无乐不作

當 天是空的 地是乾的
我要为妳 倒進狂熱
让妳疯狂 让妳渴
让全世界 知道 妳是我的 

天氣疯了 海水滾了
所以我要 无乐不作

不要浪費 每一刻 快樂
當夢的 天行者 

Sleep and Death

To me, one of the main difference between sleep n death is that one u wake up, and the other u dont. And u cannot be asleep and dead simultaneously.

Death is like sleeping without dreaming n not waking up anymore.. to me. Both of them do share some similarities. We fall asleep n die similarly, i suppose, as in they share the common initiating processes. Closing eyes, slowly losing consciousness and then gradually, u dont even know, u fell asleep until u wake up the next morning, or forever.

I had a strange dream last night.

I dreamt that i was dead.

I was dead, but i m still walking around, people seeing me. 

The coffin was still there, but i dint dare to go see it.

I talked to everyone at home.

The mood was kinda somber.

The picture was grey.

I dont remember any colors in it.

I woke up.. confirmed i was still breathing and my heart was still beating. 

It was 2:30 am.

May those perished in the Mumbai attacks rest in peace.

Mid Autumn

It has been ‘years’ since i last updated my blog! And, I am back.. Back in moscow, back to miserable student life.

September is the month which i can lag and slack most. Having only surgery, dentistry and radiology this month, considered to be super free compared to the following months. Have been gaming a lot, sleeping a little, eating a lot, studying a little. Something's wrong...

C&C3 : Kane's Wrath ... My Game of the Month

Flight from KL to Moscow was not as bad as i expected. Qatar Airways upgraded their planes. I got free hotel with meals provided for transiting for around 13 hours! Did came out of the hotel for a while, went to the Doha City Centre shopping mall.. Desert is really hot, Doha is like an open-air oven! I wonder how ppl can survive there if there's no airconditioning. I would have melted~

(Clockwise from above) Doha International Airport; Door of Bus sending us to the hotel; Free Wifi Porivded by the Hotel; Getting Connected in the hotel room; Outer view of Mercure Grand Hotel.

 

(Clockwise from topleft) Doha CBD - construction everywhere; One of the high rise buildings; Interior of City Center-Doha; City Center-Doha; Sunset; McDonald's in Shopping Center - 1QAR~RM1.

 

 

 

It's mid autumn festival today~ 中秋节快了!!!

昔年八月十五夜，曲江池畔杏园边。
今年八月十五夜，湓浦沙头水馆前。
西北望乡何处是，东南见月几回圆。
昨风一吹无人会，今夜清光似往年。

白居易

 

ZHIHAO eevolvin~

A Week in A&E

Finally, i've finished my 4-week posting in Sarawak General Hospital. And i spent my last week there in the Accident and Emergency Department.

Before that, i went to few departments in the hospital. Got to see a lot of patients, a lot of signs and symptoms, heard a lot of complaints, scolding, crying, sobbing... DId a few resuscitation but all of them failed. Went to a few talks sponsored by pharmaceuticals, they turned out great, especially when they come with a free meal!! They are really rich companies!!

1st day in A&E, we got some introductory seminar. We were 'toured' around the department with a few medical assistant students and some offshore medic who were here for training. That took the whole morning!

Seen a few fracture cases. There're 2 little boys, with fracture of the forearm, and the bones are really out of shape!

I went out with the ambulance once at night to attend a road traffic accident. A drunk motorist knocked down another motorist. The drunk one was lying on the floor dozing off i think, and the other motorist was sitting on the floor moaning. Not much blood was seen. There were so many flashlights around (i suppose they were reporters) and also so many ppl around watching the 'show'. I also took out my cam and shot a few photos.. hehe

After night shift, it's supper time!

No one can really resist food here, especially after 10 months not at home, not going to coffee shops, not eating local food and drinks. Hehe..

         

There is a Japanese Neurosurgeon in A&E. I dunno his name. He looks japanese, he speaks english japanesely and speaks a bit of malay too! and he's nice and friendly. ONce, there was a head trauma case that was 'helicoptered' from sibu i think. We tried sitting outside to wait for the helicopter to arrive, but then due to some technical problem, we missed that. And the helicopter arrived without us knowing. The patient was then rushed to the Red Zone, his head is really badly hurt, with black eyes, anisocoria, lotsa blood and patient unconscious. There's a huge epidural hematoma seen in the CT. This NihonJin was so excited and animated and rushed to the red zone when the patient is sent in, the first thing he did was taking out his camera and started flashing, taking photos, exclaiming that this is a good case and we must see it! Fine! really interesting one. He showed us the signs and explained the mechanisms and gave us a short lecture with lots of information, slides and photos!

                                       

At the end of the week, i got to do cannulation of the vein, did a few ECGs, got my papers signed and stamped (that's the most important part)! Much thanks to the friendly nurses and doctors in A&E! I also got to see the record breaking Batman show. It was superb!!! really worth watching! STRONGLY RECOMMENDED! Why so serious?

                            

Looking forward to watching Mummy: Tomb of the  Dragon Emperor.

 

Happy HoLidayS!

woootzzzz

Finally, i m going home!!!
after so much of trouble and timetable-changing from my school, my ticket company and the airline i m taking
changing is inevitable~
change
change
change
yesterday i saw that the flight was transferred to doha, then to bangkok, then to KL.
now the flight to KL has been cancelled again..
...
...
...

sigh...

It's exam season now
and a 'no adapter for my laptop' season
i dunno if i should say it's good timing or a bad one, to have my laptop adapter 'burnt' at this period of time
due to the very fussy process of charging batteries at friend's computer, i ve greatly reduced the time using my computer, therefore, lesser time to update blog, check mail, chit chat online, click here n there, blog hopping.....

anyway, it exam period, i think i should study more~ hahaha

had my first subject yesterday, it was great
went lunch after exam, a bit of supermarketing, spent sometime at the dean's office and fixed my new neighbour's computer.. she has a 22inch samasung lcd for her monitor!!!!!.. everything is great
went to bed at 9pm, woke up this morning at 9 too!
and went to gen surg department, and thanks to the head of department, i had a 'great' time! sigh..
trying to fix exam dates, so that i do not need to resit the exam after holidays
but to no avail...
and also took the bus home, wait for a while at the bus stop
a russian boy talked to me.. he looked mature for his looks, size and voice
but he is only 15, in class 11
he's from chechnya, said caucasus is beautiful, and he dislikes russia, he hates the police, he loathes city women smoking and drinking, saying he would migrate out of the country as soon as he has the money.
i never expect a 15 yr old to talk like that!!!
not until today...
good luck to him
and to all of us who r sitting for exams
and i m still tired after sleeping for 12hours....
help!!!

champions league finale

just some photos~
my laptop AC adapter went down last night.. laptop on battery now.. darn!
heard my fren said it cost around 2000rubs = RM280 for a new one... but i see dell selling only RM141 online... should i get one here? or wait til i reach home....

but.. i m not a big fan of chelsea, of course!
THE TEAM!!!

we will see if it really is a priceless win or wad tonight!
Glory Glory Man Utd!!!
viva ronaldo!!!

Confirm??... NOT!

"In russia, nothing is confirmed until it starts/happens"
I quoted this from my lecturer.

Yes, this is true.

The official timetable for this coming examination was out early this week on tuesday.
I dropped by to take a look on wednesday~
The timetable looked like that



And i went to the dean's office again on thursday.. it became like that



And today, i went again.. coz i heard someone said it was changed.. i dont believe. and it became like that



*curses*

McPrawns...

                                                                    Big Tasty with Bacon

Visited McD, the easiest, cheapest, busiest, and cleanest restaurant here, last week.

McCheap. McD sells the cheapest burger to be found in town... 30rubs for a hamburger! It's one of the 'cheapest' kind burger with two pieces of bun, a piece of meat patty, 2 pieces of pickles and some ketchup.. i think it's just like that... But on the other side, McD also sell burgers that cost u 2 McValue meals for a one burger -- the BigTasty

McEasy. McD offers u the easiest service. Queue, order, pay, stand n wait.... for ur meal and a seat, sit down, eat, stand up, leave! ... and also free clean toilets!!

McToilets! McD is the place where u can get one of the cleanest and free of charge public toilets in moscow. Just go in, visit the toilet, wash your hands and leave. No tips, no hassle. But i see that the queue to the ladies room is sometimes a bit long. *updated*

McBusy. McD is one of the busiest restaurants here in Moscow. I've never entered a McD with no customers, no matter wad time. I've never had chance not queueing up to order. Btw, world's busiest McD is in Mosco's Pushkin Square.
Oh, and a thing, i tried counting before. I think there's like more than 40+ workers behind the counter and in the kitchen of a McD stall in a food court in one of the malls here.
And a strange thing.. McD vacancy ads are in each n every corner of the city. They are always underemployed!!

McClean. McD - the cleanest restaurant! hahaha.. try sitting down n eat in one of the McDs here in moscow and count how many times have the cleaning lady mopped the floor around u throughout the whole meal!
And also, try counting how many rounds are the boys cleaning the area behind the counter while u r in the queue.

Okay. Last week i visited McD and... NEW MENU!!
I ordered this "большие креветки" - so called 'big prawns' which costs 70rubs a set.
so excited while waiting, n i look into the poster they put up.. seems like there r only 4 prawns in a set that is in the poster! 4 prawns.. shouldn't be so little la~ telling myself.
Prawn came, find a seat, sit, clean hands, open the box.... 4 PRAWNS! gosh.. really 4 only! hahaha.. big joke!

4 McPrawns for 59rubs (RM8)
plus a "coctail" sauce 11rubs (RM1.50)
and a chicken burger 32rubs (RM4.50)

My favorite burger (big tasty) vs BigMac

It's huge

it's juicy

it's delicious

it's 89rubs each (RM12)

*This is not an advertisement*
I'm lovin' it

adverts...

I ve been trying hard to find something that can let me earn a few bucks through this blog these few days.
Spending hours researching on how to attract traffic to my blog, how to get indexed in google, trying to accustom to Google Webmaster tools, getting adsense, signing and posting up ads from advertlets and nuffnang.

I ve added quite a few links and stuff on my sidebar, hoping sometime somehow someone will click on it and let me earn those few bucks.
But it seems to me like i m just planting a bush that doesnt bear fruits.
Or, maybe i'm just seeding an apple tree, needing tens of yrs for the tree to grow and a few more years for it to fruit?

From these 3 days after adding advertlets, i got some positive reaction... my account has RM0.003... lolz~
Is this good? 3 days RM0.003... i need a hundred days to get to RM0.1!!! 1 yr = RM0.365
Anyway, i consider this as a positive result coz my nuffnang account is still RM0.00 since the first day i added it to my site, that was like a month ago.

Pls support my adds~ Click on them on the side bar~ THANKS! haha
seems like i need the money very desperately~
haha

Bought 2 books from Dom Knigi (House of Books) today.. Classics.. at only 238rubles(around RM30)!
1. Selected stories by Anton Chekov
2. Crime n Punishment by Fyodor Dostoevsky
And yes, both of them r russian~

Read more, see more, think more
Click less, slack less, eat less

Beta-Blockers in Hypertension?

"Should we stop using beta-blockers as first line therapy in hypertension?"

National and international guidelines have promoted beta-blockers as being on equal footing with thiazide diuretics, calcium channel blockers (CCBs), or renin-angiotensin-aldosterone system (RAAS) blockers, including angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs).

 
But the latest review of the evidence presented in an issue of the Journal of the American College of Cardiology (JACC) in 2007 noted that no study has shown that beta-blocker monotherapy reduces morbidity or mortality in hypertensive patients, even when compared with placebo despite three decades of using beta-blockers for hypertension.

Indeed, in some early trials, such as the British Medical Research Council study in the elderly, beta-blocker monotherapy was not only ineffective, but whenever a beta-blocker was added to diuretics, the benefits of the antihypertensive therapy distinctly diminished.

Besides that recent data of an analysis evaluating 13 randomized controlled trials of beta-blockers compared to other antihypertensive drugs show that the relative risk of stroke was 16% higher for beta-blockers than for other drugs and there was no difference in terms of myocardial infarction (MI). When the effect of beta-blockers were compared with that of placebo or no treatment, the relative risk of stroke was reduced by 19% for all beta-blockers, but that was about half the risk reduction expected from previous hypertension trials using other agents and, again, there was no difference for MI or mortality.

In a 2006 analysis, compared to placebo, beta-blockers reduced the risk of stroke with a marginal fall in total cardiovascular events, but beta-blockers had no effect on all-cause mortality, coronary heart disease, or cardiovascular mortality. Moreover, the effect on stroke was less than that of CCBs and RAAS inhibitors, and the effect on total cardiovascular events was less than that of CCBs. Moreover, patients on beta-blockers were more likely to discontinue treatment than those on diuretics or RAAS inhibitors.

Other problems associated with beta-blocker therapy reviewed by JACC:

• Beta-blockers reduce blood pressure compared with placebo. However, compared with other antihypertensive agents, the blood pressure-lowering efficacy of beta-blockers is suboptimal.  
• Beta-blockers are not only less efficacious at reducing peripheral blood pressure but also have a lesser effect on perhaps the more important central aortic pressure when compared with RAAS blockers, diuretics, and calcium antagonists.  
• All hypertension management guidelines recommend weight loss and/or avoidance of medications that cause weight gain in obese hypertensive patients. Beta-blocker use, however, has been associated with small but systematic weight gain (as much as 1.2 kg).  
• Exercise endurance in a healthy person depends, in part, on a properly functioning sympathetic nervous system. Beta-blockers, by antagonizing this effect, may hamper exercise capacity.

What would account for the increased risk of stroke by beta-blockers?
Based on evidence that just about every antihypertensive trial that included an atenolol arm will show more new diabetes (30%-40% increased incidence) at follow-up.
At least one of the probable mechanisms is that beta-blockers cause insulin resistance -- and, thus, cause new diabetes. This may explain why even though they lower blood pressure, beta-blockers do not actually decrease cardiovascular events and stroke.
Another mechanism may be endothelial dysfunction which comes a long with insulin-resistance.

Strength of Evidence for the Use of Beta-Blockers in Cardiovasular Disease

Article modified from Medscape.

trying..

drinking warm milk with honey
again...

again...
trying hard to fall asleep
tired but unwilling to sleep
hate to think on the bed
hate to flip up n down on the bed
just wish i could lie down..
close my eyes..
stop thinking..
fall asleep..
no dreams..
no worries..



does warm milk with honey really help?
i don't know.. maybe, psychologically
or maybe i really need chlorpheniramine? em?

trying hard to fall asleep?

Multi-religious

Today during class, we were given patients and were asked to do medical case report. I got this Patient X whom i found interesting.

During inquiry session, we found out that he is a christian, his wife is a judaist, and his daughter is a muslim. 3 of them consist a small multi-religious family, which i've never encountered before. And he drew this....

              

Besides that, we also found out that he has situs inversus totalis. This means that he has his heart on the right (dextrocardia) and his visceral organs mirrored from normal position!!! Imagine, auscultating on opposite sides, doing palpation and percussion of liver on the right....

Today is the day where in my life, i first met a multi-religious family, judaist + christian + muslim, living together in harmony, and also someone with situs inversus! Thanks to Mr. X...

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Pink Panther

a sudden nostalgia struck me when i heard dave koz's recent album..
track no.6 Pink Panther

when i was a kid,
i liked to hum the theme song of Pink Panther,
i liked to watch Pink Panther on the tv.
As i grew up,
then came Power Rangers,
n i said goodbye to disney cartoons, tom n jerry, pink panther, etc.
I started watching hongkong vampire movies~
Later as a teenager,
thanks to Astro and my brother,
i started cartoon network n disney cartoons again...
road runner *beep beep*, bugs bunny, daffy duck, donald duck, mickey, etc
and also dexter, ppg, scooby doo....
And in secondary 5, i accidentally spotted Pink Panther on TV3 on sunday morning.
That is when i was willing to wake up early on Sundays just to watch Pink Panther!

Around 20 years living,
i see things change, people change,
what has passed will not come back again,
it's not like cartoons, not like movies,
where we can still repeat the same video or song or animation that we missed.
We have to live life to the fullest, i agree,
but i do not agree to "do what u want to do most! don't miss any chance!"
think, consider, obtain a balance, then decide and do.
At many times, we will need to sacrifice some things in our life,
things that u love most, things that u need most, things that u want most.


amazing... no talking needed





album recommended: Dave Koz's Double Feature for relaxation

no guns allowed!

this morning i went to the european mall, and found this interesting...

no smoking, no blades, no pet , no alcohol, no guns!

guns allowed on streets??

The second heart sound is the key to auscultation of the heart. - Leatham A. 1964

Today, we had practical class in the central  medical library.  We managed to listen to few heart sounds with and without murmurs and some lung sounds too through the simulator.

  

At first, it looked very interesting to me.. listening from machines!! Never used such things before.. first time leh.. Then when class started, everything was like.. err.. everyone was so quiet, no one answered the doctor's questions... and he started.. THIS IS VERY BAD.. VERY BAD...

What causes split S2? Fixed split S2?

1)	Physiological split during inspiration
	-During inspiration, negative intrathoracic pressure causes increased blood return into the right side of the heart, yet some slowing of emptying from the left side. The increased blood volume in the right ventricle causes the pulmonary valve to stay open longer during ventricular systole. This causes an increased delay in the P2 component of S2 relative to the A2 component. -During expiration, the positive intrathoracic pressure causes decreased blood return to the right side of the heart. The reduced volume in the right ventricle allows the pulmonary valve to close earlier at the end of ventricular systole, causing P2 to occur earlier, and "closer" to A2.
2)	Fixed split S2
	-Usually due to an atrial septal defect(ASD) or ventricular septal defect(VSD). -The ASD or VSD creates a left to right shunt that increases the blood flow to the right side of the heart, thereby causing the pulmonic valve to close later than the aortic valve independent of inspiration/expiration.
3)	Reverse splitting
	-aortic stenosis (decreased LV outflow)  -hypertrophic cardiomyopathy - left bundle branch block (delayed depolarization)
4)	Persistent splitting
	- Right bundle branch block (from delayed pulmonic closure) - Mitral Regurgitation (from early closure of aortic valve)

 

Finally, just before leaving the library, the doctor reminded us that it's always good to start from the basics, that is, listen to more normal heart sounds. Practise on your friends! Practise Practise Practise!

  

 

Some sites for practising:

3M Littmann

Blaufuss Multimedia

Texas Heart Institute

Ausculatation Assistant

favicons

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1) paint, draw or design your own icon and save it as a '.png' file
(you can do it with Paint)

2) upload this file to any image hosting site like photobucket or fileden

3) Edit HTML of ur blogger site

add the HTML code highlighted in the picture above before the HEAD part
and remember to change the "something.com/image.png" into the source of ur icon.

4) Save and that's all!


Special thanks to reuby

Chocolate Mousse

I love chocolate mousse!!!

It's Saturday morning! Woke up early just to go to Auchan before the crowd filled up all the 80+ counters. I just love Sat n Sun mornings, sun + less cars + less people on the streets + less noise!

Amazingly, i finished marketing before 10 o'clock.. Remembering that i had to buy something in Ikea, I walked past Mega's food court. SUBWAY. The green Subway signboard caught my eyes and i decided that i would have a fresh sandwich for lunch, after Ikea.

But after entering Ikea, subconsciously, I walked to the restaurant, took a tray and serviettes.. Took a breakfast set, a CHOCOLATE MOUSSE, a bowl of soup and a muffin. I paid and sat down and ate... Halfway eating, i realised i told myself that i m going to have a sandwich for lunch! not lunch in Ikea!!!

Amnesia. Forgetfulness. Addiction. Broken Promises. Irresponsibility. Loss of mind, control n discipline.

I don't know why... I just love chocolate mousse.Each and every visit to Ikea will not be without it...

29 roubles each

P.S. anyone knows how to make chocolate mousse?? let me know!!

清明節

杜牧《清明》

清明時節雨紛紛

路上行人欲斷魂

借問酒家何處有

牧童遙指杏花村

Dodo, the above post is for u...

Sorry Dodo... Today when i was browsing through Wikipedia, i accidentally come across this page about "Dodo". And I was in a dilemma, for quite sometime... I found out sth...

P.s. Please consider another nickname

The Forbidden Kingdom

An American teenager who is obsessed with Hong Kong cinema and kung-fu classics makes an extraordinary discovery in a Chinatown pawnshop: the legendary stick weapon of the Chinese sage and warrior, the Monkey King. With the lost relic in hand, the teenager unexpectedly finds himself traveling back to ancient China to join a crew of warriors from martial arts lore on a dangerous quest to free the imprisoned Monkey King.

Starring	Jet Li (as Silent Monk and the Monkey King)
	Jackie Chan (as Lu Yan, the Drunken Immortal)
	Michael Angarano (as Jason Tripitikas, the Traveller)
	Liu YiFei (as Golden Sparrow, the Orphan Warrior)
	Li BingBing (as Ni Chan, the White Haired Assassin)
	Collin Chou (as Jade War Lord)

Premiering on the 17th of April, 2008 in Russia and Singapore.

For more details, see http://www.forbiddenkingdommovie.com/