Saturday, October 29, 2011

[sehat] Digest Number 16370

Messages In This Digest (25 Messages)

1.
Reminder Pembayaran Sesi 3 PESAT 2 Bekasi (Paling lambat Selasa, 1 N From: pesat2 bekasi
2a.
Re: [OOT] Jazz for Children, lagu anak2 rasa jazz. => warning From: /ghz
3a.
Re: tanya bhs medis utk pengapuran From: vanessa sutopo
3b.
Re: tanya bhs medis utk pengapuran From: vanessa sutopo
3c.
Re: tanya bhs medis utk pengapuran From: roxiefoxy@yahoo.com
4a.
Re: Apakah imunisasi campak n polio yg dilakukan diposyandu wajib? From: WienTha
5a.
Bibir bawah putih From: fullofmaya@yahoo.com
5b.
Bibir bawah putih From: fullofmaya@yahoo.com
6a.
Re: [News] Saturday, 29 October is World Stroke Day From: Laksmi Purwitosari
6b.
Re: [News] Saturday, 29 October is World Stroke Day From: Laksmi Purwitosari
6c.
Re: [News] Saturday, 29 October is World Stroke Day From: Laksmi Purwitosari
7a.
Tanya Hasil Lab From: Elin
7b.
Re: Tanya Hasil Lab From: niken qinen
7c.
Re: Tanya Hasil Lab From: Elin
7d.
Re: Tanya Hasil Lab From: niken qinen
7e.
Re: Tanya Hasil Lab From: purnamawati.spak@cbn.net.id
8a.
Re: General Medical Check-Up From: rika.corner@gmail.com
9a.
denyut di kepala bayi From: liana_ibu@yahoo.com
9b.
Re: denyut di kepala bayi From: Laksmi Purwitosari
10a.
Bls: [sehat] denyut di kepala bayi From: 'Ita' Elisabeth Dianita
10b.
Re: Bls: [sehat] denyut di kepala bayi From: Elin
11.
The Newborn Examination: Part I. Emergencies and Common Abnormalitie From: Laksmi Purwitosari
12a.
Re: (Tanya) Imunisasi DPT+HiB From: purnamawati.spak@cbn.net.id
13a.
[INFO] Generic Drugs: Questions and Answers From: Laksmi Purwitosari
13b.
Re: [INFO] Generic Drugs: Questions and Answers From: mommyarsa@yahoo.com

Messages

1.

Reminder Pembayaran Sesi 3 PESAT 2 Bekasi (Paling lambat Selasa, 1 N

Posted by: "pesat2 bekasi" pesat2bekasi@gmail.com

Fri Oct 28, 2011 10:34 pm (PDT)



Selamat siang SPs,

PESAT 2 Bekasi Sesi 3 akan diadakan tanggal 13 November 2011 dengan
tema Common Problems...Sementara ini pendaftaran peserta sudah full
booked, SP's yang berminat untuk ikut sesi 3 bisa mendaftar sebagai
waiting list :)

Ini adalah reminder pembayaran kepada peserta yang terdaftar sebagai
peserta lepasan pasangan dan perorangan sesi 3 PESAT 2 Bekasi.

Kepada para peserta yang telah mendapat nomor pendaftaran, silahkan
melakukan pembayaran selambat-lambatnya hari Selasa tanggal 1 November 2011.

Mohon maaf, kepada para peserta yang tidak melakukan pembayaran sampai
dengan tanggal 1 November 2011 akan dicoret namanya dan digantikan
oleh calon peserta dari daftar waitinglist.

Silahkan melakukan pembayaran sebesar biaya kepesertaan anda, ke salah
satu rekening di bawah ini :

* Rekening BCA ; 7340121141 cabang Wisma Nusantara a.n Rika Elfira
* Rekening Bank Mandiri 1250004441325 cabang Perumnas Klender; a.n Rika Elfira

Setelah anda melakukan pembayaran, konfirmasikan kepada kami melalui
(pilih salah satu):

* SMS ke 08562198047 dengan format: [NoPendaftaran] | [Nama Bank yang
dituju] | [Nama bank dan nama pemilik rekening] | [Jumlah yang
ditransfer] |Tanggal transfer
* Email Pesat 2 Bekasi (pesat2bekasi@gmail.com) dengan format yang sama

Salam SEHAT and have a nice weekend

Panitia PESAT 2 BEKASI
pesat2bekasi@gmail.com
Twitter: @PESAT2bks
Facebook: pesat dua bekasi
http://milissehat.web.id/?p=1841

PESAT 2 BEKASI ini diselenggarakan oleh Yayasan Orangtua Peduli (YOP)
dan didukung sepenuhnya oleh: PT. Buanareksa Binaperkasa

Official Media Partner:
1. Majalah Ayahbunda
2. Mommies Daily (www.mommiesdaily.com)

2a.

Re: [OOT] Jazz for Children, lagu anak2 rasa jazz. => warning

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

Fri Oct 28, 2011 10:54 pm (PDT)



On 10/28/2011 3:43 PM, Sarah Isyaturrodiyah wrote:
> Mods, maaf ya, izin sharing event boleh tidak? kalo tidak boleh tidak apa2,
> ga usah di publish. terima kasih
>
=>selamat siang
mohon maaf yah..
besok lagiiii kalau mau ijin moderator cukup kesini aja yah....
sehat-owner@yahoogroups.com.

salamku
bapakeghozan

3a.

Re: tanya bhs medis utk pengapuran

Posted by: "vanessa sutopo" psycho_laziale@yahoo.com   psycho_laziale

Fri Oct 28, 2011 11:11 pm (PDT)



Osteporosis: pengeroposan tulang
Atritis: radang sendi
Biasanya dr bilang pengapuran itu bisa:
Spur atau
Spondyloatritis

Cmiiw
Vanessa
Sent from my AXIS Worry Free BlackBerry® smartphone
3b.

Re: tanya bhs medis utk pengapuran

Posted by: "vanessa sutopo" psycho_laziale@yahoo.com   psycho_laziale

Fri Oct 28, 2011 11:11 pm (PDT)



Spur
Spondyloatritis

Vanessa
Sent from my AXIS Worry Free BlackBerry® smartphone
3c.

Re: tanya bhs medis utk pengapuran

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

Sat Oct 29, 2011 12:04 am (PDT)



Thanks all

Sol

Menda
Powered by Telkomsel BlackBerry®
4a.

Re: Apakah imunisasi campak n polio yg dilakukan diposyandu wajib?

Posted by: "WienTha" Muhammad.athaya@gmail.com

Sat Oct 29, 2011 12:02 am (PDT)



Hiii yop
Minggu ini+kmrn threadnya byk soal yg ini bisa ubek2 di file milis,btw kalo arya+thariq udah mmr? Better mmr aja drpd ikutan crash program cmiiw ya

Br
Wiwinn

Powered by AthayArkanaBerry®
5a.

Bibir bawah putih

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

Sat Oct 29, 2011 12:38 am (PDT)



Dear sps n docs,
Sejak kemarin anakku (1th6bln) diatas bibir bawahnya ada putih2. Yg agak belendung lalu skrg jd berbekas putih. Skrg ada belendungannya lg.tp sangat kecil sekali. Anakku tetap aktif dan ga kliatan sakit. Cuma makannya aja jd agak susah. Walaupun tidak uring.
Kira2 kenapa ya..? apa yg hrs aku lakukan?
Thx ya..
Powered by Telkomsel BlackBerry®
5b.

Bibir bawah putih

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

Sat Oct 29, 2011 3:03 am (PDT)



Dear sps n docs,
Sejak kemarin anakku (1th6bln) diatas bibir bawahnya ada putih2. Yg agak belendung lalu skrg jd berbekas putih. Skrg ada belendungannya lg.tp sangat kecil sekali. Anakku tetap aktif dan ga kliatan sakit. Cuma makannya aja jd agak susah. Walaupun tidak uring.
Kira2 kenapa ya..? apa yg hrs aku lakukan?
Thx ya..
Powered by Telkomsel BlackBerry®
6a.

Re: [News] Saturday, 29 October is World Stroke Day

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

Sat Oct 29, 2011 1:07 am (PDT)



http://www.detikhealth.com/read/2009/10/29/111008/1230864/775/hari-stroke-sedunia-apa-yang-dapat-anda-lakukan?ld991107763
Hari Stroke Sedunia, Apa yang Dapat Anda Lakukan?

Jakarta, Setiap tahun tanggal 29 Oktober diperingati sebagai 'Hari Stroke Sedunia'. Hari stroke sedunia digagas oleh World Stroke Organization (WHO) yang membawa pesan bahwa 'stroke dapat dicegah dan stroke dapat diobati'.

Tema hari stroke sedunia tahun ini adalah 'Apa yang dapat saya lakukan?'. Sebuah pertanyaan kritis bagi setiap orang yang peduli tentang stroke untuk menggugah hati dan tindakan nyata. Sebuah tantangan bagi setiap orang untuk dapat memberikan kontribusi kecil bagi semakin baiknya pelayanan stroke di dunia.

Stroke dapat dicegah

Stroke disebabkan oleh akumulasi faktor risiko stroke. Faktor risiko stroke ada yang tidak dapat diubah dan ada yang dapat diubah. Faktor risiko stroke yang tidak dapat diubah adalah usia, jenis kelamin, ras, riwayat keluarga dan riwayat stroke sebelumnya.

Laki-laki lebih mudah terkena stroke dibanding perempuan. Usia tua lebih mudah pula terkena stroke dibanding usia muda. Ras kulit berwarna lebih mudah terkena stroke dibanding ras kulit putih. Seseorang dengan riwayat keluarga stroke memiliki risiko yang lebih besar pula untuk terkena stroke. Berbagai faktor risiko stroke tersebut adalah faktor risiko yang tidak dapat diubah.

Faktor risiko stroke ada pula yang dapat diubah. Faktor risiko stroke yang utama adalah hipertensi. Berbagai penelitian memperlihatkan bahwa 60-70 persen pasien stroke menderita hipertensi pada saat masuk RS. Masalah yang umum dijumpai adalah ketidaktahuan dan ketidakpedulian sebagian besar anggota masyarakat tentang hipertensi.

Hipertensi tidak memberikan gejala yang spesifik. Seorang penderita hipertensi akan datang berobat akibat komplikasi yang ditimbulkan oleh hipertensi. Hal itulah yang menyebabkan hipertensi disebut sebagai 'the silent killer'.

Hipertensi akan membunuh penderita secara diam-diam dan perlahan, hampir tanpa gejala. Ketika disadari, komplikasi hipertensi sudah sedemikian parahnya (misalnya: penyakit jantung, stroke, dan gagal ginjal).

Faktor risiko stroke lain yang dapat diubah adalah diabetes, kadar kolesterol darah yang tinggi, kegemukan, merokok, gangguan tidur, dan kekentalan darah yang berlebih. Sama dengan hipertensi, maka seringkali faktor risiko stroke tersebut diabaikan dan kurang terkelola dengan baik.

Pencegahan stroke diawali dengan mengenali faktor risiko stroke pada diri kita semua. Ajukan pertanyaan-pertanyaan berikut ini kepada diri anda sendiri: 'Tahukah saya tekanan darah saya pada bulan ini?', 'Tahukah saya kadar gula darah terakhir saya?', 'Pernahkah saya mengukur lingkar perut saya?', dan 'Tahukah saya kadar kolesterol darah saya?'

Bila ada 2 atau lebih jawaban 'tidak', maka artinya Anda kurang peduli. Kenalilah faktor risiko stroke yang dapat dikendalikan pada diri Anda, pada kerabat atau keluraga dan pada masyarakat di sekitar Anda.

Langkah berikutnya adalah mengendalikan fakor risiko stroke tersebut. Kendalikan tekanan darah yang tinggi dengan membatasi asupan garam, menghindari stress, mengkonsumsi banyak buah dan sayur, berhenti merokok, dan berolahraga secara teratur.

Pada banyak keadaan seringkali diperlukan intervensi obat-obatan untuk mendukung perubahan pola hidup yang telah diusahakan. Berbagai penelitian menunjukkan keberhasilan program intervensi faktor risiko untuk menurunkan angka kejadian stroke.

Angka kejadian stroke di berbagai negara menunjukkan penurunan akibat dari berhasilnya program pengurangan konsumsi garam, kampanye berhenti merokok, dan diet kaya buah dan syaur.

Stroke dapat diobati

Salah satu isu utama dalam penanganan stroke yang optimal adalah berpacu dengan waktu. Suatu istilah yang dikenal sebagai 'time is brain'. Tujuan utama penanganan stroke adalah menyelamatkan jaringan otak yang menderita kekurangan pasokan nutrisi dan oksigen. Batas waku penanganan stroke yang optimal adalah 4,5 jam. Semakin cepat mendapat diagnosis dan penanganan yang tepat, maka akan semakin besar kemungkinan pemulihan.

Salah satu kendala yang utama dalam penatalaksanaan stroke adalah keterlambatan pasien datang berobat ke RS. Penyebab utama keterlambatan datang ke RS adalah kurang dikenalinya gejala stroke oleh masyarakat luas.

Perhimpunan stroke di Amerika Serikat mengkampanyekan penggunaan alat ukur sederhana untuk deteksi dini stroke. Alat ukur ini dikenal dengan nama FAST (Face, Arm, Speech, and Tell Test). Di dalam bahasa Indonesia alat ukur ini dapat diterjemahkan sebagai 'senyum, gerak, dan bicara'.

Kampanye alat ukur ini terbukti memperbaiki waktu kedatangan pasien ke RS. Alat ukur ini dipakai dengan meminta pasien untuk tersenyum, mengangkat lengan, dan bicara. Salah satu gangguan dari fungsi senyum, gerak dan bicara harus dicurigai sebagai suatu gejala stroke sampai dengan terbukti bukan.

Apa yang dapat saya lakukan?

Tema hari stroke sedunia tahun ini adalah 'apa yang dapat saya lakukan?'. Sebuah pertanyaan kritis yang menantang semua pihak yang peduli tehadap pelayanan stroke. Masyarakat harus lebih peduli tetang faktor risiko stroke.

Tanyakan pada diri anda dan orang-orang terdekat Anda 'Apakah sudah tahu tekaanan darahnya minggu ini?'. Bila belum ukurlah tekanan darah Anda, dan bila tinggi lakukanlah segera intervensi untuk menurunkan tekanan darah tersebut. Lakukan hal serupa untuk kadar gula darah dan kolesterol. Ingatkan diri Anda dan orang-orang terdekat untuk berhenti merokok.

Stroke adalah kedaruratan medik. Langkah diagnosis dan penanganan yang tepat akan memberikan hasil yang optimal. Segera kenali gejala stroke, dan segeralah bawa ke RS dengan fasilitas stroke yang memadai. Kampanye 'Senyum, Gerak dan Bicara' dapat digunakan untuk mencurigai seseorang terkena stroke.

Petugas medis yang terlibat dalam penatalaksanaan stroke harus melihat stroke sebagai kedaruratan medik. Penanganan stroke adalah berpacu dengan waktu. Pada kondisi demikian penanganan yang cepat dan tepat akan sangat diperlukan.

Keberhasilan penanganan stroke akan tergantung dari kerjasama pasien, keluarga, dan petugas medis. Mari menyambut hari stroke sedunia, dengan sebuah harapan 'Akan semakin baiknya pelayanan stroke di Indonesia'.

Rizaldy Pinzon
SMF Saraf RS Bethesda Yogyakarta

Semoga bermanfaat,

Laksmi Purwitosari

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

6b.

Re: [News] Saturday, 29 October is World Stroke Day

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

Sat Oct 29, 2011 1:20 am (PDT)




http://www.worldstrokecampaign.org/2011/learn/Pages/The_facts_behind-1in6.aspx
THE FACTS BEHIND “1 IN 6”
The theme of the campaign is "1 in 6". The reason behind this is to emphasize how widespread stroke is. Not many people are aware of this fact. One in six people in the world will suffer a stroke in their lifetime; on this page, you will find the data and references behind that statistic and others.
The Lifetime Risk Of Stroke Is 1 In 5 For Women, 1 In 6 For Men:
Sources
Seshadri S., Wolf P.A. (2007). Lifetime risk of stroke and dementia: current concepts, and estimates from the Framingham Study. The Lancet Neurology 6(12), 1106-14. Link
Seshadri S. et al. (2006). The lifetime risk of stroke: estimates from the Framingham Study. Stroke 37, 45-350. Link

Participants (n=4897) who were stroke- and dementia-free at 55 years of age were followed biennially for up to 51 years. ... A total of 875 participants (522 women) developed a first-ever stroke; 749 (448 women) had an ischemic stroke. LTR of stroke was high and remained similar at ages 55, 65, and 75 years, approximating 1 in 5 for women and 1 in 6 for men. Participants with a normal BP (<120/80 mm Hg) had approximately half the LTR of stroke compared with those with high BP (≥140/90 mm Hg)
We observed that the LTR of stroke for middle-aged and "young-old" adults (55 to 75 years of age) was substantial at 1 in 6 or higher. This risk was higher in women (1 in 5) compared with men, largely because of the greater life expectancy in women, which increased their period at risk.

Bushnell, C.D. (2008). Stroke and the female brain. Nature Clinical Practice Neurology 4(1), 22-33. Link

Stroke is the third leading cause of death in most countries, and is one of the leading causes of long-term disability. Women have a higher lifetime risk of stroke than men (1 in 5 vs 1 in 6), a statistic that is influenced in part by the longer life expectancy in women. The female population not only carries a higher burden of stroke during their lifespan - women also account for the majority of stroke deaths.

Annually, 15 million people worldwide suffer a stroke.
Every Two Seconds, Someone In The World Suffers A Stroke
Every Six Seconds, Someone Dies Of A Stroke
Every Six Seconds, Someone’s Quality Of Life Will Forever Be Changed â€" They Will Permanently Be Physically Disabled Due To Stroke
Source
World Health Organization (2004). Atlas of Heart Disease and Stroke.

Semoga bermanfaat,
Laksmi Purwitosari

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

6c.

Re: [News] Saturday, 29 October is World Stroke Day

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

Sat Oct 29, 2011 1:49 am (PDT)



CDC's Public Health Efforts, Januari 2010
Stroke Facts

ï‚· Stroke is the third leading cause of death in the United States. Around 137,000 Americans die of stroke every year.1

ï‚· A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts.

ï‚· Someone in the United States has a stroke every 40 seconds. Every three to four minutes, someone dies of stroke.2

ï‚· Stroke is a leading cause of death for both men and women. In 2006, 6 out of every 10 deaths due to stroke were in 1 women.

ï‚· Every year, about 795,000 people in the United States have a stroke. About 610,000 of these are first or new
strokes. About 185,000 people who survive a stroke eventually have another.2


ï‚· Stroke is an important cause of disability. In 2005, nearly 1.1 million stroke survivors reported difficulty performing basic activities of daily life.3

ï‚· In 2010, stroke will cost the United States $73.7 billion.2 This total includes the cost of health care services,
medications, and lost productivity.
ï‚· Common stroke warning signs and symptoms includeâ€"

o Sudden numbness or weakness of the face, arm, or legâ€"especially on one side of the body.

o Sudden confusion, trouble speaking or understanding.

o Sudden trouble seeing in one or both eyes.

o Sudden trouble walking, dizziness, loss of balance or coordination.

o Sudden severe headache with no known cause.

ï‚· You can't control some stroke risk factors, such as heredity, age, gender, and ethnicity. Some medical conditions, including high blood pressure, high cholesterol, heart disease, diabetes, overweight or obesity, and previous stroke or transient ischemic attack (TIA), can raise also your stroke risk. Not smoking, not drinking excessively, and getting exercise are all choices you can make to reduce your risk.

Laksmi Purwitosari

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

7a.

Tanya Hasil Lab

Posted by: "Elin" elin_s05@yahoo.com   elin_s05

Sat Oct 29, 2011 1:28 am (PDT)



Dear sps n doc,
Hari ini sy putuskan utk test fases anak sy, berikut hasil lab nya :
Mikroskopik faces :
*leukosit : 4-5
*eritrosit : 0
*epitel : negatif
*amilum : positif 1
*jamur : positif 1
*pseudohypa : positif 1
*amuba : negatif
*telur cacing : negatif

Kimia faces :
*pH : 6,0
*reduksi : negatif
*darah samar : positif

Bakteriologi faces :
*coccus gram positif : negatif
*batang gram negatif : positif

Sy sdh konsul ke dsa langganan, beliay blg anak sy positif bakteri ( melihat nilai leukositnya yg tinggi) dan di resepin :
*sporetik sirup
*lacto b sachet
*numico drop

Apa utk obat2annya sdh tepat utk kondisi anak sy ?

Mohon infonya yah.

Terima kasih,
Elin


Sent from my NevanBerry®
7b.

Re: Tanya Hasil Lab

Posted by: "niken qinen" nikenqinen@gmail.com   qinen_q9

Sat Oct 29, 2011 2:22 am (PDT)



Mba Elin, diagnosa awalnya apa yaa?
Fesesnya dikultur ga mba?

Salam,
-Niken-

On 10/29/11, Elin <elin_s05@yahoo.com> wrote:
> Dear sps n doc,
> Hari ini sy putuskan utk test fases anak sy, berikut hasil lab nya :
> Mikroskopik faces :
> *leukosit : 4-5
> *eritrosit : 0
> *epitel : negatif
> *amilum : positif 1
> *jamur : positif 1
> *pseudohypa : positif 1
> *amuba : negatif
> *telur cacing : negatif
>
> Kimia faces :
> *pH : 6,0
> *reduksi : negatif
> *darah samar : positif
>
> Bakteriologi faces :
> *coccus gram positif : negatif
> *batang gram negatif : positif
>
> Sy sdh konsul ke dsa langganan, beliay blg anak sy positif bakteri ( melihat
> nilai leukositnya yg tinggi) dan di resepin :
> *sporetik sirup
> *lacto b sachet
> *numico drop
>
> Apa utk obat2annya sdh tepat utk kondisi anak sy ?
>
> Mohon infonya yah.
>
> Terima kasih,
> Elin
>
>
> Sent from my NevanBerry®
>
> ------------------------------------
>
> Milis SEHAT mengucapkan terimakasih kepada:
> - Asuransi AIA atas partisipasinya sebagai sponsor PESAT Bali 2011
> - PT LG Electronics Indonesia atas partisipasinya sebagai Sponsor Tunggal
> FAMILY FUN DAY MILIS SEHAT 2011.
>
> 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)."
>
> "Milis SEHAT didukung oleh : CBN Net Internet Access &Website.
> =================================================================
> Milis Sehat thanks to:
> - AIA Insurance as sponsor for PESAT Bali 2011
> - PT LG Electronics Indonesia as exclusive partner of FAMILY FUN DAY MILIS
> SEHAT 2011.
>
> Our biggest gratitude to: HBTLaw, PT. Intiland, and PT. Permata Bank Tbk.
> who have consistently sponsored our program, PESAT (Program Edukasi
> Kesehatan Anak Untuk Orang Tua)."
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>
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7c.

Re: Tanya Hasil Lab

Posted by: "Elin" elin_s05@yahoo.com   elin_s05

Sat Oct 29, 2011 2:34 am (PDT)



Mba Niken,
Anak sy nevan (2th) sdh 5hr klo mau pup suka ngeluh sakit perut. Pupnya dlm 1hr bs 3-4x, bentuknya lembek. Kadang agak encer. Utk sakit perutnya sndr hilang timbul. Dan kmrn wkt lg pup sy perhatiin kaya ada darahnya. Makanya sy inisiatif utk test facesnya.

Terima kasih,
Elin

Sent from my NevanBerry®
7d.

Re: Tanya Hasil Lab

Posted by: "niken qinen" nikenqinen@gmail.com   qinen_q9

Sat Oct 29, 2011 2:43 am (PDT)



Mba Elin, positif bakteri tdk lihat dari nilai lekositnya.
Sebaiknya kultur feses mba, utk melihat jenis bakteri, jumlah bakteri
dan jenis AB yg cocok utk bakteri tsb.

Utk obat2annya, mba elin bisa cek ke drugs.com
Searching dgn menggunakan nama zat aktif obat tsb ya mba.

Salam,
-Niken-

On 10/29/11, Elin <elin_s05@yahoo.com> wrote:
> Mba Niken,
> Anak sy nevan (2th) sdh 5hr klo mau pup suka ngeluh sakit perut. Pupnya dlm
> 1hr bs 3-4x, bentuknya lembek. Kadang agak encer. Utk sakit perutnya sndr
> hilang timbul. Dan kmrn wkt lg pup sy perhatiin kaya ada darahnya. Makanya
> sy inisiatif utk test facesnya.
>
> Terima kasih,
> Elin
>
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7e.

Re: Tanya Hasil Lab

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Sat Oct 29, 2011 3:14 am (PDT)



Dear Elin
Saat ini sih tdk ada indikasi infeksi amuba maupun E coli patogen (E coli yang jahat)

Di lain sisi, kalaupun amuba atau E coli patogen, tetap saja - obat yg diberikan tidak tepat apalagi antibiotiknya

Leukosit 4-5 di tinja mah normakl

Wati
Patient Safety, first

8a.

Re: General Medical Check-Up

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

Sat Oct 29, 2011 1:35 am (PDT)



Mba'putri,

Sharing medical check'up kantorku meliputi:
-rontgen thorax
-rontgen panoramic
-usg payudara
-usg abdomen
-darah lengkap
-urin lengkap
-ECG
-papsmear
-mata (plus,minus), tonometry
-konsul dr. gigi
-konsul internis

Oiyah, kalo 35 tahun keatas plus treadmill buat cardiology nya

Lumayan banyak yak..lama pula setengah hari lebih...tp krn ada usg abdomen ketauan jg aku suspect nephrolithiasis di ginjal kanan, blm sempet ke internis nih (any recomendation?) Hasil medcheck USG+rontgen keluar dlm bentuk CD euy...susah cari rumkit di jaktim yg ada komputer di ruang dokter *lah...curcol

ImHO, gpp mahal sedikit yang penting ada deteksi dini (terutama buat papsmear)...kalo udah ketemu paketan medical check up yang murmer dan lengkap..letmeknow yah...mau jg buat medical check up ortu

Thx&regards,
@rikaelfira
(bunda of talitha alifya "alya"-22m)

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9a.

denyut di kepala bayi

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

Sat Oct 29, 2011 2:06 am (PDT)



Dear SPs and docs,

Saya sedikit penasaran (saya tidak mendapat keyword yg tepat untuk browsing) tentang denyut di kepala bayi. Tapi ada artikel yang menyebutkan kalo tempurung kepala bayi menutup di usia 2 thn, jadi denyut bisa terjadi sampai usia itu. CMIIW.

Lufi (3m) sptnya tidak ada denyut lagi di kepalanya. Saya tidak yakin juga krn saya sudah bekerja dan tidak bisa menjaganya sepanjang hari lagi.

Saya ingin tau apakah wajar bayi usia 3 bulan sudah tidak ada denyut di kepalanya.

BuLi
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9b.

Re: denyut di kepala bayi

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

Sat Oct 29, 2011 2:16 am (PDT)



Semoga membantu,
Ubun-ubun=fontanel, ini ada bacaan lengkap mengenai ubun ubun yang abnormal.

http://www.aafp.org/afp/2003/0615/p2547.html
The Abnormal Fontanel
JOSEPH KIESLER, M.D., and RICK RICER, M.D., University of Cincinnati College of Medicine, Cincinnati, Ohio
Am Fam Physician. 2003 Jun 15;67(12):2547-2552.
The diagnosis of an abnormal fontanel requires an understanding of the wide variation of normal. At birth, an infant has six fontanels. The anterior fontanel is the largest and most important for clinical evaluation. The average size of the anterior fontanel is 2.1 cm, and the median time of closure is 13.8 months. The most common causes of a large anterior fontanel or delayed fontanel closure are achondroplasia, hypothyroidism, Down syndrome, increased intracranial pressure, and rickets. A bulging anterior fontanel can be a result of increased intracranial pressure or intracranial and extracranial tumors, and a sunken fontanel usually is a sign of dehydration. A physical examination helps the physician determine which imaging modality, such as plain films, ultrasonography, computed tomographic scan, or magnetic resonance imaging, to use for diagnosis.

Examination of a newborn's fontanels offers the physician a window into the infant's developing brain and general state of health. The word “fontanel” is derived from the Latin fonticulus and the Old French fontaine, meaning a little fountain or spring.1â€"3 The normal fontanel varies widely in shape and time of closure. The incidence of abnormal fontanel differs, depending on the abnormality and cause.

FIGURE 1.
(Left) Lateral view of the newborn skull. (Right) Superior view of the newborn skull.
Redrawn with permission after Netter FH. Atlas of human anatomy. Summit, N.J.: Ciba-Geigy, 1994.

FIGURE 2.
Measurement of the anterior fontanel.
Anatomy of the Fontanels
Fontanels are the fibrous, membrane-covered gaps created when more than two cranial bones are juxtaposed, as opposed to sutures, which are narrow seams of fibrous connective tissue that separate the flat bones of the skull.

A newborn has six fontanels (Figure 1): the anterior and posterior, two mastoid, and two sphenoid.4The rhomboid-shaped anterior fontanel, located at the juncture of the two parietal and two frontal bones, is the most prominent. The superior sagittal dural venous sinus is partially situated beneath the anterior fontanel. The triangular posterior fontanel is located at the junction of the occipital and two parietal bones.1,5

Growth and Development of the Skull
The flat bones of the skull develop as part of the membranous neurocranium. Needle-like spicules radiate from a primary ossification center toward the periphery. These irregular bone islands are remodeled into flattened sheets of bone by osteoblast and osteoclast activity. During fetal and postnatal life, the membranous bones enlarge by resorption centrally and by apposition of new layers at the edges of the sutures.5

Growth of the cranium is triggered by brain growth, two thirds of which occurs by two years of age. Except for the metopic suture between the frontal bones, which closes at two years of age, the sutures remain open until brain growth ceases in the second decade of life.6 Once a suture is fused, growth perpendicular to that suture is restricted. Therefore, fontanel size is influenced by brain growth, dural attachments, suture development, and osteogenesis.7

Examination of the Fontanels
PHYSICAL EXAMINATION
The newborn's skull is molded during birth. The frontal bone flattens, the occipital bone is pulled outward, and the parietal bones override. These changes aid delivery through the birth canal and usually resolve after three to five days.8 The newborn's skull should be evaluated for shape, circumference, suture ridges, and size of anterior and posterior fontanels. Size is calculated by the average of the anteroposterior and transverse dimensions9 (Figure 2).

The fontanels should be examined while the infant is calm and held in both supine and upright positions. In select cases, such as newborns with multiple hemangiomas or heart failure, the anterior fontanel is auscultated to detect a bruit, which can indicate an arteriovenous malformation.10Palpation of the fontanel in the upright position may reveal a normal, slight pulsation. If the fontanels are closed and intracranial pressure has increased, percussion produces a “cracked-pot” sound (dull, lacking resonance), known as Macewen's sign.

Any associated dysmorphic facial features should be noted. Asymmetry of the head is detected by looking at the infant's head from above. Head circumference is an important indicator of brain development and should be monitored over time, especially if a fontanel closes early.6,11

IMAGING
Plain radiographs of the skull are the least expensive way to evaluate the sutures and cranial bones, but they are limited by the lack of mineralization of the neonatal cranium. Bridging of bone over a suture, an indistinct suture, or sclerosis along the suture margins indicates fusion. Cortical thinning, widened sutures, and a beaten-metal appearance known as “thumbprinting” are associated with increased intracranial pressure.12

If the anterior fontanel is open, ultrasonography is useful to evaluate ventricular dilatation.13 A computed tomographic (CT) scan can detect a fused suture, dilated ventricles, enlarged subarachnoid space, brain size, or an intracranial or extracranial mass.14 Magnetic resonance imaging (MRI) can detect cortical and white-matter abnormalities, such as degenerative diseases, and document the extent of calvarial masses. Disadvantages of CT scans and MRI include cost, the need for sedation, and, in the case of CT, irradiation.13,15

Normal Fontanel
POSTERIOR FONTANEL
At birth, the average size of the posterior fontanel is 0.5 cm in white infants and 0.7 cm in black infants.16 The fontanel usually is completely closed by two months of age.10

ANTERIOR FONTANEL
The key feature of a normal anterior fontanel is variation. On the first day of an infant's life, the normal fontanel ranges from 0.6 cm to 3.6 cm, with a mean of 2.1 cm.17 Black infants have larger fontanels (1.4 cm to 4.7 cm).16 The fontanels of full-term and preterm infants are similar in size once preterm infants reach term. The fontanel can enlarge in the first few months of life,18 and the median age of closure is 13.8 months. By three months of age, the anterior fontanel is closed in 1 percent of infants; by 12 months, it is closed in 38 percent; and by 24 months, it is closed in 96 percent. Anterior fontanels tend to close earlier in boys than in girls; the initial size of the fontanel is not a predictor of when it will close.19

Abnormal Anterior Fontanel
LARGE FONTANEL AND DELAYED FONTANEL CLOSURE
A list of the medical conditions associated with a large fontanel or delayed fontanel closure can be found in Table 1.20,21 Achondroplasia, congenital hypothyroidism, Down syndrome, rickets, and increased intracranial pressure are among the most common conditions.

Achondroplasia is an autosomal-dominant disorder of the epiphyseal plate cartilage that results in dwarfism.22 At birth, the infant has an enlarged head, low nasal bridge, prominent forehead, and shortened extremities, in addition to a large fontanel.9

An elevated thyroid-stimulating hormone level on a newborn screening usually detects congenital hypothyroidism, but an abnormally large anterior fontanel in conjunction with an open posterior fontanel can be an early sign of the disorder. Myxedema and growth deficiency are later signs.

TABLE 1
Conditions Associated with an Enlarged Anterior Fontanel and Delayed Closure
Conditions Enlarged fontanel Delayed closure
Most common
Achondroplasia
âœ"
âœ"
Congenital hypothyroidism
âœ"
âœ"
Down syndrome
âœ"
âœ"
Increased intracranial pressure
âœ"
âœ"
Normal variation
âœ"
âœ"
Familial macrocephaly
âœ"
Rickets
âœ"
âœ"
Less common
Skeletal disorders
Acrocallosal syndrome (seizures, polydactyly, mental retardation)
âœ"
Apert's syndrome (craniosynostosis, proptosis, hypertension)
âœ"
âœ"
Campomelic dysplasia (prenatal growth deficiency, large cranium, bowed legs)
âœ"
Hypophosphatasia (polyhydramnios, short, deformed limbs, soft skull)
âœ"
âœ"
Kenny-Caffey syndrome (hypoparathyroidism, dwarfism, macrocephaly)
âœ"
âœ"
Osteogenesis imperfecta (shortened limbs, wormian calvarial bones)
âœ"
âœ"
Chromosomal abnormalities
Trisomy 13 (polydactyly, microcephaly, cleft lip and palate)
âœ"
âœ"
Trisomy 18 (growth retardation, small cranium, open metopic suture)
âœ"
âœ"
Congenital infections
Rubella (low birth weight, cataracts, “blueberry muffin” skin lesions)
âœ"
âœ"
Syphilis (saddle nose deformity, joint swelling, maculopapular rash)
âœ"
âœ"
Drugs and toxins
Aminopterin-induced malformation (craniosynostosis, absences of frontal bones, hypertelorism)
âœ"
âœ"
Fetal hydantoin syndrome (microcephaly, broad nasal bridge, hypoplasia of nails)
âœ"
âœ"
Dysmorphogenetic syndromes
Beckwith-Wiedemann syndrome (macrosomia, abdominal wall defect, macroglossia)
âœ"
âœ"
Zellweger syndrome (high forehead, flat occiput, abnormal ears, hypotonia)
âœ"
âœ"
Cutis laxa (pendulous skin folds, hoarse cry)
âœ"
âœ"
VATER association (vertebral defects, anal atresia, tracheoesophageal fistula, renal dysplasia)
âœ"
âœ"
Otopalatodigital syndrome (frontal bossing, broad terminal phalanges, syndactyly)
âœ"
Miscellaneous
Malnutrition (poor weight gain, asymmetric growth)
âœ"
âœ"
Hydranencephaly (macrocephaly, thinned skull vault, primitive reflexes preserved)
âœ"
Intrauterine growth retardation (birth weight less than 2 standard deviations below mean)
âœ"
Information from references 20 and 21.
A third fontanel between the anterior and posterior fontanels is associated with hypothyroidism and Down syndrome.23 Infants with Down syndrome often have a single palmar crease, flat occiput and facies, rounded ears, and slanted palpebral fissures.

Rickets resulting from vitamin D deficiency rarely occurs in the United States but is one of the five most common childhood diseases in developing nations. Risk factors include breastfeeding without vitamin D supplementation, dark skin, and low sunlight exposure. One of the signs of rickets is craniotabes, a softened outer table of the occipital bone that buckles under pressure, producing a reaction similar to a ping-pong ball indenting and popping back out. Craniotabes is not present at birth but develops over the first few months of life. Craniotabes can occur normally in premature infants and in children younger than six months.18,24,25 Disorders associated with increased intracranial pressure that results in an abnormally large fontanel or delayed fontanel closure are discussed later in this article.

SMALL FONTANEL OR EARLY FONTANEL CLOSURE
Fontanel closure that occurs as early as three months of age can be within normal limits, but careful monitoring of head circumference in such cases is essential to exclude a pathologic condition. The fontanel sometimes can be open but difficult to detect during a physical examination. Craniosynostosis and abnormal brain development are associated with a small fontanel or early fontanel closure.20

TABLE 2
Differential Diagnosis of Microcephaly
Most common
Chromosomal defects
Congenital infections
Fetal alcohol syndrome
Hypoxic-ischemic encephalopathy
Normal genetic variation
Others
Autosomal dominant or recessive types
Dysmorphic syndromes
Malnutrition
Maternal phenylketonuria
Normal variation
Structural brain defects
Universal craniosynostosis
Information from references 20 and 28.
Craniosynostosis is the premature closing of one or more cranial sutures, resulting in an abnormal head shape. The condition can be idiopathic or caused by hyperthyroidism, hypophosphatasia, rickets, or hyperparathyroidism.20 It is also associated with more than 50 syndromes, such as Apert's, Crouzon's and Pfeiffer's. The risk of primary isolated craniosynostosis is 0.4 per 1,000 live births, and the sagittal suture is most commonly involved.

Examination at birth of an infant with craniosynostosis might reveal a ridge over a suture or lack of movement along a suture when alternating sides are gently pressed. Overriding of sutures from the normal molding process should resolve within the first few days of life.9 Later physical findings in infants with primary craniosynostosis include stunted cranial growth, increased intracranial pressure, proptosis, strabismus, and hearing impairment.26

Plain radiographs of the skull are used for initial evaluation. If craniosynostosis is present, a three-dimensional CT scan is obtained to detect any underlying brain abnormalities and to assist planning for surgery.27

Abnormal brain development that results in microcephaly also can cause a small anterior fontanel or early fontanel closure. Prenatal trauma to the brain, such as maternal alcohol abuse, and postnatal trauma, such as hypoxia, are potential causes of microcephaly.20 Table 220,28 lists the differential diagnosis for microcephaly.

BULGING OR SUNKEN FONTANELS
Disorders associated with increased intracranial pressure can cause a bulging anterior fontanel. The most common disorders are meningitis, encephalitis, hydrocephalus, hypoxic-ischemic injury, trauma, and intracranial hemorrhage.20 Table 320 lists the differential diagnoses for a bulging fontanel. Palpation may reveal a tense fontanel that feels similar to bone.23

Meningitis and encephalitis also cause temperature instability, poor feeding, and irritability. If meningitis is suspected, a lumbar puncture should be performed to evaluate the cerebrospinal fluid for Gram stain, protein, glucose, cell count, and culture. A CT scan of a child with meningitis shows the subarachnoid space expanding into the anterior fontanel.21

Hydrocephalus can result from an imbalance between the production and the absorption of cerebral spinal fluid. This condition affects 3 per 1,000 live births. Most cases occur before two years of age, while the anterior fontanel is still open. Physical signs include an abnormal rate of head growth, frontal bossing of the forehead, widened sutures, and dilated scalp veins. Imaging with ultrasonography, CT, or MRI shows enlarged ventricles in the absence of brain atrophy. Because ultrasonic waves will not penetrate bone, the anterior fontanel must be open if ultrasonography is used for diagnosis.13,15

Hypoxic-ischemic injury results in cytotoxic edema and diffuse brain swelling. Associated findings include poor feeding, decreased muscle tone, respiratory difficulties, and alterations in consciousness. Intracranial hemorrhage can be intraventricular, parenchymal, subarachnoid, or subdural. Associated findings include decreased muscle tone, seizures, decreased hematocrit, vomiting, and alterations in consciousness.20

Tumors also should be considered in the differential diagnosis of a bulging fontanel. Dermoid tumors of the scalp are the most frequent lesions presenting over the anterior fontanel and also may be found over the posterior fontanel.29,30 They usually are slow-growing and nontender, and they are twice as common among girls. A CT scan is necessary to exclude intracranial involvement.30 Brain tumors, which can present with signs of increased intracranial pressure and focal neurologic findings, are best diagnosed with MRI.31

The primary cause of a sunken fontanel is dehydration. Other signs include reduced peripheral perfusion, poor skin turgor, and sunken eyes.32

TABLE 3
Differential Diagnosis of a Bulging Fontanel
Hydrocephalus
Space-occupying lesions
Brain tumor
Intracranial hemorrhage
Brain abscess
Infections
Meningitis
Encephalitis
Roseola
Shigella
Mononucleosis
Lyme disease
Mastoiditis
Cerebral malaria
Cysticercosis
Poliomyelitis
Endocrine disorders
Hyperthyroidism
Hypoparathyroidism
Pseudohypoparathyroidism
Addison's disease
Hypothyroidism
Cardiovascular disorders
Congestive heart failure
Dural sinus thrombosis
Hematologic disorders
Polycythemia
Anemia
Leukemia
Metabolic disorders
Diabetic ketoacidosis
Electrolyte disturbance
Hepatic encephalopathy
Uremia
Galactosemia
Hypophosphatasia
Osteoporosis
Maple syrup urine disease
Miscellaneous
Hypervitaminosis A
Lead encephalopathy
Aluminum toxicity
Brain contusions
Hypoxic-ischemic injury
Coronal synostosis
Trauma
Dermoid cyst
Information from reference 20.

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

10a.

Bls: [sehat] denyut di kepala bayi

Posted by: "'Ita' Elisabeth Dianita" ita_sehat@yahoo.com   ita_sehat

Sat Oct 29, 2011 2:20 am (PDT)



Maksudnya ubun2 mbak?
Normalnya mulai menutup di usia 8 bulan ke atas (cmiiw). Coba diubek2 arsip milis, pernah dibahas deh.. (Haduh saya waktu itu nemu, tp lupa tak disimpan, ntar jg mau ubek2 lagi). Kalau 3 bulan dah nutup, sepertinya abnormal.


salam sehat,
ita (ibuke Saka & Ambar)
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10b.

Re: Bls: [sehat] denyut di kepala bayi

Posted by: "Elin" elin_s05@yahoo.com   elin_s05

Sat Oct 29, 2011 2:24 am (PDT)



Mba, utk ubun2 sy pernah nanya ke dsa klo akan nutup umur 2th. Anak sy nutup ubun2 klo ga salah umur 1,5th.

B/R,
Elin
Sent from my NevanBerry®
11.

The Newborn Examination: Part I. Emergencies and Common Abnormalitie

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

Sat Oct 29, 2011 2:39 am (PDT)



Dear all,
Mungkin ada yang membutuhkan
The Newborn Examination: Part I. Emergencies and Common Abnormalities Involving the Skin, Head, Neck, Chest, and Respiratory and Cardiovascular Systems
MAMTA FULORIA, M.D., and SHELLEY KREITER, M.D., Wake Forest University School of Medicine, Winston-Salem, North Carolina
Am Fam Physician. 2002 Jan 1;65(1):61-69.
This is part I of a two-part article on the newborn examination. Part II, “Emergencies and Common Abnormalities Involving the Abdomen, Pelvis, Extremities, Genitalia, and Spine” will appear in the next issue.
The routine newborn assessment should include an examination for size, macrocephaly or microcephaly, changes in skin color, signs of birth trauma, malformations, evidence of respiratory distress, level of arousal, posture, tone, presence of spontaneous movements, and symmetry of movements. A newborn with one anatomic malformation should be evaluated for associated anomalies. Total and direct bilirubin levels should be measured in newborns with jaundice, and a complete blood count should be obtained in those with pallor or a ruddy complexion. Neurosurgical consultation is necessary in infants with craniosynostosis accompanied by restricted brain growth or hydrocephalus, cephaloceles, or exophytic scalp nodules. Neck masses can be identified by their location and include vascular malformations, abnormal lymphatic tissue, teratomas, and dermoid cysts. Most facial nerve palsies resolve spontaneously. Conjunctivitis is relatively common in newborns. Infants
with chest abnormalities may need to be evaluated for Poland's syndrome or Turner's syndrome. Murmurs in the immediate newborn period are usually innocent and represent a transition from fetal to neonatal circulation. Because cyanosis is primarily secondary to respiratory or cardiac causes, affected newborns should be evaluated expeditiously, with the involvement of a cardiologist or neonatologist.

A careful examination at delivery helps the physician detect anomalies, birth injuries, and cardiorespiratory disorders that may compromise a newborn's successful adaptation to extrauterine life. A detailed examination should also be performed after the newborn has completed the transition from fetal to neonatal life. The examination may begin with an evaluation of neonatal size (Table 1). The presence of one anatomic malformation should prompt an evaluation for associated anomalies. Part I of this two-part article focuses on anomalies and disorders involving the skin, head and neck, chest, and respiratory and cardiovascular systems.

TABLE 1
Factors to Consider in Evaluating Size in Newborns
Small for gestational age (birth weight below 10th percentile)
Symmetric
Features: onset early in gestation; brain size corresponding with body size; glycogen and fat content corresponding with body size (hence, lower risk of hypoglycemia)
Etiology: environmental factors such as smoking or drugs (heroin, methadone, ethanol, phenytoin [Dilantin]); genetic factors such as small maternal size or chromosomal disorder (trisomy 13, 18, and 21 syndromes, Turner's syndrome); intrauterine infections such as TORCH, bacterial (tuberculosis), or spirochetic (syphilis); metabolic disorders such as phenylketonuria
Asymmetric
Features: onset late in gestation; no effect or minimal effect on fetal brain growth; reduced glycogen and fat content relative to body size (hence, increased risk of hypoglycemia); increased risk of perinatal asphyxia and polycythemia (hyperviscosity)
Etiology: uteroplacental insufficiency with chronic fetal hypoxia
Large for gestational age (birth weight above 90th percentile)
Features: increased incidence of perinatal asphyxia and birth injuries; respiratory distress syndrome; hypoglycemia
Etiology: maternal diabetes (increased likelihood of large birth size, respiratory distress syndrome, and hypoglycemia)
TORCH =toxoplasmosis,other viruses,rubella,cytomegaloviruses,herpes [simplex] viruses.
Skin
Erythema toxicum neonatorum, transient neonatal pustular melanosis, sucking blister, miliaria, and mongolian spots are among the many benign skin conditions that can occur in newborns. Total and direct bilirubin levels should be measured in newborns with jaundice, and various causes for this condition should be considered (Table 2). The American Academy of Pediatrics1 has published guidelines on the management of hyperbilirubinemia in healthy term infants. A complete blood count should be obtained in newborns with pallor or a ruddy complexion.

TABLE 2
Causes of Hyperbilirubinemia in Newborns
Unconjugated hyperbilirubinemia
Physiologic hyperbilirubinemia (most common cause)
Breastfeeding and breastmilk jaundice
Increased production of bilirubin: hemolysis (immune or nonimmune), sequestered blood (subdural hematoma, cephalhematoma, hemangioma, ecchymosis), polycythemia, sepsis
Decreased hepatic uptake or conjugation: hypothyroidism, Gilbert syndrome, Crigler-Najjar syndrome (types I and II), transient familial neonatal hyperbilirubinemia (Lucey-Driscoll syndrome)
Conjugated hyperbilirubinemia
Hepatobiliary disorders: neonatal idiopathic hepatitis, infections (TORCH, echovirus, syphilis, systemic infections), prolonged parenteral nutrition, severe hemolytic disease, metabolic disorders (galactosemia, glycogen storage diseases)
Ductal disturbances in bilirubin excretion: biliary atresia, choledochal cyst, bile plug syndrome
TORCH =toxoplasmosis,other viruses,rubella,cytomegaloviruses,herpes [simplex] viruses.
The diagnosis and treatment of cutaneous vascular lesions in newborns are reviewed elsewhere.2

Head and Neck
Head circumference and fontanelle size can indicate a congenital disorder or head trauma (Tables 3and 43). Craniosynostosis, or premature fusion of cranial sutures, results in growth restriction perpendicular to the affected suture(s) and compensatory overgrowth in unrestricted regions4 (Figure 1). This anomaly may suggest a genetic disorder such as Apert's syndrome or Crouzon's disease. If the synostosis is accompanied by restricted brain growth or hydrocephalus, neurosurgical intervention is necessary.

TABLE 3
Head Circumference and Fontanelle Size in Newborns*
Macrocephaly: as an isolated anomaly, is often familial, with autosomal dominant inheritance; may be a manifestation of other anomalies, including hydrocephalus and skeletal disorders such as achondroplasia
Microcephaly: can be familial, with autosomal dominant or recessive inheritance; may be associated with infections (viruses such as cytomegalovirus) and syndromes such as trisomy 13 and 18, Cornelia de Lange's, Rubinstein-Taybi, Prader-Willi, and fetal alcohol
Large fontanelles: may be associated with hypothyroidism, trisomy 13, 18, and 21 syndromes, and bone disorders such as cleidocranial dysostosis or hypophosphatasia
*â€"The size of the head and the anterior and posterior fontanelles should be compared with appropriate standards. Head size varies with age, sex, and ethnicity and has a general correlation with body size.
TABLE 4
Common Forms of Head Trauma in Newborns
Caput succedaneum
Commonly observed after prolonged labor
Secondary to accumulation of blood or serum above the periosteum
Clinical features: poorly demarcated soft tissue swelling that crosses suture lines; accompanying pitting edema and overlying petechiae, ecchymoses and purpura
Treatment: none needed because condition usually resolves within days
Cephalhematoma
Less common than caput succedaneum but may occur after prolonged labor and instrumentation
Secondary to rupture of blood vessels that traverse skull to periosteum
Clinical features: well-demarcated, often fluctuant swelling that does not cross suture lines; no overlying skin discoloration; possibly, skull fractures; sometimes, elevated ridge of organizing tissue
Complications: intracranial hemorrhage with resultant shock; hyperbilirubinemia
Treatment: none recommended for uncomplicated lesions, which usually reabsorb in 2 weeks to 3 months; for suspected or detected fracture, radiographs again at 4 to 6 weeks to ensure closure of linear fractures and to exclude formation of leptomeningeal cysts, which can be detected by radiography (if there is doubt, cranial computed tomographic scanning can be helpful)3; for depressed skull fractures, immediate neurosurgical consultation

FIGURE 1.
Skull shapes associated with premature closure of single sutures. Arrows denote directions of continued growth across sutures that remain open. Heavy lines indicate areas of maximal skull flattening. When combinations of sutures remain closed, more complex skull shapes occur.
Large meningoceles or encephaloceles are usually diagnosed prenatally or at birth. Smaller defects may be mistaken for cutaneous lesions such as hemangiomas or dermoid cysts. Congenital exophytic scalp nodules should always be evaluated further, because 20 to 37 percent of these lesions connect to the underlying central nervous system.5 Cutaneous signs of cranial dysraphism include the “hair collar sign” (darker, coarser hair encircling the scalp nodule), vascular malformations, and cutaneous dimples and sinuses. Cephaloceles and exophytic scalp nodules should be assessed by magnetic resonance imaging (MRI), and a neurosurgical consultation should be obtained.5

The most common neck masses are vascular malformations, abnormal lymphatic tissue, teratomas, and dermoid cysts. Neck masses can be identified based on their location (Figure 2).6 Thyroglossal duct cysts, one of the most frequent congenital anomalies of the neck, are typically midline and inferior to the hyoid bone. Surgical consultation is required in newborns with thyroglossal duct cysts.

FIGURE 2.
Identification of neck masses based on their location.
KEY:
1 = Preauricular area (parotid gland): congenital lesions-cystic hygroma, hemangioma, venous malformation; inflammatory condition-lymphadenitis secondary to infection in upper face and/or anterior scalp
2 = Postauricular area: congenital lesions-branchial cleft I (cystic, inflamed, or both); inflammatory condition-lymphadenitis secondary to inflammation of posterior scalp
3 = Submental area: congenital lesions-thyroglossal duct cyst, cystic hygroma, dermoid cyst, venous malformation; inflammatory condition-lymphadenitis secondary to inflammation in perioral area, anteriour oral area, or nasal cavity
4 = Submandibular area: congenital lesions-cystic hygroma, hamangioma, ranula; inflammatory condition-lymphadenitis of submandibular gland secondary to inflammation in cheek and/or mid-oral cavity; in cystic fibrosis, enlartement of submandibular gland without inflammation
5 = Jugulodiagastric area (tonsil node; normal structures include transverse process of C2 and styloid process): congenital lesions-bronchial cleft I or II, hemangioma, cystic hygrom; inflammatory condition- lymphadenitis secondary to oropharyngeal inflammation
6 = Area of neck midline (normal structures include hyoid, thyrouid isthmus, and thyroid cartilage): congenital lesions-thyroglossal duct cyst, dermoid cyst; inflammatory condition-lymphadenitis
7 = Area at anterior border of sternocleidomastoid muscle (normal structures include hyoid, thyroid cartilage, and carotid bulb): congenital lesions-branchial cleft I, II, or III (IV is rare), laryngocele, hemangioma, lymphangioma, hematoma (fibroma of sternocleidomastoid muscle)
8 = Spinal accessorry: inflammatory condition-lymphadenitis secondary to nasopharyngeal inflammation
9 = Paratracheal area: thyroid mass, parathyroid mass, esophageal diverticulum, metastatic lesion
10 = Supraclavicular area (normal structures include fat pad, pneumatocele from apical lobe related to defect in Gibson fascia[prominent mass with Valsalva's maneuver]): congenital lesion-cystic hygroma; neoplastic lesion-lipoma.
11 = Suprasternal area: thyroid mass, lipoma, dermoid cyst, thymis mass, mediastinal mass
Information from May M. Neck masses in children: diagnosis and treatment. Pediatr Ann 1976;5:518â€"35.
Clavicular fractures are the most common broken bones in newborns, especially large neonates. Of these, greenstick fractures are the most frequent and are usually asymptomatic. Newborns may present with decreased or absent movement and pain or tenderness on movement of the arm on the affected side, deformity and discoloration over the fracture site, and crepitus or irregularity along the clavicle. Treatment is directed at minimizing the newborn's pain or discomfort. If the newborn with clavicular fracture is in pain, the affected arm should be immobilized, with the arm abducted more than 60 degrees and the elbow flexed more than 90 degrees.3

FACE
Facial nerve paralysis is caused by compression of the nerve against the sacral promontory or by trauma resulting from the use of forceps during delivery. Paralysis is usually apparent on the first or second day of life. The nasolabial fold on the paralyzed side is obliterated, and the corner of the mouth droops; with crying, the mouth is drawn to the normal side4 (Figure 3). With peripheral facial nerve paresis, the forehead and eyes may be affected.

FIGURE 3.
Asymmetry caused by facial nerve paralysis, with inability to close eye, nasolabial fold flattening, and inability to move lips on the affected side. Newborns with facial nerve paralysis have difficulty effecting a seal around the nipple and consequently exhibit drooling of milk or formula from the paralyzed side of the mouth.
Most facial nerve palsies resolve spontaneously within days, although full recovery may require weeks to months. A persistently open eye should be protected from corneal drying. Electrodiagnostic testing may be necessary if no improvement occurs within seven to 10 days; rarely, surgical intervention is needed.3 Congenital absence or hypoplasia of the depressor anguli oris muscle may simulate facial palsy.

Erupted teeth are present in approximately one of 2,000 newborns.7 Although natal teeth are frequently found in normal infants, they are more often present in newborns with cleft palate. They are also commonly associated with Ellisâ€"van Creveld syndrome, Hallermann-Streiff syndrome, and pachyonychia congenita syndrome. Most erupted teeth, particularly if loose, require removal.

Isolated cleft palate differs genetically from cleft lip. Mild forms of cleft palate include sub-mucosal clefts, pharyngeal incompetence and bifid uvula. Cleft lip, with or without cleft palate, is found in newborns with trisomy 13 syndrome, holoprosencephaly (median cleft lip), and amnion rupture sequence. Newborns with a cleft lip or palate require genetic evaluation and plastic surgery. Because of feeding difficulties, the mothers of these infants may benefit from lactation consultation and occupational therapy.

EYES
Marked lid edema often results in eversion of the upper lid when force is applied to open the eye. Examination should be postponed until the edema resolves. Subconjunctival hemorrhages, which are common after vaginal delivery, usually do not represent ocular trauma. Conjunctivitis is relatively common in newborns (Table 5).8,9

TABLE 5
Conjunctivitis in Newborns
Chemical conjunctivitis
Usually occurs within 24 hours of instillation of eye prophylaxis after birth
Clinical features: mild lid edema with sterile discharge from eyes
Treatment: none needed because condition usually resolves within 48 hours after birth
Gonorrheal conjunctivitis
Usually occurs within 24 to 48 hours after birth
Clinical features: profound lid edema, chemosis, intensely purulent exudates, corneal ulceration
Treatment: for proven penicillin-susceptible organisms, aqueous crystalline penicillin G, 100,000 units per kg per day IV given in four divided doses for 7 days; because of emergence of resistant strains of Neisseria gonorrhoeae, recommended therapy is ceftriaxone (Rocephin), 25 to 50 mg per kg IV or IM (not to exceed 125 mg) given once, or cefotaxime (Claforan), 100 mg per kg IV or IM given once; until discharge is eliminated, frequent eye irrigations with saline; gonorrheal treatment for the mother and her sexual partner(s)
Chlamydial conjunctivitis
Usually occurs within 7 to 14 days after birth
Clinical features: watery discharge that later becomes copious and purulent; if untreated, may result in corneal scarring and pannus formation
Treatment: orally administered erythromycin, 50 mg per kg per day in four divided doses for 2 weeks
HSV conjunctivitis
Usually occurs within 2 weeks after birth
Eyes involved in 5% to 20% of HSV-infected infants
Clinical features: infants may present with keratitis, cataracts, chorioretinitis, or optic neuritis; imperative to rule out disseminated herpes
Treatment: both topical and systemic antiviral agents, because HSV-infected neonates do not present with isolated conjunctivitis; systemic therapyâ€"acyclovir (Zovirax), 60 mg per kg per day in three divided doses for 14 days if disease is limited to skin, eyes, and mouth; topical therapyâ€"1% trifluridine (Viroptic) or 3% vidarabine (Vira-A); referral to subspecialist
IV = intravenous; IM = intramuscular; HSV = herpes simplex virus.
Information from Meisler DM, Beauchamp GR. Disorders of the conjunctiva. In: Nelson LB, Harley RD, eds. Harley's Pediatric ophthalmology. 4th ed. Philadelphia: Saunders, 1998:199â€"214, and Pickering LK, ed. 2000 Red book: report of the Committee on Infectious Diseases. 25th ed. Elk Grove Village, Ill.: American Academy of Pediatrics, 2000.
Coloboma (absence or defect of some ocular tissue) may involve the eyelid margin, as in Treacher Collins syndrome, or the iris and retina, as in the CHARGE association (syndrome of coloboma,heart disease, choanal atresia, postnatal growth retardation, genital hypoplasia and ear anomalies). Aniridia (absence of the iris) is usually bilateral and is almost always associated with poor vision and nystagmus. Newborns with aniridia or coloboma should have a formal eye examination.

The red reflex normally shows no dullness or irregularities. A white pupil (cat's eye reflex) denotes an abnormality of the lens, vitreous, or fundus. One of the most common presenting signs of a cataract is a white pupillary reflex. Congenital cataract is present in 0.4 percent of newborns. These infants should be tested for TORCH (toxoplasmosis, other viruses, rubella, cytomegaloviruses,herpes [simplex] viruses) infections. Newborns with monocular congenital or dense cataracts are at risk for developing deprivation amblyopia. Newborns with cataracts should be evaluated by an ophthalmologist.10

Congenital glaucoma, while uncommon, may present at birth. More often, signs of glaucoma develop during the first several weeks or months of life and include corneal cloudiness and enlargement, tearing, blepharospasm, and photophobia. Corneal edema can also occur secondary to the malpositioning of forceps during delivery. Prompt referral to an ophthalmologist is indicated.11

Chest
Although pectus carinatum and pectus excavatum are of concern to parents, these physical anomalies are rarely of clinical significance. Unilateral absence or hypoplasia of the pectoralis major muscle suggests the diagnosis of Poland's syndrome (sometimes called Poland's sequence). Common associated findings in this syndrome include rib defects, hypoplasia of the upper extremities, and syndactyly. Occasionally, more severe limb reduction deformities, hemivertebrae, renal anomalies, and dextrocardia may be present.

Widely spaced nipples, excessive nuchal skin, and lymphedema are findings associated with Turner's syndrome. The evaluation of newborns suspected of having this syndrome should include chromosomal analysis, echocardiography to detect cardiac lesions, and a genetic consultation.

A small thorax suggests pulmonary hypoplasia. A bell-shaped thorax is often present in newborns with neurologic abnormalities or some dwarfing syndromes.

Respiratory and Cardiovascular Systems
Newborns with choanal atresia present with cyanosis that is relieved by crying. The diagnosis is usually established by the inability to pass a catheter through the nostril(s). Unilateral choanal atresia may remain undiagnosed for years. Infants and children with this congenital anomaly may present with mucus or foul-smelling secretions from the affected nares and respiratory distress associated with upper respiratory infection.

Newborns with significant cyanosis should be evaluated expeditiously. Depending on the clinical findings, consultation with a neonatologist may be required. Respiratory disease is more likely in newborns who are tachypneic and using accessory muscles of respiration. Newborns with heart disease generally breathe normally, except for mild tachypnea or hyperpnea. The differential diagnosis and evaluation of cyanosis in infants are presented in Table 6.

The normal heart rate in newborns is 120 to 160 beats per minute. Some term newborns have a resting heart rate below 90 beats per minute. If the heart rate does not increase appropriately with stimulation, serum electrolyte levels should be checked, and an electrocardiogram should be obtained to rule out heart block.

TABLE 6
Differential Diagnosis of Cyanosis in Infants
Pulmonary disorders
Respiratory distress syndrome
Aspiration syndromes: blood, meconium, amniotic fluid
Infections: pneumonia
Pneumothorax, pleural effusion
Diaphragmatic hernia
Persistent pulmonary hypertension of the newborn
Choanal atresia
Pierre Robin syndrome*
Abdominal distension: elevation of
diaphragm
Cardiac disorders
Fallot's tetrology
Transposition of the great arteries
Tricuspid atresia
Pulmonary atresia with intact ventricular septum
Truncus arteriosus
Ebstein's anomaly
Double-outlet right ventricle
Single ventricle with pulmonary stenosis
Total anomalous pulmonary venous drainage
Coarctation of the aorta†
Interrupted aortic arch†
Hypoplastic left heart syndrome†
Others
Central nervous system disorders: neuromuscular infections, asphyxia, seizures, hemorrhage, apnea
Hematologic disorders: polycythemia
Metabolic and endocrine disorders: hypoglycemia, hypocalcemia, hypermagnesemia
Hypothermia
*â€"Pierre Robin syndrome includes micrognathia, glossoptosis, and cleft of the soft palate; the primary defect is early mandibular hypoplasia.
†â€"Coarctation of the aorta, interrupted aortic arch, and hypoplastic left heart syndrome cause systemic hypoperfusion with mild or no cyanosis.
Diminished pulses in all extremities indicate poor cardiac output or peripheral vasoconstriction. Absent or diminished femoral pulses suggest the presence of ductaldependent cardiac lesions (e.g., coarctation of the aorta). Although hypertension is uncommon in newborns, it is rarely idiopathic. An approach to determining the cause of neonatal hypertension is presented in Figure 4.12

Newborn with Hypertension

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

FIGURE 4.
Palpation and auscultation may reveal a shift in the position of the heart from normal, as occurs in dextrocardia. In newborns, a murmur does not always signify the presence of heart disease, nor does the absence of a murmur provide reassurance of normalcy. Newborns with relatively benign lesions, such as small ventricular septal defects, often have the loudest murmurs, whereas newborns withsevere heart disease may have no murmurs. The most commonly auscultated murmurs in the immediate newborn period are flow murmurs that represent a transition from fetal to neonatal circulation (e.g., tricuspid regurgitation, patent ductus arteriosus). Further evaluation is required if a murmur persists beyond several weeks in a healthy newborn or if a murmur is present in a critically ill infant.

Laksmi Purwitosari

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

12a.

Re: (Tanya) Imunisasi DPT+HiB

Posted by: "purnamawati.spak@cbn.net.id" purnamawati.spak@cbn.net.id

Sat Oct 29, 2011 3:26 am (PDT)



Dear Rizaini

Thx again atas kepeduliannya
Maaf, umur anak temanmu berapa?

1. "dsa-nya blg klo disini (daerah tsb) imunnya cm smpe 3. Dan dia ngga pny imun yg ke 4".
----
Maaf, menurut saya statement nya agak aneh.
Vaksin DPT buat yg ke 1 atau ke 3 atau ke 4 sama saja
Tentunya sayaratnya, bayar
Kalau mau program DPT nya pemerintah, yang bersubsidi, memang hanya sampai usia 5 bulan. Booster di usia 18 bulan gak diprogramkan oleh pemerintah (makanya ada "wabah", hiks)

Jadi - bilang dokternya, minta DPT non pemerintah aja, bayar.

2. "dsanya blg lg dr hasil seminarnya klo DPT 4 dan 5 dan HiB 4 mau diambil pemerintah (programnya dikasih gratis pas sekolah)".
----
Maaf, gak pernah denger
Masak sih?
Kayaknya gak deh
Apalagi untuk HiB nya
Apalagi HiB nya usia 5 tahun - impossible
Kamu benar, usia 5 tahun mah gak butuh HiB

Jadi? Ya mungkin harus hunting dokter atau bidan lain

Wati
Patient Safety, first

13a.

[INFO] Generic Drugs: Questions and Answers

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

Sat Oct 29, 2011 3:39 am (PDT)



http://www.fda.gov/Drugs/ResourcesForYou/Consumers/QuestionsAnswers/ucm100100.htm

Generic Drugs: Questions and Answers

What are generic drugs?

A generic drug is identical -- or bioequivalent -- to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Although generic drugs are chemically identical to their branded counterparts, they are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. Even more billions are saved when hospitals use generics.

Is there a generic equivalent for my brand-name drug?

To find out if there is a generic equivalent for your brand-name drug, use Drugs@FDA, a catalog of FDA-approved drug products, as well as drug labeling.

You can also search for generic equivalents by using the "Electronic Orange Book." Search by proprietary "brand" name," then search again by using the active ingredient name. If other manufacturers are listed besides the "brand name" manufacturer when searching by the "active ingredient," they are the generic product manufacturers.

Since there is a lag time after generic products are approved and they appear in the "Orange Book," you should also consult the most recent monthly approvals for "First Generics".

Are generic drugs as effective as brand-name drugs?

Yes. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken and the way it should be used.

FDA requires generic drugs have the same high quality, strength, purity and stability as brand-name drugs.

Not every brand-name drug has a generic drug. When new drugs are first made they have drug patents. Most drug patents are protected for 20 years. The patent, which protects the company that made the drug first, doesn't allow anyone else to make and sell the drug. When the patent expires, other drug companies can start selling a generic version of the drug. But, first, they must test the drug and the FDA must approve it.

Creating a drug costs lots of money. Since generic drug makers do not develop a drug from scratch, the costs to bring the drug to market are less; therefore, generic drugs are usually less expensive than brand-name drugs. But, generic drug makers must show that their product performs in the same way as the brand-name drug.

How are generic drugs approved?

Drug companies must submit an abbreviated new drug application (ANDA) for approval to market a generic product. The Drug Price Competition and Patent Term Restoration Act of 1984, more commonly known as the Hatch-Waxman Act, made ANDAs possible by creating a compromise in the drug industry. Generic drug companies gained greater access to the market for prescription drugs, and innovator companies gained restoration of patent life of their products lost during FDA's approval process.

New drugs, like other new products, are developed under patent protection. The patent protects the investment in the drug's development by giving the company the sole right to sell the drug while the patent is in effect. When patents or other periods of exclusivity expire, manufacturers can apply to the FDA to sell generic versions.

The ANDA process does not require the drug sponsor to repeat costly animal and clinical research on ingredients or dosage forms already approved for safety and effectiveness. This applies to drugs first marketed after 1962.

What standards do generic drugs have to meet?

Health professionals and consumers can be assured that FDA approved generic drugs have met the same rigid standards as the innovator drug. To gain FDA approval, a generic drug must:

contain the same active ingredients as the innovator drug(inactive ingredients may vary)
be identical in strength, dosage form, and route of administration
have the same use indications
be bioequivalent
meet the same batch requirements for identity, strength, purity, and quality
be manufactured under the same strict standards of FDA's good manufacturing practice regulations required for innovator products

Laksmi Purwitosari

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

13b.

Re: [INFO] Generic Drugs: Questions and Answers

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

Sat Oct 29, 2011 3:51 am (PDT)



Mba Laksmi,
Lalu bagaimana kondisinya di indonesia? Apakah regulasi yg ckp ketat untuk mengeluarkan obat generik berlaku jg di indonesia melalui badan POM?
Lalu kualitas obat generik yg ada di indonesia, apakah sesuai dengan obat patentnya?

Thank

Sanny
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