Tuesday, October 4, 2011

[sehat] Digest Number 16178

Milis SEHAT Group

Messages In This Digest (25 Messages)

1.1.
Re: Ruang ASI di kantor ==> Update From: riana_cantiq@yahoo.com
2a.
Re: Stroke atau apa ya? From: marcella.kasih@indosat.blackberry.com
2b.
Re: Stroke atau apa ya? From: dewi ck
2c.
Re: Stroke atau apa ya? From: feira24@yahoo.com
2d.
Re: Stroke atau apa ya?==> Mas Arief From: /ghz
2e.
Re: Stroke atau apa ya?==> Mas Arief From: indah_suciati@yahoo.com
3a.
Hamil 7 minggu naik pesawat From: Retna Soraya
3b.
Re: Hamil 7 minggu naik pesawat From: anastasia.sabon@yahoo.com
3c.
Re: Hamil 7 minggu naik pesawat From: F.B.Monika
4a.
Re: Teguran dr guru From: marcella.kasih@indosat.blackberry.com
5.1.
KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011 From: klasibdg@yahoo.com
6a.
Re: sorry, mau nanya batuk lagi From: kusumaningrummelati@yahoo.com
6b.
Re: sorry, mau nanya batuk lagi From: kusumaningrummelati@yahoo.com
7.
Kejang pada orng  Dewasa From: Yesi Vonila
8a.
Re: kaki ngangkang? was Re: Balet unt anak From: Cherie Hadiwidjaja
9a.
Batuk semalaman From: vera031174@yahoo.co.id
9b.
Re: Batuk semalaman From: dewi_bundAtha
10.
[news] Cautions with codeine From: /ghz
11a.
Stlh mkn lgsg BAB From: LiNa
12.
[news] Dental notes: Cautions with codeine From: /ghz
13a.
(sehat) curhat, beberapa pantangan ibu hamil From: pujie
13b.
Re: (sehat) curhat, beberapa pantangan ibu hamil From: hilda iriany
13c.
Re: (sehat) curhat, beberapa pantangan ibu hamil From: pujie
13d.
Re: (sehat) curhat, beberapa pantangan ibu hamil From: rulinovich94@yahoo.com
13e.
Re: (sehat) curhat, beberapa pantangan ibu hamil From: Inta

Messages

1.1.

Re: Ruang ASI di kantor ==> Update

Posted by: "riana_cantiq@yahoo.com" riana_cantiq@yahoo.com

Mon Oct 3, 2011 5:07 pm (PDT)



Tp yg di WPI gk bisa dipake untuk orang luar ya :(
Aku pernah meeting di sana dgn pihak Erisson nya, tiba jam mompa tp kata receptionis lt2 nursery room nya gak bisa dipakai orang luar :((
Akhir nya mompa di toilet deh...


Vera
*sori gk potek*

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-----Original Message-----
From: Hari Rahmi <hari.rahmi@ericsson.com>
Sender: sehat@yahoogroups.com
Date: Wed, 28 Sep 2011 15:30:44
To: sehat@yahoogroups.com<sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: [sehat] Re: Ruang ASI di kantor ==> Update

Update tambahan : PT Ericsson Indonesia (Wisma Pondok Indah) juga ada ruang ASI, lengkap dengan kulkasnya, sofa, plus dispenser (kalau ibu2 haus waktu memerah)...nyaman karena kalau masuk harus register dulu, jadi Cuma ibu2 menyusui yang bisa access ke dalam ruangan.

Regards
Rahmi


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



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

2a.

Re: Stroke atau apa ya?

Posted by: "marcella.kasih@indosat.blackberry.com" marcella.kasih@indosat.blackberry.com

Mon Oct 3, 2011 5:21 pm (PDT)



Slamat pagi
Ikutan nimbrung ya

Jadi ayah sudah dirawat di rs saat ini.
Bagian diminta ke rs seperti kata dr Anto dan dr Wati sudah dijalankan.

So what next ?
Baca posting2 dr Laksmi sudah beres ?

Bisa tolong diceritakan, kondisi ayah sekarang bagaimana ? Masih sadar ? Bisa bicara ? Ingatan baik ? Ada perbaikan dibandingkan kondisi yang diceritakan mbak di posting pertama ?

Sekarang tenang dulu bareng2 bahas biar gak bingung ngapain.

1.
Q: di ekg oksigen,
A: Ekg oksigen maksudnya apa ?
Ekg = elektrokardiogram (*tolong kureksi) benarkah ? Memang pakai oksigen ?

2
Q: infus natrium chloride glucose,
A: Status kesadaran pasien gimana ?
Bisa tanya dokter atau perawat, infus ini tujuannya apa ? Boleh kok tanya, ini hak kita buat tahu. Stroke itu mengharuskan keluarga ikut dalam proses belajar. Jadi bertanya pada nakes ybs itu wajib hukumnya.

3.
Q: Dan sudah dilakukan foto thorax dan CT scan, tapi hasil baru bisa dilihat bsk.
A: Oke, kita tunggu hasilnya. Cuma itu yang bisa dilakukan

4.
Q: Tensi 180/100
Obat norvax 5mg
Takutnya tensi naik lg, apa yg mesti dilakukan ya?
A : Obatnya sudah dikonsumsi ?
Ada reaksi positifkah, dalam arti tensi stabil atau turun ? Biar gak takut, lanjutkan observasi sambil belajar. Biar tenang.

5.
Q :Apa ada makanan yg dilarang?Soalnya blum diisi makanan dari siang.
A: Lho, kok bisa selama itu belum makan ? Kenapa ? Di suruh puasa ? Gak bisa makan ? Mual ? Biasanya pihak rs sudah menentukan diet atau menu makanan yang disesuaikan dengan pasien. Tanyakan pada perawat, lalu bandingkan dengan yang ditulis dr Laksmi di emailnya. Ada yang bertentangan gak.

Sementara itu dulu ya.
Kalau mau tabel observasi yang saya pakai dulu saat menemani ibu dirawat karena stroke, bisa japri. Di awal subject jangan lupa tulis JAPRI ya, biar gak tertimbun email2 milis.

Ohya, ada buku tentang stroke, yang nulis dokter Rudi, lumayan mudah buat di pahami. Satu lagi dari RSCM, cuma yang ini bacanya mesti pelan2, lebih medis bahasanya.

Kalau ada waktu, ke toko buku, cari2 buku tentang stroke. Bisa dibaca sambil observasi kondisi ayah. Proses belajar dimulai nih, jangan ditunda.

Satu lagi, komunikasi dengan nakes dibina dan dipupuk agar baik dan lancar ya. Hindari konflik. Karena jalan masih panjang.

Selamat berbakti pada ayah tercinta.

Regards,
Marcella
*seperti biasa, bawel pas macet
Sent from my BlackBerry0…3
powered by Sinyal Kuat INDOSAT
2b.

Re: Stroke atau apa ya?

Posted by: "dewi ck" ck_kusumadewi@yahoo.com   ck_kusumadewi

Mon Oct 3, 2011 6:02 pm (PDT)



Selamat pagi,
Trimakasih mba
Saat ini kondisi sadar, visual baik,bicara baik, tubuh bag.kanan terasa lemas mati rasa tapi masih bisa gerak,tensi 150/85,

1 maksudnya dilakukan EKG dan diberi bantuan oksigen.

Trimakasih infonya ya, sampe lemes nih badan..

Nakesnya si baik dirs ini tp smua serba procedural sampai mau priksa darah tambahan u/asam urat hrs turun surat jalan dulu jd darah yg diambil smalam sdh rusak mesti ambil lagi.

Di ugd smua hasil lab harus tercatat dulu sblum msk kamar, hiruk pikuk ugd membuat tambah stress..bth waktu 2jam untuk bisa dilakukan CT scan..

Trimakasi buat dokter2 dan sps yg sudah support disini,

Love,
Dewi ck + rieza



2c.

Re: Stroke atau apa ya?

Posted by: "feira24@yahoo.com" feira24@yahoo.com   feira24

Mon Oct 3, 2011 6:21 pm (PDT)



Gw baru denger kabarnya dew..
Yg sabar yaa..semoga beliau cepet sehat seperti sediakala..

Salam buat reja yaa..

Gw mau cerita dikit, sblm puasa kemaren, nemenin sahabatku yg pulang dr london, makan duren, martabak keju n sate padang (kebetulan sama reja, suaminya dewi ck..0š10š10«70š10š10«70š10š10«7 "0Á2)

Abis makan itu kpala gw langsung pusiiing..pdhl gw rajin cek up n biasanya baik2 aje..

Besoknya langsung daftar gym..
Pesennya, selalu aware sama kesehatan diri yaa..

Gw terlalu "sombong" kemaren2..kagak ngerokok, hidup sehat, maniac olah raga (duluuu) dll..tapi krn sombongnya gw kagak aware, bahwa akhir2 nda pernah olah raga, stress, makan makanan kagak jelas dll..

So, gw ngajak temen2 kembali aware..
Sehat itu dimulai dr awareness masing2.

Makin lihat "kelucuan dan kegantengan" anak gw, bikin gw sadar bahwa "gw sehat" itu juga investasi buat anak gw.

Selamat beraktivitas

Arief,
Ambil roller blade dr bagasi..yihaaaa..
Sent from BlackBerry0…3 on 3
2d.

Re: Stroke atau apa ya?==> Mas Arief

Posted by: "/ghz" ghozan10032005@gmail.com

Mon Oct 3, 2011 6:43 pm (PDT)



On 10/4/2011 8:20 AM, feira24@yahoo.com wrote:
> Makin lihat "kelucuan dan kegantengan" anak gw, bikin gw sadar bahwa "gw sehat" itu juga investasi buat anak gw.
>
==> demen banged gw sama yg ini.maaf oot.thx -sol-

2e.

Re: Stroke atau apa ya?==> Mas Arief

Posted by: "indah_suciati@yahoo.com" indah_suciati@yahoo.com   indah_suciati

Mon Oct 3, 2011 6:51 pm (PDT)



Dear All,
Mohon maaf, numpang thread.
Ayah mertua saya juga pernah kena stroke krn sumbatan.
Mulutnya sudah mencong, tangan lemas separuh, ngomong ga jelas.
Alhamdulillah, setelah bbrp bulan terapi, sudah mulai membaik.
Yg ingin saya tanyakan, saat ini ngomongnya masih agak cadel.
Apakah ini karena pengaruh golden period?

Ayah mertua saya ada riwayat hipertensi dan kolesterol tinggi.

Mohon pencerahannya,


Indah Suciati, mom of Afi, Sasya, Dheea
3a.

Hamil 7 minggu naik pesawat

Posted by: "Retna Soraya" retna_s@bi.go.id   retna_sor

Mon Oct 3, 2011 5:30 pm (PDT)



Dear all,

Saat ini sedang hamil anak kedua umur 6 minggu,insya Allah minggu depan saat kehamilan sy 7 minggu akan berpergian dinas menggunakan pesawat kurang lebih 4 jam. Apakah aman utk janin saya?apakah ada treatment khusus?Alhamdulillah selama kehamilan ini sy tidak pusing atau mual
Mohon infonya ya.
Makasih banyak
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!

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3b.

Re: Hamil 7 minggu naik pesawat

Posted by: "anastasia.sabon@yahoo.com" anastasia.sabon@yahoo.com   anastasia.sabon

Mon Oct 3, 2011 5:42 pm (PDT)



Dear mbak retna,

Saya juga pernah kaya gitu.
Saya baru tau hamil ketika saya sedang mengunjungi suami yang tugas di ternate.
Dan ketika itu usia kehamilan saya 6 minggu. Dan saya balik lagi ke jakarta krn memang saya kerjanya di jakarta.
Syukurnya tidak kenapa-napa.
Tapi sprt nya tergantung kekuatan rahim orang masing2 mbak.
Semoga lancar ya perjalanannya.

Anas
MamanyaKeanu
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-----Original Message-----
From: Retna Soraya <retna_s@bi.go.id>
Sender: sehat@yahoogroups.com
Date: Tue, 4 Oct 2011 07:26:59
To: sehat@yahoogroups.com<sehat@yahoogroups.com>
Reply-To: sehat@yahoogroups.com
Subject: [sehat] Hamil 7 minggu naik pesawat

Dear all,

Saat ini sedang hamil anak kedua umur 6 minggu,insya Allah minggu depan saat kehamilan sy 7 minggu akan berpergian dinas menggunakan pesawat kurang lebih 4 jam. Apakah aman utk janin saya?apakah ada treatment khusus?Alhamdulillah selama kehamilan ini sy tidak pusing atau mual
Mohon infonya ya.
Makasih banyak
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!

"This e-mail (including any attachments) is intended solely for the addressee and could contain information that is confidential; If you are not the intended recipient, you are hereby notified that any use, disclosure, copying or dissemination of this e-mail and any attachment is strictly prohibited and you should immediately delete it. This message does not necessarily reflect the views of Bank Indonesia. Although this e-mail has been checked for computer viruses, Bank Indonesia accepts no liability for any damage caused by any virus and any malicious code transmitted by this e-mail. Therefore, the recipient should check again for the risk of viruses, malicious codes, etc as a result of e-mail transmission through Internet."


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3c.

Re: Hamil 7 minggu naik pesawat

Posted by: "F.B.Monika" f_monika_b@yahoo.com   f_monika_b

Mon Oct 3, 2011 5:43 pm (PDT)



Dear Mba Retna,

Beberapa airline menerapkan peraturan mengenai penumpang wanita hamil, ini sekedar contoh :

" Di bawah kehamilan 28 minggu, Mandala dapat mengijinkan penumpang hamil untuk terbang dengan Mandala tanpa harus menunjukkan surat dokter. Penumpang akan diminta untuk menandatangani formulir yang menyatakn bahwa kehamilannya masih di bawah 28 minggu.? Kehamilan antara 28 – 36 minggu, Mandala menyaratkan surat keterangan dari dokter yang menyatakan bahwa penumpang tersebut dslam kondisi sehat untuk terbang. Dalam surat keterangan harus dicantumkan waktu akan melahirkan, nama dokter, alamat dan nomor telepon.? Lebih dari kehamilan 36 minggu, Mandala tidak bisa menerbangakan penumpang hamil untuk menghindarkan dari kejadian yang tidak diinginkan."

IMHO ditanyakan peraturannya ke airline yg Mbak akan pakai.
Jangan lupa konsultasi + minta surat keterangan ke dsog (bila kondisi Mba ok untuk traveling dengan pesawat).

HTH
F.B.Monika
4a.

Re: Teguran dr guru

Posted by: "marcella.kasih@indosat.blackberry.com" marcella.kasih@indosat.blackberry.com

Mon Oct 3, 2011 5:38 pm (PDT)



Mel, kalau aku pakai caranya jeung Ratna.
Kejadian kok di Sanmar juga.

Nanti kalau issue sudah ke dokter atau belum mereda, mulai ajak diskusi tentang RUM.

Aku sih koleksi artikel2 RUM dan antibiotik di media2 umum. Btw, di NOVA terbaru, ada artikel, narasumbernya dr Wati. Bisa jadi modal koleksi pertama.

Nah, artikel2 di media umum (harian Kompas, majalah Intisari, Sekar, Reader's Digest, Nova, dll) ini yang aku suka sodorkan, sebagai awal diskusi.

Lama prosesnya Mel, pesat sekolah Sanmar aja prosesnya sudah 1th, masih susah gol nya. Mau coba lagi tahun ini, ke guru yang sekarang, soalnya udah sempat naik kelas, he2.

Selamat berjuang ya Mel.
Juga buat sps yang sama2 lagi jadi pendekar RUM di sekolah anak masing2

Regards,
Marcella
*deket kantor
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5.1.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG 29-30 Oktober 2011

Posted by: "klasibdg@yahoo.com" klasibdg@yahoo.com   klasibdg

Mon Oct 3, 2011 5:47 pm (PDT)



Dear Smart Parents,

Sadarkah kita bahwa ASI, TataLaksana Kehamilan & Kelahiran dan juga Penangananan Bayi Baru Lahir ternyata sangat berkaitan? Alangkah baiknya jika kesadaran itu kita munculkan sekarang, sebelum tugas sebagai orangtua kita jalani.

Yuk, maksimalkan setiap usaha dalam memberikan yang terbaik dan juga benar sesuai tata laksana kepada buah hati kita.

Klub Peduli ASI YOP hadir untuk memfasilitasi orangtua menjalani salah satu perannya dengan menyediakan informasi seputar persiapan kelahiran dan menyusui serta media support group orangtua peduli ASI.

KELAS PERSIAPAN KELAHIRAN & MENYUSUI BANDUNG

Pelaksanaan :Hari : Sabtu , 29 Okt  dan Minggu, 30 Okt 2011
Waktu : Pukul 09:00 â€" 14:00 WIB
Tempat : ‎​Koffielosophy.
Jl.Anggrek 36 Bandung.
Tel : (022) ‎​7234227

Materi di dalam Kelas Persiapan Kelahiran & Menyusui ini adalah semua hal yang penting diketahui setiap orangtua/calon orangtua, atau siapapun yang berhubungan erat dengan pengasuhan anak. 

Kelas ini dibagi menjadi 2 Sesi.
Sesi I: ASI dan Seputar Kehamilan (29 Okt 2011)
- Inisiasi Menyusu Dini (IMD)
- Keuntungan ASI
- Posisi Menyusui (latch-on)
- Prinsip dasar
- Persiapan menjelang kelahiran
- Hamil ≠ sakit, suplemen, makanan, mitos-mitos
- Indikasi caesar
- Perawatanbayi baru lahir
- Kegawatdaruratan pada kehamilan 

Sesi II: Masalah-masalah Menyusui dan Pasca Kehamilan (30 Okt 2011)
- Memerah ASI
- ASI Perah dan Penyimpanannya
- Mastitis, Inverted Nipple , Cracked Nipple
- Nursing Strike
- Self Weaning
- Hal-hal penting dalam check-up bayi sampai dengan 6 bulan.
- Kecukupan ASI dari segi nutrisi, terutama ASI perah
- Mengenali dan mencegah gagal tumbuh pada neonatus
- Jaundice
- Cara memantau pertumbuhan dengan kurva pertumbuhan
- Cara memantau perkembangan dan milestones
- Prinsip Rational Use of Medicines (RUM) 

Materi akan disampaikan oleh dokter dan TIM ASI YOP disertai dengan praktek, pemutaran video dan diskusi grup.

Melalui kelas ASI ini diharapkan peserta akan memperoleh pengetahuan yang komprehensif mengenai persiapan kelahiran dan menyusui sekaligus mendapatkan kelompok support yang bisa saling mendukung dan berbagi.

Biaya Rp 130.000,- per orang, atau Rp. 230.000 untuk pasangan. Biaya ini sudah termasuk handout materi, CDmateri, snack dan makan siang. Bagi yang berminat menjadi peserta, silakan mengisi dan mengirimkan formulir pendaftaran di bawah ini kirim ke
klasibdg@yahoo.com dengan Subject: “Kelas Persiapan Kelahiran & Menyusui”.

Untuk informasi lebih lanjut dapat hubungi : Monika . Tlp : 081320678893

http://klasibandung.com/kelas-persiapan-kelahiran-dan-menyusui-29-30-oktober-2011

Tempat Terbatas!
Salam SEHAT, Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

FORMULIR PENDAFTARAN KELAS PERSIAPAN KELAHIRAN &MENYUSUI 29-30 Oktober 2011

Nama Lengkap 1 :_____ (diisi oleh peserta perorangan)

Nama Lengkap 2 :_____ (diisi apabila mengajak pasangan)

Alamat :_____

Telepon/HP :_____

Email aktif :_____ (untuk mengingatkan peserta)

Jumlah anak:_____

Usia anak:_____ bulan/tahun

Due Date (tanggal perkiraan kelahiran): ____ (jika sedang hamil)

Ibu bekerja di luar rumah:_____ (ya/tidak)

Apakah sudah pernah mengetahui ilmu tentang laktasi / menyusui?_____ (ya/tidak)

Jika ya, dari mana sumbernya?_____ (buku/milis/tenaga kesehatan/lainnya …)

Apakah sudah pernah menyusui?_____ (ya/tidak)

Jika ya, apakah berhasil melakukan ASI eksklusif?_____

Permasalahan yang sedang atau pernah dihadapi dalam proses menyusui:_____

Apa yang diharapkan dari kelas Persiapan Kelahiran dan Menyusui yang akan

diikuti?_____

Salam SEHAT,

Tim KLASI YOP (Bandung) Proudly Supports Breastfeeding

http://klasibandung.com/

klasibdg@yahoo.com

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6a.

Re: sorry, mau nanya batuk lagi

Posted by: "kusumaningrummelati@yahoo.com" kusumaningrummelati@yahoo.com   kusumaningrummelati

Mon Oct 3, 2011 5:52 pm (PDT)



Slmt pagi bunda, mba wulan.

Iya bunda mksd sy sekali episode batuk lama (ngetrill), jd kuncinya tetep bnyk mnm sm sabar ya mba hehehe.

Tks
Mel
*semoga batuk cepat berlalu, ga enak bgt ngikik kyk gini, ga indahhh*
Sent from my BlackBerry® wireless device from XL GPRS/EDGE/3G network
6b.

Re: sorry, mau nanya batuk lagi

Posted by: "kusumaningrummelati@yahoo.com" kusumaningrummelati@yahoo.com   kusumaningrummelati

Mon Oct 3, 2011 5:55 pm (PDT)



Slmt pagi bunda, mba wulan.

Iya bunda mksd sy sekali episode batuk lama (ngetrill), jd kuncinya tetep bnyk mnm sm sabar ya mba hehehe.

Tks
Mel
*semoga batuk cepat berlalu, ga enak bgt ngikik kyk gini, ga indahhh*
Sent from my BlackBerry® wireless device from XL GPRS/EDGE/3G network
7.

Kejang pada orng  Dewasa

Posted by: "Yesi Vonila" yesi.vonila@cahayakalbar.com

Mon Oct 3, 2011 5:54 pm (PDT)



Dear SPs dan dokter

Mohon bantuan informasinya ,mengenai penyakit ayahanda saya, beliau sering kejang dan tak sadarkan diri , sudah konsul ke dokter saraf setelah dilakukan CT scan dokter menyatakan kalau ada penyempitan pembuluh saraf. dan disuruh terapi minum obat selama 1 th. tapi saya belum tau detail obat yang diberikan. karena kami tinggal beda pulau. apakah benar penaganan tersebut dengan cara terapi, kira - kira apa penyebab dari penyakit ini dan apa saja yang perlu dihindari. mohon masukan dan pencerahannya.thanks

Rgds,
Yesi

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

8a.

Re: kaki ngangkang? was Re: Balet unt anak

Posted by: "Cherie Hadiwidjaja" cherie.hadiwidjaja@gmail.com   cherie_ph

Mon Oct 3, 2011 6:01 pm (PDT)



Mitos,mbak...kalo ngangkang ya udah dari sononya.bukan krn
digendong.sama jg balet bikin kaki gede..bukan gede tapi berotot
aja,SOL panjang

BR
Mamanya K n Aiko

On 10/3/11, Inta <dini.maesarinta@gmail.com> wrote:
> Mitos mba Erika.
>
> Cheers, Inta-sol
> terkirim dari henponkuh
>

9a.

Batuk semalaman

Posted by: "vera031174@yahoo.co.id" vera031174@yahoo.co.id

Mon Oct 3, 2011 6:24 pm (PDT)




Dear smart parents and doct

anakku 3th udah seminggu batuk pilek, aku masih bertahan utk terus ht, tapi semalem anakku lima menit sekali batuk, aku udah coba pake air panas sama kayu putih, minum air hangat, sampe2 suami nyuruh ke dokter, gm ya? Mohon sarannya, kl dokter yg RUM di bandung dimana ya?:::0:85f44aeaf26b4ddc012b21dd506649c2:7d0::::
Makasih banget
bunda alvaro

9b.

Re: Batuk semalaman

Posted by: "dewi_bundAtha" bundatha@gmail.com   abri_fajar

Mon Oct 3, 2011 7:00 pm (PDT)



ACnya terlalu dingin kali mba..

SOL
-dewi-

10.

[news] Cautions with codeine

Posted by: "/ghz" ghozan10032005@gmail.com

Mon Oct 3, 2011 6:27 pm (PDT)



Cautions with codeine

*Joel Iedema*, Clinical pharmacology fellow, Royal Brisbane and Women's
Hospital, Brisbane

Summary

Codeine is a weak opioid analgesic. It has to be converted to morphine,
but there is significant inter-individual variation in its
pharmacokinetics which results in variable effectiveness. Codeine's
efficacy in clinical trials is generally modest and while its adverse
events are usually mild, serious adverse events, including death, have
occurred. Tolerance and drug dependence can occur. There is a risk of
toxicity especially if combination products containing codeine and other
drugs are misused. Treatment with simple analgesics, or other opioids if
required, provides a more predictable response.

Key words: analgesia, opioids, pharmacogenetics, pharmacokinetics.

(Aust Prescr 2011;34:133-5)

Introduction

Codeine is a widely available analgesic in both prescription and
over-the-counter preparations in Australia. It is often combined with
paracetamol or a non-steroidal anti-inflammatory drug (NSAID). Codeine
is generally perceived as a safe and effective analgesic, however there
have been calls to withdraw codeine from the market.1
<http://www.australianprescriber.com/magazine/34/5/133/5#R1>

Pharmacokinetics and pharmacogenetics

Codeine has low affinity and low intrinsic activity at the opioid
receptor which is responsible for most of the analgesic effect. It
therefore requires conversion to morphine by endogenous enzymes,
principally cytochrome P450 2D6, to have an analgesic effect. There is
significant inter-individual variability in the activity of this enzyme.
These genetic variations affect the rate at which people convert the
prodrug to morphine.

Slow metabolisers are unable to convert enough codeine to produce the
morphine concentrations needed for an analgesic response. These patients
may experience some of the adverse effects of codeine,2
<http://www.australianprescriber.com/magazine/34/5/133/5#R2>
particularly if the dose is increased to try and improve the response.
However, some adverse effects such as constipation may be mediated
through morphine (similar in mechanism to the analgesic effect),
suggesting that slow metabolisers are less prone to these effects.3
<http://www.australianprescriber.com/magazine/34/5/133/5#R3> Ultrafast
metabolisers may be at risk of opioid toxicity, including
life-threatening respiratory depression, because of the augmented
metabolism of codeine to morphine. The prevalence of both slow and
ultrafast CYP2D6 metabolism in the population varies (approximately
2--20%), differing significantly with ethnic background ( Table 1
<http://www.australianprescriber.com/magazine/34/5/133/5#t1> ).4
<http://www.australianprescriber.com/magazine/34/5/133/5#R4> While it is
possible to screen for CYP2D6 polymorphisms prospectively (at least in
some countries), this is unlikely to be a cost- or time-efficient strategy.

Drugs which inhibit CYP2D6, including many antidepressants such as
paroxetine, sertraline and citalopram, may reduce the efficacy of
codeine. Enzyme inducers, such as phenytoin, may augment the effect. In
addition to the CYP2D6 variations, other genetic variants affecting
morphine metabolism, blood--brain barrier transit and opioid receptor
kinetics may also have significant effects on an individual's response
to codeine.1 <http://www.australianprescriber.com/magazine/34/5/133/5#R1>

Efficacy and place in therapy

The World Health Organization places codeine as a 'step 2' (weak opioid)
on its pain ladder. Published in 1990, this was originally a guideline
for the treatment of cancer pain, but has often been extrapolated to
other painful conditions. Other organisations, however, have been much
less convinced of the role of codeine in therapy. Therapeutic
Guidelines: Analgesic states that codeine's 'place in therapy is
uncertain' and highlights that it has a limited role in palliative
care.2 <http://www.australianprescriber.com/magazine/34/5/133/5#R2>

There is great heterogeneity in the clinical trials involving codeine,
with marked differences in patient enrolment, type of pain, dose of
codeine and the comparative drugs used. In general, the efficacy of
codeine in clinical trials is disappointing. In a meta-analysis,
codeine, as a single drug for postoperative pain, did not provide
adequate analgesia (defined as a 50% pain relief over 4--6 hours) in a
large proportion of patients (response rate 26% for codeine 60 mg vs 17%
for placebo).

/Table 1 /
Prevalence rates of CYP2D6 polymorphisms by ethnicity4
<http://www.australianprescriber.com/magazine/34/5/133/5#R4>
Ethnicity Slow metabolisers Ultra-fast metabolisers
Western European 8--10% 1--4%
Southern European
7--10%
African 0--20% 5--30%
Eastern Asian 0--1%
Arabian
Up to 20%

The response rate was worse in dental procedures than with other
surgical procedures. Codeine performed unfavourably compared with simple
analgesics such as paracetamol and NSAIDs.5
<http://www.australianprescriber.com/magazine/34/5/133/5#R5> When
combined with paracetamol, codeine appeared more clinically useful.
However, the additional effect of codeine, compared with the same dose
of paracetamol alone, was modest, with a further 10--15% of patients
achieving adequate analgesia.6
<http://www.australianprescriber.com/magazine/34/5/133/5#R6> A
meta-analysis of opioids for osteoarthritis of the knee or hip found
that the modest benefits of codeine were outweighed by adverse events.7
<http://www.australianprescriber.com/magazine/34/5/133/5#R7>

Many of the preparations available in Australia contain less codeine
than the doses studied in most clinical trials (generally 60 mg
codeine). It is questionable if these low-dose codeine combination
products (containing 8--15 mg codeine per tablet) provide meaningful
analgesia over simple non-opioid analgesics alone.8
<http://www.australianprescriber.com/magazine/34/5/133/5#R8>

Adverse effects

The common adverse effects of codeine, which include nausea, vomiting,
constipation, drowsiness and dizziness, become more likely with higher
or repeated doses. Constipation can be particularly problematic with
larger doses and codeine is best avoided after bowel surgery. Medication
overuse headaches are a concern in people using codeine-containing
medications regularly (more than 10 days per month). While the risk of
developing medication overuse headache with codeine is unknown (given
multiple confounding factors in observational studies), combination
analgesics and opioids (such as codeine) are likely to have a
significantly higher risk than simple analgesics such as paracetamol or
NSAIDs.9 <http://www.australianprescriber.com/magazine/34/5/133/5#R9>,10
<http://www.australianprescriber.com/magazine/34/5/133/5#R10> Less well
appreciated, but seen in some epidemiological studies, is the small but
significant risk of falls, fractures and even motor vehicle
accidents.11-13
<http://www.australianprescriber.com/magazine/34/5/133/5#R11>

At higher doses, or in ultrafast metabolisers, life-threatening
respiratory depression can occur especially when codeine is combined
with other respiratory depressant drugs, such as benzodiazepines.

Breastfeeding

Attention was raised to the potential harms of codeine during
breastfeeding after the death of a neonate whose mother had been
prescribed codeine postpartum. Very high concentrations of morphine in
the deceased baby's blood were attributed to the mother being a CYP2D6
ultrafast metaboliser.14
<http://www.australianprescriber.com/magazine/34/5/133/5#R14>,15
<http://www.australianprescriber.com/magazine/34/5/133/5#R15> The US
Food and Drug Administration issued a letter outlining the need for
caution and close monitoring if prescribing codeine to breastfeeding
women.15 <http://www.australianprescriber.com/magazine/34/5/133/5#R15>
The Australian Medicines Handbook advises avoiding codeine in
breastfeeding women.16
<http://www.australianprescriber.com/magazine/34/5/133/5#R16>

Children

Due to their developing physiology and body composition, infants and
young children have an increased susceptibility to the adverse effects
of opioids. Pharmacogenetic variants were identified as a causal factor
in the death and anoxic brain injury of two young children given codeine
for analgesia after tonsillectomy. Several countries have set minimum
ages for codeine use, however the age they set varies considerably given
the lack of clarity as to when the risk diminishes.1
<http://www.australianprescriber.com/magazine/34/5/133/5#R1> Some
children's hospitals have removed codeine from their formularies.1
<http://www.australianprescriber.com/magazine/34/5/133/5#R1> The UK
Medicines and Healthcare Products Regulatory Agency advises that
codeine-containing preparations for cough should not be used by people
less than 18 years old, as the risks outweigh the benefits.17
<http://www.australianprescriber.com/magazine/34/5/133/5#R17>

Elderly

Older people have an increased susceptibility to opioids. They may also
be taking interacting drugs. Pharmacogenetic variability can have a
considerable impact on adverse effects such as sedation, confusion,
falls and injury. While combination products containing codeine are
often considered safe, a cohort study found the risk of injury was
higher in older people using these products than in those taking other
opioids or sedating drugs.13
<http://www.australianprescriber.com/magazine/34/5/133/5#R13>

Drug dependence and codeine abuse

Although considered a weak opioid, codeine, like all opioids, is
associated with the problems of tolerance and drug dependence with
long-term use. Codeine abuse is also of concern particularly with
combination products, as it frequently results in exposure to
supratherapeutic doses of paracetamol or NSAIDs. Deaths and serious
morbidity, such as liver toxicity and gastric haemorrhage, have been
reported.18 <http://www.australianprescriber.com/magazine/34/5/133/5#R18>

Access to codeine within Australia is inconsistent. Codeine 30 mg
tablets are classified Schedule 8 (drugs with potential for abuse or
addiction), whereas the same dose combined with paracetamol is
classified Schedule 4 (drugs available with prescription). A large
number of lower-dose combination preparations are available without
prescription. Codeine dependence and subsequent abuse has been reported
to occur in people who had initially used over-the-counter products for
painful conditions.18
<http://www.australianprescriber.com/magazine/34/5/133/5#R18>

Conclusion

Codeine's use as an analgesic is confounded by variable pharmacokinetics
that make its efficacy and safety difficult to predict in an individual.

The limited efficacy seen in clinical trials, even at higher doses, is
disappointing and raises questions as to the value of the low-dose
combination preparations available in Australia. In many instances where
a combination containing codeine has been prescribed, treatment with
paracetamol or an NSAID may have been just as effective. In cases where
there is a genuine need for stronger analgesia, treatment with a low
dose of the active metabolite morphine (or one of the synthetic
alternatives) provides a more predictable response.

While codeine's adverse effects are generally troublesome rather than
serious, there are reports of serious adverse events and fatalities. The
potential for drug dependence and misuse, resulting in toxicity from the
paracetamol or NSAIDs used in combination products, also raises concerns
regarding the availability of codeine in the community. As with any
medicine, due care should be taken in recommending or prescribing this
drug. In other words, take caution with codeine.

*References *

1. MacDonald N, MacLeod SM. Has the time come to phase out codeine?
Can Med Assoc J 2010;182:1825
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988526/>.
2. Analgesic: Getting to know your drugs [2007]. In: eTG complete
[Internet]. Melbourne: Therapeutic Guidelines; 2010
<http://www.tg.org.au>.
3. Miks G, Trausch B, Rodewald C, Hofmann U, Richter K, Gramatte T,
et al. Effect of codeine on gastrointestinal motility in relation
to CYP2D6 phenotype.
Clin Pharmacol Ther 1997;61:459-66.
<http://www.ncbi.nlm.nih.gov/pubmed/9129563>
4. Zhou S. Polymorphism of human cytochrome P450 2D6 and its clinical
significance. Part 1. Clin Pharmacokinet 2009;48:689-723.
<http://www.ncbi.nlm.nih.gov/pubmed/19817501>
5. Derry SM. Single dose codeine, as a single agent, for acute
postoperative pain in adults. Cochrane Database Syst Rev
2010;14:CD008099 <http://www.ncbi.nlm.nih.gov/pubmed/20393966>.
6. Toms L, Derry S, Moore RA, McQuay HJ. Single dose oral paracetamol
(acetaminophen) with codeine for postoperative pain in adults.
Cochrane Database Syst Rev 2009;21:CD001547
<http://www.ncbi.nlm.nih.gov/pubmed/19160199>.
7. Nuesch ER, Rutjes AW, Husni E, Welch V, Juni P. Oral or
transdermal opioids for osteoarthritis of the knee or hip.
Cochrane Database Syst Rev 2009;7:CD003115
<http://www.ncbi.nlm.nih.gov/pubmed/19821302>.
8. Murnion BP. Combination analgesics in adults. Aust Prescr
2010;33:113-5.
<http://www.australianprescriber.com/magazine/33/4/113/5>
9. Williams D. Medication overuse headache. Aust Prescr
2005;28:143-5.
<http://www.australianprescriber.com/magazine/28/6/143/5>
10. Headache Classification Committee, Olesen J, Bousser MG, Diener
HC, Dodick D, First M, et al. New appendix criteria open for a
broader concept of chronic migraine. Cephalalgia 2006;26:742-6.
<http://www.ncbi.nlm.nih.gov/pubmed/16686915>
11. Vestergaard P, Rejnmark L, Mosekilde L. Fracture risk associated
with the use of morphine and opiates.
J Intern Med 2006;260:76-87.
<http://www.ncbi.nlm.nih.gov/pubmed/16789982>
12. Bachs LC, Engeland A, Morland JG, Skirtveit S. The risk of motor
vehicle accidents involving drivers with prescriptions of codeine
or tramadol. Clin Pharmacol Ther 2009;85:596-9.
<http://www.ncbi.nlm.nih.gov/pubmed/19279562>
13. Buckeridge D, Huang A, Hanley J, Kelome A, Reidel K, Verma A, et
al. Risk of injury associated with opioid use in older adults. J
Am Geriatr Soc 2010;58:1664-70.
<http://www.ncbi.nlm.nih.gov/pubmed/20863326>
14. Kennedy D. Analgesics and pain relief in pregnancy and
breastfeeding. Aust Prescr 2011;34:8-10.
<http://www.australianprescriber.com/magazine/34/1/8/10>
15. Use of codeine products in nursing mothers -- questions and
answers. 2007. US Food and Drug Administration.
www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm118113.htm
<http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm118113.htm>
[cited 2011 Sep 9]
16. Australian Medicines Handbook. Codeine -- Analgesics. In:
Australian Medicines Handbook. Adelaide: AMH Pty Ltd; 2011. p.
50-1 <http://www.amh.net.au/>.
17. Medicines and Healthcare Products Regulatory Agency. Oral liquid
cough medicines containing codeine should not be used in children
and young people under 18 years. 2010
<http://www.mhra.gov.uk/Safetyinformation/Safetywarningsalertsandrecalls/Safetywarningsandmessagesformedicines/CON096796>.
www.mhra.gov.uk <http://www.mhra.gov.uk> [cited 2011 Sep 9]
18. Frei MY, Neilsen S, Dobbin MD, Tobin CL. Serious morbidity
associated with misuse of over-the-counter codeine-ibuprofen
analgesics: a series of 27 cases. Med J Aust 2010;193:294-6.
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22The+Medical+journal+of+Australia%22%5BJour%5D+AND+2010%5Bpdat%5D+AND+Serious+morbidity+associated+with+misuse+of+over%E2%80%93the%E2%80%93counter+codeine%E2%80%93ibuprofen+analgesics%3A+a+series+of+27+cases&TransS>

/Content created: October - 2011
http://www.australianprescriber.com/magazine/34/5/133/5
/

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

11a.

Stlh mkn lgsg BAB

Posted by: "LiNa" lina.twin09@yahoo.com

Mon Oct 3, 2011 6:33 pm (PDT)



Dear doct n sp's.

Mau nanya neh, ini mslh tmn ku. Knp y setiap dia hbs mkn lgsg BAB, terkdg, blum 5 mnt dia selesai mkn lgsg BAB. Apapun yg dia mkn. Mknan ringan berat. Pasti lgsg BAB. Pdhal dia gak gt suka mkn pedas dan asem.

Saya prnh baca di email bunda wati ttg tdk ada nya enzim pencernaan. Apa mgkn tmn ku mengalami itu? Sehingga apa yg dimkn spt ny tdk terserap tubuh dgn baik. Apa krn jonjot dlm usus ny tdk bekerja dgn baik?

Ktny dia prnh kedoktr, ktny semua fine.jd hanya dibekali vit, tp dia lupa apa nama vit ny.
Soal ny bdn ny termsk sgt kurus. Tggi 165cm, dgn berat hanya 42kg.

Thx y respon ny.


LiNa «мoммy si KэмBαя»
PowÑ"яÑ"d вy TELKOMSEL®
12.

[news] Dental notes: Cautions with codeine

Posted by: "/ghz" ghozan10032005@gmail.com

Mon Oct 3, 2011 6:33 pm (PDT)



Dental notes

Prepared by *Michael McCullough*, Chair, Therapeutics Committee,
Australian Dental Association

(Aust Prescr 2011;34:135)

Cautions with codeine

Patients who present with profound dental pain often do not require
prescribed analgesics if they are treated promptly by a dentist. In the
vast majority of presentations, the dental treatment will manage the
patients' pain. Nevertheless, although the prescription of an analgesic
for ongoing pain management is often not required, professional advice
about the most appropriate and effective over-the-counter medicine to
use is a professional courtesy we should offer to our patients.

The considerable inter-individual variation in the effectiveness of
codeine, combined with its rare but potentially serious adverse events,
suggests that codeine for dental pain should be avoided. Patients with
ongoing pain who are able to use a non-steroidal anti-inflammatory drug,
such as ibuprofen, are likely to have more predictable control of their
pain. The pain management strategies outlined in Therapeutic Guidelines:
Oral and dental1
<http://www.australianprescriber.com/magazine/34/5/artid/1218#R1>
provide clear advice to help patients manage their pain or their
expected pain, following dental treatment.

The warning 'take caution with codeine' should resound in the dental
setting, particularly with patients who specifically request opioid
drugs as an alternative to adequate dental treatment.

* Reference *

1. Oral and Dental Expert Group. Dental management of patients taking
medications. In: Therapeutic guidelines: oral and dental. Version
1. Melbourne: Therapeutic Guidelines Limited; 2007. p.62
<http://www.tg.com.au/>.

/Content created: October - 2011
http://www.australianprescriber.com/magazine/34/5/artid/1218

/

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

13a.

(sehat) curhat, beberapa pantangan ibu hamil

Posted by: "pujie" pujie@rocketmail.com

Mon Oct 3, 2011 6:40 pm (PDT)



Dear Mom's

Saya ini mengandung anak pertama, dan banyak masukan dari sekitar Saya yang memberi wejangan macem2 tentang kehamilan (cont: ga boleh merendam cucian, ga boleh berperilaku aneh, ga boleh ini ga boleh itu, ect)

Saya tuh termasuk orang yang mikir pake logika, jadi gimana yah mau percaya ga masuk logika dan ga percaya itu kata orang tua pamali sama janinnya tar kenapa2.

Orang tua mana sih yang ga mau calon anaknya Sehat dan Normal.Tolong dong sahabat Sehat semua gimana cara menyikapinya, Soalnya Saya stress juga denger itu semua. Saya ga mau kehamilan pertama ini jadi beban buat Saya juga.

Salam Sehat
Pujie

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

13b.

Re: (sehat) curhat, beberapa pantangan ibu hamil

Posted by: "hilda iriany" hilda.iriany@gmail.com   h_iriany

Mon Oct 3, 2011 6:46 pm (PDT)



Jangan stres mbak Pujie, dibawa senyum aja.

Kalo boleh tau, mbak Pujie tinggal di rumah sendiri atau di rmh orang tua?

Akan lebih mudah jika di rumah sendiri ya? Tidak ada yang banyak memberi
"wejangan" dan mbak bisa nyaman menikmati kehamilannya.
Nah kalo masih tinggal di rumah ortu, butuh sedikit skill utk "ngeles",
hehehe.
Gimana kalo sekali2 ajak ortu ikutan kontrol kehamilan ke dokter. Nah disana
mbak Pujie bisa tanyakan ke dokter ttg mitos2 tsb, boleh atau tidak.
Mudah2an sedikit2 bisa berkurang larangan ini-itu-nya.

Semangat ya mbak, semua itu karena mereka sayaaaaaang sm mbak Pujie dan si
janin :) hanya saja mereka ga sadar itu bikin mbak jd stres.

-hilda-

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

13c.

Re: (sehat) curhat, beberapa pantangan ibu hamil

Posted by: "pujie" pujie@rocketmail.com

Mon Oct 3, 2011 7:06 pm (PDT)



Thanx banget mba Hilda Supportnya, Saya tinggal misah dari orang tua, tapi Saya seorang karyawati justru wejangan yang Saya dapat itu banyak dari teman2 kantor. Jadi Kalo pulang kerumah tuh tenang banget. dan besok lagi mau masuk jadi males, Sumpah jadi stress banget.

Saya tau mereka melakukan itu karna Sayang, tapi jadi membatasi ruang gerak Saya. Tapi sekali lagi Thanx suppotnya.

----- Original Message -----
From: hilda iriany
To: sehat@yahoogroups.com
Sent: Tuesday, October 04, 2011 8:46 AM
Subject: Re: [sehat] (sehat) curhat, beberapa pantangan ibu hamil

Jangan stres mbak Pujie, dibawa senyum aja.

Kalo boleh tau, mbak Pujie tinggal di rumah sendiri atau di rmh orang tua?

Akan lebih mudah jika di rumah sendiri ya? Tidak ada yang banyak memberi
"wejangan" dan mbak bisa nyaman menikmati kehamilannya.
Nah kalo masih tinggal di rumah ortu, butuh sedikit skill utk "ngeles",
hehehe.
Gimana kalo sekali2 ajak ortu ikutan kontrol kehamilan ke dokter. Nah disana
mbak Pujie bisa tanyakan ke dokter ttg mitos2 tsb, boleh atau tidak.
Mudah2an sedikit2 bisa berkurang larangan ini-itu-nya.

Semangat ya mbak, semua itu karena mereka sayaaaaaang sm mbak Pujie dan si
janin :) hanya saja mereka ga sadar itu bikin mbak jd stres.

-hilda-

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

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

13d.

Re: (sehat) curhat, beberapa pantangan ibu hamil

Posted by: "rulinovich94@yahoo.com" rulinovich94@yahoo.com   rulinovich94

Mon Oct 3, 2011 7:13 pm (PDT)



Mba pujie,kita hampir senasib,bedanya aku bukan d ktr,tp di lingkungan sekolah anak,kan rata2 yg nganter anak2nya usianya udh di atas aku,jadi mungkin merasa lbh berpengalaman yaa,biasanya mereka 'bawel'nya soal makanan,kan aku sukanya jajan2 tuh,kadang beli es duren,kagetlah mereka,trus ksh wejangan2,aku sih jawabnya,"lah,kan gak makan segalon" hehehehe...
Anggep aja selingan mba,yah tutup kupinglah,pura2 gak denger :D
Maaf ya kalo gak bantu


Regards
-ibunya andra-
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
13e.

Re: (sehat) curhat, beberapa pantangan ibu hamil

Posted by: "Inta" dini.maesarinta@gmail.com

Mon Oct 3, 2011 7:14 pm (PDT)



Mba Pujie,

Sama dulu saya juga gitu, dan sama juga saya yakin mereka juga begitu karena mereka care sama saya. Persis kayak hilda bilang, kalau saya cuma senyum aja tapi sambil bilang: gak apa2 kok mba sama dokter saya gak dilarang.

Trus saya mulai banyak baca2 soal asi, soal mitos selama menyusui, soal tatalaksana bayi baru lahir, untung sempet baca2 walaupun sedikit, karena gempuran mitos justru lebih banyak datangnya setelah anak kita lahir.

Sekarang sih nikmatin aja kehamilannya yah mba. Jalan jalan, ikut senam hamil, berenang, cari2 perlengkapan bayi, ikut KLASI, PESAT. Pokoknya alihin aja pikirannya ke yg positif2 deh, nanti juga hilang tuh suara2 mitos itu ;)

Cheers, Inta
terkirim dari henponkuh

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Terima kasih & penghargaan sedalam-dalamnya kepada : HBTLaw, PT.Intiland, dan PT. Permata Bank Tbk. yang telah dan konsisten mensponsori program kami, PESAT (Program Edukasi Kesehatan Anak Untuk Orang Tua)."
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"SEHAT mailing list is supported by CBN Net for Internet Access&Website.
Our biggest gratitude to: HBTLaw, PT. Intiland, and PT. Permata Bank Tbk. who have consistently sponsored our programme, PESAT (Program Edukasi Kesehatan Anak Untuk Orang Tua)."

Kunjungi kami di (Visit us at):
Official Web : http://milissehat.web.id/
FB           : http://www.facebook.com/pages/Milissehat/131922690207238
Twitter      : @milissehat <http://twitter.com/milissehat/>
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Donasi
Rekening YOP
Yayasan Orang Tua Peduli
Bank Mandiri
Cabang Kemang Raya Jakarta
Account Number: 126.000.4634514
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MARKETPLACE

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