JPMC organised Osteoporosis CME

OSTEOPOROSIS CME

The Organising Committee with Guest Speakers

Dr Wang explaining the pathogenesis of Osteoporosis

Dr Hjh Haslinda (Endocrinology Specialist)

Mr Ketan Pande from Orthopaedics sharing his knowledge

The Special Guest Speaker from Singapore

HSBC brings magic to children's Ward

HSBC brings magic to Children's Ward

27th October 2007

HSBC once again brought smile all around the paediatric ward at RIPAS hospital by doing its charity rounds and bringing gifts and prizes to the children's ward. The group led by the Manager of Kiulap Branch Hjh Rohani and her crew from various branches kept the children entertained and even brought in a magician to liven up the day. Thank you HSBC for your continuous charity work, perhaps one day you will visit the Doctors Mess as well :-)

When doctors wed..

Congratulations to Dr Norlenny & Dr Taufique!

21st October 2007

To those who attended the Akad & Nikah Ceremony between Dr Norlenny (Radiology) & Dr Taufique (Intensive Care Unit) it was one to be remembered. Not only because it was the first time I saw Taufique, whom I have known since med school wear a traditional malay costume, which by the way you look good dude... keep it up hehe..!

But also it was the first time we've heard the akad & nikah ceremony done in English! Well done to the brave Khadi who managed to translate the whole khutbah into english and performed the ceremony smoothly indeed for the first time! Well ofcourse the choice of verbs and nouns could have been better (Who am I to comment ofcourse), but I'm sure perhaps words like 'sexual intercourse' could have been avoided in the khutbah... :-D Hmm well I could say there were several smiling faces in the crowd for a moment then.

Well done to Taufique for being able to perform the akad at One Go! I met him a few minutes before the ceremony and he was well nervous (who wouldn't aye) but Taufique was a cool as ever. Of course not stressful and nerve wrecking like saving people's lives everyday in the ICU unit, but someone's got to do it dude ;-).

Lenny was beautiful in her nikah dress as expected.. a few tears was shed, ofcourse from both the parents and bride.. but she manage to whole her make-up very well indeed.

Finally Congratulations to the newly weds, and a big warm welcome to Dr Taufique Ahmed (from UK) whom we will see more of in the near future.

DOCTORS HARI RAYA-ING

SELAMAT HARI RAYA AIDLFITIRI
to All our Families, Friends & Colleagues

from

BRUNEIAN DOCTORS, RIPAS Hospital

At Azmi's House
L to R: Dr Azmiman, Dr Azmi, Dr Hj Amri (Back)
Dr Wadi, Dr Ariff, Dr Sofi & Hubby (Si) (Front)

Celebrating Raya at RIPAS
(Can't you tell the happy faces!!! erm..)

Dr Herry's crew (2nd from left)

The Eligible Bachelors
(except the one sitting on the far right! Sorry Mrs Ady!)

Ofcourse there are still more pics that should be posted, but I haven't had the time to steal them from their facebook accounts :-) Will post it as it comes ok!

SELAMAT HARI RAYA FROM THE DOCTORS MESS COMMITTEE!!

LIVE 'Keyhole' Spinal Surgery in Brunei

1st International Endoscopic Lumbar Spine Workshop in Brunei

5th October 2007

RIPAS Hospital was once again host to an international meet, when a world renowned Neurosurgeon from France Prof Jean Destandau was invited to Brunei Darussalam to demonstrate 'live' the most recent advancement in treatment of Lumbar Disc Prolapse (Backpain) to 20 surgeons from Brunei, Malaysia, Singapore, Indonesia, India and the UAE.

Present to watch for the 1st time in Brunei Live Surgery telecasted from the Main Operating Theatre at RIPAS to the Lecture Hall was the Honourable Minister of Health Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Hj Suyoi who also earlier officiated the endoscopic workshop.

Prof Jean Destandau explaining his technique

Amongst the guests that attend the Live Surgery Demonstration

The patient being prepared for surgery

Over 2 days Prof Jean Destandau performed live surgery on 4 Bruneian patients who had been troubled with backpain for several years and found to have a Lumbar Disc Problem. The 2 days workshop was held at RIPAS 2nd Floor Lecture Hall and the visual was telecast from the Operating Theatre. Prof Jean Destandau has been using this special technique which he innovated to correct disc herniation since 1993 and since then has operated over 5000 patients worldwide with back problems. The advantage of his technique over the traditional 'open' procedure is reduction in hospital stay to just 2-3 nights, reduction in infection rate and improved visual capability.

It was impressive to watch Prof Destandau in action, live as he smoothly carved his way through the lamina (cartilage at the spine) and release the bulging contents of the Lumbar spinal canal. It was very much a different story when the rest of the participating surgeons was given the oppurtunity to try this technique on dummies the next day... hmmm.. let's just say some will take a lot more practice before they should be doing it on real people... However there were others who were quite keen already to try on this technique on their patients back home.

One of the Bruneian surgeons trying his skills with the dummy... what can i say.. hmm

Well done again Department of Neurosurgery for organising and Thank you to Misti Jaya & STORZ for sponsoring.


Lumbar Discectomy

What is the diagnosis?

This is an 18 year old female who presented with a pelvic fracture after having fallen from the bed. She also has a history of recurrent fractures of her wrists and ankles. Despite her recurrent admissions no body spotted the spot diagnosis of her eyes.

What is the abnormalities on her eyes?

What is the differential diagnosis of this abnormality?

With her clinical presentation, what is her likely diagnosis?

4th Surgical Forum

The 4th Surgical Forum in Conjunction with the
1st Annual Surgical Scientific Conference

The Organising Committee
Front (L to R): Mr V Matthew, Mr Tan, Mr Kok, Dato Yapp, Mr Chua, Mr William, Hjh Rumput
Back (L to R): Dr Nourul, Mr Yusri, Mr Mackie, Dr Ak Azmi, Ms Zue, Mr Tin.

9th September 2007.

For the 4th consecutive year the Department of General Surgery successfully held it's annual surgical forum with this year's theme ‘Management of the Trauma Patient – Working Towards Better Survival’.

In the morning sessions, we had interesting talks about the current trend in trauma and the statistics by Dr Da of Accident & Emergency. Dr Ang presented on Fluid management in the Trauma patient, Mr Paw talked about cardiothoracic injuries and Mr Tan shared his experience in management of abdominal injuries.

We also lucky when we had a guest speaker from Singapore who was also a Specialist Trauma Surgeon who spoke of his experience as a Trauma surgeon in singapore and advised our surgeons on current standard management for trauma patients.

Dr Ang giving his talk

Mr Zul & Dr Vui Heng amongst the guests

For the first time this year, the organising committee also held it's first annual Scientific Conference and invited scientific papers from all the surgeons working in Brunei to present their study, research or interesting cases of which top 10 papers were presented in the afternoon. The Best Scientific Paper was awarded to Mr Yusri Yahya a General Surgeon, who's paper triggered an interesting remark from one of our guests, Dr Hjh Roslina. Mr Yusri's Paper was an interesting case report of a male patient who injected his genitalia with foreign substance to make it ... well 'bigger' however it ended up all wrong (as usual) and the patient had to end up having surgery to make it 'smaller'! And oh yes.. when Dr Hjh Roslina said what is that.... the whole room just burst into laughter... who wouldnt aye.. Anyway due to certain restrictions we are not allowed to show the gruesome pics of the surgery however it's enough for us to deter anyone from having any one of these nasty injections. Well done Mr Yusri!

Nokia 8800 Sirocco Edition For Sale

Only 5 Months old
-asking for $780 neg
-Market price $1320

-Complete set given with the original box..refer to the attached pics

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Crystalline designer ring tones composed by renowned composer and ambient
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If you are interested please contact:
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Inmates Version of Thriller.. just for laugh

contributed by sCalpel

How to get started: working in MOH

How to get started: working in MOH

A complicated and longwinded way to start. Get yourself organized and it will save time and lots of hassle. A piece of advice – set a date when you want to start work. Report 2 weeks prior to this date. In the meantime get your medical fitness exam sorted and buy a car. Only then start work!

(Be warned: enjoy your holiday as you will not be entitled to any leave for 1 year)

Prepare:

1. 8 coloured passport photos
2. BJCE and GCE O and A Level certificates – 2 copies each
3. Curriculum Vitae – 2 copies each
4. University degrees and Postgraduate certs/ courses certs/ GMC – 2 copies each
5. RITA/ CCST from UK – 2 copies each
6. IC - 4 copies
7. Letter Gaji Hari – 4 copies
8. Bank book (front page) – 1 copy
9. BND $90

*you will also need to know in hand your parents’ IC number and previous employers’ addresses and contact numbers/ emails to fill in the referees section.

1. Report at Scholarship Dept, MOE (4^th floor). You will need to bring (d). They will issue you a letter to say to report to MOH. This letter is to be brought along when reporting at MOH.

2. Call DGMS (Director General of Medical Services)/ DGHS (Director General of Health Services) secretary to make an appointment for reporting.

3. On day of reporting, got to 2^nd floor of MOH, Jln Menteri Besar. You will report to DGMS/ DGHS and have a chit chat with him/ her, and tell him/ her when you want to start work. He/ she will produce a Gaji Hari letter offer. Bring along (a) – (h). You will need these for:
• SPA forms X 2
• Brunei Medical Board

4. Once you have the Gaji Hari letter, make a copy – take it to your nearest hospital and go to the reception. They will direct you to a counter where they will issue you a medical fitness form. You then have to go to various depts.: ENT/ Dental/ Eye/ Radiology for CXR and Phlebotomy for blood taking/ urine samples. Ensure bloods for F. lipid/ glucose/ Hep B and HIV serology is done for you. Once all done and all results available, they will contact you and make an appointment for you to go to Occupational Health at Ong Sum Ping OPD (5^th floor). It will take about 2 weeks for all these to complete. Once medically fit, Occupational Health will issue a Certificate of Medical fitness.

5. You then need to go to MOH 1^st floor (administration) and ask for those managing Gaji Hari/TAP. Will require 2 passport photos, copies of certificates, Gaji hari letter copy and Medical fitness certificate. Your TAP certificate will be mailed to you.

RIPAS Hospital:

6. Once all above done, you need to report to CEO RIPAS (located at admin). Bring along 2 passport photos (for your ID badge) and Letter Gaji Hari. More forms to fill in. Ensure that you get your badge done there and then. No excuse for them to wait for a day or two (because its only a piece of laminated card with your photo stuck on it). Whilst there, arrange parking permit in the same dept. $40 a year, yet not guaranteed a parking space.

7. CEO will then direct you to your relevant Head of Division. They will then instruct you to which subspecialty you will be working and sort out rotations and oncalls. Be ready to start work straight away!

8. Library: located 4^th floor. Get your library card sorted. Fill in their form. You will require your Head of dept to sign and stamp the application form. Also provide IC copy and letter Gaji Hari copy.

9. Also ensure your secretary of Dept/ or yourself sort out your Time sheet for gaji hari. Bring along bank book front cover copy. Otherwise you won’t get paid at the end of the month.

10. Doctors Mess is situated on the 4^th floor. Yearly fee is $50 and payments to be made to Mess Treasurer.

11. You will be on the Gaji Hari basis for at least 3 months. Those under medical services should be on the Gaji Bulan basis after 3 months. You then again need to go through the Medical fitness process and this time to bring the medical fitness certificate to SPA (behind MOE) 2^nd floor.

12. Last but not least, you may need to buy a car after all that. Documents needed for a bank loan are copies of Gaji Hari letter offer and IC. Once that has all been approved, away you go with your new car!

All the best!

Painful Finger

42 yr old gentleman who works in the construction industry presented with a 2/7 history of painful, discoloured left 2nd finger. Spot diagnosis?

Online Exam Questions

Guys here are useful links for those seeking challenging exam questions

www.onexamination.com

www.pastest.co.uk

www.123doc.com


www.mrcpuk.org


Enjoy!

Golf Irons

Who's got a 2nd hand Callaway Hybrid Iron (rescue) and wants to sell it?
Contact me..
messdoctors@gmail.com

HM Raja Permaisuri Agong visit to RIPAS

3rd July 2007 marked another significant history to RIPAS Hospital when Her Majesty Paduka Seri Baginda Raja Permaisuri Agong consented to visit RIPAS hospital as part of the official visit to Brunei. We were lucky the Doctors Mess was chosen by the Malaysian entourage as an ideal place for Her Majesty to be briefed about the visit and it was an oppurtunity for our doctors to gain a closer look and speak to the Malaysian Queen.

Her Majesty's arrival at 1500hrs was greeted by the honourable Minister of Health YB Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Hj Suyoi b Hj Osman and Datin, and senior officials at the Ministry of Health and RIPAS Hospital. Her Majesty consented to hear a briefing from our CEO Dr Hjh Norlila before donating a contribution to RIPAS as a gift from Her Majesty. The event continued with a visit of the SCBU and Ward 2, where again Her Majesty consented to give donations to patients who were admitted at the respective wards. Our sincere gratitude to Her Majesty Paduka Seri Baginda Raja Permaisuri Agong on her majesty's visit and the officials involved in making the event a success.

On a lighter note as a result of the visit, The Doctors Mess received extra attention than usual from the administration and we are very thankful to RIPAS for providing the Mess with brand new carpets, blind and lightings which are all added bonus to improving our Doctors Mess Fascilities.

Part of the organising committee

Mr Dato Yapp

Dato Yapp

Awaiting Report... Coming soon

The 1st Scoliosis Surgery in Brunei

Pre-operative x-rays

The Spine Exposed

Scoliosis surgery in Brunei

In early July 2007, the department of Neurosurgery RIPAS hospital had organised for the first time Scoliosis surgery to be undertaken in the country. A Professor of Orthopaedic Surgery with a specialist interest in Spine from India was brought into the country through sponsorship of a drug company and performed 3 Scoliosis surgery with the help of our Neurosugeons.

A little bit about Scoliosis surgery:

Surgery for scoliosis is only recommended for patients with curves that are greater than 40 to 45 degrees and continuing to progress, and for most patients with curves that are greater than 50 degrees. The main objective of scoliosis surgery is to fuse the spine so that the curve will not continue to progress into adulthood.

Only more severe curvatures (greater than 50 degrees) are likely to progress in adulthood. If a curve is allowed to progress to 70 - 90 degrees, it will not only result in a very disfiguring deformity, but will start to result in cardiopulmonary compromise. This happens because the curve in the spine rotates the chest and closes down the space available for the lungs and heart.

Besides preventing further curvature, scoliosis surgery can also reduce the amount of deformity. Usually, about a 50% correction can be obtained with surgery using modern instrumentation systems in which hooks and screws are applied to the spine to anchor long rods. The rods are then used to reduce and hold the spine while bone that is added fuses together.

Once the bone fuses, the spine does not move and the curve cannot progress. The rods are used as a temporary splint to hold the spine in place while the bone fuses together, and after the spine is fused the bone (not the rods) holds the spine in place. However, the rods are generally not removed since this is a large surgery and it is not necessary to remove them. Occasionally a rod can irritate the soft tissue around the spine, and if this happens the rod can be removed.



Following scoliosis surgery, patients can usually start to move around about 2 to 3 days after the surgery and when they start feeling better, and total hospital stay is usually about 4 to 7 days. Patients can return to school about 2 to 4 weeks after surgery, but their activity needs to be limited while the bone is fusing.

It is important to note that the more immobile the spine is kept the better it will fuse. Bending, lifting, and twisting are all discouraged for the first three months after surgery. For this reason, some surgeons will prescribe wearing a back brace for a period following the surgery. Any physical contact or jarring type activities are restricted for about 6 to 12 months after surgery.

Generally the patient will be monitored with intermittent examinations and x-rays for 1 to 2 years after the surgery. Once the bone is solidly fused no further treatment is required.

For the most part, patients can resume normal activity levels after a thoracic fusion since fusing the thoracic and upper lumbar spine does not change the biomechanics of the spine all that much. Female patients who have had a scoliosis fusion can still become pregnant and deliver babies vaginally.

adapted from spine-health.com

RIPAS POOL TOURNAMENT 2007

On the 1st of July 2007, the Doctors Mess Ripas was host to the Finals of the 1st RIPAS POOL TOURNAMENT which was open to all the Doctors in Brunei. It featured the showdown between two very young and talented players, Dr Ang (A&E Specialist) and Dr Herryzul (Orthopaedics MO).

Ang, Ady & Herryzul

18 contestants battled through the qualifying rounds, and one by one we saw the favourites being eliminated. From the likes of Dr Ady, Dr Ak Azmi, Dr Isham (Cardiothoracic Surgeon), Dr Chong (Gastro Specialist), Dr Hj Zulaidi (Anaesthetist Specialist) and Dr Chua (General Surgeon) to name a few that succumbed to defeat at the hands of these 2 finalists.

Dr Hj Zulaidi finding his target

Mr Chua Hock Beng

Dr Tin, claims it's his first time holding the cue... sure Dr Tin...

The finals was played with the best of 5 frames and on hand to witness the match was the Honourable Minister of Health Pehin Orang Kaya Indera Pahlawan Dato Seri Setia Hj Suyoi b Hj Osman.

The 'Hustler'

Crowned Champion of 8 ball Pool was Dr Herryzul after a fairly somewhat convincing win of 3 frames to 1 over Dr Ang, who despite playing an excellent game was unable to pot the decisive shots when it mattered. Perhaps the overwhelming attention was just a little bit too much for our Emergency Specialist.

Zieda (L) & Amalinda (R)
Runner-up and Champion for the Female category

Before the finals of the male category began, an invitational vip match was played between The Honourable Minister of Health and the Director General Of Medical Services, Dr Hj Affendy. Never has the doctors mess witnessed such a tense moment when Dr Hj Affendy was only one ball away from winning the match but somehow managed to follow through the cue ball and potted it in and inadvertently loss the match. Rest assurred the results of the match has not been rigged by the doctors mess committee :-)

Listening to the rules from our Referee

Are you sure you never played before DG?

Thank you to the sponsors HSBC Kiulap Branch

Amy, Amalinda & Ady

Guests at the event

Mess Committee (Rudin & Aziman - away)

Sweaty Palm Surgery

Bilateral Video Assissted Thoracoscopic Sympathectomy

Surgeon: Mr Hj Isham
Anaesthetist: Dr Hj Zulaidi

Indication: Palmar hyperhidrosis

Good News for those suffering from excessive sweating especially in the palms and axilla, a new surgical technique that reduces this troublesome symptom has recently been undertaken at RIPAS hospital and proven to be a success. Mr Hj Isham Hj Jaafar, our very own Cardiothoracic Surgeon demonstrated this technique where via three small holes (10 mm each) a camera and 2 instruments was inserted through the axilla to gain access to the sympathetic chain which supplies the sweat glands. The Anaesthestist involved Dr Hj Zulaidi Hj Abd Latif then provided an excellent view of the chain by collapsing one lung at a time using a special Endotracheal Tube which allows the main bronchus to be blocked. This anaesthetic manouvre required endoscopic equipment which was also vital for a successful surgery.

The 1st patient in Brunei to ever receive this treatment was a 31 year old businessman who had been suffering from Palmar Hyperhidrosis for the last 13 years and has been waiting for this surgery for 3 years. He said he sweats even in the coldest environment and is exacerbated during anxious situations. The symptoms can get so bad that his hand dribbles in sweat and shaking people’s hand become something that he would rather avoid. This is extremely difficult for a businessman who meets new and important clients on a regular basis.

The surgery had certainly given him an extra confidence and he now looks forward to shake peoples hands.

Dr Hj Zulaidi & Mr Hj Isham

Alternative to Viagra!

Royal College of Surgeons England MRCS Part 3 Preparatory Course

A Bloated Tummy

65 year old man presented to casualty with a 3 days history of colicky abdominal pain, vomitting and distended abdomen. Whats your diagnosis and what would you propose the treatment.

Emergency Cardiac Surgery on 4 year old

USS of the Ruptured Atrium

An emergency cardiac surgery took place recently at RIPAS Hospital which saved a 4 year old boy after sustaining a blunt injury to his chest. Dr William Chong, one of 2 Bruneian's Cardiothoracic Specialist took about 1 hour to repair the boy's torn Right Atrium (one of the chambers in the heart) which leaked blood into the pericardial space and resulted in a cardiac tamponade.

The incident occurred just as the family was preparing to go for Friday prayers when the young boy slipped after climbing over an unsuspectedly unsecured ceramic sink at home and fell backwards bringing the weight of the ceramic sink that landed on top of him. According to family members he was under the sink for a good 15 minutes before family members were alarmed and after taking him to casualty department at RIPAS, he was unresponsive for 5 minutes before emergency duty doctors manage to resuscitate and Dr Lim Kian Soon, radiologist on-call diagnosed the pericardial tamponade.

Dr William Chong and the surgical team on call took the boy to theatre immediately and exposed the heart through a midline sternotomy before discovering the boy had sustained laceration through the right atrium and was losing blood by the seconds. The torn appendage was sutured and the pericardial tamponade was evacuated within minutes.

This accident highlighted how important it was to consider intra-thoracic injuries on an unsuspectedly innocent blunt injuries especially to chest and what a difference adequate resuscitation and definitive treatment can do to save someone's life. Thank you to our emergency services and well done Dr William Chong!