Humza Khizer

TB symptoms include coughing for three or more weeks, usually with blood or mucus. Latent TB may not show signs but can be deadly. Read more about TB at Meri Sehat.

The nation's stance against TB

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The Nation’s Stance Against TB

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Ismail Munir

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

Know Your Blood Pressure Numbers

Introduction

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

Understanding blood pressure readings

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

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

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

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

Conclusion

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

Key Points

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

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

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

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

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

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

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

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

Zarlish Kazmi

AL SHIFA CLINIC KARACHI

Syed Intisar Hussain

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

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

Understanding the Association Between Blood Groups and Risk of a Stroke

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

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

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

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

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

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

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

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

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

[2] Bailey E. Blood Type Linked to Risk of Stroke Before Age 60. Healthline.

[3] What Is A Universal Blood Type?. Redcrossblood.org.

[4] Conditions H, Risk S, Haase M. This Blood Type May Mean You’re at a Higher Risk of Early Stroke, New Study Finds. Prevention.

[5] Norris J. Type A vs. O: Does blood type influence stroke risk?. Medicalnewstoday.com.

[6] Solis-Moriera J. Your Blood Type May Influence Your Stroke Risk, Study Shows. Health.Published 2022.

[7] CDC.

Nawal Adnan

Can Laughter Really Lower Blood Pressure?

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

Understanding benefits of laughter therapy

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

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

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

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

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

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

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

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

Staff Writer

Iqra Mazhar

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

A Short, Bloody Story About Long COVID

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

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

Understanding Long COVID

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[6] BMJ 2022;377:e069676

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

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

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

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

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

Nimrah H. Sattar

Medilink Consultant clinic

ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

MDR-TB: Here To Stay

<a href="https://www.merisehat.pk/disease/tuberculosis">Tuberculosis (TB)</a> is an infection brought about by microscopic organisms that spread from one individual to another through the air<a href="#accordion">[4]</a>.&nbsp; 
&nbsp;

While it generally influences the lungs, it could have negatively affected different organs of the body, including the brain, the kidneys, and the spine.&nbsp; 
&nbsp;

Fortunately, TB is treatable to a large extent, but this is not always the norm as a patient&#39;s health could deteriorate, resulting in death if people diagnosed with TB are unable to seek the appropriate treatment on time. 
&nbsp;

What affects the already unpredictable infection is its transition to multidrug-resistant TB, which is bound to happen when microscopic organisms become resistant to the medications used to treat TB. This implies that the usual medications are ineffective against the TB microscopic organisms<a href="#accordion">[4]</a>. 
&nbsp;

Multidrug-resistant TB (MDR-TB) follows the same path of transmission as its more common counterpart, the drug-susceptible TB. TB is known as an airborne infection, which implies that it spreads through the air starting with one individual and then onto the next<a href="#accordion">[4]</a>. The TB microorganisms enter the atmosphere when an individual with TB coughs, sniffles, talks, or sings &ndash; basically they perform any mouth movement without maintaining a safe distance or using a medically approved face mask. Individuals who are in close proximity to the patient might inhale these microbes and become infected as well<a href="#accordion">[4]</a>.

&nbsp;

Understanding Drug Resistant TB

MDR-TB happens when the bacterium is resistant to 2 or more of the first-line medications against TB, like Rifampicin (RIF) and Isoniazid (INH)<a href="#accordion">[7]</a>.&nbsp;

Multidrug-resistant TB could be categorized as primary or acquired<a href="#accordion">[8]</a>. The primary MDR-TB happens because of transmission of drug-resistant TB strains, while acquired MDR-TB is drug resistance that develops due to insufficient treatment, either due to poor patient compliance or incomplete administration of treatment.&nbsp;

Although ongoing MDR-TB reports are obtained from major metropolitan cities, there have been increasing cases with no past TB treatment in both high-predominance HIV settings (South Africa: 55%)<a href="#accordion">[6]</a>&nbsp;and low-pre-dominance HIV settings (Shanghai, China: 60%; Latvia: 37%; Japan: 45%). The general assumption is that drug-resistant TB is mainly acquired resistance to TB treatment medications<a href="#accordion">[8]</a>.&nbsp;

&nbsp;

According to the World Health Organization, the treatment of MDR-TB has proved to be a difficult challenge globally for different reasons, including limited assets and the development of negative impacts in treated patients. 
&nbsp;

Research conducted in Iran tracked down numerous undesirable and unexpected impacts of MDR-TB treatment e.g. auditory poisonous impairment, hepatitis, rash, and renal damage<a href="#accordion">[3]</a>.&nbsp; 
&nbsp;

A notable concern today is regarding changes in MDR-TB strains which have brought about the formation of extensively drug-resistant TB (XDR-TB). XDR-TB strains are characterized as MDR-TB strains that are impervious to second-line injectable medications along with other types of medications such as fluoroquinolones. Of the 558 000 MDR-TB cases that were monitored around the world in 2017, approximately 8.5% of cases were of XDR-TB. 
&nbsp;

Moreover, there are several risk factors that are prevalent now. Erroneous or unseemly anti-toxin admission, and one individual to the next transmission have a significant role to play in the development of MDR-TB strains.&nbsp; 
&nbsp;

One review expressed that among the main sources of contamination with MDR-TB is the history of tuberculosis disease<a href="#accordion">[9]</a>. This hypothesis confirms a link between the significance of counteraction of tuberculosis and the botched handling in treatment; both incline towards possible MDR-TB contamination.&nbsp; 
&nbsp;

MDR-TB could influence numerous regions of the body other than the lungs, like the spine, brain, and kidneys<a href="#accordion">[5]</a>. Exploring treatment choices in the restricted range accessible to fix these superimposed problems could be hard for medical care experts all over the planet, particularly for those practicing in non-industrial nations with very scant assets.&nbsp; 
&nbsp;

In addition to that, patients with HIV have a high death rate if they contract MDR-TB or XDR-TB. A few examinations show a casualty rate of more than 90%. But the connection with HIV does not end there; what is more threatening is the prevalence among patients with HIV. MDR-TB is considered two times more common in tuberculosis patients with HIV as opposed to tuberculosis patients without HIV. 
&nbsp;

The rise of SARS-COV-2 has rendered previous solutions useless. For instance, a recently published article in India revealed that disturbances in the stock chains of drugs have brought about a lack of accessibility for some patients to get their necessary amounts. Moreover, the mortality of patients infected with COVID-19 alongside a primary lung infection, for example tuberculosis, is high 
.&nbsp;

Another new report from Haiti shows that individuals infected with MDR-TB and COVID-19 are more inclined to unproductive results due to a prominent decrease in lobar volume and an expanded measure of cavities than individuals contaminated with drug-susceptible tuberculosis.

&nbsp;

The administration of MDR-TB requires a strategic, successful, and organized plan of action at both the federal and provincial levels. The public authorities have introduced creative and implementable methodologies as per the WHO rules to manage the multidrug-safe TB emergency in the country.&nbsp; 
&nbsp;

In 2001, the announcement of TB as a public crisis compelled the Ministry of Health to make the National TB Program (NTP) which by 2025, plans to diminish the occurrence of TB by half when contrasted with the frequency rate in 2012.&nbsp; 
&nbsp;

In 2009, the WHO conceived a TBIC (TB infection control) strategy to forestall the spread of TB, and this strategy was praised and implemented by Pakistan&#39;s public TBIC plan. Adoption of these strategies drove NTP to create a Programmatic Management of Drug-Resistant Tuberculosis (PMDT) model of care in 2010<a href="#accordion">[1]</a>.&nbsp; 
&nbsp;

PMDT program of Pakistan comprises a reigning and senior macrosystem of global organizations with similar objectives such as WHO and Global Fund and a microsystem at the base containing cooperative and collaborative public and provincial TB projects and NGOs. As mandated by this program, NTP laid out numerous facilities throughout the nation that function by providing patients relief and liberation from the cost of medical counsel and medications for drug-resistant TB. Also, they provide contact tracing following the mandatory TB case notification project (MCN).&nbsp; 
&nbsp;

The commencement of these facilities prompted the achievement rate to come to 76% when contrasted with the previous 10-46%, and the death rate declined from 40-13% by 2011<a href="#accordion">[1].</a> 
&nbsp;

However, the NTP is not the only mechanism to combat TB. The provincial TB program (PTP) is additionally initiated in each territory and has comparative plans to suppress TB in the approaching 10 years. To abbreviate and eliminate the differences between notified cases and actual cases, NTP laid out a Public-Private Mix Model (PPM) in 2014 which had 4 classifications of the public domain in particular the general practitioner (GP), TB care given by NGOs, private clinics, and another public area (Parastatal) medical clinics like WAPDA, Railway clinics and so forth. 
&nbsp;

The PPM model prompted increased case notifications in the age demographics of less than 15 years and greater than 54 years. It started Directly Observed Treatment and Short course (DOTS) in each one of the territories as per the WHO rules, in which the patients are given short course sedatives and medications for pain alleviation alongside the careful observation of TB treatment by the medical services laborers. 
&nbsp;

The End TB Summit, scheduled on January 18, 2021, was eventful as the then president, Dr. Arif Alvi took notice of the continuous TB emergency by referencing the alarming quantity of TB cases recognized every year. At the time, the number was a whopping 350,000 and required immediate attention and a planned strategy across the globe to develop a united front to assist countries such as Pakistan to eradicate TB by 2030<a href="#accordion">[2]</a>.&nbsp; 
&nbsp;

The uncanny similarities between the two respiratory illnesses - COVID-19 and TB - cannot be denied. Since they have similar symptoms such as fever, cough, suppression of appetite, and breathlessness, it is important to mandate TB screening in COVID-19 cases as well.&nbsp; 
&nbsp;

In an attempt to diminish the severity of the two illnesses occurring simultaneously, a few methodologies were put in effect in various urban communities like Karachi which incorporate: 
&nbsp;

<ul>
	<li>Co-evaluating for COVID-19 and TB in prior TB habitats</li>
	<li>Home conveyance of prescriptions</li>
	<li>Support of conventions for the security of both the patients and medical services&nbsp;laborers</li>
	<li>Intently observing the psychological prosperity of medical care&nbsp;laborers</li>
	<li>Bringing in to follow up the status of the patients who test positive</li>
</ul>

&nbsp;

The development of MDR-TB has made the administration of TB exceptionally demanding and taxing. The prevalence of such resistant types of TB among the Pakistani populace is alarmingly high because of insufficient awareness campaigns on the transmission of this lethal respiratory contamination, non-adherence of diagnosed patients to the medication regimens, and the absence of preventive estimates rehearsed by everybody.&nbsp; 
&nbsp;

The advancement up until this point, to destroy MDR-TB, has been inefficient and inadequate. Thus, severe measures by the general society and private medical services areas ought to be strictly enforced on a wide scale to achieve a guaranteed maximal decrease of MDR-TB cases.

&nbsp;

The existence of MDR-TB is a challenge to medical health care providers and the government of every nation. It is important to note that:

<ul>
	<li>Multiple Drug-Resistant Tuberculosis (MDR-TB) is when patients diagnosed with TB develop resistance to prescribed medications such as Rifampicin (RIF) and Isoniazid (INH) and also show resistance to four first-line medications.</li>
	<li>Resistance is developed when the prescribed dosages are not administered, and the drugs are misused.</li>
	<li>MDR-TB is difficult to treat and causes complications for individuals with HIV or COVID-19.&nbsp;</li>
	<li>The fight against MDR-TB is a global one as it proves to be a risk to the general well-being of the public; therefore, steps have been taken by international organizations&nbsp;such as WHO and the Global Fund along with the Government of Pakistan to eradicate MDR-TB.</li>
	<li>Tuberculosis is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately.</li>
</ul>

&nbsp;

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

[2] APP. (2022, January 19). President for collective efforts to eliminate TB.

[3] Baghaei, P., Tabarsi, P., Dorriz, D., Marjani, M., Shamaei, M., Pooramiri, M., . . . Velayati, A. (2011). Adverse effects of multidrug-resistant tuberculosis treatment with a standardized regimen: a report from Iran. American journal of therapeutics, 18(2), e29-e34.

[4] Centers for Disease Control and Prevention (CDC). (2016, May 4). Multidrug-Resistant Tuberculosis (MDR TB) Fact Sheet.

[5] Centers for Disease Control and Prevention (CDC). (2017). Division of Tuberculosis Elimination, National Center for HIV, Viral Hepatitis, STD, and T. P. Retrieved from Centers for Disease Control and Prevention (CDC):

[6] Gandhi, N. R., Moll, A., Sturm, A. W., Pawinski, R., Govender, T., Lalloo, U., . . . Friedland, G. (2006). Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet (London, England), 368(9547), 1575-1580.

[7] Khan, M. A., Bilal, W., Asim, H., Rahmat, Z. S., Essar, M. Y., & Ahmad, S. (2022). MDR-TB in Pakistan: Challenges, efforts, and recommendations. Annals of Medicine and Surgery, Volume 79.

[8] Leung, E. C., Leung, C. C., Kam, K. M., Yew, W. W., Chang, K. C., Leung, W. M., & Tam, C. M. (2013). Transmission of multidrug-resistant and extensively drug-resistant tuberculosis in a metropolitan city. European Respiratory Journal, 41 (4), 901-908.

[9] Malik, A. A., Hussain, H., Maniar, R., Safdar, N., Mohiuddin, A., Riaz, N., . . . Khowaja, S. (2022). Integrated Tuberculosis and COVID-19 Activities in Karachi and Tuberculosis Case Notifications. Tropical medicine and infectious disease, 7(1), 12.

[10] Marwah, V., Peter, D. K., Kumar, T. A., Bhati, G., & Kumar, A. (2021). Multidrug-resistant tuberculosis in COVID-19: Double trouble. Medical Journal Armed Forces India, 77, S479-S482.

[11] Murase, Y., Maeda, S., Yamada, H., Ohkado, A., Chikamatsu, K., Mizuno, K., . . . Mitarai, S. (2010). Clonal expansion of multidrug-resistant and extensively drug-resistant tuberculosis, Japan. Emerging infectious diseases, 16(6), 948-954.

[12]  Pradipta, I. S., Forsman, L. D., Bruchfeld, J., Hak, E., & Alffenaar, J. W. (2018). Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. Journal of Infection, 77(6), 469-478.

[13]  Ullah, W., Wali, A., Haq, M. U., Yaqoob, A., Fatima, R., & Khan, G. M. (2021). Public–Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Frontiers in public health, 9.

[14] UNAIDS. (2008, February 28). MDR-TB more common in people living with HIV.

[15]  Vilbrun, S. C., Mathurin, L., Pape, J. W., Fitzgerald, D., & Walsh, K. F. (2020). Case report: multidrug-resistant tuberculosis and COVID-19 coinfection in Port-au-Prince, Haiti. The American Journal of Tropical Medicine and Hygiene, 103(5).

[16]  Waheed, Y., Khan, M. A., Fatima, R., Yaqoob, A., Mirza, A., Qadeer, E., . . . Kumar, A. M. (2017). Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public health action, 7(1), 26-31.

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

Understanding Pakistan's Fight Against TB

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

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

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

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

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

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

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

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