In Indonesia, endoscopy services are limited and studies about gastric mucosal status by using pepsinogens (PGs) are rare. We measured PG levels, and calculated the best cutoff and predictive values for discriminating gastric mucosal status among ethnic groups in Indonesia. We collected gastric biopsy specimens and sera from 233 patients with dyspepsia living in three Indonesian islands. When ≥5.5 U/mL was used as the best cutoff value of Helicobacter pylori antibody titer, 8.6% (20 of 233) were positive for H. pylori infection. PG I and II levels were higher among smokers, and PG I was higher in alcohol drinkers than in their counterparts. PG II level was significantly higher, whereas PG I/II ratios were lower in H. pylori-positive than in H. pylori-negative patients. PG I/II ratios showed a significant inverse correlation with the inflammation and atrophy scores of the antrum. The best cutoff values of PG I/II were 4.05 and 3.55 for discriminating chronic and atrophic gastritis, respectively. PG I, PG II, and PG I/II ratios were significantly lower in subjects from Bangli than in those from Makassar and Surabaya, and concordant with the ABC group distribution; however, group D (H. pylori negative/PG positive) was the lowest in subjects from Bangli. In conclusion, validation of indirect methods is necessary before their application. We confirmed that serum PG level is a useful biomarker determining chronic gastritis, but a modest sensitivity for atrophic gastritis in Indonesia. The ABC method should be used with caution in areas with a low prevalence of H. pylori.

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, posing considerable challenges due to its complex progression and limited curative options. Transarterial chemoembolization (TACE) is a cornerstone treatment for intermediate-stage HCC, as outlined in widely accepted clinical guidelines, including the Barcelona Clinic Liver Cancer (BCLC) framework. Over the years, TACE has evolved through technological innovations and novel therapeutic combinations designed to enhance efficacy and improve patient outcomes. Recent advancements include refined imaging techniques, innovative embolic materials, and the integration of systemic therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitors. These developments have not only broadened the applicability of TACE but also enhanced its effectiveness in controlling tumor progression and extending survival in patients with unresectable disease. Despite these advancements, challenges persist, including the optimization of treatment protocols, the management of complications, and the need for personalized therapy tailored to diverse patient populations. This review highlights the latest progress and current understanding of TACE as a therapeutic modality for HCC. It also explores emerging trends, ongoing challenges, and the potential for novel combinations to redefine the therapeutic landscape. By synthesizing the latest evidence, this article aims to provide valuable insights for clinicians and researchers striving to improve HCC management and patient outcomes.

Introduction: Chronic hepatitis B raises serious concern due to its high morbidity, such as cirrhosis and hepatocellular carcinoma, and mortality from 267 per 100,000 person-years. Up to now, medical therapy that successfully eradicates the hepatitis B virus is not available. Therapy is given in the long term for suppressing viral replication and disease progression. Nucleoside analog (NA) is a medication that is consumed orally once a day for years. Previous studies showed that patients who were treated with NA had a different quality of life (QoL) compared to naïve patients. This research aimed to analyze the QoL of chronic hepatitis B patients who consumed NA by comparing it with naïve patients at Dr. Soetomo General Academic Hospital Surabaya. Methods: Subjects were recruited consecutively from chronic hepatitis B patients at Dr. Soetomo General Academic Hospital Surabaya during 9 February – 31 May 2021. Data about sociodemographic characteristics, hepatitis B therapy history, and QoL were gained by using the SF-36 questionnaire and medical records. Subjects were divided into NA and naïve groups which responses underwent an analytical comparison. Results: NA group had significantly higher QoL in a physical component score (PCS) and mental component score (MCS), with physical functioning (PF), role limitations due to physical health (RP), role limitations due to emotional problems (RM), energy/fatigue (VT), emotional well-being (MH), social functioning (SF), and general health perception (GH) subscales having p<0.05 Conclusion: The QoL of patients who were treated with NA was significantly higher than that of naïve patients in terms of physical and mental components.

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.

Background: HBV DNA assays have several limitations including being expensive and not widely available. Detection of HBsAg in serum has been the hallmark of HBV infection. However, previous studies regarding the association between HBsAg and HBV DNA revealed contradictory results. This study aims to reassess the correlation between HBsAg and HBV DNA in chronic hepatitis B patients. Methods: Observational studies with näive chronic hepatitis B patients were included, while studies with other coinfections were excluded. The studies were identified by searching through Google Scholar, PubMed, ScienceDirect, and Springer Link for English and Bahasa articles from 2011 to 2021. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) was followed. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal. Results: A total of 17 studies with 4134 participants met the criteria. The overall analysis revealed a moderate correlation between quantitative HBsAg and quantitative HBV DNA in the total sample of chronic hepatitis B patients (r = 0.57, 95% CI 0.40–0.75, P < 0.00001). In HBeAg + group, a moderate correlation was indicated while in HBeAg − revealed a weak association (r = 0.55, 95% CI 0.39–0.70, P < 0.00001 vs r = 0.29, 95% CI 0.20–0.38, P < 0.00001). The strongest correlation was discovered in HBeAg + chronic HBV infection phase (r = 0.59, 95% CI 0.35–0.82, P < 0.00001). Conclusion: Serum HBsAg titer supports as a predictor of serum HBV DNA levels in clinical practice with moderate strength of correlation. Trial registration: This review had been registered in PROSPERO (ID: CRD42023421246).