My Story

My bro’s condition did not improve after chest tube..

Dr Raja Amin, cardiothoracic surgeon from KL is going to do VATS for him..

Hopefully everything will be alright then.. Take care..

Oh ya, there was another 30 years old man who got pneumothorax as well and underwent open surgery..

Guess how much when he was discharged after 5 days in hospital?

RM19,000!!!

What is VATS?

Video-assisted thoracoscopic surgery is a minimally invasive surgical technique used to diagnose and treat problems in the chest.

During this surgery, one or more small incisions are made in the chest. A tiny fiber-optic camera (called a thorascope) is inserted through one incision, and surgical instruments are inserted through this or other small incisions. The thorascope transmits images of the inside of the chest on a video monitor, guiding the surgeon in maneuvering the instruments to complete the procedure.

VATS can replace a traditional thoracotomy, which uses one larger incision to gain access to the chest. The minimally invasive procedure typically results in less pain and faster recovery time for the patient, among other advantages for patients.

Who said pneumothorax no family history? hehe

After 1 year of attack-free previous pneumothorax, my bro got his 1st attack yesterday..

His symptoms are exactly same as mine..

Deep breathing will feel pain & cough..

mild SOB..

felt something inside when jump..

He’s going to do Chest tube tonight at Johor Specialist..

40% of the lung has collapsed..

Hope he can get well soon and NO relapse!!

Oh ya, he’s the typical TALL & THIN..

so next time make sure u’re FAT! (the only reason to be fat :D)

Here: Recognized Postgraduate Qualifications (20)

Another EOP has just over.. Surgery.. This time a totally different one..

Previous Paeds & O&G i’m not too interested but this one i’m interested..

Got Prof Khin Tun & Mr Ashok for my long case..

Epigastric pain + hard epigastric mass (liver origin i suppose) + splenomegaly + fever + signs of chronic liver disease + signs of obstructive jaundice..

My provisional diagnosis: HCC since the epigastric mass is so hard..

Then Prof Khin Tun asked points against my diagnosis..

I knew something is wrong out there.. I said pain & fever.. He agreed & asked me how come fever & pain & chronic liver disease signs?

I remembered the nurse opened the case note & told me the current diagnosis they had at the moment.. It’s cholangitis with known case of Hep B..

So WTH, who cares, i shot cholangitis & said Charcot’s Triad matched..

Prof Khin Tun did not agree.. Tough Luck.. Didn’t went into investigations or management..

Kept on beating around the provisional diagnosis only.. sigh

As for short case, i was the last one to take the exam.. so imagine how much energy has been wasted during the waiting from 8am till 11.30am? Lol

I got abscess for the 1st one… Left lower back abscess.. With Dr Kyi & AP Dr Ong..

Everything went smoothly this time.. Thank God!

2nd one was Fibrolipoma.. With AP Dr Thaung & Dr Nyi..

This time was disaster!

On inspection, there is a 10×11cm swelling at right axilla region.. Looks like lipoma to me..

On palpation, WTH? Soft & firm consistency at the same time.. The firm one was like “fibroadenoma” in the breast.. So freely mobile.. LOL

In a man.. i was confused at that moment..

I kept on palpating the swelling and too nervous to speak out..

Dr Nyi guided me a while and at last i did slipping sign.. Lol

Dy Thaung asked me provisional Dx..

I said Lipoma due to skin can be pinched & slipping sign +ve

He asked me why cannot be hemangioma? I answered correctly

He asked what is lipoma? I answered correctly

He asked DDx? I said sebaceous cyst

He asked how to differentiate from lipoma.. I answered correctly again

Then he asked what are the places where lipoma cannot occur?

This time i mixed up with the sebaceous cyst and i said palm & sole.. LOL

They laughed..

They told me “you confused with another disease”

They asked me what is that disease that i’m confused with?

Luckily i said sebaceous cyst..

And the time is up..

However, Dr Thaung said there was scar and i didn’t mentioned inspection correctly.. sigh

I think i’m quite unlucky to get these cases but i hope I’m lucky enough to pass the exam..

Oh ya, that day Dr Kyi asked Jun Ing to take care of me.. LOL

And today she asked me to take care of Jun Ing.. LOL

Anyway, i really  like surgery than paeds & O&G..

surgery, paeds, O&G.. I really dislike O&G :-P

Chikungunya Facts

1. Chikungunya is a viral disease.
2. Chikungunya is caused by an Arborvirus, belongs to the genus Alphavirus under the Togaviridae family.
3. The virus is transmitted to human by infected Aedes mosquitoes, Aedes albopictus in the rural area and Aedes aegypti in the urban area.
4. The urban outbreaks are sporadic but explosive in nature.
5. It then disappears and reappears at irregular intervals.
6. The incubation period of the disease is 2 to 4 days.
7. The symptoms is less severe and fewer in children than adults.
8. Infected patients manifest sudden onset of fever, chills, severe arthralgia and headache.
9. Patients also have maculopapular rash mostly in trunk.
10. Migratory polyarthritis (commonly swelling and reddening) occurs in 70 % of cases and mainly affected the small joints.
11. They may also manifest photophobia, anorexia, nausea, conjunctival injection and abdominal pain.
12. The acute illness usually last for 5 to 7 days.
13. Chikungunya has not been reported causing severe haemorrhagic manifestation or death.
14. Older patients usually continue to suffer recurrent joint pain and effusion for several years.
15. Chikungunya infection may be mistaken for dengue and / or West Nile disease.
16. Provisional diagnosis is often made based on the clinical features.
17. Acute or viraemic phase serum samples collected within 2 to 4 days of onset have yielded positive virus isolates and detection of viral nucleic acids.
18. Paired sera drawn 1 to 3 weeks apart will demonstrate rising antibody titre.
19. Rapid diagnosis can be used to detect Chikungunya antibody (IgM) after 5 days of onset i.e. ELISA, immunofluorescene etc.
20. Reverse transcriptase polymerase chain reaction (RT-PCR) tests may yield diagnoses based on samples without detectable antibodies and may also provide genetic information of the virus.
21. The disease is self-limiting.
22. There is no specific treatment or vaccine for Chikungunya, patients are only given symptomatic or supportive treatment.
23. To avoid further transmission, patients who is in the viraemic phase (first 4 days of onset) should be protected from mosquito bites especially from Aedes species.
24. Aedes mosquito feeding time is during dawn (5.00 am to 8.00 am) and dust (5.00 pm to 8.00 pm).

I think most people will concern about the progress of disease and the treatment.. only the medical field ppl will like to know other details.. hehe

So, Chikungunya is a viral disease with symptoms almost same like Dengue Fever with no specific treatment..

From Dr Zul: ” Dulu saya medical student pun kena dengue, admit buat apa? balik minum banyak banyak air la.. masuk ward pun IV drip je~”

Made some changes since HO is 2 years now..

Consultant.. dunno when will be my turn.. hehe..

Source: Influenza A

Oh ya, in case u dont know, WHO changed the Swine Flu name to Influenza A (H1N1)..

Infected states are Selangor and Penang!!

So fast, yesterday Selangor now Penang.. No!!!

Dont go to Sarawak..

Dont go to Sibu!!!

Source: Swine FLu

OMG, i’m going to KL on 27th leh.. walao.. dont be like this ma..

The guy is currently now in Selangor Hospital..

I watched the Singapore news only know about this.. then googled and found the news from The Star dot com..

What is H1N1? You will find the answer below..

Source: Lippincott’s Illustrated Microbiology

What is Influenza Virus?

Influenza virus is a type of Negative single stranded RNA virus from family  Orthomyxoviruses.

Classification of viruses:

Continue reading »

Nowadays we can read from newspaper regarding the phases.. From 3 to 4 and now phase 5 for Swine Flu!!

So what the heck are those phases?

Source: CDC Website

The World Health Organization (WHO) has developed a global influenza preparedness plan, which defines the stages of a pandemic, outlines the role of WHO, and makes recommendations for national measures before and during a pandemic. The phases are:

Interpandemic period

Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.

Pandemic alert period

Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

Phase 6: Pandemic: increased and sustained transmission in general population.

Notes: The distinction between phases 1 and 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and other scientific parameters.

The distinction among phases 3, 4, and 5 is based on an assessment of the risk of a pandemic. Various factors and their relative importance according to current scientific knowledge may be considered. Factors may include rate of transmission, geographical location and spread, severity of illness, presence of genes from human strains (if derived from an animal strain), and other scientific parameters.