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Effect of Combined Probiotics and Zinc Supplementation on Immune Status of Pulmonary Tuberculosis Patients



Patients with pulmonary tuberculosis generally malnourished due to side effect in anti-tuberculosis drugs, which altering gastrointestinal tract, it affects on recovery process, immune system and response. Probiotics and zinc are thought to have beneficial effects for nutritional status and immune response. This study was conducted to analyze the effect of combined probiotics and zinc on levels of lymphocytes, neutrophils lymphocyte count ratio (NLR) and monocytes in patients with pulmonary tuberculosis in Lung Health Center of Semarang. In a quasi-experimental study (quasi experiment) randomized design with pre-post test control group design, fifty four pulmonary tuberculosis patients were divided into 2 groups, the treatment group received a combination of probiotics and zinc, as well as a control group given a placebo, administration for 4 weeks. There were no differences in mean age, levels of lymphocytes and monocytes NLR at baseline (p>0.05). Increased levels of lymphocytes and decreased levels of monocytes and NLR after administration of the combination of probiotics and zinc (p<0.05). There was no significant relationship between nutriens intake with high levels of lymphocytes, NLR and monocytes (p>0.05). The most powerful effectiveness of the combination probiotics and zinc contained in the lymphocyte levels (12.8%). It is concluded that the combined probiotics and zinc over 4 weeks improve the immune system of patients with pulmonary tuberculosis measured by lymphocytes, NLR and monocytes.
... Infeksi mengakibatkan inflamasi kronis, penurunan asupan, malabsorpsi nutrient, perubahan metabolisme tubuh dan radikal bebas, immunitas tubuh dan antioksidan tubuh menurun. 7,8 Obat-obat TBC berspektrum antibiotik kuat, menyebabkan kerusakan pada saluran pencernaan pada makroflora usus, penurunan penyerapan zat gizi, menurunnya respon imun tubuh yang disertai dengan penurunan status gizi dan nafsu makan penderita dan penyebab mual, muntah, diare, tidak nafsu makan, peningkatan suhu tubuh dan penurunan makroflora usus. 9 Pasien tuberculosis paru, mengalami penurunan status gizi disebabkan tingkat perilaku terhadap makanan dan kesehatan, khususnya kecukupan energi dan protein, lama menderita penyakit paru, serta pendapatan perkapita pasien. ...
Latar belakang : Penyakit tuberkulosis (TBC) paru merupakan masalah kesehatan masyarakat global termasuk Indonesia. Penyakit tuberkulosis paru pada umumnya terjadi malnutrisi akibat efek samping obat anti tuberculosis, yang menyebabkan gangguan saluran cerna dan respon imunitas. Probiotik dan Selenium diduga memiliki efek menguntungkan respon imunitas dan status gizi pada pasien terinfeksi tuberculosisTujuan : Untuk menganalisis pengaruh pemberian suplementasi probiotik dan selenium terhadap NLR ( Neutrophill Ratio Lymphocyte ), Hemoglobin dan Albumin pada tikus wistar yang diinduksi Mycobacterium tuberculosis.Metode : Penelitian eksperimen dengan rancangan Randomized Post test Control Group Design. Dua puluh delapan tikus Wistar dibagi 4 kelompok, kelompok 1 : kelompok kontrol hanya diberikan OAT, kelompok 2 : probiotik + OAT, kelompok 3 : selenium + OAT serta kelompok 4 : probiotik dan selenium + OAT. Setelah diinduksi 14 hari, hewan diberikan perlakuan selama 28 hari. Analisis data menggunakan Anova, Post Hoc atau Kruskal Wallis, Mann Whitney pada tingkat kemaknaan p<0.05. Hasil : Terjadi penurunan kadar NLR, peningkatan kadar Hemoglobin dan Albumin pada tikus kelompok 1 (p<0.05), kelompok 2 (p<0.05) serta kelompok 3 (p<0.05). Efektifitas pemberian probiotik dan selenium paling kuat terdapat pada NLR, Hemoglobin dan AlbuminSimpulan : Suplementasi probiotik dan selenium selama 28 hari mampu meningkatkan sistem imunitas ( NRL ), Hemoglobin dan Albumin pada kelompok perlakuan lebih baik dibanding kelompok kontrol.
The use of probiotics in modulating the gut microbiome to confer clinical benefits in various disease conditions is increasing. Probiotics are defined as “live microorganisms which when administered in adequate amounts confer a health benefit on the host.” The challenges in treating tuberculosis (TB) in the present era are the multidrug-resistant, extensively drug-resistant, and latent strains of TB; patient noncompliance resulting from anti-TB-related adverse effects; and undesirable treatment outcomes due to treatment discontinuation. The application of probiotics in TB is promising to combat these challenges. Preclinical study data have established the antimycobacterial characteristics of the probiotics by simulating the phagocytic action via release of antipathogenic substances. The mode of action of probiotics includes remodeling of the microbial ecosystem, which leads to inhibition of pathogens by adherence and production of antipathogenic byproducts such as bacteriocins and indole propionic acid. The additional mechanisms involve immunomodulation by balancing the proinflammatory and antiinflammatory mediators, promoting intestinal barrier function, and the biosynthesis of short-chain fatty acids, vitamin K and vitamin B. This chapter briefly discusses the gut-axis and its role in immune homeostasis, the role of the gut microbiome, and probiotics in tuberculosis prevention and treatment.
Objectives This study aims to determine the characteristics of Lactobacillus acidophilus and Lactobacillus reuteri from fermented soursop fruit juice and cow’s milk, respectively as probiotic candidate based on exposure to pH, bile salts, pathogenic bacteria, and antibiotics. Methods In vitro studies were conducted to examine the resistance of Lactobacillus acidophilus and Lactobacillus reuteri in pH 2, 2.5, 3.2, and 7.2, resistance to bile salts, resistance to pathogenic bacteria (Escherichia coli, Staphylococcus aureus and Enterococcus faecalis) and antituberculosis antibiotics. Results Viability of Lactobacillus acidophilus and Lactobacillus reuteri isolates remained unchanged (6.3 × 10 ⁷ CFU/mL and 5.03 × 10 ⁷ CFU/mL) at various acidic pH, and had a low survival rate in Ox gall 0.3% (bile salts). These isolates also showed antibacterial properties against pathogens in the gastrointestinal tract. Both of these bacteria are quite safe to be used together with ofloxacin, linezolid, moxifloxacin, and levofloxacin, antibiotic for tuberculosis therapy. Conclusions The results showed that Lactobacillus acidophilus and Lactobacillus reuteri from fermented soursop fruit juice and cow’s milk respectively fulfilled the characteristics of probiotic and could potentially be used as adjunct therapy in tuberculosis drug-resistance.
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The neutrophil-to-lymphocyte ratio (NLR) is a strong predictor of mortality in patients with colorectal, gastric, hepatocellular, pancreatic, and lung cancer. To date, the utility of NLR to predict mortality in breast cancer patients has not been studied. Therefore, the aim of our study was to determine whether the NLR is predictive of short- and long-term mortality in breast cancer patients. Our observational study used an unselected cohort of breast cancer patients treated at the Staten Island University Hospital between January 2004 and December 2006. A total of 316 patients had a differential leukocyte count recorded prior to chemotherapy. Survival status was retrieved from our cancer registry and Social Security death index. Survival analysis, stratified by NLR quartiles, was used to evaluate the predictive value of NLR. Patients in the highest NLR quartile (NLR > 3.3) had higher 1-year (16% vs 0%) and 5-year (44% vs 13%) mortality rates compared with those in the lowest quartile (NLR < 1.8) (P < .0001). Those in the highest NLR quartile were statistically significantly older and had more advanced stages of cancer. After adjusting for the factors affecting the mortality and/or NLR (using two multivariate models), NLR level > 3.3 remained an independent significant predictor of mortality in both models (hazard ratio 3.13, P = .01) (hazard ratio 4.09, P = .002). NLR is an independent predictor of short- and long-term mortality in breast cancer patients with NLR > 3.3. We suggest prospective studies to evaluate the NLR as a simple prognostic test for breast cancer.