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All Journal Medical Journal of Indonesia Molecular and Cellular Biomedical Sciences (MCBS) Jurnal Gizi Klinik Indonesia The Indonesian Journal of Community and Occupational Medicine Indonesian Journal of Cancer The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Occupational and Environmental Medicine Journal of Indonesia

Rino A Gani

Department Of Internal Medicine, Faculty Of Medicine, Universitas Indonesia, Jakarta, Indonesia

Author-ID : 268596

Biochemistry, Genetics & Molecular Biology Dentistry Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health

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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
Publisher : UI Scholars Hub

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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
Publisher : UI Scholars Hub

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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 Vol. 12, No. 3
Publisher : UI Scholars Hub

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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

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.

Effect of matrix metalloproteinase-9 inhibitors in hepatitis B virus replication Kalista, Kemal Fariz; Harimurti, Kuntjoro; Immanuel, Suzanna; Iskandriati, Diah; Lesmana, Cosmas Rinaldi Adithya; Ibrahim, Fera; Gani, Rino Alvani
Medical Journal of Indonesia Vol. 34 No. 4 (2025): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.oa.257895

BACKGROUND Hepatitis B virus (HBV) remains difficult to eradicate due to the persistence of covalently closed circular DNA (cccDNA). Matrix metalloproteinase-9 (MMP-9) enhances HBV replication, but the effects of its inhibition remain unexplored. This study aimed to investigate the effects of MMP-9 inhibitors on HBV replication markers. METHODS Primary hepatocyte cultures were obtained from the livers of 6 Tupaia javanica. Cultures were infected with HBV from human sera and divided into control and intervention groups. The intervention group received MMP-9 inhibitors at 1, 3, and 7 nM. The control group received phosphate-buffered saline. Levels of hepatitis B surface antigen (HBsAg), HBV DNA, cccDNA, MMP-9, interferon alpha and beta receptor subunit 1 (IFNAR1), and interferon beta (IFN-β) were measured in both groups before and 72 hours post-intervention. RESULTS MMP-9 inhibitor administration at 1, 3, and 7 nM consistently reduced HBsAg, HBV DNA, cccDNA, and MMP-9 levels, though not statistically significant. Median HBV DNA levels at 1, 3, and 7 nM were 7.05, 5.29, and 5.98 ×103 copies/ml, respectively. Mean cccDNA levels at 1, 3, and 7 nM were 14.15, 11.04, and 13.94 ×103 copies/ml, respectively. The 3 nM dose increased IFNAR1 levels, while the 7 nM dose increased IFN-β, but neither change was significant. Among the tested doses, 3 nM showed the most favorable effects despite the lack of significance. CONCLUSIONS MMP-9 inhibitor suppressed HBsAg, HBV DNA, cccDNA, and MMP-9 while increasing IFNAR1 and IFN-β in vitro.

Kesintasan Hidup Satu Tahun Pasien Sirosis Hati yang Dirawat di Rumah Sakit Cipto Mangunkusumo pada Periode COVID-19 Aprilicia, Gita; Baihaki, Ichwan; Banjarnahor, Riri Oktavani; Kalista, Kemal Fariz; Gani, Rino Alvani
Jurnal Penyakit Dalam Indonesia Vol. 13, No. 1
Publisher : UI Scholars Hub

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Introduction. Liver cirrhosis represents the terminal stage of chronic liver disease and is characterized by a markedly reduced survival rate. Understanding the characteristics and laboratory parameters of patients with liver cirrhosis can provide valuable insights into their prognosis and potential interventions. This study was conducted during the COVID-19 pandemic period, which may have influenced patient outcomes due to potential impact of COVID-19 infection on patients with chronic liver disease. This study aimed to evaluate the one-year survival rate of hospitalized liver cirrhosis patients at Cipto Mangunkusumo Hospital during the COVID-19 and to identify clinical and laboratory factors associated with patient survival. Methods. This retrospective study analyzed data from 73 in-hospital liver cirrhosis patients during January to December 2020. Demographic characteristics, comorbidities, diagnosis upon admission, and laboratory parameters were collected. Patients were categorized into two groups: those who survived and those who died within one year of hospitalization. Survival analysis was performed using the Kaplan–Meier method to estimate 1 year survival probability of cirrhosis patients. Results. The analysis revealed significant differences in several characteristics and laboratory parameters between the survival and death groups during COVID-19 period. The etiology of liver cirrhosis was predominantly related to HBV (41.1%) and HCV (23.3%), which constituted the most common causes. Diagnosis upon admission showed a significant association with survival, with bleeding esophageal varices (53.4%) being the most prevalent. Laboratory parameters such as SGOT, SGPT, albumin, bilirubin, prothrombin time, INR, and Child Pugh score demonstrated significant differences between the two groups. The 1-year survival rate for the Child Pugh class A, B and C was approximately 100%, 61.2% (CI 95% 42.2 - 80.2%) and 0%, respectively. The overall 1-year survival rate of in-hospital liver cirrhosis patients was 52.6% (CI 95% 38.7 - 66.5%). Conclusions. This study found the overall survival of in-hospital liver cirrhosis patients during COVID-19 period was low. It’s essential to develop a comprehensive and personalized treatment plan for optimal patient outcomes.

Hypertension and Its Association with Noise Exposure among Blacksmith Workers in an Indonesian Village Christopher F. Jaya; Marsen Isbayuputra; Jenny Bashiruddin; Dewi Sumaryani Soemarko; Rino Alvani Gani
The Indonesian Journal of Community and Occupational Medicine Vol. 6 No. 1 (2026): ijcom
Publisher : ILUNI MKK FKUI and PRODI MKK FKUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53773/ijcom.v6i1.212.8-15

Background: Blacksmith workers are at high risk of hypertension due to occupational exposures such as noise, heat, and heavy physical activity. Although noise exposure has been linked to cardiovascular stress through sympathetic activation, evidence regarding its direct association with hypertension in informal workers remains limited.Objective: To determine the prevalence of hypertension and its associated factors among blacksmith workers in an Indonesian village and to identify whether occupational noise exposure contributes to increased blood pressure.Methods: This was an analytical observational study with a cross-sectional design involving 107 blacksmith workers. Data were collected through interviews, blood pressure measurements, noise level assessment using a sound level meter, and body mass index (BMI) calculation. Bivariate analysis used Chi-square and Mann–Whitney tests, while multivariate analysis used logistic regression.Results: The prevalence of hypertension was 34.5%. Bivariate analysis showed significant associations between noise intensity (p=0.008), age (p=0.001), working duration (p=0.042), smoking degree (p=0.002), and BMI (p<0.001) with hypertension, whereas noise type was not significant (p>0.05). In multivariate analysis, only BMI remained significant (aOR=2; 95% CI: 1.3–3.3).Conclusion: The prevalence of hypertension was 34.5%. BMI is an independent risk factor for hypertension among blacksmith workers. Noise exposure was not significantly associated with increased blood pressure, likely due to confounding effects and non-differential noise types. Interventions should focus on weight management and regular blood pressure monitoring in this worker population.

Immune-Excluded CD4⁺ and CD8⁺ T-Cell Depletion Predicts Early Recurrence in Hepatocellular Carcinoma with Microvascular Invasion: T-Cell Depletion and Early HCC Recurrence Lianda Siregar; Rino Alvani Gani; Toar J.M. Lalisang; Irsan Hasan; Suhendro Suhendro; Heriawan Soejono; Siti Boedina Kresno; Nurjati Chairani Siregar; Begawan Bestari
Indonesian Journal of Cancer Vol. 20 No. 3 (2026): September
Publisher : http://dharmais.co.id/

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33371/ijoc.v20i3.1674

Background: Early recurrence within six months after resection continues to pose a major clinical challenge in hepatocellular carcinoma (HCC) patients, occurring in approximately 31.9% of patients. This study aims to investigate whether reduced immune cell infiltration across intratumoral and peritumoral compartments is associated with early HCC recurrence in patients with high angiogenic activity and microvascular invasion (MVI). Methods: A multicenter nested case–control study was conducted using liver tissue samples from 49 patients with HCC who underwent surgical resection. Clinical data were retrieved from medical records. Pathological and immunological parameters were assessed using hematoxylin–eosin (H&E) staining for tumor-infiltrating lymphocytes (TILs) and immunohistochemistry for VEGF, CD4, CD8, and regulatory T cells. The analytical approach included ROC curve analysis, Kaplan-Meier survival estimation, and multivariate Cox regression. Results: Early recurrence occurred in 11 of 49 patients, all showing high VEGF and most with microvascular invasion. Patients with early recurrence had markedly lower intratumoral CD4⁺ T-cell density and reduced peritumoral CD8⁺ T-cell density, while peritumoral CD4⁺ and overall TILs remained higher than intratumoral. Multivariable analysis identified low intratumoral CD4⁺ (HR 7.98; 95% CI: 1.63–39.07) and decreased peritumoral CD8⁺ (HR 4.98; 95% CI: 1.14–21.70) as independent predictors. Intratumoral and peritumoral Treg densities showed no significant association. Conclusions: Low intratumoral CD4⁺ and peritumoral CD8⁺ infiltration were identified as independent predictors of early HCC recurrence, reflecting an immune-excluded tumor phenotype characterized by high peritumoral CD4⁺ and TILs. In this context, angiogenesis-driven stromal and vascular barriers impede effective T-cell trafficking into the tumor core, facilitating early recurrence, particularly in tumors with microvascular invasion. These findings underscore the need for intensified post-resection surveillance and may define a high-risk subgroup for future evaluation of adjuvant therapies.

Co-Authors -, Arles - -, Suhendro - -, Suhendro - A. D. Handayu A.A. Ketut Agung Cahyawan W Abdul Aziz Rani Adang Sabarudin Adityo Susilo, Adityo Agus Sudiro Waspodo Agus Waspodo Ahimsa, Titos Ahimsa, Titos Aida Lydia Alexander Michael Joseph Saudale Ali Sulaiman Ali Sulaiman Alvina Widhani, Alvina Amanda Trixie Hardigaloeh Anandhara Indriani Khumaedi Anandhara Indriani Khumaedi, Anandhara Indriani Anandita, Faizal Ablansah Andi Utama ANDI UTAMA Andri Sanityoso Andri Sanityoso Andri Sanityoso Sulaiman Aprilicia, Gita Ari Fahrial Syam Arles - - Baiq Kirana DN Mandasari Bambang Sutopo Banjarnahor, Riri Oktavani Begawan Bestari Bhanu S Kumar C Martin Rumende C Martin Rumende C Rinaldi A Lesmana Christopher F. Jaya Chudahman Manan Chudahman Manan Chyntia Olivia M. Jasirwan Chyntia Olivia Maurine Chyntia Olivia Maurine Jasirwan, Chyntia Olivia Maurine Cleopas Martin Rumende Daldiyono Daldiyono Daldiyono Daldiyono Devy Serevina Dewi Sumaryani Soemarko DIAH ISKANDRIATI Diah Iskandriati Dyah Ratna Budiani E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Edy Rizal Wahyudi Ening Krisnuhoni Epistel Pangujian Simatupang Erni Erfan, Erni Evy Yunihastuti Fera Ibrahim FX Pridady Griscalia Christine H. M.S. Noer H.M. Sjaifoellah Noer Hanif, Muhammad Yusuf Hardigaloeh, Amanda Trixie Heriawan Soejono Ichwan Baihaki Ignatius R Tenggara, Ignatius R Ihsanil Husna Ika Prasetya Wijaya Ikhwan Rinaldi Imelda Maria Loho Imelda Maria Loho, Imelda Maria Indra Marki Indra Marki Indra, Suwito Irsan Hasan Irsan Hasan Irsan Hasan Isman Firdaus Jacobus Albertus Jasirwan, Chyntia Olivia M Jenny Bashiruddin Joyce Bratanata Joyce Bratanata, Joyce Juferdy Kurniawan Julius R Samban Kaka Renaldi Kemal F Calista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista Kemal Fariz Kalista, Kemal Fariz Kuntjoro Harimurti L. A. Lesmana Laurentius A Lesmana Laurentius A Lesmana, Laurentius A Laurentius Lesmana Laurentius Lesmana Lianda Siregar Lianda Siregar Lies Luthariana Loli J Simanjuntak Lutfie Lutfie, Lutfie Marcellus Simadibrata K Marcellus Simandibrata Marsen Isbayuputra Maryati Surya Matthew Billy Maulana Suryamin Maulana Suryamin, Maulana Mesanti, Oska Muchtaruddin Mansyur Muhammad Sjaifoellah Noer Muhammad Yusuf Hanif Murdani Abdullah Nababan, Saut Horas Hatoguan Nafrialdi Nafrialdi Nanang Sukmana Nanang Sukmana Nurjati Chairani Siregar Nurul Akbar Nurul Akbar Oliver Emmanuel Yausep Oska Mesanti Prasna Pramita Pratiwi, Amalia Nur Profitasari Kusumaningrum Radhian Amandito Raksheeth Agarwal Ralph Girson Ralph Girson Gunarsa Ratu Ratih Kusumayanti Reny Mulatsih Retno Asti Werdhani Rika Bur Sabarinah Prasetyo Sabarudin, Adang Saut HH Nababan Seruni Tyas Khairunissa Silmi Mariya Siti Boedina Kresno Siti Setiati Sjaifoellah Noer Soemarno Soemarno Soemarno Soemarno Sri Agustini Kurniawati Sri Agustini Kurniawati, Sri Agustini Suhendro - - Suhendro Suhendro Suhendro Suhendro Suhendro Suhendro Sulaeman, Andri Sanityoso Susan Tai Suwito Indra Suzanna Immanuel Syahrizal Syarif Teguh H Karjadi Teguh H Karjadi, Teguh H Teguh H. Karjadi, Teguh H. Teguh Haryono Karjadi Teguh Haryono Karjadi, Teguh Haryono Teressa, Maria Titos Ahimsa Toar J.M. Lalisang Unggul Budihusodo Vera Yuwono Vito Filbert Jayalie, Vito Filbert Wirasmi Marwoto Wirasmi Marwoto Yustar Mulyadi Zubairi Djoerban Zubairi Djoerban

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