Healthcare

Orthodontic micro implants treatments : removable, fixed cekat, remofic, retainer

2011-04-30T09:04:00.000-07:00

Many people have an irregular arrangement of teeth, or "malocclusion" in the medical term. There are 'crooked', like tooth upper jaw forward, crowded teeth, or teeth are small and rare.

The situation can irritate the tooth's appearance. Sufferers often feel inferior, insecure and reluctant to smile. But the most important thing is to do with your dental health. Crowded teeth make it difficult to clean, so the teeth can get cavities or gingivitis disease. It may also happen mastication disorder, which causes headaches or neck pain. Malocclusion should be corrected as much as possible, not merely for the sake of aesthetics, but also dental health.

Whether your dental problems? If you have a tooth arrangement which does not want to make it more neat and organized so that you are more confident, you can find specialist doctors of Orthodontic braces / orthodontic / orthodonti : one of the specialty branch of dentistry to improve dental composition.

There are several kinds of tools commonly used, as we often call begel or fixed braces / Orthodontic / orthodonti cekat. Maybe you often find people have a tooth with a 'fence' wire. The tool is the braces, the braces appliance fixed / Orthodontic / orthodonti cekat. This tool can only be installed and removed by a dentist only. While the retainer is a device of Orthodontic which is removable, which can be released-off by the wearer.

Fixed tools braces of Orthodontic / orthodonti cekat able to make more complex movements in unitary row of teeth, which is a tool with orthodonti advantages than loose, so as to further accelerate the process of irregular teeth.

During the early years, fixed braces care of Orthodontic / orthodonti, maybe you'll feel a little pain, if necessary, take painkillers. That must be considered, you take twice as long to clean the teeth, because in addition to cleaning teeth, you also clean the wire teeth. When food scraps collected in the vicinity of the tool, there is a risk of cavities and gingivitis. Although rare, fixed braces tools of Orthodontic / orthodonti cekat to be damaged or loose, thus injuring the mouth. So should avoid foods which is too hard, sticky and sweet.

For successful treatment, the success rate can increase to 95 percent if the patient is cooperative in the state of his teeth when get checked. For difficult cases, success can only reach 90 percent.

The amount of the cost of treatment varies, depending on the difficulty factor, duration of treatment and the tools used. Usually with details of 30 percent to the cost of physicians and 70 percent for fixed braces tools of Orthodontic / orthodonti cekat. In addition, also because when you control, its arch wire must be replaced.

Along with the development of the age and the desire to look more beautiful with a beautiful smile, this time the use of fixed braces of Orthodontic / orthodonti cekat is no longer only to improve the function of teeth, but have become accessories. Fixed tools braces of Orthodontic / orthodonti cekat even growing. Brackets can be made of various materials, which is widely used is made of steel, those that are made of gold, ceramic and others available in various colors.

The newest "Braces" is made of transparent colored porcelain like the color of the teeth so that its use disguised. Consumers or users of wire teeth are those who want to look more elegant. Colorful rubber which adorn many braces, serves to tighten the bracket, while also giving the impression fashionable in fixed braces of Orthodontic / orthodonti cekat, so it is more favored by teenagers.

Orthodontic Micro-implants

Currently, micro-implants is one of the treatments that strengthen the anchorage in orthodontic, which also shorten the time of treatment : tooth move one unit or reduce the risk resorbsi movement of eliminate tooth roots. Micro-implants require : infiltration anesthesia, incisi vertical, and drilling on the processus alveolar canal.

In modern orthodontics, micro-implants is important to reinforce the anchorage, is essential to shorten treatment time and eliminate the unwanted side effects. Nevertheless, the placement of a micro-screw produce tissue discontinuities that can not be avoided.

This procedure, in line with the installation of micro-implants and removal of risk factors that potential, which can trigger, which is caused by the discontinuity of tissue, infection, mechanical and thermal damage, inflammation and tissue swelling. In some countries, antibiotic prophylaxis has been endorsed very important.

The purpose of this action is an attempt to establish regulations of pharmacotherapy in micro-implants for orthodontic purposes.

Ninety-conical micro implants, diameter 1.3 to 1.2, approximately no.12 special syringes used on patients, without preceded the use of antibiotics or surgical procedures. Lignokain 2% noradrenaline used for infiltration anesthesia.

Place the entry of the needle is determined based on anatomical boundaries and biomechanical maintenance requirements. Incisi vertical (4-5 mm) was made through the soft tissues followed by penetration (with a round bur 0.9 mm) on the surface of cortical bone.

Both pain and inflammation develops after the installation of 90 micro-implants, therefore, the efficiency of infiltration anesthesia with certain analgesics is recommended. Not required the use of non-steroidal anti-inflammatory drug with analgesic / anti-inflammatory.

Antibiotics are used to control microbial infections that may occur. Antibiotic therapy after initial diagnosis, but still a consideration and selection of antibiotics based on the data of potential disease.

All micro-implants are designed as a means of self-drilling, but the method of self-tapping expressed less invasive in terms of excessive pressure or force against Prepared tunnel oral mucosa. Although seven micro self tapping implants rejected, but none of the patients who need antibiotics, provided it does not conflict with the basic rules of asepsis technique is efficient in preventing infection.

However, there could be circumstances where the species infections are resistant to many types of antibiotics, can be resolved by 1-methyl-N-(hidroximetil) nicotinamide which was recently reported as non-toxic drug with anti-inflammatory and anti-bacterial, caused by the release of formaldehyde slow that reduce irritation and pain.

Efficiency infiltration anesthesia with certain analgesics are also encouraged back, because no single individual who reported experiencing pain during operating procedures and the installation of micro-implants. The increased threshold of sensibility in patients with Cornelia de Lange first syndrome, micro-implants can be installed without analgesia.

Although the patient did not require anti-inflammatory drugs non-steroidal analgesic / anti-inflammatory, they should be monitored regularly. Recent reports on coxibs, siklooksigenation-2 inhibitor, appears promising in terms of antipiuretic and anti-analgesic action without serious effects on gastrointestinal.

Although the use of these drugs should be based on careful research, due to thromboembolic, etoricoxib is very efficient as a reliever postoperative dental pain in populations with low cardiovascular risk.

In conclusion, Micro-implants are some actions with a low-invasive. Basically, these actions do not require antibiotic prophylaxis, a special type of local anesthetic and non-steroidal anti-inflammatory drugs. Not many risks and side effects and types of unwanted after injection , specifically with ordinary needle. But should not be overlooked that could have a case that requires a different treatment with pharmacotherapy.

Types of orthodontic appliance

Removable orthodontic appliance is a tool that its use can be installed and removed by the patient. This tool has the ability to care which is more simple compared with fixed appliance. Treatment failure often occurs, because the patient did not wear appropriate discipline with terms of usage (often happens on removable appliance).

Removable orthodontic appliance can be selected to treat, if :

1. Abnormalities of dental patients are not too complex, only caused by the location of teeth in defiance at the curved jaw while the situation is still normal.

2. Age of patients over 6 years of age who are deemed capable enough to install, disconnect the appliance in the mouth, care, cleaning the equipment used.

3. Patients want the appearance of her or his teeth are not too crowded, can be removed at any time alone.

4. The cost of treatment available are not sufficient to fixed appliance.

Use tools of Orthodontics cekat

Fixed orthodontic appliance is a device mounted on the teeth, fixed by gluing in the patient's teeth so that the tool can not be removed by the patient until treatment is completed.

This tool has very high ability to care, the chances of success are very great with the details for better treatment results.

Fixed orthodontic appliance is usually chosen to treat, if :

1. Dental disorders in patients is complex enough and it involves the jaw. Setup requires a lot of gear shifting and changing the relationship of the jaw.

2. Age of patients above 12 years, the permanent teeth have grown but the molars very back. Patients are able to maintain a healthy mouth by brushing, more precisely, avoid hard and sticky foods.

3. No problem with the appearance of Patient's teeth that became more crowded as each tooth attached by means of metal.

4. To reduce the appearance of a crowd, there is a tool of ceramic or plastic transparent material whose color resembles the color of teeth.

5. But now the use of fixed equipment has become a fashion trend of teenage children, it made colorful to look more attractive.

6. Maintenance costs become a problem because it is much more expensive.

Use tools Remofic Orthodontics

Remofic orthodontic appliance is a tool that is a combination of fixed appliance with removable appliance to improve the capabilities and results of teeth treatment.

This tool is an option, if :

1. The case is very complex, can not be treated with one type of instrument only.

2. Age of patients is crucial, also depending on the case.

3. Consideration of appearance should be ignored because their use is mandatory so that treatment can give results.

4. Costs should be provided to increase the performance of the patient's teeth.

The use of retainer

Retainer tool is a tool used to hold orthodontic treatment results:

1. This tool is used after active treatment.

2. Dental patients are neat but not yet stable and sturdy.

3. To be stable, required the use of retainer at least six months to one year after active treatment is completed.

Changes between Teeth Care and After Teeth Care

Severity of such an orthodontic treatment can produce a better facial appearance :

1. Before complete dental care seem full of patches bracket.

2. The composition of irregular teeth seem still to some ex-scraped.

3. Although teeth seem crowded no awkward smile, after teeth treatment you will have more smile than before.

4. After care, you will have very beautiful smile and look very pretty.

5. Confidence in the community will be increased.

Diarrhea : Cause, Symptoms, Diagnosis, Treatment, Dehydration, Prevention, Outbreak

2011-04-14T09:21:00.000-07:00

Diarrhea disease is one disease that often happen with babies and toddlers. What is diarrhea? What you should be done? What are the causes of diarrhea? Can you prevented diarrhea? How about the treatment of diarrhea?

What is Diarrhea?

Diarrhea is a disease with signs of a change in shape and consistency of feces, which become soft until melted and increased frequency of stools more than normal (3 times or more in 1 day).

If your baby or your child suddenly has a change in bowel movements than usual, both the frequency / amount of waste water that became frequent and out in the consistency of liquid than solid, then it is diarrhea.

A newborn baby will generally defecate more than ten times a day, and larger babies will have the time of each bowel movement, there are 2-3 times a day or there are only 2 times a week. In other words you must know what is normal for your baby or child from their bowel habits.

Is Diarrhea Harmful?

The greatest risk of diarrhea is dehydration. If you have diarrhea, we can lose five liters of water every day. Along with this water, we also eliminate mineral substances ('electrolyte') that are essential for normal body function. The main electrolytes are sodium and potassium.

Severe dehydration can cause the body into shock and can be deadly. Dehydration is more serious for infants and children than for adults. Anyone with diarrhea should drink plenty of clear fluids, such as tea, chicken broth, or soda water. This is better than water alone, which does not return the mineral substances. We can also drink electrolyte fluids (ORS) that can be bought without a prescription at a pharmacy.

Diarrhea that continues for a prolonged period can cause poor absorption of nutrients. This can lead to wasting. Diarrhea can be serious. Make sure your doctor knows if you have diarrhea that continues for more than a few days.

Diarrhea disease is still often cause outbreaks (Extraordinary Events) as well as cholera with the number of patients who are many in a short time. But with the fast treatment of diarrhea, accurate and quality, death can be reduced to a minimum. In October of 1992, a new strain of Vibrio Cholera 0139 discovered which was then replaced with Vibrio cholerae El Tor strain in 1993 and then disappeared in 1995-1996, except in India and Bangladesh which are still found. While E. Coli 0157 as the cause bloody diarrhea and HUS (Haemolytic Uremia Syndrome). Outbreaks have occurred in the USA, Japan, southern Africa and Australia.

What Causes Diarrhea?

Sometimes it is difficult to find the cause of diarrhea. Diarrhea can be caused by infection in the stomach or intestine. Infection can be caused by bacteria, parasites, fungi or viruses.

The cause diarrhea :
1. Parasites : The parasites cryptosporidium or microsporidium cause diarrhea that occurs in many people with HIV. Incidence of parasitic infections in the U.S. have decreased since highly active antiretroviral therapy (HAART) is used.
2. ARV Drugs : Several types of medications used by people with HIV can cause diarrhea. This is often true with nelfinavir, ritonavir, Kaletra, ddI, tipranavir, foscarnet and interferon alpha.
3. Other causes : The use of antibiotics can kill "good" bacteria in the stomach and intestines, causing diarrhea. Diarrhea can also be caused by the inability to digest dairy products (lactose intolerance), by the pancreas problems, or by emotional stress.
4. Viruses (the most common cause of diarrhea and usually because of Rotavirus) symptoms : water stools (watery), foam, no blood mucus, sour smell.
5. GE / gastroenteritis (stomach flu) virus.
6. Bacteria
Defecation through blood or mucus, abdominal pain. Requires antibiotics as a therapeutic treatment.
7. Infection from bacteria or viruses that accompany other diseases : for example, urinary tract infections, ear infections, measles, and etc.
8. Immuno deficiency.
9. Artificial sweeteners.

Based on a meta-analysis in the whole world, every child has diarrhea at least once every year. From each of five pediatric patients who come because of diarrhea, one of them due to rotavirus. Then, from 60 children hospitalized due to diarrhea, one of whom is also due to rotavirus.

Bacteria and parasites can also cause diarrhea. These organisms interfere with the absorption of food in the small intestine. The impact of food is not digested and then immediately enter the large intestine.

The food is not digested and not absorbed by the intestine will draw water from the intestinal wall. On the other hand, in these circumstances the process of transit in the intestine is very short so that the water did not get absorbed by the colon. This is what causes watery stool in diarrhea.

Actually, the colon is not just spending extra water but also electrolytes. Loss of fluid and electrolytes through this diarrhea and can cause dehydration. Dehydration is a life-threatening diarrhea.

Factors that affecting diarrhea :
- Environmental Nutrition within Population.
- Social Education and Economic Behaviour Society.

How Do We Know the Cause of Diarrhea?

The doctor will ask what we eat or drink recently, and if we just make the trip. Examples of impurities can be tested for signs of bacteria or parasites. Your doctor may repeat this test if the first time there was no sign of anything. Perhaps the blood or urine, doctor also tested on you.

If this test does not indicate the cause of diarrhea, your doctor may observe the flow of digestive us with a special tool. The name of this process depends on where the doctor looks. 'Endoscopy' is a generic term to 'look inside'. 'Colonoscopy' means the doctor check the colon (large intestine). The cause of about one-third of cases of diarrhea could not be determined.

Treatment of diarrhea depends on the type of clinical illness, which is easily determined when a child is sick for the first time. Laboratory tests are not required.

Types of diarrhea :
- Diarrhea Acute = less than 2 weeks.
Acute diarrhea mixed with water (including cholera) which lasted for several hours / days : The main danger is dehydration, and weight loss if not given food / drink.
- Diarrhea Persistent = more than 2 weeks.
Persistent diarrhea (lasting 14 days or longer) : The main danger is malnutrition and serious infections outside the intestine, dehydration can also occur.
- Dysentery = diarrhea accompanied by blood with or without mucus.
Acute diarrhea mixed with blood (dysentery) : The main danger is damage to the small intestine (intestinum), sepsis (bacterial infection in the blood) and malnutrition, and other complications including dehydration.
- Cholera = diarrhea where there are bacteria Cholera stool.
- Diarrhea with severe malnutrition (marasmus or kwashiorkor) : The main danger is a systemic infection (overall) weight, dehydration, heart failure, and the deficiency (lack) of vitamins and minerals.

Symptoms of Acute Diarrhea (Sudden Diarrhea) :

The cause of acute diarrhea (sudden diarrhea) is common because the virus, typical shit-water stools (watery), foam, no blood or mucus, and smelled of acid.

Diarrhea disease transmission is contact with the feces of infected directly, such as :

- Foods and beverages that have been contaminated, either already infected by insects or contamination by dirty hands.

- Playing with a toy that is contaminated, especially in infants often include hands / toys / anything into the mouth. Because the virus can survive on the surface of the air until a few days.

- Use of contaminated water sources and no water to cook properly.

- Wash and use of milk bottles that are not clean.

- Not washing hands thoroughly after defecation or cleaning the feces of infected children, thus contaminating the furniture and equipment that you held.

Symptoms of diarrhea is watery stools with a frequency of 4 x or more in a day, sometimes accompanied by :
- Vomiting.
- Body lethargic or weak.
- Heat.
- No appetite.
- Blood and mucus in the feces.

Criteria for outbreaks of diarrhea :
Increased incidence of morbidity / mortality due to diarrhea constantly for 3 consecutive period of time (hours, days, weeks). Increased incidence / mortality cases of diarrhea 2 times / more than the amount of morbidity / mortality due to diarrhea which is common in the previous period (hours, days, weeks). CFR due to diarrhea in a specified period showed an increase of 50% or more compared to the previous period.

Diarrhea Diagnosis

Diarrhea Diagnosis based on symptoms and physical examination. Observe stool consistency and frequency of bowel movements from your baby or toddler. If watery stools with a frequency of bowel movements 3 times or more in a day, then the baby or toddler is suffering from diarrhea.

Blood tests can be performed to determine electrolyte levels and white blood cell count. However, to know the organisms that cause diarrhea, need to be breeding on stool samples.

Diarrhea Treatment

Because the causes of acute diarrhea is the most common sudden virus, no treatment that can cure, because it usually will heal on its own after a few days. So the treatment of diarrhea is intended to treat existing symptoms and prevent dehydration or less liquid.

How Diarrhea Treated?

1. Changing what we eat
Acute diarrhea can be cured only by continuing the provision of food as usual and drink enough fluids. Some foods can cause diarrhea, and others can help stop it.

Do not eat :
- Dairy products (milk or cheese).
- Deep-fried cuisine.
- Fatty foods including butter, margarine, oil or nuts.
- Spicy foods.
- Foods that contain a lot of insoluble fiber. These include fruits or raw vegetables, bread wheat, corn, or the skin and seeds of fruits.

You Should eat :
- Banana.
- White rice.
- Applesauce.
- Cereals.
- Fresh grilled bread or crackers.
- Macaroni or noodles.
- Poached eggs.
- Porridge oats.
- Mashed boiled potatoes.
- Yogurt (although these dairy products, food is partially digested by the bacteria used to make).

2. Treatment
Drugs used to treat diarrhea depends on its type. Doctors can not prescribe drugs without he knows our diarrhea cause.

Some drugs can be obtained without a prescription, of which there are very good for diarrhea, including the amino acid L-glutamine, bismuth subsalicylate, attapulgite and loperamid. A new treatment for HIV-related diarrhea is krofelemer. The drug is being tested.

Some other products that are usually sold to treat constipation can also help with diarrhea. These products contain soluble fiber, which add to the amount of dirt and absorb water. These products include products that contain psilium.

3. Supporting therapy for diarrhea
Acidophilus capsules (which contain helpful bacteria) can restore digestion, especially if you are taking antibiotics. Some types of yogurt contain "live cultures' acidophilus that work the same way.

Peppermint, ginger and nutmeg considered to help digestive problems, so peppermint or ginger tea, or soda with ginger is a good option to 'clear fluids'. Try adding nutmeg to foods or beverages.

Research shows that the extra calcium helps relieve diarrhea in people taking nelfinavir. This may succeed with diarrhea caused by other drugs.

Remember not to give drug treatment to stop the diarrhea, since diarrhea is a body's defense mechanism to remove the contamination of food from the gut. Trying to stop the diarrhea with drugs such as clogged pipes that will come out and cause back-flow and will aggravate the channel.

Therefore, diarrhea is the process of the body's defense mechanism, will heal by itself after a few days (14 days) which contains more diarrhea, from water (watery) began solid, reduced its frequency and recovery.

Most important in the diarrhea is to prevent and cope with symptoms of dehydration.

Signs of dehydration

The degree of dehydration assessed from signs and symptoms that describe the loss of body fluids.

At the outset, that there is only a dry mouth and thirst. With increasing dehydration, there are signs such as : increased thirst, anxiety, elasticity (turgor) decreases skin, dry mucous membranes, eyes appear sunken, concaved fontanel (in infants), and the absence of tears even cry loudly.

Dehydration minimal or no dehydration (loss of <3% of body fluids) :
- Mental status: good, vigilant.
- Thirst : drink better, perhaps refusing fluids.
- Pulse rate : normal.
- The quality of the adequacy of the contents of the pulse : normal.
- Breathing : normal.
- Eyes : normal.
- Tears : no.
- Mouth and tongue : damp (wet).
- Skin elasticity : quick return after pinched.
- Completion of capillary blood : normal.
- Temperature arms and legs : warm.
- Production of urine : normal until reduced.

Mild to moderate dehydration (loss of 3-9% of body fluids) :
- Mental status : normal, sluggish, or fussy.
- Thirst : thirsty and wanted to continue drinking.
- The pulse : normal to increased.
- The quality of the adequacy of the contents of the pulse : normal until reduced.
- Breathing : normal, fast.
- Eyes : slightly concave.
- Tears : reduced.
- Mouth and tongue : dry.
- Skin elasticity : back before 2 seconds.
- Completion of capillary blood : longitudinal (long).
- Temperature arms and legs : the cold.
- Production of urine : decrease.

Severe dehydration (loss of> 9% of body fluids):
- Mental Status : lethargic, until unconscious.
- Thirst : drink very little, could not even drink.
- Pulse rate : to increase, until weakened in severe circumstances.
- The quality of the adequacy of the contents of the pulse : weak, until not palpable.
- Breathing : deep.
- Eyes : very concave.
- Tears : None.
- Mouth and tongue : chapped.
- Skin elasticity : back after 2 seconds.
- Completion of capillary blood : longitudinal (long), at a minimum.
- Temperature arms and legs : the cold, blue.
- Production of urine : minimal (very little).

The most important note in case of sudden diarrhea are :
- Remember to stop diarrhea virus with drugs is not the best way. But do not get confused if diarrhea persists for several days. Because usually lasts several days, 14 days. And cured. Depending on the state of health of children and the amount of fluid intake.
- The most important of diarrhea is to notice any signs of dehydration.
- Handling of the best is still providing food and drink (milk) as usual. When you are accompanied by vomiting, to substitute liquid you can give Pedialyte (ORS fatherly children with some sense). Reduce foods that contain too much sugar. Remember it's not easy to give kids a little taste salty liquid, even some children will resist. But be patient and keep trying to find a way so that children can drink this liquid.
- And the most important thing is to make children return their food digestive density (with milk formula / breast milk) as it is best to treat diarrhea. Because intestinal cells are destroyed by the virus requires nutrients for the re-establishment. Research suggests that the usual feeding time will shorten the symptoms of diarrhea.

Medicinal plants that can be used to help overcome dysentery and diarrhea among others has the effect as adstringent (chelate) that can be pursed intestinal mucous membrane, thereby reducing the discharge of diarrhea and dysentery, besides it also has the effect as anti-inflammatory, and antibacterial.

Here are a few kinds of herbs that can be used to treat diarrhea, namely:

1. Euphorbia hirta
Efficacy and effect : as anti-inflammatory. Efficacious basiler overcome dysentery, amoebic dysentery, diarrhea, indigestion, colitis, and others.

2. Guava leaves (Psidium guajava)
Efficacy and effect : as an astringent / chelate (pursed intestinal mucous membrane so as to reduce the secretion of fluid), anti-diarrhea, dysentery, anti-inflammatory, and stop the bleeding.

3. Sambiloto (Andrographis paniculata)
Efficacy and effect : as anti-inflammatory, antibacterial, antidote to poison. efficacious to overcome diarrhea, dysentery basiler, colitis, and others.

4. Curcuma longa
Efficacy and effect : as anti-inflammatory, anti-bacterial, astringent / chelate. Efficacious to overcome dysentery, diarrhea, colitis, digestive disorders, and others.

5. Portulaca oleracea
Efficacy and effect : anti-inflammatory, reduce heat, antitoxic. For dysentery, acute diarrhea, appendicitis, and others.

6. Pomegranate skin (Punica granatum)
Efficacy and effect : as astingent / chelate, anti-diarrhea and dysentery, antibacterial.

7. Tea (Thea chinensis)
Efficacy and effect : as chelate for intestine / astringent, anti-bacterial. Efficacious concentrated tea from diarrhea, dysentery, colitis, indigestion.

8. Spoon leaf (Plantago major)
Efficacy and effect : as anti-inflammatory, efficacious overcome diarrhea, dysentery, fever, dysentery basiler, indigestion, and others.

Note: Fixed with consult to a physician if you still feel natural dysentery.

Proper of effective treatment of diarrhea in patients :

1. Management of patients with diarrhea at home
- Increasing the provision of household liquids (vegetable broth, water, starch, salt sugar solution, if there is give ORS).
- Forwarding of foods that are soft and do not stimulate as well as extra food after diarrhea.
- Bringing people with diarrhea to health facilities in 3 days if not improving or :
a. Bowel movements more frequent and abundant.
b. Vomiting continuously.
c. Real thirst.
d. Unable to drink or eat.
e. High fever.
f. There is blood in the stool.

The important thing to remember :
- Infants and young children easily become dehydrated, so they need a liquid that is given little but often.
- Infants under six months with diarrhea should be checked by a doctor after 6-12 hours handling of diarrhea.
- Give drink every time the baby vomits. Permanent give milk to babies who are breast-feeding. For infants who drink formula, milk still be given to more than 12-24 hours.
- Give older children a cup (150-200 ml) of fluid for any vomiting or a lot of diarrhea.
- Continue giving food if your child still wants to eat. Do not let the children do not get food intake at all in 24 hours.
- Your baby or child is very infectious, so wash your hands thoroughly with soap and warm water, especially before feeding and after changing diapers or pants.
- Separate children or infants with diarrhea from the child or another baby as much as possible, until the diarrhea stops.
- Oral Rehydration Fluids (CRO) / Clear fluid
Children with diarrhea should continue to drink CRO or clear fluid. CRO as we know it usually ORS (in the form of sachet bags with or without additional flavor) or special CRO child (which is available in plastic bottles with different flavors). The liquid can be purchased at a pharmacy or drug store, if not available to be given with another CRO as mentioned. For infants up to age nine months, making CRO should use boiling water that has cooled.

Handling Procedures with diarrhea outbreak / epidemic :

1. Pre-outbreak
Information possibility of an outbreak / epidemic is to implement the Early Alert System is carefully, but it must done with other measures :
1. Improving early warning in good health center, manpower and logistics.
2. Establish and train TIM Rapid clinic.
3. Intensify health education to the community.
4. Improving laboratory work.
5. Increase cooperation with other agencies.

Rapid Team (TGC):
A group of health personnel in charge of completing the observation and outbreak response in the field in accordance with patient data centers or epideomologic data investigation. Task / activity :

1. Observations :
- Search for other patients who did not come for treatment.
- Intake of rectal swabs of suspected especially family members.
- Sampling of well water, river, water plants, and etc. That allegedly contaminated and a source of infection.
- Tracking of cases to search for the origin and transmission of the virus distribution.
- Prevention of dehydration with ORS for every patient who was found in the field.
- Give information to both individuals and families.
- Create a report about the incidence of epidemics and how to overcome completely.

2. Rehydration Centre Establishment
To accommodate people with diarrhea who require care and treatment.

Rehydration centre task :
- Maintain and provide treatment of patients with diarrhea who visit.
- To record the name, age, complete address, the incubation period, symptoms, diagnosis and so on.
- Provide patient data into TGC officer.
- Manage logistics.
- Taking a rectal swab on patients before treatment.
- Counseling for patients and families.
- Keeping the rehydration center does not become a source of transmission (lisolisation).
- Create a daily, weekly diarrhea patients schedulle who were treated (Which is infused, non-infused, outpatient, drug use).

Prevention of diarrhea :

- Continue Giving BMS (Breast Milk).

- Pay attention to hygiene and balanced nutrition for the provision of complementary feeding after the baby is 4 months old.

- Because the transmission of direct contact of feces through the hands / insects, so keep clean by making the habit of washing hands for the entire family. Wash hands before eating or providing food for your children.

- Remember to maintain the cleanliness of food or beverages that we eat. Also, eat or clean furniture and baby toys.

Contact your doctor if :
- Diarrhea with blood, need specific treatment with antibiotics.
- Any signs of dehydration (no tears when crying, urinating less or no urine in 6-8 hours, dry mouth).
- The presence of high heat (38.5 C) which do not fall within 2 days.
- Vomiting continuously, can not enter the food.
- Existence of abdominal pain /colic, the baby will cry strong and usually bend the legs, sweating and restlessness.

Aromatherapy : Dose, Type, Benefits

2011-04-05T07:42:00.001-07:00

The term aromatherapy was first appeared in 1920. Generally, aromatherapy oils are concentrated liquids from plants obtained through distillation. Oil produced from plants that are then used for healing and therapy (soul & body). There also are used for herbal therapy.

Rene Maurice Gattefosse was the name of a French chemist who popularized the term aromatherapy. When he was doing research on the function of the oil treatment plant, he was accidentally burned his arm and then touch lavender oil. Lavender oil is spilled before the burn healed quickly and without a trace. Rene then published a paper entitled Aromatherapie: Les Huiles essentielles, hormones végé tales that became a reference for the development of aromatherapy in Europe.

The use of aromatherapy

The most widely used as an air freshener, both at home and office to create the atmosphere relaxed, calm and simultaneously get rid of odors that are not desired. For example, lighting scented candles or aromatherapy oils to create a kitchen and free from the smell of cooking the rest. Likewise with such beauty spa in Bali.

A mild scent to make you more comfortable after a long day at the office. Fragrances popular enough to evoke the atmosphere relaxed and comfortable such as bergamot, eucalyptus, lavender, jasmine and rose. Makanay used also for the beauty, spa like Bali. Spa aromatherapy oils can also help you fight bacteria, such as lavender oil for example. While others, such as camphor and menthol to increase your metabolism and endocrine system, central nervous system repair and strengthen the immune system.

Natural essential oils used in aromatherapy is extracted from flowers, seeds, fruit peel, bark, roots and leaves through distillation, extraction or extortion. Such oils typically contain organic acids in addition to terpenes, sesquiterpenes, esters, alcohols, phenols, aldehydes and ketones.

Ensensial oil marketed is usually not pure, but with a mixture of (carrier) vegetable oil and added a number of substances such as iodine and vitamin E to have a balancing effect. Vegetable oil is used as a mixture of almond oil, spacing, soybean, grape seed and sunflower.

Aromatherapy oils are also often used as a massage oil. When absorbed by skin and muscle, aromatherapy oils will give a soothing sensation of warmth in your muscles. Examples of other uses of aroma therapy is for treatment, either by applied to the skin, inhaled, or swallowed.

You can find various dosage forms of oil or essential oil and use it with ease. Dosage form such as :
- Spray bottle.
- Potpourri consisting of a mixture of flowers, leaves, herbs with beautiful colors and shapes in a glass or bowl place a sealed, which poured into it with essential oils and then mixed in a sealed condition left a few days, when opened, fragrance will fill the room.
- Incense, its use with fire.
There are 2 kinds of shapes that is combustible (in the form of bricks, cones, or tonkat, the user with a fire at the tip and placed in the censer) and non-combustible shaped like an application by sprinkled powder over charchoal block in a censer that has been burned.
- Candles are scented.
- Essential oils are mixed while showering (bathing), the addition of essential oils should not be exaggerated, because there are some essential oils can cause irritation of the mucous membranes, usually 5-7 essential oils are added in 1 ounce of carrier oil before added to the water bath. More practically, you can choose a salt bath in accordance with the scent you want.

When using aromatherapy

When you decide to use aromatherapy for healing and therapy, such as herbal therapies, there are also some things to note :
- Pure aromatherapy oils can have a strong effect both for pets, kids and your own. A good idea to pay attention to labels when buying products of aromatherapy, or just ask the seller.
- Avoid using aromatherapy oils during pregnancy, or if you have epilepsy or asthma.
- Before you begin using aromatherapy oil, try first a drop or two drops to test whether you have an allergy or not.
- It is recommended to use aromatherapy oils in small quantities to avoid unwanted negative reaction.

The types of aromatherapy oils and their benefits

Content of treatment with these essential oils can make a relaxed, vibrant, strengthen and soothe. Essential oils are absorbed through the skin or inhaled.

Essential oils can be used for bathing by adding 10 drops of oil into the tub. As a body lotion can add 5 drops of essential oil. As a facial moisturizer added 2 drops of essential oils. For the massage can be added 10-12 drops of essential oils. As an air freshener can add 2 drops into the 150 ml of warm water in a spray bottle.

Here are some types of essential oils and its uses :

1. Camomile, can make a relaxed, calm and ward off free radicals that can cause aging.

2. Clary sage, can be soothing, to strengthen and cleanse the mind.

3. Cypress can be used for revitalization, chelating medicine, to relieve swelling, reduce pain during menstrual cramps, but you should avoid at 1-3 months of pregnancy.

4. Eucalyptus, can be used for antiseptics, medicines swelling and help respiratory problems.

5. Grapefruit, can be used for the refreshing, detoxifying, cleansing, to relieve nerve, and relaxes muscles.

6. Jasmine, can be used to soothe, aprodisiak, antidepressant, but it should not be used during pregnancy and if the skin is sensitive.

7. Lavender, can be used for antiseptic, calming and comforting.

8. Lemon, can be comforting, energizing, refreshing and improve mood.

9. Mandarin, can calm, relax, give the sensation of peace and can be used by children.

10. Peppermint, can be used as an antiseptic, stimulant and relieve pain.

11. Sandalwood, can be used as a counterweight, aprodisiak, antiseptic, to treat coughs and sore throats.

12. Tea Tree, can be used as an antibacterial, antiviral, antifungal, controlling dandruff and skin problems.

13. Citronella to reduce tension, relieve nasal congestion, overcoming insomnia, snoring and migraine.

14. Green tea for improving the circulatory system, help remove phlegm and clear the lungs. Also slow the aging process.

15. Rose to create an atmosphere of romantic and passionate, improve metabolism and circulatory system, balance hormones, relieve sensitive skin and allergies.

16. Ylang-ylang (Cananga interest) are useful relieve high blood pressure, removing sebum on the skin. Peppermint Aroma as a refreshing, evokes the atmosphere, reducing abdominal pain, tension, and cure headaches.

17. Dandellion to treat joint pain, kidney and bladder problems, hepatitis, screening blood and digestive problems. Also effective cure a bee sting.

18. Thyme helps prevent the flu, fever, detoxification of toxins and prevent infection, reduce nasal congestion and sinus allergies.

19. Lotus flower, increase vitality, concentration, reduce the heat, increasing the function of the spleen and kidney.

20. Patchouli increase the passion and spirit, increase sensuality, provide a calming effect, and make sleep more soundly.

21. Basil to reduce headaches and migraines as well as improving concentration.

22. Green apple to cure hangover and diarrhea, strengthen the digestive system, purify the mind, relieve symptoms of heartburn.

23. Black Pepper has a pungent smell but efficacious reduce pain in muscles.

24. Vanilla with soft and warm scent calms the mind.

25. Strawberry can increase appetite, reduce heart disease, high blood pressure and cancer.

The use of essential oils also should not be indiscriminate. Here are tips to safely using essential oils :

1. Keep all essential oils in dark bottles and not exposed to heat, sun and beam it directly, because it can damage the composition of essential oils.

2. Essential oils are only used as an outside medicine, not to drink or eat.

3. Avoid contact with eyes, if contact with eyes then rinse off with milk or vegetable oil and consult with a physician.

4. Many essential oils are sensitive to light, which means it can cause a reaction with the skin when exposed to sunlight, then do not use essential oils if you will come out of the house.

5. Keep out of reach of children.

6. Essential oils are usually easy to explode.

7. Pregnant women should not use essential oils without consulting with your doctor first.

8. Aromatherapy massage is not allowed for people who are sick or have had broken bones.

9. If you do not want to buy essential oils, one by one, you can buy products that are mixed, or use body products that contain an essential oil.

10. Do not attempt to cure the diseases only with aromatherapy oils, always consult with a physician.

11. Do not apply oil to the skin that has not been diluted. Oil is not diluted still too strong and can trigger inflammation. Lavender is the only exception, which can be applied directly to the skin area to cope with insect bites and stings. Essential oils should be mixed with other types of oil (carrier oil).

12. Avoid rubbing the oil into the cracked areas of skin, inflamed skin or which just scratched.

13. When using aromatherapy, close the door of the room to prevent the flight of the scent.

14. To obtain a direct result of aromatherapy, try inhaling steam. Add 4 drops of essential oil of your choice into a bowl of hot water, you lean toward the bowl and cover head with a towel. Inhale deeply for 5 minutes.

15. Do not forget to bring a tissue that has been poured with your favorite oil. That way, you can breathe whenever you want. In addition, you also can shed a chamomile or lavender oil on the pillow to help you sleep more soundly.

Aroma therapy can reduce stress, calm the mind and evoke the spirit and passion. Some even believed to cleanse toxins in the body.

To produce a useful fragrance of aroma therapy is not difficult. Now many shops selling various kinds of essential oils, candles to burn and the cup. Then you can choose what scent that matches your mood and your body condition.

Benefits of aromatherapy :

Aromatherapy for babies

In baby care, aromatherapy is used to soothe babies and children so as not restless / fussy and can sleep soundly.

Different essential oils have different properties and are used for different reasons. Here are some gentle essential oils are often used for babies : geranium (Pelargonium graveolens), lavender (Lavandula angustifolia), rose (Rosa damascena), roman chamomile (Nobile chamaemelum), lemon, grapefruit, mandarin orange (Aurantium sinensis).

There are some essential oils that should not be recommended for infants, among other high volatile oil such as peppermint menthone (Mentha piperita) and cornmint (Mentha arvensis), hyssop (Hyssop officinalis), basil (Ocimum basilicum), and juniper (Juniperus communis).

Ask the expert advice to get the aromatherapy oil that is suitable and safe for your baby. Be careful, because the flavor is too strong, it can make your baby's headaches and nausea. Your baby may also have allergic reactions to aromatherapy oils. Always do a limited test before you apply it to your baby. In principle, do not do aromatherapy without the guidance of experts who are more competent. Infant age, usage, type and composition of aromatherapy oils will determine the appropriate dose.

Examples of aromatherapy for babies:
- Use lavender lotion when you massage your baby. In general, essential oils are provided through a mixture of white lotion is better than vegetable oil, which is not easily absorbed by the skin of infants and may be too slippery.
- Use a small drop of lavender oil on your baby's clothes, so that the product is not in direct contact with your baby's delicate skin.
- Change your baby soap with mixed lavender soap available on the market.
- Use air freshener with lavender or chamomile oil to put in spreader aroma and leave for 15 minutes to spread in the baby room.

Therapeutic treatment of dementia

Aromatherapy not only helps them relax a stress but also help address the mental and physical disorders of dementia sufferers. Therapy using flower extracts, herbal, and tree, can alleviate sleep disturbances and anxiety commonly experienced by patients with Alzheimer's and other forms of dementia.

A study lasting for 4 weeks to see the effects of aromatherapy on elderly dementia patients found that approximately one third of patients experienced reduction of symptoms of anxiety when rubbed with lemon balm. Medium when using sunflower oil with no aroma, only 1 of 10 patients who experienced improvement.

The frequency of brain waves also find things that match. Studies in this field showed that smelling lavender increases alpha waves in the back of the head, which serves to bring a frelaxed eeling. The smell of jasmine increases beta waves in the front of the head, which is associated with increased alertness.

How it works?

Each type of essential oil contains about 100 chemical components, which work together to produce a strong effect on the body. Each type of oil work differently, depending on which component is more dominant. For example, some types of oils are soothing, nothing makes you relax, nothing to relieve pain, and so forth.

Essential oils stimulate the olfactory senses of strength. The smell that you smell otherwise have a significant effect on your feelings. And the doctors have found, patients who lost most of his sense of smell experience more psychological disorders such as anxiety and depression. Scent is believed to enter through cilia (tiny hairs in the lining of the nose) to the limbic system (part of the brain that controls mood, emotions, and our learning abilities).

This oil does not leave harmful residue. Oil enters the body through absorption or through breathing

Aromatherapy to boost sex drive

Ever wondered why Aphrodite, Goddess of Love and Sensuality, put rose petals in the room? Why Kamasutra use itars and aroma? The reason, because the fragrance is very helpful for someone to stimulate passion.

Sense of smell that stimulates nerve endings located in the back of the nose which will flow to the brain stimulation. This is called the limbic system, triggering a person's libido.

The essential oil has a magic that can stimulate the pituitary gland where it is a master of endoktrin gland which controls hormone production. Active pituitary gland can cause a low sex drive. Thus, the existence of aromatherapy oils will help keep these levels remained stable.

However, if you are already have decreased libido, it's time to treat yourself with some fragrances that can make it back in action. Aromatherapy oil is the best way to enable the libido.

The molecules of oil can be mixed quickly in the bloodstream and running it through the body. Natural fragrance that comes in aromatherapy oil became an important key to bring sex appeal.

If you want to try it, here are some fragrances that can evoke an aphrodisiac for women :

- Ylang Ylang

Considered one of the most powerful aphrodisiac. Ylang ylang can increase libido, and attraction between couples. This is a form of energy that can intensify the eroticism and sexual experimentation.

Want to try? Use a cotton bud dipped in ylang ylang, and place it near your bed. Just enough to use one drop only. Do not use too much because it will make the effects of headaches and nausea.

- Rose Otto

Oil work effectively for women, especially to balance hormones. The use of this oil will give effect to strengthen the reproductive organs so that they can work a maximum in the increase of sexuality.

Want to try? Please treat her with love to give a soothing massage.

- Jasmine

The smell of this flower will enhance mood and increase your energy level. Traditionally, this oil is used to combat frigidity, impotence, and premature ejaculation due to the strong influence of the fragrance.

Want to try? Mix with sandalwood, citrus oils, and proceed with aromatic bath. Women are advised not to use jasmine oil during pregnancy.

Heart attack : cause, symptoms, complications, diagnosis, treatment, prognosis, rehabilitation

2011-03-29T07:32:00.001-07:00

Heart Attack (myocardial infarction/myocardial infarct/myocardial infarction) is a state where all of a sudden happened restriction or termination of blood flow to the heart, which causes the heart muscle (myocardium) dies from lack of oxygen.

Cause

These diseases can affect any part of the heart. However, the most common disease is a chronic disease in the coronary artery which is called atherosclerosis. Therefore, heart disease commonly known and most common is coronary heart disease or coronary artery disease. The disease is most often causes a heart attack in someone who can cause death. The cause is narrowing of the coronary arteries, where the vessel serves to provide blood to the heart muscle. The narrowing is caused by a pile of cholesterol or other proteins derived from food intake in the body. This buildup causes the coronary arteries become stiff. Rigidity is referred to as atherosclerosis.

Atherosclerosis occurs if there is buildup of plaque or fatty deposits in artery walls. Over time, plaque can accumulate, harden and narrow the arteries, and inhibit blood flow to the heart. Coronary artery disease or coronary artery disease (CAD) is that basically leads to most heart attacks.

Blockage in one or more coronary arteries can cause heart attack suddenly. The reason for the heart to ask exceeds the available oxygen so that trigger heart attacks. Why? If the heart muscle does not receive oxygen for a long time, the surrounding tissue can be damaged. Unlike other tissues, the heart muscle does not regenerate. The longer the attack, the more damage to the heart and the more likely to die.

Even in the arteries that are not too narrow because a lot of plaque and fat, accumulation of plaque can rupture and form a crust of blood or thrombus. In addition, the diseased arteries also tend to experience sudden muscle contractions. Thus, a piece of crust of blood can form a contraction, releasing chemicals which then result in narrowing the artery wall, triggering a heart attack.

Heart damage can be enlarged, and partly an attempt to compensate for cardiac pumping ability which is reduced (because of the larger heart will beat stronger). An enlarged heart is also a picture of the damage to heart muscle itself. Enlargement of the heart after a heart attack provides a poorer prognosis.

If the working system of the heart is damaged, the normal heart rhythm can become chaotic and the heart began to tremble with uncertainty or experiencing fibrillation. This abnormal rhythm known as arrhythmia is a deviation from normal heart rhythm. This will cause the heart loses its ability to pump blood effectively to the brain. Within ten minutes, brain death and the patient was beyond help.

In addition to coronary heart disease due to fat deposition in the arterial wall, there are also other heart diseases caused by abnormalities at birth. For example, an imperfect heart, heart valve disorders, weakened heart muscle. Another cause is the bacteria that cause infections of the heart.

Other causes of heart attack are : A clot from the heart itself. Sometimes a clot (embolus) forms in the heart, then broke and stuck in the coronary arteries. Spasm in the coronary arteries that causes cessation of blood flow. Seizures can be caused by drugs (like cocaine) or because of smoking, but sometimes the cause is unknown.

Symptoms of heart disease

The symptoms are perceived if you have coronary heart disease include pain in the chest, which most people thought it was just as indigestion. Then other symptoms of feeling depressed in the middle of the chest for 30 seconds to 5 minutes. Another thing is the cold sweat, palpitations, dizziness, and felt like fainting. These symptoms are not always perceived sufferer. Another warning sign is gasping for breath during exercise.

For several months before the heart attack usually people with heart disease often feel very tired. Do not assume these symptoms are caused by lack of sleep and stress of the job.

Pain or feeling of pressure in the chest, called angina, give warning to half of those who suffer a heart attack. Some people get breathless or exhausted and feeling weak as the symptoms, indicating that the heart is not getting enough oxygen due to blockage of a coronary.

At mid-chest pain radiating to the back, jaw or left arm, or more rarely spread to his right arm. Pain may arise in those places without chest pain at all.

Pain in heart attack similar to angina pain but more intense and longer, not relieved by rest or giving nitroglliserin. Sometimes the pain is felt in the abdomen and be mistaken for one meal, especially since after the patients burp a little pain diminished or disappeared for a while.

Other symptoms are feeling like going to faint and palpitations.
Abnormal heart rhythms (arrhythmia) can affect the pumping ability of the heart or can cause cardiac arrest (heart stops pumping effectively), resulting in a decrease in consciousness or death.

Usually a few days before having a massive heart attack, a person will experience muscle contractions suddenly in the chest which has a small attack or a mild heart attack. Generally mild heart attack occur before a major attack a few days later. During attacks, patients may feel anxious, sweaty and could feel his death will soon arrive. Lips, hands and legs look bluish. Geriatric patients may experience disorientation (daze).

There are 5 signs of a heart attack to watch out for :

1. Stress (load seemed to be overwritten, pain, pinched and burned), which causes shortness of breath and choking on the neck.
2. The pain may spread to the left arm, neck and back.
3. The pain can last about 15-20 minutes and occur continuously.
4. Arise in a cold sweat, weak body, heart palpitations and even fainting.
5. The pain can be reduced when it is resting, but will gain weight if you're on the move.

Complications

Frequent complication is myocardial rupture, blood clots, arrhythmias (heart rhythm disorder), heart failure or shock, or pericarditis.

Myocardial rupture

Damaged heart muscle becomes weak, so sometimes have tears because of pressure from the heart pumping action. 2 parts of the heart that often tears during or after a heart attack are heart muscle wall and the muscles that control the opening and closing one of the heart valve (valve mitralis). If a muscle tear, the valve can not functioning so that a sudden severe heart failure.

Cardiac muscle in the walls that limit both ventricles (septum) or on the outside wall of the heart muscle may also experience tearing. Torn septum can sometimes be repaired through surgery, but the tears in the outer wall almost always cause death.

Heart muscle damaged from heart attack will not contract properly, although not experiencing tear. Damaged muscle is replaced by fibrous scar tissue is rigid and can not be contracted. Sometimes this section will be bulging at the time should be contracted. To reduce the extent of this function can not be given ACE-inhibitors.

Damaged muscle may form a small protrusion on the heart wall (aneurysm). The existence of aneurysm can be known from the description of an abnormal ECG, and to strengthen this conjecture can be done an echocardiogram. Aneurysm should not have any tears, but can cause irregular heart rhythms and can cause a reduction in cardiac pumping ability. Blood flow through the aneurysm more slowly, because it may form clots within the heart chambers.

Blood clot

At approximately 20-60% of people who had experienced heart attacks, blood clots form within the heart. At 5% of these patients, the clot can be broken, to flow in the artery and lodged in smaller blood vessels throughout the body, causing blockage of blood flow to part of the brain (causing stroke) or to other organs. To find the clot in the heart or to find out the predisposing factors that are owned by the patient, performed an echocardiogram.

To help prevent blood clot formation, patients are often given anticoagulants (like heparin and warfarain). The drug is usually taken for 3-6 months after a heart attack.

Diagnosis

If a man above 35 years old or a woman over 50 years complaining of chest pain, usually considered as the possibility of a heart attack. Diagnosis of heart attack can be amplified by performing the following checks :
1. ECG
If there was a suspected heart attack, the ECG is the initial diagnostic examination of the most important. Some abnormalities can be seen on the ECG, depending on the size and location of heart damage.
2. Blood tests
Blood tests done to determine the levels of certain enzymes. CK-MB enzyme normally found in heart muscle and released into the blood when heart damage occurs. Increased levels of this enzyme would appear within 6 hours after a heart attack and persist for 36-48 hours. Levels of these enzymes are usually checked at the time of patient admission and every 6-8 hours during the next 24 hours.
3. Echocardiogram
Echocardiogram will describe some of the walls of reduced movement of the left ventricle (heart chamber that pumps blood throughout the body), which is an indication of damage from a heart attack.
4. Radionuclide imaging
Depictions of the radionuclides could indicate reduced blood flow to one section of heart muscle, which is indicative of scar tissue (tissue death) of a heart attack.

Treatment

Half of deaths from heart attack occur within the first 3-4 hours after the occurrence of symptoms. The sooner help is given, the more likely the patient can be saved.

A person with a suspected heart attack are usually treated in the cardiac care unit, and to assess damage to heart, made strict monitoring of heart rhythm, blood pressure and the amount of oxygen in his blood.

Early Treatment

Usually immediately given aspirin tablet, it should be chewed. Giving this drug will reduce the formation of blood clots in the coronary arteries.

Beta-blockers are given to slow the heart rate and so the heart does not work too hard to pump blood throughout the body. Oxygen is often given through a face shield or a small tube inserted into the nostril. By providing oxygen, the oxygen pressure in the blood will increase so that more oxygen to the heart and heart damage can be minimized.

If a blockage in a coronary artery can be quickly resolved, then the heart tissue can be saved. Blood clots in the arteries can often be dissolved with thrombolytic therapy, namely by giving streptokinase, tissue plasminogen activator urikinase. To be effective, these drugs are administered intravenously within 6 hours after the symptoms of a heart attack, because if it is more than 6 hours, some damage will be permanent in nature.

Early treatment increases the blood flow in 60-80% of patients and can minimize damage to heart tissue. Aspirin (to prevent blood clot formation of platelets) or heparin (stop bleeding) may increase the effectiveness of thrombolytic therapy.

Thrombolytic therapy can cause bleeding, so are not usually given to patients who have :
- Gastrointestinal bleeding.
- Have severe high blood pressure.
- Just suffered a stroke.
- New undergo surgery.

Elderly patient who does not have the circumstances mentioned above, can undergo thrombolytic therapy safely.

Some hospitals use angioplasty or coronary artery bypass surgery immediately after a heart attack. Nitroglycerin can overcome the pain by reducing the workload of the heart, and is usually given intravenously at first.

If the drug used to improve coronary artery blood flow, also failed to reduce symptoms of heart attack, usually given an injection of morphine. Morphine is also a sedative and reduces the heart's workload.

Advanced Treatment

Someone who just had a heart attack, should undergo bed rest in a quiet room for several days, due to excitement, physical activity and emotional stress can aggravate heart work. Stool softeners and laxatives may be used to prevent constipation.

Anxiety and depression often occur after a heart attack. Severe anxiety which can burden the heart, so that given a sedative. ACE-inhibitors are routinely given to reduce heart enlargement, which often occur after a heart attack.

When you are alone, and have a heart attack, how do you should help yourself?

A person can not be beat when the heart normally and feel almost fainted, he had only about one - 10 seconds, after that it will unconsciousness. If there are no people around him to give first aid , sufferers should use this short 10 second self-help techniques.

Do not panic, try to cough and hold with a vengeance. Every time before a cough, should take a deep breath. Then strong hoop, deep and long as want to remove phlegm in the chest. Every interval of two seconds, must take a deep breath and cough once. Until help arrives, or until you feel your heart rate is normal, just may break.

The purpose of breathing, to enter oxigen into the lungs - pulmonary. The purpose of cough, to suppress heart for pressing heart circulates blood flow, it can also help the heart rate returned to normal. Relief in this way, so that patients have the opportunity to go to hospital.

If you suspect someone is having a heart attack, act quickly to help save his life. Even if you do not believe he had a heart attack, do not wait too long to think but to do things quickly.

1. Sit or lie down patients.
2. Give aspirin if he did not have allergies. Aspirin inhibits the blood to clot and helps keep blood flowing to the arteries. Chewing aspirin during a heart attack can reduce the risk of death by 25 percent.
3. Direct telephone number or hospital emergency and explain the symptoms experienced a brief and clear, like "The patient experienced severe chest pain and difficulty breathing."
4. 1 hour and 90 minutes since the heart attack until the trip to the hospital is expected to still be able to give relief to the patient.

Why 1 hour as a crisis time for heart attack patients?

1. Time 1 hour based on experience is considered critical because physicians treating patients with heart attack, in which most patients are not helped in 1 hour after heart attack.

2. The heart is a muscle, and muscles will stop working or begin to die if deprived of oxygen. Heart muscle needs blood supply that contains oxygen on a regular basis in order to function properly. If the coronary arteries become narrow, the heart can not accept all the blood it needs.

3. When heart muscle is deprived of oxygen then some cells would die and the muscles can not work anymore.

4. Every minute that passed during a heart attack, it is the heart deprived of oxygen and the longer the wait the longer the heart muscle goes without oxygen, causing death.

5. When the heart began to lack of blood supply, it will occur an unstable heart rhythm that causes the blood flow can not walk well into vital organs like the brain.

6. If within one hour can be handled then it can prevent further damage.

The success of the rescue of a heart attack also depends on how many areas of blockage. The less the blocked area, the possibility of recovery is greater. Average heart attack patients died because of delays in aid, weighing attack happened and the problem the ability of patients to get into surgery.

Overcoming heart disease

If you feel the early symptoms of heart disease or had suffered a mild heart attack, do not ignore it. You really need early treatment by trained medical personnel. This can save the heart from further damage and even to avoid more fatal consequences such as death.

But if heart attack symptoms begin to occur, it is important to seek immediate medical assistance. The biggest risk of death from heart attack is within one hour after a heart attack. Rapid and appropriate treatment of a medical team to save heart muscle from damage that can not be repaired. The more heart muscle that is saved, the more effective heart pumping will return after the attack. Do not put off getting medical help because of fear is considered absurd.

When a blockage has occurred, the medical action is generally taken with the installation of catheterization and rings that keep coronary arteries are not clogged. However, there may be some blockage in other arteries.

To reduce risk of coronary heart disease, you can do the following things :

- A healthy diet.
Avoid foods that contain lots of fat or high cholesterol. Seafood contains high cholesterol that can harm the heart. Reduce eating fried foods that contain lots of fat, otherwise the food can be processed by boiling, steaming or roasting.

Wherever possible, the food products we eat are low-fat or no fat. Choose milk, cheese, butter or other foods that are low in fat. Fry using olive oil has less fat content so that it can be an option if the need to process food by frying.

Apart from avoiding fatty foods, avoid foods with sugar content is also high, such as soft drinks. Do not consume too much carbohydrates, because in the body, carbohydrates are broken down into fat. In contrast, consumption of oats or wheat that can help keep the heart healthy.

Keep your diet in moderation to avoid obesity, because someone who has a waist circumference of more than 80 cm, greater risk of developing this disease.

- Stop smoking.
Cigarette is not good for heart health, then immediately stop this practice for heart stay healthy.

- Avoid Stress.
Stress is very difficult to avoid when living in a city which known for traffic jams and preoccupations. When a person experiences stress, the body will release the hormone cortisol, which causes the blood vessels become stiff. Hormone norepinephrine would produce the body when suffering from stress, which will result in increased blood pressure. So, very good if you avoid the stress both in the office or at home.

- Hypertension.
Problem hypertension or high blood pressure can also cause heart disease. Hypertension can injure the arterial wall and allows the channel to enter the arterial LDL cholesterol and increase the accumulation of plaque.

- Obesity.
Overweight or obese increases the high blood pressure and abnormal fat. Avoiding or treating obesity is the main way to avoid diabetes. Diabetes accelerate coronary heart disease and increased risk of heart attack.

- Exercise regularly.
You can do sports activities such as walking, brisk or jogging. Sporting activities which are neither too much competition and not to strengthen the work of the heart and blood circulation throughout the body.

- Consumption of antioxidants.
Air pollution, motor vehicle fumes or cigarette smoke create the emergence of free radicals in the body. Free radicals can cause ulcers or deposition of the arteries that can cause blockages. To remove the content of free radicals in the body, there needs to be an antioxidant that will catch and throw. Antioxidants can be obtained from a variety of fruits and vegetables.

- Heredity.
A person who has a parent or sibling had suffered a heart attack before age 60 have a greater risk of suffering from this disease. Therefore, if you have relatives who have had a heart attack, you should be more careful in keeping your diet and your lifestyle to support a healthy heart.

8 Facts about heart attack

1. Sexual intercourse is done routinely can be healthy for the heart. But for men, the condition should be done with the official partner for having sex with mistresses even enhance the risk of heart attack.

Playboy who more likely to show symptoms of depression than other male whom sex life was fine. In that study, the men admitted having an affair because of the household was not harmony. This condition can trigger depression which is marked by several symptoms that observed in studies that include obesity, high blood pressure and lifestyle changes including consuming alcohol and more frequent smoking .

Depression is accompanied by symptoms such clearly increases the risk of heart attack. Although not directly triggered by infidelity, increased risk of heart attacks could worsen if the forbidden relationships lead to new conflict. 85 percent of men who cheated his wife died of a heart attack.

2. Milk is not only complementary foods, it should be consumed every day. But it is also useful to support health. Drinking three glasses of milk every day, can reduce the risk of heart disease by 18 %. This deny the myth that states that the consumption of milk every day can lead to weight gain and lead to the emergence of heart disease, stroke, and even death. Consumed higher calcium will affect the weight loss.

3. This yellow-skinned fruit that is already popular. It was sweet and fragrant aroma. Besides as fresh fruit or cake, bananas are very rich in nutrients. Can make heart healthier and feeling more comfortable. This fruit contains a lot of potassium, energy, vitamins, and enzymes. Such as sucrose, glucose, and lactose 14.8 grams and 1 gram of protein (2% of the recommended daily to consumed). It also has 400 mg potassium (10% of the recommended daily intake).

A study shows if you eat bananas every day, get a 22% lower risk of heart disease than people who do not eat bananas. High content of potassium which can increase the regularity of heart rate, activating muscle contractions, and helps regulate blood pressure.

Adequate consumption of potassium, may reduce the effects of sodium that can increase blood pressure and may reduce the risk of stroke. One banana has 4 grams or 16% fiber is recommended to be consumed per day. These fibers facilitate digestion and makes the cardiovascular system work better.

When under stress, your metabolism work harder and this makes potassium levels dropped dramatically. Eating a banana will provide a quick supply of potassium and also normalize the function of the nervous system.

The content of nutrients, like folic acid, magnesium, vitamin A, vitamin C, and potasium. Bananas play an important role to encourage the production of serotonin or the hormone of happiness. This hormone works to increase the mood and gives a sense of healthy, calm and comfortable in every person.

Low content of sodium. makes bananas safe to eat for people affected by high blood pressure and a diet because low in salt, but requires potassium. U.S. Food and Drug Administration (U.S. FDA) said, the consumption of a banana each day can treat high blood pressure. High blood pressure is what triggered the heart attack or stroke.

4. Based on data collected from various research and clinical trials, diabetes drug, Avandia , increased the risk of heart attack. However, U.S. Food and Drug Administration (FDA) will decide the fate of new drugs in July.

The debate about the benefits and side effects Avandia is a lively discussion in some time. GlaxoSmithKline production showed no risk of death from cardiovascular disease.

Elderly patients who took Avandia had heart attack risk greater than patients taking similar drugs from other manufacturers.

Avandia was approved by the FDA in 1990 to cope with the increase of blood sugar in people with type 2 diabetes. Fears about side effects of these drugs in heart appeared in 2007. Since then, various studies conducted to prove the existence of the risk of heart attack, although not a little more research that focuses on the benefits of this drug for patients with diabetes.

Amid all the controversy, in 2005, the United States court ordered GlaxoSmithKline to conduct clinical trials and the results made public. Research randomized to 35 500 patients. Apparently, Avandia is proven to increase risk of heart attack between 28 and 39 percent, but did not increase the risk of death.

5. Flavonoids are known as one of the antioxidants in tea water substance that magnitude is very strong that it can eliminate the damaging effects that occur at the oxygen in the human body. Right now the researchers are very interested about the potential benefits of such chemical substances that also are found mainly in onions, apples, and red wine.

Drinking tea is good for heart health, recent findings conclude the truth of these dramatic effects for men and women. The study includes results of research on types of tea are produced from black tea. The research scientist said that black tea contains flavonoids a magnitude stronger than green tea, while herbal teas contain concluded it was not the slightest flavonoids. People who drank one to two cups of tea every day cut the risk by about 46% of aortic disease , atherosclerossis, namely narrowing of the arteries due to fatty deposits or other substances in the walls of blood vessels in the channel. By drinking up to 4 cups of tea then the risk is reduced to 69%.

Coffee does not have an effect on the occurrence of heart attacks, although it has been processed as decaffeinated coffee. While other studies have shown that adding milk, sugar or lemon to the water does not eliminate the beneficial effects of flavonoids in tea. There were no differences in the benefits of drinking tea, which is serve hot or cold, or with a different way, whether directly from dried tea leaves, tea bags, or granulation of the crystal.

Tea is a very large flavonoids source, which can prevent cell damage that can lead to heart attacks, cancer, and blood clotting in blood vessels. Two cups of tea have anti-oxidant strength is equivalent to 4 apples, 5 onions, 7 orange orange, or 2 glasses of red wine.

How much tea you must to drink?

The question of how much tea should be drunk and how long it takes tea preservation in order to obtain the greatest benefit for heart health until now still open to debate. It takes 6 cups of tea a day to prevent blood clots in heart arteries that cause heart attacks due to interruption of blood flow to the heart.

Recent research makes clear that, at least a cup of tea a day can reduce the risk of heart attack by almost half. Processing of tea produced components known as flavonoids that can neutralize toxic chemicals that can damage cells, so it can lead to heart attacks, strokes and cancer.

6. While nice and recommended, exercise can not be done blindly. It is wrong if any of you think that the harder exercise, the better. Various aspects should be considered before exercise such as age, physical condition, history and other diseases.

Some things to consider in the exercise are :
1. If you are aged 40 years or more, before exercising you should consult with your doctor to determine what type of exercise, frequency, and duration of the match. Similarly if you have a history of cardiovascular disease such as heart disease or hypertension.
2. Before exercising, you should warm up first. Similarly thereafter, it is important to perform cooling.
3. Avoid sudden heavy exercise. Should be done with intensity that is slowly increasing.
4. Sports should be done regularly, 3-5 days a week.

7. Heart attacks can indeed affect anyone. But recent studies show people with blood type O have less risk of heart attack.

Certain genes can cause a person susceptible to plaque buildup in heart arteries but did not experience a heart attack, while a different gene causes heart attack when someone already has a plaque in arteries.

A new gene called ADAMTS7 associated with an increased risk of coronary heart disease.

In addition, specific genes that are owned by the blood O group was able to protect them from heart attacks, and type O blood type is known as the red blood cells universal donor. Nonetheless blood group O only protects the heart attack risk was not heart disease and stroke overall.

8. One of the nutrients contained in tomatoes is 9-oxo-oktadekadioneat, compounds capable to reduced dyslipidemia, or abnormal levels of fat in the blood. Abnormal levels of fat in the blood vessels is a risk factor for heart attack.

Dyslipidemia often have no symptoms. But if left unchecked, this condition can lead to serious disorders, like arteriosclerosis and cirrhosis.

Arteriosclerosis is an inflammation of blood vessels triggered by excess fat that eventually form a plaque on blood vessel walls. Meanwhile, cirrhosis is a chronic inflammation in the liver which would exacerbate disorders of fat metabolism.

Content of 9-oxo-oktadekadioneat in tomatoes may help setting fat metabolism in the liver. In the form of acid, these compounds can neutralize the excess fat in the bloodstream and prevent heart attacks.

Besides good for the heart, since the first tomato is also known as a source of antioxidants. This compound is able to ward off free radicals which is the trigger various health problems including cancer and premature aging.

Prognosis

Most patients who survive for several days after a heart attack may experience total healing, but about 10% die within 1 year. Death occurs within 3-4 months, especially in patients who experienced returned angina, ventricular arrhythmias and heart failure.

Rehabilitation

Cardiac rehabilitation is an important part in the healing process. Stay in bed for more than 2-3 days will cause the cessation of physical activity and sometimes cause depression and a sense of dependency.

On the third or fourth day after the heart attack, the patient is gradually trained to sit, engage in passive, walked into the bathroom and engage in activities that do not cause stress (like reading).
After 3-6 weeks, the patient must gradually increase his activity. If it does not happen shortness of breath and chest pain, normal activity can be re-done after about 6 weeks.

Nuclear radioactive effects to health : food, organ, isotope, maximum dose

2011-03-21T07:20:00.000-07:00

Nuclear reactor explosion at Fukushima Daiichi, Japan, causing widespread concern about the implications for humans. The worst nuclear reactor meltdowns in history occurred at Chernobyl, Ukraine in April, 1986. How dangerous this radiation for humans?

Naturally, the human body has mechanisms to protect themselves from cell damage from radiation and other harmful chemicals.

For the case in Japan, the WHO believes the public health risk is small. Of course it mean for those who do not live near a nuclear reactor site. There is also no specific recommendations from the WHO about Japanese food and others.

Nuclear radiation exposure that produces a very high radioactive substances that can trigger a number of health problems like hair loss, nerve cell death, seizures and sudden death, circulatory disorders, heart disease, and damage the reproductive system.

Radiation effect is very dependent on levels and types of radioactive substances.

Radiation Effects

Radiation effects for the human body can be divided into two groups :

1. Stochastic Effect
Stochastic effects of radiation effects on individuals whose occurrence can not be ascertained by a factor of 5-10 (from the estimated 100,000 people affected by only 1 person). The effect of radiation is said to be stochastic if the radiation is absorbed by the body in low doses, 0.25 to 1000 mSv. For example, in the goiter diagnostic tool, receiving low radiation is allowed not only safe but actually beneficial.

2. Deterministic effects
Deterministic effects of radiation effects that would arise when the tissues of the body exposed to Ionizing radiation exposure. Deterministic effects can occur if the dose of radiation received was more than the threshold should be below 3000 mSv. When the radiation received between 3000-6000 mSv, it will cause flushed skin or hair loss. 6000-12000 mSv will cause feelings of nausea, decreased appetite, lethargy, weakness, fever, excessive sweating, causing shock that some time will arise that more severe complaints of abdominal pain, hair loss, even death.

But the possibility of deterministic effects is very little, because based on a survey of research institutions that handle nuclear, nuclear radiation only at 0.08 mSv.

Sensitive Organ

The organs that are sensitive to radiation exposure, among others, the thyroid gland, intestines, kidneys, spleen, and bone marrow.

Exposure in pregnant women may interfere with fetal growth, like irregularities in the process of organ growth. Depending on the time of exposure, what body organs are developing in the fetus in the womb.

Exposure in children was also dangerous since the body cells more vulnerable in children. In addition, the extent of the child's body is smaller than adults. Although the same amount of exposure. Children with a smaller doses in the body, the exposure becomes greater.

Efforts to eliminate contamination of radioactive substances on the skin should be done properly and not rude to minimize absorption. Cleanup of radioactive substances on the skin surface by washing in the contaminated section.

To reduce the radioactive substance which has entered the body, sought to reduce the absorption in the digestive tract, inhibiting the deposition in the body organs, dilution, change the chemical properties of materials, and the use of chelate techniques.

Prevention on food supply

Radioactive particles would directly or indirectly bring influence to humans if they eat foods made from ingredients such as dairy products and meat from animals that consume plants and water that has been contaminated.

The release of radioactive particles into the atmosphere will contaminate the surface of the particle. It will befall the agricultural fruit, vegetable crops, grazing land and water resources.

Radioactive contamination through the food

What are the risk of radioactive contamination in food? That depends on several factors. According to experts, the duration is mainly dependent on the type of radioactive element.

Japan found abnormal levels of radiation in milk and spinach from areas near Fukushima. Also, in the tap water in Tokyo and five prefectures center, but there is no threat to health.

In the history of contamination, the main source is wind-borne dust stored in the fruit or vegetables or fall on the ground, where it is absorbed by grass and leafy plants.

Radioactive particles are then transmitted through the food chain, which explains why the cow could have a higher level than normal radioactivity in milk and meat.

When ingested, the particles are dangerous because they release energy that can sneak through in the DNA binding molecule, thereby increasing the risk of cancer.

The problem can be short term or long term, depending on the nature of the radioactive source and amount of contamination in the local environment, which in turn also affected by the weather.

Radioactive isotope

Nuclear power plant (NPP) using an atomic nucleus fission reactions in nuclear reactors. Fission reactions that produce energy and various isotopes, including xenon-133, krypton-85, and iodine-131.

Nuclear radiation containing radioactive substances that produce alpha rays, beta and gamma. The most dangerous gamma radiation. Common isotopes detected in gamma radiation include cobalt-60, cesium-137, cadmium-109, sodium-22, manganese-54, barium-133 and cobalt-57.

Isotopes have a half-life (time required for the whole), which is quite long. For example, cobalt-60 has a half-life 5.26 years. In that period, the radioactive decay half from the original amount, and so on until whole dismiss.

Leakage of nuclear reactors can release radioactive substances into the environment. The case of the 1996 Chernobyl release of radioactive material, especially radio-isotopes of cesium and iodine that contaminate water, food, and air.

Radioactive isotope pollution

Iodine 131, for example, has a "half life" just eight days, which means the possibility of rupture in the neighborhood in recent weeks.

There is a short-term risk to human health if radioactive iodine in food is absorbed into the human body. If swallowed, it can accumulate in the body and cause damage to the thyroid. Children and adolescents are at risk in this regard.

Taking iodine in the form of "stable" as tablets of potassium iodide (PI), to block radioactive iodine in the thyroid.

Long-term problem comes from the timeless elements such as Cesium 137, a "half life" is measured in 30 years and maybe even take a few centuries before it breaks down completely.

The fall of Cesium from the nuclear disaster at Chernobyl in April 1986 caused a long-term contamination problems in many European countries, leading to restrictions on sales of beef, milk.

Strontium 90 is another long-term harmful contamination, such as Plutonium 239.

Plutonium is one of the most toxic to humans, but through direct contact, not through food.

Plutonium 239 is absorbed to a negligible level in the soil by plants and is very poorly absorbed by the digestive tract of animals and humans.

The maximum dose of radioactive

Health impacts experienced by residents living near nuclear reactors, also vary depending on the amount of radiation exposure dose, exposure period, and many parts of the body exposed to radiation.

For example, a single dose given in a short time can be fatal. But the same dose administered over several weeks or several months, could only cause a mild effect.

So the total number of doses and exposure speed to determine the effects of radiation on genetic material in cells.

Maximum dose of radioactive iodine, according to the EURATOM guidelines, is 150 Bq / kg or becquerels per liter (l / Bq) for baby food; 500 Bq / kg or Bq / l for milk products; 2000 Bq / kg or Bq / l for another food and 500 Bq / l for liquids intended for consumption.

The maximum dose of the radioactive element lasted more than 10 days, thus including the Cesium, is 400 Bq / kg or Bq / l for baby food, 1,000 Bq / kg or Bq / l for milk products; 1250 Bq / kg or Bq / l for another food, and 1,000 Bq / l for liquids intended for consumption.

Radioactivity also exist in natural environments, such as the originating source of several types of rock. In addition, many states allow irradiated food products which are safe to kill or prevent bacteria to prolong shelf life.

Dangers to health

Once inside the body, radioactive isotopes will be distributed throughout the body. A person can be exposed to radioactive substances from outside the body or internally from radioactive substances when breathing, eating, drinking, or through wounds. Most settle in the organ or tissue, partly out through the urine, feces, and sweat.

Contamination can occur in sea water used for cooling the reactors. Radioactive particles can be ingested fish and will go into the human body that eating contaminated fish.

Radioactive particles could be flown by wind and contaminate soil, water and air. To prevent the impact of radioactive contamination, the Japanese government banned the use of food sources such as vegetable or other needs, such as water, from the region around a nuclear reactor.

The impact of radiation on health can occur rapidly (acute) or slow (long term). It was not separated from the dose and duration of exposure.

Radiation dose for the treatment of individual maximal 0.05 Sv (Sievert) or 5 rem per year. Radiation exposure that is too large can cause nausea, diarrhea, and headache.

Radioactive contaminants can accumulate in body organs according to the nature of chemical and physics. If the body exposed to doses of 350-450 rem in quick time, there is a 50 percent risk of death within 30 days. Dose of 100 rem in a long time cause cell damage that can not be restored.

Acute radiation syndrome can also attack a variety of different body organs, such as brain syndrome which occurs if the total dose of radiation is very high, more than 30 gray. It's fatal, symptoms include nausea and vomiting initially followed by fatigue, drowsiness and sometimes coma. This phenomenon is most likely caused by inflammation of the brain. A few hours later there will be tremors (shaking), convulsions, unable to walk, and death.

The next impact is gastrointestinal syndrome occurs due to lower total radiation dose, which is 4 or more gray. Symptoms include severe nausea, vomiting and diarrhea, which causes severe dehydration.

Other syndromes due to the impact of this radiation is hematopioetic syndrome, which attacks the bone marrow, spleen and lymph nodes. The formation of blood cells are the main.

This syndrome occurs when a total dose of 10-20 gray and beginning with the loss of appetite, apathy, nausea and vomiting. The most severe symptoms occur within 6-12 hours after exposure and will disappear within 24-36 after exposure.

The impact of nuclear radiation also resulted in the shortage of white blood cells that often lead to severe infection. If the total dose of more than 6 gray, then usually the function of hematopoietic disorders and digestive tract will be fatal.

Cell damage can impair organ function. Depending on which part of contaminated radioactive substances. If exposure to the gonads (testicles or ovaries), infertility can occur. In addition, mutations can occur that cause cancer cells to organs and blood.

Besides having a momentary effect, the radiation on the human body will provide long-term effects of chronic nuclear radiation.

Generally it is triggered by low levels of radiation that is not realized and are not anticipated until some years. Some of the lethal effects due to long-term exposure to nuclear radiation include cancer, premature aging, nervous system and reproductive disorders, and genetic mutations.

For workers at a nuclear reactor, there are three basic radiation protection (radiation safety). Like working time arrangements with radiation, the spacing with radiation sources, and use of radiation protective materials. The shorter the time spent in the radiation field, the farther from the radiation and thicker protective material, will reduce the radiation dose received.

Nuclear also use as medicine

In addition to power generator, nuclear technology is also used in the medical world, especially in the field of nuclear medicine. Utilization of radioisotopes make it easier for doctors to find the location of the cancer without make operation, as well as to kill cancer cells by radiotherapy.

Radioisotopes are also used to sterilize medical devices from a variety of germs that cause disease. This technology is typically used for medical devices which are not resistant to high heat or easily reacts with chemical compounds used in cleaning fluids.

The risk of nuclear use in the medical field are minimized by ensuring radiation doses do not exceed safe limits. Your doctor will also give a lag time before undergoing radiotherapy or subsequent radiological examination for healthy, cells do not become damaged as most radiation.

Among radiation biologists, recently the term of hormesis are increasingly being discussed. Radiation Hormesis is actually a nuclear radiation in small doses (low dose), which is essential for life. The literature shows that a low dose of radiation to provide a beneficial role for growth, development, fertility, health, and increasing average age of experimental animals.

Does it apply to humans? The effects of radiation for irradiation with a dose high enough will give somatic and genetic effects. Somatic effects suffered by individuals who are exposed to radiation. For example, tissue or cell damage that continues to cancer or shortening of age. Genetic effects of chromosomal aberrations, which enhances the possibility of mutation (change in genetic properties) on the next generation. This effect is not expected to occur in humans. However, it can be used for engineering of seeds, both for plants and animals. Effects are clearly visible, when someone receives a high dose of radiation (10 to 50 rem) within a few minutes. Decrease the number of white blood cells can be observed, and the more severe effects are nausea and internal bleeding. Short radiation throughout the body that cause death, half of the number of individuals, estimated to about 600 rem. When the dose was gradually accepted in the longer term, sustained damage to the cellular level. It is most difficult to observe the effects of low dose radiation exposure due to highly variable and easily confused with other causes.

Almost all living things on this earth always receive low-dose radiation exposure, known as the cosmic background radiation, the magnitude 0.1 to 0.2 rem per year. It comes from cosmic rays and natural radioactive substances on earth. Slightly higher than the background dose received by radiation workers, residents in the area of the geologic structure contains a lot of natural radioactive substances, and most of the residents of Hiroshima and Nagasaki shortly after the bomb was dropped. From the description above, it appears the assumption that nuclear radiation is always bad for humans, regardless of dose level. However, it began to appear contrary about the assumption of low-dose radiation after evaluation in some existing literature. Previously, the data indicate that radiation hormesis is considered abnormality or deviation, so often ignored. However, when combined with other data, it turns out that data shows the consistency.

Radiation Hormesis it applies to single-celled organisms, insects, fish and other vertebrate animals, including humans. For example, the percentage of white blood cell death in Nagasaki residents affected by radiation, from 1958 to 1982, there is a minimum percentage of the population affected by irradiation 36 rad (radiation unit). In the end, there is the possibility that radiation below the threshold dose is not just safe, but actually beneficial to human health. That means that contrary to recent philosophy of radiation protection for low doses.

Radiation Fact :
- Humans are exposed to radioactive radiation 2 mSv per year.
- The crew of airlines that fly New York-Tokyo route that passes through the north pole , receive radiation exposure to 9 mSv per year.
- Radioactive radiation that causes cancer at least reach 100 mSv per year. If the accumulated reached 1,000 mSv would cause a fatal cancer in the next few years, incidence rates 5 out of 100 people.
- A dose of 1000 mSv of radiation cause illness such as nausea, but not deadly. While a single dose of 5000 mSv of radiation can cause death in 1 month.

If we assume independently with a question; number of casualties among which the most number of people who died because of nuclear radiation with the people who die from smoking?. If you are health experts, of course you would say conclusively that the people who died because of smoking, more numerous. But because the information media such as TV, newspapers, or the Internet, presents more nuclear negative, so it influence public opinion.

You imagine it, if you are presented with the events of Hiroshima and Nagasaki or Chernobyl tragedy events have claimed the lives of thousands of people at once. It is far different from the victims of smoking, of course we never heard of any mass casualties due to toxicity of cigarette smoke. There are victims of smoking fell around us, sometimes we do not realize. Based on data from World Health Organization (WHO) estimated 4.9 million people die each year. Generally, the final verdict in health care for victims of smoking are due to cancer.

The above description is one example of that natural radiation is more dangerous than nuclear radiation? Unwittingly by smokers, that as long as they smoke, they have been exposed to radiation, one of which is the natural radioactive gas radon gas found in tobacco leaves. It comes from natural radioactive fospat fertilizer (P) which already on tobacco leaves so that radon gas accumulates in tobacco. So that smokers will easily affected by lung cancer due to radiation from radon gas which can enter the lungs.

In general, radon gas is mostly absorbed by the miners of excavated materials, because of miners are directly inhaled excessive radon gas. According to estimates, the risk of dying from radon gas to reach 0.005%.

Some building materials such as asbestos and gypsum is widely used as roofing, cement, and others contain radioactive material. In Sweden, the houses are made of a thick wall with a little ventilation. Therefore accumulation of radon in homes is exceeded, so that there are some homes that contain elements of natural radioactive like U238, Th232, and K40 in the upper limit of normality. Levels of radon gas in homes has reached 260 Bq/m3, whereas normal levels in the air is 10 Bq/m3.

In addition to radon gas radiation, several other natural radiation is cosmic radiation and UV rays from fluorescent lights. When compared with this natural radiation, dangers of nuclear radiation is much smaller than the natural radiation that we receive. This is because the intensity of natural radiation, we are exposed nearly every day while the nuclear radiation occurs only when a leak from reactor. But with advances technology, the possibility of leakage is very small due to reactor safety. Also, benefited from artificial nuclear radiation with a half-life of a short radiation sources, including Ce137, Co60, Xe, and I131. Artificial radiation has a short half-life and this can be expressed radioactive substances if it has 10 times of the half-life. Such half-life of I131 is 8 days, so if a leak from reactor, the reaction of iodine will be exhausted within 80 days.

From the above explanation, we know that nuclear is not a terrible scourge for us. Various things we feared did not as fear as we imagined. It can even be said that nuclear technology is environmentally friendly technologies and we can derive benefits from this nuclear. The government and society should try to understand more about nuclear.

Medical technician average salary in Indonesia

2011-03-18T02:41:00.000-07:00

MyLoveMyWorld healthcare will tell you about medical technician average salary in Indonesia. MyLoveMyWorld healthcare get it from Indonesian's hospital and clinic data. The salaries are usually not counted as such per patients pay in the clinic. If MyLoveMyWorld did not make any wrong database, the standard salary will vary depending on the party that holds funds. Usually each funder (hospital) has different standards. For project implementation in environmental standards set by the Indonesian government are the standard costs of the department of finance. The table below shown the medical technician acceptable average salary :

1. Doctor (program development, experienced): up to IDR 15 million (USD 1667)
2. Doctor (specialist children, court, not the program development): IDR 5 million (USD 556)
3. Doctor (general, field): IDR 3 million (USD 333)
4. Nurses (D-3): IDR 1.5 million (USD 167)
5. Lab technician (D-3): IDR 1.5 million (USD 167)
6. Driver: IDR 750 thousand (USD 83)
7. Logistics (less obvious, deem qualified high school): IDR 500 thousand (USD 56)

Explanation :
- D3 is a academical degree in Indonesia with study time 3 years (same like polytechnic).
- S1 is a academical degree in Indonesia with study time 4 years (same like bachelor).
- Specialist is advanced S1, it means you need to take more medic study course after get bachelor degree (S1). Specialist is different with S2 (master degree). Specialist will learn more specifically with one heal area (example : specialist in ear diseases, nose diseases, eyes diseases, and etc).
- To get practical license to heal people, students need to take more study course after S1 (but not specialist), need to work with government hospital and need to be replacement in sub urn (other province or other state), usually placed in small town.
- High school degree needed for lower medical technician like for logistic.

Note :
The data of average medical technician salary in Indonesia is based on Indonesian government medical technician data and given monthly (some routine and some not given routine). The average salary in private hospital and clinic are different. This will be vary different with health project that host by foreign countries as health aid.

Leptospirosis ; Transmission, Symptoms, Diagnosis, Complications, Prevention

2011-03-15T07:25:00.000-07:00

One of the diseases that lurk earthquake victims is leptospirosis. This disease is one of infectious diseases originating from animals and infect humans and includes as the most common zoonotic diseases in the world. Zoonoses are animal diseases that transmitted to humans, such as Antrax, rabies, Toxoplasmolisis, including leptospirosis. Nevertheless, the disease is still dangerous as the diseases that attack humans, especially the vital areas such as heart, kidney, liver, stomach, and etc.

Since 1886, the disease of leptospirosis is already there. But the etiology (cause) is not clear. It was until 30 years later, two researchers from Japan have discovered the precise etiology of the leptospirosis disease.

Leptospirosis is a disease of humans and animals caused by germs and Leptospira bacteria that found in urine and animal cells which is affected. Leptospirosis is caused by spiral-shaped pathogenic bacteria of the genus Leptospira, families Leptospiraceae spirochaetales. The genus Leptospira consists of 2 species of the pathogen L. interrogans and L. biflexa which is saprophytic. Leptospirosis is caused by the bacterium Leptospira Interogans, rodent-borne mainly by rats.

Transmission of this disease could be through mice, pigs, cows, goats, horses, dogs, insects, birds, hedgehogs, bats and squirrels. The disease can strike all ages, the majority aged 10-39 years, then maybe age as risk factor.

The death rate due to leptospirosis is high, reaching 40-50 percent. Mild infection is estimated at 90 percent of cases. Children under five, the elderly and patients who have low body resistance has a high mortality risk. At the age of 50 years, the risk of death could reach 56 percent. In patients with jaundice who have suffered liver damage, have higher risk of death.

Leptospirosis disease remains as public health disease issues, especially in tropical and subtropical developing countries.

The spread of Leptospira bacteria usually enters the body through cuts or skin abrasions, and sometimes through the membranes in the mouth, nose and eyes. Various types of animals can carry leptospira bacteria in their kidneys.

Rat urine carried by floods and then enter the human body through the injured skin surface, mucous membranes of the eyes and nose. Can also through contaminated food or drink leptospira-infected mice urine. So far the rats are breeding grounds and also the main spreaders of leptospirosis. Some other animals like cows, goats, sheep, horses, pigs, dogs can develop leptospirosis, but the spread potential to humans is not as big as rats. Leptospirosis is not directly transmitted from patient to patient.

Who face the danger is whom frequent touching animals or water, mud, soil and plants that have been contaminated with animal urine. Some jobs are more dangerous jobs such as farmers, veterinarians, abattoir workers and farmers of sugarcane and bananas. Various craze involving contact with water or contaminated soil can transmit leptospirosis like camping, gardening, wandering in the woods, rafting and other water sports.

Eating food or drinking contaminated water is also sometimes as the delivery cause.

Transmission

Contact with urine-contaminated animals through :
1. Mucous membranes.
2. Skin wounds and submerged in water contaminated with leptospira.
3. Digestive tract.

Symptoms

The incubation period for leptospirosis 2-26 days. Once in the bloodstream, these bacteria can spread throughout the body and cause liver and kidney disorders in particular. In the kidney, the bacteria can cause kidney inflammation and tissue death through kidney failure. Liver disorders also may occur that can cause jaundice (yellowish skin). If leptospira in the muscle, it can cause swelling, tissue damage to the disruption of capillary permeability of blood vessels, whereas pulmonary disorders that often happens is coughing up with blood.

Leptospirosis infection have symptoms that vary widely even sometimes almost has no symptoms, so frequent errors in diagnosis. Nearly 15-40 percent of infected patients had no symptoms but have positive laboratory tests.

The incubation period of 7-12 days with a range of 2-20 days. About 90 percent of patients with mild jaundice, severe jaundice 5-10 percent which is often known as Weil's disease. Travel leptospira disease consists of 2 phases, namely septicemia phase and immune phase. Transition period for 1-3 days after the condition of patients improved.

The initial phase is known as a septicemic phase or leptospiremic because the bacteria can be isolated from blood, cerebrospinal fluid and most body tissues.

The initial phase about 4-7 days, characterized by nonspecific flu-like symptoms with some variations. Clinical manifestations of fever, chills, fatigue and pain, especially the ribs, back and stomach. Other symptoms are sore throat, cough, chest pain, vomiting of blood, rash, frontal headache, photo phobia, mental disorders, and meningitis.

Symptoms :
1. The incubation period between 2 to 26 days (average 10 days).
2. Begins with fever, chills, sore limbs and headaches. These symptoms involve more than 70% to 100% patients.
3. Cough with phlegm (25% - 35%).
4. Do not have energy, vomiting and diarrhea (50%). Sore joints, bones, throat and stomach is a symptom that often occurs.
5. Inflammation of the lining of the eye.
6. Between 7% to 40% of patients may experience muscle pain, enlarged spleen or liver, swollen glands, sore throat, muscle hardness, changes in lung sounds or a rash.

Leptospirosis infections are usually followed by a group consisting of Weil's syndrome, Spiroketal Jaundice (jaundice) and Kanikola Fever.

There are further leptospirosis patients developing severe illness, including Weil's disease which is kidney failure, jaundice (yellowing of the skin that indicates liver disease) and bleeding into the skin and mucous membranes. Swelling of the lining of the brain and bleeding in the lungs can occur. Most terminally ill patients who require hospitalization and even severe leptospirosis can sometimes be fatal.

Weil syndrome

Weil syndrome is a more severe form of leptospirosis that causes persistent fever, decreased awareness and reducing the ability of blood to clot, causing bleeding in the network. The early symptoms of Weil's syndrome is lighter than leptospirosis.

Blood tests showed anemia. On day 3 to day 6, there are signs of kidney and liver damage. The patient will feel pain during urination or bloody urine. Liver damage is usually mild and will recover completely. Patients who did not experience jaundice will usually recover. Showed jaundice and liver disorders will increase the risk of death to 10% in patients over 60 years.

This disease can slow healing. Patient will get sick like chronic fatigue for months. There is also a headache or depressed. Occasionally the bacteria can persist in the eyes and causes chronic eye inflammation.

Diagnosis

A doctor may suspect leptospirosis in an asymptomatic, usually 1-2 weeks after exposure. Confirmation of diagnosis is usually by a blood sample which will state whether exposed to these germs. The diagnosis is generally required 2 times blood sample with interval of 2 weeks. Occasionally the bacteria can be cultured from blood, cerebrospinal fluid and urine.

Diagnosis :
1. Examination of white blood cells.
2. Urine analysis also showed remarkable decision.
3. Between 40% of patients had slightly elevated liver enzymes.
4. Diagnosis is usually made by serologic tests (antibodies).
5. Germs can be clearly observed with dark field microscopy, silver stained or fluorescent microscopy.
6. Unlike Treponema pallidum, Leptospira can multiply through the blood and water spine. It usually multiply slowly and future diagnose required.
7. 50% viscosity succeeded in separating bacteria from the blood.
8. Examination of urine is usually positive in the second week after the attacks and lasting up to 30 days.

What are complications of leptospirosis?

Complications depend on the course of the disease and its treatment. Approximate condition of the patient in the future depending on the light or the severity of infection.

At the heart : a yellowish occurred on day 4 and 6. Beating irregularly, the heart swells and heart failure that can cause sudden death.
In the kidney : renal failure that can cause death.
In the lungs : coughing up blood, chest pain, and shortness of breath.
Bleeding : bleeding caused by damage to blood vessels in the respiratory tract, gastrointestinal tract, kidney, genital tract and the eye (conjunctiva).
On the pregnancy : miscarriage, prematurity, birth defects and stillbirths.
In the brain : there are germs in the brain (meningitis).
There are no any replies of Jarisch-Herxheimer test if given penicillin.

Care :
Leptospirosis is commonly treated with cephalosporins, penicillin, doxycycline, chloramphenicol, and erythromycin. Because the testing takes time and disease can be severe, your doctor may start giving antibiotics prior to confirming the diagnosis with tests. Treatment with antibiotics is considered the most effective if started early. In severe cases antibiotics given intravenously (through a vein).

Prevention :
- Personal Hygiene.
- Use of PPE (personal protective equipment).
- Environmental Sanitation.
- Rodent control.
- Vaccination of animals.
- Maintaining a healthy animal.

Avoid visiting the calm water, mainly in the area of equatorial climate. If you are exposed to a risk area, taking doxycycline medication may reduce the risk.

If you fall ill in the weeks after possible exposure of animal urine in contaminated environment, it is important consult with your doctor.

Note :
Since there are many different types of Leptospira bacteria, patients might be hit by another species and gets leptospirosis again. Leptospirosis can be transmitted to others such as transmission through sex or mother's milk, though rarely. Leptospira germs can be transmitted through urine for months after exposure.

The importance of Life Insurance

2011-03-07T06:41:00.000-08:00

Insurance is indemnity agreement between the insured and the insurer which the contract called insurance policy. Insurance contract is very specific because only signed by the insurer (insurance company), but bind the insured. The contents of the agreement is generally prepared by the insurance company into something that is standard. Therefore make sure all the guarantees that we want, listed in the policy.

Definition of Insurance, really needs to be understood that there are legal commitments therein to protect and ensure the rights and obligations of the insured and the insured as the person to run the company according to agreement.

Why we need life insurance?
"Life is full of uncertainty, but death is one thing that definitely will happen in our lives without a doubt"

According to research, at this time human could be expected to live to age of 120 years, even every year around the world may be about 3000 people celebrated the anniversary of 100 years of age, but not everyone can live that long. Most of us may die prematurely in a workplace by work accident, road accident or because they hurt. The problem is the risk of death is not just the psychological impact of losing a beloved one, even further the risk of death can also lead to financial losses in the event of the breadwinner. For most families in general, death of the breadwinner, then they will inevitably experience financial difficulties in line with the cessation of family income.

For those of you who want to avoid unpleasant financial situation, then the answer is to anticipate the risk of financial loss by buying life insurance, which will pay money for damages when an insured person dies. Anticipating financial losses by purchasing life insurance is important for every person who has dependents, especially for those who are married especially if the spouse has no income, plus they already had children. Took life insurance as part of your family financial planning means ensuring that people whose lives depend on you financially will not experience financial hardship if you die.

But buying life insurance are also not as easy as it should. Lots of life insurance products currently offered in the market, unfortunately some of them do not provide maximum benefits in accordance with the money we spend.

Who needs life insurance?

Anyone who has dependents, or if your family still depends on your income. As a result, if you die and automatic income was also suspended, then that person will find it hard to provide for his life. Most income protection needs arising from the risk of death when someone was married and had children. At the time, the death of a parent or main breadwinner can cause a very serious financial losses. It needs appropriate action to undertaken risk aversion which available in time whenever the risk of death occurred and also be able to replace income lost due to death of the breadwinner. The more dependents, the greater the amount of money required coverage.

Besides life insurance should also be taken by whom have mortgage debt obligations, especially large amounts of debt with long-term payments such as mortgage or home loan mortgage car loan. Life insurance is taken in particular designed to guarantee repayment of loans that can cover the remaining debt, if you death. Thus if there is risk of death, you should not leave the family or spouse and your children in debt payment obligations.

How much money coverage?

Ideally the sum insured provided by the insurer should be able to replace the previous income so that family expenditure could be covered. However, to achieve the ideal condition, you certainly needed some insurance money which can be very large, consequently the more expensive premium payments. Inevitably we must be realistic in determining the sum insured.

For example, for a young family, it needs protection as early as possible and not have to force yourself to take insurance with a large sum. But the value should be based on the minimum for his family in order to survive. For example, someone recently married with the man who predicted that has a capital of USD 20 million, his wife can support herself by starting a business that until his death. Therefore, the man can buy insurance with sum assured of USD 20 million. So no need to set aside income for insurance. Do not forget, there are many other household needs that must be financed, not to mention the need to save for future needs.

Insurance coverage can also be purchased in stages, so do not need all at once. Example: back on top, before having a child, young family had enough money to take insurance with coverage of USD 20 million. After had children, then re-evaluated what their family needs in the long term after the child big, for example the next 18 years or until the child finished his schooling. Thus the men had enough to buy insurance for the child needs in that period. Then the next child is born, they need to calculated how much the family needs right now after the birth of the second children, at least they must had enough insurance money to help couples or to be able to support his family. For a young family, the death of one of them means that their partner should try to maintain family living standards on, at least until the youngest child can be financially independent. So a realistic amount of insurance money should exist, although not able to meet all the needs of the household registration in advance.

The amount of insured money depends on several factors such as age, number of dependents, regular income, and how much debt they own. A young family may need a larger sum, than couples who are 40 or 50 years where the possibility of their children are independent. When the children can have their own income, the necessity of parents to have some life insurance money on the wane. At this time the sum assured can be reduced.

Methods of calculating the sum insured is diverse, but generally divided into 3 methods of calculation, namely :

1.Human Life Value Method : in this method the absolute sum is calculated based on monthly income multiplied by the time of the available funds to sustain life, regardless of the interest or growth factor if the sum assured of funds saved in banking products.

2.Income Based Value Method : This method calculates the sum assured by calculating the amount of interest or return if the money received is stored in insured banking products.

3.Value-Based Financial Needs Method : a large sum to have a range of at least equal to the amount of money to particular need at this time (present value) multiplied by 150%. While the maximum sum insured is money in the future (future value) multiplied by 80%.

This method is absolutely combined with the investments made (either monthly or yearly) to achieve financial needs in the future (future value) of financial needs. This method can also be used for those who already have a very large monthly income so that the two other methods mentioned above can not be used anymore because it will give the large amount of insurance money (unlikely sum approved by the insurance company).

How many types of life insurance?

There are several types of life insurance. So you have to buy the best that suits your needs. The types of life insurance :

1. Life Term Insurance is a type of life insurance where the insurance contract lasts for a certain period. In the event of risk of death for insurance contracts in progress, then the insurance coverage will pay some money to your heirs. However, if there is no risk of death during the insurance contract took place then you do not get any cash neither sum assured or refund of premiums that already paid. There is no element of savings and investments in term insurance. Because life term insurance is taken only for protection.

2. Two function Life Insurance (endowment), this type of life insurance is similar to life insurance deposits that can be taken over a certain period. The difference, in order to ensure that the amount of cash could be a number of sum assured or can paid with the following investment results. A number of the cash value will still be given, no matter happens the risk of death or not. What is certain if there is risk of death then the insurance company will pay the sum assured, if it does not happen the risk of death, the insurance company will also continue to pay some cash value at the end of the insurance contract. Thus, because the pay is not only protection but the following deposit savings, then the life insurance premiums be more expensive than Life Term insurance.

3. Lifetime Life Insurance (whole life insurance), the same as two function life insurance that combines elements of savings and investment protection with a single life insurance, but the period or life insurance contracts (usually lasts till 99 years old). As a result, premiums for life insurance is more expensive than life term insurance, and also more expensive than two function life insurance premiums. Because besides getting some cash following the results of development funds, profit protection also lasts for a lifetime.

What type of life insurance that you should take?

Life insurance is actually purchased in order to anticipate the risk of unpaid living needs for a person or a family because of interruption of income due to death of family breadwinner. Thus it is the nature of life insurance protection and not as a savings. Saving only as a supplement. So if anyone offers life insurance as well as saving money, it is not appropriate.

Therefore, life insurance as protection should have a simple concept and easy to understand, the insurance company guarantees to pay a sum assured, if there is risk of death in the duration of insurance contract. If it does not happen the risk of death during the ongoing insurance, no insurance money is paid.

Also choose a life insurance with the most flexible conditions, with low insurance premiums and amount of insurance money that can be tailored to your needs, which vary with time. Avoid buying a life insurance policy that you do not understand because the various calculations of numbers of illustrations and investment and other benefits hodgepodge that actually make you more confused.

Then what kind of life insurance should be selected?
Finally, to meet the needs of protection with the cheapest premiums and other considerations based on the above, then the life term insurance is a type of life insurance that best meets the financial needs of the family against the risk of financial loss due to death. Make most of the people or families in general, where the allocation of income must be divided between the necessities of life, savings, future investment and protection, then the amount of protection should be granted not too big. Therefore, life term insurance is the cheapest premium payments compared with other types of life insurance protection but with a maximum benefit could be the best option.

Sometimes I'm confused, why there is a problem of perception about insurance, which is hard to claim the right of the insured, agent hard to contact when needed and many other things that provide trauma for you to participate in life insurance programs that in fact is very important for the future.

Maybe I will describe below. It will give you a little more guidance before making a decision to participate in life insurance programs.

In my opinion there are 3 issues that are highly complex :
1. Company Strength Problems
Society in general, many people did not examine the strength of insurance companies, many people buy insurance because of forced.

The company financial is important to know the insurance company ability to pay of customers claims. As we save money in the bank then it is advisable to examine the bank financial condition to handle the management of customer funds.

With the existence of at least 2 aspect which are competence and integrity, then there is hope for minimized potential problems.

2. Agents who are not professional
Many customers are disappointed because the agents who are not professional supported by lack of attention to customer care.

Example:
Agent A provides information for the prospect about the benefits of a, b, c, d, e, f, while the last deal that are listed in the policy only the a to c and the customer does not check the insurance policy, in the future if customers want to claim the benefit d to f, they will not be granted.

Lots of customers who do not check insurance policies after the purchase that led to misunderstanding between the company and the customer.

There are also agents who do not pay the premium to insurance companies. Therefore, 'YOU MUST CAREFUL IF YOU WANT TO GIVE PREMIUM PAYMENT TO AN INSURANCE AGENT'.

3. Customers who are not honest when give information
In insurance, honesty demanded in filling customers health data. Dishonesty in charging data can result in a cancellation payment of claims.

Example:
Mr.Johndoe on first month diagnosed with heart disease. Then on third month Mr.Johndoe buy life insurance by lying about his health and supported by fake medical check ups which do not provide the heart check up result (medical check ups / does not depend on the premium paid)

If Mr.Johndoe died within 2 years, insurers have the right to conduct investigations for 3 months in the hospital, office and family, if the data obtained that on first month Mr.Johndoe got heart disease then his family will not get anything even only 1 penny will not be paid.

Choosing a good insurance agent is crucial. A good insurance agent will help you get the right insurance solutions and make your insurance experience enjoyable. Remember that your relationship and your family relationship with insurance company are long term, even beyond the age of your life. Insurance agents are intermediaries who represent you in front of insurance companies and representing insurance companies in your presence.

Here are three tips to choose a good life insurance agent :

1. Choose an agent with integrity

Integrity of an insurance agent is much more important than everything else. Many features of the insurance policy is quite complex and not all are equally important. Some agents recommend explain certain products for no other reason except to get a higher commission. Not a few insurance agents who "hit and run", only good when selling but not so concerned with after-sales service.

Find someone who will act as your partner, to provide additional information, propose alternatives, and not force you to buy the product. If you get too much pressure to buy quickly, move on to someone else.

One of the best ways to get a good agent is to ask for references from friends, family members, colleagues or other professionals who have worked with you (tax consultants, bankers, notaries, etc). When the insurance agent came to you, ask for references of customers whom he have served. You can check the track record of the agent's customers.

2. Choose a professional agent

You need to ensure that the agent that you choose has the expertise to meet your needs :
- Check the license.
Life insurance agents must be licensed to sell insurance products. Agents who sell unit-linked insurance products must have additional special license. To obtain these licenses, an agent must pass a competency exam in number in the field. Agents that are not licensed to deliver product information will give inaccurate or misleading information to customers.
- Know agent's specialization.
Some insurance agents have specialize in traditional life insurance, while others might better explore on the unit-linked life insurance, group insurance or health insurance.
- Know agent's qualification.
Professional titles such as Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Certified Financial Planner (CFP) and Life Underwriter Training Council Fellow (LUTCF) indicates that the agent has completed advanced training, pass a rigorous exam and serious with the development of the profession . An agent who becomes a member of the Million Dollar Round Table (MDRT) means he has entered the elite ranks of top agents. They must have a long list of customers, experience and follow a strict code of professional conduct.

3. Choose from several agents.

If necessary, see at least two insurance agents in order to do the comparison in terms of qualifications and character of the agent and the suitability of the products offered. Nothing can replace direct contact in judging a person. A good agent will diligently listen and ask questions about your situation and help arrange the right insurance solutions for your specific needs. If you are not comfortable with your agent after face to face, or you're not sure she provides the services you want, find another agent.

7 Ways to stimuli your Sexual Life

2011-02-28T05:38:00.001-08:00

Like a car, sex drive is a wheel that will take you to the destination. If sex drive dies, the climax would not be achieved.

Loss of sexual desire or libido, in both men and women could be the impact of several problems, including anxiety, disease, heavy alcohol addicts, and lack of self esteem. Loss of sexual desire can be a burden for households, not even a few that ended in divorce.

There are several ways to increase libido in both men and women for hot sex life back.

1. Talk

Talk to your partner about the problem decrease in sexual desire that you experience. You can communicate about what your likes and dislikes, both in matters of the bed and outside bed, can add intimacy.

2. Try a new style

The next solution is to try new sexual positions or communication with a partner about sexual fantasies that arouse your sex drive.

3. Use reference sources

Take advantage of books and erotic videos to help increase sexual arousal and as a means for learning the new techniques you might want to practice in the bedroom.

4. Perform relaxation technique

Bath or sit for a while before having sex. It can help men and women are more relaxed, which can help alleviate any anxiety that may cause decreased libido.

5. Activities intimacy amplifier

Try to take the time to sex and intimacy with your partner every weekend. Timed intercourse can push you to make relationships a priority. In the end, can increase sexual desire.

6. Exercise Routinely

Add a schedule of regular exercise in your daily or weekly schedule. Sport can be used as a way to improve self-image and increase feelings of happiness, which is good for increasing libido.

7. Consult to your sexual doctor

Talk to your sexual doctor about the lack of sexual desire that you experience. You may have an underlying medical problems for decreased libido, such as testosterone or estrogen deficiency, or treatment effects that can lead to low libido.

Kawasaki : Cause, Symptoms, Complications, Diagnosis, Treatment, Prognosis

2011-02-22T06:24:00.000-08:00

Beware if your toddler have high fever for a long time. Maybe your child has Kawasaki disease. How to cope with and prevent this disease?

The first time I hear the word of Kawasaki a few days ago, I immediately thought of one brand of motorcycles, but this had nothing to do with motorcycles. This disease name is Kawasaki syndrome or syndrome Lymph Nodes Mucocutaneus, Poliarteritis Infantil is a non-specific disease, without a specific infectious agent, which attacks the mucous membranes, lymph nodes, lining of blood vessels and heart.

Cause

Kawasaki syndrome or Kawasaki disease is a disease that attacks children aged 2 months to 5 years and 2 times more common in boys. This disease was first discovered by Dr.Tomisaku Kawasaki from Japan in 1967, and was then known as mucocutaneous lymphnode syndrome.

Doctors who can handle this disease is still small. Kawasaki disease attacks the body's immune system and if not treated promptly, can cause complications to the heart that can cause swelling of blood vessels of heart and heart damage. The appearance of this disease also can fool the eye so that it can diagnosed as measles, allergy medicines, viral infections, or even the mumps disease. The disease is more frequently attacked the Mongol race which is primarily attacked a toddler.

Symptoms

The symptoms of Kawasaki disease :

- Fever up and down, but usually above 40 degrees Celsius, are settled (over 5 days) and do not respond to acetaminophen or ibuprofen in normal doses. Fever may last for 1-2 weeks, if not treated at all, even a fever can last 3-4 weeks, but if given proper treatment quickly, within 2 days of fever can also be dropped.
- Fussy, looking sleepy.
- Sometimes there is abdominal cramping pain.
- Skin rash on the trunk and around the diaper-covered area.
- A rash on the mucous membranes (like lining of the mouth and vagina).
- Throat appear red.
- Red lips, dry and cracked and peeling even bleed.
- The tongue looks red (strawberry-red tongue).
- Both eyes became red, without any discharge.
- The palm of the hands and feet appear red, swollen hands and feet.
- The skin on fingers and toes to peel (on days 10-20), usually starts from the skin of fingers or toes.
- Swollen lymph nodes on neck.
- Painful joints (atralgia) and swelling, often symmetrical (on the left and right sides of the body).
- His heart rate faster than normal.
- It sometimes happens complaints of breathing difficulty.

Complications

Kawasaki disease has no known cause, so it can not be avoided. However, this disease should be given treatment immediately, because it can cause complications to the heart that can cause swelling of blood vessels of heart and heart damage. It could even cause a heart attack in young anak. Complications to the heart can be avoided if treatment is not more than 1 week after the child had a fever.

Approximately 20-40% of patients experienced cardiac complications, which usually occurs in week 2-4 :
· Inflammation of the coronary arteries (arteries that carry blood to the heart).
· Aneurysms (widening of part of the coronary arteries).
· Pericarditis (inflammation of the heart sac).
· Acute Myocarditis (inflammation of the heart muscle).
· Heart failure.
· Death of heart muscle (myocardial infarction).

Other complications :
· Unusual rash of anterior uveitis.
· Pain or inflammation of the joints (especially the small joints).
· Non-infectious inflammation of the lining of the brain (aseptic meningitis).
· Inflammation of gall bladder.
· Diarrhea.

Most will recover, but others are forced to live with heart defects caused by disrupted coronary blood flow. A small number will die because of heart damage. This disease occurs during the winter, but can occur throughout the year.

Diagnosis

It should be noted, if there is high fever in children until they reach 40 degrees Celsius and does not go down for 5 days followed by 4 to 5 symptoms, can be sure the child is suffering from Kawasaki disease. The disease is also not proved contagious. In untreated children, fever can last for 1-4 weeks without a break. Give antibiotics do not help. Approximately 2-3 days after fever, other symptoms began to appear in stages like red spots on the body that looks like measles. However, cough and cold symptoms which are dominant in measles is usually mild or nonexistent in Kawasaki disease.

Diagnosis in case of fever for more than 5 days and found 4 out of 5 the following description :
- Skin rash.
- Tools of motion (arms and legs), red and swollen.
- Red eyes.
- Changes in the lips and mouth.
- Swelling of the lymph nodes.

Inspection is usually done by :
· ECG (echocardiography), can show signs of myocarditis, pericarditis, arthritis, aseptic meningitis or coronary vasculitis.
· Complete blood count (indicating increased number of white blood cells and anemia or reduced number of red blood cells); subsequent blood tests showed increased platelet counts.
· Chest X-rays.
· Analysis of urine (may reveal protein in urine).

Treatment

Early treatment can significantly reduce the risk of damage to the coronary arteries and accelerate the recovery of fever, rash and uncomfortable. Over the past 1-4 days is given high doses of intravenous immunoglobulin and high doses of aspirin by mouth. After the fever down, , give aspirin in lower doses, given over several months to reduce the risk of damage to the coronary arteries and blood clot formation.

How to handle children with Kawasaki disease :
1. Children with Kawasaki disease should be hospitalized and monitored by a pediatrician and cardiologist for children.

2. Giving immunoglobulin.
This is the standard treatment should be administered to patients to prevent complications to heart disease. Giving immunoglobulin is very effective to reduce fever within 24 hours after administration and to prevent complications to the heart if the fever has not exceeded 1 week.

3. Giving aspirin.
Aspirin also plays an important role, usually after the fever down, remains patient is given aspirin to prevent blood clotting.

4. Aspirin also plays an important role, usually after the fever down, remains patient is given aspirin to prevent blood clotting.

At first vessel dilation can occur, and can occur narrowing or blockage of the inside. As a result blood flow to the heart muscle disturbed so that it can cause damage to the heart muscle, known as myocardial infarction. Examination of the heart becomes very important, including ECG or echocardiography (cardiac ultrasound). Sometimes ultrafast CT scan, MRA (magnetic resonance angiography) and cardiac catheterization is required in severe cases. Laboratory tests for this disease is necesarry.

Drugs that must given is immunoglobulin by intravenously for 10-12 hours. Drug plasma obtained from blood donors is effective to relieve symptoms of Kawasaki disease and reduce the risk of heart damage. If the drugs do not work, sometimes required coronary bypass surgery or even, though very rarely, a heart transplant. Death can occur in 1-5 percent of patients who are generally too late to treat and the peak occurred at 15-45 days after the initial onset of fever.

After recovering, remains to be done ECG or cardiac examination a few weeks to monitor heart conditions, if the result is good for some time, 1 or 2 years still have to conduct an ECG test to ensure heart health. Large aneurysms treated with aspirin and other anti-clotting (like warfarin). A small aneurysm is treated with aspirin.

In patients who had clinically fully recovered, he still can have coronary artery abnormalities in the inner layer that facilitates the occurrence of coronary heart disease in later young adulthood. If found in acute coronary heart attacks in young adults, may need to consider the possibility of Kawasaki disease ever exposed while still a child.

If the child is suffering from influenza or chicken pox, to reduce the risk of Reye's syndrome, preferably for a while given dipiridamol, not aspirin. Presumably we all need to be aware of this disease to avoid further casualties.

Prognosis

Complications to the heart usually starts happening after days 7-8 since the inception of a fever. If no cardiac complications occur, usually there will be a perfect recovery. Approximately 1-2% of patients die, usually due to heart complications, 50% of them died in the first month, 75% died in the second month, 95% died in the sixth month. But death can occur 10 years later and sometimes suddenly.

Kawasaki disease can also damage the heart valves (especially mitral valve) that can cause sudden death a few years later. The possibility of a recurrence of this disease is about 3 percent.

Small aneurysms tend to disappear within 1 year, but the coronary arteries remain weak so that a few years later arise heart abnormalities.

Although it has been cured, the risk for relapse remains, can even cause sudden death many years later. Remember, delays in handling resulted in a fatal cardiac complications or even cause death.

Enterobacter sakazakii : History, Symptoms, Contamination, Anticipation

2011-02-16T06:34:00.000-08:00

Enterobacter sakazakii was first discovered in 1958 within 78 cases of infants with meningitis infection. So far, also reported several similar cases in several countries. Although this bacterium can infect at any age, the greatest risk of exposure is the age of the baby. Large increase in cases reported in the U.S. Neonatal Intensive Care Units (NICU), several hospitals in England, Holland, U.S., and Canada.

In the United States the incidence of E. sakazakii infection that have ever been reported is 1 per 100,000 infants. An increasing incidence rate to 9.4 per 100,000 in infants with very low birth weight (less than 1.5 kg of body weight). Enterobacter sakazakii is a facultative anaerobic gram-negative bacteria, in the form of coliform (kokoid), and do not form spores. These bacteria included in the family Enterobacteriaceae. The organism is known as the yellow pigmented Enterobacter cloacae. In 1980, the bacterium was introduced as a new bacterial species based on differences in the DNA hybridization analysis, biochemical reactions and antibiotic sensitivity test. DNA hybridization showed E. sakazakii was associated with 2 different species of the genus with correlation 53-54 percent or 0.53 until 0.54, namely Enterobacter and Citrobacter.

Some researchers clarify the criteria for the taxonomy using more sophisticated way, namely by f-AFLP, automated ribotyping, full-length 16S rRNA gene sequencing and Inter DNA hybridization. The results obtained are alternative classification with the findings of a new genus, namely Cronobacter consisting of 5 species.

The death rate due to Enterobacter sakazakii infections reached 40 percent to 80 percent. Some 50% of patients who reported suffering from infection of E. sakazakii die within a week after diagnosis. Until now there has been no determination of infectious dose of E. sakazakii, but at 3 cfu/100 g can be used as an initial estimate of dose of infection.

Until now not many people know about this harmful bacteria virulence and patogenity power. Materials enterotoxins produced by several types of bacteria strains. By using tissue culture, known enterotoxin effects. 2 types of bacteria strains that have the potential to cause death, while several other strains of non-pathogenic or harmless. This is what might explain why so many have been found contaminated milk, but not many casualties were reported infected with the bacteria.

Although very rare, infections because these bacteria can cause a very dangerous disease to life-threatening, include neonatal meningitis (infection of the lining of the brain in infants), hydrocephalus (big head because of excessive cerebrospinal fluid), sepsis (severe infection), and necrotizing enterocolitis (severe damage to the gastrointestinal tract). E. sakazakii can cause various kinds of infections including bacteremia, lower respiratory tract infections, skin and soft tissue infections, urinary tract infection, infection in the stomach, heart inflammation, arthritis, osteomyelitis, and eye infections. While in some cases reported urinary tract infection. E. sakazakii infection showed that these bacteria can cause meningitis and inflammation of the intestines in infants.

Enterobacter sakazakii is a gram-negative pathogens which are very deadly in newborns, age 0-6 months. While the bacterium E. Sakazakii is a threat to infants aged 6-12 months. In general, fatality case rates or life-threatening risk to range between 40-80 percent of newborns who received diagnosis of severe infections due to this disease. Brain infections caused by E. sakazakii can cause myocardial or brain abscess (brain damage) with the formation of cysts, neurological disorders and severe developmental disorder sequelae. The group of infants who have the highest risk of E. sakazakii infection are neonates (new born up to age 28 days), infants with disorders of the body systems, infants with low birth weight (LBW), preterm infants, and infants born to mothers who suffered from human immunodeficiency virus (HIV).

Symptoms that may occur in infants or children include diarrhea, bloating, vomiting, high fever, the baby looks yellow, decreased consciousness (lazy to drink, do not cry), suddenly blue, tight spasm. Premature babies, low birth weight (less than 2,500 grams) and patients with immune disorders are those individuals most at risk for these infections. Although rarely pathogenic bacteria also can cause bakterimeia and osteomyelitis (bone infection) in adult patients. 12 types of strains of E. sakazakii is able to survive at a temperature of 58 degrees Celsius in warming rehydration formula.

Contamination

Enterobacter sakazakii is not the normal microorganisms in the digestive tract of animals and humans. Allegedly, soil, water, vegetables, rodents, and flies are the source of this bacterial infection. These bacteria can be found in several food industry environment, aqueous environment, moist soil and sediment.

The occurrence of bacterial contamination can be started when dairy cows milked from the nipple. Nipple hole has a small diameter that allows bacteria to grow in the vicinity. The bacteria is carried on with the milk when milked. However, application of technology can reduce pollution levels at this stage with the use of milking machine, so that the milk comes out of the nipple is not in contact with air.

Contamination of milk by microorganisms can further occur during milking, handling, storage, and others pre-processing activities. Milk production chain requires a sterile process from upstream to downstream so that the bacteria do not get a chance to grow and thrive in milk.

Unsterile milking equipment and storage area that is not clean can cause contamination of milk by bacteria. Milk requires storage in a low temperature to avoid bacterial contamination. The air contained in the environment surrounding the processing is a media that can carry the bacteria to contaminate the milk. Milk processing is highly recommended to be done behind closed doors.

Humans who are in the process of milking and milk processing can be a cause of bacteria in milk. Hands and other limbs must be sterile when milking and milk processing. In fact, human breath when the process of milking and milk processing can be a source of emergence of bacteria. Dairy cows and ranchers who are in a farm must be in good health and clean so it will not contaminate the milk. The process of milk production at farm level requires application of good farming practice as it has been applied in developed countries. These bacteria are in the digestive tract and is found in products like infant formula, cheese, meat, grains, and spices. Bacteria E. sakazakii can grow optimally at 30-40 degrees Celsius temperature range.

Infectious diseases due to E. sakazakii could be fatal if the patient is late to diagnose and can cause side effects such as cerebral palsy. If taxable to the brain, the child would be disabled for life. E. sakazakii quickly get into the brain, because brain barrier is not good. Thus, poor prognosis if not treated quickly and if late known. Between the blood to the brain is the barrier (called the blood brain barrier). This barrier should have been strong. But in infants or young children, especially with low body resistance, the barrier will loose. Thus, the bacteria can penetrate directly into the brain. Unlike with adults, very difficult to be infected because germs cannot get into the very strong brain barrier.

Anticipation

From the various studies and experiences in several countries and the World Health Organization (World Health Organization / WHO), United States Food and Drug Administration (USFDA) and some other developed countries fact, have established that powdered infant formula is not commercially sterile products.

The liquid formula is ready to food is considered commercially sterile products due to the heating process is sufficient. Thus, in the NICU infant care, using the U.S. FDA recommended changes to the provision of infant milk formula prepared liquid food for patients with premature babies prone to infection. Unfortunately in Indonesia, there are a lot of dairy products and relatively expensive. To use at home, baby milk formula is generally prepared with minimal heating process. Usually, only milk formula mixed with warm water temperatures less than 70 degrees C, which is not enough to kill bacteria.

Other recommendations that must be considered to reduce the risk of infection is how the presentation is right? Only in small amounts is present at a correct time for drinking to reduce the quantity of bacteria and reduce infant formula contaminated time with room air. Minimize hang time or the time between room air contact with milk. The recommended time is no more than 4 hours. The longer time will increase risk of microbial growth in infant formula.

Another important thing is way of presenting the infant formula for babies, according to the instructions in cans or general instructions. Increased knowledge of parenting, baby nurses, and other clinical practitioners on the preparation procedure, good and right formula feeding must continue to be done.

Regardless whether or not the accuracy of these findings, the government should check this case in the health department data and must act quickly, appropriately before it happen a consuming anxiety and victim of Enterobacter sakazakii. While parents remain vigilant and no need to worry too much because these findings case have also been reported by the U.S. FDA, but not exceptional cases. This is because probably mostly non-pathogens or germs that are harmless. But do not sacrificed many children just because of the delay anticipated circumstances.

Tips to be done to avoid or overcome the contamination of E. sakazakii, one of them is the manufacture of infant formula milk :
1. Wash your hands before making milk.
2. Read the instructions on the milk packaging. How to make the milk must be correct and appropriate.
3. Water used to make milk should be boiled first.
4. Do not use water from dispenser because the water dispenser is not boiled.
5. After boiling, cool the boiled water for 30 minutes until the milk temperature drop near 70 degrees C.
6. Clean the used bottle with shake it with boiling water.
7. Into the 70 degrees C water temperature, add the milk formula in accordance with the recommended dosage.
8. Whisk until dissolved.
9. Chill until lukewarm (about 37 degrees C) in order to be given to infants.
10. Milk should be consumed immediately, should not be allowed more than 4 hours.

Boiled milk which is directly presented must be cooled first. Then left for 10-15 minutes for the temperature drop, no less than 70 percent from boiling temperature. Manufacture of infant formula should not be excessive. That is, provided according to baby ability to taste milk. Prepare as much milk as your baby can drink in accordance with the recommended dosage on the label. If indeed, better discarded and not saved for hours. Time of waste milk must discarded after two hours until four hours.

Bacteria that can contaminated milk :
- Clostridium botulinum.
- Enterobacter sakazakii.
- Salmonella agona.
- Salmonella anatum.
- Salmonella bredeney.
- Salmonella Ealing.
- Salmonella london.
- Salmonella Tennessee.
- Salmonella Virchow.

Milk can get contaminated from the hospital spesific bacteria like :
- Citrobacter freundii.
- Enterobacter sakazakii.
- Leuconostoc mesenteroides.
- Escherichia coli.
- Salmonella isangi.
- Salmonella saintpaul.
- Serratia marcescens.

Until now, the World Health Organization (WHO) has not yet require WHO member countries conduct regular checks of Enterobacter sakazakii, because in 42 years, only 46 cases of death reported worldwide.

Human Papilloma Virus :Characteristic, Pathogenesis, Prevention, Circumcision

2011-02-08T06:50:00.000-08:00

Human papilloma virus infection

Human Papilloma Virus infection is viral infection caused by Pappiloma virus that specifically infects the epithelium layer in the skin and mucous membranes. These infections may not show symptoms, produce warts, or in the form of malignant neoplasia. Condyloma akuminata is a manifestation of epidermotropic of human papillomavirus (HPV). More than 100 types of HPV can be isolated at this time. Many of them have been linked directly to increased neoplastic risk in men and women. HPV infection is most common in young adults (18-28 years). More than 95 percent of cervical cancer is caused by a virus known as Human Papilloma Virus (HPV).

Virus Characteristics

Characteristics of HPV is a virus with the family Papillomaviridae. This virus isohedral shaped with a diameter of 55 nm. The composition of this virus is 90% protein and DNA by 10%. HPV is a virus that have double chain circular DNA with 5-8 genes and the virus is not sheathed. This virus infects cells and causes the state of flattened epithelium hyperplasia of lamellar epithelial cells. Characteristics of this virus are capable of stimulating DNA cell, significantly cause cancer in humans, such as cervical cancer. Several types of HIV which commonly known is the HPV types ,16 and 18 types are more oncogenes, and types 6 and 11 which are benign.

Pathogenesis

Incubation period of HPV infection is 3-4 months (range 1 month to 2 years). All types of flat epithelium can be infected by HPV. Replication of this virus originated from basal cells infection. Then came cellular differentiation. Furthermore, the virus assembles itself in the cell nucleus and escape while keratin cells rupture. This process is associated with proliferation of all epidermal layers except the basal layer and production of acanthosis, paraceratosis, and hyperceratosis. Viewed in hitology, normal epithelium remains contain HPV DNA, and residues of these DNA after treatment may be associated with HPV disease. Episomal HPV DNA will be in the nucleus of infected cells and will cause a benign lesion.

Patient's response against HPV infection is still unclear. However, several studies mentioned by vaccination will produce high titer antibodies that will protect against HPV infection. HPV infection can last a long time, especially in people with HIV.

Various types of HPV cause warts, usually on the hands or feet. Infections of the hands and feet are usually not transmitted through sexual activity. Some types of HPV can cause genital warts on the penis, vagina and rectum. People with HIV may experience a worse injury in the rectum and the uterus. HPV also can cause problems in the mouth or on tongue and lips. Other types of HPV can cause abnormal cell growth known as dysplasia. Dysplasia can develop into anal cancer in men and women, and cervical cancer, or cancer of the penis.

Dysplasia around the anus called anal neoplasia intraepitelial (AIN). AIN is a new development of abnormal cells in the lining of the rectum. Dysplasia in the cervix called cervical intraepitelial neoplasia (CIN). AIN or CIN appear to be more common in people with HIV than those who are HIV-negative.

The warts can be divided into two, namely Veruca vulgaris (ticks) and Epidermodysplasia verruciformis. Epiderma means skin, dysplasia are cells that divide, while verruciformis means stemmed resemble chicken's comb. So Epidermodysplasia verruciformis means the skin cells that divide stemmed resemble chicken's comb, which is caused by the Human papilloma virus (HPV).

HPV virus often found in genital warts (condiloma), which attacks the genital organs through intercourse. Marked genital warts bumps on the sex organs. The lump was easily solved if known early and get immediate treatment. If not treated promptly, the warts will grow become a chicken's comb could even potentially become cancerous.

HPV virus can be transmitted through direct contact or wear clothing of people who carry the virus. Warts can also appear in people who have a genetic disorder (descendants). Genetic disorder prevents the immune system and make it unable to stem the growth of warts.

Warts caused by HPV virus can be addressed before it's too late. Treatment is by giving oral anti-viral drug. If there is no result, the treatment can be followed by electric surgical or frozen surgical. Also given drugs to increase endurance. Only warts due to HPV virus that has a tendency to relapse. If the ballast factor is a genetic disorder that makes the body resistance is low, then the patient who is given drugs, need to increase his or her endurance for a lifetime. That way, the wart will not appear even if infected with the HPV virus.

Human Papilloma Virus (HPV) can cause giant wart growth. The disease is not due to genetic factors but rather is caused by human papilloma virus (HPV), but a genetic disorder that continues to expand the growth of warts is also due to weak link in the white blood cells in the body so that undermine developing malignant virus, this virus causes the disease : Epidermodisplasia verruciformis (EV ) and giant cutaneous horn. The disease is medically known as epidermo (epidermis) dysplacia (one of the developments) verucca (warts). Warts are types of benign tumor of the skin from excessive thickening of the outer skin, warts in form large or small, are usually held no ill, and when it is very large, it can bleed if galling, when it grow shaped like cauliflower.

Epidermodisplasia

Epidermodisplasia verruciformis and giant cutaneous horn

How HPV was Found?

Many people have HPV infection without detection. HPV infection can disappear without causing problems. To detect HPV, doctors look for dysplasia or genital warts.

Pap test (Pap smear) is used to examine a woman's cervix. This test can also be used to check the anus of men and women. Swab rubbed on the area which being checked to pick up some cells. These cells smeared on glass and examined with a microscope. Tues examined for abnormalities that may show abnormal changes in cells, such as dysplasia or cervical cancer.

Dysplasia can be detected with Pap tests.

Some researchers believe that anal Pap testing and the cervix should be done every year for people who are at higher risk :
- People who receive anal sex (penis into the anus).
- Women who have had CIN.
- Anyone with a CD4 count below 500.

Genital warts can appear anywhere from several weeks to several months after an infection with HPV. Warts can look like small bumps. Sometimes, these warts can become more fully with the meat and look like cauliflower. The longer, the warts can be even greater.

Generally, doctors can determine whether we have genital warts. Sometimes a tool called anoscope used to check the anal area. If necessary, cut warts samples and examined with a microscope. This is called a biopsy.

Types of HPV that cause genital warts are not the same type of virus that cause cancer. But if we have the warts, we may also be infected with other HPV types that can cause cancer.

Is HPV Infection Preventable?

There is no easy way to tell if someone is infected with HPV. People who do not show signs or symptoms of HPV infection can transmit the infection.

Condoms do not prevent transmission of HPV. This virus can be transmitted by direct contact with infected areas that are not covered by a condom.

Men and women with HIV who are sexually active may want to have regular Pap smear, vaginal and / or rectum to look for abnormal cells or early signs of warts. Positive results can be followed up to see if any treatment is needed.

Therapy of diseases caused by this EV can be done by given salicylic acid or lactic acid when the lesion is still small, when it reached 40%, it can be added with trichloroacetic acid (TCA), it can also be done by freezing with liquid nitrogen cryotherapy, chemotherapy with bleomicin; or it could be burned.

Human papillomavirus (HPV) vaccine can prevent 90 percent of cases of genital warts in males. Clinical trials also found to find the effectiveness of 66 percent population of boys. HPV vaccine can be used as prophylaxis or prevention of disease in men.

Previously, HPV vaccine is already approved by U.S. FDA for its use for girls since 2006 in cervical cancer prevention. However, the fact of infection and disease caused by HPV general also affects men, including genital warts, which is one of sexually transmitted diseases (STDs), the most common. If we vaccinate boys, most cases of external genital warts in men can be prevented.

In addition, to prevent warts, the vaccine is also effective in preventing persistent HPV infection by 86 percent in patients who have not been exposed to HPV.

How HPV Infection Treated?

There is no direct treatment for HPV infection. The immune system can be "cleared" (cure) of HPV infection. But that person can be infected again. Dysplasia and warts can be removed. There are several ways to do this :
- Burning them with an electric needle (electrocautery) or laser.
- Freezing them with liquid nitrogen.
- Interrupted by surgery.
- Treating them with chemicals. TCA is effective for some people.

Other, less common treatment for warts include the drugs 5-FU (5-fluorouracil) and interferon alpha. 5-FU cream form. A new drug, namely imicuimod, approved by the U.S. FDA for the treatment of genital warts. Cidofovir, originally developed to treat cytomegalovirus (CMV) may also help fight HPV.

HPV infection can last for a long time, especially in people infected with HIV. Dysplasia and warts can recur. They should be treated as soon as possible to reduce the possibility of the spread or recurrence. Treatment of other HPV is by circumcision.

Circumcision

Circumcision is the first type of surgery known by human. In the history, this procedure is carried out for various reasons such as religious reasons, social, or both. Circumcision in adults for the treatment of phimosis has been mentioned in literature since the early 19^th century. However, the American Academy of Pediatrics (AAP) does not recommend this action in neonates.

1. On male, circumcision eliminates the folds of skin that normally covers the penis glans.
2. Many cultures have a history of using circumcision as a sanitary reasons or as ritual offerings to the gods. At the end of the 19^th century, this ritual turned into routine medical practice because it is influenced reports this action relates to an amazing treatment for hernia, paralysis, epilepsy, insanity, headaches, and others.

1. Indication

The main indication for circumcision is phimosis action of pathology. Another indication for this procedure is done by paraphimosis, balanitis that often arise again or balanoposthitis, for social or religious reasons.

In the long-term prospective study, 40% of boys who were treated for phimosis were found to have Balanitis Xerotica Obliteraus (BXO), which has a relationship with the development of the penis flat cell carcinoma (penile SCC), also a relative indication for doing circumcision. Paraphimosis is not a disease that can be found at various ages, usually as the result of the incident on preputium. Paraphimosis is the second most common indication.

Another indication is relatively rare for circumcision is carried out by a small preputium tumor or condyloma and penile lymphedema. In other cases, circumcision performed on boys with Vesicourethral reflux (Vur) suffering from a Urinary Tract Infection (UTI). The Foley catheter is often found problems; this is commonly used as an indication to performed circumcision.

2. Contraindications

In general, circumcision is not performed on babies born prematurely or who have blood dyscrasis. In addition, this procedure should not be performed on children with congenital penile anomalies such as Hypospadia, Epispadia, chordee, Penile Webbing, and Buried penis.

Technical Operations

There are two kinds of Circumcision techniques in general, namely dorsal slit and sleeve technique. A surgical procedure is divided into two parts, namely pre-operative and intra-operative.

1. Pre-operative

It is vital to informed consent before performing circumcision. Provide information on the risks that might occur, including bleeding, hematoma formation, infection, disturbances in stitches, scars by accident in the urethra or gland, and changes in sensation during intercourse. Patients with balanitis should be free from infection before the procedure.

Circumcision can be done in practice with local anesthesia or in the operating room with regional or general anesthesia. For patients who experience anxiety or anxiety in practice can be given diazepam (Valium), 2-5 mg orally one hour prior to the action. The dose for adults is 10-20 mg. While the children are not recommended for this procedure.

2. Intra-operative

The patient is positioned in the supine position. Genital area is prepared with povidine-iodine solution. Pubic hair usually needs to be eliminated. In children, general anesthesia is usually required. For adult patients can use a local anesthetic. Local anesthesia is given with the dorsal penile nerve block followed by blocking the ring. Local anesthetic that can be used is 0.5% bupivacaine (Marcaine) and 1-2% lidocaine without epineprin with the same volume ratio. Use of epineprin usually will cause ischemia.

- Dorsal Slit circumcision

To do Dorsal Slit, preputium in clamps on the clock of 12 with two hemostats to minimize bleeding. Clamp was conducted over two minutes.

Tissue incision between the two clamps, perpendicular to the corona. Create inisisi also limits the proximal.

Preputium excision at the bottom (about 1 cm from the corona sulcus) with scissors to produce good skin cut. Left Skin below the corona sulcus can not cut longer than 1 cm in length to prevent edema, adhesions and paraphimosis.

Tie the superficial veins and stop the bleeding with electrocauter. Sew the circular boundary of the proximal and distal preputium with absorbable suture thread from 4.0 to 5.0 for children and adults with sizes from 3.0 to 4.0 for interupted stitching.

The sewing needle using a thin flat noncutting to reduce complications and bleeding trauma to the tissue.

- Mechanical Sleeve

Sleeve technique is an alternative technique on circumcision. After doing anesthesia, mark preputium with marker. Before making an initial incision, which will confirm the amount of skin removed by using the index finger so that we get the limit on preputium corona sulcus. Give a mark on the area. Make a circular incision located at the distal 1 cm of proximal corona sulcus.

When this is done, the sleeve preputium formed between two incisions, and skin leaving the penis is not too short or long.

Among excessive skin clamp, circumcision incision at 12 clock direction and the incision was done.

Remove the sleeve using electrocauter. To stop the bleeding can use Cauter and ligature. Edge can be sewn with thread preputium absorbable 3.0 to 5.0.

3. Post-operative

After doing the circumcision, many urologists recommend not wearing clothes. However, jelly and sterile gauze or Xeroform gauze can be used to cover the penis to prevent adhesions.

In adult patients, whom ever feel cessation of narcotic drugs. Patients should wear clothing that is loose once the surgery. For complete healing takes 4-6 weeks, so the patient is not allowed to have sex.

Complication

Circumcision is a minor surgical procedure which well tolerated by many patients. However, complications that can arise in the form of bleeding, infection, hematoma, swelling, pain, and lack of form in cosmetics.

Post-operative bleeding is the most frequent complication. Infection is rare after circumcision, and it can be treated with local or oral antibiotics. Urethral injury is rare, usually occur at the circumcision fistula subcoronal urethrocutaneous.

Circumcision may worsen erectile function and derive the sensitivity of the penis. But sexual activity did not change and increased satisfaction. This is probably due to reduced sensitivity of the penis so that ejaculation takes much longer.

Circumcision relationship with Human papilloma virus

Circumcision As A Prevention of HPV Infection

Penile shaft and outer surface of the outer skin is covered by flat creatine epithelium plated that provides protection against HPV infection. Different things found on the inside of the mucosa that lines inside preputium. This layer is the mucous layer that is not creatined so this may make it more vulnerable to viruses. During sexual intercourse, the outer skin layer will be folded back. This will cause the inner mucosal surface will be dealing directly with the secretions from the vagina. HPV may be able to reach the basal cells through small abrasions or ulcers in the lining epithelium. Removal of the outer skin to minimize the possibility of virus entry with a marked reduction in size of the area susceptible to HPV and decrease mucosal trauma during sexual intercourse. Gland already circumcised, penis would become thicker and covered with epithelium that makes it more resistant to abrasion which will reduce the vulnerability of the virus entry.

Penile HPV Infection and Cancer cervix

Circumcision in men associated with decreased risk of HPV infection on the penis and on the side of the man with a history of multiple partners, reduce the risk of cervical cancer in female partners. The study was conducted in several countries, namely Brazil, Philippines, Thailand, Colombia, and Spain.

HPV infection in the penis

Overall odds ratio for infection related to circumcision penis obtained were 0.37 (95% CI, 0.16 to 0.85). This ratio is obtained after performing adjusted on age, study location, educational level, age at first intercourse, number of partners, and frequency of washing the genital area after intercourse.

Odds ratio for HPV infection in men who are circumcised, compared with those not, is the same as if done on a sample exclusion from Spain and Colombia. The same is found in the time with the Philippines exclusion, the results did not change significantly in statistics.

Cancer cervix

Circumcision in men who have a moderate relationship, but not significant, to decrease the risk of cervical cancer in women who are invited to intercourse with him. There is no evidence of heterogeneity with the location of this study.

However, the opposite relationship found between circumcision and risk of cervical cancer in women who have high-risk couples and sexual intercourse are at risk such as sex before age 17 years old and has a history associated with prostitution. This difference is more powerful and significant.

Circumcision will increase the likelihood of maintaining penile hygiene, there are other channels that show circumcision reduce HPV infection.

This study also report the reasons why circumcision may reduce cervical cancer in women, couples sexual relationship. First, circumcision is significantly related to lower risk of HPV infection on the penis. Second, HPV infection in penile related with 4 times increase against the risk of HPV infection in the cervix in sexual partners. Third, infection of the cervix because of HPV associated with 77 times increase of the cervical cancer risk.

HPV infection by serology

Seropositivity in HPV infection relate to the number of sexual partners (P = 0.03) and the low moral-religious approach in the family (P <0.001).>HSV-2 infection, HPV, and syphilis

On male circumcision significantly lowers the incidence of HSV-2 infection and prevalent HPV infection. This indicates that circumcision is a procedure that could potentially benefit the public.

Efficacy of circumcision against the prevention of prevalent HPV was 35%. Prevalent high-risk HPV genotypes in the intervention group was 18.0%. While in the control group 27.9%. These results with adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90, P = 0,009.

Clearance of HPV high-risk

Male circumcision can reduce the incidence of HPV high-risk multiple infections and increased clearance of high-risk HPV infection in men who are HIV negative. The study was conducted in Rakai, Uganda.

As a group of this study intervention is circumcised men. Meanwhile, as the control group are those who are not circumcised. The definition of high-risk HPV types are HPV-16, 18, 31, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68, or known as types of oncogenes.

The incidence of HPV infection in high-risk group was 19.7 cases/100 people/ intervention year. While in the control group acquired incident as much as 29.4 cases/100 people/year (RR, 0.67; 95% CI, 0.51 to 0.89, P = 0.006). In addition, the clearance of preexisting high-risk HPV infection was 215.8 cases/100 people/year in the intervention group and in the control group of 159 cases/100 people/year (Adjusted RR, 1.39, 95% CI, 1.17 to 1 , 64).

Circumcision is a minor surgical procedure which often performed in public. This procedure is performed with a variety of reasons, ranging from cultural reasons, religious, social, and to medical reasons. This action removes partially covering preputium penis gland.

All types of flat epithelium can be infected by HPV. Repication of this virus originated from an infection of the basal cells. Then came cellular differentiation. Furthermore, the virus assembles itself in the nucleus and escape while cells ceratine rupture. This process is associated with proliferation of all epidermal layers except the basal layer and production of acanthosis, paraceratosis, and hyperceratosis.

With action circumcision, penis gland surface will become thicker and coated the epithelium which makes it more resistant to abrasion which will reduce the vulnerability of the virus entry.

Several studies have been conducted to see the relationship between circumcision with HPV infection. Some of these studies support each other in the conclusion, circumcision can reduce the incidence of HPV infection to the type of oncogene and non-oncogene.

On male, circumcision is a personal decision of patients and parents. Despite scientific evidence suggests that circumcision is done for the sake of prevention and this should be disseminated.

Future research is needed about the factors that help circumcision to prevent HPV infection. It should also consider other pathways which are used HPV to infect humans.

14 most common daily fatigue

2011-01-31T05:49:00.001-08:00

Do you lately feel tired or quickly weary? Are you interspersed with yawning during the daily activity? Could be, that occurs because you are not getting enough sleep, lack of energy, or even a sign or symptom of disease, such as anemia.

Beware. Recognize the causes of tiredness with following 14 points. Discover the causes and fix it with this tips :

1. Not Enough Sleep
Generally adults need seven to eight hours a day to sleep. If you are sleepy during the daily activity, it could be because the quality and quantity of your sleep decreases. Be careful, because lack of sleep can be bad for your health and concentration.

To fix it : set priorities and schedule regular bedtime to sleep. Keep your laptop, cell phone, or PDA away when you sleep because it will help reduce disturbance during sleep.

2. "Sleep Apnea"
Some people think that they had enough sleep. However, they never thinking that they have sleep apnea. Sleep apnea is a sleep disorder characterized by difficulty of breathing and occur repeatedly. You may not realize it, but each time this disorder came, sleep quality will decline. This causes you still feel the lack of sleep despite having spent eight hours for rest.

Sleep apnea is also associated with various diseases, such as hypertension, heart disorders, diabetes, and stroke. Sleep apnea occurs due to narrowing of the airway during sleep. As a result, the supply of oxygen will repeatedly stalled all night.

To fix it : if you overweight, quit smoking, and try to sleep using a tool called "CPAP" that keeps you breathing all night.

3. Lack of Energy
Eating too little causes the body to fatigue, but eating the wrong foods can also be a problem. Balanced diet helps keep your blood sugar levels within normal range and prevent fatigue when your blood sugar decreases.

To fix it : always eat breakfast every morning and try to add protein and carbohydrates complex at every meal. For example, eating an egg with wheat bread. You can also eat a distraction to maintain energy throughout the day.

4. Anemia
Anemia is a major cause of fatigue in women. Bleeding during menstruation can cause iron deficiency. Red blood cells in the body is necessary because they carry oxygen to tissues and organs.

To fix it : regular anemia caused by lack of iron. You'll want to outsmart by drinking iron supplements and eating foods rich in iron, such as meat, liver, shellfish, nuts, and iron-fortified cereals.

5. Depression
You might think depression is just emotional distress. However, this was also associated with physical symptoms. One of the most common physical symptoms are fatigue, headaches, and loss of appetite. If you still feel tired and depressed for more than two weeks, you should consult with a physician.

To fix it : depression can be addressed through psychotherapy and medical treatment.

6. Hypothyroidism
The thyroid is a small gland at the base of your neck. This organ serves to control and regulate the body's metabolism speeds and convert food into energy. When the gland is not functioning properly and metabolic functions in the body is slow, you may feel weak and grow fat.

To fix it : if blood tests show you have low thyroid hormone, your doctor will prescribe synthetic hormones to restore your body's performance.

7. Most drank caffeine
Consuming caffeine in normal doses can increase alertness and concentration. However, too much caffeine can increase heart rate, blood pressure, and seizures. Based on research, consuming too much caffeine can also cause fatigue in some people.

To fix it : gradually reduce the consumption of coffee, tea, chocolate, soft drinks, and any drug that contains caffeine. Stopping suddenly can cause caffeine withdrawal and excessive fatigue.

8. Urinary Tract Infection
If you've ever experienced a urinary tract infection (UTI), you may experience a burning pain. However, these infections do not always indicated by the symptoms. In some cases, fatigue may be the only sign that you get UTI. You can do an urine test to confirm UTI.

To fix it : see a doctor. These medications can be prescribed antibiotics to deal with UTI and fatigue usually disappear after a week.

9. Diabetes
People with diabetes generally have high blood sugar levels, but this blood sugar stays in the bloodstream and not into the body cells, that is why it can not be changed into energy.

As a result, the body can run out of energy even if you have enough to eat. If you often suffer from fatigue for no reason, ask your doctor to test for diabetes.

To fix it : the treatment of diabetes by lifestyle changes, like diet and exercise, insulin therapy and medications can help the body to process sugar.

10. Dehydration
Fatigue can be a sign that you are subject to dehydration. Even if you work outside or dwell on the table, the body still needs water to work well and remain calm. The signs of dehydration is that you experience thirst.

To fix it : drink water throughout the day so that your urine is light colored. At least two glasses of water every hour or consume more water before doing physical activities that are planned by you. Then, continue your work and then drink two more glasses.

11. Heart Disease
When you feel fatigue caused by routine activities, like cleaning the house or mow the page, could be a sign that the heart does not work properly. If it turns out in daily activities easily even more difficult to do, consult your doctor.

To fix it : changing lifestyles, treatment, and follow the procedures of the therapy that you run to make your heart in better condition to restore your energy.

12. "Shift" Work
Working at night or doing shift work can disrupt your sleep clock. You may feel tired when you have to wake up. And, you may have trouble sleeping during the day.

To fix it : limit your activity during the day when you need a break. Create atmosphere of the bedroom with dark, quiet, and cool situation.

13. Food Allergies
Some doctors believe the unconscious to be allergic to certain foods, and it can make you drowsy. If the intensity of fatigue increases after eat a meal, you may have noticed the type of food may not cause you to itch, but enough to make you drowsy.

To fix it : Try to stop eating one kind of food to see if it correlated with increased fatigue in yourself. You also can ask your doctor to test food allergy.

14. Fibromyalgia and CFS
If your fatigue lasts more than six months and is very severe, so you can not manage your daily activities, chronic fatigue syndrome (chronic fatigue syndrome / CFS) or fibromyalgia is a possibility. Both can have a variety of symptoms, one of the main thing is fatigue.

To fix it : although there is no quick cure for CFS or fibromyalgia, the patient would benefit from changes in the daily schedule, try to learn to improve sleeping habits for the better and begin a light exercise program.

Tips for Reducing Fatigue

If you feel tired, but had nothing to do with medical conditions, perhaps one best solution is exercise. Research shows that healthy adults often feel tired but can obtain significant additional energy from a simple exercise program.

You can ride stationary bicycle for 20 minutes with the speed of light. Doing this type of exercise three times a week is enough to treat fatigue.

Combustio (Burn Injury) care guide

2011-01-28T07:23:00.000-08:00

Combustio (Burn)

Burn (combustio) is an injury as a result of direct contact or exposure to sources of heat (thermal), electricity (electric), chemicals, or radiation.

Treatment of burns has been improve in the last decade, which resulted in decreasing mortality due to burns. The centers of the burn treatment has been available quite good, with team members who deal with burns consists of various disciplines who work together to perform maintenance on the client and his family.

In the United States approximately 2 million people each year require medical help for injury caused by burns. 70,000 of them hospitalized with a severe injury.

Burns is the third leading cause of death due to accidents in all age groups. Men tend to more often experience of burns rather than females, especially in the elderly (above 70 years).

Burns are categorized according to the injury mechanisms :
1. Thermal Burns
Thermal burns (heat) caused by exposure to or contact with flame, hot liquids or other hot objects.
2. Chemical Burns
Chemical burns can be caused by skin tissue contacts with a strong acid or base. Chemical concentration, duration and number of contacts that are exposed to determine the extent of tissue injury due to these chemicals. Chemical burns can occur for example due to contacts with cleansing agents are often used for domestic purposes and various chemicals used in industry, agriculture and military. More than 25,000 chemical products known to cause chemical burns.
3. Electrical Burns
Burns Electric (electricity) is caused by heat driven from the electrical energy that is delivered through the body. Severity of injury is influenced by the duration of contacts, high voltage and electrical waves.
4. Radiation Burns
Radiation burns caused by exposure to radioactive sources. This type of injury is often associated with the use of ionizing radiation on the industry or from sources of radiation for therapeutic purposes in the medical world. Burned by the sun due to prolonged exposure is also one type of radiation burns.

Risk Factors

75% of all cases of burn injury, occurred within the home environment. Clients with more than 70 years of age are at high risk for the occurrence of burns.

Burn injury pathophysiology effect :

1. In the Skin
Patofisiologic changes that occur in skin immediately after a burn depends on the area and size of burns. For small burns area, the response in local body is limited to areas experiencing injury. While on a broader burns for example 25% of the total body surface (TBSA: total body surface area) or greater, then the body's response to injury may be systemic and in accordance with the extent of injury.

2. Cardiovascular system
Immediately after the burn injury, released vasoactive substances (catecholamine, histamine, serotonin, leukotrienes, and prostaglandins) from tissue injury. These substances cause increased capillary permeability so that plasma leak (to SEEP) into the surrounding tissue. Heat injury that is directly on the vessel will further increase capillary permeability. A direct injury on cell membrane cause sodium in and potassium out of cells. As a whole will lead to high osmotic pressure that causes the increase of intracellular and interstitial fluid and that the circumstances causing further shortages intravascular fluid volume. Extensive burns causing general body edema both in the area of tissue injury or who had not had burns and a decline in circulation of intravascular blood volume. Heart rate increased in response to catecholamine and the occurrence of relative hypovolemia, which started the decline in output cardiac. Increased hematocrit levels of expenditure that shows hemoconsentration of intravascular fluid. Besides secretion of fluid by evaporation via a wound occurs 20-40 times greater than normal. While the normal discharge in adults with normal body temperature is 350 ml per day.

This situation can lead to a decrease in organ perfusion. If the intravascular space is filled again with intravenous fluids then hypovolaemic shock and threat of death for patients with extensive burns can occur.

Approximately 18-36 hours after the burn, capillary permeability decreased, but did not reach normal until 2 or 3 weeks after injury. Cardiac output back to normal and then increased to meet the needs of the hipermetabolic body approximately 24 hours after burns. Changes in cardiac output occurred before the amount of intravenous circulation volume back to normal. In the beginning, there is an increase of hematocrit and then decreased to below normal within 3-4 days after the burn due to loss of red blood cells and damage that occurs in injury time. The body then reabsorbtion edema fluid and diuresis fluid within the next 2-3 weeks.

3. Renal and Gastrointestinal System
The response of the body at the beginning was the reduction of blood to the kidneys and decreased GFR (glomerular filtration rate), which led to oliguric. Blood flow to the intestine was also reduced, which in turn can occur ileus and gastrointestia intestinal dysfunction on the client with burns over 25%.

4. Immune System
Depressed immune system function. Depression in lymphocyte activity, a decrease in the production of immunoglobulin, complement suppression activity and changes / disturbances in neutropil and macrophage function can occur in clients who suffered extensive burns. These changes increase the risk of infection and sepsis which threaten the survival of the client.

5. Respiratory System
Respiratory system can have pulmonary arterial hypertension, resulting in a decrease in arterial oxygen levels and "lung compliance."

a. Smoke inhalation

Inhaling the smoke can cause pulmonary injury that is often associated with injury due to wildfire. Incidence of inhalation injury is estimated at more than 30% injury caused by fire.

Clinical manifestations that could be suspected of inhalation injury include the burns hit the face, redness and swelling of the oropharynx or nasopharynx, nose hair is singed, agitation or anxiety, tachipnoe, redness of the lining of the nose, stridor, wheezing, dyspnea, hoarseness, there are carbon in sputum, and cough. Bronchoscopy and lung scanning can confirm the diagnosis.

Pulmonary pathophysiology of inhalation injury can occur in relation to weight and type of smoke or gas is inhaled.

b. Carbon Monoxide Poisoning.

CO is a product that is often produced when organic substances get burn. It is a gas that is colorless, odorless, tasteless, which can bind to hemoglobin 200 times greater than oxygen. With the inhalation of CO, the CO molecules and oxygen replaced reversibly binds to hemoglobin in carboxyhemoglobin (COHb) form. Tissue hypoxia may occur due to the overall decline in the ability of the delivery of oxygen in the blood. COHb levels can be easily monitored through blood serum. Manifestations of CO poisoning are as follows :

Burn severity classification

1. Factors affecting the severity of burns

Some factors affecting severity of the burn injury, among others, the depth of burns, extensive burns, burns location, general health, the mechanism of injury and age.

a. Depth of burns
The depth of burns can be divided into 4 categories which is based on elements of the damaged skin.

- Superficial (first degree), with the following characteristics :

* Only the epidermal layer.
* Injury that looks bright pink to red (mild to severe erythema).
* Skin blanch when pressed.
* Minimal edema.
* No blister.
* Skin warm / dry.
* Pain / hyperethetic.
* Pain is reduced by cooling.
* Discomfort approximately ended within 48 hours.
* Able to recover spontaneously within 3-7 days.

- Partial thickness (second degree), with the following characteristics :

* Partial tihckness grouped as superpicial partial thickness and deep partial thickness.
* About the epidermis and dermis.
* Wound looks red to pink.
* Formed blister.
* Edema.
* Pain.
* Sensitive to cold air.
* Healing wounds :
# Superficial partial thickness : 14-21 days.
# Deep partial thickness : 21-28 days.
(However, its treatment varies depending on the depth and the presence or absence of infection).

- Full thickness (third degree)

* Regarding all layers of skin, fat subcutan and can also on the surface of the muscle, and innervation and blood vessels.
* Injury looks vary from white, red to brown or black.
* Without blister.
* Dry wound surface with a texture rough / hard.
* Edema.
* A little pain or without pain.
* Wound does not heal spontaneously.
* Requires skin graft.
* Able hypertrophic scar and contracture occur if there is no preventive action.

- Fourth degree (degree IV)

* Regarding all layers of skin, muscle and bone.

b. Extensive burns

There are several methods to determine the extent of burns include (1) the rule of nine, (2) Lund and Browder, and (3) hand palm. The size of the burn can be determined by using one of these methods. Size of burns is determined by the percentage of body surface affected by burns. Accuracy of calculation varies according to the methods used and determine the extent of one's experience in burns.

Method rule of nine was introduced since the 1940's as a rapid assessment tool to determine the approximate size / area of burns. The basis of this method is the body was divided into anatomic sections, where each part represents 9% except the genital region of 1%.

The Lund and Browder method is a modification of the body parts percentage according to age, which can provide a more accurate calculation of the burn area.

Apart from the two methods mentioned above, determine burns can also be used other ways of using the method of hand palm. This method is how to determine the extent or percentage of burns using the palm of the hand. One palm represents 1% of body surface burns.

c. The location of the burn (part of the body affected)

Severity of burns is also influenced by the location of burns. Burns near the head, neck and chest is often associated with pulmonary complications. Facial burns often cause corneal abrasion. Burns on arms and joints often require physical therapy and occupation and may lead to implications for working time lost and / or inability to work permanently. Burns on the perineal area may be contaminated by urine or feces. While that burns on the piston can cause the adekwat has no chest wall expansion and occurrence of pulmonary insufficiency.

d. Public Health

Of the weakness of the heart, pulmonary disease, endocrine and kidney diseases, particularly diabetes, cardiopulmonary insufficiency, alcoholism and renal failure, should be observed because all it will affect the client response to injury and treatment.

Overall mortality rate in clients who have heart disease is 3.5 - 4 times higher than clients who did not suffer heart disease. Similarly, clients who also alcoholism will get 3 times higher death rate than the client of non alcoholism. Besides, the burns affected on alcoholism clients has longer lifetime in the hospital, meaning that people with severe burns who also alcoholism, he will has longer days in the hospital.

e. Mechanism of injury

The mechanism of injury is another factor used to determine the severity of burns. General secra burns who also suffered inhalation injury require special attention.

In electrical burns, heat is conducted through the body, causing internal tissue damage. Injury to the skin may not be so mean but the damage to muscles and other soft tissues can happen broader, especially when get high voltage electric injury. Therefore, voltage, current type (direct or alternating), the contacts, and duration of contact is very important to know and be considered because it can affect morbidity.

Alternating current (AC) is more dangerous than direct current (DC). It is often associated with the occurrence cardiac arrest, ventricular fibrillation, muscle contraction tetani, and compression fracture of long bones or vertebrae.

In chemical burns as a result of systemic poisoning by skin absorption may occur.

f. Age

Client age affects the severity of burns. Mortality rate is high in children younger than 4 years, especially in the age group 0-1 year and clients whom are aged over 65 yr.

The high mortality and morbidity statistics on older people affected by burns is due to a combination of various functional disorders (such as slow to react, the disturbance in the rate, and decreased mobility), living alone, and other environmental hazards. Besides, they are more vulnerable to injury because the skin becomes thinner, and get athropi in other parts of the skin. So bathing and cooking can cause burns.

2. Category severe burns according to the ABA

American Burn Association (American Burn Association / ABA) published guidance on the classification of severity of burns. Society classifies the severity of burns into 3 categories. Hint burn severity classification according to the ABA :

- Serious Burns

* 25% in adults.
* 25% in children with age less than 10 years.
* 20% in adults with more than 40 years of age.
* Sores on the face, eyes, ears, arms, legs, and perineum that cause functional impairment or cosmetic or cause disability.
* Burn injury due to high voltage electricity.
* All burn injury accompanied by inhalation injury or severe trauma.

- Medium Burn Injury

* 15-25% of adults.
* 10-20% in children aged less than 10 years.
* 10-20% in adults aged over 40 years.

- Light Burns
* <10> 40 years old.
* There is no risk of cosmetic or functional disorders or disability.

A variety of organ system responses that occur after experiencing burns require the need for interdisciplinary approaches. Nurses are responsible for developing treatment plans based on assessment data that reflect the physical and psychosocial needs of clients and families or other people that are considered important.

Nursing diagnosis, goals and intervention can be seen in the planned treatment in other pages. Clinically client burns can be divided into 3 phases, namely: 1) emergent and resuscitation phase 2) acute phase and 3) Rehabilitation Phase. Here are a glimpse of the phase :

1. Emergent phase (Resuscitation)

Emergency phase begins at the time of injury and ends with the improvement in capillary permeability, which usually occurs in 48-72 hours after injury. The main purpose of recovery during this phase is to prevent hypovolemic shock and preserve the function of vital organs. What is included in the emergency phase is (a) before treatment in the hospital, (b) handling of the emergency and (c) the period of resuscitation. This will be discussed as :

a. Treatment before the hospital (pre-hospital care)

Treatment before the client was taken to the hospital beginning on the scene of burns and ends when the emergency services arrived at the institution. Pre-hospital care begins with the remove / prevent the client from the source or cause burn injury and eliminate sources of heat.

Hint burns client care before get into the hospital :

1. Keep away patients from sources of burns

* Rage Again the burning clothes.
* Eliminate causing chemical burns.
* Flush with water as much as possible.
* Turn off the power or remove the power source using a dry object and does not conduct current (non conductive).

2. Assess ABC (airway, breathing, circulation) :

* Notice the airway.
* Make sure breathing by adekwat.
* Assess circulation.

3. Assess other trauma.
4. Maintain body heat.
5. Consider the need for intravenous fluid administration.
6. Transportation (immediately tell the client hospital).

b. Emergency section Handling

Treatment at the emergency is a continuation of actions that have been given at the time of the incident. If the assessment and treatment conducted are inadequate, then the pre-hospital care given in the emergency. Handling injury (debridement and dressing) does not take precedence if there are other problems that threaten the life of the client, then the problem is what should come first

1. Handling of Light Burns

Treatment of clients with minor burns are often given to outpatients. In making the decision whether the client can be sent home or not is determine by 1) the ability of clients to be able to run or follow the instructions and ability to do maintenance on their own (self care), 2) the home environment. If the client is able to follow instructions (self-care) and home environment support the patient recovery, the client can be repatriated.

Treatment in the emergency of minor burns include : pain management, tetanus prophylaxis, wound care and health education at early stage.

a) Management of pain

Management of pain is often done with give a light dose of morphine or meperidine emergency section. While oral analgesics given to outpatients.

b) tetanus prophylaxis

Guidelines for tetanus prophylaxis are the same in patients with burn injury both light and other types of injury. On the client whom never received immunization against tetanus, but not within 5 years can be given tetanus toxoid booster. For clients whom are not immunized with human tetanus immune globulin and tetanus toxoid should be given a series of active immunization with tetanus toxoid.

c) initial wound care

Burn injury treatment for minor injuries consisted of cleaning the wound (cleansing) are debridement of dead tissue, dispose of substances that damage (chemicals, tar, etc.), the provision / use of topical antimicrobial cream or ointment and a sterile bandage. In addition, nurses are responsible to provide education about wound care at home and clinical manifestations of infection for the client to immediately seek help. Other necessary education is about the importance of doing exercises ROM (range of motion) actively to maintain normal joint function in order to stay and to reduce edema formation and the possibility of scar formation. And the need for follow up evaluation or treatment must also be discussed with the client at the time.

d) Education / health counseling

Education on wound care, treatment, complications, prevention of complications, diet, health facilities that exist in society that can be visited if the patient need assistance and other relevant information necessary for clients to help themselves.

2. Handling of Serious Burn Injury.

For clients with extensive wounds, then the emergency section will include the reevaluation of the ABC (airway, respiratory, circulatory) and other trauma that might occur; fluid resuscitation (replacement of lost fluids); urinary catheter placement; installation of nasogastric tube (NGT ); Vital Signs and laboratory examination; management of pain; tetanus prophylaxis; data collection, and wound care.

Here is an explanation of each treatment is, namely :

a) the reevaluation of the airway, respiratory, circulatory and other trauma that might occur.

Reassess the state of the airway, respiratory conditions, and ensure the circulation of more fatherly presence or absence of gravity and to ensure early treatment. Also done a research on the presence or absence of other trauma that accompanies the burn injuries as broken bones, a bleeding and others need to be done so that can be immediately identified and addressed.

b) fluid resuscitation (replacement of lost fluids)

For adult clients with severe burns over 15%, then generally required intravenous fluid resuscitation. Peripheral intravenous administration may be given through the skin that do not get burn on the proximal part of the burned limb. As for clients who suffered extensive burns enough or for a client where the places to peripheral intravenous administration is limited, then the installation cannula (cannulation) in the central veins (such as the subclavian, internal or external jugular, or femoral) by the physician may be required.

Extensive burns or percentage must be determined and then followed by fluid resuscitation. Fluid resuscitation can use different formulas.

Resuscitation period begins with fluid resuscitation and closed when the integrity of the capillary return to near normal state and a lot of fluid displacement decreased.

Fluid resuscitation begun to minimize the damaging effects of fluid shifts. The objective is to maintain fluid resuscitation ferfusi vital organs complication and avoid inadequate therapy or excessive.

Number / amount of liquid that must be based on client weight and breadth of the burn injury. Another factor to be considered include the presence of inhalation injury, initial resuscitation delay, or damage to deeper tissues. These factors tend to increase the number / amount of intravenous fluid needed for resuscitation adequately above the amount that was calculated. With the exception of Evan and Brooke formula, liquid containing colloid was not given during this period due to changes in capillary permeability which causes leakage of fluid that contain lots of protein into the interstitial space, by increasing edema formation. During the second 24 hours after burns, solution containing a colloid can be given, with 5% dextrose and water in varying amounts.

It is important to remember that resuscitation formula is only as a tool and should be tailored to the client's physiological response. The success or fluid resuscitation effect in adults is characterized by stable vital signs, inadequate urine output, and peripheral pulse that can be touched.

c) Installation of a urine catheter

Catheter placement should be conducted to measure the production of urine every hour. Urine output is a reliable indicator to determine fluid resuscitation effect.

d) Installation of nasogastric tube (NGT)

NGT give for the client with installation burns 20% -25% or more should be done to prevent emesis, and reduce the risk of aspiration. Ganstrointestinal dysfunction resulting from ileus may occur commonly in client's early stage after severe burns. Therefore, all giving fluids orally should be limited at that time.

e) Checking Vital Signs and Laboratory

Vital Signs are important information as additional data to determine whether adequate resuscitation.

Basic laboratory examination will include examination of blood sugar, BUN (blood ures nitrogen), creatini, serum electrolytes, and hematocrit levels. Levels of arterial blood gases (blood gas analysis), COHb also be checked, especially if there is inhalation injury. Other laboratory tests are x-ray examination to find out a fracture or other trauma may need to be done if needed. Continuous ECG monitoring should be performed on all clients with burn injury, especially if caused by the high voltage electricity, or the clients who have a history of cardiac ischemia or dysrhythmia.

f) Management of pain

Pain management can be achieved through narcotic intravenous drug administration, such as morphine. Giving via intramuscular or subcutan not recommended because absorption of the soft tissue is not good enough during this period when hypovolemia and fluid change that still occur. Similarly, the provision of drugs to overcome orally is not recommended because of the gastrointestial dysfunction.

g) tetanus prophylaxis

Tetanus prophylaxis in burns client is the same, either on heavy burns and minor burns.

h) Data collection

Data collection is a very important responsibility for a team that was in the emergency room. To the client or others need to be asked about the burn injury accident. The required information includes the time of injury, level of consciousness at the time of the incident, whether the injury occurred when clients are in a closed or open space, are there other truma, and how the injury mechanism. If the client is on fire because of chemicals; try to ask about what is the cause, concentration, duration of exposure and whether the patient get immediately cure after injury. Meanwhile, if the client suffers because electrically, then need to be asked about the source, type and voltage flow that can be used to determine the extent of injury. Other information that is needed is about the medical history of past clients such as clients public health record book. More specific information is related to heart diseases, pulmonary, endocrine and kidney disease because it has implications for treatment. Besides it is also important to know about the history of client allergies, either by the drug or the other.

i) Nursing wounds

Wound around the limb and the piston can interfere with circulation and respiration, and therefore should receive attention. Complications are more often occur during resuscitation, when the fluid moves into the peak of interstitial tissue. At around burn injury area on the extremities, then raise the limb above the heart will help reduce dependent edema; although circulatory disorders can still occur. Hence the frequent assessment of the distal limb perfusion is very important to do.

Escharotomy, an appropriate action for the problem of circulation disorders due to burns that circles part of the body. A doctor can do incision of the eschar that will reduce / eliminate constriction of circulation. Generally carried out the client in bed and without use anaetesi because eschar are bloodless and painless. But the network still lives below the wound. If adequate tissue perfusion does not work, then it can be done fasciotomy. This procedure is called fascia, which is performed in the operating room using anesthesia.

Likewise, escharotomy can be done at the burns on the piston to improve ventilation. After escharotomy action, the nurse needs to monitor the improvement of ventilation.

Emergency wound care section consist closing wounds with sheets of dry, clean and warm clothing to preserve body heat. Clients with burns around the head and face placed in the position of head elevation and all the burned extremities by using a pillow to above the surface of the heart. This can help reduce the formation of dependent edema. Mild cold and sterile compresses burn injury to overcome pain. Then taken to health facilities.

3. Acute Phase

The acute phase begins when the patient has stable hemodynamics, capillary permeability improved and diuresis had begun. This phase is generally considered to occur at 48-72 hours after injury.

The focus of management for clients / patients in the acute phase are as follows : to overcome the infection, wound care, wound closure, nutrition, pain management, and physical therapy.

a. Overcoming infection

The sources of infection in the client with burns covering autocontamination from :

* Oropharynx.
* Fecal flora.
* To whom do not get burn skin and cross contamination from staff, cross contamination of visitors, cross contamination from the air.

Special activities to overcome the infection and isolation techniques should be performed on all burn injury treatment centers. These activities vary and include use of gloves, heads but, masks, foot coverings, and plastic clothes. Good hand hygiene should be emphasized to reduce incidence of cross contamination between clients. Staff and visitors are generally prevented from contact with the client if he is suffering from either an infection of the skin, gastrointestinal or respiratory infections.

b. Wound care

Wound care is directed to improve wound healing. Daily wound care includes cleaning the wound, debridement, and wound dressings.

1. Hydrotherapy

Clean the wound can be done by hydrotherapy. Hydrotherapy consists of soaking (immersion) and the shower (spray). This action is carried out for 30 minutes or less for clients with acute burn injury. If too long, it can increase spending sodium (because water is hypotonic) through wounds, spending the heat, pain and stress. During hydrotherapy, wound cleaned slowly and carefully by using various solutions such as sodium hipochloride, providon iodine and chlorohexidine. Care must be maintained to minimize bleeding and to maintain the temperature during this procedure done. Clients are not encouraged to do hydrotherapy, which are usually hemodynamically unstable and made skin graft. If hydrotherapy is not done, the wound can be cleaned and rinsed on the bed of the client and added with antimicrobial substances.

2. Debridement

Wound debridement includes removal of eschar. This measure is intended to improve wound healing by preventing the proliferation of bacteria in the bottom of the eschar. Wound debridement include mechanical debridement, enzymatic debridement, and with surgery.

a) mechanical debridement

Mechanical debridement is carried out carefully using scissors and forceps to cut and lift eschar. Wrap replacement is another way that is also effective from the action of mechanical debridement. This can be done by using a wet to dry dressing (wet-to-dry) and dried to the bandage dressings (dry-to-wet). Mechanical debridement in burn injury can cause great pain, therefore first action needs to be taken to overcome the pain more effectively.

b) enzymatic debridement

Enzymatic debridement using topical preparations of proteolytic and fibrinolytic enzymes. These products selectively digests necrotic networks, and facilitate the removal of eschar. This product requires a wet environment to become more effective and used directly against the wound. Pain and bleeding is a major problem with this treatment and should be reviewed on an ongoing basis during the treatment performed.

c) surgical debridement

Debridement surgery involves excision of tissue injury devitalis (dead). There are 2 techniques that can be used: tangential excision and fascial excision. In tangential, excision is to shave or cut up a very thin layer of eschar until you see the living tissue. tends to be lifted while the fascial excision of scar tissue and fat to the fascia. This technique is often used for very deep burn injury.

3. Wrap

a) The use of specialized wound closure

Deep burn or full thickness initially performed using substances / topical antimicrobial drugs. The drug is used 1-2 times after cleansing, debridement and wound inspection. Nurses need to conduct a review of the eschar, granulation tissue or the presence of reepitelisation and any signs of infection. No single drug used in general, therefore, in some burns service center, no one vote silfer sulfadiazine cream as a topical treatment for burns earlier.

b) open and closed methods

Burn injury can be treatment using open or closed methods / techniques. Open method used antimicrobial cream evenly applied and left exposed to air without bandaged. Cream can be repeated use as needed, ie every 12 hours in accordance with drug activity. advantages of this method is that the wound can be more easily observed, facilitate mobility and joint ROM, and wound care becomes more simple / easy. While the weakness of this method is the increased possibility of hypothermia, and psychological effects on clients because of frequent visits.

In wound care with closed methods, require different types of bandages. Wrap prepared for use as a cap on the used cream. The bandage should be careful to use starting from the distal towards proximal to ensure that circulation is not disturbed. The advantage of this method is to reduce evavoration fluid and heat loss from the surface of the wound, bandage also helps in debridement. While the loss is to limit the mobility of the effectiveness of exercise reduce the possibility of ROM. Examination of the wound also be limited, because it can only be done if you're changing a bandage only.

c) Wound closure

1) While Wound Closure

Temporary wound closure is often used as a wound dressing. A variety of wound closure either biological, biosynthetic, and synthetic materials have been available. Each product has an indication of wound closure special. Characteristics of the wound (depth, exudate amount, location of wounds on the body and the healing phase / recovery) as well as objective measures / treatment should be considered when will select a more appropriate wound closure.

Improving wound healing superficial partial thickness. For use of the excision wound, you need to secure surrounding skin using a sutura, staples, and then wrapped with a bandage. These pads can be lifted out / replaced within 48 hours to check / know the attachment of Biobrane. When you have attached / connecting the sutura, staples can be removed. And let biobrane exposed with air.

Place of new donors, on foot healing requires an advocate during ambulation. Review signs of wound infection and the peripheral part.

2) skin transplant

Skin transplant from a portion of the intact skin of the patient's own autografting which is surgery to lift a skin thin layer that is still intact and then used on burns. This procedure is performed in the operating room by giving anaetesi.

Autograft postoperative care include : assessing bleeding from the donor; improve positioning and immobilization to the donor, donor site care; autograft special treatment (such as: cultur epithelial autograft).

- Bleeding

Bleeding in the autograft to deter / prevent / interfere with the successful attachment of the grafted skin in the excision wound and can lead to graft loss. When there is little blood or serum can be cleaned by turning (by using a sterile cotton swab) from the center toward perifer graft. If the numbers quite a lot, it can be done with aspiration of blood / serum by using a small syringe and needle.

- Setting Position and Immobilization

Autograft should be immobilized after surgery, usually for 3-7 days. The period of immobilization time is make possible to autogratt attached and embedded at the base of the wound. Immobilization can be done with various cama. Setting the right position, traction, splint, can be used to prevent unwanted movement and graft loss. Nurses also have to perform various actions to reduce the danger of immobilization.

- Place of Donor Care

Various types of packing can be use to close the donor site, and this depends on the size, location and boundary conditions of the skin or tissue. The action also depends on the type of treatment used bandages. If the wrapping is done by using sutura and staples, it can be removed at 3-4 days after surgery.

Although there are differences in treatment practice, but the wound on donor site requires actions require the same accuracy for the healing and prevent infection. If the donor has an infection, then the bandage should be removed carefully and cleaned. Then the wound should always be cleaned and used antibacterial drugs. When the donor feels better / recover, the lotion can be used to dissolve the lubrication and relieve itching. Place can be used again if the complete healing has occurred.

d) Nutrition

Maintaining adequate nutritional intake during the acute phase is essential to improve wound healing and prevention of infection. BMR (basal metabolic rate) may be 40-100% higher than normal, depending on the extent of burns. This response is expected to result in adrenal and cause increase heat production in hypotatamus. Metabolic rate is decreased when the wound has closed. In addition, glucose metabolism changed after suffering severe burns, resulting in hyperglycemia. Low levels of insulin during the emergent phase can inhibit insulin activity by increasing catecholamine circulation, and increase gluconeogenesis during the acute phase which all have implications for the occurrence of hyperglycemia on the client.

Aggressive nutritional support is needed to meet growing energy needs in order to promote healing and prevent catabolism unexpected effects.

The formula used to calculate energy needs, is influenced by several things, namely body weight, sex, age, extent and activity of burns or injury. Its formulation is as follows :

(25 kcal x weight (kg) + (40 kcal x% burns) = kcal / day.

Aggressive nutritional support is indicated for clients whom get general burns to 30% or more, clinically require multiple surgery, the need to use a mechanical ventilator, mental status and nutritional status.

The method can include the provision of nutrition via oral diet, enteral tube feeding, parenteral nutrition peripherals, total parenteral nutrition, or a combination.

e) Management of pain

Physiological factors that can affect pain include depth of injury, extent and stage of wound healing. For the type of partial burns thickness, the donor will feel very painful due to stimulation of nerve endings. Contrary to the case with full burns thickness that did not experience pain because the ends have been damaged superficial. However, nerve endings located on the edge of the wound will be very sensitive. Psychological factors that can affect a person's perception of pain is anxiety, fear and the client's ability to use koping. While social factors include past experience of pain, personality, family background, and separation from family and home. And keep in mind that the perception of pain and response to pain stimuli is individualized and therefore the plan of care treatment done on an individual basis as well.

The most often used technique to overcome the pain is use pharmacologic substances. Morphine, codeine, meperidine, nanalgetic narcotics are often used to treat pain associated with burn injury and treatment. Other pharmacologic medications that can be used include analgesics such as nitrous oxide inhalation, and etc. Nonsteroidal anti-inflammatory drug is also recommended to overcome mild to moderate pain.

While the action Non farmacologic used to overcome the pain associated with burns include hypnosis, guided imagery, play therapy, relaxation techniques, distraction, and music therapy. This action is effective to reduce anxiety and reduce perceptions of pain and used in conjunction with the use of pharmacologic drugs.

f) Physical Therapy

Maintain optimal physical function on the client with a burn injury is a challenge for teams who do burn injury medicare. Nurses must work closely with occupational therapists, physioterapist to identify the rehabilitation needs of clients. Exercise programs, ambulation, daily activities should be implemented early in the recovery phase until the repair function works optimally.

Wound contracture and scar formation (scar) are the two main problems in the burns client. Contractures due to injury can occur in a wide wound. The location of the occurrence of contracture are hand, head, neck, and axila.

Measures used to prevent and treat contractures include positioning therapy, ROM exercise, and give education to clients and families.

1) Therapeutic Position

2) Exercise

Active ROM exercises recommended in the immediate recovery in the acute phase to reduce edema, maintain strength and joint function. In addition to the activities and daily activities , ADL is very effective in maintaining the ROM function. Ambulation can also maintain the strength and ROM in the lower limb and must begin when the client has been stable physiologically. Passive ROM is part of the action plan on clients whom are unable to perform active ROM exercises.

3) Splinting

Splint used to maintain position and prevent or correct joint contractures. There are two types of splints are often used, namely static and dynamic. Static splints are immobilization of the joints. Performed at the time of immobilization, during sleep, and on an uncooperative client who can not defend the position well. Unlike the case with dynamic splints. Dynamic splint can train the affected joints.

4) Education

On the client and family, medicator should give education about the correct position and the need to perform a continuous exercise. Written instructions about the various positions which are correct, about splinting and regular exercise that can ease the process of client learning and can be more cooperative.

g) Overcoming Scar

Scar hypertrophy as a result of the collagen deposit in the burns healing treatment. Weighing hypertrophy scar depends on many factors such as burn injury depth, race, age, and type of autograft. Non operation methods to minimize scar hypertrophy is done by pressure treatment (pressure therapy), by using a wrapper and elastic bandage (elastic wraps and bandages).

While surgery method to overcome contracture and scar hypertrophy include :

1. Split thickness and full thickness skin graft.
2. Skin flaps.
3. Z-plasties.
4. Tissue expansion.

4. Rehabilitation Phase

Rehabilitation phase is the last phase of recovery and the last phase of burns treatment. The emphasis of the burn patient rehabilitation program is to increase self-sufficiency through the attainment of maximum function improvement. Measures to improve wound healing, preventing or minimizing deformities and scar hypertrophy, increase strength and function, provide emotional support and education are part of the rehabilitation process.

Special attention on psychosocial aspects

Psychological rehabilitation is as important as physical rehabilitation in the overall recovery process. There are so many psychological and emotional response to a burn injury that can be identified, ranging from "fear up to psychosis." Patient response is influenced by age, personality , cultural and ethnic background, extent and location of injury, and consequently in body image. In addition, separation from family and friends, changes in the roles and responsibilities affect the client's normal reaction to burn injury trauma.

The focus of care is on psychosocial recovery efforts to maximize clients through appropriate intervention.

There are 4 stages of psychosocial burn injury trauma response characterized by : impact; retreat or withdrawal ; acknowledgment (received) and reconstructive (rebuild).

a. Impact.

Impact period occurs immediately after injury is characterized by shock, do not believe (disbelieve), feeling overwhelmed. Clients and families may be aware of what happened but at that time, his koping bad. Research indicates that families with critically ill clients whom need for certainty (assurance), the need to close with other family members and the need for information. More specifically, the family wants to know when family members can be handled, what will be done on the client / family member, the facts about the development / progress of the client, and why the actions / procedures carried out on the client.

b. Retreat or withdrawal

Setbacks (retreat) are marked by repression, withdrawal, the denial / rejection, and suppression.

c. Acknowledgment (received)

The third phase is to receive, beginning when the client receives injury and changes in body image. During this phase the client may get benefit from other burns clients meeting, both in contacts with individuals and groups.

d. Reconstructive (rebuild)

The final phase is the phase of reconstruction, beginning when the client and family receiving the limitations that exist due to injury and start making future plans.

Nursing Process

A. Assessment

Assessment is the first step of the nursing process which aims to collect data both subjective data and objective data. Subjective data obtained on the basis of good interviews with clients, whereas objective data obtained based on the observation and physical examination.

1. Biographical data

The first step is to conduct an assessment of client's biographical data that include name, age, sex, occupation, race, and others. Once the assessment is done then performed assessment biographical data.

2. Extensive burns

To determine the extent of burns can use one of the existing methods, the method of "rule of nine" or method "Lund and Browder", as described earlier.

3. Depth of burns

The depth of the burn can be classified into 4 types, namely first degree burns, second degree, third degree and fourth degree, with the characteristics as described earlier.

4. Location / area of wound

Burns on certain places require special attention, because of the consequences that can cause various problems. Like, if burns area around the face, neck and chest, it can interfere with the airway and chest expansion caused by edema in the larynx. Meanwhile, if the limb, it can cause a decrease in circulation to the extremities due to the formation of local edema and scar tissue. Therefore, assessment of the airway and respiratory (breathing) and circulation are necessary. Burns of the eyes can cause corneal lacerations, retinal damage and decreased vision sharp.

Further data will be obtained depend on the type of burns, wounds and surface weight or body parts affected by burns. The data include in activities and recess may be shown a decline in muscle strength, stiffness, limitation of joint range of motion (ROM), which exposed burns, damage to muscle mass. While in circulation is likely to occur because of hypotensive shock ( hypovolemia shock) or neurogenic shock, peripheral pulses on the distal part of the affected extremity injuries will decrease and the surrounding skin will feel cold. It can also found tachicardia when clients experience anxiety or severe pain. Heart rhythm disturbances may occur in burns due to electric current. In addition, edema was formed almost on all burns. Therefore, monitoring of vital signs (temperature, pulse, respiration and blood pressure) is necessary.

The data relating to respiration is likely to be found the signs and symptoms that showed the presence of inhalation injury, such as hoarseness, cough, carbon particles contained in sputum, redness and edema in oropharing, larynx and cyanosis can occur. If the wound on the chest area, the development of piston will be disrupted. Additional breath sounds that can be heard through auscultation is cracles (on pulmonary edema), stridor (the edema of the larynx) and ronhi due to accumulated secretions in the airway.

Other data that need to be studied is the urine output. Urine output may decrease even no urine during emergen phase. Color blackish urine may appear red if there is myoglobin which indicate a deeper muscle damage. while in the intestine will be found decreased bowel sounds or absent bowel sounds, especially if the wound is more than 20%. Therefore, it can also found the anorexia, nausea and vomiting.

5. Other health problems

The existence of other health problems experienced by the client needs to be studied. Health problems may be experienced by the client's problems before they get burns such as diabetes mellitus, or peripheral vascular disease and others that will slow the healing of wounds. Besides it is also important to watch out for any other injury that occurs during the burn incident occurred as fractures or other trauma. History of allergies need to know whether an allergy to food, drugs or anything else, and the history of the last tetanus immunization.

6. Supporting Data

1. Red blood cells (RBC) : a decline in red blood cells (Red Blood Cell) because red blood cell damage during injury and also due to reduced production of red blood cells as bone marrow depression.
2. White blood cells (WBC) : can occur leukocytosis (elevated white blood cell) as an inflammatory response to injury.
3. Arterial blood gas (ABG) : it is also important to note that the value of arterial blood gases, especially in case of inhalation injury. PaO2 decrease or increase in PaCO2.
4. Carboxy (COHbg) : COHbg levels (carboxy) can be increased by more than 15%, which indicates carbon monoxide poisoning.
5. Serum electrolytes :

1) Potassium in the beginning will increase due to tissue injury or damage to red blood cells and decreased renal function; hipocalemia can occurs when diuresis begins; magnesium may decrease.

2) Sodium get early declines with the loss of water from the body; subsequent hypernatremia can occur.

- Sodium urine : if greater than 20 mEq / L indicate excess fluid resuscitation, whereas if less than 10 mEq / L indicates inadequate fluid resuscitation.
- Alkaline posphatase : increase due to migration of interstitial fluid / sodium pump damage.
- Serum Glucose : increased as a reflection of the stress response.
- BUN / creatinine : increased which reflects the decrease in perfusion / renal function, however, creatinine may be elevated due to tissue injury.
- Urine : presence of albumin, hemoglobin, and myoglobin in the urine indicates that the tissue damage and loss / expense of protein. Blackish red color of urine showed the presence of myoglobin.
- Chest X-rays : To know the description of lung injury, especially on inhalation.
- Bronhoscopy : to diagnose the extent of inhalation injury. It may be found of the edema, hemorrhage and / or ulceration in the upper respiratory tract.
- ECG : to know the existence of disturbances in heart rhythm due to electrical burns.
- Photo Injuries : as documentation to watch the development of burn healing.

Nursing Diagnosis and Intervention

Diagnosis / problem of collaboration, the objectives and criteria for the intervention

Rationalisation Phase Eemergensi (RPE)

1. Fluid volume deficit in capillary permeability and branch fluid from the intravascular space into interstitial space. Clients will shown repair in fluid balance, which is characterized by :
- Not thirsty.
- Mucosa of the mouth / lips moist.
- Urine output: 30-50 cc / hour.
- Good sensory.
- Normal pulse.
- Review of hipovolemia every 1 hour for 36 hours.
- Measure of weight every day.
- Monitor and document every individuals and organizations intake and output every hour.
- Give the fluid replacement and electrolytes through intravenous appropriate programs.
- Monitor serum electrolytes and hematocrit by :
* Transfer fluids that can cause hipovolemia.
* Weight loss was a distinguished accurate index of fluid balance.
* Urine output as a measure of the take effectively reply to the success of resuscitation fluid.
* Used intravenous fluids to improve fluid volume.
* Hypercalaemia and increased hematocrit is a common thing.

2. Illeus paralytic potential stress from injury.

3. Potential renal failure like hemachromagen presence in the urine because of deep burn
Nurses will monitor normal sounds active bowel, the presence of abdominal distension, flatus production and normal bowel movements.

Nurses will record hemachromagen in the urine output which is inadequate: 75-100 cc / day.
- Assess the need for the NGT installation.
- Assess bowel function :
* Auscultation by singing every 4 hours.
* Observation abdominal distension :
a. Monitor gastric output, quantity, color and the blood pH.
b. Monitor and document individuals and organizations every hour (urine output and urine color).
c. Make sure to cateter urine flow in good condition.
d. Give intravenous fluids according to the program.
e. Prepare a urine sample for myoglobin/hemoglobin examination of appropriate levels of the program.
o · Illeus generally occurs in burns> 20-25%.
o · Bowel peristaltic may indicate sounds.
o · Showed abdominal distension to occur illeus.
o · Expenditures of gastric fluids require replacement of liquid. Gastric ulcers often happened to severe burns.
o · Urine turns red or dark brown if hemachromagen occur.
o · The catheter can be blocked by hemachromagen.
o · Hemachromagen will splint out of the body.
o · Providing information about the risk of kidney failure.

4. Impaired gas exchange like carbonmonoxida poisoning, lung damage.
Client will demonstrate improved gas exchange, which is characterized by :
- Respiration 16-24 times / minute without any effort.
- PaO2> 90 mmHg.
- PaCO2: 35-45 mm-Hg.
- SaO2> 95%.
- Voice clean breath of both lungs.
- Review the signs of respiratory distress characterized by :
* Nervous, confused.
* There are efforts to breath, tachypnea, dyspnea, tachicardia.
* Levels of PaO2 and SaO2 decreased.
* Cyanosis :
a. Monitor arterial blood gas levels and COHb as requested by physician.
b. Monitor SaO2 levels continuously.
c. Give oxygen regarding to the program.
d. Teach the patient to use spirometry.
e. Elevate bed head.
f. Monitor the need for intubation endotraheal installation :
o · Impaired gas exchange respiratory distress due to hypocsemia.
o · Providing data on bag respiration / oxygenation effectivity.
o · Providing non invasive oxygenation data.
o · Lowering hypoxemia.
o. Empowering to breathe deeply.
o · Easing lung expansion.
o · Intubation may be required to maintain oxygenation.

5. Ineffective airway clearance, such as edema trahea, decreased lung function due to injury inhalation ciliar.

6. Changes in peripheral tissue perfusion like constriction due to burns.
Airway clearance in the client will be effective, which is characterized by:
- Voice of clean breath.
- Clean until pulmonary secretions white.
- Mobility of effective pulmonary secretion.
- Respiration without effort.
- Respiration rate :16-24 times / min.
- It does not show ronchi, whezing, stridor.
- No dyspnea.
- No cyanosis.

Peripheral perfusion client will be adequate, which is characterized by :
- Pulse can be felt through Dopler.
- Capilari refill on the skin that is not in flames.
- No immune.
- There is no increase in pain during ROM exercises.
- Teach client to cough and breath in every 1-2 hours for 24 hours, then every 2-4 hours, while awake.
- Put the oral suction equipment in client range for its own use by the client.
- Perform endotracheal suctioning if necessary, and monitor and document the characteristics of the sputum.
- Remove all jewelry and tight / narrow clothes.
- Limit the use of blood pressure cuff that can cause constriction in the extremities.
- Monitor arterial pulse by palpation or by Dopler every hour for 27 hours.
- Record capilary refill on the skin which is not burning in the affected limb reply :
* Ease in cleaning the upper respiratory tract.
* Empowering clients to clean up their own oral secretions and sputum.
* Removes secretions from the upper respiratory tract. The color, consistency, smell and the number could indicate an infection.
* Able to endanger the circulation as a result of edema.
* Able to reduce the flow of arterial and venous return.
* Eliminate hypoxemia.
* Capilary refil become elongated and circulatory disorders.

7. Hypotermia is the loss of epithelial tissue and the fluctuations in air temperature.
Client will maintain normal body temperature, which is characterized by a core body temperature between 99.6 to 101.0 degrees F.
- Assess the level of pain with active ROM exercises.
- Elevate the affected limb above the heart.
- Encourage the client to perform active ROM exercises.
- Anticipate & prepare clients for escharotomy.
- Care Escharotomy Post:
Assess circulation :
* Check pulse.
* Record the color, movement and affected sensation motion.
a. Overcome escharotomy postoperative bleeding with an emphasis, electrocautery, sew the vessel which was bleeding.
b. Monitor rectal temperature as indicated (every hour during the emergency phase and after the surgery).
c. Tissue ischaemia causing pain.
d. Lowering dependent edema formation.
e. Improve venous return and reduce muscle atrophy.
f. Escharotomy done to improve the circulation and tissues.
g. Data indicating a distinguished adekwat perfusion.
h. Networks are still living before it will bleed :
o · Hypothermia can occur after skin loss due to damage to the heat regulator.

8. High risk of stress ulcers occur as a result of neurohormonal stress response to burn.

9. Changes in nutrition: less than body requirements make the increased metabolic needs for wound healing. Nurses will monitor bleeding gastrointestin and will maintain gastric pH> 5. Adequate nutrition clients, shown by 85-90% to maintain the weight before it burns.
- Limit the exposed body part during wound care.
- Limit long hydrotherapy treatment to 30 minutes or less with the water temperature between 98 to 102.0 degrees F.
- Use the external heating / radiation heating lamps.
- Preserve / keep the procedure room to stay warm.
- Monitor and document the value of gastric pH and the presence of blood every 2 hours during NGT inserted.
- Give antacida and / or H2 receptor antagonist suitable physician program.
- Monitor the existence of fecal blood.
- Assess the weight before the burn.
- Consult to the dietitian.
* Section is open (exposed) and it can cause hypothermia. Heat out of the wound open and after hydrotherapy through evaporation.
* External heat source.
* Secretion gastric acid can cause bleeding.
* Lowers gastric acid contents.
* Stress ulcer causing bleeding, and may be excreted into the feces.
* Caloric needs based on pre-burn weight.
* To conduct a study of nutrition.

Rationalization
- Assess eating patterns, preferences, food allergies within 72 hours after a meal.
- Record caloric intake (total calories).
- Measure weight every day to follow the trend at some agencies (exception : if the operating procedures require restrictions on movement).
- Perform oral hygiene each shift / if needed.
- Set a schedule treatments provided as not to disturb the feeding schedule.
- Take time before the hour meal break if the client is experiencing pain due to procedures or treatments.
- Provide tools to facilitate feeding.
- Encourage client / family to bring favorite foods from home.
- Provide nutritional supplements between meals.
- Provide positive reinforcement to eat.
- Data quantitative caloric intake.
- Weight loss will be stable if met calory intake.
- Prevent stomatitis and increased my appetite.
- If disturbed, eating schedule can reduce calorie intake.
- Pain reduce appetite.
- Facilitate self care.
- The client will taste the foods that are preferred.
- Calorie needs often needs to be improved.
- Client with anorexia believe that eating is not beneficial.

10. High risk of infection due to loss of skin defense, disruption imune response, the presence of catheter placement (indweling urinary cateter and intravenous cateter), and invasive procedures (blood sampling both arteries and veins, and bronchoscopy). Clients will not experience the invasion of microbes on the wound, which is characterized by :
- The wound culture.
- Temperature : 36-37 ° C.
- No swelling, redness, or purulent secretions on the places stabbing (catheters, vein).
- The culture of blood, urine and sputum negative.
- Provide tetanus prophylaxis if necessary.
- Maintain a technique to control infection.
- Instruct other families about infection control measures.
- Wash your hands thoroughly.
- Review the clinical signs of infection : changes in color or wound drainage, odor, long healing, headache, chills, anorexia, nausea, changes in vital signs; hyperglycemia and glicosuria; paralitic ileus, confusion, anxiety, hallucinations.
- Before regiven topical medication, wash and clean the wound first.
- Dispose of tissues which have been dead.
- Hair cut around the edge of the wound body (except hair and eyebrows).
- Environment eschar which allows anaerobic growth of the causative organism of tetanus.
- Prevent cross contamination.
- Improve awareness / compliance.
- Reduce the incidence of cross contamination.
- Open wound imunocompromy to the client so that the infection of both local and systemic injury is a risk to the client.
- Remove dirt.
- The network is a good medium for bacterial growth.
- Hair can be contaminated and disturb the attachment of cream.

11. Pain on the burn injury, stimulation of nerve endings, and anxiety treatments. Clients will be more comfortable characterized by :
- Expressing pain / discomfort reduced.
- The client can identify the factors affecting pain.
- Assess client's response to pain during wound care and at rest.
- Give pain medication :
* 45 minutes earlier if through the mouth.
* 30 minutes earlier if through intramuscular.
* 5-10 minutes earlier if intravenous.

Do not be given via intramuscular in clients with severe burns emergent phase :
- Teach relaxation techniques, music therapy, guided imagery, distraction, and hypnosis.
- Explain all procedures on the client and provide time for preparation.
- Talk with clients while performing maintenance and perform the procedure.
- Assess the possibility of the need for granting anxiolitic.
- Record the client's response to medication and treatment nonfarmachologic.
- Adequate time to onset of analgesic.
- Injection is not recommended because of limited circulation interfere with the absorption.
- Degrees is analgesic nonfarmachologic.
- Reduce anxiety.
- Improve client confidence.
- Anxiety lowered pain threshold.
- Assessing the effectiveness of interventions.

12. Less able to care for themselves (grooming, bathing, eating, elimination), the functional deficit resulting from a burn injury, pain, bandages, and immobilization advice.

13. Impaired physical mobility such as edema, pain, bandages, surgical procedures, and wound contracture. Clients will experience a decrease in reduced ability in self care and will show increased participation in self-care.

Clients will experience improved physical mobility marked by a return to maximum perform daily activities with a disability and minimal interference figure.
- Assess client's ability in self care.
- Consult with occupational therapy on the need to use tools.
- Encourage clients to participate in self care tasks.
- Reassure the client that he needs sufficient time to complete tasks.
- Provide positive reinforcement when client tasks can be achieved.
- Assess ROM and muscle strength in the wound area that may have contractures every day or as needed.
- Keep the wound area in a position of physiological functions.
- Explain the reasons for the need for activity and setting the position of the client and family.
- Improve self care.
- Assist clients motivate and remove fears / worries and dependence.
- Assist to control himself.
- Improve self reliance and motivation.
- Prevent / reduce the occurrence of contracture.
- Improve compliance.

14. High risk of self esteem problems such as threats change / actual changes in body image, physical loss and loss of roles and responsibilities. Clients will develop self esteem improvement characterized by :
- Create social contact with people other than family members.
- Developing an effective koping mechanism during the recovery phase.
- Express grievances about the concept of self.
- Consultation for physical and occupational therapy and adjust schedule as needed.
- Encourage perform active ROM every 2-4 hours while awake if there are no contraindications for a graph procedure is being done.
- Ambulation client to a chair or walking (if not contraindicated by the procedure graph or other injury).
- Passive exercise if the client is unable to participate actively.
- Determine previous coping styles.
- Explain the projected appearance of burns and graft during the phases of wound healing.
- Make sure the client through the development stages of denial, grief and accept injury and recovery.
- To be given any tool.
- Controlling edema post resuscitation and prevent muscle atrophy, tendon adhesions, joint stiffness and capsular shortening.
- Ambulation increase muscle strength and function cardiopulmoner.
- Passive ROM maintain joint motion and muscle tone.
- As basic data about koping , maybe the client will try again these koping styles.
- Providing information; to reduce misconceptions.
- The development of the client varies depending on the level of injury, perceptions of injury, ancillary systems and koping style.

15. High risk of ineffective family koping in an emergency and critical nature of burns and separation / away from home and friends. Families will experience improved koping strategies characterized by :
- Reveal medicinal purposes, express emotional stress.
- Understand available support services.
- Search for maladaptif behavior.
- Increase the confidence the client :
* Ensure continuity of care.
* Discuss all activities and procedures before starting.
* Support client's role in the care and treatment bridge.
* Convey the development of client information.
* Give honest information, and positive reinforcement.
* Help family members / other people to interact with clients.
- Push for interacting with others outside the home.
- For information on family or others who visit for the first time about :
* The extent of injuries and changes in clients appearance.
* Control procedures and wearing equipment.
- Maladaptif behavior is dangerous.
- Improve confidence.
- Down the anxiety.
- Motivating clients; reduce fear.
- Do not give false hope of a repair function if happens irreversible damage.
- Family may fear and need guidance.
- Facilitating social reinteraction.
- Preparing to reduce fear.

Rationalization
- Determine how clients and families cope with stress in the past.
- Help clients cope with stress by providing koping strategies such as diversion and relaxation techniques.
- Inform the family about the developments / changes to clients every day.
- Consult to psychologists, psychiatrists, social workers, psychiatric nurse specialist if necessary.
- Providing new strategies on the client.
- Maintain a realistic perception of the development of client.
- Professionals can help improve the client's koping strategies.

Treatment of burns is a complex and challenging. Physical and psychological trauma experienced after the injury can cause suffering for both patients and families themselves and others that are considered important. The burn care team whom became a key member are nurses who are responsible for making individual treatment plan that reflects the client's overall condition.

Broken bones : Type, Cause, Symptoms, Diagnosis, Treatment, Herbal Treatment

2011-01-19T06:53:00.000-08:00

Broken bones are a medical condition in which bone was broken or cracked. Broken bones can occur because of external factors (like fall) or from conditions such as softening of the bones due to osteoporosis, cancer, or other disability.

Types of Fractures

There are various types of fractures. To be more systematic, can be divided based on :
1. Location
Fractures can occur in various places on the bone as in diaphisis, metaphysical, epiphyseal, or intraarticular. If the fracture is obtained in conjunction with dislocation of joints, then it called a fracture dislocation.
2. Size
Divided into complete and incomplete fractures. Fractures incomplete is cracked.
3. Configuration
Fractures can be divided into transverse (horizontal), oblique (slanting), or spiral (spiral). If more than one fracture line, then called cominutive.
4. The relationship between the fractures
Inter-part fractures can still relate (undisplaced) or are far apart (displaced).
5. The relationship between fracture with surrounding tissue
Fractures can be divided into an open fracture (if there is a relationship between bone and the outside world) or fracture closed (if there is no relationship between the fracture with the outside world).
6. Complication
Fractures can occur with accompanying complications, such as nerve disorders, muscle, joints, and etc. or without complications.

There are many common types of the bone fracture, namely as :

1. Closed fractures and open fractures.
Closed fracture is a bone condition broken (or cracked), the broken bones resides in the skin (muscle) while open conditions are broken bones out of the skin (muscle).

2. Simple fracture and multiple fractures.
In simple fracture, broken only in one place and multiple broken bones are in many places.

Simple closed fractures is easier to treated if we compare with open fractures of multiple fractures (especially coupled infection). The handling of every fracture case, either use a pen, gypsum, or other treatments, it will be very dependent on the type and origin of damage to the bone itself.

Broken bones may occur as a result of severe injuries on the body so that the bone be broken down, and cause pain. If we find someone whose get bones broken, we should be careful if you want to help him because his injured will worsen if you give him wrong treatment.

People who get broken fracture should be immediately brought to hospitals, health centers, clinics, doctors, or other health centers to immediately be given intensive treatment. Broken bone can gradually recover.

How to respond :

A. Broken Bones Closed/Closed factures

Closed fractures are fractures where the fracture bones do not hurt / ripped flesh the nearby skin. These fractures can be open if get bleeding wounds.
Treatment :
- Lay down the victims of broken bones and do not move around unnecessarily.
- Put a buffer for a broken bone fracture. Broken bones are not getting better by using spalk / splint, cane, wood, broom fibers, mast antenna, etc. The lightweight and strong tied or wrapped in strong but did not make bond or a bandage on the broken part.

B. Broken Bones Open/Open fractures

Open fractures are fractures where the fracture make meat and the skin around the fracture to be torn injured. These fractures should really need to watch out because easy to get infection because of the gaping wound.
Treatment :
- Lay down the victims of broken bones and do not move around unnecessarily.
- If the blood is still flowing, stop the bleeding by pressing and binding the injured part with a clean cloth.
- Put a buffer for a broken bone fracture. Broken bones are not getting better by using spalk / splint, cane, wood, broom fibers, mast antenna, etc. The lightweight and strong tied or wrapped in strong but did not make bond or a bandage on the broken or injured .

C. Broken Spine / Spinal fractures

On condition broken backbone or spine, the patient will feel pain in the back or the neck. If so then do not cause much movement on the victim. As the movement not to damage the spinal cord that can cause permanent paralysis. I recommend that you wait for an ambulance or medical personnel with experience to take care of the victims further.
Treatment :
- Do not make a lot of move with the patient, like raising his head, standing, sitting, etc. If not to urgent, you should not moved fractures from its original place and keep the remain position with the head straight up.
- Warm the body of a spine fracture patients with blanket.
- Use a carrier with a strong base and hard like a board, table, and etc. Transported at least two people to be stable on the table.

Types of fractures based on the wound :
1. Closed fractures (broken bones simplex).
A broken bone is not visible from the outside.
2. Open bone fracture (compound fracture).
A broken bone looks from the outside because the bone had broken through the skin or the skin has torn. Open fractures more easily infected.
3. Compression fractures (broken bones due to suppression).
Compression fractures is the result of the energy that drives a bone against other bones or a pressing force against the long bone. Common in older women who become brittle due to spinal osteoporosis.
4. Fractures due to run over.
A very great power caused some cracks that occurred on a few bone fragments. If blood flow to the affected bone disorder, then the healing will run very slowly.
5. Avulsi fractures.
Avulsi fractures caused by strong muscle contraction, so part of the bone are attached. Most often occurs in shoulders and knees, but can also occur on the leg and heel.
6. Pathological fractures.
Occur if a tumor (usually cancer) has grown into the bone and causes bones to become brittle. Brittle bones that can break bones, although with minor injuries or no injuries at all.

Cause

Most fractures are the result of injury, such as car accidents, sports or a fall. Fractures occur when a power greater than the bone against bone strength.

The type and severity of fracture are influenced by :
- The direction, speed and strength of the force against the bone
- The age of patients.
- Flexibility of the bone.
- The type of bone.

Fragile bones due to osteoporosis or tumor may become a broken bone.

Clinical Symptoms of Fractures

A fracture can be characterized by:
- Swelling.
- Changes in shape, can occur angulation (formed angle), rotation (distorted), or shortening.
- There is pain at the fracture area.

Pain is usually a real symptom. Pain can be very severe and usually increasingly worse, especially if the affected bone is moved. Touching the area around the broken bone can also cause pain.

Tool motion can not function properly, so people can not move her arm, standing on one leg or with her hands clasped.

Blood can leak from a broken bone (sometimes in considerable amounts) and into surrounding tissue or out of the wound due to injury.

Diagnosis

X-rays can usually indicate a broken bone. Sometimes need to do a CT scan or MRI to see more clearly the areas of broken bone. If the patient get more improvement, x-rays are also used to monitor healing.

Treatment

Four main goal of fracture treatment are :
1. To relieve pain.
Pain arising in the fracture is not because the fracture itself, but because the injured tissue around the broken bone. To reduce pain, it can be given pain-killers and also with immobilization techniques (not moving the fracture area.) Immobilization techniques can be achieved by installation of a splint or cast.
- Scan : hard object placed in the area around the bone.
- Installation of gypsum : a strong material that is wrapped around a broken bone
In some fractures, need scan to restrict movement. With this treatment, broken collarbone (especially in children), shoulder bones, ribs, toes and fingers, will recover completely. Other fractures should really not be moved (immobilization).

2. To produce and maintain the ideal position of the fracture.

Splint and cast is not able to maintain position in a long time. It required more technique that is more stable as the installation of continuous traction, external fixation or internal fixation depends on the type of fracture.
- Withdrawal (traction) :
Using a burden to hold a limb in place. It is now rarely used, but once the main treatment for broken femur and pelvis.
- Internal Fixation :
Surgery to place the dish or metal rod on the bone fragments.

3. If bone re-unification occurs
Usually a broken bone will begin to merge within 4 weeks and will blend perfectly within 6 months. But sometimes there is interference in the union of the bone, so that required bone graft. The healing process takes at least 4 weeks, but in the elderly usually require a longer time. After recovery, the bone is usually strong and return to function properly.

4. To restore its original function

Immobilization can lead to a decrease in rigidity of muscles and joints. Thus the mobilization efforts are needed as quickly as possible.

Immobilization can be done through :
- Scan : hard object placed in the area around the bone.
- Installation of gypsum : a strong material that is wrapped around a broken bone
- Withdrawal (traction) : using weights to hold a limb in place. It is now rarely used, but as main treatment for hip fracture.
- Internal Fixation : Surgery to place the dish or metal rod on the bone fragments. Is the best treatment for hip fractures and fractures with complications.

Immobilization of the arm or leg causing the muscles become weak and shrinking. Therefore, most patients need to undergo physical therapy. Therapy begins at the time of immobilization performed and continued until scan, plaster or traction has been released. In particular fractures (especially hip fracture), to achieve complete healing, patients need to undergo physical therapy for 6-8 weeks or sometimes even longer.

Supplementary Examination

Normally physical examination, a diagnosis of fracture has to be enforced. Imaging studies (such as x-ray) to assist in viewing the type of fracture to assist in the selection of subsequent therapy. Things to remember in the x-ray examination is the result should consist of two joints, the two sides, and two bones (right and left). Roentgen is also useful for evaluating the results of the given therapy.

United States Food and Drug Administration (FDA) has recently issued a warning to the drugs that used to prevent brittle bones or osteoporosis because it can increase the risk of fractures. The FDA added that all drugs in the bisphosphonate class must add warnings on the labels that these drugs have side effects that are not normal.

For information, bisphosphonates has been given to more than half a million patients in an effort to strengthen bones and reduce fracture risk. In the UK, only a bisphosphonate drug, alendronate, that is suspected include in the warning. Nearly three million people in the UK have osteoporosis. This brittle bone condition is also causes 230 thousand people suffer a fracture each year.

Herbal treatment for broken bones

Characteristic of Broken Bones (Eupharbia tirucalli L.) plant is not only composed of leaves and stalks that resemble bones. This plant can grow up with the trunk. Despite the cut, these plants can live if placed in the ground. The sap contained in Broken Bones plant proved empirically can treat broken bones.

The content of the sap :
- Euphorbone.
- Taractsasterol.
- Alacttucerol.
- Euphol.
- Rubber substance.
- Bitter substances.

Benefits using Broken Bones plant's sap :
As the name implies, Broken Bones plant to treat bone fractures. This plant bark finely ground and mixed with oil, then used the sap as ointment in the skin of broken bone (where the broken bone is located). After given the tree sap, the broken bone location need to be wrapped.

Cataract : cause, symptoms, diagnosis, treatment, prevention

2011-01-12T06:52:00.000-08:00

It is said that about 80 percent of human experience gained through his eyes. When the vision faded, even though a person's life go dim. The main cause of blindness in the world are cataracts (45 percent). Other causes include glaucoma, diabetes mellitus, trauma (37.5 percent), trachoma (12.5 percent), and onchocerciasis or river blindness (0.6 percent). Cataract is the turbidity that occurs in some or all parts of the eye lens. The cause of cataracts is due to aging, accident, disruption of metabolism due to prolonged illness, congenital birth or even poisoning. Symptoms are felt by people with cataract is a cloudy vision, glare, when viewed with the aid of light on the pupil will look cloudy.

The lens serves to form a shadow on the retina. Eye lens is composed of protein, water, and lipids with a specific structure so that light can penetrate the lens. Eye lens cataract patients covered with protein, so a bit murky. One allegation is that there is a change of proteins and lipids with age. The cloudy lens is difficult to continue the light into the retina for processing.

According to the cause, cataract is divided into several types :
1. Senile cataract (aging).
namely cataracts that arise after age 40 years, the process certainly is not known, allegedly because of aging.
2. Congenital cataracts.
namely cataracts that arise in the womb or arise after birth, generally caused by an infection, and metabolic abnormalities during embryo formation. Congenital cataracts are often caused by infection of the mother during pregnancy, especially in the first 3 months of pregnancy.
3. Traumatic cataract.
namely cataracts that can strike all ages, usually because of post-traumatic both sharp and blunt on the eye especially on the lens.
4. Cataract Complicated, is attributable to post-cataract eye infection.

Congenital cataracts

The existence of congenital or infantile cataract is a threat to vision, not only because of direct obstruction to the vision but also because of the shadow of retinal disorders disrupt visual maturation in infants and result in amblyopia. If there are bilateral cataracts and has significant effect on the keen eyesight and oscillation will occur amblyopia meta (nistagmus). Both lenses are experiencing cataracts requiring immediate surgery and the use of contact lenses for correcting afakia.

Congenitalis cataracts can be hereditary (inherited in an autosomal dominant) or can be caused by :
1. Congenital infection, such as German measles.
2. Associated with metabolic diseases, such as galactosemia.

Risk factors for congenitalis cataract are :
1. Inherited metabolic disease.
2. History of cataracts in the family.
3. Viral infection in the mother when the baby is still in the womb.

Management of contact lenses require input and motivation from parents. Unioncular congenital cataract therapy remains controversial. Unfortunately the results of surgery and vision just a little disappointing because amblyopia persists despite better optical correction with contact lenses. Therapy to maximize the success must be done within the first few weeks of life and is accompanied by coordinated patching regularly in the eye contralateral to stimulated visual maturation in the eye ambliopic. Intraocular lens implanted in more and more children over the age of 2 years. The eyes are getting myopic with age children, Thus, the lens power is difficult to make choices.

Changes Lens Shape
Abnormal lens shape is very rare. Curvature of the anterior lens can be increased in the central (anterior lentikonus) in Alport syndrome, a condition derived recessive on deafness and nephropathy. Small abnormal lens can be connected with short stature and other skeletal abnormality.

Lens Position Change (Ektopia lentis)
Weaknesses zonula cause a shift lens. The lens becomes more rounded and more myopic. It is found in :
- Trauma.
- Impaired metabolisms from birth (like homosistinuria, recessive disorder with mental defect and skeletal characteristics. Lenses typically shifts down).
- Certain syndromes (like Marfan syndrome, dominant disorder with skeletal and cardiac abnormalities and the risk of aortic aneurysm dissection. The lens is usually shifted towards the top). There is a defect in protein zonula because fibrilin gene mutation.

Irregular myopia can be corrected optically afakia although sometimes necessary correction if the lens is substantially shifted from the visual axis. Appointment of surgery may be indicated, especially when the lens is shifted causing secondary glaucoma but the surgery can lead to further complications.

Cataracts in adults is usually associated with aging. Cataracts in adults are grouped into:
1. Immature Cataract: lens still has a clear section.
2. Mature cataracts: the lens is completely opaque.
3. Cataract hipermature: there are parts of the lens surface that has seeped through the lens capsule and can cause inflammation of other eye structures.

Cataracts are classified into three types:
1. Sub capsular cataract begins at the back of the lens. People with diabetes, severe farsightedness, retinitis pigmentosa, or those taking high doses of steroids, can suffer from this cataract.
2. Nuclear cataract occurs in the nucleus or center of the lens and is usually associated with natural aging (senile cataract), which usually occurs after 60 years.
3. Cortical cataracts form in the lens cortex and gradually extends from the outside to the center of the lens. Many people with diabetes had cortical cataract.

Cataract is the medical term for each state cloudy in the eye lens. Eye lens mainly composed by water, proteins, and lipids. Proteins are made up simple so that light can penetrate the lens and focused on the retina. Sometimes, these proteins accumulate together so muddy or cover a small part of the lens. That's called a cataract. The longer, the enlarged collection of proteins and cloud on the lens. The signs of cataracts include blurred vision, light seem too bright at night, sunlight or light glare, and colors looked faded.

Until now, experts are not yet able to ensure the main cause of cataracts. However, they believe that cataracts are caused by many factors, individually or together. One of the logical cause is a change in protein and lipids in the eye lens associated with increasing age. This is consistent with the fact that most cataracts occur in the elderly.

The cause and process of cataract occurrence

Most cataracts occur due to aging, but cataracts can also be caused by several other risk factors, such as :

1. Traumatic cataract caused by a history of trauma / injury to the eye.
2. Secondary cataracts caused by other diseases, such as: disease / disorder metabolism, the process of inflammation in the eye, or diabetes mellitus.
3. Cataracts that are caused by exposure to radiation.
4. Cataracts that are caused by the use of long-term medications, such as corticosteroids and cholesterol-lowering drugs.
5. Congenital cataracts that are influenced by genetic factors.

Cataracts in the elderly occurs through two processes, namely :

1. Buildup of protein in the eye lens.

The composition of the eye lens is mostly by water and protein. Buildup of protein in the eye lens may cause cloudiness in the eye lens and reduce the amount of light entering the retina. The process of accumulation of these proteins occur in phases, so that in the early stages a person does not feel the complaint / disturbance of vision. In the next process, this protein buildup will be more widespread so that the visually impaired will be more widespread and can be up to blindness. This process is the most common cause leading to cataracts which occur in the elderly.

2. Change the color of the lens of the eye that occurs gradually with age.

In normal circumstances the eye lens is clear. Along with age, the lens may change color to yellow or brown turbid. This process can cause visual disturbances (blurred vision) to someone, but did not inhibit the delivery of light to the retina.

Other risk factors that may cause cataracts :

- Patients with diabetes mellitus.
- The use of some drugs in the long term (like corticosteroids).
- Bad habits such as smoking and consuming alcohol.
- Lack of intake of antioxidants, like vitamins A, C and E.
- Exposure / ultraviolet radiation.
- Low blood calcium levels.

Long-term use of cholesterol-lowering drugs, such as drugs statins and squalene synthase inhibitors may increase the risk of lens opacities (cataracts). Squalene is an enzyme found in the body and plays a role in cholesterol metabolism. Inhibition of squalene synthase enzyme due to the use of cholesterol-lowering drugs can trigger the occurrence of cataracts.

Therefore, try to consider the addition of squalene intake to prevent the occurrence of cataracts in the long-term use of cholesterol-lowering drugs.

Squalene can be found in foods derived from animal and vegetable, such as fish liver extract "shark bottle" (Centrophorus atromarginatus), olive oil, palm oil, wheat germ oil, Amaranth oil and rice oil. The highest levels of squalene found in fish liver extract "shark bottle."

Patients with prostate cancer appear to be faced with a dilemma situation. If left untreated the cancer will continue to spread, while the available hormonal therapies can increase the risk of cataracts.

Prostate cancer mostly happen with male type cancer, which is triggered by an increase male hormone "testosterone". To overcome this, a given therapy is to suppress production of testosterone with androgen deprivation therapy (ADT).

There are several ways of ADT, the most popular is in the form of drugs such as Lupron and Zoladex. Another way that is rarely done is through surgery, to remove the second item or scrotal testes. Both have similar side effects, namely increased risk of diabetes and obesity.

Symptoms of cataracts

In general a cataract patients will feel :
- Blurred or foggy vision, even can not see.
- Frequently replace the glass eye, because of its size easily changed.
- In the light of circumstances, the eye was dazzled.
- Sight increasingly blurred in the afternoon.
- Sometimes the vision becomes shaded.

Complaints or symptoms of cataracts caused by turbidity process that occurs in the eye lens. This process does not occur in a short time, so the symptoms do not appear suddenly. Cataract consists of 4 stages, namely: early stage (incipient), immature stage, mature stage, and stage hipermature. In the early stages (cataract incipient) turbidity of the lens is still very minimal, not even visible without using a tool to check. At this time the sufferer often does not feel the complaints or disturbances in vision, so that tends to be ignored. In the next stage, the process of lens opacities has continued and increased, so that complaints are often delivered by patients with cataract is difficult when reading, vision becomes blurred, and difficulty doing daily activities.

Cataract Diagnosis

Diagnosis based on symptoms and eye examination results.

Diagnostic tests that commonly performed are :
1. Standard eye examination, including examination by slit lamp.
2. Ultrasound eye in preparation for cataract surgery.

Cataract Treatment

The symptoms that arise in the mild cataracts can be helped with using eyeglasses, magnifying lenses, light the lighter, or glasses that can deaden the light. At this stage no action required surgery.

When symptoms of cataracts begin to appear, you can improve your vision temporarily by wearing new glasses, stronger glasses, magnifying glass, proper lighting or other visual aids. Eye drops are not helpful to clarify the eye lens.

Cataract surgery is an effective way to improve the eye lens, but not all cases require cataract surgery. Cataract surgery is necessary if the turbidity of the lens causing a sharp decline. Cataract surgery may be considered to be done if the cataract occurs in conjunction with other eye diseases, such as uveitis, glaucoma, and diabetic retinopathy. In addition, if the results obtained after surgery is much more advantageous compared to operating risks that may occur.

Cataract operations, which can be overcome by making the lens cloudy. There are several surgical technique performed in hospitals, namely : Operating with large slices with conventional suture and with a small incision without stitches removed with a tool "Phaceomulsification" lens (small incision surgery).

The most common surgical technique and advanced to cataracts is phacoemulsification. In phacoemulsification, a device that is controlled by the ultra sound is used to form emulsion and issued a cataract lens through a small opening about the size of 1.8mm. The tools used by hand has a metallic tip, which vibrates at high speed. This vibration control device is a machine that controls the entry of the fluid flow into the eye. The entire system is essential to create stable and reasonably moist eyes so the doctor could operate safely and efficiently.

After eye cataracts removed, an artificial replacement lens, Artificial Intraocular Lens (IOL) implanted into the eye. Length is about 12.5mm. This artificial lens is inserted and will forever be in the eye. With technology the previous IOL, cataract patients were forced to wear thick glasses or contact lenses after surgery. But in recent years, medician has developed the latest technology in IOL design. Now, most of the IOL in phacoemulsification made of silicone or acrylic IOL so that the lens becomes flexible.

Therefore, it can be rolled easily or folded when inserted into the eye. The process is relatively fast because it does not require eye stitched, low levels of discomfort, quick healing process even has a chance to not wear glasses anymore.

Wound incision in the cornea sometimes do not require sutures, so that recovery of vision can be felt immediately. Phacoemulsification technique takes 20-30 minutes and requires only topical anesthesia / eye drops during the operation.

Selection of surgical technique depends on hardness of the lens. After the cataract lens is taken, the patient could only count fingers at a distance of 1 meter, unless the patient replaced the lens.

Replacement lenses with two ways :
- Patients after surgery use positive eyeglasses or contact lenses for approximately 10 diopters.
- Patients with a lens mounted at the same time conducted operations planting, the advantage is the patient heal immediately after surgery, and patients can see clearly, do not need to wear very thick glasses, the patient remained wide visual field and distortion of the rays can be eliminated.

Extras capsular

With this technique required a longer slice the cornea, in order to remove the lens nucleus as a whole, then the rest of the lens is aspiration. Eye lens that have been taken, is replaced with permanent crops. Terminated by closing the wound with a few stitches.

The elderly are not the only party that can be affected by cataract disease. Cataract disease can strike children, the symptoms are difficult to identify and detect. Cataracts in children usually occurs because of infection while still in the womb. Mothers who conceive and develop measles (morbili) at risk of bearing children with abnormalities of cataracts, opacities in the eye lens marked the first view clear and white. If the eye lens cloudy because of cataract, the light from outside can not enter the eye causing blurred vision.

Therefore, pregnant women must often control the womb to the doctor and must not underestimate the possibility that the infection will cause their children stricken with cataracts. Symptoms of cataracts which easily seen in children and infants is a condition in which pupils looks white or gray, and then his eyesight got worse and be accompanied by nystagmus (eyes).

Patients who already get nystagmus, especially in infants, is easy to see tangible marked pupils which do not respond to body movement. Normally, the pupils of the eyes will follow the motions of objects that shown to him, but for people with cataracts, they will see it with rocked vision.

Cataract surgery in children is usually with general anesthesia with the lifting of the lens which is cloudy. However, cataract surgery can not be directly performed on infants, because it only can be done when the baby is 2-6 months old by the same method, for picked up the cloudy eye lens.

Cataract Prevention

Primary prevention is to control diseases associated with cataracts and avoiding the factors that accelerate the formation of cataracts. Someone who had cataract, his vision became foggy / blurry. Cataracts are difficult to avoid because of the related process of degeneration. However, this disorder can be slowed with healthy lifestyle, including meals with balanced nutrition and adequate intake of vitamins and minerals. Consumption of fruits and vegetables rich in vitamins and minerals, such as broccoli, tomatoes, and carrots, are strongly encouraged to maintain eye health. Vitamins and minerals in vegetables and fruits, such as vitamin A or beta carotene, vitamin C, vitamin E, lutein, zeaxantin, zinc, and selenium, acting as an antioxidant that prevents the occurrence of cataracts.

Sore eye cataract / cataract can be cured by using carrot juice therapeutic, spinach juice, celery juice, and juice peterselli. Rules of the therapy are as follows: 1 glass of carrot juice and 1 / 2 cup spinach juice taken in the morning, 1 glass of carrot juice, 1 / 2 cup celery juice, and 1 / 4 cup juice peterselli drunk at noon; 1 cup carrot juice , 1 / 2 celery juice, and 1 / 4 cup celery juice drink in the afternoon; 1 cup carrot juice drink at night. If done regularly, cataracts can be treated.

Another prevention effort is to avoid cigarette smoke and protect the eyes from direct exposure to ultraviolet that contribute to the occurrence of free radicals. For people with diabetes, controlling blood sugar levels tightly is very important because diabetes can accelerate the occurrence of cataracts.

The lens is a clear part of the eye that serve to capture light and images. The retina is the tissue that was in the back of the eye, which is sensitive to light. In normal circumstances, the incoming light or the image will be received by the eye lens, then it will be forwarded to the retina, light stimulation, or drawing the next line will be converted into signals / impulses to be transmitted to the brain through the vision nerves and ultimately will be translated so it can be understood. Using the sunglasses when going outdoors during the day can reduce the amount of ultraviolet rays that enter the eye.

Squalene derived from"Centrophorus atromarginatus" shark liver extract with squalene content of 430 mg. Squalene is useful to provide squalene supplement which decreases with increasing age or due to long-term use of cholesterol-lowering drugs, which can help prevent cataracts.

"Lutein" and "zeaxanthin"

Various recent findings reveal that a healthy lifestyle and consumption of food rich in antioxidants act to prevent or delay the occurrence of cataract. Antioxidants that have been proven to prevent or delay the occurrence of cataract is lutein and zeaxanthin.

The existence of hydroxyl groups on the molecular structure of lutein and zeaxanthin differentiate with other carotenoids. With the existence of these hydroxyl groups, lutein and zeaxanthin are more polar than the other carotenoids, like beta-carotene. Polarity is related to its ability to bind free radicals that damage the eye.

Mechanism of "Lutein" and "zeaxanthin"

How lutein and zeaxanthin work to prevent or delay the appearance of cataract? Potent antioxidant properties which give an answer to this question. Free radicals, which comes from the sun or air contamination, which entered the eye vulnerable to oxidize molecules in the eye lens.

These molecules are proteins and lipids that make up the eye lens composition. The effect of this oxidation is the emergence hordes of damaged proteins or lipids in the eye lens. Along with increasing age and increasing accumulation of free radicals pressure, gangs, proteins and lipids such defective greater. That is what makes vision blurred and eventually become blind.

Lutein and zeaxanthin arresting free radicals (by binding with them) before they damage the lens protein or lipid. Lutein and zeaxanthin can be likened to a "bodyguard" of the lens against free radical attack.

Wise proverb which says "It is better to prevent than cure" may be very relevant in this regard. Scientific evidence has conclusively proved that the consumption of lutein and zeaxanthin may prevent or delay the onset of cataracts in the elderly.

Eating three diverse vegetable a day to meet the needs of lutein and zeaxanthin each about 5-6 milligrams per day. If it is hard to do, eating food supplement containing lutein and zeaxanthin are the other options, of course,you must consult first with a nutritionist or doctor.

TORCH (Toxoplasma, Rubella, Cytomegalovirus, Herpes)

2011-01-04T08:27:00.001-08:00

TORCH is a term to describe the combination of four types of infectious diseases that Toxoplasma, Rubella, Cytomegalovirus and Herpes. The four types of defect of this infection, are equally harmful to the fetus if infection suffered by pregnant women.

Now, the diagnosis for infectious diseases has been growing among the other direction immunological examination. The principle of this examination is the detection of anti-(antibody) that specifically against germs that cause infections such as the body's response to bacteria and virus. Worst Antibodies can be either immunoglobulin M (IgM) and immunoglobulin G (IgG)

Toxoplasma

Toxoplasma infection is caused by a parasite called Toxoplasma gondii. In general, Toxoplasma infections occur without specific symptoms. Approximately only 10-20% of cases of infection have specific symptoms. Toxoplasma is accompanied by mild symptoms, influenza-like symptoms, may develop fatigue, malaise, fever, and generally does not cause problems.

Toxoplasma infection harmful if the mother is pregnant or in people with impaired immune systems (like AIDS patients, patients who receive transplantation organ or immune response to suppressing drugs).

If a pregnant woman infected with Toxoplasma, the consequences that can happen is a spontaneous abortion or miscarriage (4%), stillbirth (3%) or infants suffering from congenital Toxoplasmosis. On congenital Toxoplasmosis, symptoms may appear after the adult, such as the eyes and ear malfunction, mental retardation, seizures with encephalitis.

Toxoplasmosis diagnosis is clinically difficult to determine because the symptoms are not specific or even no symptoms (sub clinical). Therefore, the laboratory examination is absolutely necessary to get the right diagnosis. A common examination is Anti-Toxoplasma IgG, IgM and IgA, and Anti-Toxoplasma IgG Avidity.

The examination should be done on people suspected with Toxoplasma infection, the mothers before or during pregnancy (when a negative result was repeated once a month, watch especially first three months, then every three months), as well as newborns from Toxoplasma infected mothers.

Rubella

Rubella infection is characterized by acute fever, rash and enlarged lymph nodes. The infection is caused by the Rubella virus, can attack children and young adults.

Rubella infections are dangerous if happens to young pregnant women, because it can cause abnormalities in babies. If infection occurs during the first month of pregnancy then the risk of abnormalities was 50%, whereas if infection occurs first three months the risk decrease to 25%.

Signs and symptoms of rubella infection varies for each individual, even in some patients are not identifiable, especially if the red rash is not visible. Hence, the correct diagnosis of Rubella infection need to be enforced with the help of laboratory examination.

Laboratory examinations conducted included examination of Anti-Rubella IgG and IgM.

Examination of Anti-rubella IgG can be used to detect the existence of immunity at the time before pregnancy. If they do not have immunity, it is recommended to be vaccinated.

Prevention

Most cases of Toxoplasmosis infection show no clinical symptoms. The only way to determine whether a mother is infected or not is to check blood serum that would indicate presence or absence of parasite called Toxoplasma gondii. Basically, the body will react to any germs that enter and cause infection by forming a specific defense system.

When first infected (primary infection), the human body will form a compound protein IgM (immunoglobulin M) as reaction to the entry of aliens into the body. Compounds of this protein in a relatively short time so the body is formed directly exposed to infection. IgM antibodies will appear in the first week of infection, reaching a peak on one month, then decreased. In some individuals, IgM may remain detectable several years after primary infection. But slowly, this IgM will disappear within 1-24 months later and could arise again if the relevant re-infected.

Depending on the conditions
Approximately 4 weeks after the primary infection, IgG (Immunoglobulin G) also will be formed, which is a repellent or immune substances. IgG is also a protein with large molecular weight. The presence of IgG indicates that the body has been established immunity. So, if you get the titer / positive number, it means the body has established immunity against the organism causing the infection. IgG, theoretically will settle in the body. Only, the levels can go up or down depending on every person's health condition. However, in most cases, IgG and IgM rising settled.

IgG and IgM positive indicate a primary infection. This needs treatment and evaluation, both the mother and baby. IgG positive and IgM negative while indicating a recent infection. If the re-examination of the results shown IgM positive and then becomes negative, it means that the detected IgM initially non-specific.

IgG antibodies appear several weeks after IgM first response and IgM antibodies will reach a maximum 6 months later. IgM antibodies can last for several years, but finally there is a decrease little by little, generate low and stable levels that may last for a lifetime. Thus, mothers who were infected with Toxoplasmosis in the past, her IgG titer is never zero or negative.

Allegations against TORCH infections usually are proven through blood tests to measure titer IgG, IgM, or both at once. If IgM can be detected about a week after the acute infection and persist for several weeks or months, IgG antibodies may not appear until several weeks later after the number of IgM increased.

If someone suspected of being infected but has negative IgM, the laboratory examination should be repeated every 4 weeks from the first laboratory examination. It is important to ensure there is infection or not. When the re-examination of IgM remained negative, but IgG titers showed increased 4 times, the possibility of being infected is concerned. The occurrence of change in IgM titer from negative to positive, the possibility of re-infected in question middle.

Reexamination
The numbers are legible on the laboratory examination of blood serum result, whether positive or negative, which is found only limited to the infectious diseases that can titrated, namely due to TORCH infections. However, although the figures are obtained, the certainty of this infection remains to be proven by further investigation, such as bacterial culture and examination of amniotic fluid. Unfortunately. In development countries, it can not be done, so the diagnosis of viral culture examination of TORCH infection based solely on laboratory results which are not necessarily 100 percent correct.

Why?
Therefore, the accuracy of the figures it selves once again based on inspection machines that used in the laboratory. That's why doctors often advise patients to do a re-examination if the laboratory examination is different because it is very likely you will have a different laboratory results in other laboratories. The difference itself can be because of the engine, but it can also be due to a decrease or increase in titer of IgG and IgM according to the current condition of the patient.

When the re-examination occurs 4-6 weeks later and IgG did not increase significantly or have no IgM positive value, you can draw a sigh of relief because it means you do not need to receive more treatment. It would be better if re-examination was followed by IgG avidity examination to determine whether a fetus is also infected or not. Low IgG avidity indicates recent infection, while high IgG avidity give a sign of past immunity.

Despite of many medical treatment, it does not mean you should neglect to check the diseases. In fact, the monitoring of the fetus is usually carried out more strictly. Among others with serial ultrasound examinations to look if there is any congenital abnormalities in the fetus while continuing to monitor its growth. Examination of Anti-rubella IgG and IgM were particularly useful for the diagnosis of acute infection in pregnancy.

Merry Christmas and Happy New Year

2010-12-23T09:43:00.000-08:00

To All Readers, May God bless you always !

Asthma : Symptom, Fact, Drugs, Prevention tips, Specialitic

2010-12-21T07:55:00.000-08:00

Asthma comes from the word "asthma", which is derived from the Greek word that means "difficulty of breathing". Asthma is known because of the symptoms of shortness of breath, coughing and caused by narrowing of airways.

Asthma is a condition in which narrowed airways due to an excessive response to certain stimuli and cause inflammation, but this constriction is temporary. In people with asthma, narrowing of airways in response to stimuli that in normal lung will not affect the respiratory tract. This narrowing can be triggered by various stimuli, such as pollen, dust, animal dander, smoke, cold air and exercise.

Inflammation is triggered by irritation or allergy. As a result, you will experience difficulty in breathing, shortness of breath, wheeze and cough. Sometimes these symptoms are so severe that the treatment required in the Emergency Room. In general, asthma begins in childhood, but not rare after become a new adult.

In an asthma attack, smooth muscle spasm of the bronchi and the tissues lining the airways have swollen because of inflammation and the release of mucus into the airways. This will reduce the diameter of the airways (called bronchoconstriction) and this causes narrowing of the patient must exert every effort in order to breathe.

Certain cells in the respiratory tract (particularly mast cells) is believed responsible for the beginning of this stricture. Mast cells throughout the bronchi release substances such as histamine and leukotrienes that cause :
- Smooth muscle contraction.
- Increased mucus formation.
- The movement of certain white blood cells into the bronchi.

Mast cells release substances as a response to something it know as foreign matter (allergens), such as pollen, fine dust contained in the house or animal fur. But asthma can also occur in some people without a specific allergy. The same reaction occurs if the person is doing sports or being in cold weather. Stress and anxiety can also trigger the release of histamine and leukotrienes. Other cells (eosnofil) are found in asthmatic airways release other materials (also leukotrienes), which also causes constriction of the airways.

Frequency and severity of asthma attacks varies in each patient. Some people more often free of symptoms and only experience shortness of breath attacks which are brief and mild, occurring at any time. Another patient almost always has a cough and wheezing (asthma) and have a great attack after suffering a viral infection, exercise or after exposure to the allergen or irritant. Crying or laughing hard can also cause the onset of symptoms.

Symptoms are usually caused by asthma, among others:
- Breath sounds (wheezing, wheezing, asthma).
- Shortness of breath, usually only happens when you're exercising.
- Sense of tightness in the chest.
- Cough only at night.

An asthma attack can occur suddenly marked by breath sounds (wheezing, asthma), cough and shortness of breath. Wheezing sound heard especially when the patient breathed. At other times, an asthma attack occurs slowly with symptoms that gradually worsened. In asthma, who first felt by a person with asthma are shortness of breath, cough or tightness in the chest. The attack could take place within a few minutes or may last up to several hours, even for a few days. Early symptoms in children can include itching in the chest or neck. Dry cough at night or while exercising can also be the only symptom.

During asthma attacks, shortness of breath may become more severe, causing anxiety. As a reaction to anxiety, patients will also be spending a lot of sweat. In a very severe attack, the patient became difficult to speak because of crowded very great. Confusion, lethargy (reduced state of consciousness, where people like to sleep soundly, but can be aroused briefly and then immediately fall asleep again) and cyanosis (bluish skin look) is a sign that people with very limited supply of oxygen and need immediate treatment. Although he has suffered a severe attack, the patient will usually recover completely.

What factors are known to trigger asthma?

List of asthma triggers :
1. Allergens :
- House-dust, house dust mites, mold spores, animal dander such as cats, dogs and other furry animals.
- Saliva-and urine of pets.
- House-dust consists of various allergens, such as food remnants, hair, fur, cockroaches and other insects.

2. Respiratory tract infections :
- Most commonly found as asthma triggers.
- Especially the viral infection.

3. Emotional stress :
- Can occur in children and adults.

4. Physical Activities :
-Sports that do without a good heating and cooling can trigger asthma attacks.
-Type, duration and severity of exercise to determine the occurrence of asthma attacks.

5. Drugs to cope with asthma :
-Most often the drugs baffle receptor beta (usually used for the treatment of heart disease and hypertension).
-Aspirin and anti-rheumatic (rare).

6. Air pollution :
- Pollution fumes, pollution, cigarettes, insect repellent sprays, hair sprays medicine and other types of pollution.

7. Other :
-Changes in weather / air (sudden temperature changes, high humidity), laugh uproariously, and the inclusion of acid from the stomach to the respiratory tract.
-Substance food preservatives (benzoic acid), yellow dye tartazin.

Rational therapeutic approach to asthma is dependent of knowledge about the pathogenesis of asthma. Asthma is a disease that is mediated by antibody binding to mast cells in airway mucosa. On repeated exposure of antigen, the bond between the antigen-antibody on the surface of mast cells trigger the release of mediators and the synthesis and release of other mediators.

At first glance unrelated, because the disorder occurs in the airways of asthma while the reflux of stomach acid occurs in the digestive tract. However, in some cases, asthma can get worse when stomach acid rises into the esophagus.

Increase in acid reflux or stomach contents into the esophagus occurs when the valve connecting the stomach to the esophagus does not close completely. This condition is characterized by pain or burning in your chest and throat.

Because the esophagus lies close to the throat of an airway, it makes sense if the rise of stomach acid can affect asthma. Stomach acid reflux symptoms are chest pain and heat in the throat, rarely would have thought if an asthma attack also could indicate reflux of stomach acid. Some of these allegations are believed to be able to explain :
1. Asthma worse when stomach acid goes up into the esophagus inhaled by the lungs.
2. The rise of stomach acid causing the chest cavity narrows, causing shortness of breath.
3. Stimulate gastric acid in the esophagus brocheolus nerve (the airways in the lungs) to narrow.
4. Conversely, asthma can also trigger reflux because of the drugs salve airways (bronchodilators) such as theophylline are known to have side effects or spending increases gastric acid secretion.

Asthma that is triggered by stomach acid is usually characterized by recurrence at irregular eating patterns, after drinking alcohol and when lying down. Not infrequently given class of ulcer drugs proton pump inhibitors to treat asthma in patients of this kind. Increased levels of gastric acid shown to reduce the immune system that create asthma.

Astma Fact

The disease can be transmitted to others if the disease is caused by bacteria, such as parasites, bacteria, viruses and fungi. Asthma is not caused even though three of the above three things that can trigger asthma attacks. Thus, asthma can not be transmitted.

Asthma triggers consist of various things, including dust, cold air, excessive physical activity, as well as animal dander or hair. Cockroach dander can trigger asthma attacks, although it has become a dead cockroach. This situation is found in an unclean environment.

Death can occur either because of asthma itself or its complications. Factors such as patient too underestimate the disease also cause death. In addition, frequently encountered patients had no anti-asthma drug supply, because asthma attacks can occur at any time.

Mother milk provides anti against various diseases in infants, so it is better if people with asthma give milk to babies who also have allergies talent. Medicine for asthma, especially the form of inhalational (Aerosols) is safe because it does not come out through asthma.

Laughter is healthy as long as it is considered good medicine for any illness. However, today's statement does not apply anymore. Laughter can cause asthma attacks. Laughter becomes a serious problem for 40 percent of two million Australians who suffer from asthma.

Nearly two out of three people with asthma out of breath when doing housework or shopping. While half of asthma while doing their favorite activity. More than one in three people feel tired because of disrupted sleep this disease. Then one of the five longer cancel their social activities, are still caused by asthma.

Actually, people with asthma can be controlled completely to life as is appropriate rather than people with asthma. In the Olympic games, for example, there is a swimming champion who suffer from asthma. This shows that if good treatment for asthma people can exercise, they capable of achieving a glorious achievement. Che Guevara, was also asthmatic. He became a doctor specializing in allergy and he is known as a rugby player who reliably. Well, from these two examples it can be concluded that people with asthma can enjoy a good quality of life without being distracted by the limitations.

But to achieve this total control need cooperation between doctor and patient or family. Now available in the form of a simple measuring instrument score system that can be used by patients to assess their own degree of asthma control. There are some questions you can answer yourself.

Through the answers will be counted scores obtained. The higher the score, the better. When consulting a doctor, the assessment can be shown to be re-assessment. Well, the achievement of the desired is total control.

It is not easy to achieve total asthma control. But with the good cooperation between doctors and patients, many who make it. Advantages achieve this total control is the quality of life improved. People with asthma can participate in various activities that had been unable to follow without being distracted by an asthma attack.

So, you need not feel too afraid to allow your child to swim. In fact, swimming exercise is recommended for people with asthma. Air humidity above the pond is a good environment for people with asthma. Just do not forget the patient must use his asthma medication regularly.

Your doctor will recommend the reduction or increase in dose of medication according to asthma control score. Well, I hope your children can enjoy their children and achieve good learning performance.

Who is at risk for asthma?

Children and adults can be affected by this disease. In general, asthma is a chronic disease of children. Allergy is the trigger asthma symptoms, 80% of children and 50% of adults who had asthma also have allergies.

The children in the house that used to burn incense may be more prone to suffer asthma, asthma also have links with certain genetic variations. Incense is used for thousands of years in various religious rituals and spiritual ceremonies. In some parts of Asia, people commonly burn incense in their house. Children whose parents used to burn incense, 36 percent likely to suffer from acute asthma and 64 percent of the shortness of breath when they exercise.

There are a few traits in children whom having asthma. Following characteristics are :
- Cough or wheeze at night or can also occur in seasonal.
After finishing the activity, the cough will disappear with or without medication.
- There is a history of allergy either to the patient or family.

Not only its properties, but the cause of asthma also need to know :
- Asthma can also be caused by abnormalities in the respiratory tract as well as respiratory muscle spasm, thickened or swollen mucus channels and more mucus is thick and sticky.
- Children with asthma are usually have shortness of breath and rapid breathing. Pain in the chest and blue dots around the mouth and difficulty of speaking.

To prevent children from developing asthma is avoid child away from dust, animals, cotton, food that can cause allergies and cigarette smoke as well as insect repellent and also keep out cold air.

Burger was delicious, especially with a solid content of different toppings and tick sauce. However, it should not be eat too often. In addition to risk clogging the arteries, a burger can increase the risk of asthma and shortness of breath, especially in children. Foods that are full of fruit, vegetables, and fish, though fatty, can help avoid asthma-related respiratory problems. Diet did not increase sensitivity to common allergens, but it was correlated with the prevalence of asthma and wheezing. Children who ate three or more hamburgers a week along with soft drinks to face a higher risk significantly.

Is asthma a genetic disease?

Asthma in children can be cured 80 percent. Asthma is a disease associated with genetic factors. As many as 30% of people with asthma, have close relatives who also suffer from asthma. If a mother has asthma, chances are her child may suffer asthma. However, if a father has asthma, the possibility of children suffering from asthma will be smaller. It related to X chromosom.

A child who has one of asthmatic parents will be at risk of developing asthma three times higher, while both parents of children with asthma, the children at risk for asthma six times higher. Everything related to genetic factors. Among boys, 48 percent do not have the gene variant, known as GSTT1, which helps regulate a group of enzymes that protect cells from oxidative damage, including the reactions caused by cigarette smoke and other chemical toxins. People without this variant has been found to be more susceptible to allergies and asthma. Children who do not have the gene counted 43 percent more likely to have asthma than children on his age who have at least one gene variant that.

Children who daily used to the smoke of incense in the house 78 percent likely to suffer from asthma than children not exposed to smoke, a different pattern in children who have the GSTT1 gene variants. Incense is generally made from fragrant plants, such as bark, resins, roots, flowers and vegetable oils. Burning these materials can create harmful substances, such as benzene and hydrocarbons poliaromatic. The burning of incense also has linkages with various respiratory cancers, including oral cancer, respiratory tract and lungs.

Between colds allergies and asthma actually have a close relationship. Some patients with allergic runny nose if further investigation was also suffering from asthma. Conversely in patients with asthma if examined in part also was suffering from allergic runny nose. Both the disease is based on the same thing, which is a process in airway inflammation.

That's why colds allergies or asthma treatment requires anti-inflammatory drugs which usually are steroids. As experienced by your child, treatment of allergic rhinitis and asthma at the same time will give good results. People with asthma are not allergic rhinitis treated with a good treatment which outcome is less good.

Indeed, since the understanding of the medical community about the disease allergic rhinitis and asthma who use inhaled steroid medicines or sprayed into more. The drug is local, direct effect where needed and less cause systemic symptoms so that the side effects of steroids are worried about the risk of very reduced.

As is known, if steroids are used systemically (like via a tablet or injection) in the long run, can cause increased risk of blood sugar, elevated blood pressure, also cause cataracts. Unfortunately the drug either in the form of local steroid inhalation or spray is still rather expensive.

Substances that play a role in the initial reaction (bronchoconstriction) is histamine, triptase, lekotrien. These substances are then spread throughout the airway wall and cause bronchial smooth muscle contraction and vascular leakage. Other mediators causing bronchoconstriction that persist, infiltrating cells in the airway mucosa and mucus hypersecretion. The mechanisms that underlie bronchial hyperactivity associated with the inflammatory process.

Interchangeable agents which increase bronchial reactivity are :
- Ozone.
- Inhaled allergens.
- Infection with the virus.

There are 3 methyl xanthine class of drugs which most important, namely :
- Theophylline.
- Theobromine.
- Caffeine.

There are several mechanisms proposed asthma medications work :
- Barriers to the enzyme phosphodiesterase erosive bronchodilating.
- Constraints on adenosine receptors in the respiratory tract so it does not happen bronchoconstriction.

Pharmacodynamics of methyl xanthine

1. In the central nervous system :
- Increases alertness and reduce fatigue.
- Anxiety and insomnia (caffeine).
- At high doses cause seizures.
- Tremor (aminophylline).
2. In Cardiovascular :
- Kronotropic and inotropic (+).
- Improve peripheral blood flow so that the blood viscosity decreases.
3. Kidney, as a weak diuretic.
4. Lymphatic channels, stimulates the secretion of digestive juice.
5. Smooth muscle, bronchodilating.

Receptor agonist medications have several pharmacological benefits in the treatment of asthma, for example for airway smooth muscle relaxation, and inhibition of expenditure bronkokonstrictor substances. These substances also inhibit microvascular leakage and increases the activity of cilia in the respiratory ward.

The most prominent characteristic of adrenoceptor agonist drugs work is to bronchial smooth muscle relaxation, with the results of bronchodilating.

In general, stimulation of the receptor will lead to :
- Relaxation of airway smooth muscle.
- Inhibits mediator expenditure.
- It causes tremors in the skeletal muscle (toxic dose).

Examples of asthma medications :
- Epinephrine, stimulates receptor beta 1 and beta 2.
- Ephedrine.
- Isoproterenol.

Beta 2 selective now increasingly used to treat symptoms of asthma. Has the effect of a long work, as well as selective towards receptor beta 2.

Beta-adrenergic receptor agonists is the best medicine to reduce asthma attacks that occur suddenly and to prevent attacks that may be triggered by exercise. These bronchodilators stimulate dilation of the airways by beta-adrenergic receptors. However, bronchodilators are the work on all beta-adrenergic receptors (like adrenaline), cause side effects such as rapid heartbeat, anxiety, headaches and tremors (shaking) muscle. Bronchodilators that only works on beta2-adrenergic receptor, which is mainly found in cells in the lungs (such as albuterol) had little side effects on other organs. Most of bronchodilators to work within a few minutes, but the effect only lasts for 4-6 hours. Bronchodilators available in the form of tablets, injections or inhalers (inhaled drugs) and very effective. Inhalation of bronchodilator drugs will precipitate directly into the airways, thus beginning its work quickly, but can not reach the airways that experienced severe blockage. Bronchodilators by mouth (swallowed) and injections to reach the area, but has side effects and it works tend to be slow at first.

Types of bronchodilators are commonly used is theophylline. Theophylline is usually given by mouth (swallowed), and available in various forms. In a severe asthma attack, can be given intravenously (through a vein). Number of theophylline in the blood can be measured in the laboratory and should be monitored closely, because the amount is too small will have no effect, while the amount is too much can cause abnormal heart rhythms or seizures. Side effects patients taking theophylline are able to experience a little nausea or anxiety, but the two effects usually disappear when the body can adjust to the medication. In larger doses, the patient could feel the rapid heartbeat or palpitations (heart pounding), insomnia (sleeplessness), agitation (anxiety, phobia), vomiting, and seizures.

Examples of drugs beta 2:
- Albuterol.
- Terbutaline.
- Metaproterenol.

Drug toxic effects of beta 2:
- Tacifilacsis.
- Hypoxemia.
- Arritmia cardiac.

Muskarinic antagonist

Examples muskarinic drug antagonists: atropine, ipratopium bromide.

Mechanism of action of drug antagonists muskarinic :
Anti muskarinic inhibits acetylcholine receptor muskarinic expenditure. In the respiratory tract, acetylcholine is produced by neuro vagus. Inhibition of acetylcholine will cause the blockade on bronchial smooth muscle contraction and gland secretion in airway mucosa.

Corticosteroids

This medicine does not have a working mechanism of relaxation of bronchial smooth muscle directly, but reduce bronchial reactivity, increased airway diameter and decreased the frequency of asthma relapse.

Corticosteroids inhibit the inflammatory response and is very effective in reducing symptoms of asthma. If used in the long term, gradually corticosteroids will cause a reduction in the likelihood of asthma attacks by reducing airway sensitivity to some stimuli. But the use of tablets or long-term corticosteroid injections can cause side effects such as disturbance of wound healing, impaired growth of children, loss of calcium from bone, gastric bleeding, premature cataracts, increased blood sugar levels, weight gain, mental disorders.

Corticosteroid tablets or injections can be used for 1-2 weeks to reduce the weight of an asthma attack. For long-term use of corticosteroid inhalers are usually given because the inhalers, the drug that reaches the lungs 50 times more than the drugs to other body parts. Corticosteroids by mouth (swallowed) is given for the long term only if other treatments do not control asthma symptoms.

Effects of airway obstruction may be caused by potentiation of the effects of beta-agonists. The main effect is to inhibit inflammation caused by eosinophils in the respiratory tract, and other mediators, such as arachidonic acid, lekotrien and prostaglandins.

Other Asthma medicines such as :
- Calcium channel blocker.
- Potassium opener.
- Cromolyn.

Cromolyn and nedocromil allegedly blocking the release of inflammatory substances from mast cells and reduces the possibility of shrinkage airways. This medicine is used to prevent attacks, not to treat an attack. These drugs are particularly effective for children and for asthma because of sports. This drug is very safe, but relatively expensive and must be taken regularly even if the patient free of symptoms.

Anticholinergic drug (like atropine and ipratropium bromide) works by blocking the smooth muscle contraction and the formation of excessive mucus in the bronchi by acetylcholine. Furthermore, this drug will cause a widening of the airways in patients who previously had consumed beta2-adrenergic receptor agonists.

Leukotrienes modifiers (like montelucas, zafirlucas and zileuton) is a new drug to help control asthma. These drugs prevent the action or formation of leukotrienes (chemicals made by the body that cause asthma symptoms).

An asthma attack should get treatment as soon as possible to open the airways. Drugs used to prevent also used to treat asthma, but in higher doses or in a different form.

Prevention tips to control asthma :
- Know your asthma, including the type of light or heavy.
- Recognize the originators, if because of the emotions then control your emotions, if influenza virus is necessary to be vaccinated, if the drug then avoid the drug, if the food then avoid these foods, if due to house dust then avoid house dust.
- Identify the medicines commonly used properly. Use of drugs that doctors were told correctly, make sure the correct medication and correct dosage.
- Control your doctor should not only when shortness of breath. Like the car service should not wait for new incoming damaged garage, do check with your doctor regularly.
- Prepare an emergency medicine for asthma attacks at night.

Specialitic asthma : asthma by the work

Asthma by the work is asthma caused or exacerbated the situation in the workplace such as irritation, chemical fumes, gases or dust. Like other types of asthma, the work can cause asthma symptoms, such as chest tightness, wheezing and shortness of breath.

If diagnosed and treated as early as possible, Asthma result by the work can be cured. But if not treated immediately,the long term effects could be worse. It is not clear why some people develop asthma due to work? This possibility has to do with the heritage nature (genetics) or because of certain substances that accumulate in the work environment from time to time.

Symptoms of asthma by the work are similar to those caused by other types of asthma. Signs and symptoms include :
- Wheezing.
- Cough.
- Shortness of breath.
- Chest tightness.
- Colds.
- Nose.
- Irritation of the eye.

Treatment of occupational asthma

If someone has asthma due to work, their doctor will probably recommend avoiding contact with irritants that trigger symptoms. Patients also need medications to help relieve symptoms of asthma. Avoiding workplace irritants, it is important to successfully treat asthma by the work.

Uncover a person character through blood group

2010-12-14T05:47:00.000-08:00

Research on the character associated with blood type from a person has performed in Japan since fifty years ago. Masahiko Nomi, who observed the people on the basis of blood type. Research results discussed in the book called Touch My Heart, compiled by his son, Toshihiko Nomi. How to uncover your personal life through blood group?

1. Blood type O
Man with this blood group has a distinctive character. Reluctant to admit mistakes and refused to budge. A bit stubborn and do not like regulated. But actually he is not the adventurous, and always speak on behalf of the facts. The owner of this blood group is also very good at flirting, and indulgence in sweet words.

Plus
Their ideas seems strong. People who easy to get consulted, engrossed and can help to solve other problems. He also has a strong sense of love. When he loves someone, he would totally, give anything that would be done to make happy of his partner. Warm and friendly personality. Tend to keep quiet and have high self-esteem.

Minus
Sometimes he does not care about other people's feelings. His ego was easily disturbed. This is what makes explosive temper, rebellious from a state that makes him uncomfortable. Although maybe he was already past 30 years old, but his attitude still childish and it frequently appears.

2. Blood type A
Person who respect the rules and generally accepted procedures. Easily worried about the situation around. Pessimistic about the future and his thoughts easily changed. Never satisfied with what he has today.

Plus
His radar is always works, so not a gullible person. Serious in doing something and appreciate teamwork. In the talk tends to be cautious, mature and wise. Like cleanliness, order and neatness. He like a planned strategy. So, when he decides a person becomes his lover, it is through careful planning. His feelings are also subtle and sensitive to the needs of his partner.

Minus
Sometimes he feels that he is the most correct person in any situation, although admitted the truth of people's opinions. If there is something that no favor in his heart, he would sulk for days. A little stubborn and suspicious easy. He is also not good at making decisions. Although for the simplest things take time to be processed before it was decided.

3. Blood type B
Like freedom, does not like restrictions. Flexible and supple. Practical and specific ways of thinking. This type like multitasking. He can concentrate on many things. In one time, he could do office work, watching television, while eating. He was always optimistic for the future. Hurt too easily cured.

Plus
His style always simple, supple, but has a high self confidence. His life to work and society. His girlfriend is not a priority. Persistent and diligent pursuit of a dream. Rich in ideas that make people salute him. The type of people who quietly and not in a hurry. Easy to talk to.

Minus
Attitudes and behavior often makes people shake their heads. He could do something unthinkable by anyone else. Easy to complain about something. Establishment is indecisive, wishy, washy and often indecisive. So, he always need someone else to help make decisions.

4. Blood type AB
He has a sharp analysis of each issue. He was unique, very interested in fantasy stories and fairy tales. Clever relationship, no wonder he has an extensive network. Easily ignited by small things. He has a high concentration, but could not keep it in a long time.

Plus
His has perfect loyalty. He is not an easy man turned his heart to another woman. Do not like to see others in trouble, so easily reached out for help. Fairly high demand. He has a myriad of criteria for the prospective partner. He has many hobbies and talents. Efficient and responsive in smell things that are considered essential or beneficial himself.

Minus
Unfortunately, he is less persistent. It is sometimes hinder progress. Less likely to risk everything. Not too happy with the formalities. He prefers to play with the outbound than following the friend's wedding. Got a "split personality", it is difficult to guess what is his will? Fixated on routines that seem monotonous and lacking initiative. Like criticize and often unconsciously hurt others.

Nausea and Vomiting : Description, Symptoms, Treatment

2010-12-09T06:41:00.000-08:00

Definition

Nausea is a discomfort in the stomach and esophagus and want to vomit. Vomiting is a reflex in which the brain (hypothalamus) signals the intestines to reverse peristalsis that forces the stomach contents go up into the mouth. Vomiting is done by issuing a strong flow of stomach contents through the mouth.

Description

Vomiting, also called emesis, is a symptom response to a number of harmful triggers. Vomiting is the expulsion strong, and differs from a simple re-regurgitation of gastric contents into the mouth. Although unpleasant, vomiting is an important function because it rids the body of harmful substances.

Vomiting is a complex process resulting from the coordinated interaction of neural pathways, brain, and muscles of the digestive system. The point of the main drivers of vomiting in the brain called the postrema area. This structure is exposed to chemicals in the bloodstream and cerebrospinal fluid (the fluid found in the brain and spinal cord). Scientific studies show that stimulation of postrema area by various drugs and bacterial toxins, radiation, and physiological conditions, induce vomiting.

Specific nerve pathways (called afferent neural pathways) induce vomiting when triggered by motion, an ear infection or a tumor, Meniere's disease (a disease characterized by recurrent vertigo), odors, visual stimulation, pain, and bad taste. Still other nerve pathways (peripheral afferent neural pathways) cause vomiting as a response to irritation of the stomach, distension of the intestine and biliary tract, stomach ulcers, and myocardial infarction (heart attack).

The physical act of vomiting is controlled by multiple sites of the brainstem. When activated, this structure sends a signal to the throat, diaphragm, and abdominal muscles. These signals result in simultaneous contraction of these muscles, which bring the contents of the stomach to the esophagus (the tube between the stomach and throat) and out the mouth. During vomiting, breathing is inhibited, except for short breaths between discharges. Bradycardia (decreased heart rate) and changes in blood pressure may occur during vomiting and vomiting.

Causes & symptoms

Vomiting can be caused by many different things. Vomiting is usually caused by infection, reactions to drugs, toxins, uremia (accumulation of breakdown products of proteins in the bloodstream), and diabetic ketoacidosis (accumulation of toxins due to uncontrolled diabetes). Vomiting lasting more than one week may be caused by medical or psychiatric condition long term. Causes of vomiting include :

- Treatment.
The drugs are the most common cause vomiting, especially in the first days of usage. Drugs can induce vomiting by stimulation of postrema area or by direct stimulation of peripheral nerve pathways. Drugs that commonly cause vomiting include cancer drugs, pain relief (especially opioids), heart medications, diuretics, hormones, antibiotics, antiasthmatics, gastrointestinal drugs, and drugs acting on the brain.
- Infection.
Infection of the digestive system or the whole body can cause vomiting. More frequent gastrointestinal infections in infants, toddlers, and young adults (20-29 years) whom usually get 1.2 infections per year. Infections that can cause vomiting include bacterial, viral, and parasitic infections of gastrointestinal, severe acute respiratory syndrome (SARS), otitis media (ear infection), meningitis (infection of the membranes surrounding the brain and spinal cord), and hepatitis (liver infection) .
- Gastrointestinal and abdominal disorders.
Digestive system disorders that can produce vomiting include blockage of the stomach or small intestine, motility disorders (muscles in the esophagus become discoordinated or weak, causing difficulty in swallowing, regurgitation, and sometimes pain), indigestion, caused by changes in radiation therapy, Crohn's disease (chronic recurrent inflammation of the intestines), peptic ulcer, worm infestations, or appendicitis, gallbladder, or pancreas.
- Nervous system disorders.
Cancer, infarction (area of dead tissue caused by obstruction of the artery supplying that area), bleeding (hemorrhage), birth defects, ear disorders, motion sickness, weight, ear tumors, Meniere's disease, unpleasant memories, psychogenic (caused by mental factors) problems, and bad taste or smell can cause vomiting.
- Hormones and physiological conditions.
Hormonal and metabolic (physical and chemical processes of the body) conditions that can cause vomiting include: parathyroidism, diabetic ketoacidosis, hyperthyroidism (a condition caused by excessive consumption or production of thyroid hormone), Addison's disease, uremia, and pregnancy. Pregnancy is the most common cause of vomiting associated with hormonal systems. Vomiting associated with pregnancy often called morning sickness.
- Postoperation.
Anesthesia and pain medications can cause nausea and vomiting, which is associated with 17-39% of complications from surgery.
- Cyclic vomiting syndrome (CVS).
These disorders rarely occur in children usually begins at age five, although also occur in adults. It is characterized by, on average, eight attacks vomiting lasts for 20 hours each year. Although the exact cause is unknown, it seems there is a relationship between cyclic vomiting and migraine headaches.
- Poison.
Cleaning materials and other heavy metals arsenic, weed killers and households, and other substances can cause vomiting if inhaled or swallowed.
- Miscellaneous causes.
Excessive alcohol consumption causes vomiting by acting both in the gastrointestinal tract and brain.
- Psychological problems.
- Pain or severe shock.
- The smell is not pleasant or disturbing images.
- Damage to the inner ear such as altitude sickness, Meniere's disease, and motion sickness. Sometimes a middle ear infection in children can cause vomiting, but this is actually caused by irritation of the nerves that you in the middle ear.
- Diseases of the organs in the body (vicera).
- Gastro-intestinal disease such as gastritis, peptic ulcer, stomach cancer, gut obstruction, appendicitis and mesenteric adenitis.
- Liver disease or gall bladder like holecystitis, hepatitis and cirrhosis.
- Pancreatitis.
- Heart disease such as myocarditis, severe hypertension, heart attack (myocardial infarction) and congestive heart failure.
- Diseases of the brain such as migraine, stroke (cerebrovascular accident), brain tumor, cerebral hypoxia and epilepsy.
- Diseases of the urinary tract such as infections and colic.
- These chemicals and toxins.
- Infection of the chemical that causes the production of certain chemicals that can cause fever and also stimulate the brain.
- Bacterial and viral infections, such as cholera and salmonella, which can cause gastrointestinal infections.
- Infections such as malaria parasites.
- Meningitis.
- Sinusitis.
- The problem of certain endocrine glands, such as hyperparathyroidism, hyperthyroidism and diabetes mellitus, the production of chemicals that stimulate the hypothalamus is not balanced.
- Accumulation of dirt in the body with renal failure and other electrolyte disturbances that stimulate the hypothalamus.
- Drugs and certain hormones may stimulate the hypothalamus which causes nausea and vomiting: digoxin, morphine, estrogens, iron preparation and aminophylline.
- Other conditions such as morning sickness, haemolytic anemia, porphyria, alcoholism and radiotherapy.
- Bulimia nervosa.
- Pyloric stenosis and gastro-oesophageal reflux.

Nausea is often associated with vomiting. Vomiting may be preceded by vomiting, in which the muscles contract, such as for vomiting but without discharge the contents of the stomach. Patients may hyperventilation (breathing fast and deep) and salivate before vomiting begins. Patients should consult a doctor immediately if there is blood in the vomit (entrails removed).

Other symptoms associated with vomiting depends on the cause. Gastrointestinal infections will also cause fever, muscle aches, and diarrhea. Patients with peptic ulcer, intestinal obstruction, or pancreatitis, cholecystitis (inflammation of the gall bladder or pancreas) will experience abdominal pain. Meningitis symptoms include neck stiffness, headache, vision changes, and changes in mental processes.

Escherichia coli and Vibrio cholerae is the cause of spread of the vomiting disease. Escherichia coli cause nausea defecation and Vibrio cholerae causes vomiting. Both bacteria were sourced from dirty water and the environment surrounding residents. The bacteria, carried by animals insects such as flies settle on food that is eaten by humans or by humans themselves because the hands have been previously infected with the bacteria and not cleaned.

There are four factors that led to the outbreak of vomiting:
1. Environmental sanitation, dirty and unhealthy.
2. Conduct normal healthy life.
3. Poor health services to the public.
4. Ancestry or population density.

For those of you who never felt the nausea and vomiting, I tell you, it would feel very uncomfortable. Besides disturbing activity, nausea and vomiting was also lower quality of life. In medical terms nausea and vomiting are known by the name of Nausea and Vomitus. Nausea is defined as nausea and vomitus as vomiting. Nausea and vomiting is a very complex reaction involving the central nervous system and digestive system in the body. Nausea and vomiting are actually a body alarm that indicates the existence of a toxic substance (toxin) in the digestive tract or a there is something wrong in our body.

Here are a cause of nausea and vomiting :
1. Seeing something that is disgusting.
2. Unpleasant smell.
3. Impaired balance as at the time of ride vehicles (or so-called motion sickness).
4. Pregnant in first quarter or so-called Hyperemesis gravidarum.
5. Suffering from diseases such as systemic infection, peptic ulcers, metabolic disorders, cancer, disorders of the body's electrolyte balance.
6. Exposed to drug side effects.

Treatment of vomiting

Drugs used to treat nausea and vomiting, there is a choice of various anti-nausea drug to use and adapted to cause vomiting, light-weight degree of severity, and degree of safety for patients.

Ondansetron including drugs used to treat nausea and vomiting with moderate to severe as the condition :
1. Nausea and vomiting after chemotherapy (therapy in patients with cancer).
2. Postoperative nausea and vomiting.
3. Nausea, vomiting, severe Hyperemesis gravidarum.

Ondansetron including drug group of serotonin 5-HT3 antagonists, which work by inhibiting the selective serotonin 5-hydroxytriptamine (5HT3) binds to receptors in the CTZ (chemoreseceptor trigger zone) and in digested tract.

Serotonin 5-hydroxytriptamine (5HT3) is a substance that will be released if there are toxins in the gastrointestinal tract, binds to its receptors and stimulates the vagus nerve stimulation delivered to the CTZ and vomiting center and then there was nausea and vomiting.

Why is your baby vomiting?

There are two main causes vomiting, which is due to abnormalities in the channel diggestion and disorders of the central nervous system (brain). Vomiting due to abnormalities in the gastrointestinal tract is usually the body's mechanism to remove toxins or foreign substances from the body. So, not much to worry about.

Children will usually be larger because of more frequent diggestion vomiting. Because of tract infections, they have started eating out, snack carelessly.

Details of the most often make a child vomit is an infection of the gastrointestinal tract or poisoning. Infection which does not have a gastrointestinal infection such as diarrhea and vomiting. Infection can be elsewhere, such as the esophagus, airway, or a good distance from the mouth of the urinary tract. In children, appendicitis and gastric diseases should also be considered as a cause of vomiting.

The second is vomiting due to disturbances in the central nervous system (brain), such as an infection or tumor in the brain. Typically, the vomiting is very typical, spray. That will be happen without children eat earlier. However, vomiting is just one symptom of the disorder in the brain nervous system. Usually, symptoms do not just throw up. Brain tumor for example, usually accompanied by severe headaches, then there is a disturbance in the eye or the other nerve.

Vomiting usually occurs when the pressure within the brain tumor was high. Children could have affected by brain tumors without vomiting, because the tumor has not grown. But if the tumor has developed, the pressure in the brain increases, eventually the child vomit. Meanwhile, if there is infection in the brain, usually accompanied by high fever, even consciousness decreased. So, there must be other accompanying symptoms.

In short, the vomiting was not dangerous. Become dangerous if it occurs constantly, while the fluids that enter fewer or even less. If you have dehydrated kids, each time the child vomits, you should immediately give a drink. By doing so, the amount of fluid flowing in and out, balanced.

During its spray or not vomit, children still want to drink, and the more drunk or equal to the exit, parents do not need to worry. Must be anxious and vigilant if spray vomiting, especially accompanied by high fever and there is a great headache, or if you vomit more than a drunk or a child does not want to drink.

Similarly, if there are particular infection, the child was vomiting, diarrhea, which came out a lot and the entrance a bit. The reason is, this will make your child dehydrated, and therefore should be given extra fluids. Sometimes when you're vomiting, electrolyte disturbances appear in the body, so that children tend to vomit. A solution was to put an IV, to enter the liquid electrolyte to stabilize the body, then vomit handled.

What also must be considered is the color of vomit. If the yellow vomit is still reasonable, because it comes from the gastric fluid. Become dangerous if the vomit is green, because it means there are blockages in the small intestine. This needs special attention, because the green color comes from bile. Means the disorder is under the hull. It could happen intestinal stricture, infection, or appendicitis.

What must you do when your baby spit?

Do not panic. Consider first what happens! Spit up and vomiting refers to a condition in which there is something out of the baby's mouth. However, there are several things you can distinguish between it so no one acted.

Spit after feeding, the baby's mouth will usually come out milk that has been swallowed up less than 10 ml. This is what is called a spit. This fluid is removed by way of flow of the baby's mouth, without abdominal wall muscle contraction. Reflux is a natural process to remove the air is ingested when the baby is drinking milk. Generally occurs in infants as old a few weeks to several months, and will disappear by itself in line with increasing age of baby.

Cause spit up all sorts, could be because the baby is too much to drink milk, a baby crying excessively, there are many babies whom participated swallowed air when sucking breast, stomach throttle yet "ripe" so not to close completely, or the baby fails to swallow because the muscle connecting the mouth and throat not yet "ripe". That is why, spit up often experienced by premature babies. Solution is to make baby spit up after each breast-fed.

In between the esophagus and the stomach are gastric throttle. In infants, the valve is usually not perfect, so if you drink some milk back up and out in the form of spit up. When out in the form of spit up, hell, anything baseball. What is dangerous is that if arrested and into the lung, because it already contains a stomach acid. It can create infection.

From the stomach to the intestine also contained the valve. In some children, usually the valve is too dense or thick, so hard to open. It would seem at the time of the child to eat solid food, then vomit. This is because solid food was not allowed to pass. However, with age, vomiting in children since this rudimentary valve that normally would be lost.

Even so, the child must still be trained for its easy-open valve. You must providing food little by little. The second reason is because babies spit up like writhing. After drinking, usually your child will immediately be put in bed and then stretched. This will create high pressure in the stomach, making out in the form of vomit or spit up. It also was normal, as long as the amount of fluid in and out of balance. Vomit or spit up once or twice a day is still reasonable, until about a year old child. But if each meal the baby vomited, then indeed there is any abnormality.

To reduce spit up, usually made baby burp. Another way is, a baby held in a standing position, then pat the back top. Better not directly provide drinking heavily. Drink a little, then drink again. So, do not air until the very bottom.

Stress can cause vomiting?

In addition because of abnormalities in the gastrointestinal and central nervous system, vomiting can also be psychological. Vomiting center in the brain. Well, sensor cables are central panhandle include neural networks that are in various parts of the body, such as the gastrointestinal tract, throat, heart, bile, and so forth. So, do not be surprised if we hate someone, then came the nausea, even vomiting. That's because all comes from the stimulation of the sympathetic nervous system. Another example, children who are afraid to the doctor and always throw up every time brought to the doctor. Usually this will disappear with age.

If the cause is psychological, parents should not worry excessively. The reason is, the more anxious parents, your child will be more frequent vomiting for attention.

For example, if the child refuses to see a doctor because of fear. For these cases, treatment is actually easy. Just ignore, do not need too be addressed. If children are a little big, ask her to clean up vomit. After a long time will definitely stop. Her own vomit, right, is not harmful.

Vomiting in babies

The volume of fluid that comes out when the baby is vomiting more than spit up, like more than 10 mL. Vomiting issued by ejected from the baby's stomach, accompanied with abdominal wall muscle contraction. Sometimes, fluid vomiting are also issued through the nostrils. Vomiting does not occur in newborns, but at least 2 months old baby and can occur throughout the ages. If your baby is vomiting, it could be a sign of health disorder or disturbance in digestive function.

Common causes of vomiting are abnormalities in the baby's digestive system, such as abnormalities in the valve separating the stomach and intestine 12 fingers. Vomit greenish fluid. In the event of narrowing at the entrance to the stomach or barriers in the intestine, can cause the baby vomits constantly. Other causes, there is an infection or injury, such as throat infections that trigger vomiting. Typically, liquid vomit with blood spots. Vomiting can also occur because the baby is allergic to cow's milk, drink or eat too fast, and cough. How to cope with vomiting tailored to the type of cause, and usually require a doctor.

What you can do at home are :
1. Do not adopt a child when spit up or vomit. Often, because of fear or worry, the mother then lifted the child from his sleeping position with the intent to stop the spit up or vomit. It's even dangerous, because the vomit or spit up can come down again, into the lungs, and eventually even disrupt the lung. Can make pneumonia. Instead, tilt your children. Let him throw up once and for all, do not hold-resistant.

2. No need to worry if your child is vomiting through the nose. Better to get out of the nose rather than inhaled into the lungs, it can be infectious.

3. Give the drink a little, but often. Always try to enter more fluid than the fluid that comes out in order to prevent dehydration. Given fluid can be anything, from ORS, sweet tea, sugar solution, and so forth. Do not be afraid to give a solution of sugar, because if you only drink water and hold, it could be child-calorie deficiency. Juice may be provided that is not acidic, because the sour taste it will induce vomiting.

4. During the regular vomit, not spray, do not worry. Just when children remain sick, spray vomit, the amount of fluid that spewed more than he received, immediately consult a doctor.

5. Be careful giving antivomit drug without medical supervision because there are side effects, while the vomiting itself is not an emergency that must be given the drug at home. What is important, give the kids drinking heavily.

6. Contact doctor if :
- Vomited greenish fluid, or there are spots of blood.
- Vomiting lasts more than 24 hours without any signs of improvement.
- During vomiting, the baby has a fever 39 ° C.
- Baby refusing to eat and drink more than 2 hours.

How to overcome vomit when pregnant?

Experience nausea or vomiting in early pregnancy is commonplace among expectant mothers. Symptoms which are also called "morning sickness", this is not yet known for certain causes by experts, but is often linked to various factors such as the increase various hormones and psychological influences.

Although the cause still not yet know, nausea and vomiting during pregnancy is associated with changes in hormonal levels in pregnant woman's body. When women are pregnant there will be increased levels of Homor Chorionic Gonadotropin (HCG) derived from the placenta. This hormone serves to maintain adequate production of the hormones estrogen and progesterone from the ovary, which affects the pregnancy for a healthy and smooth.

But in addition, these hormones have an effect thought to cause nausea and vomiting, especially in the three months of pregnancy (first trimester) and will fall back after the fourth month. Therefore, nausea and vomiting usually go away after entering the fourth month. Besides this HCG hormone, estrogen also considered to be the cause of nausea and vomiting in pregnant women.

If severe nausea or never decreases after passing a few weeks, would be handled and examined whether there are further complications. The doctor will look for other causes which led because there may be abnormalities in the pancreas, spleen, or kidneys.

So that morning sickness is not to interfere with the process of pregnancy and fetal growth, there are actually several steps can be taken by pregnant women to relieve symptoms. One of it is take vitamin B6 and ginger.

Vitamin B6 or Pyridoxine and ginger with a warmth that gives a sense of discomfort in the stomach may reduce nausea and vomiting during pregnancy. Nausea can also be reduced with the consumption of high carbohydrate foods.

What is Hyperemesis gravidarum?

Nausea and vomiting in pregnancy is a normal and lasted only the first trimester, but sometimes arise very severe nausea and vomiting called Hyperemesis gravidarum. The sign are as follows :
- Weight loss fell 2.5 to 5 kg or more during the first trimester.
- Unable to swallow food or drink anything for 24 hours.
- Water is very dark yellow urine or no urine for 8 hours.
- Vomiting very often every hour or more.
- Nausea so intense that always throw up when eating.

Therefore, we must be aware of this and should immediately contact your doctor. If the left can cause death for both mother and babies born with low weight.

The cause of blood vomiting

Vomiting fresh blood in these patients might be due to bleeding so much that not enough stomach acid to make the contaminated blood and blood still fresh, sometimes difficult to distinguish fresh blood or blood that has been contaminated with gastric acid (red-black or blackish red) . In these patients when viewed from the location of spleen nodules are very reasonable when these nodules cause short gastric venous flow resulting in varicose veins in the gastric fundus.

Tuberculossis spleen causing splenic vein occlusion and the diagnosis depends on detecting gastric varices by gastroscopy and selective angiography in men aged 17 years. Or it could be due to cirrhosis. Cirrhosis is the destruction of normal liver tissue that leaves non-functioning scar tissue around the heart tissue that is still functioning.

Here are tips to overcome Nausea and Vomiting :
1. Snacking when you wake up.
2. Start with fun activities.
3. Do not let your stomach empty.
Eat small but frequent portions. This is necessary because of increased levels of gastric acid is one of the main causes nausea.
4. Choose foods that are more easily digested.
Avoid spicy foods, due to aggravate gastric acid.
5. Create a variety of food menu so you do not get bored.
6. Do not dehydrated.
Consumption of foods high water levels, such as vegetables and fruits
7. Consumption of Vitamin B6, ginger and honey.
8. Avoid strong-smelling foods, smoke cigarettes or perfume odor that can lead to nausea and vomiting.
9. Do not lie down immediately after eating, you should sit upright for a while so as not to bloating or nausea.
10. Avoid drinking a lot while eating, wait 30 minutes after eating just drinking water.
Outside the meal you are expected to drink more.
11. Eat small meals but often (every 2-3 hours) to avoid nausea without the risk of malnutrition.
12. A diet full and balanced.
13. Get plenty of rest.
14. Consultation to your obstetrician if nausea and vomiting continues.