Semua pekerjaan yang dilakukannya memang banyak melibatkan pikiran, dan jauh dari aktivitas yang melibatkan tenaga. Tapi ia tetap mengeluh akan hal tersebut. Ia selalu merasa lelah dan tidak bersemangat dalam hidupnya. Meski di malam hari seharusnya ia bias tertidur dengan nyenyak, tapi ia justru memilih mengkhawatirkan hidupnya yang sebenarnya sangat beruntung itu.

Turning point terjadi saat ia bertemu seseorang yang berkata, “bila jenuh di malam hari, jenuh dengan semua usaha kita, jenuh dengan hidup kita, pergilah sesekali di malam hari, lihatlah bagaimana kehidupan di malam hari, dan aku yakin kamu akan bersyukur”.
Ia ragu dan bingung dengan nasihat itu, namun pada akhirnya suatu malam ia mencoba menikmati kehidupan malam. Ia sempat berpikir apakah yang dimaksud kehidupan malam itu? Ia melewati jalan-jalan protokol, akhirnya ia mengetahui apa yang dimaksud dengan kehidupan malam itu. Dalam suasana malam yang dingin seorang pria tua sedang menyapu jalanan, hanya berbekal rompi yang compang camping. Meski berat ia menjalaninya sepenuh hati demi keluarganya di rumah. Melewati daerah sentra makanan, Nampak sudah mulai berkemas semua penjual makanan. Para pekerja mulai merapikan tenda-tenda makan yang ada. Di malam yang seharusnya semua orang beristirahat, tapi karena kebutuhan keluarga maka mereka bekerja dengan keras. Berbelok di daerah pusat kota Nampak penjual wedang sudah semalaman berkeliling, menjajakan minuman untuk memperoleh rezeki mereka. Mereka tidak pernah mengeluh akan hal tersebut. Mungkin rasa penuh tanggung jawab sudah menutup semua rasa lelahnya. Yang terpenting adalah anak-anaknya tidak kelaparan. Targetnya hanya terjualnya makanan yang mereka jajakan. Tidak lebih, dan mereka selalu bersyukur. Kadang hujan datang dan barang dagangan mereka tidak terjual habis, tapi mereka tidak pernah menyalahkan hujan, mereka hanya tersenyum sambil bersyukur masih ada yang membeli dagangan mereka.

Saat memasuki kompleks perumahan, ia tercengang, mendapati seorang penjual sate, masih duduk termenung di dekat pos kampling. Ia segera turun dari kendaraan, dan mendekatinya. Karena ia juga kelaparan, maka ia memesan sate. Sambil makan ia banyak bercerita dengan si penjual sate. Rupanya sudah 10 tahun dia berjualan sate. Setiap malam dia berkeliling menjajakan makanannya. Saat ditanyakan apa dia tidak lelah, dia menjelaskan, ia adalah tulang punggung keluarganya, isterinya bekerja sebagai buruh di pabrik rokok. Anaknya ada 2, dan semuanya masih bersekolah di sekolah dasar dan sekolah menengah pertama. Ia hanya berharap bias memenuhi kebutuhan keluarga.

Tercengang dengan hal itu, ia merasa sangat bersyukur. Semua pekerjaannya dilakukan dengan modal pikiran saja, dan sedikit sekali aktivitas fisik. Di siang yang panas, ia bekerja dalam ruangan berpendingin, dan saat malam ia tidak perlu ada di luar ruangan yang dingin. Tapi semua selalu ia keluh kesahkan, semua ia anggap sebagai tekanan dan stress. Semua yang ia dapatkan tidak pernah ia sukuri. Ia lebih memilih memikirkan target-target yang tertinggal ketimbang mensyukuri apa yang dia telah capai, dan semua kemudahan dalam hidup yang selalu ia anggap sulit.

Kehidupan malam memang mengajarkan banyak hal. Kasih sayang orang tua. Puji syukur atas apa yang kita dapatkan. Semua dicerminkan pada kehidupan malam. Bukan kehidupan malam yang glamor. Bukan kehidupan malam yang berkonotasi buruk. Tapi kehidupan malam yang dingin, gelap, tapi semua bekerja dengan penuh semangat, ikhlas, dan penuh syukur. Tanpa pernah merasa kurang beruntung dan kecewa akan hal yang mereka hadapi. Maka hiduplah dengan penuh semangat, tabah dan sabar, selalu bersyukur pada apa yang kita capai, jangan biarkan hidup kita sia-sia karena tidak pernah bersyukur.

Fadel Muhammad Garishah

Secara fisiologis, Sel Parietal akan menghasilkan HCl, yang dipengaruhi oleh beberapafaktor, misalnya produksi akan meningkat sejalan stimulus dari Histamin (untuk reseptor H2), Gastrin (untuk reseptor Kolesistokinin B), Asetilkolin (untuk reseptor Muskarinik 3), dan produksi akan dihambat bila adanya hambatan pada reseptor-reseptor tadi, atau dihambat oleh Prostaglandin E2 (PGE2) melalui reseptor Prostaglandin E3, yang menghambat cAMP-dependent pathway.

Sel epitel superfisial dari Gaster juga secara fisiologis dibantu Asetilkolin pada reseptor Muskarinik tertentu, dan Prostasilkin (PGI2) melaui reseptor Prostagalandin E3, yang meningkatkan sekresi mukus maupun HCO3, sebagai sitoproteksi terhadap sel-sel gaster sendiri. Pada lapisan sitoproteksi yang kaya mukus dan HCO3 ini pH gaster terjaga tetap 7. Pada lumen Gaster, pH sangat diatur oleh komponen H+ dari HCL yang merupakan asam lambung.

Obat –obatan antiinflamasi nonsteroid memiliki peranan dalam mencegah perubahan rantai asam arakhidonat, oleh COX (enzim siklooksigenase) terutama COX1 menjadi prostaglandin, maupun prostasiklin dan tromboksan. Keberadaan prostaglandin, prostasiklin dan tromboksan sebagai mediator inflamasi menyebabkan demam, dan agregasi trombosit di pembuluh darah.

Proses pembentukan prostaglandin, tromboksan maupun prostasiklin dapat dicegah dengan pemberian antiinflamasi nonsteroid dan yang paling mengganggu adalah efek samping pemberian Aspirin sebagai terapi pencegahan penyakit jantung koroner. Pembentukan tromboksan akibat gangguan endotel, menyebabkan agregasi trombosit, sehingga bisa terbentuk thrombus yang dapat menyumbat Arteria coronaria.

Terapi pencegahan ini memang efektif, tetapi efek samping utama yang berbahaya adalah adanya ukus peptikum pada Gaster. Penyebab ulkus yang diawali dengan gastritis kronik ini sangat dikaitkan dengan antiinflamasi nonsteroid.

Pathogenesis gastritis diawali dengan keberadaan aspirin dalam mencegah aktivitas COX1 (Siklooksigenase 1) dalam mengubah asam arakhidonat menjadi prostaglandin. Akibat berkurangnya prostaglandin menyebabkan jumlahnya berkurang, padahal sangat mempengaruhi aktivitas berlebihan sel parietal dalam mensekresikan HCl maupun sel epitel gaster dalam memproduksi HCO3 dan mukus. Akibatnya proteksi dari gaster sendiri hilang. HCl dengan mudah mengiritasi epitel mukosa Gaster. Bila efek gastritis sudah semakin parah dan mengenai pembuluh darah, maka pendarahan tidak akan terhindarkan. Salah satu pertahanan tubuh adalah dengan agregasi trombosit. Tromboksan A2, dan prostasiklin terlibat dalam mekanisme ini.

Tetapi kadar antiinflamasi nonsteroid dalam tubuh menyebabkan sintesis Tromboksan A2 dan Prostasiklin terganggu, sehingga agregasi trombosit juga dihambat. Proses ini menyebabkan ulkus peptikum makin parah. Selain sitoproteksi mukosa dan HCO3 sudah tidak ada, pendarahan yang terjadi terus berlangsung.

Tegal is one of developing cities in Central Java, Indonesia.  As located in one big line in Indonesia, the Lane north coast (Pantura), Tegal is quite strategic and gives many opportunities to the People of Tegal to live and living their lives. The city is about 205 Miles from Jakarta and 103 Miles from Semarang, two large cities that support the economic and social development in Lane north coast. Being known as the city of maritime, Tegal has the motto to support the development and courage the People of Tegal that they get used to live depend on the Sea.

During Dutch Colonialism, Tegal was known as important port in the Lane North Coast. Not only place where the traders stopped and traded their stuff, but also origin of the Dutch East Indies colonial sugar industry, and the regency remained a major sugar production center until the mid-20th century1.

People of Tegal, have the tradition and culture of their life as the people of Coastal Area, where they built their Coastal Community. Based on the people History, the previous Era, many People of Tegal are fishermen, whom lived nearby the beach, and fulfilled their life from the Sea. Now in the new Era, the coastal community has raised and enhanced their condition into a raising city of trades and industries. The developments of the industry and trades are shown from the amount of investments and chances that have been put by the investors in Tegal.

Some commodities that attracts the investors are such as the Shuttlecock Factories (IBF (International Badminton Federation) recorded three shuttlecock brands from Tegal such as Garuda, Gajah Mada, dan Sinar Mutiara, received the  standart international certificate of eligibility.), the fish fillets factories (offers the fresh fillet to consumers)2, the duck farming, home industries of blacksmith that designed and spare parts of vehicles and Tegal Batik Fabrics that quite unique and attractive.

The Fisherman Villages are spread in almost north part of Tegal. These villages are such as Western District of Tegal, known as Tegalsari is the center of fishermen area. People live as the fishermen. They usually work as the managing fishermen and worker fishermen. The managing fishermen own Fishing Ships and the fish storage rooms/tools. The worker fishermen works for the managing fisherman as his crews.

Mangroves and Fish banks are another attraction that can be found in Coastal Community in Tegal. Realizing the importance of mangrove as the coastal protection towards high wave, the People in Tegal emerging to build the fish banks with mangrove at the side. So the mangrove is not only protecting the fish banks but also protect the coastal area where the people live. This situation makes Tegal closer to be the better  example of Coastal Community.

1.            Knight, G.R. (1993) Colonial Production in Provincial Java. The Sugar Industry in Pekalongan-Tegal, 1800-1942. Amsterdam: VU University Press.

2.            POLA PEMBIAYAAN USAHA KECIL (PPUK) BANK INDOENSIA. Cited: Wednesday, August 3rd 2011

(http://www.bi.go.id/NR/rdonlyres/B42DA6A8-A712-488B-A0CC-70ACBCBFD3DB/15982/FilletIkan.pdf)

This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist.

Jessica, a 16 years old Indonesian high school student questions her mother about her later education. She’d like to get into school of medicine. She asked about medical education system, primarily the undergraduate system in Indonesia.

DISCUSSION

Medical education encompasses both undergraduate and clinical educations which are obtained by a medical student during their metamorphosis into a medical doctor.

Undergraduate education in Indonesia applies the new competency problem-based education, where the different subjects are incorporated into one module/block. One of the instances, in Maternal and Child Health Block, not only educated biomedical sciences like Anatomy, Physiology and others, but also Obstetrics, Gynecology, Pediatrics, an soon which have relation with the subjects. The system turned into SPICES(1) (Student centered, Problem-based, Integrated, Community Based, Early Clinical Exposure, Systematic). Students must obtained and gain the information themselves, by the guide from a tutor/lecturer. Lectures are given at the end of every block/module. The students are completely prepared to learn based on the problems that will be experienced and solved by them in their real live. So they don’t have to learn all medical stuff that don’t relate to their later cases. Problem-based learning also trains the students to actively self-study, communication and also professional conduct during discussion. Some researches had revealed the students with PBL: have more positive feelings toward medical education, responsibilities toward their study, and develop the critical thinking skill(2,3).

The conventional system teaches the students as the other faculties do. Every subject has its own regulation and power. Students must master the different subjects their own way. As the conventional system put the basic and fundamentals of medical science, the students have stronger concepts of medicine. In new competency based education, the students don’t cover all and basic part also fundamental part of medical science because of redundancy.

Some universities refuse to use the new competency based fully education due to their awareness and fear. They afraid if the students only educated based on the problems, they will see a patient per problem/body part, not as an entirely human. This redundancy is particularly striking in the basic medical sciences (for example, anatomy, biochemistry, physiology, pathology, and pharmacology)(4). Undergraduates should learn biochemical pathways that even though consultants in metabolic medicine do not need for their everyday work, because the factual information must be kept to the essential minimum that students need at this stage of medical education(5). The universities usually combine, the students keep get the regular lectures and system, while they can still discussed the problem-based cases. This is known as Innovative Conventional System.

References:

1. Kristina, Tri Nur (2011) Inovasi Pendidikan Dokter: Pencapaian Lulusan dengan Standar Internasional; dan Adaptif Terhadap Permasalahan Kesehatan Global. Documentation;Pengukuhan Guru Besar Ilmu Kedokteran. Fakultas Kedokteran Universitas Diponegoro.
2. Tiwari A, Lai P, So M, Yuen K. A Comparison of the effects of Problem-based learning and lecturing on the development of students’ critical thinking. Medical Education. 2006; 40: 547-54
3. Albanese MA. 1993. Problem based learning: A review of Literature on Its outcomes and implementation issues. Academic Medicine. 1993; 68:52 81
4. General Medical Council. Tomorrow’s doctors. Recommendations on undergraduate medical education. London: GMC, 2002.
5. Williams G, Lau A. Reform of undergraduate medical teaching in the United Kingdom: a triumph of evangelism over common sense. BMJ. 2004 July 10; 329(7457): 92–94.

                Hindia Belanda, atau The Dutch East Indies(1), beribukota di Batavia (sekarang Jakarta). Kota – kota besar dengan jumlah bangunan era kolonial yang terbanyak ada di kota-kota pulau jawa, seperti Jakarta, Semarang, Bandung dan Surabaya. Arsitek yang terkenal sebagai perancangnya termasuk Albert Aalbers, Thomas Karsten, Henri Maclaine-Pont, J. Gerber dan C.P.W. Schoemaker(2).  Semarang merupakan kota business terbesar ketiga di Hindia Belanda, setelah Jakarta dan Surabaya,  di masa colonial setelah pendirian Perusahaan Dagang Belanda Verenigde Oost-Indie Compagnie (VOC) di tahun  1705(3).

Kawasan Kota Lama Semarang atau juga biasa disebut “ Little Netherlands” merupakan sebuah kawasan kuno bersejarah yang penuh dengan bebagai bangunan peninggalan colonial Belanda. Kawasan yang semula dikelilingi benteng ini merupakan kawasan pemukiman dan pusat pemerintahan Kolonial Belanda pada masa pendudukan Belanda (VOC) di Indonesia pada abad ke-17. Pada tahun 1842, benteng yang mengelilingi kota lama tersebut dibongkar karena Belanda ingin mengembangkan kota Semarang menjadi kota yang lebih modern dengan membangun jaringan kereta api dan membuka terusan pelabuhan yang diberi nama Kalibaru(4).

Dari sekian kota di Hindia Belanda, memang hanya kota lama Semarang yang disebut sebagai Little Netherlands, karena menurut cerita (9), saat itu didesain hampir serupa dengan kota di Netherlands (9). Meskipun waterway atau transportasi air dengan kanal tidak berkembang lagi, tetapi, sungai yang semula kanal di Little Netherlands sangat mirip dengan kanal – kanal yang ada di Amsterdam(9).

Beberapa notable buildings little Netherlands:

Gereja Kristen tertua di Jawa Tengah yang sampai saat ini masih digunakan sebagai tempat ibadah ini dibangun masyarakat Belanda yang tinggal di Semarang pada tahun 1753 dengan bentuk heksagonal atau persegi delapan, direnovasi tahun 1894 oleh W. Westmaas dan H.P.A. de Wilde, yang menambahkan kedua menara di depan bangunan gereja(5).

Stasiun Tawang merupakan pengganti stasiun pertama milik Nederlandsche-Indische Spoorweg Maatschappij (N.I.S), Tambak Sari. Pembangunan stasiun Tambak Sari ditandai dengan upacara pencangkulan tanah oleh Gubernur Jenderal Mr. Baron Sloet van de Beele, bersamaan dengan pembentukan sistem perangkutan kereta api pada tanggal 16 Juni 1864. N.I.S melayani jalur Semarang – Yogya – Solo. Setelah mengalami proses pembangunan yang tersendat-sendat akhirnya jalur pelayanan kereta api ini terselesaikan pada 10 Pebruari 1870. Berkembangnya kegiatan perdagangan menyebabkan stasiun Tambak Sari tidak memenuhi syarat lagi. Maka direncanakanlah stasiun  baru dengan arsitek J.P de Bordes yang kemudian hari lebih di kenal dengan nama Stasiun Tawang. Stasiun Tawang dibangun pada bulan Mei 1914 (6). Lapangan di depan Stasiun Tawang (sekarang menjadi polder) juga mempunyai nilai historis yang tinggi, menjadi ruang terbuka dari Kota Lama yang difungsikan sebagai tempat upacara, olahraga, pertandingan, dan sebagainya.

Gedung karya Thomas Karsten di tahun 1916 yang kini menjadi gedung Asuransi Jiwasraya dan masih dalam kompleks Little Netherlands(5).

Pasar Johar, pernah merupakan bagian dari alun-alun. Disebut Pasar Johar karena di daerah tersebut tumbuh pohon johar atau mahoni yang digunakan untuk berteduh sehingga pedagang berjualan di bawah pohon tersebut yang terus berkembang dan membesar menjadi pasar. Berdasarkan kreasi Thomas Karsten, 1865 dibangunlah tempat berjualan dan dikenal sebagai Pasar Johar (5). Masjid Besar Kauman (1890) dan bangunan Pasar Johar (1936) adalah dua buah bangunan cagar budaya yang terdapat pada kawasan ini. Menurut beberapa sumber, Pasar Johar merupakan pasar terbesar dan termodern di Asia Tenggara sekitar tahun 1930-an. Hingga era 1980-an, pasar ini berkembang menjadi sentra perdagangan di Jawa Tengah(7),(8).

Demikianlah cerita singkat mengenai The Little Netherlands, Belanda Kecil yang sekarang nampaknnya tidak terlalu terurus, mungkin karena sudah tidak lagi seperti dulu. Tapi sejarah akan tetap dikenang sampai kapanpun, dan Semarang tetaplah The Little Netherlands.

Referensi, dan Tautan terkait

1.  Dagh-register gehouden int Casteel Batavia vant passerende daer ter plaetse als over geheel Nederlandts-India anno 1624–1629.”English: “The official register at Catle Bavaria, of the census of the Dutch East Indies. VOC. 1624.
2. Schoppert (1997), pp. 102–105
3. Suherdjoko . Semarang Revives Old City to Lure Tourists. The Jakarta Post. 21-03-2010
4. Endah Purwandini, Nur  (2002) Shopping Mall Di Kota Lama Semarang. Undergraduate thesis, Jurusan Arsitektur Fakultas Teknik Undip.
5. Yudono, Jodhi. Merindu “Litle Netherland” Kota Semarang. Kompas. 17-03-2011
6.  http://visitsemarang.com/artikel/stasiun-tawang
7. Sumalyo, Yulianto (1993). “Arsitektur Kolonial Belanda di Indonesia”. Yogyakarta : Gajah Mada University Press.
8. Tio, Jongkie (2002). “Kota Semarang dalam Kenangan”. Semarang.
9. Pengamatan. Dr. Nani Maharani, dosen farmakologi fakultas kedokteran UNDIP  yang belajar di Negeri Belanda.

A new breakthrough in biomedical sciences born out. This breakthrough will give relief to many idiopathic-infertile males, azoospermic and helpless infertile male. As we know, azoospermic condition caused by many aspects, including Infertility of known (possible) cause 42.6%, Idiopathic infertility 30.0%, Hypogonadism 10.1%, General/systemic disease 2.2%, Cryopreservation due to malignant disease 7.8%, Disturbance of erection/ejaculation 2.4%, Obstruction 2.2%, Gynecomastia 1.5%, Y-chromosomal deletion 0.3%, Other chromosomal aberrations 0.2%, and other 0.7%.

Idiopathic infertility, Cryopreservation due to malignant, Y-chromosome deletion, and Sertoli cells only phenomenon make more impossible for infertile couples to achive even Intracytoplasmic sperm injection (ICSI). The absence of spermatozoa, is the main role key that blocks the possibilities.

Sperm Made from Bone Marrow Stem Cells

Stem cells are undifferentiated and naive cells that may turn into every single cell that consist our body. They used to be known as embryonic stem cells during our embriological development. During our adult stage, certainly we have adult stem cells, primarily located within our bone marrow, where they constitutes all of our cellular component of blood. Those naive stem cells may induced and directed to differentiate into the specified human body cell. Previous researches and studies indicated that it may build up some organ such as liver, heart, and pancreas.

Designed by Professor Karim Nayernia, a professor of Cell Biology, Stem Cells from Newcastle Unversity Institute of Human Genetics, Newcastle, England, those stem cells are induced and directed to change into spermatogonia cells that may help male with Sertoly-cells-only syndrome.This research is mice-based research, and to be continued into human based research as soon as possible.

Mechanism

1) Stem cells isolated from bone marrow of male volunteers. 2) In laboratory, stem cells cultured and identified. Some induced to become spermatological cells – which normally become sperm cells. 3) Transplantation of cells into testicle – so far performed in mice

Discussion
Prof Nayernia and his team took bone marrow from male volunteers and isolated the mesenchymal stem cells. These cells have previously been found to grow into other body tissues such as muscle. But the researchers induced a small number of them to develop into what appeared to be spermatagonial cells – cells found in the testes which would normally develop into mature sperm cells.”Our next goal is to see if we can get the spermatagonial stem cells to progress to mature sperm in the laboratory and this should take around three to five years of experiments,” Professor Nayernia said.

The researchers say that they have already created spermatogonial cells from bone marrow tissue taken from men, which may make it possible for scientists one day soon to restore fertility for men who are unable to produce sperm naturally. Having succeeded in the procedure using male bone marrow, the researchers are seeking ethical permission to attempt to create synthetic sperm cells from a woman’s bone marrow tissue.

“Theoretically it is possible,” said Nayernia. “The problem is whether the sperm cells are functional or not. I don’t think there is an ethical barrier, so long as it’s safe. We are in the process of applying for ethical approval. We are preparing now to apply to use the existing bone marrow stem cell bank here in Newcastle. We need permission from the patient who supplied the bone marrow, the ethics committee and the hospital itself.”

Conclusion

If this method works, and the sperms not only able to be created but also effective and able to behave like the spermatozoa themselves, it’s totally a relief for azoospermic males. Although certainly need more confirmation from ethical aspects and also genetics if then later find some abnormalities related this sperm.

References:

• BBC News Human Sperm Made form Bone Marrow, Friday, 13 April 2007, cited July 9th 2011, 18.30
• Percentage distribution of diagnoses of 12,945 patients attending the Institute of Reproductive Medicine of the University of Münster, Cited from Andrology Male Reproductive Health and Dysfunction 3rd Edition, Susan Nieschlag, © Springer-Verlag Berlin Heidelberg 2010

H. pylori is considered to be the pathogen responsible for chronic antral gastritis rather than a commensal organism that colonizes injured gastric mucosa because (1) gastritis develops in healthy persons after ingesting the organism, (2) H. pylori attaches to the epithelium in areas of chronic gastritis and is absent from uninvolved areas of the gastric mucosa, (3) eradicating the infection with bismuth or antibiotics cures the gastritis, (4) antibodies against H. pylori are routinely found in persons with chronic gastritis, and (5) the increasing prevalence of H. pylori infection with age parallels that of chronic gastritis. Chronic infection with H. pylori also predisposes to the development of mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach and is associated with adenocarcinoma of the stomach.

As specified above, H. pylori is implicated in the production of gastric and, more particularly, duodenal ulcers and is a risk factor for gastric cancer. Combination therapy with three drugs is employed to eradicate H. pylori, usually omeprazole, amoxicillin and metronidazole. Other combinations used are omeprazole, clarythromycin, and amoxicillin or tetracycline, metronidazole and bismuth chelates.

refferences:

Gastritis with Helicobacter pylori treatment. Pharmacology Rang et al, 5th Edition

H.pylorii associated Gastritis. Pathological aspects. Rubin’s Pathology 8th Edition

Maturation Index/Indeks Maturasi

Shift to the left MI mengindikasikan lebih banyak sel immatur pada permukaan (atrofi), shift to the right menandakan sel epitel yang lebih matur.

Diurutkan dari % sel parabasal, % sel intermediate dan % sel superficial. Sel parabasal adalah sel yang belum matur, belum dipengaruhi oleh Estrogen dan Progesterone. Sel intermediate merupakan sel yang mild mature, dipengaruhi oleh Progesterone. Sel superficial merupakan sel yang paling matur dan dipengaruhi oleh Estrogen.

Indeks Maturasi

MI=% Parabasal Cells/% Intermediate Cells/% Superficial Cells

*This is an example only; actual patients will show marked variability depending on history.

Hari 14 – Ovulation MI = 0:40:60 mengindikasikan kebanyakan stimulasi Estrogen

Hari 28 – Premenstrual MI = 0:70:30 mengindikasikan kebanyakan stimulasi Progesterone.

Menopausal MI = 0:100:0 hanya Progesterone tanpa Estrogen. 

Atrophic MI = 100:0:0 tanpa Progesterone maupun Estrogen.

Child MI = 100:0:0 tanpa Progesterone maupun Estrogen.

Puberty MI = 0:90:10 Kebanyakan stimulasi Progesterone, minimal stimulai Estrogen.

Pregnancy MI = 0:100:0 Hanya Progesterone tanpa Estrogen

Post Partum MI = 90:10:0 Stimulasi hormone paling minimal. Fungsi Ovarium kembali dalam 6-8 minggu.

Fakta-fakta terbaru

• Infeksi akibat resistensi organisme terhadap obat menyebabkan kegagalan pada pengobatan, berakibat pada prolonged illness dan risiko kematian yang lebih berbahaya.
• Sekitar 440 000 kasus baru akibat multidrug-resistant tuberculosis (MDR-TB) menyebabkan  150 000 kematian pasien.
• —Resistensi ke generasi terbaru antimalaria seperti chloroquine dan sulfadoxine-pyrimethamine meluas ke malaria-endemic countries.
• Prosentase hospital-acquired infections disebabkan oleh methicillin-resistant Staphylococcus aureus (MRSA)
• Penggunaan antibiotik yang Inappropriate dan irrational menyediakan kondisi yang “pas” untuk mikroorganisme resisten makin muncul, menyebar dan bertahan.

—Apa itu MMR?
—Antimicrobial resistance (AMR) merupakan resistensi organisme patogen, terhadap antibiotik yang sebelumnya bisa membunuh organisme tersebut. Resistant organisme misalnya  (bakteria, virus dan parasit) bisa bertahan terhadap antimikroba seperti antibiotik, antivirus, dan antimalaria, jadi pengobatan standar menjadi tidak efektif dan infeksi yang bertahan, yang dapat pula menyebar. AMR merupakan konsekuensi dr penyalahgunaan antimikrobial, menyebabkan mikroorganisme bermutasi/memperoleh gen resistensi.
Mengapa menjadi masalah global??

• —AMR mengurangi efektivitas pengobatan, pasien tetap terinfeksi, berpotensi menular.
• AMR menyebabkan infectious diseases menjadi tak terkendali, menggagalkan program UN, Millenium Dev Goal 2015.
• Saat infeksi resisten pada first-line medicine, maka terapi jadi semakin mahal, financial burden to families and societies.
• Tanpa antimikrobial efektif, kesuksesan treatments seperti organ transplantation, kemoterapi kanker, dan operasi besar diragukan (berujung pada infeksi)
• Perdagangan dan traveling bebas mengancam makin maraknya penyebaran mikroba resisten ke mancanegara dan semua benua

Pembahasan

• Resistance menjadi concerns untuk treatment of HIV infection
• Ciprofloxacin, untuk pengobatan shigellosis, resisten pada anak-anak. New antibiotics sangat diperlukan.
• Untreatable gonococcal (GO) infections meningkatkan kejadian penyakit dan kematian
• Mekanisme resistance baru, seperti beta-lactamase, muncul pada bbrp gram-negative bacilli.

—Penggunaan yang tidak tepat dan irasional:

• Pengobatan secara asal-asalan
• Penggunaan tidak sesuai dosis, bakteri yang baru dilemahkan, sempat melakukan mutasi, dan mensintesis enzim penghancur cincin B-lactam antibiotik, berhasil mencegah pelemahan/pembunuhan
• Beberapa parasit memiliki kecerdasan immunological escape, bermutasi, sehingga bebas dari antiparasitik

Pencegahan

• Pencegahan terhadap penyakit infeksi (infection control)
• Penggunaan antibiotik dengan penuh pertimbangan dan sesuai takaran dan dosis tepat (Rational Drug Use)
• Mencegah spread dengan menjaga kebersihan/mencegah infeksi (Hygiene control)

Message:
“WHO has selected combating antimicrobial resistance as the theme for World Health Day 2011. On this day, WHO issues an international call for concerted action to halt the spread of antimicrobial resistance and recommends a six-point policy package for governments.”
—
referensi:
Antimicrobial Resistance WHO Perspective. World Health Day Theme. April 7th 2011. WHO-UN

Some stories come from family with bipolar-disorder-member within. They at first confused due to their bipolar-disorder-member, ”they’re truly different. Sometimes they seem so passionate and happy, while suddenly they become very sensitive, and irritable that they may not being insulted at all”. Some families ever told the tendency to hurt themselves up to self-suicide of people with bipolar disorder. They has a very negative mindset and sometimes feel unworthy about themselves, although people judge them as a ”magnificent” person.

There’s still no main cause of bipolar disorder, although the genetically inherited is suspected as the main cause. Genetic studies have suggested many chromosomal regions and candidate genes appearing to relate to the development of bipolar disorder, but the results are not consistent and often not replicated. Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar. A general reduction of brain volume and anatomically specific differences in areas such as the prefrontal cortex and the globus pallidus are most commonly found. If there’s one member with bipolar disorder in a family, then it’s important to be aware when there are emotion, psychological and acts change, uncontrollably, and abnormally for other members.

Another research found the imbalance of the neurotransmitter also included in bipolar disorder. American Journal of Psychiatry reported bipolar patient has 30% more neurons than normal person. This research assumed the neurons send more signals, causing simulations that represented into bipolar disorder.

Dopamine, serotonine and norepinephrine are three main neurotransmitters in brain that take responsibility of mood, emotion, and the response of body for stimulation, doing cognitive function and soon. Jon Zubieta MD, from University of Michigan stated that the bipolar patient has the neurons that produce the neurotransmitters actively, even when the patient takes a rest.

Pharmacology therapy is absolutely needed with certain dosage to stabilize the patients condition. Generally thee antidepressant medicine stabilize their emotion and neurotransmitter in the brain. Usually, after get medication from psychiatrist, they can get control their mood.

The other way to solve the bipolar disorder mood with stress management, by mindset guidance. Once they get many problems, they have to solve it one by one. Bipolar patient can get inspiration about how to live better from movies and others experience sharing.

Some therapies can be done to control their emotion, behavior:

• Cognition therapy: patient guided to develop their correct mindset
• Act Therapy: patient trained to control their impulsive actions
• Psychoanalyst Therapy: patient trained to manage their buried past conflict and emotion
• Group therapy: patient trained to interact socially
• Family therapy: train patient and family to together solve the conflict within them, train family to be more supportive.

The main thing is the people around patient with bipolar disorder have to understand and always give support them by not make them easily get impulsive emotion appear. The bipolar patient is only need to be understood and supported to control their mood and mindset.

The first disorder appears in 15 years old, then explodes in 18 years old, but can be medically managed in 22 years old.

Mania symptoms:

• Euphoria for quite long time
• Talks fast, jumps from one to another idea
• Easily mind disturbed
• Do many activities to reach something
• Insomnia
• Sleep just in time
• Has a belief of unreal ability
• Doing many risky things, like impulsive pressure to shop, invest and sex

Depressive Symptoms:

• Feel worried and empty
• Loss attraction to things they used to like
• Feel tired all the time
• Difficult to take rest and relaxation
• Easily get upset
• Too sensitive in some way
• Think of death even self-suicide tendency

Veronica Sri Utami (February 2011). Bipolar Disorder a Mood Change in a Second. Nirmala Magazine. 85-87

Kato T (February 2007). “Molecular genetics of bipolar disorder and depression”. Psychiatry and Clinical Neurosciences 61 (1): 3–19.

Arnone D, Cavanagh J, Gerber D, Lawrie SM, Ebmeier KP, McIntosh AM (September 2009). “Magnetic resonance imaging studies in bipolar disorder and schizophrenia: meta-analysis”. Br J Psychiatry 195 (3): 194–201.