Wednesday, August 30, 2006

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Exciting marriage

Two days ago, Siti Nurhaliza married with Dato K and held the bersanding at KLCC. The ceremony was held live by TV 3. When i am doing round the next morning, All patient who is not comatose or confused talking about the marriage . It seems that our pop star is the head news for everything. Very little people get to know about their disease or their parents.Even a lot of patient don't know about the medication they are taking. They seems to be more care about their idol.
That's why if the artist do something wrong everyone will follow their foot step.
Anticipation for the action happens in this few year. A lot of Malaysian will try to tackle other people husband following Siti's foot step "kononnya demi cinta bukan demi harta".

Saturday, August 26, 2006

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Coma patient ! Endocrine or nephro Patient?

Yesterday is the last day of working day ,Friday. I as a nephrology MO incharge of periphery (means i will take pager and see the patient in whole Hospital and referral from district hospital) expected a cool and relax day as most of the expected problem already been settled down. Out of my expectation, i received a pager at 11.00 am. from endocrine ward. They referred one case for me for metabolic acidosis and renal impairment. As I go there, the consultant nephrologist LSL told me that this patient was wrongly admitted in their ward.
This patient is from Selama ,Perak. A diabetic and hypertensive patient actually got chronic renal failure(baseline crea unknown) defaulted penang GH follow up and presented to Selama Hospital for loss of consciousness.Glucose strip revealed patient is hypoglycaemia(1.3mmol/dl). 50 cc detrose 50% given to patient. Patient not regain consciousness despite sugar improved.Patient is intubated but unable to find ventilator in Ipoh so sent to us for ventilator support. At here,CXR appeared congested lung ,ABG shows metabolic acidosis (pH7.121 HCO3 13),Blood urea 31.Creatinine awaiting.paedal oedema and basal crepitation on examination. Neurological examination no significant focal deficit and pupil is equal on both side.
When I reviewed the patient there ,patient is on Dextrose 10% and ventilated with sedation.Vital side is stable and patient is afebrile.
Glucose is still at lowish side(3.2).Ct brain is pending.
I am not quite satisfy with the thing is that how can you say it is coma secondary to uraemic encephalopathy(renal causes) and ask us to take over the case when the CT is not yet back and glucose is not fully corrected. Is it the commonest causes for coma in Malaysia is uraemic encephalopathy?
Due to the divided medical ward according to speciality, this type of incidence always happened in Penang GH. Every patient who got chronic renal failure,end stage renal failure will normally admitted to our ward or asked to be transferred to our ward regardless they are sick due to UTI, pneumonia ,cellulitis or other causes. This only won't happened when there is a very clear cut causes for admission like massive haemoptysis ,severe per rectum bleeding .
Notes:Causes of coma see here

Thursday, August 24, 2006

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stem cell therapy-heart

What is the stem cell therapy in heart. I came across the stem cell therapy today at internet. Actually this procedure been trial in IJN (institut Jantung Negara).
It mainly can be used in patient who failed angioplasty or not suitable for CABG,end stage cardiac failure.
It uses patient's own blood so that's no graft vs host rejection existed. Patient need to donate his blood then the stem cell(angiogenic cell precursors)(ACPS) is harvested from own blood.Because there are far too few stem cells in anyone's blood to be effective, so a proprietary technology to generate millions of ACPs from the patient's blood sample. This takes about a week. This generated stem cell (ACPS) is injected into patient's coronary through angiogram.After that,these cell will start to build vessels and heart muscle. With a month or two ,the effects will be seen.

Wednesday, August 23, 2006

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Is it real

people nowadays talking about earn more with less work. What does that meant ?It meant use your hard earn money with minimum energy to earn more. I am not talking about extra income through part time job like locum or direct saling. I am talking about stock exchange,mutual fund or swiss cash. What is swiss cash ? What is the pro and cons. You can search from internet to learn more. Claiming about 300% return in 450 days. My advice is invest minimum and wait and see. This is the key to investment and everything .Interestes click here

Tuesday, August 22, 2006

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add in new site

I just add in some new site for medical purposes.Medscape ,free registration for everyone . Mrcppaces free blog with lots of pictures.

Doctor,patient and closest relative of patient

You may wonder what I try to write about that. As times go by, i see more and more patient and more and more of patient 's children, I find one important facts that treating patient is not a solution for patient 's disease. It means to treat patient effectively 50% -80% need a patient caregiver /children/wife good support. For example , if a patient got diabetis ,restricting patient to eat sugar or sweet food need family 's understanding of disease and support because Malaysian people like sweet food regardless they are diabetic or not . Milo is the best drink for them. They need to be monitored by their relative/children to be restraint from sweet food. People says 'spare the rod ,spoil the kid' .I will rather says if we got rod or patient 's children use the rod, patient will be keep healthy and with better quality of life longer.

Friday, August 11, 2006

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Great addition to my blog

I recently add in some new link to my blog.
First is the feng yuen comic free viewing site where a group of people using countless effort to scan every feng yuen(HK comic) to this web site from episode 1 till the latest.
Cytusm my best friend + colleague blog which features interesting photo and comment.
A google +firefox toolbar for installation a bar towards the fastest browsing (firefox)with good search machine ever in web. My best tool to use for my blog and browsing . For me, it is better than internet explorer and stupid msn search.
Happy browsing the new features

Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy

this is a recent trial (meta analysis) i think would alter our management
OBJECTIVES: The purpose of this study was to conduct a meta-analysis that compares the reduction of cardiovascular outcomes with high-dose statin therapy versus standard dosing.
METHODS: We searched PubMed and article references for randomized controlled trials of intensive versus standard-dose statin therapy enrolling more than 1,000 patients with either stable coronary heart disease or acute coronary syndromes.
4 trial was selected
TNT (Treating to New Targets) and the IDEAL (Incremental Decrease in End Points Through Aggressive Lipid-Lowering) trials involved patients with stable cardiovascular disease
PROVE IT-TIMI-22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction-22) and A-to-Z (Aggrastat-to-Zocor) trials involved patients with acute coronary syndromes.
meta-analysis of the relative odds on the basis of a fixed-effects model using the Mantel-Haenszel method for the major outcomes of death and cardiovascular events.
RESULTS : combined analysis yielded a significant 16% odds reduction in coronary death or myocardial infarction (p < 0.00001), as well as a significant 16% odds reduction of coronary death or any cardiovascular event (p < 0.00001).
No difference was observed in total or non-cardiovascular mortality, but a trend toward decreased cardiovascular mortality (odds reduction 12%, p = 0.054) was observed.
CONCLUSIONS: Intensive lipid lowering with high-dose statin therapy provides a significant benefit over standard-dose therapy for preventing predominantly non-fatal cardiovascular events.

Thursday, August 10, 2006

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Pity dialysis patient

Yesterday i was on call in nephro and chest ward . At 4.00 am ,my pager beep and a message came from casualty. I called up them the casualty doctor told me the patient just discharged from our ward 2 weeks ago who refused renal replacement therapy (either hemodialysis or peritoneal dialysis) came in for acute pulmonary oedema. Quickly, i went and saw the patient is in acute respiratory distress . Sp O2 is 87-90% on high flow mask. Patient in semi conscious state. Immediately I went and discussed with patient's family regarding patient's condition and need of intubation and temporary PD (peritoneal dialysis) later. After long time discussion, patient's family agreed and Intubation done . Patient survived and now PD done to him.
This is a real story happens everyday. Patent whether affordable or not for dialysis or got good financial aid from government (patient's daughter is teacher) or not . This is only a part of the issue. The most important thing is patient willing to accept the fact he is in end stage renal failure. It is very easy for us (doctors) to talk about the RRT(renal replacement therapy) but for them to accept it is very difficult. Basically they are at denial state until PD is being done to them or they got severe pulmonary oedema. The lesson being paid sometimes is too high . Sometimes they may lose their life on this process.
I think Malaysia should got better access for financial aid and information regarding dialysis just like this site.

Monday, August 07, 2006

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White coat,DG and microb

I went to work as usual today except feel a bit dizziness because 2 day weekend (woke up for round also this week). Dr OCK saw me and straight walked to me and told me to wear white coat.
I asked why should i wear it. She told me DG is coming today. You know nowadays DG stress on white coat for medical doctor because he felt that we won't look like a doctor if we don't wear white coat . As a result bogus doctor appeared because patient cannot differentiate between real doctor and bogus one just like some people cannot differentiate between original VCD and fake VCD. As a result people end up buy pirate VCD . DG worried same thing happens in medical world as a result a lot of patient would be morested by bogus doctor.
I actually not quite believe her statement but today is not April 1st and she is famous for honesty.
I saw my houseman all wearing white coat then i know today may be i m in trouble .Further more our Dr CYt also wearing white coat . My luck is not too bad because he is not coming today but tomorrow.
I think DG want us to wear white because he want us to look like the film star in scrub(pic 1), healing heart (pic 2, 3,4). All this movie take place in air cond hospital not in a hot,humid and warm hospital like Penang GH.
In warm, hot place like Penang GH , bacteria tend to overgrowth because activity increase in warm and moist area.That is why a lot of MRSA and MRSE in Penang GH.
With white coat, the bacteria can just stick to white coat and happily shift with the graceful doctor who will went from ward to another ward to see referral case. Bacteria will say the slogan of Mc D ' I'm loving it' if you wear white coat because nobody wash their lab coat daily . At most, weekly. Some ,monthly. Some 3 monthly.
At last, cheers to our DG, He is coming for H penang tomorrow . Let's welcome him with our clean white coat. Who cares about the microb just let them have fun because we must follow leader's order as we are government servant.

Thursday, August 03, 2006

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My Big Day

Today i am on leave and stay at home supposingly to celebrate my big day {birthday} but bad thing happens just like what you can't predict for stock exchange and human emotion. I fell sick 4 days ago , don't worry? It s not Ca. It s just a bad flu with severe myalgia and arthalgia which happens to me once to twice a year last time but currently already 2 times for past 3 month.
This time it really torture me. For the past 3 days it is not improving but getting more and more severe .I think things get worse because of not enough rest.Similiar trhing happens to my colleague 3 weeks ago. So today ican't do anything other than sleep, see a bit internet,eat poriidge at house and no other entertainment. What a big day for me.
Hi, tomorrow need to go for round again. What a world it is.