The Fates of Today's Children

There are many things concerning children. I will list some of them and you can extend the list.

1. A child is born to a pair of parents. However, not all parents are married. Even if parents are married and have children, sometimes parents choose to go separate ways and the children end up either with the father or the mother or neither parent but with the grandparents. Or they go to foster homes or orphanages (rumah anak yatim) with some hope to be adopted.
2. Many children are adopted. Adopted children either do well in the new family setting or they don't. Many do well as babies and children but later in the teenage years and young adulthood, they will struggle to find out their origins and biological parents. That's when a lot of problems come in. Some problems can be easily resolved but most problems do not end and have no ending. Adopted children are bitter about being adopted when they should be happy living with their original biological family. That's fated.
3. When children or adults find out that they are adopted, what can they possibly do? They can break down and cry. What comes after crying? Revenge. Children, teenagers and young adults cannot accept the thought of being adopted and therefore harbour ill feelings and revenge as their first instincts in hitting back at their foster parents. But foster parents are of 2 main types - good and bad. Mostly, children revenge at the good foster parents without a second thought. The adopted children do not dare speak out against their bad foster parents or the dealings will even be more severe. That's life.
4. What happens if a child wants to find out its biological parents? Who will disclose the results of the DNA paternity testing? Whose right is it not to tell a child his/her true biological parents? What right has a child to find out its biological parents? What right has a child to find out that the parents he/she has been living with are not his/her biological parents?
5. What happens if a couple wants to ascertain that a child they own is their biological issue and not that exchanged or swapped at the nursery? How certain are the nurseries and hospitals today that mothers are taking home the babies that they delivered? How certain are we that no baby swap has occurred? 
6. In Islam, there are rules and regulations about adopting and looking after children. Things are ok before puberty. Once a child reaches puberty, then that's when problems begin. How then do we tackle the problem of adopted children at puberty? There are 2 issues - 1) aurat, and 2) breastfeeding.
7. A girl at puberty may not be a girl anymore and must stay away from the foster father. The problem of aurat comes in and the girl must cover herself before her foster father and her foster brothers. This girl can legally marry her adoptive father or any of her foster brothers.
8. The same if a baby boy is adopted. When he reaches puberty, his foster mother cannot face him without strict cover of aurat. Same with her daughter, they all have to cover aurat when the boy reaches puberty. This boy can also legally marry his foster mother or sisters.
9. To avoid the problems of aurat and possible marriage within family members, Islam advocates breastfeeding of the adopted baby. When an adopted baby is breastfed by the foster mother, the baby becomes a part of the family and is legally a son or a daughter of that family, except the baby's father's name remains unchanged. Changing the father's name for an adopted baby is forbidden in Islam.
10. When adopted babies are breastfed by the foster mother, they cannot marry with any family member. In this respect, breastfeeding is a big YES in Islam.
11. Do foster parents have to answer if their adopted children ask whether they were breastfed or not? Yes, they must be honest. Parents must be honest to their adopted children.
12. Why do today's children get hurt when they find out they are adopted? Because parents failed to inform early on in the children's life. This is the greatest wrong foster parents can do. It saves a lot of trouble if they inform the child from very early on but yet show a lot of love towards the adopted child.
13. Adopted children often grow up to become troubled teenagers or adults and that problem shapes their character, which is often accompanied by brute actions, indifference or rudeness. There's a lot of anger and apathy that linger in them.

Internet pic

PBL

PBL = problem-based learning

We offer PBL in year 2 and year 3 medicine. Our PBL is based on the one used at the McMaster University in Canada. Why did we choose that model? I don't know but it was in place before my time. I have never studied the McMaster model nor seen it in action; I merely followed what I am told to do at PBL.

The Medical Education department is in charge of seeing that we execute PBL properly at the school. However, there was no assessment of students at PBL for a long time (~20 years) until someone visited Texas ANM University (?) and brought back the assessment system for us to implement (again without fully understanding the pros and cons for PBL assessment). Students may remember the scoring system used: 1-4 for participation at PBL. To me this scoring is absolutely irrelevant in our PBL system.

Today, I found a good article that explains how students themselves can evaluate how well they have performed at PBL. There is what is called an expert system pre-operated by professionals (specialists and experienced physicians). This is the link:

http://www.mcgill.ca/files/edu-acsrg/CogAnalysisofClinicalDiscourse.pdf

The above article is very good and I hope lecturers and medical schools that wish to implement PBL in their curriculum will study the paper first, and then decide.

As for researchers who are looking into electronic PBL (e-PBL), the same paper does give some ideas for POI (point of investigation) which can be built into an intelligent system. We were researching e-PBL till someone from the medical education department thought it was against PBL procedure to be doing such thing and we were told to scrape the idea of e-PBL (that was what we did, scraped e-PBL). But the paper above provides strong reasons why we should proceed with e-PBL.

I would like to highlight that for the purpose of clinical PBL, the best choice would be to deploy interested clinicians as facilitators (and omit the non clinicians). Non clinicians cannot stand in as facilitators for clinical PBL; it would be unfair to the students. The perpetual problem of forcing non clinicians to do PBL in medical school is unethical on the part of the administrators.

Other articles:
Google "problem-solving in medicine".

Chemical Structure of Carbohydrates

If you thought carbohydrates are just bread, bananas and pudding, then you are definitely wrong. Carbohydrates can appear in many forms and in many foods today. You wouldn't imagine that you can even drink them! Let's have a closer look at the wonders of carbohydrates we have today.

The food technology industry has expanded very rapidly in the past 100 years to meet the world's demands and to feed the hungry. Yes, the world needs more and more carbohydrates as the population increases. Without sufficient carbohydrates, we would all be lanky or twiggy. Carbohydrates give us the stuffing material to make us look good and well fed.

There are many types of carbohydrates, from simple monosaccharides (glucose, fructose and galactose) to dissacharides (sucrose, lactose and maltose) to more complex carbohydrates. We will easily get fat if we just stick to the mono- and disaccharides as our main source of carbohydrates, eg canned drinks which are high in glucose and sucrose.

However, we are fortunate today that the food technology industry has come up with varied choices of complex carbohydrates and made them available in our foods, mostly instant foods. Today, we can easily fix a breakfast drink consisting of oligosaccharides. We can also fix a nutritious meal of instant cereals and have a sufficient amount of beta-glucans to absorb cholesterol from our ingested foods. Our menu today is also varied and mixed from many cultures that we can be sure we are getting all the necessary fibres daily. Our correct approach to selecting high-fibre foods and skipping all the attractive tasty fizzy drinks and fatty fast foods will help in bringing us reach a ripe old age of 75 for many Malaysians (90 for many Australians).

Why do the Australians generally live longer than their Asian counterparts? Well, you can study that. They eat a lot of high-fibre foods, fruits and greens. Malaysians on the whole tend to prefer fried and fatty foods and hardly any greens. It is quite difficult to get Malaysians to eat enough vegetables in their daily intake. You must have watched how Popeye fed canned spinach to Olive Oyl? Yes, it's that difficult. Malaysians tend not to like vegetables as the Australians loved their vegetables.

But we have a lot of workaround today that we don't have to worry so much about whether Malaysians eat their vegetables or not, because now we have so many oligos and who knows what may come out on the supermarket shelves next? Today's youngsters can easily fix an oligo drink in minutes and be done for their daily needs of complex carbohydrates. Today's carbohydrate engineering world has delivered what the world needs. However, consumers are not aware that they are doing something good for themselves when they consume such highly engineered foodstuff. Engineered foodstuffs are not all that bad actually. Engineered carbohydrates are good for health and we can depend on them for improving our health status, especially in controlling cholesterol intake, blood cholesterol level and the risk of ischaemic heart disease (IHD). Alternatively, we can also chew prawn shells and swallow that while eating prawns. Prawn shell is chitin, a type of absorbent carbohydrate that will absorb cholesterol from the prawn itself.

As we get older, the more we will depend on engineered carbohydrates for our continued health. With menopause comes pain in the knees and other joints. Complex carbohydrates such as glucosamine (glycosaminoglycans) tablets, creams and injections can help to relief joint pain.

Chemical structure of carbohydrates:
http://www.scientificpsychic.com/fitness/carbohydrates.html
http://www.scientificpsychic.com/fitness/carbohydrates1.html
http://www.scientificpsychic.com/fitness/carbohydrates2.html

Sandals

Sometimes you get to buy a good pair of shoes, sometimes there are no good shoes to buy. What should you look for when you buy shoes?

The shoe industry is the most interesting beside the textile industry. Everyone wears a shoe of some sort. We only go barefoot when we are down on the beach or walking in shallow water.

Materials for making shoes are important, eg Gore-Tex, a bullet proof material.

When do we need a good pair of shoes? When should we buy them? Why should we buy them? What sort of shoes should we buy?

If you are heavy weight like me, you can simply choose a pair of sandals to go everywhere and for all occasions. Sandals are airy and there is no perspiration locked as in tight closed shoes. The toes and soles remain dry. However, sand and dust can get underneath the toenails and make them unsightly.

Some sandals are hard and they hurt when you walk for long periods. Some sandals are soft and support your feet and legs well. Some sandals are durable and you can even play tennis in them. These are sports sandals.


Clarks sandals:
http://www.clarks.my/features/technology/gore-tex


Birkenstock sandals:
http://www.youtube.com/watch

Shoesurfing:
http://shoesurfing.com/

Diet for Cholesterol

This is a simple site to understand food limitations and suggestions for overcoming the problems of cholesterol.
http://blog.caloricious.com/category/health-conditions/cholesterol-health-conditions/

Fibre

You wouldn't believe it that fibre is not just what you think it is - plain, dull and dry. Fibre is interesting when we get down to its structure at the microscopic level and its properties chemically.

You can Google "fibre" and also try that with Google Images. There are thousands of images to look at and web pages to read about structure and function of fibre, something we often forget to cover in detail in biochemistry lectures.

If you eat oats, mushrooms & barley soup and yeast-raised bread, then you would have eaten some of the world's best foods. These foods contain soluble fibre called beta-glucans. Beta-glucans are some of the best soluble fibre that absorb cholesterol, thus reducing the amount of cholesterol absorbed and finally making it into the bloodstream.

http://blog.caloricious.com/2011/09/15/dietary-fiber-effective-in-lowering-cholesterol-levels/

Oat beta-glucan

http://www.vitaminpros.com/oat-beta-glucan.htm

OxLDL ELISA

LDL (low density lipoproteins) are implicated in the development of the much dreaded atherosclerosis. But there is a more perilous condition that prevails prior to the development of atherosclerosis and which favours the formation of even smaller LDL. This is a condition called prolonged lipaemia.

Normal lipaemia follows ingestion of food. The lymph is milky and stays that way for about 4 hours before it clears up. The most important enzyme that clears a milky plasma after food ingestion (postprandial lipaemia) is lipoprotein lipase (LPL). LPL is an enzyme that appears stuck to fibrilar structures called heparan sulphate (like the heads of matchsticks).

What happens in prolonged lipaemia? In certain conditions, lipaemia remains for very long and is thus referred to as prolonged lipaemia. The plasma doesn't seem to clear up for a long long time. This is a clear sign of a danger that will be quite difficult to solve and resolve. Prolonged lipaemia is a clear sign of the inability of LPL to clear up plasma and make it clear again. Why LPL cannot clear up plasma as fast is another realm of research.

When prolonged lipaemia prevails, it gives LDL an opportunity to be made even smaller, so much smaller that they become highly penetrative, ie they easily penetrate the arterial intima and cause damage. What damage can small LDL possibly do in the underlying tissues? A lot of irreversible damages.

Small LDL are "dense" and are referred to as small dense LDL. Due to their small size (a continuum of sizes), they have a large surface area and are highly prone to oxidation. What is oxidised? What are the surface components of LDL which can be possibly oxidised? There is apolipoprotein B-100 (apoB-100) and some of the surface lipids (can be mono- or polyunsaturated fatty acids of the phospholipids). Cholesterol in the surface layer should not be changed (cholesterol itself is stable). So most probably apoB-100 and some of the unsaturated fatty acid components of the surface lipids can be oxidised. ApoB-100 itself is a huge protein that occupies practically the entire surface of small dense LDL. So it is most likely that in small dense LDL, apoB-100 are oxidised to such an extent that it renders the LDL "good enough" to be consumed by macrophages. So macrophages consume all the oxidised LDL and in turn die from over-consumption of oxidised LDL. This is referred to as the scavenger-receptor pathway, an unregulated pathway where macrophages eat up as much oxidised LDL as they possibly can till they die, becoming foam cells. Foam cells are a key cell found in atherosclerosis.

We can detect oxidised LDL (oxLDL) in the clinical research laboratory using enzyme-linked immunoassay (oxLDL ELISA). A high level of oxLDL indicates a high level of oxLDL in the plasma sample and in the real life situation. High oxLDL possibly equates to high macrophage activity in the underlying tissues of the common carotid artery (CCA), and possible changes/damages to the arterial intima, and intima media thickness (IMT).


OxLDL ELISA:
http://www.cellbiolabs.com/human-oxidized-ldl-elisa-kit
http://www.cellbiolabs.com/human-oxidized-ldl-elisa-kit
http://www.cellbiolabs.com/sites/default/files/STA-369-human-oxldl-elisa-kit.pdf

Vendor:
AXON SCIENTIFIC SDN. BHD.
No. 13-4, Jalan SP2/1,
Taman Serdang Perdana,
43300 Seri Kembangan,
Selangor DE, Malaysia
Tel: +603-89451482
Fax: +603-89419421
Email: info@axonscientific.com
Website: www.axonscientific.com

Depression

http://www.academia.edu/2113434/Population_Analysis_Depression_in_Medical_Students

Obesity in Malaysia

Malaysia was a different country 50 years ago. Its people were thin and tall. They were fit and could manage a lot of manual work from morning till dark. Today's population is different. Many are fat or obese, and cannot manage to perform manual work for the whole day. They tire fast and eat more, and rest longer. They prefer a sedantary lifestyle as opposed to a laborious one. They don't want to sweat at all and prefer air-conditioned rooms.

In the old days, diabetes was a small problem and only a few suffered its complications. Today, many Malaysians, young and old, have this unfortunate disease. A cause of concern is the way we eat and stuff ourselves. We eat to the fullest and drink the sweetest or milkiest (eg air katheera, air bandung, milkshakes, banana shake with chinchau, etc). We always want the best for out tummies and nothing for our brains or in our brains. This is the root of evil and a certain cause for obesity, and diabetes naturally follows suit. Can we stop becoming fat and steer away from diabetes? Yes, but believe me, it is quite hard to do.

Nobody can say no to food when one is hungry. Nobody can say no to water when one is thirsty. We cannot say no to a lot of things today. Everything that appears in front of our two round eyes is appetizing to the nth degree. We must have what we see. We must eat what we see. We must have food of our choice. Our bodies have not learned to say no or to stop eating. We have not trained our bodies to say no or to stop munching. We let out wants and desires guide our lives and so we eat to live and live to eat endlessly and carelessly. We stuff ourselves with extra unneeded food. We transform ourselves from our human form to a wastebin. With a waistbin mentality, we eat and eat and eat till something comes out at the other end. We no longer use our brain to reason why we must stop eating before we are full. Feeling full is no longer a red traffic light. We choose to beat the red traffic light. The STOP sign means nothing to us and is just an icon with no attached meaning.

Today, almost all of us undeniably prefer this waistbin mentality and thus open ourselves to excessive eating, in trying to fulfill all our cravings. With supermarket shelves always well-stocked, it is easy to stick to frozen food. It is easy to serve frozen food, we only need to re-heat and then eat till we are full. We can keep eating and not worry about our frozen foodstock running low or running out. With this strategic supply-demand working in our favour, we can sit back and eat, and enjoy life to the fullest while we can. We become obese in our very own homes from our own doing. Ask your hands and mouths.

This happy life cannot go on forever. With good food 24/7, there is an open invitation to obesity, which must come hand-in-hand with diabetes. We actually don't really have a choice once we hit obesity. The choice is doubly not there when we hit diabetes. There is however one unavoidable choice after diabetes and this is death! The central dogma for us wrt eating today is: Eat excessively --> Obesity --> Diabetes --> Death. Notice that the arrows are irreversible.

http://www.ncbi.nlm.nih.gov/pubmed/12164473

Seabuckthorn Research

Please Google "seabuckthorn" and find the products which are sold in Malaysia.
http://www.produksne.com.my/Clinical+Study

Seabuckthorn
Hippophae Rhamnoides
Hippophae Salicifolia
Hippophae Tibetana
Hippophae Neurocarpa
Hippophae gyantsensis

The tree grows in Mongolia and inner China regions. The fruits are sour and orange (high in vitamins C and A). The seabuckthorn fruit oil is beneficial for general health and to overcome many health problems, including diabetic complications (leg amputation) and cancer. Research is on-going mainly in China, and also in Russia, Germany and Canada.

I gave the links in Facebook in the Medicinal Plant Interest Group.

Diabetic Dyslipidaemia

Determinants of uncontrolled dyslipidaemia among adult type 2 diabetes in Malaysia: The Malaysian Diabetes Registry 2009
Original Research Article
Diabetes Research and Clinical Practice, Volume 96, Issue 3, June 2012, Pages 339-347
Boon How Chew*, Mastura Ismail, Ping Yein Lee, Sri Wahyu Taher, Jamaiyah Haniff, Feisul Idzwan Mustapha, Mohd Adam Bujang

* Corresponding author at: Department of Family Medicine, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia. Tel.: +60 3 89472520; fax: +60 3 89472328.
E-mail address: chewboonhow@yahoo.com (B.H. Chew).
Contents available at Sciverse ScienceDirect (institutional subscription)

What is CAD?

CAD is the most common complication and a major cause of mortality in T2DM (type 2 diabetes mellitus). Patients with T2DM have a higher prevalence of small and dense LDL particles, which are more susceptible to oxidation (ie become oxLDL), therefore increasing atherogenic risk (high oxLDL, high risk CAD) even when there is not a high concentration of LDL cholesterol. This is true of the Indians who usually have low LDL-C but still have high risk for CAD.

What is LDL-C? 

LDL cholesterol (LDL-C) is a measure of the cholesterol carrying capacity of the lipoprotein constituents in blood. Generally, a high total cholesterol (high TC) correlates with a high LDL-C. When LDL-C is high, the opposite occurs to HDL-C. When LDL-C is high, HDL-C is low and this is true is most populations which have been studied except in the Indians. In the case with Indians, they have low LDL-C and low HDL-C. The low HDL-C generally is attributed to endothelial dysfunction, a prerequisite for atherosclerosis and impending CAD. So when we detect Indians with low LDL-C and low HDL-C, it is a tell tale sign and hallmark of an impending CAD. There is no doubt about it.

What is HDL-C?

If LDL carry cholesterol to peripheral tissues (extrahepatic tissues, ie not the liver; tissues apart from the liver), the HDL carry excess cholesterol in the reverse direction, ie back to the liver. For this role, HDL activity is described as reverse cholesterol transport (RCT). What can go wrong with HDL activity. HDL formation and cholesterol uptake are significant initial steps in RCT. When there is prolonged lipaemia, LPL activity is arrested (inhibited). So very little nascent HDL are formed by lipolysis (the other sources of HDL being hepatic production and intestinal production).

When there is disruption to the endothelial surface, cholesterol efflux is affected (less efficient or inefficient). Because choleserol uptake by nascent discoidal HDL is affected, HDL cannot 'grow big', ie they cannot imbibe the excess cholesterol from endothelial cells. Hence, these nascent or small HDL do not contain sufficient cholesterol for the next step to occur - cholesterol esterification by an enzyme called lecithin:cholesterol acyltransferase (LCAT). We must remember that the spherical structure of HDL itself is only possible when the ratio of its lipid components is correct (there is a formula for this). Otherwise the HDL remain discoidal (flattened) and not spherical. Since LCAT activity is limited, the HDL size cannot grow and thus it should be expected there would be a lot of tiny HDL particles in those who have high risk of CAD.

What lipid ratios and indices or combinations are safe or unsafe?

There are so many reports and findings today, which have not been properly tabulated for easy reference. It takes a lot of knowledge to understand what the data means and to be able to interpret correctly. It does take practice and every case is different. Generally,

1. high LDL-C: high risk CAD
2. high HDL-C: low risk CAD
3. high LDL-C, low HDL-C: high risk CAD
4. low-C, low HDL-C: high risk CAD
5. diabetics: high risk CAD
6. diabetic dyslipidaemia: high risk CAD

What is diabetic dyslipidaemia?

When lipaemia is prolonged, a lot of things go wrong intravascularly (in the blood itself). In diabetics, there is prolonged lipaemia; the blood does not rapidly clear up after we eat. Why? This is because a lot of the apparatus to clear up the blood has gone bonkers. I'm talking about lipolysis by lipoprotein liase (LPL). Because of prolonged lipaemia, it gives time for LDL to transform to very small and dense particles called small dense LDL. These little particles are dangerous not only because of their tiny sizes but because they are prone to oxidation. Tiny LDL are oxidised to oxLDL. Tiny LDL can penetrate the arterial intima and lodge in the underlying tissues. They are oxidised and gorged by macrophages. The oxLDL maybe gone but the macrophages now become laden and die to become foam cells. That is the beginning of all the problems related to arterial stiffening etc. Then CAD is the ultimate happening.

Dyslipidaemia of Chinese Yi people

Prevalence of dyslipidemia and associated factors in the Yi farmers and migrants of southwestern China
Original Research Article
Atherosclerosis, Volume 223, Issue 2, August 2012, Pages 512-518
Bin Wang, Daying Wei, Chunxiu Wang, Jianhua Zhang, Li Pan, Mingju Ma, Fang Xue, Zhenglai Wu, Guangliang Shan

1. The paper reported the lipid profile in Chinese Yi people. 
2. The epidemiology study looks at the impact of migration and the environment on serum lipid levels. 
3. The findings showed a future increasing trend of dyslipidemia among the Yi people in southwestern China. 
4. The Yi migrants had a higher prevalence of dyslipidemia than the resident Yi farmers, possibly attributed to their urbanized lifestyles (including drinking alcoholics).

Lipid ratios and indices

Comparison of the various lipid ratios and indices for risk assessment in patients of myocardial infarction
Original Research Article
Clinical Biochemistry, Volume 45, Issue 6, April 2012, Pages 445-449
Binita Goswami, Medha Rajappa, Baidarbhi Chakraborty, S.K. Patra, Suresh Kumar, V. Mallika


► CAD is the main cause of morbidity and mortality.

► Asian Indians are predisposed to CAD due to their unique genetic and environmental predisposition.

► Lipids are the mainstay of risk assessment for cardiovascular disorders.

► The paper highlights the utility of various lipid ratios and indices in risk stratification.

► The ratio Lp(a)/HDL emerges as the best biomarker.

► This will prove beneficial in screening protocols.


Download from Science Direct (institutional subscription required)

APOE Polymorphism

Atherosclerosis. 2003 Oct;170(2):253-60.
APOE polymorphism and lipid profile in three ethnic groups in the Singapore population.
Tan CE, Tai ES, Tan CS, Chia KS, Lee J, Chew SK, Ordovas JM.

Source:
Department of Endocrinology, Singapore General Hospital, Block 6 Level 6, Outram Road, Singapore 169608, Singapore. ce_tan@sgh.com.sg

More at PubMed: http://www.ncbi.nlm.nih.gov/pubmed/14612205

Organ Donation (Derma Organ)

Organ donation was discussed live on TV AlHijrah on Monday, 5 November 2012 at 10.00-10.30pm (Malaysia time). The Islamic ruling on organ donation is described as 'mubah' (allowed, diharuskan).


Would you donate your organs? 

Depends

Would you donate your child's organs? 

Depends. Many people have mixed feelings and doubts. Many are scared to donate. Many don't want to even think about it.

What can we donate?

We can donate eyes, corneas, hearts, heart valves, kidneys, intestines, liver, etc.

Do the organs come from live or dead patients?

Depends on individual case. The situation is complex. Some patients are brain injured, alive but vegetative, on respirator, and the heart is still beating. When the brain is dead, then the heart will cease to function and eventually stop beating, and the patient dies and is declared dead. If the brain is severely injured (accident, stroke, cancer, etc), the brain will not be receiving oxygen since the blood supply is cut short or cannot make it to the brain due to injury. Without a continuous supply of oxygen, the brain dies. When the brain dies, the heart will die, and when the heart stops, the patient is declared dead.

Can we mutilate the corpse?

No. We must follow SOP (standard operating procedure). Organs can survive and are viable when they are properly removed and transported to the recipient. We can only cut out the organ that is required and nothing else. We cannot play with the corpse. We cannot simply mutilate the corpse. We cannot bring shame to the corpse. We must fully respect the corpse, despite not knowing its identity. The corpse is a teaching model and therefore must be respected.

Can we steal body parts during post-mortem?

No. We cannot take any part of the corpse when we do post-mortem. We have to sign papers and strictly follow SOP.

Does age matter?

Old corpse - cannot use the aged heart but can obtain the healthy valves. Must check first if the valves are healthy before obtaining them.

Young child corpse - cannot use the young heart but can obtain the healthy valves. Must check the status of the valves first.

Does religion matter?

The body (jasad) does not matter. Muslims can donate their body parts for non Muslim patients and vice versa. It is hoped that when Muslims donate their body parts, the recipients become good Muslims or better persons.

More information is available at:
Malaysian Society of Transplantation
Facebook: Organ Donation - A Gift of Life

Medical book

Medical Biochemistry at a Glance, 3rd Edition
J. G. Salway
ISBN: 978-0-470-65451-4
Paperback
176 pages
January 2012, Wiley-Blackwell
US $42.95

http://www.ataglanceseries.com/medicalbiochemistry/default.asp

This is a good medical book for insight before class lecture and for revision.

Good points about this book:

• It has all the diagrams nicely laid out in soft colours, and which are self-explanatory
• Major enzymes, inhibitors and disorders or metabolic defects are indicated
• Clipart is used to indicate hydrophobic (cat), hydrophilic (duck), excrete (man on toilet seat), etc
• There is sufficient text which is systematically laid out to guide the student
• The small print is crisp and clear
• It is very pleasant to read, even at night or early morning
• It has an associated website that has Short Answer Questions (SAQ) with answers
• Students can become reviewers for further improvement of the book

Research on Glybera Gene Therapy

Scenario
Gene therapy has ventured out of the clinical research lab and is now available for treating patients. Glybera is used for patients with fat problems, especially those who have hypertriglyceridaemia and therefore face problems of clumped fat leading to pancreatitis-like symptoms and other high-fat related problems (problems with lipases). With Glybera, the virus infects cells and genetic reconstruction leads to normal function of lipase(s) and fat usage. The blood is cleared of excess fatty material and build-up. Prolonged hyperlipidaemia is halted. There is less chances of pancreatitis occurring following high fat intake (eg after makan kenduri). Patients no longer have to rush to A&E, complaining of excruciating pain of supposedly pancreatitis. Reduced occurrence of prolonged hyperlipaemia means less chances for formation of oxidised LDL (ox-LDL). Less ox-LDL means less chances for macrophages to foam cell conversion in the arterial intima, and therefore reduced atherosclerosis, hence reduced possibilities of ischaemic heart disease (IHD). So, overall, a priori, gene therapy is good for patients with genetic problems such as fat-related problems.

Other applications
Glybera should also be good for diabetics since diabetics have prolonged lipaemia. Prolonged lipaemia is a hallmark of those who have IGT (impaired glucose tolerance) before they progress to full blown diabetes. It is a big hope that Glybera can help IGT patients. IGT patients are difficult to find or trace since they don't come to hospital (they are not ill or sick and don't have diabetes). IGT is a pre-diabetic state. The other category of patients is those who have IFG (impaired fasting glucose). When fasted, IFG patients have high blood glucose. I have not seen clinical trials of Glybera in IGT and IFG patients. So we have to wait till someone does the research and the research findings are out. That's the future.

More on gene therapy at BBC News:
http://www.bbc.co.uk/news/health-20179561

Blood Bank HUSM

Dr Abdul Ghani (Langkawi) asked me about what we do with PRS (platelet-rich serum) at USM in Facebook so many days ago. I didn't have the time and chance to go to Blood Bank to ask but the opportunity came today. I arrived early at my department today and left my bags, book and rattan basket in my office and quickly walked over to Blood Bank which is next door. I have to do this quickly because after this I need to run to the mini post-office (opens at 9 am) to mail my book (Research on the Early Malay Doctors) to friends.

This is information about Blood Bank and the contact person. Blood Bank is also running a program to collect blood before the monsoon season comes. I talked to Mr Saw Teik Hock (JTMP) who also managed  and cross-checked my blood for my first surgery 28 years ago. He's a great friend.

Unit Perubatan Transfusi (Tabung Darah)
Waktu Urusan:
Ahad-Rabu: 8.10 pg - 4.40 ptg
Khamis: 8.10 pg - 4.40 ptg
Rehat: 1 pm - 2 pm
Jumaat-Sabtu & Cuti Am: Tutup

Mr Saw Teik Hock (JTMP)
Technical Manager ISO
Blood Bank HUSM
thsaw@kb.usm.my
Tel: 09-760 3337

Assoc Prof Dr Rosline Hassan
HOD Hematology & Blood Bank HUSM
http://www.medic.usm.my/hematology/
http://www.medic.usm.my/hematology/index.php/our-people/lect/rosline

According to Mr Saw Teik Hock, Blood Bank HUSM fractionates and obtains platelet-rich plasma. However, platelet-rich plasma is voluminous (big volume, banyak) and therefore it needs to be reduced (volume-wise) and the Blood Bank hence spins (centrifuges) it and collects and stores the platelet concentrate for use in patients. There is a big need for platelet concentrate and it is used for many types of patients, including orthopedic patients, where the platelet concentrate is applied (injected) to the painful joint. There was previously a research project done on platelets by Dr Wong (please Google him). However, the project was discontinued due to strict ethical procedures later implemented by USM, whereby downstream stuff from patients cannot be used for research unless the blood donors/patients themselves initially approved of such research. However, researchers can reapply for ethical approval to continue their former research with the Blood Bank. Dr Wong will be continuing his research on platelets with prior approval of the USM ethics committee. USM has a special research committee that looks at clinical research and use of patients' products (stuffs that are obtained from patients including blood & blood products, teeth, bones, etc). Mr Saw Teik Hock advised that the best way to go about platelet testing and research is to write to the Head of Department (HOD), Assoc Prof Dr Rosline Hassan. Potential researchers can always write to him regarding the Blood Bank and everything that's connected. I guess this bit of information helps everyone who is looking forward to platelet research. The Blood Bank also has stem cells - please visit the website to find out more.

I will disappear to the mini post-office now.

Wiley Asia Blog

We have made good progress this year. The Wiley Asia Blog (based in Singapore) has indicated its interest to link up with this blog on Medicine Newbie and another blog of mine, The Early Malay Doctors. I have prepared a short description for each of the blogs as requested by the Wiley rep to facilitate the linkup.
http://www.wileyasiablog.com/resources/useful-links/

MEDICINE NEWBIE
http://medicinenewbie.blogspot.com/

Description of blog:

This is an academic as well as a research blog that aims to provide simple, current and brief information to new students in medicine, dentistry and health sciences. Lecturers and researchers who are new to medicine and health sciences may also find this blog useful for writing their first research proposals. Medical students who plan to apply for scholarships may find this blog useful for ideas and suggestions. This blog covers topics and materials covered in lectures, small group discussion (SGD), cases used for problem-based learning (PBL), contents covered in fixed-learning modules (FLM), simple cases for class use, data interpretation, links to relevant YouTube videos to enhance learning, and various other resources to help with initial learning (head start). Questions posed during lecture, SGD, PBL, FLM, etc are discussed where possible. Textbooks, image databases and examination questions are discussed in detail where possible. Exam marking schemes are shown and students' mistakes are highlighted where possible. Learning difficulties, confusing matters and uncertainties are highlighted where relevant.

Language used: English (UK). Expect some Malay words.

Mode of access: Free access

Download of photos: Links are provided to the original image source.

Citation: Encouraged

Copyright: Medicine Newbie

Blog administrator & owner: Faridah Abdul Rashid

Main author: Faridah Abdul Rashid

Guest authors: 1

THE EARLY MALAY DOCTORS 
http://theearlymalaydoctors.blogspot.com/

Description of blog:

This is an academic as well as a research blog that aims to cater to the needs of various levels of readers, students, lecturers and researchers. The posts within contain articles, reports, interviews, feedback, cases & case reports, census reports, issues, news articles, opinions, conference calls, email re-posts, reviews, research findings, useful links and many other resources including biographies which maybe relevant to your needs. The contributors for this blog comprise academics, the general public, retired government servants, medical practitioners, historians, local museums, archives and various special interest groups. Topics covered range from Malay medical history, Malay herbs and herbal medicine, Malay traditional medicine, modern medicine, Malay political history, Malay political science, telehealth, bioethics, and various other topics about the Malay people which are rarely covered in medical textbooks and books on the Malay people, their lives, culture and civilisation.

Language used: English (UK). Expect some Malay words.

Mode of access: Free access

Download of photos: Restricted for photos which are owned by contributors, readers, govt agencies, institutions and other publishers. Some contributors will not allow reproduction of their online photos.

Citation: Encouraged. Follow any established format for blog post.

Copyright: The Early Malay Doctors

Blog administrator & owner: Faridah Abdul Rashid

Main author: Faridah Abdul Rashid

Guest authors: 10