15 New Messages
Digest #19982
11
[news] Journal Watch Pediatrics and Adolescent Medicine Alert for Ma by "Ghozansehat" ghozansehat
Messages
Wed May 22, 2013 9:30 am (PDT) . Posted by:
"yoga pranata" doyogh
>
> 1. Apakah diagnosis "multiple cholelithiasis dan cholecystitis chronic"
> cukup ditegakan dengan usg abdomen?
> 2. Apa penyebab meningkatnya SGPT/SGOT pada kasus ini?
>
> hatut nuhun
>
> salam pembelajar
saya nyumbang bacaan aja ya pak'e:
http://www.bsg.org.uk/clinical-guidelines/pancreatic/guidelines-on-the-management-of-common-bile-duct-stones-cbds.html
http://www.ssat.com/cgi-bin/chole7.cgi
selamat belajar :)
[Non-text portions of this message have been removed]
> 1. Apakah diagnosis "multiple cholelithiasis dan cholecystitis chronic"
> cukup ditegakan dengan usg abdomen?
> 2. Apa penyebab meningkatnya SGPT/SGOT pada kasus ini?
>
> hatut nuhun
>
> salam pembelajar
saya nyumbang bacaan aja ya pak'e:
http://www.bsg.
http://www.ssat.
selamat belajar :)
[Non-text portions of this message have been removed]
Wed May 22, 2013 10:15 am (PDT) . Posted by:
"Tata Kinan" tata.rasyad
Dear ibu,
Maaf sebelumnya ga bisa bantu, tapi mungkin bisa diperjelas informasinya
tentang tekstur BABnya apakah masih normal untuk bayi yang full sufor? Maaf
lagi ya ibu, saya rasanya pernah liat di internet, lupa website nya tentang
macam2 pup bayi, mungkin bisa ibu browsing aja dengan keywords baby's poo
atau apa ya... duh maaf ya, lupa. Di babycenter(dot)com bukan yaa?
Lalu maksudnya sebelumnya demam tinggi dan kesalahan fatal itu bagaimana
ya? Apakah ada hubungannya dengan frekuensi BAB yang 10x hari ini?
♡Bundo Katya♡
t: @TataRasyad
[Non-text portions of this message have been removed]
Maaf sebelumnya ga bisa bantu, tapi mungkin bisa diperjelas informasinya
tentang tekstur BABnya apakah masih normal untuk bayi yang full sufor? Maaf
lagi ya ibu, saya rasanya pernah liat di internet, lupa website nya tentang
macam2 pup bayi, mungkin bisa ibu browsing aja dengan keywords baby's poo
atau apa ya... duh maaf ya, lupa. Di babycenter(dot)
Lalu maksudnya sebelumnya demam tinggi dan kesalahan fatal itu bagaimana
ya? Apakah ada hubungannya dengan frekuensi BAB yang 10x hari ini?
♡Bundo Katya♡
t: @TataRasyad
[Non-text portions of this message have been removed]
Wed May 22, 2013 11:43 am (PDT) . Posted by:
"Hilda" h_iriany
Data lainnya apa ya bu. minim sekali informasinya, jdnya ga ngerti mau bantu gimana.
Sekarang anaknya sudah di rumah atau masih dirawat di rs?
Ada obat2an yg dikonsumsi gak sblm BABnya 10x. Konsistensinya gmn? Gejala lain?
Sekarang anaknya sudah di rumah atau masih dirawat di rs?
Ada obat2an yg dikonsumsi gak sblm BABnya 10x. Konsistensinya gmn? Gejala lain?
Dear Nuke
Boleh ya ikut urun rembug
Pertama, meski sounds easier said than done, but please please don't panic.
The more reason not to panic is ... In order to avoid unnecessary hospitalization (that was already experienced; semoga cukup satu kali ya Nuke, krn demam tinggi, bukan alasan untuk hospitalisasi).
Kedua, please sempatkan baca2
Penyakitnya anak anak kan cuma 3: demam, batpil, dan diare (dg atau tanpa muntah).
Ketiga, saat ini tetap berikan sufor selang seling dengan cairan rehidrasi oral (atau yg sering dijuluki sbg oralit). Untuk anak bisa beli sediaan khusus anak (baik botolan macam pedialyte, renalyte atau yg sachet).
Kalau susah ya beli saja sachet yg utk dewasa (mis pharolit) tetapi diencerkan dua kali lipat (setengah sachet dicampur 1 gelas air).
Berikan sedikit2 tetapi sering.
Keempat, amati tanda2 dehidrasi (pelajari di web nya who)
Kelima, ingat ingat terus bahwa pada diare (gastroenteritis) JANGAN berikan obat anti diare, obat anti muntah.
Tujuan terapi bukan menyembuhkan atau mengehntikan diare nya melainkan mencegah dehidrasi.
Keenam, kalau anakmu sdh sembuh, mulai buat folder diskusi or isu2 yg di brought up di milis. Lalu buat agenda, per 2 minggu, apa masalah yg mau dipelajari
Ketujuh, sering2 ya tanya di milis ini. Jangan kecil hati kalau gak ada yg jawab. Biasanya ada reason nya.
Gws
Wati
-patient's safety first-
Boleh ya ikut urun rembug
Pertama, meski sounds easier said than done, but please please don't panic.
The more reason not to panic is ... In order to avoid unnecessary hospitalization (that was already experienced; semoga cukup satu kali ya Nuke, krn demam tinggi, bukan alasan untuk hospitalisasi)
Kedua, please sempatkan baca2
Penyakitnya anak anak kan cuma 3: demam, batpil, dan diare (dg atau tanpa muntah).
Ketiga, saat ini tetap berikan sufor selang seling dengan cairan rehidrasi oral (atau yg sering dijuluki sbg oralit). Untuk anak bisa beli sediaan khusus anak (baik botolan macam pedialyte, renalyte atau yg sachet).
Kalau susah ya beli saja sachet yg utk dewasa (mis pharolit) tetapi diencerkan dua kali lipat (setengah sachet dicampur 1 gelas air).
Berikan sedikit2 tetapi sering.
Keempat, amati tanda2 dehidrasi (pelajari di web nya who)
Kelima, ingat ingat terus bahwa pada diare (gastroenteritis) JANGAN berikan obat anti diare, obat anti muntah.
Tujuan terapi bukan menyembuhkan atau mengehntikan diare nya melainkan mencegah dehidrasi.
Keenam, kalau anakmu sdh sembuh, mulai buat folder diskusi or isu2 yg di brought up di milis. Lalu buat agenda, per 2 minggu, apa masalah yg mau dipelajari
Ketujuh, sering2 ya tanya di milis ini. Jangan kecil hati kalau gak ada yg jawab. Biasanya ada reason nya.
Gws
Wati
-patient'
Dear all
Fyi
Masih banyak parents yg "ingin" CT scan saat anaknya jatuh
Ayo baca2 head injury
Baca2 juga soal penelitian dampak ct scan kepala.
Dengan demikian, kita bisa tetap rasional dan evidence based
Wati
-patient's safety first-
-----Original Message-----
From: Mike South <Mike.South@rch.org.au >
Date: Wed, 22 May 2013 15:56:47
To: wati<purnamawati.spak@cbn.net.id >
Cc: Timothy Cain<Tim.Cain@rch.org.au >
Subject: FTJ - CT scans and cancer
Dear %%fullname%%.
.
The log of all postings since Sept. 2010, instructions on inviting a friend, unsubscribing, and details of our other free online resources are on Wordpress at: www.ftjmikesouth.wordpress.com<http://www.ftjmikesouth.wordpress.com > (with a nice search tool)
You can also follow the postings on Facebook at: http://sn.im/FTJ-facebook & Twitter at: http://twitter.com/MikeSouthRCH
________________________________
Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians
BMJ 2013;346:f2360 doi: 10.1136/bmj.f2360 (Published 22 May 2013) Page 2
John D Mathews epidemiologist1, Anna V Forsythe research officer1, Zoe Brady medical physicist1 2,
Martin W Butler data analyst3, Stacy K Goergen radiologist4, Graham B Byrnes statistician5, Graham
G Giles epidemiologist6, Anthony B Wallace medical physicist7, Philip R Anderson epidemiologist8 9,
Tenniel A Guiver data analyst 8, Paul McGale statistician 10, Timothy M Cain radiologist 11, James G
Dowty research fellow 1, Adrian C Bickerstaffe computer scientist 1, Sarah C Darby statistician 10
1School of Population and Global Health, University of Melbourne, Carlton, Vic 3053, Australia; 2Department of Radiology, Alfred Health, Prahran,
Vic, Australia; 3Medical Benefits Scheme Analytics Section, Department of Health and Ageing, Canberra, ACT, Australia; 4Department of Diagnostic
Imaging, Southern Health, and Monash University Southern Clinical School, Clayton, Vic, Australia; 5Biostatistics Group, International Agency for
Research on Cancer, Lyon, France; 6Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Vic, Australia; 7Diagnostic Imaging and Nuclear
Medicine Section, Australian Radiation Protection and Nuclear Safety Agency, Yallambie, Vic, Australia; 8Data Linkage Unit, Australian Institute of
Health and Welfare, Canberra, Australia; 9Faculty of Health, University of Canberra, Canberra, Australia; 10Clinical Trial Service Unit and Epidemiological
Studies Unit, University of Oxford, Oxford, UK; 11Medical Imaging, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
I have posted articles on the risks for cancer and cognitive impairment associated with the use of CT scans in children before
See http://ftjmikesouth.wordpress.com/2010/09/23/ftj-safety-of-ct-scans/
Another recent study of 180 000 young people exposed to CT scans in the United Kingdom found an increasing risk of leukaemia and brain cancer with increasing radiation dose
I'm posting this study which was published today because it is Australian and has high quality data from linkage studies.
This study showed that overall cancer incidence was 24% (95% confidence interval 20% to 29%) greater for children (<19years) who had a CT scan compared to those who had not. There was a clear dose response effect.
24% sounds like a big increase but of course the low background rate means absolute effect size is small but not insignificant – an excess of 600 cancers in the 680,000 cases who had a CT scan. These rates are an underestimate because most individuals have not yet been followed for their whole lifespan. In fact the average follow-up period is only 9.5 years so many more cancers may develop in this group.
There is a clear case for limiting CT scans to situations where imaging is genuinely needed and will be highly likely to influence management and where alternative imaging is unsuitable/impractical.
Mike
Abstract
Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans.
Design Population based, cohort, data linkage study in Australia.
Cohort members 10.9 million people identified from Australian Medicare records, aged 0-19 years on 1 January 1985 or born between 1 January 1985 and 31 December 2005; all exposures to CT scans funded by Medicare during 1985-2005 were identified for this cohort. Cancers diagnosed in cohort members up to 31 December 2007 were obtained through linkage to national cancer records.
Main outcome Cancer incidence rates in individuals exposed to a CT scan more than one year before any cancer diagnosis, compared with cancer incidence rates in unexposed individuals.
Results 60 674 cancers were recorded, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years. Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan. The IRR was greater after exposure at younger ages (P<0.001 for trend). At 1-4, 5-9, 10-14, and 15 or more years since first exposure, IRRs were 1.35 (1.25 to 1.45), 1.25 (1.17 to 1.34), 1.14 (1.06 to 1.22), and 1.24 (1.14 to 1.34), respectively. The IRR increased significantly for many types of solid cancer (digestive organs, melanoma, soft tissue, female genital, urinary tract, brain, and thyroid); leukaemia, myelodysplasia, and some other lymphoid cancers. There was an excess of 608 cancers in people exposed to CT scans (147 brain, 356 other solid, 48 leukaemia or myelodysplasia, and 57 other lymphoid). The absolute excess incidence rate for all cancers combined was 9.38 per 100 000 person years at risk, as of 31 December 2007. The average effective radiation dose per scan was estimated as 4.5 mSv.
Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose.
The article is available at: http://www.bmj.com/content/346/bmj.f2360
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
PS Archives of all postings are at www.ftjmikesouth.wordpress.com<http://www.ftjmikesouth.wordpress.com > and www.mikesouthgeneralstuff.wordpress.com<http://www.mikesouthgeneralstuff.wordpress.com >
________________________________
Fyi
Masih banyak parents yg "ingin" CT scan saat anaknya jatuh
Ayo baca2 head injury
Baca2 juga soal penelitian dampak ct scan kepala.
Dengan demikian, kita bisa tetap rasional dan evidence based
Wati
-patient'
-----Original Message-----
From: Mike South <Mike.South@rch.
Date: Wed, 22 May 2013 15:56:47
To: wati<purnamawati.
Cc: Timothy Cain<Tim.Cain@rch.
Subject: FTJ - CT scans and cancer
Dear %%fullname%%
.
The log of all postings since Sept. 2010, instructions on inviting a friend, unsubscribing, and details of our other free online resources are on Wordpress at: www.ftjmikesouth.
You can also follow the postings on Facebook at: http://sn.im/
____________
Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians
BMJ 2013;346:f2360 doi: 10.1136/bmj.
John D Mathews epidemiologist1, Anna V Forsythe research officer1, Zoe Brady medical physicist1 2,
Martin W Butler data analyst3, Stacy K Goergen radiologist4, Graham B Byrnes statistician5, Graham
G Giles epidemiologist6, Anthony B Wallace medical physicist7, Philip R Anderson epidemiologist8 9,
Tenniel A Guiver data analyst 8, Paul McGale statistician 10, Timothy M Cain radiologist 11, James G
Dowty research fellow 1, Adrian C Bickerstaffe computer scientist 1, Sarah C Darby statistician 10
1School of Population and Global Health, University of Melbourne, Carlton, Vic 3053, Australia; 2Department of Radiology, Alfred Health, Prahran,
Vic, Australia; 3Medical Benefits Scheme Analytics Section, Department of Health and Ageing, Canberra, ACT, Australia; 4Department of Diagnostic
Imaging, Southern Health, and Monash University Southern Clinical School, Clayton, Vic, Australia; 5Biostatistics Group, International Agency for
Research on Cancer, Lyon, France; 6Cancer Epidemiology Centre, Cancer Council Victoria, Carlton, Vic, Australia; 7Diagnostic Imaging and Nuclear
Medicine Section, Australian Radiation Protection and Nuclear Safety Agency, Yallambie, Vic, Australia; 8Data Linkage Unit, Australian Institute of
Health and Welfare, Canberra, Australia; 9Faculty of Health, University of Canberra, Canberra, Australia; 10Clinical Trial Service Unit and Epidemiological
Studies Unit, University of Oxford, Oxford, UK; 11Medical Imaging, Royal Children's Hospital Melbourne, Parkville, Vic, Australia
I have posted articles on the risks for cancer and cognitive impairment associated with the use of CT scans in children before
See http://ftjmikesouth
Another recent study of 180 000 young people exposed to CT scans in the United Kingdom found an increasing risk of leukaemia and brain cancer with increasing radiation dose
I'm posting this study which was published today because it is Australian and has high quality data from linkage studies.
This study showed that overall cancer incidence was 24% (95% confidence interval 20% to 29%) greater for children (<19years) who had a CT scan compared to those who had not. There was a clear dose response effect.
24% sounds like a big increase but of course the low background rate means absolute effect size is small but not insignificant – an excess of 600 cancers in the 680,000 cases who had a CT scan. These rates are an underestimate because most individuals have not yet been followed for their whole lifespan. In fact the average follow-up period is only 9.5 years so many more cancers may develop in this group.
There is a clear case for limiting CT scans to situations where imaging is genuinely needed and will be highly likely to influence management and where alternative imaging is unsuitable/impracti
Mike
Abstract
Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans.
Design Population based, cohort, data linkage study in Australia.
Cohort members 10.9 million people identified from Australian Medicare records, aged 0-19 years on 1 January 1985 or born between 1 January 1985 and 31 December 2005; all exposures to CT scans funded by Medicare during 1985-2005 were identified for this cohort. Cancers diagnosed in cohort members up to 31 December 2007 were obtained through linkage to national cancer records.
Main outcome Cancer incidence rates in individuals exposed to a CT scan more than one year before any cancer diagnosis, compared with cancer incidence rates in unexposed individuals.
Results 60 674 cancers were recorded, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years. Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan. The IRR was greater after exposure at younger ages (P<0.001 for trend). At 1-4, 5-9, 10-14, and 15 or more years since first exposure, IRRs were 1.35 (1.25 to 1.45), 1.25 (1.17 to 1.34), 1.14 (1.06 to 1.22), and 1.24 (1.14 to 1.34), respectively. The IRR increased significantly for many types of solid cancer (digestive organs, melanoma, soft tissue, female genital, urinary tract, brain, and thyroid); leukaemia, myelodysplasia, and some other lymphoid cancers. There was an excess of 608 cancers in people exposed to CT scans (147 brain, 356 other solid, 48 leukaemia or myelodysplasia, and 57 other lymphoid). The absolute excess incidence rate for all cancers combined was 9.38 per 100 000 person years at risk, as of 31 December 2007. The average effective radiation dose per scan was estimated as 4.5 mSv.
Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose.
The article is available at: http://www.bmj.
Mike
Prof Mike South,
Royal Children'
PS Archives of all postings are at www.ftjmikesouth.
____________