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All Journal Jurnal Ners International Journal of Biomedical Science and Travel Medicine
I Putu Arya Giri Prebawa
Universitas Warmadewa
Health Professions Medicine & Pharmacology Nursing Public Health

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Transformasi Paradigma Ensefalopati Hepatikum: Integrasi Gut–Liver–Brain Axis, Neuroinflamasi, dan Biomarker Modern I Putu Arya Giri Prebawa
Jurnal Ners Vol. 10 No. 1 (2026): JANUARI 2026
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jn.v10i1.53474

Abstract

Hepatic encephalopathy (HE) is increasingly recognized as a complex neuropsychiatric disorder driven by multidimensional interactions within the gut–liver–brain axis rather than ammonia toxicity alone. Recent evidence demonstrates that the synergy between hyperammonemia, systemic inflammation, microbiota dysbiosis, and metabolite dysregulation—particularly bile acids—triggers microglial activation, astrocytic dysfunction, and blood–brain barrier disruption. Sarcopenia and myosteatosis further impair ammonia detoxification and reduce neuroprotective signaling. Emerging biomarkers, including neurofilament light chain (NfL), YKL-40, bile-acid panels, and functional neuroimaging (rs-fMRI, DTI), provide improved sensitivity for early detection of subclinical impairment. Therapeutic strategies now extend beyond ammonia reduction to microbiota modulation (rifaximin, FMT), next-generation ammonia scavengers, and muscle-targeted interventions. Integration of metabolomic profiles with artificial intelligence supports the development of precision medicine approaches, enabling accurate risk stratification and personalized therapeutic planning. This article summarizes the evolving pathophysiological paradigm, diagnostic advances, and future therapeutic innovations in HE.
Update on the Diagnosis of Traveler’s Diarrhea: Current Strategies and Emerging Trends Kennedy Winata; Kartika Cahyaningrum; Dayana Puspawarna; Ngakan Satria Wibawa; Agung Kesuma Putra; Bagas Aditya Kurnia Pratama; Eva Santhy; Adi Arya; Miracle Lie; Herliana Yuliartha; Arnelia Tasau; Arya Giri Prebawa; Saraswati Laksmi Dewi
International Journal of Biomedical Science and Travel Medicine Vol. 1 No. 2 (2024)
Publisher : Publication Department, Universitas Warmadewa

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22225/ijbstm.1.2.2024.37-44

Abstract

Traveler’s diarrhea (TD) remains a prevalent condition affecting individuals traveling to regions with varying sanitation standards. The diagnosis of TD has evolved with advancements in diagnostic tools and a better understanding of its etiology. Traditionally diagnosed based on clinical presentation and exposure history, current approaches increasingly incorporate molecular techniques to identify causative pathogens more accurately. Recent updates highlight the integration of polymerase chain reaction (PCR) and other molecular diagnostic methods that offer rapid, sensitive, and specific detection of bacterial, viral, and parasitic pathogens. These advances enable differentiation between infectious and non-infectious causes of diarrhea, which is crucial for effective management and treatment. Additionally, the role of stool cultures, although less commonly used in rapid diagnostics, remains important for comprehensive pathogen identification. Emerging research emphasizes the need for a tailored diagnostic approach considering geographic region, patient history, and symptom profile. The use of multiplex assays and metagenomic sequencing is showing promise in identifying a broad spectrum of pathogens and understanding the complex microbiological landscape of TD. This update underscores the importance of adopting a multifaceted diagnostic strategy to improve the accuracy of TD diagnosis, thereby enhancing patient care and contributing to the development of targeted treatment and preventive measures.
Co-Authors Adi Arya Agung Kesuma Putra Arnelia Tasau Bagas Aditya Kurnia Pratama Dayana Puspawarna Eva Santhy Herliana Yuliartha Kartika Cahyaningrum Kennedy Winata Miracle Lie Ngakan Satria Wibawa Saraswati Laksmi Dewi