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Significance Level of Pleural Fluid Tissue Inhibitor Metalloproteinase-1 (TIMP-1) and Glucose Levels as Biomarkers of Malignant Pleural Effusion Michaela, Cleine; Putra, Ngakan Putu Parsama; Djajalaksana, Susanthy; Setijowati, Nanik; Listyoko, Aditya Sri
Jurnal Respirasi Vol. 11 No. 3 (2025): September 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.3.2025.208-215

Abstract

Introduction: Distinguishing between malignant and non-malignant pleural effusions is often challenging due to overlapping biochemical profiles. Conventional diagnostic methods, including cytology and biopsy, are limited by their invasive nature, high costs, and potential complications. Emerging biomarkers, such as tissue inhibitor of metalloproteinase-1 (TIMP-1) and pleural fluid glucose levels, show promise as alternative diagnostic tools, but their clinical utility requires further validation. This study investigated the diagnostic value of TIMP-1 and pleural fluid glucose levels in differentiating malignant from non-malignant pleural effusions and explored their correlation in malignant cases. Methods: This cross-sectional analytical study included patients with exudative pleural effusion, categorized as malignant or non-malignant based on cytology and/or biopsy results. Biomarker levels of TIMP-1 and pleural fluid glucose were measured using enzyme-linked immunosorbent assay (ELISA) and biochemical analysis. Diagnostic thresholds for both biomarkers were determined using receiver operating characteristic (ROC) curve analysis. Results: Among 88 patients studied (33 malignant, 55 non-malignant), pleural fluid glucose levels were significantly lower in malignant cases (55.97 vs. 93.71 mg/dL; p=0.001), while TIMP-1 levels were notably higher (13.88 vs. 13.34 pg/mL; p<0.001). Tissue inhibitor of metalloproteinase-1 demonstrated superior diagnostic accuracy (86.5%) compared to glucose (70.6%) and the combined biomarker model (76.5%), with the sensitivity and specificity of 84.8% and 83.6%, respectively. Conclusion: Elevated TIMP-1 levels and reduced pleural fluid glucose levels are promising diagnostic biomarkers for malignant pleural effusion (MPE). Tissue inhibitor of metalloproteinase-1 exhibited the highest diagnostic accuracy, highlighting its potential as a non-invasive diagnostic tool in clinical practice.
Analysis of Urinary Midkine and Volatile Organic Compound (VOC) Levels Using a Breath Analyzer for Screening and Early Diagnosis of Lung Cancer Mafisah, Saidah; Setyawan, Ungky Agus; Tantular, Rezki; Permana, Deden; Djajalaksana, Susanthy; Wardoyo, Arinto Yudi Ponco; Listyoko, Aditya Sri
Jurnal Respirasi Vol. 11 No. 3 (2025): September 2025
Publisher : Faculty of Medicine Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/jr.v11-I.3.2025.223-231

Abstract

Introduction: Lung cancer is the leading cause of cancer-related mortality worldwide. Midkine, a heparin-binding growth factor, promotes proliferation, angiogenesis, and metastasis. Volatile organic compounds (VOCs) reflect cellular and molecular changes, aiding in cancer diagnosis. This study explored urinary midkine and VOC profiles as biomarkers for lung cancer screening and early diagnosis. Methods: A case-control, cross-sectional study was conducted on 20 controls (family members of lung cancer patients) and 20 lung cancer patients who had not received therapy. Volatile organic compounds breath analysis and urinary midkine measurements were performed. Volatile organic compounds, including total volatile organic compounds (TVOCs), ethanol (C2H5OH), formaldehyde (CH2O), toluene (C7H8), acetone (C3H6O), hexane (C6H14), and methane (CH4), were collected from exhaled breath using Tedlar bags and measured with a µβreath analyzer. Meanwhile, urinary midkine levels were determined using the Enzyme-Linked ImmunoSorbent Assay (ELISA) method. Statistical analyses included an independent t-test, Mann-Whitney U test, Spearman correlation, and diagnostic testing with receiver operating characteristic (ROC) analysis. Results: Urinary midkine levels were higher in lung cancer patients than in controls (330.56±120.50 vs. 282.18±146.28 pg/mL), although not significant (p>0.05). The independent t-test revealed that ethanol levels were significantly elevated in lung cancer patients (p < 0.001), whereas methane levels were not (p > 0.50). Receiver operating characteristic analysis demonstrated sensitivity and specificity: urinary midkine (60%, 60%), ethanol (75%, 75%), and methane (45%, 45%). Conclusion: Ethanol VOC appears to be a promising non-invasive biomarker for the early detection of lung cancer, whereas elevated urinary midkine levels did not demonstrate significant diagnostic value.
Risk Analysis of Obstructive Sleep Apnea and Mental Disorders with Self-Reporting Questionnaire (SRQ-20) in Hospitalized COVID-19 Patients Falyani, Silvy Amalia; Pratiwi, Suryanti Dwi; Sugiri, Yani Jane Rosihaningsih; Djajalaksana, Susanthy; Listyoko, Aditya Sri
Malang Respiratory Journal Vol. 7 No. 2 (2025): Volume 7 No 2, September 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.02.07

Abstract

Introduction: Obstructive Sleep Apnea (OSA) is closely related to diseases such as hypertension, diabetes, cardiovascular disease, and obesity. Evaluation of sleep disorders and mental health in COVID-19 patients who are hospitalized has not been widely studied. The purpose of this study was to analyze the risk of OSA with STOP-Bang and mental disorders with the Self-Reporting Questionnaire (SRQ-20) in hospitalized COVID-19 patients at RSUD dr. Saiful Anwar Malang. Case: Thirty five respondents with confirmed mild and moderate COVID-19 criteria randomly selected and agreed to give informed consent were given the STOP-Bang and SRQ-20 questionnaires, then the score was associated with the oxygenation ratio through blood gas levels. The research was conducted by cross sectional and statistical test using Chi Square and Mann Whitney test with p<0.05. Thirty five respondents were divided into two groups, 17 people (48%) with mild criteria and 18 people (52%) with severe criteria. The severity of COVID-19 had low effect on the risk of OSA (p=0.581) and mental disorders (p=0.191). The risk of mental disorders through SRQ-20 scoring had low effect on the severity of COVID-19 (p=0.229) and on the oxygenation ratio (p=0.068). Conclusion: The severity of COVID-19 and oxygenation ratio had low effect to the risk of OSA and mental disorders through the STOP-Bang and SRQ-20 scores in hospitalized COVID-19 patients at dr. Saiful Anwar Malang.
The Sleep Disorders And Depression Symptoms Among Hospitalized COVID-19 Patients Febriawati, Juwita; Astuti, Triwahju; Djajalaksana, Susanthy; Listyoko, Aditya Sri
Malang Respiratory Journal Vol. 7 No. 2 (2025): Volume 7 No 2, September 2025 Edition
Publisher : Universitaas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mrj.2025.007.02.06

Abstract

Introduction: Sleep disorders are found to be associated with hypertension, diabetes, cardiovascular disease and obesity, and can affect quality of life. Evaluation of sleep disorders and risk of depression in hospitalized COVID-19 patients have not been widely studied. The purpose of this study was to identify, evaluate, and analyze of sleep disorders and depression symptoms in hospitalized COVID-19 patients according to their severity and PaO2/FiO2 ratio. Case Report: A total of 35 patients with mild and moderate COVID-19 were given a questionnaire consisting of Epworth Sleepiness Scale (ESS) and Beck Depression Inventory (BDI), which was then analyzed together with the patient's blood gas analysis. Categorical data was compared using Chi Square Test, while the relationship between the continuous variables were measured with Pearson correlation test. A two-sided p value < 0.05 was considered statistically significant. About 42,85% and 62,9% COVID-19 patients were found to have sleep disorders and depression symptoms respectively. There were no significant differences between sleep disorders and the severity of COVID-19 (P=0.118) as well as PaO2/FiO2 ratio (P=0.411). Similarly, depression symptoms was not significantly different according to the severity of COVID-19 and PaO2/FiO2 ratio obtained with P=0.083 and P=0.061 respectively. Correlation test showed no significant correlation between sleep disorders and severity as well as PaO2/FiO2 ratio with r=0,274(p=0,111) and r=0,041(p=0,814) respectively. Likewise, negative correlation was found between depression symptoms and severity of COVID-19 (r=0,218;p=0,258)  as well as PaO2/FiO2 ratio (r=0,078, p=0,057). Conclusion:  In hospitalized COVID-19 patients, sleep disorders and depression were found, but there was no significant differences and correlation between sleep disorders and depression symptoms with the severity of COVID-19 and PaO2/FiO2 ratio.