Paraneoplastic Arthritis in a Patient with Non-Hodgkin’s Lymphoma

Paraneoplastic syndromes are a group of disorders associated with benign or malignant tumors but not related to mass effect or invasion directly. Paraneoplastic syndromes may affect any organic system of the human body, such as endocrine, neurologic, dermatologic, hematologic, rheumatologic. Paraneoplastic rheumatic syndromes are not quite common, about 7-10% of paraneoplastic syndromes, and may mimic rheumatic diseases. We present an interesting case of paraneoplastic arthritis in a woman with non-Hodgkin’s lymphoma

Chromobacterium violaceum: The Deadly Sepsis

Chromobacterium violaceum is a Gram-negative facultatively anaerobic, oxidase-positive bacterium producing a dark violet antioxidant pigment called violacein. It is an opportunistic pathogen and has an ubiquitous distribution, mainly resides in water and soil of tropical and subtropical regions.An-18-year-old man referred to the emergency room with a 5-day history of progressively worsening swelling of the right cheek. He sought consult and hospitalized at another institution for three days prior this admission; however, his condition deteriorated. He had a history of having abscesses several time. Four month before this visit, he was also admitted in our hospital due to an abscess in the right thigh. Pus and blood culture were positive for Staphylococcus haemolyticus, with a total serum IgE of 2493.0 IU/ml. He recovered completely after being treated with vancomycin in this event. He had neither diabetes mellitus nor human immunodeficiency virus infection history. In this presentation, he was in a critically ill state with septic shock. Physical examination revealed diffuse, indurated, partly fluctuant, and some deep purple area of right hemifacial swelling. It was extended anteriorly from angle of mouth to retroauricular, superiorly from superior palpebra to lower border of mandible. Laboratory studies were notable for a white-cell count of 12,970/mm3 (total lymphocyte count 778.2), platelet count 96,000/mm3. The patient got norepinephrine drip and broad-spectrum antibiotic intravenously. He also underwent superficial drainage of the abscess. Unfortunately, the patient eventually succumbed. Sample from right submandibular abscess showed no growth, but blood sample was confirmed to grow C. violaceum. It showed sensitivity to ciprofloxacin, amikacin, cotrimoxazole, chloramphenicol, tetracycline.Since it was firstly described in 1927, only a few cases of human infection with C. violaceum have been reported. As shown in our case, the classical clinical manifestation was localized soft tissue infection which rapidly progressed to fulminant sepsis with a high mortality rate. A defect in host defense system might be the predisposing factor for this kind of infection in our case. As this is such a rare infection, there is no guideline on the choice of antibiotics or duration of treatment at present. Successful treatment is most likely due to early recognition, prompt surgical drainage and appropriate antibiotic. To the best of our knowledge, this is the first reported case from Indonesia that could be identified in the literature

Triple Negative Breast Cancer Characteristics Based on Basal-like and Non-Basal-like Subtypes

Objective: To observe triple negative breast cancer (TNBC) characteristics in three hospitals located in Bandung based on basal-like (BL) and non-basal-like (NBL) subtypes.Methods: This was a cross-sectional study which used descriptive categorical data from medical records and paraffin blocks of TNBC patients treated in Dr. Hasan Sadikin General Hospital, Bandung; Borromeus Hospital; and Santosa Hospital Bandung Central in the period of January 1, 2012–December 31, 2016. The subjects of the study were 57 TNBC patients. The data collected in the study based on medical records were age, tumor size, histopathological images, severity, and immunohistochemical data. The paraffin blocks of the patients based on the completed medicals records were investigated through examinations of immunohistochemichal cytokeratin (CK) 5/6 expressions and epidermal growth factor receptor (EGFR).Results: Prevalence of TNBC were 82.5% of basal-like subjects and 17.5% of non-basal-like subjects. Among the TNBC subjects, median age of each subtype was 50 years of basal-like subtype and 45 years of non-basal-like subtype. Both subtypes were mostly found in the subjects who aged >40 years. Higher histopathological grade was discovered in both subtypes. The therapy mostly carried out to the subjects was adjuvant chemotherapy. Majority of basal-like subtype subjects were still alive and had longer survival rate and lower incidences of deaths when compared to the non-basal-like subtype.Conclusion: In TNBC, the basal-like subjects showed greater median age, lower severity stage, and longer survival rate than the non-basal-like subjects. There was no histopathology grade between both subtypes. Keywords: Basal-like and non-basal-like subtypes, breast cancer, characteristics, triple negative

IDENTIA Registry: Incidence of Deep Vein Thrombosis in Medically Ill Subjects at High Risk in Indonesia: A Prospective Study

Background: medically ill hospitalized patients are at risk of deep vein thrombosis (DVT) and consequentially have high chances of mortality. In Indonesia, there is disparity in healthcare facility and data on incidence of DVT in this multi-ethnic, geographically unique country with large population are limited. Hence, we determined the incidence of DVT and evaluated mean Wells score among medically ill hospitalized persons at increased risk. Methods: in this multicenter, prospective, observational registry in Indonesia, subjects (age >40 years) with acute medical illness (like cancer, acute infection, or severe respiratory disease) confined to bed for >3 days were enrolled between January 2016 and November 2017. Data for medical history, Wells score, and DVT diagnosis with compression ultrasonography (CUS) were recorded. DVT incidence was analyzed in eligible and evaluable groups. Data were analyzed by descriptive method. Results: out of 360 subjects enrolled, 334 were included in the eligible group for analyses. CUS could not be performed in 26 subjects. Thus, 308 subjects who completed the study were included in the evaluable group. Javanese were predominant in the eligible group and obesity was the most common medical history at presentation. Overall, incidence of DVT in eligible and evaluable patients was 37.1% and 40.3%, respectively. Mean (SD) Wells score and bedridden days were 3 (1.20) and 9 (6.89), respectively. Conclusion: this study indicated that the incidence of DVT is high in medically ill patients in Indonesia and will provide new insights and awareness about DVT in Indonesia

Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) as Covid-19 Screening Parameters

Covid-19 diagnosis generally uses RT-PCR as the gold standard to detect coronavirus-2 (SARS-CoV-2); however, this method requires advanced laboratory equipment. Alternatively, Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) can be used to identify viral infection. The study aimed: (1) to compare each NLR and LMR ratio in patients with and without COVID-19 and (2) to test the effectiveness of these ratios in identifying COVID-19. The study was conducted at the Haji Adam Malik Central General Hospital by acquiring 87 medical records data. The complete hematologic profile was analyzed from patients with and without COVID-19. The NLR and LMR ratio accuracy were analyzed as a screening tool for COVID-19. The AUC of NLR was 0.638, with cut-off ≤ 2.49, 47.6% sensitivity, and 80% specificity; therefore, the NLR accuracy as a screening for COVID-19 was defined as not good (just sufficient) because of AUC &lt;0,7. The AUC of LMR was 0.661, with cut-off ≥ 3.23, 45.2% sensitivity, and 82.2% specificity; therefore, the LMR accuracy as a screening parameter for COVID-19 is defined as not good (just sufficient) because of AUC &lt;0,7. There were significant differences in hematologic profile in neutrophil, lymphocyte, NLR, LMR between the patients in the COVID-19 group and non-COVID-19 group. NLR and LMR cannot be used as a screening tool because the Area Under Curve (AUC) is not good enough (just sufficient) in detecting COVID-19.</jats:p

Clinical features of oral cavity of patients with non-Hodgkin’s lymphoma undergoing chemotherapy

Introduction: Non-Hodgkin`s lymphoma is one of hematologic malignancy that responds to chemotherapy. Chemotherapy agent can cause oral complication such as oral mucositis, hemorrhage, xerostomia, hyposalivation and periodontitist. The purpose of this study is to determine the clinical feature of the oral cavity in patients with non-Hodgkin`s lymphoma whose underwent chemotherapy  Method: This study used an observational descriptive method. This type of research is observational descriptive. The study population was non-Hodgkin’s lymphoma sufferers who were undergoing chemotherapy at the Hematology and Medical Oncology Outpatient Installation Division of Internal Medicine at Hasan Sadikin Hospital Bandung. The study sample was taken by consecutive sampling method The numbers of samples in this study were 30 people according to predetermined criteria. Result: The result shows that all samples have abnormalities of the oral cavity that patients who have an abnormality are amounted to 20% and patients who have more than one kind of oral abnormalities amounted to 80%. An abnormality of the oral cavity that the most often found in this study is xerostomia with hyposalivation. Conclusion: Clinical feature of the oral cavity in patients with non-Hodgkin`s lymphoma whose underwent chemotherapy are abnormalities in the oral cavity, where the number of samples that experienced more than one type of oral cavity abnormality was greater when compared to the number of samples with a kind of abnormality. Oral cavity. Most of the samples studied had oral cavity abnormalities in the form of serostomia accompanied by hyposalivation.</jats:p