Introduction: Cancer-associated cachexia (CAC) is a complex metabolic syndrome. It affects 0,5-1% of the general population and 60-83% of cancer patients. Vitamin D has a potential immunological role in cancer cachexia. However, the mechanism remains unclear. Method: This review outlines the complex mechanisms of CAC, a metabolic syndrome marked by muscle loss affecting 80% of cancer patients and the potential action of vitamin D. We highlight the limited studies exploring vitamin D’s impact on CAC, based on cachexia parameters. Result: The Warburg effects in CAC are understood to involve elevated energy use, driven by the tumor microenvironment (TME) and pro-inflammatory cytokines. This present review explores the mechanism of cachexia on skeletal, adipose tissue, liver and tumor microenvironment. At the same time vitamin D deficiency in cancer correlates with poor prognosis due to its critical role in immune modulation. Notably, various clinical trials showed the beneficial roles of vitamin D in reducing inflammation, pain and increasing weight. Conclusion: Few studies had explored the beneficial effects of vitamin D in cancer; However, limited evidence exists on immunomodulatory effects of vitamin D. This critical gaps stressing the need for further clinical research across various cancer types.

BACKGROUND: Indonesia has the second highest burden of tuberculosis (TB) worldwide, with an incidence of 354 per 100,000 population and approximately 969,000 cases reported in 2021. Micronutrients such as vitamin A and zinc play important roles in immune function and may influence inflammatory responses in TB. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are potential markers of systemic inflammation; however, evidence regarding their association with dietary micronutrient intake in pulmonary TB patients remains limited, particularly in Indonesia. AIMS: To examine the association between vitamin A and zinc intake and inflammatory markers in pulmonary TB patients. METHODS: A cross-sectional study was conducted among 133 pulmonary TB patients recruited consecutively from March to April 2024 at Persahabatan Hospital. Vitamin A and zinc intake were assessed using a semi-quantitative food frequency questionnaire (SQ-FFQ), while NLR and PLR values were obtained from medical records. Data normality was tested using the Kolmogorov–Smirnov test, and correlations were analyzed using Spearman’s test. The median vitamin A intake was 105.47 RE/day and zinc intake was 7.38 mg/day, with median NLR and PLR of 2.91 and 202.08, respectively. RESULTS: No significant correlations were found between vitamin A or zinc intake and NLR or PLR (p > 0.05). CONCLUSION: In conclusion, vitamin A and zinc intake were not associated with inflammatory markers in pulmonary TB patients, although host-related factors may contribute to the inflammatory response.

ABSTRACT BACKGROUND: Hyponatremia and respiratory failure are common in cancer patients, but their relationship among lung cancer patients remains unclear. This study aimed to determine the prevalence of hyponatremia and its association with respiratory failure on admission among lung cancer patients presenting to the emergency room (ER). METHODS: This cross-sectional study was conducted between July 1, 2023, and June 30, 2024, in the ER of Persahabatan Hospital. Adults with histopathologically confirmed or previously established, untreated lung cancer were consecutively enrolled. Hyponatremia was defined as serum sodium <135 mmol/L, and respiratory failure as PaO 2 <60 mmHg or PaCO 2 >45 mmHg. Associations were analyzed using bivariate analysis and simplified exploratory multivariable logistic regression. RESULTS: Among 101 patients, hyponatremia and respiratory failure occurred in 51.5% and 20.8%, respectively. Respiratory failure was more frequent with hyponatremia than without hyponatremia (34.6% vs. 6.1%; odds ratio [OR]: 8.12, 95% confidence interval [CI]: 2.21–29.79; P < 0.001). In the exploratory multivariable model, hyponatremia (adjusted OR [aOR] 6.05, 95% CI: 1.58–23.14; P = 0.009) and tuberculosis (aOR 8.05, 95% CI: 1.73–37.37; P = 0.008) remained associated with respiratory failure. The model showed acceptable discrimination (area under the curve: 0.769, 95% CI: 0.652–0.885), with sensitivity 85.7% (95% CI: 63.7%–97.0%), specificity 56.3% (95% CI: 44.7%–67.3%), positive predictive value 34.0% (95% CI: 21.5%–48.3%), and negative predictive value 93.8% (95% CI: 82.8%–98.7%). CONCLUSION: Among lung cancer patients, hyponatremia was prevalent and associated with respiratory failure at ER admission. These findings are exploratory and hypothesis-generating.

Background:Idiopathic Pulmonary Fibrosis (IPF) is a progressive lung disease with limited life expectancy after diagnosis. The median survival time ranges from 2 to 4 years, indicating a poor prognosis. Multiple telomere-related genes that cause telomere shortening have been associated with a significant percentage of IPF cases. This review aims to analyze the association of short telomere length with IPF incidence. Methods:A systematic online search was conducted on PubMed, Scopus, and Cochrane. Articles that met the criteria were included. Quality of included literature was assessed using the Newcastle-Ottawa Scale (NOS). The pooled standard mean difference (SMD) with 95% confidence interval (CI) of telomere length was calculated using a random-effect model. Results:Six original studies containing 622 IPF patients and 544 controls were included in the meta-analysis. The study designs were case control and cohort. Pooled analysis showed shorter telomere length in IPF patients compared to controls (SMD: -0.84, 95%CI -1.21 to -0.48, Z = 4.55, p < 0.00001). Subgroup analysis showed that steeper telomere shortening was found in lung tissue compared to peripheral blood sample. The findings suggested that telomere length may be closely associated with the pathogenesis of pulmonary fibrosis. Discussion:Repeated cell divisions gradually shorten telomeres that lead to senescence and apoptosis. Premature senescence disrupts the balance of lung epithelial cells, potentially activating lung remodeling processes that result in fibrotic damage through senescence-associated secretory phenotype (SASP). Conclusion:This study shows significant shorter telomere lengths in IPF patients compared to healthy controls that suggest telomere as a risk factor for IPF occurrence. These findings highlight the value of telomere assessment not only for early detection but also as a potential predictive biomarker for clinical outcomes.

Background: Tuberculosis (TB) infection triggers a decrease in appetite and disrupts protein metabolism. Protein provides the main source of amino acids for immune system formation and tissue repair, both of which are impaired in tuberculosis patients. Intensive phase anti-tuberculosis therapy aims to boost immunity, reduce bacterial load, and improve nutritional status. Pulmonary TB is the leading cause of death in Timor Leste (94% mortality rate by 2021), yet few studies have explored the relationship between nutrition and treatment response. This study investigated the relationship between protein intake, nutritional status, and treatment response in pulmonary TB patients undergoing intensive therapy in Dili and Oecusse. Method: Using a cross-sectional study design, 104 participants were recruited using consecutive sampling. Data collection included both primary and secondary data. Analyses were conducted using the independent samples t-test, Mann-Whitney, and Fisher's Exact Test. Results: There are 66.3% at risk of malnutrition based on upper arm circumference, a mean body mass index of 17.86 kg/m². The median daily protein intake was 1.07 g/kgBW/day, with lower intake of animal protein compared to plant protein (0.44 g/kgBW/day vs. 0.59 g/kgBW/day). The study found no significant relationship between protein intake and nutritional status in response to the intensive phase therapy (p>0.05). Conclusion: There is no significant relationship between protein intake and nutritional status in response to the intensive phase therapy. Further research with a case-control study design is needed to confirm findings and evaluate factors affecting unbalanced therapy response.

Pneumocystis pneumonia (PCP) is a serious lung infection caused by Pneumocystis jirovecii, primarily affecting immunocompromised individuals. It remains a major health concern, especially in HIV/AIDS patients and those undergoing immunosuppressive therapy. This review discusses how the immune system responds to P. jirovecii and why immunocompromised individuals are more vulnerable. In healthy individuals, CD4+ T cells, B cells, and macrophages help control the infection. However, in immunocompromised individuals, a weakened immune response allows fungal overgrowth, leading to severe lung damage. The review also covers symptoms, diagnosis, and treatment options. TMP-SMX is the preferred treatment, while alternative drugs are available for those who cannot tolerate it. Understanding the immune response to PCP can help improve treatment and patient care.

Introduction: After completion of pulmonary tuberculosis (TB) treatment, some people may continue to experience respiratory issues that can progress into post-TB lung disease (PTLD). Individuals with PTLD exhibit suboptimal nutritional status. The loss of appetite is a significant factor influencing nutritional status. Zinc plays a role in hunger control. Lack of zinc reduces taste sensitivity and food intake. This study examined the relationship between zinc intake and appetite in patients with PTLD at Persahabatan National Respiratory Referral Hospital, Jakarta. Methods: This cross-sectional study was conducted at Persahabatan National Respiratory Referral Hospital, Jakarta, from November 2024 to March 2025. Eighty-five adult patients with PTLD were included. Zinc intake was assessed by a semi-quantitative food frequency questionnaire (SQ-FFQ) and analyzed by NutriSurvey software. Appetite was measured using the visual analog scale (VAS) for appetite. Results: A total of 85 subjects participated in the study, comprising 78.8% males and 21.2% females. The average daily zinc intake was 4.4 mg/day, and 92.9% of the subjects had zinc intake below the recommended dietary allowance (RDA). The average VAS appetite score was 70 mm. A significant positive correlation was found between zinc intake and appetite, indicating that a decrease in zinc intake might result in a reduced appetite (r=0.266, p=0.014). Conclusion: Zinc intake is positively associated with appetite in patients with PTLD. Therefore, zinc intake monitoring is essential for supporting nutritional recovery and lung function in PTLD.

Background: Post-tuberculosis lung disease (PTLD) is a form of progressive lung tissue damage following tuberculosis (TB) infection. In addition to clinical symptoms, patients with PTLD often experience nutritional problems. Appetite plays a crucial role in determining adequate nutrient intake, which can affect nutritional status, the recovery process, and overall quality of life. One factor that may influence appetite is age. Although age is known to affect appetite, the relationship between the two has not been studied, particularly in patients with PTLD at Persahabatan Hospital, National Respiratory Centre.

Introduction: As one of the leading causes of death worldwide, pulmonary tuberculosis (PTB) is an infectious disease that continues to pose a serious threat to public health. The presence of cavities in radiological imaging of patients with PTB is associated with malnutrition, age, gender, and other comorbidities, including diabetes mellitus. This study aimed to find the association between nutritional status and lung cavity in PTB patients. Methods: This was an analytical observational study with a cross-sectional design that involved 134 adult patients who were diagnosed with PTB at Persahabatan National Respiratory Referral Hospital, Jakarta. All patients were interviewed using a questionnaire for sociodemographic and anthropometric data, the nutritional status was assessed using the subjective global assessment (SGA), and the lung cavity was determined using a chest X-ray interpreted by radiologists. The Chi-square test was performed using the Statistical Package for the Social Sciences (SPSS) version 25 for Windows. Results: Of 134 PTB patients, 61.9% were males, and 92.5% were from the 18-59 years old age group. Based on the SGA score, 77 (57.5%) were grouped as mild-moderate malnutrition/SGA B and 22 (16.4%) as severe malnutrition/SGA C. Lung cavity was found in 42 (31.3%) patients. The analysis showed that malnutrition was statistically significantly associated with lung cavity with OR=6.933 (95%CI 1.986-24.205; p=0.002) and the adjusted OR were 7.303 (95%CI 2.060-25.890; p=0.002) after controlling for age, sex, smoking, education, and comorbidities. Conclusion: This study found that malnutrition was associated with lung cavities in PTB patients. These findings might indicate how malnutrition impaired the immune function in PTB patients.

BACKGROUND:Ovarian cancer patients often face poor nutritional status, with body composition (BC) serving as a significant prognostic indicator. Skeletal muscle mass (SMM) and fat-free mass (FFM) are crucial predictors of both survival and hospitalization duration. Increasing protein intake has been linked to improvements in SMM and FFM.OBJECTIVE:This study aimed to document the alterations in BC parameters among ovarian cancer patients undergoing chemotherapy and correlate these changes with their nutrient intake.METHODS:Twelve female patients with stage III ovarian cancer who received first-line chemotherapy were categorized based on their body mass indices (BMI). BC parameters were assessed using an 8-point bioelectrical impedance analysis with a frequency of 50 Hz-60 Hz and measurement impedance range of 10 Ω-1000 Ω. Nutrient intake (energy, protein, fat, and carbohydrate) was assessed before (T0), during the 3rd (T3), and 6th cycle of chemotherapy (T6) through 24-hour food recall.RESULTS:Significant increases in body weight (BW)were observed in the underweight group (from 40.9 to 46.8 kg, p=0.001), concomitant with enhancements in all BC parameters. While changes were noted in SMM, they were not statistically significant (p=0.105).Among the underweight group, a protein intake above 1.2 g/kg BW led to an uptrend trend in SMM. Conversely, FFM in overweight/obese patients decreased significantly (from 37.6 to 36.4 kg, p=0.005) due to a a reduction in body water. Throughout chemotherapy, fat mass (FM), visceral fat (VAT), and phase angle (PhA) increased in all patient groups, reflecting heightened fat and carbohydrate intake.CONCLUSION:Among stage III ovarian cancer patients, BC undergoes dynamic changes dynamically during the course of chemotherapy, with more pronounced enhancements observed in FFM among underweight patients. Notably, improvements in PhA, SMM or FFM were particularly evident among underweight patients with a protein intake above 1.2 g/kg BW.

Asthma is a chronic respiratory condition with a growing global prevalence, affecting millions of individuals annually. While asthma can develop at any age, late-onset asthma is a specific phenotype that begins in adulthood, as recognized by the Global Initiative for Asthma (GINA) in its 2024 guidelines. This form of asthma is often associated with several predisposing factors, including gender, obesity, occupational exposure, rhinitis, respiratory infections, smoking, stress, and diminished lung function. Unlike early-onset asthma, which frequently involves a history of allergies, late-onset asthma tends to lack allergic triggers, making it a distinct and challenging form of the disease. Managing late-onset asthma is often more complex, as it typically requires higher doses of corticosteroids and demonstrates a reduced responsiveness to standard steroid treatments. The exact mechanisms and pathophysiological processes contributing to the increased severity and poorer clinical outcomes in late-onset asthma remain largely unclear. This uncertainty often leads to underdiagnosis and inadequate management, further complicating patient care. Phenotypic analysis is recommended to improve treatment outcomes. This includes assessing clinical features and utilizing biomarkers, such as inflammatory markers and immunoglobulin E (IgE) levels, to guide targeted therapy when conventional steroid treatments are insufficient. However, there is a significant need for further research to elucidate the underlying mechanisms of late-onset asthma. This literature review is essential to develop more effective, personalized treatment strategies that can address the unique challenges posed by this asthma phenotype, ultimately leading to better management and improved patient outcomes.

Patofisiologi COVID-19 melibatkan jalur persinyalan seluler dan molekuler kompleks terkait inflamasi. Salah satu jalur yang mungkin terlibat adalah jalur bradikinin yang mengalami disregulasi. Bradikinin adalah suatu nonapeptida linear derivat dari kininogen yang terdistribusi di berbagai jaringan dan di plasma. Bukti ilmiah memperlihatkan peningkatan produksi bradikinin pada inflamasi. Manifestasi klinis seperti batuk juga berhubungan dengan aktivitas bradikinin. Memahami patogenesi COVID-19 menjadi penting dalam upaya menemukan pendekatan baru pada terapi efektif yang melibatkan jalur bradikinin. Pada tinjauan pustaka ini, akan dibahas bagaimana peranan bradikinin dan metabolitnya pada patogenesis COVID-19.

Tuberculosis causes decreased appetite and hypermetabolism, disrupting protein breakdown and synthesis, leading to malnutrition. Proteins, as the primary source of amino acids, support immune cells and help prevent malnutrition and susceptibility to other infections. The intensive phase of tuberculosis therapy is crucial for enhancing immune defense, reducing the bacterial load, and decreasing energy expenditure, thereby increasing body weight.

Nuclei as a cell nucleus have been found since the 18th century. This discovery was then developed for the need for methods for diagnosing pathogenic organisms of an infectious disease at that time. The aim of this study is to review the principle of nucleic acid amplification test and describe the existing evidence regarding the role of the test in respiratory diseases. The study use the keywords, such as nucleic acid, diagonsis and nucleic acid amplification test, to invesitage relevant studies in PubMed and Google Scholar database. We found that nucleic acid-based testing techniques have evolved to adapt to the need for early and rapid detection and rely on a high level of accuracy. This continuously developed technology can replace conventional test methods. Conventional examination is known to take longer time so the definitive therapeutic might be delayed. However, there is still an obstacle, namely the cost of tests quite expensive because of the standard procedure that must be strictly followed, otherwise result might not be valid. The technique from the beginning needs to be carried out following the procedure, starting with the preparation of tools, how to take samples, how to deliver the samples to the laboratory, and how to process and analyze data. This procedure is necessary to minimize false positive or negative results. As a conclusion, nucleic acid assays is beneficial in pulmonary infectious diseases diagnosis, however it is high-cost and not recommended for treatment evaluation in pulmonary infection.

Introduction: Drug-induced hepatitis (DIH) is one of the serious side effects of anti-tuberculosis drugs (ATD) that can reduce patient compliance with tuberculosis (TB) treatment, increase the risk of treatment failure, or develop drug resistance. Vitamin C is a potential antioxidant known to have a protective effect against DIH. This study examined the relationship between vitamin C intake and the incidence of ATD-induced hepatitis (ATDIH) in pulmonary TB patients at Persahabatan National Respiratory Referral Hospital, Jakarta. Methods: This was a cross-sectional study of 108 patients with drug-sensitive pulmonary TB. Data was collected using a sociodemographic questionnaire, anthropometric measurements, semi-quantitative food frequency questionnaire (SQ FFQ), and data on the subject's liver function laboratory results in the last 1 month. Fisher exact test was utilized to analyze the association between adequacy of vitamin C intake and DIH. Results: The proportion of DIH in pulmonary TB patients in this study was 6.5%. Most subjects were males (54.6%) with a median age of 41. The median vitamin C intake was 66.65 mg/day, with 63.0% of patients having an intake below the recommendation. Fisher's exact test showed that vitamin C intake was not statistically significantly associated with the incidence of ATDIH (OR 3.77 95% CI 0.44-32.55, p-value 0.256). No factors also influenced the incidence of ATDIH in this study. Conclusion: No association was found between vitamin C intake and other factors related to the incidence of ATDIH. This is the first study in Indonesia to link vitamin C and E intake with the incidence of DIH in drug-sensitive pulmonary TB patients, providing information for future studies.