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Abstrak :
Effectively manage the chronic problems of your hypertensive patients with the practical clinical tools inside Hypertension, 2nd Edition: A Companion to Braunwald's Heart Disease. This respected cardiology reference covers everything you need to know - from epidemiology and pathophysiology through diagnosis, risk stratification, treatment, outcome studies, concomitant diseases, special populations and special situations, and future treatments. Confidently meet the needs of special populations with chronic hypertensive disease, as well as hypertension and concomitant disease. Learn new methods of aggressive patient management and disease prevention to help ensure minimal risk of further cardiovascular problems. Benefit from the authors' Clinical Pearls to reduce complications of hypertension

Abstrak :
he fourth edition of this authoritative text covers every aspect of liver disease affecting infants, children, and adolescents. As in the previous editions, it offers an integrative approach to the science and clinical practice of pediatric hepatology and charts the substantial progress in understanding and treating these diseases. All of the chapters are written by international experts and address the unique pathophysiology, manifestations, and management of these disorders. This edition of the landmark text features extended coverage of viral hepatitis, metabolic liver disease, fatty liver disease, and liver transplantation, including a new chapter on post-transplant care and outcomes. All of the chapters have been updated to reflect changing epidemiology and recent advances in molecular medicine and genomics. With the continued evolution of pediatric hepatology as a discipline, this text remains an essential reference for all physicians involved in the care of children with liver disease.

Abstrak :
Latar Belakang dan tujuan: Penyakit hati kronik pada pasien pediatrik merupakan salah satu masalah utama kesehatan pada populasi anak-anak dengan angka morbiditas dan mortalitas yang cukup tinggi. Penilaian derajat fibrosis hati diperlukan untuk menentukan tatalaksana yang sesuai, menentukan prognosis, dan tindak lanjut pasca pengobatan. Pemeriksaan USG elastografi acoustic radiation force impulse ARFI merupakan metode penilaian derajat fibrosis hati yang bersifat tidak invasif, mudah dan cepat dikerjakan. Penelitian ini bertujuan untuk mendapatkan nilai titik potong derajat fibrosis USG elastografi ARFI pada pasien pediatrik dengan penyakit hati kronik. Metode: Pasien pediatrik dengan penyakit hati kronik menjalani pemeriksaan USG elastografi ARFI. Didapatkan nilai shear wave velocity SWV dari pemeriksaan ARFI yang menunjukkan elastisitas jaringan hati pada 18 subjek dan dihubungkan dengan hasil biopsi hati METAVIR . Kurva receiver-operating characteristic ROC dilakukan untuk menentukan titik potong derajat fibrosis hati. Hasil: Rerata nilai median ARFI pada pasien pediatrik dengan penyakit hati kronik tanpa fibrosis hati 1,21 m/s; fibrosis ringan F1 1,13 m/s; fibrosis signifikan F2 ; fibrosis berat F3 2,76 m/s; dan sirosis F4 3,84 m/s. Kurva ROC menunjukkan titik potong ARFI pada 1,98 m/s memiliki sensitivitas 100 untuk mendeteksi derajat fibrosis ge;F3. Kesimpulan: USG elastografi ARFI merupakan metode yang dapat diandalkan, cepat, dan non invasif untuk menentukan derajat fibrosis berat dan sirosis pada pasien pediatrik. Hasil pemeriksaan ARFI dapat membantu klinisi dalam tindak lanjut pengobatan dan alternatif biopsi hati pada kondisi tertentu. ......Background and objectives: Chronic liver disease in pediatric patients is one of the major health problems with high rates of morbidity and mortality. Assessment of the degree of liver fibrosis is needed to determine appropriate management, determine prognosis, and post treatment follow up. Ultrasound acoustic radiation force impulse ARFI elastography examination is a non invasive, easily and rapidly performed liver fibrosis assessment method. The objective of this study was to obtain the cut off value of fibrosis degree with ARFI examination in pediatric patients with chronic liver disease. Methods: Pediatric patients with chronic liver disease underwent ARFI ultrasound measurements. Shear wave velocity SWV value obtained from ARFI examination showing elasticity of liver tissue in 18 subjects and associated with liver biopsy results METAVIR . The receiver operating characteristic ROC curve is performed to determine cut off value of degree of liver fibrosis. Results Mean of SWV value in pediatric patients with chronic liver disease without liver fibrosis 1.21 m s mild fibrosis F1 1.13 m s significant fibrosis F2 severe fibrosis F3 2.76 m s and cirrhosis F4 3.84 m s. The ROC curve shows the cut off at 1.98 m s yielded a 100 sensitivity to detect the degree of fibrosis ge F3. Conclusions USG elastographic ARFI is a reliable, rapid, and non invasive method for determining the degree of severe fibrosis and cirrhosis in pediatric patients. The results of the ARFI examination may assist the clinician in the follow up of treatment and alternatives of liver biopsy in certain condition.

Abstrak :
Kanker hati adalah kondisi ketika sel-sel dalam hati tumbuh di luar kendali. Pada tahun 2020, kanker hati menempati urutan keempat kanker dengan jumlah kasus baru dan kematian tertinggi di Indonesia. Faktor risiko utama kanker hati adalah penyakit hati kronis. Tujuan penelitian ini adalah mengetahui risiko penyakit hati berkembang menjadi kanker hati pada peserta dengan dan tanpa penyakit hati di Indonesia tahun 2019-2021. Penelitian ini menggunakan Data Sampel BPJS Kesehatan tahun 2019-2021 dengan desain kohort retrospektif dan didapatkan jumlah sampel 824.592 terbobot. Analisis menggunakan uji Cox Proportional Hazard. Hasil penelitian menunjukan bahwa peserta dengan penyakit hati memiliki probabilitas dan risiko kanker hati yang lebih tinggi dibandingkan peserta yang tidak memiliki penyakit hati (CEP 1,61%; 95% CI 0,08% – 3,14%; AHR 98,5; 95% CI 40,6 – 239,4). Berdasarkan jenis dan jumlah penyakit hatinya, peserta dengan hepatitis kronis (AHR 153,9; 95% CI 32,3 – 690,7) dan menderita lebih dari 2 jenis penyakit hati (AHR 140,1; 95% CI 18,5 – 1061,7) memiliki risiko kanker hati paling tinggi dibandingkan kategori lainnya. Hasil studi menyimpulkan bahwa penderita penyakit hati, terutama hepatitis kronis, memiliki risiko sangat tinggi mengalami kanker hati. Untuk itu, perlu surveilans kanker hati secara nasional pada kelompok penduduk tersebut guna mencegah penyakit hati berkembang menjadi kanker hati. ......Liver cancer is condition characterized by uncontrolled growth of liver cells. In 2020, Liver cancer ranked fourth among new cancer cases and had highest mortality rate among cancers in Indonesia. The main risk factor for liver cancer is chronic liver disease. This study aimed to determine risk of liver disease progressing to liver cancer in participants with and without liver disease in Indonesia from 2019-2021. Retrospective cohort study was conducted using BPJS Kesehatan Sample Data from 2019-2021, with weighted sample size of 824,592. Cox Proportional Hazard analysis was performed. The results showed that participants with liver disease had higher probability and risk of liver cancer compared to those without liver disease (CEP 1.61%; 95% CI 0.08%–3.14%; AHR 98.5; 95% CI 40.6–239.4). Among different types and numbers of liver diseases, participants with chronic hepatitis (AHR 153.9; 95% CI 32.3–690.7) and those with more than two types of liver diseases (AHR 140.1; 95% CI 18.5–1061.7) had highest risk of liver cancer compared to others. The study concluded that patients with liver disease, particularly chronic hepatitis, have elevated risk of developing liver cancer. Therefore, national surveillance for liver cancer in this group is crucial to prevent progression of liver disease to liver cancer.

Abstrak :
Latar Belakang. Keluarga derajat pertama (first degree relatives/FDR) dari Diabetes Melitus tipe 2 (DMT2) memiliki kecenderungan untuk memiliki gangguan metabolik dan vaskular lebih dini tanpa melaui resistensi insulin (RI) sebagai perantaranya seperti lebih tebalnya tunika intima media karotis. Penyakit perlemakan hati non-alkoholik (non-alcoholic fatty liver disease/NAFLD) adalah penyakit hati kronik yang banyak ditemukan pada pasien DMT2 yang dependen terhadap RI. Studi tentang hubungan FDR DMT2 dengan NAFLD masih sangat terbatas dan inkonklusif. Hubungan tersebut masih belum jelas apakah kejadian NAFLD pada FDR DMT2 dependen terhadap RI atau karena kerentanan genetik FDR DMT2. Tujuan. Untuk mengetahui hubungan antara FDR DMT2 dengan NAFLD. Metode. Sebanyak 118 dewasa muda (19-39 tahun) dengan toleransi glukosa normal (59 subjek FDR DMT2 dan 59 subjek non-FDR dengan matching usia dan jenis kelamin) diikutsertakan dalam penelitian potong lintang ini. Pengukuran antropometri (tinggi, berat badan, indeks massa tubuh (IMT) dan lingkar perut) dan analisis laboratorium (glukosa darah puasa, HbA1c, profil lipid, serum glutamic pyruvic transaminase (SGPT)), serum glutamic oxaloacetic transaminase (SGOT)) diperiksa pada penelitian ini. Perlemakan hati didiagnosis dengan ultrasonografi (USG) menggunakan kriteria standar. Hasil Penelitian. Dua puluh enam subjek (22,03%) dengan NAFLD terdeteksi dengan USG dalam penelitian ini dengan proporsi yang sama pada kedua kelompok. Pada kelompok FDR DMT2 didapatkan jumlah subjek dengan angka HDL rendah dan sindrom metabolik lebih tinggi dibandingkan dengan kelompok tanpa FDR. Kesimpulan. Pada penelitian ini tidak didapatkan hubungan antara FDR DMT2 dengan NAFLD. ...... Background. First degree relatives (FDR) of type 2 diabetes mellitus (T2DM) predisposes individuals to have earlier metabolic and vascular disorders independent of insulin resistance (IR) such as thicker carotid intima media thickness than that of non-FDR. Non-alcoholic fatty liver disease (NAFLD) is the most commonly found chronic liver disease in T2DM which is IR dependent. Studies about NAFLD in FDR of T2DM populations are very limited and inconclusive. It is unclear whether the occurrence of NAFLD in FDR of T2DM is IR dependent or due to genetic vulnerability. Aim. to determine the association between NAFLD and FDR of T2DM. Method. A total of 118 young adults (19-39 years old) with normal glucose tolerance (59 FDR of T2DM and age-sex matched 59 non-FDR subjects) were included in this cross-sectional study. Anthropometric measurement (height, weight, BMI and waist circumference) and routine laboratory analysis (fasting blood glucose, HbA1c, lipid profile, alanine aminotransferase (ALT), aspartate transaminase (AST)) were examined. Fatty liver was diagnosed by ultrasonography (US) using standard criteria. Result. Twenty-six (22,03%) subjects with NAFLD were detected by US with similar proportion for each group. Low HDL level and metabolic syndrome were found higher in FDR group. Conclusion. we couldn`t prove the association between FDR of T2DM and NAFLD in this research.

Abstrak :
Latar belakang: Penyakit hati imbas obat akibat penggunaan obat anti tuberkulosis OAT merupakan salah satu faktor risiko yang telah dilaporkan Faktor kerentanan individu dalam memetabolisme dan detoksifikasi setiap obat yang dipengaruhi oleh faktor faktor genetik juga mempengaruhi kejadian penyakit hati imbas obat. Penelitian ini bertujuan untuk meneliti status asetilator enzim N Acetylator Transferase 2 NAT2 dan polimorfisme sitokrom P450 CYP 2E1 terhadap kejadian penyakit hati imbas obat. Metode: Studi kasus kontrol pada 50 pasien tuberkulosis di Rumah Sakit Cipto Mangunkusumo dan klinik paru PPTI yang dikelompokkan menjadi grup kasus n 25 dan grup kontrol n 25. Hasil: Dari 50 subyek penelitian didapatkan bahwa karakteristik subyek penelitian terbanyak berjenis kelamin perempuan 62 berusia 45 tahun 56 normoweight 66. Pada analisis bivariat terhadap faktor risiko kejadian penyakit hati imbas obat yang diinduksi oleh OAT hanya ditemukan faktor risiko status asetilator lambat enzim NAT2 yang signifikan dengan crude OR 1 563 95 KI 1 165 2 097 dengan p 0 002 sedangkan pada faktor risiko polimorfisme CYP 2E1 tidak ditemukan hasil yang bermakna secara statistik. Kesimpulan: Faktor risiko status asetilator lambat enzim NAT2 merupakan faktor risiko kejadian penyakit hati imbas obat yang diinduksi oleh OAT. ...... Background: Antituberculous agents is one of a drug induced liver injury's risk factors Individual susceptibility in drug metabolism and detoxification due to genetic factors was also reported lately. Among the individual susceptibility factors we would like to identify the genotype of N acetylator 2 enzyme status and polymorphism of cytochrome P450 2E1 as a risks factors of antituberculous agent induced liver injury. Methods: This is a case control study in 50 tuberculous rsquo patient at Cipto Mangunkusumo hospital and PPTI clinics which were divided in control group n 25 and case group n 25. Results: From 50 subjects the baseline charactersitic were mostly female 62 age 45 years old 56 normoweight 66 Bivariate analysis were performed to identify the risk factors and only slow acetylator status of NAT2 enzymes was found significant with crude OR 1 563 95 CI 1 165 ndash 2 097 p 0 002 but not in a CYP 2E1 polymorphism status. Conclusions: Slow acetylator status of NAT2 enzymes was a risk factor for antituberculous agents ndash induced liver injury.