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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Dwijo Anargha Sindhughosa, Dwijo Anargha
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Medicine & Pharmacology

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Severity of Liver Injury and Its Relation to Clinical Outcome and Duration of Hospitalization in COVID 19 Patients Kumbara, Cokorde Istri Yuliandari Krisnawardani; Mariadi, I Ketut; Somayana, Gde; Wibawa, I Dewa Nyoman; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202447-52

Abstract

Background: Coronavirus Disease 2019 (COVID-19) can affect not only the respiratory system but also other organs such as the liver. Liver injury tends to occur in severe disease of COVID-19 patients and might contribute to clinical outcomes for patients. This study aimed to find the relationship between the severity of liver injury with clinical outcome and duration of hospitalizations.Methods: This study was a retrospective study of hospitalized COVID-19 patients period April 2020 to April 2021. The inclusion criteria were severe COVID-19 patients who developed a liver injury. The severity of the liver injury was classified into mild, moderate, and severe. The relationship between the severity of liver injury with clinical outcome and duration of hospitalization was analyzed. Univariate and logistic regression were used. Results: 90 samples fill the inclusion criteria. The liver injury severity was statistically significantly related to clinical outcome patients (p= 0.047), which is the increase in liver injury severity resulting in poor clinical outcomes. No significant relationship was found between the severity of liver injury with the duration of hospitalization.Conclusion: liver injury increases mortality in severe COVID-19 patients.
Correlation of Simple Laboratory Result Parameters to CTP and MELD Scores, and the Diagnostic Role of Simple Laboratory Indexes to Cirrhosis Decompensation Dewi, Ni Nyoman Gita Kharisma; Dewi, Ni Luh Putu Yunia; Dewi, Putu Itta Sandi Lesmana; Pamungkas, Kadek Mercu Narapati; Sindhughosa, Dwijo Anargha; Mariadi, I Ketut
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202427-33

Abstract

BackgroundCirrhosis of the liver is a final condition of all chronic liver diseases. Liver cirrhosis is the leading cause of increasing morbidity and mortality in adults worldwide. Systemic inflammation has been suggested to play an important role in causing progressive liver damage and is one of the leading causes of compensated and decompensated liver cirrhosis.Aim of StudyEvaluate the correlation of neutrophil-lymphocyte ratio (NLR), albumin-bilirubin ratio (ABR), albumin-bilirubin score (ALBI), aspartate aminotransferase to platelet ratio (APRI), albumin-creatinine ratio (ACR), lymphocyte-monocyte ratio (LMR), de ritis ratio to the severity of liver cirrhosis as assessed by CTP score and MELD score. In addition, this study also evaluated the diagnostic ability of NLR, ABR, ALBI, APRI, ACR, LMR, de ritis ratio, and CTP and MELD scores in predicting decompensated liver cirrhosis.MethodWe conducted a cross-sectional study involving patients diagnosed with liver cirrhosis at Prof DR IGNG Ngoerah General Hospital. All patients were diagnosed based on clinical history, physical examination, and investigations. This study enrolled 96 cirrhotic patients regardless of etiology. Laboratory examination results recorded platelets, neutrophils, lymphocytes, monocytes, AST, ALT, albumin, and creatinine. Then NLR, ACR, APRI, LMR, de raitis, ALBI, and ABR are calculated. CTP and MELD scores were calculated by taking data from the patient's medical recordResultOf the 96 patients tested in our study, the majority were male (66). The study found a significant moderate to very strong relationship to the MELD score between ACR, APRI, ALBI, ABR, LMR, WBC, sodium, and albumin. Neutrophil to lymphocyte ratio, ACR, De ritis, APRI, LMR, ALBI, ABR, sodium levels, and albumin have a moderate to very strong significant relationship to CTP score. ACR, De ritis, APRI, LMR, ALBI, ABR, WBC, sodium, and albumin levels with respective cut-offs £ 3.6; ≥ 1.5; ≥ 0.3; £ 2.8; ≥ 0.7; £1.6; ≥ 6.7, £ 136.50, and £ 3.0 can be used to help predict decompensated cirrhosisConclusionIn addition to using the CTP score and MELD score as a tool to predict the severity of liver cirrhosis, data from laboratory examination results in the form of albumin and ABR levels can help establish the diagnosis of decompensated cirrhosis. The sensitivity and specificity of ABR were 96.8% and 75.4% with a cut-off of £  1.6, while albumin levels were 93.5% and 81.5% with an amount off of £  3.0.
Knowledge, Attitude and Obstacles of Colorectal Cancer Screening in Primary Health Care in Bali, Indonesia Mariadi, I Ketut; Somayana, Gde; Sindhughosa, Dwijo Anargha
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023235

Abstract

Background: The knowledge of CRC and its screening methods of healthcare workers is the bedrock of CRC early detection particularly in countries lacking national screening programs. Unknown factors influencing colorectal cancer early detection program implementation. We aimed to evaluate the knowledge and attitudes of primary health care (PHC) provider regarding CRC screening and identify the barriers associated with the screening plan.Methods: A cross-sectional study was conducted among PHC physicians and nurses in public primary health care centers in Bali, Indonesia. A 44-item self-administered questionnaire was used to assess the knowledge, attitude and practice of CRC screening. The questionnaire was spread using google form. Results: Two hundred and five respondents have participated in this study. The average duration of doing practice in PHC is 6.6 years. In knowledge of CRC, 50.2% of them have good knowledge, and there is no difference between PCPs vs nurses (51.9% vs 47.3%; p=0.53). In attitude toward CRC screening, 58.5% out of the have good attitude, and there is no difference between PCPs vs nurses (60.3% vs 55.4%; p=0.50). The barriers of the screening was divided into two areas, a barrier from the health care system and patients. There was no association between knowledge and attitude towards CRC screening (p=0.63).Conclusion: The majority of health workers' knowledge and attitudes toward CRC screening were in the "good" category. The patient's fear of being diagnosed with cancer, as well as the patient's fear and anxiety of screening tests, is the most significant barrier to colorectal cancer screening.
Relationship between Bile Reflux and the Severity of Gastric Mucosal Damage in Patients with Dyspepsia Saturti, Tjokorda Istri Anom; Mariadi, I Ketut; Triyanayasa, I Nyoman; Sindhughosa, Dwijo Anargha; Kuwai, Toshio
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 2 (2024): VOLUME 25, NUMBER 2, August, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2522024295

Abstract

Background: Dyspepsia is a complaint of pain in the epigastrium that lasts for at least 1 month and is closely related to upper gastrointestinal complaints such as nausea, vomiting, and a feeling of early fullness. One of the risk factors for dyspepsia is bile acid reflux. The most common endoscopic findings in patients with bile acid reflux include mucosal erythema, the presence of bile acid on the mucosa, erosion, hyperugosity, and gastric mucosal atrophy.Methods: This study was a cross-sectional study conducted on 99 dyspeptic patients who underwent endoscopy at Prof. Dr. I.G.N.G. Ngoerah Denpasar Hospital. Bile acid examination was performed using the enzymatic calorimetric method, and mucosal damage assessment was based on the Lanza score evaluated by 2 observers. The degree of mucosal damage was classified as mild (score 0-2) and severe (score 3-5).Results: The age range of the 99 subjects was 19-83 years, with 58 (58.6%) males and 41 (41.4%) females. H. pylori antibodies were detected in 21% of the subjects, and 48% had a pH below 2.77; 48% had a history of NSAID consumption. The mean value of bile acid levels in gastric fluid was 156.07 μmol/L, with a median of 170.09 μmol/L (≥170.09 μmol/L classified as high, 170.09 μmol/L classified as low). During endoscopic observation, mild mucosal damage was found in 61%, and severe damage was found in 39% (kappa 1, P0.001). According to the Chi-square test, there was a statistically significant relationship between gastric fluid bile acid levels and mucosal damage (P0.05).Conclusion: This study concludes that there is a relationship between the level of bile acid in gastric fluid and the degree of mucosal damage.
Co-Authors Dewi, Ni Luh Putu Yunia Dewi, Ni Nyoman Gita Kharisma Dewi, Putu Itta Sandi Lesmana Gde Somayana I Dewa Nyoman Wibawa I Ketut Mariadi Kumbara, Cokorde Istri Yuliandari Krisnawardani Kuwai, Toshio Pamungkas, Kadek Mercu Narapati Saturti, Tjokorda Istri Anom Triyanayasa, I Nyoman