Background:There are very few studies about the mechanism of fibrosis in tuberculosis (TB). This study aimed to determine the levels of tumor necrosis factor-α (TNF-α), insulin-like growth factor-1 (IGF-1), and transforming growth factor-β1 (TGF-β1) in pulmonary TB patients with minimal and extensive lesions.Materials and Methods:Cross-sectional observational study design was used to observe the pulmonary TB patients with minimal and extensive lesions, and also healthy controls, each consisting of ten patients.Results:The plasma levels of TNF-α, IGF-1, and TGF-β1 in pulmonary TB groups were higher compared to the healthy controls. The TNF-α level in the minimal lesion of TB group was higher than the level in the extensive lesion but not significant (P = 0.741). The IGF-1 level in the minimal lesion of TB group was significantly (P = 0.007) increased compared to the extensive lesion. While the TGF-β1 level in the minimal lesion of TB group was significantly (P = 0.005) lower than the level in the extensive lesion.Conclusion:In extensive lesion of TB group, there are differences in the levels of TNF-α, IGF-1, and TGF-β1 compared to the minimal lesion of TB group as well as the healthy controls. The extent of lesions on chest radiograph also describes the state of ongoing pulmonary fibrosis which can be shown by the differences in the levels of pro-fibrotic cytokines.
Background and Objective:COVID–19 is a newly emerging disease and considered an emergency health problem, worldwide.It has a wide range of clinical features, from mild fever to severe respiratory failure that leads to a higher mortality rate. Previous studies state that CRPhas a very strong positive correlation with the diameter of the lung lesion, and in intensive care patients had a higher level of LDH. This study aims to determine the correlation between CRP, LDH and disease severity and mortality in hospitalized COVID-19 patients. Methods: We conducted a retrospective cohort, a single-center study including 69 laboratory-confirmed patients in our hospital in Malang City, Indonesia from April - June 2020. Result: Subjects consisted of 26 patients (37.7%) in the mild-moderate group and 43 patients in severe group (62.3%).Statistical analysis showed CRP and LDH associated with disease severity (p=0.011 and p<0.001). Analysis of CRPand LDH in survivor and non-survivior group showed that CRP and LDH also asscociated with mortality in hospitalized COVID-19 patients (p=0.034 and 0.002). We also evaluate CRP and LDH with degrees of hypoxemia by assessed P/F ratio. Statistical analysis showed that CRP did not correlate with degrees of hypoxemia (p=0.079) but LDH inverse correlate with degrees of hypoxemia (p<0.001, pearson correlation = -0,489) Conclusion: In our retrospective cohort study demonstrated LDH and CRP can be a crucial indicator to predict severity and mortality for hospitalized COVID-19 patients and LDH may usefull test for predict early identification of patients who become respiratory failure or ARDS. Keywords: COVID-19, LDH, CRP, P/F Ratio
The soluble urokinase plasminogen activator receptor (suPAR) has been shown to be a strong prognostic biomarker for tuberculosis (TB). In the present study, the profiles of plasma suPAR levels in pulmonary TB patients at high risk for multidrug resistance were analyzed and compared with those in multidrug resistant (MDR)-TB patients. Forty patients were prospectively included, consisting of 10 MDR-TB patients and 30 TB patients at high risk for MDR, underwent clinical assesment. Plasma suPAR levels were measured using ELISA (SUPARnostic, Denmark) and bacterial cultures were performed in addition to drug susceptibility tests. All patients of suspected MDR-TB group demonstrated significantly higher suPAR levels compared with the healthy TB-negative group (1.79 ng/mL). Among the three groups at high risk for MDR-TB, only the relapse group (7.87 ng/mL) demonstrated suPAR levels comparable with those of MDR-TB patients (7.67 ng/mL). suPAR levels in the two-month negative acid-fast bacilli conversion group (9.29 ng/mL) were higher than positive control, whereas levels in the group consisting of therapy failure patients (5.32 ng/mL) were lower. Our results strongly suggest that suPAR levels enable rapid screening of suspected MDR-TB patients, but cannot differentiate between groups.
Penyakit Paru Obstruktif Kronik (PPOK) merupakan penyakit paru yang didasari salah satunya oleh reaksi inflamasi yang meningkat sehingga menimbulkan hambatan aliran udara dan perusakan pada eritrosit, sehingga terjadi resistensi hormon eritropoietin. Populasi D merupakan pasien PPOK yang memiliki risiko eksaserbasi tertinggi dan gejala yang paling berat di antara populasi lainnya. Terapi lini pertama untuk pasien PPOK populasi D yang direkomendasikan GOLD adalah terapi LABACS (long acting beta2 agonist and corticosteroid). Penelitian ini dilakukan untuk mengetahui perbedaan kadar hemoglobin dan parameter eritrosit berupa jumlah eritrosit, nilai red blod cell distribution width dan indeks eritrosit penderita PPOK populasi D yang mendapat dan tidak mendapat LABACS. Penelitian ini menggunakan metode observational cross sectional dengan melihat rekam medis pasien PPOK pada bulan Juni sampai November 2015. Hasilnya pada terapi LABACS didapatkan kadar hemoglobin yang lebih tinggi dibandingkan dengan tanpa terapi, jumlah eritrosit, nilai MCV, MCH, MCHC lebih rendah dibandingkan dengan tanpa terapi, dan nilai RDW lebih tinggi dibandingkan dengan tanpa terapi LABACS. Selain itu, persentase pasien PPOK yang terkena anemia pada kelompok yang mendapat terapi LABACS lebih rendah dibanding dengan yang tidak mendapat terapi. Kadar hemoglobin, jumlah eritrosit, indeks eritrosit, dan RDW dievaluasi dengan program SPSS 16.0. Tidak didapatkan perbedaan yang signifikan pada semua parameter. Kesimpulannya, tidak terdapat perbedaan kadar hemogolobin dan parameter eritrosit antara pasien PPOK populasi D yang mendapat dan tidak mendapatkan terapi LABACS. Kata kunci: eritrosit, hemoglobin, LABACS, penyakit paru obstruktif kronik, red blood cell distribution width.
<p><br />Keberhasilan vaksin BCG dalam memberikan perlindungan terhadap tuberkulosis (TB) pada orang dewasa di Indonesia belum optimal (37%) sehingga diperlukan vaksin alternatif yang lebih efektif. Protein rekombinan fusi ESAT6-CFP10 merupakan kandidat vaksin yang potensial. Penelitian dilakukan untuk menguji efektifitas protein rekombinan fusi ESAT6-CFP10 dalam meningkatkan ekspresi IL2 dan IL10 sel T CD8 yang memainkan peran penting dalam respon imun melawan TB. Pengujian kandidat vaksin dilakukan secara in vitro pada peripheral blood mononuclear cell (PBMC) dari kelompok sehat endemik TB, kelompok kontak TB, dan kelompok pasien TB dengan melihat persentase IL2 dan IL10 CD8. Setiap kelompok diberi perlakuan tanpa antigen, PPD, dan protein rekombinan fusi ESAT6-CFP10. Persentase IL2 meningkat secara signifikan dari kelompok sehat, kontak TB, hingga Pasien TB. Sebaliknya peningkatan persentase IL2 antar kelompok yang dipaparkan PPD tidak signifikan secara statistik (p=0,396). Persentase IL10 tidak menunjukkan perbedaan yang signifikan antar kelompoknya baik tanpa paparan antigen (p=0,617), PPD (p=0,351), maupun protein rekombinan fusi ESAT6-CFP10 (p=0,257). Didapatkan persentase IL2 yang tidak berbeda secara signifikan antar perlakuan pada kelompok sehat (p=0,309), kelompok kontak TB (p=0,318), dan kelompok pasien TB (p=0,424). Demikian juga dengan persentase IL10 yang tidak berbeda secara signifikan antar perlakuan pada kelompok sehat (p=0,908), kelompok kontak TB (p=0,352), dan kelompok pasien TB (p=0,776). Hal ini menunjukkan bahwa protein fusi rekombinan ESAT6-CFP10 dapat meningkatkan persentase IL2 tetapi tidak dengan IL10 meskipun secara statistik tidak signifikan.</p>
Background: Mesothelioma is a primary malignant tumor arising from the mesothelial surface of the pleura, peritoneal, tunica vaginalis, and pericardium. Most cases of mesothelioma originate from the pleura. Most patients have a history of asbestos exposure. A common diagnostic problem is distinguishing mesothelioma from adenocarcinoma since both tumors invade the pleura. Immunocytochemistry of calretinin and TTF-1 can be used to establish the diagnosis of mesothelioma. Case: Male, 56 years old presented with chest pain, shortness of breath, cough, and weight loss since 5 months before hospitalization. The patient had a history of occupational exposure to asbestos for 30 years. The movement and breath sounds were decreased as well as dull upon percussion at the right chest. A chest X-ray revealed a right lung tumor with pleural effusion. Thorax CT scan suggested pleural mass in right hemithorax, infiltration to intercostal muscles, and destruction of the 7th right rib, right perihilar lymphadenopathy, right pleural effusion, and liver nodules according to mesothelioma T4N1M1 Stage IV. Infiltrative stenting of the right and inferior lobe of the right lung, infiltrative and obstructive stenting of the medius lobe suggestive of a chronic malignancy and inflammation were found on FOB. Cytologic examination of pleural fluid, sputum, and Washing-and-brushing of FOB were a class II (no malignant cells). USG-guided transthoracic FNAB revealed adenocarcinoma with differential diagnosis of mesothelioma. Immunocytochemistry with calretinin showed positive results and TTF-1 showed a negative result. These confirmed the diagnosis of pleural mesothelioma T4N1M1 Stage IV. The patient showed a stable response from carboplatin/gemcitabine treatment.
Latar belakang : Pandemi COVID-19 pada tahun 2020 menyebabkan kematian di seluruh dunia. Hingga bulan Februari 2022, didapatkan 5,84 juta kematian akibat infeksi COVID-19. Sejumlah 1,1% kematian didapatkan pada kasus ringan-sedang, dan 32,5% pada kasus berat-kritikal. Penelitian ini dilakukan untuk mengetahui hubungan antara usia, merokok, pendidikan, pekerjaan, dan komorbid dengan tingkat severitas (ringan, sedang, berat dan kritis) dan waktu kematian (<48 jam dan >48 jam ) pada infeksi COVID-19, serta hubungan antara tingkat severitas penyakit dengan waktu kematian (<48 jam dan >48 jam) pada infeksi COVID-19. Metode : Penelitian dilakukan secara retrospektif dengan 300 sampel di RSSA pada bulan April 2020 hingga bulan September 2021, dengan subjek pasien berusia 18 tahun ke atas yang dirawat karena COVID-19. Data mengenai epidemiologis, klinis, dan komorbid diambil dari rekam medis. Data kategorik dua variabel dianalisis dengan menggunakan Chi Square dan uji Fischer untuk data yang tidak memenuhi kriteria Chi Square. Batas kemaknaan dinyatakan pada p<0,05 dengan interval kepercayaan 95%. Statistik dikerjakan dengan SPSS versi 26. Hasil : Analisis statistik menunjukkan terdapat hubungan yang signifikan antara: usia, merokok, komorbid, tingkat severitas COVID-19 dengan waktu kematian (p<0,001). Tidak terdapat hubungan yang signifikan antara pendidikan dan pekerjaan dengan derajat awal dari COVID-19 dengan waktu kematian (p>0,001). Pembahasan : Pasien dengan usia tua berisiko mengalami mortalitas lebih tinggi diduga terkait dengan fungsi sel T dan sel B, produksi sitokin tipe 2 berlebihan yang menyebabkan terjadinya respon proinflamasi yang berkepanjangan. Penelitian lain menyebutkan bahwa usia, pasien laki-laki, dan perokok aktif merupakan faktor prognosis mortalitas. Gejala berat-kritikal COVID-19 merupakan prediktor independen terjadinya mortalitas. Gejala berat seperti sesak napas dan distres pernapasan berat terkait dengan mortalitas yang lebih tinggi. Simpulan : Terdapat hubungan yang signifikan antara usia, merokok, komorbid dan tingkat severitas dengan waktu kematian. Didapatkan juga tidak adanya hubungan signifikan antara pekerjaan dan pendidikan dengan waktu kematian
Background: Lung cancer has the highest mortality rate in the world. Lung cancer management requires biomarkers to evaluate the chemotherapy response. Levels of Plasminogen Activator Inhibitor-1 (PAI-1) in malignancy >14 ng/ml shows poor prognosis. Increased levels of PAI-1 are associated with stage, metastasis, and prognosis of lung cancer. The chemotherapy is thought to decrease PAI-1 levels. The aim this study is analyze the profile of PAI-1 levels before and after 3rd and 6th chemotherapy cycle and their changes by type of lung cancer and Response Evaluation Criteria in Solid Tumors (RECIST). Methods: This research was conducted from December 2016 to December 2017 at RSSA Malang. The study design was a cohort of 18 lung cancer patients. PAI-1 levels were measured by ELISA in 18 lung cancer stage III or IV patients before (PAI-1(1)) and after 3rd chemotherapy cycle (PAI-1(2)), and 9 patients after 6th chemotherapy cycle (PAI-1(3)). Average PAI-1 levels are presented in tables and graphs. Result: PAI-1(1) 2,151±0,564 ng/ml, PAI-1(2) 1,951±0,534 ng/ml, and PAI-1(3) 1,647±0,495 ng/ml. PAI-1 levels in non-small cell lung carcinoma (NSCLC) were 1.658±0.562 ng/ml and small cell lung carcinoma (SCLC) were 1.609±0.244 ng/ml. Levels of PAI-1(2) in partial response 1.784 ± 0.363 ng/ml, stable disease 1.980 ± 0.304 ng/ml, and progressive disease 2.020±0.635 ng/ml. Levels of PAI-1(3) in the partial response 1.427 ± 0.324 ng/ml and in progressive disease 2.085±0.532 ng/ml. Conclusions: PAI-1 levels in patients with stage III and IV lung cancer after chemotherapy were lower than before chemotherapy, and showed changes corresponding to the response according to RECIST. PAI-1 levels in NSCLC are higher than SCLC. (J Respir Indo 2018; 38(1): 48-56)
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