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Background: liver cirrhosis is a global health problem. The mortality rate due to cirrhosis was estimated to achieve 1 million per year worldwide. The aim of this study is to elaborate the characteristics of patients with liver cirrhosis and factors affecting mortality during hospitalization in Fatmawati General Hospital. Method: The design of this study was retrospective cohort involving patients admitted to the hospital between January and March 2019. Results: Among 41 liver cirrhosis patients, it was found that the average age was 52.9 ±13.8 years old and the percentage of male patients among participants was 75.6%. Patients who died during hospitalization was 12.2%. The average length of stay in hospital was 10.8±6.4 days. Patients were admitted to the hospital with various complaints; the most common complaint was gastrointestinal bleeding in 46.3%, decreased consciousness in 22% and massive ascites in 17.1% patients. Physical examination findings of anaemic conjunctiva, icteric sclera, and shifting dullness were found in 73.2%; 29.3% and 61% patients, respectively. Icteric condition during hospital admission has higher mortality risk with RR 9.6 (95% CI: 1.2-77.8). Approximately 53.7% cirrhosis patients were diagnosed with hepatitis B, while 22% of them were diagnosed with hepatitis C. Coinfection of hepatitis B and C were found in 4.8% patients, while 29% patients were neither infected with hepatitis B nor C. Based on the laboratory examination, creatinine level 1.3 mg/dL had higher mortality risk with RR 8.3 (95% CI: 1.04-66.7), while natrium level ≤ 125 mmol/L had higher mortality risk with RR 26.4 (95% CI: 3.6-191). Based on Child-Pugh classification, 24.4% patients had Child-Pugh A, while 14.6% had Child Pugh C, and 39% patients could not be classified. The mean Child-Pugh score in this study was 8 ± 2.2. Through the bivariate analysis, we found the association between Child-Pugh classification and mortality; higher classification has higher mortality risk (p = 0.028). Child-Pugh C had mortality risk with RR = 9.5 (95% CI: 1.2-75.1). Conclusion: Liver cirrhosis patients were hospitalized due to the ongoing decompensation. The mortality rate during hospitalization in liver cirrhosis patients was high. Mortality in these patients was associated with icteric condition upon admission, high initial creatinine level, low sodium level, and high Child-Pugh classification.

Mortality rate among maintenance hemodialysis (HD) patients with COVID-19 is alarmingly high. In Fatmawati General Hospital, most of HD patients with COVID-19 presented with acute respiratory distress syndrome (ARDS). Hemoperfusion (HP) is a blood purification therapy used to remove cytokines and inflammatory mediators to prevent ARDS worsening and organ failure. We report 6 cases of COVID-19 in maintenance HD patients. HP and HD were performed in two consecutive days when patient developed early ARDS as indicated by inflammatory markers elevation. HP and HD were conducted by using resin-containing cartridge and high-flux dialyzer, respectively, for 4 hours. Improvements in CRP levels, PaO2/FiO2 ratios, and chest X-rays were observed after 2 sessions of HP in most of our patients. Based on our clinical experience, the timing of HP delivery is critical and should be undertaken in the early phase of ARDS, but larger studies are still needed.

Background: COVID-19, caused by SARS-CoV-2 virus, is a novel disease that has not been previously identified. The disease may result in multiple organ impairment leading to death. Liver is also affected by this viral infection. This study aimed to investigate the association of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with mortality rate in these patients. Method: This is a retrospective cohort study of COVID-19 patients admitted in Fatmawati General Hospital during a period of March-April, 2020. Diagnosis of COVID-19 was established from real time Polymerase chain reaction (RT PCR). Association of AST and ALT levels with mortality was analyzed by using SPSS® version 16.0. Results: Forty-two patients were diagnosed as confirmed case of COVID-19, 52.3% of them were male. Mean age was 54.6±12 years. Median (IQR) value of AST and ALT levels were 55(48) U/L and 39(40) U/L, respectively. AST and ALT was elevated in 71.4% and 42.9%, respectively. Increased levels of AST and ALT 2 times above the upper normal limit (UNL), 2 times ULN, and 5 times ULN were found in 33.3% and 21.4%; 38.1% and 21.4%; 4.8% and 4.8%, respectively. Mortality was recorded in 45.1% of these confirmed cases, 50% occurred within 2 days of hospitalization. Higher mean value of AST is associated with an increased mortality risk (101 ± 147 U/L vs. 82.78 ± 173 U/L; p 0.032). Sub-analysis identified that abnormal AST 2 times above UNL has a higher mortality proportion compared with AST 2 times UNL and normal AST levels (62.5% vs. 50% vs. 16.7%; p 0.05). Mean value of ALT is not associated with mortality (p 0.479). Further sub-analysis found that in patients who succumbed to the disease, abnormal levels of AST and ALT is related to the time of death during hospitalization despite being statistically not significant. Conclusion: Mortality rate of COVID-19 in hospitalized patients remains high. Increased AST levels was significantly associated with higher mortality rate. This finding merit further investigation by incorporating larger sample size to discern the role of these factors’ contribution to mortality in COVID-19.

Background: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute liver decompensation with extrahepatic organ failure in patients with pre-existing liver disease causing high short-term mortality. A good knowledge about characteristics and diagnostic of ACLF will help us to give proper treatment. The aim of this study is to know the profile and characteristics of ACLF patient Method: Retrospective study was conducted to find patient with ACLF between January 2017-January 2018 at Fatmawati General Hospital. Results: Ten patients were diagnosed with ACLF. Six patients admitted with a chief complaint: unconscious, 2 of them had hematemesis in the course-of-treatment. Three patients were admitted with abdominal pain, and 1 patient with hematemesis-melena. Seven patients had Hepatitis-B infection. Aspartate-transaminase to platelet-ratio index (APRI) values varied (median 8.1;minimum 2.81-maximum 34.67). Hepatic encephalopathy, ascites, and acute renal failure were found in 90% of patients. Jaundice can be found in all patients, with mean values of bilirubin levels in patients undergoing test for bilirubin level were 18.56 mg/dL (9/10). Coagulation disorders were found in 60% of patients undergoing haemostasis test. Four patients were diagnosed with grade 3 ACLF. All ACLF patients eventually died during treatment, including third-degree patients who all died within 7 days. Only 2 patients survived more than 7 days, and 4 patients died within 3 days of treatment. Conclusion: mortality rates of ACLF were very high, and are often found in patients with advanced liver disease characterized by high APRI values. The prognosis is related to the number of organ failures. Central nervous system, kidneys and liver are the organs that are often impaired. Because the current treatment method is still limited, further research is needed, especially on biomarkers for better prevention, diagnosis and treatment.

Coronavirus disease 2019 (COVID-19) is a new infectious disease that spreads very rapidly and therefore, WHO has declared it as a global pandemic disease. The main clinical symptoms found in COVID-19 patients are cough and fever; however, in some cases, diarrhea can be one of the early symptoms. The present case report describes a patient who came with a complaint of diarrhea without fever and she was later confirmed to be positive for COVID-19 during hospitalization. The presence of unspecified initial symptoms calls for greater vigilance from health workers in establishing diagnosis patients with COVID-19.

Background: 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.