I'm today

Salam...

I'm in obstetric n gynecology posting now..
Nice to meet mother n feel for baby position in the uterus...
Got only two examination!! Examine gravid uterus n abdominal exam...
But the still got many theory to be red..

Hmmm... Most of mothers in ward now are around my age.. Huhu

Ooohhhhh... My feeling today is not good..
I know I'm the sensitive person...
But I'm weird with people attitude..
Yupp... It is true that I am only the medical student, dont have the right to manage patient, dont have the right to make decision, dont have the right to do this and that in ward...
But why they cannot treat us as a people who will take the responsibility as a doctor later, work with with them later?? The way they look at me like I am non-invitable person there.
Or they think I'm still childish who dont know anything..


BUT, this statement is not for all nurses, got many other nurses who are very kind, help and teach us!! nice to meet them!!!

Okaaayyy... Saje nak emo ptg2... Bye!!

rest for my iPad

Salam...

Today my iPad had broken down, I couldn't open it. Just Apple logo was came out. 

I felt like I had lost my iPad at this time, oooohhhhh Noooo!!!!!

What to do???

I tried to open it for many times while Dr Lim Poh Hin was delivering his lecture about epilepsy, I couldn't focus anymore at that time. I just wait for class to finish at that time. Sorry Dr, I didn't really want to do it actually!! 

After finish class, I went to Alamanda with Nadiah to Apple store. Fortunately, my iPad was still alive and , the man said that it occurred may be due to jailbreak. He suggested me to un-jailbreak it but I will lost most of my applications if did that. hmmmm... Lastly, I decided to think first and came back if I got the same problem. 

When I`m going back home, I realized that I couldn't use  the home button. Hmmm.. felt sad again!!! My iPad was not normal already!!!

I search about home button problem and at last I found the way to treat it from a blog. I tried to used that procedure to treat my iPad, and Alhamdulillah it made happy. I can use it already but it still not as usual. 

In Shaa Allah, I will give my iPad a rest tonite and tomorrow for recovery time. Hope it will be like before again!!!

Today  I realized that I became dependence to iPad already, I could not live without it, and it was part of my life!!! 

Last words: I am not studying gynaecology tonite becoz of googling about broken iPad and tomorrow I should have class with Dr Shahril In Kajang Hospital. hmmm... so, how to answer Dr`s questions?????

Mencari cinta

Salam...

Jauhi kami dari kealpaan, kelalaian dan kesibukan untuk mensyukuri nikmat-Mu Ya Allah..

Alhamdulillah..

Salam..

Alhamdulillah.. I passed the pead exam!!!
My curiosity to know he result cause me to text Dr Johan.. Huhu, fortunately I passed it, but I though my short case was bad actually. Huhu...

Got Another 1 O&G exam before Pro exam III.

Hope can do well!!

Ahmad Adam Syukri

Salam...

Al Fatihah to Ahmad Adam Syukri who had passed away about 2 hours ago at Institute Pediatric, HKL. I started to know about Ahmad Adam since I saw him in MHI. He was about 7 months old at that time and having Hypoxic Ischaemic Encephalopathy(HIE). First time I saw him, he was very thin with muscle wasting and depend on ventilation and suction machine.  Then I tried to followed his condition through his facebook fanpage. Recently, he looked more stable and having muscle bulk already.

I think this is Adam after few days of life.

He was on endotracheal tube and nasogastric tube already.

Differ with above picture right??

There was muscle wasting and the eyes looked cloudy.

Nasal prong to deliver oxygen.

Tembam suda Adam masa ni, comel and cute!!!!

Had undergone eye surgery at this time and looked like he was respond to surrounding already, and want to smile actually!!! 

Allah loves him more, he had passed away this afternoon. Takziah to his family.

Another special about Adam was he had a good support from his parents. I am proud with his parents!!!

 I believed that family support is a part of therapy in treating medical illness anyway. So, give support if you have any family member, relative or friends who are ill. I am sure they will appreciate you and help in recovery.

Hypoxic Ischaemic Encephalopathy
- Is a clinical manifestation of brain injury less than 48 hours after hypoxia event
- it occurs as reduce of oxygen and glucose delivery to the brain that cause cell death by
   inflammation reaction and apoptosis
- the causes can be due to antenatal, perinatal and postnatal condition

- Causes :
1. Fetal - Twin to twin transfusion
             - cord prolapse
             - preterm
2.  Maternal - placenta abruptio
                    - placenta previa
                    - pre-eclampsia
                    - uterine rupture

- Many HIE case are referred to newborn infant but can apply to many other brain injury as well like drug overdose, blood loss, smoke inhalation and choking.  
- the prevalence is about 1-6% per 100 live term births
      25% die or have multiple disabilities, 4% have mild to moderate cerebral palsy and 10% have 
      developmental delay

- Classification of HIE:

• Stage 1: hyperalert (eyes wide open, ↓ blinking, excessive response to stimulation), impaired feeding 2° to weak suck but normal tone
• Stage 2: lethargic, mild hypotonia, reduced spontaneous movement, seizures
• Stage 3: no spontaneous movements, withdrawal or decerebrate posturing only to pain, variable abnormal tone (hypotonia/​hypertonia), suppression of primitive (Moro, tonic neck, sucking) and brainstem (corneal, gag) reflexes. Prolonged seizures refractory to treatment.

- Essential criteria for diagnosis HIE
   1. Metabolic acidosis
   2. Early onset encephalopathy
   3. Multisystem organ dysfucntion

- Complications of HIE
   1. Acute renal failure
   2. Myocardial dysfunction and hypotension
   3. Coagulation impairment
   4. Necrotising enterocolitis
   5. Hypoglycemia

- Basically, the treatment is to prevent secondary central nervous system insult like seizure control, correct hypoglycemia, hypotension, hyponatremia, hypocalcemia, hypomagnesemia, control brain edema, prevent fluid overload, appropriate oxygenation and treat affected organs.
- Therapeutic cooling or treat hypothermia is important to reduce mortality and major neurodevelopmental disbility

Okaayyyyy... all that I wrote here was based on I saw him from MHI and red from his FB fanpage and other blogs. So, if got any mistake, I felt sorry for it.

I hope I will remembered Ahmad Adam Syukri when I was asked about HIE  or facing with HIE patient when I worked later!!!!!!

Al Fatihah again for `bakal ahli syurga Ahmad Adam Syukri`.

Tq...

References :
1. Hypoxic Ischaemic Encephalopathy slide by The University of Chicago Medical Centre. Reviewed on 7th February 2013.
2. Helen AB and Ram N. Peadiatric & Child Health. 2nd edition. Wiley-Blackwell 2010.

Rash

Salam...

I'm here again today. Hmmm... Actually I dont know what to do rite now, I'm alone in Masjid Sultan Ahmad Shah UIAM, waiting for my brother.

Okay... What is rash???

Rash is changes of the skin in term of colour, texture and appearance.
There are many types of rashes like :
1. Macule - non-palpable, size less than 5mm
2. Patch - Non-palbable, size more than 5 mm
3. Papule - palpable, size less than 5 mm
4. Plaque - palpable, seize more than 5 mm
5. Purpura - red-purplish lesion, non blanching, size about 5mm to 10mm
6. Petichiae - is a purpura but less than 3 mm
7. Echymosis - also a purpura bu size more than 10mm
8. Erythematous - Redness, usually not palpable, blanching

Different between purpura and erythematous is purpura is caused by bleeding, usually occured in vasculitis, while erythematous Is hyperemia of capillary.

9. Vesicle - fluid-contain, well circumscribed, elevated lesion, size Less than 5mm
10. Bullous - large vesicle, more than 5mm, contain serpus or seropurulent fluid
11. Pustule - small size, elevated, contain purulent fluid
12. Telangiectasia - Enlargement of superficial blood vessel

When someone had rash, we must thing 2 major causes of rash, wether it was a skin disease or systemic disease that manifested as skin lesion. Usually, patient with systemic disease will have associated symptom of fever.

When I was in peadiatric posting in year 4, Dr Kamarul had told us the easier way to remember of  rash associated with fever by the menumonic of 'very sick people must take early retirement' .
Day 1 - Very - varicella
Day 2 - sick - scarlet fever
Day 3 - people - pox (chicken pox)
Day 4 - must - measle
Day 5 - take - thypus
Day 6 - early - enterovirus (thypoid fever)
Day 7 - retirement (rubella) ( plus dengue)
So, onset of fever is important here to make diagnosis of rash.

Other diagnoses of rash that usually found among peadiatric patient Are Kawasaki disease, Henoch-scholein purpura and idiopatic thrombocytopeanic purpura.

Most common skin disease are eczema and psoriasis. The manifestation are variable, depends on the types of eczema an psoariasis.

Okay.. I need to stop here, I need to take my bus to go back to my hometown!!! Yeaaahh..... Balik kampung!! Bye n salam!

Peads made me writing today..

Salam...

I'm here again after months disappear. Huhu... Means that I cant be a blogger actually.. Just writing when I want... Hmmmm...

Peadiatric posting made me to be here and writing today.. n my 3rd last entry was also about pead, But it was a year ago.. Too long rite?

NVM, what I want to share here is my journey in peadiatric posting.. Woohooo... For me, pead posting is the most tough posting in year 5. At first, I'm very excited to be in pead posting, but day from day, I became more stressful and felt like I'm never in peads posting anymore before. SOB SOB.. My major weakness is in physical examination, I'm depressed when I failed the 1st short case class. Then, I got the borderline for 2nd short case and again failed for 3rd short case.. very sad.. What to do?? Crying?? Down feeling??? Isolated myself?? N the worse was I'm still thinking why I'm in medicine though in 5th year already?

Alhamdulillah... Though I felt down n had bad mood most of time, it had motivated me to do better n studying harder. Try to appreciate Signs that I saw n being thinking person. Hmmm.. I'm not genius, I need to learn repeatedly to remembered n understanding it. Keep repeat n repeat.

Another episode of worry is exam. Exam was in 5th week n we only had 4 week to revise pead. I had both long and short case on the 1st day. Huhu... Happy or not?? I'm happy becoz can finish it early, but anxiety made me not happy. Anxiety to be in exam.. I'm worried I could not do the best in exam.

N yesterday, I already finished the exam. Hmmm... I'm very very worried wif my short cases. I put wrong estimated age for DA. Ya Allah!! I tried to be calm but that thing always crossed my mind.  The result will come out after CNY, before starting O&G posting. But I'm still hope I can pass it. I need a calm feeling for entering O&G. Amin.

By the way, I still enjoying to be wif children. They are very cute!! Hope U will get well soon all my boboys and gegurls!!