BIRD FLU

Definitions
Bird flu (Avian influenza) is an acute infectious disease caused by
virus that attacks the birds in general, and can also spread from birds
to humans.
Causes
Influenza virus type A H5N1 sub-type
Ways of transmission
Spread the disease to humans can be through:
a. Animals: direct contact with sick poultry or poultry products which
dakit
b. Environment: air or equipment tercemar virus either
comes from the feces or sekret birds fell ill that bird flu virus (AI)
c. Human: very limited and inefficient (found several cases
in group / cluster)
d. The consumption of poultry products that do not have any cooked perfectly
the potential of bird flu virus.
Clinical picture
The period of incubation average 3 (1 - 7 days). The period of transmission in humans is 1 day
before and 3 - 5 days after the symptoms arise, while the transmission to the child
can reach 21 days. Caused the same symptoms as ordinary flu, marked
with a sudden fever (temperature • 38oC), cough, runny nose, sore throat, shortness,
headache, malaise, vomiting, diarrhea and muscle pain.
Diagnosis
1. Suspect bird flu
When the fever (temperature • 38oC) with one or more of the following symptoms:
- Coughing
- Pain Management throat
- Colds
- Breathless,

Accompanied by one or more of Exposure below 7 days before
the incidence of symptoms:
- My close (within 1 meter), such as caring, talking, or
in contact with the suspect patient (suspek), or probabel cases of H5N1
which confirmed.
- Touch such as handling, slaughter, revoke wool, cut,
prepared for consumption with chickens, wild birds, dead
birds or the environment against tercemar by the poultry faeces
in areas where infection with H5N1 in humans or animals
have been suspected or confirmed in the last one month.
- Consuming raw poultry products, or that are not cooked with
perfect in the region that is suspected or found animals or
human H5N1 infection in the last one month.
- Contact closely with other animals (other than poultry or other birds),
such as cats or pigs that have been confirmed infected with H5N1.
- Hold / sample handling (animal or human) suspected of containing
H5N1 virus in a laboratory suastu or other places
- Found leukopenia (under the normal value: 5000 - 10,000).
- Found titer antibody against H5 with inspections using the HI test
eritrosit horse or ELISA test for influenza A without a sub-type.
- Photos Toraks show the pneumonia quickly deteriorate in the serial
photo.
2. People (confirmation) bird flu
When the suspect, along with one of the positive results following the
conducted in the laboratory influenza national, regional or international
the results of the examination H5N1nya recognized by WHO as a confirmation:
- Isolation influenza A/H5N1 virus-positive
- Results PCR positive influenza A/H5N1
- Increased • 4-fold antibody titer for H5N1 from netralisasi specimens
konvalesen specimens compared with the acute (7 days is taken up
ONSET disease), and antibody titer must also netralisasi • 1 / 80).
•

- Titer antibody mikronetralisasi H5N1 • 1 / 80 in the serum specimens
taken on the day to 14 after • ONSET disease, along with the results postif
serologis another test, for example, HI titer horse red blood cells • 1 / 160 or
western blot specific H5 positive.
Treatmnet
a. Suspect bird flu given oseltamivir 75 mg x 2 a day for 5 days.
Children in accordance with the dose of body weight (age> 1 year: 2mg/kgBB), and
referred to hospitals bird flu
b. Provision must follow the system skoring agreed (see
book Bird Flu Control and Use of Oseltamivir in the health,
2006)
c. Each of oseltamivir should be based on a doctor's note and and
reported in accordance with a format that is available.
d. Oseltamivir is not recommended for profilaksis and by pemberiannya
doctor.
Prevention
Efforts to do with the prevention of ways to avoid that
contaminated feces and sekret poultry, with the following:
- Any person related to the material that comes from the channel dissolved
poultry should use protective (mask, glasses pool)
- Materials that come from channels such as indigestion poultry excrement must treat
well (planted / burned) in order not to become a source of transmission for
the surrounding
- Tools used in livestock should be washed with
disinfectant
- Coop feces and can not be excluded from the location of livestock
- Consume chicken that has been cooked at a temperature less than most
80oC for 1 minute, while poultry eggs should be heated at a temperature
64oC for 5 minutes
- Maintain environmental hygiene
- Maintain cleanliness self
- For those who do not be concerned, are forbidden to enter the farm
- When exposed to influenza are forbidden to enter the farm.
- If you're planting farming using manure required
using gloves and masks
- Each farm workers, cutting penjamah poultry and poultry that
exposed to influenza immediately to a health clinic or other health services.

FARINGITIS acute

Definitions
Faringitis is Inflamasi or infection of the membrane mukosa faring (can also
tonsilo palatina).
Acute Faringitis is usually the part of the acute infection orofaring namely tonsilo
faringitis acute, or part of the influenza (rinofaringitis).
Causes
Faringitis can be caused by a virus or bacteria.
- Virus (that is, rhinovirus, adenovirus, parainfluenza, coxsackievirus, Epstein --
Barr virus, herpes virus)
- Bakteria (ie, group A ß-hemolytic Streptococcus [most]), Chlamydia,
Corynebacterium diphtheriae, Hemophilus influenzae, Neisseria gonorrhoeae
- Jamur (ie Candida); rare except in people with imunokompromis (ie
those with HIV and AIDS)
Irritation that stimulate food is often a factor or a fuse
aggravate.
Clinical picture
Travel disease depends on the existence of secondary infection and virulensi
kumannya and resistance of the body, but usually recover faringitis
in the 3 - 5 days.
Faringitis caused bacteria:
- Fever or shivering
- Nyeri swallow
- Faring posterior red and swollen
- There are folikel bereksudat and purulen on the wall faring
- Perhaps the cough
- Pembesaran neck lymph gland anterior part
- Do not want to eat / swallow
- ONSET sore throat of a sudden
- Malaise
- Anoreksia

Faringitis because of the virus:
- ONSET inflammation tenggorokannya slow, progressive
- Fever
- Nyeri swallow
- Faring posterior red and swollen
- Malaise light
- Coughing
- Nasal congestion
Diagnosis
Diagnosis based on symptoms and physical examination results.
Treatment
- Care and treatment is not different from the influenza.
- For children there is no specific suggestion medicine.
- For fever and pain:
Adult §
Paracetamol 250 or 500 mg, 1 - 2 tablets per day oral 4 x if necessary,
or ibuprofen, 200 mg 1 - 2 x 4 tablets a day if needed.
§ Children
Paracetamol given 3 times a day if the fever
- Under 1 year: 60 mg / time (1 / 8 tablet)
- 1 - 3 years: 60 - 120 mg / time (1 / 4 tablet)
- 3 - 6 years: 120 - 170 mg / time (1 / 3 tablets)
- 6 - 12 years: 170 - 300 mg / time (1 / 2 tablet)
- Obati with antibiotics if there is suspected infection:
Adult §
o Kotrimoksazol 2 x 2 adult tablets a day for 5 days
o Amoksisilin 500 mg x 3 a day for 5 days
o either erythromycin 500 mg x 3 a day for 5 days
§ Children
o Kotrimoksazol 2 children 2 x tablets a day for 5 days
o Amoksisilin 30 - 50mg/kgBB per day for 5 days
o either erythromycin 20 - 40 mg / kgBB per day for 5 days

EPILEPSI

Definitions
Epilepsy is a disease with a marked tendency for
experienced recurrent convulsions.
attackted form is the most common strain that began with
loss of consciousness, loss of control of the movement and the occurrence of convulsions and tonic
klonik members or on the body.
Causes
Deviation of functional brain attackted are relapse. Aberration organic
also in the brain can cause epilepsy, so that this possibility should be considered.
From the pattern attackted, epilepsy be top general for example epilepsy epilepsy
grand mal, Petit mal, or mioklonik and partial epilepsy for example, attacks fokal
motor, fokal sensorik.
Clinical picture
- Grand mal seizures often begin with a sense of aura or sink
float. The decline in the awareness, the head turned to one side, the teeth
tight and the loss of bladder control, breath
snore, frothy and mouth can occur inkontinesia. Then there
tonic convulsions throughout the body for 20 - 30 seconds followed by a strain on klonik
members of muscle, muscle back and neck muscles which lasted 2 - 3 minutes.
After missing a strain of weak lie asleep or 3 - 4 hours,
awareness and then gradually recover. After the attack patients are often
in a state of confusion.
- Petit mal seizures, also called the attack lena, begins with the awareness of missing
for 10 - 30 seconds. During phase lena (absence) of motor stopped
and patients still do not act. Sometimes look like there is no attack, but
sometimes arise in the mouth movement klonik or lid.
- The attack mioklonik is a short muscle contraction or groups
muscle.
- Motor simple partial seizures can be a strain that started in the wrong
one hand and spreading sesisi, while partial seizures can sensorik
a sense of Baal pins or unilateral.

- Simple partial seizures (psikomotor) complex, people lost contact
the environment for 1 - 2 minutes, move the arms and
tungkainya with a strange and without a goal, issued suarasuara
that means no, not able to understand what other people say
and refused assistance. Confusion lasted several minutes and
followed by total healing.
- On Epilepsi primary generalisata, people with experience as a reaction to a strain
the body of the cargo that abnormal. Then the patient may experience
headache, while the weak and felt very tired. Usually people
can not remember what happened during convulsions.
- Stats epileptikus is the most serious strain, the strain occurred
continuously, do not stop. Muscle contraction is very strong, not able to breathe
as appropriate and in the electrical load otaknya spread wide.
If not treated promptly, the damage can occur and the brain of the heart
people can live and die.
Diagnosis
Ditegakkan diagnosis based on symptoms presented by others
who witnessed the occurrence of attacks in people with epilepsy and a history
disease earlier.
Penatalaksanaan
- The principle of common idiopatik epilepsy therapy is to reduce / prevent attacks,
while organic epilepsy therapy directed against it.
- The spark attacks, such as fatigue, emotional eating or rupture
drugs must be avoided.
- When the attacks occurred convulsions, strived avoid injury from a strain,
for example bited tongue or injury or other injury.
- Step that is important to keep the patient does not drop,
loosen clothes (especially in the neck) and install a pillow
under the head of the patient.
- If the patient does not sadarkan should position themselves to be more dimiringkan
easy to breathe and can not be left alone to actually
conscious and able to move normally.
- Anti-convulsive medicine to prevent the occurrence of further convulsions, usually given
to the people who experience cramps kambuhan. Status epileptikus
is a state of emergency, therefore, anti-convulsive medication was given in doses
the high intravena.

- Wherever possible and use a single drug to start with low doses.
- When a single dose of medication does not effectively use a maximum of two types of drugs with
the lowest dose.
- When the attacks do not think overcame the possibility of disloyalty,
organic causes, the choice and dose of drugs that are less precise.
- If during the 2 - 3 years does not arise again attack, drugs can be stopped
gradually.
- Options antiepilepsi
Type Kejang Type Drugs
Fokal / Partial
Common
Tonic-klonik
Mioklonik
Lena attack
Fenobarbital or fenitoin
Fenobarbital or fenitoin
Fenobarbital or fenitoin
Diazepam
Diazepam
- Babies and children:
o iv 0.2 - 0.3 mg / kgBB / dose (1 mg / year age) was given in 3 - 5
minutes, every 15 - 30 minutes to a maximum total dose of 5 mg, repeated
in 2 - 4 hours if necessary;
o rektal: infants <6 months, is not recommended; <2 years: security and
effectiveness has not been tested; 2 - 5 years: 0.5 mg / kgBB; 6 - 11 years: 0.3
mg / kgBB; • 12 years: 0.2 mg / kgBB.
- To maintain:
Fenobarbital 1 - 5 mg / kgBB / day x 1 day
Fenitoin 4 - 20 mg / kgBB 2 - 3 x day

Diphtheritic

Definitions
Diphtheria is an acute infection of the respiratory channels of the top
caused by the bacteria Corynebacterium diphtheriae. More often attacked
children.
Causes
The bacteria is Corynebacterium diphtheriae. The bacteria is usually
the respiratory channel, especially laring, tonsil and throat. But
not less toxic and also attacks the skin and even cause nerve damage
and heart.
Clinic picture
- The period of the shoot 2 - 7 days
- People complain pain and swallow breath (stridor),
the children do not often followed by fever, nausea, vomiting, shivering and headache.
- People with shortness of breath appear with or without signs obstruksi breath.
- Not a high fever.
- On examination throat membrane appear grayish white that is easily
bleed when touched.
- Symptoms do not always have this:
§ Stopped roads so that people breath sianosis
§ smell breath
§ bleeding nose
- The enlargement limfe gland in the neck (bullneck)
- Inflamasi with many local eksudat faring, eksudat in a sticky
mukosa gray or dark edema and network software. In the children,
phases of this disease can lead to road obstruksi breath.
- Systemic disease caused by bacterial toxin started 1 - 2
sunday after a local phenomenon. Toxin affects the heart (miokarditis,
aritmia especially during the second week of illness) and nerve system
(paralisis, neuritis 2 - 7 sunday after ONSET disease). When patients
recover from the acute phase of disease, usually recover without deviation broadcaster.

Diagnosis
Therapy needs to be decided on the basis of anamnesis and description
clinical.
Diagnosis is confirmed with a culture of bacteria taken into eksudat
tube to sample bacteria. Samples must dikultur on special media, for that
need to first notify the laboratory. Lear preparat taken 3 days
respectively.
Treatment
- Patients asimtomatik given antibiotics profilaktik either erythromycin.
- Patients should simtomatik referred to hospital

NON specific DIARE

Definitions
Diarrhea is a condition dispose waste water with a lot of liquids and is a symptom
from certain diseases or other interference.
Acute diarrhea is defecate soft / thin liquid consistency, more often
usually accompanied's slimy, smell, and even can be a foamy water only
frekwensi that more often than usual.
Diarrhea is nonspesifik diarrhea that was not caused by bacteria or special
parasites.
Causes
It is a virus, or food that stimulates the kontaminated toxin,
indigestion, and so forth.
Clinical picture
- Fever that often accompany the disease aggravate dehydration. Symptoms
dehydration will not be visible until fluid loss reaches 4 - 5% weight
body.
- Symptoms and signs of dehydration are:
§ Pain thirst, dry mouth and lips
§ The decreasing skin turgor
§ The decreasing weight, hipotensi, weak muscles
§ shortness breath, anxiety
§ sunken eyes, no tears
§ crown of the baby in the cavernous
§ Oliguria and anuria
§ The decreasing awareness, nod
- If lack of fluid reaches 10% or more people to fall in
weight and dehydration can occur if the ongoing shock and death.
Diagnosis
Determined from the symptoms defecate repeated more often than usual
with the consistency of soft and liquid.
treatment

- WHO has set a key element in 4 of acute diarrhea
namely:
§ The provision of fluids, such as efforts rehidrasi oral (URO) to prevent
and treat dehydration.
§ Continuing the provision of food as usual, especially breastfeeding, during the
diarrhea, and in healing.
§ Not using antidiare, while antibiotics and antimikroba
only to cases of suspected cholera, dysentery, or giardiasis or terbukti
amubiasis.
§ Provision of effective guidance for mothers and children and their families
about oral rehidrasi efforts at home, signs, and to refer
ways to prevent diarrhea in the future.
- Primary treatment is acute diarrhea and improve rehidrasi
fluid and electrolyte balance. Thus the first step is
specify the degree of dehydration.
examination
degree of dehydration
no
dehydration
dehydration
light - weight are dehydration
general situation
eye
tears
the mouth and tongue
feeling thirsty
skin turgor
well aware
normal
There
wet
Normal,
not thirsty
you are welcome
fast
nervous
cavernous
nothing
dry
thirsty, you want to
drink lots
slow return
lethargic, not aware
very sunken
nothing
very dry
lazy or drink
can not drink
again very
slow
Basic guidelines Medicine Clinic in 2007
58
- Then do rehidrasi as efforts made to dehydration
as cholera.
- In the patients without diarrhea dehydration: (Terapi A)
§ Provide liquid (water starch, sugar salt solution, oralit) of the desired
to stop diarrhea, as per the instructions given out
CHAPTER
o Children <1 yr: 50 - 100 ml
o Child 1 - 4 yr: 100 - 200 ml.
o Children> 5 years: 200 - 300 ml
o Adult: 300 - 400 ml
§ Forward feeding or breastfeeding for infants
- In people with mild diarrhea with dehydration - are (Terapi B):
§ Oralit given 75 ml / kg BB in 3 hours, not the bottle.
§ If the child vomits (because the fluid is too fast), wait 5-10
minutes ago that again, with the slower (one spoonful each
2-3 minutes).
- In patients with diarrhea dehydration weight (Terapi C):
Given Ringer Laktat § 100 ml of divided in some time
§ Every 1-2 hours re-examined the patient, if not improved hidrasi
dipercepat drops. After 6 hours (infants) or three hours (older patients)
patients back in check
Age
Giving the first
30 ml / kg
Provision and
70 ml / kg
infants (<12 days)
> 12 months
in 1 hour
30 minutes
in 5 hours
2.5 hours

DIABETES MELITUS

Definitions
Melitus diabetes (DM) is a metabolic disease marked by high
measure plasma glucose (hiperglikemia) caused by interference sekresi
insulin, insulin action or both.
Have type 2 DM on the basis of the start of the disease, namely:
1. Type-1, Insulin dependent Diabetes Melitus (IDDM) or type of youth
On this there is a type of destruction beta cells pancreas, so it does not
insulin producing cells and consequently can not absorb glucose from the blood.
Blood glucose level increased so that the excess glucose was issued through
urine. Type this happens a lot at the age of 30 years and most often starts in
age 10 - 13 years.
2. Type-2, Non-Insulin dependent Diabetes Melitus (NIDDM) or type of adult
This does not depend on the type of insulin, usually occurs at the age of above 40
years with a greater incidence in the fat and old age.
Causes
The lack of hormone insulin, which functions as a source of glucose utilizing
sintesa energy and fat.
Type-1 it can not clearly caused by a virus infection
cause auto-immune reaction to cope with excess virus, more than that
descendants of factors holding role.
Type-2 is caused by declining function of beta cells and the cumulation amiloid
the beta cells.
Insufisiensi insulin function caused by the disruption of production or defisiensi
insulin by beta cells langerhans pancreas gland, or due to less
responsifnya cells of the body's insulin.

Clinical picture
a. People often complain that weak, sometimes feels a sense pins or
Baal and itching that chronicles.
b. People in general have poliuria , polidipsia
(lots of drinking) and polifagia (many meals).
c. A decrease in body weight that can not be explained.
d. Besides, people will feel very thirsty, loss of energy, feeling faint
and quickly tired.
e. In the case may go decrease the sharpness of vision
Diagnosis
Based on the symptoms of diabetes with the 3P (polifagia, poliuria, polidipsia). Diagnosis
can be ascertained with the determination of blood sugar.
a. When the blood glucose level at 200 mg / dl
b. Fasting blood glucose 126 mg / dl
c. Tolerance Test in Oral glucose (TTGO) obtained results of the examination content
blood sugar 2 hours 200 mg / dl after 75 grams of glucose.
Penatalaksanaan
a. Actions undertaken for diabetics, among others; diet with
calorie restriction, exercise occurs when insulin resistance exercise
regularly can minimize it, stop smoking because nicotine can
affect the absorption of glucose by cells.
b. if public action is not effective in lowering blood glucose of
Type 2 diabetes-the oral antidiabetik can be given:
- Klorpropamid start with 0.1 gr / day in the once, the maximum
0.5 mg / day
- Glibenklamid start with 5 mg / day in the once, the maximum
10 mg / day
- Metformin started with 0.5 gr / day in 2 - 3 times a provision, the maximum
2 g / day.
This medicine must begin with the smallest dose. After 2 weeks treatment,
dose can be increased.
c. In the diabetics Type-1 was given insulin for life, not
recommended drinking antidiabetik oral.