Typhoid Fever (TIPES)

Three months ago, my job partner’s daughter got “tipes”. Whats that? If you were Indonesian people, you knew that is Indonesian name for Typhoid fever. she appeared to feel weak and sore when I touch her stomach. Is it a dangerous disease?

Typhoid fever is acute alimentary tract infections caused by bacteria. Salmonella typhi and Salmonella partyphi are bacteria that cause typhoid fever. Actually “tipes” name is taken from “tifus” , a desease caused by Ricketsia. However, caused the signs and symptoms are same, Typhoid be called tifus (the meaning of –oid is same). Typhoid fever is transmitted through the fecal-oral.

What are signs and symptoms of typhoid fever

1. Remitten fever

Whats it mean remitten? Remitten fever is fever that shows significants variations in 24 hours without return to normal temperature. Typically typhoid fever is high temperature when after midday until night, the morning, temperature gets down. Temperature of fever getting up slowly Onset fever is 10-14 days.

2. Abdominal pain

Why do typhoid patient get abdominal pain? Salmonella typhi has O somatic antigen and HH flagella antigen. In intestine Salmonella penetrates into ileum then catched by mononuclear cell. In Retyculoendotelial system, salmonella gets replication. Interaction between Salmonella and macrofag makes inflammation mediators. So patch of payer in intestinal wall get hyperplasia, necrosis and ulcer. It can be intestinal wound. So patient feel stomach pain.

3. Gi tract signs

Diarrhoe, constipation, vomit. They are caused by malfunction of intestine.

4. in second week. We can find dirty tongue, white plaque in middle tongue and red light on the tongue edge.
5. many cases, we can find red spot on chest skin
6. liver and spleen enlargement

treatment and therapy for typhoid

1. bed rest, 3 weeks minimum
2. antibiotic. Cefotaxim, chloramphenicol, erytromicin. The drug of choice is Chloramphenicol. For women who is get menorrhea, used erytromycin.
3. Healthy carriers should be excluded from handling food.
4. don’t eat more fiber, ex vegetables and fruit!!!!!! FORBIDDEN.

Attention

If Salmonella can inside into gallbladder, the patient can be the carrier of disease.

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ALL (Acute Lymphoma Leukemia)

Lymphocytes is form of leucocyte cell which produced in bone marow and tymus gland. Lymphocyte which produced in bone marrow is called B-Lymphocyte and T-Lymphocyte wich produced in tymus gland. In acute lymphoblastic leukemia there is an overproduction of immature lymphocytes. Called lymphoblats (sometimes referred to as blast cells)

Pathophysiology

ALL malignant sells are lymphoid cells that arrested in early stage of development. This arrest is caused by an abnormal expression of genes, often as a result of chromosomal translocations. The lymphoblasts replace the normal marrow elements, resulting in marked decrease in the production of normal blood cells (pansitopenia). Consequently, anemia caused erytrocyt decreased, bleeding caused trombocytopenia, and netropenia. The lymphoblasts also proliferate in organs other than the marrow, particularly the liver, spleen, and lymph nodes

Diagnosis

Find out ALL types by taken from the blood and bone marrow to learn:

1. The size and number of Lekemia cells
2. the type of lymphocyte, B cells or T celss
3. the chromosomes of the leukemia cells which called cytogenetics

also use lumbal puncture to find out whether there are leukemia cells in the cerebrospinal fluid.

Based of these tests, ALL can categorized:

1. early pre-B ALL
2. common ALL
3. Pre-B-cell
4. Mature B-cell ALL (Burkit Leukemia)
5. Pre-T-cell ALL
6. Mature T-cell ALL

Signs and symptoms ALL

There are sign and symptoms ALL which same with another type Leukemia.

1. aches in arms, leg, back
2. Black and blue marks for no apparent reason
3. enlarged lymph nodes
4. headaches
5. pale-looking skin
6. prolong bleeding
7. vomiting
8. dyspneu

in child with an infection caused low mature leukocyte number may also have:

1. coughing
   
2. sore throat
3. pain when urinating
4. frequent loose bowel movements

Therapy

1. transfusions of packed red cell to increase erythrocyte
2. platelets transfusions
   
3. antibiotic
4. Neulasta or Neupogen and Leukine are drugs that increase the number of white cells

Epidemiology

ALL most common in children (under 15 years old) and slightly more common in males than females

refferences

www.cancerbackup.org.uk

emedicine.medscape.com

www.marrow.org

www.leukemia-lymphoma.org

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CML (Chronic Myelocytic Leukemia/ Chronic Granulocytic Leukemia

In the last post, i wrote about Acute Myelocytic Leukemia. Now i post my new article about Chronic Myelocytic Leukemia.

CML cell

What is Chronic Myelocytic Leukemia?

Chronic Myelocytic Leukemia commonly called CML. The sell type which affected this cancer is granulocytic Leukocyte so called Chronic Granulocytic Leukemia. The term “chronic” indicates that this cancer tends to progress more slowly than acute forms of Leukemia. Its characterized by the increased and unregulated growth of predominantly myeloid cells (granulocyte blast) in bone marrow and accumulation of these cells in blood.

Pathology

There is a switch in pieces of chromosome 22 and 9. This translocation takes place in a single bone marrow cell and, through the process of clonal expansion. The break on chromosome 22 involves a gene called “BCR” and the break on chromosome 9 involves a gene called “ABL”. Apiece of chromosome 9 attaches to the end of chromosome 22 and the BCR-ABL cancer gene is made. The BCR-ABL cancer gene gives the cell instructions to make a protein that leads to CML The breaking off of chromosome 22 makes abnormal chromosome wich called Philadelphia chromosome. The Philadelphia chromosome produces tyrone kinase wich is responsible for the abnormal growth pattern of leukocyte in CML. Philadelphia chromosome is the mark of CML.

Translocation material between chromosome 9 and 22

Pathophysiology

CML can have three phases:

1. The Chronic desease
2. The accelerated phase
3. The blast crisis phase

During chronic phase, CML symptoms are less intense. Almost blood components can do their jobs normally. In the accelerated phase, the leukocyte number may go up or go down, erytrocyte and trombocyte number may drop. So in this phase patients can develop anemia. IN the blast crisis, we can find signs and symptoms example: spleenomegaly, increasing of blast cell, the number of erytrocyte and trombocyte drops wich make the patients look tired, dyspneu, abdominal and bone pain, also bleeding.

What are sign and symptoms of CML?

1. tired and weakness
2. fever
3. easy bleeding
4. frequent infections
5. Losing weight without trying
6. spleenomegaly
7. pain
8. Philadelphia chromosome sign

How to diagnosis CML?

The diagnosis of CML is suspected based on the result of a simple blood test. The test blood cell shows more immature white blood cell. Bone marrow aspirate and a bone marrow biopsy are two test that are done to look at the marrow cells for changes that can not be seen in cells blood. Philadelphia chromosome is detected by analyzes chromosome test.

How to treat patient of CML?

The treatment options depend on the following:

1. patient’s age and general health
2. the phase of CML
3. the amount of blasts in the blood or bone marrow
4. the size of the spleen

there are six types of standard treatment are used:

1. Imanitib mesylate and dasatinib: these drugs used initial treatment for certain types of CML in newly diagnosed patient. they block tyrosine kinase wich produced by Philadelphia chromosome. Tyrosine kinase is enzyme that causes stem cell to develop into granulocyte cell than the body needs.
2. Chemotherapy: using drugs to stop the growth of cancer celll
3. Biologic therapy is e treatment that uses the patient’s immune system to fidght cancer
4. Stem cell transplant: used during blast crisis
5. DLI (Donor lymphocyte Infusion)
6. Splenectomy: surgery to remove spleen

What are risk factors of CML

1. Very high level radiation
2. High dose radiation therapy used to treat other cancers

Attention!!! There is no link between dental or medical x-rays and increased risk of CML.

Epidemiology

Most of patients CML are adult.

refferences:

1. www.medterms.com

2. www.cancer.gov

3. www.merck.com

4. www.nlm.nih.gov

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AML (Acute Myelogenous Leukemia/Acute Myelocytic Leukemia)

AML patient with skin infected

Leukemia cell

How is Acute Myelogenous Leukemia hapenned?

Its hapenned when bone marrow produces blood cells abnormally. Normally bone marrow produces Blasts cell wich develop into white cell. However in AML, the blast cells can’t differentiate into mature white cell and grows faster than normal. It makes Bone marrow has no much time to compensated so bone marrow also produces abnormal erytrocyt and platelet. In this case, white cells mature has low number so patient get infection frequently.

Low numbers erytrocyt lead to anemia. We know that function of erytrocyt is oxygen transport to cell. If erytrocyt number is decreased, the body compensate with less activities to press using oxygen. Patient look tired, lethargy, and short breath (dyspneu).

Ptechiae also found on skin patient. Its caused low number trombocyt. Bleeding like DHF syndrome can found, example : epistaxis, hematemesis, melena, mucous bleeding, etc.

High number leukemia cell cause pain in abdominal, joints and bones.

This case is so dangerous because acute. So need treatment immediately. There are steps of AML treatment.

1. Induction chemotherapy (intensive until recover)

- cytarabine

- daunomycin and idamycin

- all trans retinoic acid for subtype acute promyelocytic leukemia

2. Consolidation to kill remaining leukemia cell
3. Organ Transplantation

- autologous transplant, however high risk relapse
- allogeneic transplant, low risk relapse

reference: www.marrow.org

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Leukemia

Atun Halimah is my friend whom i knew from cyber. She works as the barber. Someday, she told me that she would go to Papua. Why do you wanna go there? vacation? I asked her. She answered that she wanted to go there just for search “Buah Merah” or Red Fruit (Pandanus conoideus lam). She said that red fruit for Leukemia therapy. Then, I asked her, who gets leukemia. She answered that her family gets leukemia grade 4^th.

So what is Leukemia? Leukemia is malignant disease of blood. It starts from bone marrow where the blood cell produced. There are three main blood cell-types: Red cells (erythrocyte), platelets (trombocyte) and white cells (leucocyte). The major types of white blood cells are granulocytes, lymphocytes, and monocytes, which are part of the body's immune system and help to fight to infection. Leukemia is characterized by the uncontrolled accumulation of leucocyte. The white cell undergoes a leukemic change and it multiplies into many cells. The white cells grow and survive better than normal cells and they crowd out normal cells. Most leucocyte wich produced by bone marrow are immature in leukemia case.

Leukemia is the general term used to describe four different disease-types called:

1. Acute Myelogenous Leukemia
2. Acute Lymphocytic Leukemia
3. Chronic Myelogenous Leukemia
4. Chronic Lymphocytic Leukemia

Leukemia is the general term used to describe four grades.

1. grade 1: local not invasive
2. grade 2: local invasive
3. grade 3: invasive and organ disorder function
4. grade 4: complicated organ malfunction

What is Acute Myelogenous Leukemia?

- increased abnormal granulocyte in less 3 weeks (acute).

- (pansitopenia) trombocyte and erythrocyte are dropt caused leucocyte activities.

- Most in adult

What is Acute Lymphocytic Leukemia?

- increased abnormal Lymphocyte in less 3 weeks acute

- most in children

- also adult upper 65 years old

What is Chronic Myelogenous Leukemia?

- increased abnormal leucocyte, specially granulocyte more 3 weeks (chronic)

- most in adult

- there’s no pansitopenia caused bone marrow has compensated.

What is Chronic Lymphocytic Leukemia?

- most in children

- increased abnormal leucocyte, specially lymphocyte more 3 weeks (chronic)

What are signs and symptoms of leukemia?

1. Acute

- tired, lethargy, breathe short/dyspneu (compensation caused anemia)

- pale skin with blue spots on skin

- mild fever

- night sweat

- Aches in bones and joints

- Prolonged bleeding caused tombocytopenia

- Abdominal pain

2. Chronic

- less symptom and sign

- sometimes found splenomegaly

Diagnosis

1. Anamnesis
2. Need blood test counting and bone marrow punction (aspiration and biopsy) A bone marrow aspiration shows the cell-type and certain abnormalities by looking at proteins on the cell's surface.

How treat Leukemia?

1. Acute, start use chemotherapy.

There are two chemotherapy, induction (kill as many AML cells as possible and get blood cell counts back to normal over time), remission and consolidation.

Important!!! Just Doctor in Hospital do it!!!!!!

2. Transplant organ is needed if very urgent. Its considered because transplant organs makes late effect. Transplant organ also makes incompatibilty immune. If it happened in early, patient could die.
3. Sometime treatment in adult same with children, caused their condition.
4. Traditional therapy can used. Attention!!!! Don't try if it has not been researched by scientist
5. Drugs for AML but still under study

- tipifarnib (Zarnestra®) or lonafarnib

- bortezomib (Velcade®)

- cyclosporine A or PSC-833

- (Genasense®, GTI-2040)

- decitabine (Dacogen®)

- depsipeptide.

Factor risks

- radiation

- genetic from parents who get radiation

- tobacco smoke

- benzene

Don’t worry if you get Leukemia!!!! Keep try to heal, and Just God Safes You

reference: www.medicine.net

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