KLE University (Part 3)

I heard the good news too! The good news I heard is the remaining students who were supposed to go to KLE University but got stuck behind in USM, have been re-routed to MSU-IMS University in Bangalore. They will be registering with MSU (campus at Shah Alam) some time this week and will be going to Bangalore next week. There will be approx. 100 new medical students in this batch going to Bangalore (largest group size). Best Wishes and Happy Learning to all who will be leaving for Bangalore.

My daughter will be in second year medic at MSU-IMS University; she leaves for Bangalore on Sunday, 2 Oct 2011 at 10pm. All flights to Bangalore are at night @10pm. MAS flies direct to Bangalore International Airport.

KLE University is in Belgaum, Karnataka, India. Belgaum is approx. 450 km or 8 hours by train, up farther northwest.

https://www.facebook.com/USM-KLE-International-Medical-Programme-Belgaum-394434213979967/timeline

Medicinal uses of alcohol

Alcohol was used in ancient times for various medicinal ends, and the Bible refers to some of these practices. It was likely used as an anesthetic to dull pain, and many interpreters suggest that it was in this capacity that wines were offered to Jesus at his crucifixion.

In the Parable of the Good Samaritan, Jesus tells a story about a man from Samaria who assists an injured man by, among other things, pouring oil and wine on his wounds. Oil mixed with wine was a common remedy in the ancient world to cleanse wounds and assuage their pain.

Paul advises Timothy that he should not drink water only, but should use a little wine for the sake of his stomach and frequent infirmities. Some have suggested this advice is particularly in reference to purifying low quality drinking water, while others suggest it was simply intended to help his digestion and general sickliness. Abstentionists generally regard this passage as a positive example of abstention from wine and see Paul's instructions as exceptional and purely for the sake of health, while other interpreters suggest that Timothy was "upright in his aims" but here guilty of an "excess of severity" or that he felt inappropriately bound by a Hellenistic custom that younger men should not drink.

Source: http://en.wikipedia.org/wiki/Alcohol_in_the_Bible

Female world records

Women do create records in their own way. Here are some records made by females.

First and oldest woman known in history:
Hawa (Eve), wife of Prophet Adam a.s. She had no parents. She was derived from Prophet Adam a.s.

Oldest woman to give birth to a son:
Sarah, wife of Prophet Ibrahim a.s. She was 80-90 years old (need to confirm her age).

Oldest woman to give birth to multiple live births:
She is a South American, aged 85 years old (need to confirm her age). Scientists are still researching her genes and why she is still fertile even in old age. She lives in the mountainous region of the Andes where the air is clean. She makes love in the woods, far away from people where it is quiet. She is a housewife. She has twins, triplets, quartets, quintuplets etc.

Oldest Malay lady known to have live birth:
She is 56 years old. She has just delivered at Hospital USM today.

Oldest woman alive:
She was a Black and lived in a small hut by the sea somewhere in the Carribean. She lived by herself but people visited her at home. She lived till 116 years old (need to confirm her age). Researchers asked her what she ate. She said she took unripe green bananas daily.

The prettiest lady in the world:
Khadijah, wife of Nabi Muhammad s.a.w. She loved her husband dearly.

Pretty wife:
Zulaikha, wife of Nabi Yusof a.s.

Most intelligent wife:
A'isyah, wife of Nabi Muhammad s.a.w.

Wife with pretty hair:
Wife of the Pharaoh.

Questions for readers:
What are the genes that give rise to beauty?
What are the beauty genes?
Why does beauty fade with age?
How can a male arm be differentiated from a female arm?

Cancer

Cancer rate increases in our society. A cure for cancer for an afflicted person is the sarang angkut-angkut (wasp hive) in his own house, and the pokok semalu (forget-me-not plant). For any disease or condition that involves swelling, the pokok semalu is the cure as it will reduce the swelling.

Take the pokok semalu, air zamzam and sarang angkut-angkut, and pound to a paste. Read Ayat al-Quran. Apply the paste to boils, swellings, etc. It will feel cool. It takes the heat away.

Read Al-Fatihah, Ayat Kursi & Surah Al-Baqarah Ayat 22.

Source: tv9, Tanyalah Ustaz (Ustaz Sharhan Shafie), Penyakit & Penawarnya, 25 Sept 2011, 7.40am 

Stroke

Stroke occurs increasingly in our society and is a cause of great concern. It is important to note down the details of a stroke. The time & venue it occurs and the body part(s) affected are important.

In Islam, if the stroke occurs in the toilet, that is thought to be caused by syaitan. A stroke with a drop-shoulder (bahu jatuh) is severe.

In Islamic Medicine, freshly squeezed goat's milk is taken for stroke. An Ayat from Surah Yaasin is read before drinking the goat's milk. This was taught by Gibreel (Jibra'il) to Nabi Muhammad s.a.w., who used this technique to overcome the stroke in his grandson, Hassan, who was playing in the sand and suffered a stroke.

Source: tv9, Tanyalah Ustaz (Ustaz Sharhan Shafie), Penyakit & Penawarnya, 25 Sept 2011, 7.30am

Note: His books can be bought at Popular and most bookstores.

Persian Military; Bam and Patish

The army of ancient Persia consisted of manageable military groupings under the individual commands. Starting at the bottom, a unit of 10 was called a dathabam and was led by a dathapatish. A unit of 1,000 was a hazarabam and was commanded by a hazarapatish. A unit of 10,000 was a baivarabam and was commanded by a baivarapatish. The Greeks called such masses of troops a myrias or myriad. Among mounted troops, an asabam was a cavalry unit led by an asapatish.

Source: Wikipedia

Mongol Military: Hierarchy

There were no ranks in the Mongol Empire in the modern sense of a hierarchy of titles, although the army was organized into a hierarchical command. The organization of the Mongol army was based on the decimal system, much like that of the Achaemenid Empire of Persia. The army was built upon a squad of ten (aravt) led by an appointed chief. Ten of these would then compose a company of a hundred (zuut), also led by an appointed chief. The next unit was a regiment of a thousand (myangat) led by an appointed noyan. The largest organic unit was a ten thousand man unit (tumen) also led by an appointed noyan. The Mongalisen is what we would call General of the Army.

Source: Wikipedia

Roman Military: Units of Measurement (Research)

Roman discipline was severe, with all ranks subject to corporal and capital punishment at the commander's discretion. For example, if a cohort broke in battle, the typical punishment was decimation, in which every tenth soldier, selected by lot, was killed. Decimation was not commonplace as lack of men would reduce combat effectiveness, which would eventually overcome the psychological "benefit" of keeping the troops in-line.

Source: Wikipedia

Greek Military: Units of Measurement

Different types of units were divided differently and therefore their leaders had different titles. For example, under a numbering system by tens, a dekas or dekania was a unit of ten led by a dekarchos, a hekatontarchia was a unit of hundred led by a hekatontarchos and a khiliostys or khiliarchia was a unit of a thousand led by a khiliarchos.

Source: Wikipedia

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Here is a special song for everyone. This is Law Kana Baynana by Raihan.

http://www.youtube.com/watch?v=g-Nsd7NUttg

Idea asal video : Ustaz Muhammad
Video : Law Kana Baynana
Lagu : Raihan - Ya Rasulullah & Law Kana Baynana
Sila lawat laman web http://ab-ab.blogspot.com

Law Kana Baynana adalah program dokumentari televisyen yang mengkaji penerapan nilai-nilai Islam yang diajarkan oleh Nabi Muhammad s.a.w., dalam realiti masyarakat semasa. Tontoni di TV Al-Hijrah setiap Ahad, jam 9 malam.

Follow this link to my other blog which has the lyrics for Law Kana Baynana in Malay.

This is the full song with clearer diction.

Cancer patient fund raising

Raising money for a cancer patient but she died.

http://www.youtube.com/watch?v=RGpZ9bchCJw&feature=related

Scabies

Scabies is an ancient disease. Archeological evidence from Egypt and the Middle East suggests that scabies was present as early as 494 BC. The first recorded reference to scabies is believed to be from the Bible (Leviticus, the third book of Moses) ca. 1200 BC. Later in fourth century BC, the ancient Greek philosopher Aristotle reported on "lice" that "escape from little pimples if they are pricked"; scholars believe this was actually a reference to scabies.

Nevertheless, it was Roman physician Celsus who is credited with naming the disease "scabies" and describing its characteristic features. The parasitic etiology of scabies was later documented by the Italian physician Giovanni Cosimo Bonomo (1663–99 AD) in his famous 1687 letter, "Observations concerning the fleshworms of the human body." With this (disputed) discovery, scabies became one of the first diseases with a known cause.

Source: Wikipedia

4 days left -- Palestine: the world's next nation

In my lecture, History of Medicine, I taught how NGOs are involved in relief work in disaster areas. I  mentioned MERCY Malaysia and Medicen Sans Frontiers (Medicine Without Borders).

Now there is Avaaz.

What is Avaaz?

Read here about Avaaz at its website.

Read here about Avaaz activities.

Join here for Avaaz in Facebook.

Find Avaaz here:
http://myspace.com/avaazorg
http://zazzle.com/avaazorg*
http://www.flickr.com/photos/avaaz/
http://www.bebo.com/Avaaz
http://youtube.com/user/AvaazOrg
http://twitter.com/Avaaz

Avaaz — means "voice" in several European, Middle Eastern and Asian languages.

We are now fighting, using ICT means, to free Palestine, and make it a free country. Will it work? 

We have 4 days left before UN can say Palestine is a free country.

Avaaz will need our support to free Palestine.

Join Avaaz here:
https://secure.avaaz.org/en/join_avaaz/?join

Prof Faridah

KLE University (Part 2)

USM has an offshore undergraduate medical program that is much talked about but nobody seems to know what is happening here in USM/Malaysia or there in KLE University/Belgaum.

Click here for USM VC's article re its offshore program.

Here is what I have on KLE University.

HOW MANY KLE STUDENTS?

USM started sending medical students to KLE University last year, in 2010. I don't have the # off hand.

This year, in 2011, USM wanted to send 100 students (as mentioned in VC's article) but I heard from the KLE students this year, that the first batch of 70 students left after Aidilfitri 2011. However, there are remaining 21 students who are still waiting to go to KLE University. Why did this happen? The story goes like this - USM did not manage to obtain approval for the remaining 21 students to go to KLE University. So the 21 KLE students are actually here with us in Medical School (PPSP). They follow our program here. Whether they will get to go in the end is my big puzzle too. All I can say is, I don't know either.

https://www.facebook.com/USM-KLE-International-Medical-Programme-Belgaum-394434213979967/timeline

ANATOMY TEACHING USING CADAVERS vs NO CADAVERS

The VC mentioned in his article that the KLE program uses cadavers.

The truth is we do not use any cadavers in the medical program in USM as we do in KLE. Why, you may ask. It is because there are no cadavers available for use in teaching of Anatomy practicals. The shortage of cadavers has been a chronic problem with our Medical School. We didn't have the problem before till the government order on zoning for supply of cadavers became effective. We no longer can obtain cadavers as we used to do before the government order. Since our Medical School is in the north and on the east coast, we are limited to obtain cadavers only from Kelantan and nearby areas. But because our Medical School is located in a state dominated by the Malay people and Malay people do not prefer autopsy, nor do they give away their dead loved ones for study purposes, we therefore do not have any cadavers. We have 200+ students, and if 10 students share half a corpse, we will roughly need at least 10 corpses for teaching every new batch of students. But the core of the problem is we cannot find nor obtain 10 corpses each year and prepare them for teaching. So the problem becomes chronic and we don't have any cadaver at all for teaching now. Even the large corpse bins have been tossed out and placed in the corridor. We are not allowed to pinch or buy corpses from outside Kelantan-Terengganu for teaching. When I first started teaching in USM Medical School in Penang in 1982, we used to buy corpses from Tanjung Rambutan and other mental hospitals. There was a good supply of corpses and we had enough corpses for teaching and learning. But now we cannot buy corpses from other places except from the specific places meant for us. 

ROYAL COLLEGE OF MEDICINE, PERAK (RCMP)

I visited the Royal College of Medicine in Ipoh, Perak (RCMP). I visited the Anatomy Department which is sited in a double-storey building near Ipoh Hospital mortuary. The hospital mortuary continuously supplies a sufficient number of corpses to the Anatomy Department at RCMP for teaching purposes. The lower floor of the building is where they store and process the corpses obtained from the hospital. There is an open (without walls) teaching area on the lower floor. The upper floor houses a large lab, a lecture hall, lecturers' rooms and anatomical models. Anatomy is well taught at RCMP and the lecturers are highly committed. They are all experienced Burmese lecturers. "Little Burma" it may seem to a visitor but this is the best place to learn Anatomy first hand from the experts themselves. The Anatomy Department is headed by a good friend of mine, a highly committed lecturer, Professor Dr Myo Than. At RCMP, medical students have to draw/sketch some of the anatomical parts they learn and have to submit that as assignment. The drawings are coloured using coloured pencils. The lecturers then carefully check the students' work and make corrections where necessary. Students pick up their assignments from the drop mail pigeonhole slots in Anatomy Department. This I think is the best way to learn Anatomy.

SUMMARY

In summary, of the three medical schools, which teaches Anatomy best? I would say both RCMP and KLE University. The Anatomy teaching at USM Medical School is dry as anatomical models are used but there are no cadavers. Students can however write to RCMP or KLE University to ask if they can do an Anatomy Elective at the two other universities. If a student aspires to become a surgeon, then RCMP or KLE University is a good choice. If a student does not aspire to become a surgeon, then USM is alright since no cadavers are used.

Prof Faridah

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Ema

Tribute to Nazia Hasan

I just learned that Pakistani pop singer and actress, Nazia Hasan died. She was 19. Inna lillahi wainna ilaihi rajiuun. May she rest in peace.

Nazia Hasan in YouTube

She was known as Divya Bharti

Herbs in daily life - Misai kucing

Source: A CAP Guide by the Consumer Association of Penang (CAP).

Misai kucing

Scientific name: Orthosiphon aristatus
Tamil name: Punai misai
Chinese name: Mao xu cao

Herbal and medicinal uses:

Treating ailments of kidney, bladder stone, urinary tract infection, bladder problems
Treating liver problems
Treating diabetes
Treating rheumatism

Teh Misai Kucing (Java tea)

This is a local tea used by the Malays. This tea recipe is by Chew Jia Xin, a new first year medical student.

Steps to Make Java Tea (teh Misai Kucing)
- by Chew Jia Xin, Year 1 Medic, USM, 13 Sept 2011

1. Pluck the ‘Misai Kucing’ leaves.

2. Tear the leaves into smaller pieces if the size of the leaves is too big.

3. Wash it thoroughly and dry it under the sun.

4. Place the dried leaves into a pot of water and then boil it. After boiling, it is ready to be served.

OR

Put some dried leaves into a tea pot and then pour water that has just been boiled into it.


My comments:


Here is what the real Misai kucing plant looks like in my backyard. It grows wild! When the bush grows really wild, just trim the bush and pluck the leaves for making tea. The plant does not die but regrows to full height in a few weeks. The plants grows best in the hot Malaysian weather, in semi sandy soils or poor soil. There is no need to add any fertiliser. The plant seems to prefer hot areas with plenty of morning and evening sunshine. Daily watering is not needed or the plant grows too bushy. Occasional watering is preferred. Insects feed on the leaves (don't know what insects). This plant needs no tender loving care. It grows wild by itself. Propagation is easy - just pluck an old stem and stick it in the ground. It seems to take root fast. You should have no regrets trying to grow this plant. Give it a try. You can also purchase a potted Misai kucing plant from Pasar Tani.

Misai kucing (Orthosiphon stamineus) with white flowers which resemble cat whiskers

Misai kucing bush without flowers

Introduction to History of Medicine (Part 3)

Presentation time. This time there was more fun in class as there was dance, drama, story-telling and more cheerfulness and lots of laughter. Here are photos of their presentations. I have missed taking photos of some of the earlier groups as it didn't occur to me to take their photos. Some of the students may have them anyway.

Indian dance by a Chinese girl to the lovely rhythm of Tumpa Se Aaye. This was a repeat as I forgot to take photos the first time and requested a repeat dance.

Headache drama

Remedy for headache

Went to see the Chakra

Group 4: Relief Efforts. Instructions for hand-wave exercise was given

All are seated on one-third of their chairs

The hand-wave exercise begins row by row

Introduction to the History of Medicine (Part 2)

Date: 13 September 2011
Venue: Dewan Kuliah 4, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
Students: Year 1 Medicine USM (230) + Year 1 Dentistry USM (60) + Year 1 KLE Program (30)

We had 6 groups: Group 1, Group 2, Group 3a, Group 3b, Group 3c and Group 4

Here are some photos of the students.

Chinese students taking a  close look at miswak and a small ceremonial gift from the old Silk Road (route). They could read the Chinese note on the gift pack which was written in Mandarin.

Fauzan (left) is Year 1 Student Leader this year

One of the groups preparing its PPT

I walked up to see the other students who were not actively involved this morning. Interesting features today were the colourful clothes, water-bottles, handphones and laptops. I think some of the boys forgot that they must wear long sleeves and a neck tie. Generally, they looked happy to be in first year Medicine. Here are their photos.

I might have given him a tasbih from Masjid Hudaibiyah

We have wonderful Indian students this year

Top most row of students in the lecture hall

Overcoming anemia in young females

I'm writing this post in response to many problems brought to my attention.

When girls have their menses, there is a tendency that they get anemic. Anemia takes a slow course before it manifests as tiredness (letih), fatigue (lesu) and movement becomes slow. When anemia manifests in this way, this is already extreme and an immediate measure needs to be taken.

What I normally tell my first-year female students is to go to the Staff Clinic at HUSM and request for anemia workup, and to ask for hematinics.

Actually it is better to take measures to avoid becoming anemic. Life feels so much better when the body is not anemic.

Young female students can take iron supplements and avoid becoming anemic (ie avoid feeling tired, fatigued and having less energy for normal movements).

Iron supplements come in basically 2 forms - chewable tablets and film tablets which are to be swallowed.

Below are some of the iron sources which can be taken to avoid from becoming anemic.


SAFERON

Saferon is a delicious chocolate flavoured uncoated chewable hematinic tablet containing iron(III)-hydroxide polymaltose complex equivalent to elemental iron (100 mg) and folic acid BP (500 mcg). Indications: Treatment of latent iron deficiency and iron deficiency anemia. Prevention of iron and folic acid deficiency before, during and after pregnancy (during lactation). For prophylactic therapy of iron deficiency to cover the recommended daily dietary allowances (RDA) during pregnancy and lactation. Dosage and Administration: Dosage and duration of therapy are dependent upon the extent of iron deficiency. The daily dose can be divided into separate doses or can be taken at one time. Saferon chewable tablets can be chewed or swallowed whole and should be taken during or immediately after a meal. In case of manifest iron deficiency the therapy takes 3-5 months until a normalisation of the hemoglobin value is achieved. Afterwards the therapy should be continued for several weeks with a dosage such as described for latent iron deficiency to replenish the iron stores.

Manifestation of iron deficiency: 1-3 Saferon tablets daily

Latent iron deficiency: 1 Saferon tablet daily

Saferon strip of 10 tablets each. Comes in a box of 3 strips.

Manufacturer:
Glenmark Pharmaceuticals Ltd. Plot No E-37, 39, MIDC Area, Satpur, Nasik - 422 007, Maharashtra, India.

OBIMIN

New Obimin is a film tablet, vitamins and mineral supplements meant for pregnant and lactating women but is safe for young menstruating females.

Each bottle contains 30 film tablets.

Dosage - Adult: One tablet daily or as prescribed by the physician.

A bottle of New Obimin

Manufacturer:
United Pharma (Vietnam) Inc, Hamlet No 2, BinhChanh Commune, BinhChanh District, Ho Chi Minh City, Vietnam. Under the authority of Westmont Pharmaceuticals Inc.

Marketing Authorization Holder by:
Unam Pharmaceutical (M) Sdn Bhd, 11th Floor, Menara ING, 84 Jalan Raja Chulan, 50200 Kuala Lumpur.

Note: Some people may have adverse reaction to Obimin including headache. Please discontinue taking Obimin. Try Saferon or Ferromed.

FERROMED

Ferromed is what we give to our blood donors. But most blood donors don't need it and don't take it anyway, so we have a surplus of Ferromed which we give away with vitamin B.

Please enquire at Blood Bank, HUSM.

Ferromed

Food Cholesterol Content Card

This chart is from MSD.

Cholesterol content of foods

Cholesterol content of common foods

HIGH-CHOLESTEROL FOODS
fat red meat
organ meat
hard cheese
whole milk
whole yoghurt
creamm
eggs
shellfish
crab
prawns
lobster
squid
chocolate
butter
lard
coconut oil
hard margarine 

MODERATE-CHOLESTEROL FOODS
lean read meat
soft cheese
ice-cream
cakes
pastries
mayonnaise
egg noodles (Maggi mee) 

LOW-CHOLESTEROL FOODS
lean white meat (rabbit, turkey)
cottage cheese
soy milk
skimmed milk
low-fat yoghurt
fish
nuts
fresh fruits
vegetables
rice and other cereals
bread
vegetable oil
olive oil
corn oil
soft margarine

Source:
Adapted from an old pamphlet, Know Your Cholesterol, by Boehringer-Mannheim, Germany
Note: This leaflet is published as a service to Family Medicine.

Gluten sensitivity

Block: Nutrition
SGD: Carbohydrate Metabolism
Topic: Gluten sensitivity


Trigger 1

Gluten-sensitive enteropathy (GSE), common in Western Europe and Scandinavian countries, is a chronic disease causing malabsorption and resulting in mucosal damage in the small bowel associated with genetic susceptibility. The main cause of the disease is hypersensitivity to a component of gluten, gliadin, which is alcohol soluble.

Gluten consists of the prolamines of wheat, rye, barley and oats. Although the etiopathogenesis of the mucosal damage is not well known, it is thought to be the result of abnormal cellular immune response to gluten, which is determined genetically. 

Trigger 2

As a consequence of continuing concern of pediatricians for a condition estimated to be more frequent in children than in adults, and which cannot be characterized unequivocally by its intestinal lesions, the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN) finally issued its most rigorous criteria of the disease in 1990. These criteria consist of: i. a state of malabsorption with total or subtotal villous atrophy of the intestinal mucosa observed while the diet contains gluten ii. cure of the clinical disorder and histological lesions following gluten withdrawal. 

Trigger 3

Although GSE presents with chronic diarrhea, failure to thrive (FTT) and clinical fatigue, it is known that the disease may develop years later without malabsorption and with a normal mucosa. Today, it is believed that GSE has a histopathological spectrum, and that it is thus necessary to make a detailed typing demonstrating this spectrum.

Suggested reading
http://www.turkgastro.org/text.php?id=105

Discussion points

1. What is gluten-sensitive enteropathy (GSE) or coeliac disease (CD)?
2. What are the features of GSE/CD?
3. What are the changes seen (if any) in the ileum in GSE/CD?

Fructose metabolism

Block: Nutrition
SGD: Carbohydrate Metabolism
Topic: Fructose Metabolism


Trigger 1

A three-year old male patient was transferred to hospital for further investigation of an enlarged liver (hepatomegaly). His parents were first cousins and he was the first child. Probing his medical history gave the finding, that he was hospitalized for recurrent vomiting at two months of age. No obvious cause was found and the symptoms then disappeared spontaneously. When he was three years old, his parents noticed his failure to thrive (FTT) and hepatomegaly was noted on physical examination. On admission to hospital, his weight and height were below the third percentile. He had 4 cm hepatomegaly below the costal margin. A blood specimen was taken for blood biochemistry and liver biopsy was done.

Trigger 2

Blood glucose on admission was normal as were arterial blood gases (ABG) (pH 7.40, pCO2 34mmHg, pO2 64.9mmHg, HCO3  20mmol/L, base excess (BE) -2mmol/L). Hemoglobin, white cell and platelet counts and prothrombin time were within normal limits. While total bilirubin and GGT were normal, SGOT and SGPT were slightly increased (SGOT 78IU/L, SGPT 60IU/L). Total protein and albumin levels were normal. There was no reducing agent (fructose) in his urine. Blood lactate and pyruvate levels were normal but alanine and methionine levels were high. Urine amino acid chromatography was normal. Hereditary fructose intolerance was raised as a putative diagnosis when a thorough evaluation of the patient's history revealed aversion to products containing fructose. 

Trigger 3

A percutaneous liver biopsy was obtained and histology revealed diffuse macro- and microvesicular steatosis with no evidence of cirrhosis. Enzyme activities were noted in the biopsy tissue. 

On the basis of these results, the diagnosis of hereditary fructose intolerance was confirmed and the child was commenced on a fructose-free diet. 

During two years of follow-up, his liver enzymes returned to normal levels and hepatomegaly disappeared. 

Suggested reading

http://www.turkgastro.org/text.php?id=88

Discussion Points

1. What are the salient features in Trigger 1?
2. What are the positive lab findings in Trigger 2?
3. What are the important findings in Trigger 3?