Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRACTBACKGROUND: Alphacalcidol, a vitamin D analog, shows immune regulatory potency as it works on the macrophage and T cell to control inflammation and T cell dysregulation in elderly. None has been known about its effect on elderly with various states of frailty syndrome, which have different level of chronic low grade inflammation. This study aimed to determine the effect of alphacalcidol on inflammatory cytokines (IL-6, IL-10, g-IFN ) and T cell subsets (CD4/CD8 ratio and CD8+ CD28-) of elderly with various stages of frailty syndrome. METHODS: from January to July 2017, a double blind randomized controlled trial (RCT) with allocation concealment, involving 110 elderly subjects from Geriatric Outpatient Clinic Cipto Mangunkusumo Hospital Jakarta, was conducted to measure the effect of 0.5 mcg alphacalcidol administration for 90 days to inflammatory cytokines (IL-6, IL-10, g-IFN) from PBMC culture supernatant, as well as CD4/CD8 and CD8+CD28- percentage using flow cytometry. Statistical analysis using SPSS version 20 was performed with t-test to measure mean difference. RESULTS: of 110 subjects involved in the RCT consisting of 27 fit, 27 pre-frail and 56 frail elderly, 25(OH)D serum level was found to be as low as 25.59 (12.2) ng/ml in alphacalcidol group and 28.27 (10.4) ng/ml in placebo group. Alphacalcidol did not decrease IL-6 (p=0.4) and g- IFN (p=0.001), but it increased IL-10 (p=0,005) and decreased IL6/IL10 ratio (p=0.008). Alphacalcidol increased CD4/CD8 ratio from 2.68 (SD 2.45) to 3.2 (SD 2.9); p=0.001 and decreased CD8+ CD28- percentage from 5.1 (SD 3.96) to 2.5 (1.5); p<0.001. Sub group analysis showed similar patterns in all frailty states. CONCLUSION: Alphacalcidol improves immune senescence by acting as anti-inflammatory agent through increased IL-10 and decreased IL6/IL-10 ratio and also improves cellular immunity through increased CD4/CD8 ratio and decreased CD8+ CD28- subset in elderly. This effect is not influenced by frailty state."

"Latar Belakang. Th17 merupakan sel T efektor proinflamasi yang berperan pada proses autoimunitas. Pada pasien Graves yang sulit remisi terdapat peningkatan Th17. Sebagai imunomodulator, vitamin D dapat menekan sitokin inflamasi yang diproduksi oleh sel dendritik, termasuk IL-23. IL-23 berperan pada diferensiasi, ekspansi dan survival Th17. Alphacalcidol bersinergi dengan tionamid dalam menghambat sintesis hormon tiroid. Belum diketahui apakah pemberian alphacalcidol juga memberikan efek imunomodulator pada penyakit Graves, terutama supresi Th17 yang dinilai dari konsentrasi IL-23 serum.Tujuan. Mengetahui efek alphacalcidol terhadap konsentrasi IL-23 pada pasien Graves.Metode. Studi ini merupakan cabang dari studi induk mengenai efek alphacalcidol terhadap pematangan sel dendritik. Studi induk merupakan uji klinis tersamar ganda yang diikuti oleh pasien Graves hipertiroid yang terbagi menjadi 12 subjek pada kelompok perlakuan dan 13 subjek pada kelompok plasebo. Kelompok perlakuan mendapatkan alphacalcidol 1,5 µg per hari dan tionamid, sedangkan kelompok plasebo mendapatkan tionamid dan plasebo. Serum pada studi induk disimpan pada suhu -80oC. Pada penelitian ini IL-23 diperiksa pada serum kedua kelompok baik sebelum maupun sesudah suplementasi alphacalcidol.Hasil. Konsentrasi IL-23 serum pada kelompok perlakuan adalah 12,322 pg/mL sedangkan pada kelompok plasebo adalah 12,380 pg/mL.Simpulan. Tidak terdapat perbedaan bermakna (p >0.05) konsentrasi IL-23 serum antara kelompok yang mendapatkan alphacalcidol 1,5 µg per hari dengan kelompok plasebo.

---

Backgroud. Th17 is a pro-inflammatory T cells effector which has a significant role in autoimmunity. Increasing proportions of Th17 cells found in intractable Graves` disease patients. As immunomodulator, vitamin D able to suppress inflammatory cytokine produced by dendritic cell, including IL-23. IL-23 has a significant role in differentiation, expansion and survival of Th17. Alphacalcidol and tionamid has a synergic effect in inhibiting thyroid hormone synthesis. There is no evidence weather alphacalcidol has immunomodulatory effect in Graves` disease, especially in suppressing Th17 which is evaluate by IL-23 concentration.Aim. To evaluate effect of alphacalcidol to IL-23 concentration in Graves` diseaseMethod. The parent study used randomized clinical trial desain. In present study 25 Graves` hyperthyroid patients, divided to 12 subjects in intervention group and 13 subjects in placebo. Alphacalcidol 1,5 µg a day and tionamid given to patients in intervention group, meanwhile subjects in placebo group only got tionamid. Serum sample from parent study stored in -80oC. In present study evaluation of IL-23 performed in both groups before and after alphacalcidol supplementation. Results. Serum concentration of IL-23 is 12,322 pg/mL in intervention group, and 12,380 pg/mL in placebo group.Conclusion. There is no significance differences (p > 0.05) of serum concentration of IL-23 between patients receiving alphacalcidol and placebo."

"ABSTRAKSaat ini terdapat perbaikan Angka Harapan Hidup (AHH) penduduk Indonesia dan penambahan populasi penduduk lanjut usia. Pada tahun 2017, AHH mencapai 71,06 tahun, dan jumlah lansia 23,4 juta orang (8,97% dari seluruh penduduk Indonesia). Hal ini berisiko meningkatkan kejadian penyakit degeneratif. Osteoartritis (OA) adalah penyakit yang sering dikaitkan dengan kondisi degeneratif dan mengakibatkan ketidakaktifan fisik. Pada Riskesdas 2013, penyakit Artritis berada di urutan kedua penyakit terbanyak diderita lansia dengan prevalensi 45% (55-64 tahun), 51,9% (65-74 tahun) dan 54,8% (usia >75 tahun). Pengobatan simtomatik dengan OAINS yang berkepanjangan dapat mengakibatkan efek samping yang fatal. Terdapat berbagai faktor risiko berkembangnya OA lutut, di antaranya konsentrasi serum Vitamin D (25(OH)D. Proporsi perempuan lansia dengan defisiensi 25(OH)D pada penelitian di Jakarta dan Bekasi mencapai 35,1%. Terdapat hubungan antara kadar Vitamin D (25(OH)D) yang rendah dengan nyeri lutut dan perubahan kartilago sendi lutut pada OA. Serum Cartilage Oligomeric Matrix Protein (COMP) merupakan produk degradasi penting dari kartilago sendi dan dapat menjadi marker diagnosis untuk OA lutut. Penelitian ini bertujuan mengetahui pengaruh pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu terhadap derajat nyeri berdasarkan indikator WOMAC, dan kondisi obyektif kartilago sendi dengan perubahan marker serum COMP pada penderita OA lutut lansia. Disain penelitian uji klinis teracak, tersamar ganda, dan terkontrol plasebo. Subyek dengan OA lutut simtomatis direkruit secara consecutive sampling dan dilakukan anamnesis, diperiksa kondisi fisik, radiologi lutut, kadar serum Vitamin D (25(OH)D), serum Calcium dan marker COMP. Subyek dialokasikan secara acak (random allocation) pada kelompok perlakuan yang diberikan suplemen Vitamin D (Alphacalcidol) atau kelompok kontrol yang diberikan plasebo. Populasi sumber xviii Universitas Indonesia pada penelitian ini ialah pasien OA lutut lanjut usia yang berobat ke KPKM FKIK UIN Jakarta. Dari hasil pemeriksaan konsentrasi serum Vitamin D 25(OH)D sebelum dilakukan intervensi, 53,4% responden mengalami insufisiensi dan 12,3% responden mengalami defisiensi Vitamin D. Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan derajat nyeri berdasarkan indikator WOMAC pada penderita OA lutut lansia yang bermakna secara statistik dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibanding kontrol sebesar 2,174 (p=0,00). Pemberian suplemen Vitamin D (Alphacalcidol) selama 12 minggu, mempengaruhi penurunan konsentrasi serum COMP pada penderita OA lutut lansia, dengan perbedaan perubahan skor pra dan pascaintervensi pada kelompok intervensi dibandingkan kelompok kontrol sebesar 38,15 ng/ml namun tidak bermakna secara statistik (p=0,39)

---

ABSTRACTAt present there are improvements in the Life Expectancy (AHH) of the Indonesian population and the addition of the elderly population. In 2017, AHH reached 71.06 yo and the number of elderly people reached 23.4 million people (8.97% of the total population of Indonesia). This has the potential to increase degenerative diseases. Osteoarthritis (OA) is a disease that is often associated with degenerative conditions and physical inactivity. Riskesdas in 2013 stated that Arthritis was the second most common disease suffered by the elderly with a prevalence of 45% (55-64 yo), 51.9% (65-74 yo) and 54.8% (>75 yo). Symptomatic treatment with prolonged NSAIDs can cause fatal side effects. There are various risk factors for developing knee OA, including serum Vitamin D (25(OH)D) concentrations. The proportion of elderly women with 25(OH)D deficiency in studies in Jakarta and Bekasi reaches 35.1%. It has been found an association between low Vitamin D levels (25(OH)D) with knee pain in OA and changes in the knee joint cartilage. Cartilage Oligomeric Matrix Protein (COMP) is an important degradation product of joint cartilage and can be act as a diagnostic marker of knee OA. This study aims to determine the effect of Vitamin D supplementation (Alphacalcidol) for 12 weeks on the degree of pain based on WOMAC indicators, and the objective conditions of joint cartilage with changes in COMP serum markers in patients with knee OA in the elderly. The research design is a randomized, double-blind, and placebo-controlled clinical trials. Subjects with symptomatic knee OA will be recruited by consecutive sampling and continued with history taking, physical conditions examinatons, knee radiology, and blood test for serum vitamin D (25(OH)D), serum calcium and marker COMP. Subjects were then randomly allocated to the treatment group given Vitamin D supplements (Alphacalcidol) or the control group given a placebo. The source population in this study was elderly with knee OA patients xx Universitas Indonesia who went to Primary Health Care Clinic (KPKM) of FKIK UIN Jakarta. We found that before intervention was done, 53.4% of respondents had Vitamin D insufficiency and 12.3% of respondents had Vitamin D deficiency. The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, influenced the decrease in the degree of pain based on the WOMAC indicator in knee OA of elderly patients significantly, with differences in changes in pre and post intervention scores of 2.174 compare with control (p=0.00). The administration of Vitamin D supplements (Alphacalcidol) for 12 weeks, affected the decrease in the serum concentration of COMP in knee OA of elderly patients, with differences in changes in pre and post intervention scores in the intervention group compared to the control group of 38.15 ng/ml but not statistically significant (p=0.39)."