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Sabtu, 27 April 2013

Case 11-2013 — A 4-Year-Old Boy with Fever and Abdominal Pain

Daniel P. Ryan, M.D., Alison M. Friedmann, M.D., Matthew D. Schmitz, M.D., and Russell J.H. Ryan, M.D.
N Engl J Med 2013; 368:1435-1444April 11, 2013DOI: 10.1056/NEJMcpc1209304

PRESENTATION OF CASE


Dr. Nicolas V. Currier (Pediatrics): A 4-year-old boy was admitted to this hospital because of fever and abdominal pain.

The night before admission, the patient awoke in the night, reported pain with urination, and urinated only in small quantities. The temperature was 37.8°C. His mother administered ibuprofen to him, and he returned to sleep. In the morning, he slept 3 hours longer than usual. During the morning, he had two episodes of nonbloody diarrhea. On examination later that day, his pediatrician palpated a mass in the abdomen. The patient was sent to the emergency department at another hospital.
The patient rated the pain at 4 on a scale of 0 to 10, with 10 indicating the most severe pain. On examination, he appeared pale. The temperature was 39.1°C, the blood pressure 106/62 mm Hg, the pulse 119 beats per minute, the respiratory rate 24 breaths per minute, and the oxygen saturation 98% while he was breathing ambient air. The weight was 17.5 kg. A mass, approximately 4 cm in diameter, was palpated in the right lower quadrant, and there was pain in the genital area on palpation. The remainder of the examination was normal. Urinalysis revealed 2+ ketones and 1+ blood, with 0 to 3 red cells per high-power field, and was otherwise normal. Ibuprofen in an oral suspension was administered. A radiograph of the abdomen showed a nonspecific bowel-gas pattern. Ultrasonography (Figure 1AFIGURE 1Imaging of the Abdomen (First Admission).) revealed a heterogeneous lobular mass (6 cm in diameter) in the pelvis. The patient was transferred to this hospital.
The patient's mother reported that, on the day of admission, his appetite was decreased and he refused solids. He had had eczema as an infant and had delayed speech. Medications included ibuprofen, acetaminophen, and a multivitamin. His immunizations were current. He had no known drug allergies. He lived with his mother and other relatives and did not attend day care. His brother had hypospadias, and his maternal grandfather had lymphoma.
On examination, the patient appeared well developed and in no distress. The temperature was 37.2°C, the blood pressure 103/53 mm Hg, the pulse 94 beats per minute, the respiratory rate 18 breaths per minute, and the oxygen saturation 99% while he was breathing ambient air. The abdomen was soft, without distention. A mass, 3 cm by 2 cm, was palpated in the right lower quadrant, which was tender to palpation, without guarding, rebound, or tap tenderness. The remainder of the examination was normal. Blood levels of glucose, total protein, albumin, globulin, amylase, and lactate dehydrogenase were normal, as were the results of tests of renal and liver function; other test results are shown in Table 1TABLE 1Laboratory Data..

Jumat, 26 April 2013

New Evidence about an Old Drug — Risk with Codeine after Adenotonsillectomy

Judith A. Racoosin, M.D., M.P.H., David W. Roberson, M.D., Michael A. Pacanowski, Pharm.D., M.P.H., and David R. Nielsen, M.D. April 24, 2013DOI: 10.1056/NEJMp1302454

During the past 10 years, efforts in pharmacogenomics have generated insights into the efficacy and safety of drugs, enhancing our understanding of the safety profile of even some of the oldest drugs, such as codeine sulfate, an opioid analgesic first approved in 1950 for relief of mild or moderate pain. Simultaneously, an increased awareness of the value of both personalized medicine and the reporting of rare adverse outcomes has resulted in the publication of information on adverse events that previously might not have been reported. These developments, in turn, led the Food and Drug Administration (FDA) to reanalyze the safety of — and ultimately restrict — codeine use in patients after adenotonsillectomy.
The activity of codeine depends on its conversion to morphine by the cytochrome P-450 isoenzyme 2D6 (CYP2D6); morphine is subsequently metabolized to the active morphine-6-glucuronide by means of UDP-glucuronosyltransferase 2B7 (see diagram).1 The gene encoding CYP2D6 has many genetic variations that affect the amount of codeine that is converted to an active form and that result in the drug's variable effect. Patients with a normal range of CYP2D6 activity represent 75 to 92% of the population and are called extensive metabolizers. At the low end of the activity spectrum are poor metabolizers (approximately 5 to 10% of the population), who have no functional alleles and therefore receive little to no morphine or analgesia from codeine. At the high end of the CYP2D6 activity spectrum, ultrarapid metabolizers have two or more functional alleles, and their bodies can convert codeine into large amounts of morphine. The prevalence of ultrarapid metabolism varies by ethnic group: it is lower than 1% among Chinese and Japanese patients but potentially higher than 15% among Middle Eastern and North African patients. Clinically significant toxic effects related to opioid excess have been reported in ultrarapid metabolizers, which suggests that the risk of toxic effects from codeine depends, in part, on genotype.1

My Lovely Pets


are they so cute ??? the girls one named deco and the man named Briko....

HAPPY ANNIVERSARY 4TH BRILLIANT LEGACY [ Lee Seung Gi and Han Hyo Joo]



PD Jin Hyuk posted a little comment and one photos taken from mipiache ( restaurant's name), this photos was taken on April 25th,2013. 

PD JIN Hyuk said :

찬유를 기념하며 미피아체에서^^ 구가의 서로 바쁜 와중에도 맛집을 직접 찾아 한 턱 쏜 승기 홧팅! 대한민국 최고 여배우로 성장했음에도 항상 착한 효주 채원이도 홧팅!

Eng-Trans: Celebrating chan-yu (Brilliant Legacy) at mipiache (restaurant’s name) ^^ Despite of guga’s in busy, He stood shot. Seunggi fighting! Even grow into the best actress, always  good-heart hyojoo and chaewon fighting!
----------------------------------------------------------------------------------------------------------------------
what a surprised !!  i had been long for waiting, like this one, isn't this amazing sight, right (?) hehehe

Baru aja kemaren sy curcol sama salah satu seungjoo shipper, bilang kalo saya kangen banget sama seungjoo, eh, malah kemaren tanggal 25 april, suddenly ..foto ini menjamur dikhayalak ramai dunia maya, sempat saya jalan2 ke blog fannya seung gi, yang beri komen terkait topik ini ramai banget, benar2 ramai, kebanyakan  bilang " i loved this couple so much"  ga sedikit juga yang ngdoain mereka dengan bilang " i hope they're became a couple in real life"

Bayangin udah 4 tahun celebratenya Brilliant Legacy tapi mereka masih tetap kompak, PD Jin hyuk,Lee Seung gi, han hyo joo, moon chae won, ( Bae son bin absent), ini benar2 pemandangan yang sangat luar biasa, seperti yang kita tahu kalau sekarang lee seung gi dengan jadwal padatnya untuk syuting Family book masihh menyempatkan waktunya untuk datang ke celebratenya Brilliant legacy, tentu saja ini bukan pemandangan yang biasa-biasa saja tetapi sangat luar biasa. Tanpak juga han hyo joo dan moon chae won, mereka berdua adalah sahabat yang sangat2 kompak, sama-sama populer, sama-sama best actress, sama-sama mempunyai karakter yang berbeda, jika moon chae won terlihat seperti wanita yang tenang dan pendiam, maka sebaliknya han hyo joo lebih tampak sebagai seorang wanita yang ceria dan lincah, tetapi mereka tetap sama-sama orang yang kalem. Mereka berdua telah tumbuh menjadi aktris top dan hebat di korea. chukkae :)

Mengenai Lee seung gi dan han hyo joo, bukan pemandangan yang tak umum lagi jika salah satu mereka selalu mengaitkan satu sama lain. Mereka bener2 dekat, teman dekat, dan teman baik. Sepanjang saya mengikuti berita-berita yang mengaitkan keduanya mulai dari kerja bareng project, menghadiri event sama-sama, saling support dalam sebuah wawancara, saling support dalam sebuah acara, kemudahan berkomunikasi, that's enough ...sudah cukup untuk saya bilang lebih dari sekedar teman baik. Foto ini sudah cukup membuat saya terobati dengan seungjoo sick syndrome. Lee seung gi tampak sangat bahagia sekali di foto itu, ( bahagia karena bisa ketemu sama han hyo joo) hehehe, han hyo joo tampak tersenyum tipis-tipis ( senyum tipis karena takut ketahuan awak media. hehe), moon chae won senyumnya ga jauh beda sama seung gi, lebar amat, tapi agak gemukan. 

Hadir itu Rindu, rindu itu karena cinta, cinta itu ada karena rasa sayang, mereka (lee seung gi dan han hyo joo) saling menyayangi jadi mereka berdua hadir...hadir di acara  4th anniversary Brillliant legacy ..di acara ini mereka reunian, bercerita panjang lebar, tertawa bersama, bercanda bersama.....tau aja lee seung gi ngasih saran ke hyo joo dan bilang  "please take one drama this year" Yup, i hope so.

Rabu, 10 April 2013

THORAKS

       
 Toraks adalah daerah pada tubuh manusia (atau hewan) yang berada di antara leher dan perut (abdomen). Toraks dapat didefinisikan sebagai area yang dibatasi di superior oleh thoracic inlet dan inferior oleh thoracic outlet; dengan batas luar adalah dinding toraks yang disusun oleh vertebra torakal, iga-iga, sternum, otot, dan jaringan ikat.
   Sedangkan rongga toraks dibatasi oleh diafragma dengan rongga abdomen. Rongga Toraks dapat dibagi kedalam dua bagian utama, yaitu : paru-paru (kiri dan kanan) dan mediastinum. 

        Mediastinum dibagi ke dalam 3 bagian: superior, anterior, dan posterior. Mediastinum terletak diantara paru kiri dan kanan dan merupakan daerah tempat organ-organ penting toraks selain paru-paru (yaitu: jantung, aorta, arteri pulmonalis, vena cavae, esofagus, trakhea, dll.).
        Thoracic inlet merupakan "pintu masuk" rongga toraks yang disusun oleh: permukaan ventral vertebra torakal I (posterior), bagian medial dari iga I kiri dan kanan (lateral), serta manubrium sterni (anterior). Thoracic inlet memiliki sudut deklinasi sehingga bagian anterior terletak lebih inferior dibanding bagian posterior. Manubrium sterni terletak kira-kira setinggi vertebra torakal II.  
Batas bawah rongga toraks atau thoracic outlet (pintu keluar toraks) adalah area yang dibatasi oleh sisi ventral vertebra torakal XII, lateral oleh batas bawah iga dan anterior oleh processus xiphoideus.
Diafragma sebagai pembatas rongga toraks dan rongga abdomen, memiliki bentuk seperti kubah dengan puncak menjorok ke superior, sehingga sebagian rongga abdomen sebenarnya terletak di dalam "area" toraks.

Selasa, 09 April 2013

BEREDARNYA AQUA PALSU DI PASARAN

Aqua Palsu. Sekedar selingan, off-topic posting kali ini akan bercerita tentang pengalaman kami membeli Aqua galon yang ternyata produk palsu serta beberapa tips penting untuk menghindarinya. Mudah-mudahan informasi ini berguna. Mohon di-share. Terima kasih.

Aqua Palsu di Pasaran!

Hari Jum'at (10 Nov 2011) yang lalu, kami membeli 4 (empat) Aqua kemasan 5-galon dari sebuah grosir sembako dan BBM yang cukup besar, tidak jauh dari tempat tinggal kami di Yogya.
Kecurigaan timbul ketika kami akan membuka tutup salah satu galon. Biasanya, alur pembuka pada tepi tutup galon itu tidak mudah sobek dan karena itu perlu ditarik kuat-kuat. Tetapi tutup galon pada hari itu sangat istimewa: gampang sekali alurnya dibuka! Setelah dilepaskan dari galon dan diamati lebih teliti bagian dalam tutup, ternyata tutup tersebut cacat: ada bekas terpapar benda panas di sekitar alur pembuka. Karena itu kami segera menelpon customer care Aqua, untuk menanyakan tutup Aqua yang baru sambil melaporkan temuan tadi.

Jumat, 05 April 2013

Welcome ApriL 2013

Welcome April,
Alhamdulillah.....
Semoga segala limpahan RahmatMu selalu ada menyertai jalan kehidupan ini. Amin

Apa kabar bloggie ?? tetep baik, bukan ?
Yah, maaf saja jika saya jarang..terlebih amat jarang menorehkan tinta di sudut blog mungil ini,
tapi jadwal berkunjung tetap selalu gak kelewatan. 

Bagaimana kabarku ? alhamdulillah, semoga allah selalu memberi saya kesehatan dan kekuatan untuk melanjutkan proposal2 hidup saya :))

Mimpi-mimpi itu selalu ada, terngiang hampir disela-sela sulkus otakku, 
Do'a tak lupa saya simpuhkan padaMu wahai pemilik Alam semesta di akhir sepertiga malamMu.
akhir-akhir ini saya terlalu banyak membaca novel, 
adalah keseruan yang bisa saya dapatkan dengan inspirasi semangat hidup yang luar biasa.
emang udah bosan hidup (?) hahaha, 
siapa bilang (?) cuman ...mimpi2 saya banyak, supaya bisa bertahan harus ada inspirasi semangatnya, 

Insya Allah,

night-night-night----------