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All Journal Folia Medica Indonesiana Journal Of Vocational Health Studies MEDICINUS
Rendi Aji Prihaningtyas
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health Other

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Primary Healthcare Providers' Knowledge on the Early Detection of Biliary Atresia Rendi Aji Prihaningtyas; Bagus Setyoboedi; Ni Nyoman Metriani Nesa; Melinda Masturina; Martono Tri Utomo; Sjamsul Arief
Folia Medica Indonesiana Vol. 60 No. 1 (2024): March
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/fmi.v60i1.48446

Abstract

Highlights:1. An evaluation is necessary to verify that the knowledge of healthcare providers is sufficient for the early detection of biliary atresia.2. It is crucial to promote education on prolonged jaundice to ensure early detection of biliary atresia in primary health facilities, as some primary healthcare providers have insufficient knowledge on the subject.   AbstractPrimary healthcare providers frequently fail to recognize biliary atresia because it closely mimics physiological jaundice. Early detection plays an important role in ensuring the optimal treatment of biliary atresia. Delays in referring to biliary atresia cases remain a problem around the world. The objective of this study was to analyze the knowledge of primary healthcare providers regarding prolonged jaundice as an early sign of biliary atresia. A cross-sectional study was conducted at primary healthcare centers using a self-administered questionnaire. The data were analyzed descriptively with the assistance of IBM SPSS Statistics for Windows, version 21.0 (IBM Corp., Armonk, N.Y., USA). A total of 271 respondents participated in this study, including midwives (63.8%), nurses (24.4%), and medical doctors (8.5%). This study found that 73.8% of the respondents agreed that infants with prolonged jaundice need to undergo a serum bilirubin level assessment. However, 40.2% of the respondents believed that pale stools and dark urine in yellow infants were symptoms of physiological jaundice. Concerning the definition of prolonged jaundice, 209 (77.1%) respondents provided a response indicating more than two weeks. A total of 137 (50.6%) respondents stated that biliary atresia is a disease that must be ruled out first in cases of prolonged jaundice. Nevertheless, 86 (31.7%) and 87 (32.1%) respondents also mentioned that breastfeeding jaundice and breast milk jaundice must be considered as potential causes to be investigated. These results indicated that primary healthcare providers still had limited knowledge regarding cholestasis. Education on prolonged jaundice in primary healthcare centers should be more improved to enhance the early detection of biliary atresia.  
Hepatitis B and Hepatocellular Carcinoma: A Case Report and Literature Review Rendi Aji Prihaningtyas; Muhammad Irawan; Qurrota Ayuni Novia Putri; Bagus Setyoboedi; Sjamsul Arief
MEDICINUS Vol. 38 No. 6 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/e6bqh839

Abstract

Introduction: Current data estimates that over 90% of primary liver tumors are hepatocellular carcinomas (HCC), a type of malignant hepatocyte tumor. Viral hepatitis B is particularly associated with HCC. Early detection of chronic hepatitis B is crucial to prevent complications. Case Presentation: A 17-year-old girl presented with a one-month history of abdominal enlargement, jaundice, dark urine, and pale-colored stool. She experienced weight loss and a lack of appetite. Anthropometric assessment indicated severe malnutrition. The abdomen appeared distended with ascites. There was a palpable liver, with a firm consistency and a lumpy surface up to the epigastrium, with a size of 8 x 7 x 6 cm, and accompanied by splenomegaly. Laboratory examination indicated anemia (hemoglobin 9.5 g/dl), white blood cells 12.38 x 10³/μl, platelets 859 x 10³/μl, AST 1,095 U/l, ALT 104 U/l, cholestasis (total bilirubin 66.5 mg/dl and direct bilirubin 4.14 mg/dl), hypoalbuminemia (albumin 2.81 g/dl), LDH 3146 U/l, reactive HBsAg >1,000, AFP >1,000 ng/ml. An abdominal ultrasound revealed hepatomegaly with multiple nodules distributed across nearly all liver segments, and some of which formed a mass measuring 7.9 x 6.4 x 5.8 cm in the right lobe. Additionally, splenomegaly and ascites were observed. CT scan of the abdomen showed masses distributed throughout the hepatic lobe with contrast enhancement in the arterial phase and feeding from hepatic artery, in the venous phase, contrast washout with ascites. These findings support the diagnosis of hepatocellular carcinoma. Conclusion: Children with HBV may have had prior medical visits without being accurately diagnosed, representing missed opportunities for timely HBV detection. There is a critical need for increased awareness and early screening for hepatitis B virus (HBV) infection in children, especially in regions where HBV prevalence is high.
LIVER CANCER ASSOCIATED WITH HEPATITIS B VIRUS INFECTION IN A CHILD: A CASE REPORT Karina Pharamita Dewi; Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief
Journal of Vocational Health Studies Vol. 9 No. 1 (2025): July 2025 | JOURNAL OF VOCATIONAL HEALTH STUDIES
Publisher : Faculty of Vocational Studies, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jvhs.V9.I1.2025.64-69

Abstract

Background: Two-thirds of primary liver tumors in children are malignant. Hepatoblastoma (HBL) accounts for 40-60 percent of pediatric liver tumors and is the most common malignant liver tumor. Hepatocellular Carcinoma (HCC) is the second most common malignancy in children, accounting for approximately 20% of cases. Both malignant liver tumors have similar clinical and imaging features, but different prognosis and treatment. Purpose: This report aims a case of liver cancer related to hepatitis B virus infection in a child. Case analysis: A 15-year-old girl presented with a two-month history of right upper quadrant pain along with abdominal distension, weight loss, back pain, anorexia, nausea, weakness and fatigue for 5 months prior to admission. Physical examination revealed a hard, firm mass with a bumpy surface in the right upper quadrant of the abdomen and splenomegaly. Laboratory test showed an increase in Lactate Dehydrogenase (LDH), Gamma-Glutamyl Transpeptidase (GGT), Alpha Feto Protein (AFP), quantitative Hepatitis B Virus (HBV) DNA, and HBsAg reactive. Abdominal Multi-Slice Computed Tomography (MSCT) revealed malignant solid mass with necrotic component inside, indistinct borders, irregular margins and kissing spleen. Result: The diagnosis of liver cancer in this patient suggested HCC associated with chronic hepatitis B infection. Conclusion: Routine follow-up of all children with chronic hepatitis B infection is crucial because of the risk of developing liver cancer in adolescence and adulthood.
Steroid Therapy on Cholestasis: A Case Report Rendi Aji Prihaningtyas; Bagus Setyoboedi; Sjamsul Arief; Prihaningtyas, Rendi Aji
MEDICINUS Vol. 38 No. 11 (2025): MEDICINUS
Publisher : PT Dexa Medica

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56951/mp7wkf03

Abstract

Introduction: Cholestasis is a pathological condition associated with immune-mediated processes that interfere with bile flow, thus requiring early diagnosis and prompt treatment to ensure optimal outcomes. The use of steroid therapy in the treatment of cholestasis has not been previously reported. Case: A 2-month and 9-day-old male infant presented with jaundice beginning at one week of age, followed by pale stools and tea-colored urine. Physical examination revealed jaundice, hepatomegaly, and splenomegaly. Laboratory investigations showed elevated liver enzymes: aspartate aminotransferase (AST) 292 U/l, alanine transaminase (ALT) 187 U/l, gamma-glutamyl transferase (GGT) 312.7 U/l, and alkaline phosphatase (ALP) 882 U/l), along with elevated bilirubin level (total bilirubin 7.9 mg/dl and direct bilirubin 6 mg/dl). Cytomegalovirus (CMV) IgG was reactive. A two-phase abdominal ultrasound examination revealed a preprandial gallbladder size of 0.65 x 0.33 x 1.91 cm, a postprandial size of 0.37 x 0.29 x 0.73 cm. Liver biopsy revealed chronic hepatitis and mild fibrosis (F1). The patient was treated with methylprednisolone, which was gradually tapered off. Following steroid therapy, liver enzyme and bilirubin levels normalized, gallbladder size increased, and stool color darkened. Posttreatment gallbladder size showed an increase (preprandial 3.05 x 0.96 x 0.72 cm, postprandial 2.45 x 0.72 x 0.82 cm). Conclusions: Steroids may improve bile flow and prevent further liver damage. Targeting immune mechanisms could represent a promising approach for future cholestasis treatments.
A CASE REPORT OF SUCCESSFUL STEROID TREATMENT IN INFANT WITH EXTRAHEPATIC CHOLESTASIS Bagus Setyoboedi; Rendi Aji Prihaningtyas; Agrasenfani Hadi; Muhammad Nur Alpi Apriansyah; Sjamsul Arief
Journal of Vocational Health Studies Vol. 9 No. 2 (2025): November 2025 | JOURNAL OF VOCATIONAL HEALTH STUDIES
Publisher : Faculty of Vocational Studies, Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jvhs.V9.I2.2025.139-145

Abstract

Background: Cholestatic jaundice in infants is a significant healthcare challenge, particularly in regions where access to surgical intervention and liver transplantation is limited. An immunologic mechanism underlies the pathogenesis of biliary atresia leading to fibro-obliteration of the bile ducts. However, the successful management of biliary atresia is often difficult because treatment typically occurs at an advanced stage. Therefore, alternative therapies that can suppress bile duct inflammation are urgently needed. Administering anti-inflammatory drugs such as methylprednisolone to infants in the early stages of cholestasis may provide opportunities to improve outcomes in the limited capacity to perform Kasai surgery and liver transplantation. Purpose: This case report describes the clinical improvement of extrahepatic cholestasis following steroid administration. Case analysis: We report a case of a 24-day-old male infant presenting with clinical symptoms of jaundice and pale stool. Liver biopsy revealed features consistent with extrahepatic obstructive cholestasis characteristic of biliary atresia. The patient was treated with methylprednisolone (a corticosteroid) and ursodeoxycholic acid without surgical intervention. Result: The combination of methylprednisolone and ursodeoxycholic acid normalized liver function tests and led to significant clinical improvement. Both jaundice and pale stools completely resolved within two months of treatment. Conclusion: Steroid therapy may provide clinical benefits for infants with extrahepatic cholestasis, particularly in settings with limited healthcare resources. Steroid administration may play a role in the suppression of the inflammatory process that causes fibrosis and bile duct obliteration in the early stages of the disease.
Co-Authors Agrasenfani Hadi Bagus Setyoboedi Karina Pharamita Dewi Martono Tri Utomo Melinda Masturina Muhammad Irawan Muhammad Nur Alpi Apriansyah Ni Nyoman Metriani Nesa Prihaningtyas, Rendi Aji Qurrota Ayuni Novia Putri Sjamsul Arief