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All Journal Indonesian Journal of Cancer Makara Journal of Health Research The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine
Divisi Hepatobilier Departemen Ilmu Penyakit Dalam, Fakultas Kedokteran Universitas Indonesia/Rumah Sakit Dr. Cipto Mangunkusumo, Jakarta
Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Public Health

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Kasabach-Merritt Syndrome in Liver Hemangioma: A Case Report Frastica, Michelle; Putranto, Rudi; Jasirwan, Chyntia Olivia Maurine; Adhiatma, Kresna
Jurnal Penyakit Dalam Indonesia Vol. 9, No. 3
Publisher : UI Scholars Hub

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Abstract

Hemangioma is the most common congenital benign liver tumor. It affects mostly female, with the incidence of 0.4- 20%. Giant liver hemangioma induce the Kasabach Merritt syndome, a life threathening coagulation disorder which occur due to consumptive coagulopathy: trombocyte sequestration and agregation inside the hemangioma. The mortality rate is around 60%, with the most common cause is multiorgan complication which may end up with sepsis. The core management is hemangioma decompression by surgical measure. However, this often considered as a very risky procedure leading to massive bleeding. In most cases, conservative treatment is the preferred option. It is important to consider Kasabach Merritt syndome as one of the differential diagnosis when facing cases with enlarged abdomen in order to plan for its treatment as well as educate the patients regarding the prognosis.
Infeksi Komorbid Virus Hepatitis B Tersamar dan Human Immunodeficiency Virus (HIV) Jasirwan, Chyntia Olivia Maurine
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Abstract

Infeksi virus hepatitis B (VHB) dapat bermanifestasi dalam berbagai kondisi mulai dari asimtomatik (karier), hepatitis kronik, sirosis hati, sampai karsinoma hepatoseluler.
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.
Surgical Shunting Versus Trans-Jugular Intrahepatic Portosystemic Shunt for Recurrent Variceal Bleeding in Portal Hypertension Due to Liver Cirrhosis: An Evidence-Based Case Report Magfira, Nadya; Nurrafiani, Arie Rozzaqi; Jasirwan, Chyntia Olivia Maurine; Suhartono, Raden
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 3 (2023): VOLUME 24, NUMBER 3, December, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2432023264

Abstract

Aim: This evidence-based case report aims to determine whether the surgical shunt is better than the trans-jugular intrahepatic portosystemic shunt (TIPS) to prevent re-bleeding in patients with portal hypertension due to liver cirrhosis.  Method: Literature searching was performed in 4 online databases, Cochrane, PubMed, Embase, and SCOPUS. Three meta-analyses were appraised critically.Results: Of all meta-analyses included, the internal validities were poor and only included a small number of trials. However, the results show that surgical shunt is better for preventing variceal re-bleeding with varied heterogeneities.Conclusion: Surgical shunts may have benefits over TIPS in preventing variceal re-bleeding. 
Kesintasan Pasien Karsinoma Hepatoselular: Sebuah Studi Komprehensif tentang Pengaruh Awitan Dini versus Lambat dan Faktor Determinannya Achmad, Ibrahim; Jasirwan, Chyntia Olivia Maurine; Rajabto, Wulyo; Abdullah, Murdani; Nababan, Saut Horas H.; Nasution, Sally Aman; Koesnoe, Sukamto; Sari, Nina Kemala
Jurnal Penyakit Dalam Indonesia
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Introduction. The prognosis for patients with Hepatocellular Carcinoma (HCC) is generally poor because most cases are diagnosed at an advanced stage. Several studies indicate that HCC is more prevalent and has a worse prognosis among younger individuals. This study aims to identify and compare the variations in survival rates between early and late-onset HCC patients at Cipto Mangunkusumo Hospital and investigate the factors that impact survival outcomes in both groups. Methods. Retrospective cohort study of HCC patients registered in HCC registry 2015-2022. Survival was visualized using Kaplan-Meier curves. Prognostic factor variables in the Cox Proportional Hazard Regression analysis by backward method in the final model became independent prognostic factors for overall survival. Results. There were 896 subjects. Patients with early onset had a median survival of 2.0 months (95% CI 1.0-2.9), while late-onset patients had a median survival of 4.0 months (95% CI 3.4-4.5) (p=0.021). During the observation period, the incidence of death in early onset was found to be higher compared to late onset (92.9% vs. 87.7%, p 0.032). In the multivariate analysis for early onset, hypertension comorbidity and lack of hepatitis treatment were prognostic factors increasing the risk of death with [HR 3.7 (95% CI: 1.0-12.7)] and [HR 2.4 (95% CI: 0.9-6.2)] (p=0.053). In the multivariate analysis for late onset, prognostic factors increasing the risk of death include AFP levels ≥200 ng/mL [HR 1.2 (95% CI: 1.0-1.5)], liver cirrhosis [HR 1.2 (95% CI: 1.0-1.3)], AJCC stage 4 as the most advanced stage [HR 4.5 (95% CI: 2.2-8.9)], supportive therapy [HR 5.2 (95% CI: 3.9-6.8)], and palliative therapy [HR 1.6 [95% CI: 1.2-2.2)]. Conclusion. The median survival of early-onset HCC patients is lower compared to late-onset ones because the majority are not given curative treatment. Independent prognostic factors in early-onset are hypertension and hepatitis treatment, while in late-onset AFP levels, liver cirrhosis, AJCC stage, and therapy are given.
Stimulation Effect of Exosome From Healthy Sera to Natural Killer (NK) Cells of Hepatocellular Carcinoma Subject In Vitro Deby, Deby; Antarianto, Radiana Dhewayani; Barasila, Atikah Chalida; Irawan, Cosphiadi; Ahani, Ardhi Rahman; Jasirwan, Chyntia Olivia Maurine; Damayanti, Lia; Ritchie, Ni Ken; Aditya, Robby Nur
Indonesian Journal of Cancer Vol 18, No 4 (2024): December
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v18i4.1122

Abstract

Background: Hepatocellular carcinoma has a poor prognosis due to limitations of therapy such as late diagnosis, lack of specific biomarkers, and insensitivity to this tumor agent. This study aims to develop immunotherapy using autologous natural killer cells (NK cells) with exosome stimulation for hepatocellular carcinoma patients, addressing treatment limitations.Methods: Experimental research conducted from October 2022 to June 2023 at Universitas Indonesia’s Faculty of Medicine involved three hepatocellular carcinoma patients at Dr. Cipto Mangunkusumo General Hospital in Jakarta, Indonesia. NK cells from hepatocellular carcinoma patients were isolated from peripheral venous blood, and exosomes were isolated from the blood serum of healthy donors. Exosome characterization with a particle size analyzer and flow cytometry. Stimulation of exosomes on NK cells for 24 hours, then evaluation of expression of NKp44, NKp46, NKp30, NKG2D, KIR2D, and NKG2A receptors, as well as perforin and granzyme B expression. Visualization of interactions of NK cells with other mononuclear cell fractions (CD4, CD8, CD11c, and CD19) by immunofluorescence. The study compares stimulated and unstimulated NK cells, analyzing their expression of activated and inhibitory receptors, using either the One-Way Anova parametric test or the Kruskal-Wallis non-parametric test for non-normally distributed data.Results: Particle size 100 nm, negative electric charge, and CD63+CD81+ (double positive) exosome isolated results. There was increased expression of receptors NKp44, NKp46, NKp30, NKG2D, decreased expression of NKG2A, and increased expression of perforin and granzyme B in exosome-induced NK cells. There was no cell interaction in the form of immune synapses between exosome-induced NK cells and other mononuclear cell fractions in hepatocellular carcinoma patients. Conclusions: Induction of exosomes into NK cells of hepatocellular carcinoma patients restores the cytotoxic ability of NK cells
Histodynamics of Natural Killer Cells from a Healthy Donor Exposed to Exosomes from the Blood of Hepatocellular Carcinoma Patients Asrinda, Indria; Antarianto, Radiana Dhewayani; Jusuf, Ahmad Aulia; Ahani, Ardhi Rahman; Jasirwan, Chyntia Olivia Maurine; Ritchie, Ni Ken; Nur Aditya, Robby; Irawan, Cosphiadi
Makara Journal of Health Research Vol. 28, No. 3
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Background: Hepatocellular carcinoma (HCC) is the leading form of liver cancer and the second leading cause of cancer-related deaths globally. Exosomes in the HCC microenvironment can induce significant changes in natural killer (NK) cells during endocytosis. The present study aimed to distinguish exosomes in the blood of HCC patients, analyze changes in NK cell phenotype, and evaluate peroxidase and toluidine blue staining as alternative methods for observing the changes. Methods: NK cells were collected from healthy donors, and exosomes were extracted from the blood of HCC patients. The exosomes were characterized in accordance with MISEV 2018 guidelines, and NK cells were incubated with HCC-derived exosomes. NK cell phenotype changes were assessed using immunofluorescence, toluidine blue staining, and peroxidase staining. Results: The identified exosomes measured 34.7 nm, had a charge of −4.33 mV, and were positive for CD81+. Changes in NK cell receptor expression following exposure to HCC exosomes were not significant (p > 0.05). Immunofluorescence confirmed exosome endocytosis by NK cells, toluidine blue staining revealed negative metachromasia and peroxidase staining indicated morphological NK cell changes. Conclusions: This study demonstrates that peroxidase and toluidine blue staining are effective for observing exosome endocytosis in NK cells, enhancing our understanding of HCC exosome-NK cell interactions and beneficial in developing future therapeutic strategies targeting the HCC microenvironment.
Diagnosis and Management of Portal Vein Thrombosis in Liver Cirrhosis Kurniawan, Cynthia; Jasirwan, Chyntia Olivia Maurine
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 1 (2025): VOLUME 26, NUMBER 1, April, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/261202568-75

Abstract

Portal vein thrombosis is formation of thrombus in main portal vein and its branches, that may also affect superior or mesenteric veins. Rebalanced coagulation system and changes in hepatic portal venous flow augment risk of portal vein thrombosis. Modalities to identify portal vein thrombosis include ultrasonography, contrast enhanced Computed Tomography (CT), and Magnetic Resonance Imaging (MRI). The management of portal vein thrombosis in hepatic cirrhosis is challenging due to intricate balance between thrombosis and bleeding complicating treatment decision. Treatment option consisted of close monitoring, anticoagulation, thrombolysis, and trans-jugular intrahepatic portosystemic shunt (TIPS). Anticoagulant options for management of portal vein thrombosis encompass Low Molecular Weight Heparin (LMWH), Vitamin K Antagonist (VKA), and Direct Oral Anticoagulant (DOAC). There is still no consensus regarding the thrombolysis for the management of portal vein thrombosis in cirrhosis due to lack of evidence. TIPS may be considered in portal vein thrombosis with insufficient response or contraindication to anticoagulation, repeated variceal bleeding, and/ or refractory ascites which unable to be controlled by medical or endoscopic management. This review aims to discuss the current update in diagnosis and management of portal vein thrombosis in liver cirrhosis.Keywords: Cirrhosis, portal vein thrombosis, anticoagulant
Clinical Practice in Intermediate Hepatocellular Carcinoma in the Real World Jasirwan, Chyntia Olivia Maurine
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 23, No 1 (2022): VOLUME 23, NUMBER 1, April 2022
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (228.056 KB) | DOI: 10.24871/23120221-2

Abstract

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Co-Authors Achmad, Ibrahim Adhiatma, Kresna Adik Wibowo Aditya, Robby Nur Adityo Susilo, Adityo Ahani, Ardhi Rahman Ahmad Aulia Amal C Sjaaf Andri Sanityoso Andri Sanityoso Sulaiman Antarianto, Radiana Dhewayani Aprilicia, Gita Asrinda, Indria Baiq Kirana DN Mandasari Barasila, Atikah Chalida C Rinaldi A Lesmana Cosphiadi Irawan Cynthia Kurniawan Deby Deby Dedy Pratama Dyah Purnamasari Evy Yunihastuti Fachriza, Ihza Frastica, Michelle Gabriella, Stacy Gita Aprilicia Gita Aprilicia Hanif, Muhammad Yusuf Ihza Fachriza Irsan Hasan Juferdy Kurniawan Karina Zulkarnain Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Lia Damayanti Lutfie Lutfie, Lutfie Magfira, Nadya Maria, Suzy Muhammad Yusuf Hanif Muradi, Akhmadu Murdani Abdullah Myranda Zahrah Putri Nababan, Saut Horas H. Ni Ken Ritchie, Ni Ken Nur Aditya, Robby Nurrafiani, Arie Rozzaqi Patrianef Darwis Putri, Myranda Zahrah Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rino Alvani Gani Rudi Putranto Sally Aman Nasution, Sally Aman Sari, Nina Kemala Saut HH Nababan Saut Horas Hatoguan Nababan Stacy Gabriella Suhartono, Raden Sukamto Koesnoe Suzy Maria Syahidatul Wafa Syahidatul Wafa, Syahidatul Syahrizal Syarif Teguh Dwi Nugroho Wulyo Rajabto