Sphygmomanometer

A sphygmomanometer or blood pressure meter is a device used to measure blood pressure, comprising an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a stethoscope.

The word comes from the Greek sphygmós (pulse), plus the scientific term manometer (pressure meter). The device was invented by Samuel Siegfried Karl Ritter von Basch in 1881. Scipione Riva-Rocci introduced a more easily used version in 1896. Harvey Cushing discovered this device in 1901 and popularized it.

A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and inflation bulb and valve, for manual instruments.

Operation
In humans, the cuff is normally placed smoothly and snugly around an upper arm, at roughly the same vertical height as the heart while the subject is seated with the arm supported. Other sites of placement depend on species, and may include the tongue, flipper, tail or teat. It is essential that the correct size of cuff is selected for the patient. Too small a cuff results in too high a pressure, whilst too large a cuff results in too low a pressure. The cuff is inflated until the artery is completely occluded. Listening with a stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. As the pressure in the cuffs falls, a "whooshing" or pounding sound is heard when blood flow first starts again in the artery. The pressure at which this sound began is noted and recorded as the systolic blood pressure. The cuff pressure is further released until the sound can no longer be heard. This is recorded as the diastolic blood pressure. In noisy environments where auscultation is impossible (such as the scenes often encountered in emergency medicine), systolic blood pressure alone may be read by releasing the pressure until a radial pulse is palpated (felt). In veterinary medicine, auscultation is rarely of use, and palpation or visualization of pulse distal to the sphygmomanometer is used to detect systolic pressure.

Significance
By observing the mercury in the column while releasing the air pressure with a control valve, one can read the values of the blood pressure in mm Hg. The peak pressure in the arteries during the cardiac cycle is the systolic pressure, and the lowest pressure (at the resting phase of the cardiac cycle) is the diastolic pressure. A stethoscope is used in the auscultatory method. Systolic pressure (first phase) is identified with the first of the continuous Korotkoff sounds. Diastolic is identified at the moment the Korotkoff sounds disappear (fifth phase).

Types
There are three types of sphygmomanometers:

• Digital with manual or automatic inflation.
  These are electronic, easy to operate, and practical in noisy environments. Many have not been validated for all patient groups, and they can give very inaccurate readings. They measure mean arterial pressure (MAP) and use oscillometric detection to calculate systolic and diastolic values. In this sense, they do not actually measure the blood pressure, but rather derive the readings. Digital oscillometric monitors are also confronted with "special conditions" for which they are not designed to be used: arteriosclerosis; arrhythmia; preeclampsia; pulsus alternans; and pulsus paradoxus. Some wrist cuff blood pressure monitors have been found to be quite accurate, but the monitor has to be at the level of the heart when the reading is taken.
  
  
• Digital portable finger blood pressure monitors with automatic inflation.
  These are more portable and easy to operate, although less accurate. They are the smallest blood pressure monitors.
  
  
• Manual.
  Should be operated by a trained person. Mercury manometers are considered to be the "gold standard" of measurement because their measurement is absolute and does not require re-calibration. For this reason they are often required in clinical trials of pharmaceuticals and for clinical evaluations of determining blood pressure for high risk patients including pregnant women. Aneroid, mechanical types are in common use, but they should be calibrated against a mercury manometer. The unit of measurement of blood pressure is millimeters of mercury (mmHg). Blood pressures are usually given as an even number. Manual sphygmomanometers require a stethoscope for auscultation.

Dengue Fever

Dengue fever is an infectious disease carried by mosquitoes and caused by any of four related dengue viruses. This disease used to be called "break-bone" fever because it sometimes causes severe joint and muscle pain that feels like bones are breaking, hence the name. Health experts have known about dengue fever for more than 200 years.

Dengue fever is found mostly during and shortly after the rainy season in tropical and subtropical areas of

• Africa
• Southeast Asia and China
• India
• Middle East
• Caribbean and Central and South America
• Australia and the South and Central Pacific

An epidemic in Hawaii in 2001 is a reminder that many locations in the United States are susceptible to dengue epidemics because they harbor the particular types of mosquitoes that transmit dengue virus.

Worldwide, 50 to 100 million cases of dengue infection occur each year. This includes 100 to 200 cases in the United States, mostly in people who have recently traveled abroad. Many more cases likely go unreported because some health care providers do not recognize the disease.

During the last part of the 20th century, many tropical regions of the world saw an increase in dengue cases. Epidemics also occurred more frequently and with more severity. In addition to typical dengue, dengue hemorrhagic fever (DHF) and dengue shock syndrome also have increased in many parts of the world. Globally, there are an estimated several hundred thousand cases of DHF per year.

Cause
Dengue fever can be caused by any one of four types of dengue virus: DEN-1, DEN-2, DEN-3, and DEN-4. You can be infected by at least two if not all four types at different times during your lifetime, but only once by the same type.

Transmission
You can get dengue virus infections from the bite of an infected Aedes mosquito. Mosquitoes become infected when they bite infected humans, and later transmit infection to other people they bite.

Two main species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all cases of dengue transmitted in this country. Dengue is not contagious from person to person.

Symptoms
Symptoms of typical uncomplicated (classic) dengue usually start with fever within 4 to 7 days after you have been bitten by an infected mosquito and include High fever, up to 105ºF

• Severe headache
• Retro-orbital (behind the eye) pain
• Severe joint and muscle pain
• Nausea and vomiting
• Rash

The rash may appear over most of your body 3 to 4 days after the fever begins, and then subsides after 1 to 2 days. You may get a second rash a few days later.

Symptoms of dengue hemorrhagic fever include all of the symptoms of classic dengue plus

• Marked damage to blood and lymph vessels
• Bleeding from the nose, gums, or under the skin, causing purplish bruises

This form of dengue disease can cause death.

Symptoms of dengue shock syndrome--the most severe form of dengue disease--include all of the symptoms of classic dengue and dengue hemorrhagic fever, plus

• Fluids leaking outside of blood vessels
• Massive bleeding
• Shock (very low blood pressure)

This form of the disease usually occurs in children (sometimes adults) experiencing their second dengue infection. It is sometimes fatal, especially in children and young adults.


Diagnosis
Your health care provider can diagnose dengue fever by doing two blood tests, 2 to 3 weeks apart. The tests can show whether a sample of your blood contains antibodies to the virus. In epidemics, a health care provider often can diagnose dengue by typical signs and symptoms.


Treatment
There is no specific treatment for classic dengue fever, and most people recover within 2 weeks. To help with recovery, health care experts recommend

• Getting plenty of bed rest
• Drinking lots of fluids
• Taking medicine to reduce fever

Centers for Disease Control and Prevention advises people with dengue fever not to take aspirin. Acetaminophen or other over-the-counter pain-reducing medicines are safe for most people.

For severe dengue symptoms, including shock and coma, early and aggressive emergency treatment with fluid and electrolyte replacement can be lifesaving.


Prevention
The best way to prevent dengue virus infection is to take special precautions to avoid being bitten by mosquitoes. Several dengue vaccines are being developed, but none is likely to be licensed by the Food and Drug Administration in the next few years.

When outdoors in an area where dengue fever has been found

• Use a mosquito repellent containing DEET, picaridin, or oil of lemon eucalyptus
• Dress in protective clothing—long-sleeved shirts, long pants, socks, and shoes

Because Aedes mosquitoes usually bite during the day, be sure to take precautions, especially during early morning hours before daybreak and in the late afternoon before dark.

Other precautions include

• Keeping unscreened windows and doors closed
• Keeping window and door screens repaired
• Getting rid of areas where mosquitoes breed, such as standing water in flower pots, containers, birdbaths, discarded tires, etc.

Complications
Most people who develop dengue fever recover completely within 2 weeks. Some, especially adults, may be tired and/or depressed for several weeks to months after being infected with the virus.

The more clinically severe dengue hemorrhagic fever and dengue shock syndromes can result in vascular (blood vessel) and liver damage, and can be life-threatening.

Sweet Memories

Cheers to the 70's... 80's babies...

Those OLD days!!!

You grew up watching He-man, Transformers, Thundercats, Silver Hawk, Space Cop Gaban, Ultraman, and Mighty Mouse. Not to forget, Ninja Turtles, Mask and Smurfs too.

You grew up brushing your teeth with a mug in primary school after recess time.

You squatted by a drain with all your classmates beside you, and brushed your teeth with a colourful mug. Remember the days when the school nurse comes with a list for the dentist appointments, the sound of the drilling when your friend has a fill in his tooth.

You remember the packets of milk (Projeck Susu Segar) and Milo we get in primary school to encourage us to drink more milk. And when we had to line up just to get one cup, and some of us would line up again for another cup of cold Milo.

And remember we use to buy susu sekolah and get stomach-ache the next day. During primary (some KBSR & 3M) school days, the teacher will punish you using a long ruler to hit your palm.

A bowl of noodle soup cost only 20 cent in primary school days.

When you were in primary school, girls like to go to the bookshop to buy cute stuff such as animal erasers, sharpeners, notebook etc. Play with these paper doll... 

With all the paper clothes, etc...

In secondary (some KBSM) school, girls go to the library to borrow their favourite romance storybook. In secondary school, girls altered their school skirt to shorten it and guys will go to the school appointed school uniform tailor shop to tailor make their school trousers to the then fashionable "baggy pants", or the GQ one with all the 'batik' or buckle at the edge of the pocket! the straight cut jeans.. or codroy...

In secondary school days, you buy the Bata BM Turbo school shoes. Some guys like to wear those china made ankle high shoes. Some even like to wear those very thick socks with their school shoes. Remember the Panda, Carefree or Warrior shoes..

Internet? E-mail? What the hell is that? So you thought a decade or more ago. Your friends don't have pagers or handphones in school.

CDs? What's that? Cassette tapes were the norm.

Movie tickets used to cost less than RM5 last time. There is no KLCC. Pertama Complex or Bukit Bintang the only place we have.

The goodies from Mamak shop used to be Mamee, Kaka, Kum Kum, Ding Dang choco balls (with toys in the box) plus the Mat Sentul voices as a jingle, colourful hard "egg", 

"cigerette" chocolate, pink bottle of bubbles, and small tubes with yellow sticks to blow "more lasting" bubbles that you can pop more air in or slam it on.

You never forget 'Ti Kam'. When exams are over, the board games (eg: UNO, Monopoly, CLUEDO) & hand held video games will be all over the class room.

Girls will start playing 'batu seremban'. Guys with 'tudung botol oren'.

For it's the homemade ice cream man. The cream that tops Haagan Dazs! The pink colour ice-cream with eyes plus a wide smile.

Your favourite sound is the bell!

Another bell is the recess bell, a time to get away from school work and to eat.

Another time when there is no bell but all guys will anxiously wait for it... The PJ, PE time (time for football!)

Your favourite childhood games were playing "guli" (marbles), five stones, zero-point, catching, and/or "Pepsi-Cola one two three"! The best thirst quencher of all times is the yummy colourful ice tubes you can buy from provision shops. To eat them, break the tab and suck while holding the freezing tube!

All gals had barbie dolls, My Little Pony, pound puppy, Polly Pocket and etc, while all boys had star wars figurines or a rubber band catapult that shoots folded paper or eraser bits.

Once was the era whereby ice-cream sticks were valueable items, than came the paper aircrafts, chalk fights.

Everyone envied the class monitor and his assitant, coz they were the ones who came up with the daily duty roster, giving names to teacher on who makes the most noise and who's running around the class.

The elite group are the prefects, the one with license to move around, they consider themselves above the law when not many students actually listened to them, and that's when the PK HEM comes in.

Some boys made their own guns from wood, and used 'Bacali' as the bullets. Some even used matches to shoot and burn kid's lanterns during Latern Festival.

And you also rather to 'ponteng sekolah' just to watch final episod of Moero Attack... Miss that much... Summersault Berkembar... He he he... Still remember this one...