Is female with Rh negative blood a problem?

Most of us will agree that Rh negative mother should be problem with Rh positive baby. But I have several instances that mother with Rh negative blood grouping is not always a problem. An old woman who is wife of a doctor and mother of doctor needed blood transfusion at the age of 70 years and surprisingly it found that she is Rh negative. Before that her blood group was not known to her family. The woman is a mother of six children who are now adult. Her Rh negative blood never created problem. She had no history of miscarriage nor any fetal death. All baby delivered normally without Cesarean section. Recently a mother who is doctor of 48 years needed minor surgical intervention and before that her blood group was not known to her. Now it was found that her blood group is AB negative. She is a mother of three children of which elder one is now a student of university. Her all babies had delivered normally and for that she never needed blood transfusion accordingly test for blood grouping was done before. There are other similar instances. But how will we explain these matter. Actually if any lady with Rh negative blood group under goes previous abortion mostly should have a chance to develop Rh antibody due to leakage of Rh positive blood through uterine vessels during the manipulation of termination of pregnancy. Later these antibodies which are IgG type ( in contrast to antibody of ABO grouping which are IgM type) creates problem to the baby ( Rh positive) of subsequent pregnancy by easy passing through placenta . We can tell it otherwise that it is the 'punishment for murdering a baby'. In normal pregancy there should not be any leakage of red cells from fetus to mother blood and in these cases there will be no problem in babies of mother of any type of blood grouping. So, it should be a advice to all ladies who are newly married or who are going to be married, not to destroy or kill their baby in their wombs.

Vewing without spectackles by Hypermetropic Persons

After 40 years of age it is physiological condition ( hypermetropia) that glasses are necessary for most people during their near vision. Suppose you incidentally left your glass at home. You have to read a telephone number in a visiting card. What will you do now? You will seek help from anybody nearby. He may be busy or illiterate. But don't be worry. You can do it yourself and its' easy. First curl your index finger on itself against thumb and so that a small hole is made. Now look through the hole with one eye in bright light to read anything that you can't read with naked eye ( the other eye must be closed). Smaller the size of the hole better will be the resolution of the image. Alternatively if time allowed make a small hole on a paper card ( e.g, visiting card) by a needle ( James clip or pin ) or tooth pic. Look through the hole with other closed and you can now read easily the smaller letters on a visiting card or news paper or on computer monitor for a considerable time. How does it work: Explanation:

Vewing in between fingers

Vewing through hole in card

1. Depth of focus of visual field and the size of aperture has a reciprocal relation in photography. In a manual camera it is possible to control this system. But our eye is like an automatic camera. Its size of aperture ( pupil) is controlled by the illumination of visual area. In hypermetropic people focusing power of eye is somewhat is impaired even in presence of high illumination of visual field. In this case if an additional diaphragm is used in front of iris with an aperture there will be increase in the depth of focus of the visual field. So in this way visual acuity is increased by increasing depth of focus by passing the light from a bright visual field through double apertures. 2. Another possibility: The air trapped in the hole in the card or between fingers behalves like a convex lens ( power approximately 0.75+). One can test it by a standard test for a convex lens by moving the card with the hole when the image behind it will move in opposite direction. It may be due effect of surface tension that may condense the trapped air in the hole which become a small convex lens.

High leucocytosis interferes with colorimetric measurement of Haemoglobin

( Originally the article was published Northern Medical Journal, 2006; Vol-15 No-2, It has been modified for blog)-Helpful for laboratory practitioner

Hemoglobin estimation of a solution or a blood sample is commonly done in most cases by cyanmethhemoglobin method. But a less familiar method, which is also a photoelectric colorimetric methed,¹developed by us, is followed in some areas of Bangladesh. The later method is a acid-hematin method and has found to have similar accuracy and stability. Unlike cyanmethhemoglobin method, it is very cheap and has a advantage that no biohazardous chemical have been used here². Interestingly, during the development of the new method with a comparison to cyanmethhemoglobin method, it is observed that in both methods prepared fluid mixed with blood of high WBC count showed optical density resulting hemoglobin level that didn’t correspond with clinical condition of the patient. That means higher hemoglobin level was observed in a clinically anemic patient whose WBC count is very high e.g. in case leukemia. Moreover the blood mixed fluid, which is clear in other cases, was found to be hazy in these cases. To get rid from the problem we centrifuge the fluid and the clear supernatant fluid was used to measure the optical density and then the actual level of hemoglobin could be estimated which corresponded well with clinical condition of the patient. The deposit, after centrifugation, was examined under microscope and found plenty intact WBC. In normal cases, the deposits also shown WBC but were in very small number. Roughly it was estimated that hemoglobin level was increased by 1.2 to 1.4 gram% for 10⁵WBC/cumm of blood. So, during estimation of hemoglobin in patient with very high WBC count (e.g leukemia) optical density should be taken from the supernatant fluid after centrifugation for few minutes (more than 3 minutes is satisfactory) of the prepared fluid.

Cyanmethaemoglobin method is followed in many countries for the last few decades, though potassium cyanide, which is used in this method, carries potential health hazard. Besides this, the limitation regarding high WBC count should be always considered. It can be easily proved in any laboratory by estimating hemoglobin of a patient having very high WBC count e.g. leukemia, by measuring absorbance before and after centrifuging the measuring fluid.

References:

1. Mujibur Rahman. A New Method for Measuring Hemoglobin. Laboratory Hematology; 2003, Vol 9, No 3: 179.
2. Barbara J Brain & Imelda Bates. Basic haematologic techniques. Dacie and Lewis Practical Haematology. Ninth Edition, Churchill Livingstone. 2001.19-46.

Why malarial parasite usually not found in peripheral blood

Pic: Malaria distribution

Pic: Malaria transmission

It is a common problem that malarial parasite is usually not found in peripheral blood in most suspected cases of malaria. The causes of this failure are many. It is important that there are many causes of febrile illnesses coming with shivering and going off with sweating like in malaria.

Among these:

1) Misdiagnosis: It is documented-

a.Tuberculosis, particularly extra pulmonary cases may be confused with malaria because of its single rise of temperature at the evening time. Particularly in younger patients the bout of fever may be so heightened that it starts with shivering and goes with sweating. In tuberculosis history is longer, weight loss and anorexia almost present in all cases but headache is rare which is common in malaria.

b. UTI (urinary tract infection)- fever in UTI case usually appears with shivering and goes with sweating but it occurs in multiple times in a day. There should be no symptoms of burning or frequency micturition when it affects the upper part of urinary tract. In this case (upper UTI) lower abdominal or back pain is common. Simple routine urine examination excludes the diagnosis.

c. Viral infection:- Viral infection is the commonest cause of febrile illnesses. Its onset is usually acute, seasonal and similar history of other members or neighbours. Most people in our country uses few doses of paracetamol before seeking advice from physician. Physician finds history of shivering and sweating in these cases but it is due to effect of paracetamol. When the action of paracetamol goes off fever comes again with shivering and when it acts fever goes with sweating.

d. Meningitis : It is a case of medical emergency. High rise of fever with headache is must so can be confused with malaria.

2. Use of some anibiotics can also prevent appearence MP in peripheral blood- like fluoroquinolones (e.g, ciprofloxacin), cotrimoxazole, tetracycline etc.

3. Collection of blood: After excluding the above causes of fever if diagnosis goes in favour of malaria, still malarial parasite may not be found in peripheral blood due to

a. Blood examined at early stage of malarial infection - Particularly in first week of illness number of infected RBC may be so low that MP can not be seen even after searching for longer period.

b. Time of collection- This is very critical that when blood should be collected for MP. Many physicians advice to collect blood at the height of temperature. But this is a wrong idea. Fever in malaria synchronizes with rupture of infected RBC releasing hemozoin, a febrile toxin. So at the height of temperature there should not be any intact infected RBC containing MP for demonstration in peripheral blood unless double cycles or multiple cycles on malarial infection are running which also not very rare. So, blood should be collected 1 to 2 hours or more before the onset of fever. When a fever goes off blood should to be collected at least 10 hours after an attack of fever because, this time is needed to develop a ring form of malarial parasite inside red cells.

Computer problems those can be solved at home

1. Computer shutdown safely on previous days don't showing display now. Particularly during damp season it is a common problem. Switch off the power button. Open the side cover of your CPU. It is easy. Remove two screws on the back of the CPU on the left side. Then push the side cover gently and remove it. In side the CPU find the slots of RAM. Push the white clips on the two ends apart of each RAM gently. Remove the RAM from its slot and clean the metallic (brass ) border with a brash or piece of cloth. And also clean the slot by a dry bash several times.Then place the RAM gently on the slot. Restart the CPU. CPU should be opened at least once a month to clean the dust regularly with blower or a soft paint brash. 2. Old keyboard may create problem: During starting, computer sounds with a short beep. During starting if computer sounds with a long beep or two or more short beep that is other than a short beep should be considered as something abnormality in the hardware. And your computer will work properly in this situation. The most provable cause is the old ( even new sometimes) keyboard, due to many causes particularly logging small insects or food particles under the keys causing abnormal command. How will you confirm it? Power off the computer, remove the keyboard and restart the CPU. If it works correctly replace the keyboard or one can also clean the old keyboard cautiously and then reuse it (better don't use it). 3. In a used computer widows or other softwares not working properly: In a used computer (particularly older than one year) when newly installed windows or any other softwares do not works properly , it may be due old CD or DVD ROM drive which fails to read any application file(s) of the windows or the softwares installed recently. For the windows setup use new CD or DVD ROM drive and for other softwares one can alternatively ( escape buying a new CD drive) use the softwares by coping it first in a drive of the hard disk and reinstalled from the hard disk. (other problems and the pictures on the next days) visit my web: www.drmujib.webs.com/ http://www.rangpurmedical.webs.com/

Resurgent of Vector borne Diseases- In context to Bangladesh :Some Suggestions

Different mosquitoes: anopheles, Culex and Ades -transmit malaria, filaria/Japanies B Encephalitis,and dengue/yellow fever/chikangunya respectively.

The effects of globalization in exacerbating the risk of spreading infectious diseases are mediated not only through the movement of people but also by the increased mobility of disease vectors, livestock and other animals that may host zoonoses, as well as the greater propensity for food-borne disease in consequence of increasing legal and illegal trade.

Infected mosquitoes can be trnsported via train, ship, bus directly in luggages or bags.

In the 120 years since arthropods were shown to transmit human disease, hundreds of viruses, bacteria, protozoa, and helminthes have been found to require a hematophagous (blood-sucking) arthropod for transmission between vertebrate hosts). Historically, malaria, dengue, yellow fever, plague, filariasis, louse-borne typhus, trypanosomiasis, leishmaniasis, and other vector-borne diseases were responsible for more human disease and death in the 17th through the early 20th centuries than all other causes combined.

In context to Bangladesh, India can be major source of those new types of diseases like dengue. In India, dengue has been epidemic for several years. Although dengue fever was documented in Bangladesh from the mid-1960s to the mid-1990s, but an outbreak of dengue haemorrhagic fever has not been previously reported.But in 2000, through mid ­November 5,575 hospitalized dengue cases were reported to the Ministry of Health in Bangladesh, with a case-fatality rate of 1.61 %.

Ades mosquito, the vector of this disease, can not fly more than 100 meters from its residence. So, there is no way to move this vector from air port to populating area of Dhaka, where dengue outbreak started first in Bangladesh. Moreover, the air way communications from Bangladesh to India have been established many years before liberation but there was no dengue outbreak during this period. So, there is very little chance of transmitting the disease by this route. Moreover, under the WHO International Health Regulation (IHR), all international airports and seaports are kept free from all types of mosquitoes for a distance of 400 meters around the perimeter of the ports.8 But it is possible that, the infected mosquito can travel via bus or train under their seats, in between luggage and transmit the disease to other populating area nearby the stoppage. The time of emergence of dengue outbreak in Bangladesh that occurred first in Dhaka coincides with period after the introduction of bus communication between Dhaka and Kolkata. So it will be logical to claim that the infected vectors can easily migrate to Dhaka via bus from India. Now, the recent introduction of railway communication can exacerbate the condition or import of new diseases agents like Japanese B encephalitis, chikangunya which are known to prevalent in many areas of India. So, it should be an urgent matter to prevent such migration of vectors through vehicles like bus or train.

The measures those can be taken to limit vectors migration could be as follows:

1) Before starting, the train or bus should make free from any vectors by using effective insecticides before the passengers take their seats.

2) The international train or bus should not be used for domestic purposes.

3) The stoppages for train or bus in both countries should be sufficiently away from localities and the area should be carefully monitored for vectors.

4) Traveler's quarantine should be strictly maintained. Our government should be aware of the factor of migration of infected vectors urgently. If it is ignored, it will be not so late when even a lay man will bother for uncommon diseases like Japanese B encephalitis, chikangunya or other uncommon vector borne diseases as like as dengue today.

The recent outbreake of swaine flu in Bangladesh is a great concern which was first introduced in Dhaka by a infected passenger came from USA through air-port. I think it was not so difficult to prevent entry of such pandemic disease in our country through airport if sufficient measures were taken to quarantine the suspected patient coming from outside of the country.

Health care: Food & Antioxidant- How does it help us

It is now a common saying that antioxidant is beneficial for health. But what is antioxidant and how does it help us? What are the sources of antioxidants? Before that we should know about oxidation better term autoxidation. In our daily life a continuous process called metabolism is going on in our body, by which we are getting energy from our foods. During this process of metabolism some chemical or elements ( called free radicals -highly reactive atoms or molecular species due to unpaired electrons) are produced in our body which cause some harm full effects on the cells of our body by a process called oxidation. Autoxidation is any oxidation that occurs in open air or in presence of oxygen and/or UV radiation. The process of autoxidation has enormous economic impact, since all foods, plastics, gasoline, oils, rubber, and other materials that must be exposed to air undergo continuous destructive reactions of this type. All good plastics and rubber and most processed foods should contain certain chemical (called antioxidant) to protect them against the attack of oxygen. The oxidation of food products involves the addition of an oxygen atom to or the removal of a hydrogen atom from the different chemical molecules found in food. Two principal types of oxidation that contribute to food deterioration are autoxidation of unsaturated fatty acids (i.e., those containing one or more double bonds between the carbon atoms of the hydrocarbon chain) and enzyme-catalyzed oxidation. The autoxidation of unsaturated fatty acids forms free radicals producing compounds that cause the off-flavours and off-odours characteristic of oxidative rancidity. Antioxidants that react with the free radicals (called free radical scavengers) can slow the rate of autoxidation. These antioxidants include the naturally occurring tocopherols (vitamin E derivatives) and the synthetic compounds butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and tertiary butylhydroquinone (TBHQ). Specific enzymes may also carry out the oxidation of many food molecules. The products of these oxidation reactions may lead to quality changes in the food. For example, enzymes called phenolases catalyze the oxidation of certain molecules (e.g., the amino acid tyrosine) when fruits and vegetables, such as apples, bananas, and potatoes, are cut or bruised become brown in colour. The product of these oxidation reactions, collectively known as enzymatic browning, is a dark pigment called melanin. Antioxidants that inhibit these browning of fruits are reducing substances such as ascorbic acid (vitamin C), and agents that inactivate the enzymes, such as citric acid and sulfites. In human, free radical injury can be minimised by Antioxidants, which are substances that may protect cells from the damage caused by unstable molecules known as free radicals. Free radical damage may lead to cancer. Antioxidants interact with and stabilize free radicals and may prevent some of the damage free radicals might otherwise cause. Examples of antioxidants include beta-carotene, lycopene, vitamins C, E, and A, and other substances.

Which foods are rich in antioxidants? Antioxidants are abundant in fruits and vegetables, as well as in other foods including nuts, grains, and some meats, poultry, and fish. The list below describes food sources of common antioxidants.

Beta-carotene is found in many foods that are orange in color, including sweet potatoes, carrots, cantaloupe, squash, apricots, pumpkin, and mangoes. Some green, leafy vegetables, including collard greens, spinach, and kale, are also rich in beta-carotene.

Lutein, best known for its association with healthy eyes, is abundant in green, leafy vegetables such as collard greens, spinach, and kale. Lycopene is a polymer of beta carotene and a potent antioxidant found in tomatoes, watermelon, guava ( red), papaya, apricots, pink grapefruit, pomegranate, blood oranges, and other foods.( not in strawberry or red berries). Lycopene is heat stable and is available in processed fruits containing natural lycopene e.g tomatoes sauch ( one tomato contain 3.5 mg lycopene but one cup of sauch contain 28 mg lycopene)

Vitamin A is found in three main forms: retinol (Vitamin A1), 3,4-didehydroretinol (Vitamin A2), and 3-hydroxy-retinol (Vitamin A3). Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks, and mozzarella cheese. Vitamin C is also called ascorbic acid, and can be found in high abundance in many fruits and vegetables and is also found in cereals, beef, poultry, and fish. Vitamin E, also known as alpha-tocopherol, is found in almonds, in many oils including wheat germ, safflower, corn, and soybean oils, and is also found in mangoes, nuts, broccoli, and other foods.

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Health care: Allergy-"CONTACT DERMATITIS"

In previous blog I tried to discuss on allergy which in medical term called Type I allergy that is mediated by a chemical, immunoglobulin (IgE) produced plasma cells in our body by the help of TH2 cells. But there are other types of allergy also. Most important of them is type IV which can be prevented by the people themselves. The disease caused by this type of allergy is mostly called 'contact dermatitis'. The very name suggests the cause. It is manifested by chronic eczematous lesion with intense itching in skin of hands or foots or any site of body that remain contact with abnoxious materials for prolong period. Pic: Contact dermatitis with rubber It is usually due to contact of our skin to many substance like cosmetics, many metals commonly nickel in watch belt or eye glass frame, plastics, rubber, different dyes specially hair dye, dye used in cloths, spray as aerosol etc. Even some sorts of light can also be harm full specially for eye causing chronic watering or itching which decrease upon exposure to day light after coming from the indoor. Here is a case report of watering from eyes of a boy of 12 years. The boy was suffering from watering and itching of both eyes for the last 2 years. Ophthalmologist prescribed him symptomatic treatment with local steroids and antihistamines but problem persisted when drugs discontinued. The family was known to me from the childhood of the boy when there was no ocular problem. During taking history I observed that the onset of the disease coincide with their changing of residence in their new house 2 years before and the patient admitted that his symptoms aggravated when he stayed at home and decreased when he became out his house. So, I became assure that the allergic agent was in side his house. I advised him to change his bed to another room when he felt better than when he was in his old room and advised him to shift his used materials from his old room to new place gradually in 2 to 3 days. Ultimately the culprit was identified that it was his table cloth which was a plastic oil cloth of bright yellowish green colour. As soon as it was removed his room he got cured from the symptoms. It is important that, any affected person who acquired the disease for the last few weeks or months, should think first of any articles including new bed seat, pillow cover or other dress or any household objects those have being used for last few months or period which coincide with the onset of his or her disease.

Pic: Plastic contact dermatitis watch belt It should also be noted that, contact dermatitis is acquired several days to few weeks after contact with the offending materials. So it is clear, that living in a artificial environment using mostly artificial materials favours allergy like contact dermatitis. Hair dyes are most dangerous and recently most (about 22) ingredients been banned by European union as they have been found to be related with bladder cancer. Body aerosols have been found to be related with breast cancer. Light colour is good and best colour is white. It is cool for all. Other webs http://www.rangpurmedical.webs.com/ http://www.drmujib.webs.com/

Health care: Allergy- how can we prevent it

google10f0934a5965041e.html Allergy is called in medical term, hypersensitivity. We are exposed day to day to many substances like chemicals in the form of cosmetic, household paints, essences or colour materials in our foods or drinks, artificial leather in our shoes, plastic materials used in different objects including toys, plastic or metal belt in watch and so many foreign ( not present in our body)materials which are needed in daily life and different organisms including bacteria, viruses, fungus or parasites. Allergy most commonly affect the nose, eyes, skin, and lungs. These disorders include atopic dermatitis, contact dermatitis, urticaria Different people show allergy to different substances. One person reacts to a particular substance whether other person do not show any reaction to the same substance. Few people in a particular family may show allergy, these are called atopic person.

Etiology :

Genetic and environmental are important factors.

Genetic factors may be involved, as suggested by familial inheritance of disease.

Environmental factors are thought to be very important. It is proved that allergy is more common in developed countries than developing countries and similarly more common in urban area than rural area. In medical science it is proved that, there are cells ( called TH2 ) in our blood responsible for development a situation during childhood that will develop allergy in later life. Early childhood exposure to bacterial and viral infections and endotoxins (eg, lipopolysaccharide) can control these cells in our blood involved in allergy by suppressing them. But trends in developed countries toward smaller families with fewer children, cleaner indoor environments, and early use of vaccinations and antibiotics may deprive children of exposure to infectious agents that fail to suppress the cells related with allergy. Such trends may explain the increased prevalence of some allergic disorders in developed countries or in urban areas of developing countries. Other factors thought to contribute to allergy development include chronic allergen exposure and sensitization, diet, and environmental pollutants. So, growing up of children in natural environment rather than a more restricted way will prevent allergy significantly.

Islam means peace for the whole universe ইসলাম সারা বিশ্বের জন্য শান্তি

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ইসলাম বিশ্বের সকলের জন্য শান্তির বার্তা স্বরুপ

মহানবী (সাঃ) এর চল্লিশ হাদীস। (first 10 hadiths)
মহানবী (সা.) বলেছেন “যে ব্যক্তি আমার উম্মতের উপকারার্থে ৪০টি হাদীস শুনাবে এবং হেফ্য করবে, আল্লাহ তায়ালা তাকে কেয়ামতের দিন আলেম ও শহীদগণের সহিত উঠাবেন এবং বলবেন, যে দরজা দিয়ে ইচ্ছা বেহেশতে প্রবেশ কর।
১. তোমাদের মধ্যে আমার নিকট সেই ব্যক্তি বেশী প্রিয় যে বেশী চরিত্রবান ।(বোখারী)
২. কোন মানুষের মিথ্যাবাদী হওয়ার জন্য এটাই যথেষ্ট যে, সে যাই শোনে তাই যাচাই না করেই অন্যের কাছে বর্ণনা করে দেয় ।(মুসলিম)
৩. হৃদয়ের প্রাচুর্যই প্রকৃত প্রাচুর্য (বোখারী)
৪. আল্লাহ তায়ালার নিকট সেই আমলই সব চাইতে প্রিয় যা নিয়মিত করা হয়, যদিও তা পরিমাণে অল্প হয় (বোখারী)
৫. যখন তুমি লজ্জা করবে না, তখন যা ইচ্ছা তাই কর(অর্থাত যখন লজ্জা নাই, তখন সকল প্রকার মন্দই সমান) (বোখারী)
৬. ঐ ব্যক্তি বীর নয় যে কুস্তিতে লোকজনকে পরাভূত করে বরং বীর ঐ ব্যক্তি যে ক্রোধের সময় নিজের উপর নিয়ন্ত্রণ রাখে (বোখারী)
৭. যে ব্যক্তি নম্র আচরণ হতে বন্ঞিত সে সকল প্রকার কল্যাণ হতে বন্ঞিত (মুসলিম)
৮. ঐ ব্যক্তি পূর্ণাঙ্গ মুসলমান যার মুখ ও হাতের অনিষ্ট হতে মুসলমানগন নিরাপদ থাকে (মুসলিম)
৯. আত্মীয়তার সম্পর্ক ছিন্নকারী বেহেশতে প্রবেশ করবে না(বোখারী)
১০. যার অনিষ্ট হতে তার প্রতিবেশীগণ নিরাপদ নয়, সে বেহেশতে প্রবেশ করতে পারবে না ।

500 important Sahih Hadiths in English (collected from a Islamic software)
Hadiths : 001 to 100
Hadiths : 101 to 200
Hadiths : 201 to 300
Hadiths : 301 to 400
Hadiths : 401 to 500
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