Circumcision procedure:Beginner

Assalamualaikum W.B.T,

Alhamdulillah,with blessing from Allah I'm able to write something to share with all of you some experience I had recently.I think i't make it even better to share this knowledge with others to make it more interesting.I hope this knowledge that I manage to grab get the blessing from Allah thus reading this article will cause some deeds to all you guys.

Importantly,i will tell to you some basic things about this procedure called circumcision.In Malay language it is called 'sunat' or 'khitan'.It is define as:The removal of all or part of the foreskin of the penis in males(Dorland pocket medical dictionary,28th edition).Nowadays it has 2 main ways to complete this procedure either by simple surgery or smart clamp method.In this article,I will be discussing on simple surgery because I find it more interesting.Smart clamp method is rather more simple even can be completed even in 5-10 minutes.This is the smart clamp tools

First thing first,I will mentioned all the material needed for this procedure:-

1.Anaesthetic solution containing combination of marcain and lignocaine
2.Alcohol swap
3.povidone(or any iodine)
4.Any type of suture(During my practical,we used cat-gut)
5.6 artery forceps(amount depend on the doctors)
6.scissors
7.Ligature needle(use to suture)
8.Gauze

A bit explanation about the material used:-

• Marcain is a much expensive anaesthetic and basically used for long-term effect.While lignocaine is much more cheaper and function for short-term effect.In practical that I joined,we com bine 2ml of marcain with 3ml of lignocaine.If it is not enough(the patient can still sense the pain),we might add some more lignocaine about 2-4ml.

• Catgut is a type of surgical suture that is naturally degraded by the body's own proteolyticenzymes. Absorption is complete by 90 days, and full tensile strength remains for at least 7 days

*I'm not stating the particular surgical instruments used since I haven't learn about it yet.(really sorry)

The procedure begin with applying the alcohol swap around the surgical area.Then inject the anesthetic solution subcutaneously(between skin) and let it for about 5 minutes to get the effect.Retract the foreskin so that it can be fold inside to make the glans of penis visible.The doctor will then clean the smegma around glans of penis using the iodine apply on the gauze.Then cut the foreskin using scissors at the top of penis by dividing it into 2 sides,right and left.basically 3 artery forceps will be holding the foreskin on each side(that's why we use 6).
*smegma=a thick, cheese-like, sebaceous secretion that collects beneath the foreskin

Then the skin will be cut away using scissors on each side.Then we will come across surturing part.The below part of the glans of penis will be suture first followed by the sides.Once it's done,clean around the surgical area using the iodine and wrap the penis with the gauze for a hygienic matter.This surgical method can be completed within 15-20 minutes averagely.The gauze can be thrown away about 2 days after.Between this period,patients provided with cream antibiotics(Chloramphenicol) and solution antibiotics and also painkiller.Averagely,patient can become active again 1 week prior to surgery.

Do you find it simple and easy?Yes it is,because I expain it very briefly since now,I'm just a beginner in this field.If there's any doctor out there that read this article,do correct any of my mistakes in this article so that I can improve on it.

I hope this article would increase our knowledge and bring benefits to all of us.May Allah bless all of us...

Akhirul kalam...

It's smell nice,but does it really good to you?

Assalamualaikum W.B.T,

Alhamdulillah,Allah have give an oppurtunity to share some fact that i learn before.InsyaAllah it will bring benefit to you guys.I'll try to deliver it in much simpler way,so that all of you can understand it well,and perhaps spread it to others with Allah will.

Usually when we heard something nice,then we expect to get a wonderful effect from it.For example when a car looks good from it appearance,then we expect it also come with great perfomance.But,it never always happen like that.I'm sure some of you might facing a situation when the appearance is good,but the perfomance of the car is really bad.Same goes here about what i'm gonna talk about

Have you heard about a disease called Phenylketonuria(PKU)?Let me tell you about it...It is a disease that result in fruity odour urine.Sounds good right?But,you have to admit it,it is a disease...This disease occur because of Inborn Error Metabolism(IEM).You can take a look at pathway I provided below:-



This disease occur when an enzyme called Phenylalanine hydroxylase is lack.In the pathway above,all the blue box is a NORMAL pathway,while the red box is the ALTERNATIVE pathway.Thus when the reaction can proceed in normal route(because lack of enzyme),it then diverge to enter the alternative route.Entering the alternative route resulting in formation of Phenylketones(Phenylpyruvate,phenyllactae & phenylacetate).Increase formation of phenylketones result in accumulation of it,thus excess phenylketone will be excrete in the urine of the patient.Presence of this phenylketones in the urine that result in fruity smell of the urine since one of the characteristict of it is this fruity smell.

How to diagnose this disease,simple!
1.Presence of Phenylketone in urine(by undergo urine test)
2.Just smell it!

The worst that can be expect from this disease is mental retardation

Treatment:-
1.Give Tyrosine supplement(Since the pathway have diverge from normal route,thus it might cause low level of tyrosine than the normal level).
2.Restrict intake of Phenylalanine from diet(To prevent accumulation of phenylketones)
3.Enzyme substitution with Phenylalanine amino lyase(PAL)(This will convert Phenyalanine to non-toxic derivatives,instead of phenylketones)

*Pathway given above is not complete,just want to give simple overview to all of you
*With Allah will,i'll try to explain regarding others IEM disease after this...

Akhirulkalam...

Ever wonder how aging occur?

Aging is a process of gradual and spontaneous change,resulting in maturation throughout the life then decline of many bodily functions at late age.Aging then can be further divided to 3 categories which are senescenes,normal aging and succesful aging.
1.Senescenes:Changes that occur with age as a result of biologic,psychologic and enviromental factors as well as lifestyle choices.
2.Normal aging:Common complex of diseases and impairments that afect many older people
3.Successful aging:Process by which aging is not accompanied by debilitating disease and disability

Now here comes the interesting part,have you ever wonder why skin of the older people become wrinkle as the age keep on increasing?Have any idea?Telomeres might be the one that responsible for this.Telomeres is a tiny cap at the end of chromosome(picture) function to protect the chromosome from any damages.





Our skin keep on replacing the older skin by newer skin through division of the cell under the skin.In order for the cell to divide,the chromosome(made up of DNA) need to be replicate fully.However,the chromosome faces some difficulty to replicate the telomere(also made of DNA) and each time it does,the telomeres become slightly shorter which further lead to disappearance of the telomeres.Since telomere function to protect the chromosome,then disappearance of it will lead to cell death.Once cell death become numerous,result of aging physically can be observed(wrinkle).Conclusion that can be made,shortening of telomere might lead to aging.

Health:Have heard of Heart murmur?

Firstly,heart murmur is actually an extra or unusual sound heard during heartbeat.The sound like hissing,whooshing or swishing noise.Additional info,normal heartbeat sounds "lub" for closing of mitral and tricuspid valve while "dupp" for closing of aortic and pulmonary valve.

Heart murmur classified into 2 types:-
+Innocent(harmless) murmur
+Abnormal murmur

Innocent murmur also called by several different name such as normal heart murmur,benign heart murmur,flow murmur,functional murmur,still's murmur and phsiologic heart murmur.This type of murmur caused by blood flowing faster and increased amount of blood flow through the heart.It is usually common in healthy children as the patient of this type of murmur has a normal heart.There are several condition that may cause blood to flow faster:-
+Fever
+Anaemia
+Excessive thyroid hormone in body(hyperthyroidism)
After childhood
+Pregnancy

Abnormal murmur also called by the name of Pathologic heart murmurs.This type of murmur cause by lot of factors but the most common one is congenital heart defects(when heart,heart valve,blood vessel attach to heart not develop normally before baby is born).2 types of congenital defects are:-
+Congenital septal defect(hole in septum)
+Congenital valve defect(narrow valve-not allow enough blood to flow through &
valve not closed properly)
other factors that may cause abnormal murmur are:-
+Rheumatic fever(serious illness develop after a person has an untreted infection)
+Endocarditis(inflammation of inner lining of heart cause by bacterial infection)
+Calcification(hardening of valve result of aging)
-------------Symptoms of heart murmur---------------
=Blue colouring of skin,especially at fingertip & inside mouth
=Fast brething
=Excessive sweating
=Shortness of breath
=DizzinesFaintings
=Easily fatigue
=Chest pain

----------How it being treated?-----------------
Innocent murmur*

Do not need treatment as they have normal heart.If the patient have an innocent murmur due to condition mentioned above(eg-anaemia),murmur will go away as the condition treated.

Abnormal murmur*

Certain medicine might be prescribe by the doctor:-
+Aspirin=anticoagulant
+Beta-blockers=slow a rapid heart beat(tachycardia)
+Diuretics=lower blood pressure
+Digoxin=Strenghten force of heartbeat

Certain surgery might be neede if condition become worsen such as:-
+Aortic valve replacement
+Heart surgery

Osteoarthritis(OA)

-1/8 between 18-79 suffer from OA-10-20% of Malaysian suffer from it

-Risk factor

:tend with women wear out
:Overweight

:Bone deformity

:Joint injuries

What happened?

+Cartilage(cushion end of bones)

+Bone rub against each other

+Sometimes

=joint swelling

=ligament damage

=muscle weakness

Symptom

#Joint stiffness

=noticable when wake up in morning

=noticable after period of inactivity

# Pain when use joints

:Incurable }to overcome

=early diagnose

= symptomatic treatment