It is always good to know the stool facts

Kids are proud to show off their poo?

but most adults rarely glance inside the toilet bowl. But the truth is…

Question #1: How long does it take you to have a bowel movement?

Less than 60 seconds

More than two minutes

Answer: Healthy bowel movements happen within 60 seconds of sitting on the toilet. The stool should easily come out without straining, grunting or any discomfort. It should have the consistency of toothpaste. If you have time to read a newspaper while sitting on the toilet? You probably have a problem with constipation or poor bowel health.

Question #2: What is the shape of your stool?

Long like a banana round, hard pellets thin, pencil-shaped

Answer: Healthy stool averages about four to six inches long and are shaped like a banana or a torpedo. Very narrow, pencil-shaped stool is a sign your colon walls are impacted or you have polyps or growths on the inside of your colon or rectum. This causes the stool to squeeze to get through. Stress can also create narrow stool. Hard, round or pellet-shaped stool is a possible sign of poor liver function, lack of exercise, dehydration or constipation.

Question #3: Is your stool accompanied by foul odor?

Yes No

Answer: Gas or odour is a sign of a bacterial imbalance in your intestinal flora. The “bad” bacteria release foul-smelling gases and toxins that can cramp your colon and create embarrassing odors.

You can eliminate this odor by removing debris and encrusted faeces from the walls of your intestines and restoring the balance in your intestinal flora.

Question #4: What color is your stool?

Yellow Green Brown

Gray Black Bright red

According to Mayo Clinic research, all shades of brown and even green are considered normal stool colors. And the foods you eat can affect the color of your stool. For example, beets, tomato juice, blueberries, popsicles and green leafy vegetables can affect your stool color. However, a distinct change in stool color can be a warning sign for health problems.

Yellow-colored stool indicates your food is moving too quickly through your digestive tract as in the case of diarrhea.

If stool is greasy or foul-smelling, it may indicate excess fat caused by mal absorption of nutrients.

Green-colored stool means your food isn’t properly being processed through your intestines. As a result, bile isn’t broken down and gives your stool that green color. Green stool can also mean you’re eating too much sugar, fruits and vegetables and not enough grains or salt.

Gray or ashy colored stool indicates undigested fats or heavy use of prescription or over-the-counter drugs that contain aluminum hydroxide. It can also indicate a lack of bile in the stool that may be caused by a bile duct obstruction.

Black stool is a serious warning sign for bleeding in the upper gastrointestinal tract, possibly the stomach.

Bright red stool may indicate bleeding in the lower intestinal tract?possibly the large intestine or rectum. Hemorrhoids may also be the source of the bleeding.

Question #5: Do you pass gas while you’re having a bowel movement or have you noticed air or bubbles in your stool?

Yes No

Answer: Air or bubbles in stool can indicate an intestinal imbalance. Gas producing bacteria may be overgrowing and competing with the healthier flora in your gut.

Please know this: A normal bowel movement happens within 60 seconds of sitting on the toilet. There should be no straining, pain, bleeding or foul odor accompanied with your bowel movements. And wiping afterwards should be easy and simple?using just one or two pieces of toilet paper!

If that’s not your experience in the bathroom? then you need to give your intestines a thorough internal cleaning!

When your colon is in danger? it will do anything and everything to send out an S.O.S. for health!

That means giving you “dragon breath” and “B.O.”!

If you notice strong body odor? especially under your arm pits…

…Or if your friends shy away and frequently offer you breath mints?

LISTEN to your colon? it’s screaming for help!

Eating dark chocolate every day may lower the risk of having a heart attack or stroke for some people at higher risk of these conditions, a new study from Australia found.

Eating dark chocolate every day may lower the risk of having a heart attack or stroke for some people at higher risk of these conditions, a new study from Australia found.

Researchers gathered data on 2,013 people who had metabolic syndrome — which is a cluster of medical issues that includes high blood pressure, a large waist and low levels of “good” cholesterol — and used mathematical equations to predict how eating dark chocolate daily could affect the number of strokes and heart attacks the group would be expected to have.

Based on their results, the researchers calculated that for every 10,000 people with metabolic syndrome who ate 3.5 ounces of dark chocolate every day for 10 years, 70 non-fatal and 15 fatal cardiovascular events, such as heart attacks or strokes, could be prevented.
Studies have shown that the risk of cardiovascular disease can be lowered over the short-term by eating compounds called flavonoids, which are abundant in dark chocolate. Flavonoids are known to have antihypertensive and anti-inflammatory effects, which relieve pressures on the heart, the researchers said.

Headache Prevention

by Dr. Behrouz Hashim.

What is a headache?

A Headache is defined as a pain in the head. It is one of the most common locations of pain in the body and has many causes.

There are three major categories of headaches:

  1. primary headaches,
  2. secondary headaches, and
  3. cranial neuralgias, facial pain, and other headaches

Headache Prevention

Avoiding your headache triggers – including stress, dehydration, and too little sleep — can help you stay pain-free. You’ll soon find that preventing a headache is a lot easier than treating one.

Headache Prevention: What You Can Control

There are headache triggers you can control, and those you can’t. Some triggers in the latter category are the weather and, if you’re female, the hormonal fluctuations that occur with menstruation, ovulation, and menopause.



Headache Prevention: Common Triggers

The following are common triggers for headaches and migraines, and many are within your control:

  • Stress
  • Drinking alcohol, and red wine in particular
  • Sensory overload — exposure to lights that are too bright, sounds that are too loud, or smells that are overpowering
  • Dehydration — not drinking enough water
  • Too much sleep or not enough sleep
  • Exercising too rigorously
  • Hormonal changes
  • Not eating frequently enough
  • Smoking
  • Straining your eyes reading or sitting at a computer
  • A difference in your caffeine intake — just skipping your morning cup for one day can cause a caffeine-withdrawal headache
  • Food additives or naturally-occurring substances, including nitrates in processed meats, MSG in fast food and Chinese food, tyramine found in certain aged cheeses and soy-based foods, and the artificial sweetener aspartame.


Headache Prevention: Keeping a Diary

Knowing your headache triggers enables you to start your own headache prevention program. Keeping a diary will help you figure out which of the many possible headache triggers affects you personally. In your headache diary, you should record each day:

  • All foods you eat
  • All beverages you drink
  • Medicines you take
  • What time you wake up and go to bed
  • All exercise and any other physical activities you undertake

Log each headache that you get, what time of day it occurred, and what you did to resolve it. It’s also a good idea to track what the weather was like and any hormonal changes, such as when you ovulated and began your period.

After a while, you should begin to see patterns.


Headache Prevention: Easy Techniques

Practicing these easy steps will help you avoid many common triggers:

  • Maintain good posture, and move around during the day. Make sure your neck isn’t remaining stiff and that you’re moving it around if you’re doing desk work, says Green. Also, take your eyes away from the computer every so often to avoid eyestrain.
  • Get the right pillows. “People should be careful to evaluate their pillows. A lot of people should travel with their [home] pillow because we don’t often like changes in pillows,” says Green.
  • Stay consistent. Keep a regular schedule, and don’t greatly vary your diet or your waking, sleeping, and exercise routines.
  • Get an appropriate amount of sleep. Either too much or too little shuteye can leave your head pounding, so make sure you get a steady eight hours each night.
  • Stick to a healthy diet and exercise regimen. Healthy foods and regular exercise help ward off headaches. Never skip meals, and have a small, healthy snack between meals so that you don’t get too hungry.
  • Drink water. Dehydration can lead to headache, so drink plenty of water throughout the day.
  • Manage stress. Stress can build up and cause your head to pound, so find ways to deal with it. Take up a hobby, exercise, try yoga, and do some deep breathing when you feel stress creeping in.

Even if you can’t stop every headache from happening, a few simple changes can help you avoid at least a few. Headache prevention is less painful than dealing with a headache, so make changes today to prevent a headache tomorrow.

What causes tension headaches?

While tension headaches are the most frequently occurring type of headache, their cause is not known. The most likely cause is contraction of the muscles that cover the skull. When the muscles covering the skull are stressed, they may spasm and cause pain. Common sites include the base of the skull where the trapezius muscles of the neck inserts, the temple where muscles that move the jaw are located, and the forehead.

What are the symptoms of tension headaches?

The pain symptoms of a tension headache are:

  • The pain begins in the back of the head and upper neck and is described as a band-like tightness or pressure.
  • Often is described as pressure encircling the head with the most intense pressure over the eyebrows.
  • The pain usually is mild (not disabling) and bilateral (affecting both sides of the head).
  • The pain allows most people to function normally, despite the headache.

How is tension headaches treated?

Tension headaches are painful, and patients may be upset that the diagnosis is “only” a tension headache. Even though it is not life-threatening, a tension headache can affect the activities of daily life.

Most people successfully treat themselves with over-the–counter (OTC) pain medications to control tension headaches. The following work well for most people:

  • aspirin,
  • ibuprofen (Motrin, Advil),
  • acetaminophen (Tylenol) and

Massage, biofeedback, and stress management can all be used as adjuncts to help with control of tension headaches.

When should I seek medical care for a headache?

A patient should seek medical care if their headache is:

  • The “worst headache of your life.” This is the wording often used in textbooks as a cue for medical practitioners to consider the diagnosis of a sub-arachnoids hemorrhage due to a ruptured cerebral aneurysm. The amount of pain will often be taken in context with the appearance of the patient and other associated signs and symptoms.
  • Different than your usual headaches
  • Starts suddenly or is aggravated by exertion, coughing, bending over, or sexual activity
  • Associated with persistent nausea and vomiting
  • Associated with fever or stiff neck
  • Associated with seizures
  • Associated with recent head trauma or a fall
  • Associated with changes in vision, speech, or behavior
  • Associated with weakness or change in sensation
  • Not responding to treatment and is getting worse
  • Requires more than the recommended dose of over-the-counter medications for pain
  • Disabling and interfering with work and quality of life



Flood Related Illnesses

by Dr. Behrouz Hashim

Pakistan is once again going through another spell of very heavy rains and floods. It was just last year that we went through a devastating catastrophe.

What did we learn from last year?

Why are we facing more problems this year?

This article will help you deal with the ailments caused by rain and floods. Hopefully you too will take preventive measures and help the flood victims.


All floods are not alike. Some floods develop slowly, sometimes over a period of days. But flash floods can develop quickly, sometimes in just a few minutes, with-out any visible signs of rain. Flash floods often have a dangerous wall of roaring water that carries rocks, mud and other debris, and can sweep away almost anything in its path. Overland flooding occurs outside a defined river or stream, such as when a levee is breached, and can still can be destructive. Flooding can also occur when a dam breaks, producing effects similar to flash floods.

Be aware of flood hazards no matter where you live, but especially if you live in a low-lying area, near water or downstream from a dam. Even very small streams, gullies, creeks, culverts, dry streambeds, or low-lying grounds that appear harmless in dry weather can flood.

Flooding is associated with an increased risk of infection, however this risk is low unless there is significant population displacement and/or water sources are compromised.




Gasteroenteritis can cause massive diarrhoea that leads to dehydration and death.

This is more common in young infants and the very old.

Flood can also potentially increase the transmission of the following diseases:


→ Water-borne diseases, such as typhoid fever, cholera, leptospirosis and hepatitis

A and E.

→ Vector-borne diseases, mainly transmitted by mosquitoes, such as malaria,

dengue and dengue haemorrhagic fever.

→ Pneumonia, influenza And meningitis, are also big killers.

→ Parasites and worm infections.

→ Various skin infections, eczema, and rash.

→ Ant and insect bites.

→ Snake bites

→ Dog bites


Other health risks


→ Include drowning, injuries or trauma.

→ Back injuries because of lifting children, belongings, sweeping floors and

clearing water from indoors and out doors, carrying sand bags, pushing cars that

got stuck on the roads or in ditches.

→ Motorcycle and cycle accidents.

→ Electric shocks due to wet feet and hands, in the house and on the streets.

→ Roof and wall collapse.

→ Falling into gutters and ditches.

→ Slips and falls causing fractures and head injuries.

→ Rat bites and other animal bites.

→ Tetanus is common after injury from flooding, and mass tetanus vaccination

programs are required. However, tetanus boosters may be indicated for previously vaccinated people who sustain open wounds or for other injured people depending on their tetanus immunization history.

→ Hypothermia may also be a problem, particularly in children, if trapped in

floodwaters for lengthy periods. There may also be an increased risk of       respiratory tract infections due to exposure (loss of shelter, exposure to flood waters and rain).

→ Power cuts related to floods may disrupt water treatment and supply plants

thereby increasing the risk of water-borne diseases as described above but may

also effect proper functioning of health facilities, including cold chain.







Communicable disease risks from flooding can be greatly reduced if the following recommendations are followed.




Chlorination of water


Ensuring uninterrupted provision of safe drinking water is the most important preventive measure to be implemented following flooding, in order to reduce the risk of outbreaks of water-borne diseases.


→ Free chlorine is the most widely and easily used, and the most affordable of the

drinking water disinfectants. It is also highly effective against nearly all

waterborne germs . At doses of a few mg/liter and contact times of about 30

minutes, free chlorine generally inactivates >99.99% of enteric bacteria and


→ For point-of-use or household water treatment, the most practical forms of free

chlorine are liquid sodium hypochlorite, solid calcium hypochlorite and

bleaching powder ( chloride of lime; a mixture of calcium hydroxide, calcium

chloride and calcium hypochlorite).

→ The amount of chlorine needed depends mainly on the concentration of organic

matter in the water and has to be determined for each situation. After 30

minutes, the residual concentration of active chlorine in the water should be

between 0.2-0.5 mg/1, which can be determined using a special test kit.

→ Water purification tablets.




→ Hepatitis A

→ Tetanus

→ Pneumonia

→ Meningitis

→ Polio

→ Typhoid

→ Flu

→ Rota virus (Gastroenteritis)





→ Insecticides: flooding does not necessarily lead to an immediate major increase

in mosquito numbers, and there may still be time to implement preventive

measures such as indoor residual spraying. This will also have an effect on other

mosquito-borne diseases.

→ Early detection: It is important to track weekly case numbers and provide

laboratory-based diagnosis (perhaps only for a percentage of fever cases to

track the slide/test positivity rate), to pick up the early stages of a malaria


→ Mosquito nets and repellants.

→ Free medical care: artemisinin-based combination therapy should be provided

when a falciparum malaria epidemic is confirmed and an active search for fever

cases may be necessary to reduce mortality in remote areas with reduced access

to health care services.




There is a massive shortage of food in floods. These are the points to keep        in mind:


→ Make sure the food that they get is not easily perishable.

→ Much of the food available may be contaminated.

→ There may be no containers or storage items to preserve the food.

→ There may be no dry wood, matches or kerosene or gas cylinder in flooded

areas. So how would you cook or boil water?



→ Burial is preferable in mass causalities and where identification of victims is not


→ The mass management of human remains is often based on the false belief that

they represent an epidemic hazard if not buried or burned immediately. Bodies

should not be disposed of unceremoniously in mass graves and this does not

constitute a public health measure, infact it violates important social norms and

can waste scarce resources.

→ Families should have the opportunity to conduct culturally appropriate funerals

and burials according to social custom.


→ Where customs vary, separate areas should be available for each social group

to exercise their own traditions with dignity.


→ Where existing facilities such as graveyards are inadequate, alternative

locations or facilities should be provided.

→ The affected community should also have access to materials to meet the needs

for culturally acceptable funeral rites.





The following items are recommended for inclusion in your basic disaster supplies kit:


→ Three-day supply of non-perishable food.

→ Three-day supply of water one gallon of water per person, per day.

→ Portable, battery-powered radio and extra batteries.

→ Flashlight and extra batteries.

→ First aid kit and manual.

→ Rope, axe, 3 meters of strong cloth like lattha and knife.

→ Sanitation and hygiene items (moist towelettes and toilet paper).

→ Matches and waterproof container.

→ Whistle.

→ Extra clothing.

→ Kitchen accessories and cooking utensils, including a can opener.

→ Photocopies of identification cards.

→ Cash and coins.

→ Special needs items, such as prescription medications, eye glasses, contact

lens solutions, and hearing aid batteries.

→ Items for infants, such as formula, diapers, bottles, and pacifiers.

→ Other items to meet your  unique family needs.





We cannot control the amount of rain, but we can control how to manage rain water usefully.

Many countries receive more than 20 times the rainfall we have every year. They do not get flooded and drown. They use the rain water to generate electricity, increase agriculture, make forests by planting trees and fish farming. It is time we learn to manage what nature bestows upon us and thereby transforming rain into a blessing for ourselves.



Dr. Behrouz Hashim

In winters, the human mind and body is exposed to new activity that influences one’s well being.  Here are some common winter ailments you should know about to prevent and minimize their effects.


SORE THROAT: We are more likely to stay indoors during winters, and to take out our old dusty blankets and quilts. We are also exposed to winter viruses.  These attack the throat, tonsils, the larynx and the pharynx, causing tonsillitis, laryngitis, pharyngits and bronchitis.


PREVENTION: (a) Avoid contact with people who have infection (b) Gargle with salt water (c) Take flu shots (d) Air out and ventilate the room (e) Dress warmly when going outdoors (f) Room heaters and their ventilation ducts and chimneys should be serviced and maintained.


DRY SKIN: With onset of winter, there is usually a drop in humidity.  This causes dryness, itching, cracks in the soles, heels and the skin, which can get infected.


PREVENTION: Use moisturizing lotions and creams.  Apply oil, Vaseline or petroleum jelly, depending on what suits your skin and how cold and dry the environment is. Vitamin A, C and E protect the skin from dryness, so increase your intake of food and vegetables rich in these vitamins. You may require vitamin supplements too.


DEPRESSION OR “WINTER BLUES”: We all feel “low” or “down” from time to time. In winter, because it tends to be cold and grey, people with strong tendency for depression tend to feel more so.


The signs and symptoms of depression include loss of interest and enjoyment in every aspect of life, feeling withdrawn from family, friends, work and hobbies, poor personal hygienic and appearance, disturbed sleep, headaches, backache, tightness in the chest, vision problems, giddiness, tiredness and weight loss.


PREVENTION: Learn about the disease, talk it over, and seek professional help. Counseling, therapy and medication are important.  Stay in touch with friends, family and the community.


BURN: Every winter the number of burns victims increases in the hospitals and emergency rooms.


Causes include unsafe room heating methods, poor storage of inflammable liquids, wooden logs, electrical circuit overload due to heaters, spilling of boiling water, particularly while taking a bath, and cooking indoors in make-shift premises.  Since children are kept indoors, they tend to play around in the kitchen and their fascination for matches and fire can draw them to disastrous accidents.


PREVENTION: Take safety precautions to avoid contact with fire, boiling water and hold oil.  Check the electrical and gas systems for safety.


EAR ACHE: Otlitis media tends to be more common in winters. The main reasons are that the nose is running, and gets blocked, and the sinuses get inflamed, all leading to a blocked Eustachian tube. As a result, ear infections due to viruses and bacteria cause intense pain.


PREVENTION: Decongestants, gargling a steam inhalation keep the Eustachian tube open so inner ear infections are less frequent.


DANDRUFF: The flaking of the scalp is common in winter and causes itching, discomfort and hair loss.


PREVENTION: Keep the room humid.  Anti-dandruff shampoo and deep oily scalp massage is very helpful.  Olive oil and mustard oil (sarsoon) provide relief. Palm oil (khopra) dries the scalp, so avoid it in winter.


ARTHRITIS: With the arrival of winter, many people with chronic arthritis complain about their joints getting stiff and hurting more.  The reason is that due to a lack of outdoor activity there is less circulation to the joints, as the body re-directs the flow of blood to the main organs like the liver, kidney and intestine, to keep them warm.  Osteoarthritis and Ankylosing Spondylitis get worse in winter.  And since there is pain, the joints are less frequently moved, causing more pain and stiffness.


PREVENTION: (a) Keep the joints moving before winter sets in (b) Use a hot water bottle or bag to keep the joints warm (c) Massage gently with warm oil or paraffin as recommended by your doctor and/or physiotherapist.


by Dr. Behrouz Hashim



Mosquitoes carry life-threatening diseases such as dengue, malaria yellow fever and encephalitis. The World Health Organization estimates that each year 300-500 million cases of malaria occur and more than one million people die of it. Some 2,500 million people (2/5of the world’s population) are now at risk from dengue. World Health Organization (WHO) estimates there may be 50 million cases of dengue infection worldwide every year.


Dengue fever is a flu-like illness spread by the bite of an infected mosquito. Dengue hemorrhagic fever is a severe, often fatal, complication of dengue fever.



Dengue and dengue hemorrhagic fever are caused by any of the four types of viruses. Infection with one virus does not protect a person against infection with another.



Dengue is spread by the bite of an Aedes mosquito. The mosquito transmits the disease by biting an infected person and then biting someone else.



Dengue viruses occur in most tropical areas of the world. It is common in Africa, Asia, the pacific, Australia and America. It is widespread in the Caribbean basin. Dengue is most common in cities but can be found in rural areas. It is rarely found in mountainous areas above 4,000 feet.

The mosquitoes that transmit dengue live among humans and breed in discarded tires, flower pots, old oil drums, and water storage containers close to human dwellings. Unlike the mosquitoes that cause malaria which prefers to bite at night, the dengue mosquitoes prefer to bite mainly during the day.



Dengue fever usually starts suddenly with high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name Break Born Fever, Nausea, vomiting, and loss of appetite and common. A rash usually appears three to four days after the initiation of fever. The illness can last up to 10 days, but complete recovery can take as long as a month.

Older, children and adults are usually sicker than young children.

Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about two to five percent of cases, mostly among children and young adults.



The time between the bite of a mosquito carrying dengue virus and the beginning of symptoms averages four to six days with a range of three to 14 days. An infected person cannot spread the infection to another person but can be a source of dengue virus for mosquitoes for about 6 days.



Dengue is diagnosed by a blood test.



There is no specific treatment for dengue. Persons with dengue fever should rest and drink plenty of fluids. They should be kept away from mosquitoes for the protection of others. Dengue hemorrhagic fever is treated by replacing lost fluids. Some patients need transfusions to control bleeding.




In tropical countries around the world, dengue is one of the most common viral diseases spread to humans by mosquitoes, Tens of millions of cases of dengue fever and up to hundreds of thousands of cases of dengue hemorrhagic fever occur each year.


All types of dengue virus are re-emerging worldwide and causing larger and more frequent epidemics, especially in cities in the tropics. The emergency of dengue as a major public health problem has been most dramatic in the western hemisphere. Several factors are contributing to the resurgence of dengue fever:

● No effective mosquito control efforts are underway in most countries with dengue.

● Rapid growth of cities in tropical countries has led to overcrowding, urban decay, and substandard sanitation, allowing more mosquitoes to live closer to more people.

● The increase in non-biodegradable plastic packaging and discarded tires is creating new breeding sites for mosquitoes.

● Increased jet air travel is helping people infected with dengue viruses to move easily from city to city.



There is no vaccine to prevent dengue. Eliminating mosquito breeding sites in these areas is another key prevention measure.

Avoid mosquito bites when travelling in tropical areas.

● Use mosquito repellents on skin and clothing.

● When outdoors, wear long-sleeved shirts and long pants tucked into socks.

● Avoid heavily populated residential areas.

● When indoors, stay in air-conditioned or screened areas. Use bed nets if sleeping areas are not screened or air-conditioned.

● If you have symptoms of dengue, report your travel history to your doctor.

● Eliminate mosquito breeding sites around homes. Discard items that can collect rain or run-off water, especially old tires.

● Regularly change the water in outdoor bird baths and pet and animal water containers.









Malaria is caused by plasmodium parasites are spread to people through the bites of infected Anopheles mosquitoes, called malaria vectors, which bite mainly between dusk and dawn.

There are four types of human malaria:

Plasmodium falciparum and Plasmodium vivax are the most common. Plasmodium falciparum is the most deadly.



Malaria is transmitted exclusively through the bites of Anopheles mosquitoes. Transmission also depends on climactic conditions that may affect the abundance and survival of mosquitoes, such as rainfall patterns temperature and humidity. In many places, transmission is seasonal, with the peak during and just after the rainy season.

Malaria can also be transmitted from a mother to her unborn baby (congenitally) and by blood transfusions.



● Anemia ● Bloody stools ● Chills ● Coma ● Convulsion ● Fever ● Headache

● Jaundice ● Muscle pain ● Nausea ● Sweating ● Vomiting

Malaria is an acute febrile illness. Symptoms appear seven days or more (usually 10-15 days) after the infective mosquito bite. The first symptoms – fever, headache, chills and vomiting – may be mild and difficult to recognize as malaria. If not treated within 24 hours, P. falciparum malaria can progress to severe illness often leading to death. For both P. vivax and P. ovale, clinical relapses may occur weeks to months after the first infection.



Early diagnosis and treatment of malaria reduces disease and prevents deaths. It also contributes to reducing malaria transmission.

The best available treatment particularly for P. falciparum malaria is artemisinin-based combination therapy (ACT).



Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like symptoms, and anemia.




Malaria is caused by a parasite that is passed from one human to another by the bite of infected Anopheles mosquitoes. After infection, the parasites (called sporozoites) travel through the bloodstream to the liver, where they mature and release another form, the merozoites. The parasites enter the bloodstream and infect red blood cells.

They multiply inside the red blood cells, which then break open within 48 to 72

hours, infecting more red blood cells. The first symptoms usually occur 10 days to four weeks after infection, through they can appear as early as eight days or as long as a year after infection. The symptoms occur in cycles of 48 to 72 hours.

Recently, a fifth type, Plasmodium Knowlesi, has been causing malaria in Malaysia and areas of Southeast Asia. Another type, falciparum malaria, affects more red blood cells than the other types and is much more serious. It can be fatal within a few hours of the first symptoms.



●Anemia ● Bloody stools ●Chills ●Coma ●Convulsion ●Fever ●Headache ●Jaundice ●Muscle pain ●Nausea ●Sweating ●Vomiting



During the physical examination, the doctor may find an enlarged liver or enlarged spleen. Malaria blood smears taken at 6 to 12 hour intervals confirm the diagnosis.

A complete blood count (CBC) will identify anemia if it is present.

Serum ICT blood test.



Malaria especially Falciparum malaria, is a medical emergency that requires a hospital stay. Chloroquine is often used as an anti-malarial medication. However, chloroquine-resistant infections are common in some parts of the world.

The best available treatment, particularly for P. falciparum malaria, is artemisinin-based combination therapy (ACT).



● Brain infection (cerebritis)

● Destruction of blood cells (hemolytic anemia)

● Kidney failure

● Liver failure

● Meningitis

● Respiratory failure from fluid in the lungs (pulmonary edema)

Rupture of the spleen leading to massive internal bleeding (hemorrhage)



Following drugs: mefloquine, doxycycline, chloroquine, hydroxychloroquine, or Malarone. Even pregnant women should take preventive medications because the risk to the fetus from the medication is less than the risk of catching this infection.

You can prevent malaria and dengue by:

● Keeping mosquitoes from biting you, especially at night for malaria and during the day from dengue.

● Taking antimalarial drugs to kill the parasites.

● Eliminating places around your home where mosquitoes breed.

● Sleeping under mosquito nets – especially effective if they have been treated with insecticide and wearing or using insect repellent and long-sleeved clothing if out-doors.

Asthma in children



Asthma is an inflammatory disorder of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.


Asthma is a disease of the respiratory system, which causes swelling and narrowing of the airways, which causes attacks of wheezing, shortness of breath, chest tightness, and coughing.

Pediatric asthma refers to asthma in children.

Causes, incidence, and risk factors

Asthma is commonly seen in children. It is a leading cause of hospital stays and school absences. Children with asthma may be able to breathe normally most of the time. When they encounter a substance that can cause problems (a “trigger”), an asthma attack (exacerbation) can occur.

Common asthma triggers include:

  • Animals (hair or dander)
  • Aspirin and other medications
  • Changes in weather (most often cold weather)
  • Chemicals in the air or in food
  • Dust
  • Exercise
  • Mold
  • Pollen
  • Strong emotions
  • Tobacco smoke
  • Viral infections, such as the common cold

In recent years, there has been a worldwide increase in the number of children with asthma. This trend has been linked to environmental factors, including air pollution. However, it is important to understand that indoor triggers can play just as much of a role as outdoor triggers in bringing on an asthma attack.

Children’s airways are narrower than those of adults. This means that triggers that may cause only a slight problem in an adult can create more serious problems in children.

In children, an asthma attack can appear suddenly with severe symptoms. For this reason, it is important that asthma be diagnosed and treated correctly. Some children may need to take medicine every day to prevent attacks, even when they do not have symptoms.


  • Difficulty breathing
  • Fast (rapid) breathing
  • Shortness of breath, even at rest
  • Tightness in the chest
  • Cough

Note: A persistent night-time cough is one common sign of asthma, even in children without other symptoms.

Emergency symptoms: GET TO A HOSPITAL QUICKLY!

  • Difficulty breathing
  • Bluish color to the lips and face
  • Severe anxiety due to shortness of breath
  • Rapid pulse
  • Sweating
  • Decreased level of alertness, such as severe drowsiness or confusion

Signs and tests

The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes.

Tests may include:

  • Lung function tests
  • Peak flow measurements
  • Chest x-ray
  • Allergy skin or blood tests
  • Arterial blood gas
  • Eosinophil count (a type of white blood cell)

Signs and tests

Allergy testing may be helpful to identify allergens in people with persistent asthma. Common allergens include:

  • Cockroach allergens
  • Dust mites
  • Molds
  • Pet dander
  • Pollens

Common respiratory irritants include:

  • Fumes from burning wood or gas
  • Pollution
  • Tobacco smoke

The doctor will use a stethoscope to listen to the lungs. Asthma-related sounds may be heard. However, lung sounds are usually normal between asthma episodes.


You and your child’s pediatrician should work together as a team to create and carry out an asthma action plan. This plan should outline how to:

  • Avoid asthma triggers
  • Monitor symptoms
  • Take medicines

The plan should also tell you when to call the nurse or doctor.

You should also have an emergency plan that outlines what to do when your child’s asthma flares up. If your child is in school, make sure teachers, school nurses, physical education teachers, and coaches know about your child’s need to take asthma medicine. Find out what you need to do to let your child take his medicine during school hours. (You may need to sign a consent form.) Make sure the school has a copy of your child’s asthma action plan.


There are two basic kinds of medication for the treatment of asthma:

  • Long-term control medications
  • Quick relief or “rescue” medications

Long-term control medications are used on a regular basis to prevent asthma symptoms, not for treatment during an attack. They should be taken every day, even when you do not have symptoms. Some people may need more than one long-term control medication.

Types of long-term control medications include:

  • Inhaled steroids (such as Azmacort, Flovent) prevent swelling in your airways – these are almost the first choice of treatment
  • Leukotriene inhibitors (such as Singulair).
  • Long-acting bronchodilators (such as Serevent) help open airways – are usually used in combination with inhaled steroids
  • Cromolyn sodium (Intal)
  • Aminophylline or theophylline (not used as frequently as in the past)

Quick relief, or rescue, medications are used to relieve symptoms during an attack. These include:

  • Short-acting bronchodilators (inhalers), such as Proventil, Ventolin
  • Corticosteroids, such as prednisone or methylprednisolone) given by mouth or into a vein

Although these are the same medications used to treat adults, there are different inhalers and dosages especially for children. In fact, children often use a nebulizer to take their medicine rather than an inhaler, because it can be difficult for them to use an inhaler properly. Children who use an inhaler should also use a “spacer” device, which helps them to get the medicine into the lung properly.

Children with mild asthma (do not have symptoms very often) may only need quick relief medication as needed. Those who more severe asthma need to take control medications on a regular basis to prevent symptoms.

A child who is having a severe asthma attack should be immediately seen by a doctor. The child may need to stay in the hospital, and may be given oxygen and medicines by an intravenous line (IV).


You and your family can help control a child’s asthma by helping get rid of the indoor triggers that make symptoms worse.

If possible, keep pets out doors, or at least away from the child’s bedroom.

No one should smoke in a house or around a child with asthma. Keeping humidity levels low and fixing leaks can reduce growth of organisms such as mold. Keep the house clean and keep food in containers and out of bedrooms — this helps reduce the possibility of cockroaches, which can trigger asthma attacks. Bedding can be covered with “allergy proof” polyurethane-coated casings to reduce exposure to dust mites. Detergents and cleaning agents in the home should be unscented.

All of these efforts can make a significant difference to the child with asthma, even though it may not be obvious right away.


The complications of asthma can be severe. Some include:

  • Persistent cough
  • Lack of sleep due to nighttime symptoms
  • Decreased ability to exercise and take part in other activities
  • Missed school
  • Missed work for parents
  • Emergency room visits and hospital stays
  • Trouble breathing that requires breathing assistance (ventilator)
  • Permanent changes in the function of the lungs
  • Death

Calling your health care provider

Call your health care provider if you think that a child has symptoms of asthma. It is very important for asthma to be diagnosed and treated early in order to reduce the risk of complications. If your child is having trouble breathing or having an asthma attack, seek medical attention immediately.


There is no fool-proof method to prevent asthma attacks. The best way to reduce the number of attacks is to eliminate triggers (especially cigarette smoke.

Remove all curtains, carpets, stuffed toys, and old pillows from the child’s bedroom.







Arthritis is a disease of the joints. Painful, stiff joints are the most common signs of arthritis. Other signs are swelling, warmth, and redness in the joints. People often have trouble moving the joints normally.

Arthritis is a problem for many adults age 50 and older. About 25 percent of people have some form of arthritis. It can affect people of all ages and races.

Why do people get arthritis?

  • They put stress on the joints over time.
  • They are overweight.
  • It runs in their family.
  • They are women. Women are affected 2-3 times more often than men.

How can the doctor tell if I have arthritis?

This can be tricky. Other diseases can have the same signs. The doctor will:

  • Ask about your health history.
  • Do an exam and look at your joints.
  • Order lab tests of blood or urine samples.
  • Order x-rays or other tests to see inside the joints.

Questions the doctor might ask

  • Is the pain in one or more joints?
  • When do you have the pain?
  • How long does the pain last?
  • What were you doing when you first had the pain?
  • Does moving around make the pain better or worse?
  • Have you been sick or had any accidents?
  • Has anyone in your family had arthritis?
  • What drugs are you taking?
  • Does anything make it better?

What are the treatments?

  • Rest
  • Exercise
  • Healthy diet
  • Weight loss
  • Medicines
  • Heat and cold
  • Learning how to relax deeply
  • Canes, splints, or other items to take stress off the joint
  • Injections
  • Surgery

What can I do to help my doctor help me?

  • Help plan your treatment.
  • Ask questions.
  • Understand your treatment plan.

Follow directions for taking your medicine.



Causes, incidence, and risk factors

Arthritis involves the breakdown of cartilage. Cartilage normally protects a joint, allowing it to move smoothly. Cartilage also absorbs shock when pressure is placed on the joint, such as when you walk. Without the normal amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

Joint inflammation may result from:

  • An autoimmune disease (the body’s immune system mistakenly attacks healthy tissue)
  • Broken bone
  • General “wear and tear” on joints
  • Infection, usually by bacteria or virus

Usually the joint inflammation goes away after the cause goes away or is treated. Sometimes it does not. When this happens, you have chronic arthritis. Arthritis may occur in men or women. Osteoarthritis is the most common type.



Arthritis causes joint pain, swelling, stiffness, and limited movement. Symptoms can include:

  • Joint pain
  • Joint swelling
  • Reduced ability to move the joint
  • Redness of the skin around a joint
  • Stiffness, especially in the morning
  • Warmth around a joint

Signs and tests

The health care provider will perform a physical exam and ask questions about your medical history.

The physical exam may show:

  • Fluid around a joint
  • Warm, red, tender joints
  • Difficulty moving a joint (called “limited range of motion”)

Some types of arthritis may cause joint deformity. This may be a sign of severe, untreated rheumatoid arthritis.

Blood tests and joint x-rays are often done to check for infection and other causes of arthritis.

Your doctor may also remove a sample of joint fluid with a needle and send it to a lab for examination.


The goal of treatment is to reduce pain, improve function, and prevent further joint damage. The underlying cause cannot usually be cured.


Lifestyle changes are the preferred treatment for osteoarthritis and other types of joint inflammation. Exercise can help relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your health care team can help you design an exercise program that is best for you.

Exercise programs may include:

  • Low-impact aerobic activity (also called endurance exercise)
  • Range of motion exercises for flexibility
  • Strength training for muscle tone

Physical therapy may be recommended. This might include:

  • Heat or ice
  • Splints or orthotics to support joints and help improve their position; this is often needed for rheumatoid arthritis
  • Water therapy
  • Massage

Other recommendations:

  • Get plenty of sleep. Sleeping 8 to 10 hours a night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent flare ups.
  • Avoid staying in one position for too long.
  • Avoid positions or movements that place extra stress on your sore joints.
  • Change your home to make activities easier. For example, install grab bars in the shower, the tub, and near the toilet.
  • Try stress-reducing activities, such as meditation, yoga, or tai chi
  • Eat a healthy diet full of fruits and vegetables, which contain important vitamins and minerals, especially vitamin E.
  • Eat foods rich in omega-3 fatty acids, such as cold water fish (salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
  • Apply capsaicin cream over your painful joints. You may feel improvement after applying the cream for 3-7 days.
  • Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.


Medications may be prescribed along with lifestyle changes. All medications have risks, some more than others. It is important that you are closely monitored by a doctor when taking arthritis medications.

Generally, over-the-counter medications are recommended first:

  • Acetaminophen (Tylenol) is usually tried first. Take up to 4 grams a day (two arthritis-strength Tylenol every 8 hours). Do not take more than the recommended dose or take the drug along with a lot of alcohol. Doing so may damage your your liver.
  • Aspirin, ibuprofen, or naproxen are nonsteroidal anti-inflammatory drugs (NSAIDs) that can relieve arthritis pain. However, they have many potential risks, especially if used for a long time. Potential side effects include heart attack, stroke, stomach ulcers, bleeding from the digestive tract, and kidney damage.

Prescription medicines include: THIS ONLY YOUR DOCTOR WILL PRESCRIBE.

It is very important to take your medications as directed by your doctor. Also make sure your doctor knows about all the medicines you are taking, including vitamins and supplements bought without a prescription.


In some cases, surgery may be done if other treatments have not worked. This may include:

Expectations (prognosis)

A few arthritis-related disorders can be completely cured with proper treatment.

Most forms of arthritis however are long-term (chronic) conditions.


Complications of arthritis include:

  • Long-term (chronic) pain
  • Disability
  • Difficulty performing daily activities

Calling your health care provider

Call your doctor if:

  • Your joint pain persists beyond 3 days.
  • You have severe unexplained joint pain.
  • The affected joint is significantly swollen.
  • You have a hard time moving the joint.
  • Your skin around the joint is red or hot to the touch.
  • You have a fever or have lost weight unintentionally.


Early diagnosis and treatment can help prevent joint damage. If you have a family history of arthritis, tell your doctor, even if you do not have joint pain.

Avoiding excessive, repeated motions may help protect you against osteoarthritis.



Food and water borne diseases are one of the most prevalent infections in our society especially among children of school going age. The source of infection can be ingestion or exposure to contaminated water or food material, and through infected mosquitoes. Symptoms can either be mild enough to be ignored or severe enough to be fatal if left entreated.


Hepatitis A and E


Fever, Chills, Abdominal discomfort and Jaundice


Vaccine against Hepatitis-A virus is recommended for children and adults travelling to developing countries.

Vaccine against Hepatitis-E is currently not available.





Repeated, Large, Watery Stools, which if not rerated appropriately, and lead to serious conditions such as shock and kidney failure.


Cholera vaccine is partially effective and has local adverse effects at the site of intramuscular injection.




Typhoid (Enteric Fever)


Prolonged severe fever, associated with nausea, vomiting, abdominal pain, dry cough and sometimes loose stools.


Typhoid vaccination is recommended for travelers proceeding to developing countries,





Fever, Rash, Hepatitis, and in serious conditions, even kidney failure can occur. Early diagnosis and treatment are essential.


No preventive vaccine is currently available.



Primary- Amoebic Meningoencephalitis.


The organism enters the brain during swimming and causes a rapidly developing deadly form of hemorrhagic meningoencephalitis.


No effective treatment is available and the disease is fatal.






Episodic high grade fever associated with chills and rigors.


No preventive vaccine is currently available.



Dengue Fever


Continuous high grade fever sometimes associated with gum or nasal bleeding, abdominal pain and rash.


No preventive vaccine is currently available.



Japanese B encephalitis


Characterised by fever and altered mental status leading to deep coma and death.


Vaccination against Japanese B encephalitis is indicated for travelers visiting high risk areas.


This information is collected from brochure published by “The Aga Khan University Hospital Karachi” named HEAL ( Health Education Awareness Learning)

Health Hazards of New Technology

By Dr. Behrouz Hashim


It is generally acknowledged that there are two sides to every thing, issue and situation. For example, despite the pleasant changes, in our lives, that have resulted from modern inventions, such as the Internet and air-conditioners, there can be negative — even harmful — effects if we misuse the devices. Numerous surveys have been conducted, in recent years, to identify unhealthy habits. The results have indicated that many women, while they enjoy their lives, tend to ignore the potential problems that result from their poor habits, such as their disrupted biological clocks, addiction to the Internet, and/or being “confined” to air-conditioned rooms.


Negative effects of technology on society and health are numerous. Although technology can be very helpful, as it helps our society advance, there are some damaging side effects. Technology is advancing computers, phones, transportation, medical studies, and many other things, but it also has negative effects. Technology is socially damaging because it is encouraging present generations to be lazier, and remain indoors, playing video games and watching television, instead of going outside or getting exercise. Television takes away time that children could spend engaged in meaningful activities, and reveals violent acts to people.

In our march to progress we have degraded the natural world. Forests are chopped down, topsoil is washed away, rivers are polluted and our waste is dumped in the oceans.

On the surface this appears to be a relatively recent problem. If we went back 100 or 200 years it would seem that mankind treads quite lightly on the planet. On face value the culprit is industrial technology. However this is not the case. The culprit is our cultural vision; our cultural vision wields technology in a destructive fashion.

Instead of seeing man as a part of nature people saw man as a separate and higher order of being. Thus the rest of nature merely existed as a resource for man’s benefit.

Destruction of the natural environment has been taking place since the birth of civilization yet it is only now that we are seeing it on a global scale. Our industrial technology has progressed to the point where we can do more damage in 100 years than we could in 10,000Nobody knows if industrial technology is sustainable because we have never used it in a sustainable manner. But perhaps it is possible to do so.

The way our culture operates is unsustainable. If we cannot find a way to operate a complex society within natural laws then we will inevitably return to a much simpler existence.


We’re suffering 21st Century Illnesses From Mobile Phone Stress To Sun bed Addiction, Pace Of Modern Life Is Too Much

IT’S a curse of the 21st Century which leaves you wanting to stop the world and jump off.

New research reveals nomophobia is the latest modern-day syndrome to send stress levels soaring. It is the fear being out of mobile phone contact.

Whether you run out of credit, lose your phone or are in an area with no reception, being phone less can cause symptoms of panic.

Here we reveal some other bizarre new symptoms of the 24/7 culture which show we’re living our lives far faster than any previous generation.


Sparked by hormonal changes, mind-numbing tiredness and the relentless responsibilities of caring for a baby, this explains why so many new mums forget things.

New mothers are dedicated to serving their infant, determined to keep him or her alive no matter what.

Other parts of your brain that are normally on high alert are taken offline. Consequently less important matters get forgotten, or at least put in to a less active area of the brain.


It may be great for your body but you can get addicted to the gym.

Sufferers become addicted to exercising and the natural chemical endorphin high they get after working out. Men and women are hit by the desire to look as good as the models in sports magazines.


We’re living our lives so fast we get on average an hour less sleep a night than we did in the 1970s, says the Sleep Council.

And when our heads do finally hit the pillow, we’re too stressed out to switch off and go to sleep.

A huge number of people are, often without realizing it, battling with persistent low-grade exhaustion due to a combination of lack of sleep or poor quality sleep.

“Around 75 per cent of the population admit to waking up exhausted every day, but many are wrongly blaming other factors like lack of exercise or a poor diet.”


Patients’ access to the internet is turning into every GP’s biggest fear. They report a rise in patients who scare themselves half to death by reading up on diseases and conditions then become convinced they have a serious illness.

But the one thing a computer can never tell you is your unique medical history, so there’s no substitute for a face to face consultation with your GP.


A worrying 33 per cent of us are becoming addicted to the internet. If you can’t last five minutes without checking your inbox then you’re not alone. But too much exposure to the net can trigger a break down of relationships.

Now there is an addiction to portable technology, which you take with you practically to bed, the cinema or a dinner party.

Today people spend more time using their technology than socializing.

You may have dozens of cyber friends on Face book but how many real ones can you count?


This is what happens when you work too hard. Adrenalin boosts triggered by stress keep you going all week at work but when you reach the weekend or holidays, your immune system collapses and you get ill.

Colds are most common during holidays, while sickness and muscle pains happened at weekends.


Long hours at a computer can cause shooting pains in your wrist, also known as repetitive stress injuries.

A form of RSI caused by excessive use of the thumb in typing text messages is also common as well as phone neck-neck and shoulder pain caused by holding a phone for long periods.

‘Being phone less can even bring on panicky symptoms


The air-conditioner was a great invention. During the summer, in particular, it is more than a modern comfort — it is essential to getting through the sweltering, sticky days. However, like most other modern conveniences, the air-conditioner has drawbacks.

Air-conditioners can aggravate diseases, such as arthritis and neuritis.

In addition, studies have proved that some subtle reactions to air-conditioners might adversely affect one’s health. For example, if you live and/or work in an air-conditioned environment, for a long time, you might be more susceptible to colds, the flu and some other minor ailments.


It is never too late to change, and become the master of your life.

Internet and Television

Ever connect to the Internet or watch Television at 9 pm and then, suddenly, it is dawn? If the answer is “yes,” you might be addicted to the Internet. Addiction to the Internet is generally defined as any on-line-related, compulsive behavior that interferes with one’s normal living, and causes severe stress on one’s family, friends, loved ones and work.

If the Television or the Internet becomes the guiding point of your life, it may adversely affect your psychological and physical well-being. For example, you might suffer from dry eyes, backaches and/or severe headaches. The fingers, wrist and elbows may develop arthritis with prolonged usage of the keyboard.

Sadly the Internet has destroyed family life. Communication with the real people around you is minimal. Marriages have been broken because you prefer the internet. Your teenage children come home from school, they prefer now is Internet or SMS.

The content of the net can influence teenagers to have SEX, or take DRUGS. Violence increases by playing violent games on the net.

Night Life

As night falls, bars, pubs, concert halls and night clubs come to life. They create a symphony of sounds, lights and music; night life has something for everyone. Many people, including young women, enjoy club-hopping and/or singing karaoke. They believe entertainment will help relieve work-related pressure.


 It starts late in the night or sometimes continues till sunrise. Drinking Cola’s, juices, tea coffee and even beer in some cases. Eating junk foods like NIMCO, CHOCLATES, SWEETS, CHIPS, POPCORN, ICE CREAM AND BISCUITS.

These days, an average person watches more than 2hours of television.


The car, the motor cycle, and the bus, are convenient and get you to your destination faster.

They all contribute to most of the air pollution and noise pollution.

Have you been stuck in a traffic jam in Karachi, Lahore, Rawalpindi or Peshawar? Ever got a headache when you do not find parking?

Have you traveled in an over crowded bus for 2 hours?

Do you like the overtaking and the loud horns?

More than 4000 people are injured in road accidents daily.

Hundreds are killed due to automobile accidents.