Humza Khizer

Vestibular Rehabilitation: Restoring Balance And Reducing Dizziness

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Ismail Munir

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Crop Burning And Allergies - Is There A Link?

Introduction

Allergic disorders are not a threat to life in most cases, but they do impair a person&rsquo;s functionality. It eventually has an adverse effect on an individual&rsquo;s physiological well-being and quality of life. However, these implications can be minimised if the <a href="https://www.merisehat.pk/disease/allergies">allergies </a>are detected early and treated appropriately. 
&nbsp;

Understanding Link Between Crop Burning And Allergies

Both indoor and outdoor activities can cause swelling and sinus pain, in addition to watery eyes, nasal congestion, and sneezing. Airborne allergens can cause hay fever or rose fever/ rose cold, which are seasonal or constant persistent allergies.

People with allergies usually have more than one type of allergy, and the most common are indoor/outdoor allergies. The triggers are grass pollen, tree pollen, weed pollen, mould spores, cockroaches, dust mites, cat or dog dander, and rodent urine.

&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Allergies In The United States</h5>
	</li>
</ul>

In the United States, more than 50 million people experience different types of allergies every year and it is the sixth leading cause of chronic illnesses. It is the most common health issue that affects children in the US, and every year 90,000 people visit the emergency room due to anaphylaxis.&nbsp;Medicines, food, insect bites, or stings are the most common anaphylactic triggers.

Furthermore, medicines cause the most common allergy-related deaths. Older adults and African Americans have the highest death rates because of allergies.

Seasonal allergies in the US equal 8% of adults and 7% of children. They usually occur during fall when pollen, trees, and grasses are in the air. Moreover, according to research from 2018, caucasian children are more likely to get hay fever compared to African American children. Allergies of the eyes are usually triggered by the same indoor/outdoor triggers<a href="#accordion">[1]</a>.

&nbsp;

<ul>
	<li>
	<h5>Allergies In The United Kingdom</h5>
	</li>
</ul>

Allergies are rising by 5% each year in the United Kingdom. The first wave of the allergic season started 50 years ago with enormous surges in asthma and hay fever. Currently, we are facing the second wave of allergic diseases, especially fatal food allergies. The figures from the year 2012 indicate that one in forty children suffer from serious allergies in the UK.

During the last decade, the emergency departments in the UK have seen an increase in anaphylactic shocks. More children and adults are being diagnosed with food allergies at present compared to the past.

One in three people is affected by allergic disorders in the UK, which is estimated to be around 20 million people. Although allergies are most common in children, 6-8% of infants have also been diagnosed with food allergies and have experienced anaphylaxis at some point. These numbers are reflected in the admission rates which have doubled. More people were admitted to hospitals with severe allergies seven times more between 2002 to 2012 compared to the 1990s.

One in four people in the UK have hay fever, and it equates to approximately sixteen million people. Also, the prevalence of allergies such as asthma, food allergies, and eczema in the UK is almost four times higher. Furthermore, allergic rhinitis is poorly managed and does not have enough recognition. The number of people being diagnosed with eczema, food allergies, and allergic rhinitis has increased over the last thirty years. The growing numbers are a cause of concern as allergies often severely restrict the sufferer&#39;s everyday activities<a href="#accordion">[2]</a>.

&nbsp;

<ul>
	<li>
	<h5>Allergies In Pakistan</h5>
	</li>
</ul>

Allergies and diseases related to allergies are very common in all parts of the world and involve all ethnicities. These diseases include allergic rhinitis, bronchial asthma, conjunctivitis, and eczema. However, the data on the prevalence of allergic diseases in Pakistan is limited, indicating a need for further exploration.&nbsp;

In recent times, allergic diseases, especially bronchial asthma is increasing worldwide. But there is no data available about the prevalence of allergic diseases among school-going kids in Pakistan. However, data is available for certain age groups i.e. adults.&nbsp;&nbsp;

To bridge this gap, researchers in Pakistan have conducted surveys to know the prevalence of allergic diseases among kids aged 3 to 16 years of age. They used the same questionnaires for data collection that had been used in Saudi and UAE in 2007. The survey was done in Karachi and distributed among various schools covering 2000 to 3000 individuals. According to the results, the frequency of asthma is 15.8%, while the frequency of allergic rhinitis is 28.5% in school kids. The parameters of the analysis included dry cough, eczema, wheezing, and breathlessness. The survey also highlighted that the presence of a smoker in the family increased the risk of asthma, dry cough, wheezing, allergic rhinitis, and breathlessness.&nbsp;

The study signified that school-going kids in Karachi displayed symptomatic allergies. It had also been postulated that indoor environmental exposure and family circumstances also play a role in increasing the chances of asthma and other allergies in kids<a href="#accordion">[3]</a>. 
&nbsp;

A survey was also conducted among healthcare workers to see the frequency of allergic rhinitis among them. These included doctors, dentists, nurses, technicians, and pharmacists. After the survey, it was noted that 13 individuals missed their work because of allergic rhinitis indicating work absence due to allergies<a href="#accordion">[4]</a>.

&nbsp;

Exposure to pesticides and crop burning in communities can cause allergies according to research. Studies have been conducted to review the effects of agricultural exposure on the respiratory health of kids. These studies were conducted predominantly in industrial agricultural areas.

These studies assessed exposure and its effect on various respiratory health outcomes, for example, asthma, measurements of lung function, and acute respiratory symptoms. It was found that pesticides influenced the respiratory health of children. Furthermore, exposure to agricultural burning influenced the respiratory health of kids and the effect was severely adverse. To summarise, a positive association between exposure to agricultural burning and adverse effects on the respiratory system was seen<a href="#accordion">[5]</a>.

&nbsp;

The burning of crops and their residue is becoming a serious problem in Pakistan, and is a cause of concern for both health reasons as well as climate change. This unfortunate situation is not only limited to Pakistan and applies everywhere else in the world, due to its mitigating effects. It has led to an impairment in the quality of air, heat waves, strong haze, and several health problems.&nbsp;

&nbsp;

The primary database of Punjab was used to assess the extent of the problem in Punjab, Pakistan. The health and environmental effects of crop burning residue were assessed. It was found that crop burning had a drastic impact on households with chronic and non-chronic diseases. Also, the severity of the diseases was seen to increase during the period of crop burning.

This situation can be avoided by adopting sustainable crop management practices. The first step towards this could be raising awareness among farmers and engaging them in this dialogue.&nbsp;&nbsp;

&nbsp;

Key Points

<ul>
	<li>Allergic rhinitis is very common in most parts of the world, which includes Pakistan as well.</li>
	<li>Asthma, a very common allergy is associated with seasonal changes, pet dander, and other environmental factors.</li>
	<li>Respiratory problems due to crop burning are also of great prevalence.</li>
	<li>New policies and meaningful implications should be adopted to promote using the residues of crops in Pakistan to improve the situation.</li>
</ul>

&nbsp;

[1] Warren, C.M., Jiang, J. and Gupta, R.S., 2020. Epidemiology and burden of food allergy. Current allergy and asthma reports, 20(2), pp.1-9.

[2] Gupta, R., Sheikh, A., Strachan, D.P. and Anderson, H.R., 2007. Time trends in allergic disorders in the UK. Thorax, 62(1), pp.91-96.

[3] Hasnain, S.M., Khan, M., Saleem, A. and Waqar, M.A., 2009. Prevalence of asthma and allergic rhinitis among school children of Karachi, Pakistan, 2007. Journal of Asthma, 46(1), pp.86-90.

[4] Siddiqui, M.I., Dhanani, R. and Moiz, H., 2020. Prevalence of allergic rhinitis among healthcare workers and its impact on their work: A cross-sectional survey at a tertiary healthcare centre in Pakistan. JPMA. The Journal of the Pakistan Medical Association, 70(8), p.1432.

[5] Van Horne, Y.O., Farzan, S.F., Razafy, M. and Johnston, J.E., 2022. Respiratory and allergic health effects in children living near agriculture: A review. Science of The Total Environment, p.155009.

[6] Raza, M.H., Abid, M., Faisal, M., Yan, T., Akhtar, S. and Adnan, K.M., 2022. Environmental and Health Impacts of Crop Residue Burning: Scope of Sustainable Crop Residue Management Practices. International Journal of Environmental Research and Public Health, 19(8), p.4753.

Staff Writer

Madeeha Syed

Navigating The Depths Of Prolonged Grief Disorder: Understanding, Coping, And Healing

Overview

Grief is a natural response to loss, a universal human experience that often accompanies the death of a loved one. While grief is a complex and challenging emotion, it typically subsides over time as individuals adapt to the loss and find ways to move forward. However, for some, the grief process becomes overwhelming and unrelenting, leading to a condition known as Prolonged Grief Disorder (PGD). In this comprehensive article, we will explore PGD, including its definition, symptoms, causes, diagnosis, and treatment options, shedding light on this often misunderstood and debilitating condition. 
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diagnosis and healing strategies

<h5>I. Defining Prolonged Grief Disorder</h5>

Prolonged Grief Disorder, also referred to as Complicated Grief or Persistent Complex Bereavement Disorder, is a mental health condition that occurs when the process of mourning becomes prolonged and intense, significantly impairing an individual&#39;s ability to function and adapt to life without their loved one. 
&nbsp;

<h5>II. Symptoms Of Prolonged Grief Disorder</h5>

PGD is characterized by a set of distinct symptoms that distinguish it from normal grief. These symptoms often persist for an extended period, typically six months or more, and can include:

<ol>
	<li>Intense Longing: A persistent and intense yearning or longing for the deceased person, accompanied by emotional pain.</li>
	<li>Preoccupation With The Deceased: Intrusive thoughts, memories, and dreams of the deceased individual that interfere with daily life.</li>
	<li>Difficulty Accepting The Loss: A persistent disbelief or inability to accept the reality of the loss, even months or years after it occurred.</li>
	<li>Emotional Numbness: Feelings of emotional numbness, detachment, or a sense of emptiness, making it challenging to experience joy or engage with others.</li>
	<li>Social And Occupational Impairment: Difficulty maintaining relationships, engaging in daily activities, or fulfilling occupational responsibilities.</li>
	<li>Emotional Dysregulation: Intense emotional reactions, such as anger, guilt, or extreme sadness, that are disproportionate to the situation or inconsistent with cultural norms. 
	&nbsp;</li>
</ol>

<h5>III. Causes Of Prolonged Grief Disorder</h5>

While anyone can experience PGD, certain factors may increase the risk:

<ol>
	<li>Sudden Or Traumatic Loss: A sudden or traumatic loss, such as a car accident or suicide, can intensify grief and increase the risk of PGD.</li>
	<li>Lack Of Social Support: A lack of a support system or social isolation can hinder the grieving process and contribute to the development of PGD.</li>
	<li>Unresolved Issues: A history of unresolved conflicts or a strained relationship with the deceased person can complicate the grieving process.</li>
	<li>Personal Vulnerabilities: Certain personal factors, such as a history of mental health issues, may make individuals more susceptible to PGD. 
	&nbsp;</li>
</ol>

<h5>IV. Diagnosis And Distinction From Normal Grief</h5>

PGD is a clinical diagnosis made by mental health professionals, such as psychologists or psychiatrists. To distinguish PGD from normal grief, clinicians often assess the duration, intensity, and impact of the symptoms. A diagnosis of PGD typically requires the presence of these symptoms for six months or more and a significant impairment in daily functioning. 
&nbsp;

<h5>V. Treatment For Prolonged Grief Disorder</h5>

PGD is a treatable condition, and several therapeutic approaches have shown promise in helping individuals cope with and heal from prolonged grief:

<ol>
	<li>Grief Counseling: Traditional grief counseling provides individuals with a safe space to express their feelings, process their grief, and learn coping strategies.</li>
	<li>Cognitive-Behavioral Therapy (CBT): CBT helps individuals identify and challenge irrational thoughts and beliefs related to their grief, facilitating healthier emotional processing.</li>
	<li>Mindfulness And Relaxation Techniques: Mindfulness practices can help individuals manage overwhelming emotions and develop greater emotional regulation.</li>
	<li>Support Groups: Joining a support group for those who have experienced similar losses can provide a sense of community and validation of one&#39;s feelings.</li>
	<li>Medication: In some cases, medication, such as antidepressants or anti-anxiety medications, may be prescribed to alleviate symptoms of depression or anxiety associated with PGD. 
	&nbsp;</li>
</ol>

<h5>VI. Coping Strategies For Prolonged Grief</h5>

In addition to professional treatment, there are several coping strategies that individuals can employ to manage PGD:

<ol>
	<li>Self-Compassion: Practice self-compassion and allow yourself to grieve without judgment. Understand that it is okay to feel the way you do.</li>
	<li>Routine And Structure: Maintain a daily routine and structure, as it can provide stability and a sense of control during a difficult time.</li>
	<li>Healthy Lifestyle: Prioritize self-care through regular exercise, a balanced diet, and sufficient sleep.</li>
	<li>Memorialization: Create meaningful rituals or memorials in honor of the deceased to keep their memory alive in a positive way.</li>
	<li>Seek Support: Lean on friends and family or seek professional help when needed. Don&#39;t hesitate to reach out for support. 
	&nbsp;</li>
</ol>

Bottom Line

Prolonged Grief Disorder is a challenging and often overwhelming condition, but it is not insurmountable. With the right support, understanding, and treatment, individuals can navigate the complex terrain of grief and move towards healing and recovery. It is crucial to recognize that healing from PGD is a unique and individual process, and there is no specific timeline for when grief should subside. Each person&#39;s journey is valid, and seeking help is a significant step toward finding hope and a sense of purpose in life once again.

Umna Salah

Vestibular rehabilitation therapy (VRT) is an effective treatment option for individuals suffering from vestibular or central balance system disorders.

VRT is a kind of physical therapy that involves specialized exercises to improve gaze and gait stability in both children and adults.

Nearly 42% of Americans have experienced dizziness at least once in their lives. Some people experience permanent balance deficits, resulting in functional limitations<a href="#accordion">[1]</a>. According to several studies, customized VRT programs fare better for these patients than generic ones<a href="#accordion">[1]</a>. 
&nbsp;

The vestibular system is a complex network of structures in the inner ear and brain that serve an important role in balance, coordination of eye movements, and spatial orientation. 

When this system is damaged or dysfunctional, a variety of symptoms, such as vertigo, dizziness, nausea, and unsteadiness, can occur. 
&nbsp;

Understanding Vestibular Rehabilitation Therapy

Dizziness can be a sign of a few medical conditions that affect the sense of balance. The individual may also feel muscle fatigue and headache as a result of dizziness.&nbsp; 

According to data from the National Health and Nutrition Examination Survey, people with symptomatic vestibular dysfunction have a 12-fold increased risk of falling<a href="#accordion">[3]</a>. 
&nbsp;

VRT benefits people suffering from the following conditions:

<ul>
	<li>Vertigo</li>
	<li>M&eacute;ni&egrave;re&#39;s disease</li>
	<li>Benign paroxysmal positional vertigo </li>
	<li>Labyrinthitis</li>
	<li>Vestibular neuritis</li>
	<li>Migraine</li>
	<li>Stroke</li>
	<li>Traumatic brain injury 
	&nbsp;</li>
</ul>

Vestibular rehabilitation stimulates and promotes the recovery of the vestibular system. Since the exercises are intended to challenge the vestibular system in a controlled manner, the difficulty level is gradually increased as the patient progresses. This technique helps to improve the vestibular system function and reduce symptoms, like vertigo, dizziness, and unsteadiness that negatively affect daily life<a href="#accordion">[2]</a>. 

A VRT program is developed based on the extent and location of vestibular system damage in an individual patient. The state of the visual and proprioceptive systems, physical strength, motor skills, and cerebellum integrity are all critical to successfully implementing a VRT program. In fact, according to research, patients with cerebellar dysfunction benefit little from vestibular rehabilitation<a href="#accordion">[1]</a>. 

Moreover, cognitive abilities including decision-making and memory are important factors that influence the outcome of a VRT program. Also, the program can do little to help a person who suffers from any psychological or anxiety disorder. 
&nbsp;

Used appropriately, VRT can be very effective for patients suffering from conditions affecting the vestibular system. These advantages include:

<ol>
	<li>Improved stability and balance</li>
	<li>Minimized dizziness and vertigo</li>
	<li>Higher tolerance for head movements and position changes</li>
	<li>Enhanced coordination and spatial awareness</li>
	<li>Decreased likelihood of falls and other accidents 
	&nbsp;</li>
</ol>

Conclusion

Vestibular rehabilitation is a safe and efficient therapy for vestibular disorders. Many people can significantly improve their balance and dizziness symptoms under the guidance of a skilled physical therapist. 
&nbsp;

Key Takeaways

<ul>
	<li>Vestibular rehabilitation is a specialized physical therapy that helps people with balance disorders and dizziness.</li>
	<li>The vestibular system in the inner ear plays a crucial role in maintaining balance and orientation.</li>
	<li>Vestibular rehabilitation is a highly efficient treatment for a variety of vestibular disorders, including BPPV, vestibular neuritis, Meniere&#39;s disease, and more.</li>
	<li>Vestibular rehabilitation typically involves a combination of exercises and techniques tailored to the patient&#39;s needs.</li>
	<li>Vestibular rehabilitation is safe and effective when performed by a skilled physical therapist.</li>
	<li>If you are experiencing balance problems or dizziness, speak to your doctor about whether vestibular rehabilitation may be proper for you. 
	&nbsp;</li>
</ul>

[1] Philip E Zapanta M. Vestibular rehabilitation. Overview, Vestibular Rehabilitation Therapy, Vestibular Rehabilitation Therapy Program.

[2] Whitney SL, Alghwiri A, Alghadir A. Physical therapy for persons with Vestibular Disorders. Current Opinion in Neurology. 2015;28(1):61-68. doi:10.1097/wco.0000000000000162.

[3] Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of Balance and Vestibular Function in US Adults: Data From the National Health and Nutrition Examination Survey, 2001-2004. Arch Intern Med. 2009;169(10):938–944. doi:10.1001/archinternmed.2009.66.