Pada 11 Dis 1993, seperti hari ini yang juga jatuh pada hari Sabtu, satu blok kondominium di projek Highlands Tower tumbang seperti susunan kad, menimbusi 48 orang hidup-hidup. Beberapa hari yang lepas satu tragedi tanah runtuh berlaku di Ulu Yam. Runtuhan tanah di Jalan Semantan hanya merosakkan kenderaan, tiada nyawa terkorban. Kini ia berlaku di Bukit Antarabangsa kira-kira satu kilometer dari tapak tragedi kondominium Highlands Tower.
Empat Terkorban, Seorang Masih Terperangkap Dalam Tanah Runtuh Di Bukit Antarabangsa
KUALA LUMPUR, 6 Dis (Bernama) -- Kejadian tanah runtuh di kawasan Bukit Antarabangsa, Hulu Klang dekat sini telah mengorbankan empat orang manakala seorang lagi mangsa dipercayai masih terperangkap dalam rumah-rumah yang tertimbus itu.
Kejadian kira-kira pukul 4 pagi itu telah menimbuskan 14 buah banglo di Taman Bukit Mewah dan Taman Bukit Utama.
Jumlah korban itu disahkan Ketua Polis Selangor Datuk Khalid Abu Bakar.
Mangsa yang terkorban dikenali sebagai Shaiful Khas Datuk Shahrudin, 20, Dr N. Yogeswari, 40 dan Eng Yee Peng, 30.
Khalid berkata pasukan mencari dan menyelamat sedang mengenal pasti kedudukan seorang lagi mangsa, iaitu seorang lelaki, yang dipercayai masih terperangkap.
"Ada rumah yang roboh sepenuhnya dan ada hanya sebahagian roboh," katanya yang berada di tempat kejadian.
Sabtu petang, pasukan mencari dan menyelamat mula menggunakan jengkaut untuk mengesan mangsa yang tertimbus itu memandangkan kejadian telah berlaku lebih 12 jam.
Khalid berkata pasukan mencari dan menyelamat akan menggunakan kepakaran untuk memastikan mangsa tertimbus tidak tercedera apabila jengkaut digunakan.
Operasi mencari dan menyelamat akan diteruskan selama 24 jam tanpa henti walaupun hujan.
"Tetapi jika hujan terlalu lebat hingga membahayakan pasukan mencari dan menyelamat, operasi akan dihentikan sementara waktu," katanya.
Beliau berkata terdapat 14 pasukan penyelamat di lokasi dan mereka akan turut membuat dua laluan alternatif supaya penghuni yang tinggal di kawasan berhampiran boleh keluar.
"Mereka yang diarahkan pindah dari kawasan kejadian akan ditempatkan di pusat sementara di Sekolah Kebangsaan Hulu Klang. Mereka dibenarkan pulang ke rumah masing-masing setelah mendapat pengesahan Ikram (Institut Kerja Raya Malaysia) jika kawasan itu selamat," katanya.
Khalid berkata masalah yang dihadapi sekarang adalah keadaan tanah yang masih bergerak dan tidak stabil apabila usaha mengorek tanah dijalankan. Kawasan runtuhan itu meliputi empat hektar dengan lingkungan satu kilometer meliputi kawasan sekitarnya, katanya.
Sebelum itu, beliau melaporkan 93 orang mangsa kejadian tanah runtuh itu berjaya menyelamatkan diri.
Khalid berkata polis telah menasihati antara 3,000 dan 5,000 penduduk di situ agar meninggalkan rumah mereka, yang kebanyakannya berupa apartmen.
Pegawai Perhubungan Awam Hospital Kuala Lumpur (HKL) Zaiton Abu Bakar berkata 14 mangsa mendapatkan rawatan sebagai pesakit luar di hospital itu.
Mangsa yang mengalami kecederaan menerima rawatan awal di surau Addinniah di Bukit Antarabangsa sebelum dihantar ke hospital berdekatan untuk rawatan susulan dengan menggunakan tidak kurang daripada 12 ambulans.
Banglo yang tertimbus itu melibatkan lapan unit banglo di Taman Bukit Utama dan enam unit di Taman Bukit Mewah, demikian menurut jurucakap bomba dan penyelamat yang berada di tempat kejadian.
Salah sebuah banglo terlibat ialah milik Ketua Setiausaha Sulit Perdana Menteri Datuk Mohamed Thajudeen Abdul Wahab.
Mohamed Thajudeen sekeluarga bagaimanapun berjaya menyelamatkan diri.
Menurut bomba dan penyelamat, tanah runtuh itu dipercayai berpunca daripada pergerakan air bawah tanah.
Pihak tentera, Jabatan Pertahanan Awam (JPAM), Pasukan Mencari dan Menyelamat Khas Malaysia (SMART), Bomba dan Penyelamat dan Majlis Perbandaran Ampang Jaya (MPAJ) sedang giat menjalankan kerja menyelamat.
Kejadian tanah runtuh itu mengakibatkan jalan utama ke kawasan perumahan terbabit terputus dan beratus-ratus orang terperangkap di Bukit Antarabangsa.
Mereka yang terperangkap dan juga pasukan penyelamat terpaksa menggunakan Jalan Wangsa 9 sebagai jalan alternatif memandangkan jalan utama ke kawasan itu tidak dapat dilalui.
Anggota Dewan Undangan Negeri kawasan Bukit Antarabangsa Mohamed Azmin Ali yang melawat tempat kejadian berkata pergerakan tanah masih berlaku dan bekalan elektrik di beberapa kawasan perumahan di Bukit Antarabangsa terputus.
Menteri Besar Selangor Tan Sri Abdul Khalid Ibrahim turut melawat tempat kejadian.
Tanah runtuh itu berlaku kira-kira 1.5km dari tempat berlaku runtuhan tiga blok 12 tingkat apartmen Highland Towers pada 11 Dis 1993, mengorbankan 48 orang.
Tanah runtuh di Bukit Antarabangsa juga yang ketiga berlaku di Lembah Klang dalam masa seminggu.
Pada 30 Nov, dua beradik Noratirah Roslan, 16, dan Nurul Intan Sarina, 9, terbunuh dalam kejadian runtuhan tanah yang menimpa banglo kediaman mereka di Ulu Yam Perdana, Gombak.
Khamis lepas, tanah runtuh di Jalan Semantan meranapkan dinding konkrit kawasan meletak kenderaan yang terletak antara dua bangunan, mengakibatkan enam kereta tertimbus selain merosakkan lima lagi kenderaan.
Kesemua kejadian tanah runtuh ini dipercayai berpunca daripada pergerakan air bawah tanah, dan keadaan itu diburukkan lagi oleh hujan lebat sejak beberapa minggu lepas.
TAKZIAH DIUCAPKAN KEPADA KELUARGA MANGSA TANAH RUNTUH
VIDEO NASYID SEBENARNYA UNTUK DIHAYATI
Sebenarnya
Artist: Raihan
Sebenarnya hati ini cinta kepada Mu
Sebenarnya diri ini rindu kepada Mu
Tapi aku tidak mengerti
Mengapa cinta masih tak hadir
Tapi aku tidak mengerti
Mengapa rindu belum berbunga
Sesungguhnya walau ku kutip
Semua permata di dasar lautan
Sesungguhnya walau ku siram
Dengan air hujan dari tujuh langit Mu
Namun cinta tak kan hadir
Namun rindu takkan ber bunga
Ku cuba menghulurkan
Sebuah hadiah kepada Mu
Tapi mungkin kerana isinya
Tidak sempurna tiada seri
Ku cuba menyiramnya
Agar tumbuh dan berbunga
Tapi mungkin kerana airnya
Tidak sesegar telaga kauthar
Sesungguhnya walau ku kutip
Semua permata di dasar lautan
Sesungguhnya walau ku siram
Dengan air hujan dari tujuh langit Mu
Namun cinta tak kan hadir
Namun rindu tak akan berbunga
Jika tidak mengharap rahmat Mu
Jika tidak menagih simpati
Pada Mu ya Allah
Tuhan hadiahkanlah kasih Mu kepadaku
Tuhan kurniakanlah rinduku kepada Mu
Moga ku tahu
Syukur ku hanyalah milik Mu
VIDEO NASYID CINTA HAKIKI
Cinta Hakiki
Telah lama cinta terbiar
Dari cinta yang suci
Telah lama cinta tersasar
Dari cinta hakiki
Kerna sekian lamanya
Manusia dibuai cinta nafsu
Kita sering menyangka
Cinta manusia itu yang sejati
Namun lupakah kita
Cinta nafsu selalu mengecewakan
Sering berubah tidak menentu
Seperti pantai dipukul ombak
Cintakan Allah cinta sebenarnya
Itulah cinta yang sejati
Kasihlah sesama manusia
Kerna cinta yang hakiki
Hanya untuk Tuhan Yang Esa
Cintakan Allah tiada kecewa
Engkaukan tenang di waktu susah
Kembalilah kepada Tuhan
Dia kan tetap menanti
Kehadiran hambaNya
Yang sebenar pasrah
Cinta kasih sayangNya tidak bertepi
ACQUIRED INFORMATION DEFICIENCY SICKNESS (a.i.d.s)
AIDS has killed more than 25 million people since 1981. That's half as many deaths as in World War II. And it's not over. 1.1 million Americans are among the 33 million people now living with HIV, the virus that causes AIDS. In this entry, we have included a pictorial history of some landmarks of AIDS in the world and a synopsis of AIDS and its Management for those interested in the modern epidemic. Despite its highly technical in nature, we have tried to avoid the heavy stuff medical jargons. Happy reading. Please share it with your mate(s) and friends.
HIV At A Glance
* The human immunodeficiency virus (HIV) is a type of virus called a retrovirus, which infects humans when it comes in contact with tissues such as those that line the vagina, anal area, mouth, or eyes, or through a break in the skin.
* HIV infection is generally a slowly progressive disease in which the virus is present throughout the body at all stages of the disease.
* Three stages of HIV infection have been described.
1. The initial stage of infection (primary infection), which occurs within weeks of acquiring the virus, and often is characterized by a "flu-" or "infectious mononucleosis-"like illness that generally resolves within weeks.
2. The stage of chronic asymptomatic infection (meaning a long duration of infection without symptoms) which lasts an average of 8 to10 years.
3. The stage of symptomatic infection, in which the body's immune (or defense) system has been suppressed and complications have developed. This stage is called the acquired immunodeficiency syndrome (AIDS). The symptoms are caused by the complications of AIDS, which include one or more unusual infections or cancers, severe loss of weight, and intellectual deterioration (called dementia).
* When HIV grows (that is, by reproducing itself), it acquires the ability to change (mutate) its own structure. This mutation enables the virus to become resistant to previously effective drug therapy.
* The goals of drug therapy are to prevent damage to the immune system by the HIV virus and to halt or delay the progress of the infection to symptomatic disease.
* Therapy for HIV includes combinations of drugs that decrease the growth of the virus to such an extent that the treatment prevents or markedly delays the development of viral resistance to the drugs.
* The best combination of drugs for HIV has not yet been defined, but one of the most important factors is that the combination be well tolerated so that it can be followed consistently without missing doses.
AIDS Timeline
Between 1884 and 1924, somewhere near modern-day Kinshasa in West Central Africa, a hunter kills a chimpanzee. Some of the animal's blood enters the hunter's body, possibly through an open wound. The blood carries a virus harmless to the chimp, but lethal to humans: HIV. The virus spreads as colonial cities sprout up, but deaths are blamed on other causes.
1981: First Cases Recognize
In June, the CDC (Centre For Disease Control in USA) publishes a report from Los Angeles of five young homosexual men with fatal or life-threatening PCP pneumonia. Almost never seen in people with intact immune systems, PCP turns out to be one of the major "opportunistic infections" that kill people with AIDS. On the Fourth of July, the CDC reports that an unusual skin cancer -- Kaposi's sarcoma or KS -- is killing young, previously healthy men in New York City and California.
1982
* The CDC calls the new disease acquired immune deficiency syndrome or AIDS. AIDS is seen in people with hemophilia, convincing scientists that the disease is spread by an infectious agent in contaminated blood.
* Gay men form the first AIDS advocacy organizations.
1983
* The CDC warns that AIDS may spread by heterosexual sex and by mother-to-child transmission.
* The U.S. Public Health Service asks "members of groups at increased risk for AIDS" to stop donating blood.
* Heterosexual spread of AIDS in Africa is confirmed.
* Public apprehension grows. False rumors of "household spread" abound. In New York, landlords are reported to evict AIDS patients.
A baby with AIDS, abandoned after her mother's death from the disease.
1983 Drs. Montagnier and Barre-Sinoussi discovered the AIDS virus.
Pasteur Institute researchers Luc Montagnier and Francoise Barre-Sinoussi isolate a virus from the swollen lymph gland of an AIDS patient. They called it lymphadenopathy-associated virus or LAV.
Independently, UCSF researcher Jay Levy isolates ARV -- AIDS-related virus. Not until 1986 does everybody agree to call the virus HIV: human immunodeficiency virus.
1984
National Cancer Institute (NCI) researcher Robert Gallo reports isolation of an AIDS virus he calls HTLV-III. Later, it turns out to be LAV from a sample sent by the Montagnier lab. 
1985
* Rock Hudson dies of AIDS.
1985 The Burke family: The father, mother, and son have HIV.
AIDS patient and advocate Ryan White, 15, wins battle to attend school
1986
* Surgeon General Everett Koop urges parents to have a "frank and open conversation" about AIDS with their children and teens.
* For the first time, President Reagan publicly utters the word "AIDS."
1987
* President Reagan makes his first speech on AIDS.
* The U.S. forbids immigration by people with HIV, a policy later signed into law by President Clinton.
* Liberace dies of AIDS.
1989
* Scientists find that even before AIDS symptoms develop, HIV replicates wildly in the blood. The goal of treatment shifts to keeping HIV at low levels.
* Robert Mapplethorpe dies of AIDS.
Esteban De Jesus, a boxer, dying of AIDS
1991-1992
* Magic Johnson announces he is HIV positive.
* Queen singer Freddy Mercury dies of AIDS.
* AIDS becomes the leading cause of death in U.S. men aged 25-44.
* FDA (Food And Drug Administration) licenses the first rapid HIV test.
1996-1997
A treatment breakthrough: The AIDS drug cocktail -- highly active anti-retroviral therapy or HAART -- can cut HIV viral load to undetectable levels. Hope surges when AIDS researcher David Ho suggests treatment could eliminate HIV from the body. He's wrong -- it's later found that HIV hides in dormant cells -- but U.S. AIDS deaths decline by more than 40%.
Dr Ho1998-2000
Awareness grows that HAART has serious side effects. Treatment failures underscore the need for newer, more powerful AIDS drugs. In the ensuing years, the FDA approves new classes of drugs that make HIV treatment safer, easier, and more effective. But the drugs still do not cure.
2001-2002
* UN Secretary General Kofi Annan proposes the Global Fund for AIDS to extend AIDS treatment -- still totally unavailable to the vast majority of people living with AIDS. Only 1% of the 4.1 million sub-Saharan Africans with HIV receive anti-HIV drugs.
* AIDS becomes the leading cause of death worldwide for people aged 15 to 59.
2003-2005
* There is an HIV outbreak in the California porn industry.
* President Bush announces the $15 billion President's Emergency Plan for AIDS Relief. The prevention portion of the plan is criticized for over-emphasis on abstinence. But the plan provides much-needed AIDS-treatment funds to 15 nations.
2006-2007
* HIV treatment is shown to extend life by 24 years, at a cost of $618,900.
* Merck's AIDS vaccine fails in clinical trials -- the latest in a long line of vaccine failures. However, new candidate vaccines continue to move through the development pipeline.
* UNAIDS recommends adult circumcision after it's found to halve AIDS transmission from women to men in regions of high prevalence.
2008
* The CDC says improved surveillance shows AIDS in America is worse than we'd thought: 1.1 million infected, up 11% from 2003.
* New HIV infection rates soar among men who have sex with men.
HIV infections go way up in young gay men, especially young African Americans
2008
* Luc Montagnier and Francoise Barre-Sinoussi awarded Nobel Prize in medicine for discovery of HIV.
* Of the 33 million people now living with HIV, 3 million are getting treatment. That's less than a third of those who need immediate treatment. Yet for the first time, global AIDS deaths decline.
A Synopsis Of AIDS and its Management
Adapted From Work Of Medical Author : Eric S. Daar, MD
1.When was HIV discovered and how is it diagnosed?
2. How is HIV spread (transmitted)?
3. What happens after an exposure to the blood or genital secretions of an HIV- infected person?
4. What laboratory tests are used to monitor HIV-infected people?
5. What are the key principles in managing HIV infection?.
6. Factors to consider before starting antiviral therapy.
7. When to start antiviral therapy
8.Initial therapy for HIV
9.What about treatment for HIV during pregnancy?
10.What about treating people exposed to the blood or genital secretions of an HIV-infected person?
11.What can be done for people who have severe immunosuppression?
12. What is in the future for HIV-infected individuals and for those at risk to contract HIV?
1.When was HIV discovered and how is it diagnosed?
In 1981, homosexual men with symptoms of a disease that now are considered typical of the acquired immunodeficiency syndrome (AIDS) were first described in Los Angeles and New York. The men had an unusual type of lung infection (pneumonia) called Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia (PCP) and rare skin tumors called Kaposi's sarcoma. The patients were noted to have a severe reduction of a type of cell in the blood that is an important part of the immune system, called CD4 cells. These cells, often referred to as T cells, help the body fight infections. Shortly thereafter, this disease was recognized throughout the United States, Western Europe, and Africa. In 1983, researchers in the United States and France described the virus that causes AIDS, now known as the human immunodeficiency virus (HIV) and belonging to the group of viruses called retroviruses. In 1985, a blood test became available that measures antibodies to HIV that are the body's immune response to the HIV. This blood test remains the best method for diagnosing HIV infection. Recently, tests have become available to look for these same antibodies in the saliva and urine, and some can provide results within 20 minutes of testing.
2.How is HIV spread (transmitted)?
HIV is present in the blood and genital secretions of virtually all individuals infected with HIV, regardless of whether or not they have symptoms. The spread of HIV can occur when these secretions come in contact with tissues such as those lining the vagina, anal area, mouth, or eyes (the mucus membranes), or with a break in the skin, such as from a cut or puncture by a needle. The most common ways in which HIV is spreading throughout the world include sexual contact, sharing needles, and by transmission from infected mothers to their newborns during pregnancy, labor (the delivery process), or breast-feeding. (See the section below on treatment during pregnancy for a discussion on reducing the risk of transmission to the newborn.)
Sexual transmission of HIV has been described from men to men, men to women, women to men, and women to women through vaginal, anal, and oral sex. The best way to avoid sexual transmission is abstinence from sex until it is certain that both partners in a monogamous relationship are not HIV-infected. Because the HIV antibody test can take up to 6 months to turn positive, both partners would need to test negative 6 months after their last potential exposure to HIV. If abstinence is out of the question, the next best method is the use of latex barriers. This involves placing a condom on the penis as soon as an erection is achieved in order to avoid exposure to pre-ejaculatory and ejaculatory fluids that contain infectious HIV. For oral sex, condoms should be used for fellatio (oral contact with the penis) and latex barriers (dental dams) for cunnilingus (oral contact with the vaginal area). A dental dam is any piece of latex that prevents vaginal secretions from coming in direct contact with the mouth. Although such dams occasionally can be purchased, they are most often created by cutting a square piece of latex from a condom.
The spread of HIV by exposure to infected blood usually results from sharing needles, as in those used for illicit drugs. HIV also can be spread by sharing needles for anabolic steroids to increase muscle, tattooing, and body piercing. To prevent the spread of HIV, as well as other diseases including hepatitis, needles should never be shared. At the beginning of the HIV epidemic, many individuals acquired HIV infection from blood transfusions or blood products, such as those used for hemophiliacs. Currently, however, because blood is tested for antibodies to HIV before transfusion, the risk of acquiring HIV from a blood transfusion in the United States is extremely small and is considered insignificant.
There is little evidence that HIV can be transferred by casual exposure, as might occur in a household setting. For example, unless there are open sores or blood in the mouth, kissing is generally considered not to be a risk factor for transmitting HIV. This is because saliva, in contrast to genital secretions, has been shown to contain very little HIV. Still, theoretical risks are associated with the sharing of toothbrushes and shaving razors because they can cause bleeding, and blood contains large amounts of HIV. Consequently, these items should not be shared with infected persons. Similarly, without sexual exposure or direct contact with blood, there is little if any risk of HIV contagion in the workplace or classroom.
3.What happens after an exposure to the blood or genital secretions of an HIV- infected person?
The risk of HIV transmission occurring after any potential exposure to bodily fluids is poorly defined. The highest risk sexual activity, however, is thought to be anal intercourse without a condom. In this case, the risk of infection may be as high as 3% to 5% for each exposure. The risk is probably less for vaginal intercourse without a condom and even less for oral sex without a latex barrier. Despite the fact that no single sexual exposure carries a high risk of contagion, HIV infection can occur after even one sexual event. Thus, people must always be diligent in protecting themselves from potential infection.
Within 2 to 6 weeks of an exposure, the majority of infected persons will have a positive HIV antibody test, with virtually all being positive by 6 months. The test used most commonly for diagnosing infection with HIV is referred to as an ELISA. If the ELISA finds the HIV antibody, the presence of the antibody is confirmed by a test called a Western blot. During this period of time shortly after infection, more than 50% of those infected will experience a "flu-like" or "infectious mono-like" illness for up to several weeks. This illness is considered the stage of primary HIV infection. The most common symptoms of primary HIV infection are:
* fever
* aching muscles and joints
* sore throat, and;
* swollen glands (lymph nodes) in the neck.
It is not known, however, why only some HIV-infected persons develop these symptoms. It also is unknown whether or not having the symptoms is related in any way to the future course of HIV disease. Regardless, infected persons will become symptom-free (asymptomatic) after this phase of primary infection. During the asymptomatic phase, infected individuals will know whether or not they are infected only if a test for HIV is done. Therefore, anyone who might possibly have been exposed to HIV should seek testing even if they are not experiencing symptoms. HIV testing can be performed by a physician or at a testing center.
During the asymptomatic stage of infection, literally billions of HIV particles (copies) are produced every day and circulate in the blood. This production of virus is associated with a decline (at an inconsistent rate) in the number of CD4 cells in the blood over the ensuing years. Although the precise mechanism by which HIV infection results in CD4 cell decline is not known, it probably results from a direct effect of the virus on the cell as well as the body's attempt to clear these infected cells from the system. In addition to virus in the blood, there is also virus throughout the body, especially in the lymph nodes, brain, and genital secretions. The time from HIV infection to the development of AIDS varies. Some people develop symptoms, signaling the complications of HIV that define AIDS, within 1 year of infection. Others, however, remain completely asymptomatic after as many as 20 years. The average time for progression from initial infection to AIDS is 8 to10 years. The reason why different people experience clinical progression of HIV at different rates remains an area of active research.
4.What laboratory tests are used to monitor HIV-infected people?
Two blood tests are routinely used to monitor HIV-infected people. One of these tests, which counts the number of CD4 cells, assesses the status of the immune system. The other test, which determines the so-called viral load, directly measures the amount of virus.
In individuals not infected with HIV, the CD4 count in the blood is normally above 500 cells per cubic milliliter (mm3) of blood. HIV-infected people generally do not become at risk for complications until their CD4 cells are fewer than 200 cells per mm3. At this level of CD4 cells, the immune system does not function adequately and is considered suppressed. Patients who have this CD4 count (fewer than 200 cells per mm3) are referred to as being immunosuppressed. A declining number of CD4 cells means that the HIV disease is advancing. Thus, a low CD4 cell count signals that the person is at risk for one of the many unusual infections (the so-called opportunistic infections) that occur in individuals who are immunosuppressed. In addition, the actual CD4 cell count indicates which specific therapies should be initiated to prevent those infections.
The viral load predicts whether or not the CD4 cells will decline in the coming months. In other words, those persons with high viral loads are more likely to experience a decline in CD4 cells and progression of disease than those with lower viral loads. Therefore, knowing the amount of virus can be used to predict the development of the disease. The viral load also is a vital tool for monitoring the effectiveness of new therapies and determining when drugs stop working. Thus, the viral load will decrease within weeks of initiating an effective antiviral regimen. If a combination of drugs is very potent, the number of HIV copies in the blood will decrease by as much as 100-fold, such as from 100,000 to 1,000 copies per mL of blood in the first 2 weeks and gradually decrease even further during the ensuing 12 to 24 weeks. Moreover, it has become increasingly clear that the greater the decline of the viral load after beginning therapy, the longer it will remain suppressed. The ultimate goal is to get viral loads to below the limits of detection by standard assays, usually less than 50 or 75 copies per mL of blood. When viral loads are reduced to these low levels, it is believed that the viral suppression may persist for many years.
Drug resistance testing also has become a key tool in the management of HIV-infected individuals. Details of these tests will be discussed later. Clearly, resistance testing is now routinely used in individuals experiencing poor responses to HIV therapy or treatment failure. In general, a poor response to initial treatment would include individuals who fail to experience a decline in viral load of approximately 100-fold in the first 8 weeks, have a viral load of greater than 500 copies per mL by week 12, or have levels greater than 50 or 75 copies per mL by week 24. Treatment failure would generally be defined as an increase in viral load after an initial decline in a person who is believed to be consistently taking his or her medications. More recent guidelines from the U.S. Department of Health and Human Services (DHHS) (www.hivatis.org) and International AIDS Society-USA (IAS-USA) have suggested that resistance testing be considered in individuals who have never been on therapy, particularly in the first months or even years of infection, to determine if they might have acquired HIV that is resistant to drugs. In fact, the most recent DHHS guidelines (May 4, 2006) formally recommend such testing be performed in all individuals starting therapy for the first time.
5.What are the key principles in managing HIV infection?
First of all, there is no evidence that people infected with HIV can be cured by the currently available therapies. In fact, individuals who are treated for up to three years and are repeatedly found to have no virus in their blood experience a prompt rebound increase in the number of viral particles when therapy is discontinued. Consequently, the decision to start therapy must balance the risk of an individual advancing to the stage of symptomatic disease against the risks associated with therapy. The risks of therapy include the short and long-term side effects of the drugs, described in subsequent sections, as well as the possibility that the virus will become resistant to therapy. This resistance then limits the options for future treatment.
A major reason that resistance develops is the patient's failure to correctly follow the prescribed treatment, for example, by not taking the medications at the correct time. In addition, the likelihood of suppressing the virus to undetectable levels is not as good for patients with lower CD4 cell counts and higher viral loads. Finally, if virus remains detectable on any given regimen, resistance eventually will develop. Indeed, with certain drugs, resistance may develop in a matter of weeks, such as with lamivudine (EpivirTM, 3TC), emtricitabine (EmtrivaTM, FTC) and the drugs in the class of nonnucleoside analogue reverse transcriptase inhibitors (NNRTI) such as nevirapine (ViramuneTM, NVP), delavirdine (RescriptorTM, DLV), and efavirenz (SustivaTM, EFV). Thus, if these drugs are used as part of a combination of drugs that does not suppress the viral load to undetectable levels, resistance will develop rapidly and the treatment will be ineffective. In contrast, HIV becomes resistant to certain other drugs, such as zidovudine (RetrovirTM, AZT), stavudine (ZeritTM, D4T), and protease inhibitors (PIs), over months. In fact, for some PIs whose effects are enhanced by giving them in combination with the PI, ritonavir (NorvirTM, RTV) to prevent their clearance by the body, resistance appears to be markedly delayed. These drugs are discussed in more detail in subsequent sections, but it is important to note that when resistance develops to one drug, it often results in resistance to other related drugs, so called cross-resistance. Nevertheless, HIV-infected individuals must realize that antiviral therapy can be very effective. This is the case even in those who have a low CD4 cell count and advanced disease, as long as drug resistance has not developed.
6.Factors to consider before starting antiviral therapy
One of the most controversial areas in the management of HIV disease is deciding the best time to start antiviral treatment. Clearly, therapy during the mildly symptomatic stage of the disease delays its progression to AIDS, and treating individuals with AIDS postpones death. Consequently, most experts agree that patients who have experienced complications of HIV disease, such as oral thrush (yeast infection in the mouth), chronic unexplained diarrhea, fevers, weight loss, opportunistic infections, or dementia (for example, forgetfulness) should be started on antiviral treatment even if the symptoms are mild. In patients who do not have symptoms, however, there is more uncertainty. Most recommendations for this group are based on the predictors of clinical progression, such as the number of CD4 cells and the viral load. Thus, several studies have demonstrated an increased risk of disease advancement in individuals with a CD4 cell count of less than 200 to 350 cells per mm3. Similarly, those with elevated viral loads, regardless of the CD4 cell count, are at increased risk for disease progression. Debate continues, however, regarding the best threshold level at which to set the viral load to trigger the beginning of drug treatment. In fact, it is likely that there will never be a proper study to answer this question. Therefore, the decision as to when to start treatment continues to be individualized, balancing the known benefits of therapy versus the risks, such as toxicity and the potential development of drug resistance. One can envision that as treatments become easier to take, better tolerated, and increasingly effective, that therapy will begin to be started earlier in the course of infection.
7. When to start antiviral therapy
Guidelines for starting antiviral therapy have been proposed by panels of experts from the DHHS and the IAS.- They recommend treating all patients who have symptoms and those who have CD4 cell counts of less than 200, and, perhaps, 350 cells per mm3 or in those with higher viral loads. Of late, there has been a trend towards focusing more on CD4 cell counts than viral loads in making the decision as to when therapy should be started in asymptomatic individuals. The DHHS guidelines have suggested that therapy be considered even in those with higher CD4 cell counts if viral load is greater than 100,000 copies per mL, or, at least, that CD4 cell counts be followed more closely in this group. The IAS-USA guidelines have tended to use a viral load cutoff for considering therapy in asymptomatic individuals with CD4 cells greater than 100,000 copies per mL. However, it should be kept in mind that the risk of developing short- and long-term toxicity from treatment, and the problem with getting patients to adhere to treatment, are major limitations of therapy that need to be considered before treatment is initiated in order to optimize the chances of success and to avoid the development of drug resistance. Other authorities, therefore, have proposed delaying therapy until the viral load is even higher. Regardless, all agree that HIV is a slowly progressive disease, and therapy rarely needs to be started abruptly. Therefore, there usually is time for each patient to carefully consider options prior to starting treatment.
Before starting treatment, patients must be aware of the short and long-term side effects of the drugs, including the fact that some long-term complications may not be known. The patients also need to realize that therapy is a long-term commitment and requires an extraordinary level of adherence to the regimen of drugs. In addition, clinicians and patients should recognize that depression, feelings of isolation, substance abuse, and side effects of the antiviral drugs can all be associated with the failure to follow the treatment program.
8.Initial therapy for HIV
Guidelines for using antiviral therapy have been developed and are updated on a regular basis by an expert panel assembled by the DHHS and the Henry J. Kaiser Foundation and the IAS-USA Panels. The DHHS guidelines are only one of several developed to provide recommendations for the treatment of HIV disease (www.hivatis.org). The most recent IAS-USA Guidelines were published in the Journal of the American Medical Association (JAMA) in the summer of 2004.
Antiviral treatment options have primarily included combinations of 2 nucleoside analogue reverse transcriptase inhibitors (NRTI), often referred to as "nucs," and 1 PI. In addition, together with 2 NRTIs, several combinations of 2 PIs have been used instead of a single PI because these regimens are easier to follow and/or have fewer side effects. Alternative preferred regimens include NRTIs with NNRTIs, often called "non-nucs." These NNRTI-containing combinations generally are easier to take than PI-containing combinations and tend to have different side-effects. Although there has been a great deal of interest in the possibility of using an all NRTI regimen, usually as 3 drugs from this class in combination, studies show that, at best, they are less potent than other treatment options. In addition, there are some triple NRTI combinations that have been shown not to be effective and that should be avoided, such as the nucleotide analogue RTI tenofovir (VireadTM, TDF) with 3TC and abacavir (ZiagenTM, ABC) and TDF, didanosine (VidexTM, ddI) and ABC. Results using combinations of 4 NRTIs are limited at this time.
9.What about treatment for HIV during pregnancy?
One of the greatest advances in the management of HIV infection has been in pregnant women. Prior to antiviral therapy, the risk of HIV transmission from an infected mother to her newborn was approximately 25-35%. The first major advance in this area came with studies giving ZDV after the first trimester of pregnancy, then intravenously during the delivery process, and then after delivery to the newborn for 6 weeks. This treatment showed a reduction in the risk of transmission to less than 10%. Although less data are available with more potent drug combinations, clinical experience suggests that the risk of transmission may be reduced to less than 5%. Current recommendations are to advise HIV-infected pregnant women regarding both the unknown side effects of antiviral therapy on the fetus, and the promising clinical experience with potent therapy in preventing transmission. In the final analysis, however, pregnant women with HIV should be treated essentially the same as non-pregnant women with HIV. Exceptions would be during the first trimester, where therapy remains controversial, and avoiding certain drugs that may cause greater concern for fetal toxicity, such as EFV.
All HIV-infected pregnant women should be managed by an obstetrician with experience in dealing with HIV-infected women. Maximal obstetric precautions to minimize transmission of the HIV virus such as avoiding scalp monitors, and minimizing labor after rupture of the uterine membranes. In addition, the potential use of an elective Caesarean section (C- section) should be discussed, particularly in those women without good viral control of their HIV infection where the risk of transmission may be increased. Breastfeeding should be avoided if alternative nutrition for the infant is available since HIV transmission can occur by this route. Despite the reduced risk of transmission associated with antiviral therapy, pregnant women with HIV need to be thoroughly counseled regarding all risks, as well as all options, including therapeutic abortions when appropriate. Updated guidelines for managing HIV-infected women are updated on a regular basis and can be found at www.hivatis.org.
10.What about treating people exposed to the blood or genital secretions of an HIV-infected person?
Recently, a great deal of interest has focused on preventing transmission to uninfected persons that are inadvertently exposed by the early administration of antiviral therapy. Because the risk of infection after most isolated exposures is relatively small, generally less than 5%, formal studies are difficult to perform. Animal studies and some human experience, however, suggest that post-exposure treatment may be effective. In fact, the current recommendation is that health care workers who experience a needlestick from an infected person take antiviral medication for 4 weeks in order to reduce the risk of infection. Extending that recommendation, many physicians have proposed similar preventive treatment for people with sexual exposures to HIV. Those individuals considering this type of preventative treatment must be aware that post-exposure treatment cannot be relied upon to prevent HIV infection. Second, such treatment is not always available at the time most needed and is probably best restricted to unusual and unexpected exposures, such as a broken condom during intercourse. Third, although regimens with 2 or 3 drugs generally are recommended for those exposed in the healthcare setting, the best therapy for sexual exposure still is unknown. Fourth, therapy probably will be most effective if started within the first 2 hours after an exposure. And finally, a 4-week supply of a three-drug combination of antiviral drugs costs approximately $1000 and generally is not covered by insurance. Updated guidelines are published and available at www.hivatis.org.
11.What can be done for people who have severe immunosuppression?
Although one goal of antiviral therapy is to prevent the development of immune suppression, some individuals are already immunosuppressed when they first seek medical care. In addition, others may progress to that stage as a result of resistance to antiviral drugs. Nevertheless, every effort must be made to optimize antiviral therapy in these patients. In addition, certain specific antibiotics should be initiated, depending on the number of CD4 cells, to prevent the complications (that is, the opportunistic infections) that are associated with HIV immunosuppression. Guidelines for the prevention of opportunistic infections can be found at www.hivatis.org.
In summary, patients with a CD4 cell count of less than 200 should receive preventative treatment against Pneumocystis carinii (the opportunistic bacteria that causes pneumonia and is now known as Pneumocystis jiroveci) with trimethoprim/sulfamethoxazole (BactrimTM, SeptraTM), given once daily or three times weekly. If they are intolerant to that drug, patients can be treated with an alternative drug such as dapsone, or atovaquone (MepronTM). Those patients with a CD4 cell count of less than 100 who also have evidence of past infection with Toxoplasma gondii, which is usually determined by the presence of toxoplasma antibodies in the blood, should receive trimethoprim/sulfamethoxazole. Toxoplasmosis is an opportunistic parasitic disease that affects the brain and liver. If a person is using dapsone to prevent Pneumocystis carinii (P. jiroveci), pyrimethamine and leucovorin can be added once a week to their regimen to prevent toxoplasmosis. Finally, patients with a CD4 cell count of less than 50 should receive preventive treatment for Mycobacterium avium complex (MAC) infection with weekly azithromycin (ZithromaxTM), or as an alternative, twice daily clarithromycin (BiaxinTM) or mycobutin (RifabutinTM). MAC is an opportunistic bacterium that causes infection throughout the body.
12.What is in the future for HIV-infected individuals and for those at risk to contract HIV?
Trends continue towards simplifying drug regimens to improve adherence and decrease side effects. In addition, many new drugs are being developed. These new drugs are in both the currently available classes of anti-HIV medications as well as in new classes of drugs, such as those that block the virus from entering cells or from incorporating itself into the human genetic material. Both of these actions prevent the virus from duplicating itself, thereby inhibiting an increase in the viral load. Perhaps even more importantly, researchers are attempting to enhance the body's natural defenses against HIV in order to control viral growth. An example of this approach is the use of an HIV vaccine, with or without antiviral therapy. Also, innovative studies are underway to try to purge or eliminate the HIV from the body. The rationale for purging is to allow for the withdrawal of therapy without a rebound increase in the number of viral particles in the blood. For example, drugs have been developed to stimulate HIV-infected CD4 cells, which then would be expected to undergo viral or immune self-destruction. Although all of this research is exciting and promising, the reality is that in the near future, patients will need to remain on antiviral therapy.
The good news is that the development of antiviral therapy has led to a marked decline in AIDS-related deaths in many parts of the world. The majority of infected individuals, however, do not have access to the expensive antiviral medications. Accordingly, the best hope for limiting the current epidemic of HIV around the world remains an effective vaccine. Unfortunately, despite increasing research in this area, the development of a vaccine continues to lag far behind the progress that has been made in antiviral therapy.
Updated guidelines for managing HIV-infected women are updated on a regular basis and can be found at www.hivatis.org.
Read More “ACQUIRED INFORMATION DEFICIENCY SICKNESS (a.i.d.s)” »»
KADAR KES BARU AIDS KALANGAN WANITA 16 PERATUS
Laporan terbaru yang dikeluarkan oleh Kementerian Kesihatan Malaysia bersama UNICEF (Tabung Kanak-kanak Pertubuhan Bangsa-Bangsa Bersatu) mendedahkan bahawa pola kes baru jangkitan HIV di kalangan wanita meningkat dari 1.2% pada tahun 1990 ke 16% pada 2007. Dulu, setiap 86 kes positif bagi HIV, hanya seorang melibatkan wanita. Ini bermakna kebanyakan mereka yang disahkan positif boleh diandaikan sebagai penagih dadah atau mengamalkan hubungan homoseks (gay). Kini statistiknya ialah setiap 6 orang yang positif HIV, seorang darinya ialah wanita. Seramai 12 orang rakyat Malaysia yang diuji darahnya positif untuk HIV pada setiap hari.Yang paling memeranjatkan ialah laporan ini menyebut bahawa pola jangkitan di kalangan wanita Malaysia ialah melalui hubungan kelamin antara lelaki dan perempuan.
Malaysia diramalkan mempunyai 300.000 orang penduduk yang bermasalah dengan HIV pada tahun 2015 menurut Datuk Dr Hassan Abdul Rahman, Pengarah Bhg Kawalan Penyakit Kementerian Kesihatan Malaysia.
Menurut Datuk Seri Tunku Puteri Safinaz, Presiden Yayasan Sultanah Bahiyah, pada tahun 2007, lebih ramai suri rumah didapati positif bagi HIV berbanding dengan pelacur dan GRO (pekerja seks).
Kesimpulan:
1. Mungkin lebih ramai suri rumah yang sedar tentang bahaya HIV maka mungkin lebih ramai lagi yang pergi menjalani ujian darah. Maka lebih ramailah yang dikesan positif HIV pada tahun 2007 berbanding tahun 1990.
2. Suri rumah mungkin dijangkiti HIV melalui aktiviti suami yang tak bermoral seperti aktiviti "makan luar" di lorong gelap atau di sempadan negara dan sebagainya.
3. Mungkin fenomena masyarakat kini yang kerap bertukar pasangan melalui kahwin-cerai-kahwin lain menjadi faktor penyumbang kadar HIV yang tinggi di kalangan suri rumah.
4. Ada pihak-pihak yang menuduh amalan poligami di kalangan umat Islam penyebab kadar HIV yang tinggi pada suri rumah. Tuduhan ini perlu kajian dengan melihat profil agama suri rumah yang terlibat dengan HIV dan bertanyakan tentang sejarah perkahwinan mereka.
5. Terdapat laporan yang menyatakan bahawa amalan "anal intercourse" penyumbang statistik kenapa suri rumah terlibat dengan HIV. Sila lihat [SINI]
*'More housewives get HIV than sex workers'
sun2surf
* M'sia May Have 300,000 HIV Positive Patients In 2015
Bernama
'More housewives get HIV than sex workers'
by Karen Arukesamy
sun2surf
KUALA LUMPUR (Dec 5, 2008): With an average of 12 Malaysians testing positive for HIV each day, Malaysia has one of the fastest growing AIDS epidemics in the East Asia and Pacific region.
What is more worrying is that the trend is gaining a feminine face, mainly through heterosexual transmission.
A new report released by the Health Ministry and United Nations Children’s Fund (Unicef) yesterday revealed that the trend of new HIV infections amongst women rose drastically to 16% in 2007 from 1.2% of total new cases in 1990.
“The proportion of women reported with HIV has increased dramatically in the last decade. In 1990, only one in every 86 new HIV infections was amongst women and girls,” Sultanah Bahiyah Foundation chairperson Datuk Seri Tunku Puteri Safinaz said at the launch of the Women and Girls Confronting HIV and AIDS in Malaysia 2008 report.
However, she said, as of December 2007, it was one in six new infections.
“Shockingly, surveys show that in 2006 more housewives tested HIV-positive than sex workers,” Tunku Puteri Safinaz said, adding that there are thousands of children living in homes shadowed by HIV.
The results are a cause for concern as the vulnerability of women and children to HIV are directly linked.
She said for families affected by HIV and AIDS, the disease itself does not have so much impact as it can be kept under control for many years with effective treatment.
“The biggest impact comes from stigma. Mothers whose families are affected by HIV and AIDS are most frightened by the reactions from friends, extended family, colleagues and their communities,” she said, citing the case of a shopkeeper in Kedah who refused to allow a woman with HIV to enter his shop.
She said fear of AIDS could hurt the patients more than the disease.
Stigma can cause a person to be ostracised by friends and family. It can even cause a HIV-positive husband to disallow his wife to be tested, she said.
“Stigma can cause a woman to be so ashamed that she does not seek treatment – meaning an early death and young innocent child left without a mother.”
Tunku Puteri Safinaz said it can also cause the children to be shunned by their teachers and friends because they are infected.
Unicef representative in Malaysia Youssouf Oomar said empowering and encouraging women to be leaders in any HIV response must be the strategy of the future.
“Malaysia must ensure that gender equality and empowerment of women go hand-in-hand with HIV and AIDS prevention and care programmes,” he said.
“We need to get more women involved and get them to work together to get their voices heard.”
He said the level of awareness amongst housewives in Malaysia is not enough to create consciousness.
“The fact that there are more housewives infected with HIV than sex workers is a serious cause of concern. There should be more serious education in learning institutions where students can bring home the knowledge,” he said.
M'sia May Have 300,000 HIV Positive Patients In 2015
Bernama
Malaysia may have 300,000 people affected by HIV by 2015, said Datuk Dr Hassan Abdul Rahman, the Director of the Disease Control Divison of the Health Ministry.
To combat this epidemic, the government has committed RM500 million to implement the National Strategic Plan on AIDS and the Harm Reduction programme between 2006 and 2010, he said at the launch of a Health Ministry and UNICEF Report 2008 entitled, "Women and Girls Confronting HIV and AIDS in Malaysia" here today in conjunction with the 'Special World AIDS Day 2008'.
The National Strategic Plan on AIDS involves various government and non-government bodies as well as international agencies such as UNICEF.
Dato' Seri Tunku Puteri Intan Safinaz, the daughter of the Sultan of Kedah, who officially launched the event, said the trend of new HIV infections occurring among women in the country had risen alarmingly from 1.2 per cent of total new cases in 1990 to 16 per cent in December 2007.
She said reducing the impact of HIV required that the needs and issues of women be addressed at various levels.
A multisectoral approach combining the political will and resources of government agenices, private sector, non-government organisations and faith-based organisations was required to tackle the underlying issues, said Tunku Puteri Intan Shafinaz.
She said there was a need to reverse the underlying socioeconomic factors that contributed to women's HIV risks, such as gender inequality, poverty, lack of economic and educational opportunity, and the lack of legal and human rights protection.
In a survey conducted in 2006, she said more housewives were tested HIV-positive than sex workers, which could have occurred through heterosexual sex.
This was a cause of concern as the vulnerability of women and children to HIV were directly linked to each other, she added.
Tunku Puteri Intan Shafinaz said for families affected by HIV and AIDS, the impact of stigma could be bigger than the disease itself.
Such a stigma could cause a person to be ostracised by friends and neighbours, and a child to be shunned by teachers and school friends because they were HIV positive, she said.
Youssouf Oomar, UNICEF's representative to Malaysia, said the increasing feminisation of HIV in Malaysia was more than just an issue of preventing or controlling spread of the virus as it required greater understanding and response to the vulnerabilities and risks related to gender discrimination and inequality, cultural and religious norms and economics.
PROJEK BERMASALAH ERA BN KERAJAAN PAKATAN TERIMA KUTUKAN
Dakwaan DR Khir Toyo yang menyalahkan kerajaan negeri kerana melewatkan projek CAR adalah tidak benar sekali dan lebih dikesali kenyataan beliau mengandungi fakta yang salah dan mengelirukan. MB Selangor berharap Menteri Tenaga, Air dan Komunikasi mengambil insiatif untuk berjumpa sendiri dengan masyarakat Kampung Sungai Terentang.
Projek CAR kenyataan Khir Toyo mengelirukan
Saidah Hairan / Harakahdaily
SHAH ALAM, 3 Dis (Hrkh) - Menteri Besar, Tan Seri Abdul Khalid Ibrahim menyelar sikap Ketua Pembangkang, Dato' Seri Dr Mohd Khir Toyo yang menyalahkan kerajaan Negeri Selangor pimpinan Pakatan Rakyat terhadap masalah projek Pengukuhan Sistem Kawasan Tengah (CAR) di Kampung Sungai Terentang, Rawang.
Beliau menegaskan masalah Kampung Sungai Terentang itu bukan perkara baru dan ia boleh diselesaikan lebih awal jika kerajaan Umno-BN di bawah pimpinan Khir Toyo dulu mempunyai pentadbiran yang efisien dan profesional.
"Saya sekali lagi menegaskan bahawa kerajaan Pakatan Rakyat tidak pernah melarang projek CAR oleh TNB daripada diteruskan," tegasnya dalam sidang media, selepas mesyuarat exco jam 2 petang, di tingkat 20 Shah Alam.
Menurut beliau, dakwaan Khir Toyo yang menyalahkan kerajaan negeri kerana melewatkan projek CAR adalah tidak benar sekali dan lebih dikesali kenyataan beliau mengandungi fakta yang salah dan mengelirukan.
Perlu dijelaskan katanya, usaha pengambilan tanah yang melibatkan jaluran asal sepertimana yang dipohon oleh TNB sudahpun dilakukan dan diwartakan oleh kerajaan Negeri.
Tambahan pula tegas beliau keputusan mahkamah mengenai permohonan TNB untuk memasuki tanah yang terlibat juga sudah diputuskan.
"Sekarang TNB dan kerajaan Pusat hanya perlu membuat rundingan dengan penduduk kampung Sungai Terentang bagi meneruskan projek tersebut, tegasnya.
Menurut beliau, rakyat sudah mengetahui bahawa Kerajaan Negeri telah mengadakan pertemuan bersama penduduk Kampung Terentang sebanyak enam kali termasuk lawatan ke kawasan tersebut.
Katanya, setelah mengambil kira pandangan semua pihak Kerajaan Negeri telah mencadangkan dua pilihan iaitu menanam kabel bawah tanah kerana ianya tdak langsung melibatkan pengambilalihan tanah dan membenarkan penduduk kampung terus tinggal di kawasan tersebut.
Selain itu tambah beliau menggunakan laluan alternatif yang tidak melibatkan ramai penduduk.
Beliau berkata, bagi usaha tersebut Kerajaan Negeri telah memulakan proses mewartakan laluan alternatif (melalui borang 5A di bawah sek 4, Akta Pengambilan Tanah) untuk menjimatkan masa proses pengambilan tanah.
Kerajaan Negeri katanya bersedia memberi taklimat mengenai perkara itu dan jika pihak TNB dan Kerajaan Pusat merasakan cadangan tersebut tidak sesuai Kerajaan Negeri tidak ada hak untuk menghalang mereka.
Bagaimanapun, tegas beliau Kerajaan Negeri akan terus membantu dan menjaga kebajikan penduduk dan berharap Menteri Tenaga, Air dan Komunikasi mengambil insiatif untuk berjumpa sendiri dengan masyarakat Kampung Sungai Terentang supaya projek itu boleh berjalan dengan cara yang terbaik.
MUSIM BERKHATAN KEMBALI LAGI
Amalan berkhatan di kala musim cuti sekolah memang sudah menjadi tradisi masyarakat Malaysia. Amalan itu kini ditambah dengan berkhatan beramai-ramai di suatu lokasi yang bukan klinik atau hospital. Biasanya sebuah dewan, bilik darjah atau tadika. Untuk pengetahuan pembaca, beberapa orang Doktor serta pakar bedah Malaysia telah mencipta nama di persada dunia dengan merekacipta teknik serta alat untuk berkhatan contohnya Dr Ismail, Dr Tasron dan Dr Singh. Lazimnya, Alhamdulillah, tiada komplikasi berlaku bagi mereka yang berkhatan kecuali sedikit pendarahan, tetapi jika komplikasi berlaku ia amat serius dan mempunyai kesan buruk jangka panjang.
Baru-baru ini dilaporkan seorang budak lelaki telah dimasukkan ke ICU setelah berlaku jangkitan pada pundi-pundi kencing. Beberapa tahun yang lalu, seorang budak bernama ******
******* telah menjalani khatan di sebuah hospital dan diberitakan telah disunat oleh seorang Pembantu Perubatan (MA) atau Pembantu Hospital (HA) yang secara tidak sengaja telah memotong kemaluan individu berkenaan. Pesakit dilaporkan telah menjalani rawatan psikatri di sebuah hospital swasta di KL.
Tara Clamp
Sunathrone
Smart KLamp
Plastibell
Ismail ClampNote: This device should not be used to do a self-circumcision. Circumcision should always be performed by a trained and skilled healthcare provider. Anda dilarang keras agar tidak melakukan sendiri berkhatan menggunakan alat di atas. Jika melakukannya, di atas tanggungan sendiri. Pemilik blog ini tidak bertanggung jawab.
Hikmah khatan
Disesuaikan dari Mymetro Oleh Idris Musa
KHATAN semakin menjadi amalan bagi masyarakat berbilang bangsa. Malah, pada kini dianggarkan sepertiga lelaki di seluruh dunia berkhatan sama ada disebabkan anjuran agama seperti Islam dan Yahudi, mahupun kerana faktor kesihatan.
Dalam Islam, khatan atau khitan adalah perkara khilafiyah ( tiada nas yang qatei atau putus) dibincangkan dalam semua mazhab, namun menurut pendapat sahih dalam Mazhab Syafie, ia wajib ke atas lelaki dan perempuan. Demikian juga pendapat kebanyakan ulama silam.
Imam Ahmad bin Hambal mengatakan wajib manakala Imam Malik dan Imam Abu Hanifah berpendapat khatan itu hukumnya sunat bagi lelaki dan perempuan.
Tetapi ada pula pendapat dalam Mazhab Abu Hanifah mengatakan wajib bagi lelaki dan sunat bagi perempuan.
Antara dalil yang dijadikan hujah dalam melaksanakan khatan ialah firman Allah yang bermaksud: "Ikutilah wahai Muhammad susunan agama Ibrahim."
Hadis diriwayatkan Abu Hurairah, Rasulullah s.a.w bersabda maksudnya: "Nabi Ibrahim berkhatan ketika berusia 80 tahun di suatu tempat bernama 'al-Qudum' (di Syam). (Riwayat Imam Bukhari dan Muslim).
Diriwayatkan Imam Ahmad daripada Syaddad bin Aus dengan terputus sanadnya dan juga oleh Imam Baihaqi daripada Saidina Ali, beliau berkata berkhatan itu sunat bagi lelaki dan suatu perkara yang terpuji bagi perempuan.
Selain itu Imam Abu Daud, Ibnu Sandah dan Ibnu 'Asakir meriwayatkan suatu hadis daripada ad-Dahak bin Tias, katanya di kota Madinah ada seorang wanita bernama Ummu 'Atiyyah kerjanya mengkhatankan anak gadis.
Rasulullah s.a.w berkata kepada wanita itu: "Apabila engkau mengkhatankan anak perempuan jangan engkau potong terlampau banyak kerana potongan itu jika disederhanakan akan menambahkan seri muka dan menyebabkan suami lebih gembira."
Dalam amalan perubatan di Malaysia, khatan bagi perempuan hanya melukakan kulit atas faraj yang berbentuk segi tiga. Bahagian itu adalah kulit lebihan di sebelah atas dan tidak sampai ke pangkalnya.
Bagi lelaki, ada dua kaedah iaitu tradisional dan moden. Kaedah tradisional ialah memotong bahagian kulit berlebihan pada zakar menggunakan pisau. Zakar terlebih dulu dibius pada bahagian atas, tepi dan hujung supaya kebas, kemudian dipotong, dilipat dan dijahit dengan benang larut sendiri.
Bagaimanapun, kaedah moden lebih mudah kerana hanya menggunakan plastik yang sudah berbentuk bulat untuk diletakkan pada bahagian hujung kulit zakar. Ia bertujuan menghentikan perjalanan darah dalam tempoh seminggu dan secara tidak langsung akan gugur dengan sendiri.
Selain mengikut sunnah generasi terdahulu, khatan mempunyai banyak kelebihan, terutama dari sudut kesihatan.
Khatan kepada lelaki mempunyai banyak kebaikan dari sudut kesihatan, terutama menghindarkan diri daripada terkena virus berbahaya seperti HIV.
Sila lihat [SINI]
Hasil kajian pakar Eropah dan Afrika di empat bandar Afrika mendapati berkhatan menghindarkan tiga kali ganda daripada dijangkiti virus HIV.
"Kami mempunyai bukti berkhatan boleh mencegah risiko dijangkiti HIV di kalangan lelaki yang sememangnya berita baik berikutan beberapa laporan mengecewakan sebelum ini," demikian menurut rencana ditulis Marie-Louise Newell dan Till Barnighausen daripada Universiti KwaZulu-Natal di South Africa dan Fakulti Kesihatan Awam, Universiti Harvard.
Di wilayah Kwazulu-Natal yang kes HIV sangat tinggi, penyelidik mendapati kadar penduduk berkhatan amat rendah.
Sebanyak 35,000 jangkitan baru mungkin dapat dicegah pada 2007 jika 2.5 juta lelaki di sana berkhatan.
Penyelidik Amerika Syarikat, Richard Bailey, ketika berucap di persidangan mengenai Aids di Sydney, sebelum ini, menggesa pihak berkuasa setiap negara mempromosi amalan berkhatan kerana bukti saintifik menunjukkan ia boleh mengurangkan jangkitan HIV sebanyak 60 peratus.
Menurutnya, tiga kajian yang dijalankan di Afrika mengesahkan kepercayaan sedia ada mengenai keberkesanan khatan dalam mengurangkan jangkitan virus itu.
"Sudah tiba masanya untuk bertindak. Melengahkan amalan berkhatan boleh mendatangkan lebih banyak keburukan," kata pensyarah Universiti Illinois itu.
Amalan berkhatan juga dapat mencegah lelaki daripada menghidap barah zakar. Media melaporkan, satu kajian mendapati 87 daripada 89 kes barah zakar adalah di kalangan lelaki yang tidak berkhatan.
Di samping itu, ada beberapa faedah lain seperti memberikan ruang kepada zakar memanjang dan mengembang selepas kulup atau kulit penghujung zakar dipotong, malah memberikan daya ereksi lebih normal serta peningkatan daya kawalan daripada cepat ejakulasi.
Teknik berkhatan kaedah Sunathrone di [SINI] Read More “MUSIM BERKHATAN KEMBALI LAGI” »»
ZAID SACKED FROM UMNO
"It is against the party's code of ethics," said Abdullah "to attend oppositions' functions." The former Kota Bahru MP had attended a DAP victory dinner in Penang and PKR’s annual national congress last weekend.
Perhaps Zaid is expecting it all along or he was testing the water.
Zaid sacked from Umno
By Adib Zalkapli/The Malaysian Insider
KUALA LUMPUR, Dec 3 – Former de facto Law Minister Datuk Zaid Ibrahim was sacked from Umno late last night for breaking the party's code of ethics.
Umno president Datuk Seri Abdullah Badawi who chaired the party supreme council meeting that lasted more than three hours said Zaid's attendance at opposition events was inappropriate.
"It is against the party's code of ethics," said Abdullah when asked to elaborate on Zaid's sacking.
The former Kota Bahru MP had attended a DAP victory dinner in Penang and PKR’s annual national congress last weekend.
When asked whether Zaid wanted to be sacked from the party by attending the events, Abdullah said it was just a perception.
"Let it be interpreted that way, but most importantly Umno has to be consistent. We cannot have double standards," said Abdullah adding that the decision cannot be appealed.
When met at the PKR congress, Zaid had told reporters that he did not expect to be sacked from the party.
Zaid had resigned from Abdullah’s Cabinet in protest against the use of the Internal Security Act (ISA) recently.
He had been appointed minister earlier this year and was tasked with bringing about reforms to the judiciary.
Since his resignation Pakatan Rakyat partides have been actively courting him to join them. when asked to elaborate on Zaid's sacking.
The former Kota Bahru MP had attended a DAP victory dinner in Penang and PKR’s annual national congress last weekend.
When asked whether Zaid wanted to be sacked from the party by attending the events, Abdullah said it was just a perception.
"Let it be interpreted that way, but most importantly Umno has to be consistent. We cannot have double standards," said Abdullah adding that the decision cannot be appealed.
When met at the PKR congress, Zaid had told reporters that he did not expect to be sacked from the party.
Zaid had resigned from Abdullah’s Cabinet in protest against the use of the Internal Security Act (ISA) recently.
He had been appointed minister earlier this year and was tasked with bringing about reforms to the judiciary.
Since his resignation Pakatan Rakyat partides have been actively courting him to join them.
DUNIA ARAK YANG SANGAT MENCABAR
SILA KLIK PADA IMEJ UNTUK DIBESARKAN
Further Readings [HERE] and {HERE]
Kumpulan Dadah Penindas
ALKOHOL
Dr. Abu Bakar Abdul Majeed Dengan Kerjasama Pusat Racun Negara
LARANGAN untuk manusia meminum arak atau alkohol kerana akibatnya yang amat buruk, telah diketahui umum sejak sekian lama dahulu. Malah, setiap agama di dunia ini turut melarang sikap tersebut di kalangan para penganutnya.
Pada 1 Julai 1995, telah diumumkan penguatkuasaan undang-undang yang melarang memandu kenderaan di bawah pengaruh alkohol di kawasan Lembah Kelang sebagai satu projek perintis. Mengikut undang-undang tersebut seseorang dilarang memandu atau cuba memandu kenderaan jika paras alkohol di dalam darahnya mencapai 80 mg/dl atau lebih. Satu kajian yang telah dijalankan dalam tahun 1991 menunjukkan hampir 20 peratus mangsa kematian akibat kemalangan jalan raya mempunyai paras alkohol di dalam darah melebihi 100 mg/dl.
Walau bagaimanapun, memang ada sedikit manfaat alkohol seperti kegunaannya sebagai agen pembunuh kuman atau disinfektan, antidot untuk keracunan metanol (yang mungkin mencemar tuak atau samsu haram), atau agen penyejuk bagi melegakan demam panas. Namun begitu, memang tidak dapat disangkal lagi bahawa keburukan daripada kesan meminum alkohol jauh mengatasi kebaikannya.
Istilah alkohol berasal daripada bahasa Arab al-kuhol, yang bermaksud 'sesuatu yang tersembunyi' atau 'antimoni yang dipecah-pecahkan sehingga halus' yang digunakan sebagai celak. Akhirnya istilah ini memberi maksud 'bauan yang harum'. Ahli kimia Arab dipercayai pertama sekali melakukan proses penyulingan bagi menyediakan alkohol, manakala proses pembuatan minuman beralkohol yang sangat kuat melalui penapaian buah anggur pertama sekali dilakukan secara besar-besaran di Eropah pada sekitar tahun Masehi 1200.
Ramuan utama minuman beralkohol ialah etanol. Etanol ialah sejenis bahan kimia yang berupaya menekan aktiviti otak, justeru mengubah kewibawaan akal fikiran. Penggunaan alkohol secara berterusan untuk jangka masa yang lama boleh menyebabkan kesan tolerans iaitu peminum terpaksa mengambil amaun yang semakin banyak bagi mendapatkan kesan yang serupa. Kesan lain ialah penagihan dari segi rohani dan jasmani.
Selepas diminum, alkohol mungkin diserap ke dalam darah melalui perut. Namun begitu, jalan utama kemasukan alkohol ke dalam darah ialah menerusi usus kecil. Alkohol erus dibawa ke jantung yang kemudiannya mengepam darah beralkohol tadi ke seleuruh tubuh. Seperti yang dinyatakan, kesa utama alkohol ialah di otak. Di sini, alkohol menyebabkan penindasan kawasan-kawasan yang biasanya mengawal maruah dan disiplin diri sehingga peminum mula merasa kurang sifat malu, fikiran bercelaru, dan pergerakannya pula agak tidak terkawal. Peminum juga kurang keupayaan dari segi belajar, membentuk idea spontan, menumpukan fikiran, dan membuat pertimbangan yang teliti.
Perbandingan paras alkohol di dalam darah dengan kesannya terhadap otak
Semakin tinggi amaun alkohol yang diminum semakin kuat otak tertindas sehinggakan boleh menyebabkan tidak sedarkan diri dan seterusnya kematian.
Selain daripada kesan-kesan terhadap otak, alkohol juga bertindak dengan pelbagai sistem dan organ tubuh. Contohnya, kesan terhadap sistem peredaran tubuh menyebabkan darah lebih banyak dialirkan ke kulit. Ini menyebabkan kulit peminum menjadi kemerah-merahan dan perpeluhan meningkat. Pengepaman jantung juga bertambah pantas dan kuat seperti individu yang sedang melakukan senaman. Alkohol juga menyebabkab keringsaan perut (gastritis) yang akhirnya boleh membawa kepada ulser. Peminum alkohol didapati lebih cenderung membuang air kecil dengan kerap kerana etanol boleh merencat hormon penahan kencing.
Bahaya alkohol juga amat ketara terhadap peminum alkohol kronik. Pengambilan alkohol secara berpanjangan boleh mengakibatkan komplikasi fizikal, kejiwaan, dan sosial. Selain daripada ulser perut, alkohol juga dikesan menyebabkan sirosis hati di Hospital Kuala Lumpur di antara tahun 1982-1988. Peminum alkohol juga mungkin mengalami anemia, hipoglisemia (kekurangan gula di dalam darah, dan ketandusan vitamin). Otot-otot, rangka, dan jantung juga mengalami degenerasi dalam jangka masa panjang.
Kerosakan saraf boleh menyebabkan pelbagai jenis penyakit seperti sindrom Wernicke-Korsakoff dan kerosakan sel-sel otak, yang seterusnya membawa kepada komplikasi psikiatri. Peminum boleh mengalami halusinasi pendengaran, amnesia, paranoia, depresi, dan kecenderungan membunuh diri. Peminum alkohol kronik yang sedang hamil boleh menyebabkan kandungannya mempunyai ciri-ciri kecacatan seperti kekurangan berat badan, saiz kepala yang terlalu kecil berbanding tubuh, kurang penyelarasan otot, keadaan muka yang rata, dan kelemahan sendi-sendi.
Justeru itu, jelas keburukan alkohol jauh mengatasi kebaikannya. Hanya manusia yang masih terus membebal!
