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Friday, May 25, 2012

garisan-garisan kehidupan

"awak study tau elok2",pesanan sblm si dia tidur.
Pesanan mcm takde masalah pape..semua yg dibincangkan tadi mcm tak pernah sebut..pelik juga,die ni dah lupa ke ape yg  dicakapkan td.Perasaan ni dah bercampur-baur dah ni.Geram,marah,sakit hati,terasa,sedih..weh esok aku exam kot..kau faham x? time2 cmnilah jugak kau nk cari masalah dgn aku kan.


haishhh...


 Tak slh klu cemburu tp jgn terlebih2 dlm mencemburui org.huh?? did i look so desperate?aku mmg kenal si dia sbb si dia mmg seorg yg sgt bersmgt setiakwn,whatever happened,he will never put the blame to his friends..his friends are always right..so that make my part so tiny..i just feel,i have no rights to say anything bout his friends.so,thats the issue.


Culture malaysia yg bebas,tak akan pernah sama dgn mesir which is kau akan ternganga besar kalau kau cakap "weh aku jeles tgk kau keluar dgn die and lg satu kau tu dah berpunya,mana bleh lepak2 cmni" org yg mendgr ayat ni akan ckp cmni blk kt kau "hello,aku ngn die ni kawan jelah..ade bf/gf or suami/bini ke,takkan xleh kuar dgn kawan2,asal sempit sgt kau ni?" Haa,kau nk jawab ape? yang kau boleh buat is sabar dan bersangka baik. lagi satu,ko kena percaya la dkt sumone yg buat kau mcm tu..minta2 la kepercayaan kau tu tak disalahguna kan oleh si dia.. aku geram nak cakap,its a BIG thing ok,klu u dah ade sumone,then u pergi cari sumone else utk luahkan mslh u,which is tak patut sesangat sbb nnt,tak kau yg sakit,partner kau tu yg sakit..lepas tu,kawan kau yg x berslh tu plak yg sakit..weiii,byk org kot yang akan sakit kalau kite buat perangai huru-hara cmni. cuba hormat dan faham perasaan orang lain and think before u do something.kadang2 kita tak sedar pun,kita dah sakitkan hati orang lain atas kegembiraan kita bercerita dgn org lain. Aku bukan nk cakap culture kt mesir ni baik sgt tp semua org ptt ade mindset cmni :  kalau kau dah ada suami/isteri,die je tmpat kau nk luahkan masalah,selain parents kita kalau mslh dah chronic sgt..Bukannye kau pergi cari kawan2 kau,teman2 lama kau,g cter mslh sume..think others feeling too !! aku cakap cmni sbb aku taknak sesape pun jadi perampas..kalau dlm dunia ni,semua org boleh ade mindset cmni,insyaAllah,istilah "perampas" tu takkan wujud.

Sunday, May 20, 2012

systemic lupus erythematosus SLE


huh,tajuk xleh nk gempak lagi ? pernah dgr psl SLE? Dulu pernah kena tnye what is SLE? mase tu cek x blaja lg ape bnda binatang SLE ni...sekarang ni baru thu ape tu SLE ...bunyi mcm simple just sekadar S L E ..tp penyakit ni seriously,memang bahaya.. jgn judge nme penyakit cm pendek tp x teruk..cm HIV jgk,3 huruf,pendek je,tapi boleh bw maut...

TANDA2 SLE :
  • malar rash - sejenis ruam dkt muka,bentuk seakan2 butterfly ( eryhematous rash over the cheek and nasal bridge ,sparing of the nasolabial fold)
  • discoid rash- plaque like lesion,eryhematous base,scales,scarring,pigmentations,telangctasia)
  • photosensitivity - sensitif dgn cahaya matahari (macular or diffusely erythematous rash in sun exposed areas)
  • oral ulcers - 
  • arthritis (sakit sendi ) non erosive 2 or more joints affected
  • serositis - pleuritis or pericarditis
  • renal disorder- proteinuria,cellular cast (ade protein dlm urine)
  • neurological disorder- seizures,psychosis
  • hematologic disorder- hemolytic anemia,leucopenia,lymphopenia or thrombocytopenia
  • immunologic disorder- positive LE cells
  •                                 - antidsDNA
  •                                 -ant-sm
  •                                 -false positive VDRL
  • antinuclear antibody ANA
at least,ade 4 dari sume tanda2 ni,diagnostic utk seseorang tu ade SLE 

saje je letak tanda2 SLE ni dulu sbb nk bg korg cek korg ade x tanda2 ni..mnta dijauhkan la yea..sbb SLE ni penyakit autoimmune,dimana kita sendiri tak tahu kenapa boleh jd camtu..
autoimmune ni sejenis proses dlm badan kita yang kita tak minta pun die jd cmtu,die jadi tiba2 tanpa punca die pun kita tak tahu.. maksudnye camni.. 
dalam badan kita ada antibody utk lawan kuman2,nk pastikan badan kita ni sihat..tapi dlm kes autoimmune ni,antibody yg baik tu serang badan kita instead sepatutnye die bunuh kuman,tp slowly die bunuh badan kita sendiri..tu secara simple jelah..byk lg proses autoimmune ni,tp cukup la tu je utk memahamkn korg.

What is SLE ? SLE is an autoimmune disorders that involve multi-system microvascular inflammation with generation of auto-antibodies.common in young female (15-30years old) ratio 9:1 to male

causes- genetic,environment ( infections,sun exposure,drugs - SLE like condition--> INH,Hydralazine,Procainamide,ppt attack of SLE - sulphadiazine,tetracycline,OCP,penicillamine STOP !,immune disturbances- positive LE cells,autoantibodies,endocrinal disorders- increase during 1st trimester and post partum,OCP and ovulation inhibitor

ok,point2 yang akan ditulis selepas ini adalah untuk saya sendiri yg bace yea.nak test diri sendiri dah igt belum ape yg dibace..klu x fhm,try search sendiri klu teringin nak tahu..sy nk hafal ni :) 
 
clinical picture of SLE
3S + body systems ( infection and thrombosis) from above-downward

S- systemic : low grade fever,weakness,tachycardia,weight loss,anorexia,malaise
S- skeletal : arthralgia>arthritis ,affect small joint of the hands and wrist-knee,but NO deformity (if deformity occur - Jaccouds artropathy -chronis arthritis and tendonitis (non-erosive hand deformities 10%), fibromyalgia -generalised widespread pain,arthralgia and myalgia,aseptic necrosis of head of femur,osteoporosis) myalgia
S- skin - R- raynauds phenomenon (blue,white,red colour change at Distal digital tips)
               M- malar rash
               A- alopecia (temporal regions or patchy patterns)
               D- discoid rash
               Vitiligo
               photosensitivity
              fingers- ulcers,peri ungual erythema
              purpura
body systems - from above to downward
CNS - ASEPTIC MENINGITIS,FOCAL NEUROLOGICAL DEFICIT,TIA
EYE- SJOGREN SYNDROME,CONJUNCTIVITIS,CYSTOID BODIES,RETINAL INFARCTION
CHEST- PULM HTN,PULM.INFARCTION,SEROSITIS,DYPSNEA
CVS- PERICARDITIS,PERICARDIAL EFFUSION,ASEPTIC ENDOCARDITIS,IHD&THROMBOSIS
GIT- ABD PAIN,PERITONITIS,PANCREATITIS,MASENTRIC VASCULITIS,BOWEL INFARCTION,JAUNDICE,painless mouth ulcer,DIARHHEA,BLEEDING PER RECTUM
RENAL- LUPUS NEPHRITIS,LUPUS NEPHROPATHY
HEMATOLOGICAL- LEUCOPENIA,LYMPOPENIA,ANEMIA,THROMBOCYTOPENIA,ANTIPHOSPHOLIPIDS-ABORTION,THROMBOSIS
RES- HSM,PAINLESS GENERALISED LYMPHADENOPATHY

INVESTIGATIONS-  
  1. lab- blood picture-pancy,bicyto,monocytopenia
  2. increased ESR
  3. increased bleeding time and coagulation time
  4. decreased C3,C4
  5. RH, factor +ve 15%
  6. LE cells 85%
  7. immunological -  diagnostic - ANA, antidsDNA,anti-sm
  8.                           - Ab aginst blood-  anticardiolipin,anti-cell AB,anticoagulation fx antibody,+ve Coombs test
  9.                           other- false +ve sor syphilis,anti-thyroid Ab
  10. others - urine analysis,ECG,xray,joint xray,biosy-renal wire loop appearance
TREATMENT :
  • PROPHYLAXIS - AVOID DRUGS,AVOID PSORALIN RICH DIET,EMOTIONAL SUPPORT
  • NSAIDS- PAINS RELIEF FOR SEROSITIS,ARTHALGIA,FEVER
  • CORTICOSTEROIDS- TOPICAL N SYSTEMICS, PREDNISONE 1-2MG/KG/DAY,METHYL PREDNISOLONE 1GM/D FOR 3 DAYS OR 0.5GM/D FOR 5 DAYS (SEVERE LUPUS)
  • IMMUNOSUPPRESANT- CYCLOPHOSPHAMIDE,METHOTREXATE,AZATHIOPRINE ( SEVERE CASES AND REFRACTORY TO STEROID
  • CHLOROQUINE - PREVENT AND TREAT LUPUS SKIN RASHES,ARTRALGIA AND ARTHRITIS
  • COMPLICATION TTT- HTN,INFECTION
  • PLASMAPHORESIS- NEPHRITIS AND ENCEPHALITIS (REMOVE IMMUNE COMPLEXES FROM PATIENT BLOOD BY REPLACING IT WITH FRSH FROZEN PLASMA OR ALBUMIN

ok,alhamdulillah..selesai dah notes SLE sy...semoga igt yea aisyah ! ok,nak tidur dulu..nite... :)

sakit osteoarthritis ke saya ni ? ?

what is osteoarthritis? rasa terpanggil utk cerita psl penyakit ni sbb rasenye diri ini mcm menghidapinya..well,medical student mmg sll PSYCO.. (nauzubillah,minta dijauhkn) aisyah xde skt ni tp sbb lutut die ade byi kruuukkkk kreeekk die rse die ade..tp tu xde pape pun.


 ok2... osteoarthiritis atau dlm bahasa org kampung pnggil skt2 sendi..lenguh2 gitu especially kt lutut..haa..mst sume rse diri die ade skt ni kn? yelah sbb ipu la klu kte x pnh skt lutut kn? tapi x sume skt lutut tu dipanggil osteoartritis..die kena ade beberapa tanda dan ujian utk confirmkn die mmg ade,bru sah anda menghidapinye.. can i speak in my language? i x reti la nk membahasamelayu kn istilah medic..tp i try buat u all fhm la istilah2 yg cm ssh yeh.firstly,aetiology osteoarthiritis ni ade 2 - 1ry and 2ry1ry - commonly genetic (from mother to daughter)         affect all the sendi KECUALI wrist joint         DISTAL INTERPHALANGEAL JOINT PUN AFFECTED dimana ia adalah point utk bezakn skt   ni  dgn skt rheumatoid arthritis2ry- commonly affect KNEE joint tp boleh je nk affect joint2 lain. antara penyebab2 die  ( Rheumatoid arthritis,obesity,joint trauma,infections,endocrinal-hyperparatyroidism,DM,acromegally,metabolic-hemachromatosis)tanda2 osteoarthritis 
  •  pain & stiffness ( <30 mins,increase by activity, decreased by rest )
  • crepitus (nilah bunyi krukkkkk krekkkkkk yg kt sendi tu klu kte try gerak2 kn die...sll nye dpt rse mcm ade geseran antara 2 permukaan) tenderness,decrease range of mov.
  • wasting of muscles around the joint
  • minimal deformities
  • NO systemic manifestations - mksdnye xde demam,xde skt2 batuk ke selsema ke,tetbe skt lnguh2..
  • 2 nodules - heberden nodules kt DIP
  •                - bouchard nodules kt PIP
penyiasatan untuk membuktikan osteoarthritis 
  • sume test kt lab normal
  • x-ray - sclerosis at the edge of the joint (sub-chondrial joint)
  •         - osteophytes ( new bone formation)
  •          -bone cysts
  • MRI - most accurate
treatment :1. kalau berat terlebih,sila kurangkn berat badan untuk mengelakkn sendi tu x dpt tampung berat bdn yg brt tu..2.analgesics - decrease the pain NSAIDS3. physiotherapy if muscle wasting appear4.surgical - osteotomy,arthroplasty (sume operation sllnye xde affect utk treat disease ni)
pesanan penaja utk penghidap osteoarthiritis 
  • jangan baring atau duduk terlalu lama dlm satu posisi
  •  jangan guna kerusi yg rendah
  • jangan berdiri dalam posisi yang sama atau berjalan dlm tempoh yang lama
  • jangan mencangkung terlalu lama
  • jangan bg sendi kita buat kerja terlebih2
  • pastikan postur badan kita dalam keadaan betul untuk elak sendi2 kita over stressed
  • jangan buat kerja berat
sakit ni dekat2 sgt tanda die dgn rheumatoid artritis so,tolg jgn tertukar... rheumatoid tu skt autoimmune tp yg ni skt sbb dh tua :)