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Ismail Munir

TORCH syndrome refers to infections in newborns from the mother through the placenta. Each letter of TORCH represents a set of infectious disease-causing agents.

Pregnant? Avoid The TORCH

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Humza Khizer

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Toxic Shock Syndrome – Frequently Asked Questions

Introduction

Toxic shock syndrome (TSS) is a combination of symptoms that affects numerous bodily systems. Some bacterial infections cause the release of toxins into circulation, which are then distributed to the body&#39;s organs and lead to serious disease and impairment. Approximately, 70% of women who tested positive for TSS in Canada, the United States, and a majority of Western Europe have been observed to use tampons during menstruation<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

TSS was explained in 1978 for the first time when occurrences of illness fitting the TSS case definition (e.g., appearance of fever, low blood pressure, rash, skin peeling, and multiorgan system involvement) had begun to emerge in large numbers<a href="#accordion">[3][5]</a>. By 1980-81, it was considered in the United States.&nbsp;

&nbsp;

Dr. Schlievert, who was the first person to identify TSS toxin-1, the primary cause of TSS, stressed that tampons had a direct connection to TSS. While it&rsquo;s not the only reason, it was considered a major risk factor since those young women, who were otherwise healthy individuals, had one thing in common &ndash; they were using super-absorbent tampons<a href="#accordion">[4][8]</a>.&nbsp; 
&nbsp;

Understanding FAQs About Toxic Shock Syndrome

&nbsp;

<h5>Is Toxic Shock Syndrome Rare? 
&nbsp;</h5>

Yes, TSS is a rare multisystem disease characterized by a wide range of symptoms. While little research has been done in this regard, results indicate that it influences approximately 3 women of reproductive age in every 100,000 in the United States annually<a href="#accordion">[6]</a>. 
&nbsp;

<h5>Which Bacteria is Responsible for Toxic Shock Syndrome? 
&nbsp;</h5>

Staphylococcus aureus (S. aureus) is a common bacterium that triggers TSS. It generally lives on the skin of about 20% of healthy individuals&nbsp;and in the nose (30%), groin, armpit, or vagina without causing harm<a href="#accordion">[7][15]</a>. In rare occurrences, specific strains of these bacteria form toxins that trigger TSS. 
&nbsp;

<h5>When does Toxic Shock Syndrome occur? 
&nbsp;</h5>

<a name="_heading=h.1fob9te"></a>TSS develops after a skin cut or burn, a recent surgery, or using contraceptive sponges, diaphragms, superabsorbent tampons, or menstrual cups. In most cases, TSS symptoms appear as early as 12 hours following a surgery<a href="#accordion">[8]</a>. 
&nbsp;

<h5>Do Seasons Influence the Incidence of Toxic Shock Syndrome? 
&nbsp;</h5>

Yes, they do. The number of cases is higher particularly in the winter and spring season<a href="#accordion">[9]</a>. 
&nbsp;

<h5>Why do Tampons cause Toxic Shock Syndrome? 
&nbsp;</h5>

Tampons induce TSS because they become a breeding ground for bacteria, especially if they are not changed frequently enough. Moreover, tampons can adhere to the walls of the vagina, particularly when blood flow is low, causing small scrapes when removed. It&rsquo;s easy for the bacteria to enter the uterus through the cervix.

&nbsp;

It&rsquo;s recommended to remove the tampons after approximately 4-6 hours (or earlier in case of heavy bleeding) to reduce the risk of TSS<a href="#accordion">[9]</a>. On the other hand, this does not imply that females will automatically acquire TSS if they leave a tampon in the vagina for more than 4 hours. 
&nbsp;

<h5>Will using Organic Tampons Lower the Risk of Developing TSS?</h5>

No. The risk of developing TSS is the same whether the woman uses organic or non-organic tampons. The only difference that can elevate the risk of TSS is the tampons&#39; absorbency. A tampon with a higher absorbency can increase the risk of TSS, whereas a tampon with a lower absorbance has a lowered risk of TSS. That is why, whether organic or conventional, it&rsquo;s best to always use the lowest permeability tampon that will manage the flow. 
&nbsp;

<h5>Do Sanitary Pads have the Potential to Trigger Toxic Shock Syndrome? 
&nbsp;</h5>

Yes; the usage of pads makes the female vulnerable to TSS. It&#39;s uncommon, but it can occur. It&rsquo;s not the tampons themselves, but the environment, which is ideal for bacterial growth, that trigger the syndrome. 
&nbsp;

<h5>Is it Possible to get TSS from Wearing A Pad for an Extended Time? 
&nbsp;</h5>

The risk of getting TSS is linked to using tampons and other menstrual products, such as discs and menstrual cups, which are inserted into the vaginas for an extended time. With pads, this risk is low; however, not practicing proper period hygiene (e.g., wearing a pad for an extended time) can lead to other infections such as a yeast infection<a href="#accordion">[10]</a>. 
&nbsp;

<h5>Who can Acquire Toxic Shock Syndrome? 
&nbsp;</h5>

It&rsquo;s not just the women; anybody can acquire TSS and that includes men and children, too! While half of all reported occurrences of TSS are linked to females who use tampons, the other half are caused by localized infections, such as those induced by burns, boils, insect bites, or surgery.

&nbsp;

Evidence suggests that the risk of TSS is higher in children and teenagers because adults are more likely to have the required antibodies to safeguard them from the toxin that triggers TSS. 
&nbsp;

<h5>Is Toxic Shock Syndrome Transmissible? 
&nbsp;</h5>

TSS is an infectious disease that itself cannot be transmitted to other people. However, S. aureus, the bacteria that trigger infections and cause TSS, can be passed from one individual to the other through one-to-one contact<a href="#accordion">[5]</a>.

<h2><a name="_heading=h.3znysh7"></a></h2>

<h5>Is Toxic Shock Syndrome Curable? 
&nbsp;</h5>

It is a serious condition, but most individuals get better completely if it&rsquo;s diagnosed and, consequently, treated early. 
&nbsp;

<h5>Is it Possible for Toxic Shock Syndrome to Resolve on its Own? 
&nbsp;</h5>

No; TSS will not resolve on its own. Immediate treatment is required to avoid possibly fatal outcomes.

<h2><a name="_heading=h.2et92p0"></a></h2>

<h5>Is Toxic Shock Syndrome Capable of Causing Sepsis? 
&nbsp;</h5>

The release of toxins into the body by specific bacteria triggers TSS. Although group A streptococcus (strep) bacteria can cause TSS, S. aureus (staph) bacteria are more commonly responsible. They can cause sepsis and septic shock<a href="#accordion">[11]</a>. 
&nbsp;

<h5>Is there a Difference Between Septic Shock and Toxic Shock? 
&nbsp;</h5>

Bacterial infections can cause septic shock and TSS in children. An overpowering immune reaction to the infection triggers septic shock, whereas toxic shock results from bacterial exotoxins<a href="#accordion">[3][12]</a>. 
&nbsp;

<h5>Is Toxic Shock Syndrome Capable of Triggering Seizures? 
&nbsp;</h5>

TSS can indeed trigger seizures. Any individual, adult or child, who exhibits symptoms of TSS should seek immediate medical attention. The infection has the potential to spread speedily throughout the body.

<h2><a name="_heading=h.tyjcwt"></a></h2>

<h5>Is Toxic Shock Syndrome always Deadly? 
&nbsp;</h5>

<a name="_heading=h.3dy6vkm"></a>TSS is a possibly fatal condition that occurs suddenly. It does not always result in death, and most people are able to recover completely if they are diagnosed and treated early.

<h2><a name="_heading=h.1t3h5sf"></a></h2>

<h5>Does Toxic Shock Syndrome have Long-Term Consequences?</h5>

 
Most patients recover completely, but since TSS is uncommon, there is less data about the long-term consequences. There have been reports of long-term muscle weakness, though, as well as psychological effects like trouble concentrating, memory loss, and emotional changes<a href="#accordion">[13]</a>. 
&nbsp;

<h5>Why does Toxic Shock Syndrome Necessitate Amputation? 
&nbsp;</h5>

The body becomes severely ill as a result of bacterial toxins which is why patients are advised amputations of toes, fingers, or even limbs<a href="#accordion">[5]</a>.

<h2><a name="_heading=h.2s8eyo1"></a></h2>

<h5>Is it Possible to Acquire Toxic Shock Syndrome Multiple Times? 
&nbsp;</h5>

Sadly, yes<a href="#accordion">[14]</a>. Anyone who has previously experienced TSS due to tampons especially should talk to their medical professional before using tampons in future. Many specialists prohibit tampons if a patient has a history of TSS.&nbsp; 
&nbsp;

Conclusion

The disease known as toxic shock syndrome or TSS is severe. It is caused by toxins that release germs. Tampon use is frequently linked to TSS. However, it can also occur as a result of childbirth, burns, skin diseases, or surgical incisions. TSS's initial symptoms include a sudden, high temperature and a rash that resembles sunburn.

Key Points

<ul><li>A rare but potentially fatal condition known as toxic shock syndrome (TSS) is believed to be triggered by bacterial infection.</li><li>TSS is brought on by toxins that have been released by bacteria in the body.</li><li>TSS requires hospitalization and intravenous antibiotic therapy.</li></ul>

[1] Parsonnet J, Hansmann MA, Delaney ML, Modern PA, DuBois AM, Wieland-Alter W, et al. Prevalence of toxic shock syndrome toxin 1-producing Staphylococcus aureus and the presence of antibodies to this superantigen in menstruating women. J Clin Microbiol. 2005;43(9):4628–34.

[2] Nelson E, Jordan M. Seeking new markets for tampons, Procter \& Gamble tries “bonding sessions” and school slide shows to win sales in Mexico. Wall Str J. 2000;

[3] Poudel B, Zhang Q, Trongtorsak A, Pyakuryal B, Egoryan G, Sous M, et al. An overlooked cause of septic shock: Staphylococcal Toxic Shock Syndrome secondary to an axillary abscess. IDCases. 2021;23:e01039.

[4] Toxic shock syndrome (TSS). Toxic Shock Syndrome (TSS) | Johns Hopkins Medicine.

[5] Toxic shock syndrome. NORD (National Organization for Rare Disorders).

[6] Stanley CN UHAA. Prevalence and antibiotic susceptibility of Staphylococcus aureus and other staphylococcal infections in pregnant women attending antenatal clinic in a tertiary hospital in Port Harcourt, Nigeria. OMICS International.

[7] Node view. Toxic Shock Syndrome | HealthLink BC.

[8] What is toxic shock syndrome? Poison Control.

[9] Santos-Longhurst A. How often should you change your pad? Healthline.

[10] Toxic shock syndrome. Sepsis Alliance.

[11] Septic and toxic shock syndrome (TSS) - children's health. Children's Health – Making Life Better for Children in Texas.

[12] Toxic shock syndrome: Symptoms, causes, and diagnosis. Medical News Today.

[13] Toxic shock syndrome. Mayo Clinic.

[14] Bush LM. Staphylococcus aureus infections - infections. MSD Manual Consumer Version.

Neelam Asad

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Everything You Need To Know About Restless Leg Syndrome

In restless leg syndrome (RLS), you may experience the need to move your legs constantly. This impulse is usually triggered when you feel uncomfortable. According to the National Institute of Neurological Disorders and Stroke, it affects roughly 10% of Americans. 5-10% of adults in North America and Europe have RLS<a href="#accordion">[1]</a>. 
&nbsp;

The fact that it frequently occurs or worsens while you&#39;re sleeping, doctors classify RLS as a sleep disorder. You also experience this sleeping-associated problem when you sit for a long time without stretching your legs, like in a movie theater or a car.&nbsp; 
&nbsp;

If you don&#39;t receive treatment, then it gets worse. Over time, sleep deprivation can lead to issues at work or home. 
&nbsp;

While anyone can experience RLS, women and middle-aged individuals are more likely to experience severe symptoms. Doctors occasionally fail to diagnose restless leg syndrome, mainly because the signs are minor or infrequent. But once diagnosed, it can be treated. 
&nbsp;

Understanding Restless Leg Syndrome(RLS)

A neural system disease called restless legs syndrome results in an excited impulse to move your legs. It is also called Willis-Ekbom illness. 35% of RLS patients reported having symptoms before the age of 20<a href="#accordion">[2]</a>. By age 10, 1 in 10 children exhibit symptoms. With time, these symptoms typically get worse.&nbsp; 
&nbsp;

While the impulse to move your legs is the main symptom, RLS can be characterized by the following: 
&nbsp;

<h5>Leg Aches Causing Discomfort</h5>

<ul>
	<li>A strong feeling that makes you move your legs. Not only is the feeling uncomfortable, it can also be painful.</li>
	<li>There are many ways to describe the experience - aches, pulls, creepy crawling sensations, etc.</li>
	<li>This need or impulse to move the legs will be the primary cause of your discomfort.</li>
	<li>Although the entire leg from the thigh to the ankle will be affected, these sensations will typically occur in your calf area.</li>
	<li>Both of your legs could be impacted or it could be just one. There&rsquo;s a possibility that you feel the sensations in your arms as well. 
	&nbsp;</li>
</ul>

<h5>It&rsquo;s Worse At Night</h5>

<ul>
	<li>Symptoms may appear only after your bedtime or when you&rsquo;re trying to sit for any length of time in the evening.</li>
	<li>You may experience symptoms all day long, but you can notice them getting worse at night and occasionally in the morning. 
	&nbsp;</li>
</ul>

<h5>It Leads To Sleep Issues</h5>

<ul>
	<li>The sensations are likely to appear whether one is attempting to lie quietly before bed or sitting during a long flight during the day.</li>
	<li>The symptoms become intolerable, whether trying to sit through a movie or calmly reading a book to enjoy some moments.</li>
	<li>You are unable to relax or calm down.</li>
	<li>Due to difficulty falling asleep, RLS frequently results in sleep issues. 
	&nbsp;</li>
</ul>

<h5>Moving Helps Relieve The Symptoms</h5>

<ul>
	<li>If you have RLS, you&rsquo;ll quickly discover that getting up and moving around immediately alleviates the pain.</li>
	<li>The symptoms typically reappear as soon as you return to a relaxed condition.</li>
	<li>Usually, any leg movement will provide some instant relief even though it would be short-lived.</li>
	<li>The legs might bounce on their own if you do not move.</li>
	<li>A fleeting feeling may precede the involuntary leg motions.</li>
	<li>Most of the time, it&rsquo;s moving your legs in a repetitive or semi-rhythmic manner when you are asleep.</li>
	<li>Your bed partner would know about this, even if you don&rsquo;t.</li>
	<li>RLS is named for the way the sufferer&#39;s legs move constantly in an effort to stave off the discomfort, giving the impression that they are restless. 
	&nbsp;</li>
</ul>

The sensations are typically felt inside the limb as opposed to on the skin, and they are described as: 
&nbsp;

<ul>
	<li>Crawling</li>
	<li>Creeping</li>
	<li>Pulling</li>
	<li>Throbbing</li>
	<li>Electric</li>
	<li>Aching</li>
	<li>Itching 
	&nbsp;</li>
</ul>

Sometimes it&#39;s challenging to convey the sensations. You cannot assume you have RLS every time you experience numbness or a muscle cramp. However, there would be this constant urge to move their legs that should be taken seriously. The degree of symptoms changes often; sometimes, symptoms go away for a while before returning. 
&nbsp;

Genetics play an important role; nearly half of the people with RLS have it because it runs in the family<a href="#accordion">[3]</a>. It could also be connected to: 
&nbsp;

<ul>
	<li>Chronic Illnesses&nbsp;</li>
	<li>It can be a symptom of several chronic medical diseases, such as: 
	&nbsp;</li>
</ul>

1.<a href="https://www.merisehat.pk/disease/iron-deficiency-anemia-64"> Iron deficiency</a>

2. Renal disease

3. Parkinson&#39;s disease

4. <a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">Diabetes </a>and peripheral neuropathy 
&nbsp;

<ul>
	<li>
	<h5>Medications</h5>
	</li>
</ul>

Some medications can potentially exacerbate symptoms. For example:&nbsp; 
&nbsp;

1. Antipsychotics

2. Antidepressants

3. Antihistamine-containing cold and allergy remedies 
&nbsp;

<ul>
	<li>
	<h5>Pregnancy</h5>
	</li>
</ul>

&nbsp;Some pregnant women might develop it, especially in their third trimester. After delivery, symptoms typically disappear within a month. 
&nbsp;

<ul>
	<li>
	<h5>Lifestyle</h5>
	</li>
</ul>

A sleep condition, like apnea, or lack of sleep can cause or exacerbate symptoms. Same is the case with smoking and consuming coffee/alcohol. 
&nbsp;

Medical testing does not exist for RLS. Your doctor might want to discuss their observations with your partner. 
&nbsp;

The following 4 factors are necessary to diagnose RLS: 
&nbsp;

1. A strong impulse to get up, especially when coupled with unsettling or strange emotions.

2. A need to move legs that appears or intensifies when you&#39;re at rest.

3. A pressure that subsides when you move, either entirely or partially.

4. A desire to move your legs that either begins or worsens in the evening in the absence of other symptoms such as muscle pains, leg cramps. 
&nbsp;

Your doctor may use lab testing to rule out other conditions. A neurological examination might look for issues with blood vessels or nerve damage. If you have any additional sleep problems that could be causing your restless legs syndrome, a sleep test called polysomnography can reveal this. 
&nbsp;

Although therapies can help control RLS and you can enjoy a decent night&#39;s sleep, there is no particular cure and treatment for the condition itself. The first step of treatment planning involves managing any underlying conditions if any. 
&nbsp;

Regardless, the focus of the treatment is centered around providing symptomatic relief. If your condition is mild or moderate, making a few minor lifestyle adjustments could be beneficial. These include obtaining regular exercise, maintaining a typical sleep pattern, and abstaining from caffeine, alcohol, and tobacco. 
&nbsp;

Some people benefit from medications. However, a drug that reduces symptoms in one person may make them worse in another, and a medication that has been effective for a while may stop working in future. 
&nbsp;

RLS medications include: 
&nbsp;

<ul>
	<li>Drugs known as dopaminergic affect the brain&#39;s dopamine neurotransmitter. For moderate to severe restless legs syndrome, the FDA has approved ropinirole (Requip), pramipexole (Mirapex), and rotigotine (Neupro).</li>
	<li>Occasionally, doctors prescribe Parkinson&#39;s disease medications: carbidopa/levodopa (Sinemet).</li>
	<li>A sedative called benzodiazepines may aid with sleep but can also make you tired during the day.</li>
	<li>Narcotic analgesics can also help alleviate symptoms.</li>
	<li>Pregabalin, carbamazepine (Tegretol), gabapentin (Neurontin), gabapentin enacarbil (Horizant), and other anticonvulsant or seizure medications (Lyrica) are appropriate treatments, too. 
	&nbsp;</li>
</ul>

A lifelong ailment, RLS may worsen with age. However, some patients experience remission and go months to years without symptoms.&nbsp; 
&nbsp;

The important point is to keep your doctor informed of your progress. They could advise alternative lifestyle modifications or different drugs if your symptoms appear to be worsening.

Pregnancy-associated RLS symptoms typically emerge in the third trimester. According to data, the risk of RLS is 2-3 times higher in pregnant women. 
&nbsp;

Unfortunately, the exact cause of RLS remains to be elucidated. However, a few potential causes such as deficiencies in vitamins or minerals, hormonal imbalances, or nerve compression have been studied. 
&nbsp;

Since leg pains and trouble sleeping are also side effects of pregnancy, it is a challenge to discriminate between these symptoms and RLS. Consult your doctor if you suffer from restless leg syndrome symptoms during pregnancy. Testing for iron deficiency or other deficiencies may be necessary. You can also test out a few of these at-home care methods: 
&nbsp;

<ul>
	<li>Don&#39;t spend too much time sitting stationary, especially in the evening.</li>
	<li>Even a short walk in the afternoon will count as some exercise.</li>
	<li>Before going to bed, massage your legs or do some leg stretches.</li>
	<li>When your legs bother you, try applying a heat or cold pack to them.</li>
	<li>Maintain a consistent sleeping routine.</li>
	<li>Steer clear of alcohol, coffee, smoking, and antihistamines.</li>
	<li>Make sure your diet or prenatal supplements have all the nutrients you require. 
	&nbsp;</li>
</ul>

Some drugs prescribed to treat RLS should not be taken during pregnancy. Besides, it typically goes away on its own after delivery. Consult your doctor about alternative treatments if it doesn&#39;t, especially if you are nursing. 
&nbsp;

Speaking with others who understand what you&#39;re going through, like a family member with restless leg syndrome or a support group, is always helpful.&nbsp; 
&nbsp;

Here are some exercise tips and lifestyle changes that can help 
&nbsp;

<ul>
	<li>
	<h5>Exercises</h5>
	</li>
</ul>

1. Exercise at lunch; walk to the park or around the block while carrying your sandwich.

2. Boost your circulation by doing some stationary jogging.

3. Make sure to stand up, stretch, and move about for five minutes after every hour or so, if RLS is troubling you at work.

4. Stretch your legs at the beginning and the end of the day for symptomatic relief.

5. Don&rsquo;t sit in one position for a long time during a long road trip. Passengers and drivers both should take frequent breaks to stretch out and switch places.

6. Indulge in a relaxing leg massage, calm the body and mind as well as your restless legs.

7. Opt for an aisle seat when flying. Increase your circulation by getting up often.

8. Skip the coffee and spend five minutes stretching your legs if you wake up at 3 am in the morning due to RLS. 
&nbsp;

<ul>
	<li>
	<h5>Lifestyle&nbsp;</h5>
	</li>
</ul>

1. Massage your legs gently while attending a conference call or observing TV.

2. Take a hot bath to relax.&nbsp;

3. Use ice packs to soothe restless legs.

4. Consult your physician on how you can increase your iron levels.&nbsp;

5. Limit your alcohol intake as it may exacerbate RLS symptoms.

6. Avoid taking large meals before bed to reduce symptoms and achieve a better night&#39;s sleep. On the same note try to also reduce your intake of junk food.&nbsp;

7. Try relaxation methods, like progressive muscle relaxation or meditation.

8. Only take prescription drugs and herbal therapies that are prescribed by your doctor. 
&nbsp;

<ul>
	<li>
	<h5>Nighttime Strategies&nbsp;</h5>
	</li>
</ul>

1. Go for a stroll with your children, pet, or friend. You might sleep better if you exercise often. Moderate exercise can help with RLS symptoms, but be careful not to overdo it, as that can worsen the condition.

2. Use a heated pad before you go to bed.

3. Breathe!&nbsp;

4. Eliminate alcohol, caffeine and nicotine from your evening routine to improve your sleep quality.

5. Try to maintain a regular sleep pattern and avoid day napping.&nbsp;

6. Think positive thoughts while in bed to reduce any anxiety.&nbsp; 
&nbsp;

<h5>Diet Recommendations&nbsp;</h5>

There are no particular dietary recommendations. However, it&#39;s wise to evaluate your diet to ensure you&#39;re getting all the necessary vitamins and nutrients. It will also help reduce your intake of processed foods that have high calories but little to no nutritional value.

Sometimes, restless leg syndrome is due to a deficiency in specific vitamins and minerals. You can alter your diet or use dietary supplements if that is the case.&nbsp; 
&nbsp;

Try increasing your intake of these iron-rich foods if you suffer from an iron deficiency:

<ul>
	<li>Dark green leafy vegetables</li>
	<li>Dried fruit</li>
	<li>Beans</li>
	<li>Poultry and seafood</li>
	<li>Peas</li>
	<li>Iron-fortified foods, such as certain cereals, pasta, and bread 
	&nbsp;</li>
</ul>

You may also wish to combine iron-rich products with these supplies of vitamin C since vitamin C aids in the body&#39;s absorption of iron:

<ul>
	<li>Citrus juices</li>
	<li>Grapefruit, oranges, tangerines</li>
	<li>Strawberries</li>
	<li>Kiwi&nbsp;</li>
	<li>Melons</li>
	<li>Tomatoes</li>
	<li>Peppers</li>
	<li>Broccoli and leafy greens| 
	&nbsp;</li>
</ul>

The role of caffeine is not clear. It triggers symptoms of RLS in some people, whereas others find it beneficial. Checking to see if caffeine affects your symptoms is worth a try. However, alcohol is definitely known to disturb sleep; avoid it at all costs, especially at night. 
&nbsp;

Restless leg syndrome results in uncomfortable feelings and a strong impulse to move the legs. This compulsive desire is usually stronger when you are resting or attempting to fall asleep. The biggest worry, thus, is that RLS interferes with sleep and you are left feeling tired and exhausted during the day.&nbsp; 
&nbsp;

If RLS and sleep deprivation are not treated, you may develop additional health issues, such as depression. Although there is no known cure for restless leg syndrome, medicines can help moderate symptoms. Primary care physicians now have more tools than ever to diagnose and treat restless leg syndrome patients, thanks to improvements in diagnostic criteria, treatment plans, and revised recommendations. Continued investigation of pharmaceutical long-term therapy results is necessary for future advancement in drug therapy guidelines. 
&nbsp;

<ul><li>A neural system disease called restless legs syndrome results in an excited impulse to move your legs.</li><li>There are no specific symptoms of the syndrome and it can occasionally be misdiagnosed as another illness.</li><li>Pregnant women are more prone to developing RLS , especially in the third trimester.</li><li>Restless legs syndrome cannot be cured, but it’s possible to manage its symptoms to a certain extent by making lifestyle adjustments.&nbsp;</li></ul>

[1] Kwatra V, Khan MA, Quadri SA, Cook TS. Differential Diagnosis and Treatment of Restless Legs Syndrome: A Literature  Review. Cureus. 2018 Sep;10(9):e3297.

[2] Bassetti CL, Mauerhofer D, Gugger M, Mathis J, Hess CW. Restless legs syndrome: a clinical study of 55 patients. Eur Neurol. 2001;45(2):67–74.

[3] Ekbom K, Ulfberg J. Restless legs syndrome. J Intern Med. 2009;266(5):419–31.

Madeeha Syed

How Your Office Is Making You Sick, And How To Fix It

Overview

We all immediately said OMG YES in our heads the moment we read the title. Our offices do make us <a href="https://merisehat.pk/article/too-sick-to-move">sick mentally</a> but this article targets more of the physical aspect of sickness.

Seems weird but it is a thing. Your office building may just be the reason behind your illness. 
&nbsp;

Sick Building Syndrome

Sick Building Syndrome (SBS) is a term used to describe a set of symptoms experienced by people who spend time in a building or enclosed space, such as an office or school, and experience health and comfort issues that are associated with the time spent in that building. Symptoms of SBS may include headaches, dizziness, nausea, fatigue, respiratory problems, and skin irritation, among others.

SBS is believed to be caused by a combination of factors related to the building environment, including poor indoor air quality, inadequate ventilation, and chemical or biological contaminants. Some of the specific causes of SBS may include: 
&nbsp;

<ul>
	<li>Poor Indoor Air Quality: This can be caused by a range of factors, such as inadequate ventilation, the presence of volatile organic compounds (VOCs) from building materials or furnishings, or the accumulation of indoor air pollutants such as dust and mold.</li>
	<li>Inadequate Ventilation: Poor ventilation can result in a build-up of pollutants and humidity, which can lead to respiratory and other health problems.</li>
	<li>Chemical Contaminants: Chemical contaminants can come from a range of sources, such as cleaning products, pesticides, or building materials, and can have negative effects on human health.</li>
	<li>Biological Contaminants: Biological contaminants, such as mold and bacteria, can thrive in indoor environments that are damp or poorly ventilated, and can cause respiratory and other health problems.</li>
	<li>Indoor Temperature And Humidity: Indoor temperature and humidity levels can affect human comfort and well-being, and inadequate heating or cooling systems can lead to discomfort and health issues. 
	&nbsp;</li>
</ul>

SBS can have negative impacts on individual health and well-being, as well as productivity and performance in the workplace or school. Additionally, it can lead to increased absenteeism and healthcare costs for employers and organizations.

&nbsp;

Fix ing SBS

The treatment or solution for Sick Building Syndrome (SBS) typically depends on the underlying causes of the symptoms. Here are some steps that can be taken to treat or fix SBS: 
&nbsp;

<ul>
	<li>Identify And Remove Sources Of Pollutants: Conduct an indoor air quality assessment to identify the sources of pollutants in the building. This may include removing or reducing the use of products or materials that emit chemicals, such as cleaning products, carpets, or furniture.</li>
	<li>Increase Ventilation: Increase the amount of fresh air circulation in the building by improving ventilation systems, opening windows or doors, or using air purifiers or filters.</li>
	<li>Regulate Indoor Temperature&nbsp; And&nbsp; Humidity: Maintain appropriate indoor temperature and humidity levels to prevent the growth of mold or other biological contaminants, and to ensure that occupants are comfortable.</li>
	<li>Educate Building Occupants: Provide education and training to building occupants on ways to reduce indoor air pollution and improve indoor air quality. This may include promoting good hygiene practices, such as washing hands regularly, and avoiding smoking indoors.</li>
	<li>Address Individual Health Issues: For individuals who experience persistent symptoms, medical treatment may be necessary to manage or alleviate their symptoms.</li>
	<li>Implement Building Design Changes: In some cases, building design changes may be necessary to improve indoor air quality, such as installing new ventilation systems or modifying building materials or furnishings.</li>
</ul>

Overall, the treatment or solution for SBS requires a holistic approach that addresses the underlying causes of poor indoor air quality and promotes a healthy and comfortable indoor environment for building occupants. 
&nbsp;

Umna Salah

Safia Mehmood

Imposter Syndrome: Are You Really A Fraud, Or Is It Just Your Brain Playing Tricks?

Have you ever achieved something great but felt like you don&#39;t truly deserve it? Do you often attribute your success to luck or think &quot;anyone could have done it&quot;? If these thoughts sound familiar, then my friend, you might be experiencing Imposter Syndrome. But what is imposter syndrome exactly, and why does it feel like your brain is hosting a never-ending &lsquo;fraud fest&rsquo;? 
&nbsp;

strategies to shatter Impostor Syndrome

Imposter Syndrome isn&#39;t just a fancy buzzword; it&#39;s a psychological pattern where people doubt their accomplishments and fear being exposed as a &quot;fraud.&quot; It&rsquo;s like having an internal critic, constantly nagging that you&rsquo;re just winging it, and soon everyone will find out.

Dr. Pauline Clance and Dr. Suzanne Imes coined the term in their seminal 1978 study, noting its prevalence among high-achieving women who felt like frauds despite evident success. However, Impostor Syndrome doesn&#39;t discriminate. It casts its shadow across genders, cultures, and professions.

At its core, IS is a psychological pattern where individuals doubt their accomplishments, attributing success to luck or error rather than ability. This self-doubt often accompanies <a href="https://merisehat.pk/disease/anxiety">anxiety</a> and depression, as discussed in a 2011 study in the Journal of Behavioral Science. Think of Imposter Syndrome as a chameleon, changing colors according to the situation. Whether you&#39;re a student, a professional, or even a new parent, it sneaks up, whispering doubts and undermining your confidence. 
&nbsp;

<h5>The Mechanics Of Doubt</h5>

Why does Impostor Syndrome take hold? Cognitive-behavioural theory provides some insight. Our beliefs shape our reality. If we harbor a core belief that we&#39;re inadequate, we&#39;re prone to dismissing evidence that contradicts this belief. In a 2020 Nature article, researchers posit that such internal narratives are self-sabotaging prophecies. 
&nbsp;

<h5>Triggers Of The Impostor Phenomenon</h5>

<ol>
	<li>Novelty: Transitioning to new roles can trigger IS. A study in the International Journal of Behavioral Science suggests the unfamiliarity of new responsibilities can magnify self-doubt. 
	&nbsp;</li>
	<li>Cultural Stereotypes: Certain cultural backgrounds that place immense value on achievement can heighten the risk of IS. The Asian American Journal of Psychology has explored how societal expectations influence self-perception, particularly in minority groups. 
	&nbsp;</li>
	<li>Upbringing: Family dynamics play a crucial role. Overly critical or protective parents might inadvertently set the stage for IS, as outlined in Developmental Psychology. 
	&nbsp;</li>
</ol>

How do we dismantle the intricate masquerade of Impostor Syndrome? Science points us to several strategies:

<ol>
	<li>Identification And Mindfulness: Recognizing the moments when IS speaks is key. Mindfulness-based approaches, as described in a 2019 study in the Journal of Clinical Psychology, teach us to observe our thoughts without judgment, reducing their power. 
	&nbsp;</li>
	<li>Cognitive Behavioural Change: Challenging the impostor narrative requires restructuring thoughts. Cognitive-behavioural therapy (CBT) has been shown to help, as per the American Psychological Association. Replacing &quot;I must not fail&quot; with &quot;I will do my best&quot; can reshape our thought patterns. 
	&nbsp;</li>
	<li>Keep A&nbsp;Success Journal: Documenting achievements helps solidify them in your memory, combating the impostor narrative. This technique aligns with positive psychology interventions aimed at enhancing well-being. 
	&nbsp;</li>
	<li>Talking About It: Disclosure lessens the impostor phenomenon&#39;s grip. According to a study in the Journal of Multicultural Counseling and Development, sharing feelings of fraudulence diminishes their intensity. 
	&nbsp;</li>
	<li>Mentorship And Networking: Connecting with mentors can be invaluable. Mentorship provides a reality check and external validation, as noted in a study in the Academy of Management Learning &amp; Education. 
	&nbsp;</li>
</ol>

<h5>Spotting The Symptoms: Is It Imposter Syndrome Or Just A Bad Day?</h5>

Imposter syndrome symptoms include:

<ul>
	<li>Chronic self-doubt.</li>
	<li>Attributing success to external factors (like luck).</li>
	<li>Fear of not meeting expectations.</li>
	<li>Overachieving and then feeling burnt out. 
	&nbsp;</li>
</ul>

<h5>Why Me? Understanding The Roots</h5>

So, why do some of us feel like imposters? It&rsquo;s often a mix of personality traits (like perfectionism), family expectations, and societal pressure. In Pakistan, where there&rsquo;s a strong emphasis on academic and professional success, imposter syndrome can hit hard. You might have grown up hearing, &quot;Beta, you need to top your class!&quot; or &quot;You must be the best in your field!&quot; No pressure, right? 
&nbsp;

<h5>Expert Insights</h5>

&quot;Overcoming impostor syndrome is about rewiring our thinking,&quot; says Dr. Carol Dweck, renowned psychologist and author. &quot;When we understand that abilities can be developed, success becomes a reflection of growth, not a confirmation of innate talent.&quot; 
&nbsp;

Bottom Line

As we conclude, remember this: Feeling like an imposter doesn&rsquo;t make you one. It&rsquo;s a sign that you&rsquo;re pushing your boundaries and stepping out of your comfort zone. So, next time your brain starts its &lsquo;fraud fest&rsquo;, take a deep breath, remember your achievements, and wear your successes like a badge of honor. You&rsquo;ve earned it, and no imposter thoughts can take that away!

With actionable strategies grounded in robust research, expert insights, and the inspiration from those who have walked this path, you&#39;re now equipped to conquer the imposter syndrome and unlock your full potential. The journey to self-acknowledgement may be challenging, but as you continue to combat IS with evidence-based tools, the narrative of self-doubt loses its grip, allowing your true capabilities and successes to shine through.

Pregnancy is a highly complex period in a woman&rsquo;s life. Hormonal changes, weight gain, stress about the future, and the fear of upcoming life changes are just the tip of the iceberg. And all of this is just related to the woman herself; add to it the fact that her choices are going to affect the fetus, and this long list becomes a plethora of advice (maintained through years of cultural wisdom and/or medical evidence) of all the things she must or mustn&rsquo;t do for her and her baby&rsquo;s health.&nbsp;

&nbsp;

One point that&rsquo;s flagged and is considered of utmost importance is staying clear of certain infections to avoid any adverse fetal outcomes. This is because multiple infections can pass from the mother to the baby in the womb and cause birth defects, miscarriages, and several developmental problems. One of these infections is called the TORCH syndrome. 
&nbsp;

Understanding TORCH Syndrome During Pregnancy & Postpartum

TORCH syndrome represents a group of infectious diseases that can be passed to the fetus during pregnancy, delivery, or after birth. The word TORCH is an acronym for Toxoplasmosis, <a href="https://merisehat.pk/disease/congenital-rubella-syndrome">Rubella</a>, Cytomegalovirus, and <a href="https://merisehat.pk/disease/genital-herpes">Herpes </a>Simplex.&nbsp;

&nbsp;

Other diseases such as <a href="https://merisehat.pk/disease/hiv-61">HIV</a>, fifth disease, varicella-zoster virus, Zika, and syphilis are also included in TORCH syndrome.&nbsp;

&nbsp;

A study conducted in Peshawar, Pakistan, revealed the frequency of TORCH infection during pregnancy as approximately 7%<a href="#accordion">[1]</a>. These infections account for 10-15% of abortions<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

According to research, 2-3% of all congenital anomalies can be linked to congenital TORCH infections<a href="#accordion">[3]</a>. Cytomegalovirus (CMV) is the most common virus transmitted during pregnancy, and is the most common fetal infection, affecting 0.5-2% of all live births<a href="#accordion">[3]</a>. Maternal toxoplasmosis and CMV have an incidence of 2-10 per 1,000 births<a href="#accordion">[4]</a>. In comparison, herpes simplex virus (HSV) infections are uncommon and occur in 1 out of every 3,200 births in the United States<a href="#accordion">[5]</a>. However, 90% of women with genital herpes are asymptomatic and underdiagnosed<a href="#accordion">[3]</a>. Therefore, there&#39;s a high risk of transmission to the fetus during delivery, or via close contact.&nbsp;

&nbsp;

These infections are generally transmitted prenatally, perinatally, and postnatally via the placenta, contact with blood and vaginal secretions, or from exposure to breast milk<a href="#accordion">[3]</a>. Even during delivery, the infant can catch pathogens (e.g., HSV-2) while passing through the birth canal.&nbsp;

&nbsp;

Women can contract viruses, such as HIV, syphilis, and <a href="https://merisehat.pk/disease/hepatitis-b-113">hepatitis B</a>, via sexual contact. Infected women may be asymptomatic. However, when they give birth, the infection typically presents itself in newborns at the time of delivery or in infants later in life. Preterm birth, miscarriage, restricted fetal growth, stillbirth, birth defects, and chronic postnatal infections are common sequelae of TORCH syndrome.&nbsp; 
&nbsp;

Infection during the first trimester is the most detrimental to the fetus&rsquo; health. Maternal risk factors include<a href="#accordion">[4]</a>:

<ul>
	<li>Missed vaccinations</li>
	<li>Animal exposure during pregnancy (e.g., toxoplasmosis via cat feces)&nbsp;</li>
	<li>Ingestion of uncooked meat or unpasteurized milk products&nbsp;</li>
	<li>Sexually transmitted infections (e.g., HIV, syphilis, and herpes simplex) 
	&nbsp;</li>
</ul>

Symptoms vary depending on the pathogen, but they usually overlap. The common signs and symptoms of TORCH syndrome are:

<ul>
	<li>Petechial, maculopapular rash (blueberry muffin rash)</li>
	<li>Difficulty feeding</li>
	<li>Low birth weight</li>
	<li>Lethargy&nbsp;</li>
	<li>Microcephaly</li>
	<li>Sensorineural hearing loss&nbsp;</li>
	<li>Chorioretinitis&nbsp;</li>
	<li>Hepatosplenomegaly</li>
	<li>Cardiac abnormalities</li>
	<li>Hydrops fetalis</li>
	<li>Developmental delay</li>
	<li>Seizure 
	&nbsp;</li>
</ul>

There are currently no maternal or neonatal screening tests for the identification of TORCH infections. Doctors typically recommend the TORCH titer test to check for titers of the pathogens in females before pregnancy.&nbsp;

&nbsp;

A negative result indicates the absence of antibodies against the pathogens, proving that there was no recent or past infection in the body. On the other hand, a positive result can mean either of the two things: (a) the person&rsquo;s been vaccinated against the disease before or (b) they&rsquo;ve had the infection earlier.&nbsp; 
&nbsp;

The following prevention strategies help reduce maternal and infant morbidity and mortality:

<ul>
	<li>Rubella and varicella-zoster vaccinations for mothers before pregnancy</li>
	<li>Cesarean delivery in women with active HSV lesions</li>
	<li>Antibiotics for mothers diagnosed with toxoplasmosis or syphilis early in the pregnancy</li>
	<li>Avoiding contact with cat&rsquo;s feces or cleaning litter boxes during pregnancy</li>
	<li>Practice regular hand washing&nbsp;</li>
	<li>Avoid sharing utensils or drinks with other people</li>
	<li>Avoid ingesting deli meats or unpasteurized dairy products</li>
	<li>Avoid contact with people who are ill</li>
	<li>Practice safe sex 
	&nbsp;</li>
</ul>

Rubella infection can result in congenital rubella syndrome, which has no cure. According to the World Health Organization (WHO), approximately 100,000 congenital rubella syndrome cases are recorded every year<a href="#accordion">[2]</a>. Therefore, it&rsquo;s recommended to get the MMR vaccine at least 28 days before conceiving.&nbsp; 
&nbsp;

Early recognition of TORCH infections and appropriate management will not only reduce maternal morbidity, but also fetal mortality and morbidity. Therefore, there is a need for better in-utero diagnostic tools. Moreover, all women should ensure that their vaccinations are up to date before and during pregnancy. Inform the healthcare professional of any illness immediately in case symptoms of an infection such as fever or rash crop up during pregnancy.&nbsp;

<ul><li>TORCH syndrome represents a group of infectious diseases that can be passed to the fetus during pregnancy, delivery, or after birth. TORCH stands for Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes Simplex. Other diseases, such as HIV, fifth disease, varicella-zoster virus, Zika, and syphilis, are also included in the TORCH syndrome.</li><li>These infections are generally transmitted prenatally, perinatally, and postnatally via the placenta, contact with blood and vaginal secretions, or from exposure to breast milk.</li><li>Preterm birth, restricted fetal growth, stillbirth, miscarriage, birth defects, and chronic postnatal infections are common sequelae of TORCH syndrome.&nbsp;</li><li>Maternal risk factors include missed vaccinations, animal exposure during pregnancy, ingestion of uncooked meat or unpasteurized milk products, and sexually transmitted infections (e.g., HIV, syphilis, and herpes simplex).</li><li>The common signs and symptoms of TORCH syndrome are petechial, maculopapular rash (blueberry muffin rash), difficulty feeding, microcephaly, sensorineural hearing loss, chorioretinitis, hepatosplenomegaly, and hydrops fetalis.&nbsp;</li><li>Doctors typically recommend the TORCH titer test to check for titers of the pathogens in females before pregnancy.</li><li>Early recognition of TORCH infections and appropriate management will not only reduce maternal morbidity, but also fetal mortality and morbidity.&nbsp;</li></ul>

[1] Zeb MA, Jamal SF, Mir A, Khan AA, Ullah A. Frequency of Torch Infections during Pregnancy in Peshawar, Pakistan. Advances in Applied Science Research. 2018;9(1).

[2] Zhang L, Wang X, Liu M, et al. The epidemiology and disease burden of congenital torch infections among hospitalized children in China: A national cross-sectional study. PLOS Neglected Tropical Diseases. 2022;16(10). doi:10.1371/journal.pntd.0010861

[3] Batra P, Batra M, Singh S. Epidemiology of torch infections and understanding the serology in their diagnosis. Journal of Fetal Medicine. 2020;7(1):25-29. doi:10.1007/s40556-019-00232-8

[4] Jaan A, Rajnik M. TORCH Complex. [Updated 2022 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-.

[5] Liu Y, Wu Y, Wang F, et al. The Association Between Previous TORCH Infections and Pregnancy and Neonatal Outcomes in IVF/ICSI-ET: A Retrospective Cohort Study. Front Endocrinol (Lausanne). 2020;11:466. Published 2020 Aug 5. doi:10.3389/fendo.2020.00466