Madeeha Syed

What to expect and how to hasten your recovery after delivering via a c-section

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What Is Cupping And Do You Need It?

Overview

Have you noticed those small, circular marks that celebrities flaunt these days? In malls, on red carpets, they&rsquo;re everywhere. What is it? Is it a cause for concern?&nbsp;

Well, they are a result of cupping therapy.&nbsp;

Cupping is a form of complementary therapy. It is believed that the suction it creates would enhance your body&#39;s energy flow and promote healing. 
&nbsp;

Cupping Treatment

Historical text referring to cupping therapy dates back to 1550 B.C. It has been a part of many ancient healing systems &ndash; Chinese, Tibetan, Korean, and Unani. Even the &ldquo;father of medicine&rdquo;, Hippocrates, wrote and compiled extensively on cupping procedures.&nbsp;

Nowadays, traditional Chinese medicine practitioners are known for using cupping therapy as a form of treatment. 
&nbsp;

The Chinese word for life force is Qi. Proponents of cupping believe the therapy is helpful in regulating the flow of Qi in the body. A lot of people also believe it balances out the negative and positive energy flow within the body. This balance is necessary to fight pathogens (illness causing microorganisms), increase blood flow, and <a href="https://merisehat.pk/article/natural-remedies-for-pain">reduce the level of pain</a>. 
&nbsp;

The process of cupping improves blood flow to the area where the cups are applied. This eases muscular tension, which, in turn, promotes cell repair and enhances general blood flow.&nbsp;

Additionally, cupping might support the development of new blood vessels and connective tissues.

Cups are frequently placed on the back, chest, abdomen, or legs. The most common site is back, though. For facial cupping, as the name suggests, the cups are placed on the face. 
&nbsp;

People use cupping as a supplementary type of treatment for a variety of symptoms and ailments:

<ul>
	<li>Neck and back pain</li>
	<li>Lowering cholesterol levels</li>
	<li>Knee and joint pains</li>
	<li>Improving immune system performance</li>
	<li>Chronic headaches 
	&nbsp;</li>
</ul>

The question here is how exactly cupping helps in treating these conditions? It is still unclear how sucking and drawing of blood under the skin could be this beneficial.&nbsp;

One study describes cupping as a complementary treatment and draws attention to how it deals with any disease-causing factors by simply restoring the body&rsquo;s energy flow and eventually improving blood circulation.

Actually, the cup is first heated with the herbs, alcohol, and paper placed within it. The heated cup is then placed on the skin upside down. The air inside the heated cup cools down. This creates a vacuum that pulls the skin and muscles up into the cup. As a result, changes in blood pressure causes the skin to turn red. 
&nbsp;

Unfortunately, despite the fact so much research has been carried out on cupping, no one seems to have come up with solid evidence to prove whether it actually works.&nbsp;

Back in 2015, an evaluation of the evidence discovered that cupping might help relieve chronic neck or back discomfort to some extent. Unfortunately, the quality of the research was insufficient to make definite conclusions.&nbsp;

In 2017, according to a study, cupping could increase the blood flow and stretch the underlying tissue.

Despite many competing theories, however, the effectiveness of cupping remains dubious. 
&nbsp;

Bottom Line

Cupping might be a useful supplemental treatment for a number of symptoms and illnesses, according to a growing body of research. However, more credible research is required to confirm the benefits of cupping.

Namwer Rao

Beat The Heat: What Happens When Heat, Sweat And Skin Collide

The summer months can be a fun time for outdoor activities and spending time with friends. But if you&rsquo;re prone to chafing or rashes, they may not be so enjoyable.&nbsp; 
&nbsp;

effect of heat on skin

Chafing and rashes are a common problem, especially during the summer months. The main cause of these annoying conditions is sweat. When your skin gets wet and rubs against itself or another surface, it can become inflamed and tender to the touch.

When you put on clothes that are too tight or made with synthetic materials like lycra, they can act like a glue trap for sweat, which contributes to chafing and rashes by trapping moisture between your skin and clothing. Sweat can also irritate sensitive skin as it evaporates off of your body &mdash; this is why you should always wear breathable fabrics such as cotton when exercising outdoors or in an air-conditioned room on hot days. 
&nbsp;

Sweat is the main cause of chafing, but it&rsquo;s not the only one. Friction is also a major factor in causing irritation and soreness that can make you unable to enjoy your day-to-day activities. 
&nbsp;

There&rsquo;s a rash for every occasion:

<ul>
	<li>Boob Rash: It&rsquo;s the bane of many a lady&rsquo;s existence, especially during sweaty summers and strenuous workouts. The friction of your bra rubbing against your skin causes irritation, which leads to red bumps and rashes.</li>
	<li>Thigh Chafing: Similar to boob rash but on your legs instead of chest, thigh chafing is caused by the constant rubbing of clothing against bare skin as you walk or run around all day long &mdash; especially if you&rsquo;re wearing shorts or skirts!</li>
	<li>Nipple Chafing: This is one particular type of nipple rash that can happen during pregnancy or breastfeeding when there&rsquo;s excess fluid flowing through those delicate glands in addition to sweat from exercise! 
	&nbsp;</li>
</ul>

Sweat itself doesn&rsquo;t cause chafing, but it can make things worse. If your skin is already sensitive to friction or susceptible to rashes and blisters, then sweat will make it even more sensitive.

&nbsp;

When you&rsquo;re trying to keep cool in the summer heat, it&rsquo;s easy to over-hydrate and end up with a gush of liquid dripping down your back as you walk around. When that happens, you might start thinking that all this sweat must be causing me some discomfort &mdash; but in reality, we just need a little bit more salt!

&nbsp;

These rashes could cause serious health problems if left untreated

Cuts and scrapes can lead to infections. Chafing can lead to blisters, and, in turn, those blisters can become infected.

Infections in the skin can cause damage that leaves you vulnerable to infection by other germs and even viruses like <a href="https://merisehat.pk/disease/hepatitis-b-113">Hepatitis B</a> and C or <a href="https://merisehat.pk/disease/hiv-61">HIV</a>, which can be fatal if left untreated.

To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw.

A rash is an uncomfortable, and sometimes painful, skin condition that can occur due to a variety of reasons. The most common cause of rashes is sweat and friction. To avoid these rashes in the first place, you need to keep the skin dry, reduce friction and stop rubbing your skin raw. 
&nbsp;

Avoiding Sweat And Friction: Using a lubricant between two surfaces that rub together without causing much wear (skin against fabric) will help prevent chafing and blisters caused by sweating under heavy loads or tight-fitting clothing like cycling jerseys or hiking shorts. Silicone-based lubricants work well because they stay slick longer than water-based lubricants; however, they&rsquo;re not as safe for use around water because silicone doesn&rsquo;t absorb into fabrics so it can be slippery when wet!

Keeping Skin Dry: You should apply sunscreen before you go outside since sun exposure makes you more susceptible to getting burned &mdash; especially if there isn&rsquo;t any breeze to cool down your body temperature during long runs outdoors (or even short ones). 
A good rule of thumb is that if it&rsquo;s hot outside but feels less humid than usual then put on sunscreen anyway just in case because humid conditions make it harder for sweat from evaporating off our bodies which means we need more frequent hydration breaks during long workouts outside in summer heat waves! 
Don&rsquo;t forget about protecting yourself against UV rays too because even though clouds may block direct sunlight from reaching us directly down here on earth&rsquo;s surface &mdash; they don&rsquo;t block UV rays which come through holes in them called &ldquo;glare points.&rdquo; These glares points are responsible for generating many different kinds of reflections including glare reflection off surfaces such as pavements when walking along city streets. 
&nbsp;

The first rule of treating any skin condition is not to try to rub it off. The rubbing can make it worse, and you may introduce bacteria into the area, which could cause inflammation and infection. The best thing to do is keep the area dry by using talcum powder or a non-oily moisturizer with a high water-content like Vaseline or Petroleum Jelly. 
&nbsp;

<h4>&quot;Most rashes will clear up within a few days after you adopt prevention techniques that keep your skin dry and limit friction&quot; 
&nbsp;</h4>

If you&rsquo;re at risk of developing a rash, it&rsquo;s best to take the following precautions:

<ul>
	<li>Use a towel to dry off immediately after swimming or sweating.</li>
	<li>Apply a moisturizer with an SPF of at least 30 every morning and reapply in the afternoon if you plan on being outside for longer than an hour.</li>
	<li>If you are wearing clothes that rub against your skin, use an anti-chafing product such as zinc oxide paste until your rash clears up and then switch to a heavier formula like dimethicone which will protect against future rashes. You may also want to try tea tree oil or aloe vera gel if those options appeal more strongly than using medication prescribed by a healthcare professional. 
	&nbsp;</li>
</ul>

The best way to prevent chafing while running is to take steps before your run. You can start with a good exfoliating shower and apply some body lotion or cream to dry areas. Then, wear the right clothes. Make sure they fit you well and aren&rsquo;t too tight or too loose where it counts &mdash; the thighs and crotch area are particularly susceptible to chafing.

Lastly, you should use products like Vaseline on dry spots before you hit the road. These products will help protect against rubbing and chafing during exercise so that when it&rsquo;s time for your next long run, all of those miles won&#39;t be spent dealing with embarrassing rashes instead of crossing finish lines! However, this is not just limited to the girlies who are active. Even when you are going on with your daily life, you can always incorporate these hacks to make summers more comfortable for you. 
&nbsp;

We know that dealing with these rashes can be frustrating. We want you to know that there is hope, though! They are all preventable, and it&rsquo;s not just about following the rules of hygiene either. You need to keep your skin dry and limit friction by wearing loose clothing and changing out of sweaty clothes as soon as possible after an activity ends. If you find yourself with a rash or chafing, don&rsquo;t try rubbing it off&mdash;that will only make things worse! Instead let your body heal naturally by keeping the affected area clean and dry until the symptoms subside on their own.

Umna Salah

Medilink Consultant clinic

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Saad Ullah Siddiqui

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Time For Men To Share The Burden Of Pregnancy

Introduction

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

Understanding Male Contraceptives

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

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

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

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

Conclusion

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

Key Points

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

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

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

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

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

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

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

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

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

Nimrah H. Sattar

Iqra Mazhar

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Is Keto Diet Safe For People With Diabetes?

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

Understanding The Advantages Of Keto Diet In Diabetes

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

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

<h4>"Good diabetes control can increase your heart rate variability. Head on over to the <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> and get your reading now!"</h4><h4> </h4>

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

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

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

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

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

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

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

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

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

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

Staff Writer

How To Heal From Grief?

Grief is a natural reaction to any kind of loss. It&rsquo;s something we all experience, but the way it manifests itself varies from person to person. Some people are able to move on quickly, while others find it harder to heal. In this article I&rsquo;ll explain how the stages of grief work and give some tips on how you can help yourself or a loved one through their grieving process. 
&nbsp;

Tips to Heal From Grief

Denial is a defense mechanism. It&rsquo;s a way to protect yourself from the pain of loss, or at least postpone facing it. You may have heard of denial as something that happens during the grieving process, but this isn&rsquo;t quite accurate. Denial doesn&rsquo;t necessarily kick in once someone has died; it can also be an immediate coping mechanism for people who aren&rsquo;t yet ready to admit their loved one is gone.

Denial helps shield you from the <a href="https://merisehat.pk/article/natural-remedies-for-pain">pain</a> of grief by avoiding reality and hiding from feelings you&rsquo;d rather not experience (such as anger and sadness). 
&nbsp;

Anger is a natural and healthy reaction to loss. Anger can help you express your feelings, release negative emotions and show others that you are upset or hurt by what happened.

However, while it is normal to feel angry after the loss of someone or something close to you, there are some things that should be avoided when expressing anger:

Don&rsquo;t direct your anger at anyone else. You may have some pent-up frustrations with people associated with the loss (e.g., family members or friends), but directing your rage toward them will only make things worse for everyone involved.&nbsp;

Directing your anger inward instead by staying home from work or school can also be harmful because it could prevent you from accomplishing goals (such as getting back into college).&nbsp;

It&rsquo;s best not to let anger boil over into lashing out at others unnecessarily; instead, find other outlets for releasing negative emotion such as yoga classes or therapy sessions with a counsellor who specialises in grief counselling. 
&nbsp;

When you are bargaining, you are essentially trying to make the best of an intolerable situation. You may start thinking that there is something you could have done differently or something that will help save your loved one&rsquo;s life. You might even try to bargain with God or a higher power in order to get them back again.

For example, you might think, &ldquo;If only I had spent more time with my husband before he died!&rdquo;, &ldquo;If only I hadn&rsquo;t taken so long buying groceries!&rdquo; or &ldquo;If only I had remembered to call him earlier!&rdquo;&nbsp;

While these thoughts and feelings aren&rsquo;t necessarily accurate (the reality is that death or breakups happens when they happen), they can still be helpful if they allow you some peace of mind and perspective during this difficult time of grieving. 
&nbsp;

Bargaining can also manifest itself as guilt &mdash; for instance, if someone close dies from an illness but another person survives the same illness, there may be some sense that it should&rsquo;ve been the other way around, even though there&rsquo;s no real reason for this feeling beyond just being human (and overthinking things).&nbsp;

If this sounds like how you&rsquo;re feeling right now &mdash; like maybe there was something else r someone else who could&rsquo;ve helped prevent their death (for example) &mdash; it might be helpful for friends and family members who care about your well-being (or just want their own questions answered) not dismiss these thoughts or feelings outright by saying things like, &ldquo;It wasn&rsquo;t your fault&rdquo; or &ldquo;Of course everything would have been different if only...&rdquo;&nbsp;

Instead, they could take those questions seriously while acknowledging how hard they must be on whoever lost their loved ones without belittling them at all &mdash; because sometimes just recognising how painful it must feel helps us move forward without letting ourselves stay stuck in grief forever.&rdquo; 
&nbsp;

The final stage of grief is sadness and acceptance. The loss of someone leaves you feeling helpless. There will be times when you are too distracted by the world and work to think about it but at times, it is common to have a depressive episode and completely lose your pace or focus.&nbsp;

People who are unable to cope and accept tend to go into depression at this stage and numb themselves towards the outside world. The only way to avoid suffering from this illness is to deal with your loss and come to terms with it mentally. This requires your maximum input as your experience life without the person, the need for acceptance and doing things differently now. The only way is the way forward.&nbsp; 
&nbsp;

The stages of grief are not a checklist, nor are they rules to follow. They aren&rsquo;t even in the same order for everyone.

The five stages &mdash; denial, anger, bargaining, sadness and acceptance &mdash; are merely a general guide to help you understand what your loved one might be experiencing during their time of grieving. However, everyone grieves differently and no two people will go through all five stages at the same time or in the same way. It&rsquo;s important to remember that every person needs different kinds of support during times like these: some may need lots of love and affection as they work through their feelings; others will want space from others so they can take care of themselves first before reaching out for support later on. 
&nbsp;

The most important thing that needs to be acknowledged is that there is no shortcut to coping with grief. You cannot skip the stages. However, you can make it easy for yourself to handle your grief and speed up the process. Following are the steps that are age-old practices employed by people to help them cope:

<ul>
	<li>There are people around you who care about you, lean on them. Share your feelings with your friends and family. Hangout with them more to keep yourself distracted.</li>
	<li>Be acceptable for whatever support you are getting. Not many people know what to say or how to act around someone grieving, appreciate their efforts. They are doing it because they care.</li>
	<li>Religion has been a very strong catalyst for people struggling with grief. If you believe in one, resort to your faith. Praying can be very relaxing for the mind.</li>
	<li>A support group or therapy. Both allows you to talk about your experience, how it has affected you without getting a biased answer from the other side.&nbsp; 
	&nbsp;</li>
</ul>

Grief is a normal part of life and it can be hard to deal with. But remember, there are ways to cope with your feelings and move on from them. If you&rsquo;re struggling with grief or have lost someone close to you, remember that you&rsquo;re not alone. Reach out for help if needed, but don&rsquo;t forget that it may take time before things feel better again!

Ismail Munir

How Do I Boost My Iron Levels?

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

Understanding Ways To Treat Iron Deficiency Anemia

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

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

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

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

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

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

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

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

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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

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

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

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

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

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

Understanding The Correct OCP For Heart Patients

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

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

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

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

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

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

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

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

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

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

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

What Anti-Vaxxers Get Wrong About the Polio Vaccine

Polio is a thing of the past, right? You don&rsquo;t see it much in the news anymore and it&rsquo;s not something we really have to worry about. Well, anti-vaxxers would like you to think that this is true. But it isn&rsquo;t. Polio still exists today and, if you&rsquo;re not vaccinated against it, you could get polio or spread it to someone else who might die from it. It&rsquo;s important for everyone not just parents with children to know how vaccines work and why they&rsquo;re safe.&nbsp;

<div>&nbsp;</div>

Anti-Vaxxers  About  Polio Vaccine

The anti-vaccine movement is growing increasingly popular, despite the fact that many of its arguments are based on erroneous historical facts. Here are just a few:

<ul>
	<li>Vaccines aren&rsquo;t effective</li>
	<li>They do not cause infertility</li>
	<li>No, your government is not injecting you with nanochips to track you</li>
	<li><a href="https://merisehat.pk/disease/autism" target="_blank">They cause autism</a></li>
	<li>They&rsquo;re not necessary because polio hasn&rsquo;t been around for decades now</li>
</ul>

&nbsp;

It&rsquo;s important to remember that, as we speak, polio is still a problem in many countries. In fact, the World Health Organisation still refers to it as an &ldquo;endemic&rdquo; disease. Since 1988 , when the UN certified that polio had been eradicated in every country on Earth, there have been only 21 cases of wild poliovirus found globally: 16 in Somalia and five in Pakistan (the last case on this list occurred just this past September).

But while anti-vaxxers are right that vaccines can&rsquo;t prevent all disease outbreaks, they&rsquo;re wrong about why we need them at all. Because the truth is this: vaccines aren&rsquo;t just useful for preventing one infectious illness, they&rsquo;re also useful for preventing other diseases from spreading by stopping people from getting sick with them too. That&rsquo;s why some people think of vaccines as a sort of &ldquo;immunity insurance&rdquo; against outbreaks rather than just something you need when you actually start showing symptoms of an illness like measles or mumps (which are both very contagious). 
&nbsp;

Thimerosal is a preservative that prevents the growth of harmful bacteria in vaccines. It has been used since the 1930s, and thimerosal-free vaccines have been available for several years. There is absolutely no scientific evidence that links thimerosal to any health problems. In fact, all credible studies have shown just the opposite. In fact, it&rsquo;s safe to use as a preservative in food items, too!

Although many anti-vaxxers will try to tell you otherwise, thimerosal isn&rsquo;t dangerous or toxic at all. It&rsquo;s just an additive used by doctors and manufacturers alike in order to make sure our vaccinations remain effective while they&#39;re being stored and transported around the world!

<div>&nbsp;</div>

It&rsquo;s important to note that the polio vaccine does not cause cancer. Nor does it cause autism, any other brain defect, autoimmune disease, or death. The idea that vaccines are some kind of hoax like climate change denialism or flat-Earth-ism is a conspiracy theory with no basis in reality. We know this because there is plenty of evidence to prove that vaccines work and are safe for children (and adults). 
&nbsp;

Vaccines Are Safe

Polio Vaccine Is Important, Polio Vaccine Is Safe: You may be thinking that anti-vaxxers are a bunch of crazy people, but there&rsquo;s actually a lot to like about them. They&rsquo;re confident in their beliefs and not afraid to stand up for what they believe in. They&rsquo;re also highly educated, which makes them more likely than others to be able to articulate their beliefs effectively.

What anti-vaxxers get wrong about polio vaccines is that it&rsquo;s not just one type of vaccine; it&#39;s two types: oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The OPV is commonly used in Pakistan due to its ease of administration. The oral polio vaccine also eradicates the need for the presence of a healthcare professional and highly sterile equipment. This has allowed Pakistan to conduct vaccinations on a mass level. Whereas the IPV on the other hand, requires the presence of proper healthcare workers, sterile equipment and multiple doses. IPV is far more effective than OPV but since we are on a mission to completely eradicate polio from the face of earth, whatever vaccine you can get your hands on, works.&nbsp;

Many countries stopped using OPVs long ago because they discovered that although it could prevent children from getting paralysed by wild versions of poliovirus, these viruses would still circulate around the community throughout childhood &mdash; which meant other kids might get infected anyway! The risk/benefit ratio was no longer proportionate. 
&nbsp;

I hope that this has helped to clear up some of the misconceptions about polio vaccines. It is important to note that the polio vaccine is not a one-size-fits-all approach, and there are many factors involved in deciding whether or not you should receive it. However, these arguments do not mean that anti-vaxxers are wrong about everything: they are right in their belief that public health decisions should be made on the basis of science rather than fear mongering.&nbsp;

How An Over-Prescription Of Antibiotics Affects Your Immune System

The ground-breaking discovery of the first antibiotic penicillin changed the fate of medical science forever. The diseases people were losing their lives over were now only a minor setback. Back then, however, we could not have imagined that our very own invention could turn on us.&nbsp; 
&nbsp;

Effect of Antibiotics

There are many kinds of microbes (bacteria, fungi, viruses etc.) that attack the human body and can be eradicated by using antimicrobial agents. Antibiotics are antimicrobial agents prescribed for bacterial infections, the most common ones being Urinary Tract Infections (UTIs), strep throat, <a href="https://merisehat.pk/disease/pneumonia">pneumonia</a>, tuberculosis, cholera etc.

Antibiotics can be naturally occurring (made by other microorganisms) such as penicilin or synthetic such as sulfonamides. Much of the progress medical science has made, surgeries for instance, can be traced back to our ability to control infections and their deleterious impact. Infections went from being the top three causes of mortality back in the 1900s to being something we now take for granted.&nbsp; 
&nbsp;

Many doctors, especially in the third-world countries, don&rsquo;t think twice before writing you a quick prescription of metronidazole, a common antibiotic given for many ordinary infections, mostly for an ailment as little as an upset stomach.&nbsp;

Some stats report that around 47 million doctors worldwide prescribe antibiotics for absolutely no reason.&nbsp;

On the other hand, these maladies are so common and the drugs so easily available and effective that some people don&rsquo;t even bother going to the doctor for an opinion and will end up taking the antibiotic prescribed by the internet at home. This casual consumption of antibiotics has led to the development of antibiotic resistance.&nbsp;

The use of antibiotics doesn&rsquo;t extend to just medical illnesses, but they are also used in agriculture and livestock. 
&nbsp;

This is when the bacteria evolve to resist the impact of antibiotics. Once that happens, patients then need stronger antibiotics and eventually even those stop working.&nbsp;

There are several reasons behind this, some of which are:&nbsp;

<ul>
	<li>The over-prescription of antibiotics. This includes both misuse and overuse of the drugs.&nbsp;</li>
	<li>Patients not completing their antibiotic course as soon as get some see relief in their symptoms.&nbsp;</li>
	<li>Excessive usage in livestock and farming.&nbsp;</li>
	<li>Lack of infection control in hospitals.&nbsp;</li>
	<li>Poor hygiene and sanitation efforts.</li>
</ul>

No wonder then that antibiotic resistance has been called &ldquo;the greatest public health challenge of our time&rdquo; by several healthcare regulatory bodies such as WHO and the CDC.&nbsp; 
&nbsp;

A study published in the Lancet way back in 2013 claimed that we were already, &ldquo;at the dawn of a post-antibiotic era&rdquo;. This is a threat to food security as well. We are at a point where common diseases such as tuberculosis and salmonella etc. are harder to treat than before. This has also added burden to the healthcare system given that we now have longer hospital stays, higher costs of treatment and increased mortality.&nbsp; 
&nbsp;

Think of our immune system as the security guards of our body. It not only destroys any foreign body or pathogen that might harm us but also memorises these invaders and will recognise and destroy them if they detect them. The function of antibiotics is to provide support to our immune system.&nbsp;

Antibiotics enter the body and coordinate with our immune system in order to control infections. What ends up happening many times, however, is that they will indiscriminately kill any bacteria they see since they can&rsquo;t distinguish between healthy and harmful bacteria. This way even helpful microbes in our body are eliminated that actually can help us fight some of the more harmful infections such as fungal infections.&nbsp; 
&nbsp;

These antibiotics also destroy the healthy gut microbes that help in running the machinery of our digestion smoothly. Once lost, our digestive system suffers immensely, our metabolism is ruined and even our mental health eventually suffers. There are also immune cells present in our gut that can&rsquo;t function normally anymore. This effect on our gut microbiome due to antibiotic consumption can also be irreversible.&nbsp;

Studies conducted in mice have shown that antibiotics were able to completely alter the natural biochemistry of their cells. Instead of helping the cells kill these bacteria, they were making the cells protect them.&nbsp; 
&nbsp;

One study found that the immune cells of these mice suffered at the hands of the antibiotics to an extent where they couldn&rsquo;t perform their normal function of killing the pathogens &mdash; which can be anything from bacteria to virus or fungi and protozoans.&nbsp;

This goes on to show that antibiotic drugs have the ability to adjust immune responses by directly acting on the cells of our immune system and overhauling the metabolic microenvironment of our body. In the absence of an appropriate protective response, all kinds of invaders can wreak havoc on the body, even the ones that would be least harmful under normal conditions.&nbsp;&nbsp; 
&nbsp;

The impact of the over-prescription of antibiotics is all kinds of new, more powerful diseases become an insurmountable issue for mankind to resolve. We have all been exposed to overuse of antibiotics in some way shape or form.

If you do end up with symptoms where the cause could be viral or bacterial and you aren&rsquo;t sure about it, schedule an appointment with your doctor and go through the necessary tests to confirm the cause. If and when prescribed antibiotics, make sure you complete the full course. Don&rsquo;t stop midway just because your symptoms have been alleviated. Maintaining better hygiene, vaccinating when needed and not demanding that your doctor prescribe you an antibiotic are some other measures you can take to protect your immune system.&nbsp;

Add probiotics to your food. These are foods such as curd, cheese, kombucha, cocoa, bananas, lentils, nuts, whole grains, beans, broccoli, peas, and berries are all great options to help restore gut bacteria.&nbsp;

Dr. Safia Mehmood

Humza Khizer

Baby Blues (Postpartum Depression): Is There A New Treatment?

The entire process of pregnancy is very rewarding, but what happens after you have delivered the baby? Your body that has gone through so many constant changes over the 9 months, reverses them all to get you back to normal. This process often leads to postpartum <a href="https://www.merisehat.pk/disease/depression">depression</a>.

About 11% of women in the United States suffer from postpartum depression (PPD).<a href="#accordion">[4]</a>&nbsp;PPD affects not just the life of the mother but also the infant. If left untreated, it can get worse and affect your spouse or other people close to you. So far, the treatment used for PPD has been very generic; similar to that of major depressive episode (MDE) consisting of conventional antidepressants like SSRIs, benzodiazepines, and tricyclic antidepressants. FDA has recently approved the first-ever drug targeted toward treating postpartum depression. 
&nbsp;

Understanding The Latest Treatment For Postpartum Depression

Postpartum depression is best explained as a worsened form of postpartum blues or baby blues. Baby blues are experienced a few days after delivery. Some new moms, however, experience a much more severe case of baby blues that can be classified as postpartum depression and it can go on for over a year.<a href="#accordion">[8]</a>&nbsp;PPD is characterized by:

<ul>
	<li>Feeling depressed and low</li>
	<li>Sleeping too little or too much</li>
	<li>Feeling tired all the time</li>
	<li>Doubting yourself as a mother</li>
	<li>Thinking that you do not want the baby</li>
	<li>Excessive crying</li>
	<li>Loss of appetite</li>
	<li>Anxiety and panic attacks&nbsp;</li>
	<li>Thoughts of harming yourself or the baby</li>
	<li>Unable to think clearly or make the right decisions</li>
	<li>Increased anger and irritability</li>
	<li>Overall reduced interest in everything</li>
</ul>

If you or anyone that you know are facing any of these symptoms, immediately contact your physician and get yourself screened through the Edinburg Postnatal Depression Scale (EPDS). It is one of the most common and quickest screening tools with high accuracy and allows your physician to assess the situation better through the score.&nbsp; 
&nbsp;

A lot of factors contribute to postpartum depression.The biggest factor that is not only responsible for PPD but also for the baby blues is the drastic change in hormones. During pregnancy, your estrogen and progesterone levels are very high. As soon as the baby is delivered, these levels are dropped drastically.

Since estrogen is directly linked to increasing serotonin levels in our brain&nbsp;and progesterone is known for stimulating dopamine release, the decrease in the production of these hormones coupled with some underlying mental issues or previous history of depression or anxiety becomes the most common and the biggest cause of PPD.<a href="#accordion">[2][3][7]</a> 
&nbsp;

While screening of postpartum depression can be done by several tools that are used for Major Depressive Episodes (MDE), the most universally acceptable tool targeted especially for PPD is Edinburgh Postnatal Depression Scale or EDPS. EDPS is a 10-item questionnaire with a response score of 0 to 3. If the total score is over 12, then there is a need for further in-depth assessment of the situation and severity of the condition.&nbsp;

PPD is best diagnosed by your medical practitioner through regular visits. Your doctor asks a series of questions every few days to assess your mental health and well-being. Another way to differentiate PPD from baby blues is to ensure that the patient has at least 3-5 of the symptoms that make up PPD. The generalized diagnostic criteria used for PPD are similar to the one used for Major Depressive Episode (MDE). Immediate attention is recommended to avoid any worsening of the symptoms and from transitioning of PPD to postpartum psychosis. 
&nbsp;

So far, the treatment of postpartum depression is similar to that of conventional major depressive disorder. Special attention is paid to the excretion of the drug and the concentration of the drug removed from the body through breast milk.

The following antidepressants are commonly used to treat postpartum depression due to their low levels of excretion in breast milk, making it safe for use if you are a breastfeeding mother:

<ul>
</ul>

<ul>
	<li>Fluoxetine</li>
	<li>Paroxetine</li>
	<li>Sertraline</li>
	<li>Bupropion</li>
	<li>Amitriptyline</li>
	<li>Doxepin</li>
	<li>Desipramine</li>
	<li>Tranylcypromine</li>
	<li>Trimipramine</li>
	<li>Desipramine</li>
	<li>Paroxetine</li>
	<li>Escitalopram</li>
</ul>

These antidepressants come with some common side effects that include nausea, vomiting, dizziness, sexual issues, diarrhea, blurry vision, weight gain, increased perspiration, etc.<a href="#accordion">[6]</a> 
&nbsp;

Brexanolone (under the brand name of Zulresso) got approved by the FDA as the first drug targeted toward PPD. Brexanolone is approved with a Risk Evaluation and Mitigation Strategy (REMS) which means that it is currently a controlled medicine available through a restricted distribution channel to carefully assess the conditions of the patients throughout the treatment. The program is currently known as Zulresso REMS Program.<a href="#accordion">[5]</a>&nbsp;Currently, to get Brexanolone administered to you for treating your PPD, you are required to enroll in the Zulresso REMS program.&nbsp; 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Mechanism Of Action</h5>
	</li>
</ul>

Brexanolone is a synthetic form of allopregnanolone. Allopregnanolone is a neurosteroid. Neuroactive steroids are a group of substances that change a receptor&rsquo;s response to a stimulus by binding to them.<a href="#accordion">[4]</a>&nbsp;Allopregnanolone is best understood as a metabolite of progesterone, which is a GABA-A receptor agonist. This means that progesterone is responsible for increasing GABA functions.

The exact mechanism of the drug and of allopregnanolone is still unknown. Their enhancement of the functions of GABA (Gamma-aminobutyric acid) means that it will inhibit neuronal excitability by blocking messages that are sent to our nervous system with the help of certain stimuli. This not only aids in dealing with depressive triggers but also helps with anxiety.<a href="#accordion">[1]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5>Dosage And Administration</h5>
	</li>
</ul>

Zulresso is administered intravenously. The dosage is determined by your doctor based on your weight and other factors. The drug is administered over a period of 2.5 days or 60 hours and requires constant monitoring due to the risk of unconsciousness.<a href="#accordion">[5]</a> 
&nbsp;

<ul dir="ltr">
	<li>
	<h5 dir="ltr">Adverse Effects</h5>
	</li>
</ul>

Since the drug is relatively new, there are a limited number of side effects reported so far. They include:

<ul>
	<li>Dry mouth</li>
	<li>Dizziness</li>
	<li>Flushed skin</li>
	<li>Losing consciousness</li>
</ul>

<h5 dir="ltr">Important!</h5>

FDA has advised to stop the treatment of Zulresso if more serious side effects occur that may include the worsening of PPD and suicidal thoughts especially in women under the age of 25. 
&nbsp;

Current research suggests that brexanolone may interact with other CNS depressants like opioids and benzodiazepines and increase the severity of the adverse effects with regard to sedation. Alcohol consumption is also not advised due to similar reasons.

During the clinical trials, patients who were taking antidepressants also showed a more severe case of sedation as compared to the ones who did not or were a part of the placebo studies. 
&nbsp;

Considering the rapid onset of action with brexanolone especially when compared to the long-term treatments offered by conventional antidepressants, it is believed that brexanolone can take over the go-to therapy for PPD. However, a much more convenient way of administration would be through oral pills instead of I/V. There are still many concerns left that can only be answered through long-term data in a lesser restricted environment as opposed to a clinical trial setting.&nbsp; 
&nbsp;

<ul>
</ul>

<ul>
	<li>Current antidepressant therapies employed for PPD are based on&nbsp;long-term treatment.</li>
	<li>Brexanolone&rsquo;s onset of action is fast and has shown significant improvement in women of all ages suffering from PPD.</li>
	<li>Some women under the age of 25 were observed to experience severe side effects that even led to the worsening of their PPD.</li>
	<li>The drug is still under strict observation with the help of the REMS program.</li>
	<li>Administration coupled with the duration over which it has to be administered can make it difficult to commercialize as compared to drugs that are available in the form of oral pills.&nbsp;</li>
</ul>

[1] Allen B, Vespa PM. Antiseizure medications in critical care: An update. Curr Opin Crit Care. 2019;25(2):117-125

[2] ATP Science, 2021. HOW DOES PROGESTERONE CREATE A DOPAMINERGIC RESPONSE?. [Online] .

[3] Debra Fulghum Bruce, P., 2020. Postpartum Depression. [Online].

[4] Fala, L., 2019. Approved by the FDA Specifically for Postpartum Depression in Adults. [Online]

[5] Federal Drug Administration, 2019. FDA approves first treatment for post-partum depression. [Online]

[6] Fields, L., 2021. Which Antidepressants Treat Postpartum Depression?. [Online]

[7] Matthew Hoffman, M., 2021. Estrogen and Women's Emotions. [Online]

[8] Mayo Clinic, 2022. Postpartum depression. [Online]

You&rsquo;ve had your baby, and you&rsquo;re ready to go home. But before you can leave the hospital, there&rsquo;s some post-delivery care that you should take care of. In this article, we&rsquo;ll cover caesarean section (C-section) aftercare, including when it&rsquo;s time to take your catheter out and when you&#39;re ready for discharge from the hospital.

&nbsp;

recovery after  a c-section

After you have a C-section, this is the most critical period. You might feel tired, emotional, or anxious about your baby or yourself. Be sure to:&nbsp; 
&nbsp;

Make Time For Yourself And Rest

<ul>
	<li>Drink water</li>
	<li>Eat healthy</li>
	<li>Do light exercises only (such <a href="https://merisehat.pk/article/how-walking-helps-you-think-bette">as walking</a>) 
	&nbsp;</li>
</ul>

Take Care Of Your Wound And Stitches (If Applicable). You Need To

<ul>
	<li>Keep your wound clean and dry</li>
	<li>Wear comfortable maternity clothes that make it easy to get in and out of bed easily. Think loose fitting tops with leggings</li>
	<li>Avoid tight clothing, such as jeans or elastic waistbands, etc.</li>
	<li>Avoid heavy lifting or carrying heavy objects, etc.</li>
	<li>Speak to your doctor if you feel there is an infection developing in your wound area (this can happen on rare occasions) 
	 
	Ask for help from friends and family members when needed 
	&nbsp;</li>
</ul>

You might feel weak and sore for a while after your surgery. Don&#39;t worry, it is normal! Moving around would help you feel better and get the blood flowing through your body again. You might want to ask someone to help with the lifting and carrying of heavy objects until you&#39;ve fully recovered from your surgery. 
&nbsp;

Here are some useful tips for moving around:

<ul>
	<li>Care For Your Incision: You&rsquo;ll likely be in the hospital for 2-3 days. During that time, your healthcare team would ask you to do a few things to help ensure you&rsquo;re on the right track.</li>
	<li>Keep Your Incision Clean And Dry. If needed, use pads or bandages.&nbsp;</li>
	<li>Avoid Placing Hot Water Bottles or heating pads over your incision area because they could increase swelling and cause pain.</li>
	<li>Do Not Lift Anything That&rsquo;s Heavy during the first six weeks following your surgery. And even after that, if there&rsquo;s something you need to move, keep it light or, better yet, ask for help!</li>
	<li>Avoid Sexual Intercourse for six weeks after having a c-section (or until advised otherwise). This is to allow your uterus and vagina to heal well before you have another child vaginally.&nbsp;</li>
	<li>After The Period Of Six Months, you might resume intercourse as normal, but again, keep it light.&nbsp; 
	&nbsp;</li>
</ul>

<ul>
	<li>Stretching. It&rsquo;s a good idea to stretch your abdominal muscles and any other muscles that have been affected by the surgery.</li>
	<li>Breathing exercises. Use diaphragmatic breathing (also called belly breathing) to help relax your body and calm down after surgery.</li>
	<li>Pelvic floor exercises. They help strengthen the pelvic floor muscles and support the uterus, bladder, and bowel function after pregnancy. They also improve sexuality for both men and women, increase energy levels (and thus productivity) and reduce lower back pain or sciatica symptoms by improving posture or alignment through strengthening these core muscles</li>
	<li>Walking is a great form of exercise during recovery time because it helps strengthen leg muscles while also building endurance, which is helpful if you have had stitches put in place during surgery! 
	&nbsp;</li>
</ul>

<ul>
	<li>If you notice any unusual bleeding, such as a sudden gush of blood, or if the flow of your postpartum discharge changes in colour or consistency</li>
	<li>If you experience pain or discomfort</li>
	<li>If you have a fever (above 100&deg;F) 
	&nbsp;</li>
</ul>

Note: If you have questions about your recovery that aren&rsquo;t covered here, please ask your obstetrician or midwife.&nbsp;

If you&rsquo;re concerned about anything at all whether it&rsquo;s the way your belly feels after surgery (which, by the way, should feel like it has been run over by a truck!), whether there&rsquo;s an abnormal amount of blood coming out of your vagina, whether there are signs of infection (fever, chills), etc., go see someone right away.

It&rsquo;s better to err on the side of caution than risk an infection setting in that could lead to more problems later on down the road. And even though C-sections carry risks themselves (mainly related with anaesthesia), they&rsquo;re still safer than vaginal births when it comes down to actually giving birth itself. 
&nbsp;

Just sitting back and waiting for your body to heal would get you there. But you could be up and running and taking care of your baby with the right care in no time.&nbsp;

<ul>
	<li>Take It Easy. It might be tempting to jump right back into your normal routine, but try to cut yourself some slack. Your body needs time to heal after having been through an invasive procedure like surgery.</li>
	<li>Don&rsquo;t Be Afraid of taking pain medication, if necessary. If soreness is keeping you from getting quality rest at night, talk with your caregiver about options for relieving this discomfort. 
	&nbsp;</li>
</ul>

C-section recovery is a process. You might not feel like doing much, but it&rsquo;s important that you get up and move around as soon as possible. The more your body moves around, the sooner it will heal!