Powdered Collagen

What is collagen? A protein.
http://en.wikipedia.org/wiki/Collagen

Powdered collagen sources:
http://www.saveonnutrition.com/product_info.php?products_id=40
http://www.ehow.com/facts_5913903_benefits-collagen-powder-drink_.html
http://wellers.ocnk.net/product/36?gclid=COuqy-iDz7UCFcV66wod5CsAVQ

http://gz-lk.en.alibaba.com/Food_Supplement_100_Pure_Fish_Collagen_powder.html
http://www.healthsuperstore.com/p-neocell-laboratories-super-collagen-plus-c-powder.htm


Malay text
http://produk-afdhal.blogspot.com/2010/12/mengapa-perlu-makan-kapsul-apricot.html

Uses of collagen:

1. Less knee pain
2. Less wrinkles
3. Firm breasts, cheeks, thighs, biceps, etc
4. Less hair loss
5. Dark hair, good hair mass
6. White hair will not increase in number
7. Less asthmatic
8. Less sinus problems
9. Less sneezing in the morning
10. Less hunger

Consuming powdered collagen:

1. Choose unflavoured collagen from fish source (bones, scales), from halal manufacturers & retailers
2. Need only a small amount daily (1 teaspoon is enough)
3. Take with vitamin C tablet
4. Mix with favourite drink (fruit juice - Yes; goat's milk - Yes; cow's milk - No)
5. If taking with goat's milk, add a bit of honey for better taste
6. Consume warm (cool - No; hot - No; cold - No; with ice - No; as milkshake - No)
7. Take daily in the morning at beginning for 2 weeks (then take less frequently, for maintenance)
8. Discard unfinished prepared collagen drink (it will taste horrible)

Human Milk Bank

Providing milk to newborn is not a problem for mothers who are able to express milk for their babies. However, there are many mothers who don't have milk on the day their babies are born. What can they do? Nurses and doctors often bug the tired mothers to try and breastfeed despite everything, and the mothers suffer from cracked nipples when the newborn tries to suck despite nil milk flow. What does all this come to? Nothing but a lot of unhappiness. What can we do to help? A lot of things if we only stop to learn.

Some places have come up with human milk banks. This is fine with non Muslims. For Muslim babies, mothers and families, this is a No! No!. Why? Because there is a statement about what happens when a lactating mother decides to breastfeed a baby which is not hers. There are rules about being a wet nurse. Also, there are the issues of relationships and what is lawful/unlawful when a baby that was nursed by someone from outside the family circle.

Why are there strict rules about breastfeeding babies who have no blood relations to the babies they nursed? Scientists don't know. Western doctors don't know what happens. Muslim doctors would know because they have been taught what happens when you breastfeed a baby that is not yours.

Let us study the issues re breastfeeding. I have written the following issues as a Muslim mother because there is no medical text that explains this in detail.

1. Muslim mothers breastfeed their newborns for 2 years (24 months) or until a time that's to be decided by the baby's parents. Breastfeeding is a mutual affair; the father must know.
2. Many mothers don't know how to breastfeed properly and run out of milk before the 2 years are up. Why? They never learnt it properly nor do it correctly.
3. When a mother has little milk or can't breastfeed her own newborn, she can hire a wet nurse to breastfeed her newborn but there are issues. These issues concern the fed baby's relationship with the wet nurse and her children. When a wet nurse takes and breastfeed a baby, that babies "becomes her child". She can salam the child any time, even as an adult. The baby is immune and not foreign to her family members. This means, the baby when it grows up and become an adult, he/she can mix around with the wet nurse and her children without worrying about the issues of haram and aurat.
4. A mother who fails to breastfeed her newborn is still a mother to her newborn. She is defective only in breastfeeding. She has played her role as a mother. However, the newborn/baby who has never been breastfed suffers from a lot of problems, mainly respiratory conditions for lack of antibodies. Breastfeeding is meant to transfer the mother's antibodies to the newborn baby so that it builds its own immunity. So babies who are not breastfed suffer from poor health due to respiratory conditions - this is bad for the baby.
5. Some mother refused to breastfeed their own infants because they think their breasts will sag and never return to being spongy and nice again.
6. Ustaz has said that breastmilk from the Human Milk Bank is haram for Muslim babies as the milk is pooled and we don't know the exact source of the milk for the needy baby.
7. Muslim mothers must prepare and make their own arrangements if they want a wet nurse to nurse their newborns. The wet nurse must be known to all parties concerned so everybody knows who are those who can legally become like sibs to the nursed infant when he becomes an adult. Children who are nurse together cannot marry each other because they are now considered like sibs even though they are not genetically related. Nurses and doctors must take note that if they are giving pooled milk from the Human Milk Bank to babies under their care, they must also inform the parents or stop it altogether as it is an offence to give pooled human milk to Muslim babies. 
8. In today's Human Milk Bank programs, the mother remains anonymous and the recipient baby also remains anonymous. This is not right in Islam and for Muslims. 
9. Babies who are nursed together by the same wet nurse cannot marry as they are considered as sibs. Sibs cannot marry each other as this is incest! Incest is not allowed in any religion.
10. Western doctors and nurses do not understand the issues of wet nurse in modern medicine and therefore are not in a position to advise their patients. They will need to learn from the Muslim doctors and wet nurses so they understand the issues and know how to advise their patients accordingly. We have so many genetic disorders today and yet we choose to overlook the problems and issues re infant breastfeeding. That's why we have many children and adults today who have social behaviour problems. 
11. We should not have a pooled Human Milk Bank if the donor name & contact remain anonymous to the recipient baby, whose parents also don't know the milk donor at all. Would you ever give milk to your own baby if you obtained milk from someone you don't know? Nobody in the right frame of mind would agree to an anonymous milk source. Being anonymous means you cannot find out and will never ever know and therefore run the risk of not being helped if something goes wrong with the milk provided or the baby's development is not up to your expectation. You cannot sue an anonymous person or the hospital that provided you with the anonymous breastmilk.
12. Why remain anonymous if you wish to be a wet nurse? It is a noble job to breastfeed a baby. The real issue is why must we make the milk source anonymous? Why have people in charge of the Human Milk Bank chose to make the donor anonymous? Can Chinese breastmilk be given to a white infant? Can an Indian baby consume breastmilk from a Norwegian woman? Can a Jewish newborn receive breastmilk from a Muslim mother? Who can decide on these issues? These are hard issues but they are real.
13. What if the mother is a non Muslim and has just taken pork and then expressed her milk for the milk bank? And then you take her milk for your Muslim baby? Is this ok in Islam? No, I don't think so. What if she decides to drink and then donate her breastmilk? Still, I think her breastmilk is not fit for a Muslim newborn; it will take 40 days for the body to clear the alcoholic residues from a drinker's blood circulation.

KEMH PREM Bank

http://www.kemh.health.wa.gov.au/services/PREM_Bank/index.htm

IVF and Preterm Birth

I found WIRF news (Issue 04 Dec 2012) on my coffee table after breakfast and decided to read it. My husband said he picked it up when we visited the King Edward Memorial Hospital for Women on 13 February 2013.

King Edward Memorial Hospital
374 Bagot Road
Subiaco, WA 6008
Web: http://www.kemh.health.wa.gov.au/

Women and Infants Research Foundation
Carson House
King Edward Memorial Hospital
374 Bagot Road
Subiaco, WA 6008
Tel: 08-9340 1437
Fax: 08-9340 1642
Email: info@wirf.com.au
Web: www.wirf.com.au
Facebook: Women-and-Infants-Research-Foundation

IVF

The front page of this research brochure is interesting - What are the long-term consequences of IVF? It says here that in Australia, 1 in 25 children is born via IVF. This to me is very high. Why? What are the reasons for Australians to decide on IVF?

IVF was invented not too long ago. Here it says, the IVF Cohort Study will study the long-term effects of IVF. Data for this comes from the Raine Study cohort, which is one of the largest and most successful longitudinal pregnancy cohorts in the world. It is also recognised to be representative of the WA (Western Australia) population. What are the details of the Raine Study Cohort?

The Raine Study Cohort
Start date: 23 years ago, in 1989
Sample size, n = 2900 pregnant women
Time of recruitment of subjects: at 18 weeks pregnancy
Pregnancy outcome: 2968 children were born
Cohort studies: 10
Aim: To study growth and development (metabolic, respiratory, psychological, immunological, and reproductive) of children born via IVF treatment.

PRETERM

The preterm birth is due to infection of the uterus. Past antibiotic treatment have failed to work. Now there is a new antibiotic that is effective against a type of bacteria called the Ureaplasma. They use discarded human placenta for research. I'm not too sure whether they mean the Klebsiella  or other bacteria. I know Klebsiella is difficult to get rid off.

I am aware that non Muslims do not wash clean their private areas after they pee but only wipe dry with tissue/roll. I wonder whether this is a cause of possible uterine infection in pregnant mothers. I don't know if the doctors and hospitals can advise their patients to wash their private parts with soap and water and then dry down with tissue/roll, in order to reduce possible uterine infection. I don't know whether Muslim mothers have a problem of this nature (uterine infections) or have preterms.

The back page of the brochure shows 2 pictures of preterm babies - one with small foot (smaller than the palm) and another with a shrinkled face. It seems to me that there must be a reason or a causative factor for these preterm and small babies to look the way they do. I wonder if it is the alcoholic beverages (wines and beers) and cigarettes that are also playing a role in these unusual features seen in preterms.

In the Muslim context, the pregnant mothers don't consume any alcoholic beverages nor smoke. They would therefore form the best Control group. Whether they do have preterm, I would say yes, but maybe not due to alcohol or smoke. My guess is they may consume traditional mixtures or potions which may have a direct effect on embryology and development, and the final features of the babies.

I am more concerned about the Down Syndrome babies born to Malay mothers in Kelantan and overall in Malaysia. There are so many of these Down's babies today in Kelantan - it seems like every family has a Down's child. I wonder what is the actual cause in the Malay society.

Neuroscience blog

http://thewayyouwearyourhead.blogspot.com/

Amenorrhea

What is amenorrhea?

Etymology

Amenorrhea comes from the Greek words, a, men, not month, and rhoia, to flow. 

Definition

Amenorrhea simply means there is no menses, no period, or the period did not flow for a particular month or duration, etc. The first menses did not occur at an expected age, ie at puberty. Females attain puberty at age 12. But many girls today menstruate earlier, at between age 9 and 13. Some girls menstruate later, at age 15. Some girls and ladies don't have any menses (no periods).

Free Dictionary

http://medical-dictionary.thefreedictionary.com/amenorrhea

What's the problem?

Amenorrhea can occur in many cases. It can occur in female athletes, unmarried girls and married women. There are reasons for amenorrhea to occur. We have to find out why. Amenorrhea affects fertility as it causes infertility. It means females with amenorrhea can't be pregnant and can't have babies in the normal way. It creates a big problem if newly weds want to have a child. Something has to be done about amenorrhea.

How do we know what is what? What can we do to find out?

Check at the nearest clinic. Have a pregnancy test. Have a pelvic examination. Have an ultrasound of the pelvic region. Have a fertility test. Have a genetic test.

Fertility test

This is a panel of hormonal tests performed by the Endocrinology Laboratory at Hospital Universiti Sains Malaysia (HUSM). We call the place the Endocrine Lab for short. The Endocrine Lab is headed by Encik Fadhil. He showed me around and helped with the test requisition form.

The test requisition form must be filled in by the doctor and sent to the Endocrine Lab together with the blood specimen tube. The Endocrine Lab processes the blood to obtain serum. 

The fertility test is a list of many hormone tests. A single hormone test will require 2 ml of serum (non fasting).  A battery of fertility tests requires 5 ml of serum (no fasting is required).

Technically, each test requires 1.5 microlitres serum + 50 microlitres serum for dead space. Thus technically, 52 microlitres serum should suffice for a hormone test on the Cobas series analyzers. The hormone tests on the Cobas e 601 analyzer are immunoassays.

In the Endocrine Lab at HUSM, serum is analysed in the Roche Hitachi Cobas 6000 and Cobas e 601 analyzer system. The turnaround time for the fertility test is 1 week. This means patients can expect to get their fertility test results in 1 week's time. 

 ENDOCRINE LAB, HUSM

Fertility test requisition form, Endocrine Lab, HUSM. 19 Feb 2013
This is the old form. The units used now are expressed differently.

Screencapture. New units are now used on the requisition form.

Roche Hitachi Cobas analyzer system, Endocrine Lab, HUSM. 19 Feb 2013

Cobas 6000 (left module) and Cobas e 601 (right module), Endocrine Lab, HUSM. 19 Feb 2013

Roche Diagnostics

roche-diagnostics-cobas-6000-analyzer-series
http://www.roche.com/index.htm
pregnancy tests

CASE STUDY

A Young Woman Without Menses

Trigger 1

A 20-year old Malay female had normal developmental milestones. However, unlike her mother and elder sister, she never attained menarche. Her mother attained menarche at age 13 while her sister had hers at age 12. She had completed high school and also obtained a diploma from a private institution. Despite not having any menses, she recently got married to a working man and had sex as part of their marriage (consummated). Now that her marriage is "complete", she wants to have children. However, she is worried about not having any menses at all. So she headed to the nearest family clinic at the hospital in town.


Trigger 2

She complained of never having menses.

On general examination, she looked good and fine. She was tall and slim (height 156 cm, weight 52 kg, BMI 21.4 kg/m2). Her secondary sexual characteristics were well-developed. She had no galactorrhoea.

She had no history of headache, nausea, vomiting, visual disturbance, abdominal pain, and vaginal discomfort before/during/after sex (dyspareunia). She denied having any pain in the vaginal tube.

She was not on any medication or drugs. She did not take any traditional herbal preparation (makjun or herba Melayu). She was social but had never taken any contraceptive.

Examination of the cardiovascular, respiratory and central nervous systems were unremarkable.

Palpation of the abdomen did not reveal any mass. She did not feel any mass in her abdomen either.

She was not involved in strenuous exercise routine, athletic activities or dietary restriction.

Pelvic examination revealed a normal vulva but a short vagina. The cervix and uterus were not palpable.

The doctor ordered a battery of tests to investigate the patient's condition.

A 2-ml blood specimen was sent to the Genetics Centre for chromosome check (Karyotyping).

A 5-ml blood specimen was obtained for fertility testing (hormone testing) by the Endocrine Lab.

She proceeded to the Radiology Department for Ultrasound of her abdomen and IV Urogram.

Laparoscopy was performed by Radiology-O&G-Surgery team.

She was asked to return in a week's time to discuss her test results.



Trigger 3

The results of the investigations were available at her next visit as follows. She came along with her supportive husband.

Karyotype: 46XX

Endocrine (hormone) tests:
Follicle Stimulating Hormone (FSH): 6.4 IU/L (3.5-12.5)
Luteinizing Hormone (LH): 5.0 IU/L (1.0-11.4)
Serum Testosterone: 2.0 nmol/L (0.22-2.9)
Oestrogen: 200 pmol/L (90.1-716)
Prolactin: 200 mIU/L (70-510)

Abdominal Ultrasound:
Ultrasonographic examination showed normal kidneys. However, the uterus was not visible but the ovaries were present.

Urology:
Intravenous urogram was normal.

Laparoscopy:
Fallopian tubes were visualised. They were attached to each other with a fibrous band. The uterus was absent. The ovaries were normal.

The doctor sat down and went through the test results and data interpretation with the couple. She understood what the doctor discussed. The diagnosis was explained to the couple.


Trigger 4

The couple wanted to know more about problems of infertility and the possibility of having a child. She asked if there were options so she could proceed to have at least a child with her beloved husband. The doctor kindly explained and the couple decided to return to try an option to have a baby despite the wife's shortcomings. The couple went home with a dear hope to have a baby some day in the near future.


Acknowledgement: I have modified and remodeled this Case Study based on a PBL (problem-based learning) for Year 3 Medicine for Week 1, O&G Block at the Universiti Sains Malaysia, School of Medicine. I have added more information on the hormone tests and also some material on traditional Malay medicine. I have made this Case Study more self-guided and more approachable for students who prefer to do self-study either before or after the real class PBL (which has 3 triggers). I will do the link-up to various resources when I have time.

Impotence

Impotence only happens in men. Impotence is mati pucuk, where the male cannot attain penile erection. The recent trend of rising impotence among Malay men indicates a rising trend of diabetes among Malay men. What has impotence got to do with diabetes in Malay men?

The Malays take hempedu bumi for overcoming diabetes. Hempedu bumi has been around and has been used by the Malays since time immemorial. The adverse effect of prolonged use of hempedu bumi is destruction of nerves, which also is a complication of diabetes. Of course we cannot detect the damaging effects of hempedu bumi in females but certainly we can detect the effect in males. It is not known if hempedu bumi worsens eyesight in diabetics.

So we now have a good question to ask Malay men who complain of impotence. We can ask "Have you been taking hempedu bumi?" If patients answer "Yes", then we have a right to request them to stop taking hempedu bumi and see if that will help.

There are many other causes of impotence in Malay males. Hypertension runs high among Malay males. Why?

So we can now check for 2 things in Malay males with impotence - consumption of hempedu bumi and presence of hypertension.


Reference:
Traditional Malay Medicinal Plants
http://books.google.com.my/books?id=UQIfGMUtCO4C&source=gbs_similarbooks

Managing High Uric Acid Levels

Hyperuricaemia is a condition of high uric acid in the blood.

Study questions:

1. Why does it happen? 
2. How does it happen? 
3. How does it present? 
4. How is it detected? 
5. What is bad about it? 
6. Is it good to tackle the condition early? 
7. Can it be prevented? 
8. Can it be cured? 
9. Is there any hope? 
10. Are there foods to avoid? 
11. Are they foods that will help? 
12. Are there herbs that will help?

Uric acid kit for automated analysis of serum uric acid in the clinical laboratory.

CASE STUDY

Here is an interesting case of hyperuricaemia posted in the Medicinal Plant Interest Group in Facebook. I have adjusted the gender to be a male.

Azlan Pa'wan asked:

question: what herbs are good for gout? or to heal gout?

my niece nephew ada gout. 27 years old. family history ada - on the dad's side - the dad and grandpa. still early but his uric acid is higher than normal. so he has to start treating it now.

So what can we do to help? What knowledge do we have to help the young man who has a gouty problem?

We can try my method. So I wrote my reply:

This is my suggestion: Minum banyak air masak hari-hari & sebelum tidur. Bangun malam kencingkan keluar excess uric acid. Minum air lagi. Buat mcm tu sampai kuring sikit uric acid. Bila tidur malam, tutup separuh badan to encourage good blood flow through the kidneys and to filter out the uric acid into urine. Excess uric acid comes out in the urine. || Kalau tak nak mimum air banyak, conditions will get worse - sakit sendi2. || There is also ubat, can try ask the hospital. || I also have high uric acid (hereditary) and it is ok now, not so bad and no pain at all. Cuba lah. InsyaAllah it will help.

Azlan Pa'wan replied:

thanks kak Faridah Abdul Rashid. yes, i have been doing research for him. it points to:
1. drink plenty of water
2. drink lemon juice
3. potassium (which i believe raisins have high potassium content)
4. goat's milk (neutraliser)
now looking if any of the local herbs and ulam-ulam will be good for gout.

Fun Mun Wah responded:

Reduce intake of meat also... and for beans, always remove the center piece of the beans....

I responded to Azlan Pa'wan:

I take all the above. Plenty of water daytime. Lemon juice or any berry juice once in a while (so as not to dissolve my teeth). Roti raisin in the morning only (bakar roti). Goat's milk at night, alternate day or a few nights a week. Works wonders for me.

Azlan Pa'wan added:

indeed Fun Mun Wah and kak Faridah Abdul Rashid. goat's milk ni baguih betul. my dad has been taking it twice a day to speed up bone growth. within 24 days, he's cracked fibula bone is recovering amazingly. dr pun surprised.

I responded to Fun Mun Wah:

Take meat rarely (with nasi briyani only, once a month) - take chicken or fish better (ikan keli goreng or sup). I am allergic to all beans (tak boleh makan peanuts, kuah satay, etc). I take baked beans in small amounts, and sometimes I take soybean milk (limited amount only). Don't take fruit juices at night because these will "crunch" the kidneys and give severe pain throughout the night (relieved by rubbing tea tree oil). The kidneys give a signal whether things are working alright or not. If sakit kidneys, drink lots of water for a few days, rub tea tree oil. Should recover by 3 days and without pain.

I responded to Azlan Pa'wan:

Goat's milk will flush the liver, create a balanced internal environment, good for bone growth, alleviate knee pain, overcome gout, etc. Yes, I too increase intake at the start but now I can survive on a few sachets of goats milk weekly. It is indeed a wonder food. Nabi Muhammad SAW seorang penggembala kambing. So ada banyak manfaat dari segi tu pun. I also had lots of cracked bones and teeth. Now most heal by themselves. Kalau sakit pun, sapu sikit tea tree oil, malam drink goat's milk, esok baik.

Gout:
http://www.health24.com/Medical/Arthritis/News/Gout-may-raise-diabetes-risk-20141006

QA of DNA Labs

When dealing with DNA, the Quality Assurance (QA) of a DNA lab is a serious matter. A DNA lab may exist within a research facility, hospital lab or specialist institute. How much attention is paid to maintaining a high quality standard and how can we be sure that such an important establishment is doing its best to maintain such standards and not slack? Are there instances where the DNA lab slacks in its QA program? How do we know? How do we audit DNA labs?

What are the likely things that can go wrong in the DNA lab?

DNA is a heat-labile material. Once isolated, DNA must be kept cool or stored frozen. What can go wrong at this stage? Electricity or power outage whereby the temperature increases beyond storage temperature, hotter than -70C, -80C or -86C. Most DNA deep freezers have alarm systems which go off if the temperature falls even a few degrees, to alert lab technicians to the potential hazard.

Contamination of DNA samples. How sure are DNA researchers that the DNA under study is not contaminated with blood, fecal matter or other?  How can we be very certain that the DNA being handled is not contaminated?

DNA sample confusion. It is possible that DNA samples can be switched or mixed up. How can this happen? Carelessness, lack or good work ethics or inability to grasp the strict requirement of QA for a DNA lab. How can this be detected? An audit of DNA samples received, processed and output. Entering details of the DNA samples into a DNA database makes sense. It is easier to detect if something happened to a DNA sample which can be automatically flagged and to act on problems fast enough before a DNA sample is processed for various tests.

Now that we have covered just a bit about QA of DNA handling in the DNA lab, how then can something go wrong in a first class DNA lab? How are DNA labs rated? Are crime labs rated the same as a DNA research lab?

Ancient DNA
http://www.wellcome.ac.uk/News/2003/Features/WTD004639.htm

Endangered species DNA
endangered-critter-dna

From NY Times
dna-problems-found-in-new-york-city-crime-lab

CLC Main Workbench
http://www.clcbio.com/products/clc-main-workbench/

DNA Tests
https://www.geni.com/dna-tests/all/male
https://www.geni.com/dna-tests/all/female