THORACIC CT-SCAN WITH EGFR MUTATIONS IN PULMONARY ADENOCARCINOMA PATIENTS WITH PULMONARY METASTASES AT DR. MOEWARDI HOSPITAL, SURAKARTA, INDONESIA

Highlights • The thoracic CT scan can be an alternative evaluation before administering EGFR-targeting medicine to patients. • EGFR is now a therapeutic target for lung cancer.   Abstract Background: EGFR mutation is one of the molecular markers associated with prognosis and therapy in lung adenocarcinoma patients, including with lung metastases. The predominant imaging modality for assessing lung cancer is a chest CT scan, which correlates with prognosis. Objective: This study aimed to explore the association between characteristics of lung adenocarcinoma based on chest CT-Scan and EGFR mutation in lung adenocarcinoma with lung metastases. Material and Method: This study involved 65 lung adenocarcinoma patients in Dr. Moewardi Hospital, Surakarta, Indonesia, from January 2018-December 2020. Result: Chest CT-Scan and EGFR mutation were assessed in all subjects. EGFR mutation was found in 32 (49.8%) subjects. The risk of EGFR mutation was found to be higher in patients with lung adenocarcinoma who had lung metastases in a peripheral location (OR=11.56; 95%CI 3.57-37.33; p<0.001), tumor size <4 cm (OR=8.00; 95%CI 2.64-24.22; p<0.001), and semi-solid density (OR=5.21; 95%CI 1.79-15.19; p=0.002). Conclusion: EGFR mutation is associated with tumor location, size, and thickness based on chest CT-Scan in lung adenocarcinoma with lung metastases patients

Thorax Ct-Scan image and demographic factors of adenocarcinoma and squamous cell carcinoma

Lung cancer is the leading cause of cancer death worldwide. As a result, CT scans are crucial in the detection and staging of lung cancer and patient follow-up after treatment. The objective of this study was to investigate the characteristics of lung adenocarcinoma and lung squamous cell carcinoma (SCC) and how they relate to demographic factors such as age, gender, and smoking history. This study uses thoracic CT-scan images to detect and stage lung cancer and monitor lung cancer patients after treatment. This research employed a cross-sectional descriptive-analytical approach. From July 2017 to December 2019, lung cancer patients underwent a chest CT scan at the Respira Lung Hospital's Radiology Installation in Yogyakarta, Indonesia. The indicators in this study included age, gender, and smoking history in adenocarcinoma or SCC patients. Data were collected through observation and documentation. The logistic regression test in SPSS 18 for Windows was used to analyze the data, with a p 0.05 threshold considered significant. The findings demonstrated that the relationship between chest CT-scan images and lung cancer detection and staging was significant, with a p-value of 0.05. Therefore, optimization of chest CT scan as a radiological modality can be used to determine the type of cytology or histology of lung cancer to improve diagnostic accuracy.El cáncer de pulmón es la principal causa de muerte por cáncer en todo el mundo. Como resultado, las tomografías computarizadas son cruciales en la detección y estadificación del cáncer de pulmón, así como en el seguimiento del paciente después del tratamiento. El objetivo de este estudio fue investigar las características del adenocarcinoma de pulmón y el carcinoma de células escamosas (SCC) de pulmón y cómo se relacionan con factores demográficos como la edad, el sexo y el historial de tabaquismo. Este estudio utiliza imágenes de tomografía computarizada torácica para detectar y estadificar el cáncer de pulmón, así como para monitorear a los pacientes con cáncer de pulmón después del tratamiento. Esta investigación empleó un enfoque transversal descriptivo-analítico. Desde julio de 2017 hasta diciembre de 2019, los pacientes con cáncer de pulmón se sometieron a una tomografía computarizada de tórax en la instalación de radiología del Respira Lung Hospital en Yogyakarta, Indonesia. Los indicadores de este estudio incluyeron la edad, el sexo y los antecedentes de tabaquismo en pacientes con adenocarcinoma o SCC. Los datos se recopilaron a través de la observación y la documentación. Para el análisis de los datos se utilizó la prueba de regresión logística en SPSS 18 para Windows, considerándose significativo un umbral de p 0,05. Los hallazgos demostraron que la relación entre las imágenes de tomografía computarizada de tórax y la detección y estadificación del cáncer de pulmón fue significativa, con un valor de p de 0,05. Por lo tanto, la optimización de la tomografía computarizada de tórax como modalidad radiológica se puede utilizar para determinar el tipo de citología o histología del cáncer de pulmón para mejorar la precisión diagnóstica

Clinical overview, laboratory findings, and radiological outcomes of COVID-19 Patients in the city of Bandung, Indonesia

This study analyzed the chest CT of COVID-19 patients with clinical and laboratory features. A retrospective study of chest CT, laboratory analysis, and clinical features of patients with COVID-19 was conducted from March to September 2020. Sixty-nine symptomatic patients agreed to join the study. The scoring for chest CT was based on the proportion of lobar involvement with visual assessment. Chest CT scores were paired with clinical and laboratory findings. The relation of all these findings with the patients’ outcomes was statistically assessed with univariate and multivariate analyses. Ground glass opacity was the most common finding in the early course of the disease (≤ 7 days), while crazy-paving, consolidation, and fibrosis were dominantly observed in the late phase (&gt;7 days). The CT score was significantly higher in severe patients (p &lt; 0.0001) and late-phase than that in early-phase patients (p &lt; 0.0001). CT score was significantly correlated with CRP (p&lt;0.001), ALC (p=0.002) and NLR (p&lt;0.001). Chest CT score correlates significantly with laboratory findings and disease severity in COVID-19 patients. Therefore, chest CT score has a potential role in estimating the outcomes of these patients. In addition, a Faster diagnostic workup in symptomatic cases would be beneficial to the patients.Este estudio analizó la TC de tórax de pacientes con COVID-19 con características clínicas y de laboratorio. Se realizó un estudio retrospectivo de TC de tórax, análisis de laboratorio y características clínicas de pacientes con COVID-19 de marzo a septiembre de 2020. Sesenta y nueve pacientes sintomáticos aceptaron unirse al estudio. La puntuación de la TC de tórax se basó en la proporción de afectación lobular con evaluación visual. Las puntuaciones de la TC de tórax se emparejaron con los hallazgos clínicos y de laboratorio. La relación de todos estos hallazgos con los resultados de los pacientes se evaluó estadísticamente con análisis univariados y multivariados. La opacidad en vidrio esmerilado fue el hallazgo más común en el curso temprano de la enfermedad (≤ 7 días), mientras que el empedrado, la consolidación y la fibrosis se observaron predominantemente en la fase tardía (&gt; 7 días). La puntuación de CT fue significativamente mayor en pacientes graves (p &lt;0,0001) y de fase tardía que en pacientes de fase temprana (p &lt;0,0001). La puntuación de CT se correlacionó significativamente con CRP (p &lt;0,001), ALC (p = 0,002) y NLR (p &lt;0,001). La puntuación de la TC de tórax se correlaciona significativamente con los hallazgos de laboratorio y la gravedad de la enfermedad en pacientes con COVID-19. Por lo tanto, la puntuación de la TC de tórax tiene un papel potencial en la estimación de los resultados de estos pacientes. Además, un estudio de diagnóstico más rápido en casos sintomáticos sería beneficioso para los pacientes

Correlation of Brixia Score Changes with Length of Stay in Patient with COVID-19

Background: The increase in Covid-19 cases in Indonesia as well as the hospital length of stay is unpredictable. The degree of lung damage in Covid-19 largely determines the severity of the disease, a serial chest X-ray using Brixia score can be used to assess changes in pulmonary parenchymal damage and could predict the length of hospitalization. This study aims to analyze the correlation of Brixia score with the length of hospitalization in Covid-19 patients.Subjects and Method: This cross-sectional study was conducted at Sumber Waras Hospital from November 2021 until January 2022. The samples are Covid-19 confirmed patients who were treated at Sumber Waras hospital. Independent variable is Brixia score and dependent variable is length of hospitalization. Brixia's score assessment from two serial chest X-rays was divided into 4 categories: low to low, low to high, high to low, and high to high. All the categories were analyzed using Kruskall-Wallis method then continued with Mann-Whitney U test. The multivariate variable was analyzed using linear regression.Results: There are 190 samples, the median score of Brixia at the beginning of treatment is 4 (range 0-18), and the median score of Brixia on serial examination is 6 (range 0-18). Patients in low to low category had median 10 days length of hospitalization, low to high category and high to low category had median 11 days, and high to high category had median 8 days. There was no statistically significant correlation between Brixia score and length of hospitalization (p= 0.377).Conclusion: There is no significant relationship between the median Brixia score changes with the length of hospitalization of covid-19 patients.Keywords: Covid-19, hospitalized, Brixia score changes, length of stayCorrespondence: Widiastuti Soewondo. Faculty of Medicine Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta, Central Java, Indonesia. Mobile: +6282134368592. Email: [email protected] Journal of Medicine (2022), 07(03): 262-268https://doi.org/10.26911/theijmed.2022.07.03.0

Brixia Score as Predictor of D-Dimer Levels of COVID-19 Patients in Intensive Care Unit

Background:  COVID-19 is caused by a novel virus that can cause lung abnormalities which can be measured with new chest x-ray scoring system named Brixia score. In COVID-19 patients, coagulation disorders are often found that can be seen through D-Dimer levels. This study aimed to prove the Brixia Score as a predictor of D-Dimer levels.Subjects and Method: This study was an observational analytic study with a cross-sectional approach. The subjects were 94 COVID-19 patients which taken from ICU Melati 1 Dr. Moewardi General Hospital, Surakarta from March 2021 to August 2021 who met the exclusion and inclusion criteria. The independent variable is the Brixia score performed by radiologists and the dependent variable is D-Dimer levels taken from laboratory results. Sampling was obtained by purposive sampling and the data were investigated using the receiver operating characteristic (ROC) curve.Results: 94 samples were obtained for analysis. The average Brixia Score of patients with D-Dimer <2 µg/mL was Mean= 15.85; SD= 1.43 and D-Dimer ≥2 µg/mL was Mean= 17.29; SD= 0.96. There was a significant difference between the Brixia Score of patients with D-Dimer <2 µg/mL and D-Dimer ≥2 µg/mL (p<0.001). Analysis with the ROC curve shows an area under the curve (AUC) of 0.793. The optimal cutoff value of the Brixia Score for predicting D-Dimer levels was 16.5 (sensitivity 77.9%, specificity 73.1%).Conclusion: Brixia Score proved to be a predictor of D-Dimer levels of COVID-19 patients in ICU care.Keywords: COVID-19, ICU, brixia score, predictor, D-Dimer.Correspondence: Widiastuti Soewondo, Radiology Department, Faculty of Medicine, Universitas Sebelas Maret. JL. Ir. Soetami No. 36A, Surakarta 57126, Indonesia. E-mail: [email protected]. Mobile: 082134368592Indonesian Journal of Medicine (2023), 08(01): 92-99https://doi.org/10.26911/theijmed.2023.08.01.0

Correlation between Mortality of COVID-19 Patients with Hypertension and Thorax Radiography Treated in the Intensive Care Unit of Dr. Moewardi Hospital

Background: Coronavirus 2019 or COVID-19, caused by the new SARS-CoV2 virus, has become a pandemic and attacked more than 200 countries, including Indonesia. The most comorbid disease in COVID-19 patients was hypertension. Chest radiography can predict prognosis and mortality in COVID-19 cases and one of the methods that can be used for chest radiographic assessment is the Brixia Score, specifically designed for COVID-19 patients to measure and analyze the severity of lung abnormalities in patients with COVID-19. This study aimed to find the correlation between the mortality of COVID-19 patients with hypertension and chest radiography using the Brixia Score treated in the intensive care unit (ICU) of Dr. Moewardi Hospital.Subjects and Method: This study used an analytic observational study with a cross-sectional approach. The subjects were 84 COVID-19 patients with hypertension who met the exclusion and inclusion criteria. The independent variable is chest radiography and dependent variable is mortality. Sampling was collected by purposive sampling and the data obtained were analyzed using the contingency coefficient test.Results: There was a significant correlation between the mortality of COVID-19 patients with hypertension and chest radiography as assessed using the Brixia Score (p<0.001). The youngest patient was 20 years old and the oldest was 87 years old.Conclusion: There was a correlation between the mortality of COVID-19 patients with hypertension and chest radiography treated in the ICU RSUD Dr. Moewardi, Surakarta.Keywords: COVID-19, mortality, hypertension, chest radiography, Brixia Score, intensive care unitCorrespondence: Widiastuti Soewondo. Faculty of Medicine Universitas Sebelas Maret Surakarta. Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. Email: [email protected]. Mobile: 082134368592.Indonesian Journal of Medicine (2022), 07(03): 269-277https://doi.org/10.26911/theijmed.2022.07.03.03

Long Covid-19, Radiological Findings, and Its Management: A Systematic Review

Background: COVID-19 is a disease caused by SARS-CoV-2 and has numerous clinical spectrums. Mild respiratory infection is the common clinical manifestation of COVID-19, and the less common is pneumonia accompanied by fever, cough, and breathing difficulty. Long COVID can be defined as prolonged signs and symptoms which cannot be explained for other reasons 4 weeks after being diagnosed with SARS-CoV-2. This study aimed to describe the cause of illness is confirmed or suspected COVID-19 patients, specifically on long COVID.Subjects and Method: We performed literature searches of the latest articles with Medline, CINAHL (EBSCO), Global Health (Ovid), WHO Global Research on COVID-19 database, LitCovid and Google Scholar databases published from 2019 to 2020. Two reviewers searched all articles independently (P and W, with 7 and 10 years of experience, respectively). We conducted a systematic review to provide recent evidence of symptoms and complications in long COVID. We followed PRISMA guidelines.Results: A total of 22 papers was identified and screened for eligibility from medical databases. There were 15 papers included in this review. Reason for the continuous symptoms covid an extent of organ destruction, continuous response of chronic inflammation or immunology reaction, non-specific effect of hospital admission, some critical disease, post ICU syndrome, complications from COVID-19 infection,  morbidities and adverse effects of medications used. Common symptoms are fatigue, shortness of breath, cough, chest pain, palpitations, dizziness, arthralgia, myalgia and weakness, sleep problems, sharp pain, gastrointestinal problems, rash and hair loss, impaired balance and ataxia, neurologic problems such as dementia, concentration disorders and poor quality of life.Conclusion: The incidence of long-term manifestations of COVID-19 has been increasing and systemic clinical symptoms affect many organs and systems. This can be due to numerous reasons like post-ICU syndrome, post-viral fatigue syndrome, permanent organ deterioration or others. Correspondence: Widiastuti Soewondo. Department of Radiology, Dr. Moewardi General Hospital/ Faculty of Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia. Email: [email protected] Journal of Medicine (2021), 06(04): 387-392https://doi.org/10.26911/theijmed.2021.06.04.0