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Human and Mind

Posted June 18, 2014

Human and mind is interesting subject.
When we are born , in infancy stage we do not know any thing about this world. We can not look after ourselves. We can not recognize any body. We are helpless and dependent upon the love of our parents.
God has created two loving figure for our selves who look after us without any greed and they sincere with their kids. They try their best in up bringing of us. We are blessed at that time by the love of mother. As we grow we start recognizing these loving figure. Then we start responding their gestures. As time passes we start to learn sitting, crawling and walking. Ultimately we learn their language what they are.
Then we are sent to various schools for studies and to make our future life.
now the question is that how every body has different minds, I mean different thinking’s , different habits and different values of life.
My question is how these changes takes place in our mind. What is the mechanism behind the development of mind.
We all are similar in our structures then what is the change in our mind which make us good people and bad people. Why some of us become criminals and why some of us become gambler
Why some of the people becomes politicians because these people are with special mind set. Not everybody can become politicians.
Now can we say that this is the programming of the brain just like the programing of formatted hard disc of computer and then what ever programming on the hard disc, only those programs will be performed by the hard disc.
I will say that their is similarity between our brain and the hard disc of computer. Both have electrical impulses. Now can we modify these impulses. This may be possible on the man made electrical system but may not be on the God made system. So what will influence the God made system. When we find the answer to this question , only then we will be able to modify the mind of people. Only then we will be able to treat the diseases of mind. That may be possible by the drugs or by other means. We need to find out those other means like psychotherapy, religion, and still unknown method. One day we may find the methods that can bring changes in the mind and that will the start of revolutions in the society.

Prof.Riaz Bhutta


Visit to USA hospital emergency room

Posted June 13, 2014

This is very interesting about the environment of American emergency room and the third world country like Pakistan.
I was trained in Pakistan as physician. We used to have emergency duty. We used to have frequent admission of the patients with emergency. Their relatives was worried about the welfare of the patient.
But we as doctors , nurses and paramedical staff were always making noise and cutting jokes.
I was always upset by the attitude of our staff. Perhaps they were used to and immune to the worries of the emergency patients.
Recently I went to one of the American hospital emergency and I was just surprised that there was similar noise and atmosphere
So I believe that emergency room whether is USA or in Pakistan , there is no difference , perhaps that is normal for emergency room..
I can presume that in emergency always there is tension and people dealing with were always in tense situation by making noise and jokes they try to relieve their tension.
I can advocate that people should not mind noise in the emergency room.
Prof.Riaz Bhutta


Motivation

Posted Jan. 29, 2014

The Importance of Finding Out what Motivates You

  1. First, let’s find out what the importance of motivation exactly is ?
  2. This is Simply motivation that driving force which allows you to achieve your goals.
  3. Take a decision and go after what you want in life.
  4. If you want to change your personality for the better, and start a new habit, be a better person.
  5. You are the part of the community, become a better parent for your kid.
  6. All of these things would be easier accomplished if you are properly motivated.
  7. When Have decided to change your life with determination, and determination and determination.
  8. As long as you have a strong personal motivation, you can achieve almost anything that you want from life.
  9. However, remember not to fall into the trap of looking for short-cuts to achieve your goals. It’s perfectly fine if you have to take a long and winding road to achieve your goal. It will be an even sweeter victory when you finally achieve your goal, knowing that you have had to go through several hurdles to attain it.
  10. Developing Motivation in Life
    1. If you wish to accomplish a goal – be it short-term or long-term in nature
    2. Here are few things that you should keep in mind:
  11. Focus on one goal at a time.
    1. This should be partnered with the fact that you should make sure that your short-term goals all help in achieving your long-term goals. One of the best ways for you to focus on one goal at a time is to make a diary of your goals and keep on writing down .
    2. Writing down your goals will have a visual representation of the things that you want to achieve rather than letting it all get lost in your head.
  12. Get rid of all the distractions which might prevent you from achieving your goal.
    1. Let’s say that you are a writer who wants to finish a book or a studen ?
    2. How can you acheive your goals when if there are many Distractions surrounding you like ::
      1. Television,
      2. Friends chattering .
      3. Aimlessly browsing through the Internet.
      4. In order for you to stay properly motivated, make sure to steer clear of any distractions.
  13. Completely block out any negative influences.
  14. Finally, make sure that you are completely blocking out any negative influences in your life.
  15. If you feel that you are being distracted from your goal by a problem which does not seem to go away, ask yourself what you can do to eliminate such a challenge and distraction in your life.
  16. Maybe you are being sidetracked by negative thoughts and feelings because you have no faith in yourself.
  17. Addressing the root of the problem, completely blocking out any negative distractions and thinking purely positive thoughts is the best way for you to develop motivation in your everyday life.
  18. Constantly Work At Motivating Yourself
    1. Place your written goal beside the refrigerator. If your goal is to get physically stronger, place your written goal near your weight bench so you can see it when you are working out. This provides the extra motivation you need for those tough days.
    2. A great way to motivate yourself with business goals is to put up a motivational quote beside your desk. Do a Google search for motivational quotes, then print off one and put it inside of a picture frame. Keep it there and read it occasionally throughout the day. Whenever you find yourself not looking at the quote anymore, or it no longer provides the inspiration that it once did, it’s time to change the quote. It’s perfectly OK to change this quote every 1-2 weeks for maximum motivation.
    3. Some people make a habit of reading their goals either when they first wake up or right before they go to bed. When you read your goals upon arising, you may begin to notice that you find yourself doing more each day to help you reach your goals. Similarly.
    4. When you read your goals right before bed, you may notice that you wake up with good ideas that you never thought of before.

Final Thoughts
  • It is important to have motivation in your life.
  • Motivation is the fuel that you need to continue striving for your goals.
  • Soak up motivating things in your life on a daily basis.
  • Read great books that will inspire you.
  • Read great blogs that are both positive and informative.
  • It’s human nature to have days were you aren’t very motivated. However, if you continue to surround yourself with positive and motivational things, those days will be few and far between.
  • Thids is your determinbation for motivation.You have to make little extra efferts to change your life.
  • This is training of your mind to do what you think is good for and for your family.
  • You have to comme out of the shell which preventing your prosperous life.Unless you break your shell of isolation, you can not acheive your goals of motivation.
  • In the end I will suggest you to take the step and follow the above guide line and you will definetly succed to motivate youreslf.

Good luck
Dr Riaz Bhutta


CHRONIC HEPATITIS C – THE PROMISE AND THE COST OF A ‘CURE'

Posted Jan. 10, 2014

Hepatitis C is spreading in Pakistan

  • Hepatitis C is very common in the underdeveloped areas of Pakistan.
  • The reason for the spread is :
    1. Lake od education about this disease in the underdeveloped areas.
    2. Quakes in the villages use one syring for number of the patient.
    3. Barbers are using the same razor for so many customers.
    4. Dentists use one needle for the local injection.
    5. Blood transfusion without proper screening.

Chronic Hepatitis C (CHC) is an inflammation of the liver caused by a virus (Hepatitis C virus, HCV). The virus was discovered in 1989 as the causative agent of what was till then known as non-A non-B hepatitis. It is transmitted through contact with infected blood and blood products. Among those who are infected, the infection becomes chronic, i.e. persists for longer than six months, in 75-85% of the people. If left untreated or unresponsive to treatment, CHC may lead to cirrhosis of the liver and liver cancer over a course of a few years to decades. Traditionally considered to be asymptomatic before cirrhosis or liver failure sets in, CHC is nevertheless associated with debilitating symptoms for many patients which reduce the quality of life considerably.

  • Approximately 2%–3% (130–170 million) of the world’s population has been infected with HCV. In many developed countries the prevalence of HCV infection is <2%. The prevalence is higher (>2%) in several countries in Latin America, Eastern Europe, and the former Soviet Union, and certain countries in Africa, the Middle East, and South Asia; the prevalence is reported to be highest (>10%) in Egypt. In Pakistan the prevalence of CHC is 4.8%., (http://www.ncbi.nlm.nih.gov/pubmed/21495584) which along with chronic hepatitis B contributes to a high burden of chronic liver disease.

  • Last month, the FDA (U S Food and Drug Administration) approved the oral drug Sofosbuvir (Sovaldi, Gilead Sciences) for treatment of chronic hepatitis C. It is being termed as a ‘game changer’ in the treatment of CHC, having shown promising results in ‘difficult to treat’ patients. It comes with a hefty price tag of $1000 a pill, which means a 12-weak course would cost $84,000 and a 24-week course, which is recommended for infection with type 3 virus will cost twice that amount.
  • I will return to this new miracle but let me first say a few words about the history of the treatment of CHC.
Chronic hepatitis C was initially treated with intramuscular interferon as a monotherapy and then in combination with Ribavirin as ‘combination therapy’. In the last decade ‘pegylated’ interferon was introduced which could be injected into the skin and needed less frequent dosing. Interferon was advertised as a “miracle cure” for CHC, after it failed to come up to expectations as an anti cancer drug in the 1980s. In effect interferon by itself clears HCV infection in only 15% of the patients. It is only by adding Ribavirin to the regimen that the ‘sustained virological response’ to this treatment increased. However, a meta-analysis of 83 randomized trials totalling 12,707 patients by the Cochrane Collaboration, a non-profit partnership of healthcare professionals from around the world, concluded the following:
in the addition of ribavirin to interferon increases the number of patients who clear the HCV and the number of patients with improved liver histology to about 40%. The combination of ribavirin and interferon is also likely to reduce the risk of liver disease or all-cause mortality. However, the number of patients that must be treated to prevent one patient from developing a disease or dying seems very high. In addition, the combined treatment was associated with an increased risk of anaemia and several other adverse reactions.

  • The results raise a dilemma: is it justified to increase the risk of gastrointestinal, infectious and other dermatological adverse reactions and hematologic disorders by adding ribavirin to interferon, while it has not been clearly demonstrated that the antiviral effect of the intervention is directly related to the reduction of all-cause mortality? We therefore suggest that the use of the combined intervention be strictly subordinated to the welfare of the specific patient. In addition, we suggest that all future trials in this area focus more on adverse clinical outcomes and long-term reactions.”
  • (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005445.pub2/abstract)
  • I have not seen any such ‘subordination to the welfare of the specific patient’ in the excessive enthusiasm for this ‘miracle cure’ as patients were prescribed the ‘combination therapy’ without much discrimination. Long term follow-up practices are already very poor in our healthcare set up, and this has a huge negative impact on the quality of care when a disease requires long term treatment. Thus even after nearly twenty years of experience with interferon therapy and 15 years with ‘combination therapy’, we are not any wiser about the adverse effects of these drugs in our patients that the Cochrane review board has warned us about. Nor do we have any reliable data that would tell us how many patients we cured or whether clearing of the virus from the blood in fact led to reduced mortality in our patient population.
  • Interferon was sold at an exorbitant price before it was subsidized by the government (nothing less than a major success for the pharmaceutical industry) and the economic fallout of getting this treatment for families of the patients cannot be ignored. In the rush for this miraculous cure, most patients in Pakistan were treated even without determining the genotype of the hepatitis C virus they are infected with when it has been established that the viral genotype is the most important factor effecting treatment outcomes for interferon therapy.
  • What makes this an even greater cause for concern are the reservations expressed by the Cochrane review board about a causative relationship between reduced mortality and the anti viral effect of the combination therapy. So we continue to enthusiastically prescribe expensive drugs while we know little to nothing about their ability to reduce mortality. What little we do know, is no more than ‘received wisdom’, and we are a rather religious lot, aren’t we?
  • Racial and ethnic differences between various patient populations that have been shown to influence treatment outcomes are also largely ignored by the multi billion dollar pharmaceutical industry while developing drugs like interferon (and now Sofosbuvir). Since these drugs have been developed in western countries, there is little evidence for efficacy, dosage and side effects of these drugs in our population. Within the US, interferon based therapies have been shown to be less effective for African Americans than white Americans.
  • Among the best known examples of drugs that have been responsible for revealing genetic variation in response between races are isoniazid, succinylcholine, primaquine, coumarin anticoagulants, certain anaesthetic agents, the thiopurines, and debrisoquine. European people show a superior anti-hypertensive response to beta blockers, which was one of the anti-hypertension drugs, when compared with their African counterparts.
  • Besides response to the anti-hypertensive drugs, different races had different risks of warfarin therapy (used for blood thinning). Clinical trials suggest that when INR, which is the blood clotting indicator, was low, Asians had a better protection from the blood clot obstruction in their blood when compared with their white counterparts and needed lower doses of warfarin to achieve the desired results as compared to white population.
  • We in Pakistan, however, have seldom sought to verify the evidence provided for the efficacy of these drugs in our own populations before we start prescribing them to tens of thousands of patients who buy them at the cost of their life’s savings. In this era of ‘evidence based medicine’, we are happy to follow wherever the pied piper might lead us. Corporate interest stumps patient care in the healthcare sector and any dissenting voices are silenced very soon as governments are prevailed upon to subsidize expensive therapies once a disease becomes a big enough public health concern. Hence we get socialized health care that is nevertheless a victory for the corporate sector. We are being played a very clever hand indeed. Unfortunately, many of those who should side with the poor patients have chosen to advocate the cause of the pharmaceutical industry, and have become marketing tools in their hands, selling one “miraculous cure” after another to unsuspecting patients.
  • In view of this history, I am sceptical about this new miraculous cure we are being sold at such a huge price tag. I strongly feel that we need to study this drug in our population for adverse effects, dosage and efficacy before we start prescribing it.
  • Medecins Sans Frontieres (MSF) has announced its support for the ‘patent opposition’ just filed at India’s Patent Office by the Initiative for Medicines, Access & Knowledge (I-MAK), which aims to prevent Gilead (Pharmasset) from gaining a patent in India on sofosbuvir. If the plaintiffs win this case, it will allow Indian companies to produce the drug locally which would reduce its cost substantially. This is now a major battleground for MSF’s Access Campaign. The patent battle achieved a major victory in India in 2007 when Glaxo was refused a patent for Combivir, a fixed-dose combination of two AIDS drugs (zidovudine/lamivudine, or AZT/3TC) which allowed Indian companies to market affordable generic versions of this drug, revolutionizing the treatment of AIDS worldwide. In April last year, India’s Supreme Court issued a major judgment against Swiss pharmaceutical company Novartis AG, denying a request to issue a patent for its cancer drug, Glivec.

  • Perhaps it is high time that we should follow the example of our neighbours and reform patent laws allowing local manufacturers to market affordable generic versions of life-saving drugs after testing them on the local population for efficacy, dosage and side effects.

Prof.Dr.Abbas Hayat Rawalpindi Medical College Pakistan


Sleep disturbance and different myths about Sleep ,Effect of Age on Sleep

Posted Nov. 24, 2013

  • We will discuss various aspects of sleep e.g.
    • How to Sleep Well as You Age.
    • Tips for Overcoming Insomnia and Sleeping Better Over 50.
    • Sleep & Aging: Patterns, Problems & What to Do
  • As we age we often experience normal changes in our sleeping patterns.
    • We may become sleepy earlier, wake up earlier, or enjoy less deep sleep.
    • Although these changes are a normal part of aging, disturbed sleep, waking up tired every day.
    • Sleep is just as important to our physical and emotional health over the age of 50 as it was when we were younger.
    • These tips can help you overcome age-related sleep problems and get a good night’s rest.

The importance of sleep for older adults

  1. No matter what is your age, sleeping well is essential to your physical health and emotional well-being.
  2. Good night’s sleep is especially important because it helps improve concentration and memory formation,
  3. Sleep allows your body to repair any cell damage that occurred during the day,
  4. Good sleep refreshes your immune system, which in turn helps to prevent disease.
  5. Many physicians consider sleep to be a barometer of a person’s health, like taking his or her temperature.
  6. Older adults who don’t sleep well are more likely to suffer from depression, attention and memory problems, and excessive daytime sleepiness.
  7. They are likely to suffer more nighttime falls, have increased sensitivity to pain.
  8. These person may use more prescription drugs or over-the-counter sleep aids.
  9. Insufficient sleep can also lead to many serious health problems in older adults, including an increased risk of cardiovascular disease, diabetes, weight problems, and breast cancer in women.

How many hours of sleep do older adults need?

  1. While sleep requirements vary from person to person, most healthy adults tend to require between seven and a half to nine hours of sleep per night to function at their best.
  2. The criteria of good sleep
    1. However, how you feel following a night’s sleep is more important than the specific number of hours you spend asleep.
    2. Frequently waking up not feeling rested or feeling tired during the day are the best indications that you’re not getting enough sleep at night.
    3. This means that you have sleep problem that needs to be addressed.

Understand how sleep changes as you age.

  1. As you age your body produces lower levels of growth hormone, so you’ll likely experience a decrease in slow wave or deep sleep.
  2. When this happens you produce less melatonin, that will lead to often more fragmented sleep (more rapid sleep cycles) and wake up more often during the night.
  3. As your circadian rhythm (the internal clock that tells you when to sleep and when to wake up) changes, you may also find yourself wanting to go to sleep earlier in the evening and waking up earlier in the morning.
  4. As you age, you may have to spend longer in bed at night to get the hours of sleep you need.
  5. Or you may have to make up the shortfall by taking a nap during the day.
  6. In most cases, such sleep changes are normal and don’t indicate a sleep problem.

Sleep problems not related to age or sleep disorder

  • At any age, when experience occasional sleep problems.
    1. However, if you experience any of the following symptoms on a regular basis, you may be dealing with a sleep disorder:
      1. Have trouble falling asleep even though you feel tired.
      2. Have trouble getting back to sleep when awakened.
      3. Don’t feel refreshed after a night’s sleep.
      4. Feel irritable or sleepy during the day.
      5. Have difficulty staying awake when sitting still, watching television, or driving.
      6. Have difficulty concentrating during the day.
      7. Rely on sleeping pills or alcohol to fall asleep.
      8. Have trouble controlling your emotions.

Identify underlying problems of Insomina or sleep disorder

  1. Many cases of insomnia are caused by underlying but very treatable causes.
    1. While emotional issues such as stress, anxiety, and depression can cause insomnia.
    2. The most common causes in adults over 50 are a poor sleep environment and poor sleep and daytime habits.
  2. Try to identify all possible causes of your insomnia so you can tailor treatment accordingly e.g.
    1. Are you under a lot of stress?.
    2. Are you depressed?.
    3. Do you feel emotionally flat or hopeless?.
    4. Do you struggle with chronic feelings of anxiety or worry?.
    5. Have you recently gone through a traumatic experience? .
    6. Are you taking any medications that might be affecting your sleep?.
    7. Do you have any health problems that may be interfering with sleep?

Common causes of insomnia and sleep problems in older adults

  1. The most common causes of insomnia and sleep problems in older adults include:
    1. Poor sleep habits and sleep environment. These include irregular sleep hours, consumption of alcohol before bedtime, and falling asleep with the TV on.
    2. Pain or medical illness.
    3. Pain can keep you from sleeping well.
    4. Health conditions such as a frequent need to urinate, arthritis, asthma, diabetes, osteoporosis, nighttime heartburn, menopause, and Alzheimer’s can interfere with sleep.
    5. Medications. Older adults tend to take more medications than younger people and the combinations of drugs, as well as their side-effects, can impair sleep.
    6. Lack of exercise. If you are too sedentary, you may never feel sleepy or feel sleepy all of the time. Regular aerobic exercise during the day, at least three hours before bedtime, can promote good sleep.
    7. Psychological stress or psychological disorders. Significant life changes like the death of a loved one or moving from a family home can cause stress. Anxiety or sadness can also keep you awake, which can, in turn, cause more anxiety or depression.
    8. Sleep disorders. Restless Legs Syndrome (RLS) and sleep-disordered breathing such as snoring and sleep apnea may occur more frequently in older adults.
    9. Learned response. People with a legitimate cause for having trouble sleeping—after suffering a loss, for example—may lie in bed and try to force themselves to sleep. Eventually their bodies learn not to sleep. Even after your original reason for sleep disruption has passed, the learned response can remain.

Improve sleep habits

  1. Poor sleep habits, including a poor sleep environment and poor daytime habits, can be the main causes of sleep problems and low-quality sleep.
  2. In many cases, older adults develop these poor sleep habits over a lifetime but find they create more and more problems as they Improve daytime habits for better sleep
    1. Be engaged. Social activities, family, and work can keep your activity level up and prepare your body for a good night’s sleep.
    2. If you’re retired, try volunteering, joining a seniors’ group, or taking an adult education class.

Improve your mood

  1. A more positive mood and outlook can reduce sleep problems.
  2. Exercise regularly. Exercise releases endorphins that can boost your mood and reduce stress, depression, and anxiety.
  3. Expose yourself to sunlight. Bright sunlight helps regulate melatonin and your sleep-wake cycles.
  4. Try to get at least two hours of sunlight a day. Keep curtains and shades open during the day, move your favorite chair to a sunny spot, or consider using a light therapy box to simulate daylight.
  5. Limit caffeine, alcohol, and nicotine. All are stimulants and interfere with the quality of your sleep.

Encourage better sleep at night

  1. Naturally boost your melatonin levels. Artificial lights at night can suppress your body’s production of melatonin, the hormone that makes you sleepy.
  2. Use low-wattage bulbs where safe to do so.Don’t read from a backlit device at night (such as an iPad).
  3. If you use a portable electronic device to read, use an eReader that is not backlit,Use soft bedside lamp.
  4. Make sure your bedroom is quiet, dark, and cool, and your bed is comfortable. Noise, light, and heat can cause sleep problems.
  5. Try using a sleep mask to help block out light.
  6. Use your bedroom only for sleep. By not working, watching TV, or using your computer in bed,
  7. you’ll associate the bedroom with sleep.so when you get into bed your brain and body get a strong signal that it’s time to nod off or be romantic.
  8. Move bedroom clocks out of view. Anxiously watching the minutes tick by when you can’t sleep is a surefire recipe for insomnia. Light emitted from a clock, telephone or other device can also disrupt your sleep.
  9. Keep a regular bedtime routine for better sleep
  10. Maintain a consistent sleep schedule. Go to bed and wake up at the same times every day, even on weekends.
  11. Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.

Keep a regular bedtime routine for better sleep

  1. Maintain a consistent sleep schedule.
  2. Go to bed and wake up at the same times every day, even on weekends.
  3. Block out snoring. If snoring is keeping you up, try earplugs, a white-noise machine, or separate bedrooms.
  4. Go to bed earlier. Adjust your bedtime to match when you feel like going to bed, even if that’s earlier than it used to be.
  5. Develop bedtime rituals. A soothing ritual, like taking a bath or playing music will help you wind down.
  6. Relxation and stress management techniques, such as deep breathing and progressive muscle relaxation, take some practice but their benefits can be substantial.
  7. Limit your use of sleeping aids and sleeping pills. Many sleep aids have side effects and are not meant for long-term use.
  8. Sleeping pills don’t address the causes of insomnia and can even make insomnia worse in the long run.
  9. Therefore, it’s best to limit sleeping pills to situations where your health or safety is threatened.

DR.Riaz Bhutta (Modified from Helpguide.org)


Things to Avoid to Protect Your Teeth.

Posted Nov. 22, 2013

  • There are few remedies to protect your teeth from being damaged.
    1. Avoid Chewing on Ice.
      1. It’s natural and sugar free, so you might think ice is harmless.
      2. But munching on hard, frozen cubes can chip or even crack your teeth.
      3. Hot foods and cold foods may trigger quick, sharp jabs of pain or a lingering toothache.
      4. If you have the urge for ice, chew some sugarless gum instead
    2. Avoid Milk bottle at bed time.
      1. Giving a baby a bedtime bottle of juice, milk, or formula, can put new teeth on a path to decay.
      2. The baby may become used to falling asleep with the bottle in his or her mouth, bathing the teeth in sugars overnight.
      3. It’s best to keep bottles out of the crib.
      4. So avoid giving bottle before baby going to sleep.
      5. Before going to bed better brush the teeth of baby.
    3. Tongue Piercings or chewing hard on hard metal.
      1. Biting down on the metal stud can crack a tooth.
      2. Lip piercings pose a similar risk. And when metal rubs against the gums, it can cause gum damage that may lead to tooth loss. ## The mouth is also a haven for bacteria, so piercings raise the risk of infections and sores.
    4. Grinding Teeth.
      1. Teeth grinding, or bruxism, can wear teeth down over time.
      2. It is most often caused by stress and sleeping habits. This makes it hard to control.
      3. Avoiding hard foods during the day can reduce pain and damage from this habit.
      4. Preventive measures are wearing a mouth guard at night can prevent grinding while sleeping.
    5. Cough Drops or Lozenges.
      1. Cough drops are loaded with sugar, no doubt there is medicinal element as well.
      2. After using cough drops or lozenge , brush your teeth,
      3. Whether the sugar comes from a cough drop or a hard candy, it reacts with the sticky plaque that coats your teeth.
      4. Then bacteria in the plaque convert the sugar into an acid that eats away at tooth enamel.
      5. This process may lead to cavity formation.
    6. Gummy candy or Jelly loaded with sugar.
      1. All sugary treats (Candy or jelly ) promote tooth decay.
      2. Gummies stick in the teeth, keeping the sugar and resulting acids in contact with your enamel for hours.
      3. Taking a meal, more saliva is produced , which helps rinse away candy bits and acids.
    7. Soft drinks or Soda.
      1. Candy isn’t the only culprit when it comes to added sugar.
      2. Sodas and soft drinks (Coca cola , Pepsi and etc.) can have up to 11 teaspoons of sugar per serving.
      3. Sodas also contain phosphoric and citric acids, which eat away at tooth enamel.
      4. Diet soft drinks let you skip the sugar, but they may have even more acid in the form of the artificial sweeteners. So these are also not safe to drink for the teeth.
    8. Opening Stuff With Your Teeth.
      1. Opening bottle caps or plastic packaging with your teeth may be convenient, but this may cause damage to your teeth.
      2. Using your teeth as tools can cause them to crack or chip.
      3. This is better to take the help of scissors or knife or bottle opener.
      4. Net shell teeth should only be used for eating purpose.
    9. Sports Drinks or Energy drinks.
      1. Cold sports drink or energy drinks are refreshing.
      2. But these drinks are usually high in sugar.
      3. Like soda or candy, sugary sports drinks create an acid attack on the enamel of your teeth.
      4. Drinking them frequently can lead to decay.
      5. A better way to stay hydrated at the gym is to drink sugar-free, calorie-free water.
    10. Fruit Juices.
      1. Fruit juice is loaded with vitamins and antioxidants, but unfortunately most juices are also loaded with sugar.
      2. Some juices can have as much sugar per serving as soda.
      3. For example, there are only 10 more grams of sugar in orange soda than in orange juice.
      4. Fruits are naturally sweet, so look for juice that has no added sugar.
      5. You can also reduce the sugar content by diluting juice with some water.
    11. Potato Chips or Starchy foods.
      1. The bacteria in plaque will also break down starchy foods into acid.
      2. This acid can attack the teeth for the next 20 minutes.
      3. Floss after eating potato chips or other starchy foods that tend to get stuck in the teeth.
      4. So eating the potato chips or starchy foods is not good for the teeth.
    12. Taking Snacks.
      1. Taking frequent snacks produces less saliva than a meal.
      2. Taking snakes leaving food bits in your teeth for hours longer.
      3. Avoid snacks too frequently.
      4. Take snacks that are low in sugar and starch e.g. carrot sticks.
    13. Chewing on Pencils, ball point or pins.
      1. Do you ever chew on your pencil, ball point or pin when concentrating on work or studies?
      2. This habit can cause teeth to chip or crack.
      3. Sugarless gum is a better option when you feel the need to chew.
      4. Sugar free gum trigger the flow of saliva, which can make teeth stronger and protect against enamel-eating acids.
    14. Drinking Coffee.
      1. Coffee’s dark color and acidity can cause yellowing of the teeth over time.
      2. Fortunately, it’s one of the easiest stains to treat with various whitening methods.
      3. This is advisable to clean or rinse your mouth after taking the coffee.
    15. Smoking cigarettes or tobacco products.
      1. Cigarettes, as well as other tobacco products, can stain teeth and cause them to fall out as a result of gum disease.
      2. Tobacco can also cause cancer of the mouth, lips, and tongue.
      3. If you were looking for one more reason to quit, think of your smile where the teeth are not stained.
    16. Drinking alcohol (Red Wine or white wine).
      1. The acids in wine eat away at tooth enamel, creating rough spots that make teeth more vulnerable to staining.
      2. Red wine also contains a deep pigment called chromogen and tannins, which help the color stick to the teeth.
      3. This combination makes it easy for the wine’s red color to stay with you long after your glass is empty.
      4. The acids still weaken the enamel, leaving the teeth porous and vulnerable to staining from other beverages, such as coffee.
      5. Toothpaste with a mild whitening agent can fight the staining effects of red and white wines.
    17. Binge Eating (Over eating).
      1. Binge eating (Over eating) often involves excessive amounts of sweets, which can lead to tooth decay.
      2. Binging and purging (bulimia nervosa) can do even more damage to your dental health.
      3. The strong acids found in vomit can erode teeth, making them brittle and weak. These acids also cause bad breath.

  • By taking care you can prolong the life of teeth.
  • This needs just slight extra time a day to clean the teeth frequently.
  • Clean and healthy teeth means good health.

Dr.Riaz Bhutta (Modified from WebMD)


Health system Comparison of Pakistan And USA

Posted Nov. 9, 2013

  • This may look very ridiculous to compare the health system of the most developed country USA and the third world country like Pakistan..
But comparison is very interesting because both the systems are not affordable by the poor population.

USA examples

  1. American health system is so expensive that one can not think of it without insurance.
  2. Health Insurance is costly and most of the daily workers can not afford it.
  3. I can quote one example which I came across, was the handyman. Who was not able to get insurance nor was getting medicade.
    1. He was heart patient and went to emergency repeatedly. For that he got the bill of $32000.00
    2. This fellow has back pain and when he goes to hospital, they ask him for insurance and without insurance they were not doing his X-ray and CT scan. Personally he was not able to pay cash which was around $3000.00.
  4. Another example is one of my own patient.
    1. We went to emergency for pain abdomen. They kept for one hour and did CBC, LFT and CT scan abdomen.
    2. After workup they found no abnormality and send us home to consult family physician.
    3. Later on we got the bill of $7000.00

Pakistan health system

  1. This is also not affordable by the poor patient.
  2. If you go to government hospital, there the working conditions are very poor.
  3. If you can afford then you can get the best available medical services from the private setup.
  4. If you are civil service officer or influential person then also you will get VIP treatment.
  5. In Pakistan health insurance system is also not available.
  6. In Pakistan few setups like Agha Khan hospital Karachi, Shifa International hospital Islamabad, and Doctor’s hospital Lahore and few more know hospital can not be afforded by the 80 % of population.

So I think these two countries are not fit for the poor to get health services and both health systems can be compared as the same