A total of 339 patients were included of which 150 (44.25%) were severe cases. The male-to-female ratio was 0.9:1 and 3:2 in the non-severe and severe groups, respectively (p=0.031). Aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin levels and acute liver injury (ALI) incidence were significantly higher in the severe group compared to non-severe group (p<0.001, p<0.001, p=0.025, p=0.014, respectively). In contrast, albumin levels were significantly lower (p=0.001). Multivariate analysis showed that ALI was significantly associated with human immunodeficiency virus (HIV) infection (odds ratio (OR): 5.275; 95% confidence interval (CI): 1.165–23.890, p=0.031), hemoglobin level (OR: 1.214; 95%CI: 1.083–1.361, p=0.001), and hypoalbuminemia (OR: 2.627; 95%CI: 1.283–5.379, p=0.008). Pre-existing liver diseases were present in 6.5% of patients. No significant differences were observed between the groups based on COVID-19 severity and ALI presence. Liver function test abnormalities, including ALI, are more prevalent in patients with severe COVID-19 infection. HIV infection, high hemoglobin levels, and hypoalbuminemia may be potential risk factors for ALI.
Triglyceride to high-density lipoprotein cholesterol ratio as a marker of non-alcoholic fatty liver disease in type 2 diabetes Dwitama Adiwinoto, Robert; Pranoto, Agung; Sugihartono, Titong; Adi Soelistijo, Soebagijo; Pratama Adiwinoto, Ronald
International Journal of Public Health Science (IJPHS) Vol 13, No 3: September 2024
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v13i3.24035

Abstract

Type 2 diabetes mellitus (T2DM) and non-alcoholic liver disease (NAFLD) shared a common feature, insulin resistance (IR), which is marked by a change in the lipoprotein fraction, namely increased triglycerides (TG) and decreased high-density lipoprotein cholesterol (HDL-C) levels. Blood lipids are routinely examined in T2DM patients; thus, our study aimed to investigate the performance of TG/HDL-C ratio values to identify hepatic steatosis, the earliest manifestation of nonalcoholic fatty liver disease (NAFLD), in T2DM patients. One hundred adult T2DM patients over 30 years old were recruited from the diabetes outpatient clinic at the Dr. Soetomo General Academic Hospital from August to October 2023. Data regarding sociodemographics, medication, glycosylated hemoglobin (HbA1c), lipid profiles, and FibroScan with controlled attenuation parameter (CAP) were collected from all participants. The group with hepatic steatosis (CAP≥237 dB/m) had a higher body mass index (BMI), higher TG levels, and TG/HDL-C ratio values. The TG/HDL-C ratio was significantly correlated with CAP values. Hepatic steatosis can be identified using the TG/HDL-C ratio with a cut-off value of 2.83 (sensitivity:72.4%; specificity:71.4%). An elevated TG/HDL-C ratio is associated with a higher risk (OR:6.562; p<0.05) of having hepatic steatosis. The TG/HDL-C ratio is a potential marker to predict NAFLD in T2DM patients.
Association of MMP9, HsCRP, and ESR with 5-ASA Treatment Duration and Disease Activity Based on Truelove and Witts Criteria in Patients with Diagnosed Ulcerative Colitis Wardana, Vasa Adi Wisnu; Sugihartono, Titong; Miftahussurur, Muhammad
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/253202432-38

Abstract

Background: The American College of Gastroenterology (ACG) currently recommends the Truelove and Witts scoring system for evaluating Ulcerative Colitis (UC) disease activity. Inflammatory markers such as Matrix Metallopeptidase 9 (MMP-9), High-sensitivity C-Reactive Protein (HsCRP), and Erythrocyte Sedimentation Rate (ESR) have previously been shown to correlate with intestinal inflammation. To evaluate the association of MMP-9, HsCRP, and LED with disease activity and treatment duration in UC according to the Truelove and Witts criteria.Methods: An observational analytic study with a cross-sectional design was conducted involving subjects with UC diagnosed pathologically and receiving 5-ASA therapy at the Gastroenterohepatology Outpatient Department of Dr. Soetomo Hospital. MMP-9, HsCRP, and ESR serum levels were measured. The disease activity was determined based on the Truelove and Witts criteria. Analysis was done by spearman's correlation. P-values and correlation coefficients (r) were presented.Results: Among the 31 subjects, the majority were female (67.7%) with an average age of 46.84 years. Approximately 35.5% subjects had been treated for more than 6 months. The MMP-9 and HsCRP serum levels were above normal range (71% and 93.5% subjects, respectively). The majority (74.2%) of the subjects had normal ESR levels. Among the investigated inflammatory markers, only ESR levels significantly had a very weak positive correlation (p=0.010; r=0.004).Conclusion: ESR serves as an effective biomarker for UC disease activity compared to MMP-9 and HsCRP. Further study is warranted to explore the role of these biomarkers in UC management. 
Co-Authors Adaninggar PN Agung Pranoto Alshawsh, Mohammed A. Amie Vidyani Budi W Budi Widodo Budi Widodo Denny Vianto Dwitama Adiwinoto, Robert Fauziah Diayu Retnaningtyas Heasty Oktaricha Herry Purbayu I Dewa Nyoman Wibawa Imro'ati, Tri Asih Iswan A Nusi Iswan A Nusi Iswan A Nusi Iswan Abbas Nusi Iswan Abbas Nusi Martino Handoyo Muhammad Miftahussurur Nefertiti, Eva Pravitasari Pangestu Adi PN, Adaninggar Poernomo B Setiawan Poernomo Boedi Setiawan Ronald Pratama Adiwinoto Setiawan, Poernomo B Soelistijo, Soebagijo Adi Supriadi Supriadi Tanaya, Willa M. Thamrin, Husin Ulfa Kholili Ummi Maimunah Vasa Adi Wisnu Wardana Wessels, Firda I. Widodo, Budi Widodo, Budi