Tonsilofaringitis Akut: Infeksi Streptococcus hemolyticus Grup A

 

 

DIAN INDAH PALUPI NUGRAHARI

Sarjana Kedokteran UPN Veteran, Jakarta

 

Infeksi saluran napas bagian atas sangat sering terjadi, terutama pada musim pan­caro­ba. Faringitis akut paling sering terjadi pada anak berusia 5–15 tahun, dengan puncak usia 4–7 tahun, terutama anak laki-laki (53,7%).1 Tonsilofaringitis adalah infeksi farin­g, tonsila palatina, atau keduanya.2,3 Pada anak, radang tenggorokan atau faring hampir selalu melibatkan jaringan sekitarnya sehingga jika anak terkena faringitis, hampir selalu juga mengalami ko-infeksi tonsillae.3

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Management Alice in Wonderland Syndrome

 

Introduction

Alice in Wonderland Syndrome (AiWS) is a symptomatology that related with perception changing, such as: distortion of body image, metamorphopsia, microp­sia, macropsia, sense of passage of time, and zooming of the environment.1,2 Terminology “Alice in Wonderland” syndrome was coined by Todd in 1955. It was described firstly by Lippman in 1952.3 A most famous person that suffers from AiWS is Käthe Schmidt Kollwitz (1867–1945), a painter and sculptor from Germany.4 AiWS can affect any ages, 7% of them 20 years old, and 10% of them 10 years old. There is diversity about the prevalence and incidence of AiWS among countries. In Indonesia, there is no epidemiological data.5,6

 

Synonym

In the medical terminology, Alice in Wonderland Syndrome (AiWS) is also called: “Alice in Wonderland“ syndrome, el síndrome de “Alicia en el País de las Maravillas”, Lilliputian Sight, Lilliputian hallucinations, a rare migraine variant. Some references consider AiWS as pediatric migraine or children’s migraine. For consistency, this scientific review is using term “AiWS” for “Alice in Wonderland Syndrome”.7,8,9

 

Etiology

Several studies support the hypothesis of a relationship between AiWS and Epstein–Barr virus (EBV) infections in children.10 AIWS also related to (pediatric) migrain­e, complex partial seizures, epilepsy, infectious mononucleosis, cerebral vasculitis, psychosis, and Epstein-Barr viral infection (the most common cause of infectious mononucleosis), varicella, Coxsackievirus B1.11

It is reported that 1–10% cases of AiWS in conjunction with neurological complication caused by Epstein-Barr viral infection. The inciden­ce of central nervous system’s involveme­nt in case of infectious mononucleosis varies between 0,7% and 20%.1

About 20% of AiWS’s cases is also related with electroencephalography (EEG) abnormality that shows reliable evidences about central nervous system’s involvement. AiWS also related to abdominal migraine and abdominal colic that affect approximately 20% of children with migraine.12

Some medication psychotropics, drug’s side effects, topiramate effects, or severe drug’s intoxication, are also connected with AiWS.13 An adult suffered from AiWS after consuming a cough syrup that contained dihyd­rocodein phosphate and dl-methylephedrine hydrochloride on a regular basis over 3 years.14 Typhoid encephalopathy cause­s AiWS through temporo-parietooccipitalis cortex in the brain.2

The interesting thing is, clinical manifestation of AiWS can be caused by brain function disorders in the medial temporal, hippocampal, temporo-occipital or temporo-parieto-occipital lobes. The unspecified cortical dysfunct­ion in AiWS sufferers is the results of multicausal, such as: decreasing cerebral perfusi­on, epileptic activities, or encephalitis. Moreover, depression is also the causal factor of AiWS.15

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Kebijakan TB DOTS dan Realisasinya

 

MUHAMAD ANGKI

FIRMANSYAH

Kepala IGD Rumah Sakit Darmo, Surabaya

 

Pemberatasan tuberkulosis (TB) dengan strategi DOTS (Directly Observed Treatment, Short-Course) telah dilaksa­na­kan selama 20 tahun sejak pertama kali dikenalkan pada 1995. Dalam rentang waktu tersebut, telah banyak dilakukan penyesuaian dalam penerapan strategi DOTS untuk meningkatkan keberhasilan program. Namun, hingga saat ini TB masih merupakan masalah kesehatan masyarakat dunia yang belum tertangani dengan baik.

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