Hiking Trip

O & G Posting

O & G Posting in Batu Pahat has been a fruitful period for all of us who come here, We are required to conduct 5 deliveries from 0 experience and 2 episiotomy. Of course, all these can be achieved "fighting" with the student nurses and the community nurses.

The first 2 weeks has been a busy period as all the portfolio (reports x 2) which are long winded and telling grandma story need to be submitted by dateline. Operation Theatre quota also need to be fulfilled as we are required to scrub in for OT with 2 cases of Obstetric cases and 2 cases of gynaecological cases. It will be easier to scrub in for LSCS and Bilateral Tubal Ligation (BTL)as it is counted as 1 obstetric and 1 gynaecological procedure. On top of all that, there is possibility of getting detention class over the weekend if the ward jobs were not covered well.

After the first 2 weeks, everyone become less tense and starting to play slow as almost all of them would have fulfilled their quota. For me, i already signed 5 of my deliveries in the first week and signed another 3 of them for assisting deliveries on the second week. Planning to do more this week for the detention and weekend call. For OT procedure, i also managed to signed all my cases of 4 in the OT week. Somehow life just gets easier on me for this week.

Nice Foods in Batu Pahat

Gerai Rakyat



Mee Racun from Gerai Rakyat (Opposite Putra Hospital)



Mee Bandung from Gerai Rakyat




HoneyDew Drink from Rose Selinda Tomyam House (Behind SquareOne Mall)



Lemonade Fried Chicken from Rose Selinda



Tomyam Dish from Rose Selinda (The best i tried in Batu Pahat)

Long Forgotten..

In the past, i used to

1) indulged in nice songs/music sometime even until the next morning without sleeping. it purified my soul and emotion..but i no longer

2) enjoy reading books ,plenty of thick books, fiction stories..found so many of excitement there inside the cover itself..now? hardly finish a chapter...

3) involve myself in martial art, looks so high upon what i might achieve with what my potential will be..until i realised the other way around..

4)work very hard just to prove that i am really on the right track of taking up medicine. Almost anything come up as common sense. but it no longer appear to be the truth

5) so confidence that i can remember even i have just read once on certain topic and be able to recollect whatever necessary, but it seems impossible now..


What has happened to me? i wonder...

Acute Immune Thrombocytopenic Purpura (ITP)

1) ITP :

Immune Thrombocytopenic Purpura (ITP) is believed to be a immunological reaction which follows an acute viral infection causing antibody binding to platelet membrane thereby allowing destruction of the antibody-coated platelets to be destroyed in reticuloendothelial system. It’s usually a clinical diagnosis with exclusion. However, those presenting with atypical features such as knee pain, inguinal mass and back pain should be investigated with bone marrow aspiration to rule out leukemia1. Platelet – associated IgG can also be tested in him and 90% of those with ITP will be tested positive1.

2) Approach in treating acute ITP :

As most of the patients of ITP achieve spontaneous remission within 8-12 weeks, it’s recommended that only those patients having platelet count of less than 20,000/mcL and significant mucous membrane bleeding or platelet count < 10,000/mcL and minor purpura be treated. He therefore fulfilled the criteria. First line of treatment would be using Prenisolone 1-2mg/kg/day until platelet count becomes normal and taper off. Prednisolone alone would be able to achieve 70% remission rate. Otherwise, intravenous gamma globulin is also effective in children usually given over 5 days or 1g/kg/day for 2 days. It’s proved to enable platelet count raise more rapidly and cost-effective than corticosteroid in acute ITP3. Platelet transfusion however is to be reserved for life threatening condition only whereas splenectomy is not indicated in the case of ITP unless severe uncontrollable haemorrhage developed. Research shows that about 22-27% of those with acute ITP will develop chronic ITP that persisted more than 6 months 4. It’s shown that active treatment do accelerate platelet count recovery however do not avert the development of chronic ITP or reduce morbidity during follow up 4. However, treatment with immunoglobulin G , intravenous Anti-D or high-dose pulse steroids have been showing promising results in delaying the need of splenectomy in chronic ITP.

Reference :
1) Jeffrey T. Kirchner Idiopathic Thrombocytopenic Purpura Diagnosis in Children
http://www.aafp.org/afp/981015ap/tips.html#12
2) Nelson Essential of Paediatrics Fifth Edition 2006 pg 714-719
3) Beck et al . Corticosteroids versus intravenous immune globulin for the treatment of acute immune thrombocytopenic purpura in children: a systematic review and meta-analysis of randomized controlled trials. 2005 Oct;147(4):521-7.
http://www.ncbi.nlm.nih.gov/pubmed/16227040?dopt=Abstract
4) Treutiger I et al Does treatment of newly diagnosed idiopathic thrombocytopenic purpura reduce morbidity? Arch Dis Child. 2007 Aug;92(8):704-7. Epub 2007 Apr 25.
http://www.ncbi.nlm.nih.gov/pubmed/17460024?dopt=Abstract

Avoidable..

I had my lovely egg smashed on the floor this morning just because i am not careful enough..all the protein just splashed on the floor ..Wasted

I have started my regime of protein increasing diet by taking eggs white but not sure whether it will be working. Hopefully it will..

Anyway, about the falling egg, its just to remind me not to do something which will lead to bad stuff because i am careless. Worst when it's something which i am expecting

Canthus twitching

It's been few days after that my right eyes external canthus has been twitching involuntarily.

Hmm...Not really signalling something good. I think it's giving me hint that something bad is coming.

Well, i am not sure if it's true enough. On the first day of twitching itself, my external hard disc somehow was claimed by my computer as "corrupted and unreadable"; And that was really of a "great help".

I promised TY to send over some stuff through the internet but finally didn't manage to send it as my external hard disc crashed. At that moment, it was really creating a sense of impending doom as all my data including my academic stuff that i will be needing in sem 10 are all inside and i have just got 1 copy of it

Sigh...i wasted almost 1-2 hours just to find the solution to it..Luckily, i manage to repair it using the repair procedure..Or else, all the data would have been lost into ash..

Today itself, i had my shoe torn with "Open mouth view" to become a flip-flop after V accidentally step on it. Well, i am expecting it to be worn out soon but not so soon...real sad. Guess i will have to send it to the butler shop to have it repaired. I likes that shoe as it was a comforting shoe and the only shoe which lasted me for about 2 years without needing to change one. I am considered lucky as it only got torn off at the end of the day and not the start of the day. Otherwise, i just can't imagine how will be the day like..haha