A 61-year-old woman presents to the emergency department (ED) after being referred from her primary care provider's (PCP) office for evaluation of tachycardia. She had been seen by her PCP for routine placement of a purified protein derivative (PPD) tuberculin skin test and was incidentally noted to have a pulse of 160 bpm. The patient currently denies any specific complaints other than occasional palpitations. On review of her systems, however, she notes having night sweats; a 110-lb (50-kg) weight loss over the preceding 12 months; and 2-3 months of anxiety, diarrhea, and occasional diplopia. She denies having any fever, chills, chest pain, dyspnea, or swelling in her extremities. She has a past medical history of an unspecified thyroid problem. She does not take any daily medications and has no medication allergies. She has a 50-pack-year smoking history, with occasional alcohol consumption. She had been homeless for a period of time but is currently living in an apartment.
On examination, the patient is awake and fully oriented. She is diaphoretic but in no apparent distress. Her temperature is 97.0°F (36.1°C); her pulse is 160 bpm; her respiratory rate is 24 breaths/min, with an oxygen saturation of 98%; and her blood pressure is 190/117 mm Hg. She has bilateral exophthalmos with exotropia of the right eye. Her visual acuity and extraocular movements are intact. The neck examination reveals a diffuse, nontender goiter, without nodules or thyroid bruits. The heart is tachycardic, intermittently irregular, and without murmurs. The lungs are clear to auscultation bilaterally. The abdomen is nondistended, soft, and nontender, with no palpable masses. There is no edema of the extremities. The neurologic examination reveals normal mentation, intact cranial nerves, intact motor strength and sensation, and normal reflexes. No tremor is noted.The initial laboratory studies reveal complete blood count, electrolytes, renal function, and cardiac marker findings that are all within normal limits. A plain chest radiograph is interpreted as normal.An electrocardiogram (ECG) is obtained. I'll discuss more about this topic on the next issue..coming with more answers!!!..think it man..
Gallstones are very common topic and are therefore frequently asked in the exams. Majority of them are asymptomatic and which require no treatment. However, they cause a wide range of clinical problems, depending on their position. They are either made up of cholesterol or pigment (bilirubin breakdown products) or a mixture of the two. Most (75%) gallstones are predominantly cholesterol. Pure pigment stones are rare (<10%) Ninety per cent of gallstones are radiolucent, i.e. they do not show on a plain X-ray (unlike renal calculi, of which 90% are radio-opaque).
Predisposing factors to gallstone formaton include: 1. female 2. sex (three times more common) 3. obesity, 4. age (10% of <50-year-olds have gallstones, and 30% of <70-year-olds), 5. Haemolytic anemia 6. Hyperlipidaemias 7. Crohn’s disease. Some people appear to have a tendency to form gallstones and are said to have ‘lithogenic bile’. People often refer to the typical gallstone patient as 4F which is fat, female, fertile and forty. Ok? So remember that 4F if u cant remember the risk factors
Complications of gallstones can be divided into 3: 1. In the gallbladder
Chronic cholecystitis
Biliary colic
Acute cholecystitis
Empyema
Biliary peritonitis
Abscess
Mucocele
Carcinoma of gallbladder
2. In the common bile duct
Obstructive jaundice
Cholangitis
Pancreatitis
3. In the gut
Gallstone ileus
BILIARY COLIC Biliary colic is the pain that associated with irritation of the viscera secondary to cholecystitis and gallstones or in a specific terms caused by gallbladder muscle spasms against a stone stuck in the neck of the gallbladder (Hartmann’s pouch) or the cystic duct. It may account for some of the symptoms for chronic cholecystitis. Unlike intestinal colic, the pain was continuous and not in waves. It is usually felt in the epigastrium or right upper quadrant and may radiate around both costal margins and into the back. The pain can be extremely severe and patients may be sweaty, pale and tachycardic because of it. They may also feel nauseated or vomit. They will usually be unable to get comfortable and will prefer to writhe around rather than stay still. Attacks usually last less than six hours and examination is usually otherwise normal. Differential diagnoses include other causes of severe upper abdominal pain, such as perforated peptic ulcer, pancreatitis, ruptured aneurysm, etc. Management involves giving analgesia, investigation to confirm gallstones (ultrasound) and subsequent cholecystectomy in most cases.
ACUTE CHOLECYSTITIS
History
At early stage acute cholecystitis may appear to be biliary colic, and indeed many attacks of acute cholecystitis probably start with biliary colic! The exact mechanisms of acute cholescystitis are poorly understood but they said that it are caused by chemical inflammation within an obstructed gallbladder. Bacterial infection probably is a secondary event in about one-third of cases and these may be the ones most likely to develop complications.
Patients will typically have symptoms of severe right upper quadrant or epigastric pain. Like biliary colic, this may radiate around the costal margins or into the back. However unlike biliary colic, patients will prefer to lie still and take shallow breaths (this is now a form of local peritonitis, not colic). They will usually have a temperature and tachycardia, and may also have nausea and vomiting.
Physical examination
Murphy’s sign may be positive and is often asked about in short case. It is elicited by pressing in the right upper quadrant under the costal margin. The patient is then asked to breathe in, and winces or gasps with pain as the gallbladder moves down and hits the examiner’s hand. The test should also be performed in the left upper quadrant to exclude nonspecific reactions due to other pathology.
A mass may be present in the right upper quadrant, but if so this is not usually the gallbladder itself but rather a ‘phlegmon’ (i.e. inflamed andadherent omentum and bowel around the gallbladder).
Investigation
The most important confirmatory test is an ultrasound scan. US confirm gallstones, showing thickening and oedema of the gallbladder wall and localise the tender spot to the gallbladder itself. It can also exclude dilatation of the common bile duct and other pathology, such as liver masses.
Image through the long axis of the GB (GB) demonstrates the gallbladder neck (red arrow). GB wall thickness is measured between the gallbladder lumen and the hepatic parenchyma (red arrowheads) with normal thickness <3cm
Only very occasionally is a HIDA scan used to help confirm or exclude cholecystitis. The principle of this test is that HIDA (a radioisotope) is taken up by the liver and excreted into the bile. If the cystic duct is patent, it will fill the gallbladder effectively, excluding cholecystitis.
Management
The treatment of acute cholecystitis is initial resuscitation with intravenous fluids and antibiotics. The patient will normally be kept nil by mouth or on sips of clear fluids, and initial investigations will be arranged, including basic blood tests such as an FBC (usually the white cell count is raised), U & Es, LFTs and amylase (as acute pancreatitis may be a differential diagnosis).
With conservative treatment approximately 80–90% of cases of acute cholecystitis will settle over the next 24–48 h (i.e. the pain settles, the temperature falls and the patient’s abdomen becomes nontender). In about 10% of cases there will not be a prompt resolution of symptoms and signs, and in these cases surgery is usually advised.
Particularly worrying signs are increasing temperature, tachycardia and the onset of increasing tenderness or the signs of peritonitis. These may indicate infarction of the gallbladder (gangrenous cholecystitis) or perforation, which may produce either a local collection or generalised peritonitis. A gallbladder full of pus (empyema of the gallbladder) usually leads to an unwell patient with the signs of sepsis (fever, tachycardia, hypotension, etc.) as well as pain, and tenderness in the right upper quadrant.
More controversial is the question of what to do with patients who do not absolutely require early surgery. Although conventional management is to allow the acute episode to settle down and to readmit the patient for elective cholecystectomy 6–8 weeks later, many surgeons now prefer cholecystectomy in the acute phase. This allows patients to recover quicker and to be spared further episodes of pain. Laparoscopic cholecystectomy can now be carried out in the acute phase by experienced surgeons.
CHRONIC CHOLECYSTITIS
Chronic cholecystitis is a term used to describe symptoms of upper abdominal pain, indigestion, bloating, burping, nausea and occasional vomiting. Sometimes this symptom complex is called flatulent dyspepsia. The patient may describe the symptoms as being precipitated by fatty food (fats stimulate the release of cholecystokinin, which causes gallbladder contractions). There is usually nothing to find on physical examination.
The main differential diagnoses include 1. peptic ulceration 2. hiatus hernia 3. irritable bowel syndrome.
Because gallstones are so common, it's important not to automatically discribe such symptoms to them simply because that gallstones are present on an US scan. A missed peptic ulcer or irritable bowel syndrome will obviously not be helped by unnecessary cholecystectomy! And the patient will continue to get those symptoms. If the symptoms are thought to be arising from the gallbladder and are significant, then the treatment is cholecystectomy, usually laparoscopic.
Attempting to dissolve gallstones using 'bile salt therapy' might be possible for patients with small, noncalcified stones. It also reserved for those who refuse or unfit for surgery. However bear in mind that this treatment is not very successful.
CHOLANGITIS
Cholangitis is a condition where there is infection within the biliary tract and it is rare unless there is associated obstruction. This is a demonstration of the surgical principle that obstructed tubes tend to get infected, i.e. appendicitis, pyelonephritis, etc. Cholangitis is clinically manifested by Charcot’s triad ofpain, jaundice and rigors(rigors means involuntary shaking in association with pyrexia). It requires prompt diagnosis and treatment, otherwise it can have a high mortality. Treatment consists of resuscitaton with fluids and the administration of intravenous antibiotics. If resolution is not rapid, then attempts to produce biliary drainage, endoscopically, radiologically or surgically, are required.
1) Minyak ape yang disukai oleh lelaki? Answer: MINYAKsikan pertandingan bolasepak EPL .....
2) Kuih ape yang bungkusnya di dalam, isinya di luar? Answer: Kuih salah bikin...
3) Binatang ape power Karate? Answer: Kuda belang.cube kira brape black belt dia ade...
4) Siape yang menemukan dompet kulit? Answer: Yang menemukan dompet kulit tersebut tolong pulangkan kepada saye...
5) Pintu ape yang walaupun dengan 10 org pun tak leh nak tolak? Answer: Pintu yang ade tulis 'TARIK'...
6) Saya ade 3 kepala, 4 tangan dan 5 kaki...siapakah saya? Answer: Pembohong...
7) Apa dia 'Jauh di mata, dekat di hati'? Answer: Usus...
8) Binatang ape yang seluruh anggota tubuhnya kat kepala? Answer: Kutu rambut...
9) Nenek sape jalannya meloncat-loncat? Answer: Neneknye si katak...
10) Knape lelaki jarang kene penyakit anjing gila? Answer: Sbb lelaki ni kan 'buaya'...
11) Ape beza sekretari baik ngan sekretari kurang baik? Answer: - Sekretari baik..................'Selamat pagi tuan' - Sekretari kurang baik...........'Dah pagi ni tuan'...
12) Ape persamaan Michael Jordan ngan Michael Jackson? Answer: Dua-dua tak kenal korang...hehe
13) Tukang ape yang kalau dipanggil, die menjenguk ke atas? Answer: Tukang gali kubur...
14) Nak mencari sikit punye susah, bile dah dapat buang, ape bendanya? Answer: Tahi hidung...
15) Ape persamaan kain jemuran ngan telefon? Answer: Dua-dua kalau dah 'kringgg' bole diangkat...
16) Knape pokok kelapa kat depan rumah harus ditebang? Answer: Mestilah kene tebang, sape nak cabut pokok kelapa ...gile ape...
17) Gajah terbang dengan ape? Answer: Dengan susah payah....
p/s just leave your price and contact number at the comment box. We will call the winner on the the dateline!! The highest bidder will be the the winner!! Only 5passes up for grab.
To those who wants us to buy the tickets for the match, can do so.
For every medical student, finals seem a daunting prospect. However, the truth is that most candidates pass the exam easily and most junior doctors look back at finals as being relatively straightforward, not me saying that, them.. The reason for it is that exam is simply a long and draining race and by the time you have arrived this point, the odds are with you to finish the course.
For many of us might think that the examiners are not there to fail candidates per se; in fact, the opposite is true and they are really trying to help you pass. However in some like our case, they must ensure that a safe junior doctor is unleashed on the public. Because of this, we must know the basics of all the common emergency situations. Luck plays only a small part in finals for most students and, there is a quote “The harder you work, the luckier you get.”
There is no doubt that the best performers in final MBBS candidates are those who think logically. They express themselves clearly and avoid putting their foot in their mouth by saying something stupid like i did before.. Their knowledge depth might not necessarily greater than that of their fellow candidates, but they do well in every part of the exam — writtens, clinicals and OSCE.
Tips for exam
The message is clear: We must start early! We need to practising a systematic approach to the subject. There might be certain approach that we've been told by our seniors or friends, but you may not like all of them, so choose a method that we can use and spend a great deal of time perfecting it. Also, note that a short pause before answering does not detract from the answer and may avoid a dreadful mistake
Objectives
The purpose i build this blog is sharing. I love putting articles that are based on medicine so that many of us will benefits from it. Over the last few years, the world of medicine has moved on with advances in almost every field. With this in mind, apart from putting what we've learn during this 6 months, I decided to bring the text which this articles are up to date and to bring in expertise to co-author many of the chapters, especially those in which we were no longer experts! LOLZ. Each articles will be reviewed and updated by the co-author whose name is listed at the side of the blog making the only blog which comprehensively reviews from all specialities required for final MBBS examinations! What an ambitious things to do. Thus, i urge to my colleagues and my juniors to make this as a reality not a as a delusion.
We are joining this LAM2WIN. This Competition basically about an open source - php, apache etc2.. No need to elaborate, i just want your help now! hehe! Please do Vote for Aizuddin Akmal, so that our group will have a chance in winning this competition. How to vote? Easy as ABC. Just click the banner and check the Azuddin Akmal and click vote! We really appretiate it. Thanks in advanced.
May 28, 09 2:18pm Setiap pelajar yang menduduki Sijil Peperiksaan Malaysia (SPM) hanya dibenarkan mengambil 10 subjek maksimum mulai tahun depan.
Serentak dengan itu, beberapa perubahan akan dilakukan terhadap sistem pengredan SPM, kata Timbalan Perdana Menteri Tan Sri Muhyiddin Yassin.
"Ia akan mempunyai banyak implikasi positif, satu yang pasti adalah para guru akan berupaya memberi lebih tumpuan terhadap bilangan mata pelajaran utama dan guru juga akan lebih khusus," katanya kepada pemberita selepas melakukan lawatan kerja ke tapak projek Kompleks Pendidikan, Bandar Enstek di Nilai hari ini, lapor Bernama.
Muhyidin, yang juga menteri pelajaran berkata, daripada setengah juta pelajar yang mengambil SPM sebelum ini, kira-kira 48,000 pelajar mengambil lebih daripada 10 subjek.
Adik Nik Nor Madihah with her 20A's. 19A1 and 1A2
Adik Nur Amalina Che Bakri, the first student who shock the country with 17A's
Ini juga akan mengatasi masalah pada sesetengah subjek yang kekurangan guru, malahan ibu bapa dapat menjimatkan wang daripada terpaksa membayar lebihan subjek perlu diambil apabila menghantar anak mereka ke kelas tuisyen, katanya.
Muhyiddin berkata kementerian amat serius untuk merapatkan jurang di antara pelajar bandar dan luar bandar walapun perbezaan jurang ini tidak sejauh mana.
"Sebenarnya jurang ini tidak terlalu jauh tetapi masih ada perbezaan yang agak ketara dari sudut lain dan ini dilihat dari segi keputusan peperiksaan," katanya.
Pembaharuan yang dilaksanakan pada Rancangan Malaysia Ke-10 membabitkan pembangunan prasarana, tenaga guru dan cara pembelajaran murid, katanya.
"Lebih-lebih lagi di kawasan luar bandar ini terdapat ramai orang bumiputera Melayu, bumiputera yang agak miskin, kurang berkemampuan.
"Kita mahu pembangunan sekolah-sekolah di luar bandar sama tahapnya baik dari segi infrastruktur, cara pembelajaran sebagaimana yang terdapat di kawasan-kawasan yang sudah maju," kata Muhyiddin.
Beliau turut menyentuh mengenai kepentingan guru-guru yang berkelayakan untuk mengajar bahasa Inggeris, Sains dan Matematik di pedalaman merupakan cabaran utama bagi kementeriannya melaksanakan pembaharuan itu.
Walaupun kementerian ada menawarkan elaun sebanyak RM1,500 sebagai insentif sejak dari tahun lalu untuk mereka datang ke kawasan pedalaman misalnya di Sabah dan Sarawak, tetapi masih banyak cabaran lain perlu ditangani.
Beliau sedang memikirkan cara untuk menyenangkan kehidupan guru-guru yang dihantar ke kawasan pedalaman ini kerana walaupun mendapat elaun, kementerian sedar masalah lain seperti perumahan menjadi asas utama perlu diatasi.
Lolz.. why need more than 10's? I've taken 9 and managed to get only 3 A1. So difficult if too many subject we need to focus on. Do we really need to take more than that? What are we after for anyway? The best student in the country? What do they get? Big income? Famous? Hall of fame?
Today is Fitri's birthday.. We from the extenders, wish him a very happy birthday at perak..LOLZ.. Miss the old klang hospital memories where the traditions begin ..
Nway this is fitri
If only i can freeze the time we spend together.. What a good, i mean the best memories we've got together at klang..
Windows 7 RC was out. Then last week i ask my little sister to brought her notebook to me to installed the new windows. I was so eager to install because all of my friends installed it without any prob. Windows 7 was marvelous. Eventhough it only an RC version, the features are so advanced and Vista is not match for it. Her computer was ok until prior to 3 days ago I've got a blue screen when i surfing the net using firefox. The problem was "CODE 43" something related to Graphic card responding to windows that the card got some error thus makes the graphic unusable and makes the windows 7 ultimately become windows "safe mode"... Agrhghhh.. I've been working for my sister's notebook for the past 3 days without any solution! I've tried to format back to XP, VIsta also no hope. My eyes was so tired sitting infront of the monitor surfing for solutionI even called the acer center and try to get a solution. - "Oh, currently we don't suggest you to use WIndows7 because we don't have any driver that is compatible with it. Please use windows XP or Vista, ORIGINAL. LOLz.. I've tried to pressure him that i don't think this is a software prob. It's genuinely hardware problem i said but he just wont listen. Damn you acer. I even post this problem at lowyat.net forum at Technical Support Section. No reply.
Adik
Then I've concluded that I cant fix it. So I wanna gave it back to adik so that she cant sent it to warranty. Suddenly the computer back to normal! I dont know how on earth did she do that when the comp in her arms. She's got a miracle hands? Then i took it back to installed all the necessary software. Soon after that i went back to my room and OMG, the CODE 43 appeared again..
Lowyat and Big Apple
Then I've fed up and wannna send it to warranty department myself at lowyat. After a hard drive to lowyat with Najmi, i showed the comp to the technician there. Suddenly, "normal", said the technician.. the computer has not shown any problem! WTF. how come? i said. Then i later not satisfied i even try to restart multiple time! I ask najmi, did we have hallucination? I even showed him a proof of screen shot i taken earlier.
Damn.. What a hard work that we went to lowyat for nothing.. But there was also some best part which i bought some Big APPLE (i love the Alien, yummy, got so many choc outside and inside the donuts). After arrived, I've test again the notebook. WHAT THE ****. The CODE 43. It happened again!!!
Fixed
The trend - Problem was intermittent and it only happen in my room. I could see each time it happened only when i put on my external hard disk to the notebook before booting the computer. Thus the only solution here is to plug off any USB connected to the notebook to make it more power stable! It works! Sigh... At last i can relax my eye and take a full 12 hours of sleep, really?
Friends and Manchester United
Not really. Just when i wanna start to close my eyes, My besfriend, Hashim comes and asked me to watch Hull vs Man U. For me, no use for me to watch the match because MU has won already! I cant resist because he wanna treat me at Mapley. So we watched. Man U won again and won 1-0 nicely from Gibson. They played with a lot of fresh players. We'll see a very good future for Man U. They got so many good young player!
I've left my computer on for 24 hours, and surprisingly I woke up this morning, SPAMS IN MY DESKTOP! How on earth could they got your login. Good thing is you can still use your YM because one of you recently chatting with me. But bad thing was Your info's are exposed, your mails, your ID at other website, your credit card info, and etc2.
Important: Those who infected wont know they are! So the only way that they will know is just by telling them and i hope they read it. LOLZ
I just wondering, did i also send spam to you? If i do, please tell me.
Here are the lists of my frens Yahoo! ID that have been exposed to spammer hacker:
So, i just hope that those YM id above can take action with the situation because your ID has been use illegally and all your data/info might been exposed. I don't know how to handle this, but the best way is to format your computer and on firewall and do antivirus checkup and change your Yahoo! ID password. Just my 2 cent.
Update 8.05 a.m.: I've just found what the possible cause of your ID being taken by spammer! Mostly because they installed some third party program in their Yahoo Messenger! The other cause is there might be phishing website that asking for your ID and password! Thus, the only way that i think work is basically just like above but no need to format. Just run antivirus, uninstall all the third party program for yahoo messenger and install the latest version of yahoo! messenger and change your password immediately!
Prevention: those who don't want your ID being taken by this spammer, 1st don't ever give information to website that is other than Yahoo! or just install On the Phishing protection in IE. 2nd don't ever install any third party software eventhough the smileys there was so cute and animated. HEY. who cares the Smiley are cute or wat so ever, there's not a lot of ppl using it!
Proceed to view the spam messages
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WTF! i got a copyright claim from skyscape - viral@skyscape.com. He claim he was 'the owner' of skyscape. U wanna know him? click here and here.. I usually dont open my gmail until today, Anonymous MS told me someone has send regards to our blog. LOLZ. Then i opened my mail and i found this Diri ini terasa sangat la bengang.. I'm just seorang yang biasa saja. Tak mahula jadi macam raja petra asik ada kontroversi dengan blog. Anyway, waiting for Anonymous MS to comment about this..
Kindly remove the content from your websiteimmediately.
Sincerely,
Webmaster,
Skyscape Inc.,
What I've done? I'm just an ordinary blogger, and i didn't do any illegal things. Right now I'll just make the post public and i want google or blogger team to judge themselves by reading the articles first or do some investigation before act.
To Viral - F word for u.. Maybe i should put spam on your email.
And for the continue of the post, Part 3 (the real CRACK version), Anonymous MS will post it at the other blog/web or somewhere else.
Hip resurfacing surgery offers relief for younger patients. SUZANNA PILLAY finds out how.
A COMMON type of hip arthritis characterised by the progressive wearing away of the cartilage of the afflicted joint, osteoarthritis can be very painful when it increases in severity.
It also affects movement, causing stiff hips, limited range of motion and an awkward gait, amongst other complaints.
“The general rule of thumb that doctors follow when dealing with patients with severe hip arthritis is to recommend total hip replacement (THR) surgery. However, they normally tell patients to wait until after they’re 60 years old, to undergo this surgery.
“THR is not done on the more active and younger patients or on athletes because the wear rates are very high,” said Dr K.
Sivanathan, consultant orthopaedic and arthroplasty surgeon, Tropicana Medical Centre in Petaling Jaya.
This is because in reality, many hip pain sufferers under the age of 60 will outlive a traditional hip replacement and may require additional surgeries (revision hip replacement surgeries) in their lifetime.
He said surgeons were concerned about possible complications that might surface in later revision surgeries because every time it is done, a larger surgery and larger implant had to be used.
Apart from revision surgery, other concerns about THR was the lack of femoral head (thighbone) preservation, reduced range of movements and higher risk of dislocation of implants in more active patients.
“If anybody were to do a THR, we would advise them not to squat or sit in a very low chair, because dislocation can occur. The implant head size is only 28mm in diameter so if you move it beyond a certain angle, the whole thing comes out, as opposed to a normal femoral head which has a higher range of movements.” Instead, younger patients were encouraged to live with their condition as best they could, dulling the pain with anti-inflammatory pain medication, joint supplements like Glucosamine and undergoing physical therapy to strengthen the muscles around the hip joint.
But today, the situation is different, thanks to improvements in hip resurfacing surgery implants. Young and active patients don’t have to live with hip pain anymore.
“Hip resurfacing surgery is an advanced surgical procedure for osteoarthritis and hip-related injuries that is suitable for younger or active patients under 60,” said Dr Sivanathan.
“The procedure is a minimally invasive, bone-conserving alternative to conventional total hip replacement because unlike THR, hip resurfacing preserves the head, neck and femur bone. “The femoral head and neck are not removed as in a THR. Instead, the femoral head is reshaped to accept a metal cap placed on the ball of the ball-and-socket hip joint, while the second piece is a cup that forms the socket of the joint. As the hip surfacing implant is made entirely of metal, there is a reduced risk of osteolysis and associated early loosening.” Another plus is that unlike THR, it also made replacement surgery easier. He said if the hip resurfacing implant wears out after 15 years or so, or developed problems, the revision surgery would simply convert it to a standard THR.
However, he said hip resurfacing surgery was not entirely without risk. If the procedure is not done correctly, the femoral neck can break. The person performing it has to be properly trained.
“Also, the hip surfacing implant has to be fitted at the correct angle and care must be taken not to notch the neck when preparing the femoral head to accept the cap.” Dr Sivanathan said patients who undergo hip resurfacing surgery would be given thromboprophylaxis during surgery and shortly after the operation to prevent deep vein thrombosis (DVT).
“It has been noted that in any surgery involving pelvic fractures, abdominal operations, hip procedures and knee replacements, there is a higher incidence of DVT because the patient would be recumbent in bed for a while.” The issue was highlighted last week (May 11-15), during Thrombosis Awareness Week. It was noted that patients going to hospitals for surgery were at risk from venous thromboembolism (VTE) where blood clots form in the leg veins (DVT), which may then break off and block blood vessels in the lungs, causing pulmonary embolism.
“Deaths from VTE can be minimised through thromboprophylaxis, which is the use of preventive medication, especially in those patients identified as bearing high risk of VTE. These include advanced age, obesity, immobility, pregnancy and past experience with DVT or PE,” said Dr Jamal Azmi Mohamad, consultant orthopaedic and trauma surgeon.
Although exact figures are unavailable, a study conducted in Malaysia among 88 patients who had undergone surgery for total knee replacement, total hip replacement and fracture of the proximal femur with no prophylaxis, found that 55 of them (62.5 per cent) showed evidence of DVT. The prevalence was highest after total knee replacement (76.5 per cent), followed by total hip replacement (64.3 per cent) and lastly, the fracture group (50 per cent).
Dr Jamal, who is also the former president of the Malaysian Orthopaedic Association, said there is a strong need to implement primary prophylaxis to prevent thrombosis, as it is potentially life-saving and more effective than treating complications that may result.
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What is missing link? Missing link is the link that have been missing or the species that have missing in the line of an evolution of a man or just a fact for the Darwin's theory to be true. The group of scientists claim that they have discovered “Ida,” a 47-million-year-old fossil that has been proclaimed the “missing link” in connecting human skeletal structure to early mammals. Scientists found it in Messel Pit, Germany. They found out that she is about twenty times older than most fossils related to human evolution. What makes Ida so special? she has certain undeniable human characteristics such as forward facing eyes and even an opposable thumb. What makes me post this article? Is this really a 'missing link' or is this just another plain species of monkeys that have gone extinct? What proof do they have of it being 46 million years old? Maybe we're all just too naive and believe whatever scientists claim because they're suppose to be 'educated' and 'know' things. "The "Darwin validated" headline from all over the news (you can just google it) makes it sound like evolutionary biologists were waiting for this one fossil to prove that evolution is true -- which is not the case."
The words "Darwin validated" makes it sound like they've been waiting a long time for just this fossil to show up so that the Darwinists could laugh and say, "We were a part of the animal kingdom afterall! We're nothing but animals that have evolved over millions and billions of years!" Shouldn't the other aspects be considered? What if that fossil is nothing but a fake, just like all the hoaxs that were suppose to support evolution from the past?
So how does this fossil link fit in the evolutionary chain? A "missing link" should be placed in a sequence, otherwise it's a random piece. Did apes suddenly become smaller and grow tails and suddenly become larger and loose their tails to become humans? It may have human characteristics, but doesn't fit a sequence.
Where are the thousands and thousands of fossils of other morphological changes necessary to change from early prosimian to a human?
Charles Darwin wrote, "If it could be demonstrated that any complex organ existed which could not possibly have been formed by numerous, successive, slight modifications, my theory would absolutely break down." We don't have "numerous, successive, slight modifications".
To my scientific mind Darwin's Theory is still a theory. Until more evidence can be produced, the "fact of evolution" is unfounded and therefore premature. This may well be a very unpopular stand but that doesn't change the reality that evolution is far from being proved.
I still remember the "Java Man" (I'm Javanese anyway), there weren't any fossils that supported Darwin's theory on his time (eventhough there isn't any today either). All the scientists found were a human (or maybe an animal skullcap), a couple of teeth and bones
The "Nebraska man"? All the scientists found was an extinct pig's tooth for goodness sake. The Piltdown man? They found a human skull, chimpanzee's tooth and an orangutan's jaw. They put it together and said, " WE HAVE THE MISSING LINK!" How serious can you get? This fossil, supposedly the 'missing link,' is probably nothing more than an extinct type of monkey.
Founding the fossil was very fascinated but concluding the discovery as the missing link or Darwin Validated is indeed, very prematured. This discovery helps to support evolution, not validate it.
Prof Dr Cheng Har Yip, a surgeon with University Malaya Medical Centre, has received an international award for her outstanding work in breast cancer treatment.
She was awarded the UICC (International Union Against Cancer) 2009 Reach to Recovery International Health Professional Award at a conference held in Brisbane, Australia, last week.
She was the only recipient outside Australia to receive the award from the United States based body.
“As much as I am happy to receive it, I also want women in Malaysia to come for screening and early detection of the disease,” she said when met at the 15the UICC Reach to Recovery International Breast Cancer Support Conference in Brisbane.
Dr Yip, a breast surgeon at UMMC, said 1 in 20 Malaysian women would develop breast cancer in their lifetime and Chinese have the highest incidence followed by Indians and Malays.She also said 1 in 16 women, for both Chinese and Indian, were at risk of getting breast cancer as compared with 1 in 28 Malay women.“The commonest age at which a woman can get the disease is between 40 and 49 years. My greatest concern is Malay women who come in at later stages with larger tumours. Consequently their survival rate is worse than with Chinese and Indian women,” she added.
She said the challenge in Malaysia was to be able to provide a comprehensive service in the diagnosis and treatment of breast cancer.
Dr Yip started the breast clinic in UMMC in 1993 and has written over 70 articles on the subject in medical journals.
She is the chairman of the National Clinical Practice Guidelines for the Management of Breast Cancer in Malaysia and is on the Council of the College of Surgeons of Malaysia.
She is an exco member of the Asian Breast Cancer Society, a member of Breast Surgery International and also sits on the Scientific Advisory Committee of the Breast Health Global Initiatives Foundation.
“My research interest are in the epidemiology, early detection and management of breast cancer in developing countries,” said Dr Yip, who works closely with breast cancer support groups and non-governmental organisations to promote health awareness and early detection of breast cancer.
p/s: I can still remember her teaching. Without her, i would not certainly experience palpating a guarding abdomen caused by peritonitis.. Thanks Prof!
I was thinking of clerking a breast cancer patient today. It's common for a medical student except me (i mean i try to be common today, sigh so delusion of me), before ever clerking a patient, you need to be at least have a basic knowledge of the disease and i've managed to get into the web and searching for the relevant articles and some pictures of breast cancer. In the middle of surfing the net, I was totally shock of what I’ve found. Guys, before u go any futher, I really need to warned you, if you not prepare for anything below or if you’re below 18 years old, don’t ever think of scrolling down and CLOSE THIS WINDOW IMMEDIATELY! You might not having breakfast today or even worse your lunch. I'll not be responsible for what happen to you after you watch the picture below. It started as an email sending around in the web, a medical case of a female anthropologist named Susan McKinley who failed to seek treatment for a rash and wound up with an infestation of larvae in her breast. OMG. Larvae in her breast???
The mail was like this
Fwd: Wash before Wearing! It is horrible. Guys tell your wife, sisters, girlfriends, and girl cousins wash bra before wearing. ALL PLEASE WASH ALL BRAS, UNDERWEAR WHEN YOU BUY BEFORE WEARING THEM. WE DO NOT KNOW WHAT PARASITE IS IN OUR CLOTHES WHEN WE BUY THEM. FORWARD TO EVERYBODY YOU KNOW. LET ME FORE WARN YOU THIS IS SO SQUIMISH, I FEEL LIKE SOMETHING IS CRAWLING ALL OVER ME EVEN AS I SEND THIS TO YOU. BE AWARE. IT IS SO GROTESQUE. PLEASE WASH YOUR UNDERWEAR BEFORE WEARING. PREFERABLY IN BOILING HOT WATER. This is not for the weak; I have never seen anything like this. Read the article first before looking at the picture and film. This looks horrible. Oh my God!!!!!!! Ladies this could happen to you and Guys this could happen to your wife, girlfriend, partner so please BEWARE,and also warn others. It has been reported that this is happening in Zimbabwe as well, please make sure you iron your undergarments before you wear them and make sure that your clothes are ironed when they are dry and not damp. The picture is horrible but I felt that I should share with you. After anthropologist Susan McKinley came back home from an expedition in South America, she noticed a very strange rash on her left breast. Nobody knew what it was and she quickly dismissed it believing that the holes would leave in time. Upon her return she decided to see a doctor after she started developing intense pains. The doctor, not knowing the exact severity of the disease, gave her antibiotics and special creams. As time lapsed the pain did not subside and her left breast became more inflamed and started to bleed. She decided to bandage her sores however as Susan's pain grew more intense she decided to seek help from a more certified doctor. Dr. Lynch could not diagnose the infection and told Susan to seek the aid of one of his colleagues who specialized in dermatology whom was sadly on vacation. She waited for two weeks and finally was able to react the dermatologist. Sadly,a life changing event was about to unfold during her appointment. To Miss McKinley's surprise, after she removed the bandages, they found larva growing and squirming within the pores and sores of her breast. Sometimes these wicked creatures would all together simultaneously move around into different crevices. What she didn't know was that the holes were in fact, deeper than she had originally thought for these larvae were feeding off the fat, tissue, and even milk canals of her bosom.
Picture and Video
Comment The picture and the video above, definitely, u can see without even taking a photofake diploma, u can see the difference between them. The top one might have been photoshop. Of coz is a fake. How come the breast so clean on the outerpart, and there is no sign of any inflammation going on there. Later i found this picha. Ah-ha! They fake by photoshopped a lotus seed pod onto a breast.
The video although, was not a fake, but seems to me, the video was not referring to Susan McKinley (I mean white people is not a black people isn’t it?). Hey man, at first I was just trying to look for complication of Breast Cancer. This larvae in the breast is a true medical condition where the terms “Myiasis of the breast”. There even one case in UMMC I couldn’t remember when, but it was a complication of breast cancer usually at the end stage (stage 4th) cancer. I never thought that this thing might occur but one of my friends said that larvae infestations of the breast, though extremely rare, can actually occur without having any of those co-morbidities! Then there is one note saying to all women to wash their bra after buying it. I was thinking, whether the video who I think it might comes from an African woman wearing bra or not.. LOLZ..
For me, I would like to suggest to all ladies or even some men, don't wait until your breast become like this then it's too late for treatment. Practice self breast examination, so that you will learn your breast better. It's a simple screening, yet it saving life's.
It’s 6.30 a.m now. Better get ready for breakfast and go to the wards. See ya later…
What is H1N1 (swine flu)? H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. Other countries, including Mexico and Canada, have reported people sick with this new virus. This virus is spreading from person-to-person, probably in much the same way that regular seasonal influenza viruses spread.
Why is this new H1N1 virus sometimes called “swine flu”? This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and avian genes and human genes. Scientists call this a "quadruple reassortant" virus.
Are there human infections with this H1N1 virus in the U.S.? Yes. Cases of human infection with this H1N1 influenza virus were first confirmed in the U.S. in Southern California and near Guadalupe County, Texas. The outbreak intensified rapidly from that time and more and more states have been reporting cases of illness from this virus. An updated case count of confirmed novel H1N1 flu infections in the United States is kept at http://www.cdc.gov/h1n1flu/investigation.htm. CDC and local and state health agencies are working together to investigate this situation.
Is this new H1N1 virus contagious? CDC has determined that this new H1N1 virus is contagious and is spreading from human to human. However, at this time, it is not known how easily the virus spreads between people.
What are the signs and symptoms of this virus in people? The symptoms of this new H1N1 flu virus in people are similar to the symptoms of seasonal flu and include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Also, like seasonal flu, severe illnesses and death has occurred as a result of illness associated with this virus.
How severe is illness associated with this new H1N1 virus? It’s not known at this time how severe this virus will be in the general population. CDC is studying the medical histories of people who have been infected with this virus to determine whether some people may be at greater risk from infection, serious illness or hospitalization from the virus. In seasonal flu, there are certain people that are at higher risk of serious flu-related complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with chronic medical conditions. It’s unknown at this time whether certain groups of people are at greater risk of serious flu-related complications from infection with this new virus. CDC also is conducting laboratory studies to see if certain people might have natural immunity to this virus, depending on their age.
How does this new H1N1 virus spread? Spread of this H1N1 virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
How long can an infected person spread this virus to others? At the current time, CDC believes that this virus has the same properties in terms of spread as seasonal flu viruses. With seasonal flu, studies have shown that people may be contagious from one day before they develop symptoms to up to 7 days after they get sick. Children, especially younger children, might potentially be contagious for longer periods. CDC is studying the virus and its capabilities to try to learn more and will provide more information as it becomes available.
Can I get infected with this new H1N1 virus from eating or preparing pork? No. H1N1 viruses are not spread by food. You cannot get this new HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.
Is there a risk from drinking water? Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of the novel H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as novel H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.
Can the new H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues? Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of the H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as novel H1N1 virus would also be similarly disinfected by chlorine.
Can H1N1 influenza virus be spread at recreational water venues outside of the water? Yes, recreational water venues are no different than any other group setting. The spread of this novel H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.
What can I do to protect myself from getting sick? There is no vaccine available right now to protect against this new H1N1 virus. There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.
Take these everyday steps to protect your health:
*Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. *Wash your hands often with soap and water, especially after you cough or sneeze. *Alcohol-based hand cleaners are also effective. *Avoid touching your eyes, nose or mouth. Germs spread this way. *Try to avoid close contact with sick people. *Stay home if you are sick for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. This is to keep from infecting others and spreading the virus further.
Other important actions that you can take are: Follow public health advice regarding school closures, avoiding crowds and other social distancing measures. Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs, tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious. What is the best way to keep from spreading the virus through coughing or sneezing? If you are sick, limit your contact with other people as much as possible. If you are sick, stay home for 7 days after your symptoms begin or until you have been symptom-free for 24 hours, whichever is longer. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.
What is the best technique for washing my hands to avoid getting the flu? Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.
What should I do if I get sick? If you live in areas where people have been identified with new H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people, except to seek medical care.
If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed
If you become ill and experience any of the following warning signs, seek emergency medical care.
In adults, emergency warning signs that need urgent medical attention include: * Difficulty breathing or shortness of breath * Pain or pressure in the chest or abdomen * Sudden dizziness * Confusion * Severe or persistent vomiting * Flu-like symptoms improve but then return with fever and worse cough
Are there medicines to treat infection with this new virus? Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with the new H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current outbreak, the priority use for influenza antiviral drugs during is to treat severe influenza illness.
What is CDC’s recommendation regarding "swine flu parties"? "Swine flu parties" are gatherings during which people have close contact with a person who has novel H1N1 flu in order to become infected with the virus. The intent of these parties is to become infected with what for many people has been a mild disease, in the hope of having natural immunity to the novel H1N1 flu virus that might circulate later and cause more severe disease.
CDC does not recommend "swine flu parties" as a way to protect against novel H1N1 flu in the future. While the disease seen in the current novel H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.
CDC recommends that people with novel H1N1 flu avoid contact with others as much as possible. They should stay home from work or school for 7 days after the onset of illness or until at least 24 hours after symptoms have resolved, whichever is longer.
How long can influenza virus remain viable on objects (such as books and doorknobs)? Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for up to 2-8 hours after being deposited on the surface.
What kills influenza virus? Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.
What surfaces are most likely to be sources of contamination? Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.
How should waste disposal be handled to prevent the spread of influenza virus? To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.
What household cleaning should be done to prevent the spread of influenza virus? To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.
How should linens, eating utensils and dishes of persons infected with influenza virus be handled? Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first. Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid “hugging” laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.
Eating utensils should be washed either in a dishwasher or by hand with water and soap.
