AIDS vaccines

A preventive vaccine is a substance introduced into the human body that teaches the immune system to detect and destroy a pathogen—which is a particular virus, bacterium or parasite that causes a preventable disease. All vaccines contain some harmless form or part of the pathogen they target. They exert their effects through the adaptive immune response, an arm of the immune system that learns to recognize and neutralize specific pathogens (as opposed to pathogens in general).

Vaccines can be made in a variety of ways, but only a handful of those approaches are applicable to the development of AIDS vaccines.

Types of vaccines:

• Whole-killed/Whole-inactivated vaccines: The active ingredient in these vaccines is an intact virus or bacterium that has been killed or otherwise stripped of its ability to infect humans. Examples include the cholera and injectable polio vaccines. This approach has not been applied to the development of vaccines against HIV, due to the small but inevitable risk that the viruses harvested for such preparations may not all have been killed or adequately inactivated.
• Live attenuated vaccines: Use a form of the targeted pathogen that is highly unlikely to be harmful—one capable, say, of multiplying, but not typically of causing disease. Examples include the measles vaccine and the oral vaccine against polio, which has been widely deployed in global efforts to eradicate the disease. Such vaccines can be very effective because they closely mimic the behavior of the targeted pathogen, giving the immune system a truer picture of what it would be up against. But due to the risk that attenuated HIV might revert to its disease-causing form, this approach has not been applied to the development of human AIDS vaccines.
• Subunit vaccines: Vaccines of this variety are composed of purified pieces of the pathogen—known as antigens—that generate a vigorous, protective immune response. Common subunit vaccines include the seasonal flu and hepatitis B vaccines. This approach was employed to devise the first AIDS vaccine candidate tested in humans, which failed to induce protection from HIV infection. AIDS researchers, including those affiliated with IAVI, are today revisiting this strategy in novel ways.
• DNA vaccine candidates: Such vaccine candidates are also designed to train the immune system to recognize a piece of the targeted bacterium or virus. The difference is that their active ingredients are not the purified antigens themselves, but circles of DNA, called plasmids, that carry genes encoding those antigens. Human cells passively take up these plasmids and produce the antigens that train the immune system to recognize the targeted pathogen. No vaccines of this sort have been approved for human use, but several AIDS vaccine development efforts have employed this approach.
• Recombinant vector vaccine candidates: These vaccine candidates, like DNA vaccine candidates, introduce genes for targeted antigens into the body. But the genes are inserted into a virus that actively infects human cells. The viruses chosen as vectors are safe to use because they do not ordinarily cause disease in humans and/or have been stripped of their ability to proliferate. No vaccines of this sort have been approved for human use, but several AIDS vaccine development efforts have employed this strategy.

ARTI SEHAT

KESEHATAN sesuatu yang jarang sekali di beri penghargaan, banyangkan sering kali seseorang lupa untuk bersyukur ketika ia sehat dan sebaliknya ketika sakit barulah kesehatan itu sangat berharga bagi nya, namun disamping itu ada sebuah pertanyaan yang perlu untuk kita fikirkan bersama apakah sebenarnya kesehatan itu? Atau dengan bahasa lain apakah definisi dari kesehatan itu? Kata " KESEHATAN " memang tidak asing di telinga kita namun apakah kita lelah mampu mendifinisikan kesehatan secara tepat. nah, bagaimana mungkin kita bisa menghargai kesehatan kalau ternyata definisi kesehatan saja kita belum mamapu untuk mengusainya dengan tepat.

seberapa pentingkah kesehatan bagi kita juga akan menentukan tingkat penghargaan kita terhadap kesehatan. upaya apa saja yang telah kita lakukan dalam mencapai tingkat kesehatan yang lebih tinggi juga menunjukkan sejauh mana kita mampu menghargai dan mengerti akan arti KESEHATAN.

Dan pastinya kesehatan sendiri mempunyai arti yang berbeda pada setiap orang tergantung dengan persepsinya dalam memandang permasalahan kesehatan. yang terpenting marilah kita memulai untuk mengerti dan menghargai " ARTI KESEHATAN "

DISTOSIA KARENA KELAINAN LETAK

a) Letak Sungsang

Letak sungsang adalah janin terletak memanjang dengan kepala di fundus
uteri dan bokong dibawah bagian cavum uteri.

Macam –Macam Letak Sungsang :

1. Letak bokong murni ( frank breech )
   Letak bokong dengan kedua tungkai terangkat ke atas.
2. Letak sungsang sempurna (complete breech)
   Kedua kaki ada disamping bokong dan letak bokong kaki sempurna.
3. Letak sungsang tidak sempurna ( incomplete breech )
   Selain bokong sebagian yang terendah adalah kaki atau lutut.

Etiologi Letak Sungsang :

1. Fiksasi kepala pada PAP tidak baik atau tidak ada ; pada panggul sempit, hidrocefalus, anencefalus, placenta previa, tumor.
2. Janin mudah bergerak ; pada hidramnion, multipara, janin kecil (prematur).
3. Gemelli
4. Kelainan uterus ; mioma uteri
5. Janin sudah lama mati
6. Sebab yang tidak diketahui.

Diagnosis Letak Sungsang :

1. Pemeriksaan luar, janin letak memanjang, kepala di daerah fundus uteri
2. Pemeriksaan dalam, teraba bokong saja, atau bokong dengan satu atau dua kaki.

Syarat Partus Pervagina Pada Letak Sungsang :

1. Janin tidak terlalu besar
2. Tidak ada suspek CPD
3. Tidak ada kelainan jalan lahir

Jika berat janin 3500 g atau lebih, terutama pada primigravida atau multipara dengan riwayat melahirkan kurang dari 3500 g, sectio cesarea lebih dianjurkan.

b) Prolaps Tali Pusat

Yaitu tali pusat berada disamping atau melewati bagian terendah janin setelah
ketuban pecah. Bila ketuban belum pecah disebut tali pusat terdepan.

Pada keadaan prolaps tali pusat ( tali pusat menumbung ) timbul bahaya besar, tali pusat terjepit pada waktu bagian janin turun dalam panggul sehingga menyebabkan asfiksia pada janin.

Prolaps tali pusat mudah terjadi bila pada waktu ketuban pecah bagian terdepan janin masih berada di atas PAP dan tidak seluruhnya menutup seperti yang terjadi pada persalinan ; hidramnion, tidak ada keseimbangan antara besar kepala dan panggul, premature, kelainan letak.

Diagnosa prolaps tali pusat ditegakkan bila tampak tali pusat keluar dari liang senggama atau bila ada pemeriksaan dalam teraba tali pusat dalam liang senggama atau teraba tali pusat di samping bagian terendah janin.

Pencegahan Prolaps Tali Pusat adalah dengan Menghindari pecahnya ketuban secara premature akibat tindakan kita.

Penanganan Tali Pusat Terdepan ( Ketuban belum pecah ) :

• Usahakan agar ketuban tidak pecah
• Ibu posisi trendelenberg
• Posisi miring, arah berlawanan dengan posisi tali pusat
• Reposisi tali pusat

Penanganan Prolaps Tali Pusat :
► Apabila janin masih hidup , janin abnormal, janin sangat kecil harapan hidup ,tunggu partus spontan.
► Pada presentasi kepala apabila pembukaan kecil, pembukaan lengkap Vacum ekstraksi, porcef.
► Pada Letak lintang atau letak sungsang Sectio cesaria

DISTOSIA

Definisi
Distosia adalah kelambatan atau kesulitan dalam jalannya persalinan.
Etiologi
Distosia dapat disebabkan karena kelainan his ( his hipotonik dan his hipertonik ), karena kelainan besar anak, bentuk anak ( hidrocefalus, kembar siam, prolaps tali pusat ), letak anak (letak sungsang, letak melintang ), serta karena kelainan jalan lahir.

1. DISTOSIA KARENA KELAINAN HIS
Kelainan his dapat berupa inersia uteri hipotonik atau inersia uteri hipertonik.

a. Inersia uteri hipotonik
Adalah kelainan his dengan kekuatan yang lemah / tidak adekuat untuk melakukan pembukaan serviks atau mendorong anak keluar. Di sini kekuatan his lemah dan frekuensinya jarang. Sering dijumpai pada penderita dengan keadaan umum kurang baik seperti anemia, uterus yang terlalu teregang misalnya akibat hidramnion atau kehamilan kembar atau makrosomia, grandemultipara atau primipara, serta pada penderita dengan keadaan emosi kurang baik.
Dapat terjadi pada kala pembukaan serviks, fase laten atau fase aktif, maupun pada kala pengeluaran.

Inertia uteri hipotonik terbagi dua, yaitu :

1. Inersia uteri primer
Terjadi pada permulaan fase laten. Sejak awal telah terjadi his yang tidak adekuat ( kelemahan his yang timbul sejak dari permulaan persalinan ), sehingga sering sulit untuk memastikan apakah penderita telah memasuki keadaan inpartu atau belum.

2. Inersia uteri sekunder
Terjadi pada fase aktif kala I atau kala II. Permulaan his baik, kemudian pada keadaan selanjutnya terdapat gangguan / kelainan.

Penanganan :

1. Keadaan umum penderita harus diperbaiki. Gizi selama kehamilan harus diperhatikan.
2. Penderita dipersiapkan menghadapi persalinan, dan dijelaskan tentang kemungkinan-kemungkinan yang ada.
3. Teliti keadaan serviks, presentasi dan posisi, penurunan kepala / bokong bila sudah masuk PAP pasien disuruh jalan, bila his timbul adekuat dapat dilakukan persalinan spontan, tetapi bila tidak berhasil maka akan dilakukan sectio cesaria.

b. Inersia uteri hipertonik
Adalah kelainan his dengan kekuatan cukup besar (kadang sampai melebihi normal) namun tidak ada koordinasi kontraksi dari bagian atas, tengah dan bawah uterus, sehingga tidak efisien untuk membuka serviks dan mendorong bayi keluar.

Disebut juga sebagai incoordinate uterine action. Contoh misalnya “tetania uteri” karena obat uterotonika yang berlebihan. Pasien merasa kesakitan karena his yang kuat dan berlangsung hampir terus-menerus. Pada janin dapat terjadi hipoksia janin karena gangguan sirkulasi uteroplasenter.

Faktor yang dapat menyebabkan kelainan ini antara lain adalah rangsangan pada uterus, misalnya pemberian oksitosin yang berlebihan, ketuban pecah lama dengan disertai infeksi, dan sebagainya.

Penanganan
Dilakukan pengobatan simtomatis untuk mengurangi tonus otot, nyeri, mengurangi ketakutan. Denyut jantung janin harus terus dievaluasi. Bila dengan cara tersebut tidak berhasil, persalinan harus diakhiri dengan sectio cesarea.

( bersambung )
......................................Lanjutan DISTOSIA KARENA KELAINAN LETAK..........

KESEHATAN GRATIS

Apakah kesehatan gratis telah menjadi solusi terbaik bagi bangsa kita saat ini? Sebuah pertanyaan yang mungkin perlu pembahasan panjang untuk menen tukan jawaban nya.
Dengan tingkat pertumbuhan ekonomi yang di alami bangsa kita sekarang ini ternyata banyak rayat kita yang hidup masih di bawah garis kemiskinan, tentu saja bagi mereka kesehatan merupakan hal yang penting dan berharap untuk terjangkau.
Sebahagian dari mereka mungkin beropini bahwa kesehatan adalah hal berharga yang mahal harganya. Bagi mereka kesehatan gratis memang sangat di idam - idam kan. Mereka berharap kesehatan tidak lagi menjadi masalah bagi hidup mereka yang memeng sudah dihipit dengan beribu masalah.
Lain halnya Dengan warga kita yang memiliki penghasilan yang berlebih mereka sudah mempersiapkan anggaran untuk kesehatan mereka, bahwa tak tangung tangung mereka berharap mendapat pelayanan “kelas satu” dalam menyelesaikan permasalahan kesehatan mereka.tentu saja untuk itu mereka rela mengeluarkan biaya yang cukup besar.
Bagi warga menegah mereka rela mengeluarkan sedikit biaya yang masih dalam kemampuan mereka guna mendapat pelayanan kesehatan, namun sebahagian mungkin menuntut pelayanan yang maksimal, ataupun lebih.
Pada kenyataan nya pelayanan kesehatan gratis saat ini belum bias memberikan pelayanan kesehatan yang maksimal seperti golongan kelas atas,semisal jenis obat obatan yang di sediakan untuk pelayanan kesehatan gratis merupakan obat dasar standart bukan obat dari perusahaan yang memiliki nama dagang dan harga yang mahal.
Yang disayangkan masih ada golongan masyarakat yang beranggapan makin mahal harga suatu obat maka makin bagus obat tersebut, sehingga mungkin pendapat mereka obat gratis tidak bagus. Ini hanya sebuah kemungkinan dari sekian banyak kemungkinan – kemungkinan lain nya.
Penyambain pemberitaan yang tepat sangat lah di butuhkan guna menyingkirkan pemhaman – pemahaman yang slah akan kesehatan, namun apakah ini sudah berjalan dengan baik?
Alhasil karna kurang nya pengetahuan akan kesehatan maka kesehatan gratis bias saja menimbulkan masalah baru di bidang kesehatan,dan mungkin ini perlu mendapat perhatian bagi mereka praktisi kesehatan.

MIGRAINE HEADACHE: ESSENTIALS OF DIAGNOSIS AND CLINICAL PRESENTATION

Migraine headache is a common disorder that affects approximately 6% of men and 17% of women, usually at the peak of their productivity.¹ According to the American Migraine Study, most patients with migraine do not seek medical care for their headaches.² Still, a significant number of them present to physician’s offices, particularly in the primary care setting. An accurate diagnosis of migraine should lead to an effective therapeutic strategy, reduce disability, and improve productivity in these patients. This newsletter provides a practical yet comprehensive approach that should help clinicians correctly recognize and identify migraine headaches.

PATIENT HISTORY

Information from the clinical history is the cornerstone of formulating a differential diagnosis, and migraine is not an exception. Most individuals seeking medical care for their headaches suffer from migraine.³ This initial evaluation should serve to promptly and reliably identify the salient features of migraine while, at the same time, detect the red flags of a secondary headache. These red flags are often called the SNOOP features. The author has adapted them as follows:

Systemic symptoms (eg, fever, weight loss)

Neurologic symptoms or abnormal signs (eg, confusion, impaired alertness)

Onset (ie, sudden, abrupt, or split-second)

Older (ie, new onset of progressive headache in patients >50 y [eg, giant cell arteritis])

Previous headache history (ie, first headache or new or different headache; change in attack frequency, severity, or clinical features)

Secondary risk factors (eg, HIV infection, systemic cancer)

In the author’s own clinical practice, patients are required to complete a headache questionnaire prior to their clinic encounter. The questionnaire is designed to characterize and rule in the salient features of a migraine headache and can include questions about the duration of the headache syndrome, individual attacks, frequency of attacks, quality and location of the pain, associated symptoms, triggering factors, relieving factors, pharmacological history (including frequency of use of individual abortive agents and prior use of prophylactic agents), family history, and comorbidities (eg, insomnia, anxiety, depression). By reviewing such a questionnaire prior to the actual patient encounter, the clinician can have a well-formed idea of the salient features of that patient’s headache disorder. Outlier responses in this questionnaire help to identify the red flags of secondary headaches or unusual primary headache syndromes, such as cluster headache or the paroxysmal hemicranias. The actual patient interview may serve to clarify or elaborate on the answers on the questionnaire.

Prodromal symptoms and aura

The migraine prodrome comprises the symptoms (eg, yawning; food cravings; changes in sleep, appetite, or mood) that precede the headache phase by hours or days. Aura precedes the headache phase by minutes and it may or may not persist during it. Aura is more often visual (eg, scotomata or positive visual phenomena such as teichopsia, photopsia, or dysmorphopsia). Sensory aura is less common; it is characterized by paresthesias in the upper extremity and perioral area (ie, cheiro-oral paresthesias). Motor and language deficits are less common. The migraine prodrome does not occur in all patients, and a history of aura is present in only about 20% of cases.⁴

Frequency, quality, location, and duration of the headache

The questionnaire inquires about total number of days with any degree of headache per month (headache days) as well as number of days with an incapacitating headache. Migraine pain is typically pulsatile or throbbing in quality and unilateral or bilateral in location. It is typically temporal, but it may be perceived as frontal, parietal, or occipital. The headache phase may last anywhere from 3-72 hours. Patients with chronic (also called transformed) migraine may report a dull, more diffuse and persistent headache in between attacks of more typical migraine pain.

Other features of the headache

Migraine headache is often accompanied by nausea, sometimes with emesis. Sensitivity to light and sound are common symptoms. Patients often seek rest, and the headache is made worse by physical activity or head movement. Allodynia or skin hypersensitivity in cranial or extracranial areas is a commonly reported symptom of prolonged headache attacks.⁵

Trigger factors

A fraction of migraine patients are able to identify environmental, dietary, or intrinsic factors, such as hormonal fluctuations or disruption of sleep habits, as triggers for an attack of migraine headache.

Family history

Migraine is often a familial disorder. A positive family history of recurrent disabling headache serves as additional evidence in favor of migraine when formulating the differential diagnosis.

HIGHLIGHTS OF THE PHYSICAL AND NEUROLOGICAL EXAMINATIONS

The physical examination of the headache patient should be comprehensive yet focus on relevant systems and organs. Palpation of the skull, scalp, and temporomandibular joints (TMJ) for localized tenderness, crepitus, or vascular induration and tenderness should be performed initially. The physician should assess the range of motion of the cervical spine and palpate for spasm of the paracervical musculature.⁶ In some situations, such as in acute sinusitis or periodontal disease, examination of the nasal and oral cavities must be undertaken.

A thorough funduscopic examination should be performed on all patients reporting headache. This examination should not be limited to visualization of the optic disk margins and should include determination of retinal venous pulsations, arteriovenous crossings, and the presence of hemorrhages. A general physical examination may elicit pertinent findings in some cases. For example, a midsystolic click on cardiac auscultation of female patients with migraine and mitral valve prolapse is a commonly found comorbidity in this group of patients.⁶

Finally, a thorough neurological examination must be performed to screen for structural etiologies for the headache. The physician should concentrate on the detection of signs of cognitive dysfunction; reduced visual acuity or field defects; or asymmetries in the motor, sensory, coordination, and reflex examinations. Rarely, structural lesions may present with localized low-grade headache and a paucity of abnormal findings in the neurological examination. Fortunately, in most cases, a thorough history and careful physical and neurological examinations are sufficient to rule out or rule in organic etiologies for the headache, thus reducing the need for costly neuroimaging studies.⁷

SCREENING INSTRUMENTS: THE ID MIGRAINE QUESTIONNAIRE

In addition to provider-specific questionnaires as described previously in this newsletter, several widely available and validated short screening tools can also be useful in the identification of migraine headache in the primary care setting. The ID Migraine screening questionnaire (developed by Pfizer, Inc.) is a self-administered test that may be completed by patients while they are sitting in the waiting room.⁸ The questions on the ID Migraine screening questionnaire are as follows:

1. Has a headache limited your activities for at least 1 day in the last 3 months?

2 .Are you nauseated or sick to your stomach when you have a headache?

3. Does light bother you when you have a headache?

Patients who have an affirmative answer to 2 or more of the questions have a high probability (93.3%) of having migraine. This questionnaire has a sensitivity of 81% and a specificity of 75%. This simple instrument can be easily incorporated into the interview or into information management systems.⁸

REFERENCES

1. Lipton RB, Stewart WF. Migraine in the United States: a review of epidemiology and health care use. Neurology. 1993;43(Suppl 3):S6-10.

2. Lipton RB, Stewart WF, Simon D. Medical consultation for migraine: results from the American Migraine Study. Headache. 1998;38:87-96.

3. Mendizabal JE. A practical approach to migraine headache. Compr Ther. 2000;26(4):263-8.

4. Silberstein SD, Young WB. Migraine aura and prodrome. Semin Neurol. 1995;15:175-82.

5. Yarnitsky D, Goor-Aryeh I, Bajwa ZH, et al. 2003 Wolff Award: Possible parasympathetic contributions to peripheral and central sensitization during migraine. Headache. 2004;44(5):447.

6. Mendizabal JE. Interviewing and examining the headache patient. Int Med. 1999;20:12-19.

7. Ramirez-Lassepas M, Espinosa CE, Cicero JJ, et al. Predictors of intracranial pathologic findings in patients who seek emergency care because of headache. Arch Neurol. 1997;54(12):1506-9.

8. Lipton RB, Dodick D, Sadovsky R, et al. A self-administered screener for migraine in primary care: the ID Migraine validation study. Neurology. 2003;61:375-82.