HEALTH Conspiracy: REFERAT

Showing posts with label REFERAT. Show all posts

Sunday, March 29, 2020

Corona Virus pada Hewan Peliharaan

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By Deden Sura Agung</div>
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Sering banget ada yg tanya ke dokter: </div>
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1. Dok kucing punya virus corona ga si? 
2. Dokter jelasin ada, terus gimana dok? 
3. Nular dong? 
4. Engga dong?</div>
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Jadi corona virus itu dalam tantanan nomerklatur tingkatan family coronaviridae, nah untuk genusnya ada 4 bagian genus yang mindok tau ada alpa, beta, gama dan delta corona virus. </div>
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Untuk spesies virusnya sendiri juga banyak per genus nya, seperti yang ada pada bagan ini, untuk spesies alfacoronavirus yang ada pada kucing ada 2 (brdasarkan beberapa jurnal) ada FECV ( menyeramg sistem pencernaan)  tidak terlalu berbahaya namun bisa bermutasi sehingga membahayakan jika tidak segera ditangani dan FIP (peradangan pada pembungkus perut / peritonium sehingga perut menjadi besar berisi cairan) lebih berbahaya dan menyebabkan banyak kasus kematian pada kucing.</div>
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Jenis corona virus pada kucing juga sangat mudah menular pada kucing yang tinggal bersamaan seperti cattery dan shelter  serta dapat beresiko tinggi terhadap penyebaran virus ini. Sehingga menjaga kenersihan dan sanitasi kandang serta alat pemberian pakan mutlak diperlukan. 
Tapi eits, ini gk nular ke manusia kok. </div>
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Untuk anjing sendiri ada juga namanya canine corona virus. 
Virus ini punya 2 tipe yaitu tipe 1 dan 2 namun yang paling berbahaya adalah tipe 1 ccov sendiri memiliki gejala yang mirip dengan parvo virus yang dapat merusak villi usus sehingga terjadi radang pada sistem pencernaan sehingga dibutuhkan uji laboratorium untuk memastikan, 
Kedua dari golongan betacorona virus yaitu canine respiratory coronavirus atau sering disebut kennel cough, menyerang sistem pernafasan 
Dan tidak menular ke manusia juga</div>
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Sehingga dapat disimpulkan  bahwa jenis corona virus pada hewan kesayangan anjing dan kucing berbeda spesies dengan corona pada manusia ya.</div>
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Tapi tetap selalu cuci tangan setelah memegang anabulmu ya dan jaga selalu kesehatan mu dan anabulmu .. 😘😘🤗</div>
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#nemudigoogle #google.com 
#djendralangela #stayathome #workfromhome #dirumahaja #ngajedok 
Silahkan share ya</div>

By Deden Sura Agung Sering banget ada yg tanya ke dokter: 1. Dok kucing punya virus corona ga si? 2. Dokter jelasin ada, terus giman...

Monday, September 23, 2013

PHYSIOLOGICAL REACTION OF WOMEN IN SEXUAL RELATIONSHIP

<div>By Deden Sura Agung</div><div> </div>The first reaction in women who experience sexual stimulation is produced sap mucus vagina, labia enlargement, lengthening and widening of the vagina. These changes are temporary and rarely last long after orgasm. Vaginal mucus is the result of transudation (sweating phenomenon) across the vagina, where the production will stop when sexual stimulation disappeared, eventually sap dries quickly (Budiyanto, 1997). 
 
The hymen is usually torn at first sexual intercourse. However, sexual intercourse can also occur without causing damage to the hymen, the vaginal introitus when wide enough. Clinical study results showed that the pain usually arises at the time of the deflorasi, but bleeding arise, either from fourchet hymen or very little. The absence of bleeding suggests also that the strain has undergone vaginal introitus without any rips, or tears occur in avascular tissue (Budiyanto, 1997). 
 
Deflorasi evidence can not always be found. Minimal found a small tear in the hymen that does not extend to the peripheral. May also be found a small tear that has healed due to the use of tampons in the vagina. In addition, the hymen can also be torn by a finger or other object (Budiyanto, 1997). 
 
Absence of a tear in the hymen, does not mean that the woman is not going penile penetration, otherwise the rips just a sign of something blunt object into the vagina. The process of healing from a torn hymen is generally achieved within 7-10 days after penetration occurs (Knight, 1991; Idries, 1997). 
 
During intercourse, during ejaculation, the semen will fill the vaginal canal. Position changes in women can cause semen out again and makes stain on pubic hair, perineum, upper thighs, as well as sheets or underwear. Ejaculation outside the vagina can lead to deposit semen in various parts of the body (Idries, 1997). 
 
After ejaculation occurs, the sperm in the vagina can still move within the next 4-5 hours. Sperm that do not move are still to be found until about 24-36 hours after ejaculation. Although victims (women) have died, sperm can still be found up to 7-8 days (Idries, 1991). 
 
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By Deden Sura Agung The first reaction in women who experience sexual stimulation is produced sap mucus vagina, labia enlargement, lengtheni...

Thursday, September 19, 2013

HEART DISORDER SYMPTOMS (Hepatitis C)

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<div class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: justify;">By Deden Sura Agung</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: justify;"> </div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0cm; text-align: justify;">
Liver
disorder itself it is diversified, with the number of patients was small. Number
of people with hepatitis C only about 3% of the population. Not
to mention the hepatitis A and B, which are more numerous. Especially
when coupled with fatty liver, cirrhosis, drug intoxication, liver fibrosis,
and other diseases that her name not so familiar.
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Diseases was generally characterized by an increase in SGOT-SGPT numbers. However,
the two enzymes was not 100% produced by the liver. A
small portion is also produced by muscle cells, heart, pancreas, and kidneys. That
is why, when muscle cells are damaged, the two levels of this enzyme increases. </div>
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Damage to the muscle cells can be caused by many things, such as strenuous
physical activity, injury, trauma, or even scrapings. When
we got the intramuscular injection (injection via the muscle tissue), muscle
cells can have a bit of damage and increase the levels of transaminase enzymes. In
short, there are many factors that can cause an increase in SGOT-SGPT. </div>
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Compared with SGOT, SGPT is more specific liver cells showed irregularities,
because only a small SGPT produced by cells nonliver. Typically,
factors not nonliver SGOT-SGPT increase drastically. Generally,
less than 100% exceeded the upper limit of normal (BAN). For
example, if BAN alanine aminotransferase levels were 65 units / liter (U / l),
the increase was due to play football usually doubled. </div>
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If levels exceed twice, the sign began red light to watch. Do
not be "hurt" if doctors suspect we suffer heartache. BAN
itself can vary between laboratories.
If ever a blood test
in two different labs, and beyond the upper limit of normal (BAN) are
different, you do not have to wonder.
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"The upper limit of normal depending on the reagents and equipment used. In
certain hospitals, BAN can SGPT levels 40 u / l, but in other clinics may 65 u
/ l. It's just a matter of technical
inspection. That's why, we can not express the
level of SGOT-SGPT of absolute numbers, but of the relative value (compared to
surpass the upper limit of normal "BAN"). </div>
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SGOT-SGPT are two transaminase enzymes are produced mainly by the liver cells. When
liver cells are damaged, for example in the case of hepatitis or cirrhosis,
usually two levels of this enzyme increases.
Hence, by the results
of laboratory tests, both considered to illustrate a disturbance in the heart. </div>
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SGOT-SGPT
were slightly above normal does not necessarily indicate someone is sick. It
could have happened is not due to an increase in liver disorders. "If
we play ball after a blood test or scrapings, SGOT-SGPT very likely we will go
up," said dr. Rino A.
Gani, Sp.PD-KGEH,
hepatolog Faculty of Medicine, University of Indonesia, Jakarta. 
SGOT-SGPT levels are also easy up and down.
Maybe when examined,
the levels are high. But after that, he was back to normal. In
others, may now be examined, the levels were normal, but usually it high. Therefore,
a single examination alone can not be used as actual argument to make
conclusions.</div>
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Planned suicide</div>
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As with other organs, the liver has a
defense mechanism. When attacked by a virus, he tried to
resist. If defeated, he had two choices: fight
to the death or suicide. On hepatitis A and B, the liver took
the first option, to fight to the death.
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Once the liver cells die, the walls collapsed and eventually liver becomes
inflamed. This condition causes increased
SGOT-SGPT levels in the blood. Because the levels
are elevated, doctors diagnose more easily.
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But
in hepatitis C, more complex affairs.
Not all liver cells
still responded to defeat by fighting to the death. Others
in a planned suicide. In medical terms it is called apotosis
(programmed cell death). Suicide event is not without purpose. With
suicide, liver cells try to "kill" the virus indirectly. </div>
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One of the weaknesses of the virus, which does not have its own mechanism in
the breed. They are bred by utilizing the
mechanism of living cells of other living creatures. In
the case of hepatitis, carrying cells are liver cells. With
suicide, trying to make viral liver cells can not proliferate. </div>
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From
suicide, liver cells do not rupture, but shrinking. What
followed instead of the inflammatory process, but shrinking. Because
the liver is not inflamed, ALT levels were not affected. That's
what causes people with hepatitis C may have normal ALT levels, even though he
has suffered a chronic illness. It's also what makes
the doctor must repeatedly adjusted his glasses, because the diagnosis is
difficult. </div>
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Need another test
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SGOT-SGPT
only describes the level of damage to the liver cells. Both
of the other enzymes can not describe the level of ability of liver cells to
regenerate themselves. Under normal conditions, the body's
cells have the ability to regenerate.
If defective, they
will replace it with new cells. Regeneration ability
is what will offset cell damage.
Things that are not
reflected in the results of tests SGOT-SGPT.
It could be someone
SGOT-SGPT increased to above normal, but the liver was not actually in a state
hospital, because the cells that have died immediately replaced by new cells. </div>
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Although SGOT-SGPT increase could be due to many factors, increasing both
should remain wary. Throughout still have two eyes, we can
not look at him with one eye. Although only
slightly above normal too, the cause must be traced, to be sure there is no
disease that attacks. Levels above the normal so we should
suspect the sign of a disturbance in the heart.
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On
hepatitis C, if the SGPT to exceed twice the upper limit of normal (BAN), the
hepatolog agreed to take therapeutic action.
For the case of
normal ALT levels or slightly above BAN, differences of sect. The
first approach requires immediate treatment.
The second school of
thought, the patient should be closely monitored before treatment. 
During the monitoring period, patients should be 4-5 times to go to the lab to
undergo liver function tests every 1-2 months.
Liver function tests
here is not just a test SGOT and SGPT.
There are many other
components of blood chemistry that needs to be checked. To
be sure, doctors need to do a biopsy.
A small segment of
the liver tissue samples taken for examination by microscope. If
the results of the examination showed normal values, patients may be a little
relieved. He just needs to control for another
year. However, if the circuit examination
showed the patient had been hurt, he should be encouraged to undergo therapy. </div>
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Hepatitis C virus (HCV) can cause liver damage.
HCV infection is
spread primarily by direct contact of blood-to-blood. Most
people infected with hepatitis C through injecting drug use with shared needles
interchangeably. Up to 90% of people who ever injected
drugs, even once, was infected with HCV.
Some people are also
infected with HCV through unprotected sex.
This risk is
especially high for men who have sex with men, people with other sexually
transmitted infections, people with multiple sex partners, and those who
perform a sexual activity that causes bleeding, for example, put your hand on
the anal (fisting). HCV can also be transmitted by
tattooing equipment. Some people are also infected in health
facilities, through inadvertently punctured with needles or other instruments
that are not sterile. HCV can also be transmitted through
blood transfusion, although blood donors in Indonesia screened for HCV. </div>
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Hepatitis C treatment as early as possible is very important. Although
your body has to fight against infection, but only 15% were successful, the treatment
is still needed to prevent chronic hepatitis C and helps reduce the possibility
of a broken heart. 
Sometimes, the treatment of hepatitis C requires a long time, and can not help. But
because the disease can become severe over time, it is important to seek the
right treatment from your doctor.
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Early diagnosis and treatment is urgent and important. A
significant percentage of people who do it can recover from Hepatitis C and
showed his improvement. Goal of treatment is to eliminate the
Hepatitis C virus from your body as early as possible to prevent the
development of worsening and end stage liver disease. 
Course of the disease is indeed impressive sinister disease. But
according to doctors Superior Budihusodo, SpPD, of subsection Hepatology, University
of Indonesia Faculty of Medicine, patients with hepatitis C can be cured if
diagnosed and treated early. Moreover, the
development of hepatitis to cirrhosis or liver cancer may take a dozen to tens
of years. </div>
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"When
patients infected with hepatitis C virus was detected at a young age and get
immediate treatment, the chance of recovery is quite large, up to 80
percent," said Dr. Excellence in Hepatitis C Issues seminar in Indonesia,
which was held in Jakarta some time ago.
 
Leading doctors say, there are several factors that influence the success of
drug therapies, namely the type of virus, the amount of virus in the body, the
patient's age, condition of liver disease, when therapy is initiated, as well
as patient compliance in therapy.
"Patients who are
younger generally greater chances of recovery," he said. In
addition, patients infected with hepatitis C virus type 2 and type 3 were
successfully cured many. "Unfortunately, the type of virus
that many in our country are type 1 is more stubborn," he said. To
determine the genotype of the virus, patients are required to do blood tests. </div>
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This
virus genotype will determine the course of treatment that should be done. Patients
with hepatitis C virus type 2 and 3 only require treatment for 6 months. Whereas
patients with type 1 virus must take medication for 12 months. </div>
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Liver disease experts today recommend combination therapy of interferon and an
antiviral drug called ribavirin as the best choice of drugs for hepatitis C. This
drug is injected once a week for several months depending on the genotype of
the virus. Most forms of Interferon Alfa
could only last one day but can be modified through Pegylation process to make
it last longer. Although interferon alfa can be used as
a single drug, including hepatitis C pegylated interferon, showed more
effective when combined with anti-viral ribavirin. </div>
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3 (three) compounds
used in the treatment of Hepatitis C are:</div>
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<li>Alfa interferon is a protein made naturally by the human body to boost the immune system / immunity and regulate the function of other cells. Recommended drugs for chronic hepatitis C is of interferon Alfa can be in the form of natural or synthetic. </li>
<li>Pegylated Interferon Alfa, made by combining water-soluble molecules called "Polyethylene Glycol (PEG)" with interferon alpha molecule. This modification of interferon alpha longer exist in the body, and studies have shown more effective in making a response to the virus survive from chronic hepatitis C patients compared to interferon alfa usual.</li>
<li>Ribavirin is an antiviral medicine that is used with interferon alfa for chronic hepatitis C treatment. Ribavirin alone is not effective when used against the Hepatitis C virus, but with a combination of interferon alfa, is more effective than interferon alfa alone.</li>
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This
treatment has been accepted by the ability to generate a response against the
virus in patients with chronic hepatitis C disease. Patient
is said to have a response against the virus if the number of Hepatitis C virus
is so low that it was undetectable in standard tests Hepatitis C virus RNA and
if the level remains undetectable for more than 6 months after treatment is
completed. </div>
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Source: </div>
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 </div>
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http://kesehatan.kompas.com/read/2009/10/23/11194643/ 
http://medicastore.com/hepatitis_c/pengobatan_hepatitis_c.htm 
http://spiritia.or.id/li/bacali.php?lino=506</div>

By Deden Sura Agung Liver disorder itself it is diversified, with the number of patients was small. Number of people with hepatitis C...

Wednesday, October 19, 2011

HEMANGIOMA

<div class="MsoNormal" style="text-align: justify; text-indent: 36pt;">By Deden Sura Agung</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"> </div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;">Hemangioma is a lesion that growth can be predicted, these lesions can be evoluted, and also aimed at vascular lesions found in adults who do not experience regression and sometimes experienced progression. The origins of the terminology on the basis of the appearance of abnormalities and maternal impressions, such as strawberry hemangiomas, cherry angiomas, port-wine stains and salmon patches. Virchow then make a histopathological classification of the first, divided into three: angioma simplex, angioma cavernosum, and angioma racemosim, and ambiguous terminology is still survive in the modern medical books until now. Diagnosis for these lesions is really not easy to do because naming of the description of ambiguous and not appropriate proficiency level, therefore, clinical correlation is needed to make a final diagnosis.</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"> 
</div><div class="MsoNormal" style="text-align: justify; text-indent: 36pt;"></div><div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">CLASSIFICATION<a class="cssButton" href="javascript:void(0)" id="publishButton" target=""></a> 
<div class="cssButtonOuter"><div class="cssButtonMiddle"><div class="cssButtonInner"><a class="cssButton" href="javascript:void(0)" id="publishButton" target=""></a></div></div></div></div><div class="MsoNormal" style="text-align: justify;"><div style="text-align: left;"></div>Mulliken and Glowacki in 1982 proposed a classification system for vascular birthmarks that connects the history of the emergence of these birthmarks and physical examination with the cellular picture. They divided the vascular lesions of infancy and the kids into two major types: hemangiomas, with endothelial hyperplasia, and malformations, with normal endothelial changes. The key of the terminology is the word "oma" is derived from the Greek language, which was originally meaning "a lump or tumor". When this suffix is used for a term that describes lesions that grow from the cell proliferation. Most of hemangioma during infancy did not appear at birth but appear postnatally. Grew rapidly during the first year (proliferative phase), slowed, then regresses spontaneously in childhood (involuting phase), and then stabilized (involuted phase). 
 Histologically, proliferative phase has the character of an increase in mitotic activity, whereas in apoptotic phase of involution occurs, fibrosis occurs slowly and infiiltrasi fat. While the vascular malformation is a wrong morphogenesis that appear at 40-10 weeks in intrauterine life. Most of the vascular malformations appear at birth, or not appear at birth but appear a year later. If it has appeared it will continue to grow in proportion with the growth of the patient, however, rapid growth can grow due to trauma, hormonal changes, thrombosis, infection, or surgical intervention. In histology, vascular malformations have kareakteristik canal dilated, with an abnormal vascular wall, and endothelial quiet. There are classifies hemangiomas as follows: Superficial, Deep, Mixed, based on the location of the skin and subcutaneous tissue. It would be more appropriate terminology for these two disorders based on the use classification of vascular anomalies.</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="text-align: justify;">FREQUENCY 
Eighty percent growth as a single tumor, 20% multiple. Hemangiomas appear more in women than in men, with a ratio of 3-5:1. Incidence is more on baby as much as 10-12% were white, and about 22% found in premature infants weighing less than 1000 grams.</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="text-align: justify;">PATHOPHYSIOLOGY 
Hemangioma is a vascular network consisting of endothelial cells to proliferate. Proliferation is not regular at first, but over time become a regular form blood vessels in the form of lobules with lumen containing blood cells. Growth properties of endothelial cells is benign and has a thin basal membrane. </div><div class="MsoNormal" style="text-align: justify;">Proliferation is slowed and eventually stopped. The hypothesis of Takahashi stated that in the last trimester of pregnancy, the fetus is formed in the immature endothelial cells with pericyte is also immature, have the ability to perform limited proliferation began at age 8 months to 18 months of the first period of life after being born so there was hemangioma. During the proliferative activity of the endothelium occurs influx of a number of mast cells (as a proliferative stimulus endothelium) and tissue inhibitors of metalloproteinase (TIMP or tissue growth inhibitors). Endothelium proliferation returned to normal after stopping the proliferation phase (involution).</div><div class="MsoNormal" style="text-align: justify;"> 
</div><div class="MsoNormal" style="margin-bottom: 0cm; text-align: justify;">RESULT AND PROGNOSIS</div><div class="MsoNormal" style="text-align: justify;">Most hemangiomas occur during the early months of life, proliferates and peaked at age 1 year, and after it undergoes involution slowly. 50% experienced a complete involution by age 5 years. Seventy percent at age 7 years, and continued improvement until the age of 10-12 years. The exception of congenital hemangioma, which appear at birth usually regresses by age 1 year. Unlike vascular malformations, hemangiomas rarely cause distortion of the bones and excess growth except for a large facial hemangioma.</div>

By Deden Sura Agung Hemangioma is a lesion that growth can be predicted, these lesions can be evoluted, and also aimed at vascular lesions ...

Saturday, September 17, 2011

COMA is a state of unconsciousness

<div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">By Deden Sura Agung</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Coma is a medical condition that needs treatment sooner, because the basic course of the disease was the cause of 'coma' and direction of development of the disease can cause severe brain damage and irreversible. So rapid and systematic examination is needed to provide appropriate therapy and diagnostic work properly. Neurologic evaluation and management of patients 'coma' or loss of consciousness is very difficult, because patients in such conditions usually in critical condition and need help fast. 'Coma' is the result of brain dysfunction that can cause damage rekticular activation system such as loss of consciousness. </div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">In formulating a diagnosis of 'coma', there are two axioms that must be followed: (1) that found a single clue about the causes of 'coma' is not meant to prove the cause, (2) a complete Neurology examination itself is not efficient, because the examination of other organ systems should also be done . Disturbance of consciousness is a marker of nervous system disorders. In the examination must be distinguished from abnormalities in the level of consciousness (somnolence, stupor, coma) and / or the contents of consciousness (confuse, hallucinations).</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">DEFINITION</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Coma is a state of 'unresponsiveness' in which a person can not feel or react in the environment. Circumstances where a person looks like falling asleep and at the same time can not be awakened by external stimuli and the needs of the body in a state referred to as 'coma'.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">ANATOMY AND PHYSIOLOGY</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">State of human consciousness is a reflection of the level of 'arousal' and combined cognitive brain functions. 'Arousal' played by the integrity of the physiological mechanisms of formation rektikularis and structures located at the top of the brainstem, starting from the front until the mid-pons to the hypothalamus. Behavior 'conscious' tend in played by functional areas of the hemisphere cerebri each other and interact with each other is widely associated with the activation system that is more noble than the upper brain stem, hypothalamus, and thalamus. Moruzzi and Mogoun (1949), argued that the rektikularis formasio area located at the rostral brain stem, which when stimulated will cause a general activation of the non-specific in the cortex cerebri, which is referred to as 'Ascending Recticular Activating System'. This system includes areas in the middle of the brain stem, extending from the midbrain to the hypothalamus and thalamus, and describe these structures in transmitting the physiological effects of a diffuse to the cortex either directly or indirectly, in the role of the arousal of consciousness. Gellhorn (1953), suggests thinking about the process of 'consciousness', which is known as the hypothalamus or hypothalamic activation system controle system, which is composed of fibers of the projection between the hypothalamus with the front lobe of the piriformis, nucleus of the amygdala and hippocampus formasio rear, to deliver visceral feelings and impulses of organic sensations through the neocortex without direct contact with formasio rektikularis. In this case the activation of the cortex cerebri is controlled by a two-way through the hypothalamus, the activation / facilitation and inhibition systems. And this system is closely related to the setting instinktuil, emotional, autonomic, and hormonal.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Formasio rektikularis extends from the caudal medulla oblongata to the midbrain rostal, with no clear boundaries. In it lie many vital centers such as the respiratory center, blood pressure, heart rate, and other vegetative functions, and also contain components of ascending and descending pathways that play an important role in the regulation of endocrine secretion, reflex, sensory input, and awareness. 'Ascending Recticular Activating System' receiving stimulation by all the general somatic sensory pathways and specific. Rektikularis excitation system is a complex trajectory polisinaps, because apart from the sensory tract, also derived from the trigeminal system, hearing, sight, and smell. Conductive pathway talamikus spino-walk toward the medulla and pons tegmentum is a morphological pathway of the excitatory noksius of 'consciousness'. Some pathways of formasio rektikularis routed through the thalamus to the next projected evenly on the cortex cerebri (specific projections), while others will end up in nuckleus specific thalamus to then projected diffusely to the cortex (the projection of non-specific).</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Broadly speaking, the causes of 'coma' could be in for two, namely intracranial and metabolic. The cause of intracranial such as head trauma, infections, neoplastic, and vascular disorders. On the causes can be metabolic imbalance of electrolytes and acid-base, endocrine disorders, hepatic coma, uremic coma, anoxia encephalopathy, vitamin deficiency (thiamine, niacin, vitamin B12), toxins and intoksikan.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">The causes of 'coma' can be categorized into:</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">a.      Dysfunction of the cerebral cortex of bilateral multifocal or diffuse, where the substantia grisea cortex is destroyed or depressed by acute and diffuse so that the curved trajectory of physiological feedback cortical-subcortical damage, the mechanism of autonomic arousal of the brain stem and cause shock terinhibisi acute rektikulaer below the level of lesion (eg : necrosis due to hypoxia-iskhaemia heavy, prolonged hipoleukhaemia, metabolic depression in ensefalopatia hepatica).</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">b.     Direct damage to the paramedian upper brain stem and posterior-inferior diencephalic ascending arousal system that is blocking the normal cortical activity (ie: encephalitis infrak or certain inflammatory lesions).</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">c.    Wide disconnection between the cortex and subcortical mechanisms of activity similar to the above two conditions (for example: dismielinisasi or extensive damage of the substantia alba severe cerebral hemisphere pascahipoperfusi-old cerebral hypoxemia due to CO poisoning). 
d. Diffuse abnormalities are usually caused by a metabolic disorder affecting competing cortical and subcortical arousal mechanisms (eg metabolic encephalopathy).</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">CLINICAL APPROACH</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">As the algorithm approaches the patients 'coma' or loss of consciousness:</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">1.   ABC: in patients who experienced loss of consciousness, carried out the liberation of the airway, breathing and circulation should be checked and maintained.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">2.   Look for signs or clues about the cause of the decline in consciousness through anamnesa (a history of hereditary diseases, the state and condition of the patient is found, etc.), physical examination (odor breathing, signs of meningeal perangsagan, scar injections, etc.), laboratory and radiological examinations.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">3.      Addressing a common cause of reversible: giving naloxone, thiamine, and dextrose 50% in patients with decreased consciousness and the cause is unknown.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">4.      Neurology examination: check the brainstem and the search for focal lesions.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">DIAGNOSIS</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Physical Examination:</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Note vital signs like blood pressure, pulse, respiration and temperature, whether there are abnormalities or not. In general observations views posture, patient age, stigmata of chronic disease, breathing patterns, and skin color (jaundice, cyanosis, pallor, red cherry). Looking for signs of trauma to the head (skull fracture, laceration), seizures (myoclonic, deserebrasi), the smell of breathing (alcohol, acetone, ammonia), check the ears and nose (bleeding or discharge of cerebrospinal fluid), check the extremities body if there is a fracture or not, and palpation - percussion and auscultation of the thorax area, heart and abdomen.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Examination Neurolgic:</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">First of all examined the level of consciousness using the GCS - Glasgow Coma Scale which consists of:</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">EYE</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Opening eyes spontaneously. (4)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Open the eyes with the sound stimuli. (3)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Open the eye with painful stimuli. (2)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Unable to open the eyes. (1)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">MOTORIC</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Moving according to the command. (6)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        It can locate pain. (5)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        avoidance reaction. (4)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Reaction dekortikasi / flexion. (3)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Directors deserebrasi / extension. (2)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        There was no reaction. (1)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;"> 
</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">VERBAL</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Good and no disorientation. (5)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        'Confuse'. (4)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Talk is not appropriate. (3)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        Can only groaned. (2)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 0.0001pt 21.25pt; text-align: justify; text-indent: -21.25pt;">-        There is no sound. (1)</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">As a benchmark for 'coma' then according to GCS equal to 3, where there were no eye-opening response, verbal and motoric. Then note the pattern of breathing and motoric examination. </div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">On motoric examination, which is seen is the patient's posture and if there are seizures or not. Cranial nerves examination was conducted to assess the function of the brain stem. Where in the patients who experienced loss of consciousness or 'coma' will happen some decline in brain stem reflexes, then examined the pupillary reflex, corneal, okulocefalik (doll's eye), and vomiting.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;">To help find out the causes of 'coma', then the examination can be performed with CT-scan or MRI, was conducted to determine abnormalities in the brain are like a tumor mass or increased intracranial fluid. If meningitis is suspected, then examination lumbar puncture. In laboratory tests that examined the levels of blood glucose, iodine, calcium, and urea nitrogen or creatinine; arterial pH, pO2, and PCO2; the concentration of ethanol in blood and urine; blood cultures and cerebrospinal fluid; and liver function.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">TREATMENT</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">The principle of treatment is generally required to be applied immediately although the diagnosis of the cause has not been enforced. Starting from:</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">1.      ABC: the liberation of the airway, breathing and circulation maintenance.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">2.      Overcome state of shock, if any.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">3.      Provision of naloxone 0.5 mg iv (if the cause is an overdose of narcotics), infusion of glucose 50% 25 50ml. And given the thiamine 50 - 100mg after administration of a bolus injection of glucose.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">4.      Giving Mannitol 50gr in a solution of 20% iv every 10 -20 minutes.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">5.      Perform lumbar puncture if meningitis is suspected or subarakhnoi hemorrhage, or perform a CT-scan.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">6.      Giving anticonvulsant such as phenytoin 500 - 1000mg iv, doses <50mg/mnt.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">7.      Rinse and gastric lavage with normal saline is very useful if the coma is because taking drugs.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">8.      The use of cooling mat to cope with hyperthermia.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">9.      Installation of a catheter to help the urine output.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">10.   Installation of stomach tube to assist the provision of food and drink.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 21.3pt; text-align: justify; text-indent: -21.3pt;">11.   Changing the sleeping position of patients and restriction of oral fluids. Patient's legs should be checked to prevent phlebothrombosis.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt; text-align: justify;"> 
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">CONCLUSION</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">'Coma' is a state of reduced consciousness that causes people to look like falling asleep but can not be aroused by stimuli from the outside or the surrounding environment and by stimulation of the body. The causes of 'coma' can be divided into two, the first of abnormalities in the intracranial and the second by metabolic abnormalities. </div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">What makes 'coma' as a state of emergency is the cause of the disease course and progression of the disease that can cause severe brain damage and irreversible, and usually patients with a 'coma' was in critical condition.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;">Therefore, in treating patients with decreased consciousness or 'coma' should be quick and systematic, is intended to provide appropriate therapies and diagnostics work properly. In an effort to provide relief, then the following steps can be followed:</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 14.2pt; text-align: justify; text-indent: -14.2pt;">1.   Remember ABC: the liberation of the airway, breathing and circulation maintenance.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 14.2pt; text-align: justify; text-indent: -14.2pt;">2.   Find the clues of the cause of the reduction state of awareness. In this case, do diagnose, checking vital signs.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 14.2pt; text-align: justify; text-indent: -14.2pt;">3.   The management of circumstances that are still reversible, such as provision of naloxone, thiamine, and dextrose to patients with decreased awareness of the cause is unknown.</div><div class="MsoNormal" style="line-height: normal; margin: 0cm 0cm 6pt 14.2pt; text-align: justify; text-indent: -14.2pt;">4.   Check your brain stem reflexes and look for the symptoms / signs of focal lesions.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 6pt; text-align: justify;"> 
LITERATUR</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">1.         Adams R.D, Maurice V. Coma and Related Disorders of Consciousness, Principles of Neurology, 5th edition. McGraw-Hill Co,Inc. 1993: 300 – 318;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">2.         Drislane F.W, Benatar M, Chang B.S, et all. The Approach to Coma and Altered Consciousness, Blueprints Neurology, 2nd edition. Lippincott Williams & Wilkins. 2002: 20 – 26;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">3.         LeBlond R.F, DeGowin R.L, Brown D.D. Coma, DeGowin’s Diagnostic Examination The Complete Guide to Assessment Examination Differential Diagnosis, 8th edition, International edition. McGraw-Hill Co,Inc. 2004: 865 – 868;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">4.         Kasper D.L, Braunwald E, Fauci A.S, et all. Confusion, Stupor, and Coma, Harrison’s Manual of Medicine, 16th edition, International edition. McGraw-Hill Co,Inc. 2005: 54 – 58;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">5.         Gilroy J. Coma, Basic Neurology, 3rd edition, International edition. McGraw-Hill Co,Inc. 61 – 70;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">6.         Listiono D. Koma dan Gangguan Kesadaran, Ilmu Bedah Saraf Satyanegara, edisi Ketiga. PT.Gramedia Pustaka Utama, Jakarta, 1998 : 130 – 143;</div><div class="MsoNormal" style="line-height: 150%; margin: 0cm 0cm 0.0001pt 21.3pt; text-align: justify; text-indent: -21.3pt;">7.         Brust  J.C.M. Coma, Current Diagnosis & Treatment in Neurology, International edition. Lange Medical Books/McGraw-Hill Co,Inc. 2007: 29 – 34.</div>

By Deden Sura Agung Coma is a medical condition that needs treatment sooner, because the basic course of the disease was the cause of '...