AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Type A blood with negative antigen red blood cells is one of the rarest blood groups. Reports show that people with type A blood have a 16% higher risk for early-onset stroke.

What Does Your Blood Type Have To Do With Your Risk Of Stroke?

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Know Your Blood Pressure Numbers

Introduction

Blood pressure refers to the force applied by the flowing blood against the walls of the body&#39;s arteries<a href="#accordion">[1]</a>.&nbsp;Not only does this force help supply organs with oxygen and nutrients but also white blood cells and antibodies for immunity, and hormones like insulin<a href="#accordion">[2]</a>. Moreover, along with transporting oxygen and nutrients, blood pressure also plays a role in removing harmful metabolic end products, including carbon dioxide and other toxins cleared from the liver and kidneys.&nbsp; 
&nbsp;

Understanding blood pressure readings

When blood pressure exceeds the normal range, it is called <a href="https://www.merisehat.pk/disease/hypertension-57">hypertension</a>. Blood pressure is composed of a pair of numbers. The first (systolic) number represents the blood vessels&#39; pressure when the heart contracts. The second (diastolic) number is associated with the pressure in the vessels when the heart rests in between the beats<a href="#accordion">[1]</a>.&nbsp;The combination of the two allows doctors and health professionals to gauge the overall well-being of an individual. 
&nbsp;

Mild and temporary fluctuations in blood pressure are normal and can be triggered due to a myriad of reasons. However, if an individual deviates from the normal range for a chronic period, then that may indicate a deeper and more complex medical condition, and should be further explored by a licensed practitioner. To analyze quantitively, blood pressure has been categorized into five categories<a href="#accordion">[3]</a>. 
&nbsp;

<h5>Normal Range</h5>

The first range of blood pressure is defined as the normal range and is expected from every healthy individual. Numbers under 120/80mmHg are viewed as normal<a href="#accordion">[4].</a>&nbsp;Activities that encourage and support the heart&rsquo;s rhythmic motions, such as a well-balanced healthy diet and physical activity can help maintain the blood pressure in the normal range<a href="#accordion">[4]</a>. 
&nbsp;

At birth, the blood pressure stays at 64/40mmHg and then rises to 120/80mmHg as one reaches adulthood<a href="#accordion">[3]</a>. Several factors, both natural and human-induced, can then cause the blood pressure to fluctuate. For example, checking the blood pressure after delivering a fervent speech or running a marathon will likely give a high reading. This is perfectly normal as the increased adrenaline levels cause the body to increase the blood pressure, and supply the heart with more oxygen for fight or flight events<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

<h5>Elevated Levels</h5>

This is a warning stage to alarm patients and usher them into hypertension treatment before it is exacerbated. Elevated levels are denoted by persistent high blood pressure readings. A doctor is likely to investigate for differential diagnosis if the systolic blood pressure is in the range of 120-129mmHg and the diastolic is less than 80mmHg<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Individuals who constantly have elevated levels of blood pressure are more vulnerable and at risk of developing various coronary diseases early in their life<a href="#accordion">[5]</a>. An aneurysm is an abnormal bulge in the blood vessel wall that can result from prolonged and unattended elevated levels of blood pressure. Elevated blood pressure levels also increase the risk of cardiovascular failure. Moreover, damage to the renal vessels can affect healthy kidney functioning. Since little veins in the eyes are particularly defenseless against harm, hypertension can also prompt vision issues and even visual impairment<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

<h5>Hypertension Stage I</h5>

If not addressed, then elevated levels can deteriorate to advanced stages of hypertension. Stage 1 is defined by consistently high blood pressure levels of systolic 130-139mmHg and diastolic 80-89mmHg<a href="#accordion">[3]</a>. At this phase of hypertension, specialists endorse and stress a reconsideration of routine activities and life changes. They may also prescribe blood pressure medications based on the individual&#39;s risk of developing an atherosclerotic cardiovascular disease (ASCVD), such as a heart attack or a stroke<a href="#accordion">[3]</a>.&nbsp;&nbsp; 
&nbsp;

<h5>Hypertension Stage II</h5>

If treatment for hypertension stage 1 does not prove to be successful, then the individual is likely to progress to hypertension stage 2. Hypertension stage 2 is defined as blood pressure readings of 140/90mmHg or higher<a href="#accordion">[3]</a>. At this stage, specialists will probably recommend lifestyle changes and alternatives to the previously prescribed blood pressure prescriptions While treating a patient with stage 2 hypertension, the clinician should decide on the proper blood pressure (BP) objective, select the underlying anti-hypertensive routine, and change that routine, as required, to accomplish the objective BP. Likewise, the clinician ought to think about the effect of the treatment routine on both the patient&#39;s consistency with treatment and long-term risk for cardiovascular disease (CVD)<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

If an individual has a history of high blood pressure, then they may be more likely to develop a hypertensive crisis. This phase of hypertension necessitates immediate and proper medical assistance. Therefore, it is important not to delay treatment. If during a routine blood pressure check, the readings out of nowhere surpass 180/120mmHg, try not to panic. Take a deep breath, wait for five minutes, and afterwards test the blood pressure once more. However, if the readings are bizarrely high twice in a row, immediately contact a hospital or a doctor<a href="#accordion">[3]</a>. Such high levels could indicate that the person is going through a hypertensive crisis.&nbsp; 
&nbsp;

Moreover, with the blood pressure reading being higher than 180/120mmHg the individual might witness other alarming and distressing symptoms. These suggest signs of conceivable organ harm<a href="#accordion">[7]</a>. They may range from chest pain to difficulty in breathing, body numbness and pain (especially in the back), visible change in vision, and communication problems. If these accompany the blood pressure readings, then an individual should not hesitate or wait for the shortness of breath to pass away, and immediately call for medical help<a href="#accordion">[7]</a>.

&nbsp;

<h4>"Stay on top of your blood pressure reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

To maintain the blood pressure (BP) goal according to the individual&rsquo;s age, health, and stage, the patient must regularly monitor their readings for comparison and to confirm if the advised treatment is leading to any progress or not. Realistically, it is neither economical nor feasible to expect an individual to travel great lengths, and pay hefty consultation fees for a quotidian blood pressure reading. Therefore, a doctor may suggest investing in a home blood pressure monitor. 
&nbsp;

A home blood pressure apparatus is a more accessible and economical alternative than rushing to the hospital each day. Moreover, a patient does not require a doctor&#39;s prescription to purchase one. Thus, increasing its prevalence in every home. However, it should be stated that home blood pressure observation is not a substitute for visits to the primary care physician for more serious concerns and complications that might arise due to hypertension. Additionally, home blood pressure apparatuses might have a few shortcomings of their own<a href="#accordion">[7].</a> However, these can be avoided if the individual makes an informed purchase.&nbsp; 
&nbsp;

Don&#39;t hesitate to venture onto the world wide web and gather all necessary specifications before buying a home blood pressure monitor. You can even bother a doctor for suggestions for a reliable and approved gadget. Make sure to be diligent with the yearly check-ups of the apparatus. For the inauguration, bring it to the doctor&#39;s office and request a doctor or nursing staff to teach you the proper method of checking blood pressure at home. This will help guarantee correct readings<a href="#accordion">[7]</a>.&nbsp;

&nbsp;

Conclusion

Hypertension is a gateway to permanent damage and life-long complications. Therefore, it is important to understand the different stages of high blood pressure and the method to monitor it. The predominance of hypertension with increasing age is a result of the gradual rise in systolic blood pressure. 
&nbsp;

Systolic hypertension is the most common type of hypertension in people older than 50 years and reflects the pathologic decline in the blood vessel and arterial compliance<a href="#accordion">[6]</a>. The increase in systolic blood pressure is a more significant risk factor for cardiovascular disease than diastolic blood pressure rise. However, both should be regulated through prescribed treatments and lifestyle changes.

&nbsp;

Key Points

While hypertension covers a range of sub-topics, it is important to remember that: 
&nbsp;

<ul>
	<li>Hypertension results from the normal blood pressure rising consistently. Blood pressure is measured through a pair of readings: systolic and diastolic.</li>
	<li>Systolic blood pressure results from the heart contracting, while diastolic pressure develops when the heart relaxes.</li>
	<li>The normal range of blood pressure is less than 120mmHg for systolic, and less than 80mmHg for diastolic.</li>
	<li>Elevated levels are defined as a systolic reading of 120-129mmHg and diastolic pressures of less than 80mmHg.</li>
	<li>Hypertension Stage 1 has blood pressure readings of 130-139mmHg and 80-89mmHg for systolic and diastolic respectively.&nbsp;</li>
	<li>Hypertension Stage 2 has blood pressure readings of 140mmHg or higher for systolic and 90mmHg or higher for diastolic.&nbsp;</li>
	<li>During a hypertensive crisis, systolic readings soar above 180mmHg while diastolic readings are higher than 120mmHg. This requires immediate medical attention.</li>
</ul>

&nbsp;

[1].World Health Organization (WHO). (2021, August 25). Hypertension. Retrieved from World Health Organization (WHO)

[2].Weatherspoon, D. (2022, March 20). What is a normal blood pressure reading? Retrieved from Medical News Today:

[3].American Heart Association. (2022). Understanding Blood Pressure Readings. Retrieved from American Heart Association:

[4].Jaret, P. (2021, September 17). High Blood Pressure. Retrieved from WebMD:

[5].Chobani, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., IzzoJr, J. L., . . . Rocella, E. J. (2003). Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension, Vol. 42, No. 6, 1206-1252

[6].Giles, T. D., & Materson, B. J. (2005). Treating stage 2 hypertension. Journal of clinical hypertension (Greenwich, Conn.), 7(8), 464–470.

[7].Mayo Clinic. (2021, July 1). High blood pressure (hypertension). Retrieved from Mayo Clinic:

Zarlish Kazmi

Humza Khizer

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The Nation’s Stance Against TB

Pakistan, with around 510,000 new <a href="https://www.merisehat.pk/disease/tuberculosis">Tuberculosis (TB)</a> cases reported every year and around 15,000 transitioning to drug-resistant TB cases consistently, is positioned 5th among high-burden nations overall. It represents 61% of the TB burden in the WHO Eastern Mediterranean Region. The nation is assessed to have the 4th most elevated predominance of multidrug-resistant TB (MDR-TB) worldwide.&nbsp; 
&nbsp;

Key explanations behind the development of the medication-resistant types of TB range from untimely and late diagnosis; unadministered, improper, and insufficient medication regimens; poor development and absence of a social help program for high-risk populaces<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

Understanding Pakistan's Fight Against TB

The Pakistan National Tuberculosis Program (NTP) has accomplished a momentous and consistent improvement in the staggering number of TB cases identified from 11,050 in 2000 to 248,115 in 2008. Likewise, treatment achievement rates recorded were an impressive 91% in 2007<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

This has been accomplished through robust responsibility and monetary contributions by the Government along with well-being advancement offered by supporters. 
&nbsp;

The World Health Organization (WHO) Directly Observed Treatment Short-course (DOTS) technique for TB was embraced and guided by Pakistan from 1995 onwards. However, significant advancement in TB control was accomplished after the recovery of the NTP in 2001 when TB had been proclaimed a public general health crisis through the Islamabad Declaration<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

The NTP operates under the Ministry of Health and is answerable for general coordination, strategy course, and specialized direction for TB control, while realistic execution is the obligation of the Provincial TB Programs (PTPs) and specialists within each region. The NTP focal unit connects elaborately with PTP chiefs and regional TB facilitators<a href="#accordion">[6]</a>. 
&nbsp;

The TB administrations are incorporated into the essential general medical care framework at the district level<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

A 2003 study led by the NTP and PTPs in Lahore and Rawalpindi locale saw that under 3% of general practitioners (GPs) were strictly abiding by the public rules for active contact tracing and the management of TB, while 90% of GPs were depending on chest radiography for confirmed diagnosis<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

Parastatal health administration&rsquo;s structure is one more place of entry outside the general medical care framework and NTP guidelines. In general, 32 government services and the federal bureau secretariat, with 208 independent (parastatal) bodies, give well-being administrations to 389,923 representatives and their dependents<a href="#accordion">[4]</a>. Excluding the Ministry of Defense, which has its own monetary cost for wellbeing administrations.&nbsp; 
&nbsp;

Lately, though, a high need has been given to creating practical organizations with medical care suppliers in the private domain, taking on a deliberate methodology following the WHO rules. Extra drives, like a better reconnaissance and research center organization, and improved follow-up and treatment modalities subsidized by international and public sources, have added to the huge improvement in recognition and treatment achievement rates framed previously.&nbsp; 
&nbsp;

The target of the survey was to feature the accomplishments of Pakistan&#39;s NTP throughout the last 10 years and to frame the exceptional needs and difficulties for what&#39;s to come. Moreover, the NTP has become more inclusive and has strived to work against discrimination of any sort while providing treatment and care for TB. This has been achieved by systematically drafting a communication manual through collaborative efforts to become more accessible to the people in Pakistan<a href="#accordion">[8]</a>.

&nbsp;

The PPM model was established to function through a typical and unanimous decision [memorandum of understanding, (MOU)] between the NTP (public arm) and the partaking wellbeing office proprietors (private arm) while adhering to the pertinent and important public TB rules<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

The NTP support component (material stockpile, monetary help, and specialized help) to the private supplier was, likewise, something very similar and uniformly disseminated in all TB offices working through the PPM model (PPM-1, 2, 3, and 4). It was provided by the Provincial TB control program (NTP provincial wing) via the area TB control program (NTP district wing) in all existing PPM approaches.&nbsp; 
&nbsp;

Nonetheless, the PPM enrolled cases were notified by private suppliers to the district TB control program (DTB), then to the Provincial TB control program (PTP), and lastly refreshed into the NTP data set. The four PPM approaches were following a specific arrangement of patient assessment, demonstrative diagnostics, and follow-up methods<a href="#accordion">[13]</a>. 
&nbsp;

First and foremost, the principal strength of the PPM mediation study (various methodologies of the customary PPM model) is that the data was gathered from regularly updated and revised program information, so the discoveries are theoretically going to mirror the program&#39;s real factors<a href="#accordion">[13]</a>. Second, the review and target population have an enormously appropriate sample size, which correspondingly allows the gauge to be a closer and more accurate representation of the truth. Third, the STROBE rules were adhered to for unparalleled concentration on the plan, procedure, and announcement of results which limits the gamble of systemic predispositions<a href="#accordion">[14]</a>. And fourth, the review gives proof and a graphic outline of all the TB case notifications (PPM and non-PPM) from all TB treatment offices accessible for 97% of Pakistani DOTS residents living in 4 regions in the review period<a href="#accordion">[13]</a>. 
&nbsp;

From the 4 PPM approaches (PPM-1, - 2, - 3, and&minus;4), increase in GP facilities ought to be centered more toward their PPM coverage result, as well as changing the PPM-1 procedure for consideration of GPs that are only practicing TB care in the private sector. On the other hand, NGO facilities should focus on an expansion in their PPM coverage, whereas private clinics should upgrade their PPM coverage proficiency, alongside broadening the treatment achievement rate up to 85%<a href="#accordion">[13]</a>.&nbsp; 
&nbsp;

However, changes in Parastatal offices cannot just be pointed toward redesigning the Parastatal commitment toward PPM TB case notification. They should also be working on their subsequent systems to prevent the default of Parastatal notified TB cases as well as holding the number of Parastatal offices offering TB administrations<a href="#accordion">[13]</a>. 
&nbsp;

The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity is a United States Agency for International Development (USAID) subsidized drive in Pakistan. Integrated in 2018, it has been working intimately with the government and district well-being specialists to reform, change, and reinforce the well-being framework that has been implemented at the provincial level<a href="#accordion">[11]</a>. 
&nbsp;

The general objective of this specialized forum was to help the Provincial TB Control Programs in Sindh and Khyber Pakhtunkhwa in further developing the dynamic contact tracing of bacteriologic positive TB cases and decentralizing the administration of drug-resistant TB cases. 
&nbsp;

The definitive goals of this technical and international action were to accumulate sufficient proof for demonstrating the viability of active contact tracing and screening as a major strategy to work on the detection of bacteriologic positive instances of TB within the networks, and to improve the testing limit of the provincial TB programs. The program began on January 1, 2021, and finished on September 30, 2021<a href="#accordion">[11]</a>. 
&nbsp;

Diagnosing and proving the necessary care for TB cases in refugee camps and new settlements is a challenging task as many individuals are unregistered and undocumented. Besides, the societal stigma revolving around TB acts as a silent suppressor. Additionally, everyday environments, financial status, and restricted admittance to medical care are boundaries to TB services<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

There are a lot of instances where healthcare agents missed out TB among the refugees of Afghan populations in the three states covered by the Global Fund award.&nbsp; 
&nbsp;

Tracing TB cases and contact tracing is an effective way to stop the spread of the disease, including the epidemic of drug-resistant strains.&nbsp; 
&nbsp;

The Global Fund is a grant that functions under UNDP&#39;s attempts to reinforce joint effort and data sharing between Afghanistan, Iran, and Pakistan to guarantee quality care for patients who are relocating<a href="#accordion">[9]</a>. 
&nbsp;

UNDP introduced a cross-country computerized platform for recording and detailing TB cases among displaced people, returnees, and mobile communities. It was planned in association with public TB programs, the Global Fund, the United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM), and others.&nbsp; 
&nbsp;

The online application was created by Dure Tech and uses the WHO Prevent TB Digital Platform. It depends on open-source technology and incorporates a patient-focused module, as well as interoperability with well-being data frameworks. Hence, empowering the screening of TB patients across the continuum of medical services, transcending borders and nationalities<a href="#accordion">[9]</a>. 
&nbsp;

The PMDT model of care in Pakistan comprises 3 connected systems of hierarchies<a href="#accordion">[7]</a>. At the highest point of the order is a full-scale framework that could be referred to as the macro system, which contains the majority of global wellbeing organizations. These include the WHO and the Global Fund, which give direction and monetary help to the PMDT model of care. 
&nbsp;

At the national level, the public and provincial TB programs work collaboratively with the non-legislative associations forming a mesosystem that gets the necessary assistance from global offices, and subsequently interprets and adjusts rules for nearby settings and districts. Together, the two frameworks build a microsystem &mdash; i.e., the PMDT facilities, which work as per universally accepted norms of care and are rooted in a former, more extensive wellbeing system<a href="#accordion">[7]</a>.&nbsp; 
&nbsp;

The PMDT model focuses on materials. For example, foundation, medications, and quantities of individuals tested and screened. Initially, there wasn&rsquo;t much emphasis on developing competencies of the PMDT staff; hence, they were incapable of giving responsive care. 
&nbsp;

Later the PMDT staff suggested prioritizing medical services connected to responsiveness which, when implemented, proved to be fruitful for patients<a href="#accordion">[1]</a>.

&nbsp;

Significant steps have been made to provide accessible and effective medical services and care for TB. However, more efforts are needed since ailing health, unfortunate lodging, and sterilization, for instance, intensified by other risk factors, like tobacco, liquor use and diabetes aggravate the condition which are still prevalent in the society.&nbsp; 
&nbsp;

The Minister pledged and vowed Pakistan&#39;s continuous and unwavering stance with the global community in the fight to eradicate TB and is undoubtedly dedicated to ending the TB pestilence by 2030 as visualized in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB<a href="#accordion">[12]</a>. 
&nbsp;

<ul>
	<li>Pakistan has a high prevalence of TB cases; it stands 5th in the world.</li>
	<li>Pakistan has made significant contributions to reducing the global burden of TB.</li>
	<li>The National TB Control Program (NTB) works at the central level to draft and implement national policies for TB care.</li>
	<li>NTB caters to the growing TB population through models such as the Public-Private Mix (PPM) Model or the Programmatic Management of Drug-Resistant Tuberculosis (PMDT).</li>
	<li>Global organisations such as WHO and the Global Fund assist Pakistan in fighting against TB.</li>
	<li>The Integrated Health System Strengthening and Service Delivery (IHSS-SD) Activity by USAID has allowed smooth provincial administration for TB.</li>
	<li>Tuberculosis is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately.</li>
	<li>In 2018, Federal Minister for National Health Services Saira Afzal Tarar said Pakistan&#39;s committed to eradicate TB by 2030 as visualised in the agenda 2030 for Sustainable Development and its Sustainable Development Goals, World Health Organization End TB Strategy, Stop TB Partnership Global Plan to End TB.</li>
</ul>

&nbsp;

[1] Abbas, S., Kermode, M., & Kane, S. (2020). Strengthening the response to drug-resistant TB in Pakistan: a practice theory-informed approach. Public health action, 10(4), 147–156.

[2] Federal Bureau of Statistics. (2009). National health accounts Pakistan 2005–06. Islamabad: Federal Bureau of Statistics, Statistics Division.

[3] Khan, J. A., Irfan, M., Zaki, A., Beg, M., Hussain, S. F., & Rizvi, N. (2006). Knowledge, attitude, and misconceptions regarding tuberculosis in Pakistani patients. Journal of Pakistan Medical Association, 56(5), 211–214.

[4] Metzger, P., Baloch, N., Kazi, G., & Bile, K. (2010). Tuberculosis control in Pakistan: reviewing a decade of success and challenges. Eastern Mediterranean Health Journal, Volume 16, 47-53.

[6] National TB Control Programme (NTP). (2014). National TB Control Programme Reach, treat, cure everyone: Annual report, 2014. Islamabad, Pakistan: Ministry of National Health Services Regulations & Coordination.

[6] National Tuberculosis Programme (NTP). (2008). Advocacy, communication and social mobilization: national strategy and operational guidelines. Islamabad: Ministry of Health.

[7] Ostby, K., & Burton, T. (2022, March 29). Tracking the 'missing cases' of TB as it moves across borders.

[8] Shah, S., Sadiq, H., Khalil, M., & Noor, A. (2003). Do private doctors follow national guidelines for managing pulmonary tuberculosis in Pakistan? Eastern Mediterranean Health Journal, 9(4), 776–788.

[9] Shaikh, B. T., Laghari, A. K., Durrani, S., Chaudhry, A., & Ali, N. (2022). Supporting tuberculosis program in active contact tracing: a case study from Pakistan. Infectious Diseases of Poverty volume 11, 42.

[10] The Frontier Post. (2018, March 27). All resources to be mobilized to fight against TB says Saira.

[11] Ullah, W., Ahmad, W., Haq, M. U., Yaqoob, A., Fatima, R., & Khan, G. M. (2021, August 10). Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Retrieved from Frontiers Public Health:

[12] Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., . . . Initiative., S. (2007). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Annals of internal medicine, 147(8), W-163.

[13] World Health Organization (WHO). (2006). Engaging all health care providers in TB control: guidance on implementing public-private mix approaches. Retrieved from World Health Organization (WHO):

[14] World Health Organization (WHO). (2022). Tuberculosis.

Can Laughter Really Lower Blood Pressure?

High blood pressure, or hypertension, is a common health issue that affects around 1.28 billion people worldwide. It is often referred to as the &quot;silent killer&quot; because it can cause serious health problems, including heart disease, kidney failure, and stroke, without obvious symptoms.<a href="#accordion">[1]</a>

While medications and lifestyle changes are standard treatments, laughter therapy, quite surprisingly, is gaining attention as one of the natural ways to lower blood pressure.

Several studies demonstrate the long-term benefits of laughter therapy for blood pressure, for e.g. participants who engaged in regular laughter exercises had sustained reductions in their blood pressure levels over several months and could be&nbsp; a useful complementary treatment for hypertension.<a href="#accordion">[2]</a> 
&nbsp;

Understanding benefits of laughter therapy

This therapy can include watching funny movies, participating in laughter <a href="https://merisehat.pk/article/yoga-a-life-changing-approach">yoga</a>, attending humor workshops, or simply engaging in activities that make you laugh. The premise is simple: laughter can have a positive impact on your physical and mental health. 
&nbsp;

Laughter therapy works by triggering several physiological changes in your body:<a href="#accordion">[3]</a> 
&nbsp;

<ul>
	<li>
	<h5>Release Of Endorphins</h5>
	</li>
</ul>

Endorphins are the body&rsquo;s natural feel-good chemicals. They promote a sense of general well-being and can provide temporary pain relief. 
&nbsp;

<ul>
	<li>
	<h5>Reduction Of Stress Hormones</h5>
	</li>
</ul>

Stress hormones like cortisol and adrenaline can lead to stress and anxiety. 
&nbsp;

<ul>
	<li>
	<h5>Improved Blood Circulation</h5>
	</li>
</ul>

A healthy blood flow can help protect against heart attacks and other cardiovascular problems. According to a study, laughter expands the inner lining of blood vessels, called the endothelium, which increases blood flow and reduces blood pressure.<a href="#accordion">[4]</a> 
&nbsp;

<ul>
	<li>
	<h5>Muscle Relaxation</h5>
	</li>
</ul>

The whole body feels relaxed for up to 45 minutes after laughing. 
&nbsp;

While laughter therapy should not replace traditional medical treatments, it can be a valuable complementary approach to managing hypertension. It can effectively reduce stress and potentially lower your blood pressure. So, go ahead and find something that makes you laugh &ndash; it&#39;s good for your heart! 
&nbsp;

<ul>
	<li>Laughter therapy involves laughter to promote overall health and well-being.</li>
	<li>It can include activities like watching funny movies, participating in laughter yoga, or attending humor workshops.</li>
	<li>Laughter is one of the most effective stress management techniques; it decreases stress and anxiety while improving mental well-being and mood.</li>
	<li>Laughter therapy can help lower blood pressure and can be used as a complementary approach alongside traditional medical treatments for managing high blood pressure.</li>
</ul>

[1] Hypertension. World Health Organization. Accessed June 24, 2024.

[2] View of effectiveness of laughter therapy on blood pressure among patients with hypertension. Accessed June 24, 2024.

[3] Stress relief from laughter? it’s no joke. Mayo Clinic. September 22, 2023. Accessed June 24, 2024.

[4] Laughter has a positive impact on vascular function. European Society of Cardiology. Accessed June 24, 2024.

Staff Writer

Iqra Mazhar

This article or video has been viewed by many visitors, and is popular.

A Short, Bloody Story About Long COVID

The first case of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic.

&nbsp;

Over the past year, several people have begun travelling to countries across Europe. Considering the recent ease in lockdown measures and international travel restrictions, this may not come as a surprise to many people. But what&rsquo;s surprising is the fact that thousands of them are spending all their life savings on these European destinations. Do they need a vacation that badly? Or are they in search of something bigger?&nbsp;

According to a BMJ study, thousands of patients with long COVID are traveling to Switzerland, Cyprus, and Germany for &lsquo;blood washing&rsquo;<a href="#accordion">[1]</a>. While this may sound like a satanic ritual, it&rsquo;s an experimental treatment being offered across private clinics in these countries. Patients report spending &euro;15,000 to &euro;40,000 on the treatment, just for a slight relief of their debilitating symptoms<a href="#accordion">[1]</a>. Although there is a lack of research on blood washing for treating <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>, long COVID sufferers are desperate. After having their symptoms dismissed by several healthcare professionals, and trying every treatment in the book, they are willing to try anything.&nbsp;

This makes us wonder: how bad could long COVID possibly be that people are willing to travel to far-off locations for an unproven &lsquo;blood washing&rsquo; treatment?

Throughout the pandemic, researchers have discovered significant information on the virulence, transmission, and mechanism of the novel coronavirus (SARS-CoV-2). Thus, with time, COVID-19 has evolved from a respiratory illness to one with multi-system effects. While many of our questions regarding the novel coronavirus and COVID-19 have been answered, several things remain a mystery. One such mystery is long COVID.&nbsp;

&nbsp;

Understanding Long COVID

The first case of COVID-19 came forward in November of 2019. However, it wasn&rsquo;t until March 2020 that the World Health Organization (WHO) declared the outbreak a pandemic<a href="#accordion">[2]</a>. As of 29th July &lsquo;22, the world has recorded more than 57 million COVID-19 infections and 6.3 million deaths<a href="#accordion">[3]</a>.

Typically, a mild or moderate coronavirus infection lasts two weeks. However, in some individuals, the symptoms can persist for months after, or return after recovery. This is called long COVID.&nbsp;

Over the years, researchers have referred to the condition by several names: long-haul COVID, chronic COVID, post-acute COVID-19, long-term effects of COVID-19, and post-acute sequelae of SARS CoV-2 infection (PASC). According to WHO, long COVID develops in people with a history of probable or confirmed coronavirus infection, typically 3 months from the onset of COVID-19<a href="#accordion">[4]</a>. The symptoms last for at least 2 months and cannot be explained by some other illness.&nbsp;

Approximately 10-20% of COVID-19 patients go on to develop long COVID<a href="#accordion">[4]</a>. As per a Lancet study, 1.5% of the UK&rsquo;s population had self-reported long COVID in July 2021<a href="#accordion">[5]</a>. Moreover, the greatest prevalence was reported among people aged 35-69 years. In contrast, the prevalence of long COVID in South-East Asia largely remains unknown; likely due to a limited number of studies. One study in India reported long COVID in 29.2% of patients; another from Pakistan found residual symptoms in 83.7% of patients, even a month after COVID<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

These symptoms are often debilitating and affect one&rsquo;s overall quality of life. The WHO has issued a list of 33 symptoms of long COVID<a href="#accordion">[4]</a>. The most common symptoms are:

<ul>
	<li>Fatigue</li>
	<li>Shortness of breath</li>
	<li>Brain fog&nbsp;or difficulty concentrating</li>
	<li>Headache</li>
	<li>Altered smell or taste</li>
	<li>Sleep disturbances</li>
	<li>Heart palpitations</li>
	<li>Joint or muscle pain</li>
	<li>Menstrual irregularities</li>
	<li>Abdominal pain</li>
	<li>Diarrhea</li>
</ul>

&nbsp;

According to a survey conducted in Pakistan, body aches, low mood, and cough were the most common residual symptom among COVID-19 survivors<a href="#accordion">[7]</a>. Recently, researchers at the University of Birmingham analyzed health records of COVID-positive people in the UK<a href="#accordion">[8]</a>. The study aimed to determine symptoms most commonly present in non-hospitalized patients, 12 weeks after infection. As per the results, loss of smell, hair loss, sneezing, ejaculation difficulties, and reduced libido were the most common long COVID symptoms among the study participants<a href="#accordion">[8]</a>.&nbsp;

But that&rsquo;s not all. Long COVID is also associated with long-term psychological manifestations. A preprint study, analyzing long-term trajectories of psychological symptoms over 22 months of follow-up, reported heightened depressive symptoms and anxiety levels among long COVID patients<a href="#accordion">[9]</a>. Thus, highlighting the importance of mental health monitoring and support for such patients.&nbsp;

&nbsp;

Regardless of whether you have a mild or severe infection, you may be at risk of long COVID. The exact cause behind why the condition develops in some and spares others remains unknown. Moreover, the symptoms and their severity also vary from person to person.&nbsp;

Researchers have proposed various theories regarding the cause of long COVID. While multiple studies are currently underway, the following factors may increase one&rsquo;s risk[10]:

<ul>
	<li>Severe COVID-19 infection</li>
	<li>Underlying health conditions</li>
	<li>Unvaccinated individuals</li>
	<li>COVID-19 re-infection</li>
	<li>Presence of neurological symptoms during acute COVID infection</li>
	<li>Hospitalization or ICU admission during infection</li>
</ul>

However, several cases of long COVID have emerged among healthy individuals without any of the above factors. Therefore, further research is required to gain a deeper understanding of the condition.

&nbsp;

<h4>"COVID infections can lower oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!"</h4>

Researchers hypothesize that the presence of neurological symptoms in long COVID patients points to nerve fiber damage. Therefore, assessing for small nerve fiber damage in the cornea can likely help identify patients with the conditions<a href="#accordion">[11]</a>. However, currently, there is no test to diagnose long COVID in suspected individuals. Moreover, the varying symptoms make it difficult for doctors to correctly diagnose patients.&nbsp;

&nbsp;

&lsquo;Blood washing&rsquo;, also called apheresis, is the process of filtering out individual components of the blood with the help of a machine. It has been used to treat diseases such as sickle cell anemia and leukemia. The procedure involves removing blood through a needle from one arm, passing it through a filtration system, and then returning the filtered blood through a needle into another arm.&nbsp;

In long COVID, doctors use apheresis to remove lipids and inflammatory proteins from the person&rsquo;s blood. Researchers hypothesize that microscopic blood clots, also called micro clots, are to blame for the clogging of capillaries, which then reduces the oxygen supply and leads to long COVID symptoms<a href="#accordion">[1]</a>. Therefore, they propose the removal of inflammatory proteins from the person&rsquo;s blood. Moreover, patients are prescribed blood thinners or anticoagulants along with blood washing. However, the procedure is yet to be proven effective for the condition.&nbsp;

While some people have reported an improvement in symptoms, many have seen no difference. Nevertheless, without any clinical trials, one cannot properly evaluate the procedure&rsquo;s risks and benefits.&nbsp;

&nbsp;

While there is no treatment for long COVID, several prevention strategies can help prevent infections and ultimately post-COVID symptoms. The following is the best way to protect yourself:<ul><li>Wear a mask in crowded areas, especially in indoor settings</li><li>Wash your hands with soap and water</li><li>Cough or sneeze in your elbow</li><li>Get vaccinated against COVID-19</li><li>Avoid close contact with someone experiencing symptoms of COVID-19</li></ul>

Although the novel coronavirus is given a bad name for causing long-term complications, it is not alone. Several other infectious diseases can also have post-infectious sequelae e.g. Epstein-Barr virus (EBV), Lyme disease, Giardia lamblia, and several viral infections. The post-infection sequel in these diseases can result in fatigue, cognitive dysfunction, muscle pain, mood disorders, and neurological symptoms. Furthermore, chronic fatigue syndrome commonly follows viral infections.&nbsp;It is important to acknowledge any new symptoms that may occur after an acute COVID infection, and not dismiss them as a ‘thing in our head’. Moreover, since long COVID can affect anyone irrespective of their health status, it is important to remain cautious of catching the infection. Thus, continue practicing social distancing, wearing a mask, washing your hands, and staying up to date with your COVID-19 vaccines.&nbsp;

<ul>
	<li>Long COVID is defined as the persistence of symptoms in a person with a history of COVID-19, usually 3 months from the onset of the infection. Moreover, the symptoms last for at least 2 months and cannot be explained by any other diagnosis.&nbsp;</li>
	<li>The WHO has a list of 33 symptoms of long COVID. Fatigue, shortness of breath, joint or muscle pain, sleep disturbances, brain fog, hair loss, altered taste or smell, and mental health disorders are the common symptoms of long COVID.&nbsp;</li>
	<li>Researchers hypothesize that certain factors may increase the risk of long COVID. These include severe acute COVID infection, underlying health conditions, unvaccinated status, ICU admission, and repeated COVID infections. However, these factors do not explain why long COVID continues to affect people with mild infections or without any of the mentioned factors.</li>
	<li>Due to a lack of available treatments, many long COVID patients have turned to various unproven treatment procedures such as &lsquo;blood washing&rsquo;, or apheresis.&nbsp;</li>
</ul>

&nbsp;

[1] Davies M. Long covid patients travel abroad for expensive and experimental “blood washing” BMJ 2022; 378 :o1671 doi:10.1136/bmj.o1671

[2] Cucinotta, D., & Vanelli, M. (2020). WHO Declares COVID-19 a Pandemic. Acta bio-medica : Atenei Parmensis, 91(1), 157–160.

[3] World Health Organization. (n.d.). WHO Coronavirus (COVID-19) Dashboard. WHO Health Emergency Dashboard.

[4] World Health Organization. (2021, October 6). A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO | World Health Organization.

[5] The Lancet. (2021). Understanding long covid: A Modern Medical Challenge. The Lancet, 398(10302), 725.

[6] BMJ 2022;377:e069676

[7] Qamar, M. A., Martins, R. S., Dhillon, R. A., Tharwani, A., Irfan, O., Suriya, Q. F., Rizwan, W., Khan, J. A., & Zubairi, A. (2022). Residual symptoms and the quality of life in individuals recovered from COVID-19 infection: A survey from Pakistan. Annals of medicine and surgery (2012), 75, 103361.

[8] Subramanian, A., Nirantharakumar, K., Hughes, S. et al. Symptoms and risk factors for long COVID in non-hospitalized adults. Nat Med (2022).

[9] Fancourt, D., Steptoe, A., & Bu, F. (2022). Long-term psychological consequences of Long Covid: A propensity score matching analysis comparing trajectories of depression and anxiety symptoms before and after contracting long covid vs short covid.

[10] CDC. (2022, July 11). Long COVID or Post-COVID Conditions - Long COVID or Post-COVID Conditions. CDC.

[11] Bitirgen G, Korkmaz C, Zamani A, et al. Corneal confocal microscopy identifies corneal nerve fibre loss and increased dendritic cells in patients with long COVID. British Journal of Ophthalmology Published Online First: 26 July 2021.

Nimrah H. Sattar

A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

FAQs About Heat Stroke

Extreme temperatures accounted for an estimated 1 to 7 million deaths globally in 2019<a href="#accordion">[1]</a>. The severity, duration, and frequency of extreme temperature events, such as heatwaves, floods, and storms, have been increasing over the past few years. According to the World Health Organization (WHO), more than 166,000 people died due to heat waves between 1998 and 2017<a href="#accordion">[2]</a>. Furthermore, the number of people exposed to heat waves increased by 125 million from 2000-2016<a href="#accordion">[2]</a>.

The inevitable climate change has drastically increased global temperatures and the frequency and intensity of heat waves across the world<a href="#accordion">[3]</a>. Extreme heat exposure affects the body&rsquo;s temperature regulations, leading to heat-related illnesses and an exacerbation of existing conditions, such as <a href="https://merisehat.pk/disease/hypertension-57">hypertension </a>and diabetes<a href="#accordion">[4]</a>. However, these effects of extreme heat are often exaggerated among city dwellers due to the urban heat island effect. Cities in both high- and low-income countries can have temperatures 3.5-12 &deg;C higher than the surrounding areas<a href="#accordion">[4]</a>.

From 2006-2015, the temperature in Karachi (Pakistan) reached a high of 45 &deg;C during May-July, and the daily average humidity ranged between 30-95%<a href="#accordion">[5]</a>. The high heat index coupled with high humidity is a common factor in the increased incidence of heat-related illnesses across Karachi and Pakistan.

&nbsp;

Understanding FAQs about heat stroke

<h5>What Are Heat-Related Illnesses?</h5>

Prolonged exposure to extreme heat and humidity coupled with dehydration can lead to heat-related illness. Working or exercising in hot and humid conditions can also cause heat illness. A high temperature and increased humidity disrupt the body&rsquo;s temperature regulation and cause normal core temperature to rise. 
&nbsp;

Heat-related illnesses can range from mild heat cramps to more severe heat stroke. The common types of heat illnesses are:

<ul>
	<li>Heat rash</li>
	<li>Heat cramps</li>
	<li>Heat syncope</li>
	<li>Heat exhaustion</li>
	<li>Heat stroke 
	&nbsp;</li>
</ul>

<h5>Is Heat Illness And Fever The Same?</h5>

Although the body temperature is raised above the normal level in a heat illness, it is not due to an infection, as is the case in a fever. Instead, high heat and humidity are the cause of hyperthermia. 
&nbsp;

<h5>What Is A Heat Stroke?</h5>

Heat stroke is a severe type of heat-related illness characterized by an elevated core body temperature (&gt;40 &deg;C) and neurologic dysfunction. It is a life-threatening condition and needs emergency medical attention.

Heat stroke can be classified into two types - exertional and non-exertional.

<ul>
	<li>Exertional Heat Stroke (EHS) - This type of heat stroke results from prolonged strenuous physical activity in hot and humid conditions. It is more common in young individuals. 
	&nbsp;</li>
	<li>Classic Non-Exertional Heat Stroke (NEHS) - Unlike exertional heat stroke, this type occurs due to heat waves and is more likely to occur in regions that do not typically experience prolonged hot conditions. It is common in the elderly, chronically ill individuals, and infants. 
	&nbsp;</li>
</ul>

<h5>What Causes A Heat Stroke?</h5>

Sweating is a normal body response to excessive heat. The evaporation of this sweat helps the body cool down. However, during periods of high heat index (&gt;90 degrees Fahrenheit) and humidity (&gt;60%), sweat evaporation is disrupted. As a result, the body absorbs more heat than releasing it, causing the internal body temperature to rise.

A depletion of salt and water in the body, likely due to dehydration, also contributes to a heat stroke as the body is unable to sweat fast enough to release heat. 
&nbsp;

<h5>What Are The Warning Signs Of A Heat Stroke?</h5>

In a heat stroke, the body temperature can rise to 106 &deg;F or higher within a span of 10-15 minutes.

Other signs and symptoms to look out for are:

<ul>
	<li>Lack of sweating</li>
	<li>Hot, red, and dry skin</li>
	<li>Confusion or altered mental status</li>
	<li>Dizziness, light-headedness, and weakness</li>
	<li>Headache</li>
	<li>Nausea</li>
	<li>Fast pulse</li>
	<li>Seizure</li>
	<li>Loss of consciousness</li>
</ul>

Note: Heat stroke is a medical emergency. If you or someone you know experiences any of the above signs and symptoms, seek help immediately. 
&nbsp;

<h5>Can Exercising Lead To A Heat Stroke?</h5>

Exercising in direct sunlight or in hot and humid environments can lead to excessive sweating, resulting in the loss of water and salts. If these are not replaced adequately, it can result in dehydration. Dehydration reduces the body&rsquo;s ability to sweat, raising the internal body temperature and causing a heat stroke. 
&nbsp;

<h5>Is Heat Stroke The Same As Heat Exhaustion?</h5>

Heat exhaustion is a milder form of heat illness. Although both heat exhaustion and heat stroke can elevate the body temperature, in heat exhaustion, the body temperature does not go above 40 &deg;C (104 &deg;F). However, it is a precursor to heat stroke.

Moreover, heat exhaustion is characterized by heavy sweating, cool, clammy skin, muscle cramps, and weakness. Whereas heat stroke has symptoms that include a lack of sweat, dizziness, and neurological dysfunction. 
&nbsp;

<h5>What Is The Difference Between A Heat Stroke And A Stroke?</h5>

Both stroke and heat stroke cause damage to brain cells. However, a heat stroke results from extreme heat exposure, while a stroke occurs due to a clot or aneurysm disrupting blood flow to the brain cells. 
&nbsp;

<h5>Can Anyone Get A Heat Stroke?</h5>

Anyone who is exposed to hot, humid conditions can develop a heat stroke. However, certain people are more at risk. These include:

<ul>
	<li>Elderly</li>
	<li>Infants</li>
	<li>Athletes</li>
	<li>People who work outdoors (e.g., laborers, firefighters, farmers)</li>
	<li>People unacclimatized to high temperatures 
	&nbsp;</li>
</ul>

<h5>Can I Get A Heat Stroke In A Car?</h5>

Cars can heat up quite rapidly in the sun, even on a mild day. Therefore, children and pets left in a locked car can die from a heat stroke in less than an hour.

Similarly, older adults in nursing homes or those shut inside their rooms during the summer can also get a heat stroke. Although the room may not seem hot, their frail bodies can slowly get overloaded by the heat. 
&nbsp;

<h5>Can Certain Medications Increase My Risk Of A Heat Stroke?</h5>

Yes, certain medications can increase the risk of heat stroke and other heat-related illnesses. They include antidepressants, diuretics, antihistamines, antipsychotics, antibiotics, anti-hypertensives, and stimulants. These medications can interfere with the body&rsquo;s normal thermoregulatory function by decreasing the sweat rate. 
&nbsp;

<h5>Are Heat Strokes Deadly?</h5>

Yes, if not treated immediately and adequately, heat stroke can be fatal. Delayed therapy can cause mortality rates of 80%<a href="#accordion">[6]</a>. 
&nbsp;

<h5>What Are The First-Aid Measures For A Heat Stroke?</h5>

The following first-aid measures can help treat a heat stroke:

<ol>
	<li>Call emergency medical services immediately.</li>
	<li>Follow the ABCs. Ensure the airways are open, and the person&rsquo;s breathing and circulation are intact.</li>
	<li>Move the person to a cool, shady area or an air-conditioned environment.</li>
	<li>Remove any unnecessary or tight clothing.</li>
	<li>Spray the person with cool water.</li>
	<li>Sponge the person with a wet cloth.</li>
	<li>Fan the person to help them sweat and promote evaporation.</li>
	<li>Place ice packs under the person&rsquo;s neck, groin, and armpits.</li>
	<li>Immerse the person in cold water.</li>
	<li>If the person can drink, offer them cool liquids, like sports drinks.</li>
	<li>Monitor body temperature with a thermometer.</li>
	<li>In cases of seizures, the patient should be moved away from injury-causing objects and not given anything by mouth.</li>
	<li>Unconscious patients should be moved to their side to avoid choking. 
	&nbsp;</li>
</ol>

The cooling efforts are continued till the body temperature decreases to 38.3-38.8 &deg;C (101-102 &deg;F).

&nbsp;

<h5>If My Child Has A Heat Stroke, Can I Place Him/Her In A Tub Of Ice Water?</h5>

Ice or cold water immersion should not be used in children and older adults. Evaporative cooling is preferred as it does not interfere with monitoring or resuscitation measures and achieves rapid cooling. 
&nbsp;

<h5>Can Medications Help Treat A Heat Stroke?</h5>

Medications usually have no role in the treatment of heat stroke. Antipyretics, such as acetaminophen, are strictly contraindicated as they can cause liver or kidney injury.

In the past, doctors have used dantrolene in the treatment of heat stroke, but research has shown it to be ineffective. Furthermore, benzodiazepines are often used to control the shivering associated with cooling methods. However, there are no universal recommendations outlining its use in heat stroke patients. 
&nbsp;

<h5>How Long Does It Take To Recover From A Heat Stroke?</h5>

Recovery typically depends on the severity of the heat stroke and whether any organ damage has taken place. Initial recovery takes 1-2 days in the hospital, while complete recovery can take anywhere from 2 months to a year. During recovery, it is advised to avoid physical activity and any heat exposure for at least a week. The doctor should be consulted before returning to normal activities.

Moreover, people who have had a heat stroke are at risk of developing it again. Therefore, it is important to take precautionary measures, especially during heatwaves. 
&nbsp;

<h5>What Are The Risk Factors Of A Heat Stroke?</h5>

The following factors may contribute to or increase the risk of a heat stroke:

<ul>
	<li>Dehydration</li>
	<li>Male gender</li>
	<li>Age (Infants and the elderly are most at risk)</li>
	<li>Wearing heavy clothing in hot weather</li>
	<li>Obesity</li>
	<li>Deprived sleep</li>
	<li>History of a heat stroke</li>
	<li>Certain medications, e.g., diuretics, antidiarrheals, calcium channel blockers, antihistamines, or laxatives</li>
	<li>Existing health conditions, such as diabetes</li>
	<li>Drinking alcohol</li>
	<li>Illicit drug use 
	&nbsp;</li>
</ul>

<h5>Can A Heat Stroke Have Long-Term Effects?</h5>

If left untreated, people with heat stroke can progress to a coma. The elevated body temperature can also lead to the following complications:

<ul>
	<li>Rhabdomyolysis</li>
	<li>Kidney failure</li>
	<li>Brain swelling</li>
	<li>Acute respiratory distress syndrome (ARDS)</li>
	<li>Liver failure</li>
	<li>Metabolic dysfunction</li>
	<li>Nerve damage</li>
	<li>Circulatory problems 
	&nbsp;</li>
</ul>

<h5>How Can I Protect Myself From A Heat Stroke?</h5>

You can prevent heat stroke by taking the following steps:

<ul>
	<li>When going outdoors, wear loose, light-colored clothing, and a hat.</li>
	<li>Ensure proper hydration by drinking eight glasses of fluids (e.g., water, fruit juice, vegetable juice) or more per day.</li>
	<li>Increase fluid intake when exercising or working outdoors in hot conditions.</li>
	<li>Exercise or work during the cooler hours of the day.</li>
	<li>Use sunscreen when going out in the sun.</li>
	<li>Avoid drinks containing caffeine or alcohol, as they can cause dehydration.</li>
	<li>Try to stay indoors during a heatwave.</li>
	<li>Close windows and draw curtains during the afternoon or hotter parts of the day.</li>
	<li>Keep cool by staying in an air-conditioned room or under a fan. In case there is no electricity, place a wet cloth or an ice pack around the neck or wrists to stay cool.</li>
</ul>

&nbsp;

[1] The Lancet. Health in a world of extreme heat. The Lancet. 2021;398(10301):641. doi:10.1016/s0140-6736(21)01860-2

[2] Heatwaves. World Health Organization.

[3] Heat and Health. World Health Organization.

[4] Razzak JA, Agrawal P, Chand Z, Quraishy S, Ghaffar A, Hyder AA. Impact of community education on heat-related health outcomes and heat literacy among low-income communities in Karachi, Pakistan: randomized controlled trial. BMJ Glob Health. 2022;7(1):e006845. doi:10.1136/bmjgh-2021-006845

[5] Khan UR, Ahmed N, Naeem R, et al. Heat Emergencies: Perceptions and Practices of Community Members and Emergency Department Healthcare Providers in Karachi, Pakistan: A Qualitative Study. Int J Environ Res Public Health. 2021;18(9):4736. Published 2021 Apr 29. doi:10.3390/ijerph18094736

[6] Robert S Helman M. Heat stroke. Practice Essentials, Pathophysiology, Etiology.

Should You Act FAST Or FASTER?

A stroke is also referred to as a brain attack, as it drastically impacts the integral component of the central nervous system. It occurs when the blood flow to the brain is blocked. The dreadful and urgent crisis requires immediate medical attention<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

The brain is a complex and demanding organ that needs a consistent flow of oxygen and supplements to function effectively. However, if for any reason that blood supply is threatened, even for a brief moment, it can lead to irreparable harm. Just a brief interruption in the oxygen and blood supply can cause brain cells to die, resulting in severed synaptic connections. When the brain cells die, the brain&#39;s functioning is lost. The individual will most likely be unable to do things that are controlled by that particular brain region. Common symptoms include trouble walking, slurred speech, difficulty remembering things, loss of control over the bladder, and affected eating<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

Anyone can be a victim of a <a href="https://www.merisehat.pk/disease/stroke">stroke</a>. Being able to react quickly would only be helpful if an individual can recognize the <a href="https://www.merisehat.pk/disease/stroke">signs of a stroke</a>. Knowledge of the signs of a stroke can lead to timely life-saving interventions.&nbsp; 
&nbsp;

Reach out to the local emergency helpline when a person experiences the following<a href="#accordion">[2]</a>. 
&nbsp;

<ul>
	<li>Sudden weakness or a sensation of numbness in various body parts such as the face, arm, or leg. This peculiar feeling only lingers on one side of the body.</li>
	<li>Loss of speech or difficulty speaking leads to communication challenges as the patient barely understands what another person is saying and vice versa.</li>
	<li>Trouble adjusting to brightness and focusing vision might exacerbate to loss of vision in one or both eyes.</li>
	<li>Struggling to regain and maintain balance and posture. The lack of muscle coordination can also be accompanied by dizziness. Moreover, the lack of strength and coordination may lead to problems with walking, posture, and gait.</li>
	<li>Frequent and unknown causes of severe headaches, which might induce repetitive fainting spells, seizures, and loss of consciousness.&nbsp;</li>
	<li>Unaccounted nausea and periodic vomiting without being triggered by a viral illness or a stomach bug. 
	&nbsp;</li>
</ul>

If a person experiences the above symptoms, but for a shorter period, they may have undergone a transient ischemic attack (TIA). Symptoms of a transient ischemic attack (TIA) bear a significant resemblance and similarity to those of a stroke<a href="#accordion">[2]</a>. However, while TIA signs are frightful, they might be passing. They can keep going for a couple of moments or as long as 24 hours. Immediately call for clinical assistance if you are under the impression that somebody is having a TIA. It very well might be an indication that a stroke is going to happen. Be that as it may, not all TIAs are followed by a stroke<a href="#accordion">[2]</a>.

&nbsp;

Understanding First aid For Stroke

Considering how the symptoms of a stroke vary, nearby attendants or passersby may not witness all the signs and symptoms, and may perhaps not have a medical background to immediately recognize the impending calamity. Therefore, recent studies have deduced quicker ways to respond to stokes<a href="#accordion">[3]</a>. These include: 
&nbsp;

<ul>
	<li>
	<h5>Think FAST</h5>
	</li>
</ul>

The FAST system is based on the Cincinnati Prehospital Stroke Scale (CPSS). It aims to replace the primitive and difficult-to-remember 5 sudden warning signs of a stroke that were previously used to provide immediate medical attention to a stroke patient<a href="#accordion">[4]</a>. The medical acronym allows individuals to recognize characteristic signs of a stroke. It stands for: 
&nbsp;

F: Facial drooping or visible signs of facial weakness, especially on one side of the face. To confirm, ask the patient to pass a smile, and check if the smile is crooked or aligned as usual<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

A: Arm weakness refers to the loss of an individual&rsquo;s regular dexterity. Ask the suspected patient to raise both arms, and observe for signs of struggle or the gradual drooping of one arm<a href="#accordion">[5]</a>.&nbsp; 
&nbsp;

S: Speech is slurred. Stroke affects brain activity and may impact a person&rsquo;s coherence. Instruct the individual to repeat a few basic sentences to notice if the speech is slurred, or the patient appears to be in a disoriented stupor. A healthy individual will be able to utter with correct pronunciations<a href="#accordion">[5]</a>. 
&nbsp;

T: Time to get help. The last part of the acronym is for the attendant to respond as soon as they are done with the basic examination detailed above. If the affected person appears to have not cleared the checklist, then one should call for help<a href="#accordion">[5]</a>. 
&nbsp;

However, realistically speaking does the acronym make for a compelling and globally endorsed informational message? Studies argue that it seems to be more effective than the previously established five warning signs<a href="#accordion">[3]</a>. This can be viewed more logically through the lens of lucrative marketing, where any impressionable product or in this case slogan needs to abide by the 3 basic standards for delivering new messages out to individuals to guarantee that the message sticks and are remembered. These principles include the consistency of the message, its simplicity, and appropriate repetition<a href="#accordion">[3]</a>.&nbsp;With an acronym such as F.A.S.T, all three rules are followed. Therefore, it happens to be a unanimous and widely used system for stroke<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Act FASTER</h5>
	</li>
</ul>

The highly revered vascular neurologists at Beaumont Health have made a new acronym which is an aversion to the previously used FAST<a href="#accordion">[6]</a>. Called &lsquo;FASTER&rsquo;, the new acronym includes two extra, but key, stroke symptom indicators.&nbsp; 
&nbsp;

A detailed breakdown of the importance of each letter in the acronym is as follows<a href="#accordion">[6]</a>: 
&nbsp;

F: F is for the face. Like its predecessor, the F in FASTER is concerned with initial and sudden signs of facial drooping, especially on one side of the face. Any visible muscle weakness should be noted as a possible indicator of an impending stroke. To corroborate the initial hypothesis, it is always safer to ask the patient to smile to report any asymmetry. 
&nbsp;

A: A represents arms. Again, bearing resemblance to FAST, the A is to record any signs of arm weakness. This can be tested by asking the patient to raise both arms simultaneously. Count to ten; if during the countdown one arm starts to drop, then the patient should be immediately directed towards a hospital. 
&nbsp;

S: S stands for stability. Bringing a new symptom to be wary of, FASTER recognizes how muscle coordination is a clear indication of disorientation. Patients who may be suffering from a stroke may find it difficult to regain balance for walking or even standing steadily without feeling dizzy. If a person who&rsquo;s generally not clumsy has trouble standing without falling, then they should be taken to the nearest doctor for stroke treatment. 
&nbsp;

T: T is for talking. Contrary to FAST, the newer version of the acronym uses its fourth letter to remind individuals to observe signs of slurred speech, incoherence, and mumbling. Garbled, distorted, and muddled noises, with the inability to construct proper sentences, should be dealt with as an alarming factor for a stroke. The patient may also find it extremely difficult to understand the noises surrounding them. Therefore, it is suggested to ask them to repeat simple sentences. 
&nbsp;

E: E draws attention to eyes. The new additional letter is included for individuals to notice eye activity and pupil movement. Patients suffering from a stroke may have their vision impaired in one or even both eyes. 
&nbsp;

R: R is important to react. This calls for help for the patient. If someone observes the symptoms of a stroke in a nearby individual, they should call an ambulance. 
&nbsp;

The unexpected lack of coordination and potentially impaired vision are two very important, and often conspicuous, outcomes of a stroke. Therefore, their addition to the new acronym is crucial for stroke treatment. Recognizing symptoms and responding rapidly guarantees early diagnosis and admittance to the emergency clinic for evaluation of potential stroke treatment<a href="#accordion">[6]</a>. 
&nbsp;

It was discerning for Beaumont to add stability and eyes when doctors made FASTER because of the unexpected lack of coordination or potentially impaired vision, which are likewise significant and conspicuous unfortunate outcomes of a stroke.

&nbsp;

<h4>"Did you know that strokes can be prevented by controlling blood pressure? Stay on top of your blood pressure reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

Regardless of which abbreviation from the medical jargon is used, both help patients receive immediate and necessary medical treatment. And ensures that the stroke does not cause irreversible and irreparable harm to the brain or any other part of the body. However, among FAST and FASTER, the latter of the two is considered more reliable as it allows an analysis of all common symptoms of a stroke. 
&nbsp;

<ul><li>A stroke is the result of a momentary loss of oxygen and blood supply to the brain. It can occur at any time to anyone.</li><li>Symptoms of a stroke include facial drooping, muscle weakness, slurred speech, disorientation, nausea, and frequent dizziness.&nbsp;</li><li>A stroke can be identified through the common FAST and FASTER acronyms.</li></ul>

[1] .John Hopkins Medicine. (2022). Stroke. Retrieved from John Hopkins Medicine:

[2] Beckerman, J. (2022, March 9). Stroke Signs and Symptoms. Retrieved from WebMD:

[3] Hodgson, C. S. (2008). To FAST or not to FAST? Stroke, Volume 38, Issue 10, 2631-2632.

[4] Stroke symptoms.

[5] Williams, S. (2021, May 11). B.E.F.A.S.T to spot a stroke. Retrieved from University Health:

[6] Beaumont Comprehensive Stroke Center. (2022). Stroke Symptoms: From FAST to FASTER.

Did you know that your blood type has a significant say in your susceptibility to <a href="https://www.merisehat.pk/disease/stroke">stroke</a>? Well, yes that&#39;s true, and, as surprising as it may sound, recent research has proven that individuals with type A blood group have a 16% higher risk of early-onset stroke, whereas individuals with blood type O have a 12% reduced risk of early onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

A study was conducted and data was collected from 48 genetic studies on the incidence of ischemic stroke in the adult population (aged 18-59 years). Ischemic stroke is caused by a clot in the blood vessel supplying the brain, thus, disrupting the blood flow to the brain tissue. The study revolved around 17,000 patients who have had a stroke in the past and 600,000 healthy individuals as controls who had no previous history of stroke 
.&nbsp;

The purpose of the study was to determine the genetic causes behind stroke since it was not known earlier and the results showed a significant correlation between an individual&#39;s blood type and the risk of early-onset stroke<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Understanding the Association Between Blood Groups and Risk of a Stroke

It is imperative to know about the different blood groups before discussing their linkage with stroke. 4 blood groups are known to exist in humans &ndash; A, B, AB, and O. The blood group O is the commonest while the blood group AB is the rarest blood type. Individuals inherit their blood group from their parents<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

These blood groups are determined based on the presence of antigen (a protein) on the surface of our red blood cells.&nbsp; 
&nbsp;

<ul>
	<li>Type A: The A antigen is present on the surface of the red blood cell while the B antigen is present in the plasma.</li>
	<li>Type B: The B antigen is present on the surface of the red blood cell while the A antigen is present in the plasma.</li>
	<li>Type AB: Both A and B antigens are present on the surface of red blood cells and no antibody is present in the plasma.</li>
	<li>Type O: No antigen is present on the surface of the red blood cell; however, both A and B antigens are present in the plasma<a href="#accordion">[2]</a>. 
	&nbsp;</li>
</ul>

Individuals with blood type O are known as universal donors because they can donate blood to anyone, while individuals with blood type AB are known as universal recipients because they can receive any and all blood types<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

According to the study, early stroke is more common in individuals with type A blood and less common in individuals with type O blood as compared to individuals who have had late onset stroke and those who had no previous history of stroke. Moreover, individuals with type B blood group are more likely to have both early and late onset of strokes<a href="#accordion">[4]</a>. 
&nbsp;

Now, you might be wondering how serious a stroke is? So, let&#39;s take a look into what stroke is and how serious it can be.&nbsp; 
&nbsp;

Stroke is referred to as a medical emergency since it can result in lifelong disability if prompt medical actions aren&#39;t taken<a href="#accordion">[5]</a>. Strokes are mostly ischemic, but they can be hemorrhagic as well.&nbsp; 
&nbsp;

In an ischemic stroke, there is blockage in a blood vessel supplying the brain. This disruption in the blood flow starves the brain tissue of oxygen and consequently results in the death of brain cells.&nbsp; 
&nbsp;

Since the brain is the control center of the body, any damage to the brain results in long-term consequences. For instance, after a stroke, people may experience blindness and problems with speech and memory. Individuals may also develop paralysis on the side of the body that is contralateral (opposite) to the site of stroke. That is, if an individual had a stroke in the right side of their brain, then the left side of their body would be paralyzed<a href="#accordion">[2]</a>. 
&nbsp;

According to the Center of Disease Control and Prevention (CDC), every 40 seconds someone in the U.S. experiences a stroke and every 3.5 minutes someone dies because of it. It is regarded as one of the leading causes of mortality (death) in the U.S<a href="#accordion">[6]</a>.&nbsp; 
&nbsp;

Stroke may present as<a href="#accordion">[7]</a>:&nbsp; 
&nbsp;

<ul>
	<li>Sudden weakness in the face, arm, or leg&nbsp;</li>
	<li>Sudden numbness in face, arm, or leg&nbsp;</li>
	<li>Sudden blindness&nbsp;</li>
	<li>Sudden confusion&nbsp;</li>
	<li>Sudden difficulty with understanding speech</li>
	<li>Sudden trouble with speaking&nbsp;</li>
	<li>Sudden dizziness</li>
	<li>Sudden loss of balance&nbsp; 
	&nbsp;</li>
</ul>

<h5>What Is An Early And Late Onset Stroke?</h5>

Stroke that occurs in individuals younger than 60 years of age is known as early onset stroke, whereas stroke that happens after 60 years of age is late onset stroke.&nbsp; 
&nbsp;

<h5>How Does Type A Blood Increase The Risk Of Early Onset Stroke?</h5>

Type A blood group increases the risk of having early onset stroke by 16% while the risk of having a late onset stroke is estimated to be 5% in individuals with type A blood<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

Unfortunately, researchers don&#39;t have the answer as to why type A blood confers a higher risk of stroke in individuals less than 60 years of age, but it is believed that it has something to do with the clotting mechanism. There are studies that suggest that people with type A blood are slightly prone to developing blood clots in the leg &ndash; a condition known as deep vein thrombosis<a href="#accordion">[1]</a>. This signals towards the pro-clotting nature of type A blood group that paves way to the formation of other clotting-related diseases, including stroke<a href="#accordion">[1]</a>. 
&nbsp;

<h5>Should I worry If I Have Type A Blood?</h5>

Researchers emphasize that the risk associated with type A blood and early onset stroke is not that significant, hence, individuals with this blood type need not to worry about it nor do they need to engage in additional screening or medical testing. If you have Type A blood, you can simply take it as a reminder to be cautious and to take steps to manage any risk factors you might have. 
&nbsp;

Additionally, stroke risk doubles every decade after 55 years of age and CDC has warned about the risk of stroke increasing with age. Most strokes occur in individuals after 50 years of age, but it has been reported that early onset stroke incidences are increasing, too. Every 1 in 7 strokes happen in individuals aged between 15 and 49 years<a href="#accordion">[6]</a>. 
&nbsp;

Yes, strokes can be prevented. As a matter of fact, 80% of strokes are preventable<a href="#accordion">[6]</a>. 
&nbsp;

While you cannot alter your blood type or stop your age from progressing, there are certain risk factors of stroke that you can control through lifestyle modifications. To do so, you first need to know the modifiable risk factors for stroke. This include<a href="#accordion">[5]</a>:&nbsp; 
&nbsp;

<ul>
	<li><a href="https://www.merisehat.pk/disease/hypertension-57">Hypertension </a>(high blood pressure)&nbsp;</li>
	<li>High cholesterol levels</li>
	<li><a href="https://www.merisehat.pk/disease/diabetes-type-1-and-2">Diabetes mellitus</a>&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li><a href="https://www.merisehat.pk/disease/obesity">Obesity&nbsp;</a> 
	&nbsp;</li>
</ul>

Taking steps, such as quitting smoking and alcohol, incorporating exercise in your routine, managing your blood pressure and cholesterol levels, and eating a diet that is rich in fruits, vegetables and fibers can significantly reduce your stroke risk. 
&nbsp;

In a nutshell, even though blood type A is associated with increased risk of early onset stroke as proven by recent research, the risk for stroke is modest. Instead of worrying and finding ways to screen stroke, you should take it as a reason to be mindful about your health and work on other modifiable risk factors to reduce your chances of stroke.&nbsp; 
&nbsp;

<ul>
	<li>Stroke is a medical emergency that can result in life-long disability.&nbsp;</li>
	<li>Certain genetic factors, such as blood type, have been discovered through research to influence the risk of stroke.</li>
	<li>Blood type A is found to be associated with increased risk of early onset stroke, while individuals with blood type O are associated with decreased risk of early onset stroke.&nbsp;</li>
	<li>Early onset stroke occurs in individuals before the age of 60 years.&nbsp;</li>
	<li>The risk of stroke with blood type A is modest. Instead of getting involved in screening for stroke, individuals with blood type A should adopt healthier practices to manage the modifiable risk factors of stroke.&nbsp;</li>
</ul>

[1] Chang N.  Published 2022. Accessed September 23, 2022.

Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com. Accessed September 23, 2022. https://www.medicalnewstoday.com/articles/is-there-a-link-between-your-blood-type-and-risk-of-stroke. Published 2022.