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Multiple Sclerosis

2012-01-10T09:37:02-08:00

What Is Multiple Sclerosis?

The name multiple sclerosis refers to scars (scleroses—better known as plaques or lesions) particularly in the white matter of the brain and spinal cord, which is mainly composed of myelin. According to Wikipedia, Multiple sclerosis (abbreviated to MS, known as disseminated sclerosis or encephalomyelitis disseminata) is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms.

There are three main types of MS:

relapsing remitting MS
secondary progressive MS
primary progressive MS

This disease affects the brain and spinal cord resulting in loss of muscle control, vision, balance, and sensation (such as numbness). MS affects the ability of nerve cells in the brain and spinal cord to communicate with each other effectively. Nerve cells communicate by sending electrical signals called action potentials down long fibers called axons, which are contained within an insulating substance called myelin. When some one surfer MS, the nerves of the brain and spinal cord are damaged by one’s own immune system. In MS, the body’s own immune system attacks and damages the myelin. Thus, the condition is called an autoimmune disease.

Multiple sclerosis symptoms generally appear between the ages of 20 and 40. MS is two to three times as common in females as in males and its occurrence is unusual before adolescence. A person has an increased risk of developing the disease from the teen years to age 50 with the risk gradually declining thereafter. MS is a lifelong condition, but it is not terminal. Most people with MS can expect to live as long as someone without the condition. However, a minority of patients (about 20%) with MS have a considerably shortened life.

What Causes Multiple Sclerosis?

In the last 20 years, researchers have focused on disorders of the immune system and genetics for explanations. No one is sure what causes the body’s immune system to go awry in multiple sclerosis, but there are interesting data that suggest that genetics, a person’s environment, and possibly even a virus may play a role, and possibly other factors like vascular problems. The risk of acquiring MS is higher in relatives of a person with the disease than in the general population, especially in the case of siblings, parents, and children.

Studies show that MS is more common in certain parts of the world, but if you move from an area with higher risk to one of lower risk, you acquire the risk of your new home if the move occurs prior to adolescence. Such data suggest that exposure to some environmental agent encountered before puberty may predispose a person to MS. Moreover, MS is a disease of temperate climates. In both hemispheres, its prevalence increases with distance from the equator.

Many microbes have been proposed as potential infectious triggers of MS, but none have been substantiated.

Multiple sclerosis symptoms

A person with MS can suffer almost any neurological symptom or sign. Symptoms of multiple sclerosis vary from person to person and can change over time in the same person. The most common early symptoms include:

Tingling
Numbness
Loss of balance
Weakness in one or more limbs
Blurred or double vision

Less common symptoms of MS may include:

Slurred speech
Sudden onset of paralysis
Lack of coordination
Cognitive difficulties

As the disease progresses, other symptoms may include muscle spasms, sensitivity to heat, fatigue, changes in thinking or perception, and sexual disturbances.

Fatigue. This is a characteristic and common symptom of MS. It is typically present in the midafternoon and may consist of increased muscle weakness, mental fatigue, sleepiness, or drowsiness. Physical exhaustion is not related to the amount of work performed; and many patients with MS complain of extreme fatigue even after a good night’s sleep.
Heat sensitivity. Heat sensitivity (the appearance or worsening of symptoms when exposed to heat, like a hot shower) occurs in most people with MS.
Spasticity. Muscle spasms are a common and often debilitating symptom of MS. Spasticity usually affects the muscles of the legs and arms, and may interfere with a persons ability to move those muscles freely.
Dizziness. Many people with MS complain of feeling “off balance” or lightheaded. Occasionally they may experience the feeling that they or their surroundings are spinning; this is called vertigo. These symptoms are caused by damage in the complex nerve pathways that coordinate vision and other inputs into the brain that are needed to maintain balance.
Impaired thinking. Impaired thinking. Problems with thinking occur in about half of people with MS. For most, this means slowed thinking, decreased concentration, or decreased memory. Approximately 10% of people with the disease have severe impairment that significantly impairs their ability to carry out tasks of daily living.
Vision problems. Vision problems are relatively common in people with MS. In fact, one vision problem, optic neuritis, occurs in 55% of people with the condition.This can result in blurring or graying of vision or blindness in one eye. However ,most vision problems in MS do not lead to blindness.
Abnormal sensations. Many people with MS experience abnormal sensations such as “pins and needles,” numbness, itching, burning, stabbing, or tearing pains. Fortunately, most of these symptoms, while aggravating, are not life-threatening or debilitating and can be managed or treated.
Speech and swallowing problems. People with MS often have swallowing difficulties. In many cases, they are associated with speech problems as well. They are caused by damaged nerves that normally aid in performing these tasks.
Tremors. Fairly common in people with MS, tremors can be debilitating and difficult to treat.
Difficulty walking. Gait disturbances are amongst the most common symptoms of MS. Mostly this problem is related to muscle weakness and/or spasticity, but having balance problems or numbness in your feet can also make walking difficult.

Other rare symptoms include breathing problems and seizures.

Early diagnosis is important, since treatment can slow the disease. In these articles, learn about testing to diagnose MS — and questions to ask your doctor.

Diagnosing Multiple Sclerosis

There is no single test that is proof-positive for diagnosing multiple sclerosis. An accurate diagnosis of multiple sclerosis is based on your medical history and a neurological exam (an exam of the function of the brain and spinal cord) using various tests. A lot depends on the skill of the doctor in asking the right questions to uncover information and to properly evaluate the signs and symptoms of a malfunctioning brain or spinal cord.

In addition to a thorough medical history and exam, a variety of specialized procedures are helpful — although not always necessary — to accurately diagnose MS. These include imaging techniques, such as MRI, spinal taps or lumbar punctures (examination of the cerebrospinal fluid that runs through the spinal column), evoked potentials (electrical tests to help determine if MS has affected a person’s nerve pathways), and lab analysis of blood samples.

Tests

MRI: Magnetic Resonance Imaging - It’s not the sole test used to diagnose MS, but MRI is a giant step in confirming a diagnosis.MRI is the best test to view the changes caused by multiple sclerosis. The precise image produced by MRI gives the neurologist clear evidence of scar tissue in the deep parts of the brain or spinal cord that is characteristic of MS.However, abnormal spots on the brain MRI can be caused by other conditions, so before making a diagnosis your doctor will consider all information including your symptoms and scan results. Similar lesions can be seen in elderly people or people with migraine headaches or high blood pressure.Also, a normal MRI does not absolutely rule out a diagnosis of MS. About 5% of patients who are confirmed to have MS on the basis of other criteria, do not have lesions in the brain on MRI. These people may have lesions in the spinal cord or may have lesions that cannot be detected by MRI.
The Spinal Tap & Multiple Sclerosis – Spinal fluid analysis holds important clues in diagnosis. Performing a spinal tap to examine the cerebrospinal fluid may be helpful in diagnosing MS in some people, but it is no longer considered necessary in all instances.
Evoked Potential Tests for Multiple Sclerosis - This painless test measures electrical activity in the brain to help diagnose MS. There are three main types of evoked potential tests:
- Visual Evoked Potentials (VEP): You sit in front of a screen on which an alternating checkerboard pattern is displayed.
- Brainstem Auditory Evoked Potentials (BAEP): You hear a series of clicks in each ear.
- Sensory Evoked Potentials (SEP): Short electrical impulses are administered to an arm or leg.

Multiple Sclerosis Treatment

A. Drug Therapy

A number of drugs have been shown to slow the progression of MS in some people.

A number of drugs have been shown to slow the progression of MS in some people. All of these drugs work by suppressing, or altering, the activity of the body’s immune system. Thus, these therapies are based on the theory that MS is, at least in part, a result of an abnormal response of the body’s immune system that causes it to attack the myelin surrounding nerves. These are called the disease modifying drugs.

They include: Avonex (interferon beta-1a), Betaseron (interferon beta-1b), Copaxone (glatiramer acetate), Novantrone (mitoxantrone), Rebif (interferon beta-1a), Tysabri (natalizumab), Gilenya (fingolimod).

Avonex (interferon beta-1a)


	Use: Treatment of relapsing forms of MS, and to treat after an initial episode of inflammation.
	How administered: Intramuscular (into the muscle) injection
	Frequency of use: Weekly
	Common side effects: Mild flu-like symptoms
	Support Program: MS Active Source 1-800-456-2255

Betaseron (interferon beta-1b)


	Use: Treatment of relapsing forms of MS
	How administered: Subcutaneous (under the skin) injection
	Frequency of use: Every other day
	Common side effects: Mild flu-like symptoms
	Support Program: MS Pathways 1-800-788-1467

Glatiramer acetate (Copaxone)

	Use: Treatment of relapsing-remitting MS
	How administered: Subcutaneous (under the skin) injection
	Frequency of use: Daily
	Common side effects: Possible reaction at the injection site
	Support Program: Shared Solutions 1-800-887-8100

Glatiramer acetate (Copaxone) is another DMD that is approved for reducing the frequency of relapses in RR-MS. Glatiramer acetate is a synthetic (man-made) amino acid mixture that may resemble a protein component of myelin. It is thought that the immune system reaction against myelin in multiple sclerosis may be blocked or diminished by glatiramer acetate. A reaction occurring immediately after the injection of glatiramer acetate is common, affecting one out of 10 patients. The reaction may involve flushing, chest pain or tightness, palpitations, anxiety, shortness of breath, tightness in the throat, or hives. The reaction usually resolves within 30 minutes and requires no treatment. Some patients may be at risk of developing lipoatrophy, inflammation and destruction of fat tissue beneath the skin at the site of injection.

Natalizumab (Tysabri®)

Natalizumab (Tysabri®) is a drug approved by the FDA to treat relapsing multiple sclerosis. Natalizumab is a monoclonal antibody against VLA-4, a molecule required for immune cells to adhere to other cells, and penetrate into the brain. It is administered via monthly intravenous infusions. It carries a warning for a potentially fatal disease, progressive multifocal leukoencephalopathy (PML), a viral infection of the brain that usually leads to death or severe disability. For this reason only patients who have signed up for treatment under a controlled drug distribution program can receive treatment with natalizumab.

Natalizumab is used alone for the treatment of patients with relapsing forms of multiple sclerosis to delay the progression of physical disability and reduce the frequency of clinical relapses. The safety and efficacy of natalizumab beyond two years are unknown. The risk of PML may increase with prolonged exposure to natalizumab. Because natalizumab increases the risk of PML, it is generally recommended only for patients who have had an inadequate response to, or are unable to tolerate an alternate multiple sclerosis therapy.

Mitoxantrone (Novantrone®)

	Use: Treatment of rapidly worsening relapsing-remitting MS and for progressive-relapsing or secondary-progressive forms of MS
	How administered: Intravenous (by vein)
	Frequency of use: Once every 3 months or four times a year. Maximum dose 8-12 doses
	Common side effects:Nausea, hair thinning, decreased white blood cell count
	Support Program: MS LifeLines 1-877-447-3243

Mitoxantrone (Novantrone®) is approved by the FDA for the treatment of multiple sclerosis (SP-MS, PR-MS, and worsening RR-MS). Mitoxantrone is a chemotherapy drug that carries the risk of serious cardiac side effects or cancer (leukemia). Because of these serious side effects, physicians tend to reserve its use for more advanced or worsening cases of multiple sclerosis, and there is a limit to the total amount of mitoxantrone that can be administered. Cardiac monitoring prior to each dose and yearly following the last dose of mitoxantrone also is necessary.

Mitoxantrone is used for reducing neurologic disability and/or the frequency of clinical relapses in patients with SP-MS, PR-MS, or worsening RR-MS (for example, patients whose neurologic status is significantly abnormal between relapses). Mitoxantrone is not used in the treatment of patients with PP-MS.

Fingolimod (Gilenya®)

Fingolimod (Gilenya®) is a daily oral medication to treat MS that was approved by the US FDA in September 2010 as the first oral medication to treat MS. Although the exact mechanism of action of fingolimod is unclear, it appears to work by reducing the number of lymphocytes (a type of white blood cell that is important for immunity and the inflammation process) in the blood. Fingolimod is taken daily in capsule form. It is not a cure for MS, but it has been shown to decrease the number of MS flares and slow down the development of physical disability caused by MS. Like many injectable therapies for MS, the long-term safety of fingolimod is unknown. The most common side effects of fingolimod are headache, flu, diarrhea, back pain, elevations of liver enzymes in the blood, and cough. Other side effects are also possible including eye problems, so those taking this drug should have regular ophthalmologic evaluations.

Rebif (interferon beta-1a)

	Use: Treatment of relapsing forms of MS
	How administered: Subcutaneous (under the skin) injection
	Frequency of use: Three times per week
	Common side effects: Mild flu-like symptoms
	Support Program: MS LifeLines 1-877-447-3243

Tysabri (natalizumab)

Use: Treatment of relapsing forms of MS
How administered: Intravenous (in the vein)
Frequency of use: Every 4 weeks
Common side effects: Headache, feeling tired, and joint pain

B. Alternative treatments

Many patients use complementary and alternative medicine. Depending on the treatments, the evidence is weak or absent. Examples are a dietary regimen, herbal medicine (including the use of medical cannabis), hyperbaric oxygenation and self-infection with hookworm (known generally as helminthic therapy).

Thalassemia Information and Treatment

2011-08-21T08:24:41-07:00

Thalassemia

Of the many blood diseases that we know, some of which is also a genetic disease which means it can be dropped into the next generation. One is Thalassemia. The disease is caused by the failure to establish one of the four amino acid chains that form hemoglobin, the main ingredient of blood.

Types of Thalassemia

Based on the amino acid chains that fail the formation, divided into thalassemia alpha thalassemia (alpha chain lost) and beta thalassemia (beta chain is lost). Meanwhile, the loss of amino acid chains can be single (thalassemia minor / heterozygous) or double (thalassemia major / homozygous).

Beta-thalassemia (?-thalassemia) is a form of thalassemia due to mutations in the HBB gene on chromosome 11, inherited in an autosomal recessive fashion.

Thalassaemia minor

Thalassaemia is also called thalassemia minor or trait / default are the ones that healthy, but potentially a carrier or carriers of thalassemia. Meanwhile, thalassemia major is a serious blood disease that begins early on children.

Thalassemia major

Patients with thalassemia major are unable to form enough hemoglobin in their blood, so that almost no oxygen can be distributed throughout the body, which is too long will cause tissue asphyxia (lack of O2), edema, congestive heart failure, and death. Therefore, patients with thalassemia major require frequent blood transfusions and medical care for survival.

What Causes Thalassemia?

Thalassemia is a disease that is genetically inherited and recessive.A person has a gene derived from the genes of his parents. If one parent has the defective gene (thalassemia) while the other healthy parents, their children will stay healthy and just may be carriers (have no symptoms of severe thalassemia). Meanwhile, when both parents have the defective gene, their children suffering from thalassemia major potential. This defective gene that can cause failure of the formation of chains of amino acids on hemoglobin.

If someone has a gene defect that causes a failure of the beta chain of amino acids, he suffered only mild to moderate anemia that causes no symptoms. Meanwhile, people who have two defective genes can suffer from severe anemia accompanied by symptoms of thalassemia.

Thalassemia carrier

If only one of the pregnant women who carry thalassemia or just her husband trait, then 50% likelihood of children born will be carriers of thalassemia and 50% chance of a child born to normal. No one will be born suffering from thalassemia. When both parents carriers of thalassemia, there are several possibilities. The first possibility, the child suffered from thalassemia (25%). The second possibility, the child will only be carriers of thalassemia (50%). Last possibility, the child will be born normal (25%).

Who Requires Inspection Thalassemia?

Family history of thalassemia
A person with symptoms of Thalassemia
Couples of childbearing age
Pregnant women (prenatal diagnosis)
Results of low hemoglobin levels between 10-12g/dL
Results of red blood cell size is smaller than normal, although normal levels of Hb

What are symptoms of thalassemia?

Thalassemia symptoms are varies greatly, depending on the type of amino acid chains are lost and the amount of loss (major or minor). Most people develop a mild anemia, especially hemolytic anemia.

In patients with beta-thalassemia major, multiple symptoms that can appear are:

suffer from anemia due to failure of blood cell formation, enlarged spleen and liver due to a long and severe anemia,
Potbelly due to enlargement of the spleen and liver,
Jaundice (jaundice),
Arising open wound in the skin (ulcers / ulcers),
The formation of gallstones,
Fatigue, his face was pale, listless.
Shortness of breath because the heart works too hard, which will lead to heart failure and lower limb swelling. Heart failure can also be caused due to frequent transfusions. In repeated transfusions, increased iron absorption and iron overload can be collected and settled in the heart muscle, which in turn can lead to heart failure.
Overactive bone marrow to produce enough blood, can cause thickening and enlargement of bones, especially the head and face.
The bones become weak and break easily. The next stage of anemia compensation implemented by the liver and spleen which helped to make red blood cells. Consequently, in these two organs also occurs enlargement.

How to diagnose?

Thalassemia is more difficult to diagnose than other hemoglobin diseases. Can we at least know the symptoms of anemia thalassemia major. Therefore, the diagnosis of thalassemia can be done in a way kind of complete blood count and a low MCV (mean corpuscular volume).

Elektroforesa can help, especially for alpha-thalassemia (though not very helpful). Since thalassemia is a hereditary disease, another useful diagnostic is based on the pattern of hereditary and specific hemoglobin checks.

So overall diagnosis of thalassemia disease included:

Routine hematology
Peripheral blood picture
Status iron: ferritin
Hemoglobin Analysis High Performance Liquid Chromatography (HPLC) – faster & quantitative
HBH inclusion bodies
DCIP precipitation test
Analysis of Hb elektroforesa
Examination Confirmation: DNA analysis (especially for prenatal diagnosis & research)

How to treat thalassemia?

Unfortunately, until now there is no medicine that can cure patients with thalassemia. Therapy can be used today is to provide blood transfusions and additional folic acid, as well as maintain his Hb above 10g/dl, so that normal activities and can carry out daily activities.

Thalassemia Spiruina as a alternative treatment

However, repeated blood transfusions can lead to accumulation of iron in the organs of the body (heart, liver, brain) and can disrupt the function of these organs. To prevent the accumulation of iron can be used to give su (Desferal) via a pump (syringe drive) for 10 to 15 hours, 5 consecutive days in a week so that iron can be removed from the body tissues. But unfortunately these drugs are still very expensive and not all parents can afford it.

Patients who undergo transfusions should avoid iron supplements and medications that are oxidative (eg sulfonamides) to prevent accumulation of iron is more severe.

In patients with severe thalassemia may need bone marrow transplants. In this case needed a suitable donor (donor usually twins or siblings of patients), and as early as possible since childhood, when children have not got a lot of blood transfusions, because the more frequent transfusions more likely for the occurrence of rejection of donor bone marrow tissue . Unfortunately, in Indonesia this action is still in early stages.

If there is excessive activity of the spleen, can be removal of the spleen. Excessive activity of the spleen can also destroy normal blood cells, resulting in patient Hb rapidly decreased. It is more common in children who received transfusions more than once a month.

How to prevent it?

Because this disease has no cure, so early prevention has become even more important than therapy. Families with a history of thalassemia should receive genetic counseling to reduce the risk of having a child with thalassemia.

Thalassemia and Pregnancy

2011-08-21T08:28:07-07:00

Thalassemia prenatal diagnosis generally the same as in normal pregnancy. The difference in blood transfusion should be done. Thalassemia is a genetic disease is an autosomal recessive inherited according to Mendel’s laws from parents to their children. Thalassemia diseases include a disease state of the mildest clinical gelaja (heterozygous form) the so-called thalassemia minor or thalassemia trait (carrier = carrier of the trait) to the most severe (homozygous form) called thalassemia major. Heterozygous form derived by one of the parents who have a disease thalassemia, while the homozygous form is derived by both parents who have a disease thalassemia.

How is thalassemia carrier?

Thalasemia carrier

If only one of the parents who carry thalassemia trait, then 50% likelihood of children born will be carriers of thalassemia and 50% chance of a child born to normal. No one will be born suffering from thalassemia.

When both parents carriers of thalassemia, there are several possibilities. The first possibility, the child suffered from thalassemia (25%). The second possibility, the child will only be carriers of thalassemia (50%). Last possibility, the child will be born normal (25%).

Diagnosis of Thalassemia in Pregnancy

The importance of premarital screening examination.

From the above it is extremely important premarital screening done to determine the “status” of the actual health of the couples getting married, to detect and prevent inherited diseases (genetic) diseases such as thalassemia, sickle cell anemia (anemia sickle sets), and disease Tay-Sachs. Fertility disorders also can be known.

If you or your husband has thalassemia and you are planning a family or are already expecting a baby, the other parent will need to have a blood test so the risk can be assessed. Prenatal diagnosis through several stages. The first stage is the maternal fetal examination including examination of a complete blood count and hemoglobin analysis. When the mother expressed a carrier of beta thalassemia trait then proceed to the second stage examination of the husband is checked complete blood count and hemoglobin analysis. When her husband also brought thalassemia trait, then the husband and wife are examined DNA to determine the type of disorder in the beta globin gene.

Furthermore, fetal tissue is taken (choriales villi or placenta tissue) at 10-12 weeks-old fetus to be examined DNA. When the fetus was carrying only one beta thalassemia gene split, then the pregnancy can be continued safely. But if the fetus was bringing both thalassemia gene which means that the fetus will suffer from beta thalassemia, the termination of pregnancy may be an option.

Decision fetal tissue from the placenta made by sticking a needle through the birth canal or the abdominal wall into the tool and through the womb to the placenta, then the area of ??the placenta called villi choriales taken by the aspirations of a number of such networks for DNA examination materials. This procedure is performed by a gynecologist who is experienced doing this action. This procedure is performed at 11 weeks gestation. This action has a risk of miscarriage by 2-3%. Another way to obtain fetal cells from amniotic fluid is by making a new one can be performed at 15 weeks gestation. The risk of abortion in this procedure is 1%.

Unfortunately, you cannot do anything to reduce the risk of passing thalassemia to your baby. However, if you have a milder form of thalassemia, there is a very good chance that you will have a healthy pregnancy. If you have thalassemia minor you might be more prone to iron deficiency (anemia) during pregnancy. However, beta thalassemia can affect blood test results during pregnancy, causing them to indicate that your iron stores are low when they are not. As a result, if you have beta thalassemia, you should have additional blood tests to confirm that you are iron-deficient before you take iron tablets. If you do become anemic, you will need to take iron supplements.

Thalassemia and Pregnancy Treatment

Routine examination. The difference with normal pregnancy, thalassemia patients have a blood transfusion and monitoring of the oxygen supply to the fetus.
Monitoring the health of mother and fetus. There are several important tests to monitor the health condition of mother and fetus, the screening test (screening) to determine the likelihood the fetus had inherited the disease thalassemia, as well as regular counseling and diagnosis.
Consumption of vitamins and supplements as recommended by doctors to prevent a deficiency of vitamins and supplements needed during pregnancy.
Keep your emotions. In addition to the physical, emotional state of pregnant women are prone to flare. Stress and depression can lead to heart, liver and hormone systems work more actively so that it can worsen the health of pregnant women.
With proper treatment and therapy, expected levels of iron in the blood of pregnant women can be maintained, and the baby can be born healthy and normal.

Dangers of Enterobacter Sakazakii in Powdered Milk Formula

2011-08-21T09:09:16-07:00

Some time ago we shocked by the news of the discovery of harmful bacteria in powdered infant milk products. The infecting organism was Enterobacter sakazakii, an unusual but often fatal, invasive pathogen. In the fatal Tennessee case, the infection was traced to contaminated powdered infant formula. Other infants in the same nursery were screened for E sakazakii. Of 49 screened infants, 10 events were discovered (1 proven infection, 2 assumed infections, and 7 colonizations). E sakazakii has been reported to cause or be associated with bacteremia,2,3 necrotizing enterocolitis,4 meningitis,5,6 and colonization.7 There are also reports of E sakazakii contaminating infant formula8–10; however, this report detailed for the first time a direct link to an unopened product.

Powdered formula is made from pasteurized (ie, sterile) liquid that is then freeze-spray dried into a powder. It is possible for organisms to be introduced in the final stages of production.

“Enterobacter sakazakii”

E. sakazakii was first discovered in 1958 in 78 cases of infants with meningitis infection. There is also reported several similar cases in several countries. Although these bacteria can infect at any age, the greatest risk of exposure is the age of the baby. A large increase in cases reported in the Neonatal Intensive Care Units (NICUs) of hospitals in England, Holland, America, and Canada.

In the United States the incidence of infection of E. sakazakii have ever been reported is 1 per 100,000 infants. An increase in the incidence to 9.4 per 100,000 in infants with very low birth weight (

In a 2007 study, some researchers to clarify the criteria taxonomy using more sophisticated way, namely by f-AFLP, automated ribotyping, full-length 16S rRNA gene sequencing and DNA-DNA hybridization. The result is an alternative classification with the findings of a new genus, namely Cronobacter consisting of 5 species.

Until now not much is known about the virulence and pathogenic power of this dangerous bacteria. Materials enterotoxins produced by some types of bacteria strains. By using tissue culture, known enterotoxin effects and some of these strains. Obtained two types of strains of bacteria that have the potential to cause death, while several other strains of non-pathogenic or harmless. This also might explain why so many have been found contaminated milk, but not many casualties were reported infected with the bacteria.

Enterobacter Sakazakii Infection

Although very rare, infections because these bacteria can cause a very dangerous disease to be life-threatening, include neonatal meningitis (infection of the lining of the brain in infants), hydrocephalus (big head because of excess brain fluid), sepsis (severe infection), and necrotizing enterocolitis (severe damage to the gastrointestinal tract). While in some cases have been reported urinary tract infection.

In general, the case fatality rate (case-fatality rate) or can be life-threatening risk to range between 40-80 percent in newborns who received a diagnosis of severe infections due to this disease. Brain infection caused by E. sakazakii may lead to myocardial or brain abscess (brain damage) with the formation of cysts, severe neurological disorders and sequelae of developmental disorders.

Enterobacter Sakazakii Symptoms

Symptoms that may occur in infants or children include:

diarrhea
bloating
vomiting
high fever
the baby looks yellow
decreased consciousness (lazy drink, do not cry)
suddenly blue
shortness of up to seizures
Premature babies
low birth weight (less than 2,500 grams) and patients with immune disorders are those individuals most at risk for this infection

Although rarely pathogenic bacteria also can lead to bacterimeia and osteomyelitis (bone infection) in adult patients. In a recent study found the ability of 12 species of strains of E. sakazakii to survive at a temperature of 58 degrees Celsius in the heating rehydration formula.

Enterobacter Sakazakii Detection

The occurrence of bacterial contamination can be initiated when dairy cows are milked from the nipple. The nipple hole has a small diameter that allows bacteria to grow around it. The bacteria is carried on with the milk when milked. Nevertheless, the application of technology can reduce pollution levels at this stage with the use of milking machine (milking machine) so that the milk coming out of the nipple is not in contact with air.
Milk contamination by microorganisms may further occur during milking (milking), handling (handling), storage (storage), and pre-processing activities (pre-processing) more. Chain of milk production requires a sterile process from upstream to downstream so that bacteria do not get a chance to grow and develop in milk.
Milking equipment is not sterile and unclean storage areas can cause contamination of milk by bacteria. Milk require storage in a low temperature to avoid bacterial contamination. The air contained in the neighborhood around where the processing is a medium that can carry the bacteria to contaminate the milk. Processing milk is highly recommended to be done behind closed doors.
Humans who are in the process of milking and milk processing can be a cause of bacteria in milk. Hands and other limbs must be sterile when milking and milk processing. In fact, the breath of humans when the milking and milk processing can be the source of the bacteria. Dairy cows and ranchers who are in a farm must be in good health and clean so as not to contaminate the milk. The process of milk production at farm level requires application of good farming practice as it has been applied in developed countries.

Solution

The recommendation to use boiling water (recommended by the FDA but not the CDC) is controversial. First, adding boiling water may not accomplish the job of killing E sakazakii13 or other organisms. Second, boiling water certainly alters the ingredients of the formula, destroying an unknown amount of vitamins, and possibly also altering other substances such as proteins. It is not clear to what extent boiling water will alter the formulas or if formula mixed in boiling water will meet the requirements of the Infant Formula Act. Third, boiling water changes the dissolution characteristics of the formula causing it to clump. Fourth, these recommendations cannot be applied to Human Milk Fortifier, because it is generally added as a powder directly to mother’s milk. Finally, adding boiling water directly to powdered formula may endanger those preparing the formula. Most formula labs are not equipped to perform this maneuver, risking spills and burns. The risks of using boiling water to reconstitute powered formula outweigh the benefits. This recommendation is not supported.

Pregnancy Sleep Tips

2010-10-27T09:42:35-07:00

Many factors can cause pregnant women have trouble sleeping. Mostly, these are the result of anxiety and stress, hormonal fluctuations, and physical discomfort. However, it is not allowed. During pregnancy, mothers often suffer from confusion to determine a safe sleeping position for not impact fetal development. When in fact it is not necessary, because women’s bodies were created so unique so as to provide protection to the fetus in the womb.

During your first trimester, the sleep-inducing hormone progesterone starts surging through your body. All the extra fluid in your body may send you scurrying to the bathroom countless times every night, and it can be very hard to get comfy. Sleep hyperhidrosis, more commonly known as the night sweats, is the occurrence of excessive sweating (hyperhidrosis) during sleep. Some women experience night sweats during pregnancy due to hormonal changes.

During your second trimester, a good night’s sleep is likely to return, and with it, a welcome energy boost. Enjoy it, because during your third trimester, the quality of your sleep may reach an all-time low.

Here are some tips that you can apply for more restful sleep during pregnancy.

Sleep and Pregnancy – How to Sleep Better

Create a comfortable atmosphere

Before bed, create a comfortable atmosphere. A soft bed will certainly make the body more relaxed. Besides, it keep the room temperature to stay cool because the body temperature during pregnancy tend to be higher. For that, make preparations fan or air conditioner that help cool the room temperature.
Determine the sleeping position

Finding a comfortable sleeping position is the biggest problem during pregnancy. You certainly can not sleep in the prone position and entered the fourth month is also not possible to sleep on her back. Sleep on your back can narrow the major blood vessels and suppress colon causing constipation or hemorrhoids. For that, you had to sleep sideways. Use a pillow between the legs or below the belt more comfortable to sleep sideways. Stretch the legs also can make sleep more comfortable. Sleep on your left side to improve the flow of blood and nutrients to your fetus and to your uterus and kidneys. Try to avoid lying on your back for extended periods of time.
- Sleep position during first trimester pregnancyA flood of the hormone progesterone is what makes moms-to-be so tired – and so wakeful at night – in the first trimester. The first trimester is the perfect time to start training yourself to sleep on your left side. That position improves the flow of blood and nutrients to your fetus and uterus, and helps your body get rid of waste and fluids.
- Pregnancy Sleep position during second trimester
  Your hormone levels are rising more slowly now, so chances are you have more energy and are sleeping better than you have in weeks. Morning sickness has probably passed, too. It’s a good idea to try to establish good sleeping habits now, while you’re not plagued with the sleeping difficulties of your first or third trimester.Make the switch to side sleeping if you haven’t already. And implementing other good habits now may serve you well in the months ahead. These might include following a relaxing bedtime routine, having a regular sleep schedule, and taking the television out of the bedroom.Second-trimester sleep stealers can include snoring and congestion, sleep apnea, leg cramps, restless legs syndrome, and vivid dreams.
- Sleep position during third trimester pregnancy
Limit fluid intake before bedtime

It is quite disturbing during sleep in pregnancy that have often awakened at night to urinate. It certainly can not be avoided, but if you limit your fluid intake several hours before bedtime, it will decimate the intensity to a small room. But, lest you become dehydrated. Therefore, be sure to consume plenty of fluids the next day.
Set the room light

Dim light makes you do not have to turn on lights when awakened to the restroom in the middle of the night. Dim light, also keeping the drowsiness so you had no trouble sleeping when you return to bed.
Relax your mind and reduce stress and anxiety.

If you have difficulty sleeping because of always thinking about the baby’s condition and any changes soon occur in your life, try practicing some relaxation techniques body. Stress and anxiety are key culprits in preventing a good night’s sleep. Remember that worrying won’t help you, but talking about your problems will. Find a friend or a professional who can listen and help you if there are issues in your life that are causing you to worry or feel upset.

Before going to sleep. Snacks, hot shower, or a little yoga to help Relax your mind so that they can sleep more sleep.
Watch your diet.

Completely eliminate caffeine and alcohol to prevent insomnia. If nausea is a problem for you, try eating frequent bland snacks (like crackers) throughout the day. Keeping your stomach slightly full helps keep nausea at bay. Eat a well-balanced diet. Not only is this crucial for you and your baby’s health, but getting the necessary nutrients will help keep you feeling satisfied and less prone to major nighttime “snack attacks” that may contribute to restlessness and insomnia when you go to sleep.
Do not force sleep

If you find it hard to sleep, wake up and do something other than turning the body in bed. Let your body feel tired by itself to the sleepy. Hopefully some tips on successfully help you sleep during pregnancy!
Nap during the day.

If you’re not getting enough rest at night, take a nap to help reduce fatigue. Find a quiet spot, and relax even if only for a half-hour nap.
Get help.

See your doctor for advice if insomnia persists. Now more than ever it’s important to get the rest you need!

Reference:
Pregnancy and Sleep
Pregnancy Sleep Help