Understanding Sore Throat Pharyngitis Disease

       Sore throat (pharyngitis) is a thickening or swelling of the throat wall, colored red, no white spots painful when swallowing food.

Pharyngitis is divided into 2 (two), namely:

a. Acute pharyngitis

       Febri throat is inflammation caused by viral organisms almost 70%. Streptokokkus group A is the most common bacterial organisms are related to acute pharyngitis.

       Uncomplicated viral infection usually disappear but soon, within 3-10 days of onset suit. However, pharyngitis caused by more virulent bacteria such as group A streptokokkus is more severe illness during the acute phase, and much more penging because of the danger of complications incident. This complication termasukl Sinuitis, otitis media, abscesses peritonsilan, kastidis, adenitis cervical, rheumatic fever and refritis, culture tenmggorokan is the main way in determining the causative organism after prescribed appropriate therapy swab laborers come and blood cultures may also be performed to identify the organism.

b. Chronic pharyngitis

Pharyngitis chronic common in adult individuals who work or live in a dusty environment. Using excessive noise, suffering from chronic cough and the habitual use of alcohol and tobacco.

Identified three types of Pharyngitis: 

1. Hepertrofik, characterized by thickening of the public and pharyngeal mucous membrane congestion, 
2. Chronic, probably the later stages of the first kind (a thin membrane, whitish slippery, and in time wrinkled) and 
3. Chronic granular (clegyran's sore throat) with some swelling of the lymph follicles in the pharyngeal wall.

Cause inflammation of throat (pharyngitis)

1. Virus, 80% of sore throat caused by a virus can cause fever

2. Cough and cold. Where cough and lenders (nasal mucus) to make irritated throat.

3. Cozsackie virus (hand, foot and mouth disease)

4. Available. Allergies can cause throat irritation, chronic nature of light (live)

5. Streptococcus bacteria. In the laboratory using the results of patient stroking throat. Can be determined from the bacteria Streptococcus classical symptoms such as pain when you swallow saw a great white spots, vomit, pus, amandelnya gland, accompanied by enlarged lymph amandelnya.

       Most of laryngitis caused by two types of infection, ie viruses and bacteria. Around 80% of laryngitis caused by a virus and caused about 10-28% of bacteria. To be able to overcome it is important to know the infection caused by the virus or bacterium Streptococcus. Virus infection is often the cause salesma (cold) and the occurrence of influenza that then lead to laryngitis. Salesma usually heals itself around a week so your body membentuh antibodies against the virus. Treatment with antibiotics will not be effective for mengtasi viral infection. Instead, the provision of antibiotics can create resistance or immunity to the antibiotic bacteria. When the bacteria resistant to antibiotics. When we use antibiotics are not effective in removing germs. As a result, suffered the disease do not recover.

Symptoms and signs of inflammation of the throat (pharyngitis) In general symptoms and signs of pharyngitis are:

1. Burning or itching and dry

2. Coughing and sneezing

3. Low fever or no fever

4. Hoarse or raspy voice

5. Meler nose and behind the nasal secretions

Signs and symptoms of acute pharyngitis among others:

1. Mucous membranes are red

2. Tonsils-tinted

3. Kolikel lymphoid swollen and filled with aksudat

4. Magnifications and painful cervical lymph press

Chronic pharyngitis signs and symptoms limiting:

1. Sensation of irritation

2. Crowded at the throat in continuous

3. Mucus that collects in the throat and cough can be produced with

4. Difficulty swallowing

Codes of inflammation of throat (pharyngitis)

a. Acute pharyngitis

       If you suspect or banterial cause shown, the medication can include providing anti irikrobial. For Streptococcus group A, penicillin or who have resistant organisms eritromisin (fifth penicillin and eritromisin), used sefalusfarin. Antibiotics given for at least 10 days to remove grouyp A Streptococcus from orofarin.

       Liquid or soft diet is given in the acute stage of disease depends on the patient's appetite and the level of discomfort that occurs with swallowing. Sore throat sometimes so fluid can not be consumed in adequate amounts by mouth. In severe cases fluids given intravenously. Instead patients are encouraged to augment drinking as much as it did with at least 2-3 liters per day.

b. Chronic pharyngitis

       Treatment of chronic pharyngitis based on the removal of symptoms, avoid pemajangan for dermatitis and correct any interference on the bronchi, lung or heart disease that may lead to chronic cough.

       Kongestinasal may be removed by spraynasal or medicines that contain epinephrine sulfate (ofrin) or fenilekrin hydrochloride (neo-syn-phrine). If there is history of allergy, antihistamines, decongestants one medication as drikoral or dinetap, drink 1-6 hours. Malaise can be controlled effectively with aspirin or asitaminofen. Contact with others should be avoided, at least until the fever is really lost.

       Prior to treatment is very important for physicians to find the causes of throat (pharyngitis) uses a true diagnosis of the cause with the aim of giving antibiotics to prevent inappropriate for most patients because of laryngitis can cause antibiotic resistant organisms. A doctor will examine the throat and neck lymph nodes. Advanced approach is to test for the throat stroked or otherwise bekteri mengetahjui there. Pat him on the throat should dilakuakn if any unexpected diagnosis of laryngitis due to Streptococcus bacteria based on clinical findings and epidermiologis and patients not consuming antibiotics.

       Hasik stroking throat culture is usually the one who takes the test, but sensitivity to the antibiotic has to be done in patients who are allergic to penicillin resistant Streptococcus bacteria because terhdap erotromisin.

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Inflammatory Bowel Disease

Inflammatory Bowel Disease

Inflammatory bowel disease (IBD) is the general name for ulcerative colitis and Crohn’s disease. The disease is characterized by swelling, ulcerations, and loss of function of the intestines.

The primary problem in IBD is inflammation, as the name suggests. Inflammation is a process that often occurs to fight off foreign invaders in the body, including viruses, bacteria, and fungi. In response to such organisms, the body’s immune system begins to produce a variety of cells and chemicals intended to stop the invasion.

These immune cells and chemicals, however, also have direct effects on the body’s tissues, resulting in heat, redness, swelling, and loss of function. No one knows what starts the cycle of inflammation in IBD, but the result is a swollen, boggy intestine.

In ulcerative colitis, the inflammation affects the lining of the rectum and large intestine. It is thought that the inflammation typically begins in the last segment of large intestine, which empties into the rectum (sigmoid colon).

This inflammation may spread through the entire large intestine, but only rarely affects the very last section of the small intestine (ileum). The rest of the small intestine remains normal.

Crohn’s disease is a form of IBD that affects both the small and large intestines. The inflammation of ulcerative colitis occurs only in the lining of the intestine (unlike Crohn’s disease which affects all of the layers of the intestinal wall). As the inflammation continues, the tissue of the intestine begins to slough off, leaving pits (ulcerations) that often become infected.

IBD can occur in all age groups, with the most common age of diagnosis being 15–35 years of age. Men and women are affected equally. Whites are more frequently affected than other racial groups, and people of Jewish origin have three to six times greater likelihood of suffering from IBD. IBD is familial; an IBD patient has a 20% chance of having other relatives who are fellow sufferers.

Causes and Symptoms

No specific cause of IBD has been identified. Although no organism (virus, bacteria, or fungi) has been found to set off the cycle of inflammation, some researchers continue to suspect that an organism is responsible.

Other researchers are concentrating on identifying some change in the cells of the colon that would make the body’s immune system accidentally begin treating those cells as foreign.

Additional evidence for a disorder of the immune system includes the high number of other immune disorders that frequently accompany IBD. The condition has also been linked to physical, mental, and emotional stress.

The first symptoms of IBD are abdominal cramping and pain, a sensation of urgent need to have a bowel movement (defecate), and blood and pus in the stools. Some patients experience diarrhea, fever, and weight loss. If the diarrhea continues, signs of severe fluid loss (dehydration) begin to appear, including low blood pressure, fast heart rate, and dizziness.

Severe complications of IBD include perforation of the intestine, toxic dilation (enlargement) of the colon, and the development of colon cancer. Intestinal perforation occurs when long-standing inflammation and ulceration of the intestine weaken the wall to such an extent that a hole occurs.

This is a life-threatening complication, because the contents of the intestine (which contain a large number of bacteria) spill into the abdomen. The presence of bacteria in the abdomen can result in a massive infection called peritonitis.

Toxic dilation of the colon is thought to occur because the intestinal inflammation interferes with the normal function of the muscles of the intestine. This allows the intestine to become lax, and its diameter begins to increase.

The enlarged diameter thins the walls further, increasing the risk of perforation and peritonitis. When the diameter of the intestine is quite large and infection is present, the condition is referred to as “toxic megacolon.”

Patients with IBD have a significant risk of developing colon cancer. This risk seems to begin around 10 years after diagnosis. The overall risk of developing cancer seems to be greatest for those patients with the largest extent of intestine involved. The risk becomes statistically greater every year:

• At 10 years, the risk of cancer is about 0.5–1%.
• At 15 years, the risk of cancer is about 12%.
• At 20 years, the risk of cancer is about 23%.
• At 24 years, the risk of cancer is about 42%.

Patients with IBD also have a high chance of experiencing other disorders, including inflammation of the joints (arthritis), inflammation of the vertebrae (spondylitis), ulcers in the mouth and on the skin, the development of painful, red bumps on the skin, inflammation of several areas of the eye, and various disorders of the liver and gallbladder.

Diagnosis

IBD is first suspected based on the symptoms that a patient is experiencing. Examination of the stool will usually reveal the presence of blood and pus (white blood cells).

Blood tests may show an increase in the number of white blood cells, which is an indication of inflammation occurring somewhere in the body. The blood test may also reveal anemia, particularly when a great deal of blood has been lost in the stool.

The most important allopathic method of diagnosis is endoscopy, during which a doctor passes a flexible tube with a tiny fiberoptic camera device through the rectum and into the colon. The doctor can then examine the lining of the intestine for signs of inflammation and ulceration.

A tiny sample (biopsy) of the intestine will be removed through the endoscope, which will be examined under a microscope for evidence of IBD. X-ray examination is helpful to determine the amount of affected intestine.

However, x-ray examinations requiring the use of barium should be delayed until treatment has begun. Barium is a chalky solution that the patient drinks or is given through the rectum and into the intestine (enema). The presence of barium in the intestine allows more detail to be seen on x ray films.

Treatment

Treatment for IBD targets the underlying inflammation, as well as the problems occurring due to continued diarrhea and blood loss. The use of alternative medicines in the treatment of IBD is common. IBD sufferers have used a variety of treatments; however, few controlled studies of their effectiveness have been performed.

Chamomile tea is used to treat IBD. Chamomile is known to have anti-inflammatory, antispasmodic, and antibacterial properties. The patient should steep dried flowers for 10 to 15 minutes and drink three to four cups daily. Chamomile can cause allergic reactions in those who are allergic to other daisies. Other antispasmodics include valerian, wild yam, and cramp bark.

There is some preliminary evidence that alteration of the kinds of bacteria in the intestine prevents or controls colitis. Intestinal bacteria can be manipulated through use of probiotics or prebiotics.

Probiotics refers to treatment with beneficial microbes either by ingestion or through a suppository. Prebiotics refers to dietary changes that favor the overgrowth of beneficial microbes.

Preliminary animal and human studies have shown that Lactobacilli and related bacteria can control colitis and prolong remission. Ingestion of the nondigestable carbohydrates inulin or lactulose as prebiotics stimulates growth of these beneficial bacteria.

In a related treatment, preliminary evidence suggests that ingestion of parasitic worm eggs eases the symptoms of IBD. Within two to three weeks, five out of the six IBD patients who ingested the eggs went into complete remission which lasted one month. The tiny, harmless worms cannot reproduce in humans and are passed out within a few months.

Ingestion of enteric coated fish oil capsules may reduce the IBD relapse rate. A small study found that patients taking fish oil supplements had a lower relapse rate (59%) than those on placebo (90%).

Seventy-two percent of ulcerative colitis patients taking a Kui Jie Qing enema (alum, Halloysite, Calamine, Indigo naturalis, and plum-blossom tongue-pointing pills) daily were considered cured, as compared with 5% of those who were taking anti-inflammatory drugs.

Fifty-three percent of ulcerative colitis patients taking Jian Pi Ling tablet and root of Sophorae flavescentis plus the flower of sophora enema were considered cured, as compared with 28% of those taking sulfasalazine and dexamethasone and 19% of those taking a placebo tablet and the enema. There are many other Chinese herbs that are useful in treating diarrhea and mucus in the bowel. Sometimes these are effective when drugs are not.

Forty-five percent of ulcerative colitis patients on an enzyme-potentiated hyposensitization protocol (B-glucuronidase enzyme and 1,3-cyclohexanediol with egg, milk, wheat, potato, and yeast) were improved, as compared with 6% of those on placebo.

Nutritionists often recommend changes in the diet for patients with inflammatory bowel disease. Food allergies and certain kinds of food are linked with the increased incidence of the disease. Eliminating diary and wheat products, common allergens, often alleviates symptoms.

The incidence of Crohn’s disease is increasing in areas where people consume a diet high in refined sugars and carbohydrates and saturated fats and low in dietary fiber. Elimination diets or those restricted in refined foods have sometimes proved successful in the alleviation of inflammatory bowel disease.

Dietary supplements are generally beneficial in the treatment of digestive disorders. Some typical recommendations include:

• vitamin C: 4000 mg daily
• vitamin B6: 250 mg daily
• magnesium (aspartate): 400 mg daily
• vitamin E: 800 IU daily
• glutamine: 3000 mg daily, taken between meals
• garlic, deodorized: 2000 mg daily
• deglycyrrhizinated licorice: chew as needed.

Other treatments for IBD include acupuncture, macrobiotics, cat’s claw (Uncaria tomentosa), slippery elm, acupressure, biofeedback, relaxation techniques, and hypnotherapy.

Allopathic treatment

Inflammation is often treated with an immune-suppressive drug called sulfasalazine. Because of poor absorption, sulfasalazine stays primarily within the intestine, where it is broken down into its two components: an antibiotic and an anti-inflammatory.

It is believed to be primarily the anti-inflammatory component, salicylic acid, that is active in treating IBD. For patients who do not respond to sulfasalazine, steroid medications (such as prednisone) are the next choice.

Depending on the degree of blood loss, a patient with IBD may require blood transfusions and fluid replacement through a needle in the vein (intravenous or IV). Medications that can slow diarrhea must be used with great care, because they may actually cause the development of toxic megacolon.

A patient with toxic megacolon requires close monitoring and care in the hospital. He or she will usually be given steroid medications through an IV, and may be put on antibiotics. If these measures do not improve the situation, the patient will have to undergo surgery to remove the colon. This is done because the risk of death after perforation of toxic megacolon is greater than 50%.

A patient with proven cancer of the colon, or even a patient who shows certain precancerous signs, will need a colectomy (colon removal). When a colectomy is performed, a piece of the small intestine (ileum) is pulled through an opening in the abdomen and fashioned surgically to allow attachment of a special bag to catch the body’s waste (feces). This opening, which will remain for the duration of the patient’s life, is called an ileostomy.

Expected results

Remission refers to a disease becoming inactive for a period of time. The rate of remission of IBD (after a first attack) is nearly 90%. Those individuals whose colitis is confined primarily to the left side of the large intestine have the best prognosis. Those individuals with extensive colitis, involving most or all of the large intestine, have a much poorer prognosis.

Recent studies show that about 10% of these patients have died within 10 years after diagnosis. About 20–25% of all IBD patients will require colectomy. Unlike the case for patients with Crohn’s disease, however, such radical surgery results in a cure of the disease.

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Influenza

Kid with influenza

Usually referred to as the flu or grippe, influenza is a highly infectious respiratory disease. Its name comes from the Italian word for “influence,” because people in eighteenth-century Europe thought that the disease was caused by the influence of bad weather. We now know that flu is caused by a virus.

When the influenza virus is inhaled, it attacks cells in the upper respiratory tract, causing such typical flu symptoms as fatigue, fever and chills, a hacking cough, and body aches. Although the stomach or intestinal “flu” is commonly blamed for stomach upsets and diarrhea, the influenza virus affects humans less often than is commonly believed.

Influenza is considerably more debilitating than the common cold. Influenza outbreaks occur suddenly, and infection spreads rapidly. The annual death toll attributable to influenza and its complications averages 20,000 in the United States alone. In the 1918-1919 Spanish flu pandemic, the death toll reached a staggering 20–40 million worldwide. Approximately 500,000 of these fatalities occurred in North America.

Influenza outbreaks occur on a regular basis. The most serious outbreaks are pandemics, which affect millions of people worldwide and last for several months. The 1918-19 influenza outbreak serves as the primary example of an influenza pandemic. Pandemics also occurred in 1957 and 1968 with the Asian flu and Hong Kong flu, respectively.

Epidemics are widespread regional outbreaks that occur every two to three years and affect 5–10% of the population. A regional epidemic is shorter lived than a pandemic, lasting only several weeks. Finally, there are smaller outbreaks each winter that are confined to specific locales.

The Great Influenza: The Story of the Deadliest Pandemic in History

Flu : The Story Of The Great Influenza Pandemic

There are three types of influenza viruses, identified as A, B, and C. Influenza A can infect a range of animal species, including humans, pigs, horses, and birds, but only humans are infected by types B and C. Influenza A is responsible for most flu cases, while infection with types B and C virus are less common and cause a milder illness.

In the United States, 90% of all deaths from influenza occur among persons older than 65. Flu-related deaths have increased substantially in the United States since the 1970s, largely because of the aging of the American population. In addition, elderly persons are vulnerable because they are often reluctant to be vaccinated against flu.

A new concern regarding influenza is the possibility that hostile groups or governments could use the virus as an agent of bioterrorism. A report published in early 2003 noted that Type A influenza virus has a high potential for use as such an agent because of the virulence of the Type A strain that broke out in Hong Kong in 1997 and the development of laboratory methods for generating large quantities of the virus. The report recommended the stockpiling of present antiviral drugs and speeding up the development of new ones.

Causes and Symptoms

Symptoms of influenza

Approximately one to four days after infection with the influenza virus, the victim develops an array of symptoms. Symptoms are usually sudden, although the sequence can be quite variable.

They include the onset of headache, sore throat, dry cough, and chills, nasal congestion, fatigue, malaise, overall achiness and a fever that may run as high as 104°F (40°C). Flu victims feel extremely tired and weak, and may not return to their normal energy levels for several days or weeks.

Influenza complications usually arise from bacterial infections of the lower respiratory tract. Signs of a secondary respiratory infection often appear just as the patient seems to be recovering. These signs include high fever, intense chills, chest pains associated with breathing, and a productive cough or sinus discharge with thick yellowish-green sputum.

If these symptoms appear, medical treatment is often necessary. Other secondary infections, such as sinus or ear infections, may also require medical intervention. Heart and lung problems and other chronic diseases, can be aggravated by influenza, which is a particular concern with elderly patients.

With children and teenagers, it is advisable to be alert for symptoms of Reye’s syndrome, a rare but serious complication that occurs when children are given aspirin. Symptoms of Reye’s syndrome are nausea and vomiting, and more seriously, such neurological problems as confusion or delirium. The syndrome is primarily associated with the use of aspirin to relieve flu symptoms in children.

Diagnosis

Although there are specific laboratory tests to identify the flu virus strain from respiratory samples, doctors typically rely on a set of symptoms and the presence of influenza in the community for diagnosis.

Specific tests are useful to determine the type of flu in the community, but they do little for individual treatment. Doctors may administer such tests as throat or sinus cultures or blood tests to identify secondary infections.

Since 1999, however, seven rapid diagnostic tests for flu have become commercially available. These tests appear to be especially useful in diagnosing flu in children, allowing doctors to make more accurate treatment decisions in less time.

Treatment

The patient should drink plenty of fluids and eat nutritious foods. Chicken soup with ginger, scallions, and rice noodles is nutritious and has healing powers. Rest, to allow the body to fight infection, is very important. Gargling with salt water (half teaspoon salt in one cup of water) helps to soothe a sore throat.

A vaporizer with eucalyptus or Vicks VapoRub will make the patient feel more comfortable by easing breathing and aiding sleep. Applying Vicks ointment over chest and back will assist and speed recovery. Returning to normal activities too quickly invites a possible relapse or complications.

Herbals

Herbal teas and other preparations can be taken to stimulate the immune system, for antiviral activity, and to relieve symptoms. The following herbs are used to treat influenza:

• Ginger (Zingiber officinalis) reduces fever and pain, has a sedative effect, settles the stomach, and suppresses cough.
• Forsythia (Forsythia suspensa) fruit can be taken as a tea for its anti-inflammatory, fever-reducing, and antimicrobial properties.
• Honeysuckle (Lonicera japonica) flower can be taken as a tea for its anti-inflammatory, fever-reducing, and antimicrobial properties.
• Anise seed (Pimpinella anisum) can be added to tea to expel phlegm, induce sweating, ease nausea, and ease stomach gas.
• Slippery elm (Ulmus rubra) can be taken as a tea or slurry to soothe sore throat and ease cough.
• Echinacea (Echinacea purpurea or angustifolia), in clinical studies, reduced flu symptoms including sore throat, chills, sweating, fatigue, weakness, body aches, and headaches. The usual dosage is 500 mg thrice on the first day, then 250 mg four times daily thereafter.
• Goldenseal (Hydrastis canadensis) has fever reducing, antibacterial, anti-inflammatory, and antitussive properties. The usual dose is 125 mg three to four times daily. Goldenseal shouldn’t be taken for more than one week.
• Astragalus (Astragalus membranaceus) boosts the immune system and improves the body’s response to stress. The common dose is 250 mg of extract four times daily.
• Cordyceps (Cordyceps sinensis) modulates and boosts the immune system and improves respiration. The usual dose is 500 mg two to three times daily.
• Elder (Sambucus nigra) has antiviral activity, increases sweating, decreases inflammation, and decreases nasal discharge. In a study, elderberry extract reduced flu symptoms within two days whereas placebo took six days. The usual dose is 500 mg of extract thrice daily. Also use 2 tsp of dried flowers in 1 cup of water as a tea. 
• Schisandra (Schisandra chinensis) helps the body fight disease and increases endurance.
• Grape (Vitis vinifera) seed extract has antihistamine and anti-inflammatory properties. The usual dose is 50 mg three times daily.
• Eucalyptus (Eucalyptus globulus) or peppermint (Mentha piperita) essential oils added to a steam vaporizer may help clear chest and nasal congestion.
• Boneset infusion (Eupatorium perfoliatum) relieves aches and fever.
• Yarrow (Achillea millefolium) relieves chills.

Other remedies

Acupuncture and acupressure are said to stimulate natural resistance, relieve nasal congestion and headaches, fight fever, and calm coughs, depending on the points used.

A homeopathic remedy called Oscillococcinum may be taken at the first sign of flu symptoms and repeated for a day or two. This remedy is said to shorten the duration of flu by one or two days. Although oscillococcinum is a popular flu remedy in Europe, however, a research study published in 2003 found it to be ineffective.

Other homeopathic remedies recommended vary according to the specific flu symptoms present. Gelsemium (Gelsemium sempervirens) is recommended to combat weakness accompanied by chills, a headache, and nasal congestion.

Bryonia (Bryonia alba) may be used to treat muscle aches, headaches, and a dry cough. For restlessness, chills, hoarseness, and achy joints, poison ivy (Rhus toxicodendron) is recommended. Finally, for achiness and a dry cough or chills, Eupatorium perfoliatum is suggested.

Hydrotherapy can be utilized. A bath to induce a fever will speed recovery from the flu. While supervised, the patient should take a bath as hot as he/she can tolerate and remain in the bath for 20–30 minutes. While in the bath, the patient drinks a cup of yarrow or elderflower tea to induce sweating.

During the bath, a cold cloth is held on the forehead or at the nape of the neck to keep the temperature down. The patient is assisted when getting out of the bath (he/she may feel weak or dizzy) and then gets into bed and covers up with layers of blankets to induce more sweating.

Supplemental vitamins are recommended for treating influenza, and include 500–2000 mg vitamin C, 400 IU to 500 IU of vitamin E, 200 micrograms to 300 micrograms selenium, and 25,000 IU beta-carotene. Zinc lozenges are helpful, as is supplemental zinc at 25 mg per day for two weeks or more.

Traditional Chinese medicine (TCM) uses mixtures of herbs to prevent flu as well as to relieve symptoms once a person has fallen ill. There are several different recipes for these remedies, but most contain ginger and Japanese honeysuckle in addition to other ingredients.

Allopathic treatment

Because influenza is a viral infection, antibiotics are useless in treating it. However, antibiotics are frequently used to treat secondary infections.

Over-the-counter medications are used to treat flu symptoms. Any medication that is designed to relieve such symptoms as pain and coughing will provide some relief. The best medicine for symptoms is an analgesic, such as aspirin, acetaminophen, or naproxen.

Without a doctor’s approval, aspirin is generally not recommended for people under 18 owing to its association with Reye’s syndrome, a rare aspirin-associated complication seen in children recovering from viral infections. Children should receive acetaminophen or ibuprofen to treat their symptoms.

There are four antiviral drugs marketed for treating influenza as of 2003. To be effective, treatment should begin no later than two days after symptoms appear. Antivirals may be useful in treating patients who have weakened immune systems or who are at risk for developing serious complications.

They include amantadine (Symmetrel, Symadine) and rimantadine (Flumandine), which work against Type A influenza; and zanamavir (Relenza) and oseltamavir phosphate (Tamiflu), which work against both Types A and B influenza. Amantadine and rimantadine can cause such side effects as nervousness, anxiety, lightheadedness, and nausea.

Severe side effects include seizures, delirium, and hallucination, but are rare and are nearly always limited to people who have kidney problems, seizure disorders, or psychiatric disorders. The new drugs zanamavir and oseltamavir phosphate have few side effects but can cause dizziness, jitters, and insomnia.

Expected results

Following proper treatment guidelines, healthy people under the age of 65 usually suffer no long-term consequences associated with flu infection. The elderly and the chronically ill are at greater risk for secondary infection and other complications, but they can also enjoy a complete recovery.

Most people recover fully from an influenza infection, but it should not be viewed complacently. Influenza is a serious disease, and approximately 1 in 1,000 cases proves fatal.

Prevention

The Centers for Disease Control and Prevention recommend that people get an influenza vaccine injection each year before flu season starts. In the United States, flu season typically runs from late December to early March. Vaccines should be received two to six weeks prior to the onset of flu season to allow the body enough time to establish immunity.

Each season’s flu vaccine contains three virus strains that are the most likely to be encountered in the coming flu season. The virus strains used to make the vaccine are inactivated and will not cause illness. When there is a good match between the anticipated flu strains and the strains used in the vaccine, the vaccine is 70-90% effective in people under 65.

Because immune response diminishes somewhat with age, people over 65 may not receive the same level of protection from the vaccine, but even if they do contract the flu, the vaccine diminishes the severity and helps prevent complications.

It should be noted that certain people should not receive an influenza vaccine. Infants six months and younger have immature immune systems and will not benefit from the vaccine.

Because the vaccines are prepared using hen eggs, people who have severe allergies to eggs or other vaccine components should not receive the influenza vaccine. Some persons may receive a course of amantadine or rimantadine, which are 70-90% effective in preventing influenza.

Certain groups are strongly advised to be vaccinated because they are at greater risk for influenza-related complications:

• All people 65 years and older.
• Residents of nursing homes and chronic-care facilities.
• Adults and children who have chronic heart or lung problems.
• Adults and children who have chronic metabolic diseases, such as diabetes and renal dysfunction, as well as severe anemia or inherited hemoglobin disorders.
• Children and teenagers who are on long-term aspirin therapy.
• Anyone who is immunocompromised, including HIV-infected persons, cancer patients, organ transplant recipients, and patients receiving steroids, chemotherapy, or radiation therapy.
• Anyone in contact with the above groups, such as teachers, care givers, health-care personnel, and family members.
• Travelers to foreign countries.

As of early 2003, researchers are working on developing an intranasal flu vaccine in aerosol form. An aerosol vaccine using a weakened form of Type A influenza virus has been tested in pilot studies and awaits further clinical trials.

The following dietary supplements may be taken to help prevent influenza:

• Elderberry prevents influenza virus from infecting cells.
• Astragalus: 250–500 mg daily.
• Multivitamins with zinc.
• Vitamin C; 500 mg.
• Echinacea; at the first sign of malaise or infection, take 3–5 ml of tincture or 2 tablets three or four times daily for three to 10 days.

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Insulin Resistance

Insulin Resistance

Insulin resistance is a condition in which cells, particularly those of muscle, fat, and liver tissue, display “resistance” to insulin by failing to take up and utilize glucose for energy and metabolism (insulin normally promotes take up and utilization of blood glucose from the blood stream).

In its early stages, the condition is asymptomatic, but may develop into Type II Diabetes. Although there are several established risk factors, the underlying cause is unknown.

It has been estimated that 30 to 33 million Americans are insulin resistant, and the number appears to be increasing.

Insulin resistance is initially asymptomatic, and in its early stages can be detected only by laboratory tests. These tests will show an abnormally high blood sugar (glucose) level, but not high enough to be considered prediabetic or diabetic.

While the condition does not always lead to further problems, the majority of people who reach the pre-diabetic level go on to develop Type II Diabetes (formerly called Maturity Onset Diabetes.

Causes and symptoms

The cause of insulin resistance is unknown, although the condition has been seen to run in families, indicating that there is a genetic association. Being overweight, and lack of exercise are also associated with insulin resistance, although the nature of the relationship is not clear. Risk factors for insulin resistance are:

• having a family history of diabetes
• having a low HDL (good) cholesterol level—and high serum lipids
• having high blood pressure
• having a history of diabetes during pregnancy, or having given birth to a baby weighing more than 9 pounds
• being a member of one of the racial groups that appear to have a high incidence of insulin resistance (African American, Native American, Hispanic American/Latino, or Asian American/Pacific Islander)
• having syndrome X
• being obese

insulin resistance cycle

In its mildest form, insulin resistance causes no symptoms, and is only recognizable on laboratory tests. In more severe cases, there may be dark patches on the back of the neck or even a dark ring around the neck. The dark patches are called Acanthosis nigricans and may also cause darkening of skin color in the elbows, knees, knuckles, and armpits.

There is a constellation of symptoms now called metabolic syndrome or insulin resistance syndrome that is linked to insulin resistance. This syndrome was formerly called syndrome X. Metabolic syndrome is defined by the National Cholesterol Education Program as the presence of any three of the following conditions:

• excess weight around the waistline (waist measurement of more than 40 inches for men and more than 35 inches for women)
• high levels of serum triglycerides (150 mg/dL or higher)
• low levels of HDL, or “good,” cholesterol (below 40 mg/dL for men and below 50 mg/dL for women)
• high blood pressure (130/85 mm Hg or higher)
• high fasting blood glucose levels (110 mg/dL or higher)

Note that the numbers are those from an expert panel convened by the National Institutes of Health in 2001. Other panels of similarly qualified experts have given slightly different definitions.

Diagnosis

The only means of diagnosis for insulin resistance is laboratory tests. While there are several tests that may be performed, the two most common screening tests are the fasting blood sugar test and glucose tolerance test.

Fasting blood sugar measures the blood glucose level after a 12-hour fast (no food). A normal level, according to the United Sates National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), should be below 100 mg/dL (milligrams of glucose in every deciliter of blood. A value in the n the 100 to 125 mg/dL range is considered evidence of insulin resistance, and is considered prediabetic.

A value of 126 mg/dL is considered diabetic. (Blood sugar levels after a 12 hr fast are typically lower than this, and are controlled by pancreatic insulin secretion that transports blood glucose out of the blood and into the muscles, brain, organs, and other tissues.)

The glucose tolerance test is performed after the patient has had nothing but water for 10 to 16 hours. The patient has his blood drawn for a a baseline blood glucose level. Next, the patient drinks a special sweetened test drink that contains exactly 75 grams of glucose (pregnant women are normally given 100 grams of glucose.)

Blood is drawn again at one-half hour and each of the next six hours to compare blood glucose levels and watch their pattern in response to the sweet drink. Normally the blood sugar levels is lower before the drink, rises quickly during the first few hours, and slowly drops again.

In insulin resistance, the blood sugar level rises but stays abnormally high because it is resistant to being removed from blood into tissues by insulin. High blood sugar from food or the test glucose drink stimulates the pancreas to secrete insulin into the blood.

However, in insulin resistance, the insulin is secreted but is only partially absorbed by the tissues. According to the National Diabetes Information Clearinghouse (NDIC) a normal level would be below 140 mg/dL 2 hours after the drink.

If it is in the 140 to 199 mg/dL range 2 hours after drinking the solution, the diagnosis is impaired glucose tolerance (IGT) or prediabetes. A level of 200 or higher, if confirmed, represents a diagnosis of diabetes.

Treatment

reverse diabetes

Among the most important treatment modalities are diet and exercise, weight loss if obese, endocrine hormone correction if unbalanced. In 2001, the National Institutes of Health completed the Diabetes Prevention Program (DPP), a clinical trial designed to find the most effective ways of preventing type 2 diabetes in overweight people with prediabetes.

The researchers found that lifestyle changes reduced the risk of diabetes by 58 percent. Also, many people with prediabetes showed a return to normal blood glucose levels.

According to the DDP results, a mere half hour of brisk walking or bicycling five days a week can significantly reduce the risk of developing type 2 diabetes. Patients should use diet and exercise to reduce their body mass index (BMI) to 25 or below.

Smoking has been associated with insulin resistance, as well as with some of the more severe problems associated with diabetes. Discontinuing smoking should be a top priority.

A healthful diet, in addition to assisting in weight loss, may reduce serum lipids and reduce some of the risk factors for diabetes. One study recommended the Mediterranean diet as being the most beneficial for people with insulin resistance.

Diet improvements include reducing sweets, desserts and high glycemic meals; eating balanced meals that contain protein, complex carbohydrates, fiber, greens and healthy oils, eating at regular times, and avoiding excess junk food and sugar.

No complimentary or alternative therapies have been proven to cure insulin resistance. Although several herbal remedies have been traditionally used for treatment of diabetes, none have been adequately documented as effective.

Among medicinal plants shown to help lower elevated blood sugar are the Asian bitter melon and the Navaho Optunia cactus. Such herbal bitters as dandelion root and yellow dock can improve digestive strength and sometimes help, though no herbal remedy alone “cures” insulin resistance or diabetes.

Guar gum, glucomannan, and psyllium seed all have demonstrated some ability to lower blood sugar in insulin resistance or diabetes, but none have been shown to be reliably effective for use in treatment of humans.

Allopathic treatment

Insulin resistance does not normally require drug therapy; however, some studies have shown that the drugs used to treat type 2 diabetes may delay development of diabetes. Two classes of drugs now used to treat diabetes act by increasing insulin sensitivity, the biguanides and the thiazolidinediones; the other drugs used to treat diabetes act in different ways.

Although drugs from both classes have been effective in treatment of insulin resistance, neither drug has been as effective as a regimen of diet and exercise. Both classes of drugs have the potential for very severe adverse effects.

They are also not approved by the FDA for control of insulin resistance, although physicians may prescribe them for this use if the condition appears to be getting worse without drug therapy.

In one study, oral hypoglycemic drugs of various mechanisms that help reduce elevated blood blood glucose reduced the rate of disease progression from insulin resistance to diabetes by about one-third over a three-year period.

Expected results

In mild asymptomatic insulin resistance, proper treatment may lead to a complete reversal, with normalization of blood sugar.

Even if complete normalization is impossible, treatment will lead to control of the condition, and a significant reduction in its rate of progression to diabetes.

Prevention

In insulin resistance, prevention is even better than treatment. Maintaining a normal weight, eating a balanced diet, and keeping up a regular program of aerobic exercise are the best preventive measures.

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Identify skin diseases

One function is to protect the body's skin. This function will be reduced or disrupted in the event of a fungal infection of the skin. After the "stick", the fungus will attack the skin and cause inflammation. Obvious symptoms of the emergence of reddish or blackish scales on the skin with an infected person. In the most severe level, fungal infections can occur in the blood causing the emergence of tissue lumps pus.

Medical term is dermatomikosis. That is, all the fungal diseases that attack the skin. Dermatomikosis term dermatophytosis should be distinguished from a class of fungi which are hooked or likes to digest the tissue that contain horn (keratin), for example, the stratum corneum in the epidermis (the epidermis), hair, and nails. Often he is called tinea, ringworm, ringworm, teigne, or herpes sirsinat1.

Dermatophytes are a class of fungi that cause dermatophytosis. It is divided into three genera, namely Trichophyton (T), mycrosporum (M), and Epidermophyton (E). The next class of dermatophytosis are classified according to location. If the strike is called tinea capitis of the scalp, hair, eyebrows and eyelashes. Tinea corporis, if attacking the body and limbs, including tinea kruris specifically attacking the groin, lower abdomen area, and around the anus. Tinea barbae invade the chin, beard and whiskers. Tinea manum strike hands and palms. Tinea pedis attack between the legs and feet. And tinea unguinum nail attack.

2.1 DISEASE phlegm

A. Understanding Disease Panu

Panu is one of a fungal disease called Malassezia furfur. Most cases of tinea versicolor is due to activation of Malassezia furfur from a change in the balance of normal flora of the skin. Factors that may affect the balance between environmental factors and the other is individual susceptibility. Environmental factors are moisture factors, whereas individual factors that affect immune diseases, malnutrition, use of medication that lowers immunity and the presence of a genetic predisposition (heredity). Due to these conditions, Malassezia furfur miselial will evolve into a form that is seen clinically pathogenic fungus as a disease.

Versicolor or pityriasis versicolor is a non-classified dermatomikosis dermatophytosis. Because the types of fungi, including dermatophytes cause is not, but Malassezia furfur. Typical clinical picture was not as tinea, a ring with a quiet area in the central part. Even if the complaint is not significant, a very popular skin problems have a tendency to chronic (chronic). Only when the body sweats, it gave birth to a skin infection itching. Clinical manifestation of scaly patches of fine white to brown. Geographic distribution can be anywhere, could be in the body, neck, arms, even in the armpits, groin, upper leg, face and scalp hair .. Phlegm, or in the medical world with a strange language called pityriasis versicolor, a fungal infection on the skin surface.

B. Causes of Disease Panu

The air was hot and humid, pregnancy, birth control pills, genetic factors, the use of steroid medications (allergy, anti-inflammatory, such as prednisone, dexamethasone, betamethasone, etc.). Malassezia fungi causing tinea versicolor usually is round, white, but can also slightly reddish or brown. Scaly skin so smooth, and it itches only when the body sweats. Can occur anywhere on the body, such as the neck, arms, groin, upper limbs, face, scalp, even in the armpit. Areas affected by fungal infection is the easy part moist. This disease often recurs. Cause the former white fungus on exposed skin after treatment. Usually recurrent and often-kumatan without complaint (asymptomatic). The disease is caused by Pityrosporum ovale.

Sometimes difficult to distinguish from allergies. But if the fungus is given anti-allergy medication was given prior anti-inflammatory (steroid), initially as improved, but the truth will become broader as anti-inflammatory allergy should not be given (Contra indications) on fungal diseases. Drug combination (anti-allergic and anti-inflammatory with anti-fungal) controversy.

The first priority should be the treatment of fungus, later followed by anti-allergic.

C. Symptoms of the disease by Panu Ditumbulkan

By naked eye. Usually itch when sweating. For those with dark skin, white spots, while for whites, light-colored patches, reddish.

D. Prevention

• Dry the towels after use and replace as often as possible.

• Bath

• Save or hanging clothes in a dry place.

If any of you are affected by fungus, there are some things you can do about it.

1. Apply antifungal medication. These include topical medications. Choose one that is completely safe for the skin and can effectively kill the fungus.

2. If the condition is severe tinea versicolor, oral treatment is needed. But, it should be by prescription from a doctor.

The more important fact is not treating this fungus disease, but how can prevent it. What can be done to prevent it are as follows:

1. Keep your skin kerbesihan. How, bathe regularly twice a day. Keep clear skin fungus to grow and develop.

b. Do not be exchanged and used the property of others, such as towels or clothes. If these items are terkera versicolor fungal spores, can be easily transmitted to other people who wear them.

c. Always keep the environment clean. Avoid dirty environments. With a clean condition skin fungus can not grow and multiply.

E. Treatment

 Drug external (topical)

Mikonazole nitrate 2% cream (for example: fungisol, interzol, ketomed, moladerm, mycoral, etc.). Cream applied morning and evening (after a shower) and is given if spotting is not widespread. If the area like the islands of the archipelago, can be given Mikonazole 2% in the form of powder, for example: daktarin, mycorine.

Duration of treatment: approximately 2-4 weeks.

For the baby should be given Mikonazole 2% in the form of powder, because the form of creams often cause uncomfortable feeling (sticky) so that the baby becomes fussy.

 Drinking Drugs (oral)

Ketokonasol tablet 200 mg (generic name), taken one tablet a day, after breakfast, for 2 weeks (other references say 10 days)

Oral medication can be supplied with an external medicine.

2.2 ringworm or scabies

Ringworm / sautu ringworm is a fungal infection of the skin caused by several different fungi and generally classified according to the affected body part. Ringworm ringworm or very popular, very often affects the skin. Ringworm (dermatophytosis) consisting of Tinea Apitis attacks the scalp, tinea corporis on the surface of the skin, Tinea Kruris in the folds of the skin, tinea pedis on the toes (athlete's foot), Tinea Manus on the skin of the palms, Tinea Imbrikata the form of scales on the skin certain areas, and Tinea Ungium (the nail). Typically in the form of scales or redness on the skin of white scales. The nail, inflammation around the nails, nail shape and can cause uneven surface, dull-colored, or blue. Ringworm / sautu Ringworm is a fungal infection of the skin caused by several different fungi and generally classified according to the affected body part.

Ringworm ringworm or very often affects the skin. Generally in the form of patches and round or oval. The color is reddish, scaly, and berbintil-nodule. If scratched can cause blisters.

A Ringworm is classified according to the location of the fungus causes, among others:

• Ringworm affecting the scalp or around the eyebrows (Tinea capitis). Beware if itchy scalp, causing hair loss. There is the possibility of diseases caused by fungi. To be sure, need to be tested. Usually the doctor gives an antifungal ointment or cream.

• Ringworm of the groin attack, lower stomach area, around the anus or genital area outside (Tinea kruris). Spots that arise will be shaped like a circle on the edge of the circle line will appear red and scaly.

• Ringworm of attack between your fingers and soles of the feet (tinea pedis). In layman's language is called water fleas. Often these water fleas extends down between the thumb and other fingers. Because damp skin was white and brittle. Initially there was no alarming symptoms or complaints. But it appears the odor from the skin of your feet, it means there is a fungal infection. Bacterial infection may also appear with a tender red nodule symptoms, can even cause a fever.

• Ringworm affecting nails (Tinea unguinum). Ringworm is a rarely complain because they do not cause pain. However, the most difficult ringworm of the nails and old healed. Then be broken nails and brittle, the shape is no longer normal. At the bottom of the nail will accumulate the rest of the fragile tissue so that it can be a source of transmission to the skin.

Or B.Penyebab ringworm Ringworm Disease

Usually caused by Trichophyton or Epidermophyton, which is a fungus that can grow in areas that are moist and warm, between your toes.

Fungi can cause the formation of the scales are very smooth with no other symptoms or scales that are more content with an itchy rash, rough and painful between toes and on the edge of the foot.

Also can form a fluid-filled blisters.

Fungi can cause the foot to be cracked, causing bacterial infection, especially in elderly patients and patients gannguan blood flow to the legs. ). Vector-borne diseases are usually dogs and cats. Ringworm can be transmitted through direct contact with patients or indirectly.

• Or ringworm Ringworm on Groin

Jick also called itch and can be caused by a fungus.

More often found in men and more common in warm weather.

Infection causes redness is shaped like a ring, sometimes accompanied by small blisters on the skin around the upper thigh selangkakan and inner skin.

Can menumbulkan itching and even pain. Although it has been treated frequently repeated infection.

• ringworm or ringworm of the scalp

The cause is Trichophyton and Microsporum. The disease is highly contagious, especially in children. Can cause the formation of a red scaly rash that sometimes itchy or cause hair loss that leaves bald patches without the rash.

• ringworm Ringworm on Nail

Is an infection of the nails caused by Trichophyton.

Mushrooms into a new nail to grow and cause deformities kuklu become dull and thickened. These infections often attack the toenails.

• ringworm Ringworm On Board

The cause is Trichophyton. Infections usually cause a rash of pink to red blotches, sometimes forming circular and the center clear. Ringworm ringworm or skin usually found in the body.

• The Beard ringworm Ringworm

Most of the infections caused by bacteria attacking beard instead of mushrooms.

C. Disease Prevention ringworm Ringworm

Wash hands thoroughly, keeping the body clean, and avoid contact with patients.

D. Pengobatanya

Clinical products used:

K-liquid 1.UIE Clorofill (U.S. $ 140,000) dose of 3 × 1 shot dissolved in 1 cup of water a day, drink, and also in kompreskan place the injured or infected with fungus

2. K-Ayu Derme (U.S. $ 272 000) × 2 Dose 2-3 capsules per day, to repair the skin's structure and can be combined with the use of K-Ayulite Products (U.S. $ 272 000) 2-3 × 2 capsules per day.

3. Propolist Paltinum (U.S. $ 99,000) can be applied directly to itchy areas, used as an anti-bacterial and drink a dose of 3 × 4-5 drops per day.

4. Clorofill Trasparant Soap (U.S. $ 30,000) The use of antifungal drugs containing miconazole (C18H14Cl4N2O) and kloritomazol (C22H17ClN2) correctly can eliminate the infection.

Most infections are mild skin due to fungal, unless the infection on the scalp and nails. For mild infections are usually given anti-fungal cream, which contains the active ingredient miconazole, clotrimazole, econazole, or ketoconazole. Cream applied 2 times / day and treatment should be continued until 7-10 days after the rash is completely gone.

 If the drug is stopped too soon, the infection has not completely gone and the rash will come back. It can take several days for anti-fungal cream to cause the effect. During this time, frequently used corticosteroid creams to relieve itching and pain. For the infection is stubborn and can be administered griseofulvin rely more serious, sometimes accompanied by anti-fungal cream.

Griseofulvin by mouth (swallowed) are very effective, but can cause side effects such as headache, indigestion, light-sensitive terhdap, rashes, swelling and decreased white blood cell count. After use is stopped, the infection can occur again. Keeping the infected area dry and clean will help prevent further mold growth and accelerate the healing of the skin.

Infected areas should be washed frequently Degnan soap and water, then sprinkled with powder. Should avoid powder containing cornstarch because it can stimulate the growth of fungi. If there is bacterial infection, antibiotics may be given.

For dry skin can also be used Burrow's solution or Whitfield ointment.

2.3 scurvy

A. Scabies Disease Conditions

Disease or also known as Scabies Scabies is a contagious disease scabies or mange the skin plagued by an itch mite parasite. Scurvy appeared around the world, but is most common in areas that are too dirty or bad hygiene.

B. What causes scabies

Scabies or itch mite of scabies develops when the microscopic enters the human body as their hosts and interfere with the sensitivity of the reaction. Mites can live his life in the human skin, causing chronic infections. Female mites burrow into the skin to lay eggs for, then become larvae, emerging wedding and then make another hole in the egg hatch under kulit.Tempoh if new infections and 2 to 6 weeks of re-infection of 1 to 4 days.

C. Symptoms of Scabies

In tripikal, scabies causes itchy skin worse at night hari.Kadang - sometimes burrows made by the scabies mite can be seen as a very fine white lines on the skin, and red swelling may also terlihat.Daerah common disorders include a more severe in the wrists, armpits, buttocks, groin and slit fingers and toes, putting milk in women, and genetiali on pri1.Dan also in children - children burrows (lesions) can be seen in the head and neck.

D. Scabies Disease Pengobatann

1. NLX cream or Kwell

used starting from the neck down to cover the entire body. Wait 15 minutes before it wrapped, and avoid bathing for 8-12 hours. Wash contaminated clothing and linens in hot water or dry cleaning.

2. Krotamiton

an itch medicine on scurvy. Avoid the use of this drug on the skin near matadan open.

3. Permethrin

4. Benzyl Benzoate

2.4 ACNE

A. Understanding Acne

Acne (English: acne) is an abnormal condition of the skin due to excessive disruption of production of oil glands (sebaceous glands) that cause blockage of hair follicles and skin pores. Area that is prone to acne on the face, chest, back, arms and upper body.

Inflammation of the skin occurs when the sebaceous glands produce skin oil (sebum), causing excessive oil gland blockage in the channels and the formation of comedones (whiteheads) and seborhoe1. If the blockage to dilate, open comedones (blackheads) appears so that the interaction with the acne bacteri1. Acne is classified as mild if the shape is still blackheads with the number of lesions less than 30. If the number of lesions ranged from 30-125 it is called acne (papule). Of acne called nodular or cystic lesions arise when above 125.

The appearance of acne often occurs during puberty between the ages of 14-19 years are caused by hormonal changes in adolescents. Early detection is very difficult acne before puberty because the child will experience flaking skin three weeks. While as a teenager, peeling skin every four weeks.

The results showed 85% of the population suffers from acne at the age of 12-25 years, 15% of the population until the age of 25 years experience. If not resolved properly, acne problems can persist up to age 40 tahun.Selain cause acne scars, its main effect is on one's soul, like a crisis of confidence or self-conscious and depressed.

B. Causes of Acne

The real cause why a person has acne and others do not have a whole is still unknown. Some of the factors that cause acne are:

• Stress

• The offspring of parents

• hormone activity: One important factor that causes acne is the increased production of the hormone testosterone, which is owned by a body of men and women. Testosterone found in male and female body cause acne by stimulating oil glands (sebaceous glands) to produce the skin oil (sebum) in excess.

• Oil glands are hyperactive

• Bacteria in the pores of the skin

• Skin irritation or due to scratching

• decreasing the appearance of acne during the usage of pills

• Being in an environment with high levels of chlorine, particularly chlorinated dioxins, which cause serious acne, called chloracne

 Misconceptions of acne

Due to medical knowledge about acne is still small, many false rumors circulating about the cause of acne:

• Food. Chocolate, snack, sugar, milk and seafood does not cause acne. Medical research has so far found no significant difference between the incidence of acne in two groups of people, one group of foods at the top and the other is not. However, in the book The Acne Prescription, radical dermatologist Nicholas Perricone said that it is also a myth, and suggests a special diet with a lot of fish menu and a little sugar.

• Sex. Common myth states and not married masturbation can cause acne. But there is no medical evidence to confirm this opinion.

C. Type - Type of Acne

• TYPE 1: Blackheads, the nature and cause

Blackheads are the scientific name of which is blocked pori2, could be open or closed. Open comedones which is also called a blackhead, looks

such pori2 crescent and blackened (black is not dirt; in fact it is porous plug which changes color krn oxidized with air). Which closed comedo, or whitehead, which has grown over the skin which pori2 clogged; so looks like kecil2 white bumps under the skin. Acne is caused by sel2 komedoini kind of dead skin and oil glands of the skin pd superfluous. If you not exfoliate (scrub can, wash your face with a washcloth, use soap which contains salicylic acid or AHA / BHA, etc.) periodically skin, dead skin sel2 accumulate in the skin; oil on the skin surface and then cover sel2 skin, there was a blockage. Makeup and styling products that contain oils can aggravate the situation. Sweaty and hot and humid air that can also clog pori2.

• TYPE 2: Acne Usually, the nature and cause

This type of acne `classic 'is easily recognized, a small bulge in color

pink or reddish. Because congestion occurred pori2 who are infected with

the bacteri1. Which these bacteria can be found on the surface of the skin, can also

of washcloths, makeup brushes, fingers, also the phone. Stress, hormones

interchangeable and humid air that increase the likelihood of acne infection, krn cause skin to produce oil, which is where

grown-breeding bacteri1. Acne is caused by a hormone which

usually appears around the jaw and chin, according to a dermatologist who

Recommend pemkaian low estrogen birth control pills like Alesse and orthotricyclen orthocept.

• TYPE 3: Cystic Acne (Pimples Stone / Acne Corn), the nature and

cause

Often referred to as big as a corn acne. If you feel the face

you like pizza toppings rampant, nah.inilah-cystic acne;

a big pimple, which inflamed with great tonjolan2, gathered in

the whole face (different from regular acne who gathered in one

bag. advance). This is the `godfather'nya acne, the most damaging not

only physically, but also confidence. Patients with cystic-acne

usually also have close relatives who also suffer from acne types

this; genetically sufferers have (1) oil glands

over-active pori2 who flooded with oil, (2) the growth of skin sel2

who normally do not regenerate as fast as unresponsive to normal skin and (3)

has a hyperbolic response to inflammation, so leaving scars on the skin.

D. How To Prevent

1. Always wash your face morning and night with a cleanser containing

salicylic-acid or AHA / BHA sel2 dead skin to peel. Or

facial skin scrub at least once a week. Always carry paper

oil absorbent to soak up excess oil on the face. Use

also mask for oily skin once a week.

2. To kill acne-causing bakteri2, use soap which

-benzoyl peroxide, or sulfur soap. And use anti-bacterial mask / acne once a week. If obat2-counter acne which does not work, ask your skin medicine acne medication containing vitamin A derivatives like Retin-1.

3. ask your doctor to prescribe antibiotic pills like tetracycline. When

tanda2 a month there is no improvement, doctors may be

prescribe Accutane (less certain in Indonesia already exists), which the drug effective, but controversial. Though healing takes up to 5 months, and can lead to defects in pregnant women, but still considered a panacea wrote a last resort.

E. Acne Treatment

For cystic acne is one-one, which effective treatment is

ask your dermatologist acne injected with cortisone, which makes

acne is cured within 48 hours. If the case is chronic, the pill

Accutane can be tried, although you will experience some side

effect, such as severe lip pecah2 reply (ask your prescribing dr.kulit

Acclovate, lip balm anti-inflammatory) and the skin which is dry.

To reduce inflammation and kill bacteria, use of drugs

acne that contains benzoyl-peroxide, or skin when you do not encounter

hold, use products which contain sulfur, such as Neo Medrol or

mujisat acne starting from Sari Ayu. If the acne was not obat2

work either, ask for a prescription ointment containing an antibiotic, one Garamicyn (can be purchased freely). This ointment can kill bacteria and reduce inflammation are also swelling.

Eliminate blackheads with plaster pore strips (like Biore pore

Pond's nose pack or tape zone). For whiteheads, acne drug use

that contains salicylic-acid, such as Neutrogena or Clinique brand of acne treatment gel solutions nigh.

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What is otitis media?

Definitions

Otitis media is an infection or inflation (inflation: Inflammation) the middle ear. The middle ear is the area bounded by the outside world by the ear drum. This area connects the sound with a hearing in the inner ear. Also in this area there is a line "eustachian" that connects the middle ear to the back of the nasal cavity and upper throat.

Use of this channel are:

1. Maintain the balance of air pressure in the ear and adjust air pressure in the outside world

2. Drain the mucus produced fewer cells lining the middle ear to the back of the nose.

Cause

The cause of acute otitis media may be a virus or bacteri1. In 25% of cases and sometimes infect the middle ear with the bacteri1. Virus / bacteria that commonly cause otitis media are Streptococcus pneumoniae. Followed by Haemophilus influenzae and Moraxella caltarhalis. To remember the otits media, although most cases are caused by bacteria, only a few cases requiring antibiotics. This is possible because no antibiotic was eustachius channel will be open again so that the bacteria will be eliminated with the flow of mucus.

Why are children more susceptible to otitis media?

Children more susceptible to otitis media as compared to adults:

1. Child's immune system is still in development

2. Eustachius tract in children is more straight and shorter horizontally so that the ARI is more easily spread ketelinga middle.

3. Adenoids (adenoids salahs atu ditenggorokkan upper organ that plays a role in the immune system) is relatively larger in children than adults. Adenoid position adjacent to the mouth of the eustachian channel. In addition adenoid itself can be infected when the infection then spreads to the middle ear through the channel uestachius.

Diagnosis

OMA diagnosis must meet three of the following:

1. Disease appear suddenly (acute)

2. The discovery marks lefusi elasi: sector in body cavity fluid collection) the middle ear. Effusion demonstrated the presence of either one of the following signs:

- Mengembungkan eardrum

- Limited / absence of movement of the eardrum

- The shadow of fluid behind the eardrum

- Fluid out of the ear.

3. Signs / symptoms of middle ear inflammation, as evidenced by the presence of either one of the following signs:

- Redness of the eardrum

- Ear pain that interferes with sleep and normal activity

Symptoms and signs of Otitis media

1. Ear pain, fever, irritability

2. Middle ear effusion

3. Eardrum bleak

4. Mengembung eardrum

5. Reduced drum movement

6. Decreased hearing

Symptoms and signs of otitis media with effusion:

1. Middle ear effusion

2. Eardrum bleak

3. Reduced drum movement

4. Decreased hearing

Handling

1. Antibiotics

OMA is a disease that will usually heal by itself. Approximately 80% of OMA cured in 3 days without antibiotics. The use of antibiotics does not reduce the complications that can occur, including decreased hearing.

Observations can be done in most cases. If symptoms do not improve within 48-72 hours or no change in symptoms, antibiotics are given

The definition of mild symptoms are mild ear pain and fever <39oC in 24 hours. While the symptoms are severe ear pain is severe or fever-39 oC.

Antibiotics on the OMA will result in improvement of symptoms within 48-72 hours. In the first 24 hours occurred within 24 hours of stabilization are both taking place improvements. If the patient does not improve within 48-72 hours, there may be other diseases or treatment provided is not adequate.

In this case such as this, antibiotics are considered:

- In patients with severe symptoms or OMA is probably caused by Haemophilus influenzae in moraxalle catarrhalis, which are then selected antibiotic is amecixillin clavumate. Another source states granting clavulanate amoxixillin do if symptoms do not improve in 7 days re-emerged in 14 days.

- If the patient's allergies can be mild to amocixillin caphalosphorin such as cefdinir, loracarbef, or cefuroxime.

- In the severe allergy to amocixillin, the money given is azithormycin or clarithornycin.

2. Analgesia / pain reliever

Besides antibiotics, treatment should be accompanied OMA pain (analgesia). Analgesia is generally used on simple analgesia such as paracetamol or ibuprofen can aggravate the digestive tract irritation.

Other:

1. Provision of other drugs: as anthihistamin (allergy) or dekongestyan not provide benefits for children.

2. Corticosteroids is not recommended

3. Myrongitomy

4. Giving antibiotics as prophylaxis to prevent recurrence of the OMA does not have sufficient evidence

Prevention

Some of this seems to reduce the risk of OMA

1. And prevention of ARI in children bayui

2. Breastfeeding for at least 6 months

3. Prevention of child-feeding while lying down dibotol

4. And avoidance of tobacco smoke exposure

Complications

Chronic otitis media is characterized circuitry in a history of chronic discharge from one or two ears. If the eardrum has been ruptured for more than 2 weeks, the risk of infection has become very common. Generally, the handling is done is wash and dry ears for several weeks until the liquid is no longer out.

Otitis media is not treated it can spread to tissues surrounding the middle ear, including the brain. But these complications are generally rare. One is mastoiditis in 1 in 1000 children who were not treated OMA circuitry.

Diagnosis appears:

1. Acute pain related to the agent bioloti

2. Sleep disorders associated with pain agent

3. Hyperthermia associated with disease or trauma

4. Anxiety related to health status.

NOC (Purpose)

DX :1

1.      Lomfosit level (2100)

-          Reported physical mell-being (210001)

-          Reproted statisfaction with symptom contril (210002)

-          Reported psyehclogikal well-beining (210003)

-          Expressed contentetement with physical remanding (210004)

-          Expressed contentement with social relationship (210005)

2.      Pain control (1605)

-          Recognize causal factor (160501)

-          Recognize pain anset (160502)

-          Use preventive inpasures (160503)

-          Use non-analgesik reliet measures (160504)

-          Use analgesic apporiatelery (160505)

3.      Pain level (2102)

-          Reported pain (210201)

-          Percent of body affectzd (210202)

-          Freluency of pain episodes (210204)

-          Oral expresnous of pain (210205)

DX : 2

1.      Anxiety control (1402)

-          Monitors of anxipty (140201)

-          Himimales proasure of anxiety (140202)

-          Decrease envirotment stimuli when anxious (140203)

-          Use effective coping strategis (140206)

-          Use relaction techniques toreduce anxiety (140207)

2.      Rest (0003)

-          Amount of rest (000301)

-          Rest pattern (000302)

-          Rest quality (000303)

-          Physically rested (000304)

-          Mentally rested (000305)

3.      Sleep (0004)

Hours of sleep (000401)

Sleep pattern (000403)

Sleep quality (000404)

Sleep effiaphcy (000405)

Sleep routnice (000407)

DX : 3

1.      Thermoregulation (0800)

-          Skin temperature IER (080001)

-          Body temperature WNL (080002)

-          Headache nol present (080003)

-          Respiratory rate IER (080014

-          Hydration adecute (080014)

2.      Thermoregulation : Neonate (080101)

-          Body temperature WNL (080101)

-          Respiratory distress not present (080102)

-          Restlesrness not present (080103)

-          Skin coles change IER (080105)

-          Weight gain IER (080106)

DX : 4

1.      Anxiety control (1402)

-          Monitors intensity of anxiety (140201)

-          Elminates precursor of anxiety (140202)

-          Decrearsus envirobmental stimulasi when anxioor (140203)

-          Plans coping strategis for stesiful situation (140205)

-          Use effective coping strategis (140206)

2.      Coping (1302)

-          Identities effective coping pattern (130201)

-          Identities ineffective coping pattern (130202)

-          Modities life style as needed (130207)

-          Employs behaviors to reduce stress (130211)

-          Use effective coping stragnes (130212)

3.      Impuls control (1405)

-          Identifies harmful implusive behaviors (140501)

-          Identities feelings that lead folmpulsive actions (140502)

-          Recognizes rinc in environtment (140505)

-          Verbaliset control of impulses (14050705)

-          Accepts rofernalis for treatment (140510)

INTERVENTION (NIC)

DX: 1

Pain Management

1.      The review comprehensively about pain, including the location, characteristics and oaset, duration, frequency, quality, intensity / severity of pain and the participation factors

2.      OPbservasi non-verbal terms of inconvenience, especially in the inability to communicate effectively

3.      Use therapeutic communication so that patients can express pain

4.      Evaluation of the effectiveness of the actions that have been used to control pain

5.      Control factor-environmental factor that can affect the patient's response to discomfort

6.      Provide information about the pain such as: causes, some of the old place and precautions

7.      Give analgesics according to the recommended circuitry

8.      Increase / adequate rest

9.      Monitor patient comfort for pain management

10.  Perform technical variations to reduce the pain

DX : 2 Sleep Enhancement

1.      Determine patients sleep /activity pattern

2.      Approximate patient regular sleep/make cycle in planning care

3.      Explain the importance of educate sleep

4.      Determine the effect of the patients mediation on sleep pattern

5.      Monitor/recorded patients sleep pattern and number of sleep hours

6.      Instruct comfort measure of message, positioning and affective touch

7.      Implement comfort measure of message, posiolioning in effective touch

8.      Promot an increase in number of hours of sleep if needed

9.      Provide for naps during the day, if in diated to meet sleep requirement.

DX: 3

Fever treatment

1.      Monitor the temperature as often as possible

2.      Monitor skin color and temperature

3.      Monitor blood pressure, pulse, and RR

4.      Monitor intake and output

5.      Give antipelink

6.      Monitor decreased level of consciousness

7.      Provide treatment to have the cause of fever

8.      selimuti patients

9.      Provide treatment to prevent shivering.

DX: 4 Anxiety Reducation

1.      Reassure the client

2.      Provide information about diagnosis, prognosis and action

3.      Assess the level of anxiety and physical reactions at the level of anxiety (toachycardia, tachppnea, non-verbal expression of dismay)

4.      Accompany the patient to support the safety and reduce fear

5.      Provide activities to reduce tension

6.      Bantul patients to identify situations that create anxiety

7.      Support the use of defensive mechanisms in the right way

8.      Instruct patient to use relaxation techniques

9.      Give medication to reduce anxiety in a proper way trying to understand the state of the client.

PHYSICAL EXAMINATION EAR

a. Assist the patient in a sitting position of patients who were children can be arranged to sit on the lap of others

b. Adjust your sitting position facing the patient's ear to be reviewed.

c. For lighting, use auroskop, past the head or other light source so that your hands will be free to work

d. Begin to observe external ear, check the state of the pinna of the size, shape, color, and the presence of mass lesions on the pinna

e. Continue assessment of palpation by holding the ear with the thumb and finger tenunjuk

f. Palpation of the outer ear cartilage, namely the systematic network of luna, then the hard tissue and note if there is pain

g. Press the tragus to the ear bones and the press are below the ear leaf. When there is inflammation amka patient will feel pain

h. Compare the left ear and right ear

i. If necessary, continue the assessment of the inner ear

j. Grasp the edge of the auricle / helix and slowly pull the ear upward and backward so that the ear canal becomes straight and easily observable. In children, the ear is pulled down.

k. Observe the entrance hole of the ear and note the presence or absence of inflammation, bleeding or dirt

l. Carefully insert the lit otoskop into the ear hole

m. If the location is right otoskop, put your eyes on eye-piece

n. Observe the presence of dirt, wax, inflammation or foreign bodies in the ear hole.

o. Observe the shape, color, transparency, luster, or perforation of a blood / fluid

EXAMINATION HEARING

Way of hearing a whisper

1. Adjust your back to the patient standing at a distance of about 4.5 to 6 meters

2. Instruct the patient to cover one ear that does not dipemeriksaan

3. Whisper of a number (eg seven six).

4. Tell the patient to repeat numbers at the hearing

5. Examination of the other ear the same way

6. Compare the ability to hear the right ear and left the patient

Ways to watch hearing

1. Hold a watch on the patient's ear

2. Have the patient states whether to hear the watch ticking

3. Move slowly watch the position of the ear and send the patient away from the states if they are not able to hear again. Normally the clock rate can still be heard at distances up to about 30 cm

4. Compare the right and left ear

Way of hearing with tuning fork

1. The first examination (Rinne)

a. Vibrasikan garputala

b. Put a fork in the left mastoid patients

c. Instruct patient to tell when no longer feel the vibrations

d. Lift and hold the tuning fork in front of the patient's left ear with a tuning fork position parallel to the external ear canal of patients.

e. Instruct patient to tell whether still hear the sound vibration or not.

2. Second examination (Weber)

a. Fibrasikan garputala

b. Put a fork in the middle of the forehead of patients

c. Ask the patient about the ears hear the sound balanced, so that the vibrations felt in the middle of the head.

d. Record the results of the hearing.

3. Determinasikan whether the patients had impaired bone conduction, air or both

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