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Is Keto Diet Safe For People With Diabetes?

Introduction

In recent years, there has been a significant surge of interest in exploring different weight loss regimes, specifically following high-protein diets. One such high-protein diet is the <a href="https://www.merisehat.pk/article/what-is-the-ketogenic-diet">ketogenic diet</a>, or simply the keto diet, which is a diet rich in proteins and fats. Initially, the ketogenic diet was primarily proposed to reduce the frequency of epileptic seizures in children, but it has since gained popularity for weight loss. While there is evidence of short-term results with the keto diet, the verdict on its long-term benefits is still inconclusive. However, unlike other low-carb diets that center around protein, the ketogenic diet focuses mainly on fat.

&nbsp;

Understanding The Advantages Of Keto Diet In Diabetes

In 2008, researchers conducted a 24-week study to determine the effects of a low-carbohydrate diet on people with diabetes type 2 and obesity. The study concluded that people who followed the ketogenic diet saw a significant improvement in the glycemic index compared to those following a low-glycemic diet<a href="#accordion">[1]</a>. Patients following a ketogenic diet also saw a significant reduction in the use of medication. Another study conducted in 2013 reported that participants on a ketogenic diet showed improvements in their blood sugar levels and were also able to taper off insulin requirements compared to other diets<a href="#accordion">[2]</a>. Similarly, the ketogenic diet outperformed a low-fat diabetes diet, and the participants showed better weight loss and control of HbA1c in another study<a href="#accordion">[3]</a>.&nbsp;

Although it may seem unlikely that a high-fat diet focuses on weight loss, the ketogenic diet is different and can potentially change the way your body stores and uses energy. The ketogenic diet is high in fat and low in carbs. Instead of sugar, your body converts fat into energy in the keto diet. As mentioned earlier, the diet was initially considered for the treatment of epilepsy in the 1920s, but the effects were later also studied for type 2 diabetes<a href="#accordion">[4]</a>. The ketogenic diet improves blood sugar levels and reduces the need for insulin. However, as with any other diet, there are risks associated with the keto diet as well. Thus, it is important to discuss the possibility of starting the keto diet with your doctor before making any drastic changes to your current diet plan.&nbsp;

&nbsp;

Diabetes is of 2 types: diabetes type 1 and diabetes type 2.&nbsp;

<ul>
	<li>In type 1 diabetes, the body is incapable of producing insulin, and the patient has to rely on medication for life. This condition is less common and is typically diagnosed during childhood.&nbsp;</li>
	<li>In diabetes type 2, which has a more common presentation of the two, the body either does not produce enough insulin to meet the body&rsquo;s needs, or the insulin produced does not work effectively in lowering blood glucose levels.&nbsp;</li>
	<li>Pre-diabetic people have higher than normal blood sugar levels&nbsp;and are at a higher risk of developing diabetes type 2 if they do not take precautionary lifestyle and dietary measures.&nbsp;</li>
	<li>Gestational diabetes is described as diabetes that develops when you are pregnant. This type of diabetes generally resolves after giving birth. Though, it places you at a higher risk of developing type 2 diabetes.&nbsp;</li>
</ul>

&nbsp;

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Unlike other low-carb diets, the keto diet aims to force your body to use a different type of fuel. And instead of relying on sugar that comes from carbohydrates, for example, fruits, vegetables, legumes, and grains, the diet relies on ketone bodies. This is a type of fuel that the liver produces using stored fat. While burning fat sounds like an ideal way to lose weight, getting the liver to make ketone bodies is a tricky process.&nbsp;

<ul>
	<li>The diet requires that you restrict your intake of carbohydrates to 20 to 25 grams per day.&nbsp;</li>
	<li>Typically, reaching the state of ketosis takes a few days.&nbsp;</li>
	<li>If your diet is too high in protein, it can also interfere with ketosis.&nbsp;</li>
</ul>

In many cases, people with type 2 diabetes are overweight and a high-fat diet may seem unhelpful. The goal of a ketogenic diet is to train the body into using fat instead of carbohydrates or glucose. On the ketogenic diet, most of the energy comes from fat and only a small amount comes from carbohydrates. However, there are some ground rules. A diet high in fats doesn&rsquo;t mean that you should load up on saturated fats. It is recommended that your diet is rich in heart-healthy fats to maintain overall health. Some healthy foods that you can eat on a ketogenic diet include:&nbsp;

<ul>
	<li>Eggs&nbsp;</li>
	<li>Fish&nbsp;</li>
	<li>Cottage cheese&nbsp;</li>
	<li>Avocado&nbsp;</li>
	<li>Olives&nbsp;</li>
	<li>Nuts&nbsp;</li>
	<li>Seeds</li>
	<li>Olive oil&nbsp;</li>
	<li>Nut butter&nbsp;</li>
</ul>

&nbsp;

Foods To Be Eaten In Moderation

<ul>
	<li>Berries -&nbsp;1 cup or less</li>
	<li>Plain, Greek yogurt -&nbsp;1 cup or less</li>
	<li>Cottage cheese -&nbsp;1/2 cup or less</li>
	<li>Nuts and peanuts -&nbsp;1&ndash;2 ounces&nbsp;or 30&ndash;60 grams</li>
	<li>Flaxseeds or chia seeds -&nbsp;2 tablespoons</li>
	<li>Dark chocolate (at least 85% cocoa) -&nbsp;30 grams or less</li>
</ul>

&nbsp;

Foods To Avoid

<ul>
	<li>Bread&nbsp;</li>
	<li>Pasta&nbsp;</li>
	<li>Cereal&nbsp;</li>
	<li>Corn and other grains&nbsp;</li>
	<li>Potatoes, sweet potatoes</li>
	<li>Milk&nbsp;</li>
	<li>Fruits excluding berries&nbsp;</li>
	<li>Juices, sodas, and sweetened teas</li>
	<li>Desserts, candies, ice cream, and other baked goods</li>
</ul>

&nbsp;

When you eat carbs, your body&rsquo;s digestive system breaks down the carbohydrates and turns them into sugars that enter your bloodstream. The more sugar there is in your bloodstream, the more insulin your body needs to break down the sugar for energy. Insulin signals the cells to use the sugar for energy and energy storage. Moreover, the pancreas releases glucagon when the cells of your body begin to use the blood sugar. The two hormones, insulin, and glucagon work together to ensure that you have enough energy. If you have diabetes, then this means that your body is not using the insulin properly or cannot make or is not making enough insulin.

Hence, for people with diabetes type 2, it is recommended to control carbohydrate intake because it turns to sugar, and having it in large quantities can cause spikes in blood sugar levels. However, the ketogenic diet has the potential to decrease the levels of blood glucose. Your doctor will determine the number of carbs you should have based on your needs, current BMI, etc. Studies have shown that some people experience reduced blood sugar by switching to a diet high in fat.

Diabetes affects about 10 percent of the American population. Whereas in Pakistan, 17.1% of the population is estimated to be living with diabetes. This makes a total of 19 million adults in Pakistan who are at risk of the life-threatening complications of diabetes making it a pertinent public health issue<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

Other than the standard keto diet, there are 3 other variations of the diet: the cyclical ketogenic diet, the targeted ketogenic diet, and the very low-carb diet.&nbsp;

<ul>
	<li>On the cyclical ketogenic diet, you can eat 100 to 150 grams of clean carbs once or twice a week.</li>
	<li>With the targeted ketogenic diet, you can follow the same rules as a regular keto diet but the time you eat carbs is fixed. It is suggested to consume carbs before or after a workout.&nbsp;</li>
	<li>The very low-carb diet, as the name suggests, allows you to eat very small quantities of carbs, high fat, and moderate protein. However, compared to the standard keto diet that allows only 50 grams of carbs a day, this diet allows you to eat 100 to 150 grams of carbs daily. However, this may not help you reach a state of ketosis.&nbsp;</li>
</ul>

&nbsp;

Conclusion

After reading this article, you may be wondering how a diet that focuses on fat makes it good for you. Especially, considering the fact that many people with diabetes also have obesity. While this question is completely reasonable, the keto diet is about redefining our understanding of fat. For years, people have focused on low-fat foods, milk, and yogurt thinking that fats are the root cause of all our health concerns, including obesity. However, the situation is more complex.&nbsp;

A recent study indicates that focusing on reducing total fats leads to harmful habits such as increased consumption of refined carbohydrates and added sugars. Moreover, it also leads to avoiding nutrient-dense foods, such as nuts, seeds, vegetable oils, and avocados. We all need fat to keep ourselves healthy and only recently researchers have started shifting from anti-fat foods to encouraging high-fat foods. In simpler words, fat is an important source of energy. It helps our bodies absorb essential vitamins and minerals, helps our muscles move, and enables blood to clot. Thus, science shows that a diet high in fat can be healthy, whereas eating low-fat diets can actually be harmful in the long run because of overconsumption of carbs and processed foods.&nbsp;

&nbsp;

Key Points

<ul>
	<li>It is important that you speak with your doctor before you start a keto diet. Speaking with your doctor is a rule that should be followed before starting any diet.&nbsp;</li>
	<li>A keto diet can be helpful for diabetics who want to lose weight and lessen the need for medications. However, for others, it might even make diabetes worse. The diet isn&rsquo;t a magic weight loss pill, and there is currently limited information on the long-term effects of a keto diet.&nbsp;</li>
	<li>Moreover, be cautious when transitioning from the keto diet to adding carbs back to your diet. Sudden high consumption of carbs can cause your blood sugar levels to spike, and cause you to gain weight.</li>
</ul>

&nbsp;

[1] Westman, E.C., Yancy, W.S., Mavropoulos, J.C., Marquart, M. and McDuffie, J.R., 2008. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutrition & metabolism, 5(1), pp.1-9.

[2] Paoli, A., Rubini, A., Volek, J.S. and Grimaldi, K.A., 2013. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), pp.789-796.

[3] Saslow, L.R., Mason, A.E., Kim, S., Goldman, V., Ploutz-Snyder, R., Bayandorian, H., Daubenmier, J., Hecht, F.M. and Moskowitz, J.T., 2017. An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: a randomized controlled trial. Journal of medical Internet research, 19(2), p.e5806.

[4] Meira, I.A., Romão, T.T., do Prado, H.P., Krüger, L.T., Pires, M.E.P. and da Conceição, P.O., 2019. Ketogenic diet and epilepsy: What we know so far, Front. Neurosci-Switz.(13), 5.

[5] Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.Akhtar, S., Nasir, J.A., Abbas, T. and Sarwar, A., 2019. Diabetes in Pakistan: a systematic review and meta-analysis. Pakistan journal of medical sciences, 35(4), p.1173.

Staff Writer

Ismail Munir

To Meat Or Not To Meat?

Research over the years has shown that a strict vegetarian diet excluding all animal fats can lead to vitamin B12 deficiency. Thus, increasing the risk of developing anemia. Newer research also suggests that a more lenient diet puts people at risk of developing <a href="https://www.merisehat.pk/disease/anemia">anemia </a>and heart disease.

There are various reasons behind people giving up eating meat and animal products (milk, cheese, and eggs). However, doing so might increase their risk of anemia, which is a potentially serious condition in which the body does not make enough red blood cells. For vegetarians, vitamin B12 deficiency anemia is typically caused because of eliminating meat from their diet. Similarly, for vegans, giving up all animal products including dairy, eggs, and even honey increases the risk of developing anemia.&nbsp; 
&nbsp;

Understanding Ways To Diversify Iron Sources In Vegetarian And Vegan Diets

A lack of vitamin B12 in your diet can cause pernicious anemia. The body needs vitamin B12 from foods such as meat, poultry, fish and eggs to make red blood cells. Pernicious anemia is a rare type of anemia in which the body is unable to absorb vitamin B12. The vitamin is only available in meat and animal products. While vegetarians who eat dairy and eggs are getting enough vitamin B12 through these sources, vegans must find other ways to include it in their diets, for example, through vitamin B12 supplements. 
&nbsp;

Vitamin B12 deficiency can boost the levels of homocysteine in the blood, a common amino acid that is associated with a higher risk of heart disease. Studies also suggest that the level of this amino acid can over time cause blockages in arteries and lead to heart disease or stroke. Vitamin B12, unlike B vitamins, is not found in any plant derived foods and fortified cereals. However, many types of meat and fish are abundant in vitamin B12. Thus, making it difficult for people following a strict vegetarian diet to get the necessary amount of vitamin B12. The answer is to eat a well-balanced diet and get the needed B12 from other sources, such as vitamin B12 supplementation, to prevent anemia.&nbsp; 
&nbsp;

Look for foods fortified with vitamin B12. Read the nutrition label on packaged foods. Some examples of processed foods that contain vitamin B12 are:&nbsp;

<ul>
	<li>Fortified rice&nbsp;</li>
	<li>Soy milk&nbsp;</li>
	<li>Grain products and cereal&nbsp;</li>
	<li>Meat substitutes</li>
	<li>Dietary supplements containing B complex&nbsp;</li>
	<li>Nutritional yeast&nbsp; 
	&nbsp;</li>
</ul>

Whether you are on a vegan or vegetarian diet, you need to create a healthy and balanced diet that includes enough vitamin B12 to prevent anemia. While fortified cereals are a good choice because of their good bioavailability, meaning it doesn&rsquo;t need to break down before the body absorbs them, vegetarians should consume the following foods on a regular basis:&nbsp;

<ul>
	<li>8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B12</li>
	<li>1 cup of low-fat milk can provide 1.2 mcg of vitamin B12</li>
	<li>1 oz of Swiss cheese can contain 0.95 mcg of vitamin B12</li>
	<li>1 large egg contains 0.6 mcg of vitamin B12</li>
</ul>

Nutritional yeast is also popular among vegetarians because of its rich, cheesy, and nutty flavor. The yeast can either be added to cooked meals or sprinkled on foods and snacks.

<div>
Since vegans avoid all animal-derived products, they may rely on vitamin B12 fortified breakfast cereals and nutritional yeast, as an alternative source of vitamin B12. For example, fortified non-dairy milk, meat substitutes, breakfast cereals, nutritional yeast, and vegan spreads. However, it is essential to read the labels of the foods as some may not be fortified in vitamin B12.&nbsp;

For those who are deficient in vitamin B12, supplemental vitamins in the form of capsules may be required.&nbsp; 
&nbsp;
</div>

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If you decide on taking a dietary supplement, there are some ground rules. A healthy body does not readily absorb all the vitamin B12 in a supplement. Food supplements should never be used as a substitute for a balanced diet and healthy lifestyle. Therefore, it is essential that you talk to your doctor or nutritionist to know the amount of vitamin B12 supplement that is right for you.&nbsp; 
&nbsp;

<ul>
	<li>Vegetarians and vegans need to take steps to make sure that they are including an adequate amount of vitamin B12 in their diet. Not maintaining proper levels of vitamin B12 increases the risk of developing anemia.</li>
	<li>Similarly, since there are no plant-derived foods that contain vitamin B12, it is essential to look into alternative sources, for example, fortified foods and vitamin B12 supplements.</li>
	<li>Speak with a healthcare provider for advice on how much you need to take and where to find sources of vitamin B12.</li>
</ul>

[1] Pawlak, R., Parrott, S.J., Raj, S., Cullum-Dugan, D. and Lucus, D., 2013. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews, 71(2), pp.110-117.

[2] Walsh, S., Appleby, P., Baron, L., Dallas-Chapman, G., Davis, B. and Harris, W., 2001. What every vegan should know about vitamin B12. Birmingham: Vegan Society.

[3] Watanabe, F., Yabuta, Y., Bito, T. and Teng, F., 2014. Vitamin B12-containing plant food sources for vegetarians. Nutrients, 6(5), pp.1861-1873.

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

I'm A Heart Patient - Are Oral Contraceptive Pills Safe For Me?

Dialogues concerning sexuality, reproductive health, contraception, and sexually transmitted illnesses (STIs) are limited worldwide. One of the biggest reasons for these decreased dialogues is the fear of spreading indecency among the younger population. Unfortunately, the failure to discuss these topics has had a great impact on public health and led to an increase in the prevalence of abortions and STIs, such as HIV, in the country. The current abortion rate in Pakistan stands at 50 per 1,000 women aged 15-49 years; one of the highest in the world<a href="#accordion">[1]</a>.

The lack of education on such topics also means that both men and women are generally unaware of reproductive health issues. Moreover, the lack of knowledge and awareness of contraception increases the risk of teenage pregnancies, unplanned pregnancies, and unsafe abortions. Thus, resulting in poor health outcomes for both mother and child.&nbsp;

As per estimates, only 35% of married women of reproductive age in Pakistan, use some form of contraception<a href="#accordion">[1]</a>. Condoms are the most common method of contraception, followed by pills and withdrawal methods<a href="#accordion">[2]</a>. Although the use of oral contraceptive pills has increased over the years, there is still poor knowledge of the drug&#39;s effects. This lack of awareness can lead to the misuse of these medications, leading to adverse effects in at-risk individuals for e.g. women with existing cardiovascular disease (CVD) are often at a higher risk of these side effects.&nbsp;

Across Europe and the world, CVD accounts for a majority of deaths in women, while contrastingly in Pakistan, men and women are at an equal risk of coronary artery disease<a href="#accordion">[3]</a>. Due to the high prevalence, it is important that women are aware of the risks associated with using oral contraceptives with pre-existing heart conditions.&nbsp;

&nbsp;

Oral contraceptive pills (OCPs) are often the most popular option among users. They range in effectiveness from 89-99%. They are of two types: combined estrogen-progesterone and the progesterone-only pill. While both are a form of birth control, they can also be used for treating medical conditions such as endometriosis, <a href="https://www.merisehat.pk/disease/polycystic-ovary-syndrome-pcos">polycystic ovary syndrome (PCOS)</a>, and other menstrual disorders.

&nbsp;

1. Combined Oral Contraceptive (COC) - These contain a combination of the hormones, estrogen and progesterone that help prevent ovulation; thus, preventing pregnancy. The pills may contain the same dose of the hormones (monophasic), or varying weekly doses of both or either component (multiphasic). A single packet typically contains 21 pills that are taken over a 28-day period and 7 placebo pills for menstruating days. Although they have a generally safe profile, nausea, vomiting, weight gain, fluid retention, and bloating are common side effects of drug use. However, in some cases, they can also cause other severe side effects, such as:

<ul>
	<li>Increased risk of blood clots</li>
	<li>Hypertension</li>
	<li>Increased risk of stroke and myocardial infarction</li>
</ul>

These drugs are usually contraindicated in smokers and those older than 35 years of age.

&nbsp;

2. Progestin-Only Pill (POP) - Unlike COCs, these only contain a synthetic progestin. The lack of estrogen reduces the risk of adverse side effects such as thromboembolism, stroke, or cardiovascular diseases. However, it can cause breast tenderness, heavy bleeding, mood swings, anxiety, and weight gain among users. POPs are typically prescribed to women who cannot have COCs or estrogen-containing compounds.

3. Emergency Contraception Pill (ECP) - Also called the morning-after pill, it may contain higher doses of the hormone estrogen, progestin, or both. They help delay ovulation or fertilization and are commonly used following unprotected sexual intercourse or a condom breakage. However, they are not meant for regular birth control.

Understanding The Correct OCP For Heart Patients

Doctors usually prescribe contraceptive methods based on a patient&#39;s health and preference. As per current guidelines, doctors must weigh the risks and benefits for each patient prior to selection of contraception.&nbsp;

Women with cardiac disease are not only at a higher risk of maternal death during pregnancy, but also complications such as stillbirth, preterm delivery, or intrauterine growth restriction. Due to the high incidence of unplanned pregnancies, it is important that these women are counselled on effective and safe contraceptive options. Moreover, they are more likely to develop adverse effects to oral contraceptives. Therefore, caution is practiced when prescribing them pills or other contraceptive options.&nbsp;

OCP use among smokers older than 35 years of age is associated with a significantly higher risk of cardiovascular side effects such as deep vein thrombosis. As per estimates, such women have a ten-fold increased risk of myocardial infarction<a href="#accordion">[4]</a>. Therefore, women older than 35 are typically assessed for risk factors such as CVD, hypertension, diabetes, and kidney disease prior to use.&nbsp;

Compared to non-users, combined oral contraceptive users have a much higher risk of myocardial infarction and stroke. Moreover, women with pre-existing hypertension have a 9-16% chance of exacerbation when using OCPs<a href="#accordion">[4]</a>.

&nbsp;

Ideally, contraception is meant to be safe, effective, and protect against sexually transmitted infections. However, no one method can guarantee all three.&nbsp;

&nbsp;

<ul>
	<li>Barrier Methods - These methods are all safe for cardiac patients; however, they have a high failure rate. Therefore, should not be prescribed in cardiac patients to avoid pregnancies.&nbsp;</li>
	<li>Combined Oral Contraceptive Pill - Due to the estrogen component, COCs are associated with multiple risks to women with cardiovascular disease. Therefore, women with CVD risk factors and existing heart disease are not prescribed COCs.</li>
	<li>Progestin-Only Pill - In women with an increased risk of thromboembolism, POPs are usually the preferred option. They are generally considered safe for all CVD patients. However, they can interfere with warfarin metabolism and decrease its therapeutic role. Therefore, careful monitoring of INR is required in such patients.&nbsp;</li>
	<li>Depo-Provera Injection - These injectable contraceptives last 12 weeks and are very effective. However, discontinuation causes a rapid return to fertility. Moreover, it can put patients at risk of ischemic heart disease.</li>
	<li>Mirena Intra-uterine Device (IUD) - Although extremely effective, its insertion can induce a vasovagal reaction in 5% of patients, and lead to a cardiovascular collapse<a href="#accordion">[5]</a>. It is contraindicated in women with pulmonary vascular disease and those at high risk of endocarditis.&nbsp;</li>
	<li>Hormonal Implants - Subcutaneous progestogen implants are highly effective and work as a form of sterilization. Moreover, they have no cardiac contraindications.</li>
</ul>

&nbsp;

According to the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[6]</a>. There are several barriers to contraceptive use among Pakistani women of reproductive age. These range from religious factors, and lack of access to low socioeconomic status. Although oral contraceptive pills are commonly used as a form of birth control, there are a lot of misconceptions regarding infertility and weight gain that further limits their use.&nbsp;

The lack of dialogue around sexual and reproductive health has left a huge majority of Pakistani women unaware of their health condition and the best health options for their bodies. Moreover, in Pakistan, there is a high prevalence of cardiovascular diseases among women. This puts them at an even higher risk of pregnancy complications; thus, emphasizing the need for better contraceptive methods for these individuals.&nbsp;

Currently, progestin-only pills and hormonal implants are considered the most effective and safe contraceptive options for women with CVD. However, newer formulations of oral contraceptive pills with lower overall risk are being developed. These are expected to help lower blood pressure in users and prevent weight gain.&nbsp;

For now, the best method is to weigh all benefits and risks associated with a particular method before use. Moreover, women should be counseled on the various options available to them and the adverse effects associated with these options.&nbsp;

&nbsp;

<ul>
</ul>

<ul>
	<li>In Pakistan, only 35% of married women of reproductive age practice some form of contraception.</li>
	<li>The stigma surrounding sexual health has placed several barriers for women to access safe contraception methods in the country.</li>
	<li>The lack of awareness of various contraceptive methods has led to an increase in abortions and sexually transmitted infections among the younger population.</li>
	<li>Due to their overall safety profile, easy availability, and high effectiveness oral contraceptive pills are mostly prescribed to women. The two common oral contraceptives include the progestin-only pill and the combined oral pill.</li>
	<li>Despite the overall safety profile, OCPs can increase the risk of several side effects, especially among women with a cardiovascular disorder.</li>
	<li>Women with existing cardiac disease are at a higher risk of maternal death during pregnancy, and complications such as preterm birth, growth restriction, and stillbirth. Therefore, there is a greater need for safe and effective contraceptive methods for these high-risk individuals.&nbsp;</li>
	<li>COCs increase the risk of stroke, thromboembolism, and myocardial infarctions. Therefore, they are contraindicated in smokers above 35 years of age and women with CVD risk factors or existing cardiac disease.</li>
	<li>POPs and hormonal implants are generally considered safe and effective in cardiac patients.</li>
	<li>Newer contraceptive pills are being developed that are expected to have a lower overall risk for cardiac patients.</li>
</ul>

&nbsp;

[1] Siddiqui, M. et al., 2020. Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10).

[2] Mushtaq, K., Ashraf, M. & Thaver, I. H., 2020. Who are the women wishing to opt for contraception?. Journal of the Pakistan Medical Association, 70(12).

[3] Jafar, T. H., Jafary, F. H., Jessani, S. & Chaturvedi, N., 2005. Heart disease epidemic in Pakistan: women and men at equal risk. American Heart Journal.

[4] Cooper, D. B., Patel, P. & Mahdy, H., 2022. Oral Contraceptive Pills. s.l.:StatPearls Publishing.

[5] Kaminski, P., Szpotanska-Sikorska, M. & Wielgos, M., 2013. Cardiovascular risk and the use of oral contraceptives. Neuro Endicrinology Letters.

[6] Hudsmith, L. & Thorne, S., 2007. Contraception in women with cardiac disease. Women's Health, 3(6), pp. 711-717.

[7] Meherali, S., Ali, A., Khaliq, A. & Lassi, Z. S., 2021. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000 Research, Volume 10.

Nimrah H. Sattar

How Do I Boost My Iron Levels?

Iron is an essential mineral that your body uses to make hemoglobin. Iron is also an essential mineral for growth and development. There are two types of iron in food: animal-derived and plant-derived. While there is enough iron available in our food sources, it can also be taken as a supplement.

Understanding Ways To Treat Iron Deficiency Anemia

Studies have shown that the average amount of iron is 8.7 milligrams per day for men and 14.8 milligrams per day for women. The requirement for iron in vegetarians and vegans is 1.8 times more than in people who eat meat.&nbsp;

&nbsp;

You need iron to function properly. A lack of iron in your diet will lead to iron deficiency. Iron plays an important role in different bodily functions; it is an essential nutrient needed to form hemoglobin and carry oxygen in your blood to organs and tissues. This is important for optimal heart health, immune function, and respiratory functions.

&nbsp;

<a href="https://www.merisehat.pk/disease/anemia">Anemia</a> occurs when the body does not have enough red blood cells to carry oxygen to the body&rsquo;s organs and tissues. There are different types of anemia, but iron-deficiency anemia is the most common type of anemia in developing countries. According to the World Health Organization, 1.62 billion people are estimated to be affected by anemia worldwide.&nbsp;

&nbsp;

Low levels of iron can further lead to iron deficiency anemia. The symptoms of anemia include:&nbsp;

<ul>
	<li>Fatigue&nbsp;</li>
	<li>Weakness&nbsp;</li>
	<li>Pale and yellow skin&nbsp;</li>
	<li>Shortness of breath&nbsp;</li>
	<li>Lightheadedness&nbsp;</li>
	<li>Chest pain&nbsp;</li>
	<li>Cold hands and feet&nbsp;</li>
	<li>Headaches&nbsp;</li>
</ul>

&nbsp;

There are some types of anemia that are inherited and cannot be prevented, for example, sickle cell anemia, hemolytic anemia, and aplastic anemia.&nbsp;

However, anemia caused because of iron deficiency, vitamin B12, and vitamin B9 deficiency, can be prevented by eating well. This includes eating foods that provide enough iron and vitamins, in addition to vitamin C food sources, because it helps with the absorption of iron. Studies have also shown that drinking enough water helps keep hemoglobin levels up.

Moreover, daily iron supplementation may increase hemoglobin levels, and decrease the risk of anemia in infants, school-aged children, and pregnant and non-pregnant women. Foods fortified with iron and improving overall diet also have benefits in reducing the risk of developing iron-deficiency anemia.

There are some types of anemia that are short-term and mild. However, others can affect you throughout your life. There are several ways to manage anemia, including:

<ul>
	<li><a href="https://www.merisehat.pk/article/anemia-best-meals-for-boosting-iron">A healthy, well-balanced diet</a></li>
	<li>Stay hydrated</li>
	<li>Regular exercise</li>
	<li>Avoid&nbsp;exposure to chemicals that trigger anemia</li>
	<li>Visiting the dentist regularly because anemia increases the risk of tooth decay and gum disease</li>
	<li>Keep track of your symptoms and talk to your doctor about any changing symptoms</li>
</ul>

&nbsp;

If you have anemia, it is important to make good food choices. For example, avoid junk foods because it means adding calories to your diet without getting any essential nutrients. In addition, some foods impair the absorption of iron. Therefore, it is important to make the right food choices.

Here are some foods you should avoid:&nbsp;

<ul>
	<li>Coffee, tea, and other tannin-containing products, such as some spices</li>
	<li>Egg whites</li>
	<li>Fiber, but not all of it because some iron supplements may cause constipation</li>
	<li>Soy protein</li>
	<li>You should not be taking calcium with iron supplements because it impairs its absorption</li>
</ul>

&nbsp;

Here are some foods you should eat:

<ul>
	<li>Whether you eat meat or not, you should generally eat iron-rich foods, such as lentils, spinach, and pistachios.&nbsp;</li>
	<li>You can also get protein from different kinds of meat, like lean beef and turkey. There are some iron-fortified foods also available for vegans and vegetarians.&nbsp;</li>
	<li>It is also important to incorporate citrus fruits, berries, and other vitamin C-containing foods such as peppers and tomatoes in your diet to improve iron consumption.</li>
</ul>

&nbsp;

Consult with a healthcare provider to help with your iron intake, and do what works best for you.&nbsp;

&nbsp;

Madeeha Syed

The Truth Behind Vaping

Overview

A quick google search will tell you about the abundance of vaping lounges and cafes all across the country. There are tons of resources from where you can buy vaping salts, oils, cartridges etc. An e-cigarette here, a juul pod there can be easily located at most social gatherings. This makes one wonder what this new craze is about. Is it just a novel trend or is there more behind this phenomenon? 
&nbsp;

Truth Behind Vaping

The process of consuming a regular cigarette is called smoking since you&rsquo;re inhaling smoke. In that vein, the term vaping is based on the inhalation of vapor. Where does this vapor come from?&nbsp;

The answer lies in the intricate mechanics of an e-cigarette. It has a tank which you fill with a liquid solution (e-liquid/vape-oil/vape juice, etc.) and a rechargeable battery that powers the atomizer. The atomizer heats the liquid and turns it into vapor. This vapor delivers nicotine (and so much more!) into your system.&nbsp;

In most countries, especially the third world, the manufacture of e-cigarettes is not regulated. This means almost any substance can be added to the vape oil. Nicotine and humectants such as propylene glycol and glycerin are usually the main components. Scents, flavours, psychoactive substances, such as THC, and sometimes even trace amounts of alcohol may be present.&nbsp; 
&nbsp;

We all know smoking is a vice. The widespread scorn for smoking is rightfully backed by a ton of peer-reviewed medical literature. But there was a time when it was actually cool to have a cigarette dangling from your lips. The downfall of smoking came once several major medical reports found a strong association of smoking with <a href="https://merisehat.pk/disease/lung-cancer-67" target="_blank">lung cancer</a>.&nbsp;

Ever since then, people who want to quit smoking have been looking for alternate ways to satiate their nicotine cravings. Nicotine patches, gums or medicines (Bupropion, Veranicline, Wellbutrin) are commonly used for this purpose. One of the most exciting prospects on this front was the introduction of e-cigarettes back in 2002. Slowly gaining popularity, we saw a sudden surge in e-cigarette users between 2011 and 2021 when number of users went from a mere seven million to a whopping 68 million. Most of these users were women and young adults.&nbsp;

Several studies have demonstrated that vaping can not only be helpful for kicking the smoking habit, but also people who used this method to quit also showed fewer withdrawal symptoms. 
&nbsp;

There is widespread consensus in the medical community that vaping still fares better than smoking when it comes to its side-effects profile. This is mostly because of it being a newer phenomenon. We haven&rsquo;t been able to collect enough data to fairly make this judgment.&nbsp;

What we do know so far already makes it sound like something you should either stay far away from or at least employ some discretion with. In 2019, many American officials were already calling it a national health crisis when several teens were rushed to the hospital for life-threatening conditions linked to vaping.&nbsp;

The market leader for e-cigarettes, Juul, was banned by the FDA when they failed to back up their claims that their products lead to smoking cessation. They were also charged with encouraging teenagers, and some of their vape pods were found to have a whole pack worth of nicotine in them.&nbsp;

Now, some of the major side-effects of vaping are:&nbsp; 
&nbsp;

Acute Lung Injury: With the rise of its popularity, vaping has managed to increase hospital admission due to a disease called EVALI (e-cigarette or vaping-product use associated lung injury). These patients usually present with pneumonia and leave doctors baffled at the lack of association with the usual causes of pneumonia.&nbsp;

Symptoms like fever, chills, cough, where some blood might also come up, are usually noted. A little digging usually leads to a history of vaping. Upon further investigations, the damage was linked to a thickening substance used in THC vaping products called Vitamin C acetate. Our lung cells are not designed to process this thick oily substance, so an inflammatory reaction is the next best thing they can do.&nbsp;

This is the current working hypothesis we have. Researchers are still looking into more reasons for why this might be happening. Outbreaks of EVALI have mostly been limited to the North American region. Isolated cases in countries like Canada, Japan, UK and Mexico failed to establish a correlation between disease presentation and vaping while some also predated the outbreak.&nbsp; 
&nbsp;

Nicotine Addictions: Increased blood pressure and heart rate, spikes in adrenaline, narrowing of blood vessels are all effects of nicotine that add to the likelihood of a heart attack. However, not all e-cigarettes contain nicotine. 
&nbsp;

Harmful Chemicals: Diacetyl is a compound used to formulate flavors for vape oils. It has been linked to popcorn lung (bronchiolitis obliterans) in factory workers. Now imagine putting that directly into your lungs! Heavy metals such as nickel, tin, lead and ultra-fine particles also cause irritation.&nbsp; 
&nbsp;

Detrimental For Brain Development: Nicotine is not just addictive, but hinders normal brain development. The part of our brain known for processing learning, memory, and attention and impulse control suffers as a result. This eventually leads to a long-term sequela of disordered cognition. 
&nbsp;

It&rsquo;s Not Just The Lungs: Owing to how the human body is designed and functions, inhaling anything means delivering it to each and every cell and organ. It causes nausea, vomiting, diarrhea and stomach aches. Sore throats, bad breath, ulcers, dry mouth, bleeding gums are also common. 
&nbsp;

Bottom Line

Traditional cigarettes have cadmium, arsenic and hydrogen cyanide with the potential to kill half the people who smoke them. E-cigarettes have roughly the same number of toxic substances. Research has shown that 90% of smokers couldn&rsquo;t quit smoking by replacing it with vaping, and a meta-analysis published in The Lancet established that adults who vape were 28% less likely to stop.&nbsp; 
 
Although branded as an alternative to cigarette smoking, most people, especially teens, are stumbling upon vaping at the start of their smoking journey. Much of the marketing around vaping is similar to what tobacco companies were telling the general public back in the day.&nbsp; 
 
The crackdown by American authorities on vaping and related products also means that promotional efforts have been doubled in developing nations such as Asia and Africa. If you are an adult trying to quit smoking,&nbsp;then this might be a good option for you but there are far healthier ones as well. Be vigilant about THC vaping products, buy from legitimate resources, avoid exposing yourself to products there&rsquo;s not much evidence for or against and in the best-case&nbsp;scenario just don&rsquo;t do it.

Dr. Safia Mehmood

Humza Khizer

Should I Be Anxious About My IBS?

<a href="https://www.merisehat.pk/disease/irritable-bowel-syndrome-62">Irritable Bowel Syndrome (IBS)</a> is defined as a type of gastrointestinal condition that causes problems in the digestive system. IBS affects 10 to 15 percent of the world&rsquo;s population. However, the symptoms are different for every person. While IBS is not a life-threatening condition, it can have a significant impact on one&rsquo;s well-being by affecting one&rsquo;s quality of life. The situation worsens when a person suffers from anxiety and IBS.

&nbsp;

Understanding Link Between Anxiety And IBS

Anxiety disorders is an umbrella term used for general anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. A shared symptom of these disorders is excessive worry or anxiety.&nbsp; Physical symptoms of anxiety disorders include fast heart rate, sweating and fatigue. This may interfere with one&rsquo;s ability to get through normal everyday activities.&nbsp;

&nbsp;

IBS is a disorder of the digestive tract that causes abnormal bowel movements. Unlike Crohn&rsquo;s disease or ulcerative colitis, the physical structure of the digestive tract is unaffected, i.e. IBS is not a functional disorder. Common symptoms of IBS include diarrhea, constipation, and abdominal pain. Anxiety disorders affect more than a third of all U.S. adults while IBS affects 7% to 21% of the U.S. population. However, there is no reliable data for how many people experience both anxiety disorder and IBS. Some studies have shown that anxiety disorders are more common in people with IBS. According to a study assessing the prevalence of anxiety disorders and IBS, 44% of people with IBS had an anxiety disorder, compared to 8% of people without IBS.&nbsp;

&nbsp;

According to scientists, the mind and gut are intertwined. This is what scientists refer to as the gut-brain axis, which is a two-way signaling system between the gut and the brain. In response to our thoughts, feelings, and environment, our bodies release chemicals that affect different processes in our bodies. However, in the case of anxiety and IBS, whenever you feel anxious, your body releases stress-related chemicals in the gut causing inflammation leading to abnormal bowel movements, abdominal pain, and a change in gut bacteria.

Additionally, a poorly functioning gut has also been linked with mental health problems. Scientists explain that this is because our brain depends on the chemicals and hormones made by the bacteria in the gut for e.g. 90% of the serotonin (which is an important chemical that controls our mood and keeps anxiety levels low) is produced in our gut. Mental health problems are associated with increased and decreased production of serotonin.&nbsp;

&nbsp;

Unfortunately, the causative factors of IBS have yet to be elucidated. However, there is reason to believe that it may depend on a person&rsquo;s mental health. Anxiety and other health conditions may trigger IBS.&nbsp;

Certain other risk factors may increase one&rsquo;s risk of IBS, including:&nbsp;

<ul>
	<li>Having a family history of IBS&nbsp;</li>
	<li>Females are at a higher risk of developing IBS than males</li>
	<li>Being younger than 50 years of age</li>
	<li>History of severe gut infections&nbsp;</li>
	<li>Chronic psychological stress either caused by traumatic life events or alcohol addiction&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Certain medications that cause changes in the gut bacteria</li>
</ul>

&nbsp;

Studies have shown that keeping stress under control can help prevent or ease the symptoms of IBS. This is because the gut has a brain of its own, known as the enteric nervous system which is why you get butterflies in your stomach when you are nervous. Also, this &ldquo;second brain&rdquo; of yours also controls how food is digested. This second brain is in constant communication with your brain via the gut-brain axis. Thus, this connection can help manage your IBS. You can try and get rid of the tension by incorporating simple things in your daily routine, for example, going shopping, listening to music, reading, or talking to a friend. Other ways to alleviate stress and anxiety include:

&nbsp;

<ul>
	<li>
	<h5>Exercise&nbsp;</h5>
	</li>
</ul>

Exercising, for example, walking, swimming, running or other such physical activities can help you cope with anxiety and depression. Exercise also helps with normal bowel contractions.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Mind-Body Exercise, Mindfulness, And Meditation&nbsp;</h5>
	</li>
</ul>

Meditation can help trigger your body&rsquo;s relaxation response. You can either sign up for meditation, breathing or yoga classes offered online or in person. They will help you manage stress by targeting the gut-mind connection and changing the way you think.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Relaxation Exercises&nbsp;</h5>
	</li>
</ul>

Relaxation techniques, such as deep breathing, can help you feel calmer. The purpose of relaxation techniques is to learn about visualization and to imagine a peaceful scene. These techniques will also help you get enough sleep and eat well. You can also consider joining a self-help group for people with IBS or other digestive disorders. Members of the group will know what it is like to deal with IBS and may also be able to offer more meaningful support that you may not be able to get from even your closest friends.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Diet And Lifestyle Changes&nbsp;</h5>
	</li>
</ul>

The food we eat has a huge impact on our overall health. Your stomach and intestines are some of the first organs that feel the effect of the food you are eating. For treating IBS, you must start with your diet. There are specific foods that can trigger the symptoms of IBS. However, these triggers differ for everyone. Maintain a food/bowel movement journal wherein you can write about how different foods affect your bowel movements. This journal could also be helpful for discussing treatment options with your doctor. Research shows that avoiding certain foods can help prevent symptoms of IBS:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Gas-Producing Foods</h5>
	</li>
</ul>

People with IBS are more sensitive to foods that make a person gassy for example, beans, bananas, and brussel sprouts. These foods may trigger discomfort after eating them.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Dairy&nbsp;</h5>
	</li>
</ul>

Even if lactose is not an issue for you, you may be sensitive to other milk proteins due to your IBS.&nbsp; Try using dairy-free alternatives, such as soy or oat milk to ease bloating and other stomach issues.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Foods High In FODMAPs</h5>
	</li>
</ul>

Foods high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are short carbohydrates, such as fructose and sorbitol that appear in many fruits, vegetables, honey, and wheat. Studies have shown that these FODMAPs can linger in our guts, absorb water, and ferment, which can then cause irregular bowel movements. If you struggle with constipation, then it is recommended you stay well hydrated and eat 4-5 small meals regularly rather than eating 3 large meals a day. A diet high in fiber and soluble fiber, such as psyllium may also be helpful. Similarly, alcohol, tobacco, and caffeine aggravate symptoms of both IBS and anxiety, so reduce their consumption.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Cognitive Behavioral Therapy&nbsp;</h5>
	</li>
</ul>

Studies have shown that cognitive behavioral therapy is an effective treatment for IBS. However, before starting with CBT, practitioners need to rule out alternative diagnoses. The most important medical conditions to rule out include inflammatory bowel disease, Crohn&rsquo;s disease, and celiac disease. Baseline blood and stool tests are generally enough to rule out these conditions. The next step is to educate the patient about the gut-brain link and how stress can directly impact gut health.

The CBT practitioner will first help train the patient in relaxation techniques including deep belly breathing. Once the patients are able to use the relaxation techniques CBT is introduced. The focus of CBT is to educate the patient that the beliefs that affect our emotions negatively can be baseless. For example, if a person is embarrassed to go to the bathroom in a public place, it can be helpful to send them to a movie theater and have them sit at the back of the theater to count the number of people who get up to use the bathroom and return. The patient will be able to see two things: the frequency of people getting up to use the bathroom and the lack of reaction towards this behavior by the surrounding people. This will help the patient understand that it is not a big deal to get up and use the bathroom.&nbsp;

Similarly, CBT exposure therapy focuses on patients overcoming their fear of doing things that they have been avoiding. For example, if a person is afraid of long car trips, make them sit in a parked car for thirty minutes. Once this gets boring, drive them around the area. Once this gets easy, drive them a mile away from home and back. If the patient worries about not being able to &ldquo;hold it&rdquo;, experiment with them to &ldquo;hold it&rdquo; for 30 seconds, then a minute, and then 5 minutes. This will prove that they can hold it and worry is unnecessary.

&nbsp;

<ul>
	<li>
	<h5>Medications&nbsp;</h5>
	</li>
</ul>

If diet and lifestyle changes are not enough to curb the problem of anxiety and IBS, many medications will help relieve symptoms.

<ul>
	<li>Metamucil, or soluble fibers available over the counter, for constipation relief.</li>
	<li>Miralax helps pull water into the intestines and encourages bowel movements.</li>
	<li>Medications approved by the FDA for IBS-related constipation, Amtizia, Linzess, and Zelnorm.&nbsp;</li>
	<li>Antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors.</li>
	<li>Imodium is a popular over-the-counter medication that slows down gut and bowel movements and treats IBS-related diarrhea.&nbsp;</li>
	<li>Antispasmodics relax the muscles of the digestive system and relieve IBS-related abdominal pain.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Although there is no clear answer as to how anxiety affects your IBS or vice versa, both conditions are triggered by many different factors.</li>
	<li>If you have IBS, then there are many treatment options (medications, cognitive behavior therapy, etc.) and lifestyle changes that have been shown to help relieve symptoms and stress.&nbsp;</li>
	<li>You can discuss these treatment options with a healthcare provider and implement whatever works best for you.</li>
</ul>

&nbsp;

[1] Banerjee, A., Sarkhel, S., Sarkar, R. and Dhali, G.K., 2017. Anxiety and depression in irritable bowel syndrome. Indian journal of psychological medicine, 39(6), pp.741-745.

[2] Locke, G.R., Olden, K., Peterson, W., Quigley, E., Schoenfeld, P., Schuster, M. and Talley, N., 2002. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol, 97, pp.S7-26.

[3] Camilleri, M., 2018, December. Management options for irritable bowel syndrome. In Mayo Clinic Proceedings (Vol. 93, No. 12, pp. 1858-1872). Elsevier.

[4] Johns Hopkins Medicine: "The Brain-Gut Connection."

[5] U.S. National Library of Medicine: "Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment."

Cholera Outbreaks – Prevention Strategies For Locals (Pakistan)

When a disease spreads in an area, it can be reduced through early detection and case confirmation. It should be followed by an appropriate and well-coordinated multisectoral response. Moreover, for a rapid response to outbreaks, countries under the effect of <a href="https://www.merisehat.pk/disease/cholera">cholera</a> should plan in accordance.

&nbsp;

Understanding Cholera Prevention Strategies In Pakistan

The common sources are:

<ul>
	<li>Contaminated water sources, which are used in cooking and washing food. It can also happen during storage, for example, through feces or cholera-soiled hands.</li>
	<li>Fecal contamination of water that we drink through unprotected wells, standpipes, and boreholes. This can happen during transport and supply, as well as when the water is being supplied.</li>
	<li>Washing uncooked food with contaminated water. Making drinks with contaminated water that is not boiled, or making ice with contaminated water.</li>
	<li>If the food is contaminated with V. cholerae and left at room temperature for hours, it can provide an environment for the growth of cholera.</li>
	<li>Contaminated seafood or seafood that hasn&rsquo;t been cooked sufficiently.</li>
	<li>Fruits and vegetables are grown in contaminated soil, and irrigated with water that consists of human waste. Even rinsing it with contaminated water and eating it raw can put you at risk of cholera.</li>
	<li>The other source of contamination is the bodies of people who have died from cholera, similar to the unfortunate <a href="https://www.merisehat.pk/disease/covid-19">COVID19</a> situation.</li>
	<li>Members of the same community are at risk if someone in their area has cholera. This especially applies to people who live in the slums in Pakistan.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>The epidemic of cholera is controllable, if the people who have been diagnosed take the necessary precautions against the causes mentioned earlier.&nbsp;</li>
	<li>Developed and harmonized&nbsp;messages via mobile networks can ensure the prevention of cholera. Furthermore, surveys and outreaches can determine people&rsquo;s knowledge about it, while simultaneously raising awareness about the disease.</li>
	<li>The message should be about the ongoing cholera outbreak, and guide people on how they should wash their hands, chlorinate, or boil water, with guidance on the preparation of ORS.</li>
	<li>Adaptation of messages based on local cultural beliefs about the disease and implementation of control based on that. For example, chlorinated soap isn&rsquo;t easily available in Pakistan, so other alternatives can be recommended.</li>
</ul>

&nbsp;

&nbsp;

<h5>Safe Drinking Water</h5>

It is essential that people have access to safe drinking water, so the spread of the disease is reduced in the community. If possible, safe drinking water should be provided to people whose areas are at high risk of cholera.

Even when the water to drink is safe, it can still be exposed to cholera and contaminated during transport. Hence, start with an improved source of water and ensure safe collection and handling. Analyzing the context can determine which method is best for treating water and select it accordingly. The treatment methods include disinfection, chlorination, and filtration. It can be chosen based on the available techniques. Moreover, combining treatments can increase effectiveness.

Although in places with high turbid water, pre-treatment may be needed to remove suspended particles. In addition to reducing the turbidity before disinfection chlorination. A turbidity tube can test the turbidity levels.

However, if the quality of water does not have a guarantee, which is very common in Pakistan, it needs to be disinfected when used. For example, boil the water you drink for at least one minute, use filters, get a dispense, and store containers for boiled water.

&nbsp;

<h5>Household Water Treatment</h5>

Various methods are available for treating household water, for example, disinfection, boiling, filtration, and chlorination.&nbsp;

Make sure that people understand the importance of household treatment techniques and the effects of chlorine resides if they use it. Furthermore, to facilitate preparing household water correctly, ensure that the containers are the right size. It is preferred that they are narrow-mouthed and closed. Water quality is also important in houses where chlorine is being used for water treatment.

The collection, transport, and handling of water should also be safe. To ensure water quality, it should be monitored regularly for the minimization of microbial regrowth. Other than the type of preferred containers, they should be cleaned regularly to prevent contamination while refilling and extracting water.

Ensure the cleanliness of the drinking water. Keep it covered at all times.

&nbsp;

<h5>Safety Measures For Healthcare Workers</h5>

Healthcare workers should be guided in teaching their patients the importance of clean water. They should also be educated about maintaining hand hygiene while filling and extracting water. It reduces the risk of contamination.

Community development in addition to monitoring can also provide access to safe water for cholera prevention.

&nbsp;

It is important to prepare food safely to prevent and reduce the transmission of cholera within a community. The food can be contaminated during production, preparation, and consumption. Safe and hygienic food preparation should be a part of the healthy hygiene program.&nbsp;

Street food is very common in Pakistan and people indulge in eating it regularly. But since the food is not always hygienic, it can make you sick. Moreover, if proper sanitation is not followed, it can spread cholera.&nbsp;

Pakistan Food Authority can introduce stringent food safety laws and inspection of restaurants (increased frequency). Food vendors should be educated on the consequences of unsafe food practices, so they may avoid them in the future. Moreover, agricultural practices should also be taken into consideration, e.g., sewage water should not be used to irrigate crops.

Reinforce practicing safe preparation of food. Furthermore, hand hygiene and washing hands before eating food should also be reinforced. Soap and safe water should also be available in markets selling food.&nbsp;

&nbsp;

Faeces should be isolated to stop them from contaminating food and water with faecal matter. This can be ensured by improving access to sanitation facilities. For example, latrines should be in places where they will not contaminate the water that people drink or the source of drinking water. It should be at least thirty meters away from any source of drinking water. In addition, it should be two meters above groundwater.

Open defection should be discouraged. People need to be taught about using the restrooms, especially in lower socio-economic areas where access to bathrooms is limited. Moreover, if latrines need to be emptied, avoid doing so during cholera outbreaks or take the necessary precautions. It should also be ensured that the waste is disposed of safely.

Furthermore, healthcare workers should also ensure that washing their hands after defecation is important. They should also wash their hands after making their kids use the latrine.

&nbsp;

Thousands of people in central Pakistan have been infected by the deadly cholera outbreak as the country is also suffering from a water crisis. The crisis has been exacerbated because of the heatwave in South Asia.

The temperatures have increased drastically in Pakistan and other parts of Asia recently, putting millions of people at risk of climate change.

The first case of cholera was identified in Pir Koh, which is a mountainous area in the province of Balochistan on 17th April 2022. According to Dr. Ahmed Baloch from the health department of Balochistan, since then, more than two thousand people have become infected and died.&nbsp;

Due to the lack of rain, the ponds have dried up and there is no access to clean drinking water. The ponds have dried up in most areas and the only source of water to drink is from the pipelines, which are rusted and contain contaminated water. The residents are forced to drink dirty water.

The cholera outbreak is transmitted by consuming dirty food and water, which is contaminated by fecal material infected with V. cholerae.&nbsp;

Scientists have warned of the impact of climate change, and have told people that rising temperatures can cause the spread of the cholera pathogen<a href="#accordion">[1]</a>. The outbreak is happening because Pakistan is facing a serious water crisis. Climate change has a severe impact on the health of humans.

&nbsp;

<ul>
	<li>To prevent yourself from getting cholera, make sure you drink water that is boiled or filtered. Do not eat raw seafood, and fruits and vegetables that have been washed with water that is not clean. If it is not possible to boil water, chlorine tablets should be used.&nbsp;</li>
	<li>Healthcare workers should also advise their patients about the importance of clean water and hygiene.</li>
	<li>Do not pass your stool in any kind of water. If you don&rsquo;t have access to a latrine, bury it in the soil.</li>
</ul>

&nbsp;

[1] Asadgol, Z., Mohammadi, H., Kermani, M., Badirzadeh, A. and Gholami, M., 2019. The effect of climate change on cholera disease: The road ahead using artificial neural network. PloS one, 14(11), p.e0224813.

[2] D’Mello-Guyett, L., Gallandat, K., Van den Bergh, R., Taylor, D., Bulit, G., Legros, D., Maes, P., Checchi, F. and Cumming, O., 2020. Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: a scoping review of current international guidelines. PLoS One, 15(1), p.e0226549.

[3] Morris Jr, J.G. and Black, R.E., 1985. Cholera and other vibrioses in the United States. New England Journal of Medicine, 312(6), pp.343-350.

[4] Colwell, R.R., 1996. Global climate and infectious disease: the cholera paradigm. Science, 274(5295), pp.2025-2031.

[5] Mendoza, C., Meites, E., Briere, E., Gernay, J., Morgan, O., Monegro, N.R. and Hospital Preparedness Working Group, 2011. Preparing health care workers for a cholera epidemic, Dominican Republic, 2010. Emerging Infectious Diseases, 17(11), p.2177.

Help! I Think I’M Having An Angina Attack

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. 
&nbsp;

Whether we talk about the first wheel from 4000 B.C or the Roomba of the 21st century, all human inventions are focused on making our lives easier. As inventors, we tend to create things that can help us do the same work more efficiently, and with less effort. Even something as simple as getting up to switch off the lights can now be done with a single tap on the phone, all from the comfort of your bed.&nbsp; 
&nbsp;

While the evolution of technology has significantly helped the field of transportation, medicine, communication, and business, it has also led to some &#39;bad&#39; behaviours in society. Over the years, there has been a marked increase in sedentary behavior among children, teens, and adults. The reduction in physical activity, coupled with poor lifestyle choices, has led to an obesity epidemic worldwide, even in low- and middle-income countries<a href="#accordion">[1]</a>. Obesity not only increases the risk of diabetes and hypertension but also cardiovascular diseases (CVDs) which are the leading cause of death globally. 
&nbsp;

In 2019, approximately 17.9 million people died due to CVDs; 85% of these deaths resulted from stroke and heart attack<a href="#accordion">[2]</a>. The Global Burden of Disease&nbsp; study in 2019 predicts that we will experience a further increase in the prevalence of CVDs because of the increasing population and rising obesity<a href="#accordion">[2]</a>. With this rise, it will be no surprise to see more and more people complaining of <a href="https://www.merisehat.pk/disease/angina">angina</a>, one of the most common clinical symptoms of coronary artery disease (CAD). As per a Lancet study, in 2010, more than 100 million people worldwide suffered from angina<a href="#accordion">[3]</a>.

&nbsp;

Angina, or chest pain, is not a disease but rather a sign of heart disease. There are different types of angina: stable, unstable, microvascular, and variant. Unstable angina is a medical emergency as it increases the risk of a heart attack. 
&nbsp;

Atherosclerotic changes in the coronary arteries result in hardening and narrowing of the vessels. The reduced blood supply is unable to meet the increased oxygen demand of the heart muscles. As a result, the cardiac muscles face an oxygen shortage and myocardial ischemia occurs. Physical exertion, smoking, stress, and exposure to cold can trigger angina by causing vasoconstriction and reducing blood supply to the muscles.&nbsp; 
&nbsp;

The chest pain in angina is often described as pressure, discomfort, heaviness, or tightness in the chest. This discomfort can also travel to the jaw, neck, shoulders, arms, and back. Moreover, the chest pain typically lasts 1-5 minutes and is relieved by rest or nitroglycerin pills. Other than chest pain, people with angina may also complain of: 
&nbsp;

<ul>
	<li>shortness of breath</li>
	<li>anxiety</li>
	<li>sudden and extreme tiredness</li>
	<li>nausea and vomiting</li>
	<li>light-headedness or fainting</li>
	<li>sweating</li>
	<li>cold, clammy skin</li>
</ul>

&nbsp;

Understanding first aid measures for an angina attack

If you see someone having angina, follow the following steps: 
&nbsp;

<h5>1.Help the patient rest</h5>

Ask the person to stop what they are doing and make them sit in a comfortable position. A half-sitting position with the back and head supported is mostly preferred. Use a cushion to support the head. If there are no chairs or cushions available, the person can sit on the floor and lean their head against a wall. Or you can kneel behind them and support their head with your hands or arms.&nbsp;

&nbsp;

<h5>2. Give medication</h5>

If the patient has their angina medication like a sublingual nitroglycerin pill or spray, then ask them to take it as instructed by their doctor. Help the person take the medication if they are unable to do so themselves. These medications relax and widen the blood vessels. Thus, improving blood flow to the heart and providing pain relief.&nbsp; 
&nbsp;

Another dose can be taken if the pain lasts longer than 5 minutes. Assess the patient for a further 5 minutes and if the second dose also fails to relieve their pain, then take them to the hospital immediately. Moreover, people experiencing angina for the first time might not have any medications and should immediately be taken to the hospital.&nbsp;

&nbsp;

<h5>3. Calm the patient down</h5>

Stress and anxiety can worsen the pain and lead to complications. Therefore, it is important to keep the patient calm. Furthermore, open shirt buttons and loosen any tight clothing to help the person breathe better. Ask the person to take slow, deep breaths through the nose and exhale slowly through the mouth.&nbsp;

&nbsp;

<h5>4. Assess the patient</h5>

If the pain is relieved within 15 minutes of resting or taking medication, the person should be able to return to what they were doing, provided it&rsquo;s not strenuous.&nbsp;

It is important to assess the patient&#39;s breathing and circulation. In case of sudden collapse, immediately start CPR and call for an ambulance.&nbsp;

&nbsp;

<h5>5. Call the ambulance</h5>

If the pain returns, worsens or lasts for more than 15 minutes despite rest and medication, then you should call an ambulance.&nbsp; 
&nbsp;

Following are the emergency/ambulance number for the various provinces in Pakistan: 
&nbsp;

<ul>
	<li>Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)</li>
	<li>Punjab - 115 (Ambulance)&nbsp;</li>
	<li>Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)</li>
	<li>Baluchistan&nbsp;- 1122 (Medical Emergency Response Centers) 
	&nbsp;</li>
</ul>

<ul>
	<li>Never leave a person having chest pain alone.&nbsp;</li>
	<li>Avoid giving any food, fluids, cigarette, coffee, or tea.</li>
	<li>Do not make the person walk or do any physical activity.</li>
	<li>Do not delay in calling for medical help.</li>
	<li>Do not wait for the symptoms to go away.</li>
	<li>Never transport a patient with chest pain in a car as it can cause additional exertion to the heart and worsen their condition.&nbsp;</li>
</ul>

&nbsp;

<h4>"All that chest pain can increase blood pressure. Check yours today with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

Angina is not a heart attack, but unstable angina can increase one&#39;s risk of a heart attack. Therefore, if someone is having angina, it is important to look out for the following warning signs: 
&nbsp;

<ul>
	<li>A heaviness, discomfort, or squeezing pressure in the chest, or below the sternum (breastbone)</li>
	<li>The pain may radiate to the jaw, neck, arm, or back</li>
	<li>Sweating</li>
	<li>Nausea or vomiting</li>
	<li>Dizziness</li>
	<li>Shortness of breath</li>
	<li>Weakness</li>
	<li>A rapid or irregular heartbeat</li>
	<li>Chest pain typically lasts longer than 5 minutes 
	&nbsp;</li>
</ul>

Unlike angina, symptoms of a heart attack are not relieved by rest or medications and can last for 30 minutes or longer. If a heart attack is suspected, take the person to the hospital immediately. Moreover, the person can be given 250mg of aspirin to chew while they wait for the ambulance. Before administering aspirin, make sure the person is not allergic to the medicine or suffers from any bleeding disorder. 
&nbsp;

In women, angina often presents with non-specific symptoms such as abdominal pain, stabbing chest pain instead of pressure, and discomfort in the teeth, jaw, and back. Moreover, chest pain, in both genders, can result from a variety of conditions. These include gastroesophageal reflux disease (GERD), indigestion, stomach ulcers, pneumonia, emotional stress, pulmonary embolism, and several more. However, it is not easy to determine the exact cause. Therefore, it is always best to contact an emergency healthcare service if you have unexplained chest pain. 
&nbsp;

Although angina is not a life-threatening condition, it can increase the risk of myocardial infarction (MI). Therefore, it is important to practice healthy lifestyle modifications, stay compliant with medications, and avoid risk factors associated with angina. Maintaining a healthy weight, quitting smoking, keeping blood glucose levels within range, exercising regularly, and eating a healthy diet can prevent angina and complications.&nbsp; 
&nbsp;

<ul>
	<li>Angina is a sign of heart disease and typically results from atherosclerotic changes in the coronary arteries. The chest pain can radiate to the jaw, neck, shoulders, arm, and back. It is often described as a heaviness, tightness, pressure, discomfort, or squeezing in the chest.&nbsp;</li>
	<li>If someone is having angina, you can help them by placing them in a comfortable position and calming them down. A semi-seated position is preferred. Moreover, patients can be administered medications such as sublingual nitroglycerin pills or sprays.&nbsp;</li>
	<li>If the chest pain is not relieved from rest or medications, recurs, worsens, or lasts longer than 15 minutes, it is important to seek emergency medical care.</li>
	<li>Unstable angina can increase one&#39;s risk of a heart attack. Therefore, always look out for warning signs in someone suffering from angina. These include sweating, nausea, vomiting, shortness of breath, rapid or irregular heartbeat, light-headedness, or pain in the jaw, neck, arm, shoulder, or back.</li>
	<li>These emergency/ambulance number for the various provinces in Pakistan:</li>
</ul>

1.&nbsp;Sindh - 115 (Edhi ambulance), 1020 (Chhipa), +92 (21) 1021 (Aman Foundation)

2.&nbsp;Punjab - 115 (Ambulance)&nbsp;

3.&nbsp;Khyber Pakhtunkhwa (KPK) - 091-2590846 (Emergency ambulance), 091-2214575 (Edhi ambulance), 091-2210836 (Red Crescent ambulance)

4.&nbsp;Baluchistan - 1122 (Medical Emergency Response Centers)

&nbsp;

[1].Roth, G. A. et al., 2020. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019: Update From the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), pp. 2982-3021.

[2].World Health Organization, 2021. Cardiovascular diseases.

[3].Vos, T. et al., 2012. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380(9859).

A Guide To CPR

CPR or Cardiopulmonary resuscitation is a lifesaving technique that aims to keep the blood flowing when the heart ceases to beat.

&nbsp;

The heart usually stops functioning due to an electrical disturbance during a cardiac arrest. CPR has a pivotal role in managing a patient who has collapsed due to cardiac arrest. 
&nbsp;

Understanding How To Perform CPR

A cardiac arrest is different from a heart attack. So, what is the difference between the two?

&nbsp;

Well, heart attack refers to the disruption in blood supply to the heart due to a blockage in the vessel(s) that nourishes the heart muscles.

&nbsp;

In a heart attack, the person is mostly conscious, whereas in a cardiac arrest, the person suddenly collapses due to disturbance in the electrical conductivity of the heart due to which the heart comes to a standstill. Heart attack can progress to cardiac arrest in the absence of timely intervention.

&nbsp;

According to the American Health Association, CPR can double or even triple the chances of survival, if performed immediately after cardiac arrest<a href="#accordion">[1]</a>.

&nbsp;

The primary goal of CPR is to keep the blood flowing to the vital organs until medical professionals are available to intervene. Therefore, it is vital to learn this lifesaving technique to help someone in an emergency<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Yes, anyone can perform CPR since it is basically the delivery of compressions to the chest. It doesn&rsquo;t matter whether you&#39;re a bystander or a trained first responder, you can deliver CPR in either case.

&nbsp;

However, the protocol of performing CPR differs for trained and untrained individuals (see below).

&nbsp;

A recent study shows that even children can perform CPR. The study was conducted on 6th-graders and it was tested if they can do hands-only CPR. The results revealed that these children can actually give adequate compressions with the correct rate. This makes children a valuable group to deliver CPR in emergency situations.

&nbsp;

The American Health Association is currently working on training young individuals to become a viable group for the community<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

Before starting CPR, check the following things<a href="#accordion">[3]</a>:&nbsp;

<ul>
	<li>Make sure that the environment is safe for the person.</li>
	<li>Check if the person is conscious or unconscious. </li>
	<li>If the person appears unconscious, call them loudly asking if they are okay or tap on their shoulder.</li>
	<li>Call an ambulance service or any local emergency service.</li>
	<li>Start doing CPR and continue doing it until emergency help arrives. 
	&nbsp;</li>
</ul>

There are 2 types of CPR<a href="#accordion">[1]</a>:

<ul>
	<li>
	Hands-only CPR&nbsp;
	</li>
	<li>
	Traditional CPR with rescue breaths&nbsp;
	</li>
</ul>

&nbsp;

Hands only CPR is used by individuals who are not trained or whose skills have become rusty due to lack of practice. These individuals can easily perform hands-only compressions that do not involve the delivery of rescue breaths.

&nbsp;

On the other hand, traditional CPR consists of 30 chest compressions followed by 2 rescue breaths. It is the right technique for individuals who are trained in CPR.&nbsp; 
&nbsp;

To perform a hands-only CPR on an adult, follow these steps<a href="#accordion">[4]</a>.

&nbsp;

Sit next to the person who has collapsed and place the lower part of your hand (the heel) on the breastbone, right at the center of the chest. Place the palm of your other hand over the hand already placed on the chest and interlock your fingers.

&nbsp;

Position yourself in such a way that your shoulders are directly above your hands. Your hands should be straight, being perpendicular to the chest or making a 90&deg; angle with the chest.

&nbsp;

Use your entire body weight to give compressions to the chest, each compression being 5-6cm (2-2.5 inches) deep.

&nbsp;

After 1 compression is delivered, release the compression while keeping your hand on the chest and allow the heart to recoil and return to its original position.

&nbsp;

Repeat these chest compressions at a rate of 100-120 in a minute and continue giving them until an ambulance arrives.&nbsp; 
&nbsp;

Following steps constitute a traditional CPR in an adult<a href="#accordion">[4]</a>:

<ul>
	<li>Sit beside the collapsed person and place the heel of your hand on the center of their chest. Place the palm of your other hand over the hand already placed over the chest and interlock your fingers.</li>
	<li>Deliver chest compressions and make sure that the compressions are 5-6cm (2-2.5 inches) deep and given at the rate of 100 to 120 compressions in a minute.</li>
	<li>After delivering 30 chest compressions, give 2 rescue breaths in every cycle.</li>
	<li>To deliver the rescue breaths, the airway of the patient should be maintained. Tilt the patient&rsquo;s head gently with one hand over the forehead of the person and use the other hand to lift the chin with 2 fingers.</li>
	<li>Pinch the nose of the person and bring your mouth over the person&#39;s mouth and blow in air for a period of about 1 second. Position your head in a way that you can check for the rise in their chest level and deliver 2 rescue breaths.</li>
	<li>Repeat the cycle by giving 30 chest compressions followed by 2 rescue breaths and keep doing it until the person regains consciousness or an ambulance arrives.&nbsp; 
	&nbsp;</li>
</ul>

Children are more likely to experience respiratory or airway problems rather than a cardiac arrest. If it&rsquo;s a cardiac arrest, they are likely to collapse, hence CPR with rescue breaths should always be prioritized for children<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<ul>
	<li>Open the airway of the child by tilting their head, placing one hand on the forehead and using the other to lift their chin with 2 fingers. </li>
	<li>Remember to remove any obstruction from the mouth if present.</li>
	<li>Pinch the nose of the child and place your mouth over their mouth. In this position, deliver 5 rescue breaths steadily. While blowing the air into the mouth also keep checking for their chest to rise.</li>
	<li>Place the heel of your 1 hand at the center of the child&rsquo;s chest and give compressions such that the chest goes down by 5 cm (2 inches). If you are not able to give effective compressions with 1 hand, use your other hand, too, to achieve the depth of 5 cm while giving compressions.</li>
	<li>After every 30 chest compressions, give 2 rescue breaths besides giving compressions at the rate of 100-120 in a minute.</li>
	<li>Repeat the cycle of 30 chest compressions and 2 rescue breaths until the child gains consciousness or emergency medical help arrives<a href="#accordion">[4]</a>.&nbsp; 
	&nbsp;</li>
</ul>

Tilt the head of the infant gently while lifting their chin. Remove any obstruction present in their mouth or nose.

&nbsp;

Place your mouth near the infant&#39;s mouth and blow air firmly into their mouth. Keep checking for the rise in their chest levels. Administer 5 rescue breaths to the infant initially.

&nbsp;

Place 2 fingers at the center of the infant&#39;s chest and compress their chest such that the chest goes down by 4 cm. It is imperative to ensure the quality of chest compressions and if you&#39;re unable to achieve it by 2 fingers, then use the heel of your hand to deliver chest compressions.

&nbsp;

After every 30-chest compression, give 2 rescue breaths. The rate of compressions should be 100-120 compressions in a minute. Continue this cycle until the infant regains consciousness or emergency help arrives<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

It is important to mention that with CPR administration, there is a possibility of a broken rib(s) but this occurrence is unlikely to happen in every case. Only 30% of individuals ended with broken ribs after surviving due to CPR. It is important to continue administering CPR, regardless of broken bones. 

&nbsp;

CPR is a lifesaving technique and considered a part of first aid. Everyone should learn how to perform effective CPR. Even if you are not trained to give CPR, it is better to intervene and try giving any compression instead of none. Any CPR is better than no CPR. So next time you see a person collapse, ensure the safety of that patient and get into action!&nbsp; 
&nbsp;

<ul>
	<li>Cardiopulmonary resuscitation or CPR is a lifesaving technique and a crucial part of first aid.</li>
	<li>Immediate CPR increases the chances of survival by two to three folds for a person who has had a cardiac arrest.&nbsp; </li>
	<li>CPR maintains the blood flow to the vital organs of the body.</li>
	<li>An ambulance should be called before starting CPR.</li>
	<li>Any individual whether trained or untrained can perform a CPR, the protocols however, vary for each category.</li>
	<li>Individuals who are trained and confident of their skills should perform traditional CPR which includes chest compressions and rescue breaths. </li>
	<li>However, individuals who aren&#39;t trained should perform hands-only CPR and shouldn&#39;t give rescue breaths.</li>
	<li>The method of giving CPR is slightly different in adults (use 2 hands), children over 1 year (use 1 hand), and in infants under 1 year of age (use 2 fingers). Details on each have been provided in this article. </li>
</ul>

&nbsp;

<ul>
	<li>CPR administration might lead to breaking a rib but that is a very unlikely occurrence, and it is important to continue administering CPR, regardless of broken bones.&nbsp;</li>
</ul>

[1] Hepler L. How to Perform CPR: Hands-Only and Mouth-to-Mouth. Healthline.

[2] What is CPR? American Heart Association.

[3] Cardiopulmonary resuscitation (CPR): First aid. Mayo Clinic.

[4] First aid - CPR. NHS UK.

Nawal Adnan

Children Under 10 And Hepatitis - A Mystery To Be Solved

On April 5th, 2022, the WHO was notified of a surge in cases of severe acute <a href="https://www.merisehat.pk/disease/hepatitis-a&amp;e">hepatitis</a>, of an unknown cause. The hepatitis cases were diagnosed in children 10 years and younger across the U.K and led to several hospitalizations. After thorough laboratory testing, hepatitis viruses A, B, C, E, D, and E were ruled out as the cause of these cases. However, investigations are still ongoing to understand the cause of these cases.

Similar cases of unexplained hepatitis and liver inflammation were reported in the U.S., Denmark, Ireland, Netherlands, and Spain. Researchers are suspecting that although the definitive cause of the cases is yet to be elucidated, it may be because of an infectious pathogen or exposure to contaminated food, drinks, or toys. However, an infectious cause is more likely because many of the cases tested positive for <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> and adenovirus. According to a recent report on the illness, the adenovirus may be an underlying cause of the disease. Also, it may be a new variant of the virus that is more severely impacting younger children with weak immunities.&nbsp;

Over the last two years, children may not have been exposed to common viral pathogens because of the COVID-19 outbreak, making them more susceptible to adenovirus and other similar viral infections. To date, 108 cases of mystery hepatitis have been reported according to a recent update by the UK Health Security Agency.

&nbsp;

Understanding Unknown Hepatitis In Children

The most common symptoms of the disease include diarrhea, vomiting, abdominal pain, and yellow discoloration of the skin. While researchers are further investigating other potential causes, out of all the reported cases so far, 77% of the children tested positive for adenovirus, which leads to a stronger suspicion of the illness being linked to the respiratory virus. Similarly, out of the five cases reported in Alabama, three children developed acute liver failure and tested positive for adenovirus. Although no deaths occurred, two of the children required liver transplants. Later in April, the CDC alerted health authorities to test the children for adenovirus, and further recommended testing whole blood instead of plasma alone.&nbsp;

&nbsp;

Adenoviruses are a group of viruses that typically cause respiratory illnesses, and infect the lining of the lungs, airways, intestines, nervous system, and urinary tract. The virus is a common cause of cough, sore throat, fever, diarrhea, and pink eye. Although the infection is more common in children than in adults, anyone can get infected. Studies have shown that every child gets infected with it at least at some point by the time they&rsquo;re 10 years old.&nbsp;

The infection typically causes mild symptoms that disappear after a few days. However, the symptoms are more serious in people, especially children with weak immune systems.&nbsp;

&nbsp;

The virus is commonly lingering in places with large groups of children, for example, schools, daycare centers, and summer camps. The viruses are very contagious and can spread via airborne droplets and with close contact with contaminated surfaces. Thus, the virus spreads through the coughs and sneezes of infected people. What&rsquo;s more, the droplets that contain the virus can also fly onto surfaces. So, if your child touches these surfaces, a toy, or any other object held by someone who has touched their nose, mouth, or eyes, they can get infected.&nbsp;

The virus spreads faster amongst children because they are more likely to touch their faces and put their hands in their mouths. Parents can get infected while changing the diaper of an infected child. The virus can also spread through food prepared by someone carrying the virus if they didn&rsquo;t wash their hands after going to the bathroom. The virus is also rampant in water, especially in swimming pools that aren&rsquo;t chlorinated. However, this does not happen too often. The adenoviruses can cause the following illnesses and present with symptoms:

<ul>
	<li>Bronchitis &ndash; Fever, chills, cough, and runny nose&nbsp;</li>
	<li>Respiratory Infections &ndash; Swollen glands, sore throat, cough, runny, and stuffy nose</li>
	<li>Croup &ndash; Difficulty breathing with high-pitched sound and barking cough</li>
	<li>Ear Infection &ndash; Fever, irritability, and ear pain&nbsp;</li>
	<li>Pink Eye &ndash; Red eyes, tearing, discharge, feeling that something is in the eye</li>
	<li>Pneumonia &ndash;&nbsp;Trouble breathing, cough, and fever&nbsp;</li>
	<li>Stomach And Intestinal Infections &ndash; Stomach cramps, diarrhea, vomiting, fever, and headache&nbsp;</li>
	<li>Meningitis And Encephalitis (Swelling Of The Brain And Spinal Cord) &ndash; Nausea, vomiting (rare), fever, and stiffness in the neck</li>
	<li>Urinary Tract Infections &ndash;&nbsp;Frequent urination, burning and painful urination,&nbsp;blood in the urine&nbsp;</li>
</ul>

If your child has any of these symptoms, it is important that you check with the pediatrician immediately. If your child is under 3 years of age and has symptoms, for example, difficulty breathing, swelling around the eyes, fever that is not going away after a few days, and signs of dehydration, consult a doctor right away. Even though the viruses typically cause respiratory infections, adenovirus 41 can cause gastroenteritis in children with respiratory symptoms. Therefore, there may be a link between this particular type of adenovirus and mysterious hepatitis. Currently, there is no vaccine against the virus.

&nbsp;

The Centers for Disease Control and Prevention (CDC) is currently investigating 180 cases that were identified in the U.S. since last year, October. The focus of the investigation is to conclude whether there has been an increase in hepatitis, or if an existing pattern has been revealed because of improved diagnostic techniques. An alert was issued for doctors nationwide to be on the lookout for children with hepatitis which can cause liver damage and liver failure.&nbsp;

However, the previous theory remains that the measures implemented to cope with the pandemic may have limited children&rsquo;s exposure to the adenovirus. But now&nbsp;that most pandemic restrictions have been lifted,&nbsp;the virus is catching up. The adenovirus is a virus that otherwise commonly causes the common cold in children. In addition, hepatitis linked to this type of adenovirus is almost exclusively seen in immunocompromised children only. Though, many of the cases initially reported by the CDC did not have such conditions.&nbsp;

While monitoring the mysterious hepatitis cases, the CDC is also investigating whether COVID-19 may be playing a role. They are also investigating other pathogens, risk factors, and medications. Although, there has been no overall increase in the incidence of severe hepatitis in children compared to pre-pandemic rates.&nbsp;

According to a recent report, most of these children recovered with only supportive care in the hospital. The care centered around maintaining fluid levels, nutrition, and monitoring of blood clots. In only a minority of the cases, the children underwent liver transplant surgery.&nbsp;

&nbsp;

[1] Marsh, K., Tayler, R., Pollock, L., Roy, K., Lakha, F., Ho, A., Henderson, D., Divala, T., Currie, S., Yirrell, D. and Lockhart, M., 2022. Investigation into cases of hepatitis of unknown aetiology among young children, Scotland, 1 January 2022 to 12 April 2022. Eurosurveillance, 27(15), p.2200318.

<a href="https://www.merisehat.pk/disease/coronary-artery-disease">Coronary Artery Disease (CAD)</a> is a leading cause of death globally. While there are some factors, such as family history, age and sex, that cannot be modified to prevent heart diseases, many lifestyle changes can decrease your risk of heart disease.

&nbsp;

Understanding measures for better cardiac health

The chemicals in tobacco can often cause irreversible damage to the heart and blood vessels. In addition, because of the damaged vessels, your heart will work harder to supply oxygen to the body and brain, causing an increase in blood pressure and heart rate. However, the good news is that the risk of heart disease starts to drop a day after quitting. Moreover, the risk of heart disease drops to almost half, a year after quitting cigarettes.

A healthy diet is low-fat, high in fiber, and includes plenty of fish, fresh fruits, vegetables, and whole grains. Also, limit the amount of salt you are eating in a day to no more than 6g, which is about a teaspoonful. Too much salt in your diet can cause an unhealthy spike in blood pressure.

There are 2 types of fats: saturated and unsaturated. Avoid foods with saturated fats since they increase the levels of bad cholesterol in your blood.

Below is a list of foods that are high in saturated fats:&nbsp;

<ul>
	<li>Fatty-cut meat&nbsp;</li>
	<li>Butter&nbsp;</li>
	<li>Ghee&nbsp;</li>
	<li>Cream&nbsp;</li>
	<li>Cheese&nbsp;</li>
	<li>Biscuits and cakes&nbsp;</li>
</ul>

A balanced diet should include unsaturated fats since they increase the levels of good cholesterol in your blood, and reduce any blockages in the arteries. Below is a list of foods high in unsaturated fats:&nbsp;

<ul>
	<li>Oily fish&nbsp;</li>
	<li>Avocados&nbsp;</li>
	<li>Sunflower, vegetable, and olive oils&nbsp;</li>
	<li>Nuts&nbsp;</li>
</ul>

You should also eliminate sugar from your diet and have carbohydrates in moderation, as this puts you at a higher risk of developing diabetes. Furthermore, this has proven to increase your risk of developing heart disease.&nbsp;

&nbsp;

A healthy diet with regular exercise is the best way to reduce your chances of developing high blood pressure. Regularly exercise will lower your cholesterol and make your heart and blood circulatory system more efficient. Exercise will also keep your blood pressure at healthy levels.&nbsp;Exercising regularly reduces your risk of heart attacks because, like any other muscle, the heart muscle will also benefit from exercise. A strong heart will be able to pump blood around your body without much effort. Aerobic exercises, for example, walking, dancing, and swimming will also help keep your heart healthy. However, if you’ve not been active for a while, slowly work your way up from moderate-intensity to high-intensity exercises. You can start with:&nbsp;<ul><li>Regularly walking at a brisk pace, or 150 minutes of aerobic exercises every day.&nbsp;</li><li>75 minutes of more strenuous aerobic activity, for example, running.&nbsp;</li><li>You can also sign up for strength training sessions once a week.</li></ul>

Being overweight increases the risk of developing heart disease, high blood pressure, type 2 diabetes, and high cholesterol. A body mass index (BMI) of 25 or higher is overweight. Moreover, unhealthy weight gain is also associated with higher blood pressure and high cholesterol which increases the risk of heart disease and stroke. Excess weight around the middle of the body also increases the chances of developing heart disease.&nbsp;

However, a mere reduction in your weight by 3% to 5% can be beneficial in decreasing certain fats in the blood, lowering blood glucose, lowering blood cholesterol, and reducing the risk of diabetes type 2.&nbsp;

&nbsp;

People who don’t get enough sleep are at a higher risk of developing obesity, depression, diabetes, high blood pressure, and heart disease. Thus, make sleep a priority. You need to set a sleep schedule and prioritise it by going to bed and waking up at the same time every day. Keeping your bedroom dark and quiet will also help you get a good night’s sleep.

Some people tend to manage stress with unhealthy habits, such as drinking or smoking, and overeating. The key is to look for alternative ways to manage stress. For example, meditation, relaxation exercises, and physical activities are great ways to manage stress and improve your overall health.&nbsp; 
&nbsp;

<ul>
	<li>Coronary artery disease is a leading cause of death globally, and while there are some factors such as family history, age and sex that cannot be modified to prevent heart diseases, many lifestyle changes can decrease your risk of heart disease.&nbsp;</li>
	<li>Eating a healthy diet, regular physical activity, and managing stress can have a positive impact on your overall health.&nbsp;</li>
	<li>However, if you feel unwell after any physical activity, speak with your doctor and they will run some tests to rule out underlying health conditions.&nbsp;</li>
	<li>If you have a family history of heart diseases, you can always speak with your doctor about regular checkups to help pick on any health concerns early on.&nbsp;</li>
</ul>

&nbsp;