Respon Imun terhadap Infeksi Virus Dengue (Patogenesis dan Patofisiologi DBD)

16 06 2010

Virus dengue termasuk ke dalam Arthropoda Borne Virus (Arbo virus) dan terdiri dari 4 serotype yaitu DEN 1, 2, 3, dan 4. Infeksi virus dengue untuk pertama kali akan merangsang terbentuknya atibodi non-netralisasi. Sesuai dengan namanya, antibodi tersebut tidak bersifat menetralkan replikasi virus, tetapi justru memacu replikasi virus. Akibatnya terbentuk kompleks imun yang lebih banyak pada infeksi sekunder oleh serotype lain. Hal itu yang menyebabkan manifestasi klinis infeksi sekunder lebih berat dibanding infeksi sekunder (Soedarmo, 2002).

Antibodi non-netralisasi yang terbentuk akan bersirkulasi bebas di darah atau menempel di sel fagosit mononuklear yang merupakan tempat utama infeksi virus dengue. Antibodi non-netralisasi yang menempel pada sel fagosit mononuklear berperan sebagai reseptor dan generator replikasi virus. Kemudian virus dengue dengan mudah masuk dan menginfeksi sel fagosit (mekanisme aferen). Selanjutnya virus bereplikasi di dalam sel fagosit dan bersama sel fagosit yang telah terinfeksi akan menyebar ke organ lain seperti hati, usus, limpa, dan sumsum tulang belakang (mekanisme eferen). Adanya sel fagosit yang terinfeksi akan memicu respon dari sel imun lain sehingga muncul berbagai manifestasi klinis \yang disebut sebagai mekanisme efektor (Soedarmo, 2002; Nainggolan et al., 2006).

Mekanisme efektor dimulai dengan aktivasi sel T helper (CD4), T sitotoksik (CD8), dan sistem komplemen oleh sel fagosit yang terinfeksi. Th selanjutnya berdiferensiasi menjadi Th1 dan Th2. Th1 akan melepaskan IFN-γ, IL-2, dan limfokin sedangkan Th2 melepaskan IL-4, IL-5, IL-6, dan IL-10. Selanjutnya IFN-γ akan merangsang monosit melepaskan TNF-α, IL-1, PAF, IL-6, dan histamin. Limfokin juga merangsang makrofag melepas IL-1. IL-2 juga merupakan stimulan pelepasan IL-1, TNF-α, dan IFN-γ. Pada jalur komplemen, kompleks imun akan menyebabkan aktivasi jalur komplemen sehingga dilepaskan C3a dan C5a (anafilatoksin) yang meningkatkan jumlah histamin. Hasil akhir respon imun tersebut adalah peningkatan IL-1, TNF-α, IFN-γ, IL-2, dan histamin (Kresno, 2001; Soedarmo, 2002; Nainggolan et al., 2006).

IL-1, TNF-α, dan IFN-γ dikenal sebagai pirogen endogen sehingga timbul demam. IL-1 langsung bekerja pada pusat termoregulator sedangkan TNF-α dan IFN-γ bekerja tidak secara langsung karena merekalah yang merangsang pelepasan IL-1. Bagaimana mekanisme IL-1 menyebabkan demam? Daerah spesifik IL-1 adalah pre-optik dan hipothalamus anterior dimana terdapat corpus callosum lamina terminalis (OVLT). OVLT terletak di dinding rostral ventriculus III dan merupakan sekelompok saraf termosensitif (cold dan hot sensitive neurons). IL-1 masuk ke dalam OVLT melalui kapiler dan merangsang sel memproduksi serta melepaskan PGE2. Selain itu, IL-1 juga dapat memfasilitasi perubahan asam arakhidonat menjadi PGE2. Selanjutnya PGE2 yang terbentuk akan berdifusi ke dalam hipothalamus atau bereaksi dengan cold sensitive neurons. Hasil akhir mekanisme tersebut adalah peningkatan thermostatic set point yang menyebabkan aktivasi sistem saraf simpatis untuk menahan panas (vasokontriksi) dan memproduksi panas dengan menggigil (Kresno, 2001; Abdoerrachman, 2002).

Selain menyebabkan demam, IL-1 juga bertanggung jawab terhadap gejala lain seperti timbulnya rasa kantuk/tidur, supresi nafsu makan, dan penurunan sintesis albumin serta transferin. Penurunan nafsu makan merupakan akibat dari kerjasama IL-1 dan TNF-α. Keduanya akan meningkatkan ekspresi leptin oleh sel adiposa. Peningkatan leptin dalam sirkulasi menyebabkan negatif feedback ke hipothalamus ventromedial yang berakibat pada penurunan intake makanan (Luheshi et al., 2000).

IFN-γ sebenarnya berfungsi sebagai penginduksi makrofag yang poten, menghambat replikasi virus, dan menstimulasi sel B untuk memproduksi antibodi. Namun, bila jumlahnya terlalu banyak akan menimbulkan efek toksik seperti demam, rasa dingin, nyeri sendi, nyeri otot, nyeri kepala berat, muntah, dan somnolen (Soedarmo, 2002).

Sejak awal demam sebenarnya telah terjadi penurunan jumlah trombosit pada penderita DBD. Penurunan jumlah trombosit memudahkan terjadinya perdarahan pada pembuluh darah kecil seperti kapiler yang bermanifes sebagai bercak kemerahan. Di sisi lain, peningkatan jumlah histamin meningkatkan permeabilitas kapiler sehingga terjadi perembesan cairan plasma dari intravaskuler ke interstisiel. Hal itu semakin diperparah dengan penurunan jumlah albumin akibat kerja IL-1 dan gangguan fungsi hati. Adanya plasma leakage tersebut menyebabkan peningkatan Hct. Trombositopenia terjadi akibat pemendekan umur trombosit akibat destruksi berlebihan oleh virus dengue dan sistem komplemen (pengikatan fragmen C3g); depresi fungsi megakariosit, serta supresi sumsum tulang. Destruksi trombosit terjadi di hepar, lien, dan sumsum tulang. Trombositopenia menyebabkan perdarahan di mukosa tubuh sehingga sering muncul keluhan melena, epistaksis, dan gusi berdarah. Hepatomegali pada pasien DBD terjadi akibat kerja berlebihan hepar untuk mendestruksi trombosit dan untuk menghasilkan albumin. Selain itu, sel-sel hepar terutama sel Kupffer mengalami banyak kerusakan akibat infeksi virus dengue. Bila kebocoran plasma dan perdarahan yang terjadi tidak segera diatasi, maka pasien dapat jatuh ke dalam kondisi kritis yang disebut DSS (Dengue Shock Sydrome) dan sering menyebabkan kematian (Soedarmo, 2002; Nainggolan et al., 2006).

References:

Abdoerrachman MH. 2002. Demam : Patogenesis dan Pengobatan. In: Soedarmo dkk (ed). Buku Ajar Ilmu Kesehatan Anak, Infeksi dan Penyakit Tropis Edisi Pertama. Jakarta: IDAI, pp: 27-51.

Kresno SB. 2001. Respons Imun terhadap Infeksi Virus. In: Imunologi – Diagnosis dan Prosedur Laboratorium. Jakarta : FK UI, pp: 178-181.

Luheshi GN, Gardner JD, Rushforth DA, Luodon SA, Rothwell NJ. 2000. Leptin actions on food intake and body temperature are mediated by IL-1. Neurobiology Journal, pp: 7047-52.

Nainggolan L, Chen K, Pohan HT, Suhendro. 2006. Demam Berdarah Dengue. In: In: Sudoyo dkk (ed). Buku Ajar Ilmu Peyakit Dalam Jilid III Edisi IV. Jakarta: FKUI, pp: 1731-1736.

Soedarmo PS. 2002. Infeksi Virus Dengue. In: Soedarmo dkk (ed). Buku Ajar Ilmu Kesehatan Anak, Infeksi dan Penyakit Tropis Edisi Pertama. Jakarta: IDAI, pp: 176-209.





Manfaat Ekstrak Daun Carica papaya untuk Meningkatkan Endurance Capacity

15 06 2010

Dalam taksonomi tumbuhan, tanaman Carica papaya diklasifikasikan sebagai berikut :

Kingdom   : Plantae

Divisio       : Spermatophyta

Subdivisio : Angiospermae

Class          : Dycotyledonae

Ordo          : Caricales

Familia      : Caricaceae

Genus        : Carica

Spesies      : Carica papaya L.

Carica papaya Linn. adalah semak berbentuk pohon dengan batang lurus dan bulat. Tinggi pohon 2,5-10 meter, tangkai daun bulat berongga, bertulang daun menjari, ujung daun runcing dengan garis tengah 25-75 centimeter. Daun di sebelah atas berwarna hijau tua, sedangkan di sebelah bawah berwarna hijau muda, bertekstur licin, dan suram (da Silva et al, 2007).

Tanaman ini dapat dijumpai hampir di seluruh Kepulauan Indonesia. Carica papaya di Jawa Tengah dikenal dengan nama kates, di Sunda dinamakan gedhang, orang Sulawesi menyebutnya kapaya, dan di Ambon dikenal dengan nama papas. Tanaman pepaya ini mempunyai banyak manfaat dan kegunaan serta telah digunakan secara tradisional untuk arthritis dan reumatik di Indonesia dan Haiti, asma dan infeksi pernapasan di Mauritius, Meksiko, dan Filipina, kanker di Australia dan Meksiko, konstipasi dan laksatif di Honduras, Panama, dan Trinidad, meningkatkan produksi susu di Indonesia dan Malaysia, untuk kasus tumor (uterus) di Ghana, Indocina, dan Nigeria, serta kasus sifilis di Afrika (Warisno, 2004).

Bagian-bagian dari pohon pepaya yang sering digunakan masyarakat adalah buah, daun, biji, dan bunga. Melalui indentifikasi ekstrak, daun Carica papaya mengandung alkaloid, dehidrokarpain, pesedokarpain, flavonol, benzylglucosinolate, papain, dan tannin. Seratus gram daun dilaporkan mengandung 74 kalori, 77,5 gram H2O, 7 gram protein, 2 gram lemak, 11,3 gram karbohidrat total, 1,8 gram serat, 2,2 gram abu, 344 mg kalsium, 142 mg fosfor, 0,8 mg besi, 18 gram natrium, 652 mg kalium, 11,565 µg beta karoten, 0,09 mg thiamin, 0,48 mg riboflavin, 2,1 mg niasin, 140 mg asam askorbat, dan 136 mg vitamin E (Canini et al, 2007).

Benzylglucosinolate dalam daun Carica papaya, terutama pada daun muda selama ini belum banyak diteliti. Penelitian sebelumnya pada benzylglucosinolate yang terkandung dalam ekstrak biji Carica papaya terbukti dapat menurunkan kadar glukosa darah secara signifikan pada dosis 0,4 mL/kgBB/hari pada Wistar sp (Adeneye, 2009). Penggunaan benzylglucosinolate sintetis sebagai bahan penelitian juga telah terbukti meningkatkan endurance capacity pada mencit (Ikeuchi et al, 2009).

Kandungan benzylglucosinolate dalam daun Carica papaya, terutama pada daun muda berpotensi meningkatkan ketahanan fisik melalui pemecahan lemak sebagai sumber energi. Lemak menghasilkan kalori lebih banyak dibanding sumber energi lain, seperti karbohidrat dan protein. Pemecahan lemak sebagai sumber energi tidak menimbulkan akumulasi laktat, sebagaimana terjadi bila sumber energinya adalah karbohidrat (Murray et al, 2003). Dengan demikian, pada aktivitas yang berat dan lama, onset kelelahan dapat dihindari sehingga ketahanan fisik akan lebih mampu bertahan. Pemberian benzylglucosinolate menginduksi pemecahan lemak melalui peningkatan hormone-sensitive-lipase sehingga glikogen yang umumnya dipecah sebagai sumber energi utama dapat dihemat (Ikeuchi et al, 2009).

Lemak merupakan cadangan makanan yang tersimpan dalam bentuk jaringan adiposa, yang dipecah hanya ketika diperlukan. Akan tetapi, dengan pemberian benzylglucosinolate, lemak justru dijadikan sebagai sumber utama untuk menghasilkan energi bagi aktivitas tubuh sehingga pemberian ini juga merangsang mobilisasi jaringan adiposa. Oleh karena lemak menghasilkan kalori lebih besar serta menunda onset kelelahan, energi yang dihasilkan pun lebih tahan lama, artinya ketahanan fisik dipertahankan prima (Ikeuchi et al, 2009).

Eksperimen tentang pengujian exercise endurance pada mencit melalui teknik swimming exercise test protocol (Ikeuchi, dkk) menunjukkan terjadinya peningkatan signifikan pada endurance capacity melalui pemberian benzylglucosinolate sintetis. Melalui eksperimen tersebut, diperoleh hasil berupa peningkatan endurance capacity, peningkatan kadar asam lemak bebas dalam darah, dan kadar glukosa darah yang cenderung dipertahankan kadarnya    (Ikeuchi et al, 2009).

References:

Da Silva JAT, Rashid Z, Nhut DT, et al. 2007. Papaya (Carica papaya L.) Biology and Biotechnology. Japan: Global Science Books.

Ikeuchi M, Koyama T, Takei S, et al. 2009. Effects of Benzylglucosinolate on Endurance Capacity in Mice. http://www.jstage.jst.go.jp/article/jhs/55/2/178/_pdf.                   (12 Agustus 2009).

Murray RK, Granner DK, Mayes PA, et al. 2003. Biokimia Harper. ed. 25. Jakarta: EGC. pp: 170-177, 225-235.

Sherwood L. 2001. Fisiologi Manusia: Dari Sel ke Sistem ed 2. Jakarta: EGC. p: 235-238.

Warisno. 2004. Budidaya Pepaya. Yogyakarta: Kanisius.





How to Succed in Our Study and Business

15 06 2010

In 2009, it was stated that there were 9,26 millions unemployment in Indonesia. The unbelievable side is 10% between them have bachelor degree. Many people still think that continuing their study until university can make their life better. They hope with their bachelor degree, they will get a good job. Maybe that statement is right for 10 years ago but it is wrong for now. Why? Let’s see the reality. Nowadays, the number of job vacancies is not appropriate with the amount of applicants. To solve that problem we can start our own business. Maybe there will be questions: How can we do that? We are still too young to start a business! What about our study, will it be disturbed? Remember that success is not determined by age because success only comes to them who have a big willingness. The real example is Purdi E. Chandra. He is a millionaire who has started his business since he was in university. Actually, your business will disturb your study or not, depends on two things. Those are what kind of business that you choose and how you give priority to each of them. If you can control those two things, I guarantee that you will be the next Purdi E. Chandra.

First is kind of business that you choose. It is better to choose a business that does not spend much time. On the other words, we can do that business outside the study time. Actually many businesses can be done while studying. College students are creative persons who prefer using their brain to their physical strength to get money. There are two kinds of business, online and offline business. Nowadays, there are many chances to start an online business such as internet marker, ads publisher, and blog monetizing. You do not need a big capital and much time for doing online business. You just create a blog (blogger, wordpress, etc) and fill it with your own articles or other’s articles. However, do not forget to cite a link source for article that you cite from others. There are many businesses which based on blog such as Google adsense, kumpulblogger.com, adsensecamp.com, etc. They will be our publisher then add advertisements in our blog. We will get 300 rupiah for each advertisement which is chosen by our blog’s visitors. If you are not too interested in online business, you can choose offline businesses. Though getting offline business is little bit difficult now, you do not have to worry because there is a way if there is a will. You can write an article then send it to a newspaper or magazine. Or maybe you can be a private course teacher for elementary to senior high school students. The others alternatives are following competition, selling cell phone vouchers, joining a research, becoming lecture’s assistant, etc.

Second is your time’s proportion for studying and business. If you have chosen your business, you must decide how many hours a day to do your business. Just do your business only on that time. Do not take your study time to do your business except you are in holiday at the time. If you choose online business, I think it is not a big problem to make schedule. You can do it at the night after you do all of your tasks as student. If you do not have your own internet connection, you do not have to worry because there are many 24 hours internet cafes outside. If you choose offline business such as becoming private course teacher, it is better to discuss with your students/student’s parents about the suitable times. The point is whatever business that you choose, you must remember that you are student who has duty to study. It is wrong if you give priority to your business.

In short, there are two things that should be controlled to be a successful student and businessman. Those are choosing the suitable business and doing it only on its time. Remember that we do our business while study, not study while do our business. Your study is still the priority. Do not consider your business as everything if you do not want to be “eternal college students”.

References:

Abadi Abdillah. 2009. Berbisis Sambil Kuliah. Accessed 28 Mei 2010. http://adabisnis.com/berbisnis-sambil-kuliah/

Antara News. 2010. Technopreneurship ITS Antisipasi Pengangguran Sarjana 20 Persen/Tahun. Accessed 28 Mei 2010. http://www.antaranews.com/berita/1268519338.

Supadiyanto. 2007. Mahasiswa Kreatif vs Pengangguran. Accessed 28 Mei 2010. http://uinuka.info/humas/index.php?option=com_content&task=view&id=49&Itemid=1





How to Slow Aging

1 06 2010

THREE EASIER WAYS TO SLOW AGING

Getting older is a certainty for all people. Naturally, when we are in adult’s phase, we can not grow anymore. On the other hand, the function of our body parts will decrease because of aging. What is aging? Aging is a process of becoming older that genetically determined and environmentally modulated. From that definition, we know that aging is caused by many factors. Those factors are divided into two groups, internal and external factors. Internal factors are related with gene, immunity, and hormones while external factors are unhealthy life style, pollution, and stress. Because of those factors, people become old, ill, and then die. If aging can be slowed or be prevented, our life quality can be maintained even be increased. Now, the question is what can we do to slow aging? Many researches have been conducted to answer that question. However, to me, avoiding the aging factors; like doing regular exercises, not eating junk foods, and thinking positively are three easier ways that we can do. How do those ways slow aging? Do they have other advantages to our body?

Firstly, regular physical exercise prevents reduction of aerobic capability and increases it. Aerobic capability is human capability to provide oxygen that is used in metabolism, a process that produces energy. Normally, aerobic capability decreases about 5ml/kg/minute for every decade. If that number decreases under 18ml/kg/minute for men and 15ml/kg/minute for women, they will get heavy fatigue when they do daily activities. Regular physical exercise such as jogging, cycling, and swimming increase that number up to 25%. It means that aging will be slowed for 10-12 years. How does regular physical examination increase aerobic capability?Normally, physic exercises increase stimulation of sympathetic nerve, a nerve that stimulates heart’s work. Our heart contracts stronger than before. It means our heart pumps more blood and our cells get more oxygen. If we do the exercise regularly, our heart will have an adaptation on it. As a result, our aerobic capability will increase. Besides slowing aging, maximum aerobic capability also has other advantages to our body such as shortens recovering time, maintains the muscle’s strength, and decreases the risk of cardiovascular disease.

Secondly, not eating junk food reduces fat amounts and indirectly reduces free radicals in our body. As we know, most of junk food contains high fat which is not good to our body. Maximum fat intake is 30 percent because fat contains triglyceride and cholesterol. If fat amounts in our body exceed that number, risk of obesity is higher. Someone with obese status has higher risk to suffer many diseases and premature death. Besides that, fat which is burned in high temperature and oil which is cooked repeatedly, like in most junk food, are free radical sources. Free radicals are chemical species with a single unpaired electron in an outer orbital. Such chemical states are extremely unstable and readily react with inorganic and organic chemicals. When generated in cells, they attack nucleic acids as well as molecule membrane. In addition, free radicals initiate autocatalytic reactions; molecules that react with free radicals are in turn converted into free radicals, thus propagating the chain of damage. Fortunately, our body has developed many mechanisms such as antioxidants to remove free radicals and minimize injury. Those mechanisms mean nothing if we still continue our habit to consume junk food. Why? Because antioxidants amount in our body is limited. If that habit is not ended, free radicals amount in our body will be in abundance. As a result is oxidative stress, a condition that causes oxidative damage from cells, tissue, until body organs. Those damage cells cause premature death cells. That condition is manifested as premature aging, cardiovascular disease, and cancer. Based on facts above, if we reduce eating junk foods, it means that we reduce free radical amounts in our body and oxidative stress can be avoided. So, many conditions that are caused by oxidative stress such as premature aging will not happen.

Lastly, thinking positively slows aging by reducing psychosocial stress. When we face a problem and we think positively on it, possibility to get psychosocial stress is less. It means our body has been saved from many diseases that are caused by psychosocial stress. You have to know that stress is every condition that threatens our body homeostasis (our body balance). It can be physical stress, chemical stress, psychosocial stress, etc. Normally, our body has complicated stress responses that involve hormones and sympathetic nerves to face it. Whatever the type of stress, the responses are the same. Those responses cause energy mobilization that is used to repair damaged cells. Unfortunately, those mechanisms are not too useful for chronic physical stress. The cause is no physical destruction in psychosocial stress. So, the responses which are produced are useless. If those responses are in abundance amount, they destruct body cell and cause premature cell death. Such conditions make aging happens earlier causing a condition that is called as premature aging. They also cause other diseases, like atherosclerosis and hypertension.

In short, aging is unavoidable for all people because it is one of life cycle.  However, there are many ways to slow it. If we can slow it, our life’s quality will be maintained even be increased. From those ways there are three easier ways that we can do. Those are doing regular examination, not eating junk foods, and thinking positively. Besides slowing aging, those ways also have other advantages to our body such as prevent cardiovascular disease like hypertension and atherosclerosis, shortens recovering time, etc.

References

Adikusumo, A. 1999. Penatalaksanaan Stres. In : Cermin Dunia Kedokteran         No 123. Accessed 22 Januari 2009       http://kalbe.co.id/cdk

Karnadi, J. 1999. Stres dalam Kehidupan Sehari-hari. In : Cermin Dunia    Kedokteran No 123. Accessed 22 Januari 2009       http://kalbe.co.id/cdk

Pamela, Ruri. 2008. Stress Oksidatif Memicu Penuaan Dini. Accessed 22    January 2009 http://ruripamela.com/2008/11/html

Robbins, S.L.,Kumar, V., Cotran, R.S. 2003. Basic Pathology 7th Edition. New      York : Elsevier Inc.

Shephard, R.J. 2008. Maximal Oxygen Intake and Independence in Old Age.          British Jurnal Sports Medicine; doi:10.1136/bsjm.2007.0448. Accessed         20 January 2009 http://bjsm.bmj.com

Sherwood, Lauralee. 2002. Human Physiology : From Cells to Systems. West : A Division of International Thomson Publishing Inc.








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