Managing liver cirrhosis in clinical practice is still a challenging problem as its progression is associated with serious complications, such as variceal bleeding that may increase mortality. Portal hypertension (PH) is the main key for the development of liver cirrhosis complications. Portal pressure above 10 mmHg, termed as clinically significant portal hypertension, is associated with formation of varices; meanwhile, portal pressure above 12 mmHg is associated with variceal bleeding. Hepatic vein pressure gradient measurement and esophagogastroduodenoscopy remain the gold standard for assessing portal pressure and detecting varices. Recently, non-invasive methods have been studied for evaluation of portal pressure and varices detection in liver cirrhotic patients. Various guidelines have been published for clinicians’ guidance in the management of esophagogastric varices which aims to prevent development of varices, acute variceal bleeding, and variceal rebleeding. This writing provides a comprehensive review on development of PH and varices in liver cirrhosis patients and its management based on current international guidelines and real experience in Indonesia.

Aim of the study:To evaluate the efficacy of sodium/glucose cotransporter-2 inhibitors (SGLT2i) in improving hepatic fibrosis and steatosis of non-alcoholic fatty liver disease (NAFLD) patients with type 2 diabetes mellitus (T2DM). Material and methods: We searched CENTRAL, MEDLINE, and EMBASE and included any clinical trials involving patients with NAFLD and T2DM aged ≥ 18 years comparing efficacy of SGLT2i and other antidiabetic drugs in improving fibrosis and steatosis, irrespective of publication status, year of publication, and language. Results: Five clinical trials were included. One study reported significant improvements in the controlled attenuation parameter 314.6 ±61.0 dB/m to 290.3 ±72.7 dB/m (p = 0.04) in the SGLT2i group measured by transient elastography. In patients with significant fibrosis, dapagliflozin treatment significantly decreased the liver stiffness measurement from 14.7 ±5.7 kPa at baseline to 11.0 ±7.3 kPa after 24 weeks (p = 0.02). One study reported a significant decrease in liver fat content 16.2% to 11.3% (p < 0.001) in the SGLT2i group compared to the control (p < 0.001). Three studies reported significant improvement in the liver-to-spleen ratio in the SGLT2i group after treatment 0.96 (0.86-1.07) to 1.07 (0.98-1.14), p < 0.01, 0.80 ±0.24 to 1.00 ±0.18, p < 0.001, and 0.91 (0.64-1.04) to 1.03 (0.80-1.20), p < 0.001 respectively. All studies reported a significant decrease in alanine aminotransferase with SGLT2i. Conclusions: SGLT2i is associated with positive effects on hepatic steatosis measured by non-invasive modalities. Further studies are needed to confirm the impact of SGLT2i on hepatic fibrosis and steatosis.

The construction of Gresik LNG receiving terminal is aimed to fulfil the 109 MMSCFD (0.87 MTPA) gas requirement for combined-cycle power plant (PLTGU) Jawa-3 which is integrated with LNG Gresik Terminal. There are several potential LNG plants in Indonesia and abroad that can be the source of gas for Gresik LNG Terminal. Each of these LNG plants has varying gas price and distance to Gresik. The modelling of the LNG logistics system for Gresik LNG Terminal was built to illustrate the LNG supply chain from the LNG plants to Gresik LNG Terminal and several supply scenarios will be proposed. The built model is linear and optimized by using linear programming. Linear programming involves the determination of objective functions, decision variables and constraints. The optimization of the logistics system aims to obtain the cheapest gas supply cost for Gresik LNG receiving terminal. The result shows that the cheapest gas supply cost is obtained through direct supply scenario with gas source from domestic and abroad with combination of delivery from Bontang equal to 0.34 MTPA (40 %) with 12 shipments, Tangguh equal to 0.26 MTPA (30 %) with 9 shipments, and Bintulu Malaysia equal to 0.26 MTPA (30 %) with 9 shipments.