Red Cell Distribution Width to Platelet Ratio is not Inferior than Aspartate Aminotransferase to Platelet Ratio Index Score in Predicting Liver Fibrosis in Chronic Hepatitis B Patients at Sanglah General Hospital Denpasar

Background: Red cell distribution width to platelet ratio (RPR) is known to be associated with a degree of liver fibrosis in patients with hepatitis B. This study aims to compare the under curve area, sensitivity, specificity, positive predictive value, and negative predictive value between RPR and aspartate aminotransferase to platelet ratio index (APRI) score with degree of fibrosis.Method: This study is a retrospective study, data taken from medical records of all chronic hepatitis B patients examined by Fibroscan at Sanglah General Hospital Denpasar, Bali from January 2016 to February 2018.Results: Ninety eight patients with chronic hepatitis B, 81 patients were recovered after exclusion of patients with chronic kidney disease, malignancy, and dengue haemorrhagic fever (DHF). In receiver operating characteristic (ROC) analysis, obtained area under the ROC curve (AUC) at RPR of 0.816, and at APRI score 0.797. In RPR with cut off 0.066 the sensitivity was 76.9%, specificity 78.6%, PPV 79.5%, NPV 73.8%. While APRI score with cut off 0.85 got 69.2% sensitivity, specificity 76.2%, PPV 73.0%, and NPV 72.7%. According to Kappa test, we found kappa coefficient 0.653 (p < 0.05).Conclusion: In predicting severe liver fibrosis in chronic hepatitis B patients, RPR is not inferior than APRI score, and may be used as a diagnostic marker, with 65.3% conformity

PENERAPAN PASAL 11 PERATURAN DAERAH KABUPATEN BULELENG NOMOR 5 TAHUN 2019 TENTANG PERLINDUNGAN PEREMPUAN DAN ANAK DARI TINDAK KEKERASAN DI KABUPATEN BULELENG TERKAIT RUMAH AMAN

Pemerintah Kabupaten Buleleng dalam menyediakan rumah aman untuk korban kekerasan terhadap perempuan dan anak belum terealisasi. Penelitian ini meneliti penerapan Pasal 11 Peraturan Daerah Nomor 5 Tahun 2019 Tentang Perlindungan Perempuan dan Anak dari Tindak Kekerasan di Kabupaten Buleleng Terkait Rumah Aman dan kendala-kendala dan upaya yang dilakukan Pemerintah Kabupaten Buleleng dalam menerapkan Pasal 11 Peraturan Daerah Nomor 5 Tahun 2019 Tentang Perlindungan Perempuan dan Anak dari Tindak Kekerasan di Kabupaten Buleleng Terkait Rumah Aman.  Penelitian ini merupakan penelitian hukum empiris, dengan sifat penelitian adalah deskriptif. Lokasi penelitian dilakukan di Dinas Pengendalian Penduduk, Keluarga Berencana, Pemberdayaan Perempuan dan Perlindungan Anak Kabupaten Buleleng (DP2KBP3A). Sumber dan jenis data penelitian ini menggunakan sumber data kepustakaan dan lapangan. Data dikumpulkan melalui teknik wawancara. Penerapan Pasal 11 Peraturan Daerah Nomor 5 Tahun 2019 Tentang Perlindungan Perempuan dan Anak dari Tindak Kekerasan di Kabupaten Buleleng Terkait Rumah Aman. Kabupaten Buleleng belum memiliki rumah aman untuk penanganan korban perempuan dan anak dari tindak kekerasan. DP2KBP3A Kabupaten Buleleng telah melakukan kerjasama dengan yayasan dan Lembaga Kesejahtraan Sosial Anak untuk penanganan kasus kekerasan terhadap perempuan dan anak dilakukan oleh Pusat Pelayanan Terpadu Pemberdayaan Perempuan dan Perlindungan Anak (P2TP2A)

High Incidence of Hepatitis B Virus Infection in Hemodialysis Patients at Sanglah General Hospital and It’s Risk Factors

Background: Patients receiving maintenance hemodialysis (HD) are at higher risk for Hepatitis B Virus (HBV) infections than in general population. Strict infection control is essential to prevent nosocomial transmission. We aimed to investigate the incidence of HBV infection in the HD population in Sanglah General Hospital as well as risk factors acquired HBV infection.Method: All adult patients receiving maintenance HD (n=267) in 3 dialysis units at Sanglah Hospital were studied between March to June 2016. In this study, medical record of patients on maintenance hemodialysis were reviewed and the patients were interviewed by the researchers to collect data regarding the serology status of these patients before and during HD, and potential risk factors which could be associated with HBV acquisition.Results: Participant mean age was 54.07 ± 0.80 years and 154 (57.7%) were male.We found 21 patients (7.8%) were sero-positive for HBV (HBsAg positive) with mean titer was 9.26±1.85. Of the sero-positive patients,1 patient (4.8%) were known to be infected before the initiation of HD and 20 patients (95.2%) were infected during HD. Incidence of HBV infection during  HD was 7.5% (20/266). Sero-positive patients were younger with mean age was 51.81±2.76 years, had longer time on dialysis and had previous blood transfusions. Risk factors, which significant associated with hepatitis B infection were history of transfusion (p<0.01; OR: 2.49; 95%CI: 1.29-8.18) and duration of hemodialysis (p < 0.01; OR: 1.07; 95% CI: 1.03-3.74).Conclusion: Patients on maintenance HD in Sanglah General Hospital have a high incidence of HBV infection. The factors associated with HBV infection are highly suggestive of nosocomial transmission within HD units. History of transfusion and duration of hemodialysis were significant risk factors for HBV infection in patients receiving maintenance HD

KESADARAN MASYARAKAT TERHADAP PENERAPAN HUKUM DI DESA JELIJIH PUNGGANG, KECAMATAN PUPUAN, KABUPATEN TABANAN-BALI

Kegiatan Pengabdian Kepada Masyarakat melalui penyuluhan hukum ini bertujuan untuk memberikan pengetahuan kepada masyarakat, sehingga masyarakat dapat paham dan sadar terhadap penerapan hukum di lingkungan sosial masyarakat baik hukum pidana maupun hukum perdata khususnya tentang undang-undang teknologi informasi, hukum pertanahan, aturan BUMDESA, hukum perkawinan dan pewarisan menurut hukum adat Bali dan tentang perceraian. Kegiatan ini telah diikuti oleh masyarakat Desa Jelijih Punggang. Kendala dalam kegiatan ini masih terbatasnya waktu dan masih dalam situasi pandemic covid-19. Penyuluhan hukum ini sangat diperlukan masyarakat mengingat akses masyarakat terhadap pemahaman hukum sangat rendah. Akibat dari kurangnya pemahaman hukum berimplikasi terhadap banyaknya prilaku-prilaku masyarakat yang melanggar hukum. Akhir kegiatan penyuluhan hukum ini para peserta dari kalangan masyarakat maupun aparat pemerintahan Desa Jelijih Punggang menjadi sadar betapa pentingnya paham terhadap hukum

PENERAPAN HUKUM PERDATA SECARA NYATA DI DESA MENYALI, KECAMATAN SAWAN KABUPATEN BULELENG-BALI

Kegiatan Pengabdian Kepada Masyarakat melalui penyuluhan hukum ini bertujuan untuk memberikan pemahaman dalam penerapan hukum perdata merupakan semua hukum privat materiil berupa segala hukum pokok mengatur kepentingan perseorangan. Hukum perdata terbagi menjadi empat, yaitu: Hukum tentang diri seseorang, Hukum Keluarga, Hukum Kekayaan, dan Hukum Waris. Kegiatan ini telah diikuti oleh orang masyarakat di desa Menyali. Kendala yang terdapat dalam kegiatan ini adalah masih kurangnya waktu dan batasan kerumunan masyrakat karena masih dalam situasi pandemi covid-19. Penyuluhan hukum ini dilakukan mengingat terlalu banyak permasalahan-permasalahan hukum yang terjadi di masyarakat. Permasalahan hukum tersebut sering terjadi, umumnya disebabkan karena rendahnya kesadaran hukum masyarakat. Kesadaran hukum masyarakat yang rendah, salah satunya disebabkan karena pengetahuan hukumnya juga rendah. Akhir kegiatan penyuluhan hukum ini para peserta dari kalangan masyarakat maupun perangkat desa Menyali menjadi sadar dan paham terhadap hukum

Association Between Red Cell Distribution Width (RDW)/Platelet Ratio and Degree of Fibrosis in Patient with Chronic Hepatitis B

Background : Histological examination of the liver remains the gold standard of assessing liver cirrhosis. However, this examination is an invasive method with many complications. Objectives : This study aims to determine the relationship between degree of liver fibrosis with RDW (Red cell Distribution Width) / platelet ratio which can then be used as non invasive diagnostic method of liver fibrosis. Methods : This was a retrospective study, the data of hematological profiles including hemoglobin, RDW, and platelet was taken from medical records of all chronic hepatitis B patients undergoing Fibroscan at Sanglah Hospital in January 2016 to February 2017. Results : Of 58 patients, 9 patients was excluded due to chronic kidney disease, malignancy and coincide with hepatitis C and HIV. The analysis using Kruskal-Wallis test, found a significant relationship between RDW / platelet ratio with degree of fibrosis in chronic hepatitis B (p<0.05). Of the 49 patients, 23 patients with mild-moderate fibrosis (metavir F0-2) and 26 patients with severe fibrosis (metavir F3-4) were found. In ROC analysis, the AUC was 0.701, using cut off 0,065 RDW/platelet ratio predict severe fibrosis about 73.1% sensitivity, spesificity 73.9%, positive prediction value 73.1%, and negative prediction value 70.8%. Conclusion : the RDW / platelet ratio can be used as a noninvasive diagnostic test of liver fibrosis in chronic hepatitis B patients

Detection of Helicobacter pylori CagA gene and Its Association with Endoscopic Appearance in Balinese Dyspepsia Patients

Background: Helicobacter pylori (H. pylori) infection causes various abnormalities in the stomach. Only particular strain can cause severe problems in the stomach. CagA is a microbial virulent factor which is associated with more severe stomach problems, such as: peptic ulcer and stomach cancer. We would like to know the prevalence of CagA in Balinese population, and the association of H. Pylori CagA status with the severity of endoscopic appearance in dyspepsia patients. Method: Study design being used was analytic cross sectional study, involving 71 dyspepsia patients who underwent upper gastrointestinal endoscopic examination in Surya Husada Hospital and Balimed Hospital in June-December 2013. Sample was chosen in consecutive manner. Later, polymerase chain reaction (PCR) examinations of the stomach mucous biopsy tissue to determine H. pylori infection status and CagA status were performed. Further, Chi square test was used to identify the difference in proportion of H. pylori and CagA between mild and severe endoscopic appearance. Results: In this study, we found that the prevalence of H. pylori infection was 22.5% using PCR examination. Prevalence of CagA positive in H. pylori positive was 62.5%. There was significant association between status of H. Pylori infection and severity of endoscopic appearance (p = 0.038; OR= 2.67; 95% CI = 1.18-6.05). Status of CagA in H. pylori infected patients was not associated with the severity of endoscopic appearance. Additionally, there was significant association between patients’ age and severity of endoscopic appearance. Conclusion: The prevalence of CagA in H. pylori positive was 62.5%. H. pylori infection was associated with severity of endoscopic appearance and CagA status in H. pylori infected patients was not associated with severity of endoscopic appearance

Age and Alarm Symptoms Predict Upper Gastrointestinal Malignancy among Patients with Dyspepsia

Background: Upper gastrointestinal (UGI) malignancy is one of the major causes of cancer related death. Endoscopy in dyspeptic patients above 45 years, or those with alarm symptoms may detect this condition. There were only limited data in Indonesia about age and alarm symptoms to predict UGI malignancy. This study was aimed to determine the prevalence of UGI malignancy among dyspepsia patients and to develop a simple clinical prediction model.Method: A cross-sectional study to 390 patients with dyspepsia underwent endoscopy in Endoscopy Unit of Sanglah Hospital Denpasar between July 2012 and June 2013 was conducted. Demography and alarm symptoms were documented. Chi-square and logistic regression test analysis were conducted to analyze variables associated with UGI malignancy.Results: Twenty (5.13%) of 390 patients with dyspepsia had UGI malignancy. Of the 20 patients, 65% were gastric cancer and 30% were esophageal cancer. The mean age was 59 ± 12 years. Variables associated with UGI malignancy were weight loss (OR = 8.2), dysphagia (OR = 6.2), age > 45 years old (OR = 5.6), gastrointestinal bleeding (OR = 5.5), persistent vomiting (OR = 5.4), and anemia (OR = 4.9). Using a simplified rule of age >45 years and the presence of any alarm symptom, sensitivity was 85% and specificity was 67.57%.Conclusions: UGI malignancy was found in 5.13% of patients with dyspepsia who underwent endoscopy. Simple clinical prediction model states that age above 45 years and alarm symptoms may be used as a screening tool to predict UGI malignancy.Keywords: dyspepsia, alarm symptoms, upper GI malignancy, clinical prediction mode

Weissella confusa F213 ameliorated inflammation and maintained intestinal mucosa integrity in chemically induced colitis rats

Abstract Objective This study was performed to investigate the potential effects of Weissella confusa F213 (WCF213) on chemically-induced colitis rats. Twelve male Wistar rats were divided into three groups: T1 (saline sterile), T2 (2.5% dextran sulfate sodium (DSS)- for 7 days), and T3 (WCF213 for 14 days, continued with 2.5% DSS for 7 days). The disease activity index (DAI) was monitored. After sacrificing the rats, the colon was collected for length measurement, local TNF-α level, HE staining for histology, and ZO-1 expression by using immunohistochemistry. Results WCF213 administration prevented weight loss and haematochezia, maintained average colon length and alleviated the clinical symptom of colitis, such as diarrhoea, albeit statistically non-significant (p < 0.05) compared with the T2 group. The histopathology of WCF213-treated colitis rats showed better architecture and less inflammatory cell infiltration into colon tissue. WCF213 significantly maintained the expression of ZO-1 in the mucosa (p < 0.001) and markedly reduced mucosal TNF-α concentration (p < 0.001) compared with the DSS group. Hence, these findings suggested that WCF213 attenuated clinical symptoms and inflammation and maintained mucosal integrity in DSS-induced colitis in vivo

Gastric mucosal status in populations with a low prevalence of <i>Helicobacter pylori</i> in Indonesia

<div><p>In Indonesia, endoscopy services are limited and studies about gastric mucosal status by using pepsinogens (PGs) are rare. We measured PG levels, and calculated the best cutoff and predictive values for discriminating gastric mucosal status among ethnic groups in Indonesia. We collected gastric biopsy specimens and sera from 233 patients with dyspepsia living in three Indonesian islands. When ≥5.5 U/mL was used as the best cutoff value of <i>Helicobacter pylori</i> antibody titer, 8.6% (20 of 233) were positive for <i>H</i>. <i>pylori</i> infection. PG I and II levels were higher among smokers, and PG I was higher in alcohol drinkers than in their counterparts. PG II level was significantly higher, whereas PG I/II ratios were lower in <i>H</i>. <i>pylori</i>-positive than in <i>H</i>. <i>pylori</i>-negative patients. PG I/II ratios showed a significant inverse correlation with the inflammation and atrophy scores of the antrum. The best cutoff values of PG I/II were 4.05 and 3.55 for discriminating chronic and atrophic gastritis, respectively. PG I, PG II, and PG I/II ratios were significantly lower in subjects from Bangli than in those from Makassar and Surabaya, and concordant with the ABC group distribution; however, group D (<i>H</i>. <i>pylori</i> negative/PG positive) was the lowest in subjects from Bangli. In conclusion, validation of indirect methods is necessary before their application. We confirmed that serum PG level is a useful biomarker determining chronic gastritis, but a modest sensitivity for atrophic gastritis in Indonesia. The ABC method should be used with caution in areas with a low prevalence of <i>H</i>. <i>pylori</i>.</p></div