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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.

Thymoma is a rare malignant tumor that usually with an indolent presentation, which was falsely assumed to be benign previously. The tumor suppressor P53 (TP53) and EGFR gene mutate most frequently in human cancers. We tried to investigate the presence of TP53 and EGFR mutations among thymoma patients referred to an Indonesian referral respiratory hospital and to discuss its potential role in thymoma management and prognosis.Surgically resected tumor tissues were collected from thymoma patients and then underwent genomic analysis. PCR was performed on the extracted Paraffinized DNA to amplify exon 6 of TP53 and exons 18, 19, and 21 of EGFR. The evaluation of mutational status was done using direct sequencing and sequence analysis of purified PCR products.Among 27 collected samples, TP53 exon 6 mutation, namely missense mutation and nonsense mutation, was observed in two samples (7.4%). EGFR exon 18 mutation, namely E709K and nonsense mutation, was found in 2 samples (7.4%). An intronic mutation in EGFR exon 19 (3.7%) and exon 21 (3.7%) was observed in one sample.TP53 and EGFR mutations were not most frequent, so it seems that these genes are not involved in the pathogenesis of thymoma in Indonesian patients. Nevertheless, we found two samples with a significant mutation in p53 and EGFR genes, suggesting further research on thymoma prognostification and targeted therapy.

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.

Background: The 2015 forest fire disaster affected almost 2.6 million hectares of land in Indonesia, and Riau was among the worst. Firefighters were the first responders to deal with the disaster, but a little was known about the influence of extinguishing forest fire activities with their health. This study aimed to evaluate respiratory symptoms and lung function among firefighters 6 months after forest fire exposure.Methods: Interviews were conducted regarding sociodemographic factors, respiratory symptoms, and history of forest fire exposure during the disaster. Spirometry and chest X-ray were also carried out with standard techniques. Statistical analysis was performed based on the existing data. Ninety firefighters participated in this study, most were male with mean age of 33 years old. About 66% were smoker, had been working as firefighters for 2 to 10 years, and had been on extinguishing forest fire duty around 2–5 hours/day during the disaster.Results: All firefighters reported respiratory symptoms after 3 months. Pulmonary function was abnormal in 50% of subjects with mild restrictive characteristic. The analysis showed that body mass index (BMI) and duration of exposure had a significant correlation with pulmonary function abnormality.Conclusion: Pulmonary function was found abnormal in most subjects 6 months after forest fire exposure in Riau.

Background: Traffic policemen are very susceptible to respiratory problems due to the potential for exposure to air pollution. Therefore, this study aimed to assess respiratory health aspects of traffic policemen in Bogor, West Java. Method: Registered traffic policemen in Bogor were evaluated for respiratory symptoms, smoking habits, Fagerström Test for Nicotine Dependence (FTND) Questionnaire, chest x-ray, and spirometry. Air quality measurements were also carried out as a reference. Result: During the study period, the air quality in Bogor was classified as “Good” and below the ambient air pollutant standard. A total of 95 traffic policemen participated with a mean age of 37.3±8.7 years (range 23–57 years), mean Body Mass Index (BMI) of 28.1±4.2 kg/m2, and a length of service of 3-38 years (mean of 12.3 years). Mild pulmonary function impairment was found in 7.4% of subjects. About 61% of subjects had a smoking habit but with a low addiction index (FTND) and exCO. Decreased lung function was correlated to BMI and age (P

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)

Introduction: Pneumocystis jirovecii pneumonia (PJP) is a lung mycosis commonly found in immunocompromised patients (e.g., HIV patients); however, its role in solid cancer remains unclear. This study aims to identify Pneumocystis jirovecii colonization among naïve non-small-cell lung cancer (NSCLC) through bronchoalveolar lavage (BAL) and explore its correlation with clinical parameters. Methodology: This cross-sectional study recruited newly diagnosed naïve NSCLC patients who had not been given systemic treatments. We tested BAL from patients for P. jirovecii colonization with nested PCR targeting the mtLSU rRNA gene. Demographic and clinical characteristics were obtained from medical records, and the correlation between P. jirovecii colonization and clinicopathological data were analyzed. Kaplan-Meier analyses were done to evaluate survival. Results: Among 56 newly diagnosed, naïve NSCLC patients enrolled, the prevalence of P. jirovecii colonization was 17.9% (10 subjects). There was no statistically significant difference in demographic and clinical characteristics between the P. jirovecii colonization group versus no colonization (p value > 0.05). The overall survival duration for both groups demonstrated no significant difference. Conclusions: This study demonstrated a relatively high prevalence of P. jirovecii colonization among BAL samples of naïve Indonesian NSCLC patients. Further study is needed to delineate its implications for the potential transmission source, lung cancer pathogenesis, and prognosis.

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 emergency hospital is intended to prevent transmission of COVID-19 in the community by isolating patients without symptoms, with mild or moderate symptoms. This study evaluated the clinical characteristics and outcomes of COVID-19 patients who were admitted to this facility. This retrospective study reviewed data of patients treated at the National Emergency Hospital Wisma Atlet Kemayoran in Jakarta, Indonesia, from March 23 to April 30, 2020. Patient characteristics (clinical symptoms, laboratory test results, Chest X-Ray, SARS-CoV-2 immunoserology, and RT-PCR results from nasopharyngeal/ oropharyngeal preparations) were compared between severity groups. There were 413 COVID-19 cases analyzed, of which 190 (46%) were asymptomatic, 93 (22.5%) were mild, and 130 (31.5%) were moderate cases. Most asymptomatic cases were male, with young age, and without comorbidity. Mild cases were dominated by female and young patients, while most moderate cases were male and older patients. The number of patients with comorbidities was higher in mild and moderate cases. The patient’s overall outcome was good and did not differ based on the severity of symptoms. Despite the many challenges, patients with moderate symptoms can be safely treated in the emergency hospital.

Kanker merupakan penyakit genetik, oleh sebab itu, tata laksana kanker didasarkan pada kelainan atau mutasi genetik yang terjadi pada masing-masing pasien kanker. Next-generation sequencing (NGS) adalah teknologi sekuensing gen dengan sensitivitas dan spesifisitas tinggi, yang dikembangkan untuk mendeteksi lebih dari satu kelainan genetik secara bersamaan dalam sekali pemeriksaan. Teknologi NGS tidak memerlukan banyak materi genetik untuk menghasilkan data besar. Diagnosis kanker paru ditegakkan berdasarkan temuan histolopatologi pada sediaan biopsi yang umumnya diperoleh melalui prosedur bronkoskopi. Sediaan biopsi dari bronkoskopi relatif sedikit sehingga pemeriksaan mutasi genetik yang dapat dilakukan hanya terbatas pada mutasi yang sering (hotspot). Oleh sebab itu, teknologi NGS dapat menjadi metode yang lebih sesuai untuk mengetahui profil mutasi pasien agar tata laksana kanker paru dengan prinsip precision medicine dapat diterapkan. Next-Generation Sequencing in Lung Cancer Cancer is a genetic disease, hence, it is understandable that cancer management should be based on genetic alterations of each cancer patients. Next-generation sequencing is a high-sensitivity and specificity technology developed to detect multiple gene alterations in a single test that requires only a little amount of genetic materials and yet may generate big data. Lung cancer diagnosis is still based on histopathological findings on a limited biopsy specimen obtained during bronchoscopy. Consequently, genetic detection in lung cancer is often limited to hotspot mutations. Therefore, NGS can be a suitable method for genetic mutation profiling in order to apply precision medicine principle in lung cancer management. &nbsp

BACKGROUND Indonesia forest fire in 2015 emitted a huge amount of pollutants into the air. This study was aimed to assess the health consequences of forest fire smoke in healthy residents in Riau during forest fire disaster in 2015. METHODS This cross-sectional study was performed in healthy residents who lived in Pekanbaru, Riau Province, Sumatera, for at least 6 months during forest fire disaster in 2015, and data were taken in October 2015. Questionnaires consisting of respiratory and non-respiratory symptoms were collected. Lung function was assessed by spirometry (MIR II Spirolab™ spirometer, Medical International Research, Italy) and exhaled carbon monoxide (CO) was assessed using piCO+ Smokerlyzer®. Heart rate at rest and oxygen saturation in the room air were measured using Onyx 9591 Pulse Oximeter®. RESULTS A total of 89 subjects were mostly female (75.3%), housewife (37.7%), nonsmoker (86.5%) with mean age of 38.9 years old. The non-respiratory and respiratory symptoms were reported in 84.7% and 71.4% subjects, respectively. Lung function was impaired in 72.6% subjects, mostly with mild obstruction and mild restriction. Exhaled CO was highly detected over normal values (mean [standard deviation] = 32.6 [9.97] ppm) with predicted carboxyhemoglobin (COHb) of 5.74 (1.56). CONCLUSIONS Forest fire smoke exposure increased the respiratory and nonrespiratory symptoms among healthy individuals, which showed impairment in lung function, exhaled CO, and predicted COHb. Long term health effects on healthy individuals exposed to forest fire smoke warrant further evaluation.

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.

Introduksi: Coronavirus Disease 2019 (COVID-19) merupakan penyakit infeksius yang masih menjadi permasalahan serius di dunia. Meskipun presentasi klinis utama COVID-19 adalah gejala respirasi, manifestasi gastrointestinal seperti nyeri perut dan diare dapat ditemukan sebagai satu-satunya presentasi dari penyakit ini. Swab anal dapat dilakukan untuk penegakkan diagnosis COVID-19 dengan presentasi gastrointestinal. Namun perananya dalam diagnosis COVID-19 masih belum diketahui secara pasti.Laporan kasus: Laporan kasus ini membahas seorang pasien dewasa yang datang dengan keluhan gastrointestinal tanpa adanya gejala respirasi. Pasien ini kemudian terkonfirmasi COVID-19 melalui pemeriksaan polymerase chain reaction (PCR) pada sampel swab nasofaring dan swab anal.Diskusi: COVID-19 dapat ditandai dengan berbagai gejala dari organ tubuh manapun, salah satunya adalah gejala gastrointestinal. Swab anal menjadi sampel yang cukup representatif dalam membantu penegakkan diagnosis COVID-19 dengan gejala gastrointestinal. Kesimpulan: Di tengah pandemi ini, presentasi gastrointestinal tanpa gejala respirasi perlu dipertimbangkan sebagai presentasi klinis atipikal dari COVID-19. Hal ini menuntut kehati-hatian tenaga kesehatan untuk menghindari misdiagnosis COVID-19 dengan menggunakan pengambilan sampel dari organ lain seperti swab anal.

Indonesia merupakan salah satu negara dengan prevalensi perokok tertinggi di dunia. Saat ini merokok masih menjadi gaya hidup di lingkungan mahasiswa, tetapi perilaku merokok pada populasi di wilayah TImur Indonesia terutama Papua masih jarang diteliti. Penelitian ini bertujuan untuk mengetahui perilaku merokok pada mahasiswa Fakultas Kedokteran (FK) dan fakultas non-kesehatan (Fakultas Teknik Pertambangan dan Perminyakan/FTPP). Studi ini menggunakan desain studi potong lintang. Pengambilan data dilakukan pada Maret 2019 dengan teknik total sampling dan instrument yang digunakan yaitu kuesioner tervalidasi dari Global Adult Tobacco Survey (GATS) dan Global Youth Tobacco Survey (GYTS). Didapatkan 113 responden mahasiswa FK dan 72 responden mahasiswa FTPP. Perilaku merokok 1 batang setiap hari dalam 30 hari terakhir didapatkan terbanyak pada mahasiswa FTPP (29,8%) dibandingkan FK (7,1%). Ditemukan juga kekerapan kebiasaan yang berpengaruh terhadap kesehatan seperti mengunyah sirih, mengunyah pinang, VAPE bahkan konsumsi alkohol pada populasi baik mahasiswa FK maupun mahasiswa FTPP. Prevalensi merokok, menyirih dan konsumsi alkohol pada mahasiswa fakultas teknik lebih tinggi daripada mahasiswa fakultas kedokteran dan perlu dilakukan penelitian terkait terjadinya gangguan kesehatan dimasa depan. Kata kunci: merokok, menyirih, mahasiswa kedokteran, mahasiswa teknik. Smoking Behavior among Medical and Engineering Students in Universitas Papua, Sorong Abstract Indonesia is among the highest prevalence of cigarette smoking in the world and it is a common lifestyle among undergraduate students. This study aims to measure smoking behaviour among undergraduate medical student and non medical students in West Papua. A cross sectional study with total sampling was done among undergraduate students in Faculty of Medicine and Faculty of Mining Engineering Universitas Papua, Sorong. Global Adults Tobacco Survey (GATS) and Global Youth Tobacco Survey (GYTS) questionnairre were administered with additional question regarding other habits that might be related to addiction such as betel nut chewing, consuming alcohol and vaping. There are 113 medical student and 72 non medical students were recruited. The prevalence of smoking among undergraduate medical students was 7.1% and 29.8% among undergraduate non medical students. Interestingly the prevalence of betel nut chewing is high among non medical students. The prevalence of smoking among undergraduate non medical students is higher compared with medical students in West Papua. The prevalence of betel-nut chewing and alcohol consumption were also high among non medical student and need further study regarding its health risk. Keywords: cigarette smoking, betel nut chewing, medical students, non medical students

Background: Benzopyrene is a carcinogenic agent found in cigarette smoke. Benzo(a)pyrene diol epoxide (BPDE) is one of the benzopyrene metabolites. In this study, we investigated the level of serum BPDE in kretek cigarette smokers compared to non-smokers. Methods: A cross-sectional study which involved 32 “healthy” kretek cigarette smokers and 32 “healthy” nonsmokers were conducted. We collected the blood sample and the serum BPDE level was assayed using enzyme-linked immunosorbent assay kit. The BPDE serum level in kretek cigarette smokers was compared to the level in nonsmokers. Results: A total of 32 kretek smokers and 32 controls underwent an examination of the BPDE-protein adducts level. In the kretek smokers group, 59.4% were aged over 45 years and 56.3% have a high educational background, while in the control group, 87.5% were aged under 45 years and 75% have high educational backgrounds. The level of BPDE-protein adducts in the kretek smokers subject was 12.15 (8.87–33.55) ng/ml and the levels in the control group were 11.4 (3.87–13.27) ng/ml, P = 0.004. The factors which influence the levels BDPE-protein adducts in smokers cigarettes, as determined by multivariate analysis, were sucking pattern (P = 0.002) and the degree of addiction (P = 0.047). Conclusion: The serum BPDE-protein adducts level was higher in smokers compared to nonsmokers, and the sucking pattern and degree of addiction are the influencing factors.

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.

Electrodes with low work functions are required to efficiently inject electrons into semiconductor devices. However, when the work function drops below about 4 electronvolts, the electrode suffers oxidation in air, which prevents its fabrication in ambient conditions. Here we show that multivalent anions such as oxalate, carbonate and sulfite can act as powerful latent electron donors when dispersed as small ion clusters in a matrix, while retaining their ability to be processed in solution in ambient conditions. The anions in these clusters can even n-dope the semiconductor core of π-conjugated polyelectrolytes that have low electron affinities, through a ground-state doping mechanism that is further amplified by a hole-sensitized or photosensitized mechanism in the device. A theoretical analysis of donor levels of these anions reveals that they are favourably upshifted from ionic lattices by a decrease in the Coulomb stabilization of small ion clusters, and by irreversibility effects. We attain an ultralow effective work function of 2.4 electronvolts with the polyfluorene core. We realize high-performance, solution-processed, white-light-emitting diodes and organic solar cells using polymer electron injection layers with these universal anion donors, demonstrating a general approach to chemically designed and ambient-processed Ohmic electron contacts for semiconductor devices. Multivalent anions are found to be capable of electron-doping polymer semiconductors to realize conductive films with very low work functions, which enable efficient electron injection into materials with low electron affinity.

Background Lung cancer patients with mutations in epidermal growth factor receptor (EGFR) gene are treated with tyrosine kinase inhibitor (TKI). Aims We aimed to evaluate polymerase chain reaction (PCR)-high-resolution melting (HRM), restriction fragment length polymorphism (RFLP), and direct sequencing (DS) to detect EGFR mutations in cell-free DNA (cfDNA) before and after TKI treatment in real-world settings of a developing country. Methods Paired cytology and plasma samples were collected from 116 treatment-naive lung cancer patients. DNA from both plasma and cytology specimens was isolated and analyzed using PCR-HRM (to detect exon 19 insertion/deletion), RFLP (to genotypes L858R and L861Q), and DS (to detect uncommon mutations G719A, G719C, or G719S [G719Xaa] in exon 18 and T790M and insertion mutations in exon 20). Results EGFR genotypes were obtained in all 116 (100%) cfDNA and 110/116 (94.82%) of cytological specimens of treatment-naive patient (baseline samples). EGFR-activating mutations were detected in 46/110 (40.6%) plasma samples, and 69/110 (63.2%) mutations were found in routine cytology samples. Using cytological EGFR genotypes as reference, we found that sensitivity and specificity of baseline plasma EGFR testing varied from 9.1% to 39.39% and 83.12% to 96.55%, respectively. In particular, the sensitivity and specificity of this assay in detecting baseline T790M mutations in exon 20 were 30% and 89.58%, respectively. Three months after TKI treatment, plasma T790M and insertion exon 20 mutations appeared in 5.4% and 2.7% patients, respectively. Conclusions Despite low sensitivity, combined DS, RFLP, and PCR-HRM was able to detect EGFR mutations in plasma cfDNA with high specificity. Moreover, TKI resistance exon 20 insertions mutation was detected as early as 3 months post TKI treatment.

OX40-OX40 ligand (OX40L) interactions have been proposed to support induction of allergic airway inflammation, which may be attributable to OX40 signaling in CD4(+) helper T cells for adaptive immune responses. However, a possible involvement of natural killer T (NKT) cells in the pathogenesis suggests that the underlying mechanisms are not yet fully elucidated.We aimed to characterize the OX40-modulated cellular contribution to allergic airway inflammation in a mouse model of house dust mite (HDM) allergen exposure.Mice were sensitized to HDM and, 3 weeks later, challenged with HDM on three consecutive days through the airways. Two days after the last exposure, bronchoalveolar lavage fluids and blood samples and lung tissues were evaluated for the airway inflammation.The development of HDM-induced eosinophilic airway inflammation was dependent on OX40 of both CD4(+) T cells and NKT cells; OX40 engagement on CD4(+) T cells in the sensitization led to pulmonary OX40L augmentation after the allergen challenge, which stimulated pulmonary NKT cells through OX40 to provide the pathogenic cytokine milieu. This was ablated by OX40L blockade by inhalation of the neutralizing antibody during the challenge, suggesting the therapeutic potential of targeting pulmonary OX40-OX40L interactions. Moreover, OX40 expression in CD4(+) T cells, but not in NKT cells, was reciprocally regulated by the helper T cell type 1-skewing transcription factor Runx3.OX40 on not only CD4(+) T cells but also NKT cells is involved in allergic airway inflammation. Notably, pulmonary blockade of OX40 ligation on NKT cells has therapeutic implications.

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.