Wednesday, January 12, 2011

hikmah behind a failure

ever heard of a saying " the harder you fall the higher you'll bounce back" ? This is entirely true. Based on the rule of kinetic energy KE=1/2mvv. So if you fall from a higher place, the velocity you have when you reached the ground is higher since gravity is constant at ~10ms-2 and based on the equation v=u + at. Hence if you fall from a very high place, you'll possess enough kinetic energy to bounce back higher. But that's only true if you possess the quality of a rubber which can convert the KE to bounce back. If you don't, the KE will just be converted to some other energy and you'll be smashed to pieces. Nonetheless, you are endowed with the ability to gather the pieces and put all that back together; start anew as more awesome entity.

-point to ponder-

Monday, December 27, 2010

sex education Malaysia

this topic has long been a debate at school level, colleges, universities and among politicians as well as academicians. Different people with different paradigm came up with opposite views. Some remain obstinate to ones opinion. Well to me, one must be flexible in discussing this matter. Take a step back and try to analyze it through multiple paradigm. As a muslim of course i have to take religious views into consideration.

short answer : i agree with the implementation of the sex education in Malaysia's school.
Long answer :
  1. Sex education sound so negative isn't it ? so we have to clarify the definition of what is actually a sex education. Is it to teach students how to do sex? I bet any sound mind would give a no for this one. Is it a teaching to promote chastity, to educate student of the danger of having sex outside marriage? -plausible-
    Is it a way to educate students of what sexual harassment like ? -plausible- Is it to teach the student if ever they decide to have sex, do it with cautions as to avoid consequences like child out of wedlock which will later lead to abortion ? -plausible-
  2. Well, if it is exactly like the plausible reasons i've listed above, then why do we have to oppose?
  3. Interesting remarks from this article " sex education is like teaching thieves to steal" . Well, if it is to teach how to do sex, then it is exactly like the saying.
  4. In this article, it mentioned about islamic ways of teaching sex, like separating room between boys and girls siblings and wearing Hijab.
  5. But how do you prevent students from surfing porn sites? or teaching girls that certain type of contact is sexual?
  6. The answer is definitely through sex education.
  7. Prevention is the best and it will remain better than cure. Just like exercise and healthy diet to prevent heart diseases. But what if a person already has the disease? We have to provide him with cure and at the same time promote preventive measures to curb disease progression. Right ?
  8. So, my stand is : Say YES to sex education and at the same time promote preventive measures exactly like the way islam teaches us.
  9. Now, although sex education seems like a good measure to me, it won't be a success unless we have trained teachers to deliver it the best way. Please read this article :
Conclusion :
Please have a healthy discussion among religious preachers, politicians, teachers etc as to make sure the ultimate goal to produce a better society can be materialized. Take into consideration that our society comprise of multiple races. As for me, for now YES to sex education is my stand unless someone can come up with points that may lead me to believe otherwise.

thank you for reading.

-i came to like writing more now as i can freely express my opinion without being involve in useless debate with obstinate person. How vexing ain't it?-

this is a good site. please visit it You can create poll, share opinions etc and get some cash or prizes.

Tuesday, December 14, 2010

doctor surplus in malaysia

i never know before that the number of medical school in malaysia is >24. Govt and private combined.

the UK has 32 medical school across the region with its population of 61.8 million. Malaysia on the other hand, has 27.5 million of population.

Canada has 17 medical schools. Its population is 33.7million.

what i'm trying to get to is that developed countries like canada stressed quality over quantity! When i was there, our class was small. Only doctors trained by canadian universities are allowed to work there eventhough they are canadian. Others would have to sit for an exam before being offered a place.

For Malaysia, it seems like quantity is more important thus putting qualities on jeopardy.

so a five-year moratoriom on medical courses is definitely a must. To put a halt on the glut of poor trained housemen in malaysia. Once a shortage in doctors, might not be there anymore as of 2009 the country has produced a surplus. more than required. in 2010 we produced 3552 more doctors than needed.

Public universities:

* University of Malaya, Faculty of Medicine

* Universiti Kebangsaan Malaysia, Faculty of Medicine

* Universiti Sains Malaysia, School of Medical Sciences

* Universiti Putra Malaysia, Faculty of Medicine and Health Sciences

* Universiti Malaysia Sabah, School of Medicine

* Universiti Malaysia Sarawak, Faculty of Medicine and Health Sciences

* International Islamic University Malaysia, Kulliyyah of Medicine

* Universiti Teknologi Mara, Faculty of Medicine

* Universiti Sains Islam Malaysia, Faculty of Medicine & Health Sciences

* Universiti Darul Iman, Faculty of Medicine

Private Universities and Colleges

* UCSI University, Faculty of Medical Sciences — School of Medicine

* Monash University Malaysia, School of Medicine and Health Sciences

* International Medical University, Faculty of Medicine

* AIMST University, Faculty of Medicine and Health Sciences

* Allianze College Of Medical Sciences, Faculty of Medicine

* Management and Science University, Faculty of Medicine

* Cyberjaya University College of Medical Sciences, Faculty of Medicine

* Royal College of Medicine Perak, School of Medicine

* Melaka Manipal Medical College, School of Medicine

* Penang Medical College, School of Medicine

* MAHSA University College, Faculty of Medicine

* Newcastle University Medicine Malaysia (NuMED)

* Taylor’s University College, School of Medicine

* Utar

---> many of univeristies listed above, i never know their existence until recently.

Saturday, December 11, 2010

Life As a Houseman in Malaysia - part 1

this is just purely my sincere opinion. complaints regarding a tough life as a HO in malaysia has been going on for years. From degrading comments by the superiors in front of patients, long hours of working to low salary has been part and parcel of their life. Caffeine has been a close friend to this poor being. Some suffered emotional distress like anxiety attack and MDD, those known to them only as some psychiatric illness listed in DSM 4 criteria whilst a student.

i'm still a medical student myself. i've always wanted to be a doctor like probably most who decide to enter this field. i studied in both malaysian environment and western ( north american ). at the age of 24 where most of my friends are already graduated or in their final years, i still have a long way to go due to some unforeseen circumstances.

i did my 2 1/2 years at international medical university before transferred to Dalhousie University Canada for another 2 years. so basically my medical course would be 4 1/2 years in total. that's not uncommon, especially in north america where all of medical courses are for 4 years. in calgary, i heard it's only for 3 years! how on earth did they do that? the system in north america is completely different from probably the rest of the world. to enter a medical school you have to have a degree. So, it's not surprising that most of my classmate are 27years old in average. Some reached 30++ years. they are married and already working as a professional like pharmacist, emergency nurse even engineers prior to medical school. i'm not sure why they still want to pursue a career in this field when they already have a good lifestyle, good jobs and handsome salary.

to me, canada has many great medical school. their health system is also the best compare to their immediate counterpart, the US. the student to doctors ratio is small unlike Malaysia which i think is relatively huge. back in family medicine rotation, i was one-to-one with my preceptor. So, of course more attention are given to you! you are the only one who's there to answer all the questions! no chance to escape or hide behind your peers to avoid being asked. in fact, as i recalled, i was one-to-one as well in psychiatry rotation and medicine and emergency. Ummm.. that sounds like all isn't it ?

Canadian medical students have early exposure to clinical stuff. as early as 1st year, they were introduced to the working environment in the hospital with once a week compulsory attachment with the doctors in the hospital. to observe what they do, and even directly involve with the diagnosis process. it's not surprising that they actually treat 3rd year medical student equivalent to a houseman in malaysia hospital! we involve in most of the decision making if not all. we are the first line for admission process if the cases is not too complicated of course. we did a real on call. staying practically overnight doing admissions to the ward (taking history, do physical examination and even suggest a diagnosis). nurses, while we are on call asked so many questions about whether to prescribe certain medication to a patient. we even write a prescription ( but of course must be discussed with resident before the orders being carried out by nurses) Our paperwork is used as a legal document in the patient chart! So no need to do once a week case write-up or whatever, if you already are doing it everyday.

--> to be continued

Saturday, December 4, 2010

HPV vaccination - to have it or not ?

Since the approval of HPV vaccination for form 1 students across malaysia, it has cause controversies. Lots of people are debating about the benefits, whether it outweighs the risk posed as well as the hefty cost imposed to our government. I found this topic is particularly interesting to do some research on. I’ve heard of it sometimes during my second year as a medical student. I’ve also heard about the vaccination against HPV, especially GARDASIL. Never did I do any research on this before, but now the curiosity is high. I did some research on websites, harrison’s online, PubMed as well as few other Malaysian authentic sites that gives statistics on this issues based on Malaysian population.


Cervical cancer like other form of cancer is an uncontrolled division of cells. For this one in particular, HPV plays a major role causing 99.7% of all cervical cancer (Munoz N, Bosch FX, de Sanjose S, et al). There are many subtypes of HPV but two strains 16 and 18 cause >70% of the cases (Walboomers JM, Jacobs MV, Manos MM, et al). This virus is transmitted through sexual intercourse. Incidence is highly correlated with early onset of sexual activity, multiple sexual partners (>6) and cigarette smoking, low socioeconomic status, poor nutrition, oral contraceptive use, and immunosuppression. The incubation period from infection to cancer presentation is about 15 years.


  • In the US, the incidence of HPV cervical cancer is 1000-fold compare to CIN.
  • Second most common cancer among women worldwide and contribute to 300,000 deaths annually.
  • In the US alone there are 9700 new cases and 3700 deaths annually
  • In Malaysia, cervical cancer was ranked 3rd among all cancers.
    • The incidence is 21.5 per 100,000 population
    • Incidence among the Chinese being highest at 33.6 per 100,000 and among Malays the lowest being 12.6 per 100,000 (Malaysian Cancer Registry 2002)
    • Indians 27.7 per 100,000.
    • In Kelantan, where the population of muslim is ~97% the incidence is much lower. 5.5 per 100,000

Sign and symptoms

These include pain around the pelvic area, vaginal bleeding and discharge as well as obstructive uropathy.


There are many ways to prevent cervical cancer or HPV infection. The obvious one would be to avoid sexual intercourse with multiple partners. The other one is of course through vaccination against the viruses. There are two vaccines available in the current market; GARDASIL (quadrivalent) and Cervarix (bivalent). Gardasil covers HPV 6/11/16/18 whereas Cervarix covers only two subtypes 16 and 18.

Vaccination against HPV 16/18 will prevent >70% on cervical cancer (Evidence level A). In HPV naïve person, the efficacy of the vaccination proved to be 100% against HPV 6/11/16/18. The antibodies produce in our body may last up to 5 years.

Adverse effects of Vaccination

Common Reactions

  • injection site rxn
  • fever
  • headache
  • nausea
  • dizziness
  • diarrhea
  • pharyngolaryngeal pain
  • vomiting

Serious Reactions

  • anaphylaxis/anaphylactoid rxn
  • bronchospasm
  • asthma
  • syncope
  • Guillain-Barre syndrome


Since the introduction of vaccination program in malaysia for form 1 students, many debate about whether it’s a wise decision or not. But I’m sure that our ministry of health has done a thorough research before coming with this decision. Based on the statistic given and research done, this vaccination is proven relatively save compare to the danger of acquiring the cancer itself. Based on research I’ve outlined above, the incidence is significantly lower among muslims (only for those that avoid sex outside marriage) thus, abstaining from having sex with multiple partners is definitely the best way. So, to parents out there please weigh the benefits of having vaccination against not having it. If you are a muslim that practice the religion well this vaccination might not give any different at all because you are unlikely to have any contact with HPV.

consumer association of penang view -

research in malaysia -->

malaysian family physician -->

Saturday, November 27, 2010

iqra' -the importance of reading

now i'm 24 years old. at this age i began to think to contribute more to the society instead of just doing things for personal gain. So i started to get involve in writing articles. My english is not that good though. I used simple structure with no bombastic words. Writing an article is no easy task. One must be knowledgeable for the article to be authentic and full of information. thus, the best way to gain knowledge is through lots of reading. Be it from wikipedia, books, newspaper or megazine it's going to always be useful.

but reading to me is no easy job either. i dont really enjoy reading. there are only few novels that i barely manage to complete reading it. on the contrary, i love reading blogs. especially those with lots of information in it that's based on concrete facts., are among blogs that i like to read.

i hope i can continue writing about medical related stuff because that's what i'm good at. wish me luck!

Sunday, November 21, 2010


I came across a status on facebook few days ago asking about the maximum amount of coffee that we can consume everyday before getting intoxicated. I thought that this was a good topic to be discussed as many people nowadays did not now that they actually drink a lot of coffee or should I say caffeine to be exact. Caffeine can be found in many food and beverages around us. The main source is of course COFFEE. Others may include chocolate and soft drinks especially colas. Some of us underestimate the amount of caffeine they ingest per day until they experience symptoms that mimics panic attack. Palpitations, hot flushes, headache, stomach upset and many more. Even when we get those symptoms we might not know that the culprit is actually the caffeine inside COFFEE that we drink. In North America, people going to the ED seeking treatment for caffeine intoxication are getting higher and higher. Children and teenagers are among those who are affected by this due to the caffeine inside colas and energy drinks. Since caffeine is naturally from cocoa seeds, coffee beans and tea leaves we sometime do not know that we are drinking caffeine-contained drink.

So what is caffeine?

Caffeine is grouped together with cocaine and amphetamine which are psychoactive stimulants. To help us understand how caffeine works we need to know how it affects our brain. Usually in our brain while we are sleeping, adenosine are secreted. It binds to its receptors causing the neurons to slow its activity. In addition, blood vessels are dilated to let more oxygen to be delivered. For these receptors, caffeine looks exactly like adenosine in fact more potent. When it binds to these receptors, the opposite effects of adenosine are produced. Neurons increase firing and blood vessels are constricted.

One gland in the brain, called pituitary, perceive this as an emergency condition just like ‘fight or flight’ response. It sends messages to the adrenal glands causing adrenaline to be produce and secreted into the blood stream. Heart started to increase its activity to meet the body requirements. Liver, produced more glucose to supply more energy. So that’s the desired effect we want to study late night for exams.

So how caffeine can be addictive? The answer is through dopamine abundance in our brain. Caffeine like cocaine increases the amount of dopamine in our brain. Dopamine is a neurotransmitter for pleasure activity like after doing sex. So you’ll feel good after consuming caffeine which in turn, might cause addiction but obviously of milder one compare to cocaine or amphetamines.


If you understand how caffeine works by now, you should be able to grasp the concept on how caffeine helps us to stay awake and feel happy and at the same time may cause addictive effect. As a medical students or as a doctor later on, when a young patient have a complaint of having palpitations or occasional headache plus some stomach related symptoms, you might one to inquire more if he’s consuming caffeine more than he should. A healthy individual according to a research may take 100-250mg that’s 2-3 cups of coffee per day. A dosage of 5-10g may be fatal! So, know your drinks. Coffee, colas, tea and energy drinks all contain caffeine. While food like chocolate have some amount in it. You might be surprised by how much of this substance you use everyday! Be wise and use responsibly.

----> learn more about Caffeine here!

-----it took me a long time to write this. i know, i'm suck at writing and loves to procrastinate----- ;)