Sunday, March 29, 2009

Wonders of Qur'an

By Nasir Hussain Peerzadah

“Does man think that we shall not gather his bones" Yea! We are able to make complete his very finger tips.” (75:3-4)

Al-Qur’an was revealed to Prophet Muhammad. It took about 23 years for the complete revelation. The revelation was gradual and in parts. The message of holy Qur’an has been inspiring and revolutionary. The book has been unique in essence and profound in meaning. Human beings cannot produce even a single ayat like that found in Al-Qur’an.

Many reckless persons exercised their futile efforts to produce the ayats like those found in Al-Qur’an, but they were utterly humiliated. The words of Al-Qur’an are from Almighty Allah who has the ultimate knowledge of realities pertaining to every branch of science.

Every ayat of Qur’an is quite amazing and full of wisdom. Modern scientific research helps us understand the meaning of many verses of Al-Qur’an more clearly. To make the point clearer example of two verses of Al-Qur’an are cited here. In Surah Qiyammah, it is mentioned:

“Does man think that we shall not gather his bones" Yea! We are able to make complete his very finger tips.” (75:3-4)

Before focusing on the meaning of these two ayats it is necessary to know that: every living organism is made up of tiny compartments called cells. These cells are basic structural and functional units of living organisms. Externally these cells are bound by cell membrane. Inside the membrane are present cell organalle each disposing its specific function. The centre of the cell is occupied by nucleus. Nucleus is master organalle of the cell as it guides the cellular function. Inside the nucleus are packed thread-like structures called chromosomes. These chromosomes play a significant role in the transmission of characters from parents to the offspring.

George Mendle, an Austrian biologist (1822-1884) was the first to reveal that chromosomes contained certain mysterious elements responsible for the transmission of characters. These elements were named as factors by Mendle. Modern research in genetics has enabled us to know more about the actual mechanism behind the transmission of character from parents to the offspring. Nowadays it is well established that chromosomes are made of certain chemical substances, which include:

  1. Two types of nucleic acids-DNA and RNA and

  2. Protein. These three substances viz. DNA, RNA, and proteins are thus responsible for storing and utilising the vast amount of genetic information and for transmitting the same from one generation to other:

  1. DNA is the hereditary material exercising the main genetic control.

  2. RNA plays a complementary role in the process leading to protein synthesis and

  3. Proteins act as organic catalysts (enzymes) to bring about the expression of specific traits.

DNA is the primary genetic material, it is confirmed by the following facts, all of which do not hold good for the other chromosome components (RNA and proteins)

  1. The total DNA content is the same in all the diploid (2n) cells of organisms of the same species.

  2. The haploid (n) cells i.e. gamets contain half the amount of DNA present in the somatic cells.

  3. In polyploid cells the DNA complement increases proportionately.

  4. Mitosis brings about an equal distribution of DNA to daughter cells. The amount present in a telophase nucleus is equal to that in a haploid cell; during the interphase this amount increases in double.

  5. Composition of DNA is similar in organisms of the same species; it is different in organisms of different species.

  6. Structure of DNA is in tune with the fact that genes are arranged in a linear fashion in chromosomes.

  7. DNA is capable of self duplication (replication) and that too with utmost accuracy. This is essential for the preservation and transmissions of genetic information from generation to generation.

  8. DNA is capable of controlling and regulating protein synthesis essential for expression of traits.

  9. DNA is known to be the most stable compound in a cell.

  10. Mutations are caused only when there is some alteration in the chemical structure of DNA.

  11. Although relatively stable it is capable of change which enables the organism to evolve to meet new environmental situations.

  12. Genetic information can be introduced onto a cell and hence an organism by means of pure DNA. DNA has three types of chemical substances:

  1. Nitrogenous bases: These are of four types - two types of purines viz adenine and guanine and two types of pyrimidines viz cystosine and thymine. The purines have a double ring of carbon (C) and nitrogen (N) atoms. The pyrimidines have a single ring of four C and two N atoms and are thus smaller molecules than purines.

  2. Deoxyribose: It is a pentose or five carbon sugar.

  3. Phosphoric acid: It occurs as a phosphate group in combination with deoxyribose.

  4. Nucleotides: The three types of chemical substances are joined together onto larger sub units called nucleotides. In a nucleotide a sugar molecule has one of the nitrogenous bases attached to it at its number 1 carbon position. Since bases are of four types, it follows that there are four types of nucleotides as follows:

a. Adenine Sugar Phosphate
b.Guanine Sugar Phosphate
c. Cytosine Sugar Phosphate
d. Thymine Sugar Phosphate

DNA is able to make its exact copies called DNA replication. Functional unit segment of DNA consisting of several sub units (nucleotide pairs) is usually referred to as gene.

The loyalty with which the gene produces its characteristic trait is remarkable. For example the gene responsible for brown eye colour does not produce any other shade. Genes produce their characteristic effects through specific proteins which they synthesise for the purpose.

The enzyme proteins control the entire metabolism of a cell. Since each enzyme catalyses a specific metabolic reaction, it follows that a specific enzyme produces a specific expression or trait. Thus a gene expresses itself through certain enzymes (proteins)

The sequence in which the four bases of DNA, and therefore of mRNA (DNA transcribes a molecule MRNA. The sequence of bases on mRNA is determined by that on the template DNA which transcribes it) are arranged and determine the type of protein to be synthesised. Thus the sequence of the bases functions like a genetic code carrying genetic information which determines the kind of protein to be synthesised.

Genes, though present in each and every cell of the body, express themselves only in some particular region or regions of the body. For instance, the genes for toe nails produce nails only at particular spots on toes and not on the head or palm. Similarly, genes for the formation of eyes are present in all cells of the body, but eyes do not appear on the feet or neck. This is due to the fact that the cytoplasm of a particular cell is sensitive to certain specific genes and not to the entire genome.

Most significantly, no two individuals have the same genetic make up in this universe (exception may be found in monozygotic twins).

Now it should be clear that every individual has his own genetic make up which governs its phenotypic characteristics i.e. external make up and further it is also clear that no two individuals have similar genome, so individuals differ both genetically and phenotypically.

It should also be borne in mind that when a human body dies, it may undergo disintegration under chemical and microbial action within the soil. Elements which make up the body do not get destroyed and under the creative powers of Allah the elements would get assembled again as testified by Al-Qur’an:

“We already know how much of them the earth takes away; with us is the record guarding.” (50:2-4) and this reconstruction will follow entirely the structure and contents of the body as it previously existed and would surely be based entirely upon its DNA content. The DNA content would express itself with such a precision and accuracy that it would even determine the structure of very tips of fingers as described by the Qur’an quoted earlier. This is the point which is referred to in Surah Qiyammah, really a scientific miracle of Al-Qur’an described some fourteen hundred years back. All this defies the human intelligence. One can say nothing except that the source of holy Qur’an is Allah and is really a guiding book for everyone.

Saturday, March 28, 2009

Tuesday, March 24, 2009

rupa-rupanya perjalanan kita masih lagi jauh...

I ended my operation for today, with a luncheon provided by the company which was involved with the implant used.

They had sponsored us food from Domino's PIzza.Usually, whenever there's a company invovled in providing the implant, they would also provided the surgeons and all those assisted with food. Previously, were McD;s or KFC. I am an avid fan of boycotting products by those who are allies with the Zionist..I've been doing that formore than 7 years ago.

However, it has seemed to be a much harder feat to do nowadays, since i have started working. Apparently, I am also shocked with the predicament, there are numerous of us who are still oblivious to the facts of boycott. I am aghast indeed, to say the least.

During my paediatric posting, the staff were regularly ordering fast food- especially PIzza hut, without much hesitations. What more, is that after my O&G posting, we had to celebrate the consultant's birthday as well..Guess what..they had ordered KFC..and i actually succumbed to the pressure of having to use my own money to supply the food.

I havent done that in years..i have sacrificed my brethren's blood...for the sake of food..for the sake of pleasing my consultant.. I cannot believe that i have stooped that low..

The journey of jihad is still a long way to go..How can i talk about Palestine, when many of my colleagues do not even wear the hijab, for that matter?

I tried to talk tomedical officers regarding the issue of palestine,and he was responding with mch enthusiasm, mind you. Much to my dismay, when i realized that the wife of the doctor, dress scantily..I could only deduce that he was talking in regards of palestine in the perspective of don't know how to end the sentence.

Ya Allah, please guide us to the right path and do not let us astray..

Monday, March 23, 2009

My first death..

My 2nd oncall proved to be disastrous indeed. In the middle of the night, at about 0100H, i was reviewing a new patient that had just come in from the emergency department. She was stable, and planned to have wound debridement done the next day. Next to her , was an old patient to the ward. She was cringing in pain, murmuring to herself that the pain was intolerable and felt it was best to die. SHe had uncontrolled diabetes with hip disarticulation already done (it was secondary to ascending infection of her leg).

She was complaining of abdominal pain and wanted to vomit. I immediately caught hold of kidney dish that was stashed near her. Upon seconds, she was profusely vomiting - it was dark red in color. I was in red alert, this was unmistakingly blood. She vomited one kidney dish full of blood and continued to have abdominal pain.

I checked her glasgow comma scale, in which proved to be full. No anemic symptoms - no symp-toms and signs of heart failure. Her vital signs were stable. No hypovolemia, good pulse volume. Her lungs were clear, her oxygen saturation was normal.
Per abdomen, it was soft, and nontenderr. No guarding.

Per rectal examintion proved no malaena.

I rushed to my Medical officer and had alerted the staff nurse to keep an eye on her while i get assistance.

We immediately referred to surgical department and within minutes they rushed to they patient. Fortunately that night, the surgical referral team were such nice people. We all attended the patient, and urgent endoscopy was decided upon.

urgent endoscopy proved that the diagnosis was from the upper gastrointestinl tract..but, they were still unsure of where the exact location was.

Thus , the patient was taken back at the ward and she was kept under surveillance.

2 days after the incident, i had wondered where the patient had been,..I was informed the day before that she was taken to the surgical department for further management.

Alas, to my disbelief, I was informed that the patient had died in ICU . She had developed cardiac arrest. Resuscitation had failed.

This is my first time having a patient died. I've never had any of patients having such critical episode before.

I dont know how to say it actually. It's not the same as it had been when you were student and "having to take charge' of the ptient per se. But this time around , you would have to be vigilant and know how to handle acute emergencies.

I dont know whether it was my fault. Whether if i was more vigilant towards the patient, the outcome would have been different.

I never got to apologize to the patient , if i had done anything cross towards her.

THis is the things that I have to face now..this is not just WORK per se..THis is about taking care of people..this is called responsibility..

Sesungguhnya Kepada Allah jua kita Kembali..

We are never in control of situation, but we are responsible for our just action.
In the akhirah later, we would all be questioned what we have done..have we done the things that should be done?

Saturday, March 21, 2009

I wonder HOw..

Sometimes i wonder, whether we are really committed to our work?As the days pass by, a sad realization befalls truth, do we really care what we do? Do we do things out of the feeling of compassion to others?

Why do you want to become who you are right now? How many of us chose our profession because of the values behind it?

I initially thought i had wanted to become a doctor because i wanted to help people...But in reality, I cannot say the same as of now. It the sad truth,unfortunately. We have become trapped in the system, that focuses more on the "medical aspect" , instead of taking care of patient as a whole.

As a houseman, I have to get to thehospital early, as to prepare for the morning rounds with the medical officers and specialist..Yes, unfortunately, that is the reason why many of us came to the hospital's not really for the patient,per se, it's more because we have to save ourselves from the grueling remarks that would be made by our superiors.

Thus, in the wee morning, the patients would be waken up early and drilled by the lifeless questions that we ask - the usual , same old questoin;;;...macamna encik/puan hari ni? ada sakit lagi? la la la...

Then, comes the rounds, where we present and at the same time get fired by our superiors..

I dont' know whether us housemen really understand what the problems the patients are facing really..or worse, whether we really care..but that's the point of the matter..

And this is the real issue that's happening right now..I wish instead, that the environment at the hospital is more towards patient oriented --..The thing is, I cannot really blame the doctors per se..because the current situation as of now also do not cater much comfort to the doctors.

Thus, we are caught in the middle. BEcause, in order to create a healthy environemtn in the hospital, we have to ensure both parties are taken care of. You cannot simply just accuse the doctors whereby you yourself do not know how much stress doctors are pressed upon.

Do you know how it feels to constantly work - for much more working time than we have with our family .. For instance, during myposting in O&G, i had about 9 times oncalls per month, which is equivalent to more than half of the month is spent in hospital. During oncalls, most of the time , you are stuck int he ward, without having the privilege to get out and get some fresh air. You work more than 30 hours nonstop, sometimes, if you're unlucky, without a wink of sleep the night before. You have to be in charge of more than 3 wards in one night - equivalent to about 100 patient that particularnight. If anything goes wrong, you are the one in charge.

Last night I had my oncall, my 2nd oncall in orthopaedics. One of my patient, suddenly complained of abdominal pain. I attended to her immediately, as her condition concerned me so. Within minutes, she had started to vomit out dark red blood vomitus. One kidney dish full. I had panicked. I was alone at the time. I continued to let her vomit, putting her in one side, as to not allow for aspiration. I called out for help and immediately alerted my Medical officer after checking her general condition. We had decided to refer to surgical , and they also attended urgently. Urgent endoscopy was decided and off we went to procedure room. The patient was not cooperative and kept on saying that she prefers to go home and seek traditional medication. Yet, she had consented for the endoscopy. She had fought a bit during the procedure but we maanged to do it.

But as the procedure was being done, I stared at the patient intently, trying to imagine what if she was my own siblings? would i allow this kind of treatmetn, whereby we had to actually force a bti the patient..Would I be taken aback if this was made to me or my relatives?

But as a doctor, i know that this is necessary and needs to be done..

Along the way, we do see many kind of injustice..and to me a lot of things need to be mended in the current system..

We need to be committed and have a sense of responsibility... There is a need to change the way doctors and patients are being treated ...

Wednesday, March 18, 2009

AIR selusuh?

During my O&G posting, i've come across many patients who came due to contraction..and the staff nurses and some of my Medical officers ( even nonmuslims) would often ask whether patients had used 'air selusuh?'..i was perplexed as to what is air selusuh..these kind of patient usually have good contractions - roughly about once to twice every ten minutes, however, the cervical dilatation is usually still small - less than 4 cm.

Fortunately I had come across this one book entitled "Ensiklopedi Perbidanan Melayu" written by Anisah Barakbah and had foreword written by Tun Dr siti hasmah and also Tan Sri Datuk Dr Hj mohd Ismail Merican ( he's the Ketua Pengarah Kesihatan Kementerian Kesihatan Malaysia- for those who are not aware of his position)

Here goes :
Mengikut petua Melayu, air selusuh merupakan satu daripada ikhtiar untuk memudahkan proses bersalin.

Petua yang mudah dipraktikkan sebagai air selusuh adalah dengan menelan tiitsn air dari hujung rambut yang dilurut turun ke dahi pada setiap kali mandi.
Selain itu, air seluruh dibuat daripada air hujan pada petang atau malam jumaat yang dibaca yasin 7X, basmallah 7x, dan dimulai with..(maksudnya ; Dengn nama Allah Yang maha Mendengar dn Maha Melihat)

sebagai ganti air hujan itu, air zamzam juga boleh dibuat air selusuh..

--these are some of the excerpts from the book..

after reading the fact,i've become a bit, this is what they mean by air selusuh..

I've got no comments ,however, i've not come across any sources based from any hadeeths regarding this ritual..if anyone has got anything legitimate regarding this air selusuh, i would be most grateful...

lets learn anatomy - lower limbs

The muscles
The X-Ray of the pelvis

the compartment - cross section

The bones of the Lower LImbs
Orthopedics is synonymous with anatomy - ever since medical schools , the orthopods (orthopedic surgeons) would bombard us with never ending questions on anatomy.
Ever since last week, i've had to assist in more than 8 operations - total hip arthroplasty , total knee replacement, posteriro of infusionof T10 - T12, hemiarthroplasty, diagnostic arthroscopy , wound debridements and such.. during my first assistance, i was asked regarding anatomy by my dear specialist..
haha..much to my disay, or to his astonishment, i wasn't able to answer even on basic anatomy..
Thus, i've promised myself to go back and revise my wholly forgotten bones and muscles ..
oh dear..back to the books..

Sunday, March 15, 2009

WELCome to Ortho !!

Today is "technically ' my last day of tagging at the ortho department, where the is overwhelmingly male dominated department. As opposed to the previous posting of O&G, this department, is pretty much in contradiction in terms of its surroundings.

Albeit I feel very much relieved to be out of the O&G department, the thought of starting another new posting is quite distressing. It starts all over again, to get used to the not so familiar pathologies and all.

In O&G and Paeds, where i was posted prevously, I had only the opportunities to be surrounded with children and female patients ( in O&G, of course) and not so much with male patients and associates. I had become quite detached with working with so many male patients and partners, in which i have to quickly adapt.

Orthopaedics is basically involving the limbs , and also the spine, muscles, bones and tendons. Anatomy is very important here, as the exact site must be known to do further management, as such in thecases of operations.

I can't say much about orthopaedics as of now, since i've only been posted here for only a week..

I have a lot more to go and to learn...Pray that everything would go well..

Monday, March 9, 2009

Help.. i think the baby's coming out!!

Six Signs that Labor is Within a Few Weeks or Days:

1. Lightening: You can breathe again! This is an indication that the baby has dropped, settling deeper into your pelvis and relieving some of the pressure on your diaphragm, so you are not so short of breath. You may feel increased pressure on your bladder, which means more trips to the bathroom. Others may comment on your changed appearance, although you might not be aware of it at all.

2. Bloody show: Loss of mucus plug. During pregnancy, a thick plug of mucus protects your cervical opening from bacteria entering the uterus. When your cervix begins to thin and relax, this plug is expelled. Some women think the plug will look solid like a cork, but it is actually stringy mucus or discharge. It can be clear, pink or blood tinged and can appear minutes, hours or even days before labor begins. Not all women notice this sign.

3. Rupture of membranes: Your water breaks! Only 1 in 10 woman experience a dramatic gush of the amniotic fluid and even then it usually happens at home, often in bed. Sometimes the amniotic sac breaks or leaks before labor begins. Your uterus is sitting directly on top of your bladder, which can cause you to leak urine. Sometimes it can be quite difficult to distinguish urine from amniotic fluid.

If your membranes have ruptured and you are leaking amniotic fluid, it will be an odorless fluid. This can occur with a sudden gush or a constant trickle. If you notice fluid leaking, you need to try to determine if it smells like urine or if it is odorless. If it does not seem to be urine, you would want to contact your health care provider.

Until you see your physician or midwife do not use tampons, have sexual intercourse or do anything that would introduce bacteria to your vagina. Let your health care provider know if the fluid is anything other than clear and odorless, particularly if it's green or foul smelling, because this could be a sign of infection.

4. Nesting: Spurt of energy. For most of your pregnancy you have probably been fighting the urge to take a nap, so you'll know when you experience this. One day you will wake up feeling full of energy! You'll start making a long list of things to do, things to clean, things to buy and everything you've put off doing will become a high priority. In all your preparations, don't forget that “Labor Day” may be just around the corner so save some energy.

5. Effacement: Thinning of the cervix. Usually in the last month the cervix begins to stretch and thin. This process means the lower segment of the uterus is getting ready for delivery. A thin cervix will also allow the cervix to dilate more easily.

Your health care provider may check for effacement in the final 2 months of pregnancy. Effacement is measured in percentages. You may hear your helath care provider say,“You are 25% effaced, 50% effaced, 75%...” The Braxton Hicks contractions or “practice contractions” you have been experiencing may play a part in the effacement process. You will not be able to determine your effacement process, this can only be done by a health care provider's exam.

6. Dilation: Opening of the cervix. Dilation is the process of the cervix opening in preparation for childbirth. Dilation is measured in centimeters or, less accurately, in “fingers” during an internal (manual) pelvic exam. “Fully dilated” means you're at 10 centimeters and are ready to give birth. In the same way that your health care provider may be checking for effacement in the last 2 months, your health care provider may also tell you how many centimeters your cervix has dilated.

One SURE Sign Labor is Really Happening:

Consistent Contractions: When you begin to experience regular uterine contractions, this is the strongest indication that you are in labor. This is a good time to get out your notebook to record the exact time each one begins and how long they last. These contractions may feel like menstrual cramps or a lower backache that comes and goes, and during early labor they may be as far apart as 20 to 30 minutes. Over the course of several hours your contractions will typically begin occurring at shorter intervals; and you may notice they start happening every 10-15 minutes or less. When your contractions are consistently 5 minutes apart, it is time to call your health care provider.

Labor Contractions Have the Following Characteristics:

  • They are regular
  • They follow a predictable pattern (such as every eight minutes)
  • They become progressively closer
  • They last progressively longer
  • They become progressively stronger
  • Each contraction is felt first in the lower back and then radiates around to the front or visa versa
  • A change in activity or position will not slow down or stop contractions
  • There may be bloody show
  • Membranes may rupture
  • Your health care provider will notice cervical changes, such as effacement (thinning), or dilation
Last Updated: 08/2007

Compiled using information from the following sources:

William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 17.


Thursday, March 5, 2009

bye bye O&G

First and foremost, Alhamdulillah ...Allah has granted that i succeeded in completing O&G posting without extension. O&G posting here is notorious for extension of the are likely to be extended rather than not..which is the scariest part.

I have finished 4 months of O&G..of which , i dont think it's really enough to become a competent MO..because in the end of the day -- all these are preparations for you to go to the higher level , which is the MO..that 4 months included also the tagging period.

The O&G department - for those who might not know - stands for obstetrics and gynaecology.

Most of the time, we are exposed to the obstetrics part. For the obstetrics part - it is further more divided into - the labor room (the most stressing place of all), the patient assessment center (PAC ), the obstetrics ward and the operation theaters for the LSCS ( lower segment caesarean section). PAC - is where the actions starts - in that place, the doctor would determine where the patients would be placed. For example, a mother -to-be comes to the PAC,..she is then seen by the attending doctor (in which the Houseman would clerk the patient first and then present to the MO), based on the symptoms and physical examinaiton, she would then be decided whehter to be placed to the obstetrics ward ( as in latent phase of labor - but this depends on the policy of the hospital ), the labor room - to proceed with labor ( as in the cases of active phases of labor), or discharged - as when the mother has false alarm , and she is in fact not in labor yet.

PAC is a very hectic place indeed - and in my case, since i am very "jonah" - which means that tendency that i would be busy during my calls, the PAC is much more so than it usually is.

It's quite amazing that patients can come in a lot simultaneously which leaves us doctors to be in quite a rut..

Then there's THE LaBOR ROOM - the most daunting place of them can go haywire, i tell you. in my hospital - the labor room can accomodate up to 12 patients at one time. When that happpens , oh my..we definitely can go crazy.
When a patient arrives to the labor room - it's either from the ward or the PAC. if its from PAC, we are less worried, because ARM has been done earlier. (ARM stands for artificial rupture of membrane) but if the patient is from the ward - ( and the patient has not had spontaneous rupture of membrane), then the work just gets busier (actually, it's not that much work in addition, mind you - it just means that we have to do the rupturing of the membrane artificially).

The labor room is where the action is..this is the place where the babies are delivered. It can last up to 12 hours, unfortunately, for some mothers. And there are also those who came with the cervix already effaced and the os already fully dilated and within seconds of arrival, already delivered.

--to be continued --

Tuesday, March 3, 2009



Three Stages Of Spiritual Development Of Soul Age

  1. Nafsul Ammara: The Passionate Soul

    "I do not absolve myself. Lo the (human) soul is prone to evil, save that whenever my Lord has mercy. Lo, my Lord is forgiving; merciful". (Qur'an 12:53)

    This soul inclines toward sensual pleasure, passion and self gratification, anger, envy, greed, and conceit. Its concerns are pleasures of body, gratification of physical appetite, and ego. In a hadith we are told, "Your most - ardent - enemy is your evil self which resides within your body". (Bukhari)

    If this evil soul is not checked, it will lead to unusual stress and its resultant effects.

  2. Nafsul Lawammah: The Reproaching Soul

    "Nay, I swear by the reproaching soul" (Qur'an 75:1)

    This soul is conscious and full aware of evil, resists it, asks for God's grace and pardon, repents and tries to amend and hopes to achieve salvation.

    "And (there are) others who have acknowledged their faults. They mix a righteous action with another that was bad. It may be that Allah will relent toward them. Lo Allah is relenting, merciful". (Qur'an 9:102)

    "There are two impulses within us. One, spirit, which calls towards good and confirms the truth. He who feels this impulse should know that it comes from Allah. Another impulse comes from our enemy (devil), which leads to doubt and untruth and encourages evil. He who feels this should seek refuge in Allah from the accursed devil" (Hadith).

    This soul warns people of their vain desire, guides and opens the door to virtue and righteousness. It is a positive step in spiritual growth.

  3. Nafsul Mutma 'innah: The Satisfied Soul

    "O (you) soul in (complete) rest and satisfaction. Come back to your Lord, well pleased (yourself) and well pleasing unto Him. Enter you then among My devotees, enter you in My heaven". (Qur'an 89-27-30)

    This is the highest state of spiritual development. A satisfied soul is in the state of bliss, content and peace. The soul is at peace because it knows that in spite of its failures in this world, it will return to God. Purified of tension, it emerges triumphant from the struggle and resides in peace and bliss.

What Should We Do In Panic And Despair?

In panic situations non-believers behave differently from believers. They have no one to turn to, to ask for mercy and forgiveness, they know and believe not in nay life other then this worldly life, over which they have no control. Naturally they get more depressed which in turn leads them to even more wrong doing. If they were used to casual drinking, after drinking, they will increase their consumption of alcohol and end up as alcoholics or habitual criminals.

In a state of depression a believer, on the other hand, is advised to do the following:

  1. Increase Dhikr (remembrance of God).

    "He guides to Himself those who turn to Him in penitence - Those who have believed and whose heart have rest in the remembrance of God. Verify in the remembrance of God, do hearts find rest". (qur'an 13:27-28)

  2. Be constant in their prayers.
    "O you who believe, seek help with steadfastness and prayer. For God is with those who are steadfast". (Qur'an 2:153)

  3. Pray to God for Forgiveness.
    "And I have said: Seek forgiveness from your Lord. Lo He was ever forgiving". (Qur'an 71:10)

In addition to the above believers are also expected to constantly struggle to better ourselves.

"Surely God does not change the condition in which people are until they change that which is in themselves". (Qur'an 13:11)

Qur'anic Recitation In Reducing The Stress

"O mankind! There has come to you a direction from you Lord, and a healing for (the disease in your) heart, and for those who believe a guidance, and mercy. (Qur'an 10:57)

The echo of sound has a medical effect, and is now widely utilized. The recitation of Qur'an or listening to the same has a wholesome effect on the body, the heart and the mind. It is said that the letter 'alif' echoes to the heart and latter 'ya' echoes in the pineal gland in the brain. Dr. Ahmed El Kadi of Akbar Clinic, at Panama City, Florida, conducted and has published the effects of listening to the Qur'anic recitation on physiological parameters i.e. the heart rate, the blood pressure and the muscle tension and reported improvement in all, irrespective of whether the listener is a Muslim or a non- Muslim, Arab or non-Arab.2 Obviously it can postulated that those who can understand and enjoy the recitation, with a belief in it as word of God, will get maximum benefit.

Prophet Muhammad's Prayer During Stress

All the prophets, being human beings, had to undergo tests and trials which resulted in temporary stress. They constantly remembered God and received peace through His remembrance. The Prophet Muhammad (pbuh), for example, himself used and advised his followers to use the following D'ua (prayer) in times of distress.

  • "Allah is sufficient for us, and He is an excellent guardian, and we repose our trust in Allah."

  • "Surely we belong to Allah and to Him shell we return. O Allah, I beseech you for the reward of my hardship. Reward me, and compensate me for it with something good."

Dr. Shahid Athar is a Clinical Associate Professor at Indiana University. He has written and published over 110 articles on Islam, authored "Peace Through Submission" and edited "Islamic Perspective in Medicine". He is a frequent speaker at many Muslim institutions, mosques, universities and churches all over the USA.

  • The above article was first published in Hamdard Medicus, Volume XII, No. 4, Winter 1989
  • For more details, please refer to Dr. Ahmed El-Kadi's article on this subject in this book. Islamic Perspectives in Medicine (pages 135 -140
  • Mengenali DEPRESSION

    What Is Depression?

    Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.

    Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.

    What are the different forms of depression?

    There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.

    Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.

    Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.

    Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:

    Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.

    Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.1

    Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.2

    Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression). Visit the NIMH website for more information about bipolar disorder.

    What are the signs and symptoms of depression?

    People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.

    Symptoms include:

    • Persistent sad, anxious or "empty" feelings
    • Feelings of hopelessness and/or pessimism
    • Feelings of guilt, worthlessness and/or helplessness
    • Irritability, restlessness
    • Loss of interest in activities or hobbies once pleasurable, including sex
    • Fatigue and decreased energy
    • Difficulty concentrating, remembering details and making decisions
    • Insomnia, early–morning wakefulness, or excessive sleeping
    • Overeating, or appetite loss
    • Thoughts of suicide, suicide attempts
    • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

    How do women experience depression?

    Depression is more common among women than among men. Biological, life cycle, hormonal and psychosocial factors unique to women may be linked to women's higher depression rate. Researchers have shown that hormones directly affect brain chemistry that controls emotions and mood. For example, women are particularly vulnerable to depression after giving birth, when hormonal and physical changes, along with the new responsibility of caring for a newborn, can be overwhelming. Many new mothers experience a brief episode of the "baby blues," but some will develop postpartum depression, a much more serious condition that requires active treatment and emotional support for the new mother. Some studies suggest that women who experience postpartum depression often have had prior depressive episodes.

    Some women may also be susceptible to a severe form of premenstrual syndrome (PMS), sometimes called premenstrual dysphoric disorder (PMDD), a condition resulting from the hormonal changes that typically occur around ovulation and before menstruation begins. During the transition into menopause, some women experience an increased risk for depression. Scientists are exploring how the cyclical rise and fall of estrogen and other hormones may affect the brain chemistry that is associated with depressive illness.11

    Finally, many women face the additional stresses of work and home responsibilities, caring for children and aging parents, abuse, poverty, and relationship strains. It remains unclear why some women faced with enormous challenges develop depression, while others with similar challenges do not.

    How do men experience depression?

    Men often experience depression differently than women and may have different ways of coping with the symptoms. Men are more likely to acknowledge having fatigue, irritability, loss of interest in once–pleasurable activities, and sleep disturbances, whereas women are more likely to admit to feelings of sadness, worthlessness and/or excessive guilt.12,13

    Men are more likely than women to turn to alcohol or drugs when they are depressed, or become frustrated, discouraged, irritable, angry and sometimes abusive. Some men throw themselves into their work to avoid talking about their depression with family or friends, or engage in reckless, risky behavior. And even though more women attempt suicide, many more men die by suicide in the United States.14

    How is depression detected and treated?

    Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented.

    The first step to getting appropriate treatment is to visit a doctor. Certain medications, and some medical conditions such as viruses or a thyroid disorder, can cause the same symptoms as depression. A doctor can rule out these possibilities by conducting a physical examination, interview and lab tests. If the doctor can eliminate a medical condition as a cause, he or she should conduct a psychological evaluation or refer the patient to a mental health professional.

    The doctor or mental health professional will conduct a complete diagnostic evaluation. He or she should discuss any family history of depression, and get a complete history of symptoms, e.g., when they started, how long they have lasted, their severity, and whether they have occurred before and if so, how they were treated. He or she should also ask if the patient is using alcohol or drugs, and whether the patient is thinking about death or suicide.

    Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.


    Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

    The newest and most popular types of antidepressant medications are called selective serotonin reuptake inhibitors (SSRIs). SSRIs include fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft) and several others. Serotonin and norepinephrine reuptake inhibitors (SNRIs) are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). SSRIs and SNRIs are more popular than the older classes of antidepressants, such as tricyclics–named for their chemical structure–and monoamine oxidase inhibitors (MAOIs) because they tend to have fewer side effects. However, medications affect everyone differently–no one–size–fits–all approach to medication exists. Therefore, for some people, tricyclics or MAOIs may be the best choice.

    People taking MAOIs must adhere to significant food and medicinal restrictions to avoid potentially serious interactions. They must avoid certain foods that contain high levels of the chemical tyramine, which is found in many cheeses, wines and pickles, and some medications including decongestants. MAOIs interact with tyramine in such a way that may cause a sharp increase in blood pressure, which could lead to a stroke. A doctor should give a patient taking an MAOI a complete list of prohibited foods, medicines and substances.

    For all classes of antidepressants, patients must take regular doses for at least three to four weeks before they are likely to experience a full therapeutic effect. They should continue taking the medication for the time specified by their doctor, even if they are feeling better, in order to prevent a relapse of the depression. Medication should be stopped only under a doctor's supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit–forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.

    In addition, if one medication does not work, patients should be open to trying another. NIMH–funded research has shown that patients who did not get well after taking a first medication increased their chances of becoming symptom–free after they switched to a different medication or added another medication to their existing one. 26,27

    Sometimes stimulants, anti–anxiety medications, or other medications are used in conjunction with an antidepressant, especially if the patient has a co–existing mental or physical disorder. However, neither anti–anxiety medications nor stimulants are effective against depression when taken alone, and both should be taken only under a doctor's close supervision.

    What are the side effects of antidepressants?

    Antidepressants may cause mild and often temporary side effects in some people, but they are usually not long–term. However, any unusual reactions or side effects that interfere with normal functioning should be reported to a doctor immediately.

    The most common side effects associated with SSRIs and SNRIs include:

    • Headache–usually temporary and will subside.
    • Nausea–temporary and usually short–lived.
    • Insomnia and nervousness (trouble falling asleep or waking often during the night)–may occur during the first few weeks but often subside over time or if the dose is reduced.
    • Agitation (feeling jittery).
    • Sexual problems–both men and women can experience sexual problems including reduced sex drive, erectile dysfunction, delayed ejaculation, or inability to have an orgasm.

    Tricyclic antidepressants also can cause side effects including:

    • Dry mouth-it is helpful to drink plenty of water, chew gum, and clean teeth daily.
    • Constipation-it is helpful to eat more bran cereals, prunes, fruits, and vegetables.
    • Bladder problems–emptying the bladder may be difficult, and the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected. The doctor should be notified if it is painful to urinate.
    • Sexual problems–sexual functioning may change, and side effects are similar to those from SSRIs.
    • Blurred vision–often passes soon and usually will not require a new corrective lenses prescription.
    • Drowsiness during the day–usually passes soon, but driving or operating heavy machinery should be avoided while drowsiness occurs. The more sedating antidepressants are generally taken at bedtime to help sleep and minimize daytime drowsiness.

    FDA Warning on Antidepressants

    Despite the relative safety and popularity of SSRIs and other antidepressants, some studies have suggested that they may have unintentional effects on some people, especially adolescents and young adults. In 2004, the Food and Drug Administration (FDA) conducted a thorough review of published and unpublished controlled clinical trials of antidepressants that involved nearly 4,400 children and adolescents. The review revealed that 4% of those taking antidepressants thought about or attempted suicide (although no suicides occurred), compared to 2% of those receiving placebos.

    This information prompted the FDA, in 2005, to adopt a "black box" warning label on all antidepressant medications to alert the public about the potential increased risk of suicidal thinking or attempts in children and adolescents taking antidepressants. In 2007, the FDA proposed that makers of all antidepressant medications extend the warning to include young adults up through age 24. A "black box" warning is the most serious type of warning on prescription drug labeling.

    The warning emphasizes that patients of all ages taking antidepressants should be closely monitored, especially during the initial weeks of treatment. Possible side effects to look for are worsening depression, suicidal thinking or behavior, or any unusual changes in behavior such as sleeplessness, agitation, or withdrawal from normal social situations. The warning adds that families and caregivers should also be told of the need for close monitoring and report any changes to the physician. The latest information from the FDA can be found on their Web site at

    Results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggested that the benefits of antidepressant medications likely outweigh their risks to children and adolescents with major depression and anxiety disorders.28 The study was funded in part by the National Institute of Mental Health.

    Also, the FDA issued a warning that combining an SSRI or SNRI antidepressant with one of the commonly-used "triptan" medications for migraine headache could cause a life-threatening "serotonin syndrome," marked by agitation, hallucinations, elevated body temperature, and rapid changes in blood pressure. Although most dramatic in the case of the MAOIs, newer antidepressants may also be associated with potentially dangerous interactions with other medications.

    What about St. John's wort?

    The extract from St. John's wort (Hypericum perforatum), a bushy, wild-growing plant with yellow flowers, has been used for centuries in many folk and herbal remedies. Today in Europe, it is used extensively to treat mild to moderate depression. In the United States, it is one of the top-selling botanical products.

    To address increasing American interests in St. John's wort, the National Institutes of Health conducted a clinical trial to determine the effectiveness of the herb in treating adults who have major depression. Involving 340 patients diagnosed with major depression, the eight-week trial randomly assigned one-third of them to a uniform dose of St. John's wort, one-third to a commonly prescribed SSRI, and one-third to a placebo. The trial found that St. John's wort was no more effective than the placebo in treating major depression.29 Another study is looking at the effectiveness of St. John's wort for treating mild or minor depression.

    Other research has shown that St. John's wort can interact unfavorably with other medications, including those used to control HIV infection. On February 10, 2000, the FDA issued a Public Health Advisory letter stating that the herb appears to interfere with certain medications used to treat heart disease, depression, seizures, certain cancers, and organ transplant rejection. The herb also may interfere with the effectiveness of oral contraceptives. Because of these potential interactions, patients should always consult with their doctors before taking any herbal supplement.


    Several types of psychotherapy–or "talk therapy"–can help people with depression.

    Some regimens are short–term (10 to 20 weeks) and other regimens are longer–term, depending on the needs of the individual. Two main types of psychotherapies–cognitive–behavioral therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression. By teaching new ways of thinking and behaving, CBT helps people change negative styles of thinking and behaving that may contribute to their depression. IPT helps people understand and work through troubled personal relationships that may cause their depression or make it worse.

    For mild to moderate depression, psychotherapy may be the best treatment option. However, for major depression or for certain people, psychotherapy may not be enough. Studies have indicated that for adolescents, a combination of medication and psychotherapy may be the most effective approach to treating major depression and reducing the likelihood for recurrence.25 Similarly, a study examining depression treatment among older adults found that patients who responded to initial treatment of medication and IPT were less likely to have recurring depression if they continued their combination treatment for at least two years.21

    Electroconvulsive Therapy

    For cases in which medication and/or psychotherapy does not help alleviate a person's treatment–resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.

    Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. A patient typically will undergo ECT several times a week, and often will need to take an antidepressant or mood stabilizing medication to supplement the ECT treatments and prevent relapse. Although some patients will need only a few courses of ECT, others may need maintenance ECT, usually once a week at first, then gradually decreasing to monthly treatments for up to one year.

    ECT may cause some short-term side effects, including confusion, disorientation and memory loss. But these side effects typically clear soon after treatment. Research has indicated that after one year of ECT treatments, patients showed no adverse cognitive effects.30

    What efforts are underway to improve treatment?

    Researchers are looking for ways to better understand, diagnose and treat depression among all groups of people. New potential treatments are being tested that give hope to those who live with depression that is particularly difficult to treat, and researchers are studying the risk factors for depression and how it affects the brain. NIMH continues to fund cutting–edge research into this debilitating disorder. --