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"ABSTRACTAtherosclerosis is a chronic inflammatory disorder involving innate and adaptive immunity process. Effector T cell (Teff) responses promote atherosclerotic disease, whereas regulatory T cells (Tregs) have been shown to play a protective role against atherosclerosis by down-regulating inflammatory responses which include multiple mechanisms. Compelling experimental data suggest that shifting the Treg/Teff balance toward Tregs may be a possible therapeutic approach for atherosclerotic disease, although the role of Tregs in human atherosclerotic disease has not been fully elucidated. In this review, we discuss recent advances in our understanding of the roles of Tregs and Teffs in experimental atherosclerosis, as well as human coronary artery disease."

"he book describes how the balance between pro- and anti-inflammatory molecules is related to health and disease. It is suggested that many diseases are initiated and their progress is influenced by inflammatory molecules and a decrease in the production and/or action of anti-inflammatory molecules and this imbalance between pro- and anti-inflammatory molecules seems to have been initiated in the perinatal period. This implies that strategies to prevent and manage various adult diseases should start in the perinatal period. An alteration in the metaolism of essential fatty acids and their anti-inflammatory molecules such as lipoxins, resolvins, protecitns, maresins and nitrolipids seems to play a major role in the pathobiology of several adult diseases. Based on these concepts, novel therapeutic approaches in the management of insulin resistance, obesity, type 2 diabetes mellitus, metabolic syndrome, cancer, lupus, rheumatoid arthritis and other auto-immune diseases are presented. Based on all these evidences, a unified concept that several adult diseases are due to an alteration in the balance between pro- and anti-inflammatory molecules is discussed and novel methods of their management are presented."

"Obstructive sleep apnea adalah salah satu komorbid asma yang saat ini menjadi perhatian karena menyebabkan hipoksia intermiten akibat OSA sehingga terjadi kerusakan lapisan endotel, terbentuknya mikropartikel, dan inflamasi. Penurunan arus puncak ekspirasi (APE) dan kualitas hidup (PAQLQ) juga berkaitan dengan asma sehingga perlu dilakukan penelitian untuk mengevaluasi pengaruh inflamasi terhadap APE dan PAQLQ pada anak asma disertai komorbid OSA.Penelitian cross-sectional komparatif dilakukan di Banding pada anak asma usia 7–15 tahun disertai dan tanpa OSA, pada bulan Agustus 2020 sampai Juni 2021. Penjaringan asma klinis berdasarkan gejala dan riwayat pengobatan dilakukan berdasarkan kuesioner ISAAC, diagnosis asma dengan peak flow meter, dan diagnosis OSA dengan polisomnografi. Sitokin pro-inflamasi diperiksa dengan metode enzyme-linked immunosorbent assay (ELISA) dan mikropartikel endotel diperiksa menggunakan flow cytometer. Data diolah menggunakan program SPSS 20.0 dan diuji dengan uji t tidak berpasangan, uji Mann-Whitney, uji korelasi Pearson dan Spearman Rho. Uji path analysis (Structural Equation Modeling, SEM) menggunakan program JASP versi 0.16.1.Jumlah subjek adalah 32 anak asma disertai OSA dan 48 anak asma tanpa OSA. Terdapat perbedaan bermakna pada indeks masa tubuh/IMT (p = 0,01), hipertrofi tonsil (p = 0,009), persentase APE (p = 0,02), semua domain nilai PAQLQ, dan kadar mikropartikel endotel antara kedua kelompok. Eosinofil dan neutrofil berpengaruh pada APE, sedangkan interleukin-6, eosinofil, neutrofil, CD62E+/CD31- mikropartikel, dan APE berpengaruh pada penurunan nilai PAQLQ pada kelompok anak asma disertai OSA. Disimpulkan mikropartikel endotel berperan pada patomekanisme asma dengan komorbid OSA.

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Obstructive sleep apnea is comorbid of asthma causes intermittent hypoxia due to damage the endothelial layer, release of microparticles, and inflammation. Decreased peak expiratory flow rate (PEFR) and quality of life (PAQLQ) are also associated with asthma. The aim of this study was to evaluate the influence of inflammation on PEFR and PAQLQ in asthmatic children with comorbid OSA.

A cross-sectional study was conducted in asthmatic children aged 7–15 years with and without OSA, from August 2020 to June 2021. Asthma symptoms and therapeutic history were carried out using the ISAAC questionnaire, diagnosis of asthma by a peak flow meter, and diagnosis of OSA by polysomnography. Pro-inflammatory cytokines were examined using the ELISA method and endothelial microparticles were examined using a flow cytometer. Statistical analysis using SPSS program v.20.0 and analyzed by unpaired t-test, Mann-Whitney U-test, Pearson and Spearman Rho test. Path analysis test (Structural Equation Modeling, SEM) using JASP v.0.16.1.

The number of subjects was 32 asthmatic children with OSA and 48 asthmatic children without OSA. There were significant differences in body mass index/BMI (p = 0.01), tonsil hypertrophy (p = 0.009), PEFR percentage (p = 0.02), all domains of PAQLQ values, and endothelial microparticle levels between the two groups. Eosinophils and neutrophils have an effect on PEFR, whereas interleukin-6, eosinophils, neutrophils, CD62E+/CD31- microparticles, and PEFR have an effect on decreasing PAQLQ values ​​in the group of asthmatic children with OSA. It is concluded that endothelial microparticles have an influence on the pathomechanism of asthma with comorbid OSA."

"Aterosklerosis sebagai penyebab terjadinya PJK merupakan proses multifaktorial karena banyak sekali faktor-faktor yang menyebabkannya dengan mekanisme yang saling terkait. Saat ini proses aterosklerosis dianggap sebagai proses inflamasi. Inflamasi terbukti berperan penting pada inisiasi, progresi maupun destabilisasi plak aterosklerosis. High sensitivity C-reactive protein (hs-CRP) merupakan salah satu petanda inflamasi yang penting pada penyakit jantung koroner (PJK) yang berhubungan dengan tingkat keparahan aterosklerosis, iskemi miokardium dan nekrosis miokardium. Tujuan penelitian ini adalah untuk mengetahui dan membandingkan kadar hs-CRP pada pasien sindroma koroner akut (SKA), PJK kronik dan bukan PJK, serta untuk mengetahui apakah terdapat hubungan antara kadar hs-CRP dengan kadar enzim CKMB pada pasien infark miokard akut (IMA). Penelitian bersifat observasional deskriptif dan analitik dengan pendekatan potong lintang. Dilakukan pemeriksaan kadar hs-CRP dengan metode chemiluminescent pada 21 pasien SKA, 20 pasien PJK kronik dan 20 bukan PJK. Didapatkan kadar hs-CRP rerata pada pasien SKA, PJK kronik dan bukan PJK sebesar 8,40 (SD 5,53) mg/l, 2,81 (SD 2,09) mg/l dan 1,07 (SD 0,81) mg/l. Analisis statistik didapatkan perbedaan kadar hs-CRP yang bermakna antara pasien SKA, PJK kronik dan bukan PJK (p 0,000). Kadar hs-CRP mempunyai korelasi positif yang bermakna dengan kadar enzim CKMB pada pasien IMA (p 0,004). Sebagai kesimpulan, kadar hs-CRP pada pasien SKA secara bermakna lebih tinggi dibanding PJK kronik dan bukan PJK. Terdapat hubungan yang bermakna antara peningkatan kadar hs-CRP dengan peningkatan kadar enzim CKMB. (Med J Indones 2004; 13: 102-6)

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Coronary heart disease (CHD) due to atherosclerosis is a multifactorial process with multiple interdependent factors. At present time, atherosclerosis is considered to be an inflammatory process. It has been proven that inflammation plays a mayor role in the initiation, progression as well as the destabilitation of the atherosclerosis plaque. High sensitivity C-reactive protein (hs-CRP) is one of the most important inflammatory marker in CHD and directly related to the extent and severity of atherosclerosis, extent of myocardial ischemia and myocardial necrosis. The purpose of this study is to determine hs-CRP levels in patients with acute coronary syndrome (ACS), chronic CHD and non CHD. And, to determine the correlation between hs-CRP levels and CKMB enzyme level in patients with acute myocardial infarction (AMI). This is a descriptive observational analytic study with cross sectional design. hs-CRP levels were measured by using chemiluminescent method on 21 ACS patients, 20 chronic CHD patients and 20 non CHD patients. The mean hs-CRP level in ACS, chronic CHD and non CHD patients were respectively 8.40 (SD 5.53) mg/l, 2.81 (SD 2.09) mg/l and 1.07 (SD 0.81) mg/l. A statistically significant difference in hs-CRP level was found between ACS, chronic CHD and non CHD (p = 0.000 ). A positive correlation was found between hs-CRP level and CKMB enzyme level in AMI patients (p = 0.004). In conclusion hs-CRP level is consistently higher in patients with ACS compared to patients with chronic CHD and non CHD. A positive correlation was found between the increased level of hs-CRP and CKMB enzyme level. (Med J Indones 2004; 13: 102-6)"

"Management of generalized dermatitis in clinical practice translates the mechanisms of dermatitis from basic science evidence to practice based recommendations for clinical care. The role of allergic contact dermatitis in atopic dermatitis is explored in depth. Primary care physicians, allergists, and dermatologists will enjoy the fresh perspective that moves beyond treatment with corticosteroids and provides diagnostic and therapeutic algorithms for this complex condition."

"atar Belakang: Balans energi positif pada obesitas ditandai dengan hiperadipositosis dan merangsang proses inflamasi kronik yang berdampak pada komplikasi penyakit pasien obesitas. Salah satu penatalaksaan obesitas adalah pemberian diet restriksi kalori. Diet restriksi kalori diduga menyebabkan penurunan kondisi inflamasi kronik yang salah satunya ditandai dengan kadar c-reactive protein (CRP). Namun demikian, berbagai studi memberikan hasil yang inkonsisten.Tujuan: Menilai efek diet restriksi kalori terhadap perubahan kadar CRP dan menilai pengaruh durasi diet tertentu terhadap perubahan kadar CRP pasien obesitas.Sumber Data: Pencarian utama dilakukan pada basis data PubMed, ProQuest, EBSCOhost, Embase dan Scopus hingga 30 Oktober 2020. Pencarian sekunder juga dilakukan secara snowballing, Google Scholar, Global Index Medicus, portal basis data nasional, dan perpustakaan digital 40 universitas di Indonesia.Seleksi Studi: Studi uji klinis acak melibatkan pasien dewasa obes yang menilai efek diet restriksi kalori (tanpa mengkombinasikan dengan terapi nondiet lain) terhadap kadar CRP. Tidak ada batasan tahun publikasi dan bahasa. Penilaian terhadap judul, abstrak dan studi dilakukan oleh dua peninjau independen. Dari 2087 artikel, 11 studi diantaranya memenuhi kriteria eligibilitas.Ekstraksi Data: Ekstraksi data dilakukan oleh kedua peninjau. Korespondensi dilakukan dengan menghubungi peneliti dan tidak didapatkan adanya data tambahan.Hasil: Diet restriksi kalori memiliki efek terhadap penurunan kadar CRP pada pasien obesitas dengan nilai Mean Difference -0.22 (IK 95% -0.40 - -0.04, p 0.006). Intervensi restriksi diet ≤ 12 minggu tidak menunjukkan penurunan bermakna pada kadar CRP, sedangkan intervensi restriksi diet > 12 minggu menunjukkan penurunan bermakna pada kadar CRP.KesimpulanDiet restriksi kalori memiliki efek menurunkan kadar CRP pada pasien obesitas.

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Background: Positive energy balance in obesity is characterized by hyperadipocytosis, which stimulates chronic inflammatory processes in obese patients. Management of obesity includes a calorie restriction diet thought to improve chronic inflammatory conditions, characterized by reduced c-reactive protein (CRP). However, studies have yielded inconsistent results.

Objective: To assess the effect of a calorie-restricted diet on changes in CRP levels and the duration of a particular diet that is significant for its effect on changes in CRP levels in obese patients

Data Source: We searched PubMed, ProQuest, EBSCOhost, Embase and Scopus through October 30,2020. Secondary searching was done by snowballing method including references of qualifying articles and manual searching through google scholar, global index medicus, national databases, and digital library of 40 universities in Indonesia

Study Selection: A randomized controlled trial involving obese adult patients assessed the effect of a calorie-restricted diet (without combination with other nondiet therapy) on CRP levels. No restriction regarding year of publication and language. Titles, abstracts, and articles were reviewed by two independent reviewer. Of the 2087 studies identified in our original search, 11 of them met the eligibility criteria.

Data Extraction: Data extraction was done by two reviewers. Correspondence was done by contacting the authors to confirm additional data. No additional data was obtained

Result: The calorie restriction diet has an effect on reducing CRP levels in obese patients with a Mean Difference value of -0.22 (95% CI -0.40 - -0.04, p 0.006). Dietary restriction interventions ≤ 12 weeks did not show a significant decrease in CRP levels, while dietary restriction interventions > 12 weeks showed a significant decrease in CRP levels

Conclusion: A calorie restriction diet has the effect of lowering CRP levels in obese patients"

"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."