Female Foot Pain

Anatomical illustration of human foot

The feet are flexible structures of bones, joints, muscles, and soft tissues that let us stand upright and perform activities like walking, running, and jumping. The feet are divided into three sections:

  • The forefoot contains the five toes (phalanges) and the five longer bones (metatarsals).
  • The midfoot is a pyramid-like collection of bones that form the arches of the feet. These include the three cuneiform bones, the cuboid bone, and the navicular bone.
  • The hindfoot forms the heel and ankle. The talus bone supports the leg bones (tibia and fibula), forming the ankle. The calcaneus (heel bone) is the largest bone in the foot.

Muscles, tendons, and ligaments run along the surfaces of the feet, allowing the complex movements needed for motion and balance. The Achilles tendon connects the heel to the calf muscle and is essential for running, jumping, and standing on the toes.

Feet Conditions

  • Plantar fasciitis: Inflammation in the plantar fascia ligament along the bottom of the foot. Pain in the heel and arch, worst in the morning, are symptoms.
  • Osteoarthritis of the feet: Age and wear and tear cause the cartilage in the feet to wear out. Pain, swelling, and deformity in the feet are symptoms of osteoarthritis.
  • Gout: An inflammatory condition in which crystals periodically deposit in joints, causing severe pain and swelling. The big toe is often affected by gout.
  • Athlete’s foot: A fungal infection of the feet, causing dry, flaking, red, and irritated skin. Daily washing and keeping the feet dry can prevent athlete’s foot.
  • Rheumatoid arthritis: An autoimmune form of arthritis that causes inflammation and joint damage. Joints in the feet, ankle, and toes may be affected by rheumatoid arthritis.
  • Bunions (hallux valgus): A bony prominence next to the base of the big toe that may cause the big toe to turn inward. Bunions may occur in anyone, but are often caused by heredity or ill-fitting footwear.
  • Achilles tendon injury: Pain in the back of the heel may suggest a problem with the Achilles tendon. The injury can be sudden or a nagging daily pain (tendinitis).
  • Diabetic foot infection: People with diabetes are vulnerable to infections of the feet, which can be more severe than they appear. People with diabetes should examine their feet daily for any injury or signs of developing infection such as redness, warmth, swelling, and pain.
  • Swollen feet (edema): A small amount of swelling in the feet can be normal after prolonged standing and common in people with varicose veins. Feet edema can also be a sign of heart, kidney, or liver problems.
  • Calluses: A buildup of tough skin over an area of frequent friction or pressure on the feet. Calluses usually develop on the balls of the feet or the heels and may be uncomfortable or painful.
  • Corns: Like calluses, corns consist of excessive tough skin buildup at areas of excessive pressure on the feet. Corns typically have a cone shape with a point, and can be painful.
  • Heel spurs: An abnormal growth of bone in the heel, which may cause severe pain during walking or standing. People with plantar fasciitis, flat feet, or high arches are more likely to develop heel spurs.
  • Ingrown toenails: One or both sides of a toenail may grow into the skin. Ingrown toenails may be painful or lead to infections.
  • Fallen arches (flat feet): The arches of the feet flatten during standing or walking, potentially causing other feet problems. Flat feet can be corrected with shoe inserts (orthotics), if necessary.
  • Nail fungal infection (onychomycosis): Fungus creates discoloration or a crumbling texture in the fingernails or toenails. Nail infections can be difficult to treat.
  • Mallet toes: The joint in the middle of a toe may become unable to straighten, causing the toe to point down. Irritation and other feet problems may develop without special footwear to accommodate the mallet toe.
  • Metatarsalgia: Pain and inflammation in the ball of the foot. Strenuous activity or ill-fitting shoes are the usual causes.
  • Claw toes: Abnormal contraction of the toe joints, causing a claw-like appearance. Claw toe can be painful and usually requires a change in footwear.
  • Fracture: The metatarsal bones are the most frequently broken bones in the feet, either from injury or repetitive use. Pain, swelling, redness, and bruising may be signs of a fracture.
  • Plantar wart:  A viral infection in the sole of the foot that can form a callus with a central dark spot.  Plantar warts can be painful and difficult to treat.
  • Morton’s neuroma: A growth consisting of nerve tissue often between the third and fourth toes. A neuroma may cause pain, numbness, and burning and often improves with a change in footwear.

    Feet Tests

    • Physical exam: A doctor may look for swelling, deformity, pain, discoloration, or skin changes to help diagnose a foot problem.
    • Feet X-ray: A plain X-ray film of the feet can detect fractures or damage from arthritis.
    • Magnetic resonance imaging (MRI scan): An MRI scanner uses a high-powered magnet and a computer to construct detailed images of the foot and ankle.
    • Computed tomography (CT scan): A CT scanner takes multiple X-rays, and a computer constructs detailed images of the foot and ankle.

    Feet Treatments

    • Orthotics: Inserts worn in the shoes can improve many foot problems. Orthotics may be custom-made or standard-sized.
    • Physical therapy: A variety of exercises can improve flexibility, strength, and support of the feet and ankles.
    • Feet surgery: In some cases, fractures or other problems with the feet require surgical repair.
    • Pain medicines: Over-the-counter or prescription pain relievers such as acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) can treat most foot pain.
    • Antibiotics: Bacterial infections of the feet may require antibacterial drugs given orally or intravenously.
    • Antifungal medicines: Athlete’s foot and other fungal infections of the feet can be treated with topical or oral antifungal medicines.
    • Cortisone injection: An injection of a steroid may be helpful in reducing pain and swelling in certain foot problems.

Anal Canal Anatomy

The anal canal is the most terminal part of the lower GI tract/large intestine, which lies between the anal verge (anal orifice, anus) in the perineum below and the rectum above. The description in this topic is from below upwards, as that is how this region is usually examined in clinical practice. Images depicting the anal canal can be seen below. [1, 2]

Coronal section of rectum and anal canal. Coronal section of rectum and anal canal.
Coronal section through the anal canal. Coronal section through the anal canal.

The pigmented, keratinized perianal skin of the buttocks (around the anal verge) has skin appendages (eg, hair, sweat glands, sebaceous glands); compare this with the anal canal skin above the anal verge, which is also pigmented and keratinized but does not have skin appendages. [3, 4]

The demarcation between the rectum above and the anal canal below is the anorectal ring or anorectal flexure, where the puborectalis muscle forms a sling around the posterior aspect of the anorectal junction, kinking it anteriorly.

The anal canal is completely extraperitoneal. The length of the anal canal is about 4 cm (range, 3-5 cm), with two thirds of this being above the pectinate line (also known as the dentate line) and one third below the pectinate line.

The epithelium of the anal canal between the anal verge below and the pectinate line above is variously described as anal mucosa or anal skin. The author believes that it should be called anal skin (anoderm), as it looks like (pigmented) skin, is sensitive like skin (why a fissure-in-ano is very painful), and is keratinized (but does not have skin appendages).

The pectinate line is the site of transition of the proctodeum below and the postallantoic gut above. It is a scalloped demarcation formed by the anal valves (transverse folds of mucosa) at the inferior-most ends of the anal columns. Anal glands open above the anal valves into the anal sinuses. The pectinate line is not seen on inspection in clinical practice, but under anesthesia the anal canal descends down, and the pectinate line can be seen on slight retraction of the anal canal skin.

The anal canal just above the pectinate line for about 1-2 cm is called the anal pecten or transitional zone. Above this transitional zone, the anal canal is lined with columnar epithelium (which is insensitive to cutting). Anal columns (of Morgagni) are 6-10 longitudinal (vertical) mucosal folds in the upper part of the anal canal.

At the bottom of these columns are anal sinuses or crypts, into which open the anal glands and anal papillae. Infection of the anal glands is likely the initial event in causation of perianal abscess and fistula-in-ano. Three of these columns (left lateral, right posterior, and right anterior, at 3-, 7-, and 11-o’clock positions in supine position) are prominent; they are called anal cushions and contain branches and tributaries of superior rectal (hemorrhoidal) artery and vein. When prominent, veins in these cushions form the internal hemorrhoids.

The anorectal junction or anorectal ring is situated about 5 cm from the anus. At the anorectal flexure or angle, the anorectal junction is pulled anterosuperiorly by the puborectal sling to continue below as the anal canal.

Levator ani and coccygeus muscles form the pelvic diaphragm. Lateral to the anal canal are the pyramidal ischioanal (ischiorectal) fossae (1 on either side), below the pelvic diaphragm and above the perianal skin. The paired ischioanal fossae communicate with each other behind the anal canal. The anterior relations of the anal canal are, in males, the seminal vesicles, prostate, and urethra, and, in females, the cervix and vagina with perineal body in between. In front of (anterior to) the anal canal is the rectovesical fascia (of Denonvilliers), and behind (posterior) is the presacral endopelvic fascia (of Waldeyer), under which lie a rich presacral plexus of veins. Posterior to the anal canal lie the tip of the coccyx (joined to it by the anococcygeal ligament) and lower sacrum.

The anal canal is surrounded by several perianal spaces: subcutaneous, submucosal, intersphincteric, ischioanal (rectal) and pelvirectal.

Blood supply and lymphatics

The anal canal above the pectinate line is supplied by the terminal branches of the superior rectal (hemorrhoidal) artery, which is the terminal branch of the inferior mesenteric artery. The middle rectal artery (a branch of the internal iliac artery) and the inferior rectal artery (a branch of the internal pudendal artery) supply the lower anal canal.

Beneath the anal canal skin (below the pectinate line) lies the external hemorrhoidal plexus of veins, which drains into systemic veins. Beneath the anal canal mucosa (above the pectinate line) lies the internal hemorrhoidal plexus of veins, which drains into the portal system of veins. The anal canal is, therefore, an important area of portosystemic venous connection (the other being the esophagogastric junction). Lymphatics from the anal canal drain into the superficial inguinal group of lymph nodes.

Physiology

Anorectal sphincter tone can be assessed during digital rectal examination (DRE) when the patient is asked to squeeze the examining finger. Anorectal manometry measures the pressures: resting and squeezing.

Embryology

The anal canal below the pectinate line develops from the proctodeum (ectoderm), while that above the pectinate line develops from the endoderm of the hindgut.

Aging doesn’t mean the end of sex

Sex may not be the same as it was in your 20s, but it can still be fulfilling. Communication is essential for maintaining a satisfying sex life. Talk with your partner about what you want from him or her. Be honest about what you’re experiencing physically and emotionally. If you take medications or have health problems that affect your sex life, don’t be afraid to talk with your doctor.

Vaccines for adults: Which do you need?

Vaccines offer protection from infectious diseases. Find out how to stay on top of the vaccines recommended for adults.

You’re not a kid anymore, so you don’t have to worry about shots, right? Wrong. Find out how to stay on top of your vaccines.

What vaccines do adults need?

Vaccines for adults are recommended based on your age, prior vaccinations, health, lifestyle, occupation and travel destinations.

The schedule is updated every year, and changes range from the addition of a new vaccine to tweaks of current recommendations. To determine exactly which vaccines you need now and which vaccines are coming up, check the Centers for Disease Control and Prevention’s website.

What factors might affect my vaccine recommendations?

Several factors can affect whether you need certain vaccines. Be sure to tell your doctor if you:

  • Are planning to travel abroad
  • Have had your spleen removed
  • Work in certain occupations where exposures could occur
  • Are or might be pregnant
  • Are breast-feeding
  • Are moderately or severely ill or have a chronic illness
  • Have any severe allergies, including a serious allergic reaction to a previous dose of a vaccine
  • Have had a disorder in which your body’s immune system attacks your nerves, such as Guillain-Barre syndrome
  • Have a weakened immune system or are being treated with an immunosuppressant
  • Have recently had another vaccine
  • Have recently had a transfusion or received other blood products
  • Have a personal or family history of seizures

Your doctor might also recommend certain vaccines based on your sexual activity. Vaccinations can protect you from hepatitis A and hepatitis B, serious liver infections that can spread through sexual contact. The HPV vaccine is recommended for men up to age 21 and women up to age 26.

Why are some vaccines particularly important for adults?

Adults of any age can benefit from vaccines. However, certain diseases, such as the flu, can be particularly serious for older adults or those living with certain chronic illnesses.

How can I keep track of my vaccines?

To gather information about your vaccination status, talk to your parents or other caregivers. Check with your doctor’s office, as well as any previous doctors’ offices, schools and employers. Some states also have registries that include adult immunizations. To check, contact your state health department.

If you can’t find your records, talk to your doctor. He or she might be able to do blood tests to see if you are immune to certain diseases that can be prevented by vaccines. You might need to get some vaccines again.

To stay on top of your vaccines, ask your doctor for an immunization record form. Bring the form with you to all of your doctor visits and ask your provider to sign and date the form for each vaccine you receive.

Symptoms Fatigue

Causes

Most of the time fatigue can be traced to one or more of your habits or routines, particularly lack of exercise. It’s also commonly related to depression. On occasion, fatigue is a symptom of other underlying conditions that require medical treatment.

Lifestyle factors

Taking an honest inventory of things that might be responsible for your fatigue is often the first step toward relief. Fatigue may be related to:

  1. Use of alcohol or drugs
  2. Excess physical activity
  3. Jet lag
  4. Lack of physical activity
  5. Lack of sleep
  6. Medications, such as antihistamines, cough medicines
  7. Unhealthy eating habits

Conditions

Unrelenting exhaustion may be a sign of a condition or an effect of the drugs or therapies used to treat it, such as:

  1. Acute liver failure
  2. Anemia
  3. Anxiety
  4. Cancer
  5. Chronic fatigue syndrome
  6. Chronic infection or inflammation
  7. Chronic kidney disease
  8. Acute liver failure
  9. COPD
  10. Depression (major depressive disorder)
  11. Diabetes
  12. Emphysema
  13. Meralgia paresthetica
  14. Grief
  15. Heart disease
  16. Hyperthyroidism (overactive thyroid)
  17. Hypothyroidism (underactive thyroid)
  18. Inflammatory bowel disease (IBD)
  19. Medications and treatments, such as chemotherapy, radiation therapy, pain drugs, heart drugs and antidepressants
  20. Multiple sclerosis
  21. Obesity
  22. Pain that’s persistent
  23. Sleep apnea
  24. Stress
  25. Toxin ingestion

When to see a doctor

 Call 911 or your local emergency number

Get emergency help if your fatigue is related to a mental health problem and your symptoms also include:

  • Thoughts of harming yourself or of suicide
  • Concern that you may harm someone else

Also get emergency care if your fatigue is accompanied by any of the following:

  • Chest pain
  • Shortness of breath
  • Irregular or fast heartbeat
  • Feeling that you might pass out
  • Severe abdominal, pelvic or back pain

Seek immediate medical attention

Get someone to take you to an emergency room or urgent care if fatigue is accompanied by:

  • Abnormal bleeding, including bleeding from your rectum or vomiting blood
  • Severe headache

Schedule a doctor’s visit

Call for an appointment with your doctor if your fatigue has persisted for two or more weeks despite making an effort to rest, reduce stress, choose a healthy diet and drink plenty of fluids.

Pneumonia

Symptoms and causes

Symptoms

The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.

Signs and symptoms of pneumonia may include:

  • Chest pain when you breathe or cough
  • Confusion or changes in mental awareness (in adults age 65 and older)
  • Cough, which may produce phlegm
  • Fatigue
  • Fever, sweating and shaking chills
  • Lower than normal body temperature (in adults older than age 65 and people with weak immune systems)
  • Nausea, vomiting or diarrhea
  • Shortness of breath

Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating.

When to see a doctor

See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough, especially if you’re coughing up pus.

It’s especially important that people in these high-risk groups see a doctor:

  • Adults older than age 65
  • Children younger than age 2 with signs and symptoms
  • People with an underlying health condition or weakened immune system
  • People receiving chemotherapy or taking medication that suppresses the immune system

For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening condition.

Causes

Pneumonia is classified according to the types of germs that cause it and where you got the infection.

Community-acquired pneumonia

Community-acquired pneumonia is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. It may be caused by:

  • Bacteria. The most common cause of bacterial pneumonia in the U.S. is Streptococcus pneumoniae. This type of pneumonia can occur on its own or after you’ve had a cold or the flu. It may affect one part (lobe) of the lung, a condition called lobar pneumonia.
  • Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia. Walking pneumonia is an informal name given to this type of pneumonia, which typically isn’t severe enough to require bed rest.
  • Fungi. This type of pneumonia is most common in people with chronic health problems or weakened immune systems, and in people who have inhaled large doses of the organisms. The fungi that cause it can be found in soil or bird droppings and vary depending upon geographic location.
  • Viruses. Some of the viruses that cause colds and the flu can cause pneumonia. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia is usually mild. But in some cases it can become very serious.

Hospital-acquired pneumonia

Some people catch pneumonia during a hospital stay for another illness. Hospital-acquired pneumonia can be serious because the bacteria causing it may be more resistant to antibiotics and because the people who get it are already sick. People who are on breathing machines (ventilators), often used in intensive care units, are at higher risk of this type of pneumonia.

Health care-acquired pneumonia

Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. Like hospital-acquired pneumonia, health care-acquired pneumonia can be caused by bacteria that are more resistant to antibiotics.

Aspiration pneumonia

Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs.

Risk factors

Pneumonia can affect anyone. But the two age groups at highest risk are:

  • Children who are 2 years old or younger
  • People who are age 65 or older

Other risk factors include:

  • Being hospitalized. You’re at greater risk of pneumonia if you’re in a hospital intensive care unit, especially if you’re on a machine that helps you breathe (a ventilator).
  • Chronic disease. You’re more likely to get pneumonia if you have asthma, chronic obstructive pulmonary disease (COPD) or heart disease.
  • Smoking. Smoking damages your body’s natural defenses against the bacteria and viruses that cause pneumonia.
  • Weakened or suppressed immune system. People who have HIV/AIDS, who’ve had an organ transplant, or who receive chemotherapy or long-term steroids are at risk.

Complications

Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including:

  • Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from your lungs can spread the infection to other organs, potentially causing organ failure.
  • Difficulty breathing. If your pneumonia is severe or you have chronic underlying lung diseases, you may have trouble breathing in enough oxygen. You may need to be hospitalized and use a breathing machine (ventilator) while your lung heals.
  • Fluid accumulation around the lungs (pleural effusion). Pneumonia may cause fluid to build up in the thin space between layers of tissue that line the lungs and chest cavity (pleura). If the fluid becomes infected, you may need to have it drained through a chest tube or removed with surgery.
  • Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or tube placed into the abscess is needed to remove the pus.

Breast Cancer Stages

Once a person is determined to have a malignant tumor or the diagnosis of breast cancer, the healthcare team will determine staging to communicate how far the disease has progressed.

Why is the breast cancer stage important?

Determining the stage helps determine the best way to contain and eli

minate the breast cancer.

How is the stage determined?

The stage is based on the following factors:

breast cancer stage1 tumor

  • The size of the tumor within the breast
  • The number of lymph nodes affected
  • The nearest lymph nodes are found under the arm, known as the axillary area
  • Signs indicating whether or not the breast cancer cancer has invaded other organs within the body

If breast cancer has spread, or metastasized, evidence be may found in the bones, liver, lungs, or brain.

What Types Of Cancer Are Diagnosed As Stage 0 And 1 Breast Cancer?

 

breast cancer stages thumb stage1 stage0

The stage of cancer indicates the size of the tumor of abnormal cells and whether or not those cells are contained to the place of origin. The most common type of breast cancer is ductal carcinoma in situ (DCIS), indicating the cancer cell growth starts in the milk ducts.

What does the term, “in situ” mean?

Stage 0 cancers are called “carcinoma in situ.” Carcinoma means cancer and “in situ” means “in the original place.” Three possible types of “in situ carcinoma” of the breast tissue are:

  • DCIS – Ductal carcinoma in situ
  • LCIS – Lobular carcinoma in situ
  • Paget disease of the nipple

    What Does It Mean To Have Stage 2 Breast Cancer?

 

  • breast cancer stages thumb stage2Stage 2 means the breast cancer is growing, but it is still contained in the breast or growth has only extended to the nearby lymph nodes.

    This stage is divided into groups: Stage 2A and Stage 2B. The difference is determined by the size of the tumor and whether the breast cancer has spread to the lymph nodes.

 

Stage 3 (III) A, B, And C

breast cancer stages thumb stage3

Stage 3 breast cancer is considered advanced cancer with evidence of cancer invading surrounding tissues near the breast.

Stage 4 (IV)

breast cancer stages thumb stage4

Stage 4 breast cancer indicates that cancer has spread beyond the breast to other areas of the body.

Current Standards Of Care

Should patients insist on comprehensive scans, regardless of the stage?
It may not be necessary, but always seek the advice of your physician. There was a time when everyone diagnosed with breast cancer would routinely have a series of scans and tests to rule out the presence of cancer in other organs.However, this standard was discontinued in 1998 by the National Comprehensive Cancer Network.

The NCCN put forth new national standards for diagnosis and treatment of each type of breast cancer. Instead of undergoing complete “staging work-ups” as they are called, such extensive testing is now often unnecessary, in part due to earlier detection.

The most extensive testing is now commonly reserved for patients with locally advanced disease  (very large tumors with cancer affecting several lymph nodes, for example) or for patients whose long-term physical symptoms may imply that breast cancer has spread elsewhere.

Choosing Your Doctor

Working with a doctor to guide your breast cancer treatment decisions is key.  Determine what you need to do to cultivate a positive partnership with your doctor and when it might be prudent to seek a second opinion

Standard Treatment Vs. Clinical Trials

Before selecting your breast cancer treatment plan, it’s a good idea to understand the difference between standard treatment and clinical trials so you can make an informed decision about what is right for you.

Surger

The most common form of treatment for breast cancer is surgery. This involves removing the tumor and nearby margins. Surgical options may include a lumpectomy, partial mastectomy, radical mastectomy, and reconstruction

 

Chemotherapy

Chemotherapy is a breast cancer treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells.

Radiation Therapy

breast cancer treatment radiation therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects the nearby skin or cells only in the part of the body that is treated with the radiation.

Hormone Therapy

If the cancer cells have hormone receptors, you may be prescribed hormone therapy drugs, such as blockers or inhibitors. Both types of drugs help to destroy cancer cells by cutting off their supply of hormones.

Targeted Therapy

Targeted therapy uses drugs that block the growth of breast cancer cells in specific ways, often reducing side effects.

Nutrition And Physical Activity

It’s important for you to take very good care of yourself before, during, and after breast cancer treatment.

Follow-Up Care

You’ll need regular check-ups after treatment for breast cancer. This helps ensure that any changes in your health are noted and treated if needed.

نواز شریف کے زوال کے اسباب

چیف جسٹس افتخار چوہدری کی کچہری کوئٹہ میں لگی ہوئی تھی، وکلا تحریک نواز شریف کے لانگ مارچ کے بعد بحالی ہوئی تھی، اتنا عروج شاید ہی پاکستان میں کسی چیف جسٹس نے دیکھا ہو۔ وہ اسی طاقت کے نشے میں بلوچستان کے مسنگ پرسنز کو ڈھونڈنے نکلے تھے اور کوئٹہ آ کر دربار سجاتے تھے۔ جب کئی طلبیوں کے باوجود کچھ سینیئر فوجی اہلکار اور حساس اداروں کے نمائندے پیش نہ ہوئے تو انھوں نے ایک دن خبردار کیا کہ دیکھیں اس وقت سے ڈریں جب مجھے کسی ادارے کے افسر کو بلانے کے لیے تھانیدار بھیجنا پڑے۔

تسلی رکھیں ایسا وقت کبھی نہ آیا۔ چوہدری صاحب بلوچستان کے غائب کیے گئے بچوں کو تو نہ ڈھونڈ پائے اپنے بچے کو صادق اور امین قرار دے کر گھر چلے گئے۔

’ثابت ہو گیا کہ طاقتور بھی قانون کے ماتحت آ سکتا ہے‘

نواز شریف کس نکتے پر نااہل ہوئے؟

’سسر نے بحال کیا تو داماد نے نااہل‘

میاں نواز شریف کے زوال کی اور بھی وجوہات ہیں لیکن جس جج کو انھوں نے بحال کرایا اس نے عدالت کو کبھی دربار تو کبھی منبر میں بدلا۔ آج اسی دربار سے فرمان ہوا کہ تو جھوٹا ہے گھر جا، تیرا خاندان بھی جھوٹا ہے اس کو بھی دیکھ لیتے ہیں۔

کسی شاعر نے کہا تھا کہ کوئی بھی حادثہ ایک لمحے میں نہیں ہوتا سالوں تک وقت اس کی پرورش کرتا ہے۔ نواز شریف کے کیس میں یہ پرورش 32 سال سے جاری ہے۔ آٹھ سال جلا وطنی کے نکال کر مرکز میں اور تخت لاہور پر وہ اور ان کا خاندان رہے ہیں۔

وہ عوام سے ووٹ لے کر آتے ہیں اور اس ووٹ سے وہ پاکستان کی ازلی اسٹیبلشمنٹ سے طاقت میں اپنا حصہ مانگتے ہیں، ان کا وزیر اعظم کا موٹر کیڈ، اس کا محل، اس کے بیرونی دورے مل جاتے ہیں، فیتے کاٹ لیتے ہیں، یوم آزادی پر جھنڈے کی رسی کھینچ لیتے ہیں، پر انھیں خیال آتا ہے کہ میں کوئی تھوڑی بہت فارن پالیسی بھی دیکھوں، ذرا پتہ کروں کہ یہ جنگ ونگ کہاں اور کیوں ہو رہی ہے، یہ سودا خریدنے کے لیے جب وہ جیب میں ہاتھ ڈالتے ہیں تو ان کی جیب خالی نکلتی ہے اور وہ خالی ہاتھ گھر واپس جاتے ہیں۔

میں نے ان کی نااہلی سے ایک دن پہلے ٹوئٹر پر پوچھا کہ ان کے زوال کے اسباب کیا ہیں۔ زیادہ تر جگتیں سننے کو ملیں۔ اسلام سے دوری؟ ابھی رمضان کے آخری عشرے میں وہ کہاں تھے؟ ممتاز قادری کو پھانسی عدالت نے دی تھی۔ مشرف پر کیس؟ انھوں نے دانت پیس کر ہاتھ اٹھا رکھے تھے۔ کسی سیانے نے یہ بھی فرمایا کہ نواز شریف نے اپنی بیٹی مریم کو سمارٹ فون کیوں لے کر دیا اور اسے ٹویٹ کرنے کی اجازت کیوں دی۔

جن لوگوں کے بچے ہیں وہ نواز شریف کی مجبوری سمجھ سکتے ہیں۔

نوازتصویر کے کاپی رائٹAFP

میرے چھوٹے سے سروے سے یہ ثابت ہوا کہ ان کے دوست اور دشمن سمجھتے ہیں کہ وہ تھوڑے موٹے دماغ کے ہیں، میرا خیال ہے کہ ان کا موٹا دماغ پنجاب کو بھاتا ہے۔ لوگ ان کے ساتھ کھڑے ہوتے ہیں لیکن کیا وہ خود لوگوں کے ساتھ کھڑے ہوتے ہیں؟

کوئٹہ میں جس مسنگ پرسنز کے کیس پر جسٹس چوہدری خبردار کر رہے تھے وہ وقت کبھی نہیں آیا نہ کبھی آئے گا۔ کوئی تھانیدار کسی ادارے والے کے گھر پر دستک نہیں دے گا۔ لیکن جو مسئلے پارلیمان میں، کابینہ میں طے ہوتے تھے وہ عدالتوں کے رحم و کرم پر چھوڑ دیے گئے۔

نواز شریف نے اپنا وزیر دفاع بھی اس دن مقرر کیا جب عدالت سے حکم صادر ہوا کہ مسنگ پرسنز کے کیس میں وزیر دفاع خود پیش ہو کر بتائے کہ اداروں کے لوگ کیوں پیش نہیں ہو رہے؟

جمہوریت میں مظلوموں کی آہ نہیں لگتی، ووٹ لگتے ہیں۔ تین مرتبہ اس جمہوریت کے مزے لوٹنے کے بعد نواز شریف اور ان کی پارٹی کو تو یہ سیکھ جانا چاہیے کہ آپ کے پاس حرام کے یا حلال کے جتنے بھی ارب روپے ہوں، آپ جیت کر یا دھاندلی سے کتنے کروڑ ووٹ بھی لے کر آئے ہوں، اس ملک کے مظلوموں سے منہ موڑ کر بڑی دکان پر سودا لینے جائیں گے تو آپ کی جیب ہمیشہ خالی ہی نکلے گی۔

میں پاکستانی مردوں سے ملی تو مجھے احساس ہوا کہ یہ تو دراصل خود۔۔۔‘ پاکستان آئی فرانسیسی خاتون نے ایسی بات کہہ دی کہ سن کر تمام پاکستانی مَردوں کے منہ کھلے کے کھلے رہ جائیں

یگر مشرقی معاشروں کی طرح پاکستانی معاشرے کو بھی ’مردوں کا معاشرہ‘ کہا جاتا ہے۔ عام طور پر تو یہی سمجھا جاتا ہے کہ پدر سری (مردانہ) معاشرے میں عورتوں کا استحصال ہوتا ہے لیکن شاید حقیقت یہ ہے کہ اس معاشرے کے مرد بھی کچھ کم مظلوم نہیں ہوتے۔ ویب سائٹ مینگو باز کی رپورٹ کے مطابق فرانسیسی خاتون آریلی سالویئر، جو کہ ایک کاروباری شخصیت اور سماجی محقق ہیں، کا یہی کہنا ہے کہ جب وہ پاکستان آئیں اور یہاں کے مردوں سے ملیں تو وہ بیچارے عورتوں سے بھی زیادہ مظلوم نظر آئے۔

آریلی یہ جاننے کے لئے پاکستان آئیں کہ یہاں کی مردانگی حرکیات کیا ہیں اور یہ کہ ایک پدرسری معاشرے میں مرد کس طرح متاثر ہوتے ہیں۔ ان کا کہنا ہے کہ پاکستانی مردوں سے بات چیت کی تو پتا چلا کہ وہ جذباتی طور پر خواتین سے بھی زیادہ متاثر ہوتے ہیں اور پدرسری ذمہ داریوں کی وجہ سے ان کی آزادی پر بھی زد پڑتی ہے۔ ان کا کہنا تھا کہ اکثر پاکستانی مرد اس بات سے آگاہ نہیں ہیں کہ معاشرے میں پائے جانے والے مردانگی کے تصور کے ان پر منفی اثرات مرتب ہوتے ہیں۔

وہ کہتی ہیں کہ اگرچہ اس طرز معاشرت کے کچھ فوائد ہیں لیکن اس کی وجہ سے آپ وہ بننے پر مجبور ہوجاتے ہیں جو دراصل آپ نہیں ہوتے۔ آپ پر دباﺅ ہوتا ہے کہ آپ اپنے جذبات کو دبا کر رکھیں۔ نہ کسی کے سامنے اپنے دکھ درد بیان کریں اور نہ کبھی آنسو بہائیں، کیونکہ یہ تو عورتوں کے کام ہیں۔ مردانہ معاشرے میں مردوں کو تربیت دی جاتی ہے کہ وہ ایسے جذبات کا اظہار نہ کریں جو انہیں کمزور ظاہر کریں۔
آریلی کہتی ہیں کہ پاکستانی معاشرے میں مرد ہونے کے فوائد حقیقی نہیں ہیں، کیونکہ اصل آزادی تو یہی ہے کہ آپ جو ہیں وہ نظر بھی آ سکیں۔ خود کو مرد ثابت کرنے کے لئے آپ اپنی فطرت کے خلاف خود پر جبر کرنے پر بھی مجبور ہوتے ہیں ۔ پاکستانی معاشرے میں خواتین اپنے بیٹوں کو شروع سے یہ تربیت دیتی ہیں کہ وہ مردوں جیسا رویہ اختیار کریں تاکہ انہیں معاشرے میں مشکلات کا سامنا نہ کرنا پڑے۔
آریلی کا کہنا ہے کہ اس نوع کی پابندیاں نہ ہوں تو مرد بہتر اور زیادہ صحت مند سماجی تعلقات استوار کرسکتے ہیں اور ان کی ازدواجی زندگی بھی بہتر ہوگی۔ وہ کہتی ہیں کہ بطور معاشرہ ہم نے مردانگی کو انسانیت سے بالا تر سمجھ لیا ہے، جس کی ہمیں قیمت ادا کرنا پڑرہی ہے۔ اگر ہم اس صورتحال کو بدل سکیں تو بحیثیت قوم زیادہ خوش رہ سکیں گے

سلم لیگ ن نے عبوری وزیر اعظم کے لیے شاہد خاقان عباسی کے نام پر اتفاق کیا ہے جس کے بعد ان کے نام کی منظوری دے دی گئی ۔میڈ یا رپورٹس کے مطابق وزیر اعظم ہاوس میں نواز شریف کی زیر صدارت غیر رسمی مشاورتی اجلاس ہوا جس میں اتفاق کیا گیا کہ شاہد خاقان عباسی کو 45دنوں کے لیے وزیر اعظم بنا یا جائے گا جس کے بعد مستقل طور پر شہباز شریف کو وزیر اعظم بنا یا جا ئےگا ۔غیر رسمی اجلاس میں اتفاق کے بعد آج شام ہونے والے پارلیمانی پارٹی کے اجلاس میں شاہد خاقان عباسی کے نام کی توثیق کرائی جائے گی ۔