السلام عليكم و رحمة الله و بركاته
الحمد لله و الصلاة و السلام على سيدنا رسول الله و على آله و صحبه و سلم

1. It's been 5 days since the last lecture of Dr. Hussein Khairy. We only got apologies from him eversince last Tuesday, for not be able to come and continue his lecture and clinical rounds as usual. Nobody dares to ask why.

2. He is seemingly busy. It is not a surprise at all, as it should be expected from the very beginning. After all, he is the dean of the faculty. What should surprise us, is to the fact that he can attend to the faculty as early as 7 am to give lecture, and then continue with clinical round before entering his office for administrative work. This goes on 5 days a week (except Friday and Saturday). and on Saturday, he has his schedule in the operating theatre. He has been practising this routine since more than 10 years, except for the 'deanship' part.

3. As regards Dr. Hussein Khairy, he keeps stressing one important concept. The concept of consolidating things. The art of learning and studying bit-by-bit. The art of doing things consistently albeit by little.

4. He also insisted us to have our own logbook for us to write down everything we see and do in clinical rounds. "You can even publish it after a good few years", he once said. Of course, at the end of the day, there are only few of us who keep documenting everything. Others are already fed up, and I'm unfortunately, among that 'others'. Just happy enough to observe and listen like a boss :)

5. It is really inspiring while reviewing my notes. Unconsciously, we have had at least 140 sessions (both lecture and clinical rounds). And we have seen more than a hundred of clinical cases, some of them are rare ones, and almost all of them are fascinating.

6. We have seen at least 3 cases of short distance firearm injuries, with abundant of clinical findings. We have seen cases as benign as lipidema and lipoma, to cases as bad as burst abdomen and infected amputation stump. We've seen almost all kinds of skin graft and tissue flap. Also many surgical procedures and post-operative management apparatus that we can easily read in books.

7. Yes, we can actually read it quite easily in text books. In addition to Dr. Google and Prof. Wikipedia. But it makes a lot of difference by seeing with your own eyes and feeling by your own hands. It CONSOLIDATES easily.

8. Alhamdulillah, I really appreciate the value of seeing things with my own eyes and the power of consolidation. I'm really looking forward to having my notes well documented, for my own good and of course for others. InsyaAllah. May Allah make it easy for me. And whatever the cause is, may Allah ease Dr. Hussein Khairy from being too busy.

والحمد لله ربّ العالمين

السلام عليكم ورحمة الله
الحمد لله رب العالمين و الصلاة و السلام على سيدنا محمد و على آله و صحبه و سلم

1. Lastweek, I got the chance to take history from one of a patient in one of the General Surgery Department. She was a 67 year old widow from Masr El-Qadeem, came complaining of painful legs.

2. At a glance, it was obvious that she is obese with several co-morbidities. She was an uncontrolled diabetic. She was sitting on wheelchair and looked stressed with the pain. I could see some obvious clinical findings even before I started asking her questions, yet I ignored it.

3. It seemed that her most distressing symptom was painful leg, so I decided to take her as "painful lower limb" case. I started assessing the complain, the present history, and excluding the possible differentials.

4. It couldn't be a case of limb ischaemia as the condition started acutely after she fell on the floor by inability to walk on her lower limbs, and before the minor trauma, she had no claudication pain at all. It couldn't be caused by any other common local causes. No signs of DVT, the skin was clean from any ulcer or pigmentation, no swelling, no redness, temperature was normal, no nothing.

5. She said something that sounds like 'fracture' in Arabic, but I thought it was irrelevant, or the patient was just misinterpreting (or exeggerating) her painful limbs.

6. Just after analysing the history of present illness (which I took it as painful lower limb case), Doctor Shareef came in. 10 minutes suppose to be sufficient enough to put a provisional diagnosis, yet I stucked still at the history of present illness.

7. To cut it short, Dr. Shareef asked few questions and.... "voila"! That was it. Unbelievably, the patient actually has recurrence of breast cancer in her right breast and bone metastasis.

8. Yup, the painful legs was due to pathological fractures of few bones of her left lower limb, and bone metastasis in her lumbar vertebra, compressing the sciatic nerve. Good job to myself! I've ignored obvious hirsutism that the patient had on her face. And the patient had done radical mastectomy for her left breast 4 years before. And the hirsutism could be due to the chemotherapy or hormonal therapy (tamoxifen). I was too slow in my history taking.

9. I know that nobody's perfect. But it's all about practice. Practice makes perfect. Good history taking needs sufficient basic knowledge and effective communication. I haven't read enough literature, and I haven't communicate well. Effective communication is a skill that needs practice.

10. Few things that I've learnt from this patient are;

- Patient doesn't come to you with label, "examine my left leg" for example. You have to figure out the problem.
- The most distressing complain of the patient is not necessarily the worst underlying problem he/she has. The underlying cause might be fatal, while the complain might well be benign.
- Communication skill is crucial, especially when dealing with foreigners, in my case, Egyptian.

11. May Allah guide us in the journey to becoming professional competent doctors. We have 4 months and a half till final exam. May Allah ease.

والحمد لله رب العالمين

الحمد لله رب العالمين
والصلاة و السلام على رسول لله وعلى آله و صحبه و سلم

1. In surgery, to be specific, in dealing with electrolytes, there's something we call "The Rule of 40".

2. The rule describes important points to be considered in dealing with potassium. There are basically 4 items, which are;

i. Not more than 40 mmol added to 1 litre solution
ii. No faster than 40 mmol/hour (to be infused)
iii. Make sure its urine output is at least 40 ml/hour
iv. Maximum amount can be given is 4 x 40 mmol/day (=160 mmol/day)

3. Potassium is really important, as a slight mistake in dosage or rate of infusion/injection could be lethal.

4. Once a upon a time, not long ago, there was a dramatic mistake in an operation that led to the death of the patient. It was a high profile case, as I could find no article or news regarding the case. My professor, Prof Dr. Hala Ezzat told us last week. I doubted it at first, so then I asked another professor, Prof Dr. Nadia El-Sharqawy. She told us the same, it did happen.

5. On that odd day, the operating surgeon was asking for one injection of an antibiotic. It was a minor surgery by the way. Unfortunely, the nurse by mistake handed the doctor an injection of potassium chloride instead. The solution was injected, and that was it. The patient died on the spot! He got immediate cardiac arrest on diastole. (As far as I know, one ampoule of potassium contains 5 ml of potassium. Each ml contains 2 mmol) My Allah bless his soul...

6. What made the case more interesting is, the patient was the son of the Minister of Health of Egypt at that time, who is, until now, an internationally well known respectable surgeon!

7. That former minister is Prof. Ibrahim Gamil Badran. He is the one responsible for establishing one of the biggest medical scholls in surgery, and is known as the Father of Surgery in Egypt. You can see his profile here. http://www.ias-worldwide.org/profiles/prof99.htm

8. May this case be a great reminder for us, doctors-to-be, that potassium kills, if given in certain amount and certain rate. And the safe range is really small. Another electrolyte that also has to be taken into consideration as serious as potassium is Calcium.

9. Don't you(and me) ever get tired of mastering medicine. We deal with lives. A slight slip, and the patient dies. May Allah bless us...

و الحمد لله رب العالمين

السلام عليكم و رحمة الله و بركلته
الحمد لله و الصلاة و السلام على رسول لله

1. I'm now in Anaesthetology rotation. It's stunning! Really cought my attention.

2. The second lecture was about General Anaesthesia (GA), by Prof. Dr. Nadia As-Sharqawi. She was really cool, with experience as vast as 35 years of service in both private & university hospitals, local & overseas. I guess she is something like 60s (didn't bother to ask).

3. As we were discussing about muscle relaxant of choice during any surgery, Prof. Nadia told us the famous story of Su'ad Nasr's death. The dark side of anaesthetology. The story that gave bad reputation to aesthetic & reconstructive surgery (or surgery generally speaking) in Egypt.

4. Suad Nasr was a famous Egyptian actress in early 1980s. And she died on 5 January 2007 after she went into coma due to some complication in the liposuction surgery back in 2006. Wikipedia says that the cause was an overdose of anaesthesia. However, our Prof. Nadia begged to differ.

5. According to her, Suad Nasr's operation was a hard one. She meant, hard position. Suad Nasr had to be positioned so that she lie on her abdomen. This change in position is one of the hardest challenge for the anaesthetist which is responsible for the patient's endotracheal tube, which basically conveys oxygen to the patient.

6. It's been said that, during the process of changing Suad Nasr's position, that the endotracheal tube slipped out. She was of course on muscle relaxant, which is a standard substance given to patient that is being operated upon. So, Suad Nasr was unable to self-breath, and the anaesthetologist was unable to promptly fix the tube back to it's place. And...snap! That was it! After more that 5 minutes without any oxygen, she went into coma, which heralded to her horrible death. May God bless her soul.

http://a5eerela5bar.blogspot.com/2009/01/death-of-soad-nasr_06.html

http://en.wikipedia.org/wiki/Suad_Nasr

7. A slipped endotracheal tube intra-operation equals potentially fatal consequences.

8. Being a doctor, you are playing with lives. It's no joke. And even worse, when it is someone popular. It's not funny at all.

9. Happy graduating for my newly graduated friends in faculties of medicine all over Malaysia and Jordan University of Science & Technology (JUST). Congratulations!


والحمد لله رب العالمين

السلام عليكم و رحمة الله و بركلته
الحمد لله و الصلاة و السلام على رسولله


1. I'm trying my best to consistently attend Dr. Hussein Khairy's morning lecture and ward round each day. And here comes one of the most important subject, "Fluid & Electrolytes".

2. I try my best to avoid talking or writing about politics now, especially if it's beyond my knowledge, as things (Malaysian politics) have become more complicated than ever.

3. But my mind tells me otherwise. One interesting thing that I got from the "fluid" lesson, can't hardly be avoided from being related to politics.

4. As a matter of fact, 60% of our body weight consists of fluid. Considering an average human being of 70 kg body weight, he will have 42 litres of fluid in his body. From that 42 L, 3.5 Litres of the fluid is in intravascular compartment, which is 5% of body weight. It is quite interesting knowing that out of 42 Litres of total body fluid, only 3.5 Litres that greatly affects our body. Subhanallah...

5. Our main concern in most of the situations (like trauma, shock, hypertensive crisis, etc) lays upon regulating this 3.5 Litres intravascular fluid. We add some more fluids, electrolytes, plasma proteins etc to make sure this 5% of body fluid stable. And in most of the cases, this 3.5 Litres that is causing us problems.

6. Out of 30 millions of Malaysian citizen, only 13 millions voted for the 13th GE. That was more or less 40% of the population. Only 40% of the population who decided the leadership of the country, generally speaking.

7. Most of the time, the national policies are determined by few, maybe tens or hundred of Malaysians in the Parliament. Even bigger decisions for the country are being determined by even lesser number of brains.

8. Remember, that the World War 1 started merely by assasination of an "Archduke", and ended with 9 millions fatalities.

9. The World War 2 was started by few leaderships of few countries, and ended with 75 millions fatalities, which made the WW2 likely the deadliest conflict in human history. It needs only one man to push the "YES" button to change the world. Look at Aghanistan and Iraq. Look at other poor countries.

10. As historians said, "war is started by few, and suffered by many". Indeed, it's not only the war. It applies to pretty much everything.

11. In any community or civilization, only few will decide the future of the rest. Be it the president, prime minister, politicians, the academicians, the scientists, the 'ulama', the artists, whoever they are. The rule is, the few will decide for the many.

12. How many students who participates actively out of a hundred in your classroom? Out of millions of citizens, how many who speaks out for their rights?

13. The question is, can we let this phenomenon to continue? If it is really the rule, should we be the "few" who changes and decides, or the "many" who follows and being changed?

"Be the change you want!"

والحمد لله رب العالمين

السلام عليكم و رحمة الله

الحمد لله و الصلاة و السلام على رسول لله


1. Have you ever be in a situation where you can't focus studying in your classrom because you feel that your classmates are too loud? And you started to blame them for your inability to focus.

2. Quite frequently that you blame the noisy surrounding in the mosque for your un-khushoo'-ness, while you can play mobile games for an hour full of khushoo' in the middle of street without being affected by the surroundings.

3. Almost everything bad that is happening to you comes from others. Bad exam results, bad traffic, your bad temperament, your headaches, oily foods, coming late to class, rising cost of living, bumpy streets, dirty room, bad house, and the list goes on. The blame is always on other than yourself.

4. As a medical student, I'm trained to be a good observer. To find the cause of a disease, the 'what' behind any clinical manifestation. To well manage and treat a patient, we should be pretty sure what is the underlying cause. We need to take a good history, do thorough clinical assessment & precise investigation before diagnosing a patient. Then only can we manage or treat him/her accordingly.

5. It is quite a dissappointment to see people putting blame on somebody else for something without relevant reason (sometimes, without any reason).

6. It's a shame when there are groups of Malays trying to boycott Malaysian Chinese products and even publicise their effort. Some more 'ultra' ones even put "Boikot Barang Cina DAP" as their cause. It's a shame because their are doing that as an effort to improve the economic status of the Malays (well, as they claim...). What kind of mind-class is that?

7. Do they even think about what have brought the Malay to it's economic status quo today? Do they even read? Do they even merely speak to any economist? Do they even bother to know, who actually gave multi-million ringgit of federal goverment's contracts to the 'selected' Chinese 'towkey' at the first place? And they shouted, "Hidup Melayu" ?

(Well, I've got some interesting stories about this high-ranked 'perompak' Melayu. Got it from a young Malay CEO of an electrical industry. I'd love to share it, but, not in this post lah ok...)

8. Some also blame few individuals and local movements when they are talking about Christian missionaries, while they(the blamed individuals & local movements) haven't got any authority over the country at all?

9. For me, we have three main problems here. First, we put the blame on something/somebody without strong evidence, or even without any evidence at all. We base our blame on emotion or mere speculations. Second, we put the blame on the wrong target. So, we are missing the real problem, hence, giving the wrong treatment. Third, we like to put on the blame, nothing more. Just blame something or somebody, that's all.

10. At the end, things become even worse, as we put the blame on the 'pseudo'-problem, not the real one. With the problems we are facing today, which are as diverse as ever, we are just getting off the pitch. We stand in front of an issue, put some blames on somebody, and stand still. Wait and see.

11. Please don't get me wrong. I'm not saying that we have to blame ourselves for every problem that comes accross us. That is totally irresponsible. But worth remembering that, when you point your index to someone in front of you, the other 4 fingers are pointing right to yourself.

12. As 'Brain' (from the cartoon series "The Pinky & The Brain") always asks 'Pinky' each night, "what are we pondering tonight?..." , we should also ponder, how do we put on our blame. And how can it solve the real problem or treat the underlying disease.

13. Putting on blames by itself, is an art. Appreciate it, and do not misuse it, as it is important and powerful, only if it's properly used.


والله أعلم

والحمد لله ربِّ العالمين

Bismillahirrahmaanirraheem,

Alhamdulillahi wassolaatu wassalaamu 'ala Rasulillah SAW...


It has been 2 months, since my last post in English. It's quite funny, as the headings of the blog is in English, and I have only 11 posts in English.


.......................



Have you seen a bumblebee? I've read something gorgeous about bumblebee.






Do you know, according to a theory of aerodynamics, as demonstrated through the wind tunnel tests, the bumblebee should be unable to fly. Because of the size, weight, and shape of its body in relation to the total wing span, flying is scientifically impossible.


However the bumblebee, being ignorant of scientific theory, goes ahead and flies anyway and makes honey everyday.


Actally this phenomenon happens in our daily life. In great people. Or even in lay people with great attitudes.


Individuals whose attitudes cause them to approach life from an entirely positive perspective are not always understood. They are what some would call a "no-limit people".


In other words, they don't accept the normal limitations of life as most people do.


It is almost illogic that dyslexic children like Albert Einstein, Picasso and Walt Disney can make great things to the world. Well, they've proven it. Or at least, bumblebee has!


So how about us? :)



...............




Then I started to think, what if the bumblebee knows that theoretically he can't fly?


What do you think? Mr. Bumblebee might probably be affected by the theory. His ability to fly might be compromised. He might be mentally influenced. Or he might not?


Allahu A'lam. :)


The I started to think, that's where the mass media play their role. They can affect others mentality, especially the ones that has no firm stand, or the ignorants.


I'm now reading the book "Aku & Ikhwanul Muslimoon" by Syeikh Dr. Yusuf Al-Qaradhawi. Dr. Al-Qaradhawi nicely wrote his remarkable experience in Ikhwanul Muslimeen during the dictatorship peroid of Jamal Abd Nasir. And I found that any dictators uses the same blue print towards its people, taking control over the mass media!


However, with immense advance in mass media technology nowadays, fabrication of facts and manipulation of mass media is rather a big challenge for the dictators.


Nearest example is Egypt. How google and facebook contributed in the 25th Revolution. And now, we should be focusing on Syria.


Please dear Muslims, there are few things that we can do for Syria.

1. Pray for Muslims there and make Solat Hajat

2. Spread the awareness

3. Keep updated about the issue

4. Study hard and keep on working!



You can start with THIS :)

Bismillahirrahmaanirraheem,

Alhamdulillahi wassolaatu wassalaamu 'ala Rasulillah SAW.


For the past few days, I've been reading an article about Nobel Prize. This is a prestigious international award given yearly since 1901 for achievements in physics, chemistry, medicine, literature and for peace.

The founder of the award, as we all know, Alfred Nobel, the genious who got very rich with invention of the famous dynamite.

Believe it or not, the Nobel Prize is actually a fulfillment of Nobel's will. His will was hardly longer than one ordinary page.

One of his will is, that he declared that his entire remaining estate should be used to endow "prizes to those who, during the preceding year, shall have conferred the greatest benefit to mankind".


Since then, scientists were racing towards excellence, to be the best for mankind in their respective fields. Nobel succeded (intentionally or unintentionally, I don't know) to ispire the humankind in a superlative manner, in a way that scientists are racing towards excellence to create the best product with greatest benefit to mankind.


To date, there were only two Muslim scientists who became the recipient of this prestigious award. Prof Dr Abdus Salam from Pakistan (1979), and Prof Dr Ahmed Zewail, from Egypt (1999).


(Up to the year 2000 there were no less than 44 Jewish winners of the Nobel Prize in Biomedical Sciences, while Muslims only 2)





Something caught my attention when I was reading Prof Dr Abdus Salam's speech at the Nobel Banquet, December 10, 1979.


He quoted, verses from Al-Quran Al-Kareem, from Surah Al-Mulk, verse 3 & 4;





Inspiration


Yes, people live with inspiration.

I am amazed, for how people can be greatly inspired by human-made awards. People are racing for awards and prizes. People are astonished by prestigious prize and big podium.

They are so inspired, that they even race and die for it. (Of course most of the Nobel Prize winner didn't ask for the prize, including Prof Dr Abdus Salam)


Let us imagine, if we, all of us, as Muslims got inspired by the best award human can ever imagine, the paradise.


In fact, we should be greatly inspired by the Jannah (Paradise) and more importantly, the day of Al-Akhirah(Hereafter) as ALlah has promised that He will grant the Jannah for devoted Muslims, who work and strive very hard to give benefit to the Ummah. To give benefit to mankind.


These are what I've been thinking when I was reading the article on Nobel Prize.


Why are we so inspired by the human-made awards while Allah's "award" is the greatest of all?

At-Taubah, verse 111

The only difference between an excellent scientist and an excellent Muslim scientist. The intention, to give benefit for the Ummah, to the mankind, LILLAHI TA'ALA!




Allahu A'lam

How can Muslims say that the Bible is corrupted?

Slavery wasn't prohibited in Islam?

Should apostates be killed?

Women inherit half of what men do

"Kill them wherever you see them!"- Al Quran

Quran commands terrorism

Don't be friends to Jews and Christians

Nabi Muhammad SAW was a pedophil?

Nabi Muhammad SAW ordered the killing of 700 Jews?

Did the prohper Muhammad SAW write the Quran?

Islam allows polygyny

Nabi Muhammad SAW had 9 wives when he wafat

حَتَّىٰ إِذَا أَتَوْا عَلَىٰ وَادِ النَّمْلِ قَالَتْ نَمْلَةٌ يَا أَيُّهَا النَّمْلُ ادْخُلُوا مَسَاكِنَكُمْ لَا يَحْطِمَنَّكُمْ سُلَيْمَانُ وَجُنُودُهُ وَهُمْ لَا يَشْعُرُونَ

At length, when they came to a (lowly) valley of ants, one of the ants said: "O ye ants, get into your habitations, lest Solomon and his hosts crush you (under foot) without knowing it."

صُنْعَ اللَّهِ الَّذِي أَتْقَنَ كُلَّ شَيْءٍ

(such is) the artistry of Allah, who disposes of all things in perfect order:

-Surah An-Naml, verse : 88-

"...some people may only need one aayah(proof) to accept Islam, but some others, let it be thousands of aayaat(proof's') he/she will never listen. They are just like what Al Quran has told us,

صُمٌّ بُكْمٌ عُمْيٌ فَهُمْ لَا يَرْجِعُونَ

Deaf, dumb, and blind, they will not return (to the path)..."