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Arthritis


Arthritis
Definition of Arthritis
Arthritis is a general term for inflammation (inflammation) and swelling in the joints.


Cause of Arthritis
Arthritis can be osteoarthritis (OA) or rheumatoid arthritis (AR), but the most of the encounter is osteoarthritis. In the main causative factor of OA the trauma or the wear of joints, whereas the AR immunological factors play a role.


Clinical Overview of Arthritis
- Symptoms of arthritis vary depending on which joint is involved. OA is more frequent
attacking backer joints weight. Therefore, obesity should be avoided. Meanwhile, AR initially more frequently attack the joints small joints such as wrist or foot, but in advanced can also attack large joints such as shoulder and hip joints.
- Another complaint is similar to the actual arthritis is reumatism derived from soft tissues outside the joint. Which in layman known as gout most are reumatism.
- The joints affected are usually swollen, red and painful.
- AR attack usually begins with prodromal symptoms of weakness, loss of appetite, pain and stiffness throughout the body. Symptoms in the joints is usually occur gradually after few weeks or months.


- Joint pain in the AR is intermittent, there is a period of remission, are symmetrical bilateral, and associated with cold air.
- Attacks are usually sesisi OA. The main symptoms are joint pain associated with the motion. Patients also feel stiff in the joints
attacked.
- On radiological examination usually shows widening of the joint OA at an early stage, osteophytes, bone sclerosis and narrowing of the cavity between joints at an advanced stage.
- Deformities can occur in OA and AR after the destruction of the health center joints

 Diagnosis of Arthritis
Pain and swelling in the joints.

Management of Arthritis
- Complaints to the joints or soft tissues around it could be solved with regular analgesics or anti-inflammatory drugs given after eat.
• asetosal 1 gram 3 times daily
• Fenilbutason 200 mg 3 times daily
• ibuprofen 400 mg three times daily
- Resting the joint is required in the acute situation. Later in the OA, patients may need to improve posture, reduce weight, or physiotherapy.
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Angina pectoris


Angina pectoris

Definition
Angina pectoris is a clinical condition characterized by discomfort or chest pain due to myocardial ischemia. Clinically indistinguishable forms of the two forms of angina, stable angina and the
unstable. Unstable angina is a more severe form that can be develop and / or an early form of myocardial infarction, so patients need to be checked and further observed in the hospital.



Cause
Ischemia occurs because the supply of oxygen carried by the coronary blood flow inadequate myocardial oxygen demand. This happens when the need increased myocardial oxygen (eg due to physical labor, emotional, thyrotoxicosis, hypertension), or when the coronary blood flow is reduced (eg in spasm or coronary thrombus) or in the event of both.

Clinical Overview
- The patient complains of chest pain of various shapes and locations.
- The pain begins as a feeling squeezed, pinched, or feel a burning sensation spread to the inside of the left arm and sometimes down to his shoulder, shoulder and left neck, even down to the left little finger.
- This feeling may also spread to the waist, throat, jaw and teeth There are also convey the right arm.
- Discomfort can also be felt in the gut, but is rarely felt in the area apex beat.
- The pain may be accompanied beberapan or one of the following symptoms: sweating chills, nausea and vomiting, weakness, palpitations and feeling faint (Fainting).
- In most cases of angina occur during physical activity (unstable angina).
- This attack will be lost if patients stop the physical activity and rest.
- The attack lasted only a few minutes (1-5 minutes) but can be up more than 20 minutes.
- Angina pain are constant. When such changes occur long attack increases, the pain is more severe, the onset threshold.
- Decreased or attack came when wake up, then the disorder should watch. This change may be a sign prainfark (angina not stable).
- A form of change (variant) called Prinzmetal angina usually arise when the patient is resting.
- Angina is said to gain weight when the next attack occurred after lighter physical work, such as after meals. It is also classified as unstable angina.
- Physical examination is generally not outside attack showed abnormalities
means. At the time of the attacks, increased heart rate, blood pressure
increased and in region of heart was beating hard precordium.
- On auscultation, heart sounds heard far away, heard the loud systolic mid or late systole and the fourth sound.
- Usually found risk factors: hypertension, obesity or diabetes mellitus.

Diagnosis
- Chest pain retrosternal
- Examination of the ECG Management
- Abnormalities of underlying angina pectoris should be sought, then reduced or treated. Factors that aggravate such as smoking, weight excessive, and coffee drinking habits should be avoided.
- High blood pressure is treated.
- Stress-controlled
- Unstable angina should be treated in the hospital.

Treatment of acute attacks
- Acute attacks overcome with the rest to the heart of diminished activity. Vasodilators work to improve the supply of oxygen and reduced cardiac oxygen consumption.
- Sublingual nitroglycerin from 0.15 to 0.6 mg is very effective. These tablets can be used several times a day with no side effects except for headache.

When the first tablet should be repeated not help, but if after repeated 3
time the symptoms did not decrease the possibility of infarction has occurred.
- Isosorbid dinitrat (ISDN) sublingual 2.5 to 5 mg which can also be repeated or oral tablets 5-30 mg.

2. Prevention of attacks
- Propranolol effective for angina pectoris because it can reduce labor
heart muscle, thereby reducing the oxygen demand of the heart. Clinical effects
propranolol is achieved when the heart rate at rest 60-70
beats / min.
Initial dose: 20 mg 2 x daily.
Maximum dose: 120 mg a day.
This drug should not be used in Prinzmetal angina.
- Nitrate old work: ISDN oral tablets 10-20 mg 2 x daily.
- Nifedipine 10-20 mg 4 times daily, or diltiazem 30 - 60mg three times daily, or verapamil 40 - 80 mg 3 times daily.
- Unstable Angina: need special care.
- Variant angina: a powerful dilator: nitrates, calcium antagonists, prazosin 0.5 - 1mg
3 x daily with titrasi.
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Anemia


Anemia

Definition of Anemia
Anemia can be classified according to several criteria, but the most is a practical grouping based on the occurrence of anemia post hemorrhage, hemolytic anemia, deficiency anemia, aplastic anemia and anemia due to malignancy.



Cause of Anemia
Insufficient blood production (due to a deficiency or failure of the bone marrow), excessive blood loss, excessive destruction of blood or a combination of these factors. Blood loss and chronic cryptic, for example in ankilostomiasis, cause iron deficiency anemia, hemolysis, among others, while it occurs G6PD deficiency and thalassemia.

Clinical Overview of Anemia
- Anemia caused by sudden blood loss, and many will spur
body's homeostatic compensation. Acute blood loss as much as 12-15%
will give the symptoms of pallor, tachycardia with normal blood pressure or
low. Loss of 15-20% causes the blood pressure begins to drop until
shock, and loss of 20% can result in death.
- Deficiency anemia is characterized by fatigue, frequent palpitations, fatigue and irritability
headache. Optic disc atrophy of the tongue looks. Sometimes enlarged heart and sound
systolic murmur. In the peripheral blood picture of anemia appear hipokrom and
mikrositer, while low serum iron content.
- Deficiency of vitamin B12 and folic acid causes megaloblastic anemia
which may be accompanied by neurological symptoms.
- Hemolytic anemia may be accompanied by an increase in blood bilirubin (jaundice).
The spleen is generally enlarged.
- Aplastic anemia is apparent from the low levels of hemoglobin and other systemic symptoms,
without enlargement of the organ.

Diagnosis
Examination of hemoglobin concentration and peripheral blood.
common Hb <12 g / dl.Pedoman Treatment in Primary Health Centers 2007


Management of Anemia
- Successful treatment depends on the ability to enforce
diagnosis at an early stage.
- Anemia pascaperdarahan treated with blood transfusions as much as 10-20
ml / kg body weight, or plasma expander. If there is no second, intravenous fluids
also can be used.
- The impact can be overcome by slow transfusion of packed red cells.
- Iron deficiency anemia treated with adequate food, sulfas ferosus
10 mg / kg 3 times daily or Iron elementary 1mg/kgBB/hari
- Anemia Megaloblastic specific treatment, therefore, should be distinguished
cause, deficiency of vitamin B12 or folic acid deficiency.
• The dose of vitamin B12 100 mcg / day im, for 5 - 10 days as initial therapy
rumat therapy followed by 100-200 mcg / months to achieve remission.
• The dose of folic acid 0.5 - 1mg/hari orally for 10 days, followed
with 0.1 - 0.5 mg / day.
The use of oral vitamin B12 is useless in pernicious anemia.
Besides the oral dosage is more expensive.
- Autoimmune Hemolysis resolved with prednisone 2-5 mg / kg / day orally and
testosterone 1-2 mg / kg / day iv, for the long term.
- Blood transfusion given only when necessary.
- Refer to hospital
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AIDS


AIDS

Definition
AIDS (Acquired Immuno Deficiency Syndrome) is a collection of symptoms diseases caused by Human Immunodeficiency Virus (HIV). HIV is found in body fluids, especially blood, semen, cairam vagina and breast milk. The virus damages the immune system people and resulted in the decline or loss of endurance, so infection and illness.



Cause of aids
HIV is a virus, a type of retrovirus that includes the virus type using RNA as a molecular carrier of genetic information.


Clinical Overview of aids

  A clinical categories include HIV infection without symptoms (asymptomatic), lymph
denopati generalized persistent and acute primary infection with the disease broadcaster.
  Category B consists of a clinical condition with symptoms in adolescents / adults
infected with HIV are not included in categories C and meet the most
less one of the following criteria:

A) The state associated with the presence of HIV infection or the presence of
immunodeficiency diperantarakan cell (Cell-mediated immunity)
or

B) The conditions that have been deemed by doctors require clinical treatment
or require the management of complications of HIV infection
with an example:
Angiomatosis basilari; oropharyngeal candidiasis; vulvovaginal candidiasis;
Cervical dysplasia; 38.5 OC fever or diarrhea for more than 1 month;
Oral hairy leukoplakia: Herpes zoster; idiopathic thrombocytopenic purpura;
Listeriosis: Pelvic inflammatory disease: Peripheral Neuropathy

  Category C includes the clinical symptoms found in AIDS patients
for example:
Kandisiasis bronchi, trachea and lungs; esophageal candidiasis; Cervical Cancer
invasive; Coccidiodomycosi spread or in the lung; cryptococcosis in
outside the lung; Retinistis cytomegalovirus; Encephalopathy associated
with HIV, Herpes simplex or chronic ulcers over a month
duration; bronchitis, esophagitis or pneumonia; Histoplasmosis spreads
or outside the lung; Isosporiasis instestinal chronicles more than a month;
Kaposi's sarcoma; Lymphoma burkit (or other terms indicate that the lesion
similar); lymphoma immuno blastik, L.primer in the brain; Micobacterium avium
Complex or M.lansii spread outside the lung; M.tuberculosis anywhere
(Pulmonary or extrapulmonary); Pneumocystis carinii pneumonia; Leukoensefalopati
progressive multifocal; recurrent salmonella septicemia;
Taksoplasmosis in the brain.

Diagnosis of aids
Diagnosis based on clinical symptoms and blood examination. On examination the blood can be tested directly against the HIV virus or indirectly by determining the anti-bodies, which have been and more easy to implement. Today many types of tests that have a sensitivity and
high specificity is available.

Treatment / Management of aids
Currently there are three classes of antiretroviral drugs available in Indonesia:

•  Nucleoside Reverse Transcriptase Inhibitors (NsRTI): This drug is known as a nucleoside analog that inhibits the process of change in viral RNA into DNA. This process is necessary so that the virus can replicate. Drug in this group include zidovudine (ZDV or AZT), lamivudine
(3TC), ddI (didanosine) zalcitabine (ddC), stavudine (d4T) and abacavir (ABC).

•  Non-Nucleside Reserve Trancriptase Inhibitor (NNsRTI): this drug although in contrast to NRTIs also inhibit the process of change in RNA into DNA. in drugs include nevirapine (NVP),
efavirenz (EFV) and delavirdine (DLV).
•  Protease Inhibitor (PI): These drugs inhibit the enzyme protease that cuts the long chain acids into proteins of interest more minor. Drugs in golonganini including indinavir (IDV), nelfinavir (NFV), saquinavir (SQV), ritonavir (RTV), amprenavir (APV), and
lopinavir / ritonavir (LPV / r).
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