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"Latar belakang: Kasus baru kanker paru semakin bertambah dan mulai banyak dialami usia muda. Pendekatan skrining dalam upaya deteksi dini dilanjutkan tindakan diagnostik yang cepat dan akurat memberikan penderita memeroleh kualitas hidup yang lebih baik dalam perjalanan penyakitnya. Biopsi paru transtorakal menggunakan jarum halus dan core menghasilkan akurasi berkisar 85%-90% dengan keunggulan tindakan minimal invasif. Variasi akurasi diagnostik dan belum terdapat data proporsi hasil biopsi transtorakal di RS Persahabatan, membuat kami melakukan penelitian ini. Metode: Kami melakukan pencatatan data sampel periode Januari 2021-September 2023 pada bulan Januari-Februari 2024. Data yang dicatat yaitu karakteristik pasien keganasan rongga toraks belum tegak jenis yang dilakukan tindakan biopsi jarum halus dan core transtorakal dengan panduan CT scan. Sebanyak 765 pasien dalam periode tindakan didapatkan 563 pasien yang sesuai kriteria inklusi dan eksklusi. Data kemudian dianalisis untuk menilai kepositifan biopsi jarum halus dan core transtorakal serta faktor yang memengaruhinya. Hasil: Sejumlah 563 subjek terdiri atas laki-laki 67,9% dan perempuan 32,1%. Usia paling muda 18 tahun dan paling tua 88 tahun dengan median usia 56 tahun. Subjek dengan keluhan respirasi 83,7% dan nonrespirasi 16,3%. Perokok merupakan mayoritas subjek sebesar 58,4%. Lokasi target biopsi paling banyak di paru 75,3% sedangkan mediastinum 24,7%. Nilai HU kami kelompokkan menjadi ≥ 30 sebanyak 91,3% dan < 30 sebanyak 8,7%. Panjang minimal kedalaman tusuk 0,7 cm dan maksimal 11,21 cm dengan median 4,2 cm. Posisi saat tindakan biopsi yaitu terlentang 67,5%, tengkurap 24,5% dan lateral dekubitus 8%. Proporsi kepositifan biopsi jarum halus 80,8% sementara biopsi core 77,6%. Selanjutnya karakteristik tersebut kami lakukan analisis bivariat didapatkan nilai HU memengaruhi kepositifan biopsi jarum halus (p < 0,05). Kesimpulan: Proporsi biopsi jarum halus dan core transtorakal di RS Persahabatan sangat baik. Nilai HU memengaruhi kepositifan biopsi TTNA namun, tidak pada biopsi core. Kedalaman tusuk dan posisi bukan faktor yang memengaruhi kepositifan biopsi TTNA dan core.

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Background: New cases of lung cancer are increasing and are starting to occur at a young age. A screening approach in an effort for early detection followed by rapid and accurate diagnosis provides patients with a better quality of life throughout their disease. Transthoracic lung biopsy using a fine needle and core produces an accuracy of around 85%-90% with the advantage of being minimally invasive. Variations in diagnostic accuracy and no database availability yet on the proportion of transthoracic biopsy results at Persahabatan Hospital prompted us to conduct this research. Methods: We recorded data from January 2021-September 2023 in January-February 2024. The data recorded were the characteristics of patients with unconfirmed type thoracic cavity malignancies who underwent fine needle and transthoracic core biopsies CT scan guided. A total of 765 patients during the action period 563 patients met the inclusion and exclusion criteria. The data is then processed to assess the positivity of transthoracic fine needle and core biopsies and the factors that influence it. Result: A total of 563 subjects consisted of 67.9% men and 32.1% women. The youngest age is 18 years and the oldest is 88 years with a median age of 56 years. Subjects with respiratory complaints were 83.7% and non-respiratory 16.3%. Smokers constituted the majority of our subjects at 58.4%. The most common biopsy target locations were the lungs, 75.3%, while the mediastinum was 24.7%. Hounsfield units are divided into ≥ 30 as many as 91.3% and < 30 as many as 8.7%. The minimum length of the puncture depth is 0.7 cm and the maximum is 11.21 cm with 4.2 cm as the median. The position during the biopsy was supination 67.5%, prone 24.5%, and lateral decubitus 8%. The positive proportion of fine needle biopsy was 80.8% while core biopsy was 77.6%. We conducted a bivariate analysis of these characteristics and found that the HU value influenced the positivity of fine needle biopsy (p < 0.05). Conclusion: The proportion of fine needle and core transthoracic lung biopsies at Persahabatan Hospital is decent. The HU value influences the positivity of TTNA biopsy but not core biopsy. Puncture depth and position were not a factor influencing the positivity of TTNA and core biopsies."

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"Latar Belakang: Pneumocystis jirovecii (P. jirovecii) adalah patogen jamur oportunistik yang dapat terdeteksi di saluran napas bawah. Kolonisasi P. jirovecii dapat berkembang menjadi infeksi yang disebut sebagai pneumocystis pneumonia (PCP). Infeksi PCP umumnya terdeteksi di pasien HIV. Pasien tanpa HIV juga dapat mengalami infeksi PCP terutama pada pasien keganasan. Penelitian ini bertujuan untuk mendeteksi kolonisasi P. Jirovecii pada sampel bilasan bronkus dengan pemeriksaan polymerase chain reaction (PCR). Metode: Penelitian ini merupakan penelitian potong lintang dengan deskriptif analitik yang pada pasien terduga kanker paru di RSUP Persahabatan. Subjek penelitian adalah pasien terduga kanker paru yang akan menjalani bronkoskopi sesuai kriteria inklusi. Sampel bilasan bronkus dikirim ke Laboratorium Departemen Parasitologi FKUI untuk ekstraksi DNA dan laboratorium BRIN untuk pemeriksaan PCR konvensional. Penelitian ini menggunakan gen MtLSU dan mTSSU. Hasil: Pada penelitian ini terdapat 72 subjek penelitian. Subjek penelitian terdiri atas 51 laki-laki (70,8%). Rerata usia subjek penelitian adalah 56,6 (9,95) tahun. Subjek penelitian sebagian besar memiliki IMT normal (18,5-22,9 kg/m2). Subjek penelitian sebagian besar adalah perokok baik perokok aktif atau bekas perokok yaitu sebanyak 50 orang (69,4%). Sebanyak 23 orang (31,9%) diantaranya memiliki IB berat (IB >600 batang per tahun). Subjek penelitian yang memiliki riwayat pengobatan TB, baik terkonfirmasi bakteriologis maupun diagnosis klinis, sebanyak 23 orang (31,9%). Sebanyak 26 orang (36,1%) memiliki 1 komorbid sedangkan 10 orang (13,9%) memiliki lebih dari 1 komorbid. Berdasarkan pemeriksaan histopatologi atau sitologi bilasan bronkus, dari 72 subjek penelitian terdapat 50 orang (69,4%) terdiagnosis kanker paru, 15 orang (20,9%) bukan kanker paru, dan 7 orang (9,7%) belum diketahui diagnosisnya. Dari 72 sampel yang diperiksa, tidak ada yang menunjukan hasil PCR positif (0%). Kesimpulan: Proporsi P. Jirovecii yang terdeteksi melalui pemeriksaan PCR pada sampel bilasan bronkus pasien terduga kanker paru sebesar 0%. Pemeriksaan PCR untuk mendeteksi P. Jirovecii tidak disarankan untuk pasien kanker yang baru terdiagnosis dan belum dilakukan pengobatan.

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Background: Pneumocystis jirovecii (P. jirovecii) is an opportunistic fungal pathogen that can be detected in the human lower respiratory tract without signs or symptoms of acute pneumonia or colonization. P. jirovecii colonization can develop into an infection known as pneumocystis pneumonia (PCP). PCP infection is commonly detected in HIV patients. However, patients without HIV can also experience PCP infection, especially in malignant patients. This study aims to detect P. Jirovecii colonization in bronchial lavage samples using polymerase chain reaction (PCR). Methods: This research is a cross-sectional study with descriptive analytics on patients suspected of lung cancer at Persahabatan Hospital. The research subjects were patients with suspected lung cancer who were selected according to the inclusion criteria. Data on clinical, radiological, laboratory and histopathological characteristics were taken from medical records. The patient will have a bronchial lavage sample taken during bronchoscopy for diagnostic purposes. The samples will be examined at the Parasitology Department Laboratory Universitas Indonesia for DNA extraction and the BRIN laboratory for PCR examination. Results: In this study there were 72 research subjects. The research subjects consisted of 51 men (70.8%). The mean age of the research subjects was 56.6 (9.95) years. Most of the research subjects had normal BMI (18.5-22.9 kg/m2). Most of the research subjects were smokers, either active smokers or former smokers, namely 50 people (69.4%). A total of 23 people (31.9%) had severe IB (IB >600 cigarettes per year). There were 23 research subjects who had a history of TB treatment, whether confirmed bacteriologically or clinically diagnosed, as many as 23 people (31.9%). A total of 26 people (36.1%) had 1 comorbid while 10 people (13.9%) had more than 1 comorbid. Based on histopathological or cytological examination of bronchial lavage, of the 72 research subjects, 50 people (69.4%) were diagnosed with lung cancer, 15 people (20.9%) had no lung cancer, and 7 people (9.7%) had no known diagnosis. Of the 72 samples examined, none showed positive PCR results (0%). Conclusion: The proportion of P. Jirovecii detected by conventional PCR examination in bronchial lavage samples from patients suspected of lung cancer was 0%. PCR examination to detect P. Jirovecii is not recommended for cancer patients who have just been diagnosed and have not received treatment."

"Latar Belakang : Merokok masih merupakan masalah kesehatan utama di Indonesia. Merokok menjadi faktor risiko bagi penyakit kanker paru dan PPOK. Hubungan antara kanker paru dan PPOK masih terus dikaji. Komorbiditas PPOK pada kanker paru dapat mempengaruhi proses diagnostik, tatalaksana serta managemen akhir kehidupan pasien kanker paru.Metode : Penelitian ini adalah studi potong lintang analitik yang dilakukan di poliklinik onkologi paru RSUP Persahabatan selama periode Agustus 2018 sampai dengan April 2019 terhadap pasien kanker paru kasus baru yang telah memenuhi kriteria inklusi dan eksklusi.Hasil : terdapat 52 subjek yang diteliti dan didapatkan 76,9% adalah laki-laki dan perokok (71,2%), jenis kanker paru yang paling banyak ditemukan ialah kanker paru karsinoma bukan sel kecil (98,1%), sebagian besar stage 4 (88%) dan tampilan klinis 1 (50%). Prevalens PPOK berdasarkan pemeriksaan spirometri menurut kriteria PNEUMOMOBILE ialah 46,2% dan prevalens emfisema berdasarkan pemeriksaan CT-scan toraks ialah 30,8%.. Subjek kanker paru yang menderita PPOK 91,7% termasuk kedalam obstruksi derajat sedang (GOLD 2) serta memiliki kelainan faal paru campuran obstruksi dan restriksi ( 70,8%). Subjek yang menderita emfisema terbanyak menderita emfisema jenis sentrilobular (43,7%). Terdapat hubungan antara letak lesi sentral terhadap beratnya obstruksi yang diukur melalalui nilai VEP1 pada subjek PPOK dan emfisema.Kesimpulan : PPOK pada kanker paru terutama ditemukan pada laki-laki, perokok serta jenis kanker yang paling banyak diderita ialah adenokarsinoma. Emfisema yang paling banyak diderita ialah jenis sentrilobular yang secara umum banyak didapatkan pada perokok.

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Background: Smoking is one of risk factors in both of lung cancer and chronic obstructive pulmonary disease (COPD). Comorbidity of COPD among lung cancer patients generally influenced outcome of their quality of life, diagnostic procedures, treatments, and end of life managements.

Methods:This analytical cross-sectional study involved newly diagnosed lung cancer cases admitted to the oncology clinics of Persahabatan Hospital Jakarta, Indonesia between August 2018 and April 2019. Patients who met the study criteria were consecutively included. Spirometric evaluation of airway obstruction and COPD was based on PNEUMOBILE and GOLD criteria. Radiological evaluation of emphysema was based on thorax CT-scan.

Results:Subjects were 52 lung cancer patients and most of them were males (76.9%) and smokers (71.2%). Most of them were diagnosed as non-small cell lung cancer (NSCLC) (98.1%), were in end-stage of the disease (88.0%) and were in performance status of 1 (50.0%). The prevalence of COPD and emphysema was 46.2% and 30.8%, respectively. Most of the COPD subjects (91.7%) experienced moderate airway obstruction (GOLD 2), along with mixed obstruction-restriction spirometric results (70.8%). Centrilobular emphysema was common (43.7%) radiological finding in this study. Degree of obstruction by spirometry (VEP1)and detection of central tumor lesion by thorax CT-scan in COPD and emphysema subjects was found to be correlated.

Conclusion:COPD in lung cancer was found in males, smokers, and NSCLC patients. Centrilobular emphysema was commonly found in this study, particularly in smoker sub-group."

"Latar Belakang: Bronkoskopi adalah prosedur yang umum digunakan sebagai tindakan membantu penegakkan diagnosis kasus tumor paru. Hipoksemia disebut sebagai salah satu komplikasi yang sering terjadi pada bronkoskopi diagnostik oleh karena itu diperlukan data untuk mengetahui faktor yang berpengaruh dan dampak klinis yang ditimbulkan.Metode: Penelitian ini menggunakan desain potong lintang pada pasien tumor paru yang menjalani bronkoskopi diagnostik dan dilakukan selamaJanuari-April 2019 di Rumah Sakit Umum Pusat Rujukan Respirasi Nasional (RSUPRRN) Persahabatan Jakarta. Total 195 pasien diikutsertakan dan dilakukan pengamatan terhadap nilai saturasi oksigen pada tahap premedikasi, durante, pascatindakan. Hipoksemia adalah subjek dengan saturasi oksigen<90% dan diamati berbagai faktor yang dianggap berpengaruh dan dampak klinis yang terjadi.Hasil:Jumlah kejadian hipoksemia pada bronkoskopi diagnostik sebanyak 40 kasus (20,5%). Waktu kejadian hipoksemia paling banyak pada tahap durante tindakan (20%) dengan median lama hipoksemia berlangsung 15 detik. Proporsi waktu muncul hipoksemia terjadi paling banyak pada 10 menit pertama tindakan (11,3%). Faktor demografi yang bermakna terhadap kejadian hipoksemia adalah jenis kelamin (p=0,04) dan riwayat merokok (p=0,005). Faktor yang dianggap berpengaruh dan memiliki hubungan bermakna dengan kejadian hipoksemia antara lain lama waktu tindakan dan timbulnya komplikasi (p<0,05). Total 5 pasien dirawat pascatindakan di ruang intensif dan tidak ada kasus kematian yang dilaporkan. Kesimpulan: Penelitian ini mendapatkan jenis kelamin, riwayat merokok, lama waktu tindakan dan timbulnya komplikasi menjadi faktor yang berpengaruh terhadap kejadian hipoksemia pada tindakan bronkoskopi diagnostik kasus tumor paru. Hipoksemia yang muncul pada bronkoskopi diagnostik kasus tumor paru tidak menimbulkan dampak klinis yang fatal seperti kematian pada penelitian ini.

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Background: Bronchoscopy is a commonly medical procedure perfomed for diagnose lung tumor cases. Hypoxemia often appear as complication related diagnostic bronchoscopy. Therefore, there is a need of research data to knowing related factors and clinical consequences may occur ahead.

Methods:Design of this study is cross sectional with suspicion lung malignancy population who undergoing diagnostic bronchoscopy from January until april 2019 at National Respiratory Center Persahabatan General Hospital Jakarta. Total 195 consecutive patients participated dan observed for oxygen saturation in premedication, during and post-bronchoscopy. Hypoxemia was defined as an desaturation <90% and reviewed several related factor and clinical consequences may appear

Results:Total hypoxemia events on diagnostic bronchoscopy was 40 cases (20,5%). The most frequent occurrence hypoxemia time is during bronchoscopy (20%) with median duration of hypoxemia is 15 seconds. The proportion of time appears hypoxemia is commonly in first 10 minutes bronchoscopy (11,3%). Demographic factors like gender and smoking history are statistically significant with hypoxemia events (p=0,04 & p=0,005). Other factors may have relation dan statiscally significant are duration of procedure and procedure with complication (p<0,05). Total 5 cases observed in intensive care unit after procedure and no death event have reported in this study

Conclusion:This study suggested gender, smoking history, duration of procedure and procedure with complication were related factors with hypoxemic events in lung tumor cases undergoing diagnostic bronchoscopy. Hypoxemia related diagnostic bronchoscopy in this study was not rise into fatal event. "

"Latar belakang : Kanker paru adalah kanker yang berasal dari epitel bronkus. Tujuan penelitian ini adalah mengetahui gambaran pola kuman dari bilasan bronkus dan faktor-faktor yang memengaruhi pada pasien terduga kanker paru di RS Persahabatan pusat Respirasi Nasional. Metode : Jenis penelitian potong lintang. Jumlah sampel 226 pasien. Kriteria inkusi yaitu pasien terduga kanker paru, usia > 18 tahun, tidak menggunakan antibiotik satu minggu sebelum tindakan bronkoskopi. Hasil : Karakteristik pasien terduga kanker paru antara lain laki-laki (63,7%), rerata usia 60 ± 11,45 tahun. Keluhan respirasi batuk (78,3%) dan sesak napas (65,5%). Sebagian besar perokok berat (30,5%). Indeks massa tubuh normal (43,8%). Nilai leukosit normal (53,5%), neutrofil normal (66,4%), neutrofil limfosit rasio meningkat (67,3%). Data histopatologis terbanyak adalah adenokarsinoma (50,9%), EGFR tidak ada mutasi (34%) dan ALK negatif (29%). Foto toraks tampak lesi sentral (84,5%), > 3 mm (89,9%) dan konsolidasi (64,2%). CT scan toraks ada keterlibatan kelenjar getah bening (67,7%) dan ada metastasis (71,2%). Gambaran bronkus tampak massa infiltratif (27,9%) dan mukosa edematous (15,9%). Diagnosis terbanyak yaitu kanker paru (71,7%), T4 (85,2%), N2 (37,7%), M1a (42,6%), metastasis efusi pleura (54,9%), stage IV A (64,2%) dan PS 1 (49,4%). Bakteri terbanyak pada bilasan bronkus adalah Pseudomonas aeruginosa (13,7%) dan Klebsiella pneumoniae(11,1%). Kesimpulan : Bakteri terbanyak pada bilasan bronkus adalah Pseudomonas aeruginosadan Klebsiella pneumoniae. Batuk, nilai leukosit, letak anatomi foto toraks, letak anatomi CT scan toraks dengan kontras, ground glass opacity dan efusi pleura pada CT scan toraks dengan kontras memengaruhi ada atau tidak bakteri pada bilasan bronkus pasien terduga kanker paru.

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Background: Lung cancer is cancer that originates from the epithelium of the bronchi. This study aims to determine microbial patterns from bronchial washing and influencing factors in suspected lung cancer patients at Persahabatan Hospital National Respiratory Center. Method: Cross-sectional research. The sample was 226 patients. The inclusion criteria are patients suspected of lung cancer, aged > 18 years, not using antibiotics one week before bronchoscopy Results: The characteristics of patients suspected of lung cancer include male (63.7%), average age 60 ± 11.45 years. Respiratory complaints of cough (78.3%) and shortness of breath (65.5%). Most were heavy smokers (30.5%). Normal body mass index (43.8%). Normal leukocyte values (53.5%), normal neutrophils (66.4%) and neutrophil-lymphocyte ratio increased (67.3%). The most histopathological data were adenocarcinoma (50.9%), EGFR no mutation (34%) and negative ALK (29%). Thoracic photographs appear as central lesions (84.5%), > 3 mm (89.9%) and consolidated (64.2%). Thoracic CT scan there was involvement of lymph nodes (67.7%) and there were metastases (71.2%). The bronchial appears as infiltrative masses (27.9%) and edematous mucosa (15.9%). The most diagnoses were lung cancer (71.7%), T4 (85.2%), N2 (37.7%), M1a (42.6%), metastatic pleural effusion (54.9%), stage  IV A (64.2%) and PS 1 (49.4%). The most common bacteria in bronchial washing are Pseudomonas aeruginosa (13.7%) and Klebsiella pneumoniae (11.1%). Conclusion: The most common bacteria in bronchial washing are Pseudomonas aeruginosa and Klebsiella pneumoniae. Cough, leukocyte value, anatomy location based on thoracic photo and thoracic CT Scan with contrast, ground glass opacity and pleural effusion affect the presence or absence of bacteria in a bronchial wash of suspected lung cancer patients."

"Latar Belakang: Kanker paru dapat memiliki gejala dan tanda yang salah satunya disebabkan sindrom paraneoplastik. Salah satu sindrom paraneoplastik melibatkan sistem hematologi yang terdiri dari anemia, leukositosis, netrofilia, hipereosinofilia, trombositosis dan hiperkoagulabilitas. Belum ada data/penelitian di Indonesia mengenai sindrom paraneoplastik hematologi pada kanker paru.Metode: Penelitian ini adalah studi potong lintang analitik yang dilakukan di poliklinik onkologi toraks RSRRN Persahabatan dalam periode September 2018 hingga Februari 2019 terhadap semua pasien kanker paru kasus baru yang sudah tegak diagnosis serta memenuhi kriteria inklusi dan eksklusi yang diambil secara total sampling.Hasil: Subjek memiliki rerata usia 56,7+11,4 tahun. Sebagian besar laki-laki, berstatus gizi normal (42,6%), memiliki riwayat merokok (75%) dan IB sedang (52%). Jenis histologi tersering KSS (39,7%) dengan stage lanjut (83,8%) dan PS <2 (94,1%). Proporsi anemia paraneoplastik adalah 40,4% yang berhubungan dengan status gizi kurang dan tersering berjenis normositik normokromik. Proporsi leukositosis paraneoplastik adalah 39% yang berhubungan dengan jenis kelamin laki-laki dan riwayat merokok. Proporsi netrofilia paraneoplastik 51,5% yang berhubungan dengan jenis kelamin laki-laki, riwayat merokok dan jenis histologi KSS. Proporsi hipereosinofilia dan trombositosis paraneoplastik masing-masing adalah 2,9% dan 18,4%. Proporsi hiperkoagulabilitas paraneoplastik adalah 91,2% yang didominasi peningkatan kadar D-dimer.Kesimpulan: Sindrom paraneoplastik hematologi yang paling sering ditemukan pada pasien kanker paru adalah hiperkoagulabilitas, netrofilia dan anemia. Diperlukan penelitian lanjutan untuk menilai hubungan sindrom paraneoplastik hematologi dengan prognosis pasien.

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Background: Lung cancer could have signs and symptoms which was caused by paraneoplastic syndromes. One of those paraneoplastic syndromes involves hematologic system consisting of anemia, leukocytosis, neutrophilia, hypereosinophilia, thrombocytosis and hypercoagulability. There has been no data/research in Indonesia regarding hematologic paraneoplastic syndrome in lung cancer.

Methods: This study was a cross-sectional analytic study conducted at the thoracic oncology clinic in Persahabatan Hospital during September 2018 to February 2019 for all patients with new case of lung cancer whose diagnosis established and fulfilled the inclusion and exclusion criteria taken in total sampling.

Results: Subjects had a mean age of 56.7+11.4 years. Most of them were male, had normal nutritional status (42.6%), had a smoking history (75%) and moderate IB (52%). The most common type of histology was SCC/squamous cell carcinoma (39.7%) with advanced stage (83.8%) and PS <2 (94.1%). The proportion of paraneoplastic anemia was 40.4% which was associated with poor nutritional status and commonly normocytic normochromic. The proportion of paraneoplastic leukocytosis was 39%, associated with male sex and smoking history. The proportion of paraneoplastic neutrophilia was 51.5%, related to male sex, smoking history and SCC histology type. The proportions of paraneoplastic hypereosinophilia and thrombocytosis were 2.9% and 18.4%, respectively. The proportion of paraneoplastic hypercoagulability was 91.2% and dominated by the increase of D-dimer level.

Conclusion: The most common hematologic paraneoplastic syndrome found in lung cancer patients were hypercoagulability, netrophilia and anemia. Further research is needed to assess the correlation of hematologic paraneoplastic syndrome and the prognosis of the patients."

"ABSTRAKLatar Belakang: Kanker paru dan tuberkulosis TB adalah dua masalah kesehatan di seluruh dunia dengan angka kesakitan dan kematian yang tinggi. Meningkatnya kasus TB aktif dan reaktivasi TB laten pada pasien kanker paru serta dampak buruknya terhadap prognosis pasien memerlukan upaya untuk melakukan deteksi TB laten pada pasien kanker paru. Penelitian ini bertujuan untuk mengetahui berapa besar proporsi TB laten pada pasien kanker paru, karakteristiknya dan hubungan antar keduanya.Metode: Penelitian ini menggunakan desain potong lintang dan sampel dikumpulkan secara consecutivesampling terhadap 86 pasien kanker paru baru terdiagnosis di Rumah Sakit Umum Pusat Persahabatan Jakarta tahun 2015 hingga 2016. Pemeriksaan sputum Xpert MTB/RIF dilakukan untuk menyingkirkan kemungkinan TB aktif. Penentuan TB laten dilakukan dengan pemeriksaan Interferon Gamma Release Assay IGRA menggunakan alat QuantiFERON-TB Gold-in-Tube QFT-GIT .Hasil: Pemeriksaan TB laten mendapatkan hasil IGRA 11 pasien 12,8 , IGRA - 59 pasien 68,6 dan IGRA indeterminate I 16 pasien 18,6 . Karakteristik sosiodemografi pasien kanker paru dengan TB laten adalah 63,6 laki-laki, rerata usia 56 tahun, 36,4 diimunisasi BCG, 9 dengan kontak erat TB, 72,7 dengan riwayat merokok. Karakteristik klinis pasien tersebut 90 memiliki status gizi normal lebih dengan nilai tengah indeks massa tubuh IMT 19,12 18,24-29,26 kg/m2, nilai tengah hitung limfosit total 1856 1197-4210 sel/ul, 9 dengan komorbid diabetes mellitus, 81,8 tumor paru mengenai lokasi khas predileksi TB paru. Jenis kanker terbanyak adalah adenokarsinoma 81,8 dengan stage lanjut 81,8 dan status tampilan umum 2-3 63,6 . Karakteristik yang menunjukkan hubungan bermakna dengan hasil IGRA adalah lokasi tumor yang mengenai daerah lesi khas TB secara radiologis. Hitung limfosit total yang rendah berhubungan dengan hasil IGRA I dengan nilai tengah 999,88 277-1492,60 sel/ul.Kesimpulan: Proporsi TB laten pada pasien kanker paru di RSUP Persahabatan adalah 12,8 . Karekteristik pasien kanker paru yang berhubungan dengan TB laten adalah lokasi tumor yang mengenai daerah lesi khas TB walaupun belum dapat disimpulkan hubungannya secara biologis. Hasil IGRA I pada pasien kanker paru dengan hitung limfosit total yang rendah menunjukkan keterbatasan sensitivitas IGRA dalam mendeteksi infeksi TB laten pada pasien imunokompromais.Kata Kunci : infeksi TB laten, kanker paru, IGRA, hitung limfosit total

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ABSTRACTBackground Lung cancer and pulmonary tuberculosis TB are two major public health problems associated with significant morbidities and mortalities. The increased prevalence of active TB and latent TB reactivation in lung cancer patients and the negative effect of pulmonary TB in lung cancer prognosis underline the need for a through screening of lung cancer patients for latent TB infection LTBI . The aims of this study are to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them.Methods This study used a cross sectional design and sample was collected using consecutive sampling of the 86 newly diagnosed treatment naive lung cancer patients from a referral respiratory hospital, Rumah Sakit Umum Pusat Persahabatan Jakarta in 2015 to 2016. The presence of LTBI was determined by Quantiferon TB Gold In Tube QFT GIT after having Mycobacterium TB not detected result from Xpert MTB RIF sputum test. Demographic characteristics and cancer related factors associated with LTBI were investigated.Results There are 11 patients 12,8 with IGRA result and 16 patients 18,6 with IGRA indeterminate I result. Sociodemographic characteristics of lung cancer patients with latent TB are 63,6 male, mean of age 56 years, 36,4 with BCG immunization, 9 had TB close contacts history, 72,7 with a history of smoking. The clinical characteristics of these patients are 90 had a normal nutritional status with the median body mass index BMI 19,12 18,24 29,26 kg m2, the median of total lymphocyte count is 1856 1197 4210 cells ul, 9 with diabetes mellitus as comorbid, 81,8 of lung tumour located in the typical predilection for pulmonary tuberculosis. Most types of lung cancer are adenocarcinomas 81.8 with advanced stage 81,8 and the WHO performance status of 2 3 63,6 . Characteristics having significant relationship with IGRA results is the tumour located in the typical TB area radiologically. Low total lymphocyte count is associated with indeterminate IGRA results with median 999,88 277 1492,6 cells ul.Conclusion The proportion of latent TB in lung cancer patients is 12,8 . Characteristics of patients with lung cancer associated with latent TB is the location of the tumor lesions typical of the area although it can not be concluded biologically. Having indeterminate IGRA results in lung cancer patients with a low total lymphocyte count showed the limitations of QFT GIT in detecting latent TB infection in immunocompromised patients.Key words latent TB infection, lung cancer, IGRA, total lymphocyte count "

"Pendahuluan: Sindrom Vena Kava Superior (SVKS) merupakan kegawatan onkologi yang membutuhkan penanganan segera, walaupun belum ada hasil histologi. Sebagian besar pasien dengan SVKS dapat ditangani dengan radioterapi. Metode penelitian: Penelitian ini menggunakan metode kohort retrospektif. Kami mengumpulkan data dari catatan rekam medis pasien keganasan rongga toraks dengan SVKS setelah radioterapi-segera di Rumah Sakit Persahabatan dalam jangka waktu Maret 2009 sampai Februari 2012. Analisis Kaplan-Meier digunakan untuk menilai angka tahan hidup pasien. Hasil Penelitian: Seluruh subjek berjumlah 104 orang. Subjek penelitian sebagian besar laki-laki (83,7%) dengan sebagian besar usia di atas 51 tahun (52,9%). Sebanyak 86 kasus merupakan kanker paru dengan jenis histologi terbanyak adenokarsinoma (61,5%), disusul dengan karsinoma sel skuamosa sebanyak 10 subjek (9,6%). Germ cell dan limfoma ditemukan masing-masing sebanyak 8 subjek (7,7%) dan 6 subjek (5,8%). Kesimpulan: Angka tahan hidup 1 tahun pasien keganasan rongga toraks dengan SVKS pasca radioterapi-segera sebesar 27%, dengan masa tengah tahan hidup (MTTH) 11 minggu, masa tahan hidup (MTH) 125 minggu, dan rerata lama hidup 13,3 minggu. Jenis kelamin perempuan, jenis keganasan tumor mediastinum dan kemoterapi merupakan faktor prognosis yang baik. Tidak ada perbedaan bermakna angka tahan hidup antara pasien kanker paru dengan jenis histologi adenokarsinoma dan non-adenokarsinoma.

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Introduction: The superior vena cava syndrome (VCSS) is considered to be an oncologic emergency that requires immediate therapeutic action, even before a histologic diagnosis is obtained. Most patients with VCSS can be successfully managed with medical or radiation therapy. Methods: This study used the retrospective cohort method. We collected the data from medical records of thoracic malignancy with VCSS patients after cito-radiotherapy in Persahabatan Hospital, within March 2009 until February 2012. The Kaplan-Meier analysis was done to obtain patients survival rate. Results: Subjects in this study were mostly male (83,7%) with predominant age group of over 51 years old (52,9%). Lung carcinoma were 86 cases with predominant histopathologic type of adenocarcinoma (61,5%), squamous cell carcinoma were 10 subjects (9,6%), germ cell were 8 subjects (7,7%) and lymphoma were 6 subjects (5,8%). Conclusion: The 1-year survival rate of thoracic malignancy patients with VCSS after radiotherapy-cito in Persahabatan Hospital was 27%, with median survival time of 11 weeks, survival time of 125 weeks and mean survival time of 13,3 weeks. We found that sex of female, mediastinum tumor and chemotheraphy were good prognostic factors. There is no significant difference survival rate between adenocarcinoma and non-adenocarcinoma."

"Pendahuluan: Pasien penyakit paru obstruktif kronik (PPOK) yang mengalami eksaserbasi akan meningkatan angka morbiditas dan mortalitas. Berdasarkan Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), PPOK derajat sedang dan berat dapat diberikan antibiotik sebagai tata laksananya. Salah satu cara menilai ketepatan pemberian antibiotik adalah dengan menggunakan alur Gyssens. Penelitian ini bertujuan melihat proporsi ketepatan pemberian antibiotik berdasarkan alur Gyssens dan hubungannya dengan mortalitas, perbaikan klinis, kebutuhan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun. Metode: Penelitian ini merupakan studi observasional dengan menggunakan desain penelitian kohort restrospektif. Sebanyak 161 pasien PPOK derajat sedang dan berat yang dirawat di RS Persahabatan Pusat Respirasi Nasional pada Januari 2022 hingga Desember 2023 mendapatkan terapi antibiotik. Pasien yang mendapatkan antibiotik selama perawatan dinilai ketepatannya sesuai alur Gyssens. Hasil: Berdasarkan ketepatan pemberian antibiotik sesuai alur Gyssens, sebanyak 93 subjek (62,8%) laki-laki dan lima subjek (38,5%) perempuan dengan rerata usia 64,34 (±9,62) tahun. Sebagian besar memiliki status merokok indeks Brinkman berat dengan kelompok PPOK grup E dan derajat esksaserbasi sedang. Hipertensi merupakan komorbiditas yang paling sering ditemukan. Terdapat hubungan bermakna antara ketepatan pembrian antibiotik dengan rerata lama rawat (p=<0,001). Proporsi ketepatan pemberian antibiotik sesuai alur Gyssens sebesar 60,9%. Antibiotik yang paling seering digunakan adalah levofloxacin. Hasil analisis bivariat menunjukkan tidak terdapat hubungan yang bermakna antara ketepatan pemberian antibiotik berdasarkan alur Gyssens dengan mortalitas, lama perbaikan klinis, penggunaan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun. Kesimpulan: Proporsi pemberian antibiotik sesuai alur Gyssens pada pasien PPOK eksaserbasi derajat sedang dan berat sebesar 60,9%. Tidak terdapat hubungan yang bermakna secara statistik antara ketepatan pemberian antibiotik sesuai alur Gyssens dengan mortalitas, lama perbaikan klinis, penggunaan ventilasi mekanis invasif dan perawatan berulang dalam satu tahun.

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Introduction: Patients with chronic obstructive pulmonary disease (COPD) experiencing exacerbations will increase morbidity and mortality rates. According to the Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD), moderate and severe COPD can be treated with antibiotics. One way to assess the appropriateness of antibiotic administration is by using the Gyssens flowchart. This study aims to examine the proportion of appropriateness of antibiotic administration based on the Gyssens flowchart and its relationship with mortality, clinical improvement, need for mechanical ventilation and readmission within one year. Method: This study is an observational study using a retrospective cohort design. A total of 161 moderate and severe COPD patients treated at Persahabatan Hospital National Respiratory Center from January 2022 to December 2023 received antibiotic therapy. The appropriateness of antibiotic administration during treatment was assessed according to the Gyssens flowchart.. Results: Based on the appropriateness of antibiotic administration according to the Gyssens flowchart, there were 93 male subjects (62.8%) and five female subjects (38.5%) with a mean age of 64.34 (±9.62) years. Most of them had a heavy Brinkman smoking index with COPD group E and moderate exacerbation. Hypertension was the most commonly found comorbidity. There is a significant relationship between the appropriateness of antibiotic administration and length of stay (p=<0.001). The proportion of appropriateness of antibiotic administration according to the Gyssens flowchart was 60.9%. Levofloxacin was the most frequently used antibiotic. Bivariate analysis results showed no significant relationship between the appropriateness of antibiotic administration based on the Gyssens flowchart with mortality, duration of clinical improvement, use of invasive mechanical ventilation and readmission within one year. Conclusion: The proportion of antibiotic administration according to the Gyssens flowchart in patients with moderate and severe exacerbations of COPD is 60.9%. There is no statistically significant relationship between the appropriateness of antibiotic administration according to the Gyssens flowchart and mortality, duration of clinical improvement, use of invasive mechanical ventilation and readmission within one year"