Stress-induced Oral Lichen Planus Immunopathogenesis and Potential Therapy: A Narrative Review

Background: Oral lichen planus is a chronic inflammatory condition that only involves in the oral cavity and is mediated by the cellular immune system. The etiology of OLP is unclear but autoreactive T lymphocytes are considered to play an important role in the development of OLP. Factors like stress and psychological anxiety have been associated with OLP but their roles in the development of OLP is yet explored. Purpose: To describe stress-induced OLP immunopathogenesis and therapeutic potential. Reviews: In the early stages, the mechanism of OLP involves the expression of keratinocyte antigens or exposure to an antigen in the form of self-peptide or heat shock protein (HSP). HSP90 is the most expressed heat shock protein in the basal layer of keratinocytes and plays a role in recruitment of cellular immune cells through the production of cytokines due to TLR2/4 and CD91 activation, inflammatory cell migration due to 4 integrin activation, and increased antigen presentation due to HSP90-peptide binding to MHC class I/II. Stress as a physiological response triggers the release of the hormone cortisol from the adrenal cortex and catecholamine hormones such as epinephrine/ adrenaline and norepinephrine/noradrenaline from the adrenal medulla. Catecholamines increase the migration of T lymphocyte cells through the interaction of integrins and integrin ligands on the endothelium through the expression of 2-integrin after binding to adrenergic receptors on the cell membrane. Conclusion: Oral lichen planus is a chronic inflammatory condition caused by various factors where stress increases the migration of T lymphocyte cells on the side that expresses self-peptides and antigens through the interaction of immune cells with catecholamines. Topical nonselective beta blockers can be supporting therapy in reducing pain and size of OLP lesions

Pengaruh Kelelahan Kerja, Stress Kerja, Motivasi Kerja dan Beban Kerja terhadap Kinerja Perawat di RSUD Kota Makassar

Background: It is undeniable that the nursing profession is a profession that has a high workload and great responsibility. This certainly can affect the performance of nurses in carrying out their duties. This study was conducted to analyze the relationship between work fatigue, work stress, work motivation and workload on the performance of nurses in Daya Makassar Hospital. Methods: This type of research uses an analytical observational method with a cross sectional study design. The sampling method using purposive sampling was carried out on Makassar City Hospital nurses who had met the criteria. In measuring work fatigue, work stress, work motivation, and workload, it is measured using a questionnaire. Results: There are 100 respondents involved in this study. Most of the respondents are in the 31-40 year age group (70%), female (69%), have a bachelor's degree in nursing (59%), and work years > 10 years (73%). The results of statistical tests showed that there was an effect of work stress (p = 0.013), work motivation (p = 0.000), and workload (p = 0.000) on the performance of nurses in Makassar City Hospital. However, work fatigue (p = 0.122) did not affect the performance of nurses in Makassar City Hospital. Conclusion: Work stress, work motivation, and workload affect the performance of nurses in Makassar City Hospital. The most influential factor on the performance of nurses in Makassar City Hospital is workload