Background: Hepatic encephalopathy (HE) is a serious complication in patients with liver cirrhosis. Its pathogenesis involved the mechanism of HE including endotoxins, ammonia production and other neurotoxins by gut microflora. Probiotic exert potential benefit for gastrointestinal microflora. The use of probiotics may provide substantial benefit for the treatment of HE. Objective: This report aimed to evaluate the benefit of probiotics in preventing HE among liver cirrhosis patients. Methods: Literature searching with keywords of ‘liver cirrhosis’, ‘probiotics’, ‘hepatic encephalopathy’ along with its synonyms and related terms was implemented in Pubmed. Additional hand-search was implemented to obtain the relevant articles Result: Three meta-analyses showed that probiotics are effective to prevent HE development. All meta-analyses obtained similar results, in which the odds ratio (OR) obtained was ranging from 0.22 to 0.42. One randomized controlled trial (RCT) by Dhiman et al showed that probiotics treatment reduces the relative risk of overt HE by 33% compared to placebo. Conclusion: Probiotics administration exert potential to prevent the development of HE in the liver cirrhotic patients. The patient may benefit with the given of probiotics.

Non-selective beta-blockers (NSBBs) are one of the recommended treatments for portal hypertension in liver cirrhosis (LC). NSBB plays the role of primary as well as secondary prophylactic upper gastrointestinal bleeding in LC. NSBB therapy has been shown to effectively reduce the risk of variceal bleeding, reduction of portal pressure, and treat other complications of portal hypertension. The safety of NSBB therapy in cirrhosis requires a good therapeutic guide and considers the side effects. The indication of NSBB administration is adjusted according to the cirrhosis stage and the specific pathophysiology that occurs in cirrhosis. Conventional NSBBs such as propranolol and nadolol which are antagonists of β1 and β2 adrenergic receptors would induce decreased cardiac output and splanchnic vasoconstriction. Carvedilol is an NSBB with the addition of α1-adrenergic activity in reducing portal pressure stronger than conventional NSBB, so carvedilol can cause greater systemic arterial pressure reduction when compared to conventional NSBB. The appropriate treatment strategies can be applied in the use of NSBB to prevent more severe complications and reduce morbidity and mortality.

Introduction. Acute Coronary Syndrome (ACS) is a cardiovascular disease that has a high mortality rate. One of the markers which play a role in the pathophysiology of ACS is Immunoglobulin E (Ig E), one of the antibodies released by B lymphocytes as the result of complex interactions that can activate mast cells. Mast cells will activate Metalloproteinase-9 (MMP-9) then facilitate pathogenesis of acute myocardial infarction or acute coronary syndrome phase. This study aimed to determine the relationship between increasing levels of IgE and MMP-9 in ACS patients at Sanglah Hospital, Denpasar, Bali.Method. This was a cross-sectional analytic study, and the samples were collected from ACS patients at Sanglah Hospital, Denpasar, Bali, using a consecutive sampling method. A total of 73 samples were included in this study, then statistical tests and Pearson correlation test was conducted.Results. Seventy-three samples included in this study contain 59 men (80.8%) and 14 women (19.2%). The IgE level is between 0.5-1000 and MMP-9 levels between 6.91-29.56. There is a statistically significant correlation between IgE levels and MMP-9 levels in Acute Coronary Syndrome patients (p = 0.018: r = 0.277).Conclusion. We found a significant association between increased IgE and MMP-9 in patients with Acute Coronary Syndrome at RSUP Sanglah, Denpasar, Bali. Pendahuluan. Sindrom Koroner Akut (SKA) merupakan penyakit kardiovaskular dengan angka kematian yang sangat tinggi. Salah satu marker yang berperan dalam patofisiologi SKA adalah Immunoglobulin E (IgE). IgE merupakan salah satu antibodi yang dilepaskan oleh limfosit B sebagai interaksi kompleks yang dapat mengaktivasi sel mast. Sel mast yang sudah aktif akan mengaktivasi Metallopriteinase-9 (MMP-9) yang ikut berperan dalam patogenesis miokard infark akut atau sindrom koroner akut. Penelitian ini bertujuan unuk mengetahui hubungan peningkatan kadar IgE dan MMP-9 pasien SKA di RSUP Sanglah, Denpasar, Bali.Metode. Penelitian ini merupakan penelitian potong lintang analitik yang dilakukan pada populasi SKA di RSUP Sanglah, Denpasar, Bali. Sampel keseluruhan berjumlah 73 orang pasien SKA secara konsekutif diikutsertakan dalam penelitian ini, kemudian dilakukan uji statistik dan uji korelasi Pearson.Hasil. Dari hasil penelitian pada 73 sampel tersebut, didapatkan jumlah sampel 59 orang laki-laki (80,8%) dan 14 orang perempuan (19,2%). Adapun kadar IgE dalam rentang antara 0,5-1000 dan kadar MMP-9 antara 6,91-29,56. Terdapat korelasi yang bermakna antara kadar IgE dengan kadar MMP-9 pada pasien Sindrom Koroner Akut (p=0,018; r=0,277).Kesimpulan. Terdapat hubungan yang signifikan antara peningkatan kadar IgE dengan peningkatan kadar MMP-9 pada pasien Sindrom Koroner Akut di RSUP Sanglah, Denpasar, Bali.