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"Latar belakang: Penyakit tiroiditis autoimun pada anak dapat bermanifestasi sebagai hipotiroid, hipotiroid subklinis, eutiroid atau hipertiroid. Belum ada kesepakatan pemberian terapi levotiroksin pada keadaan eutiroid, meskipun beberapa penelitian menyatakan manfaat untuk mengurangi volume tiroid, mempengaruhi fungsi tiroid serta menstabilkan proses imunologis yang berlangsung.Tujuan: Mengetahui efek pemberian levotiroksin terhadap perubahan volume tiroid, fungsi tiroid dan antibodi tiroid pada anak eutiroid dengan tiroiditis autoimun.Metode: review sistematik (metaanalisis) penelitian-penelitian pada anak eutiroid dengan tiroiditis autoimun yang diberikan levotiroksin terhadap perubahan volume tiroid. Penelusuran dilakukan dari the Cochrane Library, MEDLINE, EBSCO, Proquest, clinicaltrials.gov serta sumber-sumber lain. Kriteria inklusi adalah studi pada populasi tersebut dengan desain randomised control trials dan quasi-randomised trials dengan luaran primer volume tiroid. Dua peneliti secara independen melakukan ekstraksi data, menilai risiko bias tiap studi yang diinklusi, melakukan pooled data menggunakan random effect model dan melakukan analisis sensitivitas.Hasil: Sebanyak 48 penelitian/studi teridentifikasi dengan metode penelusuran yang disusun, setelah dianalisis didapatkan 2 (dua) penelitian (80 subyek) yang memenuhi kriteria inklusi. Hanya data volume tiroid SDS yang dapat diagregrasi dari kedua penelitian. Perbedaan perubahan volume tiroid sebesar -1,18 (IK95%; -1,65; -0,70) SDS pada pemberian levotiroksin dibandingkan kontrol. Perbedaan perubahan rerata kadar TSH, fT4, TPOAb dan TgAb antara kelompok intervensi dibandingkan kelompok kontrol adalah -0,24 mU/liter (IK95% -1,96; 1,12); -0,76 pmol/liter (IK95% -4,77; 3,25); 135,2 U/ml (IK95% -319,8; 590,2); dan -75,53 U/mililiter (IK95% -255,32; 104,26). Pemberian levotiroksin memberikan efek kejadian goiter yang lebih sedikit (3 subyek) dibandingkan dengan kontrol (17 subyek) (rasio odd 0,06; IK95% 0,01-0,28).Kesimpulan: Terapi levotiroksin pada anak tiroiditis autoimun yang eutiroid mungkin bermanfaat dalam menurunkan volume tiroid (SDS) dan risiko kejadian goiter. Terapi levotiroksin pada anak tiroiditis autoimun yang eutiroid belum terbukti mempengaruhi perubahan kadar TSH, fT4, TPOAb dan TgAb.

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Background: Children with autoimmune thyroiditis may manifest as overt hypothyroidism, subclinical hypothyroidism, euthyroid or hyperthyroidism. Although there is no consensus on treating euthyroid condition in thyroiditis autoimmune children, some studies showed efficacy of levothyroxine in decreasing thyroid volume, improving thyroid function, and stabilizing immunological process.Objectives: to determine the effect of levothyroxine on thyroid volume changes, thyroid functions and thyroid antibodies in euthyroid children with autoimmune thyroiditis.Methods: Systematic review was performed in euthyroid children with autoimmune thyroiditis. Electronic databases search (the Cochrane Library, MEDLINE, EBSCO, Proquest, clinicaltrials.gov and other sources) and non-electronic search (handsearch of journals, conference proceeding) were done. Randomised and quasi-randomised controlled trials comparing levothyroxine to control in all euthyroid children with autoimmune thyroiditis were selected. Two person independently extracted data, assessed the risk of bias, analyzed pooled data from included study by random effect model and performed sensitivity analysis.Results: Two studies (80 participants) were included from 48 studies identified from searching methods. Only thyroid volume SDS data could be aggregated. Mean difference of thyroid volume change was -1,18 (95%CI; -1,65; -0,70) SDS between levothyroxine and control. Mean difference of TSH, fT4, TPOAb and TgAb change between levothyroxine and control were -0,24 mU/liter (IK95% -1,96; 1,12); -0,76 pmol/liter (95%CI -4,77; 3,25); 135,2 U/ml (95%CI -319,8; 590,2); and -75,53 U/mililiter (95%CI -255,32; 104,26). Risk of goiter was decreasing with levothyroxine treatment (OR 0,06; IK95% 0,01-0,28).Conclusion: Levothyroxine treatment for euthyroid children with autoimmune thyroid might reduce thyroid volume (SDS) and risk of goiter. Treatment of levothyroxine do not conclusively improve changes of TSH, fT4, TPOAb and TgAb."

"ABSTRAKLatar Belakang: Penyakit autoimun terjadi karena tubuh tidak mampu untuk mengenali sel atau jaringan tubuh sendiri, sehingga tubuh memberikan respons seperti proses eliminasi antigen terhadap sel atau jaringan tubuh sendiri. Berbagai faktor risiko, antara lain genetik, lingkungan dan nutrisi berperan pada perkembangan penyakit autoimun. Saat penyakit autoimun telah menimbulkan gejala, pasien memiliki risiko mendapat nutrisi yang tidak adekuat. Selain itu, kondisi autoimun akan menimbulkan respons inflamasi terus-menerus di dalam tubuh. Bila kondisi ini terus berlanjut akan menyebabkan peningkatan status metabolisme, status nutrisi, status imun dan menimbulkan gangguan kapasitas fungsional pada pasien. Pasien dengan penyakit autoimun harus didukung dengan edukasi dan mendapat terapi nutrisi yang tepat dan adekuat, terutama saat menjalani proses terapi sehingga kebutuhan nutrisi dapat terpenuhi sesuai dengan kondisi pasien. Metode: Laporan serial kasus ini menguraikan empat kasus penyakit autoimun. Dua kasus merupakan kasus neurologi, sementara dua kasus lain adalah kasus penyakit kulit. Dua pasien memiliki status nutrisi malnutrisi berat, satu pasien berat badan normal berisiko malnutrisi dan satu pasien obes I berisiko malnutrisi. Terapi nutrisi sesuai mengacu pada diet seimbang. Semua pasien mendapat terapi nutrisi sejak dikonsulkan ke Departemen Medik Ilmu Gizi hingga hari terakhir perawatan di RS. Asupan energi dan protein diberikan meningkat bertahap sesuai dengan kondisi klinis dan toleransi pasien. Suplementasi mikronutrien diberikan kepada pasien. Pemantauan pasien meliputi keluhan subjektif, hemodinamik, analisis dan toleransi asupan, pemeriksaan laboratorium, antropometri, imbang cairan, dan kapasitas fungsional. Hasil: Selama pemantauan di RS, asupan pasien dapat mencapai kebutuhan energi total dan mikronutrien diterima oleh pasien. Perbaikan klinis dan perbaikan kapasitas fungsional terjadi pada 3 pasien. Satu pasien mengalami perburukan dan meninggal akibat sepsis pada hari perawatan ke-33. Kesimpulan: Terapi nutrisi pada pasien autoimun dapat mendukung proses pengobatan berupa perbaikan kapasitas fungsional dan lama rawat 3 pasien.

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ABSTRACTObjective Autoimmune disease is a condition of body inability to recognize the cells or tissues itself. It will response as antigen elimination process against the cells or tissue itself. Autoimmune risk factors, such as genetic, enviromental and nutrients play a role in the development of autoimmune diseases. When the symptoms occur, the patient have a risk of inadequate nutrition. In addition, autoimmune condition will cause continuous inflammatory response. This situation will increase patients rsquo s metabolic, nutritional, and immune status. Thus, reduce the patient rsquo s functional capacity. Patient with autoimmune disease should be supported by appropriate and adequate nutrition education and therapy, especially during the therapeutic process so that the nutrition requirements can be fulfilled according to the patient 39 s condition. Methods These case report outlines four cases of autoimmune disease. Two cases are cases of neurology, while the other two cases are cases of skin disease. Two patients had severe malnutrition, one normoweight patient at risk for malnutrition and one obese patient at risk of malnutrition. Management of appropriate nutrition refers to a balanced diet. All patients received nutritional therapy from the Clinical Nutrition Department until the last day of hospitalization. The energy and protein intake increase gradually in accordance with improved clinical conditions and patient rsquo s tolerance. Supplementation of micronutrients is given to the patient. Patient monitoring includes subjective, hemodynamics, analysis and tolerance of intake, laboratory examination, anthropometry, fluid balance, and functional capacity Results During hospital monitoring, the patient 39 s nutrition intake can achieve the total energy and protein requirement as well as the micronutrients. Clinical condition and functional capacity improvements occurred in 3 patients. One patient had worsening condition and died due to sepsis in the 33rd day of treatment. Conclusion Nutritional therapy for patients with autoimmune disease can support the treatment process in improvement of functional capacity and length of stay."

"Penyakit autoimun berisiko mengalami komplikasi yang berujung pada sakit kritis. Hal ini dapat menyebabkan peningkatan morbiditas dan mortalitas. Tata laksana nutrisi dapat membantu mencegah malnutrisi, meningkatkan status nutrisi, dan memperbaiki status metabolik, sehingga dapat memperbaiki luaran klinis, mempersingkat fase sakit kritis, dan lama rawat rumah sakit (RS). Pasien dalam serial kasus ini mengalami komplikasi penyakit autoimun yang menyebabkan pasien mengalami sakit kritis, danmembutuhkan perawatan intensif. Keempat pasien adalah perempuan, dengan rentang usia 19−37 tahun, dengan status gizi obes 1 pada dua pasien, dan malnutrisi berat pada pasien lainnya. Dua dari empat pasien mendapatkan tata laksana nutrisi sejak awal fase sakit kritis, sedangkan sisanya setelah lebih dari tujuh hari perawatan intensif. Terapi medik gizi diberikan selama berada di ruang perawatan intensif, meliputi pemenuhanenergi, makronutrien, dan mikronutrien, sesuai kondisi klinis dan toleransi pasien. Asupan energi pada keempat pasien saat perawatan intensif mencapai 25−47 kkal/kg BB/hari, dengan asupan protein tertinggi sebesar 1,4−2,7 g/kg BB/hari. Durasi pemakaian ventilator mekanik, hari perawatan intensif dan RS terpanjang, terdapat pada pasien yang mengalami malnutrisi berat. Tiga dari empat pasien dengan toleransi asupan yang baik mengalami perbaikan luaran klinis, peningkatan kapasitas fungsional,dan diizinkan untuk rawat jalan. Satu pasien pulang atas permintaan sendiri sebelum perbaikan kondisi klinis. Tingkat keparahan penyakit, komplikasi, dan status gizi pada pasien autoimun yang mengalami sakit kritis, mempengaruhi luaran klinis. Tata laksana nutrisi dapat meningkatkan status gizi, sehingga membantu memperbaiki kondisi klinis, menurunkan morbiditas dan mortalitas pasien

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Autoimmune diseases pose risks for complications, leading to critical illnesses, thus increase the morbidity and mortality rate. Nutritional management can prevent malnutrition, improve metabolic and nutritional status, thereby, improve clinical outcomes, shorten critical illness phase, and reduce hospital length of stay. In these case series, all patients had autoimmune diseases with complications, leading to critically ill conditions that required intensive care. All patients were women, aged of 19−37 years. There were two patients with obesity and others with severe malnutrition. Two patients received nutritional management starting from the acute phase, while the rest were at the late period. Medical nutrition therapy was given while in the intensive care unit (ICU), including the energy fulfillment, macro- and micro-nutrients, according to the clinical condition and patient’s tolerance. The energy intake of patients during the critical ilness was 25−47 kcal/kg BW/day, with the protein intake was 1.4−2.7 g/kg BW/day. The longest duration of mechanical ventilator use, length of ICU and hospital stay, were found in patients who were severely malnourished. Three patients with good nutritional intake, had better improvement in clinical conditions, complications, and functional capacity. They were allowed to be discharged and followed up at outpatient unit, while one patient returned home on her own request, before required improvement of clinical conditions. Severity of the diseases, complications, and the nutritional status of autoimmune patients with critical illnesses affected overall clinical outcomes. Medical nutrition therapy can improve metabolic and nutritional status, thereby improve clinical conditions, reduce morbidity and mortality of the patient"

"Latar Belakang. Pasien autoimun rentan terhadap infeksi COVID-19 dan luaran yang lebih berat, sehingga penting untuk mendapat vaksinasi. Namun, terdapat kekhawatiran efek samping, kekambuhan penyakit, serta efektivitas dan imunogenitas vaksin. Tujuan. Mengetahui cakupan vaksinasi COVID-19 di Poli Alergi Imunologi RSCM dan faktor-faktor yang berhubungan. Metode. Studi potong lintang ini melibatkan 260 pasien autoimun dari Poli Alergi Imunologi RSCM periode Juli-Agustus 2023. Pengambilan data menggunakan kuesioner. Analisis bivariat dengan Uji Chi-Square atau Fischer dan analisis multivariat dengan regresi Poisson. Hasil. Cakupan vaksinasi COVID-19 pasien autoimun untuk dosis pertama 60%, dosis kedua 57.3%, dan dosis ketiga 40%. Melalui analisis bivariat, didapatkan faktor yang berhubungan dengan cakupan berupa pekerjaan tenaga kesehatan (PR 1,68; p < 0,001), rekomendasi dokter yang merawat (PR 6,47; p<0,001), dan skala persepsi pasien terhadap keparahan penyakit (p<0,001). Analisis multivariat menunjukkan hubungan antara rekomendasi dokter yang merawat (PR 4,67; p<0,001), pekerjaan tenaga kesehatan (PR 1,56; p=0,01), diagnosis SLE (PR 0,81; p=0,003) dan skala persepsi pasien terhadap keparahan penyakit (PR 0,88; p<0,001). Simpulan. Cakupan vaksinasi COVID-19 dosis pertama pada pasien autoimun di Poli Alergi-Imunologi RSCM adalah 60%. Studi ini menemukan hubungan cakupan vaksinasi dengan rekomendasi dokter yang merawat, pekerjaan sebagai tenaga kesehatan, diagnosis SLE, dan persepsi pasien terhadap keparahan penyakit.

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Background. Autoimmune patients are susceptible to COVID-19 infection and severe outcomes, so it is important to receive vaccination. However, there are concerns about side effects, disease recurrence, and vaccine effectiveness and immunogenicity.

Objective. To explore uptake of COVID-19 vaccination at RSCM Allergy Immunology Clinic and related factors.

Method. This cross-sectional study involved 260 autoimmune patients from the RSCM Allergy Immunology Clinic for July-August 2023. Data was collected with questionnaire. Bivariate analysis with Chi-Square or Fischer Test and multivariate analysis with Poisson regression.

Results. COVID-19 vaccination coverage for autoimmune patients for the first dose is 60%, the second dose is 57.3%, and third dose is 40%. Through bivariate analysis, associated factors were health worker employment (PR 1.68; p < 0.001), recommendation of treating doctor (PR 6.47; p < 0.001), and patients’ perception of their illness (p< 0.001). Multivariate analysis showed association between recommendation of treating doctor (PR 4.67;p<0.001), health worker's occupation (PR 1.56;p=0.01), SLE diagnosis (PR 0.81;p=0.003) and the scale patient perception of disease severity (PR 0.88;p<0.001).

Conclusion. Coverage first dose COVID-19 vaccination in autoimmune patients at RSCM Allergy-Immunology Clinic is 60%. This study found association between recommendation of treating doctor, healthcare workers, SLE diagnosis, and patients’ perception of their illness."

"ABSTRACTThis case study aim to evaluate the response of steroid treatment for autoimmune endocarditis. Valvular heart disease is relatively rising in both congenital and acquired cases, but the autoimmune endocarditis remains rare. In this case, a 34 year old woman with clinical manifestation resembling systemic lupus erythematosus (SLE) is diagnosed with Libman-sacks Endocarditis. After six months of steroid treatment, her clinical manifestations and heart structure improved."

"Penelitian ini bertujuan untuk menyelidiki efek audiens dalam menyimpul tali sepatu di kalangan mahasiswa. Sebanyak 29 mahasiswa di University of Queensland berpartisipasi dalam eksperimen independent groups ini. Partisipan diminta untuk menyimpul tali sepatu dalam kurun waktu tertentu, dimana mereka ditempatkan pada salah satu dari dua kondisi eksperimental, yaitu dalam kondisi audiens dan tanpa audiens. Hasil penelitian menunjukkan bahwa peserta dalam kondisi audiens mempunyai kinerja lebih lama daripada peserta dalam kondisi tanpa audiens. Evaluation Apprehension skor bagi peserta di kedua kondisi juga tidak berbeda. Hasil ini bertentangan dengan Drive Theory (Zajonc, 1965) dan Evaluation Apprehension Theory (Cottrell, 1972) yang menyatakan bahwa kehadiran audiens akan meningkatkan performa partisipan dan membuat peserta berpikir bahwa kinerja mereka dievaluasi.

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The present study aims to examine the audience effects on tying shoelaces among university students. A total of 29 university students participated in an independent group experiment where each participant was assigned to either audience or no audience condition. The participants were asked to tie the shoelaces of six identical shoes, in which the performance will be measured by the average time taken in seconds for completion. Results revealed that participants in the audience condition were performing slower than those in no audience condition. Evaluation apprehension also did not differ in both audience conditions. This suggested that findings of this study were not consistent with Drive Theory (Zajonc, 1965) and Evaluation Apprehension Theory (Cottrell, 1972) which suggested that the presence of audiences would improve one’s performance and make participants feel evaluated, respectively."