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All Journal Jurnal Penyakit Dalam Indonesia
Kemal Fariz Kalista, Kemal Fariz
Fakultas Kedokteran Universitas Indonesia Ciptomangunkusumo National General Hospital
Medicine & Pharmacology

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Nucleoside/Nucleotide Analogues for the Treatment of Chronic Hepatitis B: A 3-Year Follow Up Study Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 3
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Introduction. Chronic hepatitis B (CHB) is endemic in Indonesia, where it is usually treated with pegylated interferon and nucleoside/nucleotide analogs (NA). The aim of this study was to determine the efficacy of treating CHB infection among Indonesian patients with NA (lamivudine, telbivudine, and tenofovir) for a 3-year period.Methods. We retrospectively reviewed the records of patients with CHB infection attending the Hepatology Clinic Cipto Mangunkusumo during 2010-2013 period. Subjects with inclusion criteria were all patients aged above 18 years treated with NA for at least three years. The degree of liver stiffness, hepatitis B virus deoxyribonucleic acid (HBV-DNA), alanine aminotransferase (ALT) levels, and hepatitis B antigen (HBeAg) were assessed before and after 3-years therapy.Results. A total of 62 subjects were included in the study. Forty-eight patients (77%) were treated with telbivudine, 9 (15%) with tenofovir, and 5 (8%) with lamivudine. At baseline prior to the onset of therapy, 52 patients (84%) had a positive HBeAg test, 15 patients (24%) had F3 liver disease (advance fibrosis), and 36 (58%) had liver cirrhosis using transient elastography. At the end of the 3 year study period, median of liver stiffness significantly decline from baseline (14.5 (3.3 – 59.3) kPa to 6.7 (3.3 – 37.2) kPa, p = 0.001), HBV DNA load significantly decline (1.31 x 107 (2.0x106 – 1.0x108) copies/mL to 0 (0 – 1.7 x 107) copies/mL, p = 0.001), alanine aminotransferase (ALT) levels significantly decline (58 (11– 404) U/L to 27 (8-291) U/L, p = 0.001). Nevertheless, there were five patients (8%) who still had F3 liver disease, and 20 patients (32.3%) had F4 liver disease, 21 (34%) had detectable HBV-DNA, 17 (27%) had not achieved ALT normalization. From 52 patients with positive HBeAg 140| Jurnal Penyakit Dalam Indonesia | Vol. 8, No. 3 | September 2021Andri S. Sulaiman, Irsan Hasan, C.R.A. Lesmana, Chyntia O.M. Jasirwan, Saut Horas H. Nababan, Kemal F. Kalista, Gita Aprilicia, Rino A. Ganibaseline, there were 20 patients (39%) who had seroconversion to negative HBeAg after three year period.Conclusion. NA therapy resulted in a reduction level of fibrosis in CHB induced liver disease.
Clinical Profile of Cirrhotic Patient with Esophageal Varices WhoUndergone Band Ligation in Cipto Mangunkusumo Hospital Kalista, Kemal Fariz; Lesmana, Cosmas Rinaldi Adithya; Sulaiman, Andri Sanityoso; Gani, Rino Alvani; Hasan, Irsan
Jurnal Penyakit Dalam Indonesia Vol. 6, No. 1
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Introduction. Liver cirrhosis (LC) is the end stage of chronic liver disease. One of the main complication caused by LC is esophageal varices (EV). Bleeding due to EV rupture is the main cause of mortality in patient with LC. EV band ligation can be used for primary or secondary prophylaxis to prevent bleeding. The purpose of this study was to know the clinical profile of LC patient with EV who underwent band ligation and who not underwent band ligation. Methods. A cross-sectional study was conducted in LC patients who underwent esophagogastroduodenoscopy (EGD) in Procedure Room Division of Hepatobiliary, Departement of Internal Medicine, Cipto Mangunkusumo Hospital from 2016 to 2017. Results. During January 2016-December 2017, a total of 313 patients underwent EGD. Most of them ( 73.2%) were male and predominantly > 60 years (34,2%). Most common LC etiology was hepatitis B (51.8%., There were 22% subjects with hepatocellular carcinoma (HCC). EV band ligations were done in 146 (46.7%) patients. In the ligation group, 56.2% patients were from outpatient clinic. The most common EGD indication (39%) was evaluation from previous ligation. Of 41.8% patients had Child-Turcotte-Pugh (CTP) class-A condition, 82.9% patients had MELD score < 15, 61.6% patients had large EV, 22.1% had red color sign (RCS) and 84,9% patients had portal hypertensive gastropathy. There were significant differences in CTP class, ascites, platelet, bilirubin, and albumin between ligation group compare to non-ligation group. Conclussion. Most of LC patients who underwent EV band ligation had CTP class-A, came from the outpatient clinic. The Jurnal Penyakit Dalam Indonesia | Vol. 6, No. 1 | Maret 2019 | 37 Profil Klinis Pasien Sirosis Hati dengan Varises Esofagus yang Menjalani Ligasi Varises Esofagus di Rumah Sakit Dr. Cipto Mangunkusumo main finding in EGD was large EV with portal hypertensive gastropathy. There were significant differences in liver functions between patient in ligation group compared to patient in non-ligation group.
Comparative Evaluation of Alpha-Fetoprotein Serum inHepatocellular Carcinoma Patients with Non-Viral Etiology Aprilicia, Gita; Bantas, Krisnawati; Syarif, Syahrizal; Kalista, Kemal Fariz
Jurnal Penyakit Dalam Indonesia Vol. 8, No. 1
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Introduction. Non-viral etiology of hepatocellular carcinoma (HCC) now needs attention. Hepatocellular carcinoma which was caused by hepatitis B and hepatitis C could be controlled in the national program, while HCC from non-B non-C etiology has become a further concern with the with the increased of metabolic syndrome. Serum alpha-fetoprotein is a tumor marker commonly used for screening for HCC in patients with liver cirrhosis (LC). However, in HCC patients with nonviral etiology, AFP serum tends to be normal. This study aimed to evaluate the performance of AFP serum based in HCC and LC patient with non-viral etiology and to evaluate the factors associated with elevated AFP. Methods. Data HCC from registry at Cipto Mangunkusumo Hospital in the period August 2015 to December 2019 were collected. Patients with liver cirrhosis (LC) were taken as the control group. The etiology of liver disease is determined by viral serological examination. Non-viral etiology was defined as a patient who was anti-HCV negative and HBsAg negative. Differences in AFP levels were evaluated by using the Mann Whitney test. Performance of serum AFP in viral and non-viral etiologies were evaluated by receiver operation character (ROC). The factors associated with an increase in AFP by a threshold of 10 ng/ml were evaluated by multivariate analysis using logistic regression. Results. There were 295 HCC patients and 155 LC patients who were included in this study. Non-viral etiology was found in 16.1% of LC group and 14.9% of HCC group. The median serum AFP in HCC patients was higher than in LC patients, 187.50 ng/ml vs. 4.60 ng/ml, p 5 cm was 2.89 (95% CI: 1.56 - 3.67; p value 0.001). Conclusions. AFP Serum is low in HCC patients with non-viral etiology. The increase of serum AFP above 10 ng/ml is associated with etiology of viral hepatitis and tumor size.
Pain Management in Advanced Hepatocellular Carcinoma:A Case Study Fitrianti, Fita; Shatri, Hamzah; Faisal, Edward; Putranto, Rud; Agung, Ratih Arianita; Nainggolan, Leonard; Kalista, Kemal Fariz; Irawan, Cophiadi
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 1
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Hepatocelullar carcinoma (HCC), the most common primary liver malignancy is the fifth most common cancer and the third most frequent cause of cancer related death globally. Pain comprises one the most common symptoms of HCC and may have severely negative effects on patient’s quality life. Furthermore, patients with HCC often presented with a cirrochis,so to control pain in this patient poses a clinical challenge. This case report discuss about a young 26-years-old male patient who presented with a four-month history of right upper quadrant abdominal pain and weight loss. HbsAg positive and serum alpha-fetoprotein level was high. Computed tomography (CT) and liver biopsy confirmed the presence of primary hepatocellular carcinoma.,with lung metastatic from the radiologic x-ray. Patient came with a loss of consciousness due to hypoglicemia. During hospitalization, patient complaint of abdominal pain and was given morphine intermediate release (MIR) to control the pain. By administering measurable and well-controlled opioids, the patient’s suffering can be reduced, thus improving the patient’s quality of life
Clinical Characteristic and Prevalence of Invasive Candidiasis Patient in Cipto Mangunkusumo Hospital Kalista, Kemal Fariz; Chen, Lie Khie; Wahyuningsih, Retno; Rumende, Cleopas Martin
Jurnal Penyakit Dalam Indonesia Vol. 4, No. 2
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Introduction. Incidence of invasive fungal infections (IFI) are reportedly increasing in many countries. Candida is the most common cause of IFI. This study was conducted to determine the prevalence, clinical characteristics, and etiologic pathogen in adult patients with invasive candidiasis (IC) at Cipto Mangunkusumo Hhospital. Methods. This was a cross sectional study with restropective data collection fromof septic patients that’ medical records hospitalized in January 2012 until June 2014. Subjects were selected based on EORTC/MSG 2008 diagnostic criteria for IC. Demographic data, clinical and supporting data, diagnosis, etiologic pathogens, antibiotics, antifungal, outcome, and length of stay were recorded. Results. The IC prevalence at Cipto Mangunkusumo hospital was 12,3% (91 patients from total of 738 sepsis patients). Subjects consisted of 35 proven, 31 probable, and 25 possible invasive candidiasis patients. Candidemia was the most common form of IC and C. albicans was the most common etiologic pathogen. Mean age were 47,9 years, dominated with medical, non-neutropenic, and septic shock patient. Most patients had malignancy with lung infection. The most common medical intervention was urinary catheter. Most patients were given 3rd generation cephalosporin and the most common antifungal used was fluconazole. Forty four percent of IC patients did not get systemic antifungal treatment. Mortality rate was 64.8% and median length of stay were 27 days. Conclusions. IC prevalence was 12,3%. Mortality due to IC was high and C. albicans was the most common etiologic pathogen.
Profil Klinis dan Kesintasan Pasien Karsinoma Sel Hati di Rumah Sakit Rujukan Tersier Indonesia Tahun 2015-2021 Hasan, Irsan; Gani, Rino Alvani; Sulaiman, Andri Sanityoso; Kurniawan, Juferdy; Lesmana, Cosmas Rinaldi A.; Jasirwan, Chyntia Olivia M; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Teressa, Maria
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 2
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Introduction. Hepatocellular carcinoma (HCC) is the most common primary liver cancer in the world and Indonesia. This study aimed to describe the clinical presentation and survival rate of HCC patients in Dr. Cipto Mangunkusumo Hospital (RSCM) as the Indonesian tertiary referral hospital in year 2015-2021 Methods. Cohort study was performed in year 2015-2021. Clinical presentations at the time of diagnosis were recorded from electronical health record. All HCC patients were followed up until death. One-year survival based on staging was assessed using log rank test and presented with Kaplan Meier curve. Results. A total of 799 HCC patients were included. Majority of HCC patients were male, 619 patients (77.5%), and aged 55 (SD 11.9) years. Hepatitis B was the major etiology, found in 500 patients (62.6%). Median of alfa feto-protein (AFP) was 1,109 (0.8-3,462,499) ng/ml. At the time of diagnosis, Barcelona Clinic Liver Cancer (BCLC) stage C (37.7%) was the most commonly found. Portal vein thrombosis was found in 205 patients (25.7%). There were 271 (33.9%) HCC patients received curative and palliative treatment, and others had supportive care. One year survival rate of HCC was 61.2%. One year survival rate of HCC based on staging for BCLC A, BCLC B, BCLC C, and BCLC D were 91.1%, 68.6%, 47.6%, and 13.3%, respectively (log-rank test: p<0.001). Conclusion. The majority of patients diagnosed with HCC were at an advanced stage so that the one-year survival is poor.
Perlemakan Hati Non-Alkoholik dan Risiko Fibrosis Hati pada Pasien Hepatitis B Kronik Sulaiman, Andri Sanityoso; Hasan, Irsan; Lesmana, Cosmas Rinaldi A.; Kurniawan, Juferdy; Jasirwan, Chyntia Olivia Maurine; Nababan, Saut Horas H.; Kalista, Kemal Fariz; Aprilicia, Gita; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
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Introduction. Prevalence of non-alcoholic fatty liver disease (NAFLD) is increasing throughout the world due to sedentary lifestyle and dietary habit, including in patients with chronic hepatitis B (CHB). In several studies, advanced of liver disease were more likely observed among those CHB patients with NAFLD. NAFLD might increase the risk of liver disease progression in CHB patients, but prior investigations were still limited. This study aimed to determine the association between NAFLD and risk of liver fibrosis in CHB patients. Methods. All patients with positive serum hepatitis B surface antigen in the Hepatobilier Data Registry, Cipto Mangunkusumo Hospital, were included in this study. Based on abdominal ultrasonography, patients were divided into two group (group I: non-NAFLD – hepatitis B patients vs. group II: NAFLD – hepatitis B patients). Data demographic and clinical examination were collected. Significant liver fibrosis was defined as stage liver fibrosis above 7 kPa (≥ F2). Logistic regression was used to identify NAFLD as risk factor for significant fibrosis. Variables were expressed as prevalence odd ratio (POR) with 95% CI. P values <0.05 were considered statistically significant. Results. Among 130 hepatitis B patients, 45 patients (34.6%) were diagnosed with NAFLD. Of 45 patients in group II, 36 patients (80%) had significant liver fibrosis. It was observed that a higher percentage of patients in group II were HBeAg negative compared to those in group I (66.7% vs. 35.9%; p=0.038). Furthermore, group II also displayed higher levels of liver stiffness compared to group I (12.22 (8.6 kPa) vs. 8.57 (7.8 kPa); p 0.016). In multivariate analysis, NAFLD was significantly associated with significant liver fibrosis (POR: 5.87; CI95%: 2.48 – 13.86; p < 0.001) after adjusted with HBeAg status. Conclusion. NAFLD associated with the higher risk of liver fibrosis in patients with hepatitis B. Modification of lifestyle and potential therapeutic intervention may help in reducing the progression of liver fibrosis.
Co-Authors A.A. Ketut Agung Cahyawan W Agung, Ratih Arianita Andri Sanityoso Andri Sanityoso Sulaiman Aprilicia, Gita C Rinaldi A Lesmana Chyntia Olivia M. Jasirwan Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Cleopas Martin Rumende Cophiadi Irawan E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edward Faisal Faisal, Edward Felix Firyanto Widjaja Fita Fitrianti Fitrianti, Fita Gita Aprilicia Gita Aprilicia Hanif, Muhammad Yusuf Irawan, Cophiadi Irsan Hasan Jasirwan, Chyntia Olivia M Juferdy Kurniawan Khie Chen Krisnawati Bantas Krisnawati Bantas Leonard Nainggolan Lutfie Lutfie, Lutfie Nababan, Saut Horas H. Putranto, Rud Ratih Arianita Agung Retno Wahyuningsih Retno Wahyuningsih Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rudi Putranto Saut Horas H. Nababan Syahrizal Syarif Syarif, Syahrizal Teressa, Maria