Thrombocytopenia is a platelet count that is under the normal lower limit (150 x 109/L). Platelets otherwise known as thrombocytes are located in the blood alongside red blood cells (erythrocytes), white blood cells (leukocytes) and plasma. The megakaryocytes are large cells that develop in bone marrow and undergo fragmentation to produce platelets. Platelets have no nucleus, instead they have granules where proteins are located to assist with its function. The function of platelets is to help with blood clotting. Platelets ‘stick’ together to stop the blood flowing from damaged blood vessels.
This can be due to a number of causes:
1) Platelet function abnormalities:
Thrombocytopathy – this can be due to defects such as genetics (inherited) and acquired of platelet function. Examples include Megakaryocytic hypoplasia – This is where megakaryocytes are underdeveloped,
Wiskott-Aldrich syndrome (WAS) – This is an X-linked recessive disease.
2) Low platelet production.
This can be due to disorders of bone marrow due to a number of reasons:
Cancer: myeloma, leukaemia, lymphoma – It can also be caused by chemotherapy!
Infection – mainly viruses such as HIV, hepatitis, Epstein-Barr, Cytomegalovirus, Herpes Simplex, Varicella-Zoster.
3) Low Platelet survival. This can be caused by:
This includes rheumatoid arthiritis, post-transfusion thrombocytopenic purpura (PTTP), neonatal alloimmune thrombocytopenia (NAIT).
PTTP: This is where antigens on transfused platelets, destruct transfused platelets as well as the platelets of the patients. This normally occurs 10 days after transfusion and can last few weeks.
NAIT: This is where the mother makes antibodies that are against the foetus (baby’s) platelets with paternal antigens. This can lead to severe neonatal thrombocytopenia.
Medications such as ibuprofen, vancomycin, heparin can cause thrombocytopenia.
In some pregnancies, HELLP syndrome can occur and stands for:
· EL (elevated liver) enzymes.
· LP (low platelet) count.
4) Dilutional thrombocytopenia
This is caused by transfusion of high volumes of blood that may have dead platelets.
Below is a diagnostic approach I created for thrombocytopenia and what tests recommended:
In our blood, we have erythrocytes (red blood cells), platelets and leukocytes (white blood cells). All are made in the bone marrow.
White blood cells protect the body from infections by ‘fighting’ them off.
Platelets adhere together to stop bleeding by cover small cuts and in blood vessels.
Red blood cells are disc-shaped and carry oxygen around our bodies and removes carbon dioxide from our bodies.
Their normal lifespan is 120 days and then they die. The bone marrow in response produces more red blood cells for replacement.
Haemolytic anaemia is where red blood cells are destructed and removed from the blood before their normal lifespan and the bone marrow cannot produce red blood cells rapidly enough to replace them. Thus, Haemolytic anaemia is a form of anaemia where there are a low number of red blood cells than normal.
Anaemia is caused mainly by high rates of red blood cell destruction, lack of red blood cell production, loss of blood, lack of haemoglobin (iron-rich protein that carries oxygen around the body from the lungs)
Haemolytic anaemia can lead to irregular heartbeats known as arrhythmias, heart failure, fatigue, enlarged heart and pain.
Please find attached a diagnostic approach for haemolytic anaemia
When is the Total Solar Eclipse?
Friday 20th March 2015
What is Solar Eclipse?
There are three different types of Solar Eclipses. I will begin with the first type as that is what will occur if God wills on Friday. Total solar eclipses takes place when the Moon intervenes between the Sun and Earth and covers the Earth with its shadow. The shadow is called the umbra. The darkest phase looks like night.
It consists of 5 phases:
1. Partial eclipse initiates: The Moon's shadow starts becoming visible over the Sun's disc.
2. Full eclipse initiates: Almost the entire disc of the Sun is covered by the Moon.
3. Total eclipse: The Moon completely covers the disc of the Sun. The Sky is dark, temperatures fall rapidly, and animals are quiet.
4. Full eclipse ends: The Moon's shadow starts moving away and the Sun reappears.
5. Partial eclipse ends: The Moon stops shadowing the Sun's disc. The eclipse ends.
Other types of eclipses include annular solar eclipse and partial solar eclipse. Annular solar eclipse is where the moon appears smaller than the sun and looks as though the sun has a bright ring surrounding the sun as shown below:
What effect can solar eclipse have on health?
Generally, the eyes can be affected from intense sunlight due to the following:
In relation to the total solar eclipse, it is very dangerous to look at the sun directly during the solar eclipse despite it being covered fully by the Moon. No matter whether it was total, partial or annular eclipse – NEVER attempt to observe it with naked eye even if it was for a FEW seconds. This can lead to permanent eye damage especially to the retina.
Eyes are very delicate ESPECIALLY children. Thus, more light are being transmitted to the retina due to higher sensitivity than the adult eye. This increases the risk to eye damage.
Damage to the retina is known as solar retinitis/solar retinopathy. Mild damage may return to normal when the swelling at the retina is lowered. However, if there is severe damage, permanent damage can take place. Men are more at risk of solar retinopathy than women.
NOTE: You will not be able to feel the effects of retinal damage as the retina has no sensitivity to pain. Amongst the symptoms that can be experienced are:
They can be experienced on both eyes (bilateral) but sometimes can affect one eye (unilateral).
How can I protect myself?
Safer techniques such as:
1) watching it via TV
2) using safe eyewear such as ‘eclipse glasses’. However, parents need to be cautious with their children who even wear such glasses. In addition due to limitations such as design, lens, improper use it is not advised to use such glasses.
3) Indirect contact such as projection method.
Is it safe to drive during this time?
There has never been a solar eclipse during ‘rush hour’. Thus there is a high chance drivers will be distracted by looking into the sky than focusing on what is happening on the road!
Moving to the Islamic perspective of the solar eclipse.
To show the power of Allah subhanahu wa taala, where none should worship only Him as He has the power to allow the moon to cover the sun and controls everything in the universe. He is the Almighty Allah subhanahu wa taala.
‘And among His Signs are the night and the day, the sun and the moon. Prostrate neither to the sun nor to the moon, but prostrate to Allah who created them, if it is truly Him you worship.’ (Surah Al-Fussilat 41:37)
Solar eclipses are reminders of the Day of Judgement where the moon, sun and stars lose lights.
‘When the sight is dazed, and the moon is buried in darkness, and the sun and moon are joined together: Man will say on that day, ‘Where is the refuge?’’ (Surah Al-Qiyamah 75: 7-10)
What do Muslims do during the solar eclipse?
During the Eclipse, Muslims pray the Salah al-Kusoof (The Solar Eclipse Prayer). Please do not get mixed up with Salah Al-Khusoof (Lunar Eclipse). Both do contain to Rak’aat (units of prayer). Majority of the people of knowledge confirm it to be a sunnah mu’akkadah. Imam Malik compared its importance to that of the Friday Prayer whereas Imam Abu Hanifah confirmed it to be obligatory.
It is sunnah to pray at the masjid in congregation. However, those who are unable to do so may pray alone. Women can pray at home or pray in congregation.
What does Salah Al-Kusoof consists of:
The prayer lasts throughout eclipse. The sermon is delivered after the Prayer. Recitation is performed loud. There are two Ruku‘s (bowing), the second of which is always shorter than the first, and there are also two recitations. After the Takbirat-ul-Ihram (saying: “Allahu Akbar [Allah is the Greatest]” upon starting Prayer), Surah Al-Fatihah and a long Surah are recited. After the first Ruku‘, Surah Al-Fatihah and a long Surah are recited, which is shorter than the preceding recitation. There are two Sujuds (Prostrations) in each Rak‘ah. This is the most authentic report mentioned regarding this Salah.
[Source: Sh. 'Abdul-`Aziz ibn `Abdullah ibn Baz; alifta.net]
Urwah bin Az-Zubair may Allah be pleased with him reported from Aishah may Allah be pleased with her, the wife of The Prophet peace be upon him, that she said:
“There was a solar eclipse during the lifetime of Allah’s Messenger peace be upon him. So, The Prophet peace be upon him went to the Masjid, stood up and said the Takbir, and the people lined up (in rows) behind him. Allah’s Messenger peace be upon him recited (the Qur’an) for a long time, then said the Takbir and went into Ruku’ for a long time. Then he raised his head & said: ‘Sami Allahu liman hamidah, Rabbana wa lakal Hamd.’ So he stood up and recited a lengthy recitation, which was not as long as the first recitation. Then he said the Takbir and went into Ruku’ for a long time, but not as lengthy as the first Ruku’. Then he said: ‘Sami Allahu liman hamidah,’ and he repeated the same acts in the other raka’at. So he completed four Ruku’ and four prostrations (Sujood), and the sun had become visible before he finished.”
[Source: Hadith No. 1180, Book of The Prayer for Rain, Sunan Abu Dawud, Vol. 2].
What is Cancer?
Cancer is one of the most serious medical problems. A tumour is the growth or lump of tissue resulting from neoplasia, abnormal new cell growth and reproduction due to loss of regulation. Tumour cells have abnormal shapes and altered plasma membranes that contain distinctive tumour antigens. There unregulated proliferation and differentiation result in invasion can result in invasive growth that forms unorganised cell masses. This reversion of primictive or less differentiated state is called anaplasia.
Types of Cancer?
There are two types of tumours known as benign tumour and malignant tumours. Benign is not cancerous, while malignant tumours are cancerous and can cause cancers such as carcinoma. The stages involve local growth of the tumour and damaging the nearby tissues, this can then spread to the lymph channels and nodes and finally they can then spread all over the other areas of the body such as small blood vessels and then get carried in the blood stream to other parts of the body.
The relationship between Viruses and Cancer
There are many causes of cancer, and only few that are related to viruses, 30-60% are related to diet and cigarette smoke. Many chemicals in our surroundings are carcinogenic and may cause cancer by inducing gene mutations or interfering with normal cell differentiation. However it is important to note that not many cancers are linked to environmental factors.
Viruses are known to cause many animal cancers, but it has been difficult to prove that this is the case with human cancers: the list below show those that can cause cancer:
Some animal viruses have the potential to change a cell from a normal cell into a tumour cell. This process is called transformation. Viruses known to cause cancer are called oncoviruses. All known human dsDNA oncoviruses trigger cancerous transformation of cells. They encode proteins that bind to and there by inactivate cellular proteins known as tumour suppressors.
Examples of proteins that can lead to cancer?
There are two major HPV proteins E6 and E7:
E6 binds to p53, a major tumor suppressor in the cell that normally activates transcription of p21, an inhibitor of kinases that promote mitosis.
The E6 oncoproteins in HPV have been shown to be one of the main players in the progression to cervical cancer. E6 in HPVs that are at high risk of causing cancer can complex with p53, which is an important tumor suppressor that plays a role in directing the cellular response to genotoxic and cytotoxic stresses that threaten genomic stability. It functions as a sequence specific transcription activator that is necessary to regulate cell growth as well as tumor growth suppression. The p53 protein suppresses cell growth by transcriptionally activating p21, which inhibits the cell-cycle kinases critical for G1 progression and cell growth.
HPV E6 has also been shown to induce degradation of p53 through ubiquitin-dependent proteolysis. E6 forms a complex with the cellular ubiquitin protein ligase E6-AP, which is then able to bind and ubiquinate p53.
p53 usually acts to arrest G1 growth or to induce apoptosis in the cell to allow the host DNA to be repaired or for the cell to be eliminated if the DNA is irreparable. E6-expressing cells do not manifest a p53-mediated cellular response to DNA damage, which leads to genomic instability. E6 can also activate telomerase independent of p53, leading to immortalization of the infected cell. There is also evidence that E6 can induce abnormal centrosome duplication, leading to genomic instability and aneuploidy.
E2F is a cell-cycle activator that is regulated by the binding of pRB, a cellular tumor suppressor. HPV protein E7 can bind to pRB, rendering it unable to bind and regulate E2F, which then can freely activate the cell cycle to progress uncontrollably.
Retro viruses release their oncogenic powers in a different manner. Some carry oncogenes captured from host cells many, many generations ago. Thus they can transform the host cell by bringing the oncogene into the cell. The human retro virus HTLV-1 and HTLV-2 transform a group of immune system cells called T cells by producing regulatory proteins that sometimes activates genes involved in cell division as well as stimulating virus reproduction. The second virus transformation mechanism used by retro virus involves the integration of a viral genome into the host chromosome such that strong, viral regularity elements are near a cellular proto-oncogene. This results in such a high level of expression of cellular protein that the gene is now oncogene.
* Oncogene - is a gene that has the potential to cause cancer. In tumour cells, they are often mutated or expressed at high levels. Many abnormal cells normally undergo a programmed form of death (apoptosis). Activated oncogenes can cause those cells to survive and proliferate instead. Most oncogenes require an additional step, such as mutations in another gene, or environmental factors, such as viral infection.
*Proto-oncogene is a normal gene that can become an oncogene due to mutations or increased expression.
There are two aspects to the prevention and treatment of virus diseases: prevetion where vaccination and public health measures. The other type being is treatment by antiviral drugs. Vaccine is a preparation of bacterial antigens that are induced into the immune system.
Vaccine may contain killed, inactivated, dead or alive bacteria. Immunization is a result of good vaccination. In the past and still today, immunisation programmes are held between herd immunity. This is when most of a population is immune against a certain infection, making it difficult for that specific bacteria/virus to find an individual who is not immune and thus cause infection and because they are not motile the can die out. Vaccines used in herd immunity have been created against smallpox & measles and many more are in progress.
Vaccine that have been given to those who are immune against certain viruses are known as ‘active’, but when women are given this virus and it is passed to the child via placenta this is known as ‘passive’. Hence the child would still require a MMR jab after the first birthday.
The types of vaccines produced can be broken down into four categories: the first is called killed/inactivated. The virus is treated with heat or chemicals so that it is no longer infectious. These vaccines stimulate good antibody responses, but because the virus is no longer infectious do not stimulate cell-mediated immunity. This type of vaccine was first used in 1885 by Louis Pasteur. A child was infected with rabies by a dog (bitten). Louis used this type of vaccine and induced to the child and it was successful. In 1950 another rabies vaccine was produced of this type, but failed as it needed was in an active form and multiplied. Other than reactivation, another disadvantage is that large scale production is required. In contrast to this vaccines drawbacks: it is cheap, simple and has low risk s of contamination.
Another type of vaccine that can be produced is called attenuated virus. Attenuated pathogens are still viable and cause infection but do not cause disease. Attenuation is usually achieved by growing the organism in cells o other species so the pathogen becomes adapted to cells of other species and grows poorly in human cells. They can stimulate cell-mediated and antibody responses. An example of this type of virus was introduced in 1977 by Edward Jenner. He used cow pox to induce into a child who was infected with small pox. Cox pox was similar but with less virulent factors. The immune system would have recognised this pathogen and eliminated small pox. This was a successful vaccine programme and is used in herd immunity. However it can show small signs of illness but it can also contaminate and virus shed. Amongst the advantages are: cheap, simple and long lasting.
In relation to subunit vaccines, many bacteria produce a polysaccharide coat that prevents phagocytosis in the absence of antibodies. Vaccination with the polysaccharide activates antibodies and is enough to provide immunity. Another type of vaccine that can be used is called purified subunits. This is usually done with influenza as it can produce new strains each year (antigenic drift). This type of vaccine is easier to store, low risk of contamination and targets immune response. Disadvantages= expensive, requires activation and complex.
Finally we have cloned vaccine. This is when a virus or bacteria are cloned based on their surface antigen structure. They are usually cloned onto yeast cells which are then recognised by the immune system. It can be expensive, low cost can depends on infection, stable, no risk of contamination.
Why are current viral vaccines more effective than antiviral chemotherapy? what are the limitations of viral vaccines?
The control of viruses and viral diseases is accomplished in two different ways: vaccines help in the prevention of viral infections whilst antiviral drugs provide treatment of diseases induced by viruses. In animals (including humans), immunisation with vaccines has been far more effective than the use of antiviral drugs, Vaccines have however been very successful in preventing some viral diseases. Nevertheless, vaccines are difficult to successfully deploy against rapidly mutating viruses, such as Influenza virus and HIV and in individuals who are already infected with a virus, they provide modest or no therapeutic effect. That is why antiviral drugs, that are capable of preventing an infection or stopping it once started, are important as a second arm of antiviral defence.
A vaccine is valuable in controlling viruses and the diseases they cause, but it has to follow certain prerequisites to be effective. First of all, a vaccine must be safe: its side effects must be minimal and it should induce protective immunity in the population as a whole, evoking innate, cell-mediated and humoral responses. Not every individual in a population needs to be immunised to stop viral spread, but a sufficient number must become immune to prevent virus transmission. Protection provided by a vaccine should be long-term, meaning that more than one inoculation may be necessary in some cases. In practical terms, an effective vaccine should be biologically stable: there should be no genetic reversion to virulence and it should be able to survive storage and use in different conditions. Vaccines should also be easy to administer at low cost.
Viral vaccines can be classified broadly into two general groups: live attenuated virus vaccines and inactivated (killed) virus vaccines. In relation to live attenuated viral vaccines; the process of producing a virus strain that causes a reduced amount of disease. An attenuated virus is therefore a weakened, less virulent virus. A vaccine with low pathogenic potential that is, nevertheless, capable of inducing a long-lived, protective immune response. Live virus vaccines allow the activation of all components of the immune system yielding both a balanced systemic and local immune response, and a balanced humoral and cell mediated response. Also it stimulates an immune response to each of the antigens of a virus. As demonstrated in a study on Influenza A virus vaccines, immunity induced by live virus vaccines is generally more durable and more effective than that induced by inactivated virus vaccines.
Examples of effective killed virus vaccines administered to humans are the inactivated HPV, Influenza virus, Hepatitis A virus and Rabies virus vaccines. The basis for the construction of an inactivated vaccine is the isolation of virions of the virus of interest and their subsequent inactivation by chemical or physical procedures. The infectivity of the virus is eliminated, but the viral antigenicity should not be compromised by these treatments. Common techniques include treatment with formalin (chemical) or disruption with a detergent (e.g. for influenza). The level of efficacy of these vaccines differs: inactivated PV is highly effective in preventing disease, whereas the Influenza virus vaccine is only partially protective.
Antiviral drugs are a class of medication used specifically for treating viral infections. The emergence of antiviral drugs is expanding knowledge of the genetic and molecular function of viruses, major advances in the techniques for finding new drugs, and the intense pressure to deal with HIV. The general idea behind antiviral drug design is to identify target viral proteins, or parts of proteins, that can be disabled. These targets should be common across many strains of a virus, or even among different species of viruses in the same family, so a single drug will have a broad effectiveness. Once targets are identified, candidate drugs can be selected. High throughput screening (HTS) allows a researcher to effectively conduct millions of biochemical, genetic or pharmacological tests in a short period of time. Through this process one can rapidly identify active compounds, antibodies or genes which modulate a particular biomolecular pathway. The results of these experiments provide starting points for drug design and for understanding the interaction or role of a particular biochemical process in biology.
There are two main difficulties with antiviral drugs. First there is the problem that by the time clinical signs and symptoms appear in acute infections, virus replication has reached such a peak that the antiviral has little therapeutic effect. The other problem is that virus multiplication is tied so intimately to certain cellular processes that most antivirals cannot discriminate between them. However, viruses do have unique features, so specific antivirals should be able to serve as effective chemotherapeutic agents. An antiviral would be effective if it inhibited any stage of virus multiplication: attachment, replication, transcription, assembly or release of progeny virus particles. The current major antivirals act in one of these ways. Most of the antivirals now available are designed to help deal with HIV; Herpesvirus, which is best known for causing cold sores but actually covers a wide range of diseases; and HBV and HCV, which can cause liver cancer.
A well designed and implemented vaccination program is a key element, however, it is important to understand and appreciate the limitations. No vaccination program can fully prevent disease. Vaccines do not prevent infection rather they prime the immune system to provide a rapid and effective response following infection. This limits multiplication and spread of the infectious agent and lessens tissue damage. The result is decreased disease severity and decreased transmission to other people.
There are some cases in which an inactivated virus vaccine has amplified disease rather than prevented it. This was first observed with a formalin-inactivated MeV vaccine. This vaccine prevented measles initially, but after several years, vaccines lost their resistance to infection and when subsequently infected with naturally circulating MeV, patients developed an atypical illness with accentuated symptoms. A further disadvantage is that inactivated virus vaccines often do not induce CTL cells as efficiently as live attenuated viral vaccines. Furthermore, to induce the same immune response as live attenuated preparations, inactivated virions require mixing with adjuvants, which are substances that stimulate early processes in immune recognition, particularly the inflammatory response. Adjuvants can mimic or induce cellular damage, stress and release of heat shock proteins which directly stimulate the immune system. Another major disadvantage is that, as the killed virus cannot multiply, the immunising dose has to contain far more virus that a dose of live vaccine and repeated doses may be required to induce adequate levels of immunity; this increases the overall cost of the vaccine.
There are also some major concerns regarding live virus vaccines. Firstly, they can contain foreign agents (contamination), although this has rarely been a problem. They can cause illness directly or lose their attenuation during manufacture or during replication in vaccines by reversion or second-site compensatory mutations. Given the high rate of mutation associated with RNA virus replication, a reversion to virulence may occur quite frequently. Some live virus vaccines, such as the MeV, Rubella virus and Yellow Fever virus vaccines, retain a low level of residual virulence. Others, such as the PV vaccine, may restore a varying degree of virulence during infection by the vaccine virus, although this occurs at an extremely low frequency. Another disadvantage is that live viral vaccines can lose infectivity during storage, transport or use. Also, naturally occurring wild-type viruses may interfere with infection by a live virus vaccine, resulting in a decrease in vaccine efficacy. Stability is also a serious problem with labile vaccine viruses such as MeV. The measles vaccine needs to be stored and transported at low temperature (4°C).
A GOOD HEALTH MAKES YOU RICH
Health is crucial in every single person’s life. Its something that money can’t buy. Thus a good health makes you rich so look after it.