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"BackgroundHepatic encephalopathy is found in 50-70% cases of liver cirrhosis. Management of hepatic encephalopathy is based on the hypothesis of ammonia and false neurotransmitters. A vegetable diet is the diet of choice, since vegetable proteins have a high biological value, contains non-ammonigenic essential amino acids, and contains fiber. The results of soy fermentation by Rhizopus sp can increase the nutritional value to make it easier for body digestion.Study aimTo determine improvements in hepatic encephalopathy by measuring the ammonium level and determining the psychometric test in patients with liver cirrhosis receiving a tempe diet compared to those receiving a liver diet (conventional diet).MethodThis is a random open clinical trial with a proportional stratification according to the Child Pugh criteria. Study subjects are patients with liver cirrhosis who are hospitalized at the Internal Medicine Ward and ambulatory patients at the out-patient Gastro-hepatology Polyclinic of Dr. Sarjito Public General Hospital, from January 1999 to May 2000. The trial was conducted for 20 days, where the first (trial) group was given a tempe diet, while the second (control) group was given liver diet Will (conventional). Measured outcomes include peripheral blood ammonium level, and psychometric test using the Numeric Connection Test (NCT).ResultsIn the first group, we found a significant reduction of ammonium level in Child-Pugh A patients and a non-significant reduction in Child-Pugh B/C patients, a non-significant psychometric test improvement in Child-Pugh A patients, and significant psychometric test improvement in Child-Pugh B/C patients. In group II: there is no significant difference in the changes in ammonium level or psychometric test in patients from both Child-Pugh categories.ConclusionA 20-day tempe diet can reduce ammonium levels and improve results on the psychometric test. Key words: liver cirrhosis, hepatic encephalopathy, tempe diet, numeric connection test, Child-Pugh criteria"

"Latar Belakang: Asam lemak rantai pendek (SCFA) merupakan metabolit utama yang diproduksi di kolon, hasil dari fermentasi bakteri terhadap serat dan resistant starch. SCFA diperkirakan memiliki peran pada patogenesis ensefalopati hepatik (EH), meskipun mekanisme yang mendasarinya belum sepenuhnya dimengerti. Disbiosis mikrobiota yang terjadi pada sirosis mengubah komposisi SCFA pada feses dan berperan dalam patogenesis EH.Tujuan: Penelitian ini bertujuan untuk membandingkan proporsi SCFA feses pasien sirosis yang mengalami EH dan non EH.Metode: Penelitian ini merupakan studi potong lintang yang dilaksanakan di Klinik Hepatobilier dan Ruang Prosedur Terpadu, IPINB Hepatobilier RSUP Dr. Cipto Mangunkusumo Jakarta periode 2023. Pasien sirosis akan dilakukan tes flicker atau stroop, pemeriksaan SCFA feses (asetat, butirat, dan propionat), dan kuesioner dengan teknik food recall untuk menilai pola diet. Analisis bivariat dan multivariat dilakukan dengan aplikasi SPSS Statistics (IBM, 2024).Hasil: 86 pasien sirosis dengan rerata usia 53 tahun ± 8,10 dan jenis kelamin mayoritas (68,6%) laki-laki mengikuti penelitian ini. 20 pasien sirosis (23,25%) mengalami EH. Analisa bivariat tidak ditemukan perbedaan bermakna (p>0,05) antara jumlah SCFA feses, komponen SCFA, ataupun proporsi komponen SCFA. Analisa multivariat terhadap proporsi SCFA absolut [OR 2,47; IK95% (0,64 – 9,56); p=0,191], proporsi asetat absolut [OR 4,72; IK 95%(0,25 – 64,01); p=0,243], dan proporsi butirat [OR 1,91; IK 95% (0,450 – 8,09); p=0,381] bersifat sebagai prediktor kejadian EH, sekalipun tidak bermakna.Simpulan: Prevalensi EH pada pasien sirosis rawat jalan di Poliklinik Hepatobilier RSCM adalah 23,3% dengan EH covert sebesar 19,8% dan EH overt sebesar 3,5%. Proporsi SCFA feses tidak berhubungan dengan kejadian EH pada pasien sirosis.

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Background: Short chain fatty acids (SCFA) are the main metabolites of the intestinal microbiota which play a role as colonocyte trophic factors and maintain the integrity of the gastrointestinal tract and blood-brain barrier. Microbiota dysbiosis that occurs in cirrhosis changes SCFA composition in feses and plays a role in the pathogenesis of hepatic encephalopathy (HE).

Objective: This study aims to compare the amount and composition of fecal SCFA in cirrhotic patients with HE and non-HE.

Methods: This research is a cross-sectional study carried out at the Hepatobiliary Clinic and Integrated Procedure Room, IPINB Hepatobiliary Hospital Dr. Cipto Mangunkusumo Jakarta period 2023. Cirrhosis patients will undergo a flicker or Stroop test, fecal SCFA examination (acetate, butyrate and propionate), and a questionnaire with a food recall technique to assess dietary patterns. Bivariate and multivariate analyzes were carried out with the SPSS Statistics application (IBM, 2024).

Results: 86 cirrhosis patients with a mean age of 53 years ± 8.10 and the majority gender (68.6%) male took part in this study. 20 cirrhosis patients (23.25%) experienced EH. Bivariate analysis found no significant differences (p>0.05) between the amount of fecal SCFA, SCFA components, or proportion of SCFA components. Multivariate analysis of absolute SCFA proportions [OR 2.47; IK95% (0.64–9.56); p=0.191], absolute proportion of acetate [OR 4.72; IK95% (0.25- 64.01); p=0.243], and the proportion of butyrate [OR 1.91; CI 95% (0.450 – 8.09); p=0.381] is a predictor of EH events, even though it is not significant. Conclusions: The prevalence of HE in outpatients with cirrhosis at the Hepatobiliary Polyclinic of RSCM was 23.3% with covert HE of 19.8% and overt HE of 3.5%. The proportion of fecal SCFA was not associated with the incidence of HE in cirrhosis patients."

"Tujuan : untuk memperoleh data profil lipid dan kadar glukosa darah penderita SH, serta hubungannya dengan asupan makanan dan status gizi.Tempat : RS Sumber Waras, Jakarta Barat. Bahan dan Cara : Setelah mendapat izin dari Komite medik RS Somber Waras, maka dilakukan penelitian dengan desain cross sectional pada 140 penderita SH(100 laki-laki dan 40 perempuan) yang sesuai dengan kriteria penerimaan. Data yang dikumpulkan meliputi umur, jenis kelamin, analisis asupan makanan selama 3 hari di RS, antropometri (TLT&LLA), USG dan pemeriksaan laboratorium darah (profil lipid, kadar glukosa puasa & 2 jam PP). Uji statistik yang digunakan adalah t-test, Mann Whitney, Kolmogorov-Smimov dan uji korelasi Pearson /Spearman rank.Hasil : Subyek penelitian berjumlah 140 orang (100 laki-laki dan 40 perempuan), 59,3 % subyek memenuhi kriteria Child C, dengan menggunakan parameter AOLA menunjukkan 70,98% subyek Child B dan 75,90% subyek Child C memiliki status gizi muscle wasting. Pada pemeriksaan profit lipid didapatkan hasil kadar kolesterol total <200mg/dL,.LDL < 130 mg/dL, HDL < 40 mg/dL dan trigliserida < 200 mg/dL pada subyek Child B dan C. Profit lipid Child C lebih rendah dari Child B ( semakin luas kerusakan jaringan hati, terdapat gangguan sintesis lipid). Tidak terdapat hubungan bermakna antara profil lipid dengan status gizi, tidak terdapat hubungan bermakna antara status gizi dengan jumlah asupan makanan. Terdapat korelasi positif antara kadar trigliserida dengan jumlah asupan makanan subyek Child B dan korelasi positif antara kadar HDL dengan jumlah asupan makanan subyek Child C. Terdapat korelasi positif antara kadar glukosa darah puasa dengan kadar glukosa darah 2 jam post prandial. KES1MPULAN : Rendahnya profil lipid pada subyek Child B dan C diduga karena asupan makanan yang kurang dari kebutuhan dan status gizi muscle wasting, disamping kerusakan sel hati yang luas, menyebabkan defisiensi sejumlah enzim LCAT dan hepatic lipase. Ditemukannya peningkatan kadar glukosa darah 2 jam post prandial (>I44mg/dL) pada subyek Child B dan C.

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Objective : to obtain data about the lipid profile and blood sugar level in patients with cirrhosis hepatic and its relation to the food intake and nutritional status.

Place: Sumber Waras Hospital, West Jakarta

Materials and methods: after receiving permission from the Medical committee of Sumber Waras hospital. Crosses sectional study was done with 140 cirrhosis hepatize patients (100 males and 40 females) as the subjects fulfilling the criteria set for the study. The data colleted consisted of age,sex,analysis of 3 days food consumption in the hospital, anthropometric measurements('[SF&MUAC), USG and blood laboratory examination (lipid profile, blood sugar fasting & 2 hours post prandial). The following tests were used for data analysis t -test, Mann whitney, Koimogorov-Smirnov and Pearson/Spearman rank.

The results: Of the 140 subjects 59,3% fulfilled Child C critera who, based on MAMA parameter, were classified as Child B subjects (70,98 %) and Child C subjects (75,90) with muscle wasting. The lipid profile was as follows. Total cholesterol < 200mg/dL; LDL < 130 mgldL, HDL < 40 mg/dL and triglyceride <200 mg/dL in Child B and C subjects. The lipid profile of Child C subjects was lower than Child B(in extensive liver tissue damage synthesis is disturbed). There is no significant relation between the lipid profile and nutritional status, and between nutritional status with food intake. There is positive correlation between blood triglyceride level and food intake of Child 13 subjects and between blood HDL level with food intake of Child B subjects. There was also positive con-elation between fasting blood glucose level and 2 hours post prandial blood sugar.

Conclusion: the low level of lipid profile of subject Child B and C subjects are assumed to be related insufficient food intake and muscle wasting besides extensive liver tissue damage which lead to a deficiency of a number of LCAT enzymes and hepatic lipase. The increase in the 2 hours post prandial blood glucose level (>140 mg/dL) of the Child B and C subjects."