Asif, Humaira

Jafri, Lena

Khan, Aysha Habib

English

khan, Aysha Habib

eCommons@AKU

eCommons@AKU Department of Pathology and Laboratory Medicine Medical College, Pakistan 1-2020 Kidney stone analysis and spiritual guides (pir faqir): The known-unknowns Lena Jafri Aysha Habib khan Humaira Asif Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol  Part of the Laboratory and Basic Science Research Commons, and the Pathology Commons Vol. 70, No. 1, January 2020196Dear Madam, Kidney stone disease represents a commonreferral for stone analysis in chemical pathologylaboratories.1 Given the irretrievable nature of the kidneystone an accurate compositional analysis is very important.Fourier transform infrared (FTIR) spectroscopy is a stateof the art technique recommended by Urolithiasis ofEuropean Association of Urology 2013 for urinary stoneanalysis.2The FTIR spectroscopy provides semi-quantitativeevaluation of each chemical component of the kidneystones and hence has implications for understanding theepidemiology of stones in Pakistan.Since Jan 2018 till to date we have identified four strangestones submitted to our clinical laboratory for analysis onseparate occasions. The stones were received  fromdifferent cities of Pakistan.  All four stones were similar inappearance. Spectra generated by FTIR spectroscopy usingNicolet iS5 FTIR Spectrometer (Thermo Fisher ScientificInc, USA) with Attenuated Total Reflection technologywere compared with spectra in the NICODOM library. Thelibrary compared the unknown stone spectrum witharound 756 synthetic reference kidney stone spectracontained in the library. In all four stones, the generatedspectra did not match with the spectra in the library. Thestones were re-analyzed with a manual chemical methodto determine the content of calcium, oxalate, ammonia,phosphate, cysteine, uric acid and magnesium in thesamples and again no chemical constituent was matched.Clinical history was sought. Details obtained over thetelephone revealed that all four patients had pain inabdomen and were being evaluated by some 'pir' (believedto be endowed with mystical powers) for black magic.Without any surgery or any medication the pir had takenout the stones from their body in a bowl lying next tothem or on the floor/ bed. Please note all four individualshad gone to separate 'pir' in their respective cities.Pakistani cities, towns and villages are littered with suchfake 'amils' and 'pirs' who claim to be the expert in breakingthe black magic and relieving the people of illnesses. Theyserve as the spiritual guides to the disciples (murid).3 Inour society, due to lack of education and awareness, manypeople turn to these fake scholars with blind trust.  Thesefake 'pirs' and 'amils' promise instant relief and resultsthus capitalizing on their urgency to see results. The lackof education leads to the vulnerability of these patients,thus believing every word these fake scholars say. Theonly way to overcome is to report such cases and bringawareness.The analysis of kidney stones is important for the diagnosisand treatment of urolithiasis. The knowledge of thequantitative composition of kidney stones is essential forunderstanding their etiology. The incidence and natureof false stones, peculiar calculi and crystals growing onsurprising materials has been reported in literature.4 Therole of the biochemical laboratory is of outstandingimportance, especially because the crystalline compositionand the morphology and clinical history of such samplesmay provide clues to the etiology. Such unusualexperiences where the identification of the stone remainsquestionable must always be shared. Once evidenceaccumulates and awareness grows, the potential forstopping this kidney stone scam exist.Disclaimer: None to declare.Conflict of Interest: None to declare.Funding Sources: None to declare.References1. Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al.The management of stone disease. BJU Int 2002; 89 Suppl 1: 62-8.2. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAUGuidelines on Diagnosis and Conservative Management ofUrolithiasis. Eur Urol 2016; 69: 468-743. Charan IA, Wang B, Yao D. Cultural and Religious Perspective on theSufi Shrines. J Relig Health 2018; 57: 1074-94.4. Sabot JF, Bornet CE, Favre S, Sabot-Gueriaux S. The analysis of peculiarurinary (and other) calculi: an endless source of challenge. Clin ChimActa 1999; 283: 151-8.Kidney stone analysis and spiritual guides (pir faqir): the known-unknownsLena Jafri, Aysha Habib Khan, Humaira AsifDepartment of Pathology and Laboratory Medicine, Aga Khan University, Karachi,Pakistan.Correspondence: Lena Jafri. e-mail: lena.jafri@aku.eduhttps://doi.org/10.5455/JPMA.50420

Kidney stone analysis and spiritual guides (pir faqir): The known-unknowns

eCommons@AKU Department of Pathology and Laboratory Medicine Medical College, Pakistan 1-2020 Kidney stone analysis and spiritual guides (pir faqir): The known-unknowns Lena Jafri Aga Khan University, lena.jafri@aku.edu Aysha Habib Khan Aga Khan University, aysha.habib@aku.edu Humaira Asif Aga Khan University Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol  Part of the Nephrology Commons, Pathology Commons, and the Urology Commons Recommended Citation Jafri, L., Khan, A. H., Asif, H. (2020). Kidney stone analysis and spiritual guides (pir faqir): The known-unknowns. JPMA. The Journal of the Pakistan Medical Association, 70(1), 196-196. Available at: https://ecommons.aku.edu/pakistan_fhs_mc_pathol_microbiol/1291 Vol. 70, No. 1, January 2020196Dear Madam, Kidney stone disease represents a commonreferral for stone analysis in chemical pathologylaboratories.1 Given the irretrievable nature of the kidneystone an accurate compositional analysis is very important.Fourier transform infrared (FTIR) spectroscopy is a stateof the art technique recommended by Urolithiasis ofEuropean Association of Urology 2013 for urinary stoneanalysis.2The FTIR spectroscopy provides semi-quantitativeevaluation of each chemical component of the kidneystones and hence has implications for understanding theepidemiology of stones in Pakistan.Since Jan 2018 till to date we have identified four strangestones submitted to our clinical laboratory for analysis onseparate occasions. The stones were received  fromdifferent cities of Pakistan.  All four stones were similar inappearance. Spectra generated by FTIR spectroscopy usingNicolet iS5 FTIR Spectrometer (Thermo Fisher ScientificInc, USA) with Attenuated Total Reflection technologywere compared with spectra in the NICODOM library. Thelibrary compared the unknown stone spectrum witharound 756 synthetic reference kidney stone spectracontained in the library. In all four stones, the generatedspectra did not match with the spectra in the library. Thestones were re-analyzed with a manual chemical methodto determine the content of calcium, oxalate, ammonia,phosphate, cysteine, uric acid and magnesium in thesamples and again no chemical constituent was matched.Clinical history was sought. Details obtained over thetelephone revealed that all four patients had pain inabdomen and were being evaluated by some 'pir' (believedto be endowed with mystical powers) for black magic.Without any surgery or any medication the pir had takenout the stones from their body in a bowl lying next tothem or on the floor/ bed. Please note all four individualshad gone to separate 'pir' in their respective cities.Pakistani cities, towns and villages are littered with suchfake 'amils' and 'pirs' who claim to be the expert in breakingthe black magic and relieving the people of illnesses. Theyserve as the spiritual guides to the disciples (murid).3 Inour society, due to lack of education and awareness, manypeople turn to these fake scholars with blind trust.  Thesefake 'pirs' and 'amils' promise instant relief and resultsthus capitalizing on their urgency to see results. The lackof education leads to the vulnerability of these patients,thus believing every word these fake scholars say. Theonly way to overcome is to report such cases and bringawareness.The analysis of kidney stones is important for the diagnosisand treatment of urolithiasis. The knowledge of thequantitative composition of kidney stones is essential forunderstanding their etiology. The incidence and natureof false stones, peculiar calculi and crystals growing onsurprising materials has been reported in literature.4 Therole of the biochemical laboratory is of outstandingimportance, especially because the crystalline compositionand the morphology and clinical history of such samplesmay provide clues to the etiology. Such unusualexperiences where the identification of the stone remainsquestionable must always be shared. Once evidenceaccumulates and awareness grows, the potential forstopping this kidney stone scam exist.Disclaimer: None to declare.Conflict of Interest: None to declare.Funding Sources: None to declare.References1. Rizvi SA, Naqvi SA, Hussain Z, Hashmi A, Hussain M, Zafar MN, et al.The management of stone disease. BJU Int 2002; 89 Suppl 1: 62-8.2. Turk C, Petrik A, Sarica K, Seitz C, Skolarikos A, Straub M, et al. EAUGuidelines on Diagnosis and Conservative Management ofUrolithiasis. Eur Urol 2016; 69: 468-743. Charan IA, Wang B, Yao D. Cultural and Religious Perspective on theSufi Shrines. J Relig Health 2018; 57: 1074-94.4. Sabot JF, Bornet CE, Favre S, Sabot-Gueriaux S. The analysis of peculiarurinary (and other) calculi: an endless source of challenge. Clin ChimActa 1999; 283: 151-8.Kidney stone analysis and spiritual guides (pir faqir): the known-unknownsLena Jafri, Aysha Habib Khan, Humaira AsifDepartment of Pathology and Laboratory Medicine, Aga Khan University, Karachi,Pakistan.Correspondence: Lena Jafri. e-mail: lena.jafri@aku.eduhttps://doi.org/10.5455/JPMA.50420

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Kidney stone analysis and spiritual guides (pir faqir): The known-unknowns

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