Sunday, December 7, 2014

The Star : Group of Prominent Malays Calls for Rational Dialogue on Position of Islam in Malaysia

Sunday December 7, 2014

PETALING JAYA: Deeply concerned over developments regarding race relations, Islam and extremist behaviour in Malaysia, a group of 25 prominent Malays have called for a rational dialogue on the position of Islam in a constitutional democracy.

"Given the impact of such vitriolic rhetoric on race relations and political stability of this country, we feel it is incumbent on us to take a public position," said Datuk Noor Farida Ariffin, former Malaysian Ambassador to the Netherlands, in a statement on Sunday issued on behalf of the 25 signatories.

The statement (attached below) was signed by prominent personalities, including former secretaries-general, directors-general, ambassadors and prominent Malay individuals who have contributed much to Malaysian society.

Noor Farida, also former director-general of the Foreign Ministry's Research, Treaties and International Law Department, said she and the others "are deeply concerned about the state of the debate on many issues of conflict on the position and application of Islamic laws in Malaysia".

"It is high time moderate Malays and Muslims speak out. Extremist, immoderate and intolerant voices as represented by Perkasa and Isma do not speak in our name.

"Given the impact of such vitriolic rhetoric on race relations and political stability of this country, we feel it is incumbent on us to take a public position and urge for an informed and rational dialogue on the ways Islam is used as a source of public law and policy in Malaysia.
"Most importantly, we call on the Prime Minister to exercise his leadership and political will to establish an inclusive consultative committee to find solutions to these intractable problems that have been allowed to fester for too long.

"We also urge more moderate Malaysians to speak up and contribute to a better informed and rational public discussion on the place of Islamic laws within a constitutional democracy and the urgency to address the breakdown of federal-state division of powers and finding solutions to the heart-wrenching stories of lives and relationships damaged and put in limbo because of battles over turf and identity," she said.


Letter to the people of Malaysia: Champion open debate and discourse on Islamic law 

We, a group of concerned citizens of Malaysia, would like to express how disturbed and deeply dismayed we are over the continuing unresolved disputes on the position and application of Islamic laws in this country. The on-going debate over these matters display a lack of clarity and understanding on the place of Islam within our Constitutional democracy. Moreover, they reflect a serious breakdown of federal-state division of powers, both in the areas of civil and criminal jurisdictions.

We refer specifically to the current situation where religious bodies seem to be asserting authority beyond their jurisdiction; where issuance of various fatwa violate the Federal Constitution and breach the democratic and consultative process of shura; where the rise of supremacist NGOs accusing dissenting voices of being anti-Islam, anti-monarchy and anti-Malay has made attempts at rational discussion and conflict resolution difficult; and most importantly, where the use of the Sedition Act hangs as a constant threat to silence anyone with a contrary opinion.

These developments undermine Malaysia's commitment to democratic principles and rule of law, breed intolerance and bigotry, and have heightened anxieties over national peace and stability.

As moderate Muslims, we are particularly concerned with the statement issued by Minister Datuk Seri Jamil Khir Baharom, in response to the recent Court of Appeal judgement on the right of transgendered women to dress according to their identity. He viewed the right of the transgender community and Sisters in Islam (SIS) to seek legal redress as a "new wave of assault on Islam" and as an attempt to lead Muslims astray from their faith, and put religious institutions on trial in a secular court.

Such an inflammatory statement from a Federal Minister (and not for the first time) sends a public message that the Prime Minister's commitment to the path of moderation need not be taken seriously when a Cabinet minister can persistently undermine it.

These issues of concern we raise are of course difficult matters to address given the extreme politicisation of race and religion in this country. But we believe there is a real need for a consultative process that will bring together experts in various fields, including Islamic and Constitutional laws, and those affected by the application of Islamic laws in adverse ways.

We also believe the Prime Minister is best placed with the resources and authority to lead this consultative process. It is urgent that all Malaysians are invested in finding solutions to these long-standing areas of conflict that have led to the deterioration of race relations, eroded citizens' sense of safety and protection under the rule of law, and undermined stability.

There are many pressing issues affecting all of us that need the urgent leadership and vision of the Prime Minister, the support of his Cabinet and all moderate Malaysians. They include:

1) A plural legal system that has led to many areas of conflict and overlap between civil and syariah laws. In particular there is an urgent need to review the Syariah Criminal Offences (SCO) laws of Malaysia.

These laws, which turn all manner of "sins" into crimes against the state have led to confusion and dispute in both substance and implementation. They are in conflict with Islamic legal principles and constitute a violation of fundamental liberties and state intrusion into the private lives of citizens.

In 1999, the Cabinet directed the Attorney-General's Chambers to review the SCO laws. But to this day, they continue to be enforced with more injustices perpetrated. The public outrage, debates over issues of jurisdiction, judicial challenge, accusations of abuses committed, gender discrimination, and deaths and injuries caused in moral policing raids have eroded the credibility of the SCO laws, the law-making process, and public confidence that Islamic law could indeed bring about justice.

2) The lack of public awareness, even among top political leaders, on the legal jurisdiction and substantive limits of the powers of the religious authorities and administration of Islamic laws in Malaysia.

The Federal Constitution is the supreme law of the land and any law enacted, including Islamic laws, cannot violate the Constitution, in particular the provisions on fundamental liberties, federal-state division of powers and legislative procedures.

All Acts, Enactments and subsidiary legislation, including fatwa, are bound by constitutional limits and are open to judicial review.

3) The need to ensure the right of citizens to debate the ways Islam is used as a source of public law and policy in this country. The Islamic laws of Malaysia are drafted by the executive arm of government and enacted in the legislative bodies by human beings. Their source may be divine, but the enacted laws are not divine. They are human-made and therefore fallible, open to debate and challenge to ensure that justice is upheld.

4) The need to promote awareness of the rich diversity of interpretive texts and juristic opinions in the Islamic tradition. This includes conceptual legal tools that exist in the tradition that enable reform to take place and the principles of equality and justice to be upheld, in particular in response to the changing demands, role and status of women in the family and community.

5) The need for the Prime Minister to assert his personal leadership as well as appoint key leaders who will, in all fairness, champion open and coherent debate and discourse on the administration of Islamic laws in this country to ensure that justice is done. We especially urge that the leadership sends a clear signal that rational and informed debate on Islamic laws in Malaysia and how they are codified and implemented are not regarded as an insult to Islam or to the religious authorities.

These issues may seem complex to many, but at the end of the day, it really boils down to this - as Muslims, we want Islamic law, even more than civil law, to meet the highest standards of justice precisely because it claims to reflect divine justice. Therefore, those who act in the name of Islam through the administration of Islamic law must bear the responsibility of demonstrating that justice is done and is seen to be done.

When Islam was revealed to our Prophet (SAW) in 7th century Arabia, it was astoundingly revolutionary and progressive. Over the centuries, the religion has guided believers through harsh and challenging times. It is our fervent belief that for Islam to continue to be relevant and universal in our times, the understanding, codification and implementation of the teachings of our faith must continue to evolve. Only with this, can justice, as enjoined by Allah SWT, prevail.

Sincerely,
1. Tan Sri Datuk Abdul Rahim Haji Din, former Secretary-General, Home Affairs Ministry
2. Tan Sri Ahmad Kamil Jaafar, former Secretary-General, Foreign Affairs Ministry
3. Tan Sri Dr Aris Othman, former Secretary-General, Finance Ministry
4. Tan Sri Dr Ismail Merican; former Director-General, Health Ministry
5. Tan Sri Mohd Sheriff Mohd Kassim, former Secretary-General, Finance Ministry
6. Tan Sri Dr Mustaffa Babjee, former Director-General, Veterinary Services Department
7. Tan Sri Nuraizah Abdul Hamid, former Secretary-General, Energy, Communications and Multimedia Ministry
8. Tan Sri Dr Yahya Awang, cardiothoracic surgeon and core founder, National Heart Institute
9. Datuk Seri Shaik Daud Md Ismail, former Court of Appeal Judge
10. Datuk' Abdul Kadir Mohd Deen, former Ambassador
11. Datuk Anwar Fazal, former senior regional advisor, United Nations Development Programme
12. Datuk Dali Mahmud Hashim, former ambassador
13. Datuk Emam Mohd Haniff Mohd Hussein, former ambassador
14. Datuk Faridah Khalid, representative of Women's Voice
15. Datuk Latifah Merican Cheong, former Assistant Governor, Bank Negara
16. Lt Gen (Rtd) Datuk Maulob Maamin, Lieutenant General (Rtd)
17. Datuk Noor Farida Ariffin, former ambassador
18. Datuk Ranita Hussein, former Suhakam Commissioner
19. Datuk Redzuan Kushairi, former ambassador
20. Datuk Dr Sharom Ahmat, former Deputy Vice-Chancellor, Universiti Sains Malaysia
21. Datuk Syed Arif Fadhillah, former ambassador
22. Datuk Zainal Abidin Ahmad, former Director-General, Malaysian Timber Industry Board
23. Datuk Zainuddin Bahari, former Deputy Secretary-General, Domestic Trade, Co-operatives and Consumerism Ministry
24. Datin Halimah Mohd Said, former lecturer, Universiti Malaya and President, Association of Voices of Peace, Conscience and Reason (PCORE)
25. Puan Hendon Mohamad, Past President, Malaysian Bar

Sunday, July 27, 2014

KLIA & klia2 Map & Plan

location map to KLIA & klia2

KLIA floor plan

klia2 floor plan

Monday, June 23, 2014

G6PD Deficiency

G6PD ( Glucose-6-phosphate dehydrogenase ) deficiency (蚕豆症) is an X-linked recessive hereditary disease.  A person with G6PD deficiency is characterized by abnormally low levels of G6PD-ase enzyme involved in the pentose phosphate pathway, especially important in red blood cell metabolism.

G6PD deficiency present in > 400 million people worldwide.  It may have been around since antiquity, as favism was widely known in the Mediterranean 2,500 years ago.


Genetics


Signs & Symptoms
·Most individual with G6PD deficiency are asymptomatic.
·Symptomatic patients are almost exclusively male ; female patients are rare.
·Prolonged neonatal jaundice, possibly leading to kernicterus.
·Hemolytic crises in response to illness, certain drugs / food / chemicals.
·Diabetic ketoacidosis.
·Acute kidney injury ( AKI )
·Favism


Triggers
·Antimalarial drugs, eg. primaquine, pamaquine, chloroquine
·Sulfonamides, eg sulfanilamide, sulfamethoxazole, mafenide
·Analgesics, eg. aspirin, phenazopyridine, acetanilide
·Non-sulfa antibiotics, eg. nalidixic acid, nitrofurantoin, isoniazid, dapsone, furazolidone
·Henna 散沫花 ( Lawsonia inermis )
·Faba bean 蚕豆 ( Vicia faba )
·金银花 ( Lonicera japonica )
·Camphor 樟脑 ( extracted from Cinnamomum camphora, Rosmarinus officinalis, etc )
·Naphthalene, eg. Mothballs 臭丸
·Gentian violet / crystal violet / methyl violet / proctanine (紫药水/藍藥水)
·Tonic water ( contains quinine )


Diagnosis
·Complete blood count & rticulocyte count
·Liver enzymes test
·Lactate dehydrogenase test
·Haptoglobin test
·Coombs’ test
·Beutler fluorescent spot test
·Motulsky dye-decolorration test


Treatment
·Avoidance of certain drugs & foods that cause hemolysis.
·Vaccination against hepatitis A & B to prevent infection-induced attacks.
·Blood transfusions in case of acute hemolysis.
·Dialysis in case of acute renal failure.
·Splenectomy to remove spleen, the site of red cell destruction.
·Folic acid


Side effect
Immune against malaria caused by Plasmodium falciparum.


Sunday, June 22, 2014

Breastfeeding Position

Type of Attachments


1. Laying Down
Mother lying down with baby in parallel position.


2a. Cradle Hold
Holding baby across the lap, supporting with the same arm


2b. Cross Cradle Hold / 
Transitional Hold
Holding baby across the lap, supporting with opposite arm.  
Useful for premature babies or babies with a weak suck because it gives extra head support and help babies stay latched.


3a. Clutch Hold / Rugby Hold
Holding baby underarm.  
Useful for mothers who had a Caesarean and mothers with large breast, flat or inverted nipples.



3b. Twins hold
Holding two babies underarm with a cushion.


4. Koala Hold
Baby straddled across the knees in an upright position.



5a. Laid Back
Semi-reclined with baby laying across stomach or shoulder.



5b. Laid Back after a  Caesarean
Semi-reclined with baby lying vertically away from the Caesarean wound.





Checking the Attachment
When baby is correctly attached to the breast :
• breastfeeding feels comfortable, not painful
• baby takes the whole nipple and a large amount of the areola into him/her mouth, more on the chin side than the nose side
• baby’s chin is pressed into the breast
• baby’s lips are turned out over your breast (not sucked in)
• nipples stay in good condition, and don’t show any signs of damage
• baby is draining the breast properly, so that it feels floppy after a feed.


Breaking the Attachment
To take baby off the breast, avoid pulling baby away from the breast. Instead, break the attachment by inserting little finger into the corner of baby’s mouth, between his gums, and gently remove him/her from the breast.

Baby might need to burp after feeding.



Source :

Thursday, May 15, 2014

初生婴儿药浴 Neonatal Herbal Bath



中医称新生儿黄疸为“胎黄”或“胎疸”,认为多由湿热之邪所致或小儿脾气虚弱,郁久成疸。故有药浴水疗治疗新生儿黄疸的治方。

民间的婴儿药浴处方、禁忌多不胜数,而且各有其说,令人眼目缭乱。


稀签草Common St. Paulswort herb
稀签草Sigesbeckia orientalis。稀签草又名土防风、落马衣、抹草、秽草、虾柑草、粘糊菜等。属菊科 ( Asteraceae ) 稀签 ( Sigesbeckia ) 一年生草本。

分布在东南、俄罗斯、台湾岛、日本、欧洲、朝鲜以及中国大陆的浙江、江苏、广东、贵州、四川、云南、福建、甘肃、安徽、广西、陕西、江西、湖南等地。生于荒草地、灌丛、山野及林下。

稀签草性平、味淡。功能:祛风、辟秽。主治风湿骨痛、历节风、蛲虫、皮肤热毒。


布京子Hempleaf Negundo Chastetree leaf
布京子 Vitex negundo的叶。布京子又名牡荆、黄荆、荆棵、布荆、土蔓荆、黄荆柴、黄荆条、黄荆子、蚊烟柴、蚊子柴、埔姜、布惊树、五指柑等等。属马鞭草科 ( Verbenaceae ) 牡荆属 ( Vitex ) 多年生灌木或小乔木。

分布于非洲东部及南亚、东亚、东南亚等地。生于荒山丘陵地带。喜光,耐荫,耐寒,对土壤要求适应性强。

味苦,性寒。主治九窍出血、小便尿血、腰脚风湿。除了叶子,根、茎、茎汁( 牡荆沥 ) 、实( 牡荆子) 亦供药用。


京芥Fineleaf Schizonepeta herb
京芥 Schizonepeta tenuifolia ( Japanese Catnip ) 的地上部分。又名荆芥、香荆荠、线荠、假苏、四棱杆蒿、香荆芥等。属唇形科 ( Lamiaceae ) 裂叶荆芥属 ( Schizonepeta ) 一年生草本。

产新疆,甘肃,陕西,河南,山西,山东,湖北,贵州,四川及云南等地;自中南欧经阿富汗,向东一直分布到日本,在美洲及非洲南部逸为野生。适应力很强,性喜阳光,多生长在温暖湿润的环境中。

味平,性温,清香气浓。功用发汗,解热药。主治流行感冒,头疼寒热发汗,呕吐。



Friday, May 9, 2014

坐月药浴 Postpartum Herbal Bath

华人产后坐月禁宜繁多。有家传秘方、道听途说、亲生经验、迷信或科学,范围不但涵盖了产妇饮食、婴儿喂养,还牵涉睡坐躺卧、家务劳动、天气变卦、洗条冲凉等。

产后冲凉更是大件事。民间盛传产后药浴,据说可有效防止产妇伤口的感染,促进子宫收缩,减少恶露,清洁美化肌肤,促进乳汁分泌等。

药浴处方繁多。各族各方,甚至不同药铺药师都有不同的药方。







大风荷Herba Balsamifera Blumea
大风荷乃 Blumea balsamifera 的叶及嫩枝。大风荷又名艾纳香、大风艾、冰片艾、大风叶、大骨风、家风艾、大艾、大毛药、紫再枫、再风艾、大黄草等。属菊科 ( Asteraceae ) 艾纳香属 ( Blumea ) 多年生草本或亚灌木。在菲律宾被称为 ‘sambong’

产云南、贵州、广西、广东、福建和台湾。生于林缘、林下、河床谷地或草地上。印度、巴基斯坦、缅甸、泰国、中南半岛、马来西亚、印度尼西亚和菲律宾也有分布。

大风荷味辛苦,性温。功用温中活血,祛风除湿,杀虫。主治寒湿泻痢,腹痛肠鸣,肿胀,筋骨疼痛,跌打损伤,癣疮。可煎汤内服或煎水洗、研末调敷。其挥发油可制龙脑 ( 又名冰片, Borneol )



薄荷 Herba Mentha Haplocalyx
薄荷乃Mentha haplocalyxera 的叶。薄荷又名野薄荷、土薄荷、南薄荷、水薄荷、野仁丹草、见肿消、水益母、接骨草、鱼香草、夜息香、香薷草等。英文名 Chinese mint。属脣形科 ( Lamiaceae ) 薄荷属 ( Mentha ) 多年生草本。

产南北各地;生于水旁潮湿地。热带亚洲,苏联远东地区,朝鲜,日本及北美洲也有。

薄荷味辛,性凉。功用发汗解热药,能治流行性感冒、头疼、目赤、身热、咽喉、牙床肿痛等症。外用可治神经痛、皮肤瘙痒、皮疹和湿疹等。



京芥草 Herba Schizonepeta Tenuifolia
京芥草乃Schizonepeta tenuifolia的干燥茎叶和花卉。京芥草又名香荆荠、线荠、姜芥、四棱杆蒿、假苏等。英文名 Japanese Catnip。属脣形科 ( Lamiaceae ) 薄荷属 ( Schizonepeta ) 多年生草本。

中国大部分地区有分布。主产安徽、江蘇、浙江、江西、湖北、河北等地。

味辛,性微温。功用發表散風,透疹消瘡,炒炭止血。能鎮痰、怯風、涼血。治流行感冒,頭疼寒熱發汗,嘔吐。


姜皮 Cortex Zingiberis Recens
姜皮乃Zingiber officinale的干燥根茎和根茎外皮。又名生姜衣。英文名 ginger peel。属姜科 ( Zingiberaceae ) 姜属 ( Zingiber ) 多年生草本。

产于中国温带地区。

味辛,性凉。有清热解毒的功效。主治水肿初起,小便不利





Sunday, April 13, 2014

The Star : Alternative Treatments for Dengue Fever

Sunday April 13, 2014
BY TAN SHIOW CHIN


DENGUE fever is a problem that just does not seem to want to go away in Malaysia. And even worse, it seems to be escalating.

The latest report from the Health Ministry states that as of March 22, both the number of cases and deaths nationwide for the year have increased by 314% compared to the same period last year.

The number of dengue cases in the latest report totalled 23,633, while the number of deaths was 58.

The problem is not just limited to Malaysia, although we are considered an endemic dengue hotspot.

The World Health Organisation (WHO) estimates there may be 50-100 million dengue infections globally every year, with two-fifths of the world population, or 2.5 billion people, at risk of this mosquito-borne infectious disease.

While being infected with dengue is an unpleasant experience – it is also known as breakbone fever – with typical symptoms being fever, headache, rashes, and muscle and joint pains, a healthy person’s immune system usually has no problems fighting the virus off.

The problem comes when dengue haemorrhagic fever develops.

This extreme form of the illness causes severe bleeding due to “leaky” blood vessels and delay in blood-clotting caused by low levels of platelets, which are essential in forming blood clots.

According to the WHO, an average of about 2.5% of those who develop dengue haemorrhagic fever die.

This number can exceed 20% in cases with no proper treatment, while the risk of death in those who receive the proper supportive treatment is less than 1%.

There is no cure for dengue, nor is there any vaccine for it, although there are several research teams currently working on one.

The main method of controlling this disease is via prevention; for example, ensuring that there is no stagnant water or any container where water can pool in around, fogging, using mosquito nets and repellent, and covering up or staying indoors at dawn and dusk when the Aedes mosquitoes are most active.

Medical management of dengue is purely supportive, with maintenance of the body’s fluid balance being the key objective, whether via oral rehydration therapy, intravenous fluid replacement, or in the worst-case scenario, blood transfusion.

With no definitive treatment from modern medicine available, it is not surprising that many have turned to alternative therapies for relief.


Papaya leaf juice

This is probably the most well-known alternative treatment for dengue.

Several small scientific studies have been carried out in dengue-endemic countries like India and Malaysia, looking into the efficacy of this herbal remedy.

While the results cannot be said to be definitive, due to their small study size, they are certainly promising.

The main effect of this juice lies in raising the level of platelets in dengue patients – a critical aspect of this viral infection.

One study, conducted by the Institute for Medical Research and Hospital Tengku Ampuan Rahimah, Klang, Selangor, reported that patients given papaya leaf juice showed a significant rise in their platelet levels 40 hours after first receiving the juice, compared to patients in the control group who were only on standard supportive therapy.

The open-label randomised controlled trial, published in Evidence-Based Complementary and Alternative Medicine last year, had a total of 228 participants recruited from the hospital’s dengue ward, divided almost equally between the control group and the juice group.

The patients in the juice group took the pure fresh juice extracted from 50gm of clean papaya leaves of the sekaki variety once daily for three consecutive days.

Pharmacist and holistic medicine practitioner Datuk Dr Rajen M adds that a blend of raw young papaya and papaya leaves made into a juice, taken two to three times a day, is one of the alternative therapies for dengue in Ayurvedic medicine.

He notes that consuming papaya in general is safe, and taking it does not contradict medical advice.


Tawa-tawa

This hairy herb is commonly used in the Philippines as an alternative treatment for dengue fever.

Also known as gatas-gatas or by its scientific name Euphorbia hirta, it is said to increase the platelet levels in dengue patients.

A 2012 animal study conducted by pharmacy students from the University of Santo Tomas, Manila, showed that a decoction of tawa-tawa did indeed increase platelet levels and decrease bleeding time in rats with induced thrombocytopenia (i.e. an abnormally low platelet level).

The Philippine’s Department of Science and Technology is currently researching the effect of this plant on dengue fever, and have stated their concern over possible toxicity resulting from overdosing on tawa-tawa.

Meanwhile, Philippine Star columnist Dr Willie T Ong said in a 2009 article that Filipino doctors in general allow dengue patients to take tawa-tawa as long as they clear it with them first.

He also explained how to prepare the herb: “Take five whole tawa-tawa plants. Cut off the roots, then wash and clean.

“Boil tawa-tawa in a pot of clean water. Pour the liquid and then let cool. Sip one glass three to four times a day.”


Traditional Chinese medicine

Inti International University Center for Traditional Chinese Medicine director and head of the traditional Chinese medicine (TCM) programme Dr Yong Kian Fui says that there is no cure for dengue fever in TCM either, and treatment is usually supportive based on the stage of the disease.

The acupuncturist and Chinese physician notes that because of the vague symptoms of dengue fever, most people are only diagnosed with the disease about four days after their fever starts.

TCM therapy at that stage consists of a herbal concoction based on the formulation called qin wen bai tu san.

“This helps to clear the plaque and detox the body,” he says.

Patients have to take one dose daily for three days. If their platelet levels are still low by the end of that period, Dr Yong says they would be referred to the hospital for further management.

He adds that he personally also prescribes a bitter gourd and meat soup, which should be double-boiled for two hours.

While the meat can be from any animal, including fish, it is crucial that the seeds in the bitter gourd must be included in the soup.

“According to TCM theory, bitter gourd is used to clear ‘fire’ and to detox the body.

“The meat neutralises the bitter gourd, so that it doesn’t become too ‘cooling’.”


Ayuverdic medicine

Dr Rajen explains that there are four ways to treat dengue patients according to Ayuverdic medicine.

Two methods are targeted at boosting the patient’s blood production and providing an antiviral effect: the papaya fruit and leaf juice mix mentioned earlier, and juice made from pegaga leaves, also known as India pennywort or Centella asiatica.

According to Dr Rajen, one dose of the pegaga juice is the amount obtained from juicing one handful of leaves.

The other two treatments are mainly applied for their general antiviral properties.

One is cow or goat colostrum, which can be drunk as often as desired. Colostrum is the first secretion from the animal’s mammary glands before the milk comes out.


The other is turmeric, which can be added to the patient’s food or milk.

Friday, April 11, 2014

新生嬰兒黃疸 Neonatal Jaundice

黃疸 ( Jaundice ),俗称黃病,是一种因人体血液中的胆紅素 ( bilirubin ) 浓度增高,所引起的皮膚、黏膜和眼球鞏膜等部份发黃的症狀。某些肝脏病、膽囊病和血液病经常會引发黃疸的症狀。

胆红素是胆色素的一种,它是人胆汁中的主要色素,呈橙黄色。它是体内血紅素的主要代谢产物,有毒性,可对大脑和神经系统引起不可逆的损害,但也有抗氧化剂功能,可以抑制亚油酸和磷脂的氧化。

胆红素是衰老紅血球 ( red blood cell )上的血紅素分解所生的产物,胆红素藉由血流被送至肝脏 ( liver ),此時称为未结合型胆红素 ( unconjugated bilirubin ),进入肝脏的胆红素经由庫佛氏細胞 ( Kupffer cells ) 及脾臟 ( spleen ) 被转化为結合型胆红素 (conjugated bilirubin),而后被排入胆管 ( bile duct ),然后至胆囊 ( gallbladder ) 儲存,最后经由总胆管再流入十二指肠 ( duodenum ) 中。大部分的胆红素在肠子里会被細菌分解成尿胆素原 ( urobilinogen ),這使得我们的糞便会出現黃褐色。


成因分类

新生婴儿黃疸种类分为 :

1. 生理性黃疸 physiological jaundice
新生嬰兒的肝臟仍未發育成熟,不能迅速處理所產生的膽紅素,所以便積存在體內。常見,正常現象,于出生后2-3天出現,4-5天為高峰期,1-2週后消失。

2. 病理性黃疸 pathological jaundice
先天性血疾等導致紅血球破坏,使胆紅素代谢增加。此外,大量溶血导致的贫血,使肝细胞处在缺氧、缺血的状态下,其摄取、结合非结合胆红素的能力降低,导致非结合胆红素在血液中浓度更为增高而出现黄疸。若是黃疸出現太早、上升得太快,或持續的時間太久,都有可能是病理性黃疸。
a. 溶血性黃疸 hemolytic
·球形红细胞增多症 Spherocytosis
·遗传性椭圆形红细胞 hereditary elliptocytosis
·脓血症 sepsis
·动静脉畸形 arteriovenous malformation
·葡萄糖-6-磷酸脱氢酶缺乏症 G6PD
·丙酮酸激酶缺乏症 pyruvate kinase deficiency
·镰状细胞病 sickle cell disease
·α-地中海贫血α-thalassemia
·母子血型不合 ( ABORh )
b. 非溶血性黃疸 non-hemolytic
·晚发型母乳性黄疸 breast milk jaundice ( BMJ )
·头血肿 cephalohematoma
·红细胞增多症 polycythemia
·尿道感染 urinary tract infections
·脓血症 sepsis
·甲状腺功能减退症hypotyroidism
·Gilbert’s syndrome
·Crigler-Najjar syndrome
·高GI阻碍 high Glycemic Index obstruction

3. 肝脏疾病 hepatic
由于肝脏疾病使肝细胞发生了广泛性损害,致使肝细胞对非结合胆红素的摄取、结合发生障碍,故血清中非结合胆红素浓度增高。而部分未受损的肝细胞仍能继续摄取、结合非结合胆红素,使其转变为结合胆红素,但其中一部分结合胆红素未能排泌于毛细胆管中,而是经坏死的肝细胞间隙反流入肝淋巴液与血液中,导致血清中结合胆红素浓度也增高而出现黄疸。
            ·半乳糖血症  galactosemia
·α-1-antitrypsin deficiency
·囊狀纖維化  cystis fibrosis
·Dubin-Johnson syndrome
·Rotor syndrome
·肝炎 ( AB )  Hepatitis
·TORCH infection

4. 梗阻性黄疸post-hepatic
肝内、肝外肝胆管、总肝管、胆总管及乏特壶腹等处的任何部位发生阻塞或胆汁郁积,则阻塞或郁积的上方胆管内压力不断增高,胆管不断扩张,最终导致肝内小胆管或微细胆管、毛细胆管发生破裂,使结合胆红素从破裂的胆管溢出,反流入血液中而发生黄疸。
·胆道闭鎖 biliary atresia
·胆管诸塞 duct obstruction


症状


一般婴儿或多或少在出生第二天开始就会有生理性黃疸的出現,第四天达到最高峰,12星期後逐渐消退。粪仍系黄色,尿中无胆红素。

黃疸病除了導致婴儿皮肤和眼睛变黃,还使婴儿嗜睡,拒奶等。

诊断

1. TSB ( Total Serum Bilirubin )。胆红素检测是新生儿黄疸诊断的重要指标,可采取静脉血或微量血方法测定血清胆红素浓度。
2. TcB  ( Transcutaneous Bilirubin )。经皮测胆红素仪为无创的检测方法,操作便捷。
3. Ingram Icterometer



危害

新生儿轻度生理性黄疸不会有严重后果。

但黄疸不论何种原因,严重时均可引起核黄疸 ( nucleus jaundice )。核黄疸不仅危及生命,也可造成神经系统受损,导致终生致残。当血中胆红素浓度过高时,血中游离胆红素可通过血脑屏障进入脑组织,影响脑细胞的能量代谢,脑细胞因能量不足有变性坏死。


治療

1. 日光浴
黄疸不重的新生儿,多晒太阳,能起到退黄的效果。
2. 光照疗法 phototerapy
光照治疗是一种通过荧光灯照射治疗新生儿高胆红素血症的辅助疗法。蓝、绿或紫外光把胆红素转变成胆绿素 ( biliverdin ),然后通过尿液排出体外。
3. 换血疗法
4. 药物治疗
供应白蛋白,纠正代谢性酸中毒,肝酶诱导剂,静脉使用免疫球蛋白。
5. 中药制剂
茵栀黄口服液,其主要成分为茵陈、栀子、黄芩、金银花。