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"Exceptional liver disease treatment starts with Biopsy Interpretation of the Liver. This book offers information on liver biopsy. It is suitable for physicians, surgeons, and clinicians."

"ABSTRAKAim: to know the effectiveness of probiotic in reducing hepatic inflammation among non-alcoholic fatty liver disease (NAFLD) patients. Methods: we performed literature searching regarding the potential role of probiotic in reducing hepatic inflammation among NAFLD patients. Results: six articles were finally critically appraised. All six studies had good validity and importance. These studies unanimously reported that probiotic is useful in reducing hepatic inflammation, and liver fat content. However, further evidence is needed to show whether or not probiotic is beneficial reducing cirrhosis progression and liver-related mortality. Conclusion: probiotic owns robust potential to treat NAFLD. Probiotic reduce hepatic inflammation, as shown by the reduction of liver aminotransferase, and inflammatory markers. Based on this evidence based report, probiotic is a promising adjunct therapy for NAFLD."

"Background: the risk of Non Alcoholic Fatty Liver Disease (NAFLD) is increasing in patients with type 2 diabetes. Prevalence and factors related to the increased risk of NAFLD in diabetic patients in Indonesia has never been studied before. Data regarding the profile of fibrosis in the population has also been unknown. This study aimed to identify the difference on the profile of diabetic patients with and without NAFLD as well as the degree of fibrosis.Methods: the study was conducted using a cross sectional method in type 2 diabetic patients who were treated at the outpatient clinic of endocrinology and metabolic division in Cipto Mangunkusumo Hospital. Sampling was done consecutively. Collected data comprised of age, duration of diabetes, body mass index (BMI), waist circumference, HDL, triglyceride, and HbA1C levels. Abdominal ultrasonography was conducted for all patients to determine the presence of NAFLD. Patients with NAFLD were subsequently underwent transient elastography in order to assess their degree of liver fibrosis. Chi-square or Fishers Exact tests were used for bivariate analysis and logistic regression was used for multivariate analysis.Results: as many as 186 patients were analyzed in the study and 84 patients (45.2%) were demonstrated to have NAFLD. Transient elastography examinations were carried out in 68 patients and 17 patients (25.0%) were found with severe fibrosis. Univariate analysis showed significant differences on BMI (PR=1.878; 95%CI= 1.296 2.721; p<0.001) and waist circumference (PR=2.368; 95%CI= 1.117 5.017; p=0.018) between patients with and without NAFLD. However, the multivariate test showed that BMI was the only factor that had a significance difference between both groups (OR=2.989; 95%CI=1.625-5.499; p<0.001).Conclusion: prevalence of NAFLD among type 2 diabetic patients in Cipto Mangunkusumo Hospital has reached 45.2% and 25.0% among them had severe fibrosis. BMI is the only factor found to be associated with the occurrence of NAFLD."

"ABSTRACTBackground: non alcoholic fatty liver disease (NAFLD) is known to be associated with some metabolic disorders. Recent studies suggested the role of uric acid in NAFLD through oxidative stress and inflammatory process. This study is aimed to evaluate the association between serum uric acid and NAFLD. Methods: a systematic literature review was conducted using Pubmed and Cochrane library. The quality of all studies was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). All data were analyzed using REVIEW MANAGER 5.3. Results: eleven studies from America and Asia involving 100,275 subjects were included. The pooled adjusted OR for NAFLD was 1.92 (95% CI: 1.66-2.23; p<0.00001). Subgroup analyses were done based on study design, gender, non-diabetic subjects, non-obese subjects. All subgroup analyses showed statistically significant adjusted OR and most of which having low to moderate heterogeneity. Two studies revealed relationship between increased serum uric acid levels and severity of NAFLD. No publication bias was observed. Conclusion: our study demonstrated association between serum uric acid level and NAFLD. This finding brings a new insight of uric acid in clinical practice. Increased in serum uric acid levels might serve as a trigger for physician to screen for NAFLD."

"Latar belakang : Seiring dengan semakin efektifnya terapi Antiretroviral (ARV) pasien HIV memiliki harapan hidup lebih lama, morbiditas dan mortalitas penyakit HIV yang tidak berhubungan dengan Acquired Immunodeficiency Syndrome semakin meningkat. Non-alcoholic Fatty Liver Disease (NAFLD) telah dikenali sebagai penyakit hati tersering yang mempengaruhi lebih dari seperempat jumlah populasi global dan jumlahnya semakin meningkat di Indonesia. Pasien yang terinfeksi HIV memiliki risiko lebih tinggi untuk terkena NAFLD. Penelitian ini bertujuan untuk mendapatkan informasi tentang prevalensi dan faktor yang berhubungan dengan NAFLD pada pasien HIV dalam pengobatan antiretroviral (ARV) tanpa hepatitis viral kronis. Metode: Penelitian ini merupakan studi potong lintang yang melibatkan pasien HIV dalam pengobatan ARV tanpa koinfeksi virus hepatitis yang berobat di poliklinik Kelompok Studi Khusus (POKDISUS) Rumah Sakit Cipto Mangunkusumo Jakarta. NAFLD didefinisikan sebagai perlemakan di jaringan hati yang dibuktikan oleh pemeriksaan imaging transient elastography dengan Controlled Attenuation Parameter (CAP) setidaknya 238 dB/m. Perkiraan faktor-faktor yang berhubungan dengan NAFLD dianalisis dengan regresi logistik bivariat dan multivariat. Hasil: Pada penelitian ini secara keseluruhan didapatkan 105 subyek pasien HIV yang direkrut secara konsekutif. Prevalensi NAFLD didapatkan 52,4% (95% CI ±9,55). Faktor-faktor yang berhubungan dengan NAFLD pada populasi ini adalah hipertensi (PR = 3,755; 95% CI 1,218-11,575; p = 0,021) dan Index Massa Tubuh (IMT) (PR = 1,212 95% CI 1,051-1,396; p = 0,008). Faktor terkait HIV seperti CD4+ nadir, lama mendapat terapi ARV didapatkan tidak terkait NAFLD. Kesimpulan: Prevalensi NAFLD pada pasien HIV di Indonesia tinggi. NAFLD didapatkan berkaitan dengan hipertensi dan IMT, namun tidak dengan faktor-faktor terkait HIV. Penapisan non invasif untuk NAFLD sebaiknya diimplementasikan pada populasi ini untuk intervensi awal dan pencegahan komplikasi.

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Background: As HIV-infected persons experience longer life expectancies, other cause of morbidity and mortality among this group are increasingly being identified. Non-alcoholic fatty liver disease (NAFLD) has been recognized as the most common liver disease affecting more than a quarter of global population and increasing number in Indonesia. HIV-infected persons are at an increased risk of having NAFLD. This study aimed to inform prevalence and factors associated with NAFLD in HIV-infected patients without chronic viral hepatitis on antiretroviral therapy (ARV). Methods: A cross sectional study of HIV-infected person on ARV without hepatitis co-infection was done in HIV Integrated Clinic Cipto Mangunkusumo Hospital, Jakarta. NAFLD was defined as having at least 238 dB/m in transient elastography with associated Controlled Attenuation Parameter (CAP) examination. Bivariate and multivariate logistic regression analysis were applied to estimate factors associated with NAFLD Results: A total of 105 consecutive HIV infected person were included in the study analyzed. The prevalence of NAFLD was 52.4% (95% CI ±9.55). Factors related to NAFLD in this population were hypertension (PR = 3.755; 95% CI 1.218-11.575; p = 0.021) and Body Mass Index (BMI) (PR = 1.212 95% CI 1.051-1.396; p = 0.008). HIV specific variables such as nadir CD4, duration of ARV were not associated with NAFLD. Conclusion : There was a high prevalence of NAFLD among Indonesian person infected with HIV. NAFLD was associated with BMI and hypertension, but not with HIV related factors. Non-invasive screening for NAFLD should be implemented in this populaton to establish early intervention and prevent complication"

"ABSTRACTBackground: hypothyroidism is a common concomitant disease of non-alcoholic fatty liver disease (NAFLD). Previous studies regarding the relationship between subclinical hypothyroidism and NAFLD showed conflicting results, ranging from a strong association to not significant one. This case report aimed to investigate the risk of developing NAFLD in subclinical hypothyroidism patients. Methods: literature searching used ScienceDirect, PubMed, ProQuest, and Scopus. Filtering process of titles and abstracts by using inclusion and exclusion criteria yielded 4 eligible articles (1 systematic review, 1 prospective cohort, 1 retrospective cohort, and 1 case-control study) for answering the clinical question. Critical appraisal was conducted by using worksheets from Centre for Evidence-Based Medicine, University of Oxford. Results: the systematic review was considered invalid due to its less comprehensive search for relevant studies, inappropriate article selection to find a causal relationship between diseases, and statistical heterogeneity. The retrospective cohort was decided unimportant because it possessed a relative risk of 0.85 (95% confidence interval [CI], 0.72--1.00) which the upper limit of its CI included 1.00. The rest were valid and had important risk relative and odds ratio (1.27 [95% CI, 1.09--1.47], 3.41 [95% CI, 1.16--9.98]; respectively). The number needed to harm (5 - 17) indicated the clinically meaningful harm of the exposure since only a few patients with subclinical hypothyroidism is needed to obtain one additional NAFLD incidence. Those two articles were also suitable to be applied in our case. Conclusion: patients with subclinical hypothyroidism, compared to euthyroid patients, are at higher risk of developing NAFLD."

"Latar belakang: Pilihan terapi terbaik untuk gagal hati terminal adalah transplantasi hati (TH). Setelah transplantasi seorang anak akan mempunyai hati dengan fungsi normal, namun tidak berarti menjadi anak yang sehat. Pasca TH anak akan berada dalam kondisi kronis dengan morbiditas tersendiri.Tujuan: Mengetahui perbedaan Quality of Life anak dengan penyakit hati kronis (PHK) yang dilakukan TH dengan yang tidak secara kuantitatif.Metode: Penelitian ini merupakan studi potong lintang terhadap anak pasca TH minimal selama 1 tahun dan anak PHK yang merupakan kandidat TH berusia 2-18 tahun. Subjek pasca TH diambil secara konsekutif, kelompok PHK minimal berjumlah setara dengan dengan kelompok pasca TH. Kedua kelompok dilakukan penilaian Quality of Life (QoL) menggunakan kuesioner PedsQLTM4.0 dalam Bahasa Indonesia yang telah divalidasi. Rerata nilai PedsQLTM4.0 pada anak sehat adalah 82,92+15,55 dan 83,91+12,47 masing-masing untuk proksi orangtua (OT) dan penilaian anak (A). Pada kondisi kronis rerata PedsQLTM,4.0 untuk proksi OT dan A masing-masing adalah 73,14+16,46 dan 74,16+15,38. Nilai yang lebih tinggi menunjukkan QoL yang lebih baik. Nilai <1 SD adalah batas anak memerlukan intervensi terkait QoL nya.Hasil: Kesintasan 1 dan 5 tahun pasca TH anak di RSCM adalah 85,4% dan 79,3%. Subjek pasca TH proporsi kelompok usia terbanyak adalah 5-7 tahun (66,7%), median usia 6 tahun 7,5 bulan; diagnosis dasar terbanyak adalah atresia bilier (84,6%). Pada subjek PHK kelompok usia terbanyak adalah 2-4 tahun (46,3%), median usia 9 tahun, penyebab terbanyak adalah kelainan vaskular (29,3%). Rerata total QoL subjek pasca TH 1 tahun lebih tinggi dibandingkan dengan subjek PHK.Kesimpulan: Rerata nilai total QoL 39 subjek pasca TH lebih baik dibandingkan 41 subjek PHK kandidat TH baik berdasarkan proksi OT maupun A secara bermakna. Penilaian QoL proksi OT dan anak menyimpulkan dimensi terbaik adalah fungsi sosial dan terendah fungsi sekolah. Pada penelitian ini QoL tidak dipengaruhi oleh status gizi, infeksi CMV/ EBV, ataupun rejeksi.

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Background: Liver transplantation (LT) is the best-known treatment for terminal chronic liver disease (CLD). Following a LT procedure, the patient will have a functional liver but is not considered as healthy child. Post LT, the patient will remain in a chronic condition with its own morbidity.

Objective: To distinguish Quality of Life (QoL) distinction between terminal CLD patient who underwent LT and not.

Methods: A cross-sectional study was conducted on 39 subjects consisting of 1 year LT survivor patient and 41 LT candidate children, aged 2-18 years. Liver recipient subjects were taken consecutively, equal amount CLD subjects were collected. Both groups were assessed for Quality of Life (QoL) using the validated PedsQLTM4.0 questionnaire in Indonesian. PedsQLTM4.0 cut-off point average scores in healthy children (population) are 82.92+15.55 and 83.91+12.47 each representing parent proxy (P) and child self-assessment (C). In chronic conditions children, cut off point average score of PedsQLTM4.0 for P and C were 73.14+16.46 and 74.16+15.38 respectively. Higher values ​​indicate better QoL. One standard deviation below the population mean was explored as a cut-off point score for an at-risk status of impaired QoL.

Results: The 1 and 5 years-survival rate of LT children in RSCM were respectively 85.4% and 79.3%. Liver recipient subjects mostly consist of 5-7 years (66.7%) age group, median age was 6 years and 7.5 months; and the most prevalent diagnosis was biliary atresia (84.6%). In CLD, a portion of 2-4 years old age group (46.3%) was the dominant, the median was 9 years, and the most common diagnosis was vascular disorders (29.3%). Higher QoL score in post-transplant subjects was observed.

Conclusion: LT children’s QoL was significantly higher than children who were candidate for LT, according to parent proxy and child self-assessment. Based on both parent proxy and child-assessment, social function was observed to have the best the QoL function and school function scored the lowest. In this study, QoL of liver recipient children were not affected by nutritional status, CMV or EBV infection, nor rejection."

"Latar Belakang: Prevalensi non-alcoholic fatty liver disease (NAFLD) diprediksi akan terus meningkat selama beberapa tahun ke depan, dimana NAFLD dikaitkan dengan peningkatan asupan lemak dan kolesterol. Pare (Momordica charantia L.) mempunyai berbagai zat aktif yang berperan dalam proteksi hati. Penelitian ini bertujuan untuk melihat gambaran histopatologi dari tikus yang diinduksi oleh pakan tinggi lemak tinggi kolesterol beserta efek dari pemberian ekstrak pare dan simvastatin terhadap perbaikan kondisi hati tikus.Metode: Penelitian ini merupakan studi eksperimental in-vivo dengan menggunakan hewan coba tikus jantan Sprague-Dawley. Sebanyak 25 ekor tikus dengan berat awal 200- 250 gram dibagi secara acak menjadi 5 kelompok. Seluruh tikus diberikan pakan tinggi lemak tinggi kolesterol selama 3 bulan. Selanjutnya, kelompok kontrol positif diberikan simvastatin dengan dosis 0,9 mg/kgBB, kelompok kontrol negatif tidak diberi perlakuan, sedangkan kelompok dosis 1, dosis 2, dan dosis 3 diberikan ekstrak pare dengan dosis 50 mg/kgBB, 100 mg/kgBB, dan 200 mg/kgBB berturut-turut. Setelah 3 pekan, organ hati tikus diambil dan dibuat preparat histopatologi. Sediaan dinilai dengan perbesaran 1x40 sebanyak 5 lapang pandang untuk setiap tikus. Nilai steatosis, ballooning hepatocyte, dan inflamasi lobular dinilai dari setiap lapang pandang dijumlahkan sebagai NAFLD activity score dan dibandingkan antar kelompok.Hasil: Terdapat gambaran steatosis dan inflamasi lobular pada tikus yang diinduksi pakan tinggi lemak tinggi kolesterol, tetapi belum mencapai gambaran ballooning hepatocyte. Dosis 3 (200 mg/kgBB) mempunyai mean rank NAS yang lebih rendah dibandingkan dengan kelompok kontrol dan dosis lainnya yaitu sebesar 9,50. Simvastatin mempunyai mean rank paling rendah dari semua kelompok yaitu sebesar 7,90. Walaupun demikian, perbedaan antar kelompok pada penelitian ini tidak mencapai nilai yang bermakna (p = 0,166).Kesimpulan: Pemberian pare dengan dosis 50 mg/kgBB, 100 mg/kgBB, dan 200 mg/kgBB serta simvastatin 0,9 mg/kgBB selama 2 pekan tidak menunjukkan perbedaan perbaikan kondisi NAFLD pada tikus yang diinduksi pakan tinggi lemak dan tinggi kolesterol yang bermakna secara statistik.

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Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) is predicted to continue to increase over the next few years, where NAFLD is associated with

increased fat and cholesterol intake. Bitter gourd (Momordica charantia L.) has various active substances that play a role in liver protection. This study aims to look at the histopathological picture of mice induced by high-fat, high-cholesterol diets along with the effects of administering bitter melon extract and simvastatin on improving the liver condition of mice.

Method: This research is an in-vivo experimental study with using male Sprague-Dawley rats. A total of 25 rats with an initial weight of 200-250 grams were randomly divided into 5 groups. All rats were given a high-fat, high-cholesterol diet for 3 months. Furthermore, the positive control group was given simvastatin at a dose of 0.9 mg/kgBW, the negative control group was given no treatment, while the group dose 1, dose 2, and dose 3 were given bitter melon extract at a dose of 50 mg/kgBW, 100 mg/kgBW, and 200 mg/kgBW consecutively. After 3 weeks, the rat livers were taken and histopathological preparations were made. The preparations were assessed at 1x40 magnification for 5 visual fields for each rat. The steatosis, hepatocyte ballooning, and lobular inflammation values assessed from each visual field were summed as a NAFLD activity score and compared between groups.

Results: There was a picture of steatosis and lobular inflammation in rats induced by a high-fat, high-cholesterol diet, but it did not reach the stage of ballooning hepatocyte . Dose 3 (200 mg/kgBW) had a lower mean NAS rank compared to the control group and other doses, namely 9.50. Simvastatin had the lowest mean rank of all groups, namely 7.90. However, the difference between groups in this study did not reach a significant value (p = 0.166).

Conclusion: The administration of bitter melon at doses of 50 mg/kg body weight, 100 mg/kg body weight, and 200 mg/kg body weight, along with simvastatin at 0.9 mg/kg body weight for two weeks, did not show statistically significant differences in the improvement of NAFLD conditions in rats induced by a high-fat and high-cholesterol diet."

"ABSTRAKLatar Belakang: Ensefalopati hepatikum minimal (EHM) adalah spektrum teringan dari abnormalitas neuropsikologis yang merupakan komplikasi dari sirosis hati yang berimplikasi pada kualitas hidup pasien. Namun, saat ini modalitas untuk mendiagnosis EHM masih terbatas. Salah satu modalitas pemeriksaan EHM adalah Critical Flicker Frequency (CFF), namun tidak semua fasilitas kesehatan memiliki alat ini. Model for End-Stage Liver Disease (MELD) adalah suatu sistem skoring yang dikembangkan untuk mengetahui prognosis pasien yang akan menerima transplantasi hati dan berdasarkan beberapa studi, berkorelasi dengan EHM. Penelitian ini bertujuan untuk mengetahui korelasi antara MELD dengan CFF pada pasien sirosis hati.Metode: Penelitian dilakukan secara potong lintang. Pengambilan data dilakukan sejak Maret hingga Mei 2016 di poliklinik Hepatologi RSUPN Cipto Mangunkusumo. Kriteria inklusi meliputi pasien sirosis hati dengan nilai GlasgowComa Scale (GCS) 15. Kriteria eksklusi meliputi pasien dengan ensefalopati hepatikum, hematemesis melena, stroke, gangguan penglihatan dan sirosis alkoholik, Subjek penelitian kemudian dilakukan pemeriksaan dengan alat CFF dan dihitung skor MELD masing masing.Hasil: Sebanyak 60 pasien memenuhi kriteria inklusi dan eksklusi. Didapatkan 28 pasien tanpa EHM dan 32 pasien dengan EHM. Rata rata usia pasien 54,8 tahun. Jumlah hepatitis terbanyak adalah hepatitis B sejumlah 34 pasien dan skor Child Pugh terbanyak adalah Child Pugh A sebanyak 39 pasien. Nilai rerata CFF 36,9 ± 8,57 Hz dan skor MELD 10,3 ± 3,6. Didapatkan nilai r -0,097.Simpulan: Tidak terdapat korelasi antara skor MELD dan skor CFF.

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ABSTRACT

Background: Minimal hepatic encephalopathy (MHE) is the mildest spectrum of neuropsychological abnormality as a complication of liver cirrhosis which has implication in quality of life. Meanwhile, there are only few modalities to diagnose MHE. One of them is Critical Flicker Frequency(CFF), but this modality is not available in every health center. Model for End-Stage Liver Disease (MELD)-a scoring system developed to determine the prognosis of patients who receive liver transplant-is correlated with EHM according to several studies. This study aimed to determine the correlation between MELD with CFF in cirrhotic patients.

Method:

This was a cross sectional study. Data were collected from March until May 2016 in Hepatological outclinic RSUPN Cipto Mangunkusumo. Inclusion criteria consist of cirrhosis pasien with Glasgow Coma Scale (GCS) 15. Exclution criteria consist of patient with hepatic encephalopathy, hematemesis melena, stroke, visual impairment, and alcoholic cirrhosis. All subjects were examined using CFF and MELD scores.

Results:

A total of 60 patients met the inclusion and exclusion criteria for the study. There are 28 patients with EHM and 32 patients without EHM. r value of -0,097. The mean age were 54.8 years old. Most subjects were diagnosed with hepatitis B (34 patients) and most subjects were scored A based on Child Pugh scoring(39 patients). Mean value of CFF and MELD are 36,9 ±8,57 Hz and 10,3 ±3,6 consecutively. The correlation score between two modalities were r -0,097.

Conclusion:

There was no correlation between MELD score and CFF score."