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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"

"Liver cirrhosis is a chronic and irreversible disease. The patients quality of life (QOL) may be impaired because of long-standing burden of the disease. This research was a cross-sectional study conducted at Dr. Sardjito Hospital, Yogyakarta to determined the QOL of patients with liver cirrhosis who hospitalized in this institution. The parameter for the QOL was measured according to Spitzer index. Sixty-five patients with liver cirrhosis of various etiology were abled to be studied. The number of male and female patients were almost equal (30 and 35 respectively). There was a reduction in QOL in both male (21/30) and female (28/ 35) but no significant different between this variable. There was a significant positive correlation between Child criteria, and nutritional status with QOL (r=0.68, p<0.05 and r=0.37, p<0.05). It was concluded that Child criteria and nutritional status were positively correlated with QOL."

"BackgroundProdromal factors of Guillain-Barre syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS.Case ReportWe report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM ami HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period.DiscussionThe incidence of HAV in GBS patients during 5 years of observation was 2%. This corresponds with the case reported by Verona et al, 1996 and Pelletier et al, 1985, i.e. the presence of peripheral neuropathy (n. facialis and n. occulomotorius). Possible alternative pathways for hepatitis virus complicating as GBS are perivascular and endometrial peripheral nerve infiltration by mononuclear cells, T cell sensitization, stimulation of IL-2 growth factor surface receptor, and B cell stimulation. All of the conditions mentioned above causes necrotizing arteritis, vascular occlusion, and at the end, segmental demyelinization. Hepatitis virus may replicate in the central nervous system or peripheral nervous system, subsequently developing into multiple neuropathy disorder and poly arteritis.ConclusionThe diagnoses of HAV and GBS in both cases were established. HAV is one of several viruses that may trigger GBS. In both cases, HAV infection was sub-clinical and sporadic. Symptoms of hepatitis infection subsided along with improvements in the patient's neurological status. Acute viral hepatitis has a wide clinical spectrum and laboratory manifestation that is in accordance with the severity, varying from unclear symptom (anicteric) to jaundice. Acute hepatitis A, B, C infections have the same symptoms in general. However, hepatitis B and C tend to be more severe. The mildest symptoms are transaminase enzyme level increment, no jaundice, gastrointestinal symptoms, flu-like symptoms, and sometimes it can not be diagnosed. The more severe symptoms are jaundice with obvious generalized symptoms.' The incidence of hepatitis A is difficult to be determined accurately because of its characters, i.e. sporadic, endemic, and has a high rate of asymptomatic infection.23-4"

"Tujuan Pengobatan untuk eradikasi H pylori dengan kombinasi PPI dan Amoksisilin 1000 mg atau Clarithromycin 500 mg yang diberikan 2 kali sehari selama 2 minggu telah terbukti efektif. Kebanyakan penelitian menyebutkan bahwa pengobatan 7 dan 10 hari sama efektif. Tujuan dari penelitian ini adalah untuk membandingkan terapi eradikasi H pylori selama 5 dan 7 hari. Metode Penelitian ini dilakukan secara prospektif pada 60 pasien yang terinfeksi H pylori, pemeriksaan dilakukan dengan endoskopi dan biopsi saluran cerna bagian atas di 6 (enam) rumah sakit di Indonesia. Diagnosis H pylori ditegakkan berdasarkan pada 2 pemeriksaan rapid urea test (Pronto Dry) dan pemeriksaan histopatologi atau adanya urea breath test (UBT) yang positif. Kemudian secara terbuka pasien akan dibagi menjadi 2 kelompok, kelompok pertama mendapatkan pengobatan oral amoksisilin 1000 mg 2 kali sehari, clarithromycin oral 500 mg 2 kali sehari, rabeprazole 10 mg 2 kali sehari selama 5 hari dan kelompok kedua mendapatkan pengobatan oral amoksisilin 1000 mg 2 kali sehari, clarithromycin oral 500 mg 2 kali sehari, rabeprazole 10 mg 2 kali sehari selama 7 hari. Empat minggu kemudian, pasien dievaluasi dengan UBT untuk memastikan keberadaan H pylori. Hasil Pada penelitian ini didapatkan 60 pasien yang terdiri dari 42 laki-laki dan 18 perempuan dengan rata-rata (usia+SD) 47.63+13.93 tahun, rentang usia 21-74 tahun. Kelompok pengobatan 5 hari terdiri dari 25 (41,7%) pasien dan kelompok pengobatan 7 hari terdiri dari 35 (58.3%) pasien. Setelah kelompok pengobatan 5 hari didapatkan 18 (72%) pasien H Pylori negatif, dan setelah pengobatan 7 hari didapatkan 32 (91.4%) pasien H Pylori negatif. Kegagalan eradikasi ditemukan pada kelompok pengobatan 5 hari sebesar 7 (28%) pasien dan pada kelompok pengobatan 7 hari sebesar 3 (8.6%) (p=0,077). Kesimpulan Penelitian ini menunjukkan bahwa eradikasi H pylori dengan pengobatan tripel dengan rabeprazole pada kelompok 7 hari masih lebih baik daripada kelompok pengobatan 5 hari. Perbedaan yang tidak bermakna secara statistik ini mungkin karena jumlah sampel tidak mencukupi.

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Aim A combination of PPI and 1000 mg amoxicillin/500 mg clarithromycin twice daily for 2 weeks has been proven effective in the eradication of H. pylori. Most studies suggested that treatment for 7 and 10 days may be equally effective. Few data are available on the effi cacy of 5-day triple therapy. Aim of this study was to compare 5-day and 7-day rabeprazole triple therapy for eradication of H. pylori infection. Methods We prospectively studied 60 consecutive H. pylori-infected patients who came to hospitals in six centres in Indonesia and who underwent upper endoscopy and biopsy. H. pylori infection was confi rmed if two rapid urease tests (Pronto Dry) and histology or urea breath test were positive. Patients were assigned to either an open-labelled 5-day or 7-day course of oral amoxicillin 1000 mg b.i.d., clarithromycin 500 mg b.i.d., and rabeprazole 10 mg b.i.d. (RAC).Four weeks after therapy, all patients had a repeated UBT for evaluation of the presence of H. pylori. Results Of the 60 patients (42 males and 18 females) with mean age (± SD) 47.63 ± 13.93 years, range 21?74 years, 25 patients (41.7%) had 5-day treatment and 35 patients (58.3%) had 7-day treatment. With 5-day treatment, 18 patients (72%) and with 7-day treatment 32 patients (91.4%) became negative for H. pylori infection. The eradication failure was found on 7 patients (28.0%) in 5-day reatment and 3 patients (8.6%) in 7-day treatment. Conclusions The study showed that the eradication of H. pylori infection by triple rabeprazole-based treatment in 7-day is still better than in 5-day."