Dante Saksono Harbuwono

The Association of Lipoprotein Changes and the Development of Plasma Leakage in Dengue Infection

There’s interrelationship between infection and lipoprotein. This is a cohort prospective study which conducted November 2010 – February 2011. This study aimed to assess the changes of HDL-C, LDL-C, total cholesterol (TC), triglyceride (TG), in acute and critical phase of dengue infection and its association with plasma leakage. Subjects who had fever 48 hours or less and Dengue NS1 antigen test positive were admitted to Cipto Mangunkusumo Hospital Jakarta. We examined clinical and CBC daily; level of albumin, HDL-C, LDL-C, TC, TG; ultrasound to find ascites and pleural effusion. Among 51 subjects, 21 subjects (41%) had plasma leakage. There were significant lower of HDL-C, LDL-C, and higher TG in critical phase than acute phase. In critical phase, subjects with plasma leakage had a significant lower HDL-C level [26.3 (8.2) vs 33.1 (12.1) mg/dL, p=0.029] but not for LDL-C, TC, and TG. They also had a significantly higher reduction in HDL-C [19.6 (9.1) vs 11.5 (5.8) mg/dL, p<0.0001] and TC [25.1 (20.0) vs 15.2 (14.5) mg/dL, 0.045] over the course of acute to critical phase. Lipoprotein changes during dengue infection were more pronounced among subjects who developed plasma leakage. The higher reduction in HDL-C is associated with the development of plasma leakage. Normal 0 false false false IN X-NONE X-NONE

The Difference of Gastric pH in Dyspepsia Patients With or Without Type 2 Diabetes Mellitus

Background: Dyspepsia syndrome often experienced by patients with diabetes mellitus (DM). Gastric acid is one of the aggressive factors of syndrome dyspepsia and peptic ulcers. This study aims to find the difference of gastric pH in dyspepsia patients with DM and without DM, and also to determine whether there is any correlation between gastric pH with proteinuria and hemoglobin A1c (HbA1c). Method: Two groups of patients consisted of 30 patients with DM and 30 patients without DM. Basal gastric pH of each group counted. Basal gastric pH was measured by inserting electrode catheter into the stomach for 30 minutes and then recorded on PH Metri brand Digitrapper pH-Z. Complication of DM was measured by microalbuminuria, while blood sugar control was measured by HbA1c. Chi-square test was done to look for difference of gastric pH between the diabetic patients group and non-diabetic patients group, by first determining the point of intersection with receiver operating characteristic (ROC) analysis. Correlation test between basal gastric pH with microalbuminuria and HbA1c were done. Result s : Basal gastric pH in dyspepsia patients with DM vs. dyspepsia patients without DM was 2.30 ± 0.83 vs. 2.19 ± 0.52. With the Chi-square test, there is a significant difference between the diabetic patients group and non-diabetic patients group. With the correlation test between gastric pH and microalbuminuria was found r = 0.47 and p 0.05. Conclusion: There is a significant difference between basal gastric pH in diabetic dyspepsia patients and non-diabetic dyspepsia patients. There is a correlation between basal gastric pH and microalbuminuria, whereas there is no correlation between basal gastric pH and HbA1c.

GW24-e3161 Non alcoholic fatty liver disease in a high risk cardiovascular disease : a case report

Objectives Non alcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymesin developed countries. This condition is characterised by insulin resistance,hepatic steatosis, and frequently diabetes mellitus type 2. The dyslipidemia in NAFLD characterised by increased in very-low-density lipoprotein (VLDL), triglycerides (TG), and low high-density lipoprotein cholesterol (HDL-C). Methods We report a clinical case of a 67-year-oldman with type 2 diabetes mellitus and dyslipidemia for 2 years. His weight was 74.2 kg with BMI 26.21 kg/m2. He was asymptomatic and undergo abdominal ultrasound 6 month ago for suspect of urolithiasis and his liver ultrasound showed a fatty infiltration, he was then referred to hepatologist regarding his condition. The initial investigations include laboratory data that showed total bilirubin of 0.6 mg/dL, IU/L alkaline phosphates of 97 mg/dL, albumin 4.6 mg/dL, fasting value for glucose of 270 mg/dL, A1c 6.1%, triglycerides of 157 mg/dL and slight elevation of aminotransferase ALT 47 U/L and AST 52 U/L (ALT and AST ratio: 0.9). Serologic markers for viral hepatitis have been negative. There is no history of alcohol consumption, past liver condition, nor family history of liver disease. There were no pathologic findings at the physical examination. We treat this patient with Metformin 3 x 500 mg, Glicuidone 2 x 60 mg, statin 1 x 10 mg, vitamin E 1 x 1 and followed a restricted diet and practice exercise for 20 weeks. Results Outcome after combination therapy of pharmacology, diet, and exercise was good, and hisliver enzyme was down to AST 25 U/L and ALT 37 U/L. Conclusions A comprehensive and aggressive treatments in both pharmacology and non pharmacology are needed to reduce cardiovascular and metabolic syndrome morbidity from this case, thus improves the quality of life of patients with fatty liver diseases.