Immune Checkpoint Inhibitor Colitis, a Rising Issue in Targeted Cancer Therapy Era: A Literature Review.

Research advances in the oncology treatment field have led to the widespread use of immunotherapy. The usage of immune checkpoint inhibitor (ICI) has improved the survival of cancer patients with metastases. This has also led to the rapidly expanding indications for ICI use. However, ICI usage may lead to toxicity, which may be immune-related, in different organ-specific targets. The immune-related adverse events (irAEs) of ICI may lead to increased morbidity, decreased quality of life, and early termination of ICI. The clinical manifestations of irAEs in the gastrointestinal system are variable, ranging from self-limited to life-threatening or fatal events. In this review article, we would like to focus on discussing ICI-induced colitis, which is one of the most common ICI irAEs in the gastrointestinal tract.

Barriers and enablers to blood culture sampling in Indonesia, Thailand and Viet Nam: a Theoretical Domains Framework-based survey.

OBJECTIVE: Blood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. We examine barriers and enablers to BC sampling in three Southeast Asian countries. DESIGN: A Theoretical Domains Framework (TDF)-based survey, comprising a case scenario of a patient presenting with community-acquired sepsis and all 14 TDF domains of barriers/enablers to BC sampling. SETTING: Hospitals in Indonesia, Thailand and Viet Nam, December 2021 to 30 April 2022. PARTICIPANTS: 1070 medical doctors and 238 final-year medical students were participated in this study. Half of the respondents were women (n=680, 52%) and most worked in governmental hospitals (n=980, 75.4%). OUTCOME MEASURES: Barriers and enablers to BC sampling. RESULTS: The proportion of respondents who answered that they would definitely take BC in the case scenario was highest at 89.8% (273/304) in Thailand, followed by 50.5% (252/499) in Viet Nam and 31.3% (157/501) in Indonesia (p<0.001). Barriers/enablers in nine TDF domains were considered key in influencing BC sampling, including 'priority of BC (TDF-goals)', 'perception about their role to order or initiate an order for BC (TDF-social professional role and identity)', 'perception that BC is helpful (TDF-beliefs about consequences)', 'intention to follow guidelines (TDF-intention)', 'awareness of guidelines (TDF-knowledge)', 'norms of BC sampling (TDF-social influence)', 'consequences that discourage BC sampling (TDF-reinforcement)', 'perceived cost-effectiveness of BC (TDF-environmental context and resources)' and 'regulation on cost reimbursement (TDF-behavioural regulation)'. There was substantial heterogeneity between the countries. In most domains, the lower (higher) proportion of Thai respondents experienced the barriers (enablers) compared with that of Indonesian and Vietnamese respondents. A range of suggested intervention types and policy options was identified. CONCLUSIONS: Barriers and enablers to BC sampling are varied and heterogenous. Cost-related barriers are more common in more resource-limited countries, while many barriers are not directly related to cost. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.

Screening of pancreatic cancer: Target population, optimal timing and how?

Pancreatic cancer patients usually present at a late stage due to subtle clinical manifestations. One of the most predictive prognostic factors in pancreatic cancer is the pancreatic cancer stage at diagnosis; therefore, early diagnosis is essential. Until now, pancreatic cancer screening has not become a standard practice for the general population due to the low incidence. In current circumstances, targeting individuals with a high risk of pancreatic cancer may be more rational. Several screening modalities for pancreatic cancer have also become debatable topics. Therefore, this article will review current evidence and recommendations regarding pancreatic screening cancer protocol in general and in high-risk populations.

Anemia in Inflammatory Bowel Disease: A Neglected Issue in Comprehensive Inflammatory Bowel Disease Management.

Anemia is the most common extraintestinal inflammatory bowel disease (IBD) manifestations and is significantly correlated with several adverse impacts such as higher hospitalization rate, relapse rate, surgical intervention requirement, and low quality of life. The prevalence of anemia in IBD patients is greatly varied between reports, which is estimated between 8.8% to 74%. However, studies showed there were still gaps in the screening protocol and anemia treatment in daily practice. Anemia in IBD tends to be an overlooked IBD complication yet significant and must be adequately addressed. Anemia in IBD may be caused by several factors that interplayed, with iron deficiency anemia being the most common etiology. Comprehensive management of anemia in IBD should consist of active screening, evaluation of the etiology, holistic treatment, and follow-up monitoring. Optimization of IBD therapy should be emphasized because it also may improve the anemic condition. A multidisciplinary approach and collaboration are needed to ensure better IBD care.

Metabolites of Pinang Yaki (Areca vestiaria) Fruit Extract: A Metabolite Profiling Study.

Background: Pinang yaki has bioactive compounds that have potential as a new herbal supplement. A better understanding of the bioactive compounds of pinang yaki using untargeted metabolomic profiling studies will provide clearer insight into the health benefits of pinang yaki and in particular its potential for the therapy and prevention of Covid-19.   Methods: Fresh samples of pinang yaki ( Areca vestiaria) are obtained from forests in North Sulawesi Province, Indonesia. Samples were used for untargeted metabolomics analysis by UPLC-MS.   Results: Based on an untargeted metabolomic profiling study of pinang yaki, 2504 compounds in ESI- and 2645 compounds in ESI+ were successfully obtained. After the analysis, 356 compounds in ESI- and 543 compounds in ESI+ were identified successfully. Major compounds Alpha-Chlorohydrin (PubChem ID: 7290) and Tagatose (PubChem ID: 439312) were found in ESI+ and ESI-.   Discussion: The Top 10 metabolites from pinang yaki extract (ESI+) juga have been indicated in preventing SARS Cov2 infection and have exhibited good neuroprotective immunity. Benzothiazole (PubChem ID: 7222), L-isoleucine (PubChem ID: 6306), D-glucono-delta-lactone (PubChem ID: 736), Diethylpyrocarbonate (PubChem ID: 3051), Bis(2-Ethylhexyl) amine (PubChem ID: 7791), Cinnamic acid (PubChem ID: 444539), and Trigonelline (PubChem ID: 5570) also had potential effects as an antiviral, anti-inflammatory, and anti-Covid19.   Conclusion: Untargeted metabolomic profiling showed many bioactive compounds contained in pinang yaki ( Areca vestiaria) extract. The top 10 compounds have been identified and explored for their potential benefits as anti-Covid19 supplement products. This is a preliminary study which still needs further research such as preclinical and clinical trials.

Cancer anorexia - cachexia syndrome.

Cancer anorexia-cachexia syndrome (CACS) is a devastating and debilitating aspect at any stage of malignancy. It presents primarily as anorexia, weight loss and muscle wasting secondary to inadequate oral intake and metabolic changes. This syndrome is highly prevalent among cancer patients, has a large impact on morbidity and mortality, and impinges on patient quality of life. The pathogenic mechanisms of CACS are multifactorial. It is suggested to be the result of tumor-host interactions and cytokines have a siginificant role. Diagnosis of cancer cachexia is complex and multifaceted and requires meticulous clinical examination of the patient. The challenge for clinicians is to know how best to manage the symptoms of weight loss and anorexia for optimal patient outcome. This article outlines the diagnosis of cancer cachexia, reviews its impact on patient quality of life and survival, and updates the reader on potential therapies that may suppress it.

Allogenic hematopoietic stem cell as curative treatment in myelofibrosis.

Myelofibrosis (MF) is one of the Philadelphia chromosome-negative clonal myeloproliferative disorders or chronic myeloid disorders, and it is caused by much deposit of collagen substances in bone marrow, definitely is classified as hematopoietic stem cells clonal abnormality, and related to chronic myeloproliferative disorders characterized by striking figure of extra-medullary hematopoiesis. Symptoms and signs of MF are included the variable degree of cachexia and marked extra-medullary hematopoiesis. The results of laboratory studies at presentation include anemia, leukocytosis or leucopenia, a left-ward shift in the granulocyte count, increased or decreased platelet count. Many conventional treatment modalities have been used in the MF treatment as supportive treatments. There is only one curative treatment in MF patients using allogenic hematopoietic stem cell transplantation (HSTC). The umbilical cord blood (UCB) as the source of stem cell has increased recently and gives promising results on MF.