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Understanding Atopic Eczema

Atopic eczema runs in families.

Atopic eczema is a dry, itchy inflammation of the skin. It can affect any part of the skin, including the face, but the areas most commonly affected are the bends of the elbows, around the knees, and around the wrists and neck. These are known as 'flexural' areas.


It affects both sexes equally and usually starts in the first weeks or months of life. It is most common in children, affecting at least 10% of infants, although it can carry on into adult life or come back in the teenage or early adult years.

Atopic eczema tends to run in families. If one or both parents suffer from eczema, asthma, or hay fever, it is more likely that their children will suffer from them too. In addition, there is a tendency for these conditions to run true to type within each family. In other words, in some families most of the affected members will have eczema, in others, asthma or hay fever will predominate.



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Causes

This is still not fully understood. Atopy runs in families and is part of one's genetic make-up. Atopic people have an overactive immune system and their skin easily becomes inflamed (red and sore). Their skin 'barrier' does not work well, so that their skin may become dry and prone to infection.

Atopic eczema is not infectious.

Reasons

• Many external factors can make eczema worse. These include heat, dust, and contact with irritants such as soap or detergents.

• Being unwell - for example having a cold can make eczema flare up.

• Infections with bacteria or viruses can make eczema worse. Bacterial infections make the skin yellow, crusty and inflamed, and may need treatment with antibiotics. A viral infection with the herpes simplex virus can cause a painful flare of eczema, and may need treatment with antiviral tablets.

• Dryness of the skin.

• Perhaps stress.


Symptoms

The main symptom is itch. Scratching in response to this may be responsible for many of the changes seen on the skin. Itching can be bad enough to interfere with sleep.

Diagnosis

It is usually easy for health care professionals, such as health visitors, practice nurses and general practitioners, to make the diagnosis when they look at the skin. However, sometimes the pattern of eczema patches in older children and adults is different, and the help of a hospital specialist may be needed.

Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.

Atopic eczema cannot be cured, but there are many ways of controlling it. Most children with atopic eczema improve as they get older — 75% clear by their teens. However, many of those who have had eczema continue to have dry skin and need to avoid irritants such as soaps or bubble baths.

Eczema may persist in adults it but should be controllable with the right treatment.

Treatment

You will need the advice of a health care professional on the best treatment for eczema and how long this should continue. The treatments used most often are moisturisers, and topical steroid creams or ointments.

Moisturisers (emollients) should be applied every day to stop your skin becoming dry. Many are available, and it is important that you choose one you like to use.

Topical steroid creams or ointments will settle the redness and itching of your eczema when it is active. They come in different strengths (potencies), and your doctor will advise you which type needs to be used where, and for how long.

Topical steroids should be used in combination with moisturisers in a skin care regime

Source : British Association of Dermatologists


More info on ECZEMA here.






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Teknik Membesarkan Saiz Zakar

Kebanyakan lelaki yang menganggap saiz zakarnya terlalu kecil sebenarnya memiliki saiz yang normal. Ramai lelaki telah meminta nasihat doktor kerana bimbang tentang saiz zakar mereka. Namun, hakikatnya, mereka ini adalah pemilik zakar bersaiz normal.

Iklan-iklan media elektronik mahupun cetak biasanya mengaburi lelaki bahawa pasangan masing-masing mementingkan saiz zakar.


Boleh jadi, saiz zakar anda sebenarnya berada dalam lingkungan normal. Saiz zakar yang sangat kecil biasanya berukuran kurang daripada 3 inci apabila berada dalam keadaan tegang. Keadaan ini dikenali sebagai zakar mikro (micropenis). Tetapi, dalam kebanyakan kajian, lelaki yang memiliki zakar mikro ini juga didapati mampu mengecapi kepuasan dalam hubungan seks dan mempunyai anak.

Ya, mungkin benar sesetengah wanita mengambil kisah mengenai saiz zakar pasangannya, tetapi kebanyakan wanita tahu saiz bukan kayu pengukur kepada segala kepuasan di ranjang. Kebenarannya ialah saiz zakar yang terlalu besar mungkin bukan satu kelebihan ketika hubungan seksual berlangsung. Ini kerana hujung zakar yang panjang mungkin akan memberi satu 'pukulan' kepada serviks pasangannya sekali gus mengakibatkan rasa sakit.

Memahami keperluan fizikal dan emosi pasangan boleh dilakukan menerusi perbincangan. Kaedah ini lebih praktikal untuk memperbaiki hubungan intim anda berbanding mengambil keputusan menukar saiz zakar.

Produk Pembesaran

Pihak peniaga dan pengiklan mungkin menawarkan sejumlah jenis produk pembesaran zakar tanpa jarum. Iklan-iklan juga kelihatan 'serius' dengan pengesahan daripada penyelidik saintifik. Hakikatnya, dakwaan tentang keselamatan dan keberkesanannya adalah tidak berasas.

Oleh kerana tiada kajian saintifik yang meluluskan sebarang jenis produk pembesaran zakar, maka, pengiklan terpaksa bergantung kepada testimoni pengguna. Malah, Pentadbiran Pemakanan dan Ubatan (FDA) Amerika Syarikat juga belum pernah meluluskan sebarang ubatan atau peralatan untuk membesarkan saiz zakar.

Jadi, berhati-hatilah dengan pelbagai teknik yang mendakwa mampu membesarkan saiz zakar kerana sesetengah daripadanya mungkin boleh mengakibatkan kerosakan serius seperti berikut :

Senaman memicit secara manual

Senaman yang menggunakan pergerakan tangan untuk menolak darah daripada pangkal ke kepala zakar yang separa-tegang, sepatutnya dilakukan secara kerap. Walaupun teknik ini mungkin lebih selamat berbanding kaedah lain, ia boleh menjurus kepada pembentukan parut, kesakitan dan kecacatan. Tiada kajian saintifik yang mengesahkan keberkesanan teknik ini.

Pam vakum


Oleh kerana pam boleh menggalakkan aliran darah ke dalam zakar dan menyebabkannya bengkak, maka, kaedah ini hanya sesuai untuk rawatan masalah ketidaksuburan. Cara ini hanya memberi ilusi saiz zakar yang lebih besar padahal kesannya jarang berkekalan. Penggunaan alat ini untuk jangka masa panjang boleh merosakkan tisu-tisu kenyal dalam zakar dan menjurus kepada ketegangan kurang kukuh.

Pil dan losen

Kandungan produk ini biasanya terdiri daripada vitamin, bahan mineral, herba atau hormon seperti testosteron yang mendakwa mampu membesarkan saiz zakar. Hakikatnya, tiada satu pun produk ini telah dibuktikan berkesan.

Pembedahan

Selain itu, pelbagai teknik pembesaran zakar telah 'dicipta' oleh pakar-pakar bedah. Namun, tiada satu pun daripadanya disahkan oleh mana-mana organisasi perubatan. Malah, semua Persatuan Urologi Amerika, Persatuan Pembedahan Plastik Estetik Amerika dan Persatuan Pakar-pakar Bedah Plastik Amerika (ASPS) telah mengeluarkan kenyataan polisi terhadap pembedahan kosmetik untuk memperbaiki keadaan zakar.

Kepelbagaian teknik yang digunakan ini cuma berada pada peringkat eksperimentasi sahaja. Belum ada kajian kukuh tentang hasil dan risiko sebenar akibat komplikasi 'membetulkan' zakar.

Salah satu prosedur memanjangkan zakar melibatkan pemotongan ligamen yang melekat pada zakar sehingga tulang pubik. Selain itu, ia juga merangkumi pemindahan kulit dari abdomen kepada hulu zakar. Apabila ligamen ini dipotong, ia mungkin membuatkan zakar kelihatan panjang kerana caranya tergantung ke bawah.

Namun, masalahnya, pemotongan ligamen tersebut boleh mengakibatkan ketegangan zakar menjadi tidak stabil dan menghala ke posisi pelik apabila menegang. Kibasan kulit dari kawasan pubik ke dalam zakar pula misalnya boleh menjurus kepada kecacatan serius seperti penumbuhan bulu pada pangkal zakar, kesan parut dan masalah lain.

Satu lagi teknik ringkas adalah mencantumkan lemak yang diambil dari bahagian abdomen atau punggung ke dalam zakar. Malah, ada sesetengah pakar bedah menggunakan tisu yang diperoleh daripada mayat!

Pihak ASPS turut menyelar kaedah suntikan lemak ke dalam zakar yang sebenarnya belum terbukti selamat dan memanfaatkan. Sebaliknya, pesakit mungkin terdedah kepada risiko jangkitan, hilang sensitiviti pada kulit, pendarahan berlebihan dan hilang fungsi zakar.

Pembedahan bukan sahaja berisiko, mahal dan tidak semestinya menjanjikan hasil yang memuaskan.

Kajian mendapati kebanyakan lelaki yang pernah menjalani pembedahan membesarkan zakar tidak berpuas hati dengan hasilnya. Dalam sesetengah kes serius, sebahagian lelaki terpaksa menjalani pembedahan tambahan untuk membetulkan kecacatan akibat prosedur rawatan asal.

Kesan-kesan negatifnya termasuk parut, zakar yang lebih pendek, hilang sensitiviti dan kehadiran bonjolan-bonjolan lemak abnormal. Impak negatif lain yang turut dilaporkan termasuk ketidaksuburan, pembuangan air kencing tidak terkawal dan kesakitan berterusan.

Akibatnya, anda terpaksa membayar 'harga' yang mahal. Di AS, sekurang-kurangnya RM37,000 diperlukan hanya untuk pembedahan asas membesarkan zakar. Jadi, disebabkan pembedahan kosmetik tidak dilindungi oleh insurans, maka, anda terpaksa menanggung segala kos terlibat.

Kaedah Berkesan

Biarpun tiada satu-satunya kaedah yang berkesan dan selamat untuk membesarkan alat sulit anda, terdapat beberapa perkara yang boleh dijadikan pedoman :

* Berinteraksi dengan pasangan anda

Membincangkan topik kedudukan kegemaran di ranjang mungkin sukar dilakukan secara terbuka. Tetapi, hanya dengan komunikasi yang baik dapat mengembalikan pengalaman seksual yang menarik.

* Bersenam

Keadaan fizikal yang lebih baik boleh menjadikan anda kelihatan menawan sekali gus memperbaiki kekuatan dan tahap ketahanan ketika beradu di ranjang.

* Singkirkan lemak badan

Sekiranya bahagian bawah abdomen anda sudah melangkaui kawasan genitalia, maka zakar anda kelihatan lebih kecil. Lebihan lemak pada badan boleh mengaburi bahagian atas zakar. Oleh itu, cuba kekalkan berat badan ideal.

* Merapi bulu-bulu pubik

Bulu pubik yang banyak dan lebat pada pangkal zakar biasanya akan menyebabkan zakar anda kelihatan pendek. Merapikan bulu pada kawasan itu mampu meningkatkan sensitiviti sekitar bahagian pangkal zakar.

* Bincang dengan doktor atau pakar kaunseling

Berbincang dengan seorang pakar boleh membantu. Ramai lelaki akan berasa selesa dan lega setelah mendapat pengesahan bahawa mereka adalah 'normal'.

Justeru itu, pertimbangkan keputusan anda sebaik mungkin sebelum beralih kepada teknik yang bukan sahaja mahal tetapi memudaratkan dan belum tentu efektif di kemudian hari.




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Endometriosis May Lead To Infertility

by Dr. Nor Ashikin Mokhtar

Have you ever had menstrual periods so bad that you dread them in the days leading up to your cycle? Do you skip several days of work or school every month because you can not stand the pain? Do you suffer pelvic pain even during sexual intercourse?

You may have a condition called endometriosis. Millions of women around the world suffer from this disease, which not only causes severe, debilitating pain, but may also lead to infertility.

For this reason, women, especially girls in their teens, should not brush off serious period pains. Getting medical advice and treatment at an early stage will prevent future problems, especially in conceiving a baby.



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Growths Outside the Uterus

Every month, during your menstrual cycle, the lining of your uterus (endometrium) builds up with blood vessels and tissues, in preparation for a fertilised egg to be implanted on the wall. However, if the egg from your ovaries is not fertilised by sperm, the hormones in your body will signal your uterus to shed the blood and tissues, which results in your monthly period.

In some women, tissue that looks and acts like the endometrium starts growing outside the uterus – creating abnormal growths on the outer surface of the uterus, the ovaries, the fallopian tubes, the ligaments that support the uterus, the intestines, the bladder, the internal area between the vagina and rectum, and the lining of the pelvic cavity.

These growths are made up of the same kind of tissue and blood vessels as the endometrium, therefore they also react to the hormonal changes of the menstrual cycle. But unlike normal endometrial tissue that is released as menstrual blood, the tissue in the abnormal growths have nowhere to go.

Thus, with each menstrual cycle, the growths get larger and larger, causing the symptoms to get more painful each month. The build-up of blood and tissue also causes inflammation and internal bleeding.

What Symptoms?

The most common symptom of endometriosis is lower abdominal pain, especially before and during menstrual periods. Some women may even experience pain throughout the menstrual cycle. The periods tend to be heavy and may even be erratic.

Some women also suffer from painful sexual intercourse, which may be caused by the stretching of the endometrial tissue behind the vagina.

One common complication of endometriosis is infertility, with an estimated 30 to 40% of women having difficulty conceiving.

Infertility can be related to several factors. For instance, the scar tissue from endometriosis can form adhesions around the ovary and restrict the available surface area of the ovary for egg release. Adhesions affecting the fallopian tubes may interfere with their ability to pick up an egg released by an ovary and transport it to the uterus.

Occasionally, endometriosis affects the inside of the fallopian tube, resulting in blockage, and making fertilisation impossible. Endometriosis can also disrupt the ovaries' normal cycle of egg development and release.

Treating Endometriosis

The most invasive form of treatment for endometriosis is a hysterectomy. A hysterectomy is an operation to remove the uterus (sometimes the cervix is removed too). More than 100,000 women in the United States undergo hysterectomies each year due to endometriosis.

However, a hysterectomy has serious repercussions on a woman's sexuality, sexual function, ability to conceive and her quality of life, as it will cause premature menopausal symptoms.

Young women of reproductive age should only consider hysterectomy after exploring other options for treatment.

Hormonal medication may also be able to reduce the activity of the endometrial tissue. You should only take hormonal medication as prescribed by your gynaecologist.

Anti-inflammatory medication can relieve the pain of endometriosis, but it has to be taken before the pain begins so that it is able to block the production of prostaglandins that produce the pain.

These painkillers have be to taken every six hours. However, taking these over the long-term can cause other complications, so get your doctor's advice.

Finally, do not discount the effects of exercise and rest. These can improve overall immune system function and will contribute to relief from endometriosis.

Physical activities release endorphins, which act as a natural painkiller in the body. Rest and relaxation can relieve stress due to work and other factors, which is important as stress can lead to hormonal changes and increased levels of pain.

Endometriosis is not an easy condition to live with, and it may cause you to feel frustrated and depressed. But take comfort in the fact that you are not alone, and that you can share your experience with other women.

Most importantly, you do not have to live with the pain every month – talk to your gynaecologist and explore options that will help you regain your quality of life.


More info on ENDOMETRIOSIS here.






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Lima Masalah Dental Yang Lazim


Setiap orang akan berdepan dengan masalah dental (gigi), sekurang-kurangnya satu kali, pada satu tahap dalam hidup mereka.

Berdasarkan Persatuan Pergigian Malaysia, sebanyak 95% daripada populasi Malaysia telah pun merasai kesan-kesan perit pereputan gigi. Kajian yang dijalankan menyatakan bahawa pereputan gigi biasanya memberi kesan yang lebih kepada orang yang berumur 35 tahun ke atas.


Sembilan daripada 10 rakyat Malaysia turut menunjukkan bukti-bukti terdapatnya penyakit gusi. Statistik ini agak membimbangkan kerana ia menunjukkan bahawa rakyat Malaysia tidak peka terhadap penjagaan gigi.



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Oleh itu, ia adalah mustahak bagi rakyat Malaysia untuk memahami cara-cara yang betul untuk mencapai dan mengekalkan penjagaan gigi yang baik. Ini dapat dicapai dengan mengambil langkah-langkah yang sepatutnya untuk meningkatkan kebersihan oral.

Walaupun terdapat banyak penyakit dental yang lazim berlaku, 5 jenis penyakit yang berpunca daripada aktiviti bakteria yang paling lazim dikesan adalah plak, pereputan gigi, gingivitis, periodontitis dan juga radang gigi.

Plak

Plak gigi

Plak adalah lapisan tidak berwarna yang sentiasa dan berterusan terbentuk di dalam mulut kita. Ia terbentuk daripada gabungan bakteria, air liur dan asid yang seterusnya membentuk deposit melekit yang melekat pada gigi.

Plak juga boleh merosakkan gusi dan asid yang dihasilkan pula boleh memusnahkan lapisan atas enamel gigi, mengakibatkan gigi berlubang dan kaviti.

Apabila plak tidak di buang, ia akan bertukar menjadi kalkulus dan tartar.

Dengan mengehadkan pengambilan makanan bergula, air bergas dan makanan yang mengandungi tahap karbohidrat yang tinggi, ia memudahkan pengawalan dan juga mengurangkan jumlah plak yang terdapat pada gigi.

Plak juga boleh disingkirkan dengan lebih kerap memberus gigi dan menggunakan flos gigi (setiap kali selepas makan).

Pereputan Gigi

Pereputan gigi, juga dikenali sebagai kaviti dental, adalah jangkitan yang berpunca daripada kombinasi makanan berkarbohidrat tinggi dan bakteria yang hidup dalam mulut kita.

Apabila bakteria ini berjumpa dengan karbohidrat, ia akan mencernakan karbohidrat tersebut lalu membentuk asid yang akan perlahan-lahan menghakis lapisan enamel yang keras pada gigi kita.

Gingivitis


Gingivitis

Gingivitis adalah kemerahan atau jangkitan gusi pada tahap awal penyakit periodontal (penyakit gusi).

Gusi yang sihat selalunya berwarna merah jambu. Gingivitis menyebabkan gusi kemerahan dan bengkak, serta sering berdarah apabila memberus gigi ataupun mengunakan flos gigi.

Sekiranya tidak mendapatkan rawatan, jangkitan akan merebak ke bawah garisan gusi dan mengakibatkan penyakit dental.

Penyakit gusi boleh memusnahkan tisu-tisu lembut, tulang dan ligamen yang menyokong gigi, lalu menyebabkan gigi longgar dan reput.

Periodontitis

Periodontitis adalah jangkitan gusi yang disebabkan bakteria sama yang dijumpai dalam plak. Jika jangkitan itu tidak di rawat, ia akan memusnahkan tisu gusi dan tulang di dalam mulut.

Rawatan untuk periodontitis adalah dengan membersihkan tapak jangkitan dan merawat dengan antibiotik .

Radang gigi

Keradangan gigi disebabkan oleh jangkitan gusi. Keradangan akan menyebabkan pembentukan nanah yang akan mengelilingi gigi. Keadaan ini amat menyakitkan dan boleh mencetuskan masalah lain jika gagal mendapat rawatan dengan segera.

Keradangan gigi boleh dirawat dengan beberapa cara, bergantung pada tahap keseriusan jangkitan. Jika keradangan berpunca daripada pereputan, gigi tersebut akan memerlukan pembedahan root canal ataupun perlu dicabut. Jika gusi yang menyebabkan keradangan gigi, gusi perlu menjalani rawatan pembersihan, rawatan pembedahan, atau mencabut gigi.

Elak Penyakit Dental

Langkah mudah seperti memberus gigi dua kali sehari dengan berus gigi yang betul (sebaik-baiknya dengan berus silang pangkah) dan membersihkan gigi dengan flos, dapat mengelakkan daripada jangkitan penyakit-penyakit dental yang lazim.

Ia juga adalah digalakkan untuk mengelakkan daripada memakan makanan bergula secara berlebihan.

Orang ramai juga disaran kerap melawat doktor gigi (sekurang-kurangnya sekali setiap enam bulan) untuk pemeriksaan dan juga pembersihan gigi dari plak yang tersembunyi.


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Vomiting Children


by Prof. Dr. Christopher Boey Chiong Meng

When your child vomits, his stomach contents are forced up his oesophagus and out of his mouth. Vomiting is not a disease, but a symptom. It may be a sign of an underlying disorder or disease.

You can expect your child to vomit several times during his early years because vomiting is a symptom of common childhood illnesses such as gastroenteritis (due to virus, bacteria or parasite infection in the gastrointestinal tract) and food poisoning. A child with a viral upper respiratory infection will also have a tendency to vomit. In such cases, the vomiting usually improves with time.


In some cases, vomiting can be a symptom of a more serious condition, such as blockage of the digestive tract, urinary tract infections, disruption of the balancing mechanism in the ear, hepatitis, and pancreatitis. Thus, causes of vomiting are not necessarily limited to the gastrointestinal tract. Increased pressure in the brain, which can be caused by head injury, bleeding in the brain, brain tumour, and infections of the brain like meningitis, can also result in vomiting. Persistent vomiting in a child must be taken seriously.



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When to See The Doctor

If in doubt, consult a doctor early. It is crucial for you to be aware of the 'trouble' signs. Bring your child to the doctor right away if your child :

* Has vomited repeatedly.

* Throws up green-yellowish liquid (bile). This could indicate an underlying obstruction of the intestines and must be investigated immediately.

* Has vomited blood (bright red or brown in colour). This could indicate inflammation or bleeding in the upper gastrointestinal tract.

* Has persistent fever or headache.

* Is irritable. An irritable child may complain of neck stiffness and his eyes may be sensitive to light.

* Is drowsy.

* Refuses to eat and is unable to keep liquids down.

* Shows signs of dehydration.

* Has severe abdominal pain.

* Starts vomiting again once he resumes his normal diet.

What To Do

You may feel helpless each time your child suffers from a bout of vomiting. Here are some measures that you can take to help ease your child's distress :

* Do not give your child anti-vomiting medication on your own without medical advice

* Turn your child's head to the side or face down over a basin/towel to prevent him from inhaling his vomit.

* After your child has vomited, help him rinse his mouth with water because vomiting may leave a sour taste.

* Vomiting may be frightening and exhausting for your young child. Offer plenty of assurance to your child and comfort him.

* Encourage your child to drink fluids in order to avoid dehydration. Oral Rehydration Solution (ORS) is effective in replacing body fluids quickly. You can find ORS in most clinics and pharmacies

* If your child is able to tolerate food, give your child smaller and more frequent meals, such as four to five smaller meals rather than two to three large meals a day. You can feed him food that is usually well-tolerated such as broth, mild soups and mashed potatoes. Avoid feeding your child fatty or spicy foods.

* Remember not to force your child to eat or drink if he is really unable to do so or if he is drowsy. Get him assessed by a doctor early.

* Make sure your child gets enough rest.

Watch Out For Dehydration

If your child is younger than one year old and is vomiting, he may need special attention. One of the reasons is that the younger the child is, the more he is at risk of losing a substantial amount of fluids, especially if he has been vomiting repeatedly and if his vomiting is accompanied by diarrhoea. This continued loss of body fluids can lead to dehydration.

If left untreated, dehydration can be life-threatening, especially in young children. As such, it is important to look out for symptoms of dehydration : dry mouth, cracked lips, little or no tears when crying, sunken fontanelles in a baby, lack of urine for six hours or more, irritability, sunken eyes, dry wrinkled skin, lethargy or inactivity, and weakness or dizziness.

It is important not to allow your child to reach a stage where he develops signs of dehydration. If your child displays any signs of dehydration, get your child assessed by a doctor immediately.


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Radang Punca Ketumbit

oleh Prof. Dr. Muhaya Mohamad

Ketika kecil dulu, sesiapa yang ada ketumbit pada mata pasti menjadi bahan usikan sekeluarga kerana ia sering dikaitkan dengan tabiat buruk, iaitu mengintai orang.

Kalau ketumbit itu kecil tidak mengapalah kerana tidak ramai yang perasan, tetapi ia jadi masalah jika benjolan seperti jerawat di tepi mata itu besar sehingga menyebabkan rasa sakit selain malu diusik.

Sebenarnya ketumbit tiada kaitan langsung dengan tabiat mengintai kerana ia sejenis keradangan pada kelopak mata yang disebabkan jangkitan kuman. Biasanya bakteria ini membiak di akar bulu mata sebelum menimbulkan masalah.

Usikan mengaitkan ketumbit dengan tabiat buruk berkenaan perlu dihentikan, terutama jika ia berlaku pada anak yang berjiwa sensitif, kerana ia boleh menyebabkan mereka jauh hati dan rendah diri. Sebaliknya terangkan keadaan sebenar mengenai masalah yang berlaku pada mata mereka.

Punca dan Gejala Ketumbit

Ketumbit boleh dibahagikan kepada 2 jenis. Yang pertama akibat jangkitan kuman pada pangkal bulu mata. Jenis kedua ialah keradangan disebabkan penyumbatan pada kelenjar yang menghasilkan minyak untuk menentukan bulu mata kalis air atau kalazion.


Adakah ketumbit itu berbahaya, terutama jika saiznya besar? Tidak. Ia tidak menjejaskan penglihatan seseorang, tetapi boleh menyebabkan kesakitan disebabkan berlaku bengkak pada satu kawasan kecil yang sensitif di kelopak mata.

Kadangkala seseorang boleh mendapat lebih daripada satu ketumbit pada satu masa, tetapi usah risau kerana ia tidak berbahaya. Selain benjolan merah pada kelopak mata, antara gejala lain yang mengiringi ketumbit ialah :

* Mata berair
* Mata terasa gatal, terutama jika ada habuk
* Mata menjadi sensitif terhadap cahaya
* Kelopak mata menjadi merah dan bengkak

Biasanya ketumbit mengambil masa 3 hari sebelum ia pecah dan kering. Bagaimanapun dalam kebanyakan kes, ketumbit akan sembuh dalam tempoh seminggu.

Ketumbit jenis kedua yang disebabkan penyumbatan kelenjar minyak (kalazion) pula 'tumbuh' lebih perlahan dan jika ia terlalu besar, ia mungkin boleh mengganggu penglihatan.

Apakah rawatan bagi ketumbit?

Rawatan utama untuk ketumbit ialah penggunaan antibiotik setempat yang harus diletakkan ke dalam mata bagi merawat jangkitan kuman dan pembedahan kecil.


Bilakah pembedahan diperlukan?

Pembedahan hanya diperlukan untuk ketumbit yang disebabkan oleh penyumbatan pada kelenjar di kelopak mata selepas rawatan antibiotik setempat tidak berkesan. Selalunya ia berlaku selepas keradangan berlanjutan melebihi 2 minggu.

Apakah rawatan pada peringkat awal bagi kalazion?

Ia dapat dirawat dengan meletak antibiotik dan diikuti dengan menuam mata dengan kain yang direndam dalam air suam untuk mengatasi penyumbatan pada kelenjar di kelopak mata. Ini harus dilakukan sebanyak 3 kali selama seminggu.

Adakah ketumbit menyebabkan kebutaan?

Tidak. Ini kerana ia hanya membabitkan kelopak mata. Fungsi melihat bergantung kepada kesihatan biji mata dan kesihatan mata tidak terganggu apabila ada ketumbit.

Bolehkah ketumbit menyebabkan gangguan penglihatan?

Ia boleh menyebabkan sedikit gangguan jika terlalu besar dan menekan pada bahagian tengah mata, yang mana ia menyebabkan astigmatisma.

Anak saya sering mendapat ketumbit, adakah ini bermakna beliau kurang sihat?

Tidak, sebenarnya ia jangkitan dan boleh berlaku pada sesiapa saja.


Bolehkah ketumbit berjangkit?

Ketumbit tidak berjangkit kepada orang lain. Ini kerana ia disebabkan penyumbatan pada kelenjar tarsal mata pesakit.

Apa harus saya lakukan jika berlaku ketumbit pada kelopak mata anak saya?

Segera jumpa doktor untuk mendapatkan antibiotik dan memulakan rawatan untuk mencegah pembesaran ketumbit.

Bagaimanakah pembedahan ketumbit jenis kalazion dilakukan?

Untuk orang dewasa, selalunya ia dilakukan dengan pembedahan menggunakan bius setempat dan tidak menyakitkan. Bagaimanapun untuk kanak kanak, pembedahan menggunakan bius am diperlukan.


Lagi info tentang KETUMBIT di sini.






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Metastatic Breast Cancer

Well-conducted research has led to a better understanding of the biology of breast cancer and more effective drugs with lesser sideeffects.

by Dr. Albert Lim Kok Hooi

Metastatic breast cancer (MBC) is breast cancer that has spread to the bone, lung, liver, brain and other organs. The median survival for patients a decade ago was 24 months. In other words, half the patients lived for less than 24 months and the other half survived more than 24 months. Few patients survived more than 5 years.


Today, the median survival for MBC is more like 36 months. In fact, a fortunate few may live up to 10 years or more.

How did this come about? The answer is simple : well-conducted laboratory research has led to a better understanding of the biology of breast cancer and more effective drugs with lesser side-effects.



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HER2 Oncogene

The important first step in treating MBC is to test the tumour for the HER2 oncogene. About 25% of breast cancer patients have tumours which over-express this oncogene. These tumours behave aggressively. If the tumour is tested positive for the HER2 oncogene, the drugs of choice are trastuzumab and/or lapatinib. These are anti-HER2 drugs in routine clinical use.

Many more drugs in this class will come on line in the next few years. Anti HER2 drugs is usually combined with conventional chemotherapy or with each other depending on the circumstances.

If the breast tumour is HER2 negative (that goes for about 75% of patients with MBC), we want to know if the tumour bears the estrogen receptor (ER) and/or the progestogen receptor (PR). If so, hormonal therapy is usually used.

Today, we have many hormonal agents that can be used one after another. In medical parlance, they are used sequentially. We use tamoxifen (the most common hormonal therapy for breast cancer) and when this is no longer effective, the aromatase inhibitors (A.I) is used. There are three drugs in this class : anastrozole, letrozole and exemestane. They are used only in post menopausal women.

Finally, we have fulvestrant, which can be used when A.I is no longer work. These hormonal therapies are 'gentle' and without the usual side-effects associated with chemotherapy.

Algorithmic Way

Let us pause for a while and move away from the world of drugs, which can be intimidating to some. The way of thinking about cancer treatment is the algorithmic way. It is based on an algorithm. We think algorithmically.

Simply put, it is like walking along a country road and meeting a fork. If HER2 is positive, I take the left lane. If not, I take the right. I go along the right lane and meet a second fork. If ER is positive, I take the left path. If ER is negative, I take the right and so on and so forth.

So much of life is and all of computer programming is algorithmic. It is really quite simple if you think about it.

Drugs

Back to MBC. If the tumour is HER2 negative and ER negative, chemotherapy will be employed. At least 8 drugs can be choosed from. Newer chemotherapy agents are more effective and have lesser side-effects. We now have many new therapies to deal with the side-effects of chemotherapy. For example, low red blood cell counts and low white blood cell counts are better managed. We also have very effective anti-vomiting drugs.

Recently, another drug was introduced for routine clinical use in treating MBC. Bevacizumab is a drug which inhibits new blood vessel formation (angiogenesis), which is a crucial process in cancer growth, proliferation and spread.

To recap, 4 classes of drugs to treat MBC are used. They are (i) anti-HER2 agents (ii) hormonal therapies (iii) conventional chemotherapy (iv) anti-angiogenic agents.

To be sure, not all 4 classes of drugs are suitable for all patients. The important thing is to seriously consider all of them. For any patient, pick the most suitable combination and the most logical sequence of the classes of drugs we discussed.

My oncologist colleague and I were privileged to celebrate Hari Raya with a patient with MBC who has gone through all the 4 classes of drugs. She is leading a good meaningful life 6 years after the diagnosis of MBC. She is living comfortably with MBC, not dying of it.

She is a true beneficiary of scientific research. She is not alone. The future is bright. More research will result in more drugs. The median survival for MBC may soon be 48 to 60 months.


More info on BREAST CANCER here.






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Pedih Ulu Hati Ketika Hamil



Sakit atau rasa tidak selesa adalah lumrah yang harus dialami oleh semua wanita hamil. Alahan, sakit belakang, sembelit, pening kepala dan sebagainya merupakan antara simptom yang tidak boleh dielakkan.

Meski pun begitu, kehamilan adalah salah satu tempoh yang cukup menggembirakan buat semua wanita dan mereka akan melupakan semua kesakitan tersebut sejurus melihat wajah comel lahir ke dunia.

Semua ketidakselesaan yang dialami adalah disebabkan perubaha dari segi fizikal, hormon dan emosi. Salah satu ketidakselesaan yang banyak dialami oleh wanita hamil adalah masalah pedih ulu hati yang disebabkan peningkatan paras hormon estrogen dan progesteron.

Perubahan hormon ini juga menyebabkan mood berubah terutama ketika trimester pertama dan terakhir.

Sebanyak 10% wanita mengandung terdedah kepada kemurungan kehamilan. Simptom termasuk sukar memberi tumpuan dan tidur, letih melampau, cepat marah dan kerisauan. Dalam keadaan ini, wanita hamil memerlukan sokongan daripada suami dan keluarga serta perlu sentiasa positif.

Apakah Pedih Ulu Hati?

Hampir 75% wanita hamil mengalami pedih ulu hati. Ia berlaku apabila kandungan dalam perut ditolak kembali ke esofagus (saluran makanan) menyebabkan ia dalam keadaan terapung (reflux), lalu mengganggu lapisan lembut dalam saluran tersebut.

Bagi wanita hamil, peningkatan hormon kehamilan menyebabkan otot sfinkter esofagus bawah (lower esophageal sphincter - LES) mengendur antara esofagus dan perut. Tekanan di dalam abdomen yang meningkat sejajar dengan perkembangan bayi menyebabkan kandungan perut mudah ditolak semula ke esofagus.

Mereka yang mengalami pedih ulu hati akan berasa pedih pada bahagian atas dada, perut tidak selesa, sukar menelan, kandungan makanan ditolak kembali, rasa pahit atau asid dalam mulut.

Pedih ulu hati yang kronik boleh mengganggu tidur dan menjejaskan selera makan.

Bagaimana Merawat Pedih Ulu Hati

* Antasid - Ia bertindak meneutralkan asid perut, namun jika diambil dalam kuantiti berlebihan boleh menyebabkan sembelit (elakkan penyediaan yang mengandungi sodium atau aluminium). Rawatannya pantas tetapi dalam bentuk jangka pendek.

* Penghalang H2, penyekat pam proton (pengurang asid) - Ia menyerap ke dalam saliran darah untuk mengurangkan penghasilan asid dalam perut. Tetapi kaedah ini tidak disyorkan ketika mengandung.

* Alginates - Dihasilkan daripada rumpai laut coklat iaitu laminaria hyperborea. Ia tidak diserap dalam saluran darah dan disahkan secara klinikal memberi kelegaan untuk pedih ulu hati ketika mengandung. Contoh ubatan yang mengandungi alginates adalah Gaviscon.

Alginate menghasilkan satu penghalang kuat yang seakan terapung apabila ia bertemu asid perut. Kandungan apungan di bahagian atas menghalang asid daripada bertemu dengan esofagus.

Apa Yang Perlu Dilakukan Bagi Mengelakkan Pedih Ulu Hati?

1. Ambil hidangan dalam jumlah yang kecil tetapi kerap.

2. Kunyah dengan perlahan setiap kali makan. Jangan tergopoh-gapah.

3. Elakkan makanan mengandungi rempah, pedas, menggunakan banyak perasa, berlemak, coklat, alkohol, kafein dan berpudina.

4. Pakai pakaian yang longgar di sekitar perut.

5. Duduk dengan selesa. Jangan lakukan pergerakan seperti melipat badan yang menyebabkan bahagian perut diasak.

6. Jangan membongkok ketika mengambil barang.

7. Lakukan senaman ringan seperti berjalan kaki secara sederhana.

8. Elakkan berbaring atau tidur dalam masa dua jam selepas makan.

9. Jangan merokok.

10. Biarkan minuman panas sejuk sebentar sebelum diminum.

11. Tangani stres dengan tenang.

12. Cuba kawal pertambahan berat badan. Dapatkan berat badan seperti yang disyorkan.

Ibu Sejahtera, Bayi Sihat

Ibu-ibu hamil perlu menjaga kesihatan diri dan lebih proaktif dalam memahami perkara yang berkaitan dengan kehamilan mereka.

Jaga pengambilan nutrien. Pengambilan vitamin dan suplemen ketika hamil amat penting iaitu asid folik, multivitamin dan kalsium.

Dengan menjaga kesihatan diri, anda juga menjaga kesihatan bayi dari mula konsepsi hingga ia dilahirkan. Ini adalah permulaan terbaik yang boleh diberi oleh ibu bapa untuk anak-anak mereka.






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Temporomandibular Disorder

by Dr Y.L.M

My husband has been suffering pain at the angle of his jaw for a long time now, ever since he broke his jaw in a rugby accident when he was a teenager. It would come on especially after he’s had a cold. He went to the doctor who said he had temporo-mandibular disorder (TMD). I have never heard of this before. What is it?


Temporo-mandibular disorders are disorders pertaining to the temporo-mandibular joint.

This is the joint on each side of your head, the part where your lower jawbone is attached to your skull. It joins the upper jaw bone (maxilla) with the lower jaw bone (mandible). This joint allows your mouth to open and therefore for you to open your mouth, talk, bite, chew food and yawn.

The temporo-mandibular joint is a hinge or a sliding 'ball-and-socket' joint, and it is extremely complex because the lower jaw's rounded edges need to glide in and out of the joint socket whenever you talk or chew, which for some people can most of the time!

It is also known to be one of the most frequently used joints in the body.



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The parts of the joint where the bones attach are naturally covered with cartilage. The two bones making up the joint are separated by a small disc to absorb shock and also to keep the movement smooth.

TMD is actually a very common disorder. Around 5 to 15% of people in the US have it, and it is more common in women than men, especially between the ages of 30 to 50.

Why do people get TMD? Is it because they talk too much?

It is jaw clenching and teeth grinding that are more likely to cause TMD than too much talking!

If anything happens to disrupt the structure or function of the temporo-mandibular joint, you may get TMD. Think of the components of the joint – the disc, the cartilages, the bones of the joint itself and even the muscles surrounding and attaching to them.

Any of these components can be damaged by :

(1) Trauma – a blow to the side of your jaw during sports or fighting. If you had an old fracture, the misalignment that results from improper healing might lead to TMD.
(2) Inflammation – when your joint's cartilage is affected by arthritis, such as rheumatoid arthritis.
(3) Erosion of the disc.
(4) When the muscles surrounding the joint are fatigued from being overworked, like if you do have a habit of grinding your teeth or clenching your jaw.

Teeth grinding and jaw clenching actually cause wear and tear on the cartilage of the joint. You may not even be aware you are doing this because a lot of people do it in their sleep. It usually takes your spouse to tell you or a dentist may notice you have a lot of wear and tear on your teeth. People under a lot of stress may constantly do this.

(5) Another common habit causing wear and tear on your cartilage is perpetual gum chewing or fingernail biting. So beware!
(6) Dental problems and misalignment of your teeth. Chewing on only one side of the jaw can lead to TMD.
(7) If you frequently hold the telephone receiver between your head and shoulder, you can also get TMD.
(8) Congenital deformity of your facial bones.

On many occasions, the cause of TMB is not known.

My husband says that sometimes he would experience a clicking sound whenever he tries to open his mouth. Is this common?

You may experience the following with TMD :

* Pain or tenderness of your jaw, especially at its angle.
* A disturbing or aching pain in and around your ear. You might sometimes mistake this for an ear infection. This happens in 50% of patients. The ear pain is usually described as being in front of or below the ear.
* Difficulty or discomfort while chewing your food.
* A general headache. 80% of TMD sufferers complain of this.
* Pain on your face – dull and aching. 40% of people complain of this.
* Sometimes your TM joint might 'lock', causing it to be difficult for you to open or close your mouth.
* The feeling that you are not able to bite properly. When you close your mouth, you may feel that one or more of your teeth are not making clean contact with their upper or lower counterparts.
* A clicking sound or a grating sensation whenever you try to open your mouth or chew. There also should be pain associated with it. Some normal people have jaws that click when they open them – they do not necessarily have TMD.
* Some people have a lot of ear symptoms associated with their TMD even though there is nothing wrong with the ear per se – such as dizziness, fullness of the ear and ringing in the ear. To this day, this cannot be fully explained, but a theory is that the muscles around your Eustachian tube (the one that connects your ear to your throat) might spasm when you have TMD.

An easy step you can do yourself to locate your TM joint is by putting your finger on the triangular structure in front of your ear. Now move your finger slightly forward and press down firmly while opening your jaw. Can you feel an immediate depression? This is your TM joint working.

If you have TMD, this simple manoeuvre can cause you considerable discomfort.


More info on TEMPOROMANDIBULAR DISORDER here.






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Penyakit Parkinson Masih Tiada Ubat


Antara hakikat yang sukar dan perit diterima ialah apabila disahkan menghidap penyakit yang dikategorikan sebagai penyakit orang tua pada usia muda seperti Parkinson. Walaupun biasanya Parkinson dihidapi golongan tua berumur 60 tahun ke atas tetapi ia juga dilaporkan berlaku pada orang muda berusia 20-an.


Penyakit Parkinson sangat mudah dikenali kerana ia menyebabkan anggota badan pesakit seperti tangan atau kaki mengalami gejala menggeletar. Hampir 70% pesakit mengalami sedikit getaran pada tangan atau kaki yang boleh berlaku pada sebelah badan saja dan biasanya lebih ketara ketika otot berehat.

Gejala getaran ini boleh beralih ke anggota lain apabila penyakit menjadi semakin teruk. Secara umumnya lebih 95% kes Parkinson berlaku pada warga emas berumur 60 tahun ke atas manakala 5% lagi menyerang pesakit muda. Jika ia berlaku pada orang muda, pesakit lebih menderita kerana Parkinson akan menjadi lebih buruk dan teruk dengan peningkatan usia.



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Gejala Parkinson

Parkinson menyebabkan sel saraf otak yang mengawal pergerakan otot kehilangan fungsinya (dan mengakibatkan anggota yang dikawal saraf berkenaan sentiasa bergerak). Ia adalah satu proses berterusan dan inilah sebabnya gejala penyakit akan bertambah buruk apabila umur meningkat.

Antara gejala biasa Parkinson ialah:

* Otot menjadi kaku kerana keanjalan otot berkurang, menjadi tegang dan sukar digerakkan.

* Bradikinesia - keadaan apabila pergerakan pesakit menjadi perlahan, pergerakan mungkin tidak lengkap, sukar memulakan pergerakan dan berhenti bergerak secara tiba-tiba tanpa dapat dikawal.

* Hilang keseimbangan, koordinasi dan bentuk tubuh - ia menyebabkan pesakit mudah jatuh, sukar mengubah kedudukan atau melakukan pergerakan mengejut.

Punca Parkinson

Parkinson dipercayai disebabkan ketidakseimbangan bahan kimia otak dipanggil dopamin yang bertugas menghantar isyarat untuk menentukan pergerakan kita. Bagaimana ketidakseimbangan ini berlaku, tiada siapa tahu dan hampir 95% kes tidak diketahui puncanya. Ini sebabnya Parkinson masih dianggap penyakit misteri.

Sehingga kini dianggarkan ada 10,000 pesakit Parkinson di negara kita tetapi jumlah sebenar mungkin lebih tinggi kerana ramai pesakit tidak menjalani pemeriksaan kesihatan, terutama yang tinggal di luar bandar dan pedalaman.

Masih Tiada Ubat

Sedihnya sehingga kini masih tiada ubat yang mampu menyembuhkan penyakit Parkinson. Ubat yang ada hanyalah untuk mengurangkan gejala dan memperlahankan kemaraan penyakit supaya pesakit boleh menjalani kehidupan sebaik mungkin.

Biasanya dos ubat bertambah atau pesakit diberikan ubat yang lebih kuat selepas 5 tahun kerana penyakit menjadi bertambah teruk. Semakin lama keadaan penyakit menjadi lebih buruk terutama apabila memasuki tahun ke 7 hingga 10 walaupun setiap hari mengambil ubat.

Lagi info tentang PARKINSON di sini.






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Female Sexual Dysfunction (FSD)


by Dr. Milton Lum

Female sexual dysfunction (FSD) refers to the various ways in which a woman is unable to participate in a sexual relationship as she would wish. It is not uncommon. The causes of FSD are usually both psychological and somatic, with each process impacting on the other.


Sidi H. and others, in their study on 'The Prevalence Of Sexual Dysfunction And Potential Risk Factors That May Impair Sexual Function In Malaysian Women' which was published in the Journal of Sexual Medicine in 2007, reported that the prevalence of FSD in the primary care population was 29.6%. The prevalence of low sexual arousal, lack of lubrication and sexual dissatisfaction were 60.9%, 50.4% and 52.2% respectively. The risk factors for FSD are older age, Malays, married longer (more than 14 years), having less sexual intercourse (less than 1 to 2 times a week), having more children, married to an older husband (aged over 42 years) and having a higher academic status.



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The American Medical Association reported a decade ago that sexual dysfunction affected about 43% of American women. Women under 20 and over 50 years experienced problems with arousal, orgasm, and satisfaction. However, the majority of FSD occurred after menopause, when hormone production drops and vascular conditions are more common.

It has been argued that FSD need to be viewed in context and not as an experience in isolation of other circumstances, and that it is necessary to measure both low sexual function and sexually related distress.

The lack or loss of sexual desire is one of the most common presenting problems but is often not easy to treat. The definition of lack or loss of desire is difficult. Whether it is abnormal or a variation of the normal state has been the subject of numerous debates. Whether desire is a thought or feeling is still unclear.

Causes of FSD

The causes of lack or loss of desire are not well understood. However, they can be divided into medical and psychological causes and medications. The human sexual response involves the sexual organs : genitals, breasts and the vascular, nervous and hormone (endocrine) systems. As such, any condition that affects the sexual organs and these systems can lead to a lack or loss of sexual desire.

Decreased blood flow to the pelvic organs can lead to a reduction in the sensitivity of the genital organs, especially the clitoris, and dryness thereby impairing arousal. This decrease can be due to aging, stress, diabetes and atherosclerosis.

Decreased levels of sex hormones, such as estrogen and testosterone, can affect sexual desire. The female hormone, oestrogen, is associated with sexual desire. Some women experience diminished sexual desire and impaired sensitivity following the menopause or hysterectomy as a result of reduced estrogen.

The male hormone, testosterone, plays an important role in a woman’s sexual development and functioning, including sensitivity of the breasts and clitoris. This hormone is produced in almost equal proportions by the ovaries and the adrenal glands, which are located on top of the kidneys. The production is reduced after the menopause, whether natural or surgical, or during chemotherapy for cancer.

Conditions and medications that cause an increase in the blood prolactin levels can also reduce sexual drive. The conditions include pituitary gland tumours, hypothyroidism, hypothalamic disease, liver cirrhosis, other liver disease and stress.

Other medical causes that may lead to lack or loss of desire include obstetric, gynaecological and urological causes of pain or discomfort on sexual intercourse; vaginal atrophy; urinary incontinence which can lead to embarrassment and avoidance; endocrine, neurological and psychiatric disorders; surgery involving the pelvic floor, bladder, abdomen, and genitals; spinal cord injury which can cause nerve damage and even paralysis; endocrine disorders; alcohol and substance abuse, including smoking.

Various medications can affect a woman’s sexual function and they include:

* Anti-androgens (cyproterone, gonadotrophin releasing hormone (GnRH) analogues)
* Anti-oestrogens and other hormones (contraceptives, tamoxifen)
* Anti-cancer drugs (methotrexate)
* Psychotrophic drugs (sedatives, hypnotics, narcotics, stimulants)

It is often difficult to separate medical from psychological causes. In considering psychological causes, it is important to remember that a woman has different and separate roles at different stages in life, as daughter, friend, worker, lover, housewife and mother. The woman's initial roles as daughter, worker and lover are usually not too onerous. However, as her responsibilities increase, the role of lover may decrease because of increasingly diverse claims on her time.

The lack or loss of desire can be due to inadequate genital stimulation. This is particularly so in healthy young women in which poor communication, inattention and lack of knowledge may lead to men not having sufficient know-how on how to stimulate a woman to arousal.

Management

The management of lack or loss of desire is challenging as it requires an integrated approach involving the participation of the affected woman and her sexual partner. The history taking and physical examination seeks to evaluate any medical conditions that cause physical illness, medication intake and their treatment(s). Issues concerning sexual history and knowledge, psychological characteristics, relationship with and attraction to the sexual partner and life's changes are also assessed.

A distinction has to be made between disorders that are life-long and those that are acquired, as well as those that are situational and comprehensive. Medical causes have to be evaluated and treated adequately, for instance, good diabetic control with medicines or hormones in postmenopausal women.

Education plays an important role in the management. This involves an affected woman and her partner. Its content includes the physiology and psychology of sex and the need for good communication between the partners as well as its improvement. Many patients with this problem will be treated with cognitive behavioural approaches. Both the woman and her sexual partner will be asked to keep a diary of a typical week. There will be focus on the time which the couple have for each other alone as this is the time that sexual activity is more likely to take place. The couple will also have to explore their sexual knowledge and priorities.

This approach helps the patient and her partner to understand the problem better. As they realise their assumptions about their feelings, they will be helped to appreciate the differences in their sexuality and sexual needs. This encourages the acceptance of difference, which will contribute significantly to a solution of the problem.

The causes of the loss of sexual desire are medical, psychological and medication. The appropriate management of medical causes is essential. A change of medication will be considered when the problem is due to the side effects of medication. Those who have psychological problems are managed with cognitive behavioural approaches. An integrated approach is often needed as there is usually a combination of causes.




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More info on FEMALE SEXUAL DYSFUNCTION here.






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Jangan Memihak Ketika Anak Bergaduh

oleh Hafizah Iszahanid

"Mak, tengok abang ni, main tolak-tolak," atau anda akan kedengaran, "Abang dulu, abang dulu, tepi.. tepi."

Sebagai ibu bapa anda tentu sudah biasa mendengar ayat berkenaan. Pergaduhan antara adik beradik memang sebahagian daripada proses pembesaran mereka. Selalunya, pergaduhan atau bibit-bibit cemburu dimulakan oleh anak yang tua. Misalnya anak sulung yang cemburukan kelahiran adik atau anak tengah yang cemburu pada adik baru.




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Bagaimanapun, ada juga di kalangan kanak-kanak ini akhirnya mampu bersahabat baik dengan adik beradik sendiri dan saling mempercayai.

"Letihlah tengok budak-budak ni, asyik bergaduh saja." Anda juga biasa mendengar luahan seperti ini dari rakan anda. Mengapa kanak-kanak bergaduh?

Sebenarnya banyak perkara boleh menyebabkan kanak-kanak bergaduh. Walaupun ada kalanya sebagai ibu bapa, kita merasakan ia perkara remeh temeh, namun bagi mereka itu adalah soal besar. Apatah lagi di kalangan si abang atau kakak, rasa cemburu atau ingin bersaing sentiasa ada dalam diri mereka.

Pergaduhan adakalanya bermula di meja makan.

Perkara Universal

Namun, pergaduhan antara adik beradik adalah perkara universal dan normal. Malah, ramai yang berpendapat ia tanda keluarga yang sihat. Kehidupan orang dewasa atau kehidupan sebenar di dunia ini juga penuh pertelingkahan dan pertikaian.

Bagaimanapun, itu tidak bermaksud anda perlu membiarkan saja mereka bergaduh terutama apabila mungkin membabitkan kecederaan fizikal, caci mencaci atau penggunaan kata-kata kesat. Anda sebagai ibu bapa harus bijak menangani situasi itu tanpa melukakan hati kedua-dua anak anda.

Mengapa Mereka Bergaduh?

# Seorang anak berasa tidak mendapat perhatian yang sama banyak dengan adik beradik lain. Atau mereka berasa dibebankan dengan banyak tanggungjawab berbanding adik beradik lain.

# Fasa pembesaran mereka juga mempengaruhi sikap mereka terhadap orang lain dan bagaimana mereka menerima hakikat perlu berkongsi perhatian dan kasih sayang ibu bapa dengan adik beradik lain.

# Ada kala kanak-kanak yang lapar, bosan dan mungkin penat dengan persekitaran menyebabkan mereka suka memulakan pergaduhan.

# Mereka inginkan perhatian ibu bapa atau kakak atau abang.


Ajar anak bertolak ansur, saling menghormati dan berkongsi barangan secara adil.

Bagaimana Anda Menangani Pergaduhan Anak-anak?

* Jangan memihak dan jangan terbabit kecuali jika pergaduhan itu boleh mendatangkan kecederaan fizikal. Sebabnya, jika anda kerap campur tangan mungkin menimbulkan pemahaman kepada mereka, ibu atau bapa akan sentiasa ada untuk membantu mereka. Jadi, mereka tidak upaya untuk berdikari menyelesaikan masalah sendiri.

Apabila anda memihak pula, akan timbul kefahaman pada seorang lagi anak, dia sentiasa dilindungi dan sentiasa selamat kerana lebih disayangi.

* Hati-hati dengan anak yang suka mengadu. Mungkin dia betul dan mungkin juga tidak. Kadangkala mendengar sebelah pihak hanya menyelesaikan perkara itu sekejap saja sebelum mereka bergaduh semula. Kadangkala mereka juga sering menuduh adik beradik lain atas kesilapan yang dibuat.

* Jangan membuat perbandingan siapa yang lebih baik dan sebaliknya.

* Perhatikan masa dan hari atau pola yang memungkinkan pergaduhan boleh tercetus. Misalnya pertukaran jadual rutin harian.

* Luangkan masa berkualiti dengan anak-anak. Misalnya berkhemah atau melancong sekeluarga. Aktiviti begini akan lebih mengeratkan lagi hubungan mereka apabila mula berkongsi cerita.

* Jangan fokus keterlaluan anak mana yang patut disalahkan, sebaliknya selesaikan dengan baik membabitkan kedua-duanya. Misalnya saling bermaafan.

* Bantu anak anda membentuk kemahiran bagi mengatasi konfliknya sendiri. Misalnya ajar mereka bertolak ansur, saling menghormati dan mengagihkan makanan atau apa saja barangan yang perlu dikongsi secara adil.

* Apabila mereka bergaduh anda cuba meleraikannya, sebaiknya jangan tengking atau membebel. Nasihat dengan baik mengapa mereka tidak boleh bergaduh dan apa kesannya jika mereka bergaduh.

* Paling utama, jika anda kerap menengking atau menaikkan suara apabila bersama mereka, mulakan dengan mengurangkan atau menghapuskannya langsung. Tingkah laku anda mudah ditiru anak.


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