Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective ...and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.
1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.
Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).
We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.
Risk Factors of Chronic Atrophic Gastritis Abdullah, Murdani
The Indonesian journal of gastroenterology, hepatology, and digestive endoscopy (Jakarta),
12/2014, Volume:
15, Issue:
3
Journal Article
BACKGROUND Kidney function profile is one of the important parameters in determining the health of the elderly. In Indonesia, no study has been conducted on kidney function profile during Ramadan ...fasting to determine the safety of Ramadan fasting in the elderly. This study aimed to determine the kidney function profile in the elderly who fasted during Ramadan.
METHODS This study used a prospective cohort design. The inclusion criteria were elderly aged >60 years undergoing Ramadan fasting in Jatinegara, Jakarta from April to July 2019. Patients with end-stage renal failure who had an acute infection, hypertension crisis, or refused to participate in the study were excluded. Patients who did not fast for 3 consecutive days were dropped out. The kidney function profile was calculated by the estimated glomerular filtration rate (eGFR) using the CKD-EPI formula 1 week before the first day of Ramadan, 3 weeks after the first day of fasting, and 2 weeks after the last day of fasting. Decreased eGFR was defined as having a minimum of 20% eGFR decline during or after the fasting period. Bivariate analysis was performed using McNemar or Cochran tests.
RESULTS 2 patients had eGFR decline during fasting, and 7 patients had eGFR decline after fasting. The median eGFR before, during, and after fasting were 81.5, 88.7, and 76.8 ml/min/1.73 m², respectively. A total of 1.4% of subjects had decreased eGFR during Ramadan, while 9.1% had decreased eGFR after Ramadan. However, the changes were not statistically significant.
CONCLUSIONS Although most elderly had lower eGFR following Ramadan fasting compared to before and during Ramadan, only individuals with several comorbidities had significant changes of kidney function.
Background and Aim
Sarcopenia is a problem affecting inflammatory bowel disease (IBD) outcome and should be evaluated by measuring muscle mass (using dual‐energy X‐ray absorptiometry DXA), muscle ...strength, and physical performance. DXA has drawbacks as it is expensive, not covered by a national program, and requires a technician. Other inexpensive and simple examinations are needed. The objective is to explore cutoff point and diagnostic accuracy of thigh circumference (TC), calf circumference (CC), subjective global assessment (SGA), and handgrip strength (HGS) to identify sarcopenia in IBD patients.
Methods
The study was conducted in Cipto Mangunkusumo Hospital during November 2020–June 2021. Analysis was performed to discover the cutoff point and diagnostic accuracy of TC, CC, SGA, and HGS to identify sarcopenia.
Results
As assessed by DXA, 7 of 60 women (11.7%) with IBD had sarcopenia. Using CC cutoff ≤31 cm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ration (PLR), and negative likelihood ratio (NLR) were 100%, 60.38%, 25%, 100%, 2.52, and 0, respectively. Using TC cutoff ≤50 cm, the sensitivity, specificity, PPV, NPV, PLR, and NLR were 100%, 83.02%, 43.75%, 100%, 5.90, and 0, respectively. SGA has sensitivity, specificity, PPV, NPV, PLR, and NLR of 42.86%, 84.91%, 27.27%, 91.84%, 2.84, and 0.67, respectively. The area under curve of HGS was 33.3%.
Conclusion
In this survey of Indonesian women with IBD, the frequency of sarcopenia was 11.7%. When compared with DXA, TC and CC values over 50 cm and 31 cm, respectively, were helpful to exclude the diagnosis of sarcopenia. SGA and HGS were of lesser value for the identification of a decrease in muscle mass.
Sarcopenia is affecting inflammatory bowel disease (IBD) outcomes and should be evaluated by measuring muscle mass (using dual‐energy X‐ray absorptiometry DXA), muscle strength, and physical performance, but DXA has drawbacks as it is expensive, not covered by a national program, and requires a technician. Other inexpensive and simple examinations are needed, such as thigh circumference (TC), calf circumference (CC), subjective global assessment, and handgrip strength, to identify sarcopenia in women IBD patients. In this study, we found that the optimal cutoff points of TC and CC were more than 50 and 31 cm, and they are very good to exclude sarcopenia in women IBD patients.
the aging process causes decreasing in the function of various organs. Skletal muscle is one of the organs affected by aging process. It is known as sarcopenia. Sarcopenia is defined as a syndrome ...characterized by progressive loss of muscle mass and strength. The handgrip strength examination is often applied as a sarcopenia filtering technique. This study aimed to determine the relationship between age, nutritional status, and chronic diseases such as stroke, hypertension (HT), diabetes mellitus (DM), coronary heart disease (CHD), and chronic obstructive pulmonary disease (COPD) with handgrip strength.
a cross-sectional study to determine factors related to the handgrip strength in elderly patients was conducted in Geriatric outpatient clinic of Cipto Mangunkusumo Hospital and Mohammad Hoesin Hospital from August to October 2015. There were 352 eligible subjects in this study recruited with consecutive sampling. The independent variables in the study consisted of age, sex, nutritional status, chronic disease (stroke, hypertension (HT), diabetes mellitus (DM), coronary heart disease (CHD) and chronic obstructive pulmonary disease (COPD)), waist circumference while the dependent variable was handgrip strength.
age of more than 75 years old and malnutriton were risk factors that affected hangrip strength. Age of >75 years increase the risk for having low handgrip strength by 2,3-fold. Malnutrition increased risk for low handgrip strength for 1,9-fold.
ages of >75 years old and malnutrition will increase the risk of low handgrip strength in elderly patients.
Background and Aim
Inflammatory bowel disease (IBD) is emerging in the newly industrialized countries of South Asia, South‐East Asia, and the Middle East, yet epidemiological data are scarce.
Methods
...We performed a cross‐sectional study of IBD demographics, disease phenotype, and treatment across 38 centers in 15 countries of South Asia, South‐East Asia, and Middle East. Intergroup comparisons included gross national income (GNI) per capita.
Results
Among 10 400 patients, ulcerative colitis (UC) was twice as common as Crohn's disease (CD), with a male predominance (UC 6678, CD 3495, IBD unclassified 227, and 58% male). Peak age of onset was in the third decade, with a low proportion of elderly‐onset IBD (5% age > 60). Familial IBD was rare (5%). The extent of UC was predominantly distal (proctitis/left sided 67%), with most being treated with mesalamine (94%), steroids (54%), or immunomodulators (31%). Ileocolic CD (43%) was the commonest, with low rates of perianal disease (8%) and only 6% smokers. Diagnostic delay for CD was common (median 12 months; interquartile range 5–30). Treatment of CD included mesalamine, steroids, and immunomodulators (61%, 51%, and 56%, respectively), but a fifth received empirical antitubercular therapy. Treatment with biologics was uncommon (4% UC and 13% CD), which increased in countries with higher GNI per capita. Surgery rates were 0.1 (UC) and 2 (CD) per 100 patients per year.
Conclusions
The IBD‐ENC cohort provides insight into IBD in South‐East Asia and the Middle East, but is not yet population based. UC is twice as common as CD, familial disease is uncommon, and rates of surgery are low. Biologic use correlates with per capita GNI.
Background
In COVID-19, the release of pro-inflammatory mediators in the cytokine storm, primarily interleukin-6 (IL-6), has been hypothesized to induce pulmonary intravascular coagulation. However, ...the relationship between IL-6 and coagulopathy remains unclear in COVID-19 progression. We aimed to investigate the correlation of IL-6 with D-dimer, fibrinogen, prothrombin time (PT), and ferritin. Furthermore, we also analyzed the effect of those parameters on the worsening of COVID-19 patients.
Methods
A prospective cohort study was conducted in moderate and severe COVID-19 patients from June 2020 to January 2021. A serial evaluation of IL-6, D-dimer, fibrinogen, ferritin, and PT was performed and correlated with the patient's condition at admission and on the 14th day. The outcomes (improvement, worsening, or discharged patients) were recorded during the study.
Results
Of 374 patients, 73 study subjects (61 severe and 12 moderate COVID-19) were included in this study. A total of 35 out of 61 severe and one out of 12 moderate illness subjects had experienced worsening. Spearman-rank correlation of IL-6 with with ferritin, D-dimer, fibrinogen, and PT was 0.08 (
p=0.5), −0.13 (
p=0.27), 0.01 (
p=0.91), and 0.03 (
p=0.77), respectively. In ROC analysis, D-dimer (74,77%) and IL-6 (71,32%) were the highest among other variables (>60%).
Conclusions
In COVID-19 patients, there was a correlation between elevated IL-6 and D-dimer levels with disease deterioration. There was no correlation between elevated IL-6 levels with ferritin, D-dimer, fibrinogen, and PT levels. Therefore, changes in IL-6 and D-dimer can predict worsening in moderate and severe COVID-19 patients.
Background The rapid increase in the incidence of colorectal cancer (CRC) in the Asia-Pacific region in the past decade has resulted in recommendations to implement mass CRC screening programs. ...However, the knowledge of screening and population screening behaviors between countries is largely lacking. Objective This multicenter, international study investigated the association of screening test participation with knowledge of, attitudes toward, and barriers to CRC and screening tests in different cultural and sociopolitical contexts. Methods Person-to-person interviews by using a standardized survey instrument were conducted with subjects from 14 Asia-Pacific countries/regions to assess the prevailing screening participation rates, knowledge of and attitudes toward and barriers to CRC and screening tests, intent to participate, and cues to action. Independent predictors of the primary endpoint, screening participation was determined from subanalyses performed for high-, medium-, and low-participation countries. Results A total of 7915 subjects (49% male, 37.8% aged 50 years and older) were recruited. Of the respondents aged 50 years and older, 809 (27%) had undergone previous CRC testing; the Philippines (69%), Australia (48%), and Japan (38%) had the highest participation rates, whereas India (1.5%), Malaysia (3%), Indonesia (3%), Pakistan (7.5%), and Brunei (13.7%) had the lowest rates. Physician recommendation and knowledge of screening tests were significant predictors of CRC test uptake. In countries with low-test participation, lower perceived access barriers and higher perceived severity were independent predictors of participation. Respondents from low-participation countries had the least knowledge of symptoms, risk factors, and tests and reported the lowest physician recommendation rates. “Intent to undergo screening” and “perceived need for screening” was positively correlated in most countries; however, this was offset by financial and access barriers. Limitations Ethnic heterogeneity may exist in each country that was not addressed. In addition, the participation tests and physician recommendation recalls were self-reported. Conclusions In the Asia-Pacific region, considerable differences were evident in the participation of CRC tests, physician recommendations, and knowledge of, attitudes toward, and barriers to CRC screening. Physician recommendation was the uniform predictor of screening behavior in all countries. Before implementing mass screening programs, improving awareness of CRC and promoting the physicians' role are necessary to increase the screening participation rates.
Background and Objectives: Annona muricata leaf infusion has traditionally been consumed to maintain health, but is now considered for use in treating cancer patients. The objective of this study was ...to elucidate the effects of 'A. muricata' leaf extract in humans and human cell lines.
Methods and Study Design: Thirty outpatients with colorectal cancer who had undergone primary tumor resection were enrolled in a randomized double-blind placebo- controlled pre-post-trial. They were divided into two groups: those who ingested 'A. muricata' leaf extract (n=14) and those who ingested a placebo (n=14) daily for 8 weeks. Twenty-eight subjects completed the trial; they were equally distributed between the two groups. Serum from patients of both groups was compared for cytotoxicity against colorectal cancer cell lines. The nutritional status of patients was monitored throughout the study.
Results: Ex vivo and clinical studies showed higher cytotoxicity in the supplemented group compared with the placebo group. Further research is required to investigate the long-term effect of 'A.muricata' leaf extract, particularly on parameters directly related to cytotoxic activity toward colorectal cancer cells and nutrition status.
Abstract
Introduction
Expert opinions presented in legal proceedings should be scientifically accountable, which is known as evidence-based practice (EBP). Although forensic medical expert opinions ...are essential in legal proceedings, the methods used to formulate them are not always evidence based or based on standard methods. In forensic medicine, EBP has not been explicitly applied, including in Indonesia. One potential approach to formulate evidence-based expert opinions is called INtegration of Forensic Epidemiology and the Rigorous EvaluatioN of Causation Elements (INFERENCE). In addition, there is also no universal guideline for making forensic pathological reports. One prospective guideline is named the Principles of Evidence-based Reporting in FORensic Medicine-Pathology version (PERFORM-P).
Methods
This article describes the validation process of INFERENCE and PERFORM-P in Indonesia. This study uses a mixed method through three interrelated phases, i.e., (1) a cross-sectional survey to determine the characteristics of Indonesian forensic doctors and their current practice, (2) the adaptation and validation process of the two tools through a review by the Indonesian College of Forensic Medicine, and (3) a one-group pre–postintervention study to assess the validity and reliability of forensic medical expert opinions formulated using Indonesian-INFERENCE (i-INFERENCE) and reported using Indonesian-PERFORM-P (i-PERFORM-P).
Results and Discussion
In general, both tools received a positive reception and can potentially be used in the Indonesian setting with some additions/clarifications in the user manuals. Participants envision that both tools will be most useful in complex cases.
Conclusions
By obtaining the i-INFERENCE and the i-PERFORM-P, it is hoped that Indonesian forensic medical doctors are better equipped in analyzing and reporting complex cases, and the implementation of EBP can be improved.
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