Back in Control .... He He

My computer got zapped by not one but two viruses: RVHost & Heap (std.txt).

They messed up my registry editor, disabling Task Manager, System Restore & REGEDIT.

For months, I kept seeing messages like "TASK MANAGER DISABLED BY ADMINSTRATOR" and multiple funny messages whenever I start up.

After some serious experimentation and internet search, I have found some links to help others to solve the same problem:

http://windowsxp.mvps.org/Taskmanager_error.htm

http://www.pchell.com/support/registryeditordisabled.shtml

http://forum.lowyat.net/topic/531132

Good luck!

PCOS (Polycystic Ovarian Syndrome)

PCOS atau Sindrom Ovari Polisistik adalah satu penyakit yang telah lama diketahui oleh pakar-pakar sakitpuan. Namun, hanya dalam seabad yang lepas, penyelidikan berkaitan PCOS makin bertambah dan mula mungungkit minat pelbagai pihak.

European Society for Human Reproduction and Embryology (ESHRE) dan the American Society for Reproductive Medicine (ASRM) adalah antara organisasi yang telah lama cuba menyeragamkan diagnosa dan cuba mewujudkan garispanduan dalam perawatan wanita yang menghidap sindrom ini. Usaha mereka akhirnya berhasil di satu sidang kemuncak PCOS di Rotterdam pada tahun 2004.

Menurut 'kriteria Rotterdam' tersebut, seseorang wanita harus memiliki sekurang-kurangnya DUA dari TIGA ciri-ciri am PCOS iaitu:
1. Haid tidak teratur atau haid sering lewat (absent)
2. Hiperandrogenisma (keadaan di mana berlaku peningkatan hormon androgen, sejenis hormon kaum lelaki)
3. Ovari polisistik, iaitu, sekurang-kurangnya satu ovari mempunyai minima 12 telur (follikel) atau saiz ovari telah membesar

Namun, PCOS masih merupakan satu sindrom dan dengan itu, diagnosa PCOS tidak TERIKAT semata-mata kepada tiga kriteria yang disebut di atas.

Berikut adalah antara masalah lazim yang saya kenalpasti di kalangan wanita yang disyakki menghidap PCOS:
1. Pertambahan berat badan yang mendadak (sekurang-kurangnya 5%) .... sering berlaku walaupun wanita-wanita ini tidak mengalami pertambahan nafsu makan
2. Ahli keluarga atau diri sendiri menghidap penyakit Diabetes (kencing manis)
3. Peningkatan pertumbuhan bulu roma yang tidak menyenangkan - roma makin menebal, hitam dan menjadi kerinting. Mula tumbuh di bahagian-bahagian 'sensitif' seolah-olah ada pertumbuhan misai halus atau janggut
4. Central obesity - kaki dan tangan tampak 'slim' tetapi lemak berkumpul di kawasan dada, abdomen dan punggung maenyebabkan wanita tersebut hilang 'shape' (maaf, saya bukan menghina kaum wanita...)
5. Kurang subur. Mengandung pun, mudah gugur.

Rawatan PCOS biasanya merangkumi strategi-strategi seperti berikut:
1. Mengurangkan berat badan
2. Ubatan seperti metformin (yang sebenarnya adalah ubat kencing manis) dan pil perancang. Pelbagai jenis pil perancang boleh diguna. Ada diantaranya yang mengandungi ubat anti-androgen (anti hormon lelaki) iaitu 'cyperoterone acetate'. Contohnya adalah Diane 35 (dipasarkan oleh syarikat farmaseutikal Schering) dan Estelle (maaf, saya tidak tahu nama syarikat)
3. Rawatan kesuburan bagi wanita yang mengingingkannya
4. Rawatan jangka panjang, terutamanya dari segi risiko kencing manis, kolestrol tinggi, darah tinggi, penyakit jantung & barah rahim
5. Rawatan kosmetik - juga untuk golongan wanita yang menginginkannya

Jenis dan cara rawatan adalah bergantung kepada kehendak pesakit, indikasi perubatan dan pendapat doktor yang merawat.

Dari segi rawatan kesuburan, tidak semua wanita yang perlu rawatan secara ubat. Ada wanita yang bijak mengurus berat badan dan ini dengan sendirinya merangsang kesuburan. Dari segi perubatan, bantuan boleh diberi dari segi:
1. Ubat metformin
2. Pil subur (clomiphene citrate) atau Suntikan harian hormon (FSH)
3. Suntikan hCG untuk menggalakkan ovulasi
4. Kaedah laparoskopik (ovarian drilling) - untuk memperbetul ketidakseimbangan hormon di dalam ovari

Ada juga doktor yang menggunakan kaedah tambahan seperti pemanian beradas (IUI) atau persenyawaan tabung uji (IVF).

Namun, kejayaan rawatan tidak boleh diukur dari segi kadar kehamilan sahaja. Ini adalah kerana kadar KELAHIRAN adalah kurang dari kadar KEHAMILAN. Bukan semua janin dapat bertahan sehingga tempoh matang. Ada yang gugur. Ada yang lahir terlalu pramatang. Ini adalah suatu kelemahan semulajadi dalam kes-kes rawatan kesuburan, apakan lagi kes PCOS di mana telur (ovum) yang terhasil kadangkala tidak sihat dan tidak stabil.

Semasa menjalan rawatan kesuburan, doktor biasanya akan memanggil wanita itu untuk datang pada hari ke 9 atau ke 10 untuk 'follicle tracking'. Ini adalah satu proses pengesanan tumbesaran telur (ovum) dengan bantuan alat skan melalui faraj. Skan ini terpaksa dilakukan berulang-kali (biasanya 3 hingga 4 kali) untuk memahami kadar tumbesaran ovum. Apabila ovum telah mencapai peringkat matang, satu suntikan penggalak ovulasi (hCG) akan diberi.

Tidak semua wanita yang memerlukan skan sehingga 3 atau 4 kali. Ada kes di mana telur matang dengan cepat.

Begitu juga dengan suntikan hCG: doktor kadangkala membuat keputusan untuk tidak memberi suntikan ini, terutamanya dalam kes respons terlalu lemah ATAU respons terlalu kuat (terlalu banyak telur yang matang sekaligus)

Kemaskini Sept 2009: Suatu kertas kerja jawatankuasa saintifik RCOG telah menyarankan bahawa metformin BUKANlah suatu rawatan 'first-line' yang disyorkan untuk PCOS. Sila ambil perhatian dan jangan ambil ubat ini tanpa arahan doktor. Untuk maklumat lanjut, layari: http://www.rcog.org.uk/files/rcog-corp/uploaded-files/SAC13metformin-minorrevision.pdf

Indications for MGTT

For the benefit of my students and those who seek knowledge:

Malaysia practices SELECTIVE screening for gestational diabetes. Not all women are screened for the disease. Here are a few indications:

1. Maternal obesity - em..... a bit tricky here.... i'm not sure whether we should follow BMI or maternal weight. Maternal weight > 80 is practical in the sense of a busy set-up such as Klinik Kesihatan. Can follow this simple rule of thumb so long you don't miss obese mothers who are short but weigh > 80 kgs

2. Excessive weight gain in pregnancy

3. Glycosuria on 2 or more occasions

4. Symptoms of frank diabetes

5. Recurrent infections, such as vulvovaginal candidiasis

6. Previous intrauterine death

7. Previous fetal anomaly

8. Previous macrosomia

9. Polyhydramnios

10. Underlying Polycystic Ovarian Disease

11. Family history of diabetes

12. GDM in previous pregnancy

I'm sure the above list is incomplete. If you think we should add more, leave me a note :-)

Biochemical Pregnancy

Have you heard of this term?

I didn't like it from the first time I heard. I mean, the term is both demeaning and confusing.

Demeaning because the affected woman feels like she's being treated like an experimental subject. Confusing because we are neither confirming or denying that she is pregnant.

Ok, background info. Decades ago, our grandmas realized they were pregnant when they began to experience 'morning sickness'. A doctor would then look for Hegar's sign and confirm the pregnancy. Then came in the urine pregnancy tests. Then, these tests became more sensitive. And we are now finally in an era where serum beta-hCG assay is easily available. To that, you add an anxious lady with fertility problems and an equally anxious doctor who wants to see the success of his/her fertility treatment.

And you get biochemical pregnancy.

These pregnancies are real, except when you have choriocarcinoma or hCG-secreting ovarian tumour. The more commoner culprit is hCG injections that are sometimes given to aid ovulation and / or provide hCG support for the early pregnancy.

If we take all the above factors away, then it has to be a pregnancy and nothing else (I stand corrected).

Most (up to 60%?) of pregnancies 'fade away' before most women realize them. These destined-to-fail pregnancies are being increasingly picked up due to heightened surveilance following fertility therapy.

For the benefit of students, a biochemical pregnancy is a pregnancy that fails before the beta-hCG levels enter the 'discriminatory zone'.

And you are what? No. 2 at home? Or is it No.3. Sure? Not 63?

I dedicate this article to all my biochemical brothers and sisters 'born' before me. :-)

Farewell Sir!

After months of persistent rumours, it is now confirmed and it is happening. Dato' Dr Ravindran, my boss, is finally leaving to KL.

Technically, he's my ex-boss. But, some figures remain 'boss' to us no matter how far we progress in life.

I were there at his farewell dinner. It was nice listening to all those parting words from my fellow colleagues. Though there was some amount of sadness, I was not emotional. You come to expect these things in government service. If I had been emotional, I would never have left my Alma mater, my favourite Hospital Tawau or even my memorable University Hospital. I felt a little guilty for not speaking out during his farewell but there was simply nothing much to be said. I have said it all in my Masters thesis. He is definitely one of the 'Giants' of O&G in Malaysia, who cared to lend me his shoulder during my uphill climb into this complex world of O&G!

I know there are many who despise him for one reason or another. But, as I sat there last night, trying to dig into my heart for some residual hatred, I found none. It is not that I have never incurred his wrath. There were awkward moments in the past......

In life, the best lessons are learnt when one is emotionally stirred. 'Boss' did stir up my emotions on many occasions! Alas, it was always attached with good lessons.

When you look back at your childhood, you only remember beatings that were meaningless .... without reason. Well deserved spankings are usually forgotten because the joy of realization overshadows the transient pain of torture.

Adios my boss!

Shoulder Dystocia

I really enjoyed the 'intellectual discourse' I had with the Sem 7 students yesterday. Left the discussion room with much contentment.

To my beloved students, I encourage you to visit this link (American Association of Family Practitioners):
http://www.aafp.org/afp/20040401/1707.html

Just to make sure you don't lose focus in Malaysian context:
1. You must be familiar with McRoberts manoeuvre + administration of suprapubic pressure
2. It is sufficient for you to be aware of the name & correct order of other manoeuvres but we will seldom ask HOW those things are done. Thats postgraduate stuff.

Remember, SHOULDER DYSTOCIA IS A HIGHLY UNPREDICTABLE OBSTETRIC EVENT. This underscores the need for ALL caregivers in the labour room to be ready / on their toes at ALL times. Labour room personnel should be ready to spring into action whenever this condotion is diagnosed. Frequent Shoulder Dystocia drills should be the norm and such events should be recorded and kept in a log by the Labour Ward Manager.

And for the benefit of those who missed my definition yesterday, here it is:

Shoulder Dystocia is defined as difficulty in delivery of the anterior shoulder with NORMAL traction with subsequent need for ancillary obstetric manoeuvres.

Nasopharyngeal Suctioning

I'm afraid I gave incorrect information to my students this morning.

I'm coming out 'naked' :-)

Its oral first, then nasal. But as I said, the usefulness of this procedure is controversial.

Visit this link:

http://www.obgynhealth.net/womens-health/obstetrics-gynecology/oropharyngeal-nasopharyngeal-suctioning-meconium-stained-neonate