Antiviral Therapy for Hepatitis C Prophylaxis in Percutaneous Exposure and Acute Hepatitis C

Incidence of percutaneous exposure to hepatitis C virus (HCV) is still quite high, particularly in medical staffs. Though not all will cause infection, but if acute HCV infection occurs, it usually develops into chronic hepatitis which finally causes cirrhosis and hepatocellular carcinoma. Untill now, there is no standard method either in regiments, administration time, or duration of administration to prevent HCV infection after exposure occurs, as well as the use of antiviral therapy in acute HCV. HCV therapy target is viral eradication, thus the therapy response is defined using virological parameter than clinical parameter. Different from hepatitis B virus (HBV), immunoglobulin administration after exposure to HCV is not recommended as it is not proven to prevent transmission, similarly with pegylated interferon (PEG-IFN) or interferon (IFN) administration. In addition, several studies concluded that risk of HCV transmission after percutaneous exposure is low, therefore regular strict monitoring (monthly in the first 16 weeks after exposure) to clinical and laboratory results (HCV-RNA, alanine aminotransferase) is more required, so that detection and early treatment to acute HCV can be performed, considering that several studies showed that early monotherapy using IFN/PEG-IFN in acute HCV could reach quite high sustained virological response (SVR)

Liver Transplant in Hepatocellular Carcinoma: Indication and Prognostic Factors

Hepatocellular carcinoma (HCC) is the most common type of liver cancer. There are several treatment modalities according to Barcelona treatment algorithm. Liver transplant is one of the curative option treatments, with its indication and prognostic factors. Carefully selected patients for liver transplant in HCC case will result in the same or slightly inferior survival rate compare with liver transplant in non-Malignancy case

Riedel’s Lobe: Clinical Importance of a Rare Variant in Liver Morphology

Riedel’s lobe is a normal variant form of right liver lobe rarely found. Here we report a case of 38 years old female with an incidental finding not revealed in physical examination, but then known to have hepatomegaly by gynecological ultrasonography. Diagnosis of Riedel’s lobe was strengthened by similar results on hepatobiliary ultrasonography, abdominal MRI, and diagnostic laparoscopy. Our patient was discharged and had follow up examination three months later. Knowledge regarding this anomaly is essential to be understood because the finding of accessory liver lobe does not always remain asymptomatic as in our patient, but rather can be related to significant clinical complication

Mortality-related Factors in Patients with Malignant Obstructive Jaundice

Aim: to obtain survival rate and mortality-related factors of malignant obstructive jaundice patients. Methods: all medical records of obstructive jaundice inpatient at Cipto Mangunkusumo Hospital, Jakarta from January 2010 to December 2013 were reviewed retrospectively. The following factors were analyzed in terms of mortality: age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid factors. Results: total 181 out of 402 patients were enrolled in this study with male proportion was 58.6%, and patients aged 50 years or above was 57.5%. Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and Charlson comorbid score ≥4 were independent predictors of mortality. Patients with significant prognostic factors had median survival 14 days compared with overall median survival 26 days. Score ≥2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769. Conclusion: sepsis, unsuccessful or no prior bilirary drainage, and Charlson comorbid score ≥4 are factors significantly associated with shortened survival in malignant obstructive jaundice patients. Prognostic score  ≥2 was determined to classify patients into high risk mortality group. Mortality of patients with those significant prognostic factors can be predicted in 76.9%

Comparison of Absolute Neutrophil Count between Hospital and Community Acquired Methicillin-Resistant Staphylococcus aureus Infection

Introduction. The virulence factors from community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) mainly due to toxins like Panton Valentin Leukocidin (PVL) and Phenol Soluble Modulin (PSM). Both of toxins cause decrease of value through neutrophil lysis. This study aimed to identify different value of absolute neutrophil count between hospital and community acquired MRSA. Methods. A cross sectional was conducted which included subjects who were infected by MRSA and hospitalized during 2012-2017. Classification of MRSA were divided due to its sensitivity and resistance to non-beta lactam antibiotics. Isolate that resistance to ≤ 2 antibiotics were classified as CA-MRSA. The others with resistance to ≥ 3 antibiotics were classified as hospital acquired MRSA. Absolute neutrophils count (ANC) were collected 24 hours from the positive MRSA culture. Data were analyzed by using independent T test and Mann-Whitney test. Results. We collected 62 subjects infected by MRSA which 35 subjects were HA-MRSA and 27 subjects were CA-MRSA. The median of ANC from CA-MRSA was 7,410.7 (1,147.3-26,560.2) and HA-MRSA was 16,198.0 (3,921.6-28,794.1) with p value < 0.001. Conclusion. There was a different value of absolute neutrophil count in infections due to community and hospital acquired MRSA

Diarrhea in HIV Infection

During the last decade, there has been an increase of immunocompromized patients all around the world; that mostly due to pandemic of Human Immunodeficiency Virus (HIV) infection. Chronic diarrhea as one of common symptoms in patients with HIV infection has different etiology compared to immunocompetent patients. Initial approach of diarrhea in HIV infection may be conducted by evaluating the temporal relationship between the development of diarrhea and the administration of antiretroviral, especially the protease inhibitor agents; which is then followed by fecal analysis/examination for pathogenic bacteria and protozoa as well as endoscopy examination. Biopsy examination of intestinal mucosa is necessary for HIV enteropathy or diarrhea due to microsporidia, which is confirmed further by electron microscopy. The etiology of chronic diarrhea in HIV patients may also different, depend on the cluster of differentiation count value of all patients. Based on such differences, it is necessary to have adequate approach, recognition and understanding in the management of chronic diarrhea, especially for HIV patients

Relationship between anal swab PCR for SARS-CoV-2 with gastrointestinal clinical manifestations and severity of COVID-19 infection in Indonesia [version 2; peer review: 2 approved]

Introduction: Coronavirus disease 2019 (COVID-19) cases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Indonesia remain high. The virus can bind with ACE2 receptor which is not only found in the lungs, but also in the digestive tract. Thus, it allows SARS-CoV-2 infection in the gastrointestinal tract, gastrointestinal manifestations, and detection of viral RNA on anal swab using polymerase chain reaction (PCR). There hasn’t been similar study about the role of anal swab in Indonesia yet. Therefore, this study aims to determine the relationship between SARS-COV-2 anal swab PCR with gastrointestinal clinical manifestations, and the severity of COVID-19 in Indonesia. Methods: This is an analytical study with cross-sectional design. Samples were obtained from hospitalized COVID-19 patients from July 2020 to January 2021. Demographic data, clinical manifestations, severity, and SARS-CoV-2 anal swabs PCR were collected using case report form. Results: A total of136 patients were analyzed. 52 patients (38.2%) had positive SARS-CoV-2 anal swabs PCR and 84 patients (61.8%) had negative results. The most common gastrointestinal clinical manifestations were nausea and vomiting in 69 patients (50.7%), anorexia in 62 patients (45.6%), and abdominal pain in 31 patients (22.8%). There were 114 patients (83,8%) classified as mild-moderate symptoms and 22 patients (16,2%) classified as severe-critical symptoms. There was a statistically significant relationship between the gastrointestinal tract SARS-CoV-2 infection and gastrointestinal clinical manifestations (P=0.031). There was no statistically significant relationship between the gastrointestinal SARS-CoV-2 infection and the severity of COVID-19 infection (P = 0.844). Conclusions: This study showed there is a significant relationship between SARS-CoV-2 anal swab PCR with gastrointestinal clinical manifestations. There is no significant relationship between anal swab PCR with the severity of COVID-19 infection