A Study of Creatinine Level among Patients with Dyslipidemia and Type 2 Diabetes Mellitus using Multilayer Perceptron and Multiple Linear Regression.

BACKGROUND AND OBJECTIVE: Dyslipidemia is one of the most important risk factors for coronary heart disease with diabetes mellitus. Diabetic dyslipidemia is correlated with reduced concentrations of high-density lipoprotein cholesterol, elevated concentrations of plasma triglycerides, and increased concentrations of dense small particles of low-density lipoprotein cholesterol. Furthermore, dyslipidemia is one of the factors that accelerate renal failure in patients with nephropathy that is observed to be higher in these patients. This paper aims to propose the variable selection using the multilayer perceptron (MLP) neural network methodology before performing the multiple linear regression (MLR) modeling. Dataset consists of patient with Dyslipidemia, and Type 2 Diabetes Mellitus was selected to illustrate the design-build methodology. According to clinical expert's opinion and based on their assessment, these variables were chosen, which comprises the level of creatinine, urea, total cholesterol, uric acid, sodium, and HbA1c. MATERIALS AND METHODS: At the first stage, all the selected variables will be a screen for their clinical important point of view, and it was found that creatinine has a significant relationship to the level of urea reading, a total of cholesterol reading, and the level of uric acid reading. By considering the level of significance, α = 0.05, these three variables are being selected and used for the input of the MLP model. Then, the MLR is being applied according to the best variable obtained through MLP process. RESULTS: Through the testing/out-sample mean squared error (MSE), the performance of MLP was assessed. MSE is an indication of the distance from the actual findings from our estimates. The smallest MSE of the MLP shows the best variable selection combination in the model. CONCLUSION: In this research paper, we also provide the R syntax for MLP better illustration. The key factors associated with creatinine were urea, total cholesterol, and uric acid in patients with dyslipidemia and type 2 diabetes mellitus.

Diagnostic value of a group of biochemical markers of liver fibrosis in patients with non-alcoholic steatohepatitis.

OBJECTIVE: The objectives of this study were to investigate the use of non-invasive biochemical markers to evaluate the severity of liver fibrosis in patients with non-alcoholic steatohepatitis (NASH). METHODS: This was a cross-sectional study of patients with histopathologically confirmed NASH between January 2005 and December 2006. The patients' characteristics were recorded and the body mass index was calculated for each patient. All patients underwent ultrasound-guided liver biopsy and a fibrosis assessment was performed using the Brunt criteria. The non-invasive laboratory markers measured were insulin resistance, tumor necrosis factor (TNF-alpha), type IV collagen and hyaluronic acid (HA). RESULTS: Thirty patients were recruited, of whom 18 (60%) were men. Their mean age was 45 +/- 13.9 (18-71) years. About 83% of patients had fibrosis stage 1-2. In bivariate analysis, age, TNF-alpha and type IV collagen concentrations showed a weak but significant correlation with the fibrosis stage. When the patients were grouped into mild fibrosis (stages 1-2) and advanced fibrosis (stages 3-4), the mean concentrations of HA and type IV collagen were significantly higher in those with advanced fibrosis than those with mild fibrosis (180.8 +/- 49.63 vs 543.6 +/- 360.45 ng/mL; for HA; P = 0.026 and 125.3 +/- 32.11 vs 288.0 +/- 171.22 ng/mL for type IV collagen; P = 0.010). CONCLUSION: Our study showed that the degree of liver fibrosis was significantly correlated with age, TNF-alpha and type IV collagen concentrations. The level of HA and type IV collagen could differentiate between mild (F1-2) and advanced fibrosis (F3-4).

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.

Incidence of helicobacter pylori infection and gastric cancer : an 8-year hospital based study.

AIM: To observe the tendency of decreased prevalence of H pylori infection in a 14 year-period and observe the prevalence of intestinal metaplasia and gastric cancer. METHODS: All patients who were diagnosed with dyspepsia and underwent esophagogastroduodenoscopy in Cikini hospital Jakarta from January 1998 until December 2005 were evaluated. We evaluated the histopathologic result of H pylori, the presence of intestinal metaplasia and gastric cancer. Data was grouped for 1 year period of time and was presented descriptively. RESULTS: Decreased prevalence of H. Pylori infection was found, from 12.8% in 1998, 12.4% in 1999, 14.7% in 2000, 9.6% in 2001, 11.9 % in 2002, 3.8% in 2003, 2.3% in 2004, 2.9% in 2005. Intestinal metaplasia was 4.7% in 1998, 3.2% in 1999, 3.1% in 2000, 2.3 % in 2001, 7.6% in 2002, 8.3% in year 2003, 6.5% in 2004, 7.1% in 2005. Prevalence of gastric cancer was 2.2% in 1998, 0.25% in 1999, 1.1% in 2000, 1.1% in 2001, 1.1% in 2002, 1.8% in 2003, 1.7% in 2004, 3.9% in 2005. CONCLUSION: There was decreased prevalence of H pylori infection in 8 year-period but there was no decreased prevalence of intestinal metaplasia and gastric cancer found.

Hepatocarcinogenesis in viral Hepatitis B infection: the role of HBx and p53.

Infection of Hepatitis B Virus (HBV) is a risk factor of chronic active hepatitis (CAH), hepatic cirrhosis and hepatocellular carcinoma (HCC). Infection of HBV may develop to HCC without antecedent hepatic cirrhosis. Pathogenesis of HBV causing malignant changes has not been fully understood. HBx, a protein of HBV, is an activator of transcription process involved in hepatocarcinogenesis. Most of human cancer associated with mutation of p53, a Tumor Suppressor Genes, a protein serves as cellular protection for growth and cell division, which is one of predisposition factor of hepatocarcinoma. Some studies indicate the correlation between mutation / inactivation of p53 and HBV protein x (HBx) in hepatocarcinogenesis. In that process, HBx will suppress p53 function, which will lead to ineffective liver cell division and resulting in HCC.