BELAJAR TENTANG POTENSIAL FATAL INFEKSI VIRUS MIDDLE EAST RESPIRATORY SYNDROME CORONA-VIRUS (MERS)

Iranian officials say they have confirmed the country's first two cases of MERS, a deadly virus first reported two years ago in Saudi Arabia, its neighbor on the western side of the Gulf.

Middle East Respiratory Syndrome Corona-Virus (MERS) causes coughing, fever and sometimes fatal pneumonia, killing an estimated 30 percent of those who are infected.

An Illinois man thought to have contracted the potentially fatal MERS virus from a business associate was not infected after all, federal health officials said Wednesday.

The U.S. Centers for Disease Control and Prevention said on May 17 that the unidentified Illinois man had been infected with MERS by a man who brought the first known case of the mysterious respiratory illness to the United States in late April. That first case was a health care worker who had traveled to Saudi Arabia -- the epicenter of the MERS outbreak -- and returned to the United States before falling ill and being hospitalized in Indiana and later released.

Preliminary tests indicated that the Illinois man had tested positive for antibodies for MERS, formally called Middle East Respiratory Syndrome. Since then, however, CDC scientists tested additional blood samples and found that he was not infected with MERS. So, the Indiana MERS patient didn't spread the virus to his Illinois business associate, officials said Wednesday.

The second MERS case in the United States involved a 44-year-old health care worker from Saudi Arabia who had traveled to Orlando, Fla., where he was hospitalized and later released.

That means that the MERS virus hasn't been found in any people who had contact with the two confirmed U.S. cases, according to the CDC. There's no evidence that MERS has spread in any community setting, the CDC said.

Both of the Americans diagnosed with MERS picked up the infection in Saudi Arabia, where it is endemic.

The health risk from MERS to the general public is very low, U.S. officials have said, because the virus is only passed through close contact.

The MERS virus first surfaced in 2012 in the Middle East, where most of the cases have occurred. As of May 22, 2014, there have been 632 confirmed cases and 193 deaths, according to the World Health Organization.

MERS symptoms typically include shortness of breath, coughing and fever. The illness kills about one-quarter of the people who contract the virus, according to CDC officials.

One-fifth of all MERS cases have occurred among health care workers, CDC officials have said.

In some countries, the MERS virus has spread from person to person through close contact, such as caring for or living with an infected person. But, there's currently no evidence of sustained spread of MERS in general settings, the CDC has said.

Camels have been identified as carriers of MERS, but it's not known how the virus is being spread to people.

There is no vaccine or specific treatment for MERS, which has killed more than 175 people in Saudi Arabia and spread throughout the region, also reaching as far as Malaysia, Greece, Lebanon and the United States.

"Four suspected cases of new corona virus infection were observed in a family in the province of Kerman. Two of these cases were confirmed in two sisters," said Mohammad Mahdi Gouya, the director-general of communicable diseases at the Iranian Health Ministry's Centre for Diseases Control and Prevention.

"One of the sisters is in critical condition and the other is currently receiving treatment under special circumstances," the ministry's website quoted him on Monday as saying.

A recent upsurge of infections in Saudi Arabia is of concern because of the influx of pilgrims from around the world expected in July during the Muslim fasting month of Ramadan.

Gouya also said that Tehran had dispatched trained medical teams to Saudi Arabia, where they studied MERS cases among Iranian Hajj pilgrims, according to Iran's Press TV.

Arrangements were being made for Iranian pilgrims to undergo medical check-ups after they return home, he added.

MERS is a virus from the same family as SARS, or Severe Acute Respiratory Syndrome, which killed about 800 people worldwide after it first appeared in China in 2002.

BELAJAR TENTANG TATA CARA MAKAN DI DALAM MENGENDALIKAN TEKANAN DARAH TINGGI (HYPERTENSION)

DASH is an eating plan that can help lower your blood pressure. DASH stands for Dietary Approaches to Stop Hypertension. Hypertension is high blood pressure.

The DASH eating plan focuses on foods that are high in calcium, potassium, and magnesium. These nutrients can lower blood pressure. The foods that are highest in these nutrients are fruits, vegetables, low-fat dairy products, nuts, seeds, and beans. Taking calcium, potassium, and magnesium supplements instead of eating these foods does not have the same effect.

The DASH eating plan

Food	Recommended servings	Examples
Low-fat and fat-free milk and milk products	2 to 3 servings a day	A serving is 8 ounces of milk, 1 cup of yogurt, or 1 1/2 ounces of cheese.
Fruits	4 to 5 servings a day	A serving is 1 medium-sized piece of fruit, 1/2 cup chopped or canned fruit, 1/4 cup dried fruit, or 4 ounces (1/2 cup) of fruit juice. Choose fruit more often than fruit juice.
Vegetables	4 to 5 servings a day	A serving is 1 cup of lettuce or raw leafy vegetables, 1/2 cup of chopped or cooked vegetables, or 4 ounces (1/2 cup) of vegetable juice. Choose vegetables more often than vegetable juice.
Grains	6 to 8 servings a day	A serving is 1 slice of bread, 1 ounce of dry cereal, or 1/2 cup of cooked rice, pasta, or cooked cereal. Try to choose whole-grain products as much as possible.
Meat, poultry, fish	No more than 2 servings a day	A serving is 3 ounces, about the size of a deck of cards
Legumes, nuts, seeds	4 to 5 servings a week	A serving is 1/3 cup of nuts, 2 tablespoons of seeds, or 1/2 cup cooked dried beans or peas.
Fats and oils	2 to 3 servings a day	A serving is 1 teaspoon of soft margarine or vegetable oil, 1 tablespoon of mayonnaise, or 2 tablespoons of salad dressing.
Sweets and added sugars	5 servings a week or less	A serving is 1 tablespoon of jelly or jam, 1/2 cup of sorbet, or 1 cup of lemonade.

The DASH eating plan is one of several lifestyle changes your doctor may recommend.

Your doctor may also want you to decrease the amount of sodium you eat. Lowering sodium while following the DASH plan can lower blood pressure even further than just the DASH plan alone. For good health, less sodium is best. Try to eat less than 2,300 milligrams (mg) of sodium a day. If you have high blood pressure, diabetes, or chronic kidney disease, if you are African-American, or if you are older than age 50, try to limit the amount of sodium you eat to less than 1,500 mg a day.1

For more information on nutrition for high blood pressure, see Blood Pressure: Nutrition Tips and DASH Diet Sample Menu.




Sumber : MD

BELAJAR TENTANG IMFLAMASI PARU-PARU (BRONCHITIS)

Perpustakaan Keluarga : Helmut Todo Tua Simamora dan dr. Olga Y.V. Hutapea

Berikut merupakan kutipan ilmiah kedokteran yang sangat bermanfaat bagi Penulis sehingga disusun dan digunakan sebagai referensi pribadi.

 

What is Bronchitis?

Bronchitis is an inflammation in the lungs that some people call a chest cold. It can be a miserable, but minor, illness that follows a viral illness like the common cold -- or may follow a more serious condition like a chronic smoker's hack. A cough, phlegm, and feeling tired are typical symptoms of bronchitis, but these are also symptoms of other illnesses, so getting the right diagnosis and treatment is important.

Bronchitis: Inside Your Lungs

When the bronchial tubes that carry air deep into your lungs become inflamed, the inner lining swells and grows thicker, narrowing the breathing passages. These irritated membranes also secrete extra mucus, which coats and sometimes clogs the small airways. Coughing spells are the body's way of trying to clear out these secretions for easier breathing.

Symptoms of Bronchitis

The main symptom of bronchitis is a productive cough that persists several days to weeks . Other symptoms that may occur are:

• Fatigue
• Wheezing sounds when breathing
• Tightness or dull pain in the chest
• Shortness of breath

Fever is unusual and suggests pneumonia or flu.

Acute Bronchitis: How Long Does It Last?

Acute bronchitis often develops three to four days after a cold or the flu. It may start with a dry cough, then after a few days the coughing spells may bring up mucus. Most people get over an acute bout of bronchitis in two to three weeks, although the cough can sometimes hang on for four weeks or more. If you're in otherwise good health, your lungs will return to normal after you've recovered from the initial infection.

Repeated Bouts: Chronic Bronchitis

Doctors suspect this illness when you have a cough with phlegm on most days for at least three months in a year, for two years in a row. Chronic bronchitis is a serious condition that makes your lungs a breeding ground for bacterial infections and may require ongoing medical treatment. It's one form of chronic obstructive pulmonary disease (COPD), a lung disease that makes it hard to breathe. The "smoker's cough" is sometimes a sign of bronchitis and COPD.

Bronchitis or Something Else?

The symptoms of bronchitis are often the same as those of other conditions, such as asthma, pneumonia, allergies, the common cold, influenza, sinusitis, and even gastroesophageal reflux disease (GERD) and lung cancer. See your doctor to get an accurate diagnosis. Serious illnesses like pneumonia require prompt treatment.

When to Call the Doctor

Check in with your medical provider if you:

• Feel short of breath or wheeze
• Cough up blood
• Have a fever greater than 101 F (38 C)
• Have a cough lasting more than four weeks

Causes of Acute Bronchitis

This form of bronchitis is more common in winter and nine out of 10 cases are caused by a virus. Irritants -- like tobacco smoke, smog, chemicals in household cleaners, even fumes or dust in the environment -- can also cause acute bronchitis.

Causes of Chronic Bronchitis

Smoking is by far the most common cause of chronic bronchitis. Workplace exposure to dust and toxic gases is a much less common cause, seen in miners and grain handlers. Air pollution can make symptoms worse for people with chronic bronchitis.

Smokers and Bronchitis

A smoker who gets acute bronchitis will have a much harder time recovering. Even one puff on a cigarette can cause temporary damage to the tiny hair-like structures (cilia) in the airways that brush out debris, irritants, and excess mucus. Further smoking continues the damage and increases the chances of chronic bronchitis, which can lead to increased risk of lung infection and permanent lung damage. Bottom line: It's time to quit.

How is Acute Bronchitis Diagnosed?

Doctors usually diagnose acute bronchitis by reviewing how your symptoms have developed over time and through a physical examination. Using a stethoscope, your doctor will listen for any abnormal sounds produced within your lungs when you breathe.

How is Chronic Bronchitis Diagnosed?

Your doctor may recommend pulmonary function testing after doing a medical history and physical exam. Pulmonary function tests like spirometry measure how well the lungs are working. A chest X-ray may also be done.

Treatment: Acute Bronchitis

The only treatment generally needed for acute bronchitis is symptom relief: Drink lots of fluids; get plenty of rest; and avoiding smoke and fumes. A non-prescription pain reliever may help with body aches. Your doctor may prescribe an expectorant to help loosen mucus so it can be more easily coughed up or an inhaled bronchodilator medicine to open your airways.

Treatment: Chronic Bronchitis

If you have chronic bronchitis related to smoking, the most important thing to do is to quit smoking to prevent ongoing damage to your lungs. Unless your doctor advises against it, get a pneumococcal vaccine and an annual flu vaccine. Treatment may include bronchodilators and steroids (inhaled or by mouth).

Chronic Bronchitis and COPD

Chronic bronchitis and emphysema are the two main forms of chronic obstructive pulmonary disease. Doctors may prescribe bronchodilators, which are drugs that help open constricted airways. Oxygen therapy helps some people breathe better and a pulmonary rehab program can improve your quality of life. Quitting smoking is a must to stop further lung damage.

How to Avoid Bronchitis

It's no surprise that the best way to decrease your risk is not to smoke or allow others to smoke in your home. Other ways include: avoiding colds and staying away from things that irritate your nose, throat, and lungs, such as dust or pets. Also, if you catch a cold, get plenty of rest and take your medicine as directed.

Sumber : MD

BELAJAR TENTANG 10 TIPS DALAM MENDAPATKAN DIAGNOSIS KANKER SECARA AKURAT

10 Tips for Receiving an Accurate Cancer Diagnosis

• Get the facts about your cancer diagnosis. The more you understand about your cancer diagnosis, the better equipped you’ll be to make informed decisions about treatment. Learn about your type of cancer, its size, location and if it has spread. Find out if it’s slow-growing or aggressive. Ask your doctor for patient education materials and resources.
• Choose your cancer team carefully. Find a hospital/facility that has experts in your form of cancer and advanced technology to diagnose and treat the disease. Also, find a cancer team that includes clinicians from many different disciplines who collaborate on a regular basis to evaluate your status using advanced diagnostic tools.
• Seek individualized care. Every cancer diagnosis is unique. Even the same type of cancer can grow at different rates and respond differently to the same treatments. What works for one may not work for another. You should have access to diagnostic tools that precisely identify and pinpoint the disease so your doctor can plan the most effective treatment.
• Take an active role in the process. You can take charge of your health by working cooperatively with your cancer team and asserting your needs. Ask ahead of time about the diagnostic testing you’ll need and how you can prepare for it. Ask for test results in a timely manner. Make sure you understand next steps before leaving your doctor's office.
• Consider a second opinion. You may want to get a second or third opinion before beginning treatment. Most doctors understand the value of a second opinion when facing major decisions. A second opinion can help you feel more confident in the accuracy of your diagnosis, or, in some cases, it can reveal inaccuracies and ensure treatments better suited to your needs.
• Get the most out of your appointments. Naturally, you may find it difficult to retain all the information you receive after a cancer diagnosis. Write down the questions you want answered ahead of time. Whenever possible, bring someone with you to appointments. They can think of questions you may not have thought to ask and take notes for you.
• Ask questions about your diagnosis. An important part of dealing with your cancer diagnosis is asking questions and clarifying what you don’t understand. If your doctor uses medical terms you don’t understand, ask him or her to explain it in another way. Try repeating what you think was said back to your doctor for confirmation. Here are some questions you may decide to ask:
  • What kind of diagnostic tests do I need?
  • What can I expect from diagnostic testing?
  • How long will it take to get the results?
  • How soon can I start treatment after diagnostic testing?
  • How will I know if treatment is working?
  • How can I stay on top of a recurrence?
• Communicate with your doctors. Communication with your cancer team is essential to understanding your diagnosis and making informed treatment decisions. Ask about what was uncovered during the diagnostic process and the treatment options that are available to you. Find out the best way to reach your care team if you have questions from home.
• Schedule follow-up visits. Once you complete treatment, make sure to schedule the necessary follow-up visits with your cancer team. During these visits, your doctor will use diagnostic tests to identify any changes in your condition and stay on top of any metastasis or recurrence. These appointments may occur more often at first and then less frequently.
• Don't give up. If you have been given no further options after a cancer diagnosis, it does not necessarily mean that other options don't exist. Remember, there are other doctors that may present a different picture. Some hospitals may be able to provide more advanced technology and resources that can help you.

Sumber : cc.com

BELAJAR TENTANG DIET MASSA OTOT

A Ketogenic diet is the fastest way to burn fat while maintaining the most muscle mass.  Bodybuilders have been using it for years, but recently it has been a growing trend among people looking to shed some excess pounds.

How Your Body Uses Food

Before getting into the specifics, let’s discuss how your body metabolizes fuel.  The average person’s diet consists of a variety of carbohydrates, proteins, and fats.  Our body turns carbs into glycogen to use for quick energy. 

At any given moment, we have approximately 2,000 calories worth of glycogen in our blood.  Proteins are broken down into amino acids which are then used to repair damaged cells and build muscle.  Our body can turn proteins into glycogen if we need it for energy.  Fat is digested and used throughout our body for insulation.  We can use it for energy, or store it for use later.

Our bodies are wonderful and efficient machines.  Any excess calories from proteins or carbs are turned into fat.  This is good news if we don’t have access to reliable food, but bad news if we want to fit into that summer swim gear.

When Our Body Burns Fat

When glycogen is unavailable for our body to process, it starts burning fat. The fat molecules are turned into ‘ketones’ and are metabolized.  Fat is actually a completely healthy and natural form of energy.  Groups of people who don’t have access to carbohydrates like Inuits (Eskimos) are naturally on a Ketogenic diet their whole lives.  Have you ever seen an obese Eskimo?

When you ingest carbs, your body breaks them down into sugars.  These sugars are digested by insulin which is released by your pancreas.  Insulin triggers ‘fat storage’ mode because it wants to gather all the calories you ate and store them for later use.  On a Ketogenic diet, your body does not release the 'hoarder' chemical insulin, helping you burn fat much faster.  Often, patients with diabetes are told to go on a Keto diet because it doesn’t affect their blood sugar levels.

How to Begin the Ketogenic Diet

The Ketogenic diet consists of fat, protein, and indigestible carbs, also known as fiber.  You should eat a ratio of 70-25-5 of fats, proteins, and carbs respectively.  Yes, 70% of your diet should be made up of fat.  Common 'Keto' foods are bacon, sausages, burgers wrapped in lettuce, and pork.  You can eat as many leafy vegetables as you want, but avoid high carb fruits and vegetables like apples, carrots, pears, and corn.  On a Keto diet, you cannot eat any form of grain or wheat.  That means no bread, pasta, cereals, potatoes, or rice.  Doing so will produce glycogen and kick you off ketosis.

Why the Diet Works

Since your body is using fat as its primary source of energy, you are constantly burning it rather than storing it.  People have the misconception that if you eat fat, you will gain fat.  In reality, gaining fat occurs only if you ingest more calories than you expend, regardless of their source. These calories can come from carbs or proteins as well as fat.

The main benefit of this diet is that however little you eat, you will never feel hungry or unsatisfied.  The taste and texture of fat-containing foods stimulate our brains to feel full and appeased.  With a Ketogenic diet, since you are eating a high level of fat, your appetite is satisfied so you don’t feel hungry as you do with traditional diets.

Some worry that cholesterol and blood lipid levels will rise to unhealthy levels.  Studies show that because you are metabolizing fats so quickly, they don’t typically increase cholesterol or fat levels.  In fact, many people find that their blood levels are much healthier on a Keto Diet.

With any diet, it’s important to talk to a medical professional such as your doctor or dietician before starting.  A Keto diet is fairly easy to follow once you understand the types of food you should and shouldn't eat. 

Sumber : l.com

BELAJAR TENTANG GEJALA SPESIFIK PENYAKIT KANKER

Cancer symptoms

Cancer symptoms vary depending on many factors, such as the cancer type, stage, size and location. The early stages of cancer may not produce noticeable symptoms. As the disease progresses, symptoms often become more apparent.

Some general symptoms of cancer include:

• Fatigue
• Unexplained weight loss/gain
• Fever
• Pain
• Change in appetite
• Nausea, vomiting
• Skin changes

Many symptoms share characteristics of other, non-cancerous conditions. If you experience any persistent symptoms or other changes in your health, it’s important to see a doctor as soon as possible.

Specific cancer symptoms

The following are specific symptoms typically associated with certain cancer types:

• Digestive/Gastrointestinal: Some common gastrointestinal cancer symptoms include: cramps, bloating, gas pain, changes in bowel/bladder habits, constipation, diarrhea, bloody stools, rectal bleeding, anemia, and/or jaundice. Learn more about symptoms of colorectal cancer.
• Gynecologic: Some common gynecologic cancer symptoms include: abnormal vaginal bleeding (after menopause, between periods, following sexual intercourse), pain during intercourse, pelvic/back pain, pain on urination, and/or watery, white or pinkish vaginal discharge. Learn more about symptoms ofovarian cancer, uterine cancer, or cervical cancer.
• Head and neck: Some common symptoms of head and neck cancers include: persistent pain, difficulty swallowing, voice changes, mouth sores, dry mouth, changes in appearance, and/or taste changes. Learn more about symptoms of head and neck cancer.
• Hematologic: Some common hematologic cancer symptoms include: flu-like symptoms, fever, chills, joint/bone pain, anemia, night sweats, lymph node swelling, itching, persistent cough, shortness of breath, abdominal discomfort, headaches, easy bruising or bleeding, and/or frequent infections. Learn more about symptoms of leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, or multiple myeloma.
• Skin: Some common skin cancer symptoms include: a change in a mole's size, shape, and color in the form of asymmetry, border/color irregularities or diameter (larger than 1/4 inch), itchiness, pain, and/or oozing around the affected area. Learn more about symptoms of skin cancer.
• Lung: Some common symptoms of lung cancer include: a cough that doesn't go away, pain in the chest area, shortness of breath, hoarseness, wheezing, coughing up blood, blood in phlegm or mucus, neck or facial swelling, and/or headaches. Learn more about symptoms of lung cancer.

View a complete list of cancers we treat to explore common symptoms

Diagnosing cancer

If you experience any cancer symptoms, it’s important to consult with a medical professional. A doctor will evaluate your symptoms and use diagnostic tests to first confirm the presence of disease, and then to identify the correct tumor type, location, extent and stage. An accurate cancer diagnosis helps your doctors determine a treatment approach that works for you.

Learn about the benefits of a second opinion

Learn about the importance of an accurate cancer diagnosis




Sumber : cc.com dalam r.com

BELAJAR TENTANG INFEKSI MRSA (METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS INFECTIONS)

Tough-to-treat staph infections that patients can pick up while in the hospital fell by nearly 30 percent in the last decade, according to U.S. health officials.

The biggest drop, of more than 50 percent, was seen in hospital-acquired infections, while rates of the drug-resistant infections not linked to hospitals or other healthcare settings barely changed.

"The good news is… the most serious kind of infection that lands people in hospitals and kills people is going down in the U.S.," Dr. Raymund Dantes, who led the study while at the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, said.

He and his colleagues found that overall, there were about 80,500 methicillin-resistant Staphylococcus aureus (MRSA) infections in the U.S. in 2011, compared to about 111,300 in 2005.

Staphylococcus aureus bacteria, or staph, live on the skin or in the noses of about a third of the U.S. population and are usually harmless. But when the bacteria find their way into the bloodstream - usually through cuts and scrapes - they can turn deadly.

Symptoms of a staph infection include small red bumps on the skin, which can turn into more severe sores. When the bacteria spread past the skin, they may cause life-threatening infections in bones, organs and the bloodstream.

Staph strains resistant to the antibiotic methicillin can only be treated with one other antibiotic, and the worry is they will become resistant to that one too.

MRSA infections are often picked up while patients are in the hospital being treated for something else, or in other healthcare settings, such as dialysis centers, that people with chronic illnesses visit regularly.

Outside the healthcare arena, MRSA infections can be picked up anywhere, such as gyms or team locker rooms.

Hospitals and other healthcare providers have been making a big push to cut down on transmission of MRSA inside their facilities.

To see whether patterns of MRSA infection have changed, the researchers analyzed 2011 data on infections from selected counties in nine U.S. states, and compared it to a 2005 CDC report on MRSA incidence.

Overall, the number of serious MRSA infections diagnosed while people were in the hospital fell by 54 percent between 2005 and 2011 - from about 9.7 infections per 100,000 people to about 4.5 per 100,000 people.

The incidence of serious infections diagnosed while people were home but after being in contact with a healthcare setting also decreased, by about 28 percent, during that time - from 21 infections per 100,000 people to about 15 infections per 100,000 people.

In contrast, so-called community-acquired infections not linked to healthcare fell by just 5 percent.

While the new study cannot explain why infection rates are dropping, Dantes said it's likely attributable, in part, to hospital efforts to reduce the spread of infections.

"It's also possible that there has been evolution of these strains and they're less invasive," Dr. Franklin Lowy, from the Columbia University College of Physicians and Surgeons in New York who wrote an editorial accompanying the new study in JAMA Internal Medicine, said.

"What's interesting about our study, we didn't see a big change … in the number of community-associated infections. So we haven't made as much progress getting those down," Dantes, who is now at Emory University in Atlanta, said.

"Certainly there is more research that needs to be done to understand community-associated invasive MRSA infections. So that's an area we're looking into more," he said.

In the same journal, a separate study suggested a possible link between MRSA infections and farms.

Researchers led by Joan Casey of the Johns Hopkins Bloomberg School of Public Health in Baltimore found that Pennsylvania residents who lived closest to farms using pig manure were at 38 percent increased risk of MRSA infections, compared to those who lived farthest away.

"I think there are several possible environmental explanations," Casey said, including that the antibiotic-resistant bacteria and antibiotics from the manure may get into the air or water and end up on people's skin.

The study, however, cannot prove that living near the farms actually cause the infections.

"It raises questions about this high-antibiotic contamination of manure and its transport. Perhaps that can be another community-based reservoir for these antibiotic-resistant strains that can be then disseminated," Lowy said.

"I think at this point it's premature that someone has to be unduly concerned about it," he added.

While Dantes said it's hard to tell people how to prevent MRSA infections outside of hospitals, he said that he encourages people who are in healthcare settings to watch their doctors and nurses wash their hands.

"If you don't see them wash their hands, ask them to," he said.

Dr. Ghinwa Dumyati, an infectious disease physician at the University of Rochester Medical Center who worked on the CDC report, also said people at higher risk for MRSA infections, such as those on kidney dialysis and people with diabetes, should wash their hands too.

"We're very optimistic and there are now more and more ways to prevent the transmission," she said, adding that hospitals are experimenting with new techniques to decrease the risk for infections.

Sumber : r.com

BELAJAR TENTANG HUBUNGAN ANTARA KESEHATAN PLASENTA DAN BAKTERIA

How newborns receive the colonies of helpful bacteria that reside in all people and make human life possible has been a mystery. A new study suggests that the placenta -- long thought a sterile environment -- actually contains a small but diverse bacterial community (a "microbiome") that might serve a crucial role in preparing newborns for life outside the womb. 

"We hypothesize it's the first feeding of the infant's microbiome," said lead author Dr. Kjersti Aagaard, an associate professor of obstetrics and gynecology at Baylor College of Medicine in Houston. "The different bacteria that we observed in the placenta are the same bacteria we see in the infant in the first week of life." The bacteria in the placenta most closely resemble the bacteria that normally reside in a person's mouth, the researchers noted. That could mean that a mother's oral health is even more important to the health of her unborn child than previously thought, said Dr. Jacques Moritz, director of gynecology at Mount Sinai St. Luke's in New York City. Moritz was not involved with the study. "Possibly people with gum disease have more pockets of this bacteria and are chronically overloading the body with bacteria," Moritz said. "That bacteria could concentrate in the placenta and cause premature delivery." 

The new research, published May 21 in Science Translational Medicine, did find that the bacteria in the placenta differs between premature and normal births. However, Aagaard was quick to note that her study does not establish a cause-and-effect relationship between those differences and premature delivery. "The placenta has a unique community profile depending on when the infant is delivered," she said. "All we can tell you is they're different, and that's an important thing to point out." 

Bacteria thrive throughout the human body, supporting functions such as digestion and immune response that are essential to life. These microbes outnumber the body's cells 10 to 1, according to the U.S. National Institutes of Health. Aagaard and her colleagues studied samples from more than 300 placentas to see whether babies might receive their first dose of life-sustaining bacteria from this crucial organ. 

The placenta connects a developing fetus to the uterus, allowing the unborn child to receive nutrients from its mother. The investigators found a very sparse bacterial community in the placenta, much less dense than the bacteria that populate a person's gut. "For every pound of placenta, you get one gram of bacterial DNA," Aagaard said. "It's tiny, but you can measure it and it changes over time." Aagaard suspects this placental bacteria likely provides a baby with its first "seeding" of healthy microbes, as opposed to the widely held theory that newborns receive their initial dose of bacteria from the mother's vagina during delivery. "As a clinician, that explanation really doesn't make any sense," she said. Closely examining the types of bacteria found in the placenta, the researchers concluded they are most similar to the mouth's microbial community.

The study authors believe that bacteria from the mouth make their way to the placenta through the bloodstream, a hypothesis Moritz agrees with. "Every time you brush your teeth, bacteria are entering your bloodstream and they go everywhere," he said. "It's usually cleansed by the body, but when it's not you can end up with bacterial infections." Moritz considers oral health a key to a healthy pregnancy. "I send all my patients for dental cleaning at 20-some weeks, just to make sure there are no pockets of bacteria that can cause premature labor," he said. Aagaard and her colleagues plan to explore the connection between oral and placental bacteria in a follow-up study involving more than 500 women at risk for preterm birth. 

Sumber : MD

BELAJAR TENTANG VIRUS CORONA MERS PADA MANUSIA (HUMAN CORONAVIRUSES)

Berikut merupakan kutipan ilmiah kedokteran tentang virology corona yang sangat bermanfaat bagi Penulis sehingga disusun dan digunakan sebagai referensi pribadi.

A second patient in the U.S. has been identified as having the potentially deadly virus known as MERS (Middle East respiratory syndrome), the CDC announced today.

The patient, like the first one identified earlier this month, is also ahealth care worker who lives and works in Saudi Arabia. The patient was visiting family in the U.S. He is now in good condition in an Orlando-area hospital. "The patient is isolated and doing well," Tom Frieden, MD, director of the CDC, said at a news conference.

CDC and Florida public health officials declined to identify the new patient or to provide the patient's gender. The patient traveled by plane from Jeddah, Saudi Arabia, to London May 1, then on to Boston, Atlanta, and Orlando.

The patient went to the emergency room on May 8. The CDC confirmed the MERS tests results on Sunday evening.

Over the next few days, public health officials will notify roughly 500 passengers who were on the U.S. legs of the flights, alerting them to be aware of possible symptoms and to seek medical help if they notice any.

The general public is at low risk for contracting the virus, said Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases. She also spoke at the news conference. "The virus has not shown the ability to spread from person to person in a community setting. It has been really universally [found] in people who have had very close contact."

The first U.S. case, a patient visiting Indiana, was confirmed last week. The first patient has recovered and was released from an Indiana hospital May 9. No one in contact with that patient has come down with any MERS symptoms.

Increase in MERS Cases

MERS was first identified in Saudi Arabia in 2012. Symptoms include fever, cough, and shortness of breath. There is no vaccine and no known cure.

The MERS virus is related to the SARS (severe acute respiratory syndrome) virus that infected more than 8,000 people worldwide in 2003, killing 774.

To date, 538 laboratory-confirmed cases of MERS have been identified worldwide, with 145 deaths, Schuchat said. Most of those cases, 450, have happened in Saudi Arabia, she said.

"Since March, there has been an increase in cases," she said. Public health officials are trying to determine why.

Worldwide, she said, about one-fifth of the MERS cases have occurred in health care workers.

After you're exposed to the virus, symptoms appear about 5 days later, Schuchat said, ''with an outer limit of 14." So most of those passengers on the same May 1 flights as the Orlando patient would be expected to have developed symptoms by now, she said.

The CDC does not suggest people change travel plans. It does advise that travelers going to countries with MERS closely watch their health and practice good hygiene. Wash your hands often and avoid people who are obviously ill.

About Coronavirus

Q:What are coronaviruses?

A: Coronaviruses are common viruses that most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses.

Coronaviruses are named for the crown-like spikes on their surface. There are three main sub-groupings of coronaviruses, known as alpha, beta and gamma, and a fourth provisionally-assigned new group called delta coronaviruses.

Human coronaviruses were first identified in the mid 1960s. The five coronaviruses that can infect people are: alpha coronaviruses 229E and NL63 and beta coronaviruses OC43, HKU1, and SARS-CoV, the coronavirus that causes severe acute respiratory syndrome.

Coronaviruses may also infect animals. Most of these coronaviruses usually infect only one animal species or, at most, a small number of closely related species. However, SARS-CoV can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

Q: How common are human coronavirus infections?

A: People around the world commonly get infected with human coronaviruses. However, one exception is SARS-CoV. Since 2004, there have not been any known cases of SARS-CoV infection reported anywhere in the world.

Q: Who can get infected?

A: Most people will get infected with human coronaviruses in their life time. Young children are most likely to get infected. However, you can have multiple infections in your life time. 

Q: How do I get infected?

A: The ways that human coronaviruses spread have not been studied very much, except for SARS. However, it is likely that human coronaviruses spread from an infected person to others through—

• the air by coughing and sneezing, and 
• close personal contact, such as touching or shaking hands.

These viruses may also spread by touching contaminated objects or surfaces then touching your mouth, nose, or eyes.

In one case, the SARS virus was though to spread through infected stool that got into the air; people breathed this in and got infected.

Q: When can I get infected?

A: In the United States, people usually get infected with human coronaviruses in the fall and winter. However, you can get infected at any time of the year. 

Q: What are the symptoms?

A: Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses of short duration. Symptoms may include runny nose, cough, sore throat, and fever. These viruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia. This is more common in people with cardiopulmonary disease or compromised immune systems, or the elderly.

SARS-CoV can cause severe illness. To learn more, see Symptoms of SARS.

Q: How can I protect myself?

A: There are currently no vaccines available to protect you against human coronavirus infection.  You may be able to reduce your risk of infection by—

• washing your hands often with soap and water,
• not touching your eyes, nose, or mouth, and
• avoiding close contact with people who are sick.

For information about hand washing, see CDC’s Clean Hands Save Lives!

Q: What should I do if I get sick?

A: If you have an illness caused by human coronaviruses, you can help protect others by—

• staying home while you are sick, 
• avoiding close contact with others,
• covering your mouth and nose when you cough or sneeze, and
• keeping objects and surfaces clean and disinfected.

Q: How do I get diagnosed?

A: Laboratory tests can be done to confirm whether your illness may be caused by human coronaviruses. However, these tests are not used very often because people usually have mild illness. Also, testing may be limited to a few specialized laboratories.

Specific laboratory tests may include:

• virus isolation in cell culture,
• polymerase chain reaction (PCR) assays that are more practical and available commercially, and   
• serological testing for antibodies to human coronaviruses.

Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires collection of blood specimens.

Q: Are there treatments?

A: There are no specific treatments for illnesses caused by human coronaviruses.

Most people with coronavirus illness will recover on their own. However, some things can be done to relieve your symptoms, such as—

• taking pain and fever medications (Caution: Aspirin should not be given to children), and
• using a room humidifier or taking a hot shower to help ease a sore throat and cough.

If you are sick, you should —

• drink plenty of liquids, and
• stay home and rest.

If you are concerned about your symptoms, you should see you healthcare provider.

Human coronaviruses (HCoVs) 229E, OC43, NL63, and HKU1, are associated most frequently with the common cold, an upper respiratory tract infection characterized by rhinorrhea, nasal congestion, sore throat, sneezing, and cough that may be associated with fever. Symptoms are self-limiting and typically peak on day 3 or 4 of illness. HCoV infections also may be associated with acute otitis media or asthma exacerbations. Less frequently, HCoVs have been associated with lower respiratory tract infections, including bronchiolitis, croup (especially HCoV-NL63), and pneumonia, primarily in infants and immunocompromised children and adults.

SARS-CoV, the HCoV responsible for the 2002–2003 global outbreaks of severe acute respiratory syndrome (SARS), is associated with more severe symptoms. It disproportionately affects adults, who typically present with fever, myalgia, headache, malaise, and chills followed by a nonproductive cough and dyspnea generally 5 to 7 days later. Approximately 25% of infected adults develop watery diarrhea. Twenty percent develop worsening respiratory distress requiring intubation and ventilation. The overall associated mortality rate is approximately 10%, with most deaths occurring in the third week of illness. The case fatality rate in people older than 60 years of age approaches 50%. Typical laboratory abnormalities include lymphopenia and increased lactate dehydrogenase and creatinine kinase concentrations. Most have progressive unilateral or bilateral ill-defined airspace infiltrates on chest imaging. Pneumothoraces and other signs of barotrauma are common in critically ill patients receiving mechanical ventilation.

SARS-CoV infections in children are less severe than adults; notably, no infants or children died from SARS-CoV infection in the 2002–2003 outbreaks. Infants and children younger than 12 years of age who develop SARS typically present with fever, cough, and rhinorrhea. Associated lymphopenia is less severe, and radiographic changes are milder and generally resolve more quickly than in adolescents and adults. Adolescents who develop SARS have clinical courses more closely resembling those of adult disease, presenting with fever, myalgia, headache, and chills. They also are more likely to develop dyspnea, hypoxemia, and worsening chest radiographic findings. Laboratory abnormalities are comparable to those in adult disease.

ETIOLOGY (See Images)

Coronaviruses are enveloped, nonsegmented, single-stranded, positive-sense RNA viruses named after their corona- or crown-like surface projections observed on electron microscopy that correspond to large surface spike proteins. Coronaviruses are classified in the Nidovirus family. Coronaviruses are host specific and can infect humans as well as a variety of different animals causing diverse clinical syndromes. Three serologically and genetically distinct groups of coronaviruses have been described. HCoVs 229E and NL63 belong to group I, and HCoVs OC43, -HKU1, and SARS-CoV belong to group II. Serogroups I and II have been isolated from mammals and serogroup III has been isolated from birds.

EPIDEMIOLOGY

Coronaviruses first were recognized as animal pathogens in the 1930s. Thirty years later, 229E and OC43 were identified as human pathogens, along with other coronavirus strains that were not investigated further and for which little is known regarding their prevalence and associated disease syndromes. In 2003, SARS-CoV was identified as a novel virus responsible for the 2002–2003 global outbreaks of SARS, which lasted for 9 months, infected 8096 people, and resulted in 774 deaths. Most experts believe SARS-CoV evolved from a natural reservoir of SARS-CoV-like viruses in bats through civet cats as intermediate hosts. Whether or not a large-scale reemergence of SARS will occur is debatable. Finding a novel HCoV sparked a renewed interest in HCoV research, and 2 years later, NL63 and HKU1 were identified as newly recognized HCoVs. One of the investigations has revealed that NL63 was present in archived human respiratory samples as early as 1981.

HCoVs other than SARS-CoV can be found worldwide. They cause most disease in the winter and spring months in temperate climates. Seroprevalence data suggest that exposure is common in early childhood, with approximately 90% of adults being seropositive for 229E, OC43, and NL63 and 60% being seropositive for HKU1. In contrast, SARS-CoV infection has not been detected in humans since early 2004, when 4 isolated cases of SARS with no associated transmission were identified in China and 2 isolated cases and a cluster of 11 cases (1 death) were identified in South East Asia related to breaches in biosafety practices in different laboratories culturing SARS-CoV.

The modes of transmission for HCoV other than SARS-CoV have not been well studied. However, on the basis of studies of other respiratory tract viruses, it is likely that transmission occurs primarily via a combination of droplet and direct and indirect contact spread. Which of these modes are most important remains to be determined, and the possible role of aerosol spread requires further study. For SARS-CoV, studies suggest that droplet and direct contact spread are likely the most common modes of transmission, although evidence of indirect contact spread and aerosol spread also exist. There is no evidence of vertical transmission of SARS-CoV.

HCoVs other than SARS-CoV are most likely to be transmitted during the first few days of illness, when symptoms and respiratory viral loads are at their highest. Further study is needed to confirm that this holds true for the NL63 and HKU1 viruses. SARS-CoV is most likely to be transmitted during the second week of illness, when both symptoms and respiratory viral loads peak.

The incubation period for HCoV infections, other than SARS-CoV, is estimated to be 2 to 5 days (median 3 days), primarily on the basis of studies with 229E. The incubation period for SARS-CoV is 2 to 10 days (median, 4 days).

DIAGNOSTIC TESTS

The 2002–2003 SARS outbreaks garnered renewed interest in better understanding the etiology of respiratory tract infections, and some clinical laboratories have since started offering comprehensive respiratory molecular diagnostic testing for non-SARS HCoVs using reverse transcriptase polymerase chain reaction assays. Diagnostic laboratory and clinical guidance for SARS is available on the Centers for Disease Control and Prevention Web site (www.cdc.gov/sars/index.html). Given the potential for false-positive test results and the associated public health implications, testing for SARS-CoV in the absence of known person-to-person transmission of SARS must be performed with caution and only in consultation with regional public health departments when there is a high degree of suspicion in a patient with no alternative diagnosis.

Specimens obtained from the upper and lower respiratory tract are the most appropriate samples for viral detection. Stool and serum samples also frequently are positive in patients with SARS-CoV. For 299E and OC43, specimens are most likely to be positive during the first few days of illness; whether this is also true for NL63 and HKU1 needs further study. For SARS-CoV, respiratory and stool specimens may not be positive until the second week of illness when symptoms and viral loads peak; serum samples are most likely positive in the first week of illness. Compared with adults, infants and children with SARS-CoV infections are less likely to have positive specimens consistent with the milder symptoms and presumed corresponding lower viral loads seen in this age group.

TREATMENT

Infections attributable to HCoVs generally are treated with supportive care. SARS-CoV infections are more serious. Steroids, type 1 interferons, convalescent plasma, ribavirin, and lopinavir/ritonavir all were used clinically to treat patients with SARS, albeit without benefit of controlled data documenting efficacy. No definitive conclusions regarding efficacy of any treatment can be made. There are reports of patients who were treated with supportive care only who recovered uneventfully. In the event that SARS-CoV reemerges, clarification of the effectiveness of treatments through controlled clinical trials is needed.

ISOLATION OF THE HOSPITALIZED PATIENT

Health care professionals should use Droplet and Contact Precautions in addition to Standard Precautions when examining and caring for infants and young children with signs and symptoms of a respiratory tract infection for the duration of their illness (www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html). Droplet Precautions may be discontinued when infectious agents that have been documented to be spread via the droplet route, such as influenza virus, adenovirus, rhinovirus, and SARS-CoV, have been ruled out. Airborne, Droplet, and Contact Precautions are recommended for patients with suspected SARS-CoV infection for the duration of illness plus 10 days after resolution of fever, provided respiratory symptoms are absent or improving.

CONTROL MEASURES

Practicing appropriate hand and respiratory hygiene likely is the most useful and easily implemented control measure to curb spread of all respiratory tract viruses, including HCoVs. For hospitalized patients, following additional infection control practices as described previously is recommended. The control of the 2002–2003 SARS outbreaks is credited to the rapid identification of cases and early implementation of infection control and public health measures, such as contact tracing and quarantine.

Coronaviruses, Including SARS Figure 1.

Microscopic appearance of control (A) and infected (B) Vero E6 cells, demonstrating cytopathic effects. The cytopathic effect of severe acute respiratory syndrome coronavirus on Vero E6 was evident within 24 hours after infection. Courtesy of Centers for Disease Control and Prevention

Coronaviruses, Including SARS Figure 2.

Electron micrograph of a coronavirus. Pleomorphic virions average 100 nm in diameter and are covered with club-shaped knobs.

Coronaviruses, Including SARS Figure 3.

Transmission electron micrograph of coronavirus OC43. Courtesy of Centers for Disease Control and Prevention

Coronaviruses, Including SARS Figure 4.

Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed in an electron microscope. Severe acute respiratory syndrome (SARS) coronavirus was the etiologic agent of the 2003 SARS outbreak. Additional specimens are being tested to learn more about this coronavirus and its etiologic link with SARS. Courtesy of Centers for Disease Control and Prevention

Coronaviruses, Including SARS Figure 5.

This scanning electron micrograph (SEM) revealed the thickened, layered edge of severe acute respiratory syndrome-infected Vero E6 culture cells. The thickened edges of the infected cells were ruffled and appeared to comprise layers of folded plasma membranes. Note the layered cell edge (arrows) seen by SEM. Virus particles (arrowheads) are extruded from the layered surfaces. Courtesy of Centers for Disease Control and Prevention.

Coronaviruses, Including SARS Figure 6.

This scanning electron micrograph (SEM) revealed the thickened, layered edge of severe acute respiratory syndrome-infected Vero E6 culture cells. The thickened edges of the infected cells were ruffled and appeared to comprise layers of folded plasma membranes. Note the layered cell edge (arrows) seen by SEM. Virus particles (arrowheads) are extruded from the layered surfaces. Courtesy of Centers for Disease Control and Prevention

Coronaviruses, Including SARS Figure 7.

Note the coronaviruses contained within cytoplasmic membrane-bound vacuoles, and cisternae of the rough endoplasmic reticulum. This thin section electron micrograph of an infected Vero E6 cell reveals coronavirus particles. Courtesy of Centers for Disease Control and Prevention

Coronaviruses, Including SARS Figure 8.

This scanning electron micrograph reveals the rosette-like appearance of the matured severe acute respiratory syndrome coronavirus particles (arrows). This scanning electron micrograph emphasizes the form and structure of the virus particle, or virion, made visible with negative staining (inset) under transmission electron microscopy. Short and stubby spikes are visible on the virus surface. Courtesy of Centers for Disease Control and Prevention.

Coronaviruses, Including SARS Figure 9.

Scanning electron microscopy (SEM) of Vero E6 cells infected with severe acute respiratory syndrome-associated coronavirus. (A) The cell surface is covered with extracellular progeny virus particles, and progeny virus particles are being extruded from or attached to numerous pseudopodia on the infected cell surface (arrows). (B) A higher magnification micrograph of the virus-clustered pseudopodia (arrows). (C) Rosette-like appearance of the matured virus particles (arrows). The SEM image complements the form and structure of the virus seen with negative staining (inset) under transmission electron microscopy. Short and stubby spikes are visible on the virus surface. (D) Arrows indicate virus particles being exported from the surfaces of the filopodia. Courtesy of Emerging Infectious Diseases.

Coronaviruses, Including SARS Figure 10.

Coronaviruses are a group of viruses that have a halo or crown-like (corona) appearance when viewed under an electron microscope. Courtesy of Centers for Disease Control and Prevention/C. S. Goldsmith and T. G. Ksiazek.

Coronaviruses, Including SARS Figure 11.

Using the NanoScope IV MultiMode atomic force microscope, the “knobby” virion surface structure was visualized (arrow). High magnification of the maturing virus particles showed a rosette appearance with short, knob-like spikes under both the scanning electron and atomic force microscopes. The spikes, which were 16-17 nm, seemed shorter than those of other coronaviruses. Courtesy of Centers for Disease Control and Prevention/Mary Ng Mah Lee, MD, National University of Singapore, Singapore.

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