Nikko Darnindro
Department of Internal Medicine, Faculty of Medicine, University of Indonesia Dr. Cipto Mangunkusumo General National Hospital, Jakarta

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Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management Darnindro, Nikko; Lesmana, Rinaldi A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Hepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.Keywords: hepatitis A, prolonged cholestasis, steroid therapy
Current Diagnosis and Management of Helicobacter pylori Darnindro, Nikko; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

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Abstract

Helicobacter pylori (H. pylori) is a microbe which cause chronic infection in human. Currently, the prevalence in developed countries continue to decrease, but the same does not happen in developing countries. Orofecal transmission and its connection with environmental condition is assumed to be its cause.Impact of H. pylori infection in gastric mucosa is influenced by the bacteria pathogenesis which is able to survive in acid condition and causes inflammatory reaction. The diagnosis is differentiated through endoscopy or non-endoscopy depends on the alarm symptoms, local prevalence, pre-test probability, availability, cost and aim of examination.Management of H. pylori depends on the high rate of clarithromycin resistence. In area with resistency prevalence below 20% triple therapy can still be used, while in increasing resistency area, use of four times daily therapy or other antibiotics such as levofloxacin and furazolidone can be considered.Keywords: Helicobacter pylori, diagnosis, alternative therapy
Gastric Mucous Atrophy and Metaplasia in Patient with Helicobacter pylori Infection Darnindro, Nikko; Syam, Ari Fahrial; Handjari, Diah Rini; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 1 (2015): VOLUME 16, NUMBER 1, April 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (121.166 KB) | DOI: 10.24871/161201513-16

Abstract

Background: Helicobacter pylori (H. pylori) is one of the most common bacteria found in human and cause chronic infection. Recent study conducted in one of private hospitals in Jakarta shows that there is a trend of declining prevalance of H. pylori from 12.5% in 1998 to 2.9% in 2005. The aim of this study is to obtain` the prevalance of gastric atrophy and metaplasia in patients with H. pylori infection based on histopathology.Method: This was a case control study between June to August 2014 with 69 cases and 71 controls using medical records datas and histopathology results. Control sample was taken consecutively from patient undergone esophagogastroduodenoscopy procedure in 2013.Results: The average age for patient with H. pylori was 51 years slightly higher than patient with negative H. pylori (p > 0.05). Generally, the prevalence rate among males was slightly lower than females (p > 0.05). From Histopathology findings, active chronic gastritis was found in 62.3% patients with positive H. pylori than only 12.7% in patient with negative H. pylori (95% CI = 4.86-26.7; OR = 11.31). Mild and moderate  atrophy was higher among H. pylori positive (p = 0.09). gastric mucous metaplasia was also higher (10% vs. 1.4%) among positive H. pylori patient (p = 0.03).Conclusion: H. pylori infection can cause atrophy and metaplasia in gastric mucosa. Prevalence of gastric metaplasia caused by H. pylori infection is lower in this study compared to the same study abroad.
Prevalensi Ketidakpatuhan Kunjungan Kontrol pada Pasien Hipertensi yang Berobat di Rumah Sakit Rujukan Primer dan Faktor-Faktor yang Memengaruhi Darnindro, Nikko; Sarwono, Johannes
Jurnal Penyakit Dalam Indonesia Vol 4, No 3 (2017)
Publisher : Jurnal Penyakit Dalam Indonesia

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Abstract

Pendahuluan. Berdasarkan WHO, hipertensi berkaitan dengan 7,5 juta kematian diseluruh dunia atau mencapai 12,8% dari total semua kematian. Sedangkan berdasarkan riskesdas 2013 di Indonesia hipertensi masih menjadi masalah kesehatan utama dengan prevalensi mencapai 26,5 %. Ketidakpatuhan merupakan penyebab utama kegagalan pengobatan hipertensi dan  faktor risiko munculnya komorbid kardiovaskular. Belum ditemukan penelitian sebelumnya yang meneliti kepatuhan kontrol pasien di komunitas suburban. Penelitian ini dilakukan untuk menganalisis besarnya prevalensi pasien yang tidak kontrol setelah pengobatan hipertensi.Metode. penelitian ini merupakan studi retrospektif, melalui penelusuran rekam medis pada pasien yang berobat antara bulan Oktober – Desember 2015.Hasil. Dari 80 pasien yang menjadi subyek penelitian, rerata usia pasien 57.5 ± 11 tahun, didominasi oleh pasien wanita (68,8%). Berdasarkan klasifikasi ESC 2013 prevalensi terbesar adalah hipertensi derajat 2 mencapai 40%. Komorbid terbanyak dijumpai adalah diabetes mellitus sebesar 22,5 %. Enam puluh persen pasien mendapatkan 1 jenis obat dan golongan Calcium Channel Blocker merupakan jenis obat yang tersering diberikan. Prevalensi pasien yang tidak kontrol mencapai 63,8 %. Dari analisa bivariate ditemukan hubungan bermakna antara kepatuhan kontrol dengan jumlah obat yang diberikan, makin sedikit obat yang dikonsumsi makin rendah kepatuhan kontrol meskipun dalam analisa multivariate tidak ditemukan kemaknaan.Simpulan. Prevalensi ketidakpatuhan kontrol masih tinggi. Diperlukan penelitian lanjutan untuk mengetahui faktor faktor lain yang menjadi penyebab.Kata Kunci: Faktor berpengaruh, hipertensi, ketidakpatuhan kontrol Prevalence of Noncompliance of Control visits in Hypertensive patients treated at Primary Referral Hospitals and Factors relatedIntroduction. According to WHO, hypertension is associated with 7.5 million deaths worldwide or 12.8% of all deaths. Meanwhile, based on 2013 riskesdas in Indonesia, hypertension is still a major health problem with a prevalence of 26.5%. Noncompliance is a major cause of treatment failure of hypertension and risk factors for cardiovascular comorbidity. No previous research has been found that examines patient control compliance in the suburban community. This study aims to analyse the prevalence of patients who did not control after hypertension treatment in primary referral hospitalsMethods. This study was a retrospective study, by tracking medical records in patients treated between October and December 2015.Results. A total of 80 hypertensive patients participated in the study (55 were females). The mean age was 57.5 ± 11  years, and 22,5% had diabetes mellitus. Mean systolic pressure was 161± 19 mmHg, diastolic pressure was 96 ± 10 mmHg. The majority of the patients had 2nd degree hypertension according to ESC 2013. Sixty percent of patient was given monotherapy and the most frequently prescribed drugs were calcium channel blockers (CCB) (70.0%). The prevalence of loss-to-follow up patient was 63,8%% (51/80). Respondents with mono-therapy, without comorbidities, and admission from emergency department were more often loss-to-follow up than those with combination therapy (OR 10.3; 95%CI 3.5 – 30.1), with comorbidities (OR 4,3; 95%CI 1.6 – 11.4), and admission from outpatient clinic (OR 14.6; 95%CI 4.8 – 44.6). Although the comorbidities variable was not significant in multivariate analysis.Conclusion. The prevalence of noncompliance of control is still high. Further research is needed to determine other factors that cause.
Gastric Mucous Atrophy and Metaplasia in Patient with Helicobacter pylori Infection Darnindro, Nikko; Syam, Ari Fahrial; Handjari, Diah Rini; Makmun, Dadang
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 16, No 1 (2015): VOLUME 16, NUMBER 1, April 2015
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (121.166 KB) | DOI: 10.24871/161201513-16

Abstract

Background: Helicobacter pylori (H. pylori) is one of the most common bacteria found in human and cause chronic infection. Recent study conducted in one of private hospitals in Jakarta shows that there is a trend of declining prevalance of H. pylori from 12.5% in 1998 to 2.9% in 2005. The aim of this study is to obtain` the prevalance of gastric atrophy and metaplasia in patients with H. pylori infection based on histopathology.Method: This was a case control study between June to August 2014 with 69 cases and 71 controls using medical records datas and histopathology results. Control sample was taken consecutively from patient undergone esophagogastroduodenoscopy procedure in 2013.Results: The average age for patient with H. pylori was 51 years slightly higher than patient with negative H. pylori (p > 0.05). Generally, the prevalence rate among males was slightly lower than females (p > 0.05). From Histopathology findings, active chronic gastritis was found in 62.3% patients with positive H. pylori than only 12.7% in patient with negative H. pylori (95% CI = 4.86-26.7; OR = 11.31). Mild and moderate  atrophy was higher among H. pylori positive (p = 0.09). gastric mucous metaplasia was also higher (10% vs. 1.4%) among positive H. pylori patient (p = 0.03).Conclusion: H. pylori infection can cause atrophy and metaplasia in gastric mucosa. Prevalence of gastric metaplasia caused by H. pylori infection is lower in this study compared to the same study abroad.
Current Diagnosis and Management of Helicobacter pylori Darnindro, Nikko; Syam, Ari Fahrial
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 3, December 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/1432013165-173

Abstract

Helicobacter pylori (H. pylori) is a microbe which cause chronic infection in human. Currently, the prevalence in developed countries continue to decrease, but the same does not happen in developing countries. Orofecal transmission and its connection with environmental condition is assumed to be its cause.Impact of H. pylori infection in gastric mucosa is influenced by the bacteria pathogenesis which is able to survive in acid condition and causes inflammatory reaction. The diagnosis is differentiated through endoscopy or non-endoscopy depends on the alarm symptoms, local prevalence, pre-test probability, availability, cost and aim of examination.Management of H. pylori depends on the high rate of clarithromycin resistence. In area with resistency prevalence below 20% triple therapy can still be used, while in increasing resistency area, use of four times daily therapy or other antibiotics such as levofloxacin and furazolidone can be considered.Keywords: Helicobacter pylori, diagnosis, alternative therapy
Prevalence of Gastroesophageal Reflux Disease (GERD) in Dyspepsia Patients in Primary Referral Hospital Darnindro, Nikko; Manurung, Annela; Mulyana, Edi; Harahap, Arnold
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 2 (2018): VOLUME 19, NUMBER 2, August 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (370.419 KB) | DOI: 10.24871/192201891-96

Abstract

ABSTRACTBackground: Gastroesophageal reflux disease (GERD) is caused by reflux of stomach contents into the esophagus and give the typical symptoms as heartburn. The prevalence of GERD was vary around the world. Prevalence of GERD by endoscopy in Jakarta was 22.8%. Limited data exist to determine the prevalence and related factors of gastroesophageal reflux disease (GERD) in the population without alarm symptoms. Validated GERDq questionnaire can be used easily to diagnose GERD in primary health care. This study aims to know the prevalence of GERD and related factors.Method: This cross-sectional study was conducted in adult dyspepsia patients at General Hospital District of Cilincing from January to March 2016. A validated GERDq questionnaire and a single proportion sample size calculation were used. Results: The prevalence of GERD was 49%, in elderly participants the prevalence was 44%. Of the 104 consecutive participants, 33.7% were male and 66.3% were female. The mean age was 47.6 ± 15.4 years old. The rate of GERD was higher in females than in males (53 vs. 40%, p = 0.189), increased as the age of the participants increased (p = 0.059) and also increased as the body mass index (BMI) of the participants increased (p > 0.05). GERD was present in 50% of active or former smokers (p > 0.05), 33.3% of daily coffee drinkers (p > 0.05), 56.2% of active or former alcohol consumers (p > 0.05), and 57.4% of daily tea drinkers (p = 0.049).Conclusion: The prevalence of GERD in dyspeptic patient was still high. There is a relation between GERD and tea consumption.Keywords: gastroesophageal reflux disease (GERD), dyspepsia, GERDq questionnaire
Prevalensi Ketidakpatuhan Kunjungan Kontrol pada Pasien Hipertensi yang Berobat di Rumah Sakit Rujukan Primer dan Faktor-Faktor yang Memengaruhi Darnindro, Nikko; Sarwono, Johannes
Jurnal Penyakit Dalam Indonesia Vol 4, No 3 (2017)
Publisher : Internal Medicine Department, Faculty of Medicine Universitas Indonesia-RSCM

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1455.701 KB) | DOI: 10.7454/jpdi.v4i3.138

Abstract

Pendahuluan. Berdasarkan WHO, hipertensi berkaitan dengan 7,5 juta kematian diseluruh dunia atau mencapai 12,8% dari total semua kematian. Sedangkan berdasarkan riskesdas 2013 di Indonesia hipertensi masih menjadi masalah kesehatan utama dengan prevalensi mencapai 26,5 %. Ketidakpatuhan merupakan penyebab utama kegagalan pengobatan hipertensi dan  faktor risiko munculnya komorbid kardiovaskular. Belum ditemukan penelitian sebelumnya yang meneliti kepatuhan kontrol pasien di komunitas suburban. Penelitian ini dilakukan untuk menganalisis besarnya prevalensi pasien yang tidak kontrol setelah pengobatan hipertensi.Metode. penelitian ini merupakan studi retrospektif, melalui penelusuran rekam medis pada pasien yang berobat antara bulan Oktober – Desember 2015.Hasil. Dari 80 pasien yang menjadi subyek penelitian, rerata usia pasien 57.5 ± 11 tahun, didominasi oleh pasien wanita (68,8%). Berdasarkan klasifikasi ESC 2013 prevalensi terbesar adalah hipertensi derajat 2 mencapai 40%. Komorbid terbanyak dijumpai adalah diabetes mellitus sebesar 22,5 %. Enam puluh persen pasien mendapatkan 1 jenis obat dan golongan Calcium Channel Blocker merupakan jenis obat yang tersering diberikan. Prevalensi pasien yang tidak kontrol mencapai 63,8 %. Dari analisa bivariate ditemukan hubungan bermakna antara kepatuhan kontrol dengan jumlah obat yang diberikan, makin sedikit obat yang dikonsumsi makin rendah kepatuhan kontrol meskipun dalam analisa multivariate tidak ditemukan kemaknaan.Simpulan. Prevalensi ketidakpatuhan kontrol masih tinggi. Diperlukan penelitian lanjutan untuk mengetahui faktor faktor lain yang menjadi penyebab.Kata Kunci: Faktor berpengaruh, hipertensi, ketidakpatuhan kontrol Prevalence of Noncompliance of Control visits in Hypertensive patients treated at Primary Referral Hospitals and Factors relatedIntroduction. According to WHO, hypertension is associated with 7.5 million deaths worldwide or 12.8% of all deaths. Meanwhile, based on 2013 riskesdas in Indonesia, hypertension is still a major health problem with a prevalence of 26.5%. Noncompliance is a major cause of treatment failure of hypertension and risk factors for cardiovascular comorbidity. No previous research has been found that examines patient control compliance in the suburban community. This study aims to analyse the prevalence of patients who did not control after hypertension treatment in primary referral hospitalsMethods. This study was a retrospective study, by tracking medical records in patients treated between October and December 2015.Results. A total of 80 hypertensive patients participated in the study (55 were females). The mean age was 57.5 ± 11  years, and 22,5% had diabetes mellitus. Mean systolic pressure was 161± 19 mmHg, diastolic pressure was 96 ± 10 mmHg. The majority of the patients had 2nd degree hypertension according to ESC 2013. Sixty percent of patient was given monotherapy and the most frequently prescribed drugs were calcium channel blockers (CCB) (70.0%). The prevalence of loss-to-follow up patient was 63,8%% (51/80). Respondents with mono-therapy, without comorbidities, and admission from emergency department were more often loss-to-follow up than those with combination therapy (OR 10.3; 95%CI 3.5 – 30.1), with comorbidities (OR 4,3; 95%CI 1.6 – 11.4), and admission from outpatient clinic (OR 14.6; 95%CI 4.8 – 44.6). Although the comorbidities variable was not significant in multivariate analysis.Conclusion. The prevalence of noncompliance of control is still high. Further research is needed to determine other factors that cause.
Prevalence of Gastroesophageal Reflux Disease (GERD) in Dyspepsia Patients in Primary Referral Hospital Darnindro, Nikko; Manurung, Annela; Mulyana, Edi; Harahap, Arnold
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 19, No 2 (2018): VOLUME 19, NUMBER 2, August 2018
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (370.419 KB) | DOI: 10.24871/192201891-96

Abstract

ABSTRACTBackground: Gastroesophageal reflux disease (GERD) is caused by reflux of stomach contents into the esophagus and give the typical symptoms as heartburn. The prevalence of GERD was vary around the world. Prevalence of GERD by endoscopy in Jakarta was 22.8%. Limited data exist to determine the prevalence and related factors of gastroesophageal reflux disease (GERD) in the population without alarm symptoms. Validated GERDq questionnaire can be used easily to diagnose GERD in primary health care. This study aims to know the prevalence of GERD and related factors.Method: This cross-sectional study was conducted in adult dyspepsia patients at General Hospital District of Cilincing from January to March 2016. A validated GERDq questionnaire and a single proportion sample size calculation were used. Results: The prevalence of GERD was 49%, in elderly participants the prevalence was 44%. Of the 104 consecutive participants, 33.7% were male and 66.3% were female. The mean age was 47.6 ± 15.4 years old. The rate of GERD was higher in females than in males (53 vs. 40%, p = 0.189), increased as the age of the participants increased (p = 0.059) and also increased as the body mass index (BMI) of the participants increased (p > 0.05). GERD was present in 50% of active or former smokers (p > 0.05), 33.3% of daily coffee drinkers (p > 0.05), 56.2% of active or former alcohol consumers (p > 0.05), and 57.4% of daily tea drinkers (p = 0.049).Conclusion: The prevalence of GERD in dyspeptic patient was still high. There is a relation between GERD and tea consumption.Keywords: gastroesophageal reflux disease (GERD), dyspepsia, GERDq questionnaire
Prolonged Cholestatic as a Typical Manifestation of Hepatitis A Infection: Diagnosis and Management Darnindro, Nikko; Lesmana, Rinaldi A
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 14, NUMBER 2, August 2013
Publisher : The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (0.036 KB) | DOI: 10.24871/1422013120-125

Abstract

Hepatitis A virus (HAV), a positive-strand RNA virus, is stable at moderate temperature and low pH level. These characteristics allow the virus to survive in the environment and be transmitted through fecal-oral route.Twenty-year-old male came with jaundice and itchy skin since one month before admission. He was diagnosed as hepatitis A cholestasis type according to his history taking, physical examination, and laboratory result. Blood test showed elevated total bilirubin 27.4 g/dL, direct bilirubin 21.2 g/dL, indirect bilirubin 6.2 g/dL, alanin aminotransferase (ALT) 95 U/L, aspartate transaminase (AST) 134 U/L, alkaline phosphatase (ALP) 221 U/L, and gamma-glutamyltransferase (gGT) 17 U/L. His ultrasound results showed mild, non-specific hepatomegaly without common bile duct dilatation. The patient got symptomatic therapy with ursodeoxycholic acid (UDCA) 300 mg twice daily for his itchy skin and steroid therapy 0.5-1 mg/kg per day on the tenth day. He did not vomit or feel nausea anymore. After five days of steroid therapy, his total bilirubin level became 10.83 g/dL. He was discharged home with steroid therapy and steroid was tapered off during follow-up in the clinic.Prolonged cholestasis is one of atypical manifestation of hepatitis A which is rarely found. Cholestasis increases morbidity and prolongs hospitalization. Steroid therapy decreased bilirubin level and gave clinicalimprovement to the patient.Keywords: hepatitis A, prolonged cholestasis, steroid therapy