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Stroke ဦးေႏွာက္ေသြးေၾကာ ေဖာင္းၿပီးေပါက္ျခင္း

• By ဒီဗီြဘီ
•  11 July 2015
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ဦးေႏွာက္ေသြးေၾကာေဖာင္းၿပီး ေပါက္သြားတာေပါ့ေနာ္။ အေျခအေနကေတာ့ စိုးရိမ္ရတယ္။ က်ေနာ္ ဒီေလာက္ပဲ ေျပာလို႔ရမယ္လို႔ ကုတင္တစ္ေထာင္ေဆးရံုက ဦးေႏွာက္ခြဲစိတ္အထူးကုဆရာဝန္ႀကီး ေဒါက္တာျမတ္သူဝင္းက ေျပာပါတယ္။

Stroke (စထုပ္ခ္) လို႔ လူသိမ်ားတဲ့ ဦးေႏွာက္-ေသြးေၾကာေရာဂါကို Cerebrovascular accident (CVA); Cerebral infarction; Cerebral hemorrhage; Ischemic stroke စသျဖင့္ ေခၚေသးတယ္။ Brain attack လို႔လည္း ေခၚတယ္။ ျမန္မာေတြက ေလျဖတ္တာလို႔ ေခၚတယ္။ ေရာဂါကဆိုးလြန္းၿပီး၊ အျဖစ္လည္း မနည္းလွပါ။

လြန္ခဲ့တဲ့ အႏွစ္ ၃ဝ အတြင္း ပိုအျဖစ္မ်ားလာတယ္။ ၉၅ ရာခုိင္ႏႈန္းဟာ အသက္ ၄၅ ႏွစ္ေက်ာ္သူေတြ ျဖစ္တယ္။ ၃ ပံု ၂ ပံုက ၆၅ ႏွစ္ေက်ာ္သူေတြ ျဖစ္တယ္။ မိသားစုထဲမွာ တေယာက္မကျဖစ္တာ ေတြ႔ရတယ္။ ေယာက္်ားေတြက မိန္းမေတြထက္ ျဖစ္ႏႈန္းမွာ ၂၅ ရာခုိင္ႏႈန္း ပိုပါတယ္။ အမ်ိဳးသမီးေတြက ေသဆံုးတာမွာ ၆ဝ ရာခုိင္ႏႈန္း ရွိတယ္။ ဒါဟာ အမ်ိဳးသမီးေတြက သက္တမ္း ပိုရွည္ၾကတာနဲ႔ ေသြးဆံုးတာေတြနဲ႔ ဆက္စပ္ႏိုင္တယ္။ ကင္ဆာ၊ နာတာရွည္ ေက်ာက္ကပ္ေရာဂါ-အဆစ္နာေရာဂါ ရွိေနသူေတြ၊ ကိုယ္ဝန္ေဆာင္နဲ႔ ကေလးဖြားၿပီးသူေတြမွာ ပိုျဖစ္တယ္။

Silent stroke (ဆိုင္းလင့္-စထုပ္ခ္) လူမသိ-သူမသိျဖစ္ျခင္း၊

ေရာဂါလကၡဏာေတြ မေပၚေပမယ့္ ဦးေႏွာက္ကိုေတာ့ ထိခိုက္ပ်က္စီးေနတာကိုေခၚတယ္။ ၁၉၉၈ ေလ့လာမႈတခုအရ အေမရိကားမွာ လူေပါင္း ၁၁ သန္း Stroke ျဖစ္တယ္။ ၇၇ဝဝဝဝ ေယာက္ဟာ Silent strokes ျဖစ္ၾကတယ္။ MRI လုပ္မွ အထဲမွာ Infarcts ေသြးခဲ ဒါမွမဟုတ္ Hemorrhages ေသြးယိုေနတာကို သိရတယ္။ ခံစားၿပီး ျဖစ္တာထက္ ၅ ဆပိုတယ္။ အသက္ႀကီးရင္ ပိုျဖစ္တယ္။ Cryptogenic ဆိုုတာ ဘာလို႔လဲ မသိဘဲ ျဖစ္တာကို ေခၚတယ္။ ၃ဝ-၄ဝ ရာခုိင္ႏႈန္း ရွိတယ္။

ဘာလို႔ျဖစ္ၾကသလဲ

• စိတ္ဖိအားမ်ားျခင္းနဲ႔ အရက္ေသာက္ျခင္းေတြဟာ ေယာက္်ားေတြအတြက္ (စထုပ္) ေခၚတဲ့ ဦးေႏွာက္ေသြးေၾကာ ရုတ္တရက္ မေတာ္တဆေရာဂါကို ျဖစ္ေစတဲ့ အဓိကအေၾကာင္းရင္းေတြ ျဖစ္ၾကတယ္။
• အိႏၵိယႏိုင္ငံမွာ (စထုပ္) ရတဲ့ လူနာေပါင္း ၂၉ဝ (ေယာက္်ား ၂၁ဝ + မိန္းမ ၈ဝ) ကို ေလ့လာခဲ့ရာကေန ေတြ႔ရွိရတာ ျဖစ္တယ္။
• ေယာက္်ားေတြမွာ စိတ္ဖိအားမ်ားျခင္း (၁၈.၆ ရာခုိင္ႏႈန္း )၊ အရက္ေသာက္ျခင္း (၁၄.၈ ရာခုိင္ႏႈန္း)၊ ေရာဂါပိုးဝင္ျခင္း (၉ ရာခုိင္ႏႈန္း)၊ ေဒါစိတ္ျဖစ္ျခင္း (၃.၃ ရာခုိင္ႏႈန္း)၊ ေကဖင္းေသာက္မ်ားျခင္း (၈.၆ ရာခုိင္ႏႈန္း )၊ လိင္နဲ႔ပတ္သက္ျခင္း (၂.၄ ရာခုိင္ႏႈန္း) ေၾကာင့္ျဖစ္ၾကတယ္။
• မိန္းမေတြမွာ စိတ္ဖိအားမ်ားျခင္း (၁၅ ရာခုိင္ႏႈန္း)၊ ေဒါစိတ္ျဖစ္ျခင္း (၆.၃ ရာခုိင္ႏႈန္း)၊ ေရာဂါပိုးဝင္ျခင္း (၆.၃ ရာခုိင္ႏႈန္း)၊ ေကဖင္း ေသာက္မ်ားျခင္း (၅ ရာခုိင္ႏႈန္း) နဲ႔ ခြဲစိတ္ကုသရျခင္း (၃.၈ ရာခုိင္ႏႈန္း) ျဖစ္ၾကတယ္။
• ေကဖင္းဆိုတာ ေကာ္ဖီ၊ လက္ဖက္ရည္၊ ကိုလာ စတဲ့အရည္ေတြျဖစ္တယ္။
• အရင္က အသက္ႀကီးမွျဖစ္တာမ်ားေပမယ့္ အခု အသက္ငယ္သူေတြမွာလည္း ျဖစ္လာေနတယ္။
• စိုးရိမ္စိတ္မ်ားတာ၊ စိတ္ဖိအားမ်ားတာနဲ႔ ေၾကာက္စိတ္ေတြျဖစ္လာၿပီးေနာက္ ဒီေရာဂါျဖစ္လာၾကတတ္တယ္။

ဒီေရာဂါဟာ ဦးေႏွာက္ကိုေပးပို႔ေနတဲ့ ေသြးေၾကာလမ္းေၾကာင္းမွာ တခုခုမွားသြားရင္ ျဖစ္လာေစတယ္။ ဦးေႏွာက္က ေသြးမရတာကို စကၠန္႔ပိုင္းထက္ပိုၿပီး မခံႏိုင္ဘူး။ ဦးေႏွာက္ (ဆဲလ္) ေတြ ေသကုန္တယ္။ ထိခိုက္မႈဟာ ရာသက္ပန္ ျဖစ္တယ္။ အဓိက ၂ မ်ိဳးရွိတယ္။

(၁) ေသြးခဲေလးကေန က်ဥ္းေနတဲ့ ေသြးလႊတ္ေၾကာထဲမွာ ပိတ္ေနတာေၾကာင့္ ျဖစ္တာကို Thrombotic stroke ေခၚတယ္။

(၂) ကိုယ္ခႏၶာရဲ႕ တျခားေနရာေတြမွာရွိေနတဲ့ ေသြးခဲက ကြဲထြက္ၿပီး ဦးေႏွာက္ဆီကို ေရာက္လာတာေၾကာင့္ ျဖစ္တာကို Embolic stroke လို႔ေခၚတယ္။

ေရာဂါျဖစ္ႏိုင္ေျခရွိသူေတြကေတာ့ -

• ေသြးတိုးေရာဂါ၊
• Atrial fibrillation ႏွလံုးခုန္မမွန္တာ၊
• ဆီးခ်ိဳ၊
• မိသားစုထဲမွာ အဲလိုျဖစ္သူရွိတာ၊
• (ကိုလက္စေထာ) မ်ားေနတာ၊
• အသက္ႀကီးလာတာ၊ ၅၅ ႏွစ္ေက်ာ္တာ၊
• အသားမည္းျဖစ္တာ၊
• ႏွလံုးေရာဂါလည္း ရွိေနမယ္၊ ေျခေထာက္ပိုင္းကို ေသြးေၾကာေတြက က်ဥ္းလို႔ေသြးေလွ်ာက္တာလဲ ေႏွးမယ္ဆိုရင္၊
• လူအဝလြန္သူေတြ၊
• အရက္ေသစာ အေသာက္မ်ားသူေတြ၊
• အငန္နဲ႔ အဆီစား မ်ားသူေတြ၊
• ေဆးလိပ္ ေသာက္သူေတြ၊
• (ကိုကိန္း) နဲ႔ တားျမစ္တားတဲ့ေဆးေတြကို သံုးသူေတြ၊
• အသက္ ၃၅ ႏွစ္ေက်ာ္ၿပီး ကိုယ္ဝန္တားေဆး သံုးသူအမ်ိဳးသမီးေတြလည္း ျဖစ္ႏိုင္တယ္။

ေသြးခဲေၾကာင့္ ျဖစ္တာမွာ ၂ မ်ိဳးရွိတယ္။ (၁) ေသြးလႊတ္ေၾကာႀကီးေရာဂါ နဲ႔ (၂) Sickle cell anemia ေသြးအားနည္းေရာဂါကေန ျဖစ္ေစတယ္။ ေသြးလႊတ္ေၾကာေတြကို လာပိတ္ေစႏိုင္တာက Fat အဆီခဲ၊ Cholesterol (ကိုလက္စေထာ) နဲ႔ ကင္ဆာ (ဆဲလ္) ေတြ ျဖစ္ႏိုင္တယ္။ ဗက္တီးရီးယား ဥပမာ Infectious endocarditis ႏွလံုးေရာဂါကေန လာတာမ်ိဳးကေနလည္း ျဖစ္တယ္။ Atrial fibrillation ႏွလံုးေရာဂါကေန ျဖစ္တာမ်ားတယ္။ Atrial or ventricular septal defect ႏွလံုးေရာဂါေတြကေနလည္း လာမယ္။ Deep vein thrombosis အတြင္းထဲမွာရွိတဲ့ ေသြးျပန္ေၾကာထဲကေနလည္း လာႏိုင္တယ္။ အဆို႔ရွင္ အတုတပ္ထားတဲ့ ႏွလံုးကေသြးခဲဟာ ဦးေႏွာက္ကို လာပိတ္တာလည္း ျဖစ္ႏိုင္တယ္။ အဲလို တျခားေနရာက လာတာမ်ိဳးအတြက္ လာရင္းေရာဂါကိုပါ ကုသရမယ္။

ေသြးေၾကာက်ဥ္းရာကေနျဖစ္ရင္ Atherosclerotic plaque (ပလိပ္) ေခၚတဲ့ Sticky substance ခပ္ေစးေစးအရာ ျဖစ္လာတယ္။ ဦးေႏွာက္ထဲက ေသြးလႊတ္ေၾကာေလးေတြ အားနည္းလာရင္ ေပါက္ထြက္ႏိုင္တယ္။ ေသြးယိုထြက္ၿပီး Hemorrhagic stroke ျဖစ္မယ္။

ဘယ္လိုခံစားရမလဲ

ဦးေႏွာက္ရဲ႕ ဘယ္ေနရာမွာ ျဖစ္သလဲအေပၚ မူတည္တယ္။ တခ်ိဳ႕မွာ ျဖစ္တာမသိဘဲ ေနတတ္တယ္။ ျဖစ္တာက ရုတ္တရက္ပဲ။ ျဖစ္စ ၁ ရက္ ၂ ရက္မွာ ျဖစ္လိုက္ ေပၚလိုက္လည္း ျဖစ္ႏိုင္တယ္။ ပထမဆံုး အႀကိမ္က ခံစားရတာ အျပင္းထန္ဆံုးပဲ။ ဒါေပမယ့္ ေနာက္ျဖစ္ရင္ ဆိုးဆိုးလာေတာ့မယ္။

• ေခါင္းကိုက္မယ္။ ႐ုတ္တရက္ျဖစ္မယ္။ ပက္လက္လွဲခ်ိန္ ျဖစ္တယ္။ အိပ္ရာကေန ႏိုးလာမယ္။ အေနအထား ေျပာင္းတာနဲ႔ ပိုဆိုးမယ္။
• ေခါင္းမူးေနမယ္၊ အိပ္ခ်င္ေနမယ္၊ သတိမေကာင္းျဖစ္မယ္၊ သတိလစ္မယ္၊ နားေကာင္းေကာင္း မၾကားျဖစ္မယ္၊ အရသာ မေကာင္း ျဖစ္မယ္၊ စိတ္ရႈတ္ေထြးေနမယ္၊
• နာတာ-ထိတာ-ဖိတာကို ခံစားမႈ၊ အပူ-အေအးသိတာ အရင္လိုမဟုတ္ျဖစ္မယ္၊
• အမ်ိဳရခက္မယ္၊ စာအေရးရ အဖတ္ရခက္မယ္၊ ဆီး-ဝမ္းအသြားရ အထိန္းရခက္မယ္၊ ကိုယ္ကို ထိန္းမတ္လို႔ မရျဖစ္မယ္၊ အျပန္အလွန္ထိန္းညႇိ မေကာင္းျဖစ္မယ္၊
• မ်က္ႏွာ-ေျခ-လက္ ႂကြက္သားေတြ အားနည္းမယ္ (တဘက္တည္းျဖစ္တာ မ်ားတယ္)၊ ထံု-က်င္ေနမယ္ (တဘက္ထတည္းျဖစ္တာ မ်ားတယ္)၊ ကိုယ္ကို မထိန္းႏိုင္တာ၊ လမ္းမေလွ်ာက္ႏိုင္ျဖစ္မယ္။ ကိုယ္တျခမ္း ေလျဖတ္တယ္လို႔ ေခၚတယ္။
• စိတ္လႈတ္ရွားမႈ-စိတ္ပံုစံ ေျပာင္းမယ္၊ စကားေျပာရခက္မယ္၊ သူမ်ားေျပာတာကို နားမလည္ျဖစ္မယ္၊
• မ်က္ခြံေအာက္က်ေနမယ္၊ မ်က္စိကို လႈတ္မရဘူး၊ သူငယ္အိမ္ဟာ အလင္းေရာင္ကို တုံ႔ျပန္တာ ေႏွးမယ္၊ မ်က္စိ အၾကည့္ရခက္မယ္၊
• ႏွလံုးခုန္-အသက္ရွဴ မမွန္တာ၊
• ေခါင္းကို တဖက္ဖက္ကို ေကာင္းေကာင္းလွည့္မရတာ၊
• လွ်ာကိုေကာင္းေကာင္း အသံုးမခ်ႏိုင္ဘူး၊
• မွတ္ဉာဏ္ေလွ်ာ့မယ္။

စစ္ေဆးမႈေတြ

1. Angiogram လုပ္ရင္ ဦးေႏွာက္ထဲမွာ ေသြးေၾကာပိတ္ေနတာ၊ ေသြးယိုေနတာ ျမင္ရမယ္။
2. Carotid duplex (Ultrasound) ရိုက္ရင္ လည္ပင္းက Carotid arteries ေသြးလႊတ္ေၾကာ က်ဥ္းေနတာ ျမင္ရမယ္။
3. CT Scan of the brain နဲ့ MRI Scan of the brain ေတြလုပ္ႏိုင္တယ္။
4. MRA နဲ့ CT angiography လုပ္ရင္ ဦးေႏွာက္ထဲက ေသြလႊတ္ေၾကာေတြ ပံုမွန္မဟုတ္တာ ျမင္ရမယ္။
5. Bleeding time, Blood cholesterol and sugar, Blood clotting tests, CBC နဲ႔ ECG ေတြလည္း လုပ္ႏိုင္တယ္။

ဘယ္လိုကုသမလဲ

တကယ့္အေရးေပၚျဖစ္တယ္။ ေဆးရံုတက္ ကုသရမယ္။ အမ်ားဆံုး လူနာေတြဟာ ၃ နာရီအတြင္း ေရာက္ၾကတယ္။ ေသြးခဲေၾကာင့္ ျဖစ္တာဆိုရင္ Thrombolytic therapy ေသြးခဲေက်ေဆး ခ်က္ခ်င္း ေပးရတယ္။ လူတိုင္းကိုေတာ့ မေပးရပါ။ ေရာဂါလကၡဏာစၿပီး ၃ နာရီအတြင္းဆို ေပးႏိုင္တယ္။ ေသြးခဲလို႔ မဟုတ္ဘဲ ေသြးယိုလို႔ ျဖစ္ေနခ်ိန္ဆိုရင္ ဒီေဆးေၾကာင့္ ပိုဆိုးေစမယ္။

ေသြးခဲေၾကာင့္ ျဖစ္တာအတြက္ Blood thinners ေသြးက်ဲေဆးျဖစ္တဲ့ Heparin or Warfarin (Coumadin) ေဆးကိုလည္း သံုးတယ္။ Aspirin နဲ႔ Clopidogrel (Plavix) ေတြကိုလည္း ေပးႏိုင္တယ္။ ေသြးခဲပိတ္လို႔ျဖစ္ရင္ အခ်ိန္လည္း မီမယ္ဆိုရင္ Thrombolysis ေသြးခဲကို ေခ်ဖ်က္နည္းနဲ႔ Thrombectomy ခြဲစိတ္နည္းေတြ လုပ္ႏိုင္တယ္။ Medications ေဆးေပးနည္းမွာ Aspirin, Clopidogrel, Dipyridamole ေဆးေတြကို Platelets ေသြးမႈံေတြစုၿပီး ေသြးမခဲေအာင္ လုပ္ေပးႏိုင္တယ္။ Thrombolysis ဆိုတာ ေဆးနဲ႔ ေသြးခဲကို ေခ်ဖ်က္နည္း ျဖစ္တယ္။ tissue Plasminogen Activator (tPA) ေဆးမ်ိဳး သုံးတယ္။ ခ်က္ခ်င္းျဖစ္တာအတြက္ သံုးသင့္-မသင့္ အယူအဆ မတူၾကဘူး။

ေသြးယိုတာအတြက္ ခြဲစိတ္နည္း သံုးလို႔ရတာလဲ ရွိတယ္။ Carotid artery လည္ပင္း-ေသြးလႊတ္ေၾကာကို ခြဲစိတ္ရတာလဲ ရွိတယ္။ Mechanical thrombectomy စက္သံုးနည္းလဲ ရွိတယ္။ ခ်က္ခ်င္းျဖစ္တာအတြက္ သံုးတယ္။ ေပါင္ျခံက Femoral artery ေသြးလႊတ္ေၾကာထဲကို Catheter ပိုက္ငယ္ေလးတခု ဦးေႏွာက္ ေသြးေပးစနစ္ထဲအထိ ထိုးသြင္းရတယ္။ Corkscrew-like device ကရိယာေလးကေန ေသြးခဲကို ဆုပ္ယူေစမယ္။ Angioplasty and stenting နည္းဆိုတာကလဲ ခ်က္ခ်င္း ျဖစ္တာကို သံုးတယ္။

ေခါင္းထဲမွာ ေသြးယိုတာျဖစ္ရင္ Neurosurgical evaluation ေလ့လာမႈေတြ လုပ္ရမယ္။ ေသြးယိုတဲ့ အေၾကာင္းကို ရွာၿပီး ကုသရမယ္။ ခြဲစိတ္တာ သိပ္မလိုတတ္ဘူး။ ေသြးတိုး ရွိေနခ်ိန္မွာ ေသြးက်ေဆး ေပးရတယ္။ တခ်ိဳ႕က အစာအာဟာရနဲ႔ အရည္ျဖည့္ေပးဖုိ႔ လိုမယ္။

ေဆးကုတာအျပင္ (ဖီဇီကယ္သာရာပီ)၊ စကားေျပာနည္း၊ လုပ္ငန္းဆိုင္ရာ ကုသနည္း၊ အစာမ်ိဳနည္းေတြလည္း လိုႏိုင္တယ္။ ေရရွည္အတြက္ ဆက္လုပ္ေပးရတယ္။ ျပန္ၿပီး နာလန္ထေရးနဲ႔ ေနာင္မျဖစ္ေအာင္အတြက္ လုပ္ရတယ္။

ေနာက္ဆက္တြဲ ျဖစ္ႏိုင္တာေတြကေတာ့ အစားအေသာက္ေတြ အသက္ရွဴလမ္းထဲ ေရာက္တာ၊ ဉာဏ္ သံုးရတဲ့အလုပ္ ခ်ိဳ႕ယြင္းတာ၊ လိမ့္က်တာ၊ မလႈပ္ရွားႏိုင္တာ၊ ကိုယ္တျခမ္း၊ တခ်ိဳ႕ေနရာေတြ ေလျဖတ္တာ၊ ႂကြက္သားေတြ ေတာင့္တင္းေနတာ၊ အစာအာဟာရ မျပည့္ဝတာ၊ ဖိအားဒဏ္ေၾကာင့္ အနာျဖစ္တာ၊ စကား ေကာင္းေကာင္းမေျပာႏိုင္တာ၊ နားမလည္တာ၊ ေတြးေတာတာ၊ အာရံုစိုက္တာ အားနည္းတာ။

ေရာဂါလကၡဏာေတြ ဆင္တူတိုင္းေတာ့ Stroke မဟုတ္ပါ။ Brain tumor ဦးေႏွာက္ကင္ဆာ၊ Subdural hematoma ဦးေႏွာက္အဖံုးလႊာေအာက္မွာရွိတဲ့ေသြးခဲ၊ ဗက္တီးရီးယား၊ မိႈကေနျဖစ္ေစတဲ့ ဦးေႏွာက္ထဲမွာ ျပည္တည္နာ၊ ဗိုင္းရပ္စ္ ဦးေႏွာက္ေရာင္ေရာဂါ၊ တခ်ိဳ႕ေဆးေတြ မ်ားသံုး-ေပးတာ၊ Sodium, Calcium, Glucose ဓယတ္ဆားေတြ နည္းသြားတာေတြကေန ခပ္ဆင္ဆင္ ျဖစ္တတ္တယ္။

ဒုတိယအႀကိမ္ ထပ္မျဖစ္ေအာင္

၁. Anticoagulation ေသြးမခဲေဆးနည္း သံုးတယ္။ Non-valvular atrial fibrillation ျဖစ္ေနသူေတြဆိုရင္ ဒီနည္းေၾကာင့္ ၆ဝ ရာခုိင္ႏႈန္း သက္သာေစႏိုင္တယ္။ Antiplatelet agents ကေန ၂ဝ% ေလွ်ာ့နည္းေစမယ္။ Embolic stroke ျဖစ္တာကို Anti-coagulation ေစာေစာေပးလို႔ ေဘးျဖစ္ေစႏိုင္တာကိုလဲ ေထာက္ျပထားတယ္။

၂. Carotid stenosis ျဖစ္ေနရင္ Carotid endarterectomy ခြဲစိတ္ေပးတာကလည္း အက်ိဳးမ်ားေစမယ္။

၃. ေဆးလိပ္မေသာက္ပါနဲ႔၊ (ကိုလက္စေထာ) ထိန္းပါ၊ ေသြးတိုးထိန္းပါ၊ ဆီးခ်ိဳထိန္းပါ၊ ကိုယ္လက္ေလ့က်င့္ခန္း ပံုမွန္ တေန႔ နာရီဝက္လုပ္ပါ၊ ကိုယ္အေလးခ်ိန္ ထိန္းပါ၊ အရက္ျဖတ္ပါ-ေလွ်ာ့ပါ၊ မူးယစ္ေဆးဝါး ျဖတ္ပါ၊

၄. အစာအဟာရ မွ်တျပည့္စံုပါေစ။ အသီး-အရြက္၊ အသီးအႏွံစားပါ၊ အဆီး-အခ်ိဳ-အငန္ ေလွ်ာ့စားပါ၊ အဆီလြတ္အသား စားပါ၊ ႏို႔ထြက္အစာေတြ ေလွ်ာ့ပါ၊ ဆိုင္ဝယ္စား အစာေတြ သတိထားပါ၊ Saturated fat, Partially-hydrogenated နဲ႔ Hydrogenated fats ေတြ သတိထားပါ။

၅. ကိုယ္ဝန္-တားေဆးသံုးရင္ ဆရာဝန္ကို တိုင္ပင္ပါ၊

အလားအလာ

အမ်ိဳးအစား၊ ဘယ္ေလာက္ပ်က္စီးသြားခဲ့သလဲ၊ ဘယ္ေနရာေတြကို ထိခိုက္သြားသလဲ၊ ေဆးကုသမႈကို ဘယ္ေလာက္ျမန္ျမန္ ရခဲ့သလဲ ဆိုတာေတြအေပၚ မူတည္ၿပီး –

• လံုးဝေကာင္းတာနဲ႔ တခ်ိဳ႕အလုပ္ေတြ ျပန္မေကာင္းႏိုင္ေတာ့တာ ျဖစ္တယ္။ တဝက္မက လူနာေတြဟာ အိမ္မွာတင္ေနႏိုင္ၿပီး အေတာ္ျပန္လုပ္ႏိုင္ၾကတယ္။
• Ischemic stroke ျဖစ္သူေတြက Hemorrhagic stroke ျဖစ္သူေတြထက္ ကံေကာင္းၾကတယ္။
• ဒုတိယအႀကိမ္ ထပ္ျဖစ္တာဟာ ပထမအႀကိမ္ေနာက္ လနည္းနည္းအၾကာမွာ ျဖစ္တတ္တယ္။
• Disability မသန္မစြမ္းျဖစ္တာ ၇၅ ရာခုိင္ႏႈန္း ရွိတယ္။ ႐ုပ္ပိုင္း၊ စိတ္ပိုင္း၊ ထိခိုက္ေစမယ္။
• Post stroke depression စိတ္ဓါတ္က်တာ ၃ဝ-၅ဝ ရာခုိင္ႏႈန္းမွာ ခံစားရမယ္။
• Emotional lability ခံစားမႈ အားနည္းသြားတာ ၂ဝ ရာခုိင္ႏႈန္း မွာ ျဖစ္ေစတယ္။
• Seizures တက္တတ္တာကို ၁ဝ ရာခုိင္ႏႈန္း မွာ ျဖစ္ႏိုင္တယ္။

ေဒါက္တာတင့္ေဆြ

(စာေရးသူ၏ ေဖ့စ္ဘြတ္ခ္မွ ခြင့္ျပဳခ်က္ျဖင့္ ေဖာ္ျပသည္)

Alibaba.com Business Tips: Finding Suppliers and Manufacturers

ကမၻာေက ်ာ္ အရမ္းကိုု ဗိုုလ္တကာဗိုုလ္လုုပ္ေနတဲ့ အေမရိကန္လိုုႏိုုင္ငံႀကီးေတာင္ စီးပြားေရးမွာ ႏွစ္တိုုင္းလိုုေငြျပေနၿပီး လက္ေျမွာက္လိုက္ရေတာ့မဲ့အေျခေနထိေရာက္ေနရတဲ့ေခတ္သစ္ဂ ်ဳးတြျဖစ္တဲ့ တရုုတ္ျပည္
ႀကီးက  Alibaba ကုုမၺဏီေသးေသးေလတခုု အေၾကာင္းေလးပါ၊ သူဒုုကၡေပးေနတာက ဘယေတြလဲ ၾကည့္လိုုက္က ်ပါအံုုး ....

The Alibaba Effect

Alibaba is the biggest business story of 2015. Why? Because it is poised to take the e-commerce world by storm.

Jim Tompkins, supply chain and retail operations strategy expert, reveals what your business needs to know about this Chinese e-marketplace that is quickly becoming the fastest growing e-commerce company in the world. With more than $1 billion invested in businesses across the U.S., Alibaba’s IPO launched in New York City on September 19, 2014.

To learn more about Alibaba, its IPO, Jack Ma’s strategies, and what all of this means for your business, review the additional resources on the web page below.

http://www.tompkinsinc.com/videos/ali...

Alibaba is the biggest business story of 2015. Why? Because it is poised to take the e-commerce world by storm.

Jim Tompkins, supply chain and retail operations strategy expert, reveals what your business needs to know about this Chinese e-marketplace that is quickly becoming the fastest growing e-commerce company in the world. With more than $1 billion invested in businesses across the U.S., Alibaba’s IPO launched in New York City on September 19, 2014. To learn more about Alibaba, its IPO, Jack Ma’s strategies, and what all of this means for your business, review the additional resources on Alibaba that are listed below the video.

In The Alibaba Effect Video, you will learn:

• The top 5 things today’s retailers need to know about Alibaba.
• Why they are investing so much in logistics over the next decade.
• How final delivery, the “get local” movement, e-commerce planning, and demand-driven supply chains are key to competing.
• How Alibaba will continue to expand both in the U.S. and globally.
• Why Jack Ma is a global leader, teacher, and visionary.
• Why Alibaba is your competition, whether you realize it or not, and what actions you need to take to respond.

Alibaba is changing the game, and it is changing the way supply chains are viewed in the U.S. To take advantage of this huge opportunity, plan your counteroffensive now. Contact Tompkins International to discuss how you can leverage your knowledge of The Alibaba Effect and lead your company to success.

The Alibaba Effect YouTube Video launched on June 25, 2014. As of May 26, 2015 at 10 am (EST) the Alibaba Effect has been viewed 187,826 times. How many views do you think the Alibaba Effect video will have by June 25, 2015 at 10 am (EST) one year after it’s launched? If your guess is the closest to the number of views without going over the number of views, you will be the winner of the Alibaba Effect contest. Win a free registration package for the Supply Chain Leadership Forum 2015. While at the forum you will have the opportunity to meet with Jim Tompkins in a one on one and learn even more about the Alibaba Effect.

• One winner.
• You must submit your entry for your chance to win by 10 am (EST) on Tuesday, June 23, 2015.
• By submitting your entry you will agree to receive Tompkins International newsletters.
• Must be at least eighteen (18) years old at time of entry.
• Only one submission per person per email address allowed.
• Winner will be notified on or after Thursday, June 25, 2015 by email and will have 48 hours to confirm their mailing address & accept winnings or forfeit prize.
• If no reply is received, another winner will be chosen and the same process will take place until a winner accepts winnings.
• Once selected winner confirms their mailing address & accepts winnings, the winner will officially be announced on the Tompkins International Website, Facebook, LinkedIn & Twitter pages thereafter.
• Participation in the contest constitutes entrants full and unconditional agreement to and acceptance of these Official Rules.
• Email addresses will not be sold to 3rd parties.

How Alibaba Works: Explained With 280 Pairs of Pant

Sept. 15 (Bloomberg) –- Alibaba's IPO could be the biggest in history. Bloomberg's Sam Grobart explains how Alibaba works through the experience of ordering 280 pairs of pants manufactured overseas. Video by: Dan Przygoda, David Yim (Source: Bloomberg)

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Bloomberg Television offers extensive coverage and analysis of international business news and stories of global importance. It is available in more than 310 million households worldwide and reaches the most affluent and influential viewers in terms of household income, asset value and education levels. With production hubs in London, New York and Hong Kong, the network provides 24-hour continuous coverage of the people, companies and ideas that move the markets.

Alibaba.com Business Tips: Finding Suppliers and Manufacturers

Successful entrepreneurs explain how they used Alibaba.com to locate Chinese companies to manufacture their innovative products

Alibaba.com

At Alibaba.com, we're helping make sourcing easy! Find just about anything from millions of manufacturers and distributors, worldwide.

Top 6 Reasons Why You Should Watch The Alibaba Effect

How many of you have heard of Alibaba, the Chinese e-marketplace? Alibaba is the fastest growing e-commerce company in the quickest growing market in the world. CEO Jim Tompkins recently sat down to discuss how Alibaba is changing the way supply chains are viewed in the U.S. Here are the top 6 reasons why you need to watch The Alibaba Effect:

1. Alibaba does 80% of the online business in the largest e-commerce market in the world.
2. Out of every dollar of revenue, Alibaba makes 43 cents profit.
3. Alibaba marketplaces have more than 10 million sellers and more than a billion product listings.
4. Jack Ma, founder of Alibaba, and Alibaba itself have invested over $1 Billion in businesses in the United States.
5. Alibaba is planning to invest more than $20 billion in logistics over the next eight years.
6. Most importantly, Alibaba will either be your competition or your biggest ally. You have no choice but to respond.

What you will hear in The Alibaba Effect video is critical and has never been discussed in detail from a supply chain perspective. Alibaba is changing the game when it comes to supply chains in the U.S.  Watch this video so you can plan your counteroffensive now and lead your company to success in omnichannel.
Ref:http://www.industryweek.com/blog/top-6-reasons-why-you-should-watch-alibaba-effect

Alibaba Founder Jack Ma: Ideas & Technology Can Change the World

Jack Ma, the founder of China's most profitable e-commerce company Alibaba Group, made his last public speech at Stanford University on May 4th, 2013 before stepping down as CEO. In his talk, Ma discussed why embracing change is critical for global leaders managing the fast turnover of technology.

The event was co-hosted by Alibaba Group and the Stanford Graduate School of Business's Stanford Program on Regions of Innovation and Entrepreneurship (SPRIE): http://stnfd.biz/lVQGt

Transcript (English): http://stnfd.biz/mZAZw 

Transcript (Mandarin): http://stnfd.biz/mZB1D

Jack Ma Speech - How to Run Business

Jack Ma's Top 10 Rules for Success

He started his business with $20,000 that his wife and friend helped him raise. He is the first mainland Chinese entrepreneur to appear on the cover of Forbes. He is the richest man in China and 18th richest man in the world with an estimated net worth of $29.7 billion. He's Jack Ma, founder of Alibaba.com, and here are his Top 10 Rules for Success.

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1. Get used to rejection

2. Keep your dream alive 

3. Focus on culture

4. Ignore the #LittleMan

5. Get inspired

6. Stay focused

7. Have a good name 

8. Customers are #1 

9. Don't complain, look for opportunities

10. Have passion

Jack Ma On 60 Minutes CBS [Full Version & Chinese subtitles][HD] 馬雲美國CBS《60分鐘》專訪[中英字幕][高清完整版]

 

Jack Ma Speech - How to Run Business

Alibaba's Ma Reflects On 12-Year Journey at China 2.0 Conference

Jack Ma, Chairman and CEO of Alibaba Group, delivered the closing keynote address at the conference "China 2.0: Transforming Media and Commerce", hosted by the Stanford Program on Regions of Innovation and Entrepreneurship (SPRIE) at the Stanford Graduate School of Business, on Sept. 30, 2011. 

Ken Chenault & Jack Ma: A Conversation about U.S. Small Businesses

Ken Chenault, chairman & CEO of American Express and Jack Ma, founder & executive chairman of Alibaba Group discuss issues related to small businesses at a meeting in Chicago. Introduction by Karen Mills, senior fellow at the Harvard Business School and the Harvard Kennedy School. Mills served in President Barack Obama's Cabinet as the Administrator of the U.S. Small Business Administration from 2009 to 2013.

Jack Ma - China Will Be Largest Buyer In The World - 11 Jun 15 | Gazunda

Jack Ma Speech - Small is Beautiful

Interview With Aung San Suu Kyi: Myanmar's Future 2015

Aung san suu kyi interview media

Leader of Myanmar’s opposition Aung San Suu Kyi sits down with The Globe

Talk to Al Jazeera - Aung San Suu Kyi: 'There is no rule of law'

Italia 2015 - Il messaggio di Aung San Suu Kyi

Suu Kyi says boycott of Myanmar election an option

NAYPYITAW | BY ANDREW R.C. MARSHALL AND SIMON WEBB

• 
  

Myanmar opposition leader Aung San Suu Kyi said boycotting an upcoming historic election was an "option" if a military-drafted constitution that bars her from becoming president remains unchanged.

In an interview on Friday, the Nobel laureate told Reuters that her opposition National League for Democracy (NLD) party was "ready to govern" but that President Thein Sein was insincere about reform and might try to postpone the election.

She also said U.S. praise for Myanmar's semi-civilian government, which took power in 2011 after nearly 50 years of brutal military rule, had made it "complacent" about reform.

While scathing about what she called Thein Sein's "hardline regime", Suu Kyi emphasised the need to reconcile with the military which detained her for 15 years until her release from house arrest in 2010.

"We don't think that boycotting the election is the best choice," said Suu Kyi, when asked whether her party would run with the constitution unchanged. "But we're not ruling it out altogether. We are leaving our options open."

However, she stressed the importance of the November general election, describing it as "the real test of whether we are on the route to democracy or not."

The NLD won Myanmar's last real election in 1990 by a landslide, but the military nullified the result.

The party boycotted the 2010 poll, widely regarded as rigged, which installed Thein Sein, a former general and junta stalwart.

His government launched a series of political and economic reforms. Many people now feel the reform process has stalled, and the military - its immense power largely unchecked - again casts a shadow over the voting.

Suu Kyi said Thein Sein was "sincere" about reform during their first meeting in 2011. But now, he was not.

"Because if he had been sincere about reform, then we would be much further ahead than we are," she said, speaking in a meeting room in Myanmar's sprawling parliamentary complex in the capital Naypyitaw.

She expressed concern that Thein Sein might use peace talks with ethnic rebels as a pretext to delay the election.

MYANMAR'S HOPE

For Suu Kyi, who turns 70 in June, this is a pivotal year.

She and 42 other NLD members entered parliament after a 2012 by-election. Since then, say critics, Suu Kyi has lent her hard-won democratic credentials to a questionable government that has given little in return.

But many more in this large, poor and ethnically diverse nation still see Suu Kyi as Myanmar's best hope. Reforms have raised expectations among its 53 million population but left most people's lives unimproved.

The constitution, drafted by the former junta, reserves a quarter of parliamentary seats for military delegates, which effectively allows them to veto any constitutional change.

It also bars presidential candidates with a foreign spouse or child. Suu Kyi's late husband and two sons are British.

She said the presidency was still within her reach. "Why not?" she said. "Constitutions are not permanent."

But changing it, she admitted, depended upon a government she repeatedly described in the interview as a "regime" of hardliners.

"They are not interested in negotiations or in amending the constitution or taking seriously the will of the people...you could hardly say they are moderates."

Suu Kyi said she questioned U.S. praise of Myanmar's government in the hopes of encouraging further reforms.

"I would ask whether it actually encourages them to do more or it simply makes them more complacent," she said.

"The United States and the West in general are too optimistic and a bit of healthy scepticism would help everybody a great deal."

A U.S. official told Reuters in November, ahead of President Barack Obama's second visit to the country, that Washington had decided not to press for changes to Myanmar's constitution in a bid to maintain influence with its government.

But Suu Kyi said she did not feel abandoned by the United States and had "good friends" there.

MILITARY MANOEUVRES

One "absolute necessity" was mending relations with the military. "We can't have a country that is split between the military and the rest of the people," she said.

In 2012, Suu Kyi upset many supporters by saying she had a "soft spot" for the military. It was founded by her father Aung San, Myanmar's independence hero, whose portrait hung on the wall behind her.

Now, she rejects criticism that she had been outmanoeuvred by Myanmar's generals.

"We've always known that they would not give up their privileges easily," she said. "There's a time when we have to stand up for our principles and there's a time when one of the principles should be national reconciliation rather than digging up the past."

Suu Kyi also denied claims she had failed to speak up for the Rohingya Muslims, a mostly stateless people living in wretched conditions in western Myanmar after deadly clashes with majority Buddhists in 2012.

"When I talked about rule of law and the fact that we condemned all forms of violence, nobody was interested," she said. "This wasn't news."

(Editing by Raju Gopalakrishnan)

Myanmar's pro-democracy leader Aung San Suu

RFA Myanmar news TV Update on 13 February 2015,Aung San Suu Kyi Pays Tribute to Late Father in His N

Aung San Suu Kyi: "I have condemned Rohingya persecution"