The Most Productive Year of My Life

1. I had memorable days working as Medical Officer in Kangar. Kangar is the principal town, the capital of Perlis. It was the placement that I was looking forward. Since my kampung is near to Kangar, it was an opportunity to go back home every week.

2. The Kangar town itself was only lively during the daytime. The market area where I used to walk with Yusry when we were in Year 3 Medic school, used to be busy. Motorcycles screamed. Van and lorry drivers honked every now and then, looking for space to park and unload their goods. Cars yelped and hooted; pedestrians leaped for their safety.

3. I remember that I had to walk from the bus station to Yusry’s house which distance was about 1-1.5 km, across the small bridge and passing in front of Dr. Hamid Pawanteh’s clinic before reaching his parents’ home. Those days, street used to be placid and docile.

4. When my dad was admitted to Kangar General Hospital in the 60s, Kangar was a quiet place of greensward and old shophouses. Kangar used to be chilled by a constant breeze of cool air from the Andaman Sea but unfortunately, lately, Kangar is flooded by water released from Timah Tasoh dam, fairly regularly.

5. When I was in Kangar, Timah Tasoh Dam was under construction. I had to use the old trunk road to Padang Besar. I still remember giving a talk to patients in Felda Mata Air, on the way to Padang Besar on special request from the Health Centre. I hope my memory serves me right on this matter after 30 over years it had taken place.

6. Perlis itself has many limestone hills. They look like elephant and indigo against the earth surface. From Kangar to Kuala Perlis, the horizon was marked by the viridian turned golden fields of padi which later ready to be harvested.

7. The new expressway from Changloon to Kuala Perlis has taken over the function of old trunk road that I’d used to drive from Arau-Kodiang-Padang Sera-Pauh to Changloon. Kodiang is famous for its pasembur which kedai is located near the bus station while Padang Sera is famous for the wat Siam called Wat Boonyaram. Those days, Pauh was so ulu (remote) with only one private clinic owned by my ex-colleague in Hospital Kangar, Dr. Maniam.

8. It was here in Kangar that I master my O+G skills. Life as a Medical Officer was less enjoyable compared to Houseman. This was due to the fact that I had to bear heavy responsibilities dealing with patients’ safety. I remember very well dealing with an emergency case of uterine inversion following manual removal of placenta. It was the most senior MO that guided me through during the difficult time.

9. The best part of the posting was performing LSCS. I am pretty sure, if I were to keep a log book, there were hundreds of them performed during the posting. We never go home before six every day. It was the most productive year of my life.

Lower Section Caesarian Section (LSCS) is an operation to deliver a baby

Study on Bilingualism

1. Studies in bilingualism come from 3 main disciplines; psychology, applied linguistics, and education. Psychologists are interested in brain functioning and cognitive processing, linguists are interested in the way individuals and groups develop and use language and educationists are interested in language teaching and learning in classroom settings as well as assessment.

2. Memory can be divided into echoic memory, short-term (working) memory and long-term memory. Long-term memory can be subdivided into episodic, semantic, procedural and declarative. In the same way, multiple languages in a brain can be divided into separate language systems. It means each language system in the brain of a multilingual can be represented by systems that are able to function independently of the other language systems.

3. Unilingual structure in the brain of a monolingual user consists of separate subsystems, namely the phonological, orthographical, syntactical, contextual and lexical systems. Modularity theory posits that even though these different subsystems work together in a single language system, they are independent of each other. Language processor is modular; (meaning it is designed with standardized units or dimensions) as for easy assembly and repair or flexible arrangement and use, whereas episodic memory is non-modular; and it is sensitive to the intention to learn and to other motivational variation.

4. The level of lexical representations was traditionally thought to refer to the semantic description of individual words.

5. One of the earliest bilingual models classifying bilinguals into coordinate bilingualism, sub-coordinate bilingualism or compound bilingualism.

6. In coordinate bilingualism, the word of 2 languages are kept separate in different conceptual systems and each word (in each language) has its own specific meaning. In this case, the languages are independent of each other. In sub-coordinate bilingualism, the first language takes the position of the dominant linguistic system and the linguistic system of the second language is attached to that of the first language. In compound bilingualism, the word of both languages are attached to the same mental representation; i.e. 2 different verbal labels are attached to a single concept. In this case, the languages are interdependent only at the conceptual level.

By: Hong Ee-Li & Rita E. Silver.

Declaration: This is based on my reading of the article entitled The Psychology of Bilingual language Acquisition. Written by: Hong Ee Li & Rita E. Silver. The whole passage is taken right from this article, courtesy to these authors. It is shared for the purpose of dissemination of knowledge. No profit motive involved.

Generating Mental Wellbeing

1. Can we generate mental wellbeing? Yes. Why not…

2. Mental wellbeing can be generated through a conscious act of empowering self-efficacy and therefore reducing dependency and creating less burden to the society.

3. It can be promoted by various steps including:
-balance diet
-Adequate rest and sleep
-Relaxation and avoidance of excessive stress
-Avoid taking illicit substances, caffeine, and alcohol

4. Imam al-Ghazali had mentioned in his book regarding 10 features that come under the commendable trait (sifat-sifat mahmudah). In contrast to the commendable trait, he had also suggested another 10 features of the reprehensible trait (sifat-sifat mazmumah).

5. The commendable trait includes repent, scare (to Allah), ascetic, patience, thankful, sincere, tawakkal (trust), mahabbah (love), redza and remembrance of death. On the other hand, the reprehensible trait includes binge-eating, talk a lot, angry, jealousy, stingy, majestic feeling, love the world and its content, pride, and show-off.

6. Prayers indeed have a lot of stress-reducing elements. Conscientious prayer can be achieved by making sure that you are fully ready for the ibadah at the time of wudhu’, understanding the meaning of Arabic prayers uttered, empty the mind from worldly affairs, thinking as if you are praying for the last time in your life, taking care of the food, the cloth, and the home and making sure they are derived from solely halal sources, scare of God and finally by joining the congregate prayers.

7. The protective factors for healthy mental well-being include sound physical health, stable and productive career, sound financial health, supportive family, and friends.

8. Those are the gests of my talk delivered at the World Mental Health Day, 2011 at the Nuclear Medicine Auditorium, HUSM on October 24th, 2011.

Organ Hunters

1. Story from a second-hand book I am reading: Organ Hunters. The writer is Gordon Thomas.

2. Dr. Gustav Romer, once the heated Stasi’s medical supremo and the world leading immunologist, has long been thought dead. But in a secret clinic on a remote island off the coast of Central America, his medical genius has found new and terrifying applications. His patients are the world criminal elite: Mafia bosses, Triad leaders, the new czars of the Russian criminal fraternity, the lord of the Japanese underworld.

3. For them, Romer provides organ transplants. And the organ themselves come from the bodies of victims especially killed for that purpose.

4. Only one man can stop the sinister trade in death – David Morton of Hammer Force, the police agency created by the United Nations. But, and his shadowy employer, the woman known only as Madam, may prove to be Morton most dangerous opponent yet….


NSAIDs increase the risk of heart attack

1. A new international study finds that popular painkillers or anti-inflammatories know as NSAIDs can increase the risk of heart attack or stroke by a third, with some having a much stronger effect than others, and size of the dose also making a difference. However, experts urge patients worried about the findings not to give up on their NSAID medication and to speak to their doctor about their concerns.

2. Researchers from Hull York Medical School (HYMS), a joint venture between the Universities of Hull and York and the NHS in the UK and the Institute for Clinical Evaluative Sciences in Canada, systematically reviewed 51 large-scale studies of non-steroidal, anti-inflammatory drug (NSAID) conducted in Europe, USA, Canada and Australia. Their findings are published online this week the journal PLoS Medicine.

3. They found that patients with heart problems who used NSAIDs, including diclofenac and indomethacin, had a significantly higher risk of serious cardiovascular events such as heart attack and stroke compared to patients who did not.

4. Even in doses available over the counter without a doctor’s prescription, diclofenac could raise someone’s risk of heart attack or stroke, they said.

5. However, other common NSAIDs, including naproxen and low doses of ibuprofen do not appear to be linked to an increase in risk.

6. Lead researcher Dr. Patricia McGettigan from HYMS told the press that:

7. “NSAIDs provide pain relief for millions of patients with chronic inflammatory disorders. The cardiovascular risk is well described but often overlooked. In choosing which one of the many available NSAIDs to use, patients and doctors would benefit from the knowledge of the balance between benefit and harm for individual NSAIDs.”

8. Many people use NSAIDs in both over the counter and prescription form for pain relief and for their anti-inflammatory effects to treat conditions such as headaches, arthritis, back pain, gout, and the aches and fever of flu.

9. In 2010 in England alone, GPs wrote out nearly 17 million prescriptions for NSAIDs, that is one for every three people in the country. Of these, nearly 6 million, more than a third, were for diclofenac; 5 million were for ibuprofen and 3 million were for naproxen. All of these can also be bought without a prescription.

10. The researchers found that for the most commonly used NSAIDs, the highest risk was seen with diclofenac, which overall was linked to an increased risk of 40% for a cardiovascular event like a heart attack or stroke, compared with non-use.

11. This means that for a person with a 5% or more background risk of a cardiovascular event (typically someone with diabetes, a history of heart problems and high blood pressure), taking diclofenac would most likely increase that risk to over 7%, explained McGettigan:

12. “In other words, one in 50 such patients might suffer an avoidable heart attack. This is important information in making choices, particularly if there is a safer alternative,” she added.

13. In contrast, a healthy young person with an annual risk of heart attack or stroke of under 0.1% will experience a negligible increase in risk from taking any of the commonly used NSAIDs, said McGettigan.

14. The researchers found that the lowest risks were with naproxen and low doses of ibuprofen: they weren’t linked to increased cardiovascular risks. But, they did find when ibuprofen daily doses exceeded 1200 mg a day, it was linked to an 80% higher risk.

15. For diclofenac, the link was there at both high and low dose: with a near doubling of increased risk at the higher dose.

16. The safest NSAID, as far as the effect on cardiovascular risk is concerned, appears to be naproxen. Neither low nor high doses of this were linked to increased risk.

17. The researchers also looked at the newer types of NSAIDs, the Cox-2 selective; these are available only on prescription. They found these newer NSAIDs are also linked to raised cardiovascular risks.

18. For instance, Rofecoxib, which was taken off the market worldwide in September 2004 because of its cardiovascular risks, was linked to an increase in the risk of 45%.

19. Of the newer NSAIDs on the UK market, the researchers found that celecoxib was tied to an increase in risk at both low and high doses and etoricoxib appeared to raise risk more than celecoxib.

20. Indomethacin, an old NSAID that is still popular for the treatment of gout, was linked to a raised cardiovascular risk of 30%. The drug also has other side effects, which together with this new finding should make its clinical use even more questionable, said the researchers.

21. One of the drawbacks of NSAIDs is that they raise the risk of gastrointestinal ulcers, which can be reduced by taking anti-ulcer drugs like omeprazole. But you can’t do this for the cardiovascular risk, so this is another reason why it is important to have these comparisons to hand when giving patients advice, said McGettigan.

22. “New NSAIDs like celecoxib were developed to have a much lower risk of gastrointestinal ulcers compared with older drugs like ibuprofen, diclofenac, and naproxen. They achieved this, but as the review finds, they do not have lower cardiovascular risks,” she warned.

23. The British Heart Foundation (BHF) urged patients who are already taking NSAIDs and are worried by these findings not to simply give up on their medication.

24. “As with any medicine there are benefits and potential risks to taking painkillers,” said Doireann Maddock, Senior Cardiac Nurse at BHF, “You should always speak to your doctor first because the benefits may well outweigh the risks for you.”

25. She explained that we have known for some time that certain painkillers are risky for heart patients and the findings of this new study should not be ignored.

26. “But scientists and drug regulators will need to delve deeper before we draw any firm conclusions about these drugs and their side effects,” she said.

Written by Catharine Paddock PhD
Courtesy: Medical News Today

My Houseman Days in Taiping

1. I did my housemanship training in Taiping, a small town which means ‘peace’ in Chinese. It has a small idle mining pond which my friend Mokhtar, my senior Pak Wan and I used to fish. It was before Sahak came and join us. If I remember correctly, the mining pond was located somewhere behind Taman Makmur. Mind you, Taman Makmur is famous for its pasar malam which we used to visit, queuing up to buy apam balik and well-marinated satay. It is just around Assam Kumbang (if my long-term memory is pretty much intact) next to the main road which brings you to Jalan Simpang next to petrol station.

2. Taiping has hardly changed since independence. It has colonial trademark; very similar to Muar.  The examples of such trademark are colonial schools such as St George & King Edward, a large municipal field next to the Municipal building and the most noticeable one is Taiping Lake garden which is situated just in the valley of Maxwell Hill. The lake garden is the place where Sahak and I practiced kayak; at least once in my lifetime.

3. How did Taiping withstand the test of time? I think, first and foremost, Taiping is bypassed by the old North-South trunk road. Therefore, the express buses have to stop at Simpang and seldom encroach right to the middle of the town. Now the new North-South (NS) Expressway has bypassed the town again, leaving behind car drivers who are craving for durian, to shop at the nearest Hentian Bukit Gantang stalls, thus bypassing the town and its legends.

4. It was during houseman time that my Surgeon, a big Punjabi man, used to have regular rounds with us around the hospital. It worked to our benefit as the round used to end up with a big feast. Menus were tosai, capati, naan and some typical Indian foodies like vadai and samoza. The foods were served by a big fat Indian sister. It was the time when I really enjoyed free Indian cuisine as never before. Those days, there were only a few housemen in each department. We worked, did some mistakes, laughed about them and the learning was done through apprenticeship.

5. We were competing with each other to make a breakthrough in our semi-professional operating skills. Those who were good would be allowed to do the operation. I did my first appendicectomy with assistance from a senior nurse, SN Puziah. OT staffs were so helpful, all those years. We were like adik beradik, brother, and sister.

6. As a young doctor, I remember attending to a young petite girl who had just skid off her motorbike and suffered from bruises and injury all over her body. As I was cleaning and did toilet and suturing, I noticed a different kind of bruises around the neck area. A senior nurse asked me whether I had noticing them. Yes, I did. What are they? I asked the nurse. Later that I learned, they were love bites. I had to be excused because I was young, single and innocent at the time. The point is mat and minah rempit exist even some 20-30 years ago. It is not a new phenomenon as many used to think.

7. The cultural shock that we housemen found in the OT those days was people were dirty minded. They uttered dirty words freely. We, the very young ones are always been victims of some kind of sexual harassment. We learned to adapt and adopt, and at the end of the day, we became tolerant of the culture of free and easy. Now when I think about it, I can just simply think of stress management as an excuse.

8. I’d still remember organizing mass circumcision in Kamunting Army Camp. During our time, young housemen were already equipped with competent surgical skills to do the mass circumcision. How do we make ourselves competent? We learned from a senior medical assistant, who in the beginning was reluctant to pass on the knowledge but with perseverance, he was convinced to share his knowledge for the benefit of the ummah. Those days, the surgeon didn’t teach us circumcision. We got to find our own guru.

9. A lady physician was a single, middle-aged, forty-something, strict, implosive grande dame. She cursed for any mistakes we made. To her, we were either useless or had no brain. We knew her weaknesses and we played the public relation well. To minimize her amuk, we tried as far as possible to impress her from the first day of our posting. That seemed to work well, at least for me, except on an occasion when I missed reviewing total white counts on an adolescent with leukemia.

Race Against Time

1. I was searching around if iPhone price has reduced since the introduction of iPhone4s. Unfortunately the answer is no. A store assistant was smiling when I posed her the question; 4S is no where to be seen, she said. Homo sapiens are searching for technology as never before. Yet, we are left behind in the race for technological supremacy. Are we the master or servant of technology when each time technology change; we are the one who are racing against time.

2. If you are a businessman who always on the look for the business opportunity; here is the figure. Over the next 10 years, number of people online doubles from 2 billion to 4 billion. Very much so, the number of internet linked devices quadruples from 5 to 20 billion. Those data speak for themselves. Any opportunity in the future is on the way people connect and use internet for social and educational purposes.

3. It is therefore very clear that people are racing against time. The speed with which new technologies have been adopted by us all, in general, has increased many folds. Those who are young, affordable and techno-savvy, the turn over of using the ever-changing technology is much higher.

Action, please?

Stress in Malaysian Students

1. Back from attending a workshop with medical students on stress. Questionnaires were distributed; students were mapped on sources of stress and how they cope with it. Before it was just delivering lectures which I refuse to give any more.

‘Stress level among school students high’

PUTRAJAYA: The Health Ministry’s pilot project ‘Healthy Mind Programme Dealing with Stress Among School Children’ shows the stress level among students is high.

Its minister Datuk Seri Liow Tiong Lai said out of 6,540 students screened, 17.1 per cent suffered severe anxiety symptoms, 5.2 per cent had depression problems while 4.8 per cent were stressed.

He said 2,345 of the students also had undergo the mental health intervention while 279 teachers were trained to identify and handle emotional, behavioral and mental problems among students.

“The ministry is working how to help such students to cope with stress problems although there is no specific study done to identify the risk factors,” he told reporters after chairing the Mental Health Promotion Advisory Council meeting here yesterday.

Liow said that parents would be also called in for assistance if the students were identified having stress, anxiety and depression problems whereby the cases would be referred to hospital for further treatment.

The project in collaboration with Education Ministry was started in March and was carried out at six schools nationwide, namely Sekolah Menengah Kebangsaan (SMK) Datuk Haji Ahmad Badawi Pulau Pinang, SMK Simpang Bekoh Jasin Melaka, Sekolah Menengah (SM) Sains Teluk Intan Perak, SM St Michael Penampang Sabah, Maktab Rendah Sains Mara Gemencheh Negeri Sembilan and SM Jenis Kebangsaan Katholik Petaling Jaya Selangor.

Liow added that so far, 637 government clinics had implemented screening services to identify mental health problems while 138 doctors and 549 paramedics had received mental health training nationwide.
— Bernama

2. Not surprising because the study on teachers found them stress too. According to a cross-sectional study conducted by Hadi AA et. al. on 580 secondary school teachers in Kota Bharu District using the Depression, Anxiety and Stress Scale (DASS 21) and Job Content Questionnaire (JCQ) found the prevalence of stress as 34.0% with 17.4% of them experienced mild stress.

3. Well if both student and teacher are distress, how are we going to run the school? Let us go beyond paper chasing mentality. Previous Minister of Education (MOE) was talking about school-based assessment in trying to curb too many exams at the national level. The current MOE @ DPM is rewarding principal for their best school performance at national level. I don’t know whether the previous policy had been reversed by the present MOE.

If that is the case, let us pray for the best!

New Approach to Keeping Coronary Arteries Open After Angioplasties

1. Research at Loyola University Chicago Stritch School of Medicine could help lead to new ways to prevent coronary arteries from reclogging after balloon angioplasties.

2. The latest in a series of studies in this effort is published online ahead of print in Arteriosclerosis, Thrombosis and Vascular Biology, a journal of the American Heart Association. The senior author is Allen M. Samarel, MD, and the first author is Yevgeniya E. Koshman, Ph.D.

3. In an angioplasty, a tiny balloon is inflated to open a clogged coronary artery. Typically, a stent is deployed to prevent the artery from collapsing after the balloon is deflated.

4. The procedure itself irritates the interior walls of the artery. In response, smooth muscle cells migrate to the site and form scar tissue. In roughly one-third of cases, the artery reclogs and another angioplasty is needed.

5. Newer stents release drugs that prevent migration of muscle cells to the site. But these drugs have the unwanted effect of also stopping endothelial cells from moving to the site. Endothelial cells are needed to repair the irritation to the walls of the artery. (The angioplasty removes endothelial cells that line the inside walls of the artery. This increases the risk that clots will form, break loose and cause heart attacks and strokes. Consequently, patients must take anti-clotting medications for months after their angioplasties.)

6. The Loyola study points to a new strategy for preventing the unwanted migration of muscle cells while allowing the beneficial movement of endothelial cells. The study involved cell cultures as well as rats that had received balloon angioplasties in their carotid arteries.

7. Researchers focused on two proteins, known as FAK and FRNK. Both proteins are products of the same gene, but have opposite effects: FAK jump-starts the migration of muscle cells to the angioplasty site, while FRNK inhibits such migration. (FAK stands for focal adhesion kinase; FRNK stands for FAK-related nonkinase.)

8. Introducing FRNK early on in the course of an angioplasty could prevent the migration of artery-clogging muscle cells while allowing the movement of artery-repairing endothelial cells, Samarel said.

9. Earlier this year, Koshman presented an abstract of the study to the American Heart Association Arteriosclerosis, Thrombosis, and Vascular Biology 2011 Scientific Sessions, where it was judged among the top 10 percent of accepted abstracts.

10. Samarel is the William B. Knapp Professor of Medicine and Physiology and Koshman is a research associate at Loyola University Chicago Stritch School of Medicine. Other co-authors are Miensheng Chu, PhD.; Steven J. Engman, MD, PhD.; Taehoon Kim, MS; Rekha Iyengar, MBA; and Seth Robia, Ph.D.

11. The study was supported by the National Institutes of Health and Dr. Ralph and Marian Falk Medical Research Trust. During the course of the study, Koshman was an American Heart Association postdoctoral fellow and Engman was a heart association predoctoral fellow.

(Courtesy: Science Daily)