COVID-19 treatment during and after recovery: What to expect

Currently, there are no clinically specific drug for COVID-19, neither novel treatments nor vaccines. Hospitals and researchers over the world are testing many different therapies on coronavirus-positive patients in an effort to find a potential COVID-19 treatment, a few medications that have been making a buzz in the science community such as remdesivir, hydroxychloroquine and chloroquine, favipiravir, oseltamifir, lopinavir/ritonavir, azithromycin, plasma convalescent, dexamethasone and stem cell

Nutritional Management in Acute Pancreatitis

Acute pancreatitis induce a catabolic stress that increase systemic inflammatory response with worsening nutritional status. Current approach in acute pancreatitis therapy was still symptomatic because of no definitive therapy yet to prevent any inflammatory and proteolytic cascade. One of the most important thing to consider in acute pancreatitis therapy was nutritional management. “Pancreatic rest” concept that formerly used have been known to increase cost, sepsis incidence due to catheter use, and also metabolic and electrolyte disorder. Nowadays, “gut rousing” concept was preferable compared to “pancreatic rest” concept, support that nutritional management was needed to stimulate and generate intestinal function. Enteral nutrition administration have to consider patient’s hemodynamic status. Necrosis incidence, respiratory failure, intensive care, and mortality was found to be lower in patients given enteral nutrition in first 48 hours compared to after 48 hours. Nutrition administration via nasogastric tube or nasojejunal tube was still in doubt while several studies showed that nasogastric tube administration was safe and tolerated, otherwise could be evaluated in larger population sample study. Nutrition and metabolic monitoring was also an important part to reach nutritional goals and reduce complications

Measurement of Health-Related Quality of Life in Patients with Functional Dyspepsia

In up to 80% of dyspepsia patients who consult a physician in the hospital, dyspepsia is considered to be functional dyspepsia. Although not associated with increased mortality, functional dyspepsia is a burden at both the community and national levels because it can cause physical, mental, and social distress that can affect a patient’s quality of life. Health-related quality of life (HRQOL) is a multidimensional construct comprising at least three broad domains—physical, psychological, and social functioning—which can all be affected by a disease and its treatment. It is important to assess HRQOL in patients with functional dyspepsia to identify the effects of the disease and its treatment on patients. Both disease-specific and generic instruments can be used to assess HRQOL in patients with functional dyspepsia. Each instrument has its own advantages and limitations. The selection of instrument to assess HRQOL is determined by the study population, research questions, disease entities, and researcher preferences. The purpose of this article is to explain the concept of HRQOL and the use of HRQOL assessment in patients with functional dyspepsia

Inducing and Aggravating Factors of Gastroesophageal Reflux Symptoms

Gastroesophageal reflux disease (subsequently abbreviated as GERD) is a  disease commonly found in the community. Several factors have been recognized as inducing and aggravating factors of GERD symptoms such as older age, female gender, obesity, smoking habit, alcohol consumption, certain diet and poor eating habit like eating fatty, spicy, and acid food

Management of Antithrombotic in Endoscopic Procedures

The use of antithrombotic medicine has increased along with the growing number of cardiovascular disease in the world. Endoscopy procedure often done to the patients who use antithrombotic medicine. Eventhough most of endoscopies are safe for those patients, there are some main things related to antithrombotic treatment management that have to be noted such as the kind of antithrombotic that being used, stratification of bleeding risk on the procedure, the risk of future thromboembolic, and the process of antithrombotic treatment re-initiation. So that, patient’s safety in undergoing endoscopy procedure is guaranteed

Functional Dyspepsia with Helicobacter pylori Infection

Helicobacter pylori infection is commonly found worldwide. In Indonesia, the prevalence of H. pylori infection is 22.1%. The bacteria are responsible for gastritis, peptic ulcer disease (PUD), and gastric cancer.Helicobacter pylori may also has a role in functional dyspepsia. Diagnostic approach consists of noninvasive and invasive examinations. One of the invasive strategy is upper gastrointestinal (UGI) endoscopy and gastric mucosa biopsy

Six-month Survival of Patients with Malignant Distal Biliary Stricture Following Endoscopic Biliary Stent Procedure and Its Associated Factors

Background: unresectable malignant distal biliary stricture patients require endoscopic biliary stent placement procedure. The survival rate and its associated factors in Indonesia are unknown. Objectives. To identify 6-month survival of patients with malignant distal biliary stricture following endoscopic biliary stent procedure and its associated factors. Methods: a retrospective cohort study was conducted using medical records of patients with unresectable malignant distal biliary stricture, which involved caput of pancreas, ampulla of Vater or distal cholangiocarcinoma following endoscopic biliary stent procedure between June 2015 and August 2017 at Cipto Mangunkusumo National Central General Hospital. The cumulative survival was defined by using the Kaplan-Meier curve. Bivariate and multivariate analyses were performed using Cox regression of some factors including failure of biliary stent insertion, bleeding, sepsis, comorbidities, malnutrition, and serum albumin levels. Results: out of total 120 subjects, 85 subjects died within 6 months following the stent procedure with a proportion of 180-day survival of 24% and a median survival of 81 days (CI 95%: 56–106 days). In bivariate analysis, factors of comorbidities, sepsis, malnutrition and albumin levels ≤ 3.0 g/dL had p values of < 0.25; while the subsequent multivariate analysis showed that albumin level of ≤ 3.0 g/dL had HR of 2.73 (CI 95%: 1.48 – 5.05; p = 0.001). Conclusion: the 6-month survival following endoscopic biliary stent procedure is 24% with a median survival of 81 days. Albumin level of ≤ 3.0 g/dL has a 2.73 times greater risk for 6-month mortality rate

The Effects of Ramadhan Fasting on Clinical Symptoms in Patients with Gastroesophageal Reflux Disease

Aim: to determine the effects of Ramadhan fasting on GERD symptoms. Methods: a total of 130 GERD patients participated in this study. Patients were divided into two groups, i.e. those who performed Ramadhan fasting (n=66), and those who did not perform Ramadhan fasting (n=64). The evaluation was done using Indonesian version of GERD questionnaire (GERD-Q) between the two groups, and between Ramadhan month and non-Ramadhan month in the Ramadhan fasting group. Results: there was a statistically significant difference (p<0.01) in the median of GERD-Q score in Ramadhan-fasting group subjects and non-Ramadhan-fasting group subjects (0 vs. 4). Moreover, a statistically significant difference (p<0.01) was also found in the median of GERD-Q score in Ramadhan-fasting group subjects and non-fasting group subjects (p<0.01). Conclusion: subjects in Ramadhan fasting group, GERD symptoms experienced less severe during fasting month (Ramadhan) than non-fasting month. During Ramadhan month, GERD symptoms were also milder in Ramadhan fasting group than those in non-fasting group subjects

Association between Severity of Dyspepsia and Urea Breath Test Results in Patients with Positive Helicobacter pylori Serology

Background: Active Helicobacter pylori infection is considered to cause more severe dyspepsia symptoms compared to inactive infection. This study was aimed to determine the association between severity of dyspepsia and urea breath test (UBT) results in subjects with positive H. pylori serology.Method: This study was a cross-sectional study in 60 subjects with positive H. pylori serology in Provincial General Hospital of West Nusa Tenggara. Severity of dyspepsia was measured using modified Glasgow Dyspepsia Severity Score (GDSS) questionnaire. Diagnosis of active H. Pylori infection was made using 14C UBT examination.Results: Proportion of active H. pylori infection in subjects with positive serology was 20%. The average of modified GDSS score in all patients was 1.95 (SD + 1.78), with minimal score of 0 and maximal score of 7. There was a statistically significant difference between average of modified GDSS score and positive and negative UBT results, (p=0.027). The cut-off point value of modified GDSS to diagnose positive UBT was 3.8. Results of diagnostic test with modified GDSS as a test and UBT results as the gold standard indicated sensitivity of 41.6% and specificity of 85.4%. Conclusion: There was a significant difference between modified GDSS score in patients and positive and negative H. pylori infection. In areas which did not have UBT examination, eradication in patients with positive serology and GDSS score of more than or equal to 4 could be considered.

Relationship Between Vascular Endothelial Growth Factor and Severity of Hepatocellular Carcinoma

Background: Severity of hepatocellular carcinoma (HCC) that is assessed using Barcelona Clinic Liver Cancer (BCLC) classification is a main prognostic factor of hepatocellular carcinoma. Assessment of the serum level of Vascular Endothelial Growth Factor (VEGF) is considered to reflect the severity of HCC. However, there is still no fundamental basis of the association of severity of HCC with the serum VEGF level. The objective of this study is to know the relationship between serum VEGF levels with the severity of HCC by assessing the average difference of serum VEGF level in various severity of HCC.Method: This study was a cross sectional study to identify the association between serum VEGF levels with the severity of HCC based on BCLC classification. This study was performed in Cipto Mangunkusumo Hospital between January and May 2015. Statistical tests used to evaluate the association between serum VEGF level with BCLC classification was one-way ANOVA analysis, and continued with post hoc Tukey Schaffe analysis.Results: A total of 61 subjects with HCC were included into this study. In this study, we did not find subjects with stage 0 BCLC. The average of serum VEGF level in stage A BCLC was 288.26 ± 156.6 pg/mL; stage B BCLC: 434 ± 164.8 pg/mL; stage C BCLC: 785.57 ± 194.25 pg/mL; stage D BCLC: 1537.97 ± 660.62 pg/mL. One-way ANOVA analysis showed significant difference (P < 0.001) between serum VEGF level and HCC severity based on BCLC classification. Post hoc Tukey Schaffe analysis showed the presence of significant difference between stage A and C BCLC (p < 0.05) and stage A and D BCLC (p < 0.001), stage B and D BCLC (p < 0.001), and stage C and D BCLC (p < 0.001). There was no significant difference between stage A and B BCLC, and between stage B and C BCLC.Conclusion: It was found that serum VEGF level increased in accordance to the HCC severity based on BCLC classification, particularly for stage B BCLC and above