Hasil attach kat farmasi klinik kesihatan…..
Lasix = ferusemide
Bactrim = co-trimoxazole
Zantac = ranitidine
Methyl cobalt = mecobalamine
MTF = metformin
Daonil = glibenclamide
Diamicron = gliclazide
Lopid = gemfibrozil
CML = chlorampehicol (eye drop, ear drop,cream/lotion etc)
LMS = methysalicylate (cream/lotion)
Bacampicillin = potassium chloride (for UTI??)
Papase = prolase
Adalat = nifedipine
Piritone : methotrexate maleate
HCT = hydrochlorothiazide
Lamotrine = diphenoxylate
Maxolone = metoclopramide
Zinnat = cefuroxime
Bisolvon = bromhexine
MES = mist ammonium appecacuanha (ubat batuk)
FES = erythromycin
Voltran = diclofenac sodium
Buscopan = hyoscine
Tapi satu saya tertarik, ubat BISOPROLOL… bentuk dia bentuk LOVE.. dan pharmacist tu x letak kat luar. Macam ubat terkawal. Sbb siap ada borang pharmacist tu kena isi. Agak2 kenapa ye? Kena Tanya kaklong ni…
Monday, November 21, 2011
case scenario : hypertension
Case Information
CC/HPI: A 37 year old white male with an otherwise unremarkable past medical history presents to his doctor for routine physical. He presents with no complaints.
Past Medical History: None
Medication History: None
Vaccination History: up to date.
Adherence/Medication Use Behaviors: Patient was on time to doctor's appointment.
Drug Allergies/Adverse Effects: NKDA
Pharmacy/Medical Payment: Employer Insurance
Medications Administered by: Self
Family Medical History:
Father/Mother: unremarkable
Siblings: unremarkable
Children: none
Other: none
Social History:
Residence: single apartment
Occupation: office worker
Smoking: none
Diet: fast food
EtOH: none
Education: Masters degree
Illicit Drugs: none
Family/Social Environment: lives alone
Symptom Analysis:
Head, Eyes, Neck, Throat: Denies blurriness or change of vision, confusion, speech and cognition disorders.
Heart: Denies chest pain and palpitations.
Lung: Denies shortness of breath.
Gastrointestinal: Denies abnormalities of frequency, color, and consistency of stool. Denies bowel pain or cramping.
Gennitourinal: Denies abnormalities of frequency, color, and consistency of urination.
Musculoskeletal: Denies weakness, cramping, pain or paralysis.
Extremities: Denies numbness, tingling, coldness, or color abnormalities.
Neuro/Psych: Denies anxiety, depression, sleep disorders.
Physical Exam:
Head, Eyes, Neck, Throat: Patient presents with no facial asymmetries or drooping. No abnormal venous pulsations. Fundoscopy not performed.
Heart: S1 and S2 heart sounds present. No murmurs. No S3 or S4 sounds present.
Lung: Lungs clear to auscultation. No wheezing, crackles or ronchi. Percussion produces neither dull or hyperresonant sounds.
Abdominal: Normal active bowel sounds present. Non-tender and non-distended. No bruits over aortic, renal or illiac positions.
Extremities: Bilateral pulses present that are regularly regular rhythm. Hair symmetrically present. No nail clubbing present.
Neuro/Psych: Patient is amiable and cooperative. Responsive to questions and commands.
Vital Signs:
Temp: 98.6 F
Heart Rate (right arm): 74 (regularly regular)
Blood Pressure (right arm, sitting): 152/94
Respiratory Rate: 16 breaths/minute
Height/Weight: 5'11'' 190 lbs (BMI: 26.5)
Discussion
Most will consider this discussion overdone especially in this patient who presents with an unremarkable presentation. However, the thoroughness of our discussion here will set the stage for further cases that have relevant presentations of hypertensive complications. This discussion will first establish a diagnosis followed by rationale for how that diagnosis was derived. Following diagnosis, we will establish a likely prognostic course in this patient if left without intervention. Finally, we will discuss the best interventions to take in this patient to promote the best prognostic outcome.
Diagnosis
With a single first measurement of blood pressure, in this patient, it is not appropriate to jump to a diagnosis of hypertension. Academically, guidelines recommend three separate measurements of an elevated blood pressure (>140/90) within a six month period prior to a hypertension diagnosis[1]. Acquiring patient specific medical and social history is vital in directing a relevant diagnosis. Hypertension is a "silent" disease that presents with no symptoms. However, complications of organ damage secondary to hypertension have symptoms that are useful in providing a sense of how serious this patient's hypertensive status, if any, presents.
We first need to evaluate any acute causes of an elevated blood pressure reading. The first might be an error in reading. Academically, guidelines recommend a 5 minute period of resting with no consumption of caffeine or nicotine products prior to the exam. It is usually difficult and impractical in a real clinical setting to follow this. There are also cases of "white coat hypertension" that occur when a patient's presence in a clinical setting cause acute increases in blood pressure.
Acute causes may also be drug or substance related, notably caffeine, nicotine, non-steroidal anti-inflammatory drugs (NSAIDs), and illicit substances such as cocaine and amphetamine. This patient denied any use of illicit drugs or medication history.
We may rule out other improbable causes such as sleep apnea. Patient denies sleep disorders. Chronic kidney disease is unlikely. Patient denies abnormalities in urination. Primary aldosteronism is unlikely as this patient denies muscle weakness or fatigue. Thyroid disease is unlikely as this patient denies mood, energy, appetite or weight change abnormalities. Patient also presents with no other abnormal cardiovascular findings, typical of thyroid disease.
Next turning to risk factors we clearly see an elevated weight (BMI: 26.5) and a regular diet of fast food. This patient does not smoke, use illicit drugs, or excess alcohol. We are not certain of his family history of blood pressure, though he does not admit to remarkable family medical problems.
Prognosis
Even if we assume this patient has hypertension, we are not certain of this patient's cholesterol levels to accurately determine his future risk of cardiovascular disease. Considering worst and best case scenarios of at goal and not-at-goal cholesterol levels, we can estimate this patient's 10 year risk of cardiovascular disease at 1% to 6%[2]. This means that if his blood pressure remains unchanged we have the following best and worst case scenarios. If his cholesterol is at goal (HDL is 40 and Total Cholesterol is 160) his risk of having a myocardial infarction, ischemic stroke, peripheral arterial disease, heart failure or death from cardiovascular causes is 1%. On the contrary, if his HDL is 30 and Total Cholesterol is 290, it is 6% likely for the aforementioned to occur.
Intervention Options
Despite no diagnosis, the lack of presenting end-organ damage complications make candidate interventions in this patient simple. He would clearly benefit from a reduction in his weight, increase in exercise activity and modification of his diet whether or not he has hypertension. Antihypertensive medications might not be helpful at this time as we do not have a formal diagnosis. While they would most likely not harm the patient, their benefit in preventing cardiovascular events in this patient would be questionable. Finally, it would be important to get a laboratory reading of this patient's cholesterol levels to make a formal prognostic risk assessment of future cardiovascular events.
Therapeutic Intervention
The most outcome benefiting intervention at this time would be to counsel this patient on lifestyle modifications as well as laboratory assessment of his cholesterol. The "Dash Diet" has been the lifestyle recommendation of choice for patients with hypertension[3]. For this patient, it recommends four servings each of fruits and vegetables daily, seven servings of whole grains, with limits of 2.5, 1.5, 0.5, 2, and 0.5 servings of dairy, meat, nuts/beans, fats, and sweets respectively. Also, the American College of Sports Medicine recommends 20 to 30 minutes three times weekly of endurance exercise training to drop systolic blood pressure by 10 mmHg[4].
Follow-Up and Monitoring
This patient should return in less than sixth months for a repeat measurement of his blood pressure and follow-up on results from his cholesterol testing.
Economic Analysis
The goal of economic analysis is to determine the value of certain health interventions or the burden of not intervening to aid in decision making. No precedence exists for the health economic evaluation on a patient level. This section follows the common taxonomy of economic analysis for decision making as well as the author's introduction of Real Options Analysis (What is this?). Our economic analysis will involve a population of 100 individuals that match the same characteristics of the patient here. Our application of Real Options Analysis will allow for evaluation on a patient level.
Preliminaries
Economic analysis requires the development of models which require assumptions and parameters. We will evaluate a horizon of 10 years under the following assumptions:
Diastolic blood pressure and the related pulse pressure will have no prediction on 10 year cardiovascular disease risk.
The mean and variance of all inputed values does not change throughout the horizon.
The only therapeutic options available are diet and exercise.
There is no difference in cost between patients' existing diet and the DASH diet.
DASH low sodium diet will reduce systolic blood pressure a mean -8.9 mmHg (95% confidence interval: -6.7 to –11.1) over 30 days[5].
Exercise as recommended will reduce systolic blood pressure a mean -10 mmHg (95% confidence interval: -7.5 to -12.5) over 30 days[4].
No additional blood pressure improvements will accrue after the initial benefit.
The blood pressure never worsens over the horizon.
Model
Figure 1 shows the model to be employed. The decision to be evaluated is comparing the impact of DASH diet and exercise versus doing nothing. The 'M' is a Markov Model (see introduction to Markov Modeling here) of which we evaluate shown in Figure 2. The markov model assumes a single change in blood pressure with a subsequent influence on cardiovascular disease outcomes over the 10 year horizon. At study initiation the blood pressure may stay the same, or drop to within 120-139 or <120. This blood pressure state has a corresponding impact on cardiovascular disease risk.
Table 1 shows the probabilities of these transition states. These were calculated from the mean and standard deviations of the studied outcome of diet[5] and exercise[4]. Instead of modeling a continuous blood pressure change, this allows for the modeling of states which may more accurately reflect the systolic pressure variability throughout the horizon.
Calculating such involved first combining the mean and standard deviations of the two interventions assuming independence in both of their outcomes. Then, we calculate the distributions based on the new mean and standard deviation. Finally we calculate the cumulate distribution of patients at different states.
The combined mean of -8.9 mmHg from [5] and -10 from [4] is a simple sum to -18.9 mmHg mean change. The standard deviations of 2.2 and 2.5 respectively were calculated from the formula . Thus the combined standard deviation was calculated to be 3.3.
Calculating the distributions involving using a statistical package, in this case R Cran, using the "rnorm" function with the inputs of mean=-18.9 and sd=3.3. The syntax is data <- rnorm(10000,18.9,3.3).
To calculate the percentage of patients transitioning to normotensive state we calculate the cumulative distribution of those that had >=20 mmHg. The syntax for this calculation in R is length(data[data>=20])/10000. To calculate the percentage of patients transitioning to a normotensive state we calculate the cumulative distribution of those that had <=10 mmHg. The syntax for this calculation in R is length(data[data<=10])/10000. Finally, calculating the cumulative distribution of patients transitioning to the prehypertensive state was simply the remaining. Table 1 shows the probabilities of these transition state calculations.
Table 2 shows the 10 year probabilities of cardiovascular risk given our uncertainty of patients' cholesterol levels. These were calculated using the framingham risk calculator. The two different transition probabilities take into account the uncertainty of the patients' cholesterol values. The lower and upper value correspond to Total and HDL inputs of 160, 40 and 280, 35, respectively. The other inputs were male 37 years old, non-smoker, and not on blood pressure therapy. The SBPs were inputed as 150, 135 and 118, respectively.
Figure 1. Decision Model for Economic Analysis (Case # s1htn.m.37)
Figure 2. Markov Model for Outcomes of Blood Pressure Lowering (Case # s1htn.m.37)
Table 1. Transition Probabilities of Blood Pressure States
Ending
State With Treatment Without
Treatment
140-159 1% 100%
120-139 60% 0%
<120 39% 0%
Table 2. Transition Probabilities of CVD States
SBP State p (CVD)
140-159 1% to 6%
120-139 1% to 4%
<120 1% to 3%
Budget Impact Analysis
Table 3. Input Parameters
Cost Effectiveness Analysis
Disclaimer: Patient information in this case is fictional and for educational purposes only. Any similarity to real persons or events is coincidental. Information contained in this knol is not to replace medical advice from a licensed health care provider. The author of this knol does not produce or endorse content from advertisements on this page.
CC/HPI: A 37 year old white male with an otherwise unremarkable past medical history presents to his doctor for routine physical. He presents with no complaints.
Past Medical History: None
Medication History: None
Vaccination History: up to date.
Adherence/Medication Use Behaviors: Patient was on time to doctor's appointment.
Drug Allergies/Adverse Effects: NKDA
Pharmacy/Medical Payment: Employer Insurance
Medications Administered by: Self
Family Medical History:
Father/Mother: unremarkable
Siblings: unremarkable
Children: none
Other: none
Social History:
Residence: single apartment
Occupation: office worker
Smoking: none
Diet: fast food
EtOH: none
Education: Masters degree
Illicit Drugs: none
Family/Social Environment: lives alone
Symptom Analysis:
Head, Eyes, Neck, Throat: Denies blurriness or change of vision, confusion, speech and cognition disorders.
Heart: Denies chest pain and palpitations.
Lung: Denies shortness of breath.
Gastrointestinal: Denies abnormalities of frequency, color, and consistency of stool. Denies bowel pain or cramping.
Gennitourinal: Denies abnormalities of frequency, color, and consistency of urination.
Musculoskeletal: Denies weakness, cramping, pain or paralysis.
Extremities: Denies numbness, tingling, coldness, or color abnormalities.
Neuro/Psych: Denies anxiety, depression, sleep disorders.
Physical Exam:
Head, Eyes, Neck, Throat: Patient presents with no facial asymmetries or drooping. No abnormal venous pulsations. Fundoscopy not performed.
Heart: S1 and S2 heart sounds present. No murmurs. No S3 or S4 sounds present.
Lung: Lungs clear to auscultation. No wheezing, crackles or ronchi. Percussion produces neither dull or hyperresonant sounds.
Abdominal: Normal active bowel sounds present. Non-tender and non-distended. No bruits over aortic, renal or illiac positions.
Extremities: Bilateral pulses present that are regularly regular rhythm. Hair symmetrically present. No nail clubbing present.
Neuro/Psych: Patient is amiable and cooperative. Responsive to questions and commands.
Vital Signs:
Temp: 98.6 F
Heart Rate (right arm): 74 (regularly regular)
Blood Pressure (right arm, sitting): 152/94
Respiratory Rate: 16 breaths/minute
Height/Weight: 5'11'' 190 lbs (BMI: 26.5)
Discussion
Most will consider this discussion overdone especially in this patient who presents with an unremarkable presentation. However, the thoroughness of our discussion here will set the stage for further cases that have relevant presentations of hypertensive complications. This discussion will first establish a diagnosis followed by rationale for how that diagnosis was derived. Following diagnosis, we will establish a likely prognostic course in this patient if left without intervention. Finally, we will discuss the best interventions to take in this patient to promote the best prognostic outcome.
Diagnosis
With a single first measurement of blood pressure, in this patient, it is not appropriate to jump to a diagnosis of hypertension. Academically, guidelines recommend three separate measurements of an elevated blood pressure (>140/90) within a six month period prior to a hypertension diagnosis[1]. Acquiring patient specific medical and social history is vital in directing a relevant diagnosis. Hypertension is a "silent" disease that presents with no symptoms. However, complications of organ damage secondary to hypertension have symptoms that are useful in providing a sense of how serious this patient's hypertensive status, if any, presents.
We first need to evaluate any acute causes of an elevated blood pressure reading. The first might be an error in reading. Academically, guidelines recommend a 5 minute period of resting with no consumption of caffeine or nicotine products prior to the exam. It is usually difficult and impractical in a real clinical setting to follow this. There are also cases of "white coat hypertension" that occur when a patient's presence in a clinical setting cause acute increases in blood pressure.
Acute causes may also be drug or substance related, notably caffeine, nicotine, non-steroidal anti-inflammatory drugs (NSAIDs), and illicit substances such as cocaine and amphetamine. This patient denied any use of illicit drugs or medication history.
We may rule out other improbable causes such as sleep apnea. Patient denies sleep disorders. Chronic kidney disease is unlikely. Patient denies abnormalities in urination. Primary aldosteronism is unlikely as this patient denies muscle weakness or fatigue. Thyroid disease is unlikely as this patient denies mood, energy, appetite or weight change abnormalities. Patient also presents with no other abnormal cardiovascular findings, typical of thyroid disease.
Next turning to risk factors we clearly see an elevated weight (BMI: 26.5) and a regular diet of fast food. This patient does not smoke, use illicit drugs, or excess alcohol. We are not certain of his family history of blood pressure, though he does not admit to remarkable family medical problems.
Prognosis
Even if we assume this patient has hypertension, we are not certain of this patient's cholesterol levels to accurately determine his future risk of cardiovascular disease. Considering worst and best case scenarios of at goal and not-at-goal cholesterol levels, we can estimate this patient's 10 year risk of cardiovascular disease at 1% to 6%[2]. This means that if his blood pressure remains unchanged we have the following best and worst case scenarios. If his cholesterol is at goal (HDL is 40 and Total Cholesterol is 160) his risk of having a myocardial infarction, ischemic stroke, peripheral arterial disease, heart failure or death from cardiovascular causes is 1%. On the contrary, if his HDL is 30 and Total Cholesterol is 290, it is 6% likely for the aforementioned to occur.
Intervention Options
Despite no diagnosis, the lack of presenting end-organ damage complications make candidate interventions in this patient simple. He would clearly benefit from a reduction in his weight, increase in exercise activity and modification of his diet whether or not he has hypertension. Antihypertensive medications might not be helpful at this time as we do not have a formal diagnosis. While they would most likely not harm the patient, their benefit in preventing cardiovascular events in this patient would be questionable. Finally, it would be important to get a laboratory reading of this patient's cholesterol levels to make a formal prognostic risk assessment of future cardiovascular events.
Therapeutic Intervention
The most outcome benefiting intervention at this time would be to counsel this patient on lifestyle modifications as well as laboratory assessment of his cholesterol. The "Dash Diet" has been the lifestyle recommendation of choice for patients with hypertension[3]. For this patient, it recommends four servings each of fruits and vegetables daily, seven servings of whole grains, with limits of 2.5, 1.5, 0.5, 2, and 0.5 servings of dairy, meat, nuts/beans, fats, and sweets respectively. Also, the American College of Sports Medicine recommends 20 to 30 minutes three times weekly of endurance exercise training to drop systolic blood pressure by 10 mmHg[4].
Follow-Up and Monitoring
This patient should return in less than sixth months for a repeat measurement of his blood pressure and follow-up on results from his cholesterol testing.
Economic Analysis
The goal of economic analysis is to determine the value of certain health interventions or the burden of not intervening to aid in decision making. No precedence exists for the health economic evaluation on a patient level. This section follows the common taxonomy of economic analysis for decision making as well as the author's introduction of Real Options Analysis (What is this?). Our economic analysis will involve a population of 100 individuals that match the same characteristics of the patient here. Our application of Real Options Analysis will allow for evaluation on a patient level.
Preliminaries
Economic analysis requires the development of models which require assumptions and parameters. We will evaluate a horizon of 10 years under the following assumptions:
Diastolic blood pressure and the related pulse pressure will have no prediction on 10 year cardiovascular disease risk.
The mean and variance of all inputed values does not change throughout the horizon.
The only therapeutic options available are diet and exercise.
There is no difference in cost between patients' existing diet and the DASH diet.
DASH low sodium diet will reduce systolic blood pressure a mean -8.9 mmHg (95% confidence interval: -6.7 to –11.1) over 30 days[5].
Exercise as recommended will reduce systolic blood pressure a mean -10 mmHg (95% confidence interval: -7.5 to -12.5) over 30 days[4].
No additional blood pressure improvements will accrue after the initial benefit.
The blood pressure never worsens over the horizon.
Model
Figure 1 shows the model to be employed. The decision to be evaluated is comparing the impact of DASH diet and exercise versus doing nothing. The 'M' is a Markov Model (see introduction to Markov Modeling here) of which we evaluate shown in Figure 2. The markov model assumes a single change in blood pressure with a subsequent influence on cardiovascular disease outcomes over the 10 year horizon. At study initiation the blood pressure may stay the same, or drop to within 120-139 or <120. This blood pressure state has a corresponding impact on cardiovascular disease risk.
Table 1 shows the probabilities of these transition states. These were calculated from the mean and standard deviations of the studied outcome of diet[5] and exercise[4]. Instead of modeling a continuous blood pressure change, this allows for the modeling of states which may more accurately reflect the systolic pressure variability throughout the horizon.
Calculating such involved first combining the mean and standard deviations of the two interventions assuming independence in both of their outcomes. Then, we calculate the distributions based on the new mean and standard deviation. Finally we calculate the cumulate distribution of patients at different states.
The combined mean of -8.9 mmHg from [5] and -10 from [4] is a simple sum to -18.9 mmHg mean change. The standard deviations of 2.2 and 2.5 respectively were calculated from the formula . Thus the combined standard deviation was calculated to be 3.3.
Calculating the distributions involving using a statistical package, in this case R Cran, using the "rnorm" function with the inputs of mean=-18.9 and sd=3.3. The syntax is data <- rnorm(10000,18.9,3.3).
To calculate the percentage of patients transitioning to normotensive state we calculate the cumulative distribution of those that had >=20 mmHg. The syntax for this calculation in R is length(data[data>=20])/10000. To calculate the percentage of patients transitioning to a normotensive state we calculate the cumulative distribution of those that had <=10 mmHg. The syntax for this calculation in R is length(data[data<=10])/10000. Finally, calculating the cumulative distribution of patients transitioning to the prehypertensive state was simply the remaining. Table 1 shows the probabilities of these transition state calculations.
Table 2 shows the 10 year probabilities of cardiovascular risk given our uncertainty of patients' cholesterol levels. These were calculated using the framingham risk calculator. The two different transition probabilities take into account the uncertainty of the patients' cholesterol values. The lower and upper value correspond to Total and HDL inputs of 160, 40 and 280, 35, respectively. The other inputs were male 37 years old, non-smoker, and not on blood pressure therapy. The SBPs were inputed as 150, 135 and 118, respectively.
Figure 1. Decision Model for Economic Analysis (Case # s1htn.m.37)
Figure 2. Markov Model for Outcomes of Blood Pressure Lowering (Case # s1htn.m.37)
Table 1. Transition Probabilities of Blood Pressure States
Ending
State With Treatment Without
Treatment
140-159 1% 100%
120-139 60% 0%
<120 39% 0%
Table 2. Transition Probabilities of CVD States
SBP State p (CVD)
140-159 1% to 6%
120-139 1% to 4%
<120 1% to 3%
Budget Impact Analysis
Table 3. Input Parameters
Cost Effectiveness Analysis
Disclaimer: Patient information in this case is fictional and for educational purposes only. Any similarity to real persons or events is coincidental. Information contained in this knol is not to replace medical advice from a licensed health care provider. The author of this knol does not produce or endorse content from advertisements on this page.
Wednesday, November 16, 2011
tanda2 telah mendapat cinta ALLAH
Antara Tanda-Tanda Telah Mencintai ALLAH
1. Solat bukan lagi semata-mata kerana perkara fardhu yang wajib tetapi adalah perkara yang dinanti-nanti dan dirindu pada setiap saat seperti seorang kekasih yang rindu untuk bertemu kekasihnya
2. Zikir bukan lagi semata-mata kerana sunnah yang dituntut melainkan kerana perasaan asyik dan tenang jiwa bila menyebut nama ALLAH yang Maha Agung seperti seronok dan asyiknya seorang kekasih menyebut nama kekasihnya
3. Nama ALLAH sentiasa disebut-sebut di dalam hati, fikiran dan sanubari sehingga terbawa-bawa dalam tidur juga menyebut namaNYA seperti seorang kekasih yang selalu bermimpi dan mengigaukan kekasihnya sewaktu beradu
4. Melakukan ibadat & ketaatan bukan lagi kerana ingin mendapat balasan pahala atau kerana takutkan azab neraka, tetapi kerana rasa tanggungjawab dan kecintaan yang mendalam dan merasa sangat bersalah apabila terlalai dari melakukan ketaatan yang telah sebati dilakukan selama beberapa waktu seperti seorang kekasih yang sanggup melakukan apa saja yang disukai kekasihnya dan membenci apa saja yang dibenci kekasihnya semata-mata kerana perkara itu disukai atau dibenci kekasihnya
5. bila hanya kepada ALLAH tempat bergantung dan tempat pengaduan segala perkara
6. bila tidak lagi mendengar panggilan dan kata-kata orang sekelilingmu kerana asyiknya memuji dan memuja ALLAH seperti asyiknya seorang yang sedang mabuk bercinta dengan kekasihnya
7. bila celaan & hinaan orang dengan mengatakan gila, sakit, atau tidak siuman hanya kerana kita terlalu rindu dan sentiasa mengingat dan memuja kebesaran dan nikmat ALLAH seperti halnya seorang kekasih yang gila bayang dan kelihatan suka menyendiri kerana mengingat dan memuja kekasih hatinya.
1. Solat bukan lagi semata-mata kerana perkara fardhu yang wajib tetapi adalah perkara yang dinanti-nanti dan dirindu pada setiap saat seperti seorang kekasih yang rindu untuk bertemu kekasihnya
2. Zikir bukan lagi semata-mata kerana sunnah yang dituntut melainkan kerana perasaan asyik dan tenang jiwa bila menyebut nama ALLAH yang Maha Agung seperti seronok dan asyiknya seorang kekasih menyebut nama kekasihnya
3. Nama ALLAH sentiasa disebut-sebut di dalam hati, fikiran dan sanubari sehingga terbawa-bawa dalam tidur juga menyebut namaNYA seperti seorang kekasih yang selalu bermimpi dan mengigaukan kekasihnya sewaktu beradu
4. Melakukan ibadat & ketaatan bukan lagi kerana ingin mendapat balasan pahala atau kerana takutkan azab neraka, tetapi kerana rasa tanggungjawab dan kecintaan yang mendalam dan merasa sangat bersalah apabila terlalai dari melakukan ketaatan yang telah sebati dilakukan selama beberapa waktu seperti seorang kekasih yang sanggup melakukan apa saja yang disukai kekasihnya dan membenci apa saja yang dibenci kekasihnya semata-mata kerana perkara itu disukai atau dibenci kekasihnya
5. bila hanya kepada ALLAH tempat bergantung dan tempat pengaduan segala perkara
6. bila tidak lagi mendengar panggilan dan kata-kata orang sekelilingmu kerana asyiknya memuji dan memuja ALLAH seperti asyiknya seorang yang sedang mabuk bercinta dengan kekasihnya
7. bila celaan & hinaan orang dengan mengatakan gila, sakit, atau tidak siuman hanya kerana kita terlalu rindu dan sentiasa mengingat dan memuja kebesaran dan nikmat ALLAH seperti halnya seorang kekasih yang gila bayang dan kelihatan suka menyendiri kerana mengingat dan memuja kekasih hatinya.
tanda2 awal cinta ALLAH
Antara Tanda-tanda awal:-
1. Solat tidak lagi menjadi perkara berat untuk dilaksanakan sebaliknya akan sangat mudah dan dinanti-nanti waktu hadirnya.
2. Mula merasa menunaikan solat sesuatu yang mengasyik & menenangkan jiwa & fikiran sehingga sangat seronok untuk melakukan sebanyak-banyaknya seperti seorang kekasih yang seronok untuk menatap dan mengadu kepada kekasihnya dengan sebanyak-banyaknya
3. Zikir kepada ALLAH adalah menjadi kata-kata yg paling digemari walaupun kadang-kala terlalai atas urusan duniawi
4. Kurang bercakap atau tidak bercakap yang sia-sia (bercakap bila perlu sahaja)
5. tiba-tiba hilang perhatian kepada material duniawi seperti kalau dulu suka berbelanja atau bersuka-ria atau suka kepada hiburan maka kini mula menjauh diri kerana hilang minat sebaliknya lebih suka menyendiri dan muhasabah diri
6. sering menangis bila mengingat dosa yang pernah dilakukan sekalipun sangat kecil
7. sering menangis kerana takutkan azab neraka yang tidak mampu menahannya
8. sering mengingati bagaimanakah keadaan menghadapi azab kubur
9. sering merasakan bahawa nyawa akan dicabut malaikatmaut pada bila-bila masa saja
10. tidak runsing atas segala yang berlaku pada dirinya samada masalah atau musibah yang datang melanda kerana percaya atas apa yang ALLAH kehendaki ke atasnya adalah kebaikan
11. sentiasa bersyukur tetapi bimbang saat menerima nikmat ALLAH yang merupakan satu ujian menguji keimanan diri
12. sering khuatir tindakan yang dilakukan pada setiap waktu apakah diberkati dan dirahmati ALLAH atau dimurkai Tuhan
13. sering merasakan musuh paling utama adalah diri sendiri yang mempunyai sifat2 mazmumah yang sukar dibendung dan dikawal
14. tiap saat merasakan telah melakukan banyak kesalahan dan dosa
15. sentiasa meminta ampunan dari ALLAH dan yakin bahawa ALLAH adalah Tuhan Yang Maha Pengampun lagi Maha Penyayang
16. sering muhasabah diri pada setiap hari dan malam
1. Solat tidak lagi menjadi perkara berat untuk dilaksanakan sebaliknya akan sangat mudah dan dinanti-nanti waktu hadirnya.
2. Mula merasa menunaikan solat sesuatu yang mengasyik & menenangkan jiwa & fikiran sehingga sangat seronok untuk melakukan sebanyak-banyaknya seperti seorang kekasih yang seronok untuk menatap dan mengadu kepada kekasihnya dengan sebanyak-banyaknya
3. Zikir kepada ALLAH adalah menjadi kata-kata yg paling digemari walaupun kadang-kala terlalai atas urusan duniawi
4. Kurang bercakap atau tidak bercakap yang sia-sia (bercakap bila perlu sahaja)
5. tiba-tiba hilang perhatian kepada material duniawi seperti kalau dulu suka berbelanja atau bersuka-ria atau suka kepada hiburan maka kini mula menjauh diri kerana hilang minat sebaliknya lebih suka menyendiri dan muhasabah diri
6. sering menangis bila mengingat dosa yang pernah dilakukan sekalipun sangat kecil
7. sering menangis kerana takutkan azab neraka yang tidak mampu menahannya
8. sering mengingati bagaimanakah keadaan menghadapi azab kubur
9. sering merasakan bahawa nyawa akan dicabut malaikatmaut pada bila-bila masa saja
10. tidak runsing atas segala yang berlaku pada dirinya samada masalah atau musibah yang datang melanda kerana percaya atas apa yang ALLAH kehendaki ke atasnya adalah kebaikan
11. sentiasa bersyukur tetapi bimbang saat menerima nikmat ALLAH yang merupakan satu ujian menguji keimanan diri
12. sering khuatir tindakan yang dilakukan pada setiap waktu apakah diberkati dan dirahmati ALLAH atau dimurkai Tuhan
13. sering merasakan musuh paling utama adalah diri sendiri yang mempunyai sifat2 mazmumah yang sukar dibendung dan dikawal
14. tiap saat merasakan telah melakukan banyak kesalahan dan dosa
15. sentiasa meminta ampunan dari ALLAH dan yakin bahawa ALLAH adalah Tuhan Yang Maha Pengampun lagi Maha Penyayang
16. sering muhasabah diri pada setiap hari dan malam
a story of today.-->>aku dan masyarakat...
sbnrnya aku pun xtau kenapa dalam banyak2 peristiwa, situasi dan kondisi yg pelbagai dalam masyarakat yg aku jumpa setiap hari, aku pilih kisah hari ini untuk dikongsi. kisah ini kisah biasa, malah ada banyak lg kes yg lebih menyentuh hatiku yg kusaksikan pada patient2ku. mungkin ada sesuatu sbb kenapa ALLAh gerakkan hatiku untuk berkongsi kisah ini..
hari ini, 16 november 2011. aku ke klinik seperti hari sebelumnya. ini hari kedua aku di klinik slps hari yg begitu sibuk semalam. alhamdulillah hari ni pesakit x ramai seperti semalam, tp tetap ramai juga sbnrnya. hari ni pagi aku bertugas bhgn consultation pesakit. so agak free pagi ni. petang aku bertugas di bilik rawatan. tp krn sedikit mslh teknikal, aku setuju untuk tukar jadual dgn my colleague yg ada appointment dgn dr gigi. hajatku ingin gunakan waktu pagi tu untuk buat test HIV untuk persediaan perkahwinanku dengan pilihan hatiku x lama lagi insyaALLAH. tp selepas ditanya pd staf di kaunter, katanya HIV test adalah pd waktu petang. maka xpelah, aku pun menuju ke bilik rawatan.
satu demi satu pesakit masuk mendapatkan rawatan. kebanyakannya adalah pesakit ulser kaki diabetes. pesakit x putus2 masuk. selepas aku memasukkan branula ke salur darah seorang pesakit untuk dimasukkan drip, masuk seorang ibu bersama anak lelakinya, awal 20-an. eh, makcik ni dah pernah jumpa dah 2 bulan lepas ni kat emergency department hospital. dia datang untuk apa ni. drpd perbncgn dgn pembantu pegawai perubatan, tahulah aku bahawa dia ingin set up medical check up untuk anak lelakinya it yg bakal masuk ke institut kemahiran mara. aku kenal makcik ni, masih ingat peristiwa kat emergency dulu, dia menangis nangis taknak masuk wad sebab katanya xde sape nak jaga anak tunggalnya itu. kini, dia mengiringi anak lelakinya untuk buat medical check up. seingat aku dulu, mak aku biarkan sorang2 je pergi buat medical check up. terkontang kanting aku cari haluan sendri kat klinik masa tu. masa PPP tgh set up appointment tu, tba2 maknya memandang aku dan tiba2 bersuara "nak ambik bahagian ke-ju-ru-te-ra-an au-to-mo-tif" sambil tersenyum lebar.. aku hanya tersenyum melihat senyuman bahagia si ibu. cara dia bgtau aku menampakkan dia sungguh bangga dengan anaknya.
seketika kemudian PPP bertanya kepadanya, "saya set up appointment kamu jam 8pagi esok ye, kat sini". si ibu pun tergelak kecil dan bertanya kepada anaknya, "blh ke pukul 8". si anak mcm serba salah tp x berkata kata apa pun tp tersengih2. aku hanya memerhati memandangkan pesakit seterusnya belum masuk lg. tba2 makcik tu bersuara pada kami "pukul 8 ni x bangun lg ni. sbb malam2 dia pergi gym, balik lewat" . si anak pandang aku, aku pandang dia. dia senyum. adehh. main mata ngan aku pulak budak kecik ni. kau ingat aku heran ke kau pergi gym. aku sbnrnya heran, kau ni bangun semayang subuh x???... hmm, bangun kot, tdo balik.. aiseh, bahaya mung ni dik.. semoga kita sama2 baiki diri ye dik..
yang aku nak ulas kat sini ialah, sama2 kita muhasabah beberpa perkara di bawah
1. betapa bangganya seorang ibu apabila anaknya blh sambung belajar. walaupun setahu aku kejuruteraan automotif, kalo sijil tu mcm pomen kereta la. kalo diploma or ijazah lain cerita. bukan niat nk pndg rendah x, tp nak katanya mak ayah kita sgt bgga ngan kita no matter what. kalo blh nak kecoh satu kampung. tp apa yg kita buat kat universiti?? layan awek?? belanja awek??? sama2 kita muhasabah..
2. ibu bapa hari ni mementingkan martabat dunia. xpe habit pergi gym lewat malam sampai balik lewat, tdo lepas subuh. bangga anak blh smbg belajar tp bagaimana dgn akhiratnya? sama2 kita muhsabah..
3. apasal budak kecik tu pandang aku mcm tu? dia ingat semua perempuan bodoh ke.. hanya perempuan bodoh je rasa lelaki yg ikut intensive training kat gym tu (tp peribadi muslim xde) cool. aku x heran lelaki mcm ni. walaupun kau baru 18/19/20 tahun, dan body kau mmg mcm model, aku x heran...
4. adehh, aku x manja mcm tu, sbb anak tunggal kot. xpela, dah dewasa nanti jaga mak kamu mcm mak kamu jaga kamu ye..
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