Introduction

Popular scientific articles that follow will explain everything about asthma in children include:

1.

Definition
2.

Classification
3.

Etiology (cause)
4.

Epidemiology
5.

Risk Factors
6.

Clinical Manifestation
7.

Examination Support
8.

Diagnosis Banding
9.

Management
10.

Prevention

Good read and follow …

Definition

According to National Asthma Guidelines for Children (PNAA) 2004, asthma is recurrent wheezing and / or persistent cough (settled) with the following characteristics:

*

occur in episodic,
*

tended at night / early morning (nocturnal),
*

seasonal,
*

after physical activity,
*

there is a history of asthma or other atopy in the patient and / or his family.

Classification

The division of asthma according to Global Initiative for Asthma (GINA, 2006) is as follows:

1.

Intermittent
2.

Persistent mild
3.

Persistent’s
4.

Persistent heavy

Meanwhile, the International Pediatric Consensus III (1998) divides the degree of asthma becomes:

1.

Rarely episodic asthma
2.

Frequent episodic asthma
3.

Persistent Asthma

Etiology (cause)

Genetic factors play an important role in asthma. Currently there are about 80 genes associated with asthma, one of which is ADAM-33 gene (a disintegrin and metalloprotease-33), genes found in 2002. In addition to genetic factors, causes of asthma is multi factor.

Epidemiology

Prevalence of asthma in the world’s total estimated 7.2% (6% in adults and 10% in children). Prevalence is highly variable. In Indonesia, the prevalence of asthma in children aged 6-7 years by 3% and for ages 13-14 years by 5.2% (Kartasasmita, 2002).

Based on reports the National Center for Health Statistics or NCHS (2003), the prevalence of asthma attacks in children aged 0-17 years was 57 per 1000 children (4.2 million the number of children), and in adults> 18 years, 38 per 1000 (number of adults 7.8 million). The number of women who experienced more attacks than men.

WHO estimates there are about 250,000 deaths due to asthma. Meanwhile, according to NCHS report (2000) there are 4487 deaths from asthma or 1.6 per 100 thousand population. Child deaths due to asthma are rare.

Risk Factors

Various factors that may affect the occurrence of asthma attacks, asthma incidence, severity of asthma, and deaths from asthma among others:

1.

Gender

The prevalence of asthma in boys more than girls.

1.

Age

Generally such as asthma symptoms first arose at a young age, ie in the first years of life.

1.

History of atopy (allergy)

Reports from England; 16-year-olds with a history of asthma or wheeze, wheezing attacks will happen more 2X if the child has experienced hay fever, allergic rhinitis, or eczema. Some reports also show that allergic sensitization to allergens inhalan, milk, eggs, or nuts in the first year of life, is a predictor of asthma incidence.

1.

Environment

Some allergens can increase asthma risk in children include: pet dander, house dust mites, mold, and cockroaches.

1.

Ras

Asthma prevalence and incidence of asthma attacks on black race is higher than whites (Steyer et al., 2003).

1.

Smoke

The prevalence of asthma in children exposed to cigarette smoke is higher than children who were not exposed to cigarette smoke.

1.

Outdoor water polution

Some small particles in the air such as dust on the highway, nitric dioxide, carbon monoxide, or SO2, thought to contribute to asthma symptoms, but have not found evidence agreed.

1.

Respiratory infections

RSV infection (respiratory syncytial virus) is a significant risk factor for the occurrence of wheezing at age 6 years. Meanwhile, recurrent viral infections that do not cause lower respiratory tract infections can give children protection against asthma.

Clinical Manifestation

* On a mild asthma attack:

- Children looked cramped as you walk.

- In infants: crying loudly.

- Position the child: to lie.

- Can speak with the sentence.

- Awareness: perhaps irritable.

- No cyanosis (bluish skin or mucous membranes).

- Wheezing was, often only at the end of expiration.

- Usually not using respiratory muscle aids.

- Intercostal retraction and shallow.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: normal.

- No pulsus paradoksus (<10 mmHg)

- SaO2%> 95%.

- Pao2 normal, usually does not need to be examined.

- PaCO2 <45 mmHg

* In an asthma attack are:

- Children looked tight as she spoke.

- In infants: short and weak crying, difficult feeding / eating.

- Position the child: would prefer to sit.

- Can speak with the line severed / disconnected.

- Awareness: usually irritable.

- No cyanosis (bluish skin or mucous membranes).

- Send a loud, long expiration ± inspiration.

- Usually used aids respiratory muscles.

- Intercostal and suprasternal retraction, nature is.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: fast (tachycardia).

- There pulsus paradoksus (10-20 mmHg)

- SaO2% of 91-95%.

- Pao2> 60 mmHg.

- PaCO2 <45 mmHg

* In severe asthma attacks without constant threat of breath:

- Children looked crowded while resting.

- In infants: do not want to drink / eat.

- Position the child: sit propped arm.

- Can speak the words.

- Awareness: usually irritable.

- There cyanosis (bluish skin or mucous membranes).

- Sent a very loud, sound, without a stethoscope during expiration and inspiration.

- Using a respirator muscles.

- Intercostal and suprasternal retraction, in nature, plus the nostril breath.

- Frequency of breath: fast (Tachypnoea).

- Frequency pulse: fast (tachycardia).

- There pulsus paradoksus (> 20 mmHg)

- SaO2% for <90%.

- Pao2 <60 mmHg.

- PaCO2> 45 mmHg

* In severe asthma attacks accompanied by the threat of stopping the breath:

- Awareness: confusion.

- True there is cyanosis (bluish skin or mucous membranes).

- Wheezing sound difficult or not.

- Use of respirator muscles: the paradox of movement torakoabdominal there.

- Shallow retraction / missing.

- Frequency of breath: slow (bradipnea).

- Frequency pulse: slow (bradikardi).

- No pulsus paradoksus; signs of muscle fatigue breath.

Guidelines for the raw value frequency conscious breathing in children:

Age of normal breathing frequency

<2 months <60 x / min

2 to 12 months <50 x / min

1 to 5 years <40 x / min

6 to 8 years <30 x / min

Guideline value of pulse frequency standard in children:

Age of normal pulse frequency

2 to 12 months <160 x / min

1 – 2 years <120 x / min

3 to 8 years <110 x / min

Examination Support

1.

Examination of lung function

Checks can be done using peak expiratory flow rate (PEFR) or peak expiratory flow (APE), pulse oxymetry, spirometri, muscle strength testing, the absolute lung volume, diffusion capacity.

In airway function tests, the most important thing is the forced expiratory maneuver to maximum. Measurements with this maneuver can be performed on children> 6 years old are forced expiratory volume in 1 second (FEV1) and vital capacity (VC) with a spirometer and the measurement of peak expiratory flow (PEF) or peak expiratory flow (APE) with a peak-flow meter .

In the National Guidelines for Asthma Children (PNAA) 2004, to support the diagnosis of asthma of children, use restrictions:

1.
1.

PEF or FEV1 variability> 15%,
2.

The increase in PEF or FEV1> 15% after the inhaled bronchodilators,
3.

Decrease in PEF or FEV1> 20% after bronchial provocation.

Variability assessment should be done by measuring for> 2 weeks.

1.

Hiperreaktivitas examination respiratory

Bronchial provocation test with histamine, metakolin, exercise or sports, and cold dry air, or with hypertonic saline is supporting a diagnosis of asthma in children.

1.

Measurement of respiratory tract inflammation indication of non-invasive

Can be done by examining eosinophils sputum (phlegm) and measured the levels of NO ekshalasi.

1.

Assessment of allergy status

This examination can help determine the risk factors or triggers of asthma.

In severe asthma attack, which required investigation is the analysis of blood gases (AGD) and chest X-ray projection images anterior-posterior (AP). Can be found on the AGD increased pCO2 and low Po2 (hipoksemia).

Diagnosis Banding

Asthma in children can be diagnosed appeal with:

1.

GER
2.

rinosinobronkitis
3.

OSAS
4.

cystic fibrosis
5.

primary cilliary dyskinesis
6.

foreign body
7.

vocal cord dysfunction

Management

A. Medical Therapy

*

On a mild asthma attack, was given medication (reliever) in the form of beta-agonists are inhaled / oral, or adrenaline 1 / 1000 subcutaneous 0.01 ml / kg body weight / time with a maximum dose of 0.3 ml / time.
*

In an asthma attack were given the drug as above plus the provision of oxygen, intravenous fluids, oral corticosteroids, and treated at the ODC (one day care) or a day care room.
*

In severe asthma attacks, in addition to the above drugs, conducted in the initial provision of aminophylline and maintenance. Corticosteroids may be given intravenously. Oral steroids at a dose of 1-2 mg / kg body weight / day divided by 3 is given for 3-5 days. Recommended steroids prednisone and prednisolon is.

B. Supportive Therapy

Supportive treatment necessary in an asthma attack. In certain circumstances, such as complications of dehydration, metabolic acidosis, or atelectasis, necessary actions to overcome them. In special circumstances, such as a psychological disorder, then the role of a child psychologist or psychiatrist is needed because the stress is one trigger asthma attacks.

C. Surgical Therapy

Surgery is usually not necessary unless complications arise in the form of pneumothorax. In the circumstances required pungsi pneumothorax and if necessary the installation done WSD (water seal drainage) to remove the air from the pleura (the membrane or the membranes covering the lungs).

Following steroid preparations can be used for an asthma attack, but before you use it you should consult with your doctor or the nearest pediatrician.

A. Oral steroids

1.

Prednisolon (generic name)

Trade name: medrol, medixon, lameson, urbason.

Dosage: 4 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

1.

Prednisone (generic name)

Trade names: hostacortin, pehacort, dellacorta.

Dosage: 5 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

1.

Triamsinolon (generic name)

Trade name: kenacort.

Dosage: 4 mg tablets.

Dose: 1-2 mg / kg body weight / day every 6 hours.

B. Steroid injections (injections)

1.

M. Prednisolon succinate (generic name)

Trade name, dosage, dose, route:

1.
1.

Solu-Medrol, vial of 125 mg, 30 mg / kgBB in 30 minutes (high dose) every 6 hours, IV / IM.
2.

Medixon, vial of 500 mg, 30 mg / kgBB within 30 minutes (high dose) every 6 hours, IV / IM.

1.

Hydrocortisone succinate (generic name)

Trade name, dosage, dose, route:

1.
1.

Solu-Cortef, vial of 100 mg, 4 mg / kgBB / times every 6 hours, IV / IM.
2.

Silacort, vial of 100 mg, 4 mg / kgBB / times every 6 hours, IV / IM.

1.

Dexamethasone (generic name)

Trade name, dosage, dose, route:

1.
1.

Oradexon, 5 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
2.

Kalmetason, 4 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
3.

Fortecortin, 4 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.
4.

Corsona, 5 mg vials, 0,5-1 mg / kgBB bolus, followed 1 mg / kgBB / day given every 6-8 hours, IV / IM.

1.

Betamethasone (generic name)

Trade name, dosage, dose, route:

Celestone, 4 mg vials, 0,05-0,1 mg / kgBB every 6 hours, IV / IM.

Prevention

Environmental control, exclusive breastfeeding at least 6 months, potentially alergenik food avoidance, reduction of exposure to house dust mites and animal fur , has been shown to reduce the incidence of food allergy and atopic dermatitis, especially in infants.

In addition, every family who has a child with asthma should make environmental controls, among other things: prevent children from cigarette smoke; no furry pets such as dogs, birds, cats; improve ventilation of the room; reduce humidity room for children who are sensitive to house dust and mites.

Another preventive step is the prevention of primary, secondary, and tertiary. Primary prevention (prenatal) performed on pregnant women who have a history of atopy (allergy) to himself, family, children before, or the husband. Primary prevention aims to prevent the occurrence of sensitization in the fetus intrauterin (while in the womb) and performed when the fetus is still in the womb and breast. Pregnant women and nursing mothers should avoid the trigger factors (inducer) such as cigarette smoke or food alergenik.

Secondary prevention aims to prevent the occurrence of inflammation (inflammation) in infants or children who have sensitisasi. Target are babies or children who have parents with a history of atopy. Antihistamines administered over 18 months in children with atopy dermatitis and history of atopy in older people.

Tertiary prevention aims to prevent the occurrence of asthma attacks in children who already suffer from asthma. Prevention of avoidance of triggers and medication delivery controller (controller)

Prof Barry J Marshall may be the only researchers in the world who want to drink the bacteria to prove the hypothesis. Barry James Marshall is an Australian doctor who proved that the bacterium Helicobacter pylori can lead to inflammatory disease of the stomach. This invention changed the belief that the medical community at that time believed that bacteria can not live in the human stomach has a high acid content (pH around 2). Many scientists reject the hypothesis, but Marshall was convinced that he was right.

In 1981 Marshall met with Robin Warren at the Royal Perth Hospital, at a training. They then studied the presence of bacteria associated with gastritis. A year later they developed the hypothesis that bacteria can cause stomach cancer and gastric inflammation.

Drinking Bacteria To (Research) Health

In 1984, Marshall drank a petri dish containing himself bacteria H. pylori and then immediately infected gastritis, with symptoms of discomfort in the stomach, nausea, vomiting and bad breath. Two weeks after infection, the results of Marshall’s stomach showed no bacteria. However, since forced his wife, Marshall and then taking the antibiotic immediately after that and could not re-check the negative results of the examination. This experiment was published in 1985 in the Medical Journal of Australia. This research eventually led to the discovery of a combination of drugs that can kill the bacteria H.pylori and gastric removed permanently injured.

Helicobacter pylori is a spiral-shaped bacteria that are sensitive to pH. These bacteria belonged to Gram-negative, microaerophilic and are living in between the layers of mucus and epithelial surfaces in the stomach. Spiral-shaped body and the existence of a Helicobacter pylori flagella can move from the lumen of the stomach (low pH) to the layer of mucus (pH neutral). Helicobacter pylori produces large amounts of urease enzyme which can outline of urea in the gastric juices into ammonia and carbon dioxide. Ammonia is produced to protect the influence of Helicobacter pyloridari acid. Helicobacter pylori produces a protein that blocks acid enable them to adapt to the low pH environment of the stomach.

International Agency for Research into Cancer (IARC) classifies H.pylori as “Class-I-Carcinogen” is included in the same category with the dangers of smoking to lung cancer and respiratory tract. Gastritis is a basic condition that can eventually lead to injury and other gastrointestinal complaints, and even can lead to stomach cancer. This disease affects nearly 50 percent of the world. The hypothesis that H.pylori is a causative factor of stomach cancer in the end accepted WHO

Solar eclipse events often create a scene, and that’s unusual natural phenomenon, although considered somewhat rare. One cause uproar is concern about the safety of the eyes, the fear that the sight of an eclipse was caused blindness.

Pupils

Like the diaphragm in the camera, the human eye has a pupil that can be widened or narrowed to measure the amount of light entering the eye. In the dark, dilated pupil diameter of 8 mm in order to collect enough light to allow people to see in the dark. On a sunny day, its diameter shrunk to 2 mm, even able to shrink to about 1.6 mm when faced with blinding light.

But measuring the pupillary light is finite, does not hinder the power of the radiance of the sun was so great. If calculated, direct light from the sun must be attenuated to be 50,000 times safe for the eyes, made the original power of 0.00002. If not, those who dared to challenge the sun is likely to be blind.

Therefore daily glare of the sun radiance is always avoided. But when the eclipse comes, people get interested to observe the sun’s face was turned into a scythe. Scarum was possible, ignorant of the danger.

Because at the time of eclipses, solar radiance partially blocked by the moon so natural to be dim and pupils were dilated. Just as people looked up at the sun, the pupils have not had time to react, when the sun’s surface brightness remains the same fierce with the daily, which shrink in size only to form crescent. It’s certainly an enormous danger that threatened blindness. Even more so when seen through binoculars, camera or other optical instruments are not modified, because there is the lens that focuses light and greatly increases the danger. Do not you ever seen a solar eclipse with the naked eye, especially with binoculars or a camera that is not equipped with a special.

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No need to worry, there are some safe ways to observe the events that once a year does not necessarily stop in the same area. The principle is widely used not see directly but watched the sun’s image on a surface. Like other way, of course the sunny weather is needed. A simple example of the form of cardboard boxes that can be made yourself (see picture).

Field of the width of about 30cm x 30cm were given a small hole (often called a pinhole) diameter of about 1 mm at a distance of 5cm from the edge. Through this hole, the sun will break through to form the image on the surface in the field below. The higher the size of the box, the greater the sun’s image. But for practical, high-box is sufficient if between 50 to 80 cm.

Then on the edge of the hole created as a place wide enough for both eyes to peer into the box. In use, with his back to the sun, holding the box while peering into the eyes.  box tilted a bit to find the best direction that produces the sun’s image in the field below.

Two reasons that make this a safe box. First because a small hole only allows a little glow in the sun. Both because we are observing with his back to the sun, keep the eyes from the spotlight of the sun.

The same principle is also found in other places. Those who could not be prepared to make the box under the tree still get a little sunlight, so that in ordinary circumstances reveal bright dots on the ground. Look at the little dots that, when a solar eclipse to be a sickle shape. If the wind shaking the leaves, bright crescent sickle-it was funny to move around.

If you suddenly realised that the application deadline for your dream graduate school is less than a month away, you may decide to start panicking. After all, you have to prepare your transcript, letters of recommendation, admissions essay and your GRE’s scores. Although you may start organising your transcript, getting your letters of recommendation and working on your admissions essay right away, you may have to wait a few weeks before taking the next available GRE test. With the amount of time you have (or lack of), you may not be able to get a second chance before the application deadline passes. In dire situations such as this, it’s imperative that you breeze through your GRE’s on the first try.

1) Always be aware of the time

This should be a no-brainer for you. As a potential graduate student, you must have already gone through hundreds of tests throughout your academic life. Still, don’t be over-confident. Always be aware of how much time you have left and plan accordingly. Never spend too much time on one question. This will result in loss of precious time and you may miss other questions you could have easily answered. Even if you are well-aware of the time however, try not to rush. Devote just the right amount of time to each question right from the start. Rushing may cost you valuable marks.

2) Don’t leave any questions blank

You will not be penalised for any wrong answers, so make sure you answer all the questions given. Even if you don’t know the answers to some questions, use the method of elimination. More often than not, you will have a good idea of which option(s) cannot be the answer. You can then make a logical choice. Take note though the questions at the beginning of the test will affect your score more than those towards the end so make sure you don’t leave them blank. Getting these questions correct will most likely already give you good scores.

3) Only key your answer in when you are absolutely sure

Since you will be using the Computer-Adaptive Test for GREs, you cannot return to a previous question once you’ve keyed your answer in. It will not be possible for you to leave the difficult questions later or check your answers at the end of the test if you have time to spare. This is why the first tip on pacing yourself right from the start is very important. Be extremely certain of your answers before answering it.

4) Be prepared

Being prepared is more than just having enough practice before the test. It involves getting adequate rest the night before the test instead of cramming until 4am in the morning. Being prepared includes knowing how to get to the test venue about fifteen to thirty minutes before time and wearing comfortable clothes to your exam.

5) Do not panic

Be calm and keep your cool even if you are encountering questions you don’t know the answers to. If you panic, you risk the chances of getting even the easiest question wrong. If you’re beginning to feel tensed, don’t be afraid to take a short break; ask for a glass of water, close your eyes for a few seconds and take deep breaths to calm down.

Of course, besides all these given tips, it’s also important for you to practise as much as possible before your test date. If you’ve prepared well by combining both your hard work and the above tips, chances are high that you will ace your GRE’s on your very first try.

One of the most important preparation techniques you have to carry out before any test is to practise. So after spending weeks or even months practising for a test, a good score should already be in the bag, right? Not necessarily. Being mentally prepared for a test is actually as important, if not more important than being well-practised. You will be surprised by how much easier you can score if you have the correct mentality to take a test. This is no exception to a GMAT test. Read on to find out how to mentally prepare for a GMAT test:

1) Don’t think that GMAT Quant is a piece of cake

Many students generally think that the quant is an easy section to score, so they choose to spend less time preparing for it, thus leading to a decrease in their overall score. In reality, while GMAT quant is easier, it is also slightly trickier. You need to focus hard to avoid making silly mistakes in this section.

Generally, throughout the whole test, you will encounter GMAT questions that include incorrect answer choices that were deliberately included to exploit possible misinterpretations of what the question is asking. Although with regular practice you will be able to avoid these deceptive choices, if you don’t mentally prepare yourself for the trickiness of the test, you may not bother to take enough time out to carry out practice questions.

2) Arm yourself with a systematic approach to data sufficiency questions

Don’t show up to your GMAT test venue choosing to ignore data sufficiency questions. Arm yourself with a systematic approach to data sufficiency questions.

• Read the data sufficiency question carefully

• Analyse the information needed to arrive at the correct answer

• Look at each of the two statements independently of the other

• If looking at the two statements independently does not give you the answer, combine the two statements

Do remember not to assume anything that’s not written in the question. Take note also that when the 2 statements convey the same exact information, the correct answer choice will be either D or E.

3) Take the Analytical Writing Assessment seriously

Don’t assume that you can just breeze through the Analytical Writing Assessment section. Take the time to review the list of essay questions to be asked in the exam and think about how you would respond to some of the selected questions. You should also then spend some time going through sample essays to get an idea on structuring the essay.

4) Prepare yourself to concentrate for 4 full hours

Don’t think that after enough practise, you can simply show up for your GMAT test and expect a good score. You have to be prepared to concentrate for 4 hours straight. This means that choosing the time of your GMAT test is also important. If you are a morning person, choose the morning slot as that’s when your mental alertness is at its peak. On the other hand, if you are not a morning person, you should choose an afternoon slot instead to ensure that you will be able to do your best for your GMAT.

Here’s a tip for quickly getting a disengaged student back on task. Like any classroom management strategy it won’t work every time with every student but it’s powerful none the less and a great tool for your classroom management tool kit.

We all know how powerful praise can be as a classroom management tool. My personal view is that when used correctly, sincere, heartfelt praise is one of the most effective strategies educators possess for managing the mood of students and increasing motivation in lessons. This tip is a novel way of using the principle of ‘proximity praise’.

Proximity praise relies on the ‘ripple effect’ – where the positive feelings generated by praising individual students who are working hard or behaving well spread or ‘ripple’ around the room. The other students in the room are given the clear message that if they behave in a similar way, they too will receive positive praise. We can multiply the power of the ripple effect with a novel praise idea which someone suggested at one of our live classroom management courses recently. It’s called ‘Windscreen wiper praise’ and although it’s very straight forward, with a name like that it obviously needs something of an explanation…

Let’s say you have a student (we’ll call him ‘Damien’) who is off-task and not working as he should be, rather than nagging him or directing him, which we’ve discovered Damien seldom responds to, we’ll use the idea of praising other pupils in the room with the hope that he will want some of the same. With ‘proximity praise’ we would praise any student around the room who is getting on with their work or behaving appropriately. With ‘Windscreen wiper’ praise we focus on students who are very close to Damien – particularly those sitting next to him. The idea is to subtly but repeatedly praise the students sitting on either side of him – let’s call them ‘Kyle’ and ‘Kieran’ – for their work and/or behaviour. If Kyle and Kieran are friends of Damien it will make this even more effective but it works well even if they aren’t. This is how it could go…

“Hey Kieran you’ve got it. I honestly didn’t think you’d manage that question; absolutely brilliant – it’s good to see you learning.”

“Let’s have a look at yours Kyle……great, you’ve really improved. You’ve got that bit right, well done. Now, how could you improve this bit and get to the next level?”

A few minutes later…

“Thank you for putting that in the bin Kyle. By the way I saw that film last night you were talking about the other day – it was really funny, thanks for suggesting it.”

“Nice one Kieran. I like what you’ve done there. I’m really pleased with both of you actually, you’re working very well, thank you.”

Do you see how it works and where the name ‘Windscreen wiper praise’ comes from? By continually engaging with Kyle and Kieran in a positive manner Damien’s head will be going from side to side like a wiper blade on high speed wondering what his two neighbours have done to attract all this attention.

Students generally like getting attention – especially if it’s positive – and by NOT giving Damien attention for his lack of effort, but instead giving it to his neighbours for their compliance, we take the power of proximity praise to the next level.