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"Background: One of the causes of chronic diarrhea is pancreatic exocrine insufficiency. Chronic diarrhea cases are commonly encountered in Indonesia.Materials & Methods: All patients with chronic diarrhea at hospitals in Jakarta were included in this study and dyspeptic patients were used as control subjects. The study and control subjects must submit their stool for fecal pancreatic elastase-1 examination at a private laboratory in Jakarta. Mild/moderate pancreatic exocrine insufficiency was defined if the concentration was between 100 - 200 [ig El/g stool. Severe pancreatic exocrine insufficiency was defined if the concentration was below 100 [ig El/g stool. The data was analyzed using Fisher or Kruskal-Wallis tests.Results: There were 32 chronic diarrhea patients with a male to female ratio of 19/13 (59.38%/40.62%). The most frequent age range was 50-59 years old (39.5%). The characteristics (sex, age and race) of chronic diarrhea patients were matched with the characteristics of dyspeptic patients as control subjects (p > 0.05). The fecal elastase-1 results in chronic diarrhea displayed greater pancreatic exocrine insufficiency (< 200 fig El/g stool) than in dyspepsia (control) (>_ 200 fj,g El/g stool, p < 0.001). The mean fecal elastase-1 result in chronic diarrhea and in dyspepsia were 316.29 ±_ 195.44 vs. 475.93 +. 65.33 fig El/g stool (p < 0.001). Six patients (18.74%) were established as having severe pancreatic exocrine insufficiency. Seven patients (21.88%) were found with mild/moderate pancreatic exocrine insufficiency.Conclusion: Pancreatic exocrine insufficiency was found frequently in chronic diarrhea."

"ABSTRAKDiare persisten merupakan masalah kesehatan serius dan sering menyebabkan malnutrisi. Kerusakan mukosa pada diare diduga menyebabkan penurunan hormon sekretin dan kolesistokinin sehingga mengurangi stimulasi ke pankreas dan memperberat diare persisten dan malnutrisi.Penelitian ini bertujuan untuk mengetahui fungsi eksokrin pankreas pada anak diare persisten, anak malnutrisi, mendapatkan nilai referensi pemeriksaan fecal elastase-1 FE-1 anak Indonesia, dan mengetahui kehandalan analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas.Penelitian potong lintang pada tahap pertama dilakukan untuk mendapatkan sebaran nilai FE-1 pada anak normal, membandingkan nilai FE-1 subjek diare persisten dan malnutrisi dengan anak normal, dan mengetahui sensitivitas, spesifisitas, dan kemampuan diskriminasi analisis feses dan steatokrit dalam mendeteksi insufisiensi eksokrin pankreas. Tahap kedua uji klinis dua kelompok paralel tersamar ganda dilakukan untuk menguji efek suplementasi enzim pankreas 8371 USP unit tiga kali sehari selama sebulan pada anak diare persisten. Penelitian dilakukan di 5 Rumah Sakit di Jakarta Januari 2015 minus;Juli 2016 pada anak berusia 6 ndash;60 bulan.Sebanyak 182 anak usia 6 ndash;60 bulan direkrut sebagai subjek yang terdiri dari 31 anak dengan diare persisten, 31 anak dengan malnutrisi, dan 120 anak normal. Nilai cut-off FE-1 yang didapatkan pada penelitian ini adalah 307 mcg/g feses. Terdapat perbedaan bermakna nilai FE-1 antara subjek diare persisten dan anak normal. Tidak ditemukan perbedaan bermakna nilai FE-1 antara subjek malnutrisi dan anak normal. Terdapat perbedaan bermakna lama diare sekitar 7 hari antara kedua kelompok. Kadar FE-1 dan prealbumin antara baseline dan endpoint pada kelompok plasebo dan perlakuan tidak berbeda bermakna. Uji kehandalan masing-masing komponen analisis feses dan steatokrit menunjukkan hasil sensitivitas dalam rentang 5 ndash;32 , spesifisitas 73 ndash;98 , nilai prediksi positif 1 ndash;43 , dan nilai prediksi negatif 87 ndash;89 . Nilai AUC analisis feses dan steatokrit masing-masing adalah 0,664 IK 95 0,539 ndash;0,788 dan 0,501 IK 95 0,372 ndash;0,629 sedangkan AUC gabungan sebesar 0,671.Kesimpulannya, pada penelitian ini didapatkan adanya insufisiensi eksokrin pankreas pada anak dengan diare persisten. Suplementasi enzim pankreas terbukti dapat memperpendek lama diare secara bermakna. Analisis feses dan/atau steatokrit memiliki sensitivitas yang rendah, spesifisitas yang tinggi, dan kemampuan diskriminasi kurang.Kata kunci: anak, diare persisten, fungsi eksokrin pankreas, malnutrisi, suplementasi enzim pankreas

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ABSTRACTPersistent diarrhea is a serious health problem and is closely related to malnutrition. Prolonged mucosal injury in diarrhea is thought to cause reduced secretin and cholecystokinin CCK secretion, which decreases stimulation to the pancreas and further aggravate persistent diarrhea and malnutrition.This research aims to study pancreatic exocrine function in children with persistent diarrhea and children with malnutrition, to obtain reference values of fecal elastase 1 FE 1 in Indonesian children, and to assess the ability of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency.Cross sectional study was done to obtain FE 1 distribution in healthy children, to study FE 1 levels in children with persistent diarrhea and children with malnutrition, and to study the sensitivity, specificity, and discriminative capacity of stool analysis and steatocrit in detecting exocrine pancreatic insufficiency. A randomized, two double blind parallel group, placebo controlled clinical trial was conducted to evaluate the effects of 8371 USP units of pancreatic enzyme replacement therapy PERT 3 times daily for 1 month in children with persistent diarrhea. This study involved children age 6 ndash 60 months in 5 hospitals in Jakarta from January 2015 to July 2016.As much as 182 children 6 ndash 60 months of age consisting of 31 children with persistent diarrhea, 31 children with malnutrition, and 120 healthy children were recruited as subjects. Cut off point of FE 1 in this study was 307 mcg g faeces. Significant difference of FE 1 was found between children with persistent diarrhea and healthy children. The FE 1 difference between subjects with malnutrition and healthy children was not significant. Duration of diarrhea was 7 days significantly shorter in the PERT group. Changes of FE 1 and prealbumin values between baseline and endpoint in placebo and treatment group were found to be statistically insignificant. The diagnostic value of each stool analysis component and steatocrit test showed that the sensitivity was within range of 5 ndash 32 , specificity 73 ndash 98 , positive predictive value 1 ndash 43 and negative predictive value 87 ndash 89 . The AUC values of stool analysis and steatocrit were 0.664 95 CI 0.539 ndash 0.788 and 0.501 95 CI 0.372 ndash 0.629 , respectively, and the combined AUC 0,671.In conclusion, exocrine pancreatic insufficiency was observed in children with persistent diarrhea, and PERT has been proven to significantly shorten the duration of diarrhea by 1 week. Stool analysis and or steatocrit has low sensitivity, high specificity, and low discrimination capacity.Keywords children, exocrine pancreatic function, malnutrition, pancreatic enzyme supplementation, persistent diarrhea"

"We describe that often colonic tuberculosis remains unsuspected prior to surgery. We therefore draw attention to pitfalls in the diagnosis and review the literature on the diagnostic modalities available to diag-nose the disease. Today, the prompt diagnosis of an unknown gastroenteritis process invoives colonoscopy.

Using a fiberscope, a procedure with instantaneous return can be carried out. Patients with clinical presen-tation suggestive of coionic tuberculosis should have had either an aggressive diagnostic work out using high-yield tests or anti tubercuiosis therapy."

"Background: Chronic diarrhea is common in Indonesia. The chronic non-infective diarrhea cases seem to be increasing recently. The aim of this study is to reveal the pattern of diseases that can cause chronic non-infective diarrhea.Materials & Methods: We examined all patients suffering from chronic non-infective diarrhea over a six years period. The patients underwent physical examination and performed laboratory tests, colon enema X-ray, colonoscopy, ileoscopy, upper gastrointestnal endoscopy and small bowel X-ray.Result: Chronic non-infective diarrhea was observed in 107 (51.7%) cases from 207 chronic diarrhea cases respectively. The frequently found abnormalities that had caused chronic non-infective diarrhea were carbohydrate maldigestion (62.61%), colorectal cancer (14.01%), Crohn's disease (11.21%), ulcerative colitis (9.34%), irritable bowel syndrome (8.41%), colorectal polyp (8.41%) etc.Conclusion: The most frequent abnormality found in chronic non-infective diarrhea was maldigestion."

"Background: The diagnosis and treatment of chronic diarrhea is sometimes difficult. Orocaecal transit time may explained some pathogenesis mechanism in chronic diarrhea.Materials & Methods: Twenty six chronic diarrhea patients and 35 normal adult subjects were included in this study. After fasting for at least 10 hours, subjects were asked to drink 20 ml (13.3 g) lactulose, then performed the breath hydrogen test. If there were an increment of H2 concentration 10 ppm in '/2 -1 hour, the subject was considered as rapid transit time, ff an increment of H2 concentration 10 ppm in 1 - 2 hour, the subject was considered as normal transit time. If an increment of H2 concentration 10 ppm in 2 - 3 hour,the subject was considered as delayed transit timeResults: In the chronic diarrhea group, 10 (38.4%) had rapid OCTT, 15 (57.6%) had normal OCTT and only 1 (4%) had delayed OCTT. In the normal adults group, 2 (5.7%) had rapid OCTT, 22 (62.9%) had normal OCTT and 11 (31.4%) had delayed OCTT. The difference was statistically significant (p < 0.001). The mean value of OCTT in chronic diarrhea and normal adults were 84.23 ± 39.82 min vs. 114.00 ± 51.35 min (p = 0.027).Conclusions: The rapid OCTT was more likely to be found in the chronic diarrhea patients compare to normal adults significantly. The mean OCTT in chronic diarrhea was shorter than the mean OCTT in normal adults."

"Amyloidosis is a rare disease, when diagnosed it's incurable and mostly affect over 40 years old male. Diagnostic is confirmed if histopathologic stained positive with Congo red and evidence of monoclonal protein. Survivals for untreated patients are 13 months in primary amyloidosis but if secondary to other chronic disease and systemic, survival could be 3-4 years. It can not be prevented but when affected, control of the underlying illness can prevent progression of amyloidosis.

We report a rare case of a 67 year old male, who came with chronic diarrhea. The stool analysis, there were no negative gram microorganisme found, only food maldigestion and fungus infection. Stool analyze from parasitology department were found microspore, but the stool culture were sterile. The patient underwent colonoscopy which revealed hyperemis mucosa in rectum, sigmoid, descending & transverse colon. From the biopsy was concluded intestinal amyloidosis. We treated the patient symptomatically and couldn't find the underlying inflammatory disease which causes the problem."

"Insidens diare kronik di Asia berkisar antara 0,8 ? 1,0%. Lokasi penyakit dan kelainan yang menimbulkan diare kronik dapat dibagi atas 3 kelompok yaitu usus halus, usus besar dan ekstra intestinal. Penyakit-penyakit pada usus halus terdiri dari infeksi dan non-infeksi. Penyakit-penyakit infeksi antara lain yaitu infeksi bakterial, infeksi parasit dll. Penyakit-penyakit non-infeksi yang menimbulkan diare kronik a.l. penyakit Crohn, ?Celiac sprue?, enteropati OAINS, intoleransi laktose, tumor jinak, tumor karsinoid, karsinoma, komplikasi pasca bedah, obat laksatif dll. Pendekatan diagnosis terdiri dari anamnesis riwayat penyakit yang baik, pemeriksaan fisik yang teliti, laboratorium penunjang, laboratorium penunjang yang lebih spesifik termasuk foto rontgen kolon, foto rontgen ?esofagogastroduodenum follow-through?, ?enteroclysis?, pemeriksaan ileo-kolonoskopi dan endoskopi saluran cerna atas termasuk usus halus dengan biopsi untuk pemeriksaan histopatologi. Pengobatan diare kronik dibagi atas pengobatan suportif dan kausal. (Med J Indones 2002; 11: 179-89)

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The incidence of chronic diarrhea in Asia is between 0.8 ? 1.0%. The diseases and abnormalities according to the location, which can cause chronic diarrhea, are divided into three locations: the small bowel, the large bowel and extraintestinal. The small bowel diseases include infectious and non-infectious diseases. The infectious diseases are bacterial infections, parasitic infections etc. The non-infectious diseases include of Crohn?s disease, Celiac sprue, NSAID enteropathy, lactose intolerance, benign tumor, carcinoid tumor, carcinoma, post surgery complications, laxative etc. The approaches to diagnosis include good anamnesis, careful physical examination, supporting laboratory tests, more specialized supporting examinations including X-ray of the colon, esophagogastroduodenum follow-through, enteroclysis, ileo-colonoscopy and endoscopy on the upper portion of the digestive tract including the small intestine with biopsy for histopathology examinations. The treatment for chronic diarrhea is divided into supportive and causal therapy. (Med J Indones 2002; 11: 179-89)"

"Chronic venous insufficiency (CVI) merupakan salah satu gangguan pada sistem vaskular Bagian dari sistem vaskular yang dipengaruhi oleh CVI yaitu sistem vena pada ekstremitas bawah. Hal ini menganggu aliran darah pada ekstremitas bawah sehingga dapat menimbulkan komplikasi luka, nyeri, dan keterbatasan rentang gerak pergelangan kaki. Masalah keperawatan yang ditegakkan yaitu nyeri akut dan gangguan integritas kulit. Karya Ilmiah Akhir Ners (KIAN) ini menguraikan analisis asuhan keperawatan dan penerapan range of motion pada pasien dengan CVI untuk meningkatkan keterbatasan rentang gerak pada pergelangan kaki dan penyembuhan luka. Hasil evaluasi dari penerapan tersebut menunjukkan peningkatan rentang gerak pergelangan kaki dari 100 menjadi 150 tetapi tidak ada peningkatan penyembuhan luka selama 6 hari perawatan. Selain itu, terdapat penurunan nyeri dari skala 6 menjadi 5. Berdasarkan hasil tersebut diharapkan latihan ROM dapat diterapkan pada pelayanan kesehatan terutama pada pasien CVI dengan keterbatasan rentang gerak pergelangan kaki.

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Chronic venous insufficiency (CVI) is one of the disorders that affects vascular system. Part of the vascular system that is affected by CVI is venous system in the lower extremities. This disrupts blood flow in the lower extremities which may cause complications such as venous leg ulcer. The main nursing problem in this case is impaired skin integrity. This nursing scientific paper aims to elaborate analysis of nursing care and range of motion application in patient with CVI to increase ankle ROM limitation and wound healing. Evaluation of the ROM application shows increase in ankle ROM from 100 to 150 during 6 days of care. However, there is no increase in the healing rate after 6 days of application. According to the evaluation, ROM exercise is proposed to be applied in healthcare services particularly for CVI patients with ankle ROM limitations"