Prevention of Cervical Cancer

Cervical cancer is cancer that occurs in the cervical region is the entrance to the uterus, located between the womb (uterus) with a hole intercourse (vaginal).

Almost all cervical cancers (99.7%) are directly related to previous infection by one or more types of HPV (Human Papilloma Virus) that are oncogenic (Judson 1992; Walboomers et al, 1999). Infection occurs after active female sexual activity, usually begins after the age of adolescents (between the ages of 20-30 years) and progression to cervical cancer usually occurs after 10-20 years later, although in rare cases, some types of early lesions can be cancer in a short time within 1-2 years.

It is estimated about 10% of women infected with HPV will have pre-cancerous changes in cervical connective tissue (dysplasia) and 8% of women who undergo pre-cancerous changes will be early cancer confined to the outer layer cells of the cervix (CIS / Carcinoma In Situ), and about 20% of women who experienced CIS will develop into malignant cancer (invasive cancer) when pre-cancerous lesions or CIS are not detected and treated.

Which is a risk factor for cervical Cancer include:
  1. Sexual activity (age<20 years)
  2. Multiple sexual partners
  3. Exposure to IMS
  4. Mother or sister suffering from cervical cancer
  5. An abnormal PAP test earlier
  6. Decreased immunity, which caused suffering from HIV / AIDS or chronic use of corticosteroids (asthma and lupus).

Clinical Symptoms of Cervical Cancer at an early stage is much less pronounced, but the following signs can rely on in determining suspicion of cervical cancer:

  1. Pain during intercourse,
  2. Removing a little blood after intercourse,
  3. Excessive bleeding during menstruation (hypermenorrhea),
  4. Bleeding outside the menstrual cycle (Polymenorrhea),
  5. Abnormal vaginal discharge (color is not clear, odor or itching),
  6. At an advanced stage: no appetite, nausea, back pain, pain and swelling in the thigh, drastic weight loss, constipation, spontaneous bleeding after menopause, brittle bones easily and pelvic pain.

Prevention of cervical cancer can be divided into, as follows:
  1. Primary prevention, carried out by administering a vaccine is the most effective way to prevent cervical cancer and other genital cancers. Each person needs to be immunized at an early age before they are sexually active. Control Risks is very important (especially the modifiable risk factor) in preventing the chances of developing cervical cancer (cervical cancer).
  2. Secondary prevention, carried out by early detection of cervical precancerous lesions (as early as possible). Tests of cancer or pre-cancer is recommended for all women aged 30 to 50 years old through IVA test (Visual Inspection Acetic Acid). IVA test can be done at any time in the menstrual cycle, including during menstruation, during pregnancy and post-partum or post-abortion care. IVA test is very important for women who have a risk factor, especially in women suspected of exposure to STIs or HIV / AIDS.

IVA test can be performed in clinics that have the following facilities:
  1. Desk Check
  2. Sources of light / lamp
  3. Bivalved speculum (Cusco or Graves)
  4. Rack or container equipment.

The light must be strong enough so that the officer can see the end of the vagina where the cervix is. Examination can not be done if there is enough light to see the entire cervix. It is important also kept the light source are not too hot.

The materials required to perform the test IVA must be available on site, including:

  1. Cotton swab sticks for
  2. Check out new gloves or surgical gloves that have been in DTT
  3. Spatula of wood and or condoms
  4. The liquid solution of 3-5% Acetic Acid (white vinegar can be used)
  5. 0.5% chlorine solution for decontamination of equipment and gloves
  6. Notes form to record findings.

Acetic acid is the main ingredient of vinegar. It is recommended to use Acetic Acid with a concentration of 3-5%. Countries are caused no vinegar. Often sold in the market is a substitute for the real vinegar is acetic acid. If vinegar or acetic acid are not available pharmacist or local chemical supplier can dilute acetic acid solution using the formula:

Total Section (TB) Water = (% concentrate : % solution) - 1

Treatment and Follow-up, In most countries with limited resources, Cryotherapy either alone or combined with LEEP (performed at referral centers) is the best choice for outpatient care.

Advantages Cryotherapy:
  1. Effective for small and medium sized lesions (85-95% cure rate)
  2. Not expensive
  3. Can be performed by personnel other than physicians
  4. No need local anesthesia
  5. No need of electricity
  6. Few complications / side effects
  7. It can be done during pregnancy.

Women who test positive IVA (SSK Acetowhite visible lesions), including women with pregnancies less than 20 weeks, should receive cryotherapy treatment, if the lesion:

  1. Not suspected cancer
  2. Cervical cover no more than 75%
  3. Does not extend to the vaginal or cervical canal beyond cryoprob
  4. Extends no more than 2 mm of diameter prob of cryotherapy including prob end.

If it does not meet the above criteria, the patient should be referred to a health facility is better able to do the inspection and action further therapy (chemotherapy, radiotherapy or surgery).

Cryotherapy can be done in a clinic that has the equipment and facilities as follows:

  1. Examining table
  2. Adequate light source
  3. Speculum Duck (Cusco or Graves)
  4. Tray or container equipment
  5. Cryotherapy Unit
  6. Supply of CO2 or NO2 regular.


Hypomagnesemia in the provision of Proton Pump Inhibitor (PPI) Long Term

Drugs included in the category of Proton Pump Inhibitor (PPI) that circulated in Indonesia, among others: Esomeprazole, Omeprazole, lansoprazole and Pantroprazole, with a working mechanism to reduce or suppress gastric acid secretion by inhibiting the enzyme activity of H / K ATPase (proton pump) in surface of gastric parietal cells at a pH less than 4. Drugs that bind to protons (H) immediately converted into a pron Sulfonamode active pump. 

PPI drugs are indicated for the treatment of patients such as: Gastro Esophageal Reflux Disease (GERD), and Small Intestine Stomach ulcer and esophageal inflammation.

From the U.S. FDA Review of Reports of Adverse Event Reporting System (AERS), Medical Literature and Periodic Safety Update Report (PSUR) for cases of hypomagnesemia in patients who are receiving an extension of PPI therapy, suggests that there is the possibility of increased risk of decreased levels of magnesium ( hypomagnesemia) if the PPI is used in the long term. Hypomagnesemia has been reported in adult patients who received PPIs at least 3 months and most occurred after 1 year of PPI. 

Hypomagnesemia cause symptoms of serious side effects in certain patients, such as muscle spasm (tetany), irregular heartbeat (arrhythmia) and convulsions (seizures), impaired parathyroid hormone secretion and hypocalcemia. The mechanism of occurrence of hypomagnesemia in the provision of long-term PPI is not known, but may be related to changes in intestinal absorption of magnesium. 

Handling patients who are experiencing is generally hypomagnesemia with magnesium supplementation and cessation of PPI. 

Suggested to the doctor to do a blood magnesium levels of patients at the time: Before the long-term PPI therapy, By periodically during treatment with PPI, what more if the PPI class of drugs given concurrently with diuretics (loop diuretics and thiazide diuretics), and digoxin. 

Sources: POM Meso News Bulletin, Vol 29, No. 1, June 2011


The Spread of Hindu Religion in the Part of the World

In an excavation in Egypt in a known inscription dated 1200 BC. It is a treaty between Ramesses II and the Hittites. In this agreement "Maitra Waruna" is the title of the manifestation of Sang Hyang Widhi Wasa, according to the Hindu religion mentioned in the Vedas is considered as a witness.

Contained the Sahara Desert in North Africa according to the study of Geology is a former lake which had dried. Sagara in Sanskrit means the sea; and the name Sahara is the development of Sagara said. Given also that the people who live around them in the past is closely linked with the King of Kosala a Hindu from India.

Native of Mexico to recognize and celebrate the holidays Rama Sinta, which coincided with celebrations in India Nawa Ratri. From the results of excavations in the area obtained Ganesha statues are closely associated with Hinduism. In addition, the ancient people of these countries are the people Astika (Aztec), namely those who believe in the teachings of the Vedas. Astika said this is a term very close relationship with the "Aztecs" is a native of the area, as is known his name today.

Native of Peru has an annual holiday that is celebrated at the sun is at the farthest distance from the equator and the natives are called Inca. The word "Inca" is derived from the word "Ina" in Sanskrit which means "sun" and indeed people the Inca Surya is worshiper.

Description of Aswameda Yadnya (horse sacrifice) in which one of the Puranic Hindu Smriti states that the King Sagara burned to ashes by sage Kapila. King's sons are trying to Patala loka (the land beneath the earth = America behind India) in victims of the horse business. Because the Supreme sage Kapila's hermitage in the woods (Aranya) annoyed, then angry and burnt all the sons of King Sagara so to ashes.

Patala loka understanding is Indian country under the United States. While Kapila Aranya name associated with the name of California and there are parks mountain ash (Ash Mountain Park).

In the neighborhood tribes indigenous Australians have a particular type of dance is described as the dance of Shiva (Shiva's Dance). The dance performed by dancer-dancers to wear a sign "Tri Kuta" or a sign of a third eye on his forehead. The signs are suggestive of this clearly shows that the country had been familiar with the culture brought by the Hindu religion.


Tanah Lot Tourism Places

Like as the others Tourism Places that had be written before, Tanah Lot is also as one of the favorite tourist destinations on the island of Bali and is located in the Beraban village, Kediri, Tabanan. This tourist attraction famous for the temple Tanah Lot is located separately from the mainland, but still within reach if the low tide without having to use the boat. This temple is one of the main temples in Bali which is known as Six heaven. Besides full of historical value, this temple also offers a fascinating charm of the sunset and very crowded visited by tourists, especially in the afternoon.

According to legend, the Tanah Lot temple is built by a Brahmin who wandered from Java. He is Danghyang Nirartha who had successful strengthen the belief of the Balinese about Hindus teaching and developing the Six heaven in the 16th century. At that time the ruler Tanah Lot, Bendesa Beraben, jealous of him because his followers began to leave and follow Nirartha Danghyang. Bendesa Beraben told to Nirartha Danghyang to leave the Tanah Lot.

He agreed, and before he left the Tanah Lot with its power to move the boulder into the middle of the beach (not into the sea) and built temples there. He also changed his scarf into a snake as temple guards. This snake was still there until now and by scientifically these snakes are including sea snakes that they have the characteristics of a flat tail like a fish, black color and striped yellow and have a poison 3 times stronger than cobra snake. End of the legend that Bendesa Beraben 'finally' becomes a follower of Danghyang Nirartha.


Socialization of the P2TP2A Institutions of Klungkung District

Yesterday dated 26 November 2009 at Praja Mandala Room of Regent Klungkung Office had been held socialization activities of P2TP2A Institutions of Klungkung regency. Participants who attend approximately 100 people from educational institutions (education Department, High Head, Head of Junior), TP PKK, Dharma Wanita, P2TP2A Board, Alit Assembly of Pekraman Village, UPT Health Center. Socialization event begins with opening remarks by the Chairman and Executive of P2TP2A Klungkung Regency, by presenting Resources of: A.A.I.A. Ratnadri, SH, Ny. Andre, Sri Wahyuni, SH, Ni Ketut Latri, SH, and Ida Bagus Alit.

Said to be the formation background P2TP2A Institute (Center for Integrated Services for Women and Children Empowerment) that generally increase the quality of life of women in various fields have obtained positive results. But still needs to improve the position and role of women, especially in strategic areas such as education, health, economic, legal and child protection as well as political. Besides, there are still many issues regarding domestic violence in the home against women and children who are often deliberately not raised surface (nerimo).

P2TP2A is one form of vehicle services for women and children in an effort to fulfill the needs of information and education, health, economic, political, legal, protection and prevention of violence and trafficking against women and children. P2TP2A Klungkung District has formed in accordance Klungkung Regent Decree No. 199 Year 2009, dated July 9, 2009 About the Formation of the Integrated Service Center for Women and Children Empowerment Klungkung regency.

In Socialization is said that the main task of P2TP2A is a container service women's empowerment and child protection community based. P2TP2A serves to facilitate various services to the community both physical and non physical, which includes information, referral, consults / counseling, skills training and other activities. P2TP2A generally aims to contribute to the realization of gender equality and justice by integrating the strategies in integrated service activities for the improvement of conditions, and protection of women's roles as well as providing welfare and child protection.


Relief efforts for patients with coronary heart disease

Heart is one of body organs which has a strong layer of muscles and it's function is pumping bloods to transfer oxygen and nutrition to all parts of body. Consequence of not apply healthy life styles like as: smoking, unbalance nutrients (obesity) and less physical activity (sports) can cause many dangerous of diseases one of all are coronary heart disease.

Coronary heart disease is a certain heart disease that is occurred by presence anomaly of coronary vessel. This anomaly of coronary vessel is the constriction blood vessel as consequence of blood vessel wall not flexible by over fat accumulation. The prime etiology of Coronary heart disease is over fat accumulation on wall in of artery coronary until occur constriction and can obstruct blood circulations.

Predisposition factors of Coronary heart disease like as: Less consume vegetables and fruits, Smoking habit, Less physical activity or sports, Hypertension, Blood cholesterol more than normal, Obesity, Stress emotion, Diabetes Mellitus, Genetics.

Clinical signs of Coronary heart disease, included of: Suppressed sense at chest like as struck down by heavy load, chest pain, heartburn sense; These senses can spread to all chests, left shoulder, left arm, back, distal neck and lower jaw; Feeling like be throttled or chest crowd; Duration of above signs about thirty minutes; Cold sweat, weakness, palpitation; Some time until coma; Heart attacks often occur at morning day.

Community’s actions to help patient with Acute Heart attack can do some procedures like as: Lie down the patient; Loose of clothes and belt; Calling a doctor or reference to hospital.

Medical treatment that can be done, among others: Isosorbide dinitrate 5 mg sublingually every 5 minutes (to maximum of 3); or Glyceryl trinitrate sublingually spray: 1 to 2 sprays (to maximum of 3 in 15 minutes); or Nifedipine 5 mg capsule (suck or chew) if intolerant of nitrates (warn about possible hypotension and unpleasant taste).

Precautions of Heart Disease that can be done, among other: Make balance nutrients by consume more vegetables and fruits, poor fat with limited salt and sugar consumptions; Don’t smoking. All of cigarettes can cause coronary heart disease; be avoiding the stress by always positive thinking, quiet and be controlled; Keep blood pressure normally by regularly control; and please do regularly sport or physical activity.


Yellow Rice offerings Dedication on the Feast Day of Kuningan

On Saturday October 24, 2009 the member of Hindus religion in Bali celebrate Kuningan Feast Day. Like we did with the family is almost similar at Galungan where arrangements were made several days before the procurement of materials needed, just a difference in our Kuningan festivals make yellow rice for offerings and to be enjoyed.

Yellow rice is referred to as a symbol of prosperity, which after the victory of Dharma (rightness) against Adharma (not rightness) on Wednesday Kliwon Wuku Dungulan (Galungan), exactly 10 days later i.e. on Saturdays Kliwon wuku Kuningan Ida Sang Hyang Widhi Wasa (the god) down to the world to bestow grace to mankind in the form of basic commodities (food and clothing), which then by the Balinese Hindus celebrated as the Feast Day of Kuningan, where the offerings be completed with yellow rice as a symbol of prosperity.

Yellow rice as offerings are placed in containers called sulanggi its entirety, and then presented to complement the offerings that will be offered on the Feast Day of Kuningan to Ida Sang Hyang Widhi Wasa (the God) as a token of gratitude and thanks as well for the gift be bestowed upon His people the form of clothing materials and food in abundance.

Kuningan Feast Day is celebrated every 210 days which falls on a Saturday Kliwon Wuku Kuningan (Tumpek Kuningan) coincided with the 10 days after Galungan Feast Day.


Knowledge of Guillain-Barre Syndrome

Guillain-Barre Syndrome (GBS) is a rare disease, characterized by a weak state of the body loses sensitivity can usually complete recovery within weeks, months or years. GBS takes its name from two French scientists, Guillain and Barré, who found the two soldiers in the year 1916 wars who suffered paralysis and recovered after receiving medical treatment. This disease affects 25 per 1 million populations each year. Can be contracted at all age levels ranging from children to adults, is rarely found in the elderly. More often found in men. Not a hereditary disease, it cannot be transmitted through birth, not contracted from someone else who developed GBS. However, could arise a week to two weeks after intestinal or throat infection.

The initial symptoms include: feeling like a needle pierced a finger tip or a hand or foot numbness in parts of the body. Legs feel heavy and stiff or hardened, the arm felt weak and could not hand clutching or play something well (unlock, open cans, etc.)

Early symptoms can disappear within a few weeks, the patient usually does not feel the need to care or hard to explain to the team doctor for further treatment because the symptoms will disappear at the time of inspection.

The next stage while the symptoms began to appear difficulties means, for example: hard-stepping foot, arm became weak pain, and then doctors found the nerve reflexes have lost the function of the arm.

Patients usually feel an acute pain at the time of GBS. Especially occur on the regions of the spine and arms and legs. But there are also patients who did not complain of pain which means that although they experienced severe paralysis. The pain comes from swelling of the affected nerve, or from a temporary loss of muscle energy supply, or from sitting or sleeping position of the patients who have difficulty to move or turn his body into a comfortable position. To combat the pain doctor will give painkillers and nurses will provide therapies to relocate parts of the body is attacked by specific therapies. The pain may come and go and it was very normal for people with GBS.

These diseases arise from inflammation of peripheral nerves, resulting in the absence of messages from the brain to make movements that can be accepted by the affected muscles.

Because many of the affected nerves, including of nerves immune system is causing our body's immune system would be chaotic. Without orders it would produce fluid immune system on places unwanted can attack the peripheral nerves.

With treatment the immune system will stop attacking the nervous and working properly.
GBS diagnosis obtained from history and medical test results of physical and laboratory tests. From the history of the disease, the usual medicine drunk, addicted to alcohol, infections have ever suffered, then tick bite doctor will conclude whether the patients included in the list of GBS patients. Do not forget the history of the disease the patient had suffered and the families of patients such as diabetes mellitus, diet done, everything will be checked carefully to the doctor can make a verdict whether patients affected by GBS or other diseases.

Patients suspected of suffering from GBS are required to test: 1) full blood, 2) Lumbar Puncture, 3) EMG (electromyogram). Order, the first test will be done and then test the two if the first test of GBS was not detected, and the next.

As the rotation time, the signs of the weakening of the nerves would appear more severe in 4 to 6 weeks. Some patients weakened in relatively short time until the point of total paralysis in a matter of days, but this situation is very rare.

Patients then entered the stage of helplessness in a few days. At this time the patient is usually advised to rest in the hospital total. Although conditions in the weak state of the patient's highly recommended to always moving the body parts are affected to avoid stiff muscles. Physiotherapy expert usually will be very necessary to train the patient with specific therapies and will provide directives to the patient's family and friends train ways GBS patients.

Patients usually would weaken within a few weeks, so from that intensive treatment is needed in the stages where GBS began detected. In accordance with the stage and level of disability the patient then the doctor will determine what patient needs care in the ICU or not.

Approximately 25% of patients will have difficulty GBS: breathing, swallowing ability and hard to cough. In above conditions, usually the patient will be given to the aid of a ventilator to help breathing.

After some time, numbness conditions will gradually improve. Patients must remain wary because only 80% of patients can recover fully, depending on the severity of the patient could walk within weeks or years. But statistics prove that the average patient will get better within 3 to 6 months. Patients will leave severe disabilities in the most severely afflicted, need therapy long enough to restore the functions of paralyzed muscles by GBS. Usually takes a maximum of 4 years.

It’s medications only a kind of GAMAMUNE (Imuno globuline) is worth about 5 hundred dollars / bottle, patients will need this medicine is calculated from body weight, to the size of an adult per day spent 5 bottles for 4 - 5 days of treatment. The way the provision made through intravenous infusion assembly.

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