Rheumatic Heart Disease Treatment

 

Rheumatic Heart Disease  or in medical language rheumatic Heart Disease is a condition where there is damage to heart valves that can be a narrowing or leakage, particularly mitral valve (mitral valve stenosis) as a result of residual symptoms of Rheumatic Fever.

Rheumatic fever is a systemic disease that can be acute, subacute, chronic, or fulminant, and can occur after infection hemolyticus beta Streptococcus group A in the upper respiratory tract. Acute rheumatic fever is characterized by prolonged fever, heart pounding, sometimes quickly tired. The peak incidence of rheumatic fever are in the age group 5-15 years, the disease is rarely found in children under the age of 4 years and residents over 50 years.

Someone who had rheumatic fever if not treated adequately, so very likely suffered an attack of rheumatic heart disease. Infection by the bacteria Streptococcus Beta Hemolyticus group A that causes a person experiences which preceded the occurrence of rheumatic fever, inflammation of the throat channel, due to the management and treatment is directed less causing toxins / toxin from the bacteria spread through the bloodstream and cause inflammation of the heart valves. As a result the leaves have adhesions that narrowed valve, or thicken and contract so that if the closing is not perfect anymore and leak.

Signs and Symptoms of Rheumatic Heart Disease

Patients generally megalami shortness of breath caused by heart already experiencing problems, joint pain that moved, reddish patches on the skin that borders, irregular hand movements and uncontrollable (Korean), or a small lump under the skin. In addition, signs are also accompanying abdominal pain, weight loss, rapid fatigue and of course the fever.

Enforcement of Rheumatic Heart Disease Diagnosis

In addition to the signs and symptoms that appear directly from the physical, the doctor will usually perform some laboratory tests, for example, routine blood tests, Asto, CRP, and reviews the throat culture. The most accurate form of examination is to do echocardiography to see the condition of heart valves and heart muscle.


Rheumatic Heart Disease Treatment

If the diagnosis of rheumatic heart disease has been established and the persistence of infection by the bacteria Streptococcus, the main thing that comes from the team doctor was the administration of antibiotics and anti inflammatory. For example, administration of oral antibiotics penicillin or benzathine penicillin G. In patients allergic to either drug, the other alternative is giving erythromycin or cephalosporin class. While anti-inflammatory that is usually given cortisone and aspirin.

Patients are encouraged to bed rest in hospital, besides the medical team will think about the handling of the likelihood of complications such as heart failure, bacterial endocarditis or trombo-embolism. Patients will be given a highly nutritious diet that contains enough vitamins.

Rheumatic Heart Disease Patients without symptoms do not require therapy. Patients with mild symptoms of heart failure requiring medical therapy to resolve complaints. Patients who are symptomatic need surgikal therapy or invasive intervention. But surgikal therapies and interventions is still limited available and cost is relatively expensive and require long-term follow-up.

Rheumatic Heart Disease Prevention

If we see above that pulmonary heart disease is likely to occur with the initial event that rheumatic fever, prevention is the best course is how our efforts do not get rheumatic fever (bacterial infection of Streptococcus beta hemolyticus).

There are several factors that can support a person attacked by the germs, including environmental factors such as poor living conditions, crowded living conditions and poor access to health care is a significant determinant in the distribution of this disease. Weather variations also have a major role in the occurrence of infection to occur streptokokkus DR.

Someone who is infected with the bacteria Streptococcus beta hemolyticus and rheumatic fever, should be given a maximum with antibiotic therapy. This is to prevent possible attacks by the second time or even lead to Rheumatic Heart Disease.

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The etiology of typhoid fever is Salmonella typhi and Salmonella enteritidis

The etiology of typhoid fever is Salmonella typhi and Salmonella enteritidis paratyphi A and B. bioserotip

Pathogenesis

The entry of Salmonella typhi (S.typhi) and Salmonella paratyphi (S.paratyphi) into the human body occurs through contaminated food germs. Some germs were destroyed in the stomach, partly escape into the intestine proliferate further. When the intestinal humoral immune response is less then the bacteria will multiply penetrate epithelial cells, especially cell-M and then to the lamina propria. In the lamina propria and breed germs difagosit by phagocyte cells mainly by macrophages. Germs can live and multiply in macrophages and subsequently taken to the plaque painful distal ileum and then to the mesenteric lymph nodes. Furthermore, through the duct torasikus germs contained in the blood circulation (resulting in the first asymptomatic bacteremia) and mnybar k sluruh retikulondotelial body organs especially the liver and spleen. In these organs the bacteria leave the phagocyte cells and proliferate outside the cell or room sinusoids and subsequent entry into the blood circulation again a second time resulting in bacteremia accompanied by signs and symptoms of systemic infection.

In the liver, the bacteria get into the gall bladder, multiply, and common bile excreted by "intermittent" into the intestinal lumen. Some germs excreted through feces and some came back into circulation after penetrating the intestine. The same process is repeated again, since macrophages have been teraktivasi and hyperactive then occur during phagocytosis of Salmonella bacteria release several inflammatory mediators which in turn will cause symptoms of systemic inflammatory reaction to a case of fever, malaise, myalgia, mental disorders, and coagulation.

In the Plaque painful hyperactive macrophage hyperplasia reaction network (intra S.typhi macrophages induce delayed type hypersensitivity reactions, tissue hyperplasia, and necrosis of organs). Salruan gastrointestinal bleeding can occur due to erosion of blood vessels around the plaque that is experiencing nkrosis painful and hyperplasia due to accumulation of mononuclear cells in the intestinal wall. Lymphoid tissue pathological process can be developed until the muscle layer, serosa intestine, and result in perforation.

Endotoxin can be attached to the capillary endothelial cell receptor with the consequent incidence of complications such as disruption nueropsikiatrik, cardiovascular, breathing, and other organ disorders.


CLINIC manifestations

The period of typhoid fever shoots last between 10-14 days. Clinical symptoms that arise are very varied from light served until severe, asymptomatic until the disease is typically accompanied by a picture of complications up to death.

In the first week of clinical symptoms was found disease complaints and symptoms similar to acute infectious diseases in general are fever, headache, dizziness, muscle pain, anorexia, nausea, vomiting, or diarrhea obstipasi, uncomfortable feeling in stomach, cough, and epistaxis. On physical examination found only body temperature to rise. The nature of the fever is rising slowly and mainly in the afternoon until the evening. In the second week of the symptoms become more obvious in the form of fever, relative bradycardia (relative bradycardia is an increase in temperature of 10C is not followed by increase in pulse rate 8 times per minute) are webbed tongue (gross in the middle, the edge of the red tip and tremor), hepatomegaly, splenomegaly, meteorismus, somnolen form of mental disorder, stupor, coma, delirium or psikosis. Roseolae rarely found rarely found in people in Indonesia.


DIAGNOSIS

There are three methods for diagnosing typhoid fever are:

1. Diagnosis mikrobiologik / breeding germs.

2. Serologic diagnosis.

3. Clinical diagnosis.

Mikrobiologik diagnosis method is the most specific method and more than 90% of untreated patients, positive blood cultures within the first week. This result is decreased drastically after the use of antibiotic drugs, where a positive result to 40%. Nonetheless bone marrow cultures still show a high yield of 90% positive. In the weeks subsequent decrease of blood culture results, but the culture of feces and urine culture increased 85% and 25% positive respectively in the week the 3rd and 4th. Organisms in the feces can still be found for 3 months from 90% of patients and approximately 3% of patients remained out S.typhi germs in stool in the long term. It can happen that a chronic carrier of germs S.typhi issue in the stool in his life, and the carrier is more common in adults than children and more often on women than men.

Diagnosis depends on serologic antibodies arising against O and H antigens, which can be detected by agglutination reaction (Widal test). Antibodies against the O antigen of group D occur within the first week of illness and reached its peak in the third and fourth weeks will decrease after 9 months to 1 year. Agglutinin titer of 1 / 200 or an increase in titer of more than 4 times the mean positive Widal test, this indicates an acute infection S.typhi.

But agglutinin O titer elevation can also be caused by germs like salmonella O antigens other than D group with a commonality factor 9 and 12 as in S.typhi. There is an increasing titer of antibody against D antigen derived from the flagellum S.typhi add specificity of Widal test results. Antibodies against flagella antigen titer escalate after the first week and peaked at week 4 to-6, and titer remain high for years. The discovery of a high titer antibody flagellum does not mean there is an acute infection. Factors to consider that affect the results of Widal test were: stage of disease, vaccination, anamnestik reaction, the endemic areas and treatment ..
MANAGEMENT

Until now, still embraced the management of typhoid fever trilogy, namely:

1. Giving antibiotics; to stop and destroy the spread of germs. Antibiotics are used:
Chloramphenicol; dose first hi 4x250 mg, 4x500 mg the second day, given during fever continued until 2 days free of fever, then the dose was reduced to 4x250 mg for 5 days later.
Ampicillin / Amoxicillin; dose of 50-150 mg / kg given for 2 weeks.
Kotrimokzasol; 2x2 tablet (1 tablet containing 400 mg sulfametokzasol-80 mg trimethoprim) was given for 2 weeks also
II and III generation cephalosporins.
Rest and treatment professionals, aims to prevent complications and speed healing. Patients should be an absolute bed rest until at least 7 days free of fever or approximately 14 days. Mobilization done gradually, in accordance with the recovery of the strength of the patient.
Diet and supporting therapy (symptomatic and supportive)

Several studies have shown Ahwa early solid feeding, which is rice with side dishes low cellulose (patang vegetables with coarse fibers) can be given safely. Also required the provision of vitamins and minerals sufficient to support the patient's general condition.

READ MORE - The etiology of typhoid fever is Salmonella typhi and Salmonella enteritidis

Typhoid Fever disease or better known

Typhoid Fever disease or better known as Typhoid disease is a disease caused by the bacterium Salmonella enterica, especially derivatives such as the bacteria Salmonella typhi. Typhoid disease attacks the digestive tract that is transmitted or spread through food and beverages that have been contaminated by the bacteria Salmonella. Children and adults can contract the disease typhoid fever. When untreated, typhoid fever can last for three weeks to a month. Death occurs between 10% and 30% of untreated cases

Typhoid Fever Symptoms


Typhoid Fever disease will usually show symptoms such as abdominal pain, nausea, vomiting, high fever (39 ° to 40 ° C), headache and diarrhea which is sometimes mixed with blood, myalgia muscle pain, body weakness, loss appetite, weak heartbeat (bradycardia), and in some cases appear distributing vlek pink ("rose spots")

Typhoid Fever Prevention

Typhoid Fever Prevention can be done by improving hygiene and environmental sanitation and health education. Immunization using oral vaccines and vaccine injections (antigen Vi Polysaccharida capular) has been widely used. Currently, prevention of Salmonella bacteria can be done with named chotipa vaccination (cholera, typhoid, paratyphoid) or TIPA (typhoid-paratyphoid). For children aged 2 years who are still vulnerable, can also be vaccinated.

Clinical Symptoms

Complaints and symptoms of Typhoid fever is not typical, and vary from mild flu-like symptoms until the appearance of severe and fatal illness of many organ systems. The clinical picture of Typhoid Fever disease in the form of prolonged fever, bowel dysfunction, and central nervous system complaints.

Heat is more than 7 days, usually starting with Sumer is increasingly rising, so that at high heat to 2 weeks continuously, especially at night.

Symptoms may include obstipasi gstrointestinal, diarrhea, nausea, vomiting, and bloating, hepatomegaly, splenomegaly and dirty tongue edge hyperemia.

Gejalah central nervous form of delirium, apathy, somnolen, sopor, and even coma.

Treatment of Typhoid Fever patients in the Hospital consists of supportive treatment melipu + ti rest and diet, medical, therapy complications (depending on complications that occur). Rest aims to prevent complications and speed healing. Patients should be absolute bed rest until at least 7 days free of fever or kurag more for 14 days. Mobilization done gradually, in accordance with the recovery of the strength of the patient.

Diet and penunjuang done with the first therapy, the patient is given slurry filtered, then rough and eventually rice porridge in accordance with a cure rate of patients. However, some research indicates that early feeding rate is low rice with side dishes cellulose (abstinence vegetables with coarse fibers) can be given safely. Also needs to be given vitamins and minerals to support the patient's general condition.
In the case of intestinal perforation and septic shock is needed intensive treatment with total parenteral nutrition. Spectrum antibiotics or a combination of several drugs that work synergistically to consider. Corticosteroids should be given in septic shock

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Typhoid Fever

Typhoid Fever

Typhoid Fever is usually called typhoid or types in the Indonesian language, is a disease caused by the bacterium Salmonella enterica, especially derivatives such as Salmonella Typhi mainly attacks the digestive tract. Typhoid fever is an acute infectious disease that always exist in society (endemic) in Indonesia, ranging from age five, children and adults.

According to dr. Arlin Algerina, SpA, of the International Hospital Bintaro, In Indonesia, estimated between 800 - 100,000 people were affected by the disease typhus or typhoid fever throughout the year. Fever is mainly appears in the dry season and is said girls are more often attacked, the current increase in cases occurred at ages under 5 years old.

How Typhoid Fever Transmission

Typhoid fever can strike when the germs enter through food or drink, resulting in infection of the digestive tract of the small intestine. And through the bloodstream, the bacteria reach the organs of the body especially the liver and spleen. He then proliferate in the liver and spleen that causes pain when touched.

Signs and Symptoms of Typhoid Fever

This disease can strike when the bacteria enter through food or drink, resulting in infection of the digestive tract of the small intestine. Then followed the bloodstream, the bacteria reach the liver and spleen that breed there, which causes pain when touched.

Clinical symptoms of typhoid fever in children usually give a mild clinical picture can be even without symptoms (asymptomatic). Broadly speaking, the signs and symptoms caused by, among others;
Fever more than a week. During the day usually looks fresh but before the night a high fever.
Tongue dirty. The middle part is white and red edges. Usually children will feel bitter tongue and tend to want to eat the sour-sour or spicy.
Weight nausea to vomiting. Salmonella typhi bacteria breed in hatidan spleen, the result is swelling and eventually suppress the stomach, causing nausea. Due to excessive nausea, eventually enter the food can not be perfect and usually come out again through the mouth.
Diarrhea or Diarrhoea. The nature of the bacteria that attacks the gastrointestinal absorption of fluid that causes the disorder eventually occurs diarrhea, but in some cases actually occur constipation (difficult bowel movements).
Weakness, dizziness, and abdominal pain. High fever cause a sense of weakness, dizziness. The occurrence of swelling of the liver and spleen causing pain in the abdomen.
Fainting, not unconscious. Patients generally feel more comfortable with a lie without much movement, but with the severe conditions often occur disturbance of consciousness.
Diagnosis of Typhoid Fever

To the accuracy of the enforcement of disease diagnosis, the doctor will perform several laboratory tests including peripheral blood examination, Widal examination and culture of bile.
Examination of peripheral blood is a simple examination that is easy to do in a simple laboratory to make the diagnosis quickly. There will be a picture of a reduced white blood count (lekopenia), which increased the number limfosis and eosinophilia.
Widal examinations are blood tests to find an anti against typhoid germs. Positive if the titer Widal O 1 / 200 or more and / or show a progressive increase.
Typhoid fever positive definite diagnosis when performed by the finding of bile cultures typhosa Salmonella bacteria in the blood when the first week and then often found in the urine and faeces.

Positive blood samples was made to establish a definitive diagnosis. Urine and faeces samples twice in a row are used to determine that the patient had completely recovered and not the germ carrier (carrier).

Meanwhile, to ascertain whether the illnesses suffered by patients is another disease it is necessary differential diagnosis. If there is a fever of more than five days, the doctor will think of possibilities other than typhoid fever are other infectious diseases such as paratyphoid A, B and C, dengue fever (dengue fever), influenza, malaria, tuberculosis (TB) and lung infection (pneumonia).

Care and Treatment of Typhoid Fever

Care and treatment of disease Typhoid fever or types aimed at stopping the invasion of bacteria, shortening the course of the disease, prevent complications, and prevent the recurrence did not return. Treatment of typhoid disease conducted by isolating patients and conduct disinfection of clothing, faeces and urine to prevent transmission. Patients must lie in bed for three days until the heat down, and then allowed to sit, stand and walk.

Apart from drugs given to reduce symptoms such as fever and dizziness (Paracetamol), For a child with typhoid fever, the main choice of antibiotic is chloramphenicol for 10 days and is expected to occur eradication / eradication of germs as well as treatment time is shortened. But there are some doctors who chose other antibiotics such as ampicillin, trimethoprim-sulfamethoxazole, cotrimoxazole, cephalosporins, and ciprofloxacin according to the patient's condition. Excessive fever causing the patient to be treated and given fluids infusion.

Complications of Typhoid Fever

Complications are often found in children with typhoid fever is intestinal bleeding due to perforation, infection of the gallbladder (cholecystitis), and hepatitis. Brain disorder (encephalopathy), sometimes found also in children.

Typhoid Fever Disease Diet

Typhoid fever disease patients during treatment should follow the dietary guidelines recommended by doctors for consumption, among others:
Food is quite fluid, calories, vitamins and proteins.
Does not contain much fiber.
Not stimulating and does not cause a lot of gas.
Food is provided during breaks.
To return to the food "normal", do it gradually along with the mobilization. For example, the first and second day of soft food, day-to-3 regular meals, and so on.

Typhoid Fever Prevention

Typhoid fever prevention of diseases can be done by improving hygiene and environmental sanitation and health education. Immunization using oral vaccines and vaccine injections (antigen Vi Polysaccharida capular) has been widely used. Currently, prevention of Salmonella bacteria can be done with named chotipa vaccination (cholera, typhoid, paratyphoid) or TIPA (typhoid-paratyphoid). For children aged 2 years who are still vulnerable, can also be vaccinated.

READ MORE - Typhoid Fever

Cervix Cancer

 

Cervix Cancer

Cervical cancer is the term health is cervical cancer is a cancer that occurs in the uterine cervix, an area in which the female reproductive organ is the entrance to the uterus located between the womb (uterus) with a hole intercourse (vagina).

Cervical cancer is caused by some type of virus called Human Papilloma Virus (HPV). The virus is spread through sexual contact, HPV can invade all the women every time regardless of age or lifestyle. Many women with a good immune system able to fight HPV infection by itself. However, sometimes the virus leads to the occurrence of cancer.

In Indonesia, Cervical Cancer is the No. 1 cancer killer of women in Indonesia is currently the highest. (Pdpersi). "Every woman in his life at risk for the virus that causes cervical cancer," especially high risk for those who smoke, gave birth to many children, use of contraceptive pills in the long term, as well as those infected with HIV Aids. (MedlinePlus)

How cervical cancer occur

Just like all cancers, cervical cancer occur characterized by the growth of cells on the cervix that is unusual (abnormal). But before these cells become cancer cells, there are some changes experienced by these cells. Changes in these cells usually take up many years before the cells had been transformed into cancer cells. During the pause, the right treatment will soon be able to stop the abnormal cells before they turn into cancer cells.

Detecting Cervical Cancer

The cells are abnormal presence can be detected with a test called a "Pap smear test", so the earlier the abnormal cells were detected, the more low person's risk of cervical cancer. A Pap smear is a test that is safe and inexpensive and has been used for many years to detect abnormalities that occur in cells of the cervix.

Signs and Symptoms of Cervical Cancer

In general, signs and symptoms is the occurrence of vaginal bleeding after sexual activity or between menstrual periods. Meanwhile, another sign that may arise include:
Loss of appetite and weight
Pelvic bone pain and spinal
Pain in the limbs (legs)
Swelling in the feet area
Accompanies the release of urine through the vagina feaces
Until hip fractures occur

Pap smear test regularly is necessary to find and detect the presence of cervical cancer in a woman.

Cervical Cancer Treatment

For you are diagnosed with abnormal cell changes early, it can be done several things like;
Heating, diathermy or laser.
Cone biopsy, that is by taking a bit of cervical cells, including cells undergoing changes. This action allows a more thorough examination to ensure that cells undergoing changes. This examination can be performed by a gynecologist.

If the course of the disease has reached the stage of pre-cancer and cervical cancer have been identified, so there are some things you can do to cure, among others;
Operation, namely by taking the cancerous area, usually the uterus and cervix.
Radiotherapy is by using high-powered X-rays that can be done internally and externally.

How is Prevention?

This is a very interesting news, that cervical cancer (cervical cancer) can be prevented. That is a way vaccinations are given to teenage girls and adult women.

The vaccine is inaugurated its copyright in 2006, its developers is a world's largest drug company in the United States (Merck & Co., Inc.). The vaccine is called "Gardasil". The vaccine, according to the WHO, is also effective in preventing infection with HPV types 6 and 11 which cause approximately 90% of all cervical cancers.

The introduction of cervical cancer prevention vaccine and the effort to get closer access to vaccines for people in all parts of Indonesia is expected to reduce the prevalence of cervical cancer, and minimize the fatality due to attack the cancer.

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Anatomy Human Heart (Understanding Cholesterol)

Anatomy Human Heart (Understanding Cholesterol)
The heart has a heart shape tends conical blunt. The heart of the human body occupies between the two lungs exactly in the middle of the thoracic cavity.

Heart Anatomy

A heart has 4 hollow space. Own heart the size of a postage fist owner.

Human heart is located to the left of the chest, between the lungs, are protected by the rib.


On the outside consists of muscles that contract with each other. These muscles play an important role in pumping blood through the arteries.


The inside of the heart consists of 4 pieces of chamber cavity. The four cavities are divided into 2 parts, namely the right and left are separated by a wall of muscle known as the septum.

On the right and the left is divided again into 2 chambers. Cavity of the upper chambers called atria and two lower chambers called the ventricle which has a role in pumping blood into the arteries.

In accordance with the etymological, the heart of the medical world has a term cardio / cardio. Is derived from the Latin words, cor. Where cast in the Latin meaning: a cavity. As the shape of a hollow muscular heart that pumps blood through blood vessels in a repetitive rhythmic contractions and have consistently.

Also, in medical terms have the meanings cardiac Count something related to the heart. In Greek, the term cardia itself is used for the heart.

The heart space is divided into four chambers.

Right atrium and left the porch that is separated by a septum intratrial,
Right ventricle and left ventricle are separated by a septum interventrikular.

READ MORE - Anatomy Human Heart (Understanding Cholesterol)

Disease Heart Attack

Disease Heart Attack

A heart attack is an emergency medical condition that is to be handled, if too late then it is very likely the patient immediately met his end (death). In developed countries, especially in America, heart disease is the number one cause of death in which a heart attack experienced by more than 1.5 million people there. Similarly in Indonesia, the Ministry of Health and Heart Disease Foundation suggests that this is now in Indonesia, heart disease ranks first as the cause of death.

Diseases of heart attack (Heart Attack), which in medical language referred to as myocardial infarction (MI), is the damage and even death of heart muscle (myocardium) caused an abrupt interruption of blood supply (as the bearer of Oxygen) is stricken area as a result of several factors. For example: Occurs when a coronary artery blockage was for some time, either due to spasm (occur tightening coronary arteries), due to thrombus (blood clot) or due to the narrowing and blockage by the buildup of fatty substances (cholesterol, triglycerides) that the longer more and more and accumulate beneath the deepest layer (endothelium) of the artery wall.

Heart attacks are caused by the spasm that causes including coronary artery blockade will disappear completely, either pain or other complaints when a coronary artery is relaxed and functioning as normal. These conditions are called crescendo angina or coronary insufficiency. If this occurred in the range 20 to 40 minutes, then it can cause death of heart muscle (infarct) as a result it lacks oxygen because the blood supply stops.

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