Background: Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide and the second leading cause of cancer-related death. The extrahepatic extension is also more common in non-cirrhotic HCC. It most commonly metastases to the regional lymph nodes, bone, and lungs. Metastasis to the small bowel is rare. Further, hematogenous metastasis to the duodenum is incredibly rare. Case: A 67-year-old man was admitted with a recurrence of hematemesis melena, weight loss, weakness, and decreased appetite. There was a history of hepatitis and a family history of liver diseases. Abdominal examination revealed a palpable liver (8 cm below the right costal margin, firm, irregular, and tender). Laboratory studies revealed Hb 5.2 g/dL, SGOT 301.1 u/L, SGPT 244.7 u/L, albumin 2.7 g/dL, HbsAg was reactive with HBV DNA 2.01 x 104 IU/ml. EGD showed that esophageal varices were not visible, the duodenum showed an irregular mass, bleeding on touch, and many blood clots. Abdominal USG revealed hepatomegaly with suspicion of multifocal hepatoma, while a CT scan suggested the appearance of HCC and no local invasion into the small bowel. The result of the fibro scan was severe fibrosis, not cirrhosis. At laparotomy, a hepatic tumor and duodenum were discovered. The histopathological study of the tumor revealed a well-differentiated HCC. The resection of the tumor could not be done. He was given palliative and symptom treatment HCC on non-cirrhotic liver remains an exceptional condition. Conclusion: We report a non-cirrhotic HCC in chronic hepatitis B infection.
Diabetes mellitus (DM) is a chronic disease characterized by increased blood glucose levels and is the fourth leading cause of death worldwide. The majority of diabetes mellitus sufferers worldwide are type 2 DM. The prevalence of DM continues to increase due to multifactorial changes in people's lifestyles and eating patterns. This study aimed to determine the risk factors associated with type 2 DM in outpatients at Sanjiwani Hospital, Gianyar. It was case-control with a consecutive sampling technique. The number of samples was 138 people, and they were analyzed using the Chi-Square test. Data was collected by interview and physical examination. The results of the analysis showed that the variable age > 45 years old with OR 2,438 (p-value = 0,003; 95% CI 1,491–5,923), gender or sex with OR 0,872 (p-value 0,711; 95% CI 0,422- 1,802), family history of DM with OR 4,219 (p-value 0,003; 95% CI 1,443–4,887), obesity with OR 2,278 (p-value 0,017; 95% CI 1,152-4,503), history of hypertension with OR 2,119 (p-value 0,035; 95% CI 1,049 – 4,280), less physical activity with OR 2,412 (p-value 0,014; 95% CI 1,188-4,900) and smoking with OR 0,779 (p-value 0,541; 95% CI 0,349- 1,737). In conclusion, a family history of DM, obesity, hypertension, and lack of physical activity were significant risk factors for the incidence of type 2 diabetes mellitus in Sanjiwani Hospital, Gianyar.
Gastroesophageal reflux disease (GERD) adalah suatu penyakit yang ditandai dengan naiknya asam lambung ke kerongkongan yang menyebabkan keluhan heartburn dan regurgitasi. Prevalensi GERD di seluruh dunia bervariasi sekitar 13%. GERD sering dikaitkan dengan penurunan kualitas tidur yang berakhir dengan penurunan produktivitas di siang hari. Refluks asam lambung di malam hari berkaitan dengan berbagai komplikasi seperti barret’s esofagus dan adenokarsinoma esofagus. Penelitian ini bertujuan untuk mengetahui hubungan antara GERD dan kualitas tidur pasien dengan menggunakan desain studi cross sectional dan dianalisis menggunakan uji Chi Square. Sampel dipilih secara consecutive sampling sebanyak 104 pasien di Rumah Sakit Umum Daerah Sanjiwani Gianyar, Bali, Indonesia dari bulan Mei 2022 hingga Juli 2022. Instrumen penelitian berupa pittsburgh sleep quality indeks (PSQI) dan GERD-questionnaire (GERD-Q). Hasil penelitian menunjukkan p value=0,002 (p< 0.05). Simpulan, GERD memilki hubungan terhadap kualitas tidur pasien rawat jalan di RSUD Sanjiwani Gianyar secara signifikan. Pemberian proton pump inhibitor (PPI) disertai penerapan gaya hidup yang sehat dapat meperbaiki keluhan GERD dengan atau tanpa gangguan tidur.
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