paint weekend

well all i did during that weekend was spending time doodling and playing with paint. trying brushes and colours. drawing some senseless stuffs and erasing them back. anyway, spray is so hard to use. it is good to make gradient but then it is also too coarse id say. so thats why i dont really use spray anymore. dunno how.

dunno how i end up drawing this thing. meramon-like shadow fiend

sailang

ni salah satu drama yang aku tgk dalam life aku and mostly time remaja. sailangman mmg banyak kat dunie ni. kawan makan kawan r katekan... dunie ni mmg camni. ko baek gile ngan member ko pon last2 member baek ko gak yang sailang ko. xke same tu ngan die tikam ko dari belakang. aku ade sorang member ni. die da dengan awek die ni lame gile r. mmg da stable gile r. ttibe je dorang clash. reason? aku x taw. n tgk2 awek member aku ni kuar ngan besfren die rupenye. frust nak mampos member aku sorang ni. chill dude, cari r yang laen. ade lg peluang....

ade gak yang kapel gune posto. maklum r jauhkan....sebelah kelas je pon x pon laen kolej. aleh2 posto tu yang grab makwe die. peh.... sadis.. harapkan pagar makan padi

so, x baek sailang menyailang ni. bikin gadoh saja. tp kalo da rebut tu rebut gak r. sape kesah maen kotor ke x ek? yang pnting ko dapat. baru r namenye selfish.

ingat, pompuan baek tuk laki baek and pompuan jahat tuk laki jahat.

dan aku masih lagi tergelak perbualan member aku...

A: weh, J pegi je gunakan peluang ko ni

J: x baek doh orang tu da berpunya. da nak tunang da pon

A: ah peduli ape sailang je

J: abeh tu kalo aku amek awek ko camne?

A: .... aaa... (kemam)

lulz everytime aku ingat perbualan ni mesti aku gelak

random doodling during paint weekend

cold feet

Damn Ancient Apparition for casting cold feet on me!!!

yes I've been having cold feet and hand now and then. it's cold!!!! especially when you're about to sleep but then your cold feet touches some part of the body...brrr no this is not raynaud's disease.

Raynaud's phenomenon consists of spasm of the digital arteries, usually precipitated by cold and relieved by heat. (known as Raynaud's disease if no known underlying cause). This disorder usually bilateral with fingers affected more commonly than toes.

Symptoms

Skin pallor(due to vasoconstriction) followed by cyanosis due to sluggish blood flow, then redness secondary to hyperaemia. numbness, a burning sensation and severe pain occur as fingers warm up.

Diagnosis

secondary causes include rheumatoid autoimmune disorder such as systemic sclerosis. can also be associated with artherosclerosis or occupations that involve use of vibrating tools. Ergot-containing drugs and beta-blockers, and smoking can aggravate symptoms

Management

avoid cold provocation, stop smoking. vasodilators can be prescribed but often unacceptable as cerebral vasodilatation causes severe headaches. sympathectomy or prostacyclin infusion is helpful in severe disease.

all resources from Kumar and Clarke

MS

let's talk about multiple sclerosis. it is a chronic inflammatory disorder of the CNS. There are multiple plaques of demyelination within the brain and spinal cord where the plaques a disseminated both in time and place.

Prevalence
it's prevalence varies being directly proprortional to distance of residence from equator. MS is a rarity at the equator but a common neurological disease of young adults at north america and europe.

Aetiology and Pathogenesis
Although the mechanism is unknown, there is an inflammatory process in white matter of the brain and cord mediated by CD4 T cells.in active lesions there is an increase in inflammatory cells, active myelin degeneration and and phagocytosis. An initial inflammatory demyelinating event may prime autoreactive cellular and humoral immune responses against myelin. antibody-mediated demyelination probably develops early in MS. First degree realtives of a [atirnt have an increased chance of developing MS, without a clear-cut  pattern of inheritance. No known links between MS and infection exists but abnormal immune response in many MS patents produces increased titres of serum and CSF antibodies to many common viruses particularly measles.

Pathology
Plaques of demyelination, initially 2-10 mm in size, are the important features. Plaques are perivenular often occurs at distinct CNS sites: optic nerves, periventricular region, the brainstem and its cerebellar connections and the cervical cords. Acute relapses are caused by focal inflammatory  demyelination, which causes conduction block and it is relieved when inflammation stops and remyelination occurs. nevertheless, if the damage is severe, secondary axonal destruction will occur. In the cord, destruction of the anterior horn cells by the plaques is rare. So, focal muscle wasting like small hand muscles is uncommon. plaques are not seen in myelin sheath of peripheral nerves.

Clinical features
age of onset commonly is between 20-45 years and more common in women. 3 characteristic common presentaitons of relapsing and remitting MS are:

- optic neuropathy - blurring of vision in one eye develops over hours to days and mild ocular pain usually occur. The optic disc appearance depends on the site of plaques within optic nerve (optic neuritis/retrobulbar neuritis) Worsening of vision of optic neuritis during fever, hot weather, or after exercise occur as central conduction is slowed when body temperature increased(Uthoff's phenomenon).

- brainstem demyelination - Acute MS in brainstem causes combinations of diplopia, vertigo, facial numbness, dysarthria, or dysphagia. Pyramidal signs in the limbs occur  when the corticospinal tracts are involved.

- spinal cord lesion - spastic paraparesis developing over days or weeks is a common features of plaque in cervical or thoracic cord. this causes difficulty in walking and lower limb numbness. Lhermitte's sign may present and urinary symptoms are common

Unusual presentations for MS include epilepsy, trigeminal neuralgia, tonic spasms, and organic psychosis.

Investigations
-MRI of brain and cord shows multiple plaques in periventricular region, corpus callosum, brainstem, and cervical cord. Head MRI also shows lesion while plaques are rarely seen with CT
-CSF examination shows oligoclonal IgG bands in 80% patients with MS. CSF cell count might be raised (5-60 mononuclear cells/mm^3)
-Evoked responses delay in visual evoked response is seen in optic neuropathy.

MS therapies
include
- Steroids (short course) for remission of acute relapse
- beta interferon (INF-beta1b and 1a) for preventing relapse and disability
- Immunosuppressants and antineoplastic drugs (azathioprine, cyclophosphamide)
- Immunomodulator (Glatiramer acetate) to reduce relapse frequency
- Natalizumab, monoclonal antibody that inhibits migration of leukocytes into CNS


all are taken from Kumar and Clark
you can see im getting lazy to type as the post goes but it is easier to read with bullet points and less writing.

Gran Canaria

So i went to Spain..... well not to say Spain exactly. Canary Island though it is under Spain but it's actually located right beside Morocco. i dont know why it belongs to Spain. anyway i went there during winter holiday right after the exam. it's nice to go somewhere hot for awhile during cold winter season. since the island is situated near to sahara desert, it has desert too. the temperature is around 25 daytime and around 20 at night. the weather is really nice since there's no cloud in the sky making it a perfect place to sunbathe whats more it is not hot and humid like in Malaysia. the cool sea breeze just makes this island a great place to relax. the middle part of the island is more like a canyon as there are mountains. this is just great.

land of sands.

i can see no end to this desert. shrubs grow here and there

spending all day playing at the desert. woohooo

thirst to death..... nope, im hugging mother nature 

alibaba and 4 thieves

travelling under the blazing sun

gold dust

my travelling fellows

cool beach perfect for swimming after playing with the sand 

yeay we're going to middle part of the island

the sun shines brightly that it is blinding

yup we travel along the road at the desert

hello cacti. having fun sunbathing?

mount panorama

we hike a bit to go to the top of the mountain.

yes thats the top of the mountain we're aiming for

the view from the top of one of the highest mountains in gran canaria, roque nublo

oh look there are small plants up here taking shelter from the sun and wind

i still cant arrange the pictures to form 3 or 2 rows instead of 1 long row of pictures for when i do that the arrangement will always get messed up.

Rozana

ever listened to rozana? well, im pretty sure every malay has heard of this song. a great song to melalak to when hanging around with friends. anyway, i have a chemistry teacher name rozana(well the spelling is a bit different but it doesnt matter) too back in secondary school. i wonder if during her younger days her lover sang this song to her or not. lol

oh well to those singing to lover out there, i hope it wont turn out to be like this.

still loving you is also a great song

urine catheter

today i learnt bout urine cath and how to do the procedure. well, i honestly didnt feel good listening to the description at first. oh come on just by looking at  the size of the tube gave me a shiver for awhile literally. and then there's also the part where you have to handle someone else genital. ok that part is not so bad but then think when you have to deal with someone unhygienic. all i can say now is oh god oh god. anyway, urine cath for woman is said to be a bit more difficult as you tend to slip the tube into other hole. well, practice makes perfect oh also with the help of pen torch everything will be much easier. lets just hope i dont have to use urine cath in the future.

rambut kemas sebab dalam hospital

music for exam

as i said before, many things change during exam period. this doesnt exclude one's music preference. last winter exam i go for techno music. a lil bit of trance, and during last summer exam my preference is more towards east asia songs like japanese songs such as scandal, hatsune miku, or some anime songs i.e be your girl, elfen lied ending song. i also listen to chinese songs randomly without even knowing the name of the song. one of the reason i listen to non english or malay songs is because i dont understand the lyrics which will not allow me to sing along if im studying or reading. the melody is good enough. so for this winter exam my preference is techno swing like parov stellar or alice francis but then i have to change the genre cuz the beat is too catchy that i feel like dancing every time i listen to them. so i change to blues jazz. ah sax(no this is not a typo) is so good. oh not to forget i still listen to instrumental and oldies from time to time. right now im listening to this psychedelic rock band, mgmt. getting high with their songs must feel really good but right now lets sing que sera sera, whatever will be will be, the future's not ours to see, que sera sera, what will be will be.

sempena result exam nak keluar, que sera sera.... lol

oh here's another song that i like to play right now