NEw Pack: Clinelle product

Hello there!

as u all knoe im really like clinelle product so this entry i would like to tell you about new product from clinelle which is whitening product. i have been using this product for about 2 week  and the result quite ok la since im just using starter kit product only.mahal meh nak beli yg besaw2....huk aloh.

i like this product since ianya wangi sangat...product yang dulu tu bau cam ubat sikit. yang ni best laa....tp nak kate kulit mkin putih tu cam xnampak sgt mungkin sebab kulit i memang warna fair so memang xnmpak perubahan sgt lah...hue hue..ataw mungkin xckup dose kot. serum dia memg bagus. tapi sebelum ni pernah cuba serum loreal...cuba sikit lah kt watson.muahahaha...mcm lg best jekk..kiki...padahal try sekali je...klu beli yg nih memang xckup lah setakat ada 3 ml je kn...hmmm...pasni nak teruskan yang dulu je sebab rasa cam sama je...keke....apa lah pompuan kan entah apa la sgt nak jd putih...padahal kulit putih lg bahaya nak dapat kanser kulit berbanding kulit hitam...hmmm...

bagi adik2 yang muka jerawat tu...akak sarankan lah pakai product clinelle ni...bgus sebab dia ada anticomedonic or antijerawat lah senang...berbanding korang pakai pencuci muka yang entah apa2 tur...
wah banyak lak bebel mak cik bella ni kan.kiki...

bila pikir balik kenapa la perempuan suka putih?padahal cantik itu subjektif. and sapa yang cakap hitam itu hodoh?hmm......disebabkan iklan2 la kita org pompuan ni senang tertipu...iklan cakap kulit putih menawan..cantikk...blaa..blaaa..n so on...kita pom yg memang kulit da cantik dan memang cantik da pom (perasan bak ang..)mengedik la pi beli product putih tu kan...padahal xtaw byk product memutihkan muka yg cepat tu guna merkuri especially product yg minum2 ni....effect dia bkn hari ni...tp kemudian..hmmm...pikir2 kan lah...apa2 pom muhasabah diri betulkan niat..

bagi saya perempuan haruslah menjaga penampilan diri...bukan nak cantik tp untuk keyakinan diri.xlah nanti bila bercakap org tuh asyik pandang jerawat jeragat kita jerr..kn?malu kot.ini bole menjatuhkan self confidence.mungkin ada yg pandang ringan bab ni tapi effect low self confident dlm masyarakat amatlah besaw....even product ini agak mahal tapi disebabkan kulit daku ni sensitif terpaksa beli jgak..bukan nak cantikk...tp sebab nak jaga kulit plus2 skrg ni cuaca amatlah tidak menyenangkan hati untuk keluar bebas sana sini..hohoh...musibah ataw ujian?

k lah ni je nak merepek malas nk tempek muka kat cni sebab tak menunujukkn perubahan pom melainkan pipi yg makin mengembong...kiki

odioussss..muchacha.lap u all yg baca nih!

Let's Move Forward =)

Assalamualaikum:)

Tajuk post kali ini memang best dan amat lah sesuai dengan diri ini. Sekarang ni perasaan yang tidak menetu amat lah kuat tapi hanya satu yang aku ingatkan dalam diri bahawa tiada siapa yang dapat menolong diri sendiri melainkan kita.jika kita rasa down bangkit lah.jika kita tak mampu mencari kekuatan sendiri carilah DIA yg maha Satu. Terlalu bergantung kepada manusia tak kemana pom malah menyakitkan diri sendiri je...Menceritakan masalah kepada orang hanya 1% kelegaan tetapi yg selebihnya bergantung kepada kita camana nak move forward. Most people love to hear our problem but not to help us to solve problem. Most people suka bila kita bermasalah dan sebarkan kepada yg tak patut mengetahui. Semoga Allah mengampuni org yg sebegitu. Aku perit memberi kepercayaan kpd org...orang yg aku percaya selama ini ..bukan berkawan 2-3 hari tetapi bertahun2..hmmmm...last2 tikam belakang jugak.mungkin dia pikir dapat menyelasaikan masalah tapi dia tak tahu yang dia telah menerukkan keadaan lg..kalu ko kawan yang baik xkan lakukan perkara belakang kawan ko kan?ko bukan xde mulut nk ckp sendiri dgn kawan ko...ko bukannya bisu...dasar pengecut! kalu berani sangat cakap face to face bukan main tikam jer belakang....Ya Allah teruk betul peraasaan bila dah marah....xper aku maafkan semua yg ko buat kat aku...tapi kalu nak percayakan kawan macam ko ni xla kan.maaflah!aku bukan nk putuskan hubungan seagaama ni tapi mungkin aku patut lebih berhati2 dalam memilih kawan...

Even kita dalam masalah sentiasa lah positivekan diri. Rasanya tahun ni adalah tahun mencabar buat diri ini.xper aku ada goal aku sendiri yang aku nak capai tahun ...semoga diberikan kemudahan oleh Allah. Jangan disebabkan marah semua tak jadi hal. Walau seteruk mana pom perasan ini aku akan cuba kuat menghadapinya...Insyaallah dgn kakuatan yg diberikannya aku akan mnjadi org lebih komitmen dan bertanggungjawab....Setiap yg kita inginkan pasti memerlukan pengorbanankan? berkorban untuk sesuatu yg berfaedah tiada ruginyaa.bercakap dgn org yg tiada faedah memang amatlah rugi.

k.lah.selamat malam.semoga ada perkembangan kelak.Ayuh!!Move forward!

Final Year!

Assalamualaikum!

hai dan selamat petang buat semua. Rasanya da hampir setahun blog ini tidak ter"update". Nak kata bizi tahap gaban xdelah, tapi bizi tahap semut ada lah.heeee... Now im already final year!yes last year for my medical course, of course la bizi kan?heee....tapi nyempat pulak update blog. Dah lame rasanya tak luahkan perasaan di laman sesawang saya neh.Rindu taw..taw..taung..hahahah..over lak!kan?dah kenapa?

Sepanjang setahun tidak mengupdate blog neh macam2 berlaku dalam kamus hidup ini. Ada duka ada ketawa ada manis ada pahit...bak kate lembu semua adalah.yer la kan kalu hidup tiada dugaan bukan kehidupan lah tu.ya idok?Tapi saya bersyukur masih diberi kesempatan untuk bernafas menghirup oxygen yg free neh...Terima kasih ya Allah kerana masih menyayangi hamba mu ini.Walau apa pom terjadi dalam hidup kita haruslah kita ingat bahawa semuanya datang dari Allah mahupun yang baik ataupun yg buruk. Redha dalam ujian kehidupan bukan lah sesuatu yg senang untuk kita tetapi apakan daya syurga Allah itu mahal.that's y lah kesabaran itu diperlukan demi syurga yang mahal itu.

Sekarang di tahun akhir even da berada di tahun kritikal tetapi kesungguhan yang kental itu masih belum hadir dalam diri ini. Pelik?hmmmm.... renung2kan lah. Kepada adik2 yang baru masuk klinikal year akak berdoa semoga korang tabah menghadapi dan kuatkan diri untuk berhadapan dengan sesuatu yang baru dan realiti alam perkerjaaan kita kelak. Jangan down jika ada yang kita tidak tahu dan terasa bodoh bila ditanya satu haprak idea pom xkeluar.no worries my dear, insyaallah 1 day u all boleh mengatasinya dengan kesungguhan belajar dan memahami kenapa we should learn that n y we should do like that.Jangan je soalan jika tidak tahu.jgn malu jgn segan kerana kita masih berada dalam situsasi belajar.its ok to make mistake this time but not during ur work situation.

cheewahh..banyak plak membebel..hmmm...kalu da nk mintak tips belajar di klinikal yer bole la bertanya....insyaallah free in charge.mehheeee...

 

tahniah to my prenzz..kak naemah yang sudah berbadan dua sekarang.semoga akak sihat dan kuat menepuhi kehidupan bersama baby dalam kandungan ketika diri sedang sibuk menghadapi final year!

hari ni nak kongsikan quote or 1 ayat dari quran dimana amat menyentuh jiwa dan perasaan saya hari ini. Betapa teguran Allah itu dekat.

"Dan jangan lah kamu iri hati terhadap kurniaan yang telah dilebihkan Allah kepada sebahagian kamu atas sebahagian yg lain. Kerana bagi lelaki ada bahagian dari apa yang mereka usahakan dan bagi perempuan pun ada bahagian dari apa yang mereka usahakan.Mohonlah kepada Allah sebahagian dari kurniaNya.Sesungguhnya Allah Maha Mengetahui segala sesuatu".

Surah Al-Nisa' ayat 32

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!