Monday, August 2, 2010

PUASA & KESIHATAN

Salam dan selamat sejahtera,

Ramadhan yang hampir tiba memberikan semangat kepada kita untuk meneruskan ibadah, ibadah pada bulan yang mulia ni digandakan oleh ALLAH. Dibawah adalah satu article yang cukup menarik untuk dikongsi bersama berkenaan dengan puasa dan kajian sains..insyALLAH sama-sama kita mengambil teladan dari article ini

Semua perintah Allah S.W.T yang Dia syariatkan, pasti mengandungi faedah dan manfaat , begitu juga dengan semua yang dilarang oleh Allah S.W.T pasti kerana adanya kemudharatan dan bahaya bagi hambaNya, baik bahaya di dunia mahupun di akhirat. Baik difahami mahu pun tidak, baik di sedari ataupun tidak pasti kerana bahayanya. Semua perintah dan larangan Allah S.W.T ada HIKMAHnya.

Begitu juga dengan puasa Ramadhan yang akan kita jalani, pasti mengandungi manfaat dan faedah yang tersendiri. Walaupun masih ada lagi orang yang kalah dengan nafsunya beranggapan bahawa puasa itu hanya sebagai beban yang memberatkan, atau hanya ujian keimanan dari Allah , atau hanya sekadar suatu amalan ibadah yang berhak dihargai dengan suatu balasan dan pahala, atau hanya sekadar untuk latihan pengekangan nafsu atau hanya sekadar untuk mengangkat manusia dari darjat haiwan.

Di dalam agama lain pun ada disuruh penganutnya agar berpuasa, cuma caranya sahaja yang berlainan dengan yang disuruh di dalam Islam. Ada agama yang berpuasa tetapi bukan menahan lapar dengan tidak makan , tetapi hanya makan dan minum dalam bilangan yang lebih sedikit dari biasa. Itu masih tetap tidak relevan untuk dipanggil puasa, dan tiada hikmahnya pun. Kerana puasa yang berhikmah adalah puasa dengan tidak makan dari pagi hingga ke maghrib, dengan merehatkan perut dari bekerja sepanjang tahun.

Kajian sains dan ilmu moden berkenaan kelebihan puasa

Para penyelidik ilmu perubatan telah membuktikan bahawa puasa dapat membuang toksik / racun2 dari badan dan secara tidak langsung dapat meningkatkan sistem imunisasi tubuh dalam melawan penyakit. Menurut Dr. Mac Fadon, seorang doktor dari Amerika, “Puasa adalah seperti tongkat ajaib yang dapat menyembuhkan penyakit yang membabitkan perut.” Banyak kejayaan beliau mengubati pesakit2nya dengan menganjurkan mereka agar berpuasa sebagai alternatif kepada ubat2 moden. Dan puasa bukan sahaja dapat menjaga kesihatan dan melawan penyakit bahkan dapat juga menajamkan minda kita.

Dalam ilmu biologi, ketika perut dan usus melakukan proses pencernaan, otak tidak dapat berfungsi dengan baik. Ini kerana tenaga dan pengaliran darah tertumpu kepada kerja-kerja penghadaman makanan. Sebab itulah apabila kita makan sampai terlalu kenyang, otak kita akan menjadi lemah untuk berfikir dan tubuh pun akan rasa mengantuk dan malas. Ketika berpuasa, tenaga dan pengaliran darah tertumpu kepada otak. Ini menjadikan otak dapat bekerja dengan lancar dan memberi peluang kepada diri kita untuk melaksanakan aktiviti-aktiviti yang menggunakan mental dan fizikal yang berkesan.

Dr. Alan Cott, Seorang pakar perubatan Amerika Syarikat melaporkan terhadap penyelidikan psikologi membuktikan bahawa puasa mempengaruhi darjah kecerdasan seseorang. Ujian dilakukan terhadap sekumpulan orang yang rajin berpuasa dan sekumpulan orang yang tidak berpuasa. Keputusannya, ternyata menunjukkan bahawa orang yang rajin berpuasa memperolehi skor (markah) yang jauh lebih tinggi dalam ujian berbanding dengan orang yang tidak berpuasa.

Puasa juga insyaAllah dapat menyembuhkan pelbagai penyakit. Suatu kongres antarabangsa bertemakan “Kesihatan dan Ramadhan” telah diadakan di Casablanca, Morocco pada tahun 1996. Pakar-pakar perubatan dari seluruh dunia telah membentangkan lebih kurang 50 kajian ketika itu. Kesemua kajian itu mengesahkan puasa mampu mencegah serta menyembuhkan pelbagai jenis penyakit yang dihidapi manusia. Kesimpulan kongres itulah yang menekankan 4 fadhilat berpuasa dari sudut kesihatan yang jelas iaitu, menurunkan gula darah, tekanan darah, lipid darah dan berat badan.

Sedangkan dunia perubatan pula telah mengenal pasti pelbagai punca penyakit yang dialami masyarakat dunia masa kini dan antara penyakit yang paling kerap berlaku di dunia masa kini menurut Pertubuhan Kesihatan SeDunia ialah disebabkan sindrom metabolik. Sindrom ini meliputi 4 masalah iaitu: (1) glukos darah tinggi (2) Tekanan darah tinggi (3) Lipid darah tinggi dan (4) lebih berat badan atau obesiti. Dengan hanya meneliti penyakit utama dunia kini dan kesan puasa pada tubuh badan dapatlah kita simpulkan bahawa berpuasa adalah sangat bersesuaian untuk mencegah penyakit sindrom metabolik yang melanda dunia masa kini.

Al-Harits seorang doktor Arab mengatakan :“Yang banyak membunuh manusia adalah kerana manusia suka memasukkan makanan pada perut sebelum makanan dalam perut dicerna.”

Dr. Alexis Carel seorang doktor antarabangsa dan pernah memperolehi penghargaan nobel dalam bidang kedoktoran telah menyatakan bahawa dengan berpuasa dapat membersihkan pernafasan.

Puasa dapat manambahkan kesegaran dan kesihatan pada tubuh, kerana perut yang sentiasa bekerja memproses makanan juga perlu berhenti bekerja buat sementara waktu. Dan ketika berpuasa itu lah perut kita berehat dan mendapat kesegaran semula untuk bekerja kemudiannya. Sama juga ibaratnya seperti enjin kereta yang mungkin tidak tahan lama jika dipaksa untuk sentiasa berjalan tanpa henti.


Saranan Rasulullah S.a.w , sahabat dan ulamak berkenaan puasa

Menahan lapar di bulan puasa ataupun diluar bulan puasa mengandungi faedah dan manfaat yang sangat besar untuk kesihatan badan dan kesihatan hati manusia. Hal ini sudah diterangkan oleh Rasulullah S.a.w dan telah dicontohkan oleh baginda dan keluarganya;

Rasulullah S.A.W bersabda ; yang ertinya, “Berpuasalah supaya kamu sihat.” Hadith Riwayat Abu Naiim

Sabdanya lagi yang bermaksud, “Puasa adalah pelindung”. Hadith Riwayat Muslim, Ahmad, dan an-Nasa`

Sayyidatina Aisyah rodhiyallohu anha berkata :

مَا شَبِعَ آلُ مُحَمَّدٍ صَلَّى اللَّهم عَلَيْهِ وَسَلَّمَ مِنْ خُبْزِ شَعِيرٍ يَوْمَيْنِ مُتَتَابِعَيْنِ حَتَّى قُبِضَ

“Keluarga Muhammad tidak pernah kenyang walaupun dengan roti gandum dua hari berturut-turut sampai beliau wafat.” (Muttafaqun alaihi)

Nabi S.a.w bersabda :

أَكْثَرَهُمْ شِبَعًا فِي الدُّنْيَا أَطْوَلُهُمْ جُوعًا يَوْمَ الْقِيَامَةِ

“Orang yang paling banyak kenyang di dunia adalah yang paling lama lapar di akhirat.” Hadith Riwayat Al-Bazzar

Al-Imam Ath-Thabrani juga meriwayatkan dengan sanad hasan yang bermaksud;

“Orang yang banyak kenyang di dunia mereka adalah orang yang banyak lapar di akhirat.”

Al-Imam Al-Baihaqi meriwayatkan : ‘Dunia adalah penjaranya orang mukmin dan syurganya orang kafir.”

Al-Imam Muslim juga meriwayatkan hadits dari Rasulullah bahawa baginda bersabda :

خَيْرٌ القُرُوْنِ قَرْنِي ثُمَّ الَّذِينَ يَلُونَهُمْ ثُمَّ الَّذِينَ يَلُونَهُمْ ثُمَّ يَأْتِيْ قَوْمٌ يَشْهَدُوْنَ وَلاَيَسْتَشْهَدُوْنَ وَيَنْذُرُوْنَ وَلاَ يُوْقُوْنَ وَيَظْهَرُوْنَ فِيْهِمُ السِّمَنُ


“Sebaik-baik generasi adalah generasiku, kemudian generasi berikutnya kemudian berikutnya. Kemudian akan datang suatu kaum mereka memberikan persaksian padahal tidak diminta persaksiannya. Mereka banyak bernadzar tetapi tidak menunaikannya. Dan banyak di kalangan mereka orang-orang gemuk/ gendut.”

Al-Imam Thabrani dan Ibnu Abi Dunya meriwayatkan hadits :“Akan terjadi pada ummatku seseorang memakan semua jenis makanan, meminum semua jenis minuman, memakai semua jenis pakaian dan banyak berbicara. Maka mereka itulah paling buruknya ummatku.”

Al-Imam At-Tirmidzi rahimahullah meriwayatkan hadits :

مَا مَلَأَ آدَمِيٌّ وِعَاءً شَرًّا مِنْ بَطْنٍ بِحَسْبِ ابْنِ آدَمَ أُكُلَاتٌ يُقِمْنَ صُلْبَهُ فَإِنْ كَانَ لَا مَحَالَةَ فَثُلُثٌ لِطَعَامِهِ وَثُلُثٌ لِشَرَابِهِ وَثُلُثٌ لِنَفَسِهِ

“ Tidaklah Bani Adam memenuhi kantung yang lebih buruk dari perutnya, hendaknya Bani Adam makan sekadar menegakkan punggungnya, jika tidak dapat tidak (terpaksa) maka makanlah sepertiga makanan sepertiga untuk minuman dan sepertiga untuk nafasnya.” (HR. Imam Tirmidzi)

Setelah membawakan sebahagian hadits-hadits di atas, Al-Imam Ash-shon’ani rahimahullah berkata :“Hadits ini menunjukkan atas tercelanya banyak makan dan kenyang kerana menimbulkan berbagai penyakit dan memberatkan seseorang untuk melaksanakan hukum syar’i/ ibadah.”


Manfaat lapar untuk kesihatan hati

Adapun manfaat lapar untuk kesihatan hati, para ulama telah menerangkannya : Luqman Al-Hakim menasihati anaknya, “Wahai anakku, apabila perut dipenuhi makanan, maka gelaplah fikiran, bisulah lidah dari menuturkan hikmah (kebijaksanaan) dan malaslah segala anggota badan untuk beribadah.”

Abdullah bin Mas’ud berkata, “Empat perkara yang mengelapkan hati atau melembapkan otak : perut yang terlalu kenyang, berkawan dengan orang yang suka membuat maksiat, tidak insaf terhadap dosa-dosa yang lalu dan panjang angan-angan.”

Berkata Dzunnun ‘ailaihissalam :“Saya tidak pernah kenyang kecuali saya berbuat maksiat atau berkeinginan untuk bermaksiat”.

Berkata ‘Aisyah radiyallahu ‘anha:“Bid’ah pertama yang terjadi setelah Rasulullah Shalallahu ‘alaihi wassalam adalah kenyang sesungguhnya suatu kaum ketika kenyang perutnya keras nafsunya untuk mendapatkan dunia”

Berkata al Imam ash Shan’ani rahimahullah :“Sesungguhnya lapar itu adalah penjaga dari penjagaan Allah dan pertama yang terhindar dengan lapar adalah dorongan syahwat jima’ dan syahwat berbicara kerana bagi orang yang lapar tidak ada keinginan untuk berbicara kecuali sangat penting sehingga dia terhindar dari berbagai penyakit lisan, pada orang yang lapar juga tidak bangkit padanya syahwat jima’nya sehingga terhindar dari penyaluran syahwat yang diharamkan, orang lapar juga sedikit tidur kerana orang yang banyak makan dan minum akan banyak tidur yang dapat membawa kepada kerugian di dunia dan akhiratnya, terluput dari berbagai kemanfataan duniawi dan ukhrowi”.

Berkata Al-Imam Ibnu Rajab rahimahullah :“Lapar itu menyebabkan lembutnya hati, kuatnya pemahaman, lembutnya jiwa, lemahnya nafsu dan kemarahan. Sedangkan kenyang menyebabkan lawannya.”

Berkata Al-Hasan Al-Bashri rahimahullah :“Wahai Bani Adam, makanlah sepertiga perutmu, minumlah sepertiga perutmu dan biarkan sepertiga untuk bernafas dan berfikir.”

Ibnu Abi Dunya meriwayatkan bahawa Ibnu Umar berkata :“Aku tidak pernah kenyang sejak aku masuk Islam.”

Diriwayatkan dari Amir bin Qois , bahawa dia berkata :“Jauhilah oleh kalian kenyang, kerana kenyang itu mengeraskan hati.”

Telah berkata Malik bin Dinar rahimahullah :“Tidak semestinya, seorang mukmin menjadikan perutnya paling besar cita-citanya dan menjadikan syahwatnya menguasai dirinya.”

Berkata Al-Hasan Al-Bashri rahimahullah :“Adalah bapa kita Adam diuji dengan makan, dan terus kalian akan diuji dengan makan sampai hari kiamat.”

Beliau juga berkata :“Barangsiapa mampu menguasai perutnya maka dia akan mampu menguasai amal sholehnya.”

Beliau berkata lagi :“Tidaklah hikmah itu berada di perut yang penuh.”

Diriwayatkan dari Abdul Aziz bin Abi Dawud bahawa telah dikatakan padanya :“Lapar itu banyak menolong seseorang bersegera melakukan kebaikan.”

Berkata Abu Imran Al-Juwaini :“Sesungguhnya nafsu, jika lapar dan haus maka bersih hati dan lembut dan jika perut kenyang dan lega maka hatinya buta.”

Beliau berkata :“Kunci dunia adalah kenyang dan kunci akhirat adalah lapar, dan pangkal segala kebaikan dunia dan akhirat adalah takut kepada Allah. Sesungguhnya Allah memberikan dunia ini kepada orang yang dicintai dan yang tidak, dan sesungguhnya lapar itu di sisi Allah ada simpanan yang ditunda dan tidak diberikan kecuali kepada orang yang dicintai-Nya.”

Berkata Al-Imam Asy-Syafi’i rahimahullah :“Saya tidak pernah kenyang selama 16 tahun, kerana kenyang itu memberatkan badan, menghilangkan kecerdasan, membuat banyak tidur dan melemahkan seseorang untuk melakukan ibadah.”

“Bukanlah puasa itu hanya sekadar menghentikan makan dan minum tetapi puasa itu ialah menghentikan omong-omong kosong dan kata-kata kotor.”
(H.R.Ibnu Khuzaimah)

Demikian kehidupan Rasulullah dan para shahabat. Beliau dan para shahabatnya lebih memilih banyak lapar dari pada kenyang kerana kefahamannya terhadap faedah lapar dan bahaya kenyang, lebih memilih mengekang syahwatnya daripada menurut syahwat, dan bukannya pada mereka tidak ada makanan tetapi beliau lebih memilih keadaan yang lebih baik dan lebih sempurna daripada lawannya. Mereka makan dan minum sekadar dapat melaksanakan ibadah, kerana hanya untuk itu (untuk beribadah) diciptakannya jin dan manusia.

Seringnya Rasulullah makan tiga hari sekali sampai wafat bukan makan sehari tiga kali seperti budaya kita.


Rahsia-rahsia puasa dan syarat-syarat kebatinannya menurut Imam AlGhazali

Semua ada enam iaitu:

1. Memejamkan mata dan menahannya dari meluaskan pemandangan kepada segala perkara yang tercela dan dibenci oleh agama dan juga kepada segala sesuatu yang boleh menganggu hati, seperti melalaikannya dari berzikir dan mengingat kepada Allah.

2. Memelihara lidah dari bersembang kosong, berbohong, mencaci maki, bercakap kotor, menimbulkan permusuhan dan riya’.

3. Memelihara pendengaran dari mendengar hal-hal yang dilarang dan dibenci, sebab setiap yang haram diucapkan haram pula didengarkan. Dan kerana itu jugalah Allah s.w.t telah menyamakan pendengaran kepada sesuatu semacam itu dengan memakan barang-barang yang diharamkan, sebagaimana dalam firmanNya yang bermaksud: “Mereka itu suka mendengar perkara yang bohong dan memakan barang yang haram.” (al-Maidah: 42)

4. Memelihara seluruh anggota yang lain dari membuat dosa seperti tangan dan kaki dan memeliharanya juga dari segala yang dibenci. Demikian pula menahan perut dari memakan barang-barang yang bersyubhat waktu berbuka puasa. Apalah gunanya berpuasa dari makanan yang halal, kemudian dia berbuka pula, dia memakan makanan yang haram. Orang berpuasa seperti ini, samalah seperti orang yang membangunkan sebuah istana yang indah, kemudian dia menghancurkan sebuah kota. Rasulullah s.a.w bersabda:

“Ada banyak orang yang berpuasa tetapi ia tiada memperolehi dari puasanya itu selain dari lapar dan dahaga (yakni tiada mendapat pahala).”

Ada yang mengatakan bahawa orang itu adalah orang yang berbuka puasanya dengan makanan yang haram. Yang lain pula mengatakan orang itu ialah orang yang menahan dirinya berpuasa dari makanan yang halal, lalu ia berbuka dengan memakan daging manusia; iaitu mencaci maki orang kerana yang demikian itu adalah haram hukumnya. Ada yang mengertikannya dengan orang yang tiada memelihara anggota-anggotanya dari dosa.

5. Janganlah dia membanyakkan makan waktu berbuka puasa, sekalipun dari makanan yang halal, sehingga terlampau kenyang, kerana tidak ada bekas yang paling dibenci oleh Allah s.w.t. daripada perut yang penuh dari makanan yang halal. Cubalah renungkan, bagaimanakah dapat menentang musuh Allah (syaitan) dan melawan syahwat kiranya apa yang dilakukan oleh orang yang berpuasa waktu berbuka itu, ialah mengisikan perut yang kosong itu dengan berbagai makanan semata-mata kerana dia tidak mengisikannya di waktu siang tadi. Kadangkala makanan-makanan yang disediakan itu berbagai-bagai rencamnya sehingga menjadi semacam adat pula kemudiannya. Akhirnya dikumpulkanlah bermacam ragam makanan untuk persediaan menyambut Ramadhan, dan dihidangkan pula dalam satu bulan itu bermacam-macam makanan yang tidak pernah dihidangkan dalam bulan-bulan sebelumnya.

Sebagaimana yang termaklum bahawa maksud puasa itu adalah menahan selera dan mengekang nafsu, agar diri menjadi kuat untuk taat dan bertaqwa kepada Allah. Tetapi kalaulah hanya sekadar mengekang perut di siang hari hingga ke masa berbuka, lalu membiarkan syahwat berlonjak-lonjak dengan kemahuannya kepada makanan, dan dihidangkan pula dengan berbagai-bagai makanan yang lazat-lazat, sehingga perut kekenyangan, tentulah perut akan bertambah keinginannya kepada makanan-makanan itu. Malah akan timbul syahwat pula keinginan yang baru, yang kalau tidak dibiasakan sebelumnya mungkin ia tetap pada kebiasaannya. Semua ini adalah bertentangan dengan maksud dan tujuan puasa yang sebenarnya. Sebab hakikat puasa dan rahsianya adalah untuk melemahkan kemahuan dan keinginan, yang digunakan oleh syaitan sebagai cara-cara yang menarik manusia kepada berbagai kejahatan. Padahal kemahuan dan keinginan ini tidak dapat ditentang, melainkan dengan mengurangkan syahwat. Barangsiapa yang menjadikan di antara hatinya dan dadanya tempat untuk dipenuhi dengan makanan, maka ia terlindung dari kerajaan langit.

6. Hendaklah hatinya merasa bimbang antara takut dan harap kerana ia tiada mengetahui apakah amalan puasanya itu diterima oleh Allah, sehingga tergolongnya ia ke dalam puak muqarrabin (hampir kepada Allah) ataupun puasanya tertolak maka terkiralah ia ke dalam golongan orang yang terjauh dari rahmat Allah Ta’ala. Perasaan seumpama ini seharusnya sentiasa ada pada diri seseorang, setiap kali selesai melakukan sesuatu ibadat kepada Allah Ta’ala.


Penutup

Semoga kita diberikan kekuatan dan kerajinan untuk berpuasa dan menambahkan ibadah2 lain di bulan Ramadhan yang mulia ini. Lebih2 lagi bulan Ramadhan ini lah digarinya para syaitan dari golongan jin dari menghasut manusia dan adanya malam Lailatul Qadar iaitu satu malam yang lebih baik dari seribu bulan, masyaAllah. Semoga kita dapat beribadah dengan baik di malam tersebut dan dikurniakan oleh Allah pahala agar dapat terselamat kita semua dari nerakaNya, amiin.

Tidak lupa kepada para perokok2, bulan Ramadhan ini lah peluang anda untuk belajar berhenti menghisap rokok kerana di siang hari anda sudah tidak dapat hisap rokok. Dan jangan pula di malam harinya anda membalas dendam apa yang anda tidak boleh lakukan pada waktu siang itu. Sebaliknya cuba makan makanan yang dapat membantu lagi untuk membuang toksik / racun dalam badan anda. Sekiranya racun2 itu sudah tiada lagi, maka insyaAllah anda tidak akan ketagih lagi. Pengalaman saya sendiri, saya cuba melawan selama hampir sebulan sahaja untuk berhenti merokok dengan tidak menyentuhnya langsung. Selepas itu anda tidak akan rasa mahu merokok lagi malahan akan rasa muak dengan asap rokok kerana badan anda sudah tiada kandungan racun2 yang menyebabkan ketagihan itu.

Ketahuilah, ramai perokok yang sudah berjaya berhenti merokok pada bulan Ramadhan, maka saya harap kali ini giliran anda pula. Saya pun sudah hampir 3 tahun berhenti merokok dan insyaAllah saya sudah tidak mahu menyentuhnya lagi. Nak seribu daya, tak nak seribu dalih! Selamat berhenti merokok kerana merokok boleh mendatangkan kepada anda segala penyakit yang merbahaya bukan sahaja kepada diri anda tetapi juga orang lain. Adakah anda mahu menanggung dosa terhadap orang lain itu? Mudah2an Allah membantu memudahkan usaha anda untuk berhenti merokok, amiin.

Dan semoga segala ibadah kita diterima di sisi Allah sebagai ibadah yang diredhai Allah, bermanfaat pada diri kita, baik dalam kehidupan di dunia mahupun di akhirat lebih2 lagi. Selamat menjalani ibadah puasa Ramadhan tahun 1429 hijriyyah. Baarokallahu lakum …….

Wallahu a‘lam …….

Rujukan :

1. Tafsir Taisirul karimur Rohman – Al-Imam As-Sa’di.
2. Bahjatun Nadzirin syarah Riyadhussholihin – Syaikh Salim bin Ied Al-Hilaly. Al-Imam Ibnul Qoyyim.
3. Jami’ul Ulum wal Hikam – Al-Imam ibnu Rajab rahimahullah.
4. Subulussalam Syarah Bulughul Maram – Al-Imam As-Shon’ani rahimahullah.
5. Hikmah Puasa Dan Qiyam Ramadhan Menurut Perspektif Islam Dan Sains – Dr. Abu Bakar bin Abdul Majid
6. Bimbingan Mu’min dari Menghidupkan Ilmu-ilmu Agama – Imam ALGhazali

Sunday, July 4, 2010

Ambil Air Tulang Belakang - Bahaya Ke ???

What is a lumbar puncture (LP)?

A lumbar puncture (an LP) is the insertion of a needle into the fluid within the spinal canal. It is termed a "lumbar puncture" because the needle goes into the lumbar portion (the "small") of the back.

Other names for a lumbar puncture (an LP) include spinal tap, spinal puncture, thecal puncture, and rachiocentesis.

Why is a lumbar puncture done?

An LP is most commonly peformed to diagnose a disease, namely to obtain a sample of the fluid in the spinal canal (the cerebrospinal fluid) for examination.

An LP can also be done to treat diseases. For example, as a way of administering antibiotics, cancer drugs, or anesthetic agents into the spinal canal. Spinal fluid is sometimes removed by LP for the purpose of decreasing spinal fluid pressure in patients with uncommon conditions (such as, for examples, normal-pressure hydrocephalus and benign intracranial hypertension).

How is the LP performed? (lihat video)

The patient is typically lying down sideways for the procedure. Less often, the procedure is performed while the patient is sitting up. LPs in infants are often done upright.

After local anesthesia is injected into the small of the back (the lumbar area), a needle is inserted in between the nearby bony building blocks (vertebrae) into the spinal canal. (The needle is usually placed between the 3rd and 4th lumbar vertebrae).

What is done next?

Spinal fluid pressure can then be measured and cerebrospinal fluid (CSF) removed for testing.

What is the cerebrospinal fluid (CSF)?

The CSF circulates around the brain and spinal cord (the central nervous system). This "water bath" acts as a support of buoyancy for the brain and spinal cord. The support of the CSF helps to protect the brain from injury.

The normal CSF contains various chemicals, such as protein and sugar (glucose), and few if any cells. The spinal fluid also has a normal pressure when first removed.

What is normal CSF?

Normal values for spinal fluid examination are as follows:

  • Protein (15-45 mg/dl)
  • Glucose (50-75 mg/dl)
  • Cell count (0-5 mononuclear cells)
  • Initial pressure (70-180 mm)

These normal values can be altered by injury or disease of the brain, spinal cord or adjacent tissues. The values are routinely evaluated during examination of the spinal fluid obtained from the lumbar puncture. Additionally, spinal fluid is tested for infection in the microbiology laboratory.

What diseases are diagnosed by examination of the CSF?

Spinal fluid obtained from the lumbar puncture can be used to diagnose many important diseases such as bleeding around the brain; increased pressure from hydrocephalus; inflammation of the brain, spinal cord, or adjacent tissues (encephalitis, meningitis); tumors of brain or spinal cord, etc. Sometimes spinal fluid can indicate diseases of the immune system, such as multiple sclerosis.

What are the risks of an LP? When spinal fluid is removed during an LP, the risks include headache, brain herniation, bleeding, and infection. Each of these complications are uncommon with the exception of headache, which can appear from hours to up to a day after LP. Headaches occur less frequently when the patient remains lying flat 1-3 hours after the procedure.

What are the benefits of an LP?

The benefits of the LP depend upon the exact situation for which it is performed, but an LP can provide lifesaving information.

Reference:
Harrison's Principles of Internal Medicine, McGraw-Hill, edited by Eugene Braunwald, et. al., 2001.

Sakit Nyaaa Kepalaku...................

What is a headache?

Headache is defined as pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.

How are headaches classified?

Headaches have numerous causes, and in 2007 the International Headache Society agreed upon an updated classification system for headache. Because so many people suffer from headaches, and because treatment is sometimes difficult, the new classification system allows health care practitioners to understand a specific diagnosis more completely to provide better and more effective treatment regimens.

There are three major categories of headaches:

1. primary headaches,

2. secondary headaches, and

3. cranial neuralgias, facial pain, and other headaches

What are primary headaches?

Primary headaches include migraine, tension, and cluster headaches, as well as a variety of other less common types of headache.

Tension headaches are the most common type of primary headache; as many as 90% of adults have had or will have tension headaches. Tension headaches are more common among women than men.

Migraine headaches are the second most common type of primary headache. An estimated 28 million people in the United States (about 12% of the population) will experience migraine headaches. Migraine headaches affect children as well as adults. Before puberty, boys and girls are affected equally by migraine headaches, but after puberty, more women than men are affected. An estimated 6% of men and up to 18% of women will experience a migraine headache.

Cluster headaches are a rare type of primary headache, affecting 0.1% of the population. An estimated 85% of cluster headache sufferers are men. The average age of cluster headache sufferers is 28-30 years of age, although headaches may begin in childhood.

Primary headaches affect quality of life. Some people have occasional headaches that resolve quickly, while others are debilitated. Tension, migraine, and cluster headaches are not life-threatening.

What are secondary headaches?

Secondary headaches are those that are due to an underlying structural problem in the head or neck. There are numerous causes of this type of headache ranging from bleeding in the brain, tumor, or meningitis and encephalitis.

What are cranial neuralgias, facial pain, and other headaches?

Neuralgia means nerve pain (neur= nerve + algia=pain). Cranial neuralgia describes a group of headaches that occur because the nerves in the head and upper neck become inflamed and are the source of the head pain. Facial pain and a variety of other causes for headache are included in this category.

What causes tension headaches?

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that assist the jaw to move are located, and the forehead.

There is little research to confirm the exact cause of tension headaches. Tension headaches occur because of physical or emotional stress placed on the body. Physical stress that may cause tension headaches include difficult and prolonged manual labor, or sitting at a desk or computer for long periods of time Emotional stress may also cause tension headaches by causing the muscles surrounding the skull to contract.

What are the symptoms of tension headaches?

The symptoms of tension headache are:

* A pain that begins in the back of the head and upper neck as a band-like tightness or pressure.

* Described as a band of pressure encircling the head with the most intense pain over the eyebrows.

* The pain is usually mild (not disabling) and bilateral (affecting both sides of the head).

* Not associated with an aura (see below) and are not associated with nausea, vomiting, or sensitivity to light and sound.

* Usually occur sporadically (infrequently and without a pattern) but can occur frequently and even daily in some people.

* Most people are able to function despite their tension headaches.

How are tension headaches diagnosed?

The key to making the diagnosis of any headache is the history given by the patient. The health care practitioner will ask the appropriate questions to understand when the headache began, learn about the quality, quantity, and duration of the pain, and ask about any associated symptoms. The history of tension headache will include pain that is mild to moderate, located on both sides of the head, described as a tightness that is not throbbing, and not made worse with activity. There will be no associated symptoms like nausea, vomiting, or light sensitivity.

The physical examination is important in tension headaches because it has to be normal to make the diagnosis. The only exception is that there may be some tenderness of the scalp or neck muscles. If the health care practitioner finds an abnormality, then the diagnosis of tension headache would not be considered.

How are tension headaches treated?

Tension headaches are painful, and often patients are upset that the diagnosis is "only" a tension headache. Though it is not life-threatening, a tension headache can affect daily life activities.

Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:

* aspirin,

* ibuprofen (Motrin, Advil),

* acetaminophen (Tylenol) and

* naproxen (Aleve)

If these fail, other supportive treatments are available. Recurrent headaches should be a signal to seek medical help. Massage, biofeedback, and stress management can all be used as adjuncts to help with headache control.

It is important to remember that OTC medications, while safe, are medications and may have side effects and potential interactions with prescription medications. It is always wise to ask your health care practitioner or pharmacist if you have questions about OTC medications and their use. This is especially important with OTC pain medications, because patients use them so frequently.

It is important to read the ingredient listing of OTC pain medications. Often an OTC medication is a combination of ingredients, and the second or third ingredient may have the potential for drug interaction or contraindication with medications the patient is currently taking. For example:

* Some OTC medications include caffeine, which may trigger rapid heartbeats in some patients.

* In night time preparations, diphenhydramine (Benadryl) may be added. This may cause drowsiness and driving or using heavy machinery may not be appropriate when taking the medication.

Other examples were caution should be used include the following:

* Aspirin should not be used in children and teenagers because of the risk of Reye's Syndrome, a disease where coma, brain damage, and death can occur with a viral like illness and aspirin use.

* Aspirin and ibuprofen are irritating to the stomach and may cause bleeding. They should be used with caution in patients who have peptic ulcer disease or who take blood thinners like warfarin (Coumadin) and clopidogrel bisulfate (Plavix).

* Acetaminophen, if used in large amounts, can cause liver damage or failure. It should be used with caution in patients who drink significant amounts of alcohol or who have liver disease.

* One cause of chronic tension headaches is overuse of medications for pain. When pain medications are used for a prolonged time, headaches can recur as the effects of the medication wear off. Thus, the headache is a symptom of medication withdrawal (rebound headache).

What causes cluster headaches?

The cause of cluster headaches is uncertain. It may be that certain parts of the brain begin to malfunction for an unknown reason. The hypothalamus, an area located at the base of the brain is responsible for the body's biologic clock and may be the part of the brain that is the source for the headaches. When brain scans are performed on patients who are in the midst of a cluster headache, there is abnormal activity in the hypothalamus.

Cluster headaches also:

* tend to run in families and this suggests that there may be a genetic role.

* may be triggered by changes in sleep patterns.

* may be triggered by medications (for example, nitroglycerin, used for heart disease) .

If the patient is in a susceptible period for cluster headache, cigarette smoking, alcohol, and some foods (for example, chocolate) can precipitate the headache.

What are the symptoms of cluster headaches?

Cluster headaches are headaches that come in groups (clusters) lasting weeks or months, separated by pain-free periods of months or years.

* During the period in which the cluster headaches occur, pain typically occurs once or twice daily, but some patients may experience pain more than twice daily.

* Each episode of pain lasts from 30 minutes to an hour and a half.

* Attacks tend to occur at about the same time every day and often awaken the patient at night from a sound sleep.

* The pain typically is excruciating and located around or behind one eye.

* Some patients describe the pain as feeling like a hot poker in the eye. The affected eye may become red, inflamed, and watery.

* The nose on the affected side may become congested and runny.

Unlike patients with migraine headaches, patients with cluster headaches tend to be restless. They often pace the floor, bang their heads against a wall, and can be driven to desperate measures. Cluster headaches are much more common in males than females.

How are cluster headaches diagnosed?

The diagnosis of cluster headache is made by the patient history of symptoms. The description of the pain and it's clock-like recurrence is usually enough to make the diagnosis.

If examined in the midst of an attack, the patient is usually in a pain crisis and may have the eye and nose watering as described above. If the patient presents when the pain is not present, the physical examination is normal and the diagnosis again depends upon the patient history.

How are cluster headaches treated?

Cluster headaches may be very difficult to treat, and it make take trial and error to find the specific treatment regimen that will work for each patient. Since the headache recurs daily, there are two treatment needs. The pain of the first episode needs to be controlled , and additional headaches need to be prevented.

Initial treatment options may include the following:

* inhalation of high concentrations of oxygen (though this will not work if the headache is well established);

* injection of tryptan medications, for example, sumatriptan (Imitrex), zolmitriptan (Zomig), and rizatriptan (Maxalt) which are commonly used for migraine treatments as well;

* injection of lidocaine, a local anesthetic, into the nostril;

* dihydroergotamine (DHE, Migranal), a medication that causes blood vessels to constrict;

* caffeine

Preventative cluster headache treatment options may include the following:

* calcium channel blockers [for example, verapamil (Calan, Verelan, Verelan PM, Isoptin, Covera-HS), diltiazem (Cardizem, Dilacor, Tiazac)]

* prednisone (Deltasone, Liquid Pred)

* antidepressant medications

* lithium (Eskalith, Lithobid)

* valproic acid, divalproex (Depakote, Depakote ER, Depakene, Depacon), and topiramate (Topamax) (often used for seizure control)

Can cluster headaches be prevented?

Since cluster headache episodes may be spaced years apart, and since the first headache of a new cluster episode can't be predicted, daily medication may not be warranted.

Lifestyle changes may help minimize the risk of a cluster headache flare. Stopping smoking and minimizing alcohol may prevent future episodes of cluster headache.

What diseases cause secondary headaches?

Headache is a symptom associated with many illnesses. While head pain itself is the issue with primary headaches, secondary headaches are due to an underlying disease or injury that needs to be diagnosed and treated. Controlling the headache symptom will need to occur at the same time diagnostic tests are being considered. Some of the causes of secondary headache may be potentially life-threatening and deadly. Early diagnosis and treatment is essential, if damage is to be limited.

The International Headache Society lists eight categories of secondary headache. A few examples in each category are noted (this is not a complete list)

1. Head and neck trauma

* Injuries to the head may cause bleeding in the spaces between the layers of tissue that surround the brain (subdural, epidural and subarachnoid bleeding) or within the brain tissue itself.

* Concussions, where head injury occurs without bleeding

* A symptom of whiplash and neck injury

2. Blood vessel problems in the head and neck

* Stroke or transient ischemic attack (TIA)

* Arteriovenous malformations (AVM) may cause headache before they leak.

* The carotid artery in the neck can become inflamed and cause pain.

* Temporal arteritis (inflammation of the temporal artery)

3. Non-blood vessel problems of the brain

* Brain tumors, either primary, originating in the brain or metastatic from a cancer that began in another organ

* Seizures

* Idiopathic intracranial hypertension, once named pseudotumor cerebri, where there is too much cerebrospinal fluid pressure within the spinal canal.

4. Medications and drugs (including withdrawal from those drugs)

5. Infection

* Meningitis

* Encephalitis

* HIV/AIDS

* Systemic infections (for example, pneumonia or influenza)

6. Changes in the body's environment

* High blood pressure (hypertension)

* Dehydration

* Hypothyroidism

* Renal dialysis

7. Problems with the eyes, ears, nose throat, teeth and neck

8. Psychiatric disorders

How are secondary headaches diagnosed?

If there is time, the diagnosis of secondary headache begins with a complete patient history followed by a physical examination and laboratory and radiology tests as appropriate.

However, some patients present in crisis with a decreased level of consciousness or unstable vital signs. In these situations, the health care practitioner may decide to treat a specific cause without waiting for tests to confirm the diagnosis.

For example, in patients with headache, fever, stiff neck, and confusion that suggest meningitis. Since meningitis can be rapidly fatal, antibiotic therapy may be started before blood tests and a lumbar puncture are performed to confirm the diagnosis.

What are the exams and tests for secondary headaches?

The patient history and physical examination provide the best means for determining the cause of secondary headaches. Therefore, it is extremely important that patients with severe headaches seek medical care and give their health care practitioner an opportunity to assess their condition. Tests that may be useful in making the diagnosis of the underlying disease causing headaches include:

* blood tests,

* computerized tomography (CT Scan),

* magnetic resonance imaging (MRI) scans of the head, and

* lumbar puncture.

Specific tests will depend upon what potential issues the health care practitioner and patient want to address.

Blood tests

Blood tests provide helpful information in association with the history and physical examination in pursuing a diagnosis. For example, an infection or inflammation in the body may cause a rise in the white blood cell count, the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP). Blood tests can also assess electrolyte disturbances, and a variety of organ functions like liver, kidney, and thyroid.

Computerized tomography of the head

Computerized tomography is able to detect bleeding, swelling, and tumor. It can also show evidence of previous stroke. With intravenous contrast injection, it can also be used to look at the arteries of the brain.

Magnetic resonance imaging (MRI) of the head

MRI is able to better look at the anatomy of the brain, meninges (the layers that cover the brain and the spinal cord). While it is more precise, the time to perform the scan is significantly longer than for computerized tomography. This type of scan is not available at all hospitals.

Lumbar puncture

Cerebro-spinal fluid, the fluid that surrounds the brain and spinal cord, can be obtained with a needle that is inserted into the spine in the lower back. Examination of the fluid can reveal infection (such as meningitis due to bacteria, a virus, or tuberculosis) or blood from hemorrhage. In almost all cases, computerized tomography is done prior to lumbar puncture to make certain there is no bleeding, swelling, or tumor in the brain.

When should patients with headache seek medical care?

A patient should seek medical care if their headache is:

* The "worst headache of your life"

* Different than your usual headaches

* Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity

* Associated with persistent nausea and vomiting

* Associated with fever or stiff neck

* Associated with seizures

* Associated with recent head trauma or a fall

* Associated with changes in vision, speech, or behavior

* Associated with weakness or change in sensation

* Not responding to treatment and is getting worse

* Requires more than the recommended dose of over-the-counter medications for pain

* Disabling and interfering with work and quality of life

Headache At A Glance

* The head is one of the most common sites of pain in the body.

* The most common types of headache can be classified as
1) primary, 2) secondary, and 3) cranial neuralgias, facial pain, and other headaches.


* The most common types of primary headaches are 1) tension, 2) migraine, and 3) cluster.

* Tension headaches are the most common type of primary headache and usually are treated with over-the-counter medications for pain

* Secondary headaches are a symptom of an injury or an underlying illness.

* Patients should seek medical care for new onset headaches, fever, stiff neck, change in behavior, vomiting, weakness or change in sensation.

Monday, June 28, 2010

Kemajuan Rawatan Menggunakan 'Stem Cells'

Apakah 'Stem Cell' ?

Sel stem atau sel induk adalah sel istimewa yang memiliki keupayaan untuk berkembang (membahagi) dalam tempoh yang tidak tetap dan boleh berubah menjadi pelbagai jenis sel yang khusus. Keupayaan yang dikenali sebagai keplastikan (plasticity) ini, adalah sifat biasa bagi telur-telur yang telah disenyawakan dan sel-sel awal embrio (juga dikenali sebagai blastomer). Telur yang telah disenyawakan dan mempunyai kebolehan untuk membentuk semua sel di dalam tubuh, mempunyai keupayaan perkembangan keplastikan yang paling tinggi. Oleh itu, ia bersifat totipoten, iaitu ia boleh berkembang menjadi embrio yang lengkap apabila diasingkan daripada kumpulan blastomer.

Sel stem terbahagi kepada dua, iaitu sel stem embrio dan sel stem orang dewasa. Apabila ditempatkan di dalam kultur, sel-sel stem ini berkembang dan mula membahagi, dan para saintis kini sedang berusaha untuk membolehkan mereka menghasilkan jenis-jenis sel yang boleh diguna pakai bagi menyembuhkan pelbagai penyakit di mana ianya akan digunakan bagi menggantikan sel-sel manusia yang telah mati seperti penyakit saraf, kegagalan jantung, kebutaan dan sebagainya.
http://wpcontent.answers.com/wikipedia/commons/thumb/3/3c/Stem_cells_diagram.png/400px-Stem_cells_diagram.png

Stem Cell Treatment Restores Vision

Study Shows Damaged Corneas May Be Regenerated With Patients' Stem Cells

A regenerative treatment that uses stem cells taken from the patient's own eyes is helping some blind patients see again.

Italian researchers report that the stem cell procedure resulted in successful corneal transplantation in three-fourths of patients with blindness in one or both eyes, caused in most patients by chemical or thermal burns.

Vision was at least partially restored in patients who did not have major damage to other parts of the affected eye, says study researcher Graziella Pellegrini, PhD, of the University of Moderna's Center for Regenerative Medicine.

Pellegrini and colleagues have performed corneal transplants in around 250 patients over the last decade using the stem cell technique, but it remains experimental and is not being done in the U.S.

Their latest study is published in the New England Journal of Medicine. The findings were also reported last week in San Francisco at a meeting of the International Society for Stem Cell Research.

"We followed the patients in this study for an average of three years and as long as a decade, and we have shown that the results can last for many years."

Regeneration of Corneas

The study included 112 patients with damaged corneas who received the stem cell treatment between 1998 and 2006.

The procedure involved extracting healthy stem cells from the limbus, which is located between the colored and white part of the eye.

Pellegrini says the procedure can be done even when only a tiny portion of the limbus remained undamaged.

Stem cells taken from the biopsied limbus tissue grew into healthy corneal tissue in a little over two weeks, she says, and the healthy tissue was then grafted onto the damaged eye.

When the procedure was successful, the damaged, opaque cornea became clear again and the eye looked normal.

In all, 77% of patients had a successful first or second graft, while the procedure was considered a partial success or failure in 13% and 10% of cases, respectively.

People with corneal damage from chemical and thermal burns often have symptoms including light sensitivity, itching, and pain. These symptoms went away or were much less severe in the successfully treated patients.

Following successful transplant, about half of the patients had further surgeries to improve visual acuity and most showed at least some improvement in vision. One patient achieved normal vision with the stem cell grafting alone.

Regenerative Treatments for Heart and Liver

University of California, Davis ophthalmology professor Ivan Schwab, MD, was among the first to perform the stem cell transplant procedure, based on Pellegrini's early work, almost a decade ago.

He treated about 15 patients, and while many showed early responses, the benefits did not last.

"This study is remarkable because these researchers have shown not only that this technique works, but that it works for up to 10 years in some cases,".

He adds that regenerative treatments show promise for a wide range of illnesses, including those involving the bladder, liver, and the heart.

"We are not talking about regenerating the entire liver or heart," he says. "The concept that you have to grow a whole liver or a whole heart is not correct."

He points out that researchers are already working on a heart "patch" that can help a damaged heart function better.


"KAEDAH TERBARU INI MASIH DALAM PERINGKAT KAJIAN, NAMUN IANYA MENJANJIKAN SEBUAH HARAPAN KEPADA PESAKIT-PESAKIT KRONIK TERTENTU. NAMUN TENTUNYA KOS RAWATAN YANG AKAN MEMBATASINYA"

Kenali Penyakit JANTUNG KORONARI

Our heart is an amazing powerhouse that pumps and circulates 5 or 6 gallons of blood each minute through our entire body.

Your heart is an amazing powerhouse that pumps and circulates 5 or  6 gallons of blood each minute through your entire body.


Heart disease begins when cholesterol, fatty material, and calcium build up in the arteries, a process known as atherosclerosis.


A human aorta opened lengthwise showing atherosclerosis  (thickening and hardening of the arterial wall as a result of fat  deposits on the inner surface).

Blockage of the coronary arteries by plaque may cause a heart attack (myocardial infarction) or a fatal rhythm disturbance (sudden cardiac arrest).

If plaque completely blocks blood flow, it may cause a heart  attack (myocardial infarction) or a fatal rhythm disturbance (sudden  cardiac arrest).

Cardiovascular disease is the leading cause of death for both men and women throughout the world including MALAYSIA

Cardiovascular disease is the leading cause of death for both men  and women in the U.S.


Some of the risk factors for heart disease include smoking, high blood pressure, high cholesterol, diabetes, and obesity.

Some of the risk factors for heart disease include smoking, high  blood pressure, high cholesterol, diabetes, and obesity.


Additional heart disease risk factors include lack of exercise, an unhealthy diet, stress, and a "type A" personality

The muscular wall of the colon grows thicker with age, and this  may reflect the increasing pressures required by the colon to eliminate  feces.


One of the most devastating consequences of heart disease can be sudden cardiac arrest.

One of the most devastating consequences of heart disease can be  sudden cardiac arrest.

Besides chest pain (angina) and shortness of breath, some other common symptoms of heart disease include jaw pain, back pain, and heart palpitations.

Besides chest pain (angina) and shortness of breath, some other  common symptoms of heart disease include jaw pain, back pain, and heart  palpitations.

Other symptoms of heart disease may include dizziness, weakness, irregular heartbeat, nausea, and abdominal pain.

Other symptoms of heart disease may include dizziness, weakness,  irregular heartbeat, nausea, and abdominal pain.

Women, seniors, and people with diabetes tend to experience heart disease differently than men such as breathlessness, malaise or fatigues i.e. no typical chest pain

Women, seniors, and people with diabetes tend to experience heart  disease differently than men.

Doctors use a variety of tests to detect heart disease. One common test is the electrocardiogram (ECG or EKG).

Doctors use a variety of tests to detect heart disease. One common  test is the electrocardiogram (ECG or EKG).

Sometimes, if an electrocardiogram comes back normal, doctors will use stress tests to detect heart disease.

Sometimes, if an electrocardiogram comes back normal, doctors will  use stress tests to detect heart disease.

Another test option is echocardiography, which uses sound waves to generate images of the heart.


Another test option is echocardiography, which uses sound waves to  generate images of the heart.

Computerized tomography (CT) scans are used to show that heart disease is not present and that the coronary arteries are normal.

Computerized tomography (CT) scans are used to show that heart  disease is not present and that the coronary arteries are normal.

Coronary angiography via cardiac catheterization is considered the "gold standard" of heart disease tests.

Coronary angiography via cardiac catheterization is considered the

Heart disease treatment is different for everyone.

Heart-disease treatment is different for everyone.

For some patients with heart disease, medications may be necessary.

For some patients with heart disease, medications may be  necessary.

When medications aren't enough, sometimes invasive procedures are used to help treat heart disease.

When medications aren't enough, sometimes invasive procedures are  used to help treat heart disease.

Heart disease is a highly preventable and reversible disease. A healthy diet is a major factor in controlling heart disease.

Heart disease is a highly preventable and reversible disease. A  healthy diet is a major factor in controlling heart disease.

Other lifestyle changes that can be made to help prevent heart disease include drinking alcohol in moderation and quitting smoking.

Other lifestyle changes that can be made  to help prevent heart  disease include drinking alcohol in moderation and quitting smoking.

Exercise, controlling high blood pressure and diabetes, and taking daily aspirin are more ways to reduce your chances of developing heart disease.

Exercise, a daily aspirin, and controlling high blood pressure and  diabetes are more ways to reduce your chances of developing heart  disease.



"SEKIRANYA ANDA MEMPUNYAI MASALAH-MASALAH YANG DIRASAKAN BERKAITAN DENGAN PENYAKIT JANTUNG KORONARI, BERJUMPALAH DENGAN DOKTOR ANDA SECEPAT MUNGKIN"

Sunday, June 27, 2010

Elak mengantuk secara NATURAL, jangan guna KOPI !!!

How to Stay Awake Naturally

With more and more of us getting less and less sleep, it’s tempting to reach for a Red Bull or an espresso when we feel sleepy at work. But consuming caffeine to combat sleepiness can lead to a vicious cycle.

The java jolt that helps you stay awake can take up to eight hours to wear off. Caffeine can also reduce your sleep time, alter the normal stages of sleep, and decrease the quality of your sleep.

How can you stay awake naturally? Try some of these 12 jitter-free tips to take the edge off sleepiness.

1. Get Up and Move Around to Feel Awake

In one well-known study, Robert Thayer, PhD, a professor at California State University, Long Beach, studied whether people were more energized by eating a candy bar or taking a brisk 10-minute walk. Though the candy bar provided a quick energy boost, participants were actually more tired and had less energy an hour later. The 10-minute walk increased energy for two hours. That’s because walking pumps oxygen through your veins, brain, and muscles.

If you work at a desk, get up frequently for short walks. At meal breaks, walk to a restaurant or, if you bring your lunch, head for a nice spot to eat it. Whether you take a walk outside or just in the building where you work, it will make you feel more alert and refreshed.

2. Take a Nap to Take the Edge Off Sleepiness

There are two things to remember about naps: Don’t take more than one and don’t take it too close to your bedtime. “Nap between five and 25 minutes,” says Barry Krakow, MD, author of Sound Sleep, Sound Mind: Seven Keys to Sleeping Through the Night. It’s best to nap about six or seven hours before you would normally go to bed. If you must take a late nap close to bedtime, make it a short one.

Napping on the job can be touchy. If you need to nap at work, do it during your break and use a vibrating alarm clock, if necessary, to make sure it doesn’t spill over into your work time. Sleeping at your desk is usually not a good idea, but many companies now provide nap rooms for employees.

“If you can’t nap, even resting quietly with your eyes closed for 10 minutes or so will help,” says Allison T. Siebern, PhD, a fellow at the Stanford University Sleep Medicine Center in Redwood City, Calif.

3. Give Your Eyes a Break to Avoid Fatigue

Continuous fixation on a computer screen can cause eyestrain and worsen sleepiness and fatigue. Look away from the screen for a few minutes periodically to relax your eyes.

4. Eat a Healthy Snack to Boost Energy

Sugary snacks give you a quick energy boost followed by the sugar “lows,” when low blood sugar produces mental fogginess and lethargy. Snacks such as these will provide better overall energy in the long run:

  • Peanut butter on a whole wheat cracker or celery sticks
  • Yogurt and a handful or nuts or fresh fruit
  • Baby carrots with a low-fat cream cheese dip

5. Start a Conversation to Wake Up Your Mind

If you’re fading fast, engaging in conversation can get your mind moving again. “Talk to a colleague about a business idea, politics, or religion,” says Krakow, medical director of Maimonides Sleep Arts and Sciences, Ltd. in Albuquerque, N.M. “It’s a very strong behavioral stimulator -- especially when it’s a conversation about politics.”

6. Turn Up the Lights to Ease Fatigue

Environments with dim lighting aggravate fatigue. Studies have shown that exposure to bright light can reduce sleepiness and increase alertness. Try increasing the intensity of your light source at work.

7. Take a Breather to Feel Alert

Deep breathing raises blood oxygen levels in the body. This slows your heart rate, lowers blood pressure, and improves circulation, ultimately aiding mental performance and energy.

The idea of deep-breathing exercises is to inhale to the abdomen, not the chest. You can do them at your desk. Sitting up straight, try this exercise up to 10 times:

  • With one hand on your belly just below your ribs and the other on your chest, inhale deeply through your nose and let your belly push your hand out. Your chest should not move.
  • Breathe out through lips pursed as if you were whistling. You can use the hand on your belly to help push air out.

Another technique, called stimulating breath, is used in yoga for a quick energy boost and increased alertness: Inhale and exhale rapidly through your nose, keeping your mouth closed but relaxed. Make your in-and-out breaths short -- do about three of each cycle in a second. Then breathe normally. You can do this for up to 15 seconds the first time and then add on five seconds each time after until you reach a minute.

8. If You’re Driving, Pull Over When Sleepy

“Driving while sleepy is as dangerous as driving under the influence of alcohol,” says Siebern. Common tricks such as opening the windows and turning on loud music won’t keep you awake for very long behind the wheel. “Have someone else drive or pull off the road and take a nap until you’re no longer sleepy,” Siebern says.

If you’re on an extended trip, change drivers often. Stop at least every two hours to take a walk and get some fresh air.

9. Switch Tasks to Stimulate Your Mind

In 2004 Finnish researchers who studied people working 12-hour night shifts found that monotonous work is as harmful as sleep loss for alertness. At work or home, try to reserve more stimulating tasks for your sleepy times. Or switch to more engaging work responsibilities when you feel yourself nodding off.

10. Drink Water to Prevent Tiredness

Dehydration can cause fatigue. Make sure you drink plenty of fluids and eat foods high in water such as fruits and vegetables.

11. Get Some Daylight to Regulate Your Sleep Cycles

Our circadian rhythms, which regulate our sleep-wake cycle, are influenced by daylight. Try to spend at least 30 minutes a day outside in natural sunlight. (Sleep experts recommend an hour of morning sunlight a day if you have insomnia.) Even a step outside for a breath of fresh air will revive your senses.

12. Exercise to Increase Energy and Reduce Fatigue

In a 2006 analysis of 70 studies involving more than 6,800 people, University of Georgia researchers found that exercise was more effective in increasing energy and reducing daytime fatigue than some medications used to treat sleep problems. Regular exercise also improves quality of sleep.

Try to exercise 30 minutes a day. If you decide to exercise hard some days, your energy level may drop for a bit and then surge for a few hours. Eating a meal that contains both protein and carbohydrates within two hours after a heavy workout will lessen the initial energy loss. Be sure to finish your workout a few hours before bedtime so you are not energized when you try to sleep.

When to See a Doctor About Your Sleepiness

If you find that you can’t stop nodding off when you need to be alert, consult a doctor or sleep specialist. You may have an underlying sleep disorder such as excessive sleepiness or narcolepsy, which can be treated. Your doctor may prescribe medications to help you with a sleep disorder. If you have trouble falling asleep because of stress or other reasons, cognitive behavioral therapy can help you develop good sleep habits and relieve sleep anxieties.

Kenali Penyakit GOUT

What is gout? What is hyperuricemia?

Gout is a disease that results from an overload of uric acid in the body. This overload of uric acid leads to the formation of tiny crystals of urate that deposit in tissues of the body, especially the joints. When crystals form in the joints, it causes recurring attacks of joint inflammation (arthritis).

Gout is considered a chronic and progressive disease. Chronic gout can also lead to deposits of hard lumps of uric acid in the tissues, particularly in and around the joints and may cause joint destruction, decreased kidney function, and kidney stone.

Gout has the unique distinction of being one of the most frequently recorded medical illnesses throughout history. It is often related to an inherited abnormality in the body's ability to process uric acid. Uric acid is a breakdown product of purines that are part of many foods we eat. An abnormality in handling uric acid can cause attacks of painful arthritis (gout attack), kidney stones, and blockage of the kidney-filtering tubules with uric acid crystals, leading to kidney failure.

On the other hand, some people may only develop elevated blood uric acid levels (hyperuricemia) without having manifestations of gout, such as arthritis or kidney problems. The state of elevated levels of uric acid in the blood without symptoms is referred to as asymptomatic hyperuricemia. Asymptomatic hyperuricemia is considered a precursor state to the development of gout.

The term gout refers the disease that is caused by an overload of uric acid in the body, resulting in painful arthritic attacks and deposits of lumps of uric acid crystals in body tissues.

Gouty arthritis is typically an extremely painful attack with a rapid onset of joint inflammation. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid (synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as the immune system reacts, causing white blood cells to engulf the uric acid crystals and chemical messengers of inflammation to be released, leading to pain, heat, and redness of the joint tissues. As gout progresses, the attacks of gouty arthritis typically occur more frequently and often in additional joints.

Who is affected by gout?

Gout is nine times more common in men than in women. It predominantly attacks males after puberty, with a peak age of 75. In women, gout attacks usually occur after menopause.

While an elevated blood level of uric acid may indicate an increased risk of gout, the relationship between hyperuricemia and gout is unclear. Many patients with hyperuricemia do not develop gout (asymptomatic hyperuricemia), while some patients with repeated gout attacks have normal or low blood uric acid levels. In fact, the blood level of uric acid often lowers during an acute attack of gout. Among the male population in the United States, approximately 10% have hyperuricemia. However, only a small portion of those with hyperuricemia will actually develop gout.

What are gout causes and risk factors?

In addition to an inherited abnormality in handling uric acid, other risk factors for developing gout include obesity, excessive weight gain (especially in youth), moderate to heavy alcohol intake, high blood pressure, and abnormal kidney function. Certain drugs, such as thiazide diuretics (hydrochlorothiazide), low-dose aspirin, niacin, cyclosporine, tuberculosis medications (pyrazinamide and ethambutol), and others can also cause elevated uric acid levels in the blood and lead to gout. Furthermore, certain diseases lead to excessive production of uric acid in the body. Examples of these diseases include leukemias, lymphomas, and hemoglobin disorders.

Interestingly, a recent study demonstrated an increased prevalence of abnormally low thyroid hormone levels (hypothyroidism) in patients with gout.

In patients at risk of developing gout, certain conditions can precipitate acute attacks of gout. These conditions include dehydration, injury to the joint, fever, excessive eating, heavy alcohol intake, and recent surgery. Gout attacks triggered by recent surgery are probably related to changes in the body-fluid balance as patients temporarily discontinue normal oral fluid intake in preparation for and after their operation.

What are gout symptoms and signs?

The small joint at the base of the big toe is the most common site of an acute gout attack of arthritis. An acute attack of gouty arthritis at the base of the big toe is medically referred to as podagra. Other joints that are commonly affected include the ankles, knees, wrists, fingers, and elbows. Acute gout attacks are characterized by a rapid onset of pain in the affected joint followed by warmth, swelling, reddish discoloration, and marked tenderness. Tenderness can be intense so that even a blanket touching the skin over the affected joint can be unbearable. Patients can develop fever with the acute gout attacks. These painful attacks usually subside in hours to days, with or without medication. In rare instances, an attack can last for weeks. Most patients with gout will experience repeated attacks of arthritis over the years.

Picture of Gout and Hyperuricemia

Uric acid crystals can deposit in tiny fluid-filled sacs (bursae) around the joints. These urate crystals can incite inflammation in the bursae, leading to pain and swelling around the joints (a condition called bursitis). In rare instances, gout leads to a more chronic type of joint inflammation that mimics rheumatoid arthritis.

In chronic (tophaceous) gout, nodular masses of uric acid crystals (tophi) deposit in different soft-tissue areas of the body. Even though they are most commonly found as hard nodules around the fingers, at the tips of the elbows, in the ears, and around the big toe, tophi nodules can appear anywhere in the body. They have been reported in unexpected areas such as in the vocal cords or (rarely) even around the spinal cord. When tophi appear in the tissues, the gout condition is felt to represent a substantial overload of uric acid within the body.

How is gouty arthritis diagnosed?

Gout is suspected when a patient reports a history of attacks of painful arthritis, particularly at the base of the toes. Ankles and knees are the next most commonly involved joints in gout. Gout usually attacks one joint at a time, while other arthritis conditions, such as systemic lupus and rheumatoid arthritis, usually attack multiple joints simultaneously.

The most reliable test for gout is finding uric acid crystals in a sample of the joint fluid obtained by joint aspiration (arthrocentesis). Arthrocentesis is a common office procedure performed under local anesthesia. Using sterile technique, fluid is withdrawn (aspirated) from the inflamed joint using a syringe and needle. The joint fluid is then analyzed for uric acid crystals and for infection. Shiny, needle-like uric acid crystals are best viewed with a special polarizing microscope. The diagnosis of gout can also be made by finding these urate crystals from material aspirated from tophi nodules and bursitis fluid. Although many doctors can do the procedure, rheumatologists are specialists who are particularly trained in this evaluation.

Sometimes patients with a classic history and symptoms of gout can be successfully treated and presumed to have gout without undergoing arthrocentesis. However, establishing a firm diagnosis is still preferable since other conditions can mimic gout. These include another crystal-induced arthritis called pseudogout, psoriatic arthritis, rheumatoid arthritis, and even infection in the joint.

X-rays can sometimes be helpful and may show tophi-crystal deposits and bone damage as a result of repeated bouts of inflammation. X-rays can also be helpful for monitoring the effects of chronic gout on the joints.

What is the treatment for gout?

There are two key concepts essential to treating gout. First, it is critical to stop the acute inflammation of joints affected by gouty arthritis. Second, it is important to address the long-term management of the disease in order to prevent future gouty arthritis attacks and shrink gouty tophi crystal deposits in the tissues.

The treatment of an acute attack of gouty arthritis involves measures and medications that reduce inflammation. Preventing future acute gout attacks is equally as important as treating the acute arthritis. Prevention of acute gout involves maintaining adequate fluid intake, weight reduction, dietary changes, reduction in alcohol consumption, and medications to lower the uric acid level in the blood (reduce hyperuricemia).

Maintaining adequate fluid intake helps prevent acute gout attacks. Adequate fluid intake also decreases the risk of kidney stone formation in patients with gout. Alcohol is known to have diuretic effects that can contribute to dehydration and precipitate acute gout attacks. Alcohol can also affect uric acid metabolism to cause hyperuricemia. Therefore, alcohol has two major effects that worsen gout by impeding (slowing down) the excretion of uric acid from the kidneys as well as by causing dehydration, both of which contribute to the precipitation of uric acid crystals in the joints.

Foods to eat and foods to avoid with gout

Dietary changes can help reduce uric acid levels in the blood. Since purine chemicals are converted by the body into uric acid, purine-rich foods are avoided. Examples of foods rich in purines include shellfish and organ meats such as liver, brains, kidneys, and sweetbreads. Researchers have reported, in general, that meat or seafood consumption increases the risk of gout attacks, while dairy food consumption seemed to reduce the risk. Protein intake or purine-rich vegetable consumption was not associated with an increased risk of gout. Total alcohol intake was strongly associated with an increased risk of gout (beer and liquor were particularly strong factors). Fructose from the corn syrup in soft drinks also increases the risk of gout.

Weight reduction can be helpful in lowering the risk of recurrent attacks of gout. This is best accomplished by reducing dietary fat and calorie intake, combined with a regular aerobic exercise program.

Gout medications

There are three aspects to the treatment of gout with medications. First, pain relievers such as acetaminophen (Paracetamol) or other more potent analgesics are used to manage pain. Secondly, anti-inflammatory agents such as nonsteroidal anti-inflammatory drugs (NSAIDS), colchicine, and corticosteroids are used to decrease joint inflammation. Finally, medications are considered for managing the chronic underlying metabolic derangement that causes hyperuricemia and gout. This means treating the elevated levels of uric acid in the blood with medications that reduce these levels.

NSAIDS such as indomethacin (Indocin) and naproxen (Naprosyn) are effective anti-inflammatory medications for acute gout. These medications are tapered after the arthritis resolves. Common side effects of NSAIDS include irritation of the gastrointestinal system, ulceration of the stomach and intestines, and even intestinal bleeding. People who have a history of allergy to aspirin or nasal polyps should avoid NSAIDS because of the risk of an intense allergic (anaphylactic) reaction. Colchicine for acute gout is administered by mouth to reduce inflammation as well as to prevent gouty arthritis attacks while correcting hyperuricemia with medications such as allopurinol (Zyloric) or febuxostat (Uloric). For acute attacks, it is given hourly or every two to four hours until there is significant improvement in pain or the patient develops gastrointestinal side effects such as severe diarrhea. For prevention, it is given once or twice daily. Other common side effects of colchicine include nausea and vomiting.

Corticosteroids such as prednisone, given in short courses, are powerful anti-inflammatory agents for treating acute gout. They can be administered orally or injected directly into the inflamed joint. Corticosteroids can be prescribed to patients who have accompanying kidney, liver, or gastrointestinal problems. Long-term chronic use of corticosteroids is discouraged because of serious long-term side effects.

In addition to medications for acute gout attacks, other drugs can be taken over prolonged periods to lower blood uric acid levels. Lowering blood uric acid levels reduces the risk of recurrent attacks of arthritis, kidney stones, and kidney disease, and also slowly dissolves hard tophi deposits. Medicines used to lower blood uric acid level work either by increasing the kidney's excretion of uric acid or by decreasing the body's production of uric acid from the purines in foods. These medicines are generally not started until after the inflammation from acute gouty arthritis has subsided because they can worsen the attack. If they are already being taken prior to the attack, they are continued and only adjusted after the attack has resolved.

Probenecid (Benemid) and sulfinpyrazone (Anturane) are medications that are commonly used to decrease uric acid blood levels by increasing the excretion of uric acid into the urine. Since these drugs can, in rare instances, cause kidney stones, they should be avoided by those patients with a history of kidney stones. These medications should be taken with plenty of fluid so as to promote the rapid passage of uric acid out of the urinary system in order to prevent kidney stone formation.

Allopurinol lowers the blood uric acid level by preventing uric acid production. It actually blocks the metabolic conversion from purines in foods to uric acid. This medication is used with caution in patients with poor kidney function, as they are at a particular risk of developing side effects, including severe rash and liver damage.

Febuxostat was approved by the U.S. Food and Drug Administration (FDA) for the chronic management of hyperuricemia from gout in 2009. Febuxostat has been shown to be more effective than allopurinol in preventing acute attacks of gouty arthritis and is effective in shrinking tophi deposits of uric acid in the tissues such as the fingers, elbows, and ears. Because febuxostat is not significantly metabolized by the kidneys, it may have advantages over allopurinol in patients with underlying kidney disease. While taking febuxostat, patients have uric acid and liver function blood tests monitored regularly.

Again, uric acid-lowering medications such as allopurinol and febuxostat are generally not started in patients who are having acute attacks of gout. These medications, when started during an acute attack, actually can worsen the acute inflammation. Therefore, uric acid-lowering drugs are usually instituted only after complete resolution of the acute arthritis attacks, but if patients are already taking these medications, they are maintained at the same doses during the acute attacks. In some patients, increasing the dose of uric acid-lowering medications can precipitate gout attacks. In these patients, low doses of colchicine can be given to prevent the precipitation of acute gout.

It is essential to monitor the blood level of uric acid regularly once uric acid-lowering medications are used for optimal maintenance, as the uric acid metabolism can change over time.

Home remedies which can alleviate the symptoms of acute gout include resting and elevating the inflamed joint. Ice-pack applications can be helpful to reduce pain and decrease inflammation. Patients should avoid aspirin-containing medications, when possible, because aspirin prevents kidney excretion of uric acid.

What does the future hold for patients with gout and hyperuricemia?

Active research is ongoing in a variety of fields related to gout and hyperuricemia. The management of the chronic gouty disease and its relationship to improving blood pressure and kidney function is becoming better defined.

Scientists recently reported that high animal protein intake slightly increased the risk for gout. Others found that dietary calcium intake may protect patients from getting gout attacks. Vitamin C may also lower blood uric acid levels.

New medications to increase the elimination of uric acid in the urine (such as benzbromarone) and lower uric acid blood levels (such as PEG-uricase) are being evaluated in clinical trials. Researchers are also reporting on experimental drugs that can affect the chemical messengers involved in gouty inflammation.

The optimal regimens for the treatment of acute gout attacks and chronic gout conditions still require further long-term studies. Research scientists will continue to develop less toxic and more effective medications to battle this "scourge of the ages."

Gout and Hyperuricemia At A Glance
  • Painful gouty arthritis is caused by uric acid crystal deposits in joint tissue.
  • Gout is a chronic, progressive disease.
  • The tendency to develop gout and elevated blood uric acid level (hyperuricemia) is often inherited.
  • Gout and hyperuricemia are aggravated by obesity, weight gain, alcohol intake, high blood pressure, fructose in corn syrup found in soft drinks, abnormal kidney function, and certain medications.
  • Gouty arthritis attacks can be precipitated by dehydration, injury, fever, heavy eating, heavy alcohol consumption, and recent trauma or surgery.
  • The most reliable diagnostic test for gout is the identification of crystals in joints, body fluids, and tissues.
  • The treatment of an attack of gouty arthritis is different than the treatment of hyperuricemia. There are two key concepts essential to treating gout. First, it is critical to stop acute inflammation of joints affected by gouty arthritis. Second, it is important to address the long-term management of the gout disease in order to prevent future gout arthritis attacks and shrink gouty tophi crystal deposits.