Imunology Revisi 2

Imunology approaches in older person
during covid pandemic & fasting ramadhan
Oleh:
DR. Dr. Binarwan Halim, M.Ked (OG), Sp.OG (K), FICS
Outline
 Immunology Covid-19
 Immunology in Elderly
 Immunology in Fasting
 Immunology in Elderly with Fasting
 Imunology approaches in older person

1. Immunology Covid-19 2. Immunology in Elderly 3. Immunology in Fasting
4. Immunology in Elderly with Fasting 5. Imunology approaches in older person
Kasus pertama Covid- 19 di Indonesia :

2 Maret 2020
The origins and intermediate hosts of

SARS-Cov-2, SARS-Cov, and MERS-CoV
Possible
Possible mechanism
mechanism ofof action
action of
of SARS-COV-2.
SARS-COV-2. Depiction
Depiction of
of the
the binding
binding of
of SARS-COV-2
SARS-COV-2 to to its
its receptor
receptor ACE-2.
ACE-2. The
The S1
S1 and
and S2
S2 subunits
subunits are
are subsequently
subsequently cleaved
cleaved
followed
followed by
by the
the shedding
shedding of
of ACE-2
ACE-2 by
by ADAM
ADAM 17.17. This
This resulting
resulting in
in an
an increased
increased amount
amount ofof Angiotensin
Angiotensin II II leading
leading to
to respiratory
respiratory distress.
distress. Upon
Upon binding,
binding, the
the virus
virus
fuses with the membrane and enters the cell, followed by translation, and replication of the proteins. ORF3a, ORF8b,E proteins and the NF-KB pathway
fuses with the membrane and enters the cell, followed by translation, and replication of the proteins. ORF3a, ORF8b,E proteins and the NF-KB pathway activates activates
the
the inflammasome
inflammasome pathway
pathway through
through various
various means,
means, leading
leading to
to the
the activation
activation of
of cytokine.
cytokine. This
This results
results in
in a
a cytokine
cytokine storm,
storm, further
further resulting
resulting in
in respiratory
respiratory distress.
distress.
Immune response of the host to coronavirus infection

Immune Senescence
 Definition
◦ Age related decline in immune system function.
◦ Increases body’s susceptibility to infection.
◦ Diminishes strength of immune response.
Physiological
Changes
Immunological
Psychological And Nutritional Sosial
Changes Status of the elderly Factors
Economic
Factors
The immune function changes seen in very healthy elderly individuals with no
other underlying causes are referred as primary ageing immune deficiency
Changes in Cell mediated immunity and T

Lymphocytes
Changes in B Lymphocytes
MAIN
Changes in Macrophages And NK Cells
CHANGES
Changes in Cytokines
Changes in Cell mediated immunity &

T Lymphocytes
> Immature T cells > Thymic function

> Memory T cells > Mature T lymphocytes
> Native T & Cytotoxic T cells
DECREASED
INCREASED
> Lyphocyte proliferation in

response to stimulation
> Functional ability of T cells
> Effectiveness of CD4+ Th cells &
CD8+ T suppressor cells
> Cell mediated immunity & DCH
responses
Changes in B Lymphocytes
> Plasma levels of IgA & IgG > IgM production
DECREASED
> Production of > Antibody response to
INCREASED
autoantibodies vaccines
> B-lymphocytes responses
unaltered
Changes in Macrophages And NK Cells
Function well preserved
Phagocytosis & lysosomal activity maintained
Macrocytes produce more prostaglandins & free radicles

Changes in Cytokines
> Th2 cytokine secretions > IL-2 secretion as young
COMPARABLE
> Production of interleukins adults
INCREASED
(IL-3, IL-4)
> During infections IL-1, IL-6
& TNF - secretions
increases
Transmission
Receptor ACE-2 ↑↑
Health Benefit Fasting

Reduced free-radical production
such as intermittent fasting  can be attributed to reduced

free-radical production
EVIDENCE :

can activate certain adaptive
cellular responses
- Improve glucose regulation
- Increase resistance to stress
- Suppress inflammatory reactions
EVIDENCE :

can activate different cellular
pathways
- which foster intrinsic defense mechanisms against
metabolic & oxidative stress  can lead to
removal of damaged cells & molecules
EVIDENCE :
Intermittent metabolic switching, neuroplasticity and brain health


can reduce stress & depression
- have positive impact on depression, anxiety

and stress and cognitive functions
EVIDENCE :
The effect of fasting on the

immune system.
CIC, circulating immune
complexes; CRP, C-reactive
protein; CXCL, chemokines;
iNOS, inducible nitricoxide
synthases.
Effect Depression
of Sleep Deprivation
Effect Depression of Sleep Deprivation

during fasting
Effects of sleep deprivation, :
- Changes Emotional state, Mood, Cognition &
Physical health
- immune functions ↓↓
Should Elderly Fasting?
Nothing solid evidence about the benefits or

how fasting might affect older adults
1. Immunology in Elderly 2. Immunology in Fasting 3. Immunology Covid-19
4. Immunology in Elderly with Fasting 5. Imunology approaches in older
person
Factors Contributing to High Risk of

Infection in Older Adults
 High prevalence of chronic conditions
 High rate of hospitalization and institutionalization
 Age-related changes
 Vaccine response decreased
person
Physiological Changes
Assosciated With Ageing
System Affected Physiological Change
Body structure A Decline in bone density can cause fractures and result in a
period of decreased physical activity and social interaction
GI tract Older adults have an increased risk of GERD, which can
affect swallowing and foods consumed. It might impair
digestion and absorption.
Mouth Missing teeth and deterioration of gums cans affect chewing
and swallowing and can reduce food intake
Neurologic Decline in cognition, steadiness, reactions, and coordination
can decline, potentially affecting food and beverage intake
Sensory Changes Taste perception (dysgeusia) or smell perception (hyposmia)
may be altered with aging and/or chronic disease
person
Problem of elderly in fasting

Choose food & in fasting can dehidration
Decreased appetite
In fasting can ↓↓↓ BB
Have a history of disease : DM, Hypertension, Cardiovaskuler,

Liver disorders, etc
In Fasting Ramadhan, many late of sleep /Insomnia  ↓ Immune

System
In Fasting Ramadhan , many religious ritual  stress ↓↓↓

person
Who is at high risk?
> 65 years old
People who have systemic and cardiovascular disease
People who need to take their medications with food
People who take heart or blood pressure medications
People who have diabetes and need food at certain times or take
medication
People who have systemic disheart

person
several different (sometimes contradictory) guidelines, fatwas have emerged .
the ultimate decision should be made by each individual person (according

to the fatwas) based on the recommendations of the physicians in charge.
person
Interventions to Strengthen
the Immune System
 Promote good general health.

 Assure immunizations are current.
 Encourage foods that have positive effect on immunity
 Teach stress management techniques.
 Encourage regular exercise.
 Adhere to strict infection prevention measures
 Stem cell a promising therapeutic methods
person
Promote general health in fasting

Regular health check
Proper hydration in non-fasting hours
humidification of indoor air
consumption of a balanced diet rich in fruits and vegetables
Avoiding dry and hot environments

person
Assure immunizations are current

PNEUMOCOCCAL POLYSACCHARIDE VACCINE  Once in a lifetime
INFLUENZA VACCINE  Annually
TETANUS AND DIPHTHERIA TOXOIDS  Every 10 years
If At Risk” Vaccinations
 Varicella
◦ Once
 Measles; mumps; rubella
◦ Once
person
Foods that have positive effect on immunity
Nutrition and Quality of life
Older adults are at risk for

inadequate dietary intakes
which may lead to :
- Healthy food - Poor nutritional status
choices positively - Decreased quality of life
influence quality of - Functional disability
life of older adults - Increased health care
costs
- Greater risk for
morbidity and mortality
person
Foods that have positive effect on immunity

Nutritional deficiencies in elderly
Micro nutrients
Inadequate
Both intakes & such as vitamin
intakes of
Nutritional plasma levels E, C, B6, Se and
macro
deficiency in of a wide Zn were
nutrients such
elderly is range of reported to be
as energy and
multinutrient vitamins and below two-
protein as well
deficiency minerals are thirds of
as of micro
lower recommended
nutrients.
levels
person
Stress Reduction Measures

 Progressive relaxation
 Meditation
 Prayer
 Yoga
 Exercise
 Diversional activity
person
Encourage regular exercise

Do moderate exercise :
 boost immune system
 ↓ in infectious disease risk
 ↑rates of vaccine efficacy
 improvements in both physical and psychosocial aspects of daily living
person
Strict infection prevention measures

person
Stem cell a promising therapeutic methods
to rejuvenate, stimulate the

indigenous immune system to
perform in a more optimal manner
person
Take a messages
 If it's not healthy, you should not fast
 Vaccines have not been found
 Health nutrition
 Do infection prevention
 Do the exercises
 Reduce stress
 Enough sleep
TERIMA KASIH

Imunology Revisi 2

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Imunology Revisi 2

Загружено:

Авторское право:

Доступные форматы

Imunology approaches in older person

during covid pandemic & fasting ramadhan

 Imunology approaches in older person

Kasus pertama Covid- 19 di Indonesia :

The origins and intermediate hosts of

Immune response of the host to coronavirus infection

Changes in Cell mediated immunity and T

Changes in Cell mediated immunity &

> Immature T cells > Thymic function

> Lyphocyte proliferation in

> Plasma levels of IgA & IgG > IgM production

Changes in Macrophages And NK Cells

Function well preserved

Phagocytosis & lysosomal activity maintained

Macrocytes produce more prostaglandins & free radicles

> Th2 cytokine secretions > IL-2 secretion as young

Health Benefit Fasting

such as intermittent fasting  can be attributed to reduced

Health Benefit Fasting

Health Benefit Fasting

Intermittent metabolic switching, neuroplasticity and brain health

Health Benefit Fasting

- have positive impact on depression, anxiety

The effect of fasting on the

Effect Depression of Sleep Deprivation

Should Elderly Fasting?

Nothing solid evidence about the benefits or

Factors Contributing to High Risk of

Problem of elderly in fasting

In fasting can ↓↓↓ BB

Have a history of disease : DM, Hypertension, Cardiovaskuler,

In Fasting Ramadhan, many late of sleep /Insomnia  ↓ Immune

In Fasting Ramadhan , many religious ritual  stress ↓↓↓

Who is at high risk?

> 65 years old

People who have systemic and cardiovascular disease

People who need to take their medications with food

People who take heart or blood pressure medications

People who have systemic disheart

several different (sometimes contradictory) guidelines, fatwas have emerged .

the ultimate decision should be made by each individual person (according

 Promote good general health.

Promote general health in fasting

Proper hydration in non-fasting hours

humidification of indoor air

consumption of a balanced diet rich in fruits and vegetables

Avoiding dry and hot environments

Assure immunizations are current

INFLUENZA VACCINE  Annually

TETANUS AND DIPHTHERIA TOXOIDS  Every 10 years

Foods that have positive effect on immunity

Nutrition and Quality of life

Older adults are at risk for

Foods that have positive effect on immunity

Stress Reduction Measures

Encourage regular exercise

Strict infection prevention measures

Stem cell a promising therapeutic methods

to rejuvenate, stimulate the

Вам также может понравиться