Background: Pulmonary hypertension is a condition which there is an increase in mean pulmonary artery pressure measured at ≥25 mmHg. The gold standard in diagnosing this condition is right heart catheterization. Enlargement of right descending pulmonary artery on chest radiographs is a sign of pulmonary hypertension. However, the value of radiographic measurements reported was diverse. The study analyzes the correlation between the right descending pulmonary artery (RDPA) diameter on chest radiographs and means pulmonary artery pressure on right heart catheterization to understand whether RDPA diameter on chest X-ray could be a predictor in determining the severity of pulmonary hypertension.Methods: Thirty-five subjects were reviewed to compare RDPA diameter from a chest X-ray on posteroanterior projection and mPAP value from the right heart catheterization. The correlation between them was analyzed using Pearson's correlation test.  RDPA diameter cut-off point was defined using the ROC curve.Result: RDPA diameter and mPAP revealed a high positive correlation (p<0.001; r=0.824). The cut-off value of the RDPA diameter was 21.8 mm (sensitivity 81% and specificity 85.7%; AUC =0.9)Conclusion: The measurement of right descending pulmonary artery diameter on chest x-ray positively correlates with mean pulmonary artery pressure. Therefore, the diameter of the right pulmonary artery on the chest x-ray can predict the severity of pulmonary hypertension.

Highlights: This study demonstrated the effect of ozonated Aloe vera oil in the healing of radiation dermatitis wound. Groups that received no treatment was compared with groups that received treatment using 2.5% hydrocortisone ointment and ozonated Aloe vera. Ozonated Aloe vera oil improves the healing of radiation dermatitis wound by increasing PDGF expression and epidermal thickness.   Abstract : The long-term use of corticosteroids as a standard treatment for skin disorders, such as radiation dermatitis, can cause many side effects. Alternatively, ozonated Aloe vera oil may replace corticosteroids due to its fewer side effects and benefits in wound healing process. Re-epithelialization and the formation of growth factors, such as platelet-derived growth factor (PDGF), play an important role in the healing of dermatitis wound. This study intended to demonstrate the effect of ozonated Aloe vera oil to improve the healing of radiation dermatitis wound by increasing PDGF expression and epidermal thickness. This study used a post-test only control group design. A sample of 36 Sprague-Dawley rats was divided into 6 groups (C1=without treatment, C2=2.5% hydrocortisone ointment, P1=pure Aloe vera (AV), P2=300 mg/mL ozonated Aloe vera (OAV), P3=600 mg/mL OAV, P4=1200 mg/mL OAV. The expression of PDGF was assessed using Allred scoring with immunohistochemical staining, whereas the epidermal thickness was assessed using hematoxylin and eosin (H&E) staining at 400x microscopic magnification. The PDGF expression and epidermal thickness between the control and the treatment groups showed significant differences using a Kruskal-Wallis test (P=0.001) and one-way ANOVA test (P<0.001). The groups that was given ozonated Aloe vera oil had higher average of PDGF expression and thicker epidermis than the other groups. The Spearman's correlation test showed a strong positive relationship (p<0.001 and r=0.709) between the two variables. In conclusion, ozonated Aloe vera oil improves healing of radiation dermatitis wound by increasing PDGF expression and epidermal thickness.

BACKGROUND: The effect of ozonated Aloe vera in the treatment of radiation dermatitis has not been studied, while long-term use of topical steroids can cause some side effects. AIM: The aim of the study was to analyze the effect of topical administration of ozonated Aloe vera oil on the expression of TGF-β and collagen density in the treatment of radiation dermatitis. METHODS: 36 Sprague Dawley rats were randomized into six groups, namely, K1 (negative control-without therapy), K2 (positive control-hydrocortisone cream 2.5%), P1 (Aloe vera oil), P2, P3, and P4 (ozonized Aloe vera oil 300/600/1200 mg/ml). Termination and immunohistopathological analysis of TGF-β expression and collagen density were performed after 7 days of treatment. RESULTS: Measurement of TGF-β expression by ANNOVA test showed a significant difference between groups p = 0.001. The Post Hoc LSD test showed significant differences between groups K1 and P1, P2, P3, and P4 also between groups K2 and P2, P3, and P4. Measurement of collagen density by Kruskal–Wallis test showed a significant difference between the treatment groups p < 0.001. Post hoc Mann–Whitney test of collagen density found a significant difference between groups K1 and P1, P2, P3, and P4 also between groups K2 and P2, P3, and P4. Spearman’s rho correlation test showed a strong and unidirectional relationship between TGF-β and collagen (p < 0.001 and r = 0.722). CONCLUSION: Topical ozonated Aloe vera oil increased TGF-β expression and collagen density in radiation dermatitis.

BACKGROUND: Central neurocytoma (CN) is one of the rarest brain tumors which can cause considerable threats to the patient. Studies and trials regarding its treatment are scarce, and no official guidelines are dedicated to this disease. The main principle of treatment generally consists of surgery and radiotherapy. The choice of radiotherapy is divided into conventional fractionated radiotherapy and stereotactic radiosurgery (SRS). However, access to SRS in developing countries such as Indonesia is still limited. AIM: We report a case delineating the timeline and process of treatment in CN with a review of the literature. METHODS: We report the case of a 29-year-old woman with a solid inhomogeneous mass (AP 5.63 × CC 5.36 × LL 5.16 cm) in the right ventricle, attached to the septum pellucidum, as displayed on the magnetic resonance imaging (MRI). The patient had been vomiting for the past three weeks and presented with bidirectional horizontal nystagmus. RESULTS: Cognitive evaluation with Montreal Cognitive Assessment (MoCA-Ina) demonstrated a mild cognitive impairment. Biopsy was performed, and pathology analysis revealed some cells with fibrillary background and some with a honeycomb-like appearance. The immunohistochemistry staining showed positive results with synaptophysin and neuronal nuclear protein. According to the WHO classification of the central nervous system tumors, the profile favored CN Grade II. Subtotal resection (STR) was performed to reduce the tumor mass, which was measured with MRI 2-month post-surgery (AP 4.09 × CC 3.01 × LL 4.13 cm) and then followed by an external radiation program. Using intensity modulated radiation therapy (IMRT), a total dose of 54 Gy was given in 27 fractions, with the average planning target volume of 54.3 Gy. There was a minuscule reduction in tumor mass as seen in post-radiotherapy MRI (AP 4.00 × CC 3.86 × LL 3.63 cm). After the last session and at the 18-month follow-up, the patient did not have any complaints or abnormalities during clinical assessment. Reevaluation using MoCA-Ina showed an improved cognitive function. CONCLUSIONS: In line with recent evidence, we demonstrated that STR followed by IMRT with the dosage of 54 Gy in 27 fractions was a feasible treatment strategy for CN that resulted in cognitive improvement, with no side effects.

Background: Keloid is a benign growth of connective tissue. There are several risk factors that play a role in keloid growth. Excision surgery is one of the modalities in the treatment of keloids. However, excision surgery alone has a recurrence rate of 45-100%.Case: Male, 37 years old, with complaints arising from a keloid lesions in the left earlobe since three years ago with a history of previous injuries. The lesions is then operated on but always grows back postoperatively. The number of surgeries that have been carried out three times with further treatment in the form of corticosteroid injection. However, keloid still recurrence. Finally it was decided to undergo treatment with surgery followed by radiotherapy within a period of no more than 24 hours postoperatively. Follow-up after six months gave good results without recurrence.Discussion: Keloid has a high recurrence rate after excision surgery. Surgery followed by radiotherapy has a low recurrence rate compared to surgery or surgery followed by administration of corticosteroid injections. Radiotherapy as adjuvant therapy for postoperative keloid excision has the role of sterilizing the connective tissue stem cell active fibroblasts and acute inflammatory cells that grow in the early postoperative period. A study states that administration of postoperative radiation with electrons in keloids in the earlobe at a dose of 15 Gy in three fractions gives a low recurrence rate and a low risk of side effects in the surrounding soft tissue.

Background: According to the 2018 Global Cancer Observatory from the World Health Organization (WHO), breast cancer is the most common cancer in Indonesia. 3-dimensional conformal radiotherapy (3D-CRT) is one of the breast cancer treatment planning. Effect of radiation on the lungs can cause radiation pneumonitis. The incidence rate of pneumonitis in breast cancer patients who received radiotherapy using 3D-CRT techniques from several researchers is still varied and there is no accurate data yet at RSUP Dr. Kariadi.Objective: To determine the incidence of pneumonitis in breast cancer patients undergoing breast cancer 3D-CRT.Methods: The research design used in this study was cross sectional. The subject is chosen by consecutive sampling methods. The independent variables of this study was 3D breast cancer radiation therapy, while the dependent variable was radiation pneumonitis. This hypothesis test on this study is analyzed with chi-square test.Results: Forty one subjects were included in this study, two subjects were found with a picture of pneumonitis on chest radiographs. The incidence of radiation pneumonitis in breast cancer patients who received radiotherapy using 3-dimensional techniques was 4.9%. There is no significant relationship between breast cancer radiation therapy 3-dimensional techniques on the incidence of pneumonitis. And there was no significant difference in the proportion of pneumonitis in patients with breast cancer locations on the right and left sides.Conclusion: The incidence of radiation pneumonitis in breast cancer patients who received radiotherapy using a 3-dimensional technique is 4.9%.   Keywords: 3 Dimensional Technique Radiotherapy, Breast Cancer, Radiation Pneumonitis