The Association Between Risk Factors And Ultrasound-Based Grades Of Non-Alcoholic Fatty Liver Disease In Type-2 Diabetes Patients

Background: Non-alcoholic fatty liver disease (NAFLD) has become more common as the cause of cirrhosis and liver cancer. The liver disease is highly prevalent in people with type-2 diabetes. Indonesia is not spared from the global epidemic of type-2 diabetes. The ultrasound examination is clinically easy-to-use, economical and non-invasive as a tool to detect NAFLD, compared to the gold standard, liver biopsy. To date, there has been no study in Indonesia to link risk factors and ultrasound-based severity grading of NAFLD. Aim: To understand the association between risk factors and ultrasound-based grades of NAFLD in patients with type-2 diabetes. Method: The present study was an observational study with a cross-sectional design (May-October 2018) that involved 82 type-2 diabetes outpatients of the internal medicine clinic in the Gotong Royong Hospital (Surabaya, Indonesia). The risk factors assessed were gender, age, diabetes duration, obesity (anthropometric measurement: body mass index/ BMI, waist circumference and waist-to-hip ratio), glycemic control (hemoglobin A1c/ HbA1c level) and dyslipidemia (lipid profile: total cholesterol, low-density lipoprotein/ LDL, high-density lipoprotein/ HDL and triglyceride). The ultrasound-based grades of NAFLD consisted of grade 0 (no NAFLD), grade 1 (increased liver echogenicity with normal images of intrahepatic vessel lines and diaphragm), grade 2 (blurred image of intrahepatic vessel lines) and grade 3 (blurred images of intrahepatic vessel lines and diaphragm). Statistical p-value was significant at ≤ 0.05. Results: Seventy-eight subjects (95,1%) had NAFLD. The ultrasound-based NAFLD grades were significantly different across age groups (Kruskal-Wallis) but the Spearman’s rank correlation test result was not significant. Body mass index and total cholesterol were positively correlated (r = 0.390 and 0.237, respectively) with the NAFLD grades. Conclusion: Higher BMI and total cholesterol are associated with increased ultrasound-based NAFLD grades

The Correlation Between Leukocytosis And Gallbladder Adhesion On Cholecystectomy Patients At X Hospital

Background: Gallbladder adhesion is a complication which causes difficulty in cholecystectomy. The author aims to seek for a test that could be used as a predictor factor for gallbladder adhesion. In this research, the elevated white blood cell (leukocyte) count is the factor studied. Aim: This study aims to seek for correlation between leukocytosis and gallbladder adhesion on cholecystectomy patients. Method: This research is an observational analytic study using cross sectional design. The independent variable in this research is leukocytosis, and the dependent variable is gallbladder adhesion. Analysis in this research is carried out with Chi-Square test, using a total sampling of 45 medical records of cholecystectomy patients at X Hospital. Result: The majority of cholelithiasis patients in this research were between 50-59 years old (33,3%), with a mean of 51 years old. The number of cholelithiasis patient was dominated by female (62,2%). According to the cholecystectomy procedure, 26 patients underwent laparoscopic cholecystectomy (58,8%). According to clinical presentation, pain in the upper right of the abdomen was experienced by 25 patients (55,6%). Complication suffered by patients was mostly cholecystitis (n=44), yielding the number of 97,8%, followed by gallbladder adhesion in 34 patients (75,6%). Leukocytosis, which is assumed to be the predictor factor of gallbladder adhesion, was found in 15 patients (33,3%). The Chi-Square test showed no significant correlation between the two variable studied (p=0,62). Conclusion: There is no significant correlation between leukocytosis and gallbladder adhesion in cholecystectomy patients

GRAVES DISEASE

Graves' disease is one of the most common autoimmune diseases. The disease is named after the scientist Robert James Graves, who first described it in the 19th century as a syndrome with an enlarged and overactive thyroid gland (hyperthyroidism due to circulating autoantibodies), rapid heart rate, and eye abnormalities. graves’ disease is the most common cause of hyperthyroidism and affects more women than men. Graves’ disease can appear at any age, but it most commonly appears for the first time between the ages of 20 and 40. Factor is a predisposition that is more dominant than environmental factors. There are circulating autoantibodies produced by B lymphocytes induced by autoreactive T lymphocytes that recognize thyrotropin-stimulating hormone (TSH) receptors in thyroid tissue as self-antigens. These autoantibodies are also known as TSH receptor antibodies (TSH-R Ab), thyrotropin stimulating antibodies (TSI), or thyrotropin receptor antibodies (TRAb). TRAb acts like TSH to cause thyroid hyperplasia (diffuse goitre), increased synthesis, and excessive and uncontrolled secretion of thyroid hormones (T4: tetraiodothyronine T4 and T3: triiodothyronine T3). Investigations to confirm Graves’ disease show elevated thyroid hormones (T4 and T3) with very low TSH and increased TRAb. On thyroid ultrasound, the majority of patients have a hypervascular and hypoechoic diffusely enlarged thyroid gland. The treatment for graves’ disease is to reduce the synthesis of thyroid hormones using anti-thyroid drugs, or to reduce the amount of thyroid tissue with radioactive iodine (RAI) or total thyroidectomy. Methimazole is the first-choice antithyroid drug with good effectiveness and safety. Although the recurrence rate after stopping the drug is still quite hig