Ovarian Cyst Malignant Treatment

Ovarian Cyst Malignant Treatment

Ovarian Cyst Malignant, is USG enough?

The malignancy level of any ovarian cysts cannot be diagnosed with certainty by using ultrasonography (USG). The best way to determine the malignancy is to identify characteristics that make it more likely to become benign or malignant cyst. But sometimes it can be confusing since many benign conditions can appear on USG as a worrisome condition for malignancy. These include: endometriosis, dermoid cysts, hydrosalpinges, pelvic abscess, etc. 

Ovarian Cyst Malignant: How About CA-125 Level?

CA-125 is an ovarian cancer antigen test but it is NOT specific. It can also become positive in many cases of benign pelvic and abdominal disease, especially premenopausal. Endometriosis, liver diseases, benign ovarian tumors, and other non-malignant conditions can cause an elevation of CA-125. The normal limit is less than 35 u/ml and only when more than 100 u/ml, it will be a great concern for a malignancy.  

Ovarian Cyst Malignant: Age Distribution

Statistically, benign cysts and other ovarian masses can happen in all age ranges. But ovarian malignancy is definitely higher in older women and lower in younger ages.  Benign cyst can occur with almost equal frequency before and after menopause.

Ovarian Cyst Malignant Treatment

Every woman with an enlarge ovary is possible to have an ovarian cancer and considered to be operated, except those women who are proven to have a small cyst less than 1 cm in diameter, or women with early pregnancy. For women with pregnancy, ovulatory phase, and small cyst, the therapy is conservative, but they should be monitored and reexaminated in 4 weeks. After 4 weeks, if the cyst becomes smaller, then it can be still conservatively followed until it is gone. So it is called: functional cyst.

Every ovulating woman has a cyst for every cycle. The size is usually just 2 cm when it later breaks and releases an egg. But in some cases, the follicle cyst do not break and becomes larger. It will eventually break on its own, but if detected during this time, then an ovarian cancer should be considered. Sometimes, a follicle cyst ruptures and becomes a corpus luteum cyst. This will go away by its own. Ovarian cyst that persists for long period will have to be operated to ensure a diagnosis of cancer. A gynecologist will perform an USG test to differ between simple cysts and complex cysts. A simple cyst is a fluid-filled cyst, only fluid; but a complex cyst has an internal structure or solid matters within it. A complex cyst should be operated to exclude the diagnosis of cancer.

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Causes Of Priapism

Causes of Priapism

What is Priapism?

Priapism is one type of male sexual disorder where penile erection occurs continuosly for 6 hours or more even without sexual stimulation. It is very painful; can damage the penile tissue permanently.

In general practice, the usual recommendation to seek medical emergency for help is painful erection that persists for more than FOUR hours.

Causes of Priapism

Normally, erection results from relaxation of the muscles inside the penis. It makes an increase in arterial blood flow towards the penis. Priapism occurs when blood inside the penis is trapped and unable to flow seamlessly. This condition can occur at all age groups, and even newborn! If it is not properly treated, permanent damage may happen.

Causes of priapism are:

• Drugs/medical treatment: psychiatric drugs (CPZ, trazodone), antihypertensive drugs (nifedipine, prazosin), anticoagulants (heparin, warfarin), miscellaneous (metoclopramide, omeprazole, tamoxifen)
• Alcoholism
• Trauma (accidental, surgical)
• Nervous system damage, such as: spinal cord injury, chronic diabetes mellitus, multiple sclerosis.
• Blood disorder, such as leukemia, sickle cell anemia, myeloma, thalassemia.
• Injection into the penis to treat impotence, such as papaverine, prostaglandin E1 (alprostadil), Viagra (R), phentolamine, etc.
• Unknown causes, approximately 35% of the priapism cases.

Treatment of Priapism

Many priapism cases resolve spontaneously after physical activity and repeated ejaculation. In emergency practice, oral terbutaline or salbutamol may help in acute onset. Next step is removing blood by inserting a needle into the penis (often followed by small amounts of heparin to reduce clotting). In persistant cases, metaraminol (a reversing agent) may be injected into the penis. Surgery is rarely performed, but its purpose is to avoid persistant damage of the penis muscle.

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Hypertension In Diabetes

Hypertension in Diabetes

If you are a diabetics then suffer from hypertension, then you should be extra careful because hypertension in diabetes will cause a lot of impact and damage important organ. Therefore, treatment of hypertension in diabetes is slightly different with general hypertension. The prevalence of hypertension in diabetics is higher than non-diabetics.

Epidemiologically, a study of large population of type 1 diabetes mellitus shows that 5 % of patients have hypertension in diabetes within 10 years, 33% have hypertension within 20 years, and 70% have hypertension by age 40. But in type 2 diabetes mellitus patients, 75% of patients with kidney disfunction also have hypertension. Patients with no kidney disfunction, 40% of them have hypertension. Generally, 35% of all people with diabetes mellitus also have hypertension.

Hypertension in diabetes mellitus are two diseases that related each other. Hypertension in diabetes is the most common complication that is difficult to treat, where hypertension makes diabetes more dangerous and end up as kidney failure.

Hypertension and diabetes mellitus tend to occur together because they have the same physiological mechanism, it means: the effects caused by one disease will make other disease more likely to occur. The effects of hypertension in diabetes are listed below.

1. Increased arterial resistance. Diabetes mellitus can decrease the blood vessels' ability to stretch, causing higher blood pressure.
2. Increased fluid volume. Diabetes mellitus can increase the total amount of fluid in the body, then end up raising blood pressure.
3. Disorder on insulin handling. Failure in the way the body produces and handles insulin can increase blood pressure.

How to Treat Hypertension in Diabetes?

1. Non pharmalogical: life style modification, exercise programs, etc.
2. Pharmalogical. This treatment's goal is to reduce cardiovascular events and microvascular complications. The drugs are:
• Diuretics: thiazide
• ACE inhibitors: captopril, lisinopril
• Angiotensin receptor blockers (ARBs): valsartan

The choice of treatment may be individually different from one patient and another. It based on clinical characteristics of the patient (including other underlying diseases), patients' tolerability, personal preferences, and cost.

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Lisfranc Fracture Dislocation Treatment

Lisfranc Fracture Dislocation Treatment

What is Lisfranc Fracture?
Lisfranc is a name of French doctor who first described this fracture. This fracture occurs at the midfoot, where a cluster of many small bones forms an arch on the top of the foot between toes and ankle. The bones are held/fixated by ligaments (connective tissues) that stretch across and down the foot, so they can be stable. However, there is no ligaments that hold the first metatarsal (long bones; all of them are five) to the second metatarsal. So when you drop a heavy box exactly on the top of  the foot, a twisting dall can shift (or dislocate) these bones out of place. That is called Lisfranc fracture.


Diagnosis of Lisfranc Fracture
Lisfranc fracture is different with sprain. But what seems outside is similar. The top of the foot may be swollen and very painful! It may be difficult to see on X-rays, make it unrecognized. Unrecognized Lisfranc fracture can have serious complications in the future such as: compartment syndrome and joint degeneration, damage of nerve cells and blood vessels around that.
You should contact an orthopaedist to ensure the diagnosis of Lisfranc fracture. He will physically examine and then perform an X-rays. If first X-rays doesn't show an injury, he will ask for other X-rays with different views. In several cases, CT-scan and MRI are also needed.

Lisfranc Fracture Dislocation Treatment
The action treatments are divided in the operative or non-operative treatment. It depends on the severity. There are non operative and operative options.

• Non operative. You will probably just have to wear a cast and refrain from putting weight in the foot and rest it for 6 weeks. After that, the cast will be removed and replace by a rigid arch support, followed by physiotherapy/ foot exercise to restore strength and help gaining full range of motion. 
• Operative. If the bones have been forced out of position, operative treatment is needed to stabilize and hold the bones in place until completing the healing process. Orthopaedist may use wires and screws. Immobilization should be done until 8 weeks.

One most important of Lisfranc fracture dislocation treatment is you should obey your doctor's orders, refrain from activities until you are allowed to do so. If you do the activities too quickly, it may harm you, another injury may happen such as damage of blood vessels and nerves, infection (arthritis), and they all need longer time of healing.

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Ovarian Cyst Symptoms During Pregnancy

Ovarian Cyst Symptoms During Pregnancy

There are usually no specific ovarian cysts symptoms during pregnancy. The case are rarely found, based on epidemiology, pregnant women are rarely found with ovarian cancer, one of more than 1,000 women suffering from ovarian cyst during pregnancy. These cysts are usually harmless. Gynaecologysts classify ovarian cysts as cancerous and non-cancereous by using ultrasound  (USG) methods. But this method can not ensure the level of malignancy of ovarian cysts.

Enlarged ovarian cysts cause complications in pregnancy. Ovarian cyst symptoms during pregnancy happen when cyst rupture can lead to pain. This pain can be eliminated by certain pain killer for pregnant women, but the underlying process must be treated well.

Treatment of ovarian cysts larger than 6 cm is surgery. Surgery generally does not interfere with pregnancy or the baby but the operation should be avoided when ongoing pregnancy. Surgical removal of ovarian cysts is better in the second trimester of pregnancy to avoid complications.

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Parkinsons Early Symptoms

Parkinsons Early Symptoms

The early symptoms of Parkinson disease can widely vary from one person to another. Parkinson's early symptoms may be silent, subtle and then can go unnoticed. Most of Parkinson's early symptoms happens unilaterally. Unilateral means "one side". These symptoms begin at one side but later it will be both sides in worst condition. Early recognition will be better for proper treatment. The Parkinson early symptoms are listed below:

Resting tremor is one of Parkinson early symptoms. By definition, it is a slight trembling in the hand when the hand is at rest. The trembling will stop when the hand is moved or does something. The tremor may continue to lower extremity at the same side, and ascendently move to lips and jaw (rare cases). Sometimes, the patient can feel a trembling inside the body (internal tremor).

The next Parkinson early symptoms is rigidity. Rigidity is muscle stiffness that typically happens in the limbs. But in Parkinson disease, whole body rigidity is also possible, called as cog-wheel rigidity, refers to a arm motion that resembles cogs in a wheel, similar to a spring like action. This muscle stiffness may happen in all daily activitie, like when turning over in bed, buttoning the clothes, etc.

Postural instability also happens as Parkinson early symptoms. The patient may have problems with body balance. He is not able to walk in a straight line, sometimes easy to fall. 

Parkinson disease can cause generalized fatique that persist up to 2 weeks. Patients feel tired, exhausted, but sometimes it is confusing with a lot of sleep.

One characteristic of Parkinson early symptoms is bradikinesia (slowed motion). It is when the patient need longer time to do things that it used to, or feel like lost the swing in the arm while walking.

Personality change is also happen at Parkinson disease at early stage. Close families can feel that the patient's personality has changed, such as more rigid, more withdrawal, not flexible as usual, etc.

Slurred speech may also happen as Parkinson early symptoms. The voice become softer, emotionless, and stumble over words more frequently than usual. It really bothers the self confidence at social life.

Bowel habit change sometimes occurs at Parkinson disease. The patients become constipated even the diet contains enough fiber.

Sleep disorder. Patients with Parkinson early symptoms take more sleep during the day. There is a REM behaviour disorder while sleeping, so without waking up, it seems to be seeing something and reacting to them as it is real. Then he awakes and recall the dream where in the dream he is attacked by animal or something.

In case you have all symptoms above, you should consult a neurologist and will be generally evaluated. You DO NOT need to have all of those symptoms above to be diagnosed with Parkinson disease. Some people never develop those symptoms but overall, most people who end up getting Parkinson disease have all of them before accepting the actual diagnosis.

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What Is Arachnoid Cyst

what is arachnoid cyst

Arachnoid Cyst is not the same with common cysts found in other body parts. Quoted from wikipedia, arachnoid cysts are cerebrospinal fluid covered by arachnoidal cells and collagen. This cysts locates between the surface of the brain and the skull base; or in the arachnoid membrane which is one of three membranes covering the brain and spinal cord. Besides in the brain, arachnoid cysts can be found on the spine. Arachnoid cysts are congenital abnormalities of the fetus, infant or delayed until adolescence. What causes arachnoid cyst is unknown yet, but presumably due to developmental disorders.

What is Arachnoid Cyst; Symptoms
The symptoms depends on its size and location. Relatively small-sized cyst give less specific symptoms, but large cysts may cause cranial deformation or macrocephaly (enlarged head), produce symptoms as listed below:

1. Headaches 
2. Seizure
3. Hydrocephalus, or swelling due to fluid head
4. Increased intracranial pressure: spreading vomitus in the morning, cephalgia, dizziness
5. Developmental disorders until behavior change (in large form)
6. Hemiparesis is interference on one side of the body
7. Reduced muscle control or called ataxia

What is Arachnoid Cyst ; Treatment
The treatment's purpose is mainly to reduce the intracranial pressure. It is mostly surgical. You should consult a neurologist and neurosurgeon to perform it. On first visit, if it is asymptomatic, you will be suggested to have a CT-scan control periodically every 1 year. If it doesn't enlarge, basically it doesn't to be removed. But if there are symptoms of high intracranial pressure, you should be hospitalized and performed surgery.

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Stevia Side Effect

Stevia Side Effect

Stevia (rebaudioside) is called a sweetleaf or sugarleaf plant. Stevia contains no calories but stevia side effect around 300 times sweeter than sugar. This plant is really a great natural sweetener especially those who has diabetic and has to take a diet. Stevia side effect is also protective to infection because it can mitigate growth of certain bacteria.
Despite of those benefits, there are some stevia side effect :
Short-term side stevia side effect consumption is due to arise gas bloating stomach, nausea and dizziness.

In addition, long-term stevia side effect cause symptoms:

1. Stevia lowers blood glucose levels.
2. Stevia can reduce the production of sperm cells as shown in hamsters reseaarch.
3. Stevia causes the problem of energy metabolism in children due to reduced absorption of carbohydrates in the body.
4. Stevia can lead to addiction because excessive sweetness.
5. Consuming a too large amounts of stevia and a period of time can lead to obesity because the body does not get enough calories.
6. Some studies in animals showed that excessive stevia consumption increases the risk of cancer due to mutations in DNA. The risk is not yet clearly supported by good research.

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Sprained Ankle Recovery Time

Sprained Ankle Recovery Time

Sprained that happens to body ligaments , such as hands and feet are caused by body stretched beyond the normal and makes an injury. The appropriate diagnosis of this injury really determines its recovery. Immediate X-ray of the joint involved should be done to exclude any fractures. And now, the most frequently asked question is: How long is sprained ankle recovery time?


Sprained ankle recovery time is influenced by internal and external factors. Internal factors are influenced by its own condition or natural course of the injury, such as swelling, whether external factors are influenced by its treatment.

There are several classes or grade which contribute the healing. Class or grade 1 requires one to two weeks because of injuries suffered consist of mild swelling. Class or grade 2 takes four to six weeks for cure because of minor damage to the ligaments. Rather than longer healing occurs in class or grade 3 require for 8 to 12 weeks.


Sprained ankle recovery time healing tips from the expert recommendations using the RICE technique:

1. Rest: limiting activity during the first 24-48 hours after the injury by reason during this period of treatment is a critical time.
2. Ice: providing an ice pack on the injury on the first 48 hours use ice made ​​from water-filled paper cup from frozen.
3. Compression: compression using a wrapper or bandage on the injured body part with respect to the circulation in that section.
4. Elevate: lifting the injured body part higher than the heart for a certain period.

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Diabetes Type 2 Symptoms In Women

Diabetes Type 2 Symptoms in Women

Diabates type 2 can be classified in Non Insulin Dependent Diabetes Mellitus (NIDDM) is a metabolic disorder characterized by high blood glucose. This type of diabetes can be controlled (but not treated!) with diet and/or taking certain medications. There are various diabetes type 2 symptoms in in women, all of them are not specific, mostly are just the same with general diabetic symptoms, as listed below.

Diabetes type 2 symptoms in women :

1. Losing weight gradually.
2. Increased thirst and desire to urinate frequently arise. 
3. Itchy vulva, caused by vaginal yeast infection.
4. Easy to be hungry and weak
5. Decreased levels of vision .
6. In the event of injury, takes longer to heal or dry.
7. In some spots there are folds of skin color or black and is called acanthosis nigricans is insulin resistance.

This diabetes type 2 symptoms in women can be controlled if patient immediately visit the doctor and follow doctor's advice, regularly control blood glucose, diet modification, and eat some drugs as needed.

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Male Breast Cancer Symptoms

Male Breast Cancer Symptoms

What is Breast Cancer?
A breast cancer is a malignant tumor, that originated from cells of the breast. Malignant tumor is a kind of cancer cells that may grow invading the tissue they are originated, and spreading to further areas of the body (liver, lungs, brain, bones). Generally, breast cancer are women-related cancer, but men can get it too. Breast tissue in men can also develop into breast cancer.

Epidemiology of Male Breast Cancer
Comparing to female breast cancer, male breast cancer is rare. Less than 1% of all breast cancers occur in men. Mostly it happens to man between the ages 60-70. There are some risk factors that contribute for male breast cancer: a family history of breast cancer, tend to have hyperestrogenism/higher estrogen levels (in disease such as liver cirrhosis or Klinefelter''s syndrome), and exposure to radiation. The recent studies have shown that Finasteride use for benign prostate hyperplasia (BPH) therapy is also a risk factor of male breast cancer.


Male Breast Cancer Symptoms
The symptoms are:

• Lumps, usually painless. It is the most common first symptom of male breast cancer. Typically it appears right beneath the breast where breast tissue is centered.
• Changes on the nipple and also skin around the breast.
• Fluid from the nipple (discharge), sometimes may be bloody.
• Nipple retraction (turning inward), followed by skin ulceration.
• Less than 1% of male breast cancers occur in both sides. 
• Overall, the size of male breast cancer is not large (approximately 2.5 cm in diameter)
• Symptoms of metastatic breast cancer: weakness, pain, weight loss.

Male Breast Cancer Treatments

Treatment options can be :

• Surgery, called mastectomy (breast tissue removal)
• Radiation
• Chemotherapy
• Hormonal therapy

Remember, earlier diagnosis can make a life saving difference. Men must increase their awareness, if they find any changes in their breast, do not hesitate to go to the doctor right away.

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Ovarian Cyst Symptoms After Menopause

Ovarian Cyst Symptoms After Menopause

Ovarian Cyst  is a fluid collection that occurs in the ovary. The fluid is wrapped by a membrane that is formed by the outermost layer of the ovary.

Ovarian Cyst in after menopausal women are quite common.

After menopause, ovarian cysts are contracted . No optimal management for cysts exists. Many cysts will be naturally absorbed  without any problems. Ovarian cysts and malignancy do not appear to have a close correlation, but we are already know that ovarian cancer is showing a disturbing rise in older women. Most of ovarian cysts are not dangerous; not cancerous. The diagnosis is made by ultrasonography (USG), although sometimes the cysts are palpable (can be touched) enough. It was highly recommended to remove the cysts seriously, but now, as rapid advance in imaging technology, clinicians have developed a criteria for how to manage an ovarian cyst especially for post menopausal women. In general, not all cysts should be removed; cysts that do not grow may just be observed.

Ovarian Cyst Causes

Ovarian cysts are formed by a variety of reasons. The cause will determine the type of cyst. Among all types of ovarian cysts, follicular type is the most common one. This follicular cysts are formed because the growth not controlled.

The follicle is a fluid cavity that normally found in the ovary. In normal circumstances, follicle containing eggs will open during the menstrual cycle to release an egg. However, in some cases, these follicles do not open, and this fluid retention will later become cysts.

Fluid inside the cysts mostly are blood which comes as a result of the injury of the small blood vessels around the ovary. But in rare cases, cysts may also contain abnormal body tissues such as: hair and teeth. This is called dermoid cysts.

Ovarian Cyst Symptoms

Most women do not realize that she is suffering from a ovarian cyst. The most ovarian cyst symptom is pain felt in the hips and lower abdomen. This pain is caused by ruptured cyst wall, cyst enlargement that rapidly grow, or bleeding inside the cyst, and torsion cyst. The pain will be severe when the cysts twist. 

When you experience the symptoms like above, better you come to an expert in pelvic sonography and also a gynecologyst. They will perform a blood test called CA-125. If there is an elevated CA-125, the cysts are potentially malignant/cancerous.If the CA-125 is within normal limits, it may be sign of simple cyst, which only contain liquid and should be followed by serial USG until a period of time. But elevated CA-125 with pain are suspected to be dangerous; so removal is considered. Gynecologyst will also perform a new blood test called OVA1 if your CA-125 is high. The result  of high OVA1 will confirm that the cyst is malignant.

Ovarian Cysts Treatments

If the cysts are confirmed malignant, they should be removed. Removal process is not always an open procedure (called laparotomy), now clinicians perform a laparoscopy technique (make a belly button or keyhole surgery). Better for you to do the procedure under the supervision of a gynecologic oncologyst.

Summary

• Most ovarian cysts in after menopausal women are benign.
• When the cyst is small (by USG), the CA-125 is normal, and painless, she should have a serial USG and CA-125 testing.
• If USG shows a growing significantly cyst, it means the cyst has potentially malignant characteristic. It usually followed by elevated CA-125 and pelvic pain.
• The approach of managing ovarian cyst in post menopausal women is now minimally invasive surgery, because older women tend to have underlying disease.

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Nasopharyngeal Cancer Symptoms And Causes

Nasopharyngeal Cancer Symptoms And Causes

What is Nasopharynx Cancer?

Nasopharynx is a space located between the back of the nose and esophagus. Nasopharyngeal cancer is the most common (60%)  malignant tumor of head and neck region. Nasopharyngeal cancer has a higher prevalence in Mongoloid countries, particularly South China; and also Greece, North Africa (Algeria, Tunisia), and the Eskimos. This cancer is more prevalent in men than women.

Nasopharyngeal Cancer Causes

The cause of nasopharyngeal cancer is still uncertainty and multifactorial, such as: Epstein Barr virus, genetics, environment, diet, and cigarette smoking. Epstein Barr virus is not specific for nasopharyngeal cancer but also cause other diseases.

Nasopharyngeal Cancer Symptoms

Nasopharyngeal cancer symptoms can be divided into 4 main groups:

1. Own nasopharyngeal symptoms: in early cancer; mild nose-bleed, nasal obstruction.
2. Ear symptoms: when tumor is located near the mouth of Eustachii tube (canal connecting nose and ear); ear ringing/buzzing, discomfort feel, until ear pain.
3. Eye and nerve symptoms: advanced symptoms because there is a close contact between tumor and skull cavity; headache, neck pain, facial pain (trigeminal neuralgia), blurred vision, and diplopia (doubble vision).
4. Symptoms of metastases (tumor spreading): form of swelling in the neck due to lymph nodes inflammation. 

Treatments of Nasopharyngeal Cancer

Radiation Therapy

Radiation therapy can rapidly destroy growing cancer cells. This therapy is carried out for 6 weeks. It is for early stage cancer only. Side effects of radiation therapy are dry mouth, hearing loss, etc.

Chemotherapy

Chemotherapy works by reducing the amount of cancer cells, and sometimes healthy cells are also killed. Side effects of chemotherapy are hair loss, nausea, weakness, malaise, vomitus.

Surgery

The goal of this therapy is to eradicate lymph nodes that have been infiltrated by cancer.

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Inflammatory Breast Cancer Symptoms

inflammatory breast cancer symptoms

Inflammatory breast cancer symptoms is different compared to common symptoms of breast cancer. Inflammatory breast cancer symptoms usually do not appear as a bump but can be shaped sheets that clog the lymphatic vessels under the skin. Inflammatory breast cancer happens when cancer cells block the lymphatic vessels inside the breast. Characteristic symptoms of inflammatory breast cancer is red and swollen breast; sometimes it appears like mastitis (breast infection).

The diagnosis can be made by following steps:

1. Biopsy. It is a gold standard.
2. Mammography
3. Breast ultrasonography (USG)

Inflammatory breast cancer symptoms occurs rapidly (about a week) with the signs below:

1. The itching continued pain in the breast accompanied by swelling or even bruising.
2. Lymph nodes tend to swell.
3. Discoloration of skin around the breast, usually red spots or pink with a thick texture and orange (peau d'orange)
4. Nipple retraction

Inflammatory breast cancer is classified as a type of cancer with an aggressive deployment. Treatment of this disease can be done by :

1. Chemotherapy aimed at reducing the number of cancer cells, thereby reducing the risk of relapse.
2. Surgery and removal of the tumor, provided the cancer cells have not spread beyond the breast.
3. Radiotherapy as neo-adjuvant therapy. This method can be done either after chemotherapy or surgery performed with the aim of prevent the cancer from growing back
4. Hormonal therapy (estrogen).
5. Supportive therapy is also important to help manage the side effects of chemotherapy and surgery. 

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Polycystic Ovary Syndrome Treatment

Polycystic Ovary Syndrome Treatment

Polycystic Ovary Syndrome
Synonim : Stein-Leventhal Syndrome, polycystic ovarian syndrome (PCOS)

Polycystic ovary syndrome is one of the most common hormonal disorder in women, at about 5-10% women of reproductive age and so far it is thought to be one cause of female infertility. Polycystic ovary syndrome defined as a collection of these symptoms, that caused by hyperandrogenism (increasing in androgen hormones) and the presence of ovulation without congenital  adrenal hyperplasia, increasing prolactin hormone (hyperprolactinemia) or  caused by tumor/neoplasm that produces androgen hormone.

The term "polycystic" means "many cysts", but it is often misunderstood. Some people still think that any cyst should require surgery, and this understanding can worry patients and families. So what is actually polycystic ovary syndrome? There are some folicles (size 4-8 mm) that aren't well developed so they seem as very little cysts at the ovary. So, it is NOT a big cyst that indicates tumor/cancer.

Symptoms of Polycystic Ovary Syndrome 
The symptoms can vary from asymptomatic until symptomatic such as infertility, chronic anovulation that is characterized by amenorrhea (no menstruation), olygomenorrhea (few menstruation), menstrual disorder, dysfunctional uterin bleeding (DUB), masculinization, obesity, and acne. Symptoms and severity of polycystic ovary syndrome vary widely among women.

According to the Rotterdam's criteria (2003), the diagnosis of polycystic ovary syndrome is established if we meet two of three following symptoms:

1. The existance of menstrual disorder due to little (oligo) or no ovulation
2. The presence of biochemical or clinical signs of hyperandrogenism
3. The presence of polycystic ovary at USG examination.

Polycystic Ovary Syndrome & Infertility
One study found that 7 of 10 women who experience infertilility due to ovulation disorder and experience menstrual disorder was suffering from polycystic ovary syndrome. Patients with increasing luteinizing hormone (LH) cause hormonal imbalance that is likely to lead to polycystic ovary syndrome. If they become pregnant, the frequency of miscarriage is high.

Treatment of Polycystic Ovary Syndrome
Women with polycystic ovary syndrome don't mean they won't get pregnant. They just need some help to make them ovulate normally. They are several things to do:

1. How to lower insulin resistance. This can be obtained by reducing body weight. Exerciee regularly, low carbohydrate diet, and take some medications such as metformin and thiazolidinedione (proglitazone). Regular consumption of metformin will normalize ovary's function. Menstruation will be normal after + 2 months of therapy.
2. How to lower androgen hormones and regulate menstruation. High androgen hormones can be lowered by medications of cyproteron acetate (birth control pills). Birth control pills can also help normalizing the abnormal composition of polycystic ovary. After several treatments, the next therapy is to stimulate ovum growth.

Polycystic ovary syndrome treatment is important, not only for reproductive health but also long term health because women with polycystic ovary syndrome tend to have diabetes mellitus, hypertension, cardiac problems, and high risk of uterus cancer in the future.

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What Is Steven Johnson Syndrome

What Is Steven Johnson Syndrome

What is Steven Johnson Syndrome? Steven Johnson Syndrome is a rare syndrome that occurs because of excessive reaction of the skin and mucous membranes to a drug or an infection. Once it attacks, the patient should be rushed to the hospital for intensive treatment, while the recovery itself need weeks until months. The very severe form can result in death.

Symptoms of Steven Johnson Syndrome

It begins with flu-like symptoms, such as mild fever and sore throat, followed by a red or purplish rash on the skin that feels like spreading and sore, or even a blister. In many cases, the cells in the outermost layer of skin will die so it manifests as skin-peeling.

What Causes Steven Johnson Syndrome?

Steven Johnson Syndrome is triggered by the use of most drugs (but no certain drugs; it's different between people), although in some people, Steven Johnson Syndrome can also be triggered by bacterial infection. In most cases, the exact cause is not always certain so that it makes difficulty in preventing.

Allergic reaction that occurs in Steven Johnson Syndrome is actually caused by substances that enter the body are considered as foreign objects by the immune system so they will cause an autoimmune response/reaction. Every drugs is likely to trigger Steven Johnson Syndrome, but different persons may give different reactions.

The following are drugs that are more likely to trigger Steven Johnson Syndrome:

1. Uric acid drugs, like allopurinol

2. Non steroidal anti inflammatory drugs (NSAID), usually prescribed as pain killers

3. Antibiotics, especially penicillin groups

4. Anticonvulsions, that usually prescribed for epileptic patients.

In certain cases, but rare, Steven Johnson Syndrome can also triggered by physical stimulus like ultraviolet and radiation.

Treatment of Steven Johnson Syndrome

• All patients with Steven Johnson Syndrome must be hospitalized. 
• First important thing to be done to overcome the drug allergy in Steven Johnson Syndrome is stop taking the drugs. 
• Next is giving antiallergy medications (antihistamines) 
• Corticosteroids to suppress the autoimmune process.  
• Fluid intake must be monitored because fluid depletion can impair patient's condition.
• Adjunctive therapy can be given in the hospital as noted: rehydration by calculating fluid need. 
• Skin that is affected must be cleaned by NaCl and wounded with antibiotics zalf to avoid secondary bacterial infection.

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Walking Pneumonia Symptoms

Walking Pneumonia Symptoms

Pneumonia is an inflammatory disease of the lungs.It is often described as inflammation on the lung alveolar and lung parenchyma; or alveolae that are filled by abnormal fluid. Pneumonia is actually a common disease in all age groups, and it is the leading cause of death among the elderly. Pneumonia rarely happens on children, but for children under 5 years, it often becomes a common cause of death, called bronchopneumonia.

Pneumonia can become epidemic. Outbreaks of this disease primarily occur in a limited group of people such as close contact school students, military members, and families. This outbreaks tend to spread slowly because the  incubation periode lasts between 1-2 weeks. Pneumonia, especially the form of walking pneumonia is most commonly found in spring season.

Classification

Pneumonia is globally divided into two: 

1. Hospital-acquired pneumonia (HAP), also called nosocomial pneumonia; pneumonia that is acquired during or after hospitalization, or a procedure initiated at least 72 hours after a hospital admission.
2. Community-acquired pneumonia (CAP), an infectious pneumonia in a person who is not obtained from the hospital. CAP is the most common pneumonia. CAP is the fourth most common cause of death in the United Kingdom and the sixth in the United States. The term "walking pneumonia" has been used to describe a less malignant type, compared with others. Walking pneumonia is usually caused by an atypical bacteria called Mycoplasma pneumoniae.

Walking Pneumonia Causes

Similar bacterial organisms, named Mycoplasma sp. and Chlamydia sp. They usually causes milder form of pneumonia and are characterized by the more prolonged course of the disease.

Walking pneumonia often attacks young people and can cause symptoms outside the lungs (eg: anemia and skin rash), neurological syndromes (meningitis, encephalitis).  Walking pneumonia can be found in all age groups. It is about 5-15% of all cases of pneumonia. Generally it is mild, with low mortality.

Walking Pneumonia Risk Factors

1. Elderly
2. Heavy smokers
3. Patients with impaired immune function (HIV, TB)
4. Patients with chronic diseases (diabetes mellitus, etc)

Walking Pneumonia Symptoms

1. Cough (maybe dry or phlegm/secretory)
2. Headache
3. Shivering, fever (can be mild only)
4. Shortness of breath
5. Muscle pain, stiffness
6. Appetite decreasing
7. Malaise (feeling weak, unwell)
8. Rash (especially if the cause is Mycoplasma)
9. Diarrhea (especially if the cause is Legionella)

Walking Pneumonia Treatments

The main treatment is antibiotics. In mild cases, antibiotics can be administered via oral and patients do not need hospitalization. In severe cases (especially if caused by Legionella), antibiotics should be given intravenously and patients may need extra oxygen so they should undergo hospitalization.

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Brain Cancer Symptoms

Brain Cancer Symptoms

Brain is the center of life. All life activities, every details, can only occur through a sophisticated mechanism regulated by the brain. At the same time, brain also must perform thousands of activities at once. All above can be simultaneously implemented because they are regulated by different parts. Yes, brain has many parts that have different functions.

Brain is divided into three parts named a large brain (cerebrum), small brain (cerebellum) and brain stem. Each sections are divided into smaller sections, smaller, and smaller again. Like other parts of the body, brain can be affected by either tumor and cancer. The difference is, if  benign tumors can be harmless for other body parts, but for brain, even benign tumors can be very disturbing and end up as death. Also, cancer from other parts of the body can spread to the brain but brain cancer itself, cannot spread to other body parts.

Brain Cancer Symptoms
Each part of the brain can be affected by tumor (benign) or cancer (malignancy). The most benign tumor can even be very dangerous if it happens on the brain, because it can interfere the brain's function and structure and therefore can damage the central nervous system. The cavity of the skull is a finite space, so any enlargement will cause depression of brain tissue, along with tumor's development. As we know, volume of the cranial cavity is very limited and unlikely to grow, this appears as headache or dizziness as early brain cancer symptom.


Characteristics of brain cancer varies widely, depend on which part of brain that is affected. The most common brain cancer symptom is nauseous and headache. Here are brain cancer symptoms that we should be aware of:

1. Headache, accompanied by vomitus and nausea. 30% of early brain cancer symptoms are headache. It varies from mild to severe and episodic, generally get worse at night and waking in the morning with vomiting because of high intracranial pressure.
2. Decreased awareness 
3. Mental instability and behavioral changes. It can be a mild mental change called psychomotoric asthenia, which only can be felt by close relatives like: irritability, emotional instability, forgetfulness, anxiety, depression, loss of initiative and spontanity. Remember, all former symptoms are progressive and can be found at 65% cases.
4. Speech disturbance
5. Reduced vision
6. Hearing loss
7. Walking imbalance
8. Weakened extremities (upper and lower)
9. Convulsion, etc.

Remember, the list above is only about symptoms. Even if you experience one or more symptoms, it doesn't directly means you are affected by brain cancer. To make sure, you should contact a neurologist and undergo further examination, especially head CT-scan, MRI, etc.

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Certified Nursing Assistant Duties And Responsibilities

Certified Nursing Assistant Duties And Responsibilities

Certified Nursing Assistant or CNA
Health industries have grown rapidly. Many people lost their jobs and fight to survive in this hard economic climate. Health providers must compete each other too, according to high demand of good quality healthcare. They should hire medical and nursing staff who have good capability.

Certified Nursing Assistant Duties And Responsibilities. Certified Nursing Assistants CNA, are nurses who are responsible for the more ordinary and basics of patient care. Compared to the ordinary nurses, they have different duties, according to their experiences and the facility of healthcare they work for. Here are some examples of duties they are responsible to handle: feeding patients who are unable to feed themselves, helping patients doing their daily activity life like dressing, moving about, preventing ulcus decubitus (bedsores), controlling patients' vital signs periodically, taking care about fluid and food intake, making beds, observing the physical and mental status of unstable patients, and all above will be reported to the nursing or medical staff.

Certified Nursing Assistant Duties And Responsibilities are most often work in home nursing, as the primary caregivers. It is likely for them to work overtime: at evenings, weekends, and holidays. Their salaries are widely variable, the average of  annual CNA salary  is about $20,500, but different from place to place. The increasing of life expectancy has been good for the outlook of this job. Many old ill patients need skilled care.

For estimation, there will be 19,800 jobs created for Certified Nursing Assistants in 2008-2009. Are you interested to become CNA? You must have at least 100 hours of clinical practice and 50 hours of classroom compulsory instruction. Department of Health Services will give you a certification with the following competensions: health screening and tuberculosis (TB) tests, completion of 150 hours of training in special program hold by Department of Health Services (certified nursing assistant programs), passing the criminal background checklist, and completion the competency CNA exams and nurse assistant certification. The license will last periodically (2 years) so you have to renew it by completing 48 hours of in-service training and college studies.

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Breast Cancer Awareness

Breast Cancer Awareness

Breast cancer is one of the most cause of death in women after cervical cancer. This cancer is actually a close problem to every single woman, but so hard to be talked between women. Every woman has the same chance to have breast cancer, even us. According to World Health Organization (WHO), there are 7 millions breast cancer cases and 5 millions of them are died.

Breast Cancer Awareness
Low level of people's awareness cause higher evidence of breast cancer with high stadium, especially on developing countries. Most patients are diagnosed in advanced stage where complications are more likely to be happened. This is much different with people on developed countries, like United States and Europe where breast cancer patients are founded in early stadium. So we can conclude that breast cancer awareness and early detection are very important concepts.

In October, especially in United States,  they commemorate it as a month of  breast cancer awareness (National Breast Cancer Awareness Month, or NBCAM). In this month, there will be a lot of programs to campaign about breast cancer awareness.
NCBAM is first founded at 1985, as a form of cooperation between American Cancer Society and Imperial Chemical Industries (now has become part of AstraZeneca, one of the great chemotherapy drug factories). NCBAM's goal initially was to promote mammography as the most effective gun to against breast cancer.

In 1993, Evelyn Lauder, Senior Corporate Vice President of the Estee Lauder Companies established The Breast Cancer Research Foundation and made pink ribbon as a symbol of breast cancer awareness. There are so many events and activities that have been done to commemorate NBCAM, but the most exciting part is when almost one dozen of famous landmarks are lighted by pink lamps to attract people's attention of mammography screening for breast cancer diagnosis. Those landmarks are: The Harbour Bridge (Australia), Niagara Falls (Canada), Tokyo Tower (Japan), Empire State (United States), and many more.

Another exciting campaign is Pink Hijab Day. The history was when a group of female moslem high school students in Columbia, Missouri, agree to simultaneously wear pink hijab to commemorate NCBAM. Now, Pink Hijab Day has become a global movement to commemorate breast cancer awareness.

Breast Cancer Awareness : Breast Cancer Store (http://www.thebreastcancersite.com)
This online store sells stuffs and merchandises related to breast cancer awareness. They contribute the money from it for charity of breast cancer awareness. Some celebrities are also concern about breast cancer awareness. There are some singles they had just released, one of them is: "Just Stand Up" by Beyonce, Carrie Underwood, Rihanna, Sheryl Crow (studio version only); Fergie, Leona Lewis, Keyshia Cole, Miley Cyrus, LeAnn Rimes (studio version only); Natasha Bedingfield, Melissa Etheridge (studio version only); Mary J Blige, Mariah Carey, Ashanti, and Nicole Scherzinger (live version). The single was released at August 21, 2008.

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How Do You Get Cerebral Palsy

How Do You Get Celebral Palsy

What is cerebral palsy  

The word cerebral palsy taken from word "cerebrum" that means brain and "palsy" that means stiffness. According to Viola E. Cardwell, cerebral palsy is a stiffness that caused by something happened on the brain. American Academy of Cerebral Palsy (AACP) states that cerebral palsy any abnormal changes in motoric functions as the result from brain defects.

Cerebral palsy can't develop progressively or uncommunicable. It is not curable, but with educational therapy, and the use of technology, it can help people with cerebral palsy to have a productive life. It is not a disease! Children with cerebral palsy will go with it in their entire life.

How Do You Get Cerebral Palsy: Prenatal Brain Damage

1. Mothers with infections or diseases while pregnancy, so they attack fetal brain. For example: syphilis, rubella, and abdominal typhus.
2. Pregnancy abnormalities that disturbs fetal brain circulatio, placenta suppression that destroys the formation of brain nerves.
3. Radiation that affects fetus, in which radiation can influence central nervous system so it disturbs its structure and function.
4. Rhesus (Rh) incompability, while mother's Rh and fetal's Rh should similar so the metabolism process can go normally. If different, it triggers rejection that causes mother-fetus abnormality.
5. Pregnant mothers experience accident or impact that disturbs central nervous system formation.

How Do You Get Cerebral Palsy: Brain Damage That Happens on Labor Process

1. Labor process takes too long and causes asphyxia; less oxygen makes disturbance on metabolic system on neonatal brain and breaks the nerve tissue.
2. The use of forceps; high pressure of it at baby's head can damage brain nerve.
3. The use of excessive anestetics agents while caesarian section can influence baby's nervous system so it disturbs its function or structure.
4. Premature labor, while actually the body is still immature so it causes physiological abnormality and baby's susceptibility against infection or disease that damages the nervous system.

How Do You Get Cerebral Palsy: Post-natal until 5 years Disturbance

1. Direct accident that destroys baby's brain: severe impact on the head
2. Infection that attacks brain, like: meningitis, encephalitis, acute influenza.
3. Typhoid or dyphteri that more likely causes anoxia (less oxygenation)
4. Carbonmonoxide intoxication. 
5. Strangulation
6. Brain tumor

Cerebral Palsy Treatments 

1. Any treatments to maximize the developmental process: movement therapy, learning, speech, hear, and socio-emotional developmental therapy.
2. Drugs, surgery, and braces can improve muscular function.
3. Professional team will cooperate to know child medical needs, like: therapyst, psycologist, psychiatrist, teacher, nurse, social workers.
4. Find some second opinions and supports from the experts 
5. The use of drugs depends on symptoms.
6. Early and intensive physiotherapy
7. Educations that appropriate to child intelligence
8. Occupational therapy
9. Speech therapy.

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Swine Flu Symptoms

Swine Flu Symptoms

Swine flu is a respiratory tract disease that caused by new strain of influenza virus. The disease actually affects pigs, but now has dramatically changed and makes it able to infect human. The swine flu symptoms are similar with what happens in pigs.

Swine flu is first isolated from a pig that had been infected at 1930 in USA. In its development, this disease can move to people especially who have close contact with pigs or livestock of pigs. After a long time, some mutations have happened on this virus so that new strain first attacked human in Mexico in early 2009. This new strain is named H1N1 virus, stands for  2 main antigens: type 1 hemagglutinin and type 1 neuraminidase.

Swine Flu Symptoms
The main symptoms of swine flu are juts similar with mostly influenza like: fever, cough, runny nose, malaise, and headache. Some patients reported to have nausea, vomitus, and diarrhea.
This can fall into the worse condition so that the patient hard to breathe and may need a ventilator. Secondary bacterial infection can happen and that makes pneumonia. Some patients also have convulsions. Cause of death usually because of the secondary infection on the lungs so it needs a potent antibiotic.

Treatments and Prevention
Until now there is no H1N1 vaccines to prevent swine flu. Some govermental laboratories have been funded by WHO to develop some researches to find H1N1 vaccines.
There are two antiviral medications: zanamivir (relenza) and oseltamivir (Tamiflu). The medication of these two drugs is very restricted to avoid resistency. Some severe conditions need intensive treatments in ICU.

How to Avoid?
Contact minimalizing with virus: wash your hands properly, do not touch your face especially nose and mouth, use mask if you're close to flu people.

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Congestive Heart Failure Symptoms

Congestive Heart Failure Symptoms

Congestive Heart Failure is a condition or patophysiology when the heart as pump is no longer able to provide a good blood supply for the tissue metabolism.

Congestive Heart Failure symptoms often ends up as a fatal condition, because patients with congestive heart failure are just like entering a no-way-out phase. Congestive Heart Failure is the only one disease where the morbidity and mortality increases, even some researches have done to know the patophysiology and the proper treatments. In fact, 50% of patients will die in 5 years. According to the World Health Organization (WHO), the prevalence of congestive heart disease is 22 million at 2002.

There are congestive heart failure symptoms :

1. The cardinal signs are weakness and shortness of breath.
2. Dyspneu d'effort: hard to breath (dyspnea) while having activities
3. Orthopnea: dyspnea while lying
4. Paroxysmal nocturnal dyspnea: an acute episode of heavy dyspnea, occurs at midnight or while sleeping and make patients awake, followed by dry cough and sometimes wheezing.
5. Anorexia, nauseous, and a full feeling of the stomach are non specifics complains of the patients.

Congestive heart failure treatments:

There are three basic points of managing patients with congestive heart failure (congestive heart failure symptoms):  treatments to the heart itself, treatments of underlying diseases, and treatments to the triggering factors. Medical treatments' goal is to reduce sodium and fluid retention, to increase contractility and to decrease heart preload. General treatments include bed rest, regulation of temperature and humidity, oxygen administration when needed, and diet. Drugs like inotropics (digitalis, digoxine), vasodilators (hidralazine), venodilator (nitrat, nitroglycerines, ISDN), mixed dilators (prazosine, captopril, nitroprusid), diuretics, and antiarythmia drugs. Surgery will be done for some congenital cases (for palliative, corrective) and acquired heart disease (valvuloplasty, valve replacement).

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Congenital Heart Disease In Children

Congenital Heart Disease In Children

I Have two children. My second child was 5 years old. His face often turn blue and has a slower growth compared to his older brothers at the same age. Her body was weak and emaciated. He does not like playing with each other kid. He has another symptom which his breath is wheezing and face seemed to turn blue when he run even though just 50 feet and not too fast. If he crying, so his face appears bluish. I've checked into the internist doctor and result said that he suffered from heart disease. I've started questioning whether it's Congenital heart disease in children.

The doctor advised me to bring him into a cardiologist for doing heart needed surgery. I become afraid because he is just a young child however should have heart surgery. I want to ask :

What exactly is my child's illness?

What causes them?

How much does it cost for surgery?

Are there any consequences if he doesn't take surgery?

Answer:

There are many kinds of heart diseases that affect children. One of the most important is Congenital heart disease in children. This heart disease is caused by rheuma, bacterial infection, etc.  

Types of congenital heart disease.

Congenital heart defects: tetralogy of Fallot, transposition of great vessels, persistent ductus arteriosus, atrial septal defect, stenosis of the aorta or atresi and others.

The heart is an important organ that the main function is to the channel part of the body to deliver oxygen and nutrients. Because of the cardiac abnormalities, there are some leaks so that the blood-containing acid is mixed with dirty blood that contains a lot of CO2. This causes blood that circulates throughout the body lacks oxygen and nutrients, while it's excess CO2.

Congenital heart disease in children is always weak, tired, irritability, listlessness, shortness of breath and face or body looks bluish. In addition, it causes the reduction of the heart's strength  so that blood is pumped around the body is not much, and results in acid and foods that are transported throughout the body is insufficient.

The treatment of congenital heart disease in children depends on the type of abnormality and the severity of these cardiac abnormalities.Tetralogy of Fallot and persistent ductus arteriosus (PDA) can be cured with surgery. But the total transposition of the great blood vessels difficult to cure because there is no effective way, including with surgery. Ventricular septal defect and atrial light and mild pulmonary artery stenosis do not need an operation, but when severe requiring treatment by surgery.

Now let us discuss your questions:

1. The examining doctor says that your child is suffering from heart disease. Most likely, it is a congenital heart disease. But I can't specify the type or name of congenital heart disease .
2. Congenital heart disease in children happens before the birth of your child while still in the womb. The changes to the heart began to occur at the time the fetus (weeks 2 and 8) at the start of the process of heart formation. Causes of congenital heart disease in children include: rubella (German measles) which contains a pathway to a mother during 1-2 months, heredity, mother's age more than 40 years, vitamin A deficiency in pregnant while containing baby, anoxia (oxygen deficiency) as pregnant women, and other factors.
3. As described above, several other severe heart disease and should be cured by surgery. Besides, there are even congenital heart disease in children that can not be treated even by way of operating. If the doctor recommends your child for surgery then treatment with surgery is the best for healing for the sake of your child's future.
4. The cost of heart surgery is relatively expensive. Please visit your surgeon, especially a cardiac surgeon in a big city. A small percentage of severe congenital heart disease in children may persist or decrease the symptoms, but most will be more severe with increasing age. Without further treatment your child will remain as it is now for several years or even be more crowded, more weak and more bluish.

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Asthma Signs And Symptoms In Children

Asthma Signs And Symptoms In Children

Asthma is a chronic disease that attacks the respiratory tract called bronchial in the lung where there is inflammation process happened in the bronchial cavity wall. The result of inflammation process is airway constriction so the patients experience shortness of breath. Asthma is one of the most prevalent disease in developed countries, especially areas with high level of air pollution.

Asthma Signs and Symptoms in Children
Until now, the cause of asthma is unknown despite a lot of reseearches has been done by the experts. Theories how do you get asthma has not been agreed upon by experts around the world. But there is a similarity between asthmatic patients, that they have a bronchial hypersensitivity. Treatment type from physicians for asthma  condition depends on their severity. Physician need to understand the asthma pathophysiology so that patient is get appropriate treatment. The followings are factors that are believed as asthma cause/risk factors and therefore can trigger asthma attack:

1. Hereditary factors. Genetic factors are quite significant. 
2. Allergenic substances, such as wool, fibers, carpet, pollen, animal hair, etc. (allergy asthma).
3. Household insects, especially cockroaches. Dead cockroaches dry and crush into powder which is very light to be floated by the air.
4. Air pollution, from cigarette smoking (as passive smokers), factory smoke, etc.
5. Exercise, especially vigorous ones like running race, soccer that is excessive enough to trigger asthma.
6. Weather. Cold air and air conditioning are also stimulants for some patients.

Asthma signs and symptoms in children :

1. Shortness of breath due to narrowing of airway
2. Respiratory sounds (wheezing), especially while exhaling. But not all asthmatics have respiratory sounds!
3. Prolonged cough at night and cold weather 
4. Severe attack can cause the patients unable to speak
5. Some patients also experience narrowing chest.
6. On children, initial symptoms can include itching in neck or chest.
7. During asthma attack, patients' anxiety can worsen their condition. They sometimes look very sweaty.
8. Treatments

Asthma signs and symptoms in children, just like in adults is a disease that cannot be treated completely. This means, there are still some possibilities that asthma attacks can occur in the future Basic principles of asthma treatment are based on severity of signs and symptoms. Treatments of asthma, the principle therapies are extra oxygen, nebulizer gas, corticosteroids injection (intravenously administration), and cough relievers.
For asthmatics, it is very recommended to take the prescribed medicines regularly, always bring nebulizer, and avoid the risk factors to prevent asthma attacks.

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