Unggul Budihusodo
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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

Abstract

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
Acalculous Cholecystitis Prevalence on Abdominal Ultrasonography Examination of HIV/HCV Co-infection Patients in Cipto Mangunkusumo Hospital Sutopo, Bambang; Budihusodo, Unggul; Hasan, Irsan; Gani, Rino Alvani; Yunihastuti, Evy
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 11, NUMBER 1, April 2010
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: 10.24871/111201032-34

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Background: Acalculous cholecystitis is commonly found in patients with human immunodeficiency virus (HIV) compared to general population. Surprisingly, the signs and symptoms are unremarkable. On the other hand, HIV/hepatitis C virus (HCV) co-infection is a common finding. The aim of this study was to evaluate whether HCV infection has any influence to HIV patients concerning acalculous cholecystitis prevalence. Method: A cross-sectional study was performed in HIV/HCV patients who visited AIDS study group clinic at Cipto Mangunkusumo hospital during September 2008 to February 2009. The patients who met the criteria were examined physically and underwent abdominal ultrasonography. Routine blood count, alanine aminotranferase, aspartate aminotransferase, cluster of differentiation 4 (CD4) and serum albumin were recorded. Results: Of 63 patients underwent ultrasonography examination, we found acalculous cholecystitis in 33 patients (52.3%), cholelithiasis and cholecystitis in 2 patients, and 28 patients were considered normal. Patients with CD4 less than 200 cells, tend to have acalculous cholecystitis more than those who had CD4 more than 200 cells. Conclusion: The prevalence of acalculous cholecystitis among HIV/HCV co-infection is higher compared to those with HIV infection alone. Keywords: acalculous cholecystitis, HIV/HCV co-infection, CD4
Benign Recurrent Intrahepatic Cholestases Akbar, Femmy Nurul; Noer, Sjaifoellah; Lesmana, L A; Budihusodo, Unggul; Marwoto, Wirasmi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 1, April 2001
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: 10.24871/21200141-44

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Benign recurrent intrahepatic cholestasis (BRIC) or idiopathic recurrent intrahepatic cholestasis is a rare case. It is a familial and autosomal recessive. The etiology of BRIC is still unknown. We report the case of a patient with BRIC who suffered from recurrent jaundice 7 times in 7 years that occurred for 1-3 months with spontaneous resolutieon. This patient received ursodeoxycholic acid, cholestiramine and prednisone. And within 2 months, the jaundice resolved together with other complaints.    Keywords: cholestasis, autosomal, familial
Measuring HBsAg and HBV DNA Levels in Cilegon Sitompul, Rolan; Roni, Martono; Budihusodo, Unggul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, NUMBER 3, December 2009
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: 10.24871/103200999-104

Abstract

Background: Implication of measuring HBsAg level is still not recognized well. The aim of this study to recognize the correlation of serum HBsAg level and serum HBV DNA level between in HBeAg positive patients and HBeAg negative patients. Method: Quantitative serum HBV DNA were collected retrospectively between January 2006 and May 2009. We stratified the patients into four groups, that were; HBeAg positive and (a) ALT > 2 x upper limited normal (UNL) (group A),( b) ALT < 2 x UNL (group B), HBeAg negative and:( a) ALT > 2 x UNL (group C) (b) ALT < 2 x UNL (group D). We studied the correlation of serum HBsAg and HBV DNA level in each group. In addition, we also studied the accuracy of HBsAg titers to predict serum HBV DNA levels in each group by using receiver operating characteristic (ROC) curve analysis. Results: Eighty nine patients were recruited in this study. Most of them 63 (70%) were male; the mean age of the patients was 38.49 ± 11.21 years. The number of patients with HBeAg positive and negative were 28 and 61 respectively. Based on the group stratification, the A, B, C and D groups we found 16, 12, 11, 50 respectively. There was a positive correlation between HBsAg titers and HBV DNA level in HBeAg positive patients but it was statistically not significant. Similar result was also found in HBeAg negative patients. There were positive correlation in group A, C, and D but they were not statistically significant. In group B the correlation was negative (r = -0.40). We found 100% sensitivity and 100% specificity of predicting serum HBV DNA levels in group A with HBsAg cut-off level of 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL. In group B, C and D the accuracy to predict serum HBV DNA level were not so good . Conclusion: There were positive correlation between HBsAg titers and HBV DNA levels in HBeAg positive and HBeAg negative patients as demonstrated in the three group stratification; however, the correlation was negative in group HBeAg positive and ALT < 2 x UNL. We found excellent (100%) specificity and sensitivity for predicting serum HBV DNA level in group HBeAg positive and ALT > 2 x UNL with HBsAg cut-off level 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL; while in other groups, the correlation were not so good.   Keywords: serum HBsAg level, serum HBV DNA level, hepatitis B, correlation
Effect of L-ornithine-L-aspartate Therapy on Low-Grade Hepatic Encephalopathy in Patients with Liver Cirrhosis Iskandar, Martha; Hasan, Irsan; Budihusodo, Unggul
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 12, NUMBER 1, April 2011
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: 10.24871/121201138-43

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Background: Minimal hepatic encephalopathy (MHE) is an abnormal condition of psychometric testing before hepatic encephalopathy (HE) condition reducing quality of life and survival rate. Impractical instrument, the psychometric hepatic encephalopathy score (PHES), has been recommended in diagnosing MHE. The new critical flicker frequency (CFF) has good precision and accuracy for diagnosing MHE. Oral L-ornithine-L-aspartate (LOLA) may increase ammonia detoxification. The aim of this study was to recognize the effect of oral LOLA on low-grade HE by investigating the mean value of CFF. Method: We included 31 patients with liver cirrhosis and low-grade HE (MHE, HE grade 1 and 2) at the outpatient clinic of hepatology, Cipto Mangunkusumo hospital between November 2009 and March 2010. It was a double-blind, randomized, placebo-controlled clinical trial. Oral LOLA was administered in a dose of 18 g/day, 3 times daily for 14 consecutive days. At the end of the study, there were 27 cirrhotic patients with CFF value < 38 Hz; 14 patients had received LOLA and 13 patients had placebo. Statistic analysis was performed by using the Mann-Whitney U test. Results: The mean value of CFF in LOLA group after treatment (39.3 Hz) was significantly different than the placebo group (36.04 Hz); (p = 0.027). Ammonia level decreased in LOLA group from 118.7 into 109.1 µ mol/L. In placebo group, it increased from 106.9 into 147.5 µ mol/L with p = 0.275 (before); p = 0.052 (after). Conclusion: Oral LOLA may improve the value of CFF and is likely to decrease blood ammonia level in patients with low-grade HE.   Keywords: low-grade hepatic encephalopathy, oral LOLA, CFF improvement, ammonia detoxification
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

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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
Study of Transaminases in Heroin Addicts Gani, Rino A; Waspodo, Agus Sudiro; Budihusodo, Unggul; Hasan, Irsan; Noer, Muhammad Sjaifoellah
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 1, April 2001
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: 10.24871/2120011-4

Abstract

A recent increase in the number of drug users particularly of heroin has been noted in the community. A cross-sectional study on the level of transaminases as a representation of liver damage in drug users was done in privated hospital in Jakarta. Exclusion criteria were fever, serious illness or the multiple use of addictive drugs based on a urinary test. The hepatitis B surface antigen (HBsAg) was examined using reverse passive hemaglutination assay (RPHA) and the antibody of hepatitis C virus core-protein (anti- HCV) with dipstick anti-HCV.  AST and ALT levels were determined using an automatic chemical analyzer. Of 132 patients who fulfill the criteria, 83.5 % were injection drug users (IDU). Means AST and ALT were significantly higher in IDU. Anti-HCV positive patients with increased AST and ALT were significantly higher compared to anti-HCV negative. The increase of transaminase was also consistent in injection drug users although no viral marker could be detected. In conclusion, the examination of transaminases in drug users especially IDU is important besides tests for hepatitis viral markers because there is often an increase with or without viral infection and this can be associated with hepatocellular damage.     Key words: Transaminase, heroin addicts, hepatitis
Effects of BCAA Enteral Nutrition to the Change of Nutritional Status and Hepatic Encephalopathy Parameters in Liver Cirrhosis Patient with Hepatic Encephalopathy Fauzi, Achmad; Budihusodo, Unggul; Akbar, Nurul; Suwondo, Pradana; Suhardjono, Suhardjono; Rani, Abdul Aziz
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 10, ISSUE 2, August 2009
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: 10.24871/102200956-62

Abstract

Background: This study was also conducted to determine the effects of high-branched chain amino acid (BCAA) enteral supplementation on altered nutritional status parameters (including plasma prealbumin) and hepatic encephalopathy parameters in liver cirrhosis patients with hepatic encephalopathy. Method: Our study was a randomized, single-blinded experimental study comparing between control group of liver cirrhosis patients with standard hospital liver diet (40 kcal/kgBW/day for male and 35 kcal/kgBW/day for female; protein 1.25 g/kgBW/day) and experimental group of liver cirrhosis patients with liver diet modification high in BCAA supplementation, which had similar protein and calorie calculation as the control group. Results: Subclinical hepatic encephalopathy prevalence was 32%. In the experimental group, prealbumin plasma, arm circumference, body weight and body mass index (BMI) increased; whereas in the control group, prealbumin plasma, arm circumference, body weight and BMI decreased (p < 0.05). In experimental group, the ammonia level significantly decreased (p < 0.01). Clinical hepatic encephalopathy, flapping tremor, the number connection test (NCT) did not show significant changes between the two groups. However, there was worsening trend in the control group. Level of albumin, bilirubin, AST, ALT did not show any significant difference between both groups. Conclusion: High-BCAA enteral supplementation which is administered to liver cirrhosis patients with hepatic encephalopathy for 14 days could improve plasma prealbumin level, arm circumference, body weight, BMI and could decrease the plasma ammonia level. However, it does not improve Fischer ratio, psychometric test and electroencephalography   Keywords: malnutrition, liver cirrhosis, BCAA, Fisher ratio
Pancreatic Adenocarcinoma Presenting as Obstructive Jaundice in A Young Woman Djoerban, Zubairi; Yunihastuti, Evy; Samban, Julius R; Noer, H.M. Sjaifoellah; Daldiyono, Daldiyono; Budihusodo, Unggul; Gani, Rino A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 2, NUMBER 2, August 2001
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: 10.24871/22200132-37

Abstract

Pancreatic carcinoma commonly occur in patients over 60 years. It is usually manifested as abdominal pain, jaundice, and pancreatic mass. In this report, a pancreatic carcinoma occurred in young woman is presented. A surgical drainage was done and followed by Whipple resection. However, the patient passed away three month after the diagnosis.    Keywords: pancreatic carcinoma, young woman, obstructive jaundice, whipple resection