APRI Index Changes After 4 Weeks Treatment of Pentoxifylline in Chronic Hepatitis B

Nowadays studies have shown that liver fibrosis is a reversible process. Theraupetic target on hepatic stellate cell (HSC) through inhibition of fibrotic signaling transduction is one of the way to treat liver fibrosis (e.g. pentoxifylline). APRI index, one of the indirect marker of liver fibrosis, had shown significant correlation (Spearman correlation y = 0.7) with liver fibrosis degree in hepatitis B and C. This study was aimed to evaluate the effect of pentoxifylline treatment in 4 weeks for liver fibrosis measured by APRI index. We conducted clinical trial on eleven chronic hepatitis B patients from Adam Malik Hospital Medan, with positive HBsAg at least 6 months after follow up. They were treated with pentoxifylline for 4 weeks. Before and after treatment, APRI index was measured. The result showed a decrease of ALT (64.64+49.61 vs 50.64+26.13;p=0.28), but AST and APRI index increased (91.82+100.16 vs 97.91+146.75; p=0.79) and (1.17+1.07 vs 1.31+1.84; p=0.96) respectively. It was concluded that the effect of pentoxifylline as antifibrotic in the liver measured by APRI index was not proven. It was shown that APRI index increased after 4 weeks treatment of pentoxifylline

Etiology Profile of Lower Gastrointestinal Bleeding

Background: Lower gastrointestinal bleeding (LGIB) is still a significant health problem since the unknown etiology had not existed until now. Similar condition occurs at Adam Malik Hospital. No data about the etiology of LGIB has been defined. Therefore, this study was aimed to recognize the etiology profile of LGIB at Adam Malik Hospital, Medan. Method: A retrospective descriptive study was conducted on medical records of patients who had undergone lower gastrointestinal tract endoscopy (colonoscopy) at Adam Malik Hospital, Medan between January 2009 and December 2010 based on their complaint of hematochezia. Data was analyzed using SPSS version 19. The data was categorized based on subjects' age, sex and etiology of their hematochezia. Results: There were 116 patients consisted of 61 (52.6%) males and 55 (47.4%) females with mean age of 50.52 (17-84) years. The colonoscopy revealed 52 (44.7%) cases of hemorrhoidal varices, 17 (14.7%) cases of rectal carcinoma, 17 (14.7%) normal endoscopic results, 8 (6.9%) cases of sigmoid carcinoma, 8 (6.9%) of proctitis, 6 (5.1%) cases of colitis, 4 (3.5%) cases of colon carcinoma, and 4 (3.5%) cases of rectosigmoid carcinoma. Conclusion: This study found that hemorrhoidal varices is the most common etiology of LGIB

Gastrointestinal Problems in HIV/AIDS Patients

Background: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital

Gastrointestinal Problems in HIV/AIDS Patients

Background: Gastrointestinal (GI) and hepatobiliary disorders are the most common complaints in patients with HIV/AIDS disease. These fundamental problems have not yet been addressed and remains a rewarding area for research. Data about the problems are scarce, especially in Indonesia. This study was aimed to identify gastrointestinal problems in HIV/AIDS patients who were hospitalized in Adam Malik Hospital, Medan.Method: A descriptive study was conducted based on medical records data from non-ambulatory HIV/AIDS patients who had GI problems and who were hospitalized in Internal Medicine wards of Adam Malik Hospital,Medan from 2010-2012. Spearman rank test was used to evaluate the correlation between CD4 level and GI problems among 68 patients with CD4 data.Results: We found 647 HIV/AIDS patients, i.e. 524 (80.9%) male and 123 (19.1%) female patients. Gastrointestinal problems were found in 315 (48.7%) patient among them. Oral candidiasis was the mostcommon case found in 306 (97.1%), which was followed by chronic diarrhea 73 (23.2%), oral candidiasis with chronic diarrhea 64 (20.3%), dyspepsia 22 (6.9%), non-cirrhotic ascites 20 (6.3%), acute diarrhea 8 (2.5%), hepatomegaly 8 (2.5%), dysphagia 6 (1.9%), chronic hepatitis C virus 6 (1.9%), chronic hepatitis B virus 4 (1.3%), GI bleeding 3 (0.9%), and acute hepatitis A virus 1 (0.3%). Unfortunately, we found that therewas only 68 data of CD4. Results of statistical tests showed a significant correlation between CD4 level and gastrointestinal problems (p = 0.04).Conclusion: Oral candidiasis is the most common gastrointestinal problems in HIV/AIDS patients hospitalized in Internal Medicine Wards of Adam Malik Hospital

The Role of Ascitic Paracentesis in Liver Cirrhosis in Improving the Function and Structure of the Heart

Background: Heart abnormalities in cirrhotic patients have been known for five decades, with atria and ventricular dilatation. Pozzi et al reported that in cirrhotic patients with or without ascites, the diastolic function was lower than control. Ascitic paracentesis improved diastolic function. The diameter of both atria was larger in cirrhotic patients with or without ascites. The diastolic diameter of left ventricle did not differ significantly in cirrhotic patients with or without ascites compared to control, but there was an increase after paracentesis. Ejection fraction was lower in cirrhotic and increased after ascitic parancentesis although the increase was not significant. The aim of the Study: To compare the function and structure of the heart before and after ascitic paracentesis in cirrhotic patients. Methods: This study took place from February 2000 to April 2001 in dr. Pringadi Hospital/H.Adam Malik Hospital. There were 18 samples (12 men and 6 women), 15 of which were cirrhotic patients with tense ascites and 3 cirrhotic patients with refractory ascites. The mean age was 51,8 + 8,28 years, the youngest being 29 years and the oldest 65 years. The mean ascitic fluid removed by paracentesis was 7,20 liters with a range of 5 to 9 liters. Immediately following paracentesis, Dextran 40 % was administered at a dose of 8g/ 1L ascitic fluid aspirated. Results: The diameter of the four heart chambers decreased after paracentesis, but the decrease was not statistically significant. There was increase in E/A ratio after ascitic paracentesis, from 0,93 + 0,370 to 1,06 + 0,383 (significant, p<0,05), meaning that there was an improvement in diastolic function after ascitic paracentesis. There was also an increase in ejection fraction from 68,99 + 13,26 % to 72,10 + 11,10 %, but this was not significant (p>0,05). Conclusion: After paracentesis, there was a significant improvement in diastolic function while the diameter of the four heart chambers decreased and the ejection fraction increased insignificantly

Nitric Oxide and Von Willebrand Factor Levels as Markers of Endothelial Dysfunction in Liver Cirrhosis

Introduction: A number of investigators have shown that endothelial dysfunction in liver cirrhosis can be indicated by increased levels of nitric oxide (NO) and von Willebrand factor (vWF). The cause of this increase is still unclear. It is believe to be correlated with hyperdinamic circulation and endotoxemia, which are common in liver cirrhosis. The Aim of This Study: To compare the levels of NO and vWF in liver cirrhosis patients with those in healthy control subjects, and to investigate whether there is a correlation between levels of NO and vWF with the severity of the disease according to the Child Pugh Criteria Material and Method: This study was conducted from February until June 2001 in 35 liver cirrhosis patients at Dr. Pirngadi and H. Adam Malik Hospital and some private hospitals in Medan. The mean age of patients with liver cirrhosis was 54 + 12.26 years, the youngest being 31 years and the oldest 75 years, and 20 healthy controls while the mean age of the control subject was 55.20 + 13.04 years, the youngest being 31 years and the oldest 76 years. Based on Child Pugh criteria, 9 were classified as Child Pugh class A, 13 in class B, 13 in class C. The criteria for liver cirrhosis were based on clinical examination, laboratory findings and liver ultrasound examination. Cirrhotic patients with hypercolestrolemia, hypertension, heart failure, myocardial infraction, renal failure diabetes, COPD were those on drugs, such as antibiotics and branchodilators were excluded from the study. Result: The mean level of NO in patients with liver cirrhosis was 6.2600 + 4.4456 mM, while the mean NO level in control subjects was 3.2325 + 3.2355 mM, p<0.05. The mean level of NO in Child Pugh class A patients was 6.6889 + 3.9757mM, compared to control p<0.05; in Child Pugh class B the mean level was 4.8308 + 2.4642 mM compared to control p>0.05. There was a significant increase in the level of NO associated with the severity of liver cirrhosis. The mean level of vWF in patients with liver cirrhosis was 399.514 + 175.313% while the mean vWF level in control subjects was 139.100 + 51.144%, p<0.05. The mean level of vWF in Child Pugh class A patients was 231.778 ± 43.8576%, compared to control p<0.05; in Child Pugh class B was 365.846 + 110.034%, compared to control p<0.05, in Child Pugh class C was 549.308 + 164.483%, compared to control p<0.05. There was significant increase in the level of vWF correlated with severity of liver cirrhosis. Conclusion: The level of NO was significant higher in liver cirrhosis patients compared to control subjects, but there was no correlation between the increase in the level of NO with the severity of the disease. The levels of vWF was significantly higher in liver cirrhosis patients compared to control, and there was a correlation between increased levels of vWF and the severity of the disease

S-Index and APRI Score to Predict Liver Fibrosis Chronic in Hepatitis B and C Patients

Background: A great interest has been dedicated to the development of non invasive predictive models in recent years to substitute liver biopsy for fibrosis assessment and follow-up. The aim of this study was to comparethe accuracy between S-index and aspartate aminotransferase to platelet ratio index (APRI) to FibroScan for predicting liver fibrosis in chronic hepatitis B and C patients.Method: A cross-sectional study was conducted in 40 patients with chronic hepatitis B and C between January 2010 - May 2011 at Division of Gastroentero-hepatology, Department of Internal Medicine, Adam Malik Hospital, Medan. Patients underwent laboratory examination and FibroScan, then used predictive values to assess the accuracy of S-index scores and APRI compared to FibroScan. The analysis was performed using SPSS 15.0.Results: S-index identified significant fibrosis in 87.5% patients with sensitivity (Se) 87.5% and specificity (Sp) 100%. About 67.5% of 40 patients could be identified correctly. S-index also could accurately predict the absence or presence of cirrhosis in 87.5% of the total 40 patients, with NPV 91.7% and PPV 81.25%, respectively. APRI for significant fibrosis has Se 85.7%, Sp 88%, PPV 88.8%, NPV 69.2%; while Se 53%, Sp 88%, PPV 72.7%, NPV 75.8% for liver cirrhosis. AUROC value for S-index was higher than APRI in predicting significant fibrosis and cirrhosis, i.e. 0.938 vs. 0.917 and 0.873 and 0.707, respectively.Conclusion: The S-index has a higher accuracy than APRI in predicting significant fibrosis and cirrhosis in patients with chronic hepatitis B virus and hepatitis C virus infection

The Profile of Upper Gastrointestinal Endoscopy in Deli Serdang Hospital

Background: Upper gastrointestinal endoscopy profile has been reported by many hospitals; however, there has never been from Deli Serdang hospital, North Sumatera. The aim of study was to determine the profile of upper endoscopy at Deli Serdang hospital. Method: The study was conducting retrospectively 453 patients during the period of December 2006– December 2008 at the Endoscopy Unit Department of Internal Medicine Deli Serdang hospital. Data were obtained from medical records including the age, sex, race, indications, and endoscopic diagnosis. All data were reported descriptively. Results: Out of 453 patients who underwent upper gastrointestinal endoscopy, 241 (53.20%) patients were male. The mean age was 66.3 ± 15.6. Most patients (51.88%) were between 40-59 years of age. Regarding the ethnicity, there were 30.91% Bataknese patients, 21.85% Javanese, 18.98% Karonese, 14.79% Malays, and 13.47% patients of other ethnicities. Dyspepsia was the mostly found indication, which was found in 75.94% patients. It was followed by hematemesis/melena in 15.01% patients and other indications in 6.84% patients. About 33.11% patients had normal upper gastrointestinal diagnosis; while gastritis was found in 26.93% patients, erosive gastritis in 18.98% patients, gastric/duodenal ulcer in 8.83%, and esophageal varices in 5.74% patients. Conclusion: About 453 patients have undergone upper gastrointestinal endoscopy during 2 years period. This study shown greater number of male patients compared to female and the patients were most frequently between 40-59 years old. Normal upper gastrointestinal diagnosis was the most frequently found in this study

Level of Gastrin Serum and Ulcer Size on Gastric Ulcer Correlated to Helicobacter Pylori Infection

Background: Previously has been defined that peptic ulcer has strongly correlated to Helicobacter pylori (H. pylori) infection. But it hasn\u27t determined about correlation of gastrin serum level to the ulcer severity on H. pylori infection. The aims of this study were to find the percentage of H. pylori infection on peptic ulcer cases and its correlation to the gastrin serum level. Method: This is analytic cross sectional study in 50 patients with gastric ulcer who came to Adam Malik hospital from February to October 2007. The correlation between gastrin serum level and the size of ulcer with positive and negative Urea Breath Test (UBT) group was analyzed by unpaired student t- test. The correlation between gastrin serum level and ulcer size were investigated with Pearson correlation test and linier regression. Result: Fifty eligible patients, 33 (66%) had positive UBT and 17 (34%) were negative. There were statistically significant difference on gastrin serum level in positive UBT and negative respectively (p = 0.017). There were also significant difference between mean of ulcer size in positive UBT and negative respectively (p = 0.025). There were correlation between gastrin serum level and ulcer size (r = 0.315; p = 0.026). It can predict the increasing ulcer size in 0.012 mm every 1 pg/mL of gastrin serum elevated. Conclusion: Patients with positive UBT has greater ulcer size and higher gastrin level as compared to the negative group. There were positive correlation between gastrin serum level to the size of ulcer in peptic ulcer patients and increase of ulcer size followed with elevated of gastrin serum level