The Power of Words (By: Reehab Ramadan)

It had been an exceptionally hard day for me, about 3 years ago. Everything seemed to be out of place and one thing after another was going wrong. I headed over to the University Center to get a bite to eat—maybe food would calm my nerves. At the time, I had been wearing niqab (the face veil), but that was the least of my worries, or so I thought. As I stood in line to get my food, I glanced behind me and noticed a few Muslim brothers. I was about to extend my salaam (greetings of peace) to them when I caught wind of what they were saying. They were talking about ME! ‘Why does she think she can dress that way? Who does she think she is?!’ On normal days, their comments would have had no effect on me, but on that day, they went straight to my heart. Perhaps their comments were like the straw that broke the camel’s back, because instantly tears began to flow down my face, which of course no one could see. I left the food line, disheartened, and walked away hoping to find a place to be alone and be at peace at last.

I walked for a good 5 minutes, trying to compose myself before I got to my destination. I reached the building I was aiming for and began to walk up the stairs as I felt a tap on my shoulder and a whispered, “Wait!” I turned around and found a woman I didn’t know, panting, trying to catch her breath. I waited until she was able to speak and what she said next took me by complete surprise. She looked me in the eye and said, “I’ve been following you, trying to catch up to you for 5 minutes! I just wanted you to know that I admire your strength in wearing what you believe in. More power to you and may the God you believe in bless you.” And that was it. That’s all she said. She turned around and walked away, without telling me her name or wanting anything from me. Instantly my pain began to melt and I began to smile. It was her kind words that made my day so much brighter. It was her kind words that reminded me why I was doing what I was doing: God. The woman didn’t know how much I needed to hear some sort of uplifting words. She didn’t know that I was having a horrible day, but she saw an opportunity to say something good, and she seized it.
It was on that day that I realized the power of words. The power that our beloved Prophet ﷺ (peace be upon him) was talking about when he said: “Indeed a servant will speak a word pleasing to Allah that he thinks to be insignificant, but because of it Allah raises him by many degrees. And indeed a servant will speak a word displeasing to Allah that he thinks to be insignificant, but because of it, He will consign him to the Hellfire.” So many times we say things that we don’t think through. We don’t think about the effects of our words. Those brothers, whom I hold no grudge against alhamdulilah (praise be to God), probably forgot the conversation they had minutes after I left, not realizing the weight of their words. And that woman probably forgot the conversation we had, minutes after she left, not realizing the weight of her words. But as we can see, years later, I still have not forgotten.
It is through such an example that we can come to think that a word is never too small to be hurtful nor too small to be beneficial. We should consider any word that we speak, out of fear that this word may be the word that causes our ultimate destruction. We should rush to say any kind and helpful word that we can, out of hope that this word will be the cause of our rising in rank. May Allah subhanahu wa ta`ala (exalted is He) cause us to be of those who are raised in rank by our words and never be condemned to hell-fire.


“Handle them carefully, for words have more power than atom bombs.” —Pearl Strachan

The Only Shelter in the Storm (By:Yasmin Mogahed)

It’s never easy to stand when the storm hits. As soon as it starts raining, lightning shortly follows. Dark clouds replace the sun and all you can see are the waves of an ocean, once calm, surrounding you. No longer able to find your way, you reach out for help.

You begin by calling the coast guard. No reply. You try again to redirect the boat. No use. You look for the lifeboat. It’s gone. You reach for a life jacket. Torn. Finally after you’ve exhausted every means, you turn your face upward.

And ask God.

But there’s something completely unique about this moment. At this instant, you experience something you otherwise could only theorize about: true tawheed. Oneness. See, on shore, you may have called on God. But you called on Him along with so many others. You may have depended on God. But you depended on Him along with so many other handholds. But for this singular moment, everything else is closed. Everything. There is nothing left to call on. Nothing left to depend on. But Him.

And that’s the point.

Do you ever wonder why when you’re most in need, every door you seek of the creation remains closed? You knock on one, but it’s slammed shut. So you go to another. It’s also shut. You go from door to door, knocking, pounding on each one, but nothing opens. And even those doors you had once depended on, suddenly shut. Why? Why does that happen?

See, we humans have certain qualities which God knows well. We are constantly in a state of need. We are weak. But, we are also hasty and impatient. When we are in trouble, we will be pushed to seek assistance. And that’s the design. Why would we seek shelter if it’s sunny and the weather is nice? When does one seek refuge? It is when the storm hits. So Allah subahanahu wa ta`ala (exlated is He) sends the storm; He makes the need through a created situation, so that we will be driven to seek shelter.

But when we do seek assistance, because of our impatience, we seek it in what is near and what seems easy. We seek it in what we can see and hear and touch. We look for shortcuts. We seek help in the creation, including our own selves. We look for help in what seems closest. And isn’t that exactly what dunya (wordly life) is? What seems near. The word ‘dunya’ itself means ‘that which is lower’. Dunya is what seems closest. But, this is only an illusion.

There is something closer.

Think for a moment about what’s nearest to us. If asked this question, many would say it is the heart and the self that are nearest. But, Allah (swt) says:

“It was We Who created man, and We know what dark suggestions his nafs (self) makes to him: for We are nearer to him than (his) jugular vein,” (Qur’an 50:16).

In this verse, Allah (swt) begins by showing us that He knows our struggles. There is comfort in knowing that someone sees our struggles. He knows what our own self calls us to. But He is closer. He is closer than our own self and what it calls for.  He is closer than our jugular vein. And why the jugular? What is striking about this part of us? The jugular vein is the most important vein that brings blood to the heart. If severed, we die almost immediately. It is literally our lifeline. But Allah (swt) is closer. Allah (swt) is closer than our own life, than our own Self, than our own nafs. And He is closer than the most important pathway to our heart.

In another verse, Allah (swt) says:

“O ye who believe! give your response to Allah and His Messenger, when He calleth you to that which will give you life; and know that Allah cometh in between a man and his heart, and that it is He to Whom ye shall (all) be gathered,” (Qur’an 8:24).

Allah (swt) knows we have a nafs. Allah knows we have a heart. Allah knows that these things drive us. But Allah tells us that He is closer to us than even these. So when we reach for other than Him, we are not only reaching for what is weaker, we are also reaching past what is closer, for what is further and more distant. Subhan Allah (Glory be to God).

So since this is our nature, as Allah (swt) knows best, He protects and redirects us by keeping all other doors of refuge closed during the storm. He knows that behind each false door is a drop. And if we enter it, we will fall. In His mercy, He keeps those false doors closed.

In His mercy, He sent the storm itself to make us seek Him. And then knowing that we’re likely to get the wrong answer, He gives us a multiple choice exam with only one option to choose from: the correct answer.  The hardship itself is ease.  By taking away all other handholds, all other multiple choice options, He has made the test simple.

It’s never easy to stand when the storm hits. And that’s exactly the point. By sending the wind, He brings us to our knees: the perfect position to pray.

Faith, Love & Hope

Miracles happen!

Heart Sounds

Never Give Up !!!

Vacutainer Colour codes (Blood sampling)

Cavitation lesion on X-ray

If you've never failed ... you've never lived...

Days of appearance of rashes

Mnemonic: "Very Sick Patients Must Take Double Exercise"

Days of appearance of rashes:
Varicella (chickenpox)- 1st day
Scarlet fever – 2nd day
Pox (smallpox) – 3rd day
Mumps – 4th day
Typhus – 5th day
Dengue – 6th day
Enteric fever (typhoid) – 7th day

Importance of Shab-E-Barat

Bismillah...

The month of Shabaan is a most auspicious one.the Holy Prophet SAWW has referred to it as"MY MONTH" and during this month,HE used to fast more than in any other month besides Ramadaan.

The 15th night of Shabaan is known as SHAB-e-BARAAT,which is next to Lailatul Qadir (27th night of Ramadaan) in auspiciousness. The Holy Prophet SAWW is reported to have said: "People are not aware of the excellence of the month of Shabaan, the month that comes between the months of Rajab and Ramadaan. In this month, the action of the people are presented (to ALLAH).I wish my actions to be presented whilst I am fasting."

On this night which begins from Magrib salaah Azan, the AMAL NAMA (record book) of a person containing all his deeds of the past year are closed and kept away in preservation till the day of resurrection and new Record books are started. Also,on this night,the various angels in charge of births, deaths, etc, are brieffed and are assigned and instructed by ALMIGHTY ALLAH their various duties-the names and number of people who are to die during the coming year, births and the dates and times they are to take place during the coming year.

DEAR MUSLIM BROTHER AND SISTERS - the bountiful ALLAH in HIS infinite mercy has provided us with such an auspicious night so that we may take advantage of it and repent for our sins,and thus obtain HIS grace and favour.it is for us to take full advantage of this night and during this night, offer special prayers and repent sincerely for our past sins and ask for HIS forgiveness.

Hazret Ali has said: "o people, spend the 15th night of shabaan in divine worship and keep fast on the 15th day of shabaan. on this auspicious night, ALLAH spreads HIS mercy on the earth and calls out: 'IS THERE ANY WHO SEEKS CURE FROM ILLNESS THAT I MAY CURE HIM? Thus HE calls the needy ,and grants them their needs, up till dawn."
(ibn majah)

Also on this night the doors of mercy and forgiveness are opened wide,and those who sincerely grieve over and repent for thier past sins and seek forgiveness from ALLAH, are pardoned and forgiven by the grace of ALLAH, the mercy.

Hazret ABU BAKR said:"on the night of Shabaan, ALLAH spreads HIS mercy on the earth and pardons all the sinners except the Polytheist,the Hypocrites and those who harbour ill-feeling towards their brethren." (baihaqi)

Further,a special point must also be made to visit the cemetery on this night and spend a long time there,reading and praying for the deceased.

Finally,on the 13th,14th,and 15th of this month one must fast not only to end one's AMAL NAMA with a good deed and begin the new AMAL NAMA with a good deed, but also because the Holy Prophethas said : "O PEOPLE,LIGHTEN AND CLEANSE THY BIDIES BY WAY OF FASTING DURING SHABAAN,SO THAT IS SHALL BE EASY AND HELPFUL TO YOU FOR THE FASTING DURING RAMADAAN.WHO SO FASTS THREE DAYS DURING SHABAAN,ALL HIS PAST SINS ARE WIPED OFF."

"O ALLAH,GUIDES US TO THE RIGHT PATH AND GRANT US WISDOM TO DO WHAT THOU HAST ORDERED SO THAT WE MAY RECEIVE THY FAVOUR."

Ameen.

Remember me in your prayers...

Quote

Talk with Dr Muhammad Nadeem (Consultant Neurosurgeon at Shifa International Hospitals)

Gyne instruments

Ayer's Spatula

Hagger's Dilator

cervical swab

Developmental Reflexes | Pediatrics

Best Friend

Ascitic Tap Procedure

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Paracentesis: A Step-by-Step Procedure Guide

Indications:
New onset ascites or ascites of unknown origin
Patient with a known ascites who has fever, abdominal pain, hypotension or encephalopathy
Symptomatic treatment of large ascites

Contraindications
Uncooperative patient
Uncorrected bleeding diathesis
Acute abdomen that requires surgery
Intra-abdominal adhesions
Distended bowel
Abdominal wall cellulitis at the site of puncture
Pregnancy

Procedure Step-by-Step
Explain the procedure to the patient and obtain a written informed consent, if possible. Explain the risks, benefits and alternatives (RBA).

Commercial paracentesis kits are pre-assembled. If you do not have a commercial kit, this is a list of the equipment you need to perform a successful paracentesis:

16 G Angiocath (or a spinal needle) x 1
10 cc syringe x 1
One-liter vacuum bottle x 5
Thoracentesis kit tubing x 2
Sterile gloves x 2
Betadine swab x 3
Sterile drape x 2
4x4 sterile gauze x 4
Band-aid x 1

Four steps of the paracentesis procedure

1. Ultrasound scan before the procedure
2. Patient preparation
3. Procedure
4. Laboratory results

1. Ultrasound scan before the procedure

If is is very helpful to get an ultrasound scan of the ascites before the procedure. The radiologist will mark the spot for paracentesis. Two things are important:

- What is the distance from the skin to the fluid? Usually 1 cm. It gives you an idea how deep you have to go with the needle before getting fluid in the syringe.

- What is distance to the midpoint of the collection? Usually 3 cm. It gives you an idea how deep you can go with the needle in relative safety. Generally, the advice is as soon as you reach the fluid, to advance the needle just a little and then to thread in the plastic catheter, and to take the needle out.


Ultrasound marking and direction of Angiocath needle


Ultrasound report of ascites for paracentesis

2. Patient preparation

Explain the RBA (risks, benefits, alternatives) to the patient. Make sure that he understands and agrees. If the patient does not understand the procedure, he or she cannot provide an informed consent and you have to ask a relative who has a durable power of attorney for health care or is next of kin.

Explain what is going on while performing the procedure, this will alleviate both the patient's anxiety and yours.

Ask the the patient to urinate before the procedure or use a Foley to empty the bladder. Position the patient in the bed with the head elevated at 45-60 degrees to allow fluid to accumulate in lower abdomen.

3. Procedure

Preparation for the procedure:

Get all the things ready at the bedside. Briefly explain to the patient what the different parts of kit are used for. Get a trash bin nearby to dispose of the plastic envelopes of needles and tubing.

The patient should lie on his back in a slightly recumbent position toward the site of paracentesis. Percuss the area of dullness to ensure that is correspond well the the ultrasound marking. Insertion site is inferior to umbilicus and at the level of percussed dullness, usually 2-3 fingerbreadths below the umbilicus.

Clean the area with betadine in a circular fashion from the center out. Apply the sterile drapes. You will place the opened parts of the kit on the drape.

Open the 16 G Angiocath and syringe place them on the sterile drapes. Place the 1-L vacuum bottles nearby.

From this point on, you have to wear sterile gloves, so please ensure that you have everything you need in the sterile area. It is time-consuming to have to reach for, let's say additional tubing in the non-sterile area and then to remove the soiled sterile gloves and to put new ones. Make sure that you have everything you need for the procedure in the sterile area.

Try to make sure that the Angiocath fits the tubing. All needles, syringes and tubing should fit.

Procedure technique:
If the marked site is in the RLQ, pull the skin down and go in with the Angiocath, then release the skin (this is called Z-technique which creates a skin track to stop ascitic fluid from leaking out after the procedure). Aspirate as you go in. Once you reach fluid in the needle, advance the needle just a little, then thread in the plastic part while withdrawing the needle. Aspirate again to make sure that the plastic catheter is still inside the fluid collection. If you get fluid in the syringe, everything is fine, unscrew the syringe and connect the tubing to the 1-L vacuum bottle.

If you cannot get fluid after withdrawing the needle, try to reposition the catheter. If still there is no fluid, you can try to pull out and reintroduce the needle (if kept sterile). Do not push hard or deeper than the midpoint of the collection as seen on the ultrasound scan.

If you are unsuccessful in obtaining ascitic fluid, you can ask for an ultrasound-guided paracentesis.

After the procedure, ask the patient to lie in his bed for 4 hours and the nurse to check vital signs q 1 hr for 4 hours to avoid hypotension.

It is generally recommended to give 25 cc of albumin (25% solution) for every 2 liters of ascitic fluid removed. For example, if the patient had a 4-liter paracentesis, he should receive 50 cc of albumin IV (25% solution) over 2 hours. The rationale for giving albumin is to avoid intravascular fluid shift and renal failure after a large-volume paracentesis.

Complications
Persistent leak from the puncture site
Abdominal wall hematoma
Perforation of bowel
Introduction of infection
Hypotension after a large-volume paracentesis
Dilutional hyponatremia
Hepatorenal syndrome
Major blood vessel laceration
Catheter fragment left in the abdominal wall or cavity

Write a procedure note which documents the following:

Patient consent
Indications for the procedure
Relevant labs, e.g INR/PTT, platelet count
Procedure technique, sterile prep, anesthetic, amount of fluid obtained, character of fluid, estimated blood loss
Any complications
Tests ordered

4. Laboratory results

Send the sample to the lab. Usually, you send only one of the 1-L bottles. The rest of the bottles (2-3, if it was a large-volume paracentesis) are disposed of in the biohazard area.

Order the relevant tests and check them yourself or sign out for somebody to check them.

General labs:
Ammonia, CBC, CMP, albumin, amylase, lipase, INR/PTT.

Labs for paracentesis ascitic fluid:
Protein, albumin, specific gravity, glucose, bilirubin, amylase, lipase, triglyceride, LDH
Cell count and differential
C&S, Gram stain, AFB, fungal
Cytology
pH

Your responsibility does not end with performing the procedure. You have to make sure that somebody follows on the test results and acts accordingly, e.g. prescribes antibiotics if the fluid shows SBP.

FOOD AND MEDICINE! (Contributed By: Habiba Ijaz)

Pepper salt appearance in xray skull- Multiple
myeloma
Pepper salt fundus--- Congenital
rubella,Congenital syphilis
CMV retinitis--- ophthalmoscopic finding--
crumble cheese and ketchup or pizza pie
appearance.
Best disease is typified by a large yolk like lesion
giving characteristic EGG YOLK APPEARANCE
STRAWBERRY: Scarlet fever, Kawasaki disease
(both of them; strawberry tongue) and also
trichomonas vaginitis causing strawberry vagina.
BLUEBERRY: Rubella, CMV(congenital disease)
MULBERRY: Tuberous sclerosis (mulberry tumor),
syphilis(mulberry molar,neonatal finding)
RASPBERRY TUMOR: Umbilical adenoma
CRANBERRY JUICE - prevents UTI
Apple peel appearance : Intestinal atresia
Apple jelly nodules: Lupus vulgaris
Lemon on stick appearance : cushing's syndrome
Apple core deformity- in carcinoma colon
(double contrast barium enema finding)
Peau'd orange skin:Breast carcinoma
Passage of grape like clots in hyaditiform mole
Apple green birefringence - Amyloidosis
Watermelon stomach : gastric antral vascular
ectasia
Cucumber shaped oesophagus on barium
swallow- Achalasia cardia
Doughnut sign--> Hyperechoic ring sorrounding
gestational sac
Ewing's bone tumour--> Onion peel appearence
Pop-corn calcification in the centre of cardiac
silhouette--> Calcified aortic valve
Egg in cup appearance(XRAY)---> Constrictive
pericarditis