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Abstrak :
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.

Abstrak :
ABSTRACT
Atherosclerosis 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.

Abstrak :
Latar belakang: Periodontitis merupakan infeksi yang melibatkan jaringan pendukung gigi disebabkan oleh biofilm plak gigi pada permukaan gigi dan inflamasi sebagai penyebab dari respons imun pejamu. Prostaglandin E2 (PGE2) sebagai mediator inflamasi terlibat dalam patogenesis berbagai penyakit inflamasi kronis, termasuk periodontitis dan sebagai regulator tekanan darah. Tujuan: Untuk membandingkan kadar prostaglandin dalam cairan krevikular gingiva pasien periodontitis dengan hipertensi dan non-hipertensi. Metode: Sampel total 60 pasien diperiksa. Terdiri dari 44 pasien kelompok hipertensi dan 16 pasien kelompok non-hipertensi sebagai kontrol. Keadaan hipertensi diukur dengan tekanan darah berdasarkan anamnesis dan menggunakan sphygmomanometer merkuri. Sampel klinis dikumpulkan dari 60 CKG subjek periodontitis. Pengukuran parameter klinis kedalaman poket (PD), dan perdarahan saat probing (BOP ≥1) dimasukkan sebagai kriteria diagnostik. Kedalaman poket dan kehilangan perlekatan klinis (CAL) dicatat sebagai kriteria subjek apabila PD ≥5 mm dan CAL adalah ≥1 mm. Kadar Prostaglandin E2 diperkirakan dalam sampel cairan crevicular gingiva dengan menggunakan uji immunosorbent link-enzyme. Hasil: Tingkat PGE2 signifikan secara statistik dalam kelompok hipertensi dibandingkan dengan kelompok non-hipertensi (p<0,05). Perbedaan yang signifikan dalam kedalaman poket, resesi, dan kehilangan perlekatan klinis (p<0,05). Kesimpulan: Tekanan darah yang lebih tinggi memiliki potensi risiko peradangan dan perkembangan penyakit periodontal. ......ackground: Periodontitis is an infection that involved tooth supporting tissues by dental plaque biofilm on the tooth surface and host immune response as causal to as inflammation resolution. Prostaglandin E2 (PGE2) as an inflammatory mediator has been implicated in the pathogenesis of various chronic inflammatory diseases, including periodontitis, and as a regulator of blood pressure. Objective: To compare the levels of prostaglandin in the gingival crevicular fluid of periodontitis patients with hypertension and non-hypertension. Methods: A total sample of 60 patients was examined. Consists of 44 patients were hypertension group and 16 patients were non-hypertension groups as a control. Hypertension state was measured by blood pressure based on anamnesis and using sphygmomanometer mercury. The clinical sample was collected from 60 gingival crevicular fluids (GCF) of periodontal disease subject. Measurement of the clinical parameter of probing pocket depth (PD) and bleeding on probing (BOP ≥1) was included as a diagnostic requisition. The pocket depth and clinical attachment loss (CAL) was defined as present if the PD was ≥5 mm and CAL was ≥1 mm. Prostaglandin E2 level was estimated in gingival crevicular fluid samples by using the enzyme-linked immunosorbent assay. Results: The level of PGE2 was statically significant difference in hypertension patient compare with non-hypertension (p<0.05). There was a significant difference in pocket depth, recession, and clinical attachment loss (p<0.05). Conclusion: Higher blood pressure related to the potential risk of inflammation and progression periodontal disease.

Abstrak :
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. Kesimpulan Diet restriksi kalori memiliki efek menurunkan kadar CRP pada pasien obesitas. ......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

Abstrak :
Pendahuluan: COVID-19 merupakan penyakit yang disebabkan oleh infeksi virus SARS-CoV-2. Gejala klinis COVID-19 yang paling sering dialami adalah demam dan batuk. Infeksi SARS-CoV-2 ke dalam tubuh pejamu akan menimbulkan respon imun dari pejamu yang akan menyebabkan terjadinya inflamasi sistemik. Hal ini dapat dilihat dari peningkatan berbagai penanda inflamasi, salah satunya adalah C-Reactive Protein (CRP). Saat ini belum ada terapi spesifik yang efektif untuk mengatasi COVID-19. Akupunktur yang merupakan modalitas terapi non-farmakologi yang telah terbukti dapat memberikan efek anti-inflamasi. Saat ini belum ada penelitian uji klinis akupunktur yang meneliti penanda inflamasi terhadap pasien COVID-19 yang telah dipublikasi. Tujuan penelitian ini adalah untuk mengetahui bagaimana efektivitas akupunktur dalam menurunkan kadar CRP dan memperbaiki gejala batuk yang dialami pasien COVID-19 gejala ringan-sedang. Metode: Sebuah penelitian pilot dengan desain studi uji klinis acak tersamar tunggal. Dua puluh dua pasien COVID-19 terkonfirmasi melalui pemeriksaan RT-PCR yang memiliki gejala ringan-sedang yang sedang dirawat inap di rumah sakit dikelompokan dalam dua kelompok: kelompok perlakuan yang mendapat terapi standar dan intervensi akupunktur manual dan kelompok kontrol yang mendapat terapi standar. Intervensi akupunktir manual dilakukan setiap 2 hari dengan total 6 sesi terapi. Sebelum intervensi dilakukan pengukuran kadar CRP dan penentuan onset batuk dan setelah 6 sesi akupunktur dilakukan dilakukan pengukuran kadar CRP dan penentuan periode lama batuk. Hasil: Terjadi penurunan rerata kadar CRP pada kedua kelompok (p=0,397). Penurunan kadar CRP pada kelompok perlakuan lebih besar dibandingkan kelompok kontrol. Gejala batuk lebih singkat pada kelompok perlakuan dibandingkan pada kelompok kontrol dan perbedaan ini bermakna secara statistik (p = 0,01). Kesimpulan: Kombinasi akupunktur manual dan terapi standar menurunkan kadar CRP dan penurunannya lebih besar dibandingkan dengan terapi standar. Namun, penurunan kadar CRP tidak bermakna secara statistik. Dan mempersingkat gejala batuk yang dialami pasien COVID-19 gejala ringan-sedang secara bermakna. ......Introduction: COVID-19 is a disease that caused by infection of SARS-CoV-2. The most common clinical symptoms of COVID-19 are fever and cough. SARS-CoV-2 infection into the host's body will cause an immune response which will cause systemic inflammation. This can be seen from the increase in various inflammatory markers, one of which is C-Reactive Protein (CRP). Currently there is no specific therapy that is effective for curing COVID-19. Acupuncture is a non-pharmacological therapeutic modality that has been shown to provide anti-inflammatory effects. Currently, there are no published studies of acupuncture clinical trials examining inflammatory markers in COVID-19 patients. The purpose of this study was to determine how effective acupuncture in reducing CRP levels and improving cough symptoms experienced by COVID-19 with mild-moderate symptoms patients. Methods: A pilot study with an experimental study design single blind randomized clinical trial. Twenty-two COVID-19 patients confirmed by RT-PCR examination who had mild-moderate symptoms who were being hospitalized were divided into two groups: the treatment group who received standard therapy and manual acupuncture intervention and the control group who received standard therapy. Manual acupuncture intervention was performed every 2 days for a total of 6 therapy sessions. Before the intervention, the CRP level was measured and the onset of the cough was determined and after 6 acupuncture sessions, the CRP level was measured and the period of cough was determined. Results: There was a decrease in the mean of CRP levels in both groups (p = 0.397). The decrease in CRP levels in the treatment group was greater than the control group. Cough symptoms were shorter in the treatment group than in the control group and this difference was statistically significant (p = 0.01). Conclusion: The combination of manual acupuncture and standard therapy reduced CRP levels and the decrease was greater than that of standard therapy. However, the reduction in CRP levels was not statistically significant. And shorten the cough symptoms experienced by mild-moderate COVID-19 patients significantly.

Abstrak :
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.

Abstrak :
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)