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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Saskia Aziza Nursyirwan, Saskia Aziza
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Medicine & Pharmacology

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Predictor Factors Affecting Seroconversion Post-InfluenzaVaccination in the Elderly Nursyirwan, Saskia Aziza; Koesnoe, Sukamto; Wahyudi, Edy Rizal
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. The influenza vaccine as the most effective method for preventing influenza virus infection currently has lower efficacy in the elderly than younger adults due to change of immune response as well as other risk factors. This study aims to identify predictor factors affecting seroconversion post-influenza vaccination in elderly. Methods. retrospective cohort study in the elderly population in East Jakarta Posyandu who got the influenza vaccine. A total of 277 subjects with antibody titre pre and one month post-vaccination influenza were examined. Risk factors such as age, gender, exercise status, smoking status, type 2 diabetes, pulmonary, and cardiovascular disease, nutritional status of MNA (Mini Nutritional Assessment), GDS (Geriatric Depression Scale), and pre-vaccination antibodi titre were assessed in each subject. Results. The proportion of elderly people who seroconverted (fourfold rise or more in antibody titer post-vaccination) was 50.9% (141/277). On multivariate analysis, the predictor factors that affect seroconversion of one month post- influenza vaccination in the elderly on the community is a no depression state (p = 0.048, OR = 2.1, CI = 1.01 to 4.30), exercise status ≥5 times per week minimal 30 minutes (p = 0.013, OR 4.0, CI 1.34 to 11.76), and not seroprotective pre-vaccination (p=0.000, OR 6.4, CI 3.40 to 11.99). Conclusion. Predictor factors affecting seroconversion post-influenza vaccination in the elderly on the community is depression status, exercise status and pre-vaccination antibody titre.
Gastrointestinal Bleeding as a Manifestation of IntestinalTuberculosis in Leprosy Patients with Reversal Reaction andHistory of Long-Term Steroid Therapy Gebrina, Meutia; Nursyirwan, Saskia Aziza; Soewondo, Pradana; Fauzi, Achmad; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 1
Publisher : UI Scholars Hub

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Abstract

Intestinal tuberculosis is difficult to be diagnosed. Signs and symptoms usually are not specific, and the results of diagnostic tools are frequently negative. One of the unusual symptoms of intestinal tuberculosis is gastrointestinal bleeding, which should increase the awareness of clinical practitioners.
Secondary Prevention of Esophageal Variceal Bleeding Using Transjugular Intrahepatic Portosystemic Shunt Compared to Endoscopic Band Ligation plus Beta-Blocker Yo, Edward Christopher; Nursyirwan, Saskia Aziza
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023275

Abstract

Aim: This study aims to compare the effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) against combination therapy in the secondary prevention of esophageal variceal bleeding.Method: Literature search was conducted using 4 databases (PubMed, Cochrane, Ovid MEDLINE, and Ovid Embase) and individual hand searching. The selected studies were then critically appraised for their validity, importance, and applicability.Results: A total of 136 results were retrieved, and 2 systematic reviews and meta-analysis of randomized controlled trials (RCTs) were selected. Both studies showed that TIPS significantly decreased incidence of esophageal variceal rebleeding but had no significant effect on reducing overall mortality when compared to combination therapy. Study by Lin et al found that TIPS was significantly better than combination therapy for reducing mortality from variceal rebleeding, but study by Jing et al found no significant difference.Conclusion: TIPS is superior to combination therapy in reducing the incidence of esophageal variceal rebleeding. Nevertheless, its effectiveness in reducing mortality needs further investigation. Future research should look into its complications and cost-effectiveness in developing countries like Indonesia.
Tranexamic Acid in the Management of Non-variceal Upper Gastrointestinal Bleeding Reza, Muhammad; Nursyirwan, Saskia Aziza
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202483-93

Abstract

Background: Non-variceal upper gastrointestinal bleeding (UGIB) is a common case of emergency in daily clinical practice with a fairly high mortality rate. The use of tranexamic acid, which has been recommended in managing trauma bleeding, may serve as an alternative pharmacological therapy to manage bleeding in non-variceal UGIB. This evidence-based case report aims to evaluate the impact of tranexamic acid on managing bleeding, risk of mortality, and thromboembolic event in non-variceal UGIB patients.Methods: A systematic literature search was conducted on 4 databases: CDSR, EMBASE, PubMed, and Scopus for meta-analyses. Studies were selected based on inclusion and exclusion criteria formulated a-priori with subsequent critical appraisal according to the OCEBM critical appraisal tools. Result: Meta analyses by Kamal, et al (2020) and Twum-Barimah, et al (2020) were included in our report. Kamal, et al shows no significant difference in mortality in tranexamic acid use compared to placebo (RR 0.84; 95%CI 0.63–1.11; I2=2%). Similarly, although Twum-Barimah reported tranexamic acid reduced risk of mortality compared to placebo (RR 0.45; 95%CI 0.23–0.88; p=0.02; I2 = 0%), none of the RCTs included shows significant result when observed individually. In addition, Kamal, et al also reported increased risk of vein thromboembolic events in high-dose tranexamic acid administration (RR 2.21; 95%CI 1.32–3.69; I2=0%) compared to low-dose administration, in UGIB patients.Conclusion: Tranexamic acid is not recommended to be used in managing bleeding in patients non-variceal UGIB patients and may increase the risk of thromboembolic event.
Evidence-Based Case Report: Comparison of Potassium Competitive Acid Blocker and Proton Pump Inhibitor as First Line Therapy in Adult Patients with H. pylori Infection Mustikarani, Dewi; Citrawijaya, Henrico; Nursyirwan, Saskia Aziza
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024%p

Abstract

ABSTRACTBackground: Increased eradication of Helicobacter pylori decreases the incidence of gastric cancer. Vonoprazan is a potassium-competitive acid blocker (PCAB) with a stronger acid production suppression effect than proton pump inhibitors (PPI). Vonoprazan has been recognized as a therapy for gastric acid reflux disease since 2015 in Japan, but the comparison of the effectiveness of PCAB first-line therapy with PPI for adult patients with H. pylori infection is still controversial.Method: A literature search was carried out on three databases: Pubmed, Cochrane, and Scopus on March 30th 2023, using keywords vonoprazan, potassium competitive acid blocker (PCAB), proton pump inhibitor, and H. pylori. There were 7 studies on Pubmed, 26 studies on Cochrane, and 144 studies on Scopus. Critical screening was conducted using the Oxford Centre for Evidence-Based Medicine for systematic reviews and randomized controlled trials. Results: Based on screening of inclusion and exclusion criteria, one study met the criteria. The intention to treat analysis (ITT) showed eradication of H. pylori in the combination of three therapies with PCAB vs PPI of 91.81% vs 75.5% (1,18 [1.08−1.28], p0,0001), no heterogeneity found (I2 = 43%). Analysis per protocol showed PCAB versus PPI eradications of 92.99% vs 78.57% (1,13 [1,02−1,26], p = 0.02), heterogeneity obtained (I 2 = 75%). Conclusion: Generally, PCAB has better eradication than PPI as first-line therapy for adult patients with H. pylori infection Keywords: potassium competitive acid blocker, proton pump inhibitors, helicobacter pylori
Updates on Management of Helicobacter pylori Infection and Antibiotic Resistant Helicobacter Infection Management Nursyirwan, Saskia Aziza; Simadibrata, Marcellus
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 1 (2022): VOLUME 23, NUMBER 1, April 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1080.631 KB) | DOI: 10.24871/231202267-73

Abstract

H. pylori is a common human pathogen and it is estimated that approximately 50% of the world's population are infected. Furthermore it's prevalence infection in Indonesia is 20% but much higher among several ethnic groups (Papuans 42.9%, Batak 40.0%, and Bugis 36.7%). H. pylori’s growth and survival has been shown to be sensitive to a variety of antimicrobial agents. The success of the treatment depends on susceptibility, dosage, formulation, dose frequency, the use of adjuvants such as anti-secretory drugs, antacids or probiotics, and duration of treatment. The treatment for H. pylori infection keep evolving and the triple therapy, levofloxacin, was replaced by CLR in triple therapy for 14-day with eradication rates over 90%. Sequential therapy, also achieved a higher cure rate against clarithromycin-resistant strains than a 7 and 10 day triple therapy. Triple bismuth therapy and quadruple bismuth therapy are used less frequently due to their inherent complexity, the large number of tablets four times a day, side effects, and lack of support from pharmaceutical companies. Inclusively, vonoprazan is also a good choice that is fully effective from day one. The role of the probiotics is unclear and is not recommended in consensus groups. Two mucolytic agents, erdosteine and N-acetylcysteine (NAC), were found to increase it's eradication efficiency clinical trials when administered in supplementation with triple therapy but are not commonly used because of the need for high doses, and increased medical costs. therefore, H. pylori resistant management should be adapted to the results of the the culture of resistance and the guidelines of existing resistance patterns.
Co-Authors Achmad Fauzi Arif Mansjoer Citrawijaya, Henrico Edy Rizal Wahyudi Kaka Renaldi Marcellus Simadibrata Meutia Gebrina, Meutia Muhammad Reza Mustikarani, Dewi Pradana Soewondo Sukamto Koesnoe Yo, Edward Christopher