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.

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), 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 sauchcontain 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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Vewing without Spectckles in Hypermetropia

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 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:

Veiwing through fingers

Vewing through hole in card


Explanations:

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. 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.

Very High leucocytosis Interfere with colorimetric measurement of Hemoglobin

( 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 1,00,000WBC/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 Solar Eclipse sometimes causes injury to Eye

It could be injurious to eye to look at the sun particularly several minutes before and after the full eclipse. At this time our pupil become larger in size because light intensity become slows down. Our eye reacts like an automatic camera . It opens in darker and closes in brighter light. In extreme light (looking at full sun) size of pupil can be 0.1 mm in diameter and in darkest light it can as large as 9 mm in diameter. During a solar eclipse size of pupil becomes 3 or 4 mm in diameter or like due to covering most part of the sun by the moon. But the light from exposed part of the sun will not loss its power of illumination and will enter our eye affecting the macula with a greater intensity of 30 to 40 times (0.1X30 or 40) than other time of normal days and it is sufficient to burn our macula causing blindness. It can be compared with looking at torch light at night or viewing television in dark room which eventually disturb our vision but not at day time. We should remember that in any time intensity of the sun never goes down or increases or there is no variation of UV light coming to the earth from the sun. Looking at sun in normal days for longer time may also causes burning our macula of eye.
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Health care: Why Malarial Parasite usually not found in PBF

Malaria –Its Misdiagnosis

Malaria is a very common cause of fever in tropical countries.¹ It is one of the major public health problems in Bangladesh. Out of 64 districts, 13 bordering districts in the east and northeast facing the Indian states of Assam, Tripura and Meghalaya and part of Myanmar belong to the high-risk malaria zone. ²

Internationally, about 3.3 billion people - half of the world's population - are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths.³ In 2008, there were 247 million cases of malaria and nearly one million deaths – mostly among children living in Africa. In Africa a child dies every 45 seconds of Malaria, the disease accounts for 20% of all childhood deaths.^4,

Early diagnosis of malaria and its effective and timely treatment reduces morbidity and prevents death from malaria. Prompt and accurate parasitological confirmation of malaria is essential for effective disease management and malaria surveillance. ³ Clinically, the first symptoms of malaria (most often fever, chills, sweats, headaches, muscle pains, nausea and vomiting) are often not specific and are also found in other diseases.⁴ In Europe and North America, imported malaria have been misdiagnosed as influenza, viral hepatitis, viral encephalitis, or traveler’s diarrhoea, sometimes with fatal consequences.⁵ In Africa, 70% cases of malaria are diagnosed in the home and in some areas three-quarters of patients with fever are advised to take anti-malarial drugs for non-malarial illness.⁶

It appears to be a common issue of failure to demonstrate malarial parasite in peripheral blood in clinically suspected cases of malaria. The causes of this failure usually may be due to over diagnosis, misdiagnosis, inappropriate timing during blood collection and other causes:

1. Common diseases of misdiagnosis are:

a. UTI (urinary tract infection) - fever in UTI case usually associated with shivering and sweating. There might not be any symptoms of burning or frequency micturition when it affects the upper part of urinary tract. In this case (upper UTI) if the physician overlooks the patient’s abdominal or back pain it would misguide in the diagnosis.

b. Viral infection: - Viral infection is the commonest cause of febrile illnesses. Most people in our country initially use few doses of paracetamol before seeking advice from physician. Physician finds history of shivering and sweating in these cases but it is due to the effect of paracetamol.

c. Tuberculosis: Usually extra pulmonary cases may be confused with malaria due to rise of temperature at the evening time and associated with drenching sweating typically at night. ^{1, 5} Tuberculin test should help in the diagnosis of tuberculosis.⁷

d. Meningitis: Although headache may be severe in meningitis, so can be confused with malaria, there is no neck stiffness or photophobia resembling that in meningitis. Acute sinusitis, dengue fever or leptospirosis, some times can confuse with malarial infection due to chills mayalgia. ¹

2. Use of some antibiotics can also prevent appearance MP in peripheral blood- like fluoroquinolones (e.g., ciprofloxacin), cotrimoxazole, and tetracycline etc.⁸

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 too low that MP can not be seen even after searching for longer period.

b. Time of collection- Some physicians may advice to collect blood at the height of temperature for malarial parasite. But this should be a misleading idea. Fever in malaria synchronizes with rupture of infected RBC at the end of erythrocytic schizogony releasing a chemical called 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 run simultaneously, which is also not very rare. So, it is better to collect blood 1 to 2 hours or like before the onset of fever. When a fever subsides blood should to be collected at least 10-12 hours after an attack of fever because this time is needed to develop a ring form of malarial parasite inside newly recruited red cells.⁸

Serology does not detect current infection but rather measures past exposure. However, antibody detection may be useful for, screening blood donors or testing a patient who has been recently treated for malaria but in whom the diagnosis is questioned.³

References:

1. Nicholas J, White, Joel G. Breman.Malaria. In Harrison’s Principles of Internal Medicine. Seventeen Editions, 2008. Page 744.

2. Communicable Disease: World Health Organization. http://www.whoban.org/communicable_dis_malaria.html

3. Malaria: Diagnosis and treatment. World Health Organization. http://www.who.int/malaria/diagnosis_treatment/en/

4. Malaria Diagnosis (U.S.) – Serology. Center for Disease Diagnosis and Prevention. http://www.cdc.gov/malaria/

5. D J Bradley,David A. Warrell. Malaria: In Oxford Text Book of Medicine.4^th edition; Volume I, 2003, Page 721-748.

6. Malaria Knowledge Programme. www.liv.ac.uk/istm/majorprog/malaria/outputs.htm/

7. SI Patrick. Value of the Tuberculin Test. N Engl J Med 1959; 261:723-724 October 1, 1959

8. K.D. Chattergee. Malarial Parasites of Man. In Parasitology. 12 the Edition.. 1980. Page 72-103.

Allergy and its Prevention

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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.Early childhood exposure to bacterial and viral infections and endotoxins (eg, lipopolysaccharide) may normally control the 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. 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.

Solar Eclipse from Rangpur, 22July 2009

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Solar eclipse is rare than lunar eclipse. Particularly full solar eclipse is very very rare. On 22nd July we enjoyed a such a full solar eclipse from many areas including Rangpur, Bangladesh. I have tried to have some picture with my nonprofessional experience but sky was somewhat cloudy particularly at the time of most exiting moment during full eclipse.

It could be injurious to eye to look at the sun particularly several minutes before and after the full eclipse. At this time our pupil become larger in size because light intensity become slows down. Our eye reacts like an automatic camera . It opens in darker and closes in brighter light. In extreme light size of pupil can be 0.1 mm in diameter and in darkest light it can as large as 9mm in diameter. So, during solar eclipse if its size become 3 or 4 mm in diameter the light from exposed part of the sun will enter in our eye on the macula with a effect of intensity of 30 to 40 times than other time of normal days and it is sufficient to burn our macula causing blindness. It can be compared with looking at torch light at night or viewing television in dark room which disturb our vision but not at day time. In any time intensity of the sun never goes down or increases or there is no variation of UV light coming to the earth from the sun. Looking at sun in normal days for few minutes or like may also causes burning our macula of eye.

Viral hepatitis and its vaccination

Hepatitis virus A (oral transmission)

Hepatitis virus B (parenteral transmission-injection)

Hepatitis virus C (parenteral transmission- e,g.injection)

Hepatitis virus E (oral transmission)

Viral hepatitis are common cause of jaundice in Bangladesh and other developing countries. There are several types of viruses responsible for hepatitis, they are type A, B, C, D, E, G etc. ( HAV, HBV, HCV, HDV, HEV, HGV). Among these HAV and HEV are commonly transmitted through oral route with contaminated food, drinks or water because these two virus are excreted in the stool of infected persons. Virus is carried by flies from stool or by cockroach from toilet and these may contaminate foods /drinks easily. Virus may contaminate water due to leakage of sewerage line or due to improper purification of water collected from river. Ice cream or any drinks/food kept in refrigerator made from contaminated water without prior boiling can also transmit viral as well as bacterial diseases. HAV is excreted 2 weeks before and 2 weeks after the onset of jaundice. So it can not be prevented easily. HBV,HCV and HDV are transmitted through parenteral route i.e, through blood transfusion or needle sharing and by sexual contact.

For the prevention of these diseases avoidance of open air defecation, use safe water for drinking or washing hands or utensil before eating ( not only filtered- but boiling or chlorination must) will prevent HAV or HEV infection. Vaccination for HAV is also available. For HBV vaccination is available and now it has been included in primary vaccination programme in Bangladesh recently.

Vaccination will prevent the respective viral disease against which vaccination has been given not the other viruses. From the above information it is clear that only two antiviral (hepatitis) vaccine are available in Bangladesh and also in other countries . So we must not feel safe after vaccination with these one or two types of antiviral vaccines, thinking, that viral hepatitis will occur no more. It should be noted that HCV is more dangerous than HBV and HEV is notorious than HAV.

So, we should be aware about the possible routes of transmission of viruses responsible for viral hepatitis or also other viruses and bacteria. We should not rely on vaccine only.

Eating with hand without spoon is more scientific

Eating with hand is always beneficial and scientific than eating with a spoon. It will be slight difficult to make understand a non medical person in this respect. Still if we clarify it simply that, we have many bacteria in our body- on the skin, in mouth, intestine called normal flora. Normal flora are usually harmless and protect us from many harmful bacteria from outside environment. We get these normal flora starting from after birth from mother skin and hands. Gradually many types of normal flora clonizes on different parts of our body. Maintenance of this colonization is needed for better health by updating the type of normal flora in our gut. If one use spoon (clean- bacteria free) for long time or drinks bottle water ( which is bacteria free) ultimately his pattern of normal flora will be changed or loss its current code of normal flora in the gut and he will loss his concomitant immunity to environmental bacterial pathogens. This type of people if suddenly exposed to a environment where water contains some sorts bacteria( that is not harm full to local people) will suffer a lot from gastroenteritis. As for example, in our country when some people come from abroad after several years of staying there mostly suffer from acute gastroenteritis within few days of coming here. Similarly when people from urban area visit their village after a long period also suffer with similar disease. Where as local people don't suffer from the disease with same foods and drinks or water.
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Water Filter and Viral Hepatitis

Water borne viral hepatitis (A, E) is a common problem in Dhaka and other areas of Bangladesh and also in many other countries. There are many causes for the present situation. It is partly due to the lack of knowledge of water purification. Boiling is best among the all methods but it needs a setup of heating appliance. So, many people think that water filters, those are used in Bangladesh are safe. Actually water filters without UV or heating can't prevent viral infection because size of virus is very very small and its access can not be prvented by the common filters. Without UV or heating some good types of filters can prevent parasitic disease and some times bacterial infections like salmonella, vibrio or shigella which are responsible for enteric fever or gastroentritis respectively. Moreover, one can easily observe that there is no BSTI logo for quality of these filters in Bangladesh. So these filters are not helping rather misleading the people. General people using the filtered water with a good faith and are suffering. Boiling is very good but if not availble then use of chlorine tablet or liquid is more helpfull then filter.