Feverfew, Plants that have a similar smell of lemon is an anti-inflammatory and works like ibuprofen. A plant shrub of Asteraceae family is very popular as an herb to overcome migraine. In addition, this herb is also believed to inhibit the chemicals cause the blood vessel tension in the head. One study found that 2 / 3 of migraine patients cured after using regular feverfew. To ensure the security level and determine the proper dose, it is better to consult first with your doctor.

Ginko biloba,  Ginko biloba leaves is a popular herb to relieve headaches. This herb can accelerate blood flow, making it suitable for headaches triggered by a circulatory disorder. Several studies conducted by French researchers found, in effective herbs alleviate vascular headaches (migraines, headaches chain, and headaches due to drinking). One study even mentions that if Ginko can reduce migraines by 80%. But, this herb can cause side effects when used with drugs such as aspirin headache and lithium. Therefore, there should first consult with your doctor.

Peppermint, This single herb has been used for hundreds of years to cope with headaches. All parts of this plant, starting from the content of oil, flavonoids, phenolic acids, and triterpenes can be used as a drug. The first study about the benefits of peppermint published in 1879. This publication is supported by the subsequent discovery in Germany in 1996. This study found, the liquid containing ethanol 10% peppermint oil was as effective as 1000 milligrams of acetaminophen in relieving headaches. Another study found that 32 participants who rub peppermint oil on the crown of pain reduction experienced significant.  Try rubbing or massaging the peppermint oil to the fontanel, down to the forehead, and into the back of the neck. This was declared effective way relieve headaches due to indigestion and migraines caused by the cold effect on the skin and relaxing cranial muscles. In addition, you can also use peppermint tea to relieve migraines. Way, pour one cup of boiling water into a container that contains 1-2 teaspoons of dried peppermint leaves, then cover and let stand for 10 minutes. Strain the mixture before drinking. To relieve a migraine, drink 1-2 cups of cold peppermint tea every day.

Passionflowers, this single herb is soothing. Passionflowers tea consumed before bedtime can help you get to sleep more soundly. One clinical trial found that this herb can reduce anxiety levels. In addition, passionflowers also believed to contain anti-inflammatory and pain relievers, so it is very good for migraines. The recommended dose of it is 4-8 grams of dried herb 3 times a day. To make tea, you can make some passionflowers to 0.5-2.5 grams in boiling water for 15 minutes and drink 2-3 times a day.

Red pepper, Red chilies contain capsaicin component, which is believed to increase endurance to pain. Red chili declared effective chain relieve headaches (cluster headaches), and commonly used in the form of a nasal spray (nasal spray). A study asked participants to rub medicine containing capsaicin on the inside and outside of the nose to find if patients experiencing 75% reduction in pain and headache frequency, within 5 days.

Chamomile, This herb contains anti-inflammatory and painkilling components that can help ease the emotional tension. Therefore, this herb is suitable for help due to tension headaches. Chamomile can be found in a brewed tea prepared.

Salt, is the key to display a random hair like a girl sexy beach is a bit stiff hair. Salt makes dry your hair looks fuller, too sexy. To make yourself at home, mix one teaspoon of salt in 118 ml of water in a spray bottle. After washing and gives the hair conditioner, salt water sprays into the hair and let it dry to give the impression of the beach girls.

Baking soda, if your hair was drenched from products that make hair soft and sticky as it will not disappear, just use baking soda. Generally, you will be advised to wash with shampoo Clarifying, but baking soda is also good to remove oil in the scalp. Simply mix a little baking soda to the shampoo in the palm of your hand when going to wash. Then, wash gently and rinse.

Aloe vera and eucalyptus, are plants that refreshing and balancing oil in the scalp. Mix aloe vera sap, eucalyptus oil, and astringent, applied directly to the scalp. Scalp massage, then rinse after 30 minutes wrapped.

Apple vinegar and lemon, if your oily scalp, why not use a natural astringent apple vinegar and lemon. Way, mix ¼ cup balsamic vinegar with a squeeze of lemon. For more powerful, also enter the lemon zest into the mixture, and let stand for 10 minutes. Strain and discard the lemon peel before, then enter lavender ½ teaspoon and ½ teaspoon lemon essential oil. Apply on the scalp, and massage. Let stand for 20 minutes, rinse, continue with the shampoo and conditioner.

Eggplant, is a fact that eggplant not only can be used for food. Eggplant contains an enzyme that stimulates hair follicles without causing irritation. The hair will look more radiant and healthy. It’s Way: cut the eggplant and massage directly into the scalp, let stand a few moments, then shampoo as usual.

There are several ways to improve the treatment of dental conditions, ranging from the use of teeth whitener, teeth cleaning and the use of coral braces.

The use of teeth whitener, teeth whitening is not part of routine maintenance, but for aesthetic reasons. To note that the white color produced by tooth whitening is not permanent. Also dental fillings and false teeth could not bleached with bleach teeth. American Dental Association teeth whitener divides into two, namely: first, bleach contains peroxide, which washes away the stain on the surface and the inside of the teeth; second is whitening toothpaste, which only washes away the stain on the surface of the tooth.

If you want to whiten your teeth, you should first consult with your dentist. Dentists need to look at problems that occur on the teeth. Is due to the stain, or black teeth due to the hole.  Or are there other causes. In addition can be done in the doctor’s surgery, we can live at home tooth whitening. However, the results achieved with the help of doctors would be more effective.

Cleaning tartar, tartar can also interfere with the beauty of your teeth. Thus, we should clean it regularly, every 6 months to 1 year. If not cleaned of plaque and tartar can cause gingivitis, or bleeding gums so often and swollen. Left untreated, this disorder can become periodontitis, namely damage to the alveolar bone around the teeth. This is what will make our teeth into rock, which eventually must be removed.

Use of braces, tooth position is not good, and the neat arrangement could not be improved with the use of braces. If we feel confident with the obvious wire when used, there are some better choices. For example, transparent colored braces, or mounted on the inside of the teeth, or Invisalign is made with special technology, so as not to be seen, very clear, and comfortable. Invisalign can only be done by a certified dentist.

Treatment with braces lasted between 1-2 years, depending on the case. Do not forget to wear your retainer or retaining teeth after the treatment, so that the teeth arrangements do not change again.

Peak growth occurs in the skin-an age of 20. At this time, all the skin components, such as epidermal, collagen, elastic tissue, blood vessel and grow so that the maximum skin texture looks fresh reddish color. The main problem in the haunt is usually only about oily and pimply skin caused by hormonal factors or treatments that are less precise. Perform light maintenance and regular every day, always clean the face with a cleanser that does not contain alcohol. Use a moisturizer that contains SPF 15 or higher, especially if you include women who are often active outside the room in a long time. Smear it 20 minutes prior to outdoor. Smear eye gel every night before bed. Enter also fruits, vegetables, and white water in your food menu. Contents the fiber and vitamins in fruits and vegetables help the process of natural regeneration of skin, while the white water is able to accelerate the expenditure toxic and superfluous fat in the body that causes a pustule. Conducting regular facial is a treatment that can be done as a precaution aging early. If your skin is not problematic with the pimple, this ritual is done once a month. For skin problems, facial do it two weeks. Elections cosmetics at the age of this can be more varied, different colors can be tested trappings. If it is not necessary, avoid the use of foundation and concealer too often. If necessary, use a water based (water based) in order to feel more light. Use foundation cause pore-pore clog so that drive the emergence whelk. As an alternative, just and mild moisturizer Lubricate spreading powder by pressed using the press-Puff. Select colors or transparent skin for the trappings that face look more fresh and shining.

Start age 30, signs aging already started happening. The process to get peeled of dead skin starts slowed, decreased collagen and elastic tissue, and the bag began to appear. In addition, the color uneven start, the skin feels drier and relief lines strung on the tip of the eyes and lips. This is because the main cause is hormone changes. Entering this age, you have to be more selective in choosing products and trappings face. Do all the daily care that you have with get more intensive again. Replace light products you normally use with the type of strength is more useful to avoid aging early. Do not forget always clean the face with a product that does not contain alcohol. Use a moisturizer for day and night on a regular basis (moisturizer contains anti screen of the afternoon sun, and night moisturizer that contains anti-aging to help skin regeneration).
Smear eye cream to moisten the eye so that the bag does not easily wrinkled or loose. Can try collagen facial twice a month in order to take optimal skin regeneration, or use a mask that serves to secure and maintain skin moisture. You can also try home Peeling (used in the home) for thin stains brown melanin as a result of damage to UV rays. Select a favorite sport and do you regularly 2-3 times a week. To trappings, do tricks face correction. Example: to disguise the black stain or fine wrinkling and eye bags that cover the visible start, smear the concealer thin and thin. Choose natural or pastel colors to appear natural. Use a little eyeliner, eye shadow, eyebrow pencil, and are highly recommended so that the face looks fresher. Next, the frame is thin lips with a pencil-thin in order to disguise the fine wrinkling around to appear on the lips, and then smear lipstick evenly on the lip.

Hyperhidrosis (excessive sweating) that occur in general (the entire body) can be a clinical manifestation that can be found in some particular heart disease, but hyperhidrosis local (and only in the hands or feet) non-specific clinical manifestation of heart disease and tuberculosis. Hyperhidrosis happens in general is not a sign of heart disease and or tuberculosis, because often only a clinical manifestation is the companion, not a major clinical manifestation. Complaints that often be found in patients with heart disease or tuberculosis is shortness of breath (difficulty breathing) and chest pain. So, if only occur excessive sweating in both hands and both feet without complaint of shortness of breath, heart pulse, chest pain, coughing, or other complaints, it’s sign is not because of heart disease or tuberculosis.

The problems in facing this Swine Flu are:

• This virus can attack human,
• If a person suffers Swine Flu, the symptoms fast come to deteriorate.
• High death rate,
• It’s transmission very fast,
• It can spread wide world and global,
• It be transmitted by animal (swine) where it nearest with human life,
• So it difficult to be prevented,

Incubation period of Swine Flu disease is 1 - 7 days, with clinical signs like common cold symptoms with clinical manifestation:

• Higher fever,
• Sore throat
• Body pain,
• Headache,
• Weak,
• Quickly breathing / breathing disorder,
• Vomit,
• Diarhea.

Swine Flu transmission same like the transmission which happened on seasonally:

• It can transmit from human to human pass through of cough and sneeze,
• Spreading of it happens by material contact or anything that is infected by H1N1 virus.

Terminology that be related in framework of vigilance and tackling effort of Swine Flu Infection:

• That be proposed of contact is treat, live together in a home or direct relating with breathing secret or body fluid from probable case or confirms swine flu H1N1 / Flu Mexico.
• That be proposed of transmission area is area or state that it has one or more confirm cases which be established by WHO.
• Be related to list of state or area transmission until on April 29, 2009 are Mexico, USA (California, Texas, New York, Kansas and Ohio), Canada, New Zealand, United Kingdom, Israel and Spain.

Steps in anticipation framework and prevention:

• Keep on guard against of all cases with influenza sign (Influenza like Illness) and immediately investigate the contact history with animal (swine) and or contact with peoples whose new come from the country which being infected by Swine Flu.
• Increase surveillance activity toward Influenza like Illness and pneumonia, so report the case with swine flu suspect to regency health department.
• Increase coordination with move across of program and sector, so information spreading be related with transmission of swine flu disease.
• Community education about Life behavior with clean and healthy lifestyle like as wash hand with detergent antiseptic, so application of cough and sneeze ethics with close nose and mouth by handkerchief or Kleenex. Use self protection tool if present in transmission area of swine flu.

Therapy of swine flu with giving Oseltamivir, with distribution dose as below:

• For adult and children > 13 years; twice 75 mg per day during 5 days,
• For children < 1 year; 2 mg/kg Body Weight, twice a day during 5 days,

Dose of Oseltamivir can be given agree with body weight as below:

• < 15 kg: 30 mg, twice a day;
• > 15 - 23 kg: 45 mg, twice a day;
• > 23 - 40 kg: 60 mg, twice a day;
• > 40 kg: 75 mg, twice a day.

Mechanism of diabetic foot very complex and seldom be effected by single pathology. Generally it’s constituted of two or more interaction cause of. Peripheral neuropathy, peripheral arterial disease, and other risk factor like as foot deformity, joint mobility disorder, micro vascular complication, long diabetes, increasing the pressure of sole of foot, peripheral edema, infection, and foot ulcer or amputation constitute the important factors of diabetic foot incidence.

By generally, management of diabetic foot case is focused on blood sugar control and therapy of other risk factors. By locally, wound care till to amputate may be done be hanged of severity of diabetic foot. Infection that constitute main problem on diabetic foot so must be cured. Wound infection must be diagnosed in accordance with clinic grounded on finding local inflammatory signs. If be needed like as on osteomyelitis maybe need laboratory examination (include of micro biologic examination). Usually, treatment of diabetic foot is hospitalized and need multidiscipline team. If be needed so participating the specialist of infection disease or medic microbiologist. To treat diabetic foot infection case is needed comprehension cause of microbiologic. One or two microbes indeed poly microbial often mixed up with on diabetic foot infection. Generally on mild diabetic foot infection case is caused by Gram-positive microbe. More than half of infection is caused by Staphylococcus aurous or coagulate-negative Staphylococcus. Staphylococci cause about a third of all cause of which on generally constitute part of poly microbial infection. Gram-negative aerobe and anaerobe microbe are seldom as cause of infection. On moderate infection, Gram-positive microbe still dominant included of Staphylococcus and Streptococcus. However so, percentages of Gram-negative aerobe microbe infection become increasingly large, especially Pseudomonas aerugenosa and Proteus mirabilis. On diabetic foot with severe infection generally is caused by poly microbial.

Broad spectrum antibiotic oral either or parenteral can be used appropriate with degree of infection and grounded on microbe cause of. Many kind of antibiotic that effective be used for various degree of diabetic foot and kind of microbe have been published by Lipsky et al (table 1) and Edmiston et al. Beside that standard therapy, using granulocyte colony-stimulating factor as addition therapy can reduce amputation rate and other surgery measure.

Table 1. Suggested empirical antibiotic regimens, based on clinical severity, for diabetic foot infections.

Definitive regimens should consider results of culture and susceptibility tests, as well as the clinical response to the empirical regimen. Similar agent of the same drug class may be substituted.

]]> http://azygosmc.com/diabetic-foot-infection-and-antibiotic-of-choice.html/feed http://azygosmc.com/clinical-symptoms-and-managements-of-rabies.html http://azygosmc.com/clinical-symptoms-and-managements-of-rabies.html#comments Wed, 03 Jun 2009 14:40:52 +0000 admin http://azygosmc.com/?p=245 Rabies is a communicable disease that deaden for it’s suffer which it be caused by RNA virus that can be grouped in Rhabdoviridae family. This disease always has a fatal consequence i.e. death for sufferer who has been contacted   by infection and don’t get vaccination. Rabies has spread in all of world particularly in the developing states.

Rabies or crazy dog disease is a zoonosis disease which most important in Indonesia because of: widely of rabies area in Indonesia, the more of animal biting cases with rabies suspected, the character of crazy dog disease on human or animal that always be finished by death. Rabies constitutes a disease that appearing the significant health problem in Asia, where occur death rate hundreds until thousands per year.  Rabies has highest case fatality rate of all infection diseases that are present. Rabies virus can infect all hot bleed animal, so human and bird. Spreading a big party is happened by animal bite from many types of reservoir animal like as: god, cat, wolf, cave bat and others. So it can spread accordance with aerosol particularly on many types of cave bat in America. In America and Canada tackling of Rabies cause problem and heavy economic burden where the governments of those states spend average of 20, 5 million dollars every year. Dog is as the main reservoir of rabies in Asia with 94 - 98% of death is caused by dog bite, highest of bite being present in Bangladesh, India and Pakistan.

Rabies be known as strategic animal disease which has high externality, its mean has impact widely loss and with characteristic spreading, spread by fast with high morbidity and high mortality along with has potential to threaten of public health. Restraint and eradication of communicable animal disease which zoonosis characteristic get priority because be seen as part of protection anticipation toward of public health.

Rabies disease be caused by rabies virus that in classification be included on group V negative-strand RNA genome, order of: mononegalovirales, family of: rhabdoviridae, genus of: lyssavirus, species of: rabies virus. The measure of this virus around of long: 180 nm and width 75 nm which be arranged by five types of proteins i.e.: nucleoprotein (N), Phospoprotein (P), matrices protein (M), glycoprotein (G), and polymerase (L). Generally Rhabdoviridae consist of two basic components: rhibonucleoprotein (RNP) on center part and be covered by envelope on outer part. RNP be shaped by nucleoprotein and be coupled by phopoprotein and polymerase (L-protein). Whereas glycoprotein shape the spike on outer surface area (envelope/membrane) and virus with long of around 10 nm with function as main antigen that it inducted and bind up of neutralizing viral antibody, it very important for immune system. Whereas envelope with RNP be coupled with matrices protein (M). The genome of rabies virus is single chain, antisense; none segmented RNA with long around of 12 kb.

Replication of virus in host cell be begun by fusion of envelope with membrane cell host, and then occur absorption interaction between glycoprotein with specific receptor of cell host surface be followed by penetration of virus to cytoplasm with endocytosis mechanism. Occur virion aggregation with vesicle on cytoplasm (endosome) and then viral membrane will fusion with endosome membrane with consequence RNP virus free moving into cytoplasm (un coating). Because this virus has single and linier RNA genome, then be needed mRNA (messenger RNA) to record in order virus has replication. This recording will be followed by printing process of protein accordance with ordering that had be recorded a while ago on free ribosome in cytoplasm cell (translation). This process will be completed on endoplasm reticulum and Golgi body. After that occurs process of duplication of virus.

PATHOGENESIS

Rabies virus has characteristic very neurotropic, Rabies virus go in the body pass through wound of animal bite spreader of rabies or direct contact with mucosa membrane. Virus cannot go in pass through intact skin. Glycoprotein of virus will bundle with nicotinic receptor (acethycholine receptor) on nerve cell surface. Virus will duplicate itself in inoculation place, spread in accordance with centripetal pass through motorist and sensoric nerve cell go to central nerve system with speed 50 - 100 mm/day and infect brain stem, diencephalon and hippocampus. Spreading pass through lumbar segment of medulla spinals and transportation to brain use nerve circuit which long be included of rubrospinale, corticospinale, spino-olivary, vestibulospinale, spinoreticular, spinocelebelum, and columna dorsal circuit. After arrive to central nerve system the virus will spread accordance with centrifuge go to multiple organs pass through somatic and autonomic nerve arrangement particularly engage parasymphatic strip which responsible toward infection on saliva gland, cornea, skin, heart, pancreas, medulla adrenal and other organ. Viral infection can appear the infiltrate and necrosis of cellular.

Sensitivity toward infection and incubation period be depended of genetic background, virus strain that mixed up with, viral receptor concentration, amount of inoculums, severe of laceration, and distance that be passed through by virus to spread to central nerve system. The symptoms faster appear and incubation period shorter if bite location on face or head.

CLINICAL SYMPTOMS

Incubation period in generally between 30-90 days, but it has variation from 4 days until some years. It depends of location of bite.

Early sign of rabies infection: itchiness and pain on area of wound or bite trace, fever, tremble, weakness, faster in feeling tired, headache, muscle pain, anxiety, depression, nervous, symptom of respiration nerve disorder or symptom of digestive nerve disorder, and after some days will appear acute neurologist symptoms manifestation.

Acute neurologist symptoms: be differenced of encephalitis rabies or furious rabies and paralytic rabies or dumb rabies depends of where organ dominant be infected, brain or medulla spinal. Encephalitis is constitute a symptom that often be found on rabies sufferer about 80%. Sufferer show hyper excitability episode which reflect of brain infection imaging, be signed by confusion episode, hallucination, agitation and aggressive behavior going on some minutes be followed by quiet phase. Hyper excitability symptom occurs spontaneously or appears by sensory irritation provocation (auditory, visual, and olfactory). A big part of sufferer show hydrophobic symptom with trias: inspiration muscle spasm, larynx spasm, and swallow anxiety.

Paralytic Rabies be found about 20% cases, be signed by paralyzed more particularly, shaped as pareses of all extremities and with sphincter anus disorder. The symptoms that appear some time resemble Guillain Barre Syndrome. Some cases be followed by hydrophobic and spasm of larynx muscle on terminal phase.

Coma, without supportive therapy 1/3 cases of rabies will pass away at the first day hydrophobic, 2/3 cases of rabies will fall in coma with or without paralysis and seldom be present hold out longer than one week without intensive care.

DIAGNOSIS

Diagnosis of rabies is building on clinical signs very difficult except be found specific clinical signs i.e. hydrophobic and be present of dog bite wound history. According to clinical experts the classical sign of involvement of brain on this disease are spasm on tactile responds, visual or stimulation olfactory after with full conscious period, agitation, confused, and signs of autonomic dysfunction. Definite diagnosis of rabies only is found by laboratory examination.

Fluorescent Antibody (FA) technique is a sensitive method to diagnostic rabies on animal and human. FA technique is constitute god standard to diagnostic rabies, but the accuracy of this test be depended of examination experience of anti rabies conjugate quality, and fluorescent microscope that be used. Nuclei cap side detection by ELISA has been used by some laboratory, this test fast and can be used on epidemic survey, but until this time that test are no provided commercially yet.

Antigen detection, viral antigen can be detected through skin biopsy which content hair follicle and nerve tissue, usually sample be taken in nape of neck, and require at least 20 samples to detect the rabies nucleocapside, this method is very sensitive but cannot be used in all situation because its require crysostat to make the frozen section. Antibody detection using serum or cerebrospinal fluid is not always giving positive result because the new antibody is formed on the eighth after the clinical symptoms appear.

Virus isolation: using the cells neuroblastome from saliva, tears and cerebrospinal fluid. The success of this method depends upon the representative sampling, antibody status and attachment of the virus on the receptor.

MANAGEMENT

The management of rabies therapy to human is not satisfied, especially if the disease has shown it symptoms. Until now, there is no case report which is the patient can survive after the disease manifestation manifest. Lots of therapy test done, but no one showing a good result. Antiviral or interferon (IFN) therapy that used in single or combination therapy is not fare well yet. Jackson et.al, 2003 recommending the rabies management of early symptom with combination therapy as following: rabies vaccine intradermisly to accelerate the immune respond; rabies immunoglobulin to stop the infection process; ribavirin and alpha-interferon intravenously and intraventricularly. High concentration of Ketamin given intravenously is proven in vitro can inhibit the virus replication. This regiment is still in controversion and requires further verifications because those combination therapies not give satisfaction result after tested in some other country. Wilde H,et al (2008) recommending that it need further researches based on pathogenesis to find effective therapy to rabies patient. Usage of steroid is not recommended in rabies case because in some cases, steroid can accelerate dead and shorten the incubation period. Symptomatic treatment to relieve patient complains can be done by using sedative, narcotic analgesic, anti convulsion and neuromuscular blocker.

The care should be done in isolation room. And to prevent infection from the patient, the doctor and staff should use gloves, goggle and mask when handle this case and the patient fixated in bed. Remember of the end condition of this disease is death as consequence of breathing muscle paralysis so  then be considered using breathing help tool.

Rabies disease can be prevented by immunization. If we find the present case of bite animal suspected of rabies then be done efforts to kill or reduce virus rabies by wash the bite wound by water flow and soap or detergent during 10-15 minutes and next be given antiseptic. The wound of animal bite is not righted to be sewn, except situation sewing. If it needs to be sewn, the wound should be infiltrated by ARS (Anti Rabies serum). Along with be considered giving anti tetanus, antibiotic and analgesic. Giving immunization to prevent rabies is done by two methods i.e.: after contact immunization and before contact immunization.

Therapy after be infected by virus rabies can be done by giving vaccine anti rabies (VAR) only or the SAR. VAR be given if present animal bite with wound which is not dangerous (laceration, excoriation) around of hand or foot. And then giving VAR with SAR if occur animal bite with dangerous wound, wound on mucosa tissues, wound above of shoulder (face, head, neck), wound on arm area, leg, genital, deep wound or multiple wound of animal bite.

Giving Vaccine Anti Rabies (VAR) procedure as below:

Purified Vero Rabies Vaccine (PVRV), be given post exposure Treatment, constitute frozen dry vaccine, formed as virus rabies (Wistar RaBIES PM/WI 38-1503 M Strain). Recommended dosage on adult same with children i.e.: at the first visiting be given two dosages each with 0, 5 ml on deltoid right and left. At the seven days more be given 0, 5 ml intramuscular of deltoid. The same dosage more be repeated at the twenty one days. If it wants to give with the Serum Anti Rabies (SAR) then the giving of anti rabies is repeated on the ninety days, with dosage 0, 5 ml.

Giving Serum Anti Rabies (SAR) procedure as below:

Heterolog serum:

This serum is created from horse serum, before injection be done skin test early. Injection is done by infiltration on wound more and more, and remaining be injected accordance with intramuscular. Extending dose is 40 IU/kg body weight or be given by similar with extending of VAR the first day visit.

Homolog serum:

This serum is created from human blood serum. Injection is done by infiltration on wound more and more, and remaining be injected accordance with intramuscular. Extending dose is 20 IU/kg body weight or be given by similar with extending of VAR the 1^st day visit.

If   we want to do prevention of rabies infection before be bitten could be done vaccination with PVRV. Giving by intramuscular on deltoid area 0, 5 ml at 1^st day visit, be continued 0, 5 ml at 28^th day is followed with revaccination one year after 1^st giving by the same dosage. Be given back every 3 years. This prevention particularly is indicated for community with high risk like as for peoples whose work on research center of rabies, domesticated animal doctor, breeder, employee zoo, and employee forestry.

]]> http://azygosmc.com/clinical-symptoms-and-managements-of-rabies.html/feed http://azygosmc.com/high-risk-behavior-and-spreading-style-of-hiv-aids.html http://azygosmc.com/high-risk-behavior-and-spreading-style-of-hiv-aids.html#comments Fri, 17 Apr 2009 11:39:52 +0000 admin http://azygosmc.com/?p=207 AIDS (Acquired Immunodeficiency Syndrome) is constituting a spectrum manifestation of  disease which range from without symptom until deadly; be signed by severe immune deficiency, opportunistic infection, and cancer; appear on people who do not get immune suppressive therapy without other immune suppressive disease. AIDS be caused by HIV-1 virus and HIV-2 virus. These retroviruses caused progressive loss  of cell T helper (so be known as T4 lymphocyte or CD4+ lymphocyte) until it can cause progressive loss of immune competency  and opportunistic infection next time.

HIV can spread pass through exchange of infected body fluid i.e. blood and semen. The behavior of people with high risk of HIV infection i.e.:

• Sexual intercourse without using protection with many sexual partner, partner with high risk (sex commercial worker, intravenous drug user), or infected partner.
• Intravenous drug user, barter sexual intercourse with drug.
• New born baby from mother who suffer HIV/AIDS. It can spread pass through placenta, blood of mother, vagina fluid, fetal membrane water, so it can pass through breast milk.

Perinatal spreading rate in uteri, in delivery,  or pass through breast milk giving is between 15 until 30%. Risk factor i.e.: continuous status of  mother’s disease. Low of  mother’s cell CD4+ account. Baby is contaminated of mother’s blood, fetal membrane broken longer, vitamin A deficiency on mother, and increasing of HIV quantity in mother’s blood while in delivery.

Breast milk giving is not suggested on mother with serum positive HIV. No evidence that engage insect vector in spreading of HIV/AIDS, so if live with a person who is infected by HIV.

]]> http://azygosmc.com/high-risk-behavior-and-spreading-style-of-hiv-aids.html/feed http://azygosmc.com/vertigo-complaint.html http://azygosmc.com/vertigo-complaint.html#comments Sun, 15 Mar 2009 12:26:46 +0000 admin http://azygosmc.com/?p=187

Vertigo is constitute the subjective complaint which it often require a patient come to find physician helping quickly. Vertigo is an illusion where a person who suffer it is feeling his body move toward his environment or otherwise.  According to Oosterveld, be found about 100 kinds of diseases can give vertigo symptom.

Physio anatomic, human body balance system including of three systems i.e. Vestibular system, Visual system, and Proprioseptive. All of these three systems collaborate to regulate human equilibrium. If happen disorder on one of all systems, so the vertigo complaint will appear.

There are some theories of phato-physiology  happening of vertigo, but which more be followed are neural mismatch / sensory rearrangement theory and sinaps theory. Neural mismatch theory is spoken by Reason that vertigo complaint appear because occur mismatching of movement experience which be saved in brain with movement that is going on. That case be happened as consequence of disorder on system which is watching body equilibrium. That mismatching stimulation with existed pattern will stimulate over brain activity included autonomous nerve system, then appear vertigo symptom be followed queasy, vomit and cold perspiration. After that will occur rearrangement of movement pattern which is going on ( sensory rearrangement ) until occur adaptation and vertigo will stopped.

Accordance with the second theory i.e. Sinaps theory, symptom of vertigo appear be begun by release of corticotrophin releasing factor/hormone ( CRF/CRH ) of hypothalamus consequence of physical stimulation ( movement ), organic disorder or psychic ( stress ). Raising of CRF will stimulate sympathetic nerve system on coeruleus locus, hypo campus, brain cortex, hypophyse, and lymphocyte cell. That other so happened release of neurotransmitter like as glutamate, histamine, acethylcholin and noradrenalin.

In facing a patient with vertigo sign be needed investigation carefully including of patient complaint and comprehensive physical examination to establish the kind of vertigo and location of lesion, so to determine of etiology and therapy. Vertigo be differentiated became two kinds i.e. :  Vertigo vestibular and Vertigo non vestibular. Vertigo vestibular is vertigo which appear as consequence of disorder on vestibular system, and Vertigo non vestibular is vertigo which appear as consequence of disorder on visual and proprioceptive systems. Clinical manifestation of Vertigo vestibular :

• Vertigo characteristic like rotate.
• Attack characteristic episodic.
• Be followed autonomic symptom and tinnitus.
• Be sparked by head movement.

Vertigo vestibular be divided became two types i.e. : periphery ( on labyrinth or vestibular nerve ) and central ( on brain stem until to brain cortex ). In a clinical manner on vertigo vestibular periphery type vertigo complaint more severe, autonomic sign more severe, very be influenced by head movement and sometime be found tinnitus. But on vertigo vestibular central type showing the symptoms milder and there is not tinnitus, however be found presence of neurologist deficit.

The clinical symptoms of vertigo non vestibular are as below :

• Fly sensation with characteristic continuously.
• Without autonomic sign.
• It did not be influenced by change of position.
• The Complaint increasingly severe if be in noisy place.

As the etiology of vertigo vestibular type periphery are Benign Paroxysmal Positional Vertigo, Meneire’s disease, neuritis vestibular, labyrinth infection,  traumatic, and tumor of N.VIII. Whereas the etiology of vertigo vestibular type central are cerebrovascular disease, traumatic, tumor, epilepsy, degenerative disease, demyelinisation disease, para neoplastic syndrome and migraine vestibular.

Physical investigation that need be done including of vital sign, general physical examination, and complete neurological examination. Supporting investigation be depended of the etiology of vertigo, Some of it are as below:

• Laboratories : complete blood check, profile lipid, uric acid, and complete homeostatic.
• Cervical photo, CT Scan, Arteriography.
• Neurophysiology : EEG, EMG.
• Calorie Test, Audiometri.

The principal therapy on vertigo cases include of causal therapy, symptomatic therapy, and rehabilitative (vestibular exercise). Anti vertigo medicine that more be used i.e. :

• Antihistamine groups : Sinarisin, prometazine, difenhidinat.
• Ca-channel blocker group : Flunarisin.
• Phenotiazine groups : prokloperazine, Chlorpromazine.
• Histamine group : betahistin.

In choice anti vertigo medicine better be prioritized on medicine  with minimally side effect.

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