The Analysis of Mutation Profile on Pre-S1 and Pre-S2 Region of Hepatitif B Virus in Chronic Liver Disease

Objective: The purpose of this study was to complete the data frequency and mutation profile of Hepatitis B Virus (HBV) pre-S1 and pre-S2 in Indonesia. Methods: This cross-sectional study was used 32 blood serum samples of Chronic Liver Disease (CLD) patients with Hepatitis B surface antigen (HbsAg) at Endoscopy Outpatient Clinic, RSUD Dr. Soetomo Hospital, Surabaya. Polymerase Chain Reaction (PCR) of HBV DNA was performed on the samples based on pre-S1 and pre-S2 region. Then, electrophoresis was performed on the PCR product and followed by sequencing on samples with positive electrophoresis result. The sequencing results were analyzed by comparing them with the published sequences of HBV nucleotide. Results: The amplification results of nested PCR DNA HBV with primers based on HBV pre-S1 and pre-S2 region were positive at 21 serums. In patients with CLD in this study, pre-S1 and / or pre-S2 HBV mutations were found in 11 (84.62%) chronically infected HBV patients, 4 (100%) patients with liver cirrhosis, and 4 (100%) HCC patients. Dominant mutations were L101V (16.57%), M120I / T or pre-S2 start codon (10.82%), and F141L (10.81%). M120 and F141L mutations have been previously reported to be associated with CLD, while the dominant L101V mutation in this study as well as several other mutations has not been reported in previous studies. Conclusions: Mutations of pre-S1 and pre-S2 HBV regions were obtained in 90.48% of CLD patients in the form of substitution and deletion of amino acids

Distribution of Hepatitis B Virus Genotypes Among Patients at Internal Medicine Unit, Dr. Soetomo General Hospital, Surabaya

Background: Hepatitis B virus (HBV) infection is a major health problem worldwide, especially in developing countries. The study of HBV genotypes is important to find out the diversity of HBV genotypes related to the severity of the disease, response to therapy, and clinical symptoms. Objective: This study was aimed to detect HBV genotypes in patients at Hepatology Outpatient Clinic, Dr. Soetomo Hospital Surabaya. Methods: This study was conducted on new patients at Hepatology Outpatient Clinic of Dr. Soetomo General Hospital, Surabaya in one month. Nested PCR was performed by targetting HBV surface genes. Samples with positive HBV DNA were sequenced and analysed further. Results: In this study, a total of 27 samples were obtained. The prevalence of HBV infection shown by positive HBsAg in patients with symptoms of liver disease was 55.55% (15/27 patients). Based on the results of electrophoresis from PCR products, positive HBV DNA was obtained in these 15 patients (100%). After sequencing samples with positive HBV DNA, genotype B of Indonesian strain was found to be predominant genotype (100%). Subgenotype analysis showed that 7/15 samples had B3 subgenotype (46.67%). Conclusion: In patients at Hepatology Outpatient Clinic of Dr. Soetomo General Hospital, Surabaya, the prevalence of HBV infection was high (55.55%) and genotype B was predominant. In Surabaya, HBV genotype infection still remained like the previous pattern, although in Indonesia there have been many inter-island and ethnic migration. Further similar studies are needed to obtain the diversity of other HBV genotypes

Detection Of Hepatitis C Virus (Hcv) Infection And Its Genotype In Patients At Hepatology Outpatient Clinic, Dr. Soetomo General Hospital, Surabaya

Hepatitis C virus (HCV) is an RNA virus that can cause liver inflammation (hepatitis) and has the potential to become chronic and can progress to liver cirrhosis and hepatocellular carcinoma. Detection of HCV RNA infection, and genotype/subtype of HCV was performed on 70 blood sera of patients at the Hepatology Outpatient Clinic of Dr Soetomo General Hospital, Surabaya, Indonesia. Detection of HCV infection was carried out by Anti-HCV determination using enzyme immunoassay (EIA) technique, detection of HCV RNA by Reverse Transcription Polymerase Chain Reaction (RT-PCR) technique based on genome regions NS5b and 5'UTR, followed by electrophoresis with agarose gel. In positive PCR results, HCV genotype/subtype was determined by direct sequencing method using ABI 310 sequencer and sequencing results were analyzed by comparing the products with previously published HCV nucleotides. Sera were obtained from 41 (58.6%) male and 29 (41.4%) female patients. Anti-HCV was found positive in 17/70 (24.29%) patients and 16/17 (94.1%) was proved to contain HCV RNA when determined by RT-PCR technique. Patients with positive HCV RNA have the potential to transmit HCV infection. From the genotype/subtype analysis of sequencing results we obtained 2/16 (12,5%), 3/16 (18,75%) and 6/16 (37,5%), 1/16 (6,25%), 1/16 (6, 25%), 2/16 (12,5%), 1/16 (6,25%) HCV genotypes 1, 2, and HCV subtypes 1b, 1c, 2a, 3a, 3k respectively.Conclusion: In patients who went to the Hepatology Outpatient Clinic, Dr. Soetomo General Hospital Surabaya, we found positive Anti-HCV was 24,29%. In 94,1% of patients with positive Anti-HCV, HCV RNA was still detected and HCV genotype 1 with subtype 1b were still dominant HCV subtypes

Associations between P53, Transforming Growth Factor Beta-1, and Interleukin-10 Serum Levels with Advanced Liver Disease and Hepatitis B Virus Infection

Background. Hepatitis B infection can lead to advanced liver disease (ALD) which causes serious health problems. Several factors that are thought to play a role in advanced liver disease are P53, Transforming Growth Factor-β1 (TGF-β1), and Interleukin-10 (IL-10). Therefore, this study aimed to determine the association between P53, TGF-β1, and IL-10 serum levels with ALD.Methods. We collected 68 sera from patients with HBV infection. P53, TGF-β1, and IL-10 serum levels were measured by ELISA. We also detected SNPs from P53 and TGF-b1 genes to determines their associations.Results and Conclusions: In this study, we obtained 41.18% CH patients and 58.82% ALD patients. Male patients outnumbered female in all groups. There was a significant relationship between serum P53 and TGF-b1 levels with ALD (p = 0.03 and 0.01, respectively), but not serum IL-10 levels. However, there was no significant relationship between SNP gene P53 and serum P53 levels nor between SNP gene TGF-b1 and serum TGF-b1 levels (p = 0.73 and 0.23, respectively).Both P53 and TGF-b1 serum leveles can act as biomarkers of prognosis and target therapy for ALD patients

Diagnostic values of helicobacter pylori stool antigen immunochromatographic method compared to histopathology in dyspepsia patient

Background: Helicobacter pylori infection often leads to complaints of dyspepsia. Enforcement of infection still relies on invasive histopathological methods through endoscopic and biopsy procedures. Helicobacter pylori stool antigen (HpSA) is a method of rapid immunochromatography that is not invasive and relatively inexpensive. We determined the diagnostic value of HpSA examination of immunochromatographic methods compared to histopathological examination as the gold standard for diagnosing H. pylori infection. Methods: HpSA examination was used to identify H. pylori infection by its ability to detect H. pylori antigen from stool of dysepeptic patients .Its diagnostic values including sensitivity, specificity, positive predictive value and negative predictive value was determined by comparing them to those of histopathologic examination as gold standard. Results: From 93 dyspeptic patients, pre-test probability of H. pylori infection using histopathologic examination showed result as much as 17.2 . The sensitivity, specificity, positive predictive value and negative predictive value of HpSA immunochromatographic methods were 38, 94, 55 and 88, respectively. A positive probability ratio of 5.78 increased the post-test probability for H. pylori infection by 37.8. A negative probability ratio of 0.68 increased the post-test probability of not being infected with H. pylori by 5.4. Conclusion: The diagnostic value of HpSA examination of immunochromatographic methods was not good enough to exclude or diagnose H. pylori infection in dyspeptic patients. © 2019, Yerevan State Medical University. All rights reserved

Helicobacter pylori density and expression of gastric mucosal interleukin-8 in dyspeptic patients

Background: The density of the H. pylori colonies is associated with more severe clinical manifestations, chronic infections, ineffective therapy responses and malignant events. Interleukin-8 (IL-8) is one of cytokines that plays a role in the inflammatory process that results in gastric mucosal damage. We determined the association between H. pylori density and gastric mucosal IL-8 expression in dyspeptic patients. Methods: H. pylori density was determined using histopathology based on Updated Sydney System. IL-8 levels were measured using immunohistochemistry from the gastric biopsy. Results: There was significant difference between gastric mucosal IL-8 expression obtained in gastric mucosal gland epithelium (p = 0.028) at mild and high density of H. pylori (p = 0.013). There was a correlation between H. pylori density with gastric mucosal IL-8 expression of glandular epithelium (r = 0.622; p = 0.004), surface epithelium (r = 0.510; p = 0.026), and inflammatory cells (r = 0.054; = 0.028). Conclusion: We found a significant positive correlation between H. pylori density and gastric mucosal IL-8 expression in dyspeptic patients. © 2019, Yerevan State Medical University. All rights reserved

Pathophysiology of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a large bowel functional disorder characterized by abdominal pain or discomfort and is associated with bowel habit changes without organic disorder. IBS is affected by many factors and is suspected of involving central and peripheral mechanisms, such as gastrointestinal dysmotility, bowel visceral/mucosal hypersensitivity, increased bowel permeability and interaction among the luminal factors including food and bowel microbiota changes, bowel epithelial barrier, mucosa immunity, genetic factor and biopsychosocial and brain gut axis which are suspected to affect IBS pathophysiology. Understanding the various factors and mechanisms underlying IBS helps in the consideration of management and repair of patients’ prognosi

Hepatitis B Virus X Gene Mutation With Predominance A1762T+G1764A Double Mutation on Chronic Liver Disease Patients in Surabaya, Indonesia

Background: HBV infection is a major problem worldwide, especially in developing countries including Indonesia. Mutations in the HBV gene X are commonly found in patients with CLD, especially in cirrhosis and hepatocellular carcinoma. Mutations in the X gene can cause loss of stability, increased transactivation function, and decreased anti-apoptotic ability of HBx protein. Aim: The aim of this study was to detect HBV X gene mutations in CLD patients in Surabaya. Methods: This was a cross sectional research taking samples at Dr. Soetomo General Hospital, Surabaya, Indonesia. This study used nested PCR by targeting HBV X gene. Samples showing positive HBV DNA PCR results were followed by sequencing and X gene mutation analysis by comparing sequencing results with reference strains. Results: In this study, 30 samples of CLD patients with positive HBsAg in Dr. Soetomo Surabaya were obtained. From the results of the multiple alignments, 12/30 samples (40%) had mutations on HBV X region which overlapped with Core Promoter region. There were 3 types of substitution mutations on HBV X gene (C1632T, T1753A/C/G, A1762T, and G1764A) with the dominant mutation types were A1762T and G1764A mutations, in which both mutations were found together as double mutation. Conclusion: X gene mutations were found in 40% CLD patients in Surabaya with the dominant mutation was in the form of double mutation A1762T and G1764A in 30% CLD patients in this study. The mutation was found mostly in advance stage of CLD

Management for a Patient with Barret’s Esophagus: A Case Report

Barrett's esophagus (BE) is a displacement of the squamocolumnar border (SCJ) site to proximal to the gastroesophageal junction (GEJ) accompanied by the presence of intestinal metaplasia. BE develops when reflux-induced stomach acid destroys the squamous epithelial layer of the esophagus and this lesion heals via a metaplasia process in which the damaged squamous epithelial layer is replaced by columnar colon-type epithelium. BE prevalence in the general population is about 1.6-1.7%. Patients with gastroesophageal reflux disease (GERD) may progress to BE. This report concerns two cases of patients with Barrett's esophagus. In both these patients BE was found without dysplasia. A diagnosis was made on the basis of anamnesis, physical examination, laboratory, radiological, endoscopy and anatomical pathology. The management of BE is aimed at three main objectives: reduction of symptoms due to GERD, avoiding progression to strictures and ulcers, and preventing progression to adenocarcinom a. Both patients were given a PPI, a prokinetic and chemoprevention NSAID which achieved clinical improvement. Neither patient had ablation, photodynamic or mucosal resection. BE survival is much better than in groups without BE (5 years survival 61% vs. 28%, P = 0.001

Diagnostic values of helicobacter pylori stool antigen immunochromatographic method compared to histopathology in dyspepsia patient

Background: Helicobacter pylori infection often leads to complaints of dyspepsia. Enforcement of infection still relies on invasive histopathological methods through endoscopic and biopsy procedures. Helicobacter pylori stool antigen (HpSA) is a method of rapid immunochromatography that is not invasive and relatively inexpensive. We determined the diagnostic value of HpSA examination of immunochromatographic methods compared to histopathological examination as the gold standard for diagnosing H. pylori infection. Methods: HpSA examination was used to identify H. pylori infection by its ability to detect H. pylori antigen from stool of dysepeptic patients .Its diagnostic values including sensitivity, specificity, positive predictive value and negative predictive value was determined by comparing them to those of histopathologic examination as gold standard. Results: From 93 dyspeptic patients, pre-test probability of H. pylori infection using histopathologic examination showed result as much as 17.2%. The sensitivity, specificity, positivepredictive value and negative predictive value of HpSA immunochromatographic methods were 38%, 94%, 55% and 88%, respectively. A positive probability ratio of 5.78 increased the post-test probability for H. pylori infection by 37.8%. A negative probability ratio of 0.68 increased the post-test probability of not being infected with H. pylori by 5.4%. Conclusion: The diagnostic value of HpSA examination of immunochromatographic methods was not good enough to exclude or diagnose H. pylori infection in dyspeptic patients