Congenital heart defects

 

Congenital heart defects : The defects in hearts structure with which a baby born are known as congenital heart defects, these are acquired due to malformation of heart during embryogenesis.

Classification on base of location of defects: On base of location these defects can be classified as;

1.      Ventricular septal defects: These arise when there is defect or malformation in formation of Inter-Ventricular septum. These may be further classified as:

a.      Defects in membranous part of Inter-Ventricular septum This is relatively more common, almost 80 to 85% of congenital heart defect cases are due to this.

b.      Defects in muscular portion of Inter-Ventricular septum These cases are less common , almost 10% to 15% are cases get rise due to it.

         Categories of inter-Ventricular septal defects:  On base of defetc’s size, these can be categorize as;

        ., Minor VSD: Have less than 3mm size. Resolves spontaneously.

        ., Average VSD: Size is between 3 to 6mm. Require surgery.

        ., Major VSD: Size is larger than 6mm. Also require surgery.

2.      Arterial septal defects (ASD): These are defects/malformation of Inter-atrial septum.

On base of location of defects, these also can be divided into;

a.      Ostium secondum Most common. Almost 75% cases of ASD belong to it.

b.      Ostium Premium

c.       Sinus Venuses defect

3.      Patent ductus Arteriosus: This  the presence of abnormally unclosed Ductus Arteriosus, Which is normally open during intra-Uterine, but with birth it spontaneously get closed, and converts into Ligamentum Arteriosus. But in some cases it remains open, which leads to congenital abnormal condition known as PDA.  

The first line treatment is to provide anti-prostaglandin or prostaglandin inhibitors. And tge surgery(Ligation) is also indicated in sever cases.

4.      Obstructions of cardiac valves : These obstruction or abnormalities may be;

a.      Pulmonary Valve Stenosis: Pulmonary Valves are  congenitally abnormally hardened. This will cause less blood flow towards lungs, Blood will dam in right ventricle.

b.      Aortic valve stenosis:  In this condition aortic valve is abnormal. Will cause the damming of blood in left ventricle, this is most dangerous because blood flow and oxygen supply will get insufficient or deficient.

c.       Abnormality of Bicuspid valve

d.      Abnormality of Tricuspid valve.

5.      Coarctation of Aorta:  Congenitally narrowing occur at any point in arc of aorta. This cause increase in blood pressure and may also leads to Aortic aneurism.

It can be categorize to two types on base of Coarctation location.

a.      Pre-ductal Coarctation: More dangerous because it effects blood flow of whole body.

b.      Post-Ductal Coarctation : Less sever because it don't effect blood flow and pressure of upper body regions like head etc.

6.      Transposition of Greater arteries: In this, the greater arteries( Aorta and Pulmonary arteries) replace each other's origins. Means Pulmonary artery get rise from left ventricle and Aorta get rise from right ventricle.  It is most dangerous form of Congenital heart diseases, almost 50% babies dies in their first month of lives, and 90% in first year.

In this condition, other congenital heart defects like left to right shunting and PDA little bit help survival.  Surgery is also possible and successful.

7.      Tetralogy of Fallot: In this condition four congenital heart defects are present simultaneously

a.      Pulmonary Valve Stenosis

b.      Right ventricle hypertrophy

c.       Ventricular septal defect

d.      Misplacement of aorta

These leads to Cyanosis, Arrhythmias and poor development or growth.

Renal stone formation or Urolithiasis Types, composition and clinical features.

 Urolithiasis or Renal stone formation and its types. 

Urolithiasis:

It is formation of stones or calculus  in kidney.

 i.  more common in man than women.

ii. above age of 70 almost 11% of men and 5.6% of women will likely to develop Renal stones.

Types of Renal stones and it composition:

Following are most common  types of kidney stones with their common causes.

1.      1. Calcium stones: about 80% of stones majorly contain calcium, either in form of Calcium Oxalate or mixture of Calcium Oxalate and Calcium Phosphate.

Common causes of Calcium stones:

a.      Most common cause is Idiopathic Hypercalciuria.

b.      Hypercalcemia and Hypercalciuria  

c.       Hyperoxaluria.

d.      Hyperuricosuria.

e.      In some cases (15 to 20%) there is no any known metabolic abnormality.

2.     2. Struvite stones : Almost 10% of stones are composed of Magnesium Ammonium Phosphate, these are commonly  known as Magnesium stones.

Causes of Struvite or Magnesium stones:

a.      Such stones are associated with Urinary track infections, specifically infections of Urea splitting bacteria like Proteus vulgaris and staphylococci. These bacteria either increase the chances of Struvite stone formation (like staphylococci and protease vulgaris etc.) or directly  cause any stone formation. During formation of these stones Patients produce alkaline Urine.

3.      3.Uric acid stone:

         Almost 6 to 7% of stones has Uric acid composition.

Causes of Uric acid stones :

a.      Almost half of cases associated with Hyperuricemia and Hyperuricosuria.

b.      Other half cases are idiopathic. There acid urine are produced, probably this lower pH urine favours uric acid stone formation.

4.      4.Cystine stones: 

       1 to 2 % of stones  has cystinic composition.

Causes of Cystine stone formation:

a.      This is almost always associated with genetic defects in renal transport of amino acids like Cystine. These also form when Urine is acidic.

Clinical features of Renal stones/ Urolithiasis:

a.     a. Clinical significance of Renal stone is associated with their capacity of abstracting urine flow or causing trauma and leading to haematuria or renal bleeding.

b.     b. Stones at their original sites are asymptomatic.

c.      c.  Flank pain (Renal pain) starts when stones dislocate or cause abstraction of urine.

d.    d.   Renal or ureteral colic is condition when renal stones replace inside kidney or to ureter, and initiate flank pain. 

 

Blood smear and its preparation

   What is blood smear?

It is a thin film of blood on slide, that after staining is used to examine mainly the morphology of blood cells.

Why we make and examine blood smears?

We make and examine or investigate smear because  from its examination we can get following useful information:

a.      a. A leukocyte estimate RBC & platelet morphology

b.      b. A 100-cell leukocyte differential Observation for the presence of abnormal Cell.

c.      c. Abnormal RBC distribution, platelet estimate Malarial parasite.

d.    d.  It help us in screening of illness and diagnosis of hematologic & non-hematologic conditions.

e.     e. It also help us to monitor patient response to therapy.

BLOOD SMEAR TYPES

There are two types of smear on base of method of preparation;

1.Spun smear

2.The wedge smear.

There are two additional types of blood smear (On base of their composition) used for specific purposes:

1.Buffy coat smear for WBCs<1.0×109/L

2.Thick blood smears for blood parasites.

1.WEDGE SMEAR :

It is most common, widely used  and preferable method. Lab workers make it by hands, using slides. It is easy to be labelled .

WEDGE SMEAR PREPARATION:

a.     a. A drop of blood is applied on slide, through capillary tube, near an end od slide.

b.     b. Spreader commonly a second slide is draw back toward drop of blood and held there for some time until blood spread to its width.

c.     c. Now the spreader at 45 degree, is pushed forward to produce a long thin and even smear or film of blood.

 CHARACTERISTICS OF A GOOD BLOOD FILM:-

1.Thick at one end, thinning out to a smooth rounded feather edge.

2.Should occupy 2/3 of the total slide area (min. length of 2.5cm)

3.Should not touch any edge of the slide.

4.Should be margin free, except for point of application5.No streaks, waves or troughs

2. SPUN METHOD OF SMEAR FORMATION:

It is an automated method . Here we produce a perfect smear by using a specific machine. Commonly Beckman Coulter Gen.SCell is used.

Preparation of smear through spun method:

a.      a. 1-2 drops of blood placed in are of glass slide.

b.      b.The   briefly spun at high speed in a special centrifuge.

c.       c.Blood spreads on slide in a monolayer Leukocytes & platelets are distributed uniformly & free of distortion. RBC  show tendency to distort •Bio hazardous (aerosols)

 

The Bilderberg

 

Bilderberg Group:

 It is a group of elites or oligarchs from whole world, that controls or rule this world.  This is one of, what people know as Deep state or secret society.

History of Bilderberg:

Its annual meetings were initiated by the Prince Bernhard of Netherland in 1954. First meeting was held in Bilderberg Hotel Holland.

Since that, every years its members attend its annual meetings at different places of world.  

After WWII predicting the fall of their Kingdoms, European Royalties made this deep state, so that they could maintain their power and wealth. They are now working as Oligarchs and control the economy and politics of whole world. At this time their members or not just Europeans rather it has elites from entire world.

Meetings of Bilderberg group:

Meetings take place every year at different places, but these are completely hidden from media, no one is allowed even to be nearer to place where they are meeting. In meetings military heads are also been there.

Aims of Bilderberg group:

The aim is controlling the every the world.

They believe in war economy and earn wealth from that.

They use human rights and Democracy as tools, for achieving their aims.

 

 

Enemies of both Pakistan and India!

 

 Enemy of India and Pakistan!

Pakistan and India on self destruction mode!

Since more than 70 years Pakistani people are feeding with narratives that India is their enemy and want to destroy Pakistan and same is feeding to Indians about enmity of Pakistan. But at this time any one who could think critically and search for truth about these two nations will find this reality that both of them have their enemies in their own countries,  Infact these both  are at self destructive mode, at least now we can see it clearly.

 The poison that is destroying India is their own politicians, a nation of such great diversity could only be run with pure democracy. But unfortunately today India has lost this thing practically(though India is still recognize as largest democracy). The ruler party dreams of great United India, but for them this word United is limited to lands, this is just union of lands. For them this land will belong only to Brahman Hindus specially those who support Hindutva supremacist ideology, and remaining Indians will have to leave India. Even Dalit and other Hindu minor communities. This Ideology has no power to even unite Hindus then how would it Unite the whole Indian Content, which is home of Islam, Sikhism, Buddhism, Jainism and many other religious ideologies, and have a very diverse  ethnicity. This ideology would only squeeze  India only to a few of its states.

On the other the poison that is destroying and not allowing Pakistan to develop, is complex of its own establishment  and politicians. A politician that is not a pro-establishment is not allowed even to speak or even live. It does not matter how popular a politician is or how much support he has from people, but if he messed with establishment, he will be out of political system and government. (we can clearly see this thing in Imran khan case.) Every system either judiciary, finance or any one is under control of establishment. They can disqualify, assassinate, suppress or do any thing a person to whom they don’t like or see him as threat to their this iron handed dictatorship. They have their own media cells and paid news channels for propagandas, glorifying and justifying their crimes and failures, also have mobs for  terrifying common people and politicians for protecting their interests.  The current govt of Pakistan is mixture of all these politicians to whom this ugly and awful system has used in past, still using and want to use In future too. These people has occupied Pakistan since the death of Quid e Azam M.A Jannah. This is the system that has never permitted democracy to prevail in Pakistan and never allowed Pakistan to get developed.

 Currently Imran khan (who was also a pro-establishment, but now apparently after realization of destructive rule of establishment,) conducting anti-establishment protests throughout Pakistan, his record breaking largest Jalsas shows that people of Pakistan are fed up of this awful system and want to get rid of them. If Imran commit compromise with establishment and do not bring changes in this system, then this will be his political suicide.

On other hands people in India who are worried about their future are fighting seemingly their last fight against Hindutva supremacist ideology, for democracy and secularism, under the leadership of left wing Party Congress.

 

Chinglai

 

Chinglai:  چینگلٸ

Meaning:  About the origin of word Chinglai there are two common theories.

First  Theory about origin of word Chinglai: one is that the original name could be چین-گلیChin- galai,  Chinglai is from two words;

Chin meaning China and   Gali Means Path, way or Road.

So the word chinglai mean way or Road to china.

There is another thing that support this meaning, and that is the only way to the Valley of Chinglai that could be used in past (in absence of roads) is a Village  _درن_Daran every one little bit known about Persian Urdu or Pukhtoo will easily understand it that Daran may be short form of Dara e Hind,_درہِ ہند means the Road or path to India. So the whole history of Chinglai lay in its name.

Second theory about word Chinglai: According to this, Chinglai may be derived from word China-Gali, Means a village built near a Spring or water source.

Instead of first theory for which we have a strong geographical proof, second theory has no such proof. This thing weakens the second theory.

Location of Chinglai:

  Chinglai is a lush green vast valley of Buner, it is one of the largest Village of District Buner Tehsil Khudu khel both on base of area and population.

 It lays at  extreme north of Khudu khel, Connected with Tehsil Mandanr(Northern boarder) on western side connected to Village Bagh and at some point village Naranji of District Swabi, on its Eastern side is Mangalthana, Malka, Tupyiala and on it south side there lays Villages of Sawawai Dhandhar and Sarwaye.

Some views of Chinglai: These are pictures taken at different weathers. 

 

This shows Chinglai with Mighty peak of Sikko

 This an important view as it almost shows the complete location of Chinglai's Valley 

This is stunning view of Chingai's night

Post code or Zip code of Chinglai:  23432 is post code that is used both by Chinglai and Totalai, as post code.

Population of Chinglai: According to recent Census, 2017 Population of Chinglai is 19545. Today it will be almost 25 thousand.

People of Chinglai: The people here are mostly the Afghan Yousafzai and some other group are people are also there like Daman, Nayan, Chumyaran, Shahkhailan, Gujran, Kolalan, Loharan,  Tarkananr, Myagan, Mulan, Dhobyanan, Jhulahgan, Tarawri and few Nomadic families of Ajaran, in addition there are some others(whose ethnicity is even unknown to them).

Few families are Sikh too.

Yousafzai Tribes in Chinglai: Yousafzai afghans are the original people of the land, who came there almost one thousand years ago, defeating Swati Pathan who were living here.

On base of ethnicity the Afghan of Chinglai can be divided into two groups,

Bam kel and Usman khel tribes.

A.      Bam khel of Chinglai: these are descents of Bam baba, these includes;

a.      Younas khel: This tribe further divided into Bar Younas khel and Kuz Younas khel.

b.      Ja’afar Khel: This tribe divided into kunji Hujra and Brah Hujra.

c.       Mada Khel: This tribe divided into Qabla Mada khel and Myanz Mada khel.

d.      Khwajas Khel: This tribe has no further division.

B.     Usman khel of Chinglai: These are descents od Usman Baba. These tribe include;

a.      Usman khel: This is one of the largest khail/tribe of Chinglai. It is further divided into 3 main hujras.

i.                   Sreekh Hujra

ii.                 Urh Usmani also know as Meyanz Hujra. This has further two Hujras.

iii.                Jalwal: These has further two Hujras.

b.      Bedi khel.

c.       Sarki khel.

d.      La’al khel.

 

Economics of Chinglai:  Most of economy of the people of Chinglai is related to Farming and agriculture, Mostly young work abroad specially in Arab countries and Malasia, some people are gov’t servants too but these are very few, due lack of interest in Business most people try their best to be a government employee. Due to having 2^nd largest Bazaar in Buner(after Swarai) and one of largest population, some people have strong businesses in Markets.

 Educational in Chinglai: Education level is too low in comparison with Upper Buner. Most of boys and girls left the school at primary level, and reaming left the educational carrier after 10^th class or 12^th, very few get admission at University level. The cause this is mainly the week financial situations and high 1 of Higher education.

Educational structure of Chinglai or Schools in Chinglai:

There are two private schools, one is Al-Usmania Public school and second is Allama Iqbal model School.

Government schools: For girls there are these primary schools, One in Chinglai I and other in Chinglai II, and only one Higher secondary school. There are also primary schools for girls in Dhandi kot,Kalan, Kangalai, Jamra, Kela, Bhato, Yagan and Sro.

For boys  primary schools are as,  Government Primary School Chinglai I was built in 1948, by government of Wali e Swat. 

 Government primary school Dhandi kot, Kalan, Kangalai, Jamra, Dhambarai, Kela, Yagan, Jamra, Sroo and Tawheed abad.

There is one midle midle school for boys in Jamra, one high school in Chinglai II and there is also a Higher secondary school (Chinglai I) this was built by Wali e Swat , it is one of his great architectural  monuments it is still under use, its beauty and greatness remained every one the great era of Wali e Swat Jahan Zaib Khan Abdul Wadood.

All these schools belong to Board of Swat.

Madrasas in Chinglai: In addition to schools there are Deeni madaris too in chinglai both fir boys and girls.

Boys madaris: Few are as; 

جامعہ فاروقیہ  

جامعہ  فاطمہ الزہرہ

جامعہ  مدینتہ القران

جامعہ محمدیہ

Madaris for Girls: In above the except the first other has separate madrasa for girl too. There are numbers of Madaris for girls but have no name, rather they learn at homes of their female teacher Mullima .

Political structure of Chinglai: Politically Village Chinglai is divided into three Union Councils;

A.      Chinglai I:  All Tribes of Usman khail.

B.      Chinglai II: All tribes of Bam khail

  C.     Kalan kangalai.

Jirga of Chinglai:

Jirga is essential to every Pakhtun societies, The Jirga of Chinglai was and still is such strong that all over the region, it is famous by name of “Da Chinglai Tabar “ means “The axe of Chinglai”, it was named so after its decisions and its effectiveness, as any thing that once get cut down by an axe can never be repaired, the same, once any thing decided by This Jirga could be never be challenged  changed or withdrew. Though it is no more such effective, but still its importance in Sulah and solving other critical issues is still unparalleled.

Crops of Chinglai: Most important are Wheat, corn, Tobacco, Onions, Potatoes, grains, Orange, Peaches and some wild fruits that are present on mountains. Though the land is too fertile but there is no system of irrigation very few lands has old Rehat  رہٹ  system and almost 85 to 85 percent of lands even lack this system too. These lands are called Baranai zmaki    means lands that depends only water of rain for irrigation.

Culture of Chinglai: In history due to most protected and unreachable region Chinglai was rich of natural Yousafzai culture and now despite globalisation of all cultures it still has  uniqueness. It also has some effects of Swabi culture (as here too women wear red doted Shals known as Parhoni or Chail) and Swati culture(Language, ways of celebration and mourning and some others).

 

Sites to be Visited in Chinglai:  As Chinglai is located among lush green mountains and hills that is why it has a lot of such beautiful points that are not less than popular sites.

1.Durmaye:  دُرماٸ

It is a hill station located at the hights where Chinglai meets with Tehsil Mandanr. It is a very best choice for picnic or other such outing activities. It is unpopular so there one will feel complete calmness and peace. Its another positive point is its location on main Chinglai to Swarai road.

2. Ghazi baba: It also a great choice for outing, it is located at point where Chinglai and Sawawai.

3. Lwe khwar: It is best for fishing, full of beauty and peace.

4. Dhandi kot ghat ڈنڈی کوٹ گھٹ

5. Brah بڑھ    

    It is an undiscovered historical site, may be related to Rani ghat and Swat, because of its location. It is waiting for research by archaeologists. It has rooms and other holes that indicate a forgotten civilization.

6. Sikko  Peak : It i the highest peak of Western mountains. Climbing to such hight may take 5 to 6 hours, but it will reveals the wild beauty of mountain.

7. Bagooch Peak: It is the highest of all peaks that cover Chinglai Valley. It become more beautiful when snow fell on its top.

8. Landar dheriy: It is hill, on top of has some indications of ruins.

9. Sites for Hiking: Every mountain of the valley is best for hiking, this statement is not exaggerating but a reality, on visiting you can experience this. Every site will be felt by you better than previous.

  Some picture captured during hiking are as