Characteristics of Vascular Access Cannulation Complications in End Stage Kidney Disease Patients in West Java from 2018 to 2022: A Retrospective Observational Study.

Background: End-stage kidney disease (ESKD) is associated with a tremendous financial burden. Data in Indonesia shows an increasing number of patients with ESKD taking hemodialysis as a routine procedure every year. Establishment and maintenance of vascular access are important in the management of ESKD. Vascular complications that often arise due to hemodialysis are common and one of the main reasons for hospitalization. Cannulation complications ranged from minor hematomas to acute bleeding from pseudoaneurysms that required emergency surgical procedures. This study aims to assess the different clinicopathological characteristics of ESKD patients with vascular access cannulation complications and the surgical management related to the complications. Materials and Methods: This research is a retrospective observational study. The research subjects in this study were ESKD patients in the vascular and endovascular surgery division of the tertiary hospital in West Java, Indonesia. There were 121 study subjects. Clinicopathological characteristics of vascular cannulation complications and surgical management are extracted from the medical record. Results: Three major vascular complications were ruptured pseudoaneurysms 64/121 (52.9%), impending rupture pseudoaneurysms 28/121 (23.1%), and pseudoaneurysms 21/121 (17.4%). Common surgical procedures were ligation of the draining vein 47/121 (38.8%), arterial primary repair 28/121 (23.1%), and arterial patch repair 18/121 (14.9%). There was a significant relationship between symptoms of bleeding in ruptured pseudoaneurysms and bulging masses in pseudoaneurysms (p = 0.001). There was a significant relationship between the diameter of the vascular mass, vascular defect size, and hematoma and the type of surgical procedure taken (p < 0.010). Conclusion: Ruptured, impending rupture, and pseudoaneurysms are major complications of vascular access in ESKD patients, and there was a significant relationship between the carried-out surgical procedure and the size of the vascular mass, defect, and hematoma.

Accuracy Rate of Methylene Blue Injection in Sentinel Lymph Node Biopsy in Early-Stage Breast Cancer Patients: A Prospective Observational Study.

Objective: Breast cancer is the most prevalent cancer in women and can spread to the lymph nodes in the axilla. The sentinel lymph node is the first lymph node to be targeted for the spread or metastasis of cancer cells involving the lymph nodes. The aim of this study is to compare the accuracy rate of methylene blue injection into sentinel lymph nodes in early-stage breast cancer patients who have undergone incisional and excisional biopsies. Methods: This is a prospective observational study conducted in two general hospitals in West Java, Indonesia. The research subjects in this study were early-stage breast cancer patients with no lymph node metastasis (N0) who had undergone a biopsy. There were 83 study subjects included in this study. The sentinel lymph node biopsy was taken after injection of methylene blue into the peritumoral area. Blue nodes in the axilla were marked as positive lymph node biopsy results and sent for histopathology examination. Results: Patients who underwent excisional biopsy surgery had a sensitivity rate of 85.3% and a specificity of 93.3%, while the accuracy rate in patients who underwent incisional biopsy surgery had a sensitivity rate of 79.2% and a specificity of 80%. Conclusion: There was no difference in the accuracy of SLNB using methylene blue in patients with early-stage breast cancer with N0 who had a history of incisional and excisional biopsy.

Relationship between age and the histopathological features to chemotherapy response in colorectal cancer patients: a prospective observational study

Introduction: Chemotherapy response in early age-onset colorectal cancer patients is still controversial, and the results of chemotherapy response are unknown. Therefore, the purpose of this study is to determine the relationship between the age of colorectal cancer patients and histopathological features and chemotherapy response. Methods: This is a prospective observational study. The subjects in this study were colorectal cancer patients in the Digestive Surgery division at Tertiary Hospital in West Java from September 2021 to September 2022. Results: There were 86 subjects who underwent chemotherapy in accordance with the inclusion and exclusion criteria. Consisting of 39 patients of early age onset and 44 female patients. The most common histopathological feature in early age onset (EAO) and late age onset (LAO) was adenocarcinoma (25% and 46%, respectively). Stage III colorectal cancer affected 38 patients, while stage IV affected 48 patients. There was a significant relationship between early age onset and late age onset with histological features (p < 0.001). The patients with the highest chemotherapy response had stable diseases in EAO (17 patients) and LAO (20 patients). There was no statistically significant relationship between age, histological features, and stage of colorectal cancer and chemotherapy response (p > 0.05). The results of the ordinal logistic regression test showed no systematic relationship between chemotherapy response and age, histopathological features, gender, or cancer stage (p > 0.05). Conclusion: There was no association between age and histopathologic features with chemotherapy response and there is no difference in chemotherapy response between early and late age onset. (AU)

The predictive value of infrared thermal imaging (IRT) for peripheral artery disease: A systematic review.

BACKGROUND: Medical infrared thermal imaging (IRT) has been applied to research blood flow, breast cancer detection, and human body muscle performance. The benefits of IRT include the fact that it is noninvasive, quick, dependable, non-contact, capable of creating several recordings in a short period of time, and secure for both patients and medical professionals. We aimed to determine the predictive value of IRT for identifying and evaluating any interventional procedure in patients affected by peripheral artery disease (PAD) of any severity. METHODS: We searched the Cochrane Library, EMBASE, and PubMed on the topic of IRT and PAD until January 20,2023. We excluded gray literature as it is lacking credibility for not undergoing a peer-reviewed process. The search strategy includes the medical topic headings for "infrared thermal imaging" and "peripheral vascular disorders." The primary outcome of this systematic review was the variation in tissue perfusion in PAD patients. Each technique's technical characteristics and therapeutic use within PAD must be described in each included study. RESULTS: This systematic review included 2 case reports and 3 observational studies. By comparing the temperatures of PAD patients hands, legs, and feet, IRT might prove to be an unduly valuable tool for treating vascular illnesses, especially in light of the knowledge gained from the temperature distribution maps. CONCLUSION: This noninvasive method demonstrated encouraging results in the detection of various areas of foot perfusion and the screening of PAD, and it gave good findings in gauging the effects of any type of intervention.

The prognostic value of COX-2 in predicting metastasis of patients with colorectal cancer: A systematic review and meta analysis.

Introduction: COX-2 is overexpressed in colorectal tumour tissue relative to the healthy colonic mucosa, thus we investigated the prognostic significance of COX-2 in determining the metastasis of patients with colorectal cancer. Methods: PubMed, EMBASE, and Cochrane Library were searched using the following terms colorectal cancer, colon cancer, rectal cancer, colorectal carcinoma, Cyclooxygenase-2, and prognosis to identify articles providing information on the prognostic importance of COX-2 in adult patients with metastatic colorectal cancer. Review papers, non-research letters, comments, case reports, animal studies, original research with sample sizes of fewer than 20, case reports and series, non-English language articles, and pediatric studies (those under the age of 17) were excluded. The Newcastle Ottawa Scale (NOS) was used to assess the credibility of the included studies. The full texts were evaluated and this study complied with the terms of the local protocol and the Helsinki Declaration. Results: Eight relevant studies were included in this review involving 937 patients. The meta-analysis revealed that COX-2 expression is associated with lymph node invasion (RR 1.85 [1.21, 2.83], P = 0.005, I2 = 88 %) and liver metastasis (RR 4.90 [1.12, 21.57], P = 0.04, I2 = 42 %), but not with venous dissemination (RR 1.48 [0.72, 3.03], P = 0.28, I2 = 87 %). Conclusion: COX-2 expression is associated with lymph node invasion in colorectal cancer but further studies are required to determine the prognostic significance of COX-2 expression in determining metastasis status for colorectal cancer patients.

Establishment of hospital-based surgical residency programs as a health policy for surgical needs provision: an Indonesian perspective.

Objective: One of the health interventions that can be implemented cost-effectively in developing countries is the provision of basic surgical procedures. One way to increase access to surgical services is to increase the production of surgeons, in this case through increasing the surgical residency program. There are similarities between university-based surgical residency programs and hospital-based surgical residency programs. However, in Indonesia, the differences between them are stark; the establishment of hospital-based surgical residency programs is challenging and requires collaboration between the government, university, college of surgery, and private sector. Design: The author reviewed the literature on post-graduate medical education for surgical programs and the contrast between university-based and hospital-based surgical residency programs. Setting: Information collected from the Indonesian Health Education Independent Accreditation Institution and varied literature was included. Participants: Not applicable. Result: In Indonesia, the implementation of an academic surgery environment in the hospital-based surgical residency program is challenging, and the implementation of the academic health system can increase student intake and provide more both from the university and the hospital-based surgical residency program.

Candlenut oil-induced sclerosing lipogranuloma of the penis: A case report.

INTRODUCTION AND IMPORTANCE: Penile sclerosis lipogranuloma, a disease that occurs as a result of the body's reaction to lipid-based foreign substances, is a rare case with manifestations that can occur years after injection. Reactions that emerge can be disturbing to the point of causing functional impairment, so proper therapy needs to be done to restore and maintain penis function and prevent complications. Here, we present a case of penile sclerosis lipogranuloma that was treated surgically with a scrotal flap and VY plasty, including circumcision. CASE PRESENTATION: We report here the case of a 19-year-old Asian male who came in with multiple, irregular, nodular masses in his penis after a candlenut oil injection that had been performed a year before presentation. An extensive excision and extraction of the penile lipogranuloma, including all areas invaded by oil injection, were performed. Then a scrotal flap and VY plasty were used to reconstruct the exposed penile shaft. The operative procedure was successful, and the patient experienced positive functional and aesthetic outcomes. CLINICAL DISCUSSION: Determining therapy for penile sclerosis granuloma becomes important to improve or restore normal penile function and for performance function. Therapy includes the complete removal of the substance and the affected part. The recommended reconstruction for the penile shaft is a scrotal flap with penile scrotal invagination and VY plasty. CONCLUSION: Proper treatment of the penis and its surroundings in cases of penile lipogranuloma is important to prevent further complications and maintain penile function.

The analysis between clinicopathological aspect of early-onset vs. late-onset colorectal cancer and mortality rate: a cross-sectional study.

Early-onset colorectal cancer (CRC) has different clinical and pathological characteristics compared with late-onset CRC. Mortality rate as a postoperative outcome is a patient's postoperative outcome considered based on the state of life or death. The objective of this research is to analyse the comparison between clinicopathological aspect of early-onset vs. late-onset CRC as well as their correlation with the mortality rate in Indonesia to support global data. Material and methods: The authors performed a case-control study on 170 subjects with CRC from November 2021 to November 2022 in a Tertiary Hospital in Bandung. Data were extracted from electronic medical records CRC Registry. Bivariate and correlation analyses were used to analyse the difference between variables using IBM SPSS 24.0. P less than 0.05 was considered statistically significant. Results: Anaemia and tumour location variables were significantly different in the early-onset group compared with the late-onset group (P<0.001). It was also found that anaemia (P<0.001), pathological features (P<0.001), and tumour location (P=0.013) had significantly low correlation with onset of CRC (r=0.325; r=0.397; r=0.342, respectively). Conclusion: There is no statistically significant correlation between the clinicopathological features of CRC in both onset and mortality rates in this study.

Identification of KRAS mutation and HER2 expression in Indonesian colorectal cancer population: a cross-sectional study.

In Indonesia, colorectal cancer is the third most common type. In 2008, Indonesia ranked fourth in the Association of Southeast Asian Nations (ASEAN) countries, with an incidence rate of 17.2 per 100 000 population. This figure is predicted to continue to increase from year to year. In 30% of colorectal cancer patients diagnosed after metastases, some patients will develop metastases after undergoing surgical resection of the primary tumor. The survival of metastatic colorectal cancer patients has improved significantly in the last 20 years with the introduction of target-oriented drugs, anti-epidermal growth factor receptor (EGFR), and anti-human epidermal growth factor receptor-2 (HER2). This study aims to assess the relationship between Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation and HER2 expression for targeted therapy implementation. Patients and methods: This research is a cross-sectional study. The research subjects in this study were colorectal cancer patients in the digestive surgery division. There were 58 study subjects. Examination of KRAS mutations was carried out by PCR on fresh tumor tissue obtained from surgery or colonoscopy. Meanwhile, the HER2 examination used the immunohistochemistry method of paraffin blocks for anatomical pathology examination. Results: Examination of KRAS mutations showed 28/58 (43.8%) patients with colorectal cancer, while HER2 overexpression was found in 6/58 (10.3%) patients with colorectal cancer. Univariate analysis of KRAS mutations and HER2 expression showed that four subjects with KRAS mutations had excess HER2 expression (P=0.341). Conclusion: There is no association between KRAS mutations and HER2 overexpression in colorectal cancer patients.

Sigmoid mesocolon internal hernia: a case report.

Primary internal hernias are rare in adults. Internal hernias present clinically as a sign of small intestinal obstruction. If left untreated, internal hernias might lead to high morbidity and mortality due to strangulation. Internal hernias are usually diagnosed intraoperatively. Here, we present an internal hernia diagnosed with an abdominal computed tomography (CT) scan. The importance of preoperative diagnosis for internal hernias leads to early surgery and keeps the patient from suffering intestinal strangulation. Case presentation: We report here the case of a 67-year-old male who presented with acute intestinal obstruction and underwent an abdominal CT scan. The patient was diagnosed with an internal hernia from the imaging of the abdominal CT scan and scheduled for an exploratory laparotomy. An internal hernia was found in the mesocolon of the sigmoid colon; one loop of jejunum was trapped in the hernia defect. After reduction, the hernial defect was closed; no resections were done, and the patient was discharged after 5 days without complication. Clinical discussion: Our finding represents a transmesosigmoid hernia, a rare variant of sigmoid mesocolon hernias. The clinical sign and the judgment of the surgeon for the diagnosis of an internal hernia became important factors related to the patient's outcome. Conclusion: The proper adjunct imaging, correct diagnosis, and timing of surgery for internal hernias save the patient from morbidity or intestinal death.

Different Clinicopathological Characteristics in Indonesian Colorectal Patients with NRAS Mutations and HER2 Over-Expression.

OBJECTIVE: This study aims to assess the association of subject characteristics and NRAS mutations with HER2 expression in CRC. METHODS: This research is a cross-sectional study. The research subjects in this study were colorectal cancer patients in the Digestive Surgery division at Dr. Hasan Sadikin Hospital. There were 58 study subjects. Examination of NRAS mutations was carried out by Polymerase Chain Reaction (PCR) from fresh tumour tissue obtained from surgery or colonoscopy. Meanwhile, HER2 examination used the Immunohistochemistry (IHC) method of paraffin blocks for anatomical pathology examination of the same patients. RESULT: HER2 overexpression was found in 6/58 (10.3%) patients with CRC, and from 8 subjects with NRAS mutations, only 1 subject (1.7%) showed overexpression of HER2. Univariate analysis of HER2 expression showed no significant associations to age, sex, histologic feature, tumor location, and NRAS mutations. A significant association was found between HER2 expression and stage of the CRC with p=0.001. CONCLUSION: There is no association between NRAS mutations and HER2 overexpression in colorectal cancer patients.

Giant splenic cyst: A case series of rare and challenging cases from the last 22 years.

INTRODUCTION AND IMPORTANCE: Splenic cyst is a rare disease, with reported incidences ranging from 0.07 to 0.3 %. A splenic cyst is typically discovered inadvertently and may not cause any symptoms until it grows to a significant size. In some cases, complications such as acute abdomen may be brought on by an intracystic hemorrhage, rupture, or infection. As a rare disease, diagnosing a splenic cyst is still precarious because only a few cases have been reported. CASE PRESENTATION: The first case is a 23-year-old Asian man without a significant history of illness who complains of a left upper quadrant mass that he discovered 10 years prior. Since then, the mass had been gradually growing and had been accompanied by severe pain. Walking made the pain worse; lying down made it lessen. A computed tomography (CT) scan of the abdomen showed a 20.05 × 15.95 × 26.71 cm splenic cyst. Surgery for a peri-cystic splenectomy was done. A primary splenic cyst was identified in the specimen after microscopic and macroscopic examination. After 10 days, the patient was released from the hospital without complications. The second case is that of a 28-year-old Asian man who complained of a mass in their abdomen that was getting bigger in size. Four years prior to the complaint, the patient had fallen while driving a motorcycle, and the left side of his abdomen collided with the sidewalk. In this patient, a splenectomy-the complete removal of all spleen parts-was done. The specimen's macroscopic and microscopic examination revealed a splenic pseudocyst. The patient was discharged after three days without complications. CLINICAL DISCUSSION: Splenic cysts are considered rare and challenging to diagnose, as there have been only a limited number of reports. Nevertheless, proper management is still needed, as it carries the risk of rupturing and causing complications such as peritonitis and anaphylactic reactions. Considering the risk of overwhelming post-splenectomy infection (OPSI), conservative treatment can be the gold standard for splenic cysts. However, considering the risk from the size of the cyst, splenectomy or peri-cystic splenectomy is an appropriate surgery option for a splenic cyst. CONCLUSION: Splenectomy, or peri-cystic splenectomy, is a surgery option for a splenic cyst with significant size and rupture risk.

The effectiveness of ginger extract addition in calorified drinks during perioperative period to nausea severity, vomitus, post-operative anxiety, and metabolic disorder: A randomized control trial.

Background: This study was aimed to evaluate the effect of ginger extract addition to pre-operative high calorie drink to reduce nausea, vomiting, anxiety level, and lactate level as a parameter for metabolic derangement in patients undergoing surgery. Materials and methods: A prospective single-blinded randomized controlled trial design, with a study subject elective surgical procedures patient at the Department of Surgery, Dr Hasan Sadikin Hospital, Bandung. Patient were divided into two groups, group A with standard high calorie drink, and group B standard high calorie drink with ginger extract addition. Anxiety was measured by HARS score and the occurrence of nausea and vomiting were assessed after the operation. The difference of lactate levels was compared before and after operation in two groups. The data distribution was calculated by kolmogorov-smirnov for continues variables. Normal distribution was calculated by t-test, non-normal distribution was calculated by Mann-U Whitney. Nominal data calculated by chi-square test and ordinal data calculated by Mann-U Whitney. Results: 40 subjects were randomly divided into two groups. The occurrence of nausea and vomiting were lower in group B patients (p < 0.0285). HARS score anxiety level was lowered in group B patients (p < 0.0293). Lactate level was lowered in group B patients, although is not statistically significant (p 0.54). Conclusion: Addition of ginger extract in pre-operative high calorie drink reduce postoperative nausea, vomiting, and anxiety level.

Translation and Validation of the Indonesian Version of the Adverse Drug Reaction Severity Level Instruments in Colorectal Cancer Patients.

Introduction: Assessment of the severity of adverse drug reaction (ADR) is very rare in Indonesia. The severity of ADR can describe how serious this affects the clinical condition of the patient. In Indonesia, there are no instruments used to measure the severity of ADR. Purpose: This study aims to translate, pilot test, and validate Hartwig instruments for measuring the severity of ADR in colorectal cancer patients in Indonesia. Patients and Methods: The translation method was used forward-backward technique from English to Indonesian, then being retranslated from Indonesia to English. The instrument of Indonesian version was used to assess the severity of ADR as the effect of chemotherapy. The assessment was conducted to 10 colorectal cancer patients by 30 health workers. The test validity was done based on content validity ratio (CVR) and content validity index (CVI); meanwhile, the test reliability was based on intraclass coefficient correlation (ICC). Results: All of the results of CVR present a value of >0.33, while the range of CVI moves between 0.8 to 1.0, which declares that the instrument is valid. The satisfactory alpha value for reliability is 0.996 with signification of 0.197 (p > 0.05) based on ANOVA analysis. Meanwhile, the ICC value of 0.896 indicates a good reliability among raters. Conclusion: Indonesian version of Hartwig Instrument can be applied in measuring the severity of ADR caused by chemotherapy in colorectal cancer patients.

Methylene blue sentinel lymph node biopsy for breast cancer learning curve in the COVID-19 era: How many cases are enough?

Background: Sentinel lymph node biopsy (SLNB) is now the gold standard for early breast cancer with clinically negative lymph nodes (N0). According to the Indonesian Board-Certified oncologist surgeon, the learning curve for evaluating fellow breast surgeons to achieve this competency could have been shorter due to the COVID-19 pandemic. This study aims to see if the learning curve for sentinel lymph node (SLN) identification can be shortened. Methods: Trainee breast surgeons were taught to perform SLNB on breast cancer patients. Intraoperative assessment and completion of axillary lymph node dissection (ALND) were performed in the first setting for standardization with the attending surgeon. Sentinel lymph node identification was plotted on cumulative sum chart (CUSUM) limitations for evaluating the variability competency between the attending and trainee surgeons based on a target identification rate of 85%. Results: We concluded that CUSUM charts are the best tools currently available for assessing psychomotor learning SLNB. According to a CUSUM chart based on a reasonable set of parameters, the learning curve for SLNB using methylene blue dye is reached after 4-5  consecutive positively detected SLN. Conclusion: CUSUM Chart showed that experienced breast surgeons have completed the SLNB learning curve after 4-5 successful methylene blue attempts. In the future, this learning curve analysis can be applied to trainee breast surgeons by utilizing a proxy measure for failure, such as failure to identify the SLN.

MSC-released TGF-ß regulate α-SMA expression of myofibroblast during wound healing.

Objective: Wound healing without fibrosis remains a clinical challenge and a new strategy to promote the optimal wound healing is needed. Mesenchymal stem cells (MSCs) can completely regenerate tissue injury due to the robust MSCs ability in controlling inflammation niche leading to granulation tissue formation, particularly through a release of various growth factors including transforming growth factor-ß (TGF-ß). In response to TGF-ß stimulation, fibroblasts differentiate into myofibroblast, marked by alpha-smooth muscle actin (α-SMA) that leads to wound healing acceleration. On the other hand, sustained activation of TGF-ß in wound areas may contribute to fibrosis-associated scar formation. The aim of this study was to evaluate the α-SMA expression of myofibroblast induced by MSC-released TGF-ß during wound healing process. Materials and Methods: Twenty-four full-thickness excisional rat wound models were randomly divided into four groups: sham (Sh), Control (C), and MSCs treatment groups; topically treated by the MSCs at doses 2x106 cells (T1) and 1x106 cells (T2), respectively. While the control group was treated with NaCl. TGF-ß level was determined using ELISA assay, α-SMA expression of myofibroblast was analyzed by immunofluorescence staining, and wound size measurement was calculated using a standard caliper. Results: This study showed a significant increase in TGF-ß levels in all treatment groups on days 3 and 6. This finding was consistent with a significant increase of α-SMA expression of myofibroblast at day 6 and wound closure percentage, indicating that MSCs might promote an increase of wound closure. Conclusion: MSCs regulated the release of TGF-ß to induce α-SMA expression of myofibroblast for accelerating an optimal wound healing.

Predictors of Complementary and Alternative Medicine Use by Breast Cancer Patients in Bandung, Indonesia.

BACKGROUND: The study aimed to assess complementary and alternative medicine (CAM) use and their associated factors with breast cancer patients in Bandung, Indonesia. MATERIALS AND METHODS: In total, 330 breast cancer patients were administered questionnaires on their CAM use and CAM predictive factors including socio-demographic parameters, clinical data and quality of life, trust in physicians, trust in hospitals, satisfaction and informational needs. Data were analyzed using univariate analysis and multivariate log regreesion analysis. RESULTS: Overall 33.3% of patients reported use of CAM. Lower income, lower education, presence of metastasis, prolonged diagnosis, less trust in physician were found to be highly associated with CAM use. CONCLUSIONS: CAM use by breast cancer patients can be interpreted as an attempt to explore all possible options, an expression of an active coping style, or expression of unmet needs in the cancer care continuum. Physicians need to openly discuss the use of CAM with their patients and identify whether they have other unmet supportive needs.