A well-said quote is “Self- confidence is something that can make you honored.”

Nobody is born with self-confidence in this world. It is something that you learn from your family, environment, friends, teachers or sometimes tragic experience that provokes your inner voice. In the same way, some factors can influence your self-confidence, like family relations, environment, long isolation, bullyings, and tortures, etc. we will consider this in the article.

Before understanding the self-confidence, discuss the two components that are an essential ingredient for self-confidence, they are self-esteem and self-efficacy.

Self-confidence, self-esteem, and self-efficacy some times apply reciprocally but they are different in aspects;

• Self-esteem:  self-esteem is the thoughts of ours for ourselves. It plays an essential role in building self-confidence because a person can not be confident who doesn’t know its self. It is essential to know your worth or worthiness in life and place. In the book “ Society and the Adolescent Self-Image,” Rosenberg defines that “ self-esteem leaned on the assumption that it was a relatively stable faith about one’s overall self-worth.”

• Self-efficacy:  self-efficacy knows the capacity and compatibility of ourselves, .it is also an important contributor to self-confidence because if a person does not know its capacity cannot control the situation. Albert Bandura defines self-efficacy as an individual’s beliefs about their capacity to influence the conclusions in their own lives.

Self-confidence is the trust, believes, judgments in oneself. It is the inner feeling which tells us that we are worthy of what we have and what will we achieve in the future, and it is the trust in ourselves that what we will choose is the best choice that we can make, it is believed that what we are doing is right, it is the feeling of love for ourselves.

Self-confidence can not stand without self-esteem(self-knowing) and self- efficacy( self capability). Self-esteem is more of a present-focused mindset, while self-efficacy is more of a forward-looking belief.

Self-confidence brings more happiness, like, the more you confident about your abilities, and capabilities, the more energized and motivated you are to take action and achieve your goals.

From reviews, it is found that self-confidence is associated with better health, better social lives, protection against mental disorders and social problems, healthy coping, and mental well-being. 

How self-esteem and self-efficacy inspire self-confidence?

Self-confidence is the thing that the world sees. The society and system cannot see your inner soul, inner struggle, your mind Strom, they see your outer look, how you act, your gate, your behavior, your appearance, and your facial expression. Let’s understand the connection between self-esteem, self-efficacy, and self-confidence. 

 This true story is about Muniba Mazari, who also called an “Iron lady of Pakistan” and “proud of Pakistan.” She is lively working as an anchor at Pakistan Television Corporation (PTV), and the first wheelchair-using artist and first female Goodwill Ambassador. Her story is so motivated to those who have a healthy working body. 

She said that “ she was 18 when she got partnered and that was never a happy marriage. After two years, she met a car accident in which her spine was crushed and had sustained multiple fractures to her arm, shoulder, ribs, and collarbone. And one day, Doctors informed her that she would never be able to walk, paint, or give birth again; that day she was devasted and questioned her existence in this world. 

One day she asked her brothers to bring colors, canvas, brushes that she wants to paint, she was tired with a white hospital room. And she painted a picture; she painted her grief, her inner violence, her heartache, and herself.

“…that day and that moment she decided that she would live only for herself. She is not going to be a perfect person for someone but herself. She was just going to take that moment and make it perfect for herself, that she will be going to fight her fears.”  she wrote all her fears one by one and decided to overcome one by one.

The day when she decided to live for herself, her self-esteem magnified because she knows she is worth living. And when she thought to fight her fears, her self-efficacy improved because she knows she has to do it. And now her confidence called Iron lady.   

There are even more realistic stories like this that tell us how a person trusts himself and turn his life and move on.

Why self-confidence matters in a person’s life?

Self-confidence is important in virtually every stage of life. However, many people faced hardships and scold just because of low self-confidence and are less likely to achieve success.  

We also saw in our lives a person who visibly nervous, mismanaging, or constantly apologizing are less attractive as compared, a person who is attentive, speaks clearly, answer efficiency, and admit their mistake.   

Self-confident people inspire others, like their class fellows,  their audience, their colleagues, their boss, their customers, their friends, and importantly their family.   And winning confidence of others is the keyway to accomplishments in life.

It is also be seen that High self-confidence people have even increased chances of survival after a serious surgical procedure and show strong and positive mental health.

Theories that define the importance of self-confidence:

Many people understand self-reliance and explain to other people that no human being is inferior to anyone; his/her self-confidence and self-esteem makes him different from people.

And there are many theories and frameworks of self-confidence in the psychological literature. Let’s look at common beliefs and popular theories surrounding self-confidence and self-esteem.

Maslow’s Hierarchy of Needs:

Maslow’s hierarchy of needs, was an out-of-date framework in psychology, in this theory, there are several needs that humans must have met to be truly fulfilled. In the pyramid of this theory, self-esteem is the second-highest level of need, just under self-actualization.

According to Maslow, humans must have their needs of physiological security, safety, love, and belonging must satisfy before they can develop healthy self-esteem.  He also observes two kinds of self-confidence, a “higher” and a “lower,” the lower self-esteem comes from the respect of others, while the higher self-esteem comes from within.

Maslow shaped his theory and included the instances of highly self-actualized people who are homeless or individuals who live in a hazardous area or war zone but are also high in self-esteem and confidence.  

This hierarchy is no longer recognised as a stringent theory of unidirectional growth, but a more general expression of how basic needs being met allows individuals the freedom and capacity to inspire an individual self-confidence.

Terror Management Theory:

A darker theory that delves a bit more extensively into the human experience to explain self-confidence is the Terror Management Theory.

Terror Management Theory (TMT) is based on the belief that a person holds excellent potential for responding with terror to the recognition of their death, and that worldviews that emphasise peoples’ opinions in their quality of significance as humans protect them against this terror.  

TMT declares that self-esteem forms as a way to protect and buffer against anxiety, and subsequently, people try for self-confidence and react negatively to anyone or anything that could undermine their beliefs in their comforting worldview.

Sociometer Theory:

Mark Leary, a social psychologist who researches self-confidence in the context of evolutionary psychology, also presented a theory of self-esteem to built confidence in individuals in the literature.

The Sociometer Theory proposes that self-esteem is an internal gauge of the degree to which one is included vs excluded by others.  This theory holds on the conception of self-worth as an individual internal perception of social acceptance and rejection.

There is some strong confirmation for the accuracy and applicability of this theory and shows that social exclusion based on personal characteristics decreases self-esteem, which also hits confidence.

10 Factors that affect your self-confidence and tips to cope with it:

It is impossible in this world to always be confident and not afraid to move forward, and there are many factors when people need company, people’s noises, bullyings, behaviour sounds terrible. Let’s discuss them and see how to cope with the circumstances.

1.Your self-image:

Self-esteem is the most important thing,  how and what you think about yourself? How do you feel yourself? How do you see yourself? How do you walk? What do you think about the situations, challenges? How do you talk for yourself? How you treat others? 

Always remember “ people will think of you as you think of yourself” if you think your self-image is that you are good looking, smart, stylish, talented, selfish, and successful than people think the same! If not, and you consider yourself ugly, lazy, confused, weak than people think the same. What you feel about yourself, it matters. It doesn’t matter what people think.  Always think positively about yourself, be loyal to yourself, take care of yourself,  love yourself.

Don’t let your mind bully your body, always thankful for what you have!

Tip:

• Never feel inferior because every human is good in his/ her way. 
• Never think badly of yourself, what you have is probably not what anyone else has.   
• If the person’s expression sings bad, or someone’s advice verbalizes bad, or there’s is something annoying, always take a deep breath and think “ is that ok or do you need to change?” if not, then trust yourself.     

2. Family and friends relations:

Understanding and good relations from our friends, family, and your love-once, also a contributing factor that enhances self-confidence. We feel proud and confident when we think our family and friends have confidence in us, in our abilities. Sometimes we feel confident and secure when a family member or friends around us in public places, seminars.  

On the other hand, if our relationship with family and friends is bad or disturbed, we will not have attention, our concentration will not be good, our thoughts will continually depress us, and we will not be able to focus on anything like work, project, learning.

Tip:

• Try to make a strong understanding and good relation between you and your family and friends.   
• Try to leave where there are conflicts so that you can focus on your work.
• If your conflict bothering you then try to send an apology or any funny text to a person, it will give you peace of mind, and you will be able to do your job comfortably.
• If you see your friend or any family member losing self-confidence, then you should move forward to support and motivate them by talking; as talking is the best therapy.

3. Environment:

A well said words “ a negative atmosphere never grow a positive tree”, in the same way, no one can develop a good habit in a negative environment.  

If a person lives where people are never happy, where no one talks to anybody, never celebrate a small success, call people with bad words, do backbiting, and ruin the whole environment with anger; this kind of negative environment will never give you hope and confidence on you to do well. 

On the other hand, a positive environment, where people live happily, solve the situations with talking, considered your deeds and thoughts, appreciates you, encourage you to move forward; this kind of environment will help you to be confident and improve yourself more.

Tip:

• First, try to make your home or living place environment better.
• Or try to have a good atmosphere wherever you live.
• If not, discover a place or corner where you can find peace of mind and get out of stress.

4. Good  appearance:

Having a good appearance is one of the key factors of self-confidence. Many people gain confidence from perceiving that they look good, and it can help mentally for things like presentations, talks with strangers.

When you buy your food, you always take a look at the cover, in the same way, it works with our personality. If you expect someone to be nice, you first intuitively judge by his appearance. However, I do not mean that being engaging is a must. I just suggest that being correct with your appearance is important.

Having good body hygiene, coherence in your outfit style, a smile on your face, your reaction is some countable outlook that attracts others.

Tip:

• Always take care of your hygiene, your body, your outfit, your response.
• It is not important to wear branded and expensive clothes, wear fine clothes which look good on you is important. 
• Treat yourself with kindness when you make a mistake or face any bad experience. 
• Don’t compare yourself to other appearances; everybody has their style and looks. 

5. Long isolation period or loneliness:

Although Loneliness and self-esteem, both are essential aspects of individuals’ lives. But an extended period of Loneliness or isolation may represent a negative affect state and reflects an individual’s subjective perception of deficiencies in his or her network of social relationships. Self-esteem may be characterized as feelings of self-worth and self-respect, while Loneliness has been linked to physical illness 

Many studies measured correlations between loneliness and a wide variety of social, emotional, and fundamental variables. Lonely individuals have been found to express depressed views and to be low in positive affect. Lonely individuals are more likely to be shy and are less confident and less satisfied with life than other individuals. They avoid social interaction, spend extended time alone, experience social anxiety, fear, which develops severe distress and loneliness. 

Long isolation periods can be the cause of failure, rejection, emotional, any pandemic situations like strikes, COVID-19, etc.

Tip:

• See your past achievement and appreciate yourself. 
• If you are a failure or you faced rejections in your life then first you should think about why it is happening? Repeatedly try because loneliness is not the solution.   
• Make yourself busy what makes you happy and perfect, spend time with your loved once.
• Try volunteering for something and somewhere and meet new people. 
• If your relative has this problem, then you should help them, comfort them, appreciate them, forced them to do.  

6. Bullying and torture:

The people who experienced bullying and torture, start to internalize it and become self-critical because it starts to affect our behaviour, which in turn, can go on to impact both our mental and physical health. 

Bullying and torture mostly affect negatively but can affect positively if we once said no to bully and take action against it. 

Tip:

• Take action immediately if you can.
• Talk to your family or trust one, never hide this from them.
• Change the route, school, college, job, etc. 
• Never tolerate bullying and torture for a long time; it gives courage to other people to use you.  

7. Social Comparison:

Social comparison, judging ourselves with others, personally and professionally, can lead to a negative evaluation of yourself. Are you attractive or ugly, a success or a failure, smart or stupid? It probably depends on who you compare yourself against. We often make the mistake of comparing ourselves to others.

Comparison can have a negative influence on our self-esteem. It is frequent for us to compare ourselves to others. 

Tip:

• Develop a clearer and faithful sense of who we are!
• If you can’t stop yourself, at least take some restriction of whom you compare yourself to. 
• Make your self-concept more realistic. 
• If your surrounding has this comparison statics, then avoid these surroundings, or keep faith in you.

8. Crowd and audience:

An Audience or crowd effect can change in confidence and behaviour caused by being observed by another person or the belief that another person is observing one. 

Zajonc’s influential claim that “ in the presence of an audience or crowd, people perform better on easy tasks but worse on hard tasks”  and  large meta-analysis finding predicted that;

• In self-presentation or reputation-management account, a people who feel embarrassed after failures on hard tasks which makes later performance worse.
• Physiological signs of arousal during hard and easy tasks.  Physiological signs are cardiovascular changes, with increases in stress response when being observed during a difficult task and decreases when being observed an easy task.

Audience effects are also seen in the setting of emotional experience and the making of emotional facial expressions.

Tip:

Before going on the stage or any crowded place  prepare your body and mind for good performance;

• Talk positively and calm yourself.
• Use the restroom.
• Strike power pose
• Stretch your body lightly or take several deep breaths.
• Never ever pretend you are nervous
• Change your nervousness with your excitement 
• Focus your words and strength.

9. Accidents: 

Sometimes we faced so many accidents that change our lives, change us, change our attitudes, change our ideology. Because these accidents also have adverse effects on how we feel about yourself. These accidents include;

•  Car accidents,
•  Losing loved once,
•  Losing yourself,
•  Harassments,
•  Cheating,
•  Bullying,
•  Seeing someone being killed, etc.

These situations have negative effects on our body, which are; Fear and anxiety, panic attacks, loneliness, and lack of self-confidence.

Or these realities sometimes make us human beings who have no worries, feelings, the pain of others, or sometimes they forget the difference between right or wrong in the fire of revenge.

Tips:

• Accept what happened to you.
• Adjust according to the situation and find diversions like work or hobby.
• Try to love yourself or seek medical help.
• Consult with a lawyer.
• Avoid situations, people, or in fact area or place.

10. Teachers:

The teacher is not a king, but he tries his best to makes you king”. Teachers- student interaction matters in everyone’s life because we follow teachers after parents. 

There are some moments in our life, one of our favourite teachers would come up to us and said: “you are going to do something big in the future”. And at some point in our lives, we realize that he was right.    

Teacher’s guidance, advice, scold, and lectures, sometimes really help you in your hard time. Teacher in the appearance or religious scholar, philosopher, school teacher, grandparents, parents, or any person who guide you, always respects them.    

Tip:

• Respect your teachers because they have the power to change your life or your thoughts.
• Always try to learn something new from them, from their life experiences.
• And always be in touch with them.

Takeaway:

Self-confidence matters in everyone’s life. Life is not a bed of roses. It always gives you challenges and situations to make you stronger. So never be dishearten, believe in yourself, and be confident, it helps you to face any situation in life. It’s ok to be alone but never isolate yourself, spend time with your family and friends, and be happy!   “Stronger the self-esteem( self-knowing), stronger self-confidence.”

Pakistan is one of those countries which have the fastest rate of coronavirus infections, according to the World Health Organization (WHO). The first coronavirus case country reported on February 26, 2020, and is now among the top 15 most-affected countries. More than 4,000 people have lost their lives from COVID-19 in Pakistan since the beginning of the outbreak. Moreover, there is a significant shortage of personal protective equipment (PPE), ventilators, and isolation rooms in the country.

In a country that is home to 220 million people have just six hospital beds with a capacity of 60,000 people. Where the official government describes a picture of Pakistan’s hospital capacity recorded, only 1,681 critical care beds are currently occupied countrywide, compared with a total capacity of 6,664.

In this pandemic situation, Hunaid Lakhani a founder of Iqra University, head od bait-ul-maal,  Naveed Lakhani a famous businessman, and Zafar Abbas general secretary of JDC foundation start to build hospital named Hussain Lakhani Hospital, where the OPD, treatment, blood test, diagnostic test, and medicine offered free to the coronavirus patient.

Background:

Hunaid Lakhani named the hospital after his father’s name because this is their will to establish the best charity hospital of Pakistan for needy people, where any patient got every possible treatment facility from free medication to a free high-level equipment facility and operation. The foundation stone laid down on 30th April 2019.

The hospital began to be built on 15 July 2019 and was completed in 6 months. Its inauguration was held on 18 December 2019, where famous Islami scholar Molana Tariq Jamil taught that “Islam orders us to value humans and don’t divide into sects because hateful nations are doomed. And if you want to be a good person, then serve the servants of Allah and help hin in his misery.”

Hussain Lakhani hospital opens its door for the public and started with ten days of free eye camp and continue medical camp where they run gynae, general, peads, family medicine, and care were provided. 

Up to January, departments that are promoting are ophthalmology, gynae, peads, pharmacy,  physiotherapy, and general, where checkups, prescriptions, and medicines are administered free.    

In 20-25 days, more than 2700 patients reported in which more than 1000 eye patients examined, and 103 got back to back cryosurgery. And in the physiotherapy department, 5-6 patients per day patients approaches and received therapy.

But after the coronavirus outbreak, the hospital closed for at least two months, which was later explained by Hunaid Lakhani to 110 NEWS HD channels.“ Because of the coronavirus and lockdown circumstances and equipment for isolation ward like personal protective equipment (PPE) was not available. Secondly, the waste disposal system and disinfected system also not possible to be quick unless the equipment and Sindh health care commission don’t grant permission.”

Hunaid Lakhani’s statement on 18 March 2020:

Naveed Lakhani, Chairman, Hussain Lakhani Hospital Chairman, along with KMC Director Health Dr Salma Kausar, stated that “coronavirus patients will be treated free of cost in the ward. The state of art isolation ward is already implemented with ventilators, incubators, and other necessary equipment. The hospital will fully support the government in an hour of need.

He also added that the management of the hospital would try its best to facilitate maximum victims. And asked the business community to come front and encourage the government for the noble cause.”

The administration of Hussain Lakhani hospital announces the reopening of OPDs with all directed SOPs, where general physicians and consultants of peads, gynae, and dental care available. 

A revolutionary step for COVID-19 patients: 

In June, Hussain Lakhani’s trust revolutionary comes back with the participation of the JDC foundation, where they assured to provide free of cost ICU, ventilator, oxygen cylinder, and other treatment facilities to COVID-19 patients.   

In this collaboration, Huanid Lakhani said thanks to the JDC foundation and claimed that “he is very hopeful that this foundation will be completed and thousands of people will benefit from it. And also requested people to come and join them in their excellent work.” he also said,” ever since the lockdown began, he has been trying to make the hospital an isolation ward, ICU for coronavirus patient. Still, he has not been able to do so, but now with the JDC support, he will able to succeed, Insha Allah!     

Zafar Abbas, a general secretary of JDC foundation, said that “this is the first surveillance project in Pakistan which has provided its free of cost in coronavirus epidemic like this. And soon, it will be declared the hospital where everything from emergency to ICU will be offered free of charge.”

An agreement has been reached between the JDC foundation and Hussain Lakhani’s trust” that Hussain Lakhani’s trust will pay the salaries of doctors, paramedics, and the cleaning staff. At the same time, the JDC Foundation will buy all the machines and equipment of the hospital. 

JDC’s important services for Hussain Lakhani hospital:

All the services of the JDC foundation are excellent that they try its best to provide their service facility and also arrange a reliable and best quality equipment facility to Hussain Lakhani hospital, which includes; 

• X-ray machine- xindray medical international CO. limited. 
• Portable X-ray machines
• Ventilator – Hamilton medical- Galileo model
• Splits- Haier 
• Oxygen cylinder – 6000-liter oxygen cylinder taken from Pakistan oxygen-limited company. 
• ECG machines
• Defibrillator- frank’s Defibrillators 
• Monitors for the vital check- life care
• Medicine Trolly
• Laryngoscopic set for adults and babies
• Hospital beds, drip stand, and stretchers
• Incubator for babies
• Bilevel positive airway pressure (BiPAP)
• C-pipe
• Compressor Nebulizer-ABM 
• PPE like a surgical mask, KN95, gloves, face sheet, goggles, isolation gown, etc.  

And even the smallest items are being provided so that the hospital can start as soon as possible.   

Zafar Abbas interviewed by Urdu point,” we can’t stand that our Pakistani dying,” he said, “that’s why we have started the process of running all hospitals of Karachi that are not running, no matter how expensive the machine is we are putting and provide it. In HUSSAIN LAKHANI HOSPITAL, we are all buying the most expensive and imported machines here.” 

He also declared,” We are not asking anyone from which religion and sect he/she from? We are all human, we are all Pakistani, and we (JDC) are ready to do whatever it takes.”   

Building structure:

Huanid Lakhani told in Ishq-e-Ramzan transmission that” the father bequeathed the land for the hospital, and we had the funds, so we started building.”

Hussain Lakhani hospital is the one hospital that doesn’t have a cash counter, and there is a  reception in the waiting area where people are guided. Community health care is also given to people.

Hussain Lakhani hospital has a 650-bed capacity where 150 beds are ready, and at the end of the year, it will increase up to 350-400 beds or more. One flour of the hospital has six big halls, and each has a minimum of 40-beds capacity. The hospital is well designed, and different departments, laboratories, diagnostic rooms, and operation theatre building will be furnished with the best medical equipment. As Zafar Abbas said,” we are trying our best to manage the best medical equipment. No matter how expensive machinery is, we are buying it and not stopping.” 

A separate place for admission has been made for coronavirus positive patients from where the place will divide into 3 zones;

• Red zone: for ICU patients.
• Yellow zone:  for HDU patients.
• Green zone: an isolation ward.

All these rooms are ready, with the ventilator machine, vitals monitor, ECG machine, defibrillator, and negative pressure. HDU still has eight beds, the ICU has 12, and isolation ward has 25 consecutive beds, and more beds will be arranged soon.  

A mini operation theater also made for the patient who needs emergency treatment. And all restricted rooms or areas are well organized with equipment and have negative pressure ducts.   

A tunnel was made where medical staff members who are treating coronavirus patients wear off their PPE and go out of the hospital clean.

Hospital team:

The hospital cannot operate without the hospital team because these are the people who build and run the hospital system. Other than Hunaid Lakhani, Naveed Lakhani, and Zafar Abbas, hospital team include;

• Dr. Kadir Shaikh, who is the head of the hospital and will run the hospital system.
• Dr. Salman, Dr. M. Yasir Malik( senior physiotherapist), Dr. Syeeda Junaid, Dr. Rabab, Dr. Akhtar are working as a hospital administrator and also hiring more doctors, paramedics staff for working. And this project manager is Dr. Hassan Khurshid.
• Dr. Mughal Baigh, an eye specialist. And other doctors.

Dr. Rubab has previously worked voluntarily at the Expo Center for coronavirus patients. 

“And all the hospital team requested to other doctors, paramedics, cleaning staff to come forward and support Pakistan in this pandemic situation. And they are ready to give the best salaries, and if anyone wants to work voluntarily, they also welcome them.” 

General questions:

How to donate:

Come forward in this hour of tribulation and cooperate with HUSSAIN LAKHANI HOSPITAL and JDC FOUNDATION, you can donate or support in equipment facility, staff salary, or frontline caregivers.

HUSSAIN LAKHANI TRUST :

• Account title: HUSSAIN LAKHANI MEMON TRUST.
• Account No.: 1535180(JS Bank).
• IBAN NO.: PK33JSBL9512000001535180.
• Feel free to contact for further information, Contact no.: 021-36723218-19

JDC FOUNDATION:

• Account title: JAFARIA DISASTER CELL WELFARE ORGANIZATION
• Account no.: 1031-0081-011633-01-2
• Swift Code: BAHL PKKA.
• Branch address: Bank AL Habib Limited, Gulberg Sub-branch, Karachi, Pakistan.
• For further information, Contact no: 03440200960, 021-36341059
• Helpline no.: 1024

For more information you can visit;

Hunaid Lakhani :

• Facebook: https://www.facebook.com/Hunaid.H.Lak…
• Instagram: https://www.instagram.com/hunaidhlakh…
• Twitter: https://twitter.com/Hunaid_Lakhani

JDC foundation:

• Twitter: https://twitter.com/JDCWelfareOrg
• Instagram: https://www.instagram.com/jdcfoundati…
• Facebook: https://web.facebook.com/jdcfoundatio…
• Youtube: https://www.youtube.com/JDCFoundation
• Website: http://www.jdcwelfare.org/

Location:

Hussain Lakhani hospital situated at Allama Rasheed Turabi Rd, opp. Iqra University, Block-B Block B North Nazimabad Town, Karachi, Karachi City, Sindh 74600. Or in front of Ziauddin hospital.

Takeaway:

Pakistan’s situation is different from the US, China, and others, because 25% of our people are in poverty. Punishment falls on the poor because of lockdown. Because of coronavirus, there are no places or beds in a hospital, and where there is, there is so much money that no one can afford it.  

In this situation, the work done by Hussain Lakhani’s trust and JDC foundation is admirable that they set up the hospital, which provides free treatment to poor or needed people. And Insha Allah Pakistan will come out of this plague soon. Insha Allah! The hospital will provide its services soon.

As Dr Rabab said” whenever Pakistan had a bad time, we faced it together. And this is also a difficult time for us for Pakistan, so please go ahead and help all the non-disabled people and those Pakistani who are outside the country, whoever can play their part, do. And soon our hard work will pay off, and we will come out of this pandemic situation, Insha Allah!”     

• The initial symptoms of COVID-19 are high fever. It can be assumed that men infected with COVID-19 will also experience reduced fertility.
• Fever can overheat the testicles, which can temporarily reduce male fertility.
• Seasonal flu is also known to reduce male fertility. 
• Allan Pacey, Ph.D., male fertility expert, explained to Newsweek that ” At present, it is somewhat premature to conclude that novel coronavirus will affect male fertility. 
• Only ⅓ or ⅕ % of infected pregnant women experienced a severe illness that required medical attention. 

There is still much information that we don’t know about novel coronavirus and its impact on fertility of patients, but “we quite know a lot about a virus, flu, and male fertility,” described by Legacy advisor and reproductive urologist Dr. Paul Turek…… where he also explains, ” seasonal flu is also known to reduce male fertility.  We can suggest that it’s due to high fever associated with the illness, which overheats the testicles.

The effect of fever and flu demonstrated in several case studies of fertile men, such as in 2000, a case report determines that fever or influenza can have latent effects on sperm chromatin structure and may result in abnormal sperm production. Another case report in 2007, they found the high risk of temporary alteration of semen parameters after an acute febrile illness.

If considering the primary symptom of novel coronavirus is high fever (pyrexia), it can assume that infected men with coronavirus will also be experienced to reduce fertility temporarily. Dr. Turek currently believes that the COVID-19 is similar to a common seasonal flu regarding its impact on male fertility.

Where did the story come from?

In March, the Mail online web addressed that professors in reproductive medicine from Wuhan, claim new coronavirus ‘ may cause damage to a man’s testicles,’ and they urged it recovered male patients to test sperm quality and hormone level.

The same post was published on the Hubie government website, where they raised an affair about COVID-19’s potential to impact and male fertility based on the fact that SARS is a similar infection that has been known to cause orchitis and damage to the testicles. 

Why do they claim new COVID-19 may cause fertility problems?

SARS, MERS, and  COVID-19 are genetically similar, which has been known to damage multiple organs and also have a severe impact on the reproductive system.

Another basis for the claim was that the protein thought to be used by novel coronavirus to enter cells called ACE2 and it is found in the testes. So theoretically, the virus can infect the testes and this might affect sperm production. 

There are 2 studies we are discussing here, but remember these studies are not peer-reviewed. 

A  study is coming out from Wuhan on March 21, 2020, where they see the effect of SARS-CoV-2 infection upon male gonadal function and compared sex-related hormones between 81 infected men with 100 healthy non-infected men.

The study doesn’t find any clinical evidence about whether SARS-CoV-2 infection affects the male gonadal function. But show little difference in the levels of their reproductive -related hormone, but not in testosterone level. Thus professor Paolo Madeddu from the University of Bristol noted that ” Hormonal changes could be the result of general inflammation also affecting the gonad function. 

Another study published on March 31, 2020, the detection of coronavirus in semen and testicular biopsy specimens of COVID-19 patients. Where they found no positive results in semen or the testicular biopsy specimen, Hence no evidence of sexual transmission of COVID-19 from males.

However, no documented cases of testicular infection have been noted during the COVID-19 pandemic and still now.

Allan Pacey, Ph.D., male fertility expert, explained to Newsweek that ” At present, it is somewhat premature to conclude that novel coronavirus will affect male fertility. 

COVID-19 and its impact on female fertility:

Many people are curious and researching about coronavirus and its impact on female fertility because they are trying to decide whether it is a safe time to conceive or plan for the future.

As compared to males fertility, there is no evidence that pyrexia, flu, or illness similar to the coronavirus, have long or short term impacts on female fertility. And in this pandemic situation, the safety of pregnant people infected with COVID-19 and the safety of their babies is very limited and may be difficult as many health care facilities are dedicated to treating coronavirus patients.

Because of these reasons, many experts are recommending that people who plan a pregnancy may stop trying to conceive for a few months. 

What is the outcome of pregnancy during the COVID-19 pandemic?

Based on the limited data, only ⅓ or ⅕ % of infected pregnant women experienced a severe illness that required medical attention.  

According to limited data, we know that pregnancy alters the immune system in a way that increases the risk of infection like influenza, typhoid, and other related infections such as MERS and SARS can cause adverse pregnancy outcomes, which include miscarriage, premature deliveries, intrauterine growth restriction or maternal death. 

Historically, respiratory tract infection in pregnant women has been thought to increase the risk and cause severe morbidity and mortality. But currently, data of COVID-19 do not indicate that pregnant women are at increased risk of infection or severe morbidity, such as the need for ICU admission, as compared to nonpregnant women. Still, there is no authentic evidence of vertical transmission of COVID-19. American College of Obstetricians and Gynecologists (ACOG) warns pregnant women who get coronavirus may have a higher risk for some complications and precautions to avoid it

Many studies of pregnant women who contracted during pandemic situations and subsequently gave healthy live births. Some of the studies are here;

The nine pregnant women from WUHAN, were all in their third trimester and underwent a cesarean section and had a history of exposure to COVID-19.  But none of the neonates shows signs and symptoms of COVID-19 and lab tests also show SARS-CoV-2 negative. It suggests that no intrauterine fetal infection occurred during the late stage of pregnancy. 

A 40-years old Hispanic female with 28 weeks and four days gestation, presented to the emergency with worsening shortness of breath, cough, and hypoxia in the setting of known COVID-19 infection.  The decision was made to proceed with delivery. Postoperatively, the patient underwent ten days under observation, and the infant’s COVID-19 testing was negative on the 2-day of life. Placenta from COVID-19 positive mother, which was submitted to the pathology lab, shows the first visualization of the SARS-CoV-2 virus in the human placenta.

These studies demonstrated that their illness was not severe and they did not pass the virus along to the babies in utero or through breast milk. 

What if I’m planning a pregnancy or fertility treatment?

The European Society of Human Reproduction and Embryology advised that “ all fertility patients who are planning or considering treatment, or even if they do not meet the diagnostic criteria for COVID-19 infection, should avoid or delay becoming pregnant at this time.”

Similarly, The American Society for Reproductive medicine expressed that fertility clinics and hospitals postpone new fertility treatments until more is known about the virus. 

Can the mother pass COVID-19 to their baby?

The passing of disease from mother to their baby is known as “ vertical transmission,” referring to infection that occurs during pregnancy, labor, soon after birth, or through breastfeeding. In the case of SARS-CoV-19, the vertical transmission may be rare, but still, it can’t be completely ruled out. 

In London, the newborn tested positive with COVID-19, just minutes after being born to a mother who was admitted to a hospital with the symptoms of coronavirus infection. Doctors can not say it happened while the baby was still in the womb or during or after birth. 

A study from Wuhan Children’s Hospital, in which 33 neonates born to mothers with coronavirus, including 3 neonates infected positive with novel coronavirus were identified, with the most common symptom was shortness of breath.

Another study of six mothers with confirmed SARS-CoV-19 shows negative results in serum or throat swab by RT-PCR in their newborns. However, virus-specific antibodies were noticed in neonatal blood sera samples. As these antibodies are too large to pass the placenta, it is believed that they were developed independently in the neonate. 

The good news is infected infants cleared virus quickly in general and deaths among babies and children are rare.

Can the mother protect themselves and their baby?

The CDC recommends some tips to avoid coronavirus infection for pregnant women and in general and includes maintaining self-isolation, social distancing, avoiding touching your face, and washing hands.

What would be impacted if I delay my pregnancy?

There are many peoples whose planning to conceive naturally or through fertility treatment has been delayed by the pandemic coronavirus. 

The answer is no. Dr.Bat-Sheva Maslow briefs that “ when we are talking about the decline of fertility with age, we are talking in terms of a year, not about months.” So there is no evidence that a delay 2-4 months any impact on the success rate.

May sperm freezing be a good option?

Sperm freezing may be a beneficial and favorable choice during this coronavirus pandemic situation for both biologically and emotionally support. 

As we know that time and age affect male fertility for men over 35. Every 8th month, sperm acquired a new genetic mutation that passed into offspring. If coronavirus is pushing off your family plans, then sperm freezing would be a good option. Sperm testing and freezing are valuable options to preserve your fertility. 

Takeaway:

There is no evidence found that the fertility rate reduces in COVID-19 patients. But still, there is a higher risk of transmission as CDC advised: “ separating members of the household who have been infected with novel coronavirus or who have any symptoms.” an unapproved report regarding coronavirus to male fertility is also removed.

Forensic pathology is one of the branches of pathology that focuses and concludes the cause of death of an individual by examining a corpse. Forensic pathology usually helps during the investigation of criminal law cases and civil law cases in some jurisdictions.

The Forensic report is also called a postmortem report or autopsy report, which is made after a medical examination of the dead body.

Who is a Forensic pathologist?

The Forensic pathologist is a subspecialist in pathology, who work competently in the examination of individuals who died suddenly, unexpectedly, violently, or murderously. The Forensic pathologist is an expert in determining the cause and manner of death.

 The Forensic pathologist is a specially trained person in performing;

• Autopsies to identify the presence or absence of disease, injury, poisoning.
• To evaluate historical and law enforcement investigation information Relating to the manner of death.
• To collect medical evidence, like trace, secretions, and marks.
• To document sexual assault.
• To rebuild how a person received an injury and how death occurs.

The Forensic pathologist is trained and specialized in multiple forensic sciences and traditional medicine too. The forensic pathologist also has working knowledge in other areas of science including toxicology, firearms examination, trace evidence, forensic serology, and DNA technology.

When Forensic pathologists working as a death investigator they bring their expertise to bear upon the evaluation of the science of death, in the estimation of the time of death, the consistency of the witness’s statement with injury, and finding of injury pattern.

In jurisdictions, Forensic pathologists are employed to perform autopsies to evaluate and identify the cause and manner of death. 

What does a Forensic pathologist do?

The Forensic pathologist is the medical doctor who specializes in examination and investigation of sudden, unexpected, murder, or violent death.  The Forensic pathologist attempts all way to determine the identification of the dead victim, the time of death, the manner or type of death (natural, accident, suicide, or homicide), the cause of death, and if the death seems murdered than nature and type of instrument used to cause death.

First, the Forensic pathologist collects all the history regarding medical, witness statements of how the death occurred.  Next, the Forensic pathologist examines the victim’s dead body externally and internally,  taking small samples of tissues for microscopic examination for any abnormal changes that are not visible to the naked eye. This postmortem examination is commonly known as an autopsy.  

For autopsy reports, many laboratory tests may be undertaken, including x-ray, fluid samples such as blood and urine, small samples of tissue for analysis, and culture of body fluid and organ for evidence of infection or toxicity. 

How to become a forensic pathologist?

After attending a 4- year undergraduate course from high school, the candidate will need to complete a 4-years bachelor’s degree in M.D or D.O. degree, where they spend 2years in class, learning clinical work, and study for an exam. And in the last two years, they complete supervised clinical rotations in internal medicine, surgical, obstetrics, and other types of medical settings. 

After graduation, the student will need to obtain a pathology residency or fellowship for at least 3-5 years in general pathology, where they can learn and practice practical experience supervised by a trained pathologist. And 1-year special training in forensic pathology. The forensic resident can perform autopsies and participate in death investigations.

To get a license in forensic pathology, the student must give a three steps examination. and for the certificate, one must pass the exam given by the American Board of Pathology in general pathology, and then they may pursue a subspecialty certificate in forensic pathology.

Other than education, the forensic pathologist must possess some skills like;

• Good communication skills.
• A flexible approach to work.
• The ability to cope under pressure. 

How long it takes to become a forensic pathologist:

It takes a minimum of 13-15 years of education and training after high school to become a competent forensic pathologist.

Forensic Pathologist job description:

Forensic pathologist job description includes;

• A person can conduct an autopsy on dead bodies to determine the cause of death.
• A person can work for the crime branch or with local police to help them in criminal cases.
• A person can write a brief note on new findings and clues to work their way up to the cause of death.
• A person must fulfill duty includes helping in the investigation of murders etc and evaluating the autopsy findings.
• A person also possesses the quality of applying knowledge of toxicology, trace evidence, and DNA technology.

A forensic pathologist must be attentive, observant, brave, courageous, and must possess excellent oral and written communication skills. 

Forensic pathologist salary:

The forensic pathologist salaries vary according to their skills, education, and state. 

The average annual salaries of forensic pathologists;

• In New York is $ 103,753- $ 157, 138.
• In Washington is $ 154,567
• In California is  $140,841
• In texas is $ 126,936

 In Pakistan, the average base salary of a forensic pathologist is PKR. 5,258,624/ year. While the average entry-level salary with 1-3 year experience is  Rs. 3,555,767 and senior-level pathologists with 8+ years experience earns an average salary of Rs. 7,095,224.    

University for Forensic pathology:

There are several universities and medical school that offer forensic pathology fellowships are;

• University of North Carolina – Chapel Hill
• The University of Washington in Seattle
• The University of Michigan in Ann Arbor
• University of Texas Southwestern Medical School
• Saint Louis University
• University of Alabama, BirminghamIndiana 
• University of New Mexico
• Emory University

In Pakistan, 6 universities are offering MPhil Forensic medicine are;

• King Edward Medical University / Mio Hospital in Lahore
• Liaquat University Of Medical Health Sciences in Jamshoro
• University Of Health Sciences in Lahore
• Gandhara University in Peshawar
• Kabir Medical College in Peshawar
• Peshawar Medical And Dental College in Peshawar
• Bahria University Medical and Dental College in Islamabad

Forensic pathology course overview:

List of common courses include;

• Forensic Pathology and Medico-legal Investigation Course
• Homicide Investigation Course
• Forensic Photography Course
• Forensic Firearms Identification Course
• Forensic Anthropology Course
• Biological Evidence Analysis Course

Here some common concepts that forensic pathology students may encounter in their courses are;

• Cybercrime
• Fingerprint analysis
• Digital analysis
• Criminal procedure
• Microscopy
• Social relations
• Bloodstain pattern analysis

Importance of forensic pathology:

Forensic pathology is becoming more important because the crime rate is increasing, and judicial and court systems are relying more on evidence and the conclusion of the forensic pathology reports

Forensic pathology is also important because it helps in finding a cure and vaccine for many diseases by finding out how exactly the infected person may have died. And this is done by examination of the body at autopsy, removing tissue for examination and analysis of fluid from the body helps to determine the cause of death.

Team of Forensic pathology consists of:

Forensic pathology is the wide field, whose team not only consists of a forensic pathologist but also a forensic pathologist assistant, forensic pathology nurse.

Forensic pathologist Assistant:

Forensic pathologist assistant helps and assists the forensic pathologist with the procedure before, during, and after the postmortem examination, which includes preparing the cadaver, and cutting and collecting the samples of tissue, hair, blood, or bodily fluid. Forensic pathologist assistant also has many administrative duties, like help in preparing reports, ordering supplies, or training staff.

To become a Forensic pathologist assistant, the student must have completed an undergraduate program in the science field, leading to a bachelor’s degree. And got a master’s degree in pathologist assistant program accredited by National Accrediting Agency for Clinical Laboratories Sciences (NAACLS). It is a two years program in which first-year students spend their time taking medical courses to include medical terminology, pathology, anatomy, histology, and management. And the second year, they serve clinical fieldwork.

 There are 14 % chances of increasing job growth from 2018-2028.

Forensic nurse:

A forensic nurse is a cross-bridge between a healthcare professional and the judicial system profession. The forensic nurse helps the forensic pathologist and performs more specialized than nurses typically perform, because they have a variety of roles, such as evaluating and caring for victims of assault, domestic abuse, and sexual crime.  The forensic nurse also helps to testify in court about the medical information and evidence they have collected.

To become a forensic nurse, the student has to earn a bachelor’s degree or an associate degree in nursing and get a master’s degree in forensic nursing. Take and pass the NCLEX-RN exam and become a registered nurse in your state. 

Forensic pathology nurses usually work in hospitals, schools, jails, clinics, tissue -organ donation departments, and are often on call for law enforcement, or can work in the emergency room and may collect evidence like bullets, clothes, photographs, and documented victims’ injury that may help in the investigation.

Takeaway:

To become a forensic pathologist is not an easy job, and it also takes a strong stomach because it can be a gruesome, smelly, and disgusting job. It also needs a lot of confidence to defend your conclusion in front of opposition from lawyers, media, and victim’s families.

Forensic pathology is an expanding field that opens new doors for new students to work in a variety of specializations.

What is Phlebotomy?

Phlebotomy is a medical technique in which a needle is used to drain blood from a vein. It is also called venipuncture or drawing of blood. Phlebotomy usually uses for laboratory workup, to remove extra RBCs from blood, or to treat blood disorders.

phlebotomy is performed to treat polycythemia, a condition in which RBCs concentration is elevated in peripheral blood, and disorders that elevate the iron level in the blood to the dangerous state like hemochromatosis, hepatitis B, hepatitis C. 

Phlebotomy is a useful technique in removing blood from the body for donation, transfusion, or analysis.

Phlebotomists:

A person who performed phlebotomy called as a phlebotomist or phlebotomy technician. Phlebotomist could be a trained and certified nurse or technician. Physicians can also be phlebotomist as their course include one-semester training of phlebotomy. 

A phlebotomist draws quality blood samples from the patient’s body or blood donors. They prepare the specimen for medical lab testing.

The phlebotomist create an environment of trust and confidence with patients while draining blood sample in a skillful, safe, and reliable manner and steps include;

• Explain the procedure to patients,
• Apply tunicate for pressure accumulation,
• Identify the vein and draw a blood sample,
• Apply pressure or bandage after drawn sample,
• Take BP, pulse, and respiration readings,
• Update the patient with a record,

Phlebotomist responsibility and  workplace:

The phlebotomist must be skillful, responsible, and work well under pressure. The communication skill of Phlebotomist must be effective, as they work directly with patients. The phlebotomist should be well-attentive while working with patients and notice and relay any important information gained during interaction with physicians, nurses, or laboratory professionals.

The phlebotomist works in hospitals, laboratories, physician’s offices, medical camps, donation facilities, and other medical settings where blood samples were taken for analysis. Sometimes Phlebotomist also travels home to home on call patients who are homebound.

How to become Phlebotomist! Course and training.

A learning period or phlebotomy program usually takes one semester or one year to complete.

The phlebotomy technician program is launched to teach the knowledge in technical and procedural aspects of phlebotomy and hand-on training. The program will teach the concept of phlebotomy, infection control, legal issues, and other subjects. This program is designed for leaner who want to advance their carrier.

The Phlebotomist program requirement include;

• Proof individually is at least +18 or older,
• High school diploma or GED,
• Signed admissions application and signed enrollment agreement,
• All applicants must be able to speak, read, and understand English.

The Phlebotomy training program teaches all the necessary techniques and procedure steps to be a competent and skilled phlebotomist. The Phlebotomy program course include;

• Anatomy and physiology
• Blood and its cell composition
• Blood sample procedures
• laboratory safety
• CPR

Blood draining procedure include hands-on training like;

• Basic Venipuncture technique
• Butterfly cannula technique, which is commonly used for the elderly and children with small veins
• Fingerstick method for people with damaged or hard to find their vein.
• Healstick or capillary puncture for the newborn.

How to choose the right training programs:

Choosing the right training program with defining priorities is important. Here are some things to consider, if you deciding to get a training program;

• Location: many people lose the chance because of the location. If you are willing to attend then look a place with easy commuting distance.
• Time or period: Phlebotomy training period very in length, from one semester to one year. Chose a program length according to your requirement.
• Accreditation: It is very important to understand if you’re attending the training program than you should be sure that your training meets the needs of a standard to get your certificate.  

Phlebotomist licensing and Certification:

Certification of Phlebotomist is optional, but it is highly recommended and requirable for future opportunities. Here some following agencies who take a test and awarded the Certified Phlebotomy Technician (CPT) or Registered Phlebotomy Technician (RPT) titles to winners;

• American Society for Clinical Pathology (ASCP)
• American Medical Technologists (AMT)
• American Society of Phlebotomy Technicians

Certified Phlebotomy technicians or phlebotomists must continue the education and management skills to maintain their status. 

Phlebotomist salary:

The Median Annual Salary of the phlebotomist is $33,670-34,000, with high chances of increasing 25% through 2026, much faster than average. Having experience can increase the salary by up to 10%. 

Phlebotomist job discription:

Phlebotomist interacts with people daily. As a Phlebotomist, you must be experienced and responsible for patient blood draining, patient name labeling, and delivering of blood samples to laboratories. The phlebotomist must be skillful in blood drawing from babies, newborns, children, and especially from the people who have a phobia of a needle.

As a responsible Phlebotomist should maintain a record of blood draining and generate the report to submit to physicians or other medical staff members.

 Phlebotomist degree requirements:

College is not required for a phlebotomist degree, but many physicians and medical staff members obtained this degree as an associated degree. A Bachelor’s degree in Medical technology is also an aspiring option for phlebotomists. The topic of instruction focus on venipuncture, vascular anatomy, and physiology, skin nick technique, safety procedure, and proper handling.

  Takeaway:

Phlebotomy is more than just talking, as this course teaches techniques and preparation for emergencies. It also helps to understand proper laboratory procedures to avoid contamination of microorganisms and infection and all the necessary techniques to be a skilled phlebotomist.

Being a Certified phlebotomist can increase your status as a medical member.

• Epilepsy is the 4th most common CNS disorder, which affects people of all ages.
• 65 million people around the world who have shown the symptoms of epilepsy.
• Brain injury and family tendency can be the cause of epilepsy.
• Epilepsy patients can show more than one type of seizure.
• 1/3 people in the world live with uncontrollable seizures because no valid and available treatment is working for them.
• 15 million people with epilepsy were found in South-East Asia.
• Epilepsy is a chronic disease and it is more common in developing countries.

What is meant by Epilepsy:

The word epilepsy is a Greek word that means to be taken, seized, or attacked.

Epilepsy is a medical condition in which repeated seizures or attacks occur due to a disorder of the brain cells. The seizures may start at any age of your life, and some suffer from it their whole life or some only for a few years (approximately up to 13 years).

Symptomatic epilepsy also called secondary epilepsy that may develop after particular identification events like asphyxia, head injury, or meningitis.

Primary epilepsy also called idiopathic epilepsy that may develop without any identifiable causes.

Epilepsy has a lifelong tendency.

Seizure:

A seizure is a defined symptom of epilepsy, which is a result of excessive nerve-cell discharge in the brain. Seizures manifest by a sudden abnormal function of the body,  often loss of consciousness, an excess of muscular activity, and an abnormal sensation.

The excitation in nerve cell discharge in a small area of the brain giving rise to a partial seizure, and start spreading from small area to the whole brain and spinal cord named as a generalized seizure. 

the seizure is also said as convulsion, fit, or attack. Nerve cell discharge or excitation, site, severity, and extent are the wide variety of clinical forms.

Classification of Epileptic Seizures:

International League against Epilepsy (ILAE) approved the classification of epileptic seizures, which is based on the clinical expression of seizures and electroencephalographic pictures. The  main classification of epileptic seizure are;

Partial seizure:

The partial seizure is the abnormal excitation in nerve cell discharge, which starts in a localized area of the brain. The signs and symptoms depend on which part of the brain is affected. The excitation may remain localized or may spread to other parts of the body.

The partial seizure is further divided into two groups depending upon the consciousness of the patient;

Simple Partial Seizure:

In a simple partial seizure, the patient does not lose consciousness and therefore can speak what happened, but the experience is so strange that the patient may not able to express properly. Manifestation is depended on the location of the affected area.

• In Motor seizure, It is a focus in the motor cortex, in which twitching starts from the distal part of the extremity or in the face for some time or spread up to the whole extremity and even become completely generalized. The spreading is known as the Jacksonian march.
• The  Sensory seizure has a focus in the postcentral gyrus. There might be a feeling of tingling, pins, and needles, cold or heat, or numbness in extremities. Sometimes a strange feeling with visual signs, hearing, or smell sensation.
• The Autonomic seizure is related to foci in the temporal lobe, which may feel sensation rising from epigastrium to the throat, palpitation, sweating, or flushing.

The Physical symptoms include;

• changes in mood, memory, and thought.
• distorted perception (time, space, and person).
• problem with language
• may be a structured hallucination.

Complex Partial seizures:

In complex partial seizure, the patient has impaired consciousness means no complete loss of consciousness. The symptoms that might the patients feel are;

• The patient slightly aware of the situation but can’t respond to anything.  
• A strange sensation of light, smell, sound, and taste.
• change in perception of time (time running too fast or too slow), light, space.
• The surrounding may seem completely strange and different, which causes the patient anxious.

Sometimes seizure with hallucination or with psychomotor show symptoms like automatisms, automatic movement e.g aimless movements, chewing, lip-smacking.  This automatism may become very complex and the patient can perform difficult tasks and go somewhere, but later not remember anything. After the attack patient becomes complete amnesiac.

Complex partial seizure previously called “psychomotor seizure”, but now called “Temporal lobe epilepsy” because the abnormal discharge occurs in the temporal lobe. 

Partial seizure of secondary generalized:

Both simple and complex partial seizure combined become generalized tonic-clonic seizures. The beginning is the same as partial seizure but ends alike the primary generalized tonic-clonic seizures.

Generalized Seizures:

The Generalized seizures are characterized by the complete loss of consciousness with the absence of an aura. It occurs suddenly and unexpectedly, and it the patient fall they may injure themselves.

The generalized seizure divided into six different types of seizures;

Absence seizure:

These are short periods of loss of consciousness lasting only a few seconds to a half minute.  An absence seizure is an onset, a blank stare, and a brief upward rotation of the eyes. The patient is unresponsive, but suddenly over and the patient continues what he was doing before a seizure.

Typical absence seizures mostly occur in school-going age or during childhood, that’s because it is also known as childhood absence epilepsy.

Myoclonic seizures:

Myoclonic seizure consists of sudden, brief, shock-like muscle contraction, which is either occurring in one limb or whole bilateral limbs.their may be single jerks or a repeated jerk for a long time. 

Clonic seizures:

These are generalized seizures, where the tonic component is not present only repetitive clinic jerks occur.  

Tonic seizures:

These jerks are sudden sustained muscle contractions, fixing the limbs in some strained position.  There is an immediate loss of consciousness, with a deviation of eyes and head towards one side, or sometimes rotation of the whole body.

Tonic-clonic seizures (GTCS):

In Tonic-clonic seizures, the patient loses consciousness, falls, develops generalized stiffness, breathing stops because all the muscles of the trunk are in spasm, and the patient becomes cyanotic. With these jerks, the patient might bite his tongue, pass urine, or sometimes stool. When a patient regains consciousness, the patient may feel tired, headache, confusion, sleepy, and no memory of what happened.  GTCS also called a “grand mal seizure.”

Atonic seizures or Astatic seizures:

In Atonic seizure, there is a sudden loss of muscle tone causing the head or a limb drop, and the patient falls suddenly to the floor. That’s why it also called “drop attacks”. The atonic seizure is a very short period (only for seconds) but may occur several times a day. These patients often present with a scar or fresh wound on the face. 

Symptoms of Epilepsy:

Recurrent seizures are the main symptoms of epilepsy. However, if the patient faced more then one symptom then he must seek medical attention. Associated symptoms include;

• Fits with no fever.
• confused and anxiety
• temporary unresponsive
• sudden stiffness of the body
• sudden falling with no reason
• fear and panic or anger
• changes in perception of time, touch, and smell

Causes:

There are no specific causes found of epilepsy, but some conditions can be associated with epilepsy include;

• genetic factor
• Head trauma (car accidents or traumatic injury)
• brain conditions (tumor or stroke)
• Infectious disease (meningitis, AIDs, viral encephalitis)
• Prenatal injury (get an infection or any trauma in mother’s womb)
• Developmental disorder (autism or neurofibromatosis)

Treatment:

There is no valid treatment is available, but doctors may prescribe antiepileptic drugs to prevent symptoms. If these drugs don’t work then a doctor refers to other options like surgery, vagus nerve stimulation, and a healthy diet. Common AEDs for epilepsy is;

• valproic acid
• carbamazepine
• lamotrigine
• levetiracetam

Surgeries include lobectomy, multiple subpial transection, corpus callosotomy, and hemispherectomy. 62% of adults show a significant reduction or no seizure for around 7 years after surgery.

Healthy diet:

In 2014, research present that a low carbohydrate diet could help with epilepsy in adults and children.

Prevention:

• Get enough sleep
• learn stress management techniques
• avoid drugs and alcohols
• take your medication on time
• try to avoid bright light 
• minimize or skip a TV or computer 
• Eat healthily.

Takeaway:

Epilepsy is a chronic CNS disorder in which excessive discharge of nerve cells stimulates the different types of seizures. Epilepsy can be overcome by AEDs, and surgeries and can prevent it with a healthy diet.