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Do Away With Chicken Pox


by Datuk Dr Zulkifli Ismail

Chicken pox, or Varicella, is a common and contagious disease of childhood, occurring most frequently among children aged 6 to 10. It is caused by the varicella-zoster virus.

Once the virus enters the body, it starts replicating in the respiratory region, which is its route of entry, and the regional lymph nodes within two to three days. The virus then enters the bloodstream and further replicates in the liver, spleen and other organs.

Symptoms

Symptoms start 10 to 21 days after exposure to the virus, beginning with fever, headache, sore throat, loss of appetite and tiredness. Then, multiple pimple-like red bumps pop up all over the body, causing mild to intense itching.

These bumps develop into blisters, which burst and dry after a few days. They then turn into brown scabs.

Children often have milder symptoms and fewer blisters than adults. The most common complications in children are secondary infection of the lesions, scarring and encephalitis (inflammation of the brain).

Most of us develop a lifetime immunity against chicken pox after the first infection. However, the virus stays in our nerve cells near the spinal cord long after the illness, remaining dormant. It may reactivate later in life, and move along the nerves to the surface of the skin, causing shingles/herpes zoster. Shingles is a rash of painful blisters that can last for two to three weeks.

About 10-20% of people who have had chickenpox develop shingles, usually those above the age of 50 years. Shingles is generally not dangerous, but it can be very painful and often cause lingering nerve pain for months after the rash is gone.

Adults and those above the age of 12 years generally suffer a more severe form of chickenpox. Adults are 20 times more likely to die from chickenpox than children, and almost 10 times more likely to be hospitalised for the disease. Adults are at a higher risk of developing bacterial pneumonia or encephalitis. The resultant scarring in adults and teenagers can be more severe too.

Varicella Vaccination

The best way to prevent chicken pox in your child is through varicella vaccination. Vaccinating also reduces the costs related to the disease. Parents need not miss work to care for their child who is suffering from chicken pox and the child need not miss school.

In Malaysia, the varicella vaccine has been available since 1997. It contains weakened live varicella-zoster virus. The vaccine is given through injection. For children between 12 months and 12 years of age, one dose of the chicken pox vaccine is required. For those above the age of 12, two doses are required, with an interval of at least 28 days in between the two shots.

The vaccine is reported to be more than 95% effective in preventing moderate to severe forms of the infection. In rare cases, vaccinated people still get chickenpox, but they experience a milder form of the illness, with fewer blisters and symptoms.

Data on the duration of immunity induced by the vaccination is still unavailable. Studies are underway to determine if a booster dose is required in the future. Current evidence shows that a booster dose may be indicated.

Side-effects caused by the chicken pox vaccine are rare and mild. Possible reactions toward the vaccine include redness, soreness, tiredness, fever, nausea and swelling of the area where the shot was given.

In 7-8% of people who have been vaccinated, a rash of several small bumps may develop at the area where the shot was given.

The chicken pox vaccine is not recommended for people with impaired immune systems, those allergic to gelatin or the antibiotic neomycin, and pregnant women. Patients who are taking steroids or aspirin should not be given the vaccine until after stopping the medicines. These will include some asthmatics and children recovering from Kawasaki disease.

In the US, the tetravalent MMR-VZV vaccine is available. It protects against four illnesses – measles, mumps, rubella and chicken pox. This vaccine may be made available in Malaysia in the future.

How It Spreads

The varicella virus is highly contagious and it spreads easily through direct contact with the infected person, through a sneeze or cough, or by touching the fluid from a chicken pox blister. It can also spread indirectly, through contact with contaminated surfaces.

People can also catch chickenpox from someone with shingles. It is contagious two days before the rash appears, up to the time when all the blisters have dried up.

Many children get infected through direct contact with their infected sibling. The US Centers for Disease Control and Prevention (CDC) reports that there is a 90% risk of developing chicken pox among people living within the same household as the infected person.

To prevent chickenpox from spreading, keep your infected child away from his siblings and get him to wash his hands frequently.

Acyclovir, an antiviral agent, is only effective when given during the early stages of the infection.

Home Treatment Tips

* Let your child have cool/lukewarm baths.

* Calamine lotion will help relieve the itchy rash.

* A prescribed antihistamine may relieve severe itching.

* Ensure your child gets adequate fluids and nutrients.

* Give foods that are cold, soft, and bland. Avoid acidic or salty foods.

* Give paracetomol, or acetaminophen, if your child is having fever.

* Trim your child’s fingernails. Let him wear gloves when he sleeps to prevent him from scratching. Scratching predisposes to secondary bacterial infection and causes scarring.

* Never use aspirin to reduce pain or fever in children with chickenpox.

Pregnancy

Contracting chicken pox during pregnancy heightens the risk of health complications. Chickenpox infection during early pregnancy leads to birth defects, low birth rate, or limb abnormalities in the foetus.

Chicken pox within one week before and after delivery can lead to severe chicken pox in the newborn baby who is not immunologically protected. If you are pregnant and have never had chicken pox, get your husband and children vaccinated to reduce the risk of them passing it on to you.

If the mother gets infected within 10 days after delivery, her newborn baby may suffer a life-threatening infection. An immune mother can protect her baby from infection within baby’s first few months of life, as her immunity can pass to the baby through the placenta and breast milk. Hence the importance of breastfeeding!

Parents are encouraged to vaccinate their children against chicken pox to spare them the risks of complications and discomforts caused by the disease. Talk to your doctor if you have any questions regarding chickenpox or the varicella vaccine.


More info on CHICKEN POX here.






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Asma Penyakit Alahan


Asma merupakan penyakit alahan yang mengganggu saluran udara (bronkus). Semasa berlaku tindak balas alahan, bronkus menjadi sempit dan dipenuhi lendir. Ini menyebabkan kesesakan nafas.

Serangan asma boleh menakutkan anak kerana perasaan lemas akan menyebabkan anak berasa panik dan ini membuat pernafasannya semakin sukar.

Punca awal yang menyebabkan alahan, iaitu alergen seperti debunga atau habuk rumah, yang biasanya dibawa oleh angin. Bagi anak yang menghidap asma, tekanan emosi dan senaman boleh menyebabkan serangan.

Asma biasanya menyerang kanak-kanak yang berumur 2 tahun ke atas. Keadaan ini biasanya masalah keturunan dan disusuli penyakit alahan lain seperti ekzema. Namun, kebanyakan kanak-kanak akan pulih semakin umur mereka meningkat.

Kebanyakan bayi yang berumur kurang 1 tahun mempunyai bunyi nafas yang berdehit jika mereka menghidap bronkitis. Ini berlaku apabila saluran udaranya yang kecil menjadi radang. Bayi-bayi ini tidak semestinya menghidap asma. Apabila umur bayi meningkat dan saluran udara mereka semakin besar, bunyi ini akan berhenti. Keadaan ini biasanya disebabkan jangkitan dan bukan alahan.

Adakah Keadaan Ini Serius?

Serangan asma mungkin menakutkan tetapi jika diberi ubat dan nasihat doktor diikuti, anak anda tidak akan menghadapi sebarang kerumitan.

Tanda-tanda

* Sesak nafas. Menghembus nafas menjadi semakin sukar dan abdomen mungkin dikempiskan semasa anak bernafas.

* Rasa lemas.

* Bunyi nafas yang berdehit.

* Batuk yang berterusan.

* Bibir kelihatan biru (sianosis) disebabkan kekurangan oksigen.

Apakah Tindakan Pertama?

1. Bawa anak berjumpa doktor dengan segera jika anda mengalami serangan asma.

2. Jika serangan ini berlaku semasa anak tidur, dudukkan anak dan sokong belakangnya dengan bantal. Anda juga boleh mendudukkan anak anda di atas kerusi dan lengannya diletakkan pada belakang kerusi supaya beban pada dadanya diringankan. Ini membolehkan otot dada mengeluarkan udara dengan lebih cekap.

3. Bertenang. Keresahan hanya akan membuat anak anda lebih takut.

4. Semasa menunggu doktor, cuba alihkan perhatian anak kepada benda lain. Misalnya, menyanyikan lagu untuk membantu anak melupakan keadaan nafasnya yang berdehit.

Perlukah Saya Berjumpa Doktor?

Bawa anak berjumpa doktor sebaik sahaja anak mengalami serangan asma.

Apakah Tindakan Doktor?

Doktor mungkin mengesyorkan penggunaan bronkodilator untuk membuka bronkus dengan mengendurkan otot. Dadah ini disedut terus ke dalam bronkus. Serangan yang teruk mungkin akan memerlukan rawatan hospital dan dos yang lebih tinggi diberikan secara sedutan atau titisan intravena.

Jika terdapat tanda-tanda jangkitan dada, antibiotik mungkin disyorkan.

Doktor akan menerangkan cara menghalang serangan akan datang. Doktor mungkin menentukan alergennya, sama ada melalui ujian bagi alergen tertentu seperti debunga dan habuk rumah.

Doktor akan memberi bekalan kecil dadah bronkodilator, sama ada dalam bentuk cecair atau kapsul untuk dimasukkan ke dalam penyedut. Ini harus diambil sebaik sahaja serangan bermula. Doktor akan menasihatkan anda supaya memberitahunya jika anak anda mengalami serangan yang teruk atau sekiranya serangan tidak reda walaupun anak anda diberi dua dos bronkodilator.

Doktor mungkin akan mengesyorkan dadah steroid jika langkah lain tidak dapat menghalang serangan berikutnya. Dos steroid yang rendah mungkin perlu disedut 3 atau 4 kali sehari atau jika tindakan ini tidak berkesan, dos yang lebih tinggi diberi dalam bentuk pil.

Bagaimanakah Saya Boleh Membantu?

* Jika doktor gagal menentukan alergen, cuba tentukannya sendiri. Catatkan bila serangan ini berlaku dan waktunya. Pastikan rumah anda bebas dari alergen yang biasa seperti kekabu. Gunakan pembersih vakum untuk memvakum habuk di rumah.

* Kebanyakan pesakit asma alah terhadap haiwan. Jika anda membela haiwan kesayangan, minta bantuan rakan untuk menjaganya selama beberapa minggu untuk menentukan sama ada kekerapan serangan asma anak anda berkurangan. Pastikan anak membawa ubat pada setiap masa. Maklumkan kepada pihak berkuasa sekolah tentang kemungkinan serangan ini akan berlaku.

* Rujuk kepada pakar fisioterapi supaya anak anda boleh mempelajari cara bernafas untuk membantunya menenangkan diri semasa berlaku serangan.

* Galakkan anak duduk atau berdiri tegak supaya paru-parunya mempunyai lebih ruang. Jangan biarkan anak menjadi terlalu gemuk kerana ini akan membebankan paru-parunya.

* Senaman ringan dapat membantu pernafasan anak tetapi latihan yang berat boleh membawa kepada serangan asma. Berenang merupakan latihan jasmani yang sangat baik.

* Anak disyorkan memakai lencana 'Medic Alert'.


Lagi info tentang ASMA di sini.






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10 Tips for Choosing the Shoe

Whether you are a casual walker or someone who walks each day for exercise, a comfortable, quality walking shoe can help you enjoy yourself, get more out of your workout and save your feet from wear and tear. Here are 10 important things to remember so you can make sure you choose the type of shoe that is best for you.


1. The first key when choosing walking shoes is to remember that it doesn't matter how stylish the shoes look if they don't support your foot properly. Fortunately, this is such a big industry these days that there are a number of chic styles available for athletic walkers as well as casual walkers. Visit a store or a website that specializes in walking shoes to see what I mean.



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2. Give yourself enough time to shop for your walking shoes. You need to try several pairs of shoes on and walk around the store in them. Make sure not to rush this process. The time to discover that a certain style of shoe hurts your feet is when you are still in the store.

3. Have the salesperson measure your foot so you can get an accurate size, especially if it has been a while since you have gone shoe shopping. While you are walking around in the store, check to make sure that your heel stays snug inside of the shoe and that you do not have any pain while you walk.

4. When you try on the shoe, you'll be able to feel how the shoe will fit over time. Unlike leather shoes, walking shoes typically will not stretch out in places where they are tight. If you have a part of the shoe rubbing up against your ankle bone or if the shoe is too tight across your toes, find a different pair to try on.

5. Look for a shoe that is flexible. When you walk, your foot will flex the sole of the shoe so you need something that will flex along with your foot. Hold the shoe in your hands with one hand on the toe and one on the heel. See if you can flex the shoe's sole back and forth in your hands. If the shoe will not budge, you need to keep looking.

6. Another important feature of a good walking shoe is the cushioning. During a walk, your foot will hit the ground thousands of times. It is important to have good cushioning underneath your feet. Check the construction of the cushioning and make sure it will hold up over time.

7. If you're going to be jogging as well as walking, look for a shoe that can be used for more than one purpose. Cross training shoes or jogging shoes will work well for walking, jogging and running. Ask the salesperson for recommendations based on the type of activity you will be doing.

8. Once you get the shoe home (or if you order the shoe online), walk around on carpeted areas only for a time so you can make sure the shoe is right for you before it is too late to return them. Quality walking shoes are not cheap, so it is important to make sure you have invested in the right shoe before you go traipsing up and down the block.

9. If your new walking shoes are for your walking workouts, keep them in good condition for using them in your exercise program only. Do not wear them around the house or while running errands, and your shoes will last a lot longer.

10. Know when it is time for a new pair. Walking experts say you should replace your shoes about every 400 to 500 miles (or about 3 to 6 months). They also recommend getting 2 pairs of walking shoes and alternating them during walking workouts, so that the shoe is completely dry and the cushioning of the shoe is always at its full effect when you put them on.


More info on SHOE here.






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Periksa Glukosa Sendiri

Pemeriksaan glukosa adalah sangat mudah dan boleh dilakukan sendiri.

Kadar kelaziman diabetes di seluruh dunia kian meningkat dan memerlukan kos rawatan yang tinggi terutamanya bagi golongan yang mengalami komplikasi diabetes.

Pengurusan dan pengawalan diabetes bukan hanya bergantung pada rawatan perubatan sahaja tetapi merangkumi aspek-aspek lain. Antaranya, pemakanan yang teratur, seimbang dan sihat, senaman yang konstan, kawalan berat badan, tidak merokok dan patuh pada jadual lawatan turutan dan hadir untuk pemeriksaan darah.


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Pemeriksaan Sendiri

Ia adalah satu cara yang berguna untuk menguruskan diabetes anda. Penghidap diabetes dinasihatkan menjalani pemeriksaan sendiri bagi memperoleh tahap glukosa dalam darah yang normal setiap masa.

Biasanya apa yang anda rasa bukanlah satu petunjuk yang baik untuk mengenal pasti tahap glukosa dalam darah anda.

* Kandungan gula yang ada dalam darah adalah lebih penting.

* Meter glukosa dalam darah yang digunakan akan memberi keputusan gula dalam darah dengan segera melalui bacaan mmol/L.

* Keputusan ini amat penting untuk melakukan pengubahsuaian dalam aspek pemakanan, dos suntikan insulin, langkah tindakan segera jika berlaku hipoglisemia (glukosa dalam darah rendah) dan seumpamanya.

Cara-cara

Sebelum makan
Diuji pada awal pagi, sekurang-kurangnya 8 jam berpuasa dan sebelum bersarapan pagi.

Sasaran : < 6 mmol/L

Selepas makan
Diuji dua jam selepas makan.

Sasaran : < 8 mmol/L
Meter glukosa boleh diperoleh di pusat-pusat sumber atau farmasi.

Pemeriksaan sendiri ini hanya menggambarkan bacaan tahap glukosa pada masa pemeriksaan sahaja. Ia tidak menggambarkan kawalan keseluruhan diabetes anda.

Untuk mengetahui tahap kawalan keseluruhan diabetes, anda harus menjalani pemeriksaan darah HbA1c.

Bacaan HbA1c adalah dalam bentuk peratusan kerana ia menggambarkan peratusan tahap glukosa yang melekat pada dinding sel darah merah anda. Ia biasanya dilakukan di makmal perubatan hospital.

Siapa Yang Memerlukan?

* Semua penghidap diabetes.

* Pemeriksaan dan pemantauan sendiri ini amat penting terutamanya bagi penghidap diabetes yang menerima rawatan suntikan insulin, mengandung, pengidap yang selalu mendapat komplikasi seperti hipoglisemia (glukosa rendah) dan hiperglisemia (glukosa tinggi).

* Meter glukosa boleh diperoleh di pusat-pusat sumber diabetes dan farmasi-farmasi. Dapatkan khidmat nasihat mengenai penggunaan peralatan meter glukosa dalam darah dan cara-cara untuk mengubah cara pemakanan dan dos insulin anda.

Kekerapan

Ia bergantung kepada tahap kawalan glukosa, jenis rawatan yang diterima, sebarang komplikasi dan kemampuan dari segi ekonomi.

Jika penghidap diabetes menerima rawatan insulin, pemeriksaan seharusnya dilakukan setiap kali sebelum suntikan insulin atau mengikut arahan doktor.

Walaupun diabetes tidak boleh disembuhkan ia boleh dikawal dan pesakit boleh meneruskan kehidupan harian seperti orang normal.




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Quit Smoking for the Family That Loves You

If you are a smoker, you may justify your smoking habit by thinking that you are only hurting yourself. After all, you have made the choice to smoke, opening yourself up to numerous smoking related diseases, but you are not forcing those you love to do the same.

If you have ever thought about trying to quit smoking, do so now. Your family loves and needs you, and your smoking habit is going to take you from them sooner rather than later.

How Smoking Affects You

Cigarette smoking may have seemed harmless when you first started, but chances are you now know about the many diseases that affect male smokers and female smokers alike. Lung cancer, emphysema, bladder infections, and other kinds of cancer are all linked to smoking. Every time you smoke a cigarette, you are hammering a nail into your coffin.

Besides this, smoking affects you as a person. You begin to smell like smoke, no matter how careful you are about your smoking habit. Your teeth and fingers will be stained by tobacco as well. Your overall appearance will change with time, and your family will have to watch this transformation happen in front of them.

How Smoking Affects Your Family

While you may have told yourself that your smoking habit only affects you, this is simply not true. Your smoking habit affects everyone in your family, even the non-smokers. Your spouse and your children are exposed to secondhand smoke every single day. While not as dangerous as smoking directly, secondhand smoke can cause all of the same conditions that direct smoking causes. Imagine learning that your precious child has developed lung cancer because you exposed her to secondhand smoke. This is entirely possible.

According to the American Lung Association, secondhand smoke is responsible for 3,400 lung cancer deaths each year in adults who are nonsmokers. As many as 300,000 children develop dangerous lower respiratory tract infections because of secondhand smoke inhalation each year.

Secondhand smoke can even kill children. Each year over 400 babies die of sudden infant death syndrome (SIDS) due to exposure to secondhand smoke. By smoking near your children, you could be killing them.

How Smoking Affects Your Family's Budget

Have you been wondering how you will pay for your children's college education? If you quit smoking, you may be able to see this possibility. Smoking has a huge effect on your family's budget, draining funds that you could use to support the family you love so much.

Depending on where you live, the cost for a pack of cigarettes is probably around $4.00. If you are smoking one pack per day, which is fairly common, you are spending $1500 a year on your cigarette smoking habit. Imagine how much money that would be if you could invest that same $1500 in a college fund for the next 18 years.

You need to quit smoking for the family who loves you. By smoking, you are slowly killing yourself, robbing your children of a parent and your spouse of a lover. You are also putting your children in danger, and could potentially kill them. To top off all of these dangers, you are draining needed funds from your family 's budget. While it is not easy to quit smoking, you need to do so, because your smoking habit is destroying your family!




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Glaukoma Tiada Penawar

Pandangan mereka yang mengalami glukoma.

oleh Hafizah Iszahanid

Kebanyakan faktor penyakit sering dikaitkan dengan sejarah kesihatan keluarga. Bagaimanapun, di negara ini dan di kebanyakan negara Asia, sejarah perubatan keluarga ada kalanya tidak lengkap.

Sejarah perubatan mengenai masalah mata misalnya, jarang diberi perhatian apabila ramai yang tidak tahu mereka berisiko diserang glaukoma kerana tiada anggota keluarga sebelum ini mendapat rawatan.


Berbeza dengan katarak, glaukoma adalah penyakit yang diwarisi dan boleh terjadi kepada mereka yang mengalami trauma pada mata. Paling utama, tiada ubat untuk glaukoma dan ia boleh menyebabkan buta.



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Glaukoma penyakit yang progresif. Biasanya seseorang itu hanya menyedari mengalaminya selepas penyakit itu pada tahap akhir. Pada waktu itu, tidak banyak yang boleh dibantu kerana saraf matanya sudah rosak dan tidak boleh dipulihkan.

Pencuri Senyap

Jika katarak boleh sembuh dengan pembedahan, tetapi tidak pada glaukoma. Glaukoma hanya boleh dirawat tetapi tidak akan sembuh. Walaupun pembedahan boleh dilakukan tetapi ia tidak banyak membantu.

Ramai orang tidak menyedari mereka berhadapan dengan glukoma. Ia selalu dirujuk sebagai pencuri senyap kerana kerap kalinya tekanan di dalam mata menjejaskan penglihatan tanpa simptom yang jelas. Glaukoma bukan satu entiti penyakit tetapi sekumpulan masalah mata yang secara perlahan-lahan menjejaskan penglihatan.

Akhirnya, tanpa rawatan, glaukoma boleh menyebabkan buta berikutan kerosakan pada saraf optik.

Mata yang mengalami glaukoma.

Glaukoma menyebabkan saraf optik di belakang mata rosak perlahan-lahan. Bagi kebanyakan orang, peningkatan tekanan dalam mata menjadi punca dan menyebabkan sekatan pada pusingan cecair (aqueous) dalam mata.

Bagi pesakit lain pula, kerosakan itu mungkin berpunca daripada kekurangan bekalan darah kepada saraf fiber optik utama, kelemahan pada struktur saraf atau masalah pada saraf fiber itu sendiri.

Data Seluruh Dunia

Mengikut data Pertubuhan Kesihatan Sedunia (WHO), 4.5 juta orang di seluruh dunia menjadi buta disebabkan glaukoma dan angka ini dijangka meningkat kepada 11.2 juta pada 2020.

Namun, angka ini disifatkan sebagai tidak tepat kerana di seluruh pelusuk dunia, terutama di negara miskin, tidak ramai yang tahu dan tampil untuk membuat pemeriksaan mata atau menerima rawatan untuk glaukoma.

Dianggarkan 60.5 juta orang akan mengalami glaukoma pada 2010, dengan jumlah warga tua yang meningkat. Glaukoma dijangka menyerang 80 juta orang pada 2020.

Glukoma progres sifatnya, menyebabkan hampir 50% mereka yang didiagnos dengan glukoma tidak pernah menyedari simptom yang dialami. Biasanya, glaukoma dikesan pada usia 50 tahun ke atas.

Di Malaysia, glaukoma yang paling biasa adalah jenis glaukoma terbuka. Glaukoma jenis ini dikaitkan dengan peningkatan tekanan cecair di dalam mata. Ia mungkin menyebabkan kerosakan pada saraf optik dan akhirnya buta.

Tiada Ubat

Setakat ini, tiada ubat untuk glukoma tetapi pemeriksaan awal terutama bagi mereka yang lahir dalam keluarga yang mengalami glaukoma boleh dilakukan pada usia 30 tahun ke atas.

Oleh kerana tiada ubat menyembuhkannya, rawatan yang diberi hanyalah titisan ubat mata yang perlu digunakan sepanjang hayat. Ia bertujuan mengelak kebutaan. Namun, prekripsi ubat-ubatan banyak bergantung pada keadaan pesakit itu.

Jenis-jenis Glaukoma

Glaukoma utama

* Glaukoma sempit (narrow angle glaucoma)
* Glaukoma terbuka (primary open angle glukoma - POAG)
* Glaukoma tekanan normal (normal pressure glaucoma)

Glaukoma sekunder

* Glaukoma pseudoexfoliative (glukoma yang disebabkan sindrom gangguan berkaitan penuaan)
* Glaukoma pigmentary (glukoma yang disebabkan pengumpulan pigmen iris berlebihan)
* Glaukoma yang disebabkan trauma
* Glaukoma neovaskular (berikutan komplikasi masalah diabetes misalnya)
* Glaukoma konjenital (di kalangan bayi dan dikesan sejak lahir)

Siapa Yang Berisiko Mengalami Glaukoma

+ Mereka yang berusia 50 tahun ke atas
+ Sejarah keluarga dengan glukoma
+ Merokok
+ Trauma pada mata
+ Mereka yang menderitai diabetes, tekanan darah tinggi
+ Rabun jauh

Simptom

Glaukoma terbuka

* Lihat penglihatan perlahan-lahan (peripheral) selalunya membabitkan kedua-dua mata
* Penglihatan sehala seakan terowong pada tahap yang teruk (tunnel vision)

Glaukoma sempit

* Sakit mata yang serius
* Muntah dan pening diikuti dengan sakit mata
* Penglihatan kabur
* Mata merah


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Kidney Cancer

This CT image indicates an abnormal mass in the left kidney.

by Dr Clarence Lei and Datuk Tan Hui Meng

There is no definite cause of kidney cancer. It accounts for 3% of all adult cancers, usually in the 5th to 7th decade of life. It occurs twice as common in men than women.

According to the National Cancer Registry for Peninsula Malaysia 2003, the kidney cancer incidence per 100,000 population in Malaysia is 1.7. This incidence rate increases to 15.6 per 100,000 population for males in the age group 60 to 69 years.

Some kidney cancers run in families and an increasing number of cases have been shown to occur this way. Patients known to have polycystic disease of the kidneys and advanced kidney failure are also more prone to develop kidney cancer.

What Are The Symptoms of Kidney Cancer?

Renal tumours are increasingly diagnosed with more widespread use of imaging techniques, e.g. ultrasound or scans. Patients with significant kidney cancers would present with blood in the urine.

In less than half the cases, the patient may actually notice a fullness or lump in the loin or the abdomen. One-third of patients may have non-specific syndromes, e.g. tiredness, fever or loss of weight.

About 20% of patients would already have the cancer spread to other organs and the symptoms may be referred to these organs, e.g. the lung, brain or bone.

In a series of 169 consecutive cases of kidney cancer operated on in a local medical centre :

* 65% were male and 35% female
* the age range was from 22 to 90 years, with a mean age 58.8 years
* 22% presented with back pain, 43.3% with blood stained urine and 12% had loss of appetite and weight
* 63% had duration of symptoms below 6 months, 23% had absolutely no complaint and the tumour was detected by routine ultrasound scan of the abdomen.

What Investigations Are Needed to Diagnose Kidney Cancer?

Unfortunately, there is no simple tumour marker (from a blood test) to screen for kidney cancer. Urine examination may show blood in the urine (haematuria), but there are many causes of haematuria, including cancers, urinary stones, infection or just inflammation.

The screening test of choice is usually an ultrasound scan. Ultrasound scans will be able to exclude non-cancerous lesions e.g. kidney cysts which are filled with fluid, or lipoma or fat containing benign tumours. Such fatty tumours often contain some muscle as well as vascular components and these tumours are known as angiomyolipoma.

Otherwise, more than 90% of solid masses of the kidney are cancerous. Therefore, renal masses are usually not subjected to the risk of a percutaneous biopsy.

At the time of the scan (usually ultrasound followed by CT or computerised tomogram), particular attention is needed to detect whether there is any local spread of the cancer to the nearby renal vein, which drains into the large main vein of the body known as the inferior vena cava (IVC).

Any enlargement of the nearby lymph nodes may indicate spread of the cancer.

What is The Treatment of Renal Cancer?

Surgery is the mainstay treatment. However, surgical cure is only possible if the tumour is in the early stages when the tumour is still confined to the kidney, i.e. Stage T1 or T2 (T2 when the tumour is more than 7cm).

Locally advanced stages include Stage T3 when the tumour extends to the tissues (including veins) near the kidney and T4 is when the tumour extends beyond the kidney fascia.

In about 25% of cases, the cancer would have spread beyond the kidney into the lymph nodes (N+) or to the distal organs e.g. the lung, brain or bone (M+).

Therefore, if there is any symptom attributable to these organs, further imaging in the form of CT scan of the lung, brain or bone scan is warranted.

What Types of Surgery Are Available For The Treatment of Kidney Cancer?

The standard surgical treatment is open surgery to remove the kidney cancer with the entire kidney. However, if the patient’s other kidney has poor function, this may result in the patient dependent on dialysis.

In such cases, efforts can be made to preserve some renal tissues in the kidney with the cancer and the procedure is known as a partial nephrectomy as compared to a radical nephrectomy (nephrectomy = surgical removal of kidney).

Partial nephrectomy is also indicated in patients who have tumours in both kidneys as removing both kidneys would mean the patient would be dependent on dialysis.

However, if it is technically not possible to do partial nephrectomy, a total nephrectomy would be indicated to remove the cancer as it is usually more important to be cancer-free and rely on dialysis, rather than to die from residual kidney cancer!

What About Small Renal Tumours That Are Found on Routine Scanning?

With widespread use of ultrasound and CT scan, many asymptomatic small renal tumours have been diagnosed. According to clinical studies (e.g. a recent study on 287 small renal tumours published in the September 2006 issue of the Journal of Urology), solid renal tumours more than 3 cm are likely to be cancerous. Therefore, renal tumours more than 3cm should be removed surgically.

What About Various Types of 'Keyhole' Surgery for Renal Tumours?

In addition to open surgery for renal tumours, some centres have the facilities for laparoscopic surgery. In addition, in centres with a surgical robot (the 'Da Vinci' system), robot assisted laparoscopic surgery can be performed.

Other energy sources may be used to ablate the renal tumours, e.g. radio frequency (RF), high intensity focussed ultrasound (HIFU) and freezing (cryosurgery).

The energy source can be delivered percutaneously or by laparoscopic means and under ultrasound guidance. However, these techniques cannot reliably ablate all the tumour cells and are only indicated in special situations e.g. multiple superficial tumours in patients who are not fit surgery.

What Is The Treatment For Kidney Cancer That Has Spread To The Other Organs?

There is still a role for open surgery if the lesion in the lung or brain is solitary and is stable. Such lesions can be removed by surgery.

In patients whose cancer has spread outside the kidney, those lesions can be treated by systemic therapy. Before systemic therapy, the large primary tumour in the kidney should be removed to improve the effectiveness of the systemic therapy.

There are 2 forms of systemic therapy for such metastatic renal cancer, namely, immunotherapy with agents such as interferon to boost the patient's immune system against the cancer cells.

In 2007, new agents (e.g. sunitinib and sorafenib) have been used with some effect against metastatic renal cancer. These agents work by reducing the growth factor supplied to the tumour via the new vessels (i.e. anti-angiogenesis action). However, these new drugs are extremely expensive.

Radiation is not effective against renal cancer.

What Is The Long-term Outcome and Follow-up of Kidney Cancer?

For early stage renal cell carcinoma, the five-year survival rate is more than 80% after removal of the tumour and kidney. After the surgery, the patient is usually followed up to 3 to 6 monthly with imaging (chest x-ray, ultrasound or CT) for 3 years, and thereafter, yearly for life.

For patients who have metastatic disease, the follow-up is usually on a 1 to 2 months' basis to monitor the progress of the cancer in response to the systemic therapy.

Once the tumour has spread out of the kidney, the long-term prognosis is poor.


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Cegah Pneumonia


oleh Norlaila Hamima Jamaluddin

Kita jarang dengar kisah orang terlantar akibat pneumonia atau keradangan paru-paru, tetapi ia sering berlaku, terutama jika pesakit masih kecil (kurang dari 2 tahun) atau berumur (lebih 65 tahun), daya ketahanan badan lemah serta menghidap penyakit kronik lain.

Pneumonia (atau selalu dipanggil paru-paru berair) adalah jangkitan kuman sama ada virus, bakteria atau fungus pada paru-paru. Apabila seseorang menghidap pneumonia, dia mengalami masalah sukar bernafas, sakit dada, batuk teruk (sama ada berkahak atau tidak) serta demam panas.

Sistem Pernafasan

Sistem pernafasan kita bermula dari hidung dan mulut, di mana udara disedut masuk dan dihembus keluar. Saluran udara dari hidung dipanggil nasofarinks, manakala saluran udara dari mulut pula orofarinks. Kedua-dua saluran ini bertemu dan bersatu menjadi larinks.

Orofarinks (saluran udara dari mulut) juga membawa bahan yang ditelan seperti makanan, air dan air liur. Semua bahan ini perlu masuk ke esofagus sebelum sampai ke perut.


Larinks kita dilindungi satu 'pintu' yang dipanggil epiglotis. Pintu ini menghalang kemasukan bahan yang ditelan daripada memasuki larinks dan sampai ke paru-paru.

Dari sini larinks bersambung ke trakea yang bercabang dua (dipanggil bronkus kiri dan kanan) dan di hujungnya ada banyak lagi cabang kecil. Di setiap hujung bronkus kecil terletak paru-paru yang membabitkan kantung udara kecil. Di sini berlaku pertukaran oksigen dan karbon dioksida ketika kita bernafas.

Bebas Kuman

Sistem pernafasan kita adalah steril, iaitu bebas daripada kuman. Ia juga ada beberapa 'barisan pertahanan' untuk memastikan sistem pernafasan sentiasa bersih.

Yang pertama ialah bulu hidung yang berfungsi sebagai penapis untuk menghalang partikel besar masuk ke saluran pernafasan.

Kedua ialah epiglotis. Seperti diterangkan di atas, ia umpama pintu untuk menghalang kemasukan bahan yang ditelan ke dalam saluran udara. Apabila ada bahan 'tersesat' masuk, kita batuk atau bersin secara automatik untuk menolak keluar bahan 'sesat' tadi.

Ketiga ialah kelenjar liur yang menghasilkan air liur. Ia memerangkap habuk dan mikro organisma berbahaya. Di dalam saluran pernafasan kita juga ada rerambut halus dipanggil silia, yang bertugas sebagai 'penyapu' untuk membersih dan menolak kekotoran terperangkap ke luar. Mekanisme ini dipanggil sistem pembersihan mukosiliari.


Pertahanan Lemah

Jadi, apabila ketahanan sistem pernafasan (termasuk refleks batuk dan sistem pembersihan mukosiliari) kita lemah, mikro-organisma berbahaya boleh masuk dan menyebabkan keradangan pada paru-paru.

Selain itu, kita boleh mengalami pneumonia jika sistem imun badan lemah dan tidak mampu menghalang kuman (daripada jangkitan yang terhasil akibat menyedut aerosol, menelan lendir atau rembesan mulut dan farinks) memasuki saluran pernafasan dan paru-paru.

Kemerosotan pertahanan badan biasanya berlaku pada pesakit kencing manis (terutama jika tidak terkawal), kanser, buah pinggang kronik, strok atau individu yang mengalami kerosakan sistem pertahanan paru-paru.

Contohnya pesakit strok mudah mendapat pneumonia kerana refleks batuk mereka menjadi lemah dan perokok pula biasanya ada masalah pada sistem pembersihan mukosiliari. Bagaimanapun, pada perokok, keberkesanan sistem ini kembali normal jika berhenti merokok.


Jenis dan Punca

Pneumonia ada banyak jenis, daripada yang ringan hingga boleh mengancam nyawa, tetapi umumnya ia dibahagikan kepada 2 kategori iaitu :

1. Pneumonia yang diperoleh dari komuniti (jangkitan berlaku di luar sebelum dimasukkan ke hospital) atau pesakit menunjukkan gejala jangkitan dalam masa kurang 48 jam selepas ditahan di dalam wad.

2. Pneumonia yang diperoleh ketika di hospital. Gejala penyakit hanya muncul selepas lebih 48 jam pesakit dimasukkan ke hospital dan dipastikan tiada punca jangkitan lain. Ia juga dipanggil jangkitan nasokomial dan biasanya lebih teruk serta membabitkan bakteria yang lebih berdaya tahan terhadap ubat.

Bagaimana boleh berlaku jangkitan di hospital? Pembiakan bakteria pada farinks dan perut boleh dirangsang dengan kemasukan tiub endotrakeal dan tiub nasogastrik ke dalam saluran pernafasan bagi pesakit yang memerlukan bantuan alat pernafasan. Jadi bakteria ini bertambah banyak dan menyerang paru-paru.

Banyak faktor boleh menyebabkan jangkitan di hospital, antaranya ketahanan badan pesakit lemah, kurang zat, umur lanjut, menghidap penyakit kronik dan hilang kesedaran.

Klasifikasi ini penting untuk membolehkan doktor mengenal pasti kuman yang menyebabkan keradangan paru-paru kerana ubat yang diberi berbeza mengikut kuman penyebabnya. Pun begitu, dalam kebanyakan kes (40 hingga 60%) penyebab pneumonia tidak dapat dipastikan dengan tepat dan hampir 5% kes disebabkan jangkitan sekurang-kurangnya 2 jenis kuman.



Bakteria

Banyak mikro-organisma boleh menyebabkan pneumonia, sama ada bakteria, virus atau fungi. Jenis mikro organisma ini pula berbeza mengikut jenis jangkitan, sama ada yang berlaku di dalam komuniti atau di hospital.

Bagi jangkitan yang berlaku dalam komuniti, penyebab utama pneumonia ialah bakteria, khususnya bakteria streptococcus pneumoniae yang menyebabkan lebih dua pertiga kes keradangan paru-paru.

Bakteria lain yang juga boleh menyebabkan pneumonia ialah haemophilus influenza, chlamydia pneumoniae, staphylococcus aereus, klebsiella pneumoniae dan spesies legionella. Manakala virus yang menyebabkan jangkitan pneumonia komuniti ialah adenovirus, virus sinsitium pernafasan dan parainfluenza.

Jangkitan di hospital membabitkan bakteria yang lebih berdaya tahan. Ini kerana di hospital ada ramai pesakit yang diberi pelbagai jenis antibiotik mengikut keperluan masing-masing. Penggunaan pelbagai antibiotik ini boleh merangsang pembiakan bakteria yang lebih berdaya tahan kepada banyak jenis antibiotik.

Antara bakteria yang menyebabkan jangkitan paru-paru di hospital ialah pseudomonas aeruginosa, enterobacter, klebsiella pneumoniae, escherichia coli, acinebacter selain fungus dan mikrobakteria.


Tanda dan Gejala

Beberapa golongan berisiko untuk mendapat pneumonia iaitu:

* pesakit yang menghidap penyakit kronik
* orang tua
* kanak-kanak
* perokok tegar
* bekas pesakit tibi (terutama jika tibi yang dialaminya serius sehingga menyebabkan paru-paru berparut)

Baik jangkitan dalam komuniti atau di hospital, gejala yang dialami pesakit adalah lebih kurang sama seperti :

+ demam panas (39° Celsius)

+ batuk, sama ada berkahak atau tidak. Jangkitan bakteria boleh menyebabkan kahak berwarna coklat atau nampak berkarat. Kadangkala pesakit alami batuk berdarah

+ mengalami masalah pernafasan (sesak nafas, nafas pendek)

+ dada terasa ketat

+ sakit dada

+ tiada selera makan

+ sakit kepala

Gejala yang disenaraikan di atas bersifat umum dan biasa berlaku setiap kali kita demam. Adalah disarankan pesakit meminta doktor menjalankan ujian lanjut jika demam dan batuk masih tidak berkurang selepas 3 atau 4 hari mengambil ubat.

Dinasihatkan agar jangan suka bertukar doktor, daripada A ke B apabila didapati masalah kesihatannya tidak berkurang. Cara yang baik ialah bertemu semula doktor sama supaya ujian selanjutnya boleh dijalankan kerana dia ada rekod kesihatan anda.


Ujian Lanjut dan Rawatan

Banyak ujian boleh dilakukan ke atas pesakit, antaranya pemeriksaan sinar-x dada, ujian darah (untuk mengetahui jumlah sel darah, fungsi buah pinggang dan hati) serta ujian kahak bagi mengenal pasti kuman dan membuat pemeriksaan untuk tuberkulosis (tibi).

Hasil pemeriksaan ini, doktor boleh menentukan jenis antibiotik yang perlu diberi. Jenis antibiotik bergantung kepada kuman yang disyaki menyebabkan keradangan paru-paru.

Antara antibiotik yang sering digunakan ialah penisilin, macrolides dan fluroquinolones yang diberi secara oral (makan) kepada pesakit yang dirawat sebagai pesakit luar (dikategorikan mengalami pneumonia ringan).

Pesakit di dalam hospital pula diberi antibiotik secara suntikan intravena (ke dalam salur darah) kerana rata-rata pesakit lemah dan membolehkan badan menyerap ubat dengan lebih baik.

Siapa memerlukan rawatan antibiotik di hospital (suntikan)?

* Pesakit berumur (lebih 50 tahun) atau kanak-kanak

* Pesakit yang menghidap penyakit kronik (kencing manis, sakit buah pinggang, penyakit jantung kongestif dan barah)


Pesakit diberi suntikan antibiotik intravena kerana ketika ini kadar penyerapan ubat kurang baik dan kadangkala mengalami masalah tidak cukup air dalam badan. Bagaimanapun, sebelum memberi suntikan antibiotik intravena, doktor melakukan pemeriksaan fizikal terlebih dulu dan antara ciri yang diperhatikan ialah :

+ pesakit mengalami demam panas
+ nadi dan degupan jantung laju
+ pesakit tidak sedarkan diri atau kelihatan keliru
+ pernafasan laju
+ pesakit sukar bernafas
+ tekanan darah menurun
+ berdasarkan hasil ujian darah dan pemeriksaan sinar-x dada

Pencegahan

Walaupun banyak jenis kuman boleh menyebabkan pneumonia, penyakit ini boleh dicegah dengan mendapatkan perlindungan daripada vaksin iaitu vaksin influenza dan vaksin pneumokokal.

Vaksin influenza bertujuan mencegah pneumonia yang disebabkan virus influenza dan ia perlu diambil setiap tahun. Vaksin diberi kepada:

* pesakit berumur lebih 65 tahun
* warga emas yang tinggal di rumah orang tua
* pesakit yang menghidap penyakit kronik, termasuk sekatan pulmonari kronik (COPD yang biasanya berlaku pada perokok)
* pesakit jantung, terutama yang mengalami kegagalan jantung kongestif


Suntikan vaksin pneumokokal pula memberi perlindungan daripada jangkitan bakteria streptococcus pneumoniae. Bagi kebanyakan orang, vaksin ini hanya perlu diambil sekali seumur hidup dan disarankan bagi orang yang mahu menunaikan haji di Makkah.

Vaksin ini diberi kepada :

+ orang berumur (lebih 65 tahun)

+ pesakit kronik (kencing manis, COPD, pesakit buang pinggang, pesakit jantung kongestif dan orang yang menghidap penyakit hati kronik)

+ penghidap penyakit yang merendahkan sistem imun badan seperti kanser, leukemia, mengalami jangkitan HIV. Bagi pesakit ini, mereka perlu mengambil vaksin ulangan setiap enam tahun.

Pesakit kronik lain perlu mendapatkan suntikan vaksin ulangan selepas berumur 65 tahun jika suntikan pertama diberi sebelum menjangkau 65 tahun. Maknanya jika pesakit mendapat suntikan vaksin ketika berumur 50 tahun, dia perlu mendapatkan vaksin ulangan apabila berumur 65 tahun dan diulang sekali lagi pada umur 71 tahun.

Jangkitan Serius

Pneumonia adalah jangkitan serius dan perlu diberi perhatian segera. Kadar kematian akibat pneumonia di negara kita tinggi iaitu kira-kira 30% yang membabitkan semua peringkat umur. Justeru, apabila anda demam panas dan batuk teruk yang tidak berkurang selepas tiga atau empat hari mengambil ubat, segera jalani pemeriksaan lanjut, terutama bagi pesakit tua dan kanak-kanak.

Perkara paling penting ialah mematuhi jadual pengambilan antibiotik yang mesti dihabiskan semuanya. Walaupun pneumonia boleh dicegah dan dirawat, ia jangkitan serius yang boleh membawa maut.


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Explaining Anaemia

Peripheral blood smear microscopy of a patient with iron-deficiency anemia.

Anemia is a condition that many do not know about. Because of this, and because the symptoms are subtle, it can go undetected for years.

Studies are showing that anaemia can seriously compromise the quality of one’s life, so it’s best you know how to minimise or prevent it.

What Is Anaemia

Anaemia is a blood disorder caused by the lack of haemoglobin in your body. Iron is required to make haemoglobin, which helps transport oxygen around your body.

A shortage of iron is the most common cause of anaemia worldwide, known as iron-deficiency anaemia. It also be caused by blood loss, either sudden (when a stomach ulcer erupts) — or over time, such as when a woman experiences a heavy menstrual flow. Poor dietary habits can bring it on too.

Other causes include :

* Underlying conditions or chronic diseases, such as inflammatory bowel disease, cancer, rheumatoid arthritis and kidney failure.

* Lack of vitamins B12 and folic acid, which are also needed to make properly functioning red blood cells.

* Damaged bone marrow (where the red blood cells are made), which leads to a shortage of good red blood cells. This is a rare and deadly form of anaemia called aplastic anaemia.

* When red blood cells are destroyed by the body too quickly, haemolytic anaemia results. This is often the result of an inherited condition, such as sickle cell anaemia.

Those At Risk

Some have a higher risk of developing the disease due to their makeup, lifestyle or dietary habits. These include:

* Teenage girls and women who have heavy periods.

* Pregnant women. A woman’s blood volume expands by almost 50% when she is with child. Her body is now trying to make up for the increased need by producing more red blood cells, leading to depleted iron supplies. At least 20% of all pregnant women are affected.

* Those who have undergone an operation and suffered extreme blood loss.

* Athletes. In their race for high energy levels, athletes tend to consume more carbohydrate-rich foods, leaving out foods packed with iron.

When a Medical Diagnosis is Needed

You should see a doctor when any of the following symptoms show up : lethargy, weakness, feeling faint and dizziness. Severe symptoms of anaemia include palpitations, shortness of breath, sore mouth and gums, headaches, a pale pallor and brittle nails.

Treating Anaemia

Once you find out the cause, then you can determine the treatment. If you are confirmed anaemic due to iron deficiency, you need a diet filled with iron-rich foods.

Iron is found in meat, liver, cereals, raw green vegetables and fortified foods. It is advisable to eat foods containing vitamin C together with non-meat sources of iron because this boosts iron absorption. Good sources of vitamin C include peppers, brussel sprouts, sweet potatoes, oranges and kiwi fruit.

Importance of Iron Supplements

If diet alone fails to meet your needs, ask your doctor about iron supplements. Sometimes it’s advisable to turn to iron supplementation to quicken the process. Your doctor will advise how much you should take, and monitor your progress accordingly.


More info on ANAEMIA here.






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Penyakit Tangan, Kaki dan Mulut (HFMD)


oleh Dr Syed Nazir Syed Kadir

Penyakit tangan, kaki dan mulut (hand, foot and mouth disease - HFMD) adalah penyakit jangkitan virus yang akut (keadaan penyakit yang menyerang dengan cepat, gejala teruk tetapi berlaku dalam masa singkat). Ia biasanya bermula dengan gejala lecur dalam mulut yang pecah. Lecur ini juga boleh berlaku pada tangan, kaki, punggung dan kemaluan.

Dalam kebanyakan kes, HFMD disebabkan virus coxsackie jenis 16 (CV16). Bagaimanapun, penyakit ini juga kerap dikaitkan dengan virus coxsackie lain seperti A5, A7, A9, A10, B2 dan B5. Di rantau Pasifik Barat, enterovirus 71 (EV-71) juga pernah menyebabkan letusan penyakit ini.

HFMD yang menyerang kanak-kanak berbeza dengan penyakit tangan, kaki dan mulut pada haiwan. HFMD biasanya berlaku pada kanak-kanak di bawah umur 10 tahun.

Yang membimbangkan ialah, penyakit ini mudah berjangkit dan merebak. Kebanyakan orang dewasa ada pengalaman mendapat penyakit ini. Selain menyebabkan ketidakselesaan, HFMD jarang menyebabkan komplikasi penyakit yang teruk atau kematian.

Jangkitan

Jangkitan berlaku dalam rantaian najis ke mulut atau melalui sentuhan kulit yang mengalami lesi (nampak seperti kudis) atau air liur individu yang dijangkiti.

Apabila dijangkiti, kumin virus (partikel halus dari virus) akan memasuki aliran darah (keadaan ini dipanggil viremia).

Ini diikuti serangan pada kulit dan membran mukus (lapisan lembap yang mengalas beberapa struktur dan rongga seperti saluran pernafasan dan sinus hidung). Dari sini lesi akan muncul di dalam mulut dan pada kulit sebelum merebak ke kawasan lain.

Komplikasi

HFMD yang disebabkan virus coxsackie adalah penyakit yang tidak berbahaya dan mengehadkan pergerakan seseorang.

Biasanya ia hilang dalam masa tujuh hingga 10 hari. Jarang berlaku HFMD yang berulang atau berpanjangan. Malah, kes HFMD yang menyebabkan komplikasi serius juga sangat jarang terjadi.

Individu yang diserang HFMD boleh mengalami beberapa ulser pada mulutnya. Keradangan pada ulser ini menyebabkan mulut sakit dan kanak-kanak biasanya enggan makan atau minum.

Masalah kekeringan atau tidak cukup air adalah komplikasi biasa pada pesakit yang mengalami HFMD.

Kadangkala seseorang itu boleh mengalami HFMD dan meningitis aseptik (meningitis steril pada selaput otak) serentak. Namun bagaimanapun kes seperti ini jarang berlaku.

HFMD yang disebabkan EV-71 mempunyai kadar insiden lebih tinggi yang membabitkan saraf, namun komplikasi kardiologi seperti keradangan otot jantung (miokarditis), keradangan paru-paru dan pulmonari edema (paru-paru bengkak atau mengandungi cecair yang menyebabkan susah bernafas) jarang berlaku.

Tanda dan Gejala

Gejala HFMD biasanya bermula 3 hingga 7 hari selepas mendapat jangkitan. Gejala ini boleh berakhir dalam tempoh tujuh hingga 10 hari dan pesakit biasanya tidak perlu dimasukkan ke hospital. Antara tanda dan gejala lazim ialah :

* Demam panas
* Sakit tekak
* Melepuh (kecil) di dalam mulut, tepi lidah, tapak tangan, jari, tapak kaki, punggung dan kemaluan. Ia tidak gatal, tidak seperti cacar air
* Hilang selera makan
* Berasa letih dan lesu

Pada permulaan, tanda lepuh ini terdapat di dalam mulut (di bahagian pipi), lidah dan lelangit. Tanda ini akan membesar dengan cepat menjadi gelembung berisi cecair.

Lebih kurang 75% pesakit HFMD akan mengalami gejala ini diikuti demam panas selama 24 hingga 48 jam.

Bagaimana HFMD Merebak?

Cara utama virus coxsackie merebak ialah melalui sentuhan cecair dari tempat yang melepuh dan cecair hidung, mulut atau dada (tersebar apabila pesakit batuk atau bersin). Virus ini boleh ada di dalam usus selama beberapa minggu selepas seseorang dijangkiti dan keluar bersama najis.

Cara terbaik untuk mengelak penyakit ini ialah :

+ Mencuci tangan dengan bersih selepas menyentuh cecair badan daripada pesakit

+ Tidak berkongsi pinggan mangkuk, sudu garfu, cawan, tuala, berus gigi dan baju

+ Pesakit perlu berehat di rumah. Jangan benarkan anak anda ke sekolah, tadika, taman permainan atau pusat jagaan kanak-kanak hinggalah semua lepuh kering kerana kanak-kanak adalah agen penyebar penyakit paling cepat.

Diagnos dan Rawatan

HFMD mudah didiagnos melalui ciri klinikal seseorang pesakit tanpa memerlukan ujian makmal.

Oleh kerana HFMD disebabkan jangkitan virus, tiada rawatan khusus untuknya dan anda tidak perlu meminta doktor memberi antibiotik kerana ia tidak berkesan (antibiotik hanya untuk membunuh bakteria, bukan virus).

Bagaimanapun, pesakit akan diberi ubat tahan sakit untuk mengurangkan kesakitan di dalam mulutnya. Antara cara yang boleh dilakukan untuk mengurangkan ketidakselesaan anak ialah :

* Beri anak minum, sedikit demi sedikit tetapi kerap untuk mengelakkan masalah kekurangan air

* Biarkan lepuh kering sendiri, jangan dipecahkan

* Jika anak anda sakit kepala, tegang leher atau sakit belakang, bawa anak ke hospital. Ini kerana dalam sesetengah kes (walaupun sangat jarang berlaku), pesakit HFMD boleh mengalami keradangan otak (ensefalitis), meningitis atau polio

Ingatan!

+ HFMD sangat mudah merebak dan pesakit perlu berehat di rumah

+ HFMD bukan penyakit berbahaya sehingga meragut nyawa

+ Tiada rawatan khusus, vaksin atau penawar untuk HFMD

+ Jika anak anda alami gejala teruk (termasuk sakit kepala, tegang leher dan sakit belakang), segera bawa ke hospital

+ HFMD tidak memberi risiko kepada wanita mengandung atau anak dalam kandungan


Lagi info tentang HFMD di sini.






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Hitting The G-Spot


by Datuk Dr Nor Ashikin Mokhtar

The G-spot is probably the most talked-about aspect of sexual relations as it is believed to be able to produce very powerful female orgasms. Yet, it remains elusive to many.

For many women (and men), finding the G-spot is practically a lifetime endeavour. Some may never find it, but half the fun is in the finding!

Does It Exist?

Is the G-spot real, or just an idea cooked up by a woman to make things more challenging for men? Well, conventional wisdom indicates that it does exist in some women but not in others, and that the sensitivity varies for every woman.

The G-spot is an area located about one to two inches inside the vagina on the front wall (the 'front' wall is the wall of the vagina on the same side as the belly button). The area consists of the bean-shaped spongy tissue of the paraurethral gland – it is to women what the prostate is to men.

When a woman is not sexually aroused, the actual area is no bigger than a pea, but once she is aroused, it increases to the size of a small coin. This is because the G-spot is composed of erectile tissue and swells up when blood rushes to it.

It feels rougher to the touch than the surrounding tissue, rather like a walnut compared to the smooth, silky wall of the vagina.

It was named after a gynaecologist called Dr Ernst Gräfenberg, who first described the G-spot in the 1940s.

Finding It

So how does one find this mysterious spot? The most commonly recommended method is to insert the forefinger and crook it into a 'come here' motion towards the front vaginal wall, sliding your fingertip along the top of the vagina until you find an area that is rougher than the rest of that vaginal wall.

Foreplay is important because a woman will be more sensitive if she is already sexually aroused. Experiment with the pressure and length of the stroke to find out what feels best.

Some women do not enjoy manual stimulation of the G-spot, but may enjoy penile stimulation during intercourse. It helps if the man’s penis has a natural upward bend and is able to make contact with the G-spot, but different positions may also work, such as the 'woman on top' or the posterior position, or raising the woman’s pelvis.

It’s quite likely that you will not be able to find the G-spot on your first try. Women should not be shy to tell their partners what they are feeling during stimulation, and what feels particularly sensitive.

Gee, What Does It Feel Like?

Different women have described different sensations with stimulation of the G-spot. Some women say that the first sensation is similar to the need to urinate – this is possibly because the G-spot is on the front wall, therefore pushing against the bladder.

However, when you become comfortable with it, you may be fortunate enough to experience a powerful orgasm, or even multiple orgasms if the G-spot is stimulated repetitively.

Some women even claim to ejaculate when their G-spot is stimulated. Research shows that approximately 10% of women release between 9ml and 900ml of fluid from the urethra during such an orgasm.

G-Spotless?

Despite all the hype built up around the G-spot, we have to face the fact that not all women are G-spot-sensitive. Some women actually find G-spot stimulation to be uncomfortable or simply produce no sensation at all.

It is believed that women can intensify their ability to have G-spot orgasms by doing Kegel exercises to strengthen their pelvic floor muscles.

Age may also make a difference in the type of orgasms women achieve. For most young women under 30, their relatively high oestrogen levels lead to thicker vaginal walls. Hence, it is more difficult to directly stimulate their G-spot area.

After their 30s, however, women’s oestrogen levels begin to decline, causing the vaginal lining to become thinner and the G-spot to become more accessible. So you may find G-spot orgasms more likely during your early to mid-30s.

Nonetheless, you don’t have to build your entire sex life around that little area known as the G-spot. If you and your partner take it too seriously, it may even end up ruining your enjoyment of sex.

If you don’t have a sensitive G-spot, just accept it. The clitoris and urethra are other erogenous zones that can be stimulated to provide pleasure. So experiment and explore other ways to improve your sex life.




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Kanser Prostat - Lelaki Jangan Malu

Kata-kata Inggeris 'life begin at 40' (hidup bermula pada usia 40 tahun) mungkin bukan lagi dianggap tepat bagi menggambarkan kehebatan lelaki.

Walaupun pada usia itu lelaki mungkin dianggap berada pada puncak kehidupannya sama ada dari segi ekonomi dan sosial, hakikatnya ia adalah garis yang menandakan bermulanya 'penurunan' fizikal mereka.

Sama seperti wanita yang menghadapi pelbagai risiko penyakit, kaum lelaki pada usia tersebut turut tidak terlepas daripada mengalami masalah sama.

Namun, sehingga kini kesedaran lelaki berbanding wanita untuk melakukan pemeriksaan bagi mengetahui tahap kesihatan mereka dilihat begitu berbeza. Malah, tidak keterlaluan jika ia dikatakan menjadi faktor penyebab utama kenapa golongan ini turut terdedah kepada pelbagai risiko penyakit yang boleh membawa kematian, termasuk kanser prostat.

Pemeriksaan Awal

Dalam kebanyakan kes, hampir 80% pesakit datang untuk mendapat rawatan sudah berada pada peringkat 3 dan 4 peringkat yang mana pesakit sukar diselamatkan.

Kanser prostat boleh dicegah sekiranya menjalani pemeriksaan awal. Ini terutamanya bagi mereka yang mempunyai sejarah ahli keluarga sama ada bapa atau datuk menghidapi penyakit tersebut.

Untuk itu mereka perlu menjalani pemeriksaan kesihatan seawal usia 40 tahun lagi, manakala bagi yang tidak mempunyai sejarah tersebut digalakkan melakukan pemeriksaan apabila memasuki usia 50 tahun.

Simptom

Menurutnya, selain tidak menunjukkan apa-apa simptom, rasa malu dan ego antara penyebab utama lelaki lebih rela menderita dalam diam daripada menjalani sebarang pemeriksaan kesihatan. Lebih-lebih lagi, tidak ramai lelaki bersedia membincangkan masalah membabitkan anggota sulit.

Seperti kanser lain, kanser prostat mengambil masa lama untuk 'membesar' dan pada peringkat awal biasanya tidak menunjukkan sebarang tanda hinggalah di peringkat serius.

Masalah kelenjar prostat biasanya berlaku kepada lelaki berumur 50 tahun ke atas terutama lewat 60-an atau awal 70-an. Namun, ia masih boleh berlaku lebih awal, khususnya bagi lelaki yang ada sejarah masalah kelenjar prostat di kalangan keluarga rapat.

Benjolan

Begitupun, punca terjadinya kanser prostat masih tidak diketahui, tetapi ia bermula dengan satu benjolan kecil pada kelenjar tanpa menunjukkan sebarang gejala.

Pun begitu, ada juga kes kanser prostat menunjukkan gejala sama seperti masalah prostatik hiperplasia benigna (BPH) iaitu ketumbuhan prostat bukan kanser yang menyebabkan kelenjar prostat membengkak dan pesakit sukar membuang air kecil.

Selain itu, pesakit mungkin menghadapi masalah sentiasa terasa hendak kencing dan kerap buang air kecil. Bagaimanapun, gejala ini lazimnya hanya timbul selepas sel kanser membesar sehingga boleh menekan saluran uretra dan menyekat laluan air kencing.

Pada peringkat serius, kanser prostat boleh menyebabkan kencing berdarah atau pesakit tidak boleh kencing langsung. Tetapi, bagi sesetengah kes, gejala hanya muncul apabila sel kanser merebak ke anggota badan lain seperti tulang (pinggul dan rusuk) dan buah pinggang.

Sel kanser prostat ini juga boleh merebak ke otak (yang menyebabkan sawan, sakit kepala, letih dan masalah saraf lain) dan tulang belakang (mengakibatkan rasa sakit, kebas dan tidak dapat menahan kencing).

Rawatan

Perkembangan kanser prostat yang lambat dan ketiadaan simptom membuatkan ujian pengesanan bagi merawat kanser pada peringkat awal menjadi sukar.

Kesedaran mengenai kanser tersebut juga masih berkurangan berikutan tidak ramai yang benar-benar memanfaatkan teknologi terkini pembedahan membuang prostat yang diperkenalkan di negara ini sejak 2004.

Pembedahan dinamakan Sistem Robotik da Vincci, yang mula diperkenalkan di Hospital Kuala Lumpur pada pertengahan 2004 itu, biarpun terbukti mempunyai banyak kelebihan berbanding pembedahan konvensional, ia dilihat masih tidak mampu mengurangkan ketakutan pesakit untuk melakukan pembedahan membuang kanser prostat.

Sehingga kini (2008), kira-kira 17 orang sudah menjalani pembedahan membuang prostat menggunakan kaedah tersebut di pusat berkenaan.


Lagi info tentang KANSER PROSTAT di sini.






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Treating Meningitis

by Dr. Milton Lum

The bacterium Neisseria meningitides causes meningitis, which is an infection of the membrane surrounding the brain and spinal cord, and septicaemia, which is an infection of the blood. There are at least 12 groups of the bacterium, which are characterised by differences in its capsule. Groups A, B and C cause the majority of meningococcal meningitis. The Y and W135 groups are increasingly important as they have been the cause of recent outbreaks and epidemics.


The meningococcus is spread by aerosol or direct contact with secretions from the nose or throat of infected persons or healthy carriers. About 5% to 15% of adolescents and young adults are carriers of the bacterium. The carrier rates in children are much lower (about 1%).

The clinical features of meningococcal meningitis are acute onset of fever, headache, nausea, vomiting, and stiff neck. There may be lethargy, delirium, coma and fits. A rash may appear on the skin. Infants with the infection may appear lethargic, irritable and go off their feeds.

About 50% of untreated cases in children result in death. The mortality rate with treatment is between 5% and 10%. Significant neurological disabilities like mental disorders, deafness, paralysis and fits occur in about 10% to 15% of those who survive. When there is also infection of the blood stream (septicaemia), the mortality rate may be more than 15% to 20%.

The risk of meningococcal infection is increased in those who are immune-deficient from various conditions such as HIV and those who do not have a spleen for various reasons.

As a consequence of the control of haemophilus influenza type B infections with immunisation, Neisseria meningitides has become the leading cause of bacterial meningitis in children and adults in many countries. The meningococcus is the only bacterium that causes epidemics of meningitis. There is rapid spread of the infection in an epidemic, leading to deaths occurring in a day or two and/or serious neurological disabilities, even if the treatment is apparently adequate. The incidence of meningococcal infection in Malaysia is unknown as it is not a notifiable disease.

Meningococcal Vaccines

There are different types of meningococcal vaccine. One vaccine protects against group C (or group C conjugate vaccine). Another vaccine protects against groups A and C (or the bivalent meningococcal vaccine). The vaccine called the ACWY vaccine (or the quadrivalent meningococcal vaccine) protects against groups A, C, Y and W135.

Another quadrivalent meningococcal vaccine is combined with the diphtheria vaccine. There is currently no vaccine that protects against Group B meningococcal infection. The vaccines provide protection by stimulating the body to produce antibodies against the meningococcus.

The meningococcal vaccines currently available are very safe and effective in children above 2 years old and adults. The vaccine against group A meningococcus stimulates a poorer antibody response and has a shorter duration of protection in children below the age of 2 years.

The vaccine against group C meningococcus does not stimulate an antibody response in the same age group. As such, groups A and C vaccine are not used in routine infant immunisation. However, when there are outbreaks of meningococcal meningitis, groups A and C vaccine may be given to children below two years of age.

It is known that non-conjugated group C vaccines, when given to infants, may lead to decreased antibody response to the bacterium in later years. The significance of this is unknown.

The group C conjugate vaccine is, however, effective, in all age groups including infants. This vaccine is used in the national immunisation programmes in many countries to immunise those whose risks of infection are high and during outbreaks or epidemics.

The quadrivalent vaccine (groups A, C, W135 and Y) does not protect against group B infections, which is a cause of some outbreaks or epidemics. This vaccine is also not very effective in children below 18 months of age. There is a belief that widespread use of the quadrivalent vaccine may reduce or do away with the need for mass vaccination in outbreaks or epidemics.

Adverse Events

Meningococcal vaccines are well tolerated and systemic reactions are very uncommon. The most common adverse reactions are redness and transient fever. Serious adverse events like hypersensitivity reactions (including anaphylaxis), bronchospasm and angioedema) are rare. Fits and purpura had been linked to the group C conjugate vaccine but no causal relationship has been found.

There is no evidence that the vaccine is unsafe in pregnancy but it is usually avoided unless the mother is at increased risk of meningococcal infections. Vaccination is not advised in those who have had a previous hypersensitivity reaction to any component of the vaccine including tetanus toxoid or diphtheria vaccine.

The vaccine against group C is offered to all babies as part of childhood immunisation in many developed countries. It is, however, optional in Malaysia. It is believed that a single dose provides lifelong immunity.

Immunisation with the quadrivalent (ACWY) vaccine is recommended when one travels to areas where the risk of infection is increased, for instance, areas of sub-Saharan Africa and Saudi Arabia. The doctor will advise on the need for this vaccine.

Pilgrims to Saudi Arabia are at increased risk of getting meningococcal infection as there have been outbreaks in recently. Proof of immunisation with the quadrivalent (ACWY) vaccine is a requirement for those performing the haj or umrah.

If one has been vaccinated with the groups A and C vaccine previously, one should be vaccinated again with the quadrivalent (ACWY) vaccine. Close household or institutional contacts of persons with meningococcal infection may be offered immunisation.

The meningococcal vaccines are safe and do not interfere with other vaccines given simultaneously. Its introduction has reduced the incidence of meningococcal infection considerably. It offers the hope of reduction or elimination of meningococcal infection and its consequences, including death and neurological disabilities.


More info on MENINGITIS here.






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