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All Journal journal of internal medicine E-Jurnal Medika Udayana Jurnal Penyakit Dalam Udayana ISM (Intisari Sains Medis) : Jurnal Kedokteran Jurnal Ilmiah Sangkareang Mataram The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
I Dewa Nyoman Wibawa
Department Of Clinical Microbiology, Faculty Of Medicine, University Of Udayana, Bali
Biochemistry, Genetics & Molecular Biology Civil Engineering, Building, Construction & Architecture Economics, Econometrics & Finance Education Health Professions Immunology & microbiology Medicine & Pharmacology Public Health Social Sciences

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Kadar Resistin Serum Berhubungan Dengan Skor Child-Turcotte Pugh Pada Penderita Sirosis Hati Koncoro, Hendra; Primadharsini, Putu Prathiwi; Mariadi, I Ketut; Somayana, Gde; Suryadarma, I Gusti Agung; Purwadi, Nyoman; Wibawa, I Dewa Nyoman
Jurnal Penyakit Dalam Udayana Vol 1 No 1 (2017): JPD Vol. 1 No.1 2017
Publisher : PAPDI BALI

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Abstract

Latar Belakang: Sirosis hati (SH) sering disertai tingginya resistensi insulin dan kondisi proinflamasi. Resistin yang merupakan suatu adipokin, diketahui memiliki hubungan dengan resistensi insulin dan inflamasi. Studi-studi resistin pada SH memperlihatkan hasil yang bervariasi. Tujuan penelitian ini adalah untuk mencari hubungan kadar resistin serum dengan skor Child-Turcotte Pugh (CTP) pada penderita SH. Metode: Penelitian observasional, studi potong lintang ini dilaksanakan di RSUP Sanglah dari September 2014 sampai dengan Juni 2015 dengan menggunakan 75 pasien sirosis hati sebagai sampel. Kriteria inklusi mencakup pasien sirosis hati tanpa memandang etiologinya dan berusia 12 tahun atau lebih. Variabel yang diperiksa pada penelitian ini yaitu skor CTP (kadar albumin serum, kadar bilirubin total serum, nilai waktu protrombin, kadar international normalized ratio (INR), tanda ascites, tanda ensefalopati hepatikum), kadar C-reactive protein (CRP), dan kadar resistin serum. Hasil: Enam puluh lima persen dari 75 sampel adalah laki-laki dan sisanya perempuan. Sebelas diantaranya (14,7%) adalah kelas CTP A, 31 (41,3%) kelas CTP B, dan 33 (44%) kelas CTP C. Rerata kadar CRP adalah 15,05 ± 15,86 mg/L. Rerata kadar resistin adalah 23,39 ± 17,79 ng/mL. Hasil uji korelasi didapatkan korelasi positif yang sedang antara kadar resistin dan skor CTP (r = 0,438; p < 0,001). Korelasi positif sedang juga didapatkan antara CRP dan resistin (r = 0,478; p < 0,001). Simpulan: Kadar resistin memiliki korelasi sedang dengan skor CTP pada pasien SH. Kadar resistin didapatkan lebih tinggi kadarnya pada SH yang berat. Hal ini menunjukkan adanya kondisi inflamasi dan resistensi insulin seiring dengan peningkatan derajat beratnya SH.
KORELASI ANTARA DERAJAT PENYAKIT SIROSIS HATI BERDASARKAN KLASIFIKASI CHILD-TURCOTTE-PUGH DENGAN KONSENTRASI TROMBOPOIETIN SERUM Juliana, I Made; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 1 Januari 2008
Publisher : journal of internal medicine

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Abstract

Thrombocytopenia is one of the most frequent haematological abnormalities in patients with livercirrhosis. It is generally considered to be due to pooling and destruction of the platelets in enlarged spleenwhich was defined as hypersplenism. Portal decompression procedures, either by surgical shunts ortransjugular intrahepatic portosystemic shunt (TIPS) have not led to a consistent rise in thrombocytes count.With the discovery of the lineage specific cytokine thrombopoietin (TPO) in 1994, the missing link betweenhepatocelular function and thrombopoiesis was found. TPO is predominantly produced by the liver andconstitutively expressed by the hepatocytes. In liver cirrhosis, the damaged of liver cells reduced TPOproduction. This leads to reduce thrombopoiesis in the bone marrow and consquently causesthrombocytopenia. However, these two pathogeneses were still remained controversial results in previousstudy abroad.The aim of this study was to determine the correlation between disease severity of liver cirrhosisbased on Child-Turcotte-Pugh classification and serum thrombopoietin concentration. An analytic crosssectional study had been conducted among liver cirrhotic patients in Sanglah Hospital Denpasar. The subjectwere adult liver cirrhotic patients that were not on upper or lower gastro-intestinal tract bleeding, septiccodition/septic shock, without history of taking antithrombocytic drugs or received platelets transfusion inlast two weeks, and no history of thrombocytopenia due to primary haematologic disorders. Statisticalanalysis was done by Spearman’s test and multivariate linier regression model, with significant level p <0,05.The number of subjects were 39 liver cirrhotic patients consist of 28 (71.8%) men and 11 (28.2%)women. The median of age was 53 (25 – 68) years. We found subjetcs with Child-Turcotte-Pugh class A 3(7.7%), B 18 (46.2%) and C 18 (46.2%) respectively with the median of Child-Turcotte-Pugh score was 9 (6– 14). The range of serum TPO concentration was 1.10 – 224.60 pg/ml, median of serum TPO was 40.60pg/ml. The median of thrombocyte was 103 x 103/L with range of 30 – 729 x 103/L. Liver cirrhoticpatients with thrombocytopenia were 29 (74.4%), 41.0% of them with moderate thromboytopenia. We foundnegative correlation between Child-Turcotte-Pugh score and serum TPO concentration ( r = - 0.319; p = 0.048) but there was no correlation between Child-Turcotte-Pugh class and TPO concentration. (r = -0.303;p = 0.061). We found significant positif correlation between thrombocyte count and serum TPOconcentration also (r = 0.354; p = 0.027). Based on multivariate linier regression model, we did not findsignificant association between TPO concentration and Child-Turcotte-Pugh score (p = 0.153) orthrombocyte count (p = 0.208), respectively. Conclusion: there was no correlation between disease severityof liver cirrhosis based on Child-Turcotte-Pugh classification and serum thrombopoietin concentration.
PENDEKATAN DIAGNOSIS DAN TERAPI FIBROSIS HATI Anom S, Tjok Istri; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Liver Þ brosis is the excessive accumulation of extracellular matrix proteins including collagen that occurs in most typesof chronic liver. The gold standard to assess disease severity of liver Þ brosis is liver biopsy, despite noninvasive methodsavailable today. A noninvasive tool (Þ bro scan) has been developed these days. This tool is similar to ultrasound in assessingliver elasticity. There are three methods frequently used to assess liver Þ brosis, Ishak score, Metavir score, and Desmet/Scheuerstaging system. The principles of antiÞ brotic therapy are: (a) to treat primary disease; (b) to reduce inß ammation responseor to avoid stimulation of stellate cell activation; (c) to reduce stellate cell activation; (d) to neutralize proliferation response,Þ brogenic response, contractic response, and/or stellate cell proinß ammation; (e) to stimulate apoptosis of stellate cell; and (f) toincrease degradation of Þ brotic tissue.
PENANGANAN DISPEPSIA PADA LANJUT USIA Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 7, No. 3 September 2006
Publisher : journal of internal medicine

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Abstract

In elderly patients with dyspeptic syndrome, organic causes more prevalence rather than fungsional related disorders. Theuse of Nonsteroid Anti Inflammatory Drugs (NSAIDs) and H. pylori infection play as important role as causes of organicdyspepsia in eldery patients. There are some changes in upper gastrointestinal tract which is related to aging process, especially inmucosal defance mechanism. The changes in aggressive factors are only a few. Diagnostic approach with endoscopic examinationis necessary in eldery patients with dyspeptic syndrome to role out the possibility of organic origin. The management of dyspepsiain eldery patients needs comprehensive approach because clinical presentation usually asymptomatic, the use of polypharmacy,co-morbidity, and the probability of organic origin as a cause needs to be proved since the beginning.
PERKEMBANGAN TERKINI DALAM DIAGNOSIS DAN PENATALAKSANAAN IRRITABEL BOWEL SYNDROME Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 8, No. 3 September 2007
Publisher : journal of internal medicine

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Abstract

Irritable bowel syndrome (IBS) is a common gastrointestinal (GI) motility and sensory disorder that ischaracterized by abdominal pain/discomfort, bloating and altered bowel habit. The disease accounts for hugecosts for both patients and health-care systems and worsens significantly patients’ quality of life. Diagnosis isbased on the identification of symptoms according to Manning, Rome I and Rome II criteria and the most recentRome III criteria and exclusion of alarm indicators. The treatment of IBS is centred on an excellent doctor–patient relationship along with drugs targeting the predominant symptom, especially during exacerbations. Thisreview aim to explain new ctriteria to diagnose IBS and to conduct a systematic evidence-based review ofpharmacological therapies currently used, or in clinical development, for the treatment of IBS
HUBUNGAN ANTARA INTERLEUKIN- 6 DAN C-REACTIVE PROTEIN PADA SIROSIS HATI DENGAN PERDARAHAN SALURAN MAKANAN BAGIAN ATAS Mariadi, I Ketut; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 9, No. 3 September 2008
Publisher : journal of internal medicine

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Abstract

Variceal bleeding is a frequent complication of liver cirrhosis. Upper gastrointestinal (GI) bleeding is a risk factor forinfection. The severity of liver cirrhosis was correlated with infection and GI bleeding. Bacterial infection and endotoxin promotecytokine proinflammation (IL-6) release from monocyte. IL-6 stimulates the liver to produce CRP. Does liver cirrhosisaffect the CRP production? Recently, there are no data about the correlation of IL-6 and CRP in liver cirrhosis with uppergastrointestinal bleeding. A cross-sectional analytic study was performed to describe the correlation between IL-6 and CRP inliver cirrhosis patient with upper gastrointestinal bleeding.We performed a cross-sectional analytic study in 52 liver cirrhosis patients. The liver cirrhosis patients with uppergastrointestinal bleeding in last 14 days, absence of steroid and statin treatment, without hepatoma, and GFR 15 ml/mnt/1.73m2, were collected consecutively. The correlation of IL-6 and CRP was analyzed with Pearson correlation test, mean differenceof CRP between Child Turcotte Pugh (CTP) group was analyzed by Ancova test continued with post hoc Tamhane test, the effectof CTP on CRP production was analyzed with Ancova test.Seventy-five percent out of 52 samples were male and the rest were female. Two of them (3.8%) with CTP score A, 20(38.5%) CTP score B and 30 (57.7%) CTP score C. Mean of IL-6 was 28.29 ± 34.60. Mean of CRP was 17.17 ± 28.80 mg/L. Wefound strong positive correlation between IL-6 and CRP (r = 0.610; p<0.001). CTP score didnt have significant independenteffect on correlation of IL-6 and CRP level (F=2.33; p=0.108). Significant mean difference of CRP was found between CTP scoregroup (F=4.27; p=0.02).In conclusion, Interleukin-6 has a strong correlation with CRP in liver cirrhosis with upper GI bleeding. CRP level issignificantly higher in severe liver cirrhosis. And the degree of liver damage doesnt have significant independent effect oncorrelation of IL-6 and CRP level. These results show us that hepatocyte in liver cirrhosis still adequately produce CRP.
KORELASI ANTARA DERAJAT GASTRITIS DAN RASIO PEPSINOGEN I/II PADA PENDERITA GASTRITIS KRONIS Dary, I Wayan; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 10, No. 2 Mei 2009
Publisher : journal of internal medicine

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Abstract

Chronic gastritis is a histopathological entity characterized by chronic inflammation of the stomach mucosa. Chronicgastritis tend to damage stomach mucosa and be atrophy sequence to change gastric physiology. Pepsinogen (PG) can be used asÔserologic biopsy,Õ as clinical application for evaluating gastric inflammations. The different cellular origins of PG I and PG II areimportant because alteration in their serum concentration can be correlated with some histological gastric anomalies. To determinethe correlation between grade of gastritis and PG I/II ratio (PGR) in chronic gastritis patients, we conducted an analyticcross sectional study in 64 gastritis patients whom enrolled consecutively. Gastric mucosal of dyspeptic patients who had uppergastrointestinal endoscopy biopsy 2 at anthrum and 2 at corpus were examined histologically using the Updated Sydney System(USS) by two pathologists independently, and also the serum examined for PG I, PG II, and IgG H. pylori. Degree of gastritis wascounted with the USS method. Pepsinogen examination used ELISA method, however IgG H. pylori examanition usedimmunochromatographic test (ICT) method with local reagen. H. pylori positive if serologically H. pylori positive and or histologicallyH. pylori positive. Interobserver agreement for histopatology abnormalities were examined by using kappa test. Thedifference PGR and severity of gastritis between subjectswith H. pylori positive and H. pylori negative were identified by usingMann-Whitney U test. Correlation between the severity of gastritis and PGR was identified by using spearmanÕs test and theeffect of total USS score and H. pylori to PGR was identified by using dummy regression, also to know the effect of PGR and H.pylorito total USS score was identified by using dummy regression. Pvalue of less than 0.05 was considered statistically significant.There were 64 chronic gastritis whom mean age 45.9 ± 15.5 year, consisted of 44 male and 20 female. The level of PG I218.70 (53,90 Ð 530.00) mg/L, PG II 15.72 (2.84 Ð 59.25) mg/L, dan PGR 12.66 (28.97 Ð 5.80). Interobserver agreement of gastrichistologic examanation shown moderate to substantial criteria (k = 0.590 Ð 0.795) with polymorphonuclear activity k = 0.795,glandular atrophy k = 0.591, density of H. pylori k = 0.727, chronic inflammation k = 0.629, and intestinal metaplasia k = 0.778.The frequency of abnormalities gastric mucosa as infected H. pylori 28.1%, inflammation 100.0%, polymorphonuclear activity22.8%, atrophy 37.5%, and intestinal metaplasia 6.2%. Total USS score from 1 to 9 and most of them had score 1 and 2 withfrequency 17 (26,6%) and 15 (24,4%) respectively. Subjects with H. pyloriinfection had lower PGR than uninfected subjects(11.2 ± 4.3 mg/L vs 15.0 ± 5.1 mg/L, p = 0.001; Mann-Whitney U test), and also subjects with H. pyloriinfection had higherseverity of gastritis than uninfected subjects either degree of inflammation, activity polymorphonuclear, and atrophy (p = 0.000,p = 0.004, p = 0.041 respectively; Mann-Whitney Utest). There was significant inversed correlation between total USS score andPGR (r = -0.470, p < 0.0001; SpearmanÕs tes). Significant effect of total USS score and positivity H. pylori to PGR (F = 7.015, p = 0.002; dummy regression), but only coefficient of total USS score significantly (t = -2.030, p = 0.047), however positvity H.pylori didnÕt influence PGR significatly (t = -1.199, p = 0.235). Total USS score influences PGR as much as 15,4% (adjusted R2= 0.154, F = 12.504, p = 0.001; linier regression) with regression coefficient -0,933 (t = -3.536, p = 0.001). H. pylori serology andPGR can be used to determine total USS score significantly (F = 9.498, p < 0.0001; dummy regression) and both of regressioncoefficient were significant (t = -3.417, p = 0.001; t = 2.360, p = 0.021 respectively; dummy regression) how ever can be madeÔserologic biopsyÕ with formula Ôtotal USS score = 6.786-0.169.PGRÕ for H. pylori positive subjects and Ôtotal USS score = 5.258Ð 0.169.PGRÕ for H. pylori negative subjects. In conclusion that there was a significant inversed correlation between total USSscore and PGR, formula Ôserologic biopsyÕ to determine total USS score were Ôtotal USS score = 6.786 Ð 0.169.PGRÕ for H. pyloripositive subjects and Ôtotal USS score = 5.258 Ð 0.169.PGRÕ for H. pylori negative subjects.
SEORANG PENDERITA DENGAN KARSINOMA SEL SKUAMUS ESOFAGUS Arsana, I Putu; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 1 Januari 2010
Publisher : journal of internal medicine

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Abstract

Oesophageal carcinoma still rare in Indonesia. Several centers reported low prevalence of oesophageal carcinoma.Three patients found in Palembang in one year, while four patients found in Bandung within ! ve years. Esophageal carcinomawas found in 1.1% of all cancer, and 7% of all digestive organ cancers in United States. Oesophageal carcinoma have mortalityratio of 0.95%. Oesophageal carcinoma more frequent in men with a ratio of 3:1. Diagnosis by anamnesis, physical examination,routine blood tests, barium esophagogram, esofago-gastroduodenoscopy, chest and abdominal CT-scan or MRI, bronchoscopy,endoscopic ultrasound, and also with laparoscopy. A 55-years old Balinese woman came with complaints of dif! culty inswallowing and diagnosed as squamous cell middle third oesophageal carcinoma stage III. Anamnesis, barium esofagogram,gastroduodenum endoscopy (OGD), and histopathological biopsy con! rmed the diagnosis of this patient. This patient givenchemotherapy with combination of 5-" uorouracil (5-FU) 40 mg/day and cisplatin 1500 mg/day 2 ? 3 cycles every 3 weeks
PENGARUH VIRUS HEPATITIS C PADA RESPON CD4 SETELAH 6 BULAN PEMAKAIAN REGIMEN KOMBINASI ANTIRETROVIRUS LINI PERTAMA PADA PASIEN INFEKSI HIV Somia, Agus; Utama, Susila; Parwati, Tuti; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 11, No. 2 Mei 2010
Publisher : journal of internal medicine

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Abstract

Hepatitis C Viral (HCV) and Human ImmunodeÞ ciency Virus (HIV) infection are global health problems. Co-infectionHIV-HCV in intravenous drug users about 53 99%. Despite very high prevalence of this co-infection, there were controversiesabout impact of hepatitis C virus in CD4 response of HIV patients receiving anti retroviral therapy. We conduct a retrospectivecohort to Þ nd out the impact of hepatitis C virus in CD4 response after 6 months of Þ rst line ART therapy. We collect data fromVCT-CST clinic patient!s record. Inclusion criteria for this study were HIV patients more than 12 years old, receiving Þ rst lineof ART treatment, and with anti HCV result.Sixty two patients enrolled for this study. Twenty eight patients found positive anti HCV and 34 negative anti HCV result.Mean of age was 29 ± 4.44 years old in anti HCV (+) group and 34 ± 7.335 in anti HCV (-) group, male dominant (92.9% and85.3% respectively). There were no signiÞ cant differences in total lymphocyte count, hemoglobine, and transaminases (AST andALT) between the two groups. The increasing of mean CD4 after 6 months ART treatment higher in anti HCV (-) group than inanti HCV (+) group, but statistically not signiÞ cant.
PERITONITIS BAKTERIAL SPONTAN PADA SIROSIS HATI DAN HUBUNGANNYA DENGAN BEBERAPA FAKTOR RISIKO Ayu Yuli Gayatri, Anak Agung; Wibawa, I Dewa Nyoman
journal of internal medicine Vol. 7, No. 2 Mei 2006
Publisher : journal of internal medicine

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Abstract

Spontaneous Bacterial Peritonitis (SBP) is a frequent and severe complication in cirrhotic patients with ascites. It occursin 10-30% of cases and assosiated mortality rate is 20-40%. Spontaneous Bacterial Peritonitis is diagnosed base on the presence ofa Polymorphonuclear leucocyte count greater than 250/mm3 or positive monomicrobial ascitic fluid culture. The key to successfultreatment of SBP is knowledge of appropriate antibiotic regimen and an understanding of the setting in wich infection develops,particularly those individuals at high risk of infection. This study was conducted to know prevalence of SBP and to evaluatepossible risk faktors for this complication such as: severe cirrhosis (Child C), upper gastrointestinal bleeding, low protein ascites(<1g/dL) and low platelet count (<98.000/mm3). Sixty two consecutive hospitalized patients with cirrhotic and ascites were followup for manifestations of SBP. Prevalence of SBP was 30.6%. Multivariate analysis and Logistic regression showed that onlysevere cirrhosis (Child C) is the risk faktor of SBP. (OR= 5.297; 95% CI=1.036-27.079).
Co-Authors - Mulyanto, - Anak Agung Ayu Yuli Gayatri Anak Agung Gde Waisampayana Putra Anwar Santoso Chandrawati, Lily Cokorda Agung Wahyu Purnamasidhi Dewa Gde Agung Budiyasa Dewa Gde Agung Budiyasa Dwijo Anargha Sindhughosa, Dwijo Anargha Gde Ngurah Idraguna Pinatih Gde Somayana Godfried Erycesar Yeremia Saragih H Da Silva Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendra Koncoro Hendriketa Da Silva, Hendriketa Da I Gde Raka Widiana I Gusti Agung Suryadarma I Ketut Agus Somia I Ketut Badjra Nadha I Ketut Mariadi I Ketut Sujana I Made Juliana I Made Susila Utama I Putu Arsana I Wayan Dary Ida Bagus Nyoman Wibawa Imro'ati, Tri Asih Indraguna Pinatih, Indraguna Jemi Tubung Juniarta, Pande Made Kumbara, Cokorde Istri Yuliandari Krisnawardani Lily Chandrawati Luh Putulin Indrayani Luh Putulin Indrayani, Luh Putulin Made Wardhana Magat, Renaldy Frederich Nathanael Mario Steffanus Mulyanto Nefertiti, Eva Pravitasari NGP Cilik Wiryan Ni Wayan Winarti Nicholas Wijayanto Nyoman Purwadi Pande Made Juniarta Paramita, Anak Agung Ketut Yunita Paramita, Ida Ayu Pradnya Prihastuti, Putu Shely Purnama, Yongkie Iswandi Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Putu Prathiwi Primadharsini Titong Sugihartono Tjok Istri Anom S Tuti Parwati Wibawa, Ida Bagus Nyoman Widodo, Budi Yaditta Mirdania Yenny Kandarini Yongkie Iswandi Purnama Yuna Ariawan