New Year, New Hope. Happy New Year 2012!

The year 2011 is closing its curtain and in a matter of hours a new year is coming. Whether you celebrate this moment in whatever style, the change is certainly felt. If any of us adopts this attitude of ‘what the big deal, its year in, year out thing, nothing special’, then just consider these few points.

The coming of new year marks a lapse of one complete year in our life. One year passed, means one year closer to death…because this is the most obvious thing but frequently forgotten. Imagine a candle, burning slowly by time, as another moment passed, the candle got shorter, the same to our life, our own life ‘candle’ is getting shorter by one year as the year turns. The ‘time’ is not known, but is certain, all we can do is prepare – for the next life, – and what best thing we want to leave to our loved one, to this world when we die.

You will be one year older, and hopefully one year (at least) wiser, more mature. So, is the new year going to see the same ME…the one that exists last year, or a NEW ME? That depends, if the old ME is good enough, it may be reasonable to maintain the same ME, preferrably make it even better…

Time to look back, what you have achieved in this one year? Did you meet your targets? Or did you have targets? Some people don’t, they just go by the flow, or live on someone else’s life (really!), or even living on someone else’s agenda – no we should not. You own your life, and in the end you will be answerable – therefore, you must have control.

A believer is encouraged to reflect on his life, and plan:
“O you who believe, fear Allah, and let every soul lok to what it has put forth for tomorrow, and fear Allah. Indeed, Allah is aware of what you do.” (Q: 59: 18)

For those already made up their own resolution, well done. May God help you to achieve it. Let’s remember, when you make intention to change for example, do not expect it’s going to happen tomorrow. But at the same time, don’t let the passing of time cause your good plan to dwindle and in the end forgotten completely. In my case, some of my ‘new year resolution’ was only achieved the following year! You may consider that I have failed, but I am still thankful for this success, and there are only all the wisdom from this delay, I think.

If you have not made up your mind, there are a few things that may be good to consider. One particular area is health – make a resolution to improve your health eg. You want to lose at least 5kg this year, as a mark of being more fit, and healthier. Another is how to be more efficient – you want to wake up early everyday (aim the time), or to be more proactive with ‘Do it Now’ principle, to avoid procrastination. Some may think of finance – how to save RM this year so it will help you achieve your big plan like going for the pilgrimage etc. Or some, simply want something more ‘spiritual’ like want to be closer to God, by adhering to the daily congregational prayers.

You will notice, whatever goal you want to achieve, it must be accompanied by a plan. Your goal is the WHAT, you are yet to state the HOW. So, a new year resolution that is not accompanied by a concrete plan of how to achieve it, is bound to fail. Intention is not good enough, there need to be the action!

Nevertheless, one most crucial question to answer is, for what are we making this new resolve? This draws the question as to who we are, what really do we want in this life. Without having this clear, then life remains an ambiguity. Let us not forget the reason why we are here on earth…a very basic question indeed. No matter how much we achieve in this life, if we fail to serve the purpose of our existence, we are still a failure.

Let be someone who make use of this opportunity for change, change for the better. May the new year bring us blessings and continuous guidance from God, let us continue to make a difference to this world, and live to inspire others to live.

Famous quotes from my patients this week…

Elderly lady, in early eighties, could hardly walk, came for heart check. I ask permission to do quick exam, and she said: “…saya ni dah nak mati ke doktor?…” (Am I going to die soon, doc?) to which I replied:
“Hmm, tu saya tak tau makcik, orang muda, lagi sihat, pun boleh mati tiba-tiba…bahagian mading-masing. Kita usaha, dan sediakan diri untuk hari tu…” (I dont have the answer, anyone, even a young healthy one may die anytime! We just have to carry on, and prepare for the day…”

Elderly man who just turned eighty, came all the way from Sabah. I told him: “Your blood pressure is a little high, you also got this irregular heart in which you opted not to have the treatment…” he interrupted: “…and I have very strong desire for sex, doc…but the ‘thing’ is weak…”
“Well” I answered; “There is absolutely nothing wrong with that, your heart is strong enough..”
“Just twice a month, doc…and I need the medicine to make the ‘thing’ stronger.”
I gladly reassured him: “Sure you can do a bit more if you like, and I will give you the meds..”

Another middle age lady, in early 60’s. Came in for risk factor screening, positive family history for heart disease. She didn’t have much really – good waist circumference, blood pressure, sugar and cholesterol all fairly normal for her age. But she has strong family history, so I keep her on atorvastatin (cholesterol medication).
“Ok Puan, kolesterol ni nampak agak ok, macamana penjagaan diet?”
She proudly answered: “Saya makan tak pantang doktor, semua boleh…”
“Hmmm…ada exercise?”
“Tidak. Malas lah, doktor”
…(scratched head…”how motivated…”)

An insight into Stereotaxis Magnetic Navigation System

Today I had this rare opportunity to visit a Cardiac centre in Taipei that is equipped with a state of the art navigation system to assist percutaneous electrophysiology studies and coronary intervention.
We were accompanied by a long known rep called Tam (knew him from the day I first worked in UKM, Tam was with St. Jude’s selling pacemakers), Chloe from Singapore and Prisca. Cheng Hsin Hospital Taipei was located about half an hour away from our hotel – Sherwood Taipei Hotel. We were met by the cath lab director a friendly Dr Yin who has performed over 70 cases of PCI using this navigation system.

This particular stereotaxis belongs to brandname Niobe that originated from St. Louis US a few years back. Its main use has been in the field of Electrophysiology (EP) for EP mapping, localisation of arrhythmic focus and ablation of pulmonary vein in Atrial Fibrillation. Lately, it has also been used in percutaneous coronary intervention (PCI). In this cardiac centre, they are using the system for both. I have come to learn the application in PCI.

The basis of this navigation system is utilisation of magnetic energy to manipulate the tip of the wire (catheter) which itself is made from magnetic material. First of all, there are currently two major cardiac angiogram system that support Stereotactic machine – Siemen and Phillip. The imaging system has to be fully compliant to the system in order to allow both of them to work hand in hand.

The control units consist of two gigantic ‘tubes’ or parts, more resembling the flat receiver of fluoroscopy system, albeit much much larger surface and body, of course. The two units when in operation are made to face each other, with cardiac angiogram table in between where the patient lies down. Simply put, these two units behave almost the same way like the lateral planes of a biplane cardiac angiogram system – by stating this, I mean, the cardiac angiogram that can be operated with stereotactic system must be a single plane one, so that the space vacated by the lateral plane is replaced by the stereotactic units.

The control panel is a touchscreen monitor mounted on the fluoroscopy table, which connects to a display facing the operator, while outside, at the control station, it connects to an external display allowing the catheter manipulation process to be viewed from the control station as well.

Next, we should spend time on the navigation wire. It basically is the same as a standard angiplasty wire (0.014mm) with a magnetic tip, and the tip is pre-shaped (it is not possible or recommended to change the pre-shaped tip). The wire is advanced in the same way as routine PCI to cross the coronary lesion. Once in the vessel, the operator control or manipulate the wire as he would with ordinary angioplasty, with the additional ability of remotely controlling the tip of the wire using the stereotactic console. Touching the console screen (a complete circle divided into twelve points like a clock) will direct the wire tip according to the desired direction up or down (or left/right), as well as anterior/posterior direction. It is this remote control of wire tip that will assist in crossing lesions, particularly difficult lesions such as bifurcation or extremely tortuous vessels. Once the wire crossed, the rest of the procedure goes on in the usual way.

It is important to note, that presence of any magnetic items such as metals, cellphones or even credit cards within radius of the magnetic field may cause interference to the navigation system, however a patient with pacemakers or other metal implants should have no problem undergoing the procedure, I was told.

This is a sophisticated system with great potentials in percutaneous interventions, the potential of expanding indications of use is there. I could think of peripheral interventions including lower limbs and cranial system, or even the emerging new procedure like renal denervation.

One may wonder how much do you need to invest for such a system? It’s estimated to cost around 5 million RM (this, easily exceed the cost of a simple single plane cardiac angiogram! However if utilised to its full potential as described in above paragraph, and perhaps bundled with manufacturer’s Odyssey (remote transmission system) then it may be worth the investment.

For further info refer to www.stereotaxis.com

Not impressed by an iPAD2? …is it the right gadget for me?

Did I make a mistake? One wonders what on earth, out of the blue I sudenly went on a string of Apple products purchase within a short space of time – an Iphone followed by a Mac Pro, a Mac Air, and guess what’s next? An IPAD2? I must be mad…

Yes, while you may think that I have gone crazy, there is somehow a very good reason for all these to happen – money or funding. The funding was available, the time could not be anymore right, so I decided to get one for each of the Investigators in our team.

So what do I think of IPAD2, you may ask, and I am answering this question after having toyed around with this gadget for less than two weeks.

First of all, I kind of made a mistake. I came from that old generation when tablet PC first came in the market. So I have this kind of thinking ingrained deeply in my mind – that Tablet works with a stylus, and if I want to type on the tablet, then I need a keyboard. Funny but true, as when the time came to purchase this device, I immediately placed an order for a hardware keyboard and a stylus. Since I went for the highest IPAD2 spec (64G with 3G), with the accessories that comprised the keyboard/sleeve set plus a stylus and a screen protector, the whole thing cost over RM3000, almost double the cost of the cheapest IPAD2…As if that is not enough to cause an upset, the whole things tucked together (IPAD2 with the carry case cum sleeve, and a keyboard) truely turned the gadget into something so bulky and awkward, no more a thin tablet that fits nicely iinto an A4 envelope! and that’s not the end of the nightmare, I quickly discovered that I could do better with my fingers alone, even typing, and drawing, what a waste of money…

I must admit, after approximately 72 hours of using this device, my general impression is, out of all the other Apple’s products, iPAD is the least inspiring one. While this may sound outrages to you iPAD’s fans, my comment is based on a high initial expectation of its value, which in the end I found something contrary.

True as some people put it, iPAD is more of a lifestyle product. If you are talking about a fancy gadget, nice to handle, more functional than a smartphone and beats any ordinary laptop in term of portability, battery longevity and fast startup – then you are talking about the right gadget. Its also a handy on-the-fly device for internet browsing, movie or music playback blahblah, alas I did not purchase this iPAD for the above stated reasons! Then I have got the wrong gadget…

A spoil brat like me, who has relied heavily on a laptop do do most of the above, would not be easily won just by the face value. More so, as I have been hypnotised by Blackbery smartphone for the last one and a half year, and this lesser friendly device had made it possible for me to enjoy facebook and emails anywhere I go. Easy connectivity between BB and laptop was a great boon, I could exchange files and share internet connection seamlessly.

However with iPAD, it’s a different world altogether. True I hav been yearning for a state of the art tablet for long, however I was greeted with a surprise to discover that an iPAD is no more than an iPhone without talking ability?

Its funny that all these while I have resisted the urge to own an iPAD, as I dont find find a niche for it. Today, I found several compellimg reason to own one.
First, eBook. Yes I am serious. These days we read less and less print materials, and more and more e-material. One of the most richly available resources is medical and cardiology, which is my professional interest. Its really more of reference ebook, though I also enjoy real plain ebook (hmmm, to be honest I havent read one, except Steven Covey’s Seven Habits…and John Grisham). I also rely so much on eQuran, though thus far none is really perfect. Other occasional though definitely important use is dictionary, to quickly check meanings of difficult or new words.
Second, note taking and quick browsing – I like to do this during lecture, workshop and conferences. Usually the main purpose of taking note is to fight sleepiness rather than serious note keeping, though the later is a valid consideration, since in the past I could not fulfil this satisfactorily (either too cumbersome with laptop, and just when I got used to do it, another limiting factor is laptop’s relatively shorter battery life.. or not very convenience with smartphone). A full time tablet is the ideal gadget though, without touch typing ability, fast entry of data is limited. Therefore the method of note taking is essentially an entry summary points of the lecture of whatever you are listening to, rather than word by word reproduction of the lecture.
A personal organiser cum fully functioning tablet device. Certainly it’s a dream to own a fully functioning gadget that takes care of all your personal agenda, plus ability to quickly browse internet without having to wait for reboot. You can also read newspaper and of course access social media like Facebook & twitter, or emails. Since a tablet has a larger and more functioning screen, it’s definitely better than a smartphone for all these purposes.
Entertainment and gaming. It’s ironic to discover how many of my friends who own tablet devices use them primarily for this purpose! They are not to blame perhaps, since the designers of these gadgets have these as one of their main aims, reason being, playing on a tablet is much more fun than on a small screen of a smartphone. Touchscreen technology has revolutionised gaming experience when combination of tactile, visual and auditory responses can be utilised to its utmost.

So, after having used this gadget for two weeks, did it meet my expectations? Hardly I say, and I maintain this despite the few obvious benefits that I am seeing more and more of now. As said earlier, I enjoy the fast startup, long battery life, and ultra-portability of this gadget – it can essentially be operated anywhere, in the car while driving, in a restaurant while sipping your coffee (caution not mix your tablet screen with that hot coffee…), and of course its ease of operation – perhaps a little bit of experience with Mac and iPhone had helped on this. Crispy, beautiful screen, slim and light – all important estatic factor, and the ‘wow’ factor of course. Perhaps, if I get hooked on to gaming, then it may broaden the usage experience, though I don’t plan to do this (I have discovered more and more now, that I am definitely worse than my kids or wife in playing games, hopeless, therefore…no way I could pin my interest on this!).

I am simply frustrated by its ‘lack of interaction’ with other devices, inability to share internet, awakward file transfer utilities, and slow operation with some ebooks particularly those PDF files. When you first start with an iPAD, there is hardly any but basic apps that you can make use of. Downloading from the Apple Store is not as easy as with the Macbook, and the experience can be quite frustrating, since the only way I can obtain internet access is via a Wifi wireless connection or 3G broadband, which has necessitated me to subscribe to an additional Celcom line (and I am so bad in paying bills you know…not financially, but failure to keep up to date payment, even in these days of online banking, is a real shame on me…). Without the 3G simcard the iPAD is of not much fun, as when you are not connected to internet, there is virtually not much things you can do really. Even with the 3G simcard, it’s unable to make or receive calls, neither send or receive sms, unlike its rival Galaxy Tab – this is another frustration point.

The point about having an electronic gadget that you want to carry everywhere is, it has the ability to increase your productitvity. A cellphone, and now smartphone does this. I owe a lot to my Blackberry, it has introduced me to the world of seamless and continuous IT communication anywhere I go. Its also of course a great phone and a useful personal organiser to some extent. Then I also carry around my laptop which I use for work, preparing lectures/presentations, research and writing blog etc. The laptop is also my real ‘workhorse’ since I do not rely on any other computer, even at home I use my laptop for all my computing work (whenever the wife has no objection for me staring at the computer monitor I mean…)

That leaves almost no gap – quick email, FB and simple search handled by my sweet BB (I got full data subscription courtesy of UKM), and for serious computing work I use my laptop. Whenever I am away from a hotspot and need to get my laptop connected to internet, I simply use a cable, or bluetooth and get connected via my BB. So, where do this cute iPAD fit in?

Lately, with the arrival of a new Macbook Pro – which I have really enjoyed using, things were going as well, till a few occassions arose when I started to complain, or heard complaints from others like my eldest daughter, that my laptop bag is getting very heavy since I changed my laptop. In fact I started to complain of shoulder ache and back ache, and since I heard this complain, everytime I walk with my laptop in the bag, indeed I could feel the weight on me. This had made me thought of an alternative. Could I get away without my heavy laptop – at least some (selected) days – or even, carry my laptop, leave it at the office, and just walk around with a tablet which would be significantly lighter, and yet I could use it (tablet) for all kind of quick works like checking or sending emails, or using it for tablet jobs as outlined above. Furthermore, during travel on a flight, I also felt so awkward, just keeping my bulky laptop in the seat pocket, it bulged out and hampered the opening and closing of seat tray.

It is with this thought in mind that I decided to go for an iPAD. Alas, an iPAD is not a replacement of a laptop, no. Though I was aware of this from the beginning, it took me an experience of missing the laptop before I realised what it means to be deprived of it, even when I got the iPAD, I felt hopeless.

I was sitting at the office one day, with one of my students who was preparing her presentation. I told her that she could make a reference to one of my previous Powerpoint slides – which I instantly retrieved by searching my MacPro HD. Then I suggested her to look at several guidelines papers, which I also happened to have in my laptop’s HD, and again I searched and open these files in no time. Next, I made some suggestions and corrections to her presentation. Then I downloaded several movie files using a pendrive USB transfer, which was handled well by MacPro by using Osirix (they came in DICOM format), then I converted the movies to Quicktime files to be incorporated in her presentation. All done with no fuss. There is no way all these jobs can be done by the iPAD.

On another occassion, we were sitting at this Cardiothoracic conference, when I suddenly found out our poor Medical Officer did not have a viewing application for DICOM files. There were several alternatives all of which would take too long, till I decided to let her use my MacPro.

The above two occassions were not exclusive, it may be unfair for me to expect an iPAD to behave like a fully functioning laptop since this was not the aim of its inventor. However, I am just trying to illustrate what sort of lifestyle I am onto that an iPAD has little role in my daily life (well, unless I change my lifestyle hmmm….)

Ok, ok, fair I cannot expect iPAD to function like a laptop. So I just do like what I thought, use it for ‘light use’ browsing internet (more convenient and workable than BB) or emailing and FB, light writing or typing works (like, I prepared this article typed entirely on my iPAD, using a bluetooth keyboard); then, when I need to do more serious works, I turn to my laptop. Not bad initially, though I ended up heavier, since now I got to carry not only my bulky laptop, in addition another half a kilo extra weight of the iPAD!

Then I discovered more glitches. It was (alleged, I say), that an iPAD can function perfectly like (or better) than your smartphone. While this is true 90% of the time, you will still need your smartphone. The other day, I thought I will take a few shots of ECGs with my iPAD, and surprisingly the quality was too bad that I could hardly read them, well, what do I expect for a camera that is just slightly better than a webcam…bad news, I still do need my smartphone (and furthermore, I do need my phone to make and receives calls and sms) – wow, now I got to carry my laptop, my iPAD and my smartphone, not any lighter in the end…

Some of you may think that I have not made full discovery of my iPAD, and yes I do admit that. I am yet to try the file sharing or sync utility that may make life easier. I have not touched (much) on other great features which iPAD excels at like video playback, iPOD and of course games (the only reason that makes my kids crazy about an iPAD). There are now many apps for specific use in Medical profession including those that will assist in patients’ education or facilitate patients data storage and sharing (subject to legal limit of course). There are also various apps that allow reading, or even editing those word processors or presentation files, I just have not planned to get them for my iPAD, unless I could use those that I have already downloaded for my Mac – since I am still in the middle of trying to fit the role of this iPAD into my life (?…really). In fairness, I do like it (hey, I never say I hate iPAD!)… and I look forward to the day when I can just walk around with my iPAD, leave behind that bulky laptop for real, occasional serious work).

Overall score: *** (3 star, one for its slimness, one for its wow factor, and another coz the kidz and all my good frens like it…)

LIKE: Its a great tablet, touch screen, great typing whether the ‘soft’ keyboard or with the bluetooth keyboard (I am still learning…); long battery life, fast startup, great with music, videos, and of course internet (decent enough)

DISLIKE: I still cannot dispense without my laptop…eg the interface for FB and emails are are different (not the full version I usually see on my Chrome or Mac’s Safari); same problem with Skype – I could not access account menu (ie to top up credit for instance)

TRACER – an extended lesson in ‘bleeding in Acute Coronary Syndrome’

One of the key things that we were encouraged to convey to our patients during the recruitment process for this study was that the trial drug was not likely going to cause excess risk of bleeding. This arguably was the conclusion that was drawn from analysis of previous studies on vorapaxar on over 20,000 patients.
In one perspective, it was one of the studies which was very flexible in term of its inclusion criteria. You may recruit any patients with ACS whether or not they are undergoing intervention. For those undergoing PCI it is encouraged to recruit them prior to the procedure, and that the study drug is continued during procedure. No adjustment whatsover needed to the dose of antiplatelets or heparin. Even for patients going for CABG, there was no strict protocol as when to stop the drug (or even the decision whether to stop them or not).
Due to this flexibility, there were groups of patients that ended up receiving dual antiplatelets, heparin/low molecular weight heparin and Glycoprotein IIbIIIa inhibitors – and undergoing PCI without requiring dose adjustment or interruption in therapy. Looking at the protocol, it reflected a highly confident trial premises, which somehow crossed the boundaries of cautions practised by other antiplatelets trials like ATLAS2 (using oral factor Xa inhibitor in ACS).
The trial result which was published in early November 2011 in NEJM showed a failure to reach primary endpoint of significant reduction in composite of death from CV causes, MI, stroke and ischaemic endpoints (including revascularisation). There was a significant reduction in key secondary endpoint of composite of death from CV, MI and stroke though this cannot be declared as superiority endpoint due to failure to achieve primary endpoint.
On the other hand, there were significant excess of bleeding including fatal bleeding and intracranial haemorrhage, and bleeding according to GUSTO or TIMI criteria. 
There was no reduction in stent thrombosis, though there was a significantly reduced events (with no increased bleed) in a group of patients who did not receive thienopyridine.
In the discussion, the authors concurred that “the magnitude of the increase (in bleeding) was not expected on the basis of preclinical and phase 2 data, which suggested that PAR-1 blockade does not increase the risk of bleeding over an above the risk with aspirin and clopidogrel”, and went on to admit the over-confidence nature of their study protocol: “Rather, the results of our study are consistent with previous study indicating that more potent antithrombotic therapy incrementally increases the risk of bleeding.”
[VORAPAXAR is a thrombin receptor antagonist that blocks Protease-activated Receptors on platelet leading to inhibition in thrombin-induced platelet activation, without interruption in haemostatic function] 

Examiner’s dilemma…

It’s exam time again, and as usual, the examiners, as much as the candidates are under stress. Well, if others don’t agree, I certainly, as one of the examiners to have this feeling! Frequent long travel (though, fortunately in a Business Class), hectic schedule (constrained by the exam schedule, you got to be at one spot, almost disconnected from the rest of the world) and the worse part is this examiners dilemma … I am I being fair to the candidate, hmm I don’t know so much about this thing, how could I examine? In other word, am I fit to be an examiner??

I used to dread going to the exam, now I begin enjoying it a bit. But I am still surrounded by that uncertainty especially when faced with ‘difficult’ cases like complex neurological or haematological cases, or all those new development in other specialties beyond my own… another serious dilemma was having to examine your own junior doctors, who have worked with you. I don’t find this particularly comforting, since, if I pass the candidate, there is always this element of ‘bias’ (especially if you encounter one of your ‘favourite’ students). On the other hand, if the student doesn’t perform, this is a more serious thing, as I will struggle to pacify him or her later when the result was known. I have the feeling that many examiners are having the same dilemma, whether or not they are willing to admit it!

This time around, I was paired with a very senior, eminent Emeritus Professor whom all these while known to be as a ‘hawk’, in fact in my previous writing, during one of those Exam calibration session, this particular senior Professor was the one who awarded a 3/10 marks to a candidate who appeared to perform well in a long case exam, and marked 6/10 or higher by others.

This time I was assigned to Part II MMED clinical examination in USM. One thing I like about examining in USM, is that everyone feels equal, since all of us were assigned to do the same sort of works – all required to examine long and short cases. Though at some points this resulted in some hiccup (such as examiners ended up examining the same candidate in the long and short cases!).

We started with the short cases. I have already prepared myself to be humbled by his seniority and eminence. I asked the Professor to take the lead, instead, he was quick to ask me to be the ‘first’ examiner, I took most of the candidates and started the cases with them, then handed over towards the end for the Professor to take over.
Prior to the actual exam, we were required to ‘callibrate’ ourselves by examining the patients, preferably blinded, in order to simulate real exam situation for the prospective candidates. I decided to go ahead of the Professor and started assessing the short cases, then caught up with him while he was still examining the long cases. I found him gentle and pleasant, and unduly thorough in the examination, checking for every possible signs. Then he pronounced the finding, and told me how he expected the candidates to find them. I could not agree more!

While the candidates were being examined, the Professor was fully focused, he kept writing on his examiner’s file, almost like notating every single words blurted our by the candidates. Then he threw in his questions and patiently waited candidates answers. He rarely interrupted, no interjection, and no condescending remarks whatsoever, though I have the impression that some candidates could be apprehended by his eminence, almost none perhaps, were frightened by his way of questioning. I found his line of questions as intelligent, discriminative and fair. In fact I learned a lot…and enjoy this experience.

Contrary to my expectation, the Professor was quite fair in his judgement and awarding marks. In most instances we differed with the markings, usually not a very wide margin, typically at 0.5 to 1 (out of 10) range, which was quite a surprise to me, and what a relief I thought, as it only means that I am getting better at examining now!

On two occasions we differed in markings, in fact I gave lower marks than him! The Professor looked at me, and remarked, ‘eh, how come, I am more generous than you?’
I awarded a ‘borderline’ pass to one candidate, while the Professor gave a clear pass.

A candidate who did so-so, both of us agreed that she did not do well, I gave her a 5, and the Professor 4.5 (so close!) – as this candidate was from his university, the Professor, in fact asked ‘my opinion’ before giving his marks, then he made up his mind, by giving a slightly lower marks.

Candidates’ Performance vs Examiners’ Performance…
Abdomen – most of the time is an easy system. This is more so when they put up all the barn door cases such as huge polycystic kidneys and massive hepatosplenomegaly. Therefore, examiners may not be impressed with your finding per se, in this case the diagnosis has to be spelt out correctly or else little chance of getting a clear pass (6 or above marks).

Our focus on candidates, on APKD cases is of course correctly diagnosing ‘End stage renal failure, on haemodialysis, secondary to APKD (in full sentence)’. Funny when our season examiner asked a candidate, why did you say that this is an AV fistula? The candidate took a moment before coming up with half correct answer…The other half of the marks given for correctly explaining about APKD including genetic & clinical association, plus screening. Genetic testing for APKD was also discussed.

One of the cases of massive hepatosplenomegaly with jaundice (the liver enlargement was not homogenous, mainly the right lobe, with firm consistency and irregular edge – yet, surprise, many candidates could not come out with this finding…) – due to chronic liver disease, with suspected hepatocellular carcinoma. The other case was a large hepatosplenomegaly where the liver has also craggy, somewhat smoother edge which almost fused with the spleen, due to enlargement of the left lobe. The patient was also jaundiced though not pale. Correct diagnosis was thalasaemia (HbE).

It was surprising to see the way many candidates examine the abdomen, bearing in mind they are close to being a specialist. There is always a difference between the undergrad and postgrad level of examination. For an undergrad, they just apply the usual technique of touching the abdo, asking patient to breath, then come out with HSP, and bingo they pass. But for a postgrad, this is not the case. Not all enlarged liver is the same. Some may be tender, some hard, some soft, some with smooth and some with irregular edges – all represent possible different pathology. When asked to ‘define’ the mass, many failed because they just simply apply the same technique of laying their fingers on the abdo and ask patient to breath! Don’t they remember one of the purposes of deep palpation is to feel and define the margin of abdominal masses?

One of the classic MRCP book said that, you never go the exam without knowing things like differential diagnosis of HSP – in contrast to Hepatomegaly alone, or splenomegaly alone, or large liver with just palpable spleen – all represents different diagnoses and should be at the fingertips before the exam. Don’t wait till you get such a case to start scratching your head trying to put things together.

Most importantly, most candidates should have known what kind of cases could be up in the short – most of the time they are about the same common things, though, yes I did get some of the weirdly rare one like Charcott marie Tooth, or XLA agammaglobulinaemia etc, etc. Even in those rare diagnostic condition, usually the examiners would have mercy on you and give some clue, and yet the main emphasis in this case is correct technique and finding, and display of reasonable knowledge about the condition in general.

Long case – in contrast to the short cases, long case is a test of how you manage a patient. Contrary to many candidates believe, long case is not about getting the correct diagnosis. So, forget about correct diagnosis. It is about synthesising patients problem and prioritising them correctly, and next addressing them in your management. In essence it is akin to your daily practice of clerking and presenting patients in the ward. Yet, many candidates fail to shine because of this oversight.

We had a case of diabetic patient who presented with polyneuropathy (and diagnosed as diabetic at the same time), the final diagnosis was CIDP. However, we as examiners were not interested in how the candidate could diagnose CIDP (since, the patient can readily tell them!), rather we wanted them to come with problem list, and of course they should be able to outline how this condition was diagnosed, along with differential, and how you distinguish it from the diabetic neuropathy.

Decision time
At the close of the exam, all the examiners gathered. The purpose of this gathering is just to formalise the marks for each candidate and any issue arising. There was one particular candidate who passed 2 short cases and barely passed the long case, earning a mark of 48.25%. (in our Final MB, they will qualify for re-examination). There is no re-examination in MMED. One of the lecturers suggested we relook at his/her marks and consider raising it a bit to a pass level or so. However, this was rejected by a number of senior examiners, stating that it is not fair to other candidate and the marks should not be changed even by 0.1% once they are finalised. I think this makes sense, though we as much as possible would like to see more passes, reconsidering marks can be tedious and controversial, so to keep to the status quo is perhaps the best.

Our external examiner made a comment that this is a clinical examination therefore the emphasis should be on clinical skill and less on theory, therefore a candidate may not be failed because of their deficiency in theory, rather in clinical finding. But of course, they should be able to synthesise the diagnosis. They should not be penalised (too much) for not knowing in depth on a particular subject. I think this is a balanced opinion and all examiners should adhere to this rule.

The funny thing about the clinical examination is the marking scheme. There are just two rules out of many for one to pass:
1. The total score (long and short cases) must be 50% or more
2. A candidate need to pass at least two short cases (any pass marks) – even though their total marks for short cases is less than 50% of total!

Because of this ruling;
Some candidates scored just bare pass (5 or 6) for the two short cases, failed the other two, and scored 8 (or even 9) in long case, and still pass the exam.
On the other hand, another candidate had borderline fail in three short cases, pass the long case with good mark, passed overall exam (score >50%) and yet fail (because of rule 2 not fulfilled).
It is still possible that a candidate passed three short cases and pass the long, but still fail – assuming his/her short case score was 5,5,5 and long case was 5 or 6, but he failed miserably in the other short (scored 1) = total marks <50%.

Well that is the game – you just have to play by the rule! The truth – in any of the exams, you rarely find a candidate passing all the four short cases – even the best of them sometime fail one of the short cases with abysmal marks (2 or 3!). The moral – if you find yourself not doing well in one case, never despair, because you are not going to fail just because you did badly in one (but you will if you did badly in 3, for sure!).


Mac Pro vs Mac Air – close call…

(A snap review of Macbook Air 11inch, i7 1.8GHz, 120GB HD, 4GB RAM)

Just within less than a month of acquiring a Macbook Pra and writing a short review about it on my blog, now I am blessed with the arrival of this much awaited Macbook Air.
Well, I knew of its coming however not certain of when.
Now it has just been practically delivered to my door at office.
And the first impression was this wow factor. Yes certainly its impressive on a first look.

Macbook Pro – Big, strong, highly versatile and still charming, seductive…!

Well, despite its bulkiness, it is the performance that really counts for this lovely (and I still maintain its seductiveness…) Macbook Pro.
And major difference that was immediately palpable was when using the keyboard to type. Though Air is certainly much better than Sony Vaio to handle, and the keyboard is far more tactile, it is still no match with the Pro in term of easiness with typing.
Macbook Pro is certainly the best. You feel so confident typing on it.
While the Air, you can almost feel the keyboard vibration through the table or your lap (wherever the Air is seated on), due to its thinness. It is this feel of ‘wanting’ as you keep on typing, as opposed to the Pro, you feel completely secure, and satisfied with each fingerstroke.
I am a keyboard mania maybe, but I maintain that keyboard is the most important hardware that matters so much, since it is the one interface between you and your laptop which you will end up massaging, tapping or stroking day in and day out. So you want nothing but the best feel and satisfaction.
Since, I have been working to make this (Pro) laptop a workhorse computer, by now it has nearly every application and setting needed to fulfill my daily need. This is a big thing since if I switch, I will have to start from basic again, I am talking about losing those valuable three weeks of time that I have spent to make my Pro my best companion on the table.

Small vs big...I was beaten!

So, after making this Pro my close companion (hmmm that I probably spent more awake time with this machine than with my wife er….dlhkoiwbit…) I get emotionally attached, and parting with it means a loss (really…?), and I bet I will keep wondering why on earth I switched? I essentially got everything from my Pro, huge HD space, fantastic keyboard, pleasant, highly viewable screen, and of course it is blistering fast. The only thing that this machine does not have is a slim and light body…and itself may be a ‘strength’ in the sense that it is less vulnerable than the Air.

Talking about bulkiness, one thing I noticed about the Pro is, despite its large size and quite substantial weight, it sits comfortably on my lap, and it doesn’t release too much heat like any other laptops. I remember my Sony Vaio, I had a little discomfort handling this laptop on my lap, on my night wares, since the heat can be felt to cause discomfort especially with prolonged use.

I should be reminded of my experience with Sony Vaio VPCX. It is a very thin and slim laptop – dimension almost matching that of Mac Air – however, little did I ever given a thought, that it’s slimliness that killed…? Have you not ever wondered why thin people are more prone to osteoporosis? If being thin means less agile, less robust in term of resistance to breakage (or accidental mishandling), than I should have learned enough from my experience with Vaio VPCX (the laptop hinges broke apart and I almost lost the whole thing, till someone clever at the repair shop managed to patch the hinges back, at a very high cost, and resulted in the screen losing a few valuable pixels…

Mac Air – Thin and Slim, Irresistible majesty – with some shortages…
So, here I go. There is no denying of its majestic beauty…slender body, thin and ultraportable, much more pleasing to the eyes compared to that bulky Mac Pro. And it boots faster, it’s just great.

It's got that 'wow' factor and 'oh this is my dream laptop' kind of thinking for anyone seeing it...

This laptop comes in an 11inch size, it is so thin and lightweight, in contrast to the (now) fat Macbook Pro which could hardly sit comfortably in your hand, this Air can can be handled by your fingers, and I am serious. It is so thin and light that you will hardly realize this little beast is sitting inside your backpack. At the same time, unlike Sony Vaio VPCX, it feels more sturdy, and the keyboard body has more weight and feel solid, making typing more pleasant if compared to Vaio VPCX.

Keyboard keys a bit superficial…
Ouch, as I am typing I could feel the thinness of the keyboard and that the keys are rather too superficial, therefore the feel is less satisfying than when you are typing on a Macbook Pro. Another little thing I notice, the power on-off switch is seated at top right, comes as one of the keys on the keyboard. So, is there a risk that you accidentally tap this power key during typing? Didn’t happen with me though but it is a theoretical possibility, you also got to be careful when cleaning the keyboard as you may accidentally hit this power key as well…

Size wise, yes it is far smaller, far thinner of course. However, I know by having this little princess, I will lose on a few key things like – hard disk space, connectivity (no SD card – I need it often), no CD/DVD (this is also frequently needed in my work), and lack of ethernet support (these days I still need it when traveling). That is a lot to sacrifice. And of course, despite a fast SSD, the capacity is way too little.
Instead what do I get – yes I will get a featherweight thin laptop which means I don’t have to be walking around with a risk of breaking my shoulder one day. And it is less disturbing in case I need to open my laptop and operate it while I am seated in a crowd or during lectures and conferences.
How about battery life? This is yet to be tested, from initial report it was said that the battery life is probably a little less durable compared to Pro. That may be a disadvantage in real life.

A little bigger, or a little smaller? Right choice when size does matter. Both are equally powerful

Well, that’s perhaps not all. I notice this laptop has also quite a fast boot up speed, palpably better than the Pro. At least in term of speed & performance it is a close match to Mac Pro, this is what all the reviewers in CNET said. The keyboard, despite it being a little superficial, has a slightly smaller overall space, therefore all the keys are realistically more reachable compared to that of Pro.

However, looking at statistic, I am already space constrained – I just run the Finder on my Macbook Pro, check the Hard Disk, and, out of 500GB, as much as 136GB already used up! Which means, whatever I do, this tiny Mac Air will not be able to accommodate everything that I already have in my Pro, if I were to switch to it, let alone the future… To try shrinking the storage is not possible, as I keep a lot of photos and clinical images plus some videos which I think take up most of the space. Yes I did this when I received the Vaio VPCX equipped with a meager 64GB HD, I ended up missing a lot of thing, having to carry that spare external HD in case I need to dig back all those archives! Then I decided to ‘upgrade’ the storage by acquiring a 32GB SD card (highest storage available then – now you can get 64, or perhaps 128?) – however, if I were to do this with the Air, it’s not a possible option since the Air is missing that essential SD card slot. This is a serious negative factor in my decision making process.

Now, I remember, at the time when the offer came for this Mac Air, I had an option of going for a bigger SSD, at cost, of course, I sillily put the thought aside and just acted lazy by accepting the baseline spec. So, now I am stuck, not much to do but have to part with this machine, and be content with this large, chunky but fully functional Mac Pro.

I could do with both….no let’s forget the lavishness
The easy way is to keep both, but I believe by doing this in the end one of them will become redundant. After a careful and calculated thought, I have resigned myself to keeping the Mac Pro, no regret. Yes it is bulky and not slim like the Air, but I got everything I need, and it is now fully loaded with apps and optimized setting, I just have to kick off with all the works that needed done. Time to say good bye to Mac Air (…I will still miss it…)

Connectivity again…Finally I managed to use my BB bluetooth modem with Macbook Pro

Success…after three weeks of fiddling with different setup preferences etc., I finally managed to figure out how to correctly use my BB as a modem for my Macbook Pro, using the bluetooth connection. As mentioned elsewhere, I successfully connected the BB modem to Macbook using the USB cable, however, the bluetooth setup was a bit different.

Funny, coz, in the end, the only reason why the bluetooth modem did not work before, because I ignored the password request! Though it still appeared to connect, there was no data received. I consider this as a bug in the Mac setting (?) – consider this. I never set a password for my Mac since the beginning. So, each time the setup preference or application asked for password access, I just ignored it ie leave the password space blank. This worked for everything. So I assume the same was the case with the bluetooth modem.

Another funny thing was, the program never asked for a password when I connect using Wifi, ethernet or USB (modem), why would it with bluetooth? And why on earth it forced me to create a password in order to make the connection work – maybe I did wrong somewhere, any of you genius help me here…

Anyway, I was willing to give it a try. So I went to setup preferences – users and group, and choose the password tab, create a new password (use blank for old password since I had none). Save, then dial the bluetooth connection. Its a hassle that everytime I connect using the bluetooth I have to type the Admin (user) name and password. I tried to find anywhere I could disable this feature, but no success. So I just have to accept it for now.

You may ask why bother, I could just keep using the wired connection? I still found bluetooth handy, since it does not involve any wire. I could for instance have my phone charged on the wall socket, and yet I could still use it as a bluetooth modem without the need to hook it up to my laptop.

The connection speed is quite decent, and as I have noticed it before, Macbook Pro works is fast and practical. Now that I can use my BB broadband connectivity for my Mac, is another reason to rejoice…

First hand on Mac….am I a convert?

(Anecdote of my first hand experience using a Macbook Pro i7 13in, Processor 2.7 GHz Intel Core i7, Memory 4 GB 1333 MHz DDR3, Graphics Intel HD Graphics 3000 384 MB, Software Mac OS X Lion 10.7 (11A511a)

Yes, finally I decided to buy an Apple Macbook Pro! Did I regret of letting go the chance to own it (for free) over a year ago? (and instead of choosing a Mac I went for a Sony Vaio Slim Netbook – which is now half broken…). Hmm, odd enough, just around the time when the news of the departure of Apple co-founder Steve Jobs, I (and wife) have acquired two of Apple products – first an iPhone 4 (bought last week) and now a Macbook Pro.

As usual, the only decent place in KL that I know sell computers is Low Yatt Plaza. There I went (again), this time with a purpose – that I have in mind of purchasing this unit. However, along the way, I was distracted, but not for long, by a barrack of various PC laptops on display – mostly are netbooks or those low powered budget laptops – with the exception of high end Sony or Toshiba laptops. I felt disturbed being constantly harrassed by salesmen who bombarded me with unwanted information about the products they are promoting, rather than disseminating information about products that I am looking for. Well as a matter of fact, at no time during my search did I tell them what I was looking for. But salesmen just do one thing, they promote – it does not matter whether what they are selling is right for the customer or not. That’s what annoyed me. I was not there to buy oranges or cheap handphone casing replica.

The atmosphere was certainly different when you enter the Macstudio. Different kind of customers I suppose, and there are no mad salesmen trying to promote budget cutdown version of netbooks or something. I already knew the pricing so it did not really take long. The salesperson, Wai was friendly and not pushy, he told me frankly the difference between a Pro and Air, and the difference between the two versions of 13inch Pro. One of the issues that constantly bugging me is the how much do I have to spend time learning a new thing when I own a Mac – it is a well known aura to IBM PC owners that Mac is a completely different system and there is always this worry of not going to enjoy the same experience as you change to a different system.

However, these days, Mac use the same microprocessors, many of the applications available as standard in PC world are also available in Mac platform. The advantage of a Mac being it is long known with its superb graphics and multimedia handling. There is no doubt about that even with the advent of Windows and a host of PC hardwares, Mac is still the king. As I used to be an avid Desktop publishing fan, I always knew about this, and DTP in Mac world is a doddle. But of course, at that time, I never thought about having a Mac, as it was much more expensive, and softwares/applications bit harder to get. Wai convinced me that many of the useful applications can be downloaded from the Apps Store at nominal price. Therefore I decided not to purchase the Microsoft Office package along with the Mac, as I had been contemplating on prior to this. Why should I stick with that boring Office applications (which I was doomed to run them for years), why not try something completely new? Perhaps this is the time to change – as what the late Steve Jobs had taught us…

Talking about applications, it is odd enough that we have unconsciously been running many applications that were originally created or made famous in Mac platform. Take for example iTune, Adobe Photoshop & PDF reader/writer, Flash, Pagemaker (which used to be my favourite DTP program), Quicktime players among others. In fact the entire line of Adobe products were made famous on the Mac platform.

How about the fear of learning a new computing platform? Mac OS has its own uniqueness as I am going to testify later. In general, both Mac OS and Windows are graphical user interfaces that make intensive use of pointers (mouse/trackpad) to execute commands. There are differences obviously but we have been unconsciously using new ‘GUI’ when buying a new phone (say, when I first had my Blackberry, or when my wife got her first android phone) – why we never fear of learning a new thing is this case, and when it comes to Mac things seem to be distantly different? In the end I don’t see any strong reason for not considering Mac as my next laptop – with some of the outstanding advantages – better graphics, faster interface, sturdy hardware, and of course many new stunning applications that will keep me entertain while learning this new platform.

On the other hand, this Macbook has such an astute look, I think it looks seductive to say the least. Well its some kind of devious word I am using, but to be honest, on a first look you already get the impression that it is a product of innovation. With aluminium casing, bright HD display, intelligent trackpad, fantastic tactile keyboard, long battery life, short startup time, great graphics handling, and beautiful, yeah seductive look, one could not resist the temptation to own this much sought after gadget.

A different new world of computing?
There is a yes and no here. The same goes with its good and bad. First the not so pleasant thing – the Pro is massive and not that slim. The 13inch beast weighs more than 2kg. In contrast to the slim Vaio PC it is a world of difference when carrying this computer during a long travel. With the Sony Vaio, I almost could not feel that it was sitting inside my backpack (well it weighs just over 600g!), but carrying a Pro on your back could easily cause me a back or neck injury, especially when I add the charger, some work folios etc. The charger comes with two connectors, one is just an adapter that plugs in straight to the adapter box making the charger sets look quite acceptably neat and light. However, if you decide to connect to the longer three pin cable, this will add more weight and mess.

With its large size and good weight, it is not really a ‘laptop’ since it hardly sits comfortably on my lap. I can hardly hold it safely with one hand due to its excess weight. Well, I might have forgotten those years of experience with the Compaq Pro laptop which weighed one and a half times more and yet I could still handle it well, I suppose as times goes by, seeing proliferation of thin and slim laptops, a Pro is considered an obese one. I also find that it wont sit snuggly in a seat pocket in an aircraft, which frequently worries me as I had to take extra care opening and closing the foldable table in case the action could cause a scratch on this laptop’s surface, or worse still crush it to its end – though I could be rest assured that its sturdy body would be able to stand against all these accidental minor knocks.

The laptop has enough connectivity however it does not offer direct connection to a LCD projector, so I have to sacrifice another RM99 to buy the ‘thunderbolt’. Another RM99 if I want to connect the unit to a digital TV with HDMI.


Apart from the above there aren’t really much to complain. The Mac OS is a great and true GUI platform unlike MS Windows. Therefore it looks and feels much nicer, however of course it comes with a few surprises which I am not used to. Launcher is perhaps similar with with the one in Windows. Finder is basically a Windows explorer like utility which appears more mature and pleasant. I missed Google Chrome, or Mozilla Firefox which I feel are much faster than Safari, which I have to struggle in the beginning to get used to. Of course it has a task manager, called Mission Control, clicking on it will display all the multitasking that you are currently running.

Now the good news. As mentioned above, Mac comes with a fantastic user interface. Anyone who has basic knowledge of windows should not have trouble running a Mac, though it will take a day or two to get used to the various commands. I can assure you that for a first timer like me, learning to use a Mac is such a pleasant experience.

I have already mentioned about the fantastic keyboard. Yes I truly enjoy typing on it. The only little hiccup is the very well spaced keys make the keyboard significantly larger overall, therefore preventing my touch typing fingers stretching well to reach all the keys. This is especially true for numbers and function keys. There are no ‘Pg down’ or ‘up’ keys which are handy when you want to scroll pages. There is also a notable absence of ‘insert’ or paste key, which I find it very useful when doing cut and paste job.

The trackpad is a very intuitive masterpiece of innovation. On a passing look, it’s just a simple trackpad, however one will be amused with the range of things one could do with this intelligent pad. I have yet to master all the various gestures, and I purposely keep the learning going rather than trying to master everything at once, since, every new thing I learn everyday, is a joy that will keep the bond with this new device.

Alright, it is nice, but does it really work?

The first thing that I usually tested on a new PC is its keyboard. I am typing this entire article using the keyboard and it’s wonderful. I have made comments earlier regarding the well spaced keys but I guessed as time goes by I will be able to fully master this large keyboard areas and all the additional keys that I need to learn. Nevertheless the first few days experience typing on this keyboard is a real gem. I haven’t found a keyboard this good, apart from that belongs to IBM Thinkpad, perhaps this one is next to Thinkpad (you know, at one point, I was mad about buying a Thinkpad, purely because it has such an excellent keyboard).

The best thing I like about this Mac is its excellent user interface. Earlier I mention about the absence of Pgdown or Pgup keys, this is barely necessary as you can just move your pointer to the left hand side of the screen, all the thumbnails of the pages appear which you can scroll at blistering speed to get to the top most or bottom most pages. Intelligent trackpad gestures allow you to switch applications or pop up the desktop at a swipe of fingers. The graphics and screen appearance is brilliant, browsing photos or videos with ‘Preview’

Since this is my first experience, I have spent the last four days trying to download various applications, mostly from Apps Store. Clearly I am missing many applications that I am used to in Windows, one of these is the radiology video converter (dicom) which I used for works and presentations. I used to run Isiview, then Microdicom on Windows. Fortunately there is Osirix for Mac, which is a far better platform – though, since I have started using it the last 2 days, it has crashed a few times and on one occassion it just froze, and I have to force quit (equivalent to force ending applications in Windows using the Taskbar – though I think the Mac one is more responsive). I guess I could not complain much for a free software like Osirix, which otherwise is excellent and works fast enough once I download the images to the disk.

As for presentations, the Keynote is an equivalent of POwerpoint, and I think the interface looks simpler somewhat, though adequate. What is more pleasing to learn, is that it reads all my Powerpoint presentations that I have created in Windows, with little distortions here and there. It’s great for incorporating graphics (simple drag and drop) and video (with ‘inspector’ element allowing you to customise Quicktime player). The same applies to Pages (Word processor). They both can also export to Windows format and so far they work well for me.

How about multimedia – well this is its goldmine. And one could not be more satisfied than getting entertained by the sleek graphics and video handling which is a far more engaging experience than with Windows. Photos can be viewed at blistering speed (thanks to its i7 fast processor), and videos run very smoothly, since this has HD screen videos and pictures come out beautifully (I am also afforded the advantage of a large screen, for the first time after having run 10/11 inch screen with my previous laptops). The Pro is equipped with a decent built in speakers which is adequate for playback.

Sure I have to make a mention on internet browsing. First of all connection issue. The wifi works great, it detects and connects palpably faster than my previous Windows PC. However, I experienced connection breakdown when using wifi at Pullman Kuching, perhaps this has nothing to do with the Mac. So I have to resort to my Celcom broadboand.

I initially have some trouble trying to use my Blackberry as a broadband modem. Trying to connect using the bluetooth failed after several attempt – perhaps due to my failure to change the ‘location’, and also not knowing which bluetooth connection option should be chosen. In the end I decided to download the Blackberry Desktop Manager (which I had to do it using my Windows PC – transfer the file to my Macbook followed by installation. Once desktop manager installed, all I have to do is open the Setting or System Preferrence menu, when the dialog box appear choose ‘network’ option. Connect the Blackberry using the supplied cable, and when I click the network option it automatically detect the BB as one of the network connection device. Change device location to Malaysia, then connect by dialing *99# (for Celcom – leave name and password blank), it works straight away, thanks God.

Internet surfing is smooth and pleasing. I don’t see too much difference between Safari and IE or Chrome, though I think Safari is perhaps a bit slower. I also could not find the shortcut for ‘new tab’ which is a handy thing with Chrome or Mozilla. I also miss the address bar – which when you open multiple tab, there is no address (http) at the address bar which represent the link of the page that you are viewing. I found this feature a handy thing in PC, since I can quickly cut & paste the address for emailing, FB etc in order to share the website’s link. Downloading seems to be very slow, I wasn’t sure if this was entirely due to the fact that I was in Kuching. As a side point, the Safari does not have a consistent way of notifying you about the progress of your download, sometimes this can be found on the ‘download’ folder in the Finder, but when I can’t see it there, I have to look at the top right hand corner of the Safari, a little download icon can be seen, clicking this will display all the recent download, which I can click the complete one open or execute accordingly.

As for downloading, it looks like Apps store is also behaving in the same way. When you have chosen download a particular software, next it went quite, sometimes I do not know for certain what is happening. I would go to Launcher, which shows this small icon ‘waiting to download’ alert.

Typing headache, really…
As with any new system, it’s all about learning a new thing. The keyboard, as mentioned above is excellent, tactile and responsive. Only the on-off switch is not overly responsive, I have to purposely press the tip of my finger hard, to ensure it turns on/off. Because the keys are widely spaced, I need a lot of getting used to before being able to use this proficiently.

When typing, you expect similar or better experience than with the IBM PC. As mentioned, there is no insert button and the delete key is actually a ‘backspace’ key which you can delete forward by holding the Fn key. No Print screen key but I have discovered ways of doing this which is handy enough (refer to my other blog writing). As with browsing text, combining the Fn, control, alt/option and command keys with the cursor keys allow you to do what you normally do with the PgUp, PgDn, Home, control plus cursor keys on IBM PC.

But the trackpad is the most versatile piece of hardware that allows you to navigate and retouch document, or even draw, in an instant. Browsing internet for example, you can easily zoom in and out using the two fingers gesture (similar to iPhone), and with four fingers swipe (left/right) allow you to swap between apps, while four fingers swipe up/down switch between apps and desktop/mission control. You can even rotate a picture just using the trackpad gesture – these are all brilliant inventions hardly available in any IBM PC.

A world of uncertainty?
I found this a bit odd, but somehow it begins to make sense – and this is not the first time I come across such experience. When editing documents in Pages or Keynote, I found no certain command to SAVE, which later I learned that the application will automatically save your file when you exit – in the same manner, in the case that the application crashes, reopening the program will bring back the files that you were working on, with no loss of data at all! This is a powerful autosave feature. But I must remember to never click ‘revert to saved’ command, or else will lose all the works done!

While the autosave feature works in your favour most of the time, there are times when you wish otherwise. For example, when I open and edit a file, I want to save as a new name, there is no such option. Oh yeah, you do ‘duplicate’ but this will give two copies of the same file, and you can ‘revert to saved’ with one of the files, therefore allowing you to have two copies of files with different content. Hmm still does not fulfil my simple routine word processing habit with the old IBM PC.

I found the Finder works as a ‘hidder’ sometimes, as I struggle to open or search a particular file. I believe it’s more powerful than I thought, perhaps I need to wait a little further as I learn the trick of the trade.

Connectivity & device compatibility
This is a most practical plug and play computer, just insert anything from CD/DVD, USM Pendrive, SD card all will be read in an instant. You can copy/exchange files between device at an enlightening speed. Of note, file exchanges can also be done via bluetooth which requires pairing.

As regard file exhchange, I have to get used to the new interface in Finder, which is some sort of similar to Explorer. However, though the Preview is quite a powerful program that can read any graphic or word processor or excel file, when it comes to photos, it will not read in succession, instead it just open the one particular graphic file that you have clicked – not allowing you to use it as a convenient tool for picture slide show as in IBM PC. Similarly, iPhoto requires you to manually import pictures to its folders in order to be able to display and edit the photos. What it is good in doing is integrating photos from a newly inserted media such as USB pendrive or SD card – it seemlessly read the files and with one click will import all the graphics in an instant. Then of course the pleasure of viewing the photos either one by one or as slide show – which you can enlarge or shrink the view quickly using finger gestures on trackpad – while being able to edit the photos if required.

One little hiccup was when using external hard disk – this one I used before for backup in IBM PC. somehow I was able to read and copy files from the hard disk, but I could not create folders or copy files/folders into the hard disk – I guess this is due to some format incompatibility between the two systems.

As regard connecting to LCD projector – is not a big problem at all. As long as I keep the thunderbolt with me, I an instantly connect the Mac, and with few clicks, get my Mac screen projected happily on the LCD projector. When I was giving a lecture last weekend, I just discovered that I could not use the cursor when running slides that contain no graphics – apparently this is just a matter of preference setting rather than absence of feature. Since I have found a video converter, now I have less worry of not being able to insert videos of various original formats into my presentations. And I must admit that Keynote, though presents you with what look like a simple interface, is indeed a powerful and fast application, with a potential to beat MS Powerpoint – this, I have yet to explore.

I have also carried out remote printing from this laptop which worked out so handy. I have wifi connected HP officejet at work, and all I do, activating Pages print menu instantly listed the printer, on choosing this another dialog box appeared offering to download the printer driver automatically from web search. It worked nicely.

Is this my dream PC?
Well, after those long years in love with IBM compatible PC, suddenly I found a new love…or is it really? Well all I can say, at least I am enjoying a new experience in computing, and I must admit that the experience has been very pleasant, and learning a new thing is almost painless, so far I have not been caught with a major surprises, there were minor glitches here and there. Therefore my Mac computing experience has been quite adequate comparing to my needs as when using IBM PC. Certainly there are features that are not available which I really miss, however, these days you got more than one way of doing things so I have less worry about this.

What I like most: Fast, very practical, beautiful (or ‘seductive’) hardware and graphic interface, and of course the trackpad is great. Battery longevity also fantastic – though it hardly lasts 7 hours or more as claimed, I could easily keep it running for 5 hours plus. Last but not least, its excellent keyboard which revives my typing skill (which I tend to lose since using the aluminium keys belonging to Sony Vaio VPCX keyboard…).

Dislike: Not many – just a few minor things, which I am still learning anyway. The worst is its heavy and large size which definitely does not fit into slim and lightweight laptop category, and a little struggle to find matching applications as that of IBM PC.

Overall, it’s a world of pleasure to have the previlige of owning this fantastic machine. With so much to treasure, I can forgive its bulkiness. Will I ever revert to IBM PC – the greatest single reason if I were to perhaps, is applications. But as the days go by, I begin finding more and more apps in Mac, which I am sure will be able to cater more than adequately my computing needs.

Rating: **** (actually 4.5*, well I would go for 5* easily if not because I have only owned this laptop for less than 3 weeks!)

When religious sensitivity hits the nation, again…

We must not let the nation plunder just because of this misunderstanding. In Malaysia, anything that has to do with the royalty, religion or ethnicity has always been treated as sensitive which can easily leads to tension within the nation.

Suddenly the issue of JAIS raided DUMC premises last August resurfaced. First the One Million People March which is planned on October 22, aimed at promoting the Muslim voice agains prosetylisation. Then the Royalty (Selangor Sultan) statement in support of JAIS action on DUMC provocative action of condemning anyone who insulted or seemed to have insulted the royalty, leading them to publish a damning article against a university professor (Aziz Bari) who openly criticized Selangor Sultan on this issue.

And as usual our exPM Tun M did not want to miss the bandwagon, added shadow to the clout by further criticising the Professor in almost similar manner to Utusan.
And the event that followed was no surprise, the Rector of the University where Prof. Aziz served issued a controversial decision of suspending his contract and withdrew his access to the university.

…Another setback to the intellectual and academic world of Malaysia. Undescribable, if only one is allowed to remark that such a stern action is the worst ever pusnishment one could be given, especially when the case has not been entered into proper investigation and formal judgment process.

So where do I stand? Do I support or totally oppose to the HIMPUN, or do I embraced in totality the opinion of Malaysiakini and the rest of the gang who support a full free-willy state of liberal opinions including condemning religious institution/religion & royalty at any rate they want? I beg to differ, I stand in the middle in the case, not because I want to compromise. But I would like to adopt the attitude of a truth seeker, and at the same time someone who loves and defends his own religion (which is only fair to anyone who professes a religion on earth).

At around the same time, there has been a healthy debate in PPIM-NET (albeit tending to a little bit abrasive one), regarding this issue. Many of the opinions expressed were polarised to one end or the other, though I think there were some misunderstanding or miscommunication here, as it is well known that majority of PPIM-NET members have fair and balance attitude.

As a Muslim, I love my religion and I want to protect it. But I have a serious doubt that HIMPUN could do anything to either protect Islam against prosetylisation or even make the Muslims more aware of the threat against their religion. In contrast to BERSIH which I fully support, HIMPUN is of a different thing altogether. The nature of the gathering itself has attracted a lot of criticism and prejudice from non-Muslims. If the intention was to raise the awareness of all Muslims over the threat of Christianisation or the like, then a few hours of gathering like this will serve little purpose. By announcing this a BIG gathering called a million gathering, itself has a provocative and boastful element, whereas the real issue at hand is not clear.

It would be different, if such a gathering is held to demonstrate against the case of Lina Joy or Aisyah Bukhari for example, then it may be fair, though many things can still be debated here. However, to call people for a broad and vague theme such as ‘selamatkan aqidah’ (save the belief) is a bit untimely.

Perhaps, they should rather raise the awareness of Muslims nationwide, about the weakness of Iman (faith) which has led to all these corruptions, child killing and political backstabbing. There is a big difference between the two (Iman and aqidah) – though they closely related. As the Prophet did mention in a tradition:
“The People will soon summon one another to attack you as people when eating invite others to share their food.” Someone asked, “Will that be because of our small numbers at that time?” He replied, “No, you will be numerous at that time: but you will be froth and scum like that carried down by a torrent (of water), and Allah will take the fear of you from the breasts (hearts) of your enemy and cast al-wahn into your hearts.” Someone asked, “O Messenger of Allah, what is al-wahn?” He replied, “Love of the world and dislike of death.” [An authentic hadith recorded by Abu Dawud and Ahmad]

Just look back at Hudud issue, why would many Muslim come forth at the cost of sacrificing their ‘aqidah’ by liberally criticising the Hudud system (read for eg. Azmi Sharom link) what is the first word that should come out from a Muslim when some issue pertinent to their faith being raised? As a person who professes the faith there should not be any hesitation nor denial. I may sound conservative, but as a Muslim if you want to preserve your faith, then one of the ways is to treat your faith as something that you really treasure and honour, not otherwise.

Having said all these, I do not deny, that there are anecdotal evidences of attempt at prosetylising Muslims – and, reading between the lines, there are some mainline national newspaper that behave like promoting Christianity, indirectly. However, this is very much the responsibility of the Government & JAKIM to monitor, to be aware of all these subtle attempts, rather than just sitting comfortably in the air-conditioned office waiting for a Muslim to announce their apostasy.

A Muslim should be aware that the threat to their faith/belief is an ongoing thing in life, however, one best way of protecting Islam, is by adopting this faith in its entirety, including a full implementation of the Islamic state system (not partial) – hudud being the last in that order. I was upset one day, to find how a huge shopping centre like Wangsa Walk provides a miniature size prayer room that is enough to accommodate less than ten people at a time – how you can practice your faith in this country if simple things like this cannot be observed (I joked by saying, how can we implement hudud, if people are not able to perform their prayers when they go out shopping?) – as about whose fault it is, is a matter of discussion, however, the moral we can draw from this is, establishing the religion (Islam) cover all spheres of life from establishing the prayers and zakat (two most fundamental – one to do with peoples’ commitment to God, the other to society), preserving the moral conduct of the society, to implementing the sphere of education, economy and political life, and followed by legal area including that of hudud etc.

Lastly, our pride and sympathy goes to Prof Aziz, who has been the victim of politic – full stop. Whatever follows, damage has been done, and this is another sad history in Malaysia. How we can make amend, collectively, is by voicing our objection to such primitive act, which only serve to detriment our progress towards a mature society.