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Lung cancer is the leading cause of mortality for all cancer globally and in Indonesia. In Indonesia, lung cancer contributes to 12.6% of death of all cancer, making it the number one cause of cancer death, and 8.6% of all cancer incidence in 2018, behind breast, cervical, and colorectal cancer. The total cases per year are expected to almost double from 30,023 in 2018 to 54,983 cases in 2040. Smoking is among the risk factors for lung cancer, after occupational/environmental risk factors, history of lung fibrosis, and family history of cancer. There was a tendency of younger smokers in Indonesia and increased lung cancer incidence and prevalence in the younger population. The median age of lung cancer in Indonesia was younger than in any country, probably due to the younger age of smoking, early onset of carcinogens, asbestos use, and environmental. Lung cancer screening is a voluntary measure to detect lung cancer in the earliest stage, to find cancer at curable disease before symptoms appear in high-risk individuals. Lung cancer early detection is strategies to find cancer earlier after symptoms appear (cough, hemoptysis, dyspnea, chest pain). Low-dose computerized tomography of the thorax (LDCT) screening has been known to reduce lung cancer mortality compared to a chest x-ray (CXR). This Indonesian Society of Respirology consensus statement was aimed to give recommendations on lung cancer screening and early diagnosis in Indonesia.

Background: Advanced lung cancer has the lowest overall survival than other stage and tyrosine kinase inhibitor (TKI) are promising to prolong life and prevent disease progression. ROS1 rearrangement was very rare and constitute around 1.4 % of all NSCLC. Previous preclinical and clinical trial have reported the efficacy and safety of crizotinib against advanced NSCLC with ROS1 rearrangement, but little is known about its efficacy with nonstandard dosage.Case: A female, 58 years old, with no history of cancer nor smoking, came with persistent chest pain and cough for three months. The patient was then diagnosed with advanced lung cancer by FDG-PET CT Scan. The biopsy confirmed adenocarcinoma with genotyped ROS1-rearrangement. After receive standar dose of 200 mg bid, the patient intolerated and treatment plan was adjusted with 200 mg of alternated daily dosage (one-day on-off drug administration). Fortunately, the intolerance symptoms were alleviated and showed positive response during 3-years therapy.Discussion: Pulmonary tuberculosis has been linked to pneumothorax in HIV-associated TB patients. This study is done to better our understanding of the link between the two. The patient had active pulmonary tuberculosis as well as HIV and a rare case of bilateral pneumothorax in the ER.Conclusion: This case showed that advanced NSCLC with ROS1 rearrangement has positive response to crizotinib despite using alternating daily dose, with good response during 3 years and on.

Background: The WHO has declared COVID-19 as a global pandemic. However, Indonesia is also challenged by high burden of tuberculosis (TB). In this study, reported an active pulmonary TB case coinciding with COVID-19 but deceased due to bacterial infection. There is a need to further explore this new problem in developing countries to determine the prognosis of COVID-19 patients with tuberculosis infection.Methods: A comprehensive literature search was conducted by using databases such as The Cochrane Library, PubMed, Google Scholar, EBSCO-Host, and Scopus, including systematic reviews of cohort studies, cohorts, and case controls. As many as 309 studies were identified, after screening for duplicates and against the inclusion and exclusion criteria, three studies were included for critical appraisal.Results: The meta-analysis by Gao et al included two studies with an odds ratio (OR) of 1.4 [95% CI=0.1-18.93], the cohort study by Sy et al reported a relative risk (RR) of 2.17 [95% CI=1.4-3.37], and Motta et al showed that COVID-19 patients with tuberculosis had a mortality rate of 11.8% [95% CI=7.75-15.45]. Conclusion: TB has yet to be an identified as a major predictor of increased mortality in COVID-19 patients but can be considered a predictor of increased severity in COVID-19 patients. Studies with a bigger sample size and better study design are suggested to obtain new evidence.

BACKGROUND Pulmonary resident physicians are part of the frontline workers for COVID-19 in the hospital and might require a suitable coping strategy to manage stress. Here, we described their mental health status and coping strategy during the COVID-19 pandemic. METHODS A cohort study was done to evaluate stress, anxiety, depression, and coping strategies among pulmonary resident physicians in a tertiary referral hospital. Questionnaires were administered in 4 time points between August 2020 and June 2021. The DASS-21 questionnaire measured depression, anxiety, and stress, while Brief COPE instrument qualified the coping strategy. RESULTS The total respondents who filled the questionnaire in 4 time points in August 2020, October 2020, February 2021, and June 2021 were 60, 93, 96, and 94 resident physicians with mean stress levels of 4.3, 6.1, 5.4, and 6.3, respectively. Depression, stress, and anxiety were less frequent during the study period, mostly mild or moderate. However, moderate anxiety slightly increased in June 2021 when the pandemic reached its peak. Most of them (95.8%) had effective coping strategies related to religious beliefs. CONCLUSIONS Effective coping strategies might preserve the pulmonary resident physicians’ mental health during the pandemic. Furthermore, the sociodemographic and cultural background might affect the coping strategy. Practicing religion and praying or meditating might be essential factors in coping with psychological distress and a key to adapt to the COVID-19 pandemic.

Background: Currently immune checkpoint pathways of PD1-PD-L1 is being used to treat lung cancer and PD-L1 served as predictive biomarker. Investigations of PD-L1 expression as a target immunotherapy in lung cancer specimens in Indonesia is needed. This study aimed to evaluate PD-L1 expression in resected lung cancer specimens using immunohistochemistry techniques. Methods: Thirty surgically resected sample from lung cancer patients were obtained. The whole specimens were stained by using immunohistochemistry techniques automatically in BOND-MAX Autostainner (Leica, Germany). PD-L1 polyclonal antibody (Genetex) at 1:1500 dilution was applied to immunohistochemistry staining procedure. Clinicopathological characteristic were acquired from the hospital registry database.Result: A total of 30 surgical specimens were assessed from lung cancer patients. Twenty-four (80%) of them were Adenocarcinoma (AC), 1 (3, 33%) Adenosquamous carcinoma, 2 (6, 67%) were Squamous Cell Carcinoma (SSC), 1 (3, 33%) were Large Cell Carcinoma, 1 (3, 33%) were Neuroendocrine Carcinoma, 1 (3, 33%) were Adenoid Cyctic Carcinoma. The expression of PDL-1 positive reactivity was 16 of 30 (53.3%) specimens and we categorized into strong positivity (>50%), medium (= 50%) and low positivity (

COVID-19 cases are still rising globally in the middle of the tuberculosis epidemic. Several countries have reported TB-COVID-19 coinfection that could pose a double burden in the health care facilities in developing countries. We reported two pulmonary tuberculosis patients coinfected with COVID-19 with an overlapping clinical manifestation of tuberculosis and COVID-19 with a good prognosis at the end of COVID-19 treatment. This paper aims to discuss TB patients' susceptibility against SARS-COV-2 infection, the clinical profile of TB-COVID-19 coinfection, and the disease's prognosis. The clinician should be aware of both common disease symptoms that appear in a patient and should be confirmed and treat promptly.

Context: The accuracy of narrow-band imaging (NBI) is a technology imaging for the assessment of lung cancer. Objectives: We aimed at summarizing the diagnostic profile of NBI for the early diagnosis of airway cancer lesions. Methods: We used PubMed, Scopus, and EMBASE databases to search for eligible studies published up to October 2022. Eligible studies have investigated the diagnostic profile of bronchoscopy NBI for the early diagnosis of lung cancer. The index test was NBI bronchoscopy, and the reference test was the histopathological results of lung cancer based on the World Health Organization (WHO) classification. In eligible studies, the detected lesions were confirmed by histopathology. We extracted true positive (TP), true negative (TN), false positive (FP), and false negative (FN) from the eligible studies to calculate the diagnostic profile of NBI. the quality assessment of diagnostic accuracy studies-2 (QUADAS-2) assessment was used as a tool to assess the risk of bias. A random-effects model was used to pool the summary receiver operating characteristic curve, specificity, and sensitivity. Results: Five studies were included, involving 1267 subjects with 1850 biopsy specimens. The overall pooled sensitivity and specificity for NBI bronchoscopy for the early detection of airway cancer lesions were 98% (95% confidence interval [CI]: 89% - 100%) and 77% (95% CI: 62% - 88%), respectively. All I2 values for sensitivity and specificity were 35.93% and 85%, respectively, with a P-value of 0.001. The positive LR was 4.35 (95% CI: 2.51 - 7.54, P < 0.001), and the negative LR was 0.03 (95% CI: 0.01 - 0.14, P = 0.006). The area under the receiver operating characteristic curve was 0.95 (95% CI: 0.92 - 0.96). Conclusions: Narrow-band imaging bronchoscopy can be used as a diagnostic modality for the early diagnosis of airway cancer lesions with good diagnostic accuracy.

Background: Bronchoscopy procedure in patients with COVID-19 poses significant challenges, especially in a developing country with limited resources. Objectives: We aim to describe the clinical characteristics of severe and critical COVID-19 patients treated in an intensive care unit (ICU) and their bronchoscopy findings. Methods: We performed a retrospective analysis of clinical data of ICU patients with COVID-19 treated and received bronchoscopy procedures. This study retrospectively included all consecutive patients who underwent bronchoscopy at a teaching hospital in Depok, Indonesia, from May, 2020, until May, 2021. Results: A total of 57 bronchoscopy procedures in 54 patients were performed in this study. Primary procedure indications were retained mucus (68.4%) and ventilatory support weaning failure (15.8%). Bronchoscopic findings were mostly hyperaemic mucosa (95.00%) and purulent secretion (50.90%). Microbiological findings from bronchoalveolar samples were Acinetobacter baumanii, Klebsiella pneumoniae, and Candida albicans (33.3%, 26.6%, and 10.5%, respectively). The most common fungal isolated were Candida albicans (28%), followed by Candida tropicalis (16%) and Aspergillus sp. (8%). The overall length of hospital stay was 24 days, and the in-ICU stay was 22.06 ± 10.99 days. The patients’ survival of 28-days postprocedural outcome was 25.9% (14 subjects). Follow-up found that 20.4% of patients survived after sixty days of hospitalization. Conclusion: Diagnostic and therapeutic bronchoscopy in ICU patients with COVID-19 was safe and feasible to perform in developing countries with limited resources. It could help bronchial mucous clearance and confirm microbiological infection. The procedures should be strictly performed for patients with indications and comply with safety standards.