A proposal for USMKLE

Salam everyone. It looks like this blog is almost doomed and was left unattended for so long because I was just too occupied with my main one. Here supposed to be something more informative, something seems more important than what I want to deliver in the main blog.

As you all can see, I am now a medical student. Haven't barely finish my first year, and still struggling through it. What I can say is that medicine is super duper hard and super duper hard work and persistence as well as perseverance are what we all need to achieve the best.

I have now a proposal, an idea on how the teaching method of USM should have been improvised. Not that I want to condemn the present way of the lecturers and the school itself, but I just think that for the benefits of all we must have this done.

So, straight to the point shall we?

The lecturer

The lecturers are brilliant and dedicated. They could just bare with you and make you understand, so just ask and ask till you really get the grip. The problem is that, they are too old fashioned. They don't do jokes that much and ask us to not laugh or even a slight talk among our peers who sit beside us is forbidden. Talking in lecture is rude according to the lecture, even though the talk is about the lecture. Automatically, when a student see something on the lecture slides and he or she cannot understand it, he or she will definitely discuss the thing personally with the his or her peers sitting on the next bench. This is not allowed in India, and rude. You don't understand something, ASK THE LECTURER. Plus, to laugh over something that you feel it's funny is also something that is so taboo to Indian education system. So, all we did was sit straight, no laugh, no discussing and be serious. Trust me: Serious learning is not the way. When it is vital to get most of the facts during the lecture as long term memory, laughing is what we need, discussing helps to clear the mess and FUN LEARNING should be implemented.

The Small Group Discussion

Here, we are divided according the first Alphabet of our names. So each group has 12 members. We are called out by NUMBERS and not names. Mine is number 8. So my group basically consists of the student from role no 1 to role no 8. That's how the thing works. Basically, our SGD is 2 times per block. Sometimes, it is all about physiology and sometimes it is all about biochemistry and sometimes both. For first year, we only have anatomy, biochem and physiology. 

Small Group Discussion is actually questions that we need to answer which are given prior 2 or 3 days before. However, it is such a drench to finish all the questions in 2-3 days. Sometimes there are more than 20 questions. We do divide the questions among us, but it is not a very good idea since during the discussion we supposed to know, is to have the very best explanation towards EVERY EACH questions. Some of the group members are not very committed to this discussion session, and thus causing us to have problem in getting all the things together. Plus, the discussion group only ends here and nowhere else. This is so bad. Because the group should persist and work as a team in most of the case. For example: during study week, during the weekends, it has to work. I remember when I was in Pre Med at UiTM, we had the similar thing. But we are more bonded compared to us here. I am so sad that the group is not as a real group, but just merely a group when the lecturer said so. This is so wrong. I just hope that students here could just do more the work as in A TEAM and not doing things proudly on their own. Sigh.

The question should also be given to us one week at least for us to work out for it. Sometimes, it is in the mere end of the week where we have to also revise for the endblock that this question appears and we have to struggle the brain more. It is always a struggle. Not to mention, with frequent night meetings that we have to attend, which sometimes aren't that important, but needed us to show the face. So ridiculous. 

For end blocks

End blocks are merely test they give us in order to test our knowledge for the block we have learnt. I would tell you that end block gives us frustration when after the end block ends, only then will the lecturers tell us why our answers aren't accepted. Sometimes, it's because of the drawing. Histological drawing by H & E pencils during the test. How we were supposed to know to use the H&E pencils if they didn't tell us earlier?? In addition, the lecturers should give us a proper guide on how to answer the essay since we sometimes do not know what really counts on certain topic. Everything seems so important BUT we need to really know what they wanna see in our answer sheets.

The MDL

MDL session is like a repeated lecture only for anatomy. It is very helpful but just that sometimes, the lecturer gives too much input compared to the real lectures during class and there's no output. I would suggest USMKLE to give questions at the end of the MDL of the topic being told. An interactive activity should be nice rather than sitting quietly and listen. We are young and we get bored easily!

So this is what my proposal would be. I know no one would see this, even the USM's behalf. But this is what I think should be done for a proper strategy to get the long termed memory.

Malaysia, Egypt and Russia...

I was not really interested to post on this one, because, I myself have not yet to pursue my degree. However, I think I should do this since I am so free.

This would be a post on where should you do your medical degree. But, this will be recommended to Malaysians, since to westerners the system would be a bit different.

Malaysia, has so much to offer for its medical schools. We have the renowned Universiti Malaya. The first Malaysian University to establish its medical faculty. Universiti Malaya is also the first university in the country to provide a pre-U course for SPM leavers, either for Biology-based science stream and Physical-based science stream. Of course, since it's the first University for both, thus many students nowadays opted it as their first choices. Its location in the midst of the capital city of Kuala Lumpur, equipped with lots of facilities especially LRT stations and five-star shopping malls, its a definite heaven to be one of its students.

Others are UiTM, Universiti Sains Islam Malaysia, Universiti Islam Antarabangsa Malaysia, Universiti Sains Malaysia, Universiti Kebangsaan Malaysia, Universiti Zainal Abidin in Terengganu and Universiti Kuala Lumpur. Requirements to get into medical schools, dental schools and also pharmacy is strict. A total CGPA of 3.5 and above is what they listed, but ACTUALLY even 3.5 you won't be able to attend the medical school. Even for USM, they recently called only the 4 flatters but not all 4 flatters made it through. So, it's a tough fight, and one has to be superbly brilliant to get into medical school. To add, one has to strive and struggle competitively with Matriculation graduates and also those from STPM.

Egypt.

Well, recently Egypt is labelled as an unsafe place to go because of the 'rusuhan' and 'pemberontakan'. A friend of mine from asasi UiTM got an offer to pursue medicine at one of Egypt's medical school, but rejected it. Many are now afraid to go there, some probably have been brainwashed by their mothers, families mainly about the dark sides. Even newspapers have been the daily culprit to emphasized how bad medical graduates from Egypt are. 

According to a friend of mine, named Hifzan Arimi, a first year medical student at Cairo University however had been telling me the 'bright' sides. You can see how Egypt is by just seeing Ayat-ayat Cinta or Ketika Cinta Bertasbih. Just look at the condition of the students' apartments. They aren't much to brag but if you are there to study and that alone, it won't be a big problem. Plus, Hifzan told me that being in Egypt you would not have a stressful lives. Class sometimes stops in the midday, and no assignments are there to be done. The train they have there is faster than our commuter with much cheaper rates. So, it's not a big deal to travel from a point to another. Food is also not a problem. But, one thing, they do not have tutorials, so learning on your own is a vital. After all, you can go to his blog for further details. (HIFZAN ARIMI)

Plus, you can also opt to go under Medic Mesir, as for SPM leavers you have to at least get at least B for Biology and for Matriculation/Foundation students, a CGPA of at least 3.00. Go to Medic Mesir blog.

Russia

I once wanna go there, with a friend, but not anymore. Studying medicine at Russia can be considered as one of the cheapest places there are. Of course, who don't wanna go there when you can experience the 3 seasons and of course seeing yourselves wearing 'trench coats'. Recently, I have chatted with a final year medical student at Russia who studies at Volgograd State Medical University. He's one of the students who were under fast track MARA and will be finishing this July.

He constantly advising me to stop planning to go there. He said dealing with Russians are hard. Plus, once he did said, that he paid RM 500 for his graduation, but the money is only for their selfish reason because the graduation is all about wearing the robes, take the certificate and that's all. Also, he doesn't got the chance experiencing the clinical trainings even though he has been there for 6 years. But, you can opt to go there if you wanna study lightly. With classes end last like 2 hours a day, who wouldn't but for those who are not under scholarships, prepare the RM300, 000 for your expenses.

Below are several photos he gave me in courtesy of his kindness...

...sampai di sini dulu...

Understanding Cells

Understanding Cancer: Metaplasia

A huge part of modern medicine is cancer, as it’s one of the leading causes of death world wide. I’ve spent the past week and a half learning the basics, so I thought I’d pass it on to anyone who is interested.

The human body is made of trillions of cells but there are different types of cells that we’re comprised of. Each type has a different structure and function as dictated by our DNA, it’s not like there’s just a random cluster of plain cells underneath your skin. Every cell and it’s type plays a role. You can spend a lifetime studying cells alone, they’re fascinating little “worlds”. One of the more interesting aspects to cells is their ability to adapt to harmful stimulus. Cells have efficient regulatory mechanisms to help them adjust, but sometimes a harmful stimulus is just waaaay too much so the cell will actually switch to a type that is better abled to handle the environmental stress. This is called metaplasia.

What do you mean a cell switches types? Well, without giving you an entire course in histology, let’s just look at 2 examples.

The first is glandular metaplasia, and it can occur in your esophagus at the junction with your stomach. There is a disease that many people suffer from called GERD (Gastroesophageal Reflux Disease). When you eat food it goes through the esophagus and into the stomach, where a muscle-ring called the Lower Esophageal Sphincter closes off to keep the contents of your stomach (food, fluids, and most importantly the acid) from leaking back into your esophagus. In patients with GERD this sphincter is really weak, so the acidic mix of stuff you just ate occasionally squirts back up the tube and damages the parts of the esophagus near the junction. What kind of effect does that acid have on the esophagus? The esophagus is lined with mainly squamous cells. These are simple, run-of-the-mill cells but when they’re constantly getting hit with acid and trying to deal with that kind of damage, they’re going to change into a cell type that’s better able to handle that stress. So they change to glandular cells, like the kind you find in your stomach. These cells secrete mucus that protect them from acid in the stomach so the switch is logical. Basically put, the lower part of the esophagus becomes an extension of your stomach tissue. We call it Barrett’s Esophagus.

The second example is what happens when people smoke cigarettes for a prolonged period of time: squamous metaplasia. The cigarette smoke is inhaled into the airway and causes chemical damage due to the polycyclic hydrocarbons. This repeated chemical damage forces the glandular cells to switch to squamous cells to better protect themselves. The bad thing about this switch is that these glandular cells in the airways secrete mucus to trap intruders, dust, debris, etc. They also have hairs called cilia that sweep this trapped, mucus coated junk up and out of your airway. This is why smoker’s are vulnerable to constant respiratory infections, their ability to trap and get rid of junk is impaired.

The great news about the metaplasia in both of these cases is that if you remove the irritation, the cells will go back to normal. In the GERD patient we use antacids and look into ways of strengthening the lower esophageal sphincter. In the smoker we… get them to stop smoking. But if it’s reversible what does this have to do with cancer? Well, if the damaging stimulant continues, and these cells keep proliferating and switching, it’s going to increase the risk of developing dysplasia, uncontrolled cell growth. That’s the beginnings of esophagus/lung cancer in these patients.

Credit to white-coat in Tumblr

>>>p./s: that's why, don't smoke!!<<<

Patologi Pertuturan

Caught up with a course that I heard for the first time: Patologi Pertuturan, a job which a medical doctor is not able to do. Copied from USM webpage, where I choose the same course at the 3rd place.

Pengenalan 

Program Patologi Pertuturan yang ditawarkan oleh Pusat Pengajian Sains Kesihatan (PPSK), Universiti Sains Malaysia (USM) merupakan program pengajian penuh masa selama 4 tahun atau 8 semester dan di akhir program pengajian, graduan akan ditauliahkan dengan Ijazah Sarjana Muda Sains Kesihatan (Patologi Pertuturan). Program ini telah dimulakan pada sidang akademik 2005/2006 dengan pengambilan pelajar yang dihadkan kepada 10 orang sahaja pada setiap tahun pada peringkat permulaan ini. Pengambilan pelajar ini akan ditambah dari masa ke semasa apabila prasarana pusat pengajian ini dapat disiapkan dan bilangan tenaga pengajar mencukupi kelak.  Secara amnya, program Patologi Pertuturan adalah satu bidang pengajian tentang perkembangan pertuturan dan bahasa, masalah-masalah komunikasi, suara, kelancaran pertuturan dan/ atau penelanan kanak-kanak dan dewasa melalui pengelakkan (prevention), identifikasi, ujian, rawatan, habilitasi dan/ atau rehabilitasi, mendidik serta perkhidmatan kaunseling kepada mereka. Program ini memberi kelayakan kepada graduan bekerja sebagai seorang Patologis / Terapis Pertuturan-Bahasa (Speech and Language Pathologist/ Therapist). Terdapat pelbagai sektor di Malaysia yang boleh diceburi oleh Terapis Patologi Pertuturan-Bahasa (rujuk bahagian Maklumat Ijazah dan Pengiktirafan), terutamanya sektor kesihatan. Ini sejajar dengan wawasan PPSK yang menyediakan graduan-graduan mahir di dalam bidang yang berasaskan sains serta berkaitan dengan kesihatan dan perubatan.

Objektif Program

1.	menghasilkan graduan yang berketerampilan dan mempunyai asas yang kukuh dari segi sains biologi manusia, linguistik yang diperlukan dalam mengendalikan pesakit-pesakit bermasalah pendengaran, pertuturan, bahasa, suara serta pesakit dengan masalah neurologi perolehan dan kongenital.
2.	melahirkan graduan yang berupaya mengendalikan sesi terapi dengan kemahiran klinikal yang mantap dan berfikiran kritikal, serta secara profesional dan beretika.
3.	menghasilkan graduan yang mantap dan mampu mengaplikasikan prinsip-prinsip, kaedah-kaedah dan prosedur-prosedur penilaian, penjangkaan, diagnosis secara bukan perubatan, pengujian, perundingan, kaunseling, memberi arahan serta menjalankan habilitasi atau rehabilitasi, tentang perkembangan dan masalah-masalah pertuturan, suara, penelanan, dan/ atau bahasa bagi tujuan diagnosis, mengelak (prevention), mengidentifikasi, membaikpulih, modifikasi masalah dan keadaan seseorang individu dan/ atau sekumpulan individu.
4.	melahirkan graduan yang mampu berdikari serta berilmu pengetahuan seterusnya membolehkan mereka melanjutkan pelajaran ke peringkat yang lebih tinggi.

BOHR effect

It has been a while since my last post, and today yeah, about BOHR effect.

Generally, we know that haemoglobin and oxygen are always in pairs. They are like the rhythm and melody. But, we must also take notice that haemoglobin do combines with carbon dioxide too, forming carbaminohaemoglobin.

In the usual oxygen dissociation curves, the shape of the curve is the normal S-shape. Easily to say, when the oxygen concentration is high, or oxygen is saturated, meaning the affinity of haemoglobin for oxygen is therefore higher. This result in the binding of oxygen to haemoglobin forming oxyhaemoglobin. When this happens, the curve moves to the left, showing higher percentage of saturation of haemoglobin to oxygen. even when the partial pressure of oxygen is relatively low.

Reversibly, when concentration of Oxygen is low, the oxyhaemoglobin dissociates into haemoglobin and oxygen, thus releasing the oxygen to the targeted area, where they are needed. Example, tissues.

higher oxygen, curve moves to the left and vice versa :)

Ok, as in BOHR effect, in respiring tissues, oxygen is lower since it has been used up in respiration, ventilation and etc but carbon dioxide is in higher concentration in contrast. 

To be exact the presence of carbon dioxide is crucial to meet the demand for oxygen in the continually respiring tissues. Why? Let us go and see together:)

When there is carbon dioxide, Bohr effect appears. Carbon dioxide helps the haemoglobin to dissociates oxygen, and thus providing oxygen for the oxygen deprived tissues. 

Here, we are still using the same concept. Higher carbon dioxide concentration, lower affinity of haemoglobin for oxygen thus curve shifts to the right, showing lower saturation percentage of haemoglobin to oxygen since carbon dioxide is in higher concentration compared to oxygen. 

Do you see the above diagram. Ok, so it is not a Doughnut, rather, it is our beloved Red Blood Cell. Referring to the above diagram, there are 6 important sequences that can explain briefly why carbon dioxide actually helps in the dissociation of oxygen.

In respiring tissues:-


1. Carbon dioxide diffuses into the red blood cells from the plasma

2. Carbon dioxide that enters the RBC will then combines with water as in the following equation 

H₂O + CO₂    H₂CO₃

<sub>--> so carbon dioxide present combines with water in the erythrocytes to form carbonic acid with the aid of enzyme carbonic anhydrase. This is a reversible process.

 

3.  Carbonic acid then dissociates into hydrogen ions and hydrogen carbonate ions. Here, the hydrogen carbonate ions will diffuse into the plasma where carbon dioxide is most transported in this form.</sub> 

H₂CO₃    H⁺ + HCO₃-

When hydrogen carbonate ions diffuse from the cytoplasm into the plasma, the reaction is balanced by the diffusion of chloride ion, Cl-. This maintains the negative and the positive balance on either side. This is known as chloride shift.

4. The dissociation of carbonic acid increases the acidity in the blood as what is left is the hydrogen ions. Hydrogen ions then react with the oxyhaemoglobin to release the bound oxygen and at the same time reducing the acidity in the blood. 

Hb.4O₂ + H⁺    HHb+ + 4O₂

 

_{The HHb is haemoglobinic acid. It is this reversible action which accounts for Bohr's effect. The carbon dioxide is higher due to respiration and ventilation of living cells and tissues and so it is here where haemoglobin releases the oxygen to the respiring tissues.} 

5. At last, the oxygen releases will be diffused out from the RBC into the plasma.

In the Lungs.

Oxygen concentration is high in the lung and the oxygen diffuses into the RBC. Here, the affinity of haemoglobin for oxygen is high so

1. Hb + O2 --> HbO (releasing H+)
2.  
3. H+ + HCO3- --> H2CO3 
4.  
5. H2CO3 --> H2O + CO2 (with the aid of carbonic anhydrase as enzyme)
6.  

The CO2 is then diffused from RBC into lungs and removed from the body through exhalation. 

 

Perbahasan

Mengapakah beraya di kampung lebih baik ??

1. Ramai saudara balik serentak ke kampung halaman, maka lebih senanglah buat kita untuk menemui mereka. Kemeriahan ditambah pula dengan gelak ketawa hasil gurau senda antara saudara-mara pasti menggamit seribu keindahan sempena syawal yang mulia. Selain itu, kebiasaannya, di kampung terdapat datuk dan nenek yang masing-masing merindui anak cucu mereka. Oleh itu, apabila anak cucu mereka pulang ke kampung, pasti akan menyenangkan hati mereka, sekaligus menyenangkan dan menggembirakan hati semua pihak.

2. Persediaan menyambut perayaan di kampung halaman, mampu mengikis sikap berdiam diri, pentingkan diri dan pemalas. Hal ini kerana, hanya di kampung sahaja, persediaan menyambut hari yang gilang gemilang itu dilakukan secara bergotong-royong. Di samping itu, terdapat juga pengkhususan kerja buat semua ahli keluarga. Mereka akan buat kerja dengan bersama-sama, dan tiada seorang pun yang akan terabai sewaktu bekerja. Ini meningkatkan semangat untuk menyambut perayaan.-Misalnya, mengacau dodol, mesti dilakukan oleh beberapa orang dan mengambil masa yang lama. Senario sebegini pastinya dapat mengukuhkan silaturahim dalam kalangan ahli keluarga itu.

3. Di kampung, persediaan menyambut hari raya, lebih menjurus kearah kekeluargaan dan keharmonian serta kesederhanaan. Jikalau di bandar, masyarakat lebih ke arah materialiti. Segelintir daripada mereka membuat persiapan secara berlebihan, misalnya, semua barang haruslah dibeli yang baharu agar tampil cantik di mata orang. Hal ini berlawanan jika di kampung. Masyarakat akan lebih menumpukan soal kesederhanaan trtapi pada masa yang sama meriah. Setiap malam pada bulan puasa mereka akan megerjakan sola tarawih, manakala masyarakat bandar ada yang tidak mampu mengerjakannya kerana terlalu sibuk dengan majlis berbuka puasa di hotel mahupun sibuk dengan urusan kerja dan kegiatan membeli belah untuk persiapan terakhir menyambut sesuatu perayaan itu.

4. Fikiran lebih tenang, kerana berjumpa sanak saudara. Masing-masing melupakan kesibukan kerja dan lebih fokus terhadap keluarga. Suasana nyaman dan nostalgia zaman2 dahulu menggamit semula keseronokan beraya di kampung berbanding dengan braya di bandar.

5. Keselamatan anak2 lebih terjamin sewaktu merek apergi mengunjungi rumah jiran2 memandangkan di kampung tiadanya jalan yang sibuk. Oleh itu, hal ini dapat menyenangkan ibubapa yang bimbang akan keselamatan anak2 mereka sewaktu pergi mengunjungi rumah jiran tetangga untuk memperoleh duit raya.

6. generasi muda dapat merasa sendiri keunikan cara membuat kuih raya mengikut teknik tradisional, cth, bahulu yang dibakar menggunakan arang. Selain itu, mereka juga boleh belajar menganyam ketupat dan memasak hidangan hari raya menggunakan bahan2 tradisional. Di samping menguatkan hubungan silaturahim dalam kalangan sepupu dan mereka yang lebih dewasa.

Dedicated to my Only Chinese Friend-Chiam Win Nee

Hello, today I am going to write about the famous chinese emperor, the one and only Qin Shih Huang, or better known as Shih Huang Ti. Now, let's start the show:

When the boy king Qin turned 21 years old, he killed the regent who had been ruling in his name and took control of his own kingdom.

He declared himself as the First Emperor in 221 B.C and became a new ruler who immediately centralized his power. He also established a powerful bureaucracy and standardized the legal systems, weights, measures, money and writing. The most famous statement made by him was,

"To have great power, the state must be united"

While he struggled to unify China,he was actually hatred by his own society. The main reason why he was hatred so much is because of his own self; a KILLER. He had killed many Confucius scholars as these scholars harden on the mercy of a king to the kingdom, meanwhile king Qin preferred to be the mean king whom must be respected by all. He was also the man behind the mega projects, The Great Wall of China and the Mausoleum which is filled with 10000 life sized terracota warriors in Xian, China.

Although King Qin did almost everything to make sure he will be immortal, but at last, as human, he too died without leaving behind any descendants. The ministers were worried upon Qin's death, that there would be a revolution, so they decided to bury the king secretly. Myth said that king Qin's tomb is located in a cave without gravity. The tomb was designed exactly like his kingdom with the palace itself. Everything is said to be floating inside the tomb.

Despite the ministers' careful management in hiding King Qin's death, China descended into chaos once again within four years of his death.

-so, chiam, are u shih huang ti? the first emperor? hahhaha:) Just joking ok darling-