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"Background: Vitamin D role in immune system have been investigated due to the presence of VDR on immune cells. Based on this information deficient level of vitamin D could affect the progression of allergic rhinitis. Unfortunately the data regarding vitamin D status in the normal population and allergic rhinitis patient were very limited in Indonesia. This research was done to provide illustration regarding the status of vitamin D in healthy and allergic rhinitis patients in Jakarta and also to investigate the factor that might affect the level of vitamin D in allergie rhinitis. Methods: This research was an observational cross sectional research. There were 22 subjects used during this research all diagnosed with moderate-severe allergic rhinitis. The study used the Electrochemiluminescence Immunoassay (ECLIA) technique. The data then were analyzed with IBM® SPSS statistic version 22 Results: The difference between the mean vitamin D of patients suffering from allergic rhinitis with healthy controls (12.7±10.3 ng/mL to 15.1±8.1 ng/mL). There was no significant diference in mean vitamin D between the gender groups (Independent Sample T-test p= 0.62). There were no statistical difference between the vitamin D level in patient with different eosinophil count and IL-5 level (IL-5 group: one-way ANOVA: p= 0.897; eosinophil group: One Way ANOVA: p = 0.752). Conclusion: The mean level of vitamin D in allergic rhinitis patients compared to healthy controls showed no significant difference. Comparison studies about level of vitamin D between groups with different gender, IL-5 and eosinophil count showed no significant difference"

"AbstrakPURPOSE:Chinese herbal medicine (CHM) has been widely used in China to treat allergic rhinitis (AR). However, several studies have produced conflicting data with regard to the efficacy of the medicine. Our aim was to perform a meta-analysis of randomized clinical trials (RCTs) to evaluate the relative efficacy of CHM.METHODS:We systematically searched the PubMed, Medline, and Springer electronic databases up to March 2017 for RCTs comparing the efficacy of CHM versus placebo for the treatment of patients with AR. Total nasal symptoms and quality of life were assessed through pooling mean difference (MD) with its 95% confidence interval (CI). Moreover, sensitivity and subgroup analyses according to control design and quality of life assessment were performed to evaluate the source of heterogeneity.RESULTS:Eleven RCTs were enrolled in the meta-analysis. Assessment of overall heterogeneity indicated significant heterogeneity among the individual studies (I²=100%, P<0.00001), and thus ransomed effects model was used to pool data. CHM was found to significantly enhance quality of life compared with placebo (MD=-0.88, (95% CI: -1.55, -0.21); P=0.01). The symptom of itchy nose, sneezing or total nasal symptoms scores were not significantly improved after CHM treatment, although the improvement in itchy nose just failed to reach significance (MD=0.09, (95% CI: 0.00, 0.18); P=0.06).CONCLUSIONS:This study suggests that CHM appears to improve the quality of life of AR patients. However, these findings, as well as the findings for the effect of CHM on sneezing, total nasal symptoms, and the symptom of itchy nose, need to be substantiated in larger cohorts of AR patients by further well-designed studies."

"Perubahan gaya hidup seiring perkembangan zaman membuat kronotipe manusia semakin bervariasi. Kronotipe malam diketahui banyak dijumpai pada kalangan remaja akhir. Pola irama sirkadian memiliki hubungan dengan sistem imun dan penyakit alergi. Rinitis alergi merupakan penyakit alergi yang paling banyak dijumpai pada kalangan remaja dan dapat menurunkan kualitas hidup penderitanya. Penelitian ini bertujuan untuk mengetahui hubungan kronotipe dan rinitis alergi pada pelajar sekolah menengah atas.

Metode: Pada penelitian potong lintang ini, analisis dilakukan pada 196 pelajar sekolah menengah atas yang telah menjawab empat kuesioner: International Study of Asthma and Allergy in Childhood Core Questionnaire, Reduced Version Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale dan Kuesioner Studi Kohort Faktor Risiko PTM Tahun 2011 Bagian Penggunaan Tembakau dan Kebiasaan Merokok. Data dianalisis menggunakan uji chi square dan analisis regresi logistik.

Hasil: Lebih banyak pelajar berkronotipe pagi (64,8%) dibandingkan tipe malam (35,2%). Sebanyak 28,1% pelajar mengalami rinitis alergi dalam 12 bulan terakhir. Kronotipe berhubungan signifikan dengan rinitis alergi (p<0,05; OR=2,273; CI 95% 1,198-4,311). Terdapat perbedaan proporsi rinitis alergi yang signifikan antara pelajar dengan kronotipe malam (39.1%) dan pelajar dengan kronotipe pagi (22%).

Kesimpulan: Terdapat perbedaan proporsi rinitis alergi yang signifikan antara pelajar sekolah menengah atas dengan kronotipe malam dan pelajar dengan kronotipe pagi.

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Changes in lifestyle over the times make human chronotypes more varied. The evening type are known to be frequently found among late adolescents. Circadian rhythm has a relationship with the immune system and allergic disease. Allergic rhinitis is the most common allergic disease among adolescents and can reduce the patient's quality of life. This study aims to determine the relationship between chronotype and allergic rhinitis in high school students.

Method: In this cross-sectional study, 196 high school students answered four different questionnaires: the International Study of Asthma and Allergy in Childhood Core Questionnaire, the Reduced Version Morningness-Eveningness Questionnaire, Epworth Sleepiness Scale and Kuesioner Studi Kohort Faktor Risiko Penyakit Tidak Menular Tahun 2011 Bagian Penggunaan Tembakau dan Kebiasaan Merokok. The data was analyzed using chi-square test and logistic regression.

Result: More students were morning type (64,8%) compared to evening type (35,2%). As many as 28.1% of students experienced allergic rhinitis in the last 12 months. Chronotype was significantly associated with allergic rhinitis (p<0,05; OR=2,273; CI 95% 1,198-4,311). There was a significant difference in the proportion of allergic rhinitis between high school students with evening chronotype (39,1%) and high school students with morning chronotype (22%).

Conclusion: There was a significant difference in the proportion of allergic rhinitis between high school students with evening chronotype and students with morning chronotype."

"ABSTRACTBackground: pollens from trees or grasses in Indonesia have a perennial distribution due to the tropical climate. However, pollen allergy has not been well studied. This study aimed to evaluate the profile of pollen IgE sensitization in respiratory allergic patients in Jakarta. Methods: this was a cross-sectional study in patients with a history of respiratory allergy in Jakarta, Indonesia between September and December 2016. Adult asthmatic patients aged 19-60 years were invited to undergo serum specific IgE testing at the Allergy and Immunology Clinic, Cipto Mangunkusumo Hospital, Jakarta. Patients were included if they showed at least one positive skin prick test with environmental allergens. Quantitative determination of specific IgE in serum was carried out by multiple allergosorbent (MAST) assays (Polycheck Allergy, Biocheck GmbH, Munster, Germany). Serum specific IgE levels of more than 0.35 kU/L or Class 1 was considered positive. Results: a total of 106 cases were eligible for analysis; 81 (76.4%) were women. Patients mean age was 38.8+12.1 (range 19-59) years old. 59.4% of patients have both asthma and allergic rhinitis. There are 9 (8.5%) patients positive for IgE-pollen sensitization; 8 among them showed sensitization to at least 2 pollens. Sensitivity to goosefoot pollen is the highest (5.7%), followed by rye pollen (4.7%), plantain pollen (4.7%), wall pellitory pollen (4.7%), and Bermuda grass pollen (3.8%). Conclusion: although most pollens tested are not originated from native plants to Indonesia, a small number of patients showed specific IgE-sensitizations. Allergic persons planning to travel to the endemic areas of the relevant pollen should be advised. A panel of pollen allergens from local plants is highly desired."

"ABSTRAKLatar belakang: Asma dan rinitis alergi merupakan penyakityang disebabkan oleh inflamasi saluran napas.United airway adalah hipotesis terdapatnya kesatuan morfologi dan fungsi sistem saluran napas atas dan bawah yang memiliki kesamaan dalam histologi, fisiologi dan patologi. Penilaian respons inflamasi pada saluran pernapasan diharapkan mampumemperbaiki derajat berat penyakit asma maupun rinitis alergi sehingga derajat penyakit terkontrol baik.Metode: Penelitian ini menggunakan metode potong lintang pada 31 pasien asma yang berobat ke RSUP Persahabatan. Subjek penelitian dinilai derajat berat penyakitnya berdasarkan derajat asma stabil, derajat kontrol asma dan derajat rinitis. Penilaian inflamasi saluran napas atas menggunakan eosinofil mukosa hidung dan inflamasi saluran napas bawah menggunakan FeNO Subjek dibagi menjadi kelompok asma dengan rinitis alergi dan asma tanpa rintis alergi menggunakan pemeriksaan alergi uji cukit kulit.Hasil: Terdapat hubungan dengan korelasi yang bermakna antara peningkatan kadar FeNO dengan asma yang tidak terkontrol (r=0,39, p = 0,02).Terdapat perbedaan yang bermakna antara jumlah eosinofil mukosa hidung (p = 0,02) dan FeNO (p = 0,01)pada subjek asma dengan rinitis alergidan asma tanpa rinitis alergi. Terdapat hubungan dengan korelasi yang bermakna antara kadar FeNO dengan jumlah eosinofil mukosa hidung. (r = 0,378, p= 0,04).

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ABSTRACTBackground:Asthma and allergic rhinitis are diseases caused by airway inflammation. The united airways hypothesis suggests a similarity of morphology and function betweenthe upper and lower airway systems. Thus, the assessment of inflammatory activities in the united airway systems should reflect the severity and the degree of disease control in asthma and allergic rhinitis.Methods:This cross-sectional study included 31 asthma patients treated in National Respiratory Referral Center Persahabatan Hospital Jakarta, Indonesia, as subjects. Subjects were grouped into asthma with allergic rhinitis and asthma without allergic rhinitis based on the skin test examination. The degrees of stable asthma, asthma control, and rhinitis of the subjects were recorded. The nasal eosinophil counts and fractional concentration of exhaled nitric oxide (FeNO) level examinations were performed to assess the lower and upper airway inflammation, respectively.Results:There was a moderate correlation between FeNO levels and degree of asthma control (r=0.39, p=0.02).Subject grouping resulted in different nasal eosinophil counts and FeNO levels (p=0.02 and p=0.01, respectively). There was a moderate correlation between nasal eosinophil counts and FeNO levels (r=0.378, p= 0.04)."

"Latar belakang: Gangguan tidur merupakan keluhan yang sering terjadi pada rinitis kronis, dengan penyebab tersering adalah hidung tersumbat. Hidung tersumbat juga merupakan faktor risiko terjadinya sleep disordered breathing (SDB). SDB memiliki spektrum penyakit yang luas, salah satunya adalah obstructive sleep apnea (OSA). Walaupun berbagai literatur telah membuktikan adanya gangguan tidur pada pasien rinitis alergi, penelitian mengenai gangguan tidur pada pasien rinitis nonalergi masih terbatas. Tujuan penelitian: Membandingkan derajat gangguan tidur antara kelompok rinitis alergi dan rinitis nonalergi di RSUPN Cipto Mangunkusumo. Metode: Penelitian ini menggunakan desain potong lintang pada 11 subjek rinitis alergi dan 11 subjek rinitis nonalergi yang berusia 18-60 tahun di Poliklinik THT RSUPN Ciptomangunkusumo. Derajat obstruksi nasal dinilai menggunakan kuesioner NOSE. Derajat gangguan tidur dinilai secara subjektif dengan kuesioner ESS, PSQI, dan ISI serta secara objektif dengan polisomnografi. Hasil: Tidak didapatkan perbedaan pada hasil skor NOSE, ESS, RSI, PSQI, ISI, maupun parameter polisomnografi antara kelompok rinitis alergi dengan kelompok rinitis nonalergi (p > 0,05). Didapatkan hubungan bermakna antara RDI NREM, RERA, saturasi minimum oksigen dan saturasi baseline oksigen dengan klasifikasi OSA pada kelompok rinitis kronis (p< 0,05). Kesimpulan: Tidak didapatkan perbedaan derajat gangguan tidur antara rinitis alergi dan rinitis nonalergi.

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Background: Sleep disturbance is common in chronic rhinitis, primarily caused by nasal congestion. Nasal congestion is also a risk factor for sleep disordered breathing (SDB). SDB refers to a spectrum of breathing abnormalities, one of which includes obstructive sleep apnea (OSA). Although many studies have linked sleep disturbance with allergic rhinitis, data regarding its association with nonallergic rhinitis seem to be limited. Aim : To compare the severity of sleep disturbance between allergic and nonallergic rhinitis. Methods: This cross-sectional study consisted of 11 subjects with allergic rhinitis and 11 subjects with nonallergic rhinitis at ORL-HNS outpatient clinic, Cipto Mangunkusumo Hospital. NOSE questionnaire was used to assess the degree of nasal obstruction. The severity of sleep disturbance was subjectively assessed using ESS, PSQI, and ISI questionnaires and objectively assessed using polysomnography. Results: No significant differences in NOSE, ESS, RSI, PSQI, and ISI scores were found between both groups (p > 0,05). There was a significant relationship between RDI NREM, RERA, minimum oxygen saturation and baseline oxygen saturation with OSA classification in the chronic rhinitis group (p <0.05). Conclusion: The type of rhinitis (allergic or nonallergic) did not influence the severity of sleep disturbance."

"Cetirizine HCl sebagai obat untuk terapi alergi memiliki tanggal kedaluwarsa pada kemasan sediaan, namun data mengenai beyond use date (BUD) dari cetirizine HCl masih terbatas. Oleh karena itu, tujuan dilakukan penelitian ini adalah untuk memperoleh BUD dari sediaan sirup cetirizine HCl berdasarkan kadar zat aktif dengan KCKT detektor UV-Vis. Metode ini dilakukan menggunakan fase gerak asetonitril-dapar fosfat pH 3 (50:50 v/v), laju alir 1 ml/menit dengan elusi isokratik dan dianalisis pada panjang gelombang 232 nm. Metode yang digunakan selektif dan spesifik. Hasil linearitas menunjukkan nilai koefisien korelasi (r) sebesar 0,9998 pada rentang konsentrasi 4-32 µg/ml. Nilai LOD dan LOQ sebesar 0,5 µg/ml dan 1,7 µg/ml berturut-turut. Metode ini memenuhi persyaratan akurasi, presisi, uji kekuatan, dan ketangguhan. Penetapan kadar dilakukan selama 5 minggu dan BUD dari sampel sediaan cetirizine HCl adalah 25 hari. Penelitian lebih lanjut perlu dilakukan untuk memperoleh hasil yang lebih baik.

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Cetirizine HCl as a drug for allergy therapy has an expiration date on it’s packaging, but for the data regarding beyond use date (BUD) of cetirizine HCl is still limited. Therefore, the purpose of this study is to obtain the BUD of cetirizine HCl syrup based on its active substance concentration using HPLC with UV-Vis detector. This method was carried out using mobile phase acetonitrile-phosphate buffer pH 3 (50:50 v/v), flow rate 1 ml/min with isocratic elution and analyzed at a wavelength of 232 nm. This method is selective and specific. The linearity results show the correlation coefficient (r) of 0.9998 in the concentration range of 4-32 g/ml. The LOD and LOQ values were 0.5 g/ml and 1.7 g/ml, respectively. This method satisfies accuracy, precision, robustness and ruggedness criteria. Concentration determination was carried out within 5 weeks and the BUD of cetirizine HCl syrup sample was 25 days. Further research needs to be done to obtain better results."

"Latar belakang: Otitis media efusi adalah penyebab tersering gangguan pendengaran pada anak-anak di negara berkembang. Diagnosis dan penatalaksanaan OME pada anak sering terlambat karena jarang dikeluhkan. OME merupakan penyakit yang memiliki banyak faktor risiko. Salah satu faktor risiko OME yang saat ini banyak dihubungkan dengan kelainan di telinga tengah adalah refluks laringofaring. Tujuan: Mengetahui peran refluks laringofaring sebagai faktor risiko OME pada anak-anak. Metode:Pemeriksaan penapisan 396 anak pada tahap pertama dan 1620 anak pada tahap kedua untuk mencari 46 anak yang masukkategori OME sebagai kelompok kasus, kemudian pemilihan 46 anakkelompok non OME sebagaikontrol secara acak, menyepadankan usia dan jenis kelamin. Pada kedua kelompok dilakukan wawancara, pengisian kuesioner, pemeriksaan THT dan pemeriksaan laring dengan nasofaringoskopi serat lentur untuk mendiagnosis refluks laringofaring. Hasil: Proporsi refluks laringofaring pada kelompok OME lebih tinggi dibandingkan non OME, yaitu sebesar 78,3% dan 52,2%.Terdapat hubungan bermakna antara refluks laringofaring dan OMEdengan nilai odds ratio (OR)3,3 dan interval kepercayaan (IK) 95% antara 1,33 sampai 8,187; p=0,01). Kesimpulan:Refluks laringofaring merupakan faktor risiko yang memiliki hubungan bermakna dengan terjadinya otitis media efusi.

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Background: Otitis media with effusion (OME) is the most cause of hearing impairment in children of developing countries. OME is usually late in diagnosis and management due to the lack of patient’s complaints. OME is a disease that has many risks factor. One of the risk factor in developing OME, that is currently being studied, is its relationship with laryngopharyngeal reflux.

Purpose: To know the role of laryngopharyngeal reflux as a risk factor for OME.

Methods: Examination of the first stage was performed to 396 children and the second stage was performed to 1620 children. Using the exclusion and inclusion criteria, 46 children were accounted as the case group. Forty six children for control group was randomly taken from non OME patients whichmatched with age and sex from the case group. Both groups were treated equally with history taking, questionnaire filling, ENT examination and larynx examination using fiberoptic flexible laryngoscope to diagnose whether there is laryngopharyngeal reflux or not.

Results: The proportional of laryngopharyngeal reflux in OME group is higher compared to non OME group, with 78,3% and 52,2%. There is a significant relationship between laryngopharyngeal reflux and OME with an odds ratio (OR) 3,3 and confidence interval (CI) 95% of 1,33-8,187 (p=0,01).

Conclusion: Laryngopharyngeal reflux is a risk factor that has significant relationship with OME."