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 CALLING ALL MEDICAL STUDENTS! V2, medical student chat+info center

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CyberSetan
post Feb 19 2011, 04:36 AM

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QUOTE
Thursday February 17, 2011

Liow: Housemen not up to mark will be booted out


KUALA LUMPUR: Housemen have two years to prove their capabilities as doctors or they will be booted out of the healthcare system, said Health Minister Datuk Seri Liow Tiong Lai.

“The Medical Qualifying Board will assess the housemen and if they do not show adequate clinical abilities and skills during the two years, their service will be terminated as provided under the Medical Act 1971,”
he said.

He said it meant that they could not practice medicine in the country.

Liow said this in response to a Malay news report on Tuesday that questioned the quality of housemen.

The Star had also highlighted complaints about local students who had trained in some foreign universities and were found to lack core knowledge and basic expertise in medicine.

Liow said there are medical graduates studying in 11 public schools and 18 private schools locally as well as students training in Britain, the United States, Australia, Indonesia, the Middle East, Russia and India.

He said that since their education curriculum and clinical experience are diverse, the Government lengthened the houseman training in 2008 from one year to two years for more clinical exposure and guidance.

“If they do not show adequate clinical abilities or capabilities in each department after four months, their training will be extended for another three months,” he said.

Liow said the Joint Technical Accreditation Committee for Medical Education continuously evaluated medical programmes by local and foreign universities.


here is another one~ laugh.gif
limeuu
post Feb 19 2011, 08:36 AM

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it is NOT so easy to extend any posting in housemanship......let alone terminate their service.........

politicians gets involved........

the head of dept gets criticised for 'failing to teach the houseman adequately'........

hosp directors hauled up to explain why houseman sacked.........asked to explain why cannot teach them.......

easiest to just pass them and let them be somebody else's problem.......

msia boleh......smile.gif
CyberSetan
post Feb 20 2011, 10:35 AM

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News~

QUOTE

Mediocre students becoming doctors


2011/02/20
By P. Selvarani
Share |



EVERYONE knew she was a mediocre student, yet Lina (not her real name) was bent on pursuing a career in medicine.

Armed with her not so spectacular Sijil Pelajaran Malaysia results of weak credits in Biology, Chemistry, and a pass in Physics and Additional Maths, she applied to do medicine in several of the local public and private universities.

Her applications were rejected. But Lina was determined to be a doctor.


On her insistence, her family enrolled her at a local medical college which offered preparatory courses to do medicine in several South Asian and East Asian countries.

Despite acknowledging that her results were not up to the mark, the college took her in as a student and made her re-sit her SPM science subjects.

Within seven months, she completed her pre-medical course and Lina is now pursuing her first year of medical studies in a relatively unknown university in Bangladesh.


» Click to show Spoiler - click again to hide... «
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This post has been edited by CyberSetan: Feb 20 2011, 10:36 AM
limeuu
post Feb 20 2011, 02:24 PM

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finally, what i have been saying all these years (and getting flammed for by the likes of hypermax etc) is coming out openly in the mainstream media and national consciousness........

'passion' is NOT an excuse to become a doctor.....ever.......all well managed countries with high standards of healthcare allow only the BEST of their youth to become doctors.......msia had no such control, and have allowed sub-standard students become sub-standard doctors ever since it existed......

msia boleh.......again.....smile.gif
NatBass
post Feb 21 2011, 04:41 AM

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these things are very political. Well its true what they say . In malaysia , its about your contacts , you survive if you know bigshots. I know 2 students doing medicine in bangladesh. 1 arts strm and another one science. The science girl just obtain all D in spm. Rich family. They told me classes are conducted in bengali , exams are held in english. so in other words they study from their text book and answer exams. it doesnt make a difference if they attend class or not. After passing the whole degree just come back and show mmc its a degree from a recognize uni and start working smile.gif

Anyways - Seniors , im sure you'd heard of mantoux test right. 10mm is the normal reading for a person with tb negative? So anything more then 10mm is positive? how do one confirm that he/she has tb? besides chest x-ray? im sure mantoux test can go false-positive due to BGC injection and the air you breathe?
StarGhazzer
post Feb 21 2011, 05:15 AM

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QUOTE(NatBass @ Feb 21 2011, 04:41 AM)
Anyways - Seniors , im sure you'd heard of mantoux test right. 10mm is the normal reading for a person with tb negative? So anything more then 10mm is positive? how do one confirm that he/she has tb? besides chest x-ray? im sure mantoux test can go false-positive due to BGC injection and the air you breathe?
*
Quantiferon-TB gold assay. Look it up.
You'll need a sputum AFB + culture as well for active disease, but it takes hell long for results to come back.

Mantoux is rarely used nowadays apart from screening tests, which if they are positive you'll need additional investigations (plus history) to determine its significance.
CyberSetan
post Feb 21 2011, 05:21 AM

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QUOTE(NatBass @ Feb 21 2011, 04:41 AM)
Anyways - Seniors , im sure you'd heard of mantoux test right. 10mm is the normal reading for a person with tb negative? So anything more then 10mm is positive? how do one confirm that he/she has tb? besides chest x-ray? im sure mantoux test can go false-positive due to BGC injection and the air you breathe?
*
Mantoux test >10mm is positive - confirm with sputum examination if the patient has pulmonary TB, gastric lavage can also be done - particularly in children since they tend to swallow sputum (use Ziehl-Neelson's/AFB staining).

Histological/cytological examination of other forms of TB can also be done - eg: skin sample from cutaneous TB, aspirate from TB lymphadenitis, samples from Pot's disease etc etc etc ... there are many forms of TB~

In other words - confirm with lab test. (CSF from TB meningitis may not show any TB bacilli - send CSF sample to biochem department for analysis).


Note: false positive can occur in ppl immunized with BCG.


Added on February 21, 2011, 5:25 amHere is how cutaneous TB looks like (taken in 2009):

user posted image

This post has been edited by CyberSetan: Feb 21 2011, 05:25 AM
tqeh
post Feb 21 2011, 08:41 AM

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QUOTE(NatBass @ Feb 21 2011, 09:41 AM)
Anyways - Seniors , im sure you'd heard of mantoux test right. 10mm is the normal reading for a person with tb negative? So anything more then 10mm is positive? how do one confirm that he/she has tb? besides chest x-ray? im sure mantoux test can go false-positive due to BGC injection and the air you breathe?
*
You have a specific criteria to determine the positivity of a Mantoux test based on your age, previous exposure to people diagnosed with TB / country with high incidence of TB, and your immune status (ie previous BCG, immunodeficiency).

Anyway, nowadays for screening test people are moving towards Quantiferon TB gold (/ in-tube), which has less false positive rates. To accurately diagnose active TB you'll need to culture something / get a PCR done/ AFB

This post has been edited by tqeh: Feb 22 2011, 06:49 PM
NatBass
post Feb 22 2011, 03:39 AM

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would it make a difference if the doctor didnt wait for 48-72hours before analyzing the mantoux test?
It can be detected by ESR too right? if im not mistaken for males in general the esr reading is 10< female 20 < ? and in general if you have an active lung infection the level of haemoglobin is lower compared to normal , no?
Speaking about pulmonary TB here.

Dont get me wrong , im not trying to be a pain in the butt here , its just that a cousin of mine was suppose to go to australia this friday and unfortunatey we found out that he had active lung infection. I followed him around during my free time , we had like 4 opinions. 2 gp said he had nothing and perfectly fine. 2more said otherwise. Today he went to umsc , to get a respiratory professors final confirmation. He has to go for CT-scan later in the morning. No symptoms of tb are shown. No weight loss or whatsoever. I'll try to post up the pictures of the x-ray once i get a hold of it for the fun of it smile.gif
I've heard of stories like the medication of tb last for 4-9 months and side effects are insane. Liver failure , jaundice and so on?




Cyber - thanks for being so proactive and posting up a picture. I cant wait for my time in med school smile.gif

This post has been edited by NatBass: Feb 22 2011, 03:42 AM
StarGhazzer
post Feb 22 2011, 05:10 AM

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QUOTE(NatBass @ Feb 22 2011, 03:39 AM)
would it make a difference if the doctor didnt wait for 48-72hours before analyzing the mantoux test?
It can be detected by ESR too right? if im not mistaken for males in general the esr reading is 10< female 20 < ? and in general if you have an active lung infection the level of haemoglobin is lower compared to normal , no?
Speaking about  pulmonary TB here.

Dont get me wrong , im not trying to be a pain in the butt here , its just that a cousin of mine was suppose to go to australia this friday and unfortunatey we found out that he had active lung infection. I followed him around during my free time , we had like 4 opinions. 2 gp said he had nothing and perfectly fine. 2more said otherwise. Today he went to umsc , to get a respiratory professors final confirmation. He has to go for CT-scan later in the morning. No symptoms of tb are shown. No weight loss or whatsoever. I'll try to post up the pictures of the x-ray once i get a hold of it for the fun of it smile.gif
I've heard of stories like the medication of tb last for 4-9 months and side effects are insane. Liver failure , jaundice and so on?
Cyber - thanks for being so proactive and posting up a picture. I cant wait for my time in med school smile.gif
*
ESR is non-specific, and should never be used as a sole investigation to diagnose any disease.

If you have been exposed to someone who has active TB, you should be worked up for possible infection as well. Mantoux's going to be pretty useless for you since we've all got BCG as a kid.

TB meds can last for long periods, with possible side effects eg liver dysfunction. But almost every drug in the world has side effects - you just need someone to monitor you while on treatment.
CyberSetan
post Feb 22 2011, 05:03 PM

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QUOTE(StarGhazzer @ Feb 22 2011, 05:10 AM)
ESR is non-specific, and should never be used as a sole investigation to diagnose any disease.

If you have been exposed to someone who has active TB, you should be worked up for possible infection as well. Mantoux's going to be pretty useless for you since we've all got BCG as a kid.

TB meds can last for long periods, with possible side effects eg liver dysfunction. But almost every drug in the world has side effects - you just need someone to monitor you while on treatment.
*
As a matter of fact - i remembered back when I was training in a Govt.Hospital pathology lab (Likas Hosp.) in Sabah that ESR should not be ordered as part of TB investigation.

That circular was even pasted on the laboratory wall.


Added on February 22, 2011, 5:07 pmThat Quantiferon-TB gold assay - isn't available in Likas Hospital (although big as it is). The basic AFB staining is still practiced there~

I'm not sure if it is available in Queen Elizabeth Hospital either (Main Ref.Hosp. for Sabah)...



This post has been edited by CyberSetan: Feb 22 2011, 05:07 PM
MBBS siang
post Feb 22 2011, 06:48 PM

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[quote=NatBass,Feb 22 2011, 04:39 AM]would it make a difference if the doctor didnt wait for 48-72hours before analyzing the mantoux test?
It can be detected by ESR too right? if im not mistaken for males in general the esr reading is 10< female 20 < ? and in general if you have an active lung infection the level of haemoglobin is lower compared to normal , no?
Speaking about  pulmonary TB here.

Dont get me wrong , im not trying to be a pain in the butt here , its just that a cousin of mine was suppose to go to australia this friday and unfortunatey we found out that he had active lung infection. I followed him around during my free time , we had like 4 opinions. 2 gp said he had nothing and perfectly fine. 2more said otherwise. Today he went to umsc , to get a respiratory professors final confirmation. He has to go for CT-scan later in the morning. No symptoms of tb are shown. No weight loss or whatsoever. I'll try to post up the pictures of the x-ray once i get a hold of it for the fun of it smile.gif
I've heard of stories like the medication of tb last for 4-9 months and side effects are insane. Liver failure , jaundice and so on?
Cyber - thanks for being so proactive and posting up a picture. I cant wait for my time in med school smile.gif
*

[/quote]

You can never detect TB by ESR, ESR is just non-specifically indicate the inflammation. For immunocompromised patients like AIDS even less than 5mm could be considered +ve mantoux test.


Added on February 22, 2011, 6:52 pm[quote=StarGhazzer,Feb 22 2011, 06:10 AM]
ESR is non-specific, and should never be used as a sole investigation to diagnose any disease.

If you have been exposed to someone who has active TB, you should be worked up for possible infection as well. Mantoux's going to be pretty useless for you since we've all got BCG as a kid.

TB meds can last for long periods, with possible side effects eg liver dysfunction. But almost every drug in the world has side effects - you just need someone to monitor you while on treatment.
*

[/quote

Rifampin is a good example for hepatoxicity.


Added on February 22, 2011, 7:00 pm[quote=NatBass,Feb 21 2011, 05:41 AM]
these things are very political. Well its true what they say . In malaysia , its about your contacts , you survive if you know bigshots. I know 2 students doing medicine in bangladesh. 1 arts strm and another one science. The science girl just obtain all D in spm. Rich family. They told me classes are conducted in bengali , exams are held in english. so in other words they study from their text book and answer exams. it doesnt make a difference if they attend class or not. After passing the whole degree just come back and show mmc its a degree from a recognize uni and start working smile.gif

Anyways - Seniors , im sure you'd heard of mantoux test right. 10mm is the normal reading for a person with tb negative? So anything more then 10mm is positive? how do one confirm that he/she has tb? besides chest x-ray? im sure mantoux test can go false-positive due to BGC injection and the air you breathe?
*

[/quote]

The diagnosis is make by observing the clinical presentation and some investigation like x-rays, AFB staining and it is not only mantoux test.


This post has been edited by MBBS siang: Feb 22 2011, 07:00 PM
StarGhazzer
post Feb 22 2011, 07:59 PM

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QUOTE(CyberSetan @ Feb 22 2011, 05:03 PM)
As a matter of fact - i remembered back when I was training in a Govt.Hospital pathology lab (Likas Hosp.) in Sabah that ESR should not be ordered as part of TB investigation.

That circular was even pasted on the laboratory wall.


Added on February 22, 2011, 5:07 pmThat Quantiferon-TB gold assay - isn't available in Likas Hospital (although big as it is). The basic AFB staining is still practiced there~

I'm not sure if it is available in Queen Elizabeth Hospital either (Main Ref.Hosp. for Sabah)...
*
QfTB gold is a fancy test (and pain in the arse to collect - 3 special tubes !). I wouldn't be surprised if it wasn't available in smaller institutions in M'sia.

Sputum AFB/culture +/- PCR is still often required to effectively rule out active pulmonary TB. Patients who are suspected of having this are often quarantined with contact precautions until at least 3x samples are negative.

ESR, like CRP is only an aid for diagnosis. It's more useful as a monitoring tool eg in rheumatological diseases/infections. We normally do more CRPs than ESRs (except for patients known to have rheumatological problems) since the CRP can be done on the same tube as routine biochems. Again, not sure how is it like back home or in India.

NatBass
post Feb 23 2011, 03:17 AM

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He did an x-ray first. Then mantoux test. It was blistering , doctor did an ESR , his reading was 12. Low lvl of haemoglobin. Today they did the ct-scan to finalize. endobronchial tuberculosis was the conclusion of the ct-scan. He is on Forecox-trac and vitamin B. 4 pills of antiB and 1VitB in the morning , daily. hah 5 tablets per day , wow? 6months he has to undergo medications. ah i finally got a hang of the x-ray. will try to get a decent picture of it with the reports. Does intravenous therapy works faster? Btw he has no main symptoms. No weight loss , no cough , no constant fever.

Quantiferon-TB gold assay - read about it on wiki. Aha , i've not heard anyone speak about this until now. Impressive.

add on : Ct-scan said that there was a tree-in-bud sign
http://www.youtube.com/watch?v=hY0uMduI8I8

So i guess the tb bacteria isnt active since no symptoms are shown?

This post has been edited by NatBass: Feb 23 2011, 04:07 AM
tqeh
post Feb 23 2011, 12:42 PM

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QUOTE(NatBass @ Feb 23 2011, 08:17 AM)
He did an x-ray first. Then mantoux test. It was blistering , doctor did an ESR ,  his reading was 12. Low lvl of haemoglobin. Today they did the ct-scan to finalize. endobronchial tuberculosis was the conclusion of the ct-scan. He is on Forecox-trac and vitamin B. 4 pills of antiB and 1VitB in the morning , daily. hah 5 tablets per day , wow? 6months he has to undergo medications. ah i finally got a hang of the x-ray. will try to get a decent picture of it with the reports. Does intravenous therapy works faster? Btw he has no main symptoms. No weight loss , no cough , no constant fever.

Quantiferon-TB gold assay  - read about it on wiki. Aha , i've not heard anyone speak about this until now. Impressive.

add on : Ct-scan said that there was a tree-in-bud sign
http://www.youtube.com/watch?v=hY0uMduI8I8

So i guess the tb bacteria isnt active since no symptoms are shown?
*
Well active TB is diagnosed when sputum is AFB/culture/PCR+. For me I think it's a grey area when we pick up TB via screening, well he is now anyhow under treatment for active TB not latent TB.

Did he get to go to australia?
limeuu
post Feb 23 2011, 12:50 PM

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QUOTE(StarGhazzer @ Feb 22 2011, 07:59 PM)


Sputum AFB/culture +/- PCR is still often required to effectively rule out active pulmonary TB. Patients who are suspected of having this are often quarantined with contact precautions until at least 3x samples are negative.

that is not correct.......cultures and afb have excellent positive predictive value, but poor negative predictive value.......

ie, if you get a positive result, it probably confirms active disease........if you get a negative result it does NOT confirm you do NOT have TB............

up to 50% of patients undergoing treatment will be based on presumptive diagnosis, taking in the whole clinical picture.......in many cases, you will NOT find the organism even in patients with very classical clinical picture........
StarGhazzer
post Feb 23 2011, 08:39 PM

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QUOTE(limeuu @ Feb 23 2011, 12:50 PM)
that is not correct.......cultures and afb have excellent positive predictive value, but poor negative predictive value.......

ie, if you get a positive result, it probably confirms active disease........if you get a negative result it does NOT confirm you do NOT have TB............

up to 50% of patients undergoing treatment will be based on presumptive diagnosis, taking in the whole clinical picture.......in many cases, you will NOT find the organism even in patients with very classical clinical picture........
*
Right. My bad.

Yet most of the time once the sputum is cleared patients are allowed out of isolation.
Diagnosis of course, is always based on history + examination + investigations as a whole clinical picture, not a sole test.

This post has been edited by StarGhazzer: Feb 23 2011, 08:43 PM
limeuu
post Feb 23 2011, 09:58 PM

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QUOTE(StarGhazzer @ Feb 23 2011, 08:39 PM)
Right. My bad.

Yet most of the time once the sputum is cleared patients are allowed out of isolation.
Diagnosis of course, is always based on history + examination + investigations as a whole clinical picture, not a sole test.
*
infectiousness and cure are 2 separate and completely different aspects of tb treatment.........

within 2 weeks of treatment, the afb will have a fragmented appearance, and deemed NOT infectious anymore, although negative smears is required before release from isolation........however, they are NOT dead yet, and if treatment is stopped prematurely, they can reactivate.......

remember, antibiotics either kill bacteria by causing cell death during multiplication process (bacteriocidal), or by stopping multiplication (bacteriostatic) and giving time for the body's natural immune system to kill the bacteria.....because the mycobacterium multiply very slowly, the effect of anyi-tb medication is mostly baceriostatic (even if the primary action of the drug is bacteriocidal, eg aminoglycosides), and time is needed for the immune system to kill and remove the bacteria.........

that is why the minimum duration for treatment for uncomplicated pulmonary and extra-pulmonary(not cns) tb is 6 months..........in the old days before rifampicin, it was either 14 or 16 months.........
MBBS siang
post Feb 23 2011, 10:11 PM

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QUOTE(limeuu @ Feb 23 2011, 10:58 PM)
infectiousness and cure are 2 separate and completely different aspects of tb treatment.........

within 2 weeks of treatment, the afb will have a fragmented appearance, and deemed NOT infectious anymore, although negative smears is required before release from isolation........however, they are NOT dead yet, and if treatment is stopped prematurely, they can reactivate.......

remember, antibiotics either kill bacteria by causing cell death during multiplication process (bacteriocidal), or by stopping multiplication (bacteriostatic) and giving time for the body's natural immune system to kill the bacteria.....because the mycobacterium multiply very slowly, the effect of anyi-tb medication is mostly baceriostatic (even if the primary action of the drug is bacteriocidal, eg aminoglycosides), and time is needed for the immune system to kill and remove the bacteria.........

that is why the minimum duration for treatment for uncomplicated pulmonary  and extra-pulmonary(not cns) tb is 6 months..........in the old days before rifampicin, it was either 14 or 16 months.........
*
True. 1 thing I want to make sure is that if the treament is stop prematurely.Will the chance for developing multi-resistance toward to anti-TB drugs higher and make the case complicated by anti-TB resistance or merely the reactivation of the M.TB?

I guess it would but not so sure.

This post has been edited by MBBS siang: Feb 23 2011, 10:12 PM
NatBass
post Feb 24 2011, 02:58 AM

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QUOTE(tqeh @ Feb 23 2011, 12:42 PM)

Did he get to go to australia?
*
Nah , his parents didnt allow him. Anyhow there is a 2nd batch going sometime 10th march. If they can see improvement by then , he might go probably. I saw him today , he is on his first day of medications today. Colour of urine turned to orange in the morning. Towards the end of the day the colour was becoming lighter. He had massive diarrhoea , After consuming food. I think after 10-15mins he has to go to the toilet. Poor guy , i feel so irritated looking at him. A healthy lad indeed , idk how he got exposed. I think the medications are very strong. he is often dehydrated . (all this after consuming the medications) i guess his kidneys are really filtering/removing some massive stuff here. A family doctor asked him to get a medicine/supplement called transfer factor. It is to boost up your immune system , according to him he has seen massive changes of his patients

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