Liput he jai ga sooraj bhee aur sitaray bhee
Jibaal upnee hee chalo pey jub chulain gay khudhi
K jub samait leaye jain gay wahoosh o hashar
Bharak perray ga Samander ajab hee khoaf say jub
Da-huktee aag jehunum ka paish khaima jub
Fisher e aag mein us nufs ka safeena leeay
Toe tuu tehr k ubhee bus tera hisaab hua
Yeh Jan o jism ka kuch dair mein nisaab hua
Bata qasoor k kio ker rawa kia tha jurm
Tha kia qasoor joe mara unhain khata o situm
Kio baykhata unhain madfoon is situm say kia
Zara si dair kio aya na yeh khayal tujhay
K ikk kitaab abhi hai tera hisab leay
Hata dea hai yeh perda k dekh lay tu samaa
Lay qurb mein hai woh firdous joe buseee thee kaheen
Lay ub to bol k laya hai kia yaha k leaaey
Nahee jo kuch bhee teray haath mein shifaut ko
Yaha bhee teray leay kuch nahee hai Rahat ka
K kha raha hoo qasam mein bbee un sitaro ki
Woh teergi mein chuphay subho k nazaron ki
K yeh kalam her ikk soe faqat rasool ka qol
Karim aisa tawana bulund Muraatib mein
K her hokum mein chupha iktiyar e noor e nazar
Joe hai qadeer bhee qadir bhe amr o hakim bhee
Suno hai kufr ki daldal mein doobtay chehro
Nahee rafeeq yeh majnoo koi bukheel nahee
Hai door sher ho ya shaitan is ki manzil say
Na qol e sher mein hai doobi huee zuban e amar
Toe phir batao k kio ker kaheen bhutuktey ho
K kia wajah hai joe tum zikr mein utuktey ho
K hai yeh zikr faqt raasti ki raah ko leeay
K raastay hai yeh ghalib aser khuda ko leay
Na zor upna chulao k kuch nahee hota
Khuda jo saath to kho ker bhee kuch nahee khota (Dr Raza)
نہی ہے آپ کے بس کی محبت میّسر جو، زہر دے ڈالئیے اب
ہے خود ھی زہرِ قاتل یہ محبت نھی اب زہر کی مجھ کو ضرورت
There is only one God and so do the mother (Dr Raza)
Deviation from rational and ethical mode of treatment has crossed the road of ancillary management in Covid -19 like a cause way, shattering its paved route of management in to multifaceted and multi-fate disease with variant morbidity and mortality ratio.
Never has been this was a
precedent earlier in which, modalities and options of treatment was a standardized operative procedure and yes same in prescription also where regimen was a protocol that was still under direct discreatory power of the clinician to finally decide what not be prescribed.
It is less of a Covid -2 virus and its virulence propensity that is taking the spike of death ratio but definitely a wrong precedent of dictated methodology of designed prescribed structural WHO treatment that is snatching love one from lovers.
What for God sake on earth has arrived that has uncontrolled milieu to the extent that even the best on earth as human race altogether gone in to compulsive submission as failure in spite of God’s best given abilities in front of just a virus?.
This is because a ridiculous unprecedented scoop of rationale of treatment being put as command by few of the backbenchers to the many on front desk to execute, institute and implement what is being put in the name of management protocol by the so called non professional functionary elites of the globe working in herd and under umbrella of WHO.
To the mount of belief and faith a very unnatural submission of doctors in front of newly define modalities of un-text and syllabi treatment is again a cause of massive death rate.
Out of my decades of professional practice never in my life have seen such stringent, sting, strict and sculptured directive dictation in treatment and options to the last as death but the only where disease as irreversible which could not succumb but to be put on machine as support.
On the contrary, as of today; there comes a disease whose only option after its contract is a machine from where no one returns as killing machine, the Ventilator.
I am astonished over the class of professional intellects as clinician whom has given up their skilled maneuvering excellence in front of fear and fright thereby reluctantly escaped leaving patient on the fate and fatality of good luck and fortune thus handing over their expertise and skilled intellect over and to a ventilator.
So the ultimate decision to the last as still to come opinion in the hand of a seasoned and polish clinician whom once fight till last with its immense skill, never take its flight to fight that will sooner land with patient survival.
Here is the reason why the masses have irrevocably run away from the hospital thereby discarding once a god on earth as clinician.
Is in it strange that cascade of events that is brought about in any fatal or grave disease, to the extent of reversible or irreversible stage, has a declared texted eventual outcome and fatality and symptoms comprehensively written and teach in thereof books have always the counter influence of added written texted management and methodology.
However since the starting day of the pandemic we do not see such hard hitting skilled retaliation stance from the clinicians that was previously used to get patient out of irreversible agony hence not a single institution of trial or regimen based patient revitalization could be seen that could revert fate with fight but, a horny fate of cruel ventilatory death.
Once any disease may it be fatal to any gravity was a mere challenge in front of doctors yet strangely things have now been upside down and it seems clear that fear has taken flee to flight than fight.
In my opinion a non statistical early endemic data being collected is put as guardian angel and the next modality of treatment as further management is assigned as protocol to be followed by whole world till further and next order of the day.
Here lies the reason of exemplary deaths in COVID-19 which are actually not treated but managed as per untested dictated protocol of WHO that has always changing minutes without penalizing and penalty to the disease but standardized dictated protocol as if an auto drag down procedures that ought to be followed without ifs and buts.
In my opinion modalities in treatment of Covid -19 should be renewed and revived as was previously treated with response to cascade of symptoms for there is nothing that is a new concept in management which is tearing and torturing human body vide ventilator.
Cytokine storm or secondary DIC (Disseminated intravascular coagulation or viral replication and infectivity all and must be an “over the counter” subject for doctors and as such treatment to shortness of breath to other fever, cough and Myalgia shall all have to be treated as was previously being treated in other respiratory ailments by steroids or antihistaminic or vasodilators at least as a first line trial regimen.
But nevertheless the same never turned up as rational rather concealed myth of treatment with dictative primary methodology of WHO deliberate policy.
Ventilators do not need medicine if you don’t prescribe.
Patient will continue to live like a dead man lying.
Let him stay for year or 8 years.
How come the last option became the first whereas what remained forerunners as wonder drugs and procedure were put aside in the name of pandemic disease with perhaps no treatment?
What is this term being used as no treatment when the cascade of event has eventual symptoms already known to clinician as well as prescibed by books therefore to turn andbtopple with treatment.
The decision to begin mechanical ventilation should start with a mode that should presume a conditional requirement as to what sort of ventilation shall be the necessary need of patient among assisted or controlled.
We must understand Mechanical ventilation cannot control disease process which needs to be corrected as such and as per prescribed text.
This intervention is a critical mode of treatment which has its own backfire as backlash.
In my opinion mechanical ventilation is only indicated when spontaneous ventilation is inadequate to engrave life hence to safe guard as prophylaxis before impending collapse of respiratory or physiological functions.
Although we all understand the myth behind falling oxygen saturation and necessity in relation to it, yet the reality is to cage and corner over gauge that machine has its predominant function that will cast and cost as ultimate loss .(Dr Raza)
کفن، قبر یہ جنازہ تو رسمِ دنیا ھے
ھے موت جب کوئی تجھ کو کہیں نہ یاد کرے
What does not bleeds,never heals.
We remain stranger unless heart beats together.(Dr Raza)
غلط…… بیوی ضرورت نھی، چاھت ھوا کرتی ھے جو دل کی مانند انسانی دلھڑکنوں کی صورت زندگی کی ضرورت
یھی ضرورت نسل کی ضمانت اور یھی حلالی ھونے کی شرط
محبوبہ اک ضرورت پر مبنی رشتہ ھوا کرتا ھے جو بلآخر ٹوٹ جایا کرتا ھے ضرورت پوری ھونے پر یا ضرورت پوری نہ ھونے پر
انسانی زندگی کی تکمیل وفاداری پر ھوا کرتی ھے اور وفادار عورت کی تصویر میں بیوی ھوا کرتی ھے
محبوبہ تو راستے کی وہ گرد ھے جو سفر میں آلودگی کی مانند فقط راستے کی ضرورت جس کی پہنچ کبھی منزل پر نھی ھوا کرتی اگر دائرہ نکاح سے منسلک نہ ھو
فطرت سے ہٹ کر فقط قدرت ہوا کرتی ھے اور قدرت معجزات کے اثر میں ہوا کرتی ھے. انبیاء آئمہ پر لازم ھے کہ وہ قدرت کے اثر سے باہر شخصیات کے اثر پر اور فطرت پر قدرت سے باہر کیفیتِ صبر پر بشر کی اہمیت اور منزلت دکھائے دعا کے اثر میں نہ کہ معجزات کے سحر میں
08 June 2020
14:47Hospital Precautions and standing operative procedures during attending patient in various presentations during Covid -19 pandemic:Wards SOP’s:• All patients attending hospital shall be considered as Covid (+ Ive) unless and otherwise proven.
• Any admission with respiratory sign and symptoms or fever of unknown origin should be kept separately from patients that are admitted for relatively other problems.
• Be vigilant, cautious and conscious and report any remarkable symptom immediately to the concerned specialist.
• Any investigation or lab requirement pertaining to bed ridden patient shall be taken or done in full SOPs within ward by maintaining minimal physical contact and preferably distancing.
• Clinician shall follow same SOPs while attending patient and under no means will attend ward without recommended stocks and gloves.
• Beds should be at a distance of 8 to 10 feet.
• There should be a curtain between beds preferably.
• There will be no attendant except when called upon in need or as necessitate.
• If patient is oriented in time and space without respiratory problem, he or she shall wear Mask.
• Any one; Ward in & ward out, shall wash hand or use sanitizer before entering or leaving.
• All ward staff on duty should not leave there place of duty unreasonably and such move as to and fro shall be restricted guarding SOP’s.
• Rest room wash room utilized by patient should be washed frequently with disinfection spray as and when required.
• All wards will be disinfected as per SOP daily or twice whatever necessitates.
• Nursing Staff should wear face visor before attending any patient where as in the mean hours should wear disposable apron or washable gowns.
• Proper gloving be ensured and surgical gloves should be worn during duty hours whereas added polythene disposable gloves shall be used during attending patient.
• A fresh polythene glove shall be used for attending each patient.
• No attendant shall get access in ward unless under possession of relevant mandatory recommendations as Mask etc.
• No children below 12 years are allowed in hospital and the same goes for wards. However patients as and with such ages are exempted with strict abidance as per SOP.
• No aerosol procedure like nebulisation etc will be conducted in ward but at solitary room with preferably negative pressure.
• Air conditioning system with their filter grill should be wash & disinfected daily and necessary precautionary majors be taken to avoid any contaminated spread due to cooling system.
• All disposal infectious or non infectious should be disposed as if infectious disposal and precautions to be taken for proper discard by incineration.
• All donning and doffing procedure related to wearing as mask gloves or apron or visor shall be followed by SOPS for proper disinfection and reuse.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.
• There will be an extra Covid charges to be charged from the patient as mandatory with in hospital charges as obligatory .ERE SOPs:• All patient attending ERE will be examined under strict protocol and as per recommended SOPs.
• Reporting in ERE will be through the preliminary level 3 safety station .
• If the provisional diagnosis at triage level 3 safety station is of fever or respiratory complain patient will be refered to Fever Clinic @ level 4 Safety Station (ERE) as suspected Covid -19ERE will have , Level 4 Safety Station
Here basic concerned is again suspected covid triage through symptoms and finding.• Triage for suspected Covid -19 at fever /respiratory/other clinic1. Fever evaluation clinic
Check for fever >38 Degree2. Respiratory evaluation clinicCough shortness of breath (etc)3. GIT ,CNS or others Symptoms• Vomiting, Loose motions, cerebral issues• If symptoms suggest provisional Covid -19 diagnosis as positive (suspect)
• Hold patient at Isolation Bay at EREProtocol at Bay• Separate from the rest of the patient• Detain /hold patient temp at Holding Bay• If test available at HC Facility Perform Covid testing/ Lab• If not refer to HC facilty for Covd -19 testingBay Environ Requirements• Single room with negative pressure.
(Negative pressure prevents airborne diseases like TB and Flu from escaping from room and infecting others . This is perform by a Machine that pulls air in to the room and filters it before moving out.A positive air pressure is used when patient has a weakened immunity in which a clean filtered air is constantly pumped in to keep contagious disease out of room.)• Ensure healthcare personnel (HCP) caring for the patient adhere to Standard, Contact, and Droplet Precautions• Only essential HCP with designated roles should enter the room and wear appropriate personal protective equipment.2. If symptoms suggest provisional Covid -19 diagnosis as Negative(asymptomatic)• Issue provisional clearance slip for OPD for further referral to OPD / ERE (non traumatic emergency cases only)OPD SOPs:• Clinician will wear mask, face visor gloves and shall be in possession of alcohol base sanitizers.
• All patients and their attendant shall wear mask and gloves and must maintain a distance of 01 meter.
• OPD reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• There will be fewer OPDs at a time and in a day.
• There will be minimum number of patient in OPDS to avoid rush hence to maintain proper social distancing etc.
• There will be an extra Covid charges to be charged from the patient as mandatory.
• All admission /investigation and laboratory test shall be with in compliance of SOPs
• Admission for surgeries shall have necessary Covid testing as mandatory or will not be entertained.
• All clinician shall be in possession of their relevant Mask /Visor / gloves /sanitizer at their own or the same can be provided by hospital at minimum charges.
• However disinfection and necessary related cleansing will be at the disposal of hospital.Lab SOP’s:• All staff will wear gloves gown, mask and visor with preferably PPE if available.
• There will be one patient at a time in laboratory with rest in waiting area under compliance of SOP.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• All waste and disposal should be treated as if biosafety level 3 labs.
• All donning and doffing procedure related to wearing as mask gloves or apron or visor shall be followed by SOPS for proper disinfection and reuse if washable.
• Relevant info regarding update and review of SOPs will be put forth as and per time to time.Radiography SOPs:• All staff will wear gloves gown, mask and visor with preferably PPE if available.
• There will be one patient at a time in Radiology with rest in waiting area under compliance of SOP.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• Staff should practice social distance avoiding unnecessary close contact.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.
• Reception should have through and through glass or plastic shield at reception to avoid close contact and exposure to reception staff.
• Any surface that shall have direct contact with machine or couch shall be disinfected before new matchable patient.
• Relevant info regarding update and review of SOPs will be put forth as and when and time to time.Operation theatre SOP:• Surgeries shall have necessary Covid testing as mandatory or will not be entertained.
• Emergency surgeries that has limited time span shall be considered as Covid positive and all SOP’S with pre and post surgical intervention will be carried out accordingly and as per Covid SOPs.
• All C-Sections /Labor and NVD deliveries will get through Covid testing prior to attending hospital as mandatory.
• It will be customary to wear mask, gown and gloves by all staff attending OT.
• Anesthetist is the prime contact that is vibrantly exposed to the threat where as the next on threat are surgeon and assistant on table.
• Anesthetist should ideally be in PPE and should follow protocol with heart and spirit.
• Since intubation and further anesthesia is an effective aerosol procedure any such threat can only be minimized by taking care.
• Disinfection of O.T, collection of histopathology and disposal of waste should be practiced as per SOP and in strict compliance.
• All instrument used be sterilized with standard solutions and methodology.Minor OT:• All protocol relevant to standard recommendation will be followed.
• Waste bandages and swab will be discarded as per SOPDialysis SOP:• It is a very difficult situation for dialysis department since many patients are chronic and undergoes twice or thrice dialysis weekly
• As such it is difficult to conduct Covid testing test every time and now and then.
• Such patient otherwise needs to be treated without undergoing test and the risk to exposure increases many fold.
• It is therefore suggested that any new comer should go for Covid testing before he comes for dialysis and all individuals who are on weekly treatment as chronic shall get a monthly testing.
• Mean while dialysis machine should be cleaned with full disinfectiing meathod as per SOP after each dialysis as if virtually Covid patient has been put on.
• All staff members should ideally be under PPE or at least washable gown and disposable gloves and mask.
• Hand sanitizers should be a regular practice and disinfection after every case is a must.
• No touch technique should be executed and attendant along shall stay out with mask and gloves.
• By now extra charges in the name of Covid changes are applicable that should be the part of treatment.ICU Protocol:• ICU will be treated a Covid Wing.
• Every one while working in ICU whether as a Covid Wing or not shall be under strict precaution with PPE or to the utmost full sleeves gown gloves face visor, shoes and cap.
• All disposal as waste will be treated as infectious and disposed as infectious item.
• Donning and doffing of kit will be conducted as per SOP.
• All beds shall be at a recommended distances with shielding effect by curtain or stand.
• Any aerosol procedures being done should be cautiously performed after taking necessary precautionary measures.
• Suction intubation, bedding, shedding cleansing & changing must all go through strict compliance of declared SOP.
• Relevant info regarding update and review of SOPs will be put forth as and per time to time.
07 June 2020
Insaan firt-e-jazbaat mein kayfiat izhaar ko leay koi na koi wajood talash kia kerta hai taskeen-e -dil ko leay .
Yahee waja hai jo wajood ki ghair mougoodgi mein wajood say jurre her shey ko ishq- e -bayqarar ki manind dhoonda kerta hai
Meri nazar mein ibadat k taqaxo mein ahtaraam aur mohtaram aqeedato say jurre ghair-e-insaan wajood ya moujood ashiya joe bayherhaal her mazhab, deen aur aqaid mein kisi na kisi soorat pai jati hain woh bilashuba mazil -e- ibadat per wajood -e-mehboob say berter nahee hua kerty magar kumter bhe nahee hua kerty.
Yeh is leay k izzat aur maqam yuksaa’ na hon to ahtaram aur adab e ahtaram furqan- e- adalat per nahee bulkay bugz -o – adawat per mubnee hua kerta hai
Ajab nahee k devi mandiro say juree aqeedat mazar, mehrab- o- mimber say paywusta sajood, ibadat ko leay Kaabay aur hajr-easwad k putharo say aqeedat yoon khaak ko leeay karbala -e-muallah say ishq bayher haal aqeedato ka woh anser hai joe insaan ko wajood- e- khulq mein zahirun abdd ka rutba ata kerta hai joe upnay ikhtiyar k bawajood khud ko kisi zaat k agey sajood mein bayikhtiyar samjhta hai goya ghayb mein bhee wajood ko upnay say berter dekha kerta hai .
Such to yeh hai k insani sajood ki dastan asman say zameen tak kisi na kisi deo malai guman- o -haqeeqat say juree hai
Yeh bhee sach hai k ibadat k her taqazay upnee irtiqa say aik ibtida leeay hain yoon her ibtida uss nafs k sajood say juree jisay quran nay upnay raastay ka rehnuma bataya aisay k
“Humay un k raastay chula”
Meri nazar mein her ibadat mein mushghool paraatna, dua,rakoo, qayam aur sajood say jurray upnay treeqo aur saleeqo per som o salat ko leeay kisi bhe mazhab o deen k payrokaar joe bayher haal upne upnee reet riwayt aur dastoori ibadaat k taqazo per amal payra hai bilashuba aik zaat- e- wahid per wajood ki soorat sajda ker rahey hain
Yahee woh manzil hai jahan talash kubhi puther ki moorti per bhagwan ki soorat sajdegah talash kerty hai ya kubhi munjanib puther upna qibla.
Werna such to yeh hai k moortee ko banay wala bhee insaa aur Kaabay ki tasweer say tabeer denay wala bhee insaan.
Meri nazar mein saancho say tayyar putharao mein Khuda tatolnay walay itnay hee bayrukh-o-rah hai jitna ik moorty mein Khuda talash kernay wala
Yeh is leeay k haath say tarasha butt ho ya deewar bilashuba wajood ka naimul badal nahee hua kerta.
Ub rahee baat yeh k phir kaha uss ko talash kero joe wajood mein moujood magar wajood ki soorat moujood nahee goya zaat ki soorat mojood magar wajood ki soorat naa-payd
تلاشِ یار میں کِس طرح رُخ تلاش کروں
ہر ایک راہ پہ منزل کا اختتام ہی عبد
ھے سجدہ گاہ میری آدم تو آسمان سے ھے
میں کس طرح سے خدا کو بتا تلاش کروں
Bus yahee falsafa tha Quran ka asman per k
“adam ko sajda kero”
Aur yahee falsafa deen – e- ibrahimi ki irtiqa ka jis ki ibtida chand sooraj sitary say hoti hua min janib wahdaho markooz rahee aisay k ibrahim k sawalo mein chuphe haqeeqat jisay quran nay ayato k anmol heero mein badal dea k
“Akhir tum boltay kio nahee, kuch khatay kio nahee, ”
Bus yahee falsafa- e- ziarat- o- hajj o umra hai k tum per wajib hai k uss ghar ki ziarat kero jis ko Khuda nay upna ghar tehraya aur woh Ghar derasl Muhammed -o -aley muhammed SAW ka ghar tha jis mein un k aba-o- ajdad ibadat kia kertay thay
Bus ferz to uss gharanay ki itaut thee ibadat ki soorat magar seerat bani faqat ghair e bashr ki manind un k ghar ki deewar -o- zeenat.
Yeh bilkul aisay k,
Loagon ko bhula dea gaya aur raasta uthalea gaya yoon
Ahdinus siratul mustaqeem ka werd kia gaya aur
Siratul lazeena unamta aleyhim say kinara kushi kerli
Bus raasto ko hidayat ka naam dea aur loagon say hadi ka laqab cheen lea gaya yoon ayat k mizdaaq huaey
Ghairill maghzoobe elayhim waluzuaaalin
Khuda ko chuna, Rasool ko suna, aal e rasool ko dekha magar undeh behray goongay honay per terjeeh dee.
عجیب ھو،کہ ھو ڈھونڈے ھو کیا، دیواروں میں
خدا ملا ھے کبھی کیاکہیں، دیواروں میں
کیا ڈ ھونڈتے ھو بتاؤ یہ اِن مزاروں میں
کبھی ملے گا نہ واحد یوں اِن ہزاروں میں
وجودِ حق تو جڑا ھے اُس ھی وجود کے ساتھ
جسے پکارا گیا اِتنے شہسواروں میں
نمازیں کتنی پڑھ لی کتنے روزے ساتھ لایا ھے
یہ محشر ھے یہاں چلنے کو کچھ اسباب لایا ھے
نھی ھےوقت گنتا میں پڑھوں تیرے عمل کو کیوں
کوئی ھے ساتھ تیرے تو کسی کو ساتھ لایا ھے
یہاں ہر ساعت کوئی نہ کوئی منزل بدلتی ھے
بدلتے ان لمحوں کے تو عوض احساس لایا ھے
بتا مجھ کو نہ کتنے فرض تو انجام کر گزرا
وکیل اپنا کوئی تو اس جہاں میں ساتھ لایا ھے
فقط سجدے وضو صومُ و رکوع وزنی نہ مالُ زر
بتا حبِ علی مدھے محمد ساتھ لایا ھے
04 June 2020
20:26AIM:Essentiality is; how to juggle with the patients who require ordinary urgent care along with treatment of those who are sick and carrying Covid -19 silently and asymptomatically.PURPOSE:
- In the midst of the pandemic outbreak;
- People will still have heart attacks and strokes.
- Babies will still be born.
- Appendixes will still burst.
Premises of current Understanding:The Theory is;
- Virtually everyone is Covid possible
- All patient are Covid-+ive unless and otherwise proven.
- “It’s very hard to cohort or gang up in a situation like this.”
- Although patients attending hospital comes with a different complaint, they are now, compulsively treated as though may be infected.
- Due to the silent spread of virus virtually everyone attending hospital is treated as “COVID-possible.”
- Precisely “A woman came in with vaginal bleeding, but she was COVID-positive,” Her complaint wasn’t the disease; it was the bleeding.
HERE IS THE REASON WHY ALL HOSPITALS ARE AT THE MOMENT WHETHER A DETAILED COVID UNIT OR NOT ARE BEING TREATED AS A COVID WING.”Mandatories:
- Strictly no visitors
- Compulsory mask wearing (All staff /patient attendant )
- Hand sanitizers (Alcohol based)
- All attendant /patient scheduled for surgery will be tested regardless of symptoms.
- Common areas like lobbies waiting room rest room to be clean often.
- Social Distancing
- Frequent hand wash
- PP E’s as per recommendation and first liners CHWs
- Shield mask or transparent plastic shield for OPD all exposed staff /doctors
- Disposable long sleeves gown
- Shoe cover
WORKING STRATEGY:The Manchester Triage System is a clinical risk management tool used by clinicians worldwide to enable them to safely manage patient flow when clinical need far exceeds capacity.Triage:
- The sorting out of patient or casualties to determine priority of need and proper place of treatment.
- During infectious disease Pandemic outbreaks, triage is particularly important to separate patients likely to be infected with the non- infected for the pathogen of concern.
Protocol & Procedure:
- Early case detection is a key to risk assessment
- Early isolation and case identification is a pivotal way to stop transmission thus keeping reproduction rate less than.
Precautions before Reception Desk:
- Implementing early triage and holding safety station shall keep threshold of transmissibility to lower level.
- Every arrival shall pass through Safety station Triage preliminaries.
- Only 1 person is allowed, less driver, with the patient to access hospital facility to avoid unwanted gathers.
- Car or driver should not gain access beyond dropping point as such a single attendant shall be allowed with the patient.
- Dropping points shall have wheel chairs and stretchers for prompt patient facilitation
Level (1) Safety station:
- Arrival (Health Care Facility HCF)
- Disinfectant spray (For cars)
- Laser Gun screening for Fever (Fever >38°C)(For patient and attendant)
- Initial inquiry /Complain (Fever /respiratory or others)
Level (2) safety station:
- Dropping point
- Surgical Mask / hand sanitizer alcohol-based hand rub
- Surgical Gloves (Compulsory)
- Soap and water counter only in rare cases if sanitizer unavailable
Level (3) Safety Station:
- Walk through Disinfection Gates( Compulsory )
- Triage Reception Desk is a respiratory virus carrier/ disease evaluation Desk
(Inquire, Identify & Sort signs and symptoms of respiratory infection)
- History taking (At least 1 sign or symptom of respiratory disease) (e.g., cough or shortness of breath)
- Compulsive Medical mask on patient and attendant/Driver
- Compulsive PPE to be wear and worn by attending CHW at reception desk or N-95 with face shield and Gloves with shielding of counter/reception desk
- Counter /desk shall have glass shield preferably so to avoid close direct contact with the patient
- Necessary details regarding Covert disease shall be obtained as follows
- Identify Travel and Direct Exposure History
- Has the patient traveled or resided in another Country / City where COVID-19 is spreading during the 14 days prior to symptom onset?
- Has the patient had contact with an individual with suspected or confirmed COVID-19 during the 14 days prior to symptom onset?
- If yes, continue with triage and referral to:
Fever Clinic @ level 4 Safety Station ERE as suspected Covid -19Level 4 Safety Station:
- Triage for suspected Covid -19
- Fever evaluation
Check for fever >38 Degree
- Respiratory evaluation clinic
Cough shortness of breath (etc)
- GIT, CNS or others Symptoms
- Vomiting, Loose motions, cerebral issues
- If symptoms suggest provisional Covid -19 diagnosis as positive (suspect)
- Hold patient at Isolation Bay at ERE for evaluation or further disposal to dedicated tertiary care Covid Facility
Protocol at Bay:
- Separate from the rest of the patient
- Detain /hold patient temp at Holding Bay
- If test available at HC Facility Perform Covid testing/ Lab
- If not refer to HC(Health Care ) facility for Covid -19 testing
Bay Environs Requirements:
- Single room with negative pressure.
(Negative pressure prevents airborne diseases like TB and Flu from escaping from room and infecting others. This is performed by a Machine that pulls air in to the room and filters it before moving out.A positive air pressure is used when patient has a weakened immunity in which a clean filtered air is constantly pumped in to keep contagious disease out of room.)
- Ensure healthcare personnel (HCP) caring for the patient adhere to Standard, Contact, and Droplet Precautions
- Only essential HCP with designated roles should enter the room and wear appropriate personal protective equipment.
- If symptoms suggest provisional Covid -19 diagnosis as negative (asymptomatic)
- Issue provisional clearance slip for OPD for further referral to OPD / ERE (non traumatic emergency cases only)
Protocol for CHW at Reception Desk:
- Wear a face mask preferably N-95 or Medical grade surgical mask with or without PPE
- Alcohol-based hand rub/sanitizer
- Tissue papers
- Social distancing one meter at least
- Face shield
- Clear signs at the entrance of the facility directing patients with Fever or respiratory symptoms for further report to the registration desk in the emergency department and thereof for next destination.
- Installation of Physical Barriers (Glass or Plastic Screen to limit close and direct contact with potentially infectious
- Trash Bin with Lid
- Walk through disinfectant gates shall be installed well before entry corridors of OPD/ indoor building with one point of entry and exit.
- Dedicated clinical staff (e.g. physicians or nurses) for physical evaluation of patients presenting with respiratory symptoms at level 4 safety triage point.
- The staff should be trained on triage procedures, COVID-19 case definition.
- Compulsory Complete appropriate personal protective equipment kit (PPE) be worn if available easily (i.e. Mask, eye protection, gown and gloves).
- Standardized triage questionnaire for use and should include questions that will determine if the patient meets the COVID-19 case definite
- Questionnaire should include history of;
- Travel within last 15 days
- Covid-19 positive contact history
- Shortness of breath
- Any associated disease ranging from respiratory to medical like diabetes, hypertension or autoimmune
- Drug history
- A notification system to hold patients to wait in personal vehicle so that social distance can be maintained and preliminary evaluation as to history or suspected Covid -19 evaluation can be made
- Limiting the number of accompanying family members in the waiting area or hospital
- No one under 18 years old unless a patient or a parent.
- Anyone and everyone within hospital premises waiting area” should wear a facemask and Gloves.
- Triage area, including waiting areas should be cleaned at least twice a day with a focus on frequently touched surfaces. (Disinfection can be done with 0.1% (1000ppm) chlorine or 70% alcohol for surfaces that do not tolerate chlorine. For large blood and body fluid spills, 0.5% (5000ppm) chlorine is recommended.)
- All HCWs (Health Care Worker) should adhere to Standard Precautions, which includes hand hygiene, selection of PPE based risk assessment, respiratory hygiene, clean and disinfection and injection safety practices.
- All HCWs should be trained on and adhere to precautions (e.g. contact and droplet precautions, appropriate hand hygiene, donning and doffing of PPE) related to COVID-19.
- If wearing a PPE all must follow appropriate PPE donning and doffing steps.
- Perform hand hygiene frequently with an alcohol-based hand rub
- HCWs who are likely to come in contact with suspected or confirmed COVID-19 patients should wear appropriate PPE
- HCWs in triage area who are conducting preliminary screening do not require PPE if they DO NOT have direct contact with the patient and MAINTAIN distance of at least one meter.
- HCW does not need PPE as long as spatial distance can be safely maintained.
- When physical distance is NOT feasible and yet NO direct contact with patients, use mask and eye protection (face shield or goggles).
- HCWs conducing physical examination of patients with respiratory symptoms should wear gowns, gloves, medical mask and eye protection (goggles or face shield).
- Cleaners in triage, waiting and examination areas should wear gown, heavy duty gloves, medical mask, eye protection (if risk of splash from organic material or chemical), boots or closed work shoes.
- Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly
- Expand hours of operation, if possible, to limit crowding at triage during peak hours and maintenance of social distancing must be observed.
- All other departments shall observed similar safety precautionary measure while handling patients for any purpose as laboratory or investigations.
- Admission discharge desk shall also follow recommended and defined SOP safeguarding desk and people in similar fashion.
- All Patients tentatively cleared from Covid -19 shall pass through walk through disinfection gate with compulsory mask and gloves.
- All clinician shall wear Gloves (disposable) for each patient with mask and face Shield so that safe distance and droplets affairs can be safely managed.
- Sampling and collection of sample shall be under strict defined SOP’s with preferred PPE or mask /shield and gloved protocol.
- All patients regardless should be treated as Covid-(+ive) hence shall be under compliance of SOP’.
- There will be one patient with attendant in a lab while and during sampling and registration with proper distancing protocol.
- Disposal of used kits /syringes etc shall be under guided criterion with proper color codes as infectious.
- Attendant at Reception counter must wear recommended available overalls.
- All patients regardless should be treated as Covid-(+ive) hence shall be under compliance of SOP’.
- Radiographer shall wear PPE or Disposable apron with mask/gloves /facial shield.
- No patient with recommended SOPS shall be treated without.
- Proper distant shall be maintained preferably and hand sanitizers be used in between patients along with disposable gloves.
- Dispenser shall wear disposable gown, mask gloves and face shield maintaining recommended distance.
- No patient or attendant shall gain access in pharmacy or dispensing Room.
Protocols at Reception Desk & counter
- All Admission- Discharge counter /OPD counter and similar labs dispensing and radiology counter and reception desk shall be shielded with transparent glass or through and through plastic shields to avoid direct contact and exposure to the staff.
- CHW/ Attendants at all reception shall be in complete compliance of SOP’s.
Protocols at OPD:
- Specialist shall have selective days and hours of their OPD.
- All walk –in patient shall abide hospital SOPS & protocols
- Clinician shall take necessary precautions at their own in examination and handling of patient for their own safety.
- Under no means clinician will be allowed to examine patient without mask, face shield and gloves.
- Hospital shall make available requisite necessities at charges for patients attending hospital and clinicians.
- There will be restricted number of patient in OPD hence as such a preferred mode of appointment shall be an E- appointment by Telephone.
- However walk in customer will be to the maximum facilitated.
- Different specialty will have different days as such specialties shall have different days.
Protocol for OT:
- All patient undergoing elective surgery regardless of specialty and procedure shall be tested for Covid -19
- Emergency surgery shall have defined Protocol of Covid-19 taking care as if operated upon Covid (+) positive case.
- All procedures from anesthesia to recovery shall be governed and watched in full SOPs and disposal shall have structured criterion.
- Gynecological procedures, caesarian sections and deliveries all shall have covid -19 testing prior to Hospital Visit.
Protocol of admission /Wards:
- All Admission regardless of specialty and diagnosis shall be treated as suspect unless testing is done.
- All Cases pertaining to fever or Respiratory symptoms should be dealt cautiously and consciously.
- Wards must have less number of beds keeping distance between.
- Rest of the SOPs as recommendation should be followed both by the patient, attendant and CHW.
- Attendants will be treated in the same way as is protocols are being followed for a Covid (+) suspect.
- Rest room and toiletries should be washed at frequent intervals.
- Waiting areas and public place shall be cleaned at least twice.
- Workers involved in cleanliness and disposal shall ideally be in PPE.
- All donning and doffing procedure need to be followed in true letter and spirit as per WHO recommended Procedure (Dr Raza)
نایاب ہے یہ دولتِ حُب علی حضور۔
ورثہ نہیں یہ ،ماؤں کا کردار چاہیے۔
*تمام مسلمان بشمول فقہ، محمد و آلِ محمد (صلی اللہ علیہ و آلہ وسلم )کے دشمنوں سے اظہارِ برات و بے تعلقی کرتے ھیں*
*ھم با حیثیتِ شیانِ علی دراصل محمد و آلِ محمد( صلی اللہ علیہ و آلہ وسلم) کے دشمنوں سےبرات و بے تعلقی کا اعلان برملا کرتے ھیں*
*ھمارے عقیدے کے مطابق محمد ( صلی اللہ علیہ و آلہ وسلم) اور اُن کے خانوادہ اور آباؤ اجداد سب کا یھی نقطہِ نظر اور عقیدہ تھا کہ وہ محمدو آلِ محمد ( صلی اللہ علیہ وآلہ وسلم) کے دشمنوں سے برات اور بے تعلقی کا اظہار کیا کرتےتھے*
*یہ براتِ آئمہ طاہرین ( علیہ سلام) کے رواج اور رسم میں اک عملِ واجب ک ی صورت امر بل معروف تھی*
*اور یہی رواج امام محمد باقر ( علیہ سلام) سنتِ اہلِ بیت( علیہ سلام)پر دشمنانِ اہلِ بیت کے بارے میں اپنے شیان کو کچھ اس طرح دیا کرتے تھے*
*تم مجھ سے کیا پوچھتے ھو اُن کافر پیشواؤں کے بارے میں؟*
*ہم اہلِ بیتِ محمد میں جو بھی اس دنیا سے واپس گیا، وہ نا پسندیدگی کی انتہا پر اِن لوگوں سے برات کرتا رھا*
*ھمارے بڑوں نے ھماری آئندہ کی نسلوں کو اس بات اور برات کی تعلیم دیتے رھے اور دے کر گئے*
*بلاشبہ ان لوگوں نے ھمارے حقوق بغیرِ حق غضب کئے*
*خدا کی قسم یہ لوگ سب سے پہلے ھماری گردنوں کا سودا کرنے والے تھے*
*لعنت ھے ان پر اللہ کی، ملائکہ کی اور انسانیت کی*
*بلاشبہ یہ پیشوا اس دنیا سے توبہ کئے بغیر گزرے، اُس جرم پر جو اُنہو ںنے علی (علیہ)کے ساتھ کیا، بلکہ وہ ھمارے خلاف برائیوں کو برائی نھی سمجھتے تھے*
*لعنت ھو اُن پر خدا کی، ملائکہ کی اور انسانیت کی*
سر مل گیا حسینؑ کابیعت نہ مل سکی
سب لعنتی یزید اسی غم میں مر گئے
دین کی بنیاد خدا کی وحدانیت اور اس کے لا شریک ھونے سے جڑی ھے
یوں خدا کی وحدانیت نبوت کے صادق اور امین ھونے سے مشروط ھے
اب سوال یہ ھے کہ جسے دیکھا نھی وہ کاملِ یقین کی منزل پر کیسے !
کسی ذات کا ھونا تقاضہ وجود میں موجودگی کی دلیل مانگا کرتا ھے
یوں کسی شہ کا موجود نہ ھونا بھی اُس کے نہ ھونے پر فیصل نھی ھوا کرتی
جہاں کسی کا ھونا کسی کے دلائل سے جڑا ھو، وہاں دلیل محتاج ھوتی ھے دلائل دینے والے کی
یوں دلائل صداقت کی بیڑی میں امانت کی ہتھکڑی میں گرفتار ھوا کرتا ھے دعوہ کرنے والے کے کردار میں
اعلانِ نبوت اور رسالت میں ایمان موجود پر ھوا کرتا ھے اور یقین موجود کی بات پر ایسے کہ کامل یقین اُس نہ دکھنے والی ذات پر جو فقط موجود کے وجود سے جڑی ھوا کرتی ھے، گویا اُس کے موجود ھونے سے
اب سوال یہ ھے کہ، موجود کی سچائی کی گواہی کون اور کیوں کر قبولِ عقل و شعور پر دے، جب کہ موجود خود اک وجود لئے خلق ھوئ بشر کی صورت خلقت ھو، ایسے کہ امانت لئے نبوت و رسالت کا دعویدار ھو اور وحدہُ لا شریک کی وحدانیت کا علم بردار ھو
یہ بلخصوص ایسے معاشرے میں جہاں وحدانیت شرک سے آلودہ ھو اور نبوت کہیں قتل اور کہیں تکزیب کے سانچوں میں دربدر بے مسندو و مال و زر ھو
ضروری ھے ! کہ دعویدار اعلانِ اقتدار سے پہلے اعتبار کی اُس منزل پر ھو جہاں دعوہ اُس کی پچھلی زندگی کا پوشاک رھا ھو، ایسے کہ شرک کی بستی میں بھی وحدانیت کا قائل اور علمبردار ھو
بس دعوہِ نبوت کی پہلی سیڑھی خاندانِ نبوت کے طور طریقے اطوار کو لئے نسلوں سے اطاعت اور پیروکار کا وہ مظہر ھوا کرتی ھے، جہاں دعوہ ہر نسل کی ترویج اور تصویر ھوا کرتا ھے گویا وحدہُ لا شریکَ کا اعلان ہر نسل کی داستان اور نبوت ہر باپ دادا کی پہچان
یہ اس لئے کہ کردار اک دن کا نھی برسوں کے دستور اور اطوار ھوا کرتا ھے
یوں صداقت کردار کا پیشہ اور امانت خلقت میں ڈھلی خصلت
ھوا کرتی ھے
یھی صداقت اور امانت خود پر دلیل بن کر وحدانیت کی مہر اور واحد سبیل ھوا کرتی ھے
اگلی نسل کا کردار پچھلی روایت کا عَلم بردار ھوا کرتا ھے
پچھلوں کی صداقت اگلی کو امانتدار بناتی ھے
وحدانیت کا دعوے میں شرک سے براعت اگر نسلوں کا کردار نہ ھو تو دعوہ مشکوک بن جاتا ھے، یوں دعوتِ دین ہر قدم
پچھلوں کے سائےمیں اگلوں کی سرزرش ھوا کرتی ھے
بس ثابت ھے کہ باپ دادا کی ریت روایت قصے اور حکایت اگلی نسل کی امارت ھوا کرتی ھے
آدم سے آخر تک کے سفر میں ابتدا انتہا سے جڑی ھے اور یوں انتہا ابتدا کا آغاز ھوا کرتی ھے، جو ازل سے ھی آبد کا راستہ ہموار کرتی ھے
جہاں آدم ہاتھوں سے خلق ھو، وہاں کن فیَکن
پہلے ھی آخر تخلیق کردیا کرتا ھے، یوں پہلے سے
آخر تک کا سفر اک ھی کُن میں ترتیب دے دیا
جاتا ھے، ایسے کہ پہلے سے پہلے آخر کا وجود
یہ اس لئے کہ ہر ابتدا انتہا کو سمیٹے ھوئے ھے، یوں بشر سے محشر اور اس کے درمیاں ہر اک کتاب دفتر میں درج ھے
آدم کی ابتدا ارتقا سے وحدہ لا شریک کے مظہر سے جڑی ھے، یوں نبوت دعوہ نھی، اس کا استر ھے، جو سجدے گاہِ مالک وعالیان و بشر تھی، یوں ہر آنے والا اک فطرت لئے فقط اک سنت پر وحدہ لا شریک کی تسبیح پر اپنی مہر و نبوت لئے اُترا
گویا جو اترا وہ معصوم اور ہر نجاست سے دور کہ مہرِ نبوت روحِ پروردگار سے جڑی اور روح ایسے کہ ہر نجاست سےدُور اک پُرنور وجود لئے بھیجنے والی ذات پر آمین کی نکیل لیے ایسے کہ پہلا اگلے کی نوید لئے اُتارا ، یوں صبر اور شکر کے ریت و رواج میں منزلِ شہادت اور استقامت پر
کیسے ممکن ھے کہ جہاں خلقت وحدہ لا شریک کا کُن لئے فَیکن کا اثر ھو، وہاں فیَکن حالتِ شرک میں شرک کے باوجود نبوت کی منزل پر زیبِ تن ھو
کیسے ممکن ھے کہ جہاں منزلِ امامت پر بعداز خدا منصبِ محراب و ممبر دعوہِ نبوت و رسالت کے استر میں لا شریک کی سبیل ھو، وہ خود مشرک کی صورت شرک کرتا رھا ھو
نہ جانے یہ کس دین کے پیروکار ھیں جہاں کبھی کے مشرک کو نبوت کے سانچے میں پِروکر تقاضہ قدرو منزلت میں سمویا کرتے ھیں ، یوں مہرِ خاتم انّبین کے بعد بھی کبھی مشرک کو نبوت کے عَلمِ بردار کی صورت گمراہ کُن اعلان کیا کرتے ھیں “ کہ میرے بعد اگر نبی ھوتا تو پتا نھی کون ھوتا”
عجب نھی کہ مسندِ نبوت کو ختمِ نبوت کے بعد منصوب کرنا بلاشبہ ختمِ نبوت و رسالت کو مشکوک کرنا ھے
یہ اس لئے کہ نبی جیسا کوئی بشر نھی اور نبوت جیسا کوئی منسب نھی
کیسے ممکن ھے جہاں خلقتِ آدم کی ابتداء سے بھی پہلے نورِ محمد ھو اور بعدِ ظہورِ محمد کسی کے کردار کو محمد کی نبوت کے ہمسر ٹھہرایا جائے، ایسے کہ صفات، ادراک،علم،منسب فطرت،عصمت،عطرت اور مجسم نور کے طلسم پر عرشِ اولہ پر موجود محمد جیسے واحد نورِ بشر جیسا دکھایا جائے، جب کہ وہ شخص اک عمر لئے بے دین و گمراہ اک نجس نطفے کے اثر میں وجودِ شر ھو، کہ قرآن کہ اٹھے کہ کیا کبھی بنی نوع انسان نے اپنی نجس خلقت نھی دیکھی، کہ کس نجس نطفے سے ھم نے اس کو خلق کیا، یوں سورۂ یاسین کی اس آیت کا مزداق ھو کہ “تاکہ تم ان لوگوں کو گمراہی سے نکالو، جن کے باپ دادا گمراہ تھے”
بس کیسے ممکن کہ شرک میں ڈوبا، نفس, اولہ کی مانند نبوت کے منصب پر نگاہِ بشر ڈال بھی سکے
عجب شرک ھے کہ جہاں کائنات کی خلقت خاتمُُ نبیٍ کی صورت محمد کے وجود کو لئے حجّتِ کائنات ھو وہاں مزاجِ مسلماں اک نجس نطفہِ بشر کو نبوت کے آنسر پر ذات، صفات اور اوصاف کے کردار پر دیکھنا شروع کردے، یوں کبھی کہ مشرک کو باوجود شرک کے نبوت کے سانچوں میں تولنا شروع کر دے
عجب نھی یہ روایت کہ جہاں دین ایمان کو لئے خاتمُُ نبیٍ سے جڑا ھو یوں آخر مانانِ ایمانِ کل ھو وہاں ایمان کو بے یقین کرنے اک نفس کو مسندِ نبوت کے ہمسر لا کھرا کیا جائے ، ایسے کہ جیسے کے وہ بھی انھی کرامات اور صفات پر جیسے وہ بھی نبوت کے ھم پلّہ ھو
جہاں مزاجِ پیروی میں مسلمان اپنے جیسے انسان کو نبوت کے سانچوں میں دیکھنے لگے وہاں دین فطرت سے ہٹ کر خواہش بن جاتا ھے ، یوں خلیفہ بلا فصل سقیفہ بل شر کہلاتا ھے
نبوت کی پہلی شرط نجاست سے پاک خلقت ھے، جہاں امر آسمانوں پر سجدہ لئے وجودِ بشر میں روح کے تعلق سے جڑا ھے”کہ جب میں اس میں اپنی روح پھونک دوں تو اس کے آگے سجدہ کرنا”
“ابھی وجود نھی پر بشر نبی ٹہرا”
اور یھی نھی،
“ ھے سجدے گاہ تیری، منزلِ عطاعت میں
میری ھی روح لیے یہ میرا ازن ٹہرا”
جہاں خلقتِ نبوت ازنِ الہی سے جڑی امر لئے روحِ پروردگار کی صورت سانچِہ نبوت ھو، وہاں کوئی مشرک اور نجس نطفے سے پیدا ھوئی مخلوق مسند نبوت و امامت پر فائزنھی ھوا کرتا، یوں یہ ضعیف روایت بلاشبہ زمانے کی گرد میں غرور و تکبر کے ارض میں کسی بے دین روی کی غفلت سے جڑی رسم بغضِ عظمتِ آلِ محمد میں ڈوبا مقروضہ ھے جس میں کفر واضح اور ایمان ناپید ھے
دراصل عبادت نماز یا اُس جیسی کوئی فرض واجبات نھی، بلکہ عبادت عبدیت کی وہ پابندِ سلاسل طوق ، ھتکڑی اور بیڑیاں پہنے قید ھے، جس کی آزادی خود قیدی کا اپنا اختیار ہو اور جو اپنی رضا کو لئے کسی کی رضا سے بے پرواہ وقت اور حسار سے باہر جزا اور سزا سے عاجز کسی بھی تسکین اورتلقین سے عاری، وقت، حالات اور پہر سے آزاد، دیکھ لئے جانے کے ڈر اور ریاکاری سے دُور قیام، رکوع اور سجدے میں ڈھلی ایسی کیفیت لئے جس میں نہ کوئی رسم اور رواج ،نہ ھی سلسلہِ طریق و تکبیر،کہ نہ کوئی طور رائج، نہ طریقہ غالب،یوں عمل کے پابند نھی اور نہ اجرِ خیر کاطالب،بس خلوص اور نیت منزلِ کمال پرنامِ محبوب سے جڑی سانسوں کی وہ تسبیح لئے جو ہوش و حواس میں محبوب کا وِرد دل کی دھڑکنوں سے بجا لائے
بس عبادت معیارِ عطا اور جزا سے بے پرواہ ہوا کرتی ھے، یوں نہ خوف معبود کا اور نہ لرزہ بندگی کا ، کہ پھر خود معبود اپنے کلام میں قبولیت اور پیار کا اعلان کچھ ایسے کرے، کہ چاند کی قسم، سورج کی قسم ،نہ تو ھم تم سے ناراض ھوے اور نہ ھی ھم نے چھوڑا
بس جب وجود ذات کے پیکر میں ڈھلتاھے تو ذات وجود کے استر میں آ موجود ھوا کرتی ھے
یھی ذات اور وجود کی اپنی ساخت اور شناخت سے جڑا ھونا گویا مانندِ وجود بشر کی صورت آ موجود ھونا دراصل مزاجِ جنوں انس و بشر میں امتزاجِ شر پیدا کیا کرتا ھے
بس ذات سے وجود اور وجود سے ذات تک کے صفر میں بصارت سے بے پرواہ انبوہ بصیرت پر ہی تقاضہِ عبادت کی تکمیل کردیا کرتا ھے
یوں بشر سے شر تک کا صفر ذات سے بے پرواہ وجود کے محور میں ھی ادا کرتا ھے
بات یہ ھے کہ جہاں بصیرت دید سے جڑی ھو وہاں بصارت گمان ھوا کرتی ھے اور کامل یقین فقط کیفیتِ بصیرت
شائد یھی وجہ ھے جو سجدے میں عبادتن جان دینا اور پھر خود کو کامیاب قرار دینا غالباًاس بات کی نوید تھی کہ بشر سے شر کو جدا کردیا
یوں وحدانیت کو سجدہ کر کے بیاں کردیا اور وحدہ لا شریک کو عیاں کردیا، ایسے کہ علی اسمِ الہی کا مظہر ھے یعنی وہ جس کا کعبہ گھر ھے
میں در بدر ضرور ھوں در سے بدر نھی
نہ پوچھ کہ اس خوف نے بےخوف کردیا
اک جہدمسلسل نے مجھے ظعف کردیا
￼جو تیرے عشق میں ڈوبا تو ہوش کھو بیٹھا
کہاں مجال کہ یوں ہوش میں کوئی لوٹے
May 2020At present, there has been a lot of debate within the professionals as to what cascade of event actually takes around the course of disease to the end as fatality in terms of pathophysiology.
- Capillary congestion
- Hyaline membrane formation
- Interstitial edema
- Pneumocytes hyperplasia
- Reactive a-typia
- Platelet-fibrin thrombi
- Necrosis of pneumocytes
- The inflammatory infiltrate with macrophages in alveolar lumens and lymphocyte within the interstitium.
- Viral particles within cytoplasmic vacuoles of pneumocytes.
As such the overall presentation fits in to the clinical context of coagulopathy that dominates in these patients.This “coagulopathy is one of the main targets of therapy in Covid -19 disease”It is said that lungs of most COVID -19 patients retain their mechanical capacity to function despite severe hypoxia.It is also been observed that patients put on ventilators do extremely badAs such the modality of treatment to put all Covid -19 patients on ventilator is a mere criminal treatment that puts unwanted deaths on score board.It is again negligently criminal to put patients on intubation/ endotracheal tube which again increase the number of run in death board.One of the bloom blessing in disguise or a bad omen whatever, in Covid -19 clinical presentation is a, “Happy hypoxia” the name being given to the condition for these patients do not have sudden air hunger to collapse them rather a late presentation of collapse in spite of low oxygen saturation.As such the initial paradigm of intubating patients as soon as oxygen saturation begins to drop is drawing skeptics and to my recommendation it must be cautiously consider before institution hence to me the same is a last irreversible slot of treatment which shall ever be tried.It is now believed that suspected patients with COVID-19 have a unique lung disease, and not the classical ARDS.Clinicians have realized that modalities that courses treatment to intubation and further to ventilators take patient farther towards mortality ranging from 30% to almost 100% this is in case they are put on ventilators. One enhanced mortality explanation is physiological reason being discussed among critical care doctors that air pushed in at high pressure by ventilators may be causing more harm to lungs thereof further damaging than providing relief vice versa.It is again a parted and impartial observation that patient with severe hypoxia that are conscious do better with oxygen provided by a tube in the nostril as compared to sedated with intubation or on ventilators.Since the main bunch of required treatment has a scoop of oxygen requirement with reference to anoxic episode many ‘layman techs and tricks have been in run to enhance oxygen delivery one being tilting patient to turn to the left or right or even prone (on the tummy)’.The same has dramatically improved oxygen saturation within minutes of applying this simple technique.It is said that the prime minister of England was treated with similar simple oxygen delivery.At the most and at if necessitate patient may be given oxygen by continuous positive airway pressure.A form of (PAPV) positive airway pressure ventilation applies mild air pressure on a continuous basis.The COVID-19 lungs have revealed that they are more like as if they’re suffering from high-altitude sickness that causes pulmonary edema.This is like dropping someone on to the peak of Mount Everest without any time to acclimatize which is a key to any one climbing the mountain above the sea level.The other qualitative characteristic of SARS-CoV-2 virus, unlike conventional pneumonia is; it attacks both lungs. The patients come to the hospital though with low oxygen levels yet not in distress.It is a clinical customary that the usual patient who attend clinics in acute distress become anxious with air hunger once oxygen drops below 80%, but not the COVID-19 patient therefore masking acute necessity.In my opinion this masking of symptom in spite of derangement can be manage easily by Pulse oximeter if at all such positive cases with symptomatic mild or moderate presentation are to be monitored for concealed derangements.In addition autopsies have revealed a strange slime in air sac (alveolar sac) that surely plays a role preventing oxygen exchange in the lungs.Due to this slimy gel and the use of ventilator support; it is a possibility that ventilator might Increase the force with which the air enters the block alveoli.The first (Covid-19 + ive)(RT-PCR) patient who died from the virus in New York was an obese 77-year-old hypertensive man, whose autopsy showed that the lung sacs were smeared with a substance that resembled thick paint.Since mechanical ventilation can pump in air with a force that may rupture the already compromised alveolar sac, it is presumed and recommended that ventilators shall work at lower pressures in selective cases but this will need a randomized controlled trial to ascertain.It is now being recommended by many critical care specialists that simple oxygen administration to the patient in a prone position is a better alternative to allow nature to takes its course.There has been a substantial reduction in the recommendation and use of ventilators in COVID-19 patients in recent choice of treatment.The current mantra is to use ventilators in selected cases and to push in oxygen less aggressively. It should be noted here that the new corona virus SARS-CoV-2 is called so because of its similarity to the SARS virus, which caused an outbreak of severe acute respiratory syndrome (SARS) in 2002-2003. Genes and Genetic:Specifically, the new virus’s genome is a 70% match to that of the SARS virus.It is being prelude that using the SARS virus’s genome as a reference, scientists could use genetic sequencing to determine if the virus causing the current outbreak is the earlier SARS virus or a new strain.Initially, scientists in China were able to sequence the full genome of the virus only four days after the first case of infection was reported, thus paving the way for scientists around the world to design rapid molecular genetic tests for COVID-19.Using a technology and sequencing, scientists are today able to sequence multiple DNA fragments in random, which are then aligned on a reference genome from a related organism to build a full genome sequence.The genomes of most organisms are made of DNA, but some viruses – like the new corona virus – have genomes of RNA. The SARS-CoV-2’s RNA genome has 32,000 nucleobases.Tracts of nucleobases make up genes.The combinations of genes make up a genome. Genes carry the instructions for the virus to synthesize different proteins, including those that make the virus infectious.DNA is usually double-stranded while RNA is usually single-stranded. Both DNA and RNA are made of four nucleobases; three of them – adenine, cytosine and guanine – are common. In DNA, the fourth is thymine and in RNA, uracil. Virus mode of attachment, action and replication:After locking on human cells, the virus first releases it’s RNA inside the cell and uses the cell’s resources to transcribe an enzyme called RNA-dependent RNA polymerase (RdRP).RNA-dependent RNA polymerase (RdRP) replicates the virus’s genetic material inside the cell which is subsequently used to produce a bunch of proteins.The newly reproduced genetic material and protein combine with new viral particles that ooze out from the host cell hence ready to infect neighboring cells.This way, the virus perpetuates itself within our cells at the expense of the human cellular machinery.Diagnostic testing:The fulcrums of modern medicine are suspended on the molecular diagnosis of infectious diseases.And one test that makes this possible is the reverse transcriptase real-time polymerase chain reaction (rRT-PCR) test.The reverse transcriptase real-time polymerase chain reaction (rRT-PCR) test is currently used to diagnose the presence of SARS-CoV-2 in a sample.If the organism SARS-CoV-2 is present in a sample, it means the person from whom the sample was obtained likely has COVID-19 which is the name of the disease caused by the new corona virus.Procedural Sampling Covid-19:
- First, a technician isolates the genetic material of the virus from a nasopharyngeal sample (obtained from a person by a swab of the upper respiratory tract).
- This RNA is then converted to complementary DNA or (cDNA), using an enzyme called reverse transcriptase.
- The diagnostic panel for COVID-19 comprises four target genes.
- Three genes are specific to the new corona virus and one is a human gene, used as an internal control.
Many of the health care workers are of the testament that they are not sure how many decomposed because of COVID-19 and how many with it. The US Centre’s for Disease Control are also flexible regarding the cause of death in connection with the COVID-19 pandemic. Confirmation of presence of SARS-CoV-2 is not mandatory when the death certificate is filed. It has been concluded that patient may die with COVID-19 and not from COVID-19Many autopsy report highlights that a person can die from a condition other than SARS-CoV-2 whereas the virus can be a bystander or vice versa yet the tag remains the wearing of Covid -19. Thus this distinction cannot easily be made by clinical judgment alone as the symptoms have pretending double standard display that fits along season disease as well.It is reported that once a person with Covid -19 remained symptomatic for six days with fever and chills and died before he could be put on a ventilator.His lung sacs were inflamed and damaged with full of lymphocytes.On the contrary there was a 42 years old man who was infected by SARS-CoV-2 but did not die from it but bacterial pneumoniaHe was admitted in critical condition for fever, cough and chills.CT scan revealed ground glass opacities in both lungs.Nasopharyngeal swabs tested positive for SARS-CoV-2 but lung swabs were negative.There were food particles in the lung and the bacteria could be grown on culture. The final autopsy listed COVID-19 as a condition but not the cause. The patient had died of bacterial pneumonia because of aspiration.Besides, the CT findings noted (ground-glass opacity, consolidation) are not specific for COVID-19 and can be observed with numerous pathogens (for example during an epidemic influenza) and in many noninfectious etiologies.The almost constant presence of ground-glass opacity and the high incidence of the crazy-paving pattern meant that the chest CT features of COVID-19 patient have “ground-glass opacities may be due to mild edema of the alveolar septi, hyperplasia of the interstitium, partial filling of air spaces, or a combination of these features.Besides, the crazy-paving pattern may correlate with hyperplasia of interlobular and intralobular interstitia”.All these features are very similar to those seen in SARS and MERS-corona virus infections and such patients were labeled as having “interstitial pneumonia” at least in the early stages.Autopsies on COVID-19-positive patients in Italy have highlighted the presence of thrombotic formations and also of a thrombofilic vasculitis in the lung, brain, and other organs culminating in to multi organ failure.Receiving influenza vaccination may increase the risk of other respiratory viruses, a phenomenon known as virus interference.
Virus is not as seasonal as influenza but like almost all respiratory viruses the group along with Covid-19 are seasonal.Summer shall give a feeling of lull and self complacency yet still we have different degree of findings in Australia and southern hemisphere so watch out.
There is a second phase of epidemic in mid or late June or early July particularly in developed countries.
This next phase would be less abnormal than the first phase.
The next upcoming will be;
You may go out but little not often and no crowded place.
Restaurant would be there but every one apart and at every other table .
Aeroplanes at your door but with empty middle seats.
School shall regain their opening but not like as it was earlier classes and will have similar social distances.Remember you can not fill stadiums with 70,00 people any more.
You will work little earn little and spend little, its no good time anymore as it used to be.
Sporting & Entertainment event will not qualify for long since live audience would continue to carry risk of spread and shed.
Religious activities will continue to be in grey shades with unclear pen picture.
There will be applications to download that shall define your immediate past mates and dates therefore contact tracing can easily be worked out.
Variable numbers of digital approaches have been introduced.
It will be through the blue tooth or beep that is inaudible to human verifying that two phone were reasonably closer to each other.
In short there are and will be application which you will install to testify your where about in previous days if you ever test positive.
Current swab test requires person to change clothing at every new sample.
Sooner within months there will be a self swab approach test like in- home pregnancy test called R-D-T Rapid diagnostic test.
This test will be like pregnancy test in which you will swab your nose and mix the same in liquid container and the same is than drop over in to a strip which will change color if you are positive.
This report will than be shared to your government to act further as per law.
Though it takes time to develop vaccine say 10 or 20 years yet the minimum and fastest ever recorded tenure would be tagged with Covid -19 vaccine development.
Not less than 18 month is the minimum period though speculated shortest period is 09 month since 3rd phase of trial has human efficacy and safety.
A single dose vaccine would have 7.5 billion target where as 02 dose vaccine would have 15 billion doses.Point has its own worth in display explaining future strategy to gun and guide money as per desire.
Best ever marketing strategy is to divide and multiply and the 7 will give 15 with two dose and the 3rd dose will put you up at 21.
Again manufacturing will be unprecedented and multiple companies would be involved in manufacturing.
However the task has a assigned dictation and the blue eyed remains the choice of interest.
It is said that health care workers would be the first to receive the vaccine followed by low income countries.
This is because of the exposure risk they have numerically.
It is expected that the virus shall expand exponentially more in poor countries for their lack of compliance and poor health system making them vulnerable.
However this is not a valid justification and if I see stats in relation to current spread for I see a low rate in snug and smug in these areas compared to developed countries.
So the plan to put and push low income countries as foremost is to pay for the cost of developing vaccine as if human guinea pig or in terms of safe human trial and in all perspective an unjustified criminal strategy.
Other imperative necessity to be kept in consideration is not every one would get the vaccine at same time so time remains the enemy and condition remains the problem.
World need to decide who are the forerunners as winners to get first as must.
Remember plan is world can only return to normal when everyone on the planet is vaccinated or have a modest treatment in hand.
Its still years to come before world is vaccinated and before its again good old days.At the end of May hydrxychloroquine shall get a modest stature in the proposed treatment of Covid-19 .
Drawing blood from patient recovered from Covid -19 and giving plasma as antibodies it contains against virus is under run as promising candidate in treatment modality.
It is postulated that every falling month without a vaccine shall have more powerful backlash on economy that would put countries on hang.
There are more lock downs to come and soon to be a next seasonal approach of honeymoon in winter.
We must know some one is too fond of vaccine and its manufacturing.
Very soon an RNA Vaccine is undertaking its flight to launching.
It will not be like influenza virus vaccine that has fragments of influenza virus in shot so to boost up antibodies against influenza antigen.
An RNA vaccine turns your body in to own vaccine manufacturing unit.
Its a new approach where RNA will give a genetic code to the immune system in place of virus and the resultant antibodies will be produced without introducing Virus.
Being new in innovative approach, I personally could not agree with the concept of genetic code and its further antigenic response to create viral immunity as antibodies.
In my opinion its a genetic mutation that will sooner or later create autoimmune adversaries since antibodies are directed against the mutated code imitating as virus though was never a virus but artificially tailored changes being brought about in immune system through genetic coding and sequence.
Immune system has a complex behavior and such manipulations in any genetic sequence without an actual viral analogue yet deranged genetic coding in its own RNA polymer shall be a precursor or basis of gene mutation leading to subsequent tumor in future.
The other very important aspect of this altered genetic coding ,the RNA vaccine unit , also supports the 5-G theory of conspiracy that puts fear among people of similar mutations and endless cancer.
Why not belief that changes in sequence in genetic code could also be brought about by 5-G internet.
This is because human body is itself an electrical system and is sensitive to environment.
This 5-G is a battlefield gauge of electromagnetic field and its frequency sequence definitely expose human to mutation on particular sequence altering and creating a cytokine storm without a virus antigenic response or its prior exposure but by mimicking a viral antigenic response similar to virus but not virus hence a cascade of autoimmune hyperactivity.
It is said that RF and MW radiation exposure causes disturbances in immune system with physical alteration along with degradation of immunological response.
Cancer cells are vulnerable to frequencies between 100,000 hertz and 300,000 hertz.
Humans are electrical chemical beings tuned to earth natural pulse frequency of 7.83 hertz known as Schumann Resonance.
When humans are in sync with 7.83 the body is able to heal and increase its vitality.
If we are out of sync with Earth’s Frequency (Schumann Resonance) we begin to exhibit signs of discomfort that can range from anxiety, insomnia, illness, suppressed immune etc.
Magneto-reception (also magnetoception) is a sense which allows an organism to detect a magnetic field to perceive direction, altitude or location.
This sensory modality is used by a range of animals for orientation.
Magneto-reception deals with the detection of the Earth’s magnetic field.
Bats may also use magnetic fields to orient themselves.
They use echolocation to navigate over short distances, it is unclear how they navigate over longer distances.Our health depends upon this natural coherence of frequency and environment.
However on the other perspective how could 5-G with billions of hertz against natural Schumann resonance could not effect our health being with such a massive hidden 5-G bombardment.
Though conspiracy theorist are running parallel with the pattern and spread of the disease on fiction and real realm; the created suspicion there off has a reserved seat in thinking mechanics of researcher who can not go without endorsing facts as per figure.
A very important scoop of attention lies in the fact that a Covid disease should be looked in a separate slot from its transmissibility during its contagious phase.
Recent studies suggest that R-O of COV -2 is 5.7 and not 2.5.
Lets understand one thing high R-O (R Naught) does not means a dangerous disease where as R-O is the infectivity of the disease.
R-O less than 1 means disease will die down where as R-O above 1 means the disease will continue to spread.
SARS have R-O of 2 to 5 but could infect only 8000 where as flu has R-O of 1.3 yet it infects millions.
These numbers tell us only potential transmissibility of virus and not disease and screening and quarantine are ways to gauge and cadre transmissibilty of the virus.
It must be emphasized here that vaccine take time to create immunity (at least 02 weeks) and the means span shall have en-route drugs effective to combat disease in mean time.
Essentiallity for a vaccine has basic criteria of safety and efficacy as a little failure will get the harmonic trump out of band.
We have a general belief that someone out there would always be ready to accommodate the worse we have.
However pandemics have little cushion and as such demoralizes this faith and belief for in reality even the best of health care system could not succumb and sooner or later unveiled or show its incapacity to hold fort for long.
Germs do not cause disease and are not cause of the disease but are the result of the disease.(Dr Raza)
بپھری ھے ہر اک موج ،عجب رن کا سماں ھے
حیدر کی شباہت لئے ،عباس کھڑا ھے
What is concerning the most is, why should vaccination be the prime treatment of choice in an anti viral treatment modality?
And same goes to anti viral treatment in a disease which has an 80 percent carrier state that is likely to vanish after incubation period of 14 days without symptom in 80 percent population and whereas few slots of different percentage and severity may turn with fatality not more than 04 percent at the most.
Is in it strange that we have acknowledge presence of carrier state of virus(Infective stage) as disease where as in reality a full blown disease from virus has very low propensity with again a crude fatality that is a mere subject of havoc or hue rather a management.
A zoonotic virus with a masked vector infecting human to human again and again as contact transmission with a further life cycle without an initial transporting vector or original specie;
That is too strange that transmission cycle has a cease recessive allele from which a virus originated say as bat or pangolin or whatever where as further progression of the virus has a human contact transmission without any input from its previous cycle rather out of cycle meaning the virus does not need anymore what is termed a necessity as vector for spreading in to human neither specie that it belongs to as commensals.
It means next breed of virus expansion and spread has human as host and no one behind as ghost vector any more.
Let’s be simple and ask our self what is the fate and life cycle of virus while in its frame of human to human spread.
A man as person zero will infect 1 or 2 where as the ground zero and human zero will become the first on earth in girth.
Fate of the one as Patient zero will either be resolution or late resolution and revival after a disease course or death as unrecovered fatality.
The point is not every one is carrying a disease yet everyone can be a potential spreader or carrier whom may help in progression of spread of virus but not disease for virus remains as carrier in 80 percent without being symptomatic.
So if in case population at large becomes the carrier, 80 percent shall not exhibit viral disease and yes shedding that shall infect many along with or without symptoms.
This shows that what does not raise symptoms in 80 percent population has limited petition to be considered on ground of pandemic or epidemic or endemic disease for which necessity shall demands urgent vaccination.
And yes considering the importance on ground of potential patient that shall get disease and turn in to fatal though may be low outcome of course; demands keen logical input for safety and treatment considering part as parcel of ailing humanity.
Let’s not take whole world as slip up and peddler who may not understand the graph and its movement around the sphere.
I am sorry but the virus could not play what is being displayed in countries that are developed.
Though the objection that no of cases are being misreported due to unavailability of test kit may be a logical ask but even with unavailable kits, lack of compliance for lockdown and similar non compliance on social distancing and etc; the calculation of disease spread and its aftermath should be on ground of infectivity of spread as disease and not on spread of virus that just makes 80 percent population as mere carrier.
This is because a non- virulent virus with no infecting capacity and a better immune response of the people that shatters infectivity of virus which is called the immunity of that population or herd immunity clearly defines that virus virulence is less as compared to people resistance as immunity especially in poor countries.
The same goes to other countries and a dangerous outcome of any disease or spread is its infective deter or spread causing fatalities and not its non-virulent spread that does nothing except making people a carrier hence tagging virus as perhaps sooner to become commensals.
Let’s be frank and logical testing people is neither a necessity nor can be tagged as necessity.
That is so immature that you go for testing 7. 5 billion people in globe therefore to see whether one is Covid positive or not.
So being logical is to create criteria that shall accommodate population at large that is less likely to be infected with population most likely at risk.
Influence of virus is different in variant countries and studies as per epidemiological criteria shall have different results.
This is insane that virus being tagged as a universal influencer who shall now disrupt this universe with its virulence and the only modality in treatment shall and would be to vaccinate globe before they start exhibiting interactive interaction again like they used to previously.
Come on come out of idiocy and define terms in a manner hood with utilizing phrases at their best.
Carrying a virus and carrying a disease are two methodologies.
Not necessarily a virus shall provident disease and may likely go unnoticed where as when it exhibit and turn in to infective episode the same is called disease.
Under no means few among the globe as caretaker can be allowed to witness truth where as all within the globe are to follow such so called prophetic soul being put up in the name of WHO .
Recent studies in relation to Covid -19 and day to day minute changes being brought about by concerned game changers suggest that there are 115 agencies looking after vaccine preparation and the run to become the first pioneer is in progress but frankly the first to come has a reserved seat which has a reserved approval of all authorities may it be Licencing, patency or WHO recommended regulatory FDA approval.
It takes lot of years to get a vaccine out of dungeon say 10 or 20 years but look at the artistic work of backbenchers that within period of few month launching shall put many poor nations on human guinea pig.
It is being thought upon that initially out of billion vaccines being manufactured; first to be vaccinated would be those countries that have a poor medical system since they are endangered species or perhaps the investigational human trial.
Next to follow would be workers in medical field perhaps or racial color or nation based samples.
In addition therapeutic accelerator and plasma substitute from those infected and recovered are also in Toto.
One must understand it’s not a game of months or years.
It is a forecast marketing strategy for a decade and so till its new arrival as new threat for the world as new pandemic.
Some people are claiming to protect globe from an unseen enemy and as such the avengers as last knight is the vaccine that is being looked after Mr. Bill Gates and Inc.
So the plan is billions of vaccine with billions of target customer in a dose of profitable concept of multi dose regimen may be like hepatitis (Engerix –B) in 012 schedule or 016 with booster at 01 yr or 5 yr.
Is in it amazing that we are waiting for a vaccine; that vanish virus after just a 20 second hand wash.
Strangely a well known soft ware expert briefs the world as scientists with his prophetic speeches as what to come next in universe thus lecturing the globe on preparedness and response.(Dr Raza)
خدا کا شکر ھے جس نے کائنات کی بہترین خلقت کو پنجتن کے سانچے میں اپنے نور سے پُر نور کر دیا
شکر ھے اس ذات کا جس نے منزلِ سعادت پر خالق کی چاھت کو ہدایت کے اصولوں پر علم کےنزول سے اپنی طرف دیکھنے والوں کو بصیرت سے روشناس کیا اور یوں دین کو دنیا اور دنیا کو دین سے منسلک کر کے اپنے پسندیدہ لوگوں میں لوگ چُنے اور اُن کو منزلِ امامت لئے نبوت پر فائز کر کے علم کو اپنی میراث بنایا،اور میراث کو علماء فقہ اور علم رکھنے والوں کو محافظ بنا کر حفاظت پر مامور کر دیا.
بس یہی علماء آج زینتِ الہِی میں دھلے علمِ رہبری میں سجے غیبتِ امام میں لوگوں کو راہ
دکھانے والے اور راہ کو محمدُ آلِ محمد کی درس گاہ بنانے والے ٹہرے.
یہ علم اور فقہ بلا شبہ عین اللہ کی مانند درسگاہ محمدُ آلِ محمد ھیں ،اور ان کی زندگی کا ھر لمحہ دین کی ترویج اور لوگوں کی اصلاح پر مرکوز ھے.
بلاشبہ آپ بھی ایک ایسی ھی ذات کے وجود سے جڑے شعور میں دھلے زینتِ محمد و آلِ محمد کے علمبردار ھیں، جن کی موجودگی ھی فقط نورِالہِی کا بشر انسر ھے.
مولا آپ کے علم کو تقویت دے اور شفاِ کاملہ عطا فرمائے، تاکہ یہ خطہ عرض آپ کی علمی تربیت سے اپنے علوم میں اضافہ کرتا رھے(آمین)
غرور کر جو اگر اس گھمنڈ کا حق ھو تجھے
انسانی شعور میں سمجھ سوجھ بوجھ کی انتہا طلبِ دیدار سے جڑی بصیرتِ نگاہ سے منسلک ھے
یوں یقین شک لئے کامل یقین کی طرف دیکھ لینے پر ھی ایمان لانے سے جڑا ھے
اندر لگی میں آگ بجھاتا ھی رہ گیا
فرصت ملی نہ پھر کہ امامت میں کر سکوں
مجھے دکھا کے تو کس طرح زندگی دے گا
کہ اس یقین کو کامل یقین کر گزروں
دکھا مجھے بھی تو چہرہ تجلیوں میں چھپا
کہ اس شعور کو اپنی نظر سے پڑھ گزرو
تقاضہِ گو کہ ھے یکساعطامیں فرق لئے
معیارِ سوچ میں فرعون کچھ غلط تو نھی
نہ دیکھ پائیں گے آنکھیں تیری بصیرت پر
یقین گر نہ ھو دیکھے بنا یوں غَیبت پر
ہے کیفیت میں چھپے کس طرح خدا جانے
یہ تم سے پھر ھو ملاقات کب خدا جانے
کٹھن سفر تھا یہ اگلا سفر خدا جانے
ھے کتنی دیر، تیری آمد لئے خدا جانے
تھا انتظار رھا، اب بھی انتظار ہے سچ
تو کر یقین، کہ یہ اعتبار خدا جانے
Is it Coro\nna (n Cov-19) or your immune system killing you!
Perhaps it’s not the virus but our own immunological system killing and destroying your lungs through ‘Cytokine storm’.
And if it’s true, a controlled epidemic of number of people would definitely be the right option to create herd immunity till its time of vaccination.
Here the principle of herd immunity lies in the assumptive fact that in case of general exposure most people will have no or mild disease where as rest populace will be effectively controlled through innate immunity hitherto the few uncontrolled would be manage as the nature takes its course in terms of disease severity.
Is in it strange; that some people with Covid takes a long route map to final fate and destiny where as many checkout un-noticing.
How come a virus with same virulence endangers many whereas most wean away unchecked without after effects.
Stats define lethal fatality ratio in limited percentage with variant mean involving ages in almost every facet of milestone.
And again in spite of ruthless turnout of the disease as engraving course from no symptom to critical yet similar toppling and symptom free retaliation by most individuals remains the fate of virus as well.
This twin behavior of the virus or body clearly explains the different reaction of the body or virus and thereafter action and reaction of the body to virus and disease.
Till now and with backup information of previous viral epidemics it has been under observation that body immunological response is creating a pivotal role in disease progression and recovery.
Studies suggest that cytokine storm might explain why disease has different modes of course in different individuals
Same lies with the fact that virus has different strain in different situation hence variant virility and different body response to variant discrete exposure.
As such stats and strategy works needs to quantify cases in terms of all such aspect that predisposes disease and exposes individual with its factors that are calibrated and counted within the contextual support of virus affectivity.
The Pars may be supported by the fact that younger’s are less affected compared to older people and female are less affected than male thus sliding the score to well above when it’s a matter of senior citizen though being a real time study all such findings have minute changes and will remain as such till the graph of disease and epidemic becomes static for studies.
The same goes to body innate response to virus and disease hence body’s immune reaction to the antigen thereby rating a list within questionnaire with the primary melt as why there is a different immunological response of the body to virus or disease exposure?
This Attention to immunological response took flight of interest due to the fact that the virus has close resemblance to the previous counter part responsible in previous epidemic that had similar fatalities of disease process.
Scooping the grave fatality of the course and pattern of Covid- 19 disease process in real time and the previous encountered observation and inference of its epidemic counter parts in 2005; cytokines took the plight of interest hence its role that was being overshadowed by pre-clinical to sub-clinical threat and fear of virus.
Regardless of suggested theories and hypothetical misnomers we must understand that it’s a new virus and is in real time so what we see and hear today can out rightly be disown or rejected tomorrow.
Yet theses minute changes that are brought about actually are the proclamation of remedy as a step up no matter what is added or subtracted during the course and run of pandemic in terms of management modalities.
So far and till now it is said that the fatality and seriousness of the disease and illness is due to the layman fact that immune system goes wild and uncontrolled that makes virus a threat to known destination by an unknown path.
Here my request would be not to take most of this upcoming discussion as a compulsive medical theology and theory where words and manners have ethics of formulary and abbreviations rather explanatory phrases.
Lets not take this extra-curriculum of defining and redefining medical terms in a professional manner but a little in a manner where unprofessional masses at large can assimilate the myth behind disease as beneficiary.
A defense mechanism to fight foreign invader in a body with many physiological and biological component;
Immunity is simply resistance of the body against an invading organism commonly known as antigen.
It’s a balance state of biological defense of an organism or cell to fight against invasion of unrecognized enemy.
Immunity can be
- Innate and adaptive system
- Acquired system
Innate system is programmed to recognize and react where as adaptive system is programmed to recognize own substances and not to react.
The reaction to foreign substance is called inflammation.
The non-reaction to own substance is termed immun-otolerance.
Immuno-Suppression is a reduction in the activation or efficacy of the immune system.
Immuno-suppressant is the method of deliberately induced Immuno-suppression in optimal circumstances.
Immunodeficiency is a state in which the immunity to fight against infection, disease and invader is compromised to subnormal level of immune system or entirely absent.
Most cases of immunodeficiency are acquired secondary due to extrinsic factors that affect the patient’s immune system.
Opportunistic infection is an infection caused by pathogens (bacteria, viruses, fungi, or protozoa) resident or non-resident that take advantage of an opportunity not normally available.
Many of these pathogens do not cause disease in a healthy indivisual that has a normal immune system.
However, a compromised diseased immune system, in a debilitated individual with lowered resistance to infection becomes disease by it s own commensals.
Commensals are Organism that resides normally on individual with symbiotic or mutualism based biological interaction with or without benefit.
Auto Immune disease:
When immune system reacts against it own substance or cell. This self inflicted injury is due to the abnormal behavior of the own immune system.
Health is a state of well being, with no infirmity or disease.
Technically when self substance is immunologically spared and foreign invader is immunologically eliminated state of equilibrium is called the health.
A disrupted state of well being
Technically as per context a disease is when foreign invader cannot be eliminated or when what is self is not spared.
- Innate immunity:
Innate immunity is a natural immunity acquired through genetic make-up without an external stimulation or exposure to previous infection.
It is divided into two types:
- Non-Specific innate immunity
It offers a degree of resistance to all infections in general.
- Specific innate immunity
It offers resistance to a particular kind of microorganism only.
- Adaptive (Acquired) immunity:
It is divided in to two;
It is acquired through chance contact with the organism.
It is through deliberate action such as Vaccination
Immunity (Organogram of divisions)
- Innate immunity
(Natural vide genetic material)
- Adaptive (acquired )Immunity
- Passive vide (Maternal)
- Active vide (Infection)
- Passive vide (Antibody Transfer)
- Active vide (Immunization)
It is still debatable whether a person is completely immune for life after exposure and recovery for immunity after any infection can range from life-long and complete to nearly non-existent.
Corona viruses, a large group of viruses that jump from animal hosts to humans
Much of our understanding of corona virus immunity is not from SARS or MERS but from the seasonal corona viruses that spread every year causing respiratory infections ranging from a common cold to pneumonia.
In two separate studies, researchers infected human volunteers with a seasonal corona virus and about a year later inoculated them with the same or a similar virus to observe whether they had acquired immunity.
Multiple assumptions with predicted theories are in run for this family of virus where a slight change in viral strain or number of years results in loss of immunity from partial to no immunity.
Same goes to the SARS and MERS virus where number of passing years reduces immunity to the virus replication on re exposure.
Corona viruses in general are family of viruses that targets and affects mammal’s respiratory system.
There are four main genera of corona virus which are called
Most of these viruses affect animals but few can also cross the barrier to human thus transmit disease to human.
The genera that crosses barrier are alpha and beta genera and the common carrier are bats, civet cats, pangolin, and dromedaries or camel through intermediary animal.
The sequence genomic DNA structure of corona SARS-COV- 2 has resemblance to two bat viruses with 88 % resemblance in genomic sequence.
It is also suggested that new virus DNA is about 79 % similar to SARS Corona Virus and 50% similar to MERS Virus
Recently it is suggested that pangolin is the initial propagator as its genomic DNA sequence is 99% of corona virus specific to these animal
Its incubation is 5-6 (any where up to 14 days new WHO advisory) days that is the virus takes 5-6 days to give rise to symptom.
It has been observed that symptoms of Covid -19 with other respiratory ailment are very difficult to distinguish until it is done by a specific specialist test that discloses and matches the viral DNA SARS- Cov-2.
As such we shall keep this in mind that not all symptoms are viral and not all diseases are viral.
Recent studies suggest that variant strains of corona viruses have spread in different parts of the globe and theses are;
- Type A
Type A is closest to virus found in bats and pangolin
It was the root cause of the outbreak.
Two sub Cluster of the viruses have been found with one linking to Wuhan while other to America and Australia Spain, Chile
- Type B
Derived from type “A” mutation that mutates slowly in china and rapidly outside china such as UK, Belgium, France, Japan, Brazil, Canada, Germany, Finland, Denmark
- Type C
Its daughter to Type “B” and mutation spread to Europe, Singapore, and Hongkong, Italy
Patho-Physiology of Covid -19:
Practically specking cytokines are the signaling molecule that alert immune system and an immune system that go wild create a cytokine storm or precisely the immune system starts harming rather helping.
Normal structured and signature stand of the immune system is to encounter any germ entering the body in an orderly and controlled environment and cascade.
However sometimes reaction to the invader takes the plight of hit and hammer without the torch test or testament thus like an uncontrolled mob with heavy weaponry as if coup against its own orderly fashion creating a messy war of sludge without flush.
As such plea to recognize own is sacrificed rather butchered and none among shall it be an invader or its own are ruined and run thus destroying own self and own tissue taking them as enemy, as well.
This is a devastating immune response with auto immune activation under the umbrella of dozens of small protein herd broadly known as cytokine storm.
Cytokines are protein made by certain immune and non immune cells which has an effect on immune system.
They can be made in lab as well and are used in grave and lethal diseases as immune modulators.
Examples of cytokines are interleukin, interferon and colony stimulating factors and are immune modulator that can cause flue like symptom matchable and almost similar to what can be predicted and isolated in this pandemic Covid -19 infections.
Increase activity of cytokine increases immune response sluddging and crossing the limit of affected area thereby destroying the unaffected vessel as well by a vicious cycle of torn and tear without fear.
Resultant is clotting cascade and sluddging, choking, decrease blood flow organ failure.
Containment and curtailing cytokine storm is the current chapter of biblical verses of the doctors at the moment.
All efforts are being prayed and exhumed to isolate alert sign of undergoing cascade before a irreversible chain of event takes its start.
Many factors have been isolated that alerts such ruthless process as has been signature and signed since they are found in high quantity as indicator. Among them are;
- IL- 6
Cytokine storm has been linked to pandemics since early and is said that there may a genetic mutation variant that had made immune system to overreact.
One must bear it’s hard to fight when immune system is compromise.
Person carrying mutated gene have mutated protein that react differently from normal and perhaps the same explains different percentage of severity in different individuals inflicted with Covid-19.
Such mutations serve the function of destruction from distracted recognition to impediment of flow or trafficking.
It is said that women’s have inherent genetic superiority on corona pandemic with her dual X-chromosome this is by a TLR -7, a specific gene that helps to recognize single stranded viruses and as such women bearing 2-X has advantage over man in early recognizing.
One of the genetic superiority of female over male is because testosterone inhibits immune system where as estrogen enhances immune system.
A Covid -19 uses its spike protein to enter in to the cell by unlocking protein on the surface of the cell known as ACE 2 protein that is found on the surface of X chromosomes.
As such if a man encounter Covid -19 with a spike protein it unlock the ACE2 thus entering cell there by more susceptible to female which has better advantage of recognition with 2X.
Thus an immune system is typically body’s personal army that works from cellular to macro level playing a pivotal role in warding off invading organism hence guarding against internal or external threat.
It is to be elaborated here that being a RNA virus it has high mutation rate which when combine with natural selection quickly adapt to changes in host.
Such enhanced level of mutation and transfer of genes in offspring also makes development of vaccination as unwanted problem with often resistance in drug prescription.
Presently there is a proposed story that stray dogs intestine might have contributed to the origin of pandemic where as animals like snakes and pangolin have all been put forth as intermediate host in spreading of disease.
It is said that Ancestor of SARS Cov-@ infected the intestine of the Canid(A closely resemble mammal in dog family) resulting in evolution of the virus and jump in to human(Dr Raza)
A Novel:In literatureNovel is a fictitious narrative in a story with sequence chain of events that include cast, character settings and an ending.It is an idea of evolving identity that has never been thought before with an image of something new and different.A Novel focuses on character development more than a plot.It is a kind of fiction and fiction is an art of crafting and engineering characters with written script.A novel is a fictitious prose typically representing character and action with some degree of realism.A manuscript of more than 40,000 or above words is considered to be a novel.A novel is a long fictional narrative that defines intimate human experiences.Summing up a novel tells about specific human experiences over a considerable length of time.One must remember not all fictions are novel but all novels are fiction.The following traits must be present in a novel.It must be written in prose rather verseStorytellers must have different degree of knowledge and different point of view.
(First person versus third person and so on)It should have a demonstrated word length, individualism and fictional content.It may have semi fictional narrative of history or a fiction that exists in real world.Its plot must have at least three act structureThis is how a “Novel” is launch, Publish, distribute in the name of the story, therefore as a real time fictional story with little bit of realism.Here we present the name that itself defines the organism and its birth.Let’s decode the code and code it for decoding remedy.Here is your “ Novel” for any one regardless of age can get it.“The Novel Corona Virus”There is always a conspiracy theory behind every presentation
What is important?Spreading of virus or the disease secondary to it?What are we trying to do; containing virus or curtailing disease.In my opinion containing virus cannot be executed whereas curtailing disease can be managed.Solution lies in herd immunity for its impossible for our people to obey the functionaries orders in true letter and spirit.Let’s be realistic.People are poor and functionaries are corrupt.People can starve but the problem is, governance will not manage this lockdown induced starvation therefore violation of order is the tunnel end.Inference is; spread of the disease has hidden remedy and that is a herd immunity secondary to primary exposure creating passive immunity for exposure retaliation again, if at all.Let’s prepare for the exposure and let exposure be contained and nullify by antibodies.My opinion of the quiz is virus is less virulent than the immunity our people are bearing.This has documented evidence from people whom have been quarantine and now discharge without a single entity going through the mild or moderate course of disease even.I am not saying; I am only true and positive but this is what a stats defines the spread map.Let’s face it for once and create antibodies for long.Trend has static graph and does not need lockdown any more for what has been presented as calculation in terms of positive cases or likely to be positive has not come up as after effects.There may be more potential cases but iconic sign is, people did not come up with the disease and virus could not show its virulence either.What if we have number of positive cases but with no modality in terms of severity?Carrying as carrier and bearing as disease are two different scopes.If major portion of population carries a disease with no symptoms population at large become immune to it.We must match our socio economic blue print with upcoming threat that shall put massive at large in to a dip that will never give them a goose bump again.There will be no vaccine in near days or months and as such a likely second wave of disease shall put the country if not before, in to a civil war.No government can hold the fort of population’s thriving for food and for long and in sustained manner.Global misfortune will soon shutter trade and mobility and sooner or later countries had to rely on their own manufacturing’s may they be food, goods or medicine.Attack has basics understanding of antonym as defence and to defend one has to face and retaliate.We cannot leave empty platform for the disease to spread in a scoop of fear where people submits their body and soul without retaliating with burst of immunity or whatever they have.If we ought to die at least die with an honor not in fear and horror.Death is eminent and life is certain till its time of death.(Dr Raza)
Herd immunity is a form of indirect immunity from infectious disease when a large percentage of population in a society is immune or protective.This immunity can be attained through active immunization by vaccination or passively by getting natural immunity after infection hence building a new response though development of antibody.Herd immunity shutters the spread of disease and contributes to disruption of spread.The percentage of people that must have required immunity to slow or stop spread of disease is called herd threshold.Natural immunity develops when one get immune after contracting disease therefore resisting it naturally vide antibodies against the organism on re-exposure.It develops when so many people in a community becomes immune to infectious disease causing epidemic break.Such massive level of protection from re infection or disease spread is called herd immunity.Sometimes a disease spread through the community unnoticed and wean off itself creating herd immunity.Thus herd immunity is the protection from a contagious infection when population at large is immune to it either through previous vaccination or through previous infection.The process of becoming immune for future includes the production of antibodies specific to the virus.This production of antibodies can be after a person develops symptom or even when it do not develop symptoms or irrespective of the symptom.A symptomless exposure develops immune response developing antibodies against the virus and thus becomes naturally protected.When large population is immune virus has the hardest time to affect and infect middle of the herd who are unprotected thus the spread dies off as no further transmission to community can be appreciated due to natural resistance in surrounding thus slowing the spread as well as social infectivity.The pivotal role of herd immunity is that if people are not vaccinated or even the vaccine could not trigger response to disease in terms of provisioning immunity yet still people who are immune would act as a buffer between infected and other.R (o) is a basic reproductive ratio of herd immunity and is define as the average person an infected individual gives disease to.It remains fairly constant to variant disease and the R (o) for corona virus is between 2 or 3.By herd immunity we reduced the basic infective reproductive ratio to effective reproductive ratio of 1.As such when R (o) remains 1 disease do not grow above and remain stable.Now if we suppose that we have a herd immunity of any kind within the community we can reduced the number and spread of disease to the major extent.Since the pattern of disease spread has Reproductive ration R (o) 3 the spread could be curtailed best by exposing and enhancing the herd immunity thereby reducing the R (o) and creating buffer of spread by people themselves.In My opinion best way to control this epidemic was to create immunity, especially in Pakistan, was through the herd immunity not vide vaccination but by exposing maximum to the epidemic so that maximum number of cases of passive immunization could have a better natural resistance .Here it must be noted that China model of theme and theory of epidemic control has demographic cum environmental based differences where as its population has a limitless level of more than 1.5 billion people of variant statistical date and data as far as age, habit and habitat are concerned.It is true that out of blues if 1 percent of the Chinese population could have been brought in to death counter the inflicted number shall have risen to 15 million people at a stretch which is a large number to pay for herd immunity.So naturally and very rightly; Chinese decision to go for city and intra / intercity lock down was justified.But this decision to go for lock down in major cities of Pakistan is somewhat immature for the population here is fivefold less than china as well the norms culture habits and politico-religious affairs at extremes of distance apart.Intercity lock down would have been a better option where as intra-city affairs should have strict partial self quarantine/ forced strict policy.Being a doctor and very well aware of the fact and figures and of course the pattern from prodromal to aftereffects of any disease that take the flight of outbreak; I under no means take this non tech. and unprofessional dealing of the so called outbreak as liquid diet to be assimilated as such and as per dictated assorted theology and assault of the functionaries.As per available data and the run of the disease in terms of course and gravity; there is no second thought but the belief that progression of disease has a mild course of influence on majority and no more than few though are still controversial takes the full blown course of critical.Stats of quarantine throughout and in special centers have not a single case being reported to the peak of no return.And yes test being conducted as part of pre -assessment tool have false positive element and even positivity does not necessarily necessitate seriousness to the level of Zombie’s catch as if some on who is a threat to the community.In my opinion functionaries must redress and redefine their policies regarding Covid-19 outbreak keeping their demographic outline and conditional requirement as deemed necessary keeping masses at large and social economical factors as foremost mandatory asylum of strategy.In my opinion as per available data and defined past drives thru course and cases, a strategy to encompass herd immunity should be considered by exposing people and developing herd immunity and not through lock down and curfews.Up till now my conclusive remarks as per critical observation and inference we as nation have a better protection and prognostic cordon and as such it is needless to put state in to affairs of social and economical misbalanceIn my personnel opinion we have an innate immunity against the virus and even if a little chance to progress as per suspicion our strategic move should be developing herd immunity before we jump in to means of other protective mechanisms like lock down or curfew vaccination etc (Dr Raza Haider )
Why not define these term once for all in its real sense of pleasure as decend
2. Donillah / Indallah
Undoubtedly meaning elaborated by you or else have different text of version than my comprehending and understanding as a layman and illiterate.
This is in my opinion an outright deviated translation of moslem scholars and it deceives majority simple masses in to distracted understanding and misconception.
Ghair allah has a simple meaning and that is those unmarked men & masses whom have not been declared by the (Mighty) as belonging to him or those whom are not being called upon on (His) (Allah) behest and behalf as his men of honor, may you call them other than “The Aliaans) or in English in a lighter mood the (Aliens).
The term Ghair Allah is not about Allah but people whom have not been declared by God as his successor in the universe.
Conversely if we will use this term in the context and meaning as of and as has been phrased in translation as “Allah”, the meaning would take the aya away and beyond along with thinking mechanics of the reader as well and calling and recalling and praising any “Marked man” of designated prophetic aptitude or a similar pride of the lions club or Messenger for help, waseela, tawassul or intercession would always remain and become shirk and will be treated as shirk just because the term has been wrongly or deliberately and deviatedly defined as Ghairallah means other than allah (rather should have been define as those not as successors or waliallah)
2.Indillah /Donillah is again from the same clan and craft yet the term again has been used menacely & mercilessly rather irrationally where as donillah is again about the people other than the God and not (God) where as indillah is from the God and not as (God) again where as minallah is from the God as (Minjanib Allah) and not Allah.
The central idea of the version of debate is what holds our scholar to elaborate their content and their meaning to be disbursed and prayed may people like or dislike.
قرآن اپنی تکمیل کے اعلان کے بعد کیوں کر اپنے
مخاطب کو اندھیروں کی اس منزل پر چھوڑ جائے
گا، جہاں اسکی اپنی آیاتیں مطالب اور انسانی
سوچ اور اسلوب کے مسلکی الفاظ کی روش پر
چڑھ دوڑیں،گویا آیتوں میں چھپا متن اک نورتن کی
مانند ہر مسلکی رنگ میں، اک نئی ترنگ لئے ترجمے کا
نیا متن بن جائے
کیسے ممکن ھے کہ تکمیل اپنے حسنِ کمال پر ھو اور
کامل یقین شکوک لئے واللہُ عالم کہ ،شبہات پر کیا
یہ عجب نھی کہ جس شاہکار کا آغاز لوحِ قرآنی کے
خوبصورت لفظوں سے ابتدا لےوہ انتہاِ عروج پر
اپنی ھی منطق کی علمی معراج سے محروم ھو۔
عجب نھی یہ واللہُ عالم ھو کا فلسفہ نہ جانے کیوں
کر انسانی شعور سے دور ھے جو بلا شبہ معبود اور
عبد میں فاصلے کی اک واضح اظہار ھے، ایسے کہ
خالی جگہ پر کی جائے ۔ بہرحال حق یہ ھے کہ
آپ وھی سوچیں جس کی اجازت آپ کا شعور
دے اور میں وہ جن کی منزلت میرا شعور سمجھے
بس میں نے آیتوں کے سمندر کو الفاظ کے کوزے
میں بند کر دیا ، گویا الف لام میم کو رب کا اظہار
سمجھا اور ذالکل کتاب کی ابتدا کو اس کوزے میں
چھپے علم کا خلاصہ
اب یہ ضروری تو نھی کہ میں خلاصہ پڑھوں یا اسمِ
الہی کے وہ با برکت لفظ جو کمالِ خلق کی صورت
الف لام میم کی مانند ھو
برسوں بیت گئے ان سے ملاقات ھوئی
آج بھی صدیاں سمیٹے ھیں یہ لمحے میرے
وقت کا کام گزرنا ھے،گزر جائے گا
زخم اب بھی ھے ہرا رھنے دو بھر جائے گا
وقت اب اتنا کہاں پھر سے اسے یاد کروں
ٹہر کچھ دیر کہ یہ وقت بھی ٹل جائے گا
دکھا دوں گر یہ تماشہ ستم گری کا اگر
ھر اک دن تیرا رسوا لگے گا روزِ حشر
میں تیری راہ میں بیشک بھٹک گیا تھا مگر
سفر ابھی بھی میرا تیری جستجو کو لئے
جو کر رھا ھوں میں سجدہ تیری اطاعت میں
ھے ڈر خدا کا فقط میری اس عبادت میں
Novel Corona Covid-19
The aim is to upraise clinician in particular and masses in general particularly regarding basics strategy as line of management while dealing SARS-Cor-2 pandemic as guide line and basic info.
Public health authorities – Clinician – Nurses – CHW and volunteers along with People of geographic area not yet affected.
In order to fight and contain unseen enemy clinician n
eed to understand following heads regarding virus and pandemic.
Joint working strategy
Knowledge to response and treatment cum management
History and severity of NCP Covid -19
Community response in terms of measures in variant situation of high spread (Community) moderate spread (Cluster) or low spread (Sporadic).
Here is a little summarization of events during episode of virus spread from endemic to epidemic and pandemic.
On 30 Dec 2019 a cluster of pneumonia cases were reported in Wuhan Hubei china.
Samples from bronchoalveolar lavage taken and were tagged pneumonia of unknown etiology from Wuhan Jinyintan hospital China.
Real time (RTPCR) assay done and found Pan Beta corona Virus.
Genomic sequence of the virus was isolated and was found to be from family of corona with lineage 2b.
Closest relationship and resemblance on genomic alignment (96%) was similar to SARS like strain BatCov RaTG 13 virus.
COVID-19 virus has a genome identity of 96% to a bat SARS-like corona virus and 86%-92% to a pangolin SARS-like corona virus, an animal source for COVID-19 is highly likely.
Crown like Virus isolated with cytopathic effect from human epithelial airway cells after approx. 96 hrs (5 Days) after first inoculation with negative staining (In this technique, the background is stained, leaving the actual specimen untouched, and thus visible).
Transgenic animal mice and rhesus monkey were challenged and isolated Covid-19 virus was detected in lungs and interstitial tissues of the said animal. .
Histological Examination Histological examination of subjected lung revealed.
Bilateral diffuse alveolar damage with cellular fibromyxoid exudates.
Evident desquamation of pneumocytes and hyaline membrane formation, indicating acute respiratory distress syndrome (ARDS) with secondary pulmonary Edema.
Interstitial mono nuclear inflammatory infiltrates with dominated lymphocytes bilaterally.
Incubation period is the time between catching the virus and beginning to have symptoms. The Incubation period of the Covid- 19 is 1 to 14 days and mostly around 05 days till update.
Carrier Case division and distribution.
Suspected carrier can readily be assessed and manage by following criterion as the carrier/disease can run a course in variant manner.
No of Days Since Exposure
Asymptomatic since presentation
Symptomatic while in observation
Clinically diagnosed (By Symptoms)
Confirmed by Lab Test (Laboratory)
Exposure. Following checklist are essential after exposure for managing patient.
First Reporting date
Time of onset of symptom from exposure
Span between presentation and aggravation of symptom
Specific test/investigation when symptomatic. Confirmation and progression or recovery of disease and its course from mild to normal or critical.
Recovery with negative virus lodging
Expected Passive immunity with future antibodies against virus.
Statistical data can be obtained from various sources and resources as well as demographically in due course of time; since the virus has involve almost globally but at present not much is available in the contest of accurate sign and sin.
However whatever we have in terms of favor and firm is from the ever supporting deal and dealt being faced and treated by great Chinese patriotic defenders HCW and their super humane work.
In my opinion it is right time to start every case as per data or log in the name of ailing humanity for future safe guard.
Cases pertaining to suspicion as a novel Corona (Covid -19) bearer must go through following 05 assumptive checks of observation during protective quarantine not like unethical zombie’s catch, an act of forced quarantine before an ethical Medical decision of isolation is initiated.
No of days (since exposure). This is important because most Corona suspects remains potential carrier with no sign or acute symptoms or recovering as mild disease.
Asymptomatic (since presentation). Most carriers remain asymptomatic for 96 hrs or 5 days before appearance of first symptom.
Symptomatic (while in observation). First symptom to appear takes few days approximately 05 days and have first sign as listed. Following are date, data and demographic based percentage and have statistical value in terms of sign and symptoms however ratio of presentation has more or less same pandemic stat.
Fever in 80%
Dry cough 38%
Productive cough 34%
Shortness of breath(SOB) 19%
Sore throat 14%
Myalgia & arthralgia 15%
Nausea vomiting 5 %
Clinically diagnosed (by symptoms).
This is as per symptoms that guide diagnosis towards virus bearing and further investigation for confirmation of disease and its course.
Confirmed by lab test (laboratory).
An essential tool to settle course of treatment focusing disease in terms of management
Current available Data and ratio among groups. Current available data suggest.
Median age – 51 years
Major age group – 30 to 69 with a percentage of approx. 78%
Male 52% approx.
Intercity variation in data has been observed with variant occupational presentation.
There is generally low attack on individual under 18 years with a percentage of 2.5 % over all.
Children have rare incidence till now.
Age below 18 has little ratio of 2.5%
High risk cases and Co- morbid. People at high risk cases are.
People above 60
Origin of Virus:
- Zoonotic origin
- Bat as reservoir
- Intermediate host unidentified
- Multiple areas of zoonotic origin are yet to be address and isolated.
Route of transmission
- By infector to infectee
- Unprotected contact from droplet to foamites.
- Air borne not yet reported and yet to be ascertained however can be envisage with aerosol agent if in vicinity and the same in recent studies have become weighty.
- By aerosol, particulate matter larger than 0.5 micrometer but smaller than droplet.
- Fecal shedding has been demonstrated and viable virus has been reported in many cases however its role is yet to be determined.
Transmission & Spread:
- Person to person
- House hold close contact
- Person to person mostly occurring in families
- 80 % of clusters are from families being isolated and checked after exposure.
- Contact tracing (In Case of endemic Spread)\
- Contact tracing is an important tool for containing spread.
- Effective and meticulous contact tracing can contain disease hence 1 to 5% of the cases can be isolated and confirmed by contact tracing.
- To upraise China has been very strict in contact tracing and as such 1800 team of more than 9000 epidemiologist were reported to be working in Wuhan only during it epidemic.
Strategy for holding transmission.
Principle of early identification, early isolation, early diagnosis and early treatment securely manages the spread of virus.
Early identification of suspect cases is critical to containment efforts and occurs via a process of temperature screening and questioning at entrances
to many institutions, communities, travel venues (airports, train stations) and hospitals.
Many hospitals have fever clinics that were established and maintained since the SARS outbreak.
In my opinion method of observation to hold transmission shall have few basic criterion approaches scooping from observation alone and shall run as basic guide line for managing such cases.
Quarantine to isolation shall have a criterion of observation to symptom and any suspicion shall be followed by laboratory confirmation whose management shall have history of travel from start to exposure and social contacts hence presentation from asymptomatic to symptomatic with brief of sign to symptoms or recovery to aggravation.
Any suspect as patient should be proceeded in meticulous well-mannered ethical way of model medical treatment that is a rationale of medical behavior and ethics.
Shamefully current means and manner is no more than crime as if handling criminals explaining non-technical handling by masses on duty at their own or on irrational order of functionaries as law implementer obviously presenting as mal and manhandling of people or suspects patient.
Let me say that today masses of corona Suspects are fictional images of zombies whom are being treated as one from perhaps other planets.
Why is there so much of panic for no reason.
They are patient and need a handful of gestures and we all must understand that the treatment of any such infected case start with a decent handling moving towards a stage quarantine followed by reversion to normal life or aggravation to symptomatic excursion.
Novel should be treated by nobles only.
Every disease has infective phase and the precaution is to stay away during its infective period known to us as incubation period.
All such cases of influenza, H1N1, Bird Flu, Measles, Diphtheria, Mumps, chickenpox, TB, typhoid or many viral infections we name it that all once bears such contagious bearing yet we have gradually adapted and tolerated its phasic infective similar quarantine tenure in which people are refrain to stay away normally.
And yes some infection have more vigor presentation in terms of infectivity as contagious disease so do this Corona Covid-19 for being new and no previous exposure or presentation or debate and of course in more virulence being without vaccination.
Regardless, selection of patient as suspect carrier with or without symptoms of novel corona, a clinician or agencies or CHW volunteer looking after subject patient – suspects shall assimilate and understand the core theme of pre- instruction protocol as has been counseled in next paras.
Please follow the guideline for eventual effective patient-public compliance for any nontechnical, unethical and irrational handling of cases would put undue loads of unwanted share on working clinicians and of course on functionaries, hospitals, doctors and paramedics as well as volunteer.
We must understand that all suspects are your and our probable patient and not criminals to be awarded punishment or be treated like a runaway absconder as if insane.
As such our duty is to look after our brethren in calamity whom have been infected and inflicted upon somehow due to a bad day of fate.
Protocol to handle a Suspected Corona Patient.
Here is few notified drag down workstation so to move each and every case accordingly and effectively.
Get a history. A Corona virus carrier Suspect (Patient) Must have a,
Close Family history
Symptoms based Presentation
Silent carrier at accidental check
Pre Medical Protective Quarantine, Medical Isolation & Management.
Get him isolated keeping doctrine and norms of medical ethics not like an aggressive lay man with mercenary approach.
Cautiously Counsel patient and explain details in relation after taking necessary precautions as safety for the patient or the clinician and yourself.
Maintain necessary distance and precautionary safeguards with reference to provisional diagnosis from touch to toe.
Explain Concept of Protective Pre Medical Quarantine (Self isolation) to the patient as well as to the people in surround by explaining the seriousness of disease and its spread, if at all bypassed or non compliant.
Elaborate condition that necessitate Medical Isolation for the purpose of Observation necessity, if in case symptoms appear during Premedical protective Quarantine.
Explain concept of necessary Medical Isolation which is necessary for observation, treatment ,management in case of progression and the course of disease that may affect patient in stages in case of noncompliance thus a course that shall hangs all along as levels from mild to moderate and severe to critical and fatal.
Here it must be under stood that people are unaware of this Quarantine terminology and it will take time to make them understand the requirement of treatment in terms of managing a case of Corona infections hence quarantine as part of medical treatment and management.
Quarantine Criterion. It has now become necessary and mandatory to define quarantine in to stages, for best possible Public-patient compliance as well as better understanding of clinician focus & focal treatment.
- Protective Pre Medical Quarantine (Self Isolation):
- Protective Medical Isolation (for Observation and progression of disease).
Protective Pre- Medical Quarantine / Self Isolation).
It is a self Medical Requirement & is the first essential mandatory immutable Recommendation).
Priority place: Home
Non Compliance: Quarantine center or Hospital
Intensity of disease: Mild or moderate without SOB (shortness of breath or major uncontrolled compromising ailments).
To be taken by both patient and family members at home.
Separate utensils ideally disposable with separate washroom and belongings.
It’s a pre medical complete protective self-isolation that necessitates watch on patient during incubation period from Asymptomatic to symptomatic.
Symptoms usually appears after 96 hrs or 05 days after first exposure (Annex i)
Protective Medical Isolation (for Observation and progression of disease)
It’s a Medical requirement and shall be a mandatory asylum of management in post exposure stages of management and is highly Recommended and immutable syllabi. It is sometime known and tagged in the contest of forced quarantine or isolation.
Place: Well-equipped Quarantine center or Hospital.
Intensity of disease: All Uncooperative suspect, cooperative Mild cases with aggravating symptoms, Moderate aggravating symptom.
Precautions: To be taken by both patient and family members.
Wearing Mask /Gloves and disposable Gown (If Possible)
Wash Hand with soap or sanitizer with 70% isopropyl alcohol.
Separate utensils ideally disposable and separate washroom and belongings.
Complete protective self-isolation.
Watch for symptoms that usually develop after 96 hrs or 05 days after first exposure.
Here it must be realized that Not necessarily all patient enter in to the stage of irreversible compromise with very low viral fatality rate.
Observation / Inference during Quarantine (Self) & Forced Quarantine (Isolation)/ Incubation period.
All patients in Quarantine /Isolation should have a regular watch for recovery versus aggravation or progressive deterioration.
To utmost they should be observed with inference trailing their condition from normal to mild and moderate to severe therefore to take decision in case of severity as critical or critically fatal.
Best circadian watch for management is to check for development of any symptom vide whole day monitoring schedule.
We must understand 80 percent of positive symptomatic cases does not cross moderate phase hence return to normal with effective antibodies and immunity with readily available passive immunization for future.
Just a few percent of cases been seen till now that crosses over in the name of virus fatality and is of course associated with multi factorial clauses and causes as co morbid.
Stats from Chinese viral statistic have revealed lower incidence of progressive move of disease towards fatality as such progression from moderate has following percentage of aggression ratio.
- Severe Disease 14%
- Critical 6%
Again it must be noted that Crude fatality ratio is different for all patients and is conditional with co- morbid and age etc.
Course & stages of disease vide symptom.
Technically course of disease can be monitored and tailed in to 4 basic stages during Quarantine cum Isolation.
- Non-Symptomatic stage: (Monitored by daily observation and monitoring).
- Symptomatic stage: (monitored and observed by symptoms).
- Suspect: (at clinical findings with presentation and aggravation of sign and symptoms).
- Confirm case: (only by lab test).
- Non-symptomatic: (Confirm case can be a Silent carrier and without Frank symptom).
- Symptomatic:(Confirm case can have multiple stages as below).
(Suspect is a potential patient on monitoring and observation. It is meticulously necessary to watch symptom for aggravation, progression or reversion as recovery in such cases).
(Course varies and most cases do not develop full blown disease though may traverse course from mild to critical).
Clinical cum differential Diagnosis of potential Carrier:
- By symptom & sign
- Routine check for other problem
- Contact history
- Travel history
- Family history
- Symptom based
- Confirmed by lab
Disease and Assessment based Decisions:
Initial phase of the disease has concealed element with no display for at least 96 hours or 05 days.
Patients have different response and different symptom in incubatory time line.
Following schedule can be an easy line of management.
- If A-symptomatic:
Just protective quarantine till no symptom or till incubation period (14 days).
- If Becomes Symptomatic.
Medical isolation with symptomatic treatment.
With Aggravation in sign and symptom. if at home shall be hospitalize. if in hospital specific test investigation for confirmation.
Progression to severity with derange inter milieu in severe and Critical Cases. It must be noted that 14 % have severe disease with Dyspnea, respiratory frequency≥30/minute, blood oxygen saturation ≤93%, PaO2/ FiO2 ratio <300, and/or lung infiltrates >50% of the lung field within 24-48 hours).
Whereas 6% are critical culminating in to (respiratory failure, septic shock or multiple organ dysfunction failure.
Management and observation:
While in protective Pre Medical quarantine observation, a doctor/ CHW attendant shall have pin point inference of understanding and that is, what to do next in case a suspect carrier turn in to patient with symptoms. As such;
- For mild (cases at Home quarantine). just observe and treat symptomatically.
- For Moderate (Home-Hospital quarantine). Symptoms dependent (if no breathing insufficiency, intractable cough or sign of respiratory failure)
- For Severe. Hospital (ICU)
- For Critical. ICU (Ventilator)
Surveillance and monitoring.
Specifically all monitoring, follow up, observation and testing to treatment of Covid- 19 shall get their start from presenting symptoms from clinic like from fever clinic or ERE.
Susceptibility to infection should be ascertained through all parameters of criteria like age, co-morbid, chronic ailments etc.
Humans on first exposure are prone to virus therefore have no immunity.
Transmissions dynamic are inherently contextual and seemingly there are 4 major types of transmission dynamic.
Acquired infection from zoonotic sources.
Human to human transmission
Implementation of control measure can halt disease progression with factors like.
Quarantine & Isolation
Social distancing and less movement
Contact tracing by comprehensive set of intervention aggressive case and contact information.
Isolation management and extreme social distancing of known or unknown case have proved beneficial in case transmission.
Spread and transmission Factors
Episodes of transmission in china epidemic has shown that most cases of transmission were exportation as Wuhan, Hubay whereas locally generated were from clustered in families.
Clustered nature has high ratio count whereas quarantine and social distancing have low.
Reported instances of transmission have been seen in custody in cells and prison.
Mode of spread is not understood and the same has not yet produced remarkable share.
Transmission in HCW noscomial infection and infection reported from all infected areas among HCW in early cases have little share.
In the later phase of spread it was noted that infection among HCW initially was due to lack of essential accessories which were not up to the mark initially.
Screening in later part of epidemic suggested most infection among HCW was due to house hold and were traced back to house hold.
There has been report of transmission in hospital closed setting like prison due to close person to person contact and less social distancing.
Asymptomatic cases are rare however cannot be over ruled.
Sign symptoms with disease progression and severity:
Up till now there is no specific trail of pattern of progression and can roll back or roll over from asymptomatic presentation to pneumonia and death or recovery.
Typical sign and symptoms include;
- Fever – 88% -5/6 days
- Dry cough – 68 % 5/6 days
- Fatigue – 38%
- Sputum production 34%
- SOB 19 %
- Sore throat 14 %
- Headache 14%
- Myalgia arthralgia 15%
- Chills 11%
- Nausea vomiting 5%
- Nasal congestion 5 %
- Diarrhea 4 %
- Haemoptysis 1 %
- Conjunctiva congestion 1 %
Crude fatality rate (CFR).
Patient with co- morbid has different CFR.
Crude fatality ratio is related with intensity and location.
It increases with underlying disease.
Standard of care is the one important fact in decreasing crude mortality rate.
It particularly increases with underlying pulmonary disease.
Mortality increase with age with CFR 22 % in people above age 80.
Male has CFR %age of 4.7 whereas female has 2.8 percent.
Retirees have the highest CFR 9% .
Patients aged over 80 years had a CFR of 14.8%.
Patient without co -morbid has CFR 1.5 percent.
Factors containing disease progression:
These factors can decrease progression of disease.
- Earlier case detection
- Contact identification
- Early treatment
- Less median time from symptom to laboratory
As per statistical data early recognition and treatment is the basic criteria for safe management against progression of disease.
Such pandemic needs movement from control approach to control measure.
Controlling epidemic shall go side by side with safe guarding social and economic guarding.
All such controlling should be step wise guided and phasic.
Modules to control virus Spread:
Most important modules of controlling virus Spread are:
- Preventing importation
- Preventing exportation
- Controlling spreading source Identifying spreading source
- Blocking transmission
- Preventing spread
- Structuring treatment
- Monitoring & surveillance
- Epidemiological investigation
- Managing close contacts of patient
- Laboratory testing
- Conducting Investigations
- Developing Focal Diagnostic kits
- Cordoning wild life and livings
- Supervising and controlling animal markets
- Reducing intensity of epidemic and slowing down increase in cases.
- Actively treating patient
- Reducing death ratio
- Closing wild lives breeding facilities
- Markets quarantine
- Defining Protocol for diagnosis, treatment and prevention.
- Improved isolation standards
- Extension of festivals/ holiday
- Controlling transportation
- Reducing movement of people
- Stopping mass gathering activities.
- Information about the epidemic prevention control measures.
- Health education
- Coordinate medical supplies
- Building or transforming hospitals in the wake of requirement.
- Stable supply of commodities and their prices to ensure the smooth operation of society.
- Reducing clusters of cases.
- Striking a balance between epidemic prevention and control.
- Sustainable economic and social development.
- Unified command
- Standardized guidance
- Scientific evidence-based policy implementation.
- Improve Pre-school preparation
- Resuming back to work in phases
- Continue Health and welfare services
- Normal social operations being restored in a stepwise fashion.
- Mean Incubation period. Mean incubation period is 5 to 6 days where as it Ranges between 1 to 14.
- Time of onset of disease to clinical recovery
- Median time for in mild cases is 02 weeks.
Median time for critical and severe disease is 03 to 06 week.
- Preliminary data suggests that the time period from onset to the development of severe disease, including hypoxia, is 1 week.
Among patients who have died, the time from symptom onset to outcome ranges from 2-8 weeks.
Myth behind Chinese strategy:
The Chinese reacted with conviction and dedication in a patriotic display with methodology of same global management executing old theology of;
- Hand washing
- Monitoring of symptom
- Social distancing
- Suspension of gathering
- Inter and intra city lock down
- Meticulous screening for contact tracing
- Quarantine & isolation
Where as to the utmost they all reacted sincerely may they be a community mobilizer or a governor.
Their bold and gallantry retaliation as approach could be understand by the available statistic which showed 2500 approx cases in first week of epidemic whereas after two weeks whereas after 02 weeks reported cases were just 409.
Strategic Advisory for countries under threat of imported cases with likely outbreaks of COVID-19:
Prepare yourself for the highest level of national Response.
Execute Containment of COVID-19 preferably with non-pharmaceutical public health measures.
Vigorous and meticulous testing quarantine /isolation strategy, contact tracing.
Educating public at large regarding seriousness of disease and its prevention.
Expanding surveillance to detect and cut off transmission chain as rapid detection is crucial in containing spread.
Testing all patient of Atypical Pneumonia.
Screening patient with upper respiratory illness or influenza like symptoms.
Screening suspect with recent exposure to Covid-19.
Deployment of more stringent measures to interrupt transmission chains.
Suspension f suspension of large-scale gatherings and the closure of schools and workplaces.
Engage clinical expert on the subject to communicate with the people through media.
Distribute national health promotion materials and create online or electronic activities for awareness.
To aware people that COVID-19 is a new and concerning disease, but that outbreaks can be manage with the right response and that the vast majority of infected people will recover.
To adopt practicing the most important preventive measures for COVID-19 by frequent hand washing and covering mouth and nose when sneezing or coughing.
Issue of health declaration card system for entry and exit into cities.
Electronic registration of health declaration during quarantine with day wise symptom reporting.
Strict monitoring of the temperature in entering and exiting passengers.
To update oneself especially on COVID-19 and its signs and symptoms because the strategies and response activities will constantly improve as new information on this disease is accumulating every day.
To pay attention on social distancing and being ready to look after old people and needy.
Role of International Community:
Whereas International community at the twilight of this catastrophe must help each other with solidarity believing necessity of time for virus has no restriction of boundaries and enemies of none single.
They must share information with each other as required under the International Health Regulations.
They must continually monitor outbreak trends and control capacities.
Continually reassess any additional health measures’ that significantly interfere with international travel and trade.
Present and future strategy to cope Disaster.
Strategy for Make shift and designated Hospitals.
Makeshift hospital places should be designated according to conditional requirement and must be equipped accordingly with facility to transfer without hassle in to more equipped unit as per disease course or depending upon the requirement.
Theses hospital shall have a slot distribution of cases depending upon conditional severity but separately.
There must be blogs for each affairs of stage with Moderate to critically ill patient so that a focus management can be promptly executed.
It must be noted that all suspected cases should be isolated in normal pressure single rooms and wear normal surgical mask.
Staff looking after suspect usually wears a cap, eye protection, N-95 masks, gown and gloves with Special Boots (single use only).
Staffs are expected to wear PPE continuously, changing it only when they leave the place.
It is emphasized that the designated hospitals must strategically be made or placed with at least one per district.
Trial Drugs and supportive line of treatment:
At the moment there are no specific antiviral or immune modulating agents proven (or recommended) to improve outcomes in patient.
The guidelines include supportive care by clinical and course category (mild, moderate, severe and critical).
No of drugs have been used in china outbreak as investigational treatments such as:
- Chloroquine (China)
- Hydroxy Chloroquine (USA)
- Phosphate (China)
- Lopinavir (China)
- Ritonavir (China)
- Alpha interferon (China)
- Ribavirin (China)
- Actemra Tocilizumab (Italy)
- Remdesivir (I/V) (USA)
- Ivermectin (Australia)(FDA Approved)
There are no US approved FDA drugs except Ivermectin at the moment.
There are no currently available data from randomized clinical trials (RCT’s) to inform clinical guidance on the use, dosing or duration of theses drug as yet.
The clinical management include is infection prevention and control measure with supportive care including supplementary oxygen and mechanical ventilator support.
(It is said that Chloroquine could block a virus from penetrating a cell if administered before exposure whereas if tissue has been already infected it inhibits the virus.)
Currently, the application of intubation, invasive, ventilation and ECMO in critically ill patients can improve survival.
Patients should be monitored by regular pulse oximeter.
Frequent Hand Wash
Mask (in case of cough and sneeze, they are only effective in combination with hand wash, its disposal should be proper).
Sanitizer with at least 70% Isopropyl alcohol.
Avoid touching nose, eyes and mouth.
Respiratory hygiene like Coughing in to the bend of your elbow staying home when sick.
Precautions while in Quarantine / Isolation. Patients with COVID-19 are not permitted with visitors.
Staff shall use coveralls, masks, eye cover, and gloves, removing PPE only when they leave the ward.
If you are at the super market you shall assume that all surfaces are being touched by sick including packaged food.
As per New England journal of medicine virus stays for 72 hrs on Stainless Steel and 24 hrs on cardboard.
The risk at super market increases to twice and is the reason to stay at least 06 feet apart all the time.
It does not mean that we should give up buying but precisely need extra care for anything we touch is probably being handled by other or coughed or sneezed.
Face mask is good in public places where it is difficult to maintain 6 feet distance
Covid-19 Hospital Discharge Criteria:
Patients are discharged after clinical recovery with following check criteria.
A-febrile >3 days.
Resolution of symptoms and radiologic improvement.
02 negative PCR tests taken 24 hours apart.
Patient at discharge are asked to minimize family and social contact and to wear a mask.
Virus Shedding(Period of Infectivity)
Virus shedding is the length of time the virus can be transmitted from someone infected.
In one instance it was found 37 days where as the median duration is 20 days.
However current recommendation for isolation is 02 weeks that shall not go beyond (Lancet).
It is observed that corona virus lingers in patient for more than a month making it a possibility to transfer virus for long.
Death Rituals & Protocols for burial. There is no evidence so far of transmission of SARS-Cov-2 through the handling of bodies of deceased person. The potential risk is considered low and is related to;
- Direct contact with remains or body fluid lodged with virus.
- Direct contact with foamites.
It is postulated that SARS- Cov -2 may persist on surfaces for 07 days hence there is a possibility on body.
During standard handling the risk is low where as conversely during postmortem or aerosol generating procedures transmission carries high risk.
However there have been reports regarding workers working in funeral companies being infected while working for preparation.
As such hospitals have adopted stringent rules while handling the dead and are straight away placed in coffin boxes without being clothed as per ritual due to the suspected risk of infection posed by their bodies.
Iran being a Muslim country washed their corpses with soap and water before burial yet some cases in the outbreak do hamper observing traditional Islamic guidelines.
It is said that corpses that who are confirmed cases lodging disease at the time of death are treated with calcium oxide to prevent them from contaminating soil once buried.
Environmental stability on in animate object:
The environmental stability of virus varies in different objects and atmosphere (Dormalen et al).
- 04 hrs on copper
- 24 hrs on card board
- 2-3 days on plastic
- 7 days on stainless steel
Test conduction facility shall have a Bio safety level 2 precautions.
Bio containment Precautions:
A set of bio containment precautions required to isolate dangerous biological agents in laboratory facility.
There are four bio safety levels are
Risks that determine levels of containment are;
- Severity of disease,
- Nature of the work
Specimens for which there is limited information, it is judicious to take a cautious approach to specimen management
- Barrier protections must be applied like (gloves, gowns, eye protection)
- Basic containment – Bio safety Level 2 practices and procedures should be the minimum requirement for handling specimens.
- Transport of all such specimens should follow national and/or international rules and regulations.
Determining Risk of handling
- Medical data on the patient
- Epidemiological data (morbidity and mortality data
- Suspected route of transmission
- Outbreak investigation data
- Information on the geographical origin of the specimen
- In the case of outbreaks of disease of unknown etiology, appropriate ad hoc guidelines by national competent authorities or WHO on the World Wide Web
Lab Restrictions and criteria:
- Permissible to only authorized persons
- Laboratory doors should be kept closed.
- Children should not be or allowed
- No one should be admitted other than those involved in the work of the laboratory.
Precautions & Personal protection Equipment (PPE)
- Laboratory coveralls
- Gowns or uniforms must be worn at all times
- Appropriate gloves must be worn for all procedures that may involve direct or accidental contact with blood, body fluids and other potentially infectious materials or infected animals
- After use, gloves should be removed aseptically and hands must then be washed.
- Person must wash their hands after handling infectious materials and animals, and before they leave the laboratory working areas.
- Bio hazard warning sign for laboratory shall be marked on doors
- Safety glasses, face shields (visors) or other protective devices must be worn when it is necessary to protect the eyes and face from splashes, impacting objects and sources of artificial ultraviolet radiation.
- It is prohibited to wear protective laboratory clothing outside the laboratory, e.g. in canteens, coffee rooms, offices, libraries, staff rooms and toilets.
- Open-toed footwear must not be worn in laboratories.
- Eating, drinking, smoking, applying cosmetics and handling contact lenses is prohibited in the laboratory working areas.
- Storing human foods or drinks anywhere in the laboratory working areas is prohibited.
- Protective laboratory clothing that has been used in the laboratory must not be stored in the same lockers or cupboards as street clothing.
Sample Bio hazard warning Sign
(BIO HAZARD ADMITTANCE TO AUTHORIZED PERSONNEL ONLY)
- Bio safety Level:_________________________
- Responsible Investigator: ___________________
- In case of emergency call: _________________
- Daytime phone: __________________
- Home phone: _____________________
Waste (Decontamination and disposal)
Waste is anything that is to be discarded.
Principally all infectious materials should be decontaminated, autoclaved or incinerated within the laboratory.
The principal questions to be asked before discharge of any objects or materials from laboratories that deal with potentially infectious microorganisms or animal tissues are:
- Have the objects or materials been effectively decontaminated or disinfected by an approved procedure?
- Have they been packaged in an approved manner for immediate on-site incineration or transfer to another facility with incineration capacity?
- Does the disposal of the decontaminated objects or materials involve any additional potential hazards, biological or otherwise, to those who carry out the immediate disposal procedures or who might come into contact with discarded items outside the facility?
LABORATORY BIO SAFETY MANUAL:
Decontamination Steam autoclaving is the preferred method for all decontamination processes.
Materials for decontamination and disposal should be placed in containers, e.g. autoclavable plastic color coded bags with clear instruction to be autoclave or incinerate.
Identification and separation system for infectious materials and their containers should be adopted.
National and international regulations must be followed.
Waste Disposal Categories
- Non-contaminated (non-infectious)
(Waste that can be reused or recycled or disposed of as general, “household” waste)
- Contaminated (infectious)
(“Sharps” – hypodermic needles, scalpels, knives and broken glass are all collected in puncture-proof containers fitted with covers and treated as infectious)
- Contaminated material (Reusable )
(They can be decontaminated by autoclaving washing and reuse after recycling procedures.)
- Contaminated material with necessary autoclaving before disposal
- Contaminated material for direct incineration.
Necessary Precautions for disposal:
- Sharps After use, hypodermic needles should not be recapped, clipped or removed from disposable syringes and the complete assembly should be placed in a sharps disposal container.
- Disposable syringes, used alone or with needles, should be placed in sharps disposal containers and incinerated, with prior autoclaving if required.
- Sharps disposal containers must be puncture-proof/-resistant and must not be filled to capacity and when they are three-quarters full they should be placed in “infectious waste” containers and incinerated with prior autoclaving if laboratory practice requires it.
- Sharps disposal containers must not be discarded in landfills.
- No pre-cleaning should be attempted of any contaminated (potentially infectious) materials to be autoclaved and reused.
- Any necessary cleaning or repair must be done only after autoclaving or disinfection.
- All contaminated (potentially infectious) materials should be autoclaved in leak proof containers, e.g. autoclavable, color-coded plastic bags, before disposal.
- Materials deriving from healthcare activities should not be discarded in landfills even after decontamination.
- If incinerator is available at the laboratory site, autoclaving may be omitted and the contaminated waste should be placed in designated containers directly to the incinerator.
- Reusable transfer containers should be leak proof and have tight-fitting covers.
- They should be disinfected and cleaned before they are returned to the laboratory for further use.
- Discard containers, pans or jars, preferably unbreakable (e.g. plastic), should be placed at every work station.
- Waste materials should remain in intimate contact with the disinfectant for the appropriate time, according to the disinfectant used
- The discard containers should be decontaminated and washed before reuse.
Incineration of contaminated waste must meet with the approval of the public health and air pollution authorities, as well as per laboratory biosafety manual.
Preparedness Plan for Handling Dead and corpses:
Practices for caring the deceased vary according to local believe culture and religious context and must be consulted with stake holders and religious reps that shall be acceptable as norms or standard.
There must be adequately trained staff, transportation physical structure or mortuary till cremation and burial.
There should be minimum delay between time of death and burial.
Risk of transmission shall be minimizing keeping all essentials of physical deterrence particularly mask gloves and PPE and long sleeves water proof goggle & gowns.
Disinfection is recommended with 0.1 % sodium hypochlorite or house hold bleach 5% whereas alternative to sodium hypochlorite is 70% ethanol.
In general care after death shall have general precautions of recommended PPE with minimum handling /exposure and crematory affairs.
Many people can spread virus with hundreds of unreported cases.
It is believed that dying from the disease has ratio from 0.5% to 1%.
Death Rates are higher in patient with co morbid and unwell with 10 times higher in age group above 80 and lower in age group under 40. However it’s not just age that determines the risk of infection and there are instances that young people have landed in to severe disease on the contrary old people had mild (Imperial College London).
Due to unavailability and registration of confirm cases death rates are actually miscalculated for dividing death rate in registered confirm cases would be higher as compared to when unconfirmed cases are included as well.
Death rates are directly proportional to health care system and can go down or up depending upon health care facility available.
It has been observed that corona virus lingers in patient for more than a month making it a possibility to transfer virus for long.
There are possibilities that high temperature and humidity can slow down virus virulence and spread.
Some people are able to spread virus without showing symptom.
Virus could witness a second wave of infection that could be more aggressive in china or else.
There is widespread use of Traditional Chinese Medicines (TCM), for which the affects must be fully evaluated.
Specimens from both the upper respiratory tract (URT; nasopharyngeal and oropharyngeal) and lower respiratory tract (LRT expectorated sputum, endotracheal aspirate, or boronchoalveolar lavage) are collected for COVID-19 testing by PCR.
COVID-19 virus has been detected in respiratory, fecal and blood specimens.
According to preliminary data virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset and persist for 7-12 days in moderate cases and up to 2 weeks in severe cases.
Viral RNA has been detected in feces in up to 30% of patients from day 5 following onset of symptoms and has been noted for up to 4-5 weeks in moderate cases. However, it is not clear whether this correlates with the presence of infectious virus.
While live virus has been cultured from stool in some cases, the role of fecal-oral transmission is not yet well understood.
COVID-19 has been isolated from the clinical specimens using human airway epithelial cells, Vero E6 and Huh-7 cell lines.
A variety of re-proposed drugs and investigational drugs have been identified as well as other interventions are planned or underway.
In Italy they are using drug tocilizumab for inflammation at Pascale Cancer institute in Naples. It is said that the drug recovers respiratory function.
The development of a safe and effective vaccine for this highly communicable respiratory virus is an important epidemic control measure and at the moment multiple multinational companies and states are in the run to introduce first ever vaccine.
Recombinant protein, MRNA, DNA, inactivated whole virus and recombinant adenovirus vaccines are being developed and some are now entering animal studies and more in to first phase of human trail.
Jennifer haller is a 43 years old female from Seattle is the first person to have been injected with a dose of experimental Covid -19 vaccines at Kaiser Permanente Washington research institute.
The ideal animal model for studying routes of virus transmission, pathogenesis, antiviral therapy, vaccine and immune responses has yet to be found.
There is a global rush for masks; hand hygiene products and other personal protective equipment. The relative importance of non-pharmaceutical control measures including use of masks, hand hygiene, and social distancing require further research to quantify their impact.
There are distinct patterns of intra-familial transmission of COVID-19. It is unclear whether or not there are host factors, including genetic factors that influence susceptibility in disease course.
COVID-19 has a varied clinical course and a precise description of stages and course is still not available.
STRATEGIC CONTIGENCY PLAN FOR :
(i) ESTABLISHING (50 BEDDED OR ABOVE )TERTIARY CARE / nCOVID -19 MAKE SHIFT HOSPITAL
(ii) DETAIL ORGANOGRAM AS PROTOCOL TO RECEIVE SUSPECTED AND CONFIRMED PATIENT
STAGE MANAGEMENT OF PROGRESSIVE DISEASE OF nCovid-19 AND THEIR DISPOSAL.
محبت کا بہترین پہلو یہ ھے کہ جس سے محبت کی جاتی ھے، اُس سے منسلک ہر شہ سے سے محبت ہو جایا کرتی ھے. یوں گھر ھو تو قبلہ اور قبلہ ھو تو کعبہ، گویا طواف عبادت لئے اور عبادت دیدار سے منسلک ، یوں دین دید کے حصارمیں اور حصار بصیرت کی آغوش میں!
نہی تو جانتا، ھے بس خدا ہی جانتا ھے
کلامِ مصطفیٰ ھے یہ قرآن،کیا مانتا ھے
نہ دیکھا کون اُترا اِس زمین پر،اُس مکان پہ
جنہیں تو کفر میں ہی مانتا ھے
بتا اجداد میں تیرے کہاھے، کون سے اسلاف
جنہیں تو اپنا مرشد، مانتا ھے
قبیلہ تیرا ھے یوں کفر میں ڈوبا طریقہ
بتا ھے دین سے ملتا، تیرا ھے کیا سلیقہ
تیرے کعبہ میں کتنے بت ،تیرے اجداد کے تھے
جنہیں توڑا علی نے ،بول یہ کیا مانتا ھے
بڑاآیا محمد کے گھرانے کے مقابل
تو نسلوں سے ھے کافر، کفر میں،نہی کیا جانتا ھے
امیرِ لشکرِ مومن، علی بعدِ محمد
میں کیوں کیا کہ رھا ھوں،خوب سب تو جانتا ھے
میں نہ اوّل،نہ دوئم، اور سوئم
تیری لکھی ھوئی، یہ نظم پوئم
سخن گفتن تیرا حرفِ ذدن
یہ سب بکواس ھے،کیا مانتا ھے
Aurr Khaana-e-Kaaba Aur KSA k baray mein kia khayal hai.
Waha bhee to corona say hifazat ka koi aasra nahee.
Itnee piari aur paak sir zameen aur Kaaba tulla bund kerna pera
Zaireen ko nikaalna aur KSA ki lock down kerna perha jub k kainaat ki her shey ka qibla ibrahim ka ghar yani kaba aur ibrahim Muhammed -o- aley muhammed ka baap dada.
Phir aisa kertay hai k saray corona walo ko Macca madina bhaij detay hai waha to aaap ki post k mutabiq Khuda shifa dey ga .
Us mareez k baray mein kia khayal hai joe bawajood dua aur dawa k sehutyab nahee hota aur marajata hai jub k us ki dua mazar per nahee hua kerty.
Fitrat aur qudrat doe alug taqazay hain
Fitrat per qudrat hawi nahee hua kerty magar us waqt jub moajaza muqadder ho aur taqaza mazhar ho.
Her wajood per sher aur her sher per aser uss say panah ki soorat hai goya taqaza dua hua kerty hai qabooliat nahee.
Subha shaam shaitan say panah mangnay walay insaan ko phir bhee panah nahee milpaati aur bilkul ishee terha A-oozo bay rab innaas aur falaq kehnay walay ko insani sher say panah nahee milpati.
Sabit hua dua haq- e- wajood- e -basher hai aur shifa muntaq -e- ata- e- elahi.
Dena na dena ikhtiyar -e- perwerdegar hua kerta hai aur maangna izhar- e- zaroorat mund.
Markaz -e- ibadaat qibla hua kerta hai jahan qibla rukh hua jaata hai upnee ibadaat aur zarooriat ko lee-aey
Qabooliat- e- dua ata say juri hai aur ata denay walay ki merzi say
Joe Khuda ko nahee maantay ata un ka bhee hasil hai aur joe Khuda ko kubhee bander, saanp aur gaa-aey mein talash kertay hai zarooriat un ki bhee poori hua kerty hain.
Ub agar duahmani ahl -e- bait say ho to dushmani k zaviaey her shaitan ki itaut kernay walay k paas bayshumar hua kertay hain.(Dr Raza)
🌹یہ رسول اﷲﷺ کا دن ہے آٸیے حضرت رسول اﷲ ﷺکی یہ زیارت پڑھیں.🌹
میں گواہی دیتا ہوں کہ اللہ کے سوا کوئی معبود نہیں جو یکتا ہے کوئی اس کا شریک نہیں اور گواہی دیتا ہوں کہ آپ اسکے رسول(ص) ہیں اور آپ اور آپ ہی محمدﷺ ابن عبداللہ (ع) ہیں اور گواہی دیتا ہوں کہ آپ نے اپنے پروردگار کے احکام پہنچائے اپنی امت کو وعظ ونصیحت کی اور آپ نے دانشمندی اور موعظہ حسنہ کے ساتھ خدا کی راہ میں جہاد کیا اور حق کے بارے میں آپ نے اپنا فرض ادا کیا ہے اور بے شک آپ مومنوں کیلئے مہربان اور کافروں کے لیے سخت تھے آپ نے اللہ کی پر خلوص عبادت کی یہاں تک کہ آپ کا وقت وفات آگیا پس خدا نے آپ کہ بزرگواروں میں سب سے بلند مقام پر پہنچایا حمد ہے اس خدا کیلئے جس نے آپ کے ذریعے ہمیں شرک اور گمراہی سے نجات دی معبود! حضرت محمدﷺ اور ان کی آل (ع)پر رحمت فرما اور اپنا درود اور اپنے ملائکہ اپنے انبیاء و مرسلین اپنے نیکوکار بندوں آسمانوں اور زمینوں میں رہنے والوں اے عالمین کے رب اولین وآخرین میں سے جو تیری تسبیح کرنے والے ہیں ان سب کا درود محمدﷺکیلئے قرار دے جو تیرے بندے تیرے رسول(ص) تیرے نبی(ص) تیرے امین تیرے نجیب تیرے حبیب تیرے برگزیدہ تیرے پاک کردہ تیرے خاص تیرے خالص اور تیری مخلوق میں سے بہترین ہیں خدایا! ان کو فضل و فضیلت اور وسیلہ بخش اور بلند درجہ عطا فرما انہیں مقام محمود پر فائز فرما کہ جس کیلئے اگلے اور پچھلے سبھی ان پر ر شک کریں اے معبود! بے شک تو نے فرمایا کہ ﴿اے رسولﷺ﴾اگر یہ لوگ اس وقت جب انہوں نے اپنے اوپر ظلم کیا تھا تمہارے پاس آتے اور اللہ سے بخشش طلب کرتے اور اس کا رسول(ص) بھی ان کیلئے مغفرت طلب کرتا تو ضرور یہ خدا کو تو بہ قبول کرنے والا مہربان پاتے۔ میرے معبود!میں اپنے گناہوں کی معافی مانگتے اور توبہ کرتے ہوئے تیرے نبی(ص) کے حضور آیا ہوں پس محمد ﷺ و آل محمد(ع) پر رحمت فرما اور میرے گناہ بخش دے اے مولا (ع)!میں آپ کے اور آپ کے اہلبیت(ع) کے ذریعے خدا کی طرف متوجہ ہوا ہوں جو آپ کا اور میرا پروردگار ہے تاکہ مجھے بخش دے گا۔ پھر تین مرتبہ کہیں بے شک ہم خدا کے لیے ہیں اور یقینا اسی کی طرف پلٹنے والے ہیں سوگوار ہیں ہم آپ کیلئے اے ہمارے دلی محبوب ، یہ کتنی بڑی مصیبت ہے کہ اب ہم میں وحی کا سلسلہ کٹ گیا ہے اور ہم آپکے ظا ہری وجود سے محروم ہیں اور بے شک ہم اللہ کیلئے ہیں اور یقینا اسی کیطرف پلٹنے والے ہیں اے ہمارے سردار اے اللہ کے رسول(ص): آپ پر خدا کی رحمتیں ہو اور آپ کے اہل خاندان پر جو پاک ہیں آج ہفتہ کا دن ہے اور یہی آپ کا دن ہے اور آج میں آپ کا مہمان اور آپ کی پناہ میں ہوں پس میری میزبانی فرما یئے اور پناہ دیجیے کہ بے شک آپ سخی اور مہمان نواز ہیں اور پناہ دینے پر مامور بھی ہیں پس مجھے مہمان کیجیے اور بہترین ضیافت کیجیے مجھے پناہ دیجیے جو بہترین پناہ ہو آپ کو واسطہ ہے خدا کی اس منزلت کا جو وہ آپکے اور آپکے اہلبیت (ع) کے نزدیک رکھتا ہے اور جو منزلت ان کی خدا کے ہاں ہے اور اس علم کا واسطہ کہ جو اس نے آپ حضرات کو عطا کیا ہے کہ وہ کریموں میں سب سے بڑا کریم ہے۔
ASA ,Dear sir this is again an episode from the series of absurd questionaire to tease and torture now and than for no reason.
But sometimes embarassment is worth than to miss an opportunity that may go away if not taken care.
Iam very much concerned to appear in declared interview as per advertisement for the position of administrator and the same unconcerned bits and pieces of someone’s desire shall have caused a handfull of botheration and irritibility at your end, possibly.
Please bear, tear and excuse to grant a minute to reward schedule of interview if it has reached the end as ripe or rip.
Iam still waiting for the call.
First they name virus
Than they alter its genome .
Symbiotic commensals becomes pathogenic residents.
They expose it to a host in vivo and in vitro changing its virility.
Exposure creates rift against antigen and host and reexposure creates antibodies .
Choice of host as ghost depends on human compatibility with human ultimate host.
Antibodies becomes the prima trail of vaccines.
Efficacy of vaccine needs trial from cadaver to human.
A global breakout exposes millions and the created vaccine gets million along with validated certification of human testing & trial.
Prophylaxis becomes the need of unexposed populace and created vaccines becomes the mainstay of financial monetary for next decade.
Strange what needs decades of trial & approval for presentation becomes the treatment of choice in just days and month.
Viruses are not born , they are created.(Dr Raza)
Baaat yeh hai k tareekh k punno say kon nahee waqif magar murrawat k libado mein ahtraam k taqazay hua kertay hain
Haq ko ayan aur batil ko bayan kernay ki zaroorat nahee hua kerty
khaas ker us waqt jub haq haqdar say jura ho aur batil budkar say
Tum un k jhootay Khudaon ko gali na do kaheen woh palut ker tumharay suchay Khuda ko gali na dey daalay
Ibtida mein to sub aik he deen per thay per yeh baad k anaey walon ki upnee zidd, anad aur dushmani nay deen k tukray tukray kerdeaey.
Bilshuba fitna qital say budter hai.
Yeh dor -e-hazir k fitnay say kum nahee joe yaqeenun aisay aghaz ki taruf hai jis ka anjam aghaz ko dekh ker hee unjam ko akhuz kerdeta hai.
Haq -e-Fatima a.s (SAL) to hamara jusv-e- deen hai aisay hi jaisay iqrar-e-wilayat- e- Ali a.s.
Mumkin nahee k yazeediat ko hussainiat per foqiat ho us deen mein jis mein hussainiat hee deen -e- kamil ho
Meri nazar mein fitna ibtida say hee groh bundi k zair -e- asr woh anser hai jis k jamal mein qital faqat pehla aur akhri manzer ho
Algherz ub woh jamul ka kaarzar ho ya karbala ka maidan qitaaal bayherhaal tey hai.
Kia aaj is qom mein koi merd -e- mujahid aisa nahee joe imamat ki us manzil per faiz ho jahan Zainab jul mernay ya jaan bachanay ki ijazat talab keray.
Kia yeh ajab nahee k zoaf say jurri zaat -e-zun say uthnay wala yeh fishaar ub reet, riwayat aur dustoor goya rusm-o-riwaaj k uss door say guzray ga jisay manazira kehtay hai yoon fazilat- o-manzilat say jurray Aliyan ko aik baar phir shaitan ki siffat -e- daaghdar k mud -e- muqabil lakurra keray ga jo bilashuba haysiat -o-munsab mein islaaf , usloob, siffat, kayfiat goya nisbat -o- itrat- o- fitrat k arz aur areezo say yani khulq aur khulqat k qareeno say bhee door paey jaatay ho aisay k taharat aur nijasat ki alug alug raho per.
Meri nazar mein Mohtarma safi Ali khan ko is fitnay ko hawa na denay ka mushwara hai aur logo ko qol- e- Mola – e- kainat say jurra woh mushwara hai k halat- e- fitna mein oont k uss 2 saala buchay ki manind hojao jis per na sawri kj jasukay na doodh jana jasukay. (Dr Raza)
الَّذِينَ آمَنُوا وَتَطْمَئِنُّ قُلُوبُهُم بِذِكْرِ اللَّـهِ ۗ أَلَا بِذِكْرِ اللَّـهِ تَطْمَئِنُّ الْقُلُوبُ ﴿٢٨﴾
[13:28] ابوالاعلی مودودی
ایسے ہی لوگ ہیں وہ جنہوں نے (اِس نبی کی دعوت کو) مان لیا اور اُن کے دلوں کو اللہ کی یاد سے اطمینان نصیب ہوتا ہے خبردار رہو! اللہ کی یاد ہی وہ چیز ہے جس سے دلوں کو اطمینان نصیب ہوا کرتا ہے
Yaad ghayb ki nahee wajood ki hua kerti hai
zahir mein batin ar batin k zahoor ki hua kerti hai
zikr yaad say jurra hai aur yaad mulaqqt say
mulaqaat wajood say hua kerty hai zaat say nahee
wajood zahir mein deed aur batin mein reet say jurra hai
reet zahir mein deen aur batin mein shaoor dastoor -e-deen goya zaat paaat ravi riwayat isajood ibadat say jurra hai
yahee torr tarreqay atwaar yaad ki soorat zikr aur zikr pichlo ka uglo per sehar
zikr qaloob ka skoon aur sakoon faqat yaad un ki jin k rusto per chulnay ka hukum.
bus yahee rustay sureh hamd ka tareeqa aur yahee momino ka saleeqa
yad zikr say jurri hai aur zikr loagon ka hua kerta hai aisay k humay un k rustay chula (Dr Raza)
Bus yeh hussaini raastay per chulnay walay loag hain joe gahey bagahey upna lahoo dey ker hamaray khoon ko germa ya kertay hain.
shukr hai paalnay walay ka joe her yazeed per hussainiat ko laa khera kerta hai .
kia yeh ajab nahee k ub tum aik hussaini maartay ho aur phir kainiat shok e shahadt mein yazeediat k khilaaf mutaharik hojaya kerty hai
bus mein samjh gaya k hussussiat khoon -e-nahaq ka naam hai joe haq per jaan dey dey aur yazeediat uss taghooti batil ka joe hussainiat ki jaan laylay .(Dr raza)
ہر اِک لمحہ رہا کچھ ایسا بھاری
فقط تھی جھوٹ پر یہ عمر ساری
سمیٹا کرتا تھا حالات اپنے
کی یا کرتا فقط تھا آہ وہ زاری
اِطاعتوں میں یہ سجدے تیری خوشی کے لیے
جلا دیاھے خودی کو تیری خودی کیلیے
میں جل رھا ھوں کہ روشن تیری صبح کو کروں
نہ پوچھ مجھ سے سزا یہ کیوں، بندگی کے لیے
14 Tuesday Apr 2009
Posted by Dr RazaHaider in constitution and pakistan, constitution of pakistan,sight and scenes of politics i, Islam, medical and surgical corridor, Medical corridor, Medical tips, Sights and scenes of politics in Pakistan, Uncategorized
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“While nothing is easier than to denounce the evildoer, nothing is more difficult than to understand him.” – Fyodor Dostoevsky
What motivates terrorists and how they differ from you and me?
How these ideas or doctrines develop?
Can psychology and behavioral science, tell us what motivates terrorists and how they differ from you and me in terms of behavior?
Evaluation and Observation (Abstracts)
Scientifically, it’s a tough task, since “terrorists don’t volunteer for psychological studies”.
Terrorism experts differ in their understanding of this motivation.
If I put a glance at different perspectives of visions by global experts; so to delineate the real means of transformation of human in to bomb; I have no reservation but to tag their work as insanely, bias and misdirected towards self presumptive belief keeping observation under complete misdirection.
This opinion is because almost every Harry and George taking origin to resolve this issue revolves and evolves around one perspective scope and that is; to assemble thought from the chapter of Islamic practice of belief as martyrdom and judgment day.
This is perhaps the reason of multiple opinions as thoughts which are still acting under the suspicion of supposed ideas.
It is a very well known fact as observation that “when you start your discussion in a preconceived format of assessment; logically, results would be felt as per your intended ideas”.
“You strive for what you desire” therefore; “you move in direction where your mind desire at subconscious level”; for ultimate “intended resultant”.
My point is “if you have intention to drag Islam and Muslims behind this idea of suicide bombing as preconceived idea”; you would delineate your thought as per your subconscious backup as “bias” thereby deceiving the resultant and the exact cause behind.
This is the main reason why this discovery to delineate “mind set of suicide bomber;” is still a matter of speculation as assumptions.
Though there are many who have logically tried; setting aside the realm of attachments of this obstinate behavior as bias but their “restricted knowledge over the subject of reality of belief and its practice as Islam” could not support their version of indictment.
Hence by all means this subject in terms of “mentality of suicide bomber” has “yet to become the verdict as validated book”.
Almost every research that has been conducted up till know since evolution; the contribution of the researcher was always seen under dominant share but since “this topic being a definite fate as death” no one has yet extended his horizon to “feel the realm of reality what a suicide bomber can feel” by putting himself under the threat.
This is another hilarious reason why “behavior of suicide bomber” is still a matter as “undocumented”.
This is also true that since “suicide bombers are invincible or invisible like supernatural”; “appearing all of a sudden and only when death as panic cordon surrounds” therefore; it limits period that could match so to predict a little about the “mood as attitude”.
Once again! Putting the subject under the platform of assumption and presumption as “hypothesis of belief;”
Under the extreme of “unavailability of proper and calculated data as evidence” modes to route this peril as threat is a real menace.
But still people at their verge are striving to dig the real theme of this “manufactured breed of bomb.”
There are many formats as belief that suicide bombers would be the “most irrational, unethical and distracted person with disturbed behavior.”
But contrary to this belief researches have proved that “these bombers and their handlers are all as similar to the lot as existing as normal.”
Hence proving that “terrorist has no abnormal behavior” and is as normal as we are.
Observations predict that any one giving an “exclusive situation” would behave in same pattern as been intended or provided.
There is a great deal of evidence to suggest that “given the right set of circumstances, almost everyone, irrespective of personality or background, will behave in a group in ways they never would when alone”.
In 1971, psychologist Philip Zambardo’s famously showed how easy it is to “turn ordinary people into monsters.”
He recruited students to imitate prison guards and inmates, and put them together in a mocked-up prison at Stanford University to observe their behavior.
The experiment was aborted after six days because the “guards” had pushed many of the “prisoners” to emotional breakdown.
Since then, many other experiments and real-life observations have reinforced the conclusion that “in a group environment for example a football crowds, a battlefield, a rioting mob; a person’s behavior is dictated far more by what is happening around them than by their own psychological temper”.
It seems we have “evolved to encourage group cohesion and co-operation.”
Suicide bombing is a classic—though extreme—example.
There is virtually no recorded case of a suicide bomber acting alone.
The “bomber is always recruited and guided by a group with specific political or ideological aims, and the bombers tend to adopt a brotherhood mentality” towards each other, “encouraged by their common cause”, their “loyalty to the group” and the “secrecy of their mission”.
To use a battlefield as symbol “they go over the top together.”
For 30 years, Rona Fields, a Washington, D.C. psychologist, has been psychologically testing terrorists and paramilitaries from Northern Ireland, Israel, the West Bank, Lebanon, Southeast Asia, and Africa.
She thinks today’s “suicide terrorists share the still-born moral and emotional development she saw in the Khmer Rouge, who created a bloodbath in Cambodia during the late 1970s.”
“Their definition of right and wrong is very black-and-white, and is directed by an authoritative director,” says Fields.
“There is a “total limitation of the capacity to think for them selves.”
“A terrorist develops gradually from a young age”, Fields says.
The boys (typically aged 10 to 16) who are easiest to recruit for suicide terrorism are “at the stage of development of moral judgment called retributive justice or vendetta.”
“This “an eye for an eye” stage of emotional development as was described by the Swiss psychologist Jean Piaget, She adds.
In “societies where there’s been intergenerational, intercommunal war,” Fields says, “many adults never outgrow the vendetta, and are trapped in righteous indignation,” which Fields found among; examined.
“They believe there’s a difference between right and wrong, but when they do something in the name of the cause, it’s justified.”
“These true believers”, she adds, “are angry, but they don’t feel guilty about their anger.”
“They are rational, they are not insane,” says Richard Pearlstein, associate professor of political science at Southeastern Oklahoma State University.
“They have goals and they are moving towards those goals.”
“Not only are terrorists; not crazy, but they don’t share a personality type”, wrote David Long, former assistant director of the State Department’s Office of Counter Terrorism.
“No comparative work on terrorist psychology has ever succeeded in revealing a particular psychological type or uniform terrorist mindset” still.
Long wrote that terrorists tend to have “low self-esteem, are attracted to groups with charismatic leaders, and, not surprisingly, enjoy risk oddly”.
Long! Concluded that many terrorists are; “ambivalent about violence and guns”
History has revealed that terrorists are capable of carrying out “bold and destructive acts” that at first glance appear to be unexplainable.
What kind of person would sacrifice his or her own life in order to kill innocent people?
What could possibly motivate a young person to become a suicide bomber?
Research shows “no indication that terrorists are crazy or psychopathic or that they lack moral feelings.”
Most “terrorists are not psychologically deviant” and do not operate outside the “normal rules of behavior”, but are instead “ordinary people from unremarkable backgrounds”.
In fact, research indicates that “terrorists tend to have considerable insight into their own actions and are aware of how others view them.”
“They believe that their violent actions, while somewhat regrettable, are justified and noble.”
Moreover, “their emotional commitment to their cause and comrades is indicative of normal human psychology.”
Often “their actions do not ultimately stem from hatred” but rather “from love of their own group and culture that they believe is threatened and requires protection.”
Human being by nature have “built-in trait” as characteristic termed the “Ego”. (Writer contd….)
The phrase of claim as “Mine” is an expression of egoistic attitude explaining the theme behind; that the person “owns his feels as features” in terms of “absolute relation” under “constrained fashion.”
Though at one end this attitude is egoistic but at other perspective it does explain that such “own as claim” can “litigate as rift”, if at all “means as maneuvering” could be put as conflict.
My Point is; “claiming legitimacy” as “Mine” or “own” would and shall counter and “retaliate as behavior”.
This is especially over grown; if at all “situations as conflicts” are created under the rule of pin point controversy as emotional attachments. (Writer)
It is important to note at the outset that the use of the term ‘suicide’ to characterize these attacks reflects an outsider’s view.
Those who commit or advocate such attacks do not regard them as acts of suicide, but rather as acts of martyrdom.
While suicide is associated with hopelessness and depression, the actions of the bombers are seen as a matter of heroism and honor.
Many theorists focus on ideology in their attempt to understand what motivates suicide bombers.
Randy Borum (2003) focuses on “terrorist ideology and the process of how these ideas or doctrines develop”.
He identifies a four-stage process whereby individuals develop extremist beliefs.
A ‘group’ or ‘individual’ first “identifies some sort of undesirable state of affairs”; then “frames that event or condition as unjust”; then “blames the injustice on a target policy, person, or nation;” and then “vilifies or demonizes the responsible party” so that aggression seems justified.
Those suffering from adverse conditions do not regard themselves as “bad” or “evil” but only as the ‘victims of injustice.’
This makes aggression against the “evildoers” to justify psychologically.
Terrorists tend to have an “apocalyptic” revelation perspective of worldview as vision” and to see the world as precariously balanced between “good and evil”.
They believe that through their actions, they can “uphold their values of family, religion, ethnicity, and nationality and bring about the triumph of the good”.
Other theorists stress the idea that “becoming a terrorist or suicide bomber is largely a matter of socialization”.
In some cases, “those personally frustrated by their life circumstances may become angry with those they view as the source of their problems”.
According to Jessica Stern (2003), terrorists are often “individuals who feel deeply humiliated and confused about their future path, or are frustrated about the political climate in which they live”.
Humiliation, poverty, and hopelessness often give rise to a sense of outrage and desperation, which can be harnessed by extremist leaders to create support for a terrorist movement.
For individuals who feel deeply alienated or desperate, ‘death provides the ultimate escape from life’s dilemmas.’
In other cases, ‘individuals become angry about the frustrations and insults experienced by their ethnic, cultural, or religious group, though they do not experience this insult at a personal level.’
This makes sense of the fact that ‘many terrorists are middle-class individuals who have fairly wide options and some degree of educational background’.
Their strong group identification and anger over group insult helps to explain their ‘willingness to sacrifice their own lives.’
Those who feel frustrated and angry may join ‘terrorist organizations, which provide a variety of emotional, social, and economic benefits.’
Individuals who have a sense of uncertainty about their future may find that ‘terrorist groups provide the sense of identity, structure, and guidance that they crave’.
“Identification with the cause and other group members” may satisfy individuals’ needs for meaning and justice and afford them an opportunity to bolster their self-esteem.
Belonging to a terrorist group may also satisfy desires for adventure, “glamour,” and ‘social connections’.
Once they join the group, ‘individuals may feel strong and powerful and believe they have a clearer purpose in life’.
Many terrorist organizations also offer economic incentives to persuade individuals that ‘it is rational to sacrifice their lives for the good of the cause’.
For those who believe they lack options, cannot find a job, and have few social safety nets in place to assist them, suicide bombing may seem like a relatively reasonable option.
Families of suicide bombers often receive money and are treated as heroes.
Once individuals join ‘organizations that share their frustrations,’ they may undergo a ‘process of indoctrination’ whereby their “beliefs and behaviors are made to confirm the group’s basic principles”.
Within these tight-knit communities, individuals’ fear of letting down their comrades becomes greater than their fear of dying.
Many come to believe that by sacrificing their own lives for the sake of the cause, those lives can take on a broader meaning.
Various grievances and social stressors can contribute to the formation of terrorist groups.
For example, poverty, unemployment, epidemics, and criminality often lead to social instability, which provides fertile ground for terrorist activity.
Over-population, socioeconomic struggle, and a lack of professional opportunities can also produce a sense of rage, powerlessness, and resentment among the populace.
Disaffected individuals and or groups may perceive the world as treating them harshly and unjustly.
In some cases, there are indeed genuine causes for grievance and a sense of group persecution.
The move from being a disaffected individual to a violent extremist is usually facilitated by some catalyst event.
In most cases it is an act of extreme violence committed against the individual, family or friends by those in authorities or by some rival group.
Research findings indicate that “most suicide bombers have had at least one of their loved ones killed or severely harmed at the hands of their enemies.”
Many of them join terrorist groups in an angry and vengeful state of mind with the intent to take part in aggressive acts.
In fact, many suicide bombers may view themselves as soldiers engaged in a war.
Casualties are then seen as the regrettable but inevitable consequence of fighting for one’s just cause.
It is not that they are bloodthirsty or that they enjoy killing civilians, but rather that they believe these missions are the only way to fight for their cause.
Although the realization that terrorists view themselves as soldiers engaged in a just war does not legitimize their cause or methods, it does provide some insight into their psychology and motivation.
It suggests that their psychology is similar to that displayed by combatants in other conflicts, and that suicide bombers view themselves as soldiers or warriors reacting to the provocative abuses and injustices of others.
According to this line of thinking, suicide bombing is a matter of fighting against unjust political or economic policies, authoritarian governments, and structural violence.
Some argue that the global economic order contributes to groups’ sense “that they have been mistreated.”
Michael Stevens (2002), for example, argues that “globalization contributes to the creation of socio cultural and psychosocial conditions from which terrorism is more likely to emerge”.
The West has exported its economic, political, and cultural systems with little regard as to how they might be received.
While globalization has no doubt generated wealth, it has also produced economic inequality, threats to language and community, and support for oppressive regimes.
Many believe that it has also contributed to the uprooting of traditional values and customs.
1990s to present: Private organizations, like the Osama bin Laden network, operate internationally as what some call “professional terrorists.”
Unlike predecessors, they often use suicide bombers, and do not gather hostages to negotiate for concessions.
Although they kill to make a political point, they seldom claim responsibility for their acts.
The motivation of terrorists may have changed along with their targets and methods.
“First-generation terrorists,” Pearlstein says, “joined for a variety of reasons: social, psychological, and political.”
There is evidence that these people suffered “narcissistic injuries” — massive and lasting damage to self-image and self-esteem which may be severe enough to force the discredited self to seek a new, positive identity.
“They represented the kind of human raw material that a recruiter for some terrorist organization would find it easy to prey upon,” Pearlstein says.
“All had a lack of other satisfying career options.
‘All had no compunctions against the use of violence”.
While these psychological factors were “quite significant” among first generation terrorists, and to some extent, the second generation, Pearlstein says “they do not apply to today’s suicide bombers.”
“The individual psychological factors are not as important as they were even 15 years ago.”
“These folks are motivated overwhelmingly by religious beliefs or at least, their interpretation of religious faith”.
“Indeed, their audience seems to be Allah, not the office workers in New York, Kenya or Tanzania, where their bombs have detonated”.
John Horgan, a psychologist at University College Cork (Ireland) echoes Fields by saying,
“One of the major appeals of fundamentalism is the remarkable ability to see the world in black and white terms.”
‘Fundamentalist terrorist groups’, Horgan adds! ‘Offer persuasive inducements to would-be bombers.
“We shouldn’t underestimate the lures of joining these groups.’
‘Some have specific ideas of what the afterlife involves.’
“Allah will forgive the sins of both the suicide bomber and his family.”
“Suicide bombers’, he adds, “are often “seen as heroes in the Palestinian struggle.”
“You can see the pictures of martyrs plastered on walls.”
“The families are praised… and the families of the bombers usually receive some financial reward.”
One goal of analyzing terrorists in psychological terms, obviously, “is to deter or prevent attacks,” but the present situation is not encouraging.
“There are not just people ready to die, but people who want to die,” Horgan notes.
Rather than analyze terrorism in terms of psychopathology, Horgan and others prefer to see it in the context of culture, politics and religion.
Terrorism, he says, “is a product of its own time and place.”