News Kashmir Magazine

Writer Syed Zumair Bukhari

 

 

Isolated every now & then, up the creep,

Life goes on with musings of heap;

Hollowness tempts me deepen deep,

Blissful often unhollows me, i cry ,i weep;

Why couldnt uh hear me? Am i that nigh?

I’ve veiled your reminiscence with every sigh;

On the wedge of hills,i scream your name,

My soul stretches tight across the skies,

The rainbow furnishes shade to reach you,

The time resumes to feel you, to feel us,

I’m burnt-out in my covetousness, blazing high,

Your shadow furnishes breeze to my lingering soul,

I espy uh in the burnt-out ends of smoky day,

Though you’ve a great vision of boulewards,

Your glimpse fades to astonish me,

And slowly I live I die, though it hardly understands,

I being a hypocrite keep things go on,

Uh exist no more in my nest, so doesnt i,

Somewhere far away, I yet feel us,

Abhorrence jammed ecstasy, life walked out,

Time passed by degrees, detached us,

Nothing much to carve up,

We departed long turns back,

Distant us,

Strangers Us . . .

 

Nazima Parray

The education sector in Kashmir has seen a drastic change over the past years. Despite the fact that government of India has introduced number of literacy programme and many other literacy campaigns one third of state’s population is illiterate. Every year huge investment is made by the government so as to improve infrastructure in schools. But this is very disappointing to see number of government schools and colleges without facilities that are required to push the education sector from the old rugged system to the ever growing state of the art pattern. The ratio of school going girls has declined only due to lack of basic health facilities in the government schools and colleges. The irony is that no one is ready to admit their children in government schools. The teachers and the other staff are highly qualified and are drawing a healthy amount of salaries from the government but quality education has become a distant dream. The government schools follow the same out dated curriculum and teaching methodology which is of no use in present innovative world.  Fear of severe punishments from the teachers has become another nightmare for the students with the result illiteracy rate have increased. Sense of morality is sacrosanct for the teachers as well as for the students. It is a sense of morality that will awaken the sense of humanity in an individual. Students should learn these things from their teachers which are their role model .But these things seems less important to the teachers. Tolerance level and intellect bend of mind is seen lacking in them. Habit of listening is a considered healing for the one who is speaking. Our teachers have become a very bad listener and our students have turned dumb. Nobody is ready to give them a patient hearing. With the result they have become distracted and disinterested. Majority of teachers are seen disinterested in teaching. They are teaching either for the monetary purpose or are there by default. Passion dedication is totally absent among many teachers with the result every year our schools drop out ratio is alarmingly increasing. Our youth needs vision and credible guidance from the teachers. Above all they need an example which in our education system is none.

Not only has this but the present political situation and turmoil across the valley become an apparent cause of illiteracy in Kashmir.  Corruption and favoritism in the government sector is on the other hand very discouraging for these poor people. Society at large is also playing its part towards illiteracy. Number of young boys has to quit school only to support their families. On the other hand many parents want to marry their daughters early so as to ease their burden. Discrimination among upper class and lower class has created a barrier for poor students to get stress free education.  It is not that teaching fraternity in the education sector especially in the government is completely responsible for the mess this sector is in, the other factors especially the apathy on the part of government and the bureaucratic setup have a nasty hand which cannot be ruled out. To bring this sector back on rails we need some tough decision making at the top level and some brushing and combing at each level so that the education in real sense is imparted to the children in the most relevant manner. This sprucing at each level should not include the government, bureaucrat   and teachers alone but also the parents, civil society, intellectuals, media and the students themselves. In addition to the changes and improvements that need to be taken care of in the system on the fronts involving teachers, government, students etc, we need thorough revamp in the infrastructure also. The modern techniques with modern equipments and gadgetry need to be employed for adopting unconventional teaching practices. The airy and spacious classrooms with sufficient lighting and comfortable heating arrangements will have to be put in place to give a sense of comfort to the students and to make their learning more attractive. Proper curriculum with the latest teaching methods and the facilities of modern libraries, laborites and computer labs are imperative in the contemporary educational setup. The ease of access to the internet and a contact through interschool competition, symposia are some add-ons that would keep the students glued and enhance the interest of the students and teachers in the process. The need of the hour is not only to focus on books and blackboard but to imbibe the new technology in to the system that along with the general line studies would expand the imagination and intellect of the students

(The writer is a research scholar)

By Raashid Ahsaan

A number of infectious diseases (such as HIV, syphilis, hepatitis B and hepatitis C, among others) can be passed from the donor to recipient.

Among the diseases than can be transmitted via transfusion are:

• HIV-1 and HIV-2
• Human T-lymphotropic virus (HTLV-1 and HTLV-2)
• Hepatitis C virus
• Hepatitis B
• Treponema pallidum
• Malaria
• Chagas Disease
• variant Creutzfeldt-Jakob Disease or “Mad Cow Disease” has been shown to be transmissible in blood products. No test exists for this, but various measures have been taken to reduce risks.

When a person’s need for a transfusion can be anticipated, as in the case of scheduled surgery, autologous donation can be used to protect against disease transmission and eliminate the problem of blood type compatibility. “Directed” donations from donors known to the recipient were a common practice during the initial years of HIV. These kinds of donations are still common in developing countries.

Processing of blood prior to transfusion

Donated blood is usually subjected to processing after it is collected, to make it suitable for use in specific patient populations. Examples include:

• Component separation: red cells, plasma and platelets are separated into different containers and stored in appropriate conditions so that their use can be adapted to the patient’s specific needs. Red cells work as oxygen transporters, plasma is used as a supplement of coagulation factors, and platelets are transfused when their number is very scarce or their function severely impaired. Blood components are usually prepared by centrifugation.
• Leukoreduction, also known as Leukodepletion is the removal of white blood cells from the blood product by filtration. Leukoreduced blood is less likely to cause alloimmunization (development of antibodies against specific blood types), and less likely to cause febrile transfusion reactions.
  • Chronically transfused patients
  • Potential transplant recipients
  • Patients with previous febrile nonhemolytic transfusion reaction
  • Patients with hereditary immune deficiencies
  • Patients receiving blood transfusions from relatives in directed-donation programs
  • Patients receiving large doses of chemotherapy, undergoing stem cell transplantation, or with AIDS (controversial).
  • Neonatal transfusionTo ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precaution to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. Most guidelines recommend the provision of CMV-negative blood components and not simply leukoreduced components for newborns or low birthweight infants in whom the immune system is not fully developed. These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Neonatal transfusions are usually top-up transfusions, exchange transfusions, partial exchange transfusions. Top-up transfusions are for investigational losses and correction of mild degrees of anemias, up to 5-15 ml/kg. Exchange transfusions are done for correction of anemia, removal of bilirubin, removal of antibodies and replacement of red cells. Ideally plasma-reduced red cells that are not older than 5 days are used.

1. If an exchange transfusion is necessary, compatible blood must be ordered. If a severely affected ( i.e. hydropic) infant with Rh hemolytic disease is anticipated at birth, it may be necessary to have blood available in the nursery prior to the delivery. The request should be for O negative packed red blood cells of the specific volume needed and of the appropriate CMV status. This blood may be utilized in any one of the following ways:
2. The RBC’s may be given as a simple transfusion (with or without additional Plasmanate) while stabilization of the infant is accomplished.
3. The RBC’s may be used for a partial exchange transfusion to acutely elevate the hematocrit without changing the blood volume in a severely anemic baby.
4. When the need for an emergency, complete exchange transfusion is virtually certain, arrangements can be made in advance for O negative whole blood or O negative PRBC’s resuspended in fresh frozen plasma.
5. For double-volume exchange transfusions for hemolytic disease of the newborn or for hyperbilirubinemia without hemolysis, the blood used will be packed cells (type O, Rh specific for the infant) resuspended to the esired hematocrit in compatible fresh frozen plasma.
6. A partial exchange transfusion is often done for polycythemia (see section on polycythemia). II. Although the standard anticoagulant (CPD) is acidic, the blood need not be buffered. If the infant is severely acidemic, consult the staff neonatologist. III. If possible, the infant should be NPO and the stomach contents aspirated prior to the procedure. IV. The exchange transfusion should be done under a radiant warmer using sterile technique.V. The donor blood should be warmed using the blood warmer to a temperature not exceeding 37oC. VI. The infants blood pressure, respiratory rate, heart rate and general condition should be monitored during the exchange transfusion according to standard nursing protocol.

VII. If the serum bilirubin concentration is at a dangerous level and the blood for exchange transfusion is not yet ready, consider priming the infant with 1 gram/kg (4 ml/kg) of a 25% solution of salt-poor albumin to bind additional bilirubin and keep it in the circulation until the exchange can be accomplished..

VIII. The umbilical vein catheter should be inserted until there is free flow of blood immediately prior to starting the exchange transfusion. See section on placement of umbilical catheters for technique. The exchange transfusion should not be done through an umbilical artery line unless the UAC is used only for blood withdrawal with simultaneous replacement through the umbilical vein or peripheral IV. At the beginning of the exchange transfusion, the first blood sample withdrawn should be sent for 1)total and direct bilirubin; 2) hemoglobin and hematocrit; 3) glucose; and 4) calcium.

1. Use the “exchange transfusion kit”, which contains catheters, stopcocks, waste bag, and calcium gluconate.
2. Ideally, blood (or colloid in the event of a partial volume exchange) should be infused through a peripheral vein at a rate equal to blood withdrawal from the UVC. If the “push-pull” (single catheter) technique is utilized, no more than 5 ml/kg body weight should be withdrawn at any one time.
3. The exchange volume is generally twice the infant’s blood volume, (generally estimated to be 80 ml/kg). The total volume exchange should not exceed one adult unit of blood (450-500 ml). A standard two-volume exchange will remove approximately 85% of the red cells in circulation before the exchange and reduce the serum indirect bilirubin level by one-half. The exchange of blood should require a minimum of 45 minutes.

XII. The need for giving supplemental calcium is controversial. If used give 0.5 to 1.0 ml of 10% calcium gluconate IV, after each 100 ml of exchange blood. Monitor heart rate for bradycardia.

XIII. At the end of an exchange transfusion blood should be sent for sodium, glucose, calcium, total and direct bilirubin, and hemoglobin and hematocrit.

XIV. At the end of an exchange transfusion, the umbilical vein catheter is usually removed. In the event of a subsequent exchange, a new catheter can be inserted.

1. Hypoglycemia often occurs in the first or second hour following an exchange transfusion. It is therefore necessary to monitor blood glucose levels for the first several hours after exchange.

XVI. The serum bilirubin concentration rebounds to a value approximately halfway between the pre- and post- exchange levels by two hours after completing the exchange transfusion. Therefore, the serum bilirubin concentration should be monitored at two to four hours after exchange and subsequently every three to four hours.

XVII. Feedings may be attempted two to four hours after the exchange transfusion.

Terminology

The terms type and screen are used for the testing that (1) determines the blood group (ABO compatibility) and (2) screens for alloantibodies. It takes about 45 minutes to complete (depending on the method used). The blood bank technologist also checks for special requirements of the patient (eg. need for washed, irradiated or CMV negative blood) and the history of the patient to see if they have a previously identified antibody.

A positive screen warrants an antibody panel/investigation. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for commonly encountered and clinically significant alloantibodies. Donor cells may have homozygous (e.g. K+k-), heterozygous (K+k+) expression or no expression of various antigens (K-k+). The phenotypes of all the donor cells being tested are shown in a chart. The patient’s serum is tested against the various donor cells using an enhancement method, eg Gel or LISS. Based on the reactions of the patient’s serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. Not all antibodies are clinically significant (i.e. cause transfusion reactions, HDN, etc). Once the patient has developed a clinically significant antibody it is vital that the patient receive antigen negative phenotyped red blood cells to prevent future transfusion reactions. A direct antiglobulin test (DAT) is also performed as part of the antibody investigation.

Once the type and screen has been completed, potential donor units will be selected based on compatibility with the patient’s blood group, special requirements (eg CMV negative, irradiated or washed) and antigen negative (in the case of an antibody). If there is no antibody present or suspected, the immediate spin or CAC (computer assisted crossmatch) method may be used.

In the immediate spin method, two drops of patient serum are tested against a drop of 3-5% suspension of donor cells in a test tube and spun in a serofuge. Agglutination or hemolysis in the test tube is a positive reaction and the unit should not be transfused.

If an antibody is suspected, potential donor units must first be screened for the corresponding antigen by phenotyping them. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read.

If there is no time the blood is called “uncross-matched blood”. Uncross-matched blood is O-positive or O-negative. O-negative is usually used for children and women of childbearing age. It is preferable for the laboratory to obtain a pre-transfusion sample in these cases so a type and screen can be performed to determine the actual blood group of the patient and to check for alloantibodies.