Ü A rash around or on one of the nipples A discharge from...

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SymptomsÜ A pain in the armpits or breast does not change with the monthly cycle Ü Pitting or redness of the skin of the breast, like the skin of an orange Ü A rash around or on one of the nipples Ü A discharge from a nipple, possibly containing blood Ü A sunken or inverted nippleÜ A change in the size or shape of the breast Ü Peeling,�laking, or scaling of the skin on the breast or nipple

July 2018

MAROOFNEWSLETTER

H E P A T I T I S D A Y

W RLD

S T O P H E P A T I T I S S T O P H E P A T I T I S

2 8 t h J u l y 2 0 1 8

Let's�ightbreastcancer,startingwithyou

Today we are going to talk about Headache, its different types and how one can manage it effectively.

Briefintroductiontoheadache:Pain in the head is called headache. It also includes the face, teeth and the neck. There can be innumerable causes of headache. From simple trauma to dental issues to largely unknown factors headache can present in variety of forms. It is very important for a physician to ask patient different questions about headache and its associated features to accurately diagnose a headache and subsequently treat it effectively. In fact, there is a separate one year fellowship for headache offered as a sub-specialty of neurology or pain medicine. The different types of headaches have different characteristics. Some can present with headache on one side of the head, some can present with headache predominantly in the front of the head, some predominantly at the back of the head. Some patients have associated sensitivity to different environmental stimuli during a headache. It should also be understood that prevention of a headache is by far the best treatment. Unfortunately majority of patient population do not recognize their headache triggers.

Whatarethedifferenttypesofheadache?There are various types of headache however the two types of headache seen in majority of patients is 1) Migraine headache and 2) Tension-type headache. There are speci�ic disgnostic criteria for each type of headache and therefore they are treated differently. Few other examples include

cluster headache, trigeminal neuralgia, Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT syndrome), giant cell arteritis etc to name a few. Why it is important to ask so many questions about a headache is because a doctor wants to localize where in brain or head could be the source of the headache. For example, a patient may have pain in the eye but may refer to it as a headache when in fact it could be increased pressure inside the eye (Glaucoma). Similarly a dental or ear pain may be referred to has a headache and certainly it is the duty of a neurophysician to diagnose it for proper management.

HEADACHE

WaqarHafeez,MDConsultant Neurologist

Maroof International Hospital

02 I Maroof Newsle�er, July 2018 Maroof Newsle�er, July 2018 I 03

Types of Headaches

Migraine Hypertension

PopularMyths1. Very popularly known that high blood pressure causes headache. This is in fact a myth and is not true. High blood pressure does not cause headache and most people would have high blood pressure without knowing. High blood however can cause a pulse-like pressure feeling at the back of the head.

2. Brain tumor causes headache? Not commonly! On a rare circumstance if a brain tumor invades the head bone, it can cause a headache but usually brain tumors do not present with headache. They can present with weakness or loss of sensation on one side of the body. The most common tumor presenting with headache is of pituitary gland only when it is big enough.

Whattriggersaheadache?Most patients cannot identify simple things that they are doing in their routine that plays a major part in the headache genesis. The most common triggers of headache include

1. Lack of sleep2. Dehydration or lack of enough water intake3. Skipping or delaying meals

Besides the ones mentioned, there are many other triggers including stress (work related or family issues), caffeine intake, chocolate intake, cheese, Chinese salt (Mono-sodium glutamate), red wine and smoking to name some.

It is important to be vigilant and try to track your headache triggers. If no cause can be identi�ied, one should at least try to sleep on time, eat on time and try to keep hydrated. Of course a visit to Neurologist is mandated to have oneself examined to rule out potentially dangerous conditions.

Red�lagsforapotentiallydangerousheadache

1. Worst headache of life never experienced beforeHeadaches can also be life threatening especially if there is a bleed in the head. This condition is called sub-arachnoid hemorrhage. It usually presents as sudden onset severe headache that patient has never experienced before. If this is the case, immediate presentation to the emergency room (ER) is a must.

2. Fever with new headache and neck stiffnessHeadaches can also be because of meningitis which can present with neck stiffness besides extreme headache. This is also potentially life threatening condition. An immediate attention should be sought at ER.3. Headache with one sided weakness, numbness or with seizuresPotentially this signi�ies a tumor or a bleeding inside the brain (also known as brain hemorrhage)

PreventionofheadacheHeadache prevention starts with identifying potential triggers. Once a trigger or more than one trigger is identi�ied, prevention becomes very easy: avoid the triggers! Some people do their best and avoid triggers but still get a headache every so often. This is a time to go to the Neurologist. Avoidance of triggers is essentially in the form of changes in lifestyle. If these do not work, then comes the time for medicines. The medicine for headache prevention is taken on a daily basis whether you have a headache or not. Usually these medicines take up to 8 weeks to start working so one has to be patient when expecting the results. One important thing that one should also bear in mind is that one medicine does not work for every kind of patient. Your doctor may try different medicines before the right match for you is found.

TreatmentofheadacheTreatment of headache starts with prevention of headache with lifestyle changes and then comes medicines. For acute treatment, usually Non-Steroidal anti-in�lammatory drugs (NSAIDs) are used. These include Brufen (Ibuprofen), Disprin (Acetylsalicylic acid), Ponstan (Mefanemic acid) to name a few. If one has a headache, one should not delay taking medicines to treat headache. Of course these are general rules and this article should not be used as a guideline to treat headache. One should always consult a physician and preferably Neurophysician (Neurologist) for headache treatment.

What should not be done for headachetreatment?Patients should not take abortive medicines (like brufen, Disprin etc) on a daily basis as it increases the chances of getting a headache from the medicine itself which is known as analgesic overuse headache.

Conclusion:

Headache is one of the most common type of neurologic symptom. It should be investigated before treatment as it varies among different sub-types of headache. An expert opinion from a neurologist is the best way to go about treating your headache. Most headaches are benign and not dangerous but cause signi�icant disturbance in one's life. It is annoying but it is treatable.

Many people all over the world can't digest a certain sugar in milk and milk products called lactose. If you're one of them, you have Lactose Intolerance.

The condition isn't harmful, but it can be uncomfortable and may be embarrassing. There's no cure, but you can manage it by watching how much milk or milk products you drink or eat.

Being lactose intolerant is not the same as being allergic to milk.

WhatIsLactose?Lactose is the sugar that's in milk.Our bodies use an enzyme called lactase to break down that sugar so we can absorb it into our bodies. But people with lactose intolerance don't have enough lactase. It's produced in the small intestine.

Even with low levels of lactase, some people can digest milk products just �ine. For people who are lactose intolerant, their low lactase levels give them symptoms after they eat dairy.

But if you give up milk completely, you can still get plenty of calcium, vitamin D and other nutrients in a healthy diet.

Instead of milk, you can substitute these foods: Almonds Dried beans Tofu Kale Calcium-forti�ied orange juice and soy milk Fatty �ish, like salmon, tuna and mackerel Egg yolks Beef liver

If you have symptoms of lactose intolerance, see your doctor. And if you're diagnosed with it, talk with her about how to be sure you're eating right.

WebMD Medical Reference

WhatHappensInMyBodyIfI'mLactoseIntolerant?When we drink milk or have a milk-based product, lactase in our intestines breaks down the milk sugar. It then gets absorbed into the body through the intestines.

But people who are lactose intolerant don't have it so easy. In them, the lactose doesn't get broken down. Instead, it goes on to the colon, where it mixes with normal bacteria and ferments. It can cause things like gas, bloating and diarrhea.

There are some steps you can take to test yourself:1. Go without milk or milk products for a couple of weeks.2. If your symptoms disappear, bring dairy products back

into your diet a little at a time to take note of how you react.

3. If your symptoms continue after cutting out the dairy -- or if they return -- see your doctor to �ind out what's going on.

WhoDevelopsIt?Believe it or not, most adults around the world can't digest milk -- 40% of humans stop producing enough lactase to digest milk between the ages of 2 and 5.It can also be inherited or associated with other speci�ic diseases.

HowDoIKnowIfI'mLactoseIntolerant?Our bodies react to milk in ways that are easily measured. Two common tests for adults are:l Breath test. This will show if you have high levels of

hydrogen when you exhale. If you do, you might be lactose intolerant. That's because hydrogen is given off when lactose is broken down in the colon. The hydrogen gets taken by the blood up to your lungs, and then you exhale it.

l Blood test. This can show how your body reacts after you drink something with a lot of lactose.

Doctors can also take a stool sample from babies and young children.

WhatIfIHaveIt?You may still be able to eat or drink small amounts of milk. Some people do better if they have their dairy with a meal. And, some dairy products, like hard cheese or yogurt, may be easier to digest.

Also, there are lots of lactose-free dairy products at the supermarket. Or you can take commonly found over-the-counter supplements (like Lactaid) to break down the milk sugars if you still want the real thing.

WhatIsLactoseIntolerance?

Galactose Glocose

Lactose



MANY PEOPLEcan live for years without

knowing they have hepatitis

SYMPTOMS OF HEPATITISA, B AND C CAN INCLUDE:

Fatigue Nausea Mild fever

Yellow skin or eyes

Stomach pain

Dark urine

Antibiotics, also known as antibacterials, are medications that destroy or slow down the growth of bacteria. These are powerful drugs and are used to treat diseases caused by bacteria. If you get an infection, it is important to know whether it is caused by bacteria or virus, as Infections caused by viruses, such as colds �lu, most coughs, sore throats cannot be treated with antibiotics.

Although there are a number of different types of antibiotic, they all work in one of two ways,

l A bactericidal antibiotic (For example penicillin) kills the bacteria; these drugs usually interfere with either the formation of the bacterium's cell wall or its cell contents

l A bacteriostatic antibiotic , stops bacteria from multiplying

AllergiesŸ Some patients may develop an allergic reaction to

antibiotics - especially penicillins. Side effects might include a rash, swelling of the tongue and face, and dif�iculty breathing.

Allergic reactions to antibiotics can be immediate or delayed hypersensitivity reactions.

Anyone who has an allergic reaction to an antibiotic must tell their doctor or pharmacist. Reactions to antibiotics can be very serious, and sometimes fatal ,they are called anaphylactic reactions.

Antibiotics should be used with extreme caution for the following individuals:Ÿ Anyone with reduced liver or kidney functionŸ Anyone who is pregnantŸ Anyone who is breastfeeding

InteractionsIndividuals taking an antibiotic, should not take other medicines or herbal remedies without consulting with a doctor/pharmacist � irst . Over the counter (non-prescription) medicines might also interact with antibiotics. For example Penicillins, cephalosporins, and some other antibiotics can undermine the effectiveness of oral c o n t r a c e p t i v e s . I f t h e a n t i b i o t i c h a s c a u s e d diarrhea/vomiting the absorption of contraceptives may also be disrupted. Anyone taking these drugs should consider taking additional contraceptive precautions.

Antibiotics are usually administered orally, however, they can also be administered by injection or applied directly to the affected part of the body.

Most antibiotics start having an effect on an infection within a few hours. It is important to complete the whole course of medication to prevent the infection from coming back. Even if an individual feels better, they still need to complete the course of treatment.

Some antibiotics should not be consumed with certain foods and drinks. Few needs to be taken on an empty stomach, few would normally be taken about an hour before meals, or 2 hours after.

If taking tetracyclines, dairy products should not be consumed, as they might affect the absorption of the medication.

Antibiotics should be administered with propers guidance of your physician/pharmacist to get optimum results & avoide any health hazard.

But there are occasions; however, when it is all too much, and some help is needed, this is where antibiotics are useful. Penicillin-related antibiotics as ampicillin, amoxicillin, and benzyl penicillin are widely used today to treat a variety of infections.

Antibiotics are prescription drugs.

Resistance:There is concern worldwide that antibiotics are being overused. This overuse is contributing toward the growing number of bacterial infections that are becoming resistant to antibacterial medications.Alexander Fleming, speaking in his Nobel Prize acceptance speech in 1945 said: "Then there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug, make them resistant."

As predicted, almost 70 years ago by the man who discovered the �irst antibiotic, drug resistance is upon us.

If antibiotics are overused, underdosed or used incorrectly, there is a risk that the bacteria will become resistant.

ProphylacticuseofAntibiotics:In some cases, antibiotics may be given to prevent rather than treat an infection, as might be the case before surgery. This is called 'prophylactic' use of antibiotics.

Fastfactsaboutantibiotics:Penicillin was the �irst natural antibiotic, discovered by Alexander Fleming, in 1928. Fleming predicted the rise of antibiotic resistance we see today.

Most common side effects of antibiotics:

l Diarrhea

l Feeling sick

l Fungal infections of the mouth, digestive tract, and vagina

l Formation of kidney stones (With Sulphonamides)

l Abnormal blood clotting (With Cephalosporins)

l Sensitivity to sunlight (With Tetracyclines)

l Blood disorders (With Trimethoprim)

l Deafness.(With Erythromycin and Aminoglycosides)

Some patients, especially older adults, may experience in�lamed bowels (a type of colitis), which can lead to severe bloody diarrhea. Clindamycin, an antibiotic used for the most serious infections, commonly has this side effect.

Antibiotics are powerful medicines that �ight certain infections and can save lives when used properly. Before bacteria can multiply and cause symptoms, the body's immune system can usually kill them. Our white blood cells attack harmful bacteria and, even if symptoms do occur, our immune system can usually cope and �ight off the infection.


Antibiotics

Dr.MaryamFarooqi(R-Ph)AM Pharmacy DepartmentMaroof International Hospital

TESTIMONIALS:


Ingredients1cuppasta2tbsp.oilJuiceof1lemon(2tbsp)1/2tsp.salt,ortotaste1/4tsp.blackpepperpowder1/4tsp.garlicpaste1smallcarrot,dicedandboiled2tbsp.sweetcorn1/4cupgreenpeas,boiled1smallredonion,�inelydiced1cupmixedbellpeppers/capsicum1chickenbreast,cubedandboiled2tbsp.choppedcoriander1choppedchilli

Warm'Confetti'Salad

InstructionsBoil and drain the pasta as per packet directions.Warm up the oil, add the onions and garlic paste. Fry until they sweat, then add the cubed capsicum, peas, sweet corn, carrots, and chicken cubes. Sprinkle the salt and pepper. You can sprinkle some coriander, cumin or turmeric powder at this point if you like. Cook until the capsicum cubes soften slightly. Then add the green chilli, lemon juice and boiled pasta. Stir to combine and taste. Adjust seasoning if needed. Sprinkle the chopped coriander and turn off the heat.

You can omit the chicken if you want, or substitute it with cubed boiled egg.Serve warm salad, although it also tastes great cold. You can drizzle some ketchup or tomato sauce over it if you like.

The best way to �ight liver disease is to avoid it, if at all possible.

1. Maintain a healthy weight. If you're obese or even somewhat overweight, you're in danger of having a fatty liver that can lead to non-alcoholic fatty liver disease (NAFLD), one of the fastest growing forms of liver disease.

2. Eat a balanced diet. Avoid high calorie-meals, saturated fat, re�ined carbohydrates (such as white bread, white rice and regular pasta) and sugars. For a well-adjusted diet, eat �iber, which you can obtain from fresh fruits, vegetables, whole grain breads, rice and cereals. Hydration is essential, so drink a lot of water.

3. Exercise regularly. When you exercise consistently, it helps to burn triglycerides for fuel and can also reduce liver fat.

4. Avoid toxins. Toxins can injure liver cells. Limit direct contact with toxins from cleaning and aerosol products, insecticides, chemicals, and additives. Don't smoke.

5. Use alcohol responsibly. Alcoholic beverages can create many health problems. They can damage or destroy liver cells and scar your liver.

6. Avoid the use of illicit drugs. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used non-medically.

7. Avoid contaminated needles. Of course, dirty needles aren't only associated with intravenous drug use. You ought to follow up with a medical practitioner and seek testing following any type of skin penetration involving sharp instruments or needles. Use only clean needles for tattoos and body piercings.

8. Get medical care if you're exposed to blood. If, for any reason, you come into contact with someone else's blood, immediately follow up with your doctor.

9. Don't share personal hygiene items. For example, razors, toothbrushes and nail clippers can carry microscopic levels of blood or other body �luids that may be contaminated.

10. Wash your hands. Use soap and warm water immediately after using the bathroom, when you have changed a diaper, and before preparing or eating food.

11. Follow directions on all medications. When medicines are taken incorrectly by taking too much, the wrong type or by mixing medicines, your liver can be harmed. Never mix alcohol with other drugs and medications even if they're not taken at the same time. Tell your doctor about any over-the-counter medicines, supplements, and natural or herbal remedies that you use.

12. Get vaccinated. There are vaccines for hepatitis A and hepatitis B. Unfortunately, there's no vaccine against the hepatitis C virus.

Staff is good. They look after very well. Doctors are excellent. (Ms.Ayesha)

Thanks to entire staff and doctors for all the care and attention. (Ms.FatimaKhawaja)

Outstanding services. Staff is very cooperative and it is up to the mark. Very well-mannered and caring staff. Thumbs Up.

(Ms.MariamTarana)

Nursing department is excellent, very caring and polite. There department head Ms. Abida is very good administrator. Big appreciation for Dr. Sajjad Naseer, Consultant Pulmonologist and Dr. Habib, Consultant

Cardiologist who cared for our patient in highly digni�ied manner and a detailed counseling and advice to the attendants. Very ef�icient housekeeping services.

(Ms.SadiqaAkhtar)

We are highly statis�ied with the services of Dr. Imran Ghani, Consultant Cardiologist at CCU. All the services, treatment and atmosphere at Maroof International Hospital are better than other private sector healthcare

institutes. (MohammadYasin)

Servings2-3

12Waystoahealthyliver

EatHealthy

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