Treatment of Chronic Hepatitis C with High Dose Interferon Therapy Experience From Pertamina Central Hospital Jakarta

Background: Until several years ago, interferon alfa was the only drug with proven benefit for the treatment of chronic Hepatitis C. Several therapy categories such as fixed-dose regimens, induction-dose regimens and escalation-dose regimens are already known. With standard dose interferon therapy of 3 MU, TIW for 6 months, a sustained response rate can ve achieved in only 10-20% of patients. This study reports the Results of treatment of chronic Hepatitis C with high dose interferon therapy of 6 MU, TIW for 6 months. Methods: From February 1996 to February 1998, 15 patients with Hepatitis C were treated with interferon alfa-2b 6 MU, TIW for 6 months. Ultrasound-guided liver-biopsy was performed using the Menghini-Technique (Hepafix). Virological and biochemical responses were assessed at the end of the treatment period at week 24 and at the end of follow-up period at week 48 and up to 2 years later. Virological and biochemical sustained responses were defined as the absence of HCV-RNA, and SGPT concentration within the normal range at both weeks 24 and 48. Histological response was assessed after the end of treatment. Side-effects were observed and noted. Results: Ten out of 15 patients (66.7%) were HCV-RNA negative and 11 out of 15 patients (73.3%) demonstrated ALT within the normal range at week 24. At the end of the follow-up, from week 48 until 2 years later, HCV-RNA negative and normal ALT were found in 6 patients (40%). Histological improvement was found in 4 out of 6 patients. Fever was the most common side-effect and was found in 13 patients, while fatigue was found in 12 patients, myalgia in 11, headache in 10, and anorexia in 11 patients. Conclusion: High dose interferon alfa-2b therapy for the treatment of chronic Hepatitis C can improve the rate of sustained response, but is associated with more side-effects

Pattern of statin use in several Hospitals in Jakarta. A cross sectional study

A preliminary, cross-sectional study on the pattern of statins use in three hospitals in Jakarta was conducted to see the responder rate of the patients who took statins. Data were taken from the Medical Records from May-July 2004 of each hospital. The inclusion criteria were outpatients diagnosed with dyslipidemia treated with statins either as first choice or add-on therapy to the other lipid-lowering drugs given. Two hundred and forty three cases were recorded during the 3-month period of examination, 127 male and 116 female. The average age of both group of patients were 56 ± 12 years (male) and 55 ± 12 years (female). The most commonly used statins as first choice and as add-on was atorvastatin (38.1%, and 1.6%, respectively), followed by rosuvastatin (20.5%), fluvastatin (11.5%), pravastatin (10.7%); whereas lovastatin (0.4%) and simvastatin (3.7%) were least prescribed. Patients’ total cholesterol levels were reduced significantly (241 ± 57 vs 207 ± 38 mg/dL, p less than 0.0001), whereas triglyceride levels were not significantly reduced (174 ± 86 vs 160 ± 71 mg/dL). Around 46% cases (72 out of 243 cases) met the NCEP ATP III goals on total cholesterol level. The most common combinations used, with respect to atorvastatin, were fenofibrate (11.3%), pravastatin (9.3%), rosuvastatin (3%), gemfibrozil (2%), whereas, with regard to rosuvastati, were gemfibrozil (9%), ciprofibrate (5%), and atorvastatin (3%). Large numbers of patients were not regularly checked up or low in compliance. In conclusion, statins usage in some hospitals in Jakarta had been inappropriately used, due to multiple factors, such as, prescribers, patients’ aspects, and the national health system. Therefore, in order to observe the efficacy of statins in clinical setting, a large scale study on the pattern of statin use should be conducted

Pattern of statin use in several Hospitals in Jakarta. A cross sectional study

A preliminary, cross-sectional study on the pattern of statins use in three hospitals in Jakarta was conducted to see the responder rate of the patients who took statins. Data were taken from the Medical Records from May-July 2004 of each hospital. The inclusion criteria were outpatients diagnosed with dyslipidemia treated with statins either as first choice or add-on therapy to the other lipid-lowering drugs given. Two hundred and forty three cases were recorded during the 3-month period of examination, 127 male and 116 female. The average age of both group ofpatients were 56 :t 12 years (male) and 55 :t 12 years (female). The most commonly used statins as first choice and as add-on was atorvastatin (38.1 %, and 1.6%, respectively), followed by rosuvastatin (20.5%), fluvastatin (11.5%), pravastatin (10.7%); whereas lovastatin (0.4%) and simvastatin (3.7%) were least prescribed. Patients' total cholesterol levels were reduced significantly (241 :t 57 vs 207 :t 38 mg/dL, p < 0.0001), whereas triglyceride levels were not significantly reduced (174 :t86 vs 160:t 71 mg/dL). Around 46% cases (72 out of 243 cases) met the NCEP ATP III goals on total cholesterol level. The most common combinations used, with respect to atorvastatin, were fenofibrate (11.3%), pravastatin (9.3%), rosuvastatin (3%), gemfibrozil (2%), whereas, with regard to rosuvastati, were gemfibrozil (9%), ciprofibrate (5%), and atorvastatin (3%). Large numbers of patients were not regularly checked up or low in compliance. In conclusion, statins usage in some hospitals in Jakarta had been inappropriately used, due to multiple factors, such as, prescribers, patients' aspects, and the national health system. Therefore, in order to observe the efficacy of statins in clinical setting, a large scale study on the pattern of statin use should b

The Prevalence of Reflux Esophagitis in the Elderly and Its Associated Risk Factors

Background: Reflux esophagitis is a common problem in the elderly. Compare to the Western Countries, esophageal cancer where reflux esophagitis is the most predominant risk factor is considered rare in Asia. Many other risk factors have not been well studied especially in most Asian countries. The objective of this study is to evaluate the presence of reflux esophagitis in elderly patients and its associated risk factors.Method: This was a cross-sectional study in elderly patients who underwent upper gastrointestinal endoscopy. Patients who received long-term proton pump inhibitor (PPI) therapy, suffered from gastrointestinal malignancies, recently receiving chemotherapy agents, diagnosed with cerebrovascular disease or Helicobacter pylori infection were excluded. Statistical analyses were performed using the SPSS software version 17.00 (SPSS Inc., Chicago, Illinois, USA).Results: A total of 238 elderly patients were enrolled. Patients’ mean age was 69.8 ± 6.8 years old. Reflux esophagitis was found in 22 (9.2%) patients. Several comorbidities were found in these patients, such as diabetes, hypertension, coronary artery disease, chronic kidney disease, and liver cirrhosis. The only factor that associated with reflux esophagitis was the presence of hiatus hernia esophagus (p = 0.038). However, reflux esophagitis seemed to be more found in the elderly patients who have history of reflux inducing drugs consumption without any proton pump inhibitor (PPI) protection.Conclusion: Reflux esophagitis is still a major problem in the elderly. The presence of hiatus hernia might give an important consideration of upper gastrointestinal endoscopy screening. However, it would be a debate matter with regards to the cost burden and the low risk of esophageal cancer in Asian countries.

The Prevalence of Reflux Esophagitis in the Elderly and Its Associated Risk Factors

Background: Reflux esophagitis is a common problem in the elderly. Compare to the Western Countries, esophageal cancer where reflux esophagitis is the most predominant risk factor is considered rare in Asia. Many other risk factors have not been well studied especially in most Asian countries. The objective of this study is to evaluate the presence of reflux esophagitis in elderly patients and its associated risk factors.Method: This was a cross-sectional study in elderly patients who underwent upper gastrointestinal endoscopy. Patients who received long-term proton pump inhibitor (PPI) therapy, suffered from gastrointestinal Malignancies, recently receiving chemotherapy agents, diagnosed with cerebrovascular disease or Helicobacter pylori infection were excluded. Statistical analyses were performed using the SPSS software version 17.00 (SPSS Inc., Chicago, Illinois, USA).Results: A total of 238 elderly patients were enrolled. Patients\u27 mean age was 69.8 ± 6.8 years old. Reflux esophagitis was found in 22 (9.2%) patients. Several comorbidities were found in these patients, such as diabetes, hypertension, coronary artery disease, chronic kidney disease, and liver cirrhosis. The only factor that associated with reflux esophagitis was the presence of hiatus hernia esophagus (p = 0.038). However, reflux esophagitis seemed to be more found in the elderly patients who have history of reflux inducing drugs consumption without any proton pump inhibitor (PPI) protection.Conclusion: Reflux esophagitis is still a major problem in the elderly. The presence of hiatus hernia might give an important consideration of upper gastrointestinal endoscopy screening. However, it would be a debate matter with regards to the cost burden and the low risk of esophageal cancer in Asian countries

Recurrent Upper Gastrointestinal Bleeding Caused by Gastric Angiodysplasias

Gastric angiodysplasia, a typical discrete lesion with flat and bright-red color in gastric mucosa and submucosa, is one of the cause of recurrent upper gastrointestinal bleeding. Mostly, angiodysplasia found as multiple lesion in different location. Melena, hematemesis, and chronic anemia is a consequence of untreated gastric angiodysplasia. Sometimes, it is hard to diagnose, because of its similarities with another gastric mucosa lesion and an inadequate gastric distention during endoscopic procedure. Both pharmacological and non-pharmacological therapy were used to treat this condition in daily clinical practice, one of them is argon plasma coagulation as thermal modalities during endoscopy procedure. This therapy promise an  effective angiodysplasia therapy to stop upper gastrointestinal bleeding and further complication.Gastric angiodysplasias causing recurrent gastrointestinal bleeding were found in a 73-year old man. He had been hospitalized for several times in the last two years in various hospitals in his home country as well as abroad, because of hematemesis and/or melena. The previous  repeated  gastroscopic examination by experienced endoscopists revealed erosive gastritis. After receiving blood transfusions, gastroscopy was performed and showed multiple small, flat bright-red mucosal lesions in different size in the stomach. The lesions were succesfully treated with argon plasma coagulation (APC). During a follow-up period of more than 18 months no further recurrent bleeding was observed