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"ABSTRAKTUJUAN (1) Menentukan peningkatan risiko terjadinya DK-T pada individu dengan DA-K; (2) Menetapkan gejala Minis DA-K tertentu yang berperan pada perkembangan DA-K menjadi DK-T dan dipengaruhi oleh faktor imunogenetik HLA kelas I; (3) Menetapkan efek imunitas selular disertai dengan peningkatan kadar IgE yang mempengaruhi perkembangan DA-K menjadi DK-T; (4) Menetapkan jenis HLA kelas I tertentu yang menentukan peningkatan derajat risiko terjadinya DK-T; (5) Menentukan derajat sakit DK-T pada individu dengan DA-K sebagai akibat pajanan oleh deterjen.TEMPAT PENELITIAN Berbagai lokasi di Rumah Sakit Umum Pusat Dr. Cipto Mangunkusumo; Makmal Terpadu RSCM-FKUI; Labotratorium Transplantasi Makmal Terpadu RSCM-FKUI.SUBJEK PENELITIAN Pekerja kebersihan lantai (PKL)RANCANGAN PENELITIAN Merupakan penelitian analitik dengan (A) membandingkan pengaruh faktor intrinsik yang terdiri atas faktor individu, faktor imunogenetis, dan faktor imunologis pada responden dengan (DA-K(+)) terhadap responden (DA-K(-)) yang terpajan deterjen untuk terjadinya DK-T. Desain yang diterapkan ialah studi kasus kontrol; (B) melakukan pengamatan selama 5 bulan terhadap sejumlah responden (yang bekerja kurang dari 2 bulan) terhadap perkembangan patogenesis DA-K menjadi DK-T akibat pajanan dengan deterjen. Desain yang diterapkan ialah studi longitudinal prospektif (terbatas).HASIL Diantara 220 PKL yang memenuhi syarat, sebanyak 136 menderita DK-T. (1)Pada lingkup gejala klinis didapatkan DA-K merupakan faktor risiko intrinsik terjadinya DK-T, peningkatan skor DA-K diikuti oleh peningkatan skor DK-T dengan korelasi cenderung linear. Ditemukannya riwayat atopi pada diri maupun keluarga berupa asma bronkial dan rinitis alergik merupakan faktor proteksi untuk terjadinya DK-T, sedangkan adanya riwayat dermatitis atopik meningkatkan risiko terjadinya DK-T. Keratosis pilaris, hiperlinearitas palmaris, dan xerosis merupakan gejala Minis primer DA-K yang meningkatkan risiko terjadinya DK-T. (2) Pada lingkup faktor imunologis didapatkan peningkatan kadar IgE dalam serum pada kadar yang lebih rendah sebagai akibat pajanan dengan antigen lingkungan pada kelompok kasus. Sel Th CD3+CD4+ dan rasio sel Th : Ts (CD3+CD4+ CD3+CD8+), serta sel NK (CDI6+CD56+) berperan pada derajat sakit DK-T. Se! MC (CD 16+CD56+) teraktivasi oleh sitokin yang dikeluarkan keratinosit sebagai akibat kerusakan sawar kulit oleh deterjen, (3) Pada lingkup faktor imunogenetis didapatkan temuan HLA-B15 lebih banyak pada kontrol dengan nilai p < 0.05 dan RR < 1; terlihat kecenderungan bersifat protektif dengan fraksi etiologik sebesar 60 %. HLAB53 didapatkan pada derajat sakit berat sehingga diperkirakan merupakan petanda untuk derajat sakit berat pada DK-T.(4) Lingkup faktor risiko ekstrinsik mendapatkan waktu pajanan ? 2jam/hari meningkatkan risiko terjadinya DK-T. Perbedaan derajat sakit DK-T lebih terlihat pada pH < 10, dan peningkatan pH menaikkan risiko terjadinya DK-T. (5) Analisis studi diagnostik menggunakan uji McNemar menunjukkan xerosis merupakan prediksi Minis terjadinya DK-T dengan sensitivitas 40 % dan spesifisitas 70 %, dan HLA-B15 berperan sebagai faktor proteksi. (6) Pengamatan longitudinal prospektif terbatas yang dilaksanakan selama 5 bulan terhadap responden baru yang bekerja < 2 bulan menemukan bahwa seluruh responden menderita DK-T pada akhir pengamatan. Responden DA-K(+) mempunyai kecendrungan menderita DK-T lebih awal dibandingkan dengan responden DA-K(-).KESIMPULAN (I) Sesuai dengan peningkatan skor atopi yang diikuti dengan peningkatan skor DK-T, maka dapat disimpulkan bahwa DA-K merupakan risiko intrinsik untuk terjadinya DK-T (2) beberapa gejala klinis primer meningkatkan risiko terjadinya DK-T, terutama riwayat pemah menderita dermatitis atopik pada diri atau keluarga dan ditemukannya xerosis kutis karena xerosis akan menyebabkan kerusakan sawar kulit sehingga mempermudah masuknya bahan iritan ke dalam kulit (3) sel Th CD4+, rasio sel Th : Ts (CD3+CD4+ 1 CD3+CD8+), dan sel NK (CD16+CD56+) meningkatkan risiko terjadinya DK-T derajat berat. Kerusakan sawar kulit akan mengaktifkan sel NK(CD16+CD56+) sebagai respons terhadap sitokin yang diproduksi akibat kerusakan keratinosit (4) HLA-B15 merupakan faktor proteksi untuk terjadinya DK-T dan HLA-B53 cenderung merupakan petanda untuk menderita DK-T berat (5) xerosis kutis dapat berperan sebagai prediktor Minis untuk terjadinya DK-T pada individu dengan DA-K (6) pajanan deterjen bersifat basa yang terjadi ? 2 jam/hari dalam waktu 5 bulan menyebabkan DK-T pada seluruh responden yang bekerja tanpa alat pelindung dengan kecenderungan menderita DK-T lebih awal pada responden DA-K(+) dibandinglcan dengan responden DA-K(-).

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ABSTRACTTITLE Clinical prediction of hand dermatitis in person with atopic skin diathesisPURPOSE To identify the role of intrinsic and extrinsic risk factors of the pathogenesis of hand dermatitisSETTING Several different parts of Dr. Cipto Mangunkusumo General Hospital, Makmal and Tranplantation Laboratory, Faculty of Medicine of the University of Indonesia, Jakarta.STUDY SUBJECTS Cleaning service workersMETHODS An analytical study comprises of two parts have been conducted as follows : (1) Case-control study to identify the role of intrinsic and extrinsic risk factors in the pathogenesis of hand dermatitis (2) Limited longitudinal (prospective) study was performed among workers who have done the work less than 2 month, to find out the immunopathogenesis of hand dermatitis in persons with atopic skin diathesis.The clinical sign of atopic skin diathesis consisted of the history of atopic diseases in oneself or history in the family, pityriasis alba, Dennie-Morgan line, Hertoghe sign, kheilitis, keratosis pilaris, food intolerance, palmar hyperlinearity, white dermographism, xerosis, and reduce itch threshold were evaluated to found out the clinical risk factors.Immunological factors such as IgE in the blood was examined by Micro particle Enzyme Immunoassay (META) and cellular immunity by flow-cytometry was preformed at the Makmal Laboratory, Faculty of Medicine of the University of Indonesia, Jakarta. Immunogenetic factors such as HLA type I was examined by microlymphocytotoxicity at the Makmal Transplantation Laboratory, Medical Faculty of the University of Indonesia, Jakarta. Statistical analysis was performed mostly with the chi-square method.RESULTS Two hundred twenty out of 241 cleaning service workers were involved in this study. Ninety four out of 136 who suffered from hand dermatitis were recruited as the case and 84 workers who were normal (without hand dermatitis) served as the control group. (1) Atopic skin diathesis was proved as an intrinsic risk factor for hand dermatitis in the case-control study conducted. Keratosis pilaris, kheilitis, hiperkeratosis palmaris, and xerosis were found significantly as the intrinsic risk factors for hand dermatitis by using the multivariate analysis. (2) Statistical analysis of the immunological factors stated that T lymphocyte CD3+ and Natural Killer cell were proven to be the immunological risk factors for hand dermatitis. Keratinosit, after exposed to irritant, produced and released different kinds of cytokine, - included epidermal derived natural killer cell activating factor, which could activate Natural Killer cells. Increasing value of the blood IgE was observed with the mean value higher in the case group than in the control group (by using the one-sided t test) with the p value < 0.05 after the logarithmic transformation. (3) Statistical analysis of the immunogenetic factor revealed HLA-B 15 was found higher in the control group than in the case group with p value 0.022 assuming a protective factor (OR < 1) for hand dermatitis with a high (60%) etiologic fraction.(4) Exposure time ? 2 hours/day was statistically significant as an extrinsic risk factor for hand dermatitis. Low pH (< 10) clearly showed the difference between the severe and the mild form of hand dermatitis. (5) Longitudinal study with 5 month observation period consisted of 18 cleaning service workers entering the job less than 2 month, resulted in hand dermatitis for all workers by the end of the observation period. (6) Xerosis cutis could be considered as the clinical predictor for hand dermatitis in person suffering from atopic skin diathesis.CONCLUSION: (1) Atopic skin diathesis was found to be an intrinsic risk factor for hand dermatitis (2) Kheilitis, keratosis pilaris, hiperlinearis palmans, and xerosis were clinical risk factors for hand dermatitis (3) T cell CD3+ and NK cell CD16+CD56+ were the immunological risk factors for hand dermatitis (4) the immunogenetic risk factors showed that HLA-B 15 was considered having a protective role and HLA-B53 was considered as the sign of the severe from of hand dermatitis (5) Xerosis cutis could be considered as the clinical predictor for hand dermatitis in person suffering from atopic skin diathesis (6) longitudinal prospective study revealed that all the newly-working workers (less then 2 month starting the work) by the end of 5 month observation period suffered from hand dermatitis with the tendency that hand dermatitis appeared earlier in person with atopic skin diathesis."

"ABSTRACTThe social impact of the crisis in Indonesia, both monetary and natural disaster had been investigated by some studies. There is empirical evidence at national level that suggests the crisis impact is very heterogeneous both between urban and rural areas and across regions. It is also found that there is little connection between initial poverty levels and the extent to which an area had been hit by the crisis. The main objective of this study was to investigate the influence of the recent economic crisis and the benefit of the Social Safety Net Program for the nutritional status of under-five children during the economic crisis in selected poor areas of Indonesia. A cross sectional study to get information on the nutritional status of children and its determinants in urban poor area of Jakarta, and rural areas of Banggai in Central Sulawesi, and Alor-Rote in East Nusa Tenggara was followed by another cross sectional study in one selected poor urban area of Cilincing sub-district, Jakarta to see the changes of key determinant(s) of the under-five children's nutritional status after receiving the Social Safety Net intervention program for 1 year period. Two-stage cluster sampling was used to get 1078 households with under-five children in the urban poor area of Jakarta, and 262 and 631 households with under-five children each for the rural areas of Banggai and Alor-Rote, respectively as the subjects of the cross-sectional study-1; and 587 households with under-five children for the cross sectional study-2 in poor urban area of Cilincing sub-district. For both studies, general socio-demographic characteristics, socio-economic, health and nutritional status, and child feeding practices data were collected through interview and observation methods using structured questionnaires. Anthropometrical assessments (of weight, stature, and arm-circumference) were done both for children and their mothers in both studies. Hemoglobin assessment was done for sub-samples of approximately 50% of the total under-five children in both studies. Quality control procedures were performed during the course of the study. Data collection for both studies was performed from January 1999 to January 2001. It revealed that 34% of fathers in the study area of Jakarta had finished junior high school and even less for mothers (22%). More than 70% of the fathers had no regular income and 7% of the sample households had both the fathers and mothers work regularly. About 42 % of the sample households was classified as having sufficient purchasing power and less that 60% of sample households was classified as having appropriate luxury goods (mostly of electronic goods). For the study area in Banggai, 23% of fathers had finished junior high school and even only 10% for mothers. Approximately 14% of the fathers had no regular income and 24% of the sample households was classified as having appropriate employment status. About 45% of the sample households was classified as having sufficient food production/purchasing power in this study and less than 50% of the sample households was classified as having appropriate luxury goods (mostly of cultivated land). For the study area in Alor-Rote, 23% of fathers had finished junior high school and even only 10.9% for mothers. Approximately 21% of the fathers had no regular income and 47% of the sample households had both the fathers and mothers work regularly. About 48% of the sample households was classified as having sufficient food production/ purchasing power in this study and 26% of sample household was classified as having appropriate luxury goods (mostly of cultivated land). Besides having a high severity of anemia (>40%), under-five children in the urban poor area of Jakarta had a very high severity of wasting (>15%) as compared to the medium severity of stunting condition (20-29%). Similar findings were found for the rural area of Banggai. Different findings for the rural area of Alor-Rote were only for its very high severity in stunting condition (>40%). By multivariate and path analyses, it was shown that Jakarta as the study site contributed significantly to the variation of wasting indicator (WHZ value) as the recent-type of malnutrition, and Alor-Rote as the study site contributed significantly to the variation of stunting indicator (HAZ value) as the longterm-type of malnutrition. For hemoglobin value, both Jakarta and Alor-Rote as the study sites contributed to its variation. High prevalence of infectious diseases in all study areas were significantly related to the higher prevalence of wasting in the study areas of Jakarta and Banggai, and also significantly related to the higher prevalence of stunting and anemia in the study area of Alor-Rote. For Jakarta, besides infectious diseases, BMI status of mothers and the possession of motorcycle used for income earning were also significantly related to the prevalence of wasting. On the other hand, for Alor-Rote, besides infectious diseases, possession of luxury goods (access to electricity, possession of transportation facility and electronic goods), environmental sanitation (housing conditions), maternal nutritional knowledge and access to complete immunization were also significantly related to the prevalence of stunting. And, infectious diseases and households' employment status contributed to the variation of stunting (HAZ value). Furthermore, for anemia, access to health services (for complete immunization) was the only key determinant which contributed significantly to the variation of hemoglobin value in Jakarta. For Alor-Rote, besides infectious diseases, formal education of the parents, employment status (especially working mothers), environmental sanitation (especially access to safe drinking water), maternal nutritional knowledge and access to health services were also significantly associated with the prevalence of anemia. And, infectious diseases, environmental sanitation, access to health services and households' employment status contributed significantly to the variation of hemoglobin value in Alor-Rote. The Social Safety Net Intervention Program in the urban poor area of Cilincing sub-district, Jakarta resulted in significant improvement in the prevalence of wasting and anemia among under-five children but not for the prevalence of stunting. It was also found that maternal and childcare, access to health services and hemoglobin were still retained as determinants of child malnutrition besides households' employment status and variety of food intake. There is a need to improve the nutritional and health status of under-five children and their mothers through the existing health care system providing basic health services and improving the capacity of health staffs across Indonesia as part of the decentralization process. Besides, the private sector and communities may support the local government in the form of informal Social Safety Net intervention programs. The significant association found between mother's BMI and wasting status of their under-five children found in this study can be used to prioritize the appropriate type of intervention needed by the poor households. Furthermore, since anemia was highly prevalent, besides iron supplementation, chronic diseases such as tuberculosis and malaria, and the prevalence of thalasemic-trait should also be considered. Further operational and academic research in the area of health and nutrition are needed to be able to construct a model that provides indicators used to predict the nutritional condition in each community setting across Indonesia during any crisis. "

"LATAR BELAKANG MASALAH (1) Prurigo Hebra (PH) merupakan penyakit kulit yang kronis, sehingga dapat mengganggu aktivitas dan estetika. Saat ini PH termasuk dalam 10 besar penyakit kulit yang sering dijumpai di Indonesia. Diagnosisnya mudah ditegakkan, namun sulit diobati karena etiologi dan mekanisme terjadinya penyakit belum seluruhnya diketahui. Selama ini pengobatan hanya bersifat simtomatik, dan tidak memuaskan. Berbagai penelitian telah dilakukan terutama ditujulcan terhadap faktor ekstrinsik, misalnya higiene, status gizi, serta hipersensitivitas gigitan nyamuk, sedangkan faktor intrinsik belum banyak diteiiti. Kekerapan munculnya penyakit di dalam keluarga menimbulkan dugaan penyakit ini diturunkan secara genetik, tetapi belum jelas apakah mengikuti pola gen tunggal atau pola multifaktor. (2) Salah satu faktor genetik yang berkaitan dengan hipersensitivitas adalah faktor imunogenetik HLA, mungkin berperan dalam mekanisme terjadinya penyakit dart mempengaruhi manifestasinya. (3) Perkembangan Iesi kulit mungkin bergantung pada inflamasi nonspesifik dan spesifik.IDENTIFIKASI MASALAH Uraian di atas menunjukkan kesenjangan patogenesis yang berkaitan dengan faktor intrinsik di antaranya poly penurunan genetic, faktor imunogenetik HLA tertentu, reaksi imunopatologik di kulit pasien prurigo Hebra.TUJUAN (1) Membuktikan apakah pola penurunan genetik pasien prurigo Hebra mengikuti poly penurunan gen tunggal yaitu resesif autosom (RA) dan dominan autosom (DA) atau multifaktor. (2) Membuktikan hubungan antara HLA tertentu dengan prurigo Hebra, dan menentukan HLA tertentu yang mempunyai pengaruh pada perkembangan penyakit. (3) Menilai perbedaan derajat sebukan sel inflamasi nonspesifik dari spesifik berkaitan dengan respons hipersensitivitas tipe I dari IV pada perkembangan lesi awal dan Iasi lanjut prurigo Hebra."

"Resipien yang mendapat transfusi berulang berisiko membentuk aloantibodi anti-HLA Kelas I karena masih adanya leukosit dalam komponen darah dan upaya pengurangan jumlah leukosit tersebut dengan filter atau radiasi belum merata tersedia di Indonesia. Antibodi anti-HLA Kelas I dapat bereaksi dengan trombosit donor pada transfusi berikutnya menyebabkan platelet refractoriness. Untuk mencegah terjadinya platelet refractoriness, pasien harus mendapat trombosit yang HLA-match atau antigen negative cell, namun belum memungkinkan karena keterbatasan jumlah donor darah yang telah diketahui antigen HLA Kelas I. Untuk itu, dilakukan pemilihan trombosit donor yang memiliki CREG HLA Kelas I yang sama dengan resipien dan selanjutnya dipastikan bahwa inkompatibilitas trombosit tidak terjadi dengan uji silang serasi trombosit pre-transfusi.Dua puluh delapan sampel pasien anemia aplastik yang mendapat transfusi berulang dilakukan skrining antibodi trombosit dengan metode whole-platelet ELISA dan dilanjutkan dengan identifikasi antibodi trombosit dengan metode MAIPA (Monoclonal Antibody Immobilization Platelet Antigen). Sampel yang terdeteksi antibodi HLA Kelas I dianalisis genotip HLA-A dan HLA-B dan dilakukan uji silang serasi dengan trombosit donor yang dipilih berdasarkan kelompok alel CREG HLA.Dari hasil skrining antibodi, terdeteksi 8 dari 28 sampel terdapat antibodi anti-trombosit. Tujuh dari 8 sampel tersebut atau 7 dari keseluruhan sampel (25%) yang memiliki antibodi HLA Kelas I. Trombosit donor yang CREG HLA Kelas I nya sama dengan resipien cocok berdasarkan hasil uji silang serasi trombosit pre-transfusi dan sebaliknya trombosit donor yang CREG HLA Kelas I nya tidak sama dengan resipien dapat menghasilkan ketidakcocokan atau inkompatibilitas pada uji silang serasi trombosit pre-transfusi. Terdapat antibodi HLA Kelas I pada 25% penderita anemia aplastik yang mendapat transfusi berulang. Dengan melakukan pemilihan trombosit yang berasal dari kelompok CREG HLA Kelas I yang sama antara donor dengan pasien maka didapatkan hasil uji silang serasi yang cocok. Studi ini sebaiknya dilanjutkan untuk melihat respon transfusi trombosit pasien yang medapat trombosit yang cocok ini.

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Allo-immunization risk to HLA class I antigen is very high in multi-transfusion patients because leukocyte contamination in blood components and At next transfusion, the patients could have platelet refractoriness due to HLA antigen and alloantibody reaction. To avoid platelet refractoriness, he should be transfused with HLA-match platelet or HLA negative-cell but the blood centre doesn`t have enough donors who have been HLA class I typed. Therefore, in this study we want to know whether donor`s platelet with the same CREG HLA class I with patients is compatible.Whole-platelet ELISA for platelet antibody screening was conducted on 28 samples of Aplastic Anemia patients from Hematology-Oncology Clinic of Cipto Mangunkusumo Hospital. We identify the samples with MAIPA (Monoclonal Antibody Immobilization Platelet Antigen). Positive sample were amplified using PCR-ssp method to analyze the genotype of HLA class I. We also analyze the platelet cross-match.With ELISA method we found 8 of 28 samples have platelet antibody. Seven of those positive samples or 7 of all samples (25%) have HLA class I antibodies. From platelet crossmatch, we found that if CREG HLA Class I between donor and patient are same, the result is compatible. 25% of aplastic anemia who received blood transfusion routinely have antibody to HLA class I. With selected platelet based on the same CREG between donor and patient, we can provide compatible platelet to those patients. But this compatible platelet must be evaluated in patients."