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All Journal CURRENT INTERNAL MEDICINE RESEARCH AND PRACTICE SURABAYA JOURNAL Cermin Dunia Kedokteran The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia
Imelda Maria Loho, Imelda Maria
Unknown Affiliation
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Drug-Induced Liver Injury – Tantangan dalam Diagnosis Loho, Imelda Maria; Hasan, Irsan
Cermin Dunia Kedokteran Vol 41, No 3 (2014): Farmakologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (812.93 KB) | DOI: 10.55175/cdk.v41i3.1152

Abstract

Jejas hati imbas obat (drug-induced liver injury, DILI), atau hepatotoksisitas imbas obat, merupakan jejas hati yang disebabkan oleh pajanan terhadap obat atau agen non-infeksius. Jejas yang ditimbulkan oleh obat bervariasi, mulai dari tidak bergejala, ringan, hingga gagal hati akut yang mengancam nyawa. Insidens hepatotoksisitas imbas obat terbilang rendah, yaitu antara 1 dari 10.000 sampai 1 dari 100.000 pasien, tampaknya karena sulitnya diagnosis dan angka pelaporan yang masih rendah. Kunci penting diagnosis DILI adalah pajanan obat harus terjadi sebelum onset jejas hati dan penyakit lain yang dapat menyebabkan jejas hati harus disingkirkan. Selain itu, jejas hati akan membaik bila penggunaan obat tertentu dihentikan dan jejas hati dapat terjadi lebih cepat dan lebih berat pada pajanan berikutnya, khususnya bila jejas hati tersebut terjadi akibat proses imunologis.Drug-induced liver injury or drug-related hepatotoxicity is injury to the liver caused by exposure to a drug or another noninfectious agent. The clinical signs could vary from very mild condition without any clinical symptoms to severe and life-threatening acute liver failure. Drug-related hepatotoxicity has a low reported incidence, ranging from 1 in 10.000 and 1 in 100.000 patients, but its true incidence may be higher because of difficulties in detection or diagnosis and underreporting. Key elements in assessing cause in the diagnosis of drug-related hepatotoxicity were : Exposure to a drug must precede the onset of liver injury. Other disease should be ruled out. Condition may improve when the drug is stopped and may recur more rapidly and severely on repeated exposure, especially if immunological process is involved. 
Pendekatan Diagnosis dan Tatalaksana Endokarditis Infektif dengan Komplikasi Emboli Septik Pulmoner pada Pasien Hemodialisis Kronik Siregar, Jeremia Immanuel; Loho, Imelda Maria; Alwi, Idrus
Jurnal Penyakit Dalam Indonesia Vol. 2, No. 4
Publisher : UI Scholars Hub

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Abstract

Pendahuluan. Endokarditis infektif (EI) pada pasien hemodialisis (HD) merupakan salah satu contoh EI yang terkait dengan perawatan kesehatan dan menjadi penyebab kematian kedua pada pasien HD setelah penyakit kardiovaskuler. Penggunaan kateter intravaskuler sebagai akses HD meningkatkan risiko kejadian bakteremia sebesar sepuluh kali lipat serta infeksi “metastatik” seperti EI dan emboli septik pulmoner sebesar 10-40%. Ilustrasi Kasus. Seorang laki-laki berusia 35 tahun datang dengan keluhan dyspnea d’effort, orthopnea, dan post-nocturnal dyspnea, disertai batuk dengan bercak darah dan demam tinggi sejak lima hari sebelum masuk rumah sakit. Pasien menjalani HD kronik selama 15 bulan dengan menggunakan catheter double-lumen (CDL). Dari pemeriksaan fisik didapatkan ronki basah kasar bilateral, murmur pansistolik grade 3/6 pada sela iga keempat linea sternalis sinistra, dan gallop S3. Pada ekokardiografi ditemukan vegetasi di katup trikuspid dan pemeriksaan CT-scan toraks memberikan gambaran emboli septik pulmoner. Didapatkan satu dari tiga kultur darah yang positif untuk infeksi methicillin-resistant Staphylococcus aureus (MRSA). Pengobatan dengan vankomisin yang adekuat selama enam minggu memberikan kemajuan klinis signifikan, meskipun pada ekokardiografi evaluasi masih didapatkan adanya vegetasi. Pasien kemudian menjalani operasi pengangkatan vegetasi, perbaikan katup jantung, dan penggantian CDL, dimana kondisinya semakin membaik dan masih menjalani HD secara rutin hingga saat ini. Simpulan. Pengenalan dini EI dan emboli septik pulmoner pada pasien yang menjalani HD kronik dengan akses kateter intravaskuler sangat penting agar tatalaksana awal yang adekuat dan komprehensif dapat dilakukan. Hal ini dapat memperbaiki kondisi klinis serta memperpanjang kesintasan hidup pasien.
Pseudoakalasia sebagai Manifestasi Awal Karsinoma Sel Skuamosa Kepala Leher Loho, Imelda Maria; Syibli, Ahmad; Fauzi, Achmad
Jurnal Penyakit Dalam Indonesia Vol. 1, No. 2
Publisher : UI Scholars Hub

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Abstract

Pada kasus-kasus yang langka, sekelompok gejala yang menyerupai akalasia dapat muncul sebagai akibat dari suatu penyebab ekstra esofageal dan disebut sebagai pseudoakalasia. Membedakan akalasia dengan pseudoakalasia merupakan sesuatu yang tidak mudah karena pemeriksaan klinis, radiologis, dan manometris, dapat memberikan hasil yang serupa. Berikut ini kami laporkan sebuah kasus pseudoakalasia yang mucul sebagai manifestasi awal karsinoma sel skuamosa kepala leher.
Liver Function and Treatment Modalities are Predictors of Survival in Patients with Hepatocellular Carcinoma Hasan, Irsan; Loho, Imelda Maria; Lesmana, Cosmas Rinaldi; Gani, Rino A.
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 3
Publisher : UI Scholars Hub

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Introduction. Hepatocellular carcinoma (HCC) is a major health problem in Indonesia because most patients are diagnosed in late stages when curative treatment is no longer possible. The aim of this study is to evaluate one-year survival rate, prognostic factors, and treatment modalities of patients with hepatocellular carcinoma. Methods. A retrospective analysis was done in patients with HCC who were admitted to Cipto Mangunkusumo General Hospital (CMGH) between January 2013 and March 2014. Clinical parameters and treatment modalities were evaluated. Patients outcome at one-year of follow-up were recorded from medical records or patients were contacted by phone call. Survival curve was produced using Kaplan-Meier method and a multivariate analysis was conducted using Cox proportional hazards model. Results. A total of 114 patients were included in this study. Incidence of mortality was 57% and one-year survival rate was 29.4% with median survival as long as 135 days (approximately 4.5 months). According to the BCLC staging system, patients who were diagnosed as early, intermediate, late, and terminal stages were 2 (1.8%), 48 (42.1%), 32 (28.1%), and 32 (28.1%), respectively. Poor liver function (Child-Pugh C class) was diagnosed in 26.3% of patients. Only two patients were diagnosed during surveillance process. Proportion of patients treated with curative/palliative modalities and best supportive care were 34.2% and 65.8%, respectively. In multivariate analysis, Child-Pugh classification and treatment modalities were significant prognostic factors with p-value of <0,001 for both factors. Conclusion. Liver function and treatment modalities are predictors of survival in patients with HCC.
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.
Metastatic Cervical Cancer Presenting as a Sessile Polyp in the Ascending Colon Loho, Imelda Maria; Siregar, Lianda; Iriani, Dewi; Faatinah, Tiyas Hasnaa
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 25, No 1 (2024): VOLUME 25, NUMBER 1, April, 2024
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/251202494-97

Abstract

Patients with metastatic cervical cancer, particularly hematogenous metastasis, have a worse prognosis compared to those with localized cervical cancer. Gastrointestinal involvement of cervical cancer occurs in approximately 8% of cases and most lesions are located in the recto-sigmoid area due to direct extension of the disease. Here, we present a case of cervical adenocarcinoma spreading to the ascending colon as a sessile polyp and mimicking a hyperplastic polyp. Histopathological evaluation followed by immunohistochemistry analysis is needed to confirm the diagnosis.
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

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (434.834 KB) | DOI: 10.24871/231202224-28

Abstract

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.
The Role of Circulating Tumour Cells and Carcinoembryonic Antigen as Diagnostic Tool for Metastatic Colorectal Cancer in Indonesia Angraeni, Sri; Abdullah, Murdani; Hasan, Irsan; Rinaldi, Ikhwan; Fauzi, Achmad; Martin, Cleopas; Shatri, Hamzah; Irawan, Cosphiadi; Nursyirwan, Saskia Aziza; Ibrahim, Febiansyah; Siregar, Lianda; Loho, Imelda Maria; Waspodo, Agus Sudiro; Margaluta, Ariansah; Firsyada, Fajar; Darnindro, Nikko; Lutfiah, Evah; Tanadi, Caroline; Ilyas, Mohammad
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy Vol 26, No 3 (2025): VOLUME 26, NUMBER 3, December, 2025
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/2632025245-254

Abstract

Background: Patients with metastatic colorectal cancer (CRC) have a poor prognosis, with a 5-year survival rate of only 14%. Early detection and early intervention may improve outcome. Both circulating tumour cells (CTC) and serum carcinoembryonic antigen (CEA) have been suggested as diagnostic biomarkers for metastatic CRC. This study explored the performance of CTC and CEA as a tools for the detection of metastatic colorectal cancer in Indonesia.Methods: This study was conducted from December 2024 to April 2025 on metastatic colorectal cancer patients from three hospitals in Jakarta. CTC was analysed using the gradient density method and flow cytometry. CEA was analysed using chemiluminescent microparticle immunoassay.Results: This study recruited 160 patients with colorectal cancer patients of whom, 45% were known to have metastatic colorectal cancer. The median age was 57 (47—66) years and analysis was done at one time point only. The area under the curve (AUC) for CTC, CEA, and the combination of both CTC and CEA in diagnosing metastatic colorectal cancer was 0.579, 0.811, and 0.703, respectively. CTC showed 56.94% sensitivity and 50.00% specificity in detecting metastatic colorectal cancer. Meanwhile, CEA showed higher sensitivity (72.22%) and specificity (72.72%). Combination of both CTC and CEA increased sensitivity to 91.67%, but with a lower specificity of 37.50%. The optimal cut-off for CTC and CEA were 34.5 cells/3 ml and 18.31 ng/ml, respectively.Conclusion: CEA showed a better performance than CTC in diagnosing metastatic colorectal cancer. Combination of CTC and CEA showed promising potential as a valuable surveillance tool for detecting metastasis in colorectal cancers, but not as a primary diagnostic tool. 
Co-Authors Achmad Fauzi Agus Sudiro Waspodo Ahmad Syibli, Ahmad Angraeni, Sri C Rinaldi A Lesmana Cosphiadi Irawan Dewi Iriani E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Faatinah, Tiyas Hasnaa Firsyada, Fajar Firsyada, Fajar Ibrahim, Febiansyah Idrus Alwi Ikhwan Rinaldi Ilyas, Mohammad Irsan Hasan Jeremia Immanuel Siregar, Jeremia Immanuel Laurentius A Lesmana, Laurentius A Lianda Siregar Lutfiah, Evah Margaluta, Ariansah Martin, Cleopas Murdani Abdullah Nandika, Getty Inash Nikko Darnindro Rejeki, Dwi Sri Rino A. Gani Rino Alvani Gani Saskia Aziza Nursyirwan, Saskia Aziza Siregar, Muhammad Iqbal Swadari, Rahmanandika Tanadi, Caroline Tjahjadi, Angela Kimberly Ummi Maimunah Winnugroho Wiratman, Manfaluthy Hakim, Tiara Aninditha, Aru W. Sudoyo, Joedo Prihartono