The Decreased Treg Cells Number Associated with Retinal Lesion Size in Ocular Toxoplasmosis

Introduction. The imbalance of the immune response is an important factor contributing to the incidence of ocular toxoplasmosis (OT). Regulatory T cells (Treg) play a key role in maintaining the balance between Th1 and Th17 immune responses, while interleukin-27 (IL-27) levels are related to the differentiation of Th17 cells. This study analyzes the differences in the number of Treg cells and the level of IL-27 between OT patients and seropositive individuals without ocular lesions and its correlation with retinal lesion size. Methods. This analytic observational study, conducted for 8 months, involved 11 OT patients and 10 seropositive individuals without ocular lesions. All subjects underwent a comprehensive ophthalmological examination. Retinal lesions were documented by fundus photographs and the size was measured using Digimizer 4.2.2.0 software. Isolation of peripheral blood mononuclear cells (PBMC) was performed to measure the number of Treg cells using flow cytometry and interleukin-27 levels were assessed using the Sandwich enzyme-linked immunosorbent assay (ELISA) technique. Data were analyzed with SPSS. Result. The number of Treg cells in the OT group (47.16 ± 15.66%) was lower than in the seropositive group without the ocular lesions (62.86 ± 17.08%) (p=0.029). The serum IL-27 levels in the OT group were not significantly different from the seropositive group without the ocular lesions (p=0.360). The number of Treg cells was significantly related to retinal lesion size (p=0.043), with a correlation coefficient of −0.648, indicating a strong and inverse correlation. There was no significant correlation between serum IL-27 levels and retinal lesion size (p=0.556). Conclusion. Ocular toxoplasmosis patients have a low number of Treg cells that are inversely related to the retinal lesion size. The size of the retinal lesion increases as the number of Treg cells decreases

Efektivitas Metode Edukasi dalam Meningkatkan Pengetahuan Ibu Pemberdayaan Kesejahteraan Keluarga (PKK) dan Kader Kesehatan terkait Pencegahan Penularan Konjungtivitis di Kota Malang

Konjungtivitis adalah salah satu penyebab mata merah yang sering terjadi, kondisi ini merupakan infeksi pada selaput lendir mata atau konjungtiva. Menurut data Profil Kesehatan RI 2009 dan 2010, konjungtivitis dan gangguan konjungtiva lainnya menjadi salah satu 10 besar penyakit terbanyak pada pasien rawat jalan di rumah sakit. Tingginya angka tersebut diakibatkan oleh wabah konjungtivitis yang dapat terjadi kapan saja sepanjang tahun. Solusi yang dapat dilakukan untuk mengatasi permasalahan tersebut adalah dengan meningkatkan pengetahuan masyarakat terkait pencegahan penularan penyakit konjungtivitis melalui kerjasama dengan Ibu PKK dan Kader Kesehatan yang berperan sebagai edukator di lingkungannya dengan pelatihan secara langsung. Berdasarkan pertimbangan tersebut, penelitian ini bertujuan untuk mengetahui efektivitas penggunaan metode pelatihan untuk meningkatkan pengetahuan Ibu PKK dan Kader Kesehatan Kota Malang penyakit konjungtivitis. Penelitian ini bertujuan meneliti efektivitas Metode Pelatihan dalam Meningkatkan Pengetahuan Ibu Pemberdayaan Kesejahteraan Keluarga (PKK) dan Kader Kesehatan terkait Pencegahan Penularan Konjungtivitis di Kota Malang. Penelitian menggunakan desain penelitian pre eksperimental dengan desain pre-test dan post-test with control group dengan teknik purpose random sampling. Berdasarkan penelitian, didapatkan peningkatan yang signifikan dari jumlah peserta yang mengalami kenaikan nilai (n>70%) yang menyatakan adanya efektivitas penggunaan metode pelatihan untuk meningkatkan pengetahuan ibu PKK dan Kader Kesehatan di kota Malang terkait konjungtivitis

Implementasi Pendekatan Algoritma Deep Learning CNN untuk Identifikasi Citra Pasien Keratitis

The incidence of keratitis globally ranges from 0.4 to 5.2 per 10,000 people annually. Keratitis can only be identified by an ophthalmologist using a slitlamp as a fundamental instrument for specific eye examination in secondary care facilities. In primary care facilities, eye specialists and slitlamps are not available. This causes delay in the diagnosis and treatment of keratitis patients in public health centers or areas with limited facilities and access to doctors/ophthalmologists. This research aims to develop a keratitis identification model using the convolutional neural network (CNN) method and training data consisting of images produced by smartphones and combined with slitlamp images. The training accuracy of the developed model is 92% with a dropout layer set at 0.3, and the average validation accuracy is 83%, indicating that the model training did not experience overfitting. The testing results with new data achieved an accuracy of 90%. Next, the parameters of the best model will be integrated into an application running on the Android operating system. However, the application’s functionality and UX/UI performance need to be improved to facilitate seamless use of the model.Insiden keratitis secara global berkisar antara 0.4 sampai 5.2 per 10,000 orang setiap tahunnya. Penanggulangan gangguan penglihatan akibat keratitis secara dini dan akurat dapat mencegah kebutaan akibat kekeruhan kornea. Keratitis dapat diidentifikasi oleh dokter spesialis mata dengan bantuan slitlamp sebagai instrumen dasar pemeriksaan spesialistik organ mata di fasilitas layanan sekunder. Pada fasilitas layanan primer tidak tersedia dokter spesialis mata dan juga slitlamp. Hal ini meyebabkan terjadinya keterlambatan diagnosis dan penanganan terhadap pasien-pasien keratitis di puskesmas atau daerah-daerah dengan fasilitas serta akses ke dokter spesialis mata yang terbatas. Penelitian ini bertujuan untuk mengembangkan model identifikasi keratitis menggunakan metode convolutional neural network (CNN) dan data latih berupa citra yang dihasilkan oleh gawai pintar dan dikombinasikan dengan citra slitlamp. Akurasi pelatihan dari model yang dikembangkan adalah 92% dengan layer dropout ditetapkan dengan nilai 0.3. Rata-rata akurasi validasinya adalah 83% sehingga dapat dikatakan pelatihan model yang dikembangkan tidak mengalami overfitting. Adapun hasil pengujian dengan data baru mencapai akurasi sebesar 90%. Selanjutnya parameter model terbaik disematkan ke dalam aplikasi yang berjalan di sistem operasi berbasis Android, namun fungsionalitas serta kinerja UX/UI dari aplikasi perlu ditingkatkan untuk memfasilitasi model agar dapat digunakan secara sempurna

Current practice in the management of ocular toxoplasmosis

Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists