Nurul Akbar
Department of Internal Medicine, Universitas Indonesia Faculty of Medicine, Jakarta.

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Hospital based cancer registry in Cipto Mangunkusumo hospital Jakarta Sibuea, Wilfried H.; Mangunkusumo, R. R.; Akbar, Nurul; Widjanarko, Abidin; Gatot, Djajadiman; Windiastuti, Endang; Hamzah, Mochtar; Panigoro, Sonar S.; Prihartono, Joedo; Krisnuhono, Ening; Lisnawati, Lisnawati; Utami, Sri M.S.; Ramli, Irwan; Roezin, Averdi; Pribadi, Sigit; Wilarso, Iik; Nasar, I Made; Cornain, Santoso
Medical Journal of Indonesia Vol 9, No 3 (2000): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (752.738 KB) | DOI: 10.13181/mji.v9i3.634

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[no abstract available]
The prevalence of hepatitis C virus ribonucleic acid, the risk factors, and relation with aminotransferase levels in a general population of Jakarta, Indonesia Akbar, Nurul
Medical Journal of Indonesia Vol 6, No 3 (1997): July-September
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (771.893 KB) | DOI: 10.13181/mji.v6i3.824

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[no abstract available]
The role of splanchnic vasoconstrictor in decreasing peripheral vasodilatation to reduce ascites formation of liver cirrhosis Akbar, Nurul; Soemarno, Soemarno; Sumarsono, Sumedi; Lesmana, Laurentius; Husodo, Unggul B.; Sulaiman, Ali; Sjaifoellah Noer, H. M.
Medical Journal of Indonesia Vol 6, No 4 (1997): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (583.239 KB) | DOI: 10.13181/mji.v6i4.833

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[no abstract available]
Genotyping of hepatitis B virus from dried and stored serum on filter paper Gani, Rino A.; Handayu, A. D.; Mulatsih, Reny; Lesmana, L. A.; Sulaiman, Ali; Akbar, Nurul
Medical Journal of Indonesia Vol 14, No 4 (2005): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (149.253 KB) | DOI: 10.13181/mji.v14i4.198

Abstract

HBV genotype has aclose association with prognosis and therapy as well as for epidemiology study. However, this examination can be done only in large cities that are not practical to send serum sample due to geographical burden and facilities. The aim of this study is to know whether HBV genotype can be determined from dried and stored serum on filter paper and compare the result with sera drawn directly from chronic hepatitis B (CHB) and hepatoma patients. Twenty-three serum samples were obtained from CHB patients. HBV DNA were quantitatively determined with Cobas Amplicor HBM (Roche Diagnostics GmBH, Germany) and dropped on to 3 x 1 cm filter papers. After allowed to dry in a plastic clip, it were put in a closed envelope then stored for 1 week in room condition (27 – 33 oC). DNA extraction were done from the filter papers after a short incubation period and HBV genotypes were determined with PCR and specific primers. For comparison, 20 CHB-Hbe(+) samples and 29 hepatoma samples were drawn directly and not dried. HBV genotype were detected in 18/23 (78.2%) from dried serum samples on filter paper while in sera that were not stored, from CHB-HBe(+) samples, 20/20 (100%) could be determined while from hepatoma patients, 24/29 (82.7%) samples. The proportion of genotype were in line with other reported HBV genotype examination for Indonesia. It is concluded that detection of HBV genotype can be done from dried serum in filter paper and stored for 1 week. (Med J Indones 2005; 14: 215-9)Keywords: Hepatitis B virus, genotype, filter paper
Combination of interferon alfa-2b and ribavirin in relapsed or nonresponding chronic hepatitis C patients following interferon therapy Lesmana, Laurentius A.; Budihusodo, Unggul; Akbar, Nurul; Sulaiman, Ali; Noer, Sjaifoellah; Kristanti, Inge A.; Setiabudy, Rianto
Medical Journal of Indonesia Vol 10, No 4 (2001): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (502.199 KB) | DOI: 10.13181/mji.v10i4.37

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Twenty six patients (pts) with chronic hepatitis C (CHC) who reLapsed or non-responded following.interferon (IFN) therapy were given lFN alfa-2b 3   MIU three times a week for 48 weeks in combination with Ribavirin 800-1000 mg daily 2I (80,8%) of the 26.pts completed the study consisted of 12 relapsers and 9 non-responders. Five pts dropped out due to drug adverse events in three pts and non-drug related reason in the other two. In the relapsed group complete response, relapse and sustained response rates were obtained in 9/12(75%), 2/2 (16,5%) and 7/12(58,3%) pts respectively. In the non- responding group, these figures were 3/9 (33,3%), 1/9(I1,1%), and 2/9(22,2%) pts, respectively. The most frequent adverse event was flu-like syndrome, which was found in 18 pts (85,7%). Combination therapy of IFN alfa-2b and ribavirin may induce sustained virological response in relapsed and non-responding CHC patients. This combination therapy is more effective for relapsers compared to for non-responders. (Med J Indones 2001; 10: 214-8)Keywords: Chronic hepatitis C, combination therapy, interferon, ribavirin
Seroepidemiology and risk factors of Hepatitis B and C virus infections among drug users in Jakarta, Indonesia Gani, Rino A.; Budihusodo, Unggul; Waspodo, Agus; Lesmana, L. A.; Hasan, Irsan; Akbar, Nurul; Noer, H. M.S.
Medical Journal of Indonesia Vol 11, No 1 (2002): January-March
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (845.285 KB) | DOI: 10.13181/mji.v11i1.51

Abstract

The number of drug users is markedly increased in recent times. Data were collected consecutively in Cipto Mangunkusumo Hospital and Mitra Menteng Abadi Hospital in Jakarta. HBsAg were examined using reverse passive hemaglutination assay (RPHA) and anti-HCV with dipstick method; both were from the laboratoium Hepatika, Mataram, Indonesia. In a 5 month period (March - August 1999) there were 203 cases of drug users. Most of them were male ( 185 cases or 91.1%) with a mean age of 21.2 ± 4.3 years. Mean age in starting to use the drug was 18.8 ± 4.0 years. The prevalence of anti-HCV and HBsAg positivity were 74.9% (151 cases) and 9.9% (19 cases), respectively. The prevalence of double infection was 7.4% (15 cases). Injection drug users (IDU) were 168 cases (84%). Extramarital sex was done by 62 cases (30.5%), but only 16 cases (8%) with more than one partner. Tattoo was found in 32 cases ( 15.8%). Multivariate analysis revealed that lDU and tattoo were the risk factors for anti-HCV positivity, with the OR of 9.15 (95% CI 3.28-5.53) and 13.24 (96% CI 1.6 - 109.55), respectively. No significant medical risk factor could be identified for HBsAg positivity. Double infection of HBV and HCV was found in 15 cases (7.4%). We concluded that the prevalence of HBV, HCV infection and double infection of HBV - HCV in drug users were high, with tattoo and injection drug usage as risk factors for hepatitis C virus infection. (Med J Indones 2002; 11: 48-55)Keywords: HBsAg, Anti-HCV, tattoo, injection drug users
Risk of anti-hepatitis A virus in an urban population in Jakarta Akbar, Nurul; Basuki, Bastaman; Garabrant, David H.; Waspadji, Sarwono; Sjaifoellah Noer, H.M.
Medical Journal of Indonesia Vol 5, No 4 (1996): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (671.18 KB) | DOI: 10.13181/mji.v5i4.877

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[no abstract available]
Do Hepatic Encephalopathy Patients Really Need a Low Protein in Their Diet Sudomo, Untung; Lelosutan, Syafruddin AR; Ruswhandi, Ruswhandi; Akbar, Nurul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8 ISSUE 2 August 2007
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/82200753-56

Abstract

Hepatic encephalopathy (HE) is an extra hepatic complication of liver cirrhosis. The clinical manifestation of HE is a reflection of a low-grade cerebral edema due to astrocyte swelling as a consequence of hyperammonia. HE mostly is induced by precipitating factors. Correcting these identifiable precipitating factors can alleviate this complication. In the past, liver cirrhosis patients were recommended to lower their protein intake. It was assumed that by limiting protein intake, the ammonia production would lower, which can lead to HE recovery. This approach, on the other hand, had worsened the nutritional status that already present in most patients with HE. There are some ways to overcome these problems without restricting protein intake including balance diet, using Branch Chain Amino Acids (BCAA), and frequent small portion diet.   Keywords: hepatic encephalopathy, astrocytes swelling, ammonia, liver cirrhosis, BCAA
The Role of Specific Cellular Immune System in Chronic Hepatitis C Husna, Ihsanil; Akbar, Nurul; Gani, Rino Alvani; Budihusodo, Unggul; Sukmana, Nanang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 1, April 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/512004%p

Abstract

Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells. Keywords: hepatitis C virus, humoral immune response,cellular immune response
Risk Factors for Recurrent Upper Gastrointestinal Tract Bleeding after Esophageal Varices Ligation on Patients with Liver Cirrhosis Hidayat, Syarif; Djojoningrat, Dharmika; Akbar, Nurul; Sukmana, Nanang; Prasetyo, Sabarinah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 5, ISSUE 3, December 2004
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/53200479-88

Abstract

Background: Upper gastrointestinal tract (GIT) bleeding on liver cirrhosis patients will increase morbidity and mortality. Recurrent bleeding’s risk rise after the first episode of variceal bleeding. The mortality risk also rises on each bleeding. Purpose: This study was done in order to identify the risk factors for the first episode of recurrent bleeding of upper GIT on liver cirrhosis patient. Evaluation of risk factors was based on preliminary data prior to ligation. Method: Evaluation of the upper GIT bleeding was done using anamnesis on the patients or their relatives by letter, home visits or telephone. The data on recurrent bleeding was obtained from medical records. They were evaluated on the 3rd month then 1st year after ligation. This study was a cross sectional study with retrospective data and a consecutive sampling method. Result: Bivariate analysis revealed the 3rd month’s risk factors for first episode of upper GIT bleeding were ascites, total bilirubin level of > 2 mg/dL, hepatoma, Child-Pugh C classification of the liver function and red color sign on esophageal varices. The risk factors for the first episode of upper GIT bleeding on first year were age £ 60 years old, hepatoma, and red color sign (RCS) on esophageal varices. The differences between risk factors on upper GIT bleeding on the 3rd month and 1st year were likely due to intervention, collateral para-esophageal varices, medication that irritated GIT, physical activities, and differences on variceal obliteration rate related to variceal ligation. Conclusion: Risk factors for recurrent upper GIT bleeding that could be minimized were ascites, total bilirubin level, Child-Pugh classification and RCS. It was expected with parascentesis, diuretics, hepatoprotector medications and drugs that lowers portal hypertension (such as propranolol and isosorbid mononitrate), might improve those risk factors thus decreasing the risk for recurrent upper GIT bleeding. Keywords: Upper gastrointestinal tract, esophageal varices, liver cirrhotic