Siapaaku??

Saat ini saya lagi disalah satu service centre dari merk mobile phone,setelah menunggu antrian yang cukup lama ada pemandangan yang benar-benar bikin saya terpana,Yaitu ada dua orang pasangan yang masuk ketempat service center ini,mereka ini berpenampilan sangat menarik bagi saya karena pasangan ini memiliki kelebihan akan pendengaran dan daya ingat,akan tetapi memiliki kekurangan dalam penglihatan.

Setelah mereka antri (seperti layaknya yg lain) dan dalam hati saya ada keperluan apa mereka ke tempat perbaikan hp ini?Apakah mereka memiliki handphone jg,sedangkan mata mereka kurang atau bahkan tidak dapat melihat,lalu jika iya bagaimana mereka menggunakan alat komunikasi ini?hmm...ternyata betul seperti apa yg saya duga,mereka berdua ke tempat ini akan mengambil handphone yg sedang diservice.

Lalu bagaimana mereka menggunakannya,terutama untuk berkirim pesan pendek,sedangkan mereka untuk melihat benda disekitarnya hanya sensasi gelap yg dpt diterima oleh sistem penglihatannya.

Jauh sungguh jauh,katro wong deso ternyata aku,mau tau tidak mereka menggunakan fitur'' yang ada di hape nya menggunakan voice aid atau bahasa sononya program yg dibuat untuk para tunanetra ini.

Meminjam sloglan iklan,ternyata handphone saat ini memang sangat membantu dan bisa membuat ''Hidup menjadi hidup'',awas jgn menghidupkan yang telah mati lho hehehehe

Kata siapa sulit makan hanya pada anak kecil,ternyata kesulitan akan asupan makanan dapat juga terjadi pada oang tua,terutama orang tua yang telah lanjut atau memiliki suatu penyakit,untuk management nya dapat kita lakukan :


Assessment with Elder and Care Givers
Rituals used before meals (e.g., hand washing and toilet use), dressing for dinner.
Blessings of food or grace, if appropriate.
Religious rites or prohibitions observed in preparation of food or before meal begins, e.g., Moslem, Jewish, Seventh Day Adventist. Consult with Pastoral counselor, if available.
Cultural or special cues of family history, especially rituals surrounding meals.
Preferences as to end-of-life decisions regarding withdrawal or administration of food and fluid in the face of incapacity, or request of designated health-proxy. Ethicist or social worker may facilitate process.

Penyebab dari kesulitan makanan :


Weight and height - on admission to determine Body Mass Index (weight in kg/height in m2); thereafter weight taken at least every 7 days if a diagnosis of alteration in nutritional status exists. Weight loss/gain strategy devised by Registered Dietician with input from provider, if appropriate.
Skin - lesions, turgor, dryness, hair loss.
Neurological - Cranial nerves V, VII, IX, X, XI, XII (involved in swallowing).
Sensory limitations - vision, smell, taste, hearing.
Oral cavity - cleanliness, dentition including caries at root and surface, fit of denture or other oral appliances, lesions, condition of gums and tongue. Refer to Dentist for evaluation and treatment.
Neck - capacity to swallow. Refer to Speech Language Pathologist for thorough assessment.
Respiratory - restrictive disease limiting ability to eat or tolerate larger quantities of food, oxygen desaturation during meals, exercise intolerance. Refer to Respiratory Therapist, if appropriate.
Cardiac - presence of heart failure -- Stages III or IV, or poorly controlled angina, indicating intolerance of any activity.
Gastrointestinal – Gastroesophageal reflux disease (GERD), hiatal hernia, hypo or hyperactive bowel (constipation or diarrhea), abdominal pain or tenderness, diverticular disease.
Strength and coordination- neuro and musculoskeletal exam (i.e., sitting posture, use of upper extremities including range of motion, tremors, fine motor movements). Refer to Occupational and Physical Therapist for assessment, as appropriate.
Psychological - affective disorders, especially depression.
Pain - general and localized especially in jaw, mouth, throat, gastrointestinal.
Endocrine - Fasting blood sugar, microalbuminuria and thyroid-stimulating hormone in weight loss, for undiagnosed/poorly controlled diabetes and thyroid disease.
Medications - sedation, abnormal movements, dehydration. Pharmacologist to determine polypharmacy

Lingkungan dan yang diharapkan dalam melakukan pemberian nutrisi :

Dining or patient room: personal trappings versus institutional; no treatments or other activities occurring during meals; no distractions.
Tableware: use of standard dinnerware, e.g., china, glasses, cup and saucer, flatware, tablecloth, napkin versus disposable tableware and "bibs".
Furniture: elders seated in armed chair, table appropriate height versus eating in wheelchair or in bed.
Noise level: environmental noise from music, care givers, television is minimal; personal conversation between patient and care giver is encouraged.
Light: adequate and nonglare-producing versus dark, shadowy, or glaring.
Odor: familiar smells of food prepared versus all food prepared away from elder or medicinal smells and waste.
Adaptive equipment: available, appropriate, and clean; caregivers and/or elder is knowledgeable in use. Occupational therapist assists in evaluation.
Social atmosphere: meal sharing versus accomplishment of task.
Position of caregiver relative to elder: eye contact, seating so faces are in same plane (en face).
Pacing and choice: caregiver allows elder to choose food and determine tempo of meal; relies on elder's preference whenever known, voiced, or expressed through gestures and/or sounds.
Cueing: caregiver cues elder whenever possible with words or gestures.
Self-feeding: encouragement to self-feed with multiple methods versus assisted-feeding to minimize time.

Kata-kata yang terkait dengan gangguan intake nutrisi :

Aphasia: cannot verbally express preferences.
Apraxia: cannot manipulate utensils and food prior to eating, cannot manipulate food within mouth/swallow.
Agnosia: cannot recognize utensils, food.
Amnesia: forgets having eaten, does not recognize need to eat .
Anorexia: lack of desire to eat, possible physiological basis (i.e., failure to thrive).

Makanan apa dan bagaimana caranya kita untuk menjaga kesehatan jantung kita ini?

The general recommendations contained in this document generally can be applied to the clinical management of patients with or at risk for cardiovascular disease (CVD). For certain patients at higher risk, the recommendations may have to be intensified. Although great advances have been made in prevention and treatment of CVD through drug therapies and procedures, diet and lifestyle therapies remain the foundation of clinical intervention for prevention. Unfortunately, the latter commonly are neglected, to the detriment of patients. Rigorous application of the principles of diet and lifestyle intervention outlined in this document to patients at risk will contribute significantly to risk reduction and will augment the benefit that may be obtained by other approaches. The clinical approach is an extension of the public health approach, with some modifications depending on the type of patient.
Table. American Heart Association (AHA) 2006 Diet and Lifestyle Goals for Cardiovascular Disease Risk Reduction
Consume an overall healthy diet
Aim for a healthy body weight
Aim for recommended levels of low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.
Aim for a normal blood pressure
Aim for a normal blood glucose level
Be physically active
Avoid use of and exposure to tobacco products
Consume an Overall Healthy Diet
An emphasis on whole diet is also appropriate to ensure nutrient adequacy and energy balance. Hence, rather than focusing on a single nutrient or food, individuals should aim to improve their whole or overall diet. Consistent with this principle, the American Heart Association (AHA) recommends that individuals consume a variety of fruits, vegetables, and grain products, especially whole grains; choose fat-free and low-fat dairy products, legumes, poultry, and lean meats; and eat fish, preferably oily fish, at least twice a week (see Table below titled "AHA 2006 Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction").
Aim for a Healthy Body Weight
A healthy body weight is currently defined as a body mass index (BMI) of 18.5 to 24.9 kg/m2. Overweight is a BMI between 25 and 29.9 kg/m2, and obesity is a BMI >30 kg/m2. Achieving and maintaining a healthy weight throughout the life cycle are critical factors in reducing cardiovascular disease (CVD) risk in the general population. Data indicate that body weight at 18 years tracks with subsequent risk of developing CVD and diabetes, as does weight gain after 18 years of age. It is important to intensify efforts in the general population to help individuals avoid inappropriate weight gain during childhood and subsequent weight gain during adult years. Increased emphasis should be put on prevention of weight gain, because achievement and maintenance of weight loss, although certainly possible, require more difficult behavioral changes (i.e., greater calorie reduction and more physical activity) than prevention of weight gain in the first place.
Aim for a Desirable Lipid Profile
LDL levels are classified as follows: optimal, <100 mg/dL; near or above optimal, 100 to 129 mg/dL; borderline high, 130 to 159 mg/dL; high, 160 to 189 mg/dL; and very high, >190 mg/dL. Current recommendations for LDL cholesterol goals depend on the estimated 10-year risk of developing CVD and the presence of CVD-related risk factors. Although drug therapy is often prescribed for those at moderate or high risk, dietary changes are recommended for all individuals. Although at this time there are no HDL cholesterol goals as there are for LDL cholesterol, levels <50 mg/dL in women and <40 mg/dL in men are considered one of the criteria for the classification of metabolic syndrome. Likewise, although at this time there are no triglyceride goals, levels >150 mg/dL are considered one of the criteria for the classification of metabolic syndrome.
Aim for a Normal Blood Pressure
A normal blood pressure (BP) is a systolic BP <120 mm Hg and a diastolic BP <80 mm Hg. No evidence of a BP threshold exists—that is, the risk of CVD increases progressively throughout the range of BP, including the prehypertensive range (a systolic BP of 120 to 139 mm Hg or diastolic BP of 80 to 89 mm Hg). Hence, efforts to reduce BP to normal levels are warranted, even among individuals with prehypertension. Dietary modifications that lower BP are reduced salt intake, caloric deficit to induce weight loss, moderation of alcohol consumption (among those who drink), increased potassium intake, and consumption of an overall healthy diet, based on the DASH (Dietary Approaches to Stop Hypertension) diet. The latter is a carbohydrate-rich diet that emphasizes fruits, vegetables, and low-fat dairy products; includes whole grains, poultry, fish, and nuts; and is reduced in fats, red meat, sweets, and sugar-containing beverages. Replacement of some carbohydrates with either protein from plant sources or with monounsaturated fat can further lower BP.
Aim for a Normal Blood Glucose Level
A normal fasting glucose level is <100 mg/dL, whereas diabetes is defined by a fasting glucose level >126 mg/dL.
Be Physically Active
Regular physical activity is essential for maintaining physical and cardiovascular fitness, maintaining healthy weight, and sustaining weight loss once achieved.
Avoid Use of and Exposure to Tobacco Products
On the basis of the overwhelming evidence for the adverse effects of tobacco products and secondary exposure to tobacco smoke on CVD, as well as cancer and other serious illness, the AHA strongly and unequivocally endorses efforts to eliminate the use of tobacco products and minimize exposure to second-hand smoke. Because cessation of smoking in habitual smokers can be associated with weight gain, particular attention should be given to preventing this outcome. Concern about weight gain should not be a reason for continued use of tobacco products.
AHA Diet and Lifestyle Recommendations
The AHA 2006 Diet and Lifestyle Recommendations (see Table below) are intended to reduce CVD risk. These recommendations are intentionally presented in a manner that allows maximal flexibility in their implementation among a group of individuals with a wide range of dietary preferences and to meet the unique needs for growth, development, and aging. They are not presented as a "diet plan," per se, but rather a lifestyle prescription to promote cardiovascular health. Two examples of eating patterns at 2000 calories per day that meet the AHA 2006 Diet and Lifestyle Recommendations are presented in Table 4 in the original guideline document. The 2 examples provide a general framework to aid health practitioners in giving general, practical food-group-based guidance. The example of 2000 calories is provided for consistency with the Nutrition Facts Panel. For individuals who consume more or less than 2000 calories, appropriate adjustments in number of servings per day that are consistent with achieving and maintaining a healthy body weight should be made.
Although the recommendations present guidance about specific nutrients and types of foods, the importance of an overall healthy diet and lifestyle cannot be overemphasized. Multiple dietary factors influence CVD risk, and not all do so via changes in the risk factors described above. Hence, CVD benefit is likely to accrue by adherence to a healthy diet and lifestyle even if these risk factors are not markedly altered. Although the Food and Drug Administration (FDA) has sanctioned health claims for certain nutrients and foods, a focus on the overall diet is preferred over a specific focus on individual dietary components. This is, in part, due to the overarching goal of achieving energy balance and nutrient adequacy. If a specific food or category of foods is added to, rather than used to displace, other food from the diet (e.g., as a result of an FDA claim or new research finding), then the additional calories can lead to weight gain.
Table. AHA 2006 Diet and Lifestyle Recommendations for Cardiovascular Disease Risk Reduction
Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
Consume a diet rich in vegetables and fruits.
Choose whole-grain, high-fiber foods.
Consume fish, especially oily fish, at least twice a week.
Limit your intake of saturated fat to <7% of energy, trans fat to <1% of energy, and cholesterol to <300 mg per day by
Choosing lean meats and vegetable alternatives
Selecting fat-free (skim), 1%-fat, and low-fat dairy products
Minimizing intake of partially hydrogenated fats
Minimize your intake of beverages and foods with added sugars.
Choose and prepare foods with little or no salt.
If you consume alcohol, do so in moderation
When you eat food that is prepared outside of the home, follow the AHA Diet and Lifestyle Recommendations.
Balance Calorie Intake and Physical Activity to Achieve or Maintain a Healthy Body Weight
To avoid weight gain after childhood, individuals must control calorie intake so that energy balance is achieved—that is, energy intake matches energy expenditure. To control calorie intake, individuals should increase their awareness of the calorie content of foods and beverages per portion consumed and should control portion size. The macronutrient composition of a diet (i.e., the amount of fat, carbohydrate, and protein) has little effect on energy balance unless macronutrient manipulation influences total energy intake or expenditure. While reducing caloric intake, individuals should adopt and maintain a diet consistent with recommendations in this document.
A physically active lifestyle is recommended to reduce risk for CVD in all individuals, regardless of body weight. Regular physical activity also reduces symptoms in patients with established CVD. Among individuals who are overweight or obese, regular physical activity along with calorie restriction is recommended as a means to achieve weight loss. Regular daily physical activity has been shown to be particularly effective in maintaining weight loss once achieved.
The AHA recommends that all adults accumulate >30 minutes of physical activity most days of the week. Additional benefits will likely be derived if activity levels exceed this minimum recommendation. At least 60 minutes of physical activity most days of the week is recommended for adults who are attempting to lose weight or maintain weight loss and for children. The physical activity can be accumulated throughout the day. It is not easy for individuals to achieve these goals. However, it is important to encourage behaviors that will facilitate achieving and maintaining these goals over time. Achieving a physically active lifestyle requires effective time management, with a particular focus on reducing sedentary activities such as screen time (e.g., watching television, surfing the Web, playing computer games) and making daily choices to move rather than be moved (e.g., taking the stairs instead of the elevator).
Consume a Diet Rich in Vegetables and Fruits
A variety of vegetables and fruits are recommended. Vegetables and fruits that are deeply colored throughout (e.g., spinach, carrots, peaches, berries) should be emphasized because they tend to be higher in micronutrient content than are other vegetables and fruits such as potatoes and corn. Fruit juice is not equivalent to the whole fruit in fiber content and perhaps satiety value and should not be emphasized. A diet rich in vegetables and fruits is a strategy for lowering the energy density of the diet to control energy intake. Equally important is the method of preparation. Techniques that preserve nutrient and fiber content without adding unnecessary calories, saturated or trans fat, sugar, and salt are recommended (see Table below titled "Practical Tips to Implement AHA 2006 Diet and Lifestyle Recommendations").
Choose Whole-Grain, High-Fiber Foods
The AHA recommends that at least half of grain intake come from whole grains.
Consume Fish, Especially Oily Fish, at Least Twice a Week
Methods used to prepare fish should minimize the addition of saturated and trans fatty acids, as occurs with the use of cream sauces or hydrogenated fat during frying.
Contamination of certain fish with methyl mercury, polychlorinated biphenyls, and other organic compounds is a potential concern. Subgroups of the population, primarily children and pregnant women, are advised by the Food and Drug Administration (FDA) to avoid eating those fish with the potential for the highest level of mercury contamination (e.g., shark, swordfish, king mackerel, or tilefish), eat up to 12 ounces (2 average meals) per week of a variety of fish and shellfish that are lower in mercury (e.g., canned light tuna, salmon, pollock, catfish), and check local advisories about the safety of fish caught by family and friends in local lakes, rivers, and coastal areas. Potential exposure to some contaminants can be reduced by removing the skin and surface fat from these fish before cooking. For middle-aged and older men and postmenopausal women, the benefits of fish consumption far outweigh the potential risks when amounts of fish are eaten within the recommendations established by the FDA and Environmental Protection Agency. Consumers should also check with local and state authorities about types of fish and watersheds that may be contaminated and the FDA Web site for the most up-to-date information on recommendations for specific subgroups of the US populations (e.g., children, pregnant women).
Limit Your Intake of Saturated and Trans Fat and Cholesterol
As a set of goals, the AHA recommends intakes of <7% of energy as saturated fat, <1% of energy as trans fat, and <300 mg cholesterol per day. These goals can be achieved by (1) choosing lean meats and vegetable alternatives; (2) selecting fat-free (skim), 1%-fat, and low-fat dairy products; and (3) minimizing intake of partially hydrogenated fats.
Efforts to reduce saturated fat and cholesterol typically rely on replacement of animal fats with unsaturated fats (polyunsaturated and monounsaturated fats) and on selection of lower-fat versions of foods (e.g., replacing full-fat dairy products with nonfat or low-fat versions). Replacing meats with vegetable alternatives (e.g., beans) or fish is one strategy to replace saturated fats with unsaturated fats and reduce the cholesterol content. In view of the positive linear relationship among dietary saturated fat, LDL cholesterol, and CVD risk, and current US intakes, the AHA now recommends a population-wide goal of <7% of energy.
There are currently no numerical goals for trans fat. The Institute of Medicine recommends limiting trans fat intake as much as possible, and both the 2005 Dietary Guidelines Advisory Committee and a recent FDA Food Advisory Committee, Nutrition Subcommittee, recommended that the intake of trans fat be <1% of energy. (The FDA subcommittee voted [6 yes, 1 abstaining] in favor of the recommendation.) For this reason, the AHA recommends the goal of a diet containing <1% trans fatty acids.
The relative health effects of polyunsaturated and monounsaturated fats are actively debated. A few clinical outcome trials have documented that replacement of saturated fat with polyunsaturated fats reduces the risk of developing CHD, whereas prospective observational studies have documented that diets rich in monounsaturated fats are associated with a reduced risk of CHD. The AHA supports the recommendations of the Institute of Medicine and the National Cholesterol Education Program for total fat. A range of 25% to 35% for total fat is an appropriate level of intake in a healthy dietary pattern.
Minimize Your Intake of Beverages and Foods with Added Sugars
The primary reasons for reducing the intake of beverages and foods with added sugars are to lower total calorie intake and promote nutrient adequacy. Individuals who consume large amounts of beverages with added sugars tend to consume more calories and gain weight.
Choose and Prepare Foods with Little or No Salt
Because of the progressive dose-response relationship between sodium intake and BP, it is difficult to set a recommended upper level of sodium intake, which could be as low as 1.5 g/d (65 mmol/d). However, in view of the available high-sodium food supply and the currently high levels of sodium consumption, a reduction in sodium intake to 1.5 g/d (65 mmol/d) is not easily achievable at present. In the interim, an achievable recommendation is 2.3 g/d (100 mmol/d).
If You Consume Alcohol, Do So in Moderation
The AHA recommends that if alcoholic beverages are consumed, they should be limited to no more than 2 drinks per day for men and 1 drink per day for women, and ideally should be consumed with meals. In general, a 12-ounce bottle of beer, a 4-ounce glass of wine, and a 1 1/2-ounce shot of 80-proof spirits all contain the same amount of alcohol (one half ounce). Each of these is considered a "drink equivalent."
When You Eat Food That is Prepared Outside of the Home, Follow the AHA 2006 Diet and Lifestyle Recommendations
Attainment of a healthy diet will require individuals to make wise choices when they eat food prepared outside of the home.
Table: Practical Tips to Implement AHA 2006 Diet and Lifestyle Recommendations
Lifestyle
Know your caloric needs to achieve and maintain a healthy weight.
Know the calorie content of the foods and beverages you consume.
Track your weight, physical activity, and calorie intake.
Prepare and eat smaller portions.
Track and, when possible, decrease screen time (e.g., watching television, surfing the Web, playing computer games).
Incorporate physical movement into habitual activities.
Do not smoke or use tobacco products.
If you consume alcohol, do so in moderation (equivalent of no more than 1 drink in women or 2 drinks in men per day).
Food choices and preparation
Use the nutrition facts panel and ingredients list when choosing foods to buy.
Eat fresh, frozen, and canned vegetables and fruits without high-calorie sauces and added salt and sugars.
Replace high-calorie foods with fruits and vegetables.
Increase fiber intake by eating beans (legumes), whole-grain products, fruits, and vegetables.
Use liquid vegetable oils in place of solid fats.
Limit beverages and foods high in added sugars. Common forms of added sugars are sucrose, glucose, fructose, maltose, dextrose, corn syrups, concentrated fruit juice, and honey.
Choose foods made with whole grains. Common forms of whole grains are whole wheat, oats/oatmeal, rye, barley, corn, popcorn, brown rice, wild rice, buckwheat, triticale, bulgur (cracked wheat), millet, quinoa, and sorghum.
Cut back on pastries and high-calorie bakery products (e.g., muffins, doughnuts).
Select milk and dairy products that are either fat free or low fat.
Reduce salt intake by
Comparing the sodium content of similar products (e.g., different brands of tomato sauce) and choosing products with less salt
Choosing versions of processed foods, including cereals and baked goods, that are reduced in salt
Limiting condiments (e.g., soy sauce, ketchup).
Use lean cuts of meat and remove skin from poultry before eating.
Limit processed meats that are high in saturated fat and sodium.
Grill, bake, or broil fish, meat, and poultry.
Incorporate vegetable-based meat substitutes into favorite recipes.
Encourage the consumption of whole vegetables and fruits in place of juices.
Other Dietary Factors That Affect CVD Risk
Fish Oil Supplements
The AHA recommends that patients without documented coronary heart disease (CHD) eat a variety of fish, preferably oily fish, at least twice a week. Patients with documented CHD are advised to consume approximately 1 g of eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA) per day, preferably from oily fish, although EPA+DHA supplements could be considered in consultation with their physician. For individuals with hypertriglyceridemia, 2 to 4 g of EPA+DHA per day, provided as capsules under a physician's care, are recommended.
Plant Stanols/Sterols
Plant stanols/sterols lower LDL cholesterol levels by up to 15% and therefore are seen as a therapeutic option, in addition to diet and lifestyle modification, for individuals with elevated LDL cholesterol levels. Maximum effects are observed at plant stanol/sterol intakes of approximately 2 g per day. Plant stanol/sterols are currently available in a wide variety of foods, drinks, and soft gel capsules. The choice of vehicle should be determined by availability and by other considerations, including caloric content. To sustain LDL cholesterol reductions from these products, individuals need to consume them daily, just as they would use lipid-lowering medication.
Special Groups
Children Over 2 Years of Age
Children can eat a diet consistent with the AHA 2006 Diet and Lifestyle Recommendations and maintain appropriate growth while lowering risk for future CVD. Furthermore, because diet in youth is associated with the occurrence of CVD outcomes later in life and because lifestyle habits in youth track into adulthood, adoption of a healthy diet and lifestyle at early ages is recommended.
Older Adults
In general, the goals and recommendations described in this document are appropriate for older-aged individuals. Because they have decreased energy needs while their vitamin and mineral requirements remain constant or increase, however, older individuals should be counseled to select nutrient-dense choices within each food group.
Persons with Metabolic Syndrome
The primary approach to reducing CVD risk in persons with the metabolic syndrome is to control the individual risk factors by diet and lifestyle intervention. Physical activity and weight maintenance are recommended as a means to prevent the development of metabolic syndrome and lower the risk of developing type 2 diabetes or CHD. Very low-fat diets should be avoided if elevated triglyceride or depressed HDL cholesterol levels are present. Reducing caloric intake while maintaining a moderate-fat diet and increasing physical activity to achieve even a modest weight loss can improve insulin resistance and the concomitant metabolic abnormalities.
Persons with Chronic Kidney Disease
Dietary therapies recommended for the general population are also recommended for persons with early stages of chronic kidney disease (CKD), even though empiric evidence is sparse. In particular, a reduced salt intake is recommended as a means to reduce BP and prevent fluid overload, and dietary strategies to manage dyslipidemia are also recommended. Replacing meat with dairy and vegetable alternatives may also slow loss of kidney function. At advanced stages of CKD, the dietary management of CKD diverges from general population recommendations; in particular, a reduced intake of protein, phosphorus, and potassium is recommended.
Socioeconomic Groups at High Risk of CVD
Promotion of a desirable diet should be culturally sensitive and should encourage healthy preparation of traditional ethnic foods.
CLINICAL ALGORITHM(S)

B agi kita orang Indonesia jarang ada pendidikan untuk masyarakat tentang melakukan pertolongan pertama untuk mengatasi henti jantung sederhana atau yang dalam bahasa medik Indonesia disebut dengan "Resusitasi jantung paru".
Padahal tindakan ini sangat penting dilakukan sebagai pertolongan pertama jika ada keluarga,teman,atau orang yang kita tidak kenal mendadak pingsan dan mengalami henti jantung.
Mengapa kita perlu melakukan tindakan ini adalah mencegah untuk kejadian fatal selanjutnya yaitu "Kematian" dan "Hilangnya aliran oksigen ke otak setelah 5 menit".
Nah karena itu saya mencoba memberi video manual melakukan tindakan ini,video ini merupakan gambaran untuk kita bila mendapat kejadian-kejadian diatas,walaupun untuk melakukan tindakan ini memerlukan pengalaman,dan syarat-syarat klinik yang lainnya.Tapi kalo tujuan nya hanya belajar dan mengetahui sepertinya tidak ada masalah,bagi yang ingin bertanya dan memberi masukan saya buka comment seluas-luasnya.

Mudah-mudahan bermanfaat video ini bagi kamu yang peduli akan tindakan pertolongan pertama
ini

link nya

24
Komplikasi yang mungkin dapat terjadi dalam kehamilan

Amniotic Fluid,Eating Disorders,Anemia,Group B Strep,Antibodies,Heart Health,Asthma Pregnancy,High Risk Pregnanc,Baby Complications,Hypertension Preeclampsia,Bed Rest,Incompetent Cervix,Birth Defects,Placenta Previa,Bleeding,Preterm Labo,rCancer in Pregnancy,Rh Factor,DES Pregnancy,Smoking & Pregnancy,Diabetes,STDs & Pregnancy,Diseases & Pregnancy,ThyroidPregnancy

19 Tanda kehamilan yang bisa menjadi salah satu patokan untuk mengetahui bahwa kamu hamil atau tidak
Terlambat bulan Possible
Siklus yg tidak biasa dan abnormal Possible
Merasa hamil Possible
Mual dan muntah Possible
Perubahan dari libido Possible
Sakit pada daerah payudara Possible
Payudara yang membesar Possible
Sering kencing Possible
Lemah badan Possible
Perubahan warna kulit Possible
Tanda garis pada kulit Possible
Pergerakan dari janin Possible
Cairan spt susu pada payudara Possible
Perut yang membesar Probable
Positive tes kehamilan Probable

Palpation of the Baby Probable
Fetal Heart Tones Positive
Ultrasound Detection Positive
X-ray Detection Positive


hmm untuk tanda yang lainnya nanti saya lanjutkan lagi yah...
kalo sudah positif hamil,sayangi dan rawat janin kamu ok cee u on next posting

I
ntroduction

How should you work up a patient who presents with a complaint of urinary frequency? What questions are useful to ask when taking the patient's history? Are there specific signs that you should look for in the initial physical examination? Are there tests or other assessments that you should order? What is the differential diagnosis for this symptom? Also, once you've made a diagnosis, what can you do to help this patient?

The purpose of this article -- the first in a series on urologic presenting symptoms -- is to provide clinicians with a basic step-by-step guide for assessing and treating patients who present with urinary frequency. Although the list of possible etiologies given below and management algorithm in Figure 1 may seem daunting, we hope to show that the primary care provider may successfully identify the underlying cause of this symptom and provide effective treatment in many cases; in addition, we describe the indications for referral:

Polyuria (increased fluid intake):
Primary polydipsia:
Diabetes mellitus

Diabetes insipidus (DI)

Medications: diuretics, belladonna, atropine, and caffeine

Psychological.
Diminished functional bladder capacity (FBC):
Nonneurogenic:

Bladder infection/inflammation/interstitial cystitis

Bladder outlet obstruction

Men -- prostatic and bladder neck, strictures

Women -- pelvic organ prolapse, post surgical

Incomplete bladder emptying

Pregnancy

Bladder cancer

Bladder stones.
Neurogenic bladder:

Stroke

Multiple sclerosis

Diabetes mellitus

Parkinson's disease

Hydrocephalus

Brain tumor

Traumatic brain injury

Spinal cord injury/tumor

Myelodysplasia

Transverse myelitis.
Psychosocial:

Habit/social

Defensive voiding (incontinence, pelvic pain syndromes)

Medical advice (kidney stones, diet, and medication).

Definition of Urinary Frequency

First of all, just what do we mean by the term "urinary frequency"? Simply put, it is defined as urinating more often than normal, but how often is normal? Most people void about 6-8 times in a 24-hour period. Large surveys and bladder diary studies in the United States and Europe found that the upper limit of normal is 8 voids per 24 hours.[1,2] Does this mean that a patient who urinates more than 8 times a day is in need of treatment? Not necessarily. Decisions concerning management depend on the cause of the frequency and the degree of bother that it causes the patient. Nevertheless, because we have postulated urinary frequency as the presenting symptom, we can assume that it causes at least some degree of bother to the patient. However, before we can think about treatment, we'll need to determine the cause of the frequency.
Diagnostic Evaluation

As the first step in the process of unraveling the cause of a patient's frequency, the clinician will need to get a more exact picture of the patient's voiding habits. It is a good idea to administer a focused questionnaire before taking a medical history because responses to the questions can be a useful guide in your history taking. There are a number of validated questionnaires designed to assess lower urinary tract symptoms. The questionnaire provided is the one that we use; we believe that it contains almost all of the questions that need to be asked about urinary symptoms. Of course, in a busy primary care practice, such a focused questionnaire may be impractical. At a minimum, the patient should be asked to estimate how often he/she voids and the approximate volume voided (eg, half a cup) per void. The patient should also be asked to specify the reason for voiding: normal urge, pain, fear of incontinence, fear of pain, or social convenience (eg, before a movie). How long has the patient been experiencing frequency -- days, weeks, months, or years? Are there any other storage or voiding symptoms that suggest urinary tract infection, overactive bladder, or difficulty voiding?

The need for physical examination is dictated by the nature of the symptoms. For patients with mild symptoms, no exam is necessary unless there is a suspicion of urinary retention (voiding frequently in small amounts in the absence of symptoms of infection, difficulty voiding, or symptoms of overflow incontinence). Urinalysis should be done, and if there is pyuria or hematuria, culture should be obtained and the patient treated with culture-specific antibiotics. Gross hematuria and microhematuria, of course, require referral for cystoscopy and upper tract imaging (computed tomographic scan [CT] with intravenous contrast or magnetic resonance imaging [MRI]). Before the end of the first visit, instruct the patient to keep a bladder diary

The bladder diary helps quantify the patient's qualitative symptoms. It provides information on the maximum functional capacity, patterns of urination (eg, what times of day the patient typically voids), the actual number of episodes of urination (patients often overestimate the frequency of urination), and provides clues as to the cause of nocturia (eg, whether it is caused by nocturnal polyuria or decreased nighttime bladder capacity). The diary can also help clarify the patient's history (polyuria or normal amounts of urine production) and direct further questions (eg, concerning the amount of liquids consumed during particular periods in the day). In patients with polyuria, a full physical examination is mandatory and can elucidate causes, such as heart failure, endocrine abnormalities, lower extremity edema, or a genitourinary cancer.

The Basics of Urinary Frequency

How frequently a person urinates depends on 3 basic factors: the volume of the 24-hour urinary output, the capacity of the bladder, and -- for lack of a better word -- psychosocial considerations.

Volume of Urinary Output

The volume of urinary output, of course, depends almost entirely on intake of fluid and food. (Remember that most foods are 60% to 90% water.) Under ordinary circumstances urine excretion is about 70% of oral fluid intake,[3] but urine output can be greatly diminished by abnormal fluid losses due to excessive sweating (from exercise, exposure to high temperature, tachypnea, etc). Oral fluid and food intake is extremely variable and dependent on not only metabolic and pathologic conditions, but social and psychological factors as well. Of course, diuretic use and liquids that contain diuretics, such as coffee and other caffeinated beverages, may greatly increase urine output.

Bladder Capacity

Bladder capacity is the maximum volume of urine that a patient can comfortably hold. Determining a patient's bladder capacity, however, is not a simple matter of measuring the volume of urine that he or she voids. Various factors besides quantity of urine can trigger the sensations that we perceive as an urge to void. For example, in some people spicy foods or caffeine (independent of the diuretic effect) cause a strong urge to void at low bladder volumes. Psychosocial and environmental factors, such as being distracted by some specific activities (exercise, intense concentration) can increase bladder capacity. Of course, urinary tract infection, involuntary bladder contractions, and urethral obstruction have just the opposite effect. Most people involuntarily retain a certain amount of urine in the bladder after voiding. The amount of the leftover or postvoid residual (PVR) urine varies greatly from person to person and generally increases with age. Because measurement of the volume of a patient's PVR is not usually carried out by nonspecialists, determination of the actual capacity of a patient's bladder is not often done in a primary care setting. However, another measurement is useful. The maximum voided volume (MVV) or FBC is the volume of the patient's single most copious void during a given time period. Although median MVV has been calculated (from a series of 300 diaries in "normal" patients) to be 330 mL (mean, 204 mL), the range of recorded volumes was large (90-1020 mL), with the 95th percentile of MVV at 679 mL.[1]

Assessment of Bladder Capacity

A patient's bladder capacity can be assessed by 2 very different techniques: the frequency/volume chart (bladder diary) and cystometry.

The frequency/volume chart is a diary in which the patient records the time and volume of each urination over a specified period of time, usually 1, 3, or 7 days. For most clinical purposes, a 1-day diary suffices.[4] The patient is given a preprinted diary form to fill out and is asked to void each time into a measuring cup. The measuring cup may be something as ubiquitous as a disposable coffee cup (of course, the volume that the cup holds must be known), or it may be a graduated cylinder. The FBC is equivalent to the largest voided volume reported in the diary.

If a patient has an FBC of 200 mL and voids 1800 mL in 24 hours, he/she is obligated to void at least 9 times. Of course, most patients do not wait until the bladder is completely full, and therefore void more often than would be predicted solely on the basis of the FBC.

Cystometric bladder capacity (CBC) is defined as the volume at which the patient can no longer delay micturition during cystometry. CBC depends on a number of technical factors, including the rate of bladder infusion, temperature of the infusant, and type of infusant. Further, CBC may be at great variance from the FBC.[5,6] For routine clinical purposes, the FBC and CBC are sufficient; CBC is mostly of interest to urologists.

Psychosocial Factors

Psychosocial factors also play a major role in the frequency of urination, especially in New York City, where we have our practice. Someone apparently told the inhabitants of this city that it is very healthy to drink a lot of water. New York City water, which comes from the Adirondack Mountains, is said to be the best in the country, but for some reason New Yorkers seem to prefer bottled water from other places. Many of our patients often carry plastic water bottles with them and imbibe a lot of water, sometimes voiding in excess of 4 L a day. These patients also void very frequently! Other patients drink a lot because they are on diets and were told that it's good to drink a lot when you are on a diet. Some drink to prevent kidney stones and others are said to have psychogenic polydipsia. We usually advise patients with urinary frequency who drink excessive amounts to cut back and drink when prompted by thirst unless there is a specific medical reason to do otherwise.

Interpreting the Bladder Diary

When the patient returns with a completed diary, the clinician can begin to narrow the diagnosis. First, count the number of voids in the 24-hour period to confirm that the patient is indeed experiencing urinary frequency (> 8 voids per 24 hours). If so, then observe the total quantity of urine voided over the 24-hour period. The clinician needs to determine whether the patient is urinating a lot because he or she has an abnormally large volume of urine to void or because his or her bladder is holding less than a normal amount. Those patients who void more than 2.8 L in a day are said to have polyuria. Those patients with an FBC of < 150 mL are said to have diminished FBC.[1,2] Many patients, though, do not, strictly speaking, fit into this classification because they have a normal FBC, yet void frequently in small amounts for reasons that defy easy explanation. See Figure 3A for a diary typical of a patient with polyuria, and Figure 3B for one indicative of diminished bladder capacity.

Polyuria

For patients with polyuria, empirical treatment is initiated by having the patient consciously reduce his/her oral fluid intake. To facilitate this, we ask the patient to simply drink according to thirst, but filling the glass only halfway. If the patient is still thirsty, he or she is instructed to drink another half glass and so on. While on this regimen, the patient is asked to complete another bladder diary. For the vast majority of patients, this "treatment" is effective and no further evaluation is necessary. Patients with functional causes of polyuria have no problem complying with this, but those with poorly controlled diabetes mellitus, DI, and disorders of thirst (dipsogenic polyuria) are unable to do so. For these patients a more thorough evaluation is necessary.

Uncontrolled diabetes mellitus, which leads to hyperglycemia and osmotic diuresis, is easily checked by fasting blood sugar. DI is further divided into central and nephrogenic DI. Central DI is caused by deficient synthesis of antidiuretic hormone (ADH) secondary to loss of neurosecretory neurons in the hypothalamus or posterior hypophysis. Nephrogenic DI is due to an inability of the kidneys to respond to ADH. DI and polydipsia can be distinguished from one another by the water deprivation test.[7] The patient fasts overnight and the first morning urine specimen is checked for osmolality. We believe that specific gravity on dipstick is inaccurate and urine osmolality is the preferred test. Osmolality greater than 800 mOsm/kg H2O indicates that there is normal ADH secretion and normal renal response to ADH. Thus, a normal water deprivation test means that polyuria is due to primary polydipsia. Primary polydipsia is either dipsogenic or psychogenic. Dipsogenic polydipsia is associated with a history of central neurologic abnormality, such as prior brain trauma, radiation, or surgery. There is no known medical treatment for dipsogenic polydipsia. Psychogenic polydipsia is a long-term behavioral or psychiatric disorder treated with behavioral modification to reduce fluid intake; unfortunately, many patients areresistant to such treatment.

Diminished Bladder Capacity

Diminished bladder capacity is not a straightforward diagnosis because many patients void at much lower volumes than their FBC. Of course, if all of the voids were at MVV, the diagnosis of reduced bladder capacity would be easy; in fact, most patients void at greatly varying voided volumes. Sometimes they void in small amounts for psychosocial reasons (for example, before a long car ride) and other times they void at their MVV. When evaluating the diary, it is pivotal to ask patients why they voided when the voided volumes were low. If it was because of urge, discomfort, or pain, one should look for infectious and inflammatory causes and be cognizant that it could be idiopathic overactive bladder, or there could be a subtle neurologic etiology or even bladder cancer.

Women urinate more often during pregnancy because their bladders don't hold as much, probably because of the weight of the uterus pushing on the bladder. Other conditions, such as radiation treatments to the lower abdomen, multiple operations on the bladder, and interstitial cystitis, also greatly reduce the capacity of the bladder.

Involuntary bladder contractions (detrusor overactivity [DO]) are a common cause of urinary frequency. There are many causes of DO that can be divided into 2 main groups -- neurogenic and nonneurogenic DO -- depending on whether there is an underlying neurologic disorder, such as multiple sclerosis. Nonneurogenic conditions associated with DO included benign prostatic hyperplasia and prostatic obstruction in men, and stress incontinence and genital prolapse in women. Much of the time, when these underlying conditions are successfully treated the DO subsides as well.


Artikel took from emedicine site

46-year-old man with a history of cerebral palsy presented with difficulty in breathing, which had gradually increased during the previous 2 weeks. He was admitted to the intensive care unit with a diagnosis of sepsis, for which he received intravenous fluids, antibiotics, and mechanical ventilation. Computed tomography of the abdomen showed a severely distended colon with fecal stasis compressing the abdominal organs and elevating the diaphragm. There were no signs of colonic perforation. After initial conservative measures were unsuccessful in evacuating the impaction, multiple enemas with the use of sodium phosphate and soapsuds finally dislodged the blockage after 2 weeks. The patient's recovery was unremarkable.

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A Puzzling Facial Rash on a 17-Year-Old Boy

BACKGROUND
A 17-year-old boy presents to the pediatric infectious disease clinic with a 10-day history of a facial rash. The rash began as several pimples over the forehead and cheek that spread to most of the right side of his face. The lesions are not itchy, but they are painful. No improvement was noted with 2 separate courses of antibiotic therapy. The patient is very active on his school wrestling team, and he was happily preparing for an upcoming competition.

What is the diagnosis?



HINT
The patient was disqualified from wrestling because of his lesions.

TO ACCESS THE ANSWER AND DISCUSSION, PLEASE CLICK HERE:

Authors:
Faisal M. Mawri, MD, Pediatric Resident, Michigan State University College of Human Medicine, Hurley Medical Center, Department of Pediatrics, Flint, MI

Ammar Alhmood, MD, Pediatric Resident, Michigan State University College of Human Medicine, Hurley Medical Center, Department of Pediatrics, Flint, MI

Walid Abuhammour, MD, FAAP, FIDSA, Associate Professor of Pediatrics, Michigan State University College of Human Medicine; Director, Pediatric Infectious Disease, Attending Physician, Department of Pediatrics, Hurely Medical Center, Flint, MI

Nida Yousef, MD, Pediatric Resident, Hurley Medical Center, Michigan State University, Department of Pediatrics, Flint, MI



Editors:
Rick G. Kulkarni, MD, FACEP, Assistant Professor, Yale School of Medicine, Section of Emergency Medicine, Department of Surgery, Attending Physician, Medical Director, Department of Emergency Services, Yale-New Haven Hospital, CT

Adam I. Rubin, MD, Assistant Instructor, Department of Dermatology, University of Pennsylvania School of Medicine; Attending Physician, Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA








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Saat kita akan melakukan sesuatu perbuatan terkadang ada saja pertentangan didalam pikiran kita bisa atau mampukah kita untuk melakukannya,dapatkah ini menjadi sesuatu hal yang merugikan,dan bla...bla...lainnya...

Saat kita kecil kita dapat mendengar,walau orang dewasa tidak dapat mendengar.

Semua orang di dunia ini mengetahui tentang benda yang berada diatas langit,yang hadir disaat gelap menyelimuti malam saat orang beristirahat menenangkan pikiran dari aktifitas,masalah,dan kelelahan akibat rutinitas yang menjemukan.
Bulan merupakan sebuah benda satelit yang selalu bergantian bersama matahari untuk memberi cahaya dan sinarnya,mengelilingi bumi kita ini yang menurut para ahli berbentuk elips.
Sedangkan bintang hadir dengan sinarnya yang tidak begitu terang karena letaknya sangat jauh dari bumi ini,akan tetapi bintang dapat muncul bersama dengan bulan saat malam datang,setiap orang didunia walaupun memiliki berbagai jenis etnis,agama,dan suku mengetahui dan terkadang menunggu hadirnya keberadaan bintang dan bulan untuk dinikmati indah cahayanya.
Bulan itu sangat indah cahayanya dan dapat kita nikmati dengan berbagai bentuk tergantung dengan situasi dan posisinya dari bumi,dapat berbentuk lunar,semi lunar,ataupun tidak muncul sama sekali.
Bila kita mengharapkan benda langit ini muncul dimalam hari,terkadang kita dapat kecewa karena untuk menikmati indahnya sinar bulan dan bintang kita tidak boleh lupa akan keadaan cuaca yang dapat menutupi cahaya keindahannya,seperti juga bila kita merindukan hadirnya seseorang maka lihatlah bintang dan bulan diatas sana akankah sinarnya muncul malam ini mengobati kerinduan kita juga.
Tetapi akankah kita menyerah untuk menikmati hadirnya dan indah pancaran sinar dari bintang dan bulan bila hari ini kita tidak dapat melihatnya,ataukah kita akan berusaha menantikan lagi munculnya sinar ini esok hari,seperti bulan dan bintang yang selalu berusaha untuk memperlihatkan cahayanya demi membuat seseorang yang berduka tersenyum,memberikan penerangan pada anak-anak yang berlarian dan mengagumi kuasaNYA walau harus bersusah payah mengatasi segala rintangan dan halangan demi sebuah senyuman pada wajah umat manusia yang mengagumi keindahannya.
Sungguh sangat disayangkan bila ternyata bulan selalu menantikan munculnya sinar matahari yang terbit di ufuk barat dan ternyata bintang selalu kalah menunjukkan sinarnya,karena jarak dan kebiasan cahayanya yang muncul dari planet yang jaraknya dari bumi ini,bukan seperti matahari yang jaraknya lebih dekat dari bumi dan bulan,juga matahari dapat memberikan manfaat yang sama-sama berguna baik kelangsungan hidup manusia seperti halnya bulan yang selalu dinantikan dan ingin untuk dijelajahi.
BIntang tetaplah bintang,bulan tetaplah bulan,matahari tetaplah matahari yang selalu berada di tata surya dan memiliki ciri dan kegunaan yang berbeda diatas sana dan selalu menimbulkan pertanyaan akan kebesaran kuasaNYA.

Terkadang di saat yang tidak terduga kita menemukan orang yang terkena serangan asma mendadak,dimana terdapat suatu gejala sulit bernapas dan suara napas yang berbunyi,jika pada serangan asma tersebut tidak diatasi secara segera maka dapat menimbulkan keluhan yang lebih berat.
Lalu apa yang harus kita lakukan jika serangan asma terjadi pada seseorang di sekitar kita: yang paling penting adalah "Jangan panik",lalu carilah obat yang biasa orang asma bawa dapat berupa obat hisap melalui mulut (lazim disebut inhaler),atau obat yang diminum berilah obat tersebut,lalu posisikan orang tersebut dengan kedua tangan menyetuh tanah dan badan diregangkan ke belakang dengan posisi duduk (pungung antara yang menolong dan yang ditolong menyatu dengan pungung penolong lebih rendah dari orang yang terkena asma tersebut),buatlah orang tersebut dengan posisi senyaman mungkin.
Untuk lebih jelasnya saya sertakan linkpenanggulangan asma dalam bentuk pdf,mudah-mudahan bermanfaat dalam keadaan darurat.

NEW TREATMENTS IN ADHD


Oscar G Bukstein, MD, MPH


University of Pittsburgh School of Medicine


INTRODUCTION


Attention deficit hyperactivity disorder (ADHD) is one of the most common problems experienced in youth.(1) Prevalence estimates of ADHD in children of school age have ranged from 2% to 18% in community samples. Of these children, 2.5 million (56%) were believed to be receiving medication for the disorder.(1) Over the past decade, numerous new long-acting formulations of methylphenidate (MPH) and amphetamine (AMP) have provided physicians with additional therapeutic options.


PHARMACOTHERAPY FOR ADHD


The pharmacotherapy for ADHD consists of stimulant and nonstimulant medications. Stimulants are often considered the cornerstone of ADHD treatment. Over the past 3 decades, almost 200 randomized clinical trials of stimulant medications have been performed in patients with ADHD that demonstrate the medications’ efficacy in the treatment of ADHD.(1) Double-blind, placebo-controlled trials in children and adults reveal that up to 75% of subjects with ADHD respond clinically to stimulants, compared with 0% to 30% of subjects treated with placebo. When clinical response is assessed via rating scales, the effect size of stimulant treatment relative to placebo in recent studies is quite large—in fact one of the largest effects for any psychotropic medication—according to effect size statistical indices.(1,2,3) However, not all patients with ADHD respond to or tolerate stimulants. The development of nonstimulant agents and the approval by the US Food and Drug Administration (FDA) of at least one of them has provided physicians with needed alternatives to stimulants.


NEW MEDICATIONS FOR ADHD: STIMULANTS


In the past decade, extensive trials have been carried out on long-acting forms of stimulants, including both MPH and AMP preparations, which are currently approved by the FDA for the treatment of ADHD.(2,3)
The MPH preparations include OROS methylphenidate (Concerta), methylphenidate extended-release (Metadate, Ritalin LA), d-methylphenidate (d-MPH) extended-release (Focalin XR), and the MPH transdermal patch (Daytrana). The AMP preparations include the extended-release version of mixed amphetamine salt (MAS XR; Adderall XR) and the prodrug lisdexamfetamine (Vyvanse).

Several differences exist (see Table below) among some of these new formulations and older extended-release preparations such as MPH extended-release (Ritalin-SR), which is a wax-matrix formulation. Metadate CD, Ritalin LA, Focalin XR, and Adderall X are based on a “bead” technology in which long-acting and short-acting beads or portions of beads release the drug so as to mimic bid dosing and extended duration of effect.(2,3) Concerta is based on OROS, an osmotic release system, in which an immediate-release portion of the MPH is in the overcoat of the capsule while the remainder is osmotically released over the course of 9 or more hours.(4)

Additional formulation differences between the newer, long-acting preparations and their predecessors are based on the development of single isomer agents, transdermal patches, and prodrugs. For example, Focalin XR is a single-isomer agent containing d-MPH (the presumed active isomer of MPH), whereas some other MPH agents are racemic mixtures of both the l- and d- MPH isomers. Similarly, Adderall and Adderall XR are mixed amphetamine salts containing both d- and l- AMP isomers, while the older AMP formulations (eg, Dexadrine) contain only d-AMP. In the Daytrana patch (methylphenidate transdermal system), MPH is absorbed through passive diffusion and provides up to 12 hours of efficacy with a 9-hour wear time. Vyvanse (lisdexamfetamine) is a therapeutically inactive molecule (d-AMP covalently bonds to the amino acid lysine) that is converted to its active form by gut enzymes in a presumed rate-limiting process. Given this process, intravenous or intranasal administration presumably yields minimal stimulant effects, and a possible lower potential for dependence is suggested by studies reporting a significantly lower abuse-related liking effect than an equivalent oral dose of d-AMP.(5,6)

The Table below provides the mean duration of the various formulations. All of these preparations are marketed as extended-release and “once-daily” medications. Based on analog classroom data, Concerta, Focalin XR, Daytrana, and Vyvanse all show efficacy at 12 hours following administration.(2,3) These agents show comparable levels of efficacy in terms of the decrease in and control of ADHD symptoms.(2,3) Extended-release formulations have been shown to be efficacious in adolescents as well as children, as they offer greater convenience for the patient and family and enhanced compliance and confidentiality.

Adverse effects of extended-release formulas are similar across formulations and similar to immediate-release stimulants.(2,3) However, largely because of the absence of head-to-head studies between these agents, the clinical significance of these variations in formulations in terms of comparative efficacy and safety is not known.



NEW MEDICATIONS FOR ADHD: NONSTIMULANTS



Atomoxetine is a noradrenergic reuptake inhibitor shown to be superior to placebo in the treatment of ADHD in children, adolescents, and adults. It is the first and only nonstimulant medication approved by the FDA for the treatment of ADHD and is approved for use in children, adolescents, and adults.(7) Unlike stimulants in general, atomoxetine can be given in the late afternoon or evening.(7) Atomoxetine may also have less pronounced effects on appetite and sleep than stimulants, although it may produce relatively more nausea or sedation.(7) Atomoxetine has been studied in the treatment of patients with ADHD and comorbid anxiety. At the end of a 12-week treatment period, atomoxetine led to a significant reduction in the symptoms ratings of both ADHD and anxiety relative to placebo, showing the drug to be potentially efficacious in the treatment of both conditions.(7)

Modafinil is currently marketed as Provigil for patients with narcolepsy, sleep apnea, and shift work sleep disorder, but it has been demonstrated to be efficacious in the treatment of ADHD in children of school age. The most commonly reported adverse effects in the modafinil group were insomnia (29%), headache (20%), and decreased appetite (16%).(8) The presence of a possible case of Stevens-Johnson syndrome prevented FDA approval.(8)

Guanfacine extended-release (XR), tentatively named Intuniv, is a selective alpha-2A-adrenoceptor agonist. Data from 2 short-term, phase III, placebo-controlled studies and 2 long-term, phase III, open-label studies demonstrated that guanfacine XR significantly improved all core symptoms of ADHD in children aged 6-17 years.(9) Guanfacine XR has received an approvable letter from the FDA, and marketing of this agent is expected in 2009.(10)



SELECTING THE “RIGHT” MEDICATION OR FORMULATION



The initial pharmacological treatment of ADHD should be a trial with an agent approved by the FDA for the treatment of ADHD. Direct comparisons of atomoxetine with MPH and AMP have shown greater treatment efficacy with the stimulants, although the studies were of short duration.(1) Of note, atomoxetine may be considered a first-line medication for ADHD in patients with an active substance abuse problem, comorbid anxiety or tics, or an intolerance of stimulants because of adverse effects.(1)

Overall efficacy and adverse effects are similar across stimulants; therefore, physicians can use their discretion when selecting a medication. For young children or others unable to swallow pills or capsules, the MPH transdermal patch and bead preparations, which allow one to open the capsules and sprinkle the beads on food, offer an alternative that may improve compliance. In addition, the prodrug lisdexamfetamine may offer a lower potential for dependence. Furthermore, while a number of agents are once-a-day preparations, some individuals may prefer a shorter-acting agent because of personal preference or a pattern of adverse effects.

Not all patients with ADHD respond to any one medication, and response prior to a trial of medication cannot be clearly predicted. For some, sequential trials with various stimulants or nonstimulant agents or formulations may be necessary to achieve an adequate or, preferably, optimal response.


REFERENCES


1. Dulcan M. Practice parameters for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry (AACAP). J Am Acad Child Adolesc Psychiatry. 1997;36(10):85S-121S.

2. Newcorn JH, Ivanov I. Psychopharmacologic treatment of attention-deficit/hyperactivity disorder and disruptive behavior disorders. Pediatric Annals. 2007;36(9):564-74.

3. Pliszka SR, Crismon ML, Hughes CW, et al. The Texas Children’s Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(6):642-57.

4. Wolraich ML, Greenhill LL, Pelham W, et al. Randomized, controlled trial of oros methylphenidate once a day in children with attention-deficit/hyperactivity disorder. Pediatrics. 2001;108(4):883-92.

5. Biederman J, Krishnan S, Zhang Y, McGough JJ, Findling RL. Efficacy and tolerability of lisdexamfetamine dimesylate (NRP-104) in children with attention-deficit/hyperactivity disorder: a phase III, multicenter, randomized, double-blind, forced-dose, parallel-group study. Clinical Therapeutics. 2007;29(3):450-63.

6. Jasinski D, Krishnan S, Kehner G. Abuse liability of intravenous lisdexamfetamine (LDX; NRP-104). Presented at the 2006 Annual Meeting of the Society for Developmental and Behavioral Pediatrics; September 17, 2006; Philadelphia, Pennsylvania.

7. Michelson D, Allen AJ, Busner J. Once-daily atomoxetine treatment for children and adolescents with attention deficit hyperactivity disorder: a randomized, placebo-controlled study. Am J Psychiatry. 2002;159(11):1896-901.

8. Biederman J, Swanson JM, Wigal SB, Boellner SW, Earl CQ, Lopez FA. A comparison of once-daily and divided doses of modafinil in children with attention-deficit/hyperactivity disorder: a randomized, double-blind, and placebo-controlled study. J Clin Psychiatry. 2006;67(5):727-35.

9. Biederman J, Melmed RD, Patel A, et al. A randomized, double-blind, placebo-controlled study of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder. Pediatrics. 2008;121(1):e73-e84.

10. Shire Press Release. http://em.emedicine.com/cgi-bin1/DM/y/eBj810UfU7M0WNK0JK8B0EN L&ref=21480 Accessed February 28, 2008.



Author Spotlight

Oscar Bukstein,MD,MPH
Associate Professor of Psychiatry
Western Psychiatric Institute and Clinic
University of Pittsburgh School of Medicine

Keracunan makanan adalah hal yang dapat terjadi bahkan tanpa kita sadari kita dapat menjadi salah satu korbannya.Keracunan makanan yang tidak ditangani dengan baik dapat menyebabkan kematian sekitar 48 jam setelah kita terkena.
Adapun ciri dari keracunan makanan adalah : mual,muntah,keram pada daerah perut,diare,pendarahan,panas badan,berkeringat hebat,dehidrasi dan perubahan dari sistem saraf.
Kapan saatnya kita harus pergi ke rumah sakit bila ada ciri ini :

1.The ill person passes out or collapse, become dizzy, lightheaded, or have problems with vision.
2.A fever higher than 101°F occurs with the abdominal symptoms.
3.Sharp or cramping pains do not go away after 10-15 minutes.
4.The ill person's stomach or abdomen swells.
5.The skin and/or eyes turn yellow.
6.The ill person is vomiting blood or having bloody bowel movements.
7.The ill person stops urinating, have decreased urination, or have urine that is dark in color.
8.The ill person develops problems with breathing, speaking, or swallowing.
9.One or more joints swell or a rash breaks out on your skin.

Untuk perawatan sementara di rumah dapat dilakukan tindakan :

1.Do not eat solid food while nauseous or vomiting but drink plenty of fluids.
2.Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
3.Avoid alcoholic, caffeinated, or sugary drinks. Over-the-counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
4.Sports drinks such as Gatorade and Powerade are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.

After successfully tolerating fluids, eating should begin slowly, when nausea and vomiting have stopped. Plain foods that are easy on the stomach should be started in small amounts. Consider eating rice, wheat, breads, potatoes, low-sugar cereals, lean meats, and chicken (not fried) to start. Milk can be given safely, although some people may experience additional stomach upset due to lactose intolerance.

Most food poisonings do not require the use of over-the-counter medicines to stop diarrhea, but they are generally safe if used as directed. It is not recommended that these medications be given to children. If there is a question or concern, you should always check with a doctor.

Nah tetapi cara untuk menhindari keracunana makanan dengan melakukan tips-tips dibawah ini :

1.Safe shopping :
Buy cold foods last during your shopping trip. Get them home fast.
Never choose torn or leaking packages.
Do not buy foods past their "sell-by" or expiration dates.
Keep raw meat and poultry separate from other foods.

2.Safe storage of foods
Keep it safe; refrigerate.
Unload perishable foods first and immediately refrigerate them. Place raw meat, poultry, or fish in the coldest section of your refrigerator.
Check the temperature of your appliances. To slow bacterial growth, the refrigerator should be at 40°F, the freezer at 0°F.
Cook or freeze fresh poultry, fish, ground meats, and variety meats within two days.

3.Safe food preparation
Keep everything clean!
Wash hands before and after handling raw meat and poultry.
Sanitize cutting boards often in a solution of one teaspoon chlorine bleach in one quart of water.
Do not cross-contaminate. Keep raw meat, poultry, fish, and their juices away from other food. After cutting raw meats, wash hands, cutting board, knife, and counter tops with hot, soapy water.
Marinate meat and poultry in a covered dish in the refrigerator. Discard any uncooked/unused marinade.
Thawing food safely
Refrigerator: Allows slow, safe thawing. Make sure thawing juices do not drip on other foods.
Cold water: For faster thawing, place food in a leak-proof plastic bag and submerge in cold tap water.
Microwave: Cook meat and poultry immediately after microwave thawing.

6.Safe cooking
Use a meat thermometer.
Cook ground meats to 160°F; ground poultry to 165°F. Beef, veal, and lamb steaks, roasts and chops may be cooked to 145°F; all cuts of fresh pork, 160°F. Whole poultry should reach 180°F in the thigh; breasts 170°F.
Keep hot foods hot and cold foods cold.
Never leave food out more than two hours (or more than one hour in temperatures above 90°F).
Bacteria that cause food poisoning grow rapidly at room temperature.
Use cooked leftovers within four days.

Nah itu lah sekilas pengetahuan ttg keracunan makanan,bagi yang mau comment silahkan yah isi comment kolom dibawah,maaf jika ada kata-kata dalam bahasa inggris.

tulisan ini saya kutip dari : sini

Passion..kata siapa orang tua tidak memiliki passion?Terbukti pada guru private ku ternyata walaupun kata orang sudah berumur tetapi beliau tetap memiliki semangat yang tinggi tuk mengajar dan mengamalkan ilmu yang beliau miliki.
Walaupun bagi sebagian orang umur yang mendekati satu abad tersebut tidak dapat melakukan hal apapun bahkan cenderung menyusahkan tetapi tidak bagi beliau,guru ku tersebut masih memiliki semangat yang tinggi,bahkan beberapa muridnya yang lain merupakan orang-orang yang sukses dan dpt disebut sebagai petinggi di negara ini.
Hebat...hebat...sungguh hebat beliau,kenapa anak muda jaman sekarang jarang yang berjiwa seperti beliau,standing applause for you sir

Kaya judul lagu User aja ya?..(confession Part bla..bla..)
Sekarang si gw mo kasih beberapa definisi dari technosexual, business as usual...dapet dr googling..

Technosexual was:

• (TEK.noh.sek.shoo.ul) n. dandyish narcissist in love with not only himself, but also his urban lifestyle & gadgets; a man who is in touch with his feminine side but has fondness for electronics such as cell phones, pda's, computers, software, and the web.

Someone who is a geek in of style, or a stylish person in need of geek is a technosexual.

Nah lo!..pada ngarti kagak tuh bahasa linggis???..
Tapi ada jg yg mendefinisikan sebagai berikut :

• A man or woman that prefers the company of an electronic device over that of a living being, typically used to describe a woman that does not have a husband/boyfriend as an insult; by claiming they prefer a vibrator to a man.

  Man: Are those moon pants, cause that ass is out of this world baby!
  Woman uses her mace on Man.
  Man: You technosexual bitch, my eyes!

WEW!!!...geuleuh gak seh?...tp menurut gw definisi yg kedua kurang tepat...gw prefer yg pertama..
Nah dari dua definisi tersebut diatas You orang bisa ngambil kesimpulan mahluk macam apa sih technosexual itu..
Kira2 itulah fenomena yg ada di urban lifestyle masa kini...mungkin You orang termasuk didalamnya..The fast n rapidly growth of technology born a new generation of human being..

Opinion n argument are welcome..