Beautiful Music in Any Language is Just As Wonderful

I came across this beautiful piece of music and would like to share with my musically-inclined blog readers. It's Japanese and I don't understand a word of what the singers are saying but the arrangement and melody coupled with the three groups of singers each with their unique sound are really entertaining for me. I heard it countless times and really enjoyed the medley sung with such gentleness and amazing intonation.... loved it!

Happy Eid - Selamat Hari Raya AidilFitri 2013

Wishing all my Muslim blog readers a Happy and Joyous Eid and Selamat hari Raya AidilFitri Maaf Zahir dan Batin. Watch out what and how much you eat during those gathering of loved ones, relatives and friends. Most of the fares doled out during the one-month celebration are both sweet and fatty and gassy. The tastiest are made of such delectable stuff.

Many of my Muslim patients have lost about 2 kg after one month of fasting but they are likely to put it on again in less than one month. It is important to think again before you take that next mouthful of "rendang" a sweetly spicy meat slowly cooked in coconut milk for hours.

I was at a relative's place on the first day of Hari Raya and noticed the "traditional fares", glutinous rice packed into bamboos (lemang), "palas" leaves (ketupat), chicken curry, rendang galore,cabbage and tofu in coconut milk, peanut sauce (kuah kacang) and bottles of coke,sarsi and orange drinks, cakes and cakes and cakes in all shapes,colors and sizes! And to think that the head of the household is a diabetic with a recent fasting blood sugar of 29mmol/L! (target range 4.1 to 6.1 mmol/L).

Festive Ketupat and Rendang- High fat and carbohydrates

It's so easy to overeat when you are with your relatives and friends, sharing stories,friendly banters and pleasant "Hari Raya" songs in the background. Some people were joking and promising to exercise more after the celebration as they gleefully helped themselves. A real festive binging on foods and drinks.

Just remember that Moderation is a virtue 

Omega-3 Fish Oil - A Healthy Heart or A Healthy Prostate

As always the case, many of my patients would ask about the goodness or advantages of their food or vitamin supplements. Many of them are led to taking these through friends' recommendations, media advertisements and lo and behold, even through their GPs (general practitioners)! some of these errant doctors even sell those vitamins at their clinics. My training has persuaded me to regard  this as unethical. Anyway this is beside the point.

I always tell my patients that for as long as they are healthy, not suffering from terminal diseases,   and have good appetite they should stick to taking a balanced diet suggested by the food pyramid. It is better to take natural foods as the body is physiologically familiar with them. Fresh fruits and vegetables contain vitamins that the body needs. Supplements may contain other chemical contaminants and artificial food stabilisers like colouring and taste at the point of processing and production.

One of the supplements highly touted to be advantageous to people suffering from heart or cardiovascular disease is omega-3 fish oil. Many of my patients take these capsules and I had earlier not much information on the long-term effects and have therefore remained rather neutral on my advice.

Omega-3 Fish oil capsules - Net Image

But the latest research findings on the link  between omega-3 fish oil and risk of prostate cancer, which confer with an earlier finding in 2011 is rather worrying. Prostate cancer especially the high grade classification is usually fatal. As suggested by the researchers here more studies need to be undertaken to determine the specific mechanisms linking this finding in prostate cancer patients with high level of blood omega-3 fatty acids, I would suggest to my elderly male patients who don't have cardiovascular disease indicators such high triglycerides level to stop taking this supplement for the time being.

Apparently it doesn't matter from which sources you take this omega-3 oil, dietary intake or supplement, you have to be aware that a high level of this fat may not be good to your prostate. I suppose omega fish oil capsule taken daily would have exposed your system to a more sustained high level of it.

It is important to note that unless a properly planned research is done we might not know the effects of any medications/supplements on our body. Some of these scientific research are triggered by cluster observations of people coming down with a certain condition and a search for links is made and findings are required to be reproducible by other groups using similar methodology and later peer-reviewed and published in reputable medical journals.

Anyway, omega-3 oil may be beneficial for the heart and its "required" blood level may have been established but then people are different in their response to their metabolism and certain factors like enzymes may affect the level in different individuals. Hence what is fine to a patient may not be so in another.

What about women taking this omega-3 fatty acid supplement? There is some suggestion here that might be beneficial for breast cancer but there is no focussed research but only a meta-analysis of 21 studies the individual methodology of which are important to look at before they can be accepted.

What 2000 Calories Looks Like

Have you ever wondered why you are getting bigger despite eating so little? It is the content of food that matters and not the size. The daily calorie requirement of an average size man is 2000 and if you eat pizza daily plus all other foods like ice cream and biscuit especially without exercises, you sure will have excess calories which your body turns to FAT! So be aware of what you eat. Choose wisely and live longer with good health.

Watch the above video if you want to know what 2000 Calories "look like".

( Obesity is usually food-related but can also be due to hormonal imbalance )

Chest XRays - Similar Symptoms, Different Infections

Two different men presented to my clinic. The first is a well-muscled, local, mid-thirties and working in a detention centre and I will call him LY. The second is a thin foreigner in his mid-forties, jobless and hard of hearing and I will refer him as FS.

LY came with a complaint of recurrent and unrelenting coughs for more than two months. He also experienced evening sweat and fever. His appetite was low and he had lost a lot of weight recently. He also gave a history of having slept in the same room as an inmate diagnosed as having tuberculosis. His coughs were productive and sputum was yellowish and occasionally streaked with blood with incessant coughs.

FS had the same symptoms except his sputum tended to be frank blood (haemoptysis). In fact, through his mother who accompanied him, I learnt that he had no contact with a known PTB patient.

Whilst LY's sputum came back negative for AFB (Acid fast bacilli) on all three good specimens, FS's was positive on the first sputum sample. There is no doubt as to FS's diagnosis and his chest xray showed the lesions on his upper left lungs. He was promptly treated with an anti-tuberculosis regime.

FS's chest x-ray showed more "stormy" picture of the lung with two cavitating lesions at the apex of the left lung. Though  most TB lesions tend to be in the apical region of the right lung  due to the more vertical position of the right bronchus, it can also occur on the left upper lobe.

LY's chest x-ray - clear apices with parahilar lesions.
Sputum AFB -ve and treated for community acquired pneumonia
and referred for further evaluation partly due to abnormal left cardiac border.

FS's chest x-ray - cloudy apex of left lung with cavitating lesions
more "snow storm" noted - Sputum AFB +ve and treated for PTB

LY's chest xray showed parahilar solid lesions likely to be lymphatic enlargements. He was treated with a twin-course of antibiotics and returned three weeks later to report that his coughs had stopped and he was feeling a lot better.

Fearing that he might suffer from other conditions, I referred to the general Hospital for further evaluation like getting a CT (computerised tomography) of the thorax done on him. His chest x-ray picture had not really changed after two weeks of the antibiotics course. Apparently, according to the respiratory physician, post-treatment lung changes might take a longer time to resolve.

Using chest x-rays alone are not sufficient in making a diagnosis of PTB (pulmonary tuberculosis), the sputum analysis is the gold standard for confirmatory tests. By the same token, it is not enough by just having a plain history as the symptoms are similar in fact, LY's contact with a PTB inmate had convinced me that he was suffering from PTB.

ASD and ASM - 2013 Dividend Declarations

Yesterday 14 June PNB (Permodalan Nasional Berhad), declared dividend for its Unit Trust ASD (Amanah Saham Didik) for financial year ending 30 June 2013 at 6.80 sen per unit. This is 0.20 sen more than last financial year at 6.60. The increase is due to better unit trust performance with a recorded gross income of RM400.61 million

PNB Chairman Ahmad Sarji (Left) with President and CEO
Ahmad Kamah Piah  at the income distribution
Announcement  for ASD 2013

 A total of RM 307.36 million, an increase of 11 per cent compared with last year's RM 276.92 million, will be distributed to 340,947 ASD unit holders who collectively own 4.5 billion units of ASD.

This dividend rate appears to indicate that other fixed-price Unit Trusts in the PNB stable such as ASW,ASM and AS1M have declared or will issue a similar income distribution. The good news, however, should take into account the inflation rate that has the habit of increasing annually. 

For some investors the receipt of dividend is a time to take out their investment for planned purchase or spending while for others it is an opportunity for reinvestment to enjoy that compounding magic. 

Apparently this is the time also for keen Bumi investors to pick up more units as ASD units are becoming hard to get as more Bumiputra investors are becoming savvy in planning for their retirement nest egg. Having PNB unit trusts in investors' portfolio is a good strategy to derive regular income for saving purposes.

Last March ASM declared a dividend of 6.50 with 0.30 special income  making the distribution also at 6.80 sen per unit. The income distribution entailed a total payout of RM 913.85 million, an increase of 11.6% from RM 818.62 million paid out in 2012. There are 542,809 ASM unitholders who hold 13.44 billion units which are more than double that of ASD. A similar increase in income performance of the two unit trusts is also noted. ASM is obviously a bigger trust than ASD and is open to both Bumi and non-Bumi. ASM has been fully subscribed for a number of years now.

Am waiting for dividends declaration for AS1M to be credited on October 1 2013 and  I expect it to be also at 6.80 if not at 6.50 with a special income distribution of 0.30 sen per unit as well. Have not really scrutinised which stocks on Bursa AS1M is heavily invested in but I am sure they are profitable counters.

Sources: The Edge, Businesstimes and Staronline

MERS- Is It A Developing Threat?

I came across this news report (read here) on a novel coronavirus referred to as MERS or Middle Eastern Respiratory Syndrome virus which has apparently claimed lives in Saudi Arabia. The virus causes high fever,respiratory symptoms such as coughing and difficulty breathing and leading to rapid kidney failure. It sounds similar to SARS or Severe Acute Respiratory Syndrome virus which precipitated a global scare back in 2003 when 800 people were reported to have succumbed to the disease.

A MERS coronavirus is shown in this colorized transmission electron micrograph.

Photograph by: THE CANADIAN PRESS , HO-US National Institute for Allergy and Infectious Diseases-RML Beth Fischer

Considering that million of people the world over perform a pilgrimage to Mecca in Saudi Arabia annually, the virus could have the potential of being spread far and wide. I hope the Saudi Health Authorities will act on this public health concern by getting the cooperation of the World Health Organisation or WHO (Read here) to collaborate with it. The concerning feature of this new virus is that it has a high fatality rate.

Unprecedented global cooperation to fight SARS ten years ago resulted in the threat being prevented from inflicting greater morbidity and mortality. The current lack of information flow from Saudi Arabia is worrying.

As it is a new virus, there is no vaccine against it and the mode of transmission which is airborne poses a danger of very rapid spread unless cases are quickly detected and quarantined. Public health measures and personal hygiene need to be promoted.

It is advisable to be overcautious than waiting for the threat to be full blown and becomes a health crisis.

More articles  here.