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... MY WISH LIST ...

=MED XENZIA=

welcome to my blog ... hope that we always could share and discussing some tips and issues here

" ilmu tanpa amal ibarat pokok yang tidak berbuah"





Wednesday, December 11, 2013

11.12.13

Norma kini semuanya hebat merperkatakan tentang tarikh yang sinonim ... ( ape benda tah ) ... tarikh yang cantik la senan cakap .. 

Ada apa pada 11 12 13 ni ... ? Tkde ape pon .. sekadar suatu nombor :P 
jangan nak taksub bebenor .. 
     Sorry ... saje nak update entry ngarut .. enjoy ur holiday orengs selangor ^_^

Tuesday, December 10, 2013

Cervical Cancer .. what have you missed ???

Mostly we as women was covered in black ... why?? Because  we always fear to face the truth ...  why do we have to manipulate the facts? I m here to day to share ... to give an awareness about cervical cancer , before its too late  ... :)

MISCONCEPTION #1: Cervical cancer is easily detected. 
Especially in its early stages, this disease may have no signs or symptoms at all. And the incidence of cervical cancer starts rising steeply at age 30. 

MISCONCEPTION #2: Cervical cancer develops quickly.
The cancer on the lower part of the uterus is caused by Human Papillomavirus virus (HPV). Sexual intercourse is the primary route of transmission of genital HPV infection.

If left untreated, it may take more than five years for the infection to develop into pre-cancerous lesions. This usually requires an average of 20 years before becoming a full-blown cervical cancer.

“In that span of time, there’s no way of knowing if you’re infected or not unless you get yourself checked. That’s why most patients are aged 40 and above,” Ganzon said.

“So it’s always better if you get protected from the virus,” she added.

MISCONCEPTION #3: HPV vaccines are best administered when you’re older.
You don’t need to wait until you’re 25 before you get yourself vaccinated. In fact, the perfect age for a girl to get HPV vaccine is when she hits puberty at the age of 10 to 12.

“The recommendation is we start at 10 years old because when you’re very young, the anti-bodies you produce are twice higher than adult women,” Ganzon explains.

“If you’re 15, you produce 100,000 units of antibodies against HPV virus. A 10-year old actually produces 200 to 300,000 units,” she clarified.

MISCONCEPTION #4: You won’t be infected if you’re not sexually active.
HPV is a highly transmissible virus. This means that it can still be passed from one person to another through direct skin-to-skin contact even without penetration.

Ganzon also recalled having a patient, who said she never engaged in sexual activity before she acquired cervical cancer.

“It’s a very rare type of cervical cancer. She was in her 20s when she came to me. She underwent surgery that set her free from the disease. But she can no longer bear a child,” she recounted.

If you can't avoid sex, get yourself vaccinated against cervical cancer.

MISCONCEPTION #5: One dose of HPV vaccine is enough to protect you.
Ganzon explained that a dose of HPV vaccine only works for young girls, who are at their peak of producing anti-bodies.

Doctors recommend that adult women, whether sexually active or not, get three doses of the HPV vaccine. Women should get each dose at an appropriate time for them to produce enough number of anti-bodies.

“The first two doses should be 28 days apart. The third dose should be taken six months after the second one,” Ganzon said.

MISCONCEPTION #6: If you miss your vaccination schedule, you need to start over.
It’s okay to get the second or third dose at least two to three months from the time you should have received the first or second shots, Ganzon clarified.

“The last dose is just to boost whatever level of antibodies you have produced with the initial two doses of HPV vaccine,” she explained.

“The vaccine may still produce anti-bodies. But if they failed to get a follow up for at least a year or two, they might need to get more doses. They must consult with their doctors,” she noted.

MISCONCEPTION #7: The HPV vaccine is useless if you already have the virus.
HPV has different types; one could be stronger than the other. This makes the vaccine still effective in giving you protection against HPV types other than the particular virus you contracted.

But Ganzon strictly noted that HPV-infected women may need stronger type of vaccines or other antibiotics to get rid of the virus.

“That is why it is recommended for sexually active females to undergo tests first like pap smear for women aged 40 and older before getting HPV vaccines,” she said.

MISCONCEPTION #8: There is no cure for cervical cancer.
Surgery, chemotherapy, and radiation are just some of your options to get rid of cervical cancer. With the help of the right people who can give your proper attention and with the support of your family and friends, you can win the battle against this disease.

Friday, August 9, 2013

raya DATANG lagi ... loner day

Terkenang Di Ketika Itu
Ku Dimanja Dan Disayang Selalu
Apa Saja Kemahuan Diri
Akan Cuba Dipenuhi

Walau Hidup Dalam Kesukaran
Kau Kan Cuba Untuk Membahagiakan
Demi Anak-Anak Yang Tersayang
Kau Berdua Kan Berkorban

Tetapi Baru Kusedari
Tidak Mungkin Kan Terbalas Budi
Pengorbanan Mu Tiada Ternilai
Hanya Tuhan Kan Membalasnya

Salam Aidilfitri
Ayah Bonda Yang Dicintai
Maafkanlah Anakmu Ini
Kerna Belum Cukup Berbakti

Pabila Menjelang Lebaran
Baju Baru Kan Disediakan
Walau Mungkin Kami Tak Mengerti
Keperitan Saat Itu

Namun Wajahmu Terus Barcahaya
Oh Sucinya Kasih Sayang Itu
Di Bibir Mu Kan Menguntum Senyum
Andai Anakmu Bahagia

Salam Aidilfitri
Ayah Bonda Yang Dicintai
Maafkanlah Anakmu Ini
Kerna Belum Cukup Berbakti
Di Aidilfitri,Di Aidilfitri



salam aidilfitri !!! hai guys .. suddenly rasa rindu nak update blog ... and this is my first Eid without my family and friends ... 
    BERBAKTI PADA NEGARA kata mereka ... hahaha .... yeahh walaupun pahit untuk ditelan , tapi inilah rayaku pada tahun ini .. di HOSPITAL !!! :o


mesti korang seronok kan beraya .. jumpa sanak saudara , kawan2 .. hangout sana sini , and me pulak ... terperap in this tiny room barely able to breath ( ok .. ini propa :p )  ... fengfeeling oncall di pagi raya ... saya dan dr oncall today ( should i mention her name? ) haha , nampaknya we all beraya berdua jeela , but ini pon satu memori :) thank you sbb saya dapat makan hidangan raya pada pagi syawal ( actually ak bawak satu botol besar twister and chocolate cadbury jer for my meals) teruk.. betul ;)   well well well ... mana reti nak masak rendang suma ni ... tak sempat lagipon ( ini bukan alasan taw!!!) 

ok .. hari ni 3 syawal masih bekerja beb !! lol :)) ~ esok last day kerja ... kerja petang jerrr haaa minggu ini , then 10.30...  FLY to KUANTAN !!! ( ok.. naik bus )

hey you all , memang la sedih tak dapat raya with family , tapi emotional support from family buatkan aq takde la rasa sebak sangat , petang raya ber " we chat" habaq hang :p hihi ,  patient and their kin pon ramai yang wish ;) ... rasa kembang hidung time tu tak kempis2 dah ... hahah (sorry ... mengarut je ni)

ok layan lagu sedih jap 

Sayang
Suratku yang ini
Bukanlah untuk memujuk engkau kepangkuanku
Cuma sekadar melahirkan kedinginanku
Terhadap falsafah cintamu
Yang hanya begitu agung dibibir
Tak sampai menusuk ke sudut hati

Sungguh sayang
Janjimu bak lautan yang dalam
Tapi tiada bertepi
Dan aku hairan
Mengapa aku sahaja yang derita akhirnya
Hingga kesaat ini
Kata kata manismu
Masih bermain ditelingaku

Hati kasih sayang rindu
Terhimpun seluruhnya bagimu sayang
Ingatlah janjiku ini
Panas hujan angin ribut
Tak mungkin memisahkan kau dariku
Inilah sumpah setiaku

Sayang
Diriku ini mengapalah
Tanpa ujudnya cintamu
Amat lemas dan resah
Tapi kau usah bimbang
Bukan simpati yang ku pinta darimu
Diam senimu membawa satu cerita
Bahasanya hanya aku sahaja yang mengerti
Aku catitkan diatas suratku yang ini
Kenangan lalu kita dalam restu

Hati kasih sayang rindu
Terhimpun seluruhnya bagimu sayang
Ingatlah janjiku ini
Panas hujan angin ribut
Tak mungkin memisahkan kau dariku
Inilah sumpah setiaku
 
hahaha ... lagu ni takde kena mengena dengan raya yerr.. suka hatilaa nak tulis :p... selamat hari raya aisilfitri maaf zahir dan batin.
 
" happy Eid'  fitri "



Tuesday, July 2, 2013

HELLP syndrome

 
URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000890.htm

HELLP syndrome is a group of symptoms that occur in pregnant women who have:

Causes

The cause of HELLP syndrome has not been found.
HELLP syndrome occurs in about 1 to 2 out of 1,000 pregnancies, and in 10-20% of pregnant women with severe preeclampsia or eclampsia.
Most often HELLP develops before the pregnancy is 37 weeks along. Sometimes it develops in the week after the baby is born.
Many women have high blood pressure and are diagnosed with preeclampsia before they develop HELLP syndrome. In some cases, HELLP symptoms are the first warning of preeclampsia and the condition can be misdiagnosed as:

Symptoms

  • Fatigue or feeling unwell
  • Fluid retention and excess weight gain
  • Headache
  • Nausea and vomiting that continues to get worse
  • Pain in the upper right part of the abdomen
  • Blurry vision
  • Nosebleed or other bleeding that won't stop easily (rare)
  • Seizures or convulsions (rare)

Exams and Tests

During a physical examination, the doctor may discover:
Liver function tests (liver enzymes) may be high. Platelet counts may be low. A CT scan may show bleeding into the liver.
Tests of the baby's health will be done. Tests include fetal non-stress test, ultrasound, among others.

Treatment

The main treatment is to deliver the baby as soon as possible, even if the baby is premature. Problems with the liver and other complications of HELLP syndrome can quickly get worse and be harmful to both the mother and child.
Your doctor may induce labor by giving you drugs to start labor, or may perform a C-section.
You may also receive:
  • A blood transfusion if bleeding problems become severe
  • Corticosteroid medications to help the baby's lungs develop faster
  • Medications to treat high blood pressure

Outlook (Prognosis)

When the condition is not treated early, up to 1 of 4 women develop serious complications. Without treatment, a small number of women die.
The death rate among babies born to mothers with HELLP syndrome depends on birth weight and the development of the baby's organs, especially the lungs. Many babies are born prematurely (born before 37 weeks of pregnancy).
HELLP syndrome may return in up to 1 out of 4 future pregnancies.

Possible Complications

There can be complications before and after the baby is delivered, including:
  • Disseminated intravascular coagulation (DIC) -- a clotting disorder that leads to excess bleeding (hemorrhage)
  • Fluid in the lungs (pulmonary edema)
  • Kidney failure
  • Liver hemorrhage and failure
  • Separation of the placenta from the uterine wall (placental abruption)
After the baby is born and HELLP syndrome has time to improve, most of these complications will go away.

When to Contact a Medical Professional

If symptoms of HELLP syndrome occur during pregnancy:
  • See your obstetrician right away
  • Call the local emergency number (such as 911)
  • Get to the hospital emergency room or labor and delivery unit
There is no known way to prevent HELLP syndrome. This is why it is important for all pregnant women to start prenatal care early and continue it through the pregnancy. This allows the health care provider to find and treat conditions such as HELLP syndrome early.

References

Sibai BM. Hypertension. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics - Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 35.
Wakim-Fleming J. Liver disease in pregnancy. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, PA: Elsevier Saunders; 2010:section 6.

Update Date: 11/8/2012

Updated by: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

Saturday, June 29, 2013

The Sacred Symbols of Illuminati

 
kadangkala anak muda kini terlalu ghairah hendak berfesyen dan mengikuti era glabalisasi sedangkan kita tidak sedar bahawasanya minda kita dijajah malah diperkotak-katikkan dengan sewenang-wenangnya ... mari kita lihat sebahagian lambang yang dikatakan suci oleh pengikut2 illuminati ini dan cuba kalian perhatikan perkara yang terdapat disekeliling anda. 



shamash

-Symbol of Liberty or Slavery?

statue of liberty pic

Pyramids



Israeli Supreme Court, Jerusalem


The Louve in France, 666 pieces of glass -*This statement has been contested.


3 More images from Israel's Supreme Court Building:



Note the Masonic Obelisk


The All Seeing Eye

Washington DC:






Washington DC
What are they hiding here?:




Pentagon




 

Pengenalan Gerakan Freemason

 

FREEMASONRY secara umum diterjemahkan sebagai pertubuhan persaudaraan dan dalam kamus dwibahasa ia memberi erti semangat persaudaraan sesama ahli pertubuhan.
Jika dilihat pada zahir pengertian itu, tiada apa yang tidak kena padanya.
Tetapi sedar atau tidak, ia suatu pertubuhan yang sangat bahaya kepada umat Islam kerana agendanya untuk melenyapkan ketaatan beragama, sekali gus menimbulkan kecelaruan di kalangan masyarakat dunia.
Buku Gerakan Freemasonry – Musuh Dalam Menghancurkan Islam membongkar pergerakan organisasi Yahudi antarabangsa itu yang bekerja untuk menghancurkan kesejahteraan manusia serta merosakkan kehidupan politik, ekonomi dan sosial.
Gerakan itu dipelopori orang Yahudi yang ingin mengambil tanah Palestin dan membina Haikal Sulaiman di bawah runtuhan Masjidil Aqsa, seterusnya melebarkan kuasa ke Syria, Iraq, Jordan, Mesir dan Madinah.
Ia ditubuh serta dirancang oleh Yahudi untuk memusuhi semua agama secara umum dan Katolik khususnya, namun kemudian mereka mengalih perhatian kepada agama Islam sebagai musuh utama.
Buku ini membincangkan secara terperinci agenda dan dakyah yang cuba dimajukan Freemasonry serta sekutunya yang berantaian di seluruh dunia dalam usaha memberikan kesedaran kepada umat Islam.
Antara misi Freemasonry seperti dilaporkan ialah menyebarkan ideologi ilhadiyah iaitu suatu fahaman tidak mempercayai kewujudan tuhan dan tidak menganuti sebarang agama.
Buktinya sebagaimana kata seorang Freemasonry, Proudon: “Freemasonry adalah suatu penyangkalan terhadap kepentingan agama. Apabila ada seseorang anggota Freemasonry yang berkata-kata mengenai kewujudan tuhan, maka yang dimaksudkan adalah alam dan kekuatan material atau mereka menganggap tuhan dan manusia sebagai suatu benda.”
Menurut penulis muda ini, kedua-duanya berkelulusan dari Universiti al-Azhar, gerakan terbabit juga menubuhkan pelbagai pertubuhan bersifat kemanusiaan dan kebajikan seperti pertubuhan Bahaiyah, Kesaksian Yehova dan pertubuhan yoga.
Pertubuhan Bahaiyah misalnya, timbul di Iran pada 1844, diasaskan seorang Yahudi yang menyamar sebagai orang Islam menggunakan nama Mirza Muhammad Ali Syirazi yang meninggal dunia pada 1853.
Ia dikatakan timbul di kalangan Syiah Imamiyah di sebuah kawasan bernama Syirazi di wilayah Iran.
Mirza Ali dikatakan mendakwa dirinya ‘albab’ yang bermaksud pintu.
Beliau mendakwa dirinya menjadi pintu bagi kaum Syiah atau seluruh umat Islam yang akan mentadbir mereka bersama imam yang ditunggu-tunggu kedatangannya pada akhir zaman.
Perkataan albab diambil daripada sabda Nabi yang bermaksud: “Aku kota ilmu dan Ali adalah pintunya.”
Menurut fahaman Syiah, Saidina Ali adalah pintu yang dimaksudkan itu, tetapi Mirza Ali mendakwa dirinya seperti dimaksudkan hadis terbabit dan menamakan ajarannya sebagai Babiyah atau Bahaiyah.
Fasa awal penubuhannya, pergerakan ini mendapat sambutan menggalakkan kerana pada zahirnya cenderung kepada amalan Islam tulen, tetapi kemudian ia jelas menyeleweng daripada kehendak Islam.
Mirza Ali merumuskan agama Islam, Yahudi dan Kristian adalah agama yang datang dari Tuhan dengan mengajak semua penganut agama terbabit membubarkan agama mereka dan membentuk agama yang satu dipanggil dinullah atau agama antarabangsa.
Sekiranya dikaji fahaman itu lebih mendalam, kesannya boleh mengakibatkan manusia meninggalkan semua agama mereka seterusnya membawa mereka kepada ilhadiyah sebagaimana matlamat dikehendaki Freemasonry.
Mereka yang mengikuti ideologi Bahaiyah menganut fahaman wahdatul wujud iaitu penyatuan antara makhluk dan tuhan.
Fahaman ini sudah tentu ternyata sesat dan syirik kepada Allah yang Maha Esa.
Pergerakan Illumanity (cahaya), ditubuhkan Adam Weishaupt pada 1776. Beliau seorang anggota Freemasonry yang murtad daripada Kristian serta meninggal dunia pada 1830.
Illumanity dinisbahkan kepada satu daripada kumpulan Yahudi. Mereka menamakan Illumanity sempena nama iblis, selaku pemerintah tunggal alam ini dengan pusat pentadbirannya di Segitiga Bermuda, tempat tinggal Dajjal.
Lambang pertubuhan terbabit dikatakan terdapat pada mata wang Amerika Syarikat, menunjukkan negara itu dikuasai bangsa Yahudi. Pereka mata wang itu seorang anggota Freemasonry daripada pergerakan Illumanity, Pat Robertson.
Antara matlamatnya ialah menghapuskan sistem warisan harta pusaka, semangat cintakan tanah air dan semua agama sedia ada di dunia supaya manusia dapat dipaksa menganuti ideologi bersifat antarabangsa.
 
Kalau kita melihat senibina tempat-tempat menarik di Malaysia ini, sebenarnya ada sesuatu yang terselindung. Kepada yang tidak meminati ataupun percaya kepada teori Konspirasi Freemason, maka abaikanlah gambar-gambar di bawah ini tanpa perlu membuang masa anda yang berharga itu.
Kolej Universiti Sains dan Teknologi Malaysia (KUSTEM), Terengganu..


Pada ketika ini, bangunan ini telah dikaburkan jika dilihat melalui Google Maps. Mungkin kerana sudah terkantoi.
Bukti: http://wikimapia.org/1620361/Kustem-Cross
Putrajaya

Vatican City & Putrajaya (perhatikan simbol mata)
Lagi gambar..

Di Alamanda, Putrajaya.


Presint 5, Putrajaya.


Mengapakah Obelisk (Tiang) dibina sebagai mercu tanda? Apakah mercu tanda senibina Islam? Adakah tiang?

Jika kita masih buta dan sentiasa menidakkan tentang semua ini, segala jenis cerita sudah dikeluarkan. Tinggal kita nak tonton sahaja. Tontonlah The Arrival dengan hati dan minda yang sedikit menerima.
Sama-sama kita mencari kebenaran di muka bumi Allah ini. InsyaAllah.
credit to : http://www.ohtidak.com/oh-senibina-freemason-di-malaysia/




Lagi cerita B/D freemason :


Top 10 Scandalous Freemason Secrets

Anonymous
The Freemasons are one of the most secretive and controversial religious groups in the world. Masons have existed for centuries – and if we are to believe their claims, they’ve existed covertly for even longer. 

Whatever their history, speculation has always been an enjoyable pastime – and this is especially true in the case of the Masons’ more scandalous secrets. Having passed down traditions and secrets from one generation of initiates to the next, they make it difficult to know what’s outdated and what’s still practiced. Consider these ten masonic activities as provisional facts – we don’t know for sure, but it’s always an interesting exercise to imagine what might be going on behind our backs.


10
They will not testify truthfully against each other
Gavel

Freemasons are commanded not to testify truthfully when another Mason is on trial. They admit that it may be perjury, but to them, it is a far greater sin to not protect one of their own.


9
They have a secret handshake
Pope Blair Mason Handshake1

Though some members deny it to the public, the Freemasons have at least one secret masonic handshake. Supposedly, there are even phrases a Freemason can utter when facing grave danger – causing other members to rush to their aid. The founder of Mormonism, Joseph Smith, is said to have uttered this phrase in the last moments before his death.


8
They have several secret passwords
Masonic French

This is one of the best-known facts about the Masons, but the general perception is that they have just one password. In fact, there are several passwords for various occasions and reasons. As the one person with the final syllable for the ultimate secret word was murdered, they substituted “mor-bon-zi” for this word, and only very few people know the actual secret word. This secret word is used only for ceremonies: “tu-bal-cain” is the more common secret password, on the tip of every Freemason tongue.


7
Their rituals involve a noose
759933-Noose Lg 716525 Large

The initiation rituals- though described by Masons as beautiful ceremonies – include a noose. It’s hard to tell whether this is meant as a threat, a call to maintain silence, or simply as the symbol of an umbilical cord (as they claim), but in any case, it’s unusual enough to warrant a mention. 


6
They’re obsessed with the sun
Flat,550X550,075,F

Freemasons believe that the east symbolizes rebirth. They sing the sun in its flight – marvelling at its passage through the sky. Masonic lodges tend to be built in the east and in the west, as an attempt to control solar power for their own purposes.




5
Masons exclude atheists
Russell-2

It’s impossible to become a Freemason if you’re an atheist. The first requirement is that potential members must believe in a higher power of some sort. They claim not to care what higher power that is, but you must define it for yourself. You can lie about it, but religion seems to be a point of honor among them. On the other hand, traditionally excluded groups – such as gay men – are included in Masonry, so long as they behave in the same moral manner as other groups. The temple still excludes women, but some groups are currently challenging that fact.


4
They work to control politics and finance in various countries
Handshake

The official corruption of Masonry is well-documented, but often covered up. Half a million Masons in England are disproportionately involved in banking, politics, and government. Even hospitals and universities are often controlled by the Masons.


3
Their symbol is on the dollar bill
Dollar Ase

If you’ve ever looked closely at the US dollar bill, you’ve probably seen the All-Seeing Eye above the pyramid. This symbol is a Freemason symbol, and the Latin underneath is a Freemason motto, meaning “new world order”. Many say that the decision to include this masonic symbol was not influenced by Freemasons – Benjamin Franklin being the only Mason on the design committee – but the coincidence remains fascinating all the same.


2
Anders Breivik was a Mason
Breivik 2194965B

Breivik – responsible for the 2011 mass murder in Norway – was a member of the Lodge of St. Olaf in Oslo. He was promptly excluded – but his degree of involvement within the organization is open for debate. 


1
Masons played a key role in space exploration
Buzz Aldrin 01

Some say that Masons have an agenda to take over the world – but some Masons seem to have their sights set on the moon. Astronauts in the Apollo program – including Buzz Aldrin – were self-professed Masons. Their rite flags have been to the moon and back, and Aldrin seems to have claimed the moon for his Masonic lodge in Texas.


Some of these strange and scandalous secrets of the Freemasons are obviously urban legends, and should be taken with a grain of salt; but others seem to contain a degree of truth. One thing’s for certain – Masonry is by no means an outdated cult. It still has many active members who seem to be working for some purpose – even if we can’t all agree on what that is.



Ok .. mari tgk gambar pula ...







 
 

 

Tuesday, June 25, 2013

10 ciri ciri calon isteri yang baik

. Taat beragama
Agama adalah salah satu pegangan hidup untuk kita manusia. Taat kepada agama juga menunjukan kalau si gadis akan taat terhadap kamu. Bukan bererti kamu bisa semena-mena terhadap dia dan menyuruh si gadis untuk menuruti apapun yang kamu mau, tapi taat beragama menunjukan bahwa si gadis juga mempunyai prinsip hidup yang baik dan yang dia tekuni.


2. Lemah-lembut

Cuba perhatikan cara gadis berbicara kepada teman-temannya. Apakah dia selalu suka bernada keras, teriak-teriak, atau malah sopan dan selalu lembut dalam berkata-kata? Ciri-ciri inilah yang mencerminkan di mana cara si gadis akan berbicara kepada kamu dan keluargamu nantinya.



3. Perhatian

“Adakah si gadis boleh mengingati  ulang tahun orang tuaku?” . Itu adalah pertanda bagus. Dia benar-benar perhatian akan hal-hal kecil seperti itu. Padahal, kalian belum menikah. Sehabis kamu pulang kerja, makanan pun sudah tersedia. Saat kamu sedang sakit, dia memasakan bubur untuk kamu. Hal-hal kecil seperti itulah yang akan membantu dan memperkuat hubungan kamu. Bukankah si jejaka juga memang suka diberi perhatian lebih dari si gadis? ( manja lettew :P )



4. Penyabar

Kamu telah berjanji untuk keluar makan bersama si gadis tapi si gadis tidak marah sama sekali saat kamu datang dan dia sudah menunggu 25 minit kelaparan. Kenapa sabar itu ciri-ciri yang baik? Cuba pikirkan kalau anda sedang dalam situasi apa saja yang berbau negatif; kesabaran itu akan membantu suasana itu tidak menjadi lebih buruk. Cuba bayangkan kamu sedang dating dengan si gadis yang tidak sabar. Sedikit-sedikit dia marah karena kamu tidak tepat waktu, berbuat sedikit kesalahan. Saat dating yang seharusnya gembira  malahan menjadi pengalaman buruk.



5. Sederhana

Perhatikan apakah si gadis kamu suka berlebihan di depan teman-temannya. Apakah dia suka mempamerkan handbag  yang baru dia beli hari itu juga? Orang yang suka pamer dan tidak sederhana menunjukan kalau si gadis  itu tidak percaya diri; ada kekurangan yang dia punya dan ingin menutupinya dengan mempamerkan sesuatu yang lebih dari dia. Ini sifat yang tidak bagus untuk para jejaka.



6. Jaga kecantikan

Tidak bererti gadis itu harus tampil cantik, tapi menjaga kecantikan itu juga bererti itu gadis tahu bagaimana caranya menjaga dan merawat dirinya sendiri. Jikalah anda sedang dating dengan dia, perhatikanlah “make-up” yang dia pakai. Apakah terlalu berlebihan sehingga menarik perhatian orang-orang lain di sekitar anda? Apakah dia memakai pakaian yang keterlaluan ? Jaga kecantikan itu berarti menjaga penampilan secukupnya dan sewajarnya di saat dan tempat yang benar.



7. Dewasa dan bijaksana

Si jejaka suka dengan si gadis  yang bijaksana dan bersikap dewasa. Di saat kesusahan, Si jejaka akan memerlukan bantuan dari seorang gadis yang dewasa dan bijaksana dalam mengambil keputusan.



8. Hemat
Si jejaka mana yang inginkan si gadis yang   materialistik ? Nanti kalau kamu sudah berkeluarga dengan si gadis  tersebut, dia akan menghabiskan wang ringgit untuk belanja baju-baju yang tidak perlu. Cuba perhatikan dari cara dia menghabiskan wangnya sekarang. Apakah dia termasuk orang yang hemat, boros, atau hura-hura?



9. Keibuan
si gadis  kalau senang bermain dengan anak kecil, boleh menggendong bayi, menunggu mereka tidur, dan sebagainya. Inilah tanda-tanda dari si gadis  yang bisa kamu bayangkan saat mereka menjadi isteri kamu. Dia akan menjadi seorang ibu yang pandai di dalam rumah tangga.



10. Tabah menderita dan mahu bekerja keras

Inilah salah satu ciri-ciri dari si gadis  yang agak susah dicari. Mengapa? si gadis  sudah terbiasa dengan tradisi di mana si jejaka  yang mencari rezeki. Di masa kesusahan, si gadis   biasanya tidak terbiasa untuk bekerja keras untuk keluarga. Jikalau kamu sudah menemukan si gadis  yang tabah menderita dan mahu bekerja keras, hargailah dia.

Ciri-ciri Suami Yang Baik Menurut Islam

buat bakal suamiku ,

Sayang ... saya berdoa sayang dalam kalangan ini ... :)



1. Berkemampuan
sebagaimana hadis Nabi Riwayat Ahmad Bukhari dan Muslim dari Abu Hurairah yang bermaksud:
"Wahai permuda-pemuda; barang siapa diantara kamu bernikah, maka hendaklah ia bernikah, yang demikian itu amat menundukkan pandangan dan amat memelihara kehormatan, tetapi barang siapa yang tidak mampu, maka hendaklah berpuasa kerana puasa itu menahan nafsu." Mampu yang dimaksudkan, berupaya menyediakan tempat tinggal, saraan hidup yang kebiasaan, serta pakaian untuk menutup aurat. Seperti memberi makan dengan apa yang dia(suami) sendiri makan, memberi pakaian dengan apa yang dia sendiri pakai. Bukan bermaksud memberi pakaian lelaki kepadaisterinya, tetapi taraf kualiti sesuatu itu, yang diperuntukkan untuk dirinya, itulah yang diperuntukkan untuk isterinya juga. Maknanya lelaki yang bertanggung jawab. Perkara-perkara ini wajib dilaksanakan suami dan kegagalan menyempurnakannya boleh mendatangkan kesan buruk dan mudah berlaku perceraian.

2. Tidak Dayus
Sanggup menjadi pembela isterinya. Boleh dijadikan sebagai ganti ayah bonda. Sanggup melindungi wanita daripada segala bahaya dan kecelakaan yang menimpa kerana apabila seorang wanita rela dinikahi, bererti ia rela melepaskan dirinya daripada ayah bonda yang selama ini menjadi tempat pergantungan hidup. Kini berpindah kepada lelaki yang bakal menjadi suaminya.

3. Pandai menjaga darjat diri dan menepati janji
Apabila berkata dikota dan diamalkan. Selain daripada itu suami yang baik akan sentiasa mengajak isteri ke arah kebaikan, menjauhkan yang mungkar dan mendahului perbuatan itu.

4. Berkebolehan didalam urusan rumahtangga.
Kebolehan memasak, menjahit juga membasuh akan membantu kerana lelaki yang biasa membuat kerja begini, tidak akan membebankan isterinya membuat kerja rumah sekiranya isteri tiada kemampuan. Bukan dari jenis lelaki yang tidak bertimbang rasa, yang sentiasa memerintahkan isterinya itu dan ini tanpa mengira isterinya sakit atau kepenatan.(Bukan juga jalan kepada isteri itu untuk mengsambil lewakan layanannya kepada suami itu.)

5. Mempunyai penuh kepercayaan kepada perempuan dan tidak mudah bersangka buruk.
Biasanya apabila suami bertugas mencari nafkah maka isteri akan menjaga segala amanah harta dan anak di rumah. Sekiranya suami tidak mempunyai kepercayaan kepada isteri, ini bererti suami akan sentiasa menyangka buruk.

6. Rajin, berpemikiran luas dan tidak memakan harta perempuan.

Lelaki begini adalah ciri-ciri lelaki yang tidak pemalas, inginkan kemajuan serta tidak mengharapkan titik peluh isteri. Allah sangat tidak menyukai manusia yang hanya bertawakal dan menyerah diri tanpa usaha sedangkan kejayaan dicapai melalui usaha. (Sebenarnya secara peribadinya saya tidak berapa setuju dengan pendapat ini, kerana saya pernah berjumpa dengan kisah ini:[Khadijah ra. membuka isi hati kepada suaminya dengan ucapan: "Wahai Al-Amiin, bergembiralah! Semua harta kekayaan ini baik yang bergerak maupun yang tidak bergerak, yang terdiri dari bangunan-bangunan, rumah-rumah, barang-barang dagangan, hamba-hamba sahaya adalah menjadi milikmu. Engkau bebas membelanjakannya ke jalan mana yang engkau ridhoi !"
Dan sebagaimana Firman Allah SWT yang bermaksud: "Dan Dia (Allah) mendapatimu sebagai seorang yang kekurangan, lalu Dia memberikan kekayaan". (Adh-Dhuhaa: 8)] Dan seperti yang kita ketahui juga Khadhijah ra. telah menghabiskan hartanya demi membantu suaminya(Rasulullah s.a.w) dalam menegakkan Islam ini. Mungkinlah pendapat ‘memakan harta perempuan’ disini adalah sepertinya seorang suami yang tidak melakukan apa-apa dengan bersenang-senangan semata-mata. Dan menghabiskan harta isterinya dalam jalan sia-sia dan syahwat pula.)


7. Mudah memaafkan.
Sifat ini adalah sebahagian daripada sifat terpuji Rasullah ketika menegakkan agama Islam. Oleh itu suami bertanggungjawab sepenuhnya kepada isteri dan anak.

8. Datang daripada keturunan orang yang baik-baik lagi rajin beribadah.
Mempunyai akhlak dan budi bahasa mulia serta sangat menghormati orang tua, berpegangan agama lagi rajin beribadah dan tidak berpenyakit keturunan seperti gila atau penyakit merbahaya yang boleh membawa kepada kesengsaraan hidup.
Inilah serba sedikit pendapat-pendapat yang sempat saya kumpulkan. Tetapi apa yang lebih utama dari segala hujah itu tadi ialah Agamanya. Pilihlah yang beragama dan teguh dengan pegangan Islam ini. Tidak mengapa jika calon suami itu terkurang sedikit dari segi keduniaannya, tetapi lebih dari segi agamanya. Namun dalam mencari cirri-ciri suami yang baik itu, mari kita lihat juga ciri-ciri isteri yang baik itu bagai mana pula. Kerana tidak adil mengharapkan Allah menjodohkan kita dengan seorang lelaki yang baik akhlaknya sedangkan diri kita sendiri sangat memandang mudah pula pada yang demikian. Kerana Allah akan menjodohkan kamu sesuai dengan dirimu sendiri itu bagaimana.
surah An-Nur ayat 3, “Lelaki yang berzina tidak dinikahi melainkan dengan perempuan yang berzina atau perempuan musyrik dan perempuan yang berzina itu tidak dinikahi melainkan dengan lelaki yang berzina atau lelaki musyrik. Demikian itu terlarang kepada orang yang beriman.”
 
 
ikhlas ,
miss hano
25/6/2013 21:48

Tuesday, May 28, 2013

anesthesia general

hai ... here i am .. back with a lot of notes ... hihi , so .. for this section ~ i would like to share few words "perhaps" hihi ... regarding postoperative pain management ... take your time to read those articles . Thank You ^_^ MUAAHHH :)



Intrathecal morphine

The intrathecal administration of opioids especially intrathecal morphine has emerged as a popular and effective form of postoperative pain control.
Intrathecal opioids are able to provide long-lasting analgesia after a single injection. They work by binding to the µ opioid receptors, which are located in the substantia gelatinosa of the dorsal horn of the spinal cord.
These receptors are concentration dependent and are typically not activated by systemic doses of opioids. Unlike intrathecal local anesthetics, intrathecal opioids provide analgesia without disrupting sensory, motor, or sympathetic functions.
Because of its hydrophilic properties and potent receptor affinity, preservative-free morphine (i.e., Duramorph or Astramorph) is the ideal opioid for intrathecal use.
The onset of analgesic effects is directly proportional to the lipid solubility of the opioid. Preservative-free morphine (along with hydromorphone and meperidine) has a relatively low lipid solubility and its onset of action is delayed for typically 20 to 40 minutes after administration.
The hydrophilic nature of the opioid also determines its duration of action. Preservative-free morphine is very hydrophilic and poorly lipid soluble, which extends its duration of analgesic effect up to 12 to 24 hours.
Because of its poor lipid solubility, intrathecal morphine remains in the cerebrospinal fluid (CSF) for a prolonged period of time. It is circulated through cerebral spinal bulk flow and eventually rises rostrally to supraspinal levels.
Intrathecal morphine, therefore, has bimodal analgesic effects. The first peak is soon after administration and is due to spinal opiate receptor binding. The second peak occurs 12 to 24 hours later and is due to supraspinal binding as the drug is circulated.
Compared with systemic dosing of morphine, intrathecal administration is effective in providing analgesia at a fraction of the systemic dose (0.25–0.5 mg) and thus has a much lower side-effect profile.
The side effects, however, are important to recognize and treat. Respiratory depression can be delayed up to 24 hours after administration and is due to the cephalad spread of intrathecal morphine to the opioid receptors in the medullary centers of the brain stem.
Thus, patients receiving intrathecal morphine must be closely monitored for up to 24 hours afterward for signs of respiratory depression.
Patients with postoperative pain despite having received intrathecal morphine present a management dilemma. Giving the patient additional systemic opioids must be done cautiously, as it may increase and potentiate the risk of respiratory depression.
Generally, patients who have received intrathecal morphine should not be placed on a patient-controlled analgesia machine and should be given only intermittent doses of short-acting narcotics until theintrathecal morphine analgesic effect occurs. Nonopioid analgesics can also be considered if not contraindicated after surgery.
Other intrathecal morphine side effects are similar to side effects of systemic morphine and include pruritus, nausea, vomiting, and urine retention. These effects are dose related and may be reversed with naloxone.
References
Raj PP, ed. Practical Management of Pain. 3rd Ed. St Louis: Mosby; 2000:180.
Rathmell JP, Lair TR, Nauman B. The role of intrathecal drugs in the treatment of acute pain. Anesth Analg 2005
Waldman SD, ed. Interventional Pain Management. 2nd Ed. Philadelphia: WB Saunders; 2001: 621 and 622

HERE... 


 2007 Mar;10(2):357-66.

Drug-related side effects of long-term intrathecal morphine therapy.

Source

Physician's Pain Specialists of Alabama, Mobile, AL, USA. xiuluruan@yahoo.com

Abstract

BACKGROUND:

The introduction of intrathecal opioid administration for intractable chronic non-malignant pain and cancer pain is considered as one of the most important breakthroughs in pain management. Morphine, the only opioid approved by FDA for intrathecal administration, has been increasingly utilized for this purpose. For over 3 decades, there have been numerous reports on the non-nociceptive side effects associated with ever increasing long-term intrathecal morphine usage.

OBJECTIVES:

To review the literature on side effects due to long-term intrathecal morphine therapy with discussions of alternate treatment options.

DESIGN:

English-language publications were identified through MEDLINE search and the bibliographies of identified articles were reviewed.

RESULTS:

Most side effects of intrathecal morphine therapy are dose dependent and mediated by opioid receptors. Common ones include nausea, vomiting, pruritus, urinary retention, constipation, sexual dysfunction, and edema. Less common ones include respiratory depression, and hyperalgesia. Catheter tip inflammatory mass formation is a less common complication that may not be mediated by opioid receptors.

CONCLUSION:

The utilization of intrathecal morphine administration for cancer and intractable non-malignant chronic pain represents an important leap forward in pain management. Yet, a wide variety of non-nociceptive side effects may also occur in susceptible patients. The side effects due to intrathecal morphine administration are mostly mediated by opioid receptors. Treatment usually involves the utilization of opioid receptor antagonist, such as naloxone. Patients considering intrathecal opioid pump therapy should be informed and advised about the possible side effects associated with long-term intrathecal morphine administration prior to placement of a permanent morphine infusion pump.


However ... in malaysia specifically our federal territory , we have provided pain management involving intrathecal morphine prior to obstetric patient in which only certain of the patient will having minor side effect ( should not be said side effect exactly) such as nauseated , vomiting , mild pruritus , or giddiness .By the way,  it will resolve in between 24 hours that we suggested the patient to drink a lot of water and encouraged early ambulation.   OH... oh... correct me if  i make some mistake... hihihi


Patient Controlled Analgesia 


Indications

  • PCA is used for the management of moderate to severe pain when inadequate analgesia would result from oral analgesia or intermittent IV morphine boluses.
  • The child must have the cognitive ability to understand the concept PCA and is willing to self-manage analgesia.
  • Lack of normal hand function does not prevent patients from using PCA. A number of alternate handsets and a breath-triggered switch are available.
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Contraindications to PCA

  • If the child is unable to understand the concept of PCA or they do not wish to control their own analgesia, a nurse controlled opioid infusion would be more suitable.
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Form t_306517

Prescription and program of PCA

  • PCA is a specialised analgesia technique and is managed by CPMS. 
  • Most patients are commenced on PCA in the recovery room. For other patients requiring PCA a referral needs to be made to CPMS by paging 5773(24 hours) and completing an inpatient consultation report sheet (MR2). The referrer needs to ensure that the patient's primary consultant has approved of CPMS involvement. 
  • ONLY CPMS and Anaesthesia staff may prescribe PCA. For safety reasonsONLY Recovery or CPMS staff may program the PCA infusion pumps. 
  • Morphine is the preferred opioid in most circumstances. Fentanyl or hydromorphone are alternative choices. Pethidine is NOT routinely used due to the concern for nor-pethidine toxicity. In some circumstances patients may have pethidine prescribed but this should only be for a short duration (generally less than 48 hours). 
  • The PCA infusion is prescribed according to the guidelines on the Patient Controlled Analgesia attachment. This attachment is only valid if attached to a current medication chart (MR52). 
  • If the prescription differs from the guidelines the designated box must be ticked.
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PCA set up

  • The PCA syringe must be prepared in accordance with RCH medication policy and labelled clearly with an intravenous additives label.
  • PCA infusion pumps (Alaris P5000 PCA) must be used for all PCA infusions.
  • The PCA infusion line should be clearly labelled with a blue IV opioid label at the 3-way-tap where the PCA line meets the maintenance line.
  • 50 mL Braun Omnifix syringes are used for PCA, together with 180 cm minimum volume extension tubing.
  • A 3-way-tap at the syringe end of the opioid infusion line is not required.
  • The two authorised persons who make up each PCA syringe must sign the record of infusion on the Patient Controlled Analgesia attachment.
  • Syringe and lines should be changed every 72 hours or more often depending on individual unit policy or the patient's medical condition.
  • Keys for the PCA infusion pumps are kept with the ward drug keys on every ward. The operating theatre recovery room also has a set of PCA keys.
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PCA delivery

  • To avoid the IV occluding between PCA tries, the patient should have maintenance IV fluids (with a minimum infusion rate of 5 mL/hr) running through an infusion pump (IVAC or similar). No anti-reflux valves are required if an infusion pump is used. 
  • The volume infused should be checked every hour and documented on the fluid balance chart. 
  • The treatment for opioid overdose is the opioid antagonist naloxone (Narcan). Naloxone is available in the ward/unit drug cupboard and on the ward/unit resuscitation trolley. 
  • The naloxone dose is available in 3 dose ranges: 1 microgram/kg for opioid induced pruritus and urinary retention 2 microgram/kg for excess sedation and 10 microgram/kg for resuscitation.
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Concurrent drugs

  • When opioid infusions are used, NO ORAL/ RECTAL/ INTRAVENOUS OR INTRAMUSCULAR opioids or sedative agents should be given without prior consultation with CPMS or an anaesthetist.
  • Paracetamol, ketamine, local anaesthetics, tramadol and NSAIDs may be used concurrently with PCA infusions and may help to reduce opioid consumption and associated side effects.
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Precautions

  • If the patient is receiving other medication that may cause sedation (e.g. antihistamines, benzodiazepines or anticonvulsants), the patient may be at increased risk of sedation and respiratory depression. 
  • Prolonged administration of opioid infusions and impaired liver and/or renal function may alter drug elimination with ALL opioids and possibly result in drug accumulation and toxicity.  
     
    • The morphine metabolite M3G causes CNS disturbances (including myoclonus and tremor) and the morphine metabolite M6G is a potent analgesic. Both these metabolites may accumulate in patients receiving long-term morphine infusions or patients with renal impairment. 
    • The hydromorphone metabolite H3G may accumulatein patients receiving long-term hydromorphone infusions orpatients with renal impairment. H3G can cause CNS disturbances (including confusion, tremor and agitation). 
    • Pethidine infusions may result in accumulation of the toxic metabolite
      nor-pethidine, which can cause CNS disturbances (including confusion, tremor and convulsions).
        
    • Prolonged fentanyl infusion may result in drug accumulation and potential increase in opioid related side effects. 
  • Development of opioid tolerance with long-term administration of opioids may require the opioid dose to be increased. 
  • Careful tapering of doses is important when weaning long-term opioids to avoid opioid withdrawal.
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Parents and PCA

  • It is important that the child's parents understand the concept of PCA, so they can support their child in its use.
  • The child's parents must NOT push the PCA button for their child, but may encourage their child to use it as required.
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Patient review

  • CPMS reviews patients twice daily on week days and once daily on weekends and public holidays.
  • If analgesia is inadequate or the patient is experiencing side-effects, CPMS must be called to review the patient.
  • CPMS can be contacted at all times on pager 5773.
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Observations

The following observations should be recorded on the general observation chart:

  • Sedation score, respiratory rate and heart rate: 1 hourly until the PCA is ceased. [The need for less frequent observations for patients receiving long-term PCA should be discussed with CPMS.] It is important to accurately assess sedation during wake and sleep periods
  • Pain score: 1 hourly while awake (using developmentally appropriate scale e.g. Wong-Baker Faces scale, Numeric scale, FLACC scale or PAT score).
      
  • Vomiting score: 1 hourly  for the first 12 hours, then 4 hourly as indicated.
  • Pulse oximetry: if indicated 

Indications for pulse oximetry:

Pulse oximetry MUST BE implemented and used continuously in high-risk patients with:
  • University of Michigan Sedation Scale (UMSS)
     0Awake and alert
     1Minimally sedated: may appear tired/sleepy, responds to verbal conversation and/or sound 
     2Moderately sedated: somnolent/sleeping, easily aroused with light tactile stimulation or simple verbal command
     3Deep sedation: deep sleep, arousable only with deep or significant physical simulation
     4Unarousable
     SPatient is sleeping
     UMSS sedation score > 2
  • Significant cardiorespiratory impairment
  • Sleep apnoea, snoring or airway obstruction
  • Spot oximetry less than 94% SaO2
or patients receiving:
  • Supplementary oxygen
  • Concurrent sedative agents
Clinical indicators for 'spot' pulse oximetry are:
  • Tachypnoea or bradypnoea
  • Respiratory distress
  • Pallor or cyanosis or impaired oxygenation
  • Confusion or agitation
  • Hypotension
  • Nurse concern
  • PCA use: good and bad tries and total mg, recorded hourly. 
  • The effectiveness of the analgesia should be recorded in the Nursing Progress notes or in the appropriate clinical pathway.
CPMS should be called if pain relief is inadequate after more than 5 good tries per hour for three hours.
Any observations outside normal values for age should be reported to CPMS +/- the primary treating team.
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Complications

IF RESPIRATORY DEPRESSION OR OVERSEDATION IS SUSPECTED:
  • CEASE the PCA
  • CEASE all other infusions that could be contributing to sedation
  • Attempt to rouse the patient
  • Call 777 [MET team] if appropriate
  • If apnoeic: administer bag & mask ventilation with 100% oxygen
  • If breathing: maintain airway, monitor oxygen saturations and administer oxygen
    via face mask at 8 L/min
  • Check circulation. If pulseless: commence chest compressions
  • Administer naloxone per instructions on the attachment chart if opioid toxicity is suspected
  • Call CPMS for urgent review
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Ceasing the PCA

  • The decision to cease the PCA should ideally be made in consultation with CPMS.
  • Most patients self-wean off PCA, using it less as their pain decreases.
  • Oral/rectal opioids may be administered immediately after the PCA is ceased.
  • The date and time of ceasing the PCA must be recorded on the Patient Controlled Analgesia attachment chart.
  • Any remaining opioid must be disposed of according to the RCH Drugs of Addiction policy.
  • The PCA infusion pump must be returned to Recovery when it is no longer required.