Ery Olivianto

The Effect of House Dust Mite Immunotherapy, Probiotic and Nigella sativa in The Number of Th17 Cell and Asthma Control Test Score

The Role of Th17 cells in the pathogenesis of asthma and immunotherapy is being a new concept and paradigm. Immunotherapy on asthma requires long periods of time, so administration of an adjuvant had been considered to improve its efficacy. The aims of this study was to evaluate the therapeutic efficacy of immunotherapy combined with probiotics and Nigella sativa in the number of Th17 cells and the improvement of clinical symptoms of asthma. A total of 31 children with mild asthma were evaluated and then randomized to receive immunotherapy or immunotherapy plus Nigella sativa or immunotherapy plus probiotic or immunotherapy plus Nigella sativa plus probiotic openly for 14 weeks. Statistical analysis found no significant difference in the mean number of Th17 cells pre and post test in all four treatment groups, however we found a significant differences asthma control test (ACT) score before and after the immunotherapy + Nigella sativa treatment (p = 0.001), before and after immunotherapy + probiotic treatment (p = 0.004), as well as before and after immunotherapy plus Nigella sativa plus probiotic treatment (p = 0.000). Correlation test found a significant association between the number of Th17 cells and ACT score in all groups. The combination immunotherapy with Nigella sativa and probiotics did not reduce the number of peripheral blood Th17 cells mild asthmatic children, but can improve the clinical symptom. Keywords - Immunotherapy, House dust mite, Probiotics, Nigella sativa, Th17 cell, Asthma Control test

The Effect of House Dust Mite Immunotherapy, Probiotic and Nigella sativa in The Number of CD4 + IL-4 + Cell, Total IgE level and Asthma Control Test (ACT) Score

Ashtma is a chronic inflammatory disorder of the airways dominated by Th2. Immunotherapy was beneficial for ashtma patients. Its long duration was oftenly caused patients to drop out treatment . Probiotic and Nigella sativa as immunomodulator for asthma expectantly could increase the efficacy of immunotherapy . The aims of this study was to evaluate the therapeutic efficacy of immunotherapy combined with probiotics and Nigella sativa in the number of CD4 + IL-4 + cells, Total IgE level and Asthma Scoring Test. A total of 31 children with mild asthma were evaluated and then randomized to receive immunotherapy or immunotherapy plus Nigella sativa or immunotherapy plus probiotic or immunotherapy plus Nigella sativa plus probiotic openly for 14 weeks. Statistical analysis found no significant difference in the mean number of CD4 + IL-4 + cells pre and posttest in all three treatment group. The Total IgE level was decreased significantly in the immunotherapy+ probiotic + Nigella sativa group (p = 0,022). The ACT score were increased in the immunotherapy + Nigella sativa group (p = 0.001), in the immunotherapy + probiotic group (p = 0.004), and immunotherapy + Nigella sativa + probiotic group (p = 0.000). Correlation test found a significant association between the number of CD4 + IL-4 + cells, Total IgE level and ACT score in all groups. The combination immunotherapy, Nigella sativa and probiotics could decrease the Total IgE level thus improve the clinical symptom. Keywords - Immunotherapy, House dust mite, Probiotics, Nigella sativa, CD4 + IL-4 + , Ig E, Asthma Control test

Pertussis in Children: Problems in Indonesia

The burden of pertussis cases has dramatically resurged and increased in highly immunized countries. However, in Indonesia those cases are still under diagnosed because of lack of awareness and laboratory support to confirm pertussis diagnoses. This review article will discuss about pertussis in children, the magnitude problems in Indonesia. We searched databases including Pubmed/MEDLINE database, Elsevier, and also official website for the following keywords: Pertussis, whooping cough, children, diagnosis and treatment, problem, Indonesia. We reviewed the most recent algorithm, case classification, and guidelines by World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) and also some problems in Indonesia in diagnose and treat children with pertussis. In Indonesia most cases are diagnosed as having bronchopneumonia while later known as probable pertussis. To understand this disease and its problems in Indonesia, it is important to enhanced awareness of diagnose and treat pertussis in children.

Perbedaan Skor ACT, CD4+CD25+Foxp3treg, CD4+IFN-γ pada Pemberian Imunoterapi, Probiotik dan Nigella Sativa

Probiotik dan Nigella sativa memiliki efek imunomodulator dan telah banyak banyak dikaji penggunaannya dalam kombinasi dengan imunoterapi asma. Imunoterapi dapat merubah perjalanan alamiah asma yang melibatkan perubahan respon imun Th2 menjadi Th1 dengan peningkatan IFN-γ. Proses tersebut juga berhubungan dengan pembentukan Tregulator, tetapi belum jelas mekanisme mana yang lebih dominan. Penelitian dilakukan untuk mengetahui perbedaan skor ACT serta jumlah sel CD4+CD25+FoxP3Treg dan CD4+IFN-γ pada anak asma ringan yang mendapat imunoterapi, probiotik dan Nigella sativa. Penelitian dilakukan dengan desain randomized clinical trial posttest only with control pada 32 subjek penelitian yang memenuhi kriteria inklusi dalam 4 kelompok yaitu kelompok A (imunoterapi+plasebo), kelompok B (imunoterapi+Nigella sativa), kelompok C (imunoterapi+probiotik), dan kelompok D (imunoterapi+Nigella sativa+probiotik). Perlakuan diberikan selama 56 minggu (imunoterapi fase induksi 14 minggu dan fase rumatan 42 minggu). Imunoterapi berupa ekstrak house dust mite diberikan subkutan, probiotik berupa Lactobacillus acidophilus dan Bifidobacterium lactis, dengan penilaian skoring asma menggunakan Asthma Control Test (ACT). Jumlah sel CD4+CD25+FoxP3+Treg dan CD4+IFN-γ diukur menggunakan flowcytometry. Hasil menunjukkan skor ACT kelompok C lebih tinggi bermakna dibandingkan kelompok A (p=0,04). Jumlah CD4+CD25+FoxP3+Treg paling tinggi pada kelompok D (15,966±9,720) , sedangkan jumlah CD4+IFN-γ paling tinggi pada kelompok C (17,506±11,576), tetapi tidak didapatkan perbedaan bermakna pada jumlah CD4+CD25+FoxP3+Treg (p=0,278) dan CD4+IFN-γ (p=0,367) antar semua kelompok. Dapat disimpulkan bahwa Imunoterapi+probiotik dapat meningkatkan skor ACT lebih baik dibandingkan imunoterapi saja. Imunoterapi, Nigella sativa, dan probiotik tidak memberikan perbedaan bermakna pada jumlah CD4+CD25+FoxP3 Treg dan CD4+IFN-γ.Kata Kunci: Asthma Control Test, CD4+CD25+FoxP3+Treg, CD4+IFN-γ, imunoterapi, Nigella sativa, probiotik

Massive pleural effusion due to radiologically diagnosed pulmonary malignancy in a 4-year-old girl

to determine the presence of tuberculosis infection or disease in children exposed to MDR-TB adult patients. Tuberculine test using PPD RT-23 was used to determine TB infection. Symptom-based screening and the presence of lymphnode enlargement on physical examination were used to determine active TB. Results: Eleven children, average aged 9.43 years, lived with 8 documented MDR-TB adult patients. Two children did not come for tuberculin test results measurement. Induration was 7mm in a 3-month old baby. The results in 8 children (88.9%) were positive with average induration diameter 11.63mm. The screening showed no active TB detected in all children. Conclusion: The study showed high infection rate of tuberculosis in children lived with MDR-TB adults patients. Follow up is needed in detecting active disease.