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Abstrak :
[ABSTRAK
Tuberkulosis penyakit infeksi yang mematikan terutama di negara berkembang, termasuk Indonesia. Upaya pencegahan dengan vaksinasi BCG yang dapat meningkatkan respon imun masih belum maksimal. Faktor yang mempengaruhi keberhasilan vaksin adalah status imun host, genetik dan kualitas/kuantitas vaksin. Indonesia sebagai negara kaya tanaman obat, misalnya pasak bumi (Eurycoma longifolia Jack) digunakan sebagai antimalaria serta meningkatkan imun tubuh. Penelitian ini menilai efek ekstrak akar pasak bumi sebagai imunomodulator terutama IFN-ɣ, TNF-α dan IL-10 pada mencit yang diberi vaksin BCG. Eksperimental in vivo dan in vitro darah mencit di kultur pada medium RPMI dengan stimulasi PHA dan BCG. Analisis tidak ada perbedaan yang bermakna (p≥0,05) diantara kelompok perlakuan, analisa dari nilai median terlihat adanya efek ekstrak pasak bumi terhadap peningkatan TNF-α, dan tidak berpengaruh terhadap produksi IFN-γ dan IL-10 pada mencit yang divaksin BCG. Ekstrak akar pasak bumi mempengaruhi respon imun tubuh mencit yang diberi vaksin BCG, walau tidak besar maknanya.

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ABSTRACT
Tuberculosis is a deadly infectious disease that occurs mainly in developing countries, including Indonesia. Preventive efforts by BCG vaccination to improve the immune response is still not maximum. Factors that affect the success of vaccine are the host immune system, the host genetic and the quality/quantity of the vaccine. Indonesia is rich in medicinal plants, one of those is Pasak Bumi (Eurycoma longifolia Jack) that is widely used as antimalaria and to improve immunity. The research assessed the effects of extracts of Pasak Bumi roots as immunomodulator by measuring IFN-ɣ, TNF-α and IL-10 on mice that were given with BCG vaccine. In vivo and in vitro experiments of mice blood cultured in RPMI medium stimulated with PHA and BCG. The result has shown no significant difference (p≥0,05) among the treatment group, result of median values has shown the effect of Pasak Bumi extract to an increase of TNF-α, and has no effect on the production of IFN-γ and IL-10 in mice vaccinated BCG. Extract of pasak bumi roots affects the immune response of mice that have got BCG vaccine, although it has no significant meaning., Tuberculosis is a deadly infectious disease that occurs mainly in developing countries, including Indonesia. Preventive efforts by BCG vaccination to improve the immune response is still not maximum. Factors that affect the success of vaccine are the host immune system, the host genetic and the quality/quantity of the vaccine. Indonesia is rich in medicinal plants, one of those is Pasak Bumi (Eurycoma longifolia Jack) that is widely used as antimalaria and to improve immunity. The research assessed the effects of extracts of Pasak Bumi roots as immunomodulator by measuring IFN-ɣ, TNF-α and IL-10 on mice that were given with BCG vaccine. In vivo and in vitro experiments of mice blood cultured in RPMI medium stimulated with PHA and BCG. The result has shown no significant difference (p≥0,05) among the treatment group, result of median values has shown the effect of Pasak Bumi extract to an increase of TNF-α, and has no effect on the production of IFN-γ and IL-10 in mice vaccinated BCG. Extract of pasak bumi roots affects the immune response of mice that have got BCG vaccine, although it has no significant meaning.]

Abstrak :
ABSTRAK
Penelitian ini menggunakan disain case control untuk melihat besar risiko anak yang tidak diimunisasi BCG untuk terkena TB Paru. Kasus dan kontrol adalah anak kota Sukabumi usia 0-5 tahun yang diperoleh dari laporan rutin program TB, imunisasi, KIA dan Gizi di dinas kesehatan kota Sukabumi. Hasil analisis bivariat menunjukkan bahwa anak yang tidak diimunisasi BCG memiliki risiko 3,270 kali lebih besar untuk terkena TB paru dibandingkan anak yang diimunisasi BCG. Sedangkan hasil analisis multivariat yang memasukkan variabel kunjungan neonatal sebagai variabel interaksi dan variabel berat badan lahir sebagai confounding menunjukkan bahwa anak yang tidak diimunisasi BCG dan kunjungan neonatal < 3 kali memiliki tingkat Risiko sebesar 5,63 kali lebih tinggi untuk terkena TB paru dibandingkan anak yang diimunisasi BCG dan kunjungan neonatal = 3 kali (kelompok referens). Adapun tingkat risiko anak yang tidak diimunisasi BCG dan kunjungan neonatal = 3 kali adalah sebesar 1,13 kali lebih besar untuk terkena TB paru dibandingkan kelompok referens dan anak yang diimunisasi BCG namun kunjungan neonatal<3 memiliki tingkat risiko 4,99 kali lebih besar dari kelompok referens. Dari hasil tersebut diketahui bahwa efikasi vaksin BCG tanpa interaksi adalah dengan 67% sedangkan efikasi vaksin BCG dengan interaksi adalah 82%. ini berarti, efikasi vaksin di Kota Sukabumi mengalami peningkatan dengan adanya interaksi variabel kunjungan neonatal dengan imunisasi BCG.

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ABSTRACT
This study used case control design to look at the risk of children not immunized with BCG for pulmonary tuberculosis. Case and control are children under 5 years old in Sukabumi City obtained from regular reports of TB program, immunization, KIA and Nutrition at health office in Sukabumi city. The result of bivariate analysis showed that children who were not immunized with BCG had a risk at 3.270 times higher to have pulmonary TB than children were immunized with BCG. While the results of multivariate analysis that included neonatal visit variables as interaction variables and born weight variables as confounding showed that children were not immunized with BCG and neonatal visits < 3 times had a Risk level at 5.63 times higher for pulmonary tuberculosis than immunized children BCG and neonatal visits = 3 times (reference group). The risk of children not immunized by BCG and neonatal visits = 3 times was 1.13 times higher for pulmonary tuberculosis than the referent group and children immunized with BCG but neonatal visits <3 had a risk level 4.99 times greater than the group Referens. From these results it is known that the efficacy of BCG vaccine without interaction is 67 % while the efficacy of BCG vaccine with interaction is 82 %. This means, the efficacy of vaccine BCG in Sukabumi City has increased with the interaction between neonatal visit variable and BCG immunization

Abstrak :
ABSTRAK
Latar belakang. Meskipun vaksin Bacille Calemette-Guerin telah menjadi program vaksinasi wajib di Indonesia, TB pada anak tetap prevalen sehingga penelitian ini akan mengevaluasi jaringan parut BCG dan hubungannya dengan kejadian TB ekstraparu (TB-EP) pada anak. Metode Penelitian. Pengambilan data dilakukan di Rumah Sakit Cipto Mangunkusumo Kiara dengan metode potong-lintang pada populasi anak terdiagnosis TB berdasarkan kriteria WHO dan konsensus IDAI. Hasil. Sebanyak 246 pasien anak dengan jangkauan usia 2 bulan -18 tahun terdiagnosis TB. Sebesar 127 anak (51,6%) mengalami TB-EP, dengan prevalensi TB tulang, KGB dan abdomen secara berurutan 13%, 10,9%, dan 6,6%. Mayoritas pasien TB EP adalah laki-laki (55,2%) dan berada dalam kelompok usia 6-14 tahun (60%). Riwayat kontak dengan kasus TB-EP ditemukan pada 49 kasus (51,5%). Penyakit komorbid penyerta dengan mayoritas keganasan (25,6%) dan infeksi HIV (23,1%) ditemukan pada 21 kasus TB-EP (35%). Status jaringan parut BCG positif ditemukan pada 140 kasus (56,9%). Dari 106 anak tanpa jaringan parut BCG, sebanyak 38 anak (35,8%) memiliki TB paru dan sebanyak 68 anak (64,2 %) memiliki TB-EP. Tidak adanya jaringan parut BCG memiliki hubungan yang bermakna dengan kejadian TB-EP pada anak (p < 0.01) dengan OR: 2,457 (IK95% : 1,46 - 4,131). Kesimpulan. Tingginya kejadian TB-EP pada anak pada proporsi tanpa jaringan parut BCG berhubungan signifikan secara statistik. Upaya vaksinasi BCG yang optimal diperlukan untuk mengurangi morbiditas dan mortalitas TB-EP pada anak di Indonesia.

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ABSTRACT
Objectives. Although the Bacille Calmette-Guerin vaccination program is already implemented nationally, childhood TB remains prevalent particularly in Indonesia so this study will evaluate the relationship between BCG vaccination scar and extra pulmonary TB in children. Methods. Data collection was conducted at Cipto Mangunkusumo Kiara Hospital by cross-sectional method. Children diagnosed with TB according to WHO criteria and IDAI consensus are included in this study. Results. A total of 246 pediatric patients with a-2 months to 18 years-age range were diagnosed with TB. Extra pulmonary TB was found in 127 children (51.6%), with the most prevalent type: bone, lymph node and abdomen TB sequentially are 13%, 10.9%, and 6.6%. The majority of patients with extrapulmonary TB are male (55.2%) and are in the age group 6-14 years (60%). History of contact with active TB cases was found in 49 out of 95 extrapulmonary cases (51.5%). Comorbidities, predominantly malignancies (25.6%) and HIV infection (23.1%), were found in 21 of 60 extrapulmonary cases (35%). BCG scar was found in 140 cases (56.9%). Of 140 children with BCG scar, 81 children (68.1%) had pulmonary TB and 59 children (42.1%) had extra-pulmonary TB. Of the 106 children without BCG scar, 38 (35.8%) had pulmonary TB and 68 (64.2%) had extra-pulmonary TB. The absence of BCG scar tissue has a significant relationship with extra-pulmonary TB incidence in children (p <0.01) with OR :2.457 (CI95% : 1.46 - 4.131). Conclusion: The high incidence of extra-pulmonary TB in children in the proportion lacking BCG scar was statistically significant.Thus, an optimal BCG vaccination effort is required to reduce the morbidity and mortality of childhood extrapulmonary TB in Indonesia.