Bagaimana menguasai diri

ALhamdulillah..rindu rasanya setelah sekian lama tidak menggerakkan kaki ke usrah.

tajuk tadi adalah bagaimana menguasai diri yang dikupas kami semua berdasarkan buku maza yakni.

ramai yg beri pendapat. akh yang pertama berkata bagaimana kita ingin kekal dalam islam. sentiasa yakin dengan islam, yakin dengan hudud, yakin untuk sampaikan islam dan tidak ragu2 memperjuangkannya.

Juga bersangkut paut dengan bagaimna kita mengawal diri dari nafsu yang tidak pernah putus asa mengalahkan kita. Juga fikrah yang jelas melengkapi penjelasannya mengenai menguasai diri.

Akhi yang kedua pula beranggapan menguasai diri adalah dengan disiplin dengan masa yang ada. mengikut jadual yang dibuat. juga di samping itu memainkan peranan masing2 dalam masyarakat. bagi anak kepada ibu dan ayah, sebagai ahli dalam masyarakat dan sebagainya.

Juga perlu difikirkan sebenarnya apa yang kita kejar? maka dengan berfikir akan hal itu kita akan menjadi insan yang mampu menguasai diri kita.

Insan yang seterusnya menyamakan menguasai diri dengan mengenal diri. bagaimana sekiranya kita kenal diri kita maka kita tidak akan meremehkan kemampuan kita atau membuat sesuatu yang diluar keupayaan kita. oleh itu hendaklah kita mengenal diri ini sebagai hamba Allah yang juga khalifah supaya kita dapat menguasai diri kita.

Juga akhi ini berkongsi bagaimana menguasai diri dari sifat marah atau ikut nafsu adalah sangat penting kerana inilah punca kepada banyak lagi masalah lain,

yang terakhir seorang akhi ini berkongsi sebuah hadis yang berbunyi :

ade seorang sahabat bertanya satu nasihat yang tidak perlu lagi ditanya pd orang lain setelah mengetahuinya maka nabi menjawab katakanlah aku beriman dan beristiqomahlah.."

maka akh tadi menyebutakan kepentingan istiqomah.

Konklusinya kami berbincang akan pentingnya menguasai diri.

Moga-moga kita dapat menguasai diri untuk menjadi hamba yang kenal akan dirinya, amanahnya tanggungjawabnya serta supaya dapat terus istiqomah dalam keadaan yang baik hinggalah mati.

wallahualam...

pleural effusion vs pulmonary edema

Just this evening we had class discussion on pleural effusion.

The scenario was of a 70 year old men underlying pleural tapping the past six months and 7pack years of smoking now presented to Hospital Teluk Intan complaining of progressive shortness of breath with cough.

at first most of us just want to diagnose as chronic pulmonary obstructive disease (COPD) due to productive cough and smoking history, but then with past history of pleural effusion and not more than 10 packed years of smoking we decide to discuss the case as pleural effusion.

the examination wise shows stony dullness, reduced chest movement, trachea towards opposite side.
chest x ray shows heterogenous opacity on apex and lower zone.

on discussion we must know the definition of pleural effusion. some mistaken it for pulmonary edema.
ok. in a simple words pleural effusion is excess fluid that accumulate in the pleural cavity, which is the fluid filled space that surrounds our lungs.

Normally, only teaspoons of watery fluid are present in the pleural space, allowing the lungs to move smoothly within the chest cavity during breathing. if in excess these fluid can impair breathing by mass effect, also it can limit the expansion of lung during the ventilation. Also in a pleural effusion its important to know the difference between exudate and transudate. exudate are simply inflammatory fluid leaking between cells, transudate are produced through tissue filtration without causing any capillary injury.

Meanwhile pulmonary edema is the accumulation of fluid in the air spaces and parenchyma of the lung. it leads to impaired gas exchange. it can either be due to failure of the left ventricle, injury to the lung parenchyma or vasculature of the lung.



So let us not mistaken these two. the management also differs. In pleural effusion, it depends also on the cause of effusion. if heart failure then gives furosemide. Also can remove the fluid by thoracentesis which is removing of fluid out of pleural space.

As for pulmonary edema, the initial management is supporting vital function.supply oxygen in hypoxic patient, tracheal intubation and mechanical support in preventing airway compromise. next priority is treating the underlying cause. for example pulmonary edema due to infection should require antibiotics.

I hope thats all to explain regarding these 2 important disease. May Allah grant us all istiqomaah in doing good things.

some more to share

it was last night class with dr yazli. at library teluk intan. as we climbed the stairs wondering what sort of class this is.

i was fortunate enough to be the first and eventually the sole presentor of the night.

what was interesting to share is on antibiotics. before we subscribe to the patient its important to know the aetiology or what organism that causes them.

you can actually diagnose by the sign. usually pustule producing wound involves stapylococcal bacteria.This type of bacteria is one you need to respect (bak kata dr yazli) as they can be present in many disease. among them is polymicrobial disease like diabetes. infective endocarditis, etc..

These are the things i learn that night:
1. among the things to ponder before giving antibiotics beside knowing their source or agent is identifying the patient allergic status.
2. sometimes you gave patient antibiotics and it doesn work. then you might be thinking of the resistent type. some resist to peniccilin. so think of giving the broad spectrum like augmentin, cloxacillin.

Also the dr ask my friend to present back the knowledge on cellulitis that we learn that morning.
These are among that we learn on bedside that Monday morning...

1. important to know the aetiology behind any wound, swelling,tender lesion. ask history of sea bath, river bath, soil as these have their own organism that can lead to cellulitis.
2. important to know whether there is blisters or not on the swelling as the presence of it may lead to necrotizing fascites which is a medical emergency (if left overnight can lead to extensive gangrene)
3. if it is NF then the pain must be severe, tacycardic, tacypnic the pressure may goes down and other unstable condition.(make sure not to miss these!!!)
4. So next management for NF is to refer to surgeon
5  So the risk factor for this patient is the underlying fillariasis(immunocmpromised) and obese
6. The physiology behind rigor is due to the release of high amount of pathogen like happen in malaria.
7. The way we ask for rigor is "does it shook the bed?"@gigil sampai gegar katil ke?"
8. Rigor are ways our bodies produce heat to adjust to the changes at the hypothalamus where the thermostat had been altered saying our body is cold whereas its not, also its important as only some disease can cause it.

All the same this patient that i clarked was very fortunate to own a very dedicated nice mum who had been taking care of him since the last 11 days in the ward. His mum praised his son as a good butcher and he is the breadwinner for the family since death of his husband 10 years ago. nice to hear a supporting mum.Also a dedicated son. May Allah heals his disease soon. insyaAllah. 

bedside at teluk intan

i just finish my bedside teaching with dr Yazli. its really a nice teaching session with a nice dr. what we learn just now is on examination of the abdominal system.

Its a patient age 66 alert to time place and people, laying comfortably supine with a massive splenomegaly on palpation. She had no other findings beside that. upon my friend's clark the patient actually had chronic cirrhosis that eventually leads to the splenomegaly.

She had no hepatomegaly as cirrhosis involve the shrinking of the liver. cirrhosis is always related to portal hypertension, thus the leading question are whether any bleeding like hemetemesis happens. this also may contribute to the large spleen that happen to be due to a congestion of blood there.

Also we need to ask any history of doing scope before.

Also the portal hypertension can lead to encelopathy and thats the reason to ask for while we approached a patient of abdominal problem.

Also we learn the right way to do examination.
1. Not to be too close to the bed
2. minimise contact with the patient.
3. Pull the sleeve (for muslimat its important to wear maksum especially in this condition)
4. Showmanship (show that what you are doing; example: stand at the end of bed and take afew seconds there)
5. Make instruction clear for the patient to follow.
6. if patient pain try to go for the other parts first.
7. let go off your finger immediately after a percuss to avoid absorbing the sound
8. the spleen we must start palpate from right lower quadrant so that we would not miss any large spleen.
9. the finger to test for spleen must be at the tips of finger as we want to feel it when it fall on inspiration
10. you can do ballotingthe kidney immediately after you ask patient to lean over while doing shifting dullness (can avoid much movement) and can check also the sacrall edema.
11. No need to measure the liver span if no hepatomegaly(some dr are not in agreement over this)
12. for superficial palpation on abdomen its enough to touch no need to press as we only want to see any pain, ex: peritonitis is painful even a touch.

well. these are among the tips we get in the bedside teaching.

hope of sharing more in the next class insyaAllah.

Nice to write back

Its nice feeling to be able to post something here. Always i write for reason.
Today let me share on being a medical student.
Maybe most of us never think of becoming a doctor because it is one of the most busiest most commitment required job on earth.

I cannot comment further on that as i am only a medical student. But from my observation it seems quite true.

By the way i'm here just to share my experienced as medical student. As medical student its more about how do you able to cope with tremendful load of things to study, memorize and when we reached our clinical years its the time we vomit(present) back our knowledge to the doctors.

It's also the game of repetition and making sure you did not repeat the same mistake.

Expectations from senior lectures that was usually the dr would be higher as years goes by. Until you become a final year student or a 5th year medical student then you realized how much that you dont know and how unprepared you are towards becoming a doctor.

All of us medical student know from the 1st year that one day we will all become dr, but that feeling just doesnt mean much as you get busy with stuff or hobbies and while also acknowledging that the final exam of pro 2 exam is a long way to go. Until the horror part came when you enter final year.

Day by day we are counting towards facing that day of exam. preparations done that previously would be strange. but not in final year. Some would spend their weekends clerking patient. some spending night time after isya at hospital. some returned early after holidays to get the extra experienced by going to hospital.
All this is in order to make ourselves competent enough to become good doctors one day. dr that doesn know would be something like killing the patient.

But then some student that just always had some other things to do beside study, some other commitment will really becomes stress if not handled rightly. Its that part that relate to me. But then if i am unable to cope from now on theres no way of a last minute study bro. never will they be, i will be one of the failure if i stick to my current way of living as medical student.

So thats why major modificaton had to be made as the time ticks. Time is still not too late. Just starting. the momentum that i hope will stay till the end insyaAllah.

I just hope that my 7 months left will be full of effort on study and at the same time not leaving out on my current commitment as .....

InsyaALlah.

this is my friends, farid and izzuddin.