Melanosis Coli

Melanosis coli is a dark pigmentation of colonic wall that is often identified at the time of colonoscopy. We present a second reported case of melanosis coli in a patient taking rhubarb containing herbal laxative. 67-year-old Caucasian female with ulcerative proctosigmoiditis (in clinical remission), sclerosing pancreatitis, and slow transit constipation, noted to have black coloration of the whole colon during a screening colonoscopy. The pigmentation was very dense, limiting the mucosal examination on both standard and peak illumination (Figure 1, panel A/B). This was new from a colonoscopy 2 years prior. Minimal coble stoning was noted in the sigmoid colon. Mucosal biopsies confirmed diagnosis of melanosis coli and chronic colitis with focal mild activity in the sigmoid colon. Her medication list included alprazolam, ascorbic acid, dexlansoprazole, dicyclomine, omega-3 fatty acids, pancrelipase, tramadol and multivitamin and an herbal fiber supplement containing rhubarb. She stopped using rhubarb extract and repeat colonoscopy 2 years later showed complete resolution of melanosis coli (Figure 1, panel C). The cobblestoning of sigmoid colon was also resolved and no active colitis. Melanosis coli is pigmentation of colonic mucosa secondary to lipofuscin deposition in macrophages in the lamina propria. It is considered a result of increased apoptosis. Lysosomal digestion on cellular organelles forms lipofuscin granules. These granules are then taken up by the macrophages. Our patient reported taking rhubarb containing herbal laxative. Rhubarb has anthraquinones which passes unabsorbed through the small bowel and get activated in the colon, where they are converted to active forms. These in turn cause epithelial cell damage leading to altered absorption, secretion and motility. The epithelial cells damage leads to apoptosis. Melanosis coli is considered benign and is reversible on discontinuing implicating agent. Disappearance of the pigment usually occurs within a year after a patient stops taking anthraquinone but microscopic feature could take longer to clear.Figure: A/B - initial colonoscopy showing severe melanosis coli. Fig 1C - Repeat colonoscopy showing improved melanosis coli.

Background: Schizophrenia is severe mental disorder with the highest proportion and relapse in Sardjito Hospital inpatient section. Report on relapse incident of schizophrenia is 60%-75%. Family histories of mental disorder are reported as risk factors of relapse in schizophrenic patients. Objective: To identify relationship between family histories of mental disorder and relapse in schizophrenic patient in Sardjito Hospital Yogyakarta. Method: Subjects were schizophrenic patient who were hospitalized in Sardjito Hospital Yogyakarta between May 2007 - May 2008. The figure of sample was 47 people. Data was collected using structured questionnaire on demography and family histories of mental disorder. This is cross sectional and descriptive analytic study. Data was analyzed using univariate analysis and multivariate analysis stepwise logistic regression. Result: Data collection showed that mean of subject’s age is 34 years. Number of males and females is equal and most of the subject is unemployee and unmarried. Majority of subject came from low socioeconomic. Educational background of subject is mostly high school. Out of 47 samples relapse rate is 55,3%. As much as 24 samples (51,1%) have family histories of mental disorder. There were 68,1% patients showed uncompliance in medication. This study showed 3 variables which have relationship with relapse in schizophrenic patient; those were age (p=0,036), family histories of mental disorder (p=0,029) and drug compliance (p=0,007). Conclusion: There is relationship betweeen family history of mental disorder and relapse in schizophrenic patient in Sardjito Hospital Yogyakarta. Multivariate analysis showed that drug compliance is the most significant influencing relapse in schizophrenic patients. Keywords: family histories of mental disorder, drug compliance, schizophrenia, relapse

In addition to the triad in the Hermansky-Pudlak syndrome (tyrosine-positive oculocutaneous albinism, mild bleeding tendency with a normal platelet-count and widespread accumulation of ceroid-like pigment in various organs), we document severe pulmonary fibrosis, pseudomelanosis coli and deeply pigmented renal cortex. In the liver, innumerable number of pigment-laden Kupffer cells and macrophages in the Glisson capsule were seen. Interestingly, many intralysosomal accumulations of the pigment within the hepatocytes were found by electron microscopy, suggesting that these configurations possibly resulted from a dysfunction of the lysosome itself, especially with regard to loss of digestive and secretory activity. The triad and other complications may also be resultants of a lysosomal dysfunction.

INTRODUCTION: Pseudomelanosis coli is the brown-black pigmentation of colon and rectum as a consequence of laxative use secondary to increasing dependency on narcotics. However, there are reports of Pseudomelanosis in the absence of laxatives and pigmentation in areas other than colon. Recently it has also been linked to colon cancer. METHODS: A selective review of existing literature on Psuedomelanosis coli was performed in PubMed. RESULTS: Early studies speculated that the pigment is melanin or an anthracene derivative. Now it is widely accepted that the pigment is actually lipofuscin. Lipofuscin predominantly accumulates in the macrophages of the lamina propria, usually in the colon. Electron microscopic examination of the pigment granules in the duodenum has revealed lysosomal bodies containing iron sulfide with traces of minerals from antacids, food additives and dental fillings. Electron microscopy of ileum revealed the pigment granule laden macrophages containing predominantly magnesium and aluminum-rich silicates. Pseudomelanosis is characteristically absent in colonic neoplasms. The area of the melanotic colon with cancer association has reduced or even lack of pigment laden macrophages. Pseudomelanosis is sometimes encountered in colonoscopy without a history of laxative use. This means that either chronic inflammation or a rapid intestinal transit in inflammation can cause pigmentation. Based on studies in guinea pigs, it is hypothesized that non-anthraquinone laxatives have the potential to cause microscopic pigment deposition, which may not result in gross discoloration on endoscopic evaluation. CONCLUSION: Pseudomelanosis coli has increased in incidence in the United States due to increasing incidence of chronic pain syndromes causing opioid dependence and secondary laxative use and with abundant purine intake. Non-anthracene Pseudomelanosis coli has a different pathogenesis and may be missed by endoscopists due to the grossly normal appearing colon. The pathogenesis of Pseudomelanosis coli in the setting of laxative naïve patients is not well understood. Interestingly, chronic colitis may have an association with Pseudomelanosis coli. There is no established correlation between Pseudomelanosis coli and cancer, but it is unclear if chronic colitis causing Pseudomelanosis has any role in carcinogenesis in these patients. Lastly, melanosis can occur in other parts of the gastrointestinal system, but is usually due to other pigments rather than lipofuscin. Further studies are needed.

Melanosis Coli is described as black or brown discoloration of the mucosa of the colon. It is a benign condition, whicharises from anthraquinone laxative abuse and usually has no symptoms of its own. Though not a very rare condition,to the best of our knowledge, no case has been reported on melanosis coli in Bangladesh . Here we report a case ofmiddle aged lady presenting with passage of blood mixed stool for one year. Colonoscopy was performed whichrevealed melanosis coli and which was later confirmed by histopathology. Not thought to be a pre malignantcondition, it has been found in some patients with other diseases.Keywords: Melanosis coli; Anthraquinone; Lipofuscin; Laxative; BangladeshDOI: 10.3329/jom.v11i2.5469J MEDICINE 2010; 11 : 183-185

Background : Verification of the irradiation set up is a process to ensure that the position and volume of the irradiated tumor is the same as planned. Verification is done by comparing the radiographic image information of the Treatment Planning System (TPS) with radiation therapy to be provided on the Electronic Portal Imaging Device (EPID) device. Existing software on the EPID in doing verification is IViewGT and Mosaiq. Radiotherapist in Radiotherapy Unit Radiology Installation of Dr. Sardjito Hospital Yogyakarta always uses IViewGT software rather than Mosaiq software in performing standard operational procedure verification set up irradiation. The purpose of this study was to describe the verification process, to examine the results of verification and to examine the differences in the results of the verification of set up irradiation between the EPID software Mosaiq with IViewGT in conformal radiotherapy of nasopharyngeal cancer. Methods: The type of research in this thesis is quantitative analytic research. The research was conducted at Radiotherapy Unit Radiology Installation of Dr. Sardjito Hospital Yogyakarta. Data in the form of 52 portal image of nasopharyngeal cancer patients performed conformal radiotherapy. The verification process uses IViewGT and Mosaiq software on the same portal image . Data analysed by Wilcoxon test. Result: The results of the verification is the value of shift set up irradiation on X axis, Y axis and Z axis. Verification using Mosaiq software got the average shift on the X axis of 0 cm, on the Y axis the average value is -0,02 cm, on the Z axis the average value is 0,07 cm. Verification using IViewGT software obtained an average shift on the X axis of 0,02 cm, on the Y axis the average value of 0,03 cm, on the Z axis value averaging 0,02 cm Conclusion: The results of this study indicate that there is no difference in verification of irradiation set up between EPID software Mosaiq with IViewGT on X axis with p value 0,361, on Y axis with p value 0,102 and on Z axis with p value 0,199.

We report the case of a 74-year-old female with an extreme picture of melanosis coli of the whole colon after chronic use of anthraquinone laxatives for the treatment of constipation over many decades. Endoscopic work-up revealed an impressive deep black pigmentation of the whole colon mucosa which could be verified by histopathology as a widespread lipofuscin granulation. In addition, various adenomas but no colorectal carcinoma could be detected. The term melanosis coli describes a brown or black pigmentation of the colonic mucosa. Induction of melanosis coli by anthraquinone laxatives and their derivatives can be regarded as verified. The question if melanosis coli predisposes for colorectal neoplasia is discussed controversially. Based on the current literature, an association of melanosis coli between colorectal adenomas, but not colorectal carcinomas, is under discussion but the mechanisms to effect the development of colorectal neoplasia are not completely understood. Considering our case and the current scientific backround, we conclude that due to pharmaceutical side effects of anthraquinone derivatives such as electrolytic shift and water loss in addition to the risk of developing melanosis coli, anthraquinone laxatives should not be used for long-term therapy of constipation.

Hypertension is the second largest of the 10 diseases on an outpatient at a hospital in Indonesia. The poor complianceto therapy of hypertension is a major cause of uncontrolled blood pressure. The aim of this study is to determinecompliance antihypertension on patient at DR. Sardjito hospital Yogyakarta. This study was designed with aretrospective cohort study design using a database of participants claimed prescribing health insurance (ASKES) inthe DR. Sardjito hospital using antihypertensive drugs. Compliance measured with medication possession ratio (MPR).Data was analysed by chi- square and logistic regression statistic. From 8.011 patients, compliance of antihypertensivedrugs during the first year is 7,6%. Analysis for compliance showed that the type of antihypertensive diuretics aremore compliance compare with angiotensin II receptor blockers, ACE inhibitors, calcium channel blockers and betablockers. Combination therapy (20,7%) is more compliance than monotherapy ( 4,1%), as well as drugs administration1 time a day (8,2%) is more compliance than drug administration 2 times (2,5%) and 3 times a day (3%). Theproportion of compliance in antihypertensive users at DR. Sardjito hospital classified as less good. Compliancepattern indicates that therapy is not continuous, the longer the use of antihypertensive therapy, the higher thediscontinuous therapy.

Background: Acute myocardial infarction (AMI) causes high hospital admission rates and mortality in Indonesia. Previous studies showed that invasive strategies on non-ST-elevation myocardial infarction (NSTEMI) patients can provide more benefit in clinical outcomes, particularly in high- and very high-risk groups. However, this strategy cannot be implemented due to transportation limitations or a lack of available catheterization facilities in some regions. Recent meta-analyses suggested that early invasive strategies (≤24 hours), delayed strategies (>24 hours), or conservative showed no differences significantly in mortality rates from any cause, stroke or cardiovascular death in NSTEMI patients. . Objective: This study aims to define the impact of invasive strategies on in-hospital mortality in high and very high-risk NSTEMI patients at Sardjito Hospital. Methods: A retrospective cohort study utilized data from 326 NSTEMI patients who satisfied the inclusion and exclusion criteria, obtained from the Sardjito Cardiovascular Intensive Care (SCIENCE) registry between January 2023 and June 2024. Result: The invasive and conservative method groups did not substantially differ in in-hospital mortality among NSTEMI patients in either unadjusted (p=0.09) or adjusted analysis (p=0.071, OR 2.251, 95% CI [0.932–5.434]). However, a significant difference was found in the high-risk group (p=0.042) but not in the very-high-risk group (p=0.525). Multivariate analysis confirmed Killip classification (p=0.000, OR 4.449, 95% CI [2.195–9.016]) and hs-Troponin T levels (p=0.006, OR 1.000, 95% CI [1.000–1.000]) as independent mortality predictors Conclusion: Invasive management gave high-risk NSTEMI patients a survival advantage over conservative therapy at Sardjito Hospital, but not in the very-high-risk population. Keyword: Concervative Treatment; Mortality; Non ST-Elevation Myocardial Infarction; Percutaneous Coronary Intervention.

BACKGROUND: In patients with coronavirus disease-19 (COVID-19), respiratory failure is a serious condition that requires immediate respiratory supports. Various clinical conditions can be determinant factors to the need for used of ventilators. AIM: The aim of the study was to determine factor related to the used of ventilators among COVID-19 patients transferred to intensive care unit Sardjito Hospital. METHODS: Using a cross-sectional design, a total of 171 of 300 medical records selected in accordance to the inclusion criteria. Association of each clinical characteristics and outcome variable used contingency coefficient and Spearman rank tests, while multivariate logistic regression model was performed for hypothesis testing. The area under curve (AUC) was test to determine model fit of the logistic approach. RESULTS: There was a significant correlation between age (p = 0.004), blood sugar levels (p < 0.001), and oxygen saturation (p < 0.001), and the used of ventilator. Patients with hypoxia and severe hypoxia had odds of using ventilation supports 5 times and 114 times (OR = 5.623) and (OR = 114.3). The AUC test indicated that null hypothesis was rejected. CONCLUSION: The clinical characteristics were associated with age, blood sugar levels, and oxygen saturation. Patients with COVID-19 who admitted to hospital with hypoxia and severe hypoxia increased the odds of the use ventilators.

Type 2 Diabetes mellitus is a chronic disease that can not be cured completely, will affect Health Related Quality Of Life (HRQOL). The purpose of this study was to determine the QOL of type 2 DM patients based on patient’s characteristic factors (age, gender, educational status) at Endocrinology Clinic Dr. Sardjito Hospital Yogyakarta. This study is a cross sectional study with descriptive method. Data are taken concurrently by interview and from medical records of patients who visited the Endocrinology Clinic Dr. Sardjito Hospital between July 2012 until March 2013. The inclusion criteria of patients include patients who visit during the study, no constraint in the language and not having a nervous breakdown, and willing to participate the study. The quality of life was measured by Diabetes Quality of Life Clinical Trial Quessionnaire (DQLCTQ). There are several statistical analysis used in this study. Mann Whitney for QOL analysis based on gender, educational status. Kruskall Wallis for QOL analysis based on patient’s age. The results of 137 patients known that gender (p value= 0,000) and education status (p value = 0,000) was significantly influence the average value of quality of life. Whereas, the patient’s age (p value = 0,530) was not significantly affect the average value of quality of life. Keywords : patients characteristics factors, quality of life, type 2 diabetes mellitus

Background: Melanosis coli is a benign pigmentation of the colonic mucosa, most commonly associated with chronic laxative use. The condition is caused by accumulation of lipofuscin within macrophages in the lamina propria. Although often incidental, its recognition is important to avoid misinterpretation as more serious colonic pathology. Case Presentation: We report the case of a 70-year-old man with chronic constipation for several years, who developed colonic melanosis while using an inulin-based laxative daily. Colonoscopy revealed diffuse brown-black pigmentation predominantly in the right colon, confirmed histologically as melanosis coli. After discontinuation of the laxative and implementation of dietary and lifestyle changes, the patient’s bowel function improved and pigmentation regressed over time. Conclusion: This case illustrates melanosis coli related to prolonged use of an inulin-based laxative. Awareness of this benign and reversible entity is crucial to prevent unnecessary alarm and to emphasize rational laxative use in elderly patients with chronic constipation.

Background: A high prevalence of malnutrition in hospitals leads to the increasing of more attention paid for nutrition management. Enteral nutrition feeding in a proper way will give advantages such as protecting nutrition status in order not to go worse and preventing or reducing the occurrence of metabolic complication and infection, It requires specific knowledge and expertise in nutrition area, management of enteral nutrition feeding is a part of nurse's responsibilities. Method: This study was aimed to obtain a description of technical feeding of enteral nutrition to adult patient at Dr. Sardjito Hospital Yogyakarta,The type of this study was descriptive explorative by means of quantitative method, data was collected through observation to research subject who are the patients undergoing enteral nutritional therapy with a total number of 21 patients. This study was done within December 19t 2005 — January 91h 2006. Result: The result showed that a high percentage of enteral nutrition feeding done by family was 40 actions (63.49%) while that done by nurses was 23 actions (36.51%). Enteral nutrition feeding that was considered as properly done was only 20 actions (31,75%) while that considered as improperly done was 43 actions (68.25%). The most frequent things that were not done in enteral nutrition feeding were checking the intestinal distortion before and after the nutrition feeding, aspirating residual volume of stomach before nutrition feeding. considering the rate of feeding, and some did not set the position of semifowler (30° — 45°) during enteral nutrition feeding. Conclusion: This study showed that most of enteral feeding had not been done based on theoretical standard. Keywords: Technical feeding. enteral nutrition, adult patient

Background: Chronic kidney disease patients undergoing hemodialysis often experience uncontrolled hypertension. Psychosocial stress can be the cause or the consecuence of hypertension. The objective of this study is to investigate correlation between depression or anxiety and uncontrolled hypertension in hemodialysis patients Subjects and Methods: Patients with diagnosed hypertension were recruited to complete the hospital anxiety and depression scale (HADS) questionnaire. There are seventhteen patients with uncontrolled hypertension with blood pressure >160/100 mmHg, and sixteen patients with blood pressure < 140/90 mmHg Result: Based on statistical analysis showed that the correlation between depression and hypertension was positive (r = 0.188), but not significant (p = 0.547), the correlation between anxiety and hypertension was not significant (r = 0.245, P = 0.549). Conclusion: There were no significant differences between depression and anxiety in raising blood pressure.

Therapeutic drug monitoring (TDM) is critical to ensure the safe and effective administration of amikacin (AMK), which has a narrow therapeutic index. This study aimed to develop and validate an efficient and simple liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for determining AMK in human plasma and applying it to hospitalized patients. Before LC-MS/MS measurements, plasma samples were treated with an optimized protein precipitation method using methanol (MeOH). Optimum chromatographic conditions for determining AMK in human plasma include using a C8 column (5 μm, 100 × 4.6 mm) and gradient elution using ammonium formate-formic acid-H2O and formic acid-MeOH mixture as the mobile phase at a 0.5 ml/minute flow rate. The method has been validated following the European Medicines Agency guidelines and has met all validation requirements with excellent selectivity, an lowest limit of quantification value of 0.2 μg/ml, good accuracy and precision in the linear range of 0.2–25 μg/ml, good dilution integrity up to 20 dilution times, and stable under various conditions. The method has also successfully been applied for measuring AMK peak levels (Cmax) and trough levels (Cmin) in the plasma of adult inpatients at Dr. Sardjito Hospital Yogyakarta, Indonesia. The LC-MS/MS measurement can be completed in 7.5 minutes, and the method can be applied in the TDM of AMK.