tolong donk.. - Printable Version +- Forum antar Dokter Indonesia (https://www.dokter.or.id) +-- Forum: Medical (https://www.dokter.or.id/forum-4.html) +--- Forum: Bincang (https://www.dokter.or.id/forum-17.html) +--- Thread: tolong donk.. (/thread-329.html) Pages:
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tolong donk.. - aryakulla - Wednesday, 04 March 2009 temen gw mencari rumah sakit yg bagus buat pengobatan anaknya yg terkena penyakit pengapuran otak (rubella), dia udah brobat ke singapura n jakarta tapi blum ada perubahan kesehatan anaknya ,. nah skr dia bingung mo brobat kmana lg.. bantuin donk klo temen2 punya informasi pengobatan masalah penyakit ini... thanks berat ya... Re: tolong donk.. - asbud - Friday, 06 March 2009 penyakit pengapuran otak?? baru denger.. rubella udah lama denger.. salah kali.. rubella itu campak, & bukan penyakit serius.. Re: tolong donk.. - denditan - Friday, 20 March 2009 Kalo pada anak bisa serius.Coba ke RS MMC aja dengan Prof Jusuf Misbach. Re: tolong donk.. - asbud - Saturday, 21 March 2009 Gua tetep rasa "aryakulla" salah diagnosis.. gak ada rubella yg bisa bikin pengapuran otak.. pengapuran otak pun jg istilah yg agak aneh kalo menurut gua.. coba tanya lagi dokternya itu penyakit apa.. Gua rasa "denditan" juga salah mengerti.. kata: Quote:Kalo pada anak bisa seriussecara penyakit ini emang sebagian besar kenanya ke anak2.. Rubella emang bisa jadi bahaya.. kalo kenanya ke wanita hamil trimester pertama (hamil muda).. janin yang dikandung bisa jadi mendapatkan kelainan kongenital, alias cacat janin.. macem2.. mulai dari malformasi (kelainan bentuk) atau kelainan fungsi (mis: tuli kongenital).. untuk lengkapnya gua quote beberapa artikel yah: quote from Code: http://www.minmalangsatu.net/detail-artikel-172/Rubella.html Quote:RUBELLA Re: tolong donk.. - denditan - Saturday, 21 March 2009 Maksud saya, pada anak2 yang memiliki imun yang rendah virus2 seperti rubella, citomegalovirus dll bisa membahayakan. Asal tahu saja saya pernah mendapatkan pasien anak yang lemah di kedua tungkai. Lemahnya tidak jelas. Ketika diperiksa anti viral, hampir semuanya positif, cytomegalovirus, rubella, dll. Dalam kedokteran clinical judgement adalah hal yang biasa, bukan semata2 texbook. Seorang dokter baru lulus walaupun lulus dengan cum laude dibandingkan dengan residen senior yang telah banyak mengelola pasien, tentu clinical judgmentnya akan beda. Begitu juga bila residen senior dibandingkan konsulen yang sudah malang melintang maka clinical judgment akan beda. Re: tolong donk.. - asbud - Saturday, 21 March 2009 yup.. bener bangeet.. CMV emang berbahaya.. tapi rubella mah bahayanya buat bumil.. tapi yah, emang kita gak bs tebak apa yg tjd.. kl saking buruknya antibody anak itu.. oke lah, bisa diterima, makanya perlu MMR.. tapi gua tetep gak sependapat kata2 "pengapuran otak (rubella)".. apa gua salah kali yah? mungkin dlm pengalaman gua tergolong kurang.. tapi pengapuran otak?? ibunya yg kena rubella tuh.. Re: tolong donk.. - asbud - Saturday, 21 March 2009 (Saturday, 21 March 2009, 16:08)denditan link Wrote: Maksud saya, pada anak2 yang memiliki imun yang rendah virus2 seperti rubella, citomegalovirus dll bisa membahayakan. Asal tahu saja saya pernah mendapatkan pasien anak yang lemah di kedua tungkai. Lemahnya tidak jelas. Ketika diperiksa anti viral, hampir semuanya positif, cytomegalovirus, rubella, dll. Dalam kedokteran clinical judgement adalah hal yang biasa, bukan semata2 texbook. Seorang dokter baru lulus walaupun lulus dengan cum laude dibandingkan dengan residen senior yang telah banyak mengelola pasien, tentu clinical judgmentnya akan beda. Begitu juga bila residen senior dibandingkan konsulen yang sudah malang melintang maka clinical judgment akan beda. coba px ibunya tuh.. gua rasa ibunya kena di trim 1.. yg hrs di px. riwayat imunisasi yg didapat.. gua rasa gak mungkin rubella yg kena anak bikin tungkai lemah.. denditan bilang kan px anti viral yg lain kan positif.. kalo gua sih cenderung mungkin di CMV ato polio.. bener juga soal kesenioran dalam bertindak di klinis.. itu bener.. kadang penyakit di lapangan emang beda ama di textbook.. gua setuju.. yg berperan di lapangan emang pengalaman.. makin senior jelas makin tau beda masing2 penyakit walaupun gejala klinisnya sulit dimengerti.. tapi sehebatnya2 konsulen nentuin diagnosis, ato profesor pun, patokannya tetep textbook bukan? kalo ngga, yah berarti si konsulen itu menemukan penyakit baru.. hehe.. Re: tolong donk.. - denditan - Sunday, 22 March 2009 Memang yang CMV lebih bahaya. Texbook memang diperlukan sebagai pegangan namun bukan segala-galanya tapi clinical judgement tak kalah pentingnya. Prof saya waktu di psikiatri bilang beliau bisa mendiagnosa schizoprenia dari baunya. Dan memang bau penderita schizoprenia berbeda. Ada di textbook? Biarkan aryakula menggunakan istilah pengapuran otak. Kita kan tidak tahu apa yang sebenarnya terjadi. Re: tolong donk.. - asbud - Tuesday, 24 March 2009 iya tuh, gua jg tau soal itu.. katanya scz bau nya beda.. subhanallah yah, Allah mempermudah seorang dokter u/ mendiagnosa penyakit.. ada kok di textbook.. Quote:"Can your nose smell the early signs of schizophrenia? According to researchers at the University of Melbourne it can. They?ve found that your ability to correctly identify smells on a scratch and sniff test can be an indicator of your risk of developing schizophrenia. In the past we?ve had very limited tools to predict whether someone is going to develop schizophrenia or not. All we?ve been able to use is family history and certain behaviour. Until now. Researchers at the University of Melbourne have found that our sense of smell is turning out to be very useful in predicting the development of schizophrenia. Take a teenager already at risk of developing schizophrenia. The worse they score on the scratch and sniff test, the higher their likelihood of developing schizophrenia" lagian bro.. itu beda keadaan.. kalo kasus kita, seperti ini: misalnya kalo tiba2 loe bilang schizo itu penyakit berbahaya.. bisa bikin buta.. aneh kan? btw, gua yakin kalo kasus diatas itu bukan kena langsung ke anaknya.. kemungkinan besar kenanya ibu nya pas lg trimester 1.. its in the book.. sorry bro, im a book person.. menurut gua, semuanya pasti ada di buku.. biarpun ada prof yg hebat yg nemuin sesuatu yg baru, pasti dia langsung berusaha taro penemuannya di buku... minimal di jurnal.. bener gak? Re: tolong donk.. - denditan - Friday, 27 March 2009 Wah...makasi dikasi tahu.Rupanya ada di textbook.Heheh.. Oh ya mengenai pengapuran otak, saya baru search di wikipedia. Untungnya ada forum ini, kita bisa saling informasi. Subacute sclerosing panencephalitis (SSPE) is a rare chronic, progressive encephalitis that affects primarily children and young adults, caused by a persistent infection of immune resistant measles virus (which can be a result of a mutation of the virus itself). 1 in 100,000 people infected with measles develop SSPE. SSPE is 'incurable' but the condition can be managed by medication if treatment is started at an early stage. Much of the work on SSPE has been completed by the National Institute of Neurological Disorders and Stroke (NINDS). SSPE is also known as Dawson Disease, Dawson encephalitis and measles encephalitis. Symptoms Characterized by a history of primary measles infection usually before the age of 2 years, followed by several asymptomatic years (6?15 on average), and then gradual, progressive psychoneurological deterioration, consisting of personality change, seizures, myoclonus, ataxia, photosensitivity, ocular abnormalities, spasticity, and coma. [edit] Progression The progression of symptoms begins with stage 1 ? in this stage the behaviour of person become more abnormal and erratic, the person can be irritable and personality alterations can occur. This is often accompanied by memory loss and mental deterioration characterised by intellectual difficulty. As the nervous system begins to lose control of movement, the person develops myoclonic spasms/jerks (these being involuntary motions and spasms in extremities). As the disease progresses towards stage 2, the intensity of the spasms and the mental deterioration increases. The spasms can grow to such an extent that loss of the ability to walk can be a common sign. Also, the person will suffer speech impairment and increasingly deteriorated comprehension coupled with dysphagia. At this point the infection is at stage 2. The final, advanced stages of SSPE include the steady decline in body function with increased intensity of the stage 2 symptoms/signs and also blindness. At the end of the final stages the person is likely to be mute and/or comatose. [edit] Diagnosis Characteristic periodic activity is seen on EEG (this activity showing widespread cortical dysfunction); pathologically, the white matter of both the hemispheres and brainstem are affected, as well as the cerebral cortex, and eosinophilic inclusion bodies are present in the cytoplasm nuclei of neurons and glial cells. Diagnosis of SSPE is often difficult due to a normal CSF profile ? noted changes in the CSF profile only include a marked elevation in CSF immunoglobulin. Rubeola Ig G Antibody Titres will be high. [edit] Prognosis Death usually occurs within 3 years. If the diagnosis is made during stage 1 of the SSPE infection then it is possible to treat the disease. However, once SSPE progresses to stage 2 then it is universally fatal in all occurrences. The standard rate of decline spans anywhere between 1?3 years after the onset of the infection. The progression of each stage is unique to the sufferer and cannot be predicted although the pattern or symptoms/signs can be. Although the prognosis is bleak for SSPE past stage 1, it should be noted that there is a 5% remission rate ? this may be either a full remission or an improvement in condition giving a longer progression period or at least a longer period with the less severe symptoms. Regardless of the stage that the infection is at, treatment with inosine pranobex combined with interferon can give up to a 50% remission/improvement rate. [edit] Treatment Should the viral progression be diagnosed during stage 1 (even during late stage 1 when stage 2 symptoms start to manifest themselves) then treatment to combat the infection can be administered successfully ? there is no cure for SSPE but if it is caught early enough then the sufferer can respond to the treatment and prevent symptom recurrence by taking the medication for the rest of their life. The treatment for the SSPE infection is the immunomodulator interferon and specific antiviral medication ? ribavirin and inosine pranobex are specifically used to greater effect than antivirals such as Amantadine. For those who have progressed to stage 2 or beyond then the disease is incurable. For patients in the terminal phase of the disease there is a palliative care and treatment scheme ? this involves anticonvulsant therapy (to help with the body's progressive loss of control of the nervous system causing gradually more intensive spasms/convulsions) alongside supportive measures to help maintain vital functioning. It is fairly standard as the infection's spread and symptoms intensify that feeding tubes need to be inserted to keep a nutritional balance. As the disease progresses to its most advanced phase, the patient will need constant nursing as normal bodily function declines to the complete collapse of the nervous system. Combinations of treatment for SSPE include:   * Oral inosine pranobex (oral isoprinosine) combined with intrathecal (injection through a lumbar puncture into the spinal fluid) or intraventricular interferon alpha.   * Oral inosine pranobex (oral isoprinosine) combined with interferon beta.   * Intrathecal interferon alpha combined with intravenous ribavirin. [edit] Global patterns of infection SSPE is an incredibly rare condition although there is still relatively high incidence in Asia and the Middle East. However, the number of reported cases is declining since the introduction of the measles vaccine ? eradication of the measles virus prevents the SSPE mutation and therefore the progression of the disease or even the initial infection itself. |