The role of oncogenes and tumor suppressor genes in determining survival rates of lung cancer patients in the population of North Sumatra, Indonesia.

Background: Gaining a better understanding of molecular alterations in the pathogenesis of lung cancer reveals a significant change in approach to the management and prognosis of lung cancer. Several oncogenes and tumor suppressor genes have been identified and have different roles related to survival rates in lung cancer patients. This study aims to determine the role of KRAS, EGFR, and TP53 mutations in the survival rate of lung cancer patients in the population of North Sumatra. Methods: This is a retrospective cohort study involving 108 subjects diagnosed with lung cancer from histopathology specimens. DNA extractions were performed using FFPE followed by PCR examinations for assessing the expressions of EGFR, RAS, and TP53 protein. Sequencing analysis was carried out to determine the mutations of EGFR exon 19 and 21, RAS protein exon 2, and TP53 exon 5-6 and 8-9. Data input and analysis were conducted using statistical analysis software for Windows. The survival rate analysis was presented with Kaplan Meier. Results: 52 subjects completed all procedures in this study. Most of the subjects are male (75%), above 60 years old (53.8%), heavy smokers (75%), and suffer from adenocarcinoma type of lung cancer (69.2%). No subjects showed KRAS exon 2 mutations. Overall survival rates increased in patients with EGFR mutations (15 months compared to 8 months; p=0.001) and decreased in patients with TP53 mutations (7 months compared to 9 months; p=0.148). Also, there was increasing Progression-Free Survival in patients with EGFR mutations (6 months compared to 3 months) ( p=0.19) and decreasing PFS in patients with TP53 mutations (3 months compared to 6 months) ( p=0.07). Conclusions: There were no KRAS mutations in this study. EGFR mutations showed a higher survival rate, while TP53 mutations showed a lower survival rate in overall survival and progression-free survival.

A Comparison of Occupational CO Levels, HbCO, and Lung Functions Between Grill and Non-grill Street Vendors.

BACKGROUND: There is a surge increase in grills-fast food outlet in the urban areas that plays an essential role in producing air pollution. Chronic accumulation of carbon monoxide might affect the airway and destroy alveolus as well as correlated with the disturbance of lung function. OBJECTIVE: The purpose of this study is to compare the occupational CO levels, HbCO, and lung functions between grill and non-grill street vendors. METHODS: This was an observational analytic study with a case-control design. The subjects were grill street vendors and non-grill street vendors in Medan city who fulfilled several inclusion criteria. The questionnaire was used to determine some characteristics, while smokerlyzer, and ELISA for expiration CO level and blood CO level, spirometer was used to determining lung function. Logistic regression was performed with p-value < 0.05 considered to be significant using SPSS ver 24.0. RESULTS: A total of 50 subjects enrolled into this study with the majority of subjects in the case group were in red (40%) zone in CO exhaled test with the results in pulmonary function test, predominantly restrictive (56%) and mixed-type (40%) with the mean value of HbCO was 486.16 (ng/mL). Meanwhile, the majority of subjects were green zone with mixed type of lung function disturbance in the control group with 540.15 (ng/mL) as HBCO mean value. Grilled street vendors have a higher level of exhaled CO level (p- value: 0.03) without significant difference in HbCO and lung functions (p-value > 0.05). Age, smoking status, HbCO, and lung function did not significantly affect the CO level (p-value: 0.05). CONCLUSION: There was a significant difference in exhaled CO level between grill-and non-grill street vendors without significant difference in HbCO and lung functions.

A rare primary posterior mediastinal angiolipoma: A case report.

Mediastinal angiolipoma is a rare benign neoplasm composed of mature adipose tissue with an abnormal vessel. Owing to its unspecific symptoms and slow progressions, the diagnosis of this disease is often delayed by clinicians. Here we present a 68-years-old-woman presented with mild chest pain radiates to the back with chronic dry cough. Chest imaging showed right medial posterior intrathoracic mass attached to 3rd-5th vertebrae body without bone destructions. Exploratory thoracotomy with segmentectomy was successfully performed. Histopathology examinations showed adipose tissue surrounded by a blood vessel nest, typical for angiolipoma. The patient showed rapid recovery and was discharged a week after the surgery. After two years of follow-up, the patient showed no sign of tumor recurrence and was clinically stable. This case is the first occurrence of non-infiltrating mediastinal angiolipoma reported in Southeast Asia.

The Absence of Mutations in the Exon 2 KRAS Gene in Several Ethnic Groups in North Sumatra May Not the Main Factor for Lung Cancer.

BACKGROUND: Rat Sarcoma (RAS) protein encoded Guanosine Triphosphate (GTP-ase) activity, known as a switch of cell proliferation. The mutation of this protein alters the early stage of carcinogenesis and along with the interaction with other oncogene drivers and environmental factors affect the clinical characteristics and prognosis in cancer patients, particularly lung cancer. OBJECTIVE: This study aims to determine the Kristen Rat Sarcoma (KRAS) mutation in lung cancer patients in North Sumatera and evaluate factors that might contribute in the development of lung cancer in the absence of KRAS mutation. METHODS: This was a retrospective cohort study enrolled 44 subjects age > 18 year with the diagnosis of lung cancer. Histopathology preparation was obtained from surgery, bronchoscopy, and percutaneus needle biopsy then formed as paraffin-block. KRAS mutation was analyzed using Polymerase Chain Reaction (PCR) method with specific primer of exon 2 for evaluating the expression of RAS protein then continued with Sanger Sequencing Method at 12th and 13th codon. RESULTS: The majority of subjects were male, age > 40 years old, bataknese, heavy smoker, with Adenocarcinoma. Almost all the subjects showed the expression of exon 2 of RAS protein in PCR examinations. However, Sequencing analysis using Bioedit Software, BLASTs and Finch T showed GGT GGC as protein base 219-224 which represented 12th and 13th Codon 12 and 13. The results interpreted there was no mutations of exon 2 of KRAS in North Sumatera Population. CONCLUSION: The absence of KRAS mutation in exon 2 in several ethnics in North Sumatera populations was not the main factors of lung cancer.

Tuberculosis of the knee: A pitfalls in clinical settings (A case report and literature review).

INTRODUCTION: Tuberculosis of the knee is a rare form of diseases associated with tuberculosis that is frequently misdiagnosed as malignancy or bacterial infections. Its symptomatology might be identical to other conditions; thus finally turns the clinician misdiagnosed of the patient circumstances. PRESENTATION OF THE CASE: A 31-year-old male patient presented a unilateral knee swelling, reddish, warmth, pain, with a limited range of movement and then diagnosed with tuberculosis of the knee, histopathologically confirmed following surgical removal, including synovectomy without arthroplasty procedure. Furthermore, the patients underwent the administration of an anti-tuberculous drug regiment for a 1-year period. There was clinical improvement attained afterward after the prompt management since the initiation of therapy progressively. DISCUSSION: This case is unique due to the unspecific clinical manifestations of the disease, which contributed to delay diagnosis. Further, either the patients and his parents still had a lack of knowledge according to his condition. Opposite to the recent studies, there was an excellent outcome after simple surgical procedure, including synovectomy without arthroplasty followed by 1 year of anti-tuberculous drug. CONCLUSION: Knee tuberculosis is a rare disease that often misdiagnosed as bacterial infections or malignancy. Mimicking clinical manifestations needs further surgical approach followed by histopathology examination to diagnose this disease. Early recognition and prompt treatment were crucially required to avoid the permanent limitation of movement that could affect the patient's quality of life. In this case, a lack of knowledge of the patient and his family significantly contributes to the delayed diagnosis.

Four-type of Masks and its Effectiveness Based on Reduced Level of Expiratory Carbon-monoxide.

INTRODUCTION: Carbon-monoxide (CO) is a major component of motor-vehicles related air pollution. Motor-vehicles emissions are a major source of air pollution in urban areas and give significant adverse effects on human life. AIM: This study aimed to assess the change of expiratory carbon-monoxide levels after using four-type of masks in people around Universitas Sumatera Utara. METHODS: This was an experimental study with a consecutive sampling technique involved 100 non-smoker subjects. They were divided into four groups based on masks given: fabric, surgical, carbon, and an N95 mask. Expiratory CO was measured by a smokerlyzer device. Data were analyzed using SPSS software with Wilcoxon and Kruskal Wallis Test. RESULTS: There was a significant change of carbon-monoxide mean level after using the mask for 8 hours in a surgical mask, N95 mask, and carbon mask (p-value: 0.002; 0.000; 0.000). After analyzed using Kruskal Wallis Test, there was a significant difference in the change of mean of pre and post wearing mask (ΔCO) among four-type of masks with p-value < 0.001. Post Hoc Analysis showed the significant difference was in the comparison between N95 mask vs Fabric Mask and Carbon Mask vs Fabric Mask (p-value: 0.002; 0.021). CONCLUSION: All three type of masks such as surgical mask, N95 mask, and carbon mask was effective to reduce CO levels from air pollution with the most significant was N95 and carbon mask. Fabric mask has the poorest protection from CO levels.

The Correlation between Levels of Transforming Growth Factor-ß with Pulmonary Fibrosis in Post Pulmonary Tuberculosis in Medan, North Sumatera - Indonesia.

BACKGROUND: Untreated or undertreated, pulmonary tuberculosis could cause severe complications until death. After treatment, residual lesions might occur. The presence of residual lesions is varied, including fibrosis, cavity, bronchiectasis and calcification. Transforming growth factor-ß (TGF-ß) is a cytokine associated with lung inflammation, which plays a role in lung fibrosis. However, only a few studies have assessed the serum level of TGF-ß in post-treatment tuberculosis patients. AIM: The main objective of this study was to determine the correlation between TGF-ß levels and pulmonary fibrosis in patients with pulmonary tuberculosis. DESIGN: A group of 51 patients that had undergone anti-tuberculosis treatment were observed, consisting of 31 men, 20 women. Of all patients, there were 26 people with a smoking history, including 25 men and 1 woman. All patients had been recovered, confirmed by the clinical state, laboratory and radiology examination. The ELISA test was performed to measure TGF-ß level, while the chest X-ray was used to look for the occurrence of pulmonary fibrosis. RESULTS: The mean level of TGF-ß in patients with a lesion (+) was 7628.02 (SD: ± 4928.38) while the mean level of TGF-ß in patients with a lesion (-) was 2315.11 (SD: ± 505.83). The statistical test showed a significant relationship between TGF-ß level and fibrosis lesion (p < 0.001). CONCLUSION: TGF-ß level was significantly higher in post-tuberculosis patients with pulmonary fibrosis.

The Impact of Upper Limb Training with Breathing Maneuver in Lung Function, Functional Capacity, Dyspnea Scale, and Quality of Life in Patient with Stable Chronic Obstructive of Lung Disease.

BACKGROUND: Exercise tolerance is one of the main impacts of COPD. COPD patients often experience dyspnea and fatigue after doing daily activities using their limb parts, even in simple thing such as lifting or grooming. Nowadays, many pulmonologists concerned in pulmonary rehabilitation to modify some limb training with breathing manoeuvre to get positive impact in stable COPD patient. AIM: The purpose of this study is to examine the impact of this modified upper limb training in lung function, functional capacity, dyspnea scale, and quality of life in patients with stable COPD. METHOD: This was a quasi-experimental study held in 2017 on 22 stable COPD patients (based on GOLD 2018 criteria). Patients were given modified upper limb training with breathing manoeuvre that leads and monitored by a physiotherapist and physician in 10-20 minutes twice a week for 8 weeks. Before and after completed all sessions of training, we measured pulmonary functions test include FEV1 and FVC, functional capacity by 6 MWT, dyspnea scale by mMRC, and quality of life by CAT assessment. Statistical analysis was performed by Wilcoxon and paired t-test. RESULTS: There was an improvement of lung function, both FEV1 (40.7 ± 13.8 to 47.3 ± 14.2; p-value 0.001) and FVC (50.7 ± 14.1 to 54.1 ± 14.7; p-value: 0.207) after training. There was a significant change of functional capacity in 6 MWT mean (277.3 ± 80.8 to 319.1 ± 78.3; p-value: 0.001). There was an improved quality of life after training, measured by decreasing in CAT score (23.9 ± 5.5 to 18.3 ± 5.2; p-value: 0.000). There was no significant change in the mMRC scale (p-value: 0.429). CONCLUSION: There was an improvement of lung function, functional capacity, and quality of life in stable COPD after upper limb training with breathing manoeuvre in stable COPD patients.