Tuesday, September 27, 2011

[sehat] Digest Number 16131

Messages In This Digest (17 Messages)

Messages

1a.

Re: Apa saja Vaksin yang bisa imunisasi simultan?

Posted by: "hanny.prasetyo@gmail.com" hanny.prasetyo@gmail.com   nyai_loh

Tue Sep 27, 2011 3:05 am (PDT)



Mbak Andini,




Baby nya umur brapa mbak?
Untuk yg DPT sm HIB, combo juga oke mbak. Yg penting bukan combo DPaT sm HiB.



Cheers,


Hanny Prasetyo
Sent from my cuteBerry®
1b.

Re: Apa saja Vaksin yang bisa imunisasi simultan?

Posted by: "andini.okto@yahoo.com" andini.okto@yahoo.com   andini.okto

Tue Sep 27, 2011 3:11 am (PDT)



Mba hanny,
Baby ku skrg 2 bulan 10 hari mbak, vaksinnya kmrn pas 2 bln.. Yaahhh kmrn DPaT sama Hib. Knp mba?? Apa perlu saya ulang? Dpat tuh yg tdk panas kan?


Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
1c.

Re: Apa saja Vaksin yang bisa imunisasi simultan?

Posted by: "siti amatullah mutmainah" amianakbinus@yahoo.com   amianakbinus

Tue Sep 27, 2011 3:51 am (PDT)



Dear mba andini,
Dibuka deh www.cdc.gov perihal DTaP dan Hib yg combo (btw, combo kan?)

Spy jelas dan puas :)

Maaf jk krg berkenan

Cheers,
Ami


Sent from AmiBerry® via Smart 1x / EVDO Network.
1d.

Re: Apa saja Vaksin yang bisa imunisasi simultan?

Posted by: "andini.okto@yahoo.com" andini.okto@yahoo.com   andini.okto

Tue Sep 27, 2011 3:58 am (PDT)



Thank u mba amiii... :)
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
2a.

Re: Kelenjar Getah Bening

Posted by: "yessiman@gmail.com" yessiman@gmail.com

Tue Sep 27, 2011 3:05 am (PDT)



Coba browsing limfadenofati, Mbak.
Saya jg kemarin mengalami hal yg sama, ternyata rubella.


Regards,
Yessi
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3a.

Re: (Tanya) lanjutan - guyur air langsung ke kepala bisa bikin strok

Posted by: "Laksmi Purwitosari" laksmipurwitosari@yahoo.com   laksmipurwitosari

Tue Sep 27, 2011 3:24 am (PDT)



Buat yang takut terhadap udara panas,
Understanding Heat-Related Illness -- the Basics
http://firstaid.webmd.com/understanding-heat-related-illness-basics
What Are Heat-Related Illnesses?

Prolonged or intense exposure to hot temperatures can cause heat-related illnesses, such as heat exhaustion, heat cramps, and heat stroke (also known as sun stroke). As your body works to cool itself under extreme or prolonged heat, blood rushes to the surface of your skin. As a result, less blood reaches your brain, muscles, and other organs. This can interfere with both your physical strength and your mental capacity, leading, in some cases, to serious danger.

By reducing excessive exposure to high temperatures and taking other precautionary steps, most heat-related illnesses can be avoided. Those who work in hot or humid environments -- such as manufacturing plants, bakeries, or construction sites during summer months -- are most at risk. However, even long, hot afternoons at the beach can pose problems if warning signs are ignored.

What Causes Heat-Related Illnesses?With prompt treatment, most people recover completely from heat illness. However, heat stroke can be deadly if not properly managed.

Heat illness can strike virtually anyone. But chronic alcoholics, the elderly, the young, the obese, and individuals whose immune systems may be compromised are at greater risk, as are individuals taking certain drugs, such as antihistamines, antipsychotic medications, and cocaine. High humidity also increases the risk of heat illness because it interferes with the evaporation of sweat, your body's way of cooling itself.

Heat exhaustion, heat cramps, and heat stroke all occur when your body cannot cool itself adequately. But each is slightly different.

Heat exhaustion occurs when the body loses large amounts of water and salt through excessive sweating, particularly through hard physical labor or exercise. This loss of essential fluids can disturb circulation and interfere with brain function. Individuals who have heart problems or are on low-sodium diets may be particularly susceptible to heat exhaustion.

As in heat exhaustion, heat cramps can strike when the body loses excessive amounts of fluids and salt. This deficiency, accompanied by the loss of other essential nutrients such as potassium and magnesium, typically occurs during heavy exertion.

Heat stroke, the most serious of the heat-related illnesses, occurs when the body suffers from long, intense exposure to heat and loses its ability to cool itself. In prolonged, extreme heat, the part of the brain that normally regulates body temperature malfunctions. This decreases the body's ability to sweat and, therefore, cool down. Those who have certain medical conditions -- such as scleroderma or cystic fibrosis -- that decrease the body's ability to sweat may be at greater risk of developing heat stroke.

Understanding Heat-Related Illness -- Symptoms
http://www.webmd.com/a-to-z-guides/understanding-heat-related-illness-symptoms
What Are the Symptoms of Heat-Related Illnesses?

Heat cramp symptoms include:

Severe, sometimes disabling, cramps that typically begin suddenly in the hands, calves, or feet.
Hard, tense muscles.
Heat exhaustion symptoms include:

Fatigue
Nausea
Headaches
Excessive thirst
Muscle aches and cramps
Weakness
Confusion or anxiety
Drenching sweats, often accompanied by cold, clammy skin.
Slowed or weakened heartbeat.
Dizziness
Fainting
Agitation
Heat exhaustion requires immediate attention but is not usually life-threatening.

Heat stroke symptoms include:

Nausea and vomiting.
Headache.
Dizziness or vertigo.
Fatigue.
Hot, flushed, dry skin.
Rapid heart rate.
Decreased sweating.
Shortness of breath.
Decreased urination.
Blood in urine or stool.
Increased body temperature (104 to 106 degrees).
Confusion, delirium, or loss of consciousness.
Convulsions.
Heat stroke can occur suddenly, without any symptoms of heat exhaustion. If a person is experiencing symptoms of heat exhaustion or heat stroke, OBTAIN MEDICAL CARE IMMEDIATELY. Any delay could be fatal. You should seek emergency medical care for anyone who has been in the heat and who has the following symptoms:

Confusion, anxiety or loss of consciousness.
Very rapid or dramatically slowed heartbeat.
Rapid rise in body temperature that reaches 104 to 106 degrees Fahrenheit.
Either drenching sweats accompanied by cold, clammy skin (which may indicate heat exhaustion); or a marked decrease in sweating accompanied by hot, flushed, dry skin (which may indicate heat stroke).
Convulsions.
Any other heat-related symptom that is not alleviated by moving to a shady or air-conditioned area and administering fluids and salts.

Laksmi Purwitosari

[Non-text portions of this message have been removed]

3b.

Re: (Tanya) lanjutan - guyur air langsung ke kepala bisa bikin strok

Posted by: "lilis nurindah sari" nyonya.zaky@gmail.com   lilo_chantiq

Tue Sep 27, 2011 3:41 am (PDT)



Huaaa..senangnya dr.laksmi muncul jawab.. ;)

​​ Ŧћαиќ φöц.  ya dok..ulasan soal heat stroke nya lengkap kap
kap.. Hehehe..

Lilis
mama keisha

On 9/27/11, Laksmi Purwitosari <laksmipurwitosari@yahoo.com> wrote:
> Dear Mba lilis adn SP semua,
>
> Och ternyata yang dimaksud heat stroke toch, kalo di Indonesia kayaknya
> sepanas panasnya udara gak pernah nyampe 40 derajat.
>
> Heat stroke beda dengan stroke (gangguan peredaran darah otak) yang sering
> kita bicarakan.
>
> Heat stroke artinya serangan panas.
>
> Silahkan mampir disini http://emedicine.medscape.com/article/166320-clinical
>
> Heat illness may be viewed as a continuum of illnesses relating to the
> body's inability to cope with heat. It includes minor illnesses, such as
> heat edema, heat rash (ie, prickly heat), heat cramps, and tetany, as well
> as heat syncope and heat exhaustion. Heatstroke is the most severe form of
> the heat-related illnesses and is defined as a body temperature higher than
> 41.1°C (106°F) associated with neurologic dysfunction.
>
> Two forms of heatstroke exist. Exertional heatstroke (EHS) generally occurs
> in young individuals who engage in strenuous physical activity for a
> prolonged period of time in a hot environment. Classic nonexertional
> heatstroke (NEHS) more commonly affects sedentary elderly individuals,
> persons who are chronically ill, and very young persons. Classic NEHS occurs
> during environmental heat waves and is more common in areas that have not
> experienced a heat wave in many years. Both types of heatstroke are
> associated with a high morbidity and mortality, especially when therapy is
> delayed.
>
> With the influence of global warming, it is predicted that the incidence of
> heatstroke cases and fatalities will also become more prevalent. Because
> behavioral responses are important in the management of temperature
> elevations, heatstroke may be entirely preventable.
>
> Pathophysiology
> Despite wide variations in ambient temperatures, humans and other mammals
> can maintain a constant body temperature by balancing heat gain with heat
> loss. When heat gain overwhelms the body's mechanisms of heat loss, the body
> temperature rises, and a major heat illness ensues. Excessive heat denatures
> proteins, destabilizes phospholipids and lipoproteins, and liquefies
> membrane lipids, leading to cardiovascular collapse, multiorgan failure,
> and, ultimately, death. The exact temperature at which cardiovascular
> collapse occurs varies among individuals because coexisting disease, drugs,
> and other factors may contribute to or delay organ dysfunction. Full
> recovery has been observed in patients with temperatures as high as 46°C,
> and death has occurred in patients with much lower temperatures.
> Temperatures exceeding 106°F or 41.1°C generally are catastrophic and
> require immediate aggressive therapy.
>
> Heat may be acquired by a number of different mechanisms. At rest, basal
> metabolic processes produce approximately 100 kcal of heat per hour or 1
> kcal/kg/h. These reactions can raise the body temperature by 1.1°C/h if the
> heat dissipating mechanisms are nonfunctional. Strenuous physical activity
> can increase heat production more than 10-fold to levels exceeding 1000
> kcal/h. Similarly, fever, shivering, tremors, convulsions,
> thyrotoxicosis,sepsis, sympathomimetic drugs, and many other conditions can
> increase heat production, thereby increasing body temperature.
>
> The body also can acquire heat from the environment through some of the same
> mechanisms involved in heat dissipation, including conduction, convection,
> and radiation. These mechanisms occur at the level of the skin and require a
> properly functioning skin surface, sweat glands, and autonomic nervous
> system, but they also may be manipulated by behavioral responses. Conduction
> refers to the transfer of heat between 2 surfaces with differing
> temperatures that are in direct contact. Convection refers to the transfer
> of heat between the body's surface and a gas or fluid with a differing
> temperature. Radiation refers to the transfer of heat in the form of
> electromagnetic waves between the body and its surroundings. The efficacy of
> radiation as a means of heat transfer depends on the angle of the sun, the
> season, and the presence of clouds, among other factors. For example, during
> summer, lying down in the sun can result in a heat gain of up to 150 kcal/h.
>
> Under normal physiologic conditions, heat gain is counteracted by a
> commensurate heat loss. This is orchestrated by the hypothalamus, which
> functions as a thermostat, guiding the body through mechanisms of heat
> production or heat dissipation, thereby maintaining the body temperature at
> a constant physiologic range. In a simplified model, thermosensors located
> in the skin, muscles, and spinal cord send information regarding the core
> body temperature to the anterior hypothalamus, where the information is
> processed and appropriate physiologic and behavioral responses are
> generated. Physiologic responses to heat include an increase in the blood
> flow to the skin (as much as 8 L/min), which is the major heat-dissipating
> organ; dilatation of the peripheral venous system; and stimulation of the
> eccrine sweat glands to produce more sweat.
>
> As the major heat-dissipating organ, the skin can transfer heat to the
> environment through conduction, convection, radiation, and evaporation.
> Radiation is the most important mechanism of heat transfer at rest in
> temperate climates, accounting for 65% of heat dissipation, and it can be
> modulated by clothing. At high ambient temperatures, conduction becomes the
> least important of the 4 mechanisms, while evaporation, which refers to the
> conversion of a liquid to a gaseous phase, becomes the most effective
> mechanism of heat loss.
>
> The efficacy of evaporation as a mechanism of heat loss depends on the
> condition of the skin and sweat glands, the function of the lung, ambient
> temperature, humidity, air movement, and whether or not the person is
> acclimated to the high temperatures. For example, evaporation does not occur
> when the ambient humidity exceeds 75% and is less effective in individuals
> who are not acclimated. Nonacclimated individuals can only produce 1 L of
> sweat per hour, which only dispels 580 kcal of heat per hour, whereas
> acclimated individuals can produce 2-3 L of sweat per hour and can dissipate
> as much as 1740 kcal of heat per hour through evaporation. Acclimatization
> to hot environments usually occurs over 7-10 days and enables individuals to
> reduce the threshold at which sweating begins, increase sweat production,
> and increase the capacity of the sweat glands to reabsorb sweat sodium,
> thereby increasing the efficiency of heat dissipation.
>
> When heat gain exceeds heat loss, the body temperature rises. Classic
> heatstroke occurs in individuals who lack the capacity to modulate the
> environment (eg, infants, elderly individuals, individuals who are
> chronically ill). Furthermore, elderly persons and patients with diminished
> cardiovascular reserves are unable to generate and cope with the physiologic
> responses to heat stress and, therefore, are at risk of heatstroke. Patients
> with skin diseases and those taking medications that interfere with sweating
> also are at increased risk for heatstroke because they are unable to
> dissipate heat adequately. Additionally, the redistribution of blood flow to
> the periphery, coupled with the loss of fluids and electrolytes in sweat,
> place a tremendous burden on the heart, which ultimately may fail to
> maintain an adequate cardiac output, leading to additional morbidity and
> mortality.
>
> Factors that interfere with heat dissipation include an inadequate
> intravascular volume, cardiovascular dysfunction, and abnormal skin.
> Additionally, high ambient temperatures, high ambient humidity, and many
> drugs can interfere with heat dissipation, resulting in a major heat
> illness. Similarly, hypothalamic dysfunction may alter temperature
> regulation and may result in an unchecked rise in temperature and heat
> illness.
>
> On a cellular level, many theories have been hypothesized and clinically
> scrutinized. Generally speaking, heat directly influences the body on a
> cellular level by interfering with cellular processes along with denaturing
> proteins and cellular membranes. In turn, an array of inflammatory cytokines
> and heat shock proteins (HSPs) (HSP-70 in particular, which allows the cell
> to endure the stress of its environment), are produced. If the stress
> continues, the cell will succumb to the stress (apoptosis) and die. Certain
> preexisting factors, such as age, genetic makeup, and the nonacclimatized
> individual, may allow progression from heat stress to heatstroke,
> multiorgan-dysfunction syndrome (MODS), and ultimately death. Progression to
> heatstroke may occur through thermoregulatory failure, an amplified
> acute-phase response, and alterations in the expression of HSPs.
>
> An index used by some, including the American College of Sports Medicine, is
> the Wet Bulb Globe Temperature (WBGT). It is an environmental heat stress
> index used to evaluate the risk of heat of heat-related illness on an
> individual. It is calculated using 3 parameters: temperature, humidity, and
> radiant heat. There is low risk if the WBGT is < 65 º F, moderate risk if it
> is between 65-73 º F, high risk if between 73-82 º F, and very high risk >82
> º F.
>
> Infants, children, and elderly persons have a higher incidence of heatstroke
> than young, healthy adults.
>
> Infants and children are at risk for heat illness due to inefficient
> sweating, a higher metabolic rate, and their inability to care for
> themselves and control their environment.
>
> Elderly persons also are at increased risk for heat-related illnesses
> because of their limited cardiovascular reserves, preexisting illness, and
> use of many medications that may affect their volume status or sweating
> ability. In addition, elderly people who are unable to care for themselves
> are at increased risk for heatstroke, presumably because of their inability
> to control their environment.
>
> EHS is the second most common cause of death among high school athletes,
> surpassed only by spinal cord injury. Lack of acclimatization is a major
> risk factor for EHS in young adults.
>
> Exertional heatstroke
> EHS is characterized by hyperthermia, diaphoresis, and an altered sensorium,
> which may manifest suddenly during extreme physical exertion in a hot
> environment.
>
> A number of symptoms (eg, abdominal and muscular cramping, nausea, vomiting,
> diarrhea, headache, dizziness, dyspnea, weakness) commonly precede the
> heatstroke and may remain unrecognized. Syncope and loss of consciousness
> also are observed commonly before the development of EHS.
>
> EHS commonly is observed in young, healthy individuals (eg, athletes,
> firefighters, military personnel) who, while engaging in strenuous physical
> activity, overwhelm their thermoregulatory system and become hyperthermic.
> Because their ability to sweat remains intact, patients with EHS are able to
> cool down after cessation of physical activity and may present for medical
> attention with temperatures well below 41°C. Despite education and
> preventative measures, EHS is still the third most common cause of death
> among high school students.
>
> Risk factors that increase the likelihood of heat-related illnesses include
> a preceding viral infection, dehydration, fatigue, obesity, lack of sleep,
> poor physical fitness, and lack of acclimatization. Although lack of
> acclimatization is a risk factor for heatstroke, EHS also can occur in
> acclimatized individuals who are subjected to moderately intense exercise.
>
> EHS also may occur because of increased motor activity due to drug use, such
> as cocaine and amphetamines, and as a complication of status epilepticus.
>
> Nonexertional heatstroke
> Classic NEHS is characterized by hyperthermia, anhidrosis, and an altered
> sensorium, which develop suddenly after a period of prolonged elevations in
> ambient temperatures (ie, heat waves). Core body temperatures greater than
> 41°C are diagnostic, although heatstroke may occur with lower core body
> temperatures.
>
> Numerous CNS symptoms, ranging from minor irritability to delusions,
> irrational behavior, hallucinations, and coma have been described.
>
> Anhidrosis due to cessation of sweating is a late occurrence in heatstroke
> and may not be present when patients are examined.
>
> Other CNS symptoms include hallucinations, seizures, cranial nerve
> abnormalities, cerebellar dysfunction, and opisthotonos.
>
> Patients with NEHS initially may exhibit a hyperdynamic circulatory state,
> but, in severe cases, hypodynamic states may be noted.
>
> Classic heatstroke most commonly occurs during episodes of prolonged
> elevations in ambient temperatures. It affects people who are unable to
> control their environment and water intake (eg, infants, elderly persons,
> individuals who are chronically ill), people with reduced cardiovascular
> reserve (eg, elderly persons, patients with chronic cardiovascular
> illnesses), and people with impaired sweating (eg, patients with skin
> disease, patients ingesting anticholinergic and psychiatric drugs). In
> addition, infants have an immature thermoregulatory system, and elderly
> persons have impaired perception of changes in body and ambient temperatures
> and a decreased capacity to sweat.
>
>
>
>
>
>
>
>
>
>
> Laksmi Purwitosari
>
>
>
> [Non-text portions of this message have been removed]
>
>

--
Sent from my mobile device

3c.

Re: (Tanya) lanjutan - guyur air langsung ke kepala bisa bikin strok

Posted by: "isti wahyuni dianing tyas" istiwahyuni@yahoo.com   mommykeisya

Tue Sep 27, 2011 4:31 am (PDT)



P
Powered by Telkomsel BlackBerry®

-----Original Message-----
From: Laksmi Purwitosari <laksmipurwitosari@yahoo.com>
Sender: sehat@yahoogroups.com
Date: Tue, 27 Sep 2011 02:48:49
To: <sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: Re: [sehat] (Tanya) lanjutan - guyur air langsung ke kepala bisa bikin stroke??

Dear Mba lilis adn SP semua,

Och ternyata yang dimaksud heat stroke toch, kalo di Indonesia kayaknya sepanas panasnya udara gak pernah nyampe 40 derajat.

Heat stroke beda dengan stroke (gangguan peredaran darah otak) yang sering kita bicarakan.

Heat stroke artinya serangan panas.

Silahkan mampir disini http://emedicine.medscape.com/article/166320-clinical

Heat illness may be viewed as a continuum of illnesses relating to the body's inability to cope with heat. It includes minor illnesses, such as heat edema, heat rash (ie, prickly heat), heat cramps, and tetany, as well as heat syncope and heat exhaustion. Heatstroke is the most severe form of the heat-related illnesses and is defined as a body temperature higher than 41.1°C (106°F) associated with neurologic dysfunction.

Two forms of heatstroke exist. Exertional heatstroke (EHS) generally occurs in young individuals who engage in strenuous physical activity for a prolonged period of time in a hot environment. Classic nonexertional heatstroke (NEHS) more commonly affects sedentary elderly individuals, persons who are chronically ill, and very young persons. Classic NEHS occurs during environmental heat waves and is more common in areas that have not experienced a heat wave in many years. Both types of heatstroke are associated with a high morbidity and mortality, especially when therapy is delayed.

With the influence of global warming, it is predicted that the incidence of heatstroke cases and fatalities will also become more prevalent. Because behavioral responses are important in the management of temperature elevations, heatstroke may be entirely preventable.

Pathophysiology
Despite wide variations in ambient temperatures, humans and other mammals can maintain a constant body temperature by balancing heat gain with heat loss. When heat gain overwhelms the body's mechanisms of heat loss, the body temperature rises, and a major heat illness ensues. Excessive heat denatures proteins, destabilizes phospholipids and lipoproteins, and liquefies membrane lipids, leading to cardiovascular collapse, multiorgan failure, and, ultimately, death. The exact temperature at which cardiovascular collapse occurs varies among individuals because coexisting disease, drugs, and other factors may contribute to or delay organ dysfunction. Full recovery has been observed in patients with temperatures as high as 46°C, and death has occurred in patients with much lower temperatures. Temperatures exceeding 106°F or 41.1°C generally are catastrophic and require immediate aggressive therapy.

Heat may be acquired by a number of different mechanisms. At rest, basal metabolic processes produce approximately 100 kcal of heat per hour or 1 kcal/kg/h. These reactions can raise the body temperature by 1.1°C/h if the heat dissipating mechanisms are nonfunctional. Strenuous physical activity can increase heat production more than 10-fold to levels exceeding 1000 kcal/h. Similarly, fever, shivering, tremors, convulsions, thyrotoxicosis,sepsis, sympathomimetic drugs, and many other conditions can increase heat production, thereby increasing body temperature.

The body also can acquire heat from the environment through some of the same mechanisms involved in heat dissipation, including conduction, convection, and radiation. These mechanisms occur at the level of the skin and require a properly functioning skin surface, sweat glands, and autonomic nervous system, but they also may be manipulated by behavioral responses. Conduction refers to the transfer of heat between 2 surfaces with differing temperatures that are in direct contact. Convection refers to the transfer of heat between the body's surface and a gas or fluid with a differing temperature. Radiation refers to the transfer of heat in the form of electromagnetic waves between the body and its surroundings. The efficacy of radiation as a means of heat transfer depends on the angle of the sun, the season, and the presence of clouds, among other factors. For example, during summer, lying down in the sun can result in a heat gain of up to 150 kcal/h.

Under normal physiologic conditions, heat gain is counteracted by a commensurate heat loss. This is orchestrated by the hypothalamus, which functions as a thermostat, guiding the body through mechanisms of heat production or heat dissipation, thereby maintaining the body temperature at a constant physiologic range. In a simplified model, thermosensors located in the skin, muscles, and spinal cord send information regarding the core body temperature to the anterior hypothalamus, where the information is processed and appropriate physiologic and behavioral responses are generated. Physiologic responses to heat include an increase in the blood flow to the skin (as much as 8 L/min), which is the major heat-dissipating organ; dilatation of the peripheral venous system; and stimulation of the eccrine sweat glands to produce more sweat.

As the major heat-dissipating organ, the skin can transfer heat to the environment through conduction, convection, radiation, and evaporation. Radiation is the most important mechanism of heat transfer at rest in temperate climates, accounting for 65% of heat dissipation, and it can be modulated by clothing. At high ambient temperatures, conduction becomes the least important of the 4 mechanisms, while evaporation, which refers to the conversion of a liquid to a gaseous phase, becomes the most effective mechanism of heat loss.

The efficacy of evaporation as a mechanism of heat loss depends on the condition of the skin and sweat glands, the function of the lung, ambient temperature, humidity, air movement, and whether or not the person is acclimated to the high temperatures. For example, evaporation does not occur when the ambient humidity exceeds 75% and is less effective in individuals who are not acclimated. Nonacclimated individuals can only produce 1 L of sweat per hour, which only dispels 580 kcal of heat per hour, whereas acclimated individuals can produce 2-3 L of sweat per hour and can dissipate as much as 1740 kcal of heat per hour through evaporation. Acclimatization to hot environments usually occurs over 7-10 days and enables individuals to reduce the threshold at which sweating begins, increase sweat production, and increase the capacity of the sweat glands to reabsorb sweat sodium, thereby increasing the efficiency of heat dissipation.

When heat gain exceeds heat loss, the body temperature rises. Classic heatstroke occurs in individuals who lack the capacity to modulate the environment (eg, infants, elderly individuals, individuals who are chronically ill). Furthermore, elderly persons and patients with diminished cardiovascular reserves are unable to generate and cope with the physiologic responses to heat stress and, therefore, are at risk of heatstroke. Patients with skin diseases and those taking medications that interfere with sweating also are at increased risk for heatstroke because they are unable to dissipate heat adequately. Additionally, the redistribution of blood flow to the periphery, coupled with the loss of fluids and electrolytes in sweat, place a tremendous burden on the heart, which ultimately may fail to maintain an adequate cardiac output, leading to additional morbidity and mortality.

Factors that interfere with heat dissipation include an inadequate intravascular volume, cardiovascular dysfunction, and abnormal skin. Additionally, high ambient temperatures, high ambient humidity, and many drugs can interfere with heat dissipation, resulting in a major heat illness. Similarly, hypothalamic dysfunction may alter temperature regulation and may result in an unchecked rise in temperature and heat illness.

On a cellular level, many theories have been hypothesized and clinically scrutinized. Generally speaking, heat directly influences the body on a cellular level by interfering with cellular processes along with denaturing proteins and cellular membranes. In turn, an array of inflammatory cytokines and heat shock proteins (HSPs) (HSP-70 in particular, which allows the cell to endure the stress of its environment), are produced. If the stress continues, the cell will succumb to the stress (apoptosis) and die. Certain preexisting factors, such as age, genetic makeup, and the nonacclimatized individual, may allow progression from heat stress to heatstroke, multiorgan-dysfunction syndrome (MODS), and ultimately death. Progression to heatstroke may occur through thermoregulatory failure, an amplified acute-phase response, and alterations in the expression of HSPs.

An index used by some, including the American College of Sports Medicine, is the Wet Bulb Globe Temperature (WBGT). It is an environmental heat stress index used to evaluate the risk of heat of heat-related illness on an individual. It is calculated using 3 parameters: temperature, humidity, and radiant heat. There is low risk if the WBGT is < 65 º F, moderate risk if it is between 65-73 º F, high risk if between 73-82 º F, and very high risk >82 º F.

Infants, children, and elderly persons have a higher incidence of heatstroke than young, healthy adults.

Infants and children are at risk for heat illness due to inefficient sweating, a higher metabolic rate, and their inability to care for themselves and control their environment.

Elderly persons also are at increased risk for heat-related illnesses because of their limited cardiovascular reserves, preexisting illness, and use of many medications that may affect their volume status or sweating ability. In addition, elderly people who are unable to care for themselves are at increased risk for heatstroke, presumably because of their inability to control their environment.

EHS is the second most common cause of death among high school athletes, surpassed only by spinal cord injury. Lack of acclimatization is a major risk factor for EHS in young adults.

Exertional heatstroke
EHS is characterized by hyperthermia, diaphoresis, and an altered sensorium, which may manifest suddenly during extreme physical exertion in a hot environment.

A number of symptoms (eg, abdominal and muscular cramping, nausea, vomiting, diarrhea, headache, dizziness, dyspnea, weakness) commonly precede the heatstroke and may remain unrecognized. Syncope and loss of consciousness also are observed commonly before the development of EHS.

EHS commonly is observed in young, healthy individuals (eg, athletes, firefighters, military personnel) who, while engaging in strenuous physical activity, overwhelm their thermoregulatory system and become hyperthermic. Because their ability to sweat remains intact, patients with EHS are able to cool down after cessation of physical activity and may present for medical attention with temperatures well below 41°C. Despite education and preventative measures, EHS is still the third most common cause of death among high school students.

Risk factors that increase the likelihood of heat-related illnesses include a preceding viral infection, dehydration, fatigue, obesity, lack of sleep, poor physical fitness, and lack of acclimatization. Although lack of acclimatization is a risk factor for heatstroke, EHS also can occur in acclimatized individuals who are subjected to moderately intense exercise.

EHS also may occur because of increased motor activity due to drug use, such as cocaine and amphetamines, and as a complication of status epilepticus.

Nonexertional heatstroke
Classic NEHS is characterized by hyperthermia, anhidrosis, and an altered sensorium, which develop suddenly after a period of prolonged elevations in ambient temperatures (ie, heat waves). Core body temperatures greater than 41°C are diagnostic, although heatstroke may occur with lower core body temperatures.

Numerous CNS symptoms, ranging from minor irritability to delusions, irrational behavior, hallucinations, and coma have been described.

Anhidrosis due to cessation of sweating is a late occurrence in heatstroke and may not be present when patients are examined.

Other CNS symptoms include hallucinations, seizures, cranial nerve abnormalities, cerebellar dysfunction, and opisthotonos.

Patients with NEHS initially may exhibit a hyperdynamic circulatory state, but, in severe cases, hypodynamic states may be noted.

Classic heatstroke most commonly occurs during episodes of prolonged elevations in ambient temperatures. It affects people who are unable to control their environment and water intake (eg, infants, elderly persons, individuals who are chronically ill), people with reduced cardiovascular reserve (eg, elderly persons, patients with chronic cardiovascular illnesses), and people with impaired sweating (eg, patients with skin disease, patients ingesting anticholinergic and psychiatric drugs). In addition, infants have an immature thermoregulatory system, and elderly persons have impaired perception of changes in body and ambient temperatures and a decreased capacity to sweat.










Laksmi Purwitosari



[Non-text portions of this message have been removed]



[Non-text portions of this message have been removed]

4a.

Re: Help...Lg Bingung Ulah si kk yg ga mau si dd nenen (dikasih asi)

Posted by: "DEWI" dewi_magenta@yahoo.com   dewi_magenta

Tue Sep 27, 2011 3:41 am (PDT)



Mbak....sabar ya...(peluk dulu deh)

mungkin pas nyusuin, pisah kamar dulu...jgn sampe keliatan...kaalo bs jgn dikasih sufor dd-nya, aplg baru 18hari gitu...kasian kan mbak... anak usia 20m, sdh bisa dikasih aturan tegas mbak...nanti kl diturutin takutnya smp gede ga mau ngalah sama adiknya...tegas kl kk hrs berbagi sama adiknya. minta tlg org rumah utk bantuin jagain kk begitu mbak nyusuin...

sabar ya Mbak...and tetap semangat!

Dewi

--- In sehat@yahoogroups.com, "Ichadiyah" <radya_cute@...> wrote:
>
> Dear All..
> Saya lg sedih plus stress nih Moms, si kk (20m) trnyata ga mau membagi ASI bwt si dd (12d).. Klo diliat saya ngasih asi bwt dd si kk menangis n brusaha ngasarin adiknya :'(
> Saya sdh brusaha maksimal ngajak ngomong si kk agar sayang adiknya, membagi asi bwt si dd tpi cuma sAat ngomong itu aj dia ngangguk pas monyusuin si dd dia berulah lg.. Sring si kk yg saya utamain tpi klo dia dah nenen ga bisa dilepas utk ngasih si dd asi..
>
> Gmn yaa Moms caranya biar saya bisa nyusuin keduanya dgn baik.. kasian si dd skrg dikasih sufor mengalah demi si kk :(
>
> Icha
> #sedih mana blm bisa pumping byk2
>
>
> Powered by Telkomsel BlackBerry�
>

4b.

Re: Help...Lg Bingung Ulah si kk yg ga mau si dd nenen (dikasih asi)

Posted by: "Ichadiyah" radya_cute@yahoo.co.id   icha_grtlo

Tue Sep 27, 2011 5:11 am (PDT)



Iya nih mba Wien.. Rada2 gmn menghadapi ulah si kk, ni saya hbs jln2 ke Mall bareng kk beliin yg dia suka sambil ngomong n janjiin macam2 ke dia klo mau berbagi Asi (nenen) eh pas pulang n dah dekat rumah si kk minta nenen n semua yg diomongin tdi hilang entah kmana yg tdinya dia ngangguk skrg geleng2 lg :(


But saya tdk blh putus asa, Moms di milis ini bikin saya lbh agak tenang hadapi si kk :)


Icha


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5a.

Re: Info DSA yg RUM dan bisa Simultan di Hermina Bogor

Posted by: "Y.Rieka" y.rieka@yahoo.co.id

Tue Sep 27, 2011 4:50 am (PDT)



Dear mom Lia

Salah satu dsa di Hermina Bogor ada yg bersedia simultan (setelah hunting ke beberapa dsa di situ) Bulan Juni lalu anak saya imunisasi MMR, Thypoid sama Varisela.

Nama depan dsa nya lupa tapi belakangnya ada nama Akbar nya. Sebelumnya dsa nya menolak Varisela tapi saya yakinkan klo anak saya akan baik2 saja dgn 3 suntikan.

Jangan lupa bawa print2an cdc mengenai vaksin simultan dan jadwal vaksin terbaru. Ketika konsul buka print2an tsb di meja dsa nya
Waktu itu dsa nya berkomentar : wah ibu update sekali. Kebetulan jadwal vaksin di meja dsa nya masih yg lama hehe....

Klo soal RUM, saya belum tahu karena belum pernah berobat. Hanya beliau sempat berkata kalo anak saya ditest widal hasilnya positif jangan dulu panik karena belum tentu typhus. Dari perkataan itu Kemungkinan besar beliau dsa yg RUM

Silakan mencoba

HTH
-Rieka

Sent from my Bogorberry

6a.

Re: Stroke di otak kecil

Posted by: "piep71@ymail.com" piep71@ymail.com

Tue Sep 27, 2011 4:53 am (PDT)




Dear dr.Laksmi, mau menyela sebentar...

Ini cerita dr Ibu say td via telpon > orang tua saya laki2 65thn tadi pagi mual2 trus maaf diare sedikit krn RM beliau bnyk (Mitral Valve sdh operasi 2x, Hipertensi, BPH sdh dilaser/ditembak tp kadang kencing darah kalo mnm obat yg ga cocok, Stroke SH sdh serangan 3-4x dgn kelumpuhn extremitas kanan dan bicaranya tdk jelas)...terus tadi krn lesu mual2 terus keringat dingin tensi tinggi gelisah akhirnya dibawa ke UGD sardjito tp krn ruang penuh tdk dirwt inap katanya td disuntik tdk tau obat apa, kata dr saraf beliau (Dr. Ismail SpS) mungkin Kaliumnya turun trus disuruh cek Lab..

yg ingin sy tny Kenapa ya kok Kaliumnya turun sebabnya apa ya Dok dan bagaimana sebaiknya ?...
Terimakasih

Sarica

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6b.

Re: Stroke di otak kecil

Posted by: "piep71@ymail.com" piep71@ymail.com

Tue Sep 27, 2011 4:57 am (PDT)




Dear dr.Laksmi, mau menyela sebentar...

Ini cerita dr Ibu say td via telpon > orang tua saya laki2 65thn tadi pagi mual2 trus maaf diare sedikit krn RM beliau bnyk (Mitral Valve sdh operasi 2x, Hipertensi, BPH sdh dilaser/ditembak tp kadang kencing darah kalo mnm obat yg ga cocok, Stroke SH sdh serangan 3-4x dgn kelumpuhn extremitas kanan dan bicaranya tdk jelas)...terus tadi krn lesu mual2 terus keringat dingin tensi tinggi gelisah akhirnya dibawa ke UGD sardjito tp krn ruang penuh tdk dirwt inap katanya td disuntik tdk tau obat apa, kata dr saraf beliau (Dr. Ismail SpS) mungkin Kaliumnya turun trus disuruh cek Lab..

yg ingin sy tny Kenapa ya kok Kaliumnya turun sebabnya apa ya Dok dan bagaimana sebaiknya ?...
Terimakasih

Sarica

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6c.

Re: Stroke di otak kecil

Posted by: "piep71@ymail.com" piep71@ymail.com

Tue Sep 27, 2011 5:21 am (PDT)




Dear dr.Laksmi, mau menyela sebentar...

Ini cerita dr Ibu say td via telpon > orang tua saya laki2 65thn tadi pagi mual2 trus maaf diare sedikit krn RM beliau bnyk (Mitral Valve sdh operasi 2x, Hipertensi, BPH sdh dilaser/ditembak tp kadang kencing darah kalo mnm obat yg ga cocok, Stroke SH sdh serangan 3-4x dgn kelumpuhn extremitas kanan dan bicaranya tdk jelas)...terus tadi krn lesu mual2 terus keringat dingin tensi tinggi gelisah akhirnya dibawa ke UGD sardjito tp krn ruang penuh tdk dirwt inap katanya td disuntik tdk tau obat apa, kata dr saraf beliau (Dr. Ismail SpS) mungkin Kaliumnya turun trus disuruh cek Lab..

yg ingin sy tny Kenapa ya kok Kaliumnya turun sebabnya apa ya Dok dan bagaimana sebaiknya ?...
Terimakasih

Sarica

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6d.

Re: Stroke di otak kecil

Posted by: "Helen_gultom" helen_gultom@yahoo.com   helen_gultom

Tue Sep 27, 2011 5:22 am (PDT)



Dear all,
Thanks buat smua respon dan masukannya, sekarang sdh dirawat di rs pik (maaf sebut nama, n tdk bermaksud iklan) di tangani oleh ahli syaraf dr MJ, kondisi pasien masih sadar dgn keluhan kepala pusing dan penglihatan berkurang
Beberapa hari ini sempat muntah muntah, saya sendiri blm baca hasil MRI keseluruhan krn msh otw ke rs,
Sekali lagi trima kasih tuk seluruh perhatian SP walau namanya tidak dpt saya sebut satu persatu , oma Wati (pinjam panggilan annakku) terutama dr Laksmi yg langsung memberikan masukan yg sgt bharga secara japri
May God bless you all

Helen Gultom
7.1.

Re: Larangan merokok dalam gedung tak berguna

Posted by: "vjlollipop@gmail.com" vjlollipop@gmail.com   vionajasin

Tue Sep 27, 2011 5:10 am (PDT)



Usul dong..:P
Kita bikin broadcast aja secara rutin d bb (kallo bisa d media lain jg) ttg ketentuan merokok(dilarang d dlm gedunglah, bahaya merokok,link2 yg terpercaya, dll)
At lleast ada org2 yg akhirnya sadar, wallaupun tdk semua...hehhe
Bisa dbuat bervariasi broadcastnya...humor..atau kaya warta berrita..atau casual...
Just an idea...

Sorry kalo tdk berkenan
Viona
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8.

annual medical check-up

Posted by: "rika.corner@gmail.com" rika.corner@gmail.com   rika_elfira

Tue Sep 27, 2011 5:12 am (PDT)



Dear SP's and docs,

Mau denger pendapat tentang medical check-up rutin. Kantor saya dan suami masing2 slalu mengadakan medical check-up setiap tahun dan semua Karyawan wajib mengikutinya.

Pemeriksaan Meliputi:
- darah lengkap
- urin rutin
- EKG dan treadmill utk usia diatas 35thn
- tes pendengaran (saya krg tau nama tesnya) dan pemeriksaan+interview dgn dokter THT
- USG abdomen
- USG mamae
- rontgen torax
- rontgen panoramic dan pemeriksaan+interview dgn dokter gigi
- papsmear dan pemeriksaan+interview dgn dsog
- tes mata (tekanan bola mata, minus/plus/silindrisnya mata) dan pemeriksaan+interview dgn dokter mata
- pemeriksaan+interview dengan internis

saya mau dengar pendapat temen2, krn kan kita tau tidak mengobati hasil lab...sebenarnya sbrp efektif kah medical check-up tahunan ini?brp banyak perusahaan yg melakukan ini? (Saya sih seneng krn ada papsmear, USG mamae, dan dokter mata :D jd ga keluar dana lg buat pemeriksaan tsb)

Saya agak concern soal rontgen, temen saya tanya...jika wanita pd masa subur dan misalnya pembuahan dilakukan setelah med check dan ternyata hamil, kehamilan kan mulai dihitung dr HPHT yg mana HPHT nya sebelum medcheck, itu pengaruh ga sama kandungan?

Thx&regards,
@rikaelfira
(bunda of talitha alifya "alya"-21m)

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