Altered Level of Consciousness in Metabolic Disease: An Emphasis on the Pathomechanism of Hepatic Encephalopathy

Authors

  • Steven Jonathan Department of Internal Medicine, Wangaya Regional General Hospital, Bali, Indonesia
  • I Ketut Suryana Allery-Immunology Division, Department of Internal Medicine, Wangaya Regional General Hospital, Bali, Indonesia
  • I Made Suma Wirawan

DOI:

https://doi.org/10.51601/ijhp.v6i2.548

Abstract

The present study reports the first comprehensive study on the freshwater macroinvertebrates and its habitat preferences in Bilah River, the largest riverin the Northern Sumatra. The riverside is characterized by the presence of anthropogenic and industrial activities which may alter the macroinvertebrate assemblage and biodiversity. Five months of investigation on 10 sampling stations from December 2016 to October 2017 was conducted based on the river flow in Bilah River. Principal component analysis indicated a decrease in trophic status from upstream to downstream of the river. A total of 27 taxa were recorded, with the most abundant group were members of Odonata, Gastropoda, and Decapoda. The highest density of macroinvertebrate was observed from station 1 (160 ind m-2), while the lowest density was observed from station 9 (38.64 ind m-2). Based on species distribution and similarity, two groups of habitats may be distinctively recognized based on the Bray-curtis similarity coefficient. Group 1 consisted of station 1, 2, 3 and 4 while group 2 consisted of station 5, 6, 7, 8, 9, and 10. Based on the diversity indices as ecological parameters, the habitat condition in Bilah River is categorized from low to moderately polluted. Spatial patterns in both environmental conditions affecting the macroinvertebrate assemblage was observed using canonical correspondence analysis (CCA) revealed the preferences from each macroinvertebrate species towards environmental conditions.

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References

[1] Cong Ma et al., “Non-Hodgkin’s lymphoma in an elderly patient with renal dysfunction: a case report,” J. Int. Med. Res., vol. 48, no. 8, p. 0300060520945858, Aug. 2020, doi: 10.1177/0300060520945858.

[2] E. C. Ayers and S. M. Smith, “Diffuse Large B-Cell Lymphoma in the Older and Frail Patient,” Cancers, vol. 17, no. 5. p. 885, 2025. doi: 10.3390/cancers17050885.

[3] A. Tucci et al., “Diffuse large B-cell lymphoma in octogenarians aged 85 and older can benefit from treatment with curative intent: a report on 129 patients prospectively registered in the Elderly Project of the Fondazione Italiana Linfomi (FIL).,” Haematologica, vol. 108, no. 4, pp. 1083–1091, Apr. 2023, doi: 10.3324/haematol.2022.281407.

[4] M. Di, S. F. Huntington, and A. J. Olszewski, “Challenges and Opportunities in the Management of Diffuse Large B‐Cell Lymphoma in Older Patients,” Oncologist, vol. 26, no. 2, pp. 120–132, Feb. 2021, doi: 10.1002/onco.13610.

[5] B. Amoozgar and B. S. Kahl, “Initial treatment of elderly population with aggressive lymphoma: a narrative review of current evidence and future directions,” Ann. Lymphoma, vol. 6, no. 9, 2022, doi: 10.21037/aol-22-9.

[6] F. Merli, S. Pozzi, H. Catellani, E. Barbieri, and S. Luminari, “The Role of Geriatric Assessment in the Management of Diffuse Large B-Cell Lymphoma,” Cancers, vol. 15, no. 24. 2023. doi: 10.3390/cancers15245845.

[7] P. J. Lugtenburg, A. R. Lyon, R. Marks, and S. Luminari, “Treatment of Aggressive Non-Hodgkin’S Lymphoma In Frail Patients: Cardiac Comorbidities and Advanced Age,” Futur. Oncol., vol. 15, no. 11, pp. 1197–1205, Feb. 2019, doi: 10.2217/fon-2019-0019.

[8] G. B. Crawford et al., “Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines☆,” ESMO Open, vol. 6, no. 4, p. 100225, 2021, doi: https://doi.org/10.1016/j.esmoop.2021.100225.

[9] O. O. Odejide, “Strategies for introducing palliative care in the management of relapsed or refractory aggressive lymphomas,” Hematology, vol. 2020, no. 1, pp. 148–153, Dec. 2020, doi: 10.1182/hematology.2020000100.

[10] A. Arcari, F. Cavallo, B. Puccini, and D. Vallisa, “New treatment options in elderly patients with Diffuse Large B-cell Lymphoma.,” Front. Oncol., vol. 13, p. 1214026, 2023, doi: 10.3389/fonc.2023.1214026.

[11] T. A. Eyre et al., “Lymphomas: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up☆,” Ann. Oncol., vol. 36, no. 11, pp. 1263–1284, 2025, doi: https://doi.org/10.1016/j.annonc.2025.07.014.

[12] F. Merli et al., “Simplified Geriatric Assessment in Older Patients With Diffuse Large B-Cell Lymphoma: The Prospective Elderly Project of the Fondazione Italiana Linfomi,” J. Clin. Oncol., vol. 39, no. 11, pp. 1214–1222, Feb. 2021, doi: 10.1200/JCO.20.02465.

[13] V. Goede, “Frailty and Cancer: Current Perspectives on Assessment and Monitoring,” Clin. Interv. Aging, vol. 18, no. null, pp. 505–521, Dec. 2023, doi: 10.2147/CIA.S365494.

[14] M. Aapro et al., “Management of anaemia and iron deficiency in patients with cancer: ESMO Clinical Practice Guidelines††FootnotesApproved by the ESMO Guidelines Committee: October 2017.,” Ann. Oncol., vol. 29, pp. iv96–iv110, 2018, doi: https://doi.org/10.1093/annonc/mdx758.

[15] G. H. Lyman et al., “American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer,” Blood Adv., vol. 5, no. 4, pp. 927–974, Feb. 2021, doi: 10.1182/bloodadvances.2020003442.

[16] D. Arakaki, M. Iwata, and T. Terasawa, “External validation and update of the International Medical Prevention Registry on Venous Thromboembolism bleeding risk score for predicting bleeding in acutely ill hospitalized medical patients: a retrospective single-center cohort study in Japan,” Thromb. J., vol. 22, no. 1, p. 31, 2024.

[17] M. Muscaritoli et al., “ESPEN practical guideline: Clinical Nutrition in cancer.,” Clin. Nutr., vol. 40, no. 5, pp. 2898–2913, May 2021, doi: 10.1016/j.clnu.2021.02.005.

[18] F. Massaro, F. Andreozzi, C. Vandevoorde, and D. Bron, “Supportive Care in Older Lymphoma Patients to Reduce Toxicity and Preserve Quality of Life,” Cancers, vol. 15, no. 22. 2023. doi: 10.3390/cancers15225381.

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Published

2026-06-04

How to Cite

Jonathan, S., Ketut Suryana, I., & Made Suma Wirawan, I. (2026). Altered Level of Consciousness in Metabolic Disease: An Emphasis on the Pathomechanism of Hepatic Encephalopathy. International Journal of Health and Pharmaceutical (IJHP), 6(2), 380–385. https://doi.org/10.51601/ijhp.v6i2.548

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