Introduction Headache is a common complaint encountered in primary care. In Indonesia, however, only migraine and tension-type headache are expected to be fully managed by general practitioners (GPS). Effective management requires a comprehensive understanding of headache diagnosis, treatment, and appropriate referral in primary care settings. Educational interventions for GPs are therefore essential to address existing unmet needs. This study aims to conduct a needs assessment to identify barriers in headache management in primary care and to determine gaps that can inform the development of targeted interventions. Methods We conducted in-depth interviews with headache stakeholders and focus group discussions involving practitioners from government-owned and privately-owned primary care facilities. Verbatim was analyzed and categorized into themes. The themes from in-depth interviews and focused group discussions are compared and synthesized to make recommendations for the module development. Results Several critical gaps were identified. First, history taking was acknowledged as essential but was often constrained by time-limited consultations and lack of structured diagnostic tools. Second, while practitioners recognized the importance of headache red flags, their application in clinical decision-making was inconsistent, leading to uncertainty in referral thresholds. Third, knowledge of secondary headache disorders and medication-overuse headache (MOH) was limited; MOH was frequently unrecognized as a distinct clinical entity. Fourth, the use of international headache guidelines and standardized diagnostic criteria was minimal, mainly due to perceived complexity and limited relevance to local practice. Based on these findings, stakeholders and practitioners agreed that priority module components should include: (1) a focused history-taking guide, with approach based on red flags for secondary headache, (2) simplified diagnostic algorithms (3) focused section on MOH and management, and (4) guidance on treatment choices aligned with locally available medications. Interactive, case-based workshops, delivered offline or in hybrid formats, were preferred. Conclusion This study provides evidence regarding barriers in headache diagnosis, treatment and referral in Indonesian primary care and translates them into concrete educational priorities. A GP headache learning module should emphasize practical diagnostic strategies, early identification of secondary headache and MOH, and guideline implementation adapted to local resource constraints and consultation realities. Our findings offer a structured framework for developing focused continuing medical education to strengthen headache management in Indonesia.

Postherpetic Neuralgia (PHN) is a persistent neuropathic pain following Herpes Zoster, particularly in the elderly. A case is reported of a 70-year-old man with PHN two months after HZ, experiencing burning and throbbing pain in the right T11–12 thoracic dermatomes with a pain scale of 8/10, paroxysmal in nature up to 10 times/day, triggered by touch, and disturbing sleep. The pain was unresponsive to gabapentin 1,800 mg/day and amitriptyline 12.5 mg/day. Two perineural injections of 5% dextrose reduced the pain to 6/10. At week 13, an ultrasound-guided erector spinae plane block was performed at the T12 level using 2% lidocaine (10 mL) and dexamethasone 5 mg, which rapidly reduced the pain from 6/10 to 0/10, with sustained improvement and discontinuation of medication. No complications were found. This case shows the erector spinae plane block as a safe, minimally invasive, and effective rescue therapy for refractory PHN.

BackgroundMeningiomas are the most common primary intracranial tumors, with clinical manifestations that vary depending on tumor location and biological behavior. Understanding the relationship between tumor location, presenting symptoms, and histopathological grade is essential for improving diagnostic accuracy and clinical management. This study aimed to evaluate the association between tumor location, clinical manifestations, and World Health Organization (WHO) grade in patients with intracranial meningioma.MethodsThis retrospective observational study included consecutive patients aged ≥18 years who underwent first-time intracranial meningioma resection over a 10-year period (2013–2023) at Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia. Demographic data, presenting symptoms, tumor location (cranial base vs. non–skull base, with convexity, parasagittal, falcine, and intraventricular tumors grouped as the non–skull base/convexity category), Simpson grade of resection (I–V), and WHO histopathological grade were extracted from medical records. Pearson’s chi-square test was used to assess associations between categorical variables and tumor location.ResultsA total of 531 patients were included. The majority were female (92.1%) with a median age of 45 years (range 18–82). Cranial base meningiomas accounted for 77.2% of cases. Female gender (p=0.037), age <60 years (p<0.001), WHO grade I tumor (p<0.001), a higher proportion of Simpson grade III–V resection (p<0.001), cranial nerve deficits (p<0.001), and visual field deficits (p=0.010) were significantly more frequent in cranial base meningiomas. In contrast, decreased consciousness (p<0.001), headache (p=0.023), motor deficits (p<0.001), sensory deficits (p=0.009), and seizures (p<0.001) were significantly more frequent in non–skull base/convexity meningiomas.ConclusionTumor location in meningioma is associated with specific clinical manifestations and histopathological grade. Cranial base tumors tend to present with cranial nerve–related and visual symptoms, whereas non–skull base tumors are more likely to cause seizures, motor deficits, and decreased consciousness. Higher-grade tumors are more commonly found in non–skull base locations. The disproportionately high female-to-male ratio observed in this Indonesian surgical cohort should be interpreted with caution, as selection and referral bias may have contributed; it warrants confirmation in population-based studies that include molecular profiling and prospectively collected hormonal-exposure data.

Pain is a common non-motor symptom in parkinsonism, often overlooked despite its significant clinical impact. The most common form is Parkinson's disease (PD), followed by secondary and atypical parkinsonisms such as PSP. Two cases presented with musculoskeletal-spinal pain as the chief complaint: a PD patient with upper back pain that improved after an erector spinae nerve block, and a PSP patient with lumbar facet pain that improved after an intra-articular steroid injection. Pain in parkinsonism can originate from muscles, bones, joints, discs, ligaments, fascia, or nerves, requiring careful evaluation. Both cases demonstrate the effectiveness of pain injection interventions in patients unresponsive to conservative therapy. Appropriate pain assessment and management are crucial to improving the quality of life of parkinsonism patients.

OBJECTIVE:Assessment of treatment efficacy in neuro-oncology is measured by radiographic criteria. This can be misleading, as imaging findings may not translate into clinical benefit. The NANO scale, constructed by multidisciplinary experts, is an objective and measurable metric of neurological function that can be evaluated during routine examinations in brain tumor patients, so that patients receive an overall assessment of progression, along with radiological findings. This study aims to determine the validity and reliability of the Indonesian version of the NANO scale (NANO-Ina). METHODS:The study was performed at Cipto Mangunkusumo National Referral Hospital, Jakarta. The validity and reliability process incorporated forward and backward translation to ensure cross-cultural equivalence, and an initial trial was conducted with 10 physicians to identify potential issues and refine item clarity. Subsequently, the 9 domains of the NANO-INA version were tested on 30 pathologically confirmed brain tumor patients by 2 distinct physicians separately. Inter-rater reliability was analyzed using the Kappa statistics. RESULT:A total of 30 subjects were enrolled from January to August 2023, which included subjects mostly diagnosed with brain metastasis (30%), and the rest were equally distributed among meningioma, glioblastoma, and other primary brain tumors (23.3%). Among these, the majority had not received any treatment (77%), and the remaining were on chemoradiation (10%), chemotherapy (10%), and radiation (3.3%). Our inter-observer variability study demonstrated that the NANO-INA scale exhibits substantial to almost perfect agreement (kappa statistic ranging from 0.629-0.935) for all domains (p<0.05), with the highest agreement observed in strength, facial strength, and language. CONCLUSION:The NANO-INA scale shows  a high level of inter-observer agreement and serves as a reliable tool for assessing neurological function in patients with brain tumors in clinical settings in Indonesia.

Introduction: Cancer-related pain remains inadequately managed in a substantial proportion of oncology patients, despite established clinical protocols. Current systematic evidence indicates that up to 55% of patients experience undertreated pain.35 Interdisciplinary oncology teams — comprising nursing professionals and primary care physicians (PCPs) — are a critical organizational strategy for improving cancer pain management across the care continuum. Methods: A systematic narrative synthesis was conducted using 30 peer-reviewed sources identified through structured searches of the PubMed, CINAHL, Scopus, and Cochrane databases. Inclusion criteria encompassed studies, reviews, and guidelines published from 2002 to 2025 that addressed professional roles, team structure, barriers, and clinical outcomes in cancer pain management. Results: Nursing professionals contribute substantially to pain assessment and management through validated instruments, pharmacological and non-pharmacological interventions, patient self-management education, and interdisciplinary advocacy. PCPs facilitate care coordination, ensure analgesic prescribing continuity, and manage the primary–specialty interface. Effective interdisciplinary teams improve patient outcomes through structured communication, clear roles, and integrated care pathways. Persistent barriers include care fragmentation, professional role ambiguity, competency gaps, and regulatory constraints on opioid prescribing. Conclusions: Although current evidence supports the effectiveness of interdisciplinary approaches to improving cancer pain outcomes, significant gaps remain in comparative effectiveness data, implementation science, and health equity research. Enhanced clinical training, organizational investment, and policy reform are necessary to optimize collaborative cancer pain management across diverse healthcare settings. Keywords: Cancer Pain, Interdisciplinary Teams, Nursing Professionals, Primary Care Physicians, Collaborative Care, Palliative Care, Pain Mechanisms

PurposeThis study aimed to refine and simplify the existing standardized headache reporting axis used in Indonesian neurology training, addressing challenges in usability, efficiency, and diagnostic clarity while maintaining essential clinical detail.MethodsA qualitative needs assessment was conducted through a focus group discussion involving six neurology residents with experience in headache management at a national referral hospital. Data were collected through a structured, moderator-led discussion, transcribed verbatim, and analyzed thematically using the Steps for Coding and Theorization (SCAT) method to identify core themes and recommendations for revision.ResultsFour major themes emerged: (1) benefits of standardized and systematic reporting; (2) challenges and barriers in documentation; (3) variability and the need for contextual adaptation across clinical settings; and (4) recommendations for simplification and efficiency. Key revisions included merging quality with phenotype, combining severity with functional status, and integrating aura and autonomic symptoms under associated symptoms. The updated axis emphasizes essential dromal elements—phenotype, duration, intensity, and location—while incorporating biopsychosocial factors for a more holistic approach. The tool was also designed to accommodate different clinical contexts, including emergency, outpatient, and inpatient settings.ConclusionA concise and structured headache documentation framework enhances diagnostic accuracy, therapeutic decision-making, and clinical efficiency. The revised headache axis offers a flexible yet standardized tool potentially adaptable across care settings, supporting both clinical practice and future research in headache management.

BACKGROUND The Douleur Neuropathique 4 (DN4) is a widely used questionnaire for assessing neuropathic pain, demonstrating good sensitivity and specificity across various languages. Originally developed in France, cultural and linguistic differences necessitate its translation, validation, and reliability testing before use in Indonesia. This study aimed to translate, culturally adapt, and evaluate the validity and reliability of the Indonesian version of the DN4 questionnaire (DN4-Ina) for use in clinical and research settings. METHODS Translation and cross-cultural adaptation were conducted following World Health Organization guidelines in Indonesian. A cross-sectional study was conducted in the Neurology Clinic, Cipto Mangunkusumo Hospital, to assess the validity and reliability of the DN4-Ina. The study subjects were selected through consecutive sampling of adult patients with chronic pain visiting the clinic from June to December 2023. Validity and reliability were assessed using SPSS software version 25. Validity testing utilized adjusted item-total correlation analysis, while reliability testing was evaluated using the test-retest method, intraclass correlation coefficient (ICC), and Cronbach's alpha for internal consistency. RESULTS Of 40 participants, 65% were female, with a mean age of 51.85 (13-92) years, moderate pain intensity (mean numeric rating scale of 4.25 [2.99]), and pain duration of 7.95 (4.41) months. All DN4-Ina questions showed a correlation coefficient (r) greater than the table's value (0.312). The reliability test showed an ICC of 0.99 and a Cronbach's alpha of 0.746. CONCLUSIONS The DN4-Ina score is a valid and reliable questionnaire for assessing neuropathic pain in the Indonesian population.

Background: Headache is an alarm for structural abnormalities, and it frequently manifests as an initial symptom of brain tumors, with an occurrence rate ranging between 36-80%, depending on the type and location of the tumorMethods: We conducted a retrospective cross-sectional study to observe hospitalized brain tumor patients at Dr. Cipto Mangunkusumo Hospital from January 2022 to March 2023. This study described the prevalence and the percentages of baseline characteristics.Results: Our study revealed that out of 101 brain tumor patients, predominated by females (60.4%) with a mean age of 46.2 years. Secondary brain tumors originating from breast cancer were more prevalent (13.9%). Frontal lobe location was frequent (32.3%), displaying rapid growth (66.3%), focal deficits (82.2%), and headaches (79.2%). Atypical headache was the most common phenotype (40%), often occurring either before the onset of neurological deficits (prechronous) or concurrently with them (synchronous). Discussion: The study revealed that high-grade, rapidly growing brain tumors tend to induce focal neurological deficits and headaches due to the tumor’s progressivity and mass effect. Brain tumor lesions were primarily found in the frontal lobe of the supratentorial region, displaying a mainly atypical headache phenotype. The absence of pain receptors in the parenchyma suggested that pain resulted from mechanical stimulation of other pain-sensitive structures.Conclusion: Atypical headaches occurring within 30 days before neurological deficits could indicate potential malignancy.

Metastatic brain tumors, surpassing primary brain tumors in prevalence by tenfold, are the most common brain neoplasms, emphasizing the role of early diagnosis in improving the patient’s quality of life. This study aimed to identify the characteristics of brain tumor metastases at dr. Cipto Mangunkusumo National Referral Hospital (RSCM). With consecutive sampling, a cross-sectional design study using secondary brain tumor data was conducted at RSCM from January 2016 to December 2020. Characteristics data were presented in percentages, and bivariate analysis was conducted using Chi-square or Fisher’s test. Among 222 subjects (mean age 50.9 ± 10.4 years, 60.8% women), metastases were predominantly supratentorial (50.6%), multiple (65.8%), and associated with mass effects (51.4%), particularly midline shift (69.6%). Primary tumors were predominantly lung (36.5%), breast (34.2%), and 55.9% experienced metastases in other organs. Brain metastases manifested metachronously in 67.6% of cases, with primary breast tumors showing a higher propensity for metatentorial and infratentorial metastases, while primary lung tumors showed a synchronous onset. The study highlighted associations between mass effects, loss of consciousness, and poor performance in subjects. Primary lung and breast tumors exhibited the highest incidence of brain metastases. Keywords: brain tumor, characteristic, metastatic. Karakteristik Tumor Otak Metastasis di RS Rujukan Nasional dr. Cipto Mangunkusumo Abstrak Tumor otak metastatik, yang prevalensinya melebihi tumor otak primer sebanyak sepuluh kali lipat, merupakan neoplasma otak yang paling umum, sehingga menekankan peran diagnosis dini dalam meningkatkan kualitas hidup pasien. Penelitian ini bertujuan untuk mengetahui karakteristik metastasis tumor otak di RSCM. Dengan metode consecutive sampling, sebuah studi desain cross-sectional menggunakan data tumor otak sekunder dilakukan di RSCM sebagai Rumah Sakit Rujukan Nasional dari Januari 2016 hingga Desember 2020. Data karakteristik disajikan dalam persentase, dan analisis bivariat dilakukan dengan menggunakan uji Chi-square atau Fisher. Di antara 222 subjek (usia rata-rata 50,9 ± 10,4 tahun, 60,8% perempuan), metastasis dominan terjadi di supratentorial (50,6%), multipel (65,8%), dan berhubungan dengan efek massa, terutama pergeseran garis tengah (69,6%). Tumor primer terbanyak adalah paru (36,5%) payudara (34,2%), dan 55,9% mengalami metastasis ke organ lain. Metastasis otak bermanifestasi secara metachronous pada 67,6% kasus, dengan tumor payudara primer menunjukkan kecenderungan lebih tinggi untuk bermetastasis metatentorial dan infratentorial, sedangkan tumor paru primer menunjukkan onset yang sinkron. Studi ini menyoroti hubungan antara efek massa, penurunan kesadaran, dan kinerja buruk pada subjek. Tumor primer paru-paru dan payudara merupakan insiden metastasis otak tertinggi. Kata kunci: tumor otak, karakteristik, metastasis.

Background. Calvarial metastases from thyroid malignancy, particularly in Hürthle cell carcinoma (HCC), are rare, with most cases affecting non-skull bones and lungs. Metastasis to the skull, especially with intracranial involvement, is exceedingly uncommon. This case highlights an unusual presentation of metastatic HCC as an extensive calvarial mass infiltrating the intracranial compartment. Case report. A 37-year-old male presented with a progressively enlarging and painful mass on his scalp over two years, growing from the size of a marble to a double-head appearance. His medical history included a neck mass present since age 12. Neurological and vital examinations were normal. CT scan and angiography showed a calcified and hemorrhagic mass supplied by the external carotid artery, destroying bilateral parietal bones and infiltrating the superior sagittal sinus and dura mater. Neck ultrasound suggested solid bilateral thyroid nodules. Histopathology of thyroid biopsy and resected tissue confirmed Hürthle cell carcinoma. A subtotal calvarial tumor resection was performed, followed by an Orticochea flap. Histopathology of the resected tissue confirmed thyroid metastasis. Post-surgery, the patient developed self-resolving right hemiparesis and acute seizures, managed with topiramate. Multidisciplinary consultation led to planned radioiodine therapy, with bevacizumab considered as an alternative if radioiodine failed. Conclusion. Calvarial metastasis is a rare manifestation of Hürthle cell carcinoma, and it can progress as a giant mass without neurological deficits. This case demonstrates the resectability of such metastasis with a favorable outcome.

Background: Meningiomas can induce inflammation in their tumorigenesis process, thereby linking inflammation with clinical symptoms, peritumoral edema, and recurrence of meningiomas. Easily accessible and cost-effective inflammatory markers include the neutrophillymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR). This study aims to investigate the relationship between peripheral inflammation markers, specifically the NLR and MLR, and their association with clinical symptoms, peritumoral edema, and meningioma recurrence. Method: A retrospective cohort study was conducted at Cipto Mangunkusumo National General Hospital from January 2016 to December 2019, utilizing a consecutive non-probability sampling method. Inclusion criteria were patients aged 18 years or older with meningiomas(gradesI-III), first surgery. Peripheral inflammatory markers were derived from differential blood counts, peritumoral edema data from radiological reports, and other data from medical records. The cut-off valuesfor NLR and MLR were determined to be 2.415 and 0.295, respectively. Bivariate analyses using ChiSquare and Mann-Whitney tests were followed by multivariate logistic regression analysis. Results: 173 patients were eligible for analysis. Of these, 27 had preoperative CT scans, 126 had MRIs, and 20 had no preoperative radiology data. Clinical and recurrence analyses were performed on all 173 patients, with radiology and tumor size analyses conducted on subsets of 153 and 126 patients, respectively. The majority of meningiomasin thisstudy were grade I, found in 94.2% of subjects, with the remainder being grade II and III. Higher NLR and MLR values were significantly associated with headaches (p < 0.001). Elevated NLR and MLR were also correlated with peritumoral edema (p < 0.001). MLR was independently associated with recurrence, with an adjusted odds ratio (aOR) of 12.647 (95% CI 2.355—67.919); p = 0.003. Conclusion: NLR and MLR as peripheral inflammatory markers demonstrated higher median values in meningioma patients with headaches and peritumoral edema. Additionally, inflammation in meningiomas was associated with the occurrence of recurrence.

Background: Leptomeningeal metastases (LM) are a condition in which malignant cells spread to the leptomeninges and subarachnoid space, with an increasing incidence and poor prognosis. Cerebrospinal fluid (CSF) analysis is an important examination, with cytology as the gold standard for detecting malignant cells in CSF. We aim to describe the CSF profile (i.e. protein, glucose, cell count, and cytology) in detecting malignant cells among patients with suspected LM in Cipto Mangunkusumo National Referral Hospital and Dharmais National Cancer Center Hospital from January 2018 to December 2021. Method: A multicenter cross-sectional retrospective study was conducted to describe the CSF profile in suspected LM from January 2018 to December 2021. Suspected LM cases were established from clinical and radiological findings. The lumbal puncture was performed in those suspected LM cases. Clinical manifestations, radiological data, tumor type, some aspects from CSF routine analysis (i.e. protein, glucose, cell count), and lumbar puncture frequency were described. Their correlation with CSF cytology was analyzed. Results: There were 153 subjects with abnormalities on CSF routine analysis (75.2%), consisting of CSF cell count 5/uL (47.1%) with a median of 5 (1–3504)/uL, CSF protein 45 mg/dL (52.9%) with a median of 50 (5–820) mg/dL, and CSF glucose 50 mg/dL (15%) with a median of 68 (3–629) mg/dL. The positive CSF cytology result was 20.3%. Positive CSF flow cytometry immunophenotyping in hematological malignancy with suspected LM was 25.6%. There was a significant correlation between the increase in CSF cell count, hematological malignancy, and MRI results with CSF cytology (p 0.001; p = 0.03; p = 0.03). There was no significant correlation between clinical manifestations and lumbar puncture frequency with CSF cytology.Conclusion: Abnormalities in CSF routine analysis were found in the majority of subjects with suspected LM, but the CSF cytology positivity rate was considered low. The presence of varied clinical symptoms and repeated lumbar punctures didn’t increase the likelihood of positive CSF cytology

BACKGROUND:Spinal metastatic tumors are a common complication in advanced cancer patients, frequently leading to debilitating pain that significantly impairs quality of life. Cancer-related pain can encompass various etiologies, including nociceptive and neuropathic components. Neuropathic pain, arising from nerve damage or dysfunction, presents unique challenges in terms of diagnosis and management. Despite its high prevalence in cancer patients, neuropathic pain often remains underrecognized and undertreated. This study aimed to determine the factors related to neuropathic pain in patients with spinal metastatic tumors who experience cancer pain. METHODS:This study used a retrospective cross-sectional to analyze cancer pain in patients with spinal metastatic tumors. It was conducted at Dr. Cipto Mangunkusumo Hospital using secondary data from January 2023 to January 2024. Prevalence data were calculated using the prevalence formula and expressed as percentages. Normality was assessed using the Kolmogorov-Smirnov test. Chi-square was employed for data management in groups with categorical scales, with Fisher's test used if the requirements for the chi-square test were not met. RESULTS:The study involved 82 patients with spinal metastatic tumors experiencing cancer pain, 51.2% were women. The patients' mean age was 51.5±12.5 years of these patients, 12.2% had lung tumors. The study findings indicate that a significant proportion (73.2%) of patients exhibited tumors with metastases in multiple locations, 61% in thoracal region with the majority (91.5%) experiencing moderate to severe pain intensity. Regarding pain characterization, 9.6% of patients reported neuropathic pain, 47.6% experienced mixed pain, and 42.2% had nociceptive pain. Data analysis found a significant proportion between pain onset (P=0.05), location of lesion (P=0.03), and pain intensity (P=0.01). CONCLUSIONS:This study shows patients with spinal metastatic tumors suffering pure neuropathic pain (9.6%) and mixed type pain (47.6%). Pain onset, location of lesion, and pain intensity were significantly different between types of pain. The high incidence of neuropathic pain and mixed pain serves as a crucial reference for treating patients with cancer pain.

BACKGROUND:Advanced cancer cases in pregnant patients present complex medico-legal and ethical challenges. We present a case of advanced leiomyosarcoma during pregnancy and its medico-legal aspect. It aims to provide insights into navigating these issues and improving decision-making frameworks for similar cases. CASE DESCRIPTION:A 22-year-old pregnant female at 18 weeks gestation presented with a complaint of a left thigh mass. The patient experienced continuous moderate-severe pain throughout the left thigh and headache accompanied by vomiting. Physical examination revealed somnolence, eyelid ptosis, and ophthalmoplegia of the left eye. The left femoral exhibited erythema, edema, and restricted range of motion due to pain. Femur magnetic resonance imaging (MRI) revealed a pathological mid-femoral fracture secondary to infiltrative soft tissue mass, with multiple inguinal lymphadenopathy metastases. Brain MRI without contrast identified multiple masses in the right frontal and left temporal regions causing significant intracranial mass effect prompting craniotomy for tumor removal. A needle biopsy of the thigh mass confirmed leiomyosarcoma. The patient's consciousness improved after the surgery but suddenly deteriorated a few days later, brain scan without contrast showed an increased size and mass effect of the left temporal lesion. Whole-brain radiation therapy was initiated, but the patient's condition worsened and the fetus also exhibited intrauterine growth restriction and severe oligohydramnios due to cancer progression. Both the patient and fetus succumbed to the disease. CONCLUSIONS:This case underscores the challenges in managing intracranial metastasis in pregnancy, necessitating a multidisciplinary approach for optimal management while minimizing harm. In this case, the ethical aspect of patient autonomy is evident as the patient and her family consented to the medical interventions, despite the risks involved. The principle of beneficence and non-maleficence is demonstrated through the medical team's diagnostic and medical interventions aiming to prevent unnecessary harm to the patient and fetus while still providing effective care for the patient. In terms of justice, the patients get fair access to healthcare resources and treatments, regardless of socioeconomic status. Unfortunately, the patient's condition worsened due to cancer progression. In conclusion, the case highlights the importance of respecting patient autonomy while striving to act in their best interests through beneficent medical intervention.

BACKGROUND:Inflammation plays an important role in proliferation, migration, and invasion of tumor cells; therefore, many research has been done to investigate inflammation parameters including systemic immune-inflammatory index (SII). Dexamethasone, a strong anti-inflammatory, is still widely used as the main treatment in vasogenic edema. High-dose administration (16 mg/day) is recommended in patients with brain tumors with increased intracranial pressure. We performed this retrospective study to determine SII profile, dexamethasone use, and the effect of high-dose dexamethasone on SII in patients with brain tumors. METHODS:We performed a retrospective study on patients with brain tumors in 2022-2023 period who were treated with intravenous high-dose dexamethasone. Patient demographics, clinical characteristics of the brain tumor, concurrent infection, as well as dexamethasone dose and duration were recorded. Platelet, neutrophil, and lymphocyte count obtained prior to dexamethasone administration, and on the fifth to seventh day were also collected. SII was calculated by the following formula: neutrophil × platelet counts/lymphocyte. Data were then analyzed using Microsoft Excel 2019 and SPSS 29.0.2.0. RESULTS:We enrolled 56 patients with brain tumors, age 47±13.5 years, 78.6% were female, 69.6% had malignant brain tumors (brain metastases and high-grade primary brain tumors) and 26.8% had concurrent infection. High-dose dexamethasone was administered with average dose of 16.8±3.3 mg/day for average duration of 4.8±1.8 days. SII was significantly higher in malignant compared to benign brain tumors both in prior and after dexamethasone administration (P=0.02, P=0.01). SII was significantly higher in metastasis brain tumor compared to primary brain tumor (P=0.005). High-dose dexamethasone significantly increased SII and decreased lymphocyte count (P=0.006, P=0.04). CONCLUSIONS:SII was found higher in malignant brain tumor and brain metastasis. High-dose dexamethasone was administered with average dose of 16.81±3.37 mg/day for average duration of 4.78±1.84 days. SII was found to be higher after high-dose dexamethasone, due to a decrease of lymphocyte counts in peripheral blood.

Background: Spinal metastasis is the most frequent type of spinal tumor. Opioid is the first line of treatment for cancer pain despite a multitude of side effects. This study aimed to evaluate the effectiveness of opioids as the latest ladder in the treatment of spinal cancer pain. Methods: A retrospective cross-sectional study was performed comprising 89 spinal metastasis patients at the National Cancer Centre, Dharmais Hospital from November 2021 to March 2022. The demographic and clinical data were retrieved from medical records. This study used the Numerical Rating Scale (NRS) to evaluate the improvement of pain. The change of NRS ≥ 2 was considered significant. The data was analyzed using bivariate (Wilcoxon, Mann-Whitney, and Fisher Exact test) and multivariate (linear regression) analysis. Results: A total of 89 subjects were included in the study (median age = 51 years, 57,3% females). There was a significant decrease in the severity of cancer pain (p0.005) between admission (initial NRS 7) and treatment completion (final NRS 2) in the first hospitalization of all groups. There was no correlation between the clinical characteristics of the participants and the NRS score determined upon admission and at the end of the course of treatment. Conclusions: There was a significant improvement in the cancer pain intensity in the subjects with spinal metastasis cancer pain who received opioid naive therapy.