Human Papillomavirus Vaccination

Human Papillomavirus Vaccination

· HPV is a virus that is spread through sexual contact. There is no symptoms so people do not know they have it.

· There are approximately 40 types of genital HPV. Somes types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. Other types can cause genital warts in both males and females.

· The HPV vaccine works by preventing the most common types of HPV that cause cervical cancer and genital warts.

· It is given as a 3-dose vaccine. The second and third doses should be given two and six months (respectively) after the first dose.

· The vaccine is recommended for girls and women 13 through 26 years of age.

· Like other vaccine, there can be minor reactions, including pain and redness at the injection site, headache, fever, fatigue or a vague feeling of discomfort. These symptoms do not last long and go away on their own.

· The vaccine is not recommended for pregnant women, but it is safe for breast feeding woman.

· Anyone who has ever had a life-threatening allergic reaction to yeast, to any other component of HPV vaccine, or to a previous dose of HPV. vaccine should not get the vaccine.

· The retail price of the vaccine is about $120 per dose ($360 for full series)

BMI

BMI

• BMI is used as a screening tool to identify possible weight problems for adults.

• Body Mass Index (BMI) is a number calculated from a person’s weight and height.

• BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems.

• For adults 20 years old and older, BMI is interpreted using standard weight status categories that are the same for all ages and for both men and women.

• BMI = weight (kg) / [height (m)]²

BMI	Weight Status
Below 18.5	Underweight
18.5 – 24.9	9 Normal
25.0 – 29.9	Overweight
30.0 andAbove	Obese

• The correlation between the BMI number and body fatness is fairly strong; however the correlation varies by sex, race, and age. ( CDC )

Cefixime

Cefixime

· The first and the only one third generation cephalosporin can administered by oral.

· Pediatric dose : 1,5 – 3 mg/kgbb given orally twice daily, may be increased until 6 mg/kgbb twice daily for severe infection.

· Adult dose : usually 100 mg given twice daily. In gonorhoea, given 400 mg as single dose.

· Active to so much gram positive ( Streptokokus sp ) and negative aerobic microorganism .( Haemopilus influenzae, Neisseria gonororrheae, E.coli )

· Very active against Enterobactericeae microorganism.

· It is extremely stable to beta lactamase produced by many organism.

· Less activity against gram positive coccus microorganism than first cephalosporin.

· There is no activity against Stafilokokus aureus and penisillin resisten pneumococcus.

· Used in uncomplicated urinary tract nfection, otitis media, pharyngitis, tonsillitis, acute bronchitis.

· Treatment of typhoid fever in children with multi drug resisten to standart regimen.

· Preucations in pregnant and nursing woman ( not contraindication ).

· Contraindication : allergy/hypersensitivity with any ingredient by this product.

· Cefixime is generally well tolerated and side effects are usually transient. Reported side effects include diarrhea, pseudomembranous colitis (can occur even after cefixime is stopped) nausea, abdominal pain, vomiting, skin rash, fever, joint pain and arthritis, abnormal liver tests, vaginitis, itching, headaches, and dizziness.

gonorhoea

Gonorrhea

• The most commonly STD in daily practice.

• Caused by Neisseria Gonorrhoeae, a diplococcus gram negative bacteria.

• The symptom are dysuria ( feel pain or burning during urination ) and the specific symptom in man is thick, yellow penile discharge.

• There is no symptom in almost 40% woman who had infected by Neisseria gonorrhoeae bacteria, other woman feel need to urinate often, itching and burning of the vagina, usually with a thick yellow/green discharge, irritation of the vagina, bleeding between menstrual periods.

• Gonococcal throat infection should be considered in people who complain of sore throat and have other signs of gonococcal infection
• In the newborn causes irritation of the mucous membranes in the eyes (if not treated, can cause blindness).
• The infection is transmitted from one person to another through vaginal, oral, or anal sexual relation.
• N. gonorrhoeae have been reported resistans to penicillins, tetracyclines, spectinomycin, and fluoroquinolones so don’t use it.
• Culture of penile discharge is golden standart in diagnostic, but microscopic examination is more simple, faster and cheaper. ( you will find a diplococcus gram negative bacteria )

• Drug of choice refered to CDC is Ceftriaxone 125 mg IM in a single dose or Cefixime 400 mg orally in a single dose. I prefer cefixime 400mg single dose and in my experience all patient have cured except patient with secondary infection.
• If chlamydial infection has not been ruled out, co-treatment with doxycycline 100 mg twice daily or azithromycin should be provided because patients with urogenital gonococcal infections often are coinfected with Chlamydia trachomatis
• Some patient may be have secondary infection by bacteria, so if your patient uncure with regimen above, provide culture urethra discharge. I found streptococcus which sensitive to erythromycin in several cases
• Ceftriaxone or spectinomycin 2 g in a single intramuscular (IM) dose are the options recommended by CDC for treating pregnant women with urogenital and rectal gonorrhea; in pregnant women with pharyngeal infection ceftriaxone is recommended. The only other regimen studied in pregnancy is cefixime 400 mg with a treatment efficacy of 96.2% for uncomplicated cervical and rectal infections (95% CI 88.8-99.6%).
• Patient with penicillin and cephalosporin allergy may be use azithromycin. Azithromycin 2 grams orally is effective against uncomplicated gonococcal infection

Rubella

Rubella

· Synonim of german measles.

· It is caused by rubella virus, which is a member of the Rubivirus genus of the family Togaviridae.

· Nearly one half of individuals infected with this virus are asymptomatic.

· Rubella is airborne disease. The virus is transmitted via the aerosolized particles from person to other person. The incubation is usually 14-21 days after exposure to a person with rubella.

• Clinical manifestations and severity of illness vary with age. The following signs and symptoms usually appear 1-5 days before the onset of rash:

- Eye pain on lateral and upward eye movement (a particularly troublesome complaint)

- Conjunctivitis

- Sore throat

- Headache

- General body aches

- Low-grade fever

- Chills

- Anorexia

- Nausea

- Tender lymphadenopathy (particularly posterior auricular and suboccipital lymph nodes)

· In older children, adolescents, and adults, rubella may be complicated by arthralgia, arthritis, and thrombocytopenic purpura.

· The major complication of rubella is its teratogenic effects when pregnant women contract the disease, especially in the early weeks of gestation. The virus can be transmitted to the fetus through the placenta and is capable of causing serious congenital defects, abortions, and stillbirths.

· Rubella is diagnosed by measures IgM and IgG specific in the blood. IgM will be found in patient who infected rubella virus or there is a fourfold rise IgG titer betwen the first and the second sample blood.

· If a person who has had immunized against rubella or has had the disease, the hemoglutination inhibition test will be greater than 1 : 10 – 1: 20.

· If the person don’t have imunity the result of HI test will be1:8 or less.

· Once IgG exists, it persists for a lifetime, but the special IgM antibody usually wanes over six months.

· There is no specific antivirus or treatment for rubella. This is self limiting disease.

Cialis

Cialis

• Another PDE5 inhibitor beside Viagra ( sildenafil sitrat ) and levitra.

• Cialis inhibits specific phosphodiesterase type 5 (PDE5), an enzyme. The inhibition of PDE5 increasing cGMP. Cyclic GMP causes smooth muscle relaxation and increased blood flow into the corpus cavernosum and make penis erection.

• Indicated to erectile dysfunction. Some study said cialis safer than others.

• Taken by mouth at least 30 minutes before sexual activity. . Cialis may be taken with or without food.

• Begin with 10 mg, evaluate, increasing the doses if necessary.

• Available in 5, 10 and 20 mg tablet.

• The maximum recommended dosing frequency is once per day in most patients.

• Don’t be given to patient who have heart disease and take nitrate including nitroglyserin everyday, patient who are allergic to CIALIS or any of its ingredients and patient who should not do sexual activity.

• Patient with severe renal inssufiency and hepatic impairment shoul not be given more than 10 mg a day.

• Headache, stomach upset, back pain, muscle pain, nasal stuffiness, flushing, pain in arms or legs, dizziness, or vision changes may occur.

• Drug interaction :

· nitrate

· alpha blocker ( usually use in hipertensi and prostate problem. Your blood pressure can suddenly drop )

· ketoconazole or itraconazole

· erythromycin