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Reviews

Treatment options in stage III non-small cell lung cancer short review

Bianca Paraschiv, Camelia Cristina Diaconu, Ștefan Dumitrache-Rujinski, Ionela Nicoleta Belaconi, Tudor Constantinescu, Carmen Columbia Stroescu, Elena Danteș, Ariadna Petronela Fildan, Miron Alexandru Bogdan, Claudia Lucia Toma
Treatment options in stage III non-small cell lung cancer short review
Lung cancer is responsible for over 1 million deaths
annually, worldwide. The disease becomes symptomatic
in advanced stages, so the diagnosis is delayed and
90% of cases cannot benefit from a curative treatment.
In NSCLC surgical resection represents the best option
for long term survival in resectable stage III and in
clinical stage I/II. Patients with stage IIIB or IV usually
receive chemotherapy or palliative treatment. For
patients with no driver mutation detected platinum
based combination chemotherapy is the first choice.
Definitive radiotherapy is considered an alternative for
patients who are not candidates for combined modality
treatment. When a stage IV cancer is diagnosed based
on an isolated metastasis, the patient's benefit from the
removal of the metastasis and of the primary tumor if it is
resectable. The prognosis in NSLC is mainly influenced by
the TNM stage at diagnosis. The rate of survival decreases
in opposing correlation with the stage of the cancer. Poor
performance status, reduced lung capacity, weight loss,
vascular invasion are indicators for a poor prognosis.
Keywords: stage III, lung cancer, treatment

Continuous positive airway pressure for the treatment of obstructive sleep apnea

Fariz Nurwidya, Agus Dwi Susanto, Dafsah A Juzar, Isao Kobayashi, Faisal Yunus
Continuous positive airway pressure for the treatment of obstructive sleep apnea

Obstructive sleep apnea (OSA) is a recurrent episode of partial or complete upper airway obstruction during sleep despite ongoing respiratory efforts and is implicated as the risk factor of cardiovascular disease. The OSA syndrome is typified by recurring partial or total occlusion of the pharynx, sleep fragmentation, episodes of gasping, and, eventually, daytime sleepiness. If it is left untreated, OSA syndrome can cause hypertension, coronary artery disease, congestive heart disease, insulin resistance and death. In this review, we describe the pathogenesis and diagnosis of OSA. We also focused on the continuous positive airway pressure (CPAP) as the main therapy for OSA. CPAP has been shown to provide benefit for not only respiratory system, but also for cardiovascular system and metabolic system. Finally, we discussed briefly about the issue of adherence of using CPAP that could contribute to lower compliant in patient with OSA. Keyword: obstructive sleep apnea, continuous positive airway pressure

LPA or GeneXpert in the diagnosis of multidrug-resistant tuberculosis

Roxana Mindru, Victor Spinu, Oana Popescu
LPA or GeneXpert in the diagnosis of multidrug-resistant tuberculosis

Facing a constant increase of multidrug-resistant tuberculosis (MDR-TB), there is large need for routine use of new diagnostic tests, based on molecular techniques that allow both a rapid diagnosis for TB complex and rapid identification of resistance mutations. The resistances are due to genetic factors: accumulation of changes within the genome structure, acquisition or loss of genes, spontaneous mutations in chromosomal genes, and changes that induce selection of resistant strains during a suboptimal treatment. The bacteriology laboratory plays a crucial role in the making of the diagnosis, monitoring and preventing TB transmission. World Health Organization offers consistent recommendations in favour of use of Xpert MTB/RIF, GeneXpert platform, as initial diagnostic test in adults and children suspected of TB, because it can simultaneously determine the presence of Mycobacterium tuberculosis and the Rifampicin resistance, which is a surrogate marker of MDR strains. The very high sensibility and specificity, also in the smear negative samples, as well as the short time needed for the results, make Xpert MTB/RIF a valuable tool in the fight against TB. Other recommended tests are: LPA, which identifies M. Tuberculosis complex, the Rifampicin and Isoniazid resistance; MTBDR plus or, for second line anti-TB drugs, the MTBDRsl.

Keywords: molecular methods, Rifampicin resistance, TB rapid diagnosis, LPA, Xpert MTB/RIF