Said NO 3M in Life

Apakah itu 3M?

1. Mengeluh
2. Merungut
3. Menyesal 

 tidak apa kalau menyesal dengan dosa dan bertaubat kepada Nya :-)

Sekian.tima kasih. 

selamat beramal!

Opthalmology posting: Diabetic retinopathy

Assalamualaikum semua!

Today's date is 18/11/2012. As you all can see in newspaper and internet there are a lots of news about ours brothers and sisters suffering a lots at Gaza because of the cruelty Israeli. Lets pray for them to be save and Allah help them to be a brave heroes to save their land and our religion, Islam. Allahuakhbar!

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my next topic is a about diabetic retinopathy  since now i'm at 3rd weeks of ophthalmology posting at HUKM. (posting mata)

DEFINITION

 

Diabetic retinopathy is a complication of diabetes and a leading cause of blindness. It occurs when diabetes damages the tiny blood vessels inside the retina in the back of the eye. Its altered vascular permeability (loss of pericytes, breakdown of blood retinal membrane and thickening of basement membrane.

CLASSIFICATION

1) Nonproliferative diabetic retinopathy (NPDR)

•  Most patients (95%) have NPDR.
•  This is the earliest stage of retinopathy and it progresses slowly. 
•  The earliest signs of retinal damage arise from capillary wall breakdown, seen on the fundus exam as vessel microaneurysms. 
• Injured capillaries can leak fluid into the retina and the aneurysms themselves can burst, forming “dot-and-blot hemorrhages.”

2) Advanced/Severely Nonproliferative diabetic retinopathy

• non proliferative findings + 

* venous beading (in 2 or 4 retinal quadrants)
*intraretinal microvascular anomalies (IRMA) in 1 or 4 retinal quadrants
                       -IRMA: dilated, leaky vessels within the retina
*cotton wool spots (nerve fiber layer infarct)

3) Proliferative Retinopathy   

  

• With ongoing injury to the retinal vasculature, there eventually comes a time when the vessels occlude entirely, shutting down all blood supply to areas of the retina. 
• In response, the ischemic retina sends out chemicals that stimulate growth of new vessels. 
• This new vessel growth is called neovascularization, and is the defining characteristic of proliferative retinopathy. 
• Far fewer patients have proliferative retinopathy, which is fortunate as this stage can advance rapidly with half of these patients going blind within five years if left untreated.

PATHOGENESIS 

other things you should know:

• What are the retinal signs of diabetic retinopathy. How do they compare to, say, hypertensive retinopathy.

-With diabetic retinopathy you typically see a lot of dot-blot hemorrhages, cotton-wool spots, and hard exudates. 
-Hypertension usually has more flame hemorrhages and vascular changes such as arterial-venous nicking and copper/silver wiring. 

• How are angiogenic molecules involved with diabetic retinas?

VEGF production by areas of ischemic retina leads to neovascularization. These new vessels are bad as they can cause traction, bleeding, detachments, etc.. 

•  What are some mechanisms in diabetic retinopathy that might lead to decreased vision? What causes the majority of vision loss in diabetic patients?

-There are several mechanisms for potential vision loss in these patients, including: 

*Macular edema (probably the leading cause of vision loss) 
*Vitreous hemorrhage 
*Retinal detachment

• How do we treat advanced diabetic retinopathy?

Proliferative diabetic retinopathy is treated with PRP (pan retinal photocoagulation). By ablating the peripheral ischemic retina with a laser, we decrease VEGF production and thus decrease neovascularization.

• A 35 year old man with bad type-1 diabetes presents with a pressure of 65. His anterior chamber is deep but you find neovascularization everywhere - in the retina and on the iris. What do you think is causing the pressure rise, and how do you treat it?

-The pressure is up because of neovascularization of the iris angle with blood vessels clogging up the trabecular drain. 
-You treat neovascularization by PRP lasering the peripheral retina to decrease VEGF production.
 - NVA (neovascularization of the angle) is hard to manage and this patient will probably require a surgical drainage procedure in the near future.

• Describe the three types of retinal detachment?

These include rhegmatogenous detachments, tractional detachments, and exudative detachments. 

• What are the symptoms of a retinal tear or detachment?

Flashes and floaters are the classic signs. With a large detachment your patient may also notice an area of “dark curtain” or “blurry spot” in their peripheral vision.

• What is a PVD?

This is a posterior vitreous detachment - with aging the vitreous jelly liquefies and contracts. A sudden contraction can cause new floaters. This event is usually harmless, but you should search carefully for retinal tears. 

• An elderly patient presents with a brief episode of flashing and now has a single floater that moves with eye movement. A thorough retina exam reveals no detachment or tear, but you observe a small vitreous opacity floating over the optic disk. What has happened?

This again sounds like a PVD. The floater is a Weis ring, a piece of optic disk debris that has pulled off with the detachment. PVDs are common and usually harmless, though patients should have a thorough exam for retinal tears and be taught about the symptoms of retinal detachment to look out for. 

• What kind of surgeries can we perform to relieve retinal detachments?

You can perform a vitrectomy to clean out the inside of the eye and relieve retinal traction. While in there you can also reappose the retina. You can also perform a scleral buckle or a pneumatic retinopexy.

• What is Schafer’s Sign?

This is when you see retinal pigment particles floating in the anterior vitreous chamber behind the lens. This slit-lamp sign increases your suspicion for a tear or detachment. 

•  What kind of travel restrictions would you tell a patient who has a pneumatic retinopexy?

Well, you don’t want these patients to fly. A decrease in ambient pressure causes gases to expand. If this happens in the eye it could explode! Your patients should also avoid SCUBA diving for similar reasons, as the change in gas volume over the changing atmospheric pressure will cause extreme pain and possible damage. 

• What’s the difference between dry and wet age-related macular degeneration?

-Dry ARMD is when you have drusen and macular RPE atrophy. 
-Wet ARMD implies choroidal neovascularization that has grown up through Bruch’s membrane.

MeREpek story from CIk BELLA:

 

 

 

pesanan penaja: Jaga lah mata anda kerna mata adalah satu anugerah yang tak ternilai harganya. Bila da hilang fungsinya baru lah anda sedar betapa nikmatnya dapat melihat. Bagi mereka yang mempunyai masalah kencing manis sila lah control pemakanan anda supaya ianya tidak menimbulkan masalah pada mata pula. Amalkan gaya sihat dan banyak makan carrot untuk kesihatan mata.

Sekian.

terima kasih.

Aligato and semoga mendapat ilmu yang bermanfaat. 

MEDIC : Parotid Tumours

The Parotid gland is the salivary gland which is situated laterally near the mandible. 

Approximately 75% of neoplasm of salivary glands occur in the parotid glands. 80% of parotid tumours are benign and of these 80% are called pleomorphic adenomas.



Classification of parotid tumours:
1. Adenoma
A) Pleomorphic

• Any age, no gender predilection
• 75% of all parotid tumours
• Over 60 years of age

 


B) Warthin's tumour

• Over 60 years
• Male to female ratio is 4:1

2. Carcinomas

• Acinic cell Carcinoma: Low grade malignancy
• Adenoid Cystic carcinoma: Commonly seen in USA. Invariably fatal due to perineural spread and pulmonary metastasis
• Adenocarcinoma and Squamous Cell Carcinoma: Both have poor prognosis. Very rare. 25% have 5 year survival

3. Non epithelial

• Hemangioma
• Lymphangioma
• Neurofibroma
• Neurilemma
• Mostly infants affected. Frequent spontaneous regression of any gland affected in this group.

4. Malignant lymphoma
5. Unclassified tumour


What are the characteristic features of parotid tumours?

• All parotid neoplasms are radioresistant
• No formal biopsy should be performed in parotid tumours except in tumours of ectopic salivary gland e.g. palatal salivary gland

What are the criteria indicating malignant change in mixed parotid tumour?

• Sudden and rapid increase in size
• Painless tumour becomes painful and tender
• Feels stony hard
• Growth becomes fixed to the deeper structures e.g. masseter, mandible
• Overlying skin may become fixed to the swelling and looks and feels reddish blue and hot
• Evidence of facial nerve involvement causing asymmetry of face and difficulty in closing the eye
• Areas of anaesthesia over the skin
• Jaw movements become restrained
• Veins over the swelling become prominent
• Enlargement of cervical lymph node
• There may be evidence of disseminated blood borne metastasis

What is the treatment of parotid tumours?
Outlined here is the treatment of parotid tumours:

• Benign: Superficial parotidectomy.
• Malignant: Radical parotidectomy or total conservative parotidectomy.
• Malignant metastatic lymph nodes may be treated by radical neck dissection or by radiotherapy.

What is the differential diagnosis of parotid swelling?
Differential diagnosis of parotid swellings:

• Winged mandible
• Masseteric hypertrophy
• Lipoma
• External carotid aneurysm
• Pre- Auricular lymph node 

References: 
1) http://specialist-ent.com/throat/parotid-tumours.aspx

2) google pictures

Example shortcase ENT posting : (what should student do)

1) General 

• Look at the patient and greet him / her

•Explain to the patient that you are going to examine him / her

•Ask if there is any tender parts so that you will not hurt the patient

2 )Inspection

–Surgical scars

–Punctum

–Skin changes / inflammation

3) Palpation

–Increased warmth

–Tenderness

–Surface

–Edge

–Mobility

–Solid / cystic

–Fixed to underlying muscle or overlying skin

4) Do a Transilluminate test

5) Ascultate for carotid bruit

6) Test facial nerve 

Questions that always doctor ask after finish do examination!

•Give Differential Diagnoses

–Pleomorphic adenoma

–Warthin’s  tumour

–Adenoid cystic carcinoma

–Lymph node enlargement within Parotid

–TB Lympadenitis

•Parotid tumour: Investigation and treatment

•Name one diagnostic investigation?

–Fine needle aspiration

•How will you treat this condition?

–Parotidectomy

•Superficial parotidectomy if benign

•Total parotidectomy if malignant

Source : Prof Sani Slide presentation.

 

p/s: just sharing. not a pirates of carribean~ehhe. ^^,

Hand-made Candy : Sticky

 Assalamualaikum and morning!

Do you like candy? ahaaa? yeeah.. candy is sweet. So sweet. like me?ahaaaa?... just kidding! hehe. I'm not really like to eat candy but sometimes i need it to relieve my sleepiness. argghhh... so ngantuk maaaa especially in lecture time. too many lectures in ENT posting maa... wuargghh~~~

Last month i had hang out to Pavillion mall with my friend then he showed me this shop called "STICKY'. waaahh ..what a name? KAyU? ehhe.. weird and never heard before. But it is a nice shop. There's you can see how they made this candy. Amazing right? how "jakun " i am to see this.... whoooaoaoa.... sambil molot ternganga.... ^ O ^

this is a short video how they make it ;)

 

 cute right?

fancy to see this? get it now... acerrrrrr....

my sticky (mix flavor)!not so much left. not just me eat it ok? i will get diabetes (kencing manis) if i eat all of this alone.=.='

RM16.90/bottle

expensive ?reasonable larhh..

 at the shop :)

can i buy all? they are so cuteeeeeeeeee!!!!!

you all can order this for your wedding door gift if u have enough money la...HAHA. then you can invite me larh so i can get free sticky from u'olls.. ehe. i love free things very much you know.!! muahahaha :D

that's all "merepek" for today. 

have a nice day and good time with your love one.

acerrrrr.

k.bye!

cuti SEmester 1 tahun 4

Good Afternoon EveryONe!

today was 2nd day i'm at home.my sweet sweet home WAKAF BHARU,KELANTAN. Even hari tuh hepi sgt nk blik kan tp skrg bila da sampi rase cam len plak...mungkin sebab risaw result yg bakal keluar nanti,xpom sebab kna bebel ngan mak sbb kita nakal. nguhahahaha.. NAKAL la sangat. XPOM sebab rindu orang KL x?hahahahaahahah...orang KL sakit lak rini,sian.. Semoga Dia cepat Sembuh. Sakit rindu ler tuhh....KOH$...koh3.. xdak maknanyer kan, sakit sebab RINDu kn? BAik makan aiskrim lgi bagus. ade kaitan ker? =.='

xde apa nak dicerita pom sbenarnya, saja nak menaip.koh3. melampaw lak kan nak menaip p la taip kat microsoft word tuh, nih nak post kat blog lak!eehhh... suka ati tangan kite ler...blog kiter.kita bayaw tenet bukan kamu. (acerrrrr..padahal org len byaw)HAHAHAHAHAAH.

semalam tgk citer nih (ADAM DAN HAWA) kat laptop ngan abang, AWWWW.. switkan kami?...koh3... time tgk tuh ingat ade 2o something jer episod die tup2 ade 80.. haiiyaaaa...xlarat den nak layan semua karenah cerita neh..dah jadi cam senetron lak banyak episod kn... kan?emmm... bagi peminat setia citer nih kompem sanggup tunggu...tapi bagi peminat jalanan cam gua neh...xdak nya nak layan citer berjele nehh....baik layan KOREA. xgitu? heheheheh

k la... abang da bising2 suruh p tolong mak kat dapur..nak p lerrrr nih.....

daa.len hari post lg.

hek3.

selamat bercuti semuaaa...

One MOre! One more!Yuhuuu...

Assalamualaikum :)

Yes 1 more to go. apa yang 1 tuh? hehe. Exam ler Sayang oiii. Ada 1 exam jer lagi sebelum pulang ke kampung halaman tercintaa.yeah! gembira sakan naa.... Exam OSCE Paediatrics (exam bahagian penyakit Kanak-kanak) jatuh hari isnin ni, kalu tak rini dah abeh da exam..malam nih kompem da kat Putra menunggu bas untuk pulang ke Kelate kito.HIHI. exam yang lepas tawakkal je lah semoga ok lah.. kita da usaha and buat yg termampu (even byk gak main,wuwuwuw). dah2,,xmaw pikir dah.. pikir yg mendatang nih pulak..

emm... bila pikir sal PAediatrics (kitorang sebut paeds), byk pengalaman yg best yg haku xdapat nak cerita smua kat hampa. Posting paeds kat hukm nih selama 2 minggu jer tuh pom sebab masuk Neonatal Care Intensive Unit (NICU) then 1 minggu kat Hospital Kajang, then lagi 5 minggu dekat Hospital Kuala LUMpur (HKL). Macam2 kes (penyakit) yang aku dapat belajar especially dekat HKL. yer la kebanyakkan pesakit adalah refer dari semua tempat xkira lah dari semenanjung mahupom Sabah and Sarawak. Haku memang suka budak2. Suka sangat2. tuh yang kadang2 terover masa lak lepak kat pesakit2 especially yang chomel2...kih3.. kesimpulan dari posting nih adalah memang best tapi penat sebab kena ulang alik dari HUKM--> HKL    HUKM--->HK.. hehe. penatkan?kuang3..korang pa taw, ingat tido lam bus best ka? :(

tapi xpa

demi mu 

pesakit ku........

cheeeewaaah....

 chomel kan?hehe...nak anak camni tak?

 alolololololo......

 dak nih orang Sabah ceria sebab nak keluar wad da..

adik nih mempunyai suare yang amat merdu!semoga adik sihat2 selalu!

 jom balut Baby!kena balut kemas2 nanti senang terbuka.

He look at me!heeeee..

 

jumpa kawan lama di Hospital Kajang.miss u mek!

kanak-kanak memang unik. susah nak kawal. tapi ade jer yang senang kawal. kesian kat ibu bila tengok anak2 over aktif and kuat meragam. Ada yang nampak sedih yang teramat karana anak yang pertama dilahirkan tetapi mempunyai pelbagai penyakit. Sabar jelah wahai Ibu, semoga kelak anak mu menjadi anak yang soleh dan solehah.Ammen. Segala jasa ibu xkan dapat anak-anak balas even dengan harta mengunung. betapa besarnya jasa ibu. Balas lah jasa ibu bila da dewasa kelak...even skrg pom boleh balas dgn menjadi anak yang terbek buat Ibu.

Huk2.. tiba2 teringat kat mama lak. Sabau lah mama t Selaasa pagi anak mu sampai di rumah.hehe... MISS u Mama. Maafkan anakmu ini andai pernah menguriskan hati mu. Fatin sayang mama. Sayang sangat.sangat. Fatin sayang mama kerna Allah. terima kasih Allah mengurniakan mama buat fatin.

 sayang peluk cium untuk mama saya!

k.dah coretan kali ini.

odioussss... doakan saya dan rakan2 ok2 aja untuk exam kali ini.

peace and lots of luv from me to YOU. :))

Congenital Heart Disease

ACYANOTIC  (Left to Right Shunt)

1. Atrial Septal Defects (ASD)

2. Ventricular Septal Defect (VSD)

3. Atrioventicular Defect (AVSD)

4. Patent Ductus Arteriosus

CYANOTIC ( Right to Left Shunt)

1. Tetralogy of Fallot (TOF)

2. Transposition of great arteries (TGA)

OBSTRUCTIVE LESION

1. Pulmonary Stenosis (PS)

2. Coarctation of the aorta (CoA)

k.bye. Selamat memahami.

Ramadhan 2012 Sudah Tiba

Assalamualaikum.

Esok da mula puasa.YEay! YEay!

       nampak dak aku hepi gila neh?mana tak nya bulan ramadhan tak dak syaiiton.

 ok da bole buka mata. :D Semoga dapat mendidik nafsu sementara Syaitoon tak dak nih.

Hari yang dinanti nanti bakal tiba. Malam ni jgn lupa yea terawih da mula. Waah...tak sangka plak begitu pantas masa berlalu. Rasa cam baru semalam sambut Raya. (melampau lak kan)

 

 tengok dinding. bukan tgk paa.....tgk jadual bawah nih ha,,, (obviously gambar webcamp,nguahahha)

 jangan lupa print jadual nih yea kawan. nanti senang, tak dak lah terlajak sahur. =) Tapi yang tempat lain jgn ikot yang nih pula. ni untuk orang KL and PUTRAJAYA sAJA.

 Nak pandang lama-lama pom tak pa. Selamat mengejar saham berganda di bulan ramadhan. Ayuh.

jangan lupa niat malam nih yo. Nak selamat niat puasa sebulan juga.

Kuatkan semangat dan azam untuk menempuhi cabaran Ramadhan. Semoga matlamat ramadhan atau target amalan di bulan ramadhan sudah di lakar di diari masing2 dan Selamat beramal dari cik Fatin Bella!

GURLz THINgs :)

Assalamualaikum.

Apa khabaq semua di pagi yang indah lagi sunyi ini?Semoga semua sehat2 belaka lah na. Macam mana hari semalam? Semoga hari ini lagi baik dari semalam lah ye. Pergh cakap pasal semalam, kenangan yang perit mula menerokai minda.DANGGG! pengalaman pertama memasuki asrama LELAKI sorang2...huhuhuhuh.memalukan. habeh maruah aku jatuh.OK jgn bagi kesimpulan awal lagi ok, aku bukan saja2 nak masuk blok asrama LELAKI tuh tetapi terpaksa kerana FELO yang agak kurang sensenya menyuruh aku naik tingkat 4 blok laki semata-mata untuk mengambil master key (sebab rumah aku terkunci sendiri,wuwuwu,dah la semua housemate balik da..). Sedey sangat2 ade patut dia kate kalu haku xnak naik pergi cari felo lain padahal felo lain semua hilang entah kemana.wuwuwu.Orang dah la dalam kesusahan xboleh masuk rumah, dia lak tengking2 paksa naik jugak.huhu..Mintak tolong turun bawah..emm...bukan nk tolong..lg marah2 ada.Kalu xnak tolong bek xyah jd felo la,nak harap duduk free jer taw..report kang bru taw....huh.MEnyampah gilerrrrr kat dia neh.... (nama dia: ikang haruang)huh.sila jgn berurusan dgn dia neh.TEETTTT..

OOpPPss,,sori lepas marah kat cnih plk.hehe.ok balik kepada tajuk post kali ini.hehe. Panjang betoi pengenalan tajuk nih.hehe.

Barang perempuan tajuk hari ini tapi rasa nyer laki pom bole pakai kot.hehe...saja tulis tajuk tuh sebab biasanya perempuan jer suka benda camni,ye dok? ok pewangi silkygirl SUGAR beli sebab kotak dia chomel ada patut?comel x?comel x?haha...plus aku tak sweet kan so beli lah yg sugar nih biar tambah manis sikit tp jgn sampai semut datang lak.hehe. Bau dia ok lah, not bad.Tapi jangan la duk sembur minyak wangi sampai menusuk hidung orang lain sebab nk tutup xmandi 10 hari. Ini melampau namanya. Wangi dalam busuk lama2 jadi lagi busuk ada lah.

Deodorant NIVEA INVISIBLE best dan tahan lame bila dipakai. Bau dia aku suka, sebab bau segar2 gitu. Tak mahal pom dik, xsampai sepuluh hengget pom. yang jenis spray pom ada tapi aku xsuka sebab 'tajam'.wuhehe

 BIORE PORE PACK first time jgk beli sebab aku xdak blackheads tapi beli sebab nk remove whiteheads.hehe...pelik tapi benar. Kesannya,memang remove lah whitehead tuh tapi xsemua...ok lah tur kan. Benda alah nih mahal, bagi aku lah sebab ada 10 jer pom dalam dia.hehe. Kalu bole nak 100 dalam dia.hehe..pak hang!, buka kedai sendiri lah wei nak banyak2 tapi murah..kiki. standard aku ler tuh nk murah tp banyak..

LAst sekali barang nk promote adelah MASK ALOE made of KOREA ok..hehe. Bunyi jer korea semua duk terbayang Girl Generation, T-ARA and so on... keh3. First try jgk neh selama nih duk pakai macam2 mask sebab nk buang kulit2 mati kn. Tapi bila cuba yang nih,,waaaaa,,,kulit jadi licin dan lembut sekali. suka.suka.suka..bole pakai 2x sebab banyak tapi selepas plastik dibuka kena simpan lam peti sejuk lah (kawan haku yg hajar neh bukan aku taw). kang xpasai kena mara ngan mak simpan barang kosmetik dalam peti sejuk.wuahhahaha...

dah boleh jadi promoter dah aku neh. Saja promote kat hampa barang-barang best untuk dipakai khususnya pare2 wanita yang haruslah menjaga kebersihan dan kecantikkan. kan? kita sebagai wanita kena lah jaga bab ni,ye dok?xdek la kusam jer muka tuh..sori lah xupload gambar muka kiter yang suda jadi lembut2 masyemello itu.hehe, nak taw kesannya cuba lah beli. tak ingat harga tp xsilap bawah RM7 kot. Tapi kalau allergic/sensitip dgn aloevera/lidah buaya neh jgn la pakai k. Aloevera neh banyak kegunaannya. Dulu time kna chickenpox/cacar air, pakai product yang berasaskan aloe jgak then alhamdulillah hilang lah parut2nyer.

oker tuh jer nak kongsi lu baca.bye!

Salam.