ICCH (Integrated Community & Child Health)

Sorry for being away for a year as I found myself lazy and have no motivation to update my blog. Now that the new term has started, I decided to update my blog on a regular basis (hopefully). ICCH this term will include GP, rural and pediatrics. I would start my GP rotation first and was allocated to Curtin Medical Practice, under Dr. Lai Chin Wing. Hopefully it would be a great experience for me 🙂

Alcohol

Just few hours ago, I hang out with one of my primary friends, Wei Lun and his other friends at a pub. Tasted mug Tiger beer again. It was not bad but I think the one at KL Midvalley  was better. In our society, we tend to relate alcohol to adulthood. When a person started to drink alcohol, we would regard him as grown up man already. When I was young, I tried to drink alcohol (more specifically beer) but it tasted very bitter and I would not understand why adults like it so much? But when I grow up, I tend to appreciate alcohol more, the bitterness of it, the adrenaline-pumping effect after drinking it! And of course my tomato face! :-p  More often now, I will buy can Heineken drink and enjoy it with snacks while watching movie in the room.

Well, from the medical view, alcohol has been regarded as evil stuff. It was the risk factors of majority of the diseases. Below are the summary of diseases it will cause which I extracted from http://emedicine.medscape.com/article/805084-overview.

Alcohol

Alcohol is a CNS depressant. In low doses, alcohol acts primarily to depress inhibitory centers. Resultant disinhibition may lead to out-of-character activities (eg, dancing with a lampshade on the head, blurting out a long-held confidence). At higher doses, alcohol inhibits excitatory centers. People may show effects ranging from impairment of rational thinking to absence of motor coordination. Physiologic effects of chronic alcohol use include the following:

• Gastrointestinal –Cirrhosis of the liver, peptic ulcer disease, gastritis, pancreatitis, and carcinoma
• Cardiovascular – Hypertension, cardiomyopathy, atrial fibrillation (“holiday heart syndrome “)
• Neurological – Peripheral neuropathy leading to ataxia, Wernicke encephalopathy, Korsakoff psychosis, and structural changes in the brain leading to dementia
• Immunologic – Suppression of neutrophil function and cell-mediated immunity
• Endocrine – In males, increase in estrogen and decrease in testosterone, leading to impotence, testicular atrophy, and gynecomastia
• Obstetric –Fetal alcohol syndrome (ie, mental retardation, facial deformity, other neurologic problems)
• Psychiatric – Depression or anxiety disorders.
  How alcohol is made is through a process called fermentation. You would understand more of the process after you read the explanation as below: (http://en.wikipedia.org/wiki/Ethanol)

  Fermentation

  Ethyl alcohol (ethanol; CH₃ -CH₂ -OH) is a low molecular weight hydrocarbon, which is derived from the fermentation of sugars and cereals. It is widely available both as an alcoholic beverage and as an ingredient in food extracts, cough and cold medications, and mouthwashes.When certain species of yeast (e.g., Saccharomyces cerevisiae)  metabolize sugar, they produce ethanol and carbon dioxide. The chemical equations below summarize the conversion:

  C₆H₁₂O₆ → 2 CH₃CH₂OH + 2 CO₂

  C₁₂H₂₂O₁₁ –> 4 CH₃CH₂OH + 4 CO₂

  The process of culturing yeast under conditions to produce alcohol is called fermentation. This process is carried out at around 35–40 °C. Toxicity of ethanol to yeast limits the ethanol concentration obtainable by brewing. The most ethanol-tolerant strains of yeast can survive up to approximately 15% ethanol by volume.

  To produce ethanol from starchy materials such as cereal grains, the starch must first be converted into sugars. In brewing beer, this has traditionally been accomplished by allowing the grain to germinate, or malt, which produces the enzyme amylase. When the malted grain is mashed, the amylase converts the remaining starches into sugars.

  
  

  Metabolism of Alcohol

  
  
  After consumption of alcohol, it is rapidly absorbed across both the gastric mucosa and the small intestines, reaching a peak concentration 20-60 minutes after ingestion. Once absorbed, it is converted to acetaldehyde. This conversion involves 3 discrete enzymes: the microsomal cytochrome P450 isoenzyme CYP2E1, the cytosol-based enzyme alcohol dehydrogenase (ADH), and the peroxisome catalase system. Acetaldehyde is then converted to acetate, which is converted to acetyl Co A, and ultimately carbon dioxide and water.

  Genetic polymorphisms coding for alcohol dehydrogenase, the amount of alcohol consumed, and the frequency at which ethanol is consumed all affect the speed of metabolism. Chronic alcoholics and those with severe liver disease have increased rates of metabolism. However, as a general rule, ethanol is metabolized at a rate of 20-25 mg/dL in the nonalcoholic but at an increased rate in chronic alcoholics.

  However, there are some studies also shown that light to moderate amount of alcohol helps in dementia in older patients. (http://www.medscape.com/viewarticle/738563) .

  In conclusion, drinking wine occasionally is still acceptable but binge drinking or chronic compulsive alcohol drinking might leads to bad health conditions and diseases. So avoid long term and large volume of alcohol consumption at a time! Take care of yourself  by not drinking too much as you want to have a healthy LIVER, HEART and TESTES!!! 🙂
  

  Sia Yang

International Clinical Trials Day

20 May marks the day of international clinical trials! It is to raise awareness of how importance research is to health care. Partnerships between patients and healthcare practitioners are extremely important to relevant clinical trials.

It was all started when James Lind initiated his famous trial on the 20th of May 1747 (*www.jameslindlibrary.org).

According to European Clinical Research Infrastructure Network (ECRIN) website,

The challenges of clinical research are not restricted to a single country, thus transnational communication on clinical trials requires initiation and co-ordination by a transnational organisation, with the objective to facilitate better clinical research, relevant to the needs of patients everywhere.

The objective is to make the International Clinical Trials’ Day a focal point for international communication events, meetings, debates, and celebrations of clinical research.

In conjunction to this, ECRIN hosts a celebration of ICTD in a European city annually.

A little bit about myself:

I was a research student for the past 1 year.My research is not clinical based as it involved no patient but animal models. My topic was related to cardiovascular disease, which are deemed to be the commonest disease which contributes to death globally. More specifically, my topic is : A biochemical & histopathological approach to study the cardioprotective effects of geraniin against isoproterenol-induced myocardial ischemia in rats. Geraniin was obtained from Nephelium lappaceum rind (in general Rambutan skin) while MI was induced in rats using 2 high doses of isoproterenol (sympathomimetic drug). Alpha lipoic acid (powerful antioxidant) was used as postive control. Several cardiac markers were examined include CK-MB, LDH and Troponin I. Assays done were antioxidant assays such as Superoxide dismutase (SOD) and Glutathione (GSH) . Protein carbonyl content and nitrate nitrite ratio were investigated too. Results displayed that geraniin possess some antioxidant property but was not as potent as alpha lipoic acid.

Well, I would say this one year of research experience had taught me something which is important to clinical field. We were taught to do literature reviews, to do biochemical tests, raise animal models, handle laboratory equipments and finally have to come out with a thesis with about 20000 words. Hopefully eventually we will get our research published and it will be my first paper 🙂 Besides that, I am now also working on WHO fact sheets with my colleagues and a co-authoring journal opportunity with Dr. Harpal. It would definitely be a great experience! Personally, I felt that research needs a lot of commitment, hardwork, statistical knowledge , huge budget and time investment. It is undeniably true that after you have gone through it. All the factors have to be there to enable you to obtain a satisfactory and accurate result because you have to repeat the result several times to make sure the findings are not due to chance but are significant. I will be getting my degree in medical sciences this coming August, hopefully in the future if time allows I will be getting master degree in medical sciences to give me more experience in research although research is torturing. Glad that now I am a GCP (Good Clinical Practice) certified member in Malaysia. Future still remains unclear but I would definitely indulge myself in a research to find a cure for cancer by studying the property of Morinda citrifolia (in general Noni fruit). Wish me luck 🙂

Sia Yang’s Medical Blog

I have always wanted to create a Medical Blog since long time ago. I had created a blog (ickesangelo.blogspot.com) in 2008 but as time passed, it was soon being abandoned and was replaced with a  blog to join contests which was not related to my medical life at all. With this new medical blog, I wish to record:

-my life journey as a medical student

-how I survived through all the hardship in medical school

-how my mind as a medical student matures to be a medical doctor who is able to make correct judgement and important decisions

-health conditions cases

– medical facts and knowledge which I would like to share

The reason this medical blog was created was also due to the inspiration I obtained from dear Dr. Tan Tow Shung.

Today after seeing Ms. Aznah posted a status comment in fb : Dr Tan Tow Shung, may you rest in peace….

Out of curiosity of who Dr. Tan is,I googled and discovered that Dr. Tan Tow Shung was from IMU graduate during year 2000 – M1/98 batch. He was somemore a bright and smart man( in the dean list) during his years in IMU.

After much exploration, I came to several blogs of Dr. Tan’s friends. They all dedicated their unique blog posts for the loss of Dr. Tan. I also discovered the very own journal of Dr.Tan (http://www.caringbridge.org/visit/towshungtan), which  was created by Dr. Tan and his wife in objective to deliver latest updates on the health conditions of Dr. Tan. 17 May 2011 was the day when Dr. Tan no longer in the world. I read his blog posts retrospectively and was really inspired by his strength in living and holding on despite the pain and side effects he had to suffer following the disease and chemotherapy. His positive perception towards life as a cancer patient, friendship and love to others and others to him were so great that it just make me feel guilty as I am nothing if compared to him. We are just 10 years apart (he is M1/98 while I am M1/08) in term of age and with the same surname ‘Tan’ but he is very much matured, caring, brilliant, and most importantly he has lived his life to the fullest and understand the meaning of life no matter what happens he is  ready and willing to accept,not blame; fight, but not give up and move on with his beloved. I really admire and salute his courage, attitude and love he brought to others 🙂 Dr. Tan had inspired and motivated me to work harder and with more passion to become a great and successful doctor and also to live and appreciate life , family and friends more. Rest in peace, Dr. Tan Tow Shung, you are my idol and inspiration from now onwards!

Dr. TTS was diagnosed with metastatic esophageal cancer in oct 2007 and he was only 29 at that time. He however face and fight the disease with courage and perseverance. Life was harsh & unfair when there was a recurrence of cancer in Nov 2008 when Dr. Tan was survived from the cancer in June 2008. It just brought disappointment to everyone. However, both Dr. Tan and his wife face the bad news with “No why” but focus on how to make it better.

Below is extracted from one of Dr. Tan’s friend’s blog: A video interview of Dr. Tan by Eagles Cancer Telethon.

http://chenghiang.wordpress.com/2008/02/26/tow-shungs-interview/

What I would like to share more is a blog by Dr. Vagus, one of Dr. Tan’s best friend, roomate, buddy, brother, Best Man.

http://doctorslife.blogspot.com/

It was utterly touching after reading the blog post (http://doctorslife.blogspot.com/2011/05/we-shall-miss-you.html) and watching the video (http://doctorslife.blogspot.com/2011/05/in-memoriam.html) posted in Dr, Vagus’s blog. I was saddened by the unfairness of life on why it could just destroy a perfect young man’s life?

Starting from now, I will learn to:

see life differently, appreciate people surrounding me more!

You too! You don’t want to regret in the future, aren’t you?

While as for me who is still on my path to become a doctor, according to Dr. Khoo (http://thestar.com.my/news/story.asp?file=/2005/2/27/education/10257778&sec=education)

Sacrifice,Determination, Hard work, Faith, Family and perhaps Luck are the factors that I need to succeed.

I will make sure I adhere to them and will regard Dr. TTS as my role model to become a good doctor. 🙂

Cheers!

Sia Yang

19/5/2011