NEWSLETTERMAROOF

August 2017

Breast cancer, what it is?Ÿ Cancer is the growth of abnormal cells.Ÿ Cancer cells can invade and damage normal tissues.Ÿ Breast Cancer can start in any part of breast.

Breast StructureŸ The breasts sit on chest

muscles that cover the ribs.Ÿ Each breast consists of 15-

20 lobes, which contain many smaller lobules.

Ÿ Lobules contain group of tiny glands that produce milk.

Ÿ Milk ows from lobules through thin tubes, called ducts to the nipple.

Ÿ The nipple is in the center of a dark area of skin called areola.

Ÿ Fat or stroma lls the spaces between the areola and ducts.

Types of Breast CancerTwo most common types are:Ÿ Ductal Carcinoma – Originates from ductsŸ Lobular Carcinoma – Originates from lobules.

Incidence, how big is the problem?Ÿ Worldwide, Breast cancer is the most common invasive

cancer in women.Ÿ Pakistan has the highest breast cancer incidence in

Asia.Ÿ Every year 44000 women die of breast cancer in

Pakistan.Ÿ At some stage of life, 1 in 9 woman in Pakistan has to

become a breast cancer patient.Ÿ Younger women are presenting with advanced stage

breast cancer.Ÿ Iran J Public Health, Vol. 44, No.4, Apr 2015, pp.586-587

CausesŸ Breast cancer is always caused by a genetic

abnormality.Ÿ Only 5-10% breast cancers are due to inherited

abnormality.Ÿ About 90% of breast cancers are due to genetic

abnormalities due to ageing process and 'wear and tear' of life in general.

Risk FactorsŸ Risk factors are anything that can increase or decrease

a person's chance of getting a disease such as cancer.Ÿ There are many known risk factors for breast cancer.

Some of these can't be changed but some can…Ÿ Gender: Female (1% males only)Ÿ Race: More common in white.Ÿ Age: Increases, as a woman gets older.Ÿ Relative: Mother or SisterŸ Menstrual history: Early onset late menopauseŸ Childbirth: First child after the age of 30 yrs or having no

children at all.Ÿ Pregnancy and Breast-feeding are protective against

breast cancer.Ÿ ObesityŸ Diet: Fat, AlcoholŸ Radiation ExposureŸ History of cancer: Breast, Uterus, Cervix, and Ovary.Ÿ Hormones: Estrogens in hormone replacement therapy

and birth control pills.Ÿ Genetics: Certain conditions that are inherited, like

BRCA 1 and 2 mutations.Ÿ More than 70% have no risk factor.

SymptomsŸ Early Breast cancer

may not have symptoms.

Ÿ Breast Lumps and masses.

Ÿ Most common symptom.

Ÿ A mass that's painless, hard, and has irregular edges is more likely to be cancer.

Ÿ But breast cancers can be tender, soft, or rounded. They can even be painful.

Ÿ For this reason, it's important to have any new breast mass, lump, or change checked by a health care provider experienced in diagnosing breast diseases.

Other SymptomsŸ Swelling of all or part of a breast (even if no distinct lump

is felt)Ÿ Skin irritation or dimplingŸ Breast or nipple painŸ Nipple retraction (turning inward)Ÿ Redness, scaliness, or thickening of the nipple or breast

skinŸ A nipple discharge other than breast milkŸ Sometimes breast cancer can spread to lymph nodes

under the arm or around the collarbone and cause a lump or swelling there, even before the original tumor in the breast t i ssue is large enough to be felt .

Triple assessment1. Clinical examinationŸ BSE– Breast Self ExaminationŸ CBE– Clinical Breast Examination by trained Health care

provider.2. Radiological assessmentŸ Ultrasonography– better age40 yrsŸ MRI Breast

3. Pathological assessmentŸ FNAC– Fine needle aspiration cytologyŸ True cut biopsyŸ Excision biopsyŸ Incisional / Wedge Biopsy

PreventionA) Screening for Breast CancerA good Breast Health PlanŸ Self Awareness—BSE, i.e monthly breast self examination

What you need to know about BREAST CANCER

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Dr. Ayesha JavedConsultant General andLaparoscopic SurgeonMBBS (Pak), MRCS (UK),M.D (USA), FCPS (Pak)Maroof International Hospital, Islamabad.IMC, NESCOM Hospital, Islamabad

Ÿ Clinical Breast Examinations--- CBEŸ Mammograms.

B) Breast Self Examination (BSE)Ÿ Opportunity for woman to become familiar with her

breasts.Ÿ Monthly examination of breasts and under arm area.Ÿ May discover any changes early.Ÿ Begin at age of 20 yrs, continue monthly.

How to do BSEŸ Menstruating women, 5-7 days after the beginning of

their period.Ÿ Menopausal women, same date each month.Ÿ Pregnant women, same date each month.Ÿ It takes about 10 minutes.Ÿ Perform BSE once a month.Ÿ Examine all the breast tissue and armpits.

Steps of BSEŸ Step 1: Begin by looking at your breasts in the mirror with

your shoulders straight and your arms on your hips.Ÿ Here's what you should look for:Ÿ Breasts that are their usual size, shape, and colorŸ Breasts that are evenly shaped without visible distortion

or swellingŸ If you see any of the following changes, bring them to

your doctor's attention:Ÿ Dimpling, puckering, or bulging of the skinŸ A nipple that has changed position or an inverted

nipple.Ÿ Redness, soreness, rash, or swellingŸ Step 2: Now, raise your arms and look for the same

changes.Ÿ Step 3: While you're at the mirror, look for any signs of

uid coming out of one or both nipples (this could be a watery, milky, or yellow uid or blood)

Ÿ Step 4: Next, feel your breasts while standing in front of mirror. Many women nd that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the circular hand movements.

Ÿ Step 5: Finally, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast.

Ÿ Use a rm, smooth touch with the nger pads of your hand, keeping the ngers at and together. Use a circular motion to feel.

Why don't more women practice BSE?Ÿ FearŸ EmbarrassmentŸ YouthŸ Lack of knowledgeŸ Too busy, forgetful.

Clinical breast Examination (CBE)Ÿ Performed by a doctor or a trained health care

provider.Ÿ Annually for women over 40 years.Ÿ At least every 3 years for women between ages 20-40

years.Ÿ More frequent examinations for high-risk patients.

C) MammographyŸ A mammogram is an X-Ray of breast.Ÿ For mammogram, the breast is pressed between two

plates to atten and spread the tissue and take images.Ÿ Two views are usually taken:

1. Cranio-caudal 2. Medio-lateral-oblque.

MammographyFor Women at average risk of breast cancerŸ Age 40-44—should be able to start breast cancer

screening, if they wish to do so.Ÿ Age 45-54---should get mammograms every year.Ÿ Age 55 years or more should switch to mammograms

every two years.

Ÿ Screening should continue as long as the woman is in good health or is expected to live ten or more years.

High Risk PatientsŸ Patients who are high risk based on various risk factors,

family history or screening mammograms, should have an MRI breast to complement mammograms.

Pathological DiagnosisFNAC- Fine Needle Aspiration CytologyŸ A very thin, hollow needle attached to a syringe is used

to withdraw (aspirate) a small amount of tissue from a suspicious area, which is then looked at under a microscope.

Ÿ FNAC is the easiest biopsy. Ÿ But it has some disadvantages. It can sometimes miss a

cancer .Ÿ It is usually not possible to determine if the cancer is

invasive. Ÿ There may not be enough cells to perform other lab tests

that are done on breast cancer specimens. Ÿ If the FNA biopsy does not provide a clear diagnosis, or

doctor is still suspicious, a second biopsy or a different type of biopsy should be done.

True-Cut BiopsyŸ A needle with a gap near its tip is passed into the lesion.Ÿ A surrounding sheath with a cutting tip is passed down

the needle.Ÿ The sheath cuts a specimen corresponding to the gap in

the needle.Ÿ The needle and sheath, with the specimen, are then

removed from the patient.True-Cut BiopsyBenetsŸ Gets a tissue specimen.Ÿ More reliable and authentic histopathological

diagnosis.Ÿ Other tests like receptor status can be performed.

DisadvantagesŸ A trained doctor needs to perform it.Ÿ Needs local anesthesia and a small 2mm incision.Ÿ Needs oral analgesics, post operatively.

Excision BiopsyŸ If the lump is small, mobile and has benign cytology on

FNAC, then some times it is excised as a whole and send for histopathology. This is known as excision biopsy.

Incisional/ Wedge BiopsyŸ If there is a large supercial or advanced fungating

lesion then, a small wedge biopsy is taken from margin of lesion. This is known as incisional biopsy.

TreatmentBreast cancer treatment can include a combination of all,

or some of the following treatments:Ÿ Surgery Ÿ RadiotherapyŸ ChemotherapyŸ Anti-Hormone therapyŸ Targeted therapy

MythsŸ Breast Cancer can only affect older women.Ÿ Touching the breasts too often will lead to breast

cancer.Ÿ Talking about cancer causes cancer.Ÿ Herbs cure breast cancer.Ÿ A bruise on the breast leads to breast cancer.Ÿ If an incision is made during breast cancer surgery, the

cancer will spread.Ÿ Getting too many mammograms can lead to breast

cancer.Ÿ Using antiperspirants causes breast cancer.Ÿ A breast cancer diagnosis is an automatic death

sentence.

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Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. Aplastic anemia leaves you feeling fatigued and with a higher risk of infections and uncontrolled bleeding.

A rare and serious condition, aplastic anemia can develop at any age. Aplastic anemia may occur suddenly, or it can occur slowly and get worse over a long period of time. Treatment for aplastic anemia may include medications, blood transfusions or a stem cell transplant, also known as a bone marrow transplant.

Symptoms

Aplastic anemia symptoms may include:

Ÿ Fatigue

Ÿ Shortness of breath with exertion

Ÿ Rapid or irregular heart rate

Ÿ Pale skin

Ÿ Frequent or prolonged infections

Ÿ Unexplained or easy bruising

Ÿ Nosebleeds and bleeding gums

Ÿ Prolonged bleeding from cuts

Ÿ Skin rash

Ÿ Dizziness

Ÿ Headache

Aplastic anemia can progress slowly over weeks or months, or it may come on suddenly. The illness may be brief, or it may become chronic. Aplastic anemia can be very severe and even fatal.

Causes

Aplastic anemia develops when damage occurs to your bone marrow, slowing or shutting down the production of new blood cells. Bone marrow is a red, spongy material inside your bones that produces stem cells, which give rise to other cells. Stem cells in the bone marrow produce blood cells — red cells, white cells and platelets. In aplastic anemia, the bone marrow is described in medical terms as aplastzic or hypoplastic — meaning that it's empty (aplastic) or contains very few blood cells (hypoplastic).

Factors that can temporarily or permanently injure bone marrow and affect blood cell production include:

Ÿ While these Radiation and chemotherapy treatments.cancer-ghting therapies kill cancer cells, they can also damage healthy cells, including stem cells in bone marrow. Aplastic anemia can be a temporary side effect of these treatments.

Ÿ Exposure to toxic Exposure to toxic chemicals.chemicals, such as some used in pesticides and insecticides, may cause aplastic anemia. Exposure to benzene — an ingredient in gasoline — also has been linked to aplastic anemia. This type of anemia may get better on its own if you avoid repeated exposure to the chemicals that caused your initial illness.

Ÿ Some medications, Use of certain drugs.such as those used to treat rheumatoid arthritis and some antibiotics, can cause aplastic anemia.

Ÿ An autoimmune Autoimmune disorders.disorder, in which your immune system begins attacking healthy cells, may involve stem cells in your bone marrow.

Ÿ Viral infections that affect A viral infection. bone marrow may play a role in the development of aplastic anemia in some people. Viruses that have been linked to the development of aplastic anemia include hepatitis, Epstein-Barr, cytomegalovirus, parvovirus B19 and HIV.

Ÿ Aplastic anemia that occurs in pregnancy Pregnancy.may be related to an autoimmune problem — your immune system may attack your bone marrow during pregnancy.

Ÿ In many cases, doctors aren't able to Unknown factors.identify the cause of aplastic anemia. This is called idiopathic aplastic anemia.

Confusion with myelodysplastic syndrome

Aplastic anemia can be mistaken for a condition called myelodysplastic syndrome. In this group of disorders, the bone marrow produces new blood cells, but they're deformed and underdeveloped. The bone marrow in myelodysplastic syndrome is sometimes called hyperplastic — meaning that it's packed with blood cells. But some people with myelodysplastic syndrome have empty marrow that's difcult to distinguish from aplastic anemia.

Connections with other rare disorders

Some people with aplastic anemia also have a rare disorder known as paroxysmal nocturnal hemoglobinuria. This disorder causes red blood cells to break down too soon. Paroxysmal nocturnal hemoglobinuria can lead to aplastic anemia, or aplastic anemia can evolve into paroxysmal nocturnal hemoglobinuria.

Fanconi's anemia is a rare, inherited disease that leads to aplastic anemia. Children born with it tend to be smaller than average and have bi r th defects , such as underdeveloped limbs. The disease is diagnosed with the help of blood tests.

Risk factors

Aplastic anemia is rare. Factors that may increase your risk include:

Ÿ Treatment with high-dose radiation or chemotherapy for cancer

Ÿ Exposure to toxic chemicals

Ÿ The use of some prescription drugs — such as chloramphenicol, which is used to treat bacterial infections, and gold compounds used to treat rheumatoid arthritis

Ÿ Certain blood diseases, autoimmune disorders and serious infections

Ÿ Pregnancy, rarely

Diagnosis

To diagnose aplast ic anemia, your doctor may recommend:

Aplastic Anemia

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Dr. Muhammad SalmanRegistrar IPD

option for people with severe aplastic anemia. A stem cell transplant, which is also called a bone marrow transplant, is generally the treatment of choice for people who are younger and have a matching donor — most often a sibling.

If a donor is found, your diseased bone marrow is rst depleted with radiation or chemotherapy. Healthy stem cells from the donor are ltered from the blood. The healthy stem cells are injected intravenously into your bloodstream, where they migrate to the bone marrow cavities and begin generating new blood cells. The procedure requires a lengthy hospital stay. After the transplant, you'll receive drugs to help prevent rejection of the donated stem cells.

A stem cell transplant carries risks. There's a chance that your body may reject the transplant, leading to life-threatening complications. In addition, not everyone is a candidate for transplantation or can nd a suitable donor.

Immunosuppressants

For people who can't undergo a bone marrow transplant or for those whose aplastic anemia may be due to an autoimmune disorder, treatment may involve drugs that alter or suppress the immune system (immunosuppressants).

Drugs such as cyclosporine (Gengraf, Neoral, Sandimmune) and anti-thymocyte globulin are examples. These drugs suppress the activity of immune cells that are damaging your bone marrow. This helps your bone marrow recover and generate new blood cells. Cyclosporine and anti-thymocyte globulin are often used in combination.

Corticosteroids, such as methylprednisolone , are often given at the same time as these drugs.

Immune-suppressing drugs can be very effective at treating aplastic anemia. The downside is that these drugs further weaken your immune system. It's also possible that after you stop taking these drugs, aplastic anemia may return.

Bone marrow stimulants

Certain drugs — including colony-stimulating factors, such as sargramostim (Leukine), lgrastim (Neupogen) and peglgrastim (Neulasta), and epoetin alfa (Epogen, Procrit) — may help stimulate the bone marrow to produce new blood cells. Growth factors are often used in combination with immune-suppressing drugs.

Antibiotics, antivirals

Having aplastic anemia weakens your immune system. You have fewer white blood cells in circulation to ght off germs. This leaves you susceptible to infections.

At the rst sign of infection, such as a fever, see your doctor. You don't want the infection to get worse, because it could prove life-threatening. If you have severe aplastic anemia, your doctor may give you antibiotics or antiviral medications to help prevent infections.

Other treatments

Aplastic anemia caused by radiation and chemotherapy treatments for cancer usually improves once you complete those treatments. The same is true for most other drugs that induce aplastic anemia.

Pregnant women with aplastic anemia are treated with blood transfusions. For many women, pregnancy-related aplastic anemia improves once the pregnancy ends. If that doesn't happen, treatment is still necessary.

Ÿ Blood tests. Normally, red blood cell, white blood cell and platelet levels stay within a certain range. Your doctor may suspect aplastic anemia when all three of these blood cell levels are very low.

Ÿ To conrm a diagnosis, you'll need Bone marrow biopsy.to undergo a bone marrow biopsy. In this procedure, a doctor uses a needle to remove a small sample of bone marrow from a large bone in your body, such as your hipbone. The bone marrow sample is examined under a microscope to rule out other blood-related diseases. In

aplastic anemia, bone marrow contains fewer blood cells than normal.

Once you've received a diagnosis of aplastic anemia, you may need additional tests to determine an underlying cause.

Treatment

Treatments for aplastic anemia may include observation for mild cases, blood transfusions and medications for more-serious cases, and in severe cases, bone marrow transplantation. Severe aplastic anemia, in which your blood cell counts are extremely low, is life-threatening and requires immediate hospitalization for treatment.

Blood transfusions

Treatment for aplastic anemia usually involves blood transfusions to control bleeding and relieve anemia symptoms. Blood transfusions aren't a cure for aplastic anemia. But they do relieve signs and symptoms by providing blood cells that your bone marrow isn't producing. A transfusion may include:

Ÿ Transfusions of red blood cells raise red Red blood cells.blood cell counts. This helps relieve anemia and fatigue.

Ÿ Transfusions of platelets help prevent Platelets.excessive bleeding.

While there's generally no limit to the number of blood cell transfusions you can have, complications can sometimes arise with multiple transfusions. Transfused red blood cells contain iron that can accumulate in your body and can damage vital organs if an iron overload isn't treated. Medications can help your body get rid of excess iron.

Over time, your body may develop antibodies to transfused blood cells, making them less effective at relieving symptoms. The use of immunosuppressant medication makes this complication less likely.

Stem cell transplant

A stem cell transplant to rebuild the bone marrow with stem cells from a donor may offer the only successful treatment

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PROPER HANDLING OF CONTACT LENS, COMPLICATIONS & ITS MANAGEMENTContact lenses are used to correct refractive error, improvement of v isual acuity, and to enhance appearance for cosmetic reasons. It is important to point out that every contact lens wearer should get his/her eyes examined buy an eye specialist in order to rule out any underlying disease of the eyes specially the lids, prior to tting of contact lenses. This will help prevent lens intolerance and possible complications in the future. It is a common observation that ocular allergies such as seasonal or perennial allergic conjunctivitis or constant irritation due to atmospheric pollution like itching, redness and lid edema which makes it difcult for a patient to wear lenses comfortably. Prescribing an anti-allergic medication for the patient before lens insertion could be a possible solution or using daily disposable lens may help extend a patient's comfortable lens-wear time.

Improper use of contact lenses can cause numerous complications manifesting various symptoms. Universally, about 4% of the contact lens wearer suffer from these complications. This could be due to incorrect handling resulting in trauma, decreased corneal oxygenation, reduced wetting, allergic reaction or inammation due to infection. Patient usually complains of pain, redness,

Dr. Jahanzeb Durrani

MBBS, DO, MS(Ophth),

FICO (UK)

watering, burning, headache, decreased vision leading to contact lens intolerance. Those who don't practice proper lens hygiene should remove the lenses at the rst sign of irritation or redness may suffer from corneal ulcers. If the symptoms still persist after removal of the lens he/she should consult an eye specialist and get immediate treatment in order to avoid further complication which could be devastating in the long run. He may also require temporary cessation of contact lens use for few days.

He should get his eyes properly examined by his doctor, possibly the contact lenses are inadequately tted. Giant papillary conjunctivitis is the sign of inamed conjunctiva (raised inner lining of the lid tissue) which is always due to contact lens intolerance. Protein deposits are another cause of irritation, blurry vision, itchiness and redness.

Hence, proper tting of lens by a trained optician, preferably an eye specialist is absolutely mandatory. In such cases, patients should avoid purchasing non-standardized cheaper lenses.

It is advisable to use daily wear contact lens for 8-12 hours only preferably with 55% water content. In case of those who have long duty hours normally use the extended wear

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There are many types of lenses in the market i.e. hard lenses, gas permeable lenses, soft lenses, disposable, toric and multi-colored lenses. The attractive colored lenses are studied with additional pigments which gives a specic hue as a preferred choice of the patient which gives a better cosmetic/ facial outlook. These colored lenses should be used only for specic functions, social gatherings and not as a routine in place of transparent lenses for prolonged periods. Dry eye can also be problematic for lens wearers, forcing them to use rewetting solutions frequently. Visual tasking such as working at a computer, reading or watching TV can be uncomfortable for people suffering from dry eye and contact lens wearer may experience exacerbation of these symptoms.

Contact Lens Solution Reaction

Switching to a multipurpose lens solution containing an enzymatic cleaner may help in keeping proper lens hygiene while daily disposable lenses can also keep protein deposits under control. There are several lens cleaning options currently available like multipurpose solutions and

are used for rinsing, disinfecting, cleaning and storing the lenses.

Preservative-free products usually have shorter shelf life. To prevent infection, discourage the use of tap water or fresh water to rinse contact lenses which may contain bacteria to cause infection. From the safety point of view, every contact lens wearer is advised to change the lens at the end of one year even if it is not hurting him/her. They should change the solution daily in the morning and must cleanse the lens before storing it in the container daily.

lenses. Scientically speaking a contact lens is a foreign body in the eye, must be used for a shorter periods during the ofce hours or school or university timings. Since it is used purely for cosmetic purposes, it should preferably be removed at the end of their working hours. No doubt, glasses are the preferred choice, and we should desist from using contact lenses unnecessarily. In case patient is very much averse to glasses, he must remove the lenses before going to the bed.

CHILDHOOD OBESITY

Over the past three decades the prevalence of overweight and obesity has increased substantially. Globally, an estimated 170 million children (aged less than 18 years) are now estimated to be overweight. The highest prevalence of childhood overweight is in upper-middle-income countries, and, when taken as a group, low-income countries have the lowest prevalence rate. However, overweight is rising in almost all countries, with prevalence rates growing fastest in lower-middle-income countries Childhood obesity is a serious medical condition that affects children and adolescents. Children who are obese are above the normal weight for their age and height.Childhood obesity is particularly troubling because the extra pounds often start children on the path to health problems that were once considered adult problems — diabetes, high blood pressure and high cholesterol. Many obese children become obese adults, especially if one or both parents are obese. Childhood obesity can also lead to poor self-esteem and depression.Obesity is dened as having excess body fat. Overweight is dened as having excess body weight for a particular height from fat, muscle, bone, water, or a combination of these factors. Body mass index, or BMI, is a widely used screening tool for measuring both overweight and obesity. BMI percentile is preferred for measuring children and young adults (ages 2–20) because it takes into account that they are still growing, and growing at different rates depending on their age and sex. Health professionals use growth charts to see whether a child’s weight falls into a healthy range for the child’s height, age, and sex.

Childhood Obesity and Child WellbeingChildhood obesity has immediate and long-term impacts on physical, social, and emotional health. For example:Ÿ Children with obesity are at higher risk for having

other chronic health conditions and diseases that impact physical health, such as asthma, sleep apnea, bone and joint problems, type 2 diabetes, and risk factors for heart disease.

Ÿ Children with obesity are bullied and teased more than their normal weight peers, and are more likely to suffer from social isolation, depression, and lower self-esteem.

Ÿ In the long term, childhood obesity also is associated

with having obesity as an adult, which is linked to serious conditions and diseases such as heart disease, type 2 diabetes, metabolic syndrome, and several types of cancer.

Energy Balance and Causes of ObesityMany factors contribute to childhood obesity, includingŸ GeneticsŸ Metabolism—how your body changes food and

oxygen into energy it can useŸ Eating and physical activity behaviorsŸ Environmental factorsŸ Social and individual psychology

Over time, consuming more energy from foods and beverages than the body uses for healthy functioning, growth, and physical activity, leads to extra weight gain. Energy imbalance is a key factor behind the high rates of obesity seen globally.The dietary and physical activity behaviors of children and adolescents are inuenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries.

What Diseases Are Obese Children at Risk For?Obese children are at risk for a number of conditions, including:

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Ÿ High cholesterol Ÿ High blood pressure Ÿ Early heart diseaseŸ Diabetes Ÿ Bone problemsŸ Skin conditions such as heat rash, fungal infections,

and acne

Controlling Childhood ObesityBalance is key in helping your child maintain a healthy weight. Balance the calories your child eats and drinks with the calories used through physical activity and normal growth.Overweight and obese children and teens should reduce the rate of weight gain while allowing normal growth and development. Do not put your child on a weight-reduction diet without talking to your health care provider.

Balancing Calories: Help Kids Develop Healthy Eating HabitsOffer your kids nutritious meals and snacks with an appropriate number of calories. You can help them develop healthy eating habits by making favorite dishes healthier and by reducing calorie-rich temptations. 1. Encourage healthy eating habits. Small changes can lead to a recipe for success! Ÿ Provide plenty of vegetables, fruits and whole-grain

products.

Ÿ Include low-fat or non-fat milk or dairy products.Ÿ Choose lean meats, poultry, sh, lentils and beans for

protein.Ÿ Serve reasonably sized portions.Ÿ Encourage your family to drink lots of water.Ÿ Limit sugar-sweetened beverages, sugar, sodium and

saturated fat. 2. Make favorite dishes healthier. Some of your favorite recipes can be healthier with a few changes. You can also try some new heart-healthy dishes that might just become favorites too! 3. Remove calorie-rich temptations.Treats are OK in moderation, but limiting high-fat and high-sugar or salty snacks can also help your children develop healthy eating habits.

4. Help your kids understand the benets of being physically active.Teach them that physical activity has great health benets like: Ÿ Strengthening boneŸ Decreasing blood pressureŸ Reducing stress and anxietyŸ Increasing self-esteemŸ Helping with weight management

5. Help kids stay active.Children and teens should participate in at least 60 minutes of moderate-intensity physical activity most days of the week, and every day if possible. You can set a

great example! Start adding physical activity to your own daily routine and encourage your child to join you. Some examples of moderate-intensity physical activity include: Ÿ Brisk walkingŸ Playing tagŸ Jumping ropeŸ Playing soccerŸ SwimmingŸ Dancing

6. Reduce sedentary time.Although quiet time for reading and homework is ne, limit “screen time” (TV, video games, Internet) to no more than two hours a day.

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Organizational goals' achievement always lay on the strength of its team. For building up this team strength, Maroof thinternational Hospital organized a teambuilding activity on 20 July 2017. Nominated employees from all the departments

participated in this activity. The aim of this activity was to focus on how to ll interdepartmental communication gaps. MS. Faiza Ameer, Sr. HR Executive, trained employees about the value of communication and its role in performing efciently as a team. Employees enjoyed this activity and appreciated the efforts of Human resource departments.

TEAMWORK MAKES THE DREAMWORK

A team from management of Fauji Fertilizer Company paid a visit to Maroof International Hospital on 19th July 2017. The aim of the visit was to see the state of the art technology and services provided at MIH. CEO Maroof, Ch. Haroon Naseer, led the visit and explained how the quality standards are always prioritized in each department and every service.

MIH VISIT BY MANAGEMENT TEAM FROMFAUJI FERTILIZER COMPANY

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Eat Healthy, Stay HealthyPina Colada SmoothiePineapple chunks 1 CupDesiccated Coconut ½ CupMilk 1 CupBanana 1Ice 1 CupSugar (Optional) 2 TablespoonPut all the ingredients in a blender and blend well. Garnish with mint leaves and

Tips to stay healthy in monsoon season

Ÿ If desired to eat road side food, the rainy season isn't the time to indulge. Water and raw vegetables are not hygienic during the monsoon.

Ÿ Use a powerful insect repellent to hold mosquitoes away and prevent getting bitten. It's furthermore good concept to take anti-malarial drug during this monsoon.

Ÿ Where likely, try to avoid walking through rainy water. It can lead to numerous fungal diseases of the feet and heels.Ÿ Keep away the children to play in the rain and rainy water.Ÿ If you suffer from asthma or diabetes, avoid residing any place with wet walls. It encourages the development of

fungus and can be especially hurtful.Ÿ Drink many of heating herbal teas, particularly those with antibacterial properties.Ÿ During the monsoon season, it is advised not to consume fast food and the snacks from the roadside stalls. This can

give rise to stomach infection. Ÿ It is really essential for you to consume adequate fruits during the monsoon season as this helps you restore energy. But

there is also choice of fruits as well. Go for the items like pears, mangoes, apples and pomegranate. Even there are some fruits that help bringing out pimples on your face. On order to remove pimples from your face, you need to avoid the fruits like muskmelon and water melon. Even consuming excessive mangos can give rise to pimples.

Ÿ It is better not to go for the watery food during the monsoon such as juices available outside, lassi and watery fruits. Instead go for the dry category of food such as pea, our, corn etc. as consumption of too much watery food during monsoon an give rise to swelling in your body. So, it's better to avoid.

Ÿ Since water borne diseases are quite common during the monsoon season, try not to drink water that is not puried. Even after ltration, it's better to drink the boiled water as this will kill all germs and bacteria that have formed in water.

Ÿ During monsoon since the weather is not too hot or too cold, you will be inclined towards the spicy foods. But this will be absolutely a wrong step. Avoid having spicy food during the monsoon season. It can lead to skin allergies and irritation.

Consultant On Board

Intercollegiate Speciality Board in Trauma &Orthopaedic Surgery (Ireland / UK)Special Interest in Joint Replacements, Arthroscopy,Paediatric Orthopaedics & TraumaConsultant Orthopaedic Surgeon Dr. Waqar Jan has recently came back from UK, and has over 20 years of experience in Orthopaedic surgery. He was working as a consultant in England prior to his present designation. Besides general Trauma & Orthopedics, Dr. Jan has special interest in knee and hip replacement. He also has specialty interest in pediatric orthopedics as well. He is on the consultants specialty register kept by GMC (UK), IMC (Ireland) and PMDC (Pakistan).

We welcome him on board and wish him all the best.

Dr. Waqar M. Jan

MBBS, FRCS (GEN),

FRCS (TR & ORTHO) UK & IRE

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UAN:+92-51-111-644-9-11Fax: +92-51-2222939

Tel:+92-51-8356165-6Email: media@maroof.com.pk

Maroof International Hospital, 10th Avenue, F-10 Markaz, Opposite F-9 Park, IslamabadMaroof Medical & Diagnostic Center, 22 West - Sardar Plaza, Opposite Poly Clinic, Fazal-e-Haq Road, Blue Area, Islamabad

PatronCh. Naseer Ahmed

Chief EditorCh. Haroon Naseer

EditorMalik Zeeshan Ali

Sub EditorMashal Rasool

Editorial Board

Department operation

As patients can present at any time and with any complaint, a key part of the operation of an emergency department is the prioritization of cases based on clinical need. Therefore, we have following sub-departments in our Accident and Emergency department based on clinical needs of the patients:

Acute pediatrics Examination room Major treatment room Male and Female wards

Accident & Emergency (A&E)

Accident & Emergency (A&E) is a medical treatment facility, specializing in acute care of patients who present without prior appointment, either by their own means or by ambulance. Due to the unplanned nature of patient attendance, we provide initial treatment for a broad spectrum of illnesses and injuries, some of which may be life-threatening and require immediate attention.Our emergency departments operate 24 hours a day, although stafng levels may be varied in an attempt to mirror patient volume. We have best personnel of Consultants, Medical Ofcers, Staff Nurses and Other paramedical staff, who are always available to serve the patient in their best capacity and capability..