• Tanggal 30 September 2009, terjadi gempa di Sumatera Barat. Diikuti tanggal 1 Oktober 2009, Gempa di Jambi dan Bengkulu. Sebagai suatu bangsa yang hidup bersama dan dipersatukan oleh Indonesia, mari kita turut membantu para korban gempa. Turut Berduka tanpa melakukan sesuatu hal, sungguh miris arti kebangsaan tersebut. Sudahkah kita membantu saudara-saudara kita?

• Bulan Oktober ini aku mulai dari kemalasan, dan cabut dari kuliah karena psikis ku lagi drop banget. "Aku sedang berada di titik terendah dari kehidupanku"..so..
• "Jangan biarkan mutiara di dasar laut semakin tertanam lebih dalam di dasar laut, Raihlah mimpimu setimggi bintang di langit dan sedalam mutiara di dasar laut."

Aku bertanya pada Bunda bagaimana memilih lelaki sejati?

Bunda menjawab, Nak...

Laki-laki Sejati bukanlah dilihat dari bahunya yang

kekar, tetapi dari kasih sayangnya pada orang

disekitarnya....



Laki-laki sejati bukanlah dilihat dari suaranya yang

lantang, tetapi dari kelembutannya mengatakan

kebenaran.....



Laki-laki sejati bukanlah dilihat dari jumlah sahabat

di sekitarnya, tetapi dari sikap bersahabatnya pada

generasi muda bangsa ...



Laki-laki sejati bukanlah dilihat dari bagaimana dia

di hormati ditempat bekerja, tetapi bagaimana dia

dihormati didalam rumah...



Laki-laki sejati bukanlah dilihat dari kerasnya

pukulan, tetapi dari sikap bijaknya memahami

persoalan...



Laki-laki sejati bukanlah dilihat dari dadanya yang

bidang, tetapi dari hati yang ada dibalik itu...



Laki-laki sejati bukanlah dilihat dari banyaknya

wanita yang memuja, tetapi komitmennya terhadap wanita

yang dicintainya...



Laki-laki sejati bukanlah dilihat dari jumlah barbel

yang dibebankan, tetapi dari tabahnya dia menghadapi

lika-liku kehidupan...



Laki-laki Sejati bukanlah dilihat dari kerasnya

membaca kitab suci, tetapi dari konsistennya dia

menjalankan ap

Kutipan :-)

The big secret in life is that there is no big secret.
Whatever your goal, you can get there if you’re willing to work.

~ Oprah Winfrey

Mia Nursalamah STORY's

Today, when i know that information and get the invitation for my friend wedding party.. huah.. feeling is unbelieveable but happy.. Congratulation my friend, Mia Nursalamah get through ur new life with happiness, become a good partner for your husband, muahhh.. :-)

Now, at 4th year programme.. is it real or not, all of us facing a difficult life from now on. Just remember for Minorthesis makes my heart beats fast, remember for our study at Respiratory System, and three more system, Gastrointestinal, Genitourinary, and Tropical Medicine, Our KKN, SOOCA, OSCE, Midterm, Final Exam.. :-(
Become patient friend, just let it flow. it's our way to be a good doctor, right?

Hope that everyday i can see happiness at ur face, even i know maybe someday it is quite difficult because everything gonna gone, everything has its own time, own places.. May God Bless Us, Friend...

HUBUNGAN HIV DENGAN TUBERKULOSIS

Tuberculosis
HIV and TB

HIV and TB form a lethal combination, each speeding the other's progress. HIV weakens the immune system. Someone who is HIV-positive and infected with TB bacilli is many times more likely to become sick with TB than someone infected with TB bacilli who is HIV-negative. TB is a leading cause of death among people who are HIV-positive. In Africa, HIV is the single most important factor contributing to the increase in incidence of TB since 1990.

WHO and its international partners have formed the TB/HIV Working Group, which develops global policy on the control of HIV-related TB and advises on how those fighting against TB and HIV can work together to tackle this lethal combination. The interim policy on collaborative TB/HIV activities describes steps to create mechanisms of collaboration between TB and HIV/AIDS programmes, to reduce the burden of TB among people and reducing the burden of HIV among TB patients.
The Stop TB Strategy, the Global Plan to Stop TB, 2006–2015 and targets for TB control

In 2006, WHO launched the new Stop TB Strategy. The core of this strategy is DOTS, the TB control approach launched by WHO in 1995. Since its launch, more than 22 million patients have been treated under DOTS-based services. The new six-point strategy builds on this success, while recognizing the key challenges of TB/HIV and MDR-TB. It also responds to access, equity and quality constraints, and adopts evidence-based innovations in engaging with private health-care providers, empowering affected people and communities and helping to strengthen health systems and promote research.

The six components of the Stop TB Strategy are:
1. Pursuing high-quality DOTS expansion and enhancement. Making high-quality services widely available and accessible to all those who need them, including the poorest and most vulnerable, requires DOTS expansion to even the remotest areas. In 2004, 183 countries (including all 22 of the high-burden countries which account for 80% of the world's TB cases) were implementing DOTS in at least part of the country.
2. Addressing TB/HIV, MDR-TB and other challenges. Addressing TB/HIV, MDR-TB and other challenges requires much greater action and input than DOTS implementation and is essential to achieving the targets set for 2015, including the United Nations Millennium Development Goal relating to TB (Goal 6; Target 8).
3. Contributing to health system strengthening. National TB control programmes must contribute to overall strategies to advance financing, planning, management, information and supply systems and innovative service delivery scale-up.
4. Engaging all care providers. TB patients seek care from a wide array of public, private, corporate and voluntary health-care providers. To be able to reach all patients and ensure that they receive high-quality care, all types of health-care providers are to be engaged.
5. Empowering people with TB, and communities. Community TB care projects have shown how people and communities can undertake some essential TB control tasks. These networks can mobilize civil societies and also ensure political support and long-term sustainability for TB control programmes.
6. Enabling and promoting research. While current tools can control TB, improved practices and elimination will depend on new diagnostics, drugs and vaccines.

The strategy is to be implemented over the next 10 years as described in The Global Plan to Stop TB, 2006–2015. The Global Plan is a comprehensive assessment of the action and resources needed to implement the Stop TB Strategy and to achieve the following targets:
• Millennium Development Goal (MDG) 6, Target 8: Halt and begin to reverse the incidence of TB by 2015
• Targets linked to the MDGs and endorsed by the Stop TB Partnership:
• by 2005: detect at least 70% of new sputum smear-positive TB cases and cure at least 85% of these cases
• by 2015: reduce TB prevalence and death rates by 50% relative to 1990
• by 2050: eliminate TB as a public health problem (1 case per million population)

Progress towards targets

In 2005, an estimated 60% of new smear-positive cases were treated under DOTS – just short of the 70% target.

Treatment success in the 2004 DOTS cohort of 2.1 million patients was 84% on average, close to the 85% target. However, cure rates in the African and European regions were only 74%.

The 2007 WHO report Global TB Control concluded that both the 2005 targets were met by the Western Pacific Region, and by 26 individual countries (including 3 of the 22 high-burden countries: China, the Philippines and Vietnam.

The global TB incidence rate had probably peaked in 2005, and if the Stop TB Strategy is implemented as set out in the Global Plan, the resulting improvements in TB control should halve prevalence and death rates in all regions except Africa and Eastern Europe by 2015.

For more information contact:
WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

SEJARAH PENANGGULANGAN TUBERCULOSIS DI INDONESIA

Sejarah Penanggulangan TBC di Indonesia


Hasil Survei Kesehatan Rumah Tangga (SKRT) tahun 1995 menunjukkan bahwa penyakit TBC adalah penyebab kematian nomor satu dari golongan penyakit infeksi pada semua kelompok usia. Pada tahun 1999, WHO memperkirakan setiap tahun terjadi 583.000 kasus baru TBC dengan kematian karena TBC sekitar 140.000. Diperkirakan pada setiap 100.000 penduduk Indonesia terdapat 130 penderita baru TBC paru BTA positif. Penyakit TBC menyerang sebagian besar kelompok usia kerja produktif, kelompok ekonomi lemah, dan berpendidikan rendah.

Sampai saat ini Program Penanggulangan TBC dengan Strategi DOTS belum dapat menjangkau seluruh Puskesmas. Demikian juga rumah sakit pemerintah, swasta dan unit pelayanan kesehatan lainnya. Pengobatan yang tidak teratur dan kombinasi obat yang tidak lengkap dimasa lalu, diduga telah menimbulkan kekebalan ganda kuman TBC terhadap Obat Anti Tuberkulosis (OAT) atau Multi Drug Resistance (MDR).

Sejak tahun 1995, Program Pemberantasan Tuberkulosis Paru telah dilak¬sanakan dengan strategi DOTS (Directly Observed Treatment Shortcourse chemotherapy) yang direkomendasi oleh WHO. Seiring dengan pembentukan GERDUNAS TBC, maka Pemberantasan Penyakit Tuberkulosis Paru berubah menjadi Program Penanggulangan Tuberkulosis (TBC).

Tujuan jangka panjang penanggulangan TBC adalah menurunkan angka kesakitan dan angka kematian penyakit TBC dengan cara memutuskan rantai penularan, sehingga penyakit TBC tidak lagi merupakan masalah kesehatan masyarakat Indonesia. Sedangkan tujuan jangka pendeknya adalah: 1) tercapainya angka kesembuhan minimal 85 % dari semua penderita baru BTA positif yang ditemukan, dan 2) tercapainya cakupan penemuan penderita secara bertahap sehingga pada tahun 2005 dapat mencapai 70% dari perkiraan semua penderita baru BTA positif.

Pada tahun 1999, Menteri Kesehatan mencanangkan Gerakan Terpadu Nasional Penanggulangan Tuberkulosis (GERDUNAS TBC), yang ditindaklanjuti dengan pertemuan antar mitra yang pertama serta peluncuran program pelatihan untuk tenaga kesehatan. Pada tahun 2001 disusun Rencana Strategis lima tahunan sebagai panduan penanggulangan TBC, sekaligus sebagai upaya mendapatkan dana dari lembaga donor. Dengan makin besarnya pendanaan dari lembaga donor serta peningkatan kapasitas manajerial di berbagai tingkatan, telah terjadi perluasan cakupan program secara signifikan sejak tahun 2002.

OTITIS MEDIA AKUT

Updated: Jul 16, 2008
ACUTE OTITIS MEDIA

DEFINITION
The American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) define acute otitis media :
Infection of the middle ear with
- acute onset,
- presence of middle ear effusion (MEE),
- and signs of middle ear inflammation.

*Presence of MEE Bulging of the tympanic membrane(highest predictive value), limited mobility of the tympanic membrane with pneumatic otoscopy and fluid visualized behind the tympanic membrane or in the ear canal (with perforation).

Distinguishing between acute otitis media and otitis media with effusion (OME) is important. OME is more common than acute otitis media. When OME is mistaken for acute otitis media, antibiotics may be prescribed unnecessarily. OME is fluid in the middle ear without signs or symptoms of infection. OME is usually caused when the eustachian tube is blocked and fluid becomes trapped in the middle ear. Signs and symptoms of acute otitis media occur when fluid in the middle ear becomes infected.

EPIDEMIOLOGY
Acute otitis media most commonly occurs in children and is the most frequent specific diagnosis in children who are febrile. Clinicians, including those in the ED, often overdiagnose acute otitis media.
Recurrent otitis media is defined as 3 episodes of acute otitis media within 6 months or 4 or more episodes within 1 year.

PATHOPHYSIOLOGY
Acute otitis media usually arises as a complication of a preceding viral upper respiratory infection (URI). The secretions and inflammation cause a relative occlusion of the eustachian tubes. Normally, the middle ear mucosa absorbs air in the middle ear. If air is not replaced because of relative obstruction of the eustachian tube, a negative pressure is generated and causes a serous effusion. This effusion of the middle ear provides a fertile media for microbial growth, and, with the URI, introduction of upper airway viruses and/or bacteria into the middle ear may occur. If growth is rapid, the patient will have a middle ear infection. If the infection and the resultant inflammatory reaction persist, perforation of the tympanic membrane or extension into the adjacent mastoid air cells may be present.

FREQUENCY
United States
Otitis media is common, with 50% of children having an episode before their first birthday and 80% of children having one by their third birthday. An estimated $3-4 billion are spent each year on care of patients with acute otitis media and related complications.

MORTALITY/MORBIDITY
• Mortality is rare in countries where treatment of complications is available, and it is not frequent in countries where treatment is not available.
• Morbidity may be significant for infants in whom persistent MEE develops. MEE leads to hearing deficits and speech delay. Most spontaneous perforations eventually heal, but some persist. Frequent recurrences of acute otitis media are relatively common.
• Otitis is not considered a major source of bacteremia or meningeal seeding, but local brain abscess has been documented, demonstrating that it is possible for acute otitis media to extend.

RACE
Otitis media is more frequent in certain racial groups (eg, Inuit and American Indians) than in others.
• Other factors in the environment (eg, crowding, daycare setting, nutrition) may be more important than race, but they have not been fully delineated.
• Otitis media is less common in groups with high rates of breastfeeding than in groups with low rates of breastfeeding.

SEX
Boys are affected more commonly than girls, but no specific causative factors have been found. Male sex is a minor determinant of infection.

AGE
Ear infection occurs in all age groups, but it is considerably more common in children, particularly those aged 6 months to 3 years, than in adults. This age distribution is presumably due to immunologic factors (eg, lack of pneumococcal antibodies) and anatomic factors (eg, a low angle of the eustachian tube with relation to the nasopharynx).
• Children with significant predisposing factors (eg, cleft palate) acquire infections so frequently that some
authors advocate the routine placement of polyethylene tubes in their tympanic membranes to maintain aeration of the middle ear.

CLINICAL HISTORY
Patients who can communicate usually describe feelings of pain or discomfort in the affected ear. However, most cases occur in children who are unable to communicate specific complaints.
• Acute otitis media
o Earache
o Fever (not required for the diagnosis)
o Accompanying or precedent URI symptoms (very common)
o Decreased hearing
• Acute otitis media in infants
o Infants may be asymptomatic.
o Irritability may be the only symptom.
• Serous OME
o Patients are usually asymptomatic.
o Decreased hearing may be demonstrated on audiometry.

Physical
If the canal is clean and if the patient is cooperative, physical examination is easy. If the canal is occluded with cerumen or debris, if the canal is anatomically small, or if the patient is unable to cooperate, examination may be difficult.
• Inflammation of the tympanic membrane and diminished movement of the membrane with insufflation or decreased visibility of the landmarks of the middle ear are the hallmarks of otitis media.
o Injection of the membrane is common in crying infants, and it may mislead the casual observer to believe the patient has acute otitis media. Therefore, pneumatic otoscopy is helpful in examining any patient with an injected tympanic membrane.
o A history suggestive of acute otitis media and an ear canal full of purulent exudate is usually considered sufficient to diagnosis acute otitis media with perforation.
o Acute otitis media should be painless. If pain is present, suspect that a foreign body in the ear canal is causing the infection or that the patient has otitis externa.
• Remove cerumen and other debris from the canal, as necessary, to allow clear visualization of the entire tympanic membrane.
o Removal may be difficult if the patient is uncooperative.
o Irrigation may be useful, as it may soften and dislodge cerumen so that it can be removed more easily.
o Soft plastic curettes are preferred to metal ones, but a firm tool may be necessary to remove a hard block of cerumen.
o Patients may require a referral if sufficient time and resources are not available for the proper and safe removal of cerumen.
o Care should be taken to avoid perforation of the tympanic membrane.
• The association between bacterial conjunctivitis and otitis media is well described.
o Any patient with purulent conjunctival exudate should receive thorough examination of the tympanic membranes.
o Sinusitis and purulent rhinitis frequently accompany otitis in children and infants.

CAUSES
Anatomic and immunologic factors in the presence of acute infection are the main causes of acute otitis media.
• Pneumococcus species, Haemophilus influenzae (untypeable), and Moraxella species are the bacteria most commonly involved in otitis media.
• Less common causes are other bacteria, Mycoplasma species, and viruses.
• Sterile effusions occur in approximately 20% of cases studied.
• Risk factors for otitis media have been identified and can generally be divided into those associated with the host and those associated with the environment.
o Host risk factors include age, prematurity, race, allergy, craniofacial abnormalities, gastroesophageal reflux, presence of adenoids, and genetic predisposition.
o Environmental risk factors include upper airway infections, seasonality, daycare, family size, exposure to passive smoking, breastfeeding, socioeconomic level, and use of pacifiers.
o Upper airway infections may lead to AOM.
o Incidence is increased in the autumn and winter months.
o Daycare center attendance increases risk of development of AOM.
o Bottle-feeding increases the incidence compared with breastfeeding.
o Pacifier use increases risk for AOM.
o Smoking in the household clearly increases the incidence of all forms of respiratory problems in childhood.
o A family history of middle ear disease increases the incidence.
o Siblings with recurrent AOM is a risk factor.
o Helicobacter pylori has recently been studied and found in middle ear, tonsillar, and adenoid tissues in patients with OME, indicating a possible role in pathogenesis of OME.
o Acute otitis media in the first year of life is a risk factor for recurrent acute otitis media.