EVALUASI TANDA DAN GEJALA PASIEN KANKER SETELAH MENJALANI KEMOTERAPI

Abstrak Kanker merupakan salah satu penyebab kematian utama di seluruh dunia.Kemoterapi merupakan salah satu pilihan terapi yang tersedia. Namun, kemoterapi memiliki agen sitotoksik yang bukan hanya menyerang sel kanker yang berproliferasi tetapi juga sel-sel yang normal yang akan mempengaruhi kemampuan fisik pasien.Penelitian ini bertujuan mengevaluasi tanda dan gejala pasien yang menjalani kemoterapi di Rumah Sakit Ibnu Sina Makassar 2016 yang meliputi nyeri, mual dan muntah dan hasil pemeriksaan laboratorium pada hematologi yaitu HGB, WBC dan PLT.Penelitian ini menggunakan desain penelitian deskriftif eksploratif. Teknik pengambilan sampel dilakukan dengan "purposive sampling" sebanyak 42 responden. Analisis data dilakukan dengan menggunakan uji Kruskall Wallis untuk hubungan siklus kemoterapi dengan nyeri, mual /muntah dan kelelahan serta uji Korelasi Spearman untuk korelasi siklus kemoterapi dengan profil hematologi (Hgb, WBC, dan PLT) dengan tingkat kepercayaan 95%. Semua data dianalisis dengan program SPSS versi 21,0 (SPSS, Inc Chicago, IL).Ada hubungan siklus kemoterapi dengan nyeri (p: 0.013), mual dan muntah (p:0.02), dan kelelahan (p:0.01). Selain itu, didapatkan ada korelasi siklus kemoterapi dengan kadar hemoglobin (p=0.026,r=-0.034), kadar PLT (p=0.050,r=-0.305), dan tidak ada korelasi siklus kemoterapi dengan WBC (p=0.889,r=0.022). Namun berdasarkan siklus kemoterapi berulang sebanyak dua kali tidak ditemukan perubahan yang berarti antara intensitas nyeri, grade mual/muntah, tingkat kelelahan, kadar, PLT dan WBC, kecuali kadar Hemoglobin dalam darah yang mengalami penurunan. Terjadi perubahan gejala (nyeri, mual dan muntah, kelelahan) dan perubahan status hematologi (Hb dan PLT) seiring dengan peningkatan siklus kemoterapi. Olehnya itu, diperlukan pemantauan dari perawat dan pihak terkait dalam penanganan pasien dengan kemoterapi. Kata kunci: siklus kemoterapi, nyeri, mual/muntah, kelelahan, hemoglobin, WBC dan PLT. Abstrak Cancer is one of the leading causes of death worldwide. Chemotherapy is one of the treatment options available. However, chemotherapy has a cytotoxic agent that is not only attacking the cancer cells poliferating but also normal cells that will affect the patient's physical abilities. This study aimed to evaluate the signs and symptoms of patients who are undergoing chemotherapy at Ibn Sina Hospital Makassar 2016 include pain, nausea and vomiting, and laboratory results in hematology, namely HGB, WBC and PLT.This study used a descriptive longitudinal research design. The sampling technique is done with the "purposive sampling" as many as 42 respondents. Data analysis was performed using Kruskal Wallis test for the relationship cycles of chemotherapy with pain, nausea / vomiting and fatigue as well as Spearman's correlation test cycles of chemotherapy with hematologic profile (Hgb, WBC, and PLT) with a 95% confidence level. All data were analyzed with SPSS version 21.0 (SPSS, Inc. Chicago, IL).There are correlation with the pain of chemotherapy cycles (p: 0.013), nausea and vomiting (p: 0.02), and fatigue (p: 0.01). In addition, it was found there was a correlation cycles of chemotherapy with hemoglobin levels (p = 0.026, r = -0034), PLT levels (p = 0.050, r = -0305), and no correlation with WBC cycles of chemotherapy (p = 0.889, r = 0022). However, based on repeated cycles of chemotherapy twice found no significant change between the intensity of pain, grade nausea / vomiting, fatigue, concentration, PLT and WBC, except hemoglobin levels in the blood decrease. There is a change of symptoms (pain, nausea and vomiting, fatigue) and hematologic status changes (Hemoglobin and PLT) along with increased cycles of chemotherapy. By him that would require monitoring of nurses and parties involved in the management of patients with chemotherapy. Keywords: cycles of chemotherapy, pain, nausea / vomiting, fatigue, hemoglobin, WBC and PLT.

Hematologic parameters in coronavirus infection (COVID-19) and their clinical implications

Coronaviruses are a class of enveloped RNA viruses that cause infections of the respiratory tract, characterized by fever, tiredness, dry cough, diarrhea, loss of smell or taste, chest pain and shortness of breath. Many patients with mysterious pneumonia were distinguished in December 2019 in Wuhan. The pneumonia of obscure origin was found to be ascribed to a novel coronavirus and described as novel coronavirus pneumonia (NCP). The Chinese authorities initially reported the wave of mysterious pneumonia on December 31st, 2019 and it was declared as an outbreak of international concern on January 30th, 2020. A systematic search of relevant research was conducted, and a total of 58 primary research articles were identified, analyzed, and debated to better understand the hematologic profile in COVID-19 (Coronavirus disease) infection and its clinical implications. All the findings in this article manifest a true impression of the current interpretation of hematological findings of the SARS-COV-2 disease. Pathophysiology of COVID-19 disease can be better interpreted by taking into consideration the hematologic parameters. Clinical implications of the hematologic profile of COVID-19 patients including cytokine storm, coagulation profile, and thrombophilic complications are under-recognized. Therefore, this review focuses on the coagulation profile, cytokine storm, and its treatment options. The role of pre-existing thrombophilia in COVID-19 patients and how it could result in the poor prognosis of the disease is also debated. The recent data suggests that hypercoagulability could be the potential cause of fatalities due to COVID-19. Potential effects of tocilizumab, metronidazole, and ulinastatin in suppressing cytokine storm may help to treat SARS-COV-2 infection. This review also highlights the significance of thrombophilia testing in SARS-CoV-2 patients depending on the clinical features and especially in pregnant women.

Sociodemographic and Hematologic Profile of Breast Cancer Patients Attending a Tertiary Care Teaching Hospital in Ethiopia: Case Control Study

Background: Breast cancer is among the leading causes of cancer death in women. Different socio-demographic factors have impact on early diagnosis and treatment of breast cancer. Hematological abnormalities are also some of the conditions to be monitored during diagnosis and treatment of breast cancer.Objective: To describe socio demographic and hematologic profile of patients with breast cancer at Tikur Anbessa Specialized Hospital.Methods: Case control study was conducted from May 2018 to June 2019. A total of 230 cases and 230 controls participated in the study. Descriptive analysis was made to assess the socio demographic characteristics. Blood samples for hematological parameters were analyzed, using SYSMEXKX21N hematology analyzer. Independent student t- test was performed to compare the mean hematological parameters of cases and controls. Results: The mean age was 42.8 + 12.1 and 39.3 + 11.1 years for cases and controls, respectively. One hundred (43%) of cases and 34 (14.8%) of controls were illiterate. Moreover, 175 (76.1%) of cases and 155 (67.4%) of controls were married. The mean value of Hemoglobin, Red Blood cell, Packed Cell Volume (13.1 + 1.6g/dl, 4.6 + 0.54/1012/L , 38.7 + 4.5 %, respectively) of cases were significantly lower than the controls (14.0 + 1.3g/dl, 4.8 + 0.47 / 1012/L, 40.5 + 3.5% respectively). The mean platelet and total WBC count were 323.4+ 108.1 x 109/L and 7.1 + 2.8 x 109/L for cases and 282.0 +70.0 x 109/L, and 7.1 + 2.4 x 109/L for controls respectively. In addition, 20.4% of cases and 5.6 % of controls were anemic based on their hemoglobin value.Conclusion and recommendations: The majority of breast cancer cases were less than 40 years of age and illiterate. Most of the RBC parameters of cases were significantly lower than the controls. Therefore, attention should be given to those with the designated hematologic abnormalities.

THE HEMATOLOGIC PROFILE IN THE ACUTE TOXICITY TEST OF COGON GRASS ROOTS ETHANOL EXTRACT IN WISTAR RATS

Objective: This study aimed to investigate the hematologic profile of Wistar rats in the acute toxicity test of Cogon grass roots ethanol extract (CGEE). Methods: Cogon grass roots were dissolved in 70% ethanol. An acute toxicity test was conducted based on The National Agency of Drug and Food Control of the Republic of Indonesia. Five female rats in the treatment group were administered a single high dose of 5000 mg/kg body weight (BW) of CGEE in 200 μl of 0.5% carboxymethyl cellulose (CMC), and the 5 female rats in the control group were administered 200 μl of 0.5% CMC. After 14 d, blood samples were collected, and 18 hematologic parameters were measured with a hematology analyzer. Statistical analyses were performed to compare the parameters between the two groups with the independent t-test for normally distributed data and the Mann Whitney test for non-normally distributed data. Results: None of the hematologic parameters in the treatment group significantly differed from those in the control group after 14 d of observation (P>0.05). Conclusion: A single high dose of 5000 mg/kg BW of CGEE did not change the hematologic profile of Wistar rats. These results indicate that CGEE does not have an acute hemotoxic effect, at least for hematologic parameters.

Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

Hematologic Profiles of Ethiopian Preterm Infants With Clinical Diagnoses of Early-Onset Sepsis, Perinatal Asphyxia, and Respiratory Distress Syndrome

Objective. To determine the hematologic profile of preterm infants with regard to different diseases. Methods. A prospective, cross-sectional, observational study, conducted in 5 hospitals in Ethiopia from July 2016 to May 2018. Preterm babies <7 days of age were included and investigated with complete blood counts (CBC) and other investigations, accordingly. Results. Out of 4919 preterms, 3852 (78.3%) were admitted to a newborn intensive care unit, and of these, 68.3% had a CBC performed. The mean values of hemoglobin, white blood cell (WBC) and platelet counts were 17.9 mg/dL; 12 685 cells/mm3, and 159 340 cells/mm3, respectively. Early onset neonatal sepsis (EONS) 1433 (37%), asphyxia 266 (6.9%), and respiratory distress syndrome (RDS) 1738 (45.3%) were common reasons for admission. The WBC count was <5000 cells/mm3 for 8.8%, 9.0%, and 11.1% of neonates with EONS, asphyxia and RDS, respectively. The hemoglobin value was <7 mg/dL for 0.6%, 1.7%, and 0.4% of preterm infants with EONS, asphyxia, and RDS, respectively. The platelet count was <50 000 cells/mm3 for 16.8%, 17.7%, and 19.8% of preterms admitted with a diagnosis of EONS, asphyxia, and RDS, respectively. Conclusion. WBC and platelet counts were the most common to be associated with EONS, asphyxia, and RDS. Further study is recommended to determine the effect of abnormal hematologic profile on the outcome of preterm babies.

Chronic Therapy with Sucroferric Oxyhydroxide Does Not Affect Iron and Anemia Markers in Dialysis Patients

Introduction: Sucroferric oxyhydroxide (SOH) is an iron-based phosphate binder (PB), and its use has been widely expanded since its initial approval in 2014. Based on the existing data, however, it remains yet unclear whether its long-term administration is followed by iron overload in dialysis patients. The purpose of this observational study was to evaluate the longstanding effects of SOH on the anemia and iron indices in patients on dialysis. Methods: A total of 110 patients from 3 dialysis centers were included in the study; 49 were under chronic treatment with SOH (cohort A), while 61 were either receiving other PB or no treatment for hyperphosphatemia (cohort B). We initially compared the hematologic profile of patients in 2 cohorts (phase I), and subsequently, we evaluated modifications of the above parameters in the SOH treated patients over a period of 6 months (phase II). Results: There were no statistically significant differences between 2 cohorts in terms of hemoglobin (Hb; 11.4 ± 1.3 vs. 11.6 ± 0.9 g/dL, p = 0.375), ferritin (473 ± 230 vs. 436 ± 235 ng/mL, p = 0.419) and transferrin saturation (TSAT;26.6 ± 13.2 vs. 26.5 ± 10.6%, p = 0.675), serum phosphate concentration (4.57 ± 1.05 vs. 4.3 ± 0.96 mg/dL, p = ns), and intact PTH (286 ± 313 vs. 239 ± 296 pg/mL, p = ns). Marginally, but significantly higher calcium levels were found in cohort A compared to cohort B (9.18 ± 0.58 vs. 8.9 ± 0.51 mg/dL, respectively, p = 0.008). In phase II, no significant changes were observed in hematological parameters after a 6-month treatment with SOH (Hb: from 11.5 ± 1.1 to 11.4 ± 1.3 g/dL, p = 0.4, serum ferritin levels: from 475 ± 264 to 473 ± 230 ng/mL, p = 0.951, TSAT: from 26.5 ± 16.7 to 26.6 ± 13.2%, p = 0.933). There were also no significant changes in the administration of iron supplements or erythropoietin dose during this period. Conclusions: SOH is an effective PB, and its long-term use is not complicated by iron overload.