week 1 time table

Science news that may concern us

Brown Recluse Spider: Range Could Expand in N. America With Changing Climate

C. Difficile Colonization Accompanied by Changes in Gut Microbiota: Study Hints at Probiotics as Treatment (What's a probiotic? Click here)

Worm Studies Shed Light on Human Cancers

Bird Flu Leaves The Nest -- Adapting To A New Host

Salmonella Utilize Multiple Modes of Infection: New Mechanism That Helps With Invading Host Cells Discovered

Research on 'Iceman' Wim Hof Suggests It May Be Possible to Influence Autonomic Nervous System and Immune Response (you may be wondering how the ANS is related to immune system, I think we learnt it in Psycho class, or click here)

That's all for today. My eyes are blur already - watched too much videos.

GAME!!!

Assalamualaikum.

Hey hey this is AWESOME. Just to make you look extra NERDY besides being a Medic student, I've found this VERY COOL GAME that not only makes you look NERDY but also makes you SMART.

This game is about protein folding. How? OK we all know that a polypeptide is a linear chain of covalently-linked amino acids right? Haa, the amino acids have the R groups that makes the protein fold. So, the art of this game is, HOW to fold a linear protein into the proper functioning conformation.

The link is here. Download and have fun!! :D

SCS's new schedule

Assalamu'alaikum wbt.
This is the new schedule for Social and Community Services activities...harap-harap akan dijalankan...Insha Allah!
If anything, juz contact your PBL group's PIC, any new update just tell them... and so sorry sbb lambat post jadual ni... :(, hope you all can prepare urself for this upcoming block  :), kalau ada silap ape2 dlm jadual ni, juz inform ur PIC. tenkiu...wassalam

PIC	PBL GROUP	PROPOSE DATE	PROPOSE VENUE	ACTIVITY/IES	REMARKS
Firdaus	1	7th May	Pantai Balok	Gotong-royong at surau and kawasan sekitarnya.
	2	7th May
	3	7th May	Telok Chempedak	Gotong-royong at surau and kawasan sekitarnya.
Ariemahfusa	4	7th May	Pantai Gelora	Gotong-royong at surau and kawasan sekitarnya.
	5	7th May	Indera Mahkota 1	Gotong-royong at playground and kwsn sekitarnya
	6	7th May	Orphanage home	...
Hafiz	7	7th May	...	...
	8	17th March	Berjaya Megamall	Gotong-royong at surau	Done
	9	7th May	Masjid IM2	Gotong-royong and raise funds for orphanage home
‘Aina	10	...	...	Cleaning graves
	11	7th May	Musolla CF Bro	Gotong-royong at surau and kwsn sekitarnya

Aren't we ashamed?

Video links

The title says it all. Look at it yourself and ask your own heart.

Blood tests for LIVER

Assalamualaikum. In the Name of Allah the Most Beneficent the Most Merciful

Blood tests for LIVER

Liver function tests

Serum albumin

This is a marker of synthetic function and is a valuable guide to the severity of chronic liver disease. A falling serum albumin in liver disease is a bad prognostic sigh. In acute liver disease initial levels may be normal.

Prothrombin time (PT)

This is also a marker of synthetic function. Because of its short half-life, it is a sensitive indicator of both acute and chronic liver disease. Vitamin K deficiency should be excluded as the cause of a prolonged PT by giving an intravenous bolus (10mg) of vitamin K. Vitamin K deficiency commonly occurs in biliary obstruction, as the low intestinal concentration of bile salts results in poor absorption of vitamin K.

Prothrombin times vary in different laboratories depending upon the thromboplastin used in the essay. The International Normalized Ratio (INR) is therefore used in many countries but does not eliminate variation across laboratories.

Liver biochemistry

Bilirubin

In the serum, bilirubin is normally almost all unconjugated. In liver disease, increased serum bilirubin is usually accompanied by other abnormalities in liver biochemistry. Determination of whether the bilirubin is conjugated or unconjugated is only necessary in congenital disorders of bilirubin metabolism or to exclude hemolysis.

Aminotransferases

These enzymes (often referred to as transaminases) are present in hepatocytes and leak into the blood with liver cell damage. Two enzymes are measured:

- Aspartate aminotransferase (AST) is primarily a mitochondrial enzyme (80%; 20% in cytoplasm) and is also present in heart, muscle, kidney and brain. High levels are seen in hepatic necrosis, myocardial infarction, muscle injury and congestive cardiac failure.

- Alanine aminotransferase (ALT) is a cytosol enzyme, more specific to the liver so that a rise only occurs with liver disease.

Alkaline phosphatase (ALP)

This is present in the canalicular and sinusoidal membranes of the liver, but is also present in many other tissues, such as bone, intestine, and placenta. If necessary, its origin can be determined by electrophoretic separation of isoenzymes or bone-specific monoclonal antibodies. Alternatively, if there is also an abnormality of, for example, the γ-GT, the ALP can be presumed to come from the liver (e.g. metastases) and cirrhosis, frequently in the absence of jaundice. The highest serum levels due to liver disease (>1000 IU/L) are seen with hepatic metastases and primary biliary cirrhosis.

γ-Glutamyl transpeptidate

This is a microsomal enzyme that is present in many tissues as well as the liver. Its activity can be induced by such drugs as phenytoin and by alcohol. If the ALP is normal, a raised serum γ-GT is a good guide to alcohol intake and can be used as screening test. Mild elevation of the γ-GT is common even with a small alcohol consumption and does not necessarily indicate liver disease if the other liver biochemical tests are normal. In cholestasis the γ-GT rises in parallel with the ALP as it has a similar pathway of excretion. This is also true for the 5-nucleotidase, another microsomal enzyme that can be measured in blood.

Total proteins

This measurement, in itself, is of little value. Serum albumin is discussed above. The globulin fraction consists of many proteins that can be separated on electrophoresis. A raised globulin fraction, seen in liver disease, is usually due to increased circulating immunoglobulins and is polyclonal.

Viral markers

Viruses are a major cause of liver disease. Virological studies have a key role in diagnosis; markers are available for most common viruses that cause hepatitis.

Additional blood investigations

Hematological

A full blood count is always performed. Anemia may be present. The red blood cells are often macrocytic and can have abnormal shapes – target cells and spur cells – owing to membrane abnormalities. Vitamin B ₁₂ levels are normal or high, while folate levels are often low owing to poor dietary intake. Other changes are caused by the following:

- Bleeding produces a hypochromic, microcytic picture.

- Alcohol causes macrocytosis, sometimes with leucopenia and thrombocytopenia.

- Hypersplenism results in pancytopenia.

- Cholestasis can often produce abnormal-shaped cells and also deficiency of vitamin K.

- Hemolysis accompanies acute liver failure and jaundice.

- Aplastic anemia is present in up to 2% of patients with acute viral hepatitis.

- A raised serum ferritin with transferrin saturation (>60%) is seen in hereditary hemochromatosis.

Biochemical

- a₁-Antitrypsin. A deficiency of this enzyme can produce cirrhosis.

- α-Fetoprotein. This is normally produced by the fetal liver. Its appearance in increasing and high concentrations in the adult indicates hepatocellular carcinoma. Increased concentrations in pregnancy in the blood and amniotic fluid suggest neural tube defects of the fetus. Blood levels are also slightly raised with regenerative liver tissues in patients with hepatitis, chronic liver disease and also in teratomas.

- Serum and urinary copper and serum caeruloplasmin – for Wilson’s disease.

Immunological tests

Serum immunoglobulins

Increased γ-globulins are thought to be due to reduced phagocytosis by sinusoidal and Kupffer cells of the antigens absorbed from the gut. These antigens then stimulate antibody production in the spleen, lymph nodes and lymphoid and plasma cell infiltrate in the portal tracts. In primary biliary cirrhosis, the predominant serum immunoglobulin that is raised is IgM, while in autoimmune hepatitis it is IgG.

Serum autoantibodies

- Anti-mitochondrial antibody (AMA) is found in the serum in over 95% of patients with primary biliary cirrhosis. Many different AMA subtypes have been described, depending on their antigen specificity. AMA is demonstrated by an immunofluorescent technique and is neither organ- nor species-specific. Some subtypes are occasionally found in autoimmune hepatitis and other autoimmune diseases.

- Nucleic, smooth muscle (actin), liver/kidney microsomal antibodies can be found in the serum in high titre in patients with autoimmune hepatitis. These antibodies can be found in the serum in other autoimmune conditions and other liver diseases.

- Anti-nuclear cytoplasmic antibodies (ANCA) are present in primarily sclerosing cholangitis.

Markers of liver fibrosis

Fibrosis plays a key role in the outcome of certain chronic liver diseases, particularly non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C disease. Blood tests are being used to decrease the reliance on liver biopsy as the definitive way of detecting fibrosis.

Fibrotest/fibrosure tests measure α₂-macroglobulin, α_2-haptoglobulin, γ-globulin, apoprotein A₁, γ-GT and total bilirubin. These results are formulated to determine a fibrosis index. The index is sensitive and specific (>90%) for the absence of fibrosis, and has 80% sensitivity and specificity for severe fibrosis.

Markers of matrix deposition include procollagen I and III peptide and Type IV collanen. Markers of matrix degradation, e.g. matrix metalloproteinases (MMP) 2, 3, 9, and tissue inhibitors of mettaloproteinases (TIMPS), e.g. TIMP1 and 2 all are being used as markers of fibrosis.

Genetic analysis

These tests are preformed routinely for hemochromatosis (HFE gene) and for α₁-antitrypsin deficiency. Markers are also available for Wilson’s disease.

Urine tests

Dipstick tests are available for bilirubin and urobilinogen. Bilirubinuria is due to the presence of conjugated (soluble) bilirubin. It is found in the jaundiced patient with hepatobiliary disease; its absence implies that the jaundice is due to increased unconjugated bilirubin. Urobilinogen in the urine is, in pracetisce, of little value but suggests hemolysis or hepatic dysfunction of any cause.

copied bulat bulat from: Kumar&Clarks, pg 324-325

General investigations for a patient with suspected infection

Assalamualaikum. In the Name of Allah the Most Beneficent the Most Merciful.

I've always wanted to share this with everyone. I know some of you have this book, but I think not all of you are aware of this table. It's interesting.

General investigations for a patient with suspected infection

(You can see it as a general interpretation of the lab investigation results)

Investigation	Possible cause
Full Blood Count
Neutrophilia	Bacterial infection
Neutropenia	Viral infection Brucellosis Typhoid Thyphus Overwhelming sepsis
Lymphocytosis	Viral infection
Lymphopenia	HIV infection (not specific)
Atypical lymphocytes	Infectious mononucleosis
Eosinophilia	Invasive parasitic infection
Thrombocytopenia	Overwhelming sepsis Malaria
ESR or C-reactive protein	Elevated in all
Urea and electrolytes	Potentially deranged in severe illness from any cause
Liver enzymes
Minor elevation of transferases	Non-specific feature of many infections Mild viral hepatitis (LOL)
High transferases, elevated bilirubin	Viral hepatitis (usually A, B or E)
Coagulation	May be deranged in hepatitis, and in overwhelming infection of any type

From: pg 88, Kumar&Clarks Clinical Medicine

Sharing is Caring

Assalamualaikum.
In the Name of Allah, the Beneficent the Merciful.

Waaah pakcik Luqman taught me how to upload documents!! xD

OK, here are the 3 files I uploaded just now. (Lesson No.1, pass xD)

General Examination (I was just amazed at what's written at the top of it LOL)

Viral Hepatitis (The exam is just over, I know, but because I've deleted that post which looks soooo weird, so I made it into a file)

Pediatrics Vital Signs (Looks kinda cool)

Kids' Lung Function Tests

Assalamualaikum.
In the name of Allah the Most Beneficent the Most Merciful.

AARC Clinical Practice Guideline - Infant/Toddler Pulmonary Function Tests

Useful in the future insyaAllah.

YOU'VE GOTTA CHECK THIS OUT

Assalamualaikum.
In the name of Allah the Most Beneficent the Most Merciful.

Guys guys I'm so excited. I've been wondering what the hell I am going to do in the 3 months of holidays. No, I refuse to rot and rust and grow fungus. So, living with the seniors, I got one tip from them:

TADA!!!

Go there, upper right corner, register. The registration is kinda troublesome but it's nothing - you just have to crap about your information - that's what I did. And then they'll give you 4 options (I tick all of them because I'm not sure), the LAST option at the VERY bottom - the case study thing, I think it's like weekly PBL. I haven't tried it yet but I have a good feeling about it.

Enjoy!

Study tips

Assalamualaikum.
In the name of Allah the Most Beneficent the Most Merciful

Studying Tips For Medical Students - The Study Room
One of our classmates posted this, it's useful for us, especially for the brothers. (LOL because brothers are messy - no offence, joking)

One tiny reminder - take what is good from here, and ignore the Feng Shui part.

IMR on Fire

Fire at IMR: Short-circuit the likely cause

Andrew Sagayam - The Malay Mail 

 Wednesday, April 20th, 2011 13:32:00


KUALA LUMPUR: An electrical short-circuit was believed to be the cause of a fire at the Institute for Medical Research (IMR) in Jalan Pahang here yesterday morning.


The fire was said to have started at 10.30am from a research laboratory storeroom on the second floor of a block at the institute.

Federal Territory Fire and Rescue Department assistant director of operations Azizan Ismail said no one was injured.



A member of the staff who noticed smoke billowing out of the unit alerted the department's headquarters in Jalan Maharajalela here.

"Seventy-two firemen in 12 fire engines from the Chow Kit, Sentul, Pudu and Selayang fire and rescue stations went to the scene," he said.


"Because of the chemicals in the laboratory, the firemen used foam instead of water to put out the blaze by 3.30pm. The affected second floor was closed for restoration and repair works."

Azizan said damage to the laboratory was largely internal.


p/s: hope u all can "ambek cakna" this thing as Pak Nasa always told us about IMR

This not the real pic. k..

Tada!! :D

Assalamualaikum to my very awesome and beloved Zenith people!

In the name of Allah, the Most Beneficent, the Most Merciful.

I'm sure many of you are surprised with the new look of our blog - really sorry about that. I practically forgot that PnI is in charge of it and brother Gapa is the boss. Really sorry, to Gapa and to PnI people. I seriously thought that everyone can play with it. But thank God Gapa is very forgiving and he didn't mind me messing up his blog design. Heehee Gapa you're too nice.

The purpose of me messing up this place is because I realized that, as time goes on and we're getting more and more blog posts, it's kinda difficult gain access to the particular post you want. So I tagged each and every post. Yes, sitting here the WHOLE day tagging. Plus, I've standardized the tags. But I swear I didn't change the content of the posts.

To summarize, here is a few new features of the new blog look:
1. Tags
2. "Microbiology" design with handwritten fonts (Gapa said it looks more personal)
3. Right at the very very bottom, there are 3 sections for the links we need: on Medic, on Islam, on Miscellaneous

    OK I want to explain about the links. We follow other Medic and religious blogs and we sometimes post the links on our Zenith fb. They're useful. So I practically dug up all the fb posts on Zenith, searched for suitable links and put them here. So we don't have to dig up old posts to search for a particular link.  InsyaAllah useful.

Hope you guys can enjoy. At least, don't be upset about me being too enthusiastic changing the blog. Sorry la, ok?

Happy holidays.

PBL made real - Auscultation Sounds

Assalamualaikum.

In the name of Allah, the Most Beneficent the Most Merciful.

In PBLs I've always been wondering how the sounds are like when performing auscultation. You know we've seen 2nd heart sounds la, stridor la, wheezing la and all those lalalas. I've tried playing with my roommates' stethoscope but of course I can't hear a thing. I mean I only heard that 'de-gup-de-gup' sounds (otherwise I'm no longer alive hehehehe)

I think it's useful to get a feel of it. I know we're not in clinical years YET. But it's never wrong to learn beforehand. There are very experienced people who made awesome websites on these sounds. So, enjoy:

Easy Auscultation

There are other websites, of course. But when you have too many choices you tend to get lost. So, finish learning this website first, and we move on to the next, insyaAllah.

P/S: BTW this website is really good. :D

Last minute quick review - Biotyping

Assalamualaikum. Bismillahirrahmanirrahim.
Still remember the Microbe lab? The many many tubes and bottles we have to interpret? Here is a list of mnemonics for you to double check. (sorry, can't put it in the Tips & Tricks thing because my line is so slow here).

Non-lactose fermenters:
"Those who don't drink milk don't PPaSS their exams."
Proteus
Pseudomonas aeruginosa
Salmonella
Shigella

Glucose fermenters but produce NO gasSS.
Salmonella
Shigella

Simon citrate? I tak KiSah.
Klebsiella
Salmonella

Indole +ive: Only E. coli, as far as we need to know la

Urea hydrolysis: Kencing/Pee
Klebsiella
Proteus

H2S (hydrogen sulphide) producers:
SaPe hitam ye? (no offence)
Salmonella
Proteus

Last minute quick review - KKM vaccines from Dr Imad's note

If you’re too lazy to look for this particular note among the sea of notes we have to memorize, then here it is:

	0 m	1 m	2 m	3 m	5 m	6 m	12 m	18 m	6 Y	15 Y
BCG	1								If no scar
HepB	1	2			3
DPT			1	2	3			4	DT	T
OPV			1	2	3			4	5
HiB			1	2	3
Measles						Sabah
MMR							1		2