Antibiotika adalah segolongan senyawa, baik alami maupun sintetik, yang mempunyai efek menekan atau menghentikan suatu proses biokimia di dalam organisme, khususnya dalam proses infeksi oleh bakteri. Penggunaan antibiotika khususnya berkaitan dengan pengobatan penyakit infeksi, meskipun dalam bioteknologi dan rekayasa genetika juga digunakan sebagai alat seleksi terhadap mutan atau transforman. Antibiotika bekerja seperti pestisida dengan menekan atau memutus satu mata rantai metabolisme, hanya saja targetnya adalah bakteri. Antibiotika berbeda dengan desinfektan karena cara kerjanya. Desifektan membunuh kuman dengan menciptakan lingkungan yang tidak wajar bagi kuman untuk hidup.
Tidak seperti perawatan infeksi sebelumnya, yang menggunakan racun seperti strychnine, antibiotika dijuluki "peluru ajaib": obat yang membidik penyakit tanpa melukai tuannya. Antibiotik tidak efektif menangani infeksi akibat virus, jamur, atau nonbakteri lainnya, dan Setiap antibiotik sangat beragam keefektifannya dalam melawan berbagai jenis bakteri. Ada antibiotika yang membidik bakteri gram negatif atau gram positif, ada pula yang spektrumnya lebih luas. Keefektifannya juga bergantung pada lokasi infeksi dan kemampuan antibiotik mencapai lokasi tersebut.
Antibiotika oral (yang dimakan) mudah digunakan bila efektif, dan antibiotika intravena (melalui infus) digunakan untuk kasus yang lebih serius. Antibiotika kadangkala dapat digunakan setempat, seperti tetes mata dan salep.
Riwayat singkat penemuan antibiotika modern
Penemuan antibiotika terjadi secara 'tidak sengaja' ketika Alexander Fleming, pada tahun 1928, lupa membersihkan sediaan bakteri pada cawan petri dan meninggalkannya di rak cuci sepanjang akhir pekan. Pada hari Senin, ketika cawan petri tersebut akan dibersihkan, ia melihat sebagian kapang telah tumbuh di media dan bagian di sekitar kapang 'bersih' dari bakteri yang sebelumnya memenuhi media. Karena tertarik dengan kenyataan ini, ia melakukan penelitian lebih lanjut terhadap kapang tersebut, yang ternyata adalah Penicillium chrysogenum syn. P. notatum (kapang berwarna biru muda ini mudah ditemukan pada roti yang dibiarkan lembab beberapa hari). Ia lalu mendapat hasil positif dalam pengujian pengaruh ekstrak kapang itu terhadap bakteri koleksinya. Dari ekstrak itu ia diakui menemukan antibiotik alami pertama: penicillin G.
Penemuan efek antibakteri dari Penicillium sebelumnya sudah diketahui oleh peneliti-peneliti dari Institut Pasteur di Perancis pada akhir abad ke-19 namun hasilnya tidak diakui oleh lembaganya sendiri dan tidak dipublikasi.
Macam-macam antibiotika
Antibiotika dapat digolongkan berdasarkan sasaran kerja senyawa tersebut dan susunan kimiawinya. Ada enam kelompok antibiotika[1] dilihat dari target atau sasaran kerjanya(nama contoh diberikan menurut ejaan Inggris karena belum semua nama diindonesiakan atau diragukan pengindonesiaannya):
1. Inhibitor sintesis dinding sel bakteri, mencakup golongan Penicillin, Polypeptide 3. dan Cephalosporin, misalnya ampicillin, penicillin G;
2. Inhibitor transkripsi dan replikasi, mencakup golongan Quinolone, misalnya rifampicin, actinomycin D, nalidixic acid;
4. Inhibitor sintesis protein, mencakup banyak jenis antibiotik, terutama dari golongan Macrolide, Aminoglycoside, dan Tetracycline, misalnya gentamycin, chloramphenicol, kanamycin, streptomycin, tetracycline, oxytetracycline;
5. Inhibitor fungsi membran sel, misalnya ionomycin, valinomycin;
6. Inhibitor fungsi sel lainnya, seperti golongan sulfa atau sulfonamida, misalnya oligomycin, tunicamycin; dan
7. Antimetabolit, misalnya azaserine.
Senin, 20 April 2009
Parasetamol
Parasetamol atau asetaminofen adalah obat analgesik and antipiretik yang populer dan digunakan untuk melegakan sakit kepala, sengal-sengal dan sakit ringan, dan demam. Digunakan dalam sebagian besar resep obat analgesik salesma dan flu. Ia aman dalam dosis standar, tetapi karena mudah didapati, overdosis obat baik sengaja atau tidak sengaja sering terjadi.
Berbeda dengan obat analgesik yang lain seperti aspirin dan ibuprofen, parasetamol tak memiliki sifat antiradang. Jadi parasetamol tidak tergolong dalam obat jenis NSAID. Dalam dosis normal, parasetamol tidak menyakiti permukaan dalam perut atau mengganggu gumpalan darah, ginjal atau duktus arteriosus pada janin
Asal kata
Kata asetaminofen dan parasetamol berasal dari singkatan nama kimia bahan tersebut:
Versi Amerika N-asetil-para-aminofenol asetominofen
Versi Inggris para-asetil-amino-fenol parasetamol
Sejarah
Sebelum penemuan asetaminofen, kulit sinkona digunakan sebagai agen antipiretik, selain digunakan untuk menghasilkan obat antimalaria, kina.
Karena pohon sinkona semakin berkurang pada 1880-an, sumber alternatif mulai dicari. Terdapat dua agen antipiretik yang dibuat pada 1880-an; asetanilida pada 1886 dan fenasetin pada 1887. Pada masa ini, parasetamol telah disintesis oleh Harmon Northrop Morse melalui pengurangan p-nitrofenol bersama timah dalam asam asetat gletser. Biarpun proses ini telah dijumpai pada tahun 1873, paraetamol tidak digunakan dalam bidang pengobatan hingga dua dekade setelahnya. Pada 1893, parasetamol telah ditemui di dalam air kencing seseorang yang mengambil fenasetin, yang memekat kepada hablur campuran berwarna putih dan berasa pahit. Pada tahun 1899, parasetamol dijumpai sebagai metabolit asetanilida. Namun penemuan ini tidak dipedulikan pada saat itu.
Pada 1946, Lembaga Studi Analgesik dan Obat-obatan Sedatif telah memberi bantuan kepada Departemen Kesehatan New York untuk mengkaji masalah yang berkaitan dengan agen analgesik. Bernard Brodie dan Julius Axelrod telah ditugaskan untuk mengkaji mengapa agen bukan aspirin dikaitkan dengan adanya methemoglobinemia, sejenis keadaan darah tidak berbahaya. Di dalam tulisan mereka pada 1948, Brodie dan Axelrod mengaitkan penggunaan asetanilida dengan methemoglobinemia dan mendapati pengaruh analgesik asetanilida adalah disebabkan metabolit parasetamol aktif. Mereka membela penggunaan parasetamol karena memandang bahan kimia ini tidak menghasilkan racun asetanilida.
Berbeda dengan obat analgesik yang lain seperti aspirin dan ibuprofen, parasetamol tak memiliki sifat antiradang. Jadi parasetamol tidak tergolong dalam obat jenis NSAID. Dalam dosis normal, parasetamol tidak menyakiti permukaan dalam perut atau mengganggu gumpalan darah, ginjal atau duktus arteriosus pada janin
Asal kata
Kata asetaminofen dan parasetamol berasal dari singkatan nama kimia bahan tersebut:
Versi Amerika N-asetil-para-aminofenol asetominofen
Versi Inggris para-asetil-amino-fenol parasetamol
Sejarah
Sebelum penemuan asetaminofen, kulit sinkona digunakan sebagai agen antipiretik, selain digunakan untuk menghasilkan obat antimalaria, kina.
Karena pohon sinkona semakin berkurang pada 1880-an, sumber alternatif mulai dicari. Terdapat dua agen antipiretik yang dibuat pada 1880-an; asetanilida pada 1886 dan fenasetin pada 1887. Pada masa ini, parasetamol telah disintesis oleh Harmon Northrop Morse melalui pengurangan p-nitrofenol bersama timah dalam asam asetat gletser. Biarpun proses ini telah dijumpai pada tahun 1873, paraetamol tidak digunakan dalam bidang pengobatan hingga dua dekade setelahnya. Pada 1893, parasetamol telah ditemui di dalam air kencing seseorang yang mengambil fenasetin, yang memekat kepada hablur campuran berwarna putih dan berasa pahit. Pada tahun 1899, parasetamol dijumpai sebagai metabolit asetanilida. Namun penemuan ini tidak dipedulikan pada saat itu.
Pada 1946, Lembaga Studi Analgesik dan Obat-obatan Sedatif telah memberi bantuan kepada Departemen Kesehatan New York untuk mengkaji masalah yang berkaitan dengan agen analgesik. Bernard Brodie dan Julius Axelrod telah ditugaskan untuk mengkaji mengapa agen bukan aspirin dikaitkan dengan adanya methemoglobinemia, sejenis keadaan darah tidak berbahaya. Di dalam tulisan mereka pada 1948, Brodie dan Axelrod mengaitkan penggunaan asetanilida dengan methemoglobinemia dan mendapati pengaruh analgesik asetanilida adalah disebabkan metabolit parasetamol aktif. Mereka membela penggunaan parasetamol karena memandang bahan kimia ini tidak menghasilkan racun asetanilida.
Universitas Islam Indonesia
Universitas Islam Indonesia adalah sebuah perguruan tinggi swasta yang terdapat di Kota Yogyakarta, Daerah Istimewa Yogyakarta, Indonesia.
Sejarah
Universitas Islam Indonesia didirikan pada tanggal 27 Rajab 1364 H atau bertepatan dengan 8 Juli 1945 (40 hari sebelum Proklamasi Kemerdekaan Indonesia), dengan nama Sekolah Tinggi Islam (STI) di Jakarta. STI adalah cita-cita luhur tokoh-tokoh nasional Indonesia yang melihat kenyataan bahwa ketika itu pendidikan tinggi yang ada adalah milik Belanda (Technische Hoogeschool atau Institut Teknologi Bandung kini, Recht Hoogeschool di Jakarta dan Sekolah Tinggi Pertanian di Bogor (Institut Pertanian Bogor sekarang). STI lahir untuk menjadi bukti adanya kesadaran berpendidikan pada masyarakat pribumi.
Dibidani oleh tokoh-tokoh nasional seperti Dr. Mohammad Hatta (Proklamator dan mantan Wakil Presiden RI), Moh. Natsir, Prof. KHA. Muzakkir, Mohamad Roem, KH. Wahid Hasjim, dll, menjadikan STI sebagai basis pengembangan pendidikan yang bercorak nasional dan Islamis serta menjadi tumpuan harapan seluruh anak bangsa.
Seiring hijrahnya ibukota Republik Indonesia ke Yogyakarta, maka STI pun hijrah dan diresmikan kembali oleh Presiden Soekarno pada tanggal 27 Rajab 1365 H atau bertepatan dengan tanggal 10 April 1946 bertempat di Dalem Pangulon Yogyakarta. Untuk peningkatan peran dalam perjuangan, maka STI yang kala itu menjadi satu-satunya perguruan tinggi Islam, diubah menjadi universitas dengan nama University Islam Indonesia atau sekarang Universitas Islam Indonesia (Islamic University of Indonesia, Al Jamiah Islamiyah Al Indonesiyah) pada tahun 1947.
Realisasi perubahan STI menjadi UII didahului pembukaan kelas pendahuluan (semacam pra universitas) yang diresmikan pada bulan Maret 1948 di Pendopo nDalem Purbojo, Ngasem Yogyakarta. Sedangkan pembukaan UII (menggantikan STI) secara resmi diselenggarakan pada tanggal 27 Rajab 1367 H (bertepatan dengan tanggal 4 Juni 1948) bertempat di nDalem Kepatihan Yogyakarta dan mendapat kunjungan dari para menteri serta pejabat sipil dan militer lainnya.
Dengan demikian, pada tanggal 27 Rajab (4 Juni 1948) hadirlah University Islam Indonesia yang merupakan wajah baru STI dan telah resmi beroperasi sejak tiga tahun sebelumnya di Negara Republik Indonesia. Pada saat diresmikan UII membuka empat Fakultas, yaitu: Fakultas Ekonomi, Fakultas Hukum, Fakultas Pendidikan, dan Fakultas Agama.
UII sebagai universitas swasta tertua di Indonesia, kemudian berkembang sangat pesat dengan lebih 22 fakultas cabang, tersebar diseluruh Indonesia (Surakarta, Madiun, Purwokerto, Gorontalo, Bangil, Cirebon dan Klaten) dengan pusatnya di Yogyakarta.
Namun seiring dengan kebijaksanaan pemerintah bahwa cabang universitas harus ditiadakan, maka cabang-cabang ini kemudian tumbuh sebagai perguruan tinggi baru (baik negeri ataupun swasta) atau tergabung dengan perguruan tinggi negeri yang telah ada. Jadi secara tidak langsung UII mendorong tumbuh dan berkembangnya perguruan-perguruan tinggi di berbagai kota di Indonesia dan UII secara nyata menjadi bagian dari sejarah pendidikan nasional itu sendiri.
Satu misi sederhana dalam kata namun berat, sangat berat, bahkan dalam kenyataannya yang teremban dalam perjalanan sejarah ini adalah mewujudkan kata-kata Bung Hatta dalam pidato peresmian UII kala itu: "Di Sekolah Tinggi Islam ini akan bertemu agama (religion) dengan ilmu (science) dalam kerjasama yang baik untuk membantu peningkatan kesejahteraan masyarakat.
Sejarah
Universitas Islam Indonesia didirikan pada tanggal 27 Rajab 1364 H atau bertepatan dengan 8 Juli 1945 (40 hari sebelum Proklamasi Kemerdekaan Indonesia), dengan nama Sekolah Tinggi Islam (STI) di Jakarta. STI adalah cita-cita luhur tokoh-tokoh nasional Indonesia yang melihat kenyataan bahwa ketika itu pendidikan tinggi yang ada adalah milik Belanda (Technische Hoogeschool atau Institut Teknologi Bandung kini, Recht Hoogeschool di Jakarta dan Sekolah Tinggi Pertanian di Bogor (Institut Pertanian Bogor sekarang). STI lahir untuk menjadi bukti adanya kesadaran berpendidikan pada masyarakat pribumi.
Dibidani oleh tokoh-tokoh nasional seperti Dr. Mohammad Hatta (Proklamator dan mantan Wakil Presiden RI), Moh. Natsir, Prof. KHA. Muzakkir, Mohamad Roem, KH. Wahid Hasjim, dll, menjadikan STI sebagai basis pengembangan pendidikan yang bercorak nasional dan Islamis serta menjadi tumpuan harapan seluruh anak bangsa.
Seiring hijrahnya ibukota Republik Indonesia ke Yogyakarta, maka STI pun hijrah dan diresmikan kembali oleh Presiden Soekarno pada tanggal 27 Rajab 1365 H atau bertepatan dengan tanggal 10 April 1946 bertempat di Dalem Pangulon Yogyakarta. Untuk peningkatan peran dalam perjuangan, maka STI yang kala itu menjadi satu-satunya perguruan tinggi Islam, diubah menjadi universitas dengan nama University Islam Indonesia atau sekarang Universitas Islam Indonesia (Islamic University of Indonesia, Al Jamiah Islamiyah Al Indonesiyah) pada tahun 1947.
Realisasi perubahan STI menjadi UII didahului pembukaan kelas pendahuluan (semacam pra universitas) yang diresmikan pada bulan Maret 1948 di Pendopo nDalem Purbojo, Ngasem Yogyakarta. Sedangkan pembukaan UII (menggantikan STI) secara resmi diselenggarakan pada tanggal 27 Rajab 1367 H (bertepatan dengan tanggal 4 Juni 1948) bertempat di nDalem Kepatihan Yogyakarta dan mendapat kunjungan dari para menteri serta pejabat sipil dan militer lainnya.
Dengan demikian, pada tanggal 27 Rajab (4 Juni 1948) hadirlah University Islam Indonesia yang merupakan wajah baru STI dan telah resmi beroperasi sejak tiga tahun sebelumnya di Negara Republik Indonesia. Pada saat diresmikan UII membuka empat Fakultas, yaitu: Fakultas Ekonomi, Fakultas Hukum, Fakultas Pendidikan, dan Fakultas Agama.
UII sebagai universitas swasta tertua di Indonesia, kemudian berkembang sangat pesat dengan lebih 22 fakultas cabang, tersebar diseluruh Indonesia (Surakarta, Madiun, Purwokerto, Gorontalo, Bangil, Cirebon dan Klaten) dengan pusatnya di Yogyakarta.
Namun seiring dengan kebijaksanaan pemerintah bahwa cabang universitas harus ditiadakan, maka cabang-cabang ini kemudian tumbuh sebagai perguruan tinggi baru (baik negeri ataupun swasta) atau tergabung dengan perguruan tinggi negeri yang telah ada. Jadi secara tidak langsung UII mendorong tumbuh dan berkembangnya perguruan-perguruan tinggi di berbagai kota di Indonesia dan UII secara nyata menjadi bagian dari sejarah pendidikan nasional itu sendiri.
Satu misi sederhana dalam kata namun berat, sangat berat, bahkan dalam kenyataannya yang teremban dalam perjalanan sejarah ini adalah mewujudkan kata-kata Bung Hatta dalam pidato peresmian UII kala itu: "Di Sekolah Tinggi Islam ini akan bertemu agama (religion) dengan ilmu (science) dalam kerjasama yang baik untuk membantu peningkatan kesejahteraan masyarakat.
Selasa, 16 Desember 2008
DISORDERS OF MENSTRUATION
The first menstrual period usually occurs around 12 years of age but the range is between 9 and 16 years. The interval between normal menstrual cycles typically varies from 25 to 34 days. Cycles shorter than 3 weeks or longer than 40 days may indicate some abnormality in ovulation. The length of flow on the average is 5 + or – 2 days. A normal menstrual cycle correlates very highly with ovulation.
PRECOCIOUS PUBERTY
The appearance of sexual development before 8 years of age characterizes precocious
puberty (PP). Seventy to 80 percent of the cases of PP are due to an early “awakening” of the hypothalamic-pituitary axis – idiopathic PP. Any secondary sex characteristic appearing before the age of 8 years warrant a clinical evaluation that involves trying to exclude serious disease such as neoplasms of the brain, adrenal, or ovary, or some disorder of the thyroid. Besides the obvious body changes, PP also contributes to major phychosocial issues. The parents are often very distressed, and the child may experience problems relating to peers. If ovulation is present, no other studies need to be done. Ovulation does not occur
during any pathological or disease states associated wit precocious puberty. If the
problem is idiopathic, Gn-RH analog therapy is used for the curtailment of physical and behavioral symptoms.
PRIMARY AMENORRHEA
The absence of breast budding by age 14 and no menses by age 16, primary amenorrhea
(PA), constitutes reason for concern. Primary amenorrhea may be due to delayed
physiological menarche. Other possible reasons include a genetic cause impacting
ovarian or gonadal function, a congenital anomaly involving the vagina and/or uterus, or a central problem influencing hypothalamic function and Gn-RH pulsatile secretion. A clinical evaluation should be directed to different compartments: the utero-vaginal tract, ovary, pituitary, CNS-hypothalamus, and other systemic problems.
Congenital abnormalities associated with primary amenorrhea can be as minor as an
imperforate hymen or as major as the complete absence of the uterus and vagina. The
diagnosis of anatomic defects is readily evident on performing a careful physical exam.
A lack of sensitivity of androgen receptors, more commonly known as “testicular
feminization syndrome”, should be included in this category. These patients have 46XY
karyotype. These patients’ gonads should be removed because of the increase risk of
neoplasia. Other causes of anatomical abnormalities include Turner’s syndrome,45,XO;46XX and 46XY(Swyer’s syndrome). These abnormalities are associated with elevated FSH. Pituitary causes of primary amenorrhea are uncommon. Any patient with primary
amenorrhea should have a serum prolactin, elevation of which would indicate a tumor.
Kallmann’s syndrome is a Gn-RH deficiency associated with the inability to smell,
absence of secondary sexual characteristics and a low FSH level. Many psychosocial issues need to be addressed with these patients. Extensive counseling will be required.
SECONDARY AMENORRHEA
After a previously menstruating individual misses three consecutive periods or 6 months pass without a period, she had met the definition of secondary amenorrhea. When pregnancy has been excluded, clinical evaluation should be directed to different
compartments. CNS-hypothalamus, pituitary, ovary and the uterovaginal tract. The most
common problem resulting in secondary amenorrhea is hypothalamic dysfunction and
includes weight-change-related disorders, severe psychological stress, and exerciseinduced problems. Pituitary causes include neoplasms; the most common being a tumor that either directly or indirectly results in hyperprolactinemia. Premature ovarian failure, the cessation of periods before age 40, is another important cause, and is characterized by an elevated serum FSH of > 40mIU/ml. Intrauterine scarring can be sufficiently extensive to result in amenorrhea. These patients have usually had curettage after pregnancy or severe endometritis.
Anenorrhea associated with dramatic or sudden significant changes in weight (plus or
minus 15% from ideal body weigh) is often associated with hypothalamic amenorrhea.
Anorexia nervosa is the most extreme form of weight loss associated with amenorrhea.
At the other end of the spectrum is pseudocyesis, a strong desire for pregnancy, with mild to moderate weight gain.
A very common cause of secondary amenorrhea is polycystic ovarian syndrome (PCOS).
This is a hyperestrogenic and hyperandrogenic syndrome associated with anovulation.
The three cardinal symptoms of PCOS are menstrual disorders (aenorrhea,
oligomenorrhea, or dysfunctional uterine bleeding), which are present in about 90 % of the cases; hirsutism, which occurs in about 70% of the cases; and infertility, which is the presenting symptom in 75% of patients. The diagnosis is made by clinical features and by the presence of an elevated serum LH.
Another cause of amenorrhea or oligomenorrhea is congenital adrenal hyperplasia. It is a common genetic disorder. It is an enzyme failure in the production of cortisol. It results in increased ACTH, which results in increased androgens, causing hirsutism and oligomenorrhea.
PREMENSTRUAL SYNDROME
Symptoms associated with the menstrual cycle are common. When the number and
severity of the symptoms increase to the point where they interfere with daily existence, this is considered premenstrual syndrome (PMS). Predominant somatic symptoms can include the feeling of bloatedness, breast pain, headache, pelvic pain, and alterations in bowel function. The major psychological symptoms can include mood alterations such as irritability, aggressive tendencies, anxiety, depression, extreme lethargy, sleep disorders, crying spells, diminished libido, and loss of concentration. The incidence of PMS is reported to be between 5 and 95 %. Two to 3% of women have a severe form. There is no known cause for PMS. Patients should be encouraged to obtain a more healthy diet and to include a moderate amount of exercise. A multiple-feeding, highprotein diet and the elimination of caffeine and alcohol have been very effective for certain patients. The following table lists some medical therapies.
DYSMENORRHEA
Dysmenorrhea, lower abdominal-pelvic cramping pain with menses and usually with a
constellation of other symptoms, is classified as primary or secondary. It can be
incapacitating. Primary dysmenorrhea (PD) usually appears shortly after the menarche and is associated with ovulatory cycles. It is not caused by or associated with demonstratable pelvic pathology such as adhesions, infection or endometriosis. The pain is cramping in nature and may radiate to the back or thighs. Other symptoms, such as nauses, emesis, headache, fatique and diaphoresis have been associated with dysmenorrhea. The severity may be correlated with the amount and duration of menstrual flow. While the exact etiology of the pain is unknown, endogenous prostaglandin seem to be important. Over the counter pain medications usually provide adequate relief for the patients. Low-estrogen containing birthcontrol pills have also been helpful. Secondary dysmenorrhea (SD) usually occurs in women over the age of 20. The most likely cause is enodmetrosis, adenomyosis, and chronic pelvic infection. The treatment is the same. Occasionally, hysterectomy is needed to resolve the condition.
ABNOMAL UTERINE BLEEDING
Abnormal uterine bleeding (AUB) is a frequent complaint of patients. Making an
accurate diagnosis and ruling out serious etiologies are important. When a woman
complains of vaginal bleeding, it is important to rule out the possibility that the origin is actually form another site i.e. bowel, urinary tract, and vulva. For women above the age of 35, endometrial cancer must be ruled out. This is done by doing and endometrial biopsy.
PRECOCIOUS PUBERTY
The appearance of sexual development before 8 years of age characterizes precocious
puberty (PP). Seventy to 80 percent of the cases of PP are due to an early “awakening” of the hypothalamic-pituitary axis – idiopathic PP. Any secondary sex characteristic appearing before the age of 8 years warrant a clinical evaluation that involves trying to exclude serious disease such as neoplasms of the brain, adrenal, or ovary, or some disorder of the thyroid. Besides the obvious body changes, PP also contributes to major phychosocial issues. The parents are often very distressed, and the child may experience problems relating to peers. If ovulation is present, no other studies need to be done. Ovulation does not occur
during any pathological or disease states associated wit precocious puberty. If the
problem is idiopathic, Gn-RH analog therapy is used for the curtailment of physical and behavioral symptoms.
PRIMARY AMENORRHEA
The absence of breast budding by age 14 and no menses by age 16, primary amenorrhea
(PA), constitutes reason for concern. Primary amenorrhea may be due to delayed
physiological menarche. Other possible reasons include a genetic cause impacting
ovarian or gonadal function, a congenital anomaly involving the vagina and/or uterus, or a central problem influencing hypothalamic function and Gn-RH pulsatile secretion. A clinical evaluation should be directed to different compartments: the utero-vaginal tract, ovary, pituitary, CNS-hypothalamus, and other systemic problems.
Congenital abnormalities associated with primary amenorrhea can be as minor as an
imperforate hymen or as major as the complete absence of the uterus and vagina. The
diagnosis of anatomic defects is readily evident on performing a careful physical exam.
A lack of sensitivity of androgen receptors, more commonly known as “testicular
feminization syndrome”, should be included in this category. These patients have 46XY
karyotype. These patients’ gonads should be removed because of the increase risk of
neoplasia. Other causes of anatomical abnormalities include Turner’s syndrome,45,XO;46XX and 46XY(Swyer’s syndrome). These abnormalities are associated with elevated FSH. Pituitary causes of primary amenorrhea are uncommon. Any patient with primary
amenorrhea should have a serum prolactin, elevation of which would indicate a tumor.
Kallmann’s syndrome is a Gn-RH deficiency associated with the inability to smell,
absence of secondary sexual characteristics and a low FSH level. Many psychosocial issues need to be addressed with these patients. Extensive counseling will be required.
SECONDARY AMENORRHEA
After a previously menstruating individual misses three consecutive periods or 6 months pass without a period, she had met the definition of secondary amenorrhea. When pregnancy has been excluded, clinical evaluation should be directed to different
compartments. CNS-hypothalamus, pituitary, ovary and the uterovaginal tract. The most
common problem resulting in secondary amenorrhea is hypothalamic dysfunction and
includes weight-change-related disorders, severe psychological stress, and exerciseinduced problems. Pituitary causes include neoplasms; the most common being a tumor that either directly or indirectly results in hyperprolactinemia. Premature ovarian failure, the cessation of periods before age 40, is another important cause, and is characterized by an elevated serum FSH of > 40mIU/ml. Intrauterine scarring can be sufficiently extensive to result in amenorrhea. These patients have usually had curettage after pregnancy or severe endometritis.
Anenorrhea associated with dramatic or sudden significant changes in weight (plus or
minus 15% from ideal body weigh) is often associated with hypothalamic amenorrhea.
Anorexia nervosa is the most extreme form of weight loss associated with amenorrhea.
At the other end of the spectrum is pseudocyesis, a strong desire for pregnancy, with mild to moderate weight gain.
A very common cause of secondary amenorrhea is polycystic ovarian syndrome (PCOS).
This is a hyperestrogenic and hyperandrogenic syndrome associated with anovulation.
The three cardinal symptoms of PCOS are menstrual disorders (aenorrhea,
oligomenorrhea, or dysfunctional uterine bleeding), which are present in about 90 % of the cases; hirsutism, which occurs in about 70% of the cases; and infertility, which is the presenting symptom in 75% of patients. The diagnosis is made by clinical features and by the presence of an elevated serum LH.
Another cause of amenorrhea or oligomenorrhea is congenital adrenal hyperplasia. It is a common genetic disorder. It is an enzyme failure in the production of cortisol. It results in increased ACTH, which results in increased androgens, causing hirsutism and oligomenorrhea.
PREMENSTRUAL SYNDROME
Symptoms associated with the menstrual cycle are common. When the number and
severity of the symptoms increase to the point where they interfere with daily existence, this is considered premenstrual syndrome (PMS). Predominant somatic symptoms can include the feeling of bloatedness, breast pain, headache, pelvic pain, and alterations in bowel function. The major psychological symptoms can include mood alterations such as irritability, aggressive tendencies, anxiety, depression, extreme lethargy, sleep disorders, crying spells, diminished libido, and loss of concentration. The incidence of PMS is reported to be between 5 and 95 %. Two to 3% of women have a severe form. There is no known cause for PMS. Patients should be encouraged to obtain a more healthy diet and to include a moderate amount of exercise. A multiple-feeding, highprotein diet and the elimination of caffeine and alcohol have been very effective for certain patients. The following table lists some medical therapies.
DYSMENORRHEA
Dysmenorrhea, lower abdominal-pelvic cramping pain with menses and usually with a
constellation of other symptoms, is classified as primary or secondary. It can be
incapacitating. Primary dysmenorrhea (PD) usually appears shortly after the menarche and is associated with ovulatory cycles. It is not caused by or associated with demonstratable pelvic pathology such as adhesions, infection or endometriosis. The pain is cramping in nature and may radiate to the back or thighs. Other symptoms, such as nauses, emesis, headache, fatique and diaphoresis have been associated with dysmenorrhea. The severity may be correlated with the amount and duration of menstrual flow. While the exact etiology of the pain is unknown, endogenous prostaglandin seem to be important. Over the counter pain medications usually provide adequate relief for the patients. Low-estrogen containing birthcontrol pills have also been helpful. Secondary dysmenorrhea (SD) usually occurs in women over the age of 20. The most likely cause is enodmetrosis, adenomyosis, and chronic pelvic infection. The treatment is the same. Occasionally, hysterectomy is needed to resolve the condition.
ABNOMAL UTERINE BLEEDING
Abnormal uterine bleeding (AUB) is a frequent complaint of patients. Making an
accurate diagnosis and ruling out serious etiologies are important. When a woman
complains of vaginal bleeding, it is important to rule out the possibility that the origin is actually form another site i.e. bowel, urinary tract, and vulva. For women above the age of 35, endometrial cancer must be ruled out. This is done by doing and endometrial biopsy.
Investigation of the Solid State Properties of Amoxicillin Trihydrate and the Effect of Powder pH
Abstract
The purpose of this research was to investigate some physicochemical and solid-state properties of amoxicillin trihydrate (AMT) with different powder pH within the pharmacopoeia-specified range. AMT batches prepared using Dane salt method with the pH values from 4.39 to 4.97 were subjected to further characterization studies. Optical and scanning electron microscopy showed that different batches of AMT powders were similar in crystal habit, but the length of the crystals increased as the pH increased. Further solid-state investigations using powder x-ray diffraction (PXRD) demonstrated the same PXRD pattern, but the intensity of the peaks raised by the powder pH, indicated increased crystallinity. Differential scanning calorimetry (DSC) studies further confirmed that as the powder pH increased, the crystallinity and, hence, thermal stability of AMT powders increased. Searching for the possible cause of the variations in the solid state properties, HPLC analysis showed that despite possessing the requirements of the United States Pharmacopoeia (USP) for purity/impurity profile, there was a direct relationship between the increase of the powder pH and the purity of AMT, and also decrease in the impurity I (α-Hydroxyphenylglycine) concentration in AMT powder. Recrystallization studies confirmed that the powder pH could be controlled by adjusting the pH of the crystallization.
Keywords: Amoxicillin trihydrate, impurity profile, degree of crystallinity, DSC, PXRD, HPLC
The purpose of this research was to investigate some physicochemical and solid-state properties of amoxicillin trihydrate (AMT) with different powder pH within the pharmacopoeia-specified range. AMT batches prepared using Dane salt method with the pH values from 4.39 to 4.97 were subjected to further characterization studies. Optical and scanning electron microscopy showed that different batches of AMT powders were similar in crystal habit, but the length of the crystals increased as the pH increased. Further solid-state investigations using powder x-ray diffraction (PXRD) demonstrated the same PXRD pattern, but the intensity of the peaks raised by the powder pH, indicated increased crystallinity. Differential scanning calorimetry (DSC) studies further confirmed that as the powder pH increased, the crystallinity and, hence, thermal stability of AMT powders increased. Searching for the possible cause of the variations in the solid state properties, HPLC analysis showed that despite possessing the requirements of the United States Pharmacopoeia (USP) for purity/impurity profile, there was a direct relationship between the increase of the powder pH and the purity of AMT, and also decrease in the impurity I (α-Hydroxyphenylglycine) concentration in AMT powder. Recrystallization studies confirmed that the powder pH could be controlled by adjusting the pH of the crystallization.
Keywords: Amoxicillin trihydrate, impurity profile, degree of crystallinity, DSC, PXRD, HPLC
Prevalence and risk factors for menstrual disorders among systemic lupus erythematosus patients
ABSTRACT
Introduction: This study aims to determine the prevalence and the types of menstrual disorders among patients with systemic lupus erythematosus (SLE) and to identify factors that influence their development.
Methods: 61 patients with SLE were enrolled into a cross-sectional, observational study at the medical outpatient clinic, Hospital Universiti Sains Malaysia. A total of 120 healthy women were selected randomly to act as the control group. A
questionnaire was administered, vital signs were recorded, and blood was evaluated for routine investigations. A review of past medical records was also undertaken.
Results: The mean age and standard deviation for the study group was 33.23 +/- 10.96 years, the majority being ethnic Malays. 75 percent had a severe SLE disease activity index score on initial presentation, and 59 percent were on cyclophosphamide. 49 percent of the study population had menstrual irregularities, of
which 60 percent had sustained amenorrhoea. Nine patients with sustained amenorrhoea had hormonal assays, which confirmed the diagnosis of premature menopause.
Conclusion: This study showed that SLE patients had a higher risk of developing menstrual irregularities compared to the normal/healthy population. The risk was higher in the older age group (greater than 30 years old) and those on
cyclophosphamide therapy, especially those with a cumulative dose of more than 10 g. Sustained amenorrhoea was the commonest irregularity and a majority of them had confirmed premature menopause.
Keywords: amenorrhoea, menstrual disorders, premature menopause, systemic lupus erythematosus
Introduction: This study aims to determine the prevalence and the types of menstrual disorders among patients with systemic lupus erythematosus (SLE) and to identify factors that influence their development.
Methods: 61 patients with SLE were enrolled into a cross-sectional, observational study at the medical outpatient clinic, Hospital Universiti Sains Malaysia. A total of 120 healthy women were selected randomly to act as the control group. A
questionnaire was administered, vital signs were recorded, and blood was evaluated for routine investigations. A review of past medical records was also undertaken.
Results: The mean age and standard deviation for the study group was 33.23 +/- 10.96 years, the majority being ethnic Malays. 75 percent had a severe SLE disease activity index score on initial presentation, and 59 percent were on cyclophosphamide. 49 percent of the study population had menstrual irregularities, of
which 60 percent had sustained amenorrhoea. Nine patients with sustained amenorrhoea had hormonal assays, which confirmed the diagnosis of premature menopause.
Conclusion: This study showed that SLE patients had a higher risk of developing menstrual irregularities compared to the normal/healthy population. The risk was higher in the older age group (greater than 30 years old) and those on
cyclophosphamide therapy, especially those with a cumulative dose of more than 10 g. Sustained amenorrhoea was the commonest irregularity and a majority of them had confirmed premature menopause.
Keywords: amenorrhoea, menstrual disorders, premature menopause, systemic lupus erythematosus
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