Aizudeen Zakaria

29/11/2022

Penyakit Buah Pinggang, Kencing Manis makin teruk, selepas menerima rawatan alternatif.

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Bacaan buah pinggang , creatinine dari 276 ke 730 ( naik lebih 2 kali ganda )
Bacaan cholesterol, dari 3.8 ke 10.5 (naik hampir 3 kali ganda)
Bacaan hypertension, naik sehingga 200/100, memerlukan infusi ubat GTN.
Bacaan gula, HI (high index), tidak boleh dibaca oleh meter, memerlukan infusi Insulin.

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Pesakit saya, mempunyai penayakit Diabetes Mellitus, Hypertension dan kidney disease stage 4.
Beliau menjalaini kehidupan harian seperti pesakit yang lain, makan ubat, diet yang betul, dan pergi ke temujanji doctor setiap 1-3 bulan untuk pemeriksaan darah dan meneruskan rawatan.
Beliau merupakan seorang pesakit yang baik, dan akur dengan nasihat dan rawatan yang diberikan.

Follow up dengan saya hampir setahun, dengan perjumpaan setiap bulan, dan yang terakhir sejak bulan 8, beliau tidak lagi berjumpa dengan saya.

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Sehinggalah pada suatu hari, dia dimasukkan ke ICU, di mana gulanya tidak boleh dibaca, tekanan darah yang sangat tinggi, muntah yang teruk, dan kerosakan buah pinggang yang teruk.

Beliau menceritakan kepada saya bahawa, beliau berhenti mengambil ubat yang dimakan dari hospital, setelah berjumpa dengan doctor alternative di luar. Yang menjanjikan kesembuhan untuk penyakit beliau.

Beliau berhenti ubat selama 3 bulan dan mulakan rawatan alternatif selama 3 bulan. Sangat bahaya !

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Akhirnya pesakit saya perlu menjalani rawatan hemodialysis , kerana mengalami Kegagalan Buah Pinggang.

Syukur, kerana beliau tidak menghadapi heart attack, atau stroke yang boleh membawa kepada kematian.

Dan saya yakin jawapan dari rawatan alternatif itu adalah, kalau tidak sembuh itu adalah takdir tuhan.

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Nasihat saya untuk pesakit di luar sana, jauhilah berjumpa dengan doctor yang tidak bertauliah.

Berbincanglah dengan doctor yang pakar dalam bidang penyakit anda. Dan jauhilah rawatan berdasarkan testimony dan media sosial, duit tidak boleh mengembalikan buah pinggang yang rosak.

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Nak berikhtiar , biarlah berilmu.
Nak beramal, biarlah berakal.
Malu bertanya, sesat jalan.
Salah bertanya, salah rawatan, nyawa jadi taruhan.

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Dua tiga kucing berlari,
Mana nak sama si kucing belang,
Dua tiga rawatan alternatif telah kau cari,
Mana nak sama dengan rawatan doktor pakar seorang.

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Ikhlas dari,
Dr Ahmad Aizudeen Zakaria
Pakar Perubatan Dalaman
MD (VSMU), MRCP-UK (London)

19/10/2022

14/10/2022

((Paru-paru bocor kerana merokok dan v**e!))
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Di suatu malam yang hening dalam jam 12 tengah malam, sewaktu saya tidur nyenyak, saya terima panggilan daripada MO Kecemasan dan Trauma.
MO: Doktor ada satu pesakit muda, datang dengan severe chest pain, dan shortness of breath
Saya: Banyak diagnosis perlu saya fikirkan ni…. ada risk factor, Diabetes, Hypertension, Cholesterol, Family history, Drug abuse, smoking?
MO: active smoker doctor, 2 packs/ day.
Saya: Ok kita buat few test dulu, bloods, ecg urgent, chest xray urgent, stabilise patient.
MO: Chest X-Ray ada tension pneumothorax
Terus bangun, tengok chest x-ray pesakit,
Saya: Masukkan pesakit ke ICU, ready chest tube insertion, saya datang dalam 5 minutes.

Alhamdulillah chest tube inserted around 12.15 mid night in ICU, successfully, and patient stabilise and feels better.

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Apakah itu Spontaneous Pneumothorax?

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Keadaan di mana paru-paru bocor secara mengejut, menyebabkan paru-paru kempis, dan udara terperangkap di antara paru-paru dan dinding dada.
Keadaan ini adalah keadaan kecemasan, dan perlu rawatan yang segera.

(Faktor Risiko )
Jangkitan paru-paru
Paru-paru kronik, berparut
Merokok dan v**e
Trauma / kemalangan

Cakap tidak untuk merokok. Say no to smoking.

Dr Ahmad Aizudeen Bin Zakaria
Consultant Internal Medicine
SALAM Senawang Specialist Hospital

22/06/2022

What is Melioidosis? (Kuman Tanah)

"Melioidosis" is an often fatal infectious disease caused by the environmental bacterium, Burkholderia pseudomallei. Melioidosis is often misdiagnosed because it causes wide range of symptoms which often mimic those of other tropical diseases. Diagnosis requires high suspicion/recognition by treating physicians and confirmation by isolation of B. pseudomallei from any clinical specimen such as blood, urine, sputum and pus.


"Burkholderia pseudomallei" is present in soil and water in the endemic areas, and infection is acquired through skin inoculation or contamination of wounds, ingestion and inhalation.

16/05/2022

During Hari Raya, if you got diarrhea or food poisoning, avoid taking coffee and milk.
It will worsen your diarrhea

11/05/2022

Happy Nurses Day. Kepada semua Nurses yang pernah bekerja dengan saya, dan semua Nurses Di seluruh dunia.
Semoga ceria selalu, dan teruskan khidmad anda yang tip top.

HUKM 2009-2010
KK Ayer Tawar 2010-2012
KK Sitiawan 2012-2013
Hosp.Kajang 2013-2014
HRPZ 2, 2014-2018
Sabah 2018-2021
Hospital QE, dan QE2
Hospital Tuaran
Hospital Likas
Hospital Kuala Penyu
Hospital Ranau
Salam Senawang Specialist 2022

Semoga Allah memberkati kalian dengan kebaikan.

26/04/2022

Rancang perjalanan dan Kalori anda bersama keluarga tersayang.

Memandangkan Ramadan sudah hampir ke penghujungnya, sedikit perkongsian mengenai diet dan Kalori semasa hari raya.

Den pon nak cheat day jugo. Tak sabar nak rayo, makan bersilang tangan. Cheat day 1 hari takpo. Jangan berterusan sampai sebulan.
Tu mentekedarah namanyo.

Teruskan bersederhana dalam makanan, kerap melakukan senaman, tambahkan manis dalam senyuman, kurangkan manis dalam makanan.

Kepada pesakit-pesakit saya, kalau gula terlebih, ingatlah pepatah
" You Look So Sweet During Aidilfitri "

Sonyum biar manis, sampai ko telingo.

Dr Ahmad Aizudeen Zakaria
Pakar Perubatan Dalaman
SALAM Senawang Specialist Hospital

04/04/2022

Puasa dan Ubat .

http://www.myhealth.gov.my/puasa-dan-ubat/

23/03/2022

COVID-19 Endemic



In 500 hospitalised patients with stage 2-3 COVID-19.
Given 5-day course of Ivermectin (0.4mg/kg/day)
Compare to standard of care group of patients.


1.Ivermectin (IVM) group and standard of care group (SOC) have similar rates of progression to severe COVID-19 disease.
2.No significant difference in terms of ICU admission, mechanical ventilation, symptoms recovery, blood parameters and chest x-ray resolution in both groups.
3. Safety analysis showed 3 times more adverse events were reported in IVM group versus SOC group, mainly diarrhoea.
4.Ivermectin doesn’t reduce risk of severe illness in COVID-19


IVERCOR-COVID-19 from Argentina
TOGETHER from Brazil
Both studies do not support the usage of Ivermectin in clinical practice.

PAXLOVID
PAXLOVID (Nirmatrelvir 300mg & Ritonavir 100mg)
-protease inhibitor antiviral therapy,
-designed to block the activity of the SARS-CoV-2-3CL protease, an enzyme that the coronavirus needs to replicate
-Co-administration with a low dose of ritonavir helps slow the metabolism, or breakdown of PAXLOVID, for it to remain active in the body for longer periods of time at higher concentrations to help combat the virus.
-inhibits viral replication at a stage known as proteolysis, which occurs before viral RNA replication. Did not demonstrate evidence of mutagenic DNA interactions.


1.Can reduce risk of hospitalization and death by 89% based on EPIC-HR study.
(Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients)

2.Common side effect: Diarrhoea 3%, Dysgeusia 6% (altered taste sensation),
Other not common side effect: Hypertension 1%, myalgia 1%

3.kidney disease dose precaution
eGFR ≥30 to

12/03/2022

(Diabetes and Ramadan)

1. Ramadhan and fasting may have favourable physiological changes among healthy individuals, such as decreased body weight and lipid profile.

2. Fasting in certain individuals with diabetes may be associated with adverse outcomes; hence they are not obliged to fast.
However, many patients with diabetes choose to fast as shown in the Epidemiology of Diabetes and Ramadan (EPIDIAR) study, despite a clear instruction from the Quran on individuals who are exempted from fasting (Surah Al Baqarah Verse 184-185).

3. There are several potential risks associated with fasting in Ramadan namely hypoglycaemia, hyperglycaemia/DKA, dehydration and thrombosis.

4. (During Ramadhan)
Plasma glucose monitoring
Patient are advised to monitor their plasma glucose and most importantly when symptomatic of hypoglycaemia or hyperglycaemia.

5. Indication for termination of fasting
Plasma glucose < 3.3 mmol/L = terminate anytime during fast
Plasma glucose < 3.9 mmol/L =Within 1st few hours of fasting, in particular if on SU, metformin or Insulin
Plasma glucose >16.7 or symptomatic of dehydration = Anytime during fast
Without plasma glucose = When experiencing symptoms of hypoglycaemia, or severe dehydration e.g giddiness, syncope, or confusion.

6. SAHUR (pre-dawn meal) - Very Important
Should never be omitted
Should consist of a balance meal with adequate carbohydrate.
To be taken as late as possible, just before Imsak (dawn)
Intake of salty foods should be avoided to reduce risk of dehydration.

7. IFTAR(breaking fast at sunset)
Should not be delayed
Intake of high-sugar foods should not be avoided. However,1-2 kurma(dates) at the start of Iftar following the practice of the Prophet (Sunnah) may be taken as a part of CHO exchange.
Sufficient fluids intake to replenish fluid loss during the day. Aim 8 glasses of fluids per day.
The main meal is encouraged after the performance of Maghrib prayers.

8. Exercise and physical activity
Light and moderate intensity exercise on regular basis
Avoid vigorous exercise during the day because the risk of hypoglycaemia
Performance of Tarawih prayers is a form of physical activity.

9. Medications Proven to be safe in Ramadan include: -
-Metformin
-Glimepiride
-Gliclazide
-Sitagliptin
-Vildagliptin

10. SGLT2-i has lower risk of hypoglycaemia, but some safety concern in particular dehydration and should be used with caution in patient Diabetic Kidney Disease stage 3 and above.
(Dapagliflozin, Canagliflozin, Empagliflozin, Ertugliflozin,Luseogliflozin)

11. Injectable glucose lowering therapies:
Liraglutide and exenatide are safe as an add-on treatment
No dose modification is required. Injection should be given at Iftar
Insulin therapy
Using insulin analogues is preferred over regular human insulin, less hypoglycaemia

12. Adjustment of Medications during Ramadan
(as per attached slide/picture)

13. Post Ramadan
Follow up with Doctor for medication and regimen readjustments.

Know your disease for life and treatment modification during Ramadan.
Sharing is caring.

Dr Ahmad Aizudeen Zakaria
Physician , Internal Medicine Specialist.
MD(VSMU), MRCP-UK

06/03/2022

Weekend study.
The continuity equation.

26/02/2022

The STORM is coming.

The Thyroid Storm!

Thyroid Strom
Life threatening thyrotoxicosis characterized by multisystem disorder with mortality rates 11-25%.
Thyroid storm result from a triggering event in conjunction with underlying hyperthyroid conditions.

Triggering/Precipitant :
1. Non-compliance or discontinuation of anti-thyroid drugs
2. Severe infection
3. Cardiac event
4. Thyroidal or non-thyroidal surgery
5. Trauma
6. Administration of iodinated contrast and radioactive iodine
7. Pregnancy and delivery
8. Adrenal insufficiency
9. Diabetic ketoacidosis

Multiorgan and acute heart failure are the main cause of mortality.

How is Thyroid Storm Diagnosed?
Clinical and Quantitative scoring
Burch-Wartofsky Point Scale (BWPS)
Japan Thyroid Association (JTA) – TS1, TS2

BW score:
>45 = thyroid storm
25-44 = impending thyroid storm

23/02/2022

Tahukah anda pengambilan minuman bergula boleh menaikkan paras Uric Acid di dalam darah ?

Kurangkan manis dalam minuman, tambahkan manis dalam senyuman. 😆😄

Banyakkan minum air masak, kurangkan minuman bergula.

20/02/2022

One of the oldest joint disease. Described by Hippocrates in 5th century BC.

Join Pain that even strong man can cry.
GOUT!!!

Gout is painful form of joint pain (arthritis).
Too much uric acid in your body creates crystals in the joints, leading to swelling and extreme pain. Gout usually starts in the big toe but can affect other joints. Gout can be treated, and the uric acid level can be reduced by medication and lifestyle changes.

(Risk factor)
1.Obesity , BMI > 30

2.Diet
-high fructose
-red meat
-seafood
-inner organ
-alcohol

3.Medications
-diuretics

4.Others
-CKD ( Chronic Kidney Disease )
-Hypertension
-Hematogical malignancies
-Menapouse

(Treat to Target)
-achieving serum uric acid

16/02/2022

Check list before round.
Let's do it.