Online Consultation

Ismail Munir

The covid-19 pandemic has shown a high fraction of symptoms of mental health. Being restricted to homes has been among the causes of mental health deterioration.

COVID 19 : Unmask your Mental Health

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

COVID-19: Unmask Your Mental Health

Madeeha Syed

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

How To Heal From Grief?

Overview

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>

Bottom Line

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!

Umna Salah

To Meat Or Not To Meat?

Introduction

Research over the years has shown that a strict vegetarian diet excluding all animal fats can lead to vitamin B12 deficiency. Thus, increasing the risk of developing anemia. Newer research also suggests that a more lenient diet puts people at risk of developing <a href="https://www.merisehat.pk/disease/anemia">anemia </a>and heart disease.

There are various reasons behind people giving up eating meat and animal products (milk, cheese, and eggs). However, doing so might increase their risk of anemia, which is a potentially serious condition in which the body does not make enough red blood cells. For vegetarians, vitamin B12 deficiency anemia is typically caused because of eliminating meat from their diet. Similarly, for vegans, giving up all animal products including dairy, eggs, and even honey increases the risk of developing anemia.&nbsp; 
&nbsp;

Understanding Ways To Diversify Iron Sources In Vegetarian And Vegan Diets

A lack of vitamin B12 in your diet can cause pernicious anemia. The body needs vitamin B12 from foods such as meat, poultry, fish and eggs to make red blood cells. Pernicious anemia is a rare type of anemia in which the body is unable to absorb vitamin B12. The vitamin is only available in meat and animal products. While vegetarians who eat dairy and eggs are getting enough vitamin B12 through these sources, vegans must find other ways to include it in their diets, for example, through vitamin B12 supplements. 
&nbsp;

Vitamin B12 deficiency can boost the levels of homocysteine in the blood, a common amino acid that is associated with a higher risk of heart disease. Studies also suggest that the level of this amino acid can over time cause blockages in arteries and lead to heart disease or stroke. Vitamin B12, unlike B vitamins, is not found in any plant derived foods and fortified cereals. However, many types of meat and fish are abundant in vitamin B12. Thus, making it difficult for people following a strict vegetarian diet to get the necessary amount of vitamin B12. The answer is to eat a well-balanced diet and get the needed B12 from other sources, such as vitamin B12 supplementation, to prevent anemia.&nbsp; 
&nbsp;

Look for foods fortified with vitamin B12. Read the nutrition label on packaged foods. Some examples of processed foods that contain vitamin B12 are:&nbsp;

<ul>
	<li>Fortified rice&nbsp;</li>
	<li>Soy milk&nbsp;</li>
	<li>Grain products and cereal&nbsp;</li>
	<li>Meat substitutes</li>
	<li>Dietary supplements containing B complex&nbsp;</li>
	<li>Nutritional yeast&nbsp; 
	&nbsp;</li>
</ul>

Whether you are on a vegan or vegetarian diet, you need to create a healthy and balanced diet that includes enough vitamin B12 to prevent anemia. While fortified cereals are a good choice because of their good bioavailability, meaning it doesn&rsquo;t need to break down before the body absorbs them, vegetarians should consume the following foods on a regular basis:&nbsp;

<ul>
	<li>8 ounces (oz) of yogurt contains about 1.1 mcg of vitamin B12</li>
	<li>1 cup of low-fat milk can provide 1.2 mcg of vitamin B12</li>
	<li>1 oz of Swiss cheese can contain 0.95 mcg of vitamin B12</li>
	<li>1 large egg contains 0.6 mcg of vitamin B12</li>
</ul>

Nutritional yeast is also popular among vegetarians because of its rich, cheesy, and nutty flavor. The yeast can either be added to cooked meals or sprinkled on foods and snacks.

<div>
Since vegans avoid all animal-derived products, they may rely on vitamin B12 fortified breakfast cereals and nutritional yeast, as an alternative source of vitamin B12. For example, fortified non-dairy milk, meat substitutes, breakfast cereals, nutritional yeast, and vegan spreads. However, it is essential to read the labels of the foods as some may not be fortified in vitamin B12.&nbsp;

For those who are deficient in vitamin B12, supplemental vitamins in the form of capsules may be required.&nbsp; 
&nbsp;
</div>

<h4>"All that meat is great for your anemia. But can it also be affecting the heart rate? Get your reading with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

If you decide on taking a dietary supplement, there are some ground rules. A healthy body does not readily absorb all the vitamin B12 in a supplement. Food supplements should never be used as a substitute for a balanced diet and healthy lifestyle. Therefore, it is essential that you talk to your doctor or nutritionist to know the amount of vitamin B12 supplement that is right for you.&nbsp; 
&nbsp;

Key Points

<ul>
	<li>Vegetarians and vegans need to take steps to make sure that they are including an adequate amount of vitamin B12 in their diet. Not maintaining proper levels of vitamin B12 increases the risk of developing anemia.</li>
	<li>Similarly, since there are no plant-derived foods that contain vitamin B12, it is essential to look into alternative sources, for example, fortified foods and vitamin B12 supplements.</li>
	<li>Speak with a healthcare provider for advice on how much you need to take and where to find sources of vitamin B12.</li>
</ul>

[1] Pawlak, R., Parrott, S.J., Raj, S., Cullum-Dugan, D. and Lucus, D., 2013. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews, 71(2), pp.110-117.

[2] Walsh, S., Appleby, P., Baron, L., Dallas-Chapman, G., Davis, B. and Harris, W., 2001. What every vegan should know about vitamin B12. Birmingham: Vegan Society.

[3] Watanabe, F., Yabuta, Y., Bito, T. and Teng, F., 2014. Vitamin B12-containing plant food sources for vegetarians. Nutrients, 6(5), pp.1861-1873.

Staff Writer

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

The Power Of Stepping Forward

There&rsquo;s a widely held perception that <a href="https://merisehat.pk/article/body-weight-exercises-for-strength-training">effective exercises</a> are meant to exhaust you and be physically difficult. When looking to build an exercise regime, most of us are quick to add high-intensity activities like weightlifting and running. Rarely, if ever, does one consider beginning with the simplest and easily accessible activity: walking.&nbsp;

While it may not necessarily outweigh the benefits of a high-intensity strength circuit, walking comes with a host of benefits for both the body and mind. If one is completely new to exercising, or even returning after a long hiatus, walking is a more sustainable place to start. There is no learning curve because it is the one movement that&rsquo;s been inherent to our lives since infancy. It also allows you to start with a gentle pace and build up as your body allows. Whether you start with a moderate pace for ten minutes a day or walk at a faster pace for an hour, you will still be able to reap the many benefits of this activity. 
&nbsp;

Benefits of walking

Walking has been shown to improve blood circulation in the body and lower one&rsquo;s resting heart rate, while lowering blood pressure and cholesterol. A six-year study found that moderately paced walking showed similar reductions in the risk of high blood pressure and cholesterol when compared to vigorous running. A study of post-menopausal woman also showed that walking just one to two miles a day can lower blood pressure by 11 points in 24 weeks. 
&nbsp;

&nbsp;Research shows that walking contributes towards preventing a range of diseases. Improvement in cardiovascular health leads to a decrease in risk of heart disease. In one study, women who walked 30 minutes a day showed a 20 percent decrease in the possibility of having a stroke. Those who walked at a faster, above average pace showed a 40 percent decrease.

In another study, women who walked seven or more hours a week were shown to be 14 percent less likely to get breast cancer as compared to women who walked less than three hours. Even women with other risk factors, such as being on supplemental hormones, were less likely to get the disease.&nbsp;

With its benefits to overall health, regular walking has been shown to reduce risk of early death by upto 39 percent as compared to a sedentary lifestyle. 
&nbsp;

&nbsp;Walking has also been shown to reduce risks of developing Type 2 diabetes, as it helps to balance blood sugar levels. A meta-analysis of 300,000 showed that walking regular decreases the likelihood of Type 2 diabetes by 30 percent. Walking at a brisk pace, of more than 20 minutes to a mile, is even more effective, reducing risk by 41 percent. Meanwhile, a smaller study, of 201 people with Type 2 diabetes showed that every additional 2,600 steps in daily activity was associated with a 0.2 percent decrease in blood sugar level. 
&nbsp;

&nbsp;A joint is the point where two or more bones are joined, such as our knees and elbows. The health of our joints greatly impacts our overall mobility and is essential for living comfortably and pain free. Walking has been shown to improve joint health while reducing chances of osteoarthritis. It lubricates the joints, which protects our bones from friction, and strengthens the muscles that support them. Research has shown that people who walk regularly experienced a 40 percent reduction in knee pain as opposed to those who didn&rsquo;t. 
&nbsp;

&nbsp;Walking has been proven to boost our immune system&rsquo;s ability to protect us against illness. A study tracked 1,000 adults during flu season. Those who walked at a moderate pace for 30 to 45 minutes a day faced 43 percent less sick days and suffered from fewer respiratory infections overall. Even if they did get sick, their symptoms were not as severe or long-lasting when compared to adults with sedentary lifestyles. 
&nbsp;

&nbsp;Like other forms of exercise, walking causes our body to release endorphins. These are neurotransmitters which elevate our mood and alleviate pain. There is ample evidence to support the positive relationship between walking and mental health. One study showed that the more steps people took in a day, the better their mood was. Just 12 minutes of walking resulted in more self-confidence and a better mood in the subjects of another study.

Walking in nature helps us ruminate less over negative experiences, which in turn decreases negative emotions and risk of depression. A study of post-menopausal women showed that walking three times a week for 40 minutes provided relief from symptoms of depression. With all the research to support walking, it&rsquo;s no surprise that psychologists agree a 10-minute walk can be as effective as a 45-minute vigorous workout when it comes to relieving depression. 
&nbsp;

&nbsp;For creative professionals, walking can be a valuable tool in facilitating idea generation. One study compared people trying to think of new ideas while they were walking with those who were sitting. Participants who were walking did better, especially if they were walking outdoors. Research has also shown that walking improves creative output by more than 60 percent. Science shows that engaging in activities that allow our mind to wander creates a mental state that is conducive to coming up with ideas. If we are able to let go of our thoughts while walking, we can go to a place where ideas flow freely to us.

Although simple, walking has incredible and wide-ranging benefits for your body and mental health and should definitely be incorporated as a part of your lifestyle.&nbsp;

Ayesha Binte Rashid

Can't Go To Sleep? Here’s Why And How To Fix It

You&rsquo;re lying in bed, trying to fall asleep. You&rsquo;ve tried everything: reading a book, taking a bath, meditating, nothing seems to work. If this sounds like you, don&rsquo;t worry, I&rsquo;m here to help. In this article, we&rsquo;ll explore some of the most common reasons why people can&rsquo;t fall asleep and what you can do about them. 
&nbsp;

trick your body into sleeping

It&rsquo;s hard to shut down the mind, but if you can allow yourself to be free of all thoughts, worries and overthinking, it&rsquo;s easier to get a good night&rsquo;s sleep. This is why meditation has become so popular as a way to relax and clear your mind.

If you are having trouble going to sleep at night because you have too much on your mind, try focusing on relaxing exercises, such as taking deep breaths for 10 minutes or listening to calming music before bedtime.

If you feel like there is simply too much for your mind to process before bedtime, try not to think about anything at all until after midnight (or whenever you plan on falling asleep). That means no worrying about things that happened earlier in the day or what needs doing tomorrow morning&mdash;just let everything go until it&#39;s time for bed!

&nbsp;

Your environment can also influence the quality of your sleep. If you are sharing a bed with a partner who snores, or have pets that are noisy at night, this can affect your ability to get into REM and deep sleep stages of sleep. If you suffer from these problems, try to keep your pets out during night time.

&nbsp;

If you nap during the day, this can make it harder to fall asleep at night. This is because napping reduces your total sleep time and delays your internal circadian rhythm. In other words, it makes for a long period of time with reduced sleep quality and quantity, which makes falling asleep at night even more difficult.

Napping during the day also makes you feel groggy when it&rsquo;s time to go to bed. It&rsquo;s like drinking coffee in the morning. Once the caffeine has worn off, you may find yourself struggling to stay awake until lunchtime, instead of the usual 3pm!

If you want an afternoon nap but don&rsquo;t want these side effects on your nighttime slumber, consider power naps (naps lasting between 15 minutes and 1 hour), instead of full-on snoozing sessions (which can last longer than 90 minutes). Naps are great if they help improve alertness or performance, however, they shouldn&#39;t be used as a substitute for nighttime sleep if that&rsquo;s what you need most!

&nbsp;

You may have heard that it&#39;s important to go to bed at the same time every night and wake up at the same time every morning. This is true, but even more important is your schedule on weekends and weekdays. If you get enough sleep every night, then it doesn&rsquo;t matter if you sleep in on Saturdays or stay up late on Sundays, your body will adjust to these changes when they happen.&nbsp;

However, if you&rsquo;re not getting enough sleep overall, especially if it&rsquo;s because of inconsistent nighttime habits, then your body might have trouble adjusting to irregular schedules.

&nbsp;

Imagine this scenario: you go to bed at 10pm as usual, but you&rsquo;re not tired. You try and get comfortable, but you can&rsquo;t stop thinking about all of the things that happened during the day &mdash; the conversations you had with colleagues, how much work is left to do tomorrow, or what your friends are doing right now. You start worrying about them and then feel guilty because they don&rsquo;t have time for a phone call when they could be sleeping.&nbsp;

Then another thought pops into your head: did I switch off my iron? Should I check? Now we all know that checking whether an appliance is turned off isn&rsquo;t going to help us sleep any better than worrying if our friends are safe (unless there&rsquo;s a fire nearby somewhere), but this process repeats itself over and over again until suddenly, it&rsquo;s 2am, and there&rsquo;s no hope for rest tonight either!

So how can we avoid these situations? The key is finding something else, anything else, to occupy our minds instead of keeping track of every single little thing that crosses our minds throughout the day.

&nbsp;

Pillow size is another important consideration. Your pillow should be firm enough to support your head and neck, but soft enough to mold around your head and neck as you sleep. A proper pillow will also allow you to keep your spine in alignment while sleeping on either side or on your back, which helps with good posture.

If you have been using the same old pillows for years, it may be time for an upgrade. If a new pillow doesn&rsquo;t work right away, try adjusting its height (keep adding or removing stuffing) until you find one that works for you 
&nbsp;

Don&rsquo;t forget about the other side of the bed - do not share a bed with someone if that person snores heavily. Snoring can really affect quality of life. If a partner snores loudly enough at night that it keeps other people awake or keeps them from getting enough sleep themselves, then this could lead to fights between couples over who gets up earlier so they don&rsquo;t disturb their spouse&#39;s slumber. This problem can be resolved by setting up separate bedrooms for each person or getting rid of noisy beds altogether by buying two twin mattresses instead!

&nbsp;

If you can&rsquo;t get to sleep, it could be for any number of reasons. There are a lot of things that can keep you from drifting off into blissful slumber.

<ul>
	<li>You have too much going on. If there&rsquo;s something weighing on your mind, or if you&rsquo;re in an environment that&rsquo;s too stimulating (like a loud restaurant or party), try taking a moment to reflect on everything that&rsquo;s stressing you out and how it might affect your sleep quality. Try jotting down some notes and setting aside time tomorrow to talk over those issues with someone else so they&rsquo;re not still bothering you when it&rsquo;s bedtime.</li>
	<li>You napped during the day or had too much caffeine/food/alcohol before bedtime. When we nap during the day, we tend to wake up feeling more alert than usual, and while this can be helpful if we have somewhere important to go after work and need the extra boost, it can also hinder our ability to fall asleep at night when all we want is rest.</li>
	<li>Your sleep schedule is off-kilter or irregularly shifted throughout the week due to travel changes etcetera. This will make it harder for us humans whose bodies are programmed over thousands of years by evolution just like all animals&rsquo; bodies, except ours has evolved way faster so now sometimes ours needs work done on them sometimes too. Thus, needing proper rest does matter, so here are some tips. 
	&nbsp;</li>
</ul>

If you are listening to music, watching TV, or playing video games, shut it off! Your brain may be losing focus and this makes it hard for you to sleep.

If you can&rsquo;t sleep, get up and do something else before going back to bed. The more time spent lying awake in bed the more difficult it becomes to fall asleep again.

&nbsp;

On a personal note, I have always <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle" target="_blank">struggled with sleeping</a>. When I was younger, I had to have my mom read me bedtime stories to help me fall asleep and would still be up way past midnight reading under my covers. These days, it&rsquo;s not as bad but there are still nights where my mind won&rsquo;t shut off and I find myself lying awake for hours. Sometimes it&rsquo;s because of something that happened earlier in the day or week; other times it&#39;s just a matter of getting enough rest.

As you can imagine, this can be frustrating when you want nothing more than to turn off your brain and go to sleep! But there are ways you can get better at falling asleep faster, and even staying asleep all night long if you want.

&nbsp;

If you have tried all of these tricks and still can&rsquo;t sleep, there&rsquo;s nothing left to do but wait it out! Just remember, sometimes things happen in life that are out of our control. If you are lying there tossing and turning, just try to breathe deeply and stay calm. It may take some time for us humans to get back into a <a href="https://merisehat.pk/article/are-you-sleeping-on-your-sleep-cycle">regular sleeping cycle</a> again, so don&rsquo;t be discouraged if you&rsquo;re stuck in bed all day without any hope of going anywhere else anytime soon!

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

Debunking Myths About COVID-19 & Anti-Malarial Drugs

A pandemic is often a cause of panic, and rightly so, as things are often difficult to make sense of at the start or even in the middle. The looming threat of a deadly illness can lead to irrational fears among people. As expected, the <a href="https://www.merisehat.pk/disease/covid-19">COVID-19 pandemic</a> also gave birth to some strange fears across the world. These ranged from thinking 5G networks cause <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a> to drinking disinfectants as a preventive measure. There has also been a lot of misinformation about coronavirus treatments. While some have touted eating garlic to be lifesaving, others have stuck to drinking camel urine.

According to the World Health Organization (WHO), as of 19th May, the world has reported more than 520 million COVID-19 cases and 6 million deaths<a href="#accordion">[1]</a>. Although the first COVID-19 case emerged in November 2019, Pakistan did not report a case until February 2020<a href="#accordion">[2]</a>. However, the fear of an outbreak had already gripped the country way before the detection of the first case. Soon enough, people were sharing various home remedies and myths about the novel coronavirus. Moreover, the pandemic also led to the prescription and use of unauthorized drugs for the treatment of COVID-19. These included antibiotics and antimalarial drugs, among others.&nbsp;

&nbsp;

Understanding The Dangers Of Unsubstantiated COVID Treatments

At the start of the pandemic, scientists conducted multiple studies in hopes to find a cure for the novel coronavirus. They investigated existing drugs such as ivermectin, anti-viral drugs, and antimalarial medications chloroquine and hydroxychloroquine as experimental therapies for COVID-19. Short on time, many doctors also began prescribing these drugs to COVID patients, without any conclusive scientific evidence of their effectiveness.&nbsp;

To make matters worse, the then U.S President, Donald J. Trump admitted to taking the antimalarial hydroxychloroquine as a preventive strategy. Many of Trump&#39;s advisers and doctors supported his decision. The statement was backed by a French trial that had demonstrated a decrease in viral load after just 6 days of treatment with hydroxychloroquine<a href="#accordion">[3]</a>. However, many experts labeled the results from the small-scale study anecdotal and insufficient.&nbsp;

As a result of the drug demonstrating anti-viral effects in experimental models, the U.S. Food and Drug Administration (FDA) further granted both chloroquine and hydroxychloroquine emergency use authorization early in the pandemic. And researchers around the world began conducting large clinical trials to evaluate the drug&#39;s safety and effectiveness against COVID-19. However, many of the trials had to be stopped in the middle due to the drug&#39;s adverse effects on participants. Moreover, many failed to show a significant benefit compared to a placebo group. In a study done among rheumatoid arthritis patients, researchers found a similar incidence of COVID-19 among both groups: 0.89% in hydroxychloroquine users and 0.62% in non-users<a href="#accordion">[4]</a>. Thus, showing that the antimalarial drug does not provide protection against the novel coronavirus.&nbsp;

As a result of the negative results in multiple trials, the FDA later revoked its emergency use authorization for chloroquine and hydroxychloroquine<a href="#accordion">[5]</a>. According to the regulatory body, the benefits no longer outweighed the risks associated with drug use. Thus, resulting in a reversal of the decision.&nbsp;

Despite the evidence, several countries such as Brazil, Pakistan, and India continued administering the antimalarial. Pakistan even banned exports of the drugs to have more available for the treatment of COVID-19. However, the increased prescription and self-medication of the drug resulted in a shortage for those that truly needed them.

&nbsp;

Both chloroquine and hydroxychloroquine are used for the treatment of malaria. Chloroquine works by preventing the malarial parasite from multiplying within the red blood cells. There was a time when it was hailed as a highly effective drug and was widely used to treat malaria. However, over the years, malaria strains have developed resistance to the drug. Therefore, in areas with chloroquine resistance, doctors usually prescribe other antimalarials such as mefloquine or atovaquone.&nbsp;&nbsp;

Hydroxychloroquine is a safer and more soluble metabolite of chloroquine. Both are used for treating or preventing malaria. However, due to their immunosuppressive effects, they are also FDA-approved for treating autoimmune conditions, such as lupus and rheumatoid arthritis.

The most common side effects of using antimalarial drugs are headache, nausea, diarrhea, itchiness, hives, double vision, anxiety, and hair discoloration. Although both are fairly safe, long-term use of these drugs can lead to retinal toxicity, heart toxicity, and even death. Moreover, in COVID-19 patients, antimalarial drugs have been shown to exert severe cardiac side effects. These include disturbances in the heart&#39;s rhythm and, in certain cases, sudden death.&nbsp;

&nbsp;

Chloroquine and hydroxychloroquine are not the only antimalarial drugs that people have used to treat COVID-19. Many have also experimented with the Artemisia plant in the form of herbal teas or supplements to cure the viral disease.&nbsp;

One of the commonly used antimalarial drugs, artemisinin-based combination therapies (ACTs) are produced from extracts of the Artemisia plant. However, no study has found the drug or the plant to exert a positive effect against COVID-19. The WHO has also found no evidence of the plant&#39;s effectiveness against the novel coronavirus.&nbsp;

One antimalarial drug, atovaquone, has shown anti-viral activity in a lab study. Atovaquone is an effective antimalarial drug used in combination with proguanil. Sold under the brand name Malarone, the medication is highly effective in treating chloroquine-resistant malaria. Moreover, atovaquone is also used to treat toxoplasmosis and mild pneumocystis pneumonia infections. Due to the drug&#39;s anti-viral effects against viruses such as Zika and dengue, scientists conducted a laboratory study investigating its effect on infected human lung cells.

The study not only demonstrated the drug&#39;s ability to prevent coronavirus replication in cells but also its effectiveness against various coronavirus variants<a href="#accordion">[6]</a>. Based on these results, researchers are now conducting clinical trials of atovaquone for COVID-19 treatment.

&nbsp;

Conclusion

The start of the COVID-19 pandemic led to scientists scrambling for a cure or breakthrough in the treatment of the novel coronavirus. Since developing new treatments can take a lot of time, researchers turned to drug repurposing. This involves investigating new uses for existing drugs. The strategy is often employed for its time and cost-effectiveness, especially in times like the pandemic.&nbsp;

During the COVID-19 pandemic, researchers repurposed various drugs such as remdesivir, ivermectin, steroids, antidepressants, vitamin C and D, Zinc, and even immunosuppressants. While this led to several safe and effective coronavirus treatments, it also helped establish which drugs don&#39;t work.&nbsp;

Antimalarial drugs, such as chloroquine and hydroxychloroquine, are among the treatment options that did not show a favorable profile against COVID-19. Although, at the start of the pandemic, many countries adopted the drugs without any validated scientific evidence. Antimalarial use was further exacerbated when the then U.S. President Donald J. Trump reported using hydroxychloroquine as a precautionary step. Despite the lack of evidence, people rushed to get their hands on a prescription for the medicine. Moreover, the increased demand led to pharmaceutical companies putting all their resources into increasing drug production. This diverted attention from the production of important pandemic supplies, like face masks, ventilators, and gowns. Experts have criticized people for hoarding these medications and causing shortages for those suffering from malaria, lupus, or rheumatoid arthritis. Moreover, recent trials and studies have proven hydroxychloroquine and chloroquine as ineffective against COVID-19. Many have also related severe side effects to the drug&#39;s use.&nbsp;

Therefore, the WHO urges people to not self-medicate with these or any drugs that have not been backed by any health regulatory body. Moreover, physicians are advised to refrain from administering such treatments to COVID-19 patients.

In conclusion, prevention is the best strategy against COVID-19. Washing hands, maintaining social distancing, and wearing a mask continue to be the best precautionary steps for preventing COVID-19.

&nbsp;

Key points

<ul></ul><ul><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The COVID-19 pandemic began in November of 2019 and has infected more than 520 million people across the world.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">The pandemic gave rise to several myths and theories about the spread and treatment of COVID-19. From eating garlic to drinking disinfectants, people have done some rather outlandish things to protect themselves.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">One such myth surrounded the use of antimalarial drugs to treat COVID-19. Early in the pandemic, several scientists also supported the theory, citing successful result from small scale in-vitro studies.&nbsp;</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">As the use of chloroquine and hydroxychloroquine increased worldwide, it also led to the development of severe side effects among COVID-19 patients.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Multiple trials also investigated the effects of these drugs on the novel coronavirus. However, none could demonstrate any benefits. Moreover, many clinical trials ended halfway due to the occurrence of severe cardiac side effects among trial patients taking hydroxychloroquine.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">Other than chloroquine and hydroxychloroquine, people have also explored the Artemisia plant for its anti-viral properties. The plant's extracts are used for making artemisinin-based combination therapies (ACTs) for malaria. However, studies have not found the plant to have anti-COVID activity.</li><li style="line-height: 1.2; margin-top: 0pt; margin-bottom: 0pt;">So far, atovaquone is the only antimalarial that has shown anti-viral properties against COVID-infected lung cells. The laboratory study is now being converted into a clinical trial to help scientists better understand the drug's mechanism of action and safety.&nbsp;</li></ul>

[1] WHO, 2022. WHO Coronavirus (COVID-19) Dashboard. [Online].

[2] Habib, M. & Abbas, M., 2021. Facing the Threat of COVID-19 in Pakistan: A Nation’s Dilemma. Value in Health Regional Issues, Volume 24, pp. 90-95.

[3] Gautret, P. et al., 2020. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. International Journal of Antimicrobial Agents.

[4] Favalli, E. G. et al., 2020. Role of antimalarials in COVID-19: observational data from a cohort of rheumatic patients. Annals of the Rheumatic Disease, 80(5).

[5] FDA, 2020. Coronavirus (COVID-19) Update: FDA Revokes Emergency Use Authorization for Chloroquine and Hydroxychloroquine. [Online].

[6] Carter-Timofte, E. M. et al., 2021. Antiviral Potential of the Antimicrobial Drug Atovaquone against SARS-CoV-2 and Emerging Variants of Concern. ACS Infectious Diseases, 7(11), pp. 3034-3051.

Nimrah H. Sattar

Iqra Mazhar

Anemia: Best Meals For Boosting Iron

Iron deficiency anemia is the most common nutritional disorder in the world according to the World Health Organization. A deficiency in the mineral i.e. iron leads to a deficiency in red blood cells, which causes anemia. Oxygen binds to the hemoglobin in the red blood cells and is transported to the organs and tissues. In anemia, the blood is not carrying enough oxygen to the cells of the body. Thus, causing you to feel weak and tired.

There are several causes of iron deficiency anemia, but inadequate dietary intake and a loss of blood are the two most common causes. Doctors typically prescribe oral iron supplements and intravenous (IV) iron to treat iron deficiency.&nbsp;

Similarly, people with iron deficiency anemia are also encouraged to follow a diet plan specifically designed for iron deficiency. The diet includes animal- and plant-based iron-rich foods, such as poultry, meat, seafood, nuts, seeds, and beans. While an iron-rich diet is necessary, you also need to include foods in your diet that improve the body&rsquo;s absorption of iron, in addition to avoiding foods that may interfere with the process.&nbsp;

&nbsp;

Understanding Ways To Increase Dietary Iron

Adding iron-rich foods to your diet and foods that increase the absorption of iron is the best way to curb iron-deficiency anemia. Iron-fortified cereals, bread products, orange juice, rice, and bread help with bringing iron levels back up. Below is a diet plan that a person with anemia may follow:&nbsp;

&nbsp;

<h5 dir="ltr">Breakfast&nbsp;</h5>

<ul>
	<li>
	Option 1: Unsweetened, iron-fortified oatmeal topped with either almonds, cashews, or walnuts, and a glass (8 ounces) of 100% orange juice which may help increase the absorption of iron in your body.&nbsp;
	</li>
	<li>Option 2: Brown bread, eggs, and apples, with a hand full of iron-rich nuts. Avoid tea and coffee with your meals as it inhibits the absorption of iron.&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Lunch&nbsp;</h5>

<ul>
	<li>
	Option 1: Boiled rice, chickpeas, or lentils with beef, chicken, or fish.&nbsp;
	</li>
	<li>Option 2: Chapati, leafy green vegetables, for example, spinach, or any other iron-rich vegetables, such as potatoes, beef, chicken, or fish curry.&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Dinner&nbsp;</h5>

<ul>
	<li>
	Option 1: Mutton curry or chops with chapati, or boiled rice with a leafy green vegetable on the side.&nbsp;
	</li>
	<li>Option 2: Stew any kind of meat with <a href="https://www.merisehat.pk/disease/chronic-kidney-disease">kidney</a> beans, chickpeas, and tomatoes with either boiled rice or chapati.</li>
</ul>

&nbsp;

<h4>"Feeling tired because of your anemia? Try our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a> to see whether your anemia is bringing down your heart rate!" </h4>

There are many foods that contain high levels of iron and can be combined to make nutritious meals to help with the intake of iron. Foods rich in vitamin C, such as tomatoes, cauliflower, apples, and oranges should also be added to your diet because they help with the absorption of iron. Below is a list of foods that you can add to your diet to help with iron-deficiency anemia:

&nbsp;

<h5 dir="ltr">Fruits And Vegetables&nbsp;</h5>

<ul>
	<li>Spinach&nbsp;</li>
	<li>Beetroot&nbsp;</li>
	<li>Soybean&nbsp;</li>
	<li>Kale&nbsp;</li>
	<li>Broccoli&nbsp;</li>
	<li>Citrus fruits, oranges, grapefruit&nbsp;</li>
	<li>Pomegranate&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Nuts&nbsp;</h5>

<ul>
</ul>

<ul>
	<li>Cashews&nbsp;</li>
	<li>Pistachios&nbsp;</li>
	<li>Almonds&nbsp;</li>
	<li>Walnuts</li>
</ul>

&nbsp;

<h5 dir="ltr">Meat And Fish&nbsp;</h5>

<ul>
</ul>

<ul>
	<li>Beef&nbsp;</li>
	<li>Lamb&nbsp;</li>
	<li>Venison&nbsp;</li>
	<li>Liver&nbsp;</li>
	<li>Shrimp&nbsp;</li>
	<li>Salmon&nbsp;</li>
	<li>Tuna&nbsp;</li>
</ul>

&nbsp;

<h5 dir="ltr">Beans And Pulses&nbsp;</h5>

<ul>
	<li>Kidney beans&nbsp;</li>
	<li>Chickpeas&nbsp;</li>
	<li>Soybeans&nbsp;</li>
	<li>Black beans&nbsp;</li>
	<li>Pinto beans&nbsp;</li>
	<li>Peas&nbsp;</li>
</ul>

&nbsp;

If you have been diagnosed with iron deficiency anemia, there are a few foods and drinks you should avoid because they can keep your body from absorbing iron into your system.&nbsp;

<ul>
	<li>Black and green teas make the iron from plant sources indigestible.&nbsp;</li>
	<li>Coffee also prevents iron from being absorbed&nbsp;into your system. If you are taking iron-rich supplements or an iron-rich meal, avoid drinking coffee an hour before and after.&nbsp;</li>
	<li>Calcium-rich foods, for example, milk, yogurt, bananas, and some nuts interfere with the absorption of iron in the body.</li>
	<li>Gluten-containing foods such as pasta, barley, rye, wheat products, and oats, damage the intestinal walls and prevent the absorption of iron.&nbsp;</li>
	<li>Foods that contain phytates, such as legumes, whole-grain wheat, and brown rice should also be avoided because they prevent the absorption of iron.&nbsp;</li>
	<li>Foods containing oxalic acids, such as peanuts, parsley, chocolates, and spinach should also be eaten in a limited quantity if you are on iron medication.&nbsp;</li>
	<li>Tannins containing foods, such as grapes and corn should also be avoided.</li>
</ul>

&nbsp;

Although iron-rich foods help raise the levels of iron in the blood, to achieve a healthy iron status, most people also need to take supplements alongside following a healthy diet. Some people also do not absorb iron well and may need IV iron treatments. Your doctor will best advise treatment based on your needs. However, the following tips can help with increasing the absorption of iron:

<ul>
	<li>Avoid tea and coffee with meals.</li>
	<li>Avoid calcium-rich foods.</li>
	<li>Have iron-rich foods with those rich in vitamin C.</li>
	<li>Cook food for shorter periods on a cast-iron skillet.</li>
</ul>

&nbsp;

Following an iron-rich meal is perhaps the easiest way to recover from anemia. All the foods mentioned on the list are easily available at well-stocked grocery stores. If you&rsquo;ve tried changing your diet, but failed at bringing your iron levels back to normal, you should speak with a doctor or dietician. They will recommend a supplement that is most effective for you, based on your needs.&nbsp;

&nbsp;

Mental Health Tips For Dysmenorrhea

If you&#39;re a woman in your 20s, 30s, or really any age, there must have been days when you struggled with your mental health. Dark thoughts, anxiety, low mood, an inability to carry out normal day-to-day chores, chances are you&#39;ve experienced them all. And if you suffer from <a href="https://www.merisehat.pk/disease/dysmenorrhea">dysmenorrhea</a>, then the chances of anxiety, irritability, etc. become much higher. Despite society conditioning us into thinking that period pain is a part of life, there is nothing okay about having to deal with debilitating pain on a monthly basis.

<a href="https://www.merisehat.pk/disease/dysmenorrhea">Dysmenorrhea</a>, also called painful menstruation, affects more than 50% of university students in Pakistan<a href="#accordion">[1]</a>. Along with severe pain, many women also report sleep disturbances, difficulty concentrating on work or studies, and frequent leaves from work or school<a href="#accordion">[2]</a>. Additionally, women with dysmenorrhea have higher depression and anxiety scores<a href="#accordion">[3]</a>. Thus, significantly impacting their quality of life.

So, if you&#39;re someone struggling with dysmenorrhea and its mental health effects, here are some of the things you can do to feel better.

&nbsp;

Understanding Dysmenorrhea And Mental Health

Over five thousand years ago, people in Northern India developed what we now call yoga. The exercise and relaxation method has evolved over the years, but what has remained the same is its ability to help people heal, both physically and emotionally. Yoga isn&#39;t just some exercise. It is also a way for people ground themselves and connect with their thoughts.

In dysmenorrhea, the increased levels of prostaglandins and estrogen cause the uterine muscles to contract. As these muscles contract, they push against the surrounding blood vessels, temporarily cutting off the oxygen supply to the muscle. Thus, resulting in pain around the lower abdomen and back.&nbsp;

Various yoga poses can help relax the muscles and improve the blood supply to the pelvic region. Moreover, the various stretches also help calm the mind and revive your energy. However, no one&#39;s asking you to twist your body into crazy positions. You can start by practicing simple poses such as the pigeon pose, fish pose, bound angle pose, and child&#39;s pose. It&#39;s best to avoid leg lifts and any rigorous physical activity during the first few days of your periods.&nbsp;

&nbsp;

Deep breathing exercises involve a combination of slow, deep inhales and exhales. They help increase blood flow in the blood vessels, relax muscles, and reduce pain perception. Thus, relieving anxiety and depression symptoms among people. It is also one of non-pharmacological methods of reducing pain in women with dysmenorrhea.

&nbsp;

Here&#39;s a simple deep breathing exercise you can try next time you feel anxious or low on emery:

<ol>
	<li>Lie on your back in bed or on a yoga mat.</li>
	<li>Inhale and exhale to relax your body.</li>
	<li>Now place a hand on your belly.</li>
	<li>As you take a deep breath in, feel your belly rise into your hand.</li>
	<li>Breath out slowly and feel the belly move down as the air exits your body.</li>
	<li>Take three more breaths like this, focusing on the movement of your belly and feeling the air filling your body and leaving with every exhale.</li>
</ol>

&nbsp;

Dysmenorrhea can be an extremely debilitating condition for women. Coupled with pain, women are also affected with mental health disorders such as depression and anxiety. Therefore, it is important to increase awareness about the mental health implications of this gynecological disorder. Moreover, researchers believe that psychiatric intervention can help women and adolescent girls suffering from dysmenorrhea have a better quality of life.

<ul>
</ul>

<ul>
	<li>Dysmenorrhea, defined as painful menstruation, is associated with higher depression and anxiety levels among women.</li>
	<li>Yoga is a simple exercise technique that can help relax muscles and calm the mind, helping ease symptoms of depression and anxiety in women with dysmenorrhea.</li>
	<li>Deep breathing exercises involve slow, deep breaths that increase oxygenation of muscles and blood vessels; thus, relaxing muscles and reducing anxiety and depression.</li>
	<li>There is a need for a multidisciplinary approach in women suffering from dysmenorrhea. Psychological intervention can help improve their quality of life.</li>
</ul>

&nbsp;

[1] Yasir, S., Kant, B. & Dar, M. F., 2014. FREQUENCY OF DYSMENORRHOEA, ITS IMPACT AND MANAGEMENT STRATEGIES ADOPTED BY MEDICAL STUDENTS. Journal of Ayub Medical College Abbotabad, 26(3).

[2] Unsal, A. et al., 2010. Prevalence of dysmenorrhea and its effect on quality of life among a group of female university students. Upsala Journal of Medical Sciences, 115(2), pp. 138-145.

[3] Sahin, N. et al., 2018. Assessment of anxiety-depression levels and perceptions of quality of life in adolescents with dysmenorrhea. Reproductive Health, Volume 15.

Humza Khizer

Should I Be Anxious About My IBS?

<a href="https://www.merisehat.pk/disease/irritable-bowel-syndrome-62">Irritable Bowel Syndrome (IBS)</a> is defined as a type of gastrointestinal condition that causes problems in the digestive system. IBS affects 10 to 15 percent of the world&rsquo;s population. However, the symptoms are different for every person. While IBS is not a life-threatening condition, it can have a significant impact on one&rsquo;s well-being by affecting one&rsquo;s quality of life. The situation worsens when a person suffers from anxiety and IBS.

&nbsp;

Understanding Link Between Anxiety And IBS

Anxiety disorders is an umbrella term used for general anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD) and social anxiety disorder. A shared symptom of these disorders is excessive worry or anxiety.&nbsp; Physical symptoms of anxiety disorders include fast heart rate, sweating and fatigue. This may interfere with one&rsquo;s ability to get through normal everyday activities.&nbsp;

&nbsp;

IBS is a disorder of the digestive tract that causes abnormal bowel movements. Unlike Crohn&rsquo;s disease or ulcerative colitis, the physical structure of the digestive tract is unaffected, i.e. IBS is not a functional disorder. Common symptoms of IBS include diarrhea, constipation, and abdominal pain. Anxiety disorders affect more than a third of all U.S. adults while IBS affects 7% to 21% of the U.S. population. However, there is no reliable data for how many people experience both anxiety disorder and IBS. Some studies have shown that anxiety disorders are more common in people with IBS. According to a study assessing the prevalence of anxiety disorders and IBS, 44% of people with IBS had an anxiety disorder, compared to 8% of people without IBS.&nbsp;

&nbsp;

According to scientists, the mind and gut are intertwined. This is what scientists refer to as the gut-brain axis, which is a two-way signaling system between the gut and the brain. In response to our thoughts, feelings, and environment, our bodies release chemicals that affect different processes in our bodies. However, in the case of anxiety and IBS, whenever you feel anxious, your body releases stress-related chemicals in the gut causing inflammation leading to abnormal bowel movements, abdominal pain, and a change in gut bacteria.

Additionally, a poorly functioning gut has also been linked with mental health problems. Scientists explain that this is because our brain depends on the chemicals and hormones made by the bacteria in the gut for e.g. 90% of the serotonin (which is an important chemical that controls our mood and keeps anxiety levels low) is produced in our gut. Mental health problems are associated with increased and decreased production of serotonin.&nbsp;

&nbsp;

Unfortunately, the causative factors of IBS have yet to be elucidated. However, there is reason to believe that it may depend on a person&rsquo;s mental health. Anxiety and other health conditions may trigger IBS.&nbsp;

Certain other risk factors may increase one&rsquo;s risk of IBS, including:&nbsp;

<ul>
	<li>Having a family history of IBS&nbsp;</li>
	<li>Females are at a higher risk of developing IBS than males</li>
	<li>Being younger than 50 years of age</li>
	<li>History of severe gut infections&nbsp;</li>
	<li>Chronic psychological stress either caused by traumatic life events or alcohol addiction&nbsp;</li>
	<li>Smoking&nbsp;</li>
	<li>Certain medications that cause changes in the gut bacteria</li>
</ul>

&nbsp;

Studies have shown that keeping stress under control can help prevent or ease the symptoms of IBS. This is because the gut has a brain of its own, known as the enteric nervous system which is why you get butterflies in your stomach when you are nervous. Also, this &ldquo;second brain&rdquo; of yours also controls how food is digested. This second brain is in constant communication with your brain via the gut-brain axis. Thus, this connection can help manage your IBS. You can try and get rid of the tension by incorporating simple things in your daily routine, for example, going shopping, listening to music, reading, or talking to a friend. Other ways to alleviate stress and anxiety include:

&nbsp;

<ul>
	<li>
	<h5>Exercise&nbsp;</h5>
	</li>
</ul>

Exercising, for example, walking, swimming, running or other such physical activities can help you cope with anxiety and depression. Exercise also helps with normal bowel contractions.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Mind-Body Exercise, Mindfulness, And Meditation&nbsp;</h5>
	</li>
</ul>

Meditation can help trigger your body&rsquo;s relaxation response. You can either sign up for meditation, breathing or yoga classes offered online or in person. They will help you manage stress by targeting the gut-mind connection and changing the way you think.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Relaxation Exercises&nbsp;</h5>
	</li>
</ul>

Relaxation techniques, such as deep breathing, can help you feel calmer. The purpose of relaxation techniques is to learn about visualization and to imagine a peaceful scene. These techniques will also help you get enough sleep and eat well. You can also consider joining a self-help group for people with IBS or other digestive disorders. Members of the group will know what it is like to deal with IBS and may also be able to offer more meaningful support that you may not be able to get from even your closest friends.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Diet And Lifestyle Changes&nbsp;</h5>
	</li>
</ul>

The food we eat has a huge impact on our overall health. Your stomach and intestines are some of the first organs that feel the effect of the food you are eating. For treating IBS, you must start with your diet. There are specific foods that can trigger the symptoms of IBS. However, these triggers differ for everyone. Maintain a food/bowel movement journal wherein you can write about how different foods affect your bowel movements. This journal could also be helpful for discussing treatment options with your doctor. Research shows that avoiding certain foods can help prevent symptoms of IBS:&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Gas-Producing Foods</h5>
	</li>
</ul>

People with IBS are more sensitive to foods that make a person gassy for example, beans, bananas, and brussel sprouts. These foods may trigger discomfort after eating them.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Dairy&nbsp;</h5>
	</li>
</ul>

Even if lactose is not an issue for you, you may be sensitive to other milk proteins due to your IBS.&nbsp; Try using dairy-free alternatives, such as soy or oat milk to ease bloating and other stomach issues.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Foods High In FODMAPs</h5>
	</li>
</ul>

Foods high in FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are short carbohydrates, such as fructose and sorbitol that appear in many fruits, vegetables, honey, and wheat. Studies have shown that these FODMAPs can linger in our guts, absorb water, and ferment, which can then cause irregular bowel movements. If you struggle with constipation, then it is recommended you stay well hydrated and eat 4-5 small meals regularly rather than eating 3 large meals a day. A diet high in fiber and soluble fiber, such as psyllium may also be helpful. Similarly, alcohol, tobacco, and caffeine aggravate symptoms of both IBS and anxiety, so reduce their consumption.&nbsp;

&nbsp;

<ul>
	<li>
	<h5>Cognitive Behavioral Therapy&nbsp;</h5>
	</li>
</ul>

Studies have shown that cognitive behavioral therapy is an effective treatment for IBS. However, before starting with CBT, practitioners need to rule out alternative diagnoses. The most important medical conditions to rule out include inflammatory bowel disease, Crohn&rsquo;s disease, and celiac disease. Baseline blood and stool tests are generally enough to rule out these conditions. The next step is to educate the patient about the gut-brain link and how stress can directly impact gut health.

The CBT practitioner will first help train the patient in relaxation techniques including deep belly breathing. Once the patients are able to use the relaxation techniques CBT is introduced. The focus of CBT is to educate the patient that the beliefs that affect our emotions negatively can be baseless. For example, if a person is embarrassed to go to the bathroom in a public place, it can be helpful to send them to a movie theater and have them sit at the back of the theater to count the number of people who get up to use the bathroom and return. The patient will be able to see two things: the frequency of people getting up to use the bathroom and the lack of reaction towards this behavior by the surrounding people. This will help the patient understand that it is not a big deal to get up and use the bathroom.&nbsp;

Similarly, CBT exposure therapy focuses on patients overcoming their fear of doing things that they have been avoiding. For example, if a person is afraid of long car trips, make them sit in a parked car for thirty minutes. Once this gets boring, drive them around the area. Once this gets easy, drive them a mile away from home and back. If the patient worries about not being able to &ldquo;hold it&rdquo;, experiment with them to &ldquo;hold it&rdquo; for 30 seconds, then a minute, and then 5 minutes. This will prove that they can hold it and worry is unnecessary.

&nbsp;

<ul>
	<li>
	<h5>Medications&nbsp;</h5>
	</li>
</ul>

If diet and lifestyle changes are not enough to curb the problem of anxiety and IBS, many medications will help relieve symptoms.

<ul>
	<li>Metamucil, or soluble fibers available over the counter, for constipation relief.</li>
	<li>Miralax helps pull water into the intestines and encourages bowel movements.</li>
	<li>Medications approved by the FDA for IBS-related constipation, Amtizia, Linzess, and Zelnorm.&nbsp;</li>
	<li>Antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors.</li>
	<li>Imodium is a popular over-the-counter medication that slows down gut and bowel movements and treats IBS-related diarrhea.&nbsp;</li>
	<li>Antispasmodics relax the muscles of the digestive system and relieve IBS-related abdominal pain.&nbsp;</li>
</ul>

&nbsp;

<ul>
	<li>Although there is no clear answer as to how anxiety affects your IBS or vice versa, both conditions are triggered by many different factors.</li>
	<li>If you have IBS, then there are many treatment options (medications, cognitive behavior therapy, etc.) and lifestyle changes that have been shown to help relieve symptoms and stress.&nbsp;</li>
	<li>You can discuss these treatment options with a healthcare provider and implement whatever works best for you.</li>
</ul>

&nbsp;

[1] Banerjee, A., Sarkhel, S., Sarkar, R. and Dhali, G.K., 2017. Anxiety and depression in irritable bowel syndrome. Indian journal of psychological medicine, 39(6), pp.741-745.

[2] Locke, G.R., Olden, K., Peterson, W., Quigley, E., Schoenfeld, P., Schuster, M. and Talley, N., 2002. Systematic review on the management of irritable bowel syndrome in North America. Am J Gastroenterol, 97, pp.S7-26.

[3] Camilleri, M., 2018, December. Management options for irritable bowel syndrome. In Mayo Clinic Proceedings (Vol. 93, No. 12, pp. 1858-1872). Elsevier.

[4] Johns Hopkins Medicine: "The Brain-Gut Connection."

[5] U.S. National Library of Medicine: "Irritable bowel syndrome treatment: cognitive behavioral therapy versus medical treatment."

Laughter Is Indeed The Best Medicine – Here's How

You probably would have laughed it off when someone mentioned laughter as the best therapy because it&#39;s too hard to believe, right?&nbsp; But, guess what? There is now a plethora of evidence and research to back the claim that a good laugh can do wonders.&nbsp;

&nbsp;

As we go along this article, you will learn more about the power of humor and what staying happy does to a person, especially if they&rsquo;ve been sick for a long time. The theory suggests humor promotes healing through staying happy. Let&rsquo;s see how it achieves that. 
&nbsp;

Understanding the Benefits of Humor Therapy

Humor therapy, also known as therapeutic humor or laughter therapy, refers to the art of using humor to relieve stress and pain, and to improve your overall sense of well-being<a href="#accordion">[1]</a>. Humor therapy uses the power of giggles and smiles to help you heal and escape the worries of life<a href="#accordion">[2]</a>.&nbsp;

&nbsp;

Scientists have proven that laughter can alter the brain chemistry, by reducing<a href="merisehat.pk/disease/stress"> stress</a> and promoting the release of happiness hormones, namely serotonin and dopamine. Humor therapy would help you to feel confident and in control of your life. Additionally, it would liberate you from the negative emotions that are pooling inside, helping you to let go of added stress and worries concerning your health condition or about life events in general<a href="#accordion">[3]</a>.

&nbsp;

Research has proven that patients who received humor therapy showed a significant improvement in their health. Among the health benefits observed in these patients was reduction in blood pressure, a boost in the activity of the immune system, reduction in stress hormone levels, and a rise in the levels of endorphins (a chemical produced in the body that brings about feelings of euphoria)<a href="#accordion">[3]</a>.

&nbsp;

In fact, upon realizing the importance of humor therapy, many hospitals have now either installed humor carts or have set up rooms where comic material is provided to people of all ages<a href="#accordion">[2]</a>. The funny material consists of comic recordings, audios, humorous films, books, or games. In certain hospitals, there are volunteers whose sole job is to make the patients laugh. Humor therapy has also become a part of the standard treatment plan for cancer patients at some hospitals<a href="#accordion">[3]</a>. 
&nbsp;

<h5>How Did Humor Therapy Come to Light?&nbsp;</h5>

It was in 1930 when humor therapy was used for the first time at a children&#39;s hospital by bringing in clowns to cheer up the children affected with polio. Later in 1979, Norman Cousins, a physician, in his book Anatomy of an Illness mentioned the benefits of humor therapy to educate the masses. He mentioned how humor therapy had a pivotal role in managing his pain while he was getting treated for rheumatoid arthritis of the spine, which is a very painful condition affecting the joints. According to Cousins, laughter eased the pain for him, as is proven by multiple researchers how having a good laugh can decrease stress and alleviate pain<a href="#accordion">[4]</a>.

&nbsp;

It was not until 1998, however, when the movie Patch Adams starring Robin Williams was released that people started appreciating the importance of laughter in treating individuals who are sick. According to the movie, &#39;Being happy is the most revolutionary act one can commit&#39;, and rightly so since happiness is associated with a myriad of health benefits<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

Laughter is a great medicine &ndash; one that has insurmountable benefits &ndash; and it&rsquo;s free! It&#39;s surprising, isn&rsquo;t it, how you laugh all day long as kids at one silly thing or the other but as you grow older, the natural tendency to enjoy life and laugh at petty moments drifts somewhere in the background. Responsibilities take over. However, if you try seeking humor, you can still fill your life with so much positivity that you&rsquo;ll be surprised.&nbsp;

&nbsp;

Humor and a good laugh can improve your emotional, physical, and psychological health. Moreover, humor is said to strengthen relationships, keep you happy, and also results in longevity<a href="#accordion">[5]</a>. 
&nbsp;

Here&#39;s a list of health benefits of a good laugh<a href="#accordion">[5]</a>:

<ul>
	<li>Helps the body to relax and dissipates the tension building in muscles. Your muscles stay relaxed for about 45 minutes after you have laughed.</li>
	<li>Promotes the release of endorphins, which is a substance that promotes feeling of wellbeing and relieves pain for some time.&nbsp;</li>
	<li>Improves heart health by increasing the blood flow within the heart. Staying happy can even reduce your risk of heart attack and other cardiovascular diseases. Now, isn&#39;t that huge?&nbsp;</li>
	<li>Helps burn calories if you&rsquo;re laughing for a good 10-15 minutes every day. While it is no substitute for gym, it can help you lose 3-4 pounds in a year.&nbsp;</li>
	<li>Lifts off the load of anger. You start looking at the funny side of the problem and this helps to resolve conflict and prevents negative feelings from developing in relationships.&nbsp;</li>
	<li>Add years to your life. A study in Norway conducted on people battling with cancer revealed that those who had a good sense of humor lived longer than their counterparts who didn&#39;t laugh often.&nbsp;</li>
	<li>Brings people together and strengthens relationships. Laughing together creates a strong, positive, and emotional bond between people.&nbsp;</li>
	<li>Relieves stress and improves mood. It helps you look at things from a different perspective so that you don&#39;t feel overwhelmed. 
	&nbsp;</li>
</ul>

Laughter or humor therapy is a non-traditional and non-pharmacological treatment approach that is mainly considered for old individuals in nursing homes, people with chronic diseases, and for patients battling with cancer. Humor therapy is offered alongside conservative treatment and has a tremendous effect on their mental health and immune function<a href="#accordion">[6]</a>.

&nbsp;

Additionally, laughter therapy does not require extra facilities or any specialized preparation, hence, it is easily available for all. Therapeutic humor is merely the use of the innate ability of humans to laugh at gleeful circumstances. But, to be able to laugh heartily after an extremely exhausting day can be extremely rewarding, too. Similarly, for patients dealing with chronic pain, a good laugh can momentarily take away their pain and it provides them an opportunity to enjoy life. Humor therapy is not just an inexpensive treatment option, it is also devoid of any adverse effects<a href="#accordion">[6]</a>.&nbsp;

&nbsp;

The elderly people in our society are already prone to mental health problems due to the natural process of aging; loneliness, pain, and discomfort in daily activities means they&rsquo;re likely to suffer from depression. A study found that older individuals endure pain considering it a normal part of the process of aging and are hesitant to request for pain relief because they don&#39;t wish to be labeled as &#39;complainers&#39;<a href="#accordion">[7]</a>. As heart wrenching as it sounds, it is true that most elderly individuals are not heard and this adds to their psychological and physical stresses<a href="#accordion">[6]</a>. Humor therapy can be a breath of fresh air in their lives, a chance to live life and laugh out loud.

&nbsp;

A study was conducted to evaluate the effectiveness of laughter therapy in relieving chronic pain, alleviating loneliness, promoting life satisfaction, and enhancing happiness in older patients who were living with chronic pain. Chronic pain is defined as pain ongoing for more than 3 months. In this study, 36 old people from a nursing home were invited for an 8-week long humor therapy program while 34 old people were taken as a control who did receive humor therapy. Upon completion of the program, the individuals who were introduced to humor therapy reported remarkable reduction in their perception of loneliness, decreased pain, and a profound feeling of happiness accompanied with life satisfaction. However, the control group reported no significant changes. Consequently, this study proves that therapeutic humor is an effective intervention in the elderly population<a href="#accordion">[7]</a>.

&nbsp;

Chronic disease patients usually have a negative attitude towards life and it worsens their physical and mental health. Incorporating humor therapy in their treatment plan will significantly improve their outlook on life.&nbsp; 
&nbsp;

There is no denying that caregiving is no easy job and it can take a significant toll on the healthcare providers. Long working hours and little rest adds on to the stress and it is believed that sharing a good laugh can benefit the doctors as it does the patients. Roughly 40-70% healthcare providers show signs of clinical depression, which is a worrying figure<a href="#accordion">[8]</a>. Humor therapy can be provided to tackle the situation because cracking jokes and sharing hearty laughs over funny movies might be all that they need to instill positive feelings<a href="#accordion">[8]</a>. Saving people is a tough job already; laughing often would renew the stamina of the caregivers and build positive energy!&nbsp; 
&nbsp;

Whether young or old, sick or healthy, everyone needs a bit of humor to feel alive. Whether they realize this or not is a different debate, but finding reasons to laugh and giggle at even the silliest of things helps to have a positive outlook on life. People who are battling with chronic diseases or older individuals fighting loneliness have all greatly benefited from humor therapy. So, grab a comic book, watch a sitcom or do anything that makes for a good laughter experience!&nbsp;

<ul><li>Humor therapy is the art of using humor to heal, to relieve pain, and to reduce stress.&nbsp;</li><li>Humor therapy creates a healthy brain environment and releases happy hormones.&nbsp;</li><li>Laughter therapy improves the physical, psychological, and emotional health of an individual.&nbsp;</li><li>Humor therapy greatly benefits individuals who are old, dealing with chronic diseases, or those battling with cancer.&nbsp;</li><li>Caregivers can also benefit from humor therapy.&nbsp;</li></ul>

[1] NCI Dictionary of Cancer Terms. National Cancer Institute.

[2] Humor Therapy – Health Information Library | PeaceHealth. Peacehealth.org.

[3] Therapeutic Humor - Therapedia. Theravive.com.

[4] Encyclopedia. Humor Therapy.

[5] Laughter is the Best Medicine - HelpGuide.org.

[6] Yim J. Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. Tohoku J Exp Med. 2016;239(3):243-249. doi:10.1620/tjem.239.243

[7] Tse M, Lo A, Cheng T, Chan E, Chan A, Chung H. Humor Therapy: Relieving Chronic Pain and Enhancing Happiness for Older Adults. J Aging Res. 2010;2010:1-9. doi:10.4061/2010/343574

[8] How Humor Can Improve your Health | Silver Creek Retirement. Silver Creek.

Nawal Adnan

Parents, Not Friends

Parenting is a very complex subject. As parents, we are always doubting ourselves, but we simultaneously justify everything we do by saying that it is for their best. Implying that we know what&rsquo;s best for them.

Most parenting habits stem from experience &mdash; both our own and other&rsquo;s as well. You go about trusting your gut, but more often than not, you are influenced by everything you have experienced yourself while growing up.&nbsp;

Perhaps, you felt your parents did something wrong, like they should have been less restrictive and more trusting to let you explore the world on your own in order to make you more independent. Perhaps, you missed out on an experience like sleepovers at a friend&rsquo;s house. Your parents justified it by saying they feared for your safety, but of course, your younger self felt left out in your group and you still feel that way.&nbsp; 
&nbsp;

So, you try to make up for these insecurities by being &lsquo;less&rsquo; like your parents were and more like you always wanted them to be &mdash; a confidante. Someone who is open-minded and maybe even more like-minded. But who says your parenting style is good or even one that&rsquo;s acceptable to your child?

Besides, even if you are the &lsquo;cool&rsquo; parent, there is always one thing that you or any parent should avoid &mdash; overdoing it. We need to realize that our kids won&rsquo;t consider us their besties, ever. Period. At max, we can be very good friends and we need to respect that.&nbsp; 
&nbsp;

Parenting, a complex subject

A lot of overprotective parents tend to argue that there should not be any secrets between a parent and a child. We understand that you want to take care of your child, but there is a fine line between raising your <a href="https://merisehat.pk/article/how-does-familial-conflict-or-domestic-violence-affect-children">child </a>to become a good person and dictating them to become whoever you want them to be. If we are being honest, dictatorship does not really work &mdash; not while running countries and definitely not in parenting.&nbsp; 
&nbsp;

Think of your child as their own person before they are your offspring. They deserve as much respect as any other person in the world. We often tend to dismiss their individuality.&nbsp;

Being your child&rsquo;s friend is all fun and games until you start trying to infiltrate their actual friend circle. Getting yourself over-involved in their lives doesn&rsquo;t work. There are always things that your child would not want you to know about them.

Invading boundaries and having no regards for them often lead to kids going astray and starting to hide things from their parents. This is where the main issue lies. It often leads to the kid losing their friendship connection with their parents. You do not want your kid to be hiding things from you on purpose.&nbsp; 
&nbsp;

Would you rather have your child lie to you about their whereabouts or tell them to you when they feel like it? You know the answer. We should never suffocate our children to the point that they feel the need to lie or hide things. Respect your child and their boundaries for a healthy parent-child relationship.

The COVID-19 pandemic has drastically changed people&rsquo;s lifestyles. The new normal is a combination of altered daily routines, uncertainty, social isolation, and financial pressures. People are constantly worried about getting sick, their jobs being affected, and the pandemic never-ending. Moreover, the rumors and overload of misinformation can make individuals feel out of control or unclear about their goals. The pandemic can lead to <a href="https://www.merisehat.pk/article/how-to-manage-anxiety">feelings of anxiety</a>, stress, fear, and loneliness which can all worsen with time

According to surveys, there is an increase in the number of adults who report symptoms of stress, anxiety, insomnia, and <a href="https://www.merisehat.pk/disease/depression">depression</a> during COVID-19 compared to the ones before the pandemic. Some people have also increased their consumption of alcohol and smoking, both of which can trigger depression and anxiety. Moreover, substance abusers, especially those addicted to tobacco or opioids, are at a higher risk of COVID-19 and adverse outcomes such as hospitalizations and death<a href="#accordion">[1]</a>. This is because addictions can harm the function of the lungs, and weaken the immune system. Furthermore, they lead to chronic conditions, like heart and lung diseases, which can increase the risk of serious COVID-19 complications. Therefore, it is important to learn self-care strategies and get the required care.

&nbsp;

Understanding The Impact Of COVID On Mental Health

The high number of cases during the COVID-19 pandemic has placed immense stress on healthcare professionals (HCPs). Long work hours and limited resources further add to their mental distress. Therefore, the mental health of caregivers should be given equal importance.

A cross-sectional study, conducted across multiple hospitals in Karachi, Pakistan, assessed depression and anxiety scores of healthcare professionals posted in the COVID-19 wards. The Depression Anxiety Stress Scale-21 was used to calculate their scores. According to the results, 72.3% of the participants suffered from moderate to extremely severe depression, 85.7% suffered from moderate to extremely severe anxiety, and 90.1% of participants reported moderate to extreme levels of stress<a href="#accordion">[2]</a>.

The presence of psychological ailments such as stress, anxiety, and depression in HCPs points to the need for regular mental health checks. However, that cannot be possible without the intervention of higher authorities.

&nbsp;

The COVID-19 pandemic caused the implementation of social restrictions, leading to an increase in mental health issues among people.&nbsp;

A study conducted in Lahore, Pakistan measured the impact of COVID-19 on anxiety levels and obsessional thinking in clinical and non-clinical populations. The online survey consisted of a demographic profile and two scales: CAS (Coronavirus Anxiety Scale) and OCS (Obsession with COVID-19 Scale). All the participants were aged eighteen and above. A total of 240 people filled out the survey, comprising 20% men and 80% women.

According to the results, there was a positive correlation between anxiety and obsessions related to COVID-19. Overall results of the study depicted that the average adult population of Lahore does not suffer from dysfunctional anxiety or obsessions linked with COVID-19<a href="#accordion">[3]</a>. In contrast, studies conducted in other countries have indicated high levels of anxiety and obsession related to COVID-19 within their population.&nbsp;

&nbsp;

<h4>"Not all COVID infections lower the oxygen saturation. Check out your oxygen levels with our <a href="https://www.merisehat.pk/page/sehat-scan/" target="_blank">sehat scan</a>!" </h4>

The CDC claims that people with specific mental health conditions have a higher risk of COVID-19. They may require hospitalization and ICU admission. Moreover, the severity of the symptoms can also lead to death among these patients.

The mental disorder schizophrenia ranks second to aging as a risk factor for COVID-19<a href="#accordion">[4]</a>. A study published in JAMA Psychiatry demonstrated higher COVID-19 mortality rates among schizophrenics<a href="#accordion">[5]</a>. However, other factors could also play a role, for example, age, race, medical conditions, and sex. Another study reported higher odds of COVID-related death and hospitalizations in people with mood disorders<a href="#accordion">[6]</a>.

Therefore, it is recommended that people who are at a higher risk of severe COVID-19 work in collaboration with their healthcare providers for the management of their condition. Moreover, getting vaccinated and keeping up with booster shots are a must.

&nbsp;

Stress is a normal human response to unforeseen circumstances. Everyone reacts to stress differently and it is completely normal to be stressed during a pandemic. However, multiple challenges, for example, the effects of COVID-19 can push you beyond your coping capabilities. As a result, many people develop mental health concerns like anxiety symptoms and depression during this period. Despite multiple efforts, some of them will feel helpless, sad, and angry, which further hinders their overall quality of life.&nbsp;

If you notice a decline in your mental health, ask for help.

&nbsp;

[1] Volkow, N., 2020. New evidence on substance use disorders and COVID-19 susceptibility. NIDA.

[2] Sandesh, R., Shahid, W., Dev, K., Mandhan, N., Shankar, P., Shaikh, A. and Rizwan, A., 2020. Impact of COVID-19 on the mental health of healthcare professionals in Pakistan. Cureus, 12(7).

[3] Majeed, S., Schwaiger, E.M., Nazim, A. and Samuel, I.S., 2021. The Psychological Impact of COVID-19 Among Pakistani Adults in Lahore. Frontiers in Public Health, 9.

[4] Mohan, M., Perry, B.I., Saravanan, P. and Singh, S.P., 2021. COVID-19 in people with schizophrenia: potential mechanisms linking schizophrenia to poor prognosis. Frontiers in Psychiatry, 12, p.684.

[5] Nemani, K., Li, C., Olfson, M., Blessing, E.M., Razavian, N., Chen, J., Petkova, E. and Goff, D.C., 2021. Association of psychiatric disorders with mortality among patients with COVID-19. JAMA psychiatry, 78(4), pp.380-386.

[6] Ceban, F., Nogo, D., Carvalho, I.P., Lee, Y., Nasri, F., Xiong, J., Lui, L.M., Subramaniapillai, M., Gill, H., Liu, R.N. and Joseph, P., 2021. Association between mood disorders and risk of COVID-19 infection, hospitalization, and death: a systematic review and meta-analysis. JAMA psychiatry, 78(10), pp.1079-1091.