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"Pendahuluan : Efusi pleura pada kanker paru merupakan salah satu faktor prognostik yang buruk dan menjadi dasar perubahan TNM sistem versi 7 yang menetapkan efusi pleura sebagai faktor metastasis. Efusi pleura malignan merupakan tanda keganasan stage lanjut dengan tingkat harapan hidup yang pendek, berkisar antara 3 hingga 12 bulan tergantung dari tipe dan stage penyakit pada saat di diagnosis. Metode : Penelitian kohort retrospektif dari catatan medis pasien kanker paru di RSUP Persahabatan Jakarta periode 1 Januari 2010 ? 31 Desember 2011. Angka penderita kanker paru yang tercatat masuk bangsal perawatan pada periode 1 januari 2010 ? 31 desember 2011 adalah 729 pasien, penderita kanker paru disertai efusi pleura sebanyak 315 pasien. Penetapan sampel dengan rumus rules of thumb didapat 50 pasien dengan sitologi dan atau histopatologi positif dan 50 pasien dengan sitologi dan atau histopatologi negatif. Dengan analisis Kaplan Meier, hubungan antara hasil sitologi dan atau histopatologi dan hari tahan hidup ditelaah. Analisis multivariat dengan Cox Regression dilakukan untuk menelaah hubungan hasil sitologi dan atau histopatologi dan hari tahan hidup dengan pengaruh umur, jenis kelamin, jenis sel kanker, terapi kanker dan volume efusi pleura. Hasil : Data dari seratus pasien kanker paru dikumpulkan untuk analisis. Median survival time untuk pasien dengan hasil sitologi positif lebih rendah dibandingkan dengan yang hasil sitologi negatif (21 vs 42 hari), begitu pula overall survival time (40.42 + 42.83 vs 104.88 + 164.63, p 0.01). Faktor jenis kelamin, umur dan volume efusi pleura tidak bermakna secara statistik terhadap angka tahan hidup jika dikaitkan dengan hasil sitologi dan atau histopatologi. Pasien yang mendapatkan terapi kanker menunjukkan peningkatan hari tahan hidup secara signifikan (Hazard ratio 0.157, 95% CI 0.092 ? 0.266, p <0.001). Penurunan hari tahan hidup ditemukan pada pasien dengan karsinoma sel kecil secara signifikan dibandingkan dengan pasien adenokarsinoma (Hazard ratio 17.685, 95% CI 2.155 ? 145.146, p 0.007). Kesimpulan : Masa tahan hidup pasien kanker paru dengan efusi pleura sitologi dan atau histopatologi positif lebih pendek dibanding kelompok yang negatif. Faktor jenis kelamin, umur dan volume efusi pleura tidak berpengaruh pada hari tahan hidup, sedangkan faktor terapi dan jenis sel kanker berpengaruh secara signifikan dalam meningkatkan hari tahan hidup.

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Introduction : Pleural effusion is one of the poor prognostic factors in lung cancer and initiates the change in the 7th TNM classification system, which sets pleural effusion as a metastatic factor. Malignant pleural effusion indicates an advanced stage of malignancy with a low life expectancy rate, ranging from 3 to 12 months depending on the type and stage of the disease at time diagnosis is confirm.

Method : A cohort retrospective was conducted using data from medical records of lung cancer patients in Persahabatan Hospital Jakarta period 1 January 2010-31 December 2011. Seven hundred and twenty nine lung cancer patients were included, among then 315 had pleural effusion. Using the rules of thumb, Sample of 50 patients with positive cytology and or histopathology and 50 patients with negative cytology and or histopathology was included in the study. By using Kaplan-Meier analysis, the relationship between the results of cytology and or histopathology and survival rate were examined. Further multivariate cox regression analysis was conducted to examine the relationship between the result of cytology and or histopathology and survival rate according to age, gender, type of cancer cell, cancer therapy and the volume of pleural effusion.

Result : Data from one hundred lung cancer patients were collected for analysis. Median survival time for patients with positive cytology was lower than those with a negative cytology result (21 vs 42 days), as well as overall survival time (40.42 vs. 42.83 + 104.88 + 164.63 days, p 0.01). Factors associated including sex, age and volume of pleural effusion do not have significant effect on the survival if associated with cytology and or histopathology results. Patients receiving cancer therapy showed a significant increase in the survival days (Hazard ratio 0.157, 95% CI 0.092-0.266, p <0.001). A significant decrease of survival days was found in patients with small cell carcinoma as compared to adenocarcinoma patients (Hazard ratio 17.685, 95% CI 2.155-145.146, p 0.007).

Conclusion : Positive cytology and or histopathology results significantly decreases the survival rate in lung cancer patients. Factors including sex, age and volume of pleural effusion has no effect on survival rate, whereas cancer therapy and type of cancer cell (adenocarcinoma) significantly improves survival rate."

"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."

"Latar Belakang: Transbronchial needle aspiration (TBNA) konvensional merupakan salah satu modalitas minimal invasif yang digunakan untuk diagnosis dan staging kanker paru serta tumor mediastinum terutama jika EBUS-TBNA tidak tersedia. Penelitian ini dilakukan untuk mengetahui tingkat kepositifan biopsi TBNA konvensional KGB paratrakeal kanan bawah (KGB 4R) dan subkarina (KGB 7) pada pasien kanker paru dan tumor mediastinum. Metode: Penelitian ini menggunakan desain potong lintang. Pengumpulan data dilakukan dengan cara observasi langsung pada pasien kanker paru atau tumor mediastinum yang menjalani TBNA konvensional pada KGB 4R dan/atau KGB 7 di RSUP Persahabatan Jakarta, Indonesia. Hasil Penelitian: Total 33 pasien menjalani tindakan TBNA konvensional. Hasil TBNA positif sebanyak 20 (60,6%) yang terdiri dari 18 kasus keganasan dan dua kasus infeksi M. Tuberculosis. Pada kasus adenokarsinoma 58,3% pemeriksaan mutasi EGFR menggunakan sediaan sitologi TBNA. Jarum 21 G memberikan hasil TBNA positif lebih banyak dibandingkan jarum 19 G (masing-masing 68,2% dan 45,5%). Kelompok 1-2 set TBNA menunjukkan hasil TBNA positif 55,6% sedangkan kelompok 3-4 set TBNA menunjukkan hasil TBNA positif 66,7%. Kelompok jiggling 10-14 tusukan menunjukkan hasil TBNA positif 70% sedangkan kelompok jiggling 15-20 tusukan menunjukkan hasil TBNA positif 56,5%. Kelenjar getah bening subkarina memberikan hasil TBNA positif lebih banyak dibandingkan KGB paratrakeal kanan bawah (masing-masing 75% dan 47,1%). Ukuran KGB < 30 mm memberikan hasil TBNA positif lebih sedikit dibandingkan ukuran KGB ≥ 30 mm (36,4% berbanding 53,8%). Kesimpulan: Jarum TBNA 21 G, pengambilan spesimen sitologi sebanyak 3-4 set TBNA, jumlah jiggling sebanyak 10-14 tusukan, KGB 7 dan KGB berukuran ≥ 30 mm memberikan hasil TBNA positif lebih banyak.

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Background: Minimally invasive conventional transbronchial needle aspiration (C-TBNA) is an alternative method for diagnosing and staging a lung cancer and mediastinal tumor when EBUS-TBNA is unavailable. This study was to determine the positivity level of C-TBNA biopsies in different techniques (repeated sets and jiggled) at the right lower paratracheal (station 4R) and subcarinal (station 7) lymph nodes in lung cancer and mediastinal tumor cases.

Methods: This cross-sectional study was carried out by direct observation of lung cancer and mediastinal tumor cases examined by using C-TBNA of the station 4R and/or 7 lymph nodes at Persahabatan Hospital Jakarta, Indonesia.

Results: A total of 33 patients underwent C-TBNA. Positive results were 20 (60.6%), of which 18 cases were malignancy and two cases were M. tuberculosis infection. In the case of adenocarcinoma, 58.3% showed EGFR mutations from cytological exam. The 21 G needle yielded more positive TBNA results than the 19 G needle (68.2% and 45.5%, respectively). Repeated 1-2 sets of TBNA showed 55.6% positive results while repeated 3-4 sets of TBNA showed 66.7% positive results. The 10-14 jiggled TBNA showed 70% positive results while the 15-20 jiggled TBNA showed 56,5% positive results. Station 7 lymph node TBNA received more positive TBNA results than station 4R lymph node (75% and 47.1%, respectively). Lymph nodes of size < 30 mm yielded less positive TBNA result than of size ≥ 30 mm (36.4% vs 53.8%).

Conclusion: Specimen collection using 21 G TBNA needle, by means of repeated 3-4 sets or 10-14 jiggled, done at station 7 lymph nodes, and at lymph nodes of size ≥ 30 mm were observed to yield more positive TBNA results."