Sirosis hepatis adalah tahap akhir penyakit hati dengan berbagai penyebab, antara lain kelainan metabolik atau infeksi hepatitis B dan hepatitis C. Hingga saat ini, sirosis hepatis diyakini sebagai proses tidak reversibel, yang berujung dengan transplantasi hati. Namun, seiring dengan perkembangan teknologi dan pemahaman tentang patogenesis, sirosis hepatis mungkin bersifat reversibel. Liver cirrhosis is a final stage of liver disease with many etiologies, i.e. metabolic disorder or infection like type B hepatitis and type C hepatitis. Liver cirrhosis is still being considered as an irreversible disease, which leads to liver transplantation. But as far as the development of technology and knowledge of liver cirrhosis pathogenesis, liver cirrhosis might be considered as a reversible process.

<p>Latar belakang: Parasetamol sering digunakan untuk mengobati gejala demam pada COVID-19. Banyak hipotesis yang menyebutkan hubungan kadar Glutathione (GSH) dengan derajat keparahan COVID-19, sedangkan parasetamol dapat menurunkan kadar GSH. Hingga saat ini, belum ada panduan khusus untuk dosis penggunaan obat parasetamol pada pasien COVID-19.</p><p>Background: Paracetamol is often used to treat fever symptoms in COVID-19. Many hypotheses state the relationship between Glutathione (GSH) levels and the severity of COVID-19, while paracetamol can reduce GSH levels. To date, there are no specific guidelines for the dosage of paracetamol in patients with COVID-19</p><p> </p>

<p>Sirosis hepatis adalah tahap akhir penyakit hati dengan berbagai penyebab, antara lain kelainan  metabolik atau infeksi hepatitis B dan hepatitis C. Hingga saat ini, sirosis hepatis diyakini sebagai proses tidak reversibel, yang berujung dengan transplantasi hati. Namun, seiring dengan perkembangan teknologi dan pemahaman tentang patogenesis, sirosis hepatis mungkin bersifat reversibel.</p><p> </p><p>Liver cirrhosis is a final stage of liver disease with many etiologies, i.e. metabolic disorder or infection like type B hepatitis and type C hepatitis. Liver cirrhosis is still being considered as an irreversible disease, which leads to liver transplantation. But as far as the development of technology and knowledge of liver cirrhosis pathogenesis, liver cirrhosis might be considered as a reversible process.</p>

According to the global cancer observatory (GLOBOCAN), there were 16,485 new cases of pancreatic cancer in Southeast Asia in 2020, with men (9458 cases) having the highest incidence compare to woman (8320 cases). The death rate from 16,485 cases was 16,167 cases (98%). A person's chance of developing pancreatic cancer in addition to other cancers is between 1% to 20%. In this study, we reported a case of pancreatic tumor with lung tumor. A 68 years old woman presented with right quadrant abdominal pain since 1 month ago. The pain occurs randomly, but mostly occur during night. The pain didn’t occur after eat fatty food and during exercise. The pain didn’t relieve by rest. The patient also experienced nausea and vomit. The vomit consist of food and blood. She complains black colored stools and dark yellow urine. She also lost weight from 62 kg to 47 kg. There was history of gastric bleeding in 4 month ago. She was passive smoker. We then did several tests such as complete blood count, blood chemistry, serology, chest x-ray and abdominal CT-scan. The test showed pancreatic tumor with suggestive primary lung tumor. Patient with multiple primary tumor are an extremely rare type of cancer, which need comprehensive approach to both diagnosis and treatment of these numerous primary tumors.

Pancreatic cancer is the seventh leading cause of cancer-related mortality worldwide and the eleventh most common cause of cancer-related death in Indonesia. In pancreatic cancer, rapid and early diagnosis is crucial. Carbohydrate antigen 19-9 (CA 19-9), the most sensitive and specific tumor marker for pancreatic cancer, may help in diagnosing and determining prognosis; however, some populations do not express CA 19-9. Cases of low CA 19-9 may occur in populations with Lewis ⍺-β- genotype. These populations are not able to express Lewis antigen and CA 19-9; therefore, CA 19-9 investigation cannot be used for diagnostic and therapeutic measures. In patients highly suspicious of pancreatic cancer where CA 19-9 levels are low, alternative tumor markers such as CA 125 and carcinoembryonic antigen or a combination of various tumor markers can be used to increase sensitivity and specificity in diagnosing pancreatic cancer. A 70-year-old man presented with a complaint of worsening abdominal pain for the last two days. The patient had dark-yellow urine and pale stool. Abdominal ultrasonography and computed tomography scan showed a mass on the head of the pancreas, which was highly suspicious of pancreatic cancer.