Background: Cholestasis occurs from the accumulation of bile product in the biliary tract due to obstruction of the hepatobiliary tract. Without early interventions, this condition will be continuing as chronic hepatic injury and form hepatic fibrosis, ending in cirrhosis. Glutathione (GSH) and curcumin were known as antioxidants and anti-inflammatory used as a therapeutic agent for the treatment of hepatopathy. This study aims to determine the effectivity of GSH and curcumin in the hepatic fibrosis mechanism induced by cholestasis. Methods: This is an experimental study using Wistar rats. They are divided into three groups of 5 rats each. All the rats regard the choledochus duct ligation surgery, rats without intervention define as first group (control), other rats treated with GSH as the second group and the third group consist of rats treated with curcumin. Data were analyzed using SPSS version 17 for Windows. Results: There was liver injury and hepatic fibrosis induced by cholestasis from this study. This condition was significantly lower in groups treated with GSH and curcumin (p<0.05). Therefore, there was a different result between GSH and curcumin in reducing the process of liver injury and hepatic fibrosis, but the difference was not statistically significant (p>0.05). Conclusion: GSH and curcumin were statistically effective in reducing liver injury and hepatic fibrosis induced by cholestasis. Despite, there were no significant difference results between them in reducing liver injury and hepatic fibrosis.

We report anunderdiagnosed fatal case of melioidosis that involved dygestion system which complicated with pneumonia, and sepsis. The case was initially diagnosed as acute appendicitis, and subsequently the patient underwent an exploratory laparatomy and appendectomy. He was discharged afer 3 days of hospitalization. Thirty days afterward, he was admitted to another private hospital to experience another exploratory laparatomy with indication of pancreatitis, intra-abdominal organs adhesions, and postoperative enterocutaneous fistula (ECF), and hospitalized there for 25 days. He eventually suffered from sepsis, pneumonia, unclosed ECF, anemia, hypoalbuminemia, and electrolyte imbalance. He then referred to a tertiary teaching hospital and hospitalized there for a total 134 days until he passed away. His clinical condition was declining, despite a long course of broad spectrum antibiotics. Treatment delay, prolong hospitalization, and complications were the inevitable, although Burkholderia pseudomallei was finally identified 2 weeks prior to his death. This case highlight that melioidosis canassociate with acute appendicitis, and that the delay on its diagnosis and treatment may trigger complications and death. ABSTRAKKami melaporkan kasus fatal melioidosis yang melibatkan sistem pencernaan dengan komplikasi pneumonia, sepsis, dan berakibat pada kematian. Appendicitis akut adalah diagnosis klinis awal pada kasus melioidosis ini, dan pasien langsung menjalani operasi laparatomi eksplorasi dan appendectomy, kemudian pulang setelah mondok selama 3 hari di sebuah rumah sakit swasta. Tiga puluh hari setelahnya, pasien mondok di rumah sakit swasta lainnya selama 25 hari, dan menjalani operasi laparatomi eksplorasi yang ke dua dengan indikasi pankreatitis, perlengketan organ intra abdomen, dan fistula enterokutan. Kondisi klinis pasien memburuk, dan terjadi sepsis disertai penumonia, luka fistula entero-kutan (FEK) terbuka, anemia, hypoalbuminenia, dan ketidakseimbangan elektrolit. Kemudian pasien dirujuk ke rumah sakit pusat rujukan dan pendidikan dan mondok selama 134 hari sebelum akhirnya meninggal. Kondisi klinis pasien terus memburuk meskipun telah mendapat rangkaian terapi antibiotik berspektrum luas. Keterlambatan terapi, lamanya waktu pemondokan, dan terjadinya komplikasi menjadi tidak terelakkan, meskipun B. pseudomallei dapat diidentifikasi pada 2 minggu sebelum kematian. Kasus ini menekankan pentingnya memahami bahwa presentasi melioidosis secara klinis dapat berhubungan dengan appendicitis akut, dan keterlambatan dalam mendiagnosis dan terapi dapat memicu terjadinya komplikasi dan kematian.

Background: Peritonitis requires emergency surgery, and delays in treatment can lead to death. We aimed to determine the correlation between the periods from onset to hospital admission with postoperative mortality for patients with peritonitis and to compare it with the effect of national health insurance implementation. Methods: This study was a cross-sectional study conducted at a tertiary health center in Indonesia. We ascertained 150 patients with peritonitis from January 2012–December 2015. Results: One hundred and fifty patients were ascertained, including 72 patients before National Health Insurance (NHI) era and 78 patients after the NHI era (Males: 90 vs females: 60). The most frequent age group was age 46–65 years (44.67%). The period between onsets to hospital mainly occurred within 24–72 h (42%). Most of the patients had some comorbidity with one or more diseases (52.67%). Mortality was found in as many as 61 people (40.67%). The highest etiology of peritonitis was appendix perforation (28%) and gastric perforation (22%). Mortality was most common in the period between onset to time treated within 24–72 h (N:35; 23.33%) (P < 0.05). Before the NHI era, the period between onset to time treated was mostly after > 72 h (18.66%), whereas after the NHI era it was mostly within 24–72 h (25.33%) (p < 0.05). Conclusion: The multilevel referral system implemented in the NHI era significantly affects the time-to-treat and outcome of patients with peritonitis. Highlights

Sigmoid vaginoplasty has been popular for neovagina reconstruction in vaginal aplasia. The most common surgical complication was vaginal stenosis caused by inadequate vascularization and tension because of graft length. Therefore, ischemia ensued and disrupted wound healing. The selection of double pedicle artery rotation sigmoid vaginoplasty is expected to reduce this problem. Five patients from April to December 2016 were diagnosed with vaginal aplasia; 4 had history of neovagina stenosis. These patients underwent sigmoid vaginoplasty with double pedicle artery rotation. No complications occurred during or after the procedure. Assessment postsurgery was conducted at 1 year. These results suggest that double pedicle artery rotation sigmoid vaginoplasty is a safe and acceptable technique for management of vaginal aplasia. The procedure decreased tension inside vascular pedicles as a result of maintaining abundant vascularization supply. Consequently, this procedure could avert graft necrosis, leakage, and severe stenosis. All of the patients exhibited regular menstrual cycle and satisfactory sexual activity. The outcomes were excellent with remarkable anatomical and functional results.