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"Background: The ideal therapy for ascites in liver cirrhosis is a low sodium chat and a combination of furosemide and spironolacton. However; this still sometimes does not produce satisfactory results, even after increasing the dose of the diuretic. Such failure occurs due to the influence ol the Renin Angiotensin Aldosterone (RAA) system. Low doses ol ACE inhibitors (captopril) should improve renal blood llow and increase filtration at the glomeruli, thus increasing natriuresis without causing haemodynamic imbalance. Study aim: To discover the natriuretic and diuretic effects of low dose captopril achuvant in patients with liver cirrhosis who have received furosemide and splronolacton by measuring urinary sodium and 24-hour urine output. Materials and method: This study was conducted on in- and out- patients with liver cirrhosis and Ascites at the Dr. Kariedi Central Public Hospital. Semarang, who met the inclusion and exclusion criteria. The study took place from June 1st, 1997 to March 3st1, 1998, and included 40 cases of liver cirrhosis with ascites. Study design: Open comparative randomized clinical trial with permuted blocks. All of the patients received a low let diet, 40 mg of lurosemide, 3x50 mg of spironolacton for 2 weeks, and patients with a urinary sodium level was below 80 mEq/L were randomized into two groups: group A receiving 3 x 6.25 mg of captopril, and group B receiving standard therapy. "

"Multiple Liver AbscessLiver abscess is a public health problem in few countries in Asia, Africa, and South America. As time goes, there were only few cases of amebic liver abscess found in developed countries, on the contrary more pyogenic liver abscess are found in those countries. Liver abscess could be caused by bacteria, parasite, or fungus J. The common symptoms among the liver' abscess are fever; chill, fatigue, loss of appetite, weight loss, right upper' abdominal pain,? in a few cases have symptoms like coughing, hiccup, pain in low right chest, or' pain on the shoulder: We reported a male patient 38 years batak ethnic was admitted with major symptoms such as high lever follow by chill, right upper abdominal pain, nausea, vomiting, appetite loss, fatigue and sometimes coughing. Based on clinical, laboratory data, and abdominal USG found this patient suspected suffered from pyogenic liver abscess. Treatment of this pattern consist of antibiotic (cefotaxime 29x1 IV metronidazol 3x500mg orally and aspiration of the liver' abscess). Aspiration was done 2 times with the interval l week, extracted 260cc totally yellow greenish watery fluid with no smell. On the follow up abdominal USG was repeated on January 8, 2003 found enlarge of the liver; 3 small abscesses on the right lobe liver and so recovery process and then patient left the hospital in good condition after 3 weeks hospitalized."

"Ultrasonography examination is an one of examination that can be used to see the abnormality of portal vein system. The technology of ultrasonography examination has further developed especially after using of Doppler ultrasonography which could portray haemodynamic changes from portal vein in liver cirrhosis patient. From this examination we also could predict bleeding."

"Pendahuluan: Volume hati sangat penting diketahui untuk menentukan kesesuaian graft pada Living Donor Liver Transplant (LDLT) dan untuk menentukan resektabilitas organ. Salah satu kunci kesuksesan dari LDLT adalah dengan diketahuinya volume parenkim hati yang adekuat baik untuk donor maupun resipien. CT Volumetri merupakan gold standard dalam menghitung volume hati non invasif. Namun pada pelaksanannya terdapat keterbatasan fasilitas, terbatasnya ketersediaan piranti lunak, dan membutuhkan waktu yang lama. Sampai saat ini belum disepakati formula biometrik yang sesuai dalam memprediksi volume hati pasien donor hati di Indonesia.Metode: Desain penelitian ini cross sectional untuk mengetahui formula yang mendekati prediksi volume hati pada pasien donor transplantasi dewasa di Indonesia. Penelitian dilakukan di Rumah Sakit dr. Cipto Mangunkusumo berdasarkan data pasien dari 1 Januari 2010 – 3 Oktober 2019.Hasil: Perbedaan antara ELV dengan CLV didapatkan paling kecil pada formula Poovatumkadavil dkk dengan perbedaan -24.484cm3, kemudian Vauthey dkk dengan nilai perbedaan -27.153 dan disusul Yoshizumi dkk dengan hasil beda -44.253. Pada grafik Bland-Altman dapat dilihat bahwa perbedaan terkecil ada pada formula yang diusulkan oleh Poovatumkadavil disertai dengan limit of agreement paling kecil dibandingkan formula lainnya.Kesimpulan: Formula biometrik yang diajukan oleh Poovatumkadavil dkk didapatkan paling akurat dalam memprediksi volume hati dewasa di RSCM berdasarkan prediksi volume hati dengan CT volumetrik.

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Liver volume calculation is very important in living donor liver transplant (LDLT) in assessing the compatibility and resectability of the graft. Accurate liver volume calculation to estimate adequate liver volume is one of the predictors of successful LDLT. CT volumetry is the gold standart for liver volume estimation, although there are some limitation in the software and facility availability and time. There are still no biometric formula agreed to predict liver volume in Indonesia. This study is conducted to acquire the best biometric formula for liver volume estimation in Indonesian population. The design of this study is cross-sectional study conducted in dr. Cipto Mangunkusumo General Hospital on 1st January 2010 – 3rd October 2019. The result of this study shows formuls by Poovatumkadavil has the least difference between estimated liver volume (ELV) and CT liver volume (CLV) with -24.4 cm3 difference. Formula by Vauthey and Yoshizumi also shows minute volume difference with -27.14cm3 and -44.25cm3 respectively. Bland-Altman graph shows the narrowest limit of agreement in Poovatumkadavil formula compared to the others. In conclusion, biometric formula by Poovatumkadavil is shown to be the most accurate in estimating liver volume in Indonesian population compared with CT volumetry.

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"The recent advances of endoscopic examination had proven that source of upper gastrointestinal bleeding in liver cirrhosis is not always caused by esophageal varices rupture but also gastric mucosal lesion. The prevalence of gastric ulcer in patients with liver cirrhosis is higher than healthy individuals. Imbalance of defensive and aggressive factors of gastric mucosa may involve in development of portal hypertensive gastropathy (PHG). Several studies reported hemodynamic changes associated wuth portal hypertension causing decreased mucus layer thickness as one of mechanism of PHG. Other dialogic factors of PHG were hypoacidity, hypergastrinemia, reduced hexosamin concentration, mucus metabolic function associated with decreased prostaglandin E2, and increased nitric oxyde which had caused mucus wall thickness changes. Gastric mucus damage induced by portal hypertension has important role in the pathogenesis of gastric ulcer in liver cirrhosis."

"Penyakit hati merupakan masalah kesehatan yang sulit diobati. Adanya masalah dalam pengobatan penyakit ini sebagian disebabkan karena tidak tersedianya obat yang terbukti herkhasiat. Kurkumin, senyawa aktif dalam ke keluarga tanaman curcuma telah diteliti dalam berbagai peyakit termasuk penyakit hati. Efek terapi kurkramin diduga berdasarkan efek antioksidatifnya. Dalam penelitian ini, kami menyelidiki efek kurkumin lerhadap swelling mitochondria yang diinduksi oleh tert-butilhidroperoksida (t-BuOOH) Mitokondria hali diisolasi secara homogen dari tikus Sprague-Dawley (relative specific activity suksinat dehidrogenase adalah 35.73 ±2.78). Pemberian 90 }M t-BuOOH menyebabkan swelling 2 fase yang khas pada mitokondria. Pola swelling dipengaruhi oleh berbagai faktor seperti komposisi bufer, kadar t-BuOOH, jumlah bufer isolasi dan protein mitokondria serta temperatur inkubasi. Swelling dapat dihambat sebesar 85 ±3% oleh kurkumin 2.50 jjM. Pada kadar rendah (1.25 //MJ dan tinggi (5.00 fiM), efek proteksi kurkumin terhadap swelling berkurang (bertitrut-turut 41 ±3% and 77+6%). Swelling dapat terjadi akibat terbukanya mitochondrial transition pore dan dapat mempakan petunjuk awal dan proses kematian sel. Efek inhibisi kurkumin terhadap swelling mitokondria yang diindukxi oleh t-BuOOH diduga disebabkan karena efek antioksidannya. (MedJ Indones 2006; 15:131-6)

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Liver diseases have been a medical problem which is difficult to manage. Some of the problems in the treatment of these diseases lie in the lack of reliable drug available. Curcumin, an active ingredient of the rhizomes of plant Curcuma has been investigated in the treatment of various disorders incuding liver diseases. The therapeutic effects of curcumin on liver diseases have been thought to be associated to its antioxidative properties. In the present study, we investigated the effects of curcumin on mitochondrial swelling in vitro induced by tert-butylhydroperoxide (t-BuOOH). Liver mitochondria were homogeneously isolated from Sprague-Dawley rats (the relative specific activity of succinate dehydrogenase was 35.73 ±2.78). Addition of 90 fj.M oft-BuOOHcauseda typical 2-phase swelling of the mitochondria. The pattern of swelling was influenced by various factors such as buffer composition, concentrations of t-BuOOH, amount of isolation buffer and mitochondrial proteins and incubation temperature.The swelling could be reduced by as much as 85 ±3% by 2.50 uM of curcumin. At lower (1.25 ^M) or higher (5.00 fjM) concentrations, the protection against swelling by curcumin were less effective (respectively were 41 ±3% and 77 ±6%). Swelling might occur due to the opening of mitochondrial transition pore and could be an initial indication in the cascade process leading to cell death. The inhibition of t-BuOOH-induced mitochondrial swelling by curcumin might be because of the antioxidant effects of the compound. (Med JIndones 2006; 15:131-6)."

"Latar Belakang. Lean NAFLD lebih sering ditemukan di negara Asia dan prevalensinya di Indonesia masih belum diketahui. Tingginya prevalensi, asimptomatik dan baru bergejala setelah timbul komplikasi, dan tingginya mortalitas lean NAFLD menjadikan perlunya deteksi dini pada populasi dewasa dengan IMT <23 kg/m2. Skrining pada populasi umum tidak direkomendasikan karena meningkatkan biaya kesehatan.Tujuan. Membuat sistem skoring untuk penapisan lean NAFLD pada populasi dewasa di Jakarta.Metode. Studi ini menggunakan desain potong lintang dari laporan pemeriksaan kesehatan individu dewasa >18 tahun dengan IMT <23 kg/m2 yang melakukan pemeriksaan kesehatan di klinik. Parameter yang dianalisis antara lain usia, jenis kelamin, lingkar pinggang, kadar GDP, kolesterol total, HDL, LDL, trigliserida, AST, ALT, dan asam urat. Variabel dengan nilai p <0,25 dilanjutkan ke analisis multivariat untuk pembuatan sistem skoring.Hasil. Sebanyak 276 individu diikutsertakan pada penelitian ini dan didapatkan prevalensi lean NAFLD sebesar 9,8%. Lean NAFLD lebih banyak ditemukan pada laki-laki dan memiliki karakteristik usia lebih tua, IMT, lingkar pinggang, kadar GDP, ALT, dan trigliserida lebih tinggi dibanding lean tanpa NAFLD. Analisis bivariat mendapatkan jenis kelamin laki-laki, usia ≥45 tahun, kadar GDP ≥100 mg/dL, ALT ≥35 U/L, dan trigliserida ≥150 mg/dL berhubungan dengan lean NAFLD. Sistem skoring melibatkan 4 parameter yaitu laki-laki, kadar GDP ≥100 mg/dL, ALT ≥35 U/L, dan trigliserida ≥150 mg/dL dengan masing-masing bernilai 1 poin. Model skoring ini memiliki sensitivitas 44,4%, spesifisitas 84,3%, dan AUROC 0,74.Kesimpulan. Parameter jenis kelamin, kadar GDP, ALT, dan trigliserida dapat digunakan sebagai sistem skoring dengan performans menengah untuk penapisan lean NAFLD dewasa......Background. Lean NAFLD is commonly found in Asian countries and its prevalence in Indonesia is still unknown. The high prevalence, asymptomatic until complications occur, and the high mortality of lean NAFLD makes it necessary for early detection in adult with BMI <23 kg/m2. Screening in general population is not recommended due to the high cost burden.Aim. To develop a scoring system for screening lean NAFLD in adults in Jakarta Methods. A cross-sectional study design was conducted from medical examination reports from individual >18 years old and BMI <23 kg/m2 who performed medical check up at the clinic. Several parameters including age, gender, waist circumference (WC), fasting blood glucose (FBG), total cholesterol (TC), HDL, LDL, triglycerides (TG), AST, ALT, and uric acid (UA) were analyzed in this study. Variabels with p-value <0.25 were included in multivariate analysis for the development of scoring systems.Results. A total of 276 people were enrolled in this study. Prevalence of lean NAFLD is 9.8%. Lean NAFLD are more commonly found in men and have older age, higher BMI, WC, GDP, ALT, and TG levels than lean non-NAFLD. In bivariate analysis, male sex, age ≥ 45 years, FBG ≥100 mg/dL, ALT ≥35 U/L, and TG ≥150 mg/dL are associated with lean NAFLD. The scoring system involves four parameters including male, FBG ≥100 mg/dL, ALT ≥35 U/L, and TG ≥150 mg/dL, worth 1 point each. This model has sensitivity 44.4%, specificity 84.3%, and AUROC 0.74.Conclusion. Parameters including gender, FBG, ALT, and TG levels can be used as a scoring system with moderate performance for screening lean NAFLD in adults."

"Latar Belakang Obesitas merupakan masalah kesehatan pada abad ke-21 dan berkaitan erat dengan peningkatan masalah kesehatan seperti non-alcoholic fatty liver disease (NAFLD). Patofisiologi obesitas tersebut melibatkan makrofag proinflamatori M1 (salah satu marker adalah Itgax atau CD11c) dalam perkembangan NAFLD. Dalam kasus yang lebih berat, NAFLD dapat berkembang menjadi fibrosis liver yang melibatkan TGF-β1. Meskipun pengobatan antiobesitas telah beredar dimasyarakat, namun obat tersebut dapat memiliki kontraindikasi dan efek samping masing-masing. Acalypha indica (Ai) merupakan salah satu tanaman herbal yang memiliki efek antihiperlipidemia dan antiobesitas. Penelitian ini akan menganalisis efek Ai terhadap perkembangan kerusakan liver melalui Itgax sebagai marker makrofag proinflamatori, TGF-β1 dan histopatologi liver pada tikus obesitas. Metode Uji reverse transcription-quantitative polymerase chain reaction (RT-qPCR) dilakukan untuk mengukur ekspresi Itgax dan TGF- β1 serta pemeriksaan histologi untuk menilai ada/tidaknya inflamasi dan persentase rerata luas area sinusoid pada organ liver tersimpan tikus obesitas dengan perlakuan: (1) diet normal (kontrol normal), (2) diet tinggi fruktosa dan kolesterol (DTFK) (kontrol negatif), (3) DTFK + Gemfibrozil (kontrol positif), serta (4) DTFK + ekstrak Ai (DTFK + Ai). HasilEkspresi Itgax pada kelompok tikus DTFK+Ai (1,580 + 0,836) terbukti lebih rendah dibanding dengan kelompok kontrol negatif (1,880 + 1,293), ekspresi TGF-β1 pada kelompok tikus DTFK+Ai (1,340 + 0,706) terbukti lebih rendah dibanding dengan kelompok kontrol negatif (1,850 + 1,358), walaupun tidak berbeda bermakna secara statistik. Di lain pihak, terjadi perbaikan inflamasi pada kelompok tikus DTFK+Ai dibanding dengan kontrol negatif, dan persentase rerata luas area sinusoid pada kelompok tikus DTFK+Ai (3,286 + 0,138) terbukti lebih tinggi dibanding dengan kontrol negatif (2,654 + 0,165).KesimpulanPemberian ekstrak akar Ai dapat menurunkan ekspresi Itgax dan TGF-β1, memperbaiki inflamasi pada liver serta meningkatkan persentase luas rerata sinusoid liver tikus obesitas, walaupun memerlukan penelitian lebih lanjut.

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Introduction

Obesity is a health problem in the 21st century and is closely related to an increase in health problems such as non-alcoholic fatty liver disease (NAFLD). The pathophysiology of obesity involves proinflammatory M1 macrophages (one of the markers is Itgax or CD11c) in the development of NAFLD. In more severe cases, NAFLD can progress to liver fibrosis involving TGF-β1. Even though anti-obesity treatments have been circulating in the community, these drugs can have their own contraindications and side effects. Acalypha indica (Ai) is a herbal plant that has antihyperlipidemia and antiobesity effects. This study will analyze the effect of Ai on the development of liver damage through Itgax as a marker for proinflammatory macrophages, TGF-β1 and liver histopathology in obese mice.

Method

The reverse transcription-quantitative polymerase chain reaction (RT-qPCR) test was carried out to measure the expression of Itgax and TGF-β1 as well as histology examination to assess the presence/absence of inflammation and the average percentage of sinusoid area in the stored liver organ of obese mice treated with: (1) diet normal (normal control), (2) high fructose and cholesterol diet (DTFK) (negative control), (3) DTFK + Gemfibrozil (positive control), and (4) DTFK + Ai extract (DTFK + Ai).

Results

Itgax expression in the DTFK+Ai group of mice (1.580 + 0.836) was proven to be lower than the negative control group (1.880 + 1.293), TGF- β1 expression in the DTFK+Ai group of mice (1.340 + 0.706) was proven to be lower than the negative control group. (1.850 + 1.358), although it is not statistically significantly different. On the other hand, there was an improvement in inflammation in the DTFK+Ai mice group compared to the negative control, and the average percentage of sinusoid area in the DTFK+Ai mice group (3.286 + 0.138) was proven to be higher than the negative control (2.654 + 0.165). Conclusion

Administration of Ai root extract can reduce the expression of Itgax and TGF-β1, improve inflammation in the liver and increase the percentage of the average area of liver sinusoids in obese mice, although further research is needed."

"ABSTRAK Sebagai salah satu penyebab terbanyak peningkatan enzim hati, dan sirosis, NAFLD perlu dinilai derajat steatosisnya. Trigliserida sebagai salah satu komponen sindrom metabolik diketahui mempunyai pengaruh terhadap terjadinya nonalcoholic fatty liver disease NAFLD , namun korelasinya dengan derajat steatosis pada pasien NAFLD belum diketahui. Studi ini bertujuan untuk mendapatkan korelasi antara kadar trigliserida dengan nilai Controlled attenuation parameter CAP pada pasien NAFLD, serta mendapatkan nilai titik potong trigliserida yang optimal untuk memprediksi derajat steatosis sedang-berat pada pasien NAFLD. Studi potong lintang dilakukan pada pasien NAFLD dewasa di poliklinik Penyakit Dalam RSCM, yang direkrut secara konsekutif. Pasien dengan sirosis hepatis dieksklusi dari penelitian. Diagnosis NAFLD dilakukan dengan menggunakan USG, sementara derajat steatosis ditentukan dengan metode CAP menggunakan alat Fibroscan. Sampel darah puasa diambil untuk pemeriksaan trigliserida. Korelasi antara kadar trigliserida dengan nilai CAP dianalisis dengan uji Pearson. Sebanyak enam puluh dua subyek, dengan median usia 55 rentang 21 ndash; 78 tahun. Median nilai IMT 26,1 rentang 19-38 kg/m2, lingkar pinggang 96,6 SB: 8,49 cm, kadar trigliserida 160,3 SB: 65,5 mg/dL, kolesterol LDL 147,8 SB: 38,2 mg/dL, kolesterol HDL 48,5 SB:11,1 mg/dL dan nilai CAP 268,5 SB: 46,8 dB/m. Obesitas sentral didapatkan sebanyak 94,8 . Komorbid didapatkan berupa hipertensi 46,8 , DM tipe 2 54,8 , dan sindrom metabolik pada 72,6 . Didapatkan adanya korelasi yang lemah antara TG dengan derajat steatosis r=0,272; p= 0,033 . Dari kurva ROC didapatkan kemampuan TG dalam memprediksi derajat steatosis kurang baik AUC 0,66 IK 95 0,48 ndash; 0,83 , sehingga tidak dilanjutkan untuk mencari titik potong. Didapatkan adanya korelasi lemah antara kadar trigliserida dengan derajat steatosis pada pasien NAFLD. Saat ini kadar trigliserida tunggal tidak dapat digunakan untuk mendeteksi derajat steatosis sedang-berat.ABSTRACT As one of the most common cause of elevated liver enzymes and cirrhosis nowadays, steatosis degree need to be evaluated in NAFLD cases. Triglyceride, one of metabolic syndrome components, is known to be associated with NAFLD. However, correlation between the triglyceride levels and steatosis degree, has not yet understood. This study aim to find correlation between triglyceride level with Controlled Attenuation Parameter CAP value in NAFLD patients, and also gain optimal cut off point of triglyceride for predicting moderate to severe NAFLD. A cross sectional study on adult NAFLD patient in RSCM Internal Medicine Clinic, recruited consecutively in four months. Patients with liver cirrhosis was excluded. Diagnosis of NAFLD using Ultrasound, meanwhile steatosis degree was assessed using CAP in Fibroscan. Blood samples were taken for Triglycerides examination. The correlation between triglyceride levels with CAP values were analyzed by Pearson test. Sixty two NAFLD subjects, with a median age of 55 range 21 78 years. Median value of BMI was 26.1 range 19 38 kg m2, mean for waist circumference, levels of LDL and HDL cholesterol was 96.6 SD 8.49 cm, 147.8 SD 38.2 mg dL, 48.5 SD 11.1 mg dL , respectively. Mean for triglyceride was 160.3 SD 65.5 mg dL, and CAP value 268.5 SD 46.8 dB m. Central obesity found in as many as 94.8 of subject. Comorbidities such as hypertension and type 2 diabetes was found at 46.8 and 54.8 respectively, and metabolic syndrome 72.6 . In this study, we found a weak correlation between triglyceride values and CAP r 0.272 p 0.033 . From the ROC we find the TG capability of predicting steatosis degree was not good enough AUC 0.66, 95 CI 0.48 to 0.83 . Therefore cut off point of TG was not assessed. As a conclusion, there is a weak correlation between triglyceride levels and degree of steatosis in patients with NAFLD. Triglyceride level cannot be used solely for assessment of steatosis degree. "