Monday, 23 October 2017
आसव अरिष्ट आणि विष, विषमत
Tuesday, 17 October 2017
ज्ञानार्जन २
*🥀 Collection 🌷 Of 🌹 Medical 🌷 Roses 💐*
🌷🌹💐 🌷🌹💐 🌷🌹💐
*🌹 Rose Sign - _DVT_ 🌷.*
*🌹 Rose Spot - _Typhoid_ 🌷.*
*🌹 Rose Waller Test - _Rheumatoid Factor_ 🌷.*
*🌹 Rose Pink Rash - _Erysipelas_ 🌷.*
*🌹 Rose Thron Ulcer - _Crohn Disease_ 🌷.*
*🌹 Rose Bengal Stain - _Sjogren Syndrome (Eye Examination)_ 🌷.*
*🌹 Rose Bengal Card Test - _Brucella_ 🌷.*
*🌹 Rose Garder's Disease - _Sporothrix Scheming_ 🌷.*
*🌹 Rose Position - _Adenoidectomy /Tonsillectomy_ 🌷.*
*🌹 Rose Water Syndrome - _A Mild Form Of Hereditary X- Linked Hypergonadotropic Hypogonadism In males, Characterized By Sterility And Gynecomastia_ 🌷.*
*🌹 Rose Fever - _Hay Fever_ 🌷.*
🌹🌷💐 🌹🌷💐 🌹🌷💐
Monday, 16 October 2017
वैद्यकीय ज्ञानार्जन १
[10/16, 11:40 PM] +91 86006 11004: *🤕 IMPORTANT SPLINTS 🤕*
*♻ Thomas Splint :-*
_# FEMUR._
*♻ Dennis Brown Splint :-*
_CTEV._ (Clubfoot or Congenital Talipes EquinoVarus).
*♻ Cock Up Splint :-*
_RADIAL NERVE PALSY._
*♻ Knuckle Bender Splint :-*
_ULNAR NERVE PALSY._
*♻ Aeroplane Splint :-*
_BRACHIAL PLEXUS INJURY._
*♻ 63 Von Rosen Splint :-*
_CDH /DDH_
Developmental Dysplasia Of Hip.
*♻ Minerva Cast :-*
_CERVICAL SPINE DISEASE._
*♻ Turn Buckle Cast :-*
_SCOLIOS._
*♻ Rissers Cast :-*
_SCOLIOSIS._
*♻ Milwaukees Brace :-*
_SCOLIOSIS._
*♻ BOSTON BRACE :-*
_SCOLIOSIS._
*♻ Frog Leg Cast :-*
_CDH /DDH_
Developmental Dysplasia Of Hip.
*♻ Cylinder Cast :-*
_# PATELLA._
*♻ Hip Spica :-*
_# FEMUR._
*♻ Hanging Cast :-*
_# HUMERUS._
*♻ Tube Cast :-*
_KNEE._
[10/16, 11:40 PM] +91 86006 11004: *👀 Spots In Ophthalmology 👁*
*÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷÷*
🙄 *Bitot's Spot*
_White, Foamy area of Keratinising Squamous Metaplasia of Bulbar Conjunctiva, seen in Vitamin A Deficiency._
😳 *Brushfield Spot*
_Whitish Grey spot in Peripheral Iris, seen in Down's Syndrome._
☺ *Elschnig Spot*
_Yellow patches overlying area of Choroidal Infarction in Hypertension._
😯 *Fischer-Khunt Spot*
_Senile Scleral Paque, area of Hyalinised Sclera Anterior Horizontal Rectus Muscle Insertion, seen in Old Age._
🤓 *Fuch's Spot*
_Pigmented (RPE Hyperplasia) Macular Leisons in Pathological Myopia._
😍 *Roth Spots*
_Haemorrhages with white centres, seen in SABE, Severe Anaemia, Collagen Vascular Disorders._
*👁 Dots In Ophthalmology 👀*
*°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°°*
😦 *Gunn's Dot*
_Light Reflectios from Internal Limiting Membrane around Disc and Macula._
🤗 *Horner-Trantras Dot*
_Collections of Oosinophils at Limbus in Vernal Conjunctivitis._
😔 *Kayes' Dot*
_Subepithelial Infiltrates seen in Corneal Graft Rejection._
☹ *Mittendorf's Dot*
_Whitish spot at Posterior Lens Surface, Remnant of Hyaloid Artery._
*👀 Lines in Ophthalmology 👀*
*----------------------------------------*
🙂 *Arlt's Line*
_Conjunctival Scar in Sulcus Subtarsalis._
😌 *Ehrlich-Turck Line*
_Linear deposition of KPs in Ueitis._
😋 *Ferry's Line*
_Corneal Epithelial Iron Line at the edge of Filtering Blebs._
😣 *Hudson-Stahil Line*
_Horizonatl Corneal Epithelial Iron Line at the inferior one third of Cornea due to Aging._
😟 *Khodadoust Line*
_Corneal Graft Endothelial Rejection Line composed of Inflammatory Cells._
😳 *Paton's Line*
_Circumferential Retinal Folds due to Optic Nerve Oedema._
🤡 *Sampaoelesi Line*
_Increased Pigmentation Anterior to Schwalbe's Line in Pseudoexfoliation Syndrome._
😎 *Scheie's Line*
_Pigment on Lens Equator and Posterior Capsule in Pigment Dispersion Syndrome._
😦 *Schwalbe's Line*
_Angle Structure Representing Peripheral Edge of Descemets Membrane._
😇 *Stockers Line*
_Corneal Epithelial Iron Line at the edge of Pterygium._
😁 *White Lines Of Vogt*
_Sheathed or Sclerosed Vessels seen in Lattice Degeneration._
*👨🏻⚕iFTHi🚘*
[10/16, 11:40 PM] +91 86006 11004: 🐻✔✔✔✔✔🐻
_🐻 Asphyxia by forcing cloth in mouth :_
*GAGGING*
_🐻 Asphyxia by closing external air passages :_
*SMOTHERING*
_🐻 Asphyxia by obstruction of internal air passages :_
*CHOKING*
_🐻 Neck constricted between 2 bamboo sticks :_
*BANDSOLA*
_🐻 Neck constricted with ligature :_
*LIGATURE STRANGULATION*
_🐻 Neck constricted with hand :_
*THROTTLING / MANUAL STRANGULATION*
_🐻 Victim attacked frm behind :_
*GARROTING*.
_🐻 Homicidal hanging :_
*LYNCHING*
_🐻 Strangulation caused by holding neck of victim in the bend of elbow :_
*MUGGING*
_🐻 Homicidal Smothering + Traumatic Asphyxia :_
*BURKING*
🐻✔✔✔✔✔✔🐻
[10/16, 11:40 PM] +91 86006 11004: *👨🏻 General Practice Tips 👩🏻⚕*
💊💉💊💉💊💉💊💉💊💉
🔴 *Problem : _A ticklish, giggly patient won't let u examine his belly._*
🔵 *Solution : _Give a broad smile, ask the patient to place his hand on abdomen, place ur fingers in between patient's fingers and then examine._*
🔴 *Problem : _Cannot hear Kortokoff's sounds through ur stethoscope !._*
🔵 *Trick : _Rise the pressure in the BP instrument Cuff above 200mmHg, ask patient to alternately open and close the first for 5 to 6 times. Now the sounds ll be distinctly audible._*
🔴 *Problem : _Interactable continuous cough ?_*
🔵 *Try this : _Mix 1ml of Lignocaine with 1ml of Salbutamol respiratory solution and nebulise._*
🔴 *Confused : _Migraine or Sinusitis ?_*
🔵 *Trick : _Give a supra orbital nerve block and wait for 5 minutes. The head ache due to sinusitis ll disappear temporarily, as the nerve supply to the frontal sinus is blocked, while the vascular head ache n migraine ll persist._*
🔴 *Problem : _Easing eye drops in children._*
🔵 *Trick : _Instill a drop at the inner canthus of closed eye. The child ll open the eye and the medicine ll then spread smoothly._*
🔴 *Struggle : _Examining child's throat !_*
🔵 *Solution : _Keep the tongue depressor away and ask the child to put out his tongue and pant like a dog._*
🔴 *Dilemma : _Grand old man, Hard of hearing._*
🔵 *Trick : _Just place the ear piece of ur stethoscope in the patient's ear and speak into the diaphragm._*
🔴 *Panicky : _A neurotic patient is in panick n hyperventilating. She might faint cos of consequent low levels of CO2 in the blood._*
🔵 *Solution : _Ask the patient to breathe in and breath out of a plastic bag._*
🔴 *Adamant Child : _To auscultatate a Child refuses to take deep breaths._*
🔵 *Solution : _Ask him to blow hard on the hand kerchief held in front of his mouth. Auscultatate during and after the blowing act for clear n loud expiratory n inspiratory sounds._*
🔴 *Afraid : _Using the tip of needle to remove the foreign body in cornea._*
🔵 *Safer Option : _Take 20 no. Intracath, draw out the stilett n use its plastic tip to remove the body, this ll not harm the cornea._*
🔴 *Safe : _To remove foreign body from nose in a child._*
🔵 *Non invasive : _Instill nasivion nasal drops in the nostril which contains foreign body. Occluded the other nostril with ur finger, then at the kid to exhale through his nose forcefully, the foreign body ll ve pushed out by the blow of air._*
🔴 *Yes or No : _In case of small cut injury, to suture or not to suture !?._*
🔵 *Don't Suture : _Approximate the edges with ur fingers, apply Fevistick and bandage the wound firmly._*
🔴 *Refusal : _A scalp injury patient bleeding profusely refusing stitches to stop bleeding._*
🔵 *Simple : _Take a bunch of hairs on either side of the wound n tie them across the wound n refer to higher center._*
🔴 *Bleed : _Stopping a posterior nasal bleed. When the anterior nasal pack fails to control the bleeding, a posterior nasal pack is necessary, which requires GA in a hospital._*
🔵 *Try this : _Insert a Foley's catheter lubricated with Lignocaine through the bleeding nostril and inflate the balloon with water. The pressure ll stop the bleeding._*
*👨🏻⚕iFTHi🚘*
💉💊💉💊💉💊💉💊💉💊
[10/16, 11:40 PM] +91 86006 11004: *💞 Important Points To Remember In _Acute Coronary Syndrome : 💘_*
1.
*Chest Pain At Rest,*
⏬
*_ST Elevation,_*
⏬
_Cardiac Enzymes Normal._
⏸
*Prinzmetal Angina.*
🔻
_Treat with Nitrates and Calcium Channel Blockers._
⚠
_Remember, here Beta Blockers Contraindicated._
2.
*Chest Pain On Exertion,*
⏬
*_Relieved By Nitroglycerin,_*
⏬
_Usually Lasts A Short Time (5 Minutes Or Less)._
⏸
*Stable Angina.*
3.
*Chest Pain At Rest,*
⏬
*_ST Elevation,_*
⏬
_Cardiac Enzymes Elevated._
⏸
*STEMI.*
4.
*Chest Pain At Rest,*
⏬
*_No ST Elevation,_*
⏬
_Cardiac Enzymes Elevated._
⏸
*NSTEMI*
5.
*Chest Pain At Rest,*
⏬
*_No ST Elevation,_*
⏬
_Cardiac Enzymes Normal._
⏸
*Unstable Angina.*
✅ ✅ ✅
Unstable Angina,
NSTEMI,
STEMI.
🔽
*Aspirin,*
*P2Y12 Antagonists,*
*Nitrates.*
_(Given in all 3),_
After stabilised,
*ACEI,*
*Beta Blockers.*
✅
NSTEMI
🔽
*Need 30 mg i/v Enoxaprin or Heparin to prevent re stenosis.*
✅
STEMI.
🔽
*Reperfusion / Angioplasty.*
✅ ✅ ✅ ✅ ✅
Acute Management Of MI :
🔽
*MONA*
_(Morphine, Oxygen, Nitrates, Aspirin)._
👌🏻 👌🏻 👌🏻 👌🏻 👌🏻
👍🏻 *REMEMBER.*
🔽
⚠ Do Not Give,
*NITROGLYCERIN* In *_Inferior Wall MI With RV Infarction and or Hypotension_* ;
but
✔ *Give i/v fluids if patient is Hypotensive.*
👌🏻 👌🏻 👌🏻 👌🏻 👌🏻
👌🏻 *REMEMBER.*
🔽
✔ *DOOR-To-First ECG- Time :*
⏬
_Goal <10 Minutes._
👍🏻 👍🏻 👍🏻 👍🏻 👍🏻
👌🏻 *REMEMBER.*
🔽
*Door-To-Needle- Time :*
⏬
_Within 30 minutes (i.e time for Thrombolysis)._
👌🏻 👌🏻 👌🏻 👌🏻 👌🏻
👍🏻 *REMEMBER.*
🔽
*Door-To-Balloon-Time :*
⏬
_Within 90 minutes. (i.e time for PCI)._
👍🏻 👍🏻 👍🏻 👍🏻 👍🏻
👌🏻 *REMEMBER.*
🔽
*Most Common Cause Of Death After MI*
⏬
_Arrhythmias._
👌🏻 👌🏻 👌🏻 👌🏻 👌🏻
👍🏻 *REMEMBER.*
🔽
*New Murmur After MI With Lung Congestion.*
⏬
_MR Due To Rupture Or Dysfunction Of Papillary Muscle._
👍🏻 👍🏻 👍🏻 👍🏻 👍🏻
👌🏻 *REMEMBER.*
🔽
*New Murmur After MI With Step Up Oxygen Saturation On Right Ventricle.*
⏬
_Ventricular Septal Rupture._
👌🏻 👌🏻 👌🏻 👌🏻 👌🏻
👍🏻 *REMEMBER.*
🔽
*Pulseless Electrical Activity After MI With Raised JVP And Muffled Heart Sound.*
⏬
_Anterior Wall Rupture._
(Cardiac Temponade).
_👨🏻⚕iFTHi🚘_
[10/17, 6:22 AM] +91 98223 17755: 🌹🌹🌹🌹🌹🌹🌹🌹🌹🌹
May your Waist Hip ratio remains below 0.85. May your BMI remains less than 25. May your HbA1c never rise despite the sweets. May your Arteries remain nice and compliant. May we all continue to have the mood to walk or exercise all year. May our TSH remain less than 4. May our creaky bones be happy. May we get enough sun to Keep Vit D 25 level around 40. May your BP never rise above 120 /80. May your LDL never rise above 70 and HDL always remain above 50.
Happy Dipawali and Happy New Year from the the Depth of my Right & Left Ventricles Wrapped with the Ribbons of Purkinje Fibers and Sealed in Pericardial.
Decorated with SA and AV Nodes with a Glitter Topping of Pericardial Fluid and Cusps of Mitral and Tricuspid Valves.
HAPPY DIPAWALI AND HAPPY NEW YEAR TO YOU !!
🙏🙏🙏🙏🙏🙏
[10/17, 8:26 AM] +91 86006 11004: #Angina pectoris and its Unani Medicine Managment
Angina, also known as angina pectoris, is chest pain or pressure, usually due to not enough blood flow to the heart muscle.
Angina is usually due to obstruction or spasm of the coronary arteries. Other causes include anemia, abnormal heart rhythms, and heart failure. The main mechanism of coronary artery obstruction is an atherosclerosis. The term derives from the Latin angere ("to strangle") and pectus ("chest"), and can therefore be translated as "a strangling feeling in the chest".
There is a weak relationship between severity of pain and degree of oxygen deprivation in the heart muscle (i.e., there can be severe pain with little or no risk of a myocardial infarction (heart attack) and a heart attack can occur without pain). In some cases, angina can be quite severe, and in the early 20th century this was a known sign of impending death. However, given current medical therapies, the outlook has improved substantially. People with an average age of 62 years, who have moderate to severe degrees of angina (grading by classes II, III, and IV) have a 5-year survival rate of approximately 92%.
Worsening angina attacks, sudden-onset angina at rest, and angina lasting more than 15 minutes are symptoms of unstable angina (usually grouped with similar conditions as the acute coronary syndrome). As these may precede a heart attack, they require urgent medical attention and are, in general, treated in similar fashion to myocardial infarction.
#When does angina pectoris occur?
Angina often occurs when the heart muscle itself needs more blood than it is getting, for example, during times of physical activity or strong emotions. Severely narrowed arteries may allow enough blood to reach the heart when the demand for oxygen is low, such as when you're sitting. But, with physical exertion—like walking up a hill or climbing stairs—the heart works harder and needs more oxygen.
#Symptoms of Stable Angina - The pain or discomfort:
Occurs when the heart must work harder, usually during physical exertion
Doesn't come as a surprise, and episodes of pain tend to be alike
Usually lasts a short time (5 minutes or less)
Is relieved by rest or medicine
May feel like gas or indigestion
May feel like chest pain that spreads to the arms, back, or other areas. Use Unani Medicines For All Your Cardiac Disorders.Contact Your Unani physician Dr Mastaan M.D.(Unani)
Tuesday, 10 October 2017
स्टेम सेल्स: काही प्रतिदावे
Umbellical cord stem cell preservation scam
I Dr. Sagar Jawale a paediatric surgeon is doing stem cell research from last 2 years and I think that the Umbellical cord stem cell preservation is a scam for following reasons. Share this article as much as you can to create awareness in the people to bust the scam.
1) Umbellical cord has haemopoetic stem cells which are already present in the bone marrow of all children in abundance and 50 ml bone marrow can be easily taken out with gap of 3 months. For the stem cell therapy at least 50 ml bone marrow is necessary.Then what is the rational of preserving 5 ml blood of the umbellical cord?
2) The bank says that the cord blood can be stored for 25 years is a complete lie. Then why all other blood products are expired in just one month in the blood bank?
3) When all blood products are stored at 2-8 degree centrigrade, how can stem cells survive at minus 150 degrees centigrade? If life is possible at -150 degree centrigrade then why there is no life on moon and Mars where one side of the planet has minus 150 degrees centigrade?
4) Animals and people died in ice 50 years ago look as if they have died today. But that does not mean that they are alive.
5) The stem cells cryopreserved at -150 degree centrigrade are nothing but cryopreserved mummies and although the morphology is intact these cells are not alive by any chance and are not going to divide when defrosted.
6) The only legitimate stem cell therapy is cells freshly prepared and put back into the patient’s body within 24 hours.
7) Now we have the technology to take even adult cells and turn them embryonic called Induced pleuripotent stem cells. Dr. Shiyama Nakayama of Japan received a Nobel Prize for that discovery. These cells can be converted to any of 220 cell types. Then where is the need to preserve umbellical cord stem cells?
8) American association of Paediatrics is totally against the Umbellical cord stem cell preservation.
References:
https://parentsguidecordblood.org/en/news/umbilical-cord-blood-stem-cell-scams-theyre-pulling-your-cord
http://www.parents.com/pregnancy/my-baby/cord-blood-banking/the-cord-blood-controversy/
http://blog.drmalpani.com/2016/11/the-cord-blood-stem-cell-banking-scam.html
https://www.nbcnews.com/business/consumer/cord-blood-banking-n400561
https://beta.theglobeandmail.com/life/health-and-fitness/why-banking-on-cord-blood-isnt-necessarily-a-good-idea/article4209835/?ref=http://www.theglobeandmail.com&
Monday, 2 October 2017
Such storage @ fingertip & too on web is good use of net
Yes friends ...broadly speaking..
1)Wbc & Neutrophil count is increased in *acute bacterial infection*.
2)Wbc,Lymphocytes & Platelet count is decreased in *Acute viral infection*
3)Wbc count is decreased & platelet count is markably reduced in *Dengue fever*
4)Decreased Hb,Wbc& platelets found in *malerial fever*
5)Decreased Wbc count & relative increase in lymphocyte count found in *typhoid fever*
6)Wbc count may be normal or decreased & platelets decreased in *Rickettial fever*
Thank u🙏
काही परंपरा
आईं तुळजाभवानी माताचा पलंग कोठून येतो पहा 👏🏻👏🏻
आईं तुळजाभवानी महाराष्ट्रातील साडेतीन शक्तिपीठांत तुळजाभवानीचे स्थान अतिशय वेगळे असून मंदिरातील वेगवेगळ्या प्रथा-परंपरा पाहिल्यास शेकडो वर्षांपासून चालत आलेले रीतीरिवाज आजही कायम आहेत. दळणवळणाची कुठलीही साधने उपलब्ध नसताना पूर्वीच्या काळी देवीच्या मानकऱ्यांनी किती कष्ट घेतले असतील याची कल्पना करू शकत नाही. पलंग, पालखी, बुधलीवाले, भुते, माया प्रताप, बोंबले यासारखी मंडळी नगर, पुणे, नाशिक, सोलापूर यांसारख्या दूरदूरच्या भागातून येऊन आपल्या सेवा आजही अखंडपणे बजावत असतात. विशेष म्हणजे सर्वांची जगन्माता आई तुळजाभवानी ज्या पालखीत बसून मिरवते व ज्या पलंगावर निद्रा घेते ते तयार करणारे हात एवढे छोटे आहेत की सर्वसामान्यांना काय पण मंदिर प्रशासनालाही त्यांच्या नावाची साधी कल्पनाही नाही. त्याचे कारण म्हणजे सेवा बजावण्याच्या मानपानातील असणारी गुंतागुंत.
तसे पाहिले तर देवाचा पलंग असो की पालखी या दोन्ही धार्मिकदृष्ट्या पवित्र असल्याने आपण कुठल्याही मंदिरात गेलो तर वापर झाल्यानंतर त्या वस्तू मंदिरातच कुठे तरी व्यवस्थितपणे सांभाळून ठेवून पुन्हा त्याचा वापर केला जातो. याच्या उलट तुळजाभवानी मंदिरातील पलंग आणि पालखीचे वैशिष्ट्य म्हणजे या दोन्ही वस्तू एकदा वापर झाल्या की त्या सन्मानपूर्वक तोडून होमात टाकून जाळून टाकल्या जातात.
तसे पाहता श्रीतुळजाभवानीच्या सर्वच प्रथा आणि परंपरा इतर देवस्थानांपेक्षा अतिशय भिन्न आहेत. कारण हिंदू धर्मात तुळजाभवानीच्या मूर्तीशिवाय इतर कुठलीही मूर्ती नसेल जी प्रत्यक्षपणे काढून मूळ मूर्तीलाच पालखीत ठेवून मंदिराभोवती प्रदक्षिणा घातली जाते. शिवाय वर्षातून तीन वेळा मूळ मूर्तीला सिंहासनावरून काढून पलंगावर झोपविले जाते. तुळजाभवानीचे आणखी एक वैशिष्ट्य म्हणजे तुळजापूरमध्ये तेलाचा घाणा चालवायला पूर्वापार परवानगी नाही. मात्र याच तुळजाभवानीला लागणारा पलंग आणि पालखी घेऊन येण्याचा मान नगर जिल्ह्यातील तेल्याचा आहे.
आपण तुळजाभवानी मंदिरातील मुख्य गाभाऱ्यात गेल्यानंतर उजव्या हाताला एका ओवरीत देवीचा पलंग दिसतो. त्या पलंगावर देवीची मूळ मूर्ती काढून भाद्रपद वद्य अष्टमी ते अमावास्या, अश्विन शुद्ध एकादशी ते पौर्णिमा व पौष शुद्ध प्रतिपदा ते अष्टमीपर्यंत झोपविली जाते. याला देवीची ' घोर निद्रा,' ' श्रमनिद्रा ' व ' भोगनिद्रा ', म्हटले जाते. तत्पूर्वी सीमोल्लंघनासाठी हीच मूर्ती पालखीत ठेवून मुख्य मंदिराभोवती मिरविली जाते. विशेष म्हणजे पालखी सीमोल्लंघनानंतर लगेचच तोडून होमात टाकली जाते. तर दसऱ्यानंतरच्या पौर्णिमेदिवशी जुना पलंग होमात टाकून नवा पलंग ठेवला जातो. तुळजापुरातील मराठा समाजातील एका घराण्याकडे या पलंगाची सेवा करण्याची परंपरा असल्याने त्याचे आडनाव 'पलंगे' पडले आहे. पलंग व पालखी या दोन्ही वस्तू देवीसाठी महत्त्वाच्या असल्या तरी त्या आणण्याचा मान हा अहमदनगरच्या तेली समाजाचा आहे. यातही पुन्हा वेगळेपण म्हणजे तेली मानकरी असले तरी त्या वस्तू वेगवेगळ्या जागी तयार होऊन कशाप्रकारे तुळजापूरपर्यंत पोचतात हा सर्व प्रवासच अनोखा आहे .
तुळजाभवानी देवीचा पलंग घेऊन येण्याचा मान परंपरेने अहमदनगर शहरातील तेली समाजातील पलंगे घराण्याला आहे. सध्या बाबूराव अंबादास पलंगे याचे मुख्य मानकरी असून नगर शहरातील तुळजाभवानी मंदिराचे ते पुजारी आहेत. तुळजापूरप्रमाणे इथेही भाविकांची मोठ्या प्रमाणावर गर्दी होत असते. देवीचा पलंग तुळजापूरला घेऊन येण्याचा मान भलेही पलंगे घराण्याला असला तरी तो तयार करण्यासाठी राबणारे हात दुसरेच आहेत. प्रत्यक्षात देवीचा पलंग तयार करण्याचे काम पुणे जिल्ह्यातील घोडेगाव येथील ठाकूर घराणे परंपरेने करते. श्रद्धापूर्वक पलंग तयार करून दिल्यानंतर पुन्हा ठाकूर यांचे काम संपले. बिचाऱ्यांना तुळजापुरात आल्यानंतर त्या पलंगापर्यंत जायचे म्हटले तर त्यांना परवानगी नाही. कारण पलंग तयार केल्यानंतर तो नगरच्या पलंगे नावाच्या तेली समाजातील मानकऱ्याच्या ताब्यात देतो. तेथून तो तुळजापूरच्या दिशेने रवाना होतो.
घोडेगावावरून वाजत-गाजत पलंगाचा प्रवास महिनाभर सुरू असतो. या दरम्यान तो जुन्नर, नारायणगाव, आळेफाटा, पारनेरमार्गे नगरपर्यंत प्रवास करत असतो. अगदी घटस्थापनेच्या दिवशी पलंग अहमदनगरमधील तुळजाभवानी मंदिरात दाखल होतो. दोन दिवस मुक्काम केल्यानंतर तिसऱ्या माळेला तो नगरजवळील भिंगारच्या मंदिराकडे प्रस्थान करतो.
याचवेळी राहुरी येथे तयार झालेली देवीची पालखी भिंगारमध्ये दाखल होते. अतिशय नयनरम्य सोहळ्यात तेथे पलंग आणि पालखीच्या भेटीचा सोहळा संपन्न होतो. तेथून पुढे तुळजापूरला पलंग घेऊन जाण्यासाठी नगर जिल्ह्यातील खुंटेफळ, चिंचोडी पाटील, सय्यदपीर आणि कुंडी या चार गावचे लोक मानकरी म्हणून सोबत असतात. अशारीतीने नगर, भिंगार, जामखेड, आष्टी, भूम, चिलवडी, आपसिंगामार्गे दसऱ्याच्या आदल्यादिवशी तुळजापुरात दाखल होतो.
ज्याप्रमाणे तुळाजाभवानीची मूळ मूर्ती काढून पलंगावर झोपवली जाते त्याचप्रमाणे दरवर्षी सीमोल्लंघन खेळण्याकरिता मूर्तीला पालखीतून मुख्य मंदिर परिसरातून प्रदक्षिणा काढून मिरवले जाते. ही पालखी आणण्याचा मान अहमदनगर शहरालगत असणाऱ्या भिंगार ( बुऱ्हानगर ) गावातील भगत नावाच्या एका तेली घराण्याकडे आहे. पलंगाप्रमाणे पालखी तयार करण्याची कथाही काही वेगळीच आहे. त्यानुसार तुळजाभवानीच्या दरबारात पालखी आणून ती मिरविण्याचा मान जरी भिंगारच्या तेली घराण्याला असला तरी प्रत्यक्षात वेगळ्या ठिकाणी तयार होते. पालखीच्या तयारीची कथाही फारच आगळी आहे.
फार पूर्वी तुळजाभवानीची पालखी नगरजवळील हिंगणगावला तयार व्हायची. पुढे अहिल्यादेवी होळकरांच्या घोगरे नावाच्या सरदारांनी पालखी तयार करण्याचा मान स्वत:कडे घेऊन आपले जहागिरीचे ठिकाण असणाऱ्या राहुरीत ती तयार करण्याची प्रथा सुरू केली. पालखीच्या तयारीतही फारच मानकरी आहेत. त्यानुसार दरवर्षी भाद्रपद प्रतिपदेला पालखीसाठी लागणारे लाकूड राहुरीच्या म्हेत्रे म्हणजे माळी घराण्याकडून येते. कदमांकडून पालखीसाठीचे उभे लाकूड ज्याला शिपाई म्हटले जाते तेच फक्त देण्यात येते. पालखीच्या खालच्या बाजूला बोरीचे लाकूड तर इतर लाकूड पूर्णपणे सागवानाचे असते. ते राहुरीतील पटेल सौमीलवाले द्यायला लागले. खांद्यासाठीचा मोठा दांडा असतो तो जुनाट वापरला जातो. पालखीचे लाकूड मिळाल्यानंतर ती तयार करण्याचा मान राहुरीतील कै. उमाकांत सुतारांच्या घराण्याला आहे.
या वेळी लाकडाची कतई करण्याचे काम धनगर समाजातील भांड घराणे करते. तर लोहाराचे रणसिंग घराणे खिळेपट्टी करते. अशा रीतीने पालखी तयार झाली की तिची सुताराकडून विधिवत् पूजा करून तेली समाजातील धोत्रे घराणे पालखीला राहुरीतील तुळजाभवानी मंदिरात घेऊन जातात. या वेळी दिवे कुंभार पुरवितो तर तेली तेल देतो. खाली घोंगडी अंथरण्याचे काम धनगर करतो. राहुरीतील तुळजाभवानी मंदिराकरिता धोंडी घोगरे यांनी स्वत:ची जागा दान केलेली आहे. देवीचे पूजारीपण धोत्रे नावाच्या तेल्याकडे आहे. भाद्रपद पौर्णिमेला पालखी नगरजवळील भिंगार गावाकडे रवाना होते. ती नदीपार करून देण्याचा मान कोळी समाजाला आहे. या वेळी ढोर आणि चांभार समाज मशाल धरतात. सुपा, पारनेर, हिंगणगाव, नगरमार्गे ४० गावांतून तिसऱ्या माळेला पालखी भिंगारगावात दाखल होते.
त्या ठिकाणी घोडेगावावरून बनविण्यात आलेला पलंग दाखल होतो. घटस्थापनेच्या तिसऱ्या दिवशी भिंगारमध्ये पलंग-पालखीची अभूतपूर्व भेट झाल्यानंतर ते दोघे तुळजापूरच्या दिशेने रवाना होतात. जामखेड, आष्टी, भूम, चिलवडी, अपसिंगामार्गे सतत २४ तास पलंगाचा प्रवास पूर्ण होऊन दसऱ्याच्या दिवशी संध्याकाळी पलंग तुळजापुरात दाखल होतो. पूर्वी पालखीही याच पद्धतीने यायची, मात्र अलीकडे ती गाडीतून थेट दाखल होते. पलंग आणि पालखी टेकविण्याकरिता तुळजापुरातील शुक्रवार पेठेत स्वतंत्र ओट्याची व्यवस्था केलेली आहे.
रात्री उशिरा पलंग आणि पालखीची गावातून स्वतंत्रपणे मिरवणूक निघते. अगदी पहाटेच्या सुमारास पलंग आणि पालखी तुळजाभवानी मंदिरात दाखल होतात. देवीचे सीमोल्लंघन हे दसऱ्याच्या दुसऱ्या दिवशी पहाटे सूर्योदयाबरोबर होत असल्याने मंदिरात प्रचंड गर्दी होत असते. याच वेळी मंदिरातील भोपे पुजारी देवीला १०८ साड्यांचे वेश्टण गुंडाळून पालखीत ठेवतात. तेव्हा बार्शी तालुक्यातील आगळगाव व गोमाळ्याचे लोक पालखीला खांदा देऊन अगदी पाच मिनिटांत मुख्य मंदिराला प्रदक्षिणा घालतात तेव्हा अपसिंग्याचा डांगे देवीवर छत्री धरतो. माया मोर्तबचा मुखवटा कर्गनचा क्षीरसागर तेली, कर्जतचा सुतार, दिवटी घेऊन देवीपुढे चालतात. तर राहुरीचे मुसलमान पलंगाच्या पुढे वाजवत तो मुख्य मंदिरापुढे आणून ठेवतात.
देवीची एक प्रदक्षिणा पूर्ण झाल्यानंतर पालखीतून उचलून देवीला पलंगावर झोपविण्यात येते. तेव्हा हा पलंग देवीच्या मुख्य गाभाऱ्यात ठेवण्यात येतो. पालखीची मिरवणूक झाली की अगदी विधिपूर्वक त्याचे वरचे दांड काढून पालखी मोडून होमात टाकली जाते. तर पुढील पौर्णिमेपर्यंत म्हणजे ४ दिवस पलंगावर झोपल्यानंतर पुन्हा देवीजीची सिंहासनावर प्रतिष्ठापना झाल्यानंतर पौर्णिमेला पलंग तोडून तोही होमात टाकून नष्ट केला जातो. अगदी सन्मानपूर्वक पलंग आणि पालखीचा प्रवास पुणे आणि नगर जिल्ह्यात सुरू होऊन मंदिरात समाप्त होतो. फक्त देवीची सेवा म्हणून नि:शुल्कपणे नगर आणि भिंगारचे तेली देवीच्या चरणी आपली चाकरी अखंडपणे पुढे चालवत आहेत.
आई राजा उधे उधे .... सदानंदीचा उधे उधे .....
बोल भवानी माता की जय ......👏🏻👏🏻👏🏻👏🏻
Friday, 22 September 2017
मूत्र तपासण्या. Details about urine examination
[9/22, 7:36 PM] Dr Nimbalkar Manoj: *Urine Examination*
Urine examination is useful to detect diseases affecting the kidneys. It may reveal diseases that would have gone unnoticed due to absence of striking signs and symptoms such as diabetes mellitus, glomerulonephritis and urinary tract infections. Urine analysis is a part of routine evaluation of a child suspected to have renal disease. Gross Inspection of the urine, dipstick analysis and microscopic examination are essential for a complete urine analysis.
*METHODS OF URINE COLLECTION:*
Ideally clean- catch midstream urine specimen should be collected after cleaning the external urethral meatus with soap & water. Urinary catheterization is required only in special situations such as in comatose or confused patients. In newborns and infants, urine can be collected with help of a urine bag or by suprapubic transabdominal bladder aspiration. To determine specific gravity, urine should be collected after a period of water deprivation such as an early morning sample before ingestion of any fluid. Specific gravity > 1.022 in a randomly collected specimen denotes adequate renal concentrating capacity as long as there are no abnormal solutes in the urine.
*MACROSCOPIC EXAMINATION OF THE URINE:*
Normally urine is pale to dark yellow or clear in color. Turbid or cloudy urine may be due to excessive cellular debris or proteins and may be seen in chyluria and UTI. Red colored urine may be seen after ingestion of a food dye, eating fresh beet, drugs such as NSAIDS or presence of hemoglobin or myoglobin. Cola colored urine is suggestive of a renal bleed such as in the nephron and is seen in glomerulonephritis.
*DIPSTICK ANALYSIS OF URINE:*
Dipsticks are available to qualitate and quantitate the presence of proteins, glucose, ketones, bacteria, pus cells and occult blood in urine. Multistix combines the tests for proteinuria, glycosuria, hematuria & detection of nitrites. pH reading through dipstick is not very accurate.
*Proteinuria:*
Dipstick methods are reliable and easy to perform. Dipstick screening should be done on whole urine but semi- quantitative tests should be done on the supernatant of centrifuged urine since the cells suspended in normal urine can produce a falsely high estimation of protein . These reagent strips are impregnated with a dye. Proteins bind with the dye and color change occurs. These dipsticks are most sensitive to albumin and detect globulins and Bence Jones proteins poorly. False positive may occur if there is delay in reading the strip. Chemical analysis with 3% sulphosalicylic acid is a very sensitive precipitation test. It can detect albumin and even globulins & Bence Jones proteins at very low concentrations.
Trace proteinuria = 10mg/dl
1+ proteinuria = 30mg/dl
2+ proteinuria =100mg/dl
3+ proteinuria =300mg/dl
4+ proteinuria = 1gm/ dl
*Glycosuria:*
Glycosuria is generally suggestive of diabetes mellitus. Dipsticks utilizing glucose oxidase reaction are specific for glucose and do not detect other reducing sugars such as galactose and fructose. Clinitest, a modified Benedict's copper reduction test is used to detect reducing substances in newborn and infant urines. False negative glycosuria may be seen with Vitamin C , tetracyclines or homogentistic acid.
*Hematuria:*
Hematuria is presence of occult blood in urine due to glomerular damage, tumors, kidney trauma, urinary stones, acute tubular necrosis, UTI and nephrotoxins. Dipsticks to detect occult blood are sensitive to any heme group and may suggest presence of either intact RBCS, hemoglobin or myoglobin. An urine examination positive by hemostix should be examined microscopically to confirm the presence of RBCs. If no RBCS are seen, hemoglobinuria can be differentiated from myoglobin by immunodiffusion techniques.
*Ketones:*
Ketones in urine may be seen in diabetic ketoacidosis or starvation. They are detected by dipsticks or tablets containing sodium nitroprusside.
*Nitrites:*
More than 90% of common urinary pathogens (Gram negative rods) are nitrite-producing bacteria. In the presence of infection urinary nitrate is converted to nitrite, which can be detected in urine using a test strip.
*Leukocyte esterase test:*
A positive test is seen in presence of WBCs in urine and suggestive of pyuria.
*URINE pH:*
The glomerular filtrate is usually acidified by renal tubules and collective ducts. The pH of urine normally ranges from 4.5 to 7.5. Urine pH should be measured with a pH meter on a freshly voided urine sample as on standing diffusional loss of CO2 or bacterial contamination may occur changing the pH value. Urine pH is important for diagnosis of RTA.
*URINE SPECIFIC GRAVITY & OSMOLALITY:*
Specific gravity determines the ability of the kidney to concentrate or dilute urine. It is precisely measured with the help of a refractometer. Normal specific gravity of a urine ranges from 1.001 to 1.030. It is necessary in diagnosis of renal or nephrogenic Diabetes Insipidus and Psychogenic DI. Normally, Osmolality of urine is between 40 to 1200mosm/kg.
Osmolality = ( Specific gravity -1.000) x 40,000.
*MICROSCOPIC EXAMINATION OF URINE:*
Fresh-centrifuged sample should be examined microscopically for presence of WBCs & RBCs. Centrifuged sediment should be examined to identify crystals, casts, and squamous cells. If microscopy is delayed, the specimen should be refrigerated at + 40C to prevent bacterial overgrowth and dissolution of cells and casts.
*Red Blood Cells:* >5RBC/cu mm in a HPF in 10ml of centrifuged sample is considered abnormal. Once hematuria is established, it is important to determine the source of bleeding. RBC casts, dysmorphic crenated RBCs suggest glomerular bleed whereas normal RBC morphology suggests lower urinary tract bleed.
*White Blood Cells:* > 10 WBC/cu mm for body and > 50 WBC/cu mm for girls is abnormal and suggestive of pyuria that is seen in UTI or with acute glomerulonephritis.
*Epithelial Cells:* They arise from renal tubules and transitional cells arise from renal pelvis, ureter or bladder & squamous epithelial cells arise from outer urethra or skin surface. Increased renal tubular epithelial cells are seen in nephrotic syndrome and tubular degeneration.
*Casts:* They are solid and cylindrical structures formed by precipitation of debris in the renal tubules. Urinary casts are formed only in the distal convoluted tubule or the collecting duct. Hyaline casts are composed primarily of Tamm-Horsfall proteins. Hyaline casts are seen in healthy individuals. RBC casts are formed when RBCs stick together and are seen in glomerular disease. WBC casts are seen in acute pyelonephritis and glomerulonephritis & denote inflammation of the kidneys. Granular and waxy casts are derived from renal tubular cell casts and are seen in Nephrotic Syndrome and tubular damage.
*Crystals:* Common crystals seen even in healthy individuals are calcium oxalate, triple phosphate crystals and amorphous phosphates. They may also be seen in renal stones. Abnormal crystals seen are cystine crystals in congenital cystinuria, tyrosine crystals in congenital tyrosinosis and leucine crystals in severe liver disease or maple syrup urine disease.
*Bacteria:* Diagnosis is established with urine culture. A colony count of >105/ml of one organism signifies significant bacteruria. Multiple organisms reflect contamination.
*Yeast:* It may be a contaminant. Budding yeast suggest a true candidal infection.
[9/22, 7:36 PM] Dr Nimbalkar Manoj: *Some Classical urine pictures in various kidney disease*
*Urine in Nephrotic Syndrome:*
Colour - Yellow Appearance - Cloudy Proteins = 4+
Blood = -ve
WBC = -ve
Casts = Waxy casts
Other = Oval fat bodies
occasional
*24 hours urine albumin >40mg/kg/day.*
*Urine in Acute Glomerulonephritis:*
Colour = Cola Coloured
Blood = ++++
Proteins = ++
WBC/hpf = 3-4/hpf
RBC/hpf = 150-200/hpf
Casts = RBC casts
*Urine in Urinary Tract Infections:*
Colour = Yellow
Appearance = Turbid
Leukocyte Esterase = 3+
Nitrite = +ve
WBC/hpf = >50/hpf
RBC/hpf = 5-10/hpf
Casts = WBC casts
Urine culture = >10^5 bacteria/ml.