Saturday, May 16, 2009

Hipertensi Krisis

Presentasi "Hipertensi Krisis" OLEH : dr. IGB. PUTRA, Sp.PD.
sebuah artikel Seminar Kesehatan


Sebuah presentasi kedokteran tentang HYPOVOLEMIC SHOCK, dan bagaimana cara penata laksanaannya.

Saturday, May 9, 2009

Mexico flu deaths raise fears of global epidemic news services
updated 7:26 p.m. ET April 24, 2009

Mexico shut down schools, museums, libraries and state-run theaters across its overcrowded capital Friday in hopes of containing a swine flu outbreak that authorities say killed at least 20 people — and perhaps dozens more. World health authorities worried openly that the strange new virus could become a global epidemic.

The U.S. Centers for Disease Control and Prevention said tests show some of the Mexico victims died from the same new strain of swine flu that sickened eight people in Texas and California. Of the 14 samples tested from Mexico, seven were matches, said the CDC's acting director Dr. Richard Besser.

Mexico put the confirmed toll at 20 dead, but 40 other fatalities were being probed, and at least 943 nationwide were sick from the suspected flu, the health department said.

Scientists said the virus combines genetic material from pigs, birds and humans in a way researchers have not seen before.

“We are very, very concerned,” World Health Organization spokesman Thomas Abraham said.

“We have what appears to be a novel virus and it has spread from human to human,” he said. “It’s all hands on deck at the moment.”

President Felipe Calderon cancelled a trip and met with his Cabinet to coordinate Mexico’s response. The government planned to administer its remaining 500,000 vaccines from the flu season to health workers, the highest risk group, although it is not known how effective they are on swine flu. It said it also has enough oseltamivir, the generic name of Tamiflu, to treat 1 million people, but the medicine will be strictly controlled and handed out only by doctors.

The CDC says Tamiflu and Relenza do seem effective against the new strain. Roche, the maker of Tamiflu, said the company is prepared to immediately deploy a stockpile of the drug if requested. Both drugs must be taken early, within a few days of the onset of symptoms, to be most effective.

Authorities urged people to avoid hospitals unless they had a medical emergency, since hospitals are centers of infection.

Interactive map
Swine flu around the country
A state-by-state look at confirmed cases in the United States.

They also said Mexicans should refrain from customary greetings such as shaking hands or kissing cheeks, and authorities at Mexico City’s international airport were questioning passengers to try to prevent anybody with possible influenza from boarding airplanes and spreading the disease.

But the CDC said Americans need not avoid traveling to Mexico, as long as they take the usual precautions, such as frequent handwashing.

“We certainly have 60 deaths that we can’t be sure are from the same virus, but it is probable,” said Health Secretary Jose Cordova. He called it a “new, different strain ... that originally came from pigs.”

Epidemiologists are particularly concerned because the only people killed so far were normally less-vulnerable young people and adults. It’s possible that more vulnerable populations — infants and the aged — had been vaccinated against other strains, and that those vaccines may be providing some protection.

All eight U.S. patients recovered from symptoms that were like those of the regular flu, mostly involving fever, cough and sore throat, though some of them also experienced vomiting and diarrhea.

Scientists have long been concerned that a new flu virus could launch a pandemic, a worldwide spread of a killer disease. A new virus could evolve when different flu viruses infect a pig, a person or a bird, mingling their genetic material. The resulting hybrid could spread quickly because people would have no natural defenses against it.

40 million died in 1918 pandemic
The most notorious flu pandemic is thought to have killed at least 40 million people worldwide in 1918-19. Two other, less deadly flu pandemics struck in 1957 and 1968.

Nobody can predict when pandemics will happen. Scientists had been concerned about swine flu in 1976, for example, and some 40 million Americans were vaccinated. No flu pandemic ever appeared, but thousands of vaccinated people filed claims saying they’d suffered a paralyzing condition and other side effects from the shots.

In recent years, scientists have been particularly concerned about birds. There have been deaths from bird flu, mostly in Asia, but the virus has so far been unable to spread from person to person easily enough to touch off a pandemic.

Closing the schools across Mexico City, a metropolis of 20 million, kept 6.1 million students home from day care centers through high schools, and thousands more were affected as colleges and universities closed down. Parents scrambled to juggle work and family concerns due to what local media said was the first citywide schools closure since Mexico City’s devastating 1985 earthquake.

Authorities also advised capital residents not to go to work if they felt ill, and to wear surgical masks if they had to move through crowds. A wider shutdown — perhaps including shutting down government offices — was being considered.

“It is very likely that classes will be suspended for several days,” Cordova said. “We will have to evaluate, and let’s hope this doesn’t happen, the need to restrict activity at workplaces.”

Past outbreaks
Mexico’s initial response in its overcrowded capital brought to mind other major outbreaks — such as when SARS hit Asia. At its peak in 2003, Beijing was the hardest-hit city in the world. Schools, cinemas and restaurants were shuttered to prevent the spread the deadly respiratory virus, and thousands of people were quarantined at home.

In March 2008, Hong Kong ordered more than a half million young students to stay home for two weeks because of a flu outbreak. It was the first such closure in Hong Kong since the outbreak of SARS, or severe acute respiratory syndrome.

Lillian Molina and other teachers at the Montessori’s World preschool scrubbed down their empty classrooms with Clorox, soap and Lysol on Friday between fielding calls from worried parents. While the school has had no known cases among its students, Molina supported the government’s decision to shutter classes, especially in preschools.

“It’s great they are taking precautions,” she said. “I think it’s a really good idea.”

Still, U.S. health officials said it’s not yet a reason for alarm in the United States. The six in California and two in Texas have all recovered, and testing indicates some common antiviral medications seem to work against the virus.

New strain has swine, bird and human viruses
Schuchat of the CDC said officials believe the new strain can spread human-to-human, which is unusual for a swine flu virus. The CDC is checking people who have been in contact with the eight confirmed U.S. cases, who all became ill between late March and mid-April.

The U.S. cases are a growing medical mystery because it’s unclear how they caught the virus. The CDC said none of the eight people were in contact with pigs, which is how people usually catch swine flu. And only a few were in contact with each other.

The virus was first detected in two children in southern California — a 10-year-old boy in San Diego County and a 9-year-old girl in neighboring Imperial County.

Image: Swine flu fears in Mexico
Dario Lopez-mills / AP
People wearing surgical masks walk toward the entrance of the General Hospital in Mexico City on Friday. More than 900 people in Mexico have fallen ill from what health officials suspect is a strain of swine flu.

The cases were detected under unusual circumstances. One was seen at a Navy clinic that participates in a specialized disease detection network, and the other was caught through a specialized surveillance system set up in border communities, CDC officials said.

Investigators have since discovered six more cases. That includes a father and his teenage daughter in San Diego County, a 41-year-old woman in Imperial County who was the only person hospitalized, and two 16-year-old boys who are friends and live in Guadalupe County, Texas, near San Antonio.

Puzzling cases
The Texas cases are especially puzzling. One of the California cases — the 10-year-old boy — traveled to Texas early this month, but that was to Dallas, about 270 miles northeast of San Antonio. He did not travel to the San Antonio area, Schuchat said.

The two 16-year-olds had not traveled recently, Texas health officials said.

No details were available about the eighth victim, a child from San Diego.

CDC officials described the virus as having a unique combination of gene segments not seen in people or pigs before. The bug contains human virus, avian virus from North America and pig viruses from North America, Europe and Asia.The virus may be something completely new, or it may have been around for a while but was only detected now because of improved lab testing and disease surveillance, CDC officials said.

It’s not known if the seasonal flu vaccine Americans got this winter protects against this type of virus. People should wash their hands and take other precautions, CDC officials said.

Antivirals ready if needed
Officials from the World Health Organization said on Friday that it was prepared with "rapid containment measures" including antivirals if needed to combat the swine flu outbreaks in Mexico and the United States.

But health authorities in the two countries have the resources required already in place and are "well equipped," WHO spokeswoman Aphaluck Bhatiasevi said in Geneva.

She said the United Nations agency saw no need at this point to issue travel advisories warning travelers not to go to parts of Mexico or the United States. WHO says it is in daily contact with U.S., Canadian and Mexican authorities and had activated its command and control center for acute public health events.

The WHO will convene a meeting of its Emergency Committee on international health regulations, probably on Saturday afternoon, she added.

Fakta-fakta penyakit flu babi

Para pakar pengendali penyakit masih berupaya mencari jalan dalam mengatasi wabah flu babi di Meksiko dan Amerika Serikat, serta dugaan kasus ini di negara lain.

Apakah flu babi?

Flu babi adalah penyakit pernapasan yang menjangkiti babi.

Disebabkan oleh influenza tipe A, wabah penyakit ini pada babi rutin terjadi dengan tingkat kasus tinggi namun jarang menjadi fatal.

Penyakit ini cenderung mewabah di musim semi dan musim dingin tetapi siklusnya adalah sepanjang tahun.

Ada banyak jenis flu babi dan seperti flu pada manusia penyakit ini secara konstan berubah.

Apakah manusia bisa terjangkit flu babi?

Flu babi biasanya tidak menjalar pada manusia, meski kasus sporadis juga terjadi dan biasanya pada orang yang berhubungan dengan babi.

Catatan mengenai kasus penularan dari manusia ke manusia juga sangat jarang.

Penularan manusia pada manusia flu babi diperkirakan menyebar seperti flu musiman - melalui batuk dan bersin.

Dalam wabah yang kini terjadi belum jelas apakah penyakit itu ditularkan dari manusia ke manusia.

Gejala flu babi pada manusia tampaknya serupa dengan gejala-gejala flu musiman manusia.

Apakah ini jenis baru flu babi?

Badan Kesehatan Dunia, WHO, membenarkan bahwa setidaknya sejumlah kasus adalah versi H1N1 influenza tipe A yang tidak pernah ada sebelumnya.

H1N1 adalah virus yang menyebabkan flu musiman pada manusia secara rutin.

Namun versi paling baru H1N1 ini berbeda: virus ini memuat materi genetik yang khas ditemukan dalam virus yang menulari manusia, unggas dan babi.

Virus flu memiliki kemampuan bertukar komponen genetik satu sama lain, dan besar kemungkinan versi baru H1N1 merupakan hasil perpaduan dari berbagai versi virus yang berbeda yang terjadi di satu binatang sumber.

Apakah aman makan daging babi?

Ya. Tidak ada bukti flu babi menular lewat konsumsi daging binatang yang terjangkit.

Namun, daging itu harus dimasak matang, suhu 70C akan membunuh virus itu.

Apakah warga harus khawatir?

Saat muncul jenis baru flu yang memiliki kemampuan menyebar dari manusia ke manusia pihak berwenang mengawai dengan seksama untuk melihat apakah memiliki potensi menyebabkan pandemi.

WHO memperingatkan kasus-kasus di Meksiko dan Amerika Serikat berpotensi menyebabkan pandemi global dan menegaskan situasi ini serius.

Akan tetapi, WHO mengatakan masih terlalu dini untuk menilai situasi ini secara akurat.

Saat ini, WHO mengatakan dunia hampir mendekati situasi pandemi flu dibandingkan tahun-tahun sejak 1968 - tingkat ancamannya adalah tiga dari skala enam.

Tidak ada yang tahu dampak pandemi penyakit ini sepenuhnya, namun para pakar memperingatkan korban tewas bisa mencapai jutaan orang di seluruh dunia.

Pandemi flu Spanyol, yang dimulai tahun 1819 dan juga disebabkan oleh virus H1N1, menewaskan jutaan orang.

Fakta bahwa kasus-kasus di Amerika Serikat sejauh ini memperlihatkan gejala-gejala ringan merupakan berita baik.

Sementara parahnya wabah di Meksiko kemungkinan disebabkan oleh faktor wilayah yang tidak biasa yang kecil kemungkinan terjadi wilayah lain di dunia.

Akan tetapi, fakta bahwa sebagian besar korban berusia muda menunjukkan satu hal yang tidak baisa.

Biasanya flu musiman cenderung melanda kaum berusia tua.

Bagaimana dengan pengobatan dan vaksin?

Pemerintah Amerika mengatakan dua obat yang biasa digunakan untuk mengobati flu, Tamiflu dan Relenza, tampaknya efektif dalam mengatasi kasus-kasus yang terjadi sejauh ini.

Belum jelas keefektifan vaksin flu yang kini ada dalam melindungi manusia dari virus baru ini, karena secara genetik berbeda dengan jenis flu lain.

Ilmuwan Amerika telah mengembangkan satu vaksin baru, namun diperlukan waktu untuk menyempurnakannya dan juga memproduksi dalam jumlah yang cukup untuk memenuhi permintaan.

Bagaimana dengan flu burung?

Jenis flu burung yang menyebabkan kematian di Asia Tenggara dalam beberapa tahun ini berbeda dengan jenis flu babi yang kini mewabah.

Bentuk baru flu babi ini adalah H1N1 jenis baru, sementara flu burung adalah H5N1.

Para pakar khawatir H5N1 berpotensi menyebabkan pendemi karena kemampuannya bermutasi secara cepat.

Akan tetapi hingga sekarang penyakit itu masih merupakan penyakit unggas.

Mereka yang terjangkit adalah mereka yang berhubungan dengan unggas dan kasus penularan dari manusia ke manusia sangat jarang - tidak ada tanda-tanda bahwa H5N1 sudah bisa menular dari manusia ke manusia dengan mudah.

Waspadai-gejala-komplikasi-diabetes-pada-retina, Jumat, 20 Februari 2009 | 16:50 WIB

DIABETIC RETINOPATHY adalah sebuah kondisi komplikasi diabetes akibat rusaknya pembuluh darah pada jaringan sensitif mata bagian belakang (retina). Penyakit diabetes yang memengaruhi retina dapat berakibat hingga menyebabkan kebutaan.

Dr Ian Yeo Yew San, dokter mata yang menjabat sebagai konsultan di Singapore National Eye Centre yang tergabung dalam layanan wisata sehat, FlyFreeForHealth, mengatakan, “Ketika terkena diabetes, tubuh tidak memanfaatkan gula (glukosa) dengan tepat. Jika kadar gula darah terlalu tinggi, maka lensa alami mata akan membengkak—sehingga pandangan menjadi kabur. Nantinya, jumlah gula yang terlalu banyak tersebut dapat merusak pembuluh darah kecil yang memberi nutrisi pada retina (capillary). Maka muncullah diabetic retinopathy.”

Pertanda dan Gejala
Pada tahap awal, diabetic retinopathy tidak memiliki gejala atau hanya menyebabkan gangguan mata ringan. Namun lama-kelamaan, bisa berujung pada kebutaan. Diabetic retinopathy biasanya memengaruhi kedua mata.

Gejala diabetic retinopathy meliputi :

• Bintik-bintik mengambang pada penglihatan
• Penglihatan kabur atau tidak fokus
• Garis-garis gelap atau merah yang menghalangi penglihatan
• Sulit melihat pada malam hari
• Penglihatan hilang sama sekali / buta

Pemeriksaan / Screening untuk Diabetic Retinopathy
Sebagai bagian dari tes mata, dokter Anda akan melakukan foto terhadap retina yang disebut dengan fluorescein angiography. Pertama-tama, dokter akan memperbesar pupil lalu memfoto bagian dalam mata. Lalu cairan warna khusus akan disuntikkan ke dalam urat nadi di lengan. Foto-foto lain akan diambil seiring dengan cairan warna yang mengalir dan mulai bersirkulasi pada mata. Dokter akan menggunakan foto-foto tersebut untuk melihat pembuluh darah mana yang tertutup, rusak ataupun bocor.

Dokter biasanya juga akan meminta Anda menjalani tes optical coherence tomography (OCT). Tes ini menghasilkan gambar-gambar pemeriksaan silang terhadap retina yang dapat menunjukkan ketebalan retina dan untuk mengetahui apakah cairan tersebut telah bocor ke dalam jaringan retina.

Dr Yeo menyarankan kepada pasien untuk mengendalikan diabetes dengan diet dan pengobatan untuk memperlambat atau mencegah pengembangan diabetic retinopathy atau komplikasi lainnya. Ada baiknya lakukan pemeriksaan mata setahun sekali.