INTRODUCTION:Mounting evidence indicates that the p53 Pro72Arg single-nucleotide polymorphisms (SNPs) may play a role in modulating hepatocarcinogenesis in the setting of chronic HBV infection. However, there is currently a lack of studies focusing on this genetic variant in Indonesia, a country characterized by its diverse genetic landscape comprising over 1300 distinct ethnic groups. We aimed to investigate the association between the p53 Pro72Arg polymorphism and the risk of hepatocellular carcinoma (HCC) among Indonesian patients with chronic HBV infection. METHODS:A total of 140 patients with chronic hepatitis B (CHB) were recruited, including 79 with HCC and 61 without HCC serving as controls. We used direct sequencing of DNA extracted from peripheral blood to analyze the SNPs of p53 codon 72. RESULTS:The distribution of p53 Pro72Arg genotypes among Indonesian CHB patients was 12.9% for proline homozygotes (Pro/Pro), 31.4% for arginine homozygotes (Arg/Arg), and 55.7% for proline/arginine heterozygotes (Pro/Arg). Despite the lack of association between the SNPs and HCC risk in the overall population, both the Pro/Arg and Arg/Arg genotypes demonstrate an increased susceptibility to HCC compared to Pro/Pro genotypes exclusively in the Madurese ethnic group. Additionally, we discovered that in those with decompensated cirrhosis, the heterozygote Pro/Arg was more likely to develop HCC than the homozygous Pro/Pro. No significant association was found between the SNPs of p53 Pro72Arg and the clinicopathological characteristics of HCC. CONCLUSIONS:The p53 Pro72Arg polymorphism might contribute to hepatocarcinogenesis in Indonesian chronic hepatitis B patients, particularly Madurese and those with liver decompensation.

Introduction: Gastroesophageal Reflux Disease (GERD) is a disorder of reflux of gastric contents into the esophagus, which can cause symptoms and complications. The global prevalence of GERD is 25% in adults, 20% in Western countries, and 3–5% in Asia, and it continues to increase. Physical therapy has been widely used, ranging from diet, exercise, and medication to surgery. Meanwhile, non-physical therapy, such as personality changes, has not been developed much. The Big Five Personality is a personality theory that consists of five dimensions, namely openness, conscientiousness, extraversion, agreeableness, and neuroticism, with each dimension representing different aspects of personality and related to health. This research aims to identify the dominant personality traits of GERD patients based on the Big Five personality model. Methods: This research used secondary data from medical records of GERD patients at RS Dr. Soetomo Surabaya and primary data from the Big Five Personality questionnaire interview using the descriptive cross-sectional method. Results: A total of 51 GERD patients at Dr. Soetomo Surabaya; it was found that the mean age of patients was 34.23 (SD 9.526) years, and there were 26 female patients (51%) and 25 male patients (49%). The interview results revealed that agreeableness was the dominant personality type. Conclusion: According to the Big Five Personality Theory, the dominant personality type in GERD patients at Dr. Soetomo General Hospital Surabaya is agreeableness.

Diarrhea is the third leading cause of death in children under five, causing nutritional deficits that hinder growth, cognitive, and academic performance. Each episode before the age of 2 years increases the risk of stunting by 5%. Systematic data, such as sociodemographic, clinical characteristics, and laboratory characteristics, are important for prevention. This descriptive observational study used a retrospective design based on medical records of children with acute diarrhea treated at Dr. Soetomo General Hospital, Surabaya, from 2021 to 2023. A total of 461 subjects met the criteria; 429 underwent electrolyte imbalance testing, 198 were assessed for urea and creatinine levels, and 68 had their acid-base balance evaluated. A total of 288 subjects (62.5%) were male children; 262 patients (75%) were 0-12 months old; 253 (61%) had good nutritional status; 339 (73.5%) underwent therapy for less than 1 week; and 402 patients (65%) recovered. A total of 40% experienced mild-moderate and severe dehydration with neurologic (16.4%) and respiration comorbidities (16.2%). Electrolyte disturbances included hyponatremia (33.1%), hypokalemia (12.1%), hyperchloremia (50.2%), increased urea (28.3%), abnormal creatinine (35.4%), hypobicarbonate (75%), and acidosis (63.2%). Therefore, early detection and appropriate management are essential to mitigate further complications and improve recovery outcomes.

The rupture rate in abscesses is still high, the presence of rupture in LA will increase the morbidity and mortality rate, the presence of rupture will affect treatment options and affect the length of stay in hospital as well as the potential cost burden for this disease. This study aimed to determine the predictive factors for rupture of liver abscess patients who were hospitalized in Dr. Soetomo Hospital in the period 2011-2017. This study uses a retrospective - single analysis. The target population was patients with liver abscesses who were hospitalized in Dr. Soetomo Hospital Surabaya since January 1, 2011 - July 31, 2017. The study sample was 137 people, sampling was done by consecutive sampling. Analysis of rupture predictive factors was carried out by bivariate test using chi square test and then variables in the bivariate analysis, results p <0.25, entered into multivariate regression analysis logistics to get a rupture predictor factor model. From 138 subjects, LA was more about males than females (4.3:1), with an average age of 44.80 ± 14.98 years, comorbid factors with the most DM, etiology of PLA higher than ALA. The most common complaints of LA are stomach pain and fever. In the rupture group, the proportion of hepatomegaly, pleural effusion, leucocytosis, elevated serum transaminases, hyperbilirubinemia, hypo albumin, giant-single abscess in right lobe was more dominant when compared to the non-rupture group. The proportion of morbidity (sepsis) and mortality in the rupture group was higher than in non-rupture group. Obtained a mortality rate of around 5.79 %, where septic shock is the most dominant cause of death. The magnitude of LA rupture is around 26.81%. The most dominant clinical manifestation of rupture is empyema, peritonitis, pneumonia and peripancreatic abscess. The results of this study indicate the size factor of abscesses and leucocytosis are independent predictive factors for rupture LA

Objective: To provide a comprehensive overview of current therapeutic strategies for colorectal cancer (CRC). Methodology: This narrative review synthesizes evidence from recent clinical guidelines, key randomized trials, and translational research related to CRC surgery, chemotherapy, radiotherapy, targeted therapy, and next-generation interventions. The integrated findings summarize established practices and evaluate ongoing advancements that may shape future CRC management. Results: Targeted therapies, including anti-EGFR and anti-VEGF monoclonal antibodies, have significantly improved outcomes in selected metastatic CRC populations. Immunotherapies, particularly immune checkpoint inhibitors, demonstrate substantial benefit in tumors with high mutational burden, such as dMMR/MSIH CRC. Emerging therapeutic avenues include KRAS G12C and HER2 inhibitors, biomarker-driven precision medicine, microbiome-based modulation, and advanced immunotherapeutic strategies. Persistent challenges such as drug resistance, tumor heterogeneity, and variable treatment response remain major obstacles to optimal care. Conclusion: Multidisciplinary and personalized treatment approaches are essential to improving survival and quality of life in patients with CRC. Continued translational research and deeper integration of molecular profiling, novel targeted drugs, and microbiome-related strategies are expected to shape the future of precision oncology for CRC.

This report discusses a 53-year-old female who complained of jaundice, right upper quadrant abdominal pain, joint complaints, swelling, weight loss, and a family history of similar disease. Laboratory findings revealed marked elevations in ALT (125 IU/L), AST (430 IU/L), Gamma GT (1051.2 IU/L), and ALP (161 IU/L), along with cholestasis (total bilirubin 6.35 mg/dL, direct bilirubin 5.76 mg/dL), and hypoalbuminemia (2.57 g/dL). Serology revealed positive anti-smooth muscle antibody (ASMA) titers and anti-mitochondrial antibody (AMA) (>= 1:20), increased antinuclear antibody (ANA) levels (81.3 IU), decreased Complement C3 (76.0; range, 82-185), and low-normal Complement C4 (17.3; range, 15-53). Coomb's test was directly positive. MR CP demonstrated cholangitis and narrowing of the cystic duct, likely secondary to mucosal oedema, and liver biopsy confirmed chronic hepatitis with mild fibrosis (F2). Extrahepatic cholestasis was highlighted by immunohistochemistry. We made the diagnosis of overlap syndrome (AIH-PBC-PSC), and the patient received ursodeoxycholic acid, n-acetylcysteine, methylprednisolone, hydroxychloroquine, mycophenolic acid, and calcium supplements. Clinical and laboratory improvement was noted post-treatment, with normalization of laboratory parameters

INTRODUCTION:Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and remains a leading cause of cancer-related mortality worldwide. Despite recent advances in immunotherapy and targeted agents, treatment efficacy is frequently limited by tumor heterogeneity, drug resistance, and systemic toxicity. Natural products, particularly carotenoid-derived compounds, have emerged as promising multi-target anticancer agents. Xanthophylls, a class of oxygenated carotenoids, exhibit pleiotropic biological activities that are relevant to cancer therapy; however, their potential against HCC remains incompletely explored. This study aimed to systematically evaluate the anti-HCC potential of xanthophyll-rich extracts from Garcinia dulcis pulp using integrated metabolomic, in silico, and in vitro approaches. METHODS:Xanthophyll-rich extracts from G. dulcis pulp were prepared using microwave-assisted extraction. Phytochemical profiling was performed using UHPLC-ESI-MS/MS. In silico analyses included bioactivity prediction, ADMET profiling, target identification, network pharmacology, pathway enrichment, and molecular docking against key HCC-related proteins (EGFR, BCL-2, and mTOR). In vitro antiproliferative activity was assessed using MTT assays on HepG2 and Huh7 hepatocellular carcinoma cell lines, with THLE-2 normal hepatocytes used as controls. RESULTS:Metabolomic analysis revealed a xanthophyll-dominated profile, with zeaxanthin and lutein as the major constituents, alongside fucoxanthin, astaxanthin, β-cryptoxanthin, β-carotene, and canthaxanthin. In silico predictions demonstrated high antineoplastic and pro-apoptotic activities, with strong involvement in the HIF-1, EGFR, PD-1/PD-L1, JAK-STAT, and mTOR signaling pathways. Molecular docking confirmed stable and high-affinity interactions of xanthophylls with EGFR, BCL-2, and mTOR. In vitro assays showed selective cytotoxicity against HCC cells, with IC50 values of 42.8 ± 3.6 µg/mL (HepG2) and 58.4 ± 4.9 µg/mL (Huh7), while exhibiting significantly lower toxicity toward normal hepatocytes. CONCLUSIONS:Xanthophyll-rich extracts from Garcinia dulcis pulp exhibit potent and selective anti-hepatocellular carcinoma activity through multi-target mechanisms involving oncogenic signaling, apoptosis regulation, and tumor metabolism. These findings support the translational potential of G. dulcis xanthophylls as promising natural candidates for further development in HCC therapy.

Tuberculosis (TB) remains an international health burden with high morbidity and mortality, especially in low- and middle-income countries. Weight loss and malnutrition often coexist with TB and are linked to poor prognosis. Literature review based on TB, malnutrition, changes of gut microbiota, gut–lung axis, and the role of microbiota metabolite. Gut dysbiosis modulates the immune system through gut–lung axis, with its primary mediators, namely short-chain fatty acids (SCFAs), regulating immune system homeostasis. TB and anti-TB drugs decrease gut microbiota diversity, leading to dysbiosis that worsens immune regulation and thus lowers host immunity to Mycobacterium tuberculosis. TB patients with malnutrition are closely associated with gut dysbiosis through immunological mechanisms and the gut–lung axis, with SCFAs as crucial mediators. This literature review aims to explain the role of gut dysbiosis in malnourished TB patients and highlight pathophysiological implications and intervention approaches.

Introduction: Hepatocellular carcinoma (HCC) progression is closely to inflammatory pathways, with tumor necrosis factor-alpha (TNF-α) recognized as a central mediator. This study aimed to examine the association between serum TNF-α concentrations and the clinical severity of HCC, as well as to evaluate its predictive value for short-term mortality. Methods: A prospective cohort study was conducted from January 2024 to December 2024, involving 76 HCC patients recruited through total sampling methods. Baseline TNF-α levels were measured, and participants were followed for 6 months to assess survival outcomes. Statistical analyses included Chi-square test, Fisher’s exact test, independent t-test, Mann–Whitney U-test, and binary logistic regression, with a significance defined as P < 0.05. Results: The mean TNF-α level was 46.96 ± 18.54 pg/mL, with survivors and nonsurvivors showing levels of 45.51 ± 19.91 pg/mL and 48.85 ± 16.7 pg/mL, respectively (Z = −1.473; P = 0.141). TNF-α levels were dichotomized using a receiver operating characteristic-derived cutoff of 44.76 pg/mL. Elevated TNF-α levels were significantly associated with HCC mortality (odds ratio [OR] = 0.306; P = 0.013), supported by bivariate (OR = 3.267; 95% confidence interval [CI] = 1.267–8.419; P = 0.012) and multivariate (OR = 0.153; 95% CI = 0.040–0.591; P = 0.006). Additional predictors included Child–Pugh score and hepatitis B status. Conclusions: Although TNF-α was not an independent predictor, its significant correlation with disease severity and mortality underscores its potential utility in prognostic stratification for HCC.

Introduction: Hepatocellular carcinoma (HCC) ranked as the third leading cause of cancer-related deaths worldwide. Hepatoma Arterial-embolization Prognostic (HAP) score was suggested as a survival predictor for HCC patients undergoing Transcatheter Arterial Chemoembolization (TACE). Objectives: This study aimed to analyse the association of HAP score with survival in HCC patients undergoing TACE. Methods: This was survival analysis with longitudinal study. The Kaplan-Meier curve was used for survival analysis, while Cox Regression test was used to analyse univariate and multivariate association between HAP score and its components to survival. Results: There were 100 patients HCC who underwent TACE at a tertiary hospital between January 2019 and September 2022. The overall survival (OS) median was 7 months, while the 12-months survival rate was 9%. The 12-months survival rates of HAP A, HAP B, HAP C and HAP D were 25%, 23.3%, 0 and 0, respectively. There was association between HAP score and 12 months’ survival of HCC patients undergoing TACE (hazard ratio (HR) 3.187, 95% confidence interval (CI) 2.002–5.074, p<0.001). Conclusions: HAP score has a prognostic value in predicting survival outcomes for HCC patients undergoing TACE.

BACKGROUND: Liver fibrosis in chronic hepatitis B (CHB) involves the host immune responses mainly T-lymphocyte regulatory cells and cytokines production. Tumor necrosis factor (TNF)-α, interleukin (IL)-6, and IL-10 have been reported to play a crucial role in the development of liver fibrosis. However, their association with liver fibrosis in treated CHB patients remains unclear. Therefore, this study was conducted to investigate the association between TNF-α, IL-6, and IL-10 with the degree of liver fibrosis in treated CHB patients. METHODS: This was a cross-sectional prospective study including 101 treated chronic hepatitis B subjects. TNF-α, IL-6, and IL-10 serum levels were measured with quantitative sandwich enzyme-linked immunosorbent assay (ELISA) kit. Transient elastography result was classified according to METAVIR score. Data was analyzed by the Spearman correlation test with a p<0.05 was considered statistically significant. RESULTS: From 101 subjects, there were significant differences were seen in TNF-α, IL-6, and IL-10 between patients with mild, significant and advance fibrosis. TNF-α (r=0.292; p<0.05), IL-6 (r=0.221; p<0.05), and IL-10 (r=0.208; p<0.05) were significantly correlated with the degree of fibrosis. After multivariate analysis, TNF-α was the only one cytokine parameter which significantly correlated with the degree of fibrosis. CONCLUSION: Levels of TNF-α, IL-6 and IL-10 are associated with the degree of liver fibrosis. These parameters may potentially be used to evaluate the development of liver fibrosis in treated CHB patients. KEYWORDS: chronic hepatitis B, liver fibrosis, cytokines, transient elastography

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.

Hepatic hydrothorax is a pleural effusion (typically ≥500 mL) that develops in patients with cirrhosis and/or portal hypertension in the absence of other causes. In most cases, hepatic hydrothorax is seen in patients with ascites. However, ascites is not always found at diagnosis and is not clinically detected in 20% of patients with hepatic hydrothorax. Some patients have no symptoms and incidental findings on radiologic examination lead to the diagnosis of the condition. In the majority of cases, the patients present with symptoms such as dyspnea at rest, cough, nausea, and pleuritic chest pain. The diagnosis of hepatic hydrothorax is based on clinical manifestations, radiological features, and thoracocentesis to exclude other etiologies such as infection (parapneumonic effusion, tuberculosis), malignancy (lymphoma, adenocarcinoma) and chylothorax. The management strategy involves a stepwise approach of one or more of the following: Reducing ascitic fluid production, preventing fluid transfer to the pleural space, fluid drainage from the pleural cavity, pleurodesis (obliteration of the pleural cavity), and liver transplantation. The complications of hepatic hydrothorax are associated with significant morbidity and mortality. The complication that causes the highest morbidity and mortality is spontaneous bacterial empyema (also called spontaneous bacterial pleuritis).

Background: Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infections are global health problems, including in Indonesia. The purpose of this study was to assess the knowledge and attitudes about HBV and HCV infection among infected patients in Indonesia. Methods: This cross-sectional study used a questionnaire survey. The questionnaire was adapted and translated into Indonesian language, and trialed with 27 HBV and 27 HCV patients. The final validated questionnaire was later used in the target population. Patients diagnosed with Hepatitis B or Hepatitis C were included. The patients were enrolled from November 2019 until February 2020 in sixteen multicenter locations. Multivariate analysis with logistic regression was conducted to determine the factors that are associated with the knowledge and attitude among HBV and HCV patients toward their illness. Results: A total of 931 HBV patients and 254 HCV patients were included in this survey. The proportion of infected patients with adequate knowledge of Hepatitis B and Hepatitis C was 72.1% and 53.9%, respectively. Positive attitudes about Hepatitis B and Hepatitis C were 28.5% and 41.3%, respectively. Multivariate analysis revealed that higher education level, higher income level, diagnosis duration of more than 5 years, and receiving of antiviral therapy were independent factors associated with adequate knowledge about Hepatitis B among HBV patients. Among HCV patients, independent factors associated with adequate knowledge about Hepatitis C were being married, higher education level, higher income level, and receiving antiviral therapy. Moreover, older age and receiving of antiviral therapy were independent factors associated with positive attitudes towards Hepatitis B among HBV patients. However, only higher education level was found to be an independent factor associated with positive attitudes towards Hepatitis C among HCV patients. Conclusion: The knowledge and attitude of patients regarding HBV and HCV were quite low among infected patients in Indonesia.

Chronic hepatitis B virus (HBV) infection poses significant risks to liver health, often progressing to complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Accurate assessment of liver fibrosis is essential for guiding treatment decisions and improving patient outcomes. Non-invasive scoring systems like the AST to Platelet Ratio Index (APRI) and the Fibrosis Index Based on 4 Factors (FIB-4) have emerged as reliable alternatives to invasive liver biopsy. These tools utilize readily available biomarkers to classify patients based on fibrosis severity, supporting early intervention and reducing the risks associated with traditional diagnostic methods. This review evaluates the diagnostic performance of APRI and FIB-4 in chronic HBV-related liver fibrosis. Studies indicate that while APRI is valued for its simplicity, FIB-4 demonstrates superior sensitivity and specificity, particularly in older populations. Both scores show strong correlations with histological findings and serve as effective tools for diagnosing significant fibrosis and cirrhosis. However, factors such as liver inflammation, comorbidities, and variable fibrosis distribution can influence their accuracy, highlighting the need for careful interpretation. Comparison with advanced methods like FibroScan® underscores the limitations of biochemical indices alone and the importance of combining multiple diagnostic approaches. Future research should focus on longitudinal studies and algorithm optimization to enhance the utility of these non-invasive tools. Integrating APRI and FIB-4 into clinical practice offers a cost-effective and accessible strategy for managing chronic HBV-related liver fibrosis, ultimately improving patient care and outcomes