Wednesday, December 31, 2008

antara suka dan duka

anis dan pesaingnya,kai yee

Disebalik kegembiraan keputusan peperiksaan PMR,ada perkara sedih yang disampaikan Anis.Seperti sedia maklum,Anis dan rakan-rakannya hanya bersekolah di kawasan hulu perak yang rata-rata penduduk bekerja sebagai penoreh getah dan nelayan ikan air tawar.Apa yang menyedihkan terdapat sebilangan rakan-rakan Anis yang terkandas dalam peperiksaan tersebut.Kebanyakannya adalah kertas yang melibatkan bahasa inggeris seperti matematik,english dan juga sains.Bagi remaja di kawasan luar bandar,mereka hanya mengharapkan ihsan daripada guru-guru yang sukarela membuat kelas tambahan untuk mengajar mereka selain kelas harian.Jika ada guru yang membuat,pelbagai bekalan dikirimkan oleh ibubapa pelajar tersebut,walaupun hanyala ikan segar atau sedikit kuih.Ibu bapa sangat menghargai jasa yang diberikan oleh guru,dan mereka sangat menghargai guru seperti itu.Mereka sanggup buat apa sahaja untuk membantu guru tersebut kerana mereka sememangnya tidak mampu membayar yuran kelas tambahan yang sangat mahal.Pernah seorang bapa pergi menjala ikan hanya kerana guru tersebut ingin menjamu keluarganya.

Kesiannya,hanya kerana lemah dalam penguasaan bahasa,mereka tidak dapat menyambung pengajian dan sebagainya.=(

Pada zaman ibu bapa kita,walaupun medium pembelajaran dalam bahasa inggeris,mereka masih mampu menyambung pelajaran kerana kurang pesaingan.Kata mak,dulu kalau ada orang dapat masuk universiti,kecoh satu kampung.Tapi kalau sekarang orang tengok biasa je.Persaingan di zaman dahulu dan sekarang sangat berbeza.

Kesiannya!!!!!!!!!!!!!!!!!!!!!
p/s;kita ni peluang dah ada,gunaje tak nak=(

Tuesday, December 30, 2008

bila gambar bercerita=p

somewhere in tumpat,so cheap,rm75/night
plus,broadband coverage sangat mantap at this area.
the beach totally superb
"cantik sungguh ciptaan Allah,SubhanaAllah"
p/s:thanks for coming bro!=p

Monday, December 29, 2008

Post Enteritis Syndrome

Post Enteritis Syndrome
the diarrhea persistent or become severe after post hydration period.why?
during the AGE,the lamina propia and the mucosal layers damage.The mucosal layer that recovered from AGE remains sensitive to antigenic food proteins such as cow's milk protein.The continued feeding of these proteins during vulnerable period results in further mucosal damage,depletion of mucosal dissaccharidases and secondary lactose intolerance.This result in persistent diarrhea.
=p
when patient is having diarrhea,the important thing is to restore the fluid loss.
the complication of diarrhea might cause renal failure in severe dehydratNumbered Listion and also hypovolumic shock.We know already the complications of shock right=p
management of diarrhea
  1. fluid replacement therapy
  2. antibiotic therapy-only in blood diarrhea,septicaemia and immunocompromised patient.
  3. antidiarrheal therapy not indicated because we want to remove the bacteria from the lumen excreted into the stool.

diarrhea-cirit birit

constipation-sembelit

Saturday, December 27, 2008

pelvic fracture,urethral injury and testicular torsion

Gosh!it makes me 2 days to understand,plus my movie time..itula dulu time dr ajar tak nak focus.hahaha=p
ok,lets say someone is having pelvic fracture.Now,refer to atlas,kita tgk organ yang ada dalam pelvic cavity(since surrounded by pelvic bone).Not to to forget the perineum.Sites of fracture akan bagi kesan dekat adjacent organ=P.
katakan fracture dekat inferior pubic ramus.
adjacent structures are membranous and spongy urethra,external spinchter muscle,nerves and blood supply.if the fracture cause urethral injury,sodekat meatus akan kuar fresh blood(kalau injury atas neck of bladder,blood akan mix dengan urine=hematuria).If he's having complete urethral injury,urine yang flow akan akan masuk dekat perineal pouches.
urethral injury
  1. membranous urethra-urine akan flow ke deep perineal pouch,and dpt abdominal pain only.
  2. spongy urethra-urine enter superficial perineal pouch and fill the scrotum and the ant of ant abdominal wall.sebab tu dappat abdominal pain and also swollen and tender scrotum(inflammation occur)

bila extravastion of urine in the scrotum,akan lead kepada testicular torsion.bahaya!sebab kalau ischemia,alamat mandul la lelaki itu=Pso kena repair.and also the contralateral testis pun kena check sebab selalu torsion berlaku bilaterally=p.

hehehe..please refer to atlas and keith moore for better understanding=p.

p/s:what will happen if the fracture cause the nerve injury?hahahahaha

Apa Yang Mesti Anda Buat Selepas Dapat Biasiswa

diolah dari www.pakdi.my
Anda baru cek akaun bank anda menerusi mesin ATM.
Yes. Biasiswa sudah masuk!
Dan seperti biasa anda sudah berkira-kira untuk membayar …
Bil internet
Bil telefon
Hutang orang a
Dan seterusnya

Kemudian anda pun membelanjakan baki scholar yang ada untuk keperluan yang lain dan urusan hidup anda sehinggalah masuk scholar seterusnya pada semester hadapan.
Kalau ada lebih, baru anda fikir untuk simpan.
Kan Kan Kan Kan ?
Tetapi amalan biasa anda sebegini adalah
Salah!

Dan anda perlu mengubah amalan ini untuk kebaikan masa depan kewangan anda.
Mahu kah anda mengetahui 2 perkara mudah yang mesti anda buat selepas dapat scholar anda ?
Ya.
Dengan melakukan 2 perkara mudah ini terlebih dahulu, keadaan kewangan anda akan berubah untuk selama-lamanya.

# 1 : Pay Yourself First
Anda mesti memperuntukkan paling kurang 30% dari keseluruhan scholar anda untuk disimpan.
Sekiranya scholar anda RM 3000 maka anda perlu menyimpan kira-kira RM 900 ke salah satu dari 4 pilihan yang berikut:
ASB
Tabung Haji
Akaun Simpanan Tetap (Fixed Deposit)
Akaun Simpanan Biasa (Savings / Current)
Sila buat potongan tetap setiap bulan secara automatik dan simpan buku akaun atau kad ATM di tempat yang sukar untuk diambil.
Maka dengan cara ini anda boleh terus menyiapkan diri anda dengan jumlah simpanan yang tetap

# 2 : Zakat & Derma
Anda perlu memperuntukkan 10% daripada scholar anda untuk tujuan zakat dan derma.
Sekiranya scholar anda RM 3000, maka RM 300 digunakan untuk tujuan ini.
Cara yang paling kool adalah dengan menderma di tabung-tabung masjid pada hari Jumaat.
Cara yang lebih kool pergi cari rumah-rumah kebajikan atau badan-badan kebajikan tertentu yang memerlukan sumbangan duit orang ramai.

Cara yang agak lari dari kebiasaan tetapi masih boleh dilakukan adalah dengan membelanja kaum keluarga dan rakan-rakan anda untuk acara makan-makan.
Ibu bapa anda mesti suka kalau tiba-tiba anak mereka (anda lah tu) mengumpulkan sesama adik beradik untuk acara makan-makan sesama keluarga.
(Ini tidak, apabila buat kenduri kahwin ada yang mengharapkan sampul becek dari tetamu. Uhuk uhuk!)

Sekarang anda mempunyai baki 60% dari gaji anda untuk dibelanjakan sesuka hati.
Balance dalam akaun adalah RM1800.Jika satu sem=5bulan;rm360/month.

RM360 akan digunakan untuk

makanan sebulan(kelantan lagi jimat where makan sehari might below RM10)

duit tiket balik rumah(1 roundtrip;RM60)

phone bill(
barang keperluan(RM100)

hiburan untuk diri sendiri(RM 100)

Apa lagi.

-->kalau ikutkan,memang tak cukup;tapi kita boleh cut sikit expense so takdela sesak di hujung sem.Dan yang penting kita ada saving untuk masa depan dan buat amal jariah.=P
"kita jangan jadi hamba dunia,hamba wang"
ismail kamaruzaman

Friday, December 26, 2008

convulsion,seizure and fit

yup,i found the differences.thanks to mama ro=p

convulsion/fit:seizure(layman term)
seizure;medical term,

but they refer to the same meaning-->abnormal neuronal discharge activities in the brain

then,what is the different epilepsy and status epilepticus?

epilepsy:recurrent seizure attack due tue unprovoked causes(brain tumor cause seizure;bukan epilepsy sebab kita tahu sebabnya)

status epilepticus:(emergency)
-->seizure attack that last more than 5 minutes,or
-->between the 2 attacks of seizure,recovery tak berlaku(normally during postictal,patient akan recover,tapi bila tak recover and followed by next attack itu dah emergency)

febrile convulsion
berlaku sebab the immature brain takboleh tahan high fever due to electrolyte disturbance.
-->we need to evercome this sebab kita nak prevent seizure dekat adult life(complex partial seizure)

ingat tak our super duper dr sani cakap,bila dapat febrile seizure,if prolonged,kita takut akan berlaku brain anoxia.if this happen,that area between the hippocampus an medial temporal lobe akan sclerosis.Sclerosis dekat area ni la akan menyebabkan seizure time dewasa=(

so untuk prevent that prolonged febrile seizure,sponge the patient and bagi rectal diazepam(antiepileptic drug)

GOSh!i read about seizure,but i still couldn't appreciate it=(need more hard work,yeah!
i still takboleh beza/paham tentang absence and grand mal seizure.BRAIN is so complicated!

p/s:hope this will help you people=p

Monday, December 22, 2008

kejayaan itu pasti=p


mereka mencipta nama di persada Antarabangsa


alhamdulillah.My next targets on them:
  • chong wei dapat kalahkan lin dan
  • azizul hasni dapat kekalkan prestasi no 1 keirin dunia
=p

Saturday, December 20, 2008

LP

OLD LINKIN PARK LOGO
LP here is not for linkin park but LUMBAR PUNCTURE
this video totally awesome!panjang gila jarum,no wonder la sakit,even dh letak LA,plus mind dah set akan sakit so bertambah-tambah sakit la.pity them=(

This is an instructional video describing how to perform a lumbar puncture. This was created for the Internal Medicine residents at Brown University

bunkface

bunkface at xfm

bravo!bravo!

alhamdulillah

alhamdulillah,syukur kepada Allah,my 2 friends dah dapat kejayaan masing-masing.
well,i still remember your suka dan duka,setiap orang diuji dengan cara yang tertentu,but my 2 friends jadikan ujian ni sebagai cabaran.And yang pasti mereka bersabar=p

my dear friends
  • syira-tahniah sayang.cabaran di alam pekerjaan menanti.nothing more i hope except our friendship.
  • ashvini-awak memang contoh untuk saya tak give up.if i were you,belum tentu saya boleh bangkit macam awak.You are such a great girl,my dear.Teruskan berusaha,because saya tahu,awak akan dapat yang lebih baik.

p/s:kecewa dengan prestasi diri sendiri,tapi sangat berbangga melihat kejayaan mereka. Alhamdulillah.


azizul hasni awang

he won the main keirin final in the second-leg of the UCI Track World Cup in Melbourne and become the first-ever Malay­sian gold medallist at the World Cup stage.

Sunday, December 14, 2008

program berkhatan anak soleh

golongan yang malas belajar untuk cfcs(except kak muna)

selepas dimandikan oleh pancutan bomba=p

besides tok mudim dan penolong,akan ada motherly people[absolutely not me] untuk distract their attention(ouch!)


tok mudim alep yunus and assistant muna chan=p

nampak ke?=p
ena:akak,sy tahu hikmah bersunat tapi kenapa Allah tak ciptakan p***s tu di exposekan glan terus,takyah nak bersunat?
kak lini:sebab Allah nak tengok siapa yang taat kepada perintahNya=p
p/s:sakit bersunat lagi kejap dari sakit beranak,aish!!


Friday, December 5, 2008

good old days~



dear my maresmawians!!

ok,i met cikgu aminah just now,and currently,she is in pengkalan hulu,somewhere near baling=p
ok,langkawi was totally superb.my 5 years life overthere memang best.i bet semua orang pun.

bwp team yg bengong
apa yang paling diingat?
form1:
seronok dengan abang angkat kelas yang best->abg test.

form 2:
berlakon untuk pertandingan drama kelas,syikin jadi mak tiri=p
blok TM kena denda dengan cikgu hasniza tawaf blok akademik sambil pegang harta karun

form3:
syikin,me,paan,ruby,teah meniru time exam sains and beberapa paper lagi
syikin lancarkan war fight dengan kakak LDP

form4:
cikgu adha bagi kami bukak buku time exam agama,my life sgt hectic dgn bwp yang bengong
time ni juga tercipta sejarah aku mula detach dari pluto
we totally kasi gegar satu pantai.sokmo ODC buat bbq dekat situ.cikgu hashim ckp pengalaman penting,tapi bagi aku duit ngan pengalaman sama penting=p


arabian dekat pulau tuba

form5:
before prep malam start,before baca doa belajar,kami baca doa makan dulu=p
me,syira and my roomates sangat kedekut dgn makanan masing-masing.
TL17 selalu habiskan makanan bilik aina farehah ngan jiha.tart nenas yang sedap
Arabi 5 memberi motivasi selepas trial SPM dekat pulau tuba(syikin anak pesawah padi;yela pesawah atas laut)
503 memang kaki tidur laki+ perempuan sama naik,tak sia-sia pak ucop suruh beli tikar
and girls in my class memang melancarkan war dengan sorang mamat ni yg kononnya antisosial ;nak cakap dengan kami pun tak,tapi ya Rabbi ngan awek lelebih gila!azira paling bengang time ni.=p
ODC menang syarikat terbaik malaysia.bangga tu;kami dinner dengan sapa entah,itu tak penting tapi yang penting makan kat city bayview=p

nak makan kat wanthai lagi!!XYC dinner best sebab kami habiskan makanan sementara shift solat=(


Wednesday, December 3, 2008

takat lebur @ takat didih

" i want to be your crying shoulder"


hello!!!sekeras-keras hati perempuan ,even kalau taiko atau ketua yakuza cakap pun boleh melting hati tu.Terus drop sampai takat lebur or maybe memang dah fully cair hati tu=p.I think lelaki memang pandai berromeo la.No wonder la ada term playboy or buaya darat.

ok,dear,cut the crap!
semalam ada talk about cinta tiruan.Tengoklah dekat TV1,dewan utama USM kubang kerian masuk tv=p.and,we met dr sharifah hayati.Ya Allah,dia sangat cantik and senyum sangatlah manis!conclusion about the one hour talk;
cita-cita>cinta

aurat=p


dan katakanlah kepada perempuan yang beriman,"Hendaklah mereka merendahkan pandangan dan menjaga kehormatannya,dan janganlah mereka memperlihatkan perhiasannya kecuali apa yang biasa dinampak daripadanya dan hendaklah mereka tutupkan tudung ke dadanya janganlah mereka menampakkan perhiasan..."


an-nur:31


sebagai umat ISlam yang menjadi hamba kepada Allah s.w.t,sebagai seorang perempuan sememangnya kita diwajibkan menutup aurat ketika berhadapan dengan bukan muhrim.Tiada siapa yang boleh meningkah perintah tersebut.Dan sesungguhnya,sudah menjadi tanggungjawab kita untuk memberikan peringatan terhadap diri sendiri dan juga masyarakat sekeliling mengenai perintah tersebut.Manusia mudah lupa dan kita juga sering terlupa.

seorang pentazkirah berkata,"sebagai perempuan diwajibkan kita menutup aurat kecuali tangan dan rambut".Ya,mungkin dia tersasul atau mungkin dia menyindir.Hanya Allah yang tahu.

In my opinion,untuk bercakap tentang aurat wanita,untuk menasihati seorang wanita menutup aurat,biarah orang itu dikalangan kaum wanita itu sendiri.Bukankah mereka lebih memahami keindahan bertudung itu.Masayrakat lebih mudah percaya atau mendengar dri orang yang lebih berpengalaman.Rasanya,kaum Adam perlu memberi penekanan mengenai aurat dikalangan lelaki sendiri. Masih ramai kaum Adam disekeliling kalian yang memakai short ketika bermain bola.Adakah ketika kalian menonton world cup,piala FA etc,kalian melihat bola,tanpa terlihat kaki yang menendang bola?

p/s:Maaf andai terkasar.Rasa mual melihat orang perasan bagus,walaupun baru ada ilmu yang sedikit.peringatan untuk diri sendiri juga=p

Monday, December 1, 2008

MSFT&Leadership

a one day camping at Home Beach Resort,PCB

Talk about leadership given by Prof Zabidi Azhar Hussin,

ringkas,padat dan bermakna

ciri-ciri pemimpin yang bagus:
  1. sentiasa ada pembaharuan untuk organisasi tersebut-yang baik ditingkatkan,yang buruk diatasi
  2. berjiwa rakyat(keperluan rakyat adalah utama,kemudian baru keperluan diri) -sekarang banyak pemimpin fikir poket sendiri ja =(
  3. sentiasa merendah diri tetapi tegas
  4. cara berjalan tidak terlalu perlahan atau cepat
  5. pemakaian sesuai mengikut keadaan-Bekas PM Singapura pernah melahirkan kerisauan ekoran beberapa pemimpin politik ISLAM Malaysia yang semakin flexible dalam pemakaian.Berkot di Parlimen contohnya.Mengambarkan Islam bukanlah agama yang rigid.(Berpakaian jubah kadang-kadang melahirkan perasaan takut di kalangan non muslim)
  6. kekuatan mental yang tinggi -walaupun dirundung masalah,muka sentiasa tenang,tidak tergambar masalah
seorang pemimpin sering mempunyai tekanan.baik dari keluarga,management ataupun masyarakat.sehingga sampai satu ketika,pasti akan terasa kelemahan diri,terasa mahu meletakkan jawatan.Itu sebenarnya adalah cabaran.kita baru memimpin sebuah organisasi,tetapi Nabi Muhammad memimpin ummah.Lagi besar tanggungjawabnya.

"pohonlah kekuatan melalui solat tahajud.rintihlah,nangislah,kerana Allah Maha Mendengar"

sumber kekuatan umat ISLAM adalah Tahajjud.Semoga sentiasa dipermudahkan segala urusan

1 Dec-World AIDS DAY

"DAD, can you please not let the principal know that I'm positive?" the 11-year-old boy asked B days before he was to step into the new school.

Even before that question came, B had long decided not to disclose his son's HIV status to anyone in school this time, learning from past experience.

It was not an easy decision to make under any circumstances because it meant having to live with the guilt and constant fear that accidents might happen in school, giving rise to the possibility of a transmission.
"I feel that my son has a right to decide whether or not to tell other people his status. We have kept it a secret until now, but the guilt is still there," says B, who adopted Danial (not his real name) when he was just 2.

At that time, B was a volunteer with an organisation working to find suitable foster families for HIV-positive babies whose parents had died of AIDS.

He interviewed potential families to decide whether they had the right personality, attitude and behaviour in handling children with HIV.There was little knowledge and understanding of AIDS then, even though people knew what HIV was, said B.
A married couple was supposed to take Danial in, but over the months, in the process of thinking and rethinking about their decision, the wife changed her mind."When the wife suddenly said, 'I don't think I want to take this kid,' we withdrew the couple's application."The kid was left hanging in hospital for two years. There was a need to place him with a family. No home would take him in and he couldn't be staying in the hospital forever."By then, I had grown attached to him and we decided to adopt the child," says B, who is still actively involved in HIV-related work.

That was 12 years ago. Danial, now 14 and studying in a secondary school, is "totally healthy, active and happy", said his dad."He looks normal. No one can tell that he is positive without us informing them."Danial's secret is still intact today."

Every time my son enrols into a school, there is a health form that I need to fill in. "I always feel guilty as a parent (to not disclose his status), and the fact that he has to go to the hospital all the time makes it hard to keep things under wraps."I was torn inside, not knowing what to tell the school."In the end, B informed the secondary school teacher that his son has a blood disorder that requires treatment in the hospital every three months.All the sleepless nights , the white lies and constant worries that plagued him were worth B's sacrifice if it meant his son did not have to relive the experiences he had in his primary school."It was all done to protect him from further discrimination."

When Danial was in kindergarten, B did not let the school operators know of his condition because he knew the kindergarten would not accept his son for who he was.But when Danial turned 7 and was ready for primary school, B could not live with the guilt and so he informed the principal."I think that was a mistake."

When my son was in Year Two, he cut himself while playing. That was the time when the whole school panicked. Everyone was afraid to touch him."The school had to call B in to tend to Danial himself. It shocked B that the teachers reacted that way, because it showed that they did not know how HIV transmission was possible.

The health department was later called in to explain to the teachers about HIV.That was a one-off dramatic incident, but throughout his four years in school, Danial received "special treatment" -- he was not allowed to play games or play an active role in sports.It wasn't good for the teachers to be so protective of him, said B, because they did not give him a chance to participate."He did ask himself why he was not allowed to join the sports. He also mentioned that whenever he played with other kids, they asked him not to play rough with them."Somehow, other parents got to know of my child's case. But the good thing is no one that I know of asked to have my child removed from the school."Academic-wise, the treatment Danial received was not too far off from what he experienced during sports lessons."The teachers didn't pay much attention to him. "They treated him like a kid who didn't want to study, letting him just play in the corner."

Such an attitude would have a psychological effect on any child, said B, who encouraged Danial to share his stories with others.Right from the start, B had no intention of hiding Danial's condition from himself or that he was adopted.Even when he was in nursery, B started talking to Danial about HIV by telling him stories from books on HIV- positive children.
"We always try to empower the child from the beginning, to arm him against stigma and discrimination."I encourage my son to share with his friends, those he feels that he can trust, but so far he hasn't told anyone of his status."And now that he is at an age where he could become interested in girls, we talk about sex and condoms. Education is necessary.

"We also talk about death and dying. I've taken him to see how people die of AIDS, from the time when they are hospitalised till the time they are buried. "He has some ideas, but he is afraid to die. I wish that one day, my son would be fully empowered by his HIV status and would be a spokesman for others."

it is all about kayak

during my last 5 days break
kayak in front of my house
=p



abah yang sporting

abah main tipu!



sesi sebelum terjun mandi=p

Myasthenia Gravis


A 35 year old woman presents to the clinic with a chief complaint of double vision. She reports intermittent and progressive worsening double vision for approximately 2months, rarely at first, but now every day. She works as a computer programmer and the symptoms increase the longer she stares at the computer screen. She had also noted a drooping of her eyelids, which seems to worsen with prolonged working at the screen. Both symptoms subside with rest. She is generally fatigued but has noted no other weakness or neurological symptoms. Her medical history is unremarkable. Physical examination is notable only for the neurological findings. Cranial nerve examination discloses impaired lateral movement of the right eye and bilateral ptosis, which worsen with repetitive eye movements. Motor, sensory and reflex examinations are otherwise unremarkable.

what is the likely diagnosis?

Myasthenia Gravis

what is the pathogenesis of this disease

An autoimmune disease where the body produce atibody towards the post synaptic Ach receptors.Also,the antibodies also attack the acethylcholine(Ach) at the synatic cleft.The net effects are decrease number of ffuncctional Ach receptor and functional Ach

explain the pathophysiology of each signs and symptoms.

patient comes to the hospital with the complaints of fatigue, ptosis and also double vision.Destruction of the receptors cause diminished transmission of the nerve impulse across the neuromuscular junction. Muscle depolarization is not achieved, therefore, muscle weakness develop.The signs and symptoms of MG depends on which muscle involve:

  • extra ocular muslces :double vision
  • levator palpebral superioris:ptosis
  • upper esophagus :dysphagia
  • palatalmuscle :dysathria
  • diaphragm :respiratoryfailure

Usually,fatigue develop due to repetitive stimulation or prolonge use.This occur due to decrease number of available neurotrasmitter and the numbers of functional Ach receptor.

what are the investigations and the significant of it?
  • TensillonTest
admistration of cholinesterase inhibitor will cause improvement of muscle power.This will increase the number of Ach in the synaptic cleft.
  • antibody towards the Ach receptor
  • chest Xray
autoimmune disease may associate with thymoma or thymic hyperplasia.

what treatments should be considered

  • cholinesteraseinhibitor
  • plasmapheresis,corticosteroid
  • thymectomy
[happy study]
=p
 
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