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"Background: Tire methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bite duct in patients with obstructive extrahepatic jaundice.

Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP dttring a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of I0 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed.

Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCR the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (28%), bile duct stone 46 cases (43.4%) carcinoma of ampula voter 20 cases (18.9%), CBD tumor 7 crises (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (38%), duodenal tumor I case (0.9%), carcinoma of ampula vater and bite duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure I6 cases (15.1%). The patients received the following treatment: sphyncterotomy 36 cases (51 .4%), stent application 11 cases (15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases ( 7. 1%)."

"ABSTRAKLatar belakang: Mengetahui faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna merupakan hal penting untuk membantu membuat perencanaan optimal dalam melakukan pendekatan terapi yang tepat untuk masing-masing etiologi dan faktor terkait guna membantu meningkatkan kesintasan dan kualitas hidup pasien.Tujuan: Mendapatkan kesintasan dan faktor-faktor yang berhubungan dengan mortalitas pada pasien ikterus obstruktif dengan etiologi maligna di RSCM.Metode: Penelitian kohort retrospektif dan prospektif dilakukan dengan data sekunder pasien ikterus obstruktif yang dirawat di ruang perawatan RSCM antara Januari 2010 ? Desember 2013. Faktor-faktor yang dinilai meliputi umur, jenis kelamin, sepsis, hipoalbumin, tingkat bilirubin serum, tingkat CA 19-9 serum, drainase bilier, keganasan non ca ampula Vater, dan komorbid dengan hasil keluaran berupa mortalitas pasien. Kesintasan kumulatif terjadinya mortalitas dalam 3 bulan setelah diagnosis dinyatakan dengan kurva Kaplan Meier. Analisis bivariat dan multivariat dilakukan dengan Cox Proportional Hazards Regression Model untuk mendapatkan Hazard Ratio (HR) dari setiap faktor prognosis. Skor prognosis dari setiap faktor bermakna ditentukan berdasarkan model akhir regresi.Hasil: Sebanyak 181 dari 402 pasien ikterus obstruktif dengan etiologi maligna memenuhi kriteria penelitian dengan proporsi laki-laki sebesar 58,6 % dengan pasien berumur ≥ 50 tahun sebesar 57,5 %. Sepsis (HR 2.462 ; IK 95% 1.552 ? 3.906), drainase bilier tidak berhasil/tidak ada (HR 1.604 ; IK 95% 0.988 ? 2.603), serta skor indeks komorbid Charlson ≥ 4 (HR 2.476 ; IK 95% 1.562 ? 3.923) merupakan faktor prognosis yang bermakna terhadap mortalitas pasien. Median kesintasan pasien dengan faktor prognosis bermakna 14 hari; IK 95% 9.66 ? 18.34 sedangkan median kesintasan keseluruhan 26 hari; IK 95% 20.82 ? 31.19 (p < 0.01). Ambang skor prognostik terbaik didapatkan pada skor ≥ 2 dengan sensitifitas 68% dan spesifisitas 75%. AUC pada kurva ROC 0.769.Kesimpulan: Kesintasan pasien dengan faktor prognosis sepsis, drainase bilier tidak berhasil/tidak ada, dan skor indeks komorbid Charlson ≥ 4 lebih pendek dibandingkan kesintasan keseluruhan pasien. Skor prognostik ≥ 2 termasuk dalam risiko tinggi kematian dan kemampuan prediksi mortalitas dari faktor prognosis bermakna sebesar 76.9%.

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ABSTRACT

Background: Understanding any related factors affecting mortality in patients with malignant obstructive jaundice will better guide to an approriate and optimal planning in making theurapetic approach for each etiological and relating factors thus improving survival and patients? quality of life.

Aim: To obtain survival rate and mortality-related factors of malignant obsructive jaundice patients in Cipto Mangunkusumo Hospital.

Methods: Retrospective-prospective cohort study was conducted with medical records of obstructive jaundice inpatient from January 2010 to December 2013 were reviewed. Suggested mortality-related factors include age, gender, sepsis, hypoalbumin, serum bilirubin level, serum CA 19-9 level, billiary drainage, non-ampulla Vateri carcinoma, and comorbid were analyzed. Three-month cumulative overall survival was calculated by Kaplan-Meier curve. Bivariat and multivariat analysis was done with Cox Proportional Hazards Regression Model to obtain Hazard Ration (HR) of each prognostic factor. Prognosis score from each mortality-related factor was calculated based on the last regression model.

Results: 181 from 402 patients were enrolled in this study with male proportion was 58.6% and patients aged 50 years or above was 57.5%. Sepsis (HR 2.462 ; CI 95% 1.552 ? 3.906), unsuccessful / no prior billiary drainage (HR 1.604 ; CI 95% 0.988 ? 2.603), and Charlson comorbid score ≥ 4 (HR 2.476 ; CI 95% 1.562 ? 3.923) were mortality-related factors with significant difference. Patients with significant prognostic factors had median survival 14 days; 95% CI: 9.66 ? 18.34 compared with overall median survival 26 days; 95% CI: 20.82 ? 31.19 (p < 0.01). Score ≥ 2 identified as the highest prognostic score threshold with sensitivity 68%, specificity 75%, and AUC on ROC curve 0.769.

Conclusion: Patients with significant prognostic factors which were sepsis, unsuccessful / no prior billiary drainage, and Charlson comorbid score ≥ 4 had shorter survival than overall survival. Prognostic threshold ≥ 2 quite good to classify malignant obstructive jaundice inpatient into high risk mortality population. Mortality of patients with those significant prognostic factors can be predicted in 76,9%."

"Chalangiocarcinoma is the second most common primary liver malignancy with global increase of incidence and mortality. The mean age at presentation is 50 years. Patients with cholangiocarcinoma usually will have symptoms of obstructive jaundice followed with supporting laboratory and imaging findings. The predominant clinical feature of extrahepatic cholangiocarcinoma is biliary obstruction resulting in Jaundice; while intrahepatic cholangiocarcinoma causes symptoms of intrahepatic mass including abdominal pain in right upper quadrant and other tumor-related symptoms such as cachexia and malaise. The diagnosis and staging of cholangiocarcinoma require multidisciplinary approaches including laboratory, radiological, endoscopic approaches and analysis on pathology. This case report describes a patient with a cholangiocarcinoma based on result of endoscopic retrograde cholangiopancreatography (ERCP) imaging. In addition to a diagnosis tool, ERCP can also be a therapeutic modality for placing stent to reduce symptoms of cholestasis. There were supporting laboratory findings such as increased bilirubin level, alkaline phosphates (ALP) and gamma glutamyltransferase (GGT) levels as well as increased level of tumor markers such as carcinoembryonic antigen (CEA), carbohydrate antigen (CA 19-9 and cytological examination."

"Ikterus neonatorum merupakan kondisi pada neonatus karena peningkatan bilirubin dalam darah. Ikterus neonatus mempunyai tanda diantaranya kulit dan sklera yang kuning akibat bilirubin tak terkonjugasi. Salah satu terapi hyperbilirubinemia adalah fototerapi. Tujuan penelitian adalah untuk mengetahui hubungan durasi fototerapi dengan nilai bilirubin total akhir pada pasien ikterik neonatorum di RS Polri DKI Jakarta. Penelitian ini menggunakan desain cross sectional dengan total 103 data yang mengalami ikterus neonatorum sebagai responden. Hasil penelitian menunjukkan rata-rata kadar bilirubin awal 14, 81 mg/dL, kadar bilirubin setelah fototerapi selama 24 jam menghasilkan penurunan sebesar 2,60 mg/dL dan fototerapi selama 48 jam menghasilkan rata-rata penurunan bilirubin sebesar 3,69 mg/dL. Terdapat hubungan durasi fototerapi dengan nilai bilirubin total pada 24 jam dan 48 jam pasca fototerapi (p Value <0,005). Rekomendasi penelitian ini adalah perlu dilakukannya eksplorasi factor-faktor yang berhubungan dengan efektivitas fototerapi.

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Neonatal jaundice is a condition in neonates due to increased bilirubin in the blood. Neonatal jaundice has signs including yellow skin and sclera due to unconjugated bilirubin. One of the therapies for hyperbilirubinemia is phototherapy. The purpose of the study was to determine the relationship between the duration of phototherapy and the final total bilirubin value in neonatal jaundice patients at DKI Jakarta Police Hospital. This study used a cross sectional design with a total of 103 data who experienced neonatal jaundice as respondents. The results showed an average initial bilirubin level of 14, 81 mg/dL, bilirubin levels after phototherapy for 24 hours resulted in a decrease of 2.60 mg/dL and phototherapy for 48 hours resulted in an average decrease in bilirubin of 3.69 mg/dL. There is a relationship between the duration of phototherapies with total bilirubin values at 24 hours and 48 hours after phototherapy (p value <0.005). The recommendation of this study is the need to explore the factors associated with the effectiveness of phototherapy."

"ABSTRAKNeonatal jaundice sering terjadi pada minggu pertama awal kehidupan bayi setelah lahir. Deteksi dini neonatal jaundice dapat mencegah terjadinya kernikterus sebagai komplikasi tingginya kadar bilirubin pada neonatus. Visual assessment merupakan salah satu pemeriksaan untuk menilai neonatal jaundice yang diperkenalkan oleh Kramer. Tujuan penelitian ini adalah mengetahui nilai sensitivitas, spesifitas dan akurasi visual assessment atau pemeriksaan Kramer pada neonatal jaundice. Penelitian ini menggunakan desain cross sectional pada 102 bayi dengan teknik pengambilan sampel consecutive sampling. Analisis data dilakukan dengan tabel uji diagnostik 2x2. Hasil penelitian ini menunjukkan bahwa visual assessment pada neonatal jaundice nilai sensitivitas 76,92 , spesifisitas 89,47 , dan nilai akurasi 86,27 . Penelitian ini dapat menjadi informasi untuk pengembangan pemeriksaan noninvasif lainnya dalam menilai neonatal jaundice untuk menurunkan angka mobiditas neonatus. Kata Kunci: akurasi, neonatal jaundice, sensitivitas, spesitifitas, visual assessment

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ABSTRACTNeonatal jaundice often occurs in the first week after birth. Early detection of neonatal jaundice can prevent kernicterus as a complication of high levels of bilirubin in neonates. Visual assessment is one of the examinations to assess the neonatal jaundice introduced by Kramer. The purpose of this study was to determine the sensitivity, specificity and accuracy of visual assessment or Kramer examination in neonatal jaundice. This study used cross sectional design to examine 102 babies as the sample which was selected by convenience sampling method. 2x2 table diagnostic test was employed in this study to analyze the data. The results of this study showed that visual assessment in neonatal jaundice had sensitivity valued 76.92 , specificity valued 89.47 , and accuracy valued 86.27 . This research can be acknowledged for the development of other non invasive examinations in assessing neonatal jaundice for decreasing the number of neonatal morbidity. Keywords accuracy, neonatal jaundice, sensitivity, specificity, visual assessment "

"Latar Belakang: Ikterus obstruktif merupakan salah satu komplikasi tersering keganasan sistem bilier. Keadaan ini akan memicu pelepasan sitokin proinflamasi. Terdapat kontroversi mengenai pengaruh drainase bilier terhadap perubahan kadar sitokin proinflamasi pada penderita kanker pankreatobilier.Tujuan: Untuk mengetahui kadar Tumor Necrosis Faktor alfa (TNF-alfa) dan Interleukin 6 (IL6) sebelum dan sesudah Endoscopic Retrograde Cholangio Pancreatography (ERCP) atau Percutaneus Transhepatic Biliary Drainage (PTBD) pada penderita ikterus obstruksi etiologi kanker pankreatobilier.Metode: Desain penelitian adalah one group before after study. Pemilihan sampel secara consecutive sampling. Sampel darah diambil sebelum dan lima hari sesudah ERCP atau PTBD. Pengukuran kadar TNF-alfa dan IL-6 dengan cara Enzyme Linked Immunosorbed Assay (ELISA).Hasil: Terdapat 40 orang responden yang diikutsertakan dalam penelitian ini, 22 laki laki dan 18 perempuan dengan usia rata rata 55,3 tahun. Berdasarkan imaging dan endoskopi, ditegakkan diagnosis kolangiokarsinoma sebanyak 22 orang, tumor ampula Vateri 10 orang, dan tumor pankreas 8 orang. Kadar rata-rata TNF- alfa sebelum tindakan 4,81 (2,91) pg/ml dan sesudah tindakan 8,05 (6,7) pg/ml, terdapat peningkatan yang bermakna setelah tindakan drainase bilier (p:0,02). Kadar rata-rata IL-6 sebelum tindakan 7,79 (1,57) pg/ml dan sesudah tindakan 7,75 (1,76) pg/ml, tidak terdapat perbedaan yang bermakna setelah tindakan drainase bilier (p:0.52). Kadar rata-rata bilirubin sebelum tindakan 15,5 mg% dan sesudah tindakan 11,3 mg%.Simpulan: Terjadi peningkatan kadar rata-rata TNF-alfa secara bermakna setelah drainase. Tidak ada penurunan yang bermakna kadar rata-rata IL-6.

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Background: Obstructive jaundice represents the most common complication of biliary tract malignancy. Obstructive jaundice causes releases of proinflammatory cytokine. There has been controversy about effect of biliary drainage on the change in proinflammatory cytokine level in pancreatobiliary cancer patients.Objective: The present study was designed to determine levels of Tumor Necrosis Factor Alpha (TNF-Alpha) and Interleukin 6 (IL-6) in preprocedure of either Endoscopic Retrograde Cholangio Pancreatography (ERCP) or Percutaneus Transhepatic Biliary Drainage (PTBD) and postprocedure of them in obstructive jaundice patient caused by pancreatobiliary cancer.Methods : The study method is before- and- after case study design with consecutive sampling. Blood was collected five days prior to either Endoscopic Retrograde Cholangio Pancreatography (ERCP) procedure or Percutaneus Transhepatic Biliary Drainage (PTBD) procedure and five days after either of them. Enzyme Linked Immunosorbed Assay (ELISA) was used to determine TNF-Alpha and IL-6.Results: Forty subjects were included in this study which consisted of 22 men and 18 women. The mean age was 55.3 years old. According to the results of imaging and endoscopy procedure, twenty two (22) people were diagnosed cholangi carcinoma, ten (10) people were diagnosed ampulla varteri and eigth (8) people were diagnosed pancreatic tumor. In preprocedure, the mean of TNF-Alpha concentration was 4.81 (2.91) pg/mL, the mean of IL-6 concentration was 7.79 (1.57) pg/mL and the mean of bilirubin concentration was 15.5 mg%. In postprocedure, the mean of TNF-Alpha concentration was 8.05 (6.7) pg/mL, there was significant increase in TNF-Alpha concentration (p:0.02). However, the mean of IL-6 concentration was 7.75 (1.76) pg/mL, there was not any significant chance in IL-6 concentration (p:0.52). The mean of bilirubin concentration was 11.3 mg%.Conclusions: On one hand, there was significant increase in mean concentration value of TNF-Alpha after biliary drainage procedure. On the other hand there was not any significant decrease in mean concentration value of IL-6 after biliary drainage procedure."

"Penilaian derajat keparahan pneumonia komunitas Community-Acquired Pneumonia (CAP) sangat penting untuk menentukan beratnya penyakit dan tata laksana yang lebih baik sehingga angka kematian 30 hari dapat dikurangi. Antitrombin III (AT-III) sebagai biomarker koagulasi dapat berperan dalam menentukan diagnosis dan prognosis pasien CAP. Tujuan penelitian ini untuk mengetahui hubungan kadar AT-III saat awal masuk rumah sakit terhadap derajat berat penyakit CAP dan kematian 30 hari pada pasien CAP. Penelitian ini menggunakan desain kohort perspectif dilakukan pada 55 subjek dengan CAP yang masuk dari instalasi gawat darurat RS H. Adam Malik, Medan dalam kurun Februari-Mei 2013 setelah memenuhi kriteria. Kadar AT-III saat awal masuk rumah sakit pada pasien CAP berkorelasi kuat dengan kematian dalam 30 hari. Semakin rendah kadar AT-III, semakin tinggi angka kematian 30 hari. "

"ABSTRAKHiperbilirubinemia tidak terkonjugasi merupakan kondisi dimana kadar total serum bilirubin (TSB) lebih dari sama dengan 5 mg per dL dan biasanya terjadi pada 60% bayi sehat lahir cukup bulan dan 80% bayi lahir kurang bulan. Kadar TSB yang meningkat hingga 20-25 mg per dL dapat menyebabkan gangguan neurologis (kernikterus) karena fraksi bebas bilirubin tidak terkonjugasi dapat melewati sawar darah otak. Peningkatan kadar bilirubin tidak terkonjugasi dapat disebabkan oleh peningkatan sirkulasi enterohepatik. Mikrobiota pencernaan memiliki peran penting dalam menurunkan sirkulasi enterohepatik dengan mereduksi bilirubin tidak terkonjugasi menjadi urobilinogen yang selanjutnya akan dimetabolisme tubuh. Profil mikrobiota pencernaan neonatus memiliki asosiasi dengan risiko perkembangan hiperbilirubinemia. Informasi mengenai profil mikrobiota pencernaan neonatus dengan hiperbilirubinemia tidak terkonjugasi pada populasi di Indonesia masih langka. Tujuan dari penelitian ini adalah untuk mendapatkan gambaran awal profil mikrobiota pencernaan dari mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi di Rumah Sakit Cipto Mangunkusumo (RSCM). Penelitian observasional dengan pendekatan cross sectional dilakukan dengan memilih sebanyak masing-masing 3 sampel neonatus dengan total serum bilirubin ³ 5 mg/dL dan < 5 mg/dL serta dilahirkan pada periode Februari-Maret 2019. Mekonium neonatus dikultur secara mikrobiologi pada medium selektif dan nonselektif kemudian dilakukan identifikasi media selektif, morfologi koloni, mikroskopik, dan molekuler dengan Polymerase Chain Reaction-16s rRNA Sanger Sequencing (PCR-sequencing). Data klinis neonatus diperoleh dengan pencatatan rekam medik di RSCM. Profil mikrobiota terkulturkan dari mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi di Rumah Sakit Cipto Mangunkusumo terdiri dari filum Firmicutes yang didominasi oleh genus Staphylococcus (50%) diikuti oleh Bacillus (37,5%) dan Enterococcus (12,5%) sedangkan neonatus normal terdiri dari filum Firmicutes yang didominasi oleh genus Staphylococcus (58,34%) diikuti oleh Bacillus (25%), Streptococcus (8,33%), dan Enterococcus (8,33%). Profil mikrobiota mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi dan normal didominasi oleh genus Staphylococcus (anaerob fakultatif) yang berpotensi sebagai patogen. Profil mikrobiota mekonium neonatus dengan hiperbilirubinemia tidak terkonjugasi (TSB ³ 5 mg/dL) memiliki keberagaman lebih rendah dibandingkan neonatus normal (TSB < 5 mg/dL) khususnya neonatus dengan metode persalinan caesar.

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ABSTRACTUnconjugated hyperbilirubinemia is a condition where total serum bilirubin (TSB) levels are greater than or equal to 5 mg per dL and usually affects up to 60% healthy term neonates and 80% preterm neonates. Increased TSB levels up to 20-25 mg per dL can cause neurological disorders (kernicterus) because the free fraction of unconjugated bilirubin can cross the blood-brain barrier. Increased unconjugated bilirubin concentration is due to increased enterohepatic circulation. Gut microbiota has an important role in reducing the enterohepatic circulation by transforming unconjugated bilirubin to urobilinogen which will be metabolized by the body. The neonates gut microbiota profile is associated with the risk of hyperbilirubinemia. Information regarding gut microbiota profile of neonates with unconjugated hyperbilirubinemia in Indonesian population is scarce. The purpose of this study was to get a preliminary description of gut microbiota profile from neonates meconium with unconjugated hyperbilirubinemia at Cipto Mangunkusumo Hospital (RSCM). Observational study with the cross-sectional design was conducted by selecting 3 samples each from neonates with TSB ³ 5 mg/dL and < 5 mg/dL and born in February-March 2019. Neonates meconium was cultured microbiologically on selective and nonselective media and identified based on selective media, morphology, microscopy, and molecular by Polymerase Chain Reaction-16s rRNA Sanger Sequencing (PCR-sequencing). Clinical data of neonates were obtained from the medical record at RSCM. Cultured microbiota profiles from neonates meconium with unconjugated hyperbilirubinemia consisted of Firmicutes which was dominated by Staphylococcus (50%) followed by Bacillus (37,5%) and Enterococcus (12,5%) whereas normal neonates meconium consisted of Firmicutes which was dominated by Staphylococcus (58,34%) followed by Bacillus (25%), Streptococcus (8,33%), and Enterococcus (8,33%). Microbiota profiles from neonates meconium with and without unconjugated hyperbilirubinemia were dominated by Staphylococcus (facultative anaerobe) with pathogenic potential. The meconium microbiota profile of neonates with unconjugated hyperbilirubinemia (TSB ³ 5 mg/dL) had lower diversity than normal neonates (TSB < 5 mg/dL), especially cesarean-born infants."