Probiotics in Ankylosing Spondylitis: A Possible Potency

Ankylosing Spondylitis (AS) is a common autoimmune arthritis which prevalence ranging from 0.1% up to 1.4% globally. Furthermore, in Asian population the prevalence of AS was increasing overtime. Up until now, there were several treatment options available in treating AS in Indonesia. However, there was still some limitations in complete remission achievement and some have limitation in potential adverse drug reaction. Eventually, these affect both patients’s daily activity and their quality of life.There were studies demonstrated the association between intestinal dysbiosis and inflammatory rheumatic disorders. Previous studies also presented there was an altered composition of gut microbiota in AS patients. Probiotic in the other hand, has been known previously for its efficacy in treating intestinal dysbiosis. Hence, this review aimed to identify potencies, efficacy and safety of probiotics as AS treatment options

Clinical, Molecular, and Histopathological Aspect of Primary Biliary Cholangitis

Primary biliary cholangitis (PBC), previously known as primary biliary cirrhosis, is an autoimmune liver disease which tends to be chronic and progressive in nature that is marked by the presence of cholangitis and small size biliary duct destruction which may cause cirrhosis or even liver failure. PBC incidence increases because PBC can now be diagnosed earlier and is due to the increasing survival rate of PBC patients. Diagnosis of PBC can be confirmed in asymptomatic state if in the indirect immunofluorescence (IIF) examination revealed AMA positive, and there is an abnormal liver function. Etiopathogenesis of PBC is multifactorial which involves genetic and environmental factors. Genetic factors which contribute to the incidence of PBC are HLA and non-HLA genes, while in the environmental factors, the triggering factors of PBC are bacterial infection and xenobiotic. Interaction of these factors causes the development of E2 subunit pyruvate dehydrogenase complex (PDC-E2) and antimitochondrial antibody (AMA) as the causing autoantigen of biliary duct desctruction in PBC, mediated by the immune system. PBC stage is divided into minimal, mild, moderate and severe. Ursodeoxycholic acid (UDCA) is the first line therapy for PBC, while obeticholic acid (OCA) and fibrate is used as the second line. Liver transplantation is the definitive therapy for PBC where disease progresses into the advanced stage, although the patients have received medical treatment

A Two Generation of Familial Adenomatous Polyposis

Familial adenomatous polyposis (FAP) is a part of genetic polyposis syndrome which is caused by germline mutation in the adenomatous polyposis coli (APC) gene located in chromosome 5q21. The pathognomonic features is formation of hundreds to thousands of colorectal adenoma in late childhood and increase in size and number during adolescence. If left untreated, almost 100% patients will develop colorectal cancer by the age 50 years. We present a case of 26 year old male who complain of rectal bleeding, diarrhea, abdominal bloating, and has multiple polyps on colonoscopic finding. Two years ago, his father was diagnosed with polyposis coli and transverse colon adenocarcinoma. The patient was planned for preventive total colectomy. In conclussion, surgery remains the cornerstone treatment of FAP and surveillance program for early detection of cancer for all family member is very important to reduce colorectal cancer-related mortality

A Systematic Review of the Frequency of Regulatory T Cells in Hepatitis B and Hepatitis C

Background: Regulatory T cells (Tregs) play an important role in sustaining the hepatitis B and C viruses (HBV and HCV) persistence and protecting the liver tissues from cytokine-associated detrimental effects through unclear mechanisms. This paper aims to review the frequency of Tregs during the course of HBV and HCV infection.Method: Electronic databases were searched to identify studies investigated the frequency of intrahepatic and peripheral Tregs of the patients infected with HBV and/ or HCV.Results: The majority of studies reported the increase of intrahepatic and peripheral Tregs in acute and chronic infection of HBV and HCV. The decrease of peripheral Tregs occurred in patients with chronic hepatitis B who respond to interferon α or nucleos(t)ide analogues treatment as well as those with chronic hepatitis C who were treated with interferon, ribavirin or liver transplantation.Conclusion: Infection with HBV and HCV appears to induce the production of Tregs in blood and hepatocytes whereas treatment may decrease Tregs levels. As the optimum balance between regulatory and effector T during HBV and HCV infection is crucial for preventing liver damage, further studies should be directed on the development of Tregs during HBV and HCV infection as well as their involvement in immunomodulatory strategies for combating HBV and HCV

The Correlation Between Depression and Gerd-Q Score Among Dyspepsia Patient in Atma Jaya Hospital

Background: In adults, the symptoms of Gastroesophageal Reflux Disease (GERD) are often complained of in daily life and their prevalence has increased. Symptoms of GERD are often found along with the occurrence of dyspepsia. One of the factors that affect the symptoms of GERD is depression. Due to the limited data available in Indonesia, this study was conducted to see the correlation between depression and Gastroesophageal Reflux Disease Questionnaire score (GERD-Q).Method: This study was conducted on dyspepsia patients at Atma Jaya Hospital (RSAJ) beginning at June to September 2018. The study was conducted using a cross-sectional design and using the GERD-Q and Depression questionnaire, Anxiety, Stress Scale 42 (DASS 42) which has been translated and validated by other researchers to measure GERD scores and depression scores.Results: The total respondents of this study were 53, with the percentage of men and women being 30.2% and 69.8% respectively. The average age of patients was 57.2, with those who were overweight / obese as much as 64.2%, and those who smoked as much as 9.4%. As many as 73.6% respondents had a GERD-Q score of ≥ 8. Moreover, 35.8% of respondents had mild depression, 15.1% had moderate depression, and 3.8% had severe depression. The results showed a significant correlation between depression and GERD-Q score in Atma Jaya Hospital dyspepsia patients (p = 0,000, r = 0,496).Conclusion: There is a correlation between depression and GERD-Q score of dyspepsia patients at Atma Jaya Hospital 

Role of Radial Endoscopic-ultrasound (EUS) to Establish Diagnosis of Undetermined Causes of Obstructive Jaundice: A Case Series

Identification the causes of obstructive jaundice are challenging. Recent radiologic imaging techniques improve diagnostic yield to determine jaundice causes. However, small lesions particularly in pancreas or periampullary area that lead to jaundice, often unrecognize with conventional radiologic imaging. Radial endoscopic-ultrasound (EUS) is the most sensitive modality to identify the lesions-related obstructive jaundice, remarkably in the lack of high-resolution radiologic facilities. We presented four cases of obstructive jaundice, without obvious obstruction causes from conventional radiologic imaging or abdominal ultrasound. All patients underwent radial EUS, pancreatic head mass revealed in 2 patients, and distal stenosis of the common bile duct without evidence of mass was found in 2 other patients. The masses size were 16 mm and 39 mm in diameter. Due to linear EUS and EUS guided fine needle were unavailable in our center, confirmation biopsy was undone. Three patients were performed endoscopic retrograde cholangiopancreatography (ERCP) for dilatation and inserting stents, and one patient referred to the surgeon. In conclusion, radial EUS aided to diagnose the definite causes of jaundice despite in the less-equipped of high-resolution radiologic imaging

Clinical Characteristics and Outcome of Acute on Chronic Liver Failure Patients at Fatmawati General Hospital

Background: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute liver decompensation with extrahepatic organ failure in patients with pre-existing liver disease causing high short-term mortality. A good knowledge about characteristics and diagnostic of ACLF will help us to give proper treatment. The aim of this study is to know the profile and characteristics of ACLF patientMethod: Retrospective study was conducted to find patient with ACLF between January 2017-January 2018 at Fatmawati General Hospital.Results: Ten patients were diagnosed with ACLF. Six patients admitted with a chief complaint: unconscious, 2 of them had hematemesis in the course-of-treatment. Three patients were admitted with abdominal pain, and 1 patient with hematemesis-melena. Seven patients had Hepatitis-B infection. Aspartate-transaminase to platelet-ratio index (APRI) values varied (median 8.1;minimum 2.81-maximum 34.67). Hepatic encephalopathy, ascites, and acute renal failure were found in 90% of patients. Jaundice can be found in all patients, with mean values of bilirubin levels in patients undergoing test for bilirubin level were 18.56 mg/dL (9/10). Coagulation disorders were found in 60% of patients undergoing haemostasis test. Four patients were diagnosed with grade 3 ACLF. All ACLF patients eventually died during treatment, including third-degree patients who all died within 7 days. Only 2 patients survived more than 7 days, and 4 patients died within 3 days of treatment.Conclusion: mortality rates of ACLF were very high, and are often found in patients with advanced liver disease characterized by high APRI values. The prognosis is related to the number of organ failures. Central nervous system, kidneys and liver are the organs that are often impaired. Because the current treatment method is still limited, further research is needed, especially on biomarkers for better prevention, diagnosis and treatment

Acute Pancreatitis – Etiology, Pathogenesis, Pathophysiology and The Current Trend in Its Management and Prevention

Acute pancreatitis is an episode of cellular injury and inflammation of the pancreas parenchyma triggered by autodigestion of pancreatic parenchyma by abnormally activated pancreatic enzymes, its manifestations ranges from mild, moderate-severe and severe pancreatitis. Most episode of acute pancreatitis resolved completely while some develop recurrent acute pancreatitis and in turn progressing to chronic pancreatitis and its sequelae. While many etiologies known may cause acute pancreatitis, current theories propose three mechanism that may be involved in the pathogenesis of acute pancreatitis i.e. duct obstruction, direct acinar injury and defective intracellular transport. Recommendations from current guidelines are very useful to treat acute pancreatitis, few groundbreaking changes from the previously dated guidelines on treating acute pancreatitis are also made, providing us dated evidence-based approach to treat acute pancreatitis. Judicious and aggressive treatment are needed to minimize the damaged area of involved pancreatic parenchyma. Holistic prevention is needed to minimize the incidence of acute pancreatitis, pushing down the numbers of recurrent acute pancreatitis and ultimately may decrease the incidence of chronic pancreatitis and its sequelae

The Diagnosis and Management of Acute Fatty Liver of Pregnancy

Acute fatty liver of pregnancy (AFLP) is a rare catastrophic illness constituting an obstetric emergency in third trimester of pregnancy and may have complications for both mother and fetus, including death. Yet it is still unclear, the pathogenesis of AFLP has been identified related to defects in fatty acid metabolism during pregnancy, especially in the setting of fetal genetic defects in fatty oxidation. Establishing the diagnosis of AFLP is challenging, further it may overlap with other liver diseases of pregnancy, such as preeclampsia and hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome. The management of AFLP is a multidisciplinary progress providing the prompt intervention more than the termination of the pregnancy. The awareness of AFLP is highly needed to provide early diagnosis and management so that it can reduce the morbidity and mortality

Inflammatory Bowel Disease in Young Adult

Inflammatory bowel disease is a chronic inflammatory disease that consist of Crohn’s disease and ulcerative colitis. A dramatic increase in the prevalence if inflammatory bowel disease (IBD) within developing countries including in Asia makes IBD a substantial global medical burden and modern refractory disease, and it is imperative that Asian healthcare systems especially physician are aware of this and familiar with the clinical manifestation and management. The aim of this case report is to present a case of IBD in young adult in Indonesia. Patient came with complaint of chronic diarrhea and had seen multiple doctor without improvement. Inflammatory bowel disease should always be considered in patient with chronic diarrhea with or without extraintestinal manifestation especially after poor response of usual antidiarrheal medication. Diagnosing of IBD is based on clinical manifestation, physical examination, laboratory result and endoscopy. Until now, ileocolonoscopy and biopsy is the most accurate diagnostic modality for IBD and can be used to differentiate between ulcerative colitis and Crohn’s disease. Treatment of IBD are drugs such as mesalazine until surgery based on the severity or complication of disease