Monday, November 10, 2008

Sensitivity and specificity

This definition of medical test is always a puzzle to me.I always get confused when trying to explain to another person.
Today i just read again the definition of it. It may give some help to you.

definition:probability of a positive test when the disease is present.
application:if the test has a high sensitivity, it will identify patients with the disease, and therefore a negative result indicates that the patient doest not have the disease.

definition:probability of a negative test when the disease is absent.
application:if the test has a high specificity, a negative result identifies people who do not have the disease , and therefore a positive result indicates that the patient has the disease.

Tuesday, October 7, 2008


Oleh chekamala"(Copy and paste)

Given below are some clarification on the recent milk adulteration in China and how you can detect China made products.

Questions and Answers on melamine:
Melamine is an organic base chemical most commonly found in the form of white crystals rich in nitrogen.

What is melamine generally used for?
Melamine is widely used in plastics, adhesives, counter-tops, dishware, whiteboards and fertilizers.

Why was melamine added into milk and powdered infant formula?
In China , where adulteration has occurred, water has been added to raw milk to add to its volume. As a result of this dilution the milk will have a lower protein concentration. Companies using the milk for further production (e.g. of powdered infant formula) would normally check the protein level through a test measuring nitrogen content. Therefore the addition of melamine - because of its rich nitrogen content - could increase the level of nitrogen, which again masquerade as falsely high protein levels as the standard protein test only measures nitrogen content. This means that the adulterated milk would have an artificially high nitrogen level, which would be interpreted erroneously as a 'normal' or 'high' protein level.

Addition of melamine into food is not approved by the FAO/WHO Codex Alimentarius (food standard commission), or by any national authorities.

Has melamine been found in other food products?
In 2007, melamine was found in pet feed manufactured in China and exported to the United States which caused the death of a large number of dogs and cats due to kidney failure.
In the present event, melamine contamination has been found in a number of different brands of powdered infant formula, in one brand of a frozen yogurt dessert and in one brand of canned coffee drink. All these products were most probably manufactured using ingredients made from melamine contaminated milk.

What are the health effects of melamine consumptions in humans?
While there are no direct human studies on the effect of melamine on humans, extrapolation from animal studies can be used to estimate adverse health effects. When combined with another chemical (e.g. cyanuric acid which is also present in melamine powder) melamine can form crystals which can give rise to kidney stones.These small crystals can also block the small tubes in the kidney potentially stopping the production of urine, kidney failure and in some cases death.

Melamine has also been shown to have carcinogenic effects in animals.

What are the symptoms and signs of melamine poisoning?
Irritability, blood in urine, little or no urine, signs of kidney infection, high blood pressure.

What is the cure for kidney failure?
Patients may receive various types of treatment, depending on the severity of kidney failure. Treatment may include infusion of fluids and urine alkalinisation, administration of sodium bicarbonate and insulin, blood and peritoneal dialysis, or surgical removal of kidney stones.

With more and more milk products from China and Taiwan having problem. We really got to check where the things are produced. Here is a way to differentiate Taiwan made products and China made products : by looking at first three digits of its Bar Code.

If the 1st 3 digits are 690, 691 or 692 - China made
If the 1st 3 digits are 471 – Taiwan made

Tuesday, July 29, 2008


Tenesmus a term use to describe a complaint of pain in the anus while defecating.Pain can be due to trauma such as tear, puncture wound , inflammation on the mucosal surfaces or structure underneath. The cause of trauma can be due to hard stool get stuck on the way out or some hard object [ penis, dildo etc] inserted into the rectum.

A doctor would ask history including diet taken ,psychological problem, and sexual history of the patient when dealing this type of cases. On examination, doctor would have examine
1.if patient is in distress, due to pain or emotionally.
2.presence of hard stool in the left side of the abdomen.
3.any sign of injury,wound,tear, change of color, bruises,swelling,hardness,imbalance contour,pus discharge and pain on palpation.
4.any visible sign of trauma in the inside, visualized using proctoscope, magnifying glass. Bruises, scratch marked on any other site of the body could be seen if the victim, or attacker have to fight for it.
5.swab usually taken for culture and sensitivity. the normal flora found in the anus is e-coli, but with the presence of other organism could be due to infection. criminal case, the examining doctor should take any sample DNA possible from the anal region to look out DNA of assailant. the doctor also should look out for jelly, semen, blood , pubic hair, saliva or even massaging oil.
7.anus which is normal, not traumatized would give a good grip to the examining finger.while patient would jump ,cry, or even shout due to pain if recently get penetrated.
8.other clinical sign of pain will be remarkable such as raised heart rate, raised blood pressure, sweating, blush,and raised respiratory rate.
9.homosexual patient , patient with past history of anal surgery,usually had poor grip anus [loosen up], may have stool incontinence.
10.patient with chronic disease,sexual transmitted disease may have sign and symptom of the disease at the same time.
11.doctors usually would observe the way the patient walk in into the consultation room, and walk out;if he had pain at the anal region, buttock, or even the thigh, the gait will be odd,limping, dragging his leg, or at least walk slowly.
12.those who get pain at the buttock, may sit at the edge of the chair, to avoid pressure on the painful site.

Tuesday, June 17, 2008

Medical Certificate

Patients when come to see doctors always without fail will request for medical certificate.By enlarge it become the most importance reason for workers to come to see general practitioner.Workers absent without MC [medical certificate] can be taken on disciplinary action such as cut part of their salary, or even terminated from work. In Malaysia if workers fail to present MC for 3 or more days absent could be terminated by the employer.
1.Recently our Director General The Ministry of Health announce that MC given by GP [general practitioner] for more than 2 days continuously for cases like chicken pox is legal and there is no need to be endorse by Government Doctor.
2.Each MC should be lasted until 12 midnight.Those patient on shift duty or on flight should be given proper consideration.
3.According to The Malaysian Medical Act, 1971.the ordinary MC cannot be use for court proceeding.The proper MC must follow the format in the Medical Act 1971.{Certificate of Unfitness to attend court}. The MC had legally binding and we are accountable to it .
4.Endorsement of MC which was certified by other GP, only required when the company are on our panel.And can only be endorse after we satisfy the reasons [diagnosis] the patient given for the MC.The usual case are obstetric ,hospital admission and infectious diseases.
5.It is understandable for; workers is compulsory to informed the employer immediately after they were given the MC by the doctor and not to wait until he fit to come to work.
6.Workers are entitle to receive full salary during the MC period, until a specific quota days used up. Some company will give 22 days MC not including hospitalization, surgery, and terminal illness.Some company will give more.

Tuesday, June 10, 2008


i think chlorox is the cheapest anti septic available. it cost you about RM 3 shows it can kill bacteria, virus, fungal and others as much as 99%. Most of us using it without knowing the real benefit of it.Some of us using chlorox just for the purpose of to whitening the school shirt.There are so many brand beside chlorox in the market and at a very competitive price.
1. if you have anybody at home who had bacterial infection like impetigo, abscess, or infected wound, you should soak all the cloths in it for few minutes,it will kill all the bacteria.Just be aware that your colorful cloth might become white overnight.
2.if you have kitchen utensil which is very dirty or stained, just soak in a pale of water with added half a cup of chlorox. It will be clean as new, but don't forget to clean it again with a lot of water.
3.if you bathroom is dirty, you can clean it with spraying chlorox overnight.all the germ will be gone. the cleaning on next day also very much easier,and the bathroom smell nicer. Those who do cleaning service in the public toilet , at the airport, mosque, bus stations etc should use it more often because it is cost effective.

p/s. i am not selling chlorox . and not receiving any benefit from the sale of it.


Wednesday, February 20, 2008

Eye Contact

There was an interesting story about eye contact.

Visiting a wealthy American, the Russian poet Evgeny Yevtushenko noticed a magnificent moose’s head mounted on the wall of the home.” How could you bear to shoot such a magnificent animal”. Yevtushenko asked.

“it was easy ,”said the host,” he didn’t look me in the eye, if he had looked me in the eye, I couldn’t have shot him.”

The ability to look someone in the eye is a sign of high self-esteem. Also a sign of assertiveness

Wednesday, February 6, 2008

VVIP coma lepas surgeri

Beberapa minggu lepas heboh di surat khabar, isteri seorang VVIP dari Sabah , koma selepas menjalani pembedahan cosmetic di Klang Selangor. Beliau menjalani pembedahan abdominal tuck in dan liposuction.

Liposuction dan abdominal tuck in, adalah pembedahan untuk membuang lemak dan mengecilkan abdomen, merampingkan pinggang. Biasanya procedure ini menjadi pilihan VVIP, artis atau orang2 yang berlebih duit.Begitulah setengah2 orang yang mewah hidupnya menggunakan duit yang berlebih2 itu.

Seingat saya, procedure liposuction dan abdominal tuck in ini mengambil masa yang lama, antara 6 hingga 10 jam, bergantung kepada berapa banyak lemak yang hendak dibuang. Pembedahan ini juga memerlukan banyak fluid replacement kerana ruangan yang terdedah adalah luas. perdarahan juga banyak dan sukar dikawal. Pesakit juga terdedah kepada kehilangan haba kerana suhu dewan bedah yang sejuk.Procedure yang panjang juga menyebabkan pesakit hypoglycemia, hanya mendapat sumber glukosa dari drip.

Kejadian koma selepas pembedahan mungkin disebabkan olih
1. fluid replacement yang tidak mencukupi, menyebabkan hypovolemic shock.
2. hypothermia, kerana terdedah kepada suhu sejuk yang terlalu lama.
3. kehilangan darah, kerana procedure penggantian darah yang hilang semasa pembedahan tidak dilakukan , atau dilakukan tapi tidak mencukupi.
4. terlebih dose ubat tahan sakit seperti fentanyl, morphine dan sebagainya.
5. hypersensitive kepada ubat bius am yang diberikan, biasanya gas anaesthetic, yang beredar dalam tubuh masa pembedahan, akan menyerap kedalam tisu lemak , otot, liver , dan sebagainya.Ia akan beredar semula kedalam darah selepas selesai pembedahan, iaitu bila sudah tiada gas itu dari sistem pernafasan, sedikit gas ini bila sampai keotak akan menyebabkan pesakit tidak sedar.
6.hypoglycemia, kerana selepas pembedahan pesakit tidak bolih mengambil apa2 makanan secara oral.

Bagaimanapun kita dapati, masalah tersebut mudah diatasi, olih itu sepatutnya dapat ditangani segera olih mereka2 yang terlibat. Kita harap tidak akan berlaku komplikasi yang serius dari kejadian tersebut.

Thursday, January 24, 2008

Benign Prostate Hyperplasia

Saya dah terfikir topik ni dalam bahasa inggeris, kalau nak translate pulak kena make special request.....

20 yrs ago, I always wonder why my father always takes very long time in the toilet. Then I realize he had benign prostate hyperplasia. It is a male problem when you reach 50’s.

It is quite troublesome to us, because the urine flow is very slow. The fuller the bladder, the longer you wait, then the slower is the urine flow. Now I reach 50’s, and I have the same problem like my father.

You may read about BPH in the internet to understand the pathology of it. Today I want to tell about the do and don’t for those who suffering on BPH. You may continue your treatment such as saw palmetto ,hitreen, cordura ,xatral etc. You won’t find this in text book.

1. Just empty your bladder when you feel it. Don’t wait until it is full. The longer you wait, the slower the urine flow.

2. Try not to take ice cold water/ drink. Drink hot drink, warm drink or at least room temperature water instead. Cold water aggravates frequent passing urine.

3. Malays like to have tongkat ali/ long jack drink. When you have BPH, try not to drink it. If you have to because your libido is low, or you need booster, try not to take more than twice a month. Those who took tongkat ali , will have recurrent of BPH symptoms within a day.

4. The same goes with MACA drink, but of less severity.

5. Those who like to have sex with the lady on top position should stop it because it aggravates the symptom of BPH.

Saw palmetto is a herbal formula. It is quite effective, but you should choose the right brand. the cheaper brand usually become less effective after you finished the first bottle. So choose wisely.

Wednesday, January 23, 2008

cerita pasal mati


Hari ini tan sri megat junit meninggal dunia. yg lain belum tau bila.Bila ada orang mati , mesti cerita pasal alam kubur. Ada orang tak percaya ada seksa kubur.
Saya teringat antara collection e mail saya menyentuh seksa kubur. It was sent to me by my close friend by the name of DR ABD AZIZ AHMAD. I think it is very interesting, and i want to share with you. Off course it is in malay.

Kisah ni aku kutip dari pengalaman seorang pemburu masa aku outstation kat
kuantan dulu...Tempat dia tinggal ni memang dekat ngan kampung orang asli
dan dia ni memang dah ramai kenalan kat situ...ada banyak cerita aku nak
kongsi ngan korang...itupun kalau sudi nak baca...

Ini cerita pasal cara-cara orang asli berucap (dlm Islam kite panggil
talkin ler) untuk si mati..tapi seingat aku diorang ni bukan beragama
Islam. Diorang gelarkan si mati tu AJIS walaupun tu bukan nama si mati
semasa hidup. Bila mayat tu dah ditanam, salah seorang kaum diorang/ tok
batin pun start lah baca 'ucapan' macam imamlah...) bunyinya camni :

DATANG...( kalau kita, malaikat mungkar dan nakir) KALAU DIA TANYA,KAO

Pastu komat kamit lah mulut pemberi 'ucapan' tu...dan diorang pun
beredar dari situ...dari mula sampai habis 'ucapan' , kawan aku yang
ikut diorang pi tanam mayat tu kena tahan gelak sampai merah padam muka
dia...bila orang asli tu tanya ngape...kawan aku cakap. "sedih...."

Moral/Pengajarannya : Dia orang pun percaya juga alam kubur....... ......


Razanif Rizuwan
Internal Audit Senior Executive
Amanah Raya Berhad