Syifa Mustika
Division of Gastroentero-hepatology, Department of Internal Medicine, Faculty of Medicine, University of Brawijaya/Dr. Saiful Anwar General Hospital, Malang

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Comparing the Effects of Genistein, Silymarin, Lecithin on Improved Liver Necrosis Induced by Paracetamol Toxic Dose Administration in Rattus novergicus Wistar Strain

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 13, NUMBER 1, April 2012
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Paracetamol, a widely used antipyretic and analgesic drug has been known for its side effect of liver toxicity resulting from free radical formation leading to necrotic hepatocytes. Oral genistein may reduce lipid peroxidation and increase total antioxidant capacity in liver. The present study was aimed to compare the effects of administering genistein, silymarin and lecithin on improved necrotic hepatocytes in Wistar rats fed with toxic dose of paracetamol. Method: An experimental study was conducted at the Laboratory of Physiology and Anatomical Pathology, University of Brawijaya between May and September 2011. About 48 male rats were categorized into 4 groups. The first group was treated with 600 mg/kgBW of oral paracetamol. The other groups were treated with 600 mg/kgBW paracetamol and additional 2 mg/kgBW genistein, 50 mg/kgBW silymarin or 100 mg/kgBW lecithin. ALT, AST, bile acid, malondialdehyde (MDA) and glutation (GSH) levels were measured and centrilobular necrosis observed by histopathological examination. Data were analyzed statistically by ANOVA. Results: AST and ALT level were significantly lower in genistein group (p = 0.004 and p = 0.001). The lowest bile acid level was found in the lecithin group (p = 0.025); while lowest MDA level was found in silymarin group (p = 0.009). The highest GSH level was found in lecithin group (p = 0.001). The lowest percentage of centrilobular necrosis was found in genistein group (p = 0.001). Conclusion: Genistein, silymarin and lecithin supplementation improve liver necrosis induced by toxic dose of paracetamol. Among them, genistein is the most significant agent. Keywords: genistein, silymarin, lecithin, paracetamol, hepatotoxicity

Alcoholic Liver Cirrhosis in Young Female: Diagnostic and Therapeutic Challenge

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Alcoholic liver cirrhosis is a disease due to excessive alcohol consumption that manifest as fatty liver, alcoholic hepatitis, and chronic hepatitis with fibrosis or liver cirrhosis. Alcohol consumption as much as 60-80 g per day for 20 years or more in male, or 20 g/day (approximately 25 mL/day) in female significantly increases the risk of hepatitis and fibrosis as much as 7-47%. The aim of this case report was to explore the diagnostic and therapeutic challenge of alcoholic liver disease in young aged female. A female, 24 years old, came with complaints of bloody vomiting, blacktarry stool, abdominal distention and history of alcohol consumption (canned beer 5%, equal to 56-70 g/day) for 9 years. Physical examination revealed anaemic conjunctiva (Hb 2.9 g/dL), ascites, hepatosplenomegaly, and bilateral legs oedema. Laboratory examinations showed thrombocytopenia (125000/uL) and hypalbuminaemia (2.65 gr/dL). AST and ALP were increased with the value of 175 U/L and 456 U/L, respectively. Albumin-globulin ratio was 0.93 g/dL with serum ascites albumin-gradient was 2.20 g/dL (ascites fluid albumin level was 0.45 gr/dL and serum albumin level was 2.65 gr/dL). Abdominal USG revealed hepatomegaly with coarse heterogenic ecoparenchyma, portal vein dilatation, and splenomegaly. Diagnosis of alcoholic liver cirrhosis was made based on clinical, laboratory, and radiologic findings, while biopsy result did not confirm the pathology. Patients condition improved with education of stop alcohol consumption and was given supportive therapy.

Reactivation of Hepatitis B Infection During the Cause of Non Hodgkins Lymphoma Chemotherapy

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 2 (2014): VOLUME 15, NUMBER 2, August 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Hepatitis due to hepatitis B virus (HBV) reactivation after cytotoxic or immunosuppressive therapy is a serious cause of liver-related morbidity and mortality. Frequently used combination regimens in Non-Hodgkin’s lymphoma are cyclophosphamide, hydroxydaunomycin (adriamycin), vincristine (oncovin), and prednison (CHOP). The use of rituximab, a monoclonal antibody targeting CD20 antigen present in benign and malignant B-cells, in combination with systemic chemotherapy has resulted in an improved duration of remission and survival for this patients. Rituximab is a HBV reactivation risk factor even greater than corticosteroids in a series of patients with lymphoma treated with combined-modality treatment (CMT).A 43 years old female patient who already diagnosed with Non-Hodgkin’s lymphoma, came with chief complain nausea and vomiting for three weeks. The patient recently got hospitalized with icteric and known have positive HBsAg. She received chemotherapy rituximab CHOP (R-CHOP) for four times and got rituximab in the last chemotherapy. Previously she had icteric and increased liver function test. After exclude other possibility causes this symptom and sign, it was concluded this is HBV reactivation. The chemotherapy was postponed until this reactivation of hepatitis B resolved and start giving lamivudine two weeks before reintroduce chemotherapy.Keywords: antiviral treatment, chemotherapy, hepatitis B virus, reactivation

Role of Phytopharmacy as Hepatoprotector in Chronic Hepatitis

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 15, No 3 (2014): VOLUME 15, NUMBER 3, December 2014
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Hepatitis is one of the health problems in Indonesia that require special treatment, in line with the increase of morbidity and mortality rate of this disease. Complications of hepatitis include liver cirrhosis and hepatocellular carcinoma. Indonesia, as a tropical country, has many medicinal plants that act as hepatoprotector, a substance that can protect liver from toxic agent. Use of medicinal plants is still considered as controversial treatment because there is still lack of studies. Medicinal plants with mix composition of phytopharmacy, such as: Curcuma xanthorrhiza, Arcangelesia flava, Nigella sativa, and Kleinhovia hospita show potency as hepatoprotector. The objective of this study is to analyse the function of phytopharmacy as hepatoprotector in chronic hepatitis.Method: This study is a clinical trial performed in the Gastroenterology Department and Outpatient Clinic in Saiful Anwar Hospital in May-June 2013. Chronic hepatitis B or C patients who have received antiviral therapy with > 3 fold increase of the threshold value of transaminase level, were included in this study. In this study, patients consumed phytopharmacy tablet 3 times per day. After 7 days of treatment, patients’ serum transaminase levels (ALT and AST) were re-assessed. Statistical analysis of before and after treatment data was performed using Wilcoxon test and the result was significant with p < 0.05.Results: From 10 patients, the average age was 50.3 years old. Sixty percent (60%) of them were male, with 50% suffered from chronic hepatitis B and the other 50% suffered from chronic hepatitis C. From this study, decrement of alanine transaminase (ALT) and aspartate transaminase (AST) after seven days of treatment were 45.06%, with p = 0.007 and 48.63%, with p = 0.007, respectivelyConclusion: Phytopharmacy supplementation in chronic hepatitis can decrease serum transaminase, however further study is needed. Keywords: chronic hepatitis, phytopharmacy, ALT, AST, hepatoprotector 

Primary Hepatic Lymphoma in a 32-year-old Male

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 1 (2017): VOLUME 18, NUMBER 1, April 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

 A 32-year-old male came with right upper abdominal pain with a mass increasing in size since the last 6 months, with no other typical symptoms. The physical findings revealed right upper abdominal mass, rubbery consistence, irregular surface, rounded edge, unclear border, immobile, without any tenderness. Other physical examination revealed normal findings, without any lymphadenopathy at another site. The laboratory findings revealed non-reactive hepatitis B and C markers, normal AFP, slightly increased LDH. Plain chest X-ray showed elevated right hemidiaphragm, and a large mass sized ± 14.18 x 8.56 x 12.56 cm compressing the liver. We’ve done biopsy with ultrasound guiding on the mass, and the histological examination revealed that it was lymphoma with negative CD20. The diagnosis was established as primary hepatic lymphoma and the patient was then given chemotherapy.

Correlation of Aerobic Exercise and High Nitrate Diet with Population of Eschericia coli in the Digestive Tract of Liver Cirrhosis Individuals

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: In liver cirrhosis, the population of E coli is increased. conditions such as reduced intestinal). Escherichia coli with 2 enzyme nitrate reductase (NRF and Nir) reduce nitrate to nitrite and subsequently converted to ammonia (99%) and nitric oxide (1%) in anaerobic condition. Regular aerobic exercise 2-3 times/week for 30 minutes resulted in increased 2,3-DPG which reduces the activity of E. coli to reduce nitrate to nitrite and ammonia, which only works on the anaerobic state. High Nitrate Diets lead to increased nitrate reducing bacteria such as E. coli resulting in the reduction of nitrate excess produce nitrite and ammonia in large quantities. Probiotic Lactobacillus spp. can suppress the growth of bacterial endotoxins and pathogens such as E. coli and other Enterobacteriaceae. This study aimed to determine the correlation of aerobic exercise and a high nitrate diet in gastrointestinal populations of Escherichia coli gastrointestinal tract in patient with liver cirrhosis.Method: This was a descriptive-experimental study in liver cirrhosis patients Child Pugh A/B in outpatient clinic Saiful Anwar Hospital in August 2015. Respondents were asked to fill out a questionnaire with information about the demographic data, the nitrate diet, aerobic exercise, other medical data and sanitation, and stool samples were taken for faecal culture. Eta Correlation statistical test was used to determine the correlation of aerobic exercise and a high nitrate diet high in population of E. coli. The significant difference are indicated by p < 0.005.Results: A total of 36 patients diagnosed with liver cirrhosis Child Pugh A/B, 14 (39%) underwent aerobic exercise 3x /week, as many as 25 (70%) consume a high nitrate diet. There was a strong relationship between aerobic exercise and high nitrate diet with population of E. coli (È  = 0.725; p < 0.05).Conclusion: There was a strong relationship between aerobic exercise and high nitrate diet with a population of E. coli in liver cirrhosis. Giving probiotics in patients with liver cirrhosis suppressed the population of E. coli.

Derajat Depresi Pasien Hepatitis C Kronis yang Mendapat Terapi PegIFN-α

Jurnal Kedokteran Brawijaya Vol 29, No. 3 (2017)
Publisher : Fakultas Kedokteran Universitas Brawijaya

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Abstract

Disamping efek dari infeksi hepatitis C, pengobatan hepatitis C dengan menggunakan pegylated interferon alfa dikatakan memiliki efek samping berupa depresi. Untuk mengevaluasi gejala depresi pada pasien hepatitis C yang mendapatkan terapi pegylated interferon alfa di divisi Gastroentero-hepatologi RSUD Dr. Saiful Anwar Malang. Penilaian depresi dilakukan 1 kali, dengan menggunakan kuisioner Patient Health Questionnaire 9 (PHQ-9). Penelitian ini dilakukan antara tahun 2014-2015. Seluruh pasien hepatitis C yang mendapatkan terapi dengan pegylated interferon alfa, diberikan formulir kuisioner dari Patient Health Questionnaire (PHQ-9) untuk dievaluasi kondisi depresi yang terjadi. Dari keseluruhan pasien berjumlah 24 pasien, didapatkan hasil berupa depresi minimal sebanyak 9 pasien (37,5%), depresi ringan sebanyak 12 pasien (50%), depresi sedang sebanyak 2 pasien (8,3%) dan depresi sedang-berat sebanyak 1 pasien (4,2%). Rerata usia pasien adalah 53,55±12,13 (dalam tahun), dengan rentang usia 30-73 tahun. Jumlah pasien pria sama dengan jumlah pasien wanita (masing-masing 12 orang). Rerata lama terapi adalah 17,78±11,88 (dalam minggu). Genotipe terbanyak adalah genotipe 1 (16 pasien, 66,67%). Manifestasi depresi yang terbanyak adalah kelelahan yang terus menerus dan penurunan nafsu makan. Penelitian membuktikan adanya gangguan depresi pada pasien-pasien hepatitis C yang mendapat terapi pegylated interferon alfa (pegIFNα). Penilaian kondisi mental sebelum memulai terapi dan setelah selesai terapi, perlu dilakukan secara rutin untuk menilai adanya efek samping yang perlu ditangani secara lebih lanjut.Kata Kunci: Derajat depresi, hepatitis C kronis, pegIFNα

Incidence of Colorectal Cancer in Saiful Anwar Hospital, Malang January 2010- April 2015

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 18, No 3 (2017): VOLUME 18, NUMBER 3, DECEMBER 2017
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: Colorectal carcinoma is the third most common malignancy worldwide and the second most frequently found cause of mortality in the United States. In Indonesia, the number of colorectal cancer patients ranks 10th (2.75%) after other cancers (cervical, breast, lymph nodes, skin, nasopharyngeal, ovarium, soft tissue, and thyroid). The main key to success in managing this carcinoma is by detecting the cancer in early stage to enable curative treatment to be performed. But, unfortunately most patients in Indonesia seek for treatment in the advanced stage, causing low survival rate. Colorectal carcinoma requires multimodalities management and there is no uniformity of management approach in the national level. This study was aimed to identify the incidence, epidemiology, and risk factors which influence the occurrence of colon and rectal cancer in Saiful Anwar Hospital (SAH), Malang based on colonoscopy examination from January 2010-April 2015.Method: Descriptive study, with total sampling method. Samples were colon and rectal cancer patients in SAH, Malang who underwent colonoscopy within January 2010 – April 2015.Results: We found 472 eligible samples, which comprised of 50 individuals (11%) with the age of less than 36 years old, 326 individuals (69%) in middle aged group with the age of 36-65 years old, 96 individuals (20%) in older aged group with the age of more than 65 years old. Patients were predominantly male with 248 individuals (53%), while female patients were 224 individuals (47%). The most common location of the tumour was in the rectum, which was found in 380 individuals (74.15%). The most common clinical symptoms was bloody stool with mucus. From patients in this study, 87 individuals (18.43%) had history of smoking, 11 individuals (2.3%) had family history of cancer, and 58 individuals (12.28%) consumed traditional herbal drinks (jamu). Patients’ characteristics of colon cancer based on anatomical pathology results showed that the most common was moderately differentiated adenocarcinoma in 33 patients (61.11%), followed by well-differentiated adenocarcinoma in 14 patients (25.93%), and the least common was those with anatomical pathology results revealing unspecific adenocarcinoma in 7 patients (12.96%). Characteristics of patients with rectal cancer based on anatomical pathology results showed that the most commonly found was moderately differentiated adenocarcinoma in 72 patients (54.15%), well-differentiated adenocarcinoma in 34 patients (25.56%), unspecific adenocarcinoma in 24 patients (18.04%) and the least common was those with anatomical pathology results of mucinous adenocarcinoma found in 3 patients (2.25%).Conclusion: The conclusion of this study was colon and rectal cancer were frequently found in middle aged group. The most common location was rectum. Mainly found in male compared to female. 

The Prevalence, Profile, and Risk Factor of Patients with Ulcerative Colitis at Dr. Saiful Anwar Malang General Hospital

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 17, No 1 (2016): VOLUME 17, NUMBER 1, April 2016
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: The prevalence ulcerative colitis (UC) in RSCM Jakarta in 1991-1995 is 2.5%. The disease affects men and women at similar rates or slightly more common in women than in men. Age of onset follows a bimodal pattern, with a peak at 15-25 years and a smaller one at 55-65 years, although the disease can occur in people of any age. The precise etiology of UC is not well understood. UC is precipitated by a complex interaction of environmental (cigarretes, diet, non-steroidal anti-inflammatory drug/NSAID, etc), genetic, and immunoregulatory factors. This study aimed to identify the prevalence, profile and risk factor of ulcerative colitis in Dr. Saiful Anwar General Hospital Malang.Method: This is a retrospective survey analysis from medical record which was taken from 2170 patients who underwent colonoscopy in Dr. Saiful Anwar General Hospital Malang from January 2010 to December 2014. Demographic setting (sex, age), clinical features, lifestyle, diagnosis based on colonoscopy were analyzed as the variables.Results: Total patients with UC was 176 patients. The prevalence of UC during 2010-2014 was 8.2% at Dr. Saiful Anwar General Hospital. There was a similar prevalence of sex between male and female patients, in which 95 (53.4%) were male and 81 (46.6%) were female. The average age of patients with UC was 41,6 years. Most patients were presented with abdominal pain (32.90%) and weight loss (42.1%). The diagnosis based on colonoscopy were pancolitis (36%), proctosigmoiditis/proctitis (31.81%), and left-sided colitis (21.9%). The risk factors of UC identified in this study were current smoker, use of NSAIDs/traditional herbs/potion and fiber diet. Majority of ulcerative colitis study samples were non-smoker (75%), not consuming herbal treatment/NSAID (60.22%), and rarely consuming fiber (36.93%). There is a significan correlation between frequency of fiber diet and UC (r = -0.106,  p = 0.000).Conclusion: The prevalence of UC was 8.2%  in our hospital with men and women were equally affected, and average age was 41.6 years. Patients presented with various clinical symptoms, most are abdominal pain and weight loss. The most frequent diagnosis were pancolitis, proctosigmoiditis/proctitis, and leftside colitis. There is a significant correlation between frequency of fiber diet and UC (r = -0.106,  p = 0.000).Keywords : ulcerative colitis, prevalence, profile, risk factors

Overview of Serum Interleukin-18 (IL-18) Levels in Liver Cirrhosis Patients and Their Correlation to Hepatic Encephalopathy

The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 2 (2018): VOLUME 19, NUMBER 2, August 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Background: The inflammatory process has an important role in the pathophysiology of hepatic encephalopathy (HE) in liver cirrhosis. IL-18 is a key mediator who plays a role in neuroinflamation processes that can lead to symptoms of HE. This study aimed to determine serum IL-18 levels in liver cirrhosis patients and to assess the association of serum IL-18 levels with HE.Method: A total of 52 subjects (32 patients with liver cirrhosis and 20 healthy controls) were enrolled in this study. 32 patients with liver cirrhosis will be assessed for HE based on West-Haven criteria. All subjects were examined for serum IL-18 levels which is measured by ELISA method. We performed a comparative analysis between serum IL-18 levels of liver cirrhosis patients and healthy controls, a correlation analysis between serum IL-18 levels and HE, and a comparative analysis of serum IL-18 levels among degrees of HE.Results: Mean serum IL-18 levels in the liver cirrhosis group were 688.5 ± 674.3 pg/ml, and in the healthy controls group were 163.9 ± 100 pg/mL with p value = 0.01 (p < 0.05). There was a significant correlation between IL-18 and HE (r = 0.85, p = 0.00). Serum IL-18 levels in covert and overt HE groups were significantly higher than those without HE (p < 0.05).Conclusion: Serum IL-18 levels were significantly higher in liver cirrhosis patients than in healthy controls. There was a positive correlation between IL-18 and HE. Serum IL-18 levels in liver cirrhosis patients with HE were significantly higher than those without HE.