International Journal of Integrated Health Sciences
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Predictive Factors of Neutropenia Following First Cycle of Chemotherapy in Patients with Non-Hodgkin’s Lymphoma in Bali, Indonesia
Get PDFBackground: Chemotherapy-induced neutropenia (CIN) is a common hematologic toxicity that increases infection risk, hospitalization, and treatment delay. Limited data exist on predictive factors of CIN among non-Hodgkin’s lymphoma (NHL) patients in Indonesia, particularly in Bali.Objective: To identify predictive factors of neutropenia following the first cycle of chemotherapy in patients with NHL at Prof. I.G.N.G Ngoerah General Hospital, Bali, Indonesia.Methods: This retrospective cohort study included all NHL patients treated from 2020–2023. Eligible patients were aged ≥18 years, received CHOP-based regimens with or without rituximab, and did not receive G-CSF prophylaxis. Data were obtained from medical records. Assessed risk factors were age, gender, BMI, comorbidities, histopathology grading, extranodal involvement, ECOG status, Ann Arbor stage, IPI score, chemotherapy regimen, pre-treatment blood count, eGFR, LDH, and albumin. The incidence of neutropenia was evaluated after the first chemotherapy cycle.Results: The mean age of the eligible patients (n=112) was 54.53 ± 14.64 years; 46 of them (41%) developed neutropenia. Significant factors associated with neutropenia were histopathology grading (p = 0.030), Ann Arbor stage (p = 0.048), IPI score (p = 0.037), chemotherapy regimen (p = 0.019), and LDH above normal (p = 0.049). Multivariate analysis identified high IPI scores (p = 0.016; OR 6.375; 95% CI 1.416–28.698) and CHOP regimen (p = 0.016; OR 3.033; 95% CI 1.230–7.476) as independent predictors of CIN.Conclusion: High IPI scores and CHOP regimens are strong predictors of neutropenia after the first chemotherapy cycle in NHL patients. Early identification of high-risk patients is essential for preventive management and improved treatment outcomes
Correlation between TSH, Prolactin, LH, FSH, Estrogen, and Progesterone in Women with Infertility
Get PDFBackground: Hormonal imbalances play a pivotal role in female infertility, affecting various endocrine pathways that warrant comprehensive evaluation.Objective: To analyze correlations between thyroid-stimulating hormone (TSH), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and progesterone in women with infertility.Methods: This retrospective observational study was conducted at the Department of Obstetrics and Gynecology of Prakash institute of Medical Sciences, India, between January 2024 and December 2024. Medical records of 140 women (90 with primary infertility and 50 with secondary infertility) aged 19–45 years were analyzed over a one-year period. Hormonal profiles including TSH, prolactin, LH, FSH, estrogen, and progesterone were analyzed. Statistical analyses were performed using the SPSS 23.0 software and a p-value of less than 0.05 was considered statistically significant.Results: Women with primary infertility were younger and had a shorter duration since marriage compared to those with secondary infertility (p0.05).Conclusion: TSH levels significantly correlate with prolactin, LH, and FSH levels in women with infertility. These findings underscore the importance of comprehensive endocrine evaluation of women with infertility to optimize diagnosis and management strategies
Anemia and Aggression Among Patients with Schizophrenia in Amino Gondohutomo Psychiatric Hospital
Get PDFBackground: Anemia has been identified as a potential modifiable factor influencing aggression levels in individuals with schizophrenia.Objective: To investigate the association between anemia and incidence of aggression in patients with schizophrenia in Amino Gondohutomo Psychiatric Hospital, Semarang, Indonesia.Methods: A cross-sectional study was conducted between January 2022 and December 2023 on patients with schizophrenia in Amino Gondohutomo Psychiatric Hospital, Semarang, Indonesia. Subjects were selected using consecutive sampling technique, and individuals with affective mood disorder and lost to follow-up were excluded from the study. Data were obtained through patients’ medical records, PANSS-EC scores, and hemoglobin measuring devices. Chi-square test and logistic regression were applied for statistical analyses.Results: Of 100 participants, patients with schizophrenia presented with aggression were predominantly above 40 years old (26 patients, 81.3%), women (17 patients, 51.1%), and non-anemic (17 patients, 57.1%). Gender and anemia were significantly associated with aggression in patients with schizophrenia (p <0.05). Schizophrenic patients with anemia had a 7.68-fold greater risk (95% CI: 2.70 – 21.8) of aggression. Men with schizophrenia was associated with a 2.37-fold greater risk (95% CI: 1.00 – 5.60) of aggression.Conclusion: Anemia and men seems to be risk factors of aggression in patients with schizophrenia. Further multicenter studies with larger sample size is needed to support this finding
Relationship between Neutrophil-Lymphocyte Ratio and Type of Febrile Seizures Event
Get PDFBackground: Febrile seizure is a common neurological condition affecting children. Complete blood count (CBC) is often used as the initial test to help determine the etiology of fever based on hematology parameters in the emergency ward.Objective: To analyze the relationship between neutrophil-lymphocyte ratio (NLR) and the type of febrile seizure among pediatric patients admitted to Wangaya General Hospital Denpasar, Indonesia.Methods: A cross-sectional design was implemented on a study using medical records of 44 children aged 6 month-5 years old admitted to the Wangaya Hospital between January 1, 2023, and September 8, 2024. Participants were grouped into simple and complex febrile seizures.Results: Among patients who experienced the first febrile seizure, the complex type accounted for most hospitalizations (n=33, 75.0%). The majority of cases occurred in children aged ≤24 months (n=32, 72.7%) with a temperature of >38°C (n=27, 61.4%). Seizure duration was ≤15 minutes in most cases (n=41, 93.9%), with upper Respiratory Infection being the most common etiology (n=20, 45.5%). NLR did not differ significantly between the simple and complex febrile seizures (P value =0.894), with a prevalence ratio (PR) of 1.1. Additionally, leukopenia, lymphocytopenia, and neutrophilia were observed in 28 (63.6%), 23 (52.3%), and 24 (54.5%) patients, respectively.Conclusion: There is no significant relationship between NLR and the type of first febrile seizures. Seizures are more frequently observed in males, particularly those aged 6-24 months with body temperature exceeding 38°C. The mean NLR of 2.78 ± 2.38 and upper respiratory infection are the most frequently associated conditions
AI-powered Somatic Cancer Cell Analysis for Early Detection of Metastasis: The 62 principal Cancer Types
Get PDFBackground: Early detection of metastasis is critical in improving survival outcomes in cancer patients, with artificial intelligence offering advanced tools for predictive analytics.Objective: To emphasize the importance of early metastasis detection in improving cancer patient outcomes, and to highlight that recent advancements in AI-powered somatic cancer cell analysis may enhance early detection and personalize treatment strategies.Methods: This study leveraged a comprehensive survival and artificial intelligence (AI) powered analysis to identify key genomic and clinical factors influencing cancer prognosis, with a focus on early metastatic detection. The AI algorithms explored the possibility of detecting tumors with a high spread risk. The study underscored the critical role of AI-powered analysis in the early detection of metastasis and the personalization of treatment strategies in cancer care.Results: By leveraging advanced AI algorithms, key predictors of cancer prognosis such as fraction genome alteration, primary tumor site, and smoking history, all of which significantly influence metastasis outcomes, were identified. Furthermore, the models demonstrated exceptional predictive accuracy, with XGBoost and Support Vector Machines achieving an accuracy of 0.95.Conclusion: Integrating AI capabilities into clinical workflows holds the promise of significantly enhancing early detection and treatment of metastatic cancer, thereby improving patient outcomes and optimizing therapeutic interventions
Eribulin in Heavily Pre-Treated Metastatic Breast Cancer: A Case Series
Get PDFBackground: Treatment options are limited for heavily pre-treated metastatic breast cancer patients, with Eribulin showing promise in improving survival outcomes.Objective: To evaluate Eribulin outcomes in patients with MBC. Metastatic or incurable diseases are observed in 4% to 10% of women despite advances in breast cancer treatment. To address this problem, EMBRACE, an important randomized phase III clinical trial was carried out by comparing eribulin to the treatment selected by physicians for individuals with previously treated locally recurrent or metastatic breast cancer (MBC). The results showed a significant and prolonged increase in median overall survival among patients treated with eribulin, compared to those who received the physician's selected treatment.Case Series: This study presents three patients who showed favorable outcomes after treatment with eribulin, despite multiple lines of previous therapy. Patient 1 was diagnosed with triple-negative breast cancer and initially achieved remission before experiencing a recurrence involving a chest lesion and enlarged lymph nodes. After two cycles of eribulin, the patient showed significant improvement. Patient 2 developed brain and liver metastases following the completion of hormonal therapy, prompting the initiation of eribulin as the next line of treatment. Patient 3 had disease progression despite undergoing multiple lines of hormonal and chemotherapy. Eribulin was administered and patient remained stable.Conclusion: Patients with MBC tend to have substantially favorable outcomes with eribulin chemotherapy even after extensive previous treatment
Assessment of Disease Progression in Idiopathic and Collagen Vascular ILDs Using Spirometry, DLCO, and 6 Minute-Walk-Test
Get PDFBackground: Monitoring progression in interstitial lung diseases is essential for timely intervention, with spirometry, DLCO, and 6MWT serving as key functional tests.Objectives: To evaluate disease progression in idiopathic and collagen vascular interstitial lung diseases (ILD) using pulmonary function parameters, including spirometry, DCLO (Diffusing Capacity of the Lungs for Carbon Monoxide), and the six-minute walk test.Methods: This prospective observational study was performed from January 2023 to December 2024 at Shadan Institute of Medical Sciences , Hyderabad, India. In this study, the pulmonary function in 51 ILD patients were assessed using spirometry, DLCO, and the six-minute walk test. Patients underwent detailed clinical evaluation, routine investigations, chest X-ray, ABG analysis, and HRCT to confirm ILD. Those suspected of CTD-ILD had RF and ANA testing, with a complete ANA profile if positive. Subjects were categorized into IPF and CTD-ILD groups. Pulmonary parameters were compared, and standard treatments were administered. Six deaths occurred during follow up period. For statistical purposes p value less than 0.05 was taken as statistically significant.Results: Fifty-one patients with diffuse parenchymal lung disease were included, with idiopathic pulmonary fibrosis (IPF) (46.4%) and connective tissue disease-associated ILD (CTD-ILD) (44.6%) as the main types. The CTD-ILD patients were younger (mean age 48.64 vs. 61.80 years, p=0.0006) and predominantly female. IPF patients had lower six-minute walk distance (239.73 vs. 312.60 meters, p=0.0066) and SpO2. Strong correlations were observed between lung function parameters in both groups. However, 6MWT showed no correlation in CTD-ILD.Conclusion: In ILD patients, FVC and DLCO were found to be reliable for disease monitoring, while simpler tests like 6MWT and FVC proved to be useful in resource-limited settings. Further research is needed to confirm their role in tracking IPF progression and treatment response
Correlation between Health Service Quality, TB Patient Behavior, and Treatment Compliance
Get PDFBackground: Tuberculosis (TB) remains a major public health problem in Indonesia, where treatment adherence is essential for preventing drug resistance, treatment failure, and continued transmission. The quality of health services and patient behavior are key determinants influencing adherence, particularly at the primary healthcare level.Objective: To analyze the effect of health services and tuberculosis (TB) patients’ behavior on adherence to TB treatment in Palu City.Methods: A cross-sectional study was conducted among 100 TB patients attending 14 community health centers (Puskesmas) in Palu City, Indonesia, selected through cluster random sampling. Data were collected from August to September 2024 using structured questionnaires. Univariate and bivariate analyses were performed, with statistical testing conducted using the Spearman rank correlation at a 95% confidence level (α = 0.05).Results: Most respondents were from Talise Health Center (12%), aged 21–29 years (24%), self-employed (50%), and had completed high school education (45%). Overall, 84% were treatment-compliant, and 97% demonstrated a positive attitude. All respondents with a less favorable attitude were non-compliant, while 86.6% of those with a good attitude were compliant. Regarding health services, 96% reported good services, and 86.5% of them were compliant, compared to 25% among those with poor services. Significant associations were found between attitude (ρ = 0.000, r = 0.417), health service quality (ρ = 0.000, r = 0.455), and treatment adherence.Conclusion: There is a significant association between the quality of healthcare services, patient attitudes, and adherence to TB treatment. Strengthening patient-centered services and ongoing counseling at Puskesmas are essential to sustain treatment success and reduce transmission
Association Between Cardiovascular Risk Factors and CAD Severity by CAD-RADS Categories and Comprehensive CTA Score
Get PDFBackground: Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide, including in Indonesia. Risk factors (RFs) play an important role in both pathogenesis and management of cardiovascular (CV) diseases. Coronary computed tomography angiography (CTA) is a reliable non-invasive diagnostic method. Coronary Artery Disease Reporting and Data System (CAD-RADS) categories and comprehensive CTA score describes CAD severity on coronary CTA and provides additional prognostic value.Objective: To explore the link between traditional cardiovascular risk factors and CAD severity based on CAD-RADS and comprehensive CTA scores.Methods: This retrospective, single-center study was conducted at a tertiary hospital using data from the Cardiovascular Imaging Database of the hospital from January 2020 to June 2022. Data meeting the inclusion and exclusion criteria were analyzed using ordinal and binary regressions.Results: A total of 423 patients' data were analyzed. Ordinal regression revealed significant links between age ≥ 65 years, male gender, hypertension, diabetes, and higher CAD severity based on both CAD-RADS and comprehensive CTA scores. Binary regression showed that older age and male gender were independently associated with CAD-RADS ≥ 3 and comprehensive CTA score ≥ 6. Diabetes was linked to CAD-RADS ≥ 3, and hypertension was tied to a comprehensive CTA score ≥ 6. The number of risk factors showed a trend toward CAD severity (p=0.069) and a significant link with comprehensive CTA score (p=0.012).Conclusion: There is a significant association between traditional cardiovascular risk factors and CAD severity as quantified by both CAD-RADS and comprehensive CTA score
Interpretation of Platelet Histograms and Its Correlation with Peripheral Smear in Data Showing Thrombocytopenia
Get PDFObjective: To analyze the significance of platelet histograms and peripheral smears in understanding thrombocytopenia and compare them for the incidence of pseudothrombocytopenia.Methods: This prospective study was conducted in the Department of Pathology at a tertiary care medical institute. The study included 200 cases of thrombocytopenia. Platelet parameters (PCT, PDW, MPV) were obtained using an autoanalyzer, and peripheral smears were examined manually. Thrombocytopenia cases were classified into hyper-destructive, hypo-productive, and abnormal pooling categories based on etiology and platelet histogram patterns. The incidence of pseudothrombocytopenia was also compared. A P value of less than 0.05 was considered statistically significant. Results: The gender distribution showed a male preponderance (56% male, 44% female). The mean age of the patients was 26.8 years. The study found hyper-destructive thrombocytopenia to be the most common type, with viral fever, sepsis, and malaria being the common etiologies for this type of thrombocytopenia. Histogram analysis revealed distinct patterns for different types of thrombocytopenia. The study also noted a higher incidence of pseudothrombocytopenia in automated analysis compared to manual methods, with a statistically significant difference.Conclusion: Platelet histograms combined with peripheral smear analysis provide crucial information about the etiology and nature of thrombocytopenia. This integrated approach enhances diagnostic accuracy and aid in effective patient management