Child Pugh C and Male Gender Were Related to Nutritional Status of Liver Cirrhosis Patients in Koja Hospital Jakarta

Background: Malnutrition is found in 65-90% patients with liver cirrhosis. Malnourished patients with cirrhosis have a higher rate of complications. Aim of this study was to evaluate the prevalence and risk of malnutrition in liver cirrhosis patients at Koja hospital, Jakarta. Method: All liver cirrhosis patients visited Koja hospital during January - March 2009 was evaluated. An inclusion criterion was liver cirrhosis. An exclusion criterion was unable to speak Indonesia. The distributions of age, gender, body mass index (BMI), triceps skin-fold thickness (TSF), mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), Child Pugh classification were assessed. The criteria of malnutrition was done according to MAMC and BMI. Result: There were 38 liver cirrhosis patients fit the criteria. Twenty five (65.8%) cases were classified as malnutrition according to MAMC, 21 (55.3%) were classified as malnutrition according to BMI. Four patients (10.5%) were Child Pugh scores A, 15 Child Pugh B (39.5%) and the rest 19 patients (50.0%) were Child Pugh C. There was a trend correlation between malnutrition according to MAMC and Child Pugh criteria but not statistically significant. Conclusion: In our study we found 65.8% of liver cirrhosis patients were malnourished according to MAMC. Malnutrition was higher in male, as well as in Child Pugh score C. MAMC is more accurate than BMI in assessing nutritional status in liver cirrhosis

Upper Gastrointestinal Endoscopic and Histopathological Findings in Patients with Dyspepsia

Background: Dyspepsia is a syndrome located in the epigastric area. Upper gastrointestinal (UGI) tract endoscopy and histopathological examination are important diagnostic tools for dyspepsia. This study aimed to evaluate the pattern of dyspepsia in patients who underwent endoscopy examination at Koja Hospital, Jakarta. Method: All patients with dyspepsia who visited Koja Hospital from January until December 2011 were evaluated in this observational study. The data taken was age, gender, clinical symptoms, risk factors, alarm symptoms, body mass index, UGI tract endoscopic and histopathological findings. Data was analyzed using descriptive statistical analysis. Results: Of 1,279 patients with dyspepsia symptoms, 148 patients underwent UGI tract endoscopy. The main symptom was epigastric pain (91.2%). The most common risk factor was female (60.1%). The most common finding of alarm symptoms was history of UGI bleeding (21.6%). The most frequent result of UGI tract endoscopy was gastritis (79.7%). The most widely found of gastritis type was moderate antral gastritis (56%). The most common gastritis histopathological finding was non-active, non- atrophic, non-dysplastic chronic moderate gastritis (56%). All biopsy results included those with gastritis as well as gastric ulcer, which revealed negative results of Helicobacter pylori (H. pylori). Conclusion: The pattern of dyspepsia at Koja Hospital includes female predominant, most patients had alarm symptom history of UGI bleeding, gastritis on endoscopic findings, but H. pylori was not found in histopathological results

Improvement of Nutritional Status in Liver Cirrhotic Patients with Adequate Dietary Feeding and High Branched-chain Amino Acids Supplementation

Background: There is still a high prevalence of malnutrition among liver cirrhotic patients despite the fact that it deteriorates their prognosis. Pre-albumin can be used as a parameter to evaluate short-term nutritional status. This study was conducted to find out the overall outcome of calories and protein diet, and substitution of branched-chain amino acids (BCAA) to enhance pre-albumin serum level in cirrhotic patients with malnutrition. Method: This was a quasi-experimental study conducted in liver cirrhotic patients who visited Koja Hospital between April and September 2009. Mid-arm muscle circumference (MAMC) was used to evaluate nutritional status. Those with MAMC below the 15th percentile were considered as malnourished. Diet of adequate calories and protein with the substitution of 2 x 4 scoop (± 60 g) BCAA milk powder in 200 mL warm water twice daily (± 7.3 g BCAA) was given for two weeks. Pre-albumin serum level was subsequently monitored (before and after intervention) to see if there were any nutritional status changes. Data was analyzed using dependent student T-test with SPSS version 15.0. Results: There were eligible 16 patients. The average pre-albumin level after diet intervention for two weeks was significantly higher than those before the intervention; i.e. from 5.8 (2.2) mg/dL to 6.8 (2.1) mg/dL, with p = 0.004. Conclusion: Diet of adequate calories and branched-chain amino acid can improve the pre-albumin serum level in liver cirrhotic patients with malnutrition

Effect of Omeprazole to Dyspeptic Symptom on Ramadan Fasting Patient Based on Dyspepsia Symptoms Severity Index Scores

Background: Dyspepsia is a symptoms collection of discomfort at the upper abdomen. Ramadan Fasting is a worship that must be run by all Moslems that do not eat and drink for ± 12 hours. Proton pump inhibitors are drugs commonly given to patients with dyspepsia with mechanism controlling gastric acid secretion. The aim of this study is to find the effect of omeprazole to the patient with dyspepsia and undergo Ramadan fasting.Method: Using analytic study design, conducted in outpatient in Koja Hospital Jakarta from June - July 2013, for patients with dyspepsia who will undergo Ramadan fasting. Subjects are divided into 2 groups; one group was given omeprazole while others were given a placebo. Before and after 2 weeks of fasting, dyspepsia symptoms severity index scores (DSSI) was taken which assessed changes in both groups and compared using student T-test.Results: DSSI scores on average before the intervention of both groups (n = 30) was not significant (p = 0.9). In the placebo group obtained increasing of DSSI score from 27.7 ± 14 to 36 ± 14.8 (p = 0.001), whereas in the omeprazole group obtained increasing of score only from 27.2 ± 9.4 to 30 ± 9.9 (p = 0.08). In the placebo group score worsened by 8.3 ± 7.2 but in the omeprazole group with only 2.7 ± 5.7 (p = 0.02).Conclusion: There was a significant decrease of DSSI scores in fasting patient with omeprazole. Therapy with omeprazole 20 mg twice daily during the month of fasting can reduce the abdominal complain in patient with dyspepsia

The Efficacy of L-Ornithine L-Aspartate Granules and Normal Protein Diet in Minimal Hepatic Encephalopathy with Malnutrition

Background: The dietary protein restriction that was commonly recommended to hepatic encephalopathy (HE) patients, often leads to malnutrition, whereas malnutrition can deteriorate cirrhosis prognosis. The aims of this study were to find out encephalopathy improvement that was measured by critical flicker frequency (CFF) test and nutritional status by measuring prealbumin level after L-Ornithine L-Aspartate (LOLA) treatment with adequate calories and protein intake in patients with HE. Method: Patients with liver cirrosis who visited Cipto Mangunkusumo hospital on June-October 2009 was evaluated by CFF test using HEPAtonormTM device. Encephalopathy was defined when CFF < 39 Hz. Nutritional status was measured by the mid-arm muscle circumference (MAMC) and was stated as malnutrition when the MAMC was below the 15th percentile. Patients had been treated by 3 x 6 mg LOLA granules for 2 weeks, and adequate calories and protein intake with branched-chain amino acid (BCAAs) substitution. The change of encephalopaty was evaluated by the CFF test and the nutritional status by measuring prealbumin blood level. Results: There were 17 patients with liver cirrhosis who fulfilled the inclusion criteria. The mean CFF Result increased from 34.1 ± 2.5 Hz to 36.5 ± 2.9 Hz after LOLA treatment with the adequate calories and protein intake including BCAAs substitution, which was statistically significant (p < 0.001) compared to before treatment. The prealbumin level also increased significantly compared before treatment, i.e. from 5.4 ± 2.1 mg/dL to 6.4 ± 2.6 mg/dL, p = 0.008. Conclusion: HE patients with malnutrition could be given adequate calorie and protein with BCAAs substitution to improve their nutritional status, and LOLA granules for the improvement of HE

Gambaran Penyakit Ginjal Kronik dan Komplikasinya di RSUD Koja Periode Juli-November 2017

Penyakit ginjal kronik (PGK) adalah suatu proses patofisiologi dengan etiologi yang beragam, mengakibatkan penurunan fungsi ginjal yang progresif, dan pada umumnya berakhir dengan gagal ginjal. Penyakit ginjal kronik merupakan masalah kesehatan masyarakat di seluruh dunia termasuk di Indonesia. Tujuan penelitian ini adalah diketahuinya proporsi dan jenis komplikasi pasien PGK di Penyakit Dalam RSUD Koja. Penelitian ini bersifat observasional, dengan mengambil sampel secara consecutive sampling pada unit rawat jalan dan rawat inap Penyakit Dalam RSUD Koja selama Juli – November 2017. Didapatkan 261 subyek, 149 (57,09%) laki-laki dan 112 (42,91%) perempuan, dengan rentang usia antara 18–72 tahun, dengan jumlah terbanyak pada kelompok usia 45-65 tahun (62,45%),stadium PGK terbanyak adalah stadium V (62,.07%), sebanyak 74,33% memiliki komplikasi, terbanyak adalah ensefalopati uremik 94,64%, anemia 88,7% dan volume overload 88,1%. Di bagian rawat jalan dan Rawat Inap Penyakit Dalam RSUD Koja periode Juli–November 2017 sebanyak 74,33% dari pasien PGK memiliki komplikasi, komplikasi terbanyak adalah ensefalopati uremik (94,64%) diikuti oleh anemia 88,7% dan volume overload 88,1%. Kata Kunci : komplikasi, penyakit ginjal kronik, ensefalopati uremi

Komplikasi Penderita Sirosis Hati Di RSUD KOJA Pada Bulan Juli - November 2017

Sirosis merupakan tahap akhir dari berbagai penyakit hati kronis. Penyebab tersering adalah infeksi virus hepatitis B, virus hepatitis C dan alkohol. Sirosis hati dengan komplikasinya merupakan masalah kesehatan yang masih sulit diatasi. Hal ini ditandai dengan angka kesakitan dan kematian yang tinggi. Penelitian ini bertujuan untuk mengetahui karakteristik dan komplikasi apa saja yang didapatkan pada pasien sirosis hati yang dirawat di RSUD Koja. Penelitian ini menggunakan rancangan penelitian observasional deskriptif, dengan mengambil pasien rawat inap Penyakit Dalam RSUD Koja selama Juli–November 2017. Didapatkan sebanyak 63 pasien yang terdiri dari 41 orang (65,1%) laki-laki dan 22 orang (34,9%) perempuan, usia 20-40 tahun sebanyak 11 orang (17,5%) , usia 40 -60 tahun 46 orang (73%), dan usia lebih dari 60 tahun 6 orang (9,5%). Keluhan utama terbanyak adalah perut membesar (40%). Stigmata sirosis terbanyak adalah ikterus (51%), dan komplikasi terbanyak adalah asites, pada 55 orang (87,3%). Hal ini memberikan kesan penting sekali melakukan evaluasi pada pasien dengan penyakit hati kronis khususnya hepatitis B mengenai kemungkinan sirosis hati. Kata kunci: Sirosis hati, gender, usia, komplikas

Profil Hipertensi Di Poliklinik Penyakit Dalam RSUD Koja

Prevalensi hipertensi meningkat di seluruh dunia, terutama di negara-negara sedang berkembang. Kesadaran berobat dan pengendalian hipertensi lebih berhasil di Amerika Utara dibandingkan negara sedang berkembang dan negara miskin, termasuk Indonesia. Tujuan penelitian ini adalah untuk mendapatkan profil penderita hipertensi di rawat jalan Penyakit Dalam RSUD Koja.Penelitian ini dilakukan dengan pendekatan deskriptif secara cross sectional. Populasi dari sampel adalah pasien poliklinik rawat jalan RSUD Koja yang didiagnosis hipertensi sepanjang bulan Oktober-Desember 2018.Proporsi hipertensi di rawat jalan RSUD Koja didapatkan sebesar 36,2% dari total 334 pasien. Jenis kelamin terbanyak adalah perempuan (71,1%), rentang usia antara 21–87 tahun, kelompok usia terbanyak 41–60 tahun, rerata tekanan darah sistolik (TDS) 153 (19.3) mmHg dan rerata tekanan darah diastolik (TDD) 84 (14.3) mmHg, sebagian besar IMT normal, sebanyak 60 % tidak rutin minum obat dan tekanan darahnya tidak mencapai target. Pasien hipertensi pada umumnya kurang patuh terhadap pengobatan karena ketidaktahuan mengenai cara mengkonsumsi obat. Banyak pasien (47%) beranggapan bahwa apabila tekanan darah sudah stabil maka obat tidak perlu dikonsumsi lagi. Proporsi hipertensi sebesar 36.2% dari total pasien rawat jalan, sebagian besar (60%) tidak terkendali karena tidak rutin berobat dengan alasan terbanyak adalah karena ketidaktahuan (47%