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All Journal Acta Interna : The Journal of Internal Medicine
Putut Bayupurnama
Division of Gastroentero-hepatology, Department of Internal Medicine Faculty of Medicine, University of Gadjah Mada/Sardjito General Hospital, Yogyakarta
Health Professions Medicine & Pharmacology

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Reactivation and Flare of Chronic Hepatitis B: Natural History, Diagnosis, Therapy and Prevention Cahyono, Suharjo Broto; Neneng Rasari, Neneng Rasari; Bayupurnama, Putut; Maduseno, Sutanto; Nurdjanah, Siti
Acta Interna The Journal of Internal Medicine Vol 4, No 1 (2014): Acta Interna The Journal Of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTAlmost 30% of the world population has been exposed to hepatitis B virus (HBV) and 400 millionof these are chronically infected. 20–30% of HBsAg carriers may develop reactivation or fl are (acuteexacerbation) of chronic hepatitis B with elevation of biochemical levels, high serum HBV DNA level with orwithout sero-coversion to HBeAg. In countries with intermediate or high endemicity for HBV, compoundedin use cytotoxic or immunosuppressive therapy for the treatment of a wide variety of clinical disease,reactivation or fl are may be the fi rst presentation of HBV infection. Sometime it is diffi cult to differentiatebetween acute hepatitis B and reactivation (fl are). Accurate diagnosis in these cases is very important fordeciding whether to start treatment or not, because acute hepatitis B does not require treatment, whilereactivation or fl are may take benefi t from it. Effort to early detect, to treat and to prevent the reactivationor fl are of chronic hepatitis B is very crucial to reduce morbidity and mortality.Keywords: Reactivation, fl are (acute exacerbation) of chronic hepatitis B, acute hepatitis B, nucleos(t)ideanalogues
Relationship between plasma fi brinogen levels with model of end stage liver disease score in patients with liver cirrhosis Nasir, Moch. Abdul; Ratnasari, Neneng; Bayupurnama, Putut
Acta Interna The Journal of Internal Medicine Vol 3, No 2 (2013): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTIntroduction. One of the complications which often occur in the liver cirrhosis is bleeding. Closely associated with weighing of bleeding were disturbance haemostatic homeostasis disorders that commonly associated with impaired liver function. Therefore certain biomarkers are needed to objectively measure the severity of liver cirrhosis. Fibrinogen is one of the clotting factors that can be used to determine the severity of liver cirrhosis.The model of end-stage liver disease (MELD) score is most excellent alternative of the Child-Pugh score. It can be used in patients with liver cirrhosis spacious ranges severity of disease and etiology even in patients whose cirrhosis etiology are not clear. Currently, there was not any data showing the correlation between the level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis. Aims. This study aimed to determine the correlation between level of plasmatic fi brinogen and MELD score in patients with liver cirrhosis.Method. This study was cross-sectionally conducted used consecutive sampling. Study population were eligible patients with liver cirrhosis who visited outpatient and inpatient clinic in the Division of Gastroentero-hepatology, Dr. Sardjito general hospital, between November 2011 to October 2012. Correlation between the level of plasmatic fibrinogen and MELD score was statistically assessed using correlation test with fi nal result stated as correlation coefficient (r).Result. There were 40 subjects that met criteria, 28 male and 12 female, with average age of 53 ± 12,51 years. Etiology of cirrhosis was viral hepatitis B in 16 (40,0%) subjects, hepatitis C in 11 (27,5%) subjects and non viral in 13 (32,5%) subjects. Subjects with ascites were 19 (47, 5%) and without ascites were 20 (52.5%). Bleeding was experienced by 30 (80.0%) subjects while 10 (20,0%) subjects did not present with bleeding. Mean of plasma fibrinogen was 198 ± 102, 89 mg/dl, and mean of the MELD score was 17,05 ± 8.79. Spearman correlation coefficients between fi brinogen and MELD score was r = -0,404 (p = 0,010).Conclusion. There was a negative correlation between plasma fi brinogen and the MELD score in liver cirrhosis patients visiting our local setting.Keywords: liver cirrhosis, fi brinogen, MELD score
Correlation between cystasin C to disease severity of cirrhosis on model of end stage liver disease score Gunadi, Heribertus; Bayupurnama, Putut; Nurdjanah, Siti
Acta Interna The Journal of Internal Medicine Vol 1, No 2 (2011): Acta Interna The Journal of Internal Medicine
Publisher : Acta Interna The Journal of Internal Medicine

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ABSTRACTBackground:    Cirrhosis patients  with renal failure  are  at   high   risk  for   death   and  reduced survival   as   compared   with   those   without   renal failure,  and have poor prognosis.  Some studies  have suggested   that  cystatin  C did  more  accurate   than creatinine /0  detect glomerulusfiltration    rate (GFR) in patients  with cirrhosis.  Model  of End Stage  Liver Disease  (MELD)  score  can be used in patients  with cirrhosis  with variously  Widely severity  disease  and etiologies.  Until nmv, there is no study about correlation  between  levels  of cystatin  C to disease severity  in cirrhosis based on MELD score.Objective:  This present  study  was to investigate  the correlation  between levels of cyst at ill C with disease severity  in cirrhosis  based on MELD score.Method:   Study  design  was cross sectional s t u d y,     This      study       was     conducted          at Gastoenterohepatology         outpatient     clinic    and Internal Medicine  ward of Dr Sardjito  General Hospital,     Yogyakarta.    Inclusion     criteria     were patients    with    cirrhosis    diagnosed     by   clinical criteria,  laboratory   and  USG.findillg,   age   >  18 years,   had  complete  medical  record  and  obtained informed consent. Exclusion criteria were chronic kidney  disease,  sepsis,  hepatocellutare   carcinoma, used high doses  of steroid,  had thyroid dysfunction. hypertension  and diabetes mellitus.Result:   The  mean  of cystatin   C based  on categorical    MELD    score   were   MELD    <10   = 0.93±0.19   mgll;   MELD    IO-19=1.08±0.26    mg/l; MELD  20-29   =  1.25±O.27 mgll;  MELD  30-39   = 2.49 mg/l and  MELD  >40  = 2.43 mgll;  0)=0.013; 95%   CI  0.000-0.061).     There   was   a  significant correlation   between  cystatin  C to MELD  score  as demonstrated   byp=O.OOOand r=0.485.Conclusion:     Our  data  suggested    a significant     correlation     with   medium    strength between cystatin  C to severity  disease  of cirrhosis based 011 MELD score. Keywords:  cirrhosis,  cystatin  C, MELD score  
Co-Authors Catharina Triwikatmani Fahmi Indrarti Hakim, Suharno Haryanto Rahardjo Hemi Senorita Heribertus Gunadi Jamhari Jamhari Moch. Abdul Nasir Neneng Rasari Neneng Rasari Neneng Ratnasari Nurdjanah S, Nurdjanah Probowati, Wiwiek Rachmad Aji Saksana Riska Humardewayani Adie SATRIYAS ILYAS Siti Nurdjanah Suharjo B Cahyono Suharjo Broto Cahyono Suryo Taroeno Sutanto Maduseno