Addison's Disease

The patient who is shown below, a female of 59 years of age, presented with following signs and symptoms in Medical ward in one of the leading government hospitals in Islamabad:

* Fatigue
* Muscle weakening particularly of lower limbs
* Loss of Appetite
* Weight Loss
* Vomitting
* Constipation
* Persistent Hypotension (low blood pressure)
* Altered taste and sense of smell
* Depression
* and the most striking one was the altered skin colour. Hyperpigmentation of skin of both exposed and unexposed parts. On examination, the hyperpigmentation was appreciated more on knuckles, elbows, lips, buccal mucose and also on the palmer creases. 

According to the patient and as seen on a picture brought by the her that was taken about two years back, her skin colour was normal. She complained of generalized blackening of skin that started to appear throughout her body at the same time.

Diagnosis: Adreno-Cortical Insufficiency or Addison's Disease.

Addison's Disease, also known as Adreno-Cortical Insufficiency, is due to the destruction or dysfunction of the entire adrenal cortex. It affects particularly glucocorticoid and mineralocorticoid function. The onset of disease occurs when 90% or more of both adrenal cortices are destroyed or dysfunctional. It tends to be more common in females and children.

The most common cause of Addison's Disease is Idiopathic autoimmune adrenocortical insufficiency resulting from autoimmune atrophy, fibrosis and lymphocytic infiltration of the adrenal cortex usually with sparing of Adrenal Medulla. Idiopathic autoimmune adrenocortical atrophy and Tuberculosis account for nearly 90% of cases of Addison's disease.

Due to destruction and dysfunction of Adrenal cortex, there is diminished synthesis of glucocorticoids, mineralocordicoids and androgens. Decrease in the level of cortisol sends impulses to pituitary gland which produces ACTH in more than normal amount in order to compensate for diminished levels of cortisol in the body. But since the cortex is dysfunctional, elevated levels of ACTH are of no use. ACTH affects the melanocytes by a complex molecular mechanism which causes hyperpigmentation of the entire body.

The signs and symptoms of Addison's Disease are as follows, compare them with those of the above mentioned patient:

* Hyperpigmentation of skin - most obvious on mucous membraness, palmer creases, knuckles and extensors.

* Musle waekness, fatigue

* Weight loss, decreased appetite

* Low Blood pressure

* Craving for salt

* Nausea, Vomitting and occasional diarrhea.

* Depression

* Loss of pubic and axillary hair

* Loss of Libido.

* Hyperkalemia

* Hyponatremia

Although very rare, Addison's disease is a very important clinical condition and a case in general ward in a hospital of Islamabad, Pakistan, suggests that this autoimmune disease is no longer a rare one.

'BHAABI'

‘Bhaabi’  –  that saintly and praiseworthy figure which has a remarkable impact on all those with whom this high stature dignitary is closely associated and linked. ‘Bhaabi’ – that glorious and charismatic personality which every nine out of ten guys are privileged to have and is that admirable as well as the notable figure which shadows upon the heads of every guy with the ultimate respect and affection, that is well and truly comparable to that they have for their mothers; well that’s an exaggeration. Such is the esteem of ‘Bhaabi’  - the Sister-in-Law, and as we call it in Urdu language.

‘Bhaabi’ is classified into two main types. First is the one which is related to one’s blood; A brother’s wife. Although this specie of ‘Bhaabi’ is endangered these days, they still acquire a very high rank in a family. This kind of ‘Bhaabi’ attains this high status after going through a long and systematic process of various customs and traditions. This class remains permanent throughout life on most occasions so we can most certainly say about this type of ‘Bhaabi’ that “Once a Bhaabi, Always a Bhaabi”.

The first type is followed by the all important second type of ‘Bhaabi’. These ‘Bhaabies’ can be found in any college or university campus, or they may be found in the academies and even in the public residence areas in homes. This Type of ‘Bhaabi’ have more extensive features and characteristics than the first type may be due to the fact that they have been’ investigated’ more thoroughly. This ‘Bhaabi’ is reversible, mostly more than one, but will always be called as ‘Bhaabi’  and never  by her name even if she is younger to the person whose ‘Bhaabi’ she is.  This is a significant kind of respect. This type of ‘Bhaabi’ is further subdivided into other types as well. Let’s have a closer look at the subdivisions of the most prevalent type of ‘Bhaabi’ that we have.

This type of ‘Bhaabi’ can be any one out of:  a) the genuine Bhaabi  (b) the forced or superimposed Bhaabi and (c) the poke-fun-at Bhaabi.

“The Genuine Bhaabi” is  the subtype of second type of’ Bhaabi’ in which there is mutual consent and expression of feelings between the guy and the girl, hence the girl becomes the ‘Bhaabi’ of the friends of the guy she likes.  This is the simplest type of ‘Bhaabi’ without any complications. Such a ‘Bhaabi’ is the most respected one by the friends of the guy who’s in relationship with that girl a.k.a the ‘Bhaabi”. To disrespect, disobey and dishonor ‘the Genuine Bhaabi’ is considered as a grave sin and such instances may lead to bitter fights among the friends. ‘The Genuine Bhaabi’ can be very dangerous, dominant and possessive hence the friends of the guy are often seen warning him about the risky steps not to be taken as the ‘Bhaabi’ may not like them. The friends are vary of the mood swings of ‘the Genuine Bhaabi’ and they caution their friend about the possibilities of a fight so they are often seen confronting their friend on various issues so that the ‘Bhaabi’ is not hurt by any means. ‘The Genuine Bhaabi’ is taken care of a lot so this line is often heard when the friends say to the guy that: ‘Yaar bhaabi naraaz hojayegi un se ek baar pooch lo!’

Another subdivision is the ‘forced or superimposed bhaabi’. In this type, the girl doesn’t know that she has been given this noble title. The guy likes a girl and in order to make his notorious friends stay away from her, he superimposes his authority and convinces them psychologically that the girl really belongs to him.  He does that by continuously referring her as his friend’s ‘Bhaabi’ by saying things like:  ‘oye sharam karo bhaabi pe ghalat nazar??’ and ‘yaar tumhari bhaabi aayi hai aaj ya nahi?? And ‘bhaaiyo tumhari  bhaabi aaj bohat pyaari lag rahi hai mashaAllah’….There comes a point that the friends are psychologically brainwashed and manipulated to such an extent that they consider this manipulation as the reality and they start calling that girl ‘Bhaabi’,  hence the ‘forced or superimposed bhaabi’ is formed.

The third subtype is the ‘poke-fun-at Bhaabi’. This existence of this type of ‘Bhaabi’ comes up out of mocking and teasing by a group of friends to any particular friend just for the sake of fun. The friends pick out the most annoying or the most unattractive girl from a group and associate her with the targeted friend. Some of the lines are like this: When the girl makes an entry in class- ‘Oye yaar daikh hamari bhaabi aagayi’ or ‘check kar bhaabi tujhay daikh rahy hai’ or ‘oye hoye aaj tou barri matching ki hui hai dono ne :P’. Although such self created ‘bhaabies’ are not the actual ones, they fit in the above mentioned definition of ‘Bhaabi’ quite well as they are eventually respected in the same manner as the genuine ones, subconsciously.

‘Bhaabi’ of main second category is found everywhere, in every house, in every class, in every college and in every set up. Each female is a ‘Bhaabi’ to somebody in any one way or the other out of the above mentioned types. Women Rights activists must take a note of the respect that each ‘bhaabi’ gets from the society. The predominance of such respect and affection would be encouraging for them. A unique way of giving respect to females by our people, isn’t it?

Ghalib-A-Day-Series: An Alcoholic

Couplet: 

ye masaail-e-tasawwuff , ye tera bayaan Ghalib

Tujhay ham Walli samajhtay jo na baada khwar hota 

Translation: 

Such matters of spirituality and your deep analysis on them, Ghalib


We would have considered you a saint, if you were not an alcoholic

Explanation:

Ghalib seems to be inspired by himself due to his remarkable insight on the complex matters of spirituality and religion. He says that he has all the qualities of being a saint except one - that he's an alcohol consumer. If he was not an alcoholic, people would have considered him a saint due to his broad vision and deep understanding of the spiritual matters.