HEALTH FOR RICH

Determining the time of death

2009-04-07T03:17:00.011+07:00

Determining the time of death
There are several ways to determine death time of the murder cases. Please note that while the death of the victim is arround between when the victim last seen alive in the circumstances and when the victim found dead

Marks that can be used to estimate time of death are:
- Post-mortem temperature decrease
- Livid corpse (livor mortis)
- Stiff corpse (rigor mortis)
- The process of decomposition
- Something which found during the examination in time and place of occurrence otopsi.

decomposted body

Which can be found in the examination at the scene of an accident:
a. Investigation at the scene of an accident:
- The date on the letter mail or newspapers
- The rest of the food that is found, is still good or have become.
- Degree of coagulation milk in bottle
- The state of parasites in the body of the victim, for example, head lice:
- Head lice can live on dead bodies 3-6 days, when all lice have been dead more than 6 hours
b. Investigation in outdoor
- If the plant / grass under the pale corpse appears, it means that there remains in place more than 8 hours.

What can be found at otopsi?
a. Larva fly
To estimate the time of death by determining the age flyblow in the cycle.
Condition: there can be no flyblow cocoon and fly the most.
Death time= Age at death flyblow (days) + 1 day
b. the process of food digestion in the stomach
If found stomach is not contain food, rectum full of faeces and the bladder is full, time of the victim died early in the morning and not wake up. If the stomach contains food found roughly means the victim died within 2-4 hours after last meal.
c. Hair and beard
Hair on the speed of life has grown 0.5 mm / day, and after death, it does not grow again. Beard hair examination should be done in the first 24 hours for more than 24 hours of hair and skin furrow can show more skin on the chin, so if the hair is still growing.

otopsi of woman body

There is case that should be solved by four detectives. Detective Sherlock Holmes, Poirot, Kindaichi and Conan Edogawa. On 28 January 2009 at 07.00 am, the male dead body found recumbent position. Livid corpses in the back, stiff joints all the dead body, and decaying. When was the victim die?

answer: victim was murdered, between 27/1/2009 at 1.00 pm until 28/1/2003 at 1.00 am.

Carcinoma Thyroid

2009-04-04T17:38:00.009+07:00

patient carcinoma thyroid

Carcinoma Thyroid is including the violence with relatively good prognosis. Although it has been agreed that thyroidectomy is the first step must be done in carcinoma thyroid treatment, at this time there is no agreement how best form of treatment of Carcinoma Thyroid suspected malignant goitre.

Histology
According to the WHO thyroid epitel malignant divided to be:
1. follicular carcinoma
2. papillary carcinoma
3. medullar carcinoma
4. anaplastic

papillar carcinoma thyroid

Clinic
Clinical suspicion of thyroid carcinoma based on the observation that pathologies confirmed with the examination, the suspicion is divided in high, medium and low.
A. High
- Historical multiple endocrine neoplasm in family
- Rapid growth of neoplasm cell
- Hard nodule when palpated
- The area around the fixation
- Paralysis vocal cords
- enlarging lymphanody regional
- The remote metastasis
B. Medium
- Age less than 20 years old or over 60 years
- History neck radiation
- Male with solitary nodule
- Diameter greater than 4 cm and cystic
C. Low
- In addition to the above mentioned

There are Clinical symptoms frequently found
- The emphasis of organ
- Interference and pain swallow
- Difficult to breathe
- Hoarse voice
- Limphadenopathy neck

Metastasis which is most often in the lungs, bones and heart.

thyroid carcinoma prognosis depends on:
- Type of carcinoma
- metastasis or not
- Age
- Sex (number of women have a better life)
- Genecology DNA tumour

how to diagnostic

Thyroidectomy

Handling
A. Operation
- total Thyroidectomy (recommended)
- partial Thyroidectomy / nodulektomy / lubektomy
B. radiation
1. external
- for carcinoma thyroid residues with large and may not be operating
- Using cobalt-60
2. Internal
- using radioactive iodine
C. Chemotherapy
- for anaplastic carcinoma
- Using adriamisin single dose or combination with cyspaltinum
D. Hormonal
- To press the TSH allegedly had a role in stimulating proliferation of growth cells malignant

Typhoid Fever (TIPES)

2009-03-30T01:24:00.004+07:00

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

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.

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.

Gi tract signs

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

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

treatment and therapy for typhoid

bed rest, 3 weeks minimum
antibiotic. Cefotaxim, chloramphenicol, erytromicin. The drug of choice is Chloramphenicol. For women who is get menorrhea, used erytromycin.
Healthy carriers should be excluded from handling food.
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.

ALL (Acute Lymphoma Leukemia)

2009-03-28T22:09:00.004+07:00

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:

The size and number of Lekemia cells
the type of lymphocyte, B cells or T celss
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:

early pre-B ALL
common ALL
Pre-B-cell
Mature B-cell ALL (Burkit Leukemia)
Pre-T-cell ALL
Mature T-cell ALL

Signs and symptoms ALL

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

aches in arms, leg, back
Black and blue marks for no apparent reason
enlarged lymph nodes
headaches
pale-looking skin
prolong bleeding
vomiting
dyspneu

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

coughing
sore throat
pain when urinating
frequent loose bowel movements

Therapy

transfusions of packed red cell to increase erythrocyte
platelets transfusions
antibiotic
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

CML (Chronic Myelocytic Leukemia/ Chronic Granulocytic Leukemia

2009-03-28T07:55:00.006+07:00

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:

The Chronic desease
The accelerated phase
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?

tired and weakness
fever
easy bleeding
frequent infections
Losing weight without trying
spleenomegaly
pain
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:

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

there are six types of standard treatment are used:

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.
Chemotherapy: using drugs to stop the growth of cancer celll
Biologic therapy is e treatment that uses the patient’s immune system to fidght cancer
Stem cell transplant: used during blast crisis
DLI (Donor lymphocyte Infusion)
Splenectomy: surgery to remove spleen

What are risk factors of CML

Very high level radiation
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

AML (Acute Myelogenous Leukemia/Acute Myelocytic Leukemia)

2009-03-23T15:13:00.006+07:00

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.

Induction chemotherapy (intensive until recover)

- cytarabine

- daunomycin and idamycin

- all trans retinoic acid for subtype acute promyelocytic leukemia

Consolidation to kill remaining leukemia cell
Organ Transplantation

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

reference: www.marrow.org

Leukemia

2009-03-21T18:14:00.003+07:00

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:

Acute Myelogenous Leukemia
Acute Lymphocytic Leukemia
Chronic Myelogenous Leukemia
Chronic Lymphocytic Leukemia

Leukemia is the general term used to describe four grades.

grade 1: local not invasive
grade 2: local invasive
grade 3: invasive and organ disorder function
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?

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

Chronic

- less symptom and sign

- sometimes found splenomegaly

Diagnosis

Anamnesis
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?

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!!!!!!

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.
Sometime treatment in adult same with children, caused their condition.
Traditional therapy can used. Attention!!!! Don't try if it has not been researched by scientist
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

Diabetes Mellitus

2009-02-13T02:14:00.001+07:00

Ten years ago, my aunty passed away. She was death caused by “kencing manis”. So what is Kencing Manis? How can it make mortality?

Kencing manis is Indonesian name of Diabetes Mellitus. Diabetes is a syndrome of disordered metabolism that leads to an increased concentration of glucose in the blood (hyperglycaemia). That’s caused the pancreas doesn’t produce enough insulin, or produces insulin with normal quantity but low quality, or when the body cannot effectively use the insulin it produces.

Blood glucose levels are controlled by a complex interaction of multiple chemicals and hormones in the body, including the hormone insulin made in the beta cells of the Pancreas. Diabetes mellitus refers to the group of diseases that lead to high blood glucose levels due to defects in either insulin secretion or insulin action.

There are two major types of diabetes, called type 1 and type 2.

Type 1:

- Insulin Dependent Diabetes Mellitus (IDDM).

- Juvenile onset diabetes mellitus (JODM)

- Characterized by a lack of insulin production.

- The pancreas undergoes an autoimmune attack by the body itself, and is rendered incapable of making insulin.

- Abnormal antibodies have been found in the majority of patients with type 1 diabetes. Antibodies are proteins in the blood that are part of the body’s immune system.

- Must rely on insulin medication for survival.

Type 2:

- Non-insulin dependent diabetes mellitus (NIDDM)

- Adult onset diabetes mellitus (AODM).

- Pancreas still produces insulin, but do so relatively inadequately for their body's needs.

- Pancreas produces larger than normal quantities of insulin but low quality.

- Lack of sensitivity to insulin by the cells of the body (particularly fat and muscle cells).

Gestational Diabetes: - occur temporarily during pregnancy

What are diabetes symptoms? Nice question that should we know the answer. The answers are:

Thirst which increases fluid intake. It makes nocturnal uri (5 or more mictie in the night).

Blurred vision : caused by increasing blood glucose level in orbital vessel
Lethargy
Unexplained weight loss
Unhealing wound

What are complications?

a. Blindness: Blurred vision in early

b. Kidney failure

c. Leading to stroke

d. Septicaemia (can make patients died)

Diagnosis

a. Oral Glucose tolerance test

b. Impaired glucose tolerance

Therapy

Insulin injection for type 1
Oral drug for type 2
Life style
Corticosteroid and antibiotic for septicaemia complication

So what we can do to prevent diabetes? You just change your life style!