Hendri Priyanto Nim. A01301757 PDF
Hendri Priyanto Nim. A01301757 PDF
Disusun oleh :
Hendri Priyanto
A01301757
i
LEMBAR PENGESAHAN PEMBIMBING
Pembimbing
ii
ASUHAN KEPERAWATAN
PEMENUHAN KEBUTUHAN KEAMANAN DAN PERLINDUNGAN:
TERMOREGULASI DENGAN HIPERTERMIA PADA AN. F
DI RUANG MELATI RSUD dr. SOEDIRMAN KEBUMEN
Mengetahui,
iii
Program Studi DIII Keperawatan
Sekolah Tinggi Ilmu Kesehatan Muhammadiyah
KTI, Agustus 2016
Hendri Priyanto1, Bambang Utoyo, M.Kep. Ns.2
ABSTRAK
ASUHAN KEPERAWATAN PEMENUHAN
KEBUTUHAN KEAMANAN DAN PERLINDUNGAN: TERMOREGULASI
DENGAN HIPERTERMIA PADA AN. F DI RUANG MELATI
RSUD dr. SOEDIRMAN KEBUMEN
Kata kunci: kebutuhan rasa aman dan perlindungan, hipertemia, cemas, gangguan pola tidur.
iv
DIPLOMA III OF NURSING PROGRAM
MUHAMMADIYAH HEALTH SCIENCE INSTITUTE OF GOMBONG
Nursing Care Report, August 2016
Hendri Priyanto1, Bambang Utoyo, M.Kep. Ns.2
ABSTRACT
NURSING CARE OF FULFILLING SECURE AND PROTECTION NEED,
THERMOREGULATION (HYPERTHERMIA) TOA CHILD “F” ATMELATI WARD
Dr. SOEDIRMAN STATE HOSPITAL OF KEBUMEN
Keywords: secure and protection need, hyperthermia, anxiety, sleeping pattern disorder
v
KATA PENGANTAR
vi
7. Bapak Hendri Tamara, M.Kep, bapak Sarwono, SKM, bapak Bambang
Utoyo, M.Kep., Ns. Ibu Mardiati, M.Kep Sp. Kep J, dan Ibu Ernawati,
M.Kep selaku Pembimbing dari Sekolah Tinggi Ilmu Kesehatan
Muhammadiyah Gombong beserta seluruh staff dan karyawan yang telah
banyak membantu dalam penyelesaian laporan ini.
8. Kedua orang tua tercinta bapak Gatot Susilo dan ibu Sri Sugiarti yang
selalu memberikan kasih sayang, dukungan baik materi, moral maupun
spiritual dan banyak hal lain yang mungkin tidak bisa disebutkan satu
persatu.
9. Teman-teman seperjuanganku Heri Siswanto, Ikhlas Arif Mukhtamar,
Janrizky Praerda syandi, Imam sechudin, Imam Kurniawan, Ludi Nur
Kurniawan di kelas 3 B Program Studi DIII Keperawatan STIKes
Muhammadiyah Gombong yang senantiasa selalu membantu dan
mendukung penulis dalam memenuhi target dalam menempuh studi.
10. Kekasih tercinta Siti Mahfiyah, Amd. Keb. yang selalu memberikan
motivasi, perhatian dan kasih sayang sehingga makalah ini dapat
terselesaikan.
Penulis
vii
DAFTAR ISI
HALAMAN JUDUL............................................................................... i
LEMBAR PENGESAHAN PEMBIMBING .......................................... ii
LEMBAR PENGESAHAN PENGUJI ................................................... iii
ABSTRAK .............................................................................................. iv
ABSTRACK . ......................................................................................... v
KATA PENGANTAR ............................................................................ vi
DAFTAR ISI ........................................................................................... viii
BAB I PENDAHULUAN ..................................................................... 1
A. Latar Belakang ..................................................................... 1
B. Tujuan ................................................................................... 4
C. Manfaat ................................................................................. 5
BAB II TINJAUAN PUSTAKA............................................................. 6
A. Konsep Termoregulasi ........................................................ 6
1. Definisi .......................................................................... 6
2. Jenis-Jenis Termoregulasi ............................................. 6
3. Faktor-Faktor Yang Mempengaruhi Suhu Tubuh ......... 7
4. Temperatur Suhu Tubuh ............................................... 8
B. Konsep Dasar Hipertermia ................................................... 9
1. Definisi Demam ............................................................ 9
2. Etiologi Demam ............................................................ 10
3. Dampak Demam............................................................ 12
4. Patofisiologi Demam ..................................................... 13
5. Klasifikasi Demam ........................................................ 14
6. Gambaran Klinis Demam ............................................. 16
7. Penanganan Demam ...................................................... 17
8. Pencegahan Hipertermia Pada Anak. ............................ 21
C. Inovasi Tindakan Dengan Bawang Merah ........................... 21
BAB III RESUME KEPERAWATAN ................................................... 24
A. Pengkajian ............................................................................. 24
viii
1. Identitas Klien ................................................................ ` 24
2. Riwayat Kesehatan ......................................................... 24
3. Pengkajian Fokus ........................................................... 25
B. Analisa Data .......................................................................... 27
C. Intervensi, Implementasi, Evaluasi ....................................... 27
BAB IV PEMBAHASAN ....................................................................... 31
A. Asuhan Keperawatan............................................................ 31
A. Analisa Inovasi Tindakan Keperawatan ............................... 39
Bab V PENUTUP ................................................................................... 42
A. Kesimpulan........................................................................... 42
B. Saran ..................................................................................... 43
DAFTAR PUSTAKA
ix
1
BAB I
PENDAHULUAN
A. Latar Belakang
Berdasarkan penelitian dari Badan Kesehatan Dunia (WHO)
dijelaskan bahwa nilai kasus demam diseluruh dunia mencapai 18-34 juta
jiwa per tahun, anak merupakan paling rentang terkena demam, meskipun
gejala yang diderita anak bisa lebih ringan dari dewasa. Kejadian demam
banyak terjadi pada anak usia 5-19 tahun hampir disemua daerah. Sedangkan
di Indonesia yang merupakan negara berkembang tidak jarang ditemui anak
yang menderita demam, hal ini bisa terjadi karena adanya pergantian cuaca
dari musim hujan kemusim kemarau ataupun sebaliknya (Suriadi, 2010).
Sedangkan menurut hasil penelitian dari Departemen Kesehatan
Republik Indonesia tahun 2010 mengemukakan bahwa anak yang berusia 5
sampai 15 tahun angka kejadian demam yang terjadi mencapai 11,66% atau
28.594.060 orang. Dalam penelitian yang sudah dilakukan di RSUD Tugurejo
Semarang pada tahun 2010 kejadian demam pada anak sudah mencapai 971
pasien anak. (Nugroho, 2011).
Namun kania (2007) mengemukakan bahwa seringkali demam pada
anak menimbulkan rasa ketakutan yang berlebihan yang tersendiri (fobia)
bagi banyak ibu. Hasil penelitian menunjukkan hampir 80% orang tua
mempunyai fobia demam. Banyak orang tua yang mengira bahwa bila tidak
diobati, demam anaknya akan semakin tinggi. Karena teori ataupun ide yang
salah ini, banyak orang tua mengobati demam ringan yang sebetulnya tidak
perlu diobati.
Hipertermia merupakan suatu peningkatan suhu tubuh yang berkaitan
dengan ketidaksanggupan atau ketidakmampuan tubuh untuk menghilangkan
panas ataupun mengurangi produksi panas. Demam juga bisa diartikan
sebagai suatu gejala penyakit atau infeksi dimana ketika kondisi otak
membatasi suhu di atas pengaturan normal yaitu di atas 380C. Suhu tubuh
yang normal adalah antara 36ºC sampai 37ºC. Jika anak demam dengan
1
2
temperatur yang diukur melalui mulut atau telinga 37,8ºC atau melalui
rektum 38ºC dan 37,2ºC melalui ketiak, kemungkinannya anak terserang
demam. Anak-anak biasanya terserang demam lebih tinggi dari pada orang
dewasa. Akibat tuntutan peningkatan pengaturan tersebut maka tubuh akan
memproduksi panas. (Purwanti, 2008).
Penyebab demam umumnya karena adanya infeksi virus, paparan
panas yang berlebihan (overhating), adanya suatu pelepasan zat pirogen
(Pirogen adalah suatu zat yang menyebabkan demam atau bahan yang
dibentuk oleh mikroorganisme) dari dalam lekosit atau sel darah putih
(bertugas melindungi tubuh agar tahan menghadapi serangan kuman), adanya
proses infeksi, adanya peningkatan suhu pada 0-72 jam, dehidrasi atau
kekurangan cairan, menurunnya kemampuan untuk berkeringat, aktivitas
yang berlebihan, maupun dikarenakan gangguan sistem imun (Purwanti,
2008).
Dampak bisa ditimbulkan oleh adanya demam ada dua macam yaitu
sisi positif dan sisi negatif. Sisi positif demam adalah sebagai mekanisme
pertahanan yang dibutuhkan sebagai salah satu bentuk perlawanan tubuh
terhadap infeksi, namun terjadinya demam juga disertai dengan hal-hal yang
negatif. Sedangkan dampak negatif demam meliputi hal-hal yang harus
diberikan perhatikan yang tinggi pada orang tua yang di antaranya:
peningkatan resiko dehidrasi, kemungkinan bisa kekurangan oksigen, demam
di atas 420c sangat jarang sekali menyebabkan kerusakan neurologis
(kerusakan saraf), kejang demam, demam seringkali diikuti dengan gejala lain
seperti lemas, nyeri otot sakit kepala, dan menurunnya nafsu makan.
(Purwanti, 2008).
Awal mula terjadinya peningkatan suhu tubuh adalah ketika timbul
infeksi bakteri virus atau juga cidera jaringan yang menimbulkan radang atau
inflamasi (satu dari respon utama system kekebalan terhadap infeksi dan
iritasi). Akumulasi atau pengumpulan sel darah putih seperti monosit,
makrofag, sel T helper serta fibroblas (fibroblas merupakan suatu elemen
utama pada proses perbaikan untuk pembentukan protein struktural yang
3
dikaji kondisi klien terlihat lemah. Klien hanya bisa berbaring di tempat tidur,
badan teraba hangat, mukosa bibir kering. Dari hasil pemeriksaan tanda tanda
vital didapatkan hasil tekanan darah 100/60 mmHg, nadi 105 kali permenit,
pernafasan 36 kali permenit, suhu: 38,2oC. Keadaan tersebut menandakan
peningkatan suhu tubuh yang dikatakan hipertermi.
Untuk itu penulis sangat tertarik untuk mengambil kasus ini dalam
suatu asuhan keperawatan yang berjudul “Asuhan Keperawatan Pemenuhan
Kebutuhan Kemanan dan perlindungan: Thermoregulasi Dengan Hipertermi
Pada An.F di Ruang Melati RSUD Dr. Soedirman Kebumen”.
B. Tujuan
1. Tujuan Umum
Tujuan umum penulisan karya tulis ini adalah untuk
mendeskripsikan atau menjelaskan asuhan keperawatan pemenuhan
keamanan dan perlindungan: termoregulasi dengan hipertermi pada An. F
di ruang Melati RSUD dr. Soedirman Kebumen.Mahasiswa mampu
memberikan wawasan dan pengetahuan tentang penanganan hipertermi
pada anak.
2. Tujuan Khusus
a. Mendeskripsikan pengkajian pada klien dengan gangguan
termoregulasi dengan hipertermi pada An. F
b. Mendeskripsikan analisa data dan diagnosa keperawatan pada klien
dengan gangguan termoregulasi dengan hipertermi pada An. F
c. Mendeskripsikan intervensi keperawatan dalam upaya pemenuhan
kebutuhan termoregulasi dengan hipertermi pada An. F
d. Mendeskripsikan implementasi keperawatan pada klien dengan
gangguan termoregulasi dengan hipertermi pada An. F
e. Mendeskripsikan evaluasi tindakan keperawatan pemenuhan
kebutuhan termoregulasi dengan hipertermi pada An. F
f. Mendeskripsikan analisa tindakan pada klien dengan gangguan
termoregulasi dengan kompres hangat, pemberian infus paracetamol
pada An. F
5
C. Manfaat
1. Manfaat Keilmuan
a. Bagi Instansi
Menjadi wacana dan bahan masukan dalam proses belajar mengajar
terhadap pemberian asuhan keperawatan pada klien dengan
pemenuhan kebutuhan temoregulasi
b. Bagi Rumah Sakit
Dapat digunakan sebagai masukan dalam menentukan tindakan
preventif dengan memberikan penyuluhan meliputi berbagai hal
yang dapat mencegah timbulnya penyakit demam
c. Bagi klien dan keluarga
Sebagai media informasi tentang demam dan cara penanganan
pasien demam serta peningkatan kebutuhan nutrisi pada anak yang
mengalami peningkatan suhu tubuh.
2. Manfaat Aplikatif
Manfaat aplikatif karya ilmiah ini diharapkan dapat memberikan
informasi mengenai inovasi keperawatan dengan cara alternatif dalam
menangani demam (hipertermia) pada anak yaitu dengan bawang merah.
DAFTAR PUSTAKA
Disusun oleh :
Hendri Priyanto
A01301757
2016
SATUAN ACARA PENYULUHAN
TENTANG DEMAM FEBRIS
A. IDENTIFIKASI MASALAH
Berdasarkan penelitian dari Badan Kesehatan Dunia (WHO)
dijelaskan bahwa nilai kasus demam di seluruh dunia mencapai 18-34 juta
jiwa pertahun, anak merupakan paling rentang terkena demam, meskipun
gejala yang diderita anak bisa lebih ringan dari dewasa. Kejadian demam
banyak terjadi pada anak usia 5-19 tahun hampir disemua daerah.
Sedangkan di Indonesia yang merupakan negara berkembang tidak jarang
ditemui anak yang menderita demam, hal ini bisa terjadi karena adanya
pergantian cuaca dari musim hujan ke musim kemarau ataupun sebaliknya.
(Suriadi, 2010).
B. TUJUAN
1. Tujuan Instruksional Umum ( TIU )
Setelah mengikuti kegiatan penyuluhan diharapkan keluarga dapat
memahami dan mengerti tentang febris atau demam.
2. Tujuan Instruksional Khusus ( TIK )
Setelah mengikuti kegiatan penyuluhan, diharapkan keluarga mampu:
a. mengetahui tentang pengertian demam,
b. mengetahui tentang penyebab demam,
c. mengetahui tentang tanda dan gejala demam,
d. mengetahui tentang dampak demam,
e. mengetahui tentang cara mengatasi demam ketika dirumah,
f. mengetahui tentang pencegahan demam
C. Materi
1. Pengertian demam
2. Penyebab demam
3. Tanda dan gejala demam
4. Dampak demam
5. Cara penanganan demam dirumah
6. Pencegahan demam
D. Metode Penyuluhan
1. Ceramah
2. Tanya Jawab
E. Media
1. Materi SAP
2. Leaflat
3. Lembar balik
F. SETTING TEMPAT
Keterangan:
: perawat
G. Kegiatan Pembelajaran
No. Waktu Kegiatan Penyuluhan Kegiatan Peserta
1 3 menit Pembukaan: Menjawab salam
1. Memberikan salam 2. Mendengarkan
2. Menjelaskan tujuan dan
pembelajaran memperhatikan
3. Kontrak waktu
4. Menyebutkan materi atau pokok
bahasan yang di sampaikan
2 10 menit Pelaksanaan materi: Menyimak dan
Menjelaskan materi penyuluhan memperhatikan
secara berurutan dan teratur.
Materi:
1. Pengertian demam
2. Penyebab demam
3. Tanda dan gejala demam
4. Dampak demam
5. Cara penanganan demam
dirumah
6. Pencegahan demam
3 5 menit Evaluasi : Bertanya dan
1. Menyimpulkan isi penyuluhan menjawab
2. Memberi kesempatan untuk pertanyaan
bertanya.
3. Memberikan kesempatan untuk
menjawab pertanyaan yang
dilontarkan.
Sasaran Mahasiswa
Mengetahui,
DAFTAR PUSTAKA
Nurlaili Susanti
ABSTRACT
Heat balance
Shivering Conduction
Thyroxin Convection
Q10 Effect
kompres dingin efektif untuk mengatasi Dalal, Shalini & Zhukovsky, Donna S.
2006. Pathophysiology and
hipertermia, karena dapat menurunkan
Management of Fever. The
temperature kulit dengan cepat. Akan Journal of Supportive Oncology.
Volume 4, Number 1: 9-16.
tetapi tidak efektif untuk mengatasi
demam karena memicu terjadinya Edwards, Helen E, et all. 2005. Fever
Management Practice : What
vasokonstriksi dan shivering. Paediatric Nurses Say. Nursing
Sedangkan pemakaian kompres hangat and Health Sciences. volume 3,
Number 3 : 119-130.
efektif untuk mengatasi demam memicu
Kayman H. 2003. Management of
vasodilatasi yang dapat meningkatkan
Fever: Making Evidence-based
pengeluaran panas tubuh. Pemakaian Decisions. Clinical Pediatrics.
Volume 42, Number 383.
kompres hangat dianjurkan sebagai
terapi kombinasi dengan antipiretik Kelly, Greg. 2006. Body Temperature
Variability (Part 1): A Review
untuk membantu menurunkan of the History of Body
temperature tubuh. Temperature and its Variability
Due to Site Selection, Biological
Rhythms, Fitness, and Aging.
DAFTAR PUSTAKA Alternative Medicine Review.
Volume 11, Number 4. Page
Axelrod, Peter. 2000. External Cooling 278-293.
in the Management of Fever.
Clinical Infectious Disease. Porat, Reuven & Dinarello, Charles A.
Volume 31 (Suppl 5) 2004. Pathophysiology and
Treatment of Fever in Adults,
Bajhatia, Neeraj, et all. 2009. Metabolic (Online),
Benefits of Surface Counter http://www.utdol.com/applicatio
Warming during Therapeutic n/topic/print.asp?
Temperature Modulation. file=othr_inf/16086. Diakses
Critical Care Medicine. Volume tanggal 1 September 2011.
37, Number 6 : 1893-1897.
Barone, James E. 2009. Fever : Fact and
Fiction. The Journal of Trauma.
Volume 67, Number 2 : 406-
409.
Boulant, Jack A. 2000. Role of the
Preoptic-Anterior Hypothalamus
in Thermoregulation and Fever.
Clinical Infectious Disease.
volume 31(suppl 5), page 157-
161.
Oleh:
dr. Nia Kania, SpA., MKes 1
PENDAHULUAN
Demam pada anak merupakan hal yang paling sering dikeluhkan oleh orang tua mulai di
ruang praktek dokter sampai ke unit gawat darurat (UGD) anak, meliputi 10-30% dari jumlah
kunjungan. Demam membuat orang tua atau pengasuh menjadi risau.1,2 Sebagian besar anak-
anak mengalami demam sebagai respon terhadap infeksi virus yang bersifat self limited dan
berlangsung tidak lebih dari 3 hari atau infeksi bakteri yang tidak memerlukan perawatan di
rumah sakit. Akan tetapi sebagian kecil demam tersebut merupakan tanda infeksi yang serius
dan mengancam jiwa seperti pneumonia, meningitis, artritis septik dan sepsis. Hal ini
merupakan tantangan bagi dokter untuk mengidentifikasi penyebab demam tersebut.2,3
Pendekatan penatalaksanaan demam pada anak bersifat age dependent karena infeksi
yang terjadi tergantung dengan maturitas sistem imun di kelompok usia tertentu.3 Penilaian
awal pada saat anak dibawa ke rumah sakit akan membantu menentukan beratnya penyakit
anak dan urgensi pengobatannya.4
Berkaitan dengan hal tersebut diatas dalam sari kepustakaan ini akan di bahas
penatalaksanaan demam yang meliputi definisi dan patofisiologi demam, cara pengukuran,
penilaian awal, penatalaksaan demam dan kondisi khusus akibat demam.
DEFINISI
Menurut kamus kedokteran Stedman’s edisi ke-25, demam adalah peningkatan suhu tubuh
diatas normal (98,6o F/ 370 C). Sedangkan menurut edisi ke-26 dalam kamus yang sama,
demam merupakan respon fisiologis tubuh terhadap penyakit yang di perantarai oleh sitokin
dan ditandai dengan peningkatan suhu pusat tubuh dan aktivitas kompleks imun. Dalam
protokol Kaiser Permanente Appointment and Advice Call Center definisi demam untuk
semua umur, demam didefinisikan temperatur rektal diatas 380 C, aksilar diatas 37,50 C dan
diatas 38,2o C dengan pengukuran membran timpani 5 , sedangkan demam tinggi bila suhu
tubuh diatas 39,50 C dan hiperpireksia bila suhu > 41,10 C.3,6
PATOFISIOLOGI DEMAM
Suhu tubuh secara normal dipertahankan pada rentang yang sempit, walaupun terpapar suhu
lingkungan yang bervariasi. Suhu tubuh secara normal berfluktuasi sepanjang hari, 0,50 C
dibawah normal pada pagi hari dan 0,5 0 C diatas normal pada malam hari.3 Suhu tubuh diatur
oleh hipotalamus yang mengatur keseimbangan antara produksi panas dan kehilangan panas.
Produksi panas tergantung pada aktivitas metabolik dan aktivitas fisik. Kehilangan panas
terjadi melalui radiasi, evaporasi, konduksi dan konveksi. Dalam keadaan normal termostat di
hipotalamus selalu diatur pada set point sekitar 37 0 C, setelah informasi tentang suhu diolah di
hipotalamus selanjutnya ditentukan pembentukan dan pengeluaran panas sesuai dengan
perubahan set point. 5,7
Hipotalamus posterior bertugas meningkatkan produksi panas dan mengurangi
pengeluaran panas. Bila hipotalamus posterior menerima informasi suhu luar lebih rendah dari
1
Disampaikan pada acara Siang Klinik Penanganan Kejang Pada Anak, Bandung, 12 Februari 2007
1
suhu tubuh maka pembentukan panas ditambah dengan meningkatkan metabolisme dan
aktivitas otot rangka dalam bentuk menggigil dan pengeluaran panas dikurangi dengan
vasokontriksi kulit dan pengurangan produksi keringat sehingga suhu tubuh tetap
dipertahankan tetap. Hipotalamus anterior mengatur suhu tubuh dengan cara mengeluarkan
panas. Bila hipotalamus anterior menerima informasi suhu luar lebih tinggi dari suhu tubuh
maka pengeluaran panas ditingkatkan dengan vasodilatasi kulit dan menambah produksi
keringat.5,7
Umumnya peninggian suhu tubuh terjadi akibat peningkatan set point. Infeksi bakteri
menimbulkan demam karena endotoksin bakteri merangsang sel PMN untuk membuat pirogen
endogen yaitu interleukin-1, interleukin 6 atau tumor nekrosis faktor. Pirogen endogen bekerja
di hipotalamus dengan bantuan enzim siklooksigenase membentuk protaglandin selanjutnya
prostaglandin meningkatkan set point hipotalamus. Selain itu pelepasan pirogen endogen
diikuti oleh pelepasan cryogens (antipiretik endogen) yang ikut memodulasi peningkatan suhu
tubuh dan mencegah peningkatan suhu tubuh pada tingkat yang mengancam jiwa.5,7
Kualitas tangisan Kuat atau senang Merengek atau terisak Lemah atau melengking
Stimulasi orang tua Tangisan segera Tangisan hilang timbul Terus menangis atau
berhenti/tidak menangis tangisan bertambah
keras
Variasi keadaan Bila bangun tetap Mata segera menutup Terus tertidur atau
terbangun atau bila tidur lalu terbangun atau Tidak terstimulasi
dan distimulasi anak terbangun dengan
segera bangun stimulasi yang lama
2
Hasil studi prospektif penggunaan skala tersebut diatas, pada anak usia < 2 tahun
sebanyak 312 anak yang mengalami demam, anak yang mempunyai nilai lebih dari 16
ternyata menderita penyakit yang serius.9
Pemeriksaan penunjang dilakukan pada anak yang mengalami demam bila secara
klinis faktor risiko tampak serta penyebab demam tidak diketahui secara spesifik. Pemeriksaan
penunjang yang dapat dilakukan yaitu:
1. Pemeriksaan awal
Darah rutin, urin dan feses rutin, morfologi darah tepi, hitung jenis lekosit
2. Pemeriksaan atas indikasi
Kultur darah, urin atau feses, pengambilan cairan serebro spinal, toraks foto.6
PENATALAKSANAAN
Pada prinsipnya demam dapat menguntungkan dan dapat pula merugikan. Pada tingkat
tertentu demam merupakan bagian dari pertahanan tubuh antara lain daya fagositosis
meningkat dan viabilitas kuman menurun, tetapi dapat juga merugikan karena anak menjadi
gelisah, nafsu makan dan minum berkurang, tidak dapat tidur dan menimbulkan kejang
demam.3
Hasil penelitian ternyata 80% orangtua mempunyai fobia demam. Orang tua mengira
bahwa bila tidak diobati, demam anaknya akan semakin tinggi. Kepercayaan tersebut tidak
terbukti berdasarkan fakta. Karena konsep yang salah ini banyak orang tua mengobati demam
ringan yang sebetulnya tidak perlu diobati.1 Demam < 390 C pada anak yang sebelumnya sehat
pada umumnya tidak memerlukan pengobatan. Bila suhu naik > 39 0 C, anak cenderung tidak
nyaman dan pemberian obat-obatan penurun panas sering membuat anak merasa lebih baik.3
Pada dasarnya menurunkan demam pada anak dapat dilakukan secara fis ik, obat-
obatan maupun kombinasi keduanya.3,5
1. Secara Fisik
a) Anak demam ditempatkan dalam ruangan bersuhu normal
b) Pakaian anak diusahakan tidak tebal
c) Memberikan minuman yang banyak karena kebutuhan air meningkat
d) Memberikan kompres.
2. Obat-obatan
Pemberian obat antipiretik merupakan pilihan pertama dalam menurunkan demam dan sangat
berguna khususnya pada pasien berisiko, yaitu anak dengan kelainan kardiopulmonal kronis,
kelainan metabolik, penyakit neurologis dan pada anak yang berisiko kejang demam.3
Obat-obat anti inflamasi, analgetik dan antipiretik terdiri dari golongan yang
bermacam-macam dan sering berbeda dalam susunan kimianya tetapi mempunyai kesamaan
dalam efek pengobatannya. Tujuannya menurunkan set point hipotalamus melalui pencegahan
pembentukan prostaglandin dengan jalan menghambat enzim cyclooxygenase.7,11,12
Asetaminofen merupakan derivat para-aminofenol yang bekerja menek an
pembentukan prostaglandin yang disintesis dalam susunan saraf pusat. Dosis terapeutik antara
10-15 mgr/kgBB/kali tiap 4 jam maksimal 5 kali sehari. Dosis maksimal 90 mgr/kbBB/hari.
Pada umumnya dosis ini dapat ditoleransi dengan baik. Dosis besar jangka lama dapat
3
menyebabkan intoksikasi dan kerusakkan hepar. Pemberiannya dapat secara per oral maupun
rektal.11-13
Turunan asam propionat seperti ibuprofen juga bekerja menekan pembentukan
prostaglandin. Obat ini bersifat antipiretik, analgetik dan antiinflamasi. Efek samping yang
timbul berupa mual, perut kembung dan perdarahan, tetapi lebih jarang dibandingkan aspirin.
Efek samping hematologis yang berat meliputi agranulositosis dan anemia aplastik. Efek
terhadap ginjal berupa gagal ginjal akut (terutama bila dikombinasikan dengan asetaminopen).
Dosis terapeutik yaitu 5-10 mgr/kgBB/kali tiap 6 sampai 8 jam.11
Metamizole (antalgin) bekerja menekan pembentukkan prostaglandin. Mempunyai
efek antipiretik, analgetik dan antiinflamasi. Efek samping pemberiannya berupa
agranulositosis, anemia aplastik dan perdarahan saluran cerna. Dosis terapeutik 10
mgr/kgBB/kali tiap 6-8 jam dan tidak dianjurkan untuk anak kurang dari 6 bulan.
Pemberiannya secara per oral, intramuskular atau intravena.11
Asam mefenamat suatu obat golo ngan fenamat. Khasiat analgetiknya lebih kuat
dibandingkan sebagai antipiretik. Efek sampingnya berupa dispepsia dan anemia hemolitik.
Dosis pemberiannya 20 mgr/kgBB/hari dibagi 3 dosis. Pemberiannya secara per oral dan tidak
boleh diberikan anak usia kurang dari 6 bulan.11
KEJANG DEMAM
Kejang demam merupakan keadaan yang umum ditemukan pada anak khususnya usia 6 bulan
sampai 5 tahun. Insidensinya di Amerika sekitar 2-4% dari seluruh kelainan neurologis pada
anak.15 Walaupun 30% dari seluruh kasus kejang pada anak adalah kejang demam tetapi
masih banyak penyebab lain dari kejang sehingga kejang demam tidak dapat didiagnosis
4
sembarangan, karena penyebab lain demam dan kejang yang serius seperti meningitis harus
disingkirkan.4
Banyak klinisi yang mengobati demam dengan pemberian parasetamol untuk
mencegah kejang demam. Dari penelitian pada 104 anak, dimana satu kelompok diberikan
profilaksis parasetamol dan kelompok lain diberikan parasetamol secara sporadis didapatkan
hasil pemberian parasetamol profilaksis tidak efektif bila dibandingkan kelompok lainnya
dalam mencegah kejang demam yang rekuren.15 Sedangkan penelitian Uhari dkk.
menunjukkan pemberian asetaminofen dan diazepam per oral menunjukkan hasil yang baik
dalam mencegah rekurensi kejang demam.16
KESIMPULAN
Demam pada umumnya merupakan respon tubuh terhadap suatu infeksi. Umur anak dan tanda
serta gejala yang muncul sangat penting dalam menentukan kemungkinan adanya penyakit
yang serius. Penilaian awal akan membantu menentukan beratnya penyakit anak dan urgensi
pengobatannya. Pemberian antipiretik merupakan terapi alternatif dalam penatalaksanaan
demam pada anak.
5
DAFTAR PUSTAKA
6
Lampiran 1. Algoritma Tatalaksana demam pada Anak < 3 tahun
TidakToksis Toksis
Rawat
Periksa kultur: Darah, urin dan LCS
Pertimbangkan antibiotika parenteral
7
Vol: 4, No. 2, September 2015 ISSN: 2302 - 2949
Abstrak—Radiasi gelombang elektromagnetik pada alat terapi hypherthermia digunakan secara klinis
untuk memanaskan jaringan dalam tubuh manusia. Peningkatan temperatur tidak diikuti oleh jaringan luar
tubuh. Penggunaan gelombang elektromagnetik pada frekuensi 915 dan 2450 MHz telah terbukti dan
banyak digunakan dalam hypherthermia. Perancangan modifikasi antenna kupu – kupu panjang dilakukan
dengan simulasi menggunakan metoda elemen hingga. Hasil simulasi menunjukan modifikasi antenna
dapat bekerja pada kedua frekuensi hypherthermia. Bentuk optimal antena menghasilkan nilai return loss
(RL) -16.6295dB pada frekuensi 915 MHz dan -18.2697dB pada frekuensi 2450 MHz.
Abstract— Therapy device of Electromagnetic Wave radiation hypherthermia used clinically to heat
tissue in the human body. Increased temperatures are not followed by tissue outside the body. The use of
electromagnetic waves at frequencies 915 and 2450 MHz has been proven and widely used in
hypherthermia. The design modifications butterfly antenna done by simulation using finite element method.
The simulation results show the modification of antenna can work in both frequency hypherthermia.
Optimal shape of the antenna produce 'return loss' (RL) -16.6295 dB at a frequency of 915 MHz and -
18.2697 dB at frequency 2450 MHz.
2. TINJAUAN PUSTAKA
RL [dB]
panjang untuk mendapatkan hasil yang -10
maksimal dalam rentang frekunesi radiasinya. -20
Untuk modifikasi antenna kupu-kupu dilakukan -30
pada sisi tertentu yang menyangkut panjang dan -40
300
600
900
1200
1500
1800
2100
2400
2700
3000
luas tangkapan atau radiasi gelombang, yaitu sisi
flare angle dan side angle adapun bentuk sisi 9…
perancangan modifikasi antenna kupu-kupu Freq [MHz]
menjadi antenna kupu-kupu panjang seperti
terlihat pada gambar berikut. Gambar 5. Hasil Simulasi Return Loss |S11| Vs.
Frequency [Perbandingan Flare Angle Kupu –
Kupu Panjang]
-20
-30
(a) (b) (c) -40
300
600
900
1500
2700
1200
1800
2100
2400
3000
1…
Gambar. 4. Modifikasi Flare Angle 2…
Freq [MHz]
Gambar 7. Hasil Simulasi Return Loss |S11|
Vs. Frequency
[Perbandingan Side Angle Antena Kupu –
Kupu Panjang]
Tabel 1. Hasil Simulasi Return Loss in 915 Antena kupu-kupu panjang yang telah
MHz and 2450 Mhz dirancang untuk bekerja pada dua frekuensi
915MHz dan 2450 MHz diperlihatkan oleh
Antenna Return Loss [RL]
gambar 8 diatas.
Parameter 915 MHz 2450 Mhz
Flare Angle
4. HASIL DAN PEMBAHASAN
90 Degree -13.8161 -3.1261
120 Degree -16.3864 -7.5353
Pengujian beberapa parameter untuk melihat
150 Degree -18.0334 -15.1285
kualitas antenna kupu-kupu panjang hasil
Side Angle rancangan adalah sebagai berikut.
10 Degree -18.0334 -15.1285
20 Degree -17.2404 -9.4930
4.1 Perhitungan Return Loss
30 Degree -14.8988 -7.2288
Perhitungan utama parameter sebuah
antenna dengan mengetahui Return Loss dari
Table 1 diatas secara detail menunjukkan antenna tersebut.
nilai RL (Return Loss) untuk masing-masing
modifikasi side angle dan flare angle. Nilai
terbaik yang menunjukkan kriteria RL adalah 0
yang bernilai ≤ -15dB. Dari nilai tersebut, maka -10
RL [dB]
Tabel 3. Perbandingan hasil simulasi nilai Tabel 4. Perbandingan hasil simulasi nilai
Return Loss (RL) antenna pada frekuensi 915 impedansi antenna pada frekuensi 915 MHz dan
MHz dan 2450 Mhz 2450 Mhz
Return Loss [dB] VSWR
Antena Antena
915 MHz 2450 MHz 915 MHz 2450 MHz
Kupu – kupu -10.6595 -2.4024 Kupu –kupu 1.8293 7.2770
Kupu – kupu Kupu kupu
-16.6295 -18.2697 1.3458 1.2780
Panjang Panjang
Dari Tabel 3 dapat dilihat dengan jelas hasil Perhitungan nilai VSWR dari antenna
perbandingan antenna kupu-kupu dengan kupu-kupu panjang juga menunjukkan nilai yang
antenna rancangan kupu-kupu panjang. Hasilnya cukup baik seperti tercatat didata nilai Tabel 4
menunjukkan nilai yang sangat baik, dimana diatas. Nilai VSWR antenna yang berkualitas
nilai return loss dari antenna kupu-kupu panjang adalah bernilai 1. Sedangkan yang didapat masih
berada di nilai ≤ -15dB. Dimana nilai tersebut sedikit lebih sebesar 0.2 hingga 0.35 dari 1. Ini
menunjukkan RL antenna kupu-kupu panjang menunjukkan bahwa antenna kupu-kupu
berada pada kualitas baik sebuah antenna. panjang yang dirancnag masih terdapat sedikit
losses pantulan dari antenna meskipun kecil
4.2 Perhitungan VSWR sekali.
Pengujian parameter antenna berikut adalah
dengan menghitung nilai ratio perbandingan 4.3 Perhitungan Impedansi
tegangan sepanjang transmisi antenna. Parameter berikutnya adalah pengujian
impedansi dari antenna. Impedansi merupakan
10 parameter penting untuk membuat antenna dapat
B… dihubung dengan rangkaian luar. Semakin kecil
8 impedansi semakin kecil losses antenna dan
VSWR
0 400
300
600
900
1200
1500
1800
2100
2400
2700
3000
300
200
[Ω]
Fatmawati Mohamad
Email : rifka_waty@yahoo.co.id
Staf Dosen Jurusan Keperawatan Politeknik Kesehatan Kemenkes Gorontalo
ABSTRAK
Demam (hipertermi) adalah suatu keadaan dimana suhu tubuh lebih tinggi dari biasanya,
dan merupakan gejala dari suatu penyakit. Menurunkan atau tepatnya mengendalikan dan
mengontrol demam pada anak dapat dilakukan dengan berbagai cara, salah satunya adalah
dengan cara kompres hangat.
Penelitian ini bertujuan untuk mengidentifikasi efektifitas kompres hangat dalam
menurunkan demam pada pasien thypoid abdominalis di Ruang G1(anak) Lt.2 RSUD. Prof. Dr.
Hi. Aloei Saboe Kota Gorontalo.
Metode penelitian yang digunakan adalah quasi eksperimen. Jumlah responden sebanyak
19 orang, yang diobservasi sebelum dan setelah dilakukan tindakan kompres hangat. Penelitian
ini menggunakan metode purposive sampling, dengan menggunakan kriteria inklusi. Analisis
data pada penelitian ini menggunakan uji statistik “Sign test.”
Hasil penelitian: ∑ b (x ; n , p) < 0,05 = ∑ b (5 ; 19 , ½) < 0,05 = 0,0318 < 0,05.
Kesimpulan; H0 ditolak, yang artinya tindakan kompres hangat efektif dalam menurunkan
demam pada pasien thypoid abdominalis di ruang G1(anak) Lt.2 RSUD. Prof. Dr. Hi. Aloei
Saboe Kota Gorontalo.
a. Ket:
x = 5 (banyaknya tanda positif atau negatif yang paling sedikit)
n = 19 (banyaknya sampel/ responden)
p = ½ (probabilitas/ peluang diterima atau ditolak H0)
b. Penyelesaian
= ∑ b (x ; n , p) < 0,05
= ∑ b (5 ; 19 , ½) < 0,05
= 0,0318
c. Kesimpulan
Dari cara penyelesaian di atas, didapatkan nilai ∑ b (x ; n , p) < 0,05 (0,0318 < 0,05).
Sehingga dapat ditarik kesimpulan bahwa: pernyataan H0 ditolak, yang artinya
peryataan bahwa tindakan kompres hangat dapat menurunkan demam pada pasien
demam thypoid dapat diterima.
Berdasarkan hasil penelitian tentang kompres dilakukan tindakan kolaborasi dengan tim
hangat yang dilakukan pada 19 responden medis.
yang mengalami demam tifoid, terdapat 14 Tindakan kompres hangat merupakan tindakan
responden yang hasilnya menunjukkan yang cukup efektif dalam menurunkan
penurunan suhu tubuh dan 5 responden demam. Oleh karena itu, sebaiknya
lainnya tidak menunjukkan penurunan suhu penggunaan antipiretik tidak diberikan secara
tubuh. Hal ini dikarenakan, 5 responden otomatis pada setiap keadaan demam. Dalam
tersebut merupakan pasien dengan diagnosa hasil penelitian Purwanti (2008) ditekankan
demam thypoid H-0 yang masa infeksinya bahwa, obat penurun panas hanya diberikan
masih tinggi, dimana demam yang dialami pada anak dengan suhu di atas 38,50C atau bila
oleh pasien tersebut juga sulit untuk anak tersebut merasa tidak nyaman
menunjukkan penurunan suhu tubuh. Oleh (uncomfortable), selain dari itu sebaiknya
karena itu, untuk pasien dengan demam jangan dulu dilakukan pemberian antipiretik.
thypoid H-0 yang masa infeksinya maupun Hal ini senada dengan teori Hartanto (2003)
demamnya masih tinggi perlu diberikan terapi yang menekankan bahwa antipiretik hanya
antibiotik secara intensif dan terapi antipiretik diberikan untuk menurunkan suhu tubuh pada
jika perlu (demam > 38,50C). Hal ini sesuai anak dengan riwayat kejang demam
dengan teori Aden (2010) yang mengatakan sebelumnya, atau ditujukan untuk mencegah
antibiotik merupakan terapi yang efektif untuk terjadinya kejang demam yang sering dialami
demam tifoid. Tetapi, pemberian antibiotik balita umur 6 bulan sampai 6 tahun.
tidak secara otomatis menurunkan demam, Selain itu, penggunaan antipiretik secara
karena di dalam tubuh masih terjadi proses berkepanjangan dapat menimbulkan efek
kerja dari antibiotik dalam mematikan bakteri toksik bagi organ tubuh seperti yang
penyebab infeksi. dijelaskan oleh Pujiarto (2007) bahwa pada
Dalam melakukan penelitian, responden yang dasarnya tidak ada obat yang tidak berisiko
dijadikan sampel telah memenuhi kriteria menimbulkan efek samping. Pemberian obat
inklusi peneliti yaitu pasien yang belum demam bisa menimbulkan efek samping mulai
mengkonsumsi antipiretik pada saat akan dari nyeri dan perdarahan lambung (yang
dilakukan penelitian, sehingga dapat paling kerap), hepatitis (kerusakan sel hati
menunjukkan hasil yang akurat dari tindakan yang ditandai dengan peningkatan enzim
kompres hangat dan bukan efek dari hasil SGOT dan SGPT, pembengkakan dan rasa
pemberian antipiretik. Pemberian tindakan nyeri di daerah hati), gangguan pada sumsum
kompres hangat merupakan bagian dari tulang (produksi sel darah merah, sel darah
tindakan mandiri perawat yang termasuk aman putih dan sel trombosit tertekan), gangguan
dan tidak memiliki efek samping dalam fungsi ginjal, rasa pusing, vertigo, penglihatan
penatalaksanaannya. Sehingga perawat dapat kabur, penglihatan ganda (diplopia),
menerapkan tindakan mandirinya sebelum mengantuk, lemas, merasa cemas, dan
sebagainya. Risiko efek samping perdarahan hipotalamus dirangsang, sistem efektor
saluran cerna misalnya, akan meningkat bila mengeluarkan sinyal yang memulai
kita memakai lebih dari satu obat (misalnya berkeringat dan vasodilatasi perifer.
parasetamol dengan aspirin atau parasetamol Perubahan ukuran pembuluh darah diatur oleh
dengan ibuprofen), pemakaian jangka panjang, pusat vasomotor pada medulla oblongata dari
atau pemakaian bersama dengan steroid. tangkai otak, dibawah pengaruh hipotalamik
Hasil penelitian tentang kompres hangat yang bagian anterior sehingga terjadi vasodilatasi.
dilakukan pada 19 responden yang mengalami Terjadinya vasodilatasi ini menyebabkan
demam tifoid, didapatkan 14 responden yang pembuangan/ kehilangan energi/ panas
mengalami penurunan suhu tubuh. Hal ini melalui kulit meningkat (berkeringat),
sesuai dengan hipotesis yang menyatakan diharapkan akan terjadi penurunan suhu tubuh
bahwa kompres hangat dapat menurunkan sehingga mencapai keadaan normal kembali.
suhu tubuh pasien. Hasil ini didukung oleh Hal ini sependapat dengan teori yang
penelitian Nurwahyuni (2009) yang dikemukakan oleh Aden (2010) bahwa tubuh
menjelaskan bahwa terdapat mekanisme tubuh memiliki pusat pengaturan suhu
terhadap kompres hangat dalam upaya (thermoregulator) di hipotalamus. Jika suhu
menurunkan suhu tubuh yaitu dengan tubuh meningkat, maka pusat pengaturan suhu
pemberian kompres hangat pada daerah tubuh berusaha menurunkannya begitu juga
akan memberikan sinyal ke hipotalamus sebaliknya. .
melalui sumsum tulang belakang. Ketika
reseptor yang peka terhadap panas di
SIMPULAN
2. Bagi Rumah Sakit
Diharapkan dapat menjadi bahan masukan
Berdasarkan hasil penelitian dapat agar penerapan tindakan kompres hangat
disimpulkan bahwa tindakan kompres hangat di ruangan dapat dimaksimalkan,
efektif dalam menurunkan demam pada pasien sehingga dapat memotivasi tenaga
thypoid abdominalis di Ruang G1 Lt. 2 keperawatan yang ada di rumah sakit
RSUD. Prof. Dr. Hi. Aloei Saboe Kota untuk menerapkan tindakan mandiri
Gorontalo. sebelum tindakan kolaborasi.
Saran 3. Bagi Peneliti Selanjutnya
1. Bagi Keluarga Diharapkan untuk dapat melakukan
Diharapkan dapat menerapkan tindakan penelitian lanjutan dengan
kompres hangat pada perawatan pasien membandingkan tindakan kompres hangat
yang demam dan dapat menjadikannya dengan tindakan keperawatan lain dalam
sebagai tindakan yang pertama dan aman perawatan pasien demam tifoid.
dilakukan pada pasien di rumah sebelum
menggunakan terapi antipiretik.
Anonimityd, 2011, Metode Kompres Yang Nursalam, 2011, Konsep dan Penerapan
Tepat Untuk Menangani Demam, Metodologi Penelitian Ilmu
http://www.berbagaihal.com/2011/04/m Keperawatan, Salemba Medika, Jakarta
etode-kompres-yang-tepat-untuk.html
Diakses 11 Februari 2012 Nurwahyuni, Ika, 2009, Perbedaan Efek
Teknik Pemberian Kompres Hangat
Anonimitye, 2007 , Profil Kesehatan Pada Daerah Aksila dan Dahi
Indonesia 2005 Terhadap Penurunan Suhu Tubuh
http://www.riskesdas.litbang.depkes.go.i Pada Klien Demam di Ruang Rawat
d/download/profilkesehatanindonesia.pd Inap RSUP Dr. Sudirohusodo
f. Diakses 8 Februari 2012 Makassar,
http://publikasiilmiah.ums.ac.id/bitstrea
Engel, Joyce, 2008, Pengkajian Pediatrik, m/handle/123456789/484/skripsi.pdf?se
EGC, Jakarta quence=1. Diakses 23 Juni 2012
Hartanto, Sinarty, 2003, Anak Demam Perlu Purwanti, Sri, 2008, Pengaruh Kompres
Kompres?, Hangat Terhadap Perubahan Suhu
http://www.balipost.co.id/balipostcetak/ Tubuh Pada Pasien Anak Hipertermia
2003/9/7/kel4.html. Diakses 23 Juni di Ruang Rawat Inap RSUD. Dr.
2012 Moewardi Surakarta,
http://publikasiilmiah.ums.ac.id/bitstrea
Hidayat, A. Aziz Alimul, 2009, Pengantar m/handle/123456789/484/2f.pdf?sequen
Ilmu Kesehatan Anak untuk ce=1. Diakses 23 Juni 2012
Pendidikan Kebidanan, Salemba
Medika, Jakarta Pujiarto, Purnamawati Sujud, 2007, Demam
Pada Anak: Fever Is Functional,
, 2009, Metode http://www.sehatgroup.web.id/?p=65.
Penelitian Kebidanan dan Teknik Diakses 23 Juni 2012
Analisa Data, Salemba Medika, Jakarta
Prasetyo, Riski Vitria, 2009, Metode
Kania, Nia, 2010, Penatalaksanaan Demam Diagnostik Demam Tifoid Pada Anak.
Pada Anak, www.pediatrik.com/buletin/0622411441
http://pustaka.unpad.ac.id/wp- 8-f53zji.doc. Diakses 8 Februari 2012
content/uploads/2010/02/penatalaksanaa
n_demam_pada_anak.pdf. Diakses 11 R, Aden, 2010, Seputar Penyakit dan
Februari 2012 Gangguan Lain Pada Anak, SIKLUS,
Jogjakarta
Maryunani, Anik, 2010, Ilmu Kesehatan
Anak Dalam Kebidanan, TIM, Jakarta Sugiyono, 2010, Statistika Untuk Penelitian,
Alfabeta, Bandung
Ngastiyah, 2005, Perawatan Anak Sakit Edisi
2, EGC, Jakarta Susanti, Nurlaili, 2012, Efektifitas Kompres
Dingin dan Hangat Pada
Penatalaksanaan Demam,
http://publikasiilmiah.uin.ac.id/bitstream Tamsuri, Anas, 2006, Tanda-Tanda Vital
/handle/123456789/287/saintis.pdf?sequ Suhu Tubuh, EGC, Jakarta
ence=2. Diakses 23 Juni 2012
EFEKTIFITAS BAWANG MERAH TERHADAP PENURUNAN
SUHU TUBUH PADA ANAK FEBRIS USIA 1 – 5 TAHUN
Fever are circumstances when individuals experiencing or at risk of increased body temperature
continuously for more than 37.80 C (1000F) per oral or 38.90 C (1010F) per rectal due to external factors) lt can
be said that normal body temperature when the temperature is 36.50 C - 37,50C. The purpose of this study is to
determine the effectiveness of red onion to the decrease of body temperature in children aged 1-5 years with
fever.
The research design used in this study is "Pre-experimental", One-Group-Post-Pre-Design Test.
Population of all children aged 1-5 years who have increased body temperature in the IHC Boegenvile 1 Hamlet
Village Tertek Pare District as much as 56 respondents, eight respondents sample taken with accidental
sampling technique. Data analysis was done by observation before and after treatment in April, 2010.
From the results showed that body temperature before administration of body temperature prior onions
were treated at 37.9750C after treatment of 37.5750 C, and the mean of the results of the settlement amounted to
0.4. Median body temperature and the mode of treatment was 380 C and body temperature after treatment was
37.6ºC.
From the above description can be concluded that after being given a ground onion and smeared
throughout the body, can be proven to decrease body temperature, which means onion effective in decreasing
body temperature in children aged 1-5 years with fever
Determination of Effectiveness Onion and Extract Onion (Allium Cepa var. Ascolonicum) into the
reducing Temperature of the Materials
Rachmad*), Dr. Sri Suryani, DEA*), Dr.Paulus Lobo Gareso, M.Sc*) Program Studi Fisika,
Jurusan Fisika, Fakultas MIPA, UNHAS Makassar
ABSTRAK
Penelitian ini dilakukan untuk mengukur waktu penurunan suhu campuran dengan bawang merah asli
dan ekstrak bawang merah dan mengukur pH bawang serta membadingkan antara bawang merah asli
dengan ekstrak bawang merah untuk mengetahui efektivitasnya dalam menurunkan suhu bahan. Hasil
penelitian menunjukkan bahwa semakin besar massa bawang merah yang diberikan pada air hangat maka
semakin sedikit jumlah waktu yang dibutuhkan untuk menurunkan suhu campuran, sehingga semakin
efektif dalam menurunkan suhu. Besarnya nilai pH panas untuk bawang merah adalah 5 dan untuk pH
panas ekstrak bawang merah adalah 4,5, sebab pH tidak dipengaruhi oleh kandungan senyawa alliin.
Penurunan suhu untuk Bawang merah asli memiliki waktu yang relatif lebih sedikit atau waktu yang
diperlukan untuk menurunkan suhu lebih cepat, sedangkan untuk Ekstrak bawang merah memiliki waktu
yang relatif lebih banyak atau waktu yang diperlukan untuk menurunkan suhu lebih banyak jika
dibandingkan dengan Bawang merah asli. Sehingga dapat dikatakan bahwa bawang merah asli lebih
efektif dalam menurunkan suhu dibanding dengan ekstrak bawang merah, dengan kata lain ekstrak
bawang merah tidak mempunyai pengaruh dalam penurunan suhu bahan.
Kata Kunci : Efektivitas, Demam, Kalor, Waktu, Bawang Merah (Allium Cepa var. asclonicum), Air
(H2O), pH.
ABSTRACT
This research was conducted to measure the temperature of the mixture with a decrease in the original
onion and onion extract and measure the pH of onions and shallots comparing the original with onion
extract to determine its effectiveness in to the reducing temperature of the materials.
The results showed that the greater the mass of red onions given in warm water the less amount of time
required to lower the temperature of the mixture, making it more effective in to the reducing temperature
of the materials. The amount of heat for the pH value is 5 and the onions for onion extract heat pH is 4.5,
because the pH is not influenced by the content of compounds Alliin. Decrease the temperature to the
original Shallots have a relatively less or the time required to lower the temperature more quickly,
whereas onion extract had a relatively more or the time it takes to lower more temperature compared to
the original red onion. So it can be said that the original onion is more effective in lowering temperature
than onion extract, in other words the onion extract had no effect into the reduction temperature of the
materials.
Keywords: Effectiveness, Fever, Heat, Time, Red Onion (Allium Cepa var. Asclonicum),water (H2O),pH.
termometer; Dicampu
5. Mengambil 2 siung bawang merah yang r dengan
akan diukur kalor jenisnya, kemudian Minyak
Kelapa
memasukkan bahan yang sudah Menimbang Menimbang
ditimbang tersebut ke dalam kalorimeter; B. Merah E. B. Merah
dgn variasi dgn variasi
6. Mencatat temperaturnya tiap 2 atau 3 5gr, 10gr, 4,4gr, 9,1gr,
detik hingga suhu konstan. 15gr, 20gr, 13,6gr,
II.3.2. Mengukur waktu penurunan suhu 25gr 17,9gr,
22,3gr
sistem campuran air hangat dengan Ekstrak
Bawang Merah Pembaha
1. Menimbang bawang merah yang sudah di san
ekstrak kemudian diukur suhunya (T1);
2. Air suling dituangkan kedalam wadah Kesimpulan
150
4,50 171,50
9,10 147,50 100
13,60 163,75
17,90 193,50 50
22,30 182,75
Sumber : Data Hasil Penelitian 0
0 10 20 30
IV.1. 2. Pengukuran pH Bawang Merah dan Massa (gram)
Ekstrak Bawang Merah (Allium
cepa var. ascalonicum)
Gambar IV.1 Grafik Hubungan Massa
Setelah dilakukan pengambilan data waktu
Terhadap Waktu Rata-rata
penurunan suhu campuran air hangat dengan
Sampel Bawang Merah
bawang merah (Allium cepa var. ascalonicum)
dilanjutkan dengan mengukur pH bahan bawang Grafik diatas menerangkan bahwa makin besar
merah tersebut. Adapun alat yang digunakan massa yang diberikan pada sampel Bawang
untuk mengukur pH adalah pH meter air.
Merah maka waktu yang dibutuhkan untuk pada sampel ekstrak bawang merah tersebut, hal
menurunkan suhu 1oC akan semakin kecil. ini disebabkan ekstrak bawang merah tidak
memiliki lagi kandungan alliin yang berfungsi
IV.2.2 Hubungan Massa Sampel Ekstrak untuk menurunkan suhu. Senyawa alliin akan
Bawang Merah Terhadap Waktu menguap bila bawang tergerus pada suhu lebih
Rata-rata besar dari 20°C.
Tabel IV.2 menerangkan bahwa untuk berat Bawang merah sering digunakan untuk kompres.
sampel dengan massa 4,5 gram menunjukkan Hal ini disebabkan bawang merah mengandung
waktu yang dibutuhkan untuk menurunkan suhu senyawa Allylcysteine sulfoxide (Alliin) yaitu
sebanyak 1oC sebesar 172 detik dengan kisaran sejenis senyawa sulfur organik. Senyawa Alliin
waktu antara 150-200 detik sedangkan sampel mempunyai sifat mudah menguap pada suhu
dengan massa 9,1 gram menunjukkan penurunan 20°C hingga 40°C. Kandungan Alliin pada
waktu sebesar 148 detik yaitu dengan daerah bawang merah merupakan nomor dua terbanyak
kisaran antara 100-150 detik sedangkan untuk setelah bawang putih.
berat sampel dengan massa 13,6 gram terdapat Bawang merah bila digerus akan melepaskan
kenaikan waktu yang dibutuhkan untuk enzim alliinase yang berfungsi sebagai
menurunkan suhu 1oC sebesar 164 detik yang katalisator untuk alliin yang akan bereaksi
jauh lebih besar dibandingkan dengan berat dengan senyawa lainnya. Reaksi akan terjadi
sampel dengan massa 9,1 gram, sedangkan untuk secara cepat dalam waktu 10 – 60 detik. Agar
sampel ekstrak bawang merah dengan massa supaya reaksi ini tidak cepat terjadi, maka pada
17,1 gram terdapat pertambahan waktu yang gerusan bawang ditambahkan minyak. Di lain
jauh lebih besar dibandingkan dengan ke empat pihak, ekstrak bawang merah sudah tidak
berat sampel (4,5 gram, 9,1 gram, 13,6 gram, mengandung alliin atau dengan kata lain
22,3 gram) yaitu dengan waktu rata-rata sebesar senyawa alliin sudah terurai menjadi thiosulfinat.
194 detik, namun pada berat sampel 22,3 gram Akibatnya, fungsi penurunan suhu yang
terdapat penurunan waktu sebesar 183 detik. dilakukan oleh senyawa alliin sudah tidak ada.
Perbedaan kelima berat sampel Ekstrak Bawang Oleh sebab itu kalor jenis bawang merah ada
Merah lebih jelasnya dapat dilihat pada gambar yaitu 0,9 kkal/kg°C (16), tetapi tidak ada untuk
grafik IV.2 berikut ini : ekstrak bawang merah. Lihat tabel IV.4. Bila
dibandingkan dengan es dalam fungsinya
Ekstrak Bawang Merah sebagai bahan penurun panas atau kompres,
250 maka bawang merah akan lebih baik, karena
nilai kalor jenisnya yang lebih besar dari es (0,5
200
kal/g.oC )(3). sehingga lebih bersifat isolator. Di
Waktu (Detik)
DAFTAR PUSTAKA
(1) Dahlan, Sopiyudin. 2009. Laporan Bawang
Merah. www. scrib. Com /doc/
41158685/, tanggal akses : 05
Agustus 2011
(2) _____,2011. Bahan Dapur Untuk Redakan
Demam / woman Health. http : //
Open Journal of Biophysics, 2015, 5, 97-114
Published Online October 2015 in SciRes. http://www.scirp.org/journal/ojbiphy
http://dx.doi.org/10.4236/ojbiphy.2015.54009
Abstract
Hyperthermia has been a modality to treat cancer for thousands of years. During this time, inten-
sive efforts are concentrated on determining the dose of the proper treatment, but the dominantly
in vitro induced cellular death does not provide enough confidence for the clinical dosing. The
cell-death by heat-monotherapy applications in laboratory experiments is difficult to apply in the
complementary therapies in clinical applications. The newly developed nanotechnologies offer
completely new possibilities in this field as well. Modulated electro-hyperthermia (mEHT, trade-
name Oncothermia) is a nanoheating technology that has selective effects on membrane rafts and
on the transmembrane proteins. This effect is thermal. The thermal action is in nanoscopic range
which makes the phenomenon special. Our objective is to show the dose concept on this emerging
method.
Keywords
Thermal Dose, Oncothermia, Nano-Targeting
1. Introduction
Hyperthermia, as a treatment in oncology, has a thousand-year tradition [1]. It has tremendous fluctuations in its
applications and trusts in its efficacy [2]. This addresses serious questions: “Where are we?” [3], “Where are we
going?” [4]. One of the central problems of the hyperthermia in oncology is the dosing [5]. The problem of the
dose is very general due to that the temperature is the central parameter of this heating method. However, the
focusing of the energy-absorption doesn’t mean the focus of the temperature too, because the heat spread by
time is forced mainly by a very effective heat-exchanger: the blood-flow. Our objective in this paper is to clarify
the dosing which is based on the in vitro experiments of necrotic distortion fitting it to the Arrhenius plot. We
*
Corresponding author.
How to cite this paper: Vincze, G., Szasz, O. and Szasz, A. (2015) Generalization of the Thermal Dose of Hyperthermia in
Oncology. Open Journal of Biophysics, 5, 97-114. http://dx.doi.org/10.4236/ojbiphy.2015.54009
G. Vincze et al.
generalize this Arrhenius based on dosing, including the direct SAR, from the selectively targeting electric field.
Oncologic hyperthermia massively uses external heat transfer from the outside towards the inside. The clas-
sical solution is based on heat-conduction from the skin. The heat-conduction is robustly increased by heat-
convection of the induced intensive blood-flow in the skin.
The whole-body heating processes definitely follow this way, using the blood-flow in the subcutaneous capil-
lary-bed, transferring the absorbed energy all over the body [6]. The method has many early descriptions [7]-
[10]; but the dominant systemic hyperthermia method is based on the infra-red radiation by multi-reflecting fil-
tering [11] [12] or by water-filtering [13] [14].
Another type of oncological hyperthermia is not systemic. Its volume ranges widely: from regional to local,
from a part of the body to a nanoscopic targeting.
Their typical parameters are summarized in Table 1.
Thermodynamically, the systemic and loco-regional treatments differ from their heat-flow direction between
the tumor and its neighborhood. The blood-heating techniques pump heat-energy from blood to the tumor, while
the blood works opposite in the loco-regional heating, cooling the anyway heated tumor because it remains in
body temperature. The physiological limits are also different. While the systemic heating is limited at 42˚C, the
local one has no limit in the tumor. The temperature limit of loco-regional treatment is only keeping the healthy
vicinity of the tumor safe, as well as the skin, where the energy is pumped into the body.
Technically, the local deep-focusing is a great challenge. Most of the local treatments with deep focusing pos-
sibility use some kind of electromagnetic energy-absorption. Multiple new techniques are devoted to deliver the
proper energy for heating [15].
One of the earliest non-invasive deep heating is the simple inductive way, which is typically achieved by the
induction of eddy-currents in the body [16]-[18]. This method has low efficacy, but its non-invasive penetration
easily crosses over the body, and its focusing or selective orienting is not possible. Other loco-regional electro-
magnetic heating methods work by radiative [19]-[21], or by capacitive [22]-[24], technical solutions. These
non-invasive electromagnetic heating solutions use a wide range of frequencies, having definitely different ef-
fects and penetration depth to the body [14]. However, in most of the cases, the limited penetration depth is
enough for effective deep heating [25].
Interestingly, the trend of the modern hyperthermia is directed to the smaller targets. Their intensive locality
is somehow similar in this character to the original galvanic methods. The typical high-energy focusing can be
solved by microwaves [26] or very locally by interstitial heating invasively [27]. It delivers heat to the tumor
mass directly using a needle providing high frequency. Typically, this type of therapy is applied in an image
guided way. These ablation methods work by typical burn-necrosis basis, and the energy is typically provided
by impedance-heating with minimally invasive electrode insertion; there is no heat-flow through the skin. Some
typical applications are for liver [28], lung [29] [30], and breast [31]. Numerous ablative, interstitial hyperther-
mia combined with local irradiation are applied for brain tumors [32]-[35], and implant applications [36] [37],
and also combined with laser techniques [38] [39].
Some modern laser ablative techniques work with ultrafast pulses with ultra large energy-density flow. De-
pending on the pulse-duration, it can be a few 100 W/cm2 and in nano-seconds can go to 107 - 108 W/cm2 [40],
but the provided energy altogether reaches its maximum at a few tenths of watts. Their application for liver [41],
[42], is common. This emerging technology, together with the electroporation techniques, has been shifted
more-and-more to become the tool of surgery, applied it on intraoperative way, or applied by interventional ra-
diology, isolated a little bit from the general hyperthermia practices.
The photodynamic therapy (PDT) [43], uses heating of the micro-targets like photosensitized liposomes or
other photosensitizers [44], by infrared or visible radiation. The micro-absorption of the heat assists targeted
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G. Vincze et al.
drug-delivery, combined with the heat development. This could non-invasively treat shallow-seated tumors, only
the light-source has to be introduced invasively (mostly with optical fibers) for heating in depth.
There is a selective tumor targeting applied by temperature sensitive liposome-jacketed drug-delivery [45], as
well as the drug delivery with temperature activated nanoparticle complexes [46]. PDT can be applied with na-
noparticle administration too [47], when the particles are the real absorbers of the energy. The method is based
on artificially set nanoparticle concentration in the targeted volume [48] [49].
The disadvantage of the weak coupling of magnetic fields in direct inductive heating turns to an advantage
when artificial absorbers are applied. The energy absorption from the magnetic field is practically limited to
these magnetic absorbing centers, orienting the SAR where the artificially inserted magnetic materials are.
These materials will solely react with the electromagnetic fields, and their absorbed energy will be the source to
heat up their surroundings. The energy absorption could be absolute, precisely guided by the place of these ab-
sorbers. In order to improve the magnetic energy absorption within the target tissue, magnetic materials, such as
micro-particles [50] and ferrite rods [51], are usually injected into the targeted area [52], orienting the field to
the particles and massively absorbing the incident energy. The emerging application of magnetic treatments is
started by the nanoparticle magnetic suspensions [53] and other magnetic liquids.
Definite shifts of hyperthermia techniques have been made in the last decade, showing a trend to nanotech-
nology [54]. Applications of various nanoparticles for combined hyperthermia are new, emerging methods in
oncology [46]. In this method the nanoparticles (which are usually administered in a suspension [53]) are small
heat-absorbers. They are selectively heated up by an outside photo-energy or magnetic field [55], which acts ex-
clusively only on these nanoparticles. The trick here is the accurate targeting of the heat-absorption. The over-
heated nanoparticles soon give their heat-energy to their neighborhood and heatup the complete lesion in their
vicinity. A great deal of energy is pumped into these nanoparticles being able to heatup the complete mass, con-
taining a large amount of electrolytes. However, most of the electrolytes are uselessly heated up because the heat
has to be concentrated on the tumor cells and exclusively on their membranes to damage them. This request
needs a higher preciosity addressing the nanoparticles selectively on the surface of the tumor cells, which can be
made by antibody-nanoparticle conjugates [56]. It releases the therapeutic targets at the connected malignant
cells while minimizing off-target side effects. When the delivering nanoparticle—which is especially bonded to
the membrane of the malignant cell—is heated up by an outside field, it could have a double effect: damaging
the membrane by heat and/or release the drug that was delivered to the target [57]. Most of the nanoparticle
hyperthermia effects are subcellular, inducing intracellular action [58]; however, the efficacy of this treatment is
debated [59].
Based on nanotechnology, a new, emerging way is connected to various immune actions [60], which could be
applied in loco-regional hyperthermia, too. This transforms the modern local hyperthermia treatment completely
systemic [61] [62], reaching bystander and abscopal effects [63] [64], by production of the immune-stimulating
character for both the innate and adaptive immune system [65], and turning the oncologic hyperthermia to a
complex immune-therapy, attacking the far-distant metastases, named “immunotherm” therapy [66].
2. Dosing of Hyperthermia
Evaluating the success of hyperthermia’s definitive dose is mandatory. Experts agree that the reliable dosing de-
termines the future of oncologic hyperthermia [66].
The heating process is an energy transfer to the target. This energy could increase the temperature and could
make many other accompanied effects [67] [68]. Naturally, the medical expectation is definitely making chan-
ges in the target, killing the malignant cells in various ways. The cell killing obviously demand senergy, which
is delivered by the electromagnetic or mechanical (ultrasound) forms in most of the hyperthermia methods. The
temperature is the average energy that is provided to the target. When the target is large, it needs more heat-
energy to reach the same temperature than the small target. This is why we introduced the absorbed energy for
unit volume or unit mass, as we did in case of ionizing radiation: J/kg (= Gy). This is an exact dose that we can
use when we know the absorbed energy. However, the target is not isolated thermally, so it loses a lot of heat-
energy by heat-conduction to the neighbors, and by the intensive heat exchange of the blood-flow. Also, the
problematic point is the energy-delivery path. The energy is transported through the non-targeted volumes from
the surface to the target, losing a large amount of the energy out of the target. This is not only wasted energy, but
also a source of the thermal toxicity. The surface cooling makes the next complication, which sinks a lot of for-
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G. Vincze et al.
warded energy to the cooler. These points request a local measurement in the target. What to measure? We
could measure the absorbed energy; or easier to measure, the temperature there, which we suppose has mono-
tonic calibration to the energy itself. So the temperature has a role of some kind of dosing by calibration to ab-
sorbed energy; also, it is a safety parameter with the help of which we can be sure that the target does not have
too toxic energy-exposition for the healthy tissue.
When the energy-absorption and the energy-distribution is heterogenic, and has fluctuations in the volume,
then the temperature measurement also has fluctuations, and we have to wait while the temperature is “equalized”
to become a steady-state condition, where the temperature can be regarded as constant. This process emphasizes
the time-parameter as important as the temperature itself in two ways: 1) Time duration and energy delivery are
linearly proportional; 2) Longer time spreads the energy, approaches equilibrium mostly by non-linear way.
Taking into consideration these parameters, complications grow with the heterogeneity of the absorbing target.
For example, in case of the nanoheating an extremely huge energy density is absorbed in a very small volume,
and the main heating effect is based on their heat-conductive environment.
For the proper dose definition, a well-defined goal (the expected effect) has to be described. The dose in this
case must be derived from various model systems (in silico, in vitro and in vivo), while clinicians apply this me-
thod at the patient’s bed. Unfortunately, the two approaches (experimental and medical) do not meet organically.
One of the multiple reasons of deviations is that the model systems are mostly treated by monotherapies, while
medical practice predominantly uses the oncologic hyperthermia as a complementary method together with one
or more “gold standards”. On the other hand, the biological variability is much more in the real treatment on
humans than in the models. During experimental trials we can investigate the basic (mainly molecular) mechan-
isms of hyperthermia, while the clinical applications are sharply connected to the various physiological reactions,
like the blood-flow, lymph-transports, and in consequence, the drug-delivery of chemotherapies, the oxygena-
tion for radio-sensitizing, etc. Some special functional parameters of the treated organ are used for control of the
in situ actions, but these methods are not at all standard enough to be used for dosing. The control of this type
gives important safety information to avoid or minimize the adverse reactions, but not appropriate to use as dose.
Some technical, mainly thermal parameters are also used to control the processes without proper dose. For ex-
ample, the highest temperature achieved is used [69], or the total heat-energy is counted [70], or the time of ex-
posure is chosen for characterization [71]. These methods are technically precise, but they are not enough to
characterize the biological response. While dosing we have to consider the complex physiological response of
the target, which drastically modifies the absorbed energy and the temperature.
The concept of oncological doses is based on the maximal tolerable dose determined by dose escalation,
measured in specific concentration of the drug (such as mg/m2), or specific energy of the radiation (such as Gy =
J/kg). The efficacy is measured mostly by the local control, the response rate, which is measured most frequent-
ly off-situ with imaging techniques. When the efficacy is measured on the survival or other long-time realization
of the development of the disease (much longer than the treatment is active), it would be too complex to verify it
as the dose, due to the fact that the interim control during the treatment process is mandatory.
The definition of the real dose must be based on the effect, which we expect by the application of the proper
dose. The dose of an action is measured by the final effect, which is made by a “tool” (such as drug concentra-
tion, radiation, temperature, etc.). The effect in our case is the selective distortion of the cancer cells. The defini-
tion of the distortion is the cell-death of malignant cells without harm (or less harm) in their healthy counterpart.
There are various possible ways of cell-killing in a wide range from necrosis to apoptosis, or autophagy, having
many variations of their “mixture”, called necroptosis, aptonecrosis, etc. [72]. These processes could happen on
avery different time-scale, depending on their regulatory pathways; and the necrotic cell-death could be com-
plexly regulated [73].
The inherent problem of dosing is that the quantity of the final result of the action of the tool is defined by the
tool itself (concentration, intensity, etc.). The way from the action to the result considered standard is too
rough—an oversimplified assumption in high complexity systems with high bio-variability.
The majority of physicians who are using heating techniques have a common view about the cellular damage,
stating its thermal behavior. However, the same forwarded energy exposition with identical energy-flow [W/m2]
can cause different energy-absorptions [74] depending on the given conditions [75] [76], the actual organ [77],
and also modified by the actual frequency [78].
The simplest thermodynamical way is of course to measure the temperature, and by the higher kinetic energy
that surmounts the energy barrier of the actual reactions. However, the heating differs in the target, even micro-
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G. Vincze et al.
scopically, and the same temperature acts differently for the large complex chemical machinery of the cell. If the
temperature is high enough it acts for most of the possible reactions, irrespective of their state or actual needs.
Due to the overall excitations the desired selection vanishes. Energizing by temperature does not take into ac-
count the individual energy barriers of the various reactions or reaction cascades; it is an overall driving force to
react. It defines a certain probability of the effect of individual reactants. When the given reaction has the Ea
barrier height (activation energy), the reaction rate k (probability of overpassing the barrier) is proportional to
the exponential function of the ratio of the height of the barrier and the energy represented by the temperature
that can be described by the Arrhenius law
E
=k A exp − a (1)
RG T
where RG is a universal gas-constant (RG ≈ 8.3 [J/K/mol]). The excitation of the particles is temperature depen-
dent. The actual pre-exponential factor (A) and the Ea activation energy have to be determined on an experimen-
tal basis. The general basis of the chemical reaction-kinetics with temperature is the Arrhenius law. The ATP
synthesis is temperature dependent, also following the Arrhenius law [79].
When the chemical or structural properties change, the value of Ec changes, too. Due to the linearity of the
Arrhenius plot and its reverse time dimension of χ, we introduce its reciprocal value as time constant [83] as
Θ =1 χ . When we have the ratio of two different time-constants as Θ (T1 ) Θ (T2 ) where T1 and T2 are close
to each other, then
(T2 −T1 )
Θ (T2 ) (T2 −T1 ) − a Ψ T2
Ea E Ea
RG T1T2
− −
( 2 1) T −T
= e RGT1T=
2
e RGT1T2 ≅ Ψ= = Ψ e (8)
Θ (T1 ) Ψ T1
101
G. Vincze et al.
The thermal damage has a characteristic graph in dependence of 1/T as usually plotted by the Arrhenius con-
ditions
Ea
1 −
1 E 1
α e RGT → ln =
= ln α − a (9)
Θ Θ RG T
In case of components of living materials (like proteins, cells, tissues) the ln(A) is approximated from the ex-
periments by linear dependence
α ξ Ea + ζ
ln= (10)
where ξ = 0.38 and ζ = −9.36 [84], or in other publication ξ = 3.832 and ζ = 10.042 [84] [85].
So the characteristic time is
1
ln (=
Θ) − ξ Ea − ζ (11)
RG T
Comparing the thermal cell damages to each other, we choose treatments made on T1 temperature by t1, time
and other one on T2 temperature by t2 duration. According to Equation (7) the thermal damage functions are
Ea
− t1
Ωt ( t1 , T1 )= α e RG T1
t1 =
Θ (T1 )
Ea
(12)
− t2
Ωt ( t2 , T2 )= α e RG T2
t2 =
Θ (T2 )
We consider two treatments thermally equal, when their thermal damages are equal. We can choose equiva-
lent times using Equation (12), when we would like to compare the effects of t1 − T1 and t2 − T2 time-temper-
ature pairs. Consequently, with the approximation in Equation (8), we get
t1 t Θ (T2 )
= 2 → t2 =t1 =t1Ψ T2 −T1 (13)
Θ (T1 ) Θ (T2 ) Θ (T1 )
If the reference-time and corresponding temperatures are tr and Tr respectively, then the iso-effective equiva-
lent time, which is necessary at the T-temperature would be
Ea − a
E
RG Tr2
tr −
t= Θ (T ) = tr Ψ Tr −T Ψ = e
RG Tr T
≈e (14)
Θ (Tr )
When we choose t2 = tr as reference time at temperature T2 = Tr , we get a simple equation for isodose with
tr − Tr pair when we use t − T in actual treatment, according to Equation (13)
∆T
T −Tr
t = tr Ψ = QΨ Tr
where Q = tr Ψ Tr ≅ const. (15)
where ∆T = T − Tr . In this way, the equivalent time depends on the relative temperature difference by a pow-
er-law
∆T
ln ( t ) =
ln ( Q ) + ln ( Ψ ) (16)
Tr
In consequence of this tr reference choice, we can introduce a dose unit; when the heating is time-dependent,
summarizing all the intervals regarded as constant temperature, using steady-state approximation. This cumula-
tive value as “cumulative equivalent minutes” (CEM) is in steady-state
n
Tr −T ( ti )
=
CEM ∑ ti Ψ (17)
i =0
where ti are the times when the corresponding T(ti) regarded as constant. In a continuous change of the tempera-
ture, the sum is transformed to an integral
102
G. Vincze et al.
t t ∆T (τ )
Tr −T (τ )
CEM =∫ dτ Ψ =Q ∫ dτ Ψ Tr
(18)
0 0
where the treatment time t is conventionally measured in minutes. The general equivalent time CEM in Equation
(18) does not fix the reference for one definite cell-death, it is general for all the cases when the Arrhenius
process is valid.
When the activation energy is constant, the Arrhenius plot is linear by the reciprocal of the temperature.
However, when a drastic new reaction or phase transition happens the activation energy changes and the deriva-
tive of the Arrhenius curve is modified by the thermal load with increasing temperature. In this case, the anyway
linear dependence of the logarithm of reaction-rate to 1/T breaks, the slope of the line changes, and a kink occurs
on the Arrhenius plot [83]. When the transition is irreversible, the modified activation energy remains characte-
ristic in the temperatures, when the curve had another derivative anyway, establishing the basic of the step-down
heating [80]. In consequence of the kinked sequentially linear dependence the temperature of the time-constant
could also be easily plotted [83]. When one of the conditions of the 273 & T2 − 273 ≥ Tk or T1 − 273 &
T2 − 273 < Tk , [where Tk is the temperature (in Celsius units) T1-where the kink (Ea1 ↔ Ea2 transition) occurs]
relations are valid, we have
− R ETa1T
e G 1 2 if T ≥ Tk Ψ1 if T ≥ Tk
=Ψ = (19)
Ψ 2 if T < Tk
Ea 2
− RGT1T2
e if T < Tk
The step-function form of Ψ is consequence of the kink measured in the Arrhenius plot at temperature Tk, [K].
Classic hyperthermia had chosen for standardization this t43 point. Conventionally, the value of Ψ is noted R in
this special necrosis-based standardization. By this choice, the reference point was definitely fixed as the ne-
crotic threshold in the special in vitro experiments [86]. In most cases of thermal necrotic cell-death, approved
mostly in in vitro experiments Tk = 316 K = 43˚C and Ψ1 = 0.5, Ψ2 = 0.25 [80], showing there is as large reduc-
tion as almost 1/3 of the activation-energy above this point [87] (Ψ denoted with R in this special case). The in
vivo model-experiments are near to this breaking point [88], due to the fact that it is connected to a lipid-phase
transition in a cell membrane. The reference values are connected tonecrosisat T2 = 43˚C, made during a treat-
ment-time t43. The dose of the actual treatment refers on the equivalent time of the treatment on other T temper-
ature (denoted by CEM43˚C) [89]. It could be calculated as
t
43−T (τ )
CEM43C = ∫ dτ R
0
(20)
0.5 if T ≥ 43C
R=
0.25 if T < 43C
which implies Ea(<43˚C) = 273 kcal/mol and Ea(≥43˚C) = 138 kcal/mol. The kink temperature of the Arrhenius plot
could vary by samples, and complementary or pre-treatments [90]. The most likely effect causing the kink is
well to the believed lipid phase transition observed around 42.5˚C [83], but other effects modifying other essen-
tial proteins are also possible. The choice of the 43˚C for the breakpoint was supported by the value of the
blood-flow contraction threshold, which is at about 42.5˚C [91], and also, it corresponds.
However, according to the various experiments below and above the breakpoint temperature, the activation
energies do not fit to the fixed R values. One well-accepted result [92] shows Ea1 = 365 kcal/mol ≈ 1527 kJ/mol
below this point, while above Ea2 = 148 kcal/mol ≈ 620 kJ/mol. These values implicate R(<43˚C) = 0.159; R(≥43˚C) =
0.474, instead of R(<43˚C) = 0.25; R(≥43˚C) = 0.5, respectively. The error is significantly robust (~36%), below the
breakpoint, showing that the non-necrotic damage cannot be described accurately with the classic CEM43˚C
dose.
4. Generalized Dose
The Arrhenius picture is useful for various heating induced changes in tissues and in physiological phenomena
[86]. The measured parameters in these biologically quite high temperatures are remarkably higher than those of
103
G. Vincze et al.
←
k−1
where A is the cell treated complexly, and Ai+ , ( i = t , n ) are their activated (transition) state, the purely thermal
component noted by subscript “t”, while the “non-thermal” with “n”, Ai , ( i = t , n ) is the death state of the cell.
The k1i , ( i = t , n ) is the transition-rate to the active state, while k−i 1 , ( i = t , n ) is transition-rate to the repaired
state, and ki , ( i = t , n ) is the transition-rate to death.
Note the “non-thermal” component is only apparently not thermal. It well depend on the heat-energy which is
needed for the chemical changes. This “latent heat” is energy associated with the energy of phase-change of the
substance and it occurs in case of every first-order phase-transition. In case of pure water the latent-heat at
melting of ice is 334 kJ/kg, while at the evaporation it is 2260 kJ/kg at 0˚C and 100˚C respectively. During of
the absorbing of the “latent heat” the temperature does not change, so it is better to use the statement of “actually
non-temperature dependent” [95] instead of the “non-thermal”, because during the absorbance process the tem-
perature remains constant. Anyway, all the “non-thermal” components have definite energy-exchange which is
thermal in the general meaning of thermodynamics.
Here, the dynamism of the processes is not included, and the time of staying in the actual state has no role.
104
G. Vincze et al.
What is probable, however, is that the electric excitation process definitely has a longer time than the thermal
one. The cross-effects are also not counted. The processes when one kind of excitation promotes the other one
are calculated only by their final death independently from the history of the process itself. We consider that the
thermal effects are dominantly necrotic, while the electrical one is dominantly necrotic, and note again that no
strict border exists between the processes, or between the thermal and electric excitation. There is a massive ap-
pearance of thermally induced electric and electrically induced thermal effects, making the complete process
complex. Applying a model of first order parallel reactions, the reaction-kinetic equations are
d [ A]
= −k1n [ A] + k−n1 An+
dt
(22)
d An+
=k1n [ A] − k−n1 An+ − kn An+
dt
Supposing the likely conditions of kn k1n , and then the An+ is probably stationer, so we get
d An+
=k1n [ A] − k−n1 An+ − kn An+ =0 (23)
dt
From this, the concentration of the cells in activated state is
kn
An+ = n 1 [ A] (24)
k−1 + kn
With this, we get the following simple reaction-kinetic equation
d [ A] kk n
= − n 1
[ A] (25)
dt k +k
n
−1 n
Following this method, the second reaction of Equation (21) will be such a simple decay reaction equation
d [ A] kt k1t
= − [ A] (26)
dt k−t 1 + kt
After these calculations the cell damage could be described by the following irreversible parallel reaction
scheme
kn k1n
An
kn + k−n1
A (27)
t
kt k1
kt + k−t 1 At
which could be described by the following reaction-kinetic equations
d [ A]
− = K n [ A] + K t [ A]
dt
d [ An ]
= K n [ A]
dt
(28)
d [ At ]
= K t [ A]
dt
kn k1n kt k1t
=Kn = , K
k−n1 + kn k−t 1 + kt
t
105
G. Vincze et al.
[ A] = [ A]0 e−( K + K )t n t
K [ A]
=[ An ] n 0 1 − e−( K n + Kt )t
(29)
K n + Kt
K t [ A]0
=[ At ] 1 − e − ( K n + Kt )t
K n + Kt
where Ci is a constant, Eai is the cellular activation energy of i-th components, and R is the universal gas-con-
stant (R = 8.314 J/K/mole). Then the consequence is a fixed ratio
K t Ct
= (32)
K n Cn
Consequently, the global cell damage described by the first equation of Equation (28) has the following kinetic
equation
d [ A] [ An ]
E E
− a Cn − a
− = Ct e RGT 1 + [=A ] C e RG T
1 + [ A] (33)
[ At ]
t
dt Ct
where we used the branching ratio from Equation (30). Introducing the damage function as
[ A] ( t 0 )
Ω (t ) =
ln
[ A] ( t ) (34)
where t0 is the starting time of the process (t0 = 0) and the a consequence of Equation (33) we get
dΩ ( t ) [ An ]
E
− a
= Ct e RGT 1 + (35)
dt [ At ]
With this, the damage function is calculable
[A ] t
E
− a
Ω ( t ) = 1 + n ∫ Ct e G ( ) dτ = Ω n ( t ) + Ωt ( t )
R T τ
[A ]
t 0
(36)
[ An ] t C e− R T (τ ) dτ
Ea Ea
t −
RG T (τ )
Ωt ( t ) ∫ Ct e τ , Ωn ( t )
[ At ] ∫0 n
= d= G
where Ωt ( t ) is the thermal damage, and Ω n ( t ) is the “non-thermal” (but anyway thermally induced) dam-
age function. Consequently, the resultant damage function by means of the branching ratio could be expressed
by the thermal damage function
106
G. Vincze et al.
[A ]
Ω ( t ) = Ω n ( t ) + Ωt ( t ) = Ωt ( t ) 1 + n (37)
[A ]
t
On the above basis we introduce the generalized iso-effect of the thermal dose. Treatments could be compared
by their efficacy, which has not only thermal, but “non-thermal” components, too. In this case
[ An ] − RGaT1
E
t
Ω ( t1 , T1 ) =
1 + Ct e t1 =1
[ At ] Θ (T1 )
(38)
[ An ] − RGaT2
E
t
Ω ( t2 , T2 ) =
1 + Ct e t2 =2
[ At ] Θ (T2 )
where the situation corresponds to the pure thermal case described in Equations (12) and (13) if the points of 1
and 2 are close to each other, and the coefficients of the exponential function are nearly equal. Consequently, the
isodose principle is identical with thermal despite of the additional (synergistic) effect of thermally induced, but
not directly temperature dependent factors.
According to Equation (38) and using the condition of the equivalence described above, the functions of
thermal damage at T − t pair of values compared to a reference pair Tr − tr are
t [A ] t [ A ] Θ (T )
= 1 + n r → t = tr 1 + n (39)
Θ (T ) [ Ar ] Θ (Tr ) [ A ] Θ (T )
r r
[A ]
Qgen =tr 1 + n Ψ Tr (43)
[A ]
r
The general equivalent time CEMgen in Equation (40) does not fix the reference for one definite cell-death or
for definite duration of the process. The An/Ar ratio could be very high in special processes (like electroporation
[101] An/Ar ≈ 77). The cell-destroying process could be guided by very little temperature change with extra huge
thermal gradient on the plasma-membrane [102], which simply describes the full process “non-thermal”. These
effects are mostly induced by the frequency-dependent non-homogeneities in the distribution of induced and
absorbed RF E-field and specific absorption rate at cellular level [2].
107
G. Vincze et al.
on multiple effects [107] that cause effective changes in the targeted cell and in its immediate vicinity [108]. The
technical details are described elsewhere [14]. Their energy absorption induces heat in the membrane. The heat-
energy spreads all over the tumor and heats it up in an effective and well oriented way. Various complex signal
pathways of transduction networks of the selectively targeted malignant cells are excited by the heated rafts
[109], including the massive Ca2+ influx into the cytoplasm.
The apoptotic damage usually takes a longer time to be performed. Its usual visibility takes at least 24 h, and
could not be globally considered as simple Arrhenius plot, because this process is much more complex by its
chemical changes. The multiple processes that are needed for apoptosis [110] contain a cell shrinking, nucleus
condensing (pyknosis, time: 4 - 8 h), blebs on plasma-membrane, nucleus fragmenting (karyorrhexis, time: 10 -
24 h), and the appearance of apoptotic bodies (phagocyte engulf apoptotic bodies, time: 48 - 72 h). The pheno-
menon of “no return” is the release of Cytochrome C [111], which happens at least 4 h after the start of apopto-
sis with the help of outer signal pathway (oncothermia cell killing) [111]. We know it from the measurements,
that the Arrhenius plot is linear (no kink) below 42˚C, so oncothermia has to use this line for dose. However, the
Arrhenius curve is mostly measured in vitro, and the necrotic cell-death was considered as the dominant thermal
effect. The Arrhenius plot for thermally activated non-necrotic cell-killing has to describe the thermal behavior
of the “point of no return” where the process becomes irreversible and the cell is “committed to die” [111]. This
is the BAX pore formation on mitochondria and the release of Cytochrome C. We have to choose a parameter
characterizing a process of the non-necrotic cell-killing.
In case of oncothermia the physical character of the action is the electric field. This applied field increases the
temperature by:
• global absorption (general SAR), which is the overall absorbed energy of the target divided by its mass,
which is selected by impedance differences between the target and the normal tissue [112] uses certain Ca2+
influx and thermolysis [111].
This is because the thermal activation of transient receptor potentials (TRPs) has a crucial role in the apoptotic
cell-death, caused by modulated electric field [111]. However, we can assume that the synergy of the thermal
and electric effect and the induced damage function is proportional with each other. This was experimentally
proven at two temperature points (38˚C and 42˚C) [113]. Unfortunately, the exact cell-destruction mechanisms
are not known in both classical hyperthermia and oncothermia cases, but the possible proportion can lead us to
the oncothermia dose.
In cases of the modulated electrohyperthermia studies, the concentrations of the dead cells by thermal damage
is [At], and the concentration of the dead cells made by electric damage is [Ae], then the branching ratio by the
experiments [112] is
[ Ae ] ≈ 2 (44)
[ At ]
Using the Equations (37) and (44) we get
Ω ( t ) =Ω
3 t (t ) (45)
The combined thermal and electric effects have three times more cell distortion than the thermal has alone.
The selective and effective cell destruction makes a new kind of hyperthermia in oncology possible. This new
treatment could use the definite electric and thermal in homogeneities of the tumor to kill effectively the can-
cer-cells without hurting their healthy vicinity. This selective SAR process causes the strong synergy between
the direct thermal and indirect thermal (special electric field absorption) processes [113]. The thermal effect in
this case is different than in the classical hyperthermia heating. In the conventional approach the goal is the ho-
mogeneous temperature all over the tumor, while according to the cellular selectivity, oncothermia is not based
on the homogeneous heating. The specific absorption rate (SAR) is derived by the specialties of the cancer-cells
allowing to find them, and absorbed the SAR in that place. Due to this process the prospects of oncothermia is
huge even in those tumor cases, which are generally contraindicated for the overall heating of the mass; like
brain, eye, or other sensitive organs or inoperable cases. These sensitive places are treated with success with
oncothermia [95] [114] and even the bleeding tumors and the inflammatory cases can also be successfully
treated with the method [115].
108
G. Vincze et al.
6. Conclusion
Generalized dose has been introduced for the non-homogeneous temperature distribution including the electric
field absorption as a component of SAR. The generalization is discussed in the frame of thermal effects applied
in the Arrhenius thermal law. The dosing and efficacy of modulated electro-hyperthermia (oncothermia) are de-
scribed, and due to the non-homogeneous heating and selective targeting it is about three times higher than that
of the homogeneous classical mass-heating.
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Conference Papers in Medicine
Volume 2013, Article ID 274687, 4 pages
http://dx.doi.org/10.1155/2013/274687
Conference Paper
Hyperthermia versus Oncothermia: Cellular Effects in
Cancer Therapy
This Conference Paper is based on a presentation given by Gyula P. Szigeti at “Conference of the International Clinical Hyperthermia
Society 2012” held from 12 October 2012 to 14 October 2012 in Budapest, Hungary.
Copyright © 2013 Gyula P. Szigeti et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hyperthermia means overheating of the living object completely or partly. Hyperthermia, the procedure of raising the temperature
of a part of or the whole body above the normal for a defined period of time, is applied alone or as an adjunctive with various
established cancer treatment modalities such as radiotherapy and chemotherapy. The fact that is the hyperthermia is not generally
accepted as conventional therapy. The problem is its controversial performance. The controversy is originated from the complica-
tions of the deep heating and the focusing of the heat effect. The idea of oncothermia solves the selective deep action on nearly
cellular resolution. We would like to demonstrate the force and perspectives of oncothermia as a highly specialized hyperthermia
in clinical oncology. Our aim is to prove the ability of oncothermia to be a candidate to become a widely accepted modality of the
standard cancer care. We would like to show the proofs and the challenges of the hyperthermia and oncothermia applications to
provide the presently available data and summarize the knowledge in the topic. Like many early-stage therapies, oncothermia lacks
adequate treatment experience and long-range, comprehensive statistics that can help us optimize its use for all indications.
1. Introduction the single temperature concept [4]. With this approach, onco-
thermia returned to the gold standards of the dose concepts in
In oncology, the term “hyperthermia” refers to the treatment medicine: instead of the parameter, which cannot be regarded
of malignant diseases by administering heat in various ways. as dose (the temperature does not depend on the volume or
Hyperthermia is usually applied as an adjunct to an already mass), oncothermia uses the energy (kJ/kg [=Gy]), like the
established treatment modality, where tumor temperatures in radiation oncology uses the same (Gy) to characterize the
the range of 40–46∘ C are aspired. Interstitial hyperthermia dosing of the treatment [5].
and whole-body hyperthermia are still under clinical inves-
tigation, and a few positive comparative trials have already
been completed. Parallel to clinical research, several aspects 2. The Concept of Hyperthermia
of heat action have been examined in numerous preclinical
studies [1–3]. The effectiveness of hyperthermia treatment is related to the
The traditional hyperthermia is controlled the only single temperature achieved during the treatment, as well as the
thermodynamic intensive parameter, with the temperature. length of treatment and cell and tissue characteristics. To
Oncothermia, which is a “spin-off ” form of the hyperthermia, ensure that the desired temperature is reached, but not
is based on the paradigm of the energy dose control, replacing exceeded, the temperature of the tumor and surrounding
2 Conference Papers in Medicine
tissues is monitored throughout the hyperthermia procedure. which may further sensitize tumor cells to hyperthermia in
The goal is to keep local temperatures under 44∘ C to avoid the sense of a positive feedback mechanism [18]. Relevant
damage to surrounding tissues and the whole body temper- pathogenic mechanisms leading to an intensified acidosis
atures under 42∘ C, which is the upper limit compatible with upon heat treatment (which is reversible after hyperthermia)
life [5]. are as follows:
(1) an increased glycolytic rate with accumulation of
lactic acid,
3. Cellular Mechanisms (2) an intensified ATP hydrolysis,
Induced by Hyperthermia (3) an increased ketogenesis with accumulation of ace-
The cellular effect of hyperthermia is more complicated [6, 7]. toacetic acid and B-hydroxybutyric acid,
Briefly, hyperthermia may kill or weaken tumor cells and is (4) an increase in CO2 partial pressures,
controlled to limit effects on healthy cells. Tumor cells, with a (5) changes in chemical equilibria of the intra- and extra-
disorganized and compact vascular structure, have difficulty cellular buffer systems, and
dissipating heat. Hyperthermia may therefore cause cancer-
ous cells to undergo apoptosis in direct response to applied (6) an inhibition of the Na+ /H+ antiporter in the cell
heat, while healthy tissues can more easily maintain a normal membrane [19, 20].
temperature. Even if the cancerous cells do not die outright, The ATP decline observed upon heat treatment is mostly due
they may become more susceptible to ionizing radiation to the following:
therapy or to certain chemotherapy drugs, which may allow
such therapy to be given in smaller doses. Intense heating (1) an increased ATP turnover rate (i.e., intensified ATP
will cause denaturation and coagulation of cellular proteins, hydrolysis). As a result of an increased ATP degra-
rapidly killing cells within the targeted tissue. A mild heat dation, an accumulation of purine catabolites has to
treatment combined with other stresses (excitation of the be expected together with a formation of H+ ions and
appropriate signal pathways) can cause cell death by apop- reactive oxygen species at several stages during degra-
tosis. dation to the final product uric acid,
The potential importance of the hyperthermia for cancer (2) a poorer ATP yield as a consequence of a shift from
treatment has been highlighted by Coffey et al. [6, 7]. Specif- oxidative glucose breakdown to glycolysis [18].
ically, the review addresses four topics: (1) hyperthermia-
induced cell killing, (2) vascular, (3) cellular and intracellular (4) Effects on Proteins That Contribute to Resistance to Other
mechanisms of thermal effects in the hyperthermia temper- Stresses, for Example, DNA Damage. At higher temperatures,
ature range, and (4) effects on proteins that contribute to inhibition of HSP-synthesis occurs above a distinct thresh-
resistance to other stresses, for example, DNA damage. old temperature. In general, the temperature, respectively,
thermal dose at which HSP-synthesis is inhibited in a given
(1) Hyperthermia-Induced Cell Killing. It has been long recog- experimental system varies between different cell types,
nized that hyperthermia in the 40–47∘ C temperature range but the respective threshold can be lowered when further
kills cells in a reproducible time- and temperature-dependent (proapoptotic) stimuli are added. As lack of HSP-synthesis is
manner. In the hyperthermic region, there are three cellular associated with exponential cell death, it is generally accepted
responses for thermal therapy: cytotoxicity, radiosensitization, that HSPs prevent cells from lethal thermal damage. Recently,
and thermotolerance [8, 9]. The intensity of cell death in an additional role has been ascribed to HSPs which should be
hyperthermia is shown as cell cycle dependence. Both S- of importance in hyperthermia as activators of the immune
and M-phase cells undergo a “slow mode of cell death” after system [21–24].
hyperthermia. Cells during G1-phase may follow a “rapid
mode of death” immediately after hyperthermia [10–12].
4. Problems with Hyperthermia
(2) Vascular. With higher heat temperatures, there is a
corresponding decrease in oxyhemoglobin saturation, and The high energy application could cause controversies: the
these changes will result in a decrease in overall oxygen high temperature burns the malignant cells, but it is missing
availability [13, 14]. This lack of oxygen will also give rise to selectivity. The healthy cells are damaged also, and the hyper-
a decrease in tumor pH and ultimately lead to ischemia and thermia starts unwanted physiological reactions as well as
cell death [15]. Normal tissues typically show a very different enlarged dissemination possibility. These conditions make
vascular response to heat, with flow essentially increasing as the hyperthermia effect not controlled.
the temperature increases [16, 17].
method creates inhomogeneous heating, microscopic tem- connections, which is also great success to save the life. The
perature differences far from thermal equilibrium. The def- built up connections could force not only the sticking
initely large temperature gradient between the intra- and together but also make bridges between the cells for infor-
extracellular liquids changes the membrane processes and mation exchange to limit the individuality and the competi-
ignites signal pathways for natural programmed cell death, tive behavior of the malignant cells. These are high efficacy
avoiding the toxic effects of the simple necrosis [25]. factors that favor oncothermia over its temperature-equi-
Oncothermia works with much less forwarded energy, by valent hyperthermia counterpart. They also produce higher
focusing energy directly on the malignant tissue using its concentration of HSPs in the outer membrane and in the
impedance selectivity even by cellular resolution. This effect extracellular matrix. The higher HSP concentration in the
is based on the low impedance of the tumor, due to its meta- vicinity of the malignant cells together with the changes of the
bolism, which is higher than that of its healthy counterpart adherent connections between the cells induces apoptosis.
[26]. For further information read the longer version of this
Based on microscopic effects, there not only the heating paper in [28].
which makes the effect but also the electric field itself has
a strong synergy with this, having significantly larger cell kil-
ling in malignancy at 38∘ C than the conventional hyperther- Acknowledgment
mia has on 42∘ C. The process is selective. The radiofrequency The authors acknowledge the experimental work and fruitful
current is choosing the “easiest” path to flow, and due to the discussions of Professor Dr. Andras Szasz, Dr. Nora Meggye-
high ionic concentration of the near neighborhood of malig- shazi, and Dr. Gabor Andocs.
nant cells, the current will be the densest at the tumor cells.
The experimental results well support this idea. In the case of
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SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH GOMBONG
PROGRAM STUDI DII KEPERAWATAN 2016
-PENG ERTIAN DEMAM-
3 4 5 6
SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH GOMBONG
PROGRAM STUDI DII KEPERAWATAN 2016
TANDA DAN GEJALA DEMAM
Taki kardi
pusing
menggigil
peningkatan
suhu tubuh
kehilangan
nafsu makan
Peningkatan resiko dehidrasi Kemungkinan bisa Demam di atas 420C bisa menyebabkan
(kekurangan cairan tubuh) kekurangan oksigen. kerusakan saraf.
Kejang Demam
lemas Nyeri Otot Sakit Kepala Menurunnya Nafsu Makan
Memberikan Banyak Minum Dan Memberikan Minuman Kesukaan Seperti Sari Buah, Minuman Ion, Juz, Teh Manis, Air Susu, Air Limun, Dll.
Ganti baju yang basah akibat keringat dengan baju tipis lakukan terapi aktifitas bermain di tempat tidur seperti mewarnai, atau tidur
ditemani orang tua.
Pemberantasan lalat
seperti dengan kipas angin, lem lalat,
Jangan biasakan anak jajan sembarangan penyediaan air minum yang memenuhi syarat.
lilin, plastik bening yang diiisi air,
jeruk lemon, apel, atau gunakan obat
atau semprotan pembasmi serangga
SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH GOMBONG
PROGRAM STUDI DII KEPERAWATAN 2016
SEKOLAH TINGGI ILMU KESEHATAN MUHAMMADIYAH GOMBONG
PROGRAM STUDI DII KEPERAWATAN 2016
2. Terpajan pada lingkungan
yang panas dalam waktu yang lama
LIFLET APA ITU DEMAM ? 3. Olah raga atau aktivitas yang berlebihan
4. Menurunnya kemampuan untuk
TENTANG DEMAM berkeringat.
5. Penyakit atau trauma
6. Reaksi imun.
DAMPAK DARI DEMAM d. Ganti baju yang basah akibat d. Makan makanan yang bersih dan
sehat
1. Peningkatan resiko dehidrasi e. Jangan biasakan anak jajan
(kekurangan cairan tubuh) sembarangan
2. Kemungkinan bisa
kekurangan oksigen
3. Demam di atas 420C bisa menyebabkan
kerusakan saraf.
4. Kejang Demam keringat dengan baju tipis
5. Lemas e. Atur suhu ruangan lebih dingin
6. Nyeri Otot Sakit Kepala f. Pemberantasan lalats seperti
misalnya membuka jendela.
7. Menurunnya Nafsu Makan f. lakukan terapi aktifitas bermain di dengan kipas angin, lem lalat, lilin,
tempat tidur seperti mewarna, atau plastik bening yang diiisi air, jeruk
CARA PENANGANAN DEMAM tidur ditemani orang tua. lemon, apel dan cengkeh, atau
gunakan obat atau semprotan
DIRUMAH mencakup: pembasmi sersing
a. Pemberian kompres hangat PENCEGAHAN DEMAM
b. Batasi aktifitas dengan cukup
istirahat. a. Jaga kondisi kesehatan lingkungan.