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Background: The COVID-19 pandemic has affected physical and mental health. SLE patients are prone to psychosomatic disorders which can decrease their quality of life. This study aimed to determine the factors associated with psychosomatic disorders among SLE patients during the COVID-19 pandemic. Methods: This was a cross-sectional study of adult female SLE patients from the outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta. Data regarding psychosomatic disorders were collected using SCL-90 questionnaires, and data on demographic factors, perception of COVID-19 conditions, perception of stress, psychosocial stressors, disease activity (MEX-SLEDAI), and treatment were also collected. Bivariate analysis for categorical data was conducted using the Chi-square test. Variables with a p-value

Background: Diagnosis of infection in advanced solid tumor patients can be challenging since signs and symptoms might be overlapping due to paraneoplastic condition. Delay diagnosis of existing infection can lead to more severe conditions and increased mortality. Procalcitonin (PCT) has been used to support the diagnosis of bacterial infection and sepsis. Unfortunately, PCT also increases in malignancy even without an infection. We investigated the diagnostic accuracy of PCT in advanced solid tumor patients with fever to diagnose sepsis. Methods: A cross-sectional study was conducted in solid advanced tumor patients with fever patients who were admitted to Cipto Mangunkusumo Hospitals, Indonesia between June 2016 and April 2018. Sepsis was defined using 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference criteria. The diagnostic accuracy of PCT was determined using the receiver operating characteristic (ROC) curve. Results: A total of 194 subjects were enrolled in this study. 60.3% were female with a mean age of 49.47±12.87 years old. 143 patients (73.7%) with advanced solid tumors. Among this latter group, 39 patients (27%) were sepsis. The ROC curve showed that the levels of PCT for sepsis in advanced solid tumor patients with fever were in the area under the curve (AUC) 0.853 (95%CI 0.785 – 0.921). The Cut-off of PCT in advanced solid tumor patients with fever to classify as sepsis was 2.87 ng/mL, with a sensitivity of 79.5%, and a specificity of 79.8%. Conclusion:PCT has good diagnosis accuracy in advanced solid tumor patients with fever to classify as sepsis, however a higher cut-off compared to non-cancerous patients should be used.

Background: Sepsis is a major problem that contributes to a high mortality rate. Its mortality is especially high in patients with malignancy. One study reported that sepsis patients with malignancy have a 2.32 times higher risk of mortality compared to patients without malignancy. For this reason, factors that influence mortality in sepsis patients with malignancy become especially important to provide effective and efficient therapy. This study aims to identify factors that influence mortality in sepsis patients with malignancy. Methods: This study is a retrospective cohort study using medical records of sepsis patients with malignancy who were treated at Cipto Mangunkusumo Hospital from 2020 to 2022. A bivariate analysis was carried out and followed by a logistic regression analysis on variables with p-value

Background: Colorectal cancer (CRC) is a significant contributor to cancer-related morbidity and mortality. Biopsy remains the gold standard for CRC diagnosis, but invasive testing may not be preferred as an initial diagnostic procedure. Therefore, alternative non-invasive approaches are needed. Circulating tumor cells (CTC) present in the bloodstream have great potential as a non-invasive diagnostic marker for CRC patients. This study aimed to assess the diagnostic potential of CTC in CRC as an adjunctive diagnostic method using a subjective manual identification method and laser capture microdissection at 40x magnification. Methods: A cross-sectional study was conducted on adult patients suspected to have CRC at Dr. Cipto Mangunkusumo National General Hospital, Jakarta, between November 2020 and March 2021. CTC analysis was performed using the negative selection immunomagnetic method with Easysep™ and the CD44 mesenchymal tumor marker. The identification and quantification of CTC were conducted manually and subjectively, with three repetitions of cell counting per field of view at 40x magnification. Results: Of 80 subjects, 77.5% were diagnosed with CRC, while 7.5% and 15% exhibited adenomatous polyps and inflammatory/hyperplastic polyps, respectively. The diagnostic analysis of CTC for detecting CRC (compared to polyps) using a CTC cutoff point of >1.5 cells/mL suggested sensitivity, specificity, and positive predictive value (PPV) of 50%, 88.89%, and 93.94%. Additionally, the negative predictive value (NPV), as well as the positive and negative likelihood ratio (PLR and NLR) were 34.04%, 4.5, and 0.56, respectively. The subjective manual identification and quantification of CTC were performed at 40x magnification using laser capture microdissection. Conclusion: This study assessed the diagnostic potential of CTC examination in CRC as an adjunctive diagnostic method using the subjective manual identification method and laser capture microdissection at 40x magnification. Despite the limitations associated with subjective cell counting, the results showed 50% sensitivity and 88.89% specificity in diagnosing CRC. Further studies are needed to optimize the manual identification process and validate the clinical utility of CTC analysis in CRC patients.

Cancer is a complex group of diseases which arises from uncontrolled growth and spread of abnormal cells in the body. The pathophysiology of cancer involves a sequence of events at the cellular and molecular levels, often initiated by genetic mutations or alterations. These mutations can be acquired due to various factors like environmental exposures such as from carcinogens, lifestyle choices, or inherited genetic conditions. When a cell’s DNA is damaged or mutated, it can disrupt the normal regulatory mechanisms that control cell division and apoptosis, leading to uncontrolled proliferation and cancer. the intricate interplay between genetic mutations, angiogenesis, hematogenic spread, CTCs, immune cells, and systemic cancer therapy defines the complex landscape of cancer progression and treatment. Understanding the role of immune cells, particularly Tregs marked by FOXP3, as prognostic markers in various cancers, alongside advancements in cancer diagnosis involving CTCs, holds promise in understanding cancer prognosis and improving cancer management. Moreover, ongoing research into alleviating chemotherapy-induced side effects, like HFS offer avenues for improving patient care and treatment outcomes in cancer management.

Background: Kidney transplantation is currently the best choice for renal replacement therapy, due to its effect in reducing mortality and improving the quality of life (QoL) of patients with end-stage renal disease. This study aimed to identify factors affecting QoL after kidney transplantation. Methods: We conducted a cross sectional study by recruiting patients who had kidney transplantation at Cipto Mangunkusumo General Hospital, Jakarta, Indonesia, from 2018 – 2020. QoL was assessed using the 36-item Short Form Health Survey (SF-36) questionnaire. We evaluated age, sex, body mass index, hemoglobin level, estimated glomerular filtration rate, duration of dialysis before transplantation, history of diabetes, depression, and performance status as factors associated with QoL score. Results: We involved 107 subjects in our study. Depression, hemoglobin level, ECOG performance status, and duration of dialysis were factors affecting the physical component score (R2=0.21). Depression and hemoglobin level were factors affecting the mental component score (R2=0.34 ). Depression, hemoglobin level, and ECOG performance status were factors contributed to the total QoL score (R2=0.41). Conclusion: Factors that contributed to QoL status were depression, ECOG performance status, and hemoglobin levels. This study supported the need for assessment of QoL on regular basis, psychological aspects including depression, as well as other factors that can affect QoL such as performance status and hemoglobin level in patients before and after kidney transplantations.

Background: Sarcopenia is associated with worse outcomes in maintenance hemodialysis (MHD) patients. Differences in criteria and methods used to diagnose sarcopenia, results in a wide range of prevalence. Factors associated with sarcopenia in MHD have not been well-studied. This study aimed to investigate the prevalence and factors associated with sarcopenia in the MHD population. Methods: Observational cross-sectional study was done with 96 MHD patients aged ≥18 years old, with dialysis vintage ≥120 days at Cipto Mangunkusumo Hospital March-May 2022. Descriptive, bivariate, and logistic regression analysis were done to find sarcopenia’s prevalence and association with Simplify Creatinine Index (SCI), type 2 diabetes (DM), Interleukin-6 (IL-6), nutritional status, physical activity, and phosphate serum level. Asian Working Group for Sarcopenia (AWGS) 2019 criteria used to diagnose sarcopenia, Hand Grip Strength (HGS) to identify muscle strength, Bioimpedance Spectroscopy (BIS) to calculate muscle mass, and 6-meter walk test to evaluate physical performance. Results: The prevalence of sarcopenia was 54.2%. Factors with a significant association in bivariate analysis were phosphate serum level (p=0.008), SCI (p=0.005) and low physical activity (International Physical Activity Questionnaire) (p-0.006). Logistic regression analysis found higher phosphate serum level and high physical activity protective of sarcopenia (OR 0.677;CI95% 0.493-0.93 and OR 0.313;CI95% 0.130-0.755 respectively). Conclusion: The prevalence of sarcopenia in the MHD population was 54.2%. Phosphate serum level, SCI, and physical activity were significantly correlated with sarcopenia. Both high phosphate level and high physical activity were protective against sarcopenia.

Background: Arteriovenous fistula (FAV) is the most widely used vascular access for end-stage renal disease (ESRD) patients undergoing routine hemodialysis in Indonesia. However, FAV can become dysfunctional before it is used for the initiation of hemodialysis, a condition known as primary failure. Clopidogrel is an anti-platelet aggregation that has been reported to reduce the incidence of primary failure in FAV compared to other anti-platelet aggregation agents. Through this systematic review, we aimed to assess the role of clopidogrel to the incidence of primary FAV failure and the risk of bleeding in ESRD patients. Methods: A literature search was carried out to obtain randomized Control Trial studies conducted since 1987 from Medline / Pubmed, EbscoHost, Embase, Proquest, Scopus, and Cochrane Central without language restrictions. Risk of bias assessment was performed with the Cochrane Risk of Bias 2 application. Results: All of the three studies involved indicated the benefit of clopidogrel for the prevention of AVF primary failure. However, all of the studies have substantial differences. Abacilar’s study included only participants with diabetes mellitus. This study also administered a combination of clopidogrel 75 mg and prostacyclin 200 mg/day, while Dember’s study gave an initial dose of clopidogrel 300 mg followed by daily dose 75 mg and Ghorbani’s study only gave clopidogrel 75 mg/day. Ghorbani and Abacilar started the intervention 7-10 days before AVF creation, while Dember started 1 day after VAF creation. Dember gave treatment for 6 weeks with an assessment of primary failure at the end of week 6, Ghorbani’s treatment lasted for 6 weeks with an assessment at week 8, while Abacilar gave treatment for one year with an assessment at weeks 4 after AVF creation. In addition, the prevalence of bleeding did not differ between the treatment and control groups. Conclusion: Clopidogrel can reduce the incidence of primary FAV failure without significant increase of bleeding events.

Background: The diagnosis of chronic lymphocytic leukemia (CLL) is mainly based on blood count, morphology, and immunophenotyping. In Indonesia, the diagnosis is more challenging as the availability of immunophenotyping tests is limited. The European Society of Medical Oncology (ESMO) stated flowcytometry as a prerequisite to establishing diagnosis of CLL, meanwhile in the original International Workshop on Chronic Lymphocytic Leukemia (iwCLL) 2018 criteria, which has been widely accepted by physicians caring for patients with CLL, the diagnosis of CLL can be made in patients with cytopenia using bone marrow biopsy where flowcytometry test is not available. The aim of the study was to compare the utility of International Workshop on Chronic Lymphocytic Leukemia 2018 [iwCLL 2018 (2)] compared with National Cancer Institute Working Group 96 (NCI-WG96) criteria in the diagnosis of CLL in Indonesia, especially in limited resource settings. Methods: The data of newly diagnosed CLL patients, including baseline demographic, clinical, and laboratory characteristics was retrieved retrospectively from medical records in Cipto Mangunkusumo General Hospital from 2015 until 2021. Diagnosis of CLL using iwCLL 2018 diagnostic criteria were then compared with National Cancer Institute Working Group 96 (NCI-WG96) criteria. Results: Thirty-eight patients were enrolled to this study. The median age was 59.5 years and dominated by males. Most of them were classified in the late-stage disease (63.4% in Binet C and about 70% in Rai III-IV). Four cases were CD5-negative CLL. Based on NCI-WG96 guideline, only 24 patients (63.2%) fulfilled all four criteria for CLL. Similarly, using the iwCLL 2018 flowcytometric criteria without biopsy data, 26 patients (68%) were diagnosed as CLL. However, if bone marrow biopsy in patient with cytopenia was taken into account, all patients (100%) can be confirmed as CLL. Conclusion: The iwCLL 2018 criteria which included bone marrow biopsy in the presence of cytopenia was more applicable to establish the diagnosis of CLL in Indonesia where flowcytometry is not available.

Background: Milk consumption in the Indonesian elderly population is among the lowest in the world, and two-thirds of the population are lactose intolerant. This might have an impact on energy and nutrient intakes. However, data on the prevalence of nutrient intake inadequacies in dairy users versus non-dairy users, as well as population characteristics, are lacking. Therefore we obtained data comparing nutritional inadequacies and characteristics of Indonesian older adults consuming or refraining from dairy products. Methods: A cross-sectional study was conducted in 2021 as a part of the INA LACTASE study, involving 194 community-dwelling older adults in the outpatient geriatric clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We collected data on demographic and clinical characteristics as part of a routinely performed comprehensive geriatric assessment. A structured questionnaire was developed to categorize participants as dairy-or non-dairy users based on habitual dairy intake. Food records were collected to assess nutrient intakes. The prevalence of inadequacies of energy, macronutrients, and a selection of micronutrients (calcium, vitamin D, and vitamin B12) was calculated by comparing the reported mean intakes to the recommended dietary intakes of the Indonesian population (Indonesian RDA). Prevalence ratios were calculated to measure the association between dairy product consumption and the prevalence of nutrient inadequacies. Results: We recruited 194 eligible participants. This study found that dairy users had a higher proportion of women, a higher monthly income, but a lower proportion of hypertension, diabetes mellitus, and dyslipidaemia in older adults consuming dairy products. We observed wide variability in energy and nutrient intakes, as well as a high prevalence of inadequacies for all dietary intake parameters, particularly micronutrients. Dairy users had a lower prevalence of micronutrient inadequacies than non-dairy users. The prevalence of vitamin D inadequacies in dairy users versus non-dairy users was 91.6% vs. 99.3% in men and 71.9% vs. 98.0% in women, respectively. Inadequate vitamin B12 intake was found in 60.6% of dairy users vs. 89.4% of non-dairy users in men and 65.5% vs.. 68.4% of women, respectively. The most pronounced difference was found in the prevalence of calcium intake inadequacies in dairy users vs. non-dairy users, which was 64.8% vs. 99.5% in men and 89.9% vs. 99.8% in women. We found statistically significant differences in the prevalence of calcium, vitamin D, and vitamin B inadequacies between dairy and non-dairy users. Conclusion: This study identified that dairy users had a higher monthly income and had a lower proportion of hypertension, diabetes mellitus, and dyslipidemia. In addition, we discovered a high prevalence of nutrient intakes inadequacies in Indonesian older adults, particularly among non-dairy users. Micronutrient inadequacies are major sources of concern, with statistically significant difference in calcium, vitamin D, and vitamin B12 prevalence of inadequacies.

Background: R-CHOP/R-CVP is the only recommended first-line treatment for Non-Hodgkin’s Lymphoma (NHL). Limited treatment alternatives often lead to relapse and refractory NHL, which increases disease progressivity and worsens prognosis. Bendamustine-rituximab is being studied for its potential as a superior first-line therapy for indolent NHL and mantle-cell NHL (MCL); however, it is not in the national guidelines. Evidence-based research is needed to demonstrate the effectivity of bendamustine-rituximab compared to R-CHOP/R-CVP for a complete response of indolent NHL and MCL. Methods: A literature search was conducted using PubMed, Scopus, EBSCOHost, and Cochrane. Studies consistent with clinical question and eligibility criteria were included and critically appraised using the Oxford Centre for Evidence-Based Medicine (CEBM) tool. Results: Two randomized controlled trials (RCTs) were included in this study, both concluding that bendamustine-rituximab is superior to R-CHOP/R-CVP with a complete response, with RR values of 0.90 (95% CI 0.80 – 1.01) and 0.86 (95% CI 0.76 – 0.98). Conclusion: Bendamustine-rituximab is more effective than R-CHOP/R-CVP as a first-line treatment of indolent NHL or MCL.

Background: Accurate prediction of survival is important for advanced cancer patients to determine medical interventions plan the patient’s lives and prepare for their death. The palliative prognostic index (PPI) is most popular scores used worldwide to predict life expectancy in advanced cancer palliative patients. The purpose of this study was to test validity and the performance of PPI in Cipto Mangunkusumo Hospital as a Tertiary Referral Nasional Hospital. Methods: This retrospective cohort study, uses total subject during study with consecutive sampling. Palliative prognostic index was assessed by a palliative care team (PCT). Demographic data were summarized as n (%) and Chi square for categorical variables and median or mean for continuous variables. Overall survival was calculated using the Kaplan-Meier method with hazard ratios. The performance of PPI analyzed using SPSS version 20.0, includes for Receiving Operator Characteristics (ROC) and Hosmer-Lemeshow calibration test. Results: 160 patients were included in the PPI study. The subjects have an average age of 50.08 years and are mostly women 68.10%. 28 (17.50%) had symptoms of dyspnoea, 22 (14.60%) pneumonia, and 19 (11.90%) had pain. The number of patients who died during hospitalisation was 83 (51.90%). PPI sum score >6 109 (68,10%). Calibration performance PPI score reached x2 = 8.915 (p = 0.259), and showed correlation r 0.799 (p 0.000). The accuracy of PPI scores in predicting survival in advanced cancer patients in studies for survival

Background: Entrustable professional activities (EPAs) are tasks entrusted to students who assist supervisors in determining their competencies. However, the competencies required and the end-educational stage in which each EPA item is assigned have yet to be determined by the stakeholders of internal medicine residency programs in Indonesia. This study aimed to identify and determine the activities in internal medicine residency programs which could be defined as EPAs in the competency-based curriculum of Indonesian internal medicine residency programs. Methods: A literature review was conducted to identify activities which could be examined as EPA items in Indonesian internal medicine residency programs, which were then validated by 10 educational experts. Two rounds of the Delphi method were conducted with participants consisting of the Indonesian Board of Internal Medicine professionals, residency program directors, internal medicine specialists, and internal medicine residents to evaluate the importance of the identified EPA items. The EPA items were rated on a Likert scale ranging from 1 to 5, and their variances were analyzed. The participants also rated the end-educational stage appropriate for each EPA item. The effect size was calculated between groups as (1) small, 0.8. Results: The literature review identified 29 modified items from the Royal College of Physicians and Surgeons (RCPS) and three items from other academically developed EPA designs. The expert discussion resulted in the validation of 28 EPA items (out of the 32 items in the initial EPA draft). All 28 items were accepted after two rounds of the Delphi method, and a decrease in their variances was found. Conclusion: This study formulated 28 EPA items for Indonesian internal medicine residency programs. Further collaboration between the Board of Internal Medicine and residency program directors will be needed for the application of these EPA items at each residency year.

Background: Extrahepatic cholangiocarcinoma is rare but fatal. Patients who come are usually already in the advanced stage that can not undergo curative resection and chemotherapy also seems to be very rarely done. The survival rate and its associated factors in Indonesia are unknown. This study aimed to identify 1-year survival of patients with extrahepatic cholangiocarcinoma without curative resection and palliative chemotherapy and its associated factors. Methods: This is a cross-sectional study using medical records of extrahepatic cholangiocarcinoma (perihilar and distal) inpatient and outpatient patients at Cipto Mangunkusumo Hospital, Jakarta from January 2015 to March 2020, reviewed retrospectively. The following factors were analyzed in terms of mortality: metastasis, sepsis, hypoalbuminemia, serum bilirubin level, serum CA 19-9 level, billiary drainage, neutrophyl lympocyte ratio (NLR) and comorbid factors. Results: 115 out of 144 patients were enrolled in this study with male proportion of 50.4%, and proportion of patients aged 65 years or above was 71.3%. 1 year survival rate was 10 % and median survival was 3 months (CI 95% 2.388-3.612)Multivariate analysis showed that only sepsis, unsuccessful or no prior biliary drainage and total bilirubin >19.8 mg/dl were independent predictors of mortality. Conclusion: 1 year survival of extrahepatic cholangiocarcinoma without curative resection and paliative chemotherapy was 10 %.Sepsis, unsuccessful or no prior bilirary drainage, and total biirubin >19.8 mg/dl are factors significantly associated with shortened survival in malignant obstructive jaundice patients.

Background: new-onset atrial fibrillation after coronary artery bypass grafting (CABG) is a common postoperative complication. This arrhytmia considered as temporary phenomenon which the majority are converted back to sinus rhytm when the patients discharged from the hospital. Despite its transience, those arrhytmia can recur and increasing the long term mortality. This study aims to determine the role of new-onset atrial fibrillation after CABG in three year survival. Methods: retrospective cohort study using survival analysis of patients who underwent coronary artery bypass grafting since January 2012 to December 2015 at Cipto Mangunkusumo Hospital. Patients with atrial fibrillation before surgery, who had surgery without cardiopulmonary bypass machine, and who died in 30 days after surgery are excluded. Subjects are divided into two category based of the presence of new-onset atrial fibrillation after CABG and the mortality status is followed up until 3 years post-surgery. The Kaplan-Meier curve is used to determine the three-year survival of the patients who had new-onset atrial fibrillation after CABG and Cox regression test used as multivariate analysis with confounding variables in order to get adjusted hazard ratio (HR). Results: new-onset atrial fibrillation after-CABG occurred in 29,59% patients. Patients with new-onset atrial fibrillation after CABG have higher three-year mortality (15,52% vs 3,62%) and significantly decreases three-year survival (p=0,008; HR 4,42; 95% CI 1,49-13,2). In multivariate analysis, new-onset atrial fibrillation after CABG is an independent factor of the three-year survival decline (adjusted HR 4,04; 95% CI; 1,34-12,14). Conclusion: new-onset atrial fibrillation after CABG independently decreases three-year survival.

Background: non-small cell lung carcinoma (NSCLC) is the most common type of lung cancer. Therefore, research into its prognostic factor is very important for better patient management. However, there have been no studies looking for the association of CYFRA 21-1 and CEA with survival of NSCLC in Indonesia, and no cut-off value for them as standardized prognostic factors. This study aims to know the association of CEA and CYFRA 21-1 with one-year survival of advanced stage NSCLC in RSCM and determining their cut-off point as a prognostic factor. Methods: a retrospective cohort study of 111 subjects with advanced stage NSCLC aged > 18 years who were diagnosed from January 2012 to May 2018, resulted in a set of data which includes an initial score of CEA and CYFRA 21-1 at diagnosis, along with their confounding factors, namely performance status (PS), type of histology, therapy, and stadium. All data were taken from the RSCM Medical Record Unit. Results: the CEA area under the curve (AUC) was less than 50% (AUC=0.446) and not significant, whereas AUC CYFRA 21-1=0.741 (0.636–0.847) with p 10.9 ng / mL with a sensitivity of 69.5% and specificity of 65.5%. The variables that met the proportional hazard assumption were CYFRA 21-1, PS, histology, and therapy. CYFRA 21-1 > 10.9 ng/mL had HR 1.744 (HR=1.744; p=0.028); ECOG 3-4 PS had HR 2.434 (HR=2.434; p=0.026); non-adenocarcinoma histology had HR 1.929 (HR=1.929; p=0.029); and the non-chemotherapy group had HR 2.633 (HR=2.633; p=2.633; p=0.015). Conclusion: from both tumour markers, only CYFRA 21-1 was proven to be significant to NSCLC survival. CYFRA 21-1 cut-off value as a prognostic factor was > 10.9 ng/mL.

Global widespread of current coronavirus disease 2019 (COVID-19) pandemic has emerged huge predicament to healthcare systems globally. This disease caused by a new beta-type coronavirus, known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), may lead to systemic multiorgan dysfunction syndrome and subsequently cause death due to abundant angiotensin converting enzyme 2 as its functional receptors throughout body. Oncology patients even have a worse prognosis with greater infection susceptibility because they are in a state of suppression of the systemic immune system due to malignancy and anticancer therapy. This problem makes adequate and appropriate treatment urgently needed. Through randomized clinical trials, various drugs were known to have good responses in COVID-19 patients. Here, we reported a-49-year-old-woman that was confirmed for COVID-19 by clinical manifestation, radiology profile, high procalcitonin concentration, and positive polymerase chain reaction (PCR) test. The patient also had breast and thyroid cancers history and had undergone various therapeutic modalities such as chemotherapy, thyroid surgery, and breast surgery. She was undergoing hormone therapy but experiencing disease progression after achieving complete remission based on PET-CT scan 4 months before. The patient was treated with various antibiotics but showed a significant clinical improvement by administering moxifloxacin.

Background: there are differences in factors associated with frailty syndrome in elderly population. The aim of this research was to determine frailty status (fit, pre-frail and frail) and to identify factors associated with physical frailty in urban community-dwelling elderly women. Methods: a cross-sectional study of community-dwelling women aged 60 years and older was conducted in West and Central Jakarta regions, Indonesia, from July until September 2017. The Cardiovascular Health Study (CHS) score was used to determine frailty status (fit/ pre-frail/ frail). Chi-Square Test and logistic regression analysis were used to determine association between independent variables and physical frailty. Results: there were 325 female subjects with a median age of 67 (60–94) years; 95.7% had income below the Provincial Minimum Income of DKI Jakarta in 2017 (

Chronic myeloid leukemia (CML) is a clonal haemopoietic stem cell disorders with reciprocal translocation in chromosome 9 (ch9) and 22 (ch22) which cause the fusion of Break cluster region-Abelson murine leukemia (BCR-ABL) oncogene. This fusion will activate tyrosine kinase. Imatinib mesylate is the first tyrosine kinase inhibitor (TKI), which could change the prognosis of CML patients. However, there is a resistance to TKI’s, and based on transcriptomic study, increase expression of gen signal transducer and activator of transcription (STAT) 5A and runt-related transcription factor 3 (RUNX3) can cause resistance to TKI’s. The STAT5 protein, which in normal myeloid cells being activated by cytokine, in CML patients was activated even without cytokines. STAT5 refer to STAT5A and STAT5B, however they have might have different role in hematopoietic stem cells or in CML cells. This review summarizes the role of STAT5 in tyrosine kinase inhibitor resistance in CML patients.

Hodgkin lymphoma is a cancer that can be cured using standard chemotherapy with or without radiation. Although it accounts for only 0.6% of all malignancy worldwide, but it usually affects young adults with median age of 38 years. About 60 to 90% cases can be cured depending on its stage and 5 to 10% cases are refractory to the first-line chemotherapy; while 20 to 30% patients experiencing relapse after receiving the first-line chemotherapy. The relapse causes new problem in treatment. A monoclonal antibody-chemotherapy conjugate, Brentuximab vedotin, was approved by Food Drug Association and European Medicine since 2011 dan was approved by European Medicine Agency since 2012 to treat relapsed classical Hodgkin lymphoma and anaplastic large cell lymphoma (ALCL). Brentuximab vedotin has also been known as anti-CD30. CD30 or Ki-1 or TNFRSF8 is a 120-kD glycoprotein, which is a trans-membrane receptor of Hodgkin lymphoma cells. The glycoprotein was first identified in 1982 using monoclonal antibody against Hodgkin lymphoma-derived cell lines. The glycoprotein was then cloned and recognized as a member of tumor necrosis factor receptor (TNFR) superfamily, which has intracellular, transcellular and extracellular domains. The monoclonal antibody obviously does cause a reaction not only with the Reed-Sternberg (RS) cells of Hodgkin lymphoma, but also with a small number of normal lymphocytes subset, which are located at perifollicular zone as well as lymphoid tumor such as anaplastic large cell lymphoma (ALCL) and other non-lymphoid tumor such as embryonic and pancreas carcinoma, undifferentiated nasopharyngeal carcinoma and malignant melanoma. Therefore, CD30 monoclonal antibody alone to confirm the diagnosis of Hodgkin lymphoma is ineffective as it must be used together with other panel of immunohistochemistry antibodies such as cytokeratins, carcinoma embryonic antigen, melanoma-associated antigen and placental alkaline phosphatide. The expression of CD30 molecules in Reed-Sternberg cells of Hodgkin lymphoma has been demonstrated in over 98% of classical Hodgkin lymphoma cases; however, there is a difference in staining intensity among various cases or even in one case.

Aim: to assess the current use of anticoagulants and implementation of International Guidelines in venous thromboembolism (VTE) prophylaxis in hospitalized patients with acute medical illnesses in Jakarta, Indonesia. Methods: a multicenter, prospective, disease registry, recruiting patients diagnosed as acutely ill medical diseases and other medical conditions at risk of VTE, with in-hospital immobilization for at least 3 days. Results: of 401 patients, 46.9% received anticoagulants which included unfractionated heparin (64.4%), fondaparinux (11.7%), enoxaparin (9.6%), warfarin (3.7%), and combination of anticoagulants (10.6%). VTE prophylaxis using physical and mechanical method was used in 81.3% of patients, either as a single modality or in combination with anticoagulants. During hospitalization, VTE were found in 3.2% patients; 10 patients (2.5%) had lower limb events and 3 patients (0.75%) had a suspected pulmonary embolism. The main reference international guidelines used were AHA/ASA 2007 (47.4%), followed by ACCP 2008 (21.7%). Conclusion: the study showed underutilization of prophylaxis anticoagulants in which mechanical thromboprophylaxis either alone or combination with anticoagulants was the most commonly used. Unfractionated heparin was the preferable choice. The most commonly used guideline was AHA/ASA 2007. VTE thromboprophylaxis in medically ill patients needs to be encouraged. Key words: venous thromboembolism (VTE), prophylaxis, registry, non-surgery hospitalization.