Jun 29

Penyakit Kekurangan Enzim G6PD. ( G6PD deficiency )

By taqidoc Medicine, Pediatric 2 Comments »

Pengenalan

Penyakit kekurangan enzim G6PD atau lebih dikenali dengan nama G6PD di kalangan rakyat Malaysia merupakan  satu penyakit bawaan genetik. Ia boleh menyebabkan anemia akibat stress pengoksidaan apabila pesakit tersebut terdedah kepada ubat-ubatan, makanan atau bahan-bahan tertentu. Akibat daripada stress pengoksidaan, sel-sel darah merah akan pecah dan ini menyebabkan anemia berlaku. Proses pemecahan sel-sel darah merah ini dinamakan hemolisis.

Penyakit ini biasanya berlaku kepada kaum lelaki dan dianggarkan 3-5% penduduk Malaysia mengalami masalah kekurangan enzim G6PD.

Pesakit yang mewarisi penyakit ini boleh hidup sebagaimana manusia normal akan tetapi ubat atau makanan tertentu yang boleh menyebabkan hemolisis perlu dielakkan.

Apakah yang dimaksudkan dengan kekurangan enzim G6PD?

Di dalam sel darah merah terdapat satu jenis enzim yang bertanggungjawab mengekalkan kestabilan sel darah merah daripada pecah iaitu enzim G6PD (Glucose-6-phosphate dehydrogenase ). Apabila paras enzim ini rendah, sel darah merah tidak mampu menahan keadaan stress seperti dalam kes jangkitan teruk atau apabila bahan kimia atau ubat-ubatan tertentu diambil, sekaligus menyebabkan sel darah merah pecah.

Hemolisis berlaku dengan cepat dan ini membawa kepada hemolitik anemia.

Berapa kerapkah berlakunya kes kekurangan enzim G6PD ?

Dianggarkan seramai 400 juta manusia seluruh dunia menghadapi masalah kekurangan enzim G6PD. Keadaan ini selalunya berlaku di bahagian-bahagian tertentu Afrika, Asia dan Mediterranean.

Kawasan yang biasanya berlaku malaria juga mempunyai kes kekurangan enzim G6PD yang tinggi.

Di Malaysia pula dianggarkan 3-5% penduduk Malaysia mengalami masalah ini.

Apakah gen yang bertangggungjawab menyebabkan kekurangan enzim G6PD?

Punca utama kepada berlakunya masalah kekurangan enzim G6PD ialah mutasi di dalam gen G6PD. Gen G6PD mengeluarkan arahan supaya enzim G6PD dibentuk. Enzim ini terlibat dengan normal pemprosesan karbohidrat dan ia juga melindungi sel-sel darah merah daripada molekul berbahaya yang dipanggil molekul oksigen reaktif. Molekul ini merupakan hasil kumuhan sel. Tindak balas kimia yang melibatkan G6PD menghasilkan unsur yang mencegah molekul oksigen reaktif daripada terbina dan terkumpul di dalam sel darah merah sekaligus melindungi sel darah merah daripada pecah.

Sekiranya mutasi di dalam gen G6PD mengurangkan kuantiti enzim G6PD atau menukarkan strukturnya, enzim ini tidak lagi dapat memainkan peranannya sebagai pelindung sel darah merah sekaligus menyebabkan pengumpulan molekul oksigen reaktif yang membawa kerosakan kepada sel darah merah. Faktor seperti jangkitan,sesetengah ubat-ubatan, ataupun memakan kacang parang boleh meningkatkan paras molekul oksigen reaktif dan ini akan menyebabkan sel darah merah dimusnahkan lebih cepat berbanding penghasilannya. Berkurangnya sel darah merah membawa kepada timbulnya simptom dan tanda hemolitik anemia.

Banyak penyelidik percaya yang pembawa-pembawa G6PD mungkin dilindungi daripada penyakit malaria. Ini kerana pada pandangan mereka berkurangnya fungsi enzim G6PD menyebabkan parasit sukar untuk masuk ke dalam sel darah merah.

Bagaimanakah seseorang itu mewarisi kekurangan enzim G6PD?

Masalah kekurangan enzim G6PD ini ditentukan oleh kromosom resesif X. Gen yang dikaitkan dengan masalah kekurangan enzim ini terletak pada kromosom X. Lelaki hanya mempunyai satu kromosom X. Oleh itu, sebarang perubahan secara mutasi pada kromosom X tersebut sudah cukup untuk mewujudkan keadaan kekurangan enzim G6PD. Berlainan pula dengan perempuan yang mempunyai 2 kromosom X, mutasi perlu berlaku pada kedua-dua kromosom untuk mewujudkan keadaan kekurangan enzim G6PD ini. Oleh kerana faktor inilah, kebanyakan pesakit kekurangan enzim G6PD adalah lelaki.

Bagaimana masalah kekurangan G6PD ini didiagnosa?

Berdasarkan sampel darah yang diambil, pesakit kekurangan enzim G6PD akan menunjukkan kandungan haemoglobin yang kurang dan bilirubin yang tinggi di dalam darah.

Selain daripada itu blood film menunjukkan wujudnya blister cells.

Gambar anak panah menunjukkan blister cells akibat akut hemolisis di dalam kes kekurangan enzim G6PD.

Ujian spesifik paras enzim G6PD menunjukkan kandungan enzim yang rendah di dalam darah. Walau bagaimanapun semasa fasa akut, paras enzim di dalam darah mungkin normal atau hampir normal kerana sel yang terbabit semuanya dimusnahkan meninggalkan sel darah merah muda yang mempunyai paras normal enzim G6PD.

Oleh kerana keadaan ini adalah diwarisi daripada ibu yang merupakan pembawa gen tersebut, darah ibu pesakit akan menunjukkan paras enzim G6PD yang rendah daripada normal ataupun sedikit rendah daripada normal. Ini menguatkan lagi diagnosis kekurangan enzim G6PD pesakit.

Apakah gejala-gejala dan tanda-tanda pesakit kekurangan enzim G6PD?

Bagi kebanyakan pesakit yang menghadapi masalah kekurangan enzim G6PD, hemolitik anemia adalah tidak ketara sehinggalah 48-96 jam selepas pesakit mengambil bahan-bahan yang boleh menyebabkan pengoksidaan seperti aspirin, sulfonamid, ubat malaria(seperti primaquin), naftalin dan kacang parang (fava beans). Selain daripada yang tersebut di atas, jangkitan bakteria atau virus juga boleh menyebabkan hemolitik anemia kepada pesakit kekurangan enzim G6PD ini.

Gejala-gejala hemolisis yang akut termasuklah kepucatan, jaundis,mudah letih, sesak nafas, jantung berdebar-debar dan hemoglobinuria (hemoglobin dalam air kencing) yang menjadikan air kencing berwarna gelap. Kematian boleh berlaku sekiranya pesakit mengalami hemolisis yang teruk.

Jaundis dapat dilihat pada bahagian mata putih pesakit apabila berlakunya hemolisis di dalam pesakit kekurangan enzim G6PD.

Bagi bayi baru lahir, kekurangan enzim G6PD boleh menyebabkan jaundis(kekuningan) yang patologik. Jaundis pada bayi-bayi yang mempunyai tahap bilirubin yang tinggi di dalam darah perlu menjalani transfusi darah.

Walaupun ramai yang mempunyai masalah kekurangan enzim G6PD ini, tetapi ramai yang tidak pernah menghadapi gejala-gejala atau tanda-tanda seperti di atas.

Apakah ubat-ubatan yang patut dielakkan bagi pesakit kekurangan enzim G6PD?

  1. Anti-malarial : Primaquine dan pamaquine( Chloroquine di bawah pengawasan mungkin digunakan apabila antimalaria diperlukan untuk pencegahan atau rawatan malaria )
  2. Sulfonamides  : Sulfacetamide, Sulfanilamide, Sulfamethoxazole (e.g. Septra, Bactrim),Sulfasalazine.
  3. Anti-bacterials : Nitrofurantoin, Nalidixic Acid, Dapsone, Mafenide Cream (Sulfamylon).
  4. Analgesics : Phenacetin, Acetanilid, Phenazopyridine (Pyridium).
  5. Antihelmintics : ß-Naphthol, Stibophen dan Niridazole.
  6. Miscellaneous
    1. Vitamin K analogues (1mg phytonadione boleh diberikan kepada bayi)
    2. Probenecid
    3. Dimercaprol (BAL)
    4. Flutamide (Eulexin)
    5. Methylene Blue
    6. Tolouidine Blue
    7. Napthalene ( ubat gegat )

Apakah ubat-ubatan yang boleh digunakan oleh pesakit kekurangan enzim G6PD?

Secara umumnya :

1)Kesemua ubat yang “contraindicated” di dalam kes G6PD

2)Mungkin tidak boleh digunakan di dalam kes Kelas 1 G6PD.

Mengikut klasifikasi WHO, G6PD dibahagikan kepada 5 kelas. Kelas 1-3 merupakan keadaan kekurangan enzim.

Kelas 1 : Kekurangan enzim yang teruk (iaitu kurang daripada 10% aktiviti) dengan kronik hemolitik anemia.

Kelas 2 : Kekurangan enzim yang teruk ( iaitu kurang daripada 10% aktiviti) dengan  kadang-kadang berlakunya hemolisis.

Kelas 3: Kekurangan enzim yang sedikit ( dengan 10-60 % aktiviti ), hemolisis hanya berlaku apabila wujudnya keadaan stres iaitu ketika jangkitan, ubat-ubatan tertentu dan pengambilan kacang parang.

Kelas 4: Varian tanpa kekurangan enzim, dengan tiadanya symptom atau tanda.

Kelas 5: Aktiviti enzim meningkat dengan tiadanya symptom atau tanda.

Antara ubat-ubatan yang boleh diambil oleh pesakit kekurangan enzim G6PD:

  1. Analgesics
    1. Acetaminophen ( paracetamol )
    2. Aspirin ( boleh diberikan tapi dalam dos yang sederhana sahaja )
    3. Auralgan
  2. Cardiovascular Agents
    1. Procainamide
    2. Quinidine
  3. Neurologic Agents
    1. Trihexyphenidyl
    2. Levodopa
    3. Phenytoin
  4. Antibiotics
    1. Chloramphenicol
    2. Chloroquine
    3. Isoniazid
    4. Probenecid
    5. Proguanil
    6. Pyrimethamine
  5. Miscellaneous
    1. Vitamin C
    2. Colchicine
    3. Diphenhydramine

Bagaimanakah anemia yang disebabkan oleh penyakit ini dirawat ?

1)Sekiranya anemia adalah teruk, transfusi darah mungkin diperlukan.

2)Di dalam kes bayi yang baru lahir, langkah untuk mengurangkan bilirubin harus dilakukan kerana keadaan ini merbahaya kepada bayi. Fototerapi diberikan untuk memusnahkan bilirubin melalui kulit. Sekiranya bilirubin terlampau tinggi di dalam darah, “exchange transfusion” diberikan. Di dalam proses “exchange transfusion” ini, darah yang kaya dengan bilirubin dan rendah haemoglobin dibuang dan diganti dengan darah yang rendah bilirubin dan kaya haemoglobin. Dengan itu darah yang mengalir di dalam tubuh bayi akan mempunyai rendah bilirubin dan normal haemoglobin.

Gambar di atas menunjukkan seorang bayi yang sedang menjalani fototerapi disebabkan oleh jaundis.

Exchange transfusion dilakukan apabila paras bilirubin terlampau tinggi di dalam darah bayi.

3) Pesakit yang menderita akibat episod hemolitik anemia perlu mengambil air yang banyak. Begitu juga, supplemen seperti folid acid perlu diambil untuk membantu pembentukan haemoglobin dan sel darah merah.

Seriuskah masalah kekurangan enzim G6PD ini?

Jika diberi rawatan dan nasihat yang betul, pesakit boleh hidup dengan gaya hidup yang normal. Kebanyakan pesakit tidak menunjukkan sebarang masalah dalam tempoh yang panjang. Walaubagaimanapun apabila episod hemolitik anemia berlaku,ia perlu dirawat dengan rawatan yang sesuai.

Sebagai seorang yang mengalami masalah kekurangan enzim G6PD, apakah yang patut saya lakukan?

Anda dinasihatkan supaya menjauhi makanan-makanan seperti kacang parang, makanan yang mengandungi pewarna tiruan methylene dan toluidine blue, kacang soya atau produk soya,semua jenis kacang atau produk kacang dan gula-gula dan makanan berperisa menthol.

Apabila berjumpa dengan doktor, anda hendaklah memberitahu doctor yang anda mempunyai masalah kekurangan enzim G6PD supaya doktor tidak mempreskripsikan ubat yang boleh menyebabkan anemia kepada anda.

Anda juga dinasihati supaya tidak mengambil ubat-ubatan terutamanya antibiotic dan lain-lain ubat-ubatab tanpa mendapat nasihat doktor terlebih dahulu.

REFERENCES :

http://kidshealth.org/parent/general/aches/g6pd.html

http://www.gleneagles-penang.com/BNBD/pdfbook/06%20what%20is%20G6PD%2026-28.pdf

http://g6pddeficiency.org/index.php

http://hubpages.com/hub/Forbidden-Food-for-G6PD-Cases

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May 25

Chicken pox.

By taqidoc Pediatric 1 Comment »


Pengenalan.

Chicken pox yang dikenali dengan nama cacar air, jintungan atau bertih dalam bahasa melayunya adalah disebabkan oleh sejenis virus yang dinamakan virus varicella-zoster. Ia amat mudah berjangkit dan ia boleh berlaku pada semua peringkat umur. Penyakit ini biasanya berlaku kepada kanak-kanak akan tetapi sekiranya ia berlaku kepada orang dewasa simptomnya akan lebih teruk berbanding kanak-kanak.

Chicken pox boleh merebak melalui sentuhan,titisan cecair daripada orang yang dijangkiti( batuk dan bersin ) dan bahan tercemar dengan cairan seperti pada pakaian atau tuala penghidap chicken pox.

Pesakit yang terkena chicken pox boleh merebakkan virus penyakit ini dalam masa 48 jam sebelum timbulnya ruam sehinggalah kantung air yang terbentuk di atas ruam menjadi kering dan berkeruping.

Selepas pulih daripada chicken pox, virus akan kekal berada di dalam badan seumur hidup. Walaupun manusia tidak boleh mendapat jangkitan chicken pox 2 kali, virus yang sama juga menyebabkan kayap ( shingles ). Oleh itu seseorang yang terkena kayap boleh menjangkitkan virus varicella-zoster kepada individu yang masih belum lagi terkena chicken pox dan sekaligus menyebabkan penyakit chicken pox kepada individu tersebut.

Simptom

Simptom-simptom selalunya bertahan selama 2 minggu dan ianya hanya muncul setelah 10-21 hari selepas pendedahan kepada penyakit ini.

Walaupun tidak merbahaya, ia boleh menjadi penyakit yang serius sekiranya sistem imuniti yang lemah contohnya di dalam bayi yang baru lahir, pesakit yang sedang dalam rawatan kemoterapi, pesakit yang mengambil steroid, wanita mengandung atau pesakit HIV/AIDS.

Simptom-simptom termasuklah :

  1. Bermula dengan demam, sakit tekak dan rasa letih.
  2. Beberapa hari kemudian disusuli pula oleh ruam dan gatal-gatal badan. Ruam selalunya bermula di bahagian kulit kepala, bawah ketiak,mulut,hidung dan kawasan pinggul.Ruam bermula dengan kawasan kemerah-merahan dengan kantung berisi air  ( blister )ditengah-tengah. Kantung air pecah dan kerak terhasil. Ruam ini tersangat mudah berjangkit dan kanak-kanak tidak dibenarkan ke sekolah sehinggalah lesion yang terakhir sudah membentuk kuping.
  3. Pesakit chicken pox  juga akan menunjukkan  batuk ringan, hidung berair dua hari sebelum bintik-bintik merah timbul.

Kanak-kanak yang dijangkiti chickenpox akan mempunyai 2 jenis lesion pada masa yang sama.

Gambar sebagaimana di bawah :

Komplikasi

Ruam atau cacar air Chickenpox akan berkurangan dalam jangka masa 2 minggu dan biasanya tiada komplikasi. Adakala penyakit boleh jadi teruk walaupun pada kanak-kanak yang sihat dan mengakibatkan komplikasi teruk termasuklah kematian. Kumpulan berisiko untuk jangkitan serta mendapat komplikasi teruk:

  • Bayi baru lahir, di mana ibu tidak penah mengidap chicken pox atau pelalian chicken pox.
  • Ibu mengandung menyebabkan kesan pada bayi dalam kandungan seperti tak cukup berat dan kecacatan anggota boleh berlaku. Sekiranya ibu mengidap chickenpox seminggu sebelum kelahiran, ia boleh menyebabkan jangkitan serius serta membahayakan nyawa pada bayi.
  • Orang yang lemah atau kurang daya tahan akibat penyakit lain seperti HIV, barah sumsum tulang (leukaemia) dan pesakit kanser dalam rawatan kemoterapi. Orang yang mengambil steroid berpanjangan pesakit asma dan sindrom nefrotik.
    Penghidap sakit radangan kulit (inflammation eczema).

Komplikasi akibat chicken pox:

  • Jangkitan kulit- menjadi lebam merah, bengkak dan sakit. Dehidrasi akibat muntah berterusan atau tidak minum air. Tanda dehidrasi ialah kurang kencing, mulut kering dan dahaga.
  • Kerosakan otak akibat radangan otak. Tanda-tanda radangan otak ialah sakit kepala teruk, keliru, mudah marah, leher keras dan belakang mengeras serta tidak sedarkan diri.
  • Radang sendi- sendi menjadi sakit, kejang dan bengkak
  • Jangkitan paru-paru (Pneumonia)- tanda-tanda seperti batuk, susah bernafas, pernafasan berbunyi (wheezing) dan sakit dada.

Rawatan

Rawatan chicken pox sebagaimana di bawah:

1. Rawatan pesakit yang telah terkena chicken pox hanyalah secara rawatan simptomatik sahaja.

a)  Demam : antipiretik – paracetamol samada sirap atau pun tablet.

Ditegah sama sekali memberikan salicylates seperti aspirin dan disalcid kepada kanak-kanak kerana ia boleh membawa kepada penyakit Reye’s syndrome.

Apakah penyakit Reye’s Syndrome?

Ia adalah sejenis penyakit yang melibatkan semua organ di dalam badan dan yang paling merbahanya ialah penglibatan hati dan otak. Penyakit Reye’s Syndrome ini dibahagikan kepada 2 fasa kerana ia selalunya dikaitkan dengan jangkitan virus sebelumnya seperti infuenza, demam atau chicken pox. Penyakit ini tidak berjangkit dan sebab terjadinya penyakit ini tidak diketahui. Ia sentiasa disalahdiagnosiskan dengan penyakit encephalitis, meningitis, diabetes, lebih dos ubat, keracunan, sudden infant death syndrome atau penyakit psikiatrik.

b)  Gatal-gatal :

1) Losyen Calamine dua hingga empat kali sehari, atau krem hydrocortisone dua kali sehari.

2) Antihistamin seperti Chlorpheniramine maleate 2mg/5ml syrup ( piriton syrup ) dapat membantu melegakan gatal.  Dos ubat ini bergantung kepada umur pesakit sebagaimana di bawah :

Kurang daripada 1 tahun : 2.5mls dua kali sehari.

1-5 tahun : 2.5 – 5.0 mls tiga kali sehari.

6-12 tahun : 10mls tiga atau empat kali sehari.

Bagi pesakit yang mempunyai masalah asthma atau porphyria, minta nasihat doktor terlebih dahulu.

3) Mandi – Kerap mandi dapat membantu mengurangkan gatal-gatal. Mandian Oatmeal atau separuh hingga satu cawan serbuk penaik yang dicampur dengan air mandian dapat membantu mengurangkan gatal.

c)  Antivirus – Acyclovir ( dapat mengurangkan tempoh pembentukan lesion baru,mengurangkan pembentukan lesion dan mempercepatkan proses penyembuhan sekiranya diambil dalam masa 24-48 jam selepas terbentuknya lesion. )

1) Aciclovir -  (Acyclovir 200 mg/5 ml Suspension )

Dewasa : 5-10mls 4 kali sehari selama 5 hari.

<2 tahun : 2.5 – 5mls 4 kali sehari selama 5 hari.

>2tahun : 5-10mls 4 kali sehari selama 5 hari.

2) Zovirax – Acyclovir 200 mg Tablet

Dewasa : 800mg 5 kali sehari selama 7 hari.

>2 tahun : 20mg/kg setiap dos empat kali sehari ( 80mg/kg/sehari ) selama 5 hari.

Kanak-kanak lebih daripada 40kg : dos orang dewasa.

d)  Selsema – actifed (Triprolidine HCl 1.25 mg & Pseudoephedrine HCl 30 mg per 5 ml Syrup )

>12 tahun : 10 ml

6 – 12 tahun : 5 ml

2 – 5 tahun : 2.5 ml

6 bulan – < 2 tahun : 1.25 ml

Dos boleh diambil 2 atau 3 kali sehari.

( Actifed tidak boleh diambil untuk bayi yang kurang daripada 6 bulan !! )

Selain daripada ubat-ubatan di atas, kanak-kanak yang terkena demam chicken pox digalakkan meminum air masak dengan lebih kerap untuk menggantikan air yang hilang dari badan akibat demam ( insensible fluid loss ).

2.Vaksin varivax – ( varicella zoster virus vaccine )

Vaksin ini sebagaimana lain-lain vaksin berfungsi dengan cara merangsang badan membina antibodi terhadap virus varicella zoster setelah suntikan protein atau virus yang dilemahkan diberi kepada pesakit.

Walaubagaimanapun, vaksin ini tidak dapat merawat pesakit yang sedang dijangkiti chicken pox.

Seperti vaksin-vaksin lain juga, varivax tidak dapat memberi perlindungan sepenuhnya kepada setiap orang. Akan tetapi sekiranya pesakit telah diberi suntikan pencegahan, ia dapat mengurangkan simptom-simptom penyakit ini.

Vaksin ini hanya boleh digunakan untuk pesakit yang berusia lebih daripada 1 tahun. Vaksinasi untuk penyakit chicken pox ini diberikan sebanyak 2 dos. Dos pertama diberikan pada usia 12-15 bulan. Dos kedua pula diberikan apabila kanak-kanak berusia 4-6 tahun.

Sekiranya pesakit adalah berumur 13 tahun ke atas dan masih belum menerima vaksin ini, pesakit perlu mendapat 2 dos suntikan vaksin dengan jarak antara 2 suntikan sekurang-kurangnya 28 hari.

Anda tidak patut mengambil vaksin ini sekiranya anda :

  1. alergi pada gelatine atau neomycin.
  2. sedang dijangkiti penyakit TB.
  3. mempunyai sejarah terkena syndrome Guillain-Barre.
  4. mempunyai masalah kronik seperti lelah atau masalah pernafasan lain, kencing manis, masalah buah pinggang atau masalah sel darah seperti anemia.
  5. menghadapi masalah kelemahan system imuniti yang disebabkan oleh penyakit seperti kanser atau AIDS, ataupun menerima rawatan seperti steroid, kemoterapi ataupun radiasi.
  6. berumur kurang 18 tahun dan baru sahaja mengambil aspirin atau ubat yang dikategorikan sebagai salicylates.
  7. baru sahaja menjalani pembedahan pemindahan organ.
  8. mengandung.

Elakkan daripada mengandung sekurang-kurangnya 3 bulan selepas mendapat suntikan vaksin varivax.

Jangan sesekali mendapatkan suntikan vaksin tanpa memberitahu doktor yang anda sedang menyusu anak.

Anda dikehendaki berjauhan daripada bayi yang baru lahir sekurang-kurangnya 6 minggu selepas mendapat suntikan vaksin varivax. Anda juga dinasihati supaya tidak mengambil suntikan seperti polio atau vaksin hidup yang dilemahkan lain sekurang-kurangnya 4 minggu selepas mendapat suntikan vaksin varivax.

Untuk lebih informasi tentang varivax, anda boleh layari website ini :

http://www.emedicinehealth.com/drug-varicella_virus_chickenpox_vaccine/article_em.htm

Diet semasa terkena chicken pox.

Pemakanan memainkan peranan yang tidak kurang pentingnya dalam mempercepatkan proses pemulihan dan mengurangkan simptom penyakit.Antara diet yang patut diamalkan semasa terkena penyakit ini ialah:

  1. Kurangkan pengambilan buah-buahan sitrus seperti limau dan oren kerana buah-buahan ini mempunyai kandungan asid yang tinggi dan boleh menerukkan ruam dan kegatalan badan.
  2. Banyakkan meminum air kerana ia dapat membantu mengawal demam dan menyingkirkan toksin badan.
  3. Tingkatkan pengambilan sayur-sayuran kerana sayur-sayuran kaya dengan vitamin dan mineral yang penting dalam mengurangkan pembentukan ruam dan jangkitan. Pengambilan karot amat digalakkan semasa terkena penyakit ini kerana ia terbukti membantu memulihkan pesakit daripada chicken pox.
  4. Jangan sesekali mengambil makanan rapu, makanan berminyak dan makanan bergula kerana kesemua makanan ini boleh menerukkan pembentukan ruam.

Perhatian : Jangan sesekali mengambil ubat tanpa mendapat nasihat doktor terlebih dahulu!!

References :

http://www.infosihat.gov.my/penyakit/Dewasa/ChickenPox.php

http://www.nlm.nih.gov/medlineplus/ency/article/001592.htm

http://www.diethealthclub.com/askquestion/2570/diet-for-chickenpox-my-neighbour-got-chicken-pox-a.html

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May 20

Safeguard Quality Of Medical Grads, Gerakan Urges Government.

By taqidoc Work Comments Off

KUALA LUMPUR, May 20 (Bernama) — To safeguard the quality of medical graduates, the government should review the issuance of new licences to set up private medical schools.

In making this call, Gerakan vice-president Datuk Dr Teng Hock Nan lamented the existence of too many private medical schools in the country.

“The sudden increase in medical schools may result in fierce competitions to enroll students…and (thus) there is a danger that some of the schools may lower their admission requirement.

“We urge the government to stop issuing new licences for medical schools until such time, we are assured of training facilities and the necessary infrastructures.

“The government needs to ensure a high standard of doctors produced and seek ways to alleviate the problem of too many house officers being posted in some of our hospitals,” he told a press conference Thursday.

Dr Teng noted that to produce good quality medical graduates, the government should ensure that the entry requirements of students met the required standard.

He said the sudden mushrooming of medical schools could also mean that there was inevitably, a shortage of qualified and experienced medical teachers.

“There is also a shortage of hospitals big enough for these medical students to receive proper training and teaching.

“In most advanced countries, setting up medical schools required many years of planning to source for qualified and experienced medical teachers,” he added.

Gerakan will be carrying out a survey and gather feedback from the public and experts in the field before sending a memorandum to the higher education ministry, said Dr Teng.

– BERNAMA

May 13

Islam forbids gambling.

By taqidoc Islam 5 Comments »

My brothers in Islam,

Let us increase our taqwa to Allah s.w.t by doing all that He commands us, and avoiding everything that He has forbidden.

As an Ummah which abides to Allah and His Messenger Prophet Muhammad s.a.w, we must uphold the principles laid down by the Syariah. May this faith give us, Muslims in Malaysia, the strength to move to a higher level, inspite of the new challenges that we shall face.

Recently we have been informed by the newspaper that the government is seriously considering legalizing sports betting before the World Cup as said by our Deputy Finance Minister. The main reason to legalise the betting is that  if the Government did not give the licence, there will be many who will gamble regardless legal or not. And it is better if the Government regulate the betting in a manner in which it can be controlled.

Remember my brothers, one activity that will bring destruction to religion, mind, wealth and offsprings, is gambling. It is an activity that will put to test the best of our faith and moral values. An activity that is very addictive.

And because of the destructive nature of gambling, Allah s.w.t mentions it in Al-Quran, reminding us to not even get near it. What more to participate in it. Allah says in surah Al-Maidah, ayat 90:

Which means: O you who believe! Alcoholic drinks, gambling, Al­Ansâb , and Al­Azlâm (arrows for seeking luck or decision) are an abomination of Satan’s handiwork. So avoid that (abomination) in order that you may be successful.

This verse clearly tells us not to get involved in any gambling activities even if we do not gamble or drink.

This verse also serves to remind us that gambling and drinking are from Satan’s handiwork. It does not mean that Satan gambles and drinks. No! But Satan promotes both activities in human beings. Why?

It is because Satan wants everything bad and evil for humans. Satan wants us to suffer, both in this life and the hereafter. It boils up from a very deep-set hatred to our father Prophet Adam a.s and his offsprings. Satan despises us. It is to his greatest satisfaction to see our lives in jeopardy. So that that we suffer in this world, and suffer together with him in Hell. He wants us to accompany him in Hell.

That is why he uses every means and ways to seduce us to do things forbidden by Allah. Satan is our greatest enemy. And Allah reminds us of this fact in many verses in Al-Quran. In surah Al-Fahtir, ayat 6, Allah says:

Which means: Surely, Satan is an enemy to you, so take him as an enemy. He only invites his followers that they may become the dwellers of the blazing Fire.

So let us not be deceived by Satan. Let us not become his followers. Gambling and drinking are among Satan’s tools to bring destructions to humans. Allah s.w.t reminds us in surah Al-Maidah, ayat 91:

Which means: Satan wants only to excite enmity and hatred between you with intoxicants (alcoholic drinks) and gambling, and hinder you from the remembrance of Allâh and from As-Salât (the prayer). So, will you not then abstain?

This verse tells us that drinking and gambling are the causes of human destruction. And our nature to be greedy and cruel pour fuel to the fire. Especially so in gambling.

When someone gambles, he does it with the intention of winning. And hopefully win big. No one wants to lose. But when he wins, he is actually being cruel to others. The money that he won comes from other people. He profited from other’s misery. There are much injustice and cruelty.

And if he loses, he will resent it, and hate those who win at his expense. But he will continue to gamble, in a feeble attempt to recover the money that he lost. Gambling will be the new focus of his life. Gone are his loved ones. Just look at how many families fell apart due to gambling?

My brothers in Islam,

Allah forbids all kinds of gambling. And these include buying lottery tickets, and betting in whatever manner and in whichever game, even in sporting events. Because betting is still betting. Regardless whether in horse racing or in friendly soccer games. So is gambling through the Internet or at casinos. All of that are HARAM.

Usually a gambler will lose more than he wins. He lost more money than he wins in gambling. And this will lead to addiction. He will be addicted to gambling. In the slimmest hope that he will win next time to recover his losses.

Islam puts high premium in social harmony and individual’s peace of mind. But gambling will cause much anguish and will slowly but surely tear the social fabric apart. The destruction is like a ripple in the pond. The misery starts with the gambler, and it will spread to his family members, and then to more and more people. In the end, the whole society will bear the burden of the misery.

Even though there are certain benefits to be reaped from gambling and casino, but the harm is more than the benefits.

Our society is facing many social and economical problems. We cannot afford to have one more problem. We need to stop this new gambling threat. And we pray to Allah that He will save us, our society, our country, from destruction, amen.

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May 12

Sinogram.

By taqidoc Radiology 9 Comments »

What is sinogram?

It is a special X-ray procedure that is done with contrast dye to visualize any abnormal opening (sinus) in the body. The contrast is injected via a rubber catheter. Serial x-ray pictures are taken to show the extension of the fistula.

Other name for sinogram is fistulogram.

What kind of contrast medium used in this procedure?

A low osmolar contrast medium, LOCM 150.

How is it done?

Technique :

  1. A prelim film is taken to exclude the presence of radio-opaque foreign body.
  2. A fine catheter is then inserted into the orifice of the sinus.
  3. After a gauze pad has been firmly placed over the orifice to discourage reflux, the contrast medium is injected under fluoroscopic control.
  4. Spot films are taken as required including tangential views.

Below are sequence of films taken to investigate a sinus at right mid thigh.

1. Prelim :  shows intramedullary fixation of right femur fracture. Site of fistula is located at mid thigh.


2. Right thigh AP : Dye is injected. There is a focal collection of contrast seen.

3. Lateral view : shows focal collection of contrast.

4. Right lower thigh AP : shows  seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.

5. Right upper thigh AP : shows seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh up to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).

How is it reported?

This is a sample report of a sinogram case.

NAME : ?

I/C : ?

SINOGRAM (01.04.2010)

Procedures:

Patient wound is cleaned. Sinus identified.

25 ml undiluted omipaque injected using 8F nasogastric tube.

Serial x-rays are taken.

Findings:

There is flow of contrast from the sinus into a focal collection measuring 3.5×4.5cm.

Seepage of contrast seen into the intramuscular layers of the lateral aspect of the right thigh.

Superiorly the contrast extends to the level of hip joint and distally to the level of distal femur (just above the femoral condyles).

There is no connection to the knee or hip joint.

CONCLUSION

No evidence of intra-articular extension of the right thigh abscess.

Radiologist 01.04.2010

Qs.

1.Why do I need a sinogram?

It is needed when your doctor has decided that you need this test to show passage of a cavity in the body that opens out onto the skin surface.

2.Where will the procedure take place ?

In a special room ( Fluoroscopy  room ) within the x-ray department.

3.How do I prepare for sonogram?

No special prep is required.

4.Who will be doing the sinogram?

Medical officer observed by radiologist /Radiologist.

5.What is actually happen during sinogram ?

a)      You may be asked to wear gown.

b)      Medical officer/ Radiologist will once again explain the procedure to you.

c)      Your skin will be washed with antiseptic solution and a small catheter is inserted into the opening of the sinus on the skin surface.

d)     A small amount of contrast is injected through the catheter into the sinus and serial x-rays are taken to show where the sinus goes.

e)      When all the x-rays have been taken, the catheter will be removed and your skin will be covered with a sterile dressing.

*If you normally use a stoma bag please bring a spare with you.This order only applies to abdomen related fistula or sinus.

6.Will it hurt?

You may experience a little discomfort during the procedure but there is usually no pain. If there is pain during the procedure, please tell someone.

7.How long will it take?

Around 30 minutes.

8.Are they any risks or complications ?

There may be a small amount of bleeding from the sinus for a short time.

Reference :

  1. A Guide to Radiological Procedures Stephen Chapman.

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May 05

10 healthy habits your kids will love.

By taqidoc Health 2 Comments »

Forget Happy Meals, sweet and computer games-here are 10 ways to get your children on the road to a healthier life.

According to the Government’s National Diet and Nutrition survey, 92% of children consume more saturated fat than the maximum recommended level for adults, and 83% consume added sugars higher than suggested adult levels. Not surprisingly, our children are getting fatter, and many experts are warning that the problem is getting out of hand. For the first time, there’s a very real chance that parents could start outliving their offspring, due to obesity-related diseases such as cancer and heart disease.

Here are some tips and ideas on how to keep your kids healthy.

1. Honesty is the best policy

Try to resist sneaking vegetables onto your plates – children are not stupid! Instead encourage them to help you in in the kitchen and explain to them what ingredients you are using and why they’re healthy .Show them how tasty sauces can be when you add some chopped veg. 

2. Avoid the dirty dozen

Some ingredients found in pre packed food especially those marketed at children  may be detrimental to their health. According to Organix, these are 12 offenders and where they can be found :

a)       Mechanically recovered / separated meat – sausages

b)       MSG E621

c)       Sodium 5-ribonucleopeptide E635 – snacks

d)       Aspartame – soft drinks, snacks

e)       Acesulfame K – snacks and soft drinks.

f)        Sodium saccharide – snacks and soft drinks.

g)       Sodium benzoate E211 – many soft and fizzy drinks and food sauces

h)       Sulphur dioxide E220 – soft drinks and some meat

i)        Artificial colorings.

j)        High salt content – processed food such as tomato ketchup and soup.

k)       Hydrogenated and saturated fat – fatty foods like take-aways, burgers, chocolate and crisps.

l)        Refined sugar – sugary foods and cereal bars.

3. Exchange bad for good

There are so many easy ways you can swap junk food for healthier alternatives without losing out on flavour.

Out with the old… In with the new..
Burger,chips,beans Chicken and sweetcorn burgers,potato wedges in their skins, beans
Sugary cereals,fruit juice Fresh fruit,glass of milk,muesli
Salty crisps Sweet potato wedges,crispy vegetable batons
Fuzzy drinks Fruit juice mixed with sparkling spring water
Sausages, potato waffles Grilled chicken and vegetable kebabs,onion mash

4.Don’t be too strict

Tastes for salty and sweet foods are developed early in life. So, it is OK to let your children take sweet food like fruit desserts,rice puddings and custards as they supply important nutrients such as vitamin C, calcium and protein. But make sure they eat a generally balanced diet.

5.What makes a good lunch?

School lunches have had a bad press of late, so turn your back on pre-packed produce and make your own lunches that are brimming with good nutrition.

a)      Keep the fats healthy – nuts, seeds, and olive oil all contain unsaturated fats which are good for health.

b)      Wholegrain reign – If you are sending them off to school with a sandwich, opt for more nutritious wholegrain varieties of bread rather than refined white bread.

c)      Think before they drink – It’s no good packing them a feast of raw vegetable if it’s washed down with a can of mirinda or pepsi. Give your kids milk, water or pure fruit juice.

d)     Variety is the spice of life – Boredom can result in children picking at meals and then snacking later on fatty items.

6.  Snack Attack

When hunger strikes, serve them with something that will not only keep the kids fulfilled but full of calories. Here are some child-friendly options: crackers, home made popcorn,yoghurt,raisins and rice cakes.

7. Dump the junk

Check out these 3 great ideas for getting more healthy foods into junk-food mad kids, from What Really Works for Kids by Susan Clark.

  • Make frozen yoghurt to keep in the freezer. Just add pureed fruits to live plain yoghurt and freeze.
  • Enhance the nutritional value of daily staples by adding fruit to breakfast cereals, yoghurt and ice creams.
  • Thicken sauces with vegetables purees instead of cream and milk.

8.  Keep a well stocked fruit bowl

Instead of stocking up the sweetie cupboard, pile the fruit bowl high with tempting fresh produce.

9.  Make fitness fun

One of the main reasons for childhood obesity is lack of physical activity. If your children are not particularly active,don’t worry. Kids are naturally active, so should not really need much encouragement to get involved in energetic pursuits.

10. Find TV alternatives

The prevalence of TV and computers combined with parents’ reluctance to allow their offpring out to play in parks and public places has been blamed for our children’s increasingly sedentary lifestyle. Another worry is that children who watch TV four hours of TV a day are exposed to as many as 40 food commercials. This barrage of advertising is often aimed specifically at children and promotes high fat, unhealthy food. So what can you do?

a)      Monitor what they watch on TV.

b)      Round up your children’s friends and head for the park. The kid can run around and let off steam.

c)      Draw up a chart and reward kids with a star every time they eat portion of fruit or veg.

d)     One evening a week, switch the TV off and play a family games.

What is a balanced diet for children?

A balanced diet should include the following food groups:

1. Fruit and vegetables ( at least 5 portions per day )

2. Bread,other cereals and potatoes ( with every meal )

3. Milk and dairy products ( several servings per day )

4. Meat, fish and vegetarian alternatives ( 1 or 2 servings a day )

5. Foods containing saturated fat and refined sugar should be limited.

* If you are at all concerned with your child’s health then you should always consult your GP.

May 02

Death threat against Nik Aziz.

By taqidoc Politics Comments Off

2010/05/02

KUALA LUMPUR: The PAS Youth wing today lodged a police report over a death threat made against the party’s spiritual leader, Datuk Nik Aziz Nik Mat, which was carried by a website.

The report was lodged by the PAS national youth leader Nasrudin Hassan At-Tantawi at the Chow Kit police station after reading about the death threat which appeared on the Facebook of an individual on Thursday.

“I became aware of the threat after reading the comment of a man using the name Mohd Safuan Mohd Hilmi, which was written on Thursday night.

“In his website, the man said he was willing to face the death penalty if he could kill Nik Aziz, who is also the Kelantan Menteri Besar,” he said when met by reporters at the police station here yesterday.

Meanwhile, Dang Wangi district police chief, ACP Mohd Zulkarnain Abdul Rahman confirmed receiving the report.

“We will investigate and track down the individual who had posted the death threat on his website,” he said. — Bernama

Mohd Safuan’s facebook account was terminated due to his comment and luckily someone was able to record every single comments he did.

What an outrageous comment !!. If he really a good muslim, he wouldn’t make such comments…

Because of his comments in facebook, not only a lot of people condemning him but there’s also police report lodged against him.

His details are as follow

I don’t know how they got his IC number but they are pretty good. For those who hates him you can visit him there…hehe

Anyway my advice to me and you all, don’t just simply threaten people or spread untrue rumours because we are being watched…

For more info, you can visit:

Herman Shamsuddin

Sekilas

Apr 26

Love, sex and the male brain.

By taqidoc behaviour 2 Comments »
This article was written by Louann Brizendine. I found it interesting on how she explains about the topic. Just want to share it with you all.

March 25, 2010 — Updated 2233 GMT (0633 HKT)

(CNN) — Although women the world over have been doing it for centuries, we can’t really blame a guy for being a guy. And this is especially true now that we know that the male and female brains have some profound differences.

Our brains are mostly alike. We are the same species, after all. But the differences can sometimes make it seem like we are worlds apart.

The “defend your turf” area — dorsal premammillary nucleus — is larger in the male brain and contains special circuits to detect territorial challenges by other males. And his amygdala, the alarm system for threats, fear and danger is also larger in men. These brain differences make men more alert than women to potential turf threats.

Meanwhile, the “I feel what you feel” part of the brain — mirror-neuron system — is larger and more active in the female brain. So women can naturally get in sync with others’ emotions by reading facial expressions, interpreting tone of voice and other nonverbal emotional cues.

Perhaps the biggest difference between the male and female brain is that men have a sexual pursuit area that is 2.5 times larger than the one in the female brain. Not only that, but beginning in their teens, they produce 20 to 25-fold more testosterone than they did during pre-adolescence.

If testosterone were beer, a 9-year-old boy would be getting the equivalent of a cup a day. But a 15-year-old would be getting the equivalent of nearly two gallons a day. This fuels their sexual engines and makes it impossible for them to stop thinking about female body parts and sex.

And so begins the ‘Man Trance’

All that testosterone drives the “Man Trance”– that glazed-eye look a man gets when he sees breasts. As a woman who was among the ranks of the early feminists, I wish I could say that men can stop themselves from entering this trance. But the truth is, they can’t. Their visual brain circuits are always on the lookout for fertile mates. Whether or not they intend to pursue a visual enticement, they have to check out the goods.

To a man, this is the most natural response in the world, so he’s dismayed by how betrayed his wife or girlfriend feels when she sees him eyeing another woman. Men look at attractive women the way we look at pretty butterflies. They catch the male brain’s attention for a second, but then they flit out of his mind. Five minutes later, while we’re still fuming, he’s deciding whether he wants ribs or chicken for dinner. He asks us, “What’s wrong?” We say, “Nothing.” He shrugs and turns on the TV. We smolder and fear that he’ll leave us for another woman.

Not surprisingly, the different objectives that men and women have in mating games put us on opposing teams — at least at first. The female brain is driven to seek security and reliability in a potential mate before she has sex. But a male brain is fueled to mate and mate again. Until, that is, he mates for life.

Despite stereotypes to the contrary, the male brain can fall in love just as hard and fast as the female brain, and maybe more so. When he meets and sets his sights on capturing “the one,” mating with her becomes his prime directive. And when he succeeds, his brain makes an indelible imprint of her. Lust and love collide and he’s hooked.

The ‘Doting Daddy Brain’

A man in hot pursuit of a mate doesn’t even remotely resemble a devoted, doting daddy. But that’s what his future holds. When his mate becomes pregnant, she’ll emit pheromones that will waft into his nostrils, stimulating his brain to make more of a hormone called prolactin. Her pheromones will also cause his testosterone production to drop by 30 percent.

These hormonal changes make him more likely to help with the baby. They also change his perceptual circuitry, increasing his ability to hear a baby cry, something many men can’t do very well before their wives are pregnant.

And a word to the wise for all the young mothers who are reluctant to let your husbands hold and care for your newborn. The more hands-on care a father gives his infant, the more his brain aligns with the role of fatherhood. So, hand over the baby.

His emotions run deep

Although men have earned the reputation for being more stoic than women, they actually have stronger emotional reactions than we do. They just don’t show it very often.

Studies of men’s faces show that the male brain’s initial emotional reaction can be stronger than the female brain’s. But within 2.5 seconds, he changes his face to hide the emotion, or even reverse it. The repeated practice of hiding his emotions gives men the classic poker face.

It’s his poker face and his analytical response to personal problems that can put him in the doghouse. She’s crying as she talks about what’s wrong with the relationship, and instead of hugging her, his mind is racing to find a way to resolve the problem as soon as possible. With practice and because of the way their brains are wired, men use their analytical brain structures, not their emotional ones, to find a solution.

They enjoy this advantage, but women often take affront to it. When you’re telling your husband your problem and he tries to solve it instead of hearing you out, you may think he’s being insensitive. But that’s not what’s going on in his brain. He’s working to solve the problem so he can relieve your pain as quickly as possible. Not because he doesn’t care or doesn’t want to listen, but because he loves you.

‘Lovable Grandpas’ and ‘Grumpy Old Men’

As men age, the male brain hormones change and the male brain and body goes into the stage of life called andropause. The king of male hormones — testosterone — goes down and the queen of female hormones — estrogen — goes up. Whether Grandpa is your kids’ hero or the grouch they hate to visit depends a lot on how he handles these hormonal changes. For example, if his testosterone levels drop to an abnormally low level, he can feel tired, irritable and even depressed. Some men in this condition seek hormone replacement therapy and others find relief in exercise, more frequent sex, and spending more time with other people.

The grandpa that kids can’t wait to see is the one who’s feeling the effects of the hormone oxytocin, often called the “cuddle hormone.” He’s fun and playful and likes to hear what his grandchildren have to say. He’s much more patient with your children than he was with you, when you were growing up. The love circuits of the mature male brain can be hijacked by his grandkids, even more than they were by his own children.

The ‘Lonely Hearts Club’

Not only is the mature male brain more receptive to closer bonds, but it’s also more sensitive to loneliness. Nobody thrives when they’re lonely, but it seems to take a major toll on older men. Sixty percent of divorces in couples over the age of 50 are initiated by women, leaving their husbands shell-shocked and devastated.

Once his wife leaves, unless he makes a point of socializing more with other people, his brain stops getting the social workout it needs to make him feel good about himself. If he becomes a loner, his social-approval circuits don’t get activated. In brain scan studies of older males researchers have found that the brain’s pleasure and reward areas, the VTA and the NAc, remain more active in men who are social. So don’t begrudge the divorcee or the new widower some socializing and seeking female companionship.

The bottom line

The human brain is the best learning machine on the planet and human beings are capable of making major changes in our lives. But there are some things that the male brain and female brain are not likely to change anytime soon. And it makes more sense to deal with these brain realities, than to argue with them or ignoring them.

The best advice I have for women is make peace with the male brain. Let men be men.

Original source : CNN

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Apr 23

France, Belgium to ban niqab from public spaces.

By taqidoc Islam Comments Off
Thursday, 22 April 2010
Brussels, April 22: Paris: France and Belgium are steadfast in ban on face coverings worn by Muslim women.

French President Nicolas Sarkozy on Wednesday ordered legislation that would ban women from wearing Islamic veils that hide the face in the street and other public places.

In seeking to forbid the garment from public view, Sarkozy defied the advice of experts sought by the government who warned that such a broad ban risked contravening France’s Constitution.

Such a measure would put France on the same track as Belgium, which is also moving toward a complete ban in a similar reaction as Islamic culture has come in conflict with native European values. Sarkozy has repeatedly said that such clothing oppresses women and is “not welcome” in France.

Belgian lawmakers are set on Thursday to impose a ban on wearing the Islamic burqa in public, the first clampdown of its kind in Europe, unless the nation’s political crisis disrupts their vote.

On March 31, the federal Parliament’s home affairs committee voted unanimously to endorse a nationwide ban on clothes or veils that do not allow the wearer to be fully identified, including the full-face niqab and burqa.

Those who ignore it could face a fine of EUR 15-25 (USD 20-34) and/or a jail sentence of up to seven days, unless they have police permission to wear the garments.

France

Government spokesman Luc Chatel said after Wednesday’s weekly Cabinet meeting that the President decided the government should submit a bill to Parliament in May on an overall ban on burqa-like veils.

“The ban on veils covering the whole face should be general, in every public space, because the dignity of women cannot be put in doubt,” Chatel said.

The decision to seek a full ban, rather than a limited ban, came as a surprise. After a Cabinet meeting just a week ago, the government spokesman announced a decision for legislation that bans the veil but takes into account conclusions on the matter by the Council of State, France’s highest administrative office.

The government had sought the council’s opinion to ensure a law would pass constitutional muster. The Council of State advised that a full ban would be “legally very fragile”. A six-month parliamentary inquiry also concluded that a full ban would raise constitutional issues, as well as enforcement problems.

“It’s a transgression, an aggression even, on the level of personal liberty,” said Abdellatif Lemsibak, a member of the National Federation of Muslims of France. “The Muslims have the right to an orthodox expression of their religion … it shocks me.”

France is a firmly secular country but has western Europe’s largest Muslim population, estimated at some five million. France worries about clashes in values as well as about a spread of radical Islam. Authorities widely see the veil in light of gender equality and security issues.

Belgium

In neighbouring Belgium, a similar initiative for a ban on full veils in public places, including in the streets, is expected to become law in July.

The governing parties and opposition agree on the move, and the full house is widely expected to easily endorse the draft law, which is on the agenda for Thursday.

But a deep political crisis is looming after a party threatened to pull out of the government if tense negotiations between the French and Dutch-language communities on power-sharing are not finalised in 24 hours.

“There is a hitch. The agenda of the chamber could be thrown into disarray depending on how the political situation evolves,” one official said.

A leading rights watchdog late Wednesday warned against the move saying it would be counterproductive.

“Bans like this lead to a lose-lose situation,” said Judith Sunderland, senior Western Europe researcher at Human Rights Watch. “They violate the rights of those who choose to wear the veil and do nothing to help those who are compelled to do so.”

It said there was no evidence that wearing the full veil in public threatened public safety, public order, health, morals, or the fundamental rights and freedoms of others.

-Agencies

Original source : Siasat.com

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Apr 21

Tonsilitis.

By taqidoc Health Comments Off

Pengenalan

Tonsil merupakan tisu limfoid yang berada pada kedua-dua bahagian tekak manusia. Inflamasi tonsil dinamakan tonsillitis.  Tonsilitis boleh wujud dalam bentuk akut tonsillitis, kronik tonsillitis, tonsillitis berulang kali dan yang paling teruk dinamakan peritonsillar abscess ( tonsil bernanah ).

Penyakit ini selalunya berlaku pada kanak-kanak dan boleh berlaku sekiranya pesakit mempunyai ahli keluarga yang telah menjalani pembedahan pembuangan tonsil.

Sungguhpun ia kerap berlaku pada kanak-kanak, tetapi ia jarang sekali berlaku kepada kanak-kanak yang berusia kurang daripada 2 tahun.

Tonsilitis yang disebabkan oleh Streptococcus selalunya berlaku pada kanak-kanak berusia 5-15 tahun manakala tonsillitis yang disebabkan oleh virus selalunya berlaku pada kanak-kanak yang lebih muda usianya.

Peritonsillar abscess ( PTA ) biasanya berlaku pada golongan remaja, tetapi ianya boleh juga berlaku kepada kanak-kanak.

Akut tonsillitis yang disebabkan oleh bakteria sebagaimana di atas.Tonsil kelihatan membengkak dan merah beserta keluar nanah.Uvula kelihatan di tengah-tengah antara 2 tonsil.

Apakah penyebab tonsillitis ?

Kebanyakan serangan penyakit tonsillitis adalah disebabkan oleh virus seperti :

  • HSV
  • EBV
  • Cytomegalovirus
  • Herpes viruses
  • Adenovirus
  • Measles virus

Bakteria pula hanya menyumbang 15-30% kepada penyakit tonsillitis.Bakteria anerobik memainkan peranan yang penting dalam penyakit ini.

Apakah simptom-simptom tonsillitis ?

Sejarah menentukan jenis tonsillitis samada ianya akut, berulang atau kronik.

Akut tonsillitis.

Simptom-simptom akut tonsillitis termasuk demam, sakit tekak, nafas berbau, susah untuk menelan, sakit untuk menelan, berdengkur, bernafas melalui mulut, letih dan lemah badan. Simptom selalunya hilang selepas 3-4 hari. Akan tetapi ia boleh bertahan selama 2 minggu sekalipun diberi rawatan yang cukup.2.

Tonsilitis berulang.

Keadaan ini berlaku apabila pesakit mengalami serangan tonsillitis sebanyak 7 kali dalam setahun, 5 jangkitan dalam masa 2 tahun berturut-turut ataupun 3 jangkitan setiap tahun dalam masa 3 tahun berturut-turut.

Kronik tonsillitis.

Simptom-simptom kronik tonsillitis termasuklah sakit tekak yang berpanjangan, mulut berbau, tonsillitis dan sakit kalenjar servikal berterusan.

Peritonsillar abscess (PTA) ( tonsil bernanah ).

Simptom-simptom tonsil bernanah termasuklah sakit tekak yang teramat sangat, demam, air liur meleleh, nafas berbau, susah untuk membuka mulut dan serak suara.

Bagaimanakah penyakit ini didiagnosakan?

Sebenarnya penyakit ini boleh sahaja didiagnosakan berdasarkan simptom-simptom yang ditunjukkan oleh pesakit. Akan tetapi pemeriksaan fizikal penting untuk memastikan penyakit tersebut adalah tonsillitis.

Pemeriksaan yang dijalankan oleh doktor sebagaimana di bawah:

Pemeriksaan tonsil dan farinx.

Penemuan positif bagi pesakit tonsillitis adalah sebagaimana di dalam gambar di bawah. Tonsil kelihatan bengkak dan merah. Kadang-kadang, nanah mungkin turut kelihatan.

Di dalam keadaan yang teruk, pesakit mungkin mengalami perubahan suara dan bernafas melalui mulut disebabkan oleh pembengkakan tonsil.

Sakit kalenjar servikal dan ketegangan otot leher mungkin boleh wujud ketika serangan penyakit ini.

Di dalam kes peritonsillar abscess (PTA), farinx kelihatan bengkak dan merah dan pesakit tidak dapat membuka mulut kerana sakit. Selalunya tonsil yang bengkak adalah berbentuk unilateral di mana salah satu tonsil adalah lebih besar berbanding yang satu lagi. Selain daripada penemuan fizikal di atas, sakit kalenjar servikal,sakit telinga di bahagian yang berkenaan dan torticollis boleh wujud.

Selain daripada perkara-perkara di atas, doktor juga akan memeriksa kulit beserta mukosa pesakit untuk melihat tanda-tanda kekurangan air di dalam badan.

Terdapat beberapa kes yang patut diambil pertimbangan semasa melakukan pemeriksaan farinx dan tonsil.

Kes-kes seperti Infectious mononucleosis dan jangkitan virus Herpes simplex mempunyai cirri-ciri tambahan yang berbeza.

Dalam kes Infectious mononucleosis, selain daripada akut tonsillitis, penyakit ini juga menunjukkan penemuan fizikal lain seperti sakit kalenjar axilla, servikal dan inguinal beserta limpa yang bengkak, letih yang amat sangat,sakit-sakit badan dan demam bersuhu rendah mengiringi akut tonsillitis. Penemuan fizikal yang paling penting membezakan infectious mononucleosis dengan akut tonsillitis yang lain ialah terdapatnya selaput berwarna kelabu yang meliputi tonsil yang membengkak sebagaimana gambar di bawah. Selaput ini boleh dibuang tanpa berlaku pendarahan.

Gambar di atas menunjukkan tonsillitis yang disebabkan oleh jangkitan Epstein-Barr (infectious mononucleosis).  Tonsil yang bengkak diselaputi oleh lapisan putih kekelabuan.

Berbeza dengan kes jangkitan virus herpes simplex, penemuan fizikal yang boleh didapati pada pesakit ialah farinx kelihatan merah, tonsil kelihatan bengkak dan kadang-kadang terdapat ulcer pada permukaan tonsil. Selain itu, radang gusi dan radang bibir boleh wujud pada pesakit.

Di dalam kes tonsillitis ini, perlukah ujian makmal dijalankan?

Tonsilitis dan peritonsillar abscess ( PTA ) boleh didiagnosis secara klinikal iaitu berdasarkan simptom-simptom dan penemuan fizikal oleh doktor.

Pemeriksaan makmal hanya dilakukan sekiranya jangkitan tonsil disyaki disebabkan oleh Kumpulan A beta-hemolytic streptococcus.  Di dalam kes ini sample diambil daripada tekak pesakit kemudian dikultur di dalam makmal. Kultur dari tekak pesakit untuk mengesan kumpulan A beta-hemolytic streptococcus adalah 90-95% sensitif. Berbeza pula dengan rapid streptococcal test kerana ia adalah kurang sensitif berbanding kultur tekak pesakit.Walau bagaimanapun, masa yang diperlukan untuk mengesan bakteria di dalam kultur dari tekak mengambil masa yang lama berbanding rapid streptococcal test. Ini menjadi faktor penggunaan rapid streptocoocal test lebih praktikal berbanding kultur dari tekak pesakit.

Selain ujian makmal di atas, ujian serum Monospot ( untuk mengesan infectious mononucleosis yang disebabkan oleh virus Epstein-Barr ), CBC (complete blood count) dan paras elektrolit di dalam serum mungkin dibuat.

Bagaimana tonsillitis dirawat?

Rawatan akut tonsillitis bertumpu kepada pengekalan air di dalam badan dan juga pengambilan kalori yang cukup . Selain itu, ia juga bertumpu kepada pengawalan sakit dan demam.

Ketidakmampuan mengekalkan pengambilan air dan kalori yang cukup boleh menyebabkan pesakit terpaksa mengambil gentian air secara intravenous, antibiotik dan pengawalan sakit. Kortikosteroid secara intravenous mungkin diberi untuk mengurangkan pembengkakan pharynx.

Rawatan yang diberikan semasa terkena tonsillitis sebagaimana di bawah :

  1. Paracetamol dapat mengurangkan sakit dan demam.
  2. Elakkan makanan yang keras, rangup, berempah dan pedas dapat mempercepatkan proses penyembuhan.
  3. Banyakkan berehat.
  4. Banyakkan minum air.
  5. Corticosteroid boleh memendekkan tempoh demam dan radang farinx di dalam kes infectious mononucleosis.
  6. Antibiotik selalunya dipreskripsikan apabila berlakunya radang farinx yang disebabkan oleh bacteria. Ampicillin dan cephalexin selalunya dipreskripsikan akan tetapi ia patut dielakkan penggunaannya sekiranya disyaki infectious mononucleosis. Erythromycin patut digunakan di dalam kes infectious mononucleosis.

Preskripsi antibiotik patut diberikan di dalam kes:

  1. Tonsil bernanah.
  2. Demam.
  3. Peningkatan sel darah putih di dalam darah.
  4. Pesakit mendapat jangkitan daripada pesakit yang telah dijangkiti oleh Group A beta-hemolytic streptococcus.

Di dalam banyak kes, inflamasi farinx yang disebabkan oleh bakteria dan virus adalah mustahil untuk dibezakan secara klinikal.

Kepentingan rawatan Group A beta-hemolytic streptococcus dengan antibiotik ialah :

  1. Untuk mengelak terjadinya demam rheumatik.
  2. Pencegahan daripada berlakunya komplikasi tonsil bernanah.
  3. Mengurangkan simptom-simptom dan tanda-tanda tonsillitis.
  4. Mengelakkan perebakan jangkitan yang disebabkan oleh Group A beta-hemolytic streptococcus.
  5. Mengurangkan kesan sampingan rawatan antibiotik yang tidak sesuai.

Bilakah kalenjar tonsil patut dibuang?

Tonsilitis berulang

Kalenjar tonsil patut dibuang sekiranya pesakit mendapat serangan penyakit tonsillitis sebanyak 6 kali dalam masa 1 tahun, 3 atau lebih jangkitan tonsil dalam masa 1 tahun sekalipun diberi rawatan perubatan, kronik atau jangkitan berulang yang dikaitkan dengan pembawa streptococcus yang tidak memberikan kesan kepada antibiotik yang tahan beta-lactamase.

Tonsilitis berulang selepas pembuangan tonsil adalah jarang sekali.

Tonsilitis selepas pembuangan tonsil mungkin disebabkan oleh pertumbuhan semula tisu tonsil yang mana dirawat dengan membuang tisu tersebut.

Kronik Tonsilitis

Rawatan terbaik untuk kronik tonsillitis ialah pembedahan pembuangan tonsil. Walau bagaimanapun risiko pendarahan semasa dan selepas pembedahan harus diambil kira sebelum ia dilakukan kerana tonsil mungkin sudah berparut. Pertimbangan ini mempengaruhi pemilihan peralatan semasa pembedahan dan keputusan untuk membenarkan pesakit balik.

Tonsillitis di dalam kes Infectious mononucleosis:

Pembesaran tonsil yang kekal selepas jangkitan infectious mononucleosis dan menyebabkan saluran pernafasan tersumbat perlu pembedahan pembuangan tonsil.

Peritonsillar abscess – PTA( Tonsil bernanah )

Rawatan untuk PTA termasuklah aspiration( nanah ditarik keluar dengan menggunakan jarum ) dan Incision and drainage( tonsil dibelah dan nanah ditarik keluar).

Pembedahan pembuangan tonsil dilakukan untuk kes PTA apabila ia dikaitkan dengan kronik atau tonsillitis berulang.

Bolehkah jangkitan pada kelenjar tonsil dielakkan?

1.Radang tonsil yang disebabkan sakit kerongkong (diphtheria) boleh dielakkan dengan pengambilan immunisasi.

2.Kalau tidak dibuang pencegahan tidak dapat dilakukan.

3.Elakkan pesakit yang mempunyai keimunan rendah seperti pesakit HIV atau pesakit yang sentiasa mengambil kortikosteroid amat berguna.

4.Pemberian immunisasi dapat mencegah radang tonsil yang disebabkan diphtheria,

namun begitu ianya sukar dicegah. Elakkan daripada bergaul dengan kanak kanak

yang ada selsema dan batuk.

Bolehkah radang tonsil mengakibatkan gejala yang teruk selain dari sakit tekak ?

Komplikasi yang teruk telah di kenal pasti. Ini termasuk:

  • Deman rheumatik (jangkitan diselaput jantung) disebabkan bakteria sreptokokus dan tidak mengambil antibiotik dengan secukupnya.
  • Radang buah pinggang (acute glomerulonephritis) juga kerana jangkitan streptococcus.
  • Pangkal kelenjar tonsil yang bernanah perlu rawatan kecemasan.
  • Radang tonsil yang berulang boleh menjelaskan kesihatan kanak-kanak dan kualiti hidupnya.

Antibiotics used in management of tonsillitis.

Reference :

1. http://emedicine.medscape.com/article/871977-overview
2. http://www.infosihat.gov.my/penyakit/Kanak-kanak/TONSILITIS.pdf
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