hiv - aids 11 breastmilk education

The provision of breastfeeding

Mother who decided to breastfeed their children must be wary that:
• Therapy profilaksi antiretrovirus given during childbirth and the baby immediately after birth, will not provide protection for a longer breast fed infants.
• More than 20% of breast fed infants of HIV positive mothers are likely to get HIV infection through breastfeeding.
1. Giving breast milk exclusive
Advantages:
- Breastfed babies easily digested and provide all the nutrition and fluids is required. Baby will not need food or other beverages during the first 6 months.
- Breastmilk is always available and does not require special preparation to provide them.
- Breastfeeding can protect babies from diseases, especially diarrhea and pneumonia.
- With breastfeeding will create inner bond between mother and baby to be more closely linked.
- Compared to the combination of milk, breast-feed exclusively on the first few months can reduce the risk of HIV transmission.
Losses:
- Risk of transmission of HIV from mother to baby during the baby's remains are still breast fed by HIV positive mothers.
- Risk of transmission of HIV to be greater when there is a breast infection such as mastitis, or abrasions, and bloody hilt.
- For mothers who work, difficult for him to provide appropriate breastfeeding baby needs (baby breastfeed at least 8-10 times a day), unless the mother have a place to store ASI (for example, in the refrigerator).
- Mother who breastfeed need extra nutrition as an additional 500-750 kcal / day to assist mothers in breastfeeding the baby exclusively for 6 months first.

2. Giving breast milk with period stop breastfeeding
Mother with HIV who choose to breastfeed the baby must stop immediately after the breastfeed available for breastfeeding. Before entering the stop breastfeeding , a few days to two weeks, the mother with HIV should get information on how to maintain breast health, psychosocial support, and additional nutrition for the baby.
Advantages:
- The period of breastfeeding stop decided early exposure of HIV through breastfeeding.
Losses:
- Baby nutrition become less after breastfeeding stops if milk of an appropriate breastmilk is not available or not provided, as appropriate.
- Babies are at risk for becoming infected diarrhea when breastfeeding is not a substitute for milk prepared correctly.
- Baby became restless and would not even be drinking if stop breastfeeding done too quickly.
- breast mother can become hot during the stop breastfeeding if breastfeeding is not removed and discarded.
- Mother's pregnancy at risk for more sexual activity, if conducted.
- Early stop breastfeeding not recommended for infants have been known to be infected with HIV.

3. ASI Trought mother giving milk
Advantages:
- The use of maternal milk does not make the existence of HIV in the baby if the mother's milk is not infected with HIV.
- Some of the benefits of breastfeeding is also valid if the breastfeeding mother with the milk.
Losses:
- Mother's milk should test first and not infected with HIV.
- Mother's milk must protect themselves from the risk of HIV transmission during breastfeeding.
- Mother's milk should always be ready to breastfeed the baby as often as possible both day and night, or he must save the milk dikefor granted when he was far from a baby.
- In certain circumstances, will raises the question of the family or community about the situation his mother and the mother have a tendency to get pregnant again when doing sexual activities.

4. Giving breast milk with heat Flash
According to Morris, 2007, with the spark that breastfeeding has an important role in the transition from exclusive breastfeeding to solid feeding. And from research conducted by Dr. Israel-Ballard in California, United States, the results obtained with the spark that breastfeeding can inactive HIV in the breastmilk of mothers infected with HIV-positive.
Protocol in the heat breastmilk in the study can be adjusted to your own home. Air susu placed in sterile container that is not closed in a large pot containing 450 ml of water. Water is heated to boiling and then immediately cooled to a temperature 37C. (Morris, 2007)

Advantages:
- The HIV virus into the warm water inactive milk.
- Breast milk is the perfect food for babies, and most nutrient are still in it after heat.
- Breastmilk is always available for babies.
- Other family members can assist in providing food for babies.
Losses:
- While the ASI heat"does not" contain HIV, milk water is not as effective as usual breastmilk protects the baby in a variety of other diseases, but still better when compared milk formula.
- Rack and heat ASI requires time and often must be done.
- ASI must be cooled before and given out within 1 hour after heat.

Education and Monitoring
Every baby born from mothers with HIV-positive should have to be guarded the confidentiality of the mother and her family, and the need for the provision of counseling on the family. In care with no difference in caring for babies in general, just need special attention on the prevention of the occurrence will risk of infection. (Pusponegoro, 2004)
In the provision of routine immunization, according to Pusponegoro, 2004, remain to be done according to the schedule that has been recommended. Effectiveness and effects caused by the provision of immunization to this many are reported. (Pusponegoro, 2004)
In the HIV infection, the baby can experience weight infants with mild or fail to grow. Therefore, the baby needs to grow flowers, followed by a monitoring body weight, head circumference, and length of the body. Mothers should also always carry the baby for further examination: (Pusponegoro, 2004)
- Hits back to the monitoring body weight.
- Counseling on the provision of nutrition at the baby.
- The supervision will be the emergence of signs on the alert that includes the baby to drink less than 6 times a day or drink only a little, diarrhea, weight loss is difficult to ride.
In addition, the therapy can anti retrovirus that can affect the prognosis previous baby to grow and develop further. In the baby had got anti retrovirus therapy when the mother must have check-up. The examination carried out until 6 years to ensure that development in children does not show deviation in development, immune system disruption, brain development, and no tumor growth. (Mofenson, 2007)

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hiv - aids 10 brestfeeding

Provision of breastfeeding

Milk replacement given to breastfed infants who do not get breastfed at all. milk of breastfeeding, when prepared correctly, can provide all the necessary nutrient baby until the baby is able to eat as food in the family. ASI covers of milk formula or a modified animal (home-modified animal milk). And through the glass more than the recommended over bottle.
1. Milk formula
Advantages:
- No / slight risk of transmission of HIV infection in the baby.
- Created to fit babies.
- Other family members can assist in providing drinking babies, even when the mother is sick.
Losses
- Does not contain antibody that can protect babies from infection.
- Required that the provision of development, is intended to prevent malnutrition.
- The price is relatively expensive
- Milk should be fresh in the circumstances of each, according to the instructions for the morning or evening.
- In certain circumstances, will raises the question of the family or community about the situation his mother and the mother have a tendency to get pregnant again when doing sexual activities.
2. Animal Milk Modified (Home-Modified Animal Milk)
milk this type can be given when milk formula is not available. Babies need about 15 liters of milk each month for the first 6 months. Baby will also require multi nutrient supplements to prevent anemia and various forms of malnutrition. This is because the animal milk relatively low iron, zinc, vitamin A, vitamin C, and acid folat. Providing the proper storage and good nutrition can provide a significant value and reduce the risk of malnutrition. Not all animal milk or beverage can according to the milk. Some milkanimal that can be used to create a modified animal milk:
• Fresh Milk (full-cream/pure) from cow, goat, cow, buffalo or camel.
• Milk powder full-cream/pure
• Milk processing (the milk evaporated)
• Milk UHT (Ultra-heat Treated)
Milk preparation also requires some modifications in order to milk suitable for babies up to age 6 months. The steps it takes to make this includes thin milk in boiling water to reduce consentration and adding sugar to increase the sugar in the womb.
Profits and losses from the provision of a modified animal milk is not much different with the milk formula. milk provision does not require a fee for the provision of milk formula. milk babies that get this type of pain tends to be easier because of diarrhea and pneumonia, and malnutrition can develop into as milk animal is digested more difficult for the baby's digestion.

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hiv - aids 9 nutrition to baby

Giving Baby Nutrition from Mother HIV - AIDS

Since HIV was first known in the milk, policymakers need to develop guidelines that are easy and appropriate to help with the HIV positive mother to decide if they will breastfeed their babies. Where the mother was faced with the dilemma of risk that may be encountered:
1. Risk of transmission of HIV from mother to her child through breastfeeding, or
2. Risk will morbiditas / infant mortality by as many as the ASI is not given. (Morrison, 2000)
Not be breast-fed infants when compared with breast fed infants appear to be greater risk for malnutrition and disease occurs infections that threaten the people, in addition to HIV, especially in the first year of life, and breastfeeding exclusively provide better protection. (Anonymous, 2003)
Risks associated with not breast-feed baby also depends on the environment, for example the availability of appropriate nutrition and hygiene water. The state of the mother and the family also affect the baby's risk, including economic status and education. (anonymous, 2003)
Some research indicates that the benefits from the protection of drug therapy given to decrease when the baby back in touch with HIV through breastfeeding. (Kanabus, 2006)
Many agencies or institutions that deal with HIV / AIDS, recommend to the HIV-infected mothers not to breastfeed the baby immediately after milk formula for breastfeeding available acceptable (acceptable), easy way making (feasible), cheap (affordable), it's easy to get (sustainable), and safe (safe) for the baby. (Kanabus, 2006)
However, for those who live where it is difficult to get clean water and safe, the risk for the occurrence of infection by milk formula is greater when compared with the ASI. (Kanabus, 2006)
With the HIV positive mother should first search for information or consultation about the choice of drink to the baby. If you want the mother to breastfeed the baby, it will be at risk to transmit HIV infection to the baby, while giving milk formula may increase the risk of pain (morbiditas) and death (mortality), especially when the milk formula should not be done safely. Then, any choice of the mother is given support at the high, however because it is the choice of the mother are best for baby. (Pusponegoro, 2004)
Babies who get milk formula does not get the special vitamin-vitamin, nutrients, and protective agents found in breast milk. Price milk formula sometimes beyond the reach capability, especially in the family can not afford, even if the product milk formula is widespread and easily obtainable. In addition, many women also have deficiencies in the knowledge, get the clean water, and materials needed to prepare the milk of a safe, or they do not have much time to prepare the milk . If making milk formula is not suitable, for example, mixed with water that is clean or not too thin, then the formula is exactly milk can cause infections, malnutrition or even death. (Kanabus, 2006)
For the HIV positive mother who decided to breastfeed the baby, breastfeeding is recommended for babies aged one month in the first, and must be stopped immediately after the milk formula breastmilk substitute is available. Giving a combination of drink (drink from animal milk, milk formula, porridge made, in addition to the ASI) are not recommended as this will make the risk of occurrence of infection is higher than the provision of exclusive breastfeeding (Pusponegoro, 2004). Infection may occur due to the combination of drinks can cause damage to the epithelial layer of stomach and intestine and that the baby is easier for the HIV virus in infants breastfed for infected. Until this time there is no research that can indicate when the best time to stop the breastfeeding period and it depends on the age of the baby, the mother, and the surrounding environment. (Kanabus, 2006)
Here is an alternative in the provision of nutrition in the infant age of 6 months: (anonymous, 2003)

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hiv - aids 8 therapy

Therapy Anti retrovirus
Without giving medications anti retrovirus, 25% of infants with HIV-positive mothers will be born before or at the time of birth, or 15% will be through breastfeeding. (Pusponegoro, 2004)
Zidovudin (AZT) is a regimen that often use at this time as anti retrovirus therapy based on the results of PACTG 076 (Pediatric AIDS Clinical trials Group study - protocol 076). (Mofenson, 2007)
In the therapy anti retrovirus this, note whether the mother before being anti retrovirus obtain treatment for HIV or get treatment for the prevention of transmission anti retrovirus on the baby.
When mothers have got AZT 4 weeks before birth, after birth the baby is given AZT 2 mg / kg BB per oral every 6 hours for 6 weeks. When mothers have got nevirapin single dose during labor and infants aged less than 3 days, the baby should be given in nevirapin Suspense 2 mg / kg BB per oral. (Pusponegoro, 2004)
When there is no therapy anti retrovirus given to the mother during pregnancy, childbirth, or at the time of birth, there are some recommendations that include: (Mofenson, 2007)
• Babies should immediately get AZT therapy immediately after birth for 6 weeks, given in 6-12 minutes.
• specialist children's doctor who specifically deal with HIV need to consider combinations of drugs anti retrovirus depending on the status of the mother.
• Mother of the examination should be performed after childbirth (eg, viral load, the number of CD4 cells), to determine whether he should get therapy anti retrovirus for health itself.
Preparat and anti retrovirus dose for infants and children: (Wahono, 2006)
1. Zidovudin (AZT)
- Neonates less hours
1.5 mg / kg BB every 12 hours until the age of 2 weeks, then 2 mg every 8 hours kg BB
- Neonates enough hours (until the age of a baby 90 days) < • Oral: 2 mg / kgBB every 6 hours (oral) • IV: 1.5 mg / kgBB every 6 hours - Pediatrics (dose range 90 mg-180mg/m2 LPB every 6-8 hours) • Oral: 160 mg/m2 every 8 hours LPB • IV (infus intermiten): 120 mg/m2 every 6 hours LPB • IV (infus rumatan): 20 mg/m2 LPB / hr - Adolesen 3x200 mg / day, or 2x300 mg / day 2. Stavudin (d4T) - Neonatus (under evaluation in the PACTG 332) - Pediatrics 1 mg / kgBB (up to 30 kg weight), 2x a day - Adolesen / adult BB> 60 mg kg 2x40, BB <60> 50 kg: 2xl50 mg / day; BB <50>

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hiv - aids 7 diagnosis

Diagnosis
Some of the diagnostic steps that can be done on a baby suspected of HIV infection obtain the mother pregnant. (Pusponegoro, 2004)

anamnesis
• Historical mother user of drugs including drug through the blood vessel.
• Historical mother receiving a blood transfusion or components, and without the filter of HIV test
• Historical aberration sexual orientation and behavior in the mother (female bisexual)
• Historical imunologis mother with a bad response.

Physical examination
Neonatus on clinical symptoms can be:
• BBLR or fail to grow.
• Infection channel repeated breath, otitis media, sinusitis, sepsis, monoliasis repetitive, sometimes happens nonspesifik infection with symptoms hepatosplenomegali, limfadenopati, and fever.
• Disturbance of progressive motor

Examination support
• CT-Scan  not have to see kalsifikasi basaltic ganglia and atrofi on korteks serebri.
• HIV antibody inspection  in children> 18 months, declared positive if the IgG anti-HIV (+) with the Blot and ELISA checks. In the infant <18> 95% baby age 3-6 months.
If test HIV, most of the babies born by HIV-positive mothers showed positive results. This means that there is antibody to HIV in the blood. However, the baby receives the mother's antibody, in order to protect the body's immune system so that the form fully. So positive test results in early life does not mean the baby being infected.
If the baby was infected, the body's immune system will form antibody against HIV, and HIV tests will continue to show positive results. If the baby is not infected, antibody from the mother will be lost so that the test results became negative after approximately 6-12 months.
A test other, similar to viral load tests can be used to determine if the baby is infected, usually several weeks after birth. This test, the search for the virus antibody is not, at this time only available in some large cities, and the price is quite expensive. (anonymous, 2007)
Both culture and virus-specific assessment RRP HIV, can be successful in the diagnosis of infection from the list of blood samples fetus. Amniocentesis and has kordosentesis can be done successfully in pregnant women with HIV sero-positive, but the way and time to perform the procedure invasive this problem because the chronology of transmission of HIV is not definitive. There are also concerns about the possibility of transmission to the fetus as a result of the procedure itself, especially kordosentesis. (Parks, 2000)

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hiv - aids 6 infection and epidemiology

HIV Epidemiology
HIV infection in children is almost always obtained from the infected mother. The virus can be transmitted through pregnancy, childbirth process, or through breastfeeding. In general, the percentage of risk of transmission of HIV from mothers to their children without the intervention can be described in the table below:
Estimated time of transmission and the absolute risk of transmission
Pregnancy 5 - 10%
The process of childbirth 10 - 15%
Breastfeeding during the 5 - 20%
Overall without breastfeeding 15 - 25%
Overall with breastfeeding to 6 months 20 - 35%
Overall with breastfeeding up to 6-24 days 30 - 45%

In 2000, WHO estimated that 1.5 million children infected with HIV, and AIDS among adult patients, 30% are mothers, including pregnant women. In the United States 0.17% sero-positive pregnant women with HIV infection in the baby figure of 14-40%. In Europe the number of transmission from mother to baby is 13-14%. (Pusponegoro, 2004)
Transmission from mother to baby transmission of the more progressive in the children. Among the babies who have spread vertically from mother, 80% showed clinical symptoms of HIV at the age of 2 years. Clinical description of symptoms of AIDS appear at the age of 1 year 23%, and at the age of 4 years at 40% of these babies. (Pusponegoro, 2004)

Transmission of HIV infection FROM MOTHER TO Baby
How the mechanism of transmission of HIV infection through breast milk is still a discussion by many health experts. Exactly, port d 'entry of HIV through breastfeeding has not yet been described. After the baby swallow infeksius the virion, HIV can go directly to the layer with the cut in order submukosa of epithelial cell layer of intestine mucosa, or the defek between intestinal epithelial cells. Defek can occur because of the alimentary tract immaturity's on neonates or interference occurs because the nutrients or because inflamasi by secondary infection in the infants who are older. Once HIV submukosa reach the intestine, the virus directly to the search and target cells, such as CD4 cells in the Peyer plaque, and it can start the infection and continue to be systemic infection. (Mofenson, 2007)
Other mechanisms that become possible port d 'entry of HIV infection include infection or active transport through the intestinal epithelial cells, for example enterosit or intestinal M cells, where deferensiation with epithelial cells that are associated closely with the transport of antigen, or foreign agent and underlie infectious of B cells Q lymphoid and network-related mukosa. This eases the spread of the virus directly from limfosit on submukosa layer. Role mucosa mouth and tonsil as a baby on the entrance of the virus infection is still examined by many experts. (Mofenson, 2007)
Many examples of HIV infection in the second trimester is known through a network of virus isolation. There are fewer examples transplasenta vertical transmission during the first trimester, but the acid and antigen nucleate HIV have been found on the network that come from the age of 8 three-week fetus. Three mechanisms have been found HIV intrauterine. First, the virus in the system is released from the mother cell desidua, next fagositosis by sinsitiotrofoblas. Second, trofoblast the invasion network desidua contact with limfosit CD4 HIV-infected mothers. Third, macrophage mothers infected invasion stroma vilus. Fagositosis may be the mechanism that is more important in the intrauterine transmission of the incident reseptor specific CD4 cells nucleous because of the molecular surface of CD4 cells have not been observed up to 12-14 days to pregnancy. (Parks, 2000)

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hiv - aids 5 clinical manifestations

Clinical manifestations

Clinical manifestation of HIV infection in the general form of infection and tumor on the normal condition controlled by immune system. The average person that a new HIV-infected do not show symptoms of AIDS. Acute HIV syndrome is often called the disease serokonversi because it is a phase of the person who does not have any antibody has a specific antibody against HIV this phase lasts 2 or 3 weeks, and then recover. Person with antibody against HIV. At this phase arise sudden fever, limfe gland enlargement, skin rash occur in the mouth and sometimes on the genital tool, often and with the gastrointestinal form of aberration anorexia Nausea, vomitus, and diarrhea. In addition ulserasi also found in the mouth inflamasi faring so sick seirng accompanied swallow. Not infrequently accompanied by symptoms of meningitis or encephalitis, fatigue, and depression letalergy which can take several weeks to months. At the beginning of this phase may be found of opportunist infections, especially candidiasis (thrush). (Rikyanto, 2006)
Along with the body's immune worsen, ODHA start symptoms appeared due to infection opportunistic, such as body weight is decreased, long fever, feeling weak, lymph gland enlargement, diarrhea, tuberculosis, fungus infection, herpes, etc.. (Djoerban, 2006)
According Soedarmo, 2002, the symptoms that arise from the infection of HIV / AIDS:
Non-Specific Symptoms (prodormal) HIV infection
- Fever
- Disturbance of growth
- Weight loss (10% or more)
- Hepatomegali
- Limfadenopati (diameter more than 0.5 cm in 2 places or more)
- Splenomegali
- Parotitis
- Diarrhea
Specific symptoms of HIV infection
1. Interference to grow flowers and intellectual function.
2. Interference brain growth
3. The progressive deficit motorist marked by 2 or more symptoms, paresis, the abnormal muscle tonus, reflex patologis, ataxia, or interference step.
4. Lymphoid interstitial pneumonitis (LIP)
5. Secondary infection, which consists of:
- Infections such as opportunistic by Pneumicystis carinii pneumonia, kandidiasis, cryptococcus infection, infection mikobakteria the atipik.
- Secondary infections by Streptococcus pneumonia, Haemophilia's influenza, Neisseria meningitides, Salmonella enteritidis, which cause sepsis, meningitis, pneumonia, and organ abses Internal.
- A heavy virus infection and recurrent, herpes stomatitis and chronicles the recurring, or herpes zoster multidermatomal knowledgeable.
6. Limfoma secondary malignancy such as primary central nervous system, Hodgkin's B cell non-Hodgkin's lymphoma, sarcoma Kaposi (generally in adults)
7. Certain other diseases such as heart failure with kardiomiopati or aritmia, some deviation hematologic (anemia and trombositopenia), glomerulo-nefropati, such as eczema skin aberration, seborrhoea, molluscum contagious a heavy and long run.

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hiv - aids 4 examination

Examination of HIV

Laboratory examination to find out exactly whether someone infected with HIV is important, because the symptoms of HIV clinis infection can be seen after many years.
There are several types of laboratory examinations to verify the diagnosis of HIV infection. In general can be divided into serology examination to detect the antibody against HIV and examination to detect the existence of the HIV virus. Detection of HIV virus in the body can be done with virus isolation and culture, antigen detection, detection and the genetic material in the blood of the patient. (Djoerban, 2006)
Examination that is more easily carried out the examination of the HIV antibody. Filter is usually used as the ELISA technique (Enzyme-Linked Immunosorbent Assay), agglutinate or dot-blot immunobinding assay. In the ELISA test is used lisat entire body of the virus with a cut off value degraded to improve the sensitivity test. The usual method in Indonesia is the ELISA.
Things that need to be in the HIV antibody test for the existence of this window period. Window period of time since the body is infected with HIV until the start of the incidence of antibody can be detected with the examination. Antibody began to form in 4-8 weeks after infection.
If the examination results of the filter states reactive, inspections can proceed with the examination to ensure the confirmation of infection by HIV, the most frequently used technique is Western Blot (WB) (Djoerban, 2006). This test is a more specific test for determining the existence of parts of the protein in the HIV p24, gp41, and gp120/160. Told found positive when 2 or 3 protein is determined.

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hiv - aids 3 pathogenesis

PATHOGENESIS HIV / AIDS

Limfosit CD4 + is the main target of HIV infection because the virus has affinities against the surface of CD4 + molecule. CD4 + Limfosit coordinate the work of a number of important functions immunologist. Loss of function causes disruption of a progressive immune response.
ODHA in the body, the virus particles to join the DNA cell patients, so that once an HIV infection, a life he will remain infected. Of all the people infected with HIV, some developing AIDS in the entry stage 3 year, 50% developed into AIDS patients after 10 years, and after 13 years almost all the people infected with HIV show symptoms of AIDS, and then died. Travel disease shows a picture of chronic diseases, according to the body's immune system impairment is also staged. (Djoerban, 2006)
After entering the blood, HIV will entry in T4 (CD4 +), a part of the integral and infected cells will lead to cell death T4. When most of the T4 have been destroyed will disease symptoms develop. Major core protein with BM / molecular weight of 24,000 (p24), and 2 on the main glikoprotein membrane with BM. BM 41,000 and 120,000 (gp 41 and gp 120), becomes the basis for diagnosis serology's. Most patients infected with HIV can be detected in the circulation of the antibody against primary HIV antigen. HIV infection spread throughout the organ. Body may react in immunologist, and clinical consequences occur aberration, called acute HIV syndrome. This phase lasts relatively short. Virus and is in the latent or concealed, does not cause symptoms. Having the infection can only be known through laboratory testing, detected antibody that is specific to people with HIV in the blood. This phase can take 8-15 years. During this phase the virus continues to multiply in the patients body and in many cells, especially cells in the immune system. AIDS is the terminal phase of HIV infection that has lasted for many years, and any damage of the body immune system. (Rikyanto, 2006)
HIV infection does not immediately show signs or symptoms specific. Some do not show symptoms typical of acute HIV infection, 3-6 weeks after infection. Symptoms that occur are fever, sore swallow, lymph gland swelling, rash, diarrhea, or coughing. After acute infection, HIV infection asymptomatic immediately. The period without symptoms is usually run for 8-10 years. But there is a small group of people who travel it is very fast, can be only about 2 years, and there is also a slow way (non-progressor). (Djoerban, 2006)
During the trip natural HIV disease, people in general do not know that his contract HIV. HIV antibody testing laboratory is the easiest way to find out, and in this phase the virus is rarely found in comparison with the acute phase. But people still infectious or can potentially transmit the virus to others. After the acute phase, people with immune system back to normal and functioning normally, but the viruses multiply, the more immune system cells to become more visible and increase worse. Then people go to the next phase, called callback (Progressive Generalized Lymphadenopathy). In the recent phase limfe gland enlargement occurs, especially in the head and neck. Size gland may swell and wane, and generally take a long time. After the phase of incoming calls phase ARC (AIDS Related Complex). (Rikyanto, 2006)
Phase ARC is a deviation from the set of symptoms that precede clinical AIDS. At this phase aberration body immune system has been significantly decreased. Three prominent clinical symptom is chronic fever, diarrhea chronicles (slim diarrhea). May also be accompanied with opportunist infections, which is the main indicator of AIDS, especially Candidiasis. Element end AIDS diagnostic phase often change the criteria. AIDS is the final phase of HIV infection is marked with various opportunist infections. Direct effect of HIV on organ damage include central nervous system, gut, forming elements of the blood, kidneys, joints and skin. Aberration in the third ARC also caused direct effects of HIV, AIDS on the more serious look. Often happens is that people appear to be fast, old, gray, wrinkled skin, and so forth. (Rikyanto, 2006)

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hiv - aids 2 definition

DEFINITION HIV / AIDS

AIDS (Acquired Immunodeficiency Syndrome) can be defined as the collection of symptoms or a disease caused by decreasing the body's immune consequences of infection by HIV (Human Immunodeficiency Virus), which include family Retroviridae and subfamily Lentiviridae. AIDS is the final stage of HIV infection. (Djoerban, 2006)
Until now the new serotipe HIV-2 is known that HIV-1 and HIV-2. HIV-2 is also called lymphadenopathy-associated virus type 2 (LAV-2) that until now only found in the case of AIDS or healthy people or healthy people in Africa. HIV-1, as the cause of AIDS, formerly known as human T-cell lymphotrophic virus type III (HTLV-III), lymphadenopathy-associated virus (LAV) and AIDS-associated virus. Morphologies the HIV-1 and rounded shape of the nucleus (core) and cover (Envelope). (Soedarmo, 2002)
The core of the virus consists of a protein cover currently consists of a glikoprotein. Protein from the nucleus consists of a genome RNA and the enzyme can change the RNA into DNA at the time of virus replication, the enzyme called reverse transcriptase (RT). Genome virus which basically consists of genes, responsible for providing the code for both the formation of the core protein, and enzyme RT glikoprotein from the shroud. In fact there are other genes that function set synthesis, the ability of infection (infecsisitas), replication, and other functions of the virus. Part Envelope consisting of glikoprotein, apparently had an important role in the occurrence of infection because of the large affinities have receptors against specific cell hospes. (Soedarmo, 2002)
HIV / AIDS occurs through body fluids containing the HIV virus through sexual relations, whether gay or
heterosexual, syringe on drug users, transfuse blood components, and from HIV-infected mothers to infants born.

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hiv - aids 1 in pregnant and breastfeeding

This paper from Ravi and Joe, thanks to Ravi and Joe..

AIDS (Acquired Immunodeficiency Syndrome) is a syndrome caused destructs immune system by HIV (Human Immunodeficiency Virus). Due to the loss of immunity of AIDS infected easily various types of bacterial infections, fungi, parasites, and viruses that are opportunistic. HIV infection at this time does not only attack those who behave sexually deviant, but this virus can be transmitted to anybody, including the "good" with a variety of roads so that relief "fear" and restlessness in the community.
HIV / AIDS is a major problem that threatens Indonesia and many countries around the world. UNAIDS, WHO bodies take the AIDS problem, estimate the number of ODHA (People With HIV / AIDS) in the world in December 2004 is 35,9-44,3 million people. There are currently no country free from HIV / AIDS. HIV / AIDS crisis caused many at the same time, the health crisis, the crisis of development countries, economic crisis, education, and humanitarian crisis. In other words, HIV / AIDS, the multidimensional crisis. As a health crisis, AIDS require a response from the community and requires care and treatment services for individuals who infected HIV. (Djoerban, 2006)
AIDS was first recognized in Los Angeles and New York in 1981 with the outbreak: Pneumocystis pneumonia Carinii (PPC) and sarcoma Kaposi on young people in a previous healthy state. (Rikyanto, 2006)

AIDS in 1983 occurred in the United States and in Africa is different in the case of the victim (patient) and the distribution pattern of the virus causes. So at that time the term AIDS arise West (Western AIDS) and AIDS, Africa (African AIDS). (Rikyanto, 2006)
In Asian countries such as India, Thailand, Malaysia and the Philippines also began to show the existence of HIV / AIDS in the amount of light. Thailand, the first find of AIDS in the country at the end of 1984, shows a very large bump in the number of AIDS were reported sufferer amounted to 1389 people and HIV in 1658, so that the whole of 3047. (Rikyanto, 2006)
In Indonesia, people with AIDS that was first found in 1987 in Bali, a Dutch tourist who fell ill and later died of. After the first of these installments are reported in a number of people with AIDS and HIV. According to Dep. Kes. RI, until the year 1993, amounted to 130 HIV and 42 AIDS patients, so that the whole amount is 172 people. This amount, when compared with that found in other countries in Asia such as Thailand, are still very small. (Rikyanto, 2006)
According to estimates by experts, in Indonesia, in the case of the number of HIV was noted that 172 people as mentioned above, the actual amount is in the community is 100 times more; to be 17,200 people. (Rikyanto, 2006)
Indonesia already entered the decade to 2 HIV / AIDS epidemic, but until now there has not been clearly visible efforts on the national firm, humane, comprehensive and reach everyone. We also have not been effectively engaged, and while we still hesitate to act, HIV / AIDS continues to go the riot spread suffering and death, and threaten social values, culture, and our economy.
From the description above is very clear how terrible disease is HIV infection. The disease of HIV infection is so severe and the immune system attacks the body and slowly but surely cause the body's immune system to be decreased and eventually function does not work in the infection of microorganisms so that eventually cause death in sufferer. Which is most often suffer infections of opportunistic, the infection by microorganisms, which in the normal person can be said does not cause disease.
One of the interesting issues about HIV / AIDS research in the popularity in the world of health, among others, transmission of HIV infection from pregnant women / breastfeeding to the child.
A child may be at risk of contracting HIV infection in the womb, during childbirth, and postnatal period through breastfeeding. In the population with many mothers who are breastfeeding, 30% to 50% transmission of HIV infection can be caused by the breastfeeding process. In general, it is estimated that 320,000 out of 800,000 spread of HIV infection in children is estimated to occur each year are caused by the process of breastfeeding (Mofenson, 2007). Although the process of breastfeeding can transmit HIV infection to about 14%, but in some circumstances where the high prevalence of HIV, breastfeeding imperfection can increase the risk of death in infants 3 to 5 time. A baby can die because of not breastfeeding or adequate of HIV infection that is transmitted through breastfeeding.

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eye: 13

CONCLUSION

1. Trauma okuli often occur due to negligence at the time activity
2. There are 4 causes of trauma is trauma okuli physics, mechanics, chemistry, and photoelectric.
3. There are 4 types of trauma mechanisms okuli the blunt trauma, sharp, and combustion rays.
4. Principles of trauma okuli must be quick, overcome bleeding, take all the foreign substances that have, irrigation, antidotum, and sometimes need help other units.
5. Examination was necessary as Funduskopi, rays, examination with a magnet, and Ultrasonografi, especially in the case of fraktur ossa cranii and corpus alienum.
6. Sterilises and delivery of antibiotics is very important to avoid the complications that exist.
7. Enukleasi is the last choice if the cure is not possible return of the feared complications oftalmia simpatico.

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eye: 12

Liquid Chemical Acid
Coagulate result that occurred because precipitate protein networks that form a barrier that impede the wide and the depth of the damage. This condition is called necroses coagulate
Liquid Chemical Basa
Basa chemical does not cause the damage so that coagulate ongoing that may lead to perforation. This condition is called necroses coalescent

Handling Chemical Trauma
Treatment for all chemical trauma must begin as soon as possible. This is the only way to keep ability sight, is to start irrigation landing soon as possible and at least about 30 minutes. The goal of treatment in chemical burns is to reduce inflammation, pain, and risk of infection.
eyes can be given if necessary to facilitate the irrigation well. check the pH of the water with litmus paper, if available every 5 minutes and continue until the pH becomes neutral (color paper will change to blue when exposed to red and •  If patients come to the right to practice or emergency unit, physiological salt solution is selected, but, if not available, ordinary tap water can be used. Anestheticbasa if exposed to acid). •  sterile solution with a solvent such as osmolaritas high amphoter (Diphoterine) or buffer solution (or Ringer Laktat BSS) is the ideal rinse. If not available, sterile saline solution isotonic is rinse matches. Hipotonik solvent, such as water, may cause further penetration of the corrosive solution into the cornea because the structure of the cornea has a more Find osmotik high (420 mos / L). •  duration and number of fluid pH by rinse eyes. Irrigation forwarded to a normal pH in 30 minutes. Use of Morgan lens eye irrigation system or other interfensi can minimize its consequences blepharospasme, which can often such severe. If this is not available, the sheath can manually drawn Desmarres with a retractor, speculum sheath, or a Paperclip crooked . The edge of the lapse intravenous can direct the flow of sterile fluid into the eye. In addition, use a cotton trunk to lift every objects that may be restrained in fornik. Trunk can clip cotton into the solution ethylenediaminetetraacetic acid (EDTA) 1% if the chemicals it contains calcium oxide. •  After irrigation, oftalmologik comprehensive examination is required. If injury light, patients can be returned to the antibiotic eye drops, oral analgesic, and bandage the eye. Further examination should be done in 24 hours. •  Injury mild chemical burn should be given to current sikloplegia using antagonisekolinergik so that does not cause the blood vessel contriksi more. Lubrication antibiotics should be given every 1 to 2 hours together with a large number of artificial tears and the anti-pain drugs per oral if necessary. Giving topical steroid is important to prevent the infiltration cells netrofil so will prevent your kolagenase, but steroid use may not be used for more than a week because of the risk melelehnya corneoscleral. In addition, some experts use of oral vitamin C (up to 2-g qid) because the production has been increasing by collagen fibroblast.

Pressure elevation intrakranial must treat with Diamox if necessary, but the beta-blocker topical can be used alone or in addition. The provision of roller press can be considered, and the patient needs to be reset every day to going reepitelisasi perfect. Burns are serious to be referred to a specialist's eye, when you need to sub cornea specialist, if available, Inpatient and very necessary. Amniotic membranes (AM) has been facilitating the migration cells epitel, strengthen adhesi cells eitel chart basalt, epitel prevent apoptosis, and increase the differentiation epitel. Cangkok AM (AM grafts) was used to help reduce network scar, inflammation, and neovascularisasi from the affected eye trauma; contact lenses AM still in the research for the purposes mentioned above.

Treatment due to injury in the sour hidrofluorida, there is no optimal treatment is available. Some research has been using the 1% calcium gluconate as material or as drops rinse pata for injuries like this. Magnesium compound has also been used anecdotal injured due to acid hydrofluoric; however, little research that supports success. Irrigation with magnesium chloride has nontoksik on the eyes. The advantage with the approach of this kind have been reported in anecdotal even 24 hours of injury when treat others do not. Some authors recommend drops every 2-3 hours for use as rinse can cause irritation and may cause over go ulserasi cornea.
The provision of lubricants may also be required. Lubricate the adequate help prevent the occurrence of symblepharon. Some penuli recommend the use of steroid topikal in some patients, especially in trauma due to acid and basa hidrofluorida. They believe steroid can limit the intraocular inflammation and the formation of fibroblasts in the lower korne. Some of the others make the risk of infection and the potential benefits exceed ulserasi obtained.

Cycloplegic mydriatics
Assist in the prevention spasme siliar. In addition, this material is stabilisated permeabilitas the vein therefore, reduce the inflammation. Homatropine 5% is often recommended because it has a lifetime of work on average 12-24 hours, a time when the patient must meet the eyes of experts for further examination. Sikloplegik the long term, such as scopolamine and atropine, more rarely used.

Antibiotics (ophthalmic)
Patients with trauma to the cornea, conjunctiva, and sclera is a usual to give antibiotics or eye drops salep eyes topical profilaksis, broad spectrum, (eg, tobramycin, gentamicin, ciprofloxacin, norfloxacin, bacitracin). Neomycin and the sulfa more rarely used because the number of cases of allergy.

Analgesics
Some experts recommend the use of diclofenac eye drops. This may be the best therapy is an alternative therapy in addition to the roller with the trauma patient in the cornea, the patient can still use both eyes during treatment.
Surgical therapy if there is additional interference wound healing after trauma chemical that is very severe:
- A conjunctival and limbal transplantation (stem cell transfer) can replace a missing parent cells that are important for the healing cornea. So that will cause a re-epitelisasi.
- If the cornea does not experience healing, a cyanoacrylate glue can be used to strike a hard contact lens (artificial epitel) to help healing.
- Procedure Tenon's capsuloplasty (mobilization and recall a forward flap [sheet / wing] of subconjunctival network to Tenon's capsula to cover the existing defect) can help eliminate defek on the conjunctiva and sclera.
Handling after eye surgery continued stable:
- Lisis of symblepharon to improve motilitas okuler and palpebra.
- Plastic Surgery on palpebra for free eyeball. (This may only be around 12 to 18 months after the injury).
- If there is a total loss of goblet cells, transplantation of nasal mucosa usually eliminate pain.
- Penetrating ceratoplasty can be done to restore the sign. Because the cornea is damaged vascularisasi get very many, the procedure is colored by the number of rejection incidence cangkokan. Corena a clear basa rarely found in the eyes that experienced severe trauma and even with a cornea cangkok with the same HLA type and therapy imunosupresif.

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eye:11

Types of burns:
electricity and the temperature
The lens can cause turbidity due to coagulate. In the electricity is called cataract electric, for example, if you be struck by lightning, or exposed to hot water. Give antibiotics on combustion stadium I, while stages II and III refer to a specialist immediately possible to get a treatment like transplant conjunctiva mucous and cornea.

Trauma Chemical Pathology
Suratmin (2007), said materials or basa sour quickly once the reaction coagulate of protein networks and cellular death. There are differences between the acid reaction and basa, basa both organic materials and non-organic cause reactions soap saponifikasi, which quickly penetrated cornea with barrier penetrate cells and cause severe injury with the occurrence of denatures mukoid. Effects of chemicals can cause trauma shaped, precipitous reactions such as salt from heavy metals, which occur in clinical deviation from this reaction can be from mild irritation to the occurrence of a reaction Astringent peel network, which consists of three stages such as / similar to burns.
Classification of the Roper-Hall on chemical trauma was criticized as not much more accurate prognosis of the burn this modern, but still a good tool for doctors in the first line service. Classification levels and prognosis from chemical burns supported is based on the amount of damage iskemia cornea and limbus, where every loss of normal blood vessel architecture conjunctiva around the cornea. Iskemia limbbus is one of the clinical factors that are very important because it shows the level of damage to the blood vessel and the limbus ability Indu cornea cells (located in the limbus) to me-regeneration of damaged cornea. Thus, unlike the condition in the trauma of another, the pale eyes more dangerous than the red eye.

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eye: 10

Combustion

Attention from the main burn okuler whatever it is the ability sight end and cosmetic problems. Chemical burns are often bilateral and very often cause loss of sight very destructive. complicated ocular in the severe injury, among others, glaucoma, cornea perforation, cataracts, scar the cornea network, cul-de-sac conjunctiva, complications in conjunctiva and palpebra, ablasio retina, cornea and ulkus. Around 1-2 years surgical correction is needed to repair damage to the injury is more serious. A research by Kuckelkorn et al reported that a third of 131 patients with burns in the eyes eventually become disabled; about 15% total is considered blind. In 1995, almost a third of cornea transplants performed in the eye injury from the chemicals. Unfortunately, the success of transplantation in this case is less than 50%. Some patients require 4-5 transplants before finally succeeded. Research in the Western Galilee-Nahariya Medical Center, Nahariya, Israel, in September 1986 to March 1993, showed 93% transplants have good results, 1 patient requires re-transplantation because of edema, 4 patients experienced secondary glaucoma (S Rumelt, 1998).
l. There are 3 degree burns following marks:
1. stadium I Hiperemi on conjunctiva, with a lot of mucus, a slight irregularity in the cornea, sometimes found on the dots cornea. 2. stadium II Conjunctiva kemosis, degeneration occurs vaskularisasi and nekrose epitel cortex and cornea. 3. stadium III There was a necroses conjunctiva, necroses part in the cornea, which becomes clouded until perforation.

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eye: 9

Injury because Rays
Kinds of causes of injury due to radiotherapy:

ultraviolet rays
Ie rays with wavelength 300 ± milimikron, akan resorpsi on the front layer of cornea. Lakrimasi common complaint, as there is sand, blefarospasme, which arise after 12 - 36 hours post-exposure. This occurred in las workers, and screening. Give a local anesthesia such as pantokain ago to do a more thorough examination, and give atropin sulphate, and antibiotics to prevent secondary infection.

infrared rays
Ie rays with wavelength> 800 milimikron, causing nerve damage in makula lutea accompanied by shifting pigment. This will lead to a decrease visus.

rays and radioactive rays
Cataracts occurred after several months or several years later, with the necessary protection to reduce the effect of Pb radiation.

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eye: 8

Injury on the Orbita
Damage that occurred greater than that of blunt injury because the ball can damage the optic nerve eyes, which can cause blindness or damage to the muscles so that bulbi muscle paralise and diplopia. Thus will easy secondary infection to occur when there is a foreign object left behind in the eyeball. Make the image rays to ensure the cavum orbita, handling appropriate procedures, and provision of anti tetanus and antibiotics because of possible secondary infection is high.

Eye Ball
Specify whether or not perforation occurred. Eyeball perforation marks the room with the eye with a shallow slices that sometimes stick to the cornea or even out through the perforation holes, TIO will down, fistel test positive. If on the posterior part will bleeding occurs in the corpus vitreous, koroid, and also the retina, TIO decreased, can also occur ablasi retina.

injured in conjunctiva
Konjungtiva cause bleeding, when smaller akan recover spontaneously, when a large sewing required.

injury in the cornea
If no perforation, if any, take a foreign object attached to provide local anesthesia drops. Next should be given antibiotics, the wound should not be a new steroid, but if neovaskularisasi form of limbus give cortisone local / subkonjungtiva.
If there is a small perforation, conjunctiva immediate release from the limbus nearest perforation hole cover (flap conjunctiva). If the large holes must be sewn first and then do the flap conjunctiva. Slices cut out, the rest reposisi. If the perforation is then do a few hours flushing with antibiotics before sewed. Give anti tetanus and broad spectrum antibiotics. Do not give steroid up to 5 days. Examination should be performed against the other (healthy). May be possibility of iritasio simpatico with the healthy eye: decreased visus, lakrimasi, injection sillier, difficult to read, Flare (+).

Sklera Injury
Wound because this can cause dangerous bleeding body glass, fill out eyeball, secondary infection, and ablasi retina. If there is a small wound, clean and close to the conjunctiva, while the wound is large but still be able to view, clean, atasi bleeding, remove the exit of the perforation, sewing without the koroid, close to the conjunctiva. Give atropin and both eyes must be closed. If the wound can not be great and to see a return to the recommended enukleasi to avoid oftalmia simpatico in the eyes healthy.

Ciliare On Board Injury
Injuries here have a bad prognosis because the most likely cause endoftalmitis, panoftalmitis ended with ptisis bulbi in the affected eye trauma and oftalmia simpatico on the healthy eye.

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eye: 7

Sharp Trauma
Checking carefully on the sharp trauma can be done using local anesthesia eye drops. Need to see whether the effect of creating trauma perforation or not. Sometimes required as the examination was Funduskopi, rays, examination with a magnet, and Ultrasonografi. Foreign substances that enter into the eye is divided into 4 groups:
a. metal objects, divided magnetic and non magnetic Magnetic objects more easily removed than the non-magnetic b. non-metallic objects c. inert objects have a better prognosis compared with reactive substances d. reactive substances.
Principle, every trauma there is a need to leave things to be taken before 7 days because at the time of the network organization will be covered, giving rise to the difficulty.

Palpebra Injury
If the injury occurred on the outskirts palpebra and do not get fixed, it will cause koloboma, palpebra akwisita. Palpebra injured due to the damage will also accelerate the cornea is very sensitive to drought. Make a reconstruction according to the anatomical position so as not cause trikiasis. If the hole resulted cutting kanalikuli lachrymal then rekanalisasi must be done without having to wait 1-2 days because it will cause difficulty in the search kanalikuli.

telusuri

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eye: 6

Bleeding Glass Body
Bleeding originating from the retina and koroid. Overcome rest with the recommendation, giving coagulant and the steroid that is intended to prevent the occurrence of network fibrotik that retinitis proliferates form, which can cause ablasi retina. If that happens due to irregularity of the blood in the corpus vitreous, then on the day-to-14, made virektomi (Brington et al, 2007).

Aberration Retina:
Edema Retina
Edema usually occurs near makula in polus area or in the posterior perifer. Looks as if coated by milk retina. If makula occurred in the central visus very disturbed with skotoma sentralis. It is advisable to give the rest back edema absorption, so that the fovea reflex appear again. Used to accelerate the absorption cortisone subkonjungtiva 0.5 cc 2 X a week.

Ruptur Retina
If the trauma is strong pressure not close the possibility of the hole, which caused ablasi retina. Ablasi usually happens because there is a V-shaped cleft potential is between epitel pigment cells, cone and rod layer. which is located on the top of the Temporal. When the going ablasi lead to total blindness. Treatment should be done as soon as possible with the principle of removing the liquid sub retina and coagulated rupture with diathermy.

Bleeding Retina
Outbreak in the vein of the retina cause the shadow on the black looking only bleeding depending on location. Handling with the bleeding body of glass.

Rags Sklera
In the case of all must be split by others bleeding first, little can be done if diathermy then sewed. Meanwhile, when the big enukleasi do to avoid oftalmia simpatika.

Enoftalmus
Split a large capsular Tenon generally caused fracture basis orbital. Make rays to determine the cranium, because enoftalmus not often visible, especially if accompanied udem. Operation must be done to close the base cranii way to bridge the bone graft material cartilage or aloplastik.

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eye: 5

Hifema
Trauma that damage the body and quickly frozen siliare is dangerous, because a blood clot be merged quickly, not giving time for regeneration to vasa blood going again so that recycling bleeding. Bleeding is common in day-to-5 after bleeding primary. If a lot of bleeding, the absorption of humor aqueous will obstructed, so that arose secondary glaucoma. Uveitis may also occur. Hemosiderin the straggling of eritrosit can be merged into endotel posterior cornea cornea that makes the color or colors is called hemosiderosis. If bleeding occurs the patient try to be elevated 30 - 45 degrees higher wafe blood pressure so that the slices will be reduced to, try to rest with the eyes close and head may not move much for at least 5 days. Give coagulant maximum up to 1 week due to the effect that prevent absorption of humor aquosus. If hifema meet the COA and the increase occurred TIO then give asetazolamid, and solution or 50% glycerol and then assessed for 24 hours. Parasentese do to remove the blood clot if the TIO does not stay down for up to 24 hours or when asetazolamid therapy to 5 days after delivery of asetazolamid TIO is still high and there are still bleeding.

Iridodialyse
If the root of the iris trauma tear, location of pupil rather fringe regular inspections so that the color will be darker than the pupil but also the place where the basic slices iridodialyse occur. On examination with optalmoskop also found the color red on the pupil and also the iridodialyse which is the fundus reflex. Treatment with midriatikum bleeding so will pressing on the root. If the cause diplopia with the repositioning should be done to associate the slices sklera.

In the lens aberration
Trauma that is able to make great rupture zonula Zinni due to pressure coming from the anterior causing subluksasi or back-luksasi lens , whereas if there is pressure behind it will be the fore. In this case when not cause glaucoma, or uveitis, then left alone, only corrections to the refraction only. If there uveitis and glaucoma then calmed first symptoms, then do the extraction lens.

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eye: 4

Emphysema Palpebra
There is emphysema palpebra with krepitasi palpebra, have the air show on palpebra caused fracture in the orbita. Trauma usually cause damage to the lamina papyricea os etmoidalis which has a thin medial wall. With a strong bandage, supposedly, in the air palpebra out. If the situation is calm palpebra without krepitasi back, it can be treatment / surgery fracture.
Laserasi Palpebra
Type of injury in cases of blunt trauma injuries caused laserasi not uniform. Injury with severe bleeding fixed point, but if there is udem, then should not be sewn first, not feared after suture udem not as expected, but better left to be first udem reduced, so that after recovery, in terms of cosmetics does not disappoint. Skin graft necessary if the trauma network palpebra many are missing. On skin graft, taken from the network of the skin retroaurikular, brakial, and supraclavikuler.

Ptosis
Due to blunt trauma, nervus III may arise paralysis so ptosis. Ptosis can also arise when palpebra tumefy was so difficult, called pseudoptosis. When damage occurs in more nerve fiber, can also arise parese nerve sfingter pupil so iridoplegia the symptoms pupil who midriasis. Parese can temporary, permanent, can also depend heavily light damage nerve. Handling with the rest, are forbidden to read so that the accommodation does not occur that aggravate, and miotikum (pilokarpin).

Bleeding Subkonjungtiva
Bleeding on subkonjungtiva generally will recover itself, as in the handling palpebra bleeding, which is warm compress 24 hours after the bleeding stops. If secondary infection occurs feared they could be given antibiotics.

Edema cornea
Visus disturbances usually cause a decrease in vision, make sure there is no ulkus cornea. Usually heal spontaneously, if there is a secondary infection may be given antibiotics. Atropine sulphate given to prevent sinechia anterior and multiply the incoming light so that vision is improved. At the time of trauma occurs, the amount of humor aqueous be merged because fewer in the more trabekula. These conditions cause a decrease TIO. Bowman and Descemet membrane is so thin will fold interference occurs visus. This interference will be back to normal if the humor aqueous is sufficient so that the fold will return to normal.

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eye: 3

For the result and handling

Trauma blunt
In the case of blunt trauma to become a big problem is the damage caused contusion from irreversible network okuli. Trauma can be caused by many things as in the case of traffic accidents, rhubarb, usually 95% damage in the bone cavum orbital first, which is protective for okuli (Gully et al, 2006). When the pressure on the trauma is too large compared to the bone, it will happen fracture orbital.

bleeding Palpebra / Ecchimosis
Trauma weight to light can cause bleeding if the trauma caused outbreak vasa blood superficial, usually bleeding vena about this, considering the wall of the vena more fragile than the arterial. As a result palpebra become swollen, and the color is caused blue-tissue fine. If the bleeding comes from the great and the basis cranii, will spreading to the other eye, giving rise to the so-called hematoma glasses hematom Brill. If this bleeding continues, the ball will be a push towards the front and cause the impression eksoftalmus. In this case bleeding usually occurs retrobulber. When eksotalmus accompanied pulses then aneurysm suspected the existence of arterial-arterial karotis the vena interna with sinus cavernous. If so, do the fastening of the arterial karotis on the same side with the eyes eksoftalmus. Necessary support, such as roentgen diagnosis to assess whether the basis cranii found fracture. If not found cranii basis of fraktur, enough handling with a cold compress vasokonstrcted veins until bleeding stops, and then continue with the warm compress after 24 hours later with a vasodilatated veins blood so fast that clot is due to be merged back fibrinolisis process. But if found fracture basis cranii immediately referred to surgical specialists (nerve).

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eye: 2

Definition

Trauma okuli are all forms of exposure either directly or indirectly derived from something that is able to cause environmental damage to the network, not because of infection. Trauma okuli has 4 main reason that is:
1. physical trauma
2. mechanical trauma
3. chemical trauma
4. trauma photoelectric
Fourth causes of trauma this causes a different mechanism 4. Mechanical trauma is also divided into 2, namely: blunt and sharp. Mechanical cause blunt trauma:
1. contusion: the blunt trauma that caused a deviation vascular and hole deviation form the network.
2. konkusio: namely that the blunt trauma to the eye that is still reversible, so it can heal spontaneously
Mechanical trauma caused perforation sharp or not perforation eyeball. If the perforation with the need to see or not to have a foreign object is left behind in the eyeball. While in the physical trauma, chemical, and photo electric rays cause trauma mechanism and combustion / burns.

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eye: 1

One senses that are important to the human eye. In addition to viewing, the eyes also play a role as cosmetics. Disability, both terms of cosmetics and function will affect the view that humans have. Although the system has been protected with a protective sheath on the bones and the outside, and a layer of fat and reflex system, there are still cases of trauma in the eye.
With advances in technology to create human protective equipment for the body. Including protective equipment for eyes, an organ that is quite important. There are several types of eye protective equipment that is standard. However, the accident occurred on the eye, especially in industry. This is because of low awareness of the importance of protective eye equipment, or protective equipment itself is less practical or less comfortable when worn during work. In addition there is also ignorance will risk factors that may occur. Therefore, information on the importance of the use of protective equipment in the eyes of employees exposed to the possibility of accidents is high enough, and need to be expanded, such as employees of the manufacturer of glass, metal casting, welder, turner. According to Vaughn, eye injuries in children due to equipment such as toys arrow, air rifle bullet, sword and others. Similarly with lidi, pencil, switch grass or wood can also cause dry eye injury, deliberately or not

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parotitis 8

Diagnosis Letter
Diagnosis parotitis include this appeal because, like a virus infection on the virus infection including human imunodefisiensi (HIV), influenza, parainfluenza 1 and 3, siotmegalo virus, or circumstances koksakivirus A rare, and infection koriomeningitis limfositik. Infection-infection can be distinguished with a specific laboratory test; parotitis supuratif, where pus can often excluded from duktus; Parotitis Repeat, a situation that is not yet known, but may be allergic to the often repeated and has the typical sialogram; calculus Salivarius clog the channel parotis , or more often a channel submandibuler, where swollen intermiten; Limfadenitis Preaurikuler or servical Anterior because any reason; limfosarkoma or tumor parotis other jarang.

Medicine
Outpatient
New patients can be treated if the road: no complications, the common good enough. Rest in bed during the summer and pembengkakkan gland parotis. Tirah lie should be arranged according to patient needs, but there is no statistical evidence that indicates that this lie tirah prevent komplikasi.
Parotitis treatment is entirely simptomatik. Simptomatik given hot or cold compress, and also given analgetika. Medikamentosa painkillers and antipiretik given only if necessary, metampiron: children> 6 years: 250 500 mg / time, maximum 2 g / day and paracetamol: 7.5 - 10 mg / kg BB / 3 times a 4dd dd. Give diet liquid or soft food, diet must be tailored to the patient able to chew .
Orkitis should be treated with the support of local and lie. Arthritis parotitis can respond to 2 weeks of anti-inflammation agents kortikosteroid or nonsteroid. Corticosteroid for 2 - 4 days and estimated gamma globulin can prevent occurrence orkitis.

Inpatient
Patients with high fever, general weakness condition, severe head pain, need to be treated in isolation space. Give diet TKTP, medikamentosa and handling of complications, depending on the type.
Monitoring
- General situation, the main sign
- Intake of food and liquids.
- Likelihood of occurrence of complications:
 Neurology
 swelling testis.
 stomach aches.
When people expressed recover :
- Symptoms and signs are missing
- Complications have or have not healed.

Prophylaxis
Passive
Parotitis hiperimun gamma globulin is not effective in preventing parotitis or reduce complicate.
Active
Routine delivery of a live vaccine parotitis weakened. Vaccines given in subkutan in children 15 months. Vaccinated children who do not usually have a fever or other clinical reactions that can be detected, not ekskretion virus, and does not spread to contact the vulnerable. Rarely parotitis may develop 7-10 days after vaccination. Vaccines stimulate antibody efficacy and have approximately 97% protection against infection parotitis natural.
The immunity and the old can be given along with measles and rubella vaccine. Can be given to adolescents and adults who have contact patients with parotitis epidemic but had never suffered from the disease.

Prognosis
Parotitis has a good prognosis, especially when the handling right and not going complicate.

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parotitis 7

Diagnosis

Diagnosis can obtained when there are clear symptoms of infection parotitis epidemika on physical examination. Besides leukopenia with relative limfositosis, also found the increase in serum level amilase a peak after one week and then became normal again in 2 weeks.
When clinical symptoms are not clear, the diagnosis is based on: 2
1. There is virus in saliva, urine, likuor serebrospinalis or blood.
2. Serum Neutralization Test
3. Obtained antibody in the serum of antigen during S epidemic have symptoms of parotitis. Number of antibody reaches its peak at the beginning of the disease and then disappear within 6 - 12 months, while the antibody against the antigen or antigen virus get up to V peak in 1 month, settled in the next 6 months and then decrease in slow up to 2 years in a number of low and that remain.
When clinical manifestations limited to the manifestation of one of the lesi less common, the diagnosis is not so clear but suspected, especially during the epidemic. Laboratory test is not specific, usually leukopeni, with relatively limfositosis, but complications often cause leukositosis are polimorfonuklear level. Commonly have increased serum amylase, tend to increase parallel with swollen parotis and then return to normal in about 2 week.
Diagnosis depends on the etiology of virus isolation from saliva, urine, Spinal fluid and blood. Antibody serum against the S antigen peak at around 75% patients and can be detected at the time the symptoms appear. This antibody gradually disappears in 6-12 month. Antibody against the V antigen or virus usually reaches peak titer at about 1 month, remain stable for about 6 months, and then slowly decreased during the 2 years until the lower level, and then the titer is settled. The existence of anti-S titer and high titer of anti-V to a low during the acute stages, if not diagnosed meningoensefalitis, very prepossess parotitis infection, which would be strengthened if convalescent serum showed four times the increase of anti-V antibody is accompanied by little change in the titer of anti-antibody S.

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parotitis 6

Complications

Viremia in early infection may be a complication knowledgeable.

Meningo encephalitis
Complications is a complication that often the children. The incidence meningoensefalitis parotitis cases around 250/100.000; 10% of these cases occurred in patients who are older than 20 years. Figures mortality is around 2%. Men exposed to three to five times more often than women. Parotitis is the one-one cause of aseptic meningitis that most often.
Can occur before, after or without swollen gland parotis. Patients initially showed symptoms of mild headache pain, which is then followed by vomiting, anxiety and a high body temperature (hiperpireksia). Estimated that the parotitis can cause stenosis and aqueducts result hidrosefalus on children. Pungsi lumbal examination shows that escalate pressure, and the examination None Pandy positive, the number of cells increased, especially limfosit, escalate protein content, glucose and klorida normal. Fifty percent of patients parotitis showed pleiositosis on liquids serebrospinal and 50% of individuals show such interference neurologist. Pungsi lumbal can also reduce the pain of head.
Pathogenesis meningoensefalitis parotitis has been described as:
(1) infection of primary neuron and
(2) post-infection with encephalitis demielinasi.
In the first type parotitis often appear together or attached to the encephalitis. In the second type, encephalitis accompanies parotitis in about 10 days. Stenosis Aqueducts and hydrocephalus has been linked with infection parotitis.
Meningoensefalitis parotitis is clinically can not be distinguished from others because meningitis. There was a medium neck stiffness, but the other neurologist examination usually normal. Serebrospinal fluid (CSS) usually contain less than 500 cells sel/mm3, although sometimes the number of cells can exceed 2000. Sel almost always limfosit, with different antivirus aseptic meningitis, which often dominate leukosit polimorfonuklear early in the disease. Parotitis virus can isolated of liquid serebrospinal.
Treatment as in the other encephalitis. Usually prognosis meningo-encephalitis parotitis epidemika is good; there are rarely symptoms of the remaining neurologist or equipment damage hearing. However, 10-20% of cases, but complications showed interference awareness and convulsions. Sequele that can occur as acute ataxia serebelar, Transverse myelitis, temporary paralysis, Guillain-Barre syndrome, coma, diabetes insipidus, neuritis optics, deaf sensoneural (and most often occur suddenly) .

Epididimo Orkitis
This rare complication occurred in boys but pubertas frequently (14-35%) in adolescents and adults. Occurred in 10 patients 20% and adolescent post pubertas. Can arise in the first week. Patients show a high body temperature, sometimes shivering, and painful swollen press in the right or the left testis. This lasted for 4 - 7 days.
Treatment with a cold compress and alternatif testis. Testis most often infected with or without epididimitis; can also occur epididimitis only. Hidrokel rare. Orkitis usually accompany parotitis in 8 days or surrounding areas; orkitis can also occur without evidence of salivary gland infection. At about 30% of the affected testis. Often start suddenly, with the increase in temperature, shivering, head aches, nausea, stomach aches and down when exposed to the right testis, appendisitis can like as a possible diagnosis. Testis to be exposed to pain and swelling, skin edema and near red. The average length is 4 day's.
Approximately 30-40% of affected testis will become atrofi. Ten to 50% of cases will be sterile. Infertility total rare, but changes may be obtained fertility's. Interference fertility is estimated about 13%, but rarely infertility's absolute happen.

Pankreatitis
Heavy involvement of the pancreas rarely occur. Pankreatitis light and asymptomatic there may be more often than we think (up to 40% of cases), occurred at the end of the week I.
Pankreatitis may not be related to the manifestation of salivary gland, and the diagnosis may be mistaken with Gastroenteritis. Epigastrium pain and illness, can also be accompanied fever, shivering, nausea, and weak. Diagnosis is based on lipase and alpha amilase increased. Level up amilase serum is typically in the parotitis, with or without clinical manifestation pankreatitis.
Other complications that are rare ooporitis, arthritis, nefritis, mastitis, aberration in the eyes of others dakriodenitis, and tiroiditis and miokarditis.

Ooforitis
Pelvis pain and tenderness found in about 7% of women in post-pubertas. There is no evidence of interference fertilitas.

Nefritis
Frequency of renal involvement in children has not been known. Nefritis the death, occurred 10-14 days after parotitis.

Tiroiditis
Although not common in children, swollen tiroid the difus painful and can occur in about 1 week after the start parotitis with the development of next antitiroid.

Miokarditis
Manifestation of a serious heart very rare, but infection may be mild miokardium more frequently than is known. Elektrokaardiografi recordings show the changes, most of the ST segment depression, at 13% of adults in one series. Such involvement can explain the pain prekordium, bradikardia, fatigue and sometimes found in teenagers and adults with parotitis.


Mastitis
Complications are not common to each type of sex.

Suffer from deafness
Hearing nerve can occur unilateral, rarely bilateral, although the insiden low (1; 15,000), parotitis is a major cause of unilateral hearing nerve. Hearing loss may be temporary or permanent.

Complications Okuler
Complications include dakriodenitis, swollen the pain, usually bilateral, of the gland lakrimalis; optic neuritis (papillitis) with symptoms of vision loss varies from opaque to light with healing in 10-20 days; uveokreatitis, usually unilateral with fotofobia, tear out , loss of vision and rapid healing in 20 days; Skleritis, tendonitis, with the result eksoftalmus; trombosis vena sentral.

Artritis
Artralgia the swollen accompanied with redness and joint complications are rare, usually it perfect.

Purpura Trombositopeni
The sign is get not often.

Embriopati Parotitis
There is no strong evidence that maternal infection infected fetus; possible relationship endokardial fibroelastosis not portrait. Parotitis in early pregnancy increase the chance abortus.

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