武汉大学的三行诗比赛冠军

螃蟹在剥我的壳，笔记本在写我。
漫天的我落在枫叶上雪花上。
而你在想我。

在星光里遗忘昨天的伤害

一觉醒来还有期待

我要握住一个最美的梦给未来的自己

未来的你会懂我的疯狂...

二月，
是是情意盎然的的季节
空气中总弥漫着我对你的眷恋

思忆仿佛又被卷入了漩涡
回到了那年的春天
青涩的我们瞬间的邂逅

喜欢这样看着你
白衣蓝裙
于学生群中穿梭
很期待你经过我教室的那一刻
开心因为你的到来
伤心因为你的离去
每天的心情
都要几经折腾，
因为你的来往，
而变得反反复复

低着头躲在教室的角落
眼角里，出现了你的身影

整颗心，砰砰地往胸膛捶打
仿佛要逃出我的胸腔

你乌黑的短发

隐约露出了你的耳垂

浓浓的眉毛下嵌着一双漆黑发亮的大眼睛

桃腮带笑显得楚楚动人
整颗心都被你拴着了

我的手，是颤抖着的

握着手里的蛋糕

是自制的红丝绒蛋糕

缓缓地伸出去递给你

也把我的甜甜的思念寄托于你

两个月后却听闻你转校的消息

我们的际遇

就这样封锁在二月的某个下午

偷偷地看你

偷偷地想你

偷偷地爱你

视线却偷偷地模糊了

NAMIC 2016

               I was lucky to be able to attend the NAMIC (National Acute Myocardial Infarction Course) held in Grand Dorsett, Subang Jaya. It was organised by the Serdang Cardiology Department with the aid of drug company Boehringer. Thanks to my MO, i was introduced to this course which i had to self pay RM 250 for the course. While most of the participants were sponsored by the department, I had no qualms about forking out my own money for the wonderful course.

The grand ballroom of the Grand Dorsett Hotel, Subang Jaya. Ambience was nice.

The schedule of the course. As you can see, the lectures were quite packed. There was one German, Japanese and Indonesian speaker each.

Roti canai was served for breakfast

The reception and the exhibition booths. There were many companies showing their latest brands of stents and balloons. Too bad I wasn't trained in a centre with a catheterization lab (known as cath lab), it was quite difficult for me to figure out what those things were. All seem so alien to me haha.

Lunch was provided. As expected, it was not disappointing. Black pepper chicken drumstick with grilled saugage and potato wedges. It was served in the grand ballroom itself as the lunch symposium carried on. As expected, many people were busy munching their food  taking down notes from the talk. 

So what do you say about lunch on day 2. Amazing isn't it? Salmon with fried rice and steamed chicken pieces. The salmon was so juicy that I became too obsessed with the food. 

Dr Oliver is a consultant anaesthesiologist from Germany who gave the lecture regarding the reversal of oral anticoagulants. He spoke about the prothrombin complex concentrate, which is not widely available in Malaysia. Afterall, who is Malaysia compared to Germany? Hah...

So this was the card that every delegate was given. Obviously isn't it? There were almost 500 participants from all over Malaysia. I met a friend from Hospital Umum Sarawak Cardiology Department too! All the way from Sarawak. There were also people from the health side (even a family medicine specialist attended the course), from the cardiology centres and people like me who do not even standout in the crowd. There were registrars and specialists among the participants. 

My UKM senior all the way from Cardio Centre Sarawak =) Glad to catch up with each other!

So now for the academic part of the course. You might want to skip this part if you are not medically trained. These are the brief summaries and take home messages from the whole course.

On lipids

- Malaysia is still the fatest and  sweetest nation in Asia: Prevalence of Dyslipidaemia 40%, DM 30%

- Fenofibrate and Statins are the best combination for treating dyslipidaemia as they 

   = reduce LDL

   = increase HDL

   = reduce TG

- Fenofibrates are compatible with statins, unlike Gemfibrozil, which has to be taken separately with statins as they cause rhabdomyolysis

On PCI

- in PCI capable centres, door to balloon time (DTBT) is 90 mins

- in non-PCI capable centres, if u wish to send a patient to a PCI capable centre, DTBT is 120 mins

- in other words, door in door out time is 30 mins. Door in door out means timing starts when the patient enters you ED and being sent out to PCI capable centre. That includes triage, clerking, ECG, referral and preparation of transport.

On chest pain

- ST elevation (STE) is defined by new onset of ST elevation at J point for 2 or more contiguous leads

- significant STE is defined as

   = ≥ 0.1mV in all leads, except

   = for lead V_2-3  , in males -- ≥ 40 y/o ≥ 0.2mV; 

                                                 < 40y/o ≥ 0.25mV

                               in females ≥ 0.15mV

- J point: point between the termination of the QRS complex and the start of ST segment

- STE in lead aVr is always sinister. Together with widespread ST depression, it signifies Left main coronary artery disease

- not all STE are MI! They can be 

   = early repolarisation

   = acute pericarditis

   = Brugada syndrome

   = Stress cardiomyopathy

   = LBBB

- in the event of STEMI, Dual antiplatelet therapy (DAPT) must be given for ≥ 12 months

On cardiac biomarkers

- Troponin is always elevated in renal patients. HD clears CKMB but not troponin

- Causes of non MI increased Trop T

   = ICB - esp SAH                                            = tachyarrhythmias

   = Pulmonary embolism                                  = myocarditis

   = Pulm HPT                                                   = aortic dissection     

   = SIRS/ sepsis/ septic shock                          = heart failure

   = hypothyroidism

On lytic therapy

- plasminogen is activated, activates plasmin which degrades the fibrin

- given within 12H onset of MI is best.

- give is unable to perform PCI within 90 mins, or delay in primary PCI > 120mins

- thrombolysis should be given with either UFH/ LMWH/ fondaparinux

- AHA recommends thrombolysis at INR ≤ 1.7. Any other interventions other than that is individual decision, with either trial of alternative e.g. aspirin or T/O tertiary centre. 

Post MI rehab

- Driving

   = 1/52 post PCI with EF >40%

   = 4/52 post MI with no operative intervention + stress test acceptable

   = 6/52 for large vehicles post MI with no operative intervention + stress test acceptable

- Return to work

   = not more than 3/12

   = not more than 6/12 if CABG/cardiac arrest

         (*too long a return will cause patient to be very reluctant to return to work. The aim of rehab is to get the patient to go back to work as a normal being and serve the country)

MI with heart block and LBBB

- complete heart block with

   = inferior involvement - temporary, allow 24-48H. Unlikely to be permanent, no intervention needed

   = anterior involvement - a/w massive infarct, temporary pacemaker till 1/52, then usually require permanent pacemaker

- normal LBBB: discordance (discordance is good, concordance is bad) 

- LBBB with concordance QRS and ST = bad. Use modified Sgarbossa's criteria

- Sgarbossa's criteria

   i) any leads concordant STE ≥ 1mV (5 marks)

   ii) leads V_{1,2 or 3} , ST depression ≥ 1mV (3 marks)

   iii) Any leads discordant ST ≥ 5mV (2 marks)

- A score of ≥3 is very specific for AMI (90%), but not very sensitive (20%) = if ≥ 3, it is very likely to be MI

(* please read here for more detailed explanation)

Cardiac rehab

- aerobic exercise is recommended

- prescribed exercise is more useful. E.g. say, walk 30 mins x 5 days, instead of saying, exercise lah, mayb can walk around lo, runing can also ah, mayb u swim everyday and see....

- 6 mins walk test is a good short test to gauge patient's ability - can walk at own pace

- For MI patients, aim 60% of max HR, 20-30mins, 3-5x/week

- For normal individuals, aim 85% max HR

(*max HR = 220 - age )

Do inform me if you find some of the information here misleading and I will try to verify it. Hope this gives everyone a small insight of what we usually miss out when dealing with patients in the crampy emergency department and the sweaty medical wards.

Overall, it was just so worth the RM250. I even got to catch some pokemon in the streets of selangor meet with my uncle and aunty for a small family gathering =)

Signing off

855pm

房间的气息，
像我手中冷掉的可可。
最最叫人残念的，
总是未完成的另一半的歌...

Housemanship

     So I started my journey ( a very long journey) as a medical doctor 2 weeks ago. 

     I was given the medical posting to start off with. Hospital Seberang Jaya would be my 2nd home for the next two years to come. It is quite a nice place, not too busy and huge, but doesn't lack the facilities to train house officers. 

        How time flies and I'm off tag now, meaning that i have to only work according to shift systems in this posting. Work will be either from 7am (we usually have to come earlier) till 6pm (or later if our work doesn't finish by that time) or the night shift of 4pm-8am. 

       Things have been going quite smoothly except for a few bad patches here and there. There were tears of joy, touched, sadness and weakness throughout these 2 weeks. I can now look forward to more good things in the future. 

        Life has been kind to me, so has been my friends/colleagues and my dear, always so supportive of me. 

Fried noodles from dear's mum. How lovely!

Homemade bread by my dear <3

Nice pastries :)

Dear dear who always thinks of me. She even reserved a lunch box with me. 

The first time having breakfast with colleagues at tim sum house in Chai Leng park.

        4 more months to go in medical (3 1/2 months to be exact), medical posting will be the best posting ever in my housemanship life. 

yikping
1028pm

等一个人·咖啡

    这个世界上，每个人都在等一个人：伴侣，恋人，另一半，携手到老。也许，你等的那个人，曾与你擦肩而过，或者在茫茫人海里窜动。缘份的瞬间，犹如拉着红线的月下老，让我们能够碰面。世界上两个根本没有任何关系的人就这样认识了，为各自的生活书写崭新的故事，人生的旅程。

 

        渗入了对方的生活，慢慢地发现，其实对方没有你想象中的那么好，你会怎样做？继续等他，还是换杯咖啡？咖啡的香浓，是表面的，口感和味觉，只有品尝的人才了解。大家都会向往甜美的爱情，如童话故事般的完美，就如总人都会被咖啡的浓郁所吸引。若果你慢慢地品尝，慢慢的细嚼，每一杯咖啡，都是独特的。从咖啡豆的名字，到产生地，收割的季节，都会令看是模棱两可的咖啡产生不同的咖啡味。

       
        你在等他，她在等你。人往往都会好高骛远，把视野放到一个很高的台阶，期望过得比人家好，比人家幸福。我们会向往美好的，甚至遥不可及的，然后忽略了我们已经拥有的，上天已经在我们周围安排好给我们的事物。电影里的思萤，把心里的空位留给了辩论社团的泽与，成天都期待着奇迹的出现。与此同时，她却不知道最好的朋友阿拓也喜欢着她。直到了阿拓的离别，她才发现原来最喜欢的是阿拓。曾经的轰轰烈烈，赴汤蹈火，昨天的我爱你，转眼间有可能演变成今天的我恨你。没有谁有义务帮你自制咖啡，只有谁有义务诚恳地喝完你泡制的咖啡。失去，往往才会让人更加惦念。

        你就是你，我才能是我，彼此都是彼此的缺口。你期望，你等的那个人，可以弥补你的缺口。但，你等的那个人，是否也和你一样，在等着你，弥补他的缺口呢？

奕斌
1133am