Wilman Indrayana

Pharmacist.

[katafrasa @katafrasafrase]

Orang2 sampai ga punya hobi, ga ada family time, ga ada me time, gara2 kerja. Lembur ga dibayar, nyari sampingan ga seberapa. Pemerintah goblok

[Wilman Indrayana @indrayanaws]

Things are starting to feel enjoyable again.

[The Shift Journal @TheShiftJournal]

“But we cannot simply sit and stare at our wounds forever.”

― Haruki Murakami

[musashi @scabberslosttoe]

they bloom regardless

[Wilman Indrayana @indrayanaws]

I’m sorry for the weight I didn’t know how to carry gently.

[✧ 𝓢𝓱𝓲𝓷𝓮 ✧ @lostshine7]

People with ADHD have what’s called Rejection Sensitive Dysphoria (RSD). It’s an extreme emotional response to perceived criticism or rejection.

Your brain can’t regulate the emotional pain, so a small comment feels like a devastating attack. A minor correction feels like total failure. Someone’s tone feels like hatred.
It’s not oversensitivity. It’s not being dramatic. Your brain literally can’t modulate the intensity of that emotional response.

It’s neurological, not a character flaw

[‏ً @itsnwts]

Actually, Humans shouldn't always stay at home, even if you have nothing to do. Because staying at home for too long makes the brain become dull and leads to overthinking. You'll have more negative emotions. Psychology calls this state mental rumination. Most of the time, people who stay at home long term are not physically lazy - but mentally exhausted. You increasingly do not want to go out or see people. Even going to the supermarket downstairs to buy a bottle of water feels troublesome. You start to get used to being in a daze alone, scrolling through your phone and staying up late. Then you repeatedly struggle with yourself in an empty room. You think you're resting. But in fact, you're quietly draining the vitality of life. Your brain needs stimulation. Movement. Connection. Without it, your thoughts turn inward and spiral. The longer you isolate, the harder it becomes to break the pattern.

[​𝐥𝐲𝐫𝐚 @sunnkssdseraph]

Someone said:
"Life can flip in a second. One phone call, one diagnosis, one unexpected moment and everything changes. Nothing is guaranteed. Not time. Not health. Not the people you love. So love louder. Appreciate deeper. Because what feels normal today could be something you pray for tomorrow" and I felt that.

[Ali 👊🏻 @mhuseinali]

Funfact:

Anak kecil usia 0 - 5 tahun itu kebutuhan mentalnya cuma satu:

TIDAK BOLEH merasa perlu effort untuk dicintai dan disayangi orangtuanya. Unconditional Love.

Kalau hal itu tidak terpenuhi, akan banyak trauma yang ia bawa sampai dewasa.

Salah satunya ADD dan NPD....

[Dr. Banda Khalifa @dr_bandak]

A recent survey of 376 healthcare professionals revealed that 63% DID NOT understand the concept of a p-value.

Do you think you can pass the P-value explanation test❓

Are you part of the 63%?

Let's break it down in simpler terms…

[dokterbedahYK @DokterbedahYK]

masyarakat dan negara tahu betul bahwa tenaga kesehatan (nakes) dibayar rendah dan kelelahan. Namun, sistem tetap berjalan seolah-olah kita tidak tahu.

[Bapak Fandom @FandomID_]

Salah satu hal awal yg penting diajarkan anak berkaitan dengan uang dan cara mengelolanya adalah delayed gratification.

Secara sederhana, artinya begini

Delayed gratification adalah kemampuan mental untuk menunda kesenangan atau kepuasan instan saat ini demi mendapatkan hasil yang lebih besar dan berharga di masa depan.

[ຸ @fvckfemi_]

for your own sanity, stop over explaining yourself.

[𝗡𝗶𝗵𝗮𝗿 𝗗𝗲𝘀𝗮𝗶 MD, DM @nihardesai89]

FDA approves nivolumab with AVD for previously untreated Hodgkin lymphoma 🙌🏽 https://t.co/0Q7COeJEJf

[nervemed @nervemed]

t(9;22)(q34;q11)

[Simon Maechling @simonmaechling]

Now that everyone is an expert on curing pancreatic cancer in mice, not rats - I want to add some context that goes beyond the headline.
You will want to read this.

Cancer is cured in mice all the time.
Thousands of times. ~90% of those “cures” fail in humans.

Why?
Because mice are:
Genetically simpler.
Treated earlier.
Short-lived.
Not humans.

Mice are a filter - not a finish line.

Yes, this study matters. It comes from the Spanish National Cancer Research Centre.

Yes, it’s pancreatic cancer - one of the deadliest there is. Yes, full tumor regression is impressive.

But here’s what it actually means:
“This approach is now good enough to risk years, trials, and millions of euros on.”
Not:
“Cancer is solved.”

What happens next?
More animal work.
Toxicology.
Phase I (safety).
Phase II (maybe works).
Phase III (beats standard care?).

Maybe 8-10 years if everything goes right.

The real damage isn’t failed drugs.
It’s failed expectations.

Every “cured cancer in mice” headline trains the public to believe:
Cures are being hidden.
Progress should be fast.
Scientists are lying when reality hits.

That’s how trust erodes.

Bottom line:
This is how real cancer progress looks.
Messy. Slow. Risky. Incremental.

Not miracles.
Not conspiracies.
Just science - doing the hard work.

[Dr. Chokri Ben Lamine @abouabdrahman0]

🩸 APL (Acute Promyelocytic Leukemia) – Hema Board Summary
🎯 Ultra-focused, guideline-based, exam-oriented
🧪 ELN + NCCN aligned

⸻

🧬 Diagnosis

• 🧲 Suspect APL with: DIC, low fibrinogen, ↑ PT/PTT, ↑ D-dimer, severe cytopenias + classical promyelocytes
• 🔬 Flow cytometry:
•CD33+++, CD13+, CD117+, MPO+
•HLA-DR−, CD34−, CD15−, CD11b−
•“Cup-shaped nuclei” blasts
• 🧬 Confirmatory test: PML-RARA by RT-PCR or FISH
• 🚨 Start ATRA immediately → do NOT wait for confirmation

⸻

💉 Transfusion Targets (Life-saving in APL)

• 🩸 Platelets > 50,000/µL at all times
• 🧵 Fibrinogen ≥ 150 mg/dL (4.4 μmol/L) → cryo preferred
• 🧪 INR < 1.5 → FFP
• 🟥 Hb 8–10 g/dL
• ⚠️ Maintain aggressively for first 10–14 days

⸻

🛑 Precautions

• 🚨 Do NOT delay ATRA
• 🩸 Treat DIC aggressively
• 🔥 Differentation syndrome (DS): monitor weight, edema, O₂ need
• 💉 Avoid IM injections
• 🧪 Keep TLS monitoring
• 🚫 Avoid anticoagulation unless mandatory (VTE with platelets >50K)

⸻

💊 Management (Detailed)

⭐ 1. ATRA – Start immediately

• Dose: 45 mg/m²/day divided BID
• If intracranial hemorrhage → still give ATRA

⭐ 2. ATO (Arsenic Trioxide)

• Standard low-risk protocol (WBC ≤10k): ATRA + ATO
• High-risk (WBC >10k): add Idarubicin or GO
• Monitor QTc, electrolytes (K >4, Mg >2), LFTs

⭐ 3. Differentiation Syndrome (DS)

• Clinical: fever, ↑ WBC, edema, hypoxia, pulmonary infiltrates
• Treatment:
•Dexamethasone 10 mg IV q12h immediately
•Hold ATRA/ATO only if life-threatening
•Diuretics if overload

⭐ 4. Supportive Care

• TLS prophylaxis
• DIC management as above
• Infection prophylaxis standard for AML

⭐ 5. Monitoring

• PCR PML-RARA every 3 months for 2 years
• Stop after 2 years if persistently negative

⸻

🧩 Hema Board Pearls

• 💥 APL = medical emergency
• 🧬 Flow: CD34– / HLA-DR– → think APL
• 🚑 Start ATRA even before labs return
• 🩸 Fibrinogen target ≥150 mg/dL saves lives
• 💊 ATRA+ATO cures >90%
• ⚠️ DS is the leading cause of early death → treat early
• 🔍 Monitor QTc every 48–72h with ATO
• 🩺 CNS prophylaxis NOT routinely needed

⸻

🎓 10 MCQs (With Perfect Answers)

1️⃣ Most important first step in suspected APL?
A. Bone marrow biopsy
B. Start ATRA
C. Cryoprecipitate
D. Confirm diagnosis by PCR
➡️ Answer: B

2️⃣ Flow cytometry hallmark?
A. CD34+ HLA-DR+
B. CD34– HLA-DR–
C. CD7+ CD3+
D. CD19+ CD10+
➡️ Answer: B

3️⃣ Fibrinogen target?
A. 100
B. 150
C. 200
D. 250
➡️ Answer: B

4️⃣ DS treatment first-line?
A. Lasix
B. Dexamethasone
C. Hold ATRA
D. IVIG
➡️ Answer: B

5️⃣ QTc risk associated with?
A. ATRA
B. ATO
C. Idarubicin
D. GO
➡️ Answer: B

6️⃣ Low-risk APL regimen?
A. 7+3
B. ATRA + ATO
C. ATRA + Idarubicin
D. ATRA alone
➡️ Answer: B

7️⃣ Platelet target?
A. >10k
B. >20k
C. >50k
D. >100k
➡️ Answer: C

8️⃣ CNS prophylaxis?
A. Routine
B. Not needed
➡️ Answer: B

9️⃣ Leading cause of early death?
A. Infection
B. DS
C. DIC/bleeding
D. TLS
➡️ Answer: C

🔟 PCR monitoring schedule?
A. Monthly
B. Every 3 months
C. Yearly
➡️ Answer: B

⸻

🧪 5 OSCE Scenarios

🩺 OSCE 1 – Emergency APL
• Patient: WBC 2k, platelets 12k, fibrinogen 80 mg/dL, bleeding gums
✔️ Start ATRA immediately
✔️ Give cryo to target ≥150
✔️ Platelets to >50k
✔️ FFP for INR

⸻

🩺 OSCE 2 – DS on Day 7 of therapy
• Fever, weight gain 5 kg, O₂ sat 90%
✔️ Start Dexamethasone IV
✔️ Chest X-ray
✔️ Continue ATRA unless severe

⸻

🩺 OSCE 3 – QTc 510 on ATO
✔️ Hold ATO
✔️ Correct K/Mg
✔️ Restart once QTc <460

⸻

🩺 OSCE 4 – APL pregnancy
✔️ Give ATRA + anthracycline
✔️ Avoid ATO
✔️ Control DIC aggressively

⸻

🩺 OSCE 5 – Post-remission monitoring
✔️ PCR every 3 months
✔️ Rising PCR → preemptive ATO-based therapy

#️⃣ #ASH #SOHO #SOHO_KSA #ESH #Emirates_Hematology_Society

[Txt Tata Kota - The Urbanist Zine @stravenues]

Gampangnya, transportasi umum memang sudah pasti rugi, tapi bukan boncos.

Harus ada 'keuntungan' dalam bentuk lain, bisa dalam bentuk peningkatan kesejahteraan masyarakat, memperoleh kesempatan, biaya transportasi lebih murah, atau yang lebih advanced, peningkatan nilai lahan di sekitar stasiun.