It's High Time Malaysian Doctors Ditch Neckties

The MMA made the call a few years back and then the DG was quoted to say:

…the policy of requiring doctors to wear their white coats, shirts and neckties would not change unless there was a “body of evidence” which proved that neckties caused infections to spread. It is a long established policy that we have had since Merdeka. Doctors must maintain their dignity and dress properly,” he said.

A study by Jimbo et al shows that there is indeed a High prevalence of methicillin-resistant Staphylococcus aureus (MRSA) on Malaysian doctors’ neckties.

We discovered that more than half (52%) of neckties worn by doctors were contaminated with Staphylococcus and out of these, 62% of them were identified as MRSA. In contrast, none of the student’s ties were contaminated with MRSA. Due to the high prevalence of staphylococcus detected on doctors’ neckties, we recommend that health care workers do not wear neckties.

So DG and MOH – perhaps the “dress code” for doctors should change now that there is local evidence?

This entry was taken from here. Just for Sharing. Selamat membaca! =)

Leia Mais…

Just For Sharing : Classification of Peritonitis

Syllabus Year 4 Phase 2 (Surgical Diseases)

CLASSIFICATION OF PERITONITIS

1. TYPES:

i - PRIMARY

(Causes are outside the abdominal cavity, mainly refer to haematogenic and lymphogenic. Primary is usually in children)

ii - SECONDARY

(This is the most common type. Causes are inside abdominal cavity, mainly due to intestinal bacteria invasion from digestive tract or biliary tract in case of inflammation & rupture of internal organs.

2. ETIOLOGY:

i - BACTERIAL PERITONITIS

(a) Specific - Intestinal sticks ( 65%) causes bacterial type. Most reason is acute appendicitis & acute cholecystitis which cause Secondary bacterial peritonitis.

(b) Unspecific - cause by microbes with no relation to GIT (eg. TB)

ii - ASEPTIC PERITONITIS

(Usually cause by pancreatonecrosis. The blood, bile, urine presence in the abdominal cavity and after several hours, aseptic contents become infected due to the microbial invasion from GIT. Need to treat a.s.a.p.

3. CURRENT PERITONITIS

i - ACUTE (most common in complication of the abdominal cavity)

ii - SUBACUTE (usually cause by TB)

iii - CHRONIC

4. SEVERITY

i - MODERATE (peritonitis alone without any disorder of other organ)

ii - SEVERE (peritonitis with involvement of 1 organ like liver or lung)

iii - VERY SEVERE (peritonitis with involvement of more than 1 organs)

5. INVOLVEMENT OF PERITONEUM IN INFLAMMATION (by FEDOROV)

i - LOCAL : This is involvement of only 1 region of peritoneum. It can be:

(a) Incapsulated - inflammation of 1 region of peritoneum without restriction

(b) Encapsulated - inflammation of 1 region of peritoneum with restriction like fibrin formation and intraperitoneal adhesions

ii - DISSEMINATED : This is involvement of >1 region of peritoneum. It can be:

(a) Diffuse - inflammation of 2-5 regions of peritoneum

(b) Generalized - inflammation of >5 regions of peritoneum

NB! There are all 9 regions of peritoneum!! Please revise how to draw them all!

6. PARAMETERS OF EXUDATES

i - SEROUS PERITONITIS (initial stage of peritonitis. The exudate is transparent)

ii - HAEMORRHAGIC (Only cause by 2 reasons: Pancreatonecrosis & AIO)

iii - SEROUS-FIBRINOUS (fluid with fibrin)

iv - PURULENT (fluid with pus)

Other forms also possible : Fecal, bile and etc.

7. TIME OF ONSET:

i - INITIAL GRADE ( within 24h)

ii - TOXIC GRADE (24 - 72h)

iii - TERMINAL GRADE (>72h)

_____________________________________________________________

ADDITIONAL RANDOM KNOWLEDGES, THAT YOU MUST KNOW:

What is the peculiarities of URGENT HERNIOPLASTY

(like in strangulated hernia)?

We must not cut the hernial ring, but need to open the hernial sac, fix and check the content!

What is the peculiarities of HERNIOPLASTY by LEINSTEIN?

Use the POLYPROPYLENE mash and must not apply any TENSION

That's all. Good luck. Tawakkal alaAllah.

'Let us forget about exam, but focus on study'

Leia Mais…

Just For Sharing : McBurney's Incision for Appendicectomy

*Sorry this picture's quality is not so good =(

HOW TO DRAW THE INCISION?

1. Draw a single line from UMBILICUS to the RIGHT ANT.SUP. ILIAC SPINE

2. Divide this line (blue in colour) into 3 parts equally.

3. Then, at the point of INFERIOR 1/3 of this line, draw a single line (red in colour) perpendicularly to the blue line.

4. This red line is the McBurney incision line for Appendicectomy.

5. The length of this incision line MUST be 1/3 superior and 2/3 inferior to the blue line that you drew.

6. One more important thing is, this incision line should be PARALLEL to the INGUINAL LIGAMENT!

That's all. Good luck! Tawakkal alaAllah. =)

Leia Mais…

Just For Sharing : Classification of Acute Intestinal Obstruction

Syllibus Year 4 Phase II (Surgical Diseases)

CLASSIFICATION OF ACUTE INTESTINAL OBSTRUCTION (AIO)

1. STAGES :

I - Impairment of passage

II - Disturbance of microcirculation

III - Peritonitis & necrosis

2. ORIGIN:

I - Congenital (eg: Complete atresia of SI, LI, anus & sclerosis)

II - Acquired (eg: Malignant tumour, trauma, bile stones ileus)

3. MECHANISM:

i. Mechanical

a) Obturation

(eg: Tumour, Foreign body, Gall stone)

b) Strangulation

(eg: Irreducible strangulated hernia, volvulus 0r mesentery twist)

Characteristic: Formation of knots or coils of SI loops with each others.

c) Mix

(eg: Invagination, adhesion)

Characteristic: Invagination (proximal part comes to distal part). This invagination is called as intersusception. Usually in children.

In adult, there are usually adhesion.

Causes of adhesion: Trauma of peritoneum, peritonitis, post-op.

Eg. of post-op that causes adhesion:

- Appendicectomy (adhesion at Right Iliac Region)

- Splenectomy (adhesion of Left Hypochondrium)

ii. Dynamic

a) Spastic (eg: Spinal cord trauma, poisonings)

b) Paralytic

(This is typical AIO. Causes: Complication of urgent abdominal diseases, eg: Peritonitis, Pancreatitis, etc.)

4. LEVEL OF OBSTRUCTION

i. High (SI)

ii. Lower (LI)

5. CLINICAL STATES OF PATIENT

i. Acute (eg: adhesion, strangulation)

ii. Chronic (eg: tumour)

6. CONDITION OF INTESTINES

i. Complete obstruction

ii. Partial obstruction

_____________________________________________________________

CONCLUSIONS:

1. There are 3 types of mechanical AIO:

I - Acute Mechanical Obturation IO

II - Acute Mechanical Strangulation IO

III - Acute Mechanical Mix IO

2. There are 2 types of dynamic AIO:

I - Acute Dynamic Spastic IO

II - Acute Dynamic Paralytic IO (typical)

NB!

STRANGULATION - Needs IMMEDIATE SURGERY!

OBTURATION - You have 4 HOURS to OPERATE!

That's all. Good luck. Tawakkal alaAllah =)

Leia Mais…

Medical CASE 1

A 45-year-old woman presents to the emergency department with bleeding gums and bruises on both forearms for the last 2 days. For the preceding 10 days she had been experiencing a high fever (which has since broken) and rigors. In addition, she complains of a rash over both forearms, but she is unable to further characterize it. She noted severe pain in both legs during the febrile portion of her illness. There was no history of hematuria, melena, cough, or hemoptysis. She is not taking any routine prescription medications or using over-the-counter products or supplements. She has no known drug allergies. She is married with 5 children and is currently unemployed. She does not smoke or drink alcohol and has no history of drug abuse. There is no travel history or any history of sick contacts. She is a resident of Pakistan.

On physical examination, she is alert and apparently well developed and well nourished. The patient has a regular pulse of 90 bpm and a respiratory rate of 14 breaths/min. Her temperature is 98.2° F (36.8° C) and blood pressure is 110/70 mm Hg. The cardiac examination reveals a normal S1 and S2, with no murmur, gallop, or rub. Auscultation of the lungs is normal, and no palpable organomegaly or tenderness is found on abdominal examination. Examination of the extremities reveals large bruises and a petechial rash across both forearms and lower extremities (Figure 1; the image shown is an example of the rash seen). Conjunctival hemorrhages are noted bilaterally. Bruises are also apparent on her soft palate, and minor trauma from oral examination results in gingival hemorrhage.

The laboratory investigation reveals a hemoglobin of 8 g/dL (80 g/L), platelet count of 11 × 10³/µL (11 × 10⁹/L), and a white blood cell count of 1.8 × 10³/µL (1.8 × 10⁹/L). Her serum blood urea nitrogen, creatinine, liver function tests, albumin, and electrolytes are normal. Coagulation studies, including a prothrombin time, activated partial thromboplastin time, fibrin degradation products, and serum fibrinogen, are normal. Blood cultures do not show any growth. Urine analysis and urine culture result negative. Posteroanterior and lateral chest radiographs, as well as abdominal ultrasonography, are unrevealing.

Based on the clinical presentation and physical examination, which of the following is the most likely diagnosis?

Hint: Bruises, conjunctival hemorrhages, and depressed cell lines in a postfebrile patient with a rash.

Leptospirosis

Meningococcemia

Plasmodium falciparum malaria

Typhoid fever

Dengue hemorrhagic fever

Leia Mais…

Books For All! [Part 2]

Salam Brothers & Sisters.

This post is specially regarded to future 3rd and 4th course medics (especially to all my brothers ikhwah in Volgograd State Medical University..hehehe).

Anyway, 3rd course medic is the last preclinical years, and it is actually semi-clinical. Students have to set up your mind, to make your vision of studying more in clinical environment and conveniently.

Remember! Clinical medics are somehow differ from your previous preclinical 'kindergarten'. You have to struggle more on understanding than just memorizing the facts, and you need to know deep down all the basics. It isn't too difficult, we will always help you and be by your side. As for me, the very first step is that you need to know how the environment (bi'ah) can help you to proceed more further.

Recommended books for 3rd course medics:

1. PHARMACOLOGY Lippincott's Illustrated Review

'Same as Biochemistry, this kind of book makes our focus on Pharmacology more comfortable because of its illustrated reviews. Nevertheless, it isn't too details in explanation. The more comprehensive and topmost Pharmacology book of all centuries is below....'

2. PHARMACOLOGY by Kharkevitch

'This book as for me, is an award-winning for Pharmacology aspect. It is so comprehensive, the details are very easy to understand. But, you must have your time to catch up with them, of course. You may borrow this new book from the library. Or just buy it for your future basic knowledge. I miss this book a lot...hehehe'

3. OXFORD HANDBOOK OF CLINICAL MEDICINE 8th Edition

'This is the latest OHCM. But don't worry if you couldn't find it at Kamal Bookstore, the former 7th edition is still in high validity as though. I would like to recommend this book as early as you are in 3rd course, because you need to 'mix' the content with your mind chronically. By the end of 3rd year, you will partially understand it, and during your 4th course you will fully get it! Make it as your favourite one'

4. PATHOLOGY by HARSH MOHAN

'This is the thickest book of mine! This pathology book has a lot of pictures and explanations. It can be used to cover up your study in both Pathological Anatomy and Pathological Physiology during your 3rd course. Roughly, this book brings you to think and develop your ideas of medical-oriented knowledges. If you don't wish to buy it (because it is so thick and heavy), you may consider to get it from your seniors. They will surely let you have one! insyaAllah.'

*This is not the real picture

Other books you may find and borrow from the library. For Therapy and Surgery, you will just need the textbooks from our university plus with lecture's notes as well. Do attend the lectures!

That is all so far. For future 4th course medics, I am still updating your recommended books. Tawakkal 'alaAllah

Leia Mais…

Books For All! [Part 1]

Salam Brothers & Sisters.

These are some sorts of books that you are highly recommended to have by your own. They can be bought anywhere (even via Amazon.com) but mostly available at Kamal Bookstore Kuala Lumpur, and the prices there also much more cheaper.

Books for 2nd course medic:

1. ATLAS OF HISTOLOGY with Functional Correlation XI Edition

"This is the latest Atlas of Histology by Victor P. Erochenko. Excellence informations, with histologic pictures"












2. ATLAS OF HUMAN ANATOMY by FRANK NETTER IV EDITION

"Atlas of Human Anatomy is a very basic book that a medical student must have one! This Netter atlas will help you not just to know the basis of medic, but through your journey in the medical field forever in your life"










3. MEDICAL PHYSIOLOGY by JAYPEE




"Simple, understandable and comprehensive"

NB! This is not the latest edition! This is the old picture.

4. BIOCHEMISTRY Lippincott's Ilustrated Reviews

"This book much more simple because of its illustration. You will learn biochem with 'arts'! But as for me, the main book still the one that you must borrow from the library"

My next post will be regarded to 3rd course and 4th course medics. That is all, so far. Tawakkal 'alaAllah.

Leia Mais…