Dr.IskandarMirza
@DIskandarmirza
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Cardiologist in the making. Opinions are mine. Email: Iskandar_mirza86 @yahoo .com URL: #MedtweetMy
Joined January 2021
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Pinned Tweet
This tweet is meant for junior doctors/pharmacist or other health professional. All teaching that I have done will be compiled here.
Hope it will be beneficial for all of you 😉
#backtobasic
#Freeeducation
#semogaistiqamah
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Anda merupakan pesakit Migraine?
6 cara untuk mengelakkan dari medapat serangan migraine
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Kenangan manis semasa menjadi houseman di sandakan
Me: embak, kasi nasi kuning ayam satu
Embak: Doc nak bahai?
Me: saya tak makan bahai
Embak: orang sabah pun x makan bahai doc, bahai ni beg plastic.
🧵
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Wife nampak anak makan gula2
Wife : asyik makan gula2 je. Rosak gigi tu kan nanti. Awak kan anak doktor. Anak doktor x makan gula2. Anak doktor makan apa?
Anak: makan ubat ibu.
Tergelak aku sendirian (didalam hati)
Indah berkeluarga. Penat bekerja pun senang terhibur 🤣
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Balai polis perlu ada tanda
"perlu lengkap 2 dos vaccine sblm membuat laporan polis"
Sudah pasti laporan polis dari antivax dan pro-ivermectin berkurangan mendadak.
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Susah nak tidur?
Anda ada “Poor Sleep Hygiene” seperti:
-Susah untuk tidur?
-Senang terjaga dari tidur?
Sila amalkan sleep hygiene ini untuk mendapat tidur yang berkualiti.
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As long as the thrombus didn't pass the valve. Once it passed the valve, it is not adorable anymore.
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Had an argument with wife. She said I have 2 umbrellas in my car. It's my car and I know there is only 1 umbrella in my car.
Turn out I have 2 umbrellas in my car 😅. Never argued with the wife.
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Info Covid
Uk menggunakan AZ vaksin
Kesannya
Kadar kematian menurun dari 1000 kematian sehari kepada 3 kematian sehari.
VAKSIN AZ adalah selamat dan berkesan.
#KitaJagaKita
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Sakit dada?
Tapi Doktor merawat mengatakan bukan sakit jantung?
Balik rumah masih sakit dada sampai seminggu?
Mungkin anda ada Costochondritis
Follow bebenang ini
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Vaping
Kita sudah sedia maklum vaping adalah merbahaya kepada kesihatan. Tapi apa kesan terhadap second atau third-hand vaping?
Adakah golongan 2nd dengan 3rd hand vaping ini juga akan mendapat kesan yang sama dengan first hand vaping?
Ikuti bebenang ini:
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Semakin ramai doctor clinic ditangkap membuat sijil palsu untuk vaksin. Boleh kira 100 000 sijil dipalsukan buat masa skrg.
Gigih kerajaan nak pastikan rakyat senang dpt vaccine dengan memberi peluang dan duit kepada clinic swasta untuk menjadi ppv.
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Family dari johor dan kl balik beraya.
Raya ke 5: ibunya masuk ke hospital - > meninggal esoknya (covid +)
Raya ke 6: adik ibunya masuk, terus dimasukkan tiub pernafasan (covid+)
Raya ke 7: si isteri masuk ward
Anak-anak: kami beraya luar rumah sahaja doc.
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4 years back when I was a medical officer. After a tiring oncall, I left my laptop in the oncall room.
Asked my friend to keep the laptop safe. And this is what he did. Next day non stop people DM me for best price.
Best friend is the one who annoys you the most.
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I just told my friend who is in dermatology that I've lost a lot of hair previously when I lost 16 kg within 6 months. Tried a lot of shampoos and it isn't working.
But after I've stopped losing weight, no more hair fall.
He said this is called telogen effluvium.
Cont.
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There's a difference between being liked and being valued.
A lot of people like you
Not many value you
Be valued
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Today I was asked about vaccine and ivermectin from one of the patient in clinic.
1st question
Why KKM don't want to give ivermectin for patient?
Answer
Up to date there is no concrete data showing the effectiveness of ivermectin.
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We need to normalise banning people/celebrities who sell/promote smoking / vaping.
Say no to cigarettes smoking / vaping
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For Junior Doctors
Im oncall today, not a busy call, but can’t sleep don’t know why.
So how about I share a case I saw previously?
Have you ever heard of purple urine bag syndrome?
Follow this thread
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Saya cadangkan
@KKMPutrajaya
memberi anugerah prestasi cemerlang (APC) untuk staff-staff yang menjaga covid.
Ini akan meningkat semangat mereka untuk terus berkhidmat dengan cemerlang.
InsyaAllah
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Mengapa pengendali makanan wajib ada suntikan vaksinasi typhoid?
Penyakit typhoid merupakan penyakit yang serius dan boleh membawa kematian.
🧵
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Adakah anda tahu, kadar kematian adalah lebih tinggi selepas banjir dari semasa banjir? Penyakit utama adalah diarrhea (cirit birit).
Ianya selalu disebabkan oleh kontaminasi air oleh najis atau bekas penyimpanan air yang tidak bersih.
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Anda ada masalah kelemumur?
Banyak iklan shampoo di televisyen, tetapi tidak berkesan?
Rawatan apa yang terbaik?
Sila follow bebenang ini
#MedTweetMY
@MedTweetMYHQ
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2 years ago.
Ingt wahai suami, walaupun kita yang beli beras, isteri yang masak beras tu.
Outcome nasi yang telah dimasak bergantung kepada tukang masak 😉
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Tension headache
Ramai betul pesakit di luar sana mengatakan mereka ada migraine
Sakit kepala sikit migraine
Tetapi apabila doktor melakukan pemeriksaan, dikatakan bukan migraine
Apa itu tension headache?
Ikuti bebenang ini
#MedTweetMY
@MedTweetMYHQ
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Hari ni sepatutnya cuti, tapi offer diri sendiri kerja tolong kawan. Sbb apa?
- peratus pesakit positive covid naik 300% (di sari ward) (2 hari punya positive bahagi dengan nomal kes sebulan!!!)
Kenapa naik sampai 300% masa hari raya 🤔.?
Sbb ada yang balik beraya la kan?
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We are currently no 1!!!!
*The number of confirmed cases is lower than the actual number of actual cases, main reason is limited testing.
No need to argue with the clause, as India now people dying due to insufficient oxygen. Buying O2 is more important than doing the test.
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Kolesterol Tinggi dan Risikonya
Pentingnya cakna paras kolesterol anda.
Ini adalah bebenang 🧵....
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Apa khabar Pro ivermectin?
Negara kegemaran anda untuk menjadi rujukan (India Council of medical research) dah keluarkan ivermectin dalam garis panduan rawatan mereka. Katanya tiada keberkesanan terhadap covid 19.
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Bariatric surgery
Famous skrg prosedur ini. Sampai ada hospital mengatakan pembayaran berperingkat menggunakan KWSP.
Apa yang anda perlu tahu sblm melakukan bariatric pembedahan.
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Update
Pesakit ke 2: baru sahaja meninggal
3 anak tinggal bersama : +covid
Anak dari johor: +covid
Bukan nak menakutkan orang lain, saya mahu anda faham golongan yang berumur + tidak divaksin akan mendapat jangkitan covid yang sgt teruk - > kematian.
Family dari johor dan kl balik beraya.
Raya ke 5: ibunya masuk ke hospital - > meninggal esoknya (covid +)
Raya ke 6: adik ibunya masuk, terus dimasukkan tiub pernafasan (covid+)
Raya ke 7: si isteri masuk ward
Anak-anak: kami beraya luar rumah sahaja doc.
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For Junior Doctors
Do you really know how diabetic medications mechanism of action?
It is really important so that you know what to explain to the patient and thus making them more compliant towards their diabetic medications.
Follow this thread
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Bell`s Palsy VS Stroke
Do you have weakness one side of your face?
This thread is meant for both the junior doctors and non-medical side.
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COVID 19 info
Tidak semua pesakit COVID 19 bergejala. Dianggarkan 50% penyebaran virus ini adalah dari mereka yang tidak bergejala (carriers).
Jika anda ada kontak positive Covid-19
- masa terbaik melakukan ujian adalah pada hari ke 4->8
#KitaJagaKita
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Pesakit bipolar tidak sepatutnya mengambil ganja. Kalau nak tenang berjumpa dengan psychiatrist / psychotherapist untuk psychoeducation.
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Me: makcik sakit berapa lama sudah?
Makcik: laaaaamaaaaa sudah
Me: berapa lama?
Makcik: laaamaaaaa suuudaaahh
Me: Setahun
Makcik: 3 hari doc
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For Junior Doctors
Do you see many case of vertigo?
It is the most common case admitted under internal medical ward, with an improper diagnosis
So, do you really know how to assess vertigo?
Let us do some discussion shall we?
Follow this thread
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For junior doctors
How to Decide on anticoagulant for Atrial Fibrillation
Follow this steps
You need to calculate the CHA2DS-VASc score first
This is how you calculate a CHA2DS-VASc score
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For junior doctors
This is simplified version of antibiotic prescription.
Remember, before you prescribe antibiotic, make sure you know which organism you want to cover.
@MedTweet_MY
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87 years old man, labourer. Admitted under HKL for NSTEMI. Came to IJN today for a daycare angiogram.
In the first sentence, he told me " I have no money Dr, I work as a labourer. I can't afford treatment here" 😔.
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There is one doctor saying his team going to Intubate only young patients. Don't worry guys, doesn't matter how limited our resources is, we will make it work. Believe me. We always go as far as we can. Never play God.
Let me share you how far (my team) has go for one patient
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Restless leg Syndrome
Anda selalu rasa tidak selesa dengna kaki anda pada waktu malam?
Kalau tak gerakkan kaki rasa tak keruan?
Apa cara untuk mengatasinya?
Follow bebenang ini
@MedTweetMYHQ
#MedTweetmy
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Jom amalkan hidup sihat.
Adakah anda tahu setiap 1 kg berat badan yang hilang bersamaan dengan pengurangan 4 kg tekanan pada sendi lutut?
Saya sudah hilang 13.8 kg dalam 3 bulan 😉
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Me: puan, baby nampak tak berapa bagus, kita perlu buat pembedahan c-sec untuk mengeluarkan bayi. Perlu puasa dari sekarang ya puan.
Puan: mana boleh doc saya berpuasa. Saya bukan islam.
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Tanah perkuburan untuk mangsa covid 19.
Semoga roh mereka dicucuri rahmat.Tak semua yang meninggal adalah orang tua, yang muda pun ada.
Doakan PPV mega yang akan dilaksanakan akan meningatkan kadar pemberian vaksin di Malaysia.
@JKJAVMY
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Fun facts:
Siapa kita perlu Tanya:
1) bila nak lockdown
@KKMPutrajaya
❌
@MKNJPM
✅
2) Permanent Houseman post
@KKMPutrajaya
❌
@jpagov
✅
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Kenapa kita rasa sakit otot semasa bersenam?
Macam mana hendak merawat sakit otot selepas bersenam?
Follow bebenang ini
#DOMS
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Me: puan ajan(teran) skrg baby mau keluar sudah
Puan: Allahhuakhbar Allahhuakhbar
*azan terus, complete pula tu
*ajan= push
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For junior doctors
Have you ever heard of catamenial pneumothorax?
if yes, do you ever wonder why it is always happened on right side of the lung ?
interesting right?
I am sharing one case of catamenial penumothorax that ive managed in Pilah
follow this thread
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For Junior Doctors and Pharmacist
Today's topic will be about GOUT
We will be talking about the Purine metabolism first then we talk about medications involved in treating gout.
Remember, you need to know the pathophysiology
Follow this thread
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Mamak
Rice + chicken + vege : RM 6.50
Sandwich : RM 20.15
It is difficult to eat healthy if the price is expensive (most healthy food is expensive)
Regardless on how aggressive the health promotion is, if the price of fast food / mamak is cheaper, it is going to be difficult.
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For junior doctors
Fast algorithm on how to decide on diagnosis and treatment for acute coronary syndrome.
Remember history toking is important. Chest pain supposed to be cardiac in nature. Then proceed with ecg and troponin test.
STEMI don't need troponin test!!!
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Anda mempunyai sakit di bahagian tumit?
Paling teruk sakit apabila mula bangun pagi dan cuba berjalan?
Anda mungkin menghidapi plantar fasciitis
Ini adalah bebenang
#DrIs_Plantarfasciiitis
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Sedih rasanya dengan kontrak doktor ini.
Gaji rendah dari houseman
Job scope as medical officer
Semoga mereka tabah
Permata Yang Tidak Harus Dibuang
Seorang doktor muda
Hatta selesai kerja petangnya
Terduduk sedih di surau
Sebuah hospital tua
Tidak mahu pulang walaupun sudah maghrib
Wajahnya tunduk sedih
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@aditeehebat
Ye saya pun ada dengar tu
1. Isteri selalu betul
2. Kalau isteri salah, pergi ke arahan no 1
😂
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Posting kecemasan
Me: kenapa dtg jabatan kecemasan pukul 3 pagi ni?
Patient: nah ambil telephone ni, call wife saya, bgth jangan marah2 saya lagi. Saya stress.
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@tyiaaaaaaa
Darah beku di dalam jantung. Bahaya ni kalau terkeluar dari jantung. Boleh block Mana2 salye darah yang kecil.
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@nxjsbsglk
Mgkn jawapan betul makanan yang berkhasiat. X nak comment banyak sbb sy yang beli gula2 tu.
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7th question
How do I tell my friend who is antivax to take the vaccine
Answer
Malaysia already have the data. For all covid death in Malaysia, only 4 is vaccinated while 13073 is not vaccinated.
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Today's topic would be Hepatorenal syndrome (HRS)
Do you understand how it happened?
Best way to treat it?
Follow this thread
#MedTwitter
#medtweetmy
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For junior doctors and pharmacist
This is a simple diagram from
@escardio
Guideline on ACS regarding the mechanism of action of antiplatelet and anticoagulant.
Remember this !!!
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Serious question:
Can i put this achievement in my CV?
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If you are ever feeling sad, just go for a run. Because then you realized that your physical health is way worse than your mental health.
Good morning guys
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Exercise headaches
(Sakit kepala selepas bersenam)
Anda selalu sakit kepala selepas bersenam?
Sudakah anda berjumpa doktor mengenai sakit ini?
Sila follow bebenang ini
#MedTweetMY
@MedTweetMYHQ
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Pelbagai masalah untuk merealisasikan program vaksinasi di Malaysia.
Masalah utama yang kami hadapi skrg adalah pesakit berumur > 60 tahun yg setuju untuk divaksinasi tetapi tidak hadir kerana anak2 mereka melarang untuk mengambil vaksin.
Jadilah anak yang bertanggungjawab
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Sharing an interesting case
70 y.o lady with known case of HPT/Dm and dyslipidemia. Came with worsening shortess of breath and cough for one week duration.
No history of fever
What can you see from the chest xray?
Follow this thread
#MedTwitter
#MedTweetMY
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Adakah dengan berhenti merokok dan menggantikan dgn Vape lebih sihat?
Tidak, menurut American college of Cardiology
⬆️ 56% risiko serangan jantung
⬆️ 30% risiko stroke
⬆️ 10-44% pembentukan darah beku
⬆️ 2X risiko depressi/ anxiety / masalah emosi.
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Why propranolol is the b-blocker of choice for thyroid storm?
- non selective B1 and B2 blockade
- controls symptomatic tachycardia and tremors
- inhibit conversion of T4 - > T3
- without intrinsic symphatomimetic activity - > will not mimic thyrotoxicosis symptoms
EBM consult
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Me: makcik sakit apa?
Makcik: ada giuk ba tangan ni
Me: apa?
Makcik: giuk ba ini tangan
Me: giuk tu apa?
Makcik: sudah lama duduk sabah, giuk pun nda tau
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For junior doctors
let me share you one interesting ECG during my oncall last night
65 years old
- smoker
- came with typical cardiac pain
- vitals: normal
- examination : normal
- Trop i : not elevated
ECG as shown
What can you see?
@ecgrhythms
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2 years back in a mall i called my wife at 100 meters range "sayang".
5 person turned and looked at me including my wife.
3 of them is a guy 😉. Life is full of surprises.
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Anda ada Gastric?
Anda faham apa itu gastric dan cara merawatnya?
Follow bebenang ini
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Heart Failure Pathophysiology Made Easy with Its Core Treatment
Understanding heart failure pathophysiology is important as we will understand which system need to be inhibited / augmented.
I will be talking about heart failure reduced ejection fraction
Follow this thread
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For junior doctors
This case I have just saw in the clinic today. 30 y.o with history of HPT since 2018. In 2019 he has bilateral lens dislocation which is under opthal f/up.
He is currently considered as having resistant HPT (3 antihypertensive)
Diagnosis?
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30 years old Malaysian, chronic smoker referred for acute Central chest pain.
ECG showed St elevation anterior leads - > cath lab activated
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Bagus penjelasan doktor ini.
🔴 ivermectin akan berkumpul di bahagian usus, hanya sebahagian kecil memasuki darah
🔴 jika hendak mendapat effect untuk Covid, dose harus ⬆️ x90 dari dose biasa
🔴 ivermectin byk kesan sampingan
🔴 ivermectin membunuh covid in vitro (di luar bdn)
Satu penjelasan yang baik dan mudah difahami mengenai ivermectin. Isunya adalah dos dan bioavailability, boleh dengarkan.
Part 1
#COVID19
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Dengar staff nurse Passover di ward
"Patient anu tu, yang sakit anu tu ba, anu ba....anu itu"
Surprisingly anu is a multipurpose word in sandakan. And only them can interpret which "anu" are they referring to.
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It is a new record for
@MedTweetMYHQ
. 12 thousands listeners in space. Congratulation to
@khairul_hafidz
. You have perform very well.
I think all the listerners can now understand why vaccine is improtant.
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For junior doctors
Hypertrophic Obstructive Cardiomyopathy
It won't be a rare case if you know what to ask and how to proceed with necessary investigation.
#HOCM
#MedTweetMY
@MedTweetMYHQ
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Acute on Chronic liver Failure (ACLF)
Do you guys know the definition of:
- Decompensated cirrhosis
- Acute on Chronic liver failure
Proper definition will help you to know the prognosis of the patients
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For junior doctors
If you presenting to a specialist please don't just say "no high risk behavior", please explain more what is the risk that you were thinking pertaining to the case.
Even if I don't listen to my wife also considered as a very high risk behavior.
Take note.
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For junior doctors
Digoxin or Amiodarone in Fast AF ?
or how about beta blocker/ adenosine or verapamil
follow this thread
#MedTweetMY
@MedTweetMYHQ
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Apakah cara terbaik untuk mengelak dari jangkitan covid 19 yg serious?
✅Vaksinasi yang lengkap
✅makan makanan yang sihat
✅menjaga paras gula dan darah tinggi untuk pesakit diabetes dan hypertensi
✅sentiasa bersenam
✅Obesity = ⬇️ berat badan
🚫Vitamin C
🚫Ivermectin
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For Junior Doctors
Do you guys know that melioidosis can mimic tuberculosis?
Ever get case where blood culture grew melioidosis and sputum AFB positive?
How to decide which infection is the patient is having?
Follow this thread.
@MedTweetMYHQ
#MedTweetMY
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Ada mengalami sakit dipergelangan tangan?
Semakin teruk apabila menaip atau menulis?
Anda mungkin menghidapi masalah carpal tunnel syndrome
Follow bebenang ini
#Dris_carpaltunnelsyndrome
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Ada 8 org duduk Satu pejabat. Seorang staff, suami ada contact dgn covid+. Suami kuarantin, si isteri masih bekerja.
Lepas 3 hari, si isteri demam, result suami keluar +, isteri check +. Staff lain check 5 org +. Salah sorg menangis takut parent yg tua +.
Bermula dgn sorg...
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In your working line, what you dislike the most?
Me:
Mother or father talking to their naughty kids "tgk tu Dr, nanti Dr cucuk awak kalau degil"
Memberi gambaran kepada budak Dr ini jahat orangnya.
Mmg hilang mood la nak kerja bila terjumpa parent mcm ni.
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Pening baca ni.
Lagi elok duit ni digunakan untuk membayar sukarelawan perubatan. Mmg kajian menunjukkan program sanitasi seperti ini tidak bermanfaat dalam melawan covid 19.
Dalam kita berkata negara tiada duit, kita masih membazir
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For junior doctors
Liver abscess.
When to drain? Do we need to try antibiotic first, then repeat imaging?
Abscess < 3-5 cm and high risk for drainage, can try antibiotics for 4-6 weeks and repeat imaging
Abscess >5 cm, surgical drainage
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Have you seen a lot of diabetic foot ulcer?
You have managed it for months, and still the ulcer is not improving? And sometimes the ulcer becoming worse.
What other options we have to make our patients recover?
Follow this thread
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Automated External Defibrillator (AED)
As we all know a good and quality CPR does improve survival chances for the patient. However there is another device that is vital in augmenting the success rate of reviving patient with sudden cardiac arrest. It is called AED
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