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"Latar Belakang: Petugas kesehatan memiliki risiko terpajan darah atau jaringan tubuh saat bekerja. World Health Organization WHO memperkirakan adanya 3 juta pajanan setiap tahunnya pada 35 juta petugas kesehatan. Adanya profilaksis pascapajanan dapat menurunkan risiko penularan.Tujuan: Mengetahui pelaksanaan profilaksis pascapajanan terhadap terhadap HIV, hepatitis B dan hepatitis C pada petugas kesehatan di RSUPN Cipto Mangunkusumo RSCM .Metode: Penelitian potong lintang dilakukan pada petugas terpajan yang terdata melalui laporan IGD, poli pegawai dan UPT HIV pada tahun 2014-2016. Data dikumpulkan dan diolah melalui SPSS versi 20.Hasil Penelitian: Dari 196 pekerja yang melaporkan pajanan, sebagian besar merupakan perempuan 69,9 , bekerja sebagai perawat 38,3 dan dokter 38,3 , serta terpajan secara perkutan 93,4 . Anti-HIV reaktif ditemui pada 25 13 sumber pajanan, HBsAg reaktif pada 13 8 dan anti-HCV reaktif pada 12 6 sumber. Petugas dengan anti-HBs protektif adalah 55 28,1 petugas. Dari 183 pajanan berisiko, 45,9 81 petugas direkomendasikan pemberian ARV, 81,5 66 petugas melakukan profilaksis dengan ARV, 60 petugas minum ARV secara lengkap 28 hari . Follow-up anti-HIV bulan ke-3 dan 6 dilakukan oleh 44 24 dan 41 22,4 petugas. Terdapat 37 pekerja yang direkomendasikan menerima vaksinasi Hepatitis B dan/atau immunoglobulin HBIG . Dari 22 59 yang direkomendasikan vaksinasi hepatitis B, hanya 1 2,7 yang melakukan. Dari 15 41 yang direkomendasikan vaksinasi hepatitis B dan HBIG, hanya 2 5,4 yang melakukannya. Follow-up 3 dan 6 bulan HBsAg serta anti-HBs dilakukan oleh 41 31,1 , 38 28,8 dan 2 1,5 petugas. Dari 182 petugas yang melakukan follow-up anti-HCV bulan ke 3 dan ke 6 adalah 39 21,4 dan 37 20,3 petugas.Kesimpulan: Pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B dan hepatitis C masih rendah. Oleh karena itu, penanganan profilaksis secara komprehensif penting dilakukan termasuk peningkatan pengetahuan dan kesadaran pekerja, peninjauan kembali SOP, dan komunikasi yang efektif.

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Introduction Health care workers HCW have exposure risk of blood or body tissue at work. World Health Organization WHO estimates there is 3 millions exposure to 35 millions workers annually. The existance of post exposure prophylaxis could reduce the transmission risk.Goal To identify the implementation of post exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in RSUPN Cipto Mangunkusumo RSCM .Method A cross sectional study was conducted to exposured workers who had been recorded in emergency ward, employee ward, and UPT HIV on 2014 2016. Data was collected and analyzed with SPSS 20.Result Among 196 HCW who reported the exposure, most of them were female 69.9 , worked as nurse 38.3 and doctor 38.3 , and exposed percutaneously 93.4 . Positive anti HIV was found in 25 13 people of exposure sources, positive HBsAg in 13 8 people and positive HCV in 12 6 people. Workers with protective anti HBs were 55 28.1 people. In 183 reports, 81 45,9 workers were recommended to receive ARV, 66 81.5 workers did receive it, and 40 60 workers took complete ARV 28 days . Follow up 3 and 6 months was done by 44 24 and 41 22,4 workers. There were 37 workers recommended to receive Hepatitis B vaccination and or immunoglobulin HBIG . In 22 59 recommended to receive Hepatitis B vaccination, only 1 2,7 who took that. In 15 41 recommended to receive both Hepatitis B vaccination and immunoglobulin, only 2 5,4 who took both. Follow up of HBsAg and anti HBs on 3rd and 6th months were done by 41 31,1 , 38 28,8 and 2 1,5 workers who were recommended to receive prophylaxis. In 182 workers recommended to do follow up of anti HCV, 39 21,4 and 37 20,3 workers did the follow up on 3rd and 6th month.Conclusion The implementation of post exposure propyhlaxis of HIV, Hepatitis B, and Hepatitis C was still low. Thus, it was important to do the management of prophylaxis comprehensively. It was also included the increasing of worker rsquo s knowledge and awareness, reconsidering the operational standard, and communicating effectively. "

"Latar Belakang: Petugas kesehatan memiliki risiko terpajan darah atau jaringan tubuh saat bekerja. World Health Organization (WHO) memperkirakan adanya 3 juta pajanan setiap tahunnya pada 35 juta petugas kesehatan. Adanya profilaksis pascapajanan dapat menurunkan risiko penularan. Tujuan: Mengetahui pelaksanaan profilaksis pascapajanan terhadap terhadap HIV, hepatitis B dan hepatitis C pada petugas kesehatan di RSUPN Cipto Mangunkusumo (RSCM). Metode: Penelitian potong lintang dilakukan pada petugas terpajan yang terdata melalui laporan IGD, poli pegawai dan UPT HIV pada tahun 2014-2016. Data dikumpulkan dan diolah melalui SPSS versi 20.Hasil Penelitian: Dari 196 pekerja yang melaporkan pajanan, sebagian besar merupakan perempuan (69,9%), bekerja sebagai perawat (38,3%) dan dokter (38,3%), serta terpajan secara perkutan (93,4%). Anti-HIV reaktif ditemui pada 25 (13%) sumber pajanan, HBsAg reaktif pada 13 (8%) dan anti-HCV reaktif pada 12 (6%) sumber. Petugas dengan anti-HBs protektif adalah 55 (28,1%) petugas. Dari 183 pajanan berisiko, 45,9% (81) petugas direkomendasikan pemberian ARV, 81,5% (66) petugas melakukan profilaksis dengan ARV, 60% petugas minum ARV secara lengkap (28 hari). Follow-up anti-HIV bulan ke-3 dan 6 dilakukan oleh 44 (24%) dan 41 (22,4%) petugas. Terdapat 37 pekerja yang direkomendasikan menerima vaksinasi Hepatitis B dan/atau immunoglobulin (HBIG). Dari 22 (59%) yang direkomendasikan vaksinasi hepatitis B, hanya 1 (2,7%) yang melakukan. Dari 15 (41%) yang direkomendasikan vaksinasi hepatitis B dan HBIG, hanya 2 (5,4%) yang melakukannya. Follow-up 3 dan 6 bulan HBsAg serta anti-HBs dilakukan oleh 41 (31,1%), 38 (28,8%) dan 2 (1,5%) petugas. Dari 182 petugas yang melakukan follow-up anti-HCV bulan ke 3 dan ke 6 adalah 39 (21,4%) dan 37 (20,3%) petugas. Kesimpulan: Pelaksanaan profilaksis pasca pajanan terhadap HIV, hepatitis B dan hepatitis C masih rendah. Oleh karena itu, penanganan profilaksis secara komprehensif penting dilakukan termasuk peningkatan pengetahuan dan kesadaran pekerja, peninjauan kembali SOP, dan komunikasi yang efektif.

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Introduction: Health care workers (HCW) have exposure risk of blood or body tissue at work. World Health Organization (WHO) estimates there is 3 millions exposure to 35 millions workers annually. The existance of post-exposure prophylaxis could reduce the transmission risk. Goal: To identify the implementation of post-exposure prophylaxis of HIV, Hepatitis B, and Hepatitis C among HCW in RSUPN Cipto Mangunkusumo (RSCM). Method: A cross-sectional study was conducted to exposured workers who had been recorded in emergency ward, employee ward, and UPT HIV on 2014-2016. Data was collected and analyzed with SPSS 20.Result: Among 196 HCW who reported the exposure, most of them were female (69.9%), worked as nurse (38.3%) and doctor (38.3%), and exposed percutaneously (93.4%). Positive anti-HIV was found in 25 (13%) people of exposure sources, positive HBsAg in 13 (8%) people and positive HCV in 12 (6%) people. Workers with protective anti-HBs were 55 (28.1%) people. In 183 reports, 81 (45,9%) workers were recommended to receive ARV, 66(81.5%) workers did receive it, and 40(60%) workers took complete ARV (28 days). Follow-up 3 and 6 months was done by 44 (24%) and 41 (22,4%) workers. There were 37 workers recommended to receive Hepatitis B vaccination and/or immunoglobulin (HBIG). In 22 (59%) recommended to receive Hepatitis B vaccination, only 1 (2,7%) who took that. In 15 (41%) recommended to receive both Hepatitis B vaccination and immunoglobulin, only 2 (5,4%) who took both. Follow-up of HBsAg and anti-HBs on 3rd and 6th months were done by 41 (31,1%), 38 (28,8%) and 2 (1,5%) workers who were recommended to receive prophylaxis. In 182 workers recommended to do follow-up of anti-HCV, 39 (21,4%) and 37 (20,3%) workers did the follow-up on 3rd and 6th month. Conclusion: The implementation of post-exposure propyhlaxis of HIV, Hepatitis B, and Hepatitis C was still low. Thus, it was important to do the management of prophylaxis comprehensively. It was also included the increasing of worker's knowledge and awareness, reconsidering the operational standard, and communicating effectively."

"Hepatitis B merupakan penyakit menular berbahaya yang menimbulkan peradangan pada organ hati dengan penyebab virus Hepatitis B. Salah satu upaya untuk mencegah dan menurunkan Hepatitis B dengan vaksinasi Hepatitis B0 pada bayi baru lahir kurang dari 24 jam, sesuai dengan Peraturan Menteri Kesehatan Nomor 12 Tahun 2017 Tentang Penyelenggaraan Imunisasi. Kementerian Kesehatan mengeluarkan kebijakan terkait upaya vaksinasi selama masa pandemi meliputi SE Dirjen P2P No.SR.02.06/4/1332/2020 tentang pelayanan imunisasi kepada anak selama masa pandemi Covid-19, Surat Menteri Kesehatan No.SR.02.01/Menkes/213/2020 tentang Pekan Imunisasi Dunia, serta Petunjuk Teknis Pelayanan Imunisasi di Puskesmas. Sebagai tindak lanjut, Pemerintah Provinsi DKI Jakarta menerbitkan SE No.3243/-1.772.1 tentang pelaksanaan imunisasi rutin dalam keadaan pandemi Covid-19. Dalam masa pandemi, capaian pelaksanaan vaksinasi Hepatitis B0 di Kota Administrasi Jakarta Selatan pada tahun 2020 tidak mencapai target, namun pada tahun 2021 dapat mencapai target sebesar 96,7%. Penelitian ini bertujuan untuk mengetahui faktor keberhasilan pelaksanaan kebijakan vaksinasi Hepatitis B0 pada masa pandemi Covid-19 di Kota Administrasi Jakarta Selatan Tahun 2021, dengan pendekatan sistem yang melihat faktor input, proses, dan output. Penelitian ini adalah penelitian kualitatif dengan pengambilan data dilakukan melalui wawancara mendalam dan telaah dokumen pada bulan April-Juli 2022. Pengambilan data dilakukan di empat Puskesmas di wilayah Jakarta Selatan, Suku Dinas Kesehatan Kota Administrasi Jakarta Selatan dan Rumah Sakit Aulia dengan jumlah informan 15 orang. Hasil penelitian menunjukkan tiga Puskesmas mencapai target pada tahun 2021. Satu Puskesmas belum mencapai target, tetapi ditemukan adanya peningkatan capaian vaksinasi Hepatitis B0. Dari hasil disimpulkan Faktor keberhasilan Sudinkes Jakarta Selatan dalam pelaksanaan kebijakan vaksinasi Hepatitis B0 yaitu dari input terdapat tenaga kesehatan yang kompeten yang didukung dengan kader, adanya penambahan sarana dan prasarana, pemberian informasi vaksinasi Hepatitis B0 melalui media sosial dan koordinasi lintas sektor. Dari proses berupa penggerakan bidan koordinasi dan kader. Selain itu, tidak ditemukan kejadian KIPI serta pencatatan dan pelaporan terlaksana dengan baik.

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Hepatitis B is a dangerous infectious disease that causes inflammation of the liver where the cause is the Hepatitis B virus. One of the efforts to prevent and reduce Hepatitis B disease is by vaccinating Hepatitis B0 in newborns for less than 24 hours, in accordance with the Regulation of the Minister of Health Number 12 of 2017 concerning Immunization. During the pandemic, the Ministry of Health issued several policies in the form of SE Director General of P2P No. SR.02.06/4/1332/2020 regarding immunization services for children during the Covid-19 pandemic, Letter of the Minister of Health Number SR.02.01/Menkes/213/2020 regarding World Immunization Week and issued a Technical Guide to Immunization Services at Health Centers. As a follow-up, Provincial Government of DKI Jakarta issued SE Number 3243/-1.772.1 regarding the implementation of routine immunizations in a state of the Covid-19 pandemic. During Covid-19 pandemic, the implementation of Hepatitis B0 vaccination in the South Jakarta Administrative City in 2020 did not reach the target, but in 2021 the Hepatitis B0 vaccination could reach the target of 96.7%. This study aims to determine the success factors for implementing the Hepatitis B0 vaccination policy during the Covid-19 pandemic in the South Jakarta Administrative City in 2021, with system approach theory that looks at input, process, and output factors. This research is a qualitative research with data collection carried out through in-depth interviews and document review conducted in April-July 2022. Data collection was carried out at four Puskesmas in South Jakarta, the South Jakarta Administrative City Health Sub-dept. and Aulia Hospital with 15 informants. The results showed that three Puskesmas reached the target in 2021. One Puskesmas had not yet reached the target, but it was found that there was an increase in the Hepatitis B0 vaccination. From the results, it was concluded that the success factors of the South Jakarta Health Office in implementing the Hepatitis B0 vaccination policy are the input, especially the presence of competent health workers who are supported by cadres, additional facilities and infrastructure, providing information on Hepatitis B0 vaccination through social media and cross-sectoral coordination. From the process, especially in the form of mobilizing coordination midwives and cadres. In addition, there were no AEFI incidents and the recording and reporting were carried out properly."

"ABSTRACTHepatitis merupakan penyakit peradangan pada hati yang dapat disebabkan oleh virus hepatitis. Di antara lima jenis hepatitis, hepatitis B dan hepatitis C merupakan jenis hepatitis yang dapat berkembang menjadi kanker hati. Kanker hati merupakan jenis kanker nomor tujuh tertinggi di dunia dan nomor tiga yang menyebabkan kematian karena kanker. Seseorang yang memiliki gejala penyakit hepatitis dapat melakukan serangkaian uji laboratorium untuk melihat kondisi kesehatannya. Hasil laboratorium hepatitis dapat kita manfaatkan untuk membentuk suatu program yang dapat mengklasifikasi hepatitis B dan hepatitis C. K-Means Clustering merupakan salah satu metode clustering yang dapat dimanfaatkan untuk mengklasifikasi hepatitis B dan hepatitis C. K-Means Clustering cukup mudah untuk diimplementasikan dan waktu yang digunakan untuk mengolah data juga cukup sedikit sehingga, metode ini cukup baik untuk mengklasifikasi data hepatitis B dan hepatitis C. Sementara, Spherical K-Means merupakan metode lanjutan dari K-Means Clustering. Hasil klasifikasi dari dua buah metode akan digunakan untuk melihat akurasi dari kedua buah metode dan membandingkan kedua metode tersebut.

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ABSTRACTHepatitis is an inflammatory disease of the liver caused by hepatitis virus. Among the five types of hepatitis virus, hepatitis B and hepatitis C is the types of hepatitis that can develop into liver cancer. Liver cancer is number seventh in the world for the highest cancer case and number third of the highest death because of cancer. Someone who has symptoms of hepatitis can carry out a series of laboratory tests to see his health condition. This laboratory results can be used to form a program to classify hepatitis B and hepatitis C data. K-Means Clustering is a clustering method which can be used to classify hepatitis B and hepatitis C data. K-Means Clustering was rather easy to use and less time was needed to running the program of K-Means Clustering, with the result that, K-Means Clustering method was good enough to classify hepatitis B and hepatitis C data. While, Spherical K-Means is an advanced method of K-Means Clustering. Classification results from this two methods will be used to see the accuracy of the data and compare the two methods."

"Data cakupan imunisasi Hepatitis B 0 (0-7hari) di desa Mangeloreng mempunyai cakupan terendah pada tahun 2011 yaitu sebanyak 45,5%. Penelitian ini bertujuan untuk mengetahui gambaran faktor pemudah,faktor pemungkin, dan faktor penguat dengan perilaku ibu dalam memberikan imunisasi Hepatitis B 0 pada bayi 0-7 hari. Desain yang digunakan adalah cross sectional. Populasi dalam penelitian adalah bayi berumur 0-12 bulan di Desa Mangeloreng yang berjumlah 52 orang. Sedangkan pemilihan sampel dalam penelitian ini adalah total populasi. Analisis data dilakukan secara univariat dan deskriptif. Dari hasil penelitian didapatkan ibu yang memberikan imunisasi Hepatitis B 0 adalah 92,3%.

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Hepatitis B 0 immunization coverage data (0-7days) in the Mangeloreng village area has the lowest coverage in 2011 as many as 45.5%. This study aims to picture of the between predisposing factors, enabling factors and reinforcing factors in maternal behavior in providing the Hepatitis B 0 immunization (0-7 days) in infants 0-12 months. The design used was cross-sectional. Population in the study were infants aged 0-12 months in the Mangeloreng village numbering 52 people. While the selection of the sample in this study is the total population. Data analysis was performed by Univariate and description. From the result showed that mothers provide Hepatitis B 0 immunization was 92.3%."

"HIV coinfection in HCV-infected patients accelerates the course of disease and affects the outcome of Peg-IFN/RBV combination treatment. HCV-HIV coinfected patients are suspected to have HCV mutation in NS5A-ISDR/PKR-BD region that had a role to the successfulness of Peg-IFN/RBV therapy. SNP IL-28B polymorphism is predicted to have an effect on the HCV quasi-species evolution. However, until now the effect of HCV NS5A mutation and SNP IL-28B of the host to the response of treatment is still unclear.This study aimed to determine the presence and role of HCV NS5A-ISDR/PKR-BD region mutation and host SNP IL-28B on the succes of Peg-IFN/RBV combination treatment in HCV-HIV coinfected patients.Prospective cohort study design was conducted in this study. Plasma sample was collected from 22 monoinfected and 134 HCV-HIV coinfected patients prior to therapy. All of them were treated with Peg-IFN/RBV for 48 weeks. The examination of HCV RNA was performed 24 weeks after the end of therapy. PCR nucleotide sequencing was performed after the RNA virus extraction and cDNA synthesis had been performed. Analysis of secondary structure and prediction of mutation function were assessed by PredictProtein (PP) program.Sixteen from thirthy HCV-HIV co-infection patients and none from eight HCV patients achieved SVR. Nonneutral mutation ≥ 1 was found in 23/30 subjects with HCV-HIV co-infection. The presence of nonneutral mutation ≥ 1 was observed more frequent in SVR group than non-SVR group. Nonneutral mutation ≥ 1 was associated with SVR achievement, regardless the monoinfection or coinfection status (p = 0.04). Interaction of CC gene and nonneutral mutation was not associated with SVR. Secondary structure transformation of VHC NS5A was not associated with SVR in coinfected subjects. NS5A binding site structure was different from consensus in SVR group, while the structure was similar to consensus in non-SVR group.Nonneutral mutation ≥ 1 has the most important role on the SVR achievement in patients treated with Peg-IFN/RBV. The interaction of CC-gene and nonneutral mutation was not associated with SVR. The change of secondary structure was also not associated with SVR achievement, however, the changes of NS5A binding site structure were found in HCV-HIV coinfected patients who achieved SVR.

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Koinfeksi HIV pada pasien dengan infeksi VHC dapat memperberat perjalanan penyakit dan memengaruhi keberhasilan terapi kombinasi Peg-IFN/RBV. Pasien koinfeksi VHC-HIV diduga mengalami mutasi VHC pada regio NS5A-ISDR/PKR-BD yang mempunyai peran terhadap keberhasilan terapi Peg-IFN/RBV. Polimorfisme SNP IL-28B diprediksi berpengaruh terhadap evolusi quasi-spesies VHC, namun hingga saat ini keberadaan dan peran mutasi VHC NS5A serta SNP IL-28B pejamu pada koinfeksi VHC-HIV terhadap keberhasilan terapi masih belum diketahui secara jelas.Penelitian ini bertujuan untuk mengetahui keberadaan dan peran mutasi VHC NS5A-ISDR/PKR-BD serta SNP IL-28B pejamu terhadap keberhasilan terapi dengan kombinasi Peg-IFN/RBV pada pasien koinfeksi VHC-HIV.Penelitian ini menggunakan desain studi kohort prospektif. Sampel plasma dikumpulkan dari 22 subjek monoinfeksi dan 134 subjek koinfeksi sebelum menjalani terapi. Seluruh pasien mendapatkan terapi Peg-IFN/RBV selama 48 minggu. Pemeriksaan VHC RNA setelah 24 minggu dari akhir terapi dilakukan untuk menilai respons terapi (sustained virological response/SVR 24). Sekuensing nukleotida menggunakan PCR dilakukan setelah ekstraksi RNA virus dan sintesis cDNA dari sampel plasma. Analisis struktur sekunder dan prediksi fungsi mutasi menggunakan program PredictProtein (PP).Sebanyak 16 pasien dari 30 pasien koinfeksi VHC-HIV yang mengalami SVR serta tidak ada dari 8 pasien monoinfeksi VHC yang mengalami SVR. Mutasi nonnetral ≥ 1 ditemukan pada 23/30 pasien koinfeksi VHC-HIV. Keberadaan mutasi nonnetral ≥ 1 didapatkan lebih tinggi pada kelompok SVR (14 pasien) dibandingkan dengan non-SVR (9 pasien). Mutasi nonnetral ≥1 berhubungan dengan kejadian SVR, tanpa memandang status monoinfeksi dan koinfeksi (p = 0,04). Interaksi antara gen CC dan mutasi nonnetral tidak berhubungan dengan SVR. Perubahan struktur sekunder NS5A tidak berhubungan dengan SVR pada pasien koinfeksi. Struktur binding site NS5A pada kelompok SVR didapatkan berbeda dengan konsensus, sedangkan pada kelompok non-SVR mirip dengan konsensus.Mutasi nonnetral ≥ 1 berperan terhadap kejadian SVR pada pasien yang mendapat terapi Peg-IFN/RBV. Interaksi mutasi nonnetral dan gen CC tidak berhubungan dengan pencapaian SVR. Perubahan struktur sekunder juga tidak berhubungan dengan pencapaian SVR, akan tetapi perubahan struktur binding site NS5A-ISDR/PKR-BD ditemukan pada pasien koinfeksi VHC-HIV yang mencapai SVR dengan terapi Peg-IFN/RBV."

"ABSTRAK<

Karsinoma hepatoseluler (KHS) merupakan karsinoma primer tersering pada sel hati. Sebagian besar KHS disebabkan oleh virus hepatitis B (VHB) dan virus hepatitis C (VHC) yang memiliki patogenesis yang berbeda dalam menyebabkan KHS. Alfa-fetoprotein (AFP) sebagai penanda tumor pada KHS dan dipengaruhi oleh berbagai faktor, salah satunya status infeksi. Berbagai penelitian sudah dilakukan untuk mengetahui pengaruh pengaruh jenis virus penyebab KHS dengan kadar AFP namun hasilnya sangat beragam. Berdasarkan hal tersebut dan ditambah dengan belum adanya penelitian serupa yang menggunakan data pasien di Indonesia maka penelitian ini bertujuan untuk membandingkan kadar AFP pada pasien KHS terkait infeksi VHB terhadap VHC. Penelitian ini dilakukan dengan desain studi potong lintang menggunakan 199 data AFP pasien KHS yang terdiri dari 129 kasus KHS terkait VHB dan 70 kasus KHS terkait VHC. Dari penelitian ini didapatkan sebanyak 97% dan 87.3% pasien KHS terkait VHC dan VHB mengalami peningkatan kadar AFP secara berurutan. Nilai median kadar AFP pada pasien KHS terkait VHB adalah 419 IU/mL sedangkan pada pasien KHS terkait VHC sebesar 400 IU/mL. Perbedaan nilai tersebut memiliki nilai p = 0.97 dalam uji Mann-Whitney U sehingga disimpulan tidak ada perbedaan bermakna pada rerata kadar AFP antara pasien KHS terkait VHB dibanding dengan VHC.

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ABSTRACT

Hepatocellular carcinoma (HCC) is the most primary common carcinoma in liver cells. Most HCC are caused by the hepatitis B virus and hepatitis C that have different pathogenesis in causing carcinoma. Alpha-fetoprotein as tumor marker in HCC is influenced by various factors, one of which is infection status. Various studies have been carried out to determine the influence of the types of viruses causing HCC with AFP levels but the results are very diverse. Based on this and coupled with the absence of similar studies using patient data in Indonesia, this study aims to compare AFP levels in HCC patients related to HBV and HCV. Using cross-sectional design, this study included 199 data of AFP in patient with HCC comprises of 129 cases of HCC related to HBV and 70 cases of HCC related to HCV. From this study, it was found that 97% and 87.3% of HCC patients related to HCV and HBV experienced an increase in AFP levels consecutively. The median value of AFP levels in HBV-related HCC patients was 419 IU / mL while in HCV-related HCC patients was 400 IU / mL. The difference in value has a p value = 0.97 in the Mann-Whitney U test thus it is concluded that there is no significant difference in AFP levels between HBV-related HCC patients compared with HCV-related HCC.

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"BackgroundProdromal factors of Guillain-Barre syndrome (GBS) are often associated with previous viral infection (60%). The ailment supported by the acquired immunomediated disorder concept. Viral hepatitis is very rarely found in GBS, preceded by cytomegalovirus (15-18%), Campylobacter jejuni (28%), and Epstein-Barr virus (5%). There is no specific etiology of GBS because those viruses usually appear sporadically (subclinically). All hepatitis virus infection can cause neurological complications, including GBS.Case ReportWe report two cases of hepatitis A virus infection (HAV) in GBS patients in Dr. Sardjito General Hospital during 5 years of observation (1996-2000) from 92 GBS patients. The diagnosis of HAV was based on more than 2 times increment of transaminase enzyme, positive IgM anti HAV, negative HbsAg, and negative IgM ami HCV. The diagnosis of GBS was based on clinical symptoms of acute generalized paralysis, cerebrospinal fluid examination, and electromyelography. In both cases, sub-clinical and sporadic symptoms appeared several days before paralysis, which makes it more likely that the prodromal period of GBS occurred at the same time of HAV incubation period.DiscussionThe incidence of HAV in GBS patients during 5 years of observation was 2%. This corresponds with the case reported by Verona et al, 1996 and Pelletier et al, 1985, i.e. the presence of peripheral neuropathy (n. facialis and n. occulomotorius). Possible alternative pathways for hepatitis virus complicating as GBS are perivascular and endometrial peripheral nerve infiltration by mononuclear cells, T cell sensitization, stimulation of IL-2 growth factor surface receptor, and B cell stimulation. All of the conditions mentioned above causes necrotizing arteritis, vascular occlusion, and at the end, segmental demyelinization. Hepatitis virus may replicate in the central nervous system or peripheral nervous system, subsequently developing into multiple neuropathy disorder and poly arteritis.ConclusionThe diagnoses of HAV and GBS in both cases were established. HAV is one of several viruses that may trigger GBS. In both cases, HAV infection was sub-clinical and sporadic. Symptoms of hepatitis infection subsided along with improvements in the patient's neurological status. Acute viral hepatitis has a wide clinical spectrum and laboratory manifestation that is in accordance with the severity, varying from unclear symptom (anicteric) to jaundice. Acute hepatitis A, B, C infections have the same symptoms in general. However, hepatitis B and C tend to be more severe. The mildest symptoms are transaminase enzyme level increment, no jaundice, gastrointestinal symptoms, flu-like symptoms, and sometimes it can not be diagnosed. The more severe symptoms are jaundice with obvious generalized symptoms.' The incidence of hepatitis A is difficult to be determined accurately because of its characters, i.e. sporadic, endemic, and has a high rate of asymptomatic infection.23-4"