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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Occupational and Environmental Medicine Journal of Indonesia
Rino Alvani Gani
Division of Hepatobiliary, Department of Internal Medicine, Faculty of Medicine University of Indonesia/Dr. Cipto Mangunkusumo Hospital, Jakarta
Environmental Science Health Professions Medicine & Pharmacology Nursing Public Health

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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.
Proporsi Infeksi Virus Hepatitis B Tersamar pada Pasien yang Terinfeksi Human Immunodeficiency Virus Bratanata, Joyce; Gani, Rino Alvani; Karjadi, Teguh Haryono
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 3
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Pendahuluan. Infeksi hati kronik merupakan penyebab penting morbiditas serta mortalitas di antara penderita HIV positif pada pemakaian highly active antiretroviral therapies (HAART). Penyakit hati kronik dapat terjadi mulai dari infeksi tersamar sampai karsinoma hepatoselular. Kejadian VHB tersamar sering ditemukan pada pasien dengan kondisi imunosupresi seperti HIV. Penelitian ini bertujuan untuk mengetahui besarnya proporsi hepatitis B tersamar, hitung CD4+, transmisi IVDU, proporsi hepatitis C dan proporsi anti-HBc yang positif pada koinfeksi hepatitis B tersamar pada pasien HIV/AIDS di RSCM. Metode. Studi potong-lintang dilakukan pada pasien HIV yang berobat di Pokdisus dan ruang rawat inap RSCM dengan pengambilan sampel secara consecutive. Kriteria inklusi adalah pasien HIV dengan hasil HBsAg negatif dan belum pernah mendapat terapi antiretroviral. Subjek dengan hasil HBsAg negatif dilanjutkan dengan pemeriksaan anti-HBc, anti-HCV dan HBV DNA dengan teknik double step (nested) polymerase chain reaction (PCR) secara kualitatif dengan sensitifitas mencapai 102 kopi genom per mililiter serum. Ekstraksi HBV DNA menggunakan High Pure Viral Nucleic Acid Kit ® (Roche Diagnostics). Primers yang digunakan pada nested PCR berasal dari HBV-DNA S gene. Amplifikasi nested PCR dilakukan sebanyak dua putaran. Hasil. Selama bulan Desember 2008 – Januari 2009 diperoleh 58 subjek HIV. Pada akhir penelitian didapatkan 57 pasien memenuhi kriteria inklusi (68,4% laki-laki, usia 26-35 tahun sebanyak 68,4%, penularan HIV/AIDS melalui penggunaan jarum suntik secara bersama-sama 42,1%, hubungan seks 36,8%, dan keduanya 21,1%) dilakukan evaluasi adanya hepatitis B tersamar. Proporsi anti-HBc positif pada penderita HIV sangat tinggi (91,2%). Proporsi hepatitis B tersamar didapatkan pada 5 dari 57 subjek (8,8%). Proporsi hepatitis B tersamar lebih banyak didapatkan pada subjek dengan hitung CD4+ < 200 sel/μL (80%), risiko penularan IVDU (60%) dan hasil anti-HBc positif (80%). Proporsi koinfeksi hepatitis C dengan hepatitis B tersamar relatif lebih sedikit yaitu 40%. Simpulan. Proporsi hepatitis B tersamar didapatkan 8,8%. Proporsi hepatitis B tersamar lebih banyak didapatkan pada subjek dengan hitung CD4+ < 200 sel/μL (80%), risiko penularan IVDU (60%) dan hasil anti-HBc positif (80%). Proporsi koinfeksi hepatitis C dengan hepatitis B tersamar relatif lebih sedikit yaitu 40%. Keterbatasan penelitian ini adalah sensitivitas dari metoda PCR yang digunakan untuk mendeteksi DNA VHB dan dilakukan hanya satu kali pada setiap subjek. Perlu dilakukan penelitian lebih lanjut dengan sensitivitas PCR yang lebih tinggi dan jumlah sampel yang memadai untuk menentukan karakteristik dan hubungan berbagai faktor dengan kejadian infeksi virus hepatitis B tersamar pada pasien HIV.
Prevention of Hepatitis B Vertical Transmission: Focus on Antenatal Antiviral Administration Khumaedi, Anandhara Indriani; Gani, Rino Alvani; Hasan, Irsan
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
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Comparison of Renal Safety of Tenofovir and Telbivudine in Chronic Hepatitis B Patients: A Real World Study in Indonesia Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 3
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Introduction. Tenofovir disoproxil fumarate (tenofovir) and telbivudine are two available nucleos(t)ide analogue (NA) for the treatment of chronic hepatitis B (CHB) patients. Tenofovir has been known as a nephrotoxic agent in HIV patients, but still controversy in CHB patients. On the other hand, telbivudine had a renal protective effect and increased estimated glomerular filtration rate (eGFR). This studi aimed to address the renal safety of tenofovir and telbivudine in Indonesian patients. Method. A retrospective cohort study design was conducted in CHB patients who prescribed with tenofovir or telbivudine from January 2013 to December 2016. Patients who hade baseline eGFR
A Cohort Retrospective Study of Framingham Score and ECG Abnormality among Coal Mining Workers Anandita, Faizal Ablansah; Firdaus, Isman; Gani, Rino Alvani; Werdhani, Retno Asti; Mansyur, Muchtaruddin
Occupational and Environmental Medicine Journal of Indonesia Vol. 1, No. 1
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Introduction. ECG is widely used for detecting cardiovascular disease in coal mine worker’s medical check-up. As the study has proven, coal mine workers have a double cardiovascular risk from their workplace hazard and their own medical risks as individuals. An early detection and risk assessment method is needed to predict ECG abnormalities in the future. This study will analyze the relationship between ECG abnormality and Framingham Risk Score on coal mine workers’. Methods. We examine ECG result from medical check-up of male coal worker during 2018 and 2021. Using Minnesota Code, we determine ECG abnormality categories in the 2021 result, then compare it with coal handling type worker and Framingham Score in 2018 as the main medical factor. Results. Among 755 male coal workers with normal ECG in 2018, 158 (20,9%) were found with ECG abnormalities in 2021. Cohort’s multivariate study shows that type of coal worker is considered a determinant, but Framingham risk score still has the highest influence (p multivariate
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.
Faktor-Faktor yang Berhubungan dengan Gejala Depresi pada Pasien Insomnia Usia Lanjut di Rawat Jalan Pratiwi, Amalia Nur; Wahyudi, Edy Rizal; Kusumaningrum, Profitasari; Shatri, Hamzah; Rinaldi, Ikhwan; Gani, Rino Alvani; Wijaya, Ika Prasetya; Susilo, Adityo; Renaldi, Kaka
Jurnal Penyakit Dalam Indonesia
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Introduction. The elderly population is increasing globally, including in Indonesia, where 10.7% of the population in 2020 were elderly. Insomnia is a common health issue among older adults and has been identified as a predictor of depression. This study aims to identify factors associated with depressive symptoms in elderly outpatients with insomnia. Methods. This cross-sectional study was conducted in 2024 on patients aged ≥60 years at the outpatient unit of Cipto Mangunkusumo Hospital (RSCM), Jakarta, Indonesia, using consecutive sampling to select participants. Elderly patients were screened using the Pittsburgh sleep quality index (PSQI), and those with a score >5 (indicating insomnia) were included as study subjects. Data were collected through interviews, covering sociodemographic characteristics, level of loneliness, duration of insomnia, depressive symptoms [Geriatric Depression Scale–15 (GDS-15) items], functional status [Barthel Activities of Daily Living (B-ADL)], cognitive status [Mini-Mental State Examination (MMSE)], nutritional status [Mini Nutritional Assessment (MNA)], and chronic diseases [Cumulative Illness Rating Scale for Geriatrics (CIRSG) score]. Results. The study included 209 elderly subjects with insomnia, with a mean age of 72.88 (SD 6.98) years, and a depression prevalence of 6.7%. Bivariate analysis showed significant associations between dependency (PR 5.24; 95% CI 1.50 – 18.29), malnutrition (PR 11.54; 95% CI 4.77 – 27.92), and chronic disease with a CIRSG score ≥9 (PR 4.15; 95% CI 1.18 – 14.50) and depressive symptoms in elderly patients with insomnia. No significant associations were found between sociodemographic factors, loneliness, duration of insomnia, or cognitive status and depression. Multivariate logistic regression analysis revealed a statistically significant association between malnutrition and depressive symptoms (p < 0.001). Conclusions. There is a significant association between malnutrition and depressive symptoms in elderly outpatients with insomnia. Further cohort studies are recommended to explore the causal relationship between malnutrition and depression in elderly patients with insomnia.
Treatment for Intermediate-Stage Hepatocellular Carcinoma: Current Practice and Outcome in Real World Study Hasan, Irsan; Loho, Imelda Maria; Lesmana, Cosmas Rinaldi A.; Gani, Rino Alvani; Siregar, Lianda; Waspodo, Agus Sudiro; Lesmana, Laurentius A
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

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Background: Intermediate-stage hepatocellular carcinoma (HCC) is a very heterogeneous disease. The first line treatment for this group is transarterial chemoembolization (TACE), however, in clinical practice, not all patients are suitable for TACE. We aim to evaluate current treatment practice and outcome of patients with intermediate-stage HCC.Methods: HCC patients database from 2013 to 2016 in Cipto Mangunkusumo Hospital and Dharmais Cancer Hospital were retrospectively analyzed. Patients with intermediate-stage HCC were included in this study.Results: A total of 456 patients were diagnosed with HCC, but only 151 (33.1%) patients with intermediate-stage HCC were included. Men outnumbered women in a ratio of 3:1. The most common etiology for HCC was hepatitis B virus (HBV) infection, which accounted for 55% of patients. Fifty-two patients (34.4%) were treated with TACE as first-line treatment. Sixty-seven patients (44%) were given best supportive care due to ineligibility for TACE. Frequency of TACE varied from one to eleven times. Overall median survival was 617 days (1.7 years). One-year survival for patients undergoing TACE and liver resection was 47% and 60%, respectively. We did not compare the survival between any treatment groups because the number of patient in each group is not sufficient to be statistically analyzed.Conclusion: Only 34.4% of patients with intermediate-stage HCC was treated with TACE as first-line treatment. An improvement in the treatment strategy should be done for HCC patients in Indonesia.
Co-Authors -, Arles - -, Suhendro - -, Suhendro - A.A. Ketut Agung Cahyawan W Abdul Aziz Rani Adityo Susilo, Adityo Agus Sudiro Waspodo Ahimsa, Titos Ahimsa, Titos Ali Sulaiman Anandhara Indriani Khumaedi, Anandhara Indriani Anandita, Faizal Ablansah ANDI UTAMA Andri Sanityoso Andri Sanityoso Sulaiman Aprilicia, Gita Ari Fahrial Syam Bambang Sutopo Bhanu S Kumar C Rinaldi A Lesmana Chudahman Manan Chyntia Olivia Maurine Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Devy Serevina Dyah Ratna Budiani E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Ening Krisnuhoni Epistel Pangujian Simatupang Evy Yunihastuti FX Pridady Griscalia Christine Hanif, Muhammad Yusuf Hardigaloeh, Amanda Trixie Ihsanil Husna Ika Prasetya Wijaya Ikhwan Rinaldi Imelda Maria Loho, Imelda Maria Indra Marki Indra, Suwito Irsan Hasan Isman Firdaus Jacobus Albertus Jasirwan, Chyntia Olivia M Joyce Bratanata, Joyce Juferdy Kurniawan Kaka Renaldi Kemal Fariz Kalista, Kemal Fariz Kuntjoro Harimurti Kusumaningrum, Profitasari Laurentius A Lesmana, Laurentius A Laurentius Lesmana Lianda Siregar Lies Luthariana Loli J Simanjuntak Lutfie Lutfie, Lutfie Marcellus Simadibrata Marcellus Simandibrata Mesanti, Oska Muchtaruddin Mansyur Murdani Abdullah Nababan, Saut Horas H. Nanang Sukmana Nurul Akbar Pratiwi, Amalia Nur Ralph Girson Gunarsa Ratu Ratih Kusumayanti Retno Asti Werdhani Sabarinah Prasetyo Sabarudin, Adang Sjaifoellah Noer Soemarno Soemarno Suhendro Suhendro Sulaeman, Andri Sanityoso Susan Tai Teguh Haryono Karjadi, Teguh Haryono Teressa, Maria Unggul Budihusodo Vera Yuwono Yustar Mulyadi