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All Journal journal of internal medicine Folia Medica Indonesiana Indonesian Journal of Tropical and Infectious Disease The Indonesian Biomedical Journal Syntax Literate: Jurnal Ilmiah Indonesia Biomolecular and Health Science Journal Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML) Majalah Biomorfologi (Biomorphology Journal) JOURNAL OF COMMUNITY MEDICINE AND PUBLIC HEALTH RESEARCH CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL Indian Journal of Forensic Medicine & Toxicology Narra J Journal of Scientech Research and Development The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy
Ummi Maimunah
Division Of Gastroentero-hepatology, Department Of Internal Medicine, Faculty Of Medicine, Universitas Airlangga/Dr Soetomo General Hospital, Surabaya
Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Earth & Planetary Sciences Education Environmental Science Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Public Health Social Sciences Other

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Hepatocellular Carcinoma with Chronic Hepatitis B and Non-Islet Cell Tumor Hypoglycemia: A Case Report: NICTH in HCC: A Case Report Tjahjadi, Angela Kimberly; Maimunah, Ummi; Loho, Imelda Maria
Current Internal Medicine Research and Practice Surabaya Journal Vol. 5 No. 2 (2024): CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/cimrj.v5i2.52406

Abstract

Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome manifestation associated with hepatocellular carcinoma (HCC). This report details a case of a 20-year-old woman with HCC linked to untreated chronic hepatitis B. The patient presented with refractory hypoglycemia that was suspected to be NICTH. She also exhibited decreased consciousness with an initial blood glucose reading of 31 mg/dL. After the administration of intravenous dextrose solution, the patient's consciousness improved, yet intermittent hypoglycemic episodes persisted due to insufficient oral intake. The laboratory findings revealed low levels of insulin and C-peptide. The management of the patient included a continuous infusion of 5% dextrose solution, administration of corticosteroids, and adherence to a high-calorie complex carbohydrate diet. Despite presenting with significant right upper abdominal discomfort and weight loss, the patient was diagnosed with HCC at stage B, according to the Barcelona Clinic Liver Cancer (BCLC) Staging System. The stage was determined based on the presence of extensive multifocal lesions, which rendered surgical resection and transarterial chemoembolization (TACE) non-viable. Consequently, palliative treatment using lenvatinib and antiviral therapy with tenofovir were initiated. NICTH involves an increased insulin-like growth factor 2 (IGF-2) precursor processing by tumor cells, leading to heightened peripheral glucose utilization and persistent hypoglycemia. Although tumor resection is the most effective treatment for NICTH, it was not feasible in this case. This report emphasizes the importance of considering NICTH in the differential diagnosis of refractory hypoglycemia for non-diabetic patients. It also underscores the need for parenteral nutrition and corticosteroid therapy to maintain euglycemia.   Highlights: 1. This case report details a rare clinical presentation of non-islet cell tumor hypoglycemia (NICTH) associated with hepatocellular carcinoma (HCC) and chronic hepatitis B in a young patient, adding to the limited documented cases of this paraneoplastic syndrome. 2. The report provides a thorough clinical description, extensive diagnostic workup, and comprehensive management strategies, offering valuable insights into the complexities and challenges in diagnosing and treating NICTH in HCC patients. 3. This case emphasizes the critical need for early detection and intervention in HCC, particularly in non-cirrhotic patients with chronic hepatitis B, and highlights the importance of considering paraneoplastic syndromes in the differential diagnosis of refractory hypoglycemia in non-diabetic patients.
Correlation between interleukin-6 expression in post-mortem core liver biopsy and degree of liver injury in patients with fatal COVID-19 Maimunah, Ummi; Maharani, Andi RK.; Soegiarto, Gatot; Rahniayu, Alphania; Gunawan, Vania A.; Wiratama, Priangga A.; Djuanda, Stephanie N.; Supriadi, Supriadi; Marhana, Isnin A.; Semedi, Bambang P.; Lefi, Achmad; Kusumastuti, Etty H.; Suyanto, Edi; Lilihata, Jilientasia G.; Anggoro, Adhitri; Rinjani, Lalu GP.; Rosyid, Alfian N.; Wahyu, Dwi; Fauziah, Dyah; Rahaju, Anny S.; Kurniasari, Nila; Ariani, Grace; Nugroho, Gilang MS.; Yandi, I KR.; Nugraha, Ricardo A.
Narra J Vol. 3 No. 3 (2023): December 2023
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v3i3.463

Abstract

Excessive release of interleukin-6 (IL-6) during the progression of coronavirus disease 2019 (COVID-19) induces cytokine storms, resulting in multi-organ damages including liver injury, similar in nature with mechanism of viral hepatitis. Systemic IL-6 has been associated with the incidence of liver injury among COVID-19 patients; however, studies on IL-6 expression in the liver tissue are completely lacking. The aim of this study was to measure the IL-6 expression in the liver tissues and to determine its correlation with the degree of liver injury in fatal COVID-19 patients. Through this first cross-sectional study, IL-6 expression was measured through immunohistochemical staining and the degree of liver injury was identified based on level of serum alanine aminotransferase (ALT). The Spearman correlation test was used to identify the correlation between IL-6 expression and the degree of liver injury. A total of 47 deceased COVID-19 patients were included and IL-6 expression was observed in all post-mortem liver specimens, ranging from mild to strong expression. Liver injury at various degrees (mild to severe) was found in more than half (59.5%) of the cases. The Spearman correlation analysis suggested a statistically insignificant correlation between liver IL-6 expression and the degree of liver injury (r=0.152; p=0.309). In conclusion, even IL-6 expression was observed in all post-mortem liver specimens, there was an insignificant correlation between IL-6 expression in the liver tissue with the degree of liver injury among fatal COVID-19 patients, suggesting that IL-6 was not the only main factor contributing to liver damage in COVID-19 patients.
Association between COVID-19 severity with liver abnormalities: A retrospective study in a referral hospital in Indonesia Maimunah, Ummi; Kholili, Ulfa; Vidyani, Amie; Sugihartono, Titong; Tanaya, Willa M.; Wessels, Firda I.; Alshawsh, Mohammed A.; Miftahussurur, Muhammad
Narra J Vol. 4 No. 2 (2024): August 2024
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v4i2.816

Abstract

Coronavirus disease 2019 (COVID-19) is characterized by an acute respiratory infection with multisystem involvement and the association of its severity to liver function abnormalities is not well characterized. The aim of this study was to assess the association between the severity of COVID-19 patients and liver function abnormalities. This retrospective study included adult patients with confirmed COVID-19, which were classified as non-severe or severe according to World Health Organization guidelines. Liver function test results were compared between the severity groups. A total of 339 patients were included of which 150 (44.25%) were severe cases. The male-to-female ratio was 0.9:1 and 3:2 in the non-severe and severe groups, respectively (p=0.031). Aspartate aminotransferase (AST), alanine transaminase (ALT), and total bilirubin levels and acute liver injury (ALI) incidence were significantly higher in the severe group compared to non-severe group (p<0.001, p<0.001, p=0.025, p=0.014, respectively). In contrast, albumin levels were significantly lower (p=0.001). Multivariate analysis showed that ALI was significantly associated with human immunodeficiency virus (HIV) infection (odds ratio (OR): 5.275; 95% confidence interval (CI): 1.165–23.890, p=0.031), hemoglobin level (OR: 1.214; 95%CI: 1.083–1.361, p=0.001), and hypoalbuminemia (OR: 2.627; 95%CI: 1.283–5.379, p=0.008). Pre-existing liver diseases were present in 6.5% of patients. No significant differences were observed between the groups based on COVID-19 severity and ALI presence. Liver function test abnormalities, including ALI, are more prevalent in patients with severe COVID-19 infection. HIV infection, high hemoglobin levels, and hypoalbuminemia may be potential risk factors for ALI.
Comorbid Factors and Duration of Illness in Dengue Hemorrhagic Fever Patients at Universitas Airlangga Hospital, Surabaya, Indonesia Savita, Lady; Sulistiawati; Bramantono; Maimunah, Ummi
Journal of Community Medicine and Public Health Research Vol. 5 No. 1 (2024): Journal Community Medicine and Public Health Research
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jcmphr.v5i1.52966

Abstract

Dengue hemorrhagic fever (DHF) continues to prevail in Indonesia annually. Individuals afflicted with dengue hemorrhagic fever may exhibit distinct clinical manifestations, and these can vary based on individual factors. Numerous elements can contribute to this diversity. Typically, adult patients with comorbidities face a less favorable prognosis for the primary disease. This study aimed to examine the impact of comorbid factors on the severity of DHF, as well as its duration. The comorbidities considered in this research encompassed hypertension, diabetes mellitus, and obesity. This research employed an analytical approach and was conducted at Universitas Airlangga Hospital from January to December 2022. Medical records served as the primary data source for this study. A total of 121 patient samples were collected based on specific criteria. The criteria included adults (>18 years) treated at Universitas Airlangga Hospital, who had no comorbid diseases other than those under study, and possessed complete medical record data. The sampling technique employed in this research was total sampling, which adhered to the inclusion and exclusion criteria. This research demonstrated that comorbid factors were not associated with the severity of DHF (p<0.05), while the duration of illness in DHF patients was correlated with the severity of the disease (p=0.027).
Gut Microbiota and Non-Alcoholic Fatty Liver Disease: Current Pathogenic Paradigm and Therapeutic Aspect Maimunah, Ummi; Soelistijo, Soebagijo Adi; Hadisuwarno, Wiharjo; Miftahussurur, Muhammad
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 24, No 2 (2023): VOLUME 24, NUMBER 2, August, 2023
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2422023154-162

Abstract

Changes in the gut microbiota are essential factors that cause non-alcoholic fatty liver disease (NAFLD), obesity, and diabetes. Small intestine bacteria overgrowth is discovered in NAFLD patients. Disruptions in the gut-liver axis include environmental factors that induce microbiota dysbiosis and/or increased intestinal permeability that causes liver inflammation. The most recommended therapy for NAFLD patients is still limited to lifestyle changes. This review will describe the role of the gut microbiota in the pathogenesis and therapeutic intervention of NAFLD. Recent evidence reveals that the gut microbiota is one of the main factors in the pathogenesis and progression of NAFLD through several mechanisms, particularly dysbiosis. This significant role makes the gut microbiota a non-invasive biomarker for NAFLD examination and a more effective therapeutic target.
Hypertension and Lipid Profiles in Middle-Aged Male Patients: A Study at a Tertiary Hospital in Surabaya, Indonesia Arin Nurtya; Artaria Tjempakasari; Ummi Maimunah; Sulistiawati; I Made Subhawa Harsa
Folia Medica Indonesiana Vol. 59 No. 4 (2023): December
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/fmi.v59i4.49674

Abstract

Highlights: 1. Uncertainty regarding the association between hypertension and the levels of low-density lipoprotein (LDL) and high-density lipoprotein (HDL) signifies the need for more research, particularly in the realm of sex-specific analysis.2. Our study uncovered significant associations between hypertension and the levels of total cholesterol and triglycerides, expanding our understanding of the impact of lipid profiles on hypertension.3. This research may potentially pave the way for personalized diagnostic and therapeutic strategies, ultimately enhancing hypertension management and patient outcomes.    Abstract Hypertension is one of the most frequent non-communicable diseases and a risk factor for cardiovascular disease, contributing to most deaths globally. The risk of hypertension is higher in those with uncontrolled lipids. In this study, the incidence of hypertension and lipid profiles were examined from March 2020 to March 2022. The aim of this study was to determine the relationship between hypertension in men aged 45–60 years and their lipid profiles, which include total cholesterol, triglycerides, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). This study used an analytical observational design with a cross-sectional approach. Medical records were utilized as secondary data. Statistical analysis was conducted using the Spearman rank correlation test. Statistical significance was determined at p<0.05. This research examined 115 patients with hypertension. The results showed that the stage of hypertension was correlated with total cholesterol (r=0.317; p=0.001) and triglyceride levels (r=0.217; p=0.02). However, the stage of hypertension was not significantly correlated with LDL (r=0.158; p=0.91) and HDL (r=0.75; p=0.423). Hence, this current study underscores the nuanced relationship between lipid profiles and the stage of hypertension in middle-aged male patients. This study highlights the importance of sex-specific analysis in hypertensive research. It also provides promising avenues for further investigation. 
Trends in Hepatocellular Carcinoma among Hepatitis C Patients Achieving Sustained Virological Response Following Direct-Acting Antivirals Treatment Maimunah, Ummi
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 3 (2024): VOLUME 25, NUMBER 3, December, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/25320241-2

Abstract

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In Vitro Antibacterial Activity of Eco Enzyme of Eucalyptus (Melaleuca leucadendra) against Escherichia coli Muhammad Aafi Baharuddin Attamimi; Wiwin Retnowati; Ummi Maimunah; Eko Budi Koendhori
Majalah Biomorfologi Vol. 35 No. 1 (2025): MAJALAH BIOMORFOLOGI
Publisher : Universitas Airlangga, Surabaya, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/mbiom.v35i1.2025.40-47

Abstract

Highlights It has been proven that the eucalyptus eco-enzyme from Lamongan does not exhibit strong enough antibacterial activity against E. coli at any concentration. The eucalyptus eco-enzyme method is less effective at extracting active compounds compared to distillation processing.   Abstract Background: Eucalyptus (Melaleuca leucadendra) is known to have antimicrobial potential due to its bioactive terpenoid compounds, including 1,8-cineole. This compound has the potential to inhibit the growth of Escherichia coli, a bacterium responsible for various infectious diseases. The eco-enzyme method, which utilizes fermentation, is simple to perform and does not require complex materials. Objective: This study aimed to assess the antibacterial activity of eucalyptus eco-enzyme against Escherichia coli. Material and Method: The M. leucadendra used in this study was sourced from Candisari Village, Lamongan, Indonesia and E. coli was obtained from laboratory isolates. Antibacterial activity was measured by observing the zone of inhibition in the well diffusion test on Muller-Hinton agar, with chloramphenicol as the positive control and distilled water as the negative control. The incubation period was 24 hours at 36°C. Result: The inhibition zone around the positive control was 25.94±1.1 mm. No inhibition zone (0 mm) was observed around the negative control or the eucalyptus eco-enzyme solution at concentrations ranging from 10% to 100%. However, a clearer zone was observed around the eco-enzyme well. The inability of the eco-enzyme to inhibit the growth of E. coli may be attributed to several factors, including the ingredients, processing method, acidity level, and bacterial resistance. Conclusion: The eucalyptus eco-enzyme did not exhibit sufficient antibacterial activity against E. coli at any of the tested concentrations.
Co-Authors Adaninggar PN Alphania Rahniayu Alshawsh, Mohammed A. Amie Vidyani Anggoro, Adhitri Annisa Zahra Mufida Ariani, Grace Arin Nurtya Artaria Tjempakasari, Artaria Aryati Aswin, R. Haryanto atika Bernadetta Jonan Bramantono Bramantono, Bramantono Budi W Budi Widodo Budi Widodo Budi Yuwono Denny Vianto Diah Rizki Rahma Dini Dio Brimantyo Djuanda, Stephanie N. DYAH FAUZIAH, DYAH Edi Suyanto Eko Budi Koendhori, Eko Budi Endang Retnowati Erik Hasudungan Esti Rohani Fauziah Diayu Retnaningtyas Gatot Soegiarto Gilda Hartecia Gunawan, Vania A. Hadisuwarno, Wiharjo Hartecia, Gilda Hendy Wirantara Hernomo Ontoseno Kusumobroto HERNOMO ONTOSENO KUSUMOBROTO Herry Purbayu I Made Subhawa Harsa Imelda Maria Loho, Imelda Maria Imro'ati, Tri Asih Inne Tria Ramafita Isna Mahmudah Iswan A Nusi Iswan A Nusi Iswan A Nusi Iswan Abbas Nusi Izzatul Fithriyah Jonan, Bernadetta Khairu Zein Kusumastuti, Etty H. KUSUMASTUTI, ETTY HARY Lefi, Achmad Lilihata, Jilientasia G. Maharani, Andi RK. Marhana, Isnin A. Maria Inge Lusida MOCHAMAD AMIN Muhammad Aafi Baharuddin Attamimi Muhammad Miftahussurur Munawaroh Fitriyah Nadya Wulandari Alshanti Natasya Ariesta Selyardi Putri Nenci Siagian Nila Kurniasari Nugraha, Ricardo A. Nugroho, Gilang MS. Pangestu Adi PN, Adaninggar Poernomo B Setiawan Poernomo Boedi Setiawan Poernomo Boedi Setiawan Poernomo Budi Setiawan Priyo Budi Purwono Puspa Wardhani Puspa Wardhani Puspitasari, Yessy Putri, Dyeneka Rustanti Indreswara Rahaju, Anny S. Retno Handajani Rheza Rahmadika Putra Rinjani, Lalu GP. Rosyid, Alfian N. Rudyanto Rudyanto Ruslan, S. Eriaty N. Savita, Lady Semedi, Bambang P. Setiawan, Poernomo B Setiawati, Rosy Shahnaz Azzahra Soelistijo, Soebagijo Adi SOETJIPTO . Sulistiawati Suprapto Ma’at Supriadi Supriadi Tanaya, Willa M. Thamrin, Husin Titong Sugiharto Titong Sugihartono Tjahjadi, Angela Kimberly Tri Asih Imro&#039;ati Ulfa Kholili Wahyu, Dwi Wessels, Firda I. Widodo, Budi Willy Sandhika Wiratama, Priangga A. Wiwin Retnowati Wungu, Citrawati Dyah Kencono Yandi, I KR. Yetti Hernaningsih Yoshio Yamaoka Yoshio Yamaoka, Yoshio Yudith Annisa Ayu Rezkitha, Yudith Annisa Ayu Zein, Khairu