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"LATAR BELAKANG : Sirosis hati merupakan salah satu masalah kesehatan di Indonesia. Penyakit ini merupakan penyakit hati yang sering dijumpai selain hepatitis virus akut dan kanker hati. Komplikasi sirosis hati yang tersering adalah asites. Adanya asites merupakan prognosis yang buruk karena hanya sekitar 50% penderita sirosis hati dengan asites dapat bertahan hidup dalarn waktu 2 tahun. Asites juga merupakan faktor predisposisi terjadinya komplikasi berbahaya seperti Peritonitis Bakteri Spontan (PBS).BAHAN DAN METODE : 74 subyek penelitian penderita sirosis hati dengan asites. Pada cairan asites dilakukan biakan aerob-anaerob, pemeriksaan hitung leukosit dengan alat hitung sel otomatis Sysmex XT2000i®, hitung jenis leukosit dengan mikroskop dan uji leukosit esterase carik celup urin sedangkan pemeriksaan albumin, protein dan LDH dilakukan untuk serum dan cairan asites.HASIL : Pada penelitian ini didapatkan penderita PBS sebanyak 14 orang (18.92%). Pada kelompok PBS didapatkan netrositik asites sebanyak 12 orang (85.71%). Dari hasil biakan yang positif pads kelompok penderita PBS berhasil diisolasi dua jenis kuman golongan Enterobacteriaceae yaitu Escherichia call dan Enterobacter aerogenes. Kedua kuman ini diduga menghasilkan Extended Spectrum Beta Lactamase (ESBL). Dengan menggunakan cara perhitungan stastistik menurut Bland-Altman didapatkan bahwa hasil hitung jumlah leukosit pada cairan asites dengan menggunakan alat otomatis Sysmex XT2000P tidak berbeda bermakna dengan cara manual. Untuk memperkirakan jumlah PMN cairan asites ? 250 sellpL maka cut off point untuk MuitistixlOSG® adaiah pada skala trace sedangkan untuk Comburl4M® adalah pada skala positif-2. Sebagian besar cairan asites pada penderita PBS termasuk transudat berdasarkan kriteria Light (85.71 %). Pada 92.86 % penderita PBS mempunyai SAAG > 1.1 g/dL.KESIMPULAN : Pada penelitian ini diperoleh proporsi PBS sebesar 18.92 % dan proporsi netrositik asites sebesar 85.71%. Kedua jenis kuman batang Gram negatif diduga menghasilkan ESBL sehingga resisten terhadap Sefotaksim. Hitung leukosit cairan asites dapat dilakukan dengan alat penghitung sel otomatis Sysmex XT2000i. Leukosit esterase carik celup urin Multistixi OSG® dan Comburl0M@ dapat digunakan untuk memperkirakan jumlah PMN cairan asites > 250 sellpL. Cairan asites pada penderita PBS temasuk transudat menurut modifikasi kriteria Light. PBS tidak mempengaruhi SAAG.SARAN : Parasentesis diagnostik harus dilakukan sebelum pemberian antibiotik empirik. Leukosit esterase carik celup urin dapat digunakan sebagai salah satu cara untuk memdiagnosis PBS secara "bedside". Penelitian lanjutan untuk mendapatkan pola dan kepekaan antibiotika kuman penyebab PBS.

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Cirrhosis is identified as one of major health problems in Indonesia. It is found to be the most prevalent liver disease in addition to acute viral hepatitis and liver cancer. Ascites is the most common complication associated with cirrhosis. About 50% of patients with cirrhosis who develop ascites die within 2 years of diagnosis. Ascites also predisposes life-threatening complication such as Spontaneous Bacterial Peritonitis (SBP).

Materials and Methods. 74 cirrhosis patients who develop ascites were included in the study. The ascitic fluid was cultured in aerobic and anaerobic media. Leukocytes were evaluated for leukocytes count using Sysmex XT2000iT"" automatic cell counter, leukocytes differential count was observed under the microscope, and dip stick urine of leukocyte esterase test. Moreover, albumin, protein, and LDH level were assessed for both serum and ascitic fluid.

Results. Spontaneous Bacterial Peritonitis was diagnosed in 14 subjects (18.92%). Twelve subjects (85.71%) within this group developed neutrocytic ascites. Enterobacteriaceae pathogens, i.e. Eschericiiia coil and Enterobacter aerogerles, had been isolated from the ascitic fluid culture. These pathogens were suspected for producing Extended Spectrum Beta Lactamase (ESBL). Using Bland-Altman test, it was discovered that there were no significant differences in leukocytes count of ascitic fluid either measured with Sysmex XT2000iT"' automatic cell counter or conventional method. The cut-off point for MultistixlOSGTm was set on trace scale, whereas the ComburlOMTM was set on scale positive-2 to obtain a number of PMN leukocytes count of more than 250 cellslpL. Based on Light criteria, 85.71% of ascitic fluid from the SBP patients were considered as transudates. Meanwhile, 92.86% of SBP group showed an SHAG ? 1.lg/dL.

Conclusions. The study reveals that the proportion of SBP is 18.92% and neutrocytic ascites is 85.71%. Both of the Gram-negative bacteria are considered producing ESBL that induce resistance to Cefotaxime. Leukocytes count of ascitic fluid can be measured using Sysmex XT2000iTM automatic cell counter. To predict PMN leukocyte count of more than 250 cells/pL, the dip stick urine leukocytes esterase test using MultistixlOSGT"^ and ComburlOMTM are available. The ascitic fluid in SBP patients are classified as transudates, based on Light criteria. SBP has no effect against SAAG.

Suggestions. A diagnostic paracentesis should be performed prior to empirical antibiotics therapy. The dip stick urine leukocytes esterase test can be use as an alternative method to diagnose SBP along with the other bedside techniques. Further study is required to attain pattern and sensitivity of SBP pathogens."

"Latar BelakangPerlemakan hepatitis non-alkoholik (NASH) merupakan bagian dari spektrum penyakit perlemakan hati non-alkoholik (NAFLD) yang dimulai dari perlemakan hati murni dan bisa berlanjut menjadi sirosis hati. Hipotesis terjadinya NASH hingga saat ini adalah teori Two Hit. Dikatakan bahwa sindrom resistensi insulin (obesitas, DM tipe II, dan dislipidemi) memegang peranan penting dalam terjadinya NASH. Sampai saat ini studi tentang resistensi insulin pada NASH belum pernali dilaporkan di Indonesia.Tujuan PenelitianMendapatkan gambaran klinik dan besar kejadian resistensi insulin pada penderita NASH.Desain PenelitianStudi ini merupakan studi abscrvasional yang bersifat deskriptif-analitik dengan desain potong lintang perbandingan. Pasien dan MetodeDidapatkan 30 pasien yang berobat ke poliklinik hepatologi di beberapa Rumah Sakit di Jakarta dengan perlemakan hati (dari hasil USG) yang bersedia menjalani pemeriksaan antropometrik, dan pemeriksaan darah perifer untuk kadar gula puasa, preftl lipid, fungsi hati dan insulin puasa. Penderita dengan riwayat minuet alkohol, narkoba, serologi virus hepatitis positif, dan ANA posilifdieksklusi.Gambaran NASH diperiksa oleh tiga ahli patologi anatomi (menurut criteria Brunt). Untuk analisa resistensi insulin (dengan reagen insulin ultrasensitif) diperiksa pada 30 penderita NASH yang dibandingkan dengan 30 kontrol normal dengan metode ELISA. Untuk analisa statistik digunakan program SPSS untuk Window versi 12 dengan uji statistik nonparametrik (Mann-Whitney).HasilDari 30 penderita NASH, hipertensi ditemukan pada 8 (26,7%) subyek, dispepsia pada 14 (46,7%) subyek, berat badan berlebih pada 6 (20%) subyek, obesitas pada 19 (63,3%) subyek, gangguan fungsi hati pada 20 (67%) subyek, hipertrigliseridemi pada 19 (63,3%) subyek, DM tipe II pada 5 (16,7%) subyek, dan sindroma metabolik pada 9 (30%) subyek. HOMA-IR didapatkan lebih tinggi pada kelompok subyek dengan NASH bila dibandingkan kontrol normal (p = 0,001). Resistensi insulin ditemukan pada 16 (53,3%) dari 30 penderita NASH (dengan batas HOMA-IR < 3,02).SimpulanKebanyakan penderita NASH memiliki minimal satu dari komponen metabolik. Resistensi insulin mungkin mempunyai peran pada penderita NASH. Dibutuhkan sampel lebih banyak dan penelitian lebih lanjut mengenai resistensi insulin di hati.

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BackgroundsNon-Alcoholic Steatohepatitis (NASH) is a spectrum of Non-Alcoholic Fatty Liver Disease (NAFLD) which is starting from pure fatty liver (steatosis) to hepatic cirrhosis. Most of studies about prevalence of NASH come from Western countries. The recent hypothesis of NASD which is accepted until now is the Two Hit Theory. It was noted that insulin resistance syndrome (obesity, diabetes, dyslipidemia) has an important sole in NAFLD especially in progression to become NASH. In Indonesia, study about insulin resistance in NASH has not been reported.Aims of the studyTo know the clinical pictures and the prevalence of insulin resistance in subjects with NASH.Study DesignThis study was a descriptive-analytic with a comparative cross-sectional design. Patients and MethodsThere were 30 outpatients who come to liver clinic in several hospitals in Jakarta, with a diagnosis of fatty liver (ultrasound examination) underwent examination of anthropometric measurement, and blood tests for fasting glucose, lipid profile, liver function and fasting insulin level. Subjects with a history of alcohol intake, drug abuser, HBsAg positive, anti I-ICV positive and ANA positive were excluded. A liver biopsy proven NASH was confirmed from every subject (according to Brunt criteria), which has been examined by three experienced pathologists. The insulin resistance measured (with ELISA method) in 30 subjects with NASH by 1-IOMA-IR was compared with 30 normal controls. All analyses were performed with SPSS for Windows version 12 A significance level of 5% was used with non-parametric test (Mann-Whitney).ResultsFrom 30 subjects with NASH, hypertension was found in 8 (26.7%) subjects, dyspepsia was found in 14 (46.7%) subjects, overweight was found in 6 (20%) subjects, obesity was found in 19 (63.3%) subjects, abnormal liver function tests was found in 20 (67%) subjects, hypertrigliseridemia was found in 19 (63.3%) subjects, DM type II was found in 6 (16.7%) subjects, and metabolic syndrome was found in 9(30%) subjects. HOMA-IR was found higher in 30 subjects with NASH compared to 30 normal controls (p= 0.001). Insulin resistance was defined when HOMA-IR was more than 3.02. Insulin resistance was found in 16 (53.3%) from 30 subjects with NASH.ConclusionsMost subjects with NASH have at least one component of the metabolic syndrome. Insulin resistance might have a role in subjects with NASH. A larger sample was needed to support this study. Further study about hepatic insulin resistance is needed."

"Modifikasi perilaku gaya hidup telah menjadi langkah strategis dalam penatalaksanaan obesitas. Salah satu contohnya adalah pemberian insentif sebagai motivasi eksternal dalam bentuk kompetisi. Penelitian ini bertujuan untuk mengetahui pelaksanaan program kompetisi penurunan berat badan “Ideal Weight Challenge” di sebuah perusahaan tambang batu bara pada tahun 2020 serta faktor-faktor yang mempengaruhi. Desain penelitian ini menggunakan mixed-method dengan concurrent embedded model. Hasil pengukuran berat badan, lingkar pinggang dan indeks massa tubuh 127 peserta Ideal Weight Challenge dianalisis, kemudian dilakukan in depth interview terhadap 15 informan yang terkait dengan pelaksanaan Ideal Weight Challenge. Sebanyak 38 subjek penelitian (29.92%) mengalami penurunan berat badan lebih dari 5% dan sebanyak 80 subjek (70.87%) mengalami penurunan lingkar pinggang sebanyak lebih dari 3 cm. Terdapat penurunan bermakna antara hasil pengukuran bulan pertama dengan bulan ketiga, dan bulan pertama dengan bulan keenam pada variabel berat badan, lingkar pinggang dan indeks massa tubuh (P<0.001). Analisis kualitatif menemukan 3 domain yang mempengaruhi pelaksanaan kompetisi yaitu motivasi individu, dukungan grup dan dukungan perusahaan, dengan motivasi individu yang paling dominan dalam mempengaruhi hasil penurunan berat badan, lingkar pinggang, indeks massa tubuh dan kepesertaan dalam mengikuti program.

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Lifestyle behavior modification has become a strategic step in obesity management. One example is the provision of incentives as external motivation in the form of competitions. This study aims to determine the implementation of the "Ideal Weight Challenge" weight loss competition program in a coal mining company in 2020 and the factors that influence it. This research design uses mixed-method with concurrent embedded model. The results of measurements of weight, waist circumference and body mass index of 127 Ideal Weight Challenge participants were analyzed, then in-depth interviews were conducted with 15 informants related to the implementation of the Ideal Weight Challenge. A total of 38 research subjects (29.92%) experienced a weight loss of more than 5% and 80 subjects (70.87%) experienced a waist circumference reduction of more than 3 cm. There was a significant decrease between the measurement results of the first month and the third month, and the first month and the sixth month on the variables of body weight, waist circumference and body mass index (P<0.001). Qualitative analysis found 3 domains that influenced the implementation of the competition: individual motivation, group support and company support, with individual motivation being the most dominant in influencing the results of weight loss, waist circumference, body mass index and participation in the program."

"Karsinoma hepatoselular (KHS) masih menjadi masalah utama di seluruh dunia, terutama dalam hal diagnosis dan penatalaksanaannya. Penelitian terdahulu menyatakan bahwa Alpha-1 acid glycoprotein (AAG) merupakan biomarker potensial dalam mendiagnosis KHS. Penelitian ini akan mengkaji nilai titik potong terbaik AAG sebagai biomarker diagnostik KHS dengan sirosis hati.Penelitian ini merupakan studi diagnostik dengan desain potong lintang. Subjek penelitian ini adalah pasien KHS dengan sirosis hati, sebagai kontrol pasien sirosis hati saja. Baku emas yang digunakan adalah USG abdomen dan CT scan abdomen degan kontras 3 fase, bila perlu dilakukan biopsi hati. Semua subjek diperiksa AAG, kemudian dianalisis dengan ROC dan dikaji beberapa titik potongnya.Subjek terdiri dari 25 pasien KHS dengan sirosis hati dan 37 pasien sirosis hati sebagai kontrol. Dari seluruh pasien KHS dengan sirosis hati, 92% laki-laki, 8% perempuan, sebagian besar berusia diatas 50 tahun (72%). Etiologi terbanyak adalah infeksi HBV (56%) dan sebagian besar dijumpai nodul multiple (80%). Dengan menggunakan ROC, didapatkan AUC sebesar 81,44%. Titik potong terbaik untuk mulai mewaspadai KHS dengan sirosis hati adalah 61 mg/dl dan untuk diagnostik adalah 136 mg/dl.

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Hepatocellular carcinoma (HCC) remains a major problem throughout the word, especially in diagnostic and management of therapy. Previous study stating that Alpha-1 acid glycoprotein (AAG) was a potensial biomarker in diagnostic of HCC. This study will assess the best cut-off value of AAG as a diagnostic biomarker of HCC with liver cirrhosis

This study was a diagnostic study with a cross-sectional design. The subjects were HCC with liver cirrhosis patients and as a control were liver cirrhosis patients. The abdominal ultrasound, the abdominal 3 phase contrast CT scan and liver biopsy (if necessary) were the gold standard in this study. All subject were examined AAG, then analyzed by ROC curve and assess of some cut-off value.

Subject consisted of 25 HCC with liver cirrhosis patients and 37 liver cirrhosis patients as a control. HCC with liver cirrhosis patients were 92% of men and 8% of woman. Most of subjects were over 50 years old (72%). HBV infection was the most etiology and found multiple nodul in the liver (80%). ROC curve evaluation showed, the AUC value were 81,44%. From this study, the best cut-off value to be aware of HCC with liver cirrhosis patient was 61 mg/dl and as a diagnostic was 136 mg/dl."

"ABSTRAK Latar Belakang : Malnutrisi merupakan faktor independen yang berhubungan dengan morbiditas, mortalitas dan tingginya biaya pengobatan sirosis hati. Kekuatan Genggam Tangan (KGT) merupakan suatu metode yang sering digunakan untuk mendeteksi malnutrisi dan menilai prognosis pasien. Hubungan KGT dengan Skor Child Pugh (CP) dan massa otot masih dalam kontroversi. Indonesia sampai saat ini belum memiliki data tersebutMetode : Studi potong lintang pada pasien sirosis hati di poliklinik hepatobilier RSCM dari Februari-Juni 2015. Status nutrisi dinilai berdasarkan KGT. Massa otot diukur menggunakan bioimpedans. Analisis statistik menggunakan uji korelasi spearmanHasil : Terdapat 115 pasien yang kontrol di poliklinik hepatobilier RSCM, 112 pasien memenuhi kriteria penelitian, terdiri dari 79 laki-laki dan 33 perempuan. Usia pasien rata-rata 54,15±10,55 tahun, median skor CP 6(5-13) dengan median KGT 26(11-50) kgF, rata-rata massa otot 44,43±8,12 kg. Median asupan energi 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalensi malnutrisi berdasarkan KGT ditemukan sebanyak 33%. Kekuatan genggam tangan tidak berkorelasi dengan skor CP (p 0,046, r=-0,19) namun berkorelasi dengan massa otot (p <0,001, r= 0,70) Simpulan Terdapat 33% kasus malnutrisi berdasarkan KGT pada pasien sirosis rawat jalan. KGT tidak berkorelasi dengan skor Child Pugh namun berkorelasi dengan massa otot pasien sirosis hati.ABSTRACT Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis.;Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis.;Background : Malnutrition is independent factor related to morbidity, mortality and high cost of treatment in liver cirrhosis. Hand grip strength (HGS) is one of the method use for malnutrition detection and prognosis evaluation. The correlation of HGS with liver function (Child Pugh or CP score) and muscle mass is controversial. These important evaluation is not yet avalaible in Indonesia.Method : This is a cross-sectional study in liver cirrhosis patients at Hepatobiliary clinic of Cipto Mangunkusumo Hospital from February to June 2015. Nutritional status was assessed by HGS. Muscle mass was obtained from bioimpedance. Data were analyzed using Spearman correlation test. Results : There were 115 patients liver cirrhosis at Hepatobiliary clinic of Cipto Mangunkusumo Hospital, 112 patients who fit the inclusion criteria, consisted of 79 men and 33 women with mean age 54,15±10,55 years, median CP score 6(5-13) with median HGS 26 (11-50) kgF, mean muscle mass 44,43±8,12 kg. The median intake of energy 1334,82(604,75-3023,7) kkal, median protein 45,87(19-114,5) gram. Prevalence of malnutrition according HGS was 33%. Hand grip strength is not correlated with CP score (p 0,046, r=-0,19) however it is correlated with muscle mass (p<0,001, r= 0,70) Conclusion There are 33% malnutrition cases based on HGS in out patient liver cirrhosis. There is no correlation between hand grip strength with Child Pugh score however HGS is correlated with muscle mass in liver cirrhosis."

"Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier.Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier.Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA).Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%.Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients.Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer.Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6.Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%.Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure."

"Latar Belakang: Meskipun berbagai kemajuan pengobatan dicapai selama lebih dari satu dekade terakhir, secara keseluruhan prognosis karsinoma sel hati tetap buruk. Efek samping terapi serta progresifitas penyakit itu sendiri sangat mempengaruhi kualitas hidup pasien. Selain kesembuhan dan survival rate, kualitas hidup menjadi poin akhir penting dalam pengobatan kanker. Kualitas hidup pada penderita karsinoma sel hati penting untuk diteliti, karena merupakan faktor prognostik penting dari survival time, selain dapat juga mengevaluasi keuntungan dan kerugian dari modalitas terapi yang dipilih. Sampai saat ini belum ada kuesioner yang andal dan sahih untuk menilai kualitas hidup pasien karsinoma sel hati secara akurat di Indonesia. Penelitian ini bertujuan untuk mendapatkan kuesioner European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Hepatocellular Carcinoma-18 (EORTC QLQ-HCC18) yang andal dan sahih untuk digunakan di Indonesia.Metode: Penelitian ini adalah studi potong lintang. Penelitian diawali dengan menerjemahkan EORTC QLQ-HCC18 ke dalam bahasa Indonesia dan kemudian diujicobakan pada 10 responden. Setelah itu, EORTC QLQ-HCC18 hasil terjemahan digunakan pada penelitian utama dengan jumlah sampel yang lebih besar. Keandalan dinilai dengan pendekatan tes ulang dan konsistensi internal. Tes ulang dinilai dengan intraclass correlation coefficient (ICC). Konsistensi internal dinilai dengan Cronbach Alpha. Kesahihan konstruksi dinilai dengan multi-trait scaling analysis. Kesahihan kriteria dinilai dengan melihat korelasi antara domain kuesioner EORTC QLQ-HCC18 dengan Short Form 36 (SF36).Hasil: Pengambilan data dilakukan terhadap 65 pasien karsinoma sel hati yang berobat ke Poli Hepatologi maupun yang sedang dirawat di RSUPN Cipto Mangunkusumo selama Oktober 2015 ? Februari 2016. Nilai ICC (interval 1 jam) pada semua domain EORTC QLQ-HCC18 sangat baik (ICC > 0,8), kecuali domain ikterus yang termasuk dalam kategori baik (ICC 0,61-0,8). Nilai Cronbach Alpha > 0,7 pada separuh jumlah domain EORTC QLQ-HCC18 kecuali domain ikterus (0,137), nyeri (0,474), dan citra tubuh (0,599). Sedangkan nilai Cronbach Alpha yang diperoleh dari penggabungan seluruh domain tetap baik, yaitu 0,897. Multi-trait scaling analysis menunjukkan korelasi cukup tinggi antara skor butir pertanyaan dengan skor domainnya sendiri. Sedangkan hubungan butir pertanyaan dengan domain yang berbeda selalu mempunyai korelasi yang lebih rendah dibandingkan dengan domainnya sendiri. Pada uji kesahihan kriteria, didapatkan 42 korelasi (dari total 64 korelasi) dengan r ≥ 0,3 dan p < 0,05 antara domain EORTC QLQ-HCC18 dengan SF36.Simpulan: Kuesioner EORTC QLQ-HCC18 merupakan alat ukur yang andal dan sahih untuk menilai kualitas hidup pasien karsinoma sel hati di Indonesia.

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Background: Despite various therapeutic progress has been achieved over the past decade, the overall prognosis of hepatocellular carcinoma remains poor. Each therapy undertaken certainly has side effects. Adverse effect of treatment and the progression of the disease itself greatly affect the patient?s quality of life. In addition to recovery and survival rate, quality of life becomes extra important end point in cancer treatment. Quality of life in hepatocellular carcinoma is important to investigate, because quality of life has become an important prognostic factor of survival time, whilst quality of life can also evaluate the cost and benefit of chosen therapeutic modalities. Currently there is no specific questionnaire that can assess the quality of life of hepatocellular carcinoma patients accurately in Indonesia. This study aims to get a reliable and valid EORTC QLQ-HCC18 questionnaire to assess the quality of life of patients with hepatocellular carcinoma in Indonesia.Methods: This is a cross-sectional study. The study began by translating the EORTC QLQ-HCC18 into Indonesian and then tested on 10 respondents. After that, the Indonesian version of EORTC QLQ-HCC18 is used in the main study with a larger sample size. The questionnaire reliability was assessed with test-retest and internal consistency approach. Test-retest was assessed with intraclass correlation coeficient (ICC). Internal consistency was assessed by Cronbach alpha. Construct validity was assessed by multi-trait scaling analysis. The criteria validity assessed by looking at the correlation between domains of EORTC QLQ-HCC18 with Short Form 36 (SF36).Results: Data was collected from 65 hepatocellular carcinoma patients who came to Hepatology Polyclinic or were hospitalized at Cipto Mangunkusumo National General Hospital from October 2015 to February 2016. ICC value (1 hour interval) in all domains of EORTC QLQ-HCC18 is very good (ICC> 0.8), except icterus domain which categorized as good value (ICC 0,61-0,8). Cronbach alpha values > 0.7 obtained in almost half of domains of EORTC QLQ-HCC18, except icterus (0,137), pain (0,474), dan body image domain (0,599). Whereas the Cronbach Alpha obtained from merging the entire domains was still good (0,897). Multi-trait scaling analysis showed a fairly high correlation between the scores of the questions with a score of his own domain. While the relationship of the questions with different domains always have a lower correlation than the domain itself. In criteria validity test, obtained 33 correlations with r ≥ 0,4 and p < 0,05 between domains of EORTC QLQ-HCC18 with SF36.Conclusion: EORTC QLQ-HCC18 is a reliable and valid instrument for assessing quality of life of hepatocellular carcinoma patients in Indonesia.

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"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."

"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"