Friday, 2 September 2016
Friday, 12 August 2016
Pancreatic Cancer
English: Pancreatic cancer
Malay: Kanser pankreas
Indonesian: Kanker pankreas
Q1. What is pancreatic cancer?
Q2. Who gets pancreatic cancer?
Q3. Why does pancreatic cancer occur in some patients and not others? What causes pancreatic cancer?
Q4. How does pancreatic cancer develop?
Q5. What are the signs and symptoms of pancreatic cancer?
Q6. Pancreatic cancer investigations and diagnosis.
Q7. Conventional pancreatic cancer treatment:
Q8. What does the pancreatic cancer patient feel? Does the patient feel pain? Yes.
Q9. Are there cures for pancreatic cancer? Yes.
Q10. Are there effective cures for treating pancreatic cancer? Yes. You can read about some of these but be careful of what you decide:
Q11. Will pancreatic cancer go away for good? Yes and No.
Q12. Will pancreatic cancer kill? Is it fatal? Yes and No.
Q13. Are there pancreatic cancer survivors? How long can they survive? Yes.
Q14. What will happen to pancreatic cancer in the future?
Q15. What is the prognosis of pancreatic cancer? Bad and Good.
Q16, Pancreatic cancer Q&A
Q17. Pancreatic cancer diary
Q18. Pancreatic cancer Patient's Guide.
Q19. Cancer Care therapy for pancreatic cancer
Q20. Eat the right food
Malay: Kanser pankreas
Indonesian: Kanker pankreas
Q1. What is pancreatic cancer?
Q2. Who gets pancreatic cancer?
- Some people are more prone than others to get pancreatic cancer.
- There are multiple risk factors associated with pancreatic cancer; it does not necessarily mean that if someone has any of these risk factors they will get pancreatic cancer. These risks factors have only a weak link to pancreatic cancer.
- Sometimes there are none of the risk factors in pancreatic cancer patients.
Q3. Why does pancreatic cancer occur in some patients and not others? What causes pancreatic cancer?
- Multiple risk factors are linked to pancreatic cancer.
- Genetics. Approximately 5% to 10% of pancreatic cancer patients have an immediate family member who also has pancreatic cancer. It should not mean that pancreatic cancer runs in families. Although genes have been associated with increased risk of pancreatic cancer, nevertheless, no pancreatic cancer gene has been identified.
- Diabetes. Pancreatic cancer is linked to diabetes, but not all diabetics have pancreatic cancer.
- Smoking. Smoking is linked to pancreatic cancer, but not all smokers have pancreatic cancer.
- Obesity. Pancreatic cancer patients are obese initially and lose weight constantly.
- Ethnicity. Over 80% of pancreatic cancers develop between the ages of 60 and 80 years, in African-American Black population.
- http://www.webmd.com/cancer/pancreatic-cancer/causes-pancreatic-cancer
Q4. How does pancreatic cancer develop?
- All cells contain DNA except mature red blood cells (mature erythrocytes).
- DNA can be damaged by constant exposure to radiation and by chemicals in the food we eat and the environment we live in.
- This damage is described as a mutation in the DNA.
- When the DNA has mutated, it produces certain proteins that can trigger new protein formation.
- These are abnormal proteins, which can trigger cells to proliferate.
- When cells proliferate at an uncontrollable rate, it can lead to a mass of cells that form a tumour.
- A tumour can be either benign or malignant.
- Tumours can spread (metastasize) via the lymphatic system (vessels that contain lymph) or the general circulatory system (vessels that contain blood).
- In this way, a single tumour cell can re-establish in another organ far away from the initial tumour site and start a new tumour growth.
- How fast or slow a tumour grows depends on what nutrients are supplied in the diet and what nutrients eventually reach the tumour.
- Tumours love loads of sugar in the food that we eat.
- Reducing sugar intake and making correct dietary adjustment to food intake can help in stopping tumour spread and get rid of the cancer itself.
- https://youtu.be/SM2VYx510y8
- https://youtu.be/6xLkhDJsDGo
Q5. What are the signs and symptoms of pancreatic cancer?
- https://youtu.be/-Ra6YrSsxB0
- https://youtu.be/TMNdb1XeeN8
- https://youtu.be/7qnJMt4q4Yk
- https://youtu.be/_DBPoiG_Prg
- https://youtu.be/0rvFETOftvY
Q6. Pancreatic cancer investigations and diagnosis.
Q7. Conventional pancreatic cancer treatment:
- surgery
- radiotherapy
- chemotherapy
- pancreatic cancer surgery: https://youtu.be/usGW6jp-MjA
- herbs are useful during radiotherapy and chemotherapy
- clinical trial of double-drug chemotherapy: https://youtu.be/EEcqWUEQlnE
Q8. What does the pancreatic cancer patient feel? Does the patient feel pain? Yes.
- Pain is in the middle of the top segment of the abdomen.
- Patients take painkillers to cover pain and forgot that there is a cure for it.
- https://youtu.be/IBIhbqSZ51Y
Q9. Are there cures for pancreatic cancer? Yes.
- There are two options.
- There is conventional treatment (surgery, radiotherapy and chemotherapy).
- There is an alternative DIY therapy, a self-taught, more herbal routine that has worked for patients.
- You can try the techniques of these successful patients or DIY (do it yourself).
- There is no one cure that will heal pancreatic cancer.
- There is no one pancreatic cancer that will respond well to all known therapies.
- There is always room for innovation and improvement for pancreatic cancer.
- https://youtu.be/NZUUYARQonI
Q10. Are there effective cures for treating pancreatic cancer? Yes. You can read about some of these but be careful of what you decide:
- Controversy of 'vitamin B-17 laetrile' https://en.wikipedia.org/wiki/Amygdalin
- Controversy of dimethyl sulphoxide or dimethyl sulfoxide (DMSO) https://en.wikipedia.org/wiki/Dimethyl_sulfoxide
- Safety issues of high dose vitamin C http://www.mayoclinic.org/drugs-supplements/vitamin-c/safety/hrb-20060322
- Porcine pancreatic enzymes https://www.pancan.org/facing-pancreatic-cancer/diet-and-nutrition/pancreatic-enzymes/
- Apricots ... source of vitamin B-17
- http://www.chrisbeatcancer.com/how-felicity-healed-stage-4-pancreatic-cancer-in-2003/
- Gerson Therapy. Charlotte Gerson (80) d/o Dr Max Gerson speaks on Gerson Therapy https://youtu.be/quuvi6Gvvmc
Q11. Will pancreatic cancer go away for good? Yes and No.
- If you look after yourself well after curing cancer, the cancer will stay away from you.
- If you don't look after yourself after curing cancer, the cancer will return.
- Stay on a right diet, live peacefully and happily, stick to your faith and live a life of no worries.
Q12. Will pancreatic cancer kill? Is it fatal? Yes and No.
- Yes, if you do nothing about your pancreatic cancer. It will kill you because you did nothing and just ignored it and just took painkillers.
- No, if you did something to stop it and reverse it. You need to learn how to by understanding your cancer, how it happened, its symptoms etc. Then read about how others have successfully managed to heal their pancreatic cancer.
- Even an elderly 74-year-old lady knows how to cure her pancreatic cancer. You decide what you want to do.
- https://youtu.be/LL3WmXIRNKg
Q13. Are there pancreatic cancer survivors? How long can they survive? Yes.
- In 2000, she had stage 4 pancreatic cancer and refused conventional treatment. https://youtu.be/xh1pOB2h97U
- In 2003, an elderly 74-year-old lady created a record for herself. She cured herself of stage 4 pancreatic cancer with her own routine. She shares her experience and routines with other pancreatic cancer patients and the world. https://youtu.be/LHKaVd_twIE
- In 2012, she had stage 4 pancreatic cancer and survived chemotherapy. She had her own natural DIY cure https://youtu.be/hdWatSJEcbM
Q14. What will happen to pancreatic cancer in the future?
- The future of pancreatic cancer is now a living past.
- We already have cures for pancreatic cancer today.
- Conventional treatment cures 40% of pancreatic cancer cases. The remainder 60% of pancreatic cancer patients have can resort to alternative DIY routines as a form of therapy to cure themselves. DIY pancreatic cancer therapies will certainly need time, commitment and patience. Nothing comes easy. Perseverance usually gives the best results. As the Arabic saying goes: Haste makes waste. There is no cure if you are going to rush things.
Q15. What is the prognosis of pancreatic cancer? Bad and Good.
- Depends on how you look at it.
- Any cancer diagnosis comes with a negative cloud and frightens patients as if it is the end of their world. This must stop.
- Patients must come to know that there are conventional treatment and alternative DIY cures for pancreatic cancer.
- The prognosis of a metastatic pancreatic cancer 5-year survival rate is 2%.
- https://youtu.be/FmZqiBo8fPw
Q16, Pancreatic cancer Q&A
Q17. Pancreatic cancer diary
Q18. Pancreatic cancer Patient's Guide.
Q19. Cancer Care therapy for pancreatic cancer
- http://www.cacare.com/the-ca-care-therapy
- https://youtu.be/aU0U1xgPaUA
- https://youtu.be/pTjAcv1Zsow
- https://youtu.be/NkugbjMOUcQ
Q20. Eat the right food
Sunday, 7 August 2016
General Healthcare Products
Gingko Products
- Gingko products are made from Gingko leaves
- Gingko is a diuretic agent and produces a lot of urine
- remember to drink more water when taking Gingko products, to avoid dehydration
- do not take Gingko products for extended periods
Hovid Gingko 10 tablets per foil RM12, round yellow pills Medica Pharmacy
Standardized Gingko Biloba Extract 80mg
24% Flavone Glycosides & 6% Terpene Lactones
Shine Gincare Film coated tablet
Blackmores Gingko Forte 2000
Standardized ...
Traditional medicine
Traditionally used to improve blood circulation
30 tablets per bottle
Gingko Forte
https://www.standardprocess.com/Products/MediHerb/Ginkgo-Forte#.V6bjU9R97Gg
-----------------------------
Skincare
- some skin and skin types need more attention than others
- some skins are difficult to treat and finding the most successful treatment needs time, and healing itself will also need time
- sometimes the cause is unknown
- sometimes skin conditions are caused by the chemicals present in food (artificial food colourings, food additives etc)
- a severe skin condition may take years to manifest and many more years to make it go away
- olive oil and paraffin oil/mineral oil are best for the worst skin conditions
- sheep wax (lanolin) is best for cracked skin, including cracked nipples during breastfeeding
- argan oil, marula oil are Old World Oils but are re-purposed for multipurpose use
- certain oils have antiseptic, antibactericidal and antifungal properties
Marula Oil Body Scrub
Contains marula oil
- smooth cream, not oily, dries fast
- good for dry skin
- apply and let dry. Wash off when you take a bath.
Thursday Plantation Tea Tree Oil
Australia's 100% Pure Tea Tree Oil 10 ml / 25 ml bottles
Multipurpose liquid
- good for itchy skin, problem areas of the skin, foot fungus/athlete's foot
- good for in-grown toenails
- kills bugs, bacteria and fungus
------------------------------
Joint pain
- knee, ankle, sprain, falls, cold days, standing too long, sitting too long
- humans age and as we age, our bones become fragile as a result of wear and bone thinning (osteoporosis)
- falls will result in broken bones (fractures)
- joint pain, bone pain (osteomalacia), osteoporosis, arthritis cause excruciating pain in the elderly
Flanil Analgesic Cream
RM9.12 Farmasi Makmur Jaya
For relief of simple muscular discomforts and painful muscles following unaccustomed exercise or exertion.
Fastum Gel
Nonsteroidal anti-inflammatory agent
Ketoprofen 2.5%
Tube of 30 g
For external use only
Voren Plus Gel
RM10 Medica Pharmacy
Each gram contains 10 mg Sodium diclofenac.
Menthol added.
Anti-inflammatory and analgesic agent
For external use only
20g
Atroxene Flex
Emulgel 100 ml
Ozonized olive oil
Bought at Subang Airport
- good for painful knee
- no more knee pain after a few applications
-----------------------
Wound Management, Care and Healing
- wounds have to be seen to at the Emergency Department at any hospital
- only after x-ray, proper wound cleaning and placing an injured limb in a cast (if any) can the patient take care of his wounds
- most open wounds cannot touch water. Bathe briefly and do not soak open wounds
- dab and let open wounds air-dry
- perform Wudhu' on the injured limbs only if necessary and when safe to do so. Else the wounds will progress to become septic or gangrenous. If pus form, clean, air-dry or dry with hair-dryer/blow dryer, and apply Solcoseryl Jelly. Never let pus form in the first place.
Solcoseryl Jelly 10%
20 g jelly
Composition: 1 g jelly contains:
4.15 mg protein-free haemodialysate of calves' blood, chemically and biologically standardised
Methyl parahydroxybenzoate (E218) 1.73 mg/g
Propyl parahydroxybenzoate (E216) 0.27 mg/g
Sodium carboxymethylcellulose, Propylene glycol, Calcium lactate, Water for injection.
Keep out of reach of children. Jauhi dari kanak-kanak.
- this product contains ingredient derived from animal origin (bovine)
- for weeping wounds and burns
- dries fast. Apply directly onto weeping wound and let dry in front of fan. Then apply Hansplast to avoid bleeding and sticking to clothing
- wash off before performing Wudhu'. Re-apply after prayers.
Hansaplast
Transparent almost invisible on skin
Strong adhesion
Tidak kelihatan pada kulit
Pelekat kuat
20 strips per box
Premier Cotton Buds RM2.80
200 tips per container
- use cotton buds to clean wound with antiseptic solution
- remove all traces of dried blood and fresh blood. Then apply Solcoseryl Jelly.
- Gingko products are made from Gingko leaves
- Gingko is a diuretic agent and produces a lot of urine
- remember to drink more water when taking Gingko products, to avoid dehydration
- do not take Gingko products for extended periods
Hovid Gingko 10 tablets per foil RM12, round yellow pills Medica Pharmacy
Standardized Gingko Biloba Extract 80mg
24% Flavone Glycosides & 6% Terpene Lactones
Shine Gincare Film coated tablet
Blackmores Gingko Forte 2000
Standardized ...
Traditional medicine
Traditionally used to improve blood circulation
30 tablets per bottle
Gingko Forte
https://www.standardprocess.com/Products/MediHerb/Ginkgo-Forte#.V6bjU9R97Gg
-----------------------------
Skincare
- some skin and skin types need more attention than others
- some skins are difficult to treat and finding the most successful treatment needs time, and healing itself will also need time
- sometimes the cause is unknown
- sometimes skin conditions are caused by the chemicals present in food (artificial food colourings, food additives etc)
- a severe skin condition may take years to manifest and many more years to make it go away
- olive oil and paraffin oil/mineral oil are best for the worst skin conditions
- sheep wax (lanolin) is best for cracked skin, including cracked nipples during breastfeeding
- argan oil, marula oil are Old World Oils but are re-purposed for multipurpose use
- certain oils have antiseptic, antibactericidal and antifungal properties
Marula Oil Body Scrub
Contains marula oil
- smooth cream, not oily, dries fast
- good for dry skin
- apply and let dry. Wash off when you take a bath.
Thursday Plantation Tea Tree Oil
Australia's 100% Pure Tea Tree Oil 10 ml / 25 ml bottles
Multipurpose liquid
- good for itchy skin, problem areas of the skin, foot fungus/athlete's foot
- good for in-grown toenails
- kills bugs, bacteria and fungus
------------------------------
Joint pain
- knee, ankle, sprain, falls, cold days, standing too long, sitting too long
- humans age and as we age, our bones become fragile as a result of wear and bone thinning (osteoporosis)
- falls will result in broken bones (fractures)
- joint pain, bone pain (osteomalacia), osteoporosis, arthritis cause excruciating pain in the elderly
Flanil Analgesic Cream
RM9.12 Farmasi Makmur Jaya
For relief of simple muscular discomforts and painful muscles following unaccustomed exercise or exertion.
Fastum Gel
Nonsteroidal anti-inflammatory agent
Ketoprofen 2.5%
Tube of 30 g
For external use only
Voren Plus Gel
RM10 Medica Pharmacy
Each gram contains 10 mg Sodium diclofenac.
Menthol added.
Anti-inflammatory and analgesic agent
For external use only
20g
Atroxene Flex
Emulgel 100 ml
Ozonized olive oil
Bought at Subang Airport
- good for painful knee
- no more knee pain after a few applications
-----------------------
Wound Management, Care and Healing
- wounds have to be seen to at the Emergency Department at any hospital
- only after x-ray, proper wound cleaning and placing an injured limb in a cast (if any) can the patient take care of his wounds
- most open wounds cannot touch water. Bathe briefly and do not soak open wounds
- dab and let open wounds air-dry
- perform Wudhu' on the injured limbs only if necessary and when safe to do so. Else the wounds will progress to become septic or gangrenous. If pus form, clean, air-dry or dry with hair-dryer/blow dryer, and apply Solcoseryl Jelly. Never let pus form in the first place.
Solcoseryl Jelly 10%
20 g jelly
Composition: 1 g jelly contains:
4.15 mg protein-free haemodialysate of calves' blood, chemically and biologically standardised
Methyl parahydroxybenzoate (E218) 1.73 mg/g
Propyl parahydroxybenzoate (E216) 0.27 mg/g
Sodium carboxymethylcellulose, Propylene glycol, Calcium lactate, Water for injection.
Keep out of reach of children. Jauhi dari kanak-kanak.
- this product contains ingredient derived from animal origin (bovine)
- for weeping wounds and burns
- dries fast. Apply directly onto weeping wound and let dry in front of fan. Then apply Hansplast to avoid bleeding and sticking to clothing
- wash off before performing Wudhu'. Re-apply after prayers.
Hansaplast
Transparent almost invisible on skin
Strong adhesion
Tidak kelihatan pada kulit
Pelekat kuat
20 strips per box
Premier Cotton Buds RM2.80
200 tips per container
- use cotton buds to clean wound with antiseptic solution
- remove all traces of dried blood and fresh blood. Then apply Solcoseryl Jelly.
Monday, 13 June 2016
Housemanship
Local graduates get posted soon after graduation. Overseas graduates have to wait about 8 months (September 2015 - May 2016 ) before they are called for an interview and then wait another month (29 May 2016) before they get a letter telling them where they have to undergo housemanship.
BTN for east coast graduates
The letter also specifies where they must do a BTN course (eg for east coast graduates, they have to report at BTN Besut). The BTN course is 5 days (Monday, 2 pm - Friday, 1 pm). Brothers are best to send and pick up for the BTN course as Monday is a work day and Friday is for Solat Jumaat. Can stop at any masjid along the way. Planning is necessary. Besut is 2 hours drive from P. Chepa airport. Going to BTN Besut is easy, but graduates may need to hitch a ride with friends from BTN Besut to the airport in P. Chepa.
------
Housemanship Guide 2016-2018
Housemanship is done immediately after graduation and lasts 2 years. It involves attachment to a few select hospitals which have vacancies for house officers (HO). Not all hospitals have the necessary expertise and facilities for housemanship training. Learning during this time is by tagging - follow other doctors and the team. The working hours are long, tiring and heart-wrenching.
A houseman has to try and meet set targets (eg handle 10 deliveries in 2 weeks at O&G).
A warning letter comes if targets are not met ... can either remedy or get kicked out for good.
This is roughly what daily life is like as a houseman:
Night before: charge handphone and powerbank.
5:00 am: Get up. Wash and have breakfast (instant oats) and drink something (eg Milo).
6:00 am: Pray solat Subuh. Bathe, iron clothes and get dressed. Pakai tudung and kasut.
6:30 am: Drive/chauffeured to hospital (fathers are best drivers at this early hour).
7: 00 am: Clock-in at O&G section (or whichever you are assigned to during prior orientation).
8: 00 am: Start work by tagging other doctors and the team.
2:00 pm : Solat Zohor. Light lunch.
5:00 pm: End of day job. Clock-out. Solat Asar.
5:00 pm: Start of on-call job. Clock-in.
8:00 pm: Solat Maghrib.
11: 00 pm: End of on-call job. Clock-out. Go home before midnight.
11:00 pm: Pick up at O&G department (fathers are best to pick up their daughters at this hour).
11:30 pm: Reach home, bathe and have dinner/supper. Solat Isya'. Write short notes in logbook.
12:00 am: Sleep. Totally knocked-out.
------
-------
Are there problems with Housemanship?
Yes and No.
Some doctors think good of Housemanship, some think otherwise.
Many doctors give up on their Housemanship and move to other areas of work.
Many persevere and make it successfully through their Housemanship.
Many leave medical practice by doing a postgraduate degree (eg Master of Medicine, MMed) and enter teaching at the university.
Many still engage in surgery and run clinics at university hospitals.
-------
What is Housemanship?
The Housemanship is necessary after completing the undergraduate medical degree (MBBS/MD).
There is an interview to evaluate the students 8 months after graduation.
The graduate is asked where she/he wants to do Housemanship.
A letter is issued from the Ministry of Health, MoH (Kementerian Kesihatan Malaysia, KKM).
The Housemanship is for 2 years at an appointed hospital.
Can't switch hospitals unless for valid reasons - anak premature masuk NICU etc.
Can't take leave unless for valid reasons - anak sakit dan kena jaga di NICU/ICU, ibu sakit dan meninggal, urusan nak kahwin etc (2 weeks leave allowed at most).
Can only do Housemanship at appointed hospitals as not all hospitals have the necessary depts, expertise, and capacity to take in Houseman to train them for 2 years.
There are 6 postings at 6 depts, for 4 months each posting, plus 1 month extension if necessary.
There is viva/written exam at the end of each posting.
If pass can continue to next posting.
If fail, must repeat another 1 month of the failed posting, and then proceed if pass.
---------------
An example of Housemanship at HRPZ II in Kota Bharu, Kelantan:
1. Posting O&G, 6 June 2016 - 28 Sept 2016 (4 months)
2. Posting Surgery, 29 Sept 2016 - 28 Feb 2017 (4 + 1 months)
3. Posting Medicine, 1 March 2017 - June 2017
4. Posting July-Oct 2017
5. Posting Nov 2017 - Feb 2018
6. Posting March - June 2018
------------
Some issues:
The major issues before/during Housemanship for female doctors are:
1. Bila boleh kahwin? Preferably after successfully completing Housemanship.
2. Bila boleh beranak? Preferably after successfully completing Housemanship.
3. Bila boleh independent? After first pay, first month of Housemanship.
4. Bila mampu berdikari? After first pay, first month of Housemanship.
Since the Housemanship is a very trying period, the houseman can start live alone at nearby rented places or Houseman quarters at the appointed hospital.
For most unmarried women, the Housemanship is very trying and leaves no time and energy for a good life. It drains the person, and worse still is she has her menses. If in this poor unmanageable state, it is not advisable to live apart or alone, but to continue to live with one's family while highly dependent. Only decide to get married when things have stabilized and life is manageable. Otherwise family problems will crop in and the marriage will tend to fail.
Some ladies have managed to get married soon after arrival from overseas after their MBBS/MD or during their undergraduate days. However, they still have to depend o others to look after their babies or children - usually their aged mothers or childcare centres. Most mothers prefer to cook, send and care for their married daughters who are undergoing Housemanship. They also do babysitting.
Most unmarried ladies dread and cannot cope with Housemanship. Their personal problems, attitudes, mood swings and menses add to their difficulties. They cannot adjust to Housemanship life. They make life difficult for themselves and others around them. They threaten to give up and scare their parents and siblings.
A few unmarried ladies are wonderful and can manage well and have no fuss about Housemanship - they can even drive daily to work and back, and back to their homes in the villages far away during weekends or off days.
----------
What is possible after Housemanship?
Graduate doctors can pursue further studies or specialise after successful completion of their compulsory 2-year Housemanship.
They can go for either a Master of Medicine (MMed), Master of Science (MSc) or Doctor of Philosophy (PhD).
MMed is 4 years.
MSc is 1-2 years.
PhD is 3-6 years.
1. Master of Medicine (MMed)
If doctors go for MMed, they become specialists in a special area of expertise (eg Gynaecologist, Orthopedic surgeon, Gastroenterologist, Pathologist, Pediatrician, Medicine specialist - Endocrinologist/Diabetes specialist etc). Without a further degree, the doctor is just a general physician (medical officer, MO) and can do private general practice (GP, doktor private) or locum.
The MMed program can only be taken up by medical graduates who have completed 2 years Housemanship at a Govt hospital. The MMed program is four years at a public university - USM, UM or UKM. After MMed, the graduate is an expert (pakar perubatan) in his/her area of specialization.
As a medical specialist later on after graduation from MMed, doctors who work in medical/surgical dept get a Clinical Allowance (about RM3k) on top of their monthly salary.
If they are a specialist after MMed, but do not run clinics or see patients daily (eg posted to non clinical/surgical/medical dept), they get a Critical Allowance on top of their monthly allowance. Critical Allowance is 3/4 of Clinical Allowance. Doctors in a Lab-based dept get a Critical Allowance.
2. Master of Science (MSc)
This is not wroth doing for a graduate doctor. The MSc will not make them a specialist but just an expert (with extra knowledge) in a specific related research area, not a clinical practice area or specialization. They can only get a Critical Allowance after graduation and if they work at a Govt hospital.
3. Doctor of Philosophy (PhD)
The MMed degree is not a match for a PhD. The MMed degree is a coursework plus research beginning in year 2. The PhD is an entirely research program from year 1 and lasts many years. They can never be one and the same. They just don't match at all.
It is not worth doing a PhD as the medical graduate only gets a Critical Allowance after all. It is better for the medical graduate to do Housemanship and then MMed, become a specialist and then go for PhD.
----------
External links:
http://successful-housemanship.blogspot.my/2013_12_01_archive.html?m=1
http://lifenotless.blogspot.my/2013/02/housemanship-where-and-which-is-best.html?m=1
https://forum.lowyat.net/topic/1238484/all
BTN for east coast graduates
The letter also specifies where they must do a BTN course (eg for east coast graduates, they have to report at BTN Besut). The BTN course is 5 days (Monday, 2 pm - Friday, 1 pm). Brothers are best to send and pick up for the BTN course as Monday is a work day and Friday is for Solat Jumaat. Can stop at any masjid along the way. Planning is necessary. Besut is 2 hours drive from P. Chepa airport. Going to BTN Besut is easy, but graduates may need to hitch a ride with friends from BTN Besut to the airport in P. Chepa.
------
Housemanship Guide 2016-2018
Housemanship is done immediately after graduation and lasts 2 years. It involves attachment to a few select hospitals which have vacancies for house officers (HO). Not all hospitals have the necessary expertise and facilities for housemanship training. Learning during this time is by tagging - follow other doctors and the team. The working hours are long, tiring and heart-wrenching.
A houseman has to try and meet set targets (eg handle 10 deliveries in 2 weeks at O&G).
A warning letter comes if targets are not met ... can either remedy or get kicked out for good.
This is roughly what daily life is like as a houseman:
Night before: charge handphone and powerbank.
5:00 am: Get up. Wash and have breakfast (instant oats) and drink something (eg Milo).
6:00 am: Pray solat Subuh. Bathe, iron clothes and get dressed. Pakai tudung and kasut.
6:30 am: Drive/chauffeured to hospital (fathers are best drivers at this early hour).
7: 00 am: Clock-in at O&G section (or whichever you are assigned to during prior orientation).
8: 00 am: Start work by tagging other doctors and the team.
2:00 pm : Solat Zohor. Light lunch.
5:00 pm: End of day job. Clock-out. Solat Asar.
5:00 pm: Start of on-call job. Clock-in.
8:00 pm: Solat Maghrib.
11: 00 pm: End of on-call job. Clock-out. Go home before midnight.
11:00 pm: Pick up at O&G department (fathers are best to pick up their daughters at this hour).
11:30 pm: Reach home, bathe and have dinner/supper. Solat Isya'. Write short notes in logbook.
12:00 am: Sleep. Totally knocked-out.
------
“Housemanship provides an opportunity for new graduates to be further trained, supervised and guided so that they can become safe and competent doctors. On top of the four monthly rotations in six major clinical disciplines – general medicine, paediatrics, general surgery, orthopaedics, obstetrics and gynaecology – one obligatory posting in emergency medicine, anaesthesiology, psychiatry or primary care is also a must under the two-year housemanship training,” explains Dr Noor Hisham.
-------
Are there problems with Housemanship?
Yes and No.
Some doctors think good of Housemanship, some think otherwise.
Many doctors give up on their Housemanship and move to other areas of work.
Many persevere and make it successfully through their Housemanship.
Many leave medical practice by doing a postgraduate degree (eg Master of Medicine, MMed) and enter teaching at the university.
Many still engage in surgery and run clinics at university hospitals.
-------
What is Housemanship?
The Housemanship is necessary after completing the undergraduate medical degree (MBBS/MD).
There is an interview to evaluate the students 8 months after graduation.
The graduate is asked where she/he wants to do Housemanship.
A letter is issued from the Ministry of Health, MoH (Kementerian Kesihatan Malaysia, KKM).
The Housemanship is for 2 years at an appointed hospital.
Can't switch hospitals unless for valid reasons - anak premature masuk NICU etc.
Can't take leave unless for valid reasons - anak sakit dan kena jaga di NICU/ICU, ibu sakit dan meninggal, urusan nak kahwin etc (2 weeks leave allowed at most).
Can only do Housemanship at appointed hospitals as not all hospitals have the necessary depts, expertise, and capacity to take in Houseman to train them for 2 years.
There are 6 postings at 6 depts, for 4 months each posting, plus 1 month extension if necessary.
There is viva/written exam at the end of each posting.
If pass can continue to next posting.
If fail, must repeat another 1 month of the failed posting, and then proceed if pass.
---------------
An example of Housemanship at HRPZ II in Kota Bharu, Kelantan:
1. Posting O&G, 6 June 2016 - 28 Sept 2016 (4 months)
2. Posting Surgery, 29 Sept 2016 - 28 Feb 2017 (4 + 1 months)
3. Posting Medicine, 1 March 2017 - June 2017
4. Posting July-Oct 2017
5. Posting Nov 2017 - Feb 2018
6. Posting March - June 2018
------------
Some issues:
The major issues before/during Housemanship for female doctors are:
1. Bila boleh kahwin? Preferably after successfully completing Housemanship.
2. Bila boleh beranak? Preferably after successfully completing Housemanship.
3. Bila boleh independent? After first pay, first month of Housemanship.
4. Bila mampu berdikari? After first pay, first month of Housemanship.
Since the Housemanship is a very trying period, the houseman can start live alone at nearby rented places or Houseman quarters at the appointed hospital.
For most unmarried women, the Housemanship is very trying and leaves no time and energy for a good life. It drains the person, and worse still is she has her menses. If in this poor unmanageable state, it is not advisable to live apart or alone, but to continue to live with one's family while highly dependent. Only decide to get married when things have stabilized and life is manageable. Otherwise family problems will crop in and the marriage will tend to fail.
Some ladies have managed to get married soon after arrival from overseas after their MBBS/MD or during their undergraduate days. However, they still have to depend o others to look after their babies or children - usually their aged mothers or childcare centres. Most mothers prefer to cook, send and care for their married daughters who are undergoing Housemanship. They also do babysitting.
Most unmarried ladies dread and cannot cope with Housemanship. Their personal problems, attitudes, mood swings and menses add to their difficulties. They cannot adjust to Housemanship life. They make life difficult for themselves and others around them. They threaten to give up and scare their parents and siblings.
A few unmarried ladies are wonderful and can manage well and have no fuss about Housemanship - they can even drive daily to work and back, and back to their homes in the villages far away during weekends or off days.
----------
What is possible after Housemanship?
Graduate doctors can pursue further studies or specialise after successful completion of their compulsory 2-year Housemanship.
They can go for either a Master of Medicine (MMed), Master of Science (MSc) or Doctor of Philosophy (PhD).
MMed is 4 years.
MSc is 1-2 years.
PhD is 3-6 years.
1. Master of Medicine (MMed)
If doctors go for MMed, they become specialists in a special area of expertise (eg Gynaecologist, Orthopedic surgeon, Gastroenterologist, Pathologist, Pediatrician, Medicine specialist - Endocrinologist/Diabetes specialist etc). Without a further degree, the doctor is just a general physician (medical officer, MO) and can do private general practice (GP, doktor private) or locum.
The MMed program can only be taken up by medical graduates who have completed 2 years Housemanship at a Govt hospital. The MMed program is four years at a public university - USM, UM or UKM. After MMed, the graduate is an expert (pakar perubatan) in his/her area of specialization.
As a medical specialist later on after graduation from MMed, doctors who work in medical/surgical dept get a Clinical Allowance (about RM3k) on top of their monthly salary.
If they are a specialist after MMed, but do not run clinics or see patients daily (eg posted to non clinical/surgical/medical dept), they get a Critical Allowance on top of their monthly allowance. Critical Allowance is 3/4 of Clinical Allowance. Doctors in a Lab-based dept get a Critical Allowance.
2. Master of Science (MSc)
This is not wroth doing for a graduate doctor. The MSc will not make them a specialist but just an expert (with extra knowledge) in a specific related research area, not a clinical practice area or specialization. They can only get a Critical Allowance after graduation and if they work at a Govt hospital.
3. Doctor of Philosophy (PhD)
The MMed degree is not a match for a PhD. The MMed degree is a coursework plus research beginning in year 2. The PhD is an entirely research program from year 1 and lasts many years. They can never be one and the same. They just don't match at all.
It is not worth doing a PhD as the medical graduate only gets a Critical Allowance after all. It is better for the medical graduate to do Housemanship and then MMed, become a specialist and then go for PhD.
----------
External links:
http://successful-housemanship.blogspot.my/2013_12_01_archive.html?m=1
http://lifenotless.blogspot.my/2013/02/housemanship-where-and-which-is-best.html?m=1
https://forum.lowyat.net/topic/1238484/all
Saturday, 28 May 2016
Staphylococcus aureus (S. aureus)
Historical perspectives and milestones:-
Staphylococcus [staffʺə-lo kokʹəs]
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810938/pdf/ET-1909.pdf
From the Greek staphyle (bunch of grapes) and kokkos (berry), Staphylococcus is a genus of gram-positive spherical bacteria that commonly cause surgical and skin infections, respiratory disease, and food poisoning.
In 1880, Scottish surgeon Sir Alexander Ogston (1844-1929) first described staphylococci in pus from a surgical abscess in a knee joint: “the masses looked like bunches of grapes.”
In 1884, German physician Friedrich Julius Rosenbach* isolated and differentiated 2 strains of staphylococci colonies by their color: S. aureus (from the Latin aurum, gold) and S. albus (Latin for white). S. albus was later renamed S. epidermidis.
*Anton J. Rosenbach (1842-1923), a German surgeon
4. Discovery of Staphylococcus aureus by Rosenbach in 1884
5. Earlier synonyms for Staphylococcus aureus:
S. aureus infections:-
S. aureus research on defense mechanisms:-
Staphylococcus [staffʺə-lo kokʹəs]
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3810938/pdf/ET-1909.pdf
From the Greek staphyle (bunch of grapes) and kokkos (berry), Staphylococcus is a genus of gram-positive spherical bacteria that commonly cause surgical and skin infections, respiratory disease, and food poisoning.
In 1880, Scottish surgeon Sir Alexander Ogston (1844-1929) first described staphylococci in pus from a surgical abscess in a knee joint: “the masses looked like bunches of grapes.”
In 1884, German physician Friedrich Julius Rosenbach* isolated and differentiated 2 strains of staphylococci colonies by their color: S. aureus (from the Latin aurum, gold) and S. albus (Latin for white). S. albus was later renamed S. epidermidis.
*Anton J. Rosenbach (1842-1923), a German surgeon
- Accidental discovery of penicillin by Fleming
- Dr Mathews Duncan first used the term 'sapraemia' to describe bacterial chemical poisoning.
- Papers published on Micrococcus Poisoning by Sir Alexander Ogston in 1882, Scottish surgeon to the Aberdeen Royal Infirmary
Ogston, A. (1882). Micrococcus Poisoning.
J Anat Physiol. 1882 Jul; 16(Pt 4), 526-567. PMCID: PMC1310038.
J Anat Physiol. 1882 Oct; 17(Pt 1): 24–58. PMCID: PMC1310127
4. Discovery of Staphylococcus aureus by Rosenbach in 1884
The type strain of S. aureus subsp. aureus Rosenbach 1884 (DSM 20231T) was first isolated in 1884 from human pleural fluid by Rosenbach.
Staphylococcus pyogenes aureus
Staphlococcus pyogenes citreus
Micrococcus pyogenes
Micrococcus aureus
6. Misnomer: Streptococcus aureus
7. Earlier authority:
Staphylococcus aureus (S. aureus) classification:
http://www.gbif.org/species/3227657
Staphylococcus aureus (S. aureus) - Overview
S. aureus epidemiology:-
7. Earlier authority:
Staphylococcus aureus Rosenbach 1884
"Staphylococcus pyogenes aureus" Rosenbach 1884
"Staphlococcus pyogenes citreus" Passet 1885
"Micrococcus pyogenes" Lehmann and Neumann 1896
"Micrococcus aureus" (Rosenbach 1884) Zopf 1885
Staphylococcus aureus (S. aureus) classification:
http://www.gbif.org/species/3227657
- Kingdom: Bacteria
- Phylum: Firmicutes
- Class: Bacilli
- Order: Bacillales
- Family: Staphylococcaceae
- Genus: Staphylococcus
- Species: Staphylococcus aureus
- Full name: Staphylococcus aureus Rosenbach, 1884
- Common name: Methicillin-resistant Staphylococcus aureus (MRSA)
Staphylococcus aureus (S. aureus) - Overview
- Places found - nasal passages (nasal tract; nose), respiratory tract, skin
- Gram stain: Gram +
- Catalase test: +
- Shape: coccus (round)
- Pigment: staphyloxanthin (golden)
- Morphology:
- Colony morphology: smooth round colonies
- Spore formation: non-spore forming
- Motility: non-motile
- Forms spreading dendrites
- Bacteria photo gallery
S. aureus epidemiology:-
- Human indigenous bacterium; 30% healthy human harbour it in their nasal passages
- Not always pathogenic
- Can become pathogenic
- Major cause of staphylococcal disease
- Now have MRSA, which are resistant to antibiotics
- Between 1963-2012, there were 3085 cases involving MRSA reported worldwide
- Penicillin was discovered just before WWII ended in 1945
- There is no mention of year/date before 1944 ... listed as N/A online
- India: Undated (1); 2007 (1); 2012 (many cases)
- UK: Undated (1); 2012 (1)
- Palestine: 2012 (1)
- Mexico: 2012 (1)
- USA: Undated (8); 1963 (2); 2005 (114); 2011 (many cases)
- China: 1997 (125); 2002 (89); 2007 (203); 2010 (1); 2011 (1)
- Chinese Taipei: 2000 (20); 2006 (1)
- Belgium: 2011 (1)
- Brazil: 2007 (7)
- Poland: Undated (47); 1996 (6); 1997 (6); 1998 (4); 1999 (1,087); 2000 (44); 2001 (10); 2002 (20); 2003 (8)
- Germany: Undated (3)
- Australia: Undated (1); 1973 (201)
- Czech Republic: Undated (12)
- Republic of Korea: Undated (3)
- French Guiana: Undated (1)
- Netherlands: Undated (2)
- United Republic of Tanzania: Undated (2)
- Islamic Republic of Iran: Undated (1)
- Japan: Undated (1)
S. aureus infections:-
- Skin infections - causes abscess; eczema
- Respiratory infections - causes sinusitis; infect in-dwelling catheters
- Bloodstream - causes bacteremia
- Contaminated food - causes food poisoning
- Cigarette smoke boosts S. aureus virulence
- Emerging public threat - methicillin-resistant Staphylococcus aureus (MRSA) infection
- Clinical management of Staphylococcus aureus bacteremia in adults
- S. aureus clinical isolates - from in-dwelling catheters
- The emergence of antibiotic-resistant forms of pathogenic S. aureus (MRSA) is a worldwide problem in clinical medicine.
- in pediatric patients (less virulent)
- in adults (more virulent)
- Genome
S. aureus has a genome size of approximately 2.8 Mb, with a GC content of 32%. The chromosome contains pathogenicity islands and antibiotic resistance genes acquired through horizontal gene transfer of mobile genetic elements (MGEs). The MGEs occupy 15% to 20% of the chromosome. During outbreaks, S. aureus genomes develop single nucleotide polymorphisms (SNPs) and small genetic rearrangements and acquire or lose MGEs containing resistance or virulence genes.
2. First complete genome sequence 2015
Genome Announc. 2015 Jul-Aug; 3(4): e00800-15.Published online 2015 Jul 16. doi: 10.1128/genomeA.00800-15PMCID: PMC4505135
First Complete Genome Sequences of Staphylococcus aureus subsp. aureus Rosenbach 1884 (DSM 20231T), Determined by PacBio Single-Molecule Real-Time Technology.Akino Shiroma, Yasunobu Terabayashi, Kazuma Nakano, Makiko Shimoji, Hinako Tamotsu, Noriko Ashimine, Shun Ohki, Misuzu Shinzato, Kuniko Teruya, Kazuhito Satou, and Takashi Hirano Okinawa Institute of Advanced Sciences, Uruma, Okinawa, Japan. Corresponding author. Akino Shiroma, Email: pj.ro.saio@amorihs.
S. aureus research on defense mechanisms:-
- Biofilm formation
- Adhesins
- Defensins
-----
Suggested additional resources and further reading
-----
Classic eBook Collection:
Catalog of scientific papers, 1800-1900; Subject Index; Royal Society of London. Volume 19. Published in 1908 by University Press in Cambridge. 902 pages. Written in English.
- Call number ABA-4714
- Digitizing sponsor Internet Archive
- Book contributor Gerstein - University of Toronto
- Collection gerstein; toronto
Can download the PDF and other versions.
----
Encyclopedia of Genetics, Genomics, Proteomics, and Informatics
NCBI = National Center for Biotechnology Information
- Database resources of the NCBI http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1781113/pdf/gkl1031.pdf
- Database resources http://www.ncbi.nlm.nih.gov/pubmed/17170002
- Home - Genome - NCBI http://www.ncbi.nlm.nih.gov/genome/
- Genomes - Genome - NCBI http://www.ncbi.nlm.nih.gov /genome/genomes/154
- Complete Genome Submission Guide http://www.ncbi.nlm.nih.gov/genbank/genomesubmit/
- Whole Genome Shotgun Submission http://www.ncbi.nlm.nih.gov/genbank/wgs/
- Shotgun Assembly Sequences: Genome (WGS) and Transcriptome (TSA) http://www.ncbi.nlm.nih.gov/Traces/wgs/
DNA information
- Nucleotide sequence accession numbers.
The complete genome sequences of the S. aureus subsp. aureus DSM 20231T chromosome and plasmid were deposited in DDBJ/ENA/GenBank under the accession numbers CP011526 and CP011527, respectively.
Protein information
Thursday, 26 May 2016
Ingrown toe nail
Ingrown toenail is a big problem that crops up all of a sudden. It is painful and pus can collect beneath the toenail and surrounding tissues. The affected toe is swollen, red and inflamed. What can be done?
There is no need to panic. Look around you and try to find something that contains alcohol or menthol. It can be any of the oils that you use when you get hurt. For most of us, we have minyak Mastika or any minyak angin. That is fine. You can use that. But there is a better oil to keep at home and always have in your home collection of medicinal oils. This is the tea tree oil. It comes in small bottles, 25 ml. You can purchase it at Guardian Pharmacy. Keep it handy. The one that I keep and often use is Thursday Plantation Tea Tree Oil 25ml (100% pure essential oil), which is an Australian brand.
There is no need to panic. Look around you and try to find something that contains alcohol or menthol. It can be any of the oils that you use when you get hurt. For most of us, we have minyak Mastika or any minyak angin. That is fine. You can use that. But there is a better oil to keep at home and always have in your home collection of medicinal oils. This is the tea tree oil. It comes in small bottles, 25 ml. You can purchase it at Guardian Pharmacy. Keep it handy. The one that I keep and often use is Thursday Plantation Tea Tree Oil 25ml (100% pure essential oil), which is an Australian brand.
For ingrown toenail, pour a drop of tea tree oil onto the painful ingrown toenail. Do that at least once a day for 3 days until the pain subsides.
Muslims pray 5 times a day and wash their feet when performing ablution - the oil is washed away. Re-apply tea tree oil to the painful ingrown toenail after each prayer, for faster healing.
Muslims pray 5 times a day and wash their feet when performing ablution - the oil is washed away. Re-apply tea tree oil to the painful ingrown toenail after each prayer, for faster healing.
Monday, 25 April 2016
Liver structure & function, tests and diseases
ANATOMY OF THE LIVER
Anatomy - Liver explained clearly
https://youtu.be/BTGkB8nOu7g
Anatomy - Liver structure, hepatic blood flow and bile
https://youtu.be/P5_BxsbmXcA
Anatomy - Liver anatomy and blood supply
https://youtu.be/a1vgszd5_yM
Anatomy - Histology of the liver
https://youtu.be/KtFJvlEDE2I
Anatomy - Shotgun Histology liver
https://youtu.be/eLpynp35i7U
Anatomy - Liver histology 1/7
https://youtu.be/S9hsMSnyeLI
LIVER PHYSIOLOGY
Physiology - Hepatic physiology 1 > Functions of the liver
https://youtu.be/EfZB83u_-O8
Physiology - Hepatic physiology 2 > Portal circulation
https://youtu.be/czTB8RpY0ag
Physiology - Hepatic physiology 3 > Sinusoids & surrounding cells
https://youtu.be/71wQle8UguU
BILIRUBIN METABOLISM
Biochemistry - Bilirubin metabolism
https://youtu.be/dJ_dasmimE4
Biochemistry - Bilirubin pathway
https://youtu.be/4K9i7MPeuVg
Biochemistry - Bilirubin metabolism and diseases
https://youtu.be/-bZmC07L394
Biochemistry - Bilirubin metabolism > Jaundice
https://youtu.be/uOK_TGNQ7mM
LIVER FUNCTION TESTS (LFT)
Biochemistry - Liver function tests (LFTs) explained clearly
https://youtu.be/bFdTgty0T0I
Biochemistry - Liver function tests (LFT)
https://youtu.be/A36Wt5hDkoE
Biochemistry - Liver tests - Use and interpretation
https://youtu.be/LErNbfx0qPA
Biochemistry - Interpretation of LFTs (Liver function tests)
https://youtu.be/UrrXITkyb2c
Biochemistry - Important liver values > Albumin, ALT, ALP & AST
https://youtu.be/NAB-jnD3JWo
LIVER DISEASES
Pathology - Liver disease explained clearly > Introduction to acute & chronic liver diseases
https://youtu.be/7onWXWOV3io
Pathology - Pathophysiology of cirrhosis > Alcoholic liver disease
https://youtu.be/03ijM2bg08w
Tuesday, 12 April 2016
Dengue
English: Dengue
Malay: Denggi
What is dengue?
http://www.who.int/features/qa/54/en/
Dengue is a viral disease spread by mosquito bite. The Aedes egyptii mosquito is the carrier of the dengue virus.
1. When does dengue occur?
It can occur anytime. It occurs mainly during the hot and dry season and with occasional rain. Breeding grounds can be outside or inside the house.
Outside the house ...
Watering the plants can help to form puddles on the uneven floor around the flowerpots. If the puddles don't dry up fast, mosquitoes can breed as they just need overnight stagnant water.
Rainwater is trapped in various containers improperly disposed off by unthinking users. Rainwater also collects in unused building materials, paint can lids, disused plastic, leaves that curl and can hold water, slippers, drains, clogged gutters etc.
Inside the house ...
Stagnant water provides a good breeding ground for mosquitoes. It doesn't matter whether the home is in the urban or rural area. Urban homes tend to have more decor and flower vases containing water. Urban homes have a lot of clutter and sunshine hardly hits the interior spaces. The interior spaces are often cold and damp .... a perfect hybernating space for mosquitoes while waiting for water to breed. Thus, it is not surprising that dengue sufferers are often found within urban homes rather than rural homes, which have plenty of sunshine and are often drier internal environment.
Most homes today are equipped with basic appliances - the usual kitchen utensils and bath utilities. These don't need daily attention and are often left as they are till the next spring cleaning activity. Flower vases with water, dishes and bowls left to dry but not properly drained, draining boards that are not frequently drained, stagnant water at the base of refrigerators, water in the containers that hold legs of cupboards, etc are among the many possibilities for dengue development.
Inside the toilet, open water tanks which are untreated with Abate, water in pails which are left overnight or for longer period, dippers half-filled with water, wet toilet slippers, water closets (WC) which are left unused for long periods, toilet floors with stagnant water at the corners and near the drainage holes, empty shampoo bottles left lying around on the toilet floor, dirty diapers left on the toilet floor, empty soap wrappers left on the toilet floor, and various other things found in the toilet, are good breeding grounds for the dengue mosquito.
2. Dengue FAQ
http://www.cdc.gov/dengue/faqfacts/index.html
3. What are the signs and symptoms of dengue?
Weakness that gradually worsens and the infected patient becomes fatigued overnight. The weakness is accompanied by an unusual fever and the entire body becomes painful. There is loss of appetite (LOA), altered taste sensation (food does not taste like food anymore), and weight loss. Sometimes the white of the eye appears red, due to hemorrhage of the capillaries in the eyes.
The patient is usually rushed to the hospital A&E, where dengue is diagnosed and the patient is warded for immediate treatment.
Since the patient is already very weak and cannot get up to go to toilet, a bed-pan is a must. Some patients prefer to wear pampers. A relative or family member may want to accompany the patient since the patient has no energy to do much except sleep and breathe. The patient is moved around in wheelchair.
4. How is dengue monitored?
This is an acute infection. It is short-lived. It peaks between 3-5 days and subsides within 2 weeks.
Platelet count is monitored at the hospital. The platelet count drops very low and can be as low as 20.
Patients are discharged home once the platelet count is sufficiently high. Normal platelet count is more than 300 in adults.
5. What food can the dengue patient eat?
Since the patient has altered taste sensation, he/she has no appetite and will not eat. But the patient must be forced to eat.
Among traditional food that can be fed to help overcome dengue are crab soup and bitter papaya leaf juice.
Crab is ketam nipah - a large crab variety that survives in the freshwater marshes by rivers. They sell these crabs in Sabak, Kelantan @ 3 crabs for RM10. They are cleaned and cooked as soup with added ginger, lemon grass (serai), and salt. Drinking the crab soup is sufficient if the patient cannot eat the crab meat.
The papaya leaf juice is prepared by pounding young papaya shoots and squeezing the juice through a sieve. Only a tablespoon a day is sufficient. It is very bitter. Some people add honey, but it is still bitter and difficult to take.
6. How is the patient monitored after being discharged?
The patient is scheduled for regular visits to the clinic (eg Klinik Staf USM) at weekly intervals, to monitor recovery progress - platelet count (if any) and overall general health.
Patients are still very tired (fatigued) after 2 weeks from the first instance of dengue diagnosis. They must be accompanied by a relative or family member when attending post-dengue clinic.
7. How is the patient's living area cared for?
Dengue is a notifiable disease. Once the health clinic is notified, health officers visit the residential area and look for possible dengue breeding grounds. Fogging notices are posted on gates or postal boxes of each home, usually early in the morning of the day of fogging, at about 9 am. Sometimes the home owners have all gone to work by that time, so they won't know till they get home in the evening.
External fogging kills the mosquitoes and larvae. Fogging is done between 6 pm and 7 pm, a time when the mosquitoes come out to feed.
Internal fogging (inside the homes) is done after external fogging between 6 pm and 7 pm.
8. Is fogging safe?
The home is safe after 30 minutes has passed after fogging. The strong oil odour is still in the house long after this and may last up to 1-2 days. Aerosol marks can be found on glass surfaces, glass windows, TV monitors, laptops etc.
9. Is repeated fogging necessary?
Fogging is repeated every 2-3 days, as long as there are dengue patients identified and warded from a particular residential area.
If 5 patients are identified in a particular residential area (taman perumahan), then it can be expected to have continuous fogging for extended periods.
If there is no dengue patient reported from a particular housing area, it means that the area is dengue-free and no fogging is necessary. This often confuses the residents as when there are plenty of mosquitoes, residents tend to think all mosquitoes are dengue mosquitoes, which is untrue.
The usual mosquitoes that build up among flower pots and in the bushes around and nearby houses are often not dengue mosquitoes, but they are a nuisance. They disrupt the peace and happy living environment and mood. They bite and residents have a hard time getting rid of them.
The usual insect spray seems not to help. Burning treated mosquito coil also seem not to work. So at this present time, there is no cure from the menacing non-dengue mosquitoes.
10. Does fogging disrupt lives?
Yes, because the fogging team starts fogging at 6 pm. Most people work outside the home and only return home by 6 pm. They are often exhausted from their daily 8 am-5 pm weekday work. They just want to eat dinner and rest for the day. Fogging activities tend to disrupt their daily routine.
Malay: Denggi
What is dengue?
http://www.who.int/features/qa/54/en/
Dengue is a viral disease spread by mosquito bite. The Aedes egyptii mosquito is the carrier of the dengue virus.
1. When does dengue occur?
It can occur anytime. It occurs mainly during the hot and dry season and with occasional rain. Breeding grounds can be outside or inside the house.
Outside the house ...
Watering the plants can help to form puddles on the uneven floor around the flowerpots. If the puddles don't dry up fast, mosquitoes can breed as they just need overnight stagnant water.
Rainwater is trapped in various containers improperly disposed off by unthinking users. Rainwater also collects in unused building materials, paint can lids, disused plastic, leaves that curl and can hold water, slippers, drains, clogged gutters etc.
Inside the house ...
Stagnant water provides a good breeding ground for mosquitoes. It doesn't matter whether the home is in the urban or rural area. Urban homes tend to have more decor and flower vases containing water. Urban homes have a lot of clutter and sunshine hardly hits the interior spaces. The interior spaces are often cold and damp .... a perfect hybernating space for mosquitoes while waiting for water to breed. Thus, it is not surprising that dengue sufferers are often found within urban homes rather than rural homes, which have plenty of sunshine and are often drier internal environment.
Most homes today are equipped with basic appliances - the usual kitchen utensils and bath utilities. These don't need daily attention and are often left as they are till the next spring cleaning activity. Flower vases with water, dishes and bowls left to dry but not properly drained, draining boards that are not frequently drained, stagnant water at the base of refrigerators, water in the containers that hold legs of cupboards, etc are among the many possibilities for dengue development.
Inside the toilet, open water tanks which are untreated with Abate, water in pails which are left overnight or for longer period, dippers half-filled with water, wet toilet slippers, water closets (WC) which are left unused for long periods, toilet floors with stagnant water at the corners and near the drainage holes, empty shampoo bottles left lying around on the toilet floor, dirty diapers left on the toilet floor, empty soap wrappers left on the toilet floor, and various other things found in the toilet, are good breeding grounds for the dengue mosquito.
2. Dengue FAQ
http://www.cdc.gov/dengue/faqfacts/index.html
3. What are the signs and symptoms of dengue?
Weakness that gradually worsens and the infected patient becomes fatigued overnight. The weakness is accompanied by an unusual fever and the entire body becomes painful. There is loss of appetite (LOA), altered taste sensation (food does not taste like food anymore), and weight loss. Sometimes the white of the eye appears red, due to hemorrhage of the capillaries in the eyes.
The patient is usually rushed to the hospital A&E, where dengue is diagnosed and the patient is warded for immediate treatment.
Since the patient is already very weak and cannot get up to go to toilet, a bed-pan is a must. Some patients prefer to wear pampers. A relative or family member may want to accompany the patient since the patient has no energy to do much except sleep and breathe. The patient is moved around in wheelchair.
4. How is dengue monitored?
This is an acute infection. It is short-lived. It peaks between 3-5 days and subsides within 2 weeks.
Platelet count is monitored at the hospital. The platelet count drops very low and can be as low as 20.
Patients are discharged home once the platelet count is sufficiently high. Normal platelet count is more than 300 in adults.
5. What food can the dengue patient eat?
Since the patient has altered taste sensation, he/she has no appetite and will not eat. But the patient must be forced to eat.
Among traditional food that can be fed to help overcome dengue are crab soup and bitter papaya leaf juice.
Crab is ketam nipah - a large crab variety that survives in the freshwater marshes by rivers. They sell these crabs in Sabak, Kelantan @ 3 crabs for RM10. They are cleaned and cooked as soup with added ginger, lemon grass (serai), and salt. Drinking the crab soup is sufficient if the patient cannot eat the crab meat.
The papaya leaf juice is prepared by pounding young papaya shoots and squeezing the juice through a sieve. Only a tablespoon a day is sufficient. It is very bitter. Some people add honey, but it is still bitter and difficult to take.
6. How is the patient monitored after being discharged?
The patient is scheduled for regular visits to the clinic (eg Klinik Staf USM) at weekly intervals, to monitor recovery progress - platelet count (if any) and overall general health.
Patients are still very tired (fatigued) after 2 weeks from the first instance of dengue diagnosis. They must be accompanied by a relative or family member when attending post-dengue clinic.
7. How is the patient's living area cared for?
Dengue is a notifiable disease. Once the health clinic is notified, health officers visit the residential area and look for possible dengue breeding grounds. Fogging notices are posted on gates or postal boxes of each home, usually early in the morning of the day of fogging, at about 9 am. Sometimes the home owners have all gone to work by that time, so they won't know till they get home in the evening.
External fogging kills the mosquitoes and larvae. Fogging is done between 6 pm and 7 pm, a time when the mosquitoes come out to feed.
Internal fogging (inside the homes) is done after external fogging between 6 pm and 7 pm.
8. Is fogging safe?
The home is safe after 30 minutes has passed after fogging. The strong oil odour is still in the house long after this and may last up to 1-2 days. Aerosol marks can be found on glass surfaces, glass windows, TV monitors, laptops etc.
9. Is repeated fogging necessary?
Fogging is repeated every 2-3 days, as long as there are dengue patients identified and warded from a particular residential area.
If 5 patients are identified in a particular residential area (taman perumahan), then it can be expected to have continuous fogging for extended periods.
If there is no dengue patient reported from a particular housing area, it means that the area is dengue-free and no fogging is necessary. This often confuses the residents as when there are plenty of mosquitoes, residents tend to think all mosquitoes are dengue mosquitoes, which is untrue.
The usual mosquitoes that build up among flower pots and in the bushes around and nearby houses are often not dengue mosquitoes, but they are a nuisance. They disrupt the peace and happy living environment and mood. They bite and residents have a hard time getting rid of them.
The usual insect spray seems not to help. Burning treated mosquito coil also seem not to work. So at this present time, there is no cure from the menacing non-dengue mosquitoes.
10. Does fogging disrupt lives?
Yes, because the fogging team starts fogging at 6 pm. Most people work outside the home and only return home by 6 pm. They are often exhausted from their daily 8 am-5 pm weekday work. They just want to eat dinner and rest for the day. Fogging activities tend to disrupt their daily routine.
 |
| External fogging by the health authorities, 10 January 2016 |
Thursday, 24 March 2016
Lymph Nodes, Lymphadenitis and Lymphadenopathy
Do we all have lymph nodes?
- Yes. # of lymph nodes in the body: ~ 600
Structure and function of lymph nodes:
- Lymph nodes are small, ovoid nodules normally ranging in size from a few millimeters to 2 cm.
- They are distributed in clusters along the course of lymphatic vessels located throughout the body.
- The primary function of lymph nodes is to filter out microorganisms and abnormal cells that have collected in lymph fluid.
- Node dimensions: In general, lymph nodes greater than 1 cm in diameter are considered to be abnormal. eg 1.7 cm x 1.8 cm x 2.2 cm ... before commencing antiobiotics (Amoxycillin + clavulanate)
- Lymphadenopathy refers to nodes that are abnormal in either size, consistency or number.
- Lymphadenitis is the inflammation or enlargement of a lymph node.
Careful palpation of the submandibular (bawah dagu), anterior and posterior cervical (leher), supraclavicular (pangkal leher), axillary (ketiak) and inguinal (celah kangkang) nodes can be accomplished in a short time and will identify patients with generalized lymphadenopathy.
A localised cervical lymphadenopathy is either on the right side or left side of the neck. It can be solitary or aggregated (like a bunch of grapes).
Characteristics:
- Location - Depends on underlying etiology
- Number - Single, local groupings (regional), or generalized (ie, multiple regions)
- Size/shape - Normal lymph nodes range in size from a few millimeters to 2 cm in diameter; enlarged nodes are greater than 2-3 cm with regular/irregular shapes
- Consistency - Soft, firm, rubbery, hard, fluctuant, warm
- Tenderness - Suggestive of an infectious process but does not rule out malignant causes
1. “Generalized lymphadenopathy” if lymph nodes are enlarged in two or more non contiguous areas (25%). eg Cytomegalovirus.
2. “Localized lymphadenopathy” if only one area is involved (75%):
- Head and neck (55%)
- Supraclavicular (1%)
- Axillary (5%)
- Inguinal (14%)
(i) Head and neck (55%)
Submandibular
- tongue
- submaxillary gland - dental caries/abscess
- lips and mouth
- conjunctivae
- lower lip
- floor of mouth
- tip of tongue
- skin of cheek
- tongue
- tonsil
- pinna
- parotid
- scalp and neck
- skin of arms and pectorals
- thorax
- cervical and axillary nodes
Suboccipital
- scalp and head
- external auditory meatus
- pinna
- scalp
- eyelids and conjunctivae
- temporal region
- pinna
Right supraclavicular node
- mediastinum; mediastinal - Epstein-Barr virus (EBV) (mononucleosis)
- lungs
- esophagus
- thorax
- abdomen
- via thoracic duct
Axillary
- arm
- thoracic wall
- breast
- ulnar aspect of forearm and hand
INVESTIGATIONS
- Skin test/Mantoux test - walk-in test done at Medical clinic (KPP). Uses 1 ml of tuberculin or purified protein derivative (PPD). To confirm the diagnosis of tuberculous lymphadenopathy; alternative is interferon-gamma release assays (IGRA). TRO TB; check for recent/past exposure to TB organism. Results are read on the 4th day: eg a 15 mm induration is considered "positive" or evidence of having antibodies/immunity to the TB organism or previous exposure - could be a recent house renovations with a coughing worker; could be a coughing husband, etc.
- Blood test: ESR, FBP. TRO bacterial/viral infection. Turnaround time (TAT) for blood results is 1 week from Hematology. CBC count - Elevated WBC count may indicate an infectious etiology. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) - Elevated ESR and CRP are nonspecific indicators of inflammation.
- Serology. Monospot or Epstein-Barr Virus (EBV) serologies. To confirm the diagnosis of infectious mononucleosis.
- CT Scan - location, size and # of abnormal lymph nodes involved; contents of lymph node - fluid/pus or cellular. Interpretations and Radiology reports are available by the 3rd day.
- CXR (chest x-ray) - Chest radiography may be helpful in determining pulmonary involvement or spread of lymphadenopathy to the chest. TRO pulmonary TB (PTB). Films are available online the same day. Radiology report is made available online.
- Ultrasound. Ultrasonography may be useful for verifying lymph node involvement and taking accurate measurements of enlarged nodes. Ultrasound is not able to differentiate between benign and malignant forms of lymphadenopathy.
- Node biopsy: FNAC versus excisional biopsy ... performed under local anaesthesia ... procedure does not need fasting; performed after 1 week course of antibiotics (Amoxycillin + calvulanate). Drainage if filled with pus or fluid. Aspirates, if any.
- Gram stain of aspirated tissue. To evaluate bacterial etiologies.
- Culture and Sensitivity (C&S). Culture of aspirated tissue or biopsy specimen. To determine the causative organism and its sensitivity to antibiotics.
- Liver function tests (LFT). May indicate hepatic or systemic involvement; elevated transaminase levels can be seen in infectious mononucleosis.
CAUSES
In most cases, a careful history and physical examination will identify a readily diagnosable cause of the lymphadenopathy. Refer to the algorithm for investigating lymphadenopathy. The causes are categorized into 3 types:
Diagnostic causes:
- upper respiratory tract infection (URTI),
- pharyngitis (sakit tekak),
- periodontal disease (penyakit gigi dan gusi),
- conjunctivitis (sakit mata),
- lymphadenitis (radang noda limfa),
- tinea (kulat),
- insect bites (gigitan serangga),
- recent immunization (imunisasi terhampir),
- cat-scratch disease (cakar kucing)
- dermatitis (radang kulit)
- mononucleosis
- syphilis
- lymphoma
- HIV
- if generalised - review epidemiologic clues. Patients with generalized lymphadenopathy will need further diagnostic evaluation that often includes biopsy.
- if localized - review history, regional examination and epidemiologic clues. Patients with localized lymphadenopathy + a worrisome clinical picture will need further diagnostic evaluation that often includes biopsy.
- Bartonella henselae (catscratch disease) – Single-node involvement determined by scratch site; discrete, mobile, nontender
- Coccidioides immitis (coccidioidomycosis) – Mediastinal
- Cytomegalovirus – Generalized
- Epstein-Barr Virus (EBV) (mononucleosis) - Anterior cervical, mediastinal, bilateral; discrete, firm, nontender
- Francisella tularensis (tularemia) - Cervical, mediastinal, or generalized; tender
- Histoplasma capsulatum (histoplasmosis) – Mediastinal
- Atypical Mycobacterium - Cervical, submandibular, submental (usually unilateral); most commonly in immunocompetent children aged 1-5 years
- Mycobacterium tuberculosis - Mediastinal, mesenteric, anterior cervical, localized disease (discrete, firm, mobile, tender); generalized hematogenous spread (soft, fluctuant, matted, and adhere to overlying, erythematous skin)
- Parvovirus - Posterior auricular, posterior cervical, occipital
- Rubella - Posterior auricular, posterior cervical, occipital
- Salmonella – Generalized
- Seborrheic dermatitis, scalp infections - Occipital, postauricular
- Staphylococcus aureus adenitis - Cervical, submandibular; unilateral, firm, tender
- Group A streptococcal (GAS) pharyngitis - Submandibular and anterior cervical; unilateral, firm, tender
- Toxoplasma gondii - Generalized, often nontender
- Viral pharyngitis - Bilateral postcervical; firm, tender
- Yersinia enterocolitica - Cervical or abdominal
- Yersinia pestis (plague) - Axillary, inguinal, femoral, cervical; extremely tender with overlying erythema
- Juvenile rheumatoid arthritis
- Graft versus host disease
- Acute lymphoblastic leukemia
- Lymphosarcoma
- Reticulum cell sarcoma
- Non-Hodgkin lymphoma
- Malignant histocytosis or histocytic lymphoma
- Nonendemic Burkitt tumor
- Nasopharyngeal rhabdomyosarcoma
- Neuroblastoma
- Thyroid carcinoma, chronic lymphocytic thyroiditis
- Histiocytosis X
- Kikuchi disease
- Benign sinus histiocytosis
- Angioimmunoblastic or immunoblastic lymphadenopathy
- Chronic pseudolymphomatous lymphadenopathy (chronic benign lymphadenopathy)
- Chronic granulomatous disease of childhood
- Acquired immunodeficiency syndrome
- Hyperimmunoglobulin E (Job) syndrome
- Gaucher disease
- Niemann-Pick disease
- Cystinosis
- Sickle cell anemia
- Thalassemia
- Congenital hemolytic anemia
- Autoimmune hemolytic anemia
- Kawasaki disease
- PFAPA (periodic fever, aphthous stomatitis, pharyngitis, and adenitis) syndrome
- Sarcoidosis
- Castleman disease (also known as benign giant lymph node hyperplasia)
- Mesantoin – most commonly causes cervical lymphadenitis
- Hydantoin - Generalized lymphadenopathy
REGIONAL LYMPHADENITIS
In a patient with regional lymphadenitis, knowledge of lymphatic drainage patterns and pathologic processes most likely to affect these areas can facilitate diagnostic investigation.
Cervical lymph nodes
Cervical lymph nodes receive lymphatic drainage from the head, neck, and oropharyngeal cavities.
Infections associated with cervical lymph nodes are as follows:
- Skin and soft tissue infections of the face
- Dental abscesses
- Otitis externa
- Bacterial pharyngitis
- Cytomegalovirus
- Adenovirus infection
- Rubella
- Toxoplasmosis
- Hodgkin lymphoma
- Non-Hodgkin lymphomas
- Squamous cell carcinomas of nasopharyngeal or laryngeal structures
BIOPSY
Choice of biopsy: FNAC versus Excisional biopsy
Fine-needle aspiration and cytology (FNAC) is an alternative to excisional biopsy.
Advantages of excisional biopsy:
- larger tissue mass to examine
- can examine the entire abnormal lymph node
- FNAC often yields a high number of non diagnostic results,
- because of the small amount of tissue obtained and
- the inability to examine the architecture of the lymph node.
- There may be some risk of sinus tract formation, depending on the underlying pathology.
Pathology reports should be available within a week of performing FNAC or excisional biopsy.
Incision and drainage is the treatment for lymphadenitis with abscess formation.
For atypical mycobacterial lymphadenitis, neither incision and drainage nor FNA should be performed as either of these may increase the risk of fistula formation and drainage.
CANCEROUS OR NOT?
Is it cancer or not? Is it benign or malignant?
Physical examination findings suggestive of malignancy are as follows:
- Firm
- Hard
- Fixed
- Non tender
- Soft
- Fluctuant
- Tender
- Overlying erythema or streaking
External links:
Lymphadenopathy
http://emedicine.medscape.com/article/956340-overview
http://www.aafp.org/afp/1998/1015/p1313.html
http://www.msdmanuals.com/professional/cardiovascular-disorders/lymphatic-disorders/lymphadenopathy
https://en.wikipedia.org/wiki/Lymphadenopathy
Lymphadenitis
http://emedicine.medscape.com/article/960858-overview
Tuesday, 15 March 2016
Insulin
YouTube videos:
Mechanism of action
https://www.youtube.com/watch?v=X0ezy1t6N08
Insulin actions and receptors
https://www.youtube.com/watch?v=kWgrc1lVQqg
Insulin, Glucose and you
https://www.youtube.com/watch?v=ae_jC4FDOUc
The role of insulin in the human body
https://www.youtube.com/watch?v=OYH1deu7-4E
Glucose
https://www.youtube.com/watch?v=b1nxDW5HPjE
Pancreas and beta-cells
https://www.youtube.com/watch?v=thljcddT3EY
https://www.youtube.com/watch?v=RE9ymUATNQ0
Diabetes made simple
https://www.youtube.com/watch?v=MGL6km1NBWE
Diabetes animation
https://www.youtube.com/watch?v=NazZCu1lwOE
https://www.youtube.com/watch?v=jJzo2xYkbb0
Diabetes pathophysiology
https://www.youtube.com/watch?v=C9XYnZdEIPE
Type 1 diabetes
https://www.youtube.com/watch?v=jxbbBmbvu7I
Type 2 diabetes
https://www.youtube.com/watch?v=JAjZv41iUJU
https://www.youtube.com/watch?v=OXAe3eOjqCk
https://www.youtube.com/watch?v=QRVaryEQOVk
Reversing Type 2 diabetes
https://www.youtube.com/watch?v=da1vvigy5tQ
https://www.youtube.com/watch?v=1NqDpqgoDAE
Diabetic medications
https://www.youtube.com/watch?v=qXSKZYGTlHA
https://www.youtube.com/watch?v=0UZd5ayEsM4
Mechanism of action
https://www.youtube.com/watch?v=X0ezy1t6N08
Insulin actions and receptors
https://www.youtube.com/watch?v=kWgrc1lVQqg
Insulin, Glucose and you
https://www.youtube.com/watch?v=ae_jC4FDOUc
The role of insulin in the human body
https://www.youtube.com/watch?v=OYH1deu7-4E
Glucose
https://www.youtube.com/watch?v=b1nxDW5HPjE
Pancreas and beta-cells
https://www.youtube.com/watch?v=thljcddT3EY
https://www.youtube.com/watch?v=RE9ymUATNQ0
Diabetes made simple
https://www.youtube.com/watch?v=MGL6km1NBWE
Diabetes animation
https://www.youtube.com/watch?v=NazZCu1lwOE
https://www.youtube.com/watch?v=jJzo2xYkbb0
Diabetes pathophysiology
https://www.youtube.com/watch?v=C9XYnZdEIPE
Type 1 diabetes
https://www.youtube.com/watch?v=jxbbBmbvu7I
Type 2 diabetes
https://www.youtube.com/watch?v=JAjZv41iUJU
https://www.youtube.com/watch?v=OXAe3eOjqCk
https://www.youtube.com/watch?v=QRVaryEQOVk
Reversing Type 2 diabetes
https://www.youtube.com/watch?v=da1vvigy5tQ
https://www.youtube.com/watch?v=1NqDpqgoDAE
Diabetic medications
https://www.youtube.com/watch?v=qXSKZYGTlHA
https://www.youtube.com/watch?v=0UZd5ayEsM4
Jugular Venous Pressure (JVP)
YouTube videos:
Visible Jugular Venous Pressure
https://www.youtube.com/watch?v=xyvqDrj18js
Jugular Venous Pulse
https://www.youtube.com/watch?v=5hX59tIaZcQ
https://www.youtube.com/watch?v=TDWohhn6Eo4
JVP Waveform
https://www.youtube.com/watch?v=cLETr8qmXPQ
Jugular Venous Pulse Curve
https://www.youtube.com/watch?v=8nxG3AN5xMw
The Cardiac Cycle
https://www.youtube.com/watch?v=QI_XqFl8yvs
https://www.youtube.com/watch?v=MxO2xTtJzH0
https://www.youtube.com/watch?v=U3Y-biG5OVw
https://www.youtube.com/watch?v=kcWNjt77uHc
https://www.youtube.com/watch?v=LMWO-_IfSbU
https://www.youtube.com/watch?v=7w6awkDREQM
ECG
https://www.youtube.com/watch?v=0sogXvxxV0E
https://www.youtube.com/watch?v=PtUNB2BNKa8
Visible Jugular Venous Pressure
https://www.youtube.com/watch?v=xyvqDrj18js
Jugular Venous Pulse
https://www.youtube.com/watch?v=5hX59tIaZcQ
https://www.youtube.com/watch?v=TDWohhn6Eo4
JVP Waveform
https://www.youtube.com/watch?v=cLETr8qmXPQ
Jugular Venous Pulse Curve
https://www.youtube.com/watch?v=8nxG3AN5xMw
The Cardiac Cycle
https://www.youtube.com/watch?v=QI_XqFl8yvs
https://www.youtube.com/watch?v=MxO2xTtJzH0
https://www.youtube.com/watch?v=U3Y-biG5OVw
https://www.youtube.com/watch?v=kcWNjt77uHc
https://www.youtube.com/watch?v=LMWO-_IfSbU
https://www.youtube.com/watch?v=7w6awkDREQM
ECG
https://www.youtube.com/watch?v=0sogXvxxV0E
https://www.youtube.com/watch?v=PtUNB2BNKa8
Friday, 4 March 2016
Vitamin B
Generally, vitamin B helps a person to eat, especially in patients who have recovered from conditions where they have suffered loss of appetite (LOA).
Vitamin B is prescribed in various forms, for certain conditions, among them poor fingernails in children after recovery from a severe illness, hair loss in children after ringworm infection of the scalp, pain in the bones and tissues in post-menopausal women after a fall - to aid nerve development, and anemia in menstruating ladies.
Vitbion is prescribed for bone pain in elderly ladies who suffered a fall and have pain in the affected area or have whole body pain from osteoporosis. This is a bright orange tablet packed in 10's on an aluminium foil.
Vitbion Forte Tablet
Manufactured by Dynapharm (M) Sdn Bhd
Malaysian code: MAL19920011X
Active ingredients:
Thiamine HCl (Vit B1 100 mg
Pyridoxine HCl (Vit B6) 200 mg
Cyanocobalamin (Vit B12) 200 mcg
Vitamin B tablets look similar to vitamin C tablets, but vitamin B tablets are much larger and flatter at the edge compared to vitamin C tablets.
Vitamin C and B tablets can be easily confused in the elderly with poor eyesight. Feeling the tablets and knowing how to differentiate them by touch is therefore important for the elderly.
Vitamin C is bright red, smaller and rounder with a smooth polished feel. Vitamin C is packed in small plastic bags that need to be snipped to create a small opening for dispensing.
External links
https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
https://en.wikipedia.org/wiki/B_vitamins
http://www.naturemade.com/resource-center/articles-and-videos/
Vitamin B is prescribed in various forms, for certain conditions, among them poor fingernails in children after recovery from a severe illness, hair loss in children after ringworm infection of the scalp, pain in the bones and tissues in post-menopausal women after a fall - to aid nerve development, and anemia in menstruating ladies.
Vitbion is prescribed for bone pain in elderly ladies who suffered a fall and have pain in the affected area or have whole body pain from osteoporosis. This is a bright orange tablet packed in 10's on an aluminium foil.
Vitbion Forte Tablet
Manufactured by Dynapharm (M) Sdn Bhd
Malaysian code: MAL19920011X
Active ingredients:
Thiamine HCl (Vit B1 100 mg
Pyridoxine HCl (Vit B6) 200 mg
Cyanocobalamin (Vit B12) 200 mcg
Vitamin B tablets look similar to vitamin C tablets, but vitamin B tablets are much larger and flatter at the edge compared to vitamin C tablets.
Vitamin C and B tablets can be easily confused in the elderly with poor eyesight. Feeling the tablets and knowing how to differentiate them by touch is therefore important for the elderly.
Vitamin C is bright red, smaller and rounder with a smooth polished feel. Vitamin C is packed in small plastic bags that need to be snipped to create a small opening for dispensing.
External links
https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/
https://en.wikipedia.org/wiki/B_vitamins
http://www.naturemade.com/resource-center/articles-and-videos/
Thursday, 3 March 2016
Tuesday, 1 March 2016
Biochemistry Courses and Textbooks
Discipline: BIOCHEMISTRY
Courses taught
The Department teaches 11 courses over 2 years, at the end of which is the in-house Professional 1 examination. Students are encouraged to take the external administered MRCP Part 1 examination after completing 2 years of study of the basic sciences or pre-clinical courses.
Year 1 Medicine
GMT 101 Cell & Tissue
GMT 102 Molecular Biology & Pharmacology
GMT 105 Respiratory System
GMT 106 Haemopoietic & Lymphoid System
GMT 107 Cardiovascular System
GMT 108 Gastrointestinal System
GMT 109 Genitourinary System
Year 2 Medicine
GMT 201 Nervous System & Psychology
GMT 202 Endocrine System
GMT 203 Reproductive System
GMT 204 Musculoskeletal System
Main Textbooks
Reference Textbooks
Courses taught
The Department teaches 11 courses over 2 years, at the end of which is the in-house Professional 1 examination. Students are encouraged to take the external administered MRCP Part 1 examination after completing 2 years of study of the basic sciences or pre-clinical courses.
Year 1 Medicine
GMT 101 Cell & Tissue
GMT 102 Molecular Biology & Pharmacology
GMT 105 Respiratory System
GMT 106 Haemopoietic & Lymphoid System
GMT 107 Cardiovascular System
GMT 108 Gastrointestinal System
GMT 109 Genitourinary System
Year 2 Medicine
GMT 201 Nervous System & Psychology
GMT 202 Endocrine System
GMT 203 Reproductive System
GMT 204 Musculoskeletal System
Main Textbooks
- Richard A. Harvey, Denise R. Ferrier, Biochemistry (Lippincott's Illustrated Reviews) 5th Edition (2010) Lippincott Williams & Wilkins
- Michael A. Lieberman, Allan D. Marks, Mark's Basic Medical Biochemistry: A Clinical Approach, 3th Edition (2009), Wolters Kluwer Health, Lippincott Williams & Wilkins
Reference Textbooks
- Murray, R, Harper's Biochemistry,.26th Ed (2003), Appleton & Lange, Norwalk, CT
- Jeremy M Berg, John L Tymoczko, and Lubert Stryer, Biochemistry, 5th Edition (2002), W.H. Freeman Co, New York
- McKee, T. & McKee, J.R. Biochemistry: An Introduction, 2nd Edition (1999) WCB/McGraw-Hill
- Meisenberg G & Simmons WH, Principles of Medical Biochemistry, 2nd Ed (2006), Mosby
MRCP Part 1
- Philippa J. Easterbrook. Basic Medical Sciences for MRCP Part 1. Third Edition (2005), Elsevier Churchill/Livingston.
- Philip A. Kalra. Essential Revision Notes for MRCP. Fourth Edition (2014), Jaypee, The Health Sciences Publisher, New Delhi.
The textbooks are available at the campus library at USM in Kubang Kerian, Kelantan.
The MRCP Part 1 revision books are sold by vendors from time to time when they come to campus. The vendors are based in Kuala Lumpur.
Medical books suppliers in Kuala Lumpur
- Utama Medilink Books, Arun - Business Develoopment, hp 012-283-5794. G-2, Sinar Magna Apartment, No. 1 Jalan Prima - 10, Metro Prima, Kepong 52100 Kuala Lumpur. Tel/fax 03-6257-9695, email arumedik@gmail.com. Comments: This is a good bookseller. The gentlemen are polite.
- Mediclink, handphone number is 012-2835794. The advantage of MedicLink is that you get your books first before you have to pay.
- Kamal Medical Book Supplies Sdn Bhd (better known as Kamal Medical Bookstore). Only 10 minutes walk from Chow Kit Monorail stop. There is limited parking (none nearby). Does not accept credit cards. For orders to Kamal, customers must pay first before the books are delivered. Refer to ordering details at: http://www.lwjuan.com/2011/04/25/how-to-order-books-from-kamal-bookstore/ Comments: The comments about this supplier are on Facebook and Foursquare.
Kamal Bookstore details:
Opening hours:
Monday to Saturday : 8 am to 8 pm
Sunday : 8 am to 2 pm
Address:
Kamal Medical Book Supplies Sdn Bhd. (government contractor) aka
Kamal Medical Bookstore
138, Jalan Pahang (opposite General Hospital KL),
53000 Kuala Lumpur.
Tel: +6-03-4021-0548 / +6-03-4021-0575
Medical books suppliers from India
- Vijay Kumar (guest): Hi we are pleased to inform you that we are leading book distributor and exporter of all kind of books of all leading publishers, could you please let us know that do you buy books from India? Regards Vijay Kumar Vkmedicalbooks34@gmail.com
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