Abstract Background Gut microbiota dysbiosis in patients with chronic kidney disease on haemodialysis (CKD-HD) creates an increase in proteolytic bacteria activity, leading to an increase in the production of uraemic toxins, such as indoxyl sulphate, worsening of constipation symptoms and reducing patients’ quality of life. Improving gut microbiota dysbiosis is expected to improve this condition. This study aimed to evaluate the effect of synbiotics on indoxyl sulphate levels, constipation symptoms, and constipation-related quality of life in haemodialysis patients. Methods This was a double-blinded randomized controlled clinical trial with a parallel design involving haemodialysis patients. We included chronic haemodialysis patients with gastrointestinal complaints, difficulty defecating, faeces with hard consistency, or a bowel movement frequency of fewer than three times per week. Patients were randomly divided into two groups (synbiotics ( Lactobacillus acidophilus and Bifidobacterium longum 5x10 9 CFU) and placebo) for 60 days of oral intervention. All participants, caregivers, and outcome assessors were blinded to group assignment. The primary outcome was a decrease in indoxyl sulphate toxin levels. Meanwhile, improvement in constipation symptoms (measured using the Patient Assessment of Constipation: Symptoms (PAC-SYM) questionnaire) and improvement in constipation-related quality of life (measured using the Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire) were assessed as secondary outcomes. Results We included 60 patients (30 intervention; median age of 51.23 (13.57) years, 33.3% male; 30 control; median age of 52.33 (11.29) years, 36.7% male). There was no significant difference in terms of pre- and postintervention indoxyl sulphate toxin levels in the synbiotics group compared to the placebo group ( p =0.438). This study found an improvement in constipation symptoms ( p = 0.006) and constipation-related quality of life ( p =0.001) after synbiotic administration. Conclusion Two months of synbiotic supplementation did not lower indoxyl sulphate toxin levels. Nevertheless, it had a major effect in improving constipation and quality of life affected by constipation in patients undergoing chronic haemodialysis. Trial registration NCT04527640 (date of first registration: 26/08/2020)
Background: Mesenchymal stem cells (MSCs) are known to have immunomodulatory, anti-inflammatory, anti-apoptotic, and angiogenesis effects that are useful for relieving inflammation, recovery, and protection of lung tissues in COVID-19 patients. Secretome, a secretory product of MSCs, has several advantages over MSCs. We conducted a study to investigate secretomes’ effectiveness and safety profile as a treatment for severe COVID-19. Methods: A double-blind, multicenter, randomized, placebo-controlled trial was conducted between February 2021 and July 2021 in three top COVID-19 referral hospitals in the Greater Jakarta area, Indonesia. Eligible subjects (n=40) were randomized in a 1:1 ratio to an intervention group (n=20) and a control group (n=20). The primary outcome of this study was the changes in inflammatory markers and the ratio of inflammatory to anti-inflammatory markers. The secondary outcomes of this study included clinical outcome, laboratory outcome, radiological outcome, RT-PCR result conversion, and safety profile of MSC secretome.Results: Our analysis showed that on the 14th day after placebo administration, IL-6 level in the control group was significantly increased [4.110 (2.403–12.820) at baseline to 13.320 (2.958–33.285) on the 14th day after intervention, p=0.017]. The IL-6/IL-10 ratio in the control group was significantly increased (p=0.036) on the 14th day after placebo administration. We also found that most of the subjects who received placebo had high levels of IL-6 and ferritin (p=0.043) on the seventh day after the intervention. However, we found no significant differences in inflammatory marker levels on the seventh day and 14th day after intervention between both groups. There was no adverse event reported. There were no significant differences in the laboratory outcome, radiology outcome, RT-PCR result conversion, and safety profiles between both groups.Conclusions: MSC secretome can control inflammation in patients with severe COVID-19 and has a good safety profile. MSC secretome is a promising treatment modality for severe COVID-19.
Background : Colorectal cancer (CRC) is the fourth most prevalent cancer in the world and is positioned the second most common cancer in the United States. Patients with CRC in Indonesia showed a greater proportion. In Jakarta, 47.85% of CRC cases occur under the age of 45 years. The purpose of this study is to determine metastasis and the factors that influence colorectal cancer patients. Method: This study was conducted retrospectively from January 2003-December 2007 in Cipto Mangunkusumo hospital. Patients are eligible if they underwent colonoscopy, tumor biopsy, anatomical pathology, abdominal CT scan, abdominal ultrasonography, and radiology procedures. Result: Of all 1,615 patients who underwent colonoscopy procedure, 377 patients were diagnosed with colorectal cancer. Subject that met the criteria consist of 86 patients, where 56 (65.1%) male. Most aged 51-60 years old (26.7%), mean age 47.90 ± 14.53 years old. The tumor is most commonly located in the rectum and sigmoid 40 (46.5%), in which 18 (45%) among them had metastasized. Compared with male patients, female patients experienced more metastases, but not statistically significant. Among the patients with metastasized CRC, 42.3% of them 60 years old. Well-differentiated CRC produce larger number of metastatic cases than poorly-differentiated CRC. Poorly-differentiated CRC tend to produce adjacent metastasis, and also happened in relatively young age in compared with well-differentiated cancer. Conclusion: There was significant correlation between younger age group with a poor degree of histopathologic differentiation. Patients with CRC consist of more male patients than female ones. Factors sex, age group, histopathologic subtypes, and tumor location was not associated with metastasis. Keywords: colorectal cancer, metastasis, well-differentiated, poorly-differentiated
Background A high quality modern diet is associated with reduced risk of metabolic disease and diabetes. However, it remains unclear whether the quality of predominantly traditional ethnic diets is associated with such conditions. Moreover, the relationship between dietary quality and microbiota, a potential mediator of metabolic disease, has not been studied. Objective We investigated the relationship of dietary quality of traditional ethnic diets in Indonesia with fasting blood glucose (FBG), HbA1c, and the number of fecal Bifidobacterium. Design A cross-sectional study was conducted in selected districts with predominantly animal- or plant-based traditional diets of West Sumatera and West Java provinces, respectively. A total of 240 apparently healthy women aged 19–50 years were randomly selected from 360 women screened by a cluster sampling design. Dietary quality was assessed by 2-day repeated 24-hour food recall, and scored using the Healthy Eating Index (HEI) 2010. FBG was quantified with the enzymatic colorimetric method, and HbA1c by using hexokinase and high-performance liquid chromatography, and total fecal Bifidobacterium by real-time quantitative polymerase chain reaction. Results The HEI scores of 99% of women were <51, indicating a low-quality diet. In adjusted multivariate regression, HEI was inversely associated with FBG (ß = -0.403; 95% CI = -0.789 to -0.016; p = 0.041) and HbA1c (ß = -0.018; 95% CI = -0.036 to 0.000; p = 0.048) but was not significantly associated with total levels of Bifidobacterium (ß = -0.007, p = 0.275). Bifidobacterium count was not significantly associated with either FBG or HbA1c levels. Conclusion Low dietary quality is clearly associated with risk of increased markers of blood glucose. However, any mediating role of Bifidobacterium between dietary quality and glucose outcomes was not apparent. Innovative interventions for healthy eating should be implemented to increase dietary quality of populations transitioning from predominantly traditional to modern diets, to reduce the risk of diabetes, especially in women.
Purpose: To know the prevalence of data oesophageal carcinoma based on Esophagogastroduodenoscopy (EGD) in Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Indonesia / dr. Cipto Mangunkusumo Hospital in the year 2004–2006. Methods: We did the retrospective study based on the EGD data in Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine University of Indonesia/dr. Cipto Mangunkusumo Hospital in the year 2004–2006. Results: We evaluated EGD data from 2,793 patients in the year 2004–2006. Oesophageal carcinoma prevalence in the year 2004–2006 was 1.18% (33 of 2,793 patients). The age range between 17–72 years. The peak age in the range of age 50–59 years (0.3%). Men had more than woman: 0.8% vs 0.3% (23 vs. 9 out of 2,793 patients). Javanese ethnic prevalence is the largest one (0.5%). The common symptom is dysphagia (0.3%), dyspepsia (0.1%), melena (0.1%), odynophagi (0.07%) and hematemesis (0.03%). Conclusion: The prevalence esophageal carcinoma in Division of Gastroenterology outpatient of Internal Medicine, Faculty of Medicine, University of Indonesia/Dr. Cipto Mangunkusumo Hospital in the year 2004–2006 was 1.18%. The most frequent characteristic were men, age between 50–59 year, Javanese ethnic, and dysphagia symptom.
Living in an urban environment may increase the risk of developing inflammatory bowel disease (IBD). It is unclear if this observation is seen globally. We conducted a population-based study to assess the relationship between urbanization and incidence of IBD in the Asia-Pacific region.Newly diagnosed IBD cases between 2011 and 2013 from 13 countries or regions in Asia-Pacific were included. Incidence was calculated with 95% confidence interval (CI) and pooled using random-effects model. Meta-regression analysis was used to assess incidence rates and their association with population density, latitude, and longitude.We identified 1175 ulcerative colitis (UC), 656 Crohn's disease (CD), and 37 IBD undetermined (IBD-U). Mean annual IBD incidence per 100 000 was 1.50 (95% CI: 1.43-1.57). India (9.31; 95% CI: 8.38-10.31) and China (3.64; 95% CI, 2.97-4.42) had the highest IBD incidence in Asia. Incidence of overall IBD (incidence rate ratio [IRR]: 2.19; 95% CI: 1.01-4.76]) and CD (IRR: 3.28; 95% CI: 1.83-9.12) was higher across 19 areas of Asia with a higher population density. In China, incidence of IBD (IRR: 2.37; 95% CI: 1.10-5.16) and UC (IRR: 2.63; 95% CI: 1.2-5.8) was positively associated with gross domestic product. A south-to-north disease gradient (IRR: 0.94; 95% CI: 0.91-0.98) was observed for IBD incidence and a west-to-east gradient (IRR: 1.14; 95% CI: 1.05-1.24) was observed for CD incidence in China. This study received IRB approval.Regions in Asia with a high population density had a higher CD and UC incidence. Coastal areas within China had higher IBD incidence. With increasing urbanization and a shift from rural areas to cities, disease incidence may continue to climb in Asia.
Sclerosing mesenteritis (SM) is a rare disease with non-specific clinical manifestations and should be supported by radiological examination and confirmed by histopathological evaluation. Its relationship with cancer especially caecal adenocarcinoma is still unclear. This case report describes a young man who was diagnosed as having SM and poorly-differentiated caecal adenocarcinoma.
Proton pump inhibitors (PPIs) are the most effective anti secretory drugs available for controlling gastric acid acidity and volume. They are the drug of choice in the treatment for gastro esophageal reflux disease (GERD), Helicobacter pylori eradication, peptic ulcer and non steroidal anti-inflammatory drug (NSAID) gastropathy: For acute cases, an intravenous PPI is needed, especially for hospitalized patient. Recently, intravenous pantoprazole represents an alternative to intravenous histamine-2 receptor antagonists. We observed 2 patients who were treated with pantoprazole for duodenal ulcer, where one case had a complication of bleeding with a history of long term use of NSAID. After two weeks of treatment with pantoprazole, significant lesion healing from endoscopy findings was achieved in both cases. Keywords : peptic ulcer, upper gastrointestinal bleeding, proton pump inhibitors, pantoprazole
Abstract Introduction These Asian Working Group guidelines on diet in inflammatory bowel disease (IBD) present a multidisciplinary focus on clinical nutrition in IBD in Asian countries. Methodology The guidelines are based on evidence from existing published literature; however, if objective data were lacking or inconclusive, expert opinion was considered. The conclusions and 38 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results Diet has an important role in IBD pathogenesis, and an increase in the incidence of IBD in Asian countries has paralleled changes in the dietary patterns. The present consensus endeavors to address the following topics in relation to IBD: (i) role of diet in the pathogenesis; (ii) diet as a therapy; (iii) malnutrition and nutritional assessment of the patients; (iv) dietary recommendations; (v) nutritional rehabilitation; and (vi) nutrition in special situations like surgery, pregnancy, and lactation. Conclusions Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 38 recommendations.
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