Background: The main purpose of treatment in patients with advanced lung cancer is more emphasizing on prolonging survival and improving the patient's quality of life (QOL). Micronutrient deficiency has an impact on the patient's QOL. The purpose of this study was to analyse the relationship between biochemical parameters of nutrient deficiency with QOL in patients with advanced non-small cell carcinoma (NSCLC) at Sanglah hospital.Methods: A cross sectional study was conducted in Sanglah general hospital on March-June 2021. Hemoglobin, albumin, and 2.5 (OH) D levels were obtained from patient's serum. The participant’s QOL was measured with EQ-5D-3L questionnaire. Bivariate analysis using chi-square test or Fisher's exact test, and multivariate analysis using logistic regression.Results: A total of 80 participants were included in this study, and 55% had poor QOL. Seventy percent participants had anemia, 36.3% had hypoalbuminemia, and 26.3% had vitamin D deficiency. The QOL of patients with advanced stage NSCLC was significantly associated with hypoalbuminemia (p=0.000) and vitamin D deficiency (p=0.044). Multivariate analysis showed that the most influential factor on the QOL of patients with advanced stage NSCLC was hypoalbuminemia (AOR 9.158; 95% CI 2.150-30.001; p=0.003).Conclusions: Hypoalbuminemia and vitamin D deficiency were significantly related with QOL of advance NSCLC patients. No relationship was found between anemia and the QOL of advance NSCLC patients. Hypoalbuminemia was the most influential factors related to the QOL of advance NSCLC patients.
Background: Pleural effusion is caused by various disease, including tuberculosis infection and malignancy. To determine the etiology, immunologic parameters are needed to distinguish tuberculous and malignant pleural effusions, including pleural fluid interleukin-6 (IL-6), neutrophil-lymphocyte ratio (NLR), and monocyte-lymphocyte ratio (MLR).Methods: This was a cross-sectional study, conducted at Sanglah General Hospital in Denpasar from March 2020 to September 2020. Pleural fluid IL-6 and leucocyte differential count were measured from subjects with tuberculous and malignant pleural effusions.Results: There were 22 tuberculous pleural effusion subjects with mean pleural fluid IL-6 9269.017±902.211 pg/ml, median (range) pleural fluid NLR 0.123 (0.044-9.449), and MLR 0.065 (0.044-0.355). There were 31 subjects with malignant pleural effusions, with mean pleural fluid IL-6 8212.146±2022.350 pg/ml, median pleural fluid NLR 0.189 (0.015-2.599), and MLR 0.065 (0.010-0.254). Pleural fluid IL-6 in tuberculous pleural effusions were significantly higher (p=0.014). With a pleural fluid IL-6 cut-off ≥9147.959 pg/ml, sensitivity of 63.6% and specificity of 64.5% were obtained. Pleural fluid NLR and MLR of the two groups were not significantly different (p=0.807 and p=0.116).Conclusions: Pleural fluid IL-6 in tuberculous pleural effusions is higher than malignant pleural effusions, with a cut-off of ≥9147.959 pg/ml, tuberculous pleural effusions can be diagnosed with sensitivity of 63.6% and specificity of 64.5%. There is no difference in pleural fluid NLR and MLR in tuberculous and malignant pleural effusions.
Introduction: Lung cancer found in young age is relatively rare with a percentage of cases only 1.4% of overall lung cancer cases in the world. Case: We reported two cases of lung adenocarcinoma in young women aged less than 30. The first case was lung adenosquamous carcinoma in a 28-year-old woman, a passive smoker, who had a family history of cancer. She had the mutation of epidermal growth factor receptor (EGFR) exon 19 deletion and received 1st generation of tyrosine kinase inhibitor. Since the patient was diagnosed at advanced stage with poor performance status, she died within 2 months after being diagnosed. The second case was lung adenocarcinoma in a 23-year-old woman. The patient was a passive smoker and had a history of cancer in the family. She was diagnosed at an advanced stage but with good performance status. The patient underwent chemotherapy with Pemetrexed-Platinum in 6 cycles and 15 cycles of radiotherapy. Conclusion: Lung cancer at a young age is more common in non-smoking female with the histopathology type adenocarcinoma. Non-specific early symptoms become a problem in the early enforcement of lung cancer at a young age. Many cancer-related issues occur in young cancer patient such as premature death, increased dependence on parents, difficulty in school and work due to medication, and reproductive disturbance.
Background: Omicron (B.1.1.529) is a variant of COVID-19 which is first reported from Gauteng Province, South Africa in November 2021. This variant was considered the fifth variant of concern (VOC) by the world health organization (WHO) due to its much faster transmission but with milder clinical manifestations than other COVID-19 variants.Methods: This retrospective cross-sectional descriptive study was conducted in Sanglah general hospital, Denpasar, Bali in March 2022. Subjects of this study were all patients who were diagnosed with probable COVID-19 Omicron by having a positive S-gene target failure (SGTF) of a reverse transcriptase polymerase chain reaction (RT-PCR) test in Sanglah general hospital from January to February 2022. All subjects must age 18 years old or older. Data on patient characteristics and clinical manifestations were obtained from medical record data and analyzed using statistical package for service solution (SPSS) for windows version 25.Results: A total of 79 probable COVID-19 Omicron patients were analyzed in this study. Most of them were elderly who age more than 65 years old (30.4%), male (50.6%), and work as an entrepreneur (24.1%). The majority of probable COVID-19 Omicron patients were symptomatic (89.9%) with the most common clinical manifestation found was cough (54.9%). Other clinical manifestations found were shortness of breath (50.7%), fever (38.0%), fatigue (21.1%), runny nose (11.3%), sore throat (8.5%), nausea and vomit (2.8%), headache (1.4%), diarrhea (1.4%), and anosmia (1.4%).Conclusions: The clinical manifestations of probable COVID-19 Omicron patients vary but most of them were classified as mild symptoms.
Background: Cancer patients are at risk of exposing COVID-19 because of their weakened immune system, caused by tumor growth and anti-cancer therapy. Cancer patients can also increase the risk of severe infection. This study aims to determine the characteristic of COVID-19 patients with malignancies in our institution Methods: We analyze the data of 68 COVID-19 patients with malignancies as comorbidities who were hospitalized or treated in our institution using cohort retrospective design. Variables assessed in this study include gender, age, type of malignancy, organ involved, cancer treatment, the severity of COVID-19, and outcome. Data were analyzed using SPSS version 25 for Windows and interpreted as number and percentage. Results: Solid malignancy was the most common type (82,4%). The lung and thorax were the most common organ involved, followed by the cervix, abdomen, breast, and nasopharynx. Most patients (66.2%) with malignancy suffered from COVID-19 with mild-moderate (non-severe) symptoms and 33,8% severe symptoms. Sixteen (23.5%) patients have died. Laboratory findings showed elevated NLR and D-dimer in both severe and non-severe cases. The median NLR of all cases was 5.97. The median D-dimer was 1.61 ìg/ml. Patients with solid malignancy (35.7%) are more exposed to severe COVID-19 than the hematological type (p=0.477). Patients with malignancy who had received therapy for their cancer had more severe symptoms than those who had not received cancer therapy (41.7% vs. 25%) (p=0.147), although not statistically significant. Conclusion: Solid malignancy was the most common type diagnosed with COVID-19. More malignancy patients experienced mild to moderate COVID-19 symptoms, and one-third of them experienced severe symptoms.
Background: Anosmia and ageusia are early symptoms that are widely reported in COVID 19 patients and are associated with low rates of intensive care and mortality, so the hypothesis arises that anosmia and ageusia can be good prognostic factors in COVID-19 patients. This study aims to examine anosmia and ageusia as prognostic factors in COVID-19 patients. Methods: This study is an observational analytic study with a retrospective cohort design conducted at Sanglah General Hospital Denpasar from January to June 2022. Results: obtained a total of 1048 subjects with 344 subjects experiencing anosmia, 210 subjects experiencing ageusia, and 474 subjects experiencing a combination of anosmia and ageusia. Variable symptoms of anosmia and ageusia were statistically significant predictors for the recovery of COVID-19 patients (p<0.05). The cure rate in the group of patients with symptoms of anosmia was 1.8 times (RR = 1.783, 95% CI = 1.667-1.908) and the group of patients with symptoms of ageusia experienced 1.6 times higher recovery (RR = 1.564, 95% CI = 1.478 -1,655). After adjusting for other variables as confounders, the combination of symptoms of anosmia and ageusia in patients was a significant predictor of recovery for COVID-19 patients by 1.5 times compared to patients who did not experience the combination of symptoms of anosmia and ageusia (ARR = 1.523, 95% CI = 1.245- 1.864, p<0.05). Conclusion: Anosmia, ageusia and the combination of both, indicate protective factors against possible mortality and indicate a good prognosis in COVID-19 patients. Latar belakang: Anosmia dan ageusia merupakan gejala awal yang banyak dilaporkan pada pasien COVID-19 serta dikaitkan dengan tingkat rawat intensif dan mortalitas yang rendah sehingga muncul hipotesis bahwa anosmia dan ageusia dapat menjadi faktor prognosis yang baik pada pasien COVID-19. Penelitian ini bertujuan untuk meneliti anosmia dan ageusia sebagai faktor prognosis pada pasien COVID- 19. Metode: Penelitian ini merupakan studi analitik observasional dengan rancangan kohort retrospektif yang dilakukan di RSUP Sanglah Denpasar pada bulan Januari hingga Juni 2022. Hasil: Didapatkan total 1048 subjek dengan 344 subjek mengalami anosmia, 210 subjek mengalami ageusia, serta 474 subjek mengalami kombinasi anosmia dan ageusia. Variabel gejala anosmia maupun ageusia secara statistik merupakan prediktor signifikan untuk kesembuhan pasien COVID-19 (p<0,05). Tingkat kesembuhan pada kelompok pasien bergejala anosmia mencapai 1,8 kali (RR = 1,783, IK 95% = 1,667-1,908) lebih tinggi dan kelompok pasien bergejala ageusia mengalami kesembuhan 1,6 kali lebih tinggi (RR = 1,564, IK 95% = 1,478-1,655). Setelah disesuaikan dengan variabel lain sebagai perancu, kombinasi gejala anosmia dan ageusia pada pasien menjadi prediktor kesembuhan pasien COVID-19 secara signifikan sebesar 1,5 kali lipat dibandingkan pasien yang tidak mengalami kombinasi gejala anosmia dan ageusia (ARR = 1,523, IK95% = 1,245-1,864, p<0,05). Simpulan: Anosmia, ageusia, dan kombinasi keduanya menunjukkan adanya faktor protektif terhadap kemungkinan mortalitas serta menandakan adanya prognosis yang baik pada pasien COVID-19
Background: Tuberculosis and HIV infections are still a combination of diseases with high mortality rates. The success of intensive phase therapy of positive bacteriological TB patients with HIV co-infection can reduce morbidity and mortality rates. This study aims to determine the relationship between CD4 levels, HB, and BMI on the success of intensive phase therapy among positive bacteriological TB patients with HIV co-infection. Method: This research was an observational analytic study using a retrospective cohort study design conducted in Bali over 5 years (January 2016 to December 2021). Of 120 subjects, 118 subjects met the research requirements. The data was analyzed by Univariate analysis, Bivariate analysis was carried out using Chi-Square, and multivariate analysis was performed using multiple logistic regression. Results: a significant correlation was found between CD4 levels (RR=3,03, p= 0,004), HB (RR= 1,92, p= 0,006), BMI (RR= 5,91 p< 0,001) with successful intensive phase therapy in Bacteriologically Confirmed TB patients with HIV co-infection. All independent variables simultaneously affected sputum conversion (p<0,001; R Square = 0,479; CI: 95%). This study also found that BMI was the dominant predictor that affected the success of intensive phase therapy in Bacteriologically Confirmed TB patients with HIV co-infection (p<0,001; OR: 5,193; CI 95%). Conclusion: CD4, HB, and BMI levels are significantly related to the success of intensive phase therapy in Bacteriologically Confirmed TB patients with HIV co-infection.
Background: Malignant pleural effusion carries a bad prognosis. Pathologic examination as the gold-standard diagnosis of malignant pleural effusion has sensitivity limitations and may cause delayed diagnosis. Several affordable examinations, such as serum pleural effusion albumin gradient, total protein, lactate dehydrogenase (LDH), and erythrocyte count, might be useful as malignant pleural effusion diagnostic tools. Methods: This is an observational analytic study with a cross-sectional design conducted at Sanglah Central General Hospital in Denpasar from December 2021 to July 2022. Pleural effusion fluid and blood were taken from subjects with malignant and non-malignant pleural effusion. Data were analyzed with SPSS version 25 software for Windows. Results: Total subjects were 47 persons consisting of 26 subjects with malignant pleural effusion and 21 subjects with non-malignant pleural effusion. Results from statistical analysis of malignant and non-malignant pleural effusion were serum pleural effusion albumin gradient median (IQR) 0.91 (0.65) g/dL vs. 1.22 (1.2) g/dL (p=0.129), total protein mean 3.92±0.95 g/dL vs. 3.52±1.67 g/dL (p=0.334), LDH median 535 (840) IU/L vs. 187 (1,016) IU/L (p=0.057), and erythrocyte count median 23,500 (109,250) cells/mm3 vs. 3,000 (11,000) cells/mm3 (p=0.004). The AUC of erythrocyte count from the ROC method was 0.745 (95%CI=0.599-0.890; p=0.004). Using a cut-off point ≥ 4,500 cells/mm3, it had a sensitivity of 80.8%, specificity of 61.9%, and Odds Ratio (OR) of 6.8 (95%CI=1.8-25.4). Conclusion: Erythrocyte count as routine examination showed good validity for diagnosing malignant pleural effusion and expected to reduce diagnosis delay. Meanwhile, albumin gradient, total protein, and LDH delivered no difference.
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