Melati Sudiro
Department of Otolaryngology-Head & Neck Surgery Faculty of Medicine Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital Bandung

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Eosinofil Kerokan Mukosa Hidung Sebagai Diagnostik Rinitis Alergi

Majalah Kedokteran Bandung Vol 1, No 42 (2010)
Publisher : Majalah Kedokteran Bandung

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AbstrakRinitis alergi merupakan gangguan fungsi hidung, terjadi setelah pajanan alergen melalui inflamasi mukosa hidung yang diperantarai IgE. Walaupun rinitis alergi bukan penyakit yang berat, penyakit ini dapat menurunkan kualitas hidup penderita. Allergic Rhinitis and Its Impact on Asthma (ARIA-WHO) menganjurkan tes kulit tusuk (TKT) sebagai pemeriksaan penunjang diagnostik, tetapi tidak semua sarana kesehatan memiliki fasilitas tersebut, oleh karena itu perlu dipilih pemeriksaan alternatif yang sesuai atau setara yaitu eosinofil kerokan mukosa hidung. Suatu uji diagnostik dilakukan pada 50 subjek tersangka rinitis alergi periode Februari-April 2005 di poliklinik alergiBagian THT-KL FKUP–RSHS. Sebanyak 78% penderita menunjukkan TKT positif, 76% terdapat eosinofil pada mukosa hidung, 64% positif terhadap kedua pemeriksaan. Uji statistik menunjukkan hubungan bermakna antara TKT positif dan eosinofil positif (X2= 3,559; p = 0,03), sensitivitas eosinofil kerokan mukosa hidung 82,1% (95%CI: 82,02-82,18), spesifisitas 64,3% (95% CI: 63,52-65,08), dan akurasi 74% (95% CI: 73,94–74,06). Penelitian ini menunjukkan pemeriksaan eosinofil kerokan mukosa hidung dapat digunakan sebagai pengganti tes kulit tusuk pada sarana kesehatan yang tidak mempunyai fasilitas tersebut. [MKB. 2010;42(1):6-11].Nasal Scrapping Eosinophil As a Diagnostic Test for Allergic RhinitisAllergic rhinitis is clinically defined as a symptomatic disorder of the nose induced by IgE mediated inflammation. Allergic Rhinitis and Its Impact on Asthma (ARIA-WHO) recommended the use of skin prick test (SPT) as a diagnostic test, but the facility to acquire this method is not always available at some of the health centres, therefore alternative diagnostic test should be performed such as nasal smear eosinophil count. The aim of this study was to assess the usefulness of nasal smear eosinophilia compared with SPT for the diagnosis of allergic rhinitis. A diagnostic study using the cross sectional design, conducted in Department of ORL-HNS at FKUP-RSHS (February-April 2005). Fifty patients with a clinical history suggestive of nasal allergy were studied. A positive SPTwas demonstrated in 78% of the study population, 76% of the patients demonstrated positive eosinophil count. There was 64% correlation between positive SPT and nasal eosinophil and it was statistically significant (X2= 3.559;p=0.03). The sensitivity of nasal smear eosinophilia count was 82.1% (95% CI 82.02-82.18), specificity 64.3% (95%CI 63.52-65.08), and accuracy 74% (95% CI 73.94-74.06). The eosinophil count of nasal scrapping can be used as the replacement of the SPT at the health centre which do not have the SPT facility.

Allergic Rhinitis Patient Characteristics in Dr. Hasan Sadikin General Hospital Bandung Indonesia

Althea Medical Journal Vol 1, No 2 (2014)
Publisher : Althea Medical Journal

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Background: Allergic rhinitis affects 500 million people worldwide, especially children and adolescents. This disease interferes with daily activities and productivity, leading to decreased quality of life. Allergic rhinitis is often accompanied by co-morbid conditions such as asthma, conjunctivitis, rhinosinusitis, urticaria and othersthat may worsen the disease. This study aimed to investigate the characteristics of patients with allergic rhinitis during the period of 2010-2011 in Dr. Hasan Sadikin General Hospital Bandung.Methods: This study was a descriptive study with a cross-sectional design using medical records of allergic rhinitis patients  who visited the allergy clinic of the Otorhinolaryngology ‒ Head and Neck Surgery ( ORL ‒ HNS ) Department of Dr. Hasan Sadikin General Hospital Bandung.Results: There were 167 patients diagnosed as suffering from allergic rhinitis during the study time with more women (53.3%) affected compared to men (46.7%). Most of them were in the age group of 18-34 years old (52.7%) and their were student (53.3%). Most  were suffered from moderate-severe persistent allergic rhinitis based on the Allergic Rhinitis and its Impact on Asthma-World Health Organization (ARIA-WHO) classification (52.7%). Co-morbid conditions were found in 73.7% of subjects and the allergic conjunctivitis (59.9%) was the most common.Conclusions: Allergic rhinitis is most commonly found in people at school age and productive age. Most allergic rhinitis patients are classified into persistent moderate/severe, showing that the rhinitis symptom has already interfered with their daily activities and decreased their quality of life.Key words: Allergic Rhinitis, Co-morbid Condition, school age  Karakteristik Pasien Rinitis Alergi di Rumah Sakit Dr Hasan Sadikin Bandung Indonesia Abstrak Latar Belakang: Rinitis alergi memengaruhi 500 juta orang di seluruh dunia, terutama anak-anak dan remaja. Penyakit ini mengganggu kegiatan dan produktivitas sehari-hari serta menyebabkan kualitas hidup menurun. Rinitis alergi sering disertai dengan penyakit penyerta seperti asma, konjungtivitis, rhinosinusitis, urtikaria dan lain-lain yang dapat memperburuk penyakit. Penelitian ini bertujuan untuk mengetahui karakteristik pasien dengan riinitis alergi periode 2010-2011 di Rumah Sakit Dr. Hasan Sadikin Bandung.Metode: Penelitian ini merupakan penelitian deskriptif dengan desain potong lintang dengan menggunakan rekam medis pasien rinitis alergi yang mengunjungi klinik alergi Departemen Telinga, Hidung, Tenggorokan - Kepala dan Leher (THT-KL)) RS Dr. Hasan Sadikin Bandung.Hasil: Ada 167 pasien yang didiagnosa menderita rinitis alergi selama usia sekolah. Perempuan lebih banyak yang terkena dampak (53,3%) dibandingkan dengan laki-laki (46,7%). Sebagian besar dari mereka berada di kelompok usia 18-34 tahun (52,7%) dan mereka adalah siswa (53,3%). Berdasarkan klasifikasi Organisasi Allergic Rhinitis and its Impact on Asthma-World Health Organization (ARIA-WHO) (ARIA-WHO) sebagian besar menderita rinitis alergi persisten sedang-berat (52,7%). Kondisi co-morbid ditemukan di 73,7% dari subyek dan yang paling umum adalah konjungtivitis alergi (59,9%).Simpulan: Rinitis alergi paling sering ditemukan pada orang di usia sekolah dan usia produktif. Sebagian besar pasien rinitis alergi diklasifikasikan menjadi persisten sedang/berat. Hal ini menunjukkan bahwa gejala rinitis telah mengganggu kegiatan sehari-hari dan menurunkan kualitas hidup mereka. Kata kunci: Rinitis alergi, Kondisi Co-morbid, usia sekolah DOI: 10.15850/amj.v1n2.350

Prevalence of Allergic Rhinitis based on World Health Organization (ARIA-WHO) questionnaire among Batch 2010 Students of the Faculty of Medicine Universitas Padjadjaran

Althea Medical Journal Vol 2, No 4 (2015)
Publisher : Althea Medical Journal

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Background: Allergic rhinitis (AR) is a common disease affecting 5–45% of Asian population. Although it is not a life-threatening disease, AR significantly hampers the quality of life of the sufferers. The prevalence of AR among adults in Indonesia is still unknown. This study aimed to measure the prevalence of AR among batch 2010 students of the Faculty of Medicine, Universitas Padjadjaran.Methods: A cross-sectional study was conducted during June–October 2013 involving Indonesian class batch 2010 students of the Faculty of Medicine, Universitas Padjadjaran. The sampling was performed usingtotal sampling approach. The measurement tool used in this study was the Indonesian translation of the Allergic Rhinitis and its Impact on Asthma-World Health Organization (ARIA-WHO) questionnairee. Thosewho were aware of being diagnosed with AR or had two/more AR defining symptoms in the questionnaire form were considered to have AR. The statistical analysis was conducted by calculating frequencies.Results: A total of 207 questionnaire forms were adequately filled out and returned. Based on the questionnaire, the prevalence rate of AR was 38.2%. Of the 79 AR cases, 66% cases involved females. In addition, 54% of the the AR cases have a parental history of allergic diseases. Nasal obstruction and itchy nose were the most frequent symptoms (90%), followed by rhinorrhea (89%), sneezing (82%), and eye symptoms (62%). Based on the duration, the majority fell into the intermittent group (91%); whereas basedon severity, the majority was in the moderate-severe group (71%).Conclusions: The prevalence rate of AR obtained in this study is within the estimated range of Asian population. [AMJ.2015;2(4):620–5] DOI: 10.15850/amj.v2n4.658

Isolation of Methicillin Resistant - Staphylococcus aureus in Midwifery Students Faculty of Medicine Universitas Padjadjaran September–December 2012

Althea Medical Journal Vol 2, No 2 (2015)
Publisher : Althea Medical Journal

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Background: Methicillin Resistant-Staphylococcus aureus (MRSA) is resistant bacteria to certain types of beta-lactam antibiotics. Commonly, the MRSA infection is acquired in hospitals, long-term care facilities, or similar institutional settings. Mid-wives are one of the health professional that have a major risk to get MRSA infection and could lead the infection among patients. This research is aimed to identify MRSA among the midwifery studentsMethods: A descriptive study was conducted from September–December 2012 at the Microbiology laboratory to identify the proportion of MRSA among the mid-wife students from Faculty of Medicine, Universitas Padjadjaran. Twenty-five samples were chosen using simple random sampling based on their registration number. The inclusion criterias were healthy students, and 18 to 22 years old. Both nostrils were sampled with a sterile culture swab on both the subject’s nostrils. Gram staining was done in order to identify the gram positive bacteria, Staphylococcus aureus. The samples were inaculated in Mannitol salt agar (MSA), incubated for 24 hours and at 37 ̊ C. After 24 hours, catalase and coagulase tests were done. Moreover, for the susceptibility testing, the chosen media for this study was Mueller Hinton Agar (MHA) and with 30μg Cefoxitin disk. After incubation, the zone of inhibition of the colony less than ≤ 21mm was considered resistant to methicillin.Results: Colonization of MRSA was about 3 out from 25 samplesConclusions: The MRSA colonization in the anterior nasal does exist in midwife students, a further study with more samples should be conducted. [AMJ.2015;2(1):204–7]

Manifestasi Klinis Refluks Laringofaring: Studi pada Anak Usia 0–24 Bulan dengan Laringomalasia

Majalah Kedokteran Bandung Vol 49, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Laringomalasia merupakan kelainan kongenital anomali laring yang banyak ditemukan pada bayi baru lahir dan penyebab tersering stridor serta obstruksi saluran napas. Pemeriksaan laringoskopi serat lentur memperlihatkan terlipat atau terhisapnya struktur supraglotik ke dalam laring selama inspirasi. Obstruksi saluran napas pada laringomalasia akan menyebabkan tekanan negatif intratorakal, menyebabkan asam lambung naik ke jaringan laringofaring dan diduga menimbulkan refluks laringofaring (RLF). Telah dilakukan penelitian dengan pendekatan potong lintang yang bertujuan mengidentifikasi dan menilai hubungan antara laringomalasia dan gambaran refluks laringofaring pada usia 0–24 bulan yang datang ke poliklinik THT-KL RSHS Bandung periode Januari 2012–Maret 2015 berdasar atas data rekam medis dan hasil pemeriksaan laringoskopi serat lentur.  Seratus tujuh pasien laringomalasia dengan keluhan stridor mengikuti penelitian ini, 69 laki-laki (64,5%) dan 38 perempuan (35,5%) dengan usia rata-rata 4,19 bulan. Laringomalasia tipe 1 merupakan tipe terbanyak (57,9%). Gambaran RLF yang berhubungan dengan tingkat berat laringomalasia adalah edema plika ventrikularis dengan OR 3,71 (IK 95%=1,07–12,91; p=0,039) dan edema aritenoid dengan OR 4,74 (IK 95%=1,19–18,89; p=0,027). Edema ventrikular dan aritenoid merupakan gambaran RLF yang berhubungan dengan tingkat berat laringomalasia pada pada anak usia 0–24 bulan. [MKB. 2017;49(2):115–21]Kata kunci: Edema aritenoid, edema plika ventrikularis, laringomalasia, refluks laringofaring Laryngopharyngeal Reflux Manifestation: a Case Study of Laryngomalacia in Children Aged 0–24 MonthsLaryngomalacia is the most common laryngeal anomaly of the newborn and the main cause of stridor and airway obstruction in infants. From a flexible laryngoscopy examination, this anomaly is observed as curled or collapsed supraglottic structures into larynx during inspiration. Airway obstruction in laryngomalacia creates a negative intra-thoracal pressure that causes acid reflux to laryngopharynx tissue and is suspected to cause laryngopharyngeal reflux (LPR). A cross-sectional study was conducted with the objectives of identifying and assessing the relationship between laryngomalacia and LPR in patients aged 0–24 months who visited the Ear, Nose, Throat, Head, and Neck Clinic of Dr. Hasan Sadikin General Hospital Bandung in the period of January 2012–March 2015, which was based on medical records and results of flexible laryngoscopy. A hundred and seven patients diagnosed with laryngomalacia  who experienced stridor symptoms in this study consisted of 69 males (64.5%) and 38  females (35.5%) with mean age of 4.19 months. Type-1 laryngomalacia represents the most cases (57.9%). Indication of LPR sign correlated with type of laryngomalacia is ventricular edema OR 3.71 (CI 95%=1.07–12.91; p=0.039) and arytenoid edema OR 4,74 (CI 95%=1.19-18.89; p=0.027). Ventricular and arytenoid edemas are signs of LPR that correlate with laryngomalacia level in patients  aged 0–24 months. [MKB. 2017;49(2):115–21]Key words: Arytenoid edema, laringomalacia, laringopharyngeal reflux, ventricular edema 

Peran Terapi Adjuvan Vitamin D3 Terhadap Kadar T Regulator dan Gejala Klinis Penderita Rinitis Alergi Yang Mendapat Imunoterapi Subkutaneus Initial Build Up Dose

Majalah Kedokteran Bandung Vol 50, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Imunoterapi spesifik (ITS) merupakan pilihan terapi pada rinitis alergi yang tidak memberikan respons perbaikan klinis dengan medikamentosa. Peran zat adjuvan diduga dapat meningkatkan efektivitas dan efikasi ITS. Penelitian ini bertujuan menganalisis peran adjuvan vitamin D3 pada ITS terhadap percepatan timbulnya respons imun toleran. Penelitian analitik komparatif numerik dua kelompok tidak berpasangan dengan rancangan uji klinis acak terkontrol ganda ini dilakukan di Klinik Rinologi-Alergi THT-KL RSUP dr. Hasan Sadikin Bandung sejak Mei 2016–April 2017. Sampel terdiri atas 18 pasien menerima ITS+kalsitriol dan 18 pasien menerima ITS+plasebo yang memenuhi kriteria penelitian diambil secara consecutive sampling. Dilakukan pemeriksaan jumlah sel Tregulator dengan flowcitometry pada baseline, minggu ke-8 dan 15 dan skor gejala hidung.  Analisis dengan Uji Mann-Whitney, uji Friedman, uji T berpasangan dan analisis Post hoc. Perbandingan kenaikan rerata median jumlah sel Treg kelompok intervensi dengan kontrol pada minggu ke 8 menunjukkan nilai p=0,04, rerata MFI Treg pada kelompok intervensi dengan kontrol nilai p=0,002. Analisis post hoc terhadap MFI Treg menunjukkan peningkatan pada kelompok intervensi dengan p=0,001 pada minggu ke-8. Disimpulkan perubahan di tingkat imunologi mulai terjadi pada minggu ke-8, tetapi perbaikan gejala klinis terlihat setara.Kata kunci: Imunoterapi spesifik, rinitis alergi, sel t-toleran perifer, sel T-regulator, vitamin D3 Role of Adjuvant Therapy with Vitamin D3 on T-Regulator in Allergic Rhinitis Patient with Subcutaneus Immunotherapy Allergen-specific immunotherapy (AIT) is a potentially disease-modifying therapy that is useful for the treatment of allergic rhinitis, especially in those who do not response to pharmacotherapy. Currently, the role of adjuvant is expected to increase the clinical efficacy in AIT.  The aim of this study was to analyze the role of vitamin D3 adjuvant in AIT to induce immune tolerance. This was an unpaired comparative analytic research with a randomized controlled trial dstudy conducted at the Rhinology-Allergy Clinic ORL-HNS of Dr. Hasan Sadikin General Hospital Bandung from May 2016 to April 2017. Eighteen subjects with AIT+ calcitriol treatment and 18 subjects with AIT+placebo treatment who met the study criteria were selected through consecutive sampling. All subjects were evaluated for Treg cells using flow citometry at baseline, week 8, and week 15. Nasal symptom score was also evaluated.  Statistical analysis performed in this study included Mann-Whitney test, Friedman test, T-Paired test,and Post hoc analysis. There was a significant different of Treg cells average results between the intervention group and control at week 8 with a p-value of 0.04. The mean delta value on MFI Treg reflected significant differences within intervention group (p=0.002). Post hoc analysis results presented a significant increase in MFI Treg in the intervention group at week 8 (p=0,001). Therefore, immunological changes start in week eight but the improvement of clinical symptoms looks similar. Key words: Allergic rhinitis, peripheral t-cell tolerance, regulatory t(treg) cell allergen specific immunotherapy, vitamin D3

Efektivitas imunoterapi terhadap gejala, temuan nasoendoskopik dan kualitas hidup pasien rinosinusitis alergi

Oto Rhino Laryngologica Indonesiana Vol 42, No 2 (2012): Volume 42, No. 2 July - December 2012
Publisher : PERHATI-KL

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Background: Rhinosinusitis is one of major health problems which increased the economic burden. With symptoms include nasal congestion, rhinorrhea, facial pain, and sometimes reduced or loss of smell, this condition may impair work productivity and quality of life (QOL). Rhinosinusitis is one of the comorbidity of allergic rhinitis. Allergen specific immunotherapy provides protection against the occurence of allergic symptoms and inflammatory reactions due to allergen exposure, that results in improvement  of QOL of allergic rhinosinusitis patients.   To assess the effectiveness of immunotherapy in the  severity of the disease, nasal symptoms, nasoendoscopic findings, drugs intake, and the QOL in allergic rhinosinusitis patients treated with specific immunotherapy. Methods: A retrospective descriptive study conducted at the Rhinology-Allergy Clinic of ORL-HNS Department, Dr.Hasan Sadikin General Hospital, Bandung, on January - December 2011, towards 25 patients, by anamnesis, severity of the disease using Visual Analogue Scale (VAS), nasal symptoms from Weeke, Davis and Okuda, nasoendoscopic findings from Lund-Kennedy, drug intake score, and QOL assesment using Rhinoconjuctivitis Quality of Life Questionaire. Results: There was a significant correlation (p<0,05) between specific immunotherapy for 1 year observed by reduced disease severity, reduced nasal symptoms, nasoendoscopic findings improvement, reduced drug intake, and increased Quality of Life which shows significant results from 3 months after immunotherapy using Wilcoxon differential test (p<0,001). Conclusion: Immunotherapy for 1 year was significantly reduced disease severity, reduced nasal symptoms, improved nasoendoscopic findings, reduced drug intake, and improvement of QOL in patients with allergic rhinosinusitis began from 3 months after immunotherapy and maintained afterwards. Key words: allergic rhinosinusitis, nasal symptoms, nasoendoscopy, specific immunotherapy, quality of life    Abstrak :  Latar belakang: Rinosinusitis merupakan salah satu masalah kesehatan yang semakin meningkat sehingga menjadi beban besar terhadap perekonomian masyarakat. Dengan gejala berupa hidung tersumbat, rinore, nyeri pada wajah dan dapat disertai berkurang atau hilangnya penciuman, kondisi ini dapat menurunkan produktivitas kerja dan kualitas hidup. Rinosinusitis merupakan salah satu komorbiditas dari rinitis alergi. Imunoterapi alergen spesifik bertujuan untuk memberikan perlindungan terhadap timbulnya gejala alergi dan reaksi inflamasi akibat pajanan alergen, sehingga dapat meningkatkan kualitas hidup pasien rinosinusitis. Tujuan: Membuktikan efektivitas imunoterapi terhadap tingkat beratnya penyakit, gejala hidung, nasoendoskopi, penggunaan obat dan kualitas hidup pasien rinosinusitis alergi yang diberikan pengobatan imunoterapi selama 3, 6, dan 12 bulan. Metode: Dilakukan penelitian deskriptif retrospektif, di Poliklinik Rinologi Alergi Ilmu Kesehatan THT-KL RSHS Bandung, dalam periode JanuariDesember 2011 pada 25 pasien, menggunakan anamnesis, tingkat berat penyakit berdasarkan Visual Analogue Scale (VAS), gejala hidung  berdasarkan Weeke, Davis dan Okuda, pemeriksaan nasoendoskopi berdasarkan Lund-Kennedy, penggunaan obat dan penilaian kualitas hidup dengan Rhinoconjuctivitis Quality of Life Questionaire. Hasil: Didapatkan hubungan bermakna berdasarkan uji chi-kuadrat-Friedman   antara imunoterapi selama 1 tahun (p<0,05) terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup. Didapat perbaikan secara bermakna sejak 3 bulan pasca imunoterapi (p<0,001) berdasarkan uji beda Wilcoxon. Kesimpulan: Imunoterapi selama 1 tahun efektif terhadap penurunan tingkat berat penyakit, penurunan gejala hidung, perbaikan temuan nasoendoskopi, penurunan penggunaan obat, serta peningkatan kualitas hidup pada pasien rinosinusitis alergi, dengan perbaikan sejak 3 bulan dan bertahan hingga 1 tahun pasca-imunoterapi. Kata kunci: rinosinusitis alergi, gejala hidung, nasoendoskopi, imunoterapi, kualitas hidup 

Manifestasi Klinis Refluks Laringofaring: Studi pada Anak Usia 0–24 Bulan dengan Laringomalasia

Majalah Kedokteran Bandung Vol 49, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Laringomalasia merupakan kelainan kongenital anomali laring yang banyak ditemukan pada bayi baru lahir dan penyebab tersering stridor serta obstruksi saluran napas. Pemeriksaan laringoskopi serat lentur memperlihatkan terlipat atau terhisapnya struktur supraglotik ke dalam laring selama inspirasi. Obstruksi saluran napas pada laringomalasia akan menyebabkan tekanan negatif intratorakal, menyebabkan asam lambung naik ke jaringan laringofaring dan diduga menimbulkan refluks laringofaring (RLF). Telah dilakukan penelitian dengan pendekatan potong lintang yang bertujuan mengidentifikasi dan menilai hubungan antara laringomalasia dan gambaran refluks laringofaring pada usia 0–24 bulan yang datang ke poliklinik THT-KL RSHS Bandung periode Januari 2012–Maret 2015 berdasar atas data rekam medis dan hasil pemeriksaan laringoskopi serat lentur.  Seratus tujuh pasien laringomalasia dengan keluhan stridor mengikuti penelitian ini, 69 laki-laki (64,5%) dan 38 perempuan (35,5%) dengan usia rata-rata 4,19 bulan. Laringomalasia tipe 1 merupakan tipe terbanyak (57,9%). Gambaran RLF yang berhubungan dengan tingkat berat laringomalasia adalah edema plika ventrikularis dengan OR 3,71 (IK 95%=1,07–12,91; p=0,039) dan edema aritenoid dengan OR 4,74 (IK 95%=1,19–18,89; p=0,027). Edema ventrikular dan aritenoid merupakan gambaran RLF yang berhubungan dengan tingkat berat laringomalasia pada pada anak usia 0–24 bulan. [MKB. 2017;49(2):115–21]Kata kunci: Edema aritenoid, edema plika ventrikularis, laringomalasia, refluks laringofaring Laryngopharyngeal Reflux Manifestation: a Case Study of Laryngomalacia in Children Aged 0–24 MonthsLaryngomalacia is the most common laryngeal anomaly of the newborn and the main cause of stridor and airway obstruction in infants. From a flexible laryngoscopy examination, this anomaly is observed as curled or collapsed supraglottic structures into larynx during inspiration. Airway obstruction in laryngomalacia creates a negative intra-thoracal pressure that causes acid reflux to laryngopharynx tissue and is suspected to cause laryngopharyngeal reflux (LPR). A cross-sectional study was conducted with the objectives of identifying and assessing the relationship between laryngomalacia and LPR in patients aged 0–24 months who visited the Ear, Nose, Throat, Head, and Neck Clinic of Dr. Hasan Sadikin General Hospital Bandung in the period of January 2012–March 2015, which was based on medical records and results of flexible laryngoscopy. A hundred and seven patients diagnosed with laryngomalacia  who experienced stridor symptoms in this study consisted of 69 males (64.5%) and 38  females (35.5%) with mean age of 4.19 months. Type-1 laryngomalacia represents the most cases (57.9%). Indication of LPR sign correlated with type of laryngomalacia is ventricular edema OR 3.71 (CI 95%=1.07–12.91; p=0.039) and arytenoid edema OR 4,74 (CI 95%=1.19-18.89; p=0.027). Ventricular and arytenoid edemas are signs of LPR that correlate with laryngomalacia level in patients  aged 0–24 months. [MKB. 2017;49(2):115–21]Key words: Arytenoid edema, laringomalacia, laringopharyngeal reflux, ventricular edema 

Peran Terapi Adjuvan Vitamin D3 Terhadap Kadar T Regulator dan Gejala Klinis Penderita Rinitis Alergi Yang Mendapat Imunoterapi Subkutaneus Initial Build Up Dose

Majalah Kedokteran Bandung Vol 50, No 2 (2018)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Imunoterapi spesifik (ITS) merupakan pilihan terapi pada rinitis alergi yang tidak memberikan respons perbaikan klinis dengan medikamentosa. Peran zat adjuvan diduga dapat meningkatkan efektivitas dan efikasi ITS. Penelitian ini bertujuan menganalisis peran adjuvan vitamin D3 pada ITS terhadap percepatan timbulnya respons imun toleran. Penelitian analitik komparatif numerik dua kelompok tidak berpasangan dengan rancangan uji klinis acak terkontrol ganda ini dilakukan di Klinik Rinologi-Alergi THT-KL RSUP dr. Hasan Sadikin Bandung sejak Mei 2016–April 2017. Sampel terdiri atas 18 pasien menerima ITS+kalsitriol dan 18 pasien menerima ITS+plasebo yang memenuhi kriteria penelitian diambil secara consecutive sampling. Dilakukan pemeriksaan jumlah sel Tregulator dengan flowcitometry pada baseline, minggu ke-8 dan 15 dan skor gejala hidung.  Analisis dengan Uji Mann-Whitney, uji Friedman, uji T berpasangan dan analisis Post hoc. Perbandingan kenaikan rerata median jumlah sel Treg kelompok intervensi dengan kontrol pada minggu ke 8 menunjukkan nilai p=0,04, rerata MFI Treg pada kelompok intervensi dengan kontrol nilai p=0,002. Analisis post hoc terhadap MFI Treg menunjukkan peningkatan pada kelompok intervensi dengan p=0,001 pada minggu ke-8. Disimpulkan perubahan di tingkat imunologi mulai terjadi pada minggu ke-8, tetapi perbaikan gejala klinis terlihat setara.Kata kunci: Imunoterapi spesifik, rinitis alergi, sel t-toleran perifer, sel T-regulator, vitamin D3 Role of Adjuvant Therapy with Vitamin D3 on T-Regulator in Allergic Rhinitis Patient with Subcutaneus Immunotherapy Allergen-specific immunotherapy (AIT) is a potentially disease-modifying therapy that is useful for the treatment of allergic rhinitis, especially in those who do not response to pharmacotherapy. Currently, the role of adjuvant is expected to increase the clinical efficacy in AIT.  The aim of this study was to analyze the role of vitamin D3 adjuvant in AIT to induce immune tolerance. This was an unpaired comparative analytic research with a randomized controlled trial dstudy conducted at the Rhinology-Allergy Clinic ORL-HNS of Dr. Hasan Sadikin General Hospital Bandung from May 2016 to April 2017. Eighteen subjects with AIT+ calcitriol treatment and 18 subjects with AIT+placebo treatment who met the study criteria were selected through consecutive sampling. All subjects were evaluated for Treg cells using flow citometry at baseline, week 8, and week 15. Nasal symptom score was also evaluated.  Statistical analysis performed in this study included Mann-Whitney test, Friedman test, T-Paired test,and Post hoc analysis. There was a significant different of Treg cells average results between the intervention group and control at week 8 with a p-value of 0.04. The mean delta value on MFI Treg reflected significant differences within intervention group (p=0.002). Post hoc analysis results presented a significant increase in MFI Treg in the intervention group at week 8 (p=0,001). Therefore, immunological changes start in week eight but the improvement of clinical symptoms looks similar. Key words: Allergic rhinitis, peripheral t-cell tolerance, regulatory t(treg) cell allergen specific immunotherapy, vitamin D3

Prevalence of Allergic Rhinitis based on World Health Organization (ARIA-WHO) questionnaire among Batch 2010 Students of the Faculty of Medicine Universitas Padjadjaran

Althea Medical Journal Vol 2, No 4 (2015)
Publisher : Althea Medical Journal

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Abstract

Background: Allergic rhinitis (AR) is a common disease affecting 5–45% of Asian population. Although it is not a life-threatening disease, AR significantly hampers the quality of life of the sufferers. The prevalence of AR among adults in Indonesia is still unknown. This study aimed to measure the prevalence of AR among batch 2010 students of the Faculty of Medicine, Universitas Padjadjaran.Methods: A cross-sectional study was conducted during June–October 2013 involving Indonesian class batch 2010 students of the Faculty of Medicine, Universitas Padjadjaran. The sampling was performed usingtotal sampling approach. The measurement tool used in this study was the Indonesian translation of the Allergic Rhinitis and its Impact on Asthma-World Health Organization (ARIA-WHO) questionnairee. Thosewho were aware of being diagnosed with AR or had two/more AR defining symptoms in the questionnaire form were considered to have AR. The statistical analysis was conducted by calculating frequencies.Results: A total of 207 questionnaire forms were adequately filled out and returned. Based on the questionnaire, the prevalence rate of AR was 38.2%. Of the 79 AR cases, 66% cases involved females. In addition, 54% of the the AR cases have a parental history of allergic diseases. Nasal obstruction and itchy nose were the most frequent symptoms (90%), followed by rhinorrhea (89%), sneezing (82%), and eye symptoms (62%). Based on the duration, the majority fell into the intermittent group (91%); whereas basedon severity, the majority was in the moderate-severe group (71%).Conclusions: The prevalence rate of AR obtained in this study is within the estimated range of Asian population. [AMJ.2015;2(4):620–5] DOI: 10.15850/amj.v2n4.658