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Backgorunds: Mediastinal germ cell tumors are relatively rare. These tumors can be benign or malignant, which has a poor prognosis malignant. Nowadays, multimodality therapy can improve the survival rate of patients’ mediastinal germ cell tumors. This study aims to determine the characteristics and factors affecting the 1-year survival rate of mediastinal germ cell tumors patients in the Persahabatan Hospital, Jakarta. Methods: The study was conducted using retrospective cohort of mediastinal germ cell tumors patients medical records in Persahabatan Hospital, Jakarta from January 1, 2007 to December 31, 2012. Data obtained were analyzed using Kaplan Meier analysis of survival. Results: As much as 60 subjects participated in this study. Mediastinal germ cell tumors were found more in male (80%) with a median age of 21 years and especially in the age group of 20-29 years (43.3%). Most clinical symptoms found were shortness of breath (66.7%), most patients came with performance status (PS) 2 (50%). The majority of the mediastinal germ cell tumors found were teratomas (53.3%), followed with nonseminoma (40%) and seminomas (6.7%). Factors affecting the survival rate of mediastinal germ cell tumors were performance status of, the patients, treatment, complications and location of the tumors. One-year survival rate of mediastinal germ cell tumors in this study was 41.67% and affected by patients’ performance status, tumor location, complications and treatment. Conclusion: Mediastinal germ cell tumors were mostly found in male, with the chief complain of dypnea and mostly was teratoma. Mediastinal germ cell tumors have high mortality rate. The 1-year survival was influenced by patient’s performance status, tumor location, complications and treatment. (J Respir Indo. 2020; 40(2): 97-102)

Background: 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 negative effect of pulmonary TB in lung cancer prognosis needed screening of lung cancer patients for latent TB infection (LTBI). This study aimed to determine the proportion of LTBI in lung cancer patients, their characteristics and the relationship between them. Methods: This study used cross-sectional design. Collecting sample used consecutive sampling of 86 newly diagnosed treatment-naive lung cancer patients from RSUP Persahabatan 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: The results of latent TB tests were IGRA(+) 12.8%, IGRA(-) 68.6% and IGRA(I) 18.6%. Number of male patients with lung cancer with latent were 68.6%, as many as 55.8% were immunized with BCG, 4.6% had close contact with TB and 64% were using smoking. Most types of cancer were adenocarcinomas (77.9%) with advanced stage (82.6%) and general display status 2 (50%). The characteristics that show an association with IGRA results are the location of the cancer and the total lymphocyte count. Conclusion: The proportion of latent TB in lung cancer patients at the RSUP Persahabatan was 12.8%. The location of the cancer associated with the area of typical TB was related to latent TB, although it cannot be canceled. Results of IGRA(I) in lung cancer patients with low total lymphocyte counts prove IGRA sensitivity in the protection of latent TB infection in immunocompromised patients. (J Respir Indo. 2019; 39(4): 256-65)

Background: Indonesia has the highest cigarette consumption in the world. We explored the clinical impact of smoking on the prevalence of EGFR and K-RAS mutations and survival in this prospective study. Methods: 143 treatment naive lung cancer patients were recruited from Persahabatan Hospital, a national tertiary hospital. DNA from cytological specimens had been extracted and genotyped for both EGFR and K-RAS mutations using a combination of PCR high resolution melting, restriction fragment length polymorphism (RFLP) and direct DNA sequencing. Results: EGFR mutation frequency in never smokers (NS) and ever smokers (ES) were 75% and 56% (p = 0.0401), respectively. In this cohort, the overall K-RAS mutation rate was 7%. Neither gender nor smoking history were associated with K-RAS mutation significantly. However, K-RAS transversion mutations were more common in male ES than transition mutations. Smoking history did not affect EGFR and K-RAS mutation frequencies in women. Concurrent EGFR/K-RAS mutation rate was 2.8% (4 of 143 patients). Four out of 91 EGFR mutation positive patients (4.4%) had simultaneous K-RAS mutation. Conclusions: In region where cigarette consumption is prevalent, smoking history affected frequencies of EGFR and K-RAS mutations, mainly in males.

The detection of Aspergillus antibody has a key role in the diagnosis of chronic pulmonary aspergillosis. Western blot (WB) and immunochromatography (ICT) lateral flow detection of Aspergillus antibody can be used as confirmatory and screening assays but their comparative performance in TB patients is not known. This study investigated the performance of these assays among 88 post-tuberculosis patients with suspected CPA. Sensitivity, specificity, receiver operating curve (ROC), area under-curve (AUC) and the agreement between two assays were evaluated. Both WB and ICT showed good sensitivity (80% and 85%, respectively) for detection of Aspergillus antibodies. Substantial agreement (0.716) between these assays was also obtained. The highest AUC result (0.804) was achieved with the combination of WB and ICT. The global intensity of WB correlated with the severity of symptoms in CPA group (p = 0.001). The combination of WB and ICT may increase specificity in CPA diagnosis.

Introduction. Combinations of gefitinib and radiotherapy have been observed to have synergistic and anti-proliferative effects on lung cancer in vitro. In the clinical setting, patients who presented with respiratory difficulties such as superior vena cava syndrome (SVCS), radiotherapy should be given immediately to address the emergency while waiting for the results of epidermal growth factor receptor (EGFR) mutation test. However, there has been no study that described the role of radio-therapy in Indonesian patients with EGFR-mutant lung adenocarcinoma. Methods. This preliminary study aimed to evaluate the efficacy and toxicities of gefitinib and radiotherapy combination in lung adenocarcinoma patients in Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia. Subjects were consecutively recruited between January 2013 and December 2016. Results. Thirty-one lung adenocarcinoma with EGFR mutations were enrolled. Most of them were male (51.61%) with a median age of 54.5 years old (range 38-70 years old). EGFR mutation characteristics were on exon 21 L858R point mutation (61.30%), exon 21 L861Q point mutation (16.12%) and exon 19 deletion (22.58%). Radiotherapy was given at doses between 30-60 Gy. Among these subjects, median progression-free survival (PFS) was 185 days (95%CI; 123.69 – 246.30), 1-year survival rate (1-yr) was 45.2%, and median overall survival (OS) was 300 days (95%CI; 130.94 – 469.06). There were no grade 3/4 hematological and nonhematological toxicities recorded. The most frequent grade 1 and 2 non-hematological toxicities were skin rash, diarrhea, and paronychia that might be related to tyrosine kinase inhibitor (TKI). Conclusion. The combination of TKI with radiation may be considered in EGFR-mutant lung adenocarcinoma subjects.

Chronic pulmonary aspergillosis (CPA) is a common sequela of pulmonary tuberculosis (TB). The diagnosis of CPA is difficult and often misdiagnosed as smear-negative TB in endemic settings. Aspergillus IgG detection is the cornerstone of CPA diagnosis. There are a lack of studies on the prevalence of CPA in GeneXpert/smear-negative TB patients in Indonesia, despite a high number of TB cases. This study aims to determine the CPA rate in HIV-negative, GeneXpert-negative patients presenting with symptoms following completion of TB therapy and to evaluate the performance of LDBio Aspergillus immunochromatographic technology (ICT) lateral flow assay in the diagnosis of CPA. CPA was diagnosed on the basis of symptoms for &ge, 3 months, characteristic chest imaging and positive Aspergillus culture. Twenty (22%) out of 90 patients met the criteria for CPA. The LDBio test was positive in 16 (80%) CPA patients and in 21 (30%) non-CPA patients (p &lt, 0.001) with 80% sensitivity and 70% specificity. Logistic regression revealed a positive LDBio Aspergillus ICT result, smoking history and diabetes to be important predictors of CPA diagnosis. Although CPA is an unrecognised disease in Indonesia, this study suggests that more than one in five GeneXpert negative patients with persistent symptoms following completion of TB therapy may have CPA.

Background: COPD is a disease due to oxidative stress causing low pulmonary function, resulting in low quality of life. A standard test to measure the quality of life in COPD is COPD Assessment Test (CAT). Vitamin C as antioxidant is widely available in the pulmonary epithelial fluid. This study aimed to investigate the correlation between serum vitamin C level and CAT score in COPD.Methods: This cross-sectional study was conducted at Persahabatan Hospital, East Jakarta, involving 47 subjects using consecutive sampling method. Interview was used to assess subjects’ characteristics and vitamin C intake using semi-quantitative FFQ. Clinical classification, lung function, comorbidity, and CAT scores were gathered from medical records or interview. BMI was used to determine nutritional status, while vitamin C serum level was assessed using spectrophotometry. Results and conclusions: All subjects were male, mean age was 66.6 years, mostly ex-heavy smokers, with decreased lung function, and 25% were undernourished. Vitamin C intake was sufficient, but low in serum vitamin C level and CAT score.There was no correlation between serum vitamin C level and CAT score.

Background : Radiation-induced pulmonary toxicity occurs in patients with lung cancer who received irradiation. The objective of this study was to determine the proportion of radiation pneumonitis among lung cancer patients that were exposed to radiation treatment in Persahabatan Hospital. There is no data about proportion of radiation pneumonitis in Indonesia.Methods: This was a retrospective study conducted in Persahabatan Hospital during June 2013– July 2015 using the medical record of lung-cancer patients who received irradiation.Results: 33 lung-cancer patients fulfilled the inclusion criteria. Most of them were male (66.7%), in age ≥ 51 years (63.6%), had a smoking history (75.8%) with moderate Brinkman Index (60%), were given irradiation doses of 3,000–4,000 (60.6%) with irradiation fractions of 10–19 (60.6%), had no history of chemotherapy (54.5%), and were diagnosed with adenocarcinoma (66.7%) and stage-IV cancer (84.84%). The proportion of radiation pneumonitis based on chest X-ray (CXR) was 39.4%; which consisted of hazy ground-glass opacities, hazy ground-glass opacities, and fibrosis, and only fibrosis. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis (p < .05).Conclusion: The proportion of radiation pneumonitis based on CXR was 39.4%. There were significant differences in age, radiation doses, and history of chemotherapy with the proportion of radiation pneumonitis.

We examined the effects of extracellular adenosine 5'-triphosphate (ATP) on single airway smooth muscle (ASM) cells from porcine trachea using a patch-clamp technique. ATP induced a sustained inward current. Phospholipase C inhibitor U-73122 failed to inhibit the current, suggesting the involvement of P2X receptor. A specific effecter of P2X(4), ivermectin, augmented the current indicating the existence of P2X(4) receptors. Immunohistochemistry and reverse transcription/polymerase chain reaction analysis and Western blot analysis also showed the distribution of the P2X(4) receptors. The inward current was reduced by SKF-96365, an inhibitor of both voltage-dependent Ca(2+) channels (VDCCs) and voltage-independent Ca(2+) channels, although a VDCC antagonist, verapamil, did not affect the current. SKF-96365 caused complete suppression of both the increase in the intracellular Ca(2+) concentration and the contraction of ASM cells induced by ATP. Our results demonstrate that P2X(4) receptors exist on ASM and that the receptors are responsible for Ca(2+) influx. These findings suggest that the Ca(2+) influx regulated by P2X(4) receptors plays an important role in ASM contraction by a pathway distinct from VDCC.

The aim of this study was to determine whether Andrographus paniculata capsule induces clinical and sputum conversion in pulmonary tuberculosis (TB) patients. Randomized, placebo-controlled, double-blind pilot study was conducted to pulmonary tuberculosis patient who admitted to Pulmonology Polyclinic of Persahabatan Central General Hospital, Jakarta. A total of 44 pulmonary TB patients were randomly divided into two groups including one group received standard antituberculosis drugs + Andrographis paniculata (n=21) (AP) and one group received standard antituberculosis drugs + placebo (n=23). APC was given 500 milligram per day for eight weeks. The distribution of sex, body weight and body mass index (BMI) as well as the frequency of cough and feature of chest radiography were not significantly different between groups (P >0.05). The proportion of posi¬tive smears in both groups decreased over time until by the twelve weeks, none remained positive. The rate of decline was more pronounced in the AP group reach statistically at weeks 4 and 6 compared to placebo group (P