serotonergic disorder? a type of headache

MIGRAINE WITHOUT AURA

-Recurrent headache 

-Manifesting in attacks lasting 4–72 hours

-Characteristics:-

1) unilateral location, 

2) pulsating quality, 

3) moderate or severe intensity, 

4) aggravation by routine physical activity 

5) nausea 

6) photophobia /phonophobia.

Diagnostic criteria:

A. At least five attacks fulfilling criteria B-D

B. Headache attacks lasting 4-72 hours [when untreated]

C. Headache has at least two of the following characteristics:

1. unilateral location

2. pulsating quality

3. moderate or severe pain intensity

4. aggravation by or causing avoidance of routine physical activity...

D. During the headache at least one of the following:

1. Nausea and/or vomiting

2. Photophobia and phonophobia

E. Not attributed to another disorder

Signs & symptoms vary from one patient to another.

It is divided into 4 phases : - 

1) Prodromal  phase 

2) May be associated with aura

3) PAINFUL phase

4) Postdromal phase

reference:-

Headache Classification Subcommittee of the International Headache Society (2004). "The International Classification of Headache Disorders: 2nd edition". Cephalalgia : an international journal of headache 24 Suppl 1: 9–160.

QUIZ 1

What is your diagnosis?

Summary:

Patient is a 10 year-old boy presented with fever 3 days and diffuse, general erythematous reticular lesions 2days duration. No history of sore throat or streptococcal infection.

Faget sign by Jean-Charles Faget

fever + bradycardia = Faget Sign

F - Fever (Yellow / Colorado Tick)

A - abortus brucellosis (Mediterranean Fever)

G - Gram negative bacillus (Legionella pneumophila)

E - Extracellular parasites attaches to Epithelial cells, treat with EES ( Mycoplasma infection)

T - Typhoid Fever/ Tularaemia

Are you troubled with Passenger Car engine oil leak

normally it is caused by degenerated / hardened seals or gaskets

Troubleshoot the followings:-

1) distributor,

2) camshaft 

3) crankshaft (on the pulley and the GB side),

4) crankcase (also known oil sump) and 

5) cylinder head

Notez:

Following is the spec for wira 1.5A year 2003

Engine model 4G15P
Displacement, cc 1468
Max.power (Net), kw(PS)/rpm 91 ps (66.93 kw) / 6000 rpm
Max.torque(Net), N*m(kg*m)/rpm 12.4 kg*m (121.60 N*m) / 3000 rpm
Power density 9.01
Engine type Serial 4 cylinder SOHC12 valve
Engine information MVV
Fuel system ECI multiple
Turbocharger No
Fuel type Unleaded regular gasoline
LEV system (Low emission vehicle) No
Compression ratio 9.4
Bore, mm 75.5
Stroke, mm 82
Fuel consumption at 10-15 modes, l/100km 4.7

NEW VIRUS FOUND - CREDIT CRISIS ETIOLOGY

Virus Name: SubPrime Mortgage (SPM)

Mode of transmission: predominantly through financial systems namely it is transmitted from bank to another bank. 

Vector: Housing Boom + Consumer Spending

Pathogenesis:-

1) Booming of the housing REIT

2) Lower interest rate

3) Higher consumer expenditure

4) Subprime lending 

5) Banks sell credit risks to investors through securitization process. Investors called it Mortgage Backed Securities (MBS) and Collateralized Debt Obligations (CDO)

6) Risks involved include credit risk, asset price risk, liquidity risk & counterparty risk. 

Clinical pictures: 

1) sub acute presentation

2) when subprime occurs, 

3) lack of liquidity in the market, 

4) money locked-in papers / bad debts

5) unable to liquidate asset 

6) cascading series of consequential credit crunch impacts

Investigation:

1) reassess your own credit status

2) get rid of bad debt

3) increase in liquidity (% investment lock in = 100 minus age, the rest keep in liquidity)

4) opportunities in crisis (buy discounted stocks)

Treatment/ Prevention: 

1) personal financial planning crucial step for prevention

2) understanding bad debt vs good debt

3) strong financial sheet

4) never greed is a good way to prevent

References:

1) http://en.wikipedia.org/wiki/Subprime_mortgage_crisis

2)

http://www.nypost.com/seven/10132008/postopinion/opedcolumnists/spreading_the_virus_133375.htm

3) http://bayareahousingreview.com/2007/08/08/the-subprime-mortgage-virus-has-spread/

4) http://www.tigersharktrading.com/articles/9361/1/The-Subprime-Virus/Page1.html

Notez:-

1) When bad debt goes systemic, it affects non financial sector. THENCE the BIG R (Recession) crawls or jumped in

2) When US having coughs, the whole world gets the flu

3) Few issues here includes: saving our faces vs letting the nature take its course and learn from mistake vs do it right the first time

4) Can we contain this contagious virus?

5) Is there exact treatment for this virus? ie injection of USD700bil bail out will actually works?

6) Can we actually dissociate our economy from the world biggest consumer? 

7) Disclaimer: the above pathogenesis may be totally wrong keeping in view i am no expert in finance or economy. But these are the info i got it from the references.

CAR ENERGY EFFICIENCY - SAVING THE PENNIES

YOKOHAMA DNA EARTH 1

intelligent Dual and Sequential Ignition (i-DSI) engine

Diagram above showed car energy distribution

http://www.fueleconomy.gov/FEG/atv.shtml

1) AERODYNAMICS - DRAG COEFFICIENT

-Smoother vehicle shapes have already reduced drag significantly, but further reductions of 20-30% are possible.

2) AIR FUEL RATIO (AFR) = MAGIC FIGURE IS 14.7 TO 1

LESS THAN 14.7 TO 1 = RICH MIXTURE

MORE THAN 14.7 TO 1 = LEAN MIXTURE

in Naturally aspirated engines (powered by octane) Max power with AFR ranging 12.5 to 13.3

The main drawback of lean burning is the large amount of NOx being generated at relatively high air/fuel ratios.

CHOOSE the engine with lean burning potential.

3) LOWERING ROLLING RESISTANCE TIRE 

IDEALLY = smooth ride, minimize noise, & good traction in a variety of weather conditions. 

But they are rarely optimized for efficiency. Tires can cause a sginificant amount of drag while driving. Therefore in Hybrid cars, special tires that are stiffer and inflated to a higher pressure than conventional tires. The result is that they cause about half the drag of regular tires.

4) WINDOWS UP vs DOWN

Studies showed that low velocity, window down improve fuel efficiency

However, driving at high velocity (>90km/h), window up is better than window down due to aerodynamics and drag coefficient.

5) START STOP SYSTEM (integrated starter/generator)

Helps to cut energy loss during traffic jams. Stop the engine when brake is pressed, restarting it instantaneously when the accelerator is pressed.

Currently it is used in Volkswagen, BMW & Citroën models.

Toyota and Mazda will be introducing stop-start technology in 2009 year model.

Renault will introduce the technology in all of its European models by 2010.

6) DRIVELINE LOSSES

- Energy is lost in the transmission and other parts of the driveline. Technologies, such as automated manual transmission (AMT) and continuously variable transmission (CVT), are being developed to reduce these losses.

7) USE LIGHT WEIGHT MATERIALS

- Reducing the overall weight of a car is one easy way to increase the mileage.

Composite materials like carbon fiber or lightweight metals like aluminum and magnesium can be used to reduce weight.

Reference:-

1) http://auto.howstuffworks.com/ten-green-driving-tips.htm

2) http://en.wikipedia.org/wiki/Lean_burn

3) http://www.bkkautos.com/2009-Honda-City-Chalks-Up-4500-Sales-in-2-Weeks

4) http://en.wikipedia.org/wiki/Start-stop_system

5) http://www.fueleconomy.gov/FEG/tech_adv.shtml

6) http://en.wikipedia.org/wiki/Honda_L_engine

7) http://www.ukipme.com/engineoftheyear/

NOTES:-

1) 62% of the fuel's energy is lost in the internal combustion engine (ICE)

2) ICE engines are very inefficient at converting the fuel's chemical energy to mechanical energy, losing energy to engine friction, pumping air into and out of the engine, and wasted heat.

3) diesels are about 30-35% more efficient than gasoline engines, and new advances in diesel technologies and fuels are making these vehicles more attractive.

4) Honda’s new Advanced VTEC (AVTEC) engine combines continuously variable valve lift and timing control with the continuously variable phase control of valve timing to achieve a good combination of better performance, fuel economy, and lower emissions.

5) Conventionally, one spark plug per cylinder but the i-DSI engine uses a radical twin-spark ignition system with just two valves per cylinder.

6) At lower velocity, spark plug nearest the inlet valve is fired much earlier than usual while the plug nearest the exhaust valve is fired later than usual.

7) At higher velocity, the sparks are fired simultaneously.In a normal engine, fuel and air enters the cylinder of an engine through the inlet valve, designers concentrate on optimizing the swirl of the mixture to ensure fuel is atomized thoroughly and evenly.

8) The 1NZ-FXE Hybrid Synergy Drive in the Toyota Prius has won several International Engine of the Year awards

9) 1NZ-FXE based on Atkinson cycle rather than the conventional Otto cycle.

10) Michelin XM1 vs Yokohama DNA EARTH 1 - which one better???

Children Learning Disability - dyslexia

\dis-ˈlek-sē-ə\ 

definition = a variable often familial learning disability involving difficulties in acquiring and processing language that is typically manifested by a lack of proficiency in reading, spelling, and writing 1

Signs: 2

a) Pre-school

-persistently jumble up phrases

-later than expected speech development

-substitute words

-difficulty of learning nursery rhyme

-unable to remember objects

-walked early but did not crawl

-not paying attention

-difficulty of catching balls

-difficulty of clapping hands

b) Primary school age.

-difficulty with reading and spelling

-putting letters and figures the wrong way round

-difficulty in memories

-occasionally confuses 'b' and 'd' and words such as 'no/on'.

-use fingers or marks on paper to make simple calculations.

-Poor concentration.

-understanding problems

-takes longer than average to do written work.

-problems processing language at speed.

-difficulty with tying shoe laces, tie, dressing.

-difficulty telling left from right, order of days of the week, months of the year etc.

-poor sense of direction and still confuses left and right.

-lacks confidence and has a poor self image.

c) 12 or over.

-reads inaccurately

-difficulties in spelling.

-Gets 'tied up' using long words, e.g. 'preliminary', 'philosophical'.

-Confuses places, times, dates.

-difficulty processing complex language or long series of instructions at speed.

-poor confidence and self-esteem

Types:

1. Surface dyslexia
   
2. Phonological dyslexia
   
3. Double deficit dyslexia

Evaluation:3

-reading ability testing

-tests of rapid naming, 

-short term memory evaluation 

-sequencing skills

-nonword reading to evaluate phonological coding skills. 

-IQ test (identify learning strengths and weaknesses)

-vision and hearing testing

...................................................................................................................................

Management:

*The Dore programme, previously known as DDAT (Dyslexia Dyspraxia Attention Treatment) is a drug-free course of treatment for dyslexia and other learning difficulties4

*Treatment programs for dyslexic children fall into three general categories: 5

a)developmental - the child needs extra time & attention

b)corrective - small groups in tutorial sessions,emphasizes child's assets and interests

c)remedial - resolve the specific educational and psychological problems that interfere with learning.

*Multisensory approach

*Rewiring Dyslexic Children's Brains Using Sound Training6

References:-

1 http://medical.merriam-webster.com/medical/dyslexia

2 http://www.bda-dyslexia.org.uk/

3 http://en.wikipedia.org/wiki/Dyslexia

4 http://en.wikipedia.org/wiki/Dore_(dyslexia_treatment)

5 http://www.healthscout.com/ency/68/267/main.html#cont

6 http://www.medicalnewstoday.com/articles/87170.php

Notez:

1\ Is there any role of low dose benzodiazepine?

2\ Is there any role of piracetam (nootropil) for dyslexic?

3\ Is there any role of ginkgo biloba for dyslexia?

4\ Dyslexia is four times more common in boys than it is among girls.

5\ Although the condition is known to be hereditary, there is no consensus among scientists about the exact cause.

6\ It is linked to a "cerebellar deficit".

7\ Dyslexia is linked to reduced activity in a primitive part of the brain that controls movement, co-ordination and balance, scientists have claimed.

New Paradigm of CardioMetabolic Syndrome - Mother of all diseases

FIGURES: VICIOUS CYCLE OF CARDIO-METABOLIC SYNDROME

HOW'S YOUR MEASUREMENT?

OBESITY: waist circumference > 40 inches men

    waist circumference > 35 inches in women

LDL > 2.6mmol/L

HDL <>

TG > 1.9mmol/L

Blood Pressure >130/90 mmHg

Fasting Blood Sugar > 6.1mmol/L

............................................................................................................................

INTERVENTIONS?

1) LIFESTYLE MODIFICATIONS

-STOP SMOKING

-EXERCISE, EXERCISE, EXERCISE

-MORE VEGE LESS RED MEAT

-LESS SUGAR

-LESS FAT

-LESS SALT

2) ROLE OF ANTIHYPERTENSIVE

-ESPECIALLY RAS BLOCKADE (IE ACE INHIBITOR, ARB, CCB)

-?DIURETICS INCRESES RISK OF DIABETES ONSET?

3) LIPID LOWERING DRUGS

-FIBRATES & NICOTINIC ACID FOR HIGH TG

-STATINS FOR THE REST

-EXERCISE FOR HDL :-) ops not a drug its a STYLE OF LIFE

4) INSULIN SENSITISER

-METFORMIN, ACARBOSE, THIAZOLIDINDIONES

-?ROSIGLITAZONE ON CARDIAC OUTCOME

5) ANTIOBESITY DRUGS

-SIBUTRAMINE (affecting monoaminergic system)

- ORLISTAT (gastrointestinal pancreatic lipase inhibitor)

- RIMONABANT (endocannabinioid, CB1 receptor antagonist)

6) ANTITHROMBOTIC DRUGS

-insulin resistance promotes pro-thrombotic states (coagulation vs fibrinolysis system)

-LOW DOSE ASPIRIN / CLOPIDOGREL

7) ?ANTI-INFLAMMATORY DRUGS

-insulin resistance recognised as inflammatory disease

-CRP + PLASMINOGEN ACTIVATOR INHIBITOR 1 & IL-6 HIGH CONCENTRATION

references:

1) DASH TRIALS

2) MEDITERRANEAN DIET

3) ATP III GUIDELINES & IDF GUIDELINES

4) ESH/ESC GUIDELINES

5) ASCOT TRIAL

6) The Rimonabant In Obesity (RIO) program

7) ATHEROGENIC DIET

NOTES:-

1) PREDIABETES STATE

2) AN APPLE A DAY KEEPS YOUR DOC AWAY STILL HOLDS TRUE

3) TO TACKLE THIS MOTHER OF ALL DISEASE IS TO KEEP YOUR BUTT OFF YOUR CHAIR/ COUCH

4) CUT DOWN ON SIMPLE CARBOHYDRATE/ FATTY FRIED FOOD

CRYPTIC DISEASE - DENGUE HEMORRHAGIC FEVER (DHF)/ DENGUE SHOCK SYNDROME(DSS)

Exact pathogenesis is not known

Clinical manifestations 

-severe thrombocytopenia, vascular leakage, and hepatomegaly.

Immunologically:

-4 serotypes, DENV1, DENV2, DENV3, DENV4

-each serotypes has its own antigenic character (induces a different antibody against each type)

-Infection by one serotype will give lifelong immunity against the same serotypes of virus but not other serotype

ANTIBODY DEPENDENT ENHANCEMENT (ADE) effect 

-antibodies raised against one serotype will provide us protection for future infections of the same serotype but induces a massive immune response for different serotype infection

DENGUE VIRUS NON-STRUCTURAL PROTEIN 1 (DENV NS 1)

-Antibodies directed against DENV NS 1 showed cross-reactivity with human platelets and endothelial cells

-this lead to platelet and endothelial cell damage, inflammatory response and abnormal immune responses caused by DEN infection, including cytokine and chemokine production (TNF-a, IL-6, IL-8, and RANTES), complement activation and immune cell activation. 

-hypothesize that anti-DV NS1 is involved in the pathogenesis of DF and DHF/DSS, and this may provide important information in dengue vaccine development

Progression of DHF/DSS

1)effect of virus load

2)virus variation, 

3)abnormal immune responses of the host after DV infection may also account for the progression of DHF/DSS.

Persistent thrombocytopenia post DF hypothesis

a) Dengue virus induces bone marrow suppression

(b) Dengue virus can bind to human platelets in presence of virus specific antibody

and immune mediated clearance of platelets

(c) Spontaneous aggregation of platelets to vascular endothelial cell pre-infected by virus inducing aggregation, lysis and platelet destruction

(d) Anti-platelet antibodies generated after dengue virus infection causes destruction of platelets

References:-

1. http://www.searo.who.int/en/Section10/Section332/Section1985_9826.htm dengue vaccine 
2. http://www.unimas.my/research/ihcm/ihcm_dengue.htm
   
3. http://www.searo.who.int/en/Section10/Section332/Section1985_9804.htm
   
4. http://www.ajtmh.org/cgi/content/full/72/4/370
   

boon or bane - The Credit Story

1) The ability to build saving helps you to build HIGH SELF NET-WORTH

2) Identify areas to cut for more savings

-bills (water/ electricity/ petrol/ mobile phone)

-credit cards

-hire purchase loans (interest rate advertised = fixed, no rest basis)

*Rule of thumb, to obtain the True Effective Annual rate, you need to Double the advertised rate and add one to it*

3) The discipline to save can check overspending in other areas. Always keep the ultimate financial goal in mind in order to avoid being swayed by temptation and overspending on the little things.

4) Understand the difference between the need and wants

5) Wise credit management falls on fundamental, knows the difference between a good debt and bad debt.

6) Principle of sound utilisation of credit remains the same, if debt is used to fund consumptive behaviour it will destroy lives ie credit crisis 08

7) If debt is used to build a business or buy appreciating assets it can be a heaven sent boon

8) It it not wise to get into a debt situation over a depreciating asset

9) Identify what is assset and what is liabilities

10) If people is aware of the charges they are paying they would be more careful about the credit they are taking on.

Reference:-

1) Personal Money issue #49 September 2005.

Notes:-

1) if you can hardly get by because you own two or three cars, that's bad. If you can hardly get by because you own three houses, you can always sell off one house.

2) for credit card holders, identify the purpose of your card and stay focused. If its for payment purposes so that you dont have to carry so much cash around, that's fine.

3) Credit card could also be used for emergencies

Financial Freedom

In the quest for the path to financial freedom is almost equivalent to the Zhifu islander Xu Fu with ships carrying hundreds of young men and women in search of Mount Penglai, around 200BC where the Eight Immortals lived in order to sought the fabled elixir of life.

There is no proper definition of financial freedom as far as i am concern in dictionary. However, Suze Orman coined this term in her book "The 9 Steps to Financial Freedom", her definition of financial freedom is "when you have power over your fears and anxieties instead of the other way around."

Nonetheless, others define financial freedom as monthly expenses are equal to our passive income. No matter how we define the word FINANCIAL FREEDOM, the most important thing is PROPER FINANCIAL PLANNING with DEBT FREEDOM and FINANCIAL INDEPENDENCE. Hence, you are FREE to do anything (aka TIME FREEDOM). Its a paradigm shift in our mindset with different point of view on GOOD QUALITY OF LIFE WITHOUT financial worries.

I am not talking about being born into a family of HIGH NET WORTH INDIVIDUAL (HNWI) - INHERITANCE of WEALTH.

In this article, i am sharing my ideas on utilizing personal financial planning to achieve "financial freedom." 

Is it possible for us to achieve our financial freedom eventhough we are on steady source of active income? 

Is it a myth? 

Is it achievable?

Can i sit at home and do nothing but earning USD 10, 000 a month?

Can i trade my way to financial freedom with stocks?

There are so many questions and doubts keep baffling with our mind. Therefore i wish to clear some doubts from a non-financial expert eye.

MYTH:

1) freedom to do anything including spending money lavishly and living in a posh service condo/ bangalows with heated swimming pool and jacuzzi

2) swiping my plastic CREDIT card like no body biz

3) no need to put in effort for passive income

4) spend as if like doom's day coming soon

5) no need to learn the meaning of "FRUGALITY"

REALITY:

1) Freedom to arrange our time for active income based on our priority
2) FRUGALITY is still the keyword for WEALTH PRESERVATION

3) PRIORITIZE our expenses

4) Utilizing EXISTING MONEY TO REPRODUCE MORE MONEY (a.k.a INVESTMENT)

5) ALWAYS REBALANCING your PASSIVE INCOME PORTFOLIO (STOCK investing, UNIT TRUST, REAL ESTATE INVESTMENT TRUST, BONDS, PROPERTIES etc)

well, well much said about the myth versus the reality of financial freedom.

Can we achieve it?

Like what i mentioned just now, it is no easy task by just developing the desire to reach the destination called "financial freedom" but the journey to achieve financial freedom requires a lot planning and thinking in advance (let say 30 to 40years in advance) and wealth preservation.

It is Never Too Late nor 

It is Never too Early to Start to PLANNING FOR PERSONAL FINANCE.

In order to plan your finance, either you can hire a certified financial planner (CFP) or DIY.

IMHO, i personally prefers DIY FINANCIAL PLANNING

Steps for Financial Planning

1) Identify our NET WORTH and ESTIMATED PERSONAL NET WORTH

[years to retire X (Annual income minus estimated Annual expenditure)]

2) Define your personal FINANCIAL GOALS 

3) Prioritize them into 

[SHORT TERM] - buying a laptop/ XBOX/ shoes/ watches

[MEDIUM TERM] - buying a car/ hi fi system/ LCD-HD

[LONG TERM] - buying a house/ retirement funding/ children education funding

4) Debt Settlement, Consolidation and Management

-Debt consolidation basically means taking up one loan to pay off another loan with lower interest rate/ fixed rate or convenience by servicing one loan

-Normally, debt consolidation normally involved payment of a number of unsecured loan against an asset that serves as collateral most commonly a house.

-Theoretically it is suitable to pay off credit card loans

5) Retirement planning

-EPF (one thing for sure is that, EPF is not gonna be enough for this time and day retirement, mainly due to high inflation with low returns)

-Even in the EPF website, it is mentioned that EPF initiative to help improve the employment prospects of members above the age of 55 and to enhance financial security of all members upon retirement (some sense of financial security but not financial freedom)

6) Intelligent portfolio management (rebalancing investment based on economy status)

investment vehicles includes: 

-saving account

-fixed deposit

-bonds

-mutual funds

-equities

-properties

-collectible

In the upcoming blog, i will focus on each individual steps mentioned above.

Reference:-

1 Suze Orman. The 9 Steps to Financial Freedom

2 http://en.wikipedia.org/wiki/Security_(finance)

3 http://en.wikipedia.org/wiki/Debt_consolidation

Notes:-

Wealth derives from the old English word "weal", which means "well-being.

The term was originally an adjective to describe the possession of great qualities.

Before Financial Freedom was popularised, Financial Independence and Financial Security were the terms used commonly.

"Financial freedom" is not a comprehensive terminology as being wealth is nothing without health. As we will spend all the money we earn to pay to maintain our health.

======================================

Financial planning + passive income = Debt Freedom 

Debt Freedom + Time Freedom = Financial Freedom 

Financial Freedom = Good Quality of Life

Can i conclude 

Financial Planning + Health = Good Quality of life?

======================================

Is it a illusion equation? or more of a logical equation?

well there is not exact delineation of black and white in life. 

There is always grey area where we are not certain. 

There are 2 certain things in life, DEATH & TAXES!

Malaysians Pay Higher Interest Rate (hire purchase)

Saw this in today's paper TheStar, 28th September 2008

Dont really know what to say, nightmare ?

Coupled with higher consumer price index (CPI) as well as higher Petrol price

quality of life will dropped due to current economic situation, STAGFLATION!

Reference:-

http://thestar.com.my/news/story.asp?file=/2008/9/28/nation/2142760&sec=nation

Wise Words - Warren Buffet

Price is what you pay. Value is what you get. 

Risk comes from not knowing what you're doing. 

Rule No.1: Never lose money. Rule No.2: Never forget rule No.1. 

The business schools reward difficult complex behavior more than simple behavior, but simple behavior is more effective. 

The investor of today does not profit from yesterday's growth. 

The only time to buy these is on a day with no "y" in it. 

Time is the friend of the wonderful company, the enemy of the mediocre. 

Value is what you get. 

We simply attempt to be fearful when others are greedy and to be greedy only when others are fearful. 

Why not invest your assets in the companies you really like? As Mae West said, "Too much of a good thing can be wonderful". 

Wide diversification is only required when investors do not understand what they are doing. 

You do things when the opportunities come along. I've had periods in my life when I've had a bundle of ideas come along, and I've had long dry spells. If I get an idea next week, I'll do something. If not, I won't do a damn thing. 

You only have to do a very few things right in your life so long as you don't do too many things wrong. 

reference:

www.brainyquote.com/quotes/authors/w/warren_buffett.html

“The most powerful force in the universe is compound interest”

Owning a house is everybody's DREAM

BUT the process of owning one is NOT AN EASY TASK

keywords:-

• lots of delayed gratification
• savings
• frugal living
• over time
• part time job

House Prices is NOT CHEAP NOWADAYS

EVEN with RM100,000 downpayment for a RM400,000 semi-Detached house in Selangor will make us toil our precious sweats out for 2 decades or 3 decades

the difference is as follows:

OPS even after paying 2 decades or 3 decades, at term, we still owes bank RM169 ,000 and RM 243,000.

Whereas in FIXED DEPOSIT bank pays us around 3.7% maximum for p.a.

Isnt it compounded interest is the most powerful force in the universe? Attracting everybody's money to the bank.

Thats how the banks make monies right. They are not charity centres.

Therefore, financial planning is of utmost importance as a working adult.

reference:-

http://www.vertex42.com/Calculators/Canadian-mortgage.html

40 keyWORDS To SAVE GAS

][wAys 2 d3aL wItH RiSiNg FuEl PrIc3][

][carpool][public transport][NGV conversion][fuel efficiency][low rolling resistance][aerodynamic drag][unnecessary travel][walking][bicycling][lower loads][off air cond][vvti][vtec][idsi][reduce trips][fueling early hours][stop idling][better lubricant][regular servicing][constant speed][auto cruise][premium fuel][fuel addictive][microcompressor][fuel stabilizer][well inflated tyre][avoid hitting brake unnecessarily][low drag coefficient][40km/h][50km/h][fuel injection][avoid rush hour][credit card rebate][bonus points][no zooming][no high revving][plan your trip][off roof rack][wind up window high speed][online banking][online shopping][

CHIKV

Recently, we have heard about Chikungunya fever outbreak in malaysia. 136 people tested positive for CHIKV from the 631 cases detected at 20 localities in Johor, Malacca, Negri Sembilan and Perak.

Chikungunya virus

-insect-borne virus (Aedes aegypti mosquitoes)

-Alphavirus genus

-symptoms are quite similar to dengue virus fever

• Fever 2 to 5days
  
• The temperature may remit for 1-2 days, resulting in a "saddle-back" fever curve.
  
• prolonged arthralgia of extremities (not so much of larger joints), often polyarticular and migratory in nature
  
• maculopapular rash may or may not be present 
  
• other symptoms includes headache, conjunctival injection, and slight photophobia
  

Common laboratory tests for chikungunya include:-

1) RT-PCR(result is ready in 1-2 days), 

2) virus isolation (result is ready in 1-2 weeks), and 

3) serological tests (Result is ready 2-3 days but with false positive ie O'nyong'nyong virus and Semliki Forest Virus)

Treatment:

1) supportive

2) Vaccine in Phase II trial 

3) Chloroquine phosphate (250 mg/day)

Prevention

1) insect repellents

2) wears a long sleeves and long pants

3) garments can be treated with pyrethroids

4) mosquito coils

5) screens the windows and doors

6) keep surrounding clean (minus the empty cans/ tyre/ container - breeding ground for aedes moquitoes)

References:

1) Chikungunya cases escalate, TheStar, Thursday July 31, 2008.

http://thestar.com.my/news/story.asp?file=/2008/7/31/nation/21964401&sec=nation

2) http://www.myhealth.gov.my/myhealth/eng/dewasa_content.jsp?lang=dewasa&sub=0&bhs=may&storyid=1193386725877

3) http://www.smtbd.com/products.html

4) OnSite Rapid Test for the detection of Chikungunya Fever http://www.ctkbiotech.com/Default.aspx?tabid=118

5) www.dph.gov.my/survelans/Guidelines%202006/SURVEILLANCE%20AND%20MANAGEMENT%20OF%20CHIKUNGUNYA%20DISEASE.pdf

 

6) Edelman, R et al. "Phase II Safety and Immunogenicity Study of Live Chikungunya Vrirus Vaccine TSI-GSD-218", American Journal of Tropical Medicine and Hygiene 62 (6): 681–685.

7) http://www.vadscorner.com/alphaviruses.html

Notes:

Chikungunya means "that which bends up" description for the classical clinical presentation of these patients due to generalised joint pain that is not relieved by NSAID nor Aspirin.

Further information can be obtained from the ministry’s website, www.moh.gov.my or call +603-88810600/0700 during office hours.

Pneumococcal vaccine

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Questions:-

1) What is pneumoccoal disease?

2) Who should be vaccinated with pneumococcal vaccine?

3) Pneumococcal vaccine timing explained

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Pneumococcal Disease (PnD) manifestations includes:-

- meningitis (infection of the lepto-meninges, covering of the brain)

- middle ear infection

- pneumonia (lung infection)

- sepsis (bacteria in the blood-stream)

Mode of transmission: air droplets via cough or sneezing

Children below 24 months old is at the highest risk of these infection

Around 60% of the preschool children is carrying this bacteria and transmission of this bacteria become imminent when they goes to day care centre.

Therefore, these group target group for pneumoccal vaccination:-

1 extreme ages (<> 65 years-old)

2 individuals with chronic disease (diabetes mellitus, heart disease, chronic obstructive lung disease, alcoholism)

3 individuals with spleen removed (2weeks before splenectomy)

4 individuals had organ transplantation and on immunosuppression

Vaccination timing:~

reference:

a) http://www.azdhs.gov/phs/oids/abx/images/prevnar.pdf

b) http://www.merck.com/product/usa/pi_circulars/p/pneumovax_23/pneumovax_pi.pdf

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Notes:

1) 1 dose = 0.5ml intramuscular/ subcutaneous injection

2) PREVNAR = heptavalent pneumococcal conjugate vaccine (PCV7)

3) PNEUMOVAX 23 = 23-valent pneumococcal polysaccharide (23PS)

4) for adults, only 1 dose is required. However may need to be repeated 5 to 10 years time.

5) following vaccination, serotype-specific antibody levels decline after 5-10 years.

6) Efficacy in immunocompetence individual is around 50 to 80%

7) PNEUMOVAX 23 may not be effective in preventing pneumococcal meningitis in patients who have chronic cerebrospinal fluid (CSF) leakage resulting from congenital lesions, skull fractures, or neurosurgical procedures.

Questions and Answers on melamine

WHAT IS MELAMINE?

Melamine is an organic base chemical most commonly found in the form of white crystals rich in nitrogen

WHAT IS MELAMINE GENERALLY USED FOR?

Melamine is widely used in plastics, adhesives, countertops, dishware, whiteboards and fertilizers.

WHY WAS MELAMINE ADDED INTO MILK AND POWDERED INFANT FORMULA

In China, where adulteration has occurred, water has been added to raw milk to increase its volume. As a result of this dilution the milk has a lower protein concentration. Companies using the milk for further production (e.g. of powdered infant formula) normally check the protein level through a test measuring nitrogen content. The addition of melamine increases the nitrogen content of the milk and therefore its apparent protein content.

Addition of melamine into food is not approved by the FAO/WHO Codex Alimentarius (food standard commission), or by any national authorities.

HAS MELAMINE BEEN FOUND IN OTHER FOOD PRODUCTS?

In 2007, melamine was found in wheat gluten and rice protein concentrate exported from China and used in the manufacture of pet food in the United States. This caused the death of a large number of dogs and cats due to kidney failure.

In the present event, melamine contamination has been found in a number of different brands of powdered infant formula, in one brand of a frozen yogurt dessert and in one brand of canned coffee drink. All these products were most probably manufactured using ingredients made from melamine-contaminated milk.

WHAT ARE THE HEALTH EFFECTS OF MELAMINE CONSUMPTIONS IN HUMANS?

While there are no direct human studies on the effect of melamine data from animal studies can be used to predict adverse health effects. Melamine alone causes bladder stones in animal tests. When combined with cyanuric acid, which may also be present in melamine powder, melamine can form crystals that can give rise to kidney stones.

These small crystals can also block the small tubes in the kidney potentially stopping the production of urine, causing kidney failure and, in some cases, death. Melamine has also been shown to have carcinogenic effects in animals in certain circumstances, but there is insufficient evidence to make a judgment on carcinogenic risk in humans.

WHAT ARE THE SYMPTOMS AND SIGNS OF MELAMINE POISONING?

Irritability, 

blood in urine, 

little or no urine, 

signs of kidney infection, 

high blood pressure

WHAT IS THE TREATMENT FOR KIDNEY STONES AND KIDNEY FAILURE?

Patients may receive various types of treatment, depending on the severity of the kidney effects. Treatment may include :-

-infusion of fluids and urine alkalinisation, 

-correction of electrolyte and acid-base disturbance, 

-haemodialysis or peritoneal dialysis, or 

-surgical removal of kidney stones.

Reference:-

1) www.moh.gov.my/MohPortal/newsFull.jsp?action=load&id=353

2) Epidemic and Pandemic Alert and Response (EPR)

http://www.who.int/csr/media/faq/QAmelamine/en/index.html

caveats:-

1) how about our malamine wares for food-packaging?

2) how about our plastic toys?

3) Romer labs now offers a rapid melamine test kit

financial quotient (FQ)

All of us have heard of Intelligence Quotient, IQ. The significance of high IQ on our society.
However, later on, we learns that emotional quotient, EQ is equally important in managing our rational decision in a very emotional situation.
Well, have you heard of financial quotient?

Simply defined as knowledge in managing our money and understanding the value of money versus time.

So, how can we achieve high financial quotient?
Some says, we have to be rich, in order to learn this FQ.
IMHO, it is not how much we earn but how much we keep/ save that counts.
Once we learned how to save, then we can plan how to manage our money.
There is another term called Portfolio Intelligence, in simple words, we learn how to allocate our money into different type of investment vehicle and diversification.

Once we are done with the portfolio allocation, we need to monitor our investment. Trying to keep the cost down, there is a few ways (namely; dollar cost averaging, value averaging and unit averaging).

Not to forget, always be smart about taxes. Learn about the exemption of taxes and utilise it.

few pointers to bear in mind:-

*Always keep emotion in check

*Always read on personal financial planning books (knowledge is power, power to make more returns in our investment)

*Time is the most important variable in maximising our returns (invest as early as we can)

*Always identify, which is asset and which is liabilities. (Spend money on liabilities are not considered as investment)

*Always keep the cost down (in other words, value investing the key to success. Thats what warren buffet is preaching)

*Always invest in MAIN STREET and NOT WALL STREET

What is preserved ejection fraction heart failure?

Introduction:-

heart failure is common. Nowadays, it is getting more common as the non-communicable disease (namely diabetes, hypertension and ishemic heart disease) prevalence is increasing day by day.

Heart failure is defined as progressive syndrome characterised by complex cardiac and systemic adaptations that vary over time. 

Pathogenesis of heart failure:-

 -myocardial ischaemia (regional/ global) with myocardium insult

 -left ventricular remodeling/ inflammation (hypertrophy, fibrosis, and dilatation)

  -reduced force of contraction

  -reduced stroke volume

 -local and systemic neurohumoral and cytokine activation, 

-sympathetic over activity stimulates hypothalamus to secrete vasopressin (ADH, water 

         retention)

 -impairment of renal hemodynamic function 

-stimulates the release of renin, catalyses vasopressor angiotensin and it stimulate aldosterone, adrenal glands). neuroendocrine hormones promotes salt and fluid retention

 -vascular dysfunction

 -> systolic and (or) diastolic dysfunction

American College of Cardiology/American Heart Association degree of functional impairment classification:-

Framingham criteria is used to diagnose heart failure.

Heart failure can be classified into few classifications:

1)  systolic versus diastolic heart failure

2)  right heart failure versus left heart failure

3)  backward versus forward failure

4)  low-output heart failure versus high-output heart failure

systolic versus diastolic heart failure:-

50% of the heart failure patient has normal ejection fraction (>50%)

therefore these patient are classified as diastolic heart failure (DHF)

studies shown that DHF associated with 

-elderly patient

-female predominance

-chronic hypertensive patient rather than ischaemic heart disease patient

diastolic heart failure is also known as preserved ejection fraction heart failure

it is hypothesised that failure to relax in diastolic phase reduces the venous return hence reduces the stroke volume. However, the sysolic function may be preserved. Thats why, left ventricular ejection fraction (LVEF) is not impaired.

Management:-

Once we understand the pathogenesis, therefore doctors normally prescribe a cocktail of pharmacological drugs (BB + ACEi + aldosterone antagonist + diuretics + vasodilators).

Latest addition to the management are as follows:-

a) Recombinant neuroendocrine hormones (Nesiritide, a recombinant form of B-natriuretic peptide)

- promotes diuresis and natriuresis, 

-thereby ameliorating volume overload. 

b) Vasopressin receptor antagonists 

-Tolvaptan and conivaptan antagonize the effects of antidiuretic hormone (vasopressin), 

-thereby promoting the specific excretion of free water, directly ameliorating the volume overloaded state

cardiac resynchronization therapy:-

CRT indicated for patients with NYHA class III or IV and left ventricular ejection fraction (LVEF) of 35% or less and a QRS interval of 120 ms

Implantable cardioverter-defibrillator:-

ICD may be beneficial for patients with NYHA class II, III or IV, and LVEF of 35% (without a QRS requirement).

Left ventricular assist devices (LVADs):-

-commoner and often used by whom waiting for heart transplants

Prognostic hemodynamic categories are based on 

-the relative derangement in cardiac output, 

-filling pressures, and 

-systemic vascular resistance.

References:-

1) Margaret M. Redfield. Understanding diastolic heart failure. NEJM 350;19:1930-1931.

2) Incorrect Classification of Patients by the AHA/ACC Stages of Heart Failure.          http://www.medscape.com/viewarticle/490041

3) The EVEREST trial

4) EFFECT rule

wealth vs health

QUESTION:
IS THE HEALTH OR WEALTH MORE IMPORTANT IN YOUR LIFE?

without health, wealth cannot be achieved, however
if
without wealth, can health be achieved?

well, answer is yes and no.

yes, because majority of non-communicable disease (example: diabetes/ hypertension/ obesity) are related to sedentary lfestyle and dietary intake related.

no, because in lower socio-economic income group from less developed nation are struggling to cope with epidemic of communicable disease (namely dengue/ cholera/ gastroenteritis/ protein malnutrition).

therefore, to strike a balance between this two is no a easy task.

Living healthily and in wealth is the objective of my blog.
To explore and share some health tips and wealth tips that i accumulated through-out the years in my university and working life.