Almost all cervical cancers (99.7%) are directly related to previous infection by one or more types of HPV (Human Papilloma Virus) that are oncogenic (Judson 1992; Walboomers et al, 1999). Infection occurs after active female sexual activity, usually begins after the age of adolescents (between the ages of 20-30 years) and progression to cervical cancer usually occurs after 10-20 years later, although in rare cases, some types of early lesions can be cancer in a short time within 1-2 years.

It is estimated about 10% of women infected with HPV will have pre-cancerous changes in cervical connective tissue (dysplasia) and 8% of women who undergo pre-cancerous changes will be early cancer confined to the outer layer cells of the cervix (CIS / Carcinoma In Situ), and about 20% of women who experienced CIS will develop into malignant cancer (invasive cancer) when pre-cancerous lesions or CIS are not detected and treated.

Which is a risk factor for cervical Cancer include:

1. Sexual activity (age<20 years)
2. Multiple sexual partners
3. Exposure to IMS
4. Mother or sister suffering from cervical cancer
5. An abnormal PAP test earlier
6. Decreased immunity, which caused suffering from HIV / AIDS or chronic use of corticosteroids (asthma and lupus).

Clinical Symptoms of Cervical Cancer at an early stage is much less pronounced, but the following signs can rely on in determining suspicion of cervical cancer:

1. Pain during intercourse,
2. Removing a little blood after intercourse,
3. Excessive bleeding during menstruation (hypermenorrhea),
4. Bleeding outside the menstrual cycle (Polymenorrhea),
5. Abnormal vaginal discharge (color is not clear, odor or itching),
6. At an advanced stage: no appetite, nausea, back pain, pain and swelling in the thigh, drastic weight loss, constipation, spontaneous bleeding after menopause, brittle bones easily and pelvic pain.

Prevention of cervical cancer can be divided into, as follows:

1. Primary prevention, carried out by administering a vaccine is the most effective way to prevent cervical cancer and other genital cancers. Each person needs to be immunized at an early age before they are sexually active. Control Risks is very important (especially the modifiable risk factor) in preventing the chances of developing cervical cancer (cervical cancer).
2. Secondary prevention, carried out by early detection of cervical precancerous lesions (as early as possible). Tests of cancer or pre-cancer is recommended for all women aged 30 to 50 years old through IVA test (Visual Inspection Acetic Acid). IVA test can be done at any time in the menstrual cycle, including during menstruation, during pregnancy and post-partum or post-abortion care. IVA test is very important for women who have a risk factor, especially in women suspected of exposure to STIs or HIV / AIDS.

IVA test can be performed in clinics that have the following facilities:

1. Desk Check
2. Sources of light / lamp
3. Bivalved speculum (Cusco or Graves)
4. Rack or container equipment.

The light must be strong enough so that the officer can see the end of the vagina where the cervix is. Examination can not be done if there is enough light to see the entire cervix. It is important also kept the light source are not too hot.

The materials required to perform the test IVA must be available on site, including:

1. Cotton swab sticks for
2. Check out new gloves or surgical gloves that have been in DTT
3. Spatula of wood and or condoms
4. The liquid solution of 3-5% Acetic Acid (white vinegar can be used)
5. 0.5% chlorine solution for decontamination of equipment and gloves
6. Notes form to record findings.

Acetic acid is the main ingredient of vinegar. It is recommended to use Acetic Acid with a concentration of 3-5%. Countries are caused no vinegar. Often sold in the market is a substitute for the real vinegar is acetic acid. If vinegar or acetic acid are not available pharmacist or local chemical supplier can dilute acetic acid solution using the formula:

Total Section (TB) Water = (% concentrate : % solution) – 1

Treatment and Follow-up, In most countries with limited resources, Cryotherapy either alone or combined with LEEP (performed at referral centers) is the best choice for outpatient care.

Advantages Cryotherapy:

1. Effective for small and medium sized lesions (85-95% cure rate)
2. Not expensive
3. Can be performed by personnel other than physicians
4. No need local anesthesia
5. No need of electricity
6. Few complications / side effects
7. It can be done during pregnancy.

Women who test positive IVA (SSK Acetowhite visible lesions), including women with pregnancies less than 20 weeks, should receive cryotherapy treatment, if the lesion:

1. Not suspected cancer
2. Cervical cover no more than 75%
3. Does not extend to the vaginal or cervical canal beyond cryoprob
4. Extends no more than 2 mm of diameter prob of cryotherapy including prob end.

If it does not meet the above criteria, the patient should be referred to a health facility is better able to do the inspection and action further therapy (chemotherapy, radiotherapy or surgery).

Cryotherapy can be done in a clinic that has the equipment and facilities as follows:

1. Examining table
2. Adequate light source
3. Speculum Duck (Cusco or Graves)
4. Tray or container equipment
5. Cryotherapy Unit
6. Supply of CO2 or NO2 regular.

In 2005 the CHMP Pharmacovigilance Working Party had conducted a review of benefits and risks associated ratio fibrates because of the limited evidence regarding the long-term benefits in reducing cardiovascular risk. CHMP Pharmacovigilance Working Party concluded that the fibrate class of drugs may continue to be used in the treatment of lipid disorders, but should not be used as first-line treatment.

Lately The European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) reviews the fibrate class of drugs because of the limited class of information security aspects of the use of fibrates in the long term. Be concluded that the fibrate class of drugs has a ratio of greater benefit than risk. But doctors should not prescribe fibrates as first-line treatment in patients newly diagnosed with blood lipid disorders, except in patients with severe hypertriglyceridemia or patients who can not use statins.

Review CHMP Pharmacovigilance Working Party on the new data are also merekomandasi fibrates can be used in conjunction with a statin if a statin alone is not strong enough to control blood lipid levels.

Meanwhile, a commonly reported side effects associated with the use of  fibrates class of drugs, such as: Digestive, gastric or intestinal disorders (such as abdominal pain, nausea, vomiting, diarrhea and flatulence); Skin Reactions (such as rash, pruritus, urticaria and photosensitivity / cutaneous photosensitivity with manifestations like as erythema, vesiculation or nodulation on parts of skin exposed to sunlight).

PPI drugs are indicated for the treatment of patients such as: Gastro Esophageal Reflux Disease (GERD), and Small Intestine Stomach ulcer and esophageal inflammation.

From the U.S. FDA Review of The Reports of Adverse Event Reporting System (AERS), Medical Literature and Periodic Safety Update Report (PSUR) for cases of hypomagnesemia in patients who are receiving an extension of PPI therapy, suggests that there is the possibility of increased risk of decreased levels of magnesium (hypomagnesemia) if the PPI is used in the long term. Hypomagnesemia has been reported in adult patients who received PPI at least 3 months and most occurred after 1 year had used PPI.

Hypomagnesemia cause symptoms of serious side effects in certain patients, such as muscle spasm, irregular heartbeat (arrhythmia) and convulsions (seizures), impaired parathyroid hormone secretion and hypocalcemia. The mechanism of occurrence of hypomagnesemia in the provision of long-term PPI is not known, but may be related to changes in intestinal absorption of magnesium.

Handling patients who are experiencing is generally hypomagnesemia with magnesium supplementation and cessation of PPI.

Suggested to the doctor to do a blood magnesium levels of patients at the time: Before the long-term PPI therapy, By periodically during treatment with PPI, what more if the PPI class of drugs given concurrently with diuretics (loop diuretics and thiazide diuretics), and digoxin.

Sources: POM Meso News Bulletin, Vol 29, No. 1, June 2011

Seminar begins with the Opening Ceremony, beginning with the Report of Chairman of the Committee, who said that the purpose of the seminar with the theme “Management of Medical Emergency” refers to: Improve or refresh your knowledge and skills for Medical and Paramedical personnel to be able to provide emergency relief to the action “Live Saving “in accordance with the norms and rules contained in the Professional Ethics / Medical Code Ethics, both at the task at government health institutions, private as well as in private practice.

Then proceed with the Speech from the Chairman of the IMA Region Bali as well as officially opening the event Seminar “Management of Medical Emergency” which suppresses the importance of each of the seminar shall include the materials on the Code of Medical Ethics as enlightenment to peer physicians in their profession.

Finish Opening Ceremony followed by a seminar event which is divided into 3 (three) sessions with 3 (three) speakers at each session plus one (1) Special Session with the Medical Code Ethics matter with the speaker of the IMA Region Bali (Prof. Suwitra).

Lung Tuberculosis

Pulmonary Tuberculosis (TB) is a  public health problem in the world, it is the third largest cause of death in Indonesia, and many suffered by productive working age groups and economically weak groups.

Pulmonary TB is a contagious disease, there are everywhere, can affect anyone, anytime. Causes of pulmonary TB disease is a germ / Mycobacterium tuberculosis bacillus is very small only visible with a tool microscope. The nature of the TB germ outside the human body in places which moist that it can live for many years. But it will quickly die when exposed to sunlight, exposed to fire or water boiling hot, exposed to soap, Lysol, carbolic acid or the like.

Symptoms or signs of pulmonary TB disease include: coughing long / continuous for more than 3 weeks (the primary), cough with phlegm or cough with bloody sputum; feel shortness of breath, pain or chest pain, heat or increased body temperature; lust food down and losing weight.

Transmission of tuberculosis disease can be directly, when the patient coughs or sneezes will be ejected spark / droplets inhaled into the lungs of others around it; can indirectly, where the patient coughs and phlegm throw a damp place, sputum containing bacilli / germ was dried and wind everywhere, and then inhaled by others.

Prevention of transmission of tuberculosis disease can be done in several ways:

1. BCG immunization since the newborn, can be obtained at health centers, neighborhood health center, midwife / doctor private practice.
2. Cover mouth and nose when coughing or sneezing.
3. Do not throw phlegm in any place, should a particular place, such as spittoons or cans filled with soap, or carbolic Lysol.
4. Keep the sunshine and fresh air can enter sufficiently into the bedroom.
5. Drying mattress and pillow, especially in the morning.
6. Patients who are undergoing treatment should diligently and regularly so as not to transmit more germs.

Treatment of tuberculosis with drug OAT (Anti-Tuberculosis Drugs) is packed in a drug program package consisting of: Rifampicin, INH, Pyrazynamid and Etahambutol, with or without Streptomicin. Given away for free in health centers or designated service facilities.

Pulmonary TB disease can be cured by treatment (no break) regularly for 6 (six) months.

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.