MEDITIMEA Medical Bulletin from TIME Pharmaceuticals (P.) Ltd.

Issue 27 Kartik - Poush 2075 (Oct. - Dec. 2018) For free circulation only

w w w . t i m e p h a r m a . c o m

DO�s and DON�Ts forDIABETICS to EnjoyFestival

Taking Care ofYour HealthDuring Festival

What to keep in Mindthis Festival Season

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Healthy Dashain;Happy Dashain

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Editorial

MEDITIMEA Medical Bulletin from TIME Pharmaceuticals (P.) Ltd.

Sudarshan Lal ShresthaEditor in Chief

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InsideEditorial 2

Health News Line 3

International Prostate Symptom Scores 4

Taking Care of Your Health

During Festivals 7

DO�s and DON�Ts for

DIABETICS to Enjoy Festival 8

What to Keep in Mind this Festival Season 9

ECG Findings of Wellens� Syndrome 10

Healthy Dashain; Happy Dashain 11

dfgl;s :jf:Yo / xfd|f] ;dfh 12

Product Information/Word Puzzle 13

Response Form 14

Moments in Time 15

MOMENTS IN TIMEMOMENTS IN TIME

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With the starting of October, the cloudy monsoonslowly changes into clear blue skies, with autumnseason being in full bloom, it signifies that thefestive season has been started. And I hope you arealso in the hang of festive mood when you receivethis quarterly magazine "MEDITIME". Hope thisfestive mood provides you full energy to workfor rest of the year.

Nepal is a country rich in culture and tradition, and out of that in Octoberwe celebrate the biggest festival like Dashain, Tihar and Chhath. This isthe season in which consumers have extra money due to good transactionin entrepreneur's business (like farmers, shopkeepers or businessman)and extra festival bonus for employees. But we have to be careful enjoyingfestivals to avert health ailment in post-festival period. Moreover thesedentary lifestyle is more prone to increase during the festival seasonwhich increases chances of non-communicable diseases likehypercholesterolemia, hypertension, diabetes etc. Also, the high intakeof meat and alcohol can also increase different disease relative to digestionor liver. Though most are aware about this, but fail to follow maintaintheir health. At least, morning exercise in fresh air energies the systemsof our body which is very important to maintain our health.

In this quarterly issue, we tried to blend the information related to festivaland health; trying to make it more informative during festive season.Inside this, there is a very informative article related to InternationalProstate Score Symptoms written in Nepali so that it can be studiedeasily and self analyzed. I extend my sincere thanks to our well supporterProf. Dr. A.D. Bhatta, Senior Consultant Urologist for his great article.Similarly, we are also happy to share other valuable articles related toWellen's syndrome and tips for diabetes during festival from our valueddoctors. To add up to the entertainment while reading articles, we alsohave features of word puzzle game and lucky prizes. I hope the blend ofinformation and entertainment will make your day good.

Wishing everyone is blessed with good health, happiness and prosperity.Happy Dashain, Tihar, Nepal Sambat 1139 and Chhath 2075.

BOD's with Motivational Trainer Mr. Dipankar Sherpa Motivational Training at Sauraha

Participation in APPON futsal Participation in APPON futsal

Various Events During Bishwokarma Puja at Factory

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Health News LineToo Much Hair Dying May Raise Breast Cancer Risk� StudyHere�s some alarming news for women who love to dye their hairmore frequently. Too much hair dying can put you at an increasedrisk of developing breast cancer, a study by British researchers haswarned. According to the study headed by Professor Kefah Mokbel,a London surgeon who works at the Princess Grace Hospital inMarylebone, women who colour their hair frequently have a 14percent higher risk of breast cancer.

Professor Mokbel advises that women dye their hair only two to fivetimes a year and proposes to use products with more naturalingredients, such as henna, beetroot and rose hip in order to reducetheir cancer risk. �What I find concerning is the fact that the industryrecommends women should dye their hair every four to six weeks,�Professor Mokbel said. �Although further work is required to confirmour results, our findings suggest that exposure to hair dyes maycontribute to breast cancer risk.�

In a post on social media, the professor has also clarified that thelink between exposure to synthetic hair dyes and breast cancer riskis only a correlation. �The positive association between the use ofhair dyes and breast cancer risk does not represent evidence of acause-effect relationship,� his post reads. Professor Mokbel�s studycomes months after a Finnish research suggested a similar link betweenwomen who use hair dye and their increased chances of developingmalignant tumors.

A team of researchers from University of Helsinki (Finland) andCancer Registry of Finland had suggested that women who changethe color of their hair increase their risk of developing breast cancerby 23 percent. The Finnish team headed by Sanna Heikkinen saidexposure to carcinogens in the synthetic dyes elevate women�s oddsfor contracting the cancer. �We did observe a statistical associationbetween hair dye use and risk of breast cancer in our study,� shesaid.

Heikkinen and colleagues, however, stressed that they weren�t certainof a cause-effect relationship though. �It is not possible to confirma true causal connection,� she said. �It might be, for example, thatwomen who use hair dyes also use other cosmetics more than womenwho reported never using hair dyes.�

Meanwhile, Professor Mokbel has suggested that since exposure tohair dyes can contribute to risk of malignant tumors, every womanshould undergo regular breast screening from 40 years.�It is better to choose a hair dye that contain a minimum concentrationof aromatic amines such as p-Phenylendiamin,� added the surgeon.

Professor Mokbel admitted that more research is needed to confirmthe role of hair dyes in triggering breast cancer risk.

Eating Omega-6 Rich Foods Can Reduce Diabetes Risk � Study

Drinking More Water May Cut Risk of Urinary TractInfections in WomenNumerous studies in the past have proven the significance of stayinghydrated when it comes to good health. Now science gives anotherreason to drink more water, saying drinking plenty of water may cutrisk of urinary tract infections (UTIs) in women.

The benefits of drinking several glasses of water per day are plenty.Drinking more water could help with weight loss, transport nutrientsin the body, regulate body temperature, digest food, and boost brainfunction.

Infection in the urinary tract generally affects the kidneys, bladder,urethra, and ureters. And if you�re a woman, your risk of urinarytract infections (UTI) is high. But do not dishearten. Now researchersin America have discovered that women can stay protected fromurinary tract infections by drinking plenty of water.

In their study, the research team led by Dr. Thomas M. Hooton, ClinicalDirector of the Division of Infectious Diseases at the University ofMiami School of Medicine, found that drinking an additional 1.4 litresof water a day slashes the UTI risk in half.

The study explains that additional water consumption on a daily basismakes it easier for the bladder to flush more of the bacteria whichenters it from the vagina. In addition, the odds of the bacteria gettingtransferred from the vagina get reduced, which in turn slashes riskof urinary tract infections.

For the study, researchers enrolled 140 women in a premenopausalstate who had at least three UTIs in the last year. They all were withno significant health conditions and reported lower daily fluid intakethan it was recommended. Of the enrolled women, half served asthe control group and were told to continue with their regular water-drinking habits, while the other half had to drink 1.5 liters more ona daily basis.

After one year, the research team found that women who hadincreased their water consumption had 48 percent less UTIs thanthose in the control group. In other words, women who increased theirwater intake had on an average 1.6 UTIs, while those with low waterintake were 3.1 times more affected with UTIs.

�While doctors have long assumed this is the case and oftenrecommended that women at risk for UTIs increase their fluid intake,it�s never really undergone a prospective trial before,� Hooton added,�It�s good to know the recommendation is valid, and that drinkingwater is an easy and safe way to prevent an uncomfortable andannoying infection.�

The findings were presented recently at IDWeek 2017, the annualmeeting of the Infectious Diseases Society of America.

Do you consume Omega-6 rich foods? If yes, then your chances ofdeveloping type 2 diabetes are very less. This is the conclusion of anew study by Australian researchers. The risk of developing thischronic condition could be significantly slashed by eating a diet richin omega-6 polyunsaturated fatty acids (PUFA), especially found inseed oils, eggs and nuts, the researchers affirmed.

In their study, a team of experts found adults with the higher levelsof linoleic acid-the major omega-6 fat in their blood were at a 35percent reduced risk of developing diabetes compared to those withthe lowest levels of this acid. �Our findings suggest that a simplechange in diet might protect people from developing type 2 diabeteswhich has reached alarming levels around the world,� lead authorDr. Jason Wu, of The George Institute for Global Health in Sydney,said.

�This is striking evidence. The people involved in the study weregenerally healthy and were not given specific guidance on what toeat. Yet those who had the highest levels of blood omega-6 markershad a much lower chance of developing type 2 diabetes,� said seniorauthor and Professor Dariush Mozaffarian, of the Friedman Schoolof Nutrition Science and Policy at Tufts University in Massachusetts.

For the study, the researchers analysed data from 20 largeobservational studies involving 39,740 adults aged 49 to 76 from10 countries. During the follow-up period, 4,347 new cases of diabeteswere identified. Blood samples were collected from the participantsand were examined for two main Omega-6 markers- linoleic acidand arachidonic acid. The analysis of blood samples showed anassociation between elevated levels of omega-6 and a reduced riskof type 2 diabetes. The team found that Linoleic acid was significantlyassociated with lower risk of diabetes, while no such association wasfound between the levels of arachidonic acid and any risk of diabetes.

�Some scientists have theorized that omega-6 is harmful to health,�said Dr. Wu. �But based on this large global study, we havedemonstrated little evidence for harms, and indeed found that themajor omega-6 fat is linked to lower risk of type 2 diabetes.�

�Based on concerns for harm, some countries recommend even lowerintakes,� added Dr. Wu. �Our results suggest that eating foods richin linoleic acid may lower risk of type 2 diabetes.� Those who didn�tknow it already, our body does not synthesise Linoleic acid and canonly be obtained from the diet. The findings were published in journalLancet Diabetes & Endocrinology.

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j}1flgsx¿sf] k|oTgk|f]i6]6 u|lGy sf]lzsfx¿sf] clt j[l4 /f]usflglDt cd]l/sg o'/f]nf]lhsn ;�n] agfPsfnIf0f ;"rfsfªs k|sfz !(() bzssf] ;'?d}eof] . k|f]i6]6 u|lGy sf]lzsfx¿sf] clej[l4x'g] /f]usf] c:j:ytf k|fo lk;fasf nIf0fx¿af6cleJoQm x'g] ub{5 . To;}n] s;/L tL d"qnIf0fx¿nfO{ d"Nof°g u/]/ Pp6f nIf0f;"rsf° tof/ ug{ ;lsG5 eGg] ;f]r cfpg':jefljs} xf] . ljleGg b]zsf j}1flgsx¿af6o:tf ;"rsfªsx? k|:tfj ul/Psf 5g\ .xfn ;a} eGbf a9L k|rngdf cfP dWo]sf]Pp6f xf] cGt/fli6«o k|f]i6]6 nIf0f k|fKtf°(IPSS) . cd]l/sg o'l/nf]hLsn ;� nIf0f;"rsf°�& (AUSI-7) ¿kfGtl/t u/]/ tof/kfl/Psf] Tof] k|ZgfjnLsf] k|of]u pkrf/ tyfcg';Gwfgsf] l;nl;nfdf Jofks dfqfdf ug]{ul/G5 . kl5Nnf] bzsdf of] k|Zg dfnfnfO{s;/L 5f]6f] 5l/tf] agfpg ;lsG5 eg]/j}1flgsx¿sf] k|oTg hf/L 5 . cGt/fli6«ok|f]i66 nIf0f k|fKtf° k|ZgfjnLsf & k|Zgaf6$ j6f k|Zg / cf7f}+ k|ZgnfO{ k'/fg} ¿kdflnb} gof k|Zg dfnf tof/ ul/of] . h;df;'Ggf b]lv !@ ;Dd dfq k|fKtf° x'g ;S5 .o;/L tof/ ul/Psf] k|ZgfjnL 5f]6f] / ;lhnf]dfq geO{ w]/}n] ckgfpg ;Sg], hjfkm lbgsd emGem6Lnf] / k|efjzfnL klg ePsf] 5.vf; u/]/ pbLodfg b]zsf nflu o:tf]5f]6f]�5l/tf] k|ZgfjnLsf] dxTj cem} a9L x'gcfpF5 . of] k|Zg dfnfn] $ d'Vo nIf0f h;n]la/fdLsf] hLjg�u'0ffj:yfdf a9L gsf/fTdsk|efj kfg]{ ub{5Gf ;dfj]z ul/Psf] 5 . tLx'gM lk;fa nfu] kl5 cljnDa ug{' kg]{,lk;fasf] wf/f n'nf] x'g], lk;fa km]l/ ;s]kl5glgv|]sf] cg'ej x'g], / /ftL lk;fa km]g{p7\g' kg]{ .

kfFrf}+ k|Zgdf la/fdLnfO{ xfns} cj:yfdf d"qnIf0fx¿ eO /x] p;nfO{ s:tf] cg'e"lt x'g]5 eg]/ ;f]lwPsf] 5 . h;sf] pQ/ p;af6Mv'l;, yfxf 5}g, b'MvL h:tf] pQ/sf] ck]Ifful/G5 .

;a} la/fdLx¿n] Ps} k|sf/sf nIf0fx¿nfO{plQs} dxTj lbFb}gg\ . To;}n] dfly pNn]lvtb'O{ k|Zg tflnsf dWo] s'g�s;sf] a9L /f]hfOdfk5{ cfkm}n] cWoog u/]/ cfk\mgf] k|Zg dfnfeb}{ cfk\mgf] /f]usf] :t/ s'g 5, klxNofP/;/;Nnfx jf pkrf/sf] lglDt lrlsT;snfO{e]6\g' pko'Qm x'G5 .

cGt/fli6«o k|f]i6]6 nIf0f k|fKtf° jf o"= 8jno"=cfO{= Pg= (UWIN) k|fKtf° k|ZgfjnL h'g5fg]sf] ePklg cGtdf /f]u nIf0fsf] cj:yfæxNsfÆ ælgolGqtÆ jf æ;VtÆ s'g l:yltdf5 Tof] 7Dofpg ;lsG5 . nIf0fsf] lx;fan]/f]usf] cj:yf æxNsfÆ ælgolGqtÆ jf æ;VtÆh] b]vf k/] klg Tof] afx]s la/fdLsf] ;du|:jf:Yosf] cj:yf dw'd]x, pRr /Qmrfk,d[uf}nfsf] sfo{ Ifdtf, 5ftL�d'6" tyf wdgL(Artery)sf /f]ux¿, d]? b08 / To;af6

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o"/f]k\mnf]d]6«Ldf pRr a]u !) ldlnld6/ k|lt ;]s]08 / lk;fa km]/]sf] ;do nfdf] tyf aLraLrdf ?Sb} ePsf] /x]5 eg] pkrf/nfO{ a9L cfqmfds 9Ën] hf/L /fVg' kb{5 . o:tf]cj:yfdf k|f]i6]6 u|lGysf] dfkg yf]/} 5 eg]/ r'k nfu]/ a:bf d"q ;+qmd0f x'g] d"q y}nLsf]

qm= slt kN6 < laNs'n} cfwf sl/a cfwfd= 5}g eGbf cfwf eGbf

(Not at sd k6s a9LpQ/ All) ;Dd ;Dd

! cljnDa lk;fa km]g{ kg]{ cj:yf cfof] < Urgency ) ! @ #@ n'nf] / sdhf]/ lk;fasf] wf/f b]vf k¥of] <

Weak stream ) ! @ ## lk;fa glgv|]sf] cg'ej eof] <

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5}g% tkfO{nfO{ ;Dk"0f{ afFsL hLjg xfns} tl/sfn]

lk;fa km]/]/ latfpg k/] s:tf] cg'ej ug{' x'g]5 < ) ! @ #

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zlQmdf x|f; cfpg] / lk;fa PSsfl; ?Sg] 8/ x'G5 . o:tfla/fdLsf] sDd/ b'MVg], lb;f slAhot x'g] jf Ps} k6s lb;fvnf; geP/ lbgsf] @�# kN6 jf a9L k6s x'g], v'§f w]/} uNg]/ k}tfnf kf]Ng] h:tf nIf0f b]vf k/] / lrlsT;ssf] /fo ljdz{cg'¿k rNg' kb{5 . dw'd]x x'g] la/fdLn] o:tf] nIf0f b]vf k/];ts{tf emg} a9L ckgfpg' kb{5 .

lk;fa y}nLsf] ;+ro / e08f/0f ug]{ Ifdtf sdL ePsfn] -l56f]l56f] lk;fa km]g{' kg]{, lk;fa nfu] kl5 /f]Sg} g;Sg], /ftL lk;fakm]g{ p7L /fVg' kg]{_ ljleGg k/LIf0f u/fpg' kg]{ x'G5 . To; dWo]lk;fa pdf/]/ ;+qmd0f eP gePsf] 6'Ëf] nufpg], /utdf Un'sf]hsf]/ lkP;Psf] :t/ gfKg], clgjfo{ k|fo x'G5 . ;fdfGo lk;fa k/LIf0fdf/ftf] /utsf] sf]lzsf b]vf k/] la/fdLx¿sf] yk k/LIf0f / SofG;/-d"q y}nL / k|f]i6]6sf]_ 5}g elg olsg x'g d"q y}nLdf cf}hf/ /b'lj{g xfn]/ x]g{' kg]{ x'G5 .

æ;VtÆcj:yfd"q nIf0f :jd"Nof°gdf /f]usf] cj:yf ;Vt cg'¿k kl/0ffdb]lvPsfx?sf] /f]u lgbfg / pkrf/ a9L cfsl:ds tl/sfn] ug{'kg]{ x'G5 . o:tf la/fdLsf] ;du| :jf:Yo cj:yfsf] klg rf}tkmL{hfFr k8tfn x'g' kb{5 . vf; u/]/ :jf;�k|:jf; k|0ffnLsf] cj:yfs:tf] 5 / To;sf] lglDt s'g cf}ifwL pkrf/ eO /x]5 To;sf]k"0f{ hfgsf/L lng" kb{5 . olb la/fdL aof]j[4 eP / To:tf] pd]/df;+qmd0fn] vf; u/]/ 5ftL, d"q k|0ffnL / kfrs k|0ffnLdf a9Lc;/ kfg]{ ePsfn] Totf lt/ Psbd} ;ts{tf ckgfpg' kb{5 .lk;fa w]/} g} glgv|]/ jf aGb} eP/ Sofly6/ -lk;fa lgsfNg k|of]ux'g] gnL_ /fVg' k/]sf v08df To;n] klg af/ af/ d"q ;+qmd0fu/fpg ;S5 . Hofb} ;'?sf] cj:yfdf aof]j[4x¿ dfem a/ a/fpg],56k6fpg] tyf ;fdfGo eGbf csf]{ / leGb} Jojxf/ ug]{ Ps dfqaflx/ b]lvg] d"q ;+qmd0fsf] k|f/lDes nIf0f x'g ;S5 . z/L/af6lgsfNg ;Sg] Ifdtf eGbf a9L kfgL lkP/�v'§f jf ;Dk"0f{ hLp;'lgPsf] v08df t/n kbfy{sf] dfqf ;'Jojl:ys/0fdf Wofg lbg'kb{5 . d"q ;+qmd0fsf] cj:yfdf dw'd]x / pRr /Qm rfksf] cf}ifwLpkrf/df ljz]if1sf] yk k/fdz{ cfjZostf kg{ ;S5 . lb;fslAhot ePsf k|f]i6]6sf la/fdLnfO{ To;sf] lgoldt s/0fdf t'?GtWofg k'?{ofpg' kb{5 . PSsfl; lk;fa ?Sg'sf] sf/0f dWo] slAhotklg Ps x'g ;S5 .

cN6«f;f]gf]u|fkmLaf6 k|f]i6]6 u|lGy tyf d"q k|0ffnLaf/] ;Dk"0f{ ljj/0fpknAw ug{' clgjfo{ x'G5 . t/ s] ;f]Rg' x'Gg eg] 7"nf] k|f]i6]6n]dfq w]/} ;d:of / d"q nIf0f lbG5 . ;fdfGo jf ;fgf] v'lDrPsf]jf l;s'l8Psf] / cfk\mgf] nrstf u'dfPsf] k|f]i6]6n] klg Tolts}jf cem} a9L d"q nIf0f lbg ;S5, hlt 7"nfn] . o'P;hLsf] l/kf]6{dfu|lGysf] tf}n eGbf klg a9L dxTj k|f]i6]6sf] dWod efu slt d"qy}nL leq 3';]sf] 5 / lk;fksf] y}nLdf lk;fa km]/]kl5 slt lk;faafFsL /xG5, d"q jflxgL gnLx¿ (ureters) / d[uf}nf km'n]sf 5g\

ls 5}gg\ Tof] cf}wL dxTjk"0f{ lgisif{ jf kl/0ffd xf] . lk;fa hfFrubf{ /ut b]vf k/] l;:6f]:sf]kL (Cystoscopy) u/]/ d"q y}nLdfcj{'b /f]u 5}g eg]/ olsg x'g' k5{ . b'/lag hfFr l;:6f]:sf]kLdfd"q y}nLsf] 3fF6L slt cUnf] 5 / To;n] d"q lgisf;gdf sltafFwf k'¥ofpg ;S5 To;sf] n]vf hf]vf x'g' kb{5 . d"q y}nL leqc¿ y}nLx¿ (Diverticulum) 5g\ jf 5}gGf, y}nL h:tf c;fdfGo;fgf] y}nL h:tf] ;+/rgf jf vfN6f] � 8fOel6{So'nd b]vf k/] To;leq st} kTy/L n's]/ a;]sf] 5 ls jf s'g} 7fFpdf df;' knfPsf]cj{'b (Tumor) b]vf k/] To;af6 jfof]K;L � tGt' k/LIf0fnfO{ lgsfn]/k7fpg' k5{ . l;:6f]:sf]kLsf] l;nl;nfdf lk;fa y}nLsf] Ifdtf slt5 / slt el/bf la/fdLnfO{ lk;fk km]g]{ OR5f x'G5 Tof] l6kf]6 ug{'kb{5 .

lgrf]8k|f]i6]6sf] xfOk/Kn]lhcfn] d"q k|0ffnLdf k/]sf] c;/n] c;'ljwfcg'ej ug{ yfn] kl5 k'?ifx¿ lrlsT;s sxfF k'Ug] ub{5g\ . c?ljleGg k/LIf0f h:t} � cN6«f;f]gf]u|fkmL / o'PkmPd ug{' cufa} k'?ifcfkm} d"q nIf0faf6 laleGg cg'e"lt ug]{ x'Fbf tL nIf0fx¿sf] cWoogu/]/ lrlsT;snfO{ k/fdz{sf] lgDtL e]6\bf a9L kmnbfO{ x'G5 . xfny'k|} k|f]i6]6 nIf0f k|fKtf° k|ZgfjnL pknAw ug{ ;lsG5 . ltgLx?dWo] w]/} k|rngdf /x]sf] cGt//fli6«o k|f]i6]6 nIf0f k|fKtf° k|ZgfjnLjf o;s} ¿kfGtl/t �UWIN Score Questionnaire� cg'¿k cfk\mgfd"q nIf0fnfO{ :jd"Nof°g u/]/ cfk\mgf] /f]usf] cj:yfM xNsf,lgolGqt jf ;Vt s'g >]0fLdf k5{ Tof] yfxf kfpg ;lsG5 .To;sf] cnfjf oL k|ZgfjnL dWo] cfkm"nfO{ h'g a9L pko'Qm nfUb5To;df /x]sf] kl5Nnf] k|Zg hLjg�u'0ffj:yfaf/] k|f]i6]6 xfOk/Kn]lhof;+Daw d"q nIf0fn] la/fdLnfO{ s:tf] c;/ kf/]sf] /x]5, p sltsi6k|b (Bothersome) cj:yfdf 5 Tof] klg yfxf kfpg ;lsG5 .k|To]s JolQmn] v'b cfkm} lg0f{o ug{ ;s] p xfnsf] cj:yf eGbfsd si6k|b hLjg ckgfpg rxfG5 eg] p To;sf] lglDt slt;Dd pkrf/df ;+nUg jf ;dfj[i6 (Involved) x'g rfxG5 . Tof]afx]s :jd"Nof°g k|fKtf°sf] lgu/fgLdf /xg]n] cfk\mgf] /f]usf] j[l4s;/L eO/x]5 Tof] yfxf kfpg ;S5 . To;}sf] cfwf/df p cfk\mgf]pkrf/af6 kfPsf] kmfObf af/] klg hfgsf/L pknAw ug{ ;S5 /lrlsT;snfO{ klg cfk\mgf] kIfdf cufl8 a9\g ;xof]u k'?{ofpg;S5 . olt x'Fbf x'Fb} klg oL :jd"Nof°g k|ZgfjnL ;o k|ltztcg's/0fLo / lrQ a'�bf] gx'g ;S5g\ . lsgeg] d"q r"jfx6 h:tfHofb} si6 k|b nIf0fnfO{ o;n] ;d]6]sf] 5}g . oL k|ZgfjnL eg{klg Tolt ;lhnf] / 5f]6f]�5l/tf] gePsf] dfq x}g ls la/fdLsf];d"rf :jf:Yon] d"q nIf0f tyf p;sf] dfgl;s cj:yfdf k/]sf]c;/nfO{ bzf{pb}g . k|f]i6]6 d"q nIf0f k|fTk°sf] h] hlt vf]6 /sdhf]/L cf}FNofpg ;lsg] ePtfklg cfhsf lbgdf o;sf] ljsNkof] eGbf /fd|f], ;'ne / sd ;dodf k|f]i6]6 la/fdL af/] a9L ;"rgflbg ;Sg] ;"rsf° gePsfn] xfnnfO{ oL k|Zg tflnsfaf6 nLg;lsg] kmfObfaf6 xfdL jl~rt x'g' x'Fb}g .

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It is the beginning of October andwhen we look outside the room andsee the misty and pleasant weather,it brings the wonderful feeling ofDashain. During season change inSeptember, we often say the weatherseems so much like Dashain. Withour hectic schedule all over the year,Dashain is the perfect time to relaxand enjoy with family and friends.For those who work away from theircity/village/home, going home duringDashain is really fascinating. One isready to face the traffic jams inhighways with bright and happy facelooking forward for the family gettogethers and be in the place whereone has grown up with wonderfulmemories. Until children from far offdo not visit home during dashain,the parents do not feel the charm ofit. Once house is filled with all thefamily members, that is when all themembers feel the charm of dashain.

During dashain, people try to forgettheir normal routine and get lavishlylazy. Those people who were regularwith their exercise, meditation andhave been eating less oily diet withlots of vegetables and fruits end uphaving oily food, with varieties ofred meat and sugary / alcoholic drinksand no exercise, comforting oneself,Ah!! Come on this is Dashain !!. Eventhe time of meal is disturbed andpeople end up missing their breakfastand have direct heavy lunch withlots of calories. People have lessmobility during dashain playing cardsand have heavy and oily food andalcoholic beverages. It might end upwith indigestion, acidity andconstipation.

Diabetic patients should be extracareful to have their food on timeand not to stay hungry for a longtime. They should not skip theirbreakfast and have their heavy mealall at once. It might shoot up theglucose level leading to furthercomplications.

We should be careful with the stalefood during dashain. People tend tocook meat at once and use it forseveral days storing in refrigerator.As we heat the same food again andagain and keep in the refrigerator,more is the chance of bacterial

contamination. So, rather we shouldkeep the raw meat in small packetsso that it will be easy to cook therequired amount which will beconsumed in one meal.

We should be careful not to reusethe oil that has been left after fryingfood. Once the heated oil reachesroom temperature, bacteria attacksthe food particles left after fryingwhich can cause food poisoning.Rancid oil (old and stale) containsfree radicals, molecules that candamage cells and lead to increasedcancer risk, as well as affect thequality of our food.

During dashain we visit our relativesfor tika. Due to our hectic schedule,we might be visiting some of ourrelatives once in a year duringdashain only and having food inevery place we visit is compulsion.Having small amount at everyhome, we end up overeating withlots of meat, salt and sugary foodwhich migh t lead to thecompl ica t ion o f d ia r rhea ,constipation etc.

Playing cards are a charm of dashainto some people. They end upplaying the cards the whole nightand have less sleep hours. To behealthy one should sleep at least 7hours a day.

So, during dashain, we should notmiss our regular exercise ormeditat ion. One should bedetermined to wake up early and beregular with exercise or meditation.We should be careful on the foodwe eat. We should eat limited friedfood and red meat. We should forceourselves on vegetables, salads andfruits rather than on red meat. Weshould be drinking lots of water aswell. We should learn, we eat to liveand not live to eat. We should becareful on the amount of spicy oilyfood, sugar and salt.

Those people who are on medicationshould follow the regular time oftaking medicine. During the merrymaking, the time of food getdisturbed and so does the time ofmedicine. So the family membersshould take care of the medicationtime and make sure he/she takesfood and medicine on time. Dashainis the wonderful time of familygathering. We should fully utilizeour festival holidays and make everydashain a memorable one.

Taking Care ofYour Health During Festivals

Arpana Pradhan BhandaryDeputy General Manager-Factory Operation

Time Pharmaceuticals (P.) Ltd.

l Butterflies are part of the body�s fight-or-flight response when there�s a threat tosurvival, nervousness or anxiety

l The stomach muscles get extra-sensitiveduring the fight-or-flight response, andthat�s partially what causes the butterflies.

l Neurons along the brain-gut axis let thestomach know when we�re freaking outabout something .

l Butterflies and the fight-or-flight responsemay serve an evolutionary function.

l There�s nothing wrong with feeling flutteryonce in a while, but if the feeling persists,it�s best to seek medical help.

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Dr. Sandip Chandra ShresthaInternal Medicine, Birtacity Hospital

Dr. Laxman DubeyCardiologist, Butwal

Dr. Pramod K. Jha (D)Dermatologist, Janakpur

Dr. Prabin ShresthaNeurosurgeon, Kathmandu

Dr. Rima MaharjanGynaecologist, Kathmandu

Dr. Ajay KumarDermatologist, Pokhara

Dr. R.P MandalOrthopedist, Rajbiraj

Dr. Arvind Pd. SinghMedical Officer, Dharan

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DO�s and DON�Ts forDIABETICS to Enjoy Festival

Dr. Suraj BaralConsultant Physician

and frequent meals to keep yourblood sugar levels in control.

w Drink plenty of water/ non-sugarydrinks (may depend on physicalactivity like dancing, travelling andconsumption of alcohol as well)to keep yourself well hydrated andenergized.

w Continue your anti-diabeticmedications as prescribed. If youare fasting you may need to avoidsome oral anti-diabetic drugs orreview your insulin dose/timings o c o n s u l t w i t h y o u rendocrinologist.

w Most people have a habit ofskipping exercise during festivaldays but those with diabetesshould continue regular physicalactivities/ exercise during thistime.

w Have enough rest and soundsleep.

w Nowadays people like to travelduring festival vacations soremember to carry yourmedicines, wear comfortableshoes and clothes, be preparedfor any hypoglycemic episodesand carry snacks as you need toeat frequently and it may be quitediff icult to get a decentrestaurant/hotel especially duringtreks. Think about reducing yourinsulin dose if you're doing a lotof activity or if it's very hot. If you

need to keep your insulin cool, usefrio wallets which work by justbeing run under water. Alwayscarry some identity card that showsyou have diabetes. Make sure yourfriends know about your diabetesand what to do if you have a hypo.

w You can drink alcohol within LIMITS if yourblood sugar levels are under control.

DON�TSw Don�t eat foods that are high in

calories such as deep fried foods,sweets, sugary desserts and drinks.Replace sugar with naturalsweetners.

w Don�t eat foods that have a highglycemic index like flour, pasta, rice,potato or white bread.

w Don�t choose red meats (mutton /buff/ beef / pork). Opt for leanmeats and fish instead, cookedwith less oil and salt.

w Don�t party late night and consumeexcess alcohol.

w Don�t skip medicines / exercise andof course self-monitoring of bloodglucose.

w Don�t rob yourself of theenjoyment. If you're prepared andyou keep safe, there's no reasonfor you not to have a good time.

Diabetes is being regarded as a globalepidemic. The number of people withdiabetes has risen from 108 million in1980 to 422 million in 2014. Diabetesprevalence has been rising more rapidlyin middle- and low-income countriesand it is a major cause of blindness,kidney failure, heart attacks, stroke andlower limb amputation. Diabetes canbe treated and its consequencesavoided or delayed with diet, physicalactivity, medication and regularscreening and treatment forcomplications.

Type 2 diabetes is currently a high-burden disease in Nepal. According toIDF (International Diabetes Federation),there were 657,200 cases of diabetesin Nepal in 2017 and its prevalenceamong adults was 4.0%. Some studieshave shown prevalence of type 2diabetes in urban and rural populationsas 8.1% and 1.0% respectively. Asystematic review from India reportedthat women are at higher risk of type2 diabetes and some reviews in Nepalhave also revealed similar results.Similar kind of gender association wasseen in few studies in Pakistan andTurkey as well.

Festival season is going to start verysoon in Nepal. We have our biggestfestivals, Dashain and Tihar coming upwithin next few days. However, it iscertainly going to create anxiety andconfusion among diabetics. Some ofthem are over conscious and try to putoff festivals and other just don�t carewhat they are eating. Therefore,increasing awareness among patients,highlighting the need to enjoy festivalsresponsibly, and promoting healthydiet habits and exercise have animportant role in maintaining glycemiccontrol during these festivals. To ensurediabetes patients have a good timewithout putting themselves at risk ofhypoglycemia or hyperglycemia,following do�s and don�ts can be reallyhelpful.

DO�Sw Include foods with high fiber

content such as vegetable and fruitsin your diet. So if you�re hankeringfor something sweet, make a fruit-based dessert adding a boost ofantioxidants and vitamin C.

w Follow the routine of eating smallSitagliptin & Metformin 50/500mg, 50/850mg,50/1000 mg Immediate Release Tablets

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Metformin 500mg, 850mg Tablets

Newly Diagnosed Obese with T2DM

DO�s and DON�Ts forDIABETICS to Enjoy Festival

I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . .Atorvastatin 5/10/20 mg TabletsLIPLOW 9

Dashain the biggest festival of theNepalese society is a festival of joy andvictory and it is all about traditions,puja and rituals. Furthermore, Tihar isthe second biggest festival afterDashain. Since festivals like these arecelebrated only once a year, most ofus do get tempted to enjoy every partof the festival, including the good food.It is difficult to avoid the foods that aremade with high usage of oil. Butfestivals should not be taken as anexcuse to eat or drink anything youwant.

Meat cooked in varieties (roasted, dried,deep fried, barbequed) are preparedwith lots of oil and spices. Such spicyfood cannot be digested all of a suddenand causes abdomen swelling,belching, indigestion, vomiting andgastritis. Also, the barbecued meatcontains carbon leading to theproduction of carcinogen (a substancethat is involved in causing cancer).When the food items are deep fried,the oil used once must be thrown awayas reusing the oil will have an adverseeffect on your health.

The intake of alcohol might give youtemporary fun but it will affect your liverin the long run. Too much drinkingweakens the immune system, affects thebrain communication pathways, functionsof heart that can cause stroke, high bloodpressure, liver inflammation, cirrhosis,cancers (esophagus, throat, liver, breastetc), pancreatitis and others.

People do cook a lot at once and storefor later use. One must be very carefulof food poisoning caused by the leftover foods. Moreover, overeatingcauses stroke, kidney disease,hypertension, diabetes, high cholesteroland others.

If Dashain is the time to enjoy meatvarieties, Tihar is to indulge in sweets.Consuming too much sweets isunhealthy for us. It could gain a fewkilos, as sweets contain a high amountof sugar, oil, butter, ghee, etc. Theartificial sweeteners and sugar contentpresent in most sweets can allowbacterial growth in teeth, causingcavities and other teeth/gum problems.Even if it is just for a few days, eatinga lot of sugary foods and sweets couldincrease the risk of diabetes; increasethe cholesterol levels of the body.

Adulteration in food items can befound in abundance during suchseason. Different sweet found in theopen market can be adulterated withcolors and harmful sugars. Suchaddition of non-permitted colors cancause liver damage, hyperactivity,cancer, allergies and birth defects.

Green leafy vegetables and fruits mustbe added to food as fruits are rich inantioxidants. It gives energy to thebody. Fruits and green leafy vegetableswill activate vitamins in the body.Though high in calories, most nuts(almonds, walnuts, even ground nuts)

are high in mono-unsaturated fattyacids that do not increase badcholesterol.

Different varieties of spices which aredaily used in kitchen shows positiveimpact on health. Regular use of garlicmaintains the blood circulation anddecrease the risk of heart disease. Rawtumeric has the capacity of maintainginsulin level hence controls the glucoselevel. In the same way, fenugreek seed,pepper, cinamon and back cuminhelps to maintain cholesterol level inthe body.

What to Keep in Mind thisFestival Season

On the occasion of Tihar festival, people burn firecrackers to express theirhappiness. A firecracker is a small explosive material which when burnedproduces a loud noise along with colorful sparks. It is made up of manyharmful chemicals and produces harmful gases when burnt which dissolvein the atmosphere and add to its contamination. Bursting crackers and rocketsin the sky may be a wonderful sight but hazardous to nature, animals andhuman beings.

Firecrackers can cause hearing loss, high blood pressure, sleepingdisturbances and sudden exposure to loud noise can cause temporary orpermanent deafness or even result in heart attack. The metallic particles inthe smoke emitted by fireworks is not just dangerous for those with respiratoryproblems and lung diseases, but also for others.

Harmful gases and toxic substances are released to environment by burstingfireworks. These prove to be hazardous for our respiratory systems and cancause serious ailments like asthma, lung cancer, shortness of breath, andmany other respiratory diseases.

The various chemicals in fireworks and their effectsSulfur dioxide : Causes wheezing and shortness of breath.Cadimium : Can cause anemia and damage to kidney and

also affect the nervous system.Nitrite : Can cause skin problems, eye irritation,

and respiratory problems in children.Lead : Affects the nervous systemMagnesium : Can cause metal fume feverNitrate : Can cause mental impairmentCopper : Irritates respiratory tractThe presence of aluminum, sulfur nitrate enables a cracker to produce loudsounds. The big bangs, whizzing whistles, and the thunderous sounds areno good for ears. It contributes in scaring the animals away in a very inhumancondition This sound is not even good for infants and pregnant women. Also,fire accidents can occur due to the sparks of the crackers.

Lets not forget our health and nature, Celebrate an ecofriendly Deepawali

Deepawali and Crackers

Kritika ShresthaMarket Planning Department

ECG Findings of Wellens� Syndrome

Dr. Kamal KumalMBBS, MD (Cardiology)

Pokhara Hosptial

A 62 year old male presents with leftsided chest pain since one week andpain increase in sort of exertions. Hedescribes crushing pain and feeling ofstones in his chest, it means heavinessof chest and gives history ofHypertension and Diabetes Mellitus. Hewent to a local clinic and done ECGwhich reveals normal and treat as GERD.

Physical ExaminationVital signs are as follows: T: 98.9 F; P:72; R: 18; BP: 155/95General: ill looking.Chest: Nontender, lungs are clear withgood air movement bilaterally.Cardiovascular: Equal, normal pulsesat the wrists, cardiac rhythm is regular.Abdomen: Non distended & nontender.Neck: No masses, No JVP or No carotidbruits.Extremities: Warm, nontender, noperipheral edema.Neurological: No deficits in mental status,motor function, coordination or gait.

was found to have a 99% stenosis ofhis proximal left anterior descendingcoronary artery, which wassuccessfully stented.

DiscussionWellens� sign first described in 1982,consists of deep, symmetric T waveinversion in the anterior ECG leads,with a less common variant beingbiphasic T wave inversion in theseleads. Approximately 90% of patientswith these changes have high-gradestenosis of the proximal left anteriordescending coronary artery. Wellens'Syndrome refers to the two differenttypes of T wave pattern that are seenat the painless period. Thecommonest form (75%), there aredeep negative T waves in leads V2and V3 and biphasic T waves typicallyobserved in V2 and V3. The clinician�sdetection of Wellens� sign in case ofmore specif ic suspicion andexpeditious referral, even though thepatient had no rest symptoms.

changes, treating patient with cardiaccatheterization rather than stresstesting, and the patient was found tohave a 99% stenosis of his proximalleft anterior descending coronaryartery, which was successfully stented.Referance1. De Zwaan C, Bar FW, Wellens HJ.

Characteristic electrocardiographic patternindicating a critical stenosis high in leftanterior descending coronary artery inpatients admitted because of impendingmyocardial infarction. Am Heart J. 1982Apr;103(4 pt 2):730-736.

2. Tandy TK, Bottomy DP, Lewis JG. Wellens�Syndrome. Ann Emerg Med. 1999Mar;33:347-351.

3. Rhinehardt J, Brady WJ, Perron AD, Mattu A.Electrocardiographic manifestations ofWellens� syndrome. Am J Emerg Med. 2002Nov;20(7):638-643

4. Arikh KS, Agarwal R, Mehrotra AK, Swamy RS.Wellens� Syndrome: A Life-Saving Diagnosis.American Journal of Emergency Medicine. 2012Jan;30(1):255.e3-5. doi: 10.1016/j.ajem.2010.10.014. Epub 2010 Nov 23.

5. Rhinehardt J, Brady W, Perron A, Mattu A:Electrocardiographic Manifestations of Wellens�Syndrome. American Journal of EmergencyMedicine. Nov 2002; 20(7):638-43. 12442245

6. Tandy TK, Bottomy DP, Lewis JG: Wellens�syndrome. Annals of Emergency Medicine.March 1999;33:347-351.10036351

Par Excellent Cardio Protector

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Doctor: "I'm sorry but you sufferfrom a terminal illness andhave only 10 to live."

Patient: "What do you mean, 10?10 wha t? Mon ths?Weeks?!"

Doctor: "Nine... Eight... Seven... "

Never ask google for medicaladvice i have gone from mildheadache to clinically dead in threeclicks...

He is pain free and completely stable.His initial troponin is negative. His ECGshows nonspecific T-Wave changes. Itshows no ST elevations, no Q waves,and a normal R wave progression.There are some T-wave inversions inV2 and V3 that have an odd, biphasicappearance.

The patient did exercise stress test forworkup of possible unstable angina.On stage II of treadmill test, hedevelops ST elevations across theprecordial leads. Immediately stoppedthe test and send to ICU. On the daywe refer to Cath lab center. The patient

ConclusionUnlike most other cases of angina,patients who present with a historyof chest pain and an ECG thatdemonstrates Wellens changes shouldnever be sent for a stress test. Instead,due to the critical LAD stenosis, thesepatients usually require invasivetherapy as soon as possible. They dopoorly with medical management.Thus, it is extremely important thatall clinician /physicians are able toquickly recognize these characteristicof ECG changes. 20% of all unstableangina patients will have this rarephenomenon. Due to the ECG

A Case Review

JOKES

I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . .10 Telmisartan 20, 40mg TabletsT-cardis

Dashain, the major festival for Nepalese entails manythings - season's greetings, new beginnings, merrymaking;and these include lavish lunches, dinners and get togetherwith family, friends and neighbors. The consumption offood increase ten-fold during festive season and amongthis, the consumption of meat and meat item is very high.Without meat, for many of us, our celebration isincomplete. People eat meat in plentiful quantities.Whether you are the guest or the host, meat has to bethere in the menu. People enjoy meat in different flavors,cooking recipe and even make special ways to treatdifferent body parts. People enjoy meats in flavors likedeep fried in oils, barbecued or roasted or even cookedas a curry. To make each variety of the meat tasty theample amount of oil, spices, and salt are added. Peopleeven keep meat for days and almost week.It is the scientific truth that meat is rich in protein and ourbody can only absorb a little up to maximum 100 gramsof protein in a day and that is when the person is on fullworkout and heavy working exercises. All the other proteinsunabsorbed by the body are a waste. In addition to that,Nepalese way of cooking meat involves many activitieswhich make it even riskier to eat a large quantity of meat.A large quantity of oil used to cook meat especially indeep-fried meat might increase the cholesterol level. Thefats and protein take a lot of time to burn which increasesfats in the body of people causing an increase in weight.Here we share with you few types of meat and theirbenefits with their nutritional valuesMutton: Generally speaking, mutton is very healthy.Because goats graze on grass all day, the omega 6 to 3ratio is very low and optimal compared to other meats.Mutton contains a broad range of health-protectivenutrients, especially zinc, potassium, selenium and Bvitamins. Mutton meat is considered a red meat and mustnot be consumed in excess; special precaution must betaken by people who have heart related diseases, & arediabetic.Chicken: Chicken is very popular, and one of the mainmeats that a lot of people consume. However, chicken hasa different classification of meat and comes under thepoultry category. Chicken are referred to as �white meat�.Chicken can be enjoyed in many different recipes. Its light,versatile flavor makes it a great accompaniment to quitea few ingredients. Chicken is very cheap and easilyaffordable. For those who are trying to consume lessfat/calories, chicken offers a smaller amount than othermeats but with the same protein content. Chicken providesa decent source of necessary vitamins and minerals,particularly selenium, potassium, phosphorus and Bvitamins. The protein in chicken is high, but the fat contentis lower. Bacterial contamination with strains such asE.coli and Salmonella is too common in chicken. As a result,strict hygiene procedures are necessary when handlingthe raw meat.Pork: Pork is one of the most popular forms of meat classedas red meat. This is because it contains a large amount ofmyoglobin, a protein responsible for the red color of meat.Pork is a particularly significant source of thiamin (vitaminB1) and hence plays an essential role in glucose metabolism

Healthy Dashain; Happy DashainMallika Gubhaju

Market Planning Department

and protecting cardiac health. It contains decent amountsof selenium and zinc, which are responsible for boostingthe immune system, defending against oxidative stress,and optimal hormone production. But compared to othermeats, pork contains extremely high levels of omega-6fatty acids. It is also more susceptible to bacterialcontamination and food-borne illnesses than other meat;ensuring pork is thoroughly cooked is essential.Duck: Duck is one of the less popular types of meat. It isa highly nutritious form of white meat which is both healthyand tasty. Duck provides a significant amount of selenium,phosphorus, and B vitamins. These vitamins are allimportant for optimal energy production and a well-functioning immune system. Making duck at home orhaving a roast duck is perfectly healthy.Wild Boar: Wild boar is a lot like pork, but it contains lessfat and more protein. Boar contains a lot of protein as wellas plenty of niacin, thiamine, vitamin B6, vitamin B12,phosphorus, zinc and selenium. While the omega-3 toomega-6 fatty acid ratio is still not fantastic, it is betterthan that of pork. This is because wild boars have morespace and access to better food than domesticated pigs.Wild boar is similar to pork, but the wild nature of theanimal means that it has eaten more nutritious food andhas a better nutrient profile itself.Rabbit: Rabbit is highly nutritious meat but is not commonlyeaten. It is rich in protein, niacin, iron, phosphorus, zinc,and selenium. It is also an excellent source of vitamin B12in particular. But it is very expensive to eat rabbit.

Mutton Chicken Pork Duck Wild boar RabbitNutrient Amount Amount Amount Amount Amount AmountCalories (kcals) 282 143 263 132 160 173Carbohydrate (g) 0 0 0 0 0.0 0.0Protein (g) 16.6 17.4 16.9 18.3 28.3 33.0Fat (g) 23.4 8.1 21 5.9 4.4 3.5Saturated (g) 10.2 2.3 7.9 2.3 1.3 1.1Monounsaturated (g) 9.6 3.6 9.4 1.5 1.7 0.9Polyunsaturated (g) 1.9 1.5 1.9 0.7 0.6 0.7Omega-3 (mg) 420 96 70 80 30.0 140Omega-6 (mg) 1360 1327 1670 670 500 540Omega 6 to 3 Ratio 1 : 3.2 1 : 13.8 1 :23.8 1 : 8.4 1 : 16.7 1 : 3.9

In some cultures, there is a tradition of eating raw meatwhich may cause an infestation of parasites like tapewormand other harmful unfamiliar bacteria that will causehealth problem sooner or later in the future. one needsto be more careful regarding the consumption of foodduring the festival as the food eaten will have an adverseeffect on one�s life.The festive season is not only about meat but about thefamily, friends and people coming together once a yearto share the joys and create memories, take and giveblessings and honor gods and thank them for their strongsupport. It is our duty to make festivals more about thesevalues rather than just about meat and flavors of the meat.Have a Happy and Healthy Dashain, Tihar and Chhath.https://www.nutritionadvance.com/types-of-meat/

Nutritional Value per 100 g

I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . .Albendazole Tablets/SuspensionWORMSTAT 11

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I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . .12 Escitalopram 5/10 mg TabletsECT

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Brand Name: PROLONGGeneric Name: DapoxetineStrength: 30mg TabletsTherapeutic Category:Selective Serotonin Reuptake Inhibitor(Short Acting)

PharmacologyPharmacodymanicsDapoxetine is a short-acting SSRI drugfor the treatment of prematureejaculation in men, which makes it thefirst drug approved for such treatment.d a p o x e t i n e h a s a u n i q u epharmacokinetic profile, with a shorttime to maximum serum concentration(about 1 h) and rapid elimination (initialhalf-life of 1-2 h).Pharmacokinetics:Dapoxetine is a short-acting SSRI drugfor the treatment of prematureejaculation in men, which makes it thefirst drug approved for such treatment.D a p o x e t i n e h a s a u n i q u epharmacokinetic profile, with a shorttime to maximum serum concentration(about 1 h) and rapid elimination (initialhalf-life of 1-2 h).Absorption:w Taken 1�3 hours before sexual

activity, it is rapidly absorbed in thebody. I ts maximum plasmaconcentration(Cmax) is reached 1�2hours after oral administration.

w food doesn't alter dapoxetinepharmacokinetics. Dapoxetine canbe taken with or without food.

Distribution:w Dapoxetine is absorbed and

distributed rapidly in the body.Greater than 99% of dapoxetine isbound to the plasma protein.

w The mean steady state volume is162 L

w Its initial half-life is 1.31 hours (30mg dose) and 1.42 hours (60 mgdose,) and its terminal half life is18.7 hours (30 mg dose) and 21.9hours (60 mg dose).

Metabolism :w Dapoxetine is metabolized

extensively in the liver and kidneyby multiple enzymes such asCYP2D6, CYP3A4, and flavinmonooxygenase 1 (FMO1).

Elimination:w The metabolites of dapoxetine are

eliminated rapidly in the urine witha terminal half-life of 18.7 hoursfor a single dose of 30 mg .

Indicationw Premature Ejaculation

DosageMissed DoseThe dose regimen for this medicine isnot fixed and hence missing ascheduled dose is highly unlikely.OverdoseContact your doctor immediately if anoverdose with this medicine issuspected. It is recommended to avoidtaking more than one tablet within 24hours.

Side effectCommon are Nausea, headacheDizziness, Diarrhoea, Fatigue,Insomnia.

Contraindicationw Allergyw Heart failurew Heart rhythm disordersw Bipolar disorderw Loss of consiousnessw Kidney Diseasew Liver diseasew Monoamine oxidase inhibitors (MAOI)w Thioridazinew Selective serotonin reuptake

inhibitors (SSRIs)w Strong CYP3A4 inhibitors

Special PrecautionThis medicine should not be used alongwith alcohol or any other recreationaldrugs since the risk of serious adverseeffects is significantly high.

Drug Interaction� Erythromycin MODERATE� Fluconazole MODERATE� Ketoconazole SEVERE� Lithium SEVERE� Tramadol SEVERE� Warfarin MINOR� Ritonavir SEVERE� Verapamil MODERATE

Pregnancy CategoryNot recommended for use in Women.

Prolong,Pre-z,Aripro,Lintab,Cefime

Last date of "Logo Game" answers Submission : 15th Poush 2075 (30th Dec. 2018)

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I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . .14 Cefpodoxime Proxetil 200mg FC TabletsCEFIME

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Dr. Mahendra K. Agrahari Dr. Krishna Bd. Thapa Dr. Niraj Nepal

Dr. Nabin Kumar Shrestha Dr. Soni Subedi Dr. R.L. Gurubacharya

Dr. Reshma Dhakal Lamichane Dr. Neeraj K.C. Dr. Tirtha Lal Upadhaya Dr. Ranjita Jaiswal

P a t r o nMr. G. Narayan B. ChhetriChairman & Managing Director

Editor in ChiefMr. Sudarshan Lal ShresthaDeputy Managing Director

EditorPhr. Sabin Raj ShakyaManager, Market Planning Department

Editorial TeamPhr. Ashesh BhandaryFactory Operation Director

Phr. Amrita AcharyaBrand Development Manager

Mrs. Mallika GubhajuSr. Resource Management Officer

Phr. Sweta RauniyarProduct Development Officer

Phr. Kritika ShresthaProduct Development Officer

Phr. Dikshya SainjuProduct Development Officer

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Editorial

MEDITIMEA Medical Bulletin from TIME Pharmaceuticals (P.) Ltd.

Sudarshan Lal ShresthaEditor in Chief

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InsideEditorial 2

Health News Line 3

International Prostate Symptom Scores 4

Taking Care of Your Health

During Festivals 7

DO�s and DON�Ts for

DIABETICS to Enjoy Festival 8

What to Keep in Mind this Festival Season 9

ECG Findings of Wellens� Syndrome 10

Healthy Dashain; Happy Dashain 11

dfgl;s :jf:Yo / xfd|f] ;dfh 12

Product Information/Word Puzzle 13

Response Form 14

Moments in Time 15

MOMENTS IN TIMEMOMENTS IN TIME

I n s p i r e d B y E x c e l l e n c e . . .I n s p i r e d B y E x c e l l e n c e . . . 15Clarithromycin 500mg TabletsCLARITH

With the starting of October, the cloudy monsoonslowly changes into clear blue skies, with autumnseason being in full bloom, it signifies that thefestive season has been started. And I hope you arealso in the hang of festive mood when you receivethis quarterly magazine "MEDITIME". Hope thisfestive mood provides you full energy to workfor rest of the year.

Nepal is a country rich in culture and tradition, and out of that in Octoberwe celebrate the biggest festival like Dashain, Tihar and Chhath. This isthe season in which consumers have extra money due to good transactionin entrepreneur's business (like farmers, shopkeepers or businessman)and extra festival bonus for employees. But we have to be careful enjoyingfestivals to avert health ailment in post-festival period. Moreover thesedentary lifestyle is more prone to increase during the festival seasonwhich increases chances of non-communicable diseases likehypercholesterolemia, hypertension, diabetes etc. Also, the high intakeof meat and alcohol can also increase different disease relative to digestionor liver. Though most are aware about this, but fail to follow maintaintheir health. At least, morning exercise in fresh air energies the systemsof our body which is very important to maintain our health.

In this quarterly issue, we tried to blend the information related to festivaland health; trying to make it more informative during festive season.Inside this, there is a very informative article related to InternationalProstate Score Symptoms written in Nepali so that it can be studiedeasily and self analyzed. I extend my sincere thanks to our well supporterProf. Dr. A.D. Bhatta, Senior Consultant Urologist for his great article.Similarly, we are also happy to share other valuable articles related toWellen's syndrome and tips for diabetes during festival from our valueddoctors. To add up to the entertainment while reading articles, we alsohave features of word puzzle game and lucky prizes. I hope the blend ofinformation and entertainment will make your day good.

Wishing everyone is blessed with good health, happiness and prosperity.Happy Dashain, Tihar, Nepal Sambat 1139 and Chhath 2075.

BOD's with Motivational Trainer Mr. Dipankar Sherpa Motivational Training at Sauraha

Participation in APPON futsal Participation in APPON futsal

Various Events During Bishwokarma Puja at Factory

MEDITIMEA Medical Bulletin from TIME Pharmaceuticals (P.) Ltd.

Issue 27 Kartik - Poush 2075 (Oct. - Dec. 2018) For free circulation only

w w w . t i m e p h a r m a . c o m

DO�s and DON�Ts forDIABETICS to EnjoyFestival

Taking Care ofYour HealthDuring Festival

What to keep in Mindthis Festival Season

Inspired by Excellence...

for more details, please visit www.timepharma.com

Dapoxetine 30mg tablets

Every one out of three men suffers from

Premature Ejaculation at least once in their lifetime

-Mayoclinic, 2017

rapid ejaculation andassociated orgasm

short plateau phase

steep excitementphase Premature

EjaculationNormalEjaculation

TimeJ Sex Med. 2006: 303

Healthy Dashain;Happy Dashain

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