Clinical Picture, Insulin Resistance, and Adipocytokines Profiles of Nonalcoholic Steatohepatitis (NASH) Patients in Indonesia.

Aim: to know the clinical picture of subjects with NASH in Jakarta, Indonesia and the prevalence of insulin resistance, TNF-a, and adiponectin levels among them. Methods: this was a comparative cross-sectional study between patients with histopathologically confirmed NASH and normal subjects. The population of study was patients with fatty liver without history or significant consumption of ethanol. Patients were consecutively enrolled in the study if the ultrasonography showed fatty liver appearance with or without increased liver transaminases. Results: thirty patients and thirty normal subjects were recruited between February 2005 and January 2006. Median age of the patients was 45 years while the median age of the control group was 32 years. More than 80% of the patients were overweight (BMI 23-25 kg/m2) and obese (BMI > 25 kg/m2). Increased alanine aminotransaminase levels were found in almost two thirds of the patients. Other comorbidities included hypertension, hypertriglyceridemia, and type-2 diabetes mellitus. In patients with NASH, fasting insulin level, insulin resistance, and TNF-a level were significantly higher, whereas adiponectin level was significantly lower than the control group. Conclusion: most of the metabolic syndrome determinants were found in patients with NASH. HOMA-IR and TNF-alpha levels in subjects with NASH are higher than those in controls. Adiponectin levels in subjects with NASH are lower than those in controls. Further epidemiological studies are still needed to elaborate the causal relationship of insulin resistance and cytokine profiles to the development of NASH in Indonesia.

Microorganisms and parasites in chronic infective diarrhea.

AIM: To reveal the pattern of microorganisms in chronic infective diarrhea cases. METHODS: We examined all patients suffering from chronic infective diarrhea over a six year period The patients were examined physically and at the same time laboratory tests,colon enema X-ray and colonoscopy, ileoscopy, upper GI endoscopy and small bowel X-ray were performed. RESULTS: We found 138 (66. 7%) chronic infective diarrhea from 207 chronic diarrhea patients. Parasitic causes were Candida albicans (48.55%), Blastocystis hominis (6.52%), Entamoeba histolytica (3.62%), and Giardia lamblia (3.62%) etc. Bacterial causes were Pathogenic E. coli(34.78%), Aerobacter aerogenes (3.62%), Mycobacterium tuberculosis (3.62%), Geotrichum (1.45%), Shigella sonnei(0. 72%), Salmonella paratyphi (2.89%)etc. CONCLUSION: The most frequent microorganisms and parasites found in chronic infective diarrhea were pathogenic E.coli and Candida albicans.

Combination of interferon alfa-2b and ribavirin in relapsed or nonresponding chronic hepatitis C patients following interferon therapy.

Twenty six patients (pts) with chronic hepatitis C (CHC) who reLapsed or non-responded following.interferon (IFN) therapy were given lFN alfa-2b 3 MIU three times a week for 48 weeks in combination with Ribavirin 800-1000 mg daily 2I (80,8%) of the 26.pts completed the study consisted of 12 relapsers and 9 non-responders. Five pts dropped out due to drug adverse events in three pts and non-drug related reason in the other two. In the relapsed group complete response, relapse and sustained response rates were obtained in 9/12(75%), 2/2 (16,5%) and 7/12(58,3%) pts respectively. In the non- responding group, these figures were 3/9 (33,3%), 1/9(I1,1%), and 2/9(22,2%) pts, respectively. The most frequent adverse event was flu-like syndrome, which was found in 18 pts (85,7%). Combination therapy of IFN alfa-2b and ribavirin may induce sustained virological response in relapsed and non-responding CHC patients. This combination therapy is more effective for relapsers compared to for non-responders.