Hepatitis a Virus Infection in Guillain-Barré Syndrome

Prodromal factors of Guillain-Barré syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS. We report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM anti HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period

Alterations in Blood Ammonium Level and Psychometric Test in Patients with Liver Cirrhosis After a Tempe Diet

Background: Hepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non- ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion. Study aim: To determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet). Method: This is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group is given a tempe diet, while the second (control) group is given liver diet II/III (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT). Results: In the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories. Conclusion: A 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test

Endoscopic Findings and Histopathological Pattern in Patients with Chronic Dyspepsia at Panti Rapih Hospital Jogjakarta

Background: To determine the relationship between clinical manifestation of chronic dyspepsia and endoscopic findings along with histopathological pattern by descriptive analysis. Methods: This study was a retrospective study. Subjects were patients with chronic dyspepsia who underwent endoscopic examination and gastric biopsy between June 2005 and July 2006. Result: There are 10.17% normal endoscopic results of 79 patients with chronic dyspepsia and almost 90% show abnormal result in endoscopic examination. The histopathological pattern is normal in 2.53% and 97.47% demonstrate abnormal result. The prevalence of Helicobacter pylori due to gastric ulcer is 1.26% and chronic atrophic gastritis is 3.80%. Conclusion: Most of chronic dyspepsia patients have abnormal endoscopic and histopathologic result

The Application of Encapsulated Gluten on Tapioca Wet Noodle Making Processing

Gluten is a specific protein found in wheat and functionally needed to improve its elasticity and texture of carbohydrate-based dough. Gluten, isolated from wheat, can be used in the free-form or encapsulation. The aim of this research was to investigate the effects of encapsulated gluten addition on properties of tapioca for wet noodle production. The parameters studied were texture, sensory, and pasting properties of the noodles. The ratios of encapsulated gluten to tapioca were 97%:3%, 96%:4% and 95%:5%. The results showed that the use of encapsulated gluten as much as 3% w/w gave the best noodle with the characteristics of setback viscosity, low cooking loss and organoleptically preferred by panelists

Penambahan Asam Asetat dan Fumarat untuk Mempertahankan Kualitas Pikel Ubi Jalar Kuning Pasca Fermentasi

Tujuan penelitian ini adalah untuk mengetahui dan membandingkan kemampuan asam fumarat, asam asetat dan kombinasinya sebagai pengawet untuk mempertahan kualitas pikel ubi jalar kuning pasca fermentasi yang disimpan pada suhu ruang selama 6 minggu; dan juga membandingkannya dengan pengawet asam benzoat. Perlakuan terdiri dari konsentrasi asam asetat 1; 1,5 dan 2%; konsentrasi asam fumarat 0,1; 0,15 dan 0,2%, dan kombinasi keduanya. Perlakuan dengan asam benzoat dan tanpa pengawet juga disiapkan sebagai kontrol. Perlakuan terbaik diperoleh dari kombinasai asam asetat 1% dan fumarat 0,2%, dengan karakteristik kualitas sebagai berikut: total kapang, khamir, bakteri bukan asam laktat, dan bakteri asam laktat masing masing <30 koloni/ml, total asam 1,35%, pH 3,18 dan total padatan terlarut 2,07o brix, warna orange pucat, beraroma asam dengan tingkat penerimaan panelis 87%. Berdasarkan penerimaan sensoris, perlakuan asam fumarat lebih baik daripada asam asetat ataupun kombinasai asam asetat-fumarat. Hasil penelitian menunjukkan bahwa asam asetat, fumarat dan kombinasi keduanya dapat mempertahankan kualitas pikel ubi jalar kuning yang berpotensi menjadi alternatif pengganti pengawet benzoat

The Role of Insulin Resistance in Diabetic Patients with Chronic Liver Disease

Background: The association between diabetes and chronic liver disease has been well documented. However, the mechanism remains unknown. The aim of this study was to investigate the insulin resistance in chronic liver disease and normal liver in diabetic patient. Method: A total of 31 diabetic, non-alcoholic patients with multiple oral hypoglycemic drugs, either with or without lipid abnormalities were enrolled in this study. Subjects were recruited from outpatient clinic of Department of Endocrine at Dr. Sardjito Hospital, Jogjakarta, Indonesia from May-June 2004. This was a cross sectional study. Fasting insulin and glucose level, liver function test, body mass index, and the presence of fatty liver by ultrasound were examined. Insulin resistance was estimated by calculating fasting insulin and glucose plasma level as the homeostasis model assessment (HOMA) index ratio. Data was described with mean ± SD and analyzed by independent sample t-test. Results: Thirty one patients were enrolled to the study, i.e. 8 patients with normal liver and 23 patients with fatty liver. Only 14 patients agreed to continue the study including 10 patients with fatty liver and 4 patients with normal liver. Mean of age was 59.1 ± 8.7 and mean value of BMI was 24.62 ± 3.05. The liver function test revealed normal Results. Triglyceride, cholesterol, fasting glucose level, and HOMA index (2.77 ± 1.95 vs. 1.66 ± 1.02) in patients with fatty liver were higher than patients with normal liver. No correlation was found between fasting insulin level as well as HOMA index and mean value of BMI (obese and non-obese) as well as hypertension. There was significant correlation between triglyceride level and fasting insulin among fatty liver patients (p = 0.048; CI 95% -7.404; -0.032). Conclusion: The non-alcoholic fatty liver disease in diabetic patients with normal liver enzymes and multiple oral hypoglycemic drugs appear to be related with insulin resistance and hypertriglyceridemia

Gallstones and Choledocolithiasis with Severe Cholestatic Jaundice in Beta-Thalasemia Intermedia Patient

Geographically, b-thalassemia can be found in many countries including in Indonesia. Thalassemia intermedia referred to patients as being ‘too haematologically severe to be called minor, but too mild to be called major\u27. Patients with thalassemia intermedia usually present themselves to medical attention in later childhood or even adulthood and are sustainable without the need for regular transfusion therapy. Three main factors are responsible for the clinical sequele of thalassemia intermedia: chronic anemia, ineffective erythropoiesis, and iron overload.There are many complications related to b-thalassemia intermedia such as gastroentero-hepatology diseases (splenomegaly, gallstones, choledocolithiasis, predispose patients to liver fibrosis and cirrhosis), vascular, endocrine and bone diseases. About 55-63% thalassemia intermedia patients suffer from gallstone with 68–85% of these patients undergo cholecystectomy, and 67-90% patients undergo splenectomy. Therefore, ultrasound examination is required to be performed regularly during illness and before patient underwent surgery or splenectomy to detect the presence of gall stones. In this case report a patient with gallstones and choledocholithiasis was reported. Severe cholestatic jaundice in b-thalassemia intermedia was diagnosed six months before hospitalization. The patient underwent open cholecystectomy and exploration common bile duct stones

Colorectal Cancer in Young Patient: a Distinguished Disease Entity?

Background: Some studies suggested that colorectal cancer at young age had a distinct biological characteristic: more advanced stage at time of diagnosis, poorer differentiated, and consisted of large proportion of mucin producing tumors. Aim of the study: To analyze clinical and histopathological differences between young aged colorectal cancer patients (&lt; 40 years old) and the older patients Methods: A cross-sectional retrospective study was conducted among our colorectal cancer patients in a general hospital between 1999-2004, using C.18, C.19, C20 ICD X code in medical record searching. It was requested that the patients had surgical treatment in Dr. Sardjito General Hospital. An inconclusive clinical staging and/or histological data were among the exclusion criteria. Chi-square, Fisher's exact test, T-test, and Mann Whitney U-test was performed to analyze the difference between patients &lt; 40 years old and ³ 40 years old, in respect to diagnostic staging, histological type, histological grade (differentiation), CEA level, hemoglobin, albumin, tumor location, and chief complain. With p &lt; 0.05 was considered as significant. Results: Sixteen young aged (&lt; 40 years old) and 72 older patients had been identified. No differences in gender proportion and mean of symptoms to diagnosis period between two groups. No statistical differences between young aged and the older patients in diagnostic staging, histological grade and type, CEA level, and hemoglobin. Young aged patients had higher albumin value at presentation (p = 0.014), all had left sided tumors (p = 0.035), more complain of anal pain (p &lt; 0.001), and less change of bowel habits complain (p = 0.009) Conclusion: The study results had failed to confirm the difference in respect to diagnostic staging, histological type and grade, CEA level, and hemoglobin. Most of our young aged patients had left sided tumors with chief complain of anal pain, and less complain of change of bowel habit