Background: The major significant factor that affected lung cancer development among female passive smokers is environmental tobacco smoke. Nicotine can be found in a never smoker population, such as a child whose father is a smoker. Lung carcinogenesis in never smoker populations is affected by nicotine metabolism by CYP2A6 gene, which encodes the main nicotine metabolizing-enzyme. The aim of this study was to assess the genetic polymorphism of CYP2A6 and its association with secondhand smokers among females who have suffered from lung cancer in North Sumatra population.Materials and methods: This study was a case-control study, composed of 53 case subjects and 46 control subjects that were involved through a purposive sampling technique from two hospitals in Medan. PCR-RFLP was used for the examination of CYP2A6 gene to determine the genotype. The data were analyzed with conditional logistic regression test using Epi Info 7.0 software.Results: The most common genotype of CYP2A6 detected in this study was *1B/*1B (40.4%), while *1B allele had the highest prevalence (55.5%). There was no significant association between CYP2A6 genotype (p-value=0.61) or alleles (p-value=0.25) and the incidence of lung cancer.Conclusion: There was no association between CYP2A6 polymorphism and the incidence of lung cancer in secondhand smoker females.Keywords: CYP2A6, PCR-RFLP, female secondhand smokers, lung cancer

Introduction: Patients with lung adenocarcinoma following epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) treatment will develop acquired resistance after 7 to 16 months of starting the medication, indicated by the emergence of exon 20 T790M mutations. This study aimed to identify the clinical and demographical profile of acquired resistance in patients with lung adenocarcinoma receiving EGFR-TKI therapy through plasma circulating tumor deoxyribonucleic acid (ctDNA) examination. Methods: This was a descriptive study with a retrospective cross-sectional design involving 108 lung adenocarcinoma patients who received EGFR-TKI for more than six months. Exon 20 T790M EGFR mutations were identified as a sign of acquired resistance using the digital droplet polymerase chain reaction (ddPCR) approach to examine plasma ctDNA Utilizing the Statistical Package for the Social Sciences, statistical tests were used to examine the data (SPSS). The data were analyzed by statistical tests using the Statistical Package for the Social Sciences (SPSS). Results: A total of 31 patients were recruited as study participants. The majority of the research subjects were female (64.5%), aged 20-69 years old (58%), and non-smokers (67.7%). Exon 19 deletions were the most prevalent EGFR mutation (58.1%). The incidence of acquired resistance was found in 10 subjects (32.3%). Patients with acquired resistance were predominately female (70%), non-smokers (80%), and with gefitinib therapy (90%). The average time for EGFR-TKI treatment until acquired resistance occurred was 12.6 months. Conclusion: The incidence of acquired resistance was mainly found in women without a smoking history after 12.6 months of treatment with EGFR-TKI.

Background: Prevalence of Epidermal Growth Factor Receptor (EGFR) mutation in ctDNA in treatment-naïve individuals are not well established in Indonesia. In recent years, ctDNA as a specific and sensitive blood-based biomarker had been developed to detect the mutation. The study was done to understand the concordance and acceptance levels of ctDNA in detecting the gene mutation in lung adenocarcinoma patients.    Methods: This study used cross-sectional approach with purposive sampling design in 100 treatment-naïve NSCLC, adenocarcinoma patients. Samples were obtained from bronchoscopy, and blood, which were examined to detect the mutation in formalin-fixed, paraffin-embedded (FFPE) specimens or plasma samples using QIAampDNA Micro Kit. Mutation was calculated by droplet digital PCR (ddPCR).   Results: A hundred subjects with primary tumor tissue samples were compared with the plasma samples and mutation was detected in 20 patients (20.0%), 12 (12.0%) on exon 19, 7 (7.0%) on exon 21 and 1 (1.0%) on both exon 19 and 21. Within the plasma samples, mutation was found in 15 patients (15%) with mutation on exon 19 and 21 in 12 (12.0%) and 3 (3.0%) patients, respectively.  Within the two samples, concordance of EGFR mutation was 83.0% (83/100, P<0.001; correlation index: 0.42). Assuming presence of mutation as the benchmark, the accuracy of mutation presence in plasma DNA was 60.0% (9/15). Kappa test showed a weak agreement between the mutation in tissues and plasma, with a coefficient of 0.414 (95% CI).   Conclusion: Tissue biopsy was still considered as the main option to detect EGFR mutation in lung cancer. More research on ctDNA as the standardized tools to detect the mutation are required.

Background: Pneumo-mediastinum is a rare disease associated with barotrauma and uncommonly occurs in viral pneumonia. Although the underlying mechanism of the incidence of pneumo-mediastinum in COVID-19 patients is not fully understood, barotrauma is the most probable cause.   Case Report: We reported a case of a 27-years-old woman with the chief complaint was shortness of breath and diagnosed with COVID19 based on RT-PCR examination. On the sixth day after being admitted to the hospital, suddenly, the intensity of dyspnea was increased with the decrease of oxygen saturation. CT of the chest confirmed pneumomediastinum and pneumonia COVID -19. There was no improvement of symptoms after oxygen and steroid administration. Emergency thoracotomy was not performed yet, and the patient has died.  Conclusions: Although pneumomediastinum is benign disease and self-limited disease, the presents of pneumomediastinum may relate to worse outcomes in COVID19 infections.

Background: Histoplasmosis is a disease caused by fungus called Histoplasma capsulatum. Several studies reported cases of histoplasmosis that resembled malignancy [3]. . It is a fact that the clinical syndrome of neoplastic disease is not limited to malignancy, so that infectious diseases should be considered in the differential diagnosis. Method: This is descriptive research with consecutive samples. The sample was the patients with lung cancer aged 25-75 years old. The researcher assessed histoplasmic skin test on interdemal administered with fungal protein [5]. After being observed for allergic reaction in 48-72 hours, induration > 5mm shows positive reaction. The Result: this research included 25 samples consisting of 21 men and 4 women. The Result showed 1 person (4%) with positive histoplasmic skin test result containing squamous cell carcinoma and radiological features of solitary pulmonary nodule. There is an insignificant relationship between cancer cell types and the histoplasmic skin test results (p = 0.24). There is an insignificant relationship between histoplamic skin test result and radiological features (p = 0.48).  The Conclusion: There is one person with positive histoplasmic skin test result with squamous cell carcinoma and radiological features of solitary pulmonary nodule.