Background:Doxorubicin, as part of the chemotherapy regimen for breast cancer, has long been associated with cardiotoxicity, primarily manifested by a reduction in left ventricular ejection fraction (LVEF). Early detection of cardiac dysfunction is essential to prevent the progression of heart failure and ensure patient safety. This study aimed to analyze trends in LVEF reduction, the incidence of cardiotoxicity, and associated risk factors in breast cancer patients receiving doxorubicin-based chemotherapy at Dr. Hasan Sadikin General Hospital, Bandung. Methods:We conducted a retrospective cohort study of 130 patients and further reviewed the medical records. The LVEF values were obtained from echocardiographic assessments performed before and after each chemotherapy cycle. The Mann-Whitney U test and Wilcoxon Signed Rank test were used to assess LVEF trends, while bivariate analysis was applied to evaluate the association between clinical variables and cardiotoxicity. Results:The results showed a statistically significant reduction in LVEF beginning after the third chemotherapy cycle and continuing through the sixth (P < .05), with a median decline of approximately 4% to 5%. The incidence of cardiotoxicity was 4.62%, with an additional 3.85% of patients classified as having borderline low LVEF. The age factor (P = .047) and a history of hypertensive heart disease (HHD) (P = .034) showed a statistically significant association with the incidence of left ventricular dysfunction, but no factors showed a statistically significant association with the incidence of cardiotoxicity. Conclusions:The early onset of LVEF reduction highlights the critical role of routine cardiac monitoring during chemotherapy as a preventive strategy against cardiotoxicity progression. Identification of risk factors such as older age and preexisting cardiovascular conditions is essential for risk stratification and the implementation of safer and individualized treatment approaches.
BACKGROUND: Colorectal cancer (CRC) is a major global health problem associated with high cancer-related mortality. Profiling of Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status has become a decisive predictive biomarker in the management of CRC. However, KRAS mutation testing is commonly performed using tumor tissue obtained through invasive biopsy or surgery; therefore, fecal DNA analysis might offer a promising non-invasive alternative. This study was conducted to evaluate the concordance of KRAS mutations between matched tumor tissue and fecal samples and their association with clinicopathological characteristics. METHODS: This cross-sectional study included 94 patients confirmed of CRC. Tumor tissue specimens were obtained during surgical resection or biopsy, while fecal samples were collected pre-operatively. KRAS mutations were analyzed using polymerase chain reaction (PCR) and DNA sequencing, and the associations with clinicopathological variables were statistically evaluated. RESULTS: KRAS mutations were detected in 45.74% of tumor tissue and 26.60% of fecal samples. The overall concordance rate was 65.96%, with a Cohen’s Kappa of 0.291 (95% CI: 0.110–0.472), indicating "fair agreement". Notably, allele-specific concordance was 100% among double-positive cases. The fecal assay demonstrated 41.86% sensitivity, 86.27% specificity, 72.00% positive predictive value (PPV), and 63.77% negative predictive value (NPV). Tumor location (colon versus rectum) was significantly associated with fecal KRAS detection (p=0.028); other variables showed no significant association (p>0.05). CONCLUSION: KRAS mutations were more frequently detected in tissue than in fecal samples, with fair agreement. High allele-specific concordance suggests fecal DNA accurately reflects the tumor's mutational profile. Tumor location significantly influences DNA detectability, supporting fecal-based KRAS testing as a potential non-invasive approach for CRC molecular assessment. KEYWORDS: colorectal neoplasms, feces, KRAS protein, human, mutation, neoplasm tissue
Background Many tuberculosis (TB) patients first seek care through the private health sector; however, most private practitioners (PPs) are not linked to the National TB Program (NTP). We aimed to map, characterize, and assess the potential contribution of PPs to the Indonesian NTP, particularly for TB diagnosis and care. Methods This study was conducted between August 2017 and April 2018 in Bandung city, West Java, Indonesia. Trained enumerators surveyed 30 (of 73) randomly selected community health centers (CHCs) to identify the location of private health care facilities (HCFs) and recorded service characteristics, including physician’s qualifications and practice schedules. We also asked whether the PPs were managing patients with respiratory tract infection (RTI), ordering a TB diagnosis in the past three months, or treating TB patients at the time of interview. Results Among the 936 practicing PPs, 27 (IQR: 12–40) were distributed widely per CHC area. We successfully interviewed 674 (72.0%) PPs, 88.1% (594/674) of whom reported managing patients with RTI symptoms. Most PPs were administered in clinics with multiple providers (78.6%; 530/674), and 21.4% (n = 144) of the PPs were administered in a single-provider clinic. A small proportion of PPs practiced in HCFs were equipped with an X-ray (10.1%) or laboratory (27.1%) facility, and 23.2% collaborated with the national health insurance system. Almost three-quarters (70.0%) practiced in an HCF with a pharmacy. A third (33.3%; 209/627) provided services after weekday office hours, and 28.3% (191/674) offered weekday and weekend clinics. Of the PPs managing RTI patients, 241 (40.6%) reported encountering TB patients, and 101 (17.0%) had TB patients under their treatment program at the time of the interview. Overall, they self-reported that 937 patients were diagnosed with TB in the past three months and that 354 TB patients were receiving treatment. Conclusions PPs have great potential to contribute to TB care because they are present in large numbers, are well distributed in all CHC areas, and can provide services after regular office hours. Some PPs even worked in HCFs supported by X-rays, laboratories, and pharmacies. We should seek ways to engage PPs optimally with the NTP.
Background:Prolonged Length of Stay (LOS) in the Emergency Department (ED) is a persistent global challenge associated with overcrowding, decreased quality of care, and increased patient risk. Despite established standards recommending shorter LOS, many EDs continue to experience inefficiencies. Understanding the determinants of LOS within a comprehensive framework is essential to improving ED performance. Objective:This study aimed to analyze factors associated with LOS among ED patients. Methods:A cross-sectional study was conducted in the ED of a tertiary referral hospital in Indonesia. A total of 229 patient records were enrolled using consecutive sampling over a one-month period. Independent variables comprised patient factors (age, gender, triage category), service factors (response time, assessment time), and organizational factors (patient-to-physician ratio, patient-to-nurse ratio, inpatient bed availability). Data were analyzed using univariate, bivariate, and multiple linear regression analyses. Results:The mean LOS was 468.27 minutes (7.8 hours), with 36.2% of patients exceeding 8 hours. Bivariate analysis showed that age, assessment time, and all organizational factors were significantly associated with LOS (p < 0.05). In the multivariable model, five variables remained significantly associated with LOS: age (β = 0.174; 95% CI [0.052, 0.297]; p = 0.005), assessment time (β = 0.185; 95% CI [0.059, 0.311]; p = 0.004), patient-to-physician ratio (β = 0.200; 95% CI [0.068, 0.332]; p = 0.003), patient-to-nurse ratio (β = 0.215; 95% CI [0.097, 0.332]; p < 0.001), and inpatient bed availability (β = 0.145; 95% CI [0.030, 0.260]; p = 0.014). The patient-to-nurse ratio showed the strongest association with LOS in the adjusted model. Conclusion:ED LOS remains substantially prolonged and is shaped predominantly by organizational and throughput factors rather than by patient characteristics, with nursing workload emerging as the most influential organizational determinant. This throughput dominance reframes prolonged LOS as a system-level rather than a purely clinical problem, underscoring the need for system-oriented interventions particularly workload optimization, staffing adequacy, and improved hospital-wide patient flow to enhance ED efficiency and reduce LOS.
BACKGROUND: Locally advanced rectal cancer (LARC) is commonly treated with neoadjuvant chemoradiotherapy (nCRT), but highly variable response limits outcomes and highlights the need for predictive biomarkers. Cyclooxygenase-2 (COX‑2) and human epidermal growth factor receptor 2 (HER‑2) are overexpressed in a subset of colorectal cancers and are mechanistically linked to radioresistance. Both pathways are therapeutically targetable and exhibit molecular crosstalk, suggesting that combined assessment may improve prediction of nCRT response, but their combined predictive value in LARC remains unexplored. Therefore, this study was conducted to evaluate the association between COX‑2 and HER‑2 expression and radiotherapy response in patients with LARC. METHODS: This observational retrospective cohort study included 59 patients with stage II–III rectal adenocarcinoma treated with standardized nCRT. COX-2 and HER-2 expressions on pretreatment biopsies were assessed by immunohistochemistry, and radiologic response 4–8 weeks post nCRT dichotomized into good and poor responses using RECIST 1.1. RESULTS: High COX-2 expression was present in 67.8% of tumors and was associated with poor response (p<0.001; OR=10.08; 95% CI: 2.92–34.78). HER-2 positivity (32.2% of cases) was also associated with poor response (p=0.039; OR=4.28; 95% CI: 1.16–15.79). In multivariate analysis, high COX-2 (adjusted OR=0.110; p=0.002) and HER-2 positivity (adjusted OR=0.197; p=0.049) remained independent predictors of poor response. Tumors with combined COX-2 low/HER-2 negative and COX-2 high/HER 2 positive profiles showed good response rates of 86.7% and 13.3%, respectively, representing a 73.4% absolute difference. CONCLUSION: Since Low COX-2 expression and HER-2 negativity is mostly associated with good radiotherapy response, hence COX-2 and HER-2 might be independent molecular predictors of radiotherapy response in LARC, and combined biomarker profiling provides robust risk stratification that may guide treatment intensification or de escalation strategies. KEYWORDS: COX-2, HER-2, rectal cancer, radiotherapy response, biomarker, personalized medicine
