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Iqra Mazhar

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Just A Little Dose

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Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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Time For Men To Share The Burden Of Pregnancy

Introduction

A fast-growing population is one of the greatest challenges currently faced by Pakistan. Increasing poverty, food shortage, health challenges, depletion of natural resources, and overcrowding are just some of the problems associated with overpopulation. According to the 2017 Census of Pakistan, with a population of more than 207 million, the country is the fifth most populated country in the world<a href="#accordion">[1]</a>. Therefore, effective birth control methods are a need of the hour to prevent the risks associated with overpopulation.

However, the use of contraception is largely stigmatized in Pakistan due to various reasons. As per the Pakistan Demographic and Health Survey (PDHS), the current contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[2]</a>. Moreover, the use of contraceptive methods among men is extremely low. Thus, resulting in the burden of pregnancy and contraception lying largely with women. This could probably be due to a lack of awareness among men regarding various contraceptive methods that are readily available. Raising awareness about these methods is the first step in ensuring that the financial and emotional burden of <a href="https://merisehat.pk/article/how-to-practice-safe-sex">safe sex</a> is shared among both partners in a couple.&nbsp;

Almost 200 years ago, humans invented the world&#39;s first condom, and for a long time that was the greatest discovery in the world of contraception. However, scientists soon discovered methods specifically designed for women that could aid further in population control. Several female contraceptive options ranging from hormonal pills to invasive tubal ligation were introduced. However, each of the proposed methods comes with its side effects. Contraception methods have been widely politicized and various speculations exist regarding the reasons behind the disparity among male and female contraceptives. However, it is important to mention that male contraceptive methods are generally safer than their female counterparts, which is why in recent years significant work has been done to search for effective male contraceptive options. This shift in tide is also perpetuated in part by the increasing awareness among men and their willingness to use contraceptives.&nbsp;&nbsp;

&nbsp;

Understanding Male Contraceptives

Currently, two widely acceptable male contraceptive methods exist: condoms and the invasive vasectomy.

&nbsp;

<h5 dir="ltr">Condoms</h5>

These are a form of barrier method and stop the sperm from entering and fertilizing the egg. Along with being an effective and inexpensive birth control, condoms also prevent sexually transmitted infections (STIs). However, incorrect use is associated with a high failure rate, and they can easily break or get damaged. In Pakistan, condoms are the most used form of contraceptive method, with a frequency of 65.5%<a href="#accordion">[3]</a>.&nbsp;

In recent years, the Pakistani government has stepped up its social media campaigns in a bid to educate the public regarding the use of condoms and other effective family planning methods. This is aimed at controlling the growing population by promoting birth spacing and awareness of women&#39;s fertility. Doorstep availability and affordable prices have significantly increased the use of condoms among the general population.&nbsp;

Unfortunately, misconceptions about condoms and other family planning methods still need to be overcome.&nbsp;

&nbsp;

<h5 dir="ltr">Vasectomy</h5>

Also called male sterilization, the surgical procedure has been in use since the 1970s. The procedure involves cutting or blocking the vas deferens that carry sperm to the urethra. As a result, the semen is devoid of sperm and the egg cannot be fertilized. It is not easily reversed; therefore, it is mostly advised to men who are sure of not wanting children or who believe their family is complete.&nbsp;

With a success rate of 99.85%, it is the most reliable contraceptive option. Moreover, compared to tubal ligation in women, it is less invasive, has fewer risks, and has a quicker recovery time. However, only 2.4% of men around the world have undergone the procedure<a href="#accordion">[4]</a>. In Pakistan, the prevalence is only 0.4%<a href="#accordion">[3]</a>.&nbsp;

The lack of knowledge regarding vasectomy plays a major role in its low acceptance. Moreover, a majority of men hold the view that it leads to impotency or reduces sex drive. However, a recent study has found that men in Pakistan are becoming more accepting of vasectomy and recognizing their role in sharing the responsibility of family planning<a href="#accordion">[5]</a>.&nbsp;

&nbsp;

While female birth control pills have been around for more than 50 years, researchers have only recently started looking into pills for men.&nbsp;

In 2019, a team of scientists conducted a clinical trial for a male birth control pill among 82 healthy men<a href="#accordion">[6]</a>.&nbsp;They administered dimethandrolone undecanoate (DMAU) in varying doses over a period of 28 days. The two active hormones, progestin, and modified testosterone, helped suppress levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the study participants. Thus, suppressing sperm production without causing symptoms of low testosterone levels.&nbsp;

Although the study did not measure sperm count, the pill was found to be safe, even in high dosages. The team is currently conducting a longer trial to assess the drug&#39;s effect on sperm production and any long-term effects on the body.&nbsp;

However, men are often hesitant to use hormonal options due to the presence of adverse effects. Therefore, a team at the University of Minnesota have developed a non-hormonal male contraceptive pill. According to early results from a trial in mice, the contraceptive was 99% effective at preventing pregnancy<a href="#accordion">[7]</a>. Moreover, it had no obvious side effects in the mice.

Called YCT529, the non-hormonal pill works by targeting a protein called the retinoic acid receptor alpha (RAR-&alpha;). Through inhibition of this receptor, the retinoic acid in the body is unable to cause cell growth and differentiation, both of which contribute to sperm formation. As a result, the contraceptive helped cause reversible sterility in male mice.&nbsp;

Researchers now plan to conduct human trials for the compound. However, it is too early to tell whether the results in mice will also translate to humans.&nbsp;

&nbsp;

Conclusion

Pakistan faces several challenges to the acceptability of various family planning methods. These range from religious and cultural beliefs, low literacy levels, misconceptions about side effects, lack of knowledge regarding various options for men and women, and reluctance to adopt a method. According to a study from Karachi, fear of side effects was the most common reason for low prevalence among users<a href="#accordion">[8]</a>.&nbsp;

Several trials are currently underway to look for safe and effective male contraceptive pills. However, it can take years till a pill is available in store. Even then, its availability will not matter until there is a change in beliefs regarding family planning.

Despite the safety and availability of male contraception, men are reluctant to use the contraception methods due to various reasons ranging from misconceptions about side effects to a lack of knowledge about safe sexual practices.&nbsp;

Therefore, there is a need for campaigns aimed at educating men about the importance of adopting contraception methods.&nbsp;

&nbsp;

Key Points

<ul>
</ul>

<ul>
	<li>A growing population poses several challenges to a country&#39;s health and economic stability.</li>
	<li>Effective implementation of family planning measures can help control overpopulation.</li>
	<li>In Pakistan, use of contraceptives is highly stigmatized due to various reasons.</li>
	<li>While several advances have been made in the search for female contraception, men have only been presented with two options: condoms and vasectomy.</li>
	<li>Condoms are the most commonly used form of contraception; however, there is a need to raise awareness on its correct usage.</li>
	<li>Vasectomy is the most effective male contraceptive method, but the lack of education and widespread myths regarding its side effects has resulted in a low frequency (0.4%) of the procedure in Pakistan.</li>
	<li>Recently, scientists have begun testing various hormonal and non-hormonal compounds as male contraceptive pills.&nbsp;</li>
	<li>In 2019, a team of scientists tested varying doses of dimethandrolone undecanoate (DMAU) among healthy males and found it was well-tolerated. They are now planning long-term clinical trials to test the compound&#39;s effect on sperm production.</li>
	<li>Recently, a team at the University of Minnesota developed a non-hormonal contraceptive pill. They tested the compound in mice and found it to be 99% effective, with no observable side effects. The team now plans to conduct human trials of the compound.</li>
	<li>The development of male contraceptive pills can help men share some of the burden of contraception and pregnancy.</li>
</ul>

&nbsp;

[1] Statistics, P. B. o., 2021. Brief on Census - 2017. [Online].

[2] 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.

[3] Shattuck, D., Perry, B., Packer, C. & Quee, D. C., 2016. A Review of 10 Years of Vasectomy Programming and Research in Low-Resource Settings. Global Health, Science and Practice, 4(4), pp. 647-660.

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

[5] Hatesh, H., Maheshwari, B. K., Shah, S. Q. & Kumar, D., 2020. Males’ perception and motivation for Vasectomy. Pakistan Journal of Public Health, 10(4).

[6] Thirumalai, A. et al., 2019. Effects of 28 Days of Oral Dimethandrolone Undecanoate in Healthy Men: A Prototype Male Pill. The Journal of Clinical Endocrinology & Metabolism, 104(2).

[7] Society, A. C., 2022. A non-hormonal pill could soon expand men’s birth control options. [Online].

[8] Bibi, S., Memon, A., Memon, Z. & Bibi, M., 2008. Contraceptive knowledge and practices in two districts of Sindh, Pakistan: A hospital based study. Journal of the Pakistan Medical Associatio, 58(5).

Nimrah H. Sattar

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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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.

Humza Khizer

Do Pregnant Women Need Booster Doses For Whooping Cough?

Young babies with whooping cough often suffer from severe symptoms and are admitted to the hospital for their illness. The severity of whooping cough can also lead to death.

Pregnant women can protect their babies from <a href="https://www.merisehat.pk/disease/whopping-cough">whooping cough</a> by getting vaccinated between sixteen to thirty-two weeks. However, if they miss getting the vaccine during their pregnancy, they can still get it till they go into labour.

&nbsp;

Understanding The Need For Pertussis Vaccination In Pregnancy

Whooping cough (pertussis) is a serious infection where the patient coughs and chokes, which makes it difficult to breathe. The cause of the whoop is gasping for breath after each bout of coughing. However, babies don&rsquo;t always make this noise.

&nbsp;

Getting vaccinated during pregnancy can protect your baby from developing whooping cough in the first few weeks after birth<a href="#accordion">[1]</a>. The immunity from the vaccine will pass to the baby through the placenta and provide protection till they are old enough for routine vaccines against whooping cough.

&nbsp;

Women are usually concerned about whether the vaccine is safe to get during pregnancy. However, there is no evidence that suggests that the whooping cough vaccine is unsafe for pregnant women and their unborn children.

The whooping cough vaccine (pertussis-containing vaccine) is used routinely in pregnant women in the UK, since October 2012. Moreover, the Medicines and Healthcare Regulatory Agency (MHRA) monitors it for safety. The MHRA study has found no risk, or evidence of risks, in pregnant women and their babies<a href="#accordion">[3]</a>.&nbsp;

69% of women have gotten the vaccine to date and so far, no safety concerns have been identified in the mother or baby<a href="#accordion">[4]</a>.

Other countries are also currently recommending vaccination against whooping cough.

&nbsp;

The best time to get vaccinated is between sixteen to thirty-two weeks of pregnancy to protect your baby from whooping cough<a href="#accordion">[2]</a>. This increases the chances of your baby being protected from birth because the antibodies are transferred when they are born.

However, if you miss the vaccine due to any reason, you can get it before labor. But the chances of your baby getting the protection are highly unlikely. However, it will protect the mother from getting whooping cough and passing it to their baby after birth.

&nbsp;

UK vaccination program says that it is highly effective for women to get vaccinated against whooping cough because it protects their young babies till they can get their first vaccination at the age of eight weeks.

Babies of women who had been vaccinated at least a week before giving birth had a 91% reduced risk of getting ill with whooping cough in their first few weeks post-birth<a href="#accordion">[5]</a>. This comparison was done between babies whose mothers had been vaccinated and those who had not been vaccinated.

In addition, another benefit of getting vaccinated is that the mothers receive protection from the vaccination, which lowers the risk of infection and passing whooping cough to the baby.&nbsp;

&nbsp;

There isn&rsquo;t a single whooping cough vaccine. The vaccine is a combination, which protects against polio, tetanus, and diphtheria. It is called the Boostrix IPV. The Boostrix IPV vaccine is like the 4-in-1 vaccine. It is a pre-school booster that is given in routine to children before they start school.

&nbsp;

The side effects are mild, which include, swelling, tenderness, swelling, or redness at the site of the vaccination (arm), just like any other vaccine. However, the side effects last for a few days only. Other side effects of the vaccine include fever, irritation, and swelling of the vaccinated arm. Loss of appetite, irritability, and headache are also seen. Although, severe side effects are extremely rare.

&nbsp;

Whooping cough is very infectious and can cause pneumonia and brain damage, especially in young babies. Most of the babies require hospitalization for the treatment of whooping cough. Moreover, if the case is very severe, they may die.

The cases of whooping cough have fallen since 2012 in England among all age groups<a href="#accordion">[6]</a>. The largest fall has been seen in young babies targeted by the pregnancy vaccination program.

However, the cases of whooping cough are high in adults, compared to the pre-2012 levels. The number of cases was high in 2016, with an increase in three to four yearly peaks in the rates of diseases<a href="#accordion">[7]</a>.

Older adults with whooping cough can infect babies; hence, it is necessary that pregnant women get vaccinated and protect their babies.

&nbsp;

<ul>
</ul>

<ul>
	<li>Pregnant women can be vaccinated with the DTaP(-IPV) booster to protect their babies from whooping cough till the age of six months.</li>
	<li>Moreover, maternal antibodies are passed to the baby through the placenta.&nbsp;</li>
	<li>Mothers should consult their physicians and discuss getting vaccinated for pertussis during their pregnancy.</li>
</ul>

&nbsp;

[1] Switzer, C., D’Heilly, C. and Macina, D., 2019. Immunological and clinical benefits of maternal immunization against pertussis: a systematic review. Infectious Diseases and Therapy, 8(4), pp.499-541.

[2] Murthy, S., Godinho, M.A., Lakiang, T., Lewis, M.G.G., Lewis, L. and Nair, N.S., 2018. Efficacy and safety of pertussis vaccination in pregnancy to prevent whooping cough in early infancy. The Cochrane Database of Systematic Reviews, 2018(4).

[3] Donegan, K., King, B. and Bryan, P., 2014. Safety of pertussis vaccination in pregnant women in UK: observational study. Bmj, 349.

[4] D’Heilly, C., Switzer, C. and Macina, D., 2019. Safety of maternal immunization against pertussis: a systematic review. Infectious Diseases and Therapy, 8(4), pp.543-568.

[5] Healy, C.M., 2016. Pertussis vaccination in pregnancy. Human vaccines & immunotherapeutics, 12(8), pp.1972-1981.

[6] Haslam, N., Hoang, U. and Goldacre, M.J., 2014. Trends in hospital admission rates for whooping cough in England across five decades: database studies. Journal of the Royal Society of Medicine, 107(4), pp.157-162.

[7] Esposito, S., Stefanelli, P., Fry, N.K., Fedele, G., He, Q., Paterson, P., Tan, T., Knuf, M., Rodrigo, C., Weil Olivier, C. and Flanagan, K.L., 2019. Pertussis prevention: reasons for resurgence, and differences in the current acellular pertussis vaccines. Frontiers in Immunology, 10, p.1344.

Staff Writer

PNS SHIFA

Debunking Myths About COVID-19 & Anti-Malarial Drugs

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Impact Of OCP On Mental Health

Oral contraceptive pills (OCPs) are popular among women of reproductive age due to their ease of use and high efficacy. However, sociodemographic disparities in its use persist around the world. Those with greater awareness and education, who are unmarried and from the upper class, are more likely to use it than others. In Pakistan, this figure is close to 8% of girls and women<a href="#accordion">[4]</a>. 
&nbsp;

Understanding OCP's Influence on Mental Health

The effects of OCPs vary depending on individual factors, the specific formulation of the pill, and how it is used. 
&nbsp;

<ul>
	<li>
	<h5>Mood Swings</h5>
	</li>
</ul>

OCPs change your body&#39;s hormone levels by preventing ovulation and thickening cervical mucus. These hormonal changes may have an impact on your brain&#39;s neurotransmitters and hormonal signaling pathways, which may have an impact on your mood and cognitive function. As a result, you go through emotional changes, such as increased feelings of irritability, sadness, or anxiety.

Some studies have pointed out a possible connection between OCP and depression. This might be brought on by pill-induced bloating, decreased sex desire, and weight gain. Headaches, fatigue, and nausea may also have an impact on mental health. 
&nbsp;

These fluctuations in mood and an increase in symptoms of depression are the most common reasons girls and women discontinue OCPs. In general, adolescent girls who use OCPs are more likely to experience hypersomnia, eating problems, and increased crying than their counterparts who do not use OCPs. According to one study, it may be related to the type and amount of progestin in these pills<a href="#accordion">[1]</a>.

Many older OCPs that contain ethinyl estradiol are linked to severe mood problems. In contrast, newer OCPs with physiological forms of estrogen are usually easier to tolerate and have a weak link to mood problems<a href="#accordion">[1]</a>.

A Danish study found an increased risk of the first diagnosis of depression and the first use of an antidepressant among users of various types of OCPs. They were highest among adolescents. However, more research is needed to fully understand this relationship.

On the plus side, studies show that OCPs improve mood and mental health while alleviating premenstrual symptoms. 
&nbsp;

<ul>
	<li>
	<h5>Cognitive Function</h5>
	</li>
</ul>

The impact of OCPs on cognitive function and brain health is complicated.

Estrogen, for example, is thought to be neuroprotective in the hippocampus, hypothalamus, amygdala, and brainstem. It helps to protect the brain from cognitive decline, neurodegenerative disease, and affective disorders. 
&nbsp;

Furthermore, estrogen can influence brain regions involved in emotional processing, such as the dorsolateral prefrontal cortex.

Progesterone, on the other hand, is not thought to be neuroprotective. It can also aggravate mood symptoms.

The clinical significance of these findings is still under investigation. 
&nbsp;

Note: It should be noted that scientific research on this topic is still ongoing, and the long-term effects of OCPs on brain health are not fully understood.

Any changes in mood or brain function associated with OCP use are likely to be temporary and reversible in many cases. When you stop using OCPs, your hormone levels will return to normal, and any negative effects on brain health will fade.

Some girls, however, may have specific sensitivities or reactions to the hormones in OCPs. In rare cases, stopping the use of OCPs may not immediately reverse certain effects on mood or brain function.

Decisions about the use of OCPs should be made in consultation with a healthcare professional who can take into account individual health needs and medical history. 
&nbsp;

This includes:

<ul>
	<li>
	<h5>Pre-Existing Mental Health Conditions</h5>
	</li>
</ul>

If you already have a mental health condition, such as depression or anxiety, OCPs may exacerbate your symptoms. Furthermore, OCPs may interact with your current medications.

Inform your doctor so that he or she can tailor your treatment to your specific needs, medical history, and potential risks and benefits of OCPs. 
&nbsp;

<ul>
	<li>
	<h5>Individual Response</h5>
	</li>
</ul>

Individual reactions to OCP use can differ greatly. Some girls tolerate OCPs well and experience no adverse effects on brain health.

At the same time, some girls may be more sensitive to the hormonal changes caused by OCPs, resulting in emotional or mental health issues. Or they may be predisposed to side effects due to risk factors. 
&nbsp;

Note: Please consult a professional doctor if you have any concerns about the effects of OCPs on your brain health or mood. They can offer personalized advice, consider alternative contraceptive options, or modify the prescription to reduce side effects. 
&nbsp;

Few studies have looked into the relationship between oral contraceptives and mental health, such as mood swings and cognitive function.

According to the Harvard Study of Moods and Cycles, 16.3% of people reported a decline in their mood, while 12.3% reported an improvement. However, the vast majority of people reported no change in their mood<a href="#accordion">[2]</a>. 
&nbsp;

32-60% of women discontinue the pill within 6 months for a variety of reasons, the most common of which are mood changes<a href="#accordion">[3]</a>.

It&rsquo;s important to talk to a doctor before starting a contraceptive pill, especially if you have known potential risks, like a history of depression.

It&rsquo;s also important for healthcare providers and adult supervisors to monitor depressive symptoms in adolescents using OCPs because it may put them at risk for nonadherence if the pill affects their quality of life. 
&nbsp;

Key Takeaways

<ul>
	<li>OCPs may have significant benefits, such as providing contraceptive protection, regulating menstrual cycles, and managing certain medical conditions like PCOS.</li>
	<li>The potential effects of OCPs on brain health in girls vary depending on the individual.</li>
	<li>According to the limited research available, it&#39;s been observed that not all girls will experience these symptoms, and those who do may have different degrees of severity.</li>
	<li>Some possible symptoms include mood swings, depression, anxiety, and changes in cognitive function like memory or concentration issues.</li>
	<li>Symptoms such as headaches, nausea, fatigue, and decreased libido can also have an impact on the overall well-being and brain health of girls who use OCPs.</li>
	<li>In most cases, these symptoms are transient and disappear once the pill is discontinued.</li>
	<li>It&#39;s crucial to weigh the potential benefits of OCP use (such as contraceptive protection, regulation of menstrual cycles, and management of certain medical conditions like PCOS) against potential risks. 
	&nbsp;</li>
</ul>

[1] Mu E, Kulkarni J. Hormonal contraception and mood disorders. Australian prescriber.

[2] MGH Center for Women’s Mental Health. Do oral contraceptives cause mood swings or depression? MGH Center for Women’s Mental Health.

[3] Anouk E. de Wit Bs. Association of use of oral contraceptives with depressive symptoms among adolescents and young women. JAMA Psychiatry.

[4] Meherali S, Ali A, Khaliq A, Lassi ZS. Prevalence and determinants of contraception use in Pakistan: trend analysis from the Pakistan Demographic and Health Surveys (PDHS) dataset from 1990 to 2018. F1000Res. 2021;10:790. Published 2021 Aug 11. doi:10.12688/f1000research.55204.1

Shermeen Zuberi

Ismail Munir

Stop Popping (ECP) Pills Like Candy

In conservative societies, where certain topics remain taboo, it is no surprise that social media has become a great tool for finding answers to questions. Online forums allow people to remain anonymous and ask queries without worrying about judgment. 
&nbsp;

Moreover, several closed groups on social media sites, like Facebook, have provided women with safe spaces to discuss issues pertaining to marriage, sexual health, workplace harassment, dating, and much more. These women-only groups are often full of posts inquiring about effective birth control methods and the use of emergency contraception. 
&nbsp;

Interestingly, in Pakistan, 20% of married women of reproductive age have an unmet need for contraception<a href="#accordion">[1]</a>, while the country&rsquo;s contraceptive prevalence rate (CPR) is only 34%<a href="#accordion">[2]</a>, indicating gaps in knowledge about safe contraception.&nbsp;This makes one wonder why women feel safer asking about emergency contraception on a Facebook group or their friends rather than discussing it with their physician.&nbsp; 
&nbsp;

In a survey conducted across a tertiary care hospital in Karachi, Pakistan<a href="#accordion">[3]</a>:&nbsp; 
&nbsp;

<ul>
	<li>40% of the participants did not find emergency contraception to be an appropriate topic of discussion with their <a href="https://merisehat.pk/doctor-now">physicians&nbsp;</a></li>
	<li>69% of the physicians felt uncomfortable prescribing emergency contraception&nbsp;&nbsp;</li>
	<li>The promotion of promiscuity was another major reason cited for the reluctance of the <a href="https://merisehat.pk/">healthcare providers</a>&nbsp; 
	&nbsp;</li>
</ul>

Similar results were seen in a study conducted among community health workers in Rawalpindi, Pakistan. Approximately four-fifths of the workers attributed emergency contraceptive pills to the promotion of &lsquo;evil&rsquo; practices in society<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

As a result of the misinformation, women have turned online for answers. This has led to the self-administration of emergency contraceptive pills. Many women report using the pills several times a month, instead of their intended emergency use. You could almost say, they&rsquo;re popping emergency contraceptive pills like candy. But is that safe?

&nbsp;

Emergency contraceptive pills (ECPs) are a type of emergency contraception method commonly used for preventing <a href="https://merisehat.pk/article/time-for-men-to-share-the-burden-of-pregnancy">pregnancies</a>.&nbsp; 
&nbsp;

In Pakistan, Greenstar&rsquo;s ECP pill<a href="#accordion">[5]</a>&nbsp;and ZAFA Pharmaceutical laboratories&rsquo; Emkit are the two commonly available options. Both contain the hormone Levonorgestrel; it helps prevent or delay <a href="https://www.merisehat.pk/article/ovulation-are-you-eggspecting">ovulation</a>.&nbsp; 
&nbsp;

Typically,&nbsp;

<ul>
	<li>1.5 mg of the hormone is taken at once&nbsp;</li>
</ul>

or&nbsp;

<ul>
	<li>Two 0.75 mg pills are taken 12 hours apart.&nbsp; 
	&nbsp;</li>
</ul>

Also called the morning-after pill, ECPs are most effective when taken within 72 hours of unprotected sexual intercourse. Women using these particular ECPs have a pregnancy rate of 1.2-2.1%<a href="#accordion">[6]</a>. Moreover, they reduce the risk of unintended pregnancy by 72-89%<a href="#accordion">[4]</a>. 
&nbsp;

As per a cross-sectional study conducted in Karachi, Pakistan, 42.9% of the study participants were aware of emergency contraception methods, whereas only 6% reported practicing the method<a href="#accordion">[1]</a>. Another study reported awareness of ECP among only 7.5% of women of childbearing age<a href="#accordion">[7]</a>. 
&nbsp;

Similar to other emergency contraception methods, ECPs are used after unprotected sexual intercourse or possible contraceptive failure, such as condom breakage or failed withdrawal.&nbsp;

&nbsp;

Understanding Dangers Of Regular ECP Use

ECPs are recommended for single use, but women often report using the pill multiple times, sometimes in the same menstrual cycle.&nbsp; 
&nbsp;

Although studies have not found any health risks, frequent ECP use could lead to increased side effects. These include: 
&nbsp;

<ul>
	<li>Menstrual irregularities</li>
	<li>Nausea</li>
	<li>Vomiting</li>
	<li>Breast tenderness</li>
	<li>Abdominal pain</li>
	<li>Fatigue</li>
	<li>Headache</li>
	<li>Dizziness 
	&nbsp;</li>
</ul>

However, if your period is unusually heavy or light, or is delayed by more than 5 days, it is best to <a href="https://merisehat.pk/doctor-now">consult a doctor</a>.&nbsp; 
&nbsp;

According to the World Health Organization (WHO), frequent or repeated ECP use has harmful effects in women that are classified as medical eligibility criteria (MEC) category 2, 3, or 4 for combined hormonal contraception or Progestin-only contraceptives (POC)<a href="#accordion">[8]</a>. 
&nbsp;

In lactating women, the use of ECPs has been associated with ectopic pregnancy<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

Also, the pills are less effective in obese women (BMI &gt; 30 kg/m2)<a href="#accordion">[8]</a>, who might require a higher dose of the drug.&nbsp;

&nbsp;

<ul>
	<li>Although repeated ECP use is relatively safe, it does not increase the drug&rsquo;s effectiveness or minimize your risk of pregnancy further.&nbsp;</li>
	<li>Nor is an ECP as effective as regular contraception.&nbsp;</li>
	<li>Furthermore, once fertilization or implantation has taken place, the pills are no longer effective at preventing pregnancy.&nbsp; 
	&nbsp;</li>
</ul>

The timing of an ECP is key in deciding how well it will protect the user.

&nbsp;

The WHO recommends that every girl at risk of unintended pregnancy have access to emergency contraception. Moreover, the methods should be part of a country&rsquo;s national family planning programs. The health authority recommends the following methods of emergency contraception:

<ul>
	<li>ECPs And Combined Oral Contraceptive Pills (COCs)&nbsp;</li>
</ul>

Emergency contraceptive pills would contain either levonorgestrel (LNG) or ulipristal acetate (UPA). ECPs with UPA are taken as a single dose of 30 mg, while ECPs with LNG are taken as a single 1.75 mg dose, or 2 doses of 0.75 mg each, 12 hours apart.&nbsp;

While both have similar efficacies, UPA is more effective if used within 2-5 days of unprotected sexual intercourse than LNG<a href="#accordion">[6]</a>. Moreover, UPA is preferred for obese women.&nbsp;

However, none of these pills can prevent sexually transmitted infections (STIs).

Combined oral contraceptive pills (COCs) are generally taken as a split dose. This includes a single dose of 100 &mu;g of ethinyl estradiol plus 0.50 mg of LNG, followed by a second dose of 100 &mu;g of ethinyl estradiol plus 0.50 mg of LNG 12 hours later. These pills are less effective than ECPs at preventing pregnancies.&nbsp;

<ul>
	<li>Copper-Bearing Intrauterine Devices (IUDs)&nbsp;</li>
</ul>

A copper IUD could be inserted within 5 days of unprotected sexual intercourse. It is the most effective emergency contraceptive method<a href="#reference">10</a>.&nbsp;

Unlike ECPs and COCs which only provide temporary protection, copper IUD has the added advantage of delivering continued contraception. Moreover, it also prevents implantation.&nbsp;

Although it carries a risk of pelvic inflammatory disease, researchers believe the benefits of a copper IUD outweigh these risks.&nbsp;&nbsp;

&nbsp;

Emergency contraception methods prevent more than 95% of pregnancies if taken within 5 days of sexual intercourse<a href="#accordion">[6]</a>.&nbsp;However, ECPs are not to be used as regular contraception as they are not long-acting and are less effective than regular contraception methods.&nbsp; 
&nbsp;

Although frequent ECPs are considered safe, their effectiveness does not increase with repeated doses. Nor do they protect against STIs. However, researchers believe that the use of ECPs significantly reduces maternal deaths and unsafe abortions in the country. But, in a country where contraception use is not well understood<a href="#accordion">[1]</a>, the use of ECPs remains a sensitive topic.&nbsp; 
&nbsp;

Pakistan currently has the highest abortion rate in the world: 50 per 1,000 women aged 15-49 years<a href="#accordion">[1]</a>. The lack of sex education has increased unplanned pregnancies and maternal mortality in the country. Therefore, there is a need to raise awareness about the various contraception options available to the community, including emergency contraception methods.&nbsp; 
&nbsp;

Although pre-marital sex is against the law in Pakistan, many teenagers and young adolescents in the country are reportedly sexually active. A cross-sectional survey conducted among urban men in Pakistan found that 11% of men participated in pre-marital sex out of the 29% who reported participating in non-marital sex<a href="#accordion">[11]</a>. However, researchers believe that the actual number is probably higher. Therefore, an implementation of sex education programs in school curriculums is needed to educate the youth about safe sex practices.&nbsp;

&nbsp;

<ul>
	<li>Emergency contraceptive pills (ECPs) are a type of emergency contraception method commonly used for preventing pregnancies. In Pakistan, Greenstar&rsquo;s ECP pill and ZAFA Pharmaceutical laboratories&rsquo; Emkit are the two commonly available options. Both contain the hormone Levonorgestrel.</li>
	<li>Frequent or repeated use of ECP could cause increased side effects, such as menstrual irregularities, <a href="https://merisehat.pk/disease/nausea">nausea</a>, vomiting, breast tenderness, abdominal pain, fatigue, <a href="https://merisehat.pk/disease/tension-headaches">headache</a>, and dizziness. Moreover, in lactating women, there is a <a href="https://merisehat.pk/disease/ectopic-pregnancy">risk of ectopic pregnancy</a> with ECP use.</li>
	<li>Although frequent ECP use is relatively safe, it is less effective than regular contraception methods at preventing pregnancy. Nor does it protect against STIs.&nbsp;</li>
	<li>As per the WHO, a copper IUD is the<a href="https://merisehat.pk/disease/female-contraception"> best emergency contraception</a> method as it could also serve as a long-term option.&nbsp;</li>
	<li>There is a need to counsel the youth and adults on safe sex practices. Moreover, women should be educated on the correct use of ECP and the various long-term contraception methods available to them.</li>
</ul>

&nbsp;

[1] Siddiqui, M., Fatima, K., Ali, S. N., Fatima, M., Naveed, W., Siddiqui, F., Naqvi, T., Khan, S., Amin, M., Liaquat, A., & Bibi, Z. (2020). Prevalence and Predictors of Contraception Usage in Karachi, Pakistan. Cureus, 12(10), e11265

[2] 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. F1000Research, 10, 790.

[3] Abdulghani, H. M., Karim, S. I., & Irfan, F. (2009). Emergency contraception: knowledge and attitudes of family physicians of a teaching hospital, Karachi, Pakistan. Journal of health, population, and nutrition, 27(3), 339–344. https://doi.org/10.3329/jhpn.v27i3.3376

[4] Mir, A. S., & Malik, R. (2010). Emergency contraceptive pills: Exploring the knowledge and attitudes of community health workers in a developing Muslim country. North American journal of medical sciences, 2(8), 359–364. https://doi.org/10.4297/najms.2010.2359

[5] Greenstar. (n.d.). Emergency Contraceptive Pill. Greenstar Social Marketing.

[6] World Health Organization. (2021, November 9). Emergency contraception. WHO | World Health Organization.

[7] Khan, S. A., Hafeez, H., & Akbar, R. (2015). EMERGENCY CONTRACEPTION: AN OVERVIEW AMONG USERS. Journal of Ayub Medical College, Abbottabad : JAMC, 27(1), 51–54.

[8] Mir, A.M., Wajid, A., Pearson, S. et al. Exploring urban male non-marital sexual behaviours in Pakistan. Reprod Health 10, 22 (2013).

[9] Masud, N., AlShaibi, S., AlBassri, T., Khan, S., & Khan, F. (2021). Case of rupture ectopic pregnancy with emergency contraception levonorgestrel 0.075 mg in a lactating woman. Clinical case reports, 9(3), 1605–1609.

[10] Mittal S. (2016). Emergency contraception: which is the best?. Minerva ginecologica, 68(6), 687–699.

Popping The Right Pills: Prenatal Vitamins

As you know, a healthy pregnancy starts with a healthy diet. It&#39;s easy to focus on what you&#39;re eating, but it&#39;s also important to think about the <a href="https://www.merisehat.pk/article/a-guide-to-essential-vitamins-and-micronutrients-and-should-you-be-taking-them">nutrients </a>in your food and how they affect your body<a href="#accordion">[1]</a>. That&#39;s where prenatal vitamins come in! These supplements contain important vitamins and minerals that help you avoid certain complications and give your baby a head start in life.&nbsp;

With so many options out there, it can be hard to know which one is best for you and your baby. This guide will elaborate on what makes a good prenatal vitamin, so you can make the right choices. 
&nbsp;

Understanding The Importance Of Prenatal Vitamins

Prenatal vitamins are a supplement used by pregnant women in order to ensure they get the recommended daily allowance of nutrients. These vitamins may also be referred to as &quot;prenatal supplements.&quot;

They are usually taken as a single dose but it&rsquo;s also okay to divide them into smaller doses throughout the day as long as you take them according to the directions on your prenatal vitamin package.&nbsp;

The recommended daily allowance (RDA) is an estimate of how much nutrition you need each day based on what&#39;s recommended for maintaining good health. The amount varies depending on factors like your age, gender, and activity level &mdash; the RDA is higher if you&#39;re pregnant or breastfeeding because during those periods your body needs more nutrition than usual. Prenatal vitamins help fill in any gaps that might exist between what you consume through food alone and what your body actually needs. 
&nbsp;

Prenatal vitamins are important for you and your baby in several ways, including:&nbsp;

Preventing Birth Defects: Prenatal vitamins help prevent neural tube defects, like spina bifida, by building your baby&#39;s brain and spinal cord during pregnancy.

Reducing The Risk Of Preeclampsia: Prenatal vitamins can also reduce your risk of preeclampsia, a pregnancy-related complication that causes high blood pressure and organ damage to mom and baby alike.

Lowering Your Chances Of Premature Birth Or Low-Birth-Weight Baby: Prenatal vitamins help keep the baby&rsquo;s organs healthy so they can grow inside your belly properly &mdash; making it less likely that you&rsquo;ll go into labor too early or have a low-birth-weight baby (less than 5 pounds)<a href="#accordion">[2]</a>. 
&nbsp;

To choose the right prenatal, look for one that has all the essential vitamins and minerals. Your doctor or midwife will recommend a brand they like, but you can also read reviews online to see what other women are saying about them.

&nbsp;

Keep in mind that there are 2 types of prenatal vitamins:&nbsp;

<ol>
	<li>Standard</li>
	<li>Chewable (or coated).&nbsp;</li>
</ol>

&nbsp;

If you don&#39;t like taking pills, go with a chewable option. If your doctor recommends one type over another given your condition, it&rsquo;s best to follow their advice<a href="#accordion">[3]</a>.

&nbsp;

<ul>
	<li>
	<h5>Vitamin D</h5>
	</li>
</ul>

Vitamin D is a fat-soluble vitamin that plays an important role in bone health and immune function.&nbsp;

There are 2 types of vitamin D &ndash; vitamin D2 (also called ergocalciferol) and vitamin D3 (also called cholecalciferol). Vitamin D2 is synthesized by plants, while the more bioactive form, vitamin D3, can only be obtained from animal sources like fish or fortified foods.

Its deficiency has been linked to an increased risk of conditions, like osteoporosis, heart disease, and cancer. So, pregnant women need to get enough vitamin D. You should aim for 600 IU daily during pregnancy or any other time when you&#39;re not breastfeeding.

You can get vitamin D through food sources such as salmon and cheese. If you don&#39;t eat these foods often enough, then consider taking a supplement with at least 400 IU per day.

&nbsp;

<ul>
	<li>
	<h5>Vitamin C</h5>
	</li>
</ul>

Ideally, the first prenatal vitamin you should be taking is a high-quality multivitamin. Most prenatal vitamins contain additional iron and folic acid. Choose one with 0% sugar and minimal ingredients as this will reduce the chance of diarrhea.

Vitamin C helps your body absorb iron from other foods, but it does not contain any iron itself. The recommended dose for adults is about 90 mg daily, however, you may need more if you are pregnant or breastfeeding because vitamin C helps with skin health and morning sickness (both common issues in pregnancy).

&nbsp;

<ul>
	<li>
	<h5>Folic Acid</h5>
	</li>
</ul>

Folic acid plays an important role in pregnancy as it helps prevent neural tube defects (NTDs). NTDs are serious birth defects that can lead to lifelong disabilities. They occur during the first month of pregnancy when a baby&#39;s spinal cord and brain are developing.&nbsp;

Folic acid works with other nutrients to help form red blood cells, which carry oxygen throughout your body. And since you need adequate red blood cell levels for your growing baby, you need folic acid, too!

Leafy green vegetables, like kale and spinach, are rich in folic acid. Beans and legumes are other great sources of this nutrient; just one cup of cooked lentils contains 35 micrograms (mcg) of folate! Whole grains, like oatmeal, also contain some folic acid naturally; one serving has about half the recommended amount per day (400 mcg). Not only that but fortified cereals and breads provide some additional doses too at 100% Daily Value or 25% Daily Value depending on which type they claim on their packaging label(s).

However, with morning sickness and mood swings, the chances of you eating all these green veggies in the right amounts are very minimal, which is why supplements are your best bet.&nbsp; 
&nbsp;

In conclusion, prenatal vitamins are an easy and effective way to make sure you and your baby are getting the nutrients you need. Prenatal vitamins support a healthy pregnancy, reducing the risk of neural tube defects, preterm birth, and low birth weight. As always, be sure to talk to <a href="https://www.merisehat.pk/doctor-now">your doctor</a> before starting any new supplement routine. They will be able to help you figure out the best option for you and your developing baby! 
&nbsp;

Prenatal vitamins are the supplements recommended for pregnant women to take during their pregnancies. <ul><li>They contain a good blend of multiple nutrients in safe amounts to allow a healthy pregnancy and support your baby’s growth.</li><li>Prenatal vitamins support a healthy pregnancy, reducing the risk of neural tube defects, preterm birth, and low birth weight.&nbsp;</li><li>Be sure to talk to your doctor before starting any new supplement routine.</li></ul>

[1] Prenatal vitamins: Why they matter, how to choose. Mayo Clinic.

[2] Home. Kansas City ObGyn – Gynecology &amp; Obstetric Care in Overland Park, KS.

[3] Pogored. How to choose the best prenatal vitamin. Cleveland Clinic.

Umna Salah

Erectile Dysfunction Pills - Hit Or Miss?

Sexual dysfunction is a common problem among both men and women. Approximately 43% of women and 31% of men report suffering from some form of problem during sex.<a href="#accordion">[1]</a>&nbsp;In men, sexual dysfunction encompasses sexual desire, orgasm, pain, and sexual arousal (maintaining erections).<a href="#accordion">[2]</a>&nbsp;Difficulty achieving or maintaining an erection is not unusual. One can experience such problems from time to time, especially if facing relationship problems or dealing with stress. However, if it progressively worsens and affects one&#39;s sexual life, it becomes a health concern.

<a href="https://www.merisehat.pk/disease/erectile-dysfunction">Erectile dysfunction</a>, or ED, is defined as an inability to maintain a firm enough and lasting erection for satisfactory sexual intercourse or achieve an erection when one wants. Although its prevalence increases with age, aging isn&#39;t a cause of ED.<a href="#accordion">[3]</a>&nbsp;Instead, several physical and psychological conditions can predispose one to ED; these include <a href="https://www.merisehat.pk/disease/depression">depression</a>, diabetes, cardiovascular disorders, and obesity.<a href="#accordion">[4]</a>&nbsp;Moreover, the use of certain medications, smoking, drug use, and alcohol consumption can also affect a person&#39;s sexual function.&nbsp;

ED is highly prevalent in the Pakistani male population, affecting 80.8% of men attending primary care clinics.<a href="#accordion">[5]</a>&nbsp;However, the true burden of the disease in the country cannot be established due to underreporting of cases. The stigma surrounding sexual health makes men hesitant to discuss their issues with a healthcare professional and at times even friends and family. Moreover, many are unaware that ED is a highly treatable condition. Thus, it not only affects one&#39;s sexual and mental health but also the overall quality of life. 
&nbsp;

Understanding Erectile Dysfunction Pills

Over the years, researchers have developed several treatment options for ED, ranging from pills and aids to surgical implants. However, oral pills such as phosphodiesterase (PDE) 5 inhibitors continue to be the first line of treatment for erectile dysfunction.<a href="#accordion">[6]</a>&nbsp;The widely popular pill, Viagra (sildenafil) was one of the first FDA-approved oral pills for ED.&nbsp;

PDE5 inhibitors relax the penile muscles during sexual arousal, thus increasing blood flow to the chambers and causing an erection. They are typically 60-80% effective at treating the symptoms of ED.<a href="#accordion">[7]</a>&nbsp;Although all are similar in safety and effectiveness, there is a difference in how long the drug&#39;s effect lasts and the side effects of the medication.&nbsp; 
&nbsp;

There are four FDA-approved PDE5 inhibitors for use against ED. They include:

<ol>
	<li>Viagra (Sildenafil) - The famous blue pill was the first PDE5 inhibitor approved for ED. It is typically taken at least an hour prior to sexual intercourse and has a quick onset of action (30 minutes). The recommended dosage is 50 milligrams(mg), and its effect typically lasts for 4-5 hours. For maximum absorption, it is advised to take the drug on an empty stomach.&nbsp;</li>
	<li>Cialis (Tadalafil) - Unlike other ED pills, tadalafil has an extremely long duration of action (36 hours). It is often prescribed as a daily 5mg dose in patients suffering from benign prostatic hyperplasia and ED. Although similar to Viagra in terms of onset and safety, people often prefer tadalafil because it improves sexual confidence.<a href="#accordion">[8]</a>&nbsp;Therefore, it is often prescribed for people with psychological factors causing ED.&nbsp;</li>
	<li>Stendra (Avanafil) - Avanafil is a newer class of PDE5 inhibitors and is typically taken 30 minutes before sexual intercourse. Compared to other ED pills, avanafil is preferred in people with cardiovascular disorders as it has fewer effects on blood pressure<a href="#reference" target="_blank">9</a>. Thus, making it safe to use in those taking anti-hypertensives.&nbsp;</li>
	<li>Levitra (Vardenafil) - This particular drug has the shortest onset of action (10 minutes) and is effective for 4-5 hours. However, it can lengthen the QTc interval and is not prescribed in patients with prolonged QTc or those taking antiarrhythmics.</li>
</ol>

Note: ED pills can have mild side effects, such as flushing, dizziness, headaches, diarrhea, and vision problems. Moreover, the medications are contraindicated in those taking nitrate drugs, or suffering from blood pressure-related problems, liver disease, or severe kidney disease. A more severe side effect of the drug is a painful, prolonged erection. In case of an erection lasting more than 4 hours, professional help should be sought. 
&nbsp;

As per a 2013 meta-analysis, all PDE5 inhibitors are more effective than a placebo for treating ED.<a href="#accordion">[7]</a>&nbsp;They have a similar safety profile; however, the study found tadalafil to be the most effective among other PDE5 inhibitors, followed by vardenafil.&nbsp;

If all are safe and effective, what is the best option? The truth is that the best option will vary from person to person. It will depend on your medical history, the underlying cause of ED, whether you want it for regular use or occasional use, and your lifestyle. Therefore, it is best to discuss all your options with a healthcare professional and then make a decision. 
&nbsp;

Sexual health has a huge impact on a person&#39;s quality of life. Letting societal pressures and social stigmas influence your decisions will only negatively affect your health. And while living with any form of sexual dysfunction can be frustrating, it is important to note that treatment is very much possible. And the presence of a sexual problem is in no way reflective of one&#39;s masculinity.&nbsp;

Therefore, if one suffers from ED or any other sexual dysfunction, seeking a healthcare professional can significantly improve the overall quality of life. Moreover, combining various treatment options such as oral pills. counselling and lifestyle changes can further improve one&#39;s sexual problems.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Erectile dysfunction is defined as an inability to maintain an erection firm enough for satisfactory sexual intercourse. It can result from a variety of physical (obesity, diabetes, cardiovascular disease) and psychological (anxiety, depression) conditions.</li>
	<li>Phosphodiesterase (PDE) 5 inhibitors are the first line of treatment for ED. There are currently four FDA-approved pills: sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra), and avanafil (Stendra).&nbsp;</li>
	<li>All ED pills are similar in safety and efficacy; however, doctors prescribe the drugs based on your medical history, lifestyle, and underlying cause of ED. It is best to consult your doctor before starting any medication.</li>
	<li>Seeking professional help is an important step in treating ED and improving one&#39;s sexual health&nbsp;and overall quality of life.</li>
</ul>

[1] Rosen, R. C., 2000. Prevalence and risk factors of sexual dysfunction in men and women. Current Psychiatry Reports, Volume 2, pp. 189-195.

[2] Wincze, J. P. & Weisberg, R. B., 2015. Sexual Dysfunction: A Guide for Assessment And Treatment. 3rd Edition ed. s.l.:Guilford Press.

[3] Johannes, C. B. et al., 2000. Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts male aging study. The Journal of Urology, 163(2), pp. 460-3.

[4] McMahon, C. G., 2019. Current diagnosis and management of erectile dysfunction. Medical Journal of Australia, 210(10), pp. 469-476.

[5] Shaeer, K. Z. M. et al., 2003. Prevalence of erectile dysfunction and its correlates among men attending primary care clinics in three countries: Pakistan, Egypt, and Nigeria. International journal of impotence research, Volume 15.

[6] Kalsi, J. S. & Kell, P. D., 2004. Update on oral treatments for male erectile dysfunction. Journal of the European Academy of Dermatology and Venereology, 18(3), pp. 267-274.

[7] Yuan, J. et al., 2013. Comparative effectiveness and safety of oral phosphodiesterase type 5 inhibitors for erectile dysfunction: a systematic review and network meta-analysis. European Urology, 63(5), pp. 902-12.

[8] Gong, B. et al., 2017. Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis. International Urology and Nephrology, 49(10).

[9] Katz, E. G., Tan, R. B., Rittenberg, D. & Hellstrom, W. J., 2014. Avanafil for erectile dysfunction in elderly and younger adults: differential pharmacology and clinical utility. Therapeutics and Clinical Risk Management, Volume 10, pp. 701-11.

Cannabis Abuse – Flying The Wrong Airplane In Adolescence

In recent years, the legalization of marijuana has become more common. This is partially due to research showing that the substance does not cause cancer like many had previously thought. However, it has also led some people to believe that cannabis usage is harmless. Thus, encouraging them to use it more often in adolescence. This might be true for adults as well, but studies have shown that young people who consume it might suffer from long-term problems related to memory loss, anxiety disorders, and other <a href="https://merisehat.pk/article/Mental%20Health">mental health issues</a>, which can be problematic later in life.

&nbsp;

Understanding Dangers Of Cannabis Abuse In Adolescence

In Pakistan, the use of the actual leaves itself is not very common due to the high prices. It is a drug that is solely enjoyed by the younger generation of the elite or upper middle class.&nbsp;

&nbsp;

The most common way of consumption in Pakistan is through ingestion, by making edible items out of the plant like brownies or gummies. However, a much cheaper alternative, that contains many of the same components as marijuana, is hash.&nbsp;

&nbsp;

Hash consumption in Pakistan is rampant in people of all classes due to its low-cost nature and easy availability. Hash is consumed by mixing it with cigarette components; smoking the mixture gives the user a feeling of lightheadedness.

&nbsp;

Recent studies in adolescent cannabis abusers show that their IQ drops with their utilization of marijuana.&nbsp;&nbsp;

&nbsp;

The usage of THC or tetrahydrocannabinol (the main component in cannabis) causes the reduction of gray matter in the brain as well as certain changes to white matter. This results in an imbalance in neurotransmitters, which leads to memory impairment and poor concentration.&nbsp;

&nbsp;

These effects worsen when exposure to THC is prior to 16 years of age. The data, thereby, suggests that the younger the users are, the longer the detrimental effects would last<a href="#accordion">[2]</a>.

&nbsp;

This is especially important because the brain continues to develop until age 25, and chronic use of cannabis in young adults might affect its development. Additionally, research shows that adolescents who have a family history of schizophrenia are at an even higher risk when using marijuana before age 16.&nbsp;

&nbsp;

While gray matter is directly related with intelligence, there are no reported direct ties of marijuana with low IQ<a href="#accordion">[5]</a>.

&nbsp;

Given how marijuana affects intelligence and mental health, it&#39;s important for parents to be aware of this information so they make informed decisions about their children&#39;s usage patterns.&nbsp;

&nbsp;

Consumption of cannabis at a young age could cause social anxiety and depression disorders due to neurobiological reasons<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

Utilization of THC affects regulation of serotonin (which is responsible for mood regulation), dopamine (which is responsible for controlling reward and pleasure centers), and norepinephrine (which is responsible for vigilance and concentration)<a href="#accordion">[7]</a>.

<h5>&nbsp;</h5>

Lack Of Motivation To Perform Daily Activities

Sometimes, heavy use of THC reduces motivation, due to activation of specific proteins in the brain. This change in motivation makes it more difficult for individuals who abuse it heavily to perform daily tasks, and even leads them to drop out of school<a href="#accordion">[3]</a>.

&nbsp;

One reason why this happens is because THC affects the brain&#39;s reward system, which is responsible for motivation, memory, and learning. THC has been shown to increase dopamine levels (a neurotransmitter involved in reward) by up to 60% after just 1 dose.&nbsp;

&nbsp;

However, research also shows that chronic use could decrease dopamine levels by as much as 50%. At first glance, these numbers seem contradictory &mdash; how could someone experience both increases and decreases? It turns out there are ways that cannabis use affects the brain&#39;s reward system differently depending on the person&rsquo;s age as well as the amount of dosage taken<a href="#accordion">[4]</a>.

&nbsp;

Decreased Cognitive Learning Ability&nbsp;

The ability to plan, organize, solve problems, make decisions, remember and control emotions and behavior is called executive function. This is a set of skills that allows us to accomplish tasks and achieve goals.

&nbsp;

Cannabis use has been proven to impair cognitive functions on a number of levels. The usage of cannabis on a developing brain worsens the impact greatly as compared to its impact on adults. While there is enough evidence that supports the claim of cannabis having detrimental effects on adolescent brains, the longevity of these effects remains to be elucidated.

&nbsp;

Individuals with cannabis-related impairment in executive functions have been found to have trouble learning and applying the skills required for successful recovery, which puts them at increased risk for relapse to cannabis use<a href="#accordion">[6]</a>.

&nbsp;

To conclude, marijuana abuse is dangerous for adolescents. It affects their cognitive and emotional development in a negative way, as well as impairs their ability to perform daily tasks. While cannabis is beneficial with respect to human health, these benefits are only for adult users consuming it in low doses. Young people should avoid using cannabis or other substances at all costs; it would help them steer clear of problems such as addiction or dependence later on in life.

<ul><li>Usage of cannabis in adolescents is known to trigger anxiety and depression.&nbsp;</li><li>Marijuana abuse in adolescence runs the risk of the individual dropping out from school due to diminished ability to learn, and reduced cognitive learning capacity.</li><li>Neurotransmitters like epinephrine, dopamine, and serotonin are greatly imbalanced due to THC use and abuse which might lead the individual towards addiction.</li><li>It is common in individuals who abuse marijuana to easily lose interest in many of the tasks they used to perform. They might even lose the motivation to carry out basic daily life tasks, which is believed to give rise to more addiction.</li></ul>

[1] Daniel K. Hall-Flavin, M., n.d. Marijuana and depression: What's the link?. Mayo Clinic

[2] Emmet Power, S. S. C. H. A. O. N. D. C. a. M. C., 2021. Intelligence quotient decline following frequent or dependent cannabis use in youth: a systematic review and meta-analysis of longitudinal studies. Psychol Med, 51(2), pp. 194-200.

[3] Ileana Pacheco-Colón, M. J. M. L. a. R. G. P., 2019. Non-Acute Effects of Cannabis Use on Motivation and Reward Sensitivity in Humans: A Systematic Review. Psychol Addict Behav..

[4] Michael A P Bloomfield, A. H. A. N. D. V. a. O. D. H., 2017. The effects of Δ9-tetrahydrocannabinol on the dopamine system. Nature, p. 369–377.

[5] Nicholas J. Jackson, J. D. I. j. R. K. ,. D. I. C. T. W. G. I. M. M. A. R. a. L. A. B., 2016. Impact of adolescent marijuana use on intelligence: Results from two longitudinal twin studies. PNAS, 113(5), pp. 500-508.

[6] Rebecca D. Crean, P. N. A. C. B. a. B. J. M. P., 2012. An Evidence Based Review of Acute and Long-Term Effects of Cannabis Use on Executive Cognitive Functions. J Addict Med, 5(1), pp. 1-8.

[7] Washington.edu, n.d. Marijuana.

A Little High, A Little Low - A Cautionary Tale

We live in a hyperactive society, where we can get things done at our fingertips. That feeling of accomplishment can give you a dopamine rush. But, what happens when that feeling is taken away from you? You start finding other ways to satisfy your brain&rsquo;s hunger for that happiness and satisfaction. In many cases, people adopt hobbies to keep themselves busy. But in some cases, things may take a darker turn, making people resort to drugs. 
&nbsp;

In a fast-paced society, everyone is trying to get things done at their earliest. Exhausted from screens, work and education, we often find ourselves looking for a break. For some people blowing off steam could be as simple as going on a trip, but for others, it may mean going on a mental trip.

&nbsp;

For most of us using drugs seems like a simple question i.e. you can choose to do it or not do it. However, the case is very different for people who find drugs as their way of escape. The frustration mentioned above is just the tip of the iceberg. Societies across the globe are facing a myriad of issues. Cancel culture is rampant, as is creating and promoting superficial lifestyles on social media; the quest to be the best is no longer an option but rather a necessity, leading to increased frustration, hopelessness and <a href="https://merisehat.pk/disease/depression">depression</a>. These frustrations are further augmented in socially-closeted countries where men are met with hate when they express any emotions, while women deal with multiple unexplainable stigmas. This causes people to shut themselves in their own minds.&nbsp; 
&nbsp;

Drug abuse is becoming a growing concern in Pakistan, and is affecting all social classes. Various existing stigmas hinder people from seeking professional help for their mental health which contributes to pent-up frustrations, traumas, or experiences.&nbsp; 
&nbsp;

Hence, drugs provide a way for people to escape their harsh reality, experience a rush of happy chemicals, or numb themselves. In many cases of drug abuse, people are often victims of abuse, rape or some sort of traumatic experience. While this does not justify drug abuse, it identifies a crucial problem &ndash; the need for increasing mental health awareness in Pakistan.

&nbsp;

Understanding The Dangers of Drug Abuse

Pakistan&rsquo;s greatest tragic loss has been its youth to drugs in the early 90s. In 1989, heroin use became very common in Pakistan and Afghanistan<a href="#accordion">[1]</a>. However, the strict regulations imposed since then have aided in gaining good control over the situation<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

<h4>"Your breathing can be influenced by many things. Try out our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> to find out your respiratory rate now!" </h4>

Some commonly abused drugs in Pakistan include:&nbsp; 
&nbsp;

Hashish: Hash, also known as chars, is by far the most commonly consumed drug by all classes of Pakistan.&nbsp;

Hash is a potent form of marijuana and is known to form several long-term and short-term side effects. These include: 
&nbsp;

<ul>
	<li>Lightheadedness&nbsp;</li>
	<li>Learning difficulties</li>
	<li>Difficulty in thinking, problem-solving and registering senses</li>
	<li>Paranoia</li>
	<li>Headaches</li>
	<li>Anxiety&nbsp;</li>
	<li>Panic attacks</li>
	<li>Respiratory issues involving bronchitis, pneumonia and lung cancer</li>
	<li>Cardiac arrhythmias&nbsp; 
	&nbsp;</li>
</ul>

Edibles: These are normal foods infused with drugs of any kind. In most cases, the drug is marijuana. Edibles are very common among the younger generation, often consumed as a recreational activity. However, edibles give a much stronger and heightened effect of the drug, and run a massive risk of overdosing<a href="#accordion">[3]</a>. The side effects of edible consumption include: 
&nbsp;

<ul>
	<li>Severe anxiety and panic attacks</li>
	<li>Excessive drowsiness</li>
	<li>Hallucinations</li>
	<li>Vomiting</li>
	<li>Paranoia</li>
	<li>Psychotic episodes</li>
	<li>Respiratory depression</li>
	<li>Agitation</li>
	<li>Impaired motor ability</li>
	<li>Psychosis 
	&nbsp;</li>
</ul>

Heroin: Most commonly used by the homeless, or people belonging to the lower class. Due to its extreme affordability, heroin is one of the most addictive drugs in the world. The opioid drug is made from morphine, and is often injected for maximum bioavailability. It is believed that even a single dose of heroin can get you addicted due to its high analgesic effects<a href="#accordion">[4]</a>.&nbsp;The side effects of heroin include: 
&nbsp;

<ul>
	<li>Insomnia</li>
	<li>Collapsed veins&nbsp;</li>
	<li>Damaged tissues</li>
	<li>Infection of heart valves and lining</li>
	<li>Abscesses</li>
	<li>Sexual dysfunction</li>
	<li>Depression and antisocial personality disorder</li>
	<li>Pneumonia</li>
	<li>Constipation and stomach cramps 
	&nbsp;</li>
</ul>

Psilocybin Mushrooms: Commonly known as magic mushrooms or shrooms, they are most commonly consumed in Karachi. The drug gives you a euphoric feeling, while making you hallucinate. So far, they are not considered addictive, but can cause permanent damage to the brain<a href="#accordion">[5]</a>. The long-term side effects may include: 
&nbsp;

<ul>
	<li>Change in personality</li>
	<li>Hallucinations</li>
	<li>Tolerance requiring the user to consume more every time</li>
	<li>Hallucinogen Persisting Perception Disorder (HPPD) also referred to as &lsquo;flashbacks&rsquo; 
	&nbsp;</li>
</ul>

Dipping tobacco: Also known as moist snuff, it is called &lsquo;naswar&rsquo; in Pakistan. Commonly used in KPK, this is grounded moist tobacco that is not for smoking purposes. It is administered by taking a small chunk out and stuffing it in a corner of your mouth<a href="#accordion">[5]</a>. Tobacco use, in general, has many side effects including: 
&nbsp;

<ul>
	<li>Oxidative stress</li>
	<li>Cardiovascular diseases</li>
	<li>Dyslipidemia</li>
	<li>High cholesterol 
	&nbsp;</li>
</ul>

Drug addiction is not a battle fought by individuals, but by societies as a whole. Drug addiction in general is deep-rooted by societal flaws.&nbsp;

Instead of shaming drug addicts or people who have been finding solace in substances, we need to create avenues for their rehabilitation.&nbsp;

Our primary responsibility in this war is to create dialogues, be more vocal about our thoughts and experiences, and help others cope with their issues in the healthiest way possible.

We as a society need to normalize discussing and seeking help for mental health and addictions issues.&nbsp; Alongside investing in avenues which allows for effective rehabilitation and re-integration of recovered addicts in society.&nbsp;

Our society needs to create more dialogue and awareness regarding drug use, along with providing better solutions for people to release their pent-up frustrations.

&nbsp;

<ul><li>Pakistan has been battling street drugs and substance abuse for ages.</li><li>The most common types of drugs consumed in Pakistan include hashish, edibles of marijuana, heroin, naswar, and psilocybin mushrooms.</li><li>The solution lies in normalizing discussing and seeking help for mental health and addictions issues, alongside creating more dialogue and awareness regarding drug use.&nbsp;</li></ul>

[1].Haq, I., 1996. Pak-Afghan Drug Trade in Historical Perspective. Asian Survey, 36(10), pp. 945-963

[2].Gossop, M., 1989. The detoxification of high-dose heroin addicts in Pakistan. Drug Alcohol Depend, 2(1), pp. 43-50.

[3].Rehab After Work, 2020. The Dangers of Marijuana Edibles.

[4].National Institute on Drug Abuse, n.d. Heroin Drug Facts.

[5].Drug Policy Alliance, n.d. What are the long-term health impacts of psilocybin mushrooms?

[6].Faiza Sajid, S. B., 2015. Effects of smokeless dipping tobacco (Naswar) consumption on antioxidant enzymes and lipid profile in its users. Pak J Pharm Sci, 5(18), pp. 29-33.

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions.

 
Microdosing sounds a lot like drug abuse, doesn&rsquo;t it? But that&rsquo;s far from the truth. The aim of microdosing is to enhance brain functioning and, in many cases, even treat mental illness through unconventional ways to minimize the side effects and possible dependency on drugs. 
&nbsp;

Understanding The Pros And Cons Of Microdosing

Microdosing, as the name suggests, is the process of administration of small doses of new or pre-approved chemicals to improve physiological functions. The microdose is also referred to as sub pharmacological dose.&nbsp;

&nbsp;

The pharmacokinetic predictors are the users, ensuring the dosage does not have an impact on the clearance, distribution or bioavailability of the compound<a href="#accordion">[1]</a>.

&nbsp;

Microdosing is often used in the process of drug development to determine the therapeutic index of the drug. This practice dates back all the way to the 16th century.

<div>&nbsp;</div>

In order for a dose to be considered sub pharmacological or a microdose, it has to be 1/10th or 1/20th of the normal dose. The target is to avoid the high and/or the intoxication associated with the drug, along with ensuring that possible addiction to the drug does not occur. Since the phenomenon is not widely supported by scientists or healthcare practitioners, there is no set schedule and people who are practicing this have been doing it all on their own based on their own observations and hypotheses<a href="#accordion">[2]</a>. A lot of the positive results are disregarded by many professionals in the name of a placebo effect, but is it what microdosing really is?&nbsp;

&nbsp;

So far, these are the benefits that have been promised by people practicing microdosing from all over the world:

<ul>
	<li>Microdosing on psychedelics has been associated with improved mood.</li>
	<li>Some psychedelics are used to treat anxiety and depression. They exert effects similar to serotonin reuptake inhibitors.</li>
	<li>Improved sleep and an increased sense of well-being.</li>
	<li>Microdosing may help manage symptoms of ADHD.</li>
	<li>It improves cognition.</li>
	<li>It boosts energy.</li>
	<li>It enhances psychomotor performance especially in people over 55 years of age.</li>
</ul>

<div>&nbsp;</div>

Lysergic acid diethylamide is known for its hallucinogenic effects in people and it is very commonly used by artists of all kinds to change their perspectives and broaden their horizons. It is now widely used for microdosing as well. 5-10% of the usual dose if taken, can induce mood enhancing effects, is beneficial for cognitive health, and even helps deal with pain.&nbsp;

&nbsp;

LSD microdosing was an open secret. The game changed when Apple founder Steve Jobs talked about how LSD played a vital role in his life.&nbsp;

&nbsp;

LSD microdosing should never be done continually. It is always better to start off with microdosing 2 days and then skip 2 days (avoid microdosing). So, you can be microdosing from Monday to Friday and leaving the weekends sober. Alternatively, it can also be done by taking small doses of LSD every other day.

&nbsp;

The following effects of LSD microdosing have been reported by many users<a href="#accordion">[8]</a>:&nbsp;&nbsp;

<ul>
	<li>Reduced anxiety</li>
	<li>Reduced depression</li>
	<li>Enhanced energy levels</li>
	<li>Reduced pain</li>
	<li>Headache&nbsp;</li>
	<li>Better sleep quality</li>
</ul>

<div>&nbsp;</div>

Though it is important to bear in mind that many, if not all of the previously mentioned&nbsp; effects, might be placebo effects as suggested by&nbsp; several researchers including the research conducted by the University of Chicago. The main issue is that these beneficial effects are reported in uncontrolled environments by regular users who have literally no idea of psychiatry and how the brain works.&nbsp;

&nbsp;

According to the research done by University of Chicago, they administered small doses of the psychedelic to people but ensured that the people were unaware of it in order to truly monitor their impact &ndash; without involving the bias from the subject&rsquo;s thoughts or attitudes towards the drug that would automatically alter the results. It was found that while the people experienced a little high, there was no actual mood enhancement or improved cognitive action in the brain<a href="#accordion">[9]</a>.

<div>&nbsp;</div>

Psilocybin is one of the most common substances that is used for microdosing. Researchers are heavily invested in trying to determine the true extent of its therapeutic uses and its impact on depression and anxiety: the two mental illnesses it is mostly used for treating. Microdosing Psilocybin has garnered mixed perspectives over the years, with experts on one hand calling it a mere placebo effect, and on the other there are studies that discuss its impact on the brain<a href="#accordion">[6]</a>.

&nbsp;

According to many researches based on experiments and data extracted from people who practice microdosing psilocybin, there has been a significant impact on their cognitive function and mental concentration<a href="#accordion">[3]</a>. However, research also indicates that&nbsp; full doses of the substance may lead to permanent behavioral changes, making it a very slippery slope with different possible outcomes, some of which may not even be desirable.&nbsp;

&nbsp;

Psilocybin administration is sometimes mixed with other substances like lion&rsquo;s mane mushrooms or niacin. This combination may not have a huge impact on younger users, but it is known to increase psychomotor functions in people over 55 years i.e., psychomotor performance was limited to older adults<a href="#accordion">[4]</a>.

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Interestingly, in many case studies, psilocybin users have been compared to placebo groups and both groups have reported similar effects<a href="#accordion">[7]</a>. Its impact on mood and mental health is still considered to be minimal and gradual.&nbsp;

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The issue is that since these <a href="https://merisehat.pk/article/the-rise-of-new-weight-loss-drugs-a-comprehensive-overview-and-accessibility-concerns">drugs</a>, especially psilocybin are illegal, there is little to no long-term extensive research on its use and its long-term effects. However, data accumulated from long-term abusers of such drugs suggests that prolonged use of psilocybin may lead to valve damage or cardiac valvulopathy<a href="#accordion">[5]</a>.

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The biggest risk with microdosing is the entire unsupervised practice itself. In many cases, people are just subjecting themselves to long-term health issues with no actual outcome because many studies have proven that in most cases, the benefits are caused due to placebo effects and the drugs may not have any significant impact on the individual at all.

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Despite this, the ever-growing community of microdosers is attracting a lot of people who are not well-versed with science. This not only gives rise to misuse and possible overdosing incidents; it also promotes the practice of illegal substance use that can potentially cause irreversible damage to the user.

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<ul>
	<li>Microdosing has been used in professional practices for a very long time for the determination of therapeutic index of the drugs.</li>
	<li>Currently, the process is used for inducing psychiatric effects on people with mental illnesses or just to enhance your brain function.</li>
	<li>While microdosing can be done on any drugs, the most commonly used type of drugs are psychedelics, including psilocybin and LSD</li>
	<li>Many researchers have reported that there is no robust evidence backing the self-proclaimed therapeutic effects of microdosing and these benefits are solely due to placebo effects.&nbsp;</li>
</ul>

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[1] Anderson T, Petranker R, Christopher A, et al. Psychedelic microdosing benefits and challenges: An empirical codebook. Harm Reduction Journal. 2019;16(1). doi:10.1186/s12954-019-0308-4

[2] Smith DG. More people are microdosing for mental health. but does it work? The New York Times.

[3] Nichols DE. Psychedelics. Pharmacological Reviews. 2016;68(2):264-355. doi:10.1124/pr.115.011478

[4] Rootman JM, Kiraga M, Kryskow P, et al. Psilocybin microdosers demonstrate greater observed improvements in mood and mental health at one month relative to non-microdosing controls. Nature News.

[5] Radcliffe S. Microdosing psilocybin mushrooms may improve mental health and mood. Healthline.

[6] Siebert A. Microdosing psychedelics is trendy, but does it work? here's what science says. Forbes.

[7] Kuypers KPC. The therapeutic potential of microdosing psychedelics in depression. Therapeutic Advances in Psychopharmacology. 2020;10:204512532095056. doi:10.1177/2045125320950567