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Parkinson : Deep Brain Stimulation


Pada ketika ini pesakit Parkinson mungkin boleh menimbangkan rawatan yang melibatkan pembedahan iaitu pembedahan otak dalaman (Deep Brain Stimulation (DBS)). Dianggarkan lebih 30,000 pesakit Parkinson di seluruh dunia sudah mendapat manfaat rawatan DBS yang dimulakan sejak 1995.


Dalam pembedahan DBS, satu elektrod (wayar halus) dimasukkan ke dalam otak selepas pemeriksaan teliti dilakukan bagi menentukan kedudukan sebenar pada otak untuk meletakkan elektrod berkenaan. Ada dua tempat di dalam otak yang boleh diletakkan elektrod ini dan penentuan dilakukan pakar pembedahan neuro dan pakar neurologi berdasarkan gejala yang ingin dikawal.



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Elektrod ini akan disambung pada neurostimulator (seperti pacemaker bagi pesakit jantung) yang akan diletakkan di bawah kulit dada. Ia berukuran 7.5 sentimeter (tiga inci) lebar dan 1.3 sentimeter (setengah inci) tebal yang mengandungi bateri kecil dan cip komputer yang diprogram untuk menghantar rangsangan elektrik bagi mengawal gejala Parkinson.

Pembedahan DBS membabitkan bukaan kecil iaitu kira-kira 2.5 sentimeter (satu inci) saja dan dilakukan dengan sangat teliti melalui kaedah stereotaktik. Ini bermakna, bingkai kepala stereotaktik akan dipasang pada kepala pesakit ketika pembedahan.

Dua Bahagian

Pembedahan DBS ada dua bahagian. Pertama, pakar bedah akan menggunakan teknik pengimejan (seperti Pengimejan Resonan Magnetik, MRI) atau tomografi komputer bagi membuat 'peta' otak dan mencari kedudukan yang perlu dirangsang. Pesakit sedar ketika pembedahan dilakukan supaya doktor boleh berinteraksi dengannya dan melalui cara ini kedudukan tepat meletakkan elektrod dapat dikesan.

Pada peringkat kedua iaitu untuk memasang alat neurostimulator, pesakit akan diberikan bius menyeluruh (tidak sedarkan diri). Tempoh pembedahan bergantung kepada bilangan elektrod yang diletakkan dalam otak yang mungkin mengambil masa sehingga 5 jam.

Syarat DBS

Walaupun kesan DBS sangat memberangsangkan tetapi rawatan ini hanya akan diberikan kepada pesakit yang memenuhi syarat iaitu :

* Penyakit sudah sampai ke tahap serius.
* Sudah menunjukkan kesan positif terhadap ubat levodopa (ubat yang kuat untuk penyakit Parkinson). Kajian menunjukkan DBS kurang berkesan bagi pesakit yang tidak memberi reaksi positif pada levodopa.
* Gejala tidak dapat dikawal dengan pengambilan ubat.
* Pesakit mesti cukup sihat untuk menjalani pembedahan dan boleh berinteraksi dengan doktor (menjawab soalan doktor ketika pembedahan).

Banyak kesan sampingan yang berkaitan rangsangan boleh dikawal dengan mengubah sedikit rangsangan yang diberi. Untuk tujuan ini pesakit perlu beberapa rawatan susulan supaya kesan sampingan ini dapat dikurangkan dan memberikan keputusan yang lebih baik.

DBS adalah langkah akhir untuk merawat Parkinson. Sebaik disahkan menghidap Parkinson pesakit perlu mematuhi jadual pengambilan ubat dan kerap berjumpa doktor bagi rawatan susulan. Paling penting ialah pesakit mesti kuat semangat untuk menjalani rawatan dan meneruskan kehidupan sebaik mungkin.


Lagi info tentang PARKINSON di sini.






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Manage Weight With a Healthy Breakfast


Eat a high quality breakfast to fight obesity.

by Kasmiah Mustapha

Breakfast may indeed be the most important meal of the day — as long as it constitutes low-calorie foods which translate into a high quality diet.

A study has found that breakfast foods low in energy density (lower calories for a given amount of food) appear to predict better food choices for the day and may help with weight management.



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The findings, reported in the American Journal of Clinical Nutrition, noted that fruits, vegetables and high-fibre whole grains, for example, are low in energy density, while Danish pastries and doughnuts have a high energy density.

The study supports previous studies that breakfast-eaters are less likely to be overweight and that eating a high-quality breakfast is the key to fighting obesity.

It also said men who ate a healthy breakfast generally weighed less. Women who ate breakfast, regardless of the food involved, tended to weigh less than those who did not.

Overall, people who ate a low energy-density breakfast the previous day were likely to choose lower-calorie foods for the day. They also had a higher-quality diet and ate a variety of foods.


More info on BREAKFAST here.






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Mental Health Problems in the Elderly

We should encourage autonomy in the elderly, including retraining in living skills. Active rehabilitation would be needed for independent living.

By Prof. Saroja Krishnaswamy

Compared to 50 years ago, there are now many more people over the age of 65, and even more are becoming centenarians. Currently in Malaysia, the life span for females is about 75 and for males 72. It is expected that there will be a doubling of those over 65 in the next 30 years in the US.


Two issues become increasingly important as people age. They are the older person's well-being, both physical and psychological, and the ability of the older person to be well integrated in the family, community and overall society.

Mental health problems over the age of 65 are becoming increasingly frequent, with cognitive impairments being the most common. About 5% of those over the age of 65 suffer from dementia, which is the most severe cognitive impairment.

Other psychiatric disorders have been under-diagnosed and this accounts for why the reported frequency is much less in the older as compared to the younger population.



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Depressive Disorders

The most common disorders of old age are depressive disorders, estimated to be about 15% of the elderly in the community.

The core symptoms of a depressive disorder are the same as in the younger age group, for example, reduced energy, sleep problems (especially early morning awakening), weight loss and somatic complaints often described as hypchondriacal.

Often complicated by physical ill health, depression in the elderly can be difficult to diagnose and can increase mortality and morbidity due to existing illness.

Therefore it is important to identify risk factors early so that they can be treated or alleviated so that the risk of getting depression can be reduced.


Risk Factors Contributing to Depression

Many old people are quite resilient in the face of adversity due to coping strategies learned from past experience and behaviour. There has been evidence to suggest that the cohorts who survived the world wars have less mental illness, and it has been postulated that the adversities they went through have become protective.

Evidence backs the notion that support systems and personal traits are important and can buffer one during adversity.

However, there is only so much that a person can take and multiple adversities or too frequent ones or very severe ones become too heavy a burden and can cause a person to succumb.

These adversities can be considered risk factors and the common ones are as follows :

1. Death of relatives and close friends are considered as losses and older people would be facing more deaths with their elderly relatives and friends as compared to younger people.

2. Poor health and physical illness associated with pain and disability curtails activity and makes the elderly more dependent on others, contributing to a sense of uselessness.

3. Loss of status, loneliness and social isolation often arise when the aged have lost their position in society and in the family and often do not have a sense of being needed.

4. Development of chronic mental illness at a younger age can result in residual deficits that can be exaggerated in the aged and become a problem to caregivers and some mental illnesses can also become more intractable with age.

5. Social and economic problems are really devastating in the aged when they are not employable and have no other support.

6. Presence of other psychiatric diagnoses e.g. alcohol and other substance abuse which occur in about 10% of the elderly often complicate the current presentation and may be masking underlying depression.

7. Other biological factors, especially degenerative changes which can result in neurotransmitter deficiencies, that can contribute to depression.

8. Environmental (especially housing which is not conducive to the elderly) and other factors e.g. poor roads, lack of bus services which make access to conveniences difficult for the elderly. Poor housing can be dangerous and increase home accidents, leading to fractures, immobilisation and even death.

9. Cultural factors (acceptable meanings given to illness by patient and family), and illness factors are confused for general ageing. Acceptance of death and disease as attributable to old age may hasten death unnecessarily.

10. Side-effects of drugs due to age related changes in drug handling and drug interactions, especially if they are on treatment for physical ailments. Hypertension, diabetes and obesity are common problems.

11. Poor treatment of other coexistent illness in old people can impair recovery of mental health problems. Illnesses causing pain and discomfort need to be adequately treated, and pain killers and other treatments should not be spared. Adequate doses of medication need to be used, as often, because of fear of side-effects, drugs are used too cautiously.

12. More frequent illnesses are prevented by closer follow-ups. Inability to attend clinics results in delay in detecting relapses or other new illnesses.

13. Neglect of optimum functioning e.g. prevention of vascular dementias if strokes are prevented with early management. Current developments in the prevention of strokes are very encouraging and more therapists need to be aware of the cutting edge developments in medical and surgical areas so that all the elderly can benefit from them.

14. Sensory deficits and cognitive defects €“ a lot of active work needs to be done by the therapist to work around these deficits and also to delay development of these deficits.

15. Encourage autonomy, including retraining in living skills and safety at home. Active rehabilitation would be needed in these areas for independent living.

16. Lack of practical support and information, including social and legal rights advice to patients and their supporters and caregivers. Practical support for those who cannot live alone should be timely, and with access to medical resources.

Depression in caregivers who need to look after the elderly is quite well documented and so caregivers need support and advice so that their needs are also taken care of.

Day-care and support groups will be needed and this will lessen the burden of the caregivers during the day, as well as be an opportunity for socialisation and development of other skills for the elderly.

Conclusion

A multidisciplinary team approach is needed and each member of the team could be confronted with different psychosocial problems when dealing with the elderly. The health worker dealing with the elderly has also to take into account the family context, local customs and culture and the social and health services available.

The key would be early detection of risk factors and this means the elderly would have to be viewed holistically and health workers need to keep this in mind at all times.


More info on MENTAL here.






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Penyakit Bayi Kuning


oleh Dr. Azwan

Pada kebiasaannya, kebanyakan bayi baru lahir dibawa ke klinik kerana penyakit kuning. Bayi kuning atau neonatal jaundice boleh mencecah sehingga 60% kelahiran. Bermakna setiap 6 orang bayi yang lahir akan menjadi kuning di dalam setiap 10 kelahiran. Dan pada kebiasaannya bayi ini menjadi kuning pada hari ketiga selepas lahir dan semakin hilang selepas beberapa hari.

Apa Itu Jaundice (Kuning)?

Jaundice berasal dari perkatan Perancis 'jaune yang bermakna kuning. Sel darah merah manusia yang terurai (kerana mati) menghasilkan partikel yang dipanggil bilirubin. Bilirubin ini adalah tidak larut air dan akan dihantar ke hati untuk diubah kepada menjadi larut air.

Setelah itu sebahagiannya akan dikeluarkan menjadi air kencing (menyebabkan air kencing berwarna kuning!). Sebahagiannya pula akan dibuang melalui najis melalui saluran hempedu (menyebabkan najis berwarna coklat kekuning-kuningan!).

Mengapa Kebanyakan Bayi Mengalami Kekuningan?

Perkara ini seolah-olah misteri kepada kita. Kenapa kebanyakan bayi ini kuning? Ada 2 sebab utama :

1. Sel darah merah bayi (fetal hemoglobin)

Kajian menunjukkan sel darah merah bayi adalah berbeza dengan sel darah merah orang dewasa. Ia mudah terurai dan jangka masa hayatnya adalah pendek. Bilangannya juga berlebihan daripada biasa. Oleh itu, penguraian sel darah bayi yang tinggi menyebabkan kadar bilirubin yang meningkat pada hari ketiga.

2. Hati bayi

Hati bayi yang belum cukup matang juga menyukarkan proses penukaran bilirubin tak larut air kepada bilirubin yang larut air. Bayi pra-matang lebih cenderung terkena kuning sebanyak 80% daripada bayi lahir cukup bulan.

Ini dipanggil kekuningan secara fisiologi atau normal. Oleh itu, tidak hairanlah ramai bayi yang terkena kuning selepas 3 hari kelahiran.

Apakah Penyebab Lain Jaundice

Ada banyak sebab-sebab lain untuk bayi baru lahir kuning. Sekiranya kekuningan datang terlalu awal contohnya hari pertama kelahiran, ini mungkin disebabkan oleh tersumbatnya pundi hempedu akibat kecacatan lahir (biliary atresia).

Antara penyebab lain :

* Trauma di kepala disebabkan oleh kelahiran secara forceps atau vakum
* Jangkitan kuman di dalam darah (sepsis)
* Jangkitan virus seperti Rubella atau Toxoplasma
* Masalah tidak Serasi dengan darah ibu (Coombs Positive)
* Masalah dengan enzim darah merah (G6PD)
* Hormon tiroid yang rendah (hypothyroidism)
* Masalah hati dan hempedu (biliary atresia, Dubin Johnson)
* Kuning disebabkan oleh susu ibu (setelah semua penyebab di atas telah dikenalpasti negatif)

Adakah Jaundice Merbahaya?


Sangat bahaya! Serum bilirubin yang berlebihan menyebabkan kernicterus. Ia adalah satu fenomena yang mana bilirubin yang tidak larut tadi menembusi lapisan otak bayi yang kurang matang. Autopsi menunjukkan otak bayi yang meninggal dunia disebabkan kernicterus berwarna kuning!

Kernicterus dikaitkan dengan kadar kematian yang tinggi. Sekiranya selamat pun akan menyebabkan bayi menjadi lumpuh, pekak atau buta.

Rawatan


1. Terapi lampu (phototherapy)

Terapi lampu adalah kaedah yang paling berkesan abad ini untuk mengurangkan kekuningan bayi. Ia adalah sumber cahaya biru dengan jarak gelombang (wavelength) kira-kira 450 nm. Dengan kaedah ini, bilirubin merbahaya ditukarkan kepada bilirubin larut air untuk dinyahkan daripada badan.

Cara menggunakan terapi lampu dengan berkesan :-

* Letakkan sumber cahaya kira-kira 35 cm - 50 cm daripada bayi
* Buka semua baju bayi kecuali lampin
* Tutup matanya
* Lampu dibuka setiap masa 24 jam kecuali ketika mandi, minum susu, menukar lampin dan mengambil darah
* Alih posisi bayi setiap 2-3 jam
* Ada kajian menunjukkan terapi lampu boleh menyebabkan bayi kekurangan air maka memasukkan air melalui salur darah adalah satu kemestian
* Paras bilirubin hanya hanya boleh disukat dengan pemeriksaan darah sahaja kerana pemerhatian visual tidak tepat
* Risiko untuk peningkatan mendadak semula (rebound effect) boleh berlaku setelah rawatan lampu diberhentikan

2. Exchange Transfusion (ET)


ET dilakukan sekiranya rawatan lampu tidak berjaya mengurangkan paras bilirubin. Kernicterus boleh berlaku sekiranya paras bilirubin tetap tinggi.

ET ialah satu rawatan yang mana darah bayi dikeluarkan secara perlahan-lahan oleh doktor secara manual melalui satu prosedur ringkas dan diganti dengan darah baru yang diambil dari bank darah. Proses ini memakan masa sehingga 5-6 jam.

Di HKL ia biasanya dijalankan pada waktu malam bermula pada pukul 11 malam dan tamat hampir pukul 5 pagi. Itu untuk seorang bayi! Doktor akan mengeluarkan darah bayi dengan perlahan-lahan melalui satu tiub yang dipasang di saluran darah di pusatnya (tali pusat masih baru lagi) dan memasukkan darah baru juga secara perlahan-lahan.

Cahaya Matahari vs. Phototherapy?

Adakah meletakkan bayi yang kuning dibawah cahaya sinar matahari pagi boleh mengurangkan kekuningan? Apa pendapat anda?

Ada yang berkata, "kau dulu aku letak bawah matahari tulah.. takde apa-apa pun..." atau "buat apa kau nak siksa budak kecik tu... masuk hospital... letak bawah lampu.. kena cucuk sana sini... letak je bawah matahari...."

Kadang-kadang idea-idea yang meruntun jiwa ni boleh juga masuk ke benak kita dan akhirnya akan melengah-lengahkan tanggungjawab kita kepada anak kita.

Pada hakikatnya, bayi dijemur di bawah sinar matahari ketika berada di rumah. Tiada ibubapa yang ingin membawa anak mereka ke hospital dengan niat menjemur anak. Oleh itu, tiada pengawasan yang sewajarnya untuk bayi tersebut ketika berada di rumah. Ibu-bapa pula berada di dalam zon selesa dan perhatian kepada anak pula berkurang.

Kenapa phototherapy lebih baik daripada menjemur bayi di bawah matahari?

* Phototerapy bersinar selama 24 jam, menukarkan bilirubin kepada bentuk yang tidak merbahaya setiap masa kecuali waktu minum susu, tukar lampin, mandi dan ambil darah
* Berapa lama bayi boleh dijemur di bawah matahari? Bayi hanya boleh dijemur pada waktu pagi selama 3 jam? 4 jam? paling lama 5 jam? Bagaimana dengan baki 20 jam lagi?
* Bagaimana anda hendak memeriksa paras bilirubin sekiranya anda begitu selesa berada di rumah menjemur anak? Adakah cukup dengan pemerhatian visual anda sahaja?
* Antara sebab kekuningan bayi meningkat ialah dehidrasi iaitu bayi kekurangan air. Sinar matahari boleh menjadikan dehidrasi bertambah teruk kerana suhunya itu. Sedangkan di hospital, dehidrasi boleh dibendung dengan menambah air melalui saluran darah
* Keputusan untuk mengadakan exchange transfusion atau ET boleh dibuat sekiranya pesakit di hospital menjalani rawatan lampu, berbanding sekiranya pesakit hanya berada di rumah
* Ujian darah boleh dilakukan serentak ketika menjalani rawatan lampu untuk mengenalpasti sebab-sebab kekuningan samada ia adalah jangkitan, masalah hati atau sebagainya.

Neonatal jaundice seperti penyakit lain boleh mendatangkan padah kepada sesiapa yang tidak mengetahui. Sekiranya anda sangat mementingkan cara tradisional untuk merawat penyakit ini, maka itu adalah keputusan anda. Ilmu perubatan semakin meningkat maju. Janganlah disebabkan pendirian anda menyebabkan bayi yang tidak berdosa menjadi mangsa.


Lagi info tentang BAYI KUNING di sini.






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Picky Eating

Does your child only eat when he’s offered a burger? That’s a sure sign of picky eating.

by Assoc. Prof. Dr. Norimah A. Karim

Sharing a meal with your loved ones, and especially with your growing child, can be a particularly rewarding and life-affirming activity. There is nothing more satisfying than seeing your child enjoying a meal prepared by you.

It is altogether a wonderful experience for you and your family, unless your child is a picky eater. Then mealtimes are often stressful, messy, and involve constant negotiation.




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What is Picky Eating?

It is a typical night in the Chang family. As mom walks in the front door, she is already feeling stressed about tonight's dinner with her daughters. Kim is 8, while Mimi is 4 years old. Although Kim is considered a good eater and will eat a variety of foods, Mimi is a picky eater.

As the family sits down for dinner, both Mimi and her mom feel stressed and anxious. Mimi has a long history of not eating and would gag or scream if forced. On this night, like many others, the tug-of-war at the dinner table is not the most pleasant of experiences.

Just like the short description above, most parents who have little picky eaters at home would agree that it is nerve-wracking when their child is being picky about food or refuses to eat.

Identifying a Picky Eater

Picky eaters are a mixed group, who exhibit a myriad of characteristics. They often exhibit one or more of the following :

1. Limited food selection. This is one of the most distinguishing characteristics. For some picky eaters, their food selection may be limited to 20 different foods; for others, it may be as few as three foods. Examples of such foods often include nuggets, instant noodles, fried rice or baked beans.

2. Limited food groups. In addition to a limited number of foods, picky eaters also limit the food groups they will eat. Some will only eat from one group, such as breads and cereals. Most will often omit foods from the fruit and vegetable group and/or meat group.

3. Adverse reaction to new foods. Anxiety, tantrums, gagging and stress-related symptoms are typical behaviours exhibited by picky eaters to demonstrate their fear when presented with new or novel foods.

4. Food jags. A food jag is defined as the insistence on eating the same foods in the same manner over long periods of time. It limits opportunities for the picky eater to experience new foods and eat a balanced diet.

What Causes Picky Eating?

Eating is an incredibly complex process that can be challenging for our young ones, especially if they are picky eaters. If your child is a picky eater, it is important for you to identify the causes so that you may help her overcome this problem.

1. Oral-motor development

A child is only able to eat food when she is developmentally ready. Forcing and coercing your child to try new foods when she does not know how to manage it in her mouth will lead to your child refusing to eat and attempting everything in her power to avoid the eating experience.

2. Food neophobia

Food neophobia or a fear of new and novel foods is a developmental stage for children between two and three years of age. A young child who is transitioning to adult foods will be offered a variety of new foods and it is during this period that some may reject and exhibit fear of the new food.

3. Environmental factors

The environment that we are living in today may pose unforeseen 'threats', such as chaotic work schedules, numerous school activities and meals in front of the television. These will create unpredictable mealtime schedules and unfavourable meal settings that may contribute to problems with eating in our children.

4. Learnt behaviour

Children often do what parents do, but not what they say. If you are a picky eater yourself, chances of your child picking up the problem is quite high.

5. Autonomy

When your child turns one, the struggle for autonomy and independence may likely contribute to the picky eater phenomenon. Any new food experience can become a power struggle between parent and child. Some picky eaters will decide they do not like something or they will like it at one time and next time they will not even touch it.

When It Becomes a Problem

Although we do not know the exact prevalence of picky eaters in our country, picky eating is becoming a major concern to parents and health practitioners alike, as it may lead to greater problems if overlooked.

First, it is important for you to know that picky eating can permanently impair long-term growth.

A child who is identified as a picky eater often has a low percentile for weight and height and this may sometimes lead to hospitalisation for malnutrition.

Second, because picky eaters often limit themselves to selected foods, a lack of an adequate, balanced diet may result. Without sound nutrition, this may interfere with a child’s ability to learn properly, thus limiting his or her potential, academically.

Last but not least, picky eaters are often isolated from their families during mealtimes, and because of that, a child's socialisation skills and self-esteem may be affected.

What Can You Do?

Considering the risks involved, you must not overlook this problem but find the best solution to help your child overcome picky eating.

Create a meal/snack schedule

* Establish a routine by serving meals around the same time everyday.

* Snack time should be at least two hours before the next mealtime so your child is hungry for meals.

Create a supportive and nurturing environment

* Encourage your child to eat by being a good meal companion (ie discuss the taste, colour, texture and smell of new foods).

* Respect your child and do not “invade” her mouth without her permission.

Consider food selection, preparation and presentation

* Take into account the texture, colour and smell when introducing a new food.

* Include your child in food preparation and presentation so that she may have a sense of pride and ownership of the food served.

More info on PICKY EATING here.






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Pembedahan Ikat Perut LAP-BAND


oleh Norlaila Hamima Jamaluddin

Pembedahan ikat perut atau mengecilkan perut dianggap sebagai langkah terakhir yang boleh diambil bagi individu obes selepas semua kaedah lain seperti bersenam, mengubah tabiat makan atau mengambil ubat mengikut arahan doktor tidak memberi kesan diharapkan.


Pembedahan ini bukan untuk cantik, sebaliknya bertujuan meningkatkan tahap kesihatan kerana individu obes mempunyai risiko mendapat pelbagai penyakit, termasuk serangan jantung, kencing manis, tekanan darah tinggi dan strok.



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Tidak Semuanya Layak

Walaupun gemuk, anda tidak semestinya layak mendapatkan rawatan ini kerana ia direka khusus bagi individu yang mempunyai Indeks Jisim Tubuh (BMI) melebihi 32 kg/m² bagi penduduk Asia atau 35 kg/m² untuk penduduk Barat. BMI dikira dengan membahagikan berat dalam kilogram dengan tinggi dalam ukuran meter yang diganda duakan.

BMI = berat (kg) / tinggi (m) * tinggi (m)

Mengapa kaedah ikat perut ini dikhususkan bagi kumpulan tertentu saja? Ini kerana bagi kumpulan ini, peluang menurunkan berat badan melalui kaedah konvensional (menjaga makan dan bersenam) amat rendah iaitu kurang daripada 10%.

Sebaliknya, kumpulan ini paling banyak berdepan risiko kesihatan seperti tekanan darah tinggi, kencing manis, paras kolesterol tinggi, penyakit jantung atau strok, terutama jika mereka mengalami masalah berat badan sejak muda.

Perut Manusia

Perut manusia yang terletak dalam ruang abdomen adalah kantung elastik berotot dengan bentuk seperti buah pir. Bentuk dan saiznya berubah mengikut kedudukan badan dan jumlah makanan yang masuk ke dalamnya. Ia berfungsi sebagai tempat simpanan makanan sementara dan di sinilah proses penghadaman makanan berlaku.

Secara purata, perut berukuran 30.5 sentimeter (12 inci) panjang dan 15.2 sentimeter lebar (enam inci). Kapasiti perut orang dewasa ketika rehat (tidak mengandungi makanan) ialah kira-kira satu liter.

Bagaimanapun, oleh kerana ia elastik atau kenyal, perut boleh mengembang dan menampung antara 2 hingga 4 liter makanan.

Isyarat Kenyang

Makanan yang dimakan akan masuk dan memenuhi bahagian bawah perut terlebih dulu. Apabila berisi makanan, perut akan mengembang tetapi ia masih tidak memberi isyarat kenyang kepada otak.

Isyarat kenyang hanya diberi apabila bahagian atas perut (dipanggil bahagian kardiak) mengembang dan isyarat ini mengambil masa untuk sampai ke otak. Apabila isyarat kenyang diterima, biasanya kita sudah terlebih makan, khususnya bagi individu yang makan cepat (makanan tidak dikunyah hingga benar-benar lumat sebelum ditelan).

Ini menyebabkan berlebihan pengambilan kalori harian dan keadaan menjadi lebih buruk (berat badan bertambah) jika penggunaan tenaga tidak setimpal dengan kemasukan tenaga dalam badan. Tenaga berlebihan ini disimpan sebagai lemak dan akibatnya tanpa disedari, kita menjadi gemuk.

Pembedahan LAP-BAND

Dalam pembedahan yang menggunakan sistem LAP-BAND, perut pesakit diikat di bahagian atas, menjadikannya berbentuk seperti 'hour-glass' atau balang waktu (tabung kaca yang berisi pasir untuk mengukur waktu). Bahagian atas ini sangat kecil dengan muatan antara 30 hingga 50 mililiter saja atau sebesar bola golf .

Perut atas yang baru ini boleh mengembang dua kali ganda saiz asalnya (60 hingga 100 mililiter). Perut diikat menggunakan getah khas yang disambungkan dengan alat kawalan dipanggil access port yang ditanam di bawah kulit. Melalui alat kawalan ini, doktor boleh memantau dan mengubah saiz perut baru pesakit.

Semua prosedur ini dilakukan dengan kaedah pembedahan lubang kunci. Pesakit tidak perlu bimbang kerana saiz luka pembedahan sangat kecil dan cepat sembuh. Malah, pesakit dirawat sebagai pesakit luar dan tidak perlu tinggal di hospital.

Dalam tempoh 6 minggu pertama, perut atas tidak mengembang kerana banyak tisu membengkak akibat kehadiran benda asing (getah pengikat). Selepas tempoh ini baru doktor membuat sedikit penyesuaian pada perut baru pesakit.

Pengurangan berat badan melalui kaedah ini juga tidak berlaku mendadak kerana ia direka supaya pesakit mengalami penurunan berat yang sihat iaitu antara dua hingga empat kilogram sebulan. Bagaimanapun, kadar penurunan berbeza antara pesakit - ada yang turun lebih banyak dalam tempoh sebulan.

Kaedah ini mensasarkan penurunan berat badan antara 50 hingga 70% daripada berat yang berlebihan dalam tempoh dua tahun. Contohnya bagi individu dengan ketinggian 1.6 meter dengan berat badan 95 kilogram mempunyai BMI sebanyak 37.1 kg/m².

Berat badan normal untuk individu ini ialah antara 46 hingga 64 kilogram, tetapi berat unggul ialah 55 kilogram. Ini bermakna berat badan berlebihan ialah 40 kilogram. Jadi dalam masa dua tahun dia perlu mengurangkan berat badan antara 20 hingga 28 kilogram.

Juga Untuk Kanak-kanak

Walaupun rawatan ini direka untuk orang dewasa, ia juga boleh dilakukan pada kanak-kanak dan remaja, dengan syarat mereka faham pembedahan itu untuk kebaikan mereka dan mendapat persetujuan ibu bapa.

Yang menarik, pembedahan ini bersifat berbalik iaitu getah pengikat boleh dikeluarkan dan perut kembali ke saiz asal. Bagaimanapun dalam kebanyakan kes, pesakit mahu ia terus kekal dalam badan supaya masalah pertambahan berat tidak berulang.

Namun perlu diingat, kaedah ini bukan untuk semua orang, kecuali bagi individu yang termasuk dalam kategori obesiti morbid iaitu kegemukan yang boleh mengundang pelbagai penyakit. Walaupun penggunaannya ke atas golongan muda (kurang 18 tahun) masih diperdebat, ia masih diberi pertimbangan.

Ini kerana kanak-kanak obes biasanya berdepan masalah psikologi dan sosial apabila mereka berasa rendah diri, terasing, diejek ahli keluarga dan rakan sebaya. Ini menyebabkan mereka lebih suka mengasingkan diri di rumah dan makan lebih banyak.

Masalah juga timbul jika ibu bapa kurang memberi perhatian kepada masalah berat badan dan menyediakan apa saja yang diminta si anak.

Amalan Pemakanan Selepas Pembedahan

Beberapa hari pertama selepas pembedahan — Sejurus selepas pembedahan, pesakit hanya dibenar menghirup sedikit air atau mengulum ais. Pada hari kedua, baru minum lebih sedikit tetapi dalam kuantiti kecil pada satu-satu masa.

Selain air, pesakit perlu memilih jenis minuman yang mengandungi kalori bagi membekalkan tenaga. Untuk mengelak rasa mual dan muntah, jangan minum terlalu banyak.

Minggu pertama hingga keempat — Pesakit disaran makan makanan yang sangat lembut atau diet cecair seperti:

# Sup (tanpa memakan sayur, daging, ayam dan tidak berkrim)
# Dadih rendah lemak
# Susu (khususnya susu rendah lemak)
# Agar-agar
# Jus atau puri buah

Doktor atau pakar pemakanan akan memberi panduan mengenai pemakanan. Ketika ini, yang mustahak ialah memberi peluang badan membiasakan diri dengan sistem LAP-BAND dan bukan mengurangkan berat badan.

Minggu keempat hingga keenam — Ketika ini pesakit dibenarkan makan makanan lebih berat seperti sup berkrim, ikan dan ayam cincang. Pertukaran daripada makanan lembut kepada yang lebih berat perlu dilakukan secara berperingkat dan perlahan-lahan.

Makanan yang lembut lebih mudah dihadam. Usah cepat sangat mahu beralih kepada makanan berat kerana sesetengah makanan seperti roti, nasi dan daging merah mungkin memberi masalah kepada pesakit.

Kunyah makanan anda hingga betul-betul lumat sebelum ditelan untuk mengelak rasa mual, muntah, keradangan perut atau kembung. Pesakit juga berdepan risiko saluran perut tersumbat jika makanan yang masuk tidak benar-benar hancur. Jika mengalami masalah ini, pesakit perlu kembali diet cecair.

Kerap muntah boleh meningkatkan kemungkinan ikatan pada perut teralih atau menyebabkan kantung perut atas meregang.

Gaya dan Tabiat Makan Selepas Pembedahan

Pesakit perlu mengubah gaya dan tabiat makan sejurus selepas menjalani pembedahan.

1. Makan 3 kali sehari dalam kuantiti kecil — Sistem yang digunakan ini membentuk kantung perut yang kecil — yang hanya boleh menampung kira-kira setengah cawan (85 hingga 113 gram) makanan.

Jika pesakit cuba makan lebih daripada muatan ini, dia akan berasa mual atau muntah. Sebaliknya jika pesakit membiasakan diri makan banyak, kantung perut yang kecil ini akan meregang dan ia boleh merosakkan tujuan utama pembedahan ini.

2. Makan perlahan-lahan dan kunyah hingga lumat (15 hingga 20 kali) — Makanan boleh memasuki stoma (lubang atau laluan perut yang baru) jika ia benar-benar hancur. Jika sebelum ini anda biasa makan cepat, belajar untuk makan perlahan-lahan dan menikmati keenakan makanan.

3. Berhenti makan sebaik terasa kenyang — Apabila perut penuh, otak menerima isyarat bahawa anda sudah cukup makan. Bagaimanapun dalam keadaan biasa, penerimaan isyarat ini mengambil masa. Ada yang mengatakan otak hanya menerima isyarat kenyang dalam masa 20 minit dan ini sebabnya kita perlu makan perlahan-lahan.

Jika makan cepat, pesakit mungkin makan lebih daripada diperlukan, boleh menyebabkan mual dan muntah. Cuba mengesan rasa kenyang dan jika ada, berhenti makan ketika itu juga.

4. Jangan minum ketika makan — Pembedahan ini hanya berkesan jika pesakit makan makanan pejal. Jika pesakit minum ketika makan, makanan itu menjadi makanan cecair dan keberkesanan sistem ini terjejas.

Jangan minum dalam masa 1 hingga 2 jam selepas makan. Kaedah ini membuatkan anda berasa kenyang lebih lama.

5. Jangan makan di antara waktu makan — Mengambil snek atau makanan ringan boleh menjadi punca utama kegagalan dalam mana-mana kaedah mengurangkan berat badan. Tabiat ini perlu dihentikan segera. Pesakit yang makan dengan cara betul biasanya tidak berasa lapar sehingga tiba waktu makan seterusnya. Jika anda kerap berasa lapar, bermakna ikatan pada perut terlalu longgar dan segeralah berjumpa doktor untuk membetulkannya.

6. Makan makanan berkualiti saja — Oleh kerana tidak boleh makan banyak, pesakit perlu makan makanan berkhasiat saja. Jangan sekali-kali mengisi perut baru yang kecil itu dengan makanan ringan.

Makanan anda perlu mengandungi protein dan vitamin. Contoh makanan yang kaya khasiat ialah sayur-sayuran segar, buah-buahan, daging, ikan dan bijirin. Elakkan makanan yang tinggi kandungan lemak dan gula seperti minuman ringan dan berkarbonat, sirap, kek, biskut, manisan, jem, madu, coklat, pai, kerepek dan keropok serta pastri.

Anda boleh makan epal dan oren, tetapi elak jus epal atau oren yang mengandungi banyak gula. Mungkin timbul kebimbangan tidak cukup zat jika pengambilan makanan dicatu ketat. Bagi yang ingin mengambil pil makanan tambahan, berbincang dengan doktor terlebih dulu.

7. Elak makanan yang tinggi serat — Makanan banyak serat seperti asparagus boleh membuatkan lubang masuk ke perut (stoma) tersekat. Ia kerana serat tidak dapat dihancurkan melalui kunyahan atau tindakan air liur. Bagaimanapun, bukan anda tidak boleh makan asparagus langsung. Jika teringin, masak hingga lembut, hiris halus dan kunyah hingga lumat.

8. Minum air secukupnya sepanjang hari — Jika berat badan anda turun, kandungan lemak dalam badan juga berkurang. Ia dikeluarkan sebagai bahan kumuh. Justeru, anda perlu minum banyak air sepanjang hari supaya proses penyingkiran bahan buangan ini lebih mudah.

Walaupun keperluan setiap individu berbeza, secara umumnya kita memerlukan antara enam hingga lapan gelas air sehari. Ingat, anda sepatutnya hanya minum air masak. Boleh juga minum teh dan kopi tetapi mestilah tanpa gula, krimer atau susu. Ingat juga untuk mengasingkan waktu makan dan minum.

9. Minum minuman rendah kalori saja — Tidak kira apa jenis minuman, semuanya boleh melalui lubang masuk ke perut dengan mudah. Jika anda minum minuman berkalori tinggi, penurunan berat badan tetap berlaku tetapi jumlahnya kecil walaupun semua syarat lain dituruti.

10. Bersenam sekurang-kurangnya 30 minit sehari — Bagi meningkatkan kejayaan mengurangkan berat badan, pesakit perlu bersenam kerana senaman menggunakan tenaga dan membakar kalori. Saiz badan anda mungkin menyukarkan anda bersenam, tetapi jangan patah semangat. Buat sekadar yang mampu. Lebih banyak berat badan anda turun, pergerakan menjadi lebih mudah.

Mulakan dengan senaman mudah seperti berjalan atau berenang. Tingkatkan aktiviti secara beransur-ansur dengan berbasikal, jogging atau melakukan senaman aerobik. Pada masa sama, ubah aktiviti harian dengan berdiri berbanding duduk atau menaiki tangga berbanding menggunakan lif.


Lagi info tentang OBESITI di sini.






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Belonephobia/Needlephobia

Children predictably, fear the needle.

Belonephobia or needlephobia is the marked and persistent fear of needles or any sharp object. A person exposed to anything associated with needles will almost immediately feel anxious and may even develop a panic attack.


Among the symptoms manifested by this fear are rapid heart rate, increased blood pressure, tremor, feeling faint or actual fainting, nausea, and feelings of panic. A full-blown panic attack can occur if the individual believes that escape is impossible.

Studies have shown that belonephobia actually afflicts up to 10% of the population, and they usually start from a young age. Adolescents and adults may recognise that their fear is unreasonable, but children may not.

Most of us of course, do not have the morbid fear of needles, although many people fear needle-sticks to some extent. However, once that fear becomes persistent, excessive, and unreasonable, the fear becomes a phobia. Others faint just by waiting in line for injections. Persons afflicted with belonephobia may also go to great lengths to avoid needle-sticks.



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Vaccination

The fear of needle becomes serious when people who have beloneophobia actually require procedures that use needles like blood tests, immunisations, dental work, and even life-saving minor procedures such as skin biopsies or vaccinations.

Getting vaccinated for example, is not only for infants and children. The elderly are especially encouraged to get vaccinated against the flu and pneumococcal disease because of the potential complications that can result from this.

Elderly patients who suffer from chronic heart and lung disease need the most protection because an infection like pneumonia can worsen their condition. Even a bout of flu can sometimes cause severe complications.

Healthcare practitioners are also encouraged to get the flu vaccination as they could 'help' spread the flu even faster in the course of their work with patients.

On safety concerns, vaccines these days are so well researched that cases of systemic side-effects are very rare, although they cannot be totally excluded. This is why patients must be vaccinated in the premise of a healthcare practitioner who is prepared for any eventuality.

However, the proverb 'prevention is better than cure' is definitely true here as the benefits of long-term protection far outweigh the fear of short-term pain.

Children predictably, fear the needle. Thankfully, vaccination for infants and children is actively encouraged by the government. One can imagine the amount of trouble a paediatrician has to go through in vaccinating a particularly difficult child.

Factor and Tips

Most people who fear needles have a history of experiencing deep numbing pain after an injection as a child and are never prepared to go for another injection again.

Children also normally dislike the environment in which they receive their injections e.g. hospitals or clinics. All these factors together make a serious negative experience and impression on them.

The majority of needlephobia victims believe that this fear of needle problem is 'all in their head'. Therefore, it is important that they are aware that there exists such a pathological problem, and that there is actually a physiological explanation to their problem.

Patients are advised to talk openly to their doctors or to nurses, and to be reassured that their healthcare practitioners are able to help them with appropriate suggestions and techniques.

Medical staff, friends and parents can inform the patient on what is going to happen, how it will be done and why it needs to be done.

For a child, you could read a story book to them while the procedure is being administered. Other than that, you could bring toys or teddy bears along to the clinic so that the child could feel at home and be comfortable in the environment.

Paediatricians sometimes adorn the needles with stress-reducing pictures, like butterflies, flowers and smiley faces to associate happy elements with the sharp objects.

If fear of pain from the injection is the main reason, physicians could provide medication, like 'magic cream', which are topical anaesthetics to temporarily numb the nerves before the procedure.

Some persistent, severe fear of needles cases would require oral medication like anti-anxiety agents, which are given a few hours before injection. For lighter medication, patients can opt for paracetamol.

Sweets have also been known to have calming and analgesic effects in some infants.

Other helpful tips to minimise severe fear of needles include :

* Do a backward count before and during the injections are given. Relax and tell your doctors what your strategy is, and they will know what to do.

* Just go for it. You do not want to spend any time longer than you already do in the clinic.

* Do not look at the needle.

* Tell yourself that you are bigger than this and it will end in no time.

* If you feel faint or dizzy at the sight and thought of a needle, may be it’s time that you consult a psychologist.


More info on BELONEPHOBIA here.






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Hemofilia Pendarahan Sepanjang Hayat

Hemofilia adalah penyakit keturunan yang boleh dirawat.

oleh Hafizah Iszahanid

Hemofilia bukanlah penyakit ganjil sebaliknya penyakit keturunan yang menyebabkan darah pengidap sukar membeku hingga mengakibatkan pendarahan yang teruk apabila luka. Walaupun begitu, tidak ramai yang mengetahui mengenainya.


Justeru, terlalu banyak tanggapan salah mengenai hemofilia memaksa pesakitnya bukan saja perlu berhadapan dengan penyesuaian harian, malah perlu mendidik orang di sekeliling mereka.

Secara saintifiknya, hemofilia adalah gangguan pendarahan sepanjang hayat yang menyebabkan darah sukar membeku disebabkan kekurangan faktor pembekuan. Justeru, ia mengakibatkan pendarahan berpanjangan walaupun hanya disebabkan kecederaan kecil atau luka biasa.



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Dua jenis hemofilia yang paling kerap dialami ialah A dan B, dengan hemofilia A lebih kerap ditemui. Di Malaysia, terdapat kira-kira 900 orang penghidap hemofilia A dan 200 lagi penghidap hemofilia B.

Penyakit Keturunan

Hemofilia adalah penyakit keturunan yang diwariskan daripada ibu kepada anak dengan anak lelaki mempunyai peluang 50% untuk mewarisi penyakit ini, manakala anak perempuan mempunyai peluang 50% menjadi pembawa.

Oleh kerana ia masalah keturunan, seharusnya semua ahli keluarga perlu diberitahu dan dimaklumkan mengenai perkembangan dan kemajuan terbaru dalam pengurusan penyakit ini.

Penderita hemofilia lazimnya mengalami pendarahan berpanjangan walaupun hanya disebabkan luka kecil.

Rawatan

Hemofilia dirawat dengan menggantikan faktor pembekuan yang tiada di dalam darah melalui suntikan yang mengandungi faktor yang diperlukan. Pendarahan akan berhenti apabila faktor pembekuan yang secukupnya sampai ke tempat pendarahan.

Banyak kemajuan dicapai dalam rawatan hemofilia dalam beberapa dekad yang lalu. Penghasilan pekatan plasma adalah satu kejayaan penting yang membolehkan pesakit menghentikan pendarahan dengan satu suntikan mudah yang boleh dilakukan sendiri.

Bagaimanapun, kemungkinan pesakit dijangkiti penyakit jangkitan darah seperti hepatitis B, hepatitis C dan HIV terus menimbulkan masalah.

Sehinggalah pada sekitar 1980 apabila pekatan faktor yang digubah secara genetik dicipta, mencetus inovasi terbaru dan revolusi dalam rawatan faktor VIII tanpa plasma manusia dan albumin daripada binatang, sekali gus melenyapkan risiko jangkitan patogen.

Namun, cabaran pesakit hemofilia tidak berhenti meskipun tercetusnya inovasi dalam dunia perubatan.

Persekutuan Hemofilia Sedunia (WFH)

Presiden Persekutuan Hemofilia Sedunia (WFH) yang juga pesakit hemofilia, Mark Skinner, berkata cabaran paling besar yang dihadapi oleh mereka yang mengalami gangguan pendarahan pesakit di kebanyakan negara ialah mendapatkan rawatan yang selamat dan termampu.

WFH sedang berusaha mencapai wawasan untuk membolehkan semua pesakit menerima rawatan, termasuk mendapatkan pekatan faktor pembekuan. Selain itu, ini juga bermakna diagnosis yang tepat, pengurusan dan penjagaan sewajarnya yang disediakan oleh pakar terlatih dalam pelbagai bidang.

Simptom-simptom

Semasa awal kelahiran :

* Pendarahan pada otot, lebam selepas menerima rutin suntikan vitamin
* Pendarahan berpanjangan selepas berkhatan
* Pendarahan berpanjangan selepas tali pusat dipotong

Lain-lain simptom :

* Pendarahan di bahagian sendi (lutut, buku lali, siku) yang menyebabkan sakit dan bengkak
* Pendarahan luar biasa selepas kecederaan atau pembedahan
* Mudah lebam
* Hidung berdarah dengan kerap
* Darah dalam air kencing
* Berdarah selepas rawatan pergigian


Lagi info tentang HEMOFILIA di sini.






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Type of Hearing Loss


by Dr Ong Chun Chiang

The media has highlighted recent studies in the US and Hong Kong that prolonged listening to MP3 players significantly increases the risk of hearing loss later in life.

These facts are not new as Ludwig van Beethoven, the famous German composer, was known to be deaf and suffering from tinnitus (persistent ringing noise in the ear). Loud rock music has been shown to contribute to hearing loss.


Hearing is very much part of our everyday life, and most of us take it for granted. Hearing loss is the second highest registered disability in Malaysia. Statistics from the Welfare Department reported 26,294 such disabilities in 2005 alone.

Any disruption or damage to this pathway can cause hearing loss.



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Hearing Loss in Children

About one in every 1000 school-age children in metropolitan Atlanta in the US has moderate to profound bilateral hearing loss. In the 1988 National Health Interview Survey – Child Health Supplement, parents reported that 3.5% of children (aged from birth to 17 years) in the United States had 'deafness or trouble hearing' in one or both ears. These affect their speech, language, cognitive and psychological developments.

Children born with hearing loss are thus afflicted due to genetic factors (more than 50% cases), intrauterine infections (rubella, cytomegalovirus and herpes simplex virus), prematurity, maternal diabetes, toxaemia during pregnancy and lack of oxygen during birth (anoxia).

Acquired hearing loss is hearing loss that appears after birth. This can be as a result of disease, infections or injury. Some of the causes include ear infections (otitis media), ototoxic drugs (drugs that damage the auditory system), meningitis, measles, encephalitis, chicken pox, influenza, mumps, head injury and noise exposure.

Hearing Loss in Adults

Adults can acquire hearing loss pretty much the same way as children. Our hearing deteriorates as we grow older. In the 1994 National Health Interview Survey Core and Second Supplement on Aging, one third of adults aged 70 and older reported that they had trouble hearing. 7% reported that they were deaf in both ears and 8% reported that they were deaf in one ear.

Types of Hearing Loss

Otitis Media

Otitis media is an inflammation in the middle ear (the area behind the eardrum) that is usually associated with build-up of fluid. Children often present with inattentiveness, wanting the television louder than usual, misunderstanding instructions, listlessness, unexplained irritability and pulling or scatching at the ears.

Older children and adults will notice some hearing loss. Pain is a symptom when there is acute infection.

Otitis media can resolve on its own but requires treatment if it is persistent or if there is acute infection. Antibiotics are usually prescribed, but if the condition recurs or persists, grommets (little plastic ventilating tubes) can be inserted for immediate relief of symptoms.

In older children and adults, nasopharyngeal cancer must be excluded by the doctor.

Sensorineural Hearing Loss

This type of hearing loss is due to damage or degeneration of the inner ear, including its nerve (vestibulocochlear nerve).

Certain drugs, including high doses of antibiotics such as gentamicin (that may be required for severe infections), can cause sensorineural hearing loss. These drugs damage the hair cells in the cochlea. Infections, as mentioned earlier, can also damage these hair cells.

As we grow older, the hair cells degenerate. Constant exposure to loud noise (more than 85 decibels for 8 hours or more per day) can do the same.

There is no cure for sensorineural hearing loss. Hearing aids help to amplify sound for sufferers. Cochlear implants help improve hearing in patients with profound sensorineural hearing loss.

Sudden sensorineural hearing loss is fortunately rare. If treated early, the majority do recover. Its cause is unknown but viral and sudden reduction in blood supply to the inner ear are possible causes.

Meniere's disease (endolymphatic hydrops) is a condition that presents with repeated attacks of vertigo (dizziness), tinnitus and hearing loss. It is believed to be an auto-immune condition whereby the body produces antibodies that cause the endolymphatic sac to swell. It can be treated with medications and if severe, operations can help relieve its symptoms.

Other types of hearing loss are rare.

Otosclerosis is due to fixation of the stapes bone (the smallest bone in our body) to its footplate. It is more common in Caucasians and people from the Indian subcontinent. Sufferers find hearing aids useful. Operations can also help.

Ear tumours giving rise to hearing loss are rare. Acoustic neuroma is a benign tumour of the vestibulocochlear nerve that gives rise to sensorineural hearing loss and sometimes tinnitus and vertigo. It can be treated by external radiation therapy or surgery.

Chronic suppurative otitis media is a condition caused by chronic inflammation of the middle ear, giving rise to persistent ear discharge, pain and hearing loss. The eardrum is usually perforated. This condition requires a mastoid operation to improve symptoms.

Consult Physician

It is important to consult a physician if one suffers from hearing loss. Treatment is directed at the cause of such hearing loss.

Even if there is no treatment, such as in the case of unilateral sensorineural hearing loss, it is important for the sufferer to understand his or her condition.


More info on HEARING LOSS here.






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Gangguan Obsesif Kompulsif


Ramai orang tidak faham mengapa mereka selalu cemas, waswas, tertekan dan murung, cepat marah, mudah tersinggung serta hilang keyakinan diri. Mereka juga kerap berasa takut, malu dan menganggap diri tidak berguna.

Apabila waswas, seseorang itu akan melakukan perkara sama berulang kali, namun masih berasa tidak puas hati. Contohnya ialah mencuci tangan berulang kali sehingga kulit terasa pedih kerana membayangkan tangannya masih kotor, atau mengambil wuduk berkali-kali tetapi masih terasa air sembahyangnya tidak rata.


Perkara yang disenaraikan di atas adalah sebahagian daripada gejala gangguan obsesif kompulsif (obsessive-compulsive disorder - OCD) iaitu antara penyakit mental dan perlu rawatan segera. Bagaimanapun, walaupun anda ada gejala yang disebut di atas, tidak bermakna anda menghadapi masalah OCD.

Seseorang itu hanya boleh disahkan menghidap OCD melalui pemeriksaan pakar berdasarkan beberapa ciri iaitu jika menunjukkan sikap keterlaluan. OCD dibahagi kepada beberapa kategori iaitu aspek pemikiran, bayangan atau cara yang berulang-ulang.



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Punca dan Faktor

Punca OCD tidak diketahui, tetapi penyelidik percaya ia ada kaitan dengan ketidakseimbangan bahan kimia otak, iaitu neurotransmiter dan gejala OCD boleh dikurangkan jika pesakit mengambil ubat serotonin.

Antara faktor yang boleh meningkatkan risiko OCD termasuk genetik (keturunan) khususnya membabitkan pertalian darah yang kuat (seperti daripada bapa kepada anak). Bagaimanapun, mereka mungkin menghadapi kerumitan pemikiran berbeza, misalnya ayah mengalami obsesif terhadap kebersihan manakala anaknya mengalami obsesif objek.

OCD boleh menyebabkan penghidapnya rendah diri terhadap orang sekeliling. Lebih malang apabila ahli keluarga tidak faham dengan masalah dialami penghidap OCD dan ini boleh menimbulkan ketegangan.

Ini kerana mereka berasa cepat marah dan mudah tersinggung. Mereka juga mempunyai personaliti obsesif seperti terlalu mementingkan kebersihan, patuh peraturan, objek, cerewet, tidak boleh bertolak ansur dan tidak mahu mengalah.

Penghidap OCD tidak mampu mengawal diri daripada berfikiran melampau. Pemikiran ini bukan sengaja dibuat-buat dan walaupun sedar masalah dihadapi, pesakit tidak mampu mengawalnya. Menahan atau melawan pemikiran obsesif menyebabkan mereka lebih resah dan takut.

Kanak-kanak OCD

Penyelidik dari Universiti Florida mendapati kanak-kanak yang ada masalah OCD mempunyai kecenderungan 3 kali ganda menjadi mangsa buli berbanding kanak-kanak normal. Kelakuan berbeza serta kurang keyakinan diri menyebabkan mereka mudah dijadikan sasaran kes buli di kalangan kanak-kanak.

Hubungan kanak-kanak OCD dengan rakan sebaya biasanya tidak baik dan kanak-kanak akan membuli orang yang dilihat menunjukkan kelakuan berbeza.

Walaupun semua kanak-kanak boleh menjadi mangsa buli, risiko kanak-kanak OCD dibuli jauh lebih tinggi dan ini menyebabkan masalah dialami pesakit semakin serius.

Akibatnya kanak-kanak OCD mengalami masalah sosial, sunyi, tiada kawan dan anggap tiada orang menyayanginya. Mereka diasingkan kerana kawan tidak faham mengapa pesakit melakukan satu perkara berulang-ulang.

Gejala OCD

Antara gejala umum OCD ialah:

* Murung
* Letih
* Berasa rendah diri dan mudah tersinggung
* Berasa diri tidak berguna
* Cepat marah dan tertekan
* Selalu resah
* Was-was
* Tidak dapat memberi tumpuan kepada tugas
* Prestasi kerja menurun
* Hubungan sosial terganggu

Semua orang mempunyai risiko diserang OCD, tetapi ia lazimnya berlaku di kalangan remaja dan awal dewasa. Antara contoh kes OCD yang biasa ialah kebimbangan keterlaluan terhadap jangkitan akan menyebabkan penghidap membasuh tangan berulang kali.

Ada juga yang mencuci tangan sehingga berdarah. Jika ingin mandi, mereka mencuci bilik mandi, mandi dan mencuci bilik mandi sekali lagi sebelum bersiap untuk ke tempat kerja.

Malah ada pesakit menyentuh objek, menyebut nama atau perkataan berulang kali. Terlalu bimbang keselamatan anak, ada ibu bercakap atau berpesan kepada gambar anak.

Ada juga terlalu bimbang akan mencederakan orang lain dengan memeriksa kepala gas dan api dapur berulang kali bagi memastikan ia dalam keadaan selamat. Sama juga halnya apabila penghidap OCD memandu kereta. Mereka akan memandu dengan sangat perlahan setiap kali berasakan ada bonggol di jalan raya kerana bimbang akan mencederakan pejalan kaki.

Kebimbangan melampau ini menyebabkan penghidap OCD mengambil masa lama dan bertindak sangat perlahan untuk menyiapkan tugas. Malah ada juga yang tidak mampu menyelesaikan tugas diamanahkan.

Dalam kes begini, pesakit perlu mendapatkan rawatan segera. Pada masa sama, mereka sangat memerlukan sokongan keluarga. Keluarga harus bersabar dan cuba memahami keadaan pesakit. Buatlah perbandingan dan beri komen positif kepada pesakit supaya mereka lebih kuat untuk mengatasi masalah OCD.


Lagi info tentang GANGGUAN OBSESIF KOMPULSIF di sini.






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Obesity Causes Cancer


by Dr Albert Lim Kok Hooi

A report prepared jointly by the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) in 2007 details the findings of the most authoritative investigation ever undertaken into the link between lifestyle, diet and cancer. The message is overwhelmingly clear - obesity causes cancer.


Smoking is the most important lifestyle cause of cancer. Obesity ranks a close second. In other words, after smoking, obesity is the highest preventable cancer risk.

We used to say that one third of all cancers can be prevented if smoking were to completely cease. We can now say that two-thirds of cancers – 12 million new cancer cases diagnosed each year in the world – would not occur if we are all transformed to slim, fit non-smokers tomorrow.



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Foods to be Avoided

What did the report say about the kinds of food we should not eat to avoid cancer? For starters, we should avoid all processed meats, including bacon (bak kua in our local context) and most sausages. It also advises against eating more than 6gm of salt per day.

One reason for avoiding processed meats is that they often contain nitrates – preservatives that may contribute to the production of suspected carcinogens called N-nitroso compounds. Processed meats also contain high levels of salt, which is linked to stomach cancer.

The fat and thin of it all is this. If you wish to avoid cancer – lung cancer, colorectal cancer, breast cancer, ovarian cancer, uterine cancer, cancers of the oesophagus, kidney, pancreas, the list goes on – stop smoking and maintain a body mass index (BMI) of 18.5 to 23 (as per international 'European' recommendations) – i.e. the healthy range.

Body Mass Index

A word or two about BMI. This figure is obtained by dividing your weight in kilograms by the square of your height in metres.

BMI = weight / height * height

In Asian societies, a woman who is 5 feet tall (1.5 metre) looks suspiciously overweight when her BMI is 23. Endocrinologists and dietitians have come up with our own Asian BMI, which is lower than the accepted BMI.

So, for all you women out there from 15 to 85, please try to achieve a BMI of 18.5 to 21. The nearer the lower figure, the better.

Lots of exercise and a strict low-calorie diet will enable you to achieve many goals : beauty, attractiveness, good mates and a much lower chance of getting cancer, diabetes, hypertension, stroke and heart disease.

What Should We Eat

What then should we eat? Eat 5 portions of fruit and non-starchy vegetables (brussel sprouts, broccoli, cauliflower, celery, mushrooms to name a few) each day and limit refined starchy food. White meat – chicken, turkey, rabbit – is much more preferable to red meat. Most of all, count your calories.

Aim for 30 to 60 minutes of moderate physical activity every day. Brisk walking is the easiest and most accessible activity. Diet and exercise go together. One or the other will not achieve your goal.

The science is there but the interventional methods to achieve a healthy lifestyle are something else. How do you overcome the virtue of white rice (and lots of it) in Malaysian and Asian societies?

They tell me there is 'semangat' (spirit or life force) in rice. White rice is an energy-dense food that is diabetogenic, has a high glycaemic index and a major culprit of obesity and getting cancer!

How do you tell the common folk that their 10 favourite foods are a no-no from the scientific health-wise point of view? Nasi lemak, roti canai, curry mee, wanton mee, burger, doughnuts, fries, char kuay teow, chicken rice and mee goreng are out.

How do you politely reject your mother-in-law's incessant heaping of seconds on your plate? How do you decouple the Asian-African notion of prosperity and a protuberant abdomen?

We spend billions of US dollars a year on research to treat cancer and rightly so. We also spend millions of US dollars on how best to get people to quit smoking and eat wisely and equally rightly so.

Wish we were more successful in our second endeavour.

More info on OBESITY here.






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Elak Dehidrasi Ketika Mengandung

Mengidam makanan masin, pelik petanda daripada bayi tagih beberapa jenis mineral.

oleh Dr. Noordin Darus

Seperti yang anda semua ketahui, air adalah satu elemen penting bagi manusia tidak kira usia dan jantina. Bagaimanapun, ada kalanya ramai yang terlupa dan alpa akan kepentingan air terhadap tubuh badan mereka terutama sekali bagi kaum wanita.


Air memberikan anda tenaga, lebih-lebih lagi wanita mengandung. Apabila anda mengandung, perkara pertama yang akan diberitahu oleh doktor anda adalah banyakkan meminum air dan susu untuk memenuhi tuntutan harian sebanyak 2 hingga 3 liter sehari. Jika tidak mampu oleh kerana alahan (morning sickness), anda boleh minum air kosong yang dicampur dengan jus, sirap dan sebagainya.



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Namun, yang seeloknya untuk minum air kosong yang ditapis. Persoalannya di sini mengapa air amat dititikberatkan terutama sekali bagi ibu mengandung?

Seperti yang anda ketahui, sebagai manusia biasa, air adalah satu keperluan yang penting untuk tubuh badan, tidak kira anda mengandung atau tidak. Kita boleh hidup berminggu-minggu tanpa makanan tetapi hanya beberapa hari tanpa air.

Wanita Mengandung

Tubuh badan kita secara semula jadi memerlukan air untuk hidup kerana sekiranya tanpa air, ia akan mengganggu fungsi sistem pengendalian dalam badan kita sekali gus membuatkan kita menjadi dehidrasi terutama untuk wanita mengandung.

Ini kerana ketika mengandung, ibu hamil kerap membuang air kecil disebabkan oleh tekanan yang diberikan kepada pundi kencing oleh bayi yang dikandung mereka. Disebabkan itulah wanita yang mengandung perlu kerap minum air kosong sekurang-kurangnya dua setengah liter sehari supaya tubuh badan mereka tidak akan dehidrasi dan cukup untuk menampung kehilangan air dari badan yang berlaku dalam pelbagai cara selain daripada kerap membuang air seperti berpeluh.

Wanita mengandung kerap berasa panas dan berpeluh, disebabkan itu jugalah mereka perlu menggantikan kandungan air yang keluar dari tubuh badan mereka dengan meminum lebih banyak air kosong.


Lagi info tentang WANITA MENGANDUNG di sini.






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Tips to Good Digestive


Billions of bacteria live in our digestive system. However, this does not mean that they cause illnesses and must be rid from our bodies.

There are 'good' bacteria that we should nurture and allow to proliferate. The key is to have a high level of 'good' bacteria co-existing with low-level of 'harmful' bacteria.


The beneficial bacteria in our digestive tract help us absorb food and minerals. Two examples are the bifidobacterium which is the main and important component amongst the bacteria strains in the gut. The second is lactobacillus acidophilus or commonly known as acidophilus, and together, they suppress harmful bacteria.



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What happens when the equilibrium is unbalanced? The digestive can be affected in many ways. However, there are signs that will prompt us to be on the alert.

Diarrhoea, gas, abdominal pains, vomiting, cramps, indigestion and bloating are some conditions that tell us something is not right.

Tips to Good Digestive

Below are some tips to good digestive and gut health.

* Load up on those beneficial bacteria

* Live cultures of 'good' bacteria like bifidobacterium and acidophilus can be found in most yoghurt or yoghurt drinks. Nowadays, these products come in a multitude of flavours to suit all consumers.

* Boost the number of these microorganisms that live in the gut to kill off the 'bad' bacteria.

* Healthy diet

Develop good, healthy eating habits. The first condition to a healthy diet is to eat a wide variety of foods so that you can gather all the different nutritional requirements.

In a nutshell, we should eat more fruits, vegetables, yoghurt and yoghurt drinks, starchy and fresh produce and less sugary, salty, fatty and processed foods.

* Eat more fibre

The best source of fibre and the easiest way to consume it is to eat more fruits, vegetables, beans and whole grains.

Nowadays, most breakfast cereals, and those for children too, are packed with fibre, vitamins and nutrients.

Start your day with a healthy serving of breakfast cereals that will take you through to the next meal.

* Healthy weight

Keeping your weight at the desired level is tough but everybody knows the benefits of maintaining a healthy weight. It lowers the risk of coronary diseases like heart attack and stroke, diabetes and hypertension, to name a few.

Be aware of what you consume with a strong emphasis on low fat and low cholesterol foods. Be more active, choose smaller portions during meal times and eat slowly.

* Move more, eat less

Be more active. Choose activities you enjoy and do them every day. If need be, do them with a friend and both of you can keep each other on track. Reduce your intake of sweet drinks and junk food.

* Turn off the TV

Watching less TV can give you more time to exercise and be active.

Also, you will not be enticed by junk food commercials. Two ways of reducing TV watching is by: a) taking it out of your bedroom; and b) switching off the TV during meal times.

* Drink plenty of water

Water helps to soften waste material in the gut and prevents constipation which, if left unchecked, could lead to digestive stress.

* Vitamins and minerals

Try to get all your vitamins and minerals from foods you consume and not from supplements. Also, food provides the 'synergy' that many nutrients require so that they can be efficiently broken down and absorbed in the body.

Once equilibrium is restored, you will enjoy a sense of well-being.

After all, a healthy body brings with it glowing skin, luscious hair and strong nails.


More info on DIGESTIVE HEALTH here.






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