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"Latar Belakang : Metastasis tulang merupakan masalah pada pasien kanker paru karena memperburuk prognosis dan kualitashidup. Nyeri merupakan salah satugejala yang paling umum. Tatalaksana metastasis tulang pada pasien kanker paru meliputi terapi pada tumor primer, radioterapi pada lesi metastasis dan pemberian ibandronic acid.Metode : Penelitian ini merupakan studi retrospektif. Kami mencatat pasien kanker paru bermetastasis tulang dan dirawat di rumah sakit pusat rujukan respirasi nasional Persahabatan Jakarta dari tanggal 1 Januari 2016 sampai 30 Juni 2018. Tujuan penelitian ini untuk mengevaluasi penurunan nyeri kanker yang berhubungan dengan metastasis tulang. Semua pasien menerima terapi ibandronic acid 6 mg intravena setiap bulan dan diukur skala nyerinya dengan menggunakan Visual Analogue Scale (VAS). Selain mendapat terapi ibandronic acid, setiap pasien juga mendapatkan modalitas terapi nyeri kanker lain seperti analgetik, radioterapi atau kombinasi keduanya. Hasil : Lokasi lesi kanker paru bermetastasis ke tulang paling sering (dari 51/71 pasien) adalah vertebra 74 (43,79%), toraks 55 (32,54%) dan pelvis 28 (17,75%). Rerata jumlah pemberian ibandronic acid adalah 8 kali pemberian. Rentang waktu pemberian ibandronic acid dari tegak jenis adalah 6 bulan. Nyeri VAS setelah pemberian ibandronic acid berturut-turut nyeri VAS ringan (VAS 1-3) 14 (27,54%), nyeri VAS sedang (VAS 4-6) 37 (72,46%) dan nyeri berat (VAS 7-10) 0 (0%). Total waktu penurunan nyeri setelah pemberian ibandronic acid adalah 4 bulan. Rerata penurunan nyeri VAS pada grup nyeri VAS ringan-sedang terjadi setelah 5 kali pemberian sedangkan rerata penurunan grup nyeri VAS berat setelah 1 kali pemberian (p = 0.0001). Terdapat beberapa kejadian efek samping setelah pemberian ibandronic acid yang ditemukan pada 9 dari 51 subjek antara lain 2 (3,9%) ruam kulit, 3 (5,9%) mual dan muntah, 3 (5,9%) sakit kepala dan 1 (2,0%) demam.Kesimpulan : Terapi ibandronic acid sangat bermanfaat untuk menurunkan nyeri kanker pada pasien kanker paru bermetastasis ke tulang

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Background: Bone metastasis (BM) is one of the problems in lung cancer because it affects the prognosis and quality of life. Pain is most common symptom. The management of bone metastasis (BM) in lung cancer are treatment of primary cancer lesion, radiotherapy on the metastatic lesions and ibandronic acid.

Method : In this retrospective study, lung cancer patients with BM and treated in Persahabatan National Respiratory Referral Hospital, Jakarta, between January 1st 2016 and June 30th 2018 were enrolled. The aim of study was to evaluate the efficacy of ibandronic acid in the treatment of cancer pain caused by BM. All of patients received ibandronic acid 6 mg (intravenously) monthly and Visual Analogue Scale (VAS) was used to evaluate pain. All patients received other management cancer pain such as analgesics, radiotherapy or combination.

Results : Most BM lesions (51/71 cases) were located in vertebra 74 (43,79%), thoracic cage 55( 32,54%) and pelvic 28 (17,75%). The averages of administration of ibandronic acid 6 mg iv was 8 times. The mean time-to-treat of ibandronic acid since the first time of lung cancer diagnosis was 6 months. VAS pain scale after administration of ibandronic acid was classified to mild pain (VAS 1-3) 14 cases (27,54%), moderate pain (VAS 4-6) 37 cases (72,46%) and severe pain (VAS 7-10) 0 cases. Overall the decrease in VAS scale was seen after 4 times ibandronic acid administration. Pain was significantly improved after the fifth administration in patients which initially suffered from moderate to mild pain and was significantly improved immediately after the first administration in patients which initially suffered from severe pain (p=0,0001). The side effects caused by ibandronic acid was observed in 9 patients, in which 2 subjects (3,9%) had a rash skin, 3 subjects (5,9%) suffered nausea and vomiting, 3 subjects (5,9%) had headache, and 1 subject (2,0%) fever.

Conclusion : Ibandronic acid treatment was useful to relieve metastatic bone pain in lung cancer patients."

"Pada penderita kanker paru terjadi inflamasi sistemik dan dapat dilihat dengan peningkatan rasio netrofil limfosit di mana pemeriksaan ini lazim dilakukan di Rumah Sakit. Inflamasi sitemik dapat menyebabkan anoreksia sehingga asupan pada penderita kanker paru menurun dan memengaruhi status gizinya.  Penelitian ini bertujuan untuk mengetahui hubungan antara status gizi dengan rasio netrofil limfosit pada pasien kanker paru di RSUP Persahabatan. Penelitian ini menggunakan desain cross-sectional. Data diambil dari wawancara, pemeriksaan fisik, pemeriksaan laboratorium, dan dari rekam medis pasien poliklinik onkologi RSUP Persahabatan (n=52). Pada penelitian ini subjek sebagian besar berjenis laki-laki (61,5%), rentang usia terbanyak antara 50-60 tahun (38,5%), memiliki riwayat merokok (55,8%) dengan indeks Brinkman berat (30,8%). Lebih dari 50% subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Sebagian besar subjek penelitian berisiko malnutrisi atau malnutrisi sedang (38,5%) dan sebanyak 67,3% mengalami malnutrisi. Sebagai kesimpulan tidak terdapat hubungan antara status gizi dengan rasio netrofil limfosit pada penelitian ini (p = 0,35).

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Systemic inflammation in patients with lung cancer can be seen by the increase in the neutrophil lymphocyte ratio where these examinations are common in hospitals. Systemic inflammation can cause anorexia, with the result that nutrition intake of patients with lung cancer decreases and affects their nutritional status. This study aims to determine the association between nutritional status and the ratio of lymphocyte neutrophils in patients with lung cancer at Persahabatan Hospital. This is a cross-sectional study. Data were taken from interviews, physical examinations, laboratory analysis, and patients medical records in the oncology clinic of Persahabatan Hospital (n = 52) The subjects of the study were mostly male (61.5%), the largest age range was between 50-60 years (38.5%), had a history of smoking (55.8%) with a severe Brinkman index (30.8%). More than 50% of the subjects with energy and protein intake were below the recommended intake for cancer patients. Most of the study subjects were at risk of malnutrition or moderate malnutrition (38.5%) and 67.3% of them were experiencing malnutrition. In conclusion, there was no relationship between nutritional status with the ratio of neutrophil to lymphocytes in this study (p = 0.35)."

"Latar belakang: Kanker paru menduduki peringkat ketiga sebagai penyebab kematian utama akibat keganasan di Indonesia, 85% di antaranya adalah kanker paru karsinoma bukan sel kecil (KPKBSK). Pasien kanker paru rentan terhadap infeksi oportunistik, termasuk kriptokokosis, yaitu infeksi jamur Cryptococcus. Penelitian tentang data klinis dan keberadaan Cryptococcus pada pasien KPKBSK di Indonesia masih terbatas. Salah satu metode untuk mendeteksi keberadaan Cryptococcus adalah pemeriksaan serologi Lateral Flow Assay (LFA). Tujuan: Penelitian ini bertujuan untuk mengetahui profil klinis pasien KPKBSK dan kaitannya dengan hasil pemeriksaan LFA Cryptococcus di RSUP Persahabatan. Metode: Penelitian dengan disain potong lintang ini dilakukan pada pasien KPKBSK yang belum dikemoterapi di RSUP Persahabatan yang memenuhi kriteria inklusi. Data klinis pasien diperoleh dari anamnesis dan pemeriksaan fisik yang diambil dari rekam medis, selanjutnya dilakukan pemeriksaan LFA Cryptococcus di laboratorium Parasitologi FKUI. Hasil: Dari 77 subjek yang memenuhi kriteri inklusi, terdapat 48 (62,3%) pasien laki-laki, dengan rerata usia 59,4 tahun. Data klinis lain menunjukkan IMT 18,5-22,9 kg/m2 (53,2%), status tampilan 1 (42,9%), perokok aktif (61,0%), Indeks Brinkman ringan (42,9%), adenokarsinoma (75,3%), stadium IIIB-IV (79,2%). Riwayat komorbid yang ditemukan adalah TB (13,0%), asma/PPOK (1,3%), DM (16,9%), dan penyakit lainnya (31,2%). Proporsi hasil pemeriksaan LFA Cryptococcus positif adalah 11,7%. Tidak ditemukan hubungan bermakna antara profil klinis dengan keberadaan Cryptococcus pada pasien KPKBSK. Simpulan: Proporsi keberadaan Cryptococcus pada pasien KPKBSK yang belum dikemoterapi adalah 11,7%. Profil klinis terbanyak berupa IMT 18,5-22,9 kg/m2, status tampilan 1, perokok aktif, Indeks Brinkman ringan, jenis keganasan adenokarsinoma, dan stadium IIIB-IV. Riwayat komorbid meliputi TB, asma/PPOK, DM, dan penyakit lain. Tidak ditemukan hubungan antara profil klinis dengan keberadaan Cryptococcus pada subjek penelitian.

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Background: Lung cancer is the third of leading cause of death due to malignancy in Indonesia. Eighty-five percent of them were non-small cell lung cancer (NSCLC). Lung cancer patients are prone to have the opportunistic infections, such as cryptococcosis. However, the clinical data on the exictance of Cryptococcus in NSCLC patients in Indonesia are scarce. One of the methods to detect Cryptococcus in those patients is the Lateral Flow Assay (LFA) serology test.

Aim: The study aimed to determine the association between the clinical profile of NSCLC patients with the Cryptococcal LFA test results at Persahabatan Hospital, Jakarta.

Methods: This cross-sectional study was conducted on naïve NSCLC patients at Persahabatan Hospital Jakarta, who met the inclusion criteria. The clinical data were obtained from history taking and physical examination from the medical records. Furthermore, the Cryptococcal LFA serology test was conducted at laboratory of Parasitology Department, Faculty of Medicine Universitas Indonesia.

Results: Of the 77 subjects, there were 48 male patients (62.3%), and the mean age was 59.4 years old. The most common clinical profile of NSCLC patients were BMI of 18.5-22.9 kg/m2 (53.2%), performance status 1 (42.9%), active smokers (61.0%), mild Brinkman Index (42.9%), adenocarcinoma (75.3%), and cancer stage of IIIB-IV (79.2%). The comorbidities of those patients were TB (13.0%), asthma/COPD (1.3%), DM (16.9%), and other diseases (31.2%). The proportion of positive Cryptococcal LFA test results was 11.7%. There was no significant association between the clinical profiles and the presence of Cryptococcus.

Conclusion: The proportion of the Cryptococcus existance in naïve NSCLC patients was 11.7%. The most common clinical profiles were BMI of 18.5-22.9 kg/m2, performance status 1, active smokers, mild Brinkman Index, adenocarcinoma histology type, and lung cancer stage at IIIB-IV. The comorbidities of those patients were TB, asthma/COPD, DM, and other diseases. No association was found between the clinical profile of those patients and the presence of Cryptococcus."

"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 "

"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: 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."

"Latar Belakang : Kanker paru merupakan salah satu penyakit yang memiliki beban terbesar di dunia. Pajanan zat karsinogen merupakan salah satu faktor risiko kanker paru, baik pada rokok maupun di lingkungan, Zat karsinogenik di tempat kerja yang dapat menyebabkan kanker paru adalah silika, asbes dan radon. Silika merupakan salah satu zat karsinogenik dalam IARC kelompok 1. Tujuan penelitian ini untuk mengetahui kadar silika kurasan bronkoalveolar pada pasien kanker paru, serta riwayat pajanannya.Metode : Penelitian ini merupakan penelitian cross sectional pada pasien tumor paru yang akan dilakukan tindakan diagnostik baik dari instalasi rawat jalan maupun rawat inap di RS Persahabaran. Pengambilan sampel dilakukan secara consecutive sampling dalam kurun waktu April 2019 sampai dengan Juni 2019.Hasil : Pada penelitian ini yang memenuhi kriteria inklusi sebesar 42 pasien kanker paru yang tegak jenis. Prevalens kanker paru dengan riwayat pajanan silika sebanyak 71.4%, status pajanan terbanyak dari pekerjaan sebanyak 38.1%. Kadar silika kurasan bronkoalveolar terbanyak adalah positif sebanyak 54,8% dengan rata-rata tertinggi dari pajanan pekerjaan dan rokok (2.85±2.9). Hasil ini bermakna secara statistik dengan nilai p<0,05. Jenis keganasan terbanyak dengan kadar silika positif adalah adenokarsinoma sebanyak 44%. Terdapat hubungan bermakna antara status pajanan dengan kadar silika (p 0.001), jenis pekerjaan dengan kadar silika (p 0.000), masa kerja dengan kadar silika (p 0.014), lama kerja dengan kadar silika (p 0.031), penggunaan Alat Pelindung Diri (APD) dengan kadar silika (p 0.005)Kesimpulan : Didapatkan kadar silika yang positif pada pasien kanker paru dengan riwayat pajanan silika dari pekerjaan dan rokok, terdapat hubungan antara status pajanan, jenis pekerjaan, masa kerja, lama kerja dan riwayat penggunaan APD dengan kadar silika kurasan bronkoalveolar pada pasien kanker paru.

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Background: Lung cancer is one leading cause of death in the world. Carcinogenic exposure is one of the risk factors for lung cancer, both in cigarettes and environment. Carcinogenic substances at work that can cause lung cancer are silica, asbestos and radon. Silica is one of the carcinogenic substances in IARC group 1. The purpose of this study was to determine the silica levels of bronchoalveolar lavage lung cancer patients and their exposure history of silica.

Method: This is cross sectional study based on prodiagnostic lung tumor patients measures both from outpatient and inpatient installations at Persahabatan Hospital. Sampling was done by consecutive sampling in the period April 2019 until June 2019.

Results: Sample of this study match with inclusion criteria are 42 patients with confirmed lung cancer. The prevalence of lung cancer with history of silica exposure was 71.4%, the most from occupational exposure was 38.1%. The highest amount of bronchoalveolar lavage silica was positive as much as 54.8% with the highest average of occupational and cigarette exposure (2.85 ± 2.9). This result is statistically significant with p value <0.05. The most common type of malignancy with positive silica levels was adenocarcinoma 44%. There is significant relationship between exposure status with silica levels (p 0.001), types of occupation with silica levels (p 0.000), years of service with silica levels (p 0.014), length of work with silica levels (p 0.031), use of Personal Protective Equipment with silica levels (p 0.005)

Conclusion: Positive silica levels from bronchoalveolar lavage in lung cancer patients with exposure silica history was found, the most from occupational and cigarettes exposure, there is relationship between exposure status, occupational type, length of service, length of work and history of using personal protective equipment with bronchoalveolar lavage silica levels in lung cancer patients."

"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"ABSTRAKLatar Belakang : Paduan kemoterapi berbasis platinum dengan generasi ketiga khususnya karboplatin-vinorelbin sudah sering digunakan sebagai kemoterapi paliatif pada pasien KPKBSK stage lanjut di Indonesia khususnya Rumah Sakit Umum Pusat RSUP Persahabatan namun sampai saat ini belum terdapat data mengenai efikasi dan toksisiti paduan kemoterapi ini di RSUP Persahabatan.Metode : Desain penelitian ini adalah survey observasional retrospektif pada pasien KPKBSK stage lanjut IIIB dan IV yang menjalani kemoterapi lini I di RSUP Persahabatan dengan paduan kemoterapi karboplatin-vinorelbin sejak 1 Januari 2015 sampai 30 Maret 2017.Hasil : Total subjek dalam penelitian ini adalah 38 pasien yang mendapatkan paduan kemoterapi Karboplatin AUC-5 pada hari ke-1 dan vinorelbin 30 mg/m2 pada hari ke1 dan ke-8. Paduan kemoterapi karboplatin-vinorelbin mempunyai efikasi yang baik dengan Objective overall response rate ORR 12,5 dan clinical benefit rate CBR 87,5 . Overall survival OS pada penelitian ini adalah 34,2 dengan masa tengah tahan hidup 387 hari 12,9 bulan dan progression free survival 323 hari 10,7 bulan. Toksisiti hematologi dan nonhematologi yang paling sering terjadi adalah anemia derajat 1 38,4 dan keluhan mual, muntah derajat 2 57,9 . Pada penelitian ini terdapat 2 kasus perdarahan saluran cerna derajat 2 namun pasien masih dapat melanjutkan kemoterapi. Kami juga mendapatkan komplikasi tindakan kemoterapi berupa phlebitis ringan pada 24 pasien 65,7 dan phlebitis sedang pada 1pasien 2,6 .Kesimpulan: Paduan karboplatin-vinorelbin sebagai kemoterapi lini I memiliki efikasi yang baik serta efek toksisiti yang masih dapat ditoleransi sehingga aman diberikan pada pasien KPKBSK stage lanjut. Kata kunci: efikasi, toksisiti, hematologi, nonhematologi, objective overall response rate, clinical benefit rate, overall survival, MTTH, TTP, PFS

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ABSTRAK Background Combination of platinum base and third generation drugs Carboplatin and vinorelbine chemotherapy are frequently used as paliative chemotherapy for Non small cell lung cancer NSCLC patients in Indonesia especially in Persahabatan Hospital. But there are still no data about the activity and tolerability of this regiment in Persahabatan Hospital. This study is conducted to evaluate the efficacy and toxicity of this regiment as first line chemotherapy for advanced NSCLC patients in Persahabatan Hospital.Method This study is an observational survey retrospective study for advanced NSCLC patientswho receive carboplatin vinorelbine regiment as fisrt line chemotherapy since 1st January 2015 to 30th March 2017.Result We observea total of 38 patients who receive carboplatin 5 AUC on day 1 and vinorelbine 30mg m2 on day 1 and 8. This regiment has a good efficacy with overall response rate ORR 12,5 and clinical benefit rate CBR 87,5 . The overall survival OS is 34,2 with median of survival time 387 days 12,9 moths and PFS 323 days 10,7 moths . We found grade 1 anemia 38,4 and grade 2 nausea vomiting 57,9 as hematological and non hematological toxicity that frequently occur in this study. We found 2 cases of grade 2 gastrointestinal bleeding but the patients are still able to continue the chemotherapy after doing some correction for the haemoglobin Hb . We also found mild phlebitis in 24 patients 65,7 and 1 moderate phlebitis in 1 patient 2,6 as procedural complication of this chemotherapyConclusion Combination ofcarboplatin and vinorelbine as first line chemotherapy has a good efficacy and tolerability for advanced NSCLC patients. Key word efficacy, toxicity, haematological, non hematological, overall objective response rate ORR , clinical benefit rate CBR , overall survival OS , median time of survival, time to progression TTP and progression free survival PFS ."

"ABSTRAKLatar Belakang:Penelitian ini merupakan studi awal untuk menetapkan proporsi pneumonitis radiasi pada pasien kanker paru yang mendapat radiasi di RSUP Persahabatan.Metode: Penelitian ini menggunakan desain retrospektif pada pasien kanker paru yang mendapat radiasi di RSUP Persahabatan antara Juni 2013-Juli 2015. Pengambilan data melalui rekam medik dan dilakukan evaluasi ulang foto toraks 1 bulan pasca radiasi.Hasil: Terdapat 33 pasien kanker paru yang memenuhi kriteria inklusi. Karakteristik subyek meliputi usia ≥51 tahun (63,6%), laki-laki (66,7%), riwayat merokok (75,8%), IB sedang (60%), dosis radiasi 300-4000 (60,6%), fraksi radiasi 10-19 (60,6%), tidak mempunyai riwayat kemoterapi (54,5%), kanker paru jenis adenokarsinoma (66,7%) dan stage IV (84,84%). Proporsi pneumonitis radiasi berdasarkan foto toraks sebesar 39,4% yang terdiri dari gambaran hazy ground glass opacities, hazy ground glass opacities dan fibrosis serta fibrosis. Ditemukan perbedaan bermakna antara usia, dosis radiasi dan riwayat kemoterapi dengan kejadian pneumonitis radiasi (p<0,05).Kesimpulan: Proporsi pneumonitis radiasi berdasarkan foto toraks sebesar 39,4%. Terdapat perbedaan bermakna antara usia, dosis radiasi dan riwayat kemoterapi dengan kejadian pneumonitis radiasi.

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ABSTRACTIntroduction: This is a preliminary study to determine proportion radiation pneumonitis in lung cancer patients who got radiaton in Persahabatan Hospital.Method: This was a retrospective study in lung cancer patients who got radiation in Persahabatan Hospital between June 2013 ? July 2015. Interpretation data were from medical record and did reevaluation chest x ray 1 month after radiation.Result: There were 33 lung cancer patients were filled inclusion criteria. Subjects characteristic were age ≥51 years (63,6%), male (66,7%), history of smoking (75,8%), moderate IB (60%), radiation doses 3000-4000 (60,6%), radiation fractions 10-19 (60,6%), had no history of chemotheraphy (54,5%), adenocarcinoma (66,7%) and stage IV (84,84%). Proportion radiation pneumonitis based on chest x ray were 39,4% that include hazy ground glass opacities, hazy ground glass opacitiesand fibrosis and only fibrosis. There were significant differences between age, radiation doses and history of chemotheraphy with proportion radiation pneumonitis (p<0,05).Conclusion: Proportion radiation pneumonitis based on chest x ray are 39,4%. There are significant differences between age, radiation doses and history of chemotheraphy with proportion radiation pneumonitis (p<0,05)."