24 research outputs found
How to Diagnose, Treat, and Monitor Treatment Response in Patients with Multiple Myeloma
No full textMultiple myeloma (MM) is a B-cell malignancy characterized by clonal proliferation of malignant plasma cells in the bone marrow, monoclonal protein production in the serum, and organ dysfunction. It is part of a disease spectrum called plasma cell disorders, and to establish the diagnosis, a bone marrow biopsy should be conducted with clinical signs of end-organ damage and/or significantly elevated monoclonal protein (M-protein). MM can also be diagnosed without end-organ damage when certain conditions are met since the International Myeloma Working Group (IMWG) has come up with new diagnostic criteria for multiple myeloma.Treatment for all patients with MM aims to enhance the depth and duration of response while limiting drug toxicity to lengthen survival, improve quality of life, alleviate symptoms and prevent further organ damage. Development of new drugs has improved the survival of patients4 Available tests for monitoring of patients with MM most often include assessments of monoclonal paraprotein and serum-free light chain levels with bone marrow examination, which directly identifies the level of malignant plasma cells
Metabolic Profile and Negatively Association Between Insulin Resistance and Metastatic Incidence in Indonesian Primary Invasive Breast Cancer: A Cross-Sectional Study
No full textAndhika Rachman,1,2 Zaenal Hakiki Fiantoro,3 Noorwati Sutandyo,4 Dimas Priantono,1 Pradana Zaky Romadhon,5 Reganedgary Jonlean6 1Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 2Siloam MRCCC Semanggi Hospital, Jakarta, Indonesia; 3Departement of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia; 4Dharmais National Cancer Referral Hospital, Jakarta, Indonesia; 5Division of Hematology and Medical Oncology, Department of Internal Medicine, Airlangga University, Surabaya, Indonesia; 6Tzu Chi Hospital, Jakarta, IndonesiaCorrespondence: Andhika Rachman, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Pangeran Diponegoro No. 71, Jakarta, 10430, Indonesia, Tel +62 813 9862 0570, Email [email protected]; [email protected]: Metastatic breast cancer was associated with high morbidity and mortality. Insulin resistance was hypothesized to be related to the incidence of advanced breast cancer. Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and Triglyceride/Glucose Index (TyG Index) are two metrics used to measure the degree of insulin resistance. This study aims to assess the relationship between the incidence of metastatic breast cancer and insulin resistance as reflected by both metrics.Material and Methods: This study is a cross-sectional study involving 150 primary invasive breast cancer patients recruited from two hospitals of different sectors from August 2019 to April 2020. Patients with double cancer and autoimmune disorder were excluded from this study. Data obtained from the patients include age, body mass index (BMI), type 2 diabetes mellitus (T2DM) status and treatment, and low-density lipoprotein (LDL) cholesterol. The electronic medical records (EMR) was consulted to find histopathology examination result, cancer staging, and any missing data. The association between HOMA-IR and TyG with metastatic incidence was analyzed using either the Mann–Whitney test (for non-normally distributed data) or the independent-sample t-test (for normally distributed data).Results: The mean of the TyG index is 8.60, and the median of HOMA-IR is 1.22. We found no significant correlation between both variables and the incidence of metastases.Conclusion: Insulin resistance was not associated with metastatic breast cancer.Keywords: HOMA-IR, TyG index, breast cancer, metastase
Challenges in Providing Treatment of Severe Malaria Case in a District Hospital of Remote Area in Indonesia
No full textSevere Malaria is commonly found due to Plasmodium falciparum infection, which is causing high mortality in patient. A Severe case might be difficult to treat optimally in the remote settings area that could be due to lack in awareness of disease manifestation and inadequate diagnostic facilities. We report a case of Severe Malaria Falciparum infection, confirmed by blood smear eamination of Plasmodium falciparum (Pf) parasites. Patient had received Artemicinin Based Combination Therapy (ACT), which consisted of dihydroartemisinin (DHA)-piperaquine and primaquine (PQ) with no clear clinical and microscopy improvement. The second line anti malaria consisted of quinine, doxycycline, and PQ was then initiated, showing clinical and microscopy responses
Pulmonary Embolism in Hospitalized Patient with Coronavirus Disease 2019 (COVID-19)
No full textCoronavirus disease 2019 (COVID-19) has been a global pandemic for over a year. Meanwhile, thrombosis occurs in up to one-third of hospitalized patients with the disease, while pulmonary embolism has been reported to be the most dangerous thrombosis which greatly increases mortality in COVID-19.Hospitalized patients with COVID-19 are at high risk of thromboembolic complications such as deep vein thrombosis and pulmonary embolism. The hypercoagulable state caused by COVID-19 leads to activation of coagulation cascade, meanwhile, CT pulmonary angiography is used to diagnose or exclude pulmonary embolism. Furthermore, ground-glass opacities are also evaluated using this modality. Low molecular weight heparin is the anticoagulant of choice due to simplicity in administration and low risk of drug-drug interactions.Pulmonary embolism occurs in COVID-19 patients without DVT. Based on the results, parenteral anticoagulant followed by DOAC is the mainstay of treatment in COVID-19 coagulopathy
An Indonesian Pregnant Woman with Lung Cancer and Liver Metastasis : a Case Report
No full textBackground: Lung cancer in pregnancy is a rare disease compared to other types of cancer. However, special issue should be applied in order to maximize benefit for mother without harming the fetus.Methods: We present a case of 37-year-old, five months pregnant woman who came to the hospital with chief complain of shortness of breath. Later on, she was found to have a stage IV Non-Small Cell Lung Cancer (NSCLC) with adenocarcinoma subtype.Result: This may be the first lung cancer in pregnancy reported in Indonesia. Being a developing country, several challenges emerged before diagnosing patient of having lung cancer.Conclusion: Careful considerations along with multidisciplinary approach are necessary to provide the best care for the patient
The Relationship between Folic Acid and Vitamin B12 Serum Levels with High Sensitivity C-reactive Protein and Homocysteine in Chronic Hemodialysis Patients: A Cross-sectional Study
No full textBackground: Folic acid (FA) and vitamin B12 treatment have been routinely prescribed to lower serum homocysteine levels and to reduce inflammation. However, no study has been conducted to determine serum folic acid (SFA) and vitamin B12 (B12) levels in patients who have twice-weekly hemodialysis. The aim of our study was to assess serum folate and B12 levels in chronic hemodialysis patients and their relationship with hsCRP and homocysteine levels. Methods: Our study was a cross-sectional study involcing patients who had twice-weekly hemodialysis in Dr Cipto Mangunkusumo National Hospital Jakarta, Indonesia. Predialysis blood samples were taken to measure SFA, B12, homocysteine and hsCRP levels. Patients with medical conditions affecting the assays were excluded. Spearman correlation was used to compare variables. Results: Eighty subjects enrolled in this study. Among those of non-given folic acid and vitamin B-12 supplementation, only 3.85% of subjects had low folic acid levels, and none had low vitamin B12 levels. A moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.42) and a weak correlation between serum vitamin B12 and homocysteine level (p=0.009; r=-0.29) was found. Among the high-risk cardiovascular group (CRP>3, n=49), there is a moderate negative correlation between serum folic acid and homocysteine level (p≤0.001; r=-0.561) and a weak negative correlation between vitamin B12 and homocysteine level (p=0.018; r=-0.338). Conclusion: There is a significant negative correlation between serum vitamin B12 and folic acid with homocysteine levels, especially in high-risk cardiovascular group
Pengaruh Induksi Hipoksia Hipobarik Intermiten pada Aktivitas Spesifik Manganese Superoxide Dismutase dan Kadar Malondialdehyde Ginjal Tikus
No full textHipoksia hipobarik merupakan kondisi yang sering dialami penerbang angkatan udara. Pengenalanhipoksia hipobarik intermiten dapat memicu mekanisme adaptasi untuk mengurangi efek buruk hipoksiahipobarik. Penelitian ini bertujuan untuk melihat pengaruh induksi hipoksia hipobarik intermiten terhadapstres oksidatif dan antioksidan serta hubungan keduanya di jaringan ginjal tikus. Sebanyak 25 ekor tikusjenis wistar dibagi menjadi lima kelompok: kelompok kontrol dan kelompok terpajan hipoksia hipobarikintermiten 1x, 2x, 3x dan 4x, dengan interval 7 hari antar pajanan. Tiap kelompok ditempatkan dalamhypobaric chamber dan dipajankan kondisi hipoksia hipobarik dengan berbagai ketinggian. Tikusdimatikan dan sampel jaringan ginjal diambil untuk diukur enzim manganese superoxide dismutase(MnSOD) dan malondialdehyde (MDA). Aktivitas enzim MnSOD tidak menunjukkan perubahanbermakna pada induksi hipoksia hipobarik 1x, 2x, 3x dan 4x dibandingkan kontrol (p>0,05). KadarMDA pada kelompok dengan perlakuan 2x hipoksia hipobarik meningkat bermakna (p<0,05). Padakelompok induksi 3x dan 4x, kadar MDA ginjal turun secara bermakna dibandingkan kelompok 2xperlakuan (p<0,05). Tidak terdapat korelasi aktivitas MnSOD dan kadar MDA (p>0,05). Setelah induksi3x, mulai terjadi adaptasi terhadap stres oksidatif. Adaptasi tersebut kemungkinan juga melibatkanantioksidan yang lain pada ginjal, seperti katalase. Dengan demikian induksi hipoksia hipobarikintermiten tampaknya dapat memberikan efek protektif pada jaringan ginjal tikus.Kata kunci: hipoksia hipobarik intermiten, stres oksidatif, manganese superoxide dismutase, malondialdehyd
The role of Zulewski’s clinical score in screening for hypothyroidism in post-radiation therapy nasopharyngeal carcinoma patients
No full textBackground: Nasopharyngeal carcinoma (NPC) is a leading cause of cancer related death in Asia; and the fourth most common malignancy in Indonesia. Hypothyroidism is one of the most commonly overlooked radiotherapy-induced late side effect due to its gradual occurrence despite its irreversibility. Unfortunately, thyroid evaluation is not widely accessible throughout Indonesia. Therefore, it is quite important to utilize a simple and reliable surrogate tool for hypothyroidism screening. This study aims to evaluate thyroid function and to validate Zulewski’s scoring system as a temporary surrogate marker for hypothyroidism in post-RT NPC patients. Method: This is a cross-sectional study involving NPC patients between November 2015 and March 2016 at Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The patients had completed radiation therapy (RT) within the preceding six months. They were evaluated for signs and symptoms of hypothyroidism with Zulewski’s clinical scoring system and with serological analysis of thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels. Results: There were 97 patients in this study. 28 (28.9) subjects experienced hypothyroidism based on the TSH and FT4 levels, with subclinical hypothyroidism (13.4) as the most common type, followed by overt hypothyroidism (9.3) and hypothyroxinemia (6.2). From the subjects with hypothyroidism, 19.6 had Zulewski’s clinical score <5, while 40.5 had scores ≥5. Subjects with <5 Zulewski’s clinical score exhibited signs and symptoms more related to the NPC itself, while those who scored ≥5 showed signs and symptoms more closely related to hypothyroidism. Conclusion: This study shows that hypothyroidism is commonly exhibited in NPC patients after radiotherapy (28.9). Zulewski’s clinical score of ≥5 indicates signs and symptoms more closely related to hypothyroidism. © 2022 by Author/s and Licensed by Modestum
