game of the heart

i still miss him....

stupid feeling that i cant stop thinking about him...
the more i refrain of thinking him the more intense the frequency of him in my though
i was thinking trough ... i never expected anything  as i know nothing can happen between us...
its just an unofficial relationship to just so call for fun .. but i didnt know that it got to me badly
that it really break my heart when it come the time for me to let go ...'
i act as if it is easy to let go .. thinking i be strong enough to face it and wishing his happiness ..
but unlikely...
its not the first time it happen like this .. i always think its just a game .. but seem like a game that u r hoping to win badly  ...
i didnt want to blame him.. because he have been giving the warning .... of impossibilities ..
but still thinking.. nah ... it just a game ...
now i m shouting back to myself ... a game  a game that ended up eating yourself....
sigh.... now i wish i didnt know him ....
someone once remind me                                                                                                                                                       ".I DONT WANT U to MAKE URSELF AN  IDIOT, WHEN U FALL DEEP, n CANNOT COME OUT..."     


when this particular person told me this i was like .. thax for reminding me...


but too bad i met a person that shower me all the affection that i needed that gradually i sink deep n drowning ..... while thinking its just a game ...


so now .. still trying to forget about you .. try to delete every piece of u out of my mind ... 
damn it is not that simple.... 


... i m being an idiot pathetic game that i created for myself....
to that someone... if u read this ... u just can read it trough but not need to take it seriously as it may related to you but its none of your concern for now.... 


one thing i realize in life is ..
when u try to be numb.. its useless u dont feel anything . its like a wooden furniture that u hit them they can feel it .. u clean them , they never feel it neither..
so u choose to have sensation.. and that the time u feel all the taste in the world
... sweet bitter sour salty....




lesson learnt !!!! 

Achievement..6 years...

6 years of medical school.... oh yeah .. i m done...
its one of my biggest achievement in life.
2005 till 2011...
still fresh in my mind, the first day of school, the first stranger who came up n said a "hi"
The first russian teacher that yell at me... the first guy that i scolded...
its all sum up to a process of maturation...
today, 6 years i m done.. but, wait a minute.. it is just a beginning of every new things...
Frankly speaking, its start getting rusty, what i learned back in medical school.. as it all processed in Short Term Memory SPACE... need to refresh..refresh and refresh
But all i can said, six years, i met different kind of people. i learned a lot of virtues, i changed.
there is also a moment of darkness.. and a  moment of glory
competing to be competent, envy to those who are better..
Hate and Love is a mixture of emotion but at the end of the day, You learn to accept and forgive... thought the scars is not pretty.. u dont like it..
But there still one person was . and still with me till these day .. That is the BIG GUY FROM ABOVE...
every success begin with Him, Every failure, He strengthen me.
every cry, He cheer me up, Evey mistake, He show me the right way..
only one things .. I said " Dei Gracia"....
And for my pillars.. mom and dad... they are the proud parents... i dont blame them.. every parenst have a decent pride for every achievement of their offspring....
I m glad to have them, their supports, their advise, their prayers... always there to tell me to be a better person in this weary world..
To my groupmates.... Group 11... 6 years of journey, counting on each other everyday... without u all, i wont have made it.. thank u...

Six year Kursk .. its a phase of life.. that always be my bitter sweet memory that u love so much.. just like the dark chocolate.... too sweet is not fine. u will get Diabetis Mellitus...

-xoxo- miggy -

" Potter Syndrome"

Do u remember the story of Harry Potter.. not my fav though... but just to used his dear name.. POTTER...

Potter syndrome or also known as Potter sequence with classic triad:
1. CLUBBED hand or leg
2. PULMONARY HYPOPLASIA

3. CRANIAL abnormality

fetus wid clubbed limbs and potter facies

this happen due to OLIGOHYDROAMION... which main course of oligohydroamnion is BRA(Bilateral Renal Agenesis)...

usually it is detected only at second trimester which lead to poorer prognosis..

get the slight idea...
few remark:
according to AFI( Amniotic Fluid Index)
normal =8-18
oligo~ <5 or 6
poly~ >20 to 24

Spalding sign

Spalding sign is an obstettric Ultrasonography sign which show overlaping of cranial bone in the uterine cavity .
what does it mean?? Its a passport to IUFD( intrauterine fetal death)

normal cephalic without overlapping 

overlapping of fetal cranial bone.

Dukes Criteria for IE

 a bit about Dukes Criteria .
Major :
Little scarry bug
•  viridans streptococci, Streptococcus bovis, or HACEK group , or
•  community-acquired Staphylococcus aureus or enterococci, in the absence of a primary focus

 

on the Heart  what is seen ?

• perivascular abcess
• prosthethic valve
• valvular regurgitation.. newly formed...

Minor criteria ..

Clinical SiGN 

Osler Nodules

 Flat, painless, erythematous lesions 

-roth spot
-splinter H/r






IE, risk factor for old age patient, drug abuse-narcotic IV,  went to OT( tooth extraction, tonsilectomy, obs n gyne procedures and etc), Prosthetic Valve Replacement, Cardiac Transplant....

IE onset with Fever followed with Chille.
Aneamic Syndrome : pallor, asthernic, fatigue and weakness. Why? huporegeneration anemia ( blood analysis may show leococytopenia).. due to Bone marrow suppression .. which later lead to Spleenomegaly.. compensatory .

IE morphology in echocardiogram commonly is vegetation and perforation of valve.. most common is aourtic valve( diff diagnose with RF=>Mitral Valve)

                                                              vegetation of aoutic valve lealet 

main target organ of damage for  IE is heart .. infective endocardial surface...

enuf for today... sambung esok ... heheheheh

Chilaiditi syndrome

Chilaiditi Syndrome is transposition of a loop of large intestine (usually transverse colon) in between the diaphragm and the liver.
also known as 

•  interpositio hepatodiaphragmatica,
•  subphrenic displacement of the colon,
•  subphrenic interposition syndrome and
•  pseudopneumoperitoneum.

triad for CS is, abdominal pain, volvulus and shortness of breath..

on X-ray, classically u will find , gas in the right hemidiagphragma always misdiagnose with pneumoperitoneum...

 A small crescent of air can be seen under the right part of the diaphragm

gas between liver and diaphragmrugal 

rugal folds within the gas suggesting that it is within bowel and not free

COD:a long and mobile colon (dolichocolon), chronic lung disease such as emphysema, or liver problems such as cirrhosis and ascites. 

Cardiac Cachexic Syndrome.... wow

Cardiac Cachexia (CC) syndrome, is a complication of CHF(Congestive Heart Failure)
I didnt know this, until i start reading my Harrison's
it is a sign of bad prognosis. and related to age, sex , LV ejection fraction and exercise capacity.

it happen when generalized lose of body lean mass, tissues, fat and skeletal. Therefore, patient is weak and very weak, asthenic syndrome.
pathogenesis: neorohumoral and immunologic disbalance.

• increase amount of norepineprine,epinephrine, cortisol, renin-angiontensin aldosteron system activation 
• and increase plasma inflamatory cytokines that is TNF-a.

increase of above mentioned lead to catabolic imbalance n metabolic imbalance and later lead to wasting...

so that about it lah... the cascade that bring to dead end= CC...