GLOBAL LIFE

MENGAPA INSAN MENCARI AGAMA

2010-04-19T12:07:00.002+08:00

MENGAPA INSAN MENCARI AGAMA?

Islam bukan agama ikutan dengan serba kejahilan tetapi Islam adalah ad-Din kefahaman dan penghayatan. Kefahaman dan penghayatan adalah satu-satu cara
untuk mempertahan dan memperkukuhkan umat. Dukacita apabila orang Islam sendiri tidak berusaha memahami Islam apatah lagi untuk benar-benar
menghayati dan menyampaikannya .

Dalam konteks dakwah, betapa kita umat Islam bertanggungjawab untuk menyampaikan Islam yang sebenar kepada mereka yang bukan muslim. Malangnya
kebanyakan umat Islam bahkan hampir keseluruhannya begitu gagal melaksanakan tugasan ini. Setiap hari kita berurusan dengan mereka yang
non-muslim atau bukan muslim tetapi sepatah pun dari dakwah Islam tidak kita sampaikan kepada mereka sehingga mereka terus terbabas tanpa
dihulurkan sebab-sebab untuk sampai kepada hidayah. Lebih malang dari itu, kita kadang-kala memberikan gambaran yang buruk tentang Islam terhadap
mereka. Apakah kita tidak merasai betapa kita akan dipersoalkan di hadapan Allah di akhirat kelak di atas kecuaian ini...

Saya begitu tertarik dengan apa yang diceritakan oleh as-Syeikh `Ali at-Tontawi dalam bukunya Ta'rif al-`Am bi Din al-Islam, katanya:"Pernah aku
bertanya kepada para pelajarku, "Sekiranya datang kepada kamu seorang lelaki asing dan berkata kepada kamu bahawa dia hanya ada waktu sebanyak
sejam sahaja dan ingin memahami apakah Islam dalam tempoh tersebut?

Bagaimanakah kamu boleh memahamkan Islam kepadanya dalam tempoh sejam?. Mereka menjawab: "Ini mustahil, dia mesti mempelajari tauhid, tajwid,
tafsir, hadith, fiqh, usul fiqh, melibatkan diri dalam perbahasan masalah-masalah agama, dan dia tidak akan tamat melainkan setelah lima
tahun". Aku pun berkata: "Subhana Allah! Adapun seorang `arab badawi datang menemui Rasulullah s.a.w. dan tinggal bersama baginda selama sehari atau
setengah hari lalu mengetahui Islam lantas membawanya kepada kaumnya.

Selepas itu, dia menjadi pembimbing dan guru, menjadi pendakwah dan mubaligh untuk Islam. Lebih dari itu, Rasulullah pernah mensyarahkan ad-Din
keseluruhannya (dalam hadith Jibril) dalam tiga ayat sahaja. Baginda berbicara dalamnya mengenai Iman, Islam dan Ihsan....Kenapa tidak kita hari
ini mensyarahkan Islam dalam tempoh satu jam!!?" [ m.s. 27, Dar al-Wafa,Mesir]

Demikian menariknya tokoh pendakwah Islam yang terkenal ini mengemukakan contoh kesilapan dalam menguruskan dakwah. Ya! Kebanyakan kita apabila
diminta memulakan dakwah terutama kepada bukan muslim dia akan bertanya "Apakah perkara pertama yang hendak diterangkan?". Inilah persoalan yang
bermain di kepala kebanyakan muslim ketika di minta berdakwah. Lebih malang lagi ada yang penerangannya bermula dengan masaalah berkhatan...

Ada pula yang apabila menemui seseorang yang baru menganut Islam atau ingin memahami Islam maka dia mengatakan "Engkau wajib menghafal sifat duapuluh
dengan perbahasan falsafahnya jika tidak iman engkau tidak dikira sah dan solat kau juga tidak bermakna....

Ini semua adalah contoh golongan yang menyusahkan manusia mendekati dan memahami Islam dengan cara yang jelas dan diterima.

Manusia Dan Agama

Sesiapa sahaja yang memiliki akal yang waras pasti akan mencari hakikat disebalik kehidupan yang dirasai dan disaksikannya. Jiwa insan yang
sempurna tidak akan terhenti bertanya tentang rahsia kehidupan ini. Allah telah menfitrahkan insan iaitu memberikan sifat di dalamnya jiwanya
perasaan ingin mengetahui. Apatah lagi jika sesuatu itu berkait langsung dengan diri insan itu sendiri.

Berbagai perkara sering kita lihat dalam kehidupan ini, sebahagian daripadanya kita gagal memberikan jawapan yang tepat mengenainya jika tidak
dibimbing oleh cahaya petunjuk yang sebenar.

Sebab itu jika diandaikan ada seorang bayi yang dihanyutkan air sehingga ke sebuah pulau yang tiada penghuni dari keturunan manusia. Sekiranya dia
ditakdirkan hidup sehingga dewasa dan akalnya tidak cacat pasti dia sering bertanya dalam dirinya bagaimana dia boleh wujud di alam ini atau hadir ke
pulau tersebut. Sekalipun tanpa bimbingan agama dia tetap akan bertanya siapakah yang menjadikan dirinya dan alam yang dia lihat. Mengapa mesti dia
hidup. Perasaan dan jiwanya akan memberontak bertanya tentang hakikat diri.

Sehingga akhirnya, jika jiwanya tidak dibimbing dengan hidayah tentu dia akan mengagak objek-objek tertentu yang dikagumi atau digeruninya sebagai
punca pergantungan harapan atau dalam kata lain sebagai tuhan dalam kehidupannya. Begitu bermulanya agama yang tidak dibimbing oleh wahyu
sebenar.

Sebabnya ini adalah sifat yang sudah wujud dalam jiwa insan iaitu keinganan mengetahui rahsia alam sekaligus desakan jiwa untuk mencari tuhan.

Allah menggambarkan hal ini di dalam al-Quran melalui watak yang ditunjukkan oleh Nabi Ibrahim a.s., firman Allah dalam menceritakan kisah
ini:Maksudnya: Dan demikian itu kami perlihatkan kepada Ibrahim tanda-tanda keagungan kami yang terdapat di langit dan di bumi agar dia termasuk di dalam orang-orang
yang yakin.Ketika malam telah menjadi gelap dia (Ibrahim) melihat sebuah bintang (lalu) dia berkata: "Ini adalah tuhanku".
Tetapi apabila bintang itu hilang dia berkata aku tidak suka kapada yang lenyap". Kemudian apabila dia melihat bulan terbit dia berkata "Ini adalah
tuhanku".Namun apabila bulan itu hilang dia berkata: "Sesungguhnya jika tuhanku tidak memberi petunjuk kepadaku tentu aku termasuk dalam golongan yang
sesat".

Kemudian apabila dia melihat matahari terbit dia berkata, "Inilah tuhanku, ini lebih besar". Namun apabila matahari itu hilang, dia berkata "Wahai kaumku! Sesungguhnya
aku berlepas diri dari apa yang kamu semua sekutukan. Sesungguhnya aku menghadapkan diriku kepada tuhan yang mencipta langit dan
bumi dalam keadaan cenderung kepada agama yang benar dan aku bukan termasuk dalam golongan yang mempersekutukan tuhan. [Surah al-An`am ayat 75-79]

Demikian Al-Quran menggambarkan peribadi insan yang waras dan sempurnaan nilai keinsanannya iaitu senantiasa mencari tuhan yang sebenar. Jika insan
tidak dibimbing oleh petunjuk dari tuhan yang sebanar maka pasti dia akan tersesat.

Manusia Dan Persoalan

Insan yang waras senantiasa menimbulkan tanda tanya tentang tuhan atau dalam kata lain bertanya "siapakah yang telah menjadikan dirinya dan alam
di sekelilingnya". Akal yang waras meyakini bahawa dirinya tidak muncul dengan kehendaknya tetapi tentulah adanya kuasa yang maha agung yang
menciptakannya. Tidak terhenti untuk itu sahaja, dia tentu juga merasai keperluan diri bergantung kepada zat yang agung itu kerana dalam hidup dia
pasti menghadapi peristiwa-peristiwa yang terjadi tanpa pilihan atau kemampuannya. Perasaan mencari tempat pergantungan akan terus timbul dan
keperluan kepada pertolongan tuhan akan benar-benar dirasai oleh setiap insan. Seterusnya, apabila insan memerlukan tuhan tentu insan ingin
mengetahui kehendak atau tuntutan tuhan terhadap dirinya. Ini bagi memboleh insan merasai tuhan bersamanya dan merestuinya. Insan melihat berbagai
kejadian dan peristiwa di alam ini, ada golongan yang baik dan ada pula yang jahat.

Ada golongan golongan yang zalim dan ada pula yang dizalimi. Ini sekali lagi mendesaknya bertanya "Apakah kesemua ini akan berlaku
begitu sahaja. Apakah yang zalim tidak ada sebarang tindakan tuhan terhadapnya sedangkan dia telah menzalimi hamba tuhan yang lain. Apakah
selepas adanya penindasan dan penginayaan maka hidup pun hilang begitu sahaja. Apakah sama antara hamba yang ingin mentaati tuhan dengan yang
memusuhi tuhan?

Demikianlah berbagai persoalan timbul yang mendesak jiwa insan sekaligus membawa sekali lagi insan bertanya ke manakah perginya manusia selepas
berakhirnya kehidupan di dunia ini...

Perumpamaan Yang Menarik

Dr. Muhammad Sa`id Ramadhan al-Buti telah memberikan perumpamaan yang menarik dalam bukunya Madkhal ila Fahm al-Juzur katanya: "Apa pendapat kamu
mengenai seorang insan yang membuka kedua matanya selepas tidur yang panjang, dia yang sebelum ini berada di atas katil di dalam bilik tidurnya,
tiba-tiba dia dapati diri berada di dalam salah satu gerabak keretapi. Dia dibawa oleh suatu perjalanan ke arah yang dia sendiri tidak tahu.
Merentangi bukit-bukau dan lurah yang dia tidak pernah dia lihat dan tahu mengenainya.

Siapakah yang membawa dan meletakkan dia di dalam keretapi tersebut? Bilakah perkara ini bermula? Siapakah yang sedang memandunya? Siapakah pula
yang menyusun dan mengatur perjalanannya? Apakah yang orang tersebut mahu daripadanya secara peribadi selepas ini? Sesungguhnya dia benar-benar tidak
tahu semua ini.....!

Apakah anda berpendapat insan berkenaan boleh menutup fikiran dari segala persoalan tersebut? Bolehkah dia merehat urat sarafnya dari terus mendesak
dan mencari jawapan mengenai apa yang dia tidak tahu itu?. Bolehkah kemudiannya dia terus asyik berseronok suka dengan melihat jalanan yang
cantik dan pandangan yang asing?

Samaada gerabak tersebut dipenuhi dengan peralatan mewah dan terhias dengan segala perkara yang melalaikan, atau ianya dipenuhi dengan perkara yang
menduka dan menyusahkan, namun apakah mungkin untuk dia menjadikan semua itu melupakan dia dari apa yang didesak kepadanya oleh tekanan fikiran dan
akalnya? Juga dari kerisauan dan kekeliruan disebabkan keadaan yang tanpa pilihannya, dia dalam lautan kejahilan.

Sekalipun demikian, namun masalah tersebut adalah masih kecil lagi terhad, bilamana keluasan keretapi tersebut adalah terhad dan dalam lingkungan alam
yang diketahui tanda-tanda dan kebiasaanya. Ini kerana, bagaimana sekalipun ia bergerak ke timur atau ke barat ia sama sekali tidak akan keluar dari
ruang lingkupnya dan tidak akan melepasi melainkan dalam lingkungan bumi.

Namun masalah tersebut bertukar menjadi besar dan begitu besar bila mana keretapi tersebut adalah alam ini keseluruhannya. Bila mana pergerakannya
itu adalah merupakan keadaan rangkaian kehidupan insan....[ m.s. 6-7,Cetakan Dar al-Fikr al-Mu`asir, Lubnan]

Demikian Muhammad Sa`id Ramadhan al-Buti cuba membayangkan keadaan insan yang sejak kecil membuka matanya dan melihat alam serta pergerakan
disekelilingnya. Juga yang lebih penting melihat dirinya sendiri serta rangkaian perjalanan hidupnya. Apakah tidak terdesak jiwanya untuk bertanya
tentang hakikat diri, apakah keadaan yang sedang dihadapinya dan apakah kesudahannya nanti? Mungkinkah pengaruh suasana sekelilingnya boleh atau
mampu melupakan dia untuk mencari jawapan bagi erti kehidupannya? Kalaulah ada insan yang demikian tentulah dia sejahil-jahil manusia secara mutlak
kerana dia telah lalai memikirkan perkara yang menjadi dasar insan berakal.

Perlunya Hidayah Islam

Persoalan-persoalan ini walaupun muncul dari fitrah manusia dan ianya sesuatu yang sangat baik untuk membolehkan insan mencari kebenaran namun
jika insan tanpa bimbingan hidayah atau petunjuk dari Allah, persoalan-persoalan tersebut juga boleh menjadi punca insan sesat dengan
sesesatnya. Jika insan tidak dibimbang dengan petunjuk daripada Allah maka persoalan-persoalan tadi terus mencari berlegar dalam fikiran insan dan
akhirnya mereka mencipta jawapan yang salah lagi sesat dalam kehidupan.

Jika petunjuk sebenar tidak sampai kepada insan maka tuhan-tuhan palsu pasti akan muncul, kehendak-kehendak tuhan secara palsu juga akan
diandaikan dan alam selepas kematian akan dibayangkan mengikut kehendak fikiran dan kepentingan tertentu. Akan ada yang mengambil kesempatan dari
kehendak atau tuntutan fitrah tersebut dengan mencari kepentingan dunia lalu mencipta ajaran agama untuk kepentingan diri dan harta. Maka lahirlah
agama-agama palsu di atas muka bumi.

Allah Tuhan Yang Sebenar tidak akan membiarkan insan tenggelam dalam kesesatan tanpa bimbingan hidayah yang asli dariNya sendiri yang
menciptakan alam keseluruhannya serta Maha Berkuasa dengan penuh keagungan. Untuk itu, setiap umat diutuskan Rasul yang membawa ajaran Islam bagi
memberikan jawapan sebenar terhadap persoalan insan dalam hidup. Para Rasul bukan mencipta ajaran mengikut akal mereka tetapi mereka menyampaikan
ajaran daripada Allah Yang menurunkannya kepada mereka menerusi proses yang dinamakan wahyu.

Tiada siapa yang berhak berbicara mengenai Allah melainkan Allah sendiri dan perbicaraan Allah itu telah disampaikan kepada sekelian insan menerusi
para Rasul. Para rasul bukan sekadar memberitahu tetapi membimbing dan mendidik. Rasul yang terakhir ialah Muhammad bin `Abdullah yang membawa
ajaran Islam dari Allah.

Firman Allah: (Maksudnya): Sesungguhnya ad-Din (agama) di sisi Allah ialah Islam. [Surah Ali `Imran ayat 19]

Firmannya lagi: (Maksudnya): Sesiapa yang mencari selain dari Islam sebagai agama maka sama sekali tidak
diterima daripadanya dan dia di akhirat kelak termasuk dari kalangan mereka yang rugi.[Surah Ali `Imran ayat 85]

Maka kedatangan Islam daripada Allah yang mencipta alam dan segala isinya telah memberikan jawapan yang sebenar kepada semua persoalan tersebut. Nabi
Muhammad s.a.w. adalah kesinambungan dalam menyampaikan risalah dari Allah dan memberikan jawapan kepada persoalan insan.

Justeru itu wajib kepada semua insan -tanpa kecuali- yang hidup selepas kedatangan Nabi s.a.w meyakini, menerima dan menghayati ajaran Islam yang
bawa oleh Muhammad bin Abdullah, utusan Allah yang akhir itu demi keselamatan kehidupan mereka yang hakiki. Setiap insan tahu bahawa dia
tidak datang ke dunia ini dengan kebijaksanaannya. Tidak juga kerana kebijaksaan kedua ibubapanya.

Kalaulah insan wujud di dunia dengan pilihan dan kebijaksanaannya tentulah semua insan dapat menentukan rupa paras yang cantik lagi menawan bagi diri
dan keluarganya. Tentu kesemuanya memilih untuk lahir di tengah banglo atau istana mewah dan keluarga yang kaya-raya. Namun keadaannya tidak begitu.
Hinggakan pasangan suami isteri pun sama sekali tidak boleh memilih paras rupa anak yang bakal lahir. Kalau hal ini boleh ditentukan sudah pasti
setiap insan lahir dalam keadaan paling sempurna. Namun ternyata ianya
diluar kawalan insani.

Ini semua menyedarkan insan bahawa adanya suatu kuasa yang Maha Agung yang mewujudkan manusia dengan kehendakNya. Dia adalah Allah. Dia tidak akan
mempersoalkan insan tentang keputusan yang dipaksa ke atas mereka seperti hitam atau putihnya warna kulit seseorang, siapa ibu atau bapanya, di mana
negeri kelahirannya, mengapa dia tidak pintar atau cerdas, sempurna atau cacat dan seumpamanya. Dia hanya akan menyoal apakah mereka telah
menunaikan tanggungjawab yang Dia wajibkan ke atas mereka. Adapun segala kejadian tanpa pilihan insan itu adalah bagi mewujudkan sistem hidup dialam
ini dan menyedarkan insan betapa mereka semua bergantung kepada Tuhan, Allah Yang Maha Esa.

Firman Allah di dalam al-Quran:

Maksudnya:
Dan Allah telah mengeluarkan kamu dari perut ibu kamu dalam keadaan tidak
mengetahui sesuatu apa pun. Dia menjadikan bagi kamu pendengaran,
penglihatan dan hati, mudah-mudahan kamu bersyukur. [Surah an-Nahl ayat 78]

Firman Allah dalam al-Quran lagi:
Maksudnya:
Dia (Allah) membuat setiap yang Dia cipta sebaik-baiknya (yang paling
sesuai) dan Dia telah memulai penciptaan manusia dari tanah.
Kemudian Dia telah menciptakan keturunannya dari saripati air yang hina.
Kemudian Dia menyempurnakan dan meniup ke dalam tubuhnya ruh dan Dia
menjadikan bagi kamu pendengaran, penglihatan dan hati, tetapi sedikit
sekali yang bersyukur.[Surah as-Sajdah ayat 7-9]

Berbagai-bagai lagi sifat dan ciri insan yang Allah bentangkan di dalam al-Quran bagi menggambarkan betapa setiap insan faqir kepada Allah yang
Maha Perkasa lagi Maha Bijaksana.

Apabila menyedari diri sebagai makhluk (yang diciptakan) dan Allah sebagai Khaliq (Pencipta) dengan segala rahsia ciptaan dan kehebatannya maka
timbulnya perasaan kehambaan dan mengharapkan Allah dalam segala hal. Timbulnya perasaan bergantung serta bertawakal kepada Allah.

Bahkan Allah juga telah membekalkan ke dalam jiwa manusia secara fitrah atau sejak kelahirannya beberapa sifat dan perasaan secara tersedih dari
sisi Allah. Dibekalkan kepada insan sifat kasih-sayang, perasaan marah, perasaan sedia, perasaan ingin dihargai, ingin dikasihi, perasaan cinta
antara lelaki dan perempuan dan berbagai lagi. Antara yang paling nyata dibekalkan tuhan dalam jiwa insan adalah sifat atau perasaan merasai
kewujudan Tuhannya. Sebab itu kita dapat saksikan walau di mana pun manusia berada mereka tetap mempercayai Tuhan. Sekalipun ajaran agama tidak sampai
kepada seseorang namun hati nuraninya tetap bertanya tentang Tuhan.

Golongan yang mengaku diri mereka komunis pun pada hakikatnya tetap merasai kewujudan Tuhan. Sifat ego sahaja yang menjadikan lidah mereka
menafikannya.

Adapun golongan mereka yang mendakwa free-thinker atau bebas dari segala ikatan kepercayaan atau agama meraka sebanarnya bukan tidak percaya tentang
adanya Tuhan tetapi mereka terkeliru dalam menentukan "siapakah Tuhan yang sebenar, sifatNya, juga apakah ajaran yang sebenar dariNya?" Mereka
terkeliru dengan agama-agama palsu yang mereka lihat. Atau nafsu mereka ingin bebas dan bermaharaja agar mereka boleh melakukan apa sahaja tanpa
ikatan agama. Sebab itu kita lihat apabila Islam yang sebenar diterangkan kepada mereka dengan jelas kita mendapati kebanyakan daripada mereka
bersegera menyahut panggilan hidayah Islam dengan rela dan gembira..

Di atas ciri ini, maka Allah yang menciptakan manusia, menyebut di dalam al-Quran tentang golongan kafir yang menentang Nabi s.a.w.:

Maksudnya:
Dan sesungguhnya jika kamu tanyakan kepada mereka (golongan kafir);
"Siapakah yang menjadikan yang menjadikan langit dan bumi dan menundukkan
(mentadbir) matahari dan bulan?" Tentu mereka akan menjawab "Allah", maka
betapakah mereka (dapat) dipalingkan (dari jalan yang benar) [Surah
al-'Ankabut ayat 61]

Menentukan Tuhan Yang Sebenar

Kesimpulannya, manusia semuanya percaya wujudnya Tuhan tetapi mereka gagal menentukan bagaimanakah Tuhan yang sebenar. Bagaimanakah sifatNya dan jalan
menghampiri diri kepadaNya. Lalu mereka meramalkan Tuhan mengikut fikiran dan suasana masing-masing. Ada yang meramalkan Tuhan itu seperti manusia
atau seperti binatang yang besar atau beranak-pinak atau apa sahaja yang terlintas di fikiran mereka. Pengikut ajaran hindu umpamanya, mereka
membayangkan Tuhan itu seperti orang-orang India. Mereka mengukir bentuk Tuhan dengan rupa paras orang-orang India. Mata, warna kulit, bentuk badan
dan segala-gala seperti rupa bangsa mereka. Seakan-akan Tuhan hanyalah untuk manusia di negeri India sahaja. Begitulah juga agama-agama lain yang
menyesatkan. Mereka mengukir atau melukis dengan tangan mereka lalu mereka menyembahnya.

Ada juga manusia yang memilih Tuhan berdasarkan apa yang dia takuti. Bila mana dia kagum atau gerun dengan pokok yang besar atau sungai atau laut
lalu mereka merasai di situ bertahtanya tuhan lalu mereka menyembahnya, ini seperti kebanyakan suku kaum yang hidup di hutan.

Demikian gambaran kekeliruan manusia dalam mencari Tuhan yang sebenar.

Keterbatasan `Akal

Insan pasti akur bahawa segala kemampuannya sekali pun hebat ada had atau batasan yang dia tidak dapat lakukan. Mata yang dimilikinya ada batasan
jarak, bentuk, warna yang tidak mampu dilihatnya. Telinga yang dimiliki ada batasan gelombang yang tidak mampu di dengar.

Bahkan kalau insan menulis angka dari satu hingga sepuluh di dalam sepuluh keping kertas yang kecil lalu dimasuk kesemuanya -secara bercampur- ke
dalam sakunya dan diminta supaya dia mengeluarnya semula menurut susunan satu hingga sepuluh tanpa melihat kepada kertas-kertas tersebut, sudah
pasti dia tidak mampu mengeluarkan secara tertib dan teratur kerana matanya tidak dapat mengesan, sekali kertas-kertas itu berada dalam sakunya
sendiri.

Demikianlah keterbatasan jangkauan insan. Maka akal insan juga amat terbatas. Bukan semua perkara boleh dirumuskan oleh akal. Kalau hanya
sepuluh keping kertas insan tidak dapat mengagaknya dengan tepat bagaimana insan ingin memikirkan tentang diri Tuhan yang sebenar, sifat Tuhan yang
sebenar, kehendak atau tuntutan Tuhan kepada insan dan apa yang bakal Tuhan lakukan kepada insan. Ini semua gagal dicapai oleh insan tanpa bimbingan
dari Tuhan sendiri melalui pengutusan para Rasul.

- LAA HAULAWALA QUWWATAILLA BILLAH -

TAK KISAH...............

2010-01-07T08:55:00.001+08:00

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4. Bila mengenangkan harga kereta Proton lebih murah diluar negara daripada di negara sendiri.

5. Walaupun berpuluh-puluh filem bollywood ditayangkan dengan hanya tajuk berbeza, tapi dengan plot yang sama, rentak tarian yang seiras dan pelakon-pelakon yang serupa, maseh ramai jugak yang berpusu-pusu untuk menontonnya.

6. Bilamana perempuan ditinggalkan oleh lelaki, lelaki dituduh tidak setia, tetapi bilamana perempuan meninggalkan lelaki, lelaki pulak dikatakan tidak memenuhi citarasa.

7. Bilamasa kita menanyakan status berkenaan sesuatu permohonan kepada Jabatan-Jabatan Kerajaan, jawapannya semua serupa....DALAM PROSES!

8. Bilamasa mengenangkan adat sopan santun kita untuk tidak menghabiskan juadah makanan yang dihidangkan oleh tuan rumah bila kita mengunjung walhal dari segi agama mengatakan jangan membazir!

9. Bilamasa kita terlambat untuk membayar pinjaman bank, kita akan dikenakan faedah keatas bayran tersebut, tetapi bila bank terlebih potong, kita kena tunggu sampai 4-5 bulan walaupun untuk mendapat 5 sen balik...tanpa faedah!.

10. Bilamasa kita terlambat untuk sampai ke lapangan terbang untuk check-in, kita akan didenda 25% dari tambang kapalterbang, tetapi bila penerbangan dibatalkan atau terlambat, satu benda pun kita tak dapat melainkan penat menunggu!

11. Kenapa pemilik teksi Bandaraya mengenakan tambang 50% selepas tengah malam sedangkan dibandaraya selalunya bercahaya terang (macam siang) dan kurang traffic jam pulak tu....mungkin takut kena rompak....tapi nak buat apa caj lebih pun kalau lepas tu kena rompak?

12. Bilamasa kita makan di restoran-restoran makanan segera kita dikenakan caj 10% cukai kerajaan dan 5% cukai perkhidmatan sedangkan cukai kerajaan itu adalah diatas untung syarikat dan cukai perkhidmatan tak pernah ada sebab semuanya layan sendiri?

KISAHNYA NABI ADAM A.S

2010-01-07T08:05:00.000+08:00

Kita selalu mendengar kisahnya Nabi Adam AS.Dan kita juga terlalu tahu tentang kejadianya manusia itu adalah dari tanah. Tetapi apakah kita tahu akan tanahnya itu?

Apakah kita tahu akan prosesnya kejadian itu?

Mari kita baca kupasan yang sedikit ini, mudah-mudahan kita lebih mengetahui tentangnya dan Insyaallah dapatlah kita mempelajarinya bersama-sama. Berpesan- pesanlah pada kebaikan dan berpesan-pesanlah pada kesabaran.

BETAPA PAYAHNYA MALAIKAT-MALAIKAT MEMINTA TANAH DARI BUMI UNTUK NABI ADAM AS (ABUL BASYAR / Bapa segala manusia)

Pada suatu ketika, Allah SWT menitahkan kepada malaikat Jibril supaya turun ke bumi untuk mengambil sebahagian tanahnya untuk mencipta Adam. Akan tetapi
apabila beliau sampai ke bumi, bumi enggan membenarkan tanahnya diambil untuk dijadikan Adam kerana bumi kuathir Adam akan menjadi maksiat kepada Allah. Lalu Jibril kembali ke hadrat Allah memberitahu bahawa ia tidak dapat berbuat apa-apa apabila mendengar mendengar sumpah bumi.

Setelah itu, Allah memerintah malaikat Mikail. Jawapan bumi masih sama lalu Allah memerintahkan malaikat Israfil dan jawapan bumi masih tidak berganjak.

Masing-masing kembali dengan jawapan yang hampa.Akhirnya, Allah menyuruh
malaikat Izrail turun ke bumi.Kata Allah:
” Hai Izrail! Engkaulah kini yang aku tugaskan mengambil tanah. Meskipun bumi bersumpah-sumpah dengan ucapan, jangan engkau mundur. Katakan bahawa
kerjamu atas perintah dan atas namaKu.”

Apabila Izrail turun ke bumi dan menyampaikan perintah Allah kepada bumi, maka akhirnya bumi mengizinkan tanahnya diambil. Setelah Izrail mengambil beberapa jenis tanah,kembalilah ia ke hadrat Allah.

Lalu Allah berfirman: “Ya Izrail, pertama engkau yang Ku tugaskan mengambil
tanah, dan kemudian di belakang hari kelak akan kutugaskan engkau mencabut
roh manusia.”

Maka kuathirlah Izrail kerana bimbang akan dibenci oleh umat manusia.Lalu Allah berfirman lagi: “Tidak, mereka tidak akan memusuhi kamu. Aku yang mengaturnya, dan aku jadikan kematian mereka itu bersebab antaranya terbunuh, terbakar, sakit dan sebagainya.

JENIS TANAH YANG DIGUNAKAN:

1. Tanah tempat bakal berdirinya Baitul Mugaddis
2. Tanah Bukit Tursina
3. Tanah Iraq
4. Tanah Aden
5. Tanah Al-Kautsar
6. Tanah tempat bakal berdiringa Baitullah
7. Tanah Paris
8. Tanah Khurasan
9. Tanah(Babylon)
10. Tanah India
11. Tanah syurga
12. Tanah Tha’if

Menurut Ibnu Abbas:

1. Kepala Adam dari tanah Baitul-Muqaddis kerana disitulah berada otak manusia,dan disitulah tempatnya akal.

2. Telinganya dari tanah Bukit Thursina, kerana dia alat pendengar dan tempat menerima nasihat.

3. Dahinya dari tanah Iraq,kerana disitu tempat sujud kepada Allah.

4. Mukanya dari tanah Aden, kerana disitu tempat berhias dan tempat kecantikan.

5. Matanya dari tanah telaga Al-Kautsar, tempat menarik perhatian.

6. Giginya dari tanah Al-Kautsar, tempat memanis-manis.

7. Tangan kanannya dari tanah Kaabah,untuk mencari nafkah dan kerjasama,sesama manusia.

8. Tangan kirinya dari tanah Paris,tempat beristinjak.

9. Perutnya dari tanah Babylon. Disitulah tempat seks(berahi) dan tipudaya syaitan untuk menjerumuskan manusia ke lembah dosa.

10.Tulangnya dari tanah Bukit Thursina,alat peneguh tubuh manusia..

11.Dua kakinya dari tanah India, tempat berdiri dan jalan.

12.Hatinya dari tanah syurga Firdaus,kerana disitulah iman, keyakinan,ilmu, kemahuan dan sebagainya.

13.Lidahnya dari tanah Tha’if, tempat mengucap Syahadat, bersyukur dan berdoakan kepada Tuhan.

PROSESNYA KEJADIANNYA:

1. Ketika Allah jadikan Adam, tanah itu dicampur dengan air tawar, air masin, air hanyir, angin dan api. Kemudian Allah resapkan Nur kebenaran dalam diri Adam dengan berbagai macam “sifat”.

2. Lalu tubuh Adam itu digenggam dengan genggaman “Jabarut” kemudian diletakkan didalam “Alam Malakut”.

3. Sesungguhnya tanah yang akan dijadikan “tubuh Adam” adalah tanah pilihan Maka sebelum dijadikan patung, tanah itu dicampurkan dengan rempah-rempah dan wangi-wangian dari sifat Nur sifat Allah, dan dirasmikan dengan air hujan “Barul Uluhiyah”.

4.Kemudian tubuh itu dibenamkan didalam air “Kudral-Izzah- Nya” iaitu sifat “Jalan dan Jammal”.Lalu terciptalah tubuh Adam yang sempurna.

5.Demikian pula roh, ketika itu diperintah masuk kedalam tubuh Adam, ia merasa malas dan enggan, lalu ia berputar-putar, mengelilingi patung Adam yang terlantar. Kemudian Allah menyuruh malaikat Izrail untuk memaksa roh itu masuk.Akhirnya mahu tidak mahu roh itupun masuk dan menyerah kepada Izrail.

Menurut riwayat ketika Adam masih berada di syurga, sangat baik sekali kulitnya. Tidak seperti warna kulit manusia. Kerana Adam telah diturunkan ke dunia, terjadilah perubahan pada warna kulitnya. Sebagai peringatan, yang masih tertinggal warnanya
hanyalah pada kuku manusia. Oleh itu, meskipun orang kulitnya hitam,tetapi warna
kukunya adalah sama, ialah putih kemerah-merahan.

Dijadikan pada tubuh Adam ada sembilan rongga atau liang. Tujuh buah liang dikepala,dan dua buah liang di bawah badan letaknya.

Tujuh buah letaknya adalah di:

1. Kepala : dua.liang mata, Dua liang telinga, Dua liang hidung dan sebuah liang mulut.
2. Dibawah: Sebuah liang kemaluan dan liang dubur.

Dijadikan pula lima buah pancaindera:

1. Mata alat penglihatan
2. Hidung alat penciuman
3. Telinga alat pendengaran
4. Mulut alat merasa manis, masin dan sebagainya.
5. Anggota tubuh lainya seperti kulit, telapak tangan, untuk merasa halus, kasar dan
sebagainya.

Setelah Roh masuk kedalam tubuh Adam :
Lalu roh itu masuk perlahan-lahan sehingga ke kepalanya yang mengambil masa 200 tahun. Demikianlah Allah memberi kekuatan pada Izrail untuk memasukkan roh ke dalam tubuh Adam.

Setelah roh meresap ke kepala Adam, maka terjadilah otak dan tersusunlah urat-urat sarafnya dengan sempurna. Kemudian terjadilah matanya dan seketika itu matanya terus terbuka melihat dan melirik kekiri, ke kanan dan kebawah dimana pada masa itu
bahagian badannya masih merupakan tanah keras.

Dilihatnya kiri dan kanan para malaikat yang sedang menyaksikan kejadian dia. Ketika itu dia telah dapat mendengar para malaikat mengucapkan tasbih dengan suara yang merdu dan mengasyikkan.

Kemudian ketika roh sampai kehidungnya lalu ia bersin, serta mulutnya terbuka.

Ketika itulah Allah ajarkan padanya ucapan Alhamdulillah. Itulah ucapan

Adam pertama kalinya kehadrat Allah. Lalu Allah berkata :”Yarhamukallah”
yang membawa erti: “Semoga engkau diberi rahmat Allah”. Oleh kerana itu jika
orang bersin, menjadi sunat mengucap “Alhamdulillah” dan orang yang mendengarnya sunat pula mengucapkan “Yarhamukallah” .

Kemudian ketika roh sampai pada dadanya, tiba-tiba saja ia mahu bangun. Padahal sebahagian bawah badannya masih tanah dan keras. Disini menunjukkan sifat manusia yang suka tergesa-gesa (tidak sabar). Sebagaimana firman Allah SWT bermaksud:
“Dan adalah manusia itu, suka tergesa-gesa” .(Al-Israk: II)

Maka ketika roh itu sampai dibahagian perutnya, maka terjadilah susunan isi perut dengan sempurna. Maka seketika itu terasalah lapar. Kemudian terus roh itu meresap
sampai ke seluruh tubuh, tangan, kaki lalu terjadi darah daging dan tulang. Urat-urat berkulit dengan sempurna, yang mana kulit itu kian lama kian cantik dan halus.

Begitulah proses kejadian-kejadian tubuh Adam. Setelah kejadian Adam sempurna sebagai manusia, maka dialah merupakan makhluk manusia yang pertama. Wajahnya cukup cantik, semua malaikat berasa kagum melihat Adam yang begitu menawan. Kemudian Adam diarak oleh malaikat-malaikat selama 100 tahun lalu diperkenalkan kepada seluruh penghuni dari langit pertama hinggalah kelangit tujuh sebelum dibawa ke syurga tempat mula-mula Adam dijadikan.

(Dipetik dari buku HIMPUNAN KISAH-KISAH MALAIKAT disusun oleh Muhammad Isa Selamat)

PROTON EXORA

2009-05-28T07:09:00.001+08:00

new Proton Exora will fit neatly into Joe Average’s idea of a family carMOST of us would have by now caught a glimpse of the Proton Exora. I saw one recently, and it looked very good indeed, especially as the owner had ‘inched up’ with 17-inch wheels and super-low profile tyres. The transformation is immediate and impressive.

However, size is not an issue here. The main concerns are fuel economy and power delivery.
I was fortunate enough to get an Exora for four days, enough for me to do a fuel consumption test and also to evaluate it from a user point of view.

The first thing I did was to take my extended family, consisting of seven adults and two pre-teens – one 12 and the other 10 years old – out for dinner. The Exora had no problem hauling all of us the short distance of 5km from our home to the diner; that is, if you are in no hurry.
The Exora has enough get-up-and-go, even under light throttle, picking up speed gradually. It cruises along fine at anything between 80 to 100kph, and does it quietly and effortlessly.
If you are impatient, the electronic throttle will respond very readily (perhaps a little too readily) by dropping down a gear, or even two, the moment you put your foot down on the accelerator pedal.

As long as you keep the accelerator flat on the floor, the auto transmission controller will not allow the gearbox to change up until you hit 6,500rpm.
Similarly, when you are in third gear, the Exora’s electronics will not allow a change to fourth and top gear until you hit the maximum revolutions, which means that if you keep pedal to metal, you can hit up to 145kph before it shifts to top gear.

However, if you lift off on the accelerator, the transmission control unit (TCU), sensing that you no longer need the additional power, will allow the gearbox to shift up to the next highest gear.
I find the acceleration pull acceptable – not the fastest kid off the block, but fast enough for the Joe Average who never drives fast anyway, be it in a BMW or a Kancil – as long as you remember to floor it.

The resultant engine roar is somewhat higher than usual, but that is better than it being gutless.
A light foot on the throttle will allow the Exora to ‘ease’ upwards in speed, until approximately 100kph, after which you might have to apply a little more pressure on the foot pedal to make it go up in speed.
For the driver who just wants to get from A to B, and doesn’t normally drive fast, the Exora would be fine.
Top speed is in the region of 160kph, but only if you are going downhill. Once you hit top speed, any slight incline will make the needle start to fall backwards, and if the slope continues, the TCU may even make the gearbox downshift a gear or two.

A shift lock in top gear at around 110 upwards might be a help to prevent undesired downshifts. Under the current settings, the shift lock only occurs at speeds over 145kph.
Fuel economy is reasonable, and considering the Exora’s bulk and weight, I would volunteer that it is actually remarkable, our test car returning 21.53 miles per gallon, or 13 litres per 100km, over a test distance that covered 350km of mixed driving at high speeds, with five people and luggage on board.

A light-footed driver could expect something in the region of 10 to 11 litres per 100km.
I believe that the Exora is all right as it is; perhaps a small change in the final drive ratio might be useful in improving the get-up-and-go, and help in reducing the frequent downshifts; the same result could come from a lower profile tyre.
There’s talk about a small turbo-charger running low boost to be fitted later on. That will be interesting indeed!

SOURCE: THE SUN ONLINE

2008-12-28T08:13:00.000+08:00

New Land Rovers do Penang

Posted by: Anthony Lim

Land Rover fans up in Penang, the new boys are coming your way. That's right - Sime Darby Auto Connexion is having a public test drive event this weekend of all the new LR models at Juru Auto City.

Land Rover enthusiasts in the north will have the opportunity to view and test-drive the multiple-award winning Freelander 2 TD4, the multi-talented Discovery 3 TDV6 and two variants of the head-turning Range Rover Sport, the 2.7l V6 turbodiesel and naturally-aspirated 4.4l V8 petrol.

The three-day Land Rover Carnival in Penang will be held at Lot 1688, Juru Auto City, in front of the Kentucky Fried Chicken outlet from 10am-6pm daily from Dec 19-21, so if you're into your LRs, this is where you'll want to be.

For more info on the new Land Rover Carnival in Penang, please call Auto ConneXion Voice at 1 800 88 3181 or 04-390 2595.

SOURCE: THE STAR ONLINE

Half-a-million $$$ baby

2008-11-26T21:00:00.000+08:00

Half-a-million $$$ baby
The new SLK 200 comes with 650 improvements to give it plenty of oomph and class
Y.S. Khong

The SLK 200 – for the person with everything.

THE Mercedes-Benz SLK 200 comes with a refreshed front and rear, and a total of 650 improvements, some of which are internal and mechanical.

Its main appeal is, of course, the electrically-actuated hardtop roof that takes less than half a minute to disappear into the rear boot at the touch of a button – always a sight to behold.

The front-end has taken some design hints from the flagship SLR, in the form of a new bumper that carries a larger air-dam and a more pronounced V-look.

A large three-pointed star sits in the middle of the front grille to make sure no one mistakes it for anything else but a Mercedes-Benz.

At the rear, there are now twin exhaust pipes and a diffuser, plus darkened tail lights. Exterior mirrors are larger to give a better rear view, and LED indicators are built into them.

Changes to the interior include a three-spoke steering wheel with multi-function buttons, and a new instrument cluster. Meters are analogue, and round with bezel surrounds to maintain the ‘sports car’ look.

Drivers now get a set of F1-type paddle shifters. Wood trim is available in two colours, and the interior colours now include ‘gull wing red’, inspired by the legendary SL300 gull wing model.

An iPod jack is standard, and a Linguatronic system allows voice control over the audio. A GPS navigation system is standard equipment.

Mechanical improvements to the 1.8-litre engine, which comes with a supercharger, give the SLK 200 an additional 21 horses to 184hp and 250Nm of torque, while fuel consumption has been reduced to 9.11 litre per 100km.

Drive is to the rear wheels, through 18-inch alloys.

Although mechanically the SLK 200 is much the same as the C200, a lighter body of some 1.3+ tons and different weight distribution means that driving dynamics is quite different.

There are three modes of driving – Manual, Sport or Comfort.

On the road, we find the SLK easy to drive, cruising around effortlessly without that ‘thoroughbred’ feeling, but responding to an exuberant driving style the moment foot is pressed to the pedal.

Response is instantaneous, and although its zero-to-100kph time is about 8.2 seconds (not the fastest kid on the block), it still gives a good account of itself if pushed. Driven in anger, it remains sure-footed and agile, and the ride is on the firm side of comfortable.

The four-wheel independent suspension has many aluminium parts that help to reduce unsprung weight and improve driving dynamics. Also built-in is ESP (electronic stability programme), ABS, EBD and BA.

The SLK 200 is designed as a roadster, and this version is the entry level model for its range. Other engine options include a 3.0-litre, 3.5-litre and the top-of-the-range AMG at a humongous 5.0-litre.

The SLK 200 is not an out-and-out racer, being designed more as an elegant roadster for weekend drives with the top down and the wind in one’s hair.

But then, there is nothing to stop you from using it daily, mindful of the fact that it is a strict two-seater.

At RM483,888, the SLK 200 is a good RM120,000+ more expensive than the E200, and over RM200k more than the C200, but well-worth the price for the person with everything.

source: http://www.thesundaily.com

TEST DRIVE A PEUGEOT

2008-10-20T08:09:00.001+08:00

Test drive a Peugeot this weekend

Posted by: Andy Mervin George

If watching the idiot box is not entertaining to you this weekend, perhaps the Blue Box will.

Nasim Sdn. Bhd. is inviting everyone to indulge in their latest offering, the Peugeot 407, in the Peugeot 407 Test Drive Me campaign happening this weekend 18 & 19 October 2008, in a whole day affair from 10am till 7pm at the Peugeot Blue Box Glenmarie and Peugeot Bangsar.

The campaign is meant for potential Peugeot owners to be up close and personal with the new Peugeot 407 sedan, where test drives of the car are available.

A mystery gift and refreshments await those who visit Peugeot Blue Box Glenmarie and Peugeot Bangsar this weekend. For more information on the event, contact Peugeot Careline at 1-800-88-6292.

SOURCE: http://star-motoring.com

2008-10-11T08:38:00.000+08:00

All's not glitter and gold at the Paris Motor Show

Posted by: Anthony Lim

Auto executives agree: their industry is headed into a giant storm.

The clouds of global economic turmoil cast a pall over the opening of the Paris Motor Show yesterday - although a staged display of thunder and blue lightning bolts provided a dramatic backdrop for the introduction of BMW AG's new 7 series.

General Motors Corp chief operating officer Fritz Henderson said the US hasn't seen such a slump in auto sales in two decades and predicted "chaos" if US lawmakers don't approve a US$700 billion financial bailout plan.

With a new Insight into things, Honda is hoping for better.

Ford Motor Co's CEO for Europe, John Fleming, said he is bracing for a difficult end to 2008 as declining housing markets and tightening credit take their toll.

And Carlos Ghosn, CEO of French carmaker Renault SA, said the global auto industry could remain in a funk for two years.

"We don't know if we are at the start of the end or the end of the start," he told reporters.

With rock music and clouds of dry ice, automakers unveiled smaller and more fuel-efficient cars to cater to consumers both cash-strapped and environmentally conscious. The new models are testimony that the industry is working to adapt to an era of expensive gas and mounting concerns about global warming.

Honda Motor Co unveiled a new five-door gasoline-electric hatchback to challenge rival Toyota Motor Corp's success with the hybrid Prius. Honda said its Insight would be cheaper than any other hybrid car on the market, to make the low-emission technology affordable for more consumers. The Japanese automaker aims to sell 200,000 of the cars each year, launching next spring in Japan, Europe and North America.

Renault showed off a revamped Megane compact hatchback. France's second-largest automaker, which is cutting 6,000 jobs to maintain profitability, hopes the car will make up for poor sales of the low-cost Laguna car.

Renault's new Megane Coupe.

And luxury car makers like Ferrari added their very own touch of glamour. The Italian automaker introduced its new California - a coupe-cabriolet with a retractable hard top - claiming that customers at the very top end of the market are immune for the moment.

"What is affecting Ferrari customers is not the financial times," CEO Amedeo Felisa said in an interview with The Associated Press.

The displays covered the entire range: fast to slow, luxury to economy. Renault displayed a Formula One racer. Peugeot showed a speedster for the Le Mans Series. Mercedes unveiled its latest armored limousine for VIPs, described as "luxuriously spacious and superbly comfortable."

Underscoring the need for green, some models had the amount of carbon dioxide they emit pasted in large numbers down their sides.

The two-week show opens to the public this Sat after two press days.

Citigroup expects 2008 to be the first year of volume declines since 2001 for the global car industry, and last month it lowered its outlook for this year and next after double-digit declines in new car registrations in western Europe, the US, and Japan.

Overall US auto sales plunged last month, dropping below one million for the first time in more than 15 years as some consumers struggled to get car loans and others stayed away from showrooms amid bank failures and Wall Street turmoil.

And the recession-proof Ferrari California.

Sales at every major US and foreign brand fell at least 24%from the previous year, with the exception of GM, which said it sold 16% fewer vehicles, helped by its month-long offer of employee pricing for all buyers.

GM's Henderson said the company can't rule out the need for more restructuring if the economic crisis worsens and said it was "extraordinarily important" that US lawmakers pass a financial bailout to shore up confidence.

France's car market has held up, thanks to government incentives to buyers of green vehicles. The French car manufacturer's association said on Wed that new car registrations rose 8.4% in Sept from a year earlier.

Last year, France introduced rebates and surcharges to encourage sales of more environmentally friendly vehicles. Under the system, dubbed "bonus-malus," car buyers can take money off the purchase price depending on how much CO2 the vehicle emits.

Larger rebates are awarded for cars meeting stricter emissions criteria, from 200 euros (US$287) all the way up to 5,000 euros (US$7,175) for electric vehicles putting out less than 60 grams of CO2 per km.

"The French market is resisting well for the moment. I hope it will continue," Renault's Ghosn said. - AP

SOURCE: http://star-motoring.com

NIK AZIZ

2008-09-20T06:49:00.001+08:00

NIK AZIZ: ISA is wrong in Islam

KOTA BARU: Menteri Besar Datuk Nik Aziz Nik Mat said yesterday he hoped that Parti Keadilan Rakyat adviser Da-tuk Seri Anwar Ibrahim would not be detained under the Internal Security Act.

"I hope he will not face it as the public has been condemning the use of the ISA. Even a minister was willing to step down to protest it. I hope that in the spirit of Ramadan, this will not happen."

The Pas spiritual leader said this after meeting Terengganu Pas commissioner Datuk Mus-tafa Ali yesterday.

Nik Aziz said the government should consider the wishes of the public, especially with the resignation of de facto law minister Datuk Zaid Ibra-him, who spoke out against recent ISA arrests.

"The ISA does not give the accused a chance to defend himself. This is wrong as in Islam, the accused is allowed to defend himself."
Meanwhile, the meeting yesterday was believed to be an effort to mend fences bet-ween the two over Mustafa's statement criticising Pakatan Rakyat for giving false hope to its supporters on the purported Sept 16 takeover of the government.

Nik Aziz, who was upset by the statement, had criticised Mustafa in the party's organ, Harakah.

SOURCE: http://www.nst.com.my

HOW TO SELL USED COMPUTERS

2008-09-14T06:36:00.002+08:00

How to Sell Used Computers

Autor: Lesley Lyon

Used computers are bought by either students who do not have good savings or earnings or they are bought by educational institutions like the schools and universities. Some parents buy used computers for their children just for browsing the Internet and to play games.

For this purpose, a used computer is more than sufficient than spending huge amounts on a new computer. These target segments however require used computers in a good working condition as well as for a lesser price.

Most of the used computers are sold in the online market, as it attracts all sorts of buyers. There are many numbers of online classifieds or auctions or online dealers who sell used computers. Selling used computers are a better option than throwing them as trash or keeping them in a corner occupying space and collecting dust.

The first and important step is to improve the appearance of the used computer by wiping it clean free of dust and dirt. Any buyer would get impressed by the way the computer looks, looks make the first impression. The selling price of a clean used computer is always better than the one, which is full of dirt and dust.

All the software manual, operating system and other supporting discs that came with the computer should be in tact. This will add more value, when selling the used computer and also will make the buyer consider the person who is selling the used computer as a trusted seller.

The most important thing to do before selling a used computer is to erase all the personal details or information from the hard disk or drive. Instead of just putting them in the trash folder it is very important to purge all the personal data from the computer’s memory, even invisible backup files can cause danger.

A tech savvy person’s help can be got if the seller does not know how to do it. If not done it may lead to accessing the bank accounts, or emails by any unknown person leading to identity theft. For that when there is a remedy.

Unused scanners, printers can also be bundled with the sale of the used computer. A buyer may sometime value it. The benefits or features of the computer can be highlighted for better sales.

Source: Free Articles

IN THE WARS, BUT THEY GET THE GANG

2008-09-08T05:54:00.001+08:00

September 05, 2008 Categories: News

Subang Jaya police crippled a house break-in gang with the arrest of three Sabahans after a high speed chase in Serdang on Thursday.

Police moved in on the suspects at about 4.30am after a week-long surveillance of the area.

Selangor police chief Datuk Khalid Abu Bakar said a police patrol car was badly damaged in the incident after it was hit by the suspect’s Proton Iswara, causing it to skid and ram into a road barrier. He said the suspects had just broken into an apartment in Vista Perdana in Bukit Serdang. They stole the victim’s Perodua Myvi and were driving away when stopped by police.

They, however, sped off causing police to give chase.

The Proton Iswara skidded after hitting the police car in the 15-minute chase. Police seized house and car break-in paraphernalia in the vehicle.

The driver of the Myvi, however, escaped. The car was later found abandoned along a road in Kajang.

Two of the suspects worked as security guards at an apartment block in Serdang while the third was unemployed. One of the suspects, a 23-year-old, was also said to have criminal record for dadah and house break-in cases.

Khalid said the gang which has been active since early this year was responsible for more than 10 cases reported in Subang Jaya district.

SOURCE: http://www.mmail.com.my

BMW'S ELECTRIC MINI TEST

2008-08-31T07:57:00.001+08:00

BMW’s electric Mini test

BMW is planning to test a fleet of several hundred Mini cars with zero-emission electric drive soon, the car maker announced.

BMW’s CEO Norbert Reithofer said, in Munich, this would help gather more know-how on how "mobility can be efficiently ensured with vehicles running only on electric-drive".

The Minis, built in Oxford, England, would be shipped to the BMW plant in Munich where they would be modified for electric drive.

The tests would be conducted in the next 12 to 18 months with details of the drive concept and marketing to be announced by late 2008, said a BMW press statement.

Several car makers are also planning to mass-produce electric-drive vehicles.

BMW’s main rival Mercedes has announced it will offer an electric-drive SMART in 2010 while Volkswagen is planning an electric version of its concept car Up!

According to reports, General Motors is already working on presenting a production-ready version of the Chevy Volt next month. – dpa

HONDA

2008-08-27T16:18:00.001+08:00

Honda's July global output jumps on demand for Fit

TOKYO (AP) - Honda reported that its global production in July jumped 17.7 percent to 342,152 vehicles, a record for that month, highlighting the Japanese automaker's solid growth amid serious trouble at American rivals.

While soaring gas prices have hurt the world's auto industry, Honda's global sales have grown, led by the Fit subcompact, which was the best-selling car in Japan in July for the ninth month in a row.

Mazda Motor Corp. also reported robust global production for July - up 25.5 percent to 126,025 vehicles.

The Hiroshima-based partner of U.S. automaker Ford Motor Co. credited healthy demand for Mazda2, sold as the Demio in Japan, and Mazda6, or Atenza in Japan, for the production increase.

Honda Motor Co., the country's second-biggest automaker, produces more autos overseas than at home. Output abroad shot up 19.3 percent to 229,996 vehicles, while domestic production rose 14.5 percent to 112,156, the first rise in 11 months.

Behind the growth was record production in North America and Asia in July, it said.

July's total output was shy of Honda's monthly production record of 363,532 vehicles last October.

All the world's automakers are struggling to shift their product offerings from the more profitable but gas-guzzling trucks and sport utility vehicles to smaller models.

Honda's exports declined in July for the third straight month at 56,415 vehicles, down 6.9 percent from a year ago.

Despite a falling dollar that hurts the earnings of global Japanese exporters, Honda reported a record 179.6 billion yen (US$1.68 billion) profit for a fiscal first quarter.

U.S. auto sales slumped to a 16-year low in July as automakers failed to keep up with consumers' growing demand for smaller, more fuel-efficient vehicles.

American sales at Ford, General Motors Corp. and even Toyota Motor Corp. are falling by double-digits.

Honda had reported U.S. sales increases in the last few months as consumers flocked to its fuel-efficient cars.

But Honda's sales fell 2 percent in July, as a 22 percent drop in truck and SUV sales dragged on a 14 percent surge in Honda's car sales.

SOURCE: http://thestar.com.my

MITSUBISHI LANCER

2008-08-24T20:13:00.002+08:00

Friday, August 22, 2008

Mitsubishi's new Lancer Evolution arrives

Posted by: Anthony Lim

Mitsubishi Motors Malaysia unveiled its tenth-generation Lancer Evolution yesterday, a relatively short 10 months after it made its Japanese debut.

Well, space was a premium at the launch, let's just say ...

Interestingly, the car is not tagged as the Evolution X here, instead only being called the Lancer Evolution. Supposedly, the X suffix has been dropped from overseas markets to present a different image for the vehicle. Oh well, whatever works ...

Some quick facts about the already familiar-shaped AWD vehicle. The 4B11 2.0l four-cylinder twin-cam, twin scroll turbocharged pot on this one features 291bhp (276bhp for the JDM unit at point of introduction), and 366Nm of torque. The grand news is that there is no speed limiter on this one, so expect this one to be a whole load of fun.

MMM is not offering the vehicle in its five-speed, close ratio manual option form, so the only drivetrain type is the Twin Clutch SST six-speed automated manual transmission, which puts odd (1st, 3rd, 5th) and even (2nd, 4th and 6th) gears on separate input shafts, each with its own clutch.

The system allows the driver to choose between Autoshift fully automatic shifting and Manual Shift, where the driver can change gears as with a manual transmission. A toggle switch located at the base of the shift selector allows the driver to choose between Normal, Sport and Super Sport modes for the optimum shift scheduling.

So here's a better, cleaner and clearer take on things.

For electronic aids, there's S-AWC (Super All Wheel Control), an advanced vehicle dynamics control system which integrates the management of the ACD (Active Centre Differential), AYC (Active Yaw Control), ASC (Active Stability Control) and Sport ABS component systems.

While continuing on the MacPherson strut front and multi-link rear suspension arrangement used on previous models in the series, this one features a revamped suspension layout with wider tracks.

The factory-fit equipment list includes Bilstein single tube shock absorbers and Eibach coil springs, as seen on the Evo IX MR. It also includes Brembo two-piece ventilated disc brakes, lighter by 1.3kg per piece over standard Brembo discs, and 18-inch BBS lightweight alloy wheels.

Other standard issue items include a 7-Airbag System (driver and front passenger SRS airbags, side and curtain airbags and driver knee airbag), ELR seatbelt with pretensioner and force limiter and HID headlamps with AFS (Adaptive Front Lighting System).

And ditto for the interior as well.

To complete the premium offering, the new Evolution also comes with Recaro full bucket front seats, multi-mode information display, genuine leather-wrapped three-spoke steering wheel with mounted audio controls and cruise control buttons and a nine-speaker Rockford Fosgate Premium Sound System. Other functional features include a keyless operating system and sunroof.

MMM is aiming to sell 50 units of the type till the end of the year; so far, there have been 30 bookings for the car.

The new Lancer Evolution is priced at RM315,436 (on the road, without insurance), and the car comes with a one-year or 20,000km warranty. Three colours are available, these being Red Metallic, Phantom Black Pearl and White Solid.

source: http://star-motoring.com

BLOG

2008-08-13T07:45:00.001+08:00

By GABEY GOH August 12, 2008 Categories: Blogspot

THE digital divide is getting smaller as more and more senior citizens take that first tentative step into the world wide web, to explore, express and learn.

Surveys have revealed that senior citizens aged 65 and above make up the fastest growing age group online, but as the number of users grows, the amount of content to cater for them remains a step or two behind.

This is where people such as Lily Fu, a 60-year-old grandmother of four, come in. She launched her blog, SeniorsAloud (seniorsaloud.blogspot.com) in May with one goal in mind.

"I wanted to provide senior citizens with an avenue to network online and share their life experiences. We believe in active ageing, and in living our golden years with passion and purpose," writes the part-time university tutor and English Language trainer who also has a professional blog (peakspeak.blogspot.com).

With a host of guest bloggers, topics relevant to the elderly are frenetically discussed to give the senior citizens a voice on the web.

When did you start using the internet?

I was first introduced to the Internet in 1994 when I was visiting my daughter in Canada. One night, I saw her emailing and chatting with her university friends online. I was amazed. What a great way to keep in touch – so much faster than by conventional mail, and far cheaper than paying for long distance calls.

Soon after, I bought my first desktop. As a high school teacher then, I was interested in using the Internet to supplement my English classes. I started a chat-room on IRC for my students in 1996. I believe we were among the early schools with an online presence. I’m quite proud of that.

How did you start to blog?

When I first read about blogging in 1999, I was keen on starting a blog for those over 50 years of age, being in that age group myself. I wrote to a newspaper about it, hoping to get positive feedback. My letter was published but there was no response at all! I guess most seniors in those days were not internet-savvy yet. Now, almost 10 years on, I believe the time is right to start a blog for seniors.

In 2007, a friend, Samuel Goh (motivationinmotion.blogspot.com), who was already a blogger, invited me to an Internet marketing seminar. I started a blog in order to apply what I had learned. SeniorsAloud is my second blog and the first article was posted on May 10, 2008, just three months ago. So it’s quite new, but the response this time around is much more encouraging. As the word gets out, I’m sure the blog will receive even more visitors.

What were your reasons?

It’s a known fact that many countries, including Malaysia, are seeing an ageing population. The average life span has increased. For males and females, it’s 73 and 76 respectively. In 2007, according to statistics from the National Population and Family Development Board (LPPKN), the elderly, or those who have touched 60, make up seven per cent of the population. There are issues concerning the elderly that need to be addressed, like health care, financial management, and housing.

There are also more seniors now with access to the internet and thus a blog would be a great avenue to reach out to these seniors, while also encouraging those who are apprehensive about the internet to take the first baby steps into this whole new realm. It literally opens up a new world, and even those seniors who are homebound can still have an active social and intellectual life via the internet.

On a personal level, I know of retirees who have difficulty adjusting to a life without a 9-5 job. They feel a tremendous loss of self-esteem. Some have lost their spouse and feel lonely and depressed.

SeniorsAloud is intended to be a community-based blog where seniors and retirees can network and share their rich life experiences. It is also a channel for them to speak out on issues that affect them, whether it is the lack of elderly-friendly public facilities, or the discrimination leveled at them. It takes a senior to understand another senior and provide moral support for one another.

What have you achieved through blogging?

The blog is only three months old, so it’s still too early to talk about achievements. But to date, the feedback has been very encouraging. "Inspiring" is the word visitors often used after reading the posts. One visitor in her 30s wrote in an email that the post about "Grandparenting – A Pleasure or Pressure?" helped her to better understand her parents.

Any regrets?

I’ve always wanted to give something back to society. SeniorsAloud is the perfect vehicle for me to accomplish this. I can blog at home and still keep an eye on my grandchildren and my elderly mother. And the best thing is that it’s free! So there’s absolutely nothing to regret. Of course, blogging can be quite time-consuming, but I enjoy the challenge of keeping the blog current.

Has blogging changed your life?

I now carry my camera everywhere I go. I’ve learned to be bold in approaching people and telling them about my blog. You can say blogging has given me new confidence and a new direction in life. Through it, I’ve been fortunate to connect with many seniors who have been most supportive in contributing to the blog content.

The "Blogosphere". What does it mean to you?

The Blogosphere adds a whole new dimension to information gathering – almost anything and everything under the sun probably has been the subject of a blog.

That said, one of the challenges of the internet, including blogs, is to sift through all the information out there – sometimes there is an information overload. Nonetheless, it’s always better to have too many options than none at all!

Favourite blogger?

I’ve got several bookmarked under "Favourites", so I won’t commit to singling out any particular one. It’d be like asking me who is my absolute favourite among all my grandchildren. I love them all.

If there were someone you could influence to blog. who would they be?

Definitely all those above 50! This is the fastest growing age group on the Internet, but certainly not in Malaysia. I still meet a lot of seniors who say they are too old to pick up computer skills, or they are simply not interested. Blogging is fun, mentally stimulating and who knows, it may help ward off Alzheimer’s!

When I’m in my 80s or 90s, provided I don’t have arthritis in my fingers, I intend to carry on blogging. I’ll take blogging anytime over knitting in a rocking chair!

SOURCE: http://www.mmail.com.my

MONITOR AND MANAGE SEARCH ENGINE

2008-08-12T12:29:00.002+08:00

How To Monitor And Manage Search Engine Results

Autor: mfleischner

Keeping track of where your website ranks on Google for important keywords and keyword phrases can be a full time job. Although many tools exist for monitoring search engine position, properly evaluating SEO performance requires a disciplined approach.There are a variety of ways to measure search engine rankings for your website.

Popular website tools like SEO Elite and Web CEO include search engine ranking tools that can track where your site ranks for identified keywords. But what if you don’t own SEO software?To evaluate search engine rankings, you simply need a means of measuring rankings on a regular basis.

Follow these simple guidelines:Create and maintain a spreadsheet of your rankings. Having a document that you continually update can help you see weekly changes as well as trends over time. Be sure to keep it updated at least once a week so that you are always aware of how you rank for keywords and keyword phrases you are watching.

You can choose your keyword list based on the keyword phrases you’ve selected as important, those your competitors rank well for, or individual phrases identified by SEO software. If you want to get a jump start, you can identify which keyword phrases your site is ranked for in the top 20 on Google using SEOdigger.com.

This tool provides a listing of which keyword phrases your site ranks within the top 20 Google search results for and can be a great tool to identify your competitor’s keyword rankings.Record changes in search engine result placements simply by entering each keyword term in to Google or using SEO software.

You can also find free tools online to report your rankings like CleverStat or GoogleRankings.com.Continue to make changes, build links, and record your results. This step will never be completed but rather is an ongoing process. You should strive to become number one on all your SERPs and get so far ahead that none of your competitors will be able to compete.

This requires constant and never ending consideration to building links and creating more and more reasons for other sites to link to you.Consider reciprocal linking, link acquisition, as well as adding free tools to your website, valuable content, and helpful downloads. Access to these tools is ideal if you want to attract links to your website.

Once you’ve added these valuable tools, make sure to let others know that they exist. Consider a free press release, email campaign or promotion.Expand your keyword list. As you improve your overall rankings on major search engines, consider adding other keywords phrases that may be relevant to your website, products or services. Focusing on an expanded keyword list can result in more traffic and broader appeal.

Monitoring and managing your search engine rankings, especially on Google is necessary if you wish to increase the organic traffic to your website. This begins with basic monitoring and evaluation of your rankings on key search engines. Once you’ve developed your spreadsheet, update your rankings each week with free tools or SEO software.

Continue to focus on your rankings and developing inbound links through free tools and resources on your site as well as proactive link requests. Over time, as you improve your rakings for key terms and phrases, expand your list. Improving your rankings is a never ending process, but an important one. Stay the course and you’ll experience the results you’re looking for.

Source: Free Articles

DOWNLOAD MP3 AL-QURAN

2008-08-10T20:13:00.001+08:00

Al-Quran Recitation by Syeikh Sa'ad Sa'id Al-Ghamidi

All audio files are compiled in Mp3 format so that you can easily download them directly to your Mp3 players.

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Name of Surah
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1
Al-Fatihah ( The Opening )
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2
Al-Baqarah ( The Cow )
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3
Al-Imran ( The Family of Imran )
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4
An-Nisa ( The Women )
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5
Al-Maidah ( The Table spread with Food )
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6
Al-An'am ( The Cattle )
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7
Al-A'raf (The Heights )
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8
Al-Anfal ( The Spoils of War )
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9
At-Taubah ( The Repentance )
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10
Yunus ( Jonah )
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11
Hud ( Hud )
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12
Yusuf (Joseph )
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13
Ar-Ra'd ( The Thunder )
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14
Ibrahim ( Abraham )
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15
Al-Hijr ( The Rocky Tract )
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16
An-Nahl ( The Bees )
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17
Al-Isra ( The Night Journey )
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18
Al-Kahf ( The Cave )
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19
Maryam ( Mary )
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20
Toha
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21
Al-Anbiya ( The Prophets )
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22
Al-Hajj ( The Pilgrimage )
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23
Al-Mu'minun ( The Believers )
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24
An-Noor ( The Light )
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25
Al-Furqan (The Criterion )
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26
Ash-Shu'ara ( The Poets )
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27
An-Naml (The Ants )
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28
Al-Qasas ( The Stories )
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29
Al-Ankabut ( The Spider )
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30
Ar-Room ( The Romans )
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31
Luqman
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32
As-Sajdah ( The Prostration )
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33
Al-Ahzab ( The Combined Forces )
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34
Saba ( Sheba )
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35
Fatir ( The Orignator )
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36
Yaa-sin
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37
As-Shoffat ( Those Ranges in Ranks )
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38
Shod ( The Letter Sad )
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39
Az-Zumar ( The Groups )
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40
Ghafir ( The Forgiver God )
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41
Fusshilat ( Explained in Detail )
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42
Ash-Shura (Consultation )
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43
Az-Zukhruf ( The Gold Adornment )
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44
Ad-Dukhan ( The Smoke )
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45
Al-Jathiya ( Crouching )
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46
Al-Ahqaf ( The Curved Sand-hills )
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47
Muhammad (Prophet Muhammad p.b.u.h)
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48
Al-Fath ( The Victory )
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49
Al-Hujurat ( The Dwellings )
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50
Qaf ( The Letter Qaf )
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51
Adh-Dzariyat ( The Wind that Scatter )
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52
At-Tur ( The Mount )
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53
An-Najm ( The Star )
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54
Al-Qamar ( The Moon )
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55
Ar-Rahman ( The Most Graciouse )
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56
Al-Waqi'ah ( The Event )
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57
Al-Hadid ( The Iron )
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58
Al-Mujadilah ( She That Disputeth )
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59
Al-Hasyr ( The Gathering )
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60
Al-Mumtahanah ( The Woman to be examined )
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61
As-Shoff ( The Row )
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62
Al-Jumu'ah ( Friday )
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63
Al-Munafiqun ( The Hypocrites )
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64
At-Taghabun ( Mutual Loss & Gain )
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65
At-Thalaq ( The Divorce )
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66
At-Tahrim ( The Prohibition )
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67
Al-Mulk ( Dominion )
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68
Al-Qalam ( The Pen )
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69
Al-Haaqqah ( The Inevitable )
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70
Al-Ma'arij (The Ways of Ascent )
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71
Nuh (Prophet Nuh a.s)
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72
Al-Jin ( The Jin )
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73
Al-Muzzammil (The One wrapped in Garments)
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74
Al-Muddaththir ( The One Enveloped )
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75
Al-Qiyamah ( The Resurrection )
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76
Al-Insan ( Man )
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77
Al-Mursalat ( Those sent forth )
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78
An-Naba' ( The Great News )
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79
An-Nazi'at ( Those who Pull Out )
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80
Abasa ( He frowned )
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81
At-Takwir ( The Overthrowing )
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82
Al-Infitar ( The Cleaving )
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83
Al-Mutaffifin (Those Who Deal in Fraud)
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84
Al-Inshiqaq (The Splitting Asunder)
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85
Al-Buruj ( The Big Stars )
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86
At-Thoriq ( The Night-Comer )
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87
Al-A'la ( The Most High )
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88
Al-Ghashiya ( The Overwhelming )
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89
Al-Fajr ( The Dawn )
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90
Al-Balad ( The City )
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91
Ash-Syams ( The Sun )
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92
Al-Lail ( The Night )
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93
Ad-Dhuha ( The Forenoon )
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94
Asy-Syarh ( The Opening Forth)
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95
At-Tin ( The Fig )
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96
Al-'Alaq ( The Clot )
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97
Al-Qadr ( The Night of Decree )
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98
Al-Bayyinah ( The Clear Evidence )
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99
Az-Zalzalah ( The Earthquake )
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100
Al-'Adiyat ( Those That Run )
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101
Al-Qari'ah ( The Striking Hour )
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102
At-Takathur ( The piling Up )
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103
Al-Asr ( The Time )
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104
Al-Humazah ( The Slanderer )
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105
Al-Fil ( The Elephant )
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106
Quraish (The tribe of Quraish)
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107
Al-Ma'un ( Small Kindnesses )
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108
Al-Kauthar ( A River in Paradise)
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109
Al-Kafirun ( The Disbelievers )
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110
An-Nasr ( The Help )
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111
Al-Masad ( The Palm Fibre )
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112
Al-Ikhlas ( Sincerity )
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113
Al-Falaq ( The Daybreak )
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114
An-Nas ( Mankind )
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ARTICLES SOURCE: http://ceramahislam.com

ON-CALL ALLOWANCE RAISED TO OVERTIME RATE

2008-08-10T15:51:00.002+08:00

Sunday August 10, 2008

Government docs want on-call allowance raised to overtime rate

By DEVID RAJAH and AUDREY EDWARDS

PETALING JAYA: Government doctors certainly have a lot to complain about, and they’re mostly to do with the much better perks offered by the private sector.

But this time, they are griping about their counterparts who do overtime at government health clinics. And it’s all about a vast discrepancy in the on-call allowance and overtime rate.

Doctors at government hospitals get a RM10 hourly on-call allowance, while those at government health clinics get RM80 for every hour’s overtime.

The hospital doctors say they have to attend to life threatening and emergency cases at casualty units, while the clinic doctors mostly only attend to patients complaining about coughs and colds.

Doctors at government hospitals have to perform on-call duty several times a month, and have called on the Health Ministry to standardise the payment rates.

“The RM10 hourly allowance for on-call doctors is grossly unfair,” said a senior doctor at a government hospital in the Klang Valley.

The doctor revealed that eight to 16 doctors were rostered for on-call duty in most large government hospitals.

”On the other hand, our counterparts at the health clinics are being paid RM80 hourly for treating patients with coughs and flu,” he said.

Other doctors, who spoke on condition of anonymity, said they preferred to serve at government health clinics which have extended operating hours to 9.30pm on weekdays, and from 8am to noon on Saturdays.

“We don’t have to work long hours and the workload is also not that heavy at health clinics,” said one doctor.

A 29-year-old doctor from Malacca said that with the current inflationary pressure, young doctors could hardly survive, especially if they were married with children.

The ministry reviewed the on-call allowance after two decades in 2005.

For weekdays, the on-call allowance was increased from RM75 to RM150 per day (calculated at the compulsory 15 hours of on-call duty which has to be performed daily), while such allowance on weekends was increased from RM113 to RM170.

The ministry started the overtime scheme at 16 government health clinics earlier this year for doctors who volunteered to work from 5pm to 9pm.

This means that a health clinic doctor who volunteers to work the four-hour period will earn RM320, compared with RM150 for a hospital doctor's 15 hours' work.

A specialist doctor cautioned that young doctors may be discouraged from serving in government hospitals if this issue was not resolved.

Health Minister Datuk Liow Tiong Lai explained that “overtime” and “on-call” were different, likening them to an apple and orange situation.

“Being on call is something that all government doctors have to do while working overtime is voluntary. You cannot compare working overtime with being on call,” he clarified.

He said the ministry was not considering raising the on-call rate but pledged to work on improving benefits for doctors to retain more of them in the public sector.

articles source: http://www.thestar.com.my

CHIKUNGUNYA OUTBREAK

2008-08-09T12:35:00.001+08:00

2008/08/09

Johor district worst hit by chikungunya outbreak

By : Syed Umar Ariff

Fang Yun Huat helps his neighbour, M.K. Thangathimuthu, to demonstrate the weakness in his hand after the infection believed to be caused by Chikungunya fever.

TANGKAK: About three weeks ago, Umamaniam Muthusamy had a high fever.

Saraswathy Govinda, Thangathimuthu wife, has similar problems.

Other than headaches, the 49-year-old tuition teacher also suffered from severe joint pains, especially on her arms and hands. These are symptoms of the chikungunya fever.

"It was awful. I couldn't even do the simplest household chores, such as mopping or scrubbing the floor," she said at her house in Jalan Sawmill here yesterday.

"It hurt so much that I could not bend to scrub the floor or even grip the mop."

Umamaniam sought treatment at the Tangkak Hospital, where she was put on saline drips and prescribed some pills for her headache.
She was not hospitalised. Three days later, Umamaniam's fever subsided, but the joint pains have lingered.

"Although I am feeling much better, the joint pains won't go away," she said, adding that her uncle, M.K. Thangathimuthu, 70, and aunt Saraswathy Govinda, 60, who lived nearby, also suffered from the same symptoms.

Umamaniam asked her neighbours whether they had suffered from chikungunya fever.

To her surprise, she discovered that at least one person in every household in her area was down with the symptoms.

"There are about 200 families in this area and you can say that at least one in every family has had high fever."

Tangkak is in the Ledang district, a district in Johor believed to be the worst hit by chikungunya fever.

The New Straits Times reported yesterday that the country was on high alert for chikungunya following outbreaks in Johor, Perak, Negri Sembilan and Malacca.

Umamaniam's neighbour, Fang Yun Huat, 47, said his father, Fang Wai Chee, died three weeks ago after suffering red rashes, high fever and severe joint pains early last month. He was 83.

"Initially, we rushed him to the local hospital, where he was also put on saline drips and given antibiotics.

"We returned home the same day and, to my relief, my father said he felt better."

However, two days later, Wai Chee fell ill again and was later admitted to a specialist centre in Ayer Keroh.

"He died four days from the day he was warded. The doctor did not mention the name of the fever, but said it was new in the country and was carried by mosquitoes."

Meanwhile, Thangathimuthu suspects that swiftlets' nests in buildings near his home might have contributed to the spread of the fever.

"I learnt that several open water retainers were placed in the nests for the birds to bathe and drink.

"I don't think the water is changed often and I believe this place has become a breeding ground for mosquitoes."

ARTICLES SOURCE: http://www.nst.com.my

PERMATANG PAUH BY ELECTION

2008-08-06T15:05:00.002+08:00

Wednesday August 6, 2008 MYT 2:59:48 PM

Permatang Pauh by-election on Aug 26 (updated)

By MAZWIN NIK ANIS

PUTRAJAYA: The Election Commission has set Aug 16 for nomination and Aug 26 for polls for the Permatang Pauh by-election.

The seat fell vacant on July 31 after PKR president Datuk Seri Wan Azizah Wan Ismail resigned as Permatang Pauh MP to make way for her husband Datuk Seri Anwar Ibrahim to contest in the by-election.

In a statement issued after the Election Commission sat for a two-hour meeting Wednesday, its chairman Tan Sri Abdul Rashid Abdul Rahman said the commission was informed of the vacancy in the Permatang Pauh parliamentary seat by the Dewan Rakyat Speaker on Aug 1.

He said the commission was fully prepared for the by-election, to be held five months after the March 8 general election, and named the Seberang Prai Tengah district officer Roslan Yahaya as returning officer.

“The nomination day will be held on Aug 16 and polling will take place on Aug 26 if there is to be any contest.

“I would like to emphasise that throughout the by-election period, it is extremely important for all parties to adhere to orders and advice of security personnel responsible in maintaining peace and order.

“Members of political parties, candidates, party workers and other individuals involved must ensure that they respect and adhere to the election laws and campaign ethics.

“All parties are also reminded that there are several petition cases from the previous election which are still ongoing. Hence, candidates are reminded not to touch issues involving these cases during their campaigns,” Rashid said.

An Election Commission (EC) officer holding up the statement on the nomination and casting date for the Permatang Pauh Parliament seat by-election in Putrajaya.

As of July 31, a total of 58,459 voters are eligible to cast their votes in the Permatang Pauh by-election. From the total, 57,969 are regular voters and 490 are postal voters.

Scores of media personnel were left disappointed when the usually media-friendly Rashid refused to hold a press conference Wednesday.

After about two-hours of waiting, the EC public relations officer Sabri Said came down to the lobby where pressmen were waiting to distribute the statement.

When asked why the chairman did not want to meet the press, Sabri said: “What Tan Sri (Rashid) wants to say is all in the statement.”

When contacted by The Star later, EC secretary Datuk Kamaruzaman Mohd Noor said transparent ballot boxes would be used in the by-election but no decision had been made on the use of the indelible ink, despite calls by PKR for its use.

“If they want the ink to be used in the Permatang Pauh by-election, then they should write officially to the commission,” Kamaruzaman said.

On whether voters would find it difficult to cast their votes as polling fell on a working day, the EC secretary said this should not be the case as previous experiences proved that voters had turned up to exercise their rights even on a working day.

“We will also ensure minimal disruption and the 25 schools to be used as polling stations will only be closed for a day.

“We will secure the premises a day before polling when school session is over and will re-open the very next day after the by-election,” he said.

articles source: http://thestar.com.my

TOUCH THERAPY

2008-08-05T17:58:00.002+08:00

Thursday July 31, 2008

Touch therapy

By WONG LI ZA

Infant massage can help in baby’s growth and well-being.

A MASSAGE is usually what a mother needs after a long day of looking after her children.

Datuk Dr Zulkifli Ismail, consultant paediatrician and former president of the Malaysian Paediatric Association, demonstrating the Touch Infant Massage technique for a baby’s leg, which includes bringing the knees up to the body.

However, studies from as far back as 1997 show that massaging babies not only relaxes the child but also has physical and psychosocial benefits.

There are many medical practitioners who think more in-depth research needs to be done to substantiate this.

However, Datuk Dr Zulkifli Ismail, consultant paediatrician and former president of the Malaysian Paediatric Association, said a gentle massage revitalises any individual and it works the same for babies.

“Massages can help a baby increase his body weight, strengthen his resistance and help build self-confidence,” said Dr Zulkifli, who adopts massage techniques advocated by the Touch Research Institute (TRI).

Among the techniques in the Touch Infant Massage set of techniques are (from top pic) the chest, back, hand, and leg massage.

The TRI was established in 1992 by Dr Tiffany Field, a pioneer of modern massage research, at the University of Miami’s School of Medicine via a start-up grant from Johnson & Johnson.

Dr Zulkifli added that studies have also shown that massage reduces the intensity and duration of colic in babies.

“In children with sleep problems, massages help them fall asleep faster and they have fewer night wakings,” said Dr Zulkifli, who specialises in paediatric cardiology.

Johnson’s Baby recently launched its Touch Infant Massage Workshop Series in Petaling Jaya, which saw the first workshop conducted involving about 200 mothers and nurses.

These workshops, to be held in seven states from July to October, will involve demonstrations of proper infant and baby massage techniques by qualified trainers.

A 2007 AC Nielsen survey on 300 Malaysian mothers with babies aged up to 36 months showed that the incidence of infant massage increased from 48% in 2003 to 56% in 2007.

However, Stanford Guo, marketing director of Johnson & Johnson Sdn Bhd, said there is still a large number of mothers who do not practise it.

“Physiological and psychiatric studies have shown that infant massage or touch therapy can trigger notable changes that help infants attain growth and development in several positive ways,” said Guo at the launch.

Another study conducted in Hospital Universiti Kebangsaan Malaysia between 2000 and 2001 on 72 babies showed that moderate touch on skin leads to better food absorption and also relieves stress, thus improving immune function.

These findings are consistent with clinical studies presented in 1997 at the American Academy of Paediatrics (AAP) annual meeting. The studies found that touch therapy also helps premature newborns gain weight faster, asthmatic children improve their breathing function and diabetic children comply with treatment.

In 1997, researchers at TRI also found improved motor development in premature newborns and cocaine-exposed infants, specifically in terms of habituation (decrease in responsiveness upon repeated exposure to a stimulus), orientation and motor and sensory development.

The top three benefits of massaging babies, Dr Zulkifli said, are weight gain, bonding between parent and child, and better psychosocial development of the child.

“Infant massage is about empowering parents with the knowledge to care for the child,” said Dr Zulkifli, who also encourages fathers to perform the massage.

The complete Touch Infant Massage advocated by Johnson’s Baby consists of a set of techniques performed on the baby’s head and face, chest, stomach, back, hands and legs. Throughout the massage, it is important to maintain eye contact, and sing or talk to the baby.

“The use of baby oil is optional,” said Dr Zulkifli. “For older babies, you can use slightly more pressure on the stomach to reduce wind.

“Remember to keep the room warm and also rub your hands to warm them up. Be relaxed when you do the massage and don’t do it when you are in a rush as your baby can sense how you feel through your touch and expression,” he said.

The Touch Infant Massage workshops will be held in Ipoh on Aug 2, Penang on Aug 3, Seremban on Aug 9, Johor Baru on Aug 10, Petaling Jaya on Aug 17 and Temerloh on Oct 11. For enquiries or registration, call 1-300-88-0566 on weekdays from 9am to 5pm.

ARTICLES SOURCE: http://thestar.com.my

HYGIENE SURVEY

2008-08-03T08:53:00.001+08:00

Home hygiene survey
Tan Teong Li

THE Hygiene Council, a global initiative supported by Dettol, recently revealed the following results in the annual Dettol Global Hygiene Survey.

The survey is based on interviews conducted with over 10,000 people from 10 countries about hygiene practices in the home and community.

• 70% of swabs and samples taken in Malaysia were highly contaminated. The dirtiest items were cloths – 100% were heavily contaminated.

• Malaysian homes had the most heavily contaminated sites (70%), with Indian homes coming in second (57%) and German homes (6%) being the least contaminated.

• Most Malaysians (47%) agree that hand washing is the most effective way to prevent the spread of germs. However, 31% said they spend less than 20 seconds in the process.

• Most Malaysians (71%) believe that the rubbish bin posed the highest risk of transmitting germs to family members.

According to the survey, which included 1,000 Malaysians, more people agreed that hand washing is the most effective way to prevent the spread of germs (47%), followed by disinfecting surfaces (29%), keeping animals out of homes (12%), avoiding kissing (7%) and disinfecting laundry (2%).

A large majority (80%) said that their children wash their hands before eating. However, when asked how long they spent doing it, 34% said five seconds and another 34% said 10 seconds.

Asian Hygiene Council chairman Dr Christopher Lee said: "The optimum time for washing hands is 20 seconds.

"Washing hands is the most inexpensive, simple and highly effective method for significantly preventing the spread of diseases."

The kitchen cloth is universally one of the most contaminated items in the home. Some 89% of kitchen cloths across the world have unsatisfactory levels of bacteria and 78% are heavily contaminated (it is 100% in Malaysia).

This means that when cleaning up, bacteria will be spread all over the kitchen – the opposite effect of cleaning.

Overall, Malaysia had the most contaminated homes in the study, followed by India.

Malaysia had the dirtiest bathroom taps, with 95% failing the standard and 75% being found to be heavily contaminated. Detailed results showed high levels of E. coli (on 50% samples).

"Greater emphasis needs to be placed on using simple, effective hygiene habits such as proper and regular hand washing and surface disinfection," said Catherine Tantoco, marketing director of Reckitt Benckiser (Malaysia and Singapore), the manufacturers of Dettol.

"The public should use disinfectant on frequently touched surfaces such as light switches, door handles, bins and toys.

"Dettol is committed to promoting good hygiene practices in the community not just through the quality of its products but also through public education initiatives.

"As a brand, we continue to be trusted by doctors and mothers because we are scientifically proven to kill germs and prevent the spread of infection," she added.

The work of the Asian Hygiene Council is supported by Dettol through an educational grant.

ARTICLES SOURCE: http://www.sun2surf.com

RECIPES

2008-08-01T01:04:00.003+08:00

Masak lemak cekur ikan keli

Ingredients1/2kg catfish (ikan keli), barbecued

To be ground:

10 cili padi
3 shallots
2 garlic
500ml fresh coconut milk
5 pieces daun cekor,
cleaned and sliced thinly
1 piece asam jawa
Salt to taste

Method

1. Put coconut milk into a medium-sized pot, add the ground ingredients, and mix well. Cook over medium fire.

2. Add the barbecued catfish, cook till the gravy begins to boil. Stir constantly.

3. Add salt, asam keping and daun cekur into the gravy, and cook over slow fire for another 10 minutes. Stir constantly.4. When the gravy thickens, it is ready to be served.

- Recipe contributed by Suriyati Paijo

NOTE: YOU CAN GIVE ME A FOOD RESIPES AT MY COMMENT OR E-MAIL AT NAZA_KKM@YAHOO.COM .... TQ

TRAVEL INSURANCE

2008-07-30T08:25:00.001+08:00

5 Key Benefits Of Travel Insurance

by Gary Zivkovich

The travel insurance is most essential for the business travelers group as well as normal citizens.

The insurance company as well as travel agencies also provides the coverage while you are on travel for either longer time or for the shorter travel plan. Based on your needs, the insurance company as well as travel agencies provides the better option to the travelers those feet to their needs.

There are various types of benefits offered by the insurance companies or travel agencies.

1. The travel insurance companies offer maximum coverage to the insured person to gives more benefits incase of accident or any types of illness.

2. The travel insurance provider provides deductibles based on your needs. It is based on the types of policy terms.

3. Some travel insurance agencies gives deductibles or co-payment against the some percentage cover under the medical expenses. It is based on the individual companies to decide the term or percentage of co-payment.

4. The travel insurance does not pay if they suspect the misuse of drugs or involvement in the narcotics activities.

5. The insurance company provides the coverage incase of mobilization of ill or injured person based on your needs. The transportation cost will cover under the medical expenses. Same way the insurance company also gives the discharge cost from the hospitals of the insured person.

It is up to you to select the plan based on your needs. It is most important to select the proper plan according to the risk associated with you.

articles source: http://www.goarticles.com

CHIKUNGUNYA

2008-07-28T07:52:00.002+08:00

Introduction

What is Chikungunya?

Chikungunya fever is a viral disease transmitted to humans by the bite of an infected mosquito.

Signs and Symptoms

The incubation period of chikungunya fever is usually 3-7 days. The symptoms are very similar to that of dengue, but unlike dengue, hemorrhagic or shock syndrome does not take place with chikungunya fever.

The infected person may experience the following symptoms:

fever
chills
headache
fatigue
nausea
vomiting
muscle pain
rash
joint pain.

[Top]

Treatment

There are currently no medications or vaccines for the treatment of chikungunya fever. However lots of rest, a nutritious diet, plenty of fluids and mild pain medications may relieve symptoms of fever and body aches. If you experience any of the symptoms mentioned above, you are advised to see a doctor immediately.

Prevention

Tips when travelling:

Use insect repellent on exposed skin surfaces when outdoors, especially during the day.
Wear long-sleeved shirts and long pants when outdoors.
Where possible, stay in accommodations that have secure screens on windows or air-conditioning to keep the mosquitoes out.

However if you still develop a fever, see a doctor immediately to test your blood for any signs of the chikungunya virus. If your blood test shows positive signs of the virus, stay indoors to limit mosquito bites in order to avoid further spread of the infection.

At home, the prevention of chikungunya fever is similar to that of dengue fever. Clear any stagnant water in flower vases, flower pots, roof gutters and watering cans to prevent the breeding of its carrier, the Aedes mosquito

ARTICLES SOURCE: http://www.myhealth.gov.my

AFFILIATE MARKETING

2008-07-24T09:34:00.001+08:00

Affiliate Marketing Tips to success

by Jossef S

How to work at home with affiliate programs? And succeed with the best niche affiliate programs. Niche affiliate marketing is the easy, fast way to make money on the internet, and give you the ultimate honest home based business opportunity.

Affiliate marketing is the best opportunity to make money on the internet, at the same time it is the best marketing strategy for any one with a product. Affiliates have the chance to make money fast without developing any products, without investing thousand of dollars on researches and testing; they can look for any product they want to promote. Merchants and companies have the opportunity to market their products with effective pay on sale marketing.

How to succeed with affiliate marketing?

There are three must do, must understand actions:

1) Change your job mentality, affiliate marketing is not -in any way- other job; affiliate marketing is a business. Business need investment of time and money to build, work and improve, you are the BOSS you need to figure out what to do? And how to do it?
In my humble opinion I think this is the major reason why beginners fail to have any kind of success in this field; this with the hundreds of lies and scams out there. They join affiliate programs and money making opportunities thinking they will make money only doing 1-2-3 steps, if it was that easy believe me no company will build affiliate programs "why to give you their money".

2) Knowledge and creativity: you must have answers to where? When? How? And why? Questions. You have to learn almost every thing about your business, what is new what work and develop your own creative and unique strategies. In affiliate marketing you need to be a leader not only success in your own but leading your team each to his success. You will begin as part of the team but you will reach a point to have your own follower team.

3) Patient; you are entering a huge market with thousands of competitors. You are better than most of the successful marketers on the net. I know a lot of them and I know that you are better than most of them. There is always a place for one more, and with niche affiliate marketing there is a place for every one.

It took me more than two years to receive my first check, I lift this business three times and always returned, this is the perfect business for me I have to do what ever it takes to make it work, and you know it pays well.

Affiliate marketing is a good business any one can have, can succeed and get rich with it; it is the only way for guys like you and me to get rich. Affiliate marketing is the only business that every one in it, are equal, no special talents, no special knowledge.
Have you seen the movie "kung-fu panda", did you understand the secret. In affiliate marketing and making money on-line the secret is the same "there is no secret", the only thing you need to have in mined is "If it is to be, it is up to me".

acticles source: http://www.goarticles.com

ELECTRICAL SAFETY

2008-07-18T11:45:00.001+08:00

Free electrical safety tips

by Sir Sparks

One of the most common concerns of our customers is the safety of their electrical installation; almost everyone is understandably wary of something they can neither see, smell nor hear, yet is capable of killing or setting fire in an instant. There are a few basic do it yourself safety rules that will help you reduce the risks, we would like to deal with a few of the more simply detectable ones in this article.

Current National Electrical code, or NEC, requires the use of GFCI protection on receptacles and other equipment in certain wet locations such as bathrooms, swimming pools and yards, These areas are mainly where the presence of water will greatly increase the risk and severity of electrical shock, this GFCI protection will eliminate almost all fatalities and is a critical safety measure. Make sure at least once a month that your device protection works. This is the simple action of pressing a Test button to see if the receptacle or circuit breaker automatically disconnects, if it does it is working correctly, and you can simply reset it.

Another important safety measure is the regular inspection of extension cords, a damaged cord can be a significant risk of both electrical shock and fire, yet a quick visual inspection for cuts or chaffing to the cord will eliminate most of the risk. Never use electrical tape to make temporary repairs, if it is damaged simply throw it away, the extra few dollars spent could easily save your, or a loved ones life.

A common practice in most homes is the use of multiple outlet extension cords; often tucked away behind stereo equipment or TV's, this modern entertainment equipment requires a lot of power which can easily overheat these multiple outlets, even worse they are in a hidden location often with very poor ventilation increasing the risk of fire drastically. Visually check behind the back of your entertainment equipment, if it looks like spaghetti then you need extra receptacles added, both for safety and convenience.

An over zealous electrical do-it-yourselfer is probably one of the greatest risks of all, and yet is possibly the most difficult to detect. Whereas a poor carpentry or other trade job is easily recognized, behind the wall or in attic wiring mistakes often go unnoticed by the homeowner, yet is serious potential fire risk, even worse a fire starting in a location not visible until it's too late.

The only sure way to protect against this last risk is by contacting a professional licensed electrical contractor to check out your wiring, some of these professionals will even make a basic safety check free of charge. Other important yet simple things they should check on are;

Tightness of all terminations in electrical panels. Inspection for signs of overheating in panels. Correct identification of circuits Compliance with National Electrical Code. Correct polarity and grounding of receptacles Correct operation of Arc Fault Devices. Correct Service entrance wiring and grounding.

If you are not the first owner of your home, or it is an older home the risks are much greater. both for deteriorated wiring and previous do-it-yourself work. Even with a new home remember that during our recent housing boom a County/City Electrical Inspector often had a busy schedule, and could only make the briefest of inspections.

articles source: http://www.goarticles.com

HOME RECYCLING

2008-07-15T17:57:00.003+08:00

5 tips to help with home recycling

by: David Lynes - Loans4

The issue of recycling has been an important one for some years, but recently, with councils resorting to fortnightly collections in a bid to encourage recycling, this is an issue that has been receiving increased attention across the country. Councils are doing what they can to encourage recycling by providing recycle bins to households to make this task easier, and the government has pledged to increase the number of recycling bins in public areas to also encourage this activity.

We can all do our bit for the environment, help to reduce landfill site waste, and help others by recycling many of the items in our home – not just rubbish but all sorts of items. And once you get the hang of recycling you will find that it is an easy, effective, and useful way to do your bit for the environment.

1. Learn more about what can be recycled. Many people just think about things like cans or bottles when they think about recycling, but you can actually recycle pretty much anything. This includes textiles, rubber, building, materials, carton and cardboard, and more. Before you automatically throw something into to rubbish for collection think carefully about whether you could actually recycle the item in some way.

2. Familiarize yourself with the recycling bins in the area. There are different recycle bins for different things, such as some for bottles and cans, some for textiles, etc. The government has also promised to increase the number of recycling bins in public areas. In the meantime, it is a good idea to try and familiarise yourself with where the bins are in your area so that you know where to go to recycle your items.

3. Make use of the council recycle bin. Local authorities have issued many households with recycle bins now so there is no excuse for not being able to recycle. Make use of this facility and recycle as much as you can – with a bin on your doorstep there is not additional hassle involved and you could really help the environment in the long term.

4. Make sure that you use the right recycle bins for the right products. It can be encouraging to also use the recycle bins in public areas, as this will encourage others to do the same if they see you and others recycling their waste. However, do make sure that you use the recycle bins appropriately and don’t just stick all of your items into one recycle bin, as they are separate depending on the type of product that you are recycling.

5. Save on fuel and emissions. Wherever possible, if you have to drive to take your recycled waste to a public recycle bin area try and drop your recycling whilst on your way somewhere rather than making a special trip. This will save any additional pollution from driving and will save you petrol. Better still, if the recycling area is not far then take a stroll up there!

articles source: http://www.articlecity.com

WRITING ARTICLES

2008-07-10T21:21:00.002+08:00

Writing Articles For Affiliate Programs

by: Nick Kaplan

Why write articles

Writing articles can make your affiliate pages unique and drive more traffic from the major search engines, resulting in more sales. In some instances the merchant's affiliate program may not provide you with more than a banner and a few text links.

If your traffic levels are low than this will not do much to drive traffic to your affiliate links. If the merchant does provide you with content then this can be viewed by search engines as duplicate material depending on how many affiliates are promoting the same product with that content.

Beginning Your Article First begin by reading all the information on the merchant's site about the affiliate program, if you are not already familiar with the product.

It is very important that you learn what it is that you are offering to your customers such as,product features,capabilities,limitations and specifications. Many merchants will include these details with the description.

Researching your article Use one of the many free or paid keyword suggestion tools to build your list of niche keywords. Google Adwords, Digitalpoint and CBtrends all have really useful keyword tools which are free. Experimenting will help you discover search trends. Testing these keywords in major search engine will give you a sense market saturation and competition.

Include Keywords In your Article When writing for search engines your article should be keyword rich. Include long tail keyword phrases in your article title and subcategories. Product specific keyword phrases will help drive targeted traffic from search engines to your specific niche.

What to include in your article Creating an outline will help you organize your article and supporting subcategories sequence. Including descriptive keywords such as, size, color and dimensions in your article will further help drive targeted visitors to your site. Helping your visitors solve a problem When promoting affiliate programs through article writing, bring attention to product features that will help your visitors resolve a problem. Use examples and illustrations of how these features can be applied in real life situations.

If your product is easy to use, then bring attention to why you believe it is better than similar products. Ways to emphasize product features Use bullet points, numbering or italics when writing articles to emphasize and bring attention to helpful product features. Free content Articles provide free instant content for ezines,newsletters and website publishers. This free content is used to optimize and attract free search engine traffic.

Submitting to article directories There are countless popular free article directories, where your can submit your article for publication. Arcanaweb publishes a list of many popular directories. These directories allow anyone to reprint the article as long as the resource box is included at the end of the article. Read and follow the guidelines before submitting your articles Do not include affiliate links in your article or resource box.

This may cause your article to be rejected by the directory. Do not plagiarize another writers material. Resource box and backlinks Writing articles can increase the number of one way links or backlinks to your site.

Included at the end of every article is a resource box,where you can include a brief bio and link back to your site. Free article directories Free article directories will allow you submit content but you are not paid for your article. Goarticles,Isnare and Articledashboard are among some of the large high traffic free article repositories. Article distribution and submission services Article distribution services will submit your article for a fee to article directories,ezines,newsletters,article email groups, social bookmarking and article announcement sites.

Article submission software Article submission software such as Artemis Lite and Article Submitter 2.2 are free and may expedite the process once your are registered. You will need to do a manual submission for sites using an access code. Paid article directories These directories will pay you for writing articles or reviews. Compensation may be in the form of revenue share or per word.

Paid to write reviews In addition to getting paid for writing articles, reviews can be another avenue to earn extra income. Review rates can range anywhere from $2.00 to $200.00. Reviewme, Reviewstream, Softwarejudge and Epinions are just a few of the popular paid to review sites that can put extra cash in your pocket.

You can also earn money with your clickbank id at Reviewsarena for up to 60 days. Paid to blog Writing blogs are yet another alternative for earning extra income. Payperpost and Smorty are blog sites that pay weekly and compensation may range anywhere from $5 to $100.

In some cases, you may be able to negotiate a price with the advertiser. In conclusion Do your research before writing an article,use targeted keywords on affiliate product landing pages. Submit to high ranking article directories to increase the number of quality backlinks. Check site stats for increase traffic levels.

Test and improve your writing skills by reading writing tutorials and ebooks. Learn from mistakes and continue writing articles.

ARTICLES SOURCE: http://www.articlecity.com

PROMOTE YOUR BUSINESS

2008-07-07T13:06:00.002+08:00

Tips For Writing Article to Promote Your Business

By Thanakit K.

Promoting any business through writing articles has become a really powerful and an effective tool, there are many website actually each of the successful websites are planning article writing to promote their business online.

There are certain tips that should be kept in mind once you have decided to write an article to promote your business. These tips are:

1) Don't advertise through them: the articles that you write to generate links and traffic should not be written in a way that they seem to give an impression of being advertisement. People search for articles not advertisements, make them interesting but not marketing or advertisements so that they give information and don't simply market your product.

2) SEO writing is one way that can attract a lot of traffic on your website, this type of writing is simply identifying a keyword that is searched by lot of people and if it relates your theme, or the theme of your business then write an article by the optimum use of such keyword and make the best use of it. This will automatically place your site on a good rank in the search engines thus giving you more hits and generate a good traffic.

3) Readers should get interested in your articles more and more, they are mostly bothered about themselves so giving them the best information and best idea for what they are searching is very important so be sure to give them these required things and guarantee a good response.

4) Articles writing should also be done on a regular basis (Easy to read and Easy to understand). Make your article interesting (It's very important), there are many ways to do it, you can tell a story, and even quotes from famous people that would enhance your article quality and you would be able to utilize the best of the space available.

5) Device a strong theme for your article and stick you it, readers would be more interested in your articles if you use a strong theme. A strong theme attracts attention and this would give you the desired traffic and good customer response too.

6) Set the tone of your article right and also be friendly with the reader it creates lot of customer attention and even awareness. The tone is what set the pulse of an article and would give you the best feed from people and customer response.

7) The best articles are the ones that provide the reader with the best possible advice and give him or her hints as to where he can go for help.

8) If you cannot give proper advice then stick to telling a story, at times it helps in improving the quality and customer response.

9) Whenever you give any advice try to keep it short and simple.

Article writing is a methodical task and proper methods will lead you to success proper ways needs to be followed so that you get the best out of every possible article attract the customer and get good links and visitors for your site.

ARTICLES SOURCE: http://www.goarticles.com

TIPS FOR AVOIDING SPAM

2008-07-05T20:58:00.000+08:00

Tips for avoiding spam

by Wayne Dunne

Spam is an ongoing problem for all internet users. But by changing your behavior online you can reduce your exposure to spammers and thus help reduce the amount of spam messages that you receive.

The tips in this post can help prevent more spam from reaching you.

Tip #1 - Do not click on the Unsubscribe link on HTML based spam

Clicking on the link will only confirm to the spammer that your email address is active. Trying to unsubscribe in this circumstance will only lead to even greater amounts of spam.

Tip #2 - Do not publish your email address on your website

As a rule of thumb, do not do this. Spammers regularly harvest websites for email addresses knowing that these accounts will be active. If you wish to provide a way for visitors to your website to contact you then do it using a contact form.

Tip #3 - Do not open attachments from people that you do not know

Opening attachments from senders that you do not recognise is giving the sender an opportunity to take control of your system, do not do this. Even if when you do know the sender do not open it unless you are expecting an attachment from them. A virus could have infected their system and be trying to replicate. If you are unsure always delete first and then contact the sender. If the attachment was valid they can always resend it.

Tip #4 - Do not load images in HTML emails

Spammers can use images within HTML to confirm that your email address is active. These images load from a remote server which alerts the spammer to the fact that you have viewed them.

Tip #5 - Report spam offenders

When you receive spam report the sender using a services like spamcop, by doing this you can aid others in preventing spam.

Tip #6 - Do not use your main email address for email lists

If you need to sign up for email lists then sign up to these lists using an account from a free provider such as yahoo or gmail.

Tip #7 - Do not allow companies to share your information with third parties

When you sign up for a product or services online be sure to uncheck any boxes during sign up that gives permission for the company to share your information with third parties.

Tip #8 - Do not list your email address in online directories

When on websites with options such as to list your contact details in an online directory you should always decline.

Tip #9 - Do not click on any links in spam emails

When you receive a spam message containing a link to a website do not click on the link. By clicking the link you are telling that spammer that your account is active and the consequence will be more spam being sent to you.

Tip #10 - Avoid using a common firstname as an email address

Many spammers try to brute force valid account names on a mail server. They will simply try to send mail to hundreds of different combinations of address at your domain in an effort to figure out valid addresses. Examples of this would be to try sending emails to john@yourdomain.com , ann@yourdomain.com , bob@yourdomain.com , xzy@yourdomain.com to see if any of them are successful. If an email to ann@yourdomain.com is successful then the spammer will know that he has hit a valid account and will use it in the future to send spam messages to this account.

Tip #11 - Use temporary or throwaway accounts

Sign up for free email accounts that will allow you to redirect mail. Set up an account with the free provider and redirect it to your own account. Any emails sent to this account will now come in to your main account. Once the spam levels on your temporary account get too high then simply turn off the redirection of mail and if at all possible close the account and go get yourself a fresh account following the same guidelines. Each time the temporary account becomes a target of too much spam for your liking, drop it and start with a fresh account.Use the temporary account for untrusted communications such as sign up forms on websites or any place else you deem appropriate.

articles source: http://www.goarticles.com

AFFILIATE MARKETING

2008-07-01T10:32:00.001+08:00

For Success With Affiliate Marketing Choose the Correct Affiliate Site Topic

by Jude Wright

Many people slap up a website, add a bunch of banners and think that they are going to make a ton of money. Sorry...not true. It takes a lot more than some pretty banners and minimal content to make a website profitable. To make money with affiliate marketing, you first need to make sure that you are choosing the correct affiliate programs and topics. If most people really paid attention, they would realize that they chose a program simply because it pays more than others. This high pay will not mean much if they cannot sell the program to make money.

For example, if you have a website a blog setup it is always good practice to put up affiliate links that have something to do with what your site is about. It is not very likely that you will get buyers from your links if you put up banners about high heels on a video game website. You need to choose the right topics because you want to target certain people.

Even offline, big companies make their money by trying to target the sex and age group of the people they think will be more likely to buy the product. For those high heel banner ads, you will get someone to buy from your affiliate if your website is about women's shoes or overall fashion.

It can be tempting to throw up off topic links if you have a site that gets many visitors but by choosing the correct topic, you are showing these affiliate links to a certain target group. These visitors are on your site because of the topic, the title and what your website is about. They want to look at and read what you have to offer. They won't pay much attention to advertising that has nothing to do with them.

Targeted advertising does not do much in more recent times because people have become almost blind to them. They have learned to look past the flashing banners to quickly find the information that they are seeking. If there is nothing of interest, they will hit the back button and continue on their search.

Another reason to choose the correct topic is so that you are advertising something that you understand. Due to the fact that you should be choosing ads that complement your website; you should know what the product is about. If you have created a site solely to get people to buy, you want to know what you are talking about. Choosing a product that you have never used or even heard of can be difficult when you can't give your visitors information about it because you don't know or understand the topic.

So, if you want to make a "real" business from an affiliate website, choose a topic that you know something about. Everyone has some passion or hobby that he or she just loves to talk about. Build your website around YOUR own interests. You'll be better able to recommend appropriate affiliate programs to match that interest...and you'll be less likely to be bored working on your website.

articles source: http://www.goarticles.com

STAY HEALTHY

2008-06-27T10:13:00.005+08:00

How You Can Stay Healthy and Avoid Practically Any Disease

by Daniel Brown

I hear so many people say they don't want to live to be old. In fact, I was talking to my 45 year-old friend just the other day. She said she only wants to live to be 75. I told when she's 74, she might change her mind.

Her fear is (as is most people's), that getting old results in getting sick. But, I'm here to tell you, it doesn't have to be that way! Many of the diseases that are prevalent today are man-made. In other words, they're largely due to modern lifestyle habits such as:

Consistently subjecting oneself to stress Consistently eating high fat foods â€¢Consistently eating a diet low in nutrients Neglecting exercise Exposing oneself toenvironmental toxin

I'm going to make a statement that's gonna sound rather narrow minded, but I truly believe it... Nothing on the earth is more valuable than your health! Not your career, not your money, and not even your family!

I know what you may be thinking... "Nothing is more important to me than my family!"

Let me explain it this way; if you lose your health, your family is gonna suffer with you. Surely, you don't want that! So, if you truly value your family, then you should put a priority on your health and well-being.

Now, there are three areas that will help us live long and healthy, and give us a better chance of avoiding degenerative diseases...

1. Balanced nutrition

A lot of the food we eat in today's world is over-processed with various chemicals and preservatives added to improve taste and increase shelf life. All this processing leads to nutritional deficiencies in our bodies.

Obviously, we should eat balanced meals and provide them for our families on a regular basis. But unfortunately, it can be rather difficult with all the demands that are placed on us day in and day out. That's why it's so important to include natural health supplements in our daily diets!

2. Physical activity

It's a well-known fact that exercise significantly lowers our chances of developing potentially fatal illnesses. One of the ways it does this is by eliminating stress.

So many of us are stressed beyond comprehension. We're so busy running around trying to get things done, we don't even realize how stressed we really are!

It's unfortunate that many of us don't even realize what stress is doing to our bodies! I don't want to go into it here, but it certainly is bad news! Just know that remaining active throughout your life will help you stay healthy and disability-free as you age.

3. Healthy lifestyle

Today's world is much more toxic than it use to be, and it seems to be getting worse! These toxins that we're constantly exposed to cause cellular damage. Therefore, making a deliberate effort to avoid excess food additives, second-hand smoke, and stress, to name just a few, will give us a fighting chance to preserve our health.

Conclusion

Making an effort to live a healthy lifestyle is critical! My 45 year old friend doesn't understand that - she's a smoker with no desire to quit. What does she expect? To live to be a healthy 75 year old, with hopes of just dropping dead in order to avoid sicknesses associated with old age? Well, if she doesn't make any effort, she may not even make it to 75.

articles source: http://www.goarticles.com

QUIT SMOKING

2008-06-23T06:56:00.001+08:00

Quit Smoking Tips that Actually WORK!

by Allen Iser

When you're sifting through pages on the Net looking for some tips which are going to help you stave off your smoking cravings, you come across a lot of nonsense. I've sifted through all the nonsense and come up with a few powerful quit smoking tips which you can easily implement which will actually help. Have a look and see if these work for you:

Quit Smoking Tip #1: Cut Back on Cigarettes Gradually

If you're going through say a pack of cigarettes daily, don't make big leaps like cutting your smoking in half. Set a plan in motion to cut back GRADUALLY. Try cutting out 1 cigarette a day every 3-4 days. Load up all the cigarettes you will be smoking for the day in *1* pack and have that be your sole source of cigarettes for that day. As time goes by, you will be removing 1 cigarette from this pack at a time, if in the process of utilizing this technique you feel any discomfort, distract yourself by chewing some gum or drinking some coffee.

Quit Smoking Tip #2: Tell your Friends and Family of your Quit Smoking Plan

The more people you tell about how you're embarking on a journey to quit smoking the better. What will take place is the principle of accountability. When we feel accountable to someone to follow through with a plan of action, we are more likely to do it. The more you speak with enthusiasm and intent to those around you about your plans the more you will feel COMPELLED to follow through. When you take pride in your word being your bond and then follow through with this exercise, the accountability and responsibility factor will take affect on your psyche each time you feel the urge to cheat on your plan.

Quit Smoking Tip #3: Take it Day by Day and assess progress weekly

If you focus on quitting smoking for good, you will only overwhelm yourself. You must learn to small chunk things, try and improve little by little and set your main focus on seeing weekly progress. Every week, re-asses what you've done for the past 7 days. Have you cut back on the cigarettes you smoke each day? If you're using the above method of cutting out 1 cigarette every 3-4 days, you should be assessing whether or not you are smoking 2 less cigarettes a week.

If for any reason you did not follow through or see any progress, don't loose hope. The fact that you have a system in place and are taking affirmative action is proof enough you are moving in the right direction, it is a process. You may re-assess your plan and make for a more gradual cutback if you failed to see progress in the last week, just as long as the overall trend each week is a decrease in smoking activity.

These tips are extremely powerful, if implemented! It is not enough to read these and get a slight positive high over what you could potentially do. Take action starting NOW! Get out a pen and paper right now, yes now, and take 10 minutes to write down your own personal cutting back plan. Once you are finished, explain this plan to at least one other person, then set it in motion by getting out a cigarette pack and placing your daily allowance of cigarettes for the following day. Pack that away in your pocket and make that your ONLY source of cigarettes for the day. Get writing, there is no tomorrow, all there is, is the eternal NOW, get up and make this a reality!

articles source : http://www.goarticles.com

GOUT

2008-06-18T16:33:00.000+08:00

Stop the Gout by Eating the Right Food by Russ Anderson

You probably already know gout is caused by high levels of uric acid in the blood. However, did you know that four stages of gout exist and each stage has very unique characteristics of this painful infliction?

Stage #1: Higher levels of uric acid begin to form. This first stage is called Asymptomatic Hyperuricemia. In this stage, you will probably not feel any symptoms. Catching the gout at this stage is vital so you don't experience the pain of the gout.

Stage #2: The gout starts to harm the body. This second stage is called acute gouty arthritis or acute gout. This is the stage that jagged crystal-like formations begin to deposit themselves in joint spaces. This is also the stage when redness, pain and swelling occurs.

Stage #3: This stage is Intercritical gout. This is when an gout attack has subsided. This is the stage the body begins to stabilize itself and fights the uric acid crystals in the joints. Getting treatment is vital at this stage if the individual wants to control the gout.

Stage #4: This is the final stage of gout and it is called chronic gout. This stage can cause permanent damage to the joints and kidney, too.

Eating Right Can Stop the Gout.

If you don't want to take medication, due to possible and serious side effects, you have another alternative that can be better then medication - eating the right food.

Here is a brief list of foods that are high in purines and should be avoided since high purine food contributes to the gout. These foods include alcohol, seafood, beans, scallops, and sweetbread.

Now that you know a few of the foods to avoid here are few suggestions on what foods to eat. Here a brief list of foods that are low in purines and you should incorporate them into your diet. These foods include peanut butter, oatmeal, eggs, cereals, fruits and milk.

For example one fruit that has a proven track record in fighting gout pain is the tart cherry. Tart cherries have been proven by medical research universities to help fight gout pain. The benefit of the tart cherry is this little fruit is available is a variety of options including tart cherry juice and tart cherry capsules. Here is a brief overview of the different ways to fight gout with tart cherries:

" Cherry juice concentrate is a highly concentrate way to get the pain relieving property of the tart cherry. It takes approximately 100 cherries to make just one ounce of tart cherry juice. A reliable source for tart cherry juice concentrate is Traverse Bay Farms http://www.traversebayfarms.com

" Tart cherry capsules are made with tart cherry powder. The tart cherry powder is made using the freeze-dried process. The freeze dried process uses low heat and low temperature, thus maintaining 100% of the phytochemicals of the tart cherry. A good source of tart cherry capsules is Fruit Advantage http://www.fruitadvantage.com

Eating right and selecting low purine foods can help you to manage gout pain and enjoy a painful life.

ARTICLES SOURCE: www.goarticles.com

BLOG

2008-06-15T08:09:00.002+08:00

Create a Blog Like a Pro by Amy Brevard

Click Here!

Starting blog entries is easy as slicing butter on a hot, Nashville afternoon. If you’ve got something to say, or you have an area of expertise, or you want to blog for your company, or just for fun, here's how to do it like a pro:

Whether you are a web savvy individual who types at 300 words per minute, or a fresh web baby who still can't program his 1980s VCR, to Create a blog you begin by choosing a blog builder. If you are serious about making your mark online, you will want a professional looking blog. Ignore “free” blog builder offers. Here's why: Most free blog builders are not updated regularly, have more viruses, less flexibility, and less or no staff support. If you plan to continue your blog in the long-term, you may regret choosing a free blog host, down the line, for several reasons: Months into blogging, after your readership has blossomed, you may encounter growth problems, finding that your space is limited or what you want to achieve is unattainable. Switching to a different blog builder at that point could result in losing readers and thus, business. By investing (usually a minimal fee) in a high quality blog builder at the start of your blog, you get the latest technological updates and technical support throughout your blogging life.

However, if your intention is to write an amateur blog for you and your friends only, you may not care about a professional appearance. If so, a free blog such as the one provided on Myspace will suffice.

Once you find the blog builder that suits your vision, make it graphically attractive. TypePad is a blog builder that helps you explore design templates. Other blog websites (many free ones) require html knowledge, which may take hours to grasp if you are not already familiar with it.

Do not underestimate the importance of graphic design! Graphics are the first thing that readers notice when they view a web page. You want their impression to be good enough that they come back for more. After all, repeat visitors is your goal. They won't come back if the design hurts their eyes, induces unpleasant sensations, or is just plain boring. Rise to the top of blogs and make sure you entertain your visitors with both your words and graphics. Consider that you will impress your readers more if your design is professional and modern.

Be careful with the graphics you choose. Do they accurately reflect the personality you wish to convey? Every website and blog has a personality, made up of a combination of text and graphics. Make sure you are sending a consistent message, one personality, in everything you present. In addition to graphics and pictures, watch out for the font. Is both the size and style easy to read? Consider that some readers have weak eyesight. Is there enough space between the text and the graphics? Go with your intuition here, and compare your website to websites you admire.

After the design is set, the fun begins! Starting blogging. Remember that once you put your words out there, anyone can see them, for years to come. Keep this in mind. Investigate your blog optimization options. Just a few steps can take your blog from reaching a handful to a stadium-full. Finally, be persistent. If at first the readers don't come: try, try again.

ARTICLES SOURCE: www.goarticles.com

DIABETES

2008-06-11T09:47:00.004+08:00

What is Diabetes

What is Diabetes?

28 December 2006 Click Here!

Diabetes is a chronic disease that has no cure. Diabetes is a disease in which the body does not produce or properly use insulin, a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life. The cause of diabetes is a mystery, although both genetics and environment appear to play roles. There are two major types of diabetes:

Insulin-Dependent (type 1).

An autoimmune disease in which the body does not produce any insulin, most often occurring in children and young adults. People with type 1 diabetes must take daily insulin injections to stay alive.

Non-Insulin-Dependent (type 2).

A metabolic disorder resulting from the body's inability to make enough or properly use insulin, it is the most common form of the disease.

Who Is At Greater Risk For Type 1 Diabetes?

Siblings of people with type 1 diabetes.

Children of parents with type 1 diabetes.

Who Is At Greater Risk For Type 2 Diabetes?

People with a family history of diabetes.

People who are overweight.

People who do not exercise regularly.

Women who have had a baby that weighed more than 9 pounds at birth.

Warning Signs Of Diabetes

Type 1 Diabetes:

Frequent urination.

Unusual thirst.

Extreme hunger.

Unusual weight loss.

Extreme fatigue.

Irritability.

Type 2 Diabetes:
Any of the type 1 symptoms, plus...

Frequent infections.

Blurred vision.

Cuts/bruises that are slow to heal.

Tingling/numbness in the hands or feet.

Recurring skin, gum, or bladder infections.

Profile Of The Diagnosed

There are nearly 1.2 million people in Malaysia who have diabetes. Diabetes is actually a general term for a number of separate but related disorders. These disorders fall into two main categories:

type 1, which usually occurs during childhood or adolescence, and

type 2, the most common form of the disease, usually occurring after age 30.

What is type 1 (insulin-dependent) diabetes?

Type 1 (insulin-dependent) diabetes is a disease which results from the body's failure to produce insulin -- the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them.

This is most often the result of an autoimmune process in which the body's immune system attacks and destroys the insulin-producing cells of the pancreas. Since glucose cannot enter the cells, it builds up in the blood and the body's cells literally starve to death.

People with type 1 diabetes must take daily insulin injections and regularly monitor blood sugar levels.

There are an estimated 24,000 people with type 1 diabetes in Malaysia today.

The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood.

Peak incidence occurs during puberty, around 10 to 12 years old in girls and 12 to 14 years old in boys. The symptoms for type 1 diabetes can mimic the flu in children.

Type 1 diabetes tends to run in families. Brothers and sisters of children with insulin-dependent diabetes have about a 10% chance, or a 20-fold increased risk, of developing the disease.

The identical twin of a person with insulin-dependent (type 1) diabetes has at least 50 times the risk of developing type 1 diabetes than a child in an unaffected family.

In type 1 diabetes, incidence is highest among whites. Scandinavian countries have the highest incidence in the world, approximately 30 cases per 100,000 children.

What is type 2 (non-insulin-dependent) diabetes?

Type 2 (non-insulin-dependent) diabetes results from the body's inability to make enough or properly use insulin. Often type 2 diabetes can be controlled through diet and exercise alone, but sometimes these are not enough and either oral medications or insulin must be used.

The fact that few people with type 2 diabetes require insulin has led to the myth that this is a "mild" form of the disease.

Of the nearly 1.2 million Malaysians with diabetes, more than 98% have type 2 diabetes.

People with type 2 diabetes often develop the disease after age 30, but are not aware they have diabetes until treated for one of its serious complications.

The risk for type 2 diabetes increases with age.

Studies indicate that diabetes is generally under reported on death certificates, particularly in the cases of older persons with multiple chronic conditions such as heart disease and hypertension. Because of this, the toll of diabetes is believed to be much higher than officially reported.

Diabetes In Youth

How Are Young People Affected?

The risk of developing type 1 diabetes is higher than virtually all other severe chronic diseases of childhood.

Peak incidence occurs during puberty, around 10 to 12 years old in girls and 12 to 14 years old in boys.

Type 1 diabetes tends to run in families. Brothers and sisters of children with type 1 diabetes have about a 10 percent chance, or a 20-fold increased risk, of developing the disease.

The identical twin of a person with type 1 diabetes has at least 50 times the risk of developing type 1 diabetes than a child in an unaffected family.

In type 1 diabetes, incidence is highest among whites. Scandinavian countries have the highest incidence in the world, approximately 30 cases per 100,000 children.

The symptoms for type 1 diabetes can mimic the flu in children.

ARTICLES SOURCE :www.diabetes.org.my

2008-06-10T07:45:00.000+08:00

Cardiovascular diseases

What are cardiovascular diseases?

Cardiovascular diseases include coronary heart disease (heart attacks), cerebrovascular disease, raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure. The major causes of cardiovascular disease are tobacco use, physical inactivity, and an unhealthy diet.

Globally, cardiovascular diseases are the number one cause of death and is projected to remain so. An estimated 17.5 million people died from cardiovascular disease in 2005, representing 30 % of all global deaths. Of these deaths, 7.6 million were due to heart attacks and 5.7 million due to stroke. About 80% of these deaths occurred in low- and middle-income countries. If current trends are allowed to continue, by 2015 an estimated 20 million people will die from cardiovascular disease (mainly from heart attacks and strokes).

What causes heart attacks and strokes?

Heart attacks and strokes are mainly caused by a blockage that prevents blood from flowing to the heart or the brain. The most common cause is a build-up of fatty deposits on the inner walls of the blood vessels that supply the heart or brain. The blood vessels become narrower and less flexible, also known as atherosclerosis (or hardening of the arteries). The blood vessels are then more likely to become blocked by blood clots. When this happens, the blocked vessels cannot supply blood to the heart and brain, which then become damaged.

What are common symptoms of cardiovascular diseases?

Often, there are no symptoms of the underlying disease of the blood vessels. A heart attack or stroke may be the first warning of underlying disease.
Symptoms of a heart attack include: pain or discomfort in the centre of the chest; pain or discomfort in the arms, the left shoulder, elbows, jaw, or back. In addition the person may experience difficulty in breathing or shortness of breath; feeling sick or vomiting; feeling light-headed or faint; breaking into a cold sweat; and becoming pale.
Women are more likely to have shortness of breath, nausea, vomiting, and back or jaw pain.
The most common symptom of a stroke is sudden weakness of the face, arm, or leg, most often on one side of the body. Other symptoms include sudden onset of: numbness of the face, arm, or leg, especially on one side of the body; confusion, difficulty speaking or understanding speech; difficulty seeing with one or both eyes; difficulty walking, dizziness, loss of balance or coordination; severe headache with no known cause; and fainting or unconsciousness.
People experiencing these symptoms should seek medical care immediately.

Why does fat build up in blood vessels?

There are three main reasons for fatty build-up, all controllable:

Smoking and other tobacco use
Unhealthy diet; and
Physical inactivity.

An early form of fatty deposits, known as ''fatty streaks'', can even be found in some children younger than 10 years. These deposits get slowly worse as the person gets older.

Key messages to protect heart health:

Heart attacks and strokes are major - but preventable - killers worldwide.
Over 80% of cardiovascular disease deaths take place in low-and middle-income countries and occur almost equally in men and women. Cardiovascular risk of women is high particularly after menopause.
Tobacco use, an unhealthy diet, and physical inactivity increase the risk of heart attacks and strokes.
Cessation of tobacco use reduces the chance of a heart attack or stroke.
Engaging in physical activity for at least 30 minutes every day of the week will help to prevent heart attacks and strokes.
Eating at least five servings of fruit and vegetables a day, and limiting your salt intake to less than one teaspoon a day, also helps to prevent heart attacks and strokes.
High blood pressure has no symptoms, but can cause a sudden stroke or heart attack. Have your blood pressure checked regularly.
Diabetes increases the risk of heart attacks and stroke. If you have diabetes control your blood pressure and blood sugar to minimize your risk.
Being overweight increases the risk of heart attacks and strokes. To maintain an ideal body weight, take regular physical activity and eat a healthy diet.
Heart attacks and strokes can strike suddenly and can be fatal if assistance is not sought immediately.

ARTICLE SOURCE: www.who.int

HMFD

2008-06-10T07:22:00.001+08:00

INFORMATION ON HFMD

What is hand, foot, and mouth disease (HFMD)? Click Here!

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children caused by a virus. It most often occurs in children under 10 years old. It is characterized by fever, sores/ulcers in the mouth, and a rash with blisters. The blisters may appear in the mouth, palms of the hands and soles of the feet. The rashes may also appear on buttocks and on the legs and arms. The ulcers in the mouth usually appear on the tongue, the sides of the cheeks, gums or near the throat.

What causes HFMD?

The most common causes of Hand, Foot and Mouth disease are coxsackie virus A16, enterovirus 71 (EV71) and other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

When and where does HFMD occur?


	Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn (in temperate countries). In the recent past, major outbreaks of HFMD attributable to enterovirus EV71 have been reported in Malaysia in 1997 and in Taiwan in 1998. HFMD is endemic in Malaysia and occurs every year. In Sarawak, the number of cases of HFMD tends to increase from February to June.

Is HFMD serious?

HFMD caused by coxsackie virus A16 infection is a mild disease and nearly all patients recover within 7 to 10 days. Complications are uncommon. HFMD caused by Enterovirus EV71 may be associated with neurological complications such as aseptic meningitis and encephalitis. Cases of fatal encephalitis which occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998 were caused by EV71.

Is HFMD contagious?

Yes, HFMD is moderately contagious. A person is most contagious during the first week of the illness. The virus can be transmitted from person to person via direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. The virus may continue to be excreted in the stools of infected persons up till 1 month. HFMD is not transmitted to or from pets or other animals.

How soon will someone become ill after getting infected?

The usual period from infection to onset of symptoms (incubation period) is 3 to 7 days. Fever is often the first symptom of HFMD followed by blister/rash.

What are the clinical signs and symptoms?

HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters on the palms of the hand and the soles of the feet. A person with HFMD may have only the rash or the mouth ulcers.

Blister on the palms of the hand

Blister on the dorsum of the feet



*Blister then become ulcer*	*Blister on the soles of the feet*
*on the inner gums*

Source of pictures:
http://tray.dermatology.uiowa.edu/Coxsack01.htm
http://www.umm.edu/imagepages
http://www.whisperingpinesmedic.../pisphotogallery


	How is hand, foot and mouth disease diagnosed?

	Hand, foot and mouth disease is usually diagnosed based on a complete history and physical examination of your child. It is generally suspected on the appearance of blister-like rash on hands, feet and mouth in children with a mild febrile illness. Usually, the doctor can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat and/or blister swab collected preferably within 2 days of onset of HFMD may be sent to a laboratory to determine which enterovirus caused the illness.


	How is HFMD treated?

	Presently, there is no specific effective antivirul drugs and vaccine available for the treatment of HFMD. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. Dehydration is a concern because the mouth sores may make it difficult and painful for children to eat and drink. Should their affected children be having fever, the parents are advised to dress their children in light, thin clothing, to do tepid sponging with water (room temperature) as often as necessary, and to expose them under the fan. Taking enough liquids is very important apart from body temperature monitoring.


	Who is at risk for HFMD?

	HFMD occurs mainly in children under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different virus belonging to the enterovirus group.


	What are the risks to pregnant women exposed to children with HFMD?

	Because enteroviruses, including those causing HFMD, are very common, pregnant women are frequently exposed to the virus as well. As for any other adults, the risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children - the primary spreaders of enteroviruses. Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects. However, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected. Strict adherence to generally recommended good hygienic practices by the pregnant woman might help to decrease the risk of infection during pregnancy and around the time of delivery.


	BACK TO TOP

	INFORMATION FOR OPERATORS OF CHILDCARE CENTERS


	HMFD in childcare facilities

	HFMD outbreaks occurring in childcare facilities usually coincide with an increased number of cases in the community. Additional cases may occur since the virus may be excreted in the stools of infected person for weeks after the symptoms subsided.
	There is no specific recommendation regarding the exclusion of children with HFMD from childcare programs, schools, or other group settings. If there is an evidence of transmission in any childcare setting (2 or more cases detected within a period of 7 days), Sarawak Health Department will close the premise for a period of 14 days.
	During an outbreak, everyone is advised:
	•	To always practise good hand washing technique and good personal hygiene,
	•	Thoroughly wash and disinfect contaminated items and surfaces using diluted solution of chlorine-containing bleach (10% concentration).
	•	Daily examination of children for HFMD; if positive, call parents to bring child home and don’t bring child back to childcare center till recover.
	•	Disinfect premises
	•	Proper handwashing demo to children












	INFORMATION FOR PARENTS


	Can HFMD be prevented?

	Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include:
	a.	Frequent hand washing, especially after diaper changes, after using toilet and before preparing food,
	b.	Maintain cleanliness of house, child care center, kindergartens or schools and its surrounding,
	c.	Cleaning of contaminated surfaces and soiled items with soap and water, and then disinfecting them with diluted solution of chlorine-containing bleach (10% concentration),
	d.	Parents are advised not to bring young children to crowded public places such as shopping centers, cinemas, swimming pools, markets or bus stations,
	e.	Bring children to the nearest clinic if they show signs and symptoms. Refrain from sending them to child care centers, kindergartens or schools.
	f.	Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children having HFMD illness to reduce of the risk of infection. ARTICKLE SOURCE : www.sarawak.health.gov.my

STRESS

2008-06-09T13:11:00.002+08:00

What Is Stress? Click Here!

Stress is a feeling that's created when we react to particular events. It's the body's way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness.
The events that provoke stress are called stressors, and they cover a whole range of situations - everything from outright physical danger to making a class presentation or taking a semester's worth of your toughest subject.
The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body's energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment.
This natural reaction is known as the stress response. Working properly, the body's stress response enhances a person's ability to perform well under pressure. But the stress response can also cause problems when it overreacts or fails to turn off and reset itself properly.

Good Stress and Bad Stress

The stress response (also called the fight or flight response) is critical during emergency situations, such as when a driver has to slam on the brakes to avoid an accident. It can also be activated in a milder form at a time when the pressure's on but there's no actual danger - like stepping up to take the foul shot that could win the game, getting ready to go to a big dance, or sitting down for a final exam. A little of this stress can help keep you on your toes, ready to rise to a challenge. And the nervous system quickly returns to its normal state, standing by to respond again when needed.
But stress doesn't always happen in response to things that are immediate or that are over quickly. Ongoing or long-term events, like coping with a divorce or moving to a new neighborhood or school, can cause stress, too. Long-term stressful situations can produce a lasting, low-level stress that's hard on people. The nervous system senses continued pressure and may remain slightly activated and continue to pump out extra stress hormones over an extended period. This can wear out the body's reserves, leave a person feeling depleted or overwhelmed, weaken the body's immune system, and cause other problems.

What Causes Stress Overload?

Although just enough stress can be a good thing, stress overload is a different story - too much stress isn't good for anyone. For example, feeling a little stress about a test that's coming up can motivate you to study hard. But stressing out too much over the test can make it hard to concentrate on the material you need to learn.
Pressures that are too intense or last too long, or troubles that are shouldered alone, can cause people to feel stress overload. Here are some of the things that can overwhelm the body's ability to cope if they continue for a long time:
being bullied or exposed to violence or injury
relationship stress, family conflicts, or the heavy emotions that can accompany a broken heart or the death of a loved one
ongoing problems with schoolwork related to a learning disability or other problems, such as ADHD (usually once the problem is recognized and the person is given the right learning support the stress disappears)
crammed schedules, not having enough time to rest and relax, and always being on the go
Some stressful situations can be extreme and may require special attention and care. Posttraumatic stress disorder is a very strong stress reaction that can develop in people who have lived through an extremely traumatic event, such as a serious car accident, a natural disaster like an earthquake, or an assault like rape.
Some people have anxiety problems that can cause them to overreact to stress, making even small difficulties seem like crises. If a person frequently feels tense, upset, worried, or stressed, it may be a sign of anxiety. Anxiety problems usually need attention, and many people turn to professional counselors for help in overcoming them.

Signs of Stress Overload

People who are experiencing stress overload may notice some of the following signs:
anxiety or panic attacks
a feeling of being constantly pressured, hassled, and hurried
irritability and moodiness
physical symptoms, such as stomach problems, headaches, or even chest pain
allergic reactions, such as eczema or asthma
problems sleeping
drinking too much, smoking, overeating, or doing drugs
sadness or depression
Everyone experiences stress a little differently. Some people become angry and act out their stress or take it out on others. Some people internalize it and develop eating disorders or substance abuse problems. And some people who have a chronic illness may find that the symptoms of their illness flare up under an overload of stress.

Keep Stress Under Control

What can you do to deal with stress overload or, better yet, to avoid it in the first place? The most helpful method of dealing with stress is learning how to manage the stress that comes along with any new challenge, good or bad. Stress-management skills work best when they're used regularly, not just when the pressure's on. Knowing how to "de-stress" and doing it when things are relatively calm can help you get through challenging circumstances that may arise. Here are some things that can help keep stress under control.
Take a stand against overscheduling. If you're feeling stretched, consider cutting out an activity or two, opting for just the ones that are most important to you.
Be realistic. Don't try to be perfect - no one is. And expecting others to be perfect can add to your stress level, too (not to mention put a lot of pressure on them!). If you need help on something, like schoolwork, ask for it.
Get a good night's sleep. Getting enough sleep helps keep your body and mind in top shape, making you better equipped to deal with any negative stressors. Because the biological "sleep clock" shifts during adolescence, many teens prefer staying up a little later at night and sleeping a little later in the morning. But if you stay up late and still need to get up early for school, you may not get all the hours of sleep you need.

Learn to relax. The body's natural antidote to stress is called the relaxation response. It's your body's opposite of stress, and it creates a sense of well-being and calm. The chemical benefits of the relaxation response can be activated simply by relaxing. You can help trigger the relaxation response by learning simple breathing exercises and then using them when you're caught up in stressful situations. (Click on the button to try one.) And ensure you stay relaxed by building time into your schedule for activities that are calming and pleasurable: reading a good book or making time for a hobby, spending time with your pet, or just taking a relaxing bath.
Treat your body well. Experts agree that getting regular exercise helps people manage stress. (Excessive or compulsive exercise can contribute to stress, though, so as in all things, use moderation.) And eat well to help your body get the right fuel to function at its best. It's easy when you're stressed out to eat on the run or eat junk food or fast food. But under stressful conditions, the body needs its vitamins and minerals more than ever. Some people may turn to substance abuse as a way to ease tension. Although alcohol or drugs may seem to lift the stress temporarily, relying on them to cope with stress actually promotes more stress because it wears down the body's ability to bounce back.
Watch what you're thinking. Your outlook, attitude, and thoughts influence the way you see things. Is your cup half full or half empty? A healthy dose of optimism can help you make the best of stressful circumstances. Even if you're out of practice, or tend to be a bit of a pessimist, everyone can learn to think more optimistically and reap the benefits.
Solve the little problems. Learning to solve everyday problems can give you a sense of control. But avoiding them can leave you feeling like you have little control and that just adds to stress. Develop skills to calmly look at a problem, figure out options, and take some action toward a solution. Feeling capable of solving little problems builds the inner confidence to move on to life's bigger ones - and it and can serve you well in times of stress.

Build Your Resilience

Ever notice that certain people seem to adapt quickly to stressful circumstances and take things in stride? They're cool under pressure and able to handle problems as they come up. Researchers have identified the qualities that make some people seem naturally resilient even when faced with high levels of stress. If you want to build your resilience, work on developing these attitudes and behaviors:
Think of change as a challenging and normal part of life.
See setbacks and problems as temporary and solvable.
Believe that you will succeed if you keep working toward your goals.
Take action to solve problems that crop up.
Build strong relationships and keep commitments to family and friends.
Have a support system and ask for help.
Participate regularly in activities for relaxation and fun.
Learn to think of challenges as opportunities and stressors as temporary problems, not disasters. Practice solving problems and asking others for help and guidance rather than complaining and letting stress build. Make goals and keep track of your progress. Make time for relaxation. Be optimistic. Believe in yourself. Be sure to breathe. And let a little stress motivate you into positive action to reach your goals.
Updated and reviewed by: D'Arcy Lyness, PhDDate reviewed: July 2007

ARTICLE SOURCE: http://www.kidshealth.org/

HYPERTENSION

2008-06-09T13:03:00.001+08:00

Background

Hypertension is one of the most common worldwide diseases afflicting humans. Because of the associated morbidity and mortality and the cost to society, hypertension is an important public health challenge. Over the past several decades, extensive research, widespread patient education, and a concerted effort on the part of health care professionals have led to decreased mortality and morbidity rates from the multiple organ damage arising from years of untreated hypertension. Hypertension is the most important modifiable risk factor for coronary heart disease (the leading cause of death in North America), stroke (the third leading cause), congestive heart failure, end-stage renal disease, and peripheral vascular disease. Therefore, health care professionals must not only identify and treat patients with hypertension but also promote a healthy lifestyle and preventive strategies to decrease the prevalence of hypertension in the general population.

Historical perspectives

Blood pressure was measured for the first time by Stephen Hales in 1773. Hales also described the importance of blood volume in blood pressure regulation. The contribution of peripheral arterioles in maintaining blood pressure, described as "tone," was first described by Lower in 1669 and subsequently by Sénac in 1783. The role of vasomotor nerves in the regulation of blood pressure was observed by such eminent investigators as Claude Bernard, Charles E. Edouard, Charles Brown-Séquard, and Augustus Waller. William Dayliss advanced this concept in a monograph published in 1923. Cannon and Rosenblueth developed the concept of humoral control of blood pressure and investigated pharmacologic effects of epinephrine. Three contributors who advanced the knowledge of humoral mechanisms of blood pressure control are T.R. Elliott, Sir Henry Dale, and Otto Loew.

Richard Bright, a physician who practiced in the first half of the 19th century, observed the changes of hypertension on the cardiovascular system in patients with chronic renal disease. George Johnson in 1868 postulated that the cause of left ventricular hypertrophy (LVH) in Bright disease was the presence of muscular hypertrophy in the smaller arteries throughout the body. Further clinical pathologic studies by Sir William Gull and H.G. Sutton (1872) led to further description of the cardiovascular changes of hypertension. Frederick Mahomed was one of the first physicians to systematically incorporate blood pressure measurement as a part of a clinical evaluation.

The recognition of primary, or essential, hypertension is credited to the work of Huchard, Vonbasch, and Albutt. Observations of Janeway and Walhard led to the recognition of target organ damage, which branded hypertension as the "silent killer." The concepts of renin, angiotensin, and aldosterone were advanced by several investigators in the late 19th and early 20th centuries. The names of Irwine, Page, van Slyke, Goldblatt, Laragh, and Tuttle prominently appear throughout the hypertension literature, and their work enhances our understanding of the biochemical basis of essential hypertension. Cushman and Ondetti developed an orally acting converting enzyme inhibitor from snake venom peptides and are credited with the successful synthesis of the modern antihypertensive captopril.

Definition

Defining abnormally high blood pressure is extremely difficult and arbitrary. Furthermore, the relationship between systemic arterial pressure and morbidity appears to be quantitative rather than qualitative. A level for high blood pressure must be agreed upon in clinical practice for screening patients with hypertension and for instituting diagnostic evaluation and initiating therapy. Because the risk to an individual patient may correlate with the severity of hypertension, a classification system is essential for making decisions about aggressiveness of treatment or therapeutic interventions.

Based on recommendations of the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII), the classification of blood pressure (expressed in mm Hg) for adults aged 18 years or older is as follows*:

Normal† - Systolic lower than 120, diastolic lower than 80
Prehypertension - Systolic 120-139, diastolic 80-99
Stage 1 - Systolic 140-159, diastolic 90-99
Stage 2 - Systolic equal to or more than 160, diastolic equal to or more than 100

*Based on the average of 2 or more readings taken at each of 2 or more visits after initial screening

†Normal blood pressure with respect to cardiovascular risk is less than 120/80 mm Hg. However, unusually low readings should be evaluated for clinical significance.

Prehypertension, a new category designated in the JNC VII report, emphasizes that patients with prehypertension are at risk for progression to hypertension and that lifestyle modifications are important preventive strategies.

Hypertension may be either essential or secondary. Essential hypertension is diagnosed in the absence of an identifiable secondary cause. Approximately 95% of American adults have essential hypertension, while secondary hypertension accounts for fewer than 5% of the cases.

Pathophysiology

Arterial blood pressure is a product of cardiac output and systemic vascular resistance. Therefore, determinants of blood pressure include factors that affect both cardiac output and arteriolar vascular physiology. There is potential relevance of blood viscosity, vascular wall sheer conditions (rate and stress), and blood flow velocity (mean and pulsatile components) on vascular and endothelial function regulating blood pressure in humans. Furthermore, changes in vascular wall thickness affect the amplification of peripheral vascular resistance in hypertensive patients and result in reflection of waves back to the aorta, increasing systolic blood pressure.

Regulation of blood pressure

Regulation of normal blood pressure is a complex process. Although a function of cardiac output and peripheral vascular resistance, both of these variables are influenced by multiple factors.

The factors affecting cardiac output include sodium intake, renal function, and mineralocorticoids; the inotropic effects occur via extracellular fluid volume augmentation and an increase in heart rate and contractility. Peripheral vascular resistance is dependent upon the sympathetic nervous system, humoral factors, and local autoregulation. The sympathetic nervous system produces its effects via the vasoconstrictor alpha effect or the vasodilator beta effect. The humoral actions on peripheral resistance are also mediated by other mediators such as vasoconstrictors (angiotensin and catecholamines) or vasodilators (prostaglandins and kinins). For additional resource, please visit Angiotensin II Receptor Blockade.

Autoregulation of blood pressure occurs by way of intravascular volume contraction and expansion, as well as by transfer of transcapillary fluid. Interactions between cardiac output and peripheral resistance are autoregulated to maintain a set blood pressure in an individual. For example, constriction of the arterioles elevates arterial pressure by increasing total peripheral resistance, whereas venular constriction leads to redistribution of the peripheral intravascular volume to the central circulation, thereby increasing preload and cardiac output.

Pathogenesis of hypertension

The pathogenesis of essential hypertension is multifactorial and highly complex. Multiple factors modulate the blood pressure for adequate tissue perfusion and include humoral mediators, vascular reactivity, circulating blood volume, vascular caliber, blood viscosity, cardiac output, blood vessel elasticity, and neural stimulation. A possible pathogenesis of essential hypertension has been proposed in which multiple factors, including genetic predisposition, excess dietary salt intake, and adrenergic tone, may interact to produce hypertension. Although genetics appears to contribute to essential hypertension, the exact mechanism has not been established.

The natural history of essential hypertension evolves from occasional to established hypotension. After a long invariable asymptomatic period, persistent hypertension develops into complicated hypertension, in which target organ damage to the aorta and small arteries, heart, kidneys, retina, and central nervous system is evident. The progression begins with prehypertension in persons aged 10-30 years (by increased cardiac output) to early hypertension in persons aged 20-40 years (in which increased peripheral resistance is prominent) to established hypertension in persons aged 30-50 years, and, finally, to complicated hypertension in persons aged 40-60 years.

The early stage of hypertension has been described as high-output hypertension. High-output hypertension results from decreased peripheral vascular resistance and concomitant cardiac stimulation by adrenergic hyperactivity and altered calcium homeostasis. In contrast, the chronic phase of essential hypertension characteristically has normal or reduced cardiac output and elevated systemic vascular resistance.

The vasoreactivity of the vascular bed, an important phenomenon mediating changes of hypertension, is influenced by the activity of vasoactive factors, reactivity of the smooth muscle cells, and structural changes in the vessel wall and vessel caliber, expressed by a lumen-to-wall ratio. Patients who develop hypertension are known to develop a systemic hypertensive response secondary to vasoconstrictive stimuli. Alterations in structural and physical properties of resistance arteries, as well as changes in endothelial function, are probably responsible for this abnormal behavior of vasculature. Furthermore, vascular remodeling occurs over the years as hypertension evolves, thereby maintaining increased vascular resistance irrespective of the initial hemodynamic pattern.

Genetic factors

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Hypertension is likely to be related to multiple genes. Hypertension develops secondary to multiple environmental factors, as well as to several genes, whose inheritance appears to be complex. Very rare secondary causes are related to single genes.

Role of the vascular endothelium

The vascular endothelium is presently considered a vital organ, where synthesis of various vasodilating and constricting mediators occurs. The interaction of autocrine and paracrine factors takes place in the vascular endothelium, leading to growth and remodeling of the vessel wall and to the hemodynamic regulation of blood pressure.

Numerous hormonal, humeral vasoactive, and growth and regulating peptides are produced in the vascular endothelium. These mediators include angiotensin II, bradykinin, endothelin, nitric oxide, and several other growth factors. Endothelin is a potent vasoconstrictor and growth factor that likely plays a major role in the pathogenesis of hypertension. Angiotensin II is a potent vasoconstrictor synthesized from angiotensin I with the help of an angiotensin-converting enzyme (ACE). Another vasoactive substance manufactured in the endothelium is nitric oxide. Nitric oxide is an extremely potent vasodilator that influences local autoregulation and other vital organ functions. Additionally, several growth factors are manufactured in the vascular endothelium; each of these plays an important role in atherogenesis and target organ damage. These factors include platelet-derived growth factor, fibroblast growth factor, insulin growth factor, and many others.

Pathophysiology of target organ damage

Hypertension and the cardiovascular system

Cardiac involvement in hypertension manifests as LVH, left atrial enlargement, aortic root dilatation, atrial and ventricular arrhythmias, systolic and diastolic heart failure, and ischemic heart disease. LVH is associated with an increased risk of premature death and morbidity. A higher frequency of cardiac atrial and ventricular dysrhythmias and sudden cardiac death may exist. Possibly, increased coronary arteriolar resistance leads to reduced blood flow to the hypertrophied myocardium, resulting in angina despite clean coronary arteries. Hypertension, along with reduced oxygen supply and other risk factors, accelerates the process of atherogenesis, thereby further reducing oxygen delivery to the myocardium.

Hypertension remains the most common cause of congestive heart failure. Antihypertensive therapy has been demonstrated to significantly reduce the risk of death from stroke and coronary heart disease. Two published meta-analyses have shown 14% and 26% reductions in cardiovascular mortality rates.

Left ventricular hypertrophy

The myocardium undergoes structural changes in response to increased afterload. Cardiac myocytes respond by hypertrophy, allowing the heart to pump more strongly against the elevated pressure. However, the contractile function of the left ventricle remains normal until later stages. Eventually, LVH lessens the chamber lumen, limiting diastolic filling and stroke volume. The left ventricular diastolic function is markedly compromised in long-standing hypertension.

The mechanisms of diastolic dysfunction have been elucidated only recently. An aberration in the passive relaxation of the left ventricle during diastole appears to exist. Over time, fibrosis may occur, further contributing to the poor compliance of the ventricle. As the left ventricle does not relax during early diastole, left ventricular end-diastolic pressure increases, further increasing left atrial pressure in late diastole. The exact determinants of left ventricular diastolic dysfunction have not been well studied; possibly, the abnormality is governed by abnormal calcium kinetics.

The central nervous system

Long-standing hypertension may manifest as hemorrhagic and atheroembolic stroke or encephalopathy. Both the high systolic and diastolic pressures are harmful; a diastolic pressure of more than 100 mm Hg and a systolic pressure of more than 160 mm Hg have led to a significant incidence of strokes. Other cerebrovascular manifestations of complicated hypertension include hypertensive hemorrhage, hypertensive encephalopathy, lacunar-type infarctions, and dementia.

Renal disease

Despite widespread treatment of hypertension in the United States, the incidence of end-stage renal disease continues to rise. The explanation for this rise may be concomitant diabetes mellitus, the progressive nature of hypertensive renal disease despite therapy, or a failure to reduce blood pressure to a protective level. A reduction in renal blood flow in conjunction with elevated afferent glomerular arteriolar resistance increases glomerular hydrostatic pressure secondary to efferent glomerular arteriolar constriction. The result is glomerular hyperfiltration, followed by development of glomerulosclerosis and further impairment of renal function.

Two studies have demonstrated that a reduction in blood pressure may result in improved renal function. Therefore, earlier detection of hypertensive nephrosclerosis using means to detect microalbuminuria and aggressive therapeutic interventions, particularly with ACE inhibitor drugs, may prevent progression to end-stage renal disease.

Nephrosclerosis is one of the possible complications of long-standing hypertension. The risk of hypertension-induced end-stage renal disease is higher in black patients, even when the blood pressure is under good control. Furthermore, patients with diabetic nephropathy who are hypertensive are also at high risk for developing end-stage renal disease. The renin-angiotensin system activity influences the progression of renal disease. Angiotensin II acts at both the afferent and the efferent arterioles, but more so on the efferent arteriole, which leads to an increase of the intraglomerular pressure. The excess glomerular pressure leads to microalbuminuria. Reducing intraglomerular pressure using an ACE inhibitor has been shown to be beneficial in patients with diabetic nephropathy, even in those who are not hypertensive. The beneficial effect of ACE inhibitors on the progression of renal insufficiency in patients who are nondiabetic is less clear.

Hypertension in renal disease

Hypertension is commonly observed in patients with kidney disease. Volume expansion is the main cause of hypertension in patients with glomerular disease (nephrotic and nephritic syndrome). Hypertension in patients with vascular disease is the result of the activation of the renin-angiotensin system, which is often secondary to ischemia. Most patients with chronic renal failure are hypertensive (80-90%). The combination of volume expansion and the activation of the renin-angiotensin system is believed to be the main factor behind hypertension in patients with chronic renal failure.

Metabolic syndrome

The metabolic syndrome is an assemblage of metabolic risk factors that directly promote the development of atherosclerotic cardiovascular disease. Dyslipidemia, hypertension, and hyperglycemia are the most widely recognized metabolic risk factors. The combination of these risk factors leads to a prothrombotic, proinflammatory state in humans and identifies individuals who are at elevated risk for atherosclerotic cardiovascular disease.

The predominant underlying risk factors for the metabolic syndrome appear to be abdominal obesity and insulin resistance. Other associated conditions are physical inactivity, aging, hormonal imbalance, and atherogenic diet. Insulin resistance, an essential cause of the metabolic syndrome, predisposes to hyperglycemia and type 2 diabetes mellitus. Individuals who insulin resistant may not be clinically obese, but they commonly have an abnormal fat distribution that is characterized by predominant upper body fat. Upper body obesity can occur either intraperitoneally (visceral fat) or subcutaneously, both of which correlate strongly with insulin resistance and the metabolic syndrome.

The rising prevalence of the metabolic syndrome is secondary to the increasing burden of obesity in our society. The adipose tissue in people who are obese is insulin resistant, raises nonesterified fatty acid levels, alters hepatic metabolism, and produces several adipokines. These include increased production of inflammatory cytokines, plasminogen activator inhibitor-1, and other bioactive products, while the synthesis of potentially protective adipokine, adiponectin, is reduced. Recently, this syndrome has been noted to be associated with a state of chronic, low-grade inflammation. Although the metabolic syndrome unequivocally predisposes to type 2 diabetes mellitus, this syndrome is multidimensional risk factor for atherosclerotic cardiovascular disease.

Frequency

United States

Forty-three million people are estimated to have hypertension, defined by a systolic blood pressure of 140 mm Hg or greater and/or diastolic blood pressure of 90 mm Hg or greater or defined as those taking antihypertensive medications. The age-adjusted prevalence of hypertension varies from 18-32%, according to data from the National Health Examination Surveys. According to the National Center for Health Statistic Surveys, the awareness for hypertension increased from 53% in 1960-1962 to 89% in 1988-1991. The percentage of patients engaged in hypertension treatment increased from 35% to 79% during this period.

The National High Blood Pressure Education Program (NHBPEP) has reported estimates of hypertension prevalence in United States. The hypertension survey was conducted from 1989-1994, and actual blood pressure and self-reported information was used. Hypertension was defined as systolic blood pressure equal to or more than 140 mm Hg, diastolic blood pressure equal or more than 90 mm Hg, or taking medication for hypertension. The data estimated 43.3 million adults with hypertension in November 1991. The prevalence according to age group, sex, and race is shown in Table 1.

Table 1. Prevalence (%) of Hypertension in the United States, 1989-1994*

Age Groups	All Races			White			Black
Age Groups	Men (%)	Women (%)	Total (%)	Men (%)	Women (%)	Total (%)	Men (%)	Women (%)	Total (%)
18-24	2.6	4.6	0.7	2.5	4.6	0.5	2.6	4.1	1.4
25-34	5.4	8.4	2.4	4.9	8.1	1.6	8.2	10.6	6.2
35-44	13.0	16.0	10.2	11.3	14.3	8.5	25.9	29.5	22.9
45-54	27.6	30.0	25.2	25.8	29.1	22.6	46.9	44.3	48.8
55-64	43.7	44.2	43.2	42.1	43.0	41.4	60.0	58.0	63.0
65-74	59.6	55.8	62.7	58.6	54.9	61.7	71.0	65.2	75.6
75⁺	70.3	60.5	76.2	69.7	59.0	76.1	75.5	71.3	77.9
Total	23.4	23.5	23.3	23.2	23.4	23.1	28.1	27.9	28.2

*Includes racial/ethnic groups not shown separately because of small sample sizes

A 2005 survey in the United States found that in the population aged 20 years or older, an estimated 41.9 million men and 27.8 million women have prehypertension, 12.8 million men and 12.2 million women have stage 1 hypertension, and 4.1 million men and 6.9 million women have stage 2 hypertension. Age- and sex-adjusted rates of prehypertension and stage I hypertension increased among non-Hispanic white, African American, and Hispanic persons between 1988-1992 and 1999-2000. Age- and sex-adjusted rates of stage 2 hypertension decreased among non-Hispanic whites between 1988-1992 and 1999-2000, but they were unchanged for African American and Hispanic persons.

International

National health surveys in various countries have shown a high prevalence of poor control of hypertension. These studies have reported that prevalence of hypertension is 22% in Canada, of which 16% is controlled; 26.3% in Egypt, of which 8% is controlled; and 13.6% in China, of which 3% is controlled. Hypertension is a worldwide epidemic; in many countries, 50% of the population older than 60 years has hypertension. Overall, approximately 20% of the world's adults are estimated to have hypertension. The 20% prevalence is for hypertension defined as blood pressure in excess of 140/90 mm Hg. The prevalence dramatically increases in patients older than 60 years.

Mortality/Morbidity

In the Framingham Heart Study, the age-adjusted risk of congestive heart failure was 2.3 times higher in men and 3 times higher in women when highest blood pressure was compared to the lowest. Multiple Risk Factor Intervention Trial (MRFIT) data showed that the relative risk for coronary heart disease mortality varied from 2.3-6.9 times higher for persons with mild-to-severe hypertension compared to persons with normal blood pressure.
The relative risk for stroke ranged from 3.6-19.2. The population-attributable risk percentage for coronary artery disease varied from 2.3-25.6%, whereas the population-attributable risk for stroke ranged from 6.8-40%.

Race

Blacks have a higher prevalence and incidence of hypertension than whites. The prevalence of hypertension was increased by 50% in African Americans. In Mexican Americans, the prevalence and incidence of hypertension is similar to or lower than in whites. The National Health and Nutrition Examination Survey (NHANES) III reported an age-adjusted prevalence of hypertension at 20.6% in Mexican Americans and 23.3% in non-Hispanic whites.

Are there ethnic differences in the pathogenesis of hypertension, and do these differences influence the choice of treatment? To understand ethnic influence, an understanding of the renin angiotensin system is essential. Renin secretion is suppressed when the kidney detects that the amount of sodium excretion is increased; thus, a clue to the excess sodium in the circulation. Black people tend to develop hypertension at an earlier age and have lower rennin activity; target organ damage also differs in black people from that in white people.
Most studies in the United Kingdom and the United States report a higher prevalence and lower awareness of hypertension in black people than in white people. Mortality from hypertension in African-Caribbean–born people is 3.5 times the national rate; similar data have been published for African American citizens. Strokes are more common in black people, but coronary heart disease is more common in Asians. Both groups have a higher incidence of chronic renal failure than white people, but this is more due to hypertension in black people and diabetes in Asians.
Black people have a poorer response to treatment with ACE inhibitors compared to white people; the evidence for beta-blockers being less effective in black people is also clear. However, diuretics are more effective at a young age in black people.

Sex

The age-adjusted prevalence of hypertension was 34%, 25.4%, and 23.2% for men and 31%, 21%, and 21.6% for women among African Americans, whites, and Mexican Americans, respectively. In the NHANES III study, the prevalence of hypertension was 12% for white men and 5% for white women aged 18-49 years. However, the age-related blood pressure rise for women exceeds that of men. The prevalence of hypertension was reported at 50% for white men and 55% for white women aged 70 years or older.

Age

A progressive rise in blood pressure with increasing age is observed. The third NHANES survey reported that the prevalence of hypertension grows significantly with increasing age in all sex and race groups. The age-specific prevalence was 3.3% in white men (aged 18-29 y); this increased to 13.2% in the group aged 30-39 years. The prevalence further increased to 22% in the group aged 40-49 years, to 37.5% in the group aged 50-59 years, and to 51% in the group aged 60-74 years. In another study, the incidence of hypertension appeared to increase approximately 5% for each 10-year interval of age. Age-related hypertension appears to be predominantly systolic rather than diastolic. The systolic blood pressure rises into the eighth or ninth decade, while the diastolic blood pressure remains constant or declines after age 40 years.¹

CLINICAL

Section 3 of 10

History

Following the documentation of hypertension, which is confirmed after an elevated blood pressure, properly measured, has been documented on at least 3 separate occasions (based on the average of 2 or more readings taken at each of 2 or more visits after initial screening), a detailed history should extract the following information:
- Extent of target organ damage
- Assessment of patients' cardiovascular risk status
- Exclusion of secondary causes of hypertension
Patients may have undiagnosed hypertension for years without having had their blood pressure checked. Therefore, a careful history of end organ damage should be obtained.
A history of cardiovascular risk factors includes hypercholesterolemia, diabetes mellitus, and tobacco use (including chewing tobacco).
Obtain a history of over-the-counter medication use, current and previous unsuccessful antihypertensive medication trials, and ethanol intake.
The historical and physical findings that suggest the possibility of secondary hypertension are a history of known renal disease, abdominal masses, anemia, and urochrome pigmentation.
A history of sweating, labile hypertension, and palpitations suggests the diagnosis of pheochromocytoma.
A history of cold or heat tolerance, sweating, lack of energy, and bradycardia or tachycardia may indicate hypothyroidism or hyperthyroidism.
A history of weakness suggests hyperaldosteronism. Abdominal bruit suggests the possibility of renal artery stenosis. Absence of femoral pulses suggests coarctation of aorta.
Kidney stones raise the possibility of hyperparathyroidism. The presence of papilledema and other neurologic signs raises the possibility of increased intracranial pressure. A history of drug ingestion, including oral contraceptives, licorice, and sympathomimetics, should be obtained.

Physical

An accurate measurement of blood pressure is the key to diagnosis. Several determinations should be made over a period of several weeks.

At any given visit, an average of 3 blood pressure readings taken 2 minutes apart using a mercury manometer is preferable. Blood pressure should be measured in both the supine and sitting positions, auscultating with the bell of the stethoscope. On the first visit, blood pressure should be checked in both arms and in one leg to avoid missing the diagnosis of coarctation of aorta or subclavian artery stenosis.

As the improper cuff size may influence blood pressure measurement, a wider cuff is preferable, particularly if the patient's arm circumference exceeds 30 cm.

The patient should rest quietly for at least 5 minutes before the measurement.

Although somewhat controversial, the common practice is to document phase V (a disappearance of all sounds) of Korotkoff sounds as the diastolic pressure.

A funduscopic evaluation of the eyes should be performed to detect any evidence of hypertensive retinopathy. These are flame-shaped hemorrhages and cotton wool exudates.
Palpation of all peripheral pulses should be performed.
Look for renal artery bruit over the upper abdomen; the presence of a unilateral bruit with both a systolic and diastolic component suggests renal artery stenosis.
A careful cardiac examination is performed to evaluate signs of LVH. These include displacement of apex, a sustained and enlarged apical impulse, and the presence of an S₄. Occasionally, a tambour S₂ is heard with aortic root dilatation.

Causes

Primary or essential hypertension (90-95%)
Secondary hypertension: A small percentage of patients (2-10%) have a secondary cause. The following is a list of secondary causes of hypertension:
- Renal (2.5-6%)
  - Renal parenchymal disease
  - Polycystic kidney disease
  - Urinary tract obstruction
  - Renin-producing tumor
  - Liddle syndrome
- Renovascular hypertension (0.2-4%)
- Vascular
  - Coarctation of aorta
  - Vasculitis
  - Collagen vascular disease
- Endocrine (1-2%) - Oral contraceptives
- Adrenal
  - Primary aldosteronism
  - Cushing syndrome
  - Pheochromocytoma
  - Congenital adrenal hyperplasia
- Hyperthyroidism and hypothyroidism
- Hypercalcemia
- Hyperparathyroidism
- Acromegaly
- Neurogenic
  - Brain tumor
  - Bulbar poliomyelitis
  - Intracranial hypertension
- Pregnancy-induced hypertension
- Drugs and toxins
  - Alcohol
  - Cocaine
  - Cyclosporin
  - Erythropoietin
  - Adrenergic medications

DIFFERENTIALS

Section 4 of 10

Adrenal Adenoma
Aortic Coarctation
Aortic Dissection
Apnea, Sleep
Atherosclerosis
Atherosclerotic Disease of the Carotid Artery
Cardiomyopathy, Cocaine
Cardiomyopathy, Hypertrophic
Hyperaldosteronism, Primary
Hypertension and Pregnancy
Hypertension, Malignant
Hypertensive Heart Disease
Hyperthyroidism
Obstructive Sleep Apnea-Hypopnea Syndrome
Pheochromocytoma
Renal Artery Stenosis

WORKUP

Section 5 of 10

Lab Studies

Unless a secondary cause for hypertension is suspected, only the following routine laboratory studies should be performed:
- CBC count, serum electrolytes, serum creatinine, serum glucose, uric acid, and urinalysis
- Lipid profile (total cholesterol, low-density lipoprotein [LDL] and high-density lipoprotein [HDL], and triglycerides)
Additional tests described below are indicated when specific clinical situations warrant further investigation.
- Microalbuminuria is an early indication of hypertensive nephrosclerosis and is also a marker for a higher risk of cardiovascular morbidity and mortality. Present recommendations suggest that individuals with type I diabetes should be screened for microalbuminuria. Usefulness of this screening in hypertensive patients without diabetes has not been established.
- Plasma renin activity (PRA) is performed to detect evidence of primary hyperaldosteronism. Low renin values confirm the diagnosis of primary hyperaldosteronism; however, hypokalemia may be associated with a form of hypertension, but it is not often present.
- Determination of sensitive thyroid-stimulating hormone (TSH) level excludes hypothyroidism or hyperthyroidism as a cause of hypertension.

Imaging Studies

Echocardiography: The limited echocardiography study, rather than the complete examination, may detect LVH more frequently than electrocardiography. The main indication for limited echocardiography is evaluation for end organ damage in a patient with borderline high blood pressure. Therefore, the presence of LVH despite normal or borderline high blood pressure measurements requires antihypertensive therapy.
Imaging studies for renovascular stenosis: If the history suggests renal artery stenosis and if a corrective procedure is considered, further radiologic investigations are performed.

Other Tests

Routine testing includes electrocardiograms.
Ambulatory blood pressure monitoring: Indications for ambulatory blood pressure monitoring include labile blood pressure, a discrepancy between blood pressure measurement inside and outside the physician's office, and poor blood pressure control. Ambulatory monitoring also identifies patients who have the distinct syndrome called white coat hypertension.

TREATMENT

Section 6 of 10

Medical Care

Consider lifestyle modifications. As the cardiovascular disease risk factors are assessed in individuals with hypertension, pay attention to the lifestyles that favorably affect blood pressure level and reduce overall cardiovascular disease risk. A relatively small reduction in blood pressure may affect the incidence of cardiovascular disease on a population basis. A decrease in blood pressure of 2 mm Hg reduces the risk of stroke by 15% and the risk of coronary artery disease by 6% in a given population.

JNC VII recommendations to lower blood pressure and decrease cardiovascular disease risk include the following:

Lose weight if overweight.
Limit alcohol intake to no more than 1 oz (30 mL) of ethanol (ie, 24 oz [720 mL] of beer, 10 oz [300 mL] of wine, 2 oz [60 mL] of 100-proof whiskey) per day or 0.5 (15 mL) ethanol per day for women and people of lighter weight.
Increase aerobic activity (30-45 min most days of the week).
Reduce sodium intake to no more than 100 mmol/d (2.4 g sodium or 6 g sodium chloride).
Maintain adequate intake of dietary potassium (approximately 90 mmol/d).
Maintain adequate intake of dietary calcium and magnesium for general health.
Stop smoking and reduce intake of dietary saturated fat and cholesterol for overall cardiovascular health.

Clinical trials

Multiple clinical trials suggest that most antihypertensive drugs provide the same degree of cardiovascular protection for the same level of blood pressure control. Well-designed prospective randomized trials, such as the Swedish Trial in Old Patients with Hypertension (STOP-2), the Nordic Diltiazem (NORDIL) trial, and the Intervention as a Goal in Hypertension Treatment (INSIGHT) trial, have shown a similar outcome with older drugs (eg, diuretics, beta-blockers) compared to the newer antihypertensive agents (eg, ACE inhibitors, calcium channel blockers).

No consensus exists regarding optimal drug therapy for treatment of hypertension; most clinicians recommend initiating therapy with a single agent and advancing to the low-dose combination therapy. Any of the first-line medications decrease blood pressure in 40-60% of patients with mild-to-moderate hypertension. In unresponsive patients, switching to a second drug (rather than combining it with the first drug) or switching to a third drug if the second drug is not effective may allow a 70-80% response rate to monotherapy. Therefore, attempt to identify a particular class of drug to which the patient responds rather than adding multiple drugs (as in combination therapy).

The JNC VII report recommends either a thiazide diuretic or a beta-blocker as the initial therapy of uncomplicated hypertension. A low dose of thiazide diuretic (12.5-25 mg hydrochlorothiazide) is a low-cost therapy with fewer complications, and it provides equivalent cardiovascular protection. Patients unresponsive to low-dose thiazide therapy should try an ACE inhibitor, beta-blocker, or calcium channel blocker, sequentially. Patients unresponsive to a diuretic may not respond to a calcium channel blocker, and an ACE inhibitor or a beta-blocker should be tried as a second-line agent in these patients. Calcium channel blocking agents and diuretics may be more effective in hypertensive black patients.

Initial therapy based on the JNC VII report recommendations is as follows:

Prehypertension (systolic 120-139, diastolic 80-89): No antihypertensive drug is indicated.
Stage 1 hypertension (systolic 140-159, diastolic 90-99): Thiazide-type diuretics are recommended for most. ACE inhibitor, angiotensin II receptor blocker (ARB), beta-blocker, calcium channel blocker, or combination may be considered.
Stage 2 hypertension (systolic more than 160, diastolic more than 100): Two-drug combination (usually thiazide-type diuretic and ACE inhibitor or ARB or beta-blocker or calcium channel blocker) is recommended for most.
For the compelling indications, other antihypertensive drugs (eg, diuretics, ACE inhibitor, ARB, beta-blocker, calcium channel blocker) may be considered as needed.

Randomized trials

Two randomized controlled trials, the Hypertension Detection and Follow-up Program (HDFP) and the Medical Research Council (MRC) trials, randomized patients with elevated levels of diastolic blood pressure to either diuretic-based stepped-care treatment or usual care. The usual care group received some form of therapy from their own physicians, whereas the stepped-care group received systematic care. In both studies, stepped-care treatment reduced diastolic blood pressure by 5 mm more than that reduced in the control group. Both trials showed a benefit from stepped-care therapy compared to the control group. In the HDFP trial, stepped-care led to relative risk reduction of 17% for total mortality; 76 hypertensive patients needed to be treated with stepped-care therapy for 5 years to prevent one death.

A meta-analysis published in the Journal of the American Medical Association (JAMA) in 1997 included several randomized controlled clinical trials. The total number of participants randomized to active therapy was 24,294, and the number for the control therapy was 23,926. Active treatment reduced diastolic blood pressure by at least 5 mm Hg. The meta-analysis showed a risk reduction of coronary heart disease of 8-14% and the reduction in stroke incidence of 35-40%. Subsequent meta-analysis reported that benefits of active treatment are similar in men and women.

Recommendations for management of hypertension

The JNC recommends certain situations for which a specific class of drug may be administered. An ACE inhibitor should be the initial treatment in situations in which hypertension is associated with congestive heart failure, diabetes mellitus with proteinuria, and postmyocardial infarction with systolic left ventricular dysfunction. In patients who develop persistent cough while on ACE inhibitor therapy, an angiotensin II receptor antagonist may be substituted, but these agents' efficacy in lowering cardiovascular mortality rates has not yet been proven. A beta-blocker should be prescribed following an acute myocardial infarction. A diuretic or a long-acting calcium channel blocker may be more effective in elderly patients with isolated systolic hypertension.

The 2004 Canadian Hypertension Society recommendations (similar to JNC VII guidelines) for the management of hypertension in specific patient groups are listed in Table 2 and Table 3, as follows:

Table 2. Synopsis of Considerations in the Use of Antihypertensive Drug Classes*

Class of Medication		When to Use	When Not to Use
Diuretics	Loop diuretics	Renal insufficiency (additional therapy)	Gout
	Potassium-sparing	Primary hyperaldosteronism (additional therapy in combination with thiazide diuretics)	Renal insufficiency
	Thiazides	Uncomplicated hypertension (preferred therapy), systolic hypertension in elderly people (preferred therapy), for older diabetic patients without nephropathy	Gout, dyslipidemia (high-dose)
Beta-adrenergic antagonists		Post–myocardial infarction, uncomplicated hypertension (preferred therapy), diabetes (without nephropathy)	Asthma, peripheral vascular disease (severe)
ACE inhibitors		Diabetes, post–myocardial infarction, heart failure, renal disease, uncomplicated hypertension (preferred therapy)	Bilateral renovascular disease, pregnancy
Angiotensin II antagonists		Diabetes (alternative therapy), heart failure (alternative therapy), uncomplicated hypertension (preferred therapy)	Bilateral renovascular disease, pregnancy
Calcium channel blockers	Nondihydropyridines	Uncomplicated hypertension (alternative therapy)	Heart block, heart failure
Calcium channel blockers	Dihydropyridines	Systolic hypertension (preferred therapy), uncomplicated therapy (alternative therapy)	Heart block, heart failure
Alpha-adrenergic antagonists/central acting agents		Uncomplicated hypertension (alternative therapy)	Autonomic dysfunction

*CMAJ 1999, 161:S1-S22

Table 3. Considerations in the Individualization of Antihypertensive Therapy*

Risk Factor/Disease	Preferred Therapy	Alternative Therapy	Avoid Therapy
Uncomplicated hypertension (<60>	Low-dose thiazidelike diuretics, beta-blockers, ACE inhibitors, or long-acting dihydropyridine calcium channel blockers	Combinations of first-line drugs	…
Uncomplicated hypertension (³60 y)	Low-dose thiazidelike diuretics, ACE inhibitors, or long-acting dihydropyridine calcium channel blockers	Combinations of first-line drugs	…
Dyslipidemia	As for uncomplicated hypertension	…	…
Diabetes mellitus with nephropathy	ACE inhibitors	Angiotensin II receptor blockers	High-dose diuretics and centrally acting agents (in the setting of autonomic neuropathy)
Diabetes mellitus without nephropathy	ACE inhibitors or beta-blockers	…	…
Diabetes mellitus without nephropathy, with systolic hypertension	Low-dose thiazidelike diuretics or long-acting dihydropyridine calcium channel blockers	…	…
Angina	Beta-blockers (ACE inhibitors as add-on therapy)	Long-acting calcium channel blockers	…
Prior myocardial infarction	Beta-blockers, ACE inhibitors	…	…
Systolic dysfunction	ACE inhibitors (thiazide or loop diuretics, beta-blockers, spironolactone is additive therapy)	Angiotensin II receptor blockers, hydralazine/isosorbide dinitrate, amlodipine	Nondihydropyridine calcium channel blockers (diltiazem, verapamil)
Left ventricular hypertrophy	Most antihypertensives reduce LVH	…	Hydralazine, minoxidil
Peripheral arterial disease	As for uncomplicated hypertension	As for uncomplicated hypertension	Beta-blockers (with severe disease)
Renal disease	ACE inhibitors (diuretics as additive therapy)	Dihydropyridine calcium channel blockers	ACE inhibitors in cases of bilateral renal artery stenosis

*Short-acting calcium channel blockers are not recommended in the treatment of hypertension

Several situations demand the addition of a second drug because 2 drugs may be used at lower doses to avoid adverse effects, which may occur with higher doses of an individual agent. Diuretics generally potentiate the effects of other antihypertensive drugs by minimizing volume expansion. Specifically, the use of the diuretic thiazide in conjunction with a beta-blocker or an ACE inhibitor has an additive effect, controlling blood pressure in up to 85% of patients.

Most drug combinations using agents that act by different mechanisms have an additive effect. The combination of a calcium channel blocker with either an ACE inhibitor or a dihydropyridine calcium channel blocker and a beta-blocker has additive effects. An ACE inhibitor may be combined with an angiotensin II receptor antagonist because the blocking of angiotensin I receptors may lead to increased plasma angiotensin II concentration, which may compete with a drug for the receptor. Some combinations may not be additive, including a beta-blocker and ACE inhibitor, a beta-blocker and an alpha1-blocker and an alpha2 stimulant, and, more controversially, a diuretic and a calcium channel blocker. Some combinations may have additive adverse effects; these include a beta-blocker combined with verapamil or diltiazem, which leads to cardiac depression, bradycardia, or heart block.

Clinical trials have shown that the effective control of blood pressure reduces the risk of cardiovascular events in high-risk patients. In the patients who achieved optimal blood pressure control compared with those with uncontrolled hypertension, significant reductions in the incidence of cardiac events, stroke, and all-cause mortality occurred (according to the Valsartan Antihypertensive Long-term Use Evaluation [VALUE] Trial). The lack of significant difference in cardiovascular mortality and morbidity among patients receiving diuretics, calcium channel blockers, or ACE inhibitors in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) possibly occurred due to confounding because of differences in the blood pressure reductions achieved with the 3 treatments.

Recent studies have consistently shown that newer antihypertensive agents, such as ACE inhibitors and calcium channel blockers, reduce cardiovascular events to a similar, or possibly greater, extent as older therapies, such as diuretics and beta-blockers. ACE inhibitors specifically offer additional benefits beyond blood pressure reduction, which include reduction of cardiovascular events and renal protection. Similarly, ARBs have demonstrated beneficial effects in heart failure, stroke, and renal protection.

Key messages of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII) are as follows:
- In those older than 50 years, systolic blood pressure (BP) of greater than 140 mm Hg is a more important cardiovascular disease risk factor than diastolic BP.
- Beginning at 115/75 mm Hg, the cardiovascular disease risk doubles for each increment of 20/10 mm Hg.
- Individuals who are normotensive at 55 years will have a 90% lifetime risk of developing hypertension.
- Prehypertension (systolic 120-139, diastolic 80-89) requires health-promoting lifestyle modifications to prevent the progressive rise in blood pressure and cardiovascular disease.
- In uncomplicated hypertension, a thiazide diuretic, either alone or combined with drugs from other classes, should be used for the drug treatment of most.
- In specific high-risk conditions, there are compelling indications for the use of other antihypertensive drug classes (eg, ACE inhibitors, angiotensin-receptor blockers, beta-blockers, calcium channel blockers).
- Two or more antihypertensive medications will be required to achieve goal BP (<140/90>
- For patients whose BP is more than 20 mm Hg above the systolic BP goal or more than 10 mm Hg above the diastolic BP goal, initiation of therapy using 2 agents, one of which usually will be a thiazide diuretic, should be considered.
- Regardless of therapy or care, hypertension will be controlled only if patients are motivated to stay on their treatment plan.
Resistant hypertension: Some patients may have persistent diastolic blood pressures above 100 mm Hg despite the use of 3 or more antihypertensive medications. These patients may be experiencing of the following factors as the cause of resistant hypertension:
- Inadequate treatment was described as the most common cause of resistant hypertension in several published series. Patients may not be on an effective drug, or concomitant volume expansion may occur as a side effect of the drug.
- Extracellular volume expansion: Volume expansion may contribute to the inability to lower systemic blood pressure. The volume expansion may occur because of renal insufficiency, sodium retention due to treatment with vasodilators, high-salt diet, or insufficient dosing of diuretic. This situation can be treated with more aggressive diuretic therapy until clinical signs of extracellular volume depletion (eg, orthostatic hypotension) develop.
- Poor compliance: Noncompliance with medical therapy or dietary modifications (eg, salt restriction) may play a role in causing resistant hypertension. Address noncompliance with extensive patient education, simplification of the drug regimen, and use of drugs with the fewest adverse effects.
- Secondary hypertension: Whenever confronted with resistant hypertension, try to exclude any secondary causes of hypertension. A reevaluation of the patient's history, physical examination, and laboratory results may provide clues to secondary hypertension (eg, renal artery stenosis, primary hyperaldosteronism).
- White coat hypertension: Blood pressure rise secondary to anxiety may be observed in 20-30% of patients. This may be avoided by having patients rest prior to measurement, having a nurse check the blood pressure, or arranging to have the blood pressure monitored at home. Development of hypotensive symptoms on medications is an indication of white coat hypertension. White coat hypertension can also be evaluated by the use of a 24-hour ambulatory monitor.
Pseudohypertension may be observed in elderly individuals who have thickened, calcified arteries. Much higher cuff pressure may be required to occlude a thickened brachial artery, and diastolic pressure may also be overestimated. Consider pseudohypertension in situations in which no organ damage occurs despite marked hypertension, when patients develop hypotensive systems on medications, and when calcification of the brachial artery is observed on radiologic examination. Direct measurement of intra-arterial pressure may be required in this setting.
Vasoactive substances: Resistant hypertension may be encountered in patients who are ingesting vasoactive substances despite taking antihypertensive drugs regularly. Use of salt and alcohol are the common examples; others include use of cocaine, amphetamines, anabolic steroids, oral contraceptives, cyclosporine, antidepressants, and nonsteroidal anti-inflammatory drugs.
Hypertension in special populations
- Age
- - The systolic pressure continues to progressively rise throughout life, reaching the highest levels in later stages of life. Isolated systolic hypertension may be present in 10% of the population aged 70 years and in 24% of those aged 80 years. Furthermore, severe arteriosclerosis may lead to pseudohypertension. Isolated hypertension results in low cardiac output because of the decreased stroke volume and high peripheral resistance. This may reduce glomerular filtration further, which is why low activity of renal angiotensin aldosterone cascade is encountered in elderly individuals who are hypertensive.
  - Despite low PRA, blood pressure responds well to ACE inhibitor and angiotensin receptor inhibitor therapy. Low doses of diuretics may also be effective. Calcium antagonists are quite useful because of their strong antihypertensive effects. Often, combining 2 drugs at a lower dose may be preferable to using a single drug at a high dose that has the potential for adverse effects.
- Sex: The prevalence of hypertension is similar between men and women, but women are protected from coronary heart disease prior to menopause. Premenopausal women have a higher resting heart rate, a higher cardiac index, and a lower peripheral resistance than men. These changes are not encountered in postmenopausal females. Therefore, in premenopausal situations, a medication such as beta-blocker may be effective. However, postmenopausal hypertension is treated similarly to that in men.
- Race
- - Blacks have a higher prevalence of hypertension and a much higher frequency of end organ damage, such as occurs in end-stage renal disease, strokes, and heart failure. Black patients also develop more severe LVH than white patients. Renal function in hypertensive black patients continues to deteriorate over time despite aggressive management of the blood pressures.
  - Black patients respond less well to beta-blockers, ACE inhibitors, and angiotensin receptor blockers than white patients. At times, this relative lack of efficacy may be overcome by increasing the dosage of the medications. Blacks may respond well to treatment with calcium antagonists, diuretics, and postsynaptic alpha-blockers.
- Obesity
- - Hypertensive patients who are obese have a higher cardiac output and a lower peripheral vascular resistance than hypertensive patients who are not obese. The increase in cardiac output manifests secondary to increased preload. The end-diastolic volume and pressure are elevated, leading to left ventricular dilatation. Left ventricular wall thickening also occurs secondary to increased afterload, which increases the risk of congestive heart failure. The concomitant diabetes often present in patients who are obese produces a devastating effect on kidneys and leads to a much higher incidence of renal failure.
  - No class of drugs seems to be of particular advantage in hypertensive patients who are obese, but thiazide diuretics may be helpful, unless the patient also has coexisting diabetes. In patients who are diabetic and who may have microalbuminuria, ACE inhibitors or calcium antagonists are recommended because they may slow declining renal function. Because of the high preload and afterload, drugs that have negative inotropic effects, such as beta-blockers, should be avoided.
The management of secondary hypertension may result in cure by the surgical correction of the underlying problem, such as removal of a pheochromocytoma. Surgery may not be feasible in a substantial number of patients for whom medical therapy is instituted to control hypertension.
- Renovascular hypertension
- - The goals of therapy are maintenance of normal blood pressure and prevention of end-stage renal disease. The therapeutic options include medical therapy, percutaneous transluminal renal angioplasty, and surgical revascularization. These options must be individualized because no randomized studies document the superiority of one option over the other. The indications for surgery or angioplasty include an inability to control blood pressure while on a medical regimen, the need to preserve renal function, and intolerable effects of medical therapy.
  - Aortal renal bypass using saphenus vein or hypogastric artery is a common revascularization technique. A synthetic graft has also been used. Percutaneous transluminal renal angioplasty (PTRA) can be effective treatment for both hypertension and preservation of renal function. PTRA may be the initial choice in younger patients with fibromuscular lesions amenable to balloon angioplasty. Renal artery stenting of osteal lesions has been associated with improved long-term patency. PTRA may also be used for arthrosclerotic renal artery stenosis; the outcome may be comparable to surgical revascularization. Medical therapy is required in the preoperative phase of interventional therapy. Medical therapy is also indicated for high-risk individuals and for older patients who have easily controlled hypertension.
  - ACE inhibitors are quite effective in patients with unilateral renal artery stenosis; however, avoid ACE inhibitors in patients with bilateral renal artery stenosis or stenosis of a solitary kidney. A diuretic can be combined with an ACE inhibitor. Because of their glomerular vasodilatory effect, calcium antagonists are effective in renal artery stenosis and do not compromise renal function.
- Pheochromocytoma
- - Following suspicion of pheochromocytoma, the presence of a tumor should be confirmed biochemically by measuring urine and plasma concentrations of catecholamine or their metabolites. In most situations, a CT scan or an MRI may be used to localize the tumor in the abdomen. In the absence of abdominal imaging, nuclear scan with metaiodobenzylguanidine (MIBG) may further help with the localization.
  - Surgical resection is the treatment of choice because hypertension is cured by tumor resection. In the preoperative phase, combined alpha- and beta-adrenergic blockade is recommended for hypertension control. Alpha-adrenergic blockade is initiated with phenoxybenzamine or prazosin, and, following adequate alpha-adrenergic blockade, beta-adrenergic blockade is initiated. These patients are often volume contracted and require saline or sodium tablets. Catecholamines can be reduced further by metyrosine. For adrenal pheochromocytoma, laparoscopic adrenalectomy is becoming the procedure of choice in suitable patients. Follow-up 24-hour urinary excretion studies of catecholamines should be performed 2 weeks following surgery (and periodically thereafter) to detect recurrence, metastases, or development of second primary lesion.
- Primary hyperaldosteronism
- - Hyperkalemia is an important clue to the presence of primary aldosteronism. However, in a subset of patients, the serum potassium concentration may be within the reference range. Measurement of PRA has been used as a screening test. A suppressed PRA value that fails to rise above 2 mg/mL/h after salt and water depletion is considered a positive test result. The best initial test is the determination of the aldosterone excretion rate during prolonged salt loading.
  - The appropriate therapy depends on the cause of excessive aldosterone production. A CT scan may help localize an adrenal mass, indicating adrenal adenoma. If the results of the CT scan are inconclusive, adrenal venous sampling for aldosterone and cortisol levels should be performed. Medical therapy is indicated in patients with adrenal hyperplasia, patients with adenoma who are poor surgical risks, and patients with bilateral adenomas. These patients are best treated with sustained salt and water depletion. Hydrochlorothiazide or furosemide in combination with either spironolactone or amiloride corrects hypokalemia and normalizes the blood pressure. Some patients may require the addition of a vasodilator or a beta-blocker for better control of hypertension.
  - Adrenal adenomas may be resected via a laparoscopic procedure. Surgical resection often leads to the control of blood pressure and the reversal of biochemical abnormalities. These patients may develop hypoaldosteronism during the postoperative follow-up period and require supplementation with fludrocortisone.

Surgical Care

Aortorenal bypass using saphenus vein graft or hypogastric artery is a common revascularization technique for renovascular hypertension. Surgical resection is the treatment of choice for pheochromocytoma because hypertension is cured by tumor resection. In patients with fibromuscular renal disease, angioplasty has a 60-80% success rate for cure or improvement of hypertension. Surgical correction of renal artery stenosis has resulted in cure of hypertension in approximately 61% of patients and amelioration in 27% of patients with fibromuscular lesions. With respect to renal artery stenosis secondary to atherosclerotic lesions, surgical correction has resulted in cure of hypertension in 38% of patients and amelioration in about 41% of patients. See Medical Care for more details.

Consultations

Consultations with a nutritionist and exercise specialist are often helpful in changing lifestyle and initiating weight loss. Consultations with an appropriate consultant are indicated for management of secondary hypertension attributable to a specific cause.

Diet

A number of studies have documented an association between sodium chloride intake and blood pressure. The effect of sodium chloride is particularly important in individuals who are middle-aged to elderly with a family history of hypertension. A moderate reduction in sodium chloride intake can lead to a small reduction in blood pressure. The American Heart Association recommends that the average daily consumption of sodium chloride not exceed 6 g, this may lower blood pressure by 2-8 mm Hg.

The Dietary Approaches to Stop Hypertension (DASH) eating plan encompasses a diet rich in fruits, vegetables, and low-fat dairy products and may lower blood pressure by 8-14 mm Hg.²
Dietary potassium, calcium, and magnesium consumption have an inverse association with blood pressures. Lower intake of these elements potentiates the affect of sodium on blood pressure. Oral potassium supplementation may lower both systolic and diastolic pressure. Calcium and magnesium supplementation have elicited small reductions in blood pressures.
In population studies, low levels of alcohol consumption have shown a favorable effect on blood pressure, with reductions of 2-4 mm Hg. However, the consumption of 3 or more drinks per day is associated with elevation of blood pressure. Alcohol intake should be restricted to less than 1 oz of ethanol in men and 0.5 oz in women.
Weight reduction may lower blood pressure by 5-20 mm Hg per 10 kg of weight loss in a patient who weighs more than 10% of ideal body weight.

Activity

Up to 60% of all individuals with hypertension are more than 20% overweight. The centripetal fat distribution is associated with insulin resistance and hypertension. Even modest weight loss (5%) can lead to reduction in blood pressure and improved insulin sensitivity. Regular aerobic physical activity can facilitate weight loss, decrease blood pressure, and reduce the overall risk of cardiovascular disease. Blood pressure may be lowered by 4-9 mm Hg with moderately intense physical activity. These activities include brisk walking for 30 minutes a day, 5 days per week. More intense workouts for 20-30 minutes, 3-4 times a week may also lower blood pressure and have additional health benefits.

ARTICLE SOURCE : www.emedicine.com

CANCER

2008-06-09T09:39:00.001+08:00

Defining Cancer Click Here!

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.
Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.
Cancer types can be grouped into broader categories. The main categories of cancer include:
Carcinoma - cancer that begins in the skin or in tissues that line or cover internal organs.
Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.
Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
Lymphoma and myeloma - cancers that begin in the cells of the immune system.
Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.
(For definitions of other cancer-related terms, see NCI's Dictionary of Cancer Terms.)
Origins of Cancer
All cancers begin in cells, the body's basic unit of life. To understand cancer, it's helpful to know what happens when normal cells become cancer cells.
The body is made up of many types of cells. These cells grow and divide in a controlled way to produce more cells as they are needed to keep the body healthy. When cells become old or damaged, they die and are replaced with new cells.
However, sometimes this orderly process goes wrong. The genetic material (DNA) of a cell can become damaged or changed, producing mutations that affect normal cell growth and division. When this happens, cells do not die when they should and new cells form when the body does not need them. The extra cells may form a mass of tissue called a tumor.
(Image from Understanding Cancer Series: Cancer.)
Not all tumors are cancerous; tumors can be benign or malignant.
Benign tumors aren't cancerous. They can often be removed, and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body.
Malignant tumors are cancerous. Cells in these tumors can invade nearby tissues and spread to other parts of the body. The spread of cancer from one part of the body to another is called metastasis.
Some cancers do not form tumors. For example, leukemia is a cancer of the bone marrow and blood.
Cancer Statistics
A new report from the nation's leading cancer organizations shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002. (Read more about the Annual Report.)
Estimated new cases and deaths from cancer in the United States in 2008:
New cases: 1,437,180 (does not include nonmelanoma skin cancers)
Deaths: 565,650
NCI's Cancer Stat Fact Sheets provide frequently requested cancer statistics for a number of cancer types.
Additional Information
Find a type of cancer:
A to Z List of Cancers
Cancers by Body Location/System
Cancers that are diagnosed with the greatest frequency in the United States are listed below. (Read more about Common Cancer Types.)
Bladder Cancer

Melanoma
Breast Cancer

Non-Hodgkin Lymphoma
Colon and Rectal Cancer

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Endometrial Cancer

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Leukemia

Thyroid Cancer
Lung Cancer

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