A. JABBAR DENTAL CLINIC KARACHI

Sadia Khan

ایک ٹارچ۔۔۔جو حاملہ خواتین نے بجھادینی ہے!

This article or video has been recorded by a subject / domain specialists with a proven track record of excellence in their area. 

Humza Khizer

Do Pregnant Women Need Booster Doses For Whooping Cough?

Introduction

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

Understanding The Need For Pertussis Vaccination In Pregnancy

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

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

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

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

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

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

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

Conclusion

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

Key Points

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

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

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

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

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

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

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

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

Staff Writer

Toxic Shock Syndrome – Frequently Asked Questions

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

Understanding FAQs About Toxic Shock Syndrome

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

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

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

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

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

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

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

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

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

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

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

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

[10] Toxic shock syndrome. Sepsis Alliance.

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

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

[13] Toxic shock syndrome. Mayo Clinic.

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

Neelam Asad

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Everything You Need To Know About Restless Leg Syndrome

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

Understanding Restless Leg Syndrome(RLS)

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

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

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

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

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

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

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

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

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

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

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

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

Online Consultation

Iqra Mazhar

Baby Loading

There&rsquo;s no doubt that pregnancy tests and ultrasounds are the only credible ways to determine whether or not you&#39;re pregnant. But urine or blood tests may give false positives and ultrasounds may take 17 days post ovulation to identify a healthy pregnancy.

&nbsp;

However, excited or anxious as you are at the mere idea of being pregnant, you&rsquo;re probably looking for additional indications and symptoms, too. A missed period (menses), smell sensitivity, weariness or fatigue, and of course, the infamous nausea and morning sickness all point towards pregnancy. In a recent study, 15.6% of participants even showed anxiety symptoms during early pregnancy<a href="#accordion">[1]</a>.&nbsp;

&nbsp;

As new parents, you&rsquo;ll come across a lot of hearsay about the topic. You need to stop reading too much into signs and let&rsquo;s just keep the fiction separate from the facts to begin with.&nbsp; 
&nbsp;

Understanding The Early Pregnancy

Your first week of pregnancy is determined by the date of your last menstrual cycle. It may seem strange because technically you weren&#39;t even pregnant at that point of time.

&nbsp;

The date of your last menstruation would also determine the estimated delivery date. For this reason, the first few weeks of your 40-week pregnancy might be symptom-free. 
&nbsp;

If you are expecting, you may experience the following signs and symptoms in the first few weeks:

<ul>
	<li>Minimal cramps and spotting</li>
	<li>Missed period</li>
	<li>Fatigue and weariness&nbsp;</li>
	<li>Nausea</li>
	<li>Painful breasts&nbsp;</li>
	<li>Bloating</li>
	<li>Frequent urination</li>
	<li>Traveling sickness</li>
	<li>Fluctuations in the mood&nbsp;</li>
	<li>Fluctuations in body temperature&nbsp; 
	&nbsp;</li>
</ul>

Other indicators may include:

<ul>
	<li>Elevated blood pressure</li>
	<li>Severe exhaustion and heartburn&nbsp;</li>
	<li>Increased heartbeat</li>
	<li>Changes in the breast and nipple</li>
	<li>Bouts of acne</li>
	<li>Noticeable increase in weight</li>
	<li>Pregnancy glow 
	&nbsp;</li>
</ul>

<h5>Implantation Bleeding&nbsp;</h5>

During the first 4 weeks, everything happens on a cellular level. The fertilized egg produces a blastocyst (a fluid-filled collection of cells) that will develop into the organs and body parts of the fetus.

&nbsp;

The blastocyst stays in the endometrium (the uterine lining) for about 10-14 days (week 4) following fertilization. This may result in implantation bleeding, which could be misinterpreted as a light period. This does not happen to everyone. If you experience it, you&rsquo;ll note that it coincides with the time you expect your period to start. 
&nbsp;

Here are a few indicators of implantation bleeding:

<ul>
	<li>Color</li>
</ul>

Each occurrence may be pink or light brown.

&nbsp;

<ul>
	<li>Bleeding</li>
</ul>

Implantation bleeding is typically a few drops of blood. It&#39;s frequently described as very light bleeding that never becomes a flow or requires the use of a pad or tampon.

&nbsp;

<ul>
	<li>Pain and other symptoms </li>
</ul>

The pain is usually milder than with regular menstrual cramps. It may be accompanied by nausea and frequent urination.

&nbsp;

<ul>
	<li>Duration</li>
</ul>

Implantation bleeding usually lasts less than 3 days and does not necessitate treatment. Occasionally, it will last only a few hours.

&nbsp;

NOTE: Although implantation bleeding is not usually a cause for concern, you should talk with a doctor if you experience symptoms such as: persistent bleeding, vaginal blood clots or bleeding that saturates a pad every 30 minutes.&nbsp; 
&nbsp;

<h5>Missed Period&nbsp;</h5>

Your placenta begins synthesizing human chorionic gonadotropin (hCG) shortly after implantation. This hormone assists the body in maintaining pregnancy. It also instructs the ovaries to stop releasing mature eggs (ovum) once a month.

&nbsp;

You are likely to miss your periods starting from 4 weeks post fertilization. If you usually have an irregular period, you should get a pregnancy test to confirm. The majority of home tests are capable of detecting hCG levels in your urine as soon as 8 days following a missed period. 
&nbsp;

<h5>Raised Body Temperature&nbsp;</h5>

An elevated body temperature might also be an indicator. It is also possible that exercise and hot weather can also cause your core temperature to rise more easily. Take precaution and drink plenty of liquids to keep yourself hydrated and maintain your body temperature. 
&nbsp;

<h5>Fatigue&nbsp;</h5>

Throughout pregnancy, you may experience fatigue and weariness at any stage, but it&rsquo;s a typical sign of early pregnancy. This is because your progesterone levels rise, which makes you feel drowsy.&nbsp; 
&nbsp;

<h5>Increased Heart Rate&nbsp;</h5>

During weeks 8-10, your heart will beat harder and more frequently. Palpitations and arrhythmias are common during pregnancy due to hormones. According to a 2016 study review, blood flow increases by 30-50% during pregnancy. This puts more strain on your heart<a href="#accordion">[2]</a>.

&nbsp;

If it was a planned pregnancy, you may have discussed any underlying cardiac problems with your medical team prior to it, right? If not, now is the time to talk about any conditions or treatment that may be required. 
&nbsp;

<h5>Early Changes To Breasts: Tenderness and&nbsp; Swelling&nbsp;</h5>

Breast modifications are possible between weeks 4 and 6. Hormone fluctuations are likely to cause sensitive and sore breasts, which will likely subside within a few weeks as your body adjusts to the hormones.

&nbsp;

Changes in the nipple and breast are also possible around week 11. Hormones continue to cause breast growth. The areola may darken and get bigger. 
&nbsp;

<h5>Changes in Mood&nbsp;</h5>

During pregnancy, your estrogen and progesterone levels are elevated. This increase may affect your mood, making you more emotional or reactive than usual. Mood swings are frequent during pregnancy and you&rsquo;ll often feel sadness or despair, irritation, anxiety, and euphoria.&nbsp; 
&nbsp;

<h5>Frequent Urination &amp; Incontinence&nbsp;</h5>

The amount of blood in the body increases during pregnancy. As a result, your kidneys process more fluid than usual, resulting in extra fluid in your bladder.

&nbsp;

Besides, hormones influence bladder health as well. You may find yourself racing to the restroom more often or accidentally leaking during pregnancy. 
&nbsp;

<h5>Bloating &amp; Constipation&nbsp;</h5>

Comparable to the signs of a menstrual period, bloating is a possibility during early pregnancy. This could be related to hormonal changes, which can also cause your digestive system to slow down. As a result, you may feel constipated and obstructed. Constipation can also promote abdominal bloating. 
&nbsp;

<h5>Morning Sickness, Nausea, &amp; Maybe Vomiting&nbsp;</h5>

Nausea and morning sickness commonly appear between weeks 4 and 6, peaking around week 9. Although it is referred to as morning sickness, it may occur at any time of day or night. The exact cause of nausea and morning sickness is uncertain; however, it is believed that hormones may play a role.

&nbsp;

Many women have mild to severe morning sickness throughout the first trimester of pregnancy. So, you should be mentally prepared for it to get more acute near the end of the first trimester. But, don&rsquo;t worry; it usually subsides as you reach the second trimester. 
&nbsp;

<h5>Smell Sensitivity &amp; Food Intolerance&nbsp;</h5>

Smell sensitivity is a common early pregnancy symptom that is primarily self-reported and has minimal scientific support. However, it may be notable because smell sensitivity triggers nausea and vomiting. It may also induce a severe intolerance to particular meals. According to 2017 research, women have an enhanced or diminished sense of smell during pregnancy<a href="#accordion">[3]</a>.&nbsp;

&nbsp;

Smell sensitivity is very common during the first and third trimesters. Only rarely will you feel as if your sense of smell has diminished; otherwise, it will be sharper and more pronounced throughout the pregnancy. You may find some scents less appealing even though they had never bothered you in the past.

&nbsp;

The good news is that the sense of smell returns to normal within 6-12 weeks after delivery. 
&nbsp;

Weight gain is a normal phenomenon near the end of the first trimester. You may gain between 1 and 4 pounds in the first several months. Calorie guidelines for early pregnancy remain similar to your regular diet, but will increase as the pregnancy advances. 
&nbsp;

<ul>
	<li>Pregnancy weight is frequently visible in the following areas in the latter stages:</li>
	<li>Breasts (approximately 1-3 pounds)&nbsp;</li>
	<li>Uterus (approximately 2 pounds)&nbsp;&nbsp;</li>
	<li>Placenta (approximately 1.5 pounds)</li>
	<li>The amniotic fluid (approximately 2 pounds)</li>
	<li>Increased blood and fluid volume (approximately 5-7 pounds)</li>
	<li>Fat (approximately 6- 8 pounds) 
	&nbsp;</li>
</ul>

<h5>Heartburn&nbsp;</h5>

Hormones can relax the valve that connects your stomach and esophagus. This permits stomach acid to escape, resulting in heartburn. 
&nbsp;

<h5>Pregnancy Skin: Glow OR Acne&nbsp;</h5>

Some individuals may begin to say that you have the &quot;pregnancy glow.&quot; It&rsquo;s the combination of an increased volume of blood and elevated hormone. Your skin appears flushed and glossy due to the increased activity of your body&#39;s oil glands. Be prepared; there&rsquo;s also the possibility of acne.

&nbsp;

<h5>Backache</h5>

More than one-third of pregnant women experience back pain. This is frequently related to ligament relaxation and a shift in posture caused by the growing pregnancy.&nbsp;

&nbsp;

Wearing flat-heeled shoes, utilizing seats with good back support, avoiding carrying heavy objects, and practicing light exercise can all help prevent back pain during pregnancy. Similarly, exercising in water, physiotherapy, and acupuncture can all help reduce back pain during pregnancy. 
&nbsp;

Pregnancy tests detect a specific level of human chorionic gonadotropin (hCG) in your urine. You can take a pregnancy test to check whether or not you are pregnant as soon as you miss your period. You get the most reliable results if you take it at least 1 week after you&#39;ve missed your period.&nbsp;

&nbsp;

While some tests claim to provide accurate results prior to a missed period, taking a test too soon can result in a false negative (the test says you&#39;re not pregnant, but you are).

&nbsp;

Additionally, your healthcare professional can take a blood sample to screen for pregnancy as early as 1 week before a missing period. 
&nbsp;

<h5>Tips</h5>

<ul>
	<li>
	If you obtain a negative result on a home pregnancy test, then it&rsquo;s recommended that you take another one 7 days later to double-check.
	</li>
	<li>Home pregnancy tests are 97% more accurate when used correctly at the right time, according to the National Institute of Child Health and Human Development in 2017<a href="#reference">4</a>. Home pregnancy tests vary in accuracy. Choose one that is known to be accurate.</li>
	<li>A blood test can typically detect pregnancy much earlier, but it must be performed in a medical professional&#39;s office or clinical setting.</li>
</ul>

&nbsp;

During early pregnancy, your body will undergo major changes. You may notice symptoms like nausea, breast discomfort, and of course, the missed period. If you suspect you&#39;re pregnant, a home pregnancy test is a good first step to take. These tests are typically available without a prescription at pharmacies and other shops.&nbsp;

&nbsp;

If you get a positive result, make an appointment with a doctor. They will examine you and run more tests to confirm your pregnancy. You can then begin a prenatal regimen to protect your and your fetus&#39; health. 
&nbsp;

<ul>
	<li>During early pregnancy, your body will undergo major changes.</li>
	<li>Missed periods, nausea, throwing up, breast modifications, exhaustion, fatigue, and frequent urination are all symptoms of a pregnancy.</li>
	<li>If you suspect you&#39;re pregnant, a home pregnancy test is a good first step to take.</li>
	<li>If you get a positive result, make an appointment with a doctor.</li>
	<li>Once your pregnancy is confirmed , your healthcare professional will guide you on the appropriate prenatal regimen.&nbsp;</li>
</ul>

[1] Rubertsson C, Hellström J, Cross M, Sydsjö G. Anxiety in early pregnancy: prevalence and contributing factors. Arch Womens Ment Health. 2014;17(3):221–8.

[2] Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy: review articles. Cardiovasc J Afr. 2016;27(2):89–94.

[3] Dikici O, Muluk NB, \cSahin E, Altintoprak N. Effects of pregnancy on olfaction. ENT Updat. 2017;7(2):104–7.

[4] PAGE JP. How Do I Know If I’m Pregnant. JAMA. 2001;286(14).

Ismail Munir

This article or video has been vetted and verified by Meri Sehat’s specialists. It contains citations and research from validated sources.

Pregnant? Avoid The TORCH

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

Understanding TORCH Syndrome During Pregnancy & Postpartum

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

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

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

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

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

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

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

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

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

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

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

Nimrah H. Sattar

Let's Talk About Sex During Pregnancy

One of the most pressing questions by couples who are expecting is, if they can have sex during pregnancy.There's no denying that pregnancy is an overwhelming period for both partners as they anticipate parenthood. For a woman, the process is obviously more challenging - her entire body is changing significantly. And even though nurturing her baby in womb would be nothing less than sheer joy, yet it cannot be denied that with all the changes happening internally and externally, a woman may experience mood swings and changes in sex drive.&nbsp;One of the most pressing questions by couples who are expecting is, if they can have sex during pregnancy. A plethora of myths surround the topic, exploiting the concern parents-to-be have for their baby, especially if it is the first pregnancy. They would want to avoid it, but with all the surging hormones, that’s not the ideal solution, is it? So, let’s see what can be done to make the whole process enjoyable, whether sex during pregnancy is possible, when it should be avoided, and what happens after delivery.&nbsp;&nbsp;

Understanding benefits of sex in pregnancy

Well, no, there is no truth to the statement. Sex is not unsafe for the baby if you and your partner have a healthy pregnancy. In fact, it is believed that sex supports and improves pregnancy.&nbsp; Your baby is well protected by the thick muscles of the uterus and is cushioned by the amniotic sac (a fluid filled cavity that surrounds the baby) so there is no potential risk to the baby during intercourse. Moreover, the cervix has a thick mucus plug and it acts as a barrier between the vagina and uterus so there's no way that the baby can get hurt or feel the penetrations<a href="#reference" target="_blank">1</a>.Many people are of the notion that sex during pregnancy induces preterm labor that results in premature birth or baby being delivered before the expected due date (before 37 weeks of gestation). However, studies show no evidence of such a relation and it is concluded that vaginal sex doesn't put the women and baby at risk of premature labor and birth<a href="#reference">1</a>.As women reach the end of their pregnancy, they might experience contractions due to orgasm or sexual penetration, which are referred to as Braxton Hicks contractions. These are mild contractions and are normal in women nearing the due date and it shouldn't arouse suspicion or concern<a href="#reference" target="_blank"> 1</a>.<div> </div>

Pregnancy can effect the sex drive of people in different ways. Some women feel that their sexual drive is fading away while others reach new heights of sexual arousal. As a woman transitions from first trimester to second and then to third, her desire for sex keeps on changing.&nbsp; During the first trimester, a woman is adjusting to the new state of her body. There are the sudden mood changes, there is with frequent nausea and vomiting, and let’s not forget the numerous trips to the loo to urinate. Hence, it’s not surprising that the mom-to-be whether out of frustration or lack of energy has zero desire to indulge in any sexual activity.&nbsp;But that’s going to change. And sooner than you think.&nbsp;The second trimester begins and along with it comes a surge in their sexual desire. The nauseous state of the first trimester has subsided. Also, there’s a spike in the level of certain hormones. Additionally, it is said that blood flow in the body increases by 40% during pregnancy and that this flow is greater in the genitals, which translates into better orgasms<a href="#reference">2</a>. Circumstances favoring, now is the time to benefit from sex during pregnancy. It’s ideal because the body isn't too big yet (as it would likely be in the third trimester) so both partners can be comfortable making love.Speaking of the third trimester, don’t be worried if the sexual drive takes a dip. It happens usually because of anxiety surrounding the impending parenthood. Besides, the baby bump is increasing and that makes many women uncomfortable, too and they consciously avoid getting involved in sex at this stage.&nbsp;

Communication between both partners is important during pregnancy. Tell your partner how you feel about yourself and if you are comfortable with sex during pregnancy.&nbsp; It is best to avoid lying flat during intercourse after the 4th month of pregnancy has passed. It exerts great pressure on the vessels that are taking blood to and from the heart and if these vessels get compressed while you’re lying, the blood supply to the baby might be compromised<a href="#reference">3</a>.This is not to discourage you! On the contrary, you can try new positions that work for both of you. Engage in activities that kindle intimacy such as hugging, cuddling, and kissing.&nbsp;<div> </div>

Pregnancy is an emotionally overwhelming period for both partners. Given that the desire for intercourse and the need for affection also varies for both partners throughout the duration of pregnancy, it is best to indulge in intimacy in ways and at times which works for both partners. Some benefits of sex during pregnancy are listed below:&nbsp;

1. Strengthens The Relationship&nbsp;

According to Terry Hoffman, an Ob-gyn at Mercy Medical Center in Baltimore, men often feel neglected and ignored during pregnancy since all the attention of their partner is directed towards the baby. Hence it is believed that pregnancy sex brings both partners closer and strengthens the relationship<a href="#reference">2</a>.&nbsp;

2. Leads To Better Orgasms

Another benefit that partners experience is better orgasms during pregnancy. This is particularly true for women who feel easily aroused with increased blood flow in the labia and vagina during pregnancy<a href="#reference">1</a>.&nbsp;

3. Improves Fitness And Immunity&nbsp;

Sex helps in burning calories and thus keeps partners fit. Furthermore, sex improves the <a href="https://merisehat.pk/article/how-an-over-prescription-of-antibiotics-affects-your-immune-system">immune system</a>. A study conducted in 2004 revealed that sex increases the level of IgA (a protein created by the body to prevent infections) and protects the individuals from cold and other common infections<a href="#reference">1</a>.

4. Increases Happiness&nbsp;

Lastly, orgasm releases endorphins, which are referred to as happiness hormones, and helps the mother and baby feel happy and relaxed<a href="#reference">1</a>.&nbsp;

<div>&nbsp;</div>

Your healthcare provider would advise you against sex if there are certain conditions in your current pregnancy or even if you have had them in previous ones. The only reason is because sex might aggravate those conditions and that would only increase the risk of complications such as miscarriage or preterm labor.&nbsp; You should not have during pregnancy if you have:<ul><li>Problems with the cervix, which increases the chances of having a miscarriage or early labor&nbsp;</li><li>A risk of miscarriage<a href="#reference">3</a></li><li>Multiple pregnancies with either twins, triplets, or multiples<a href="#reference">4</a></li><li>A low-lying placenta that covers the cervix either partially or fully, a condition called placenta previa<a href="#reference">4</a></li><li>A condition called cervical incompetence where the cervix progresses to labor prematurely&nbsp;</li><li>A history of premature labor&nbsp;</li><li>Experienced unexplained vaginal blood loss</li><li>Complications or high-risk pregnancies where the amniotic fluid leaks or the waters have broken. These conditions increase the risk of infection, hence making sex during pregnancy a no-go area.</li></ul>Seek Help Immediately!&nbsp;Call your healthcare provider if you experience any of the following while having sex in pregnancy<a href="#reference">3</a>.<ul><li>Menstrual-like bleeding</li><li>Pain and discomfort&nbsp;</li><li>Fluid or discharge&nbsp;</li><li>Constant contractions&nbsp;</li></ul><div> </div>

The 6 weeks following the delivery of the baby are known as the postpartum period. This is the time when partners are settling in as parents and with many sleepless nights and tiring days while taking care of the baby, sex is usually the last thing on their mind.&nbsp; For a woman, their body has not stopped changing. It has experienced a lot and is continuing to adjust to this new role during the recovery period. For starters, the episiotomy incision (scar during vaginal birth) or cesarean scar (through C-section) during the birth of the baby takes time to heal. Then, the postpartum bleeding takes 4-6 weeks to resolve. Additionally, fatigue associated with taking care of the baby and sore breasts due to breastfeeding are some of the other factors that contribute to low sex drive in women after birth<a href="#reference">3</a>.Moreover, women may have postpartum blues and might be depressed for a while. Consequently, they might not feel like engaging in activities that previously caused pleasure.&nbsp;It has been proven by research that it takes time for couples to resume sexual activities after giving birth to a baby. Swedish research conducted on 820 first-time parents showed that 6 months following the birth of their first child, the couples could only manage to have sex once or twice in a month<a href="#reference">2</a>.<div> </div>

Pregnancy is undoubtedly a very emotionally demanding phase and both partners may experience different levels of sex drives throughout the period. The change in desire is notably more significant in women than men due to changes in hormone levels, body shape, and increased blood flow in their body. Their libido fluctuates throughout the 3 trimesters, reaching its peak in the second trimester.&nbsp; The myth that sex during pregnancy results in miscarriages and promotes preterm labor and birth has no scientific evidence and, hence, is considered false. On the contrary, several benefits are attributed to having sex during pregnancy including but not limited to the facts that it brings the couples together and keeps them bonded in this very special phase of their life.&nbsp;<div> </div>

Many couples are puzzled about having or not having sex during pregnancy.&nbsp; <ul><li>However, it is completely safe to have sex during pregnancy as it doesn’t harm the baby.</li><li>Pregnancy sex is not associated with miscarriages or increased risk of preterm labor and birth.</li><li>Sex drive may vary in women across the three trimesters with the highest drive being in the second trimester.</li><li>Sex during pregnancy has many benefits such as an increase in intimacy between partner, improved health and immunity, etc.&nbsp;</li><li>There are certain conditions in which sex is not allowed during pregnancy. A woman who is at risk of having miscarriages or preterm birth is advised against sex during pregnancy.&nbsp;</li><li>Many partners find it cumbersome to resume sex immediately after giving birth due to the exhaustion that comes with parenting and taking care of their baby.&nbsp;</li></ul><div> </div>

Cadman B. Sex during pregnancy: Safety tips, positions, effects, and information. Medicalnewstoday.com. https://www.medicalnewstoday.com/articles/321648. Published 2022. Accessed August 18, 2022.

Dworkin-McDaniel N. Sex During Pregnancy: What Every Pregnant Person Should Know. Parents. https://www.parents.com/pregnancy/my-life/sex-relationship/pregnancy-sex-guide/. Published 2022. Accessed August 18, 2022.

Taylor R. Sex During and After Pregnancy. WebMD. https://www.webmd.com/baby/guide/sex-and-pregnancy. Published 2022. Accessed August 18, 2022.

Sex in pregnancy. nhs.uk. https://www.nhs.uk/pregnancy/keeping-well/sex/. Published 2022. Accessed August 18, 2022.

Nawal Adnan

Madeeha Syed

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

Overview

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

Sick Building Syndrome

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

Fix ing SBS

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

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

Umna Salah

Safia Mehmood

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

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

strategies to shatter Impostor Syndrome

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

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

Bottom Line

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

تعارف

حمل عورت کی زندگی میں ایک انتہائی پیچیدہ، مگر خوبصورت نتیجے والا مرحلہ ہے۔ ہارمونل تبدیلیاں، وزن میں اضافہ، مستقبل کے بارے میں تناؤ اور زندگی میں آنے والی تبدیلیوں کا خوف، یعنی یہ مشکل اور صبر آزما ہوتا ہے۔ اوریہ تمام مسائل عورت کے ذات کےحوالے سے ہیں&nbsp; جن کا وہ بہادری سے مقابلہ کرتی ہے۔ یہ حقیقت ہےکہ حاملہ ماں کے فیصلے جنین پر اثرانداز ہوتے ہیں۔ اچھی بات یہ ہے کہ حاملہ خواتین کے لئے مشوروں کا ایک بڑا خزانہ موجود ہے(جو برسوں کی ثقافتی دانائی اور/یا طبی ثبوتوں کے ذریعے جمع کیا گیا ہے)جن کی مدد سے وہ جان سکتی ہیں کہ، انہیں اپنے اور اپنے بچے کی صحت کے لئے کرنا چاہئے اور کیا نہیں۔ایک اہم نکتہ جسے انتہائی اہمیت کا حامل سمجھا جاتا ہے، وہ ہے بعض انفیکشنز سے&nbsp; محفوظ رہنا، تاکہ جنین کو ہونے والی&nbsp; پیچیدگی سے بچا جا سکے۔ اس کی وجہ یہ ہے کہ متعدد انفیکشنز ماں سے رحم میں موجود بچے کو منتقل ہو سکتے ہیں اور پیدائشی نقائص، اسقاط حمل اور دیگر نشو ونما کے مسائل پیدا کر سکتے ہیں۔ ان میں سے ایک انفیکشن ٹارچ سنڈروم کہلاتا ہے۔<div> </div>

حمل کے دوران اور بعد از پیدائش  ٹارچ سنڈروم کی وضاحت

ٹارچ سنڈروم متعدی بیماریوں کے ایک گروپ کی نمائندگی کرتا ہے، جو حمل، زچگی ، یا پیدائش کے بعد جنین میں منتقل ہوسکتے ہیں ۔ ٹارچ کا لفظ ٹوکسوپلاسموسس ، روبیلا ، سائٹومیلووائرس ، اور ہرپس سمپلیکس کا مخفف ہے۔دیگر بیماریاں جیسے کہ ،ایچ آئی وی ، گالوں پرسرخ دانے(fifth disease) ، ویریسیلا زوسٹر وائرس، زیکا ، اور سیفیلس بھی ٹارچ سنڈروم میں شامل ہیں۔پشاور، پاکستان میں کی جانے والی ایک تحقیق میں حمل کے دوران ٹارچ انفیکشن کی تعداد تقریبا 7 فیصد ہے ۔ یہ انفیکشن اسقاط حمل کے 10-15فیصد کا سبب بنتے ہیں۔تحقیق کے مطابق، تمام پیدائشی بے قاعدگیوں میں سے 2-3فیصد پیدائشی ٹارچ انفیکشن سے منسلک کیا جا سکتا ہے۔ سائٹومیگالووائرس (سی ایم وی) حمل کے دوران منتقل ہونے والا سب سے عام وائرس ہے&nbsp; اور یہ جنین کا سب سے عام انفیکشن ہے ، جو تمام زندہ پیدائشوں میں سے 0.5-2 فیصدکو متاثر کرتا ہے۔ زچگی کے ٹاکسوپلاسموسس اور سی ایم وی کے واقعات 2-10 فی 1000 پیدائشوں میں ہوتے ہیں۔اس کے مقابلے میں ، ہرپس سمپلیکس وائرس (ایچ ایس وی) انفیکشن غیر معمولی&nbsp; ہوتےہیں اور امریکہ میں ہر 3،200 پیدائشوں میں سے 1 میں پائے جاتے ہیں۔ تاہم، جینیاتی ہرپس والی خواتین میں علامات نہیں ہوتی ہیں اور ان کی تشخیص نہیں ہوتی ۔ اس لیے زچگی کے دوران یا قریبی تعلق کے ذریعے جنین میں منتقل ہونے کا زیادہ خطرہ ہوتا ہے۔ یہ انفیکشن عام طور پر پیدائش سے پہلے، پیدائشی طور پر اور پیدائش کے بعد پلیسینٹا کے ذریعہ ، خون اور اندام نہانی کی رطوبتوں کے&nbsp; ذریعے، یا&nbsp; ماں کے دودھ سے منتقل ہوتے ہیں۔ یہاں تک کہ زچگی کے دوران بچہ اندام نہانی کی نالی birth canal) (سے گزرتے وقت انفیکشنز(مثال کے طور پر، ایچ ایس وی -2)سے متاثر ہو سکتا ہے۔خواتین کو جنسی&nbsp; عمل کے ذریعے ایچ آئی وی، سیفیلس اور ہیپاٹائٹس بی جیسے وائرس لگ سکتے ہیں۔ متاثرہ خواتین غیر علامتی ہوسکتی ہیں۔ تاہم، جب بچے کی پیدائش ہوتی ہے تو، انفیکشن عام طور پر زچگی کے وقت یا بعد کی زندگی میں نوزائیدہ بچوں میں ظاہر ہوتا ہے۔ قبل از وقت پیدائش، اسقاط حمل، جنین کی محدود نشوونما، مردہ پیدائش، پیدائشی نقائص&nbsp; اور&nbsp; بعد از پیدائش کے انفیکشن ٹارچ سنڈروم کا عام نتیجہ ہیں۔

پہلی سہ ماہی کے دوران ،انفیکشن جنین کی صحت کے لئے سب سے زیادہ نقصان دہ ہے۔زچگی کے خطرے کے عوامل میں مندرجہ ذیل شامل ہیں:<ul><li>چھوٹ جانے والی ویکسینیشن</li><li>حمل کے دوران جانوروں کے ذریعے(مثال کے طور پر، بلی کے فضلے کے ذریعہ ٹوکسوپلاسموسس)&nbsp;</li><li>&nbsp;بغیر پکے ہوئے گوشت یا غیر محفوظ شدہ دودھ کی مصنوعات کا استعمال</li><li>جنسی طور پر منتقل ہونے والے انفیکشن (مثال کے طور پر، ایچ آئی وی، سیفیلس، اور ہرپس سمپلیکس) </li></ul>علامات پیتھوجین کے لحاظ سے مختلف ہوتی ہیں ، لیکن وہ عام طور پر&nbsp; ملتی جلتی ہیں۔ ٹارچ سنڈروم کی عام نشانیاں اور علامات&nbsp; مندرجہ ذیل ہیں:&nbsp; <ul><li>پیٹیشل، میکولوپاپولر ریش (بلیو بیری مفن ریش)</li><li>&nbsp;کھانا کھلانے میں دشواری</li><li>کم پیدائشی وزن</li><li>سستی</li><li>&nbsp;مائیکرو سیفلی</li><li>حسی قوت سماعت کا نقصان</li><li>کوریوریٹائنائٹس</li><li>ہیپاٹوسپلینومیگالی</li><li>دل کی بے قاعدگی</li><li>ہائیڈروپس جنین</li><li>نشوونما میں تاخیر</li><li>دورہ </li></ul>

ٹارچ انفیکشن کی شناخت کے لئے، فی الحال ماں یا نوزائیدہ بچوں کے کوئی اسکریننگ ٹیسٹس نہیں ہیں۔ ڈاکٹر عام طور پر حمل سے پہلے خواتین میں پیتھوجینز کے ٹائٹرز کی جانچ کرنے&nbsp; کے لئے ،ٹارچ ٹائٹر ٹیسٹ کی سفارش کرتے ہیں۔&nbsp;ایک منفی نتیجہ پیتھوجینز کے خلاف اینٹی باڈیز کی عدم موجودگی کی نشاندہی کرتا ہے ، جس سے یہ ثابت ہوتا ہے کہ جسم میں کوئی حالیہ یا ماضی کا انفیکشن نہیں تھا۔ دوسری طرف، ایک مثبت نتیجہ دونوں میں سے&nbsp; کوئی&nbsp; ایک&nbsp; ہوسکتا ہے کہ : (اے) اس شخص کو اس سے پہلے بیماری کے خلاف ویکسین لگائی گئی تھی یا (ب) اسے پہلے انفیکشن ہوا تھا۔

مندرجہ ذیل روک تھام کی حکمت عملی زچگی اور نوزائیدہ بچوں کی بیماری اور اموات کو کم کرنے میں مدد کرتی ہے:<ul><li>حمل سے پہلے ماؤں کے لئے روبیلا اور ویریسیلا-زوسٹر ویکسینیشن</li><li>خواتین کی سیزیرین زچگی میں فعال ایچ ایس وی زخم</li><li>حمل کی ابتدا میں ٹوکسوپلاسموسس یا سیفیلس کی تشخیص کردہ ماؤں کے لئے اینٹی بائیوٹکس</li><li>حمل کے دوران بلی کے فضلے سے بچنا یا کوڑے کے ڈبوں کی صفائی سے گریز کرنا</li><li>باقاعدگی سے ہاتھ دھونے کو معمو ل بنا ئیں</li><li>دوسرے لوگوں کے ساتھ برتن یا مشروبات کا اشتراک کرنے سے گریز کریں</li><li>گوشت جو پہلے سے پکا ہوا ہو، (deli meats)یا غیر پاسچر شدہ ڈیری مصنوعات کھانے سے پرہیز کریں</li><li>بیمار لوگوں سے رابطے سے گریز کریں</li><li>&nbsp;محفوظ جنسی عمل&nbsp;</li></ul>روبیلا انفیکشن کے نتیجے میں پیدائشی روبیلا سنڈروم ہوسکتا ہے ، جس کا کوئی علاج نہیں ہے۔ ورلڈ ہیلتھ آرگنائزیشن (ڈبلیو ایچ او) کے مطابق، ہر سال تقریباً 100,000 پیدائشی روبیلا سنڈروم کے کیسز ریکارڈ کیے جاتے ہیں۔لہذا، حاملہ ہونے سے کم از کم 28 دن پہلے ایم ایم آر ویکسین لگوانےکی سفارش کی جاتی ہے۔

خلاصہ

ٹارچ انفیکشن کی جلد شناخت اور مناسب انتظام نہ صرف ماں کی بیماری کو کم کرے گی، بلکہ جنین کی اموات اور بیماری میں بھی کمی آئے گی۔ لہٰذا، بہتر تشخیصی آلات&nbsp; (in-utero)کی ضرورت ہوتی ہے۔ مزید یہ کہ تمام خواتین کو یہ یقینی بنانا چاہیے کہ، ان کی ویکسین حمل سے پہلے اور حمل کے دوران تازہ ترین ہیں۔ حمل کے دوران بخار یا خارش جیسی انفیکشن کی علامات کی صورت میں کسی بھی بیماری کے بارے میں ڈاکٹرکو فوری طور پر مطلع کریں۔

اہم نکات

<ul><li>ٹارچ سنڈروم متعدی بیماریوں کے ایک گروپ کی نمائندگی کرتا ہے، جو حمل، پیدائش ، یا پیدائش کے بعد جنین کو منتقل کیا جا سکتا ہے۔ٹارچ کا مطلب ٹوکسوپلاسموسس، روبیلا ، سائٹومیلووائرس، اور ہرپس سمپلیکس ہے۔ دیگر بیماریاں ، جیسے ایچ آئی وی ، پانچویں بیماری، ویریسیلا زوسٹر وائرس ، زیکا، اور سیفیلس ، بھی ٹارچ سنڈروم میں شامل ہیں۔</li><li>یہ انفیکشن عام طور پر پیدائش سے پہلے، پیدائشی طور پر اور پیدائش کے بعد پلیسینٹا کے ذریعہ، خون اور اندام نہانی کی رطوبتوں کے ذریعے، یا&nbsp; ماں کے دودھ سے منتقل ہوتے ہیں۔قبل از وقت پیدائش، جنین کی محدود نشوونما ، مردہ پیدائش، اسقاط حمل، پیدائشی نقائص اور بعد از پیدائش کے انفیکشن ٹارچ سنڈروم کا عام نتیجہ ہیں۔</li><li>زچگی کے خطرے کے عوامل میں چھوٹ جانے والی ویکسینیشن، حمل کے دوران جانوروں&nbsp; کے انفیکشن کی زد میں آنا، deli meats یا غیر محفوظ شدہ دودھ کی مصنوعات کا استعمال اور جنسی طور پر منتقل ہونے والے انفیکشن&nbsp; (جیسے ، ایچ آئی وی، سیفیلس ، اور ہرپس سمپلیکس) شامل ہیں۔</li><li>ٹارچ سنڈروم کی عام نشانیاں اور علامات پیٹیشل، میکولوپاپولر ریش (بلیو بیری مفن ریش)، دودھ پلانے میں دشواری، مائکروسیفلی، حسی قوت سماعت کا نقصان، کوریوریٹنائٹس، ہیپاٹوسپلینومیگالی، اور ہائیڈروپس فیٹلس ہیں۔</li><li>ڈاکٹر عام طور پر حمل سے پہلے، خواتین میں پیتھوجینز کے ٹائٹرز کی جانچ&nbsp; کرنے کے لئے ٹارچ ٹائٹر ٹیسٹ کی سفارش کرتے ہیں۔</li><li>ٹارچ انفیکشن کی جلد شناخت اور مناسب انتظام نہ صرف زچگی کی بیماری کو کم کرے گی ، بلکہ جنین کی اموات اور بیماری میں بھی کمی آئے گی۔ </li></ul>

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