Powdered drink from local organic soymilk, bromo and Willis from varieties that have proven to be more nutritious and delicious taste of the imported soybean varieties.
Excellence SOYANATURA instant soybean powder, among others:
1. RESEARCH, SOYANATURA is the best treatment outcome and soy because it has been through research on soy for years.
2. Taste, taste guaranteed Soyanatura smoother, more and more delicious than Gurih soy other instant powder in the market for another product usually pays little attention to "sense" because of its processing technology is very conventional with the usual toasted method so that only sick people are forced to take it to terapy nutrition or treatment of the disease, while SOYANATURA liked by the children for more savory can even be eaten directly without menyedu water to taste like bread.
3. Local Non-transgenic soybean, made from local soybean Soyanatura choice (purple flowers) that is free of transgenic (genetically modified), more nutritious and taste more delicious than the soybean imports. Soybean imports in the producer countries (United States / China) through a process of transgenic or genetically engineered and grown with synthetic fertilizers and pesticides so that harvest more, larger seeds but did not consider nutrient content and taste because it's not for human food but for animal feed ingredients , ironically on imports to Indonesia to feed the people. Soyanatura should use locally grown soybean farmers in Yogyakarta, Central Java and East Java, which cooperates with CV.SOYANATURA plasma and is supported by the Ministry of Agriculture and Higher Education in Indonesia
4. Special Processing without Sangray, SOYANATURA modern processed without the sangray until able to maintain the main content of soy such as isoflavones and other essential amino acids that are beneficial for health.
5. With its natural processing can eliminate the protease inhibitor compounds (inhibitors of protein digestion in the body) and anti-nutrients present in raw soybean.
6. The smell fresher, SOYANATURA have a lighter flavor and delicious that would make a great daily drink. Unpleasant aroma (typical nuts) are not felt.
7. Natural without the addition of any chemicals either preservatives, dyes and artificial sweeteners (aspartame or cyclamate) or other additives to be safe for the body.
8. Durable without preservatives, SOYANATURA more durable, without preservatives can last longer than liquid soy milk.
9. Instant Truly, SOYANATURA only soy milk powder really instant, can menyedu with cold water (do not have hot water) directly dissolve without clumping like other products.
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11. Economical, SOYANATURA cheaper and more viscous than the liquid soybean milk purchased in units of the same drinks (liquid soybean milk sold in the market in general is very dilute) 12. Flexible, SOYANATURA can be presented in a practical and hiegenis with natural soy flavor, so you can add a sense of taste, such as added sugar, syrup, ginger, creamer, etc..
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Showing posts with label skin disease. Show all posts
Showing posts with label skin disease. Show all posts
The first and second pregnancies do not get too close, can cause Autism Risk
* Social interaction
* Communication (language and speech)
* Behavioral-emotional
* Pattern play
* Sensory and motor disturbances
* Delayed or abnormal development.
These symptoms begin to appear from birth or during childhood, usually before the child is 3 years old.
Autism in the Diagnostic and Statistical Manual of Mental Disorder R-IV is one of five types of disorders under the umbrella of PDD (Pervasive Development Disorder) outside of ADHD (Attention Deficit Hyperactivity Disorder) and ADD (Attention Deficit Disorder).
The cause of autism has not yet been resolved. A new study says the time of birth play a role in autism. Proximity within a range of birth with the oldest siblings tend to be diagnosed with autism.
In an article in the journal Pediatrics, the second child was conceived within a year of birth of their older brothers, three times more likely to be diagnosed with autism than the brother who was conceived in more than three years after their brother was born.
Researchers see the records of babies born in California between 1992 and 2002 and examine the possibility of autism more than 660,000 children a second. They found, further pregnancy, tend to lower the risk of autism in children if the distance is more than three years.
Compared with children who are conceived more than three years after their oldest brother was born, the child who was conceived 12 months to 23 months after the previous birth, two times more likely to be diagnosed with autism and children conceived after 24 months to 35 months is one to one-quarter more likely to be diagnosed .
The author of this study did not know why the time of pregnancy and autism are linked, but they suggest some factors that may be to blame, although they did not test it. Some possible causes are low levels of nutrients such as folate and iron, and higher stress levels. Results are recorded low birth weight, premature birth, and age of parents, the article said.
This finding is very important because the number of babies born within two years of their siblings increased, rising from 11 percent in 1992 to 18 percent in 2002. (Various sources)
Vascular disease
Vascular disease is the second leading cause of dementia, after Alzheimer's disease. Vascular disease can be prevented and treated, with increased vigilance and control of vascular factors, so that the incidence of dementia can be derived.
New little is known about the underlying cause of this vascular disease. Several studies in the U.S. reported a picture of the incidence of specific for vascular disease, and have been able to identify risk factors that berhubungan2.
At the end of the 19th century, Otto Biswanger and Alois Alzheimer studied the relationship between vascular pathology and reduced cognitive ability. Seventy years later, Tomlisson and equip Blessed with more systematic studies showing the relationship between vascular pathology with dementia.
In 1974, Hachinski introduce the term multi-infarct dementia (MID) to emphasize that unlicensed infarct dementia is associated with cerebral blood vessels both large and small vessels. Then the researchers use the term vascular dementia (VAD), which helps the doctors to consider a variety of vascular pathologies, including hemorrhage, which can cause dementia.
Recently, the researchers introduced isitlah vascular cognitive impairment (VCI) in order to expand the concept further. Intended that vascular disease can cause a cognitive deficit on the scale of mild to severe, and early recognition of these deficits to help clinicians to intervene before demesia terjadi1.
Incidence and reported VAD prevalence varies by study population, the detection method, the diagnosis criteria used and the period of observation time. Vascular dementia estimated to contribute 10% - 20% of all cases of dementia.
Data from European countries reported prevalence of 1.6% in the age group over 65 years with incidence of 3.4 per 1000 people per year. Research in Lundby in Sweden disclose the lifetime risk of developing VAD 34.5% in men and 19.4% in women when all levels of cognition disorders included in the calculation.
It has long been known that cognitive deficits can occur after a stroke. Recent research has shown that dementia occurs at an average of a quarter to a third of stroke cases.
The prevalence of all forms of dementia including vascular demesia, increased with age. In Europe, prevalence of vascular dementia is estimated around 1.5-4.8% in individuals aged between 70 and 80 years.
Recent research has also shown a link between a genetic factor € apolipoprotein E4 with vascular damage and cerebrovascular disease. DeCarli et. ApoE4 al found that the increase in cardiovascular patients and also in stroke patients. ApoE4 will cause changes in serum cholesterol, and LDL levels.
ApoE4 also played a part in forming arterosklerosis7. ApoE4 will assist hemostasis of cholesterol, and is a component of chylomicrons, VLDL, and their degradation products. Some receptors in liver recognize apoE, including receptor LDL, LDL receptor-bound protein, and receptor VLDL8. Research conducted by DeLeewu et. al concluded that patients with the ApoE4 are at high risk for lesions in substansia alba when he also suffered from hypertension.
In a recent study conducted Kokobu et al, reported an association between ApoE4 with subarachnoid hemorrhage. This makes the allegation that the ApoE4 play a role in response to the trauma of the central nervous system 10.
The purpose of this paper is to provide a deep understanding of the study of vascular dementia in a comprehensive manner. Expected to not give knowledge of pathology and pathophysiology, risk factors, diagnosis criteria, examination and prevention of disease will help the clinician in making the diagnosis of vascular dementia patients, so management will be more focused and measurable.
DISCUSSION
DefinisiDemensia syndrome is a progressive decline in intellectual ability that causes cognitive and functional decline, causing disruption of social function of work, and activities harian.Demensia vascular (VAD) is a heterogeneous group that includes all of the dementia syndrome due to ischemia, hemorrhage, anoxic or hypoxic brain with cognitive impairment ranging from mild to the most severe and include all domains, not necessarily with memory disorders menonjol4. Broadly speaking VAD consists of three subtypes, namely:
1. VAD post-stroke, which includes strategic infarct dementia, multi-infarct dementia, stroke and bleeding. Usually has a clear time correlation between the occurrence of stroke with dementia.
2. Subcortical VAD which includes myocardial lakuner and Binswanger disease with the incidence of TIA or stroke is often not detected but have vascular risk factors.
3. Mixed type dementia, ie with the pathology of vascular dementia in combination with Alzheimer's dementia (AD).
While the division of clinical VAD is as follows:
1. Post-stroke VAD
Strategic infarct dementia: lesions in girus angularis, thalamus, basal forebrain, the posterior cerebral artery territory, and the anterior cerebral artery.
Multiple infarction dementia (MID)
Intracerebral hemorrhage
2. Subcortical VAD
Ischemic lesions substansia Alb
Lakuner subcortical infarction
Non-lakuner subcortical infarction
3. VAD type mixture of Alzheimer Disease and Cerebrovascular Disease.
Pathology and PatofisologiPatologi of vascular disease and cognitive changes have been studied. Various macroscopic and microscopic changes were observed. Some studies have successfully demonstrated the location of the tendency of pathological lesions, that is bilateral and involves the large blood vessels (cerebral arteries anterior and posterior cerebral arteries).
Other studies demonstrate the existence of lakuna-lakuna in the brain such as in the anterolateral and medial thalamus, which is associated with severe neuropsychological deficits. Some strategic locations including substansia alba frontal or basal forebrain of, basal ganglia, internal capsule, genu of the hippocampus, mamillary bodies, midbrain and the pons. At microscopic analysis of change - change in Alzheimer's type (neurofibrillary tangles and senile plaques) was found as well so that will complicate the picture. The term dementia is used when a good mixture and degeneration of the vascular changes contribute to the decline kognisi1.
Patoisiologi mechanism whereby vascular pathology causing cognitive damage is unclear. This can be explained that in reality several different vascular pathologies can cause cognitive damage, including brain embolism thrombosis heart, and abnormalities substansia perdarahan.Peran of alba as a cause of cognitive dysfunction has been known. A recent study of pathology substansia alba in 40 cases with vascular dementia showed:
1. Pathology focal infarct area includes broad and narrow at substansia alba
2. Diffuse pathology substansia alba involving rarefaction surrounded perifokal infarction and substansia alba without infarction.
ResikoFaktor-factor risk factors have been studied by several scientists in 4 years.
They share that risk factors into 4 categories:
1. Demographic factors, including the old age, race and ethnicity (Asian, Africo-American), gender (male), low education, rural area.
2. Atherogenic factors, including the hypertension, cigaret smoking, cardiovascular disease, diabetes, hyperlipidemia, carotid noisy, menopause without estrogen replacement therapies, and the picture of the abnomal ECG.
3. Non-atherogenic factors, including the genetic, changes in hemostatis, high alcohol consumption, aspirin use, psychologic stress, exposure to job-related substances (pesticides, herbicides, plastics), socio-economics.
4. Factors related to stroke including the volume of brain tissue loss, and the number and location of infarction.
Sex is a factor that remains controversial, and some studies have found no difference in gender. Everything can be affected in the same comparison.
Genetics is also an influential factor. Arteriopati cerebral autosomal dominant with subcortical infarcts and leukoencepalopati (CADASIL) is a genetic disease involving a mutation Notch 3, causing subcortical infarcts and dementia in 90% of affected patients who ultimately died with this condition.
History of previous stroke is an important risk factor in vascular dementia. Not only associated with an area and the number of infarcts, but also location and even single strategic lesions can lead to demensia1.Katzman et.al have reported risk of vascular dementia are associated with a state of depression or psychological stress before.
Depression is a syndrome premonitori to VAD in patients with stroke, and also an important marker for damage to the otak.Hubungan between VAD and € 4 of the apoE alleles have been observed in several studies, and found that the presence of this allele is not only an specific marker for Alzheimer's Disease, but also connected with the repair process in the nervous system.
Frison et. al hypothesized that apoE plays a role in normal brain metabolism, and the presence of allele € 4 in a large amount of damage to the brain indicate the presence of either degenerative or vascular. However, since the diagnosis of VAD is set by using the NINDS-AIREN criteria, then the concurrency with Alzheimer's Disease is possible and explain the relationship with apoE.
Risks associated with exposure pepstisida and fertilizers have been confirmed in many previous studies, and explain the relationship with rural areas. The high incidence of VAD in rural areas also reported Liu et.al, and. relationship between this substance also present in Alzheimer's Disease and Parkinson's.
EtiologiBaru recently shown that vascular demesia not only due to the discret infarction (multi-infarct dementia), but also by a cerebrovascular condition. Several vascular disorders that can cause dementia, among others listed in the table on next page of this.
DiagnosisKriteria diagnostic criteria used today is the NINDS-AIREN (National Institute Neurological Disorders and of Stroke, and L'Association pour la Recherche et Internationale L'Enseignmement en Neurosciences), .1. Probable clinical diagnosis of VAD include all of the following: a) Demensiab) cerebrovascular disease (CVD) is characterized by focal neurologic deficit on physical examination such as hemiparese, lower facial muscle paralysis, Babinski reflex, sensory deficits, hemianopsia, disartria, etc..
Consistent with stroke (with or without a history of stroke), and relevant evidence of CVD by brain imaging studies (CT scan or MRI) involves multiple large blood vessels of stroke or myocardial single vantage point (girus angularis, thalamus, basal forebrain, territory posterio cerebral artery and anterior), or multiple lakuner infarction in the basal ganglia and substantia alba substantia alba periventrikuler or extensive lesions, or a combination of abnormalities in atas.c) There is a relationship between the two problems above by one or more of the following circumstances: - Awitan dementia were within 3 months post stroke cognitive functions .- Deterioration of sudden or fluctuating, progressive cognitive deficits and are the stepwise.
2. Criteria for diagnosis of probable subcortical VAD:
A. Syndrome cognition that include both:
• disexecution syndrome: disturbance formulation purposes, initiation, planning, organizing, sequential, execution, set-shifting, maintain activity and abstraction.
Deterioration of memory function • cause occupational and social dysfunction are not caused by a physical disturbance due to a stroke.
B. CVD that include both:
CVD • which is evidenced by neuroimaging
• A history of neurological deficits as part of a CVD: hemiparese, parese facial muscle, a positive Babinski reflex, sensory disturbances, disartri, walking disturbances, extrapyramidal disorder associated with subcortical brain lesions.
Preview KlinisSesuai with NINDS-AIREN clinical picture of VAD are obtained as follows: A. The clinical features consistent with a diagnosis of probable VAD:
1. Walking disturbance (small steps, or marche a petit-fitting, magnetic, apraxic-ataxic gait or Parkinson's)
2. History miksi early and urinary complaints that were not caused by abnormalities urologi3. Changes in personality and mood, abulia and depression. Emotional incontinence, the symptoms of subcortical deficits include psychomotor retardation and impaired function of execution.
B. Clinical features which do not contribute to diagnosis of VAD
: 1. Memory deficits in early stages, deterioration of memory function and other cognitive disorders such as language (transkortikal sensory ataxia), motor skills (apraksia) and perception (agnosia) without any corresponding lesion on brain imaging.
2. No finding of focal neurologic deficit other than cognition disorders. Not found lesions on CT-scan or MRI of the head.
C. Clinical features which contribute to diagnose subcortical VAD:
1. Episodes of upper motor neuron lesion disorders (UMN) light as a mild paralysis, reflex asymmetry, and inkoordinasi.
2. Impaired walking at an early stage of dementia.
3. History of balance disorder, frequent falls, without cause
4. The urgency of early miksi not caused by urologic abnormalities
5. Disartri, disfagi and extrapyramidal symptoms
6. Behavior and psychological disorders such as depression, personality changes, emotional instability, and psychomotor retardation.
D. The picture does not support the diagnosis of subcortical VAD
1. Early Awitan progressive worsening of memory disorders and cognitive disturbances such as disfasia, dispraksi, and agnosia.
2. Nothing found related focal lesions on imaging
3. No finding of relevance to the cerebral lesion in the CT-scan or MRI1.7.
PemeriksaanPemeriksaan VAD generally include:
A. Medical history included
1. UmumWawancara medical history includes medical disorders can cause dementia, such as coronary heart disease, disorders of the heart valves, collagen of heart disease, hypertension, hyperlipidemia, diabetes, peripheral arteriosclerosis, hypothyroidism., Neoplasms, chronic infections (syphilis, AIDS)
2. History umumWawancara Neurology neurology history as a history of stroke, TIA, head injury, central nervous system infection, history of epilepsy and brain surgery because of tumor or hydrocephalus. Accompanying symptoms of dementia such as sensory motor disturbances, impaired walking, coordination and balance disturbances are sudden in the early phase of focal neurologic deficit suggests that lead to VAD.
3. NeurobehaviourInformasi history of the family about the decline in cognition fuingsi, glittering intellectual abilities of daily activities and behavior change is very important in the diagnosis of dementia.
4. History of psychiatric psikiatrikRiwayat important to determine whether patients experienced depression, psychosis, personality changes, aggressive behavior, delusions, hallucinations, paranoid thoughts, and whether this disorder occurs before or after awitan dementia.
5. History poisoning, nutrition, drug-obatan.Keracunan heavy metals, pesticides, glue, and fertilizer, nutritional deficiencies, chronic alcohol consumption can lead to dementia, although not specific to VAD. The use of drugs antidepressants, anticholinergics and herb also may interfere with cognition.
6. History keluargaPemeriksa must explore all the incidence of dementia in the family.
B. Objective examination include:
1. Physical examination appearance umumMeliputi observation, vital signs, arteriosclerosis, vascular risk factors.
2. Examination neurologisGangguuan walking, impaired strength, tone or motor control, sensory disturbance and visual field of the brain nerve disorders, balance disorders and impaired reflexes.
3. MentalPemeriksaan cognitive status examination mental status include memory, orientation, language, cortical function, associated with arithmetic, writing, the praxis, gnosis, visuospasial, and visuopersepsi.
4. Inspection activities fungsionalAdalah real performance examination persons in everyday life activities as premorbid or current.
5. This psikiatrikPemeriksaan examination to determine the mental condition of persons with dementia, whether he is suffering from depression, delirium., Anxiety or psychotic symptoms.
Therapy Management
A. FarmakologikPenderita therapy with cerebrovascular disease risk factors such as hypertension, diabetes mellitus, heart disease, atherosclerosis, arteriosclerosis, dyslipidemia, and smoking, should control the disease well and improving lifestyles. Regular control of primary disease can improve the function of vascular dementia kognisinya.Terapi simptomatikPada the cholinergic neurotransmitter decline so that cholinesterase inhibitors can be given. Recent studies show this class of drugs may stabilize fiungsi improve cognition and daily activities in patients with mild and moderate vascular dementia. Cholinergic side effects that need attention are nausea, vomiting, diarrhea, bradycardia and supraventricular conduction disorders. B. Therapy of non-farmakologisBertujuan to maximize / maintain cognitive function is still there.
The program must be made on an individual basis include interventions to patients themselves, caregivers and the environment, according to the stages of the disease and resources available.
The intervention of the patient includes:
1. Healthy behavior
2. Rehabilitation therapy, is the reality orientation, cognitive stimulation, reminiscent, movement and train the brain and other sports, education, counseling, music therapy, speech therapy and occupational.
3. Environmental interventions, carried out through spatial facilitation activities, tarapi light, the provision of care facilities, day care center, nursing home, and respite center.
Mood and behavioral disorders found in patients with vascular dementia can vary according to location of the damaged brain function. Symptoms that often arises is depression, agitation, hallucinations, delusions, anxiety, violence, trouble sleeping and wandering (walking to and fro). Before starting pharmacological therapy, non-pharmacological therapy should be conducted first to control this disorder but in practice is often necessary a combination of both methods of therapy. It is important to carefully analyze every symptom that arises, is there any behavioral or psychiatric symptoms related to physical conditions (pain), situation (crowded, forced, etc.) or solely due penyakitnya3.DepresiPasien vascular dementia with depression showed severe functional impairment that labih compared with dementia of Alzheimer's patients without depression. Antidepressants can improve depressive symptoms, reduce disability but does not improve cognition disorders.
Handling of non-pharmacological;
1. Giving encouragement of inactivity.
2.Menghindari complex task.
3.Bersosialisasi to reduce depression.
4.Konseling with a psychiatrist.
Management pharmacologic therapy:
1.Semua antidepressants mampunyai the same effectiveness and onset of action within a specified period (about 2 weeks) in the treatment of depression.
2.Pemilihan appropriate medication based on a history of previous drug response, drug side effects and drug interactions.
3. Antidepressants that can be used in patients with vascular dementia, among others
a. Group Selective serotonin reuptake inhibitors (SSRIs). This group has a high tolerability in elderly patients larena without anticholinergic effects and cardiotoxic, orthostatic hypotension is minimal effect
b. Group Reversible MAO-A inhibitors (RIMA)
c. NASSA4 Group. Class of atypical antidepressants
d. Tricyclic class. Not recommended for the elderly because of the effects agitasi.Sebagian sampingnya.Ansietas and vascular dementia patients can be hypersensitive to the surrounding events.
Management of non-pharmacological therapy:
1.Usahakan home environment calm and stable.
2.Tanggapi patients with patience and loving
3.Buatlah constructive activities for the supply of restless.
Caffeinated beverages 4.Hindari unbtuk help reduce symptoms of anxiety and restlessness.
Management pharmacological therapy:
1. Ansiolitik bezodiazepin particularly useful, especially for short-term therapy is not too severe anxiety or agitation.
2. Neuroleptics is indicated in severe agitation, completely unable to sleep, great anxiety, hallucinations or delusions.
3. Antidepressants especially SSRIs and trazadone also effective in treating agitation.
Sleep disturbance
Sleep disorders in patients with vascular dementia often lead to caregiver often waking at night. Some useful practical guide for caregivers (caregiver) are:
1. Give activity during the day
2. Avoid naps if possible
3.Kurangi drink before bed
4. Try daytime exposure to sunlight
PencegahanManajemen of risk factors has a target at various levels, depending on the medical background of patients and where patients are in the course of disease. Chui et. al propose an integrated classification of vascular brain injury, based on the treatment strategy. For each case, clinicians should focus systematically on specific treatment strategies, aimed at primary prevention (risk factors), secondary prevention (the basic mechanisms of vascular brain damage) and tertiary prevention (in cases where there is functional impairment). This classification also emphasizes the need for early detection of patients with minimal cognitive disorders who are at risk of developing dementia uintuk. These patients will receive benefit from treatment agresif1.
CONCLUSIONS AND SUGGESTIONS
1. Vascular dementia is a form that can be reduced incidence of dementia by controlling risk factors, and also the underlying disease.
2. The need for a comprehensive treatment of vascular dementia patients.
3. Need further studies to explore risk factors that influenced the incidence of vascular dementia
New little is known about the underlying cause of this vascular disease. Several studies in the U.S. reported a picture of the incidence of specific for vascular disease, and have been able to identify risk factors that berhubungan2.
At the end of the 19th century, Otto Biswanger and Alois Alzheimer studied the relationship between vascular pathology and reduced cognitive ability. Seventy years later, Tomlisson and equip Blessed with more systematic studies showing the relationship between vascular pathology with dementia.
In 1974, Hachinski introduce the term multi-infarct dementia (MID) to emphasize that unlicensed infarct dementia is associated with cerebral blood vessels both large and small vessels. Then the researchers use the term vascular dementia (VAD), which helps the doctors to consider a variety of vascular pathologies, including hemorrhage, which can cause dementia.
Recently, the researchers introduced isitlah vascular cognitive impairment (VCI) in order to expand the concept further. Intended that vascular disease can cause a cognitive deficit on the scale of mild to severe, and early recognition of these deficits to help clinicians to intervene before demesia terjadi1.
Incidence and reported VAD prevalence varies by study population, the detection method, the diagnosis criteria used and the period of observation time. Vascular dementia estimated to contribute 10% - 20% of all cases of dementia.
Data from European countries reported prevalence of 1.6% in the age group over 65 years with incidence of 3.4 per 1000 people per year. Research in Lundby in Sweden disclose the lifetime risk of developing VAD 34.5% in men and 19.4% in women when all levels of cognition disorders included in the calculation.
It has long been known that cognitive deficits can occur after a stroke. Recent research has shown that dementia occurs at an average of a quarter to a third of stroke cases.
The prevalence of all forms of dementia including vascular demesia, increased with age. In Europe, prevalence of vascular dementia is estimated around 1.5-4.8% in individuals aged between 70 and 80 years.
Recent research has also shown a link between a genetic factor € apolipoprotein E4 with vascular damage and cerebrovascular disease. DeCarli et. ApoE4 al found that the increase in cardiovascular patients and also in stroke patients. ApoE4 will cause changes in serum cholesterol, and LDL levels.
ApoE4 also played a part in forming arterosklerosis7. ApoE4 will assist hemostasis of cholesterol, and is a component of chylomicrons, VLDL, and their degradation products. Some receptors in liver recognize apoE, including receptor LDL, LDL receptor-bound protein, and receptor VLDL8. Research conducted by DeLeewu et. al concluded that patients with the ApoE4 are at high risk for lesions in substansia alba when he also suffered from hypertension.
In a recent study conducted Kokobu et al, reported an association between ApoE4 with subarachnoid hemorrhage. This makes the allegation that the ApoE4 play a role in response to the trauma of the central nervous system 10.
The purpose of this paper is to provide a deep understanding of the study of vascular dementia in a comprehensive manner. Expected to not give knowledge of pathology and pathophysiology, risk factors, diagnosis criteria, examination and prevention of disease will help the clinician in making the diagnosis of vascular dementia patients, so management will be more focused and measurable.
DISCUSSION
DefinisiDemensia syndrome is a progressive decline in intellectual ability that causes cognitive and functional decline, causing disruption of social function of work, and activities harian.Demensia vascular (VAD) is a heterogeneous group that includes all of the dementia syndrome due to ischemia, hemorrhage, anoxic or hypoxic brain with cognitive impairment ranging from mild to the most severe and include all domains, not necessarily with memory disorders menonjol4. Broadly speaking VAD consists of three subtypes, namely:
1. VAD post-stroke, which includes strategic infarct dementia, multi-infarct dementia, stroke and bleeding. Usually has a clear time correlation between the occurrence of stroke with dementia.
2. Subcortical VAD which includes myocardial lakuner and Binswanger disease with the incidence of TIA or stroke is often not detected but have vascular risk factors.
3. Mixed type dementia, ie with the pathology of vascular dementia in combination with Alzheimer's dementia (AD).
While the division of clinical VAD is as follows:
1. Post-stroke VAD
Strategic infarct dementia: lesions in girus angularis, thalamus, basal forebrain, the posterior cerebral artery territory, and the anterior cerebral artery.
Multiple infarction dementia (MID)
Intracerebral hemorrhage
2. Subcortical VAD
Ischemic lesions substansia Alb
Lakuner subcortical infarction
Non-lakuner subcortical infarction
3. VAD type mixture of Alzheimer Disease and Cerebrovascular Disease.
Pathology and PatofisologiPatologi of vascular disease and cognitive changes have been studied. Various macroscopic and microscopic changes were observed. Some studies have successfully demonstrated the location of the tendency of pathological lesions, that is bilateral and involves the large blood vessels (cerebral arteries anterior and posterior cerebral arteries).
Other studies demonstrate the existence of lakuna-lakuna in the brain such as in the anterolateral and medial thalamus, which is associated with severe neuropsychological deficits. Some strategic locations including substansia alba frontal or basal forebrain of, basal ganglia, internal capsule, genu of the hippocampus, mamillary bodies, midbrain and the pons. At microscopic analysis of change - change in Alzheimer's type (neurofibrillary tangles and senile plaques) was found as well so that will complicate the picture. The term dementia is used when a good mixture and degeneration of the vascular changes contribute to the decline kognisi1.
Patoisiologi mechanism whereby vascular pathology causing cognitive damage is unclear. This can be explained that in reality several different vascular pathologies can cause cognitive damage, including brain embolism thrombosis heart, and abnormalities substansia perdarahan.Peran of alba as a cause of cognitive dysfunction has been known. A recent study of pathology substansia alba in 40 cases with vascular dementia showed:
1. Pathology focal infarct area includes broad and narrow at substansia alba
2. Diffuse pathology substansia alba involving rarefaction surrounded perifokal infarction and substansia alba without infarction.
ResikoFaktor-factor risk factors have been studied by several scientists in 4 years.
They share that risk factors into 4 categories:
1. Demographic factors, including the old age, race and ethnicity (Asian, Africo-American), gender (male), low education, rural area.
2. Atherogenic factors, including the hypertension, cigaret smoking, cardiovascular disease, diabetes, hyperlipidemia, carotid noisy, menopause without estrogen replacement therapies, and the picture of the abnomal ECG.
3. Non-atherogenic factors, including the genetic, changes in hemostatis, high alcohol consumption, aspirin use, psychologic stress, exposure to job-related substances (pesticides, herbicides, plastics), socio-economics.
4. Factors related to stroke including the volume of brain tissue loss, and the number and location of infarction.
Sex is a factor that remains controversial, and some studies have found no difference in gender. Everything can be affected in the same comparison.
Genetics is also an influential factor. Arteriopati cerebral autosomal dominant with subcortical infarcts and leukoencepalopati (CADASIL) is a genetic disease involving a mutation Notch 3, causing subcortical infarcts and dementia in 90% of affected patients who ultimately died with this condition.
History of previous stroke is an important risk factor in vascular dementia. Not only associated with an area and the number of infarcts, but also location and even single strategic lesions can lead to demensia1.Katzman et.al have reported risk of vascular dementia are associated with a state of depression or psychological stress before.
Depression is a syndrome premonitori to VAD in patients with stroke, and also an important marker for damage to the otak.Hubungan between VAD and € 4 of the apoE alleles have been observed in several studies, and found that the presence of this allele is not only an specific marker for Alzheimer's Disease, but also connected with the repair process in the nervous system.
Frison et. al hypothesized that apoE plays a role in normal brain metabolism, and the presence of allele € 4 in a large amount of damage to the brain indicate the presence of either degenerative or vascular. However, since the diagnosis of VAD is set by using the NINDS-AIREN criteria, then the concurrency with Alzheimer's Disease is possible and explain the relationship with apoE.
Risks associated with exposure pepstisida and fertilizers have been confirmed in many previous studies, and explain the relationship with rural areas. The high incidence of VAD in rural areas also reported Liu et.al, and. relationship between this substance also present in Alzheimer's Disease and Parkinson's.
EtiologiBaru recently shown that vascular demesia not only due to the discret infarction (multi-infarct dementia), but also by a cerebrovascular condition. Several vascular disorders that can cause dementia, among others listed in the table on next page of this.
DiagnosisKriteria diagnostic criteria used today is the NINDS-AIREN (National Institute Neurological Disorders and of Stroke, and L'Association pour la Recherche et Internationale L'Enseignmement en Neurosciences), .1. Probable clinical diagnosis of VAD include all of the following: a) Demensiab) cerebrovascular disease (CVD) is characterized by focal neurologic deficit on physical examination such as hemiparese, lower facial muscle paralysis, Babinski reflex, sensory deficits, hemianopsia, disartria, etc..
Consistent with stroke (with or without a history of stroke), and relevant evidence of CVD by brain imaging studies (CT scan or MRI) involves multiple large blood vessels of stroke or myocardial single vantage point (girus angularis, thalamus, basal forebrain, territory posterio cerebral artery and anterior), or multiple lakuner infarction in the basal ganglia and substantia alba substantia alba periventrikuler or extensive lesions, or a combination of abnormalities in atas.c) There is a relationship between the two problems above by one or more of the following circumstances: - Awitan dementia were within 3 months post stroke cognitive functions .- Deterioration of sudden or fluctuating, progressive cognitive deficits and are the stepwise.
2. Criteria for diagnosis of probable subcortical VAD:
A. Syndrome cognition that include both:
• disexecution syndrome: disturbance formulation purposes, initiation, planning, organizing, sequential, execution, set-shifting, maintain activity and abstraction.
Deterioration of memory function • cause occupational and social dysfunction are not caused by a physical disturbance due to a stroke.
B. CVD that include both:
CVD • which is evidenced by neuroimaging
• A history of neurological deficits as part of a CVD: hemiparese, parese facial muscle, a positive Babinski reflex, sensory disturbances, disartri, walking disturbances, extrapyramidal disorder associated with subcortical brain lesions.
Preview KlinisSesuai with NINDS-AIREN clinical picture of VAD are obtained as follows: A. The clinical features consistent with a diagnosis of probable VAD:
1. Walking disturbance (small steps, or marche a petit-fitting, magnetic, apraxic-ataxic gait or Parkinson's)
2. History miksi early and urinary complaints that were not caused by abnormalities urologi3. Changes in personality and mood, abulia and depression. Emotional incontinence, the symptoms of subcortical deficits include psychomotor retardation and impaired function of execution.
B. Clinical features which do not contribute to diagnosis of VAD
: 1. Memory deficits in early stages, deterioration of memory function and other cognitive disorders such as language (transkortikal sensory ataxia), motor skills (apraksia) and perception (agnosia) without any corresponding lesion on brain imaging.
2. No finding of focal neurologic deficit other than cognition disorders. Not found lesions on CT-scan or MRI of the head.
C. Clinical features which contribute to diagnose subcortical VAD:
1. Episodes of upper motor neuron lesion disorders (UMN) light as a mild paralysis, reflex asymmetry, and inkoordinasi.
2. Impaired walking at an early stage of dementia.
3. History of balance disorder, frequent falls, without cause
4. The urgency of early miksi not caused by urologic abnormalities
5. Disartri, disfagi and extrapyramidal symptoms
6. Behavior and psychological disorders such as depression, personality changes, emotional instability, and psychomotor retardation.
D. The picture does not support the diagnosis of subcortical VAD
1. Early Awitan progressive worsening of memory disorders and cognitive disturbances such as disfasia, dispraksi, and agnosia.
2. Nothing found related focal lesions on imaging
3. No finding of relevance to the cerebral lesion in the CT-scan or MRI1.7.
PemeriksaanPemeriksaan VAD generally include:
A. Medical history included
1. UmumWawancara medical history includes medical disorders can cause dementia, such as coronary heart disease, disorders of the heart valves, collagen of heart disease, hypertension, hyperlipidemia, diabetes, peripheral arteriosclerosis, hypothyroidism., Neoplasms, chronic infections (syphilis, AIDS)
2. History umumWawancara Neurology neurology history as a history of stroke, TIA, head injury, central nervous system infection, history of epilepsy and brain surgery because of tumor or hydrocephalus. Accompanying symptoms of dementia such as sensory motor disturbances, impaired walking, coordination and balance disturbances are sudden in the early phase of focal neurologic deficit suggests that lead to VAD.
3. NeurobehaviourInformasi history of the family about the decline in cognition fuingsi, glittering intellectual abilities of daily activities and behavior change is very important in the diagnosis of dementia.
4. History of psychiatric psikiatrikRiwayat important to determine whether patients experienced depression, psychosis, personality changes, aggressive behavior, delusions, hallucinations, paranoid thoughts, and whether this disorder occurs before or after awitan dementia.
5. History poisoning, nutrition, drug-obatan.Keracunan heavy metals, pesticides, glue, and fertilizer, nutritional deficiencies, chronic alcohol consumption can lead to dementia, although not specific to VAD. The use of drugs antidepressants, anticholinergics and herb also may interfere with cognition.
6. History keluargaPemeriksa must explore all the incidence of dementia in the family.
B. Objective examination include:
1. Physical examination appearance umumMeliputi observation, vital signs, arteriosclerosis, vascular risk factors.
2. Examination neurologisGangguuan walking, impaired strength, tone or motor control, sensory disturbance and visual field of the brain nerve disorders, balance disorders and impaired reflexes.
3. MentalPemeriksaan cognitive status examination mental status include memory, orientation, language, cortical function, associated with arithmetic, writing, the praxis, gnosis, visuospasial, and visuopersepsi.
4. Inspection activities fungsionalAdalah real performance examination persons in everyday life activities as premorbid or current.
5. This psikiatrikPemeriksaan examination to determine the mental condition of persons with dementia, whether he is suffering from depression, delirium., Anxiety or psychotic symptoms.
Therapy Management
A. FarmakologikPenderita therapy with cerebrovascular disease risk factors such as hypertension, diabetes mellitus, heart disease, atherosclerosis, arteriosclerosis, dyslipidemia, and smoking, should control the disease well and improving lifestyles. Regular control of primary disease can improve the function of vascular dementia kognisinya.Terapi simptomatikPada the cholinergic neurotransmitter decline so that cholinesterase inhibitors can be given. Recent studies show this class of drugs may stabilize fiungsi improve cognition and daily activities in patients with mild and moderate vascular dementia. Cholinergic side effects that need attention are nausea, vomiting, diarrhea, bradycardia and supraventricular conduction disorders. B. Therapy of non-farmakologisBertujuan to maximize / maintain cognitive function is still there.
The program must be made on an individual basis include interventions to patients themselves, caregivers and the environment, according to the stages of the disease and resources available.
The intervention of the patient includes:
1. Healthy behavior
2. Rehabilitation therapy, is the reality orientation, cognitive stimulation, reminiscent, movement and train the brain and other sports, education, counseling, music therapy, speech therapy and occupational.
3. Environmental interventions, carried out through spatial facilitation activities, tarapi light, the provision of care facilities, day care center, nursing home, and respite center.
Mood and behavioral disorders found in patients with vascular dementia can vary according to location of the damaged brain function. Symptoms that often arises is depression, agitation, hallucinations, delusions, anxiety, violence, trouble sleeping and wandering (walking to and fro). Before starting pharmacological therapy, non-pharmacological therapy should be conducted first to control this disorder but in practice is often necessary a combination of both methods of therapy. It is important to carefully analyze every symptom that arises, is there any behavioral or psychiatric symptoms related to physical conditions (pain), situation (crowded, forced, etc.) or solely due penyakitnya3.DepresiPasien vascular dementia with depression showed severe functional impairment that labih compared with dementia of Alzheimer's patients without depression. Antidepressants can improve depressive symptoms, reduce disability but does not improve cognition disorders.
Handling of non-pharmacological;
1. Giving encouragement of inactivity.
2.Menghindari complex task.
3.Bersosialisasi to reduce depression.
4.Konseling with a psychiatrist.
Management pharmacologic therapy:
1.Semua antidepressants mampunyai the same effectiveness and onset of action within a specified period (about 2 weeks) in the treatment of depression.
2.Pemilihan appropriate medication based on a history of previous drug response, drug side effects and drug interactions.
3. Antidepressants that can be used in patients with vascular dementia, among others
a. Group Selective serotonin reuptake inhibitors (SSRIs). This group has a high tolerability in elderly patients larena without anticholinergic effects and cardiotoxic, orthostatic hypotension is minimal effect
b. Group Reversible MAO-A inhibitors (RIMA)
c. NASSA4 Group. Class of atypical antidepressants
d. Tricyclic class. Not recommended for the elderly because of the effects agitasi.Sebagian sampingnya.Ansietas and vascular dementia patients can be hypersensitive to the surrounding events.
Management of non-pharmacological therapy:
1.Usahakan home environment calm and stable.
2.Tanggapi patients with patience and loving
3.Buatlah constructive activities for the supply of restless.
Caffeinated beverages 4.Hindari unbtuk help reduce symptoms of anxiety and restlessness.
Management pharmacological therapy:
1. Ansiolitik bezodiazepin particularly useful, especially for short-term therapy is not too severe anxiety or agitation.
2. Neuroleptics is indicated in severe agitation, completely unable to sleep, great anxiety, hallucinations or delusions.
3. Antidepressants especially SSRIs and trazadone also effective in treating agitation.
Sleep disturbance
Sleep disorders in patients with vascular dementia often lead to caregiver often waking at night. Some useful practical guide for caregivers (caregiver) are:
1. Give activity during the day
2. Avoid naps if possible
3.Kurangi drink before bed
4. Try daytime exposure to sunlight
PencegahanManajemen of risk factors has a target at various levels, depending on the medical background of patients and where patients are in the course of disease. Chui et. al propose an integrated classification of vascular brain injury, based on the treatment strategy. For each case, clinicians should focus systematically on specific treatment strategies, aimed at primary prevention (risk factors), secondary prevention (the basic mechanisms of vascular brain damage) and tertiary prevention (in cases where there is functional impairment). This classification also emphasizes the need for early detection of patients with minimal cognitive disorders who are at risk of developing dementia uintuk. These patients will receive benefit from treatment agresif1.
CONCLUSIONS AND SUGGESTIONS
1. Vascular dementia is a form that can be reduced incidence of dementia by controlling risk factors, and also the underlying disease.
2. The need for a comprehensive treatment of vascular dementia patients.
3. Need further studies to explore risk factors that influenced the incidence of vascular dementia
Tropism
Tropism is part of the body movement of plants in which direction the movement is influenced by stimuli outside the body that comes from these plants.
Response of plants to external stimuli such padaumumnya
A. Change form
B. Movement
C. Change color
D. Latex production
Following stimulation from outside influence causing plant response, except:
A. Pest
B. Gravitation
C. Light
D. Water
Negative Geotropisme a response in plants in the form ....
A. Opening closed leaves at night
B. Shoot growth
C. The fall of the fruit from the stalks
D. Root growth
The roots of plants always grow downwards caused by stimulation:
A. Touch of soil
C. Gravity
B. Air Humidity
D. Light intensity
Closed leaves sikejut because touch merupakangerakan:
A. KemotaksisB. Fototropisme posistive
C. Negative Fototropisme
D. NastiJawaban
Which include irritability in plants is the following, except:
A. Sikejut leaves untouched contract
B. Leaf shoots grow towards light
C. Stem climbing to convolute
D. Trunk sway if it hit the water
Daughter leaves shut when touched is suatutanggapan ashamed to stimuli that include:
A. Tropism
C. Dynasty
B. Geotropisme
D. Fototropisme
Type of movement is classified iritabiltas are:
A. Tropism
C. Nasty
B. Taksis
D. All right
The motion is influenced by light stimuli is called:
A. Negative Fototropisme
B. Positive Fototropisme
C. KemotaksisD. FototropismeJawaban
Grain crops are grown shoots a motion:
A. Kemotaksis
B. Nasty
C. Positive Fototropisme
D. Negative Fototropisme
Response of plants to external stimuli such padaumumnya
A. Change form
B. Movement
C. Change color
D. Latex production
Following stimulation from outside influence causing plant response, except:
A. Pest
B. Gravitation
C. Light
D. Water
Negative Geotropisme a response in plants in the form ....
A. Opening closed leaves at night
B. Shoot growth
C. The fall of the fruit from the stalks
D. Root growth
The roots of plants always grow downwards caused by stimulation:
A. Touch of soil
C. Gravity
B. Air Humidity
D. Light intensity
Closed leaves sikejut because touch merupakangerakan:
A. KemotaksisB. Fototropisme posistive
C. Negative Fototropisme
D. NastiJawaban
Which include irritability in plants is the following, except:
A. Sikejut leaves untouched contract
B. Leaf shoots grow towards light
C. Stem climbing to convolute
D. Trunk sway if it hit the water
Daughter leaves shut when touched is suatutanggapan ashamed to stimuli that include:
A. Tropism
C. Dynasty
B. Geotropisme
D. Fototropisme
Type of movement is classified iritabiltas are:
A. Tropism
C. Nasty
B. Taksis
D. All right
The motion is influenced by light stimuli is called:
A. Negative Fototropisme
B. Positive Fototropisme
C. KemotaksisD. FototropismeJawaban
Grain crops are grown shoots a motion:
A. Kemotaksis
B. Nasty
C. Positive Fototropisme
D. Negative Fototropisme
Phloem, vascular, Photosynthesis
Phloem is a filter vessel which is a network carrier (vascular) that serves to circulate the sari - sari foods of photosynthesis, such as carbohydrates, amino - amino acids, oligopeptides and a number of lipid from the leaves to all parts of the plant.
vascular part is commonly called the cambium only. Usually restrict the pepagan cambium (bark) of wood in tree trunk columns. Go in, cambium will form timber vessels (xylem) and outward vascular cambium forming filters (phloem, phloem).
Photosynthesis is a biochemical process of formation of food substances or energy that is carried out glucose plants, algae, and some types of bacteria with nutrients, carbon dioxide, and water and sunlight needed energy aid.
Nearly all living things depend on energy produced in photosynthesis. As a result, photosynthesis becomes very important for life on earth.
Photosynthesis is also credited with producing most of the oxygen found in Earth's atmosphere. Organisms that produce energy through photosynthesis (photos meaning light) is called a fototrof.
Photosynthesis is one way of photosynthetic carbon assimilation due to free carbon from CO2 tied (fixed) into sugar as energy storage molecules. Another way taken by the organism to assimilate carbon is through chemosynthesis, which carried by a number of sulfur bacteria.
loem composed of several different cell types of filter vessel, the cell escort, parenchymal, fibers, and sklerenkim. Phloem is part of the bark.
Constituent element of phloem vessels consist of two forms, namely: cell filter (sieve plate) in the form of single cells and the elongated shape and reed filter (sieve tubes), a similar pipe. With this kind of filter vessels to distribute sugar, amino acid and the results of other photosynthesis from the leaves to all parts of the plant. In plants there are certain phloem fibers or fiber containing lignin.
These fibers can be used as a rope and textiles, for example, hemp (Boehmeria NIVEA), linen (Linum usitatissimum), and Jute (Corchorus capsularis). In the phloem translocation fotosintat happen. Translocation is the transfer of soluble material that can occur in all parts of the plant.
Vascular surgery was part of that includes vascular system of arterial, venous and lymphatic channels. Surgical vascular (blood vessel) experienced impressive progress over the last few decades. Many techniques and surgical procedures and safe efsien growing.
Similarly, diagnostic methods that can diagnose abnormalities of blood vessels early and the discovery of various synthetic blood vessels to replace damaged blood vessels or clogged leg vascular disorders in the form of obstruction or darh flow resistance, can be acute or chronic. The main cause of acute obstruction or resistance of blood vessels is a thrombosis, embolism and trauma. The cause of chronic arterial obstruction or obstacle in the legs most often is arteriosclerosis.
There was also a Bueger diseases included in the group of vascular inflammation. This disease is an inflammatory disease that kebanyakn occlusive young personal attack with the main risk factor is smoking. Subsequent chronic vascular disorders of Angiopati diabetic. Prevention of diabetic complications can be given health education a list of herus done dab should be avoided by patients. One of the main objectives for leg vascular surgery is to prevent amputation.
If it iini can be met then the influence of vascular surgery it is a pengguhan of amputation or a reduction of the number amputasi.Beberapa way nyat and vascular surgical techniques between lian Tromboendarterektomi, bypass surgery which can use synthetic material or vein autogen.
vascular part is commonly called the cambium only. Usually restrict the pepagan cambium (bark) of wood in tree trunk columns. Go in, cambium will form timber vessels (xylem) and outward vascular cambium forming filters (phloem, phloem).
Photosynthesis is a biochemical process of formation of food substances or energy that is carried out glucose plants, algae, and some types of bacteria with nutrients, carbon dioxide, and water and sunlight needed energy aid.
Nearly all living things depend on energy produced in photosynthesis. As a result, photosynthesis becomes very important for life on earth.
Photosynthesis is also credited with producing most of the oxygen found in Earth's atmosphere. Organisms that produce energy through photosynthesis (photos meaning light) is called a fototrof.
Photosynthesis is one way of photosynthetic carbon assimilation due to free carbon from CO2 tied (fixed) into sugar as energy storage molecules. Another way taken by the organism to assimilate carbon is through chemosynthesis, which carried by a number of sulfur bacteria.
loem composed of several different cell types of filter vessel, the cell escort, parenchymal, fibers, and sklerenkim. Phloem is part of the bark.
Constituent element of phloem vessels consist of two forms, namely: cell filter (sieve plate) in the form of single cells and the elongated shape and reed filter (sieve tubes), a similar pipe. With this kind of filter vessels to distribute sugar, amino acid and the results of other photosynthesis from the leaves to all parts of the plant. In plants there are certain phloem fibers or fiber containing lignin.
These fibers can be used as a rope and textiles, for example, hemp (Boehmeria NIVEA), linen (Linum usitatissimum), and Jute (Corchorus capsularis). In the phloem translocation fotosintat happen. Translocation is the transfer of soluble material that can occur in all parts of the plant.
Vascular surgery was part of that includes vascular system of arterial, venous and lymphatic channels. Surgical vascular (blood vessel) experienced impressive progress over the last few decades. Many techniques and surgical procedures and safe efsien growing.
Similarly, diagnostic methods that can diagnose abnormalities of blood vessels early and the discovery of various synthetic blood vessels to replace damaged blood vessels or clogged leg vascular disorders in the form of obstruction or darh flow resistance, can be acute or chronic. The main cause of acute obstruction or resistance of blood vessels is a thrombosis, embolism and trauma. The cause of chronic arterial obstruction or obstacle in the legs most often is arteriosclerosis.
There was also a Bueger diseases included in the group of vascular inflammation. This disease is an inflammatory disease that kebanyakn occlusive young personal attack with the main risk factor is smoking. Subsequent chronic vascular disorders of Angiopati diabetic. Prevention of diabetic complications can be given health education a list of herus done dab should be avoided by patients. One of the main objectives for leg vascular surgery is to prevent amputation.
If it iini can be met then the influence of vascular surgery it is a pengguhan of amputation or a reduction of the number amputasi.Beberapa way nyat and vascular surgical techniques between lian Tromboendarterektomi, bypass surgery which can use synthetic material or vein autogen.
Xylem, vascular Dementia
Xylem is a timber vessel which is a network carrier (vascular), which serves to transport the material - food ingredients from the root to the leaves for further processing
xylem is the tissue complex. Associated with the phloem and xylem tissue form of ongoing throughout the plant body. Xylem composed of several types of cells. Xylem can be derived from primary or secondary growth.
Xylem is composed of tracheid wood reed, jejari cells, fibers, and xylem parenchyma. Tracheid is pointed elongated cells, protoplasmanya dead soon after his cell was formed. Berpenebalan tracheid walls in many spiral or ring of lignocellulose, and often bernoktah. In certain plant species, for example in open seed plants, xylem is composed almost entirely by tracheid that form part of the main carrier.
Reed wood not a single cell but a long series of vertical tubes are composed of cells of the wood reed. Bernoktah wood reed walls and often have various types of thickening. Areas of thickening in the wall of wood and reeds add strength tracheid xylem tissue. Reed wood is a staple carrier structure in seed plants xylem mostly closed. Jejari cells mainly parenkimatis.
Vascular dementia is a form of dementia that can be pressed incidence is a way to control risk factors, and also the underlying disease.
xylem is the tissue complex. Associated with the phloem and xylem tissue form of ongoing throughout the plant body. Xylem composed of several types of cells. Xylem can be derived from primary or secondary growth.
Xylem is composed of tracheid wood reed, jejari cells, fibers, and xylem parenchyma. Tracheid is pointed elongated cells, protoplasmanya dead soon after his cell was formed. Berpenebalan tracheid walls in many spiral or ring of lignocellulose, and often bernoktah. In certain plant species, for example in open seed plants, xylem is composed almost entirely by tracheid that form part of the main carrier.
Reed wood not a single cell but a long series of vertical tubes are composed of cells of the wood reed. Bernoktah wood reed walls and often have various types of thickening. Areas of thickening in the wall of wood and reeds add strength tracheid xylem tissue. Reed wood is a staple carrier structure in seed plants xylem mostly closed. Jejari cells mainly parenkimatis.
Vascular dementia is a form of dementia that can be pressed incidence is a way to control risk factors, and also the underlying disease.
Avoid illness in children hyperactive and impulsive
Since the last twenty years centrality of Attention Disorders are often referred to as ADHD (attention deficit hyperactive disorders. This disorder is characterized by the inability of children to concentrate on something that is encountered, so that his attention span is very short time compared to other children that age, usually accompanied by symptoms hyperactive and impulsive behavior. These disorders can interfere with the child's development in terms of cognitive, behavioral, socialization and communication.
Hyperactivity disorder is a disorder that is often encountered in behavioral disorders in children. In recent years hyperactivity disorder is a problem that was highlighted and a major concern in the medical community nor the general public .. The incidence of this disorder is around 30-10%, in the United States around 3-7% while in Germany, Canada and New Zealand about 5-10%. Diagnosis and Statistics Manual (DSM IV) mentions the prevalence of the incidence of ADHD in school age children ranging from 3 to 5 percent. Incidence rate in Indonesia is still not a definite figure, meskipujh this disorder seems to appear quite a lot happening.
Sometimes a child is only considered 'naughty' or 'stubborn' and 'stupid', so often handled incorrectly, such as the violence perpetrated by parents and teachers because of lack of insight and understanding of ADHD. There is a tendency more frequently in boys than girls.
In epidemiological incidence ratio with a ratio of 4: 1. But it seems the longer it seems incidence is increasing. Often found in pre-school age children and school age, there is a tendency of this complaint will be reduced after primary school age. Although not rare few clinical manifestations are found in adolescents or adults. ADHD is a developmental disorder that has onset of symptoms before age 7 years. After age children, will remain as a teenager or adult. It is estimated that people with ADHD will settle around 15-20% in adulthood.
About 65% will experience residual symptoms during adulthood or sometimes slowly disappearing. The incidence of adult ADHD at the age of about 2-7%. Predisposition of this disorder is 25 percent in families with parents who membakat.
Early detection of these disorders is very important to minimize the symptoms and consequences thereof in the future.
This should involve multiple levels of society. Among both medical and nonmedical. General practitioners, pediatricians and other clinicians associated with kesehatn child should be able to detect early risk factors and symptoms that occur. Clinical manifestations that occur can arise at an early age but the symptoms will be evident at the start of school to do a diagnose to parents and teachers, to evaluate progress and directing the pattern of education and parenting a child with hyperactive when it can be done early detection and treatment at an early stage.
DEFINITIONS
In normal children often show signs of: lack of attention, easily distracted, emotional explosiveness even excessive activity. It's just that in children with ADHD disorder, these symptoms are more frequent and heavier quality than a normal child his age.
The pattern of children's attention to a case is divided into several classifications. The most severe group is exclusive over which a child is only focused on something that caught his attention without regard to other things to extremes (such as in infants who are considering ignoring her buttons and other stimuli), this pattern is called autism. The group with the degree of focus of attention is going easily distracted child. Attention can only survive a few moments just by other stimuli that may not be adequate.
This is called the difficulty of attention (attention deficit hyperactivity disorder). Normal conditions is the best pattern because children are able to notice something and divert it to the other at the right time without losing the power of concentration, this pattern is a normal pattern of mental development of children are mature.
The definition of hyperactivity is an increase in motor activity up to a certain extent the cause behavioral disturbances that occurred, at least at two places and a different atmosphere.
Child activities that are not common and tend to be characterized by excessive anxiety disorders, always waving fingers, feet, pencil, can not sit still and always left his seat even though at the time where he should sit quietly degan.
Other terminology used includes several behavioral disorders include: bubbling feelings, excessive activity, likes to make trouble, defying persistent and destructive.
Temperament of a child is a living and dynamic characteristics, though sometimes in a child is more dynamic than other children. If there is an excessive increase in motor activity on a child than other children her age, then often times 'the kids' complaints as hyperactive by their parents.
Such assessment is very subjective and depends on the standards used by parents in assessing a child's normal activity levels. The notion that the kids 'hyperactivity' may not be appropriate if only because the children showed signs of 'naughty' and 'making noise' at certain times but overall showed normal activity.
In the case of 'children are' precisely the parents who should be given the understanding and knowledge of how to properly guide and direct a child with a pattern of behavior that 'according to parents' excessive.
CAUSE
The exact cause and pathology of ADHD still have not been revealed clearly. As with autism disorder, ADHD is a statu multi-factorial disorder.
Many factors are considered as peneyebab this disorder, including genetic factors, brain development during pregnancy, during perinatal brain development, level of intelligence (IQ), the occurrence of metabolic dysfunction, lack of hormonal disorder, physical environment, social and patterns of child care by parents, teachers and influential people around him.
Many studies show the effectiveness of treatment with psychostimulants, which facilitate expulsion of dopamine and noradrenergic tricyclics. This condition mengungatkan sepukalsi disruption of brain areas associated with kekuirangan neurotransmitters. Thus, neurotransmitters dopamine and norepinephrine often diokaitkan with ADHD ..
Genetic factors appear to hold the biggest role of behavioral disturbances of ADHD. Several studies conducted found that the hyperactivity that occurs in a child is always accompanied by a history of similar disorders in families in which at least one close family.
Also found a third of people with hyperactive father also suffered from the same disorder in their childhood. Parents and relatives with ADHD at risk of 2-8 times more prone to occur with ADHD, monozygotic twins is more apt to occur with ADHD compared with dizygotic twins also showed the involvement of genetic fator in the ADHD disorder.
The involvement of genetic and chromosome is still not clearly known. Several genes associated with the code of dopamine receptors and serotonin production, including DRD4, DRD5, DAT, DBH, 5-HTT, and 5-HTR1B, many associated with ADHD.
Neuropsychological research indicating cortical circuits connecting the frontal and executive function hall ganglia. Catecholamines are the main neurotransmitter function associated with frontal lobe brain function.
Thus, dopaminergic and noradrenergic neurotransmission appears to be a major target in the treatment of ADHD.
Another theory mentions the possibility of a dysfunction of neuronal circuits in the brain that is affected by the neurotransmitter dopamine as the originator of the movement and as self-control activities. Due to minimal brain disorder, which causes the occurrence of resistance at the control system of the child's behavior.
In a study conducted by using MRI examinations obtained picture of brain dysfunction in the right mesial prefrontal region and striae Subcortical which implies the occurrence of barriers to responses that do not relefan and certain functions. In people with ADHD there is weakness of the brain activity of the lower right prefrontal cortex and left kaudatus related to the influence of delay time of motor responses to sensory stimuli.
Several other researchers reveal maturation theory of lack or a slowness in the process of development of children with ADHD. According to this theory, people can finally pursue his delay and this situation postulated would occur around the age of puberty. So these symptoms do not settle but only temporarily before the delay that occurred can be pursued.
Many researchers have ADHD patients with gastrointestinal disorders are often associated with the acceptance of certain food reactions. Theories about food allergies, Feingold theory which assumed that the salicylates have unfavorable effects on the child's behavior, as well as the theory that sugar is a substance that stimulates hyperactivity in children. Mentioned among others about the theory and ortomolecular megavitamin as therapy
Damage to brain tissue or a brain damage caused by trauma to primary and recurrent trauma in the same place. Both theories are worth considering as the cause of the hyperactivity syndrome which the author divided into three groups.
In this disorder structural deviation from the normal form due to a variety of reasons other than because of trauma. Another disturbance in the form of damage to the central nervous system (CNS) is anatomically as well as that caused by infection, bleeding and hypoxia.
Other changes occurred without any disruption of brain function and anatomical changes in the structure clear. This deviation caused the stimulus barrier or even the emergence of excessive stimulus that causes a significant deviation in the development of child relationships with parents and the surrounding environment.
The study by comparing the MRI images between children with ADHD and normal children, it produces a different picture, where in children with ADHD have a picture of the brain that is more symmetrical than the normal children who are generally more right brain than left brain.
With the radiologic examination of the brain PET (positron emission tomography) got the idea that in children with ADHD with hyperactivity disorder is more prevalent obtained excessive brain activity compared to normal children by measuring sugar levels (as a primary energy source of brain activity) that found a significant difference between patients with hyperactive and normal children.
RISK FACTORS
In the early detection of this behavior disorder it is necessary to know the risk factors that could lead to disruption of ADHD. Much research evidence shows the role of composition of the central nervous dysfunction (CNS). Thus, some abnormalities and disorders that occur after pregnancy, childbirth and childhood should be considered a risk factor.
During the period of gestation, the CNS dysfunction caused by metabolic disorders, genetic, infection, intoxication, drugs, smoking, alcohol and psychogenic factors. Diabetes and preeclampsia disease should also be observed.
At the time of delivery, caused by prematurity, post date, constraints, labor, labor induction, abnormal position (presentation babies), the side effects of therapy, immune system depression and trauma during vaginal birth. While the childhood period har5uis observed chronic gastrointestinal disorders, infections, trauma, medication therapy, poisoning, metabolic disorders, vascular disorders, psychological factors, malignancy and the occurrence of seizures. Accident history to be admitted to hospital, physical violence, verbal, emotional or feeling abandoned. Serious trauma, receive harsh treatment or miss something during childhood, not self-conscious or unconscious.
EARLY DETECTION OF SYMPTOMS hyperactive
To be able to have a disorder called ADHD, there should be three main symptoms that appear in the behavior of a child, namely inatensi, hyperactivity, and impulsivity. Inatensi or less concentration of attention can be seen from the failure of a child in giving full attention to something. Children are not able to maintain concentration on something, so easy to switch attention from one thing to another.
Symptoms can be seen from the behavior of hyperactive children who can not be silent. Sitting quietly is something that is difficult. He would get up and running, running to and fro, and even climb climb. In addition, he tends to talk a lot and cause noise.
Impulsive symptoms characterized by difficulty the child to delay the response. There is a kind of encouragement to say / do things that are not controlled. The drive is urged to be expressed immediately and without consideration. A concrete example of impulsive symptoms are impatient behavior.
Children will not be impatient to wait for the complete discussion. Children will interrupt the conversation or to rush to answer before the question submitted is complete. Children are also not able to wait their turn, like a queue for example. Another aspect of impulsivity is the son of a high potential for conducting activities that endanger, either for himself or others.
The third addition to the above symptoms, diagnosis can be given to hyperactive there are still some other conditions. Interference on already settled at least 6 months, and occurred before the children aged 7 years. These symptoms appeared at least in 2 situations, for example at home and at school.
Clinical manifestations that occur are very broad, ranging from mild to severe, or can occur with a minimal number of symptoms until more symptoms. The clinical presentation of ADHD can tampaknuya Sejas detected early infant age.
Symptoms that should be further examined at the age of the baby is a baby who is very sensitive to sound and light, crying, screaming, it's hard to be quiet, sleep time is very less and often woke up, colic, difficulty eating or drinking milk either breast milk or bottle., Can not appeased or held, refused to be loved, excessive salivation, sometimes as thirst is often asked for a drink, head banging (banging head, hitting the head, knocking his head backward) and often angry excessive.
Other complaints on big boy is the son looks Clumsy (awkward), impulsive, often have an accident or fall, odd behavior / change that annoying, constant movement or monotonous, more noisy than other children. Aggressive, Intellectual (IQ) but normal or high achievement in poor schools, lack of concentration when in school, excessive activity and not be silent, irritability and explosive temper, poor appetite. Bad hand / eye coordination., Hard working, rebellious and disobedient, like hurting yourself (pulling hair, skin hurt, hit the head etc) and sleep disorders.
Signs and symptoms in older children is an act which only focused on one thing only and are likely to act recklessly, easily confused, forget the lessons of school and work at home, difficulty doing tasks at school and at home, difficulties in listening, difficulty in performing some command, often let slip talk, impatient, noisy and convoluted speech, anxiety and overreacted, in a hurry, talkative and likes to make trouble, and like to cut the conversation and intervened speech of others
The above symptoms usually occur before age 7 years, experienced in 2 or more different atmosphere (at school, at home or in clinics, etc.), accompanied by a significant obstacle in the social, academic achievement and often wrong in putting something and can also arise in conjunction with the development disorder, schizophrenia or psychotic disorders lainnya20).
Other views on children with hyperactivity occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality. In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Approximately 50-60% of ADHD patients get sedkitnya one other comorbid behavioral disorders. Behavioral disorders are learning disorders, restless-legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorders, personality antisosia, substance abuse, conduction disorders and obsessive-compulsive behavior.
ADHD occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality.
In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Risk of ADHD that more increases if one brother or parents have ADHD or other psychological disorders. Posikologis and behavioral disorders include bipolar disorders, conduction disorders, depression, dissociative disorders, anxiety disorders, learning disorders, mood disorders, panic disorder, obsessive-compulsive disorder, panic disorder accompanied goraphobia.
Also lainnnya behavioral disorders such as developmental disorders perfasif including Asperger's disorder, Posttraumatic stress disorder (PTSD), Psychotic, Social phobia, ganggguan sleep, Tourette syndrome and ticks.
ADHD DIAGNOSIS
Diagnosis of hyperactivity can not be made solely based on biased information from the parents but at least people with information of schools, and the patient must do the examination even when checking the patient did not show signs of hyperactivity, considering the circumstances when the examination and possible other things that might form the trigger of hyperactivity.
In some cases even require psychometric examination and evaluation of education. Until now there is no one standard of physical and psychological examination for hyperactivity.
This means that clinical examination should be done very carefully, although not yet found a clear relationship between the type of examination conducted by the occurrence of hyperactivity. A variety of questionnaires can be arranged to help diagnose, but most importantly is a major concern and continuous examination, because it is not possible diagnosis is established only in a single examination.
When you get a child to age 6 to 12 years who show signs of hyperactivity with low academic achievement and behavioral disorders, the possibility should be evaluated early
To diagnose ADHD use the DSM IV criteria are also used, must have 3 symptoms: Hyperactivity, attention problems and conduction problems.
Hyperactivity disorder is a disorder that is often encountered in behavioral disorders in children. In recent years hyperactivity disorder is a problem that was highlighted and a major concern in the medical community nor the general public .. The incidence of this disorder is around 30-10%, in the United States around 3-7% while in Germany, Canada and New Zealand about 5-10%. Diagnosis and Statistics Manual (DSM IV) mentions the prevalence of the incidence of ADHD in school age children ranging from 3 to 5 percent. Incidence rate in Indonesia is still not a definite figure, meskipujh this disorder seems to appear quite a lot happening.
Sometimes a child is only considered 'naughty' or 'stubborn' and 'stupid', so often handled incorrectly, such as the violence perpetrated by parents and teachers because of lack of insight and understanding of ADHD. There is a tendency more frequently in boys than girls.
In epidemiological incidence ratio with a ratio of 4: 1. But it seems the longer it seems incidence is increasing. Often found in pre-school age children and school age, there is a tendency of this complaint will be reduced after primary school age. Although not rare few clinical manifestations are found in adolescents or adults. ADHD is a developmental disorder that has onset of symptoms before age 7 years. After age children, will remain as a teenager or adult. It is estimated that people with ADHD will settle around 15-20% in adulthood.
About 65% will experience residual symptoms during adulthood or sometimes slowly disappearing. The incidence of adult ADHD at the age of about 2-7%. Predisposition of this disorder is 25 percent in families with parents who membakat.
Early detection of these disorders is very important to minimize the symptoms and consequences thereof in the future.
This should involve multiple levels of society. Among both medical and nonmedical. General practitioners, pediatricians and other clinicians associated with kesehatn child should be able to detect early risk factors and symptoms that occur. Clinical manifestations that occur can arise at an early age but the symptoms will be evident at the start of school to do a diagnose to parents and teachers, to evaluate progress and directing the pattern of education and parenting a child with hyperactive when it can be done early detection and treatment at an early stage.
DEFINITIONS
In normal children often show signs of: lack of attention, easily distracted, emotional explosiveness even excessive activity. It's just that in children with ADHD disorder, these symptoms are more frequent and heavier quality than a normal child his age.
The pattern of children's attention to a case is divided into several classifications. The most severe group is exclusive over which a child is only focused on something that caught his attention without regard to other things to extremes (such as in infants who are considering ignoring her buttons and other stimuli), this pattern is called autism. The group with the degree of focus of attention is going easily distracted child. Attention can only survive a few moments just by other stimuli that may not be adequate.
This is called the difficulty of attention (attention deficit hyperactivity disorder). Normal conditions is the best pattern because children are able to notice something and divert it to the other at the right time without losing the power of concentration, this pattern is a normal pattern of mental development of children are mature.
The definition of hyperactivity is an increase in motor activity up to a certain extent the cause behavioral disturbances that occurred, at least at two places and a different atmosphere.
Child activities that are not common and tend to be characterized by excessive anxiety disorders, always waving fingers, feet, pencil, can not sit still and always left his seat even though at the time where he should sit quietly degan.
Other terminology used includes several behavioral disorders include: bubbling feelings, excessive activity, likes to make trouble, defying persistent and destructive.
Temperament of a child is a living and dynamic characteristics, though sometimes in a child is more dynamic than other children. If there is an excessive increase in motor activity on a child than other children her age, then often times 'the kids' complaints as hyperactive by their parents.
Such assessment is very subjective and depends on the standards used by parents in assessing a child's normal activity levels. The notion that the kids 'hyperactivity' may not be appropriate if only because the children showed signs of 'naughty' and 'making noise' at certain times but overall showed normal activity.
In the case of 'children are' precisely the parents who should be given the understanding and knowledge of how to properly guide and direct a child with a pattern of behavior that 'according to parents' excessive.
CAUSE
The exact cause and pathology of ADHD still have not been revealed clearly. As with autism disorder, ADHD is a statu multi-factorial disorder.
Many factors are considered as peneyebab this disorder, including genetic factors, brain development during pregnancy, during perinatal brain development, level of intelligence (IQ), the occurrence of metabolic dysfunction, lack of hormonal disorder, physical environment, social and patterns of child care by parents, teachers and influential people around him.
Many studies show the effectiveness of treatment with psychostimulants, which facilitate expulsion of dopamine and noradrenergic tricyclics. This condition mengungatkan sepukalsi disruption of brain areas associated with kekuirangan neurotransmitters. Thus, neurotransmitters dopamine and norepinephrine often diokaitkan with ADHD ..
Genetic factors appear to hold the biggest role of behavioral disturbances of ADHD. Several studies conducted found that the hyperactivity that occurs in a child is always accompanied by a history of similar disorders in families in which at least one close family.
Also found a third of people with hyperactive father also suffered from the same disorder in their childhood. Parents and relatives with ADHD at risk of 2-8 times more prone to occur with ADHD, monozygotic twins is more apt to occur with ADHD compared with dizygotic twins also showed the involvement of genetic fator in the ADHD disorder.
The involvement of genetic and chromosome is still not clearly known. Several genes associated with the code of dopamine receptors and serotonin production, including DRD4, DRD5, DAT, DBH, 5-HTT, and 5-HTR1B, many associated with ADHD.
Neuropsychological research indicating cortical circuits connecting the frontal and executive function hall ganglia. Catecholamines are the main neurotransmitter function associated with frontal lobe brain function.
Thus, dopaminergic and noradrenergic neurotransmission appears to be a major target in the treatment of ADHD.
Another theory mentions the possibility of a dysfunction of neuronal circuits in the brain that is affected by the neurotransmitter dopamine as the originator of the movement and as self-control activities. Due to minimal brain disorder, which causes the occurrence of resistance at the control system of the child's behavior.
In a study conducted by using MRI examinations obtained picture of brain dysfunction in the right mesial prefrontal region and striae Subcortical which implies the occurrence of barriers to responses that do not relefan and certain functions. In people with ADHD there is weakness of the brain activity of the lower right prefrontal cortex and left kaudatus related to the influence of delay time of motor responses to sensory stimuli.
Several other researchers reveal maturation theory of lack or a slowness in the process of development of children with ADHD. According to this theory, people can finally pursue his delay and this situation postulated would occur around the age of puberty. So these symptoms do not settle but only temporarily before the delay that occurred can be pursued.
Many researchers have ADHD patients with gastrointestinal disorders are often associated with the acceptance of certain food reactions. Theories about food allergies, Feingold theory which assumed that the salicylates have unfavorable effects on the child's behavior, as well as the theory that sugar is a substance that stimulates hyperactivity in children. Mentioned among others about the theory and ortomolecular megavitamin as therapy
Damage to brain tissue or a brain damage caused by trauma to primary and recurrent trauma in the same place. Both theories are worth considering as the cause of the hyperactivity syndrome which the author divided into three groups.
In this disorder structural deviation from the normal form due to a variety of reasons other than because of trauma. Another disturbance in the form of damage to the central nervous system (CNS) is anatomically as well as that caused by infection, bleeding and hypoxia.
Other changes occurred without any disruption of brain function and anatomical changes in the structure clear. This deviation caused the stimulus barrier or even the emergence of excessive stimulus that causes a significant deviation in the development of child relationships with parents and the surrounding environment.
The study by comparing the MRI images between children with ADHD and normal children, it produces a different picture, where in children with ADHD have a picture of the brain that is more symmetrical than the normal children who are generally more right brain than left brain.
With the radiologic examination of the brain PET (positron emission tomography) got the idea that in children with ADHD with hyperactivity disorder is more prevalent obtained excessive brain activity compared to normal children by measuring sugar levels (as a primary energy source of brain activity) that found a significant difference between patients with hyperactive and normal children.
RISK FACTORS
In the early detection of this behavior disorder it is necessary to know the risk factors that could lead to disruption of ADHD. Much research evidence shows the role of composition of the central nervous dysfunction (CNS). Thus, some abnormalities and disorders that occur after pregnancy, childbirth and childhood should be considered a risk factor.
During the period of gestation, the CNS dysfunction caused by metabolic disorders, genetic, infection, intoxication, drugs, smoking, alcohol and psychogenic factors. Diabetes and preeclampsia disease should also be observed.
At the time of delivery, caused by prematurity, post date, constraints, labor, labor induction, abnormal position (presentation babies), the side effects of therapy, immune system depression and trauma during vaginal birth. While the childhood period har5uis observed chronic gastrointestinal disorders, infections, trauma, medication therapy, poisoning, metabolic disorders, vascular disorders, psychological factors, malignancy and the occurrence of seizures. Accident history to be admitted to hospital, physical violence, verbal, emotional or feeling abandoned. Serious trauma, receive harsh treatment or miss something during childhood, not self-conscious or unconscious.
EARLY DETECTION OF SYMPTOMS hyperactive
To be able to have a disorder called ADHD, there should be three main symptoms that appear in the behavior of a child, namely inatensi, hyperactivity, and impulsivity. Inatensi or less concentration of attention can be seen from the failure of a child in giving full attention to something. Children are not able to maintain concentration on something, so easy to switch attention from one thing to another.
Symptoms can be seen from the behavior of hyperactive children who can not be silent. Sitting quietly is something that is difficult. He would get up and running, running to and fro, and even climb climb. In addition, he tends to talk a lot and cause noise.
Impulsive symptoms characterized by difficulty the child to delay the response. There is a kind of encouragement to say / do things that are not controlled. The drive is urged to be expressed immediately and without consideration. A concrete example of impulsive symptoms are impatient behavior.
Children will not be impatient to wait for the complete discussion. Children will interrupt the conversation or to rush to answer before the question submitted is complete. Children are also not able to wait their turn, like a queue for example. Another aspect of impulsivity is the son of a high potential for conducting activities that endanger, either for himself or others.
The third addition to the above symptoms, diagnosis can be given to hyperactive there are still some other conditions. Interference on already settled at least 6 months, and occurred before the children aged 7 years. These symptoms appeared at least in 2 situations, for example at home and at school.
Clinical manifestations that occur are very broad, ranging from mild to severe, or can occur with a minimal number of symptoms until more symptoms. The clinical presentation of ADHD can tampaknuya Sejas detected early infant age.
Symptoms that should be further examined at the age of the baby is a baby who is very sensitive to sound and light, crying, screaming, it's hard to be quiet, sleep time is very less and often woke up, colic, difficulty eating or drinking milk either breast milk or bottle., Can not appeased or held, refused to be loved, excessive salivation, sometimes as thirst is often asked for a drink, head banging (banging head, hitting the head, knocking his head backward) and often angry excessive.
Other complaints on big boy is the son looks Clumsy (awkward), impulsive, often have an accident or fall, odd behavior / change that annoying, constant movement or monotonous, more noisy than other children. Aggressive, Intellectual (IQ) but normal or high achievement in poor schools, lack of concentration when in school, excessive activity and not be silent, irritability and explosive temper, poor appetite. Bad hand / eye coordination., Hard working, rebellious and disobedient, like hurting yourself (pulling hair, skin hurt, hit the head etc) and sleep disorders.
Signs and symptoms in older children is an act which only focused on one thing only and are likely to act recklessly, easily confused, forget the lessons of school and work at home, difficulty doing tasks at school and at home, difficulties in listening, difficulty in performing some command, often let slip talk, impatient, noisy and convoluted speech, anxiety and overreacted, in a hurry, talkative and likes to make trouble, and like to cut the conversation and intervened speech of others
The above symptoms usually occur before age 7 years, experienced in 2 or more different atmosphere (at school, at home or in clinics, etc.), accompanied by a significant obstacle in the social, academic achievement and often wrong in putting something and can also arise in conjunction with the development disorder, schizophrenia or psychotic disorders lainnya20).
Other views on children with hyperactivity occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality. In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Approximately 50-60% of ADHD patients get sedkitnya one other comorbid behavioral disorders. Behavioral disorders are learning disorders, restless-legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorders, personality antisosia, substance abuse, conduction disorders and obsessive-compulsive behavior.
ADHD occurs affective disorganization, decreased self-control and excessive activity significantly. They usually act in 'reckless' and impulsive, irreverent, and likes to interrupt and interfere in other people's business. Often less noticed, is not able to concentrate and often do not complete the work on something and try to avoid jobs that require high power concentration, ignoring his toys or something, irritable, hard to get along and often unpopular with their peers.
Not infrequently those with this disorder accompanied by stunted growth and development, but we did not find a specific brain abnormality.
In general, their academic achievement is low and insecure. They often show an act of anti-social with a variety of reasons that parents, teachers and treat their environment by not precise and does not solve the problem.
Risk of ADHD that more increases if one brother or parents have ADHD or other psychological disorders. Posikologis and behavioral disorders include bipolar disorders, conduction disorders, depression, dissociative disorders, anxiety disorders, learning disorders, mood disorders, panic disorder, obsessive-compulsive disorder, panic disorder accompanied goraphobia.
Also lainnnya behavioral disorders such as developmental disorders perfasif including Asperger's disorder, Posttraumatic stress disorder (PTSD), Psychotic, Social phobia, ganggguan sleep, Tourette syndrome and ticks.
ADHD DIAGNOSIS
Diagnosis of hyperactivity can not be made solely based on biased information from the parents but at least people with information of schools, and the patient must do the examination even when checking the patient did not show signs of hyperactivity, considering the circumstances when the examination and possible other things that might form the trigger of hyperactivity.
In some cases even require psychometric examination and evaluation of education. Until now there is no one standard of physical and psychological examination for hyperactivity.
This means that clinical examination should be done very carefully, although not yet found a clear relationship between the type of examination conducted by the occurrence of hyperactivity. A variety of questionnaires can be arranged to help diagnose, but most importantly is a major concern and continuous examination, because it is not possible diagnosis is established only in a single examination.
When you get a child to age 6 to 12 years who show signs of hyperactivity with low academic achievement and behavioral disorders, the possibility should be evaluated early
To diagnose ADHD use the DSM IV criteria are also used, must have 3 symptoms: Hyperactivity, attention problems and conduction problems.
Genes, inheritance of properties for living organisms
Gene (from Dutch: the gene) is a unit of heredity for living organisms. Physical form is a DNA sequence that encodes a protein, polypeptide, or a strand of RNA that has a function for organisms that have them. Limitation of modern gene is a specific location on the genome associated with inheritance of properties and can be connected to function as a regulator (controlling), the target transcription, or other functional roles.
The use of "gene" in everyday conversations (eg "smart gene" or "hair color gene") is often intended to alleles: the variation of available options by a gene. Although the expression of alleles similar to, people more often use the term allele to the phenotypic expression of different genes. Genes inherited by an individual to their offspring through a process of reproduction, together with DNA that carry it. Thus, information that maintain the integrity of form and function of an organism's life can be maintained.
Or Genes are the basic substance of heredity that mengandnung genetic information, composed of nucleic acids (nukleo protein) and contained dilokus genes in the chromosome.
Prof. Christine Williams, of the University of Reading, said: "This is a very interesting study - although very small." He said he would be very useful to gain a better understanding of what genes are involved.
"Matches are also quite good with some of our own studies which indicate that certain genotypes are more responsive than others to certain types of fat, for example a diet high in omega-3 fatty acids," he added.
Genotype is the genetic makeup of an individual (something that can not be observed). The nature of an individual's genotype given the symbol with double letters. For example, genotype for trunked plant height = TT genotype for low-trunked plants = tt. The letter T and t is called gametes.
Genes are divided into two kinds, one is homozygous and there are also genes that are heterozygous genes. Homozygous is the nature of an individual who genotipnya consists of the same genes from each type of gene, such as AA and aa. Meanwhile, the heterozygote is the nature of an individual who genotipnya consists of genes that are different from each type of gene, such as Aa and Bb.
Outer shape or the properties that can be observed is called the phenotype. Phenotype is influenced by genes and environment. If the genes of a plant has a high character, but if the environment is not supportive, then the crop will not reach the height they should be. Phenotype not given a symbol, but is written according to appearances.
For example, red flower color, fruit-flavored sweet, tall or short stems. A red flower, called a red phenotype, and written genotifnya MM or Mm. Two individuals who have the same phenotypic characteristics do not necessarily have the same genotype. Genotifnya be homozygous can also heterozygous. For example, two high-trunked tree, can have TT or Tt genotype with phenotype similar.
Omega 3 helps overcome the pain? Researchers at the University of Pittsburgh Medical Center found that nearly two thirds of patients with chronic neck and back pain successfully overcome the problem by consuming this oil. After taking anti-pain pills in the form of fish oil pills, pain can be improved within 20-30 days. It's one of the functions of omega 3 which has the ability to fight inflammation.
Hopefully useful.
Controlling Oversecretion and the Disease
Pituitary tumors are the most commonly occurring intracranial neoplasm.1
Acromegaly is characterized by:2,3
* Chronic hypersecretion of growth factor (GH)
* Excessive synthesis of insulin-like growth factor 1 (IGF-1)
* Significant morbidities
* Increased mortality
Although surgery is first-line therapy in acromegaly, individuals who have had an unsuccessful prior surgery, are unsuitable surgical candidates, or have had a recurrence require medical management.
Current somatostatin analogs are widely used to treat patients with acromegaly, but they have therapeutic limitations:
* Efficacy is limited in some patients; approximately 30% to 40% of patients fail to achieve biochemical control, ie normalization of GH and IGF-1 levels4
* Antitumor activity is limited in some patients; approximately 37% achieve a significant reduction in tumor volume5,6
* Resistance to somatostatin-analog therapy may rarely occur due to the selective loss of the SST2 receptor which is the primary target of current anlaogs7
[Acromegaly: Controlling Oversecretion and the Disease]
Somatostatin Receptor Expression and Targeting
Analysis of somatostatin-receptor expression in cells from GH-secreting adenomas has shown that:8,9
* 96% express SST2
* 86% express SST5
* 44% express SST1 and SST3
* Antisecretory effects for GH are regulated by SST1, SST2, and SST5
Current somatostatin analogs bind with high affinity to only 1 of the 5 somatostatin receptors.10 Tumor-specific receptor expression profiles and the multiple signaling pathways regulating secretory function may explain why current somatostatin analogs sometimes fail to induce biochemical control in acromegaly. This is supported by data from a study of patients with acromegaly.7 Analysis of tumor tissue from patients who demonstrated a <50% reduction in GH level when treated with octreotide had no detectable SST2.7
Because of its rational design, pasireotide:10
* Binds to 4 of the 5 somatostatin receptors
* Does not bind significantly to other receptor families
* Potentially activates more receptor-regulated pathways than current analogs
* May provide improved biochemical and disease control in acromegaly
Pasireotide in Acromegaly: A Phase II Study
In a phase II study of patients with de novo or persistent active acromegaly, after 3 months of therapy with pasireotide:11
* 56% achieved GH levels of < 2.5 µg/L
* 49% had normalized sex- and age adjusted IGF-1 levels
* 39% achieved GH levels of = 2.5 µg/L and normalized sex- and age adjusted IGF-1 levels
* 39% achieved a > 20% reduction in tumor volume by serial MRI
[Pasireotide in Acromegaly: A Phase II Study]
From Glusman JE, et al.11
PASPORT Acromegaly
PASPORT Acromegaly, part of the PASPORT clinical trial research program, is evaluating the safety and efficacy of pasireotide in patients with active acromegaly. This study is designed as a registration trial for pasireotide in acromegaly.
Acromegaly is characterized by:2,3
* Chronic hypersecretion of growth factor (GH)
* Excessive synthesis of insulin-like growth factor 1 (IGF-1)
* Significant morbidities
* Increased mortality
Although surgery is first-line therapy in acromegaly, individuals who have had an unsuccessful prior surgery, are unsuitable surgical candidates, or have had a recurrence require medical management.
Current somatostatin analogs are widely used to treat patients with acromegaly, but they have therapeutic limitations:
* Efficacy is limited in some patients; approximately 30% to 40% of patients fail to achieve biochemical control, ie normalization of GH and IGF-1 levels4
* Antitumor activity is limited in some patients; approximately 37% achieve a significant reduction in tumor volume5,6
* Resistance to somatostatin-analog therapy may rarely occur due to the selective loss of the SST2 receptor which is the primary target of current anlaogs7
[Acromegaly: Controlling Oversecretion and the Disease]
Somatostatin Receptor Expression and Targeting
Analysis of somatostatin-receptor expression in cells from GH-secreting adenomas has shown that:8,9
* 96% express SST2
* 86% express SST5
* 44% express SST1 and SST3
* Antisecretory effects for GH are regulated by SST1, SST2, and SST5
Current somatostatin analogs bind with high affinity to only 1 of the 5 somatostatin receptors.10 Tumor-specific receptor expression profiles and the multiple signaling pathways regulating secretory function may explain why current somatostatin analogs sometimes fail to induce biochemical control in acromegaly. This is supported by data from a study of patients with acromegaly.7 Analysis of tumor tissue from patients who demonstrated a <50% reduction in GH level when treated with octreotide had no detectable SST2.7
Because of its rational design, pasireotide:10
* Binds to 4 of the 5 somatostatin receptors
* Does not bind significantly to other receptor families
* Potentially activates more receptor-regulated pathways than current analogs
* May provide improved biochemical and disease control in acromegaly
Pasireotide in Acromegaly: A Phase II Study
In a phase II study of patients with de novo or persistent active acromegaly, after 3 months of therapy with pasireotide:11
* 56% achieved GH levels of < 2.5 µg/L
* 49% had normalized sex- and age adjusted IGF-1 levels
* 39% achieved GH levels of = 2.5 µg/L and normalized sex- and age adjusted IGF-1 levels
* 39% achieved a > 20% reduction in tumor volume by serial MRI
[Pasireotide in Acromegaly: A Phase II Study]
From Glusman JE, et al.11
PASPORT Acromegaly
PASPORT Acromegaly, part of the PASPORT clinical trial research program, is evaluating the safety and efficacy of pasireotide in patients with active acromegaly. This study is designed as a registration trial for pasireotide in acromegaly.
Anencephalic babies - babies Anencephalic
Children with this disorder without NAC ... in front of the biggest parts of the brain responsible for thinking and coordination. Left brain tissue is often exposed, ie not protected by bone or skin.
Recent research shows that the addition of folic acid in women of fertile diet can significantly reduce the incidence of neural tube defects. Therefore, it is recommended that all pregnant women age consume 0.4 milligrams of folic acid every day.
Anencephaly is a cephalic disorder was the result of neural tube defects Happens When It's cephalic (head) end of the neural tube fails to close, usually between December 23 and 26 of pregnancy, which occurs in the absence of most of the brain, skull, and scalp.
Children with this disorder are born without a forebrain, the largest part of the brain consists mainly of cerebral hemisphere (which includes the neocortex, which is responsible for high-level cognition, ie, thinking). Left brain tissue is often exposed-not covered by bone or skin.
Scaly and itchy skin
Does your skin disorder that only in one place, or some other body dibagian.
If only in one place that it is likely because of eczema, and the cause is allergies or it could be due to chronic scratching continuously.
If allergies cause must be sought allergic to anything, and we avoid, whereas if the result of scratching it should not scratch-scratch.
Because if it feels good to scratch, scrape the skin, new skin comes thicker, harder carded and so on. Well this cycle we must break with the provision of cream and also not carded. Easily cured hopefully guaranteed.
If only in one place that it is likely because of eczema, and the cause is allergies or it could be due to chronic scratching continuously.
If allergies cause must be sought allergic to anything, and we avoid, whereas if the result of scratching it should not scratch-scratch.
Because if it feels good to scratch, scrape the skin, new skin comes thicker, harder carded and so on. Well this cycle we must break with the provision of cream and also not carded. Easily cured hopefully guaranteed.
Chemotherapy can damage the joints
Aggressive chemotherapy and high doses in cases of breast cancer is beginning suspected bring more negative effects than benefits received. Risk chemotherapy destroys the bone joints of patients who received temporary benefits are not comparable. Because, chemotherapy does not guarantee the cancer will not come back up.
The study recommended the discontinuation of chemotherapy known action expensive and full of controversy. However, some parties actually consider this therapy is effective in some particular woman.
Dose chemotherapy is usually given to patients is usually far greater than the dose consumed drugs the patient. Because chemotherapy can damage the joints, patients often must undergo transplants derived from their own bodies.
High-dose chemotherapy has been widely performed on patients suffering from advanced-stage breast cancer. In the conventional pattern, chemotherapy actually performed when a woman has finished the operation.
However, a convincing study in the era of the 1990s proved intensive care can not not give much benefit in cancer patients has spread to several parts of the body.
The results of study published in the New England Journal of Medicine and the CNN quoted the fact that this shows that the cancer patients had spread to lymph lympe remain at risk of recurrence.
The study recommended the discontinuation of chemotherapy known action expensive and full of controversy. However, some parties actually consider this therapy is effective in some particular woman.
Dose chemotherapy is usually given to patients is usually far greater than the dose consumed drugs the patient. Because chemotherapy can damage the joints, patients often must undergo transplants derived from their own bodies.
High-dose chemotherapy has been widely performed on patients suffering from advanced-stage breast cancer. In the conventional pattern, chemotherapy actually performed when a woman has finished the operation.
However, a convincing study in the era of the 1990s proved intensive care can not not give much benefit in cancer patients has spread to several parts of the body.
The results of study published in the New England Journal of Medicine and the CNN quoted the fact that this shows that the cancer patients had spread to lymph lympe remain at risk of recurrence.
Chemotherapy can damage the joints
Aggressive chemotherapy and high doses in cases of breast cancer is beginning suspected bring more negative effects than benefits received. Risk chemotherapy destroys the bone joints of patients who received temporary benefits are not comparable. Because, chemotherapy does not guarantee the cancer will not come back up.
The study recommended the discontinuation of chemotherapy known action expensive and full of controversy. However, some parties actually consider this therapy is effective in some particular woman.
Dose chemotherapy is usually given to patients is usually far greater than the dose consumed drugs the patient. Because chemotherapy can damage the joints, patients often must undergo transplants derived from their own bodies.
High-dose chemotherapy has been widely performed on patients suffering from advanced-stage breast cancer. In the conventional pattern, chemotherapy actually performed when a woman has finished the operation.
However, a convincing study in the era of the 1990s proved intensive care can not not give much benefit in cancer patients has spread to several parts of the body.
The results of study published in the New England Journal of Medicine and the CNN quoted the fact that this shows that the cancer patients had spread to lymph lympe remain at risk of recurrence.
The study recommended the discontinuation of chemotherapy known action expensive and full of controversy. However, some parties actually consider this therapy is effective in some particular woman.
Dose chemotherapy is usually given to patients is usually far greater than the dose consumed drugs the patient. Because chemotherapy can damage the joints, patients often must undergo transplants derived from their own bodies.
High-dose chemotherapy has been widely performed on patients suffering from advanced-stage breast cancer. In the conventional pattern, chemotherapy actually performed when a woman has finished the operation.
However, a convincing study in the era of the 1990s proved intensive care can not not give much benefit in cancer patients has spread to several parts of the body.
The results of study published in the New England Journal of Medicine and the CNN quoted the fact that this shows that the cancer patients had spread to lymph lympe remain at risk of recurrence.
Maternity Benefits In Water there, and there's no downside risk
Delivery method in water or a water birth and becoming increasingly popular trend of labor. Many who felt the benefits. In addition to reducing pain, childbirth in the pool of warm water also makes the pregnant women have more power to push.
As quoted from Modernmom.com, some research even claims that this method of giving birth in water is also beneficial for the baby to be born.
International water birth based reports, this method requires a special maternity pool containing water with a temperature of 95-100 degrees Fahrenheit. It is strongly recommended to avoid the use of bathtubs or swimming a small child, because it is difficult to maintain the right temperature.
Here are some things you need to know about water birth.
Benefit
Water birth helps pregnant women feel more relaxed so it can reduce pain during childbirth. In water depth, the skin will have a greater elasticity, thus minimizing the risk of tearing a baby in the birth canal.
Giving birth in water is also beneficial for babies. Water medium baby ease the transition from the womb, contains amniotic fluid, to the outside world. Supporters of this technique say that birth in the water harmless. The baby will breathe in the water, because he will not start using his lungs until he was taken to the air in the first 10 seconds after birth.
Weakness
An investigation revealed concerns that the medium of water will make the umbilical cord becomes tangled or compressed, so that the baby likely akanterengah breath and suck water into their lungs.
A 2002 study published in the medical journal Pediatrics, also concluded that birth in water increases the risk of infant drowning.
Live Science site adds that the birth in water is not recommended by the American College of obstetricians and Gynecologists as a feasible option childbirth. Birth in water is feared to trigger the risk of pneumonia or infection of the brain, and oxygen kekuarangan attacks.
Risk
Women with certain medical conditions or pregnancy should avoid doing complicated process of giving birth in water. Including women with herpes, high blood pressure, women who have experienced unexpected bleeding during the course of pregnancy, women who are pregnant twins, and when the baby is in breech position. Giving birth in water is also not recommended for women who go into preterm labor. (Pet)
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