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Background and objectives. The incidence of brain metastases is higher than primary brain tumors, with lung cancer as a common etiology at “Dr. Cipto Mangunkusumo” General Hospital. Delay in diagnosis can cause brain herniation, resulting in disability and death. We aimed to investigate the compatibility between daily clinical practice and clinical practice guidelines for diagnosing brain metastases due to lung cancer at “Dr. Cipto Mangunkusumo” General Hospital while also examining factors that might influence the duration of the diagnosis. Materials and methods. We conducted a retrospective cohort study to determine the conformity between the duration of diagnosis of metastatic brain tumors due to lung cancer in daily clinical practice with clinical practice guidelines. Secondary data was obtained from medical records from November 2021 until June 2022. Results. Twelve subjects (30%) were diagnosed with brain metastases from lung cancer within two weeks with a median duration of 18.5 days (IQR 12-34 days). The duration of 7 days (IQR 4-11 days) was required to obtain a lung mass, 8 days (IQR 4.5-13 days) to perform a biopsy, and 6 days (IQR 3.5-7 days) to obtain t pathology results. No statistically significant relationship exists between the variables assessed and the duration of diagnosis. Conclusions. The clinical practice guidelines at “Dr. Cipto Mangunkusumo” General Hospital for diagnosing brain metastases from lung cancer within two weeks could only be carried out in 30% of subjects in this study. Collaboration between departments is needed to make the diagnosis faster.

Sickle cell disease (SCD) is a hemoglobinopathy inherited in an autosomal recessive pattern arising from a mutation causing substitution of valine for glutamic acid in the sixth amino acid of the β-globin chain. The clinical manifestation of SCD varies from acute pain, chronic anemia, to multi-organ infarct and failure. SCD is known to be rare in Indonesia. However, we recently encountered a SCD patient presenting with recurrent pain and hypesthesia since a year ago. The diagnosis of SCD in this patient was established based on the results of peripheral blood smear and hemoglobin electrophoresis. The patient had previously been diagnosed with thalassemia at the age of 19 years old due to a history of icterus, thus delaying prompt treatment. This further emphasizes the challenges in distinguishing SCD, which is relatively rare in Indonesia compared to thalassemia, especially considering the complexity and the variability in the phenotypic presentation of SCD. The patient was then given supportive therapy consisting of blood transfusion and symptomatic treatment, as well as consideration to administer hydroxyurea if the patient’s clinical condition worsens.

Continuously holding its position as the sixth most common cause of cancer and the third leading cause of cancer death, globally, Hepatocellular Carcinoma (HCC) remains as a healthcare priority. Production of various substances may result into systemic or metabolic complications, often known as paraneoplastic phenomena of HCC. A 56-year-old male with history of untreated chronic hepatitis B arrived with generalized weakness and intermittent headache in the last two days prior to admission. Laboratory findings demonstrated elevated hemoglobin (20.5 g/dl), alpha-fetoprotein (29,845 ng/dl), and d-Dimer (2,120 ng/ml) levels. Hypoglycemia (44 mg/dl) was documented with normal basal insulin level, confirming non-islet cell tumor hypoglycemia. Abdominal multiphasic CT-scan demonstrated a large solid lesion involving the whole right liver lobe, hyper-enhanced at arterial phase and wash-out pattern at venous and delayed phases, with portal vein thrombosis; thus, confirming HCC BCLC C. Further examinations revealed hypercellularity from bone marrow biopsy with the absence of JAK2 mutation. He underwent serial phlebotomy and received 80 mg acetylsalicylic acid orally, as well as cytoreductive agent to reduce the risk of thrombosis. Despite applications of different interventions, control of hypoglycemia could not be achieved without parenteral administration of high dextrose load. He was planned to receive oral multikinase inhibitor, however, he passed away due to severe hospital-acquired pneumonia. Paraneoplastic phenomena are common in HCC. Increased risk of blood hyper-viscosity and thrombosis attributed to polycythemia, as well as medical emergency resulting from hypoglycemia showed that both conditions should not be overlooked since they may worsen the patient’s prognosis.

Background Cancer patients have an increased risk of a severe COVID-19 infection with higher mortality rate. This study aimed to analyze the levels of anti-SARS-CoV-2 S-RBD IgG and NAB among cancer patients who were vaccinated with COVID-19 vaccines, either with BNT162b2, mRNA-1273, AZD1222/ChAdOx1nCoV-19, or Coronavac/BBIBP-CorV vaccines. Method A cross-sectional study was conducted among subjects with either solid or hematological cancers who had received two doses of either mRNA or non-mRNA vaccines within 6 months. The levels of anti-SARS-CoV-2 S-RBD IgG and NAb were analyzed using the Mindray Immunoassay Analyzer CL-900i. Statistical analysis was conducted using mean comparison and regression analysis. Result The mRNA-1273 vaccine had the highest median levels of S-RBD IgG and NAb, followed by BNT162b, ChAdOx1nCoV-19, and BBIBP-CorV/Coronavac. The levels of S-RBD IgG and NAb in subjects vaccinated with mRNA vaccines were significantly higher than those of non-mRNA vaccines when grouped based on their characteristics, including age, type of cancer, chemotherapy regimen, and comorbidity (pConclusions Generally, mRNA vaccines produced significantly higher anti-SARS-CoV-2 S-RBD IgG and NAb levels than non-mRNA vaccines in cancer subjects.

Introduction. Indonesia has a high incidence of young HIV-positive population which is 20-29 years of age is in the highest group (50%). For this reason, it is important to make a better quality of life for them. Unfortunately, beside all the opportunistic infection, it was proved that osteopenia/osteoporosis has become a new emerging metabolic condition for HIV-infected patients. There is still no study about the description of bone mass density in HIV/AIDS patients in Indonesia. Methods. A cross sectional study was conducted in a total of 75 HIV-seropositive antiretroviral-naïve patients. Bone mineral density (BMD) was determined by dual energy X-ray absorptiometry in lumbar spine. Results. Seventy-five subjects had been recruited. Low BMD was found in 29.3% HIV-seropositive patients with osteopenia and 1,3% with osteoporosis. There was a higher number of osteopenia/osteoporosis in subjects who consume alcohol, smoking, lymphocyte CD4