Indonesia has limited data on asbestos-related diseases despite abundant use. This study investigated the risk of occupational asbestos exposure for lung cancer development, utilizing a hospital-based case-control study. Subjects were patients who received a thoracic CT scan at Persahabatan Hospital, Jakarta. The cases had primary lung cancer confirmed by histology, the controls were negative for lung cancer. The cumulative occupational asbestos exposure was calculated by multiplying the exposure intensity by the years of exposure. The exposure intensity was obtained by adopting the weighted arithmetic mean value of asbestos exposure from a job-exposure matrix developed in Korea. The primary data analysis was based on logistic regression. The study included 696 subjects, with 336 cases and 360 controls. The chance of lung cancer for subjects exposed to asbestos was doubled (OR = 2.04, 95% CI = 1.21–3.42) compared with unexposed, and subjects with a cumulative asbestos exposure of 10 fiber-years or more even showed an OR of 3.08 (95% CI = 1.01–9.46). The OR of the combined effect between smoking and asbestos was 8.7 (95% CI = 1.71–44.39); the interaction was consistent with an additive and multiplicative risk model. Asbestos exposure is associated with a higher chance of lung cancer. Improved policies are needed to protect the population from asbestos hazards.
In Indonesia, many occupations and industries involve a variety of hazardous and toxic materials. The ILO estimates that about 21.1% of the tracheal, bronchial, and lung cancer deaths among men were attributable to workplace hazardous substances. This study investigated the relationship between occupations or workplace exposure and the risk of lung cancer in the country. The results will help determine how Indonesia can best mitigate the risk for its workers. This case-control study utilizes the Indonesian Standard of Industrial Classification (IndSIC) 2015 with the aim of exploring the risk of lung cancer among Indonesian workers. The study included patients aged 35 years old or older receiving thoracic CT at the radiology department of Persahabatan Hospital. The cases were histological-confirmed primary lung cancers, while the controls were negative thoracic CT scan for lung cancer. The subjects’ job titles and industries were classified according to IndSIC 2015 and blind to the patient’s grouping as a case or control. Logistic regression was used to determine the odds ratios for lung cancer among all sections and some divisions or groups of IndSIC 2015. The mean age was 58.1 (±10.23) years for lung cancer patients and 54.5 (±10.23) years for controls. The majority of subjects (19.6%) worked in Section G (Wholesale and retail trade; repair of motor vehicles and motorcycle). After adjusting for age, gender, level of education, and smoking habit, the risk of lung cancer was nearly three-times higher (OR = 2.8, 95% CI = 1.11–7.02) in workers of Division A01 (crop, animal production, and hunting) and two-times higher (OR = 1.9, 95% CI = 1.05–3.46) in workers of Section F (construction) compared to the workers in other sections or divisions. The excess risk of lung cancer among certain categories of workers confirms the need for improved policy, monitoring, and control of occupational exposure for primary cancer prevention and workers’ compensation purposes.
1 July 2024 in International Journal of Chronic Obstructive Pulmonary Disease
Purpose: The exact link between cognitive impairment (CI) and chronic obstructive pulmonary disease (COPD) is still limited. Thus, we aim to find the relationship and interaction of quantitative CT (QCT), lung function, HIF-1α, and clinical factors with the development of CI among COPD patients. Patients and Methods: A cross-sectional multicentre study was conducted from January 2022 to December 2023. We collected clinical data, spirometry, CT images, and venous blood samples from 114 COPD participants. Cognitive impairment assessment using the Montreal Cognitive Assessment Indonesian version (MoCA-Ina) with a cutoff value 26. The QCT analysis consists of lung density, airway wall thickness, pulmonary artery-to-aorta ratio (PA:A), and pectoralis muscles using 3D Slicer software. Serum HIF-1α analysis was performed using ELISA. Results: We found significant differences between %LAA− 950, age, COPD duration, BMI, FEV1 pp, and FEV1/FVC among GOLD grades I–IV. Only education duration was found to correlate with CI (r = 0.40; p < 0.001). We found no significant difference in HIF-1α among GOLD grades (p = 0.149) and no correlation between HIF-1α and CI (p = 0.105). From multiple linear regression, we observed that the MoCA-Ina score was influenced mainly by %LAA− 950 (p = 0.02) and education duration (p = 0.01). The path analysis model showed both %LAA and education duration directly and indirectly through FEV1 pp contributing to CI. Conclusion: We conclude that the utilization of QCT parameters is beneficial as it can identify abnormalities and contribute to the development of CI, indicating its potential utility in clinical decision-making. The MoCA-Ina score in COPD is mainly affected by %LAA− 950 and education duration. Contrary to expectations, this study concludes that HIF-1α does not affect CI among COPD patients.
Diabetic kidney disease (DKD) significantly increases mortality, with patients facing a fourfold risk of death within ten years. Chronic inflammation, marked by transforming growth factor-β (TGF-β) and intracellular adhesion molecule-1 (ICAM-1) activity, contributes to kidney damage and fibrosis. This study investigates the effect of autologous dendritic cells on inflammation and kidney function, focusing on apparent diffusion coefficient (ADC), TGF-β, and ICAM-1 levels. This quasi-experimental clinical trial involved 22 DKD patients at Gatot Soebroto Army Hospital. Patients received autologous dendritic cell injections. Baseline and post-intervention magnetic resonance imaging (MRI) scans measured ADC values, and ICAM-1 and TGF-β levels were analyzed. Post intervention, the median ADC decreased from 1.75 mm2/s to 1.64 mm2/s (p = 0.223). ICAM-1 levels increased significantly in females (p = 0.04) but not in males (p = 0.35). No significant changes were found in TGF-β levels (p = 0.506). ADC changes were statistically insignificant and did not correlate with CKD severity. ICAM-1 increases in females correlated with improved creatinine levels, suggesting kidney function improvement. Autologous dendritic cell therapy revealed potential gender-specific immune responses but showed limited overall biomarker improvements. Further studies are required to validate its therapeutic value.
Background Indonesia is one of the world's largest asbestos importing countries. While asbestos is the main contributor to work-related lung cancer, studies or reports regarding the CT findings of asbestos-related lung cancer have been limited in the country. The objective of this study was to compare CT findings of the size of the tumor and pleural and lung parenchymal changes between lung cancer patients exposed to asbestosis and those not exposed. Methods This cross-sectional study involved 96 lung cancer patients consisting of 48 subjects who had been exposed to asbestos and 48 who had not been exposed. They underwent thoracic CT scans at the Radiology Department of Persahabatan Hospital. Asbestos exposure was determined using interviews that followed a protocol similar to that of a previous study about asbestos-related lung cancer. Senior radiologists investigated the existence of pleural and parenchymal changes. An independent T- test and chi-square test to compare CT scan features between the two groups. Results The mean age was 57.75 ± 8.56 years in the asbestos-exposed group and 58.56 ± 7.99 years in the unexposed group. The proportion of tumor sizes of more than five cm, pleural plaques, and subpleural dot-like or branching opacities were significantly higher among asbestos-exposed subjects compared to the non-exposed group (p = 0.044;p=0.37;p=0.041, respectively). Conclusions Asbestos exposure is significantly related to the size of the tumor and the existence of pleural plaques and asbestosis. These findings may help further management of lung cancer patients and the policy of asbestos use in Indonesia.
Menetapkan komponen gambaran morfologi kanker paru primer pada CT scan toraks yang dapat dipakai sebagai kriteria diagnosis. Penelitian ini menggunakan desain cross sectional. Dalam kurun waktu Desember 2006 - Mei 2007 di RS. Persahabatan Jakarta dilakukan pemeriksaan CT scan toraks terhadap 28 pasien dengan gambaran klinis diduga kanker paru primer. DinilailO gambaran morfologi kanker paru pada CT scan toraks, setiap gambaran morfologi kanker dibandingkan dengan hasil sitologi CT guided TTNA sebagai baku emas. Terdapat 7 komponen morfologi kanker paru primer pada CT scan toraks yang mempunyai sensitivitas yang tinggi dalam diagnosis yaitu: ukuran tumor > 3 cm sensitivitas 95,7%, penyangatan s24 HU sensitivitas 82,6%, tepi irregular-spiculated sensitivitas 78,3%, lobulated sensitivitas 73,9%, air bronchograms sensitivitas 69,6%, ground glass opacity sensitivitas 65,2 % dan densitas heterogen sensitivitas 65,2%. Komponen morfologi ukuran tumor > 3 cm, penyangatan 24 HU, tepi irregular spiculated, lobulated, air bronchograms, ground glass opacity dan densitas heterogen mempunyai sensitivitas yang tinggi serta dapat dipakai sebagai kriteria diagnosis kanker paru primer pada CT scan toraks. Kata kunci: morfologi, kanker paru primer, CT scan toraks