Usingranitidinemayincreaseyourriskofdevelopingpneumonia.

Symptomsofpneumoniainclude
chestpain,fever,feelingshortofbreath,andcoughingupgreenoryellowmucus.Talkwithyour
doctoraboutyourspecificriskofdevelopingpneumonia.
Donotusethismedicationifyouareallergictoranitidine.

Slideshow
The Dangers Of DVT: Don't Ignore The Signs
Askadoctororpharmacistifitissafeforyoutotakethismedicineifyouhavekidneydisease,liver
disease,orporphyria.
Heartburnisoftenconfusedwiththefirstsymptomsofaheartattack.Seekemergencymedical
attentionifyouhavechestpainorheavyfeeling,painspreadingtothearmorshoulder,nausea,
sweating,andageneralillfeeling.
Ranitidinegranulesandeffervescenttabletsmustbedissolvedinwaterbeforeyoutakethem.Your
doctormayrecommendanantacidtohelprelievepain.Carefullyfollowyourdoctor'sdirectionsabout
thetypeofantacidtouse,andwhentouseit.Avoiddrinkingalcohol.Itcanincreasetheriskof
damagetoyourstomach.Itmaytakeupto8weeksofusingthismedicine

What is ranitidine?
Ranitidineisinagroupofdrugscalledhistamine2blockers.Ranitidineworksbyreducingtheamount
ofacidyourstomachproduces.
Ranitidineisusedtotreatandpreventulcersinthestomachandintestines.Italsotreatsconditionsin
whichthestomachproducestoomuchacid,suchasZollingerEllisonsyndrome.Ranitidinealsotreats
gastroesophagealrefluxdisease(GERD)andotherconditionsinwhichacidbacksupfromthestomach
intotheesophagus,causingheartburn.

016, Bahwa Waktu Kepaniteraan Klinik Tersebut Diperpanjang 1

Minggu. Sehingga Seluruh Kepaniteraan Klinik di Rumah Sakit
Pendidikan Menjadi 6 Minggu (Minor) dan 11 Minggu (Mayor).
Diberikan Kewenangan Penuh Kepada Rumah Sakit Pendidikan
Mengenai Bebas Atau Tidaknya Kegiatan Di Waktu Tambahan
Kepaniteraan Klinik.
Kepaniteraan Berikutnya Akan Terjadwal Pada Tanggal 1 Agustus
2016.
Berikut Surat Perpanjanga
In a time not of this time a little girl named Munrize lived in a town called Umoja.
The town sat near the seashore, surrounded by a rich forest. Munrize lived
happily with her mother, father, and two older brothers. The sound of drums was
the earliest memory of this wide-eyed girl. Her mother loved to tell the story of
her daughters birth. "When you began to kick in my belly your brothers began
drumming. They played a rhythm like the rolling of the sea, like waves dancing to
shore so I felt no pain."

Before she could walk Munrize danced to her rhythm. When she took her first
step her second step was a dance. By the age of three, Munrize was the featured
dancer for the harvest festival. Her brown legs moved in perfect rhythm to the
beat of her brothers drums while her long be

UnitedStates.78Thesubjectsreceivedpirenzipine0.5%forthefirstweek,1.0%forthesecondweek,
and2.0%foranadditional2weeks.Anotherstudyof49adultmalevolunteersfoundthatpirenzepine
ophthalmicgelat0.5%,1.0%,and2.0%waswelltolerated,producedminimalmydriasis,andtheonly
adverseeventnotedwasatransientunilaterallossofvisualacuityinonepatientwhichrecoveredby
thenextvisit.79Althoughrandomisedclinicaltrialsarecurrentlyinprogress,efficacydataarenotyet
available.

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TROPICAMIDE EYE DROPS

Tropicamideisashortactingcycloplegicagentthatrelaxesciliarymuscletoneandblocks
accommodation.Inastudyof61childrenaged616yearsgiven0.4%tropicamideeyedrops,the
averagedegreeofmyopiawasreducedfrom0.85Dto0.62D.80Therewas,however,nocontrol
group.Amatchedpairdesignof

dosesofatropine(1%atropine)may,however,beassociatedwithanincreasedincidenceandseverity
oflocaleffects(examplesincludemydriasis,photophobia,blurredvision,allergicdermatitis)and
systemiceffects34,68,69;lowerdosesofatropine(0.5%,0.25%,0.1%)werebettertolerated.68Thelong
termsideeffectsofatropineeyedropsinchildrenarerelativelyunknownandtheremaybeariskof
longtermultravioletlightrelatedretinaldamageandcataractformationasaresultofchronicpupillary
dilatation.64
PirenzipineisarelativelyselectiveM1subtypemuscarinicreceptorantagonistandM1receptorsare
foundintheciliaryprocesses.7074Inbothavianandmammalianmodels,pirenzipinehasbeenshownto
blockformdeprivationmyopiaandaxialelongation.7577Thetolerabilityofpirenzipinegelformulation
wastestedinadoublemaskedplacebocontrolledrandomisedclinicaltrialofchildrenaged912years
inthe

Atropinesuppressesgrowthhormonesecretionfromthepituitaryglandwhichcoulddisturbnormal
eyegrowth.57,58
ThefirstreportsofatropinetreatmentformyopiawerebyWellsinthe19thcentury.3In1979,
Bedrossianevaluatedtheeffectof1%atropineointmentinstilledonceatnightinoneeyefor1year
withthefelloweyeasthecontrolinanonrandomisedtrial.After1year,treatmentwasswitchedtothe
felloweye,andthecontroleyesshowedsignificantincreasesintherateofmyopia. 59However,the
felloweyemaynotbesuitableasacontrolastheremaybesystemicresidualeffectsofatropineonthe
felloweye.Severalotherstudieshaveevaluatedtopicalatropinetherapybutunfortunatelyhad
sufficientmethodologicalflawstoprecludeanyreliableconclusions.15,16,6067Arangeofconcentrations
(0.1%to1%)ofatropineeyedropsweretestedinthreerandomisedclinicaltrialsofschoolchildrenin
Taiwanandtherateofprogressionofmyopiaintheatropinegroupwassignificantlylowercompared
withthecontrolgroup.34,68,69Higher

tropineisanalkaloidfromthedeadlynightshadeAtropabelladonnaandhasseveralproposed
mechanismsofaction.Firstly,atropinemayblockaccommodationandreducetheputativeeffectsof
excessiveaccommodationontheprogressionofmyopia.11Secondly,atropineisanonselective
muscarinicantagonistandithasbeenobservedthatinanimalstreatedwithatropine,formdeprivation
myopiamaybesuppressedwithretardationofaxiallengthelongation.5355Atropinealsoaffects
dopamineneurotransmitterreleasefromcellularstoresandthusmayinfluenceretinalsignalsthat
controlthegrowthoftheeye.56Thirdly,atropinemayreachsufficientlevelsinthebloodstreamtohave
systemiceffects.
usuallywornovernight,withthepotentialcomplicationsofinfectivekeratitisrelatingtoclosedeye
contactlenswear.However,cornealflatteningdoesnottreattheintrinsiccauseofmyopiaandmaybe
aremedyratherthanacure.IntheBerkeleyOrthokeratologyStudy,80subjectswererandomisedto
orthokeratologyoracontrolgroupwearingcontactlensesfittedinthestandardclinicalmanner.There
wasasignificantlylargerreductioninmyopiaforthepatientsrandomisedtoorthokeratology,butthe
reductiondidnotpersistafterorthokeratology.52Thus,orthokeratologyhaslittleclinicalvalueforthe
retardationofmyopiaprogression.

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ATROPINE AND PIRENZIPINE EYE DROPS

spectaclewearerswas2.3Dincontrastwith1.3Dforcontactlenswearers(p<0.05).51Nomajor
adverseeventswerenoted.However,inamorerecentandlargerrandomisedclinicaltrialofrigid
contactlenseswith383Singaporechildrenaged612yearsover2years,therewasnosignificant
differencesintherateofprogressionofmyopiaoraxiallengthinthetwogroups(KatzJetal,
submittedforpublication)

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ORTHOKERATOLOGY
Thetechniqueknownasorthokeratologyhasbeenpractisedfordecades:thecorneaisflattenedby
fittingprogressivelyflatterrigidcontactlensesuntilthecornealshapeissufficientlyalteredtoachieve
myopiareduction.52Thetemporaryalterationofcornealshapeandhencecorrectionofmyopiaallows
forperiodsofclearunaidedvisionduringthedaywithouttheuseoflenses,butrequiresconstantuseof
retainerlens,

Inthe3yearHoustonstudyofrigidgaspermeablecontactlenses,100myopicchildrenaged813
yearswerefittedwithParapermoxygenpluscontactlensesandwerecomparedwith20spectacle
wearers.Theaverageprogressionofmyopiawassignificantlydifferent:0.48Dperyearforrigid
contactlenswearerscomparedwith1.53Dperyearforspectaclewearers.50However,theallocation
oftreatmentwasnotrandomised.Itwasalsoobservedthatapproximatelyhalfoftheeffectofrigidgas
permeablecontactlenseswasduetotransientcornealflattening.Inanonrandomisedstudyof45rigid
contactlenswearersand45spectaclewearersinSingapore10yearoldchildren,themeanincreasein
myopiaovera3yearperiodof
polymethylmethacrylate(PMMA)hardcontactlenses,thusalteringtheshapeofthecornea. 49
However,therewerehypoxiarelatedcornealchanges.Newrigidgaspermeablelenseswithhigh
oxygenpermeabilityareasuitableandsaferalternative.45Thepotentialmechanismsofactionofrigid
contactlensesincludetransientflatteningofthecornea,andimprovedqualityoftheretinalimagewith
reducedperipheralimageblur.Perhapsrigidcontactlensesmayevenretardaxialelongation.
However,thepermanenceofthesemechanismsofactionisstillunknown.

Ininfantprimateswearingminuscontactlenses,compensatoryoculargrowthmayleadtofunctional
myopia.38,39Alargenumberofreportsontheefficacyofvarioustypesofcontactlenses(silicone
acrylatecontactlenses,hydrophiliccontactlenses,hydrogellenses)werenotrandomised,hadsmall
samplesizes,andhighdropoutrates.4047Inarandomisedclinicaltrialoftheefficacyofsoftcontact
lensesin175childrenbyHornerandassociatesintheUnitedStates,therewasnosignificantdifference
intherateofprogressionofmyopiabetweenthecontactlens(0.36Dperyear)andcontrolgroup
(0.30Dperyear).48
Morrisonin1956fitted1021myopicchildren(79years)flatterthantheflattestcurvaturewith

reductionoftheprogressionofmyopia(meanmyopiaprogression1.19Dperyearinmultifocalgroup
versus1.40Dperyearinsinglevisiongroup)in227myopicchildrenaged612yearsafter1
years.34TheCorrectionofMyopiaEvaluationTrial(COMET)isalargeongoing3yearmulticentre
randomised,doublemaskedtrialevaluatingtheeffectofprogressiveadditionlensesversussingle
visionlensesin469myopicchildren(sphericalequivalentbetween1.25and4.50D)aged611
yearsintheUnitedStates.35,36Theresultsfromthistrialmayprovidenewevidencefortheefficacyof
multifocallenses.

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CONTACT LENSES
ContactlenseshavealonghistoryofuseasopticalcorrectionsincetheirintroductionbyEugenFickin
1888.37Contactlensesmayincreaseperipheralvision,providecosmeticbenefits,andpromotemore
outdooractivity.However,potentialcomplicationsofcontactlensuseincludeallergicconjunctivitis,
cornealinfiltrates,andinfectivekeratitis,andcontactlenshygienecompliancemaybeaproblemin
lessresponsiblechildren.

theprogressiveadditionlensmustbefittedveryhightofacilitatetheuseofthesegmentforreading.In
aclinicaltrialconductedbyLeungandBrowninHongKong,22childrenwereassignedtowear
progressivelenseswith+1.50Daddition,14tolenseswith+2.00Daddition,and32tosinglevision
lenses.Themeanprogressionrateofmyopiawas3.73Dforthechildrenassignedto+1.50D
additions,3.67Dforchildrenwearing+2.00Dadditions,and3.67Dforchildrenwearingsingle
visionlenses(p<0.001).However,theassignmentwasnotrandom:subjectswithevencaserecord
numberswereplacedintheprogressivelensesgroup,whilesubjectswithoddcaserecordnumbers
wereplacedinthesinglevisionlensesgroup.19ATaiwaneserandomisedclinicaltrialbyShihand
colleaguesshowedanonsignificantreductionoftheprogressionofmyopia(meanmyopiaprogression
1.19Dperyearinmultifocalgroup
Whenmyopiaisnotcorrected,lackofaclearvisualimagemayleadtoformdeprivationmyopia.11
Conversely,correctingachildsmyopiawithnegativelensesmayresultincompensatoryaberranteye
growthandthedevelopmentofmyopia.10Animalexperimentshaveshownthatcompensatorychanges
intheaxiallengthofaneyemayoccurinresponsetoerrorsignalsfromlensinduceddefocus.10,12Ina
nonrandomisedclinicaltrialevaluatingparttimedistancespectaclewearintheUnitedStates,43
myopeswerecategorisedintofourtreatmentgroups:(a)fulltimespectaclewear,(b)wearfordistance
viewingandthenaswitchtofulltimewear,(c)wearfordistanceviewingonly,and(d)nonwear.Over
aperiodof3years,therewerenosignificantdifferencesinrefractiveshiftsasmeasuredbynon
cycloplegicdistance
Whenmyopiaisnotcorrected,lackofaclearvisualimagemayleadtoformdeprivationmyopia.11
Conversely,correctingachildsmyopiawithnegativelensesmayresultincompensatoryaberranteye
growthandthedevelopmentofmyopia.10Animalexperimentshaveshownthatcompensatorychanges
intheaxiallengthofaneyemayoccurinresponsetoerrorsignalsfromlensinduceddefocus.10,12Ina

nonrandomisedclinicaltrialevaluatingparttimedistancespectaclewearintheUnitedStates,43
myopeswerecategorisedintofourtreatmentgroups:(a)fulltimespectaclewear,(b)wearfordistance
viewingandthenaswitchtofulltimewear,(c)wearfordistanceviewingonly,and(d)nonwear.Over
aperiodof3years,therewerenosignificantdifferencesinrefractiveshiftsasmeasuredbynon
Myopiaisclassifiedinasimplemanneras
i)simple
ii)pathological
SimpleMyopiaisnotprogresivebeyondtheamountincludedwithinnormaldevelopment;isassociated
withgoodvisionandrequiresnotreatmentexceptopticalcorrection.
PathologicalMyopiaontheotherhandisadegenerativemyopiaaccompaniedbychangesinthe
posteriorsegmentoftheeyeballwithlengtheningofAPaxisoftheglobe.Besides,theaxial
pathologicalmyopia,thereareothertypesofmyopiaduetodefectsinthecurvatureofcorneaandlens
andduetodrauma.Today,IwillconfinemyremarksonlytopathologicalaxialMyopia.
Thepathologicalmyopiashowsdegenerativechangesintheposteriorpole.Thusitcanbenamedas
degenerativemyopia(DukeElder).Itmayoccurasanindependentdevelopmental(congenital)
conditionorinassociationwithotherocculardiseasesorgeneraldisease.