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"Kanker paru memiliki mortalitas tinggi dan sering terdiagnosis pada stage lanjut. Kelainan morfologis sel trakeobronkial dan biomolekuler mendahului proses karsinogenesis. Bronkoskopi gelombang cahaya spektrum sempit (GCSS) dikembangkan untuk meningkatkan akurasi diagnostik. Tujuan penelitian ini adalah untuk mengetahui akurasi diagnostik bronkoskopi GCSS dalam mendeteksi kelainan morfologis sel trakeobronkial dan hubungannya dengan mutasi gen p53.Studi ini merupakan studi diagnostik eksperimental yang dilakukan pada subjek kanker paru yang menjalani prosedur bronkoskopi di RS Persahabatan periode Januari-November 2023. Prosedur bronkoskopi GCSS dan biopsi forseps bronkus dilakukan di lesi non-tumor, dilanjutkan dengan pemeriksaan histopatologi hematoksilin dan eosin (HE), serta pemeriksaan Polymerase Chain Reaction (PCR) sekuensing sanger mutasi p53 pada titik R175L, R248W, dan R273C. Analisis kesesuaian juga dilakukan.Sebanyak 105 subjek diikutsertakan dalam analisis penelitian, dengan dominasi laki-laki, perokok, jenis kanker adenokarsinoma dan stage lanjut. Kelainan morfologis sel trakeobronkial ditemukan pada 34 subjek (32,4%) berupa metaplasi, sel atipik dan sel tumor. Mutasi p53 wild type pada titik R175L, R248W, dan R273C ditemukan pada seluruh jaringan biopsi. Satu jaringan metaplasi dengan mutasi p53 Kodon 267 heterozigot CT dan satu jaringan hiperplasi dengan mutasi p53 Kodon 180 heterozigot GC. Pola vaskular berliku didapatkan sebagai kriteria diagnostik paling baik dibandingkan dengan pola vaskular lainnya dengan area under the curve (AUC) 78,4%; sensitivitas 79,41%; spesifisitas 77,46%; nilai prediktif positif 62,8% dan nilai prediktif negatif 88,7%. Kesesuaian antar pengamat dalam menilai pola vaskular GCSS cukup baik dengan nilai kappa 0,88 (standar eror 0,06; nilai p <0,01). Mukosa edematosa berhubungan dengan pola vaskular berliku pada bronkoskopi GCSS dengan OR 3,6 (IK95% 1,53-8,46; nilai p <0,01). Subjek dengan pola vaskular berliku [OR 21,89 (IK95% 6,50-73,71; nilai p<0,01)] dan subjek dengan IB ³ 600 [OR 5,39 (IK95% 1,62-17,71; nilai p 0,01)] berhubungan dengan kelainan morfologis sel trakeobronkial.

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Lung cancer has high mortality and is often diagnosed at an advanced stage. Additionally, morphological abnormalities of tracheobronchial cells precede the carcinogenesis process and are based on molecular abnormalities. Moreover, Narrow-Band Imaging Bronchoscopy (NBI) has been developed to improve diagnostic accuracy. The objective of this study is to determine the diagnostic accuracy of NBI bronchoscopy in detecting morphological abnormalities of tracheobronchial cells and their relationship with p53 gene mutations.

This study is an experimental diagnostic study conducted on lung cancer subjects undergoing bronchoscopy procedures at RS Persahabatan from January to November 2023. NBI bronchoscopy procedures and bronchial forceps biopsies were performed on non-tumor lesions, followed by haematoxylin and eosin (HE) histopathological examination, as well as Polymerase Chain Reaction (PCR) Sanger sequencing for p53 mutations at the R175L, R248W, and R273C points. Reliability analysis was also performed.

A total of 105 subjects were included in the study analysis, predominantly male, smokers, with adenocarcinoma type cancer and advanced stage. Tracheobronchial cell morphological abnormalities were found in 34 subjects (32.4%), in the form of metaplasia, atypical cells, and tumor cells. Wild type p53 mutations at the R175L, R248W, and R273C points were found in all biopsy tissues. One metaplastic tissue had a p53 Codon 267 CT heterozygous mutation and one hyperplastic tissue had a p53 Codon 180 GC heterozygous mutation. The tortuous vascular pattern was identified as the best diagnostic criteria compared to other patterns with an area under the curve (AUC) of 78.4%; sensitivity 79.41%; specificity 77.46%; positive predictive value 62.8% and negative predictive value 88.7%. Inter-observer agreement in assessing vascular patterns was good with a kappa value of 0.88 (standard error 0.06; p-value <0.01). Edematous mucosa was associated with a tortuous vascular pattern on NBI bronchoscopy with an OR of 3.6 (95% CI 1.53-8.46; p-value <0.01). Subjects with a tortuous vascular pattern (OR of 21.89; 95% CI 6.50-73.71; p-value <0.01) and subjects with IB ≥ 600 (OR of 5.39; 95% CI 1.62-17.71; p-value 0.01) were associated with tracheobronchial cell morphological abnormalities."

"Latar Belakang: Penegakkan diagnosis sedini dan setepat mungkin menjadi hal utama dalam penatalaksanaan kanker paru. Beberapa penelitian sebelumnya tentang biopsi transtorakal dengan panduan USG menunjukkan akurasi diagnosis yang cukup baik. USG dinilai sebagai modalitas radiologi yang mudah digunakan secara aman, bedside, real-time, mobile dan bebas pajanan radiasi. Saat ini di RSUP Persahabatan Jakarta belum terdapat penelitian tentang biopsi jarum halus transtorakal dengan panduan USG.Metode Penelitian:  Studi observasional dengan pendekatan potong lintang terhadap subjek dengan tumor paru atau tumor mediastinum yang dilakukan biopsi jarum halus transtorakal dengan panduan ultrasononografi toraks pada bulan April-September 2021. Pengambilan sampel dilakukan secara consecutive sampling. Peneliti melakukan observasi terhadap karakteristik lesi, karakteristik prosedur dan komplikasi. Diagnosis akhir berdasarkan hasil sitologi biopsi jarum halus transtorakal dengan panduan USG.Hasil Penelitian: Dari 46 subjek, rerata usia subjek adalah 52 tahun dan didominasi jenis kelamin laki-laki (69,6%) dan jenis tumor terbanyak adalah tumor paru (80,4%). Proporsi kepositifan sitologi biopsi jarum halus transtorakal dengan panduan USG toraks adalah 78,3%. Karakteristik lesi pada subjek dengan hasil sitologi TTNA positif antara lain memiliki rerata diameter lesi 9,61 ± 2,27 cm, lesi di anterosuperior paru (63,9%), memiliki gambaran ekogenitas hipoekoik heterogen (58,3%) dan memiliki kontak dengan pleura (77,8%). Karakteristik prosedur pada subjek dengan hasil sitologi TTNA positif antara lain dilakukan teknik aspirasi (77,8%), pengambilan TTNA sebanyak < 3 set (58,3%), rerata jumlah gelas objek yang terpakai adalah 15 ± 4 dan median kedalaman insersi adalah 4 (2 – 6) cm. Komplikasi pasca tindakan terjadi pada dua subjek yaitu hemoptisis (4%).Kesimpulan: Biopsi jarum halus transtorakal merupakan metode diagnostik yang invasif minimal dengan proporsi kepositifan yang tinggi (78,3%) dan angka komplikasi yang rendah (4%).

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Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) using second-line drugs is known to have more side effects. Recent studies have shown concern about bedaquiline and delamanid that can cause a prolonged QT interval. This condition is a known risk factor for Torsades de Pointes, a lethal cardiac arrhythmia. This study sought to observe the condition among such patients treated in the study location.

Methods: This study was a prospective cohort study  of MDR-TB patients receiving bedaquilin in the outpatient clinic and inpatient ward of National Respiratory Referral Hospital Persahabatan, Jakarta, Indonesia between February 2020 to February 2021. Patients received 400 mg on week 0-2 (intensive phase) and followed by 200 mg 3 times per week (continuation phase) of bedaquiline. Sampling was carried out by consecutive sampling and data on subjects who met the inclusion criteria were taken from medical records.

Result: From a total of 71 subjects, all of them met the inclusion criteria. Prolonged QT interval was experienced in 18.3% patients. From eleven patients who experienced prolonged QT interval, two patients required hospitalization: one presented with nausea and gastric upset and one patient presented with dyspnea and palpitation. Prolonged QT interval occurred in initial phase and correlated with drug dosing. A mycobacterial culture conversion at month-6 was observed in those receiving multidrug regimens which include bedaquiline, quinolone, and clofazimine. There was a correlation between prolonged QT interval and hypocalemia. Treatment success rate was 46.5% without prolonged QT. Other outcomes included 4.2% died, 26.8% loss-to-follow up, and 4.1% treatment failed.

Conclusion: The use of bedaquiline MDR-TB appeared to be effective and safe across different settings, although the certainty of evidence was assessed as very low. Hypokalemia was correlated with the outcomes of patients receiving bedaquiline, particularly in those experienced prolonged QT interval."

"Penelitian ini menerapkan dan menganalisa teknik pengolahan citra untuk deteksi kanker paru-paru. Teknik pengolahan citra banyak digunakan di beberapa masalah medis untuk perbaikan citra dalam deteksi fase dan pengobatan dini. Penelitian ini mengusulkan metode deteksi kanker paru-paru berbasis segmentasi citra. Segmentasi citra adalah salah satu pengolahan tingkat menengah dalam pengolahan citra. Pendekatan wilayah dan watershed digunakan untuk proses segmentasi citra CT scan. Fase deteksi yaitu peningkatan kualitas citra menggunakan filter Gabor, segmentasi citra, dan ekstraksi fitur dengan binerisasi. Dari hasil percobaan, ditemukan efektivitas dari pendekatan tersebut. Fitur utama untuk mendeteksi kanker adalah dengan menggunakan perbandingan yang dilakukan dengan persentase piksel dan penanda citra.

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In this undergraduate thesis, we implement and analyze the image processing method for detection of lung cancer. Image processing techniques are widely used in several medical problems for repairs picture in the phase detection and early treatment. This research proposed a detection method of lung cancer using image segmentation. Image segmentation is one of intermediate level processing in image processing. Marker control and watershed approach are used to segment of CT scan image. Detection phases are followed by image enhancement using Gabor filter, image segmentation, and features extraction with binarization. From the experimental results, we found the effectiveness of our approach. The main detected features for accurate images comparison are mask labeling with high accuracy and robust."