INDIAN NATIONAL EPILEPSY DAY

Today ls our national epilepsy day. It is a common problem. Most of our people are living in rural area and also most of them are illiterate . So over people are not aware much about epilepsy. And the proper treatment for this disorder is also delayed duo to frequent intervention by traditional healers in rural area . So the treatment cap for epilepsy is more. So a national program to aware detect treat and prevent epilepsy in india is needed . So our indian govt should initiate a EPILEPSY AWARENESS DETECTION TREATMENT AND PREVENTION PROGRAM and it should be implemented at primary health centre level as one of our indian govt national health program. Another important problem jr epilespy common in poor underdeveloped and developing countries . So improve epilepsy service in these regions WHO should adopt WORLD EPILEPSY DAY. . There by epilepsy prevention and treatment and awareness can be easily carried out globally . .......)DR.M.A.ALEEM NEUROLOGIST TAMIL NADU TRICHY INDIA

உலகில் மருத்துவம் தான் முதன்மையான தொழில் : புத்தக வெளியீட்டு விழாவில் கலெக்டர் புகழாரம்

உலகில் மருத்துவம் தான் முதன்மையான தொழில் : புத்தக வெளியீட்டு விழாவில் கலெக்டர் புகழாரம்

பதிவு செய்த நாள் : நவம்பர் 14,2010,02:05 IST
தினமலர்

திருச்சி: ""டாக்டர்கள் கடவுளாக பார்க்கப்படுவதால், உலகில் மருத்துவம் தான் முதன்மையான தொழில்,'' என்று வாதநோய் பற்றிய விழிப்புணர்வு புத்தக வெளியீட்டு விழாவில் திருச்சி கலெக்டர் மகேசன் காசிராஜன் பேசினார். திருச்சி கி.ஆ.பெ., விஸ்வநாதம் அரசு மருத்துவக்கல்லூரி துணைமுதல்வரும், நரம்பியல் துறை வல்லுனருமான டாக்டர் அலீம் தமிழில் எழுதிய வாதநோய் வராமல் தடுக்கும் முறைகள் பற்றிய விழிப்புணர்வு புத்தக வெளியீட்டு விழா மாவட்ட அரசு மருத்துவமனை வளாகத்தில் நடந்தது. இதில், பங்கேற்ற கலெக்டர் மகேசன் காசிராஜன், உலக பக்கவாத தினத்தையொட்டி டாக்டர் அலீம் எழுதிய புத்தகத்தை வெளியிட, அரசு மருத்துவமனை கண்காணிப்பாளர் டாக்டர் பன்னீர்செல்வம் பெற்றுக் கொண்டார். நிகழ்ச்சியில் அரசு மருத்துவமனையில் டாக்டர்கள், நர்ஸ்கள், மருத்துவ மாணவிகள், நர்சிங் பயிலும் மாணவிகள் என பலர் பங்கேற்றனர். அரசு மருத்துவக்கல்லூரி துணைமுதல்வர் டாக்டர் அலீம் பேசியதாவது: நாட்டில் முன்பெல்லாம் பரவக்கூடிய நோய்கள் இருந்து வந்தது. அவை மத்திய, மாநில அரசுகளின் சுகாதார திட்டங்களால் தடுக்கப்பட்டுள்ளது. ஆனால், தற்போது மக்களின் முறையற்ற பழக்கவழக்கம், வாழ்க்கை முறை ஆகியவற்றால் மாரடைப்பு, சர்க்கரை நோய், வாதம் ஆகிய தொற்று அல்லாத நோய்கள் வருகின்றன. சுதந்திரம் பெறும் முன் இந்தியர்களின் சராசரி வயது 37ஆக இருந்தது. ஆனால், தற்போது சுகாதாரத்திட்டங்களால் 65ஆக மாறியுள்ளது.

உணவு, வாழ்க்கை முறையில் தவறான பழக்கவழக்கங்களே வாதநோய்க்கு முக்கிய காரணமாகும். கடந்த 1960ம் ஆண்டுகளில் நாட்டில் ஒருலட்சம் பேருக்கு வெறும் 13 பேர் தான் வாதநோயால் பாதிக்கப்பட்டனர். ஆனால் தற்போது ஒருலட்சம் பேருக்கு 141 பேர் பாதிக்கப்படுகின்றனர். இதற்கு தவறான வாழ்க்கை முறையே காரணம். உலக பக்கவாத தினம் கொண்டாடும் நோக்கமே வாதநோய் பற்றிய விழிப்புணர்வு மக்களிடம் ஏற்படுத்த வேண்டும் என்பதற்காகத்தான். வாதநோயால் பாதிக்கப்பட்டவர்களுக்கு மூன்று மணிநேரத்தில் சிகிச்சை அளித்தால் விரைவில் குணமாகிவிடுவர். இவ்வாறு அவர் பேசினார். திருச்சி கலெக்டர் மகேசன் காசிராஜன் பேசியதாவது: மனித சமுதாயத்துக்கு எதிராக பலநோய்கள் உள்ளது. அவற்றை அழிக்க மருத்துவக்கல்வி முக்கியம். நரம்பியல் துறையை பொறுத்தவரை நீண்டநாள் சிகிச்சை எடுக்கவேண்டும் என்று கேள்விப்பட்டுள்ளேன். ஆனால் எந்தநோயால் பாதிக்கப்பட்டவரும் குறித்தநேரத்தில் மருத்துவ சிகிச்øகு உட்பட்டால் விரைவில் குணமாகும் வாய்ப்பு உள்ளது. அதற்காகத்தான் அரசால் 108 ஆம்புலன்ஸ் திட்டம், கலைஞர் காப்பீடு திட்டமெல்லாம் செயல்படுத்தப்பட்டு வருகிறது.

டாக்டர்கள் வரும் நோயாளிகளிடம் நோய்கள் பற்றிய விழிப்புணர்வு ஏற்படுத்த வேண்டும். மருத்துவத்தை பொறுத்தவரை கனிவான பார்வை, அன்பான உபசரிப்பு, கனிவான பேச்சு ஆகியவை இருக்கவேண்டும். உலகில் எவ்வளவு தொழில் இருந்தாலும், மருத்துவம் தான் முதன்மையான தொழிலாகும். அதிலும் வளர்ந்து வரும் இந்தியா போன்ற நாடுகளுக்கு மருத்துத்துறை மிகவும் முக்கியத்துவம் வாய்ந்தது. டாக்டர்கள் மக்களால் கடவுள் போல் பார்க்கப்படுகின்றனர். மக்களை எளிதில் சென்றடையும் வகையில் தமிழில் வாதநோய் விழிப்புணர்வு புத்தகம் எழுதிய டாக்டர் அலீமை பாராட்டுகிறேன். திருச்சி மாவட்ட அரசு மருத்துவமனைக்கு இன்னும் அதிக வசதிகள் வரும் வாய்ப்புள்ளது. இவ்வாறு அவர் பேசினார்.

Hypertension Management in acute Stroke

Dr.M.A.Aleem M.D,D.M.,Professor of Neurology,KAPV Medical College as invited facult member has given a talk on Hypertension Management in acute Stroke on first day of the three days International conference on critical care and Medicine organized by balaji medical college at chennai on 23th oct,2010.His talk was well received by the audience.Dr.S.M.Rajandran as organizing secretary of the above conference invited Dr.M.A.Aleem as faculty member.

suggesion for free swine flu vaccination‏

POOR RESPONSE FOR THE SWINE FLU FREE VACCINATION PROGRAM- HOW TO IMPROVE




The Incidence of swine flu is more commonly reported in people living in urban

than rural living population.


In Tamil nadu the first and second out break of swine flu is not that much

severe and the swine flu infected patients number were very less in comparison with other states in India, due to prompt preventive measures taken by the Tamil Nadu Government. The death rate is also very less and that is less than 1% in our state and also now the spread of swine flu is very much reduced in out state.


Tamil Nadu government swine flu vaccination program with reduced rate, implemented in last month attracted mild to moderate response among people.


Now our government implements free swine flu vaccination to all the people who are holding the Kalaingar Kappitu Thittam (KKT) card. The response is also poor among them.


Compare to reduced rate vaccination acceptors in first 5 days we got less than 25% of response among KKT card holder in Trichy district for free swine flu vaccination.


The reason for the poor response to the free swine flu vaccination program and the remedies to improve is as follow.


1.

The incidence of swine flu is more in urban then rural area so to encourage the number of vaccinated persons all willing people can be given vaccine at free of cost in the centre as present state in every Medical College Hospital and District Head Quarters Hospitals.
2.

Most of the KKT card holders are located in the rural area then in urban area. If we want to create more vaccination in rural it can be corrected by providing Vaccine through PHC by mass vaccination program like pulse Polio. But the incidence of swine flu is not that much alarming. So this type of vaccination need not be implemented in our state.


3.

So finally the present free vaccination program can be carried out for all willing people in urban & rural along with KKT card holders in the vaccination centre situated in Medical College Hospital and District Head Quarters Hospitals.


For this at presents the supplied 25,000 doses of swine flu vaccination is enough in Trichy District because of poor response for paid and free swine flu vaccination.

மருத்துவம் குறித்த விழிப்புணர்வை மருத்துவர்கள் ஏற்படுத்த யோசனை

மருத்துவம் குறித்த விழிப்புணர்வை மருத்துவர்கள் ஏற்படுத்த யோசனை

First Published : 10 Nov 2010 12:43:05 PM IST
தினமணி

Last Updated :

திருச்சி, நவ. 9: மருத்துவர்கள் சிகிச்சை அளிப்பதுடன் மருத்துவம் குறித்த விழிப்புணர்வையும் ஏற்படுத்த வேண்டும் என்றார் மாவட்ட ஆட்சியர் மகேசன் காசிராஜன்.

திருச்சியில் செவ்வாய்க்கிழமை நடைபெற்ற உலக வாத நோய் தின நிகழ்ச்சியில் அவர் மேலும் பேசியது:

"மனித சமுதாயம் பலவித நோய்களை எதிர்கொள்ளும் சூழ்நிலையில் உள்ளது. இன்றைக்கு உள்ள வாழ்க்கை முறையால் பல வித நோய்கள் ஏற்படுகின்றன.

நோய் வந்த பிறகு சிகிச்சை அளிப்பதைவிட முன்னெச்சரிக்கையாகத் தற்காத்துக் கொள்வது நல்லது.

மருத்துவர்கள் நோயாளிகளுக்கு சிகிச்சை அளிப்பதுடன், அந்த நோய்க்கான காரணங்கள் குறித்த விழிப்புணர்வை ஏற்படுத்தவேண்டும்.

மருத்துவர்களை மக்கள் கடவுளாக நினைக்கிறார்கள். அவர்களிடம் மருத்துவர்கள் கனிவுடன் பழகவேண்டும்.

திருச்சி அரசு மருத்துவமனைக்கு நிறைய வசதிகள் வர உள்ளன என்றார் மகேசன் காசிராஜன்.

நிகழ்ச்சியில், கி.ஆ.பெ. விசுவாநாதம் அரசு மருத்துவக் கல்லூரி துணை முதல்வரும், மூளை நரம்பியல் நிபுணருமான மருத்துவர் எம்.ஏ. அலீம் எழுதிய வாத நோய், அவற்றைத் தவிர்ப்பது குறித்த கையேட்டை மாவட்ட ஆட்சியர் மகேசன் காசிராஜன் வெளியிட, அதை அரசு மருத்துவமனைக் கண்காணிப்பாளர் எஸ். பன்னீர்செல்வம் பெற்றுக் கொண்டார்.

மருத்துவர் அலீம் பேசியது:

"ஒரு காலத்தில் தொற்று நோய்கள் அதிகம் பரவின. தற்போது மக்களின் வாழ்க்கை முறை, நடவடிக்கைகளால் சர்க்கரை, வாதம் போன்ற நோய்கள் ஏற்படுகின்றன.

நம் நாடு சுதந்திரம் அடைந்த காலக்கட்டத்தில் சராசரி மனிதரின் ஆயுள் 37 ஆண்டுகளாக இருந்தது. மருத்துவ வளர்ச்சி, அரசின் சுகாதாரத் திட்டங்கள் போன்ற காரணங்களால் தற்போது இது 65 ஆண்டுகளாக ஆக உயர்ந்துள்ளது.

தவறான பழக்க வழக்கங்களால் பலவித நோய்கள் உருவாகின்றன. அதில் ஒன்றுதான் வாத நோய்.

1960-ம் ஆண்டில் ஒரு லட்சம் பேரில் 13 பேருக்கு இந்த நோய் பாதிப்பு இருந்தது. தற்போது 141 பேருக்கு இந்த நோய் உள்ளது. திருச்சி மாவட்டத்தில் ஒரு லட்சம் பேரில் 26 பேருக்கு இந்த நோய் உள்ளது.

பக்கவாதம் ஏற்பட்டு 3 மணி நேரத்துக்குள் உரிய சிகிச்சை எடுத்தால் சரிசெய்துவிடலாம்' என்றார் அலீம்.

‘Lifestyle modification can prevent stroke'

‘Lifestyle modification can prevent stroke'

Staff Reporte

right stroke: Collector Mahesan Kasirajan, centre, handing over the booklet to M.Panneerselvam, Medical Superintendent, Annal Gandhi Memorial Hospital, in Tiruchi. The author M.A. Aleem is in the picture.

TIRUCHI: Lifestyle modification can prevent stroke, stressed speakers at the ‘World Stroke Day' at K.A.P.Viswanatham Government Medical College and Annal Gandhi Government Hospital, Tiruchi on Tuesday.

Collector Mahesan Kasirajan released the booklet on ‘Stroke and its prevention' authored by M.A Aleem, Head of the department, Neurology. The educational booklet in Tamil elaborates on causes, symptoms and prevention of stroke besides addressing simple questions on the subject. Mr. Kasirajan underlined the need for educating patients on their diseases. He urged doctors, nurses and medical students present to adopt a sensitive approach to patients.

Dr. Aleem said early recognition of symptoms such as slurring, trouble with vision and difficulty in using limbs can lead to timely treatment and averting a major attack. Stroke occurs when a blood vessel that supplies blood to the brain bursts or is blocked by a blood clot. He noted that the window period for admission of a patient suffering from stroke is diminishing in Tamil Nadu thanks to 108 ambulance services. He added that, concluding from a city based study, early morning stroke, occurring between 6 a.m. and noon was a common feature in the city.

Dr. Aleem threw light on the ‘one in six' campaign launched by the World Stroke organisation on October 29, World Stroke Day.

The campaign that seeks a prime place for the fight against stroke in the global health agenda highlights the prevention of stroke and rehabilitation of survivors. It is based on the estimate that one in six people worldwide are likely have a stroke in their lifetime.

The two year campaign aims at reducing stroke with emphasis on six criteria: knowledge and control of personal risk factors such as high blood pressure; diabetes and high blood cholesterol; physical activity and exercise; avoiding obesity with a healthy diet; limiting alcohol consumption; avoiding smoking and recognising warning signs of a stroke.

S.Paneerselvam, Medical Superintendent of the hospital said that the government hospital was equipped with all facilities to handle stroke and provide preventive treatment.



The Hindu
Online edition of India's National Newspaper
Wednesday, Nov 10, 2010

Louis Pasteur (1822-1895). Postal stamp of France 1972

Index Medicus for South-East Asia: IMSEAR >
Journals >
India >
Journal of the Association of Physicians of India >


Please use this identifier to cite or link to this item: http://imsear.hellis.org/handle/123456789/86495

Title: Louis Pasteur (1822-1895). Postal stamp of France 1972.
Authors: Aleem, M A
Issue Date: 1-Feb-2002
Citation: Aleem MA. Louis Pasteur (1822-1895). Postal stamp of France 1972. Journal of the Association of Physicians of India. 2002 Feb; 50(): 293
Type: Biography
Historical Article
Journal Article
Source: http://www.japi.org
URI: http://imsear.hellis.org/handle/123456789/86495
Subjects: Bacteriology --history
France
History, 19th Century
Philately
Appears in Collections: Journal of the Association of Physicians of India

Seizure Termination by Sensory Stimulation

You have full text access to this OnlineOpen article
Seizure Termination by Sensory Stimulation

1. Mohaamed A. Aleem M.D., D.M., (Neuro)

Article first published online: 12 NOV 2007

DOI: 10.1111/j.1528-1167.2007.01311.x

Issue
Epilepsia
Epilepsia

Volume 48, Issue 11, pages 2192–2193, November 2007

பன்றிக் காய்ச்சல் தடுப்பூசி போடும் முகாம் தொடக்கம்

பன்றிக் காய்ச்சல் தடுப்பூசி போடும் முகாம் தொடக்கம்

First Published : 07 Nov 2010 01:06:02 PM IST
Last Updated :


திருச்சி, நவ. 6: திருச்சி அரசு மருத்துவமனையில் பன்றிக் காய்ச்சலுக்கு இலவசமாக தடுப்பூசி போடும் முகாம் சனிக்கிழமை தொடங்கியது.

திருச்சி அண்ணல் காந்தி நினைவு அரசு மருத்துவமனையில் கடந்த சில மாதங்களுக்கு முன் மருத்துவப் பணியாளர்கள் மற்றும் செவிலியர்களுக்கு இலவசமாக பன்றிக் காய்ச்சல் தடுப்பு மருந்து வழங்கப்பட்டது.

தொடர்ந்து, பொதுமக்களுக்கு குறைந்த விலையில் பன்றிக் காய்ச்சல் தடுப்பு மருந்து மற்றும் தடுப்பூசி போடும் முகாம் நடைபெற்றது.

இந்நிலையில், கலைஞர் காப்பீட்டுத் திட்டத்தில் உறுப்பினர்களாக உள்ளவர்களுக்கு இலவசமாக தடுப்பூசி போடும் முகாம் சனிக்கிழமை தொடங்கியது.

மாநில போக்குவரத்துத் துறை அமைச்சர் கே.என். நேரு முகாமை தொடக்கி வைத்தார். தினமும் காலை 9 மணி முதல் பகல் 1 மணி வரை இலவசமாக தடுப்பூசி போடப்படும்.

முகாம் தொடக்க விழா நிகழ்ச்சியில், மாவட்ட வருவாய் அலுவலர் சி.அ. ராமன், சட்டப் பேரவை உறுப்பினர் அன்பில் பெரியசாமி, மாநகராட்சி ஆணையர் த.தி. பால்சாமி, துணை மேயர் மு. அன்பழகன், மருத்துவக் கல்லூரி முதன்மையர் அ. கார்த்திகேயன், துணை முதன்மையர் எம்.ஏ. அலீம், அரசு மருத்துவமனை கண்காணிப்பாளர் பன்னீர்செல்வம் உள்ளிட்டோர் கலந்து கொண்டனர்.



தினமணி
Sunday, November 07, 2010 2:12 PM IST

Profile of Diabetic Foot Complications and itsAssociated Complications - A Multicentric Study from India

Profile of Diabetic Foot Complications and itsAssociated Complications - A Multicentric Study from India
V Viswanathan*, N Thomas**, N Tandon***, A Asirvatham+, Seena Rajasekar*,A Ramachandran *, K Senthilvasan**, VS Murugan+, Muthulakshmi+



Abstract

Aim : The aims of this study were to determine. The prevalence of foot complications such as neuropathy,peripheral vascular disease (PVD), amputations and infections and the associated diabetic complicationsand practice of foot care among these subjects.

Methods : A total of 1319 type 2 diabetic patients, were selected from four different centres across India. Thecentres were Diabetes Research Centre (DRC), Chennai, Government Rajaji Hospital (GRH), Madurai, ChristianMedical College (CMC), Vellore and All India Institute of Medical Science (AIIMS), Delhi. Details were collectedregarding foot problems and associated complications.

Results : The prevalence of neuropathy was 15% (n=193) and PVD was 5% (n=64). Infections were present in7.6% (n=100) of patients. The infection rate varied from 6–11% in the different centres. Nearly 3% of subjectshad undergone a minor or major amputation.

Discussion : This study found that the prevalence of infection was 6-11% and prevalence of amputation was3% in type 2 diabetic patients. Neuropathy (15%) was found to be an important risk factor for diabetic footinfections. Effective foot care advice should be propagated to reduce the burden imposed by diabetic footcomplication particularly in developing countries like India. ©



INTRODUCTION

Diabetes and its complications pose a major threat tofuture public health resources throughout theworld.1 Based on a compilation of studies from differentparts of the world, the World Health Organisation(WHO) has projected that the maximum increase indiabetes would occur in India.2 Considering the largepopulation and the high prevalence of diabetes, theburden of diabetes in India would become enormous.Diabetic foot infection is a common cause for the hospitaladmissions of the diabetic patients in India.1 This couldbe attributed to several sociocultural practices such asbarefoot walking; inadequate facilities for diabetic carelow education and poor socio-economic conditions.1Diabetic foot amputations are the most frequent of diabetic complications in developing countries. Patientswith foot complications spend higher percentage of theirincome (32.3%) for treatment when compared with thosewithout foot infections.3

Considering the immense burden superimposed byfoot complications, aggressive management becomesimperative. Indian data regarding various aspects of footcomplications such as percentage prevalence of footdeformity, infections and amputations and level of footcare among patients are very scarce. This study was doneto evaluate the prevalence of various diabetic footcomplications and associated complications in type 2diabetic subjects from various parts of India. The aimsof this study were to determine. The prevalence of footcomplications such as neuropathy, peripheral vasculardisease (PVD), amputations and infections andassociated diabetic complications and practice of footcare among these subjects

METHODS AND MATERIAL

A total of 1319 type 2 diabetic patients, according tothe WHO criteria, were selected from four differentcentres across India. The centres were Diabetes Research Centre (DRC), Chennai, Government Rajaji Hospital(GRH), Madurai, Christian Medical College (CMC),Vellore and All India Institute of Medical Science (AIIMS),Delhi. Among these centres, DRC is a private specialitycentre for diabetes, GRH and AIIMS are Governmentgeneral hospitals and CMC is a private charitablemedical college. Hospital based diabetes team in each ofthe above centres except DRC were invited to participatein this project. Every third type 2 diabetic subjects ofoutpatient department of the different centres attendingthe centres was recruited into this study.
*Diabetes Research Centre, 4, Main Road, Royapuram,Chennai – 600 013 [WHO Collaborating Centre for Research,Education and Training in Diabetes]; **Department ofEndocrinology, Christian Medical College, (Private CharitableMedical College), Vellore; ***All India Institute of MedicalScience (AIIMS), Delhi; +Government Rajaji Hospital, Madurai.#Rapid Publication Received : 24.8.2005; Accepted : 28.9.2005

Medical history was taken for all subjects. Detailsregarding duration, treatment of diabetes, patient’ssocial history and habit of smoking were noted. Bloodpressure was measured in all subjects in sitting positionon the right arm with a standard mercurysphygmomanometer. Mean values were determined fromtwo independent measurements taken at 5 min intervals.Hypertension (HTN) was defined as the presence ofsystolic blood pressure (SBP) of > 140 mmHg and/ordiastolic blood pressure (DBP) of > 90 mmHg or whenantihypertensive treatment was being taken.

Peripheral vascular disease was assessed usingDoppler studies. Cutaneous pressure perception wasassessed using 10g Semmes Weinstein monofilamentsat five plantar sites (1st, 3rd and 5th metatarsal heads, midfoot and the heel) on each foot. With eyes closed, thepatients were required to elicit a ‘yes / no’ response tomonofilament pressure and correctly identify the site ofcontact. Each filament was placed against the plantarsurface of the foot in a perpendicular fashion so that itbent with a constant force, with the 10g filament.Insensitivity to 10g monofilament at any one site oneither foot indicated abnormal sensation.1,2 Dataregarding myocardial infarction and ischaemic heartdisease were collected from the patient’s case sheets. Adetailed examination of the feet for the presence of footdeformity, infections and amputations was done.

A questionnaire was given to all the patients and thedetails regarding their day to day practice of footcare,types of footwear used, frequency of using the footwearand the aetiology of foot infection were noted. Thesedetails however could not be collected from AIIMS, Delhi.

Statistical Analysis

Statistical analysis was performed using SPSS, version4.0.1 (SPSS, USA) and EPI INFO V 5.01a program (CDCof Atlanta, USA and the WHO, Geneva, Switzerland).Data with normal distribution were expressed as mean± SD. ANOVA was used to determine the differencesbetween the groups. Chi square test was performed forcategorical variables. A 2-tailed p value < 0.05 wasconsidered as statistically significant. RESULTS Among the 1319 patients, 462 (35%) were selected from DRC, Chennai, 640 (46%) were included from theGovernment general hospitals, Madurai and Delhi, and253 (19%) were recruited from CMC, Vellore. All thesubjects from the four centres were age and sex matched.The mean age of the total cohort was 53 ± 11 yrs and themean duration of diabetes was 6.9 ± 5.9 yrs. The meanSBP was 133 ± 19 mmHg and DBP was 84 ± 10 mmHg.The mean blood urea, creatinine and cholesterol valueswere found to be within normal limits (Urea : 26 ± 12mg/dl , Creatinine : 0.95 ± 0.5 mg/dl, Cholesterol : 192 ±47 mg/dl). Hypertension was found in 34% (n=443)subjects and retinopathy in 15% (n=198). Among thestudy subjects, 11% (n = 148) were smokers. The prevalence of neuropathy was 15% (n=193) andPVD was 5% (n=64). Infections were present in 7.6%(n=100) of patients. The infection rate varied from 6 –11% in the different centres. Nearly 3% of subjects hadundergone a minor or major amputation. The characteristics of the subjects from the four centresare shown in Table 1 and Table 2. The prevalence ofhypertension and retinopathy was found to be thehighest among the AIIMS group. The prevalence ofneuropathy was however lowest in this group.Prevalence of myocardial infarction was found to be thehighest in CMC (5.5%). No difference in the prevalenceof PVD was noted across the four centres. The infectionrate varied from 6-11%in the different centres. Foot care practices among study subjects: Foot care practice was done by 36% (n = 400) patientsby themselves. Family members were involved in 2%(n=20) of patients and professional help was sought bynearly 2% (n=15) of subjects. Nearly, 65% of the studysubjects did not follow any footcare procedures. While 90 % of the study subjects wore footwear outsidethe house only 3% of them did so inside the house.Hawaii slippers were the most commonly used footwear(49%) followed by sandals (14%). Special diabeticfootwear and shoes were used by only 8% of the studypopulation. Bare foot walking was practiced by 7% ofthe study population. Improper footwear use, injurywhile doing a foot care procedure and unknown causesequally contributed to the development of footcomplications. DISCUSSION This study found that the prevalence of infection was6-11% and prevalence of amputation was 3% in type 2diabetic patients. Neuropathy (15%) was found to be animportant risk factor for diabetic foot infections. In a study by Chaturvedi et al,4 it was found that SouthAsians had higher prevalence of neuropathy (30%)compared with PVD (9%) and this prevalence was lesserwhen compared to the Caucasians. It has also beenshown that most of the foot problems associated withdiabetes in India are neuropathic and infective rather than vascular in origin as in developed countries.5 Theprevalence of PVD has been found to be 3.9% in anothercross-sectional population–based study conducted insouth Indians subjects which is similar to the findings of this study.6 The higher prevalence of hypertension andretinopathy in the AIIMS group of patients could beattributed to the fact that AIIMS is a large secondaryreferral centre. In this study, subjects with age >50 years had higherprevalence of all complications when compared withthose lesser than 50 years of age. Particularly theprevalence of neuropathy (72%) and PVD (80%) wasvery high. This finding is similar to the findings ofPremalatha et al7 who had shown that prevalence of PVDincreased with age. Age >50 yrs was found to beassociated with PVD (OR 6.3%), thereby identifying ageas a most significant risk factor for PVD.

It is of clinical importance that nearly 65% of the studypopulation did not follow any footcare procedures,which could be one of the major reasons for increasedprevalence of infections.

In a study by Vijay et al, it was shown that strategiessuch as intensive management and foot care educationare helpful in preventing newer problems and surgeryin diabetic foot disease. In the study of 4872 type 2diabetic patients, it was shown that patients whofollowed strict control developed lesser complicationwhen compared to those who did not follow the advice.8

Effective foot care advice should be propagated toreduce the burden imposed by diabetic foot complicationparticularly in developing countries like India.
REFERENCES

1.Vijay V, Snehalatha C, Ramachandran A. Socio-culturalpractices that may affect the development of the diabeticfoot. IDF Bulletin 1997;42:10–2.

2.Definition, diagnosis and classification of diabetes mellitusand its complication. Report of consultation. WHO, Geneva1999, Report 250.

3.Vijay V, Narasimham A, Seena R, Snehalatha C,Ramachandran A. Clinical profile of diabetic foot infectionsin South India- a retrospective study. Diabetic Medicine2000;17:215-8.

4.Chaturvedi N, Abbot CA, Whalley A, Widdows P, LeggetterSY, Boulton AJM. Risk of diabetes related amputation inSouth Asian vs Europeans in the UK. Diabetic Medicine2002;19:99–104.

5.Aleem MA. Factors that precipitate development of diabeticfoot ulcers in rural India. Lancet 2003;362:1858.

6.Mohan V, Premalatha G, Sastry NG. Peripheral vasculardisease in non-insulin dependent diabetes mellitus in southIndia. Diabetes Research and Clinical Practice 1995;27:235–40.

7.Premalatha G, Shanthirani CS, Deepa R, Markovitz J, MohanV. Prevalence and risk factors of peripheral vascular diseasein selected south Indian population. The Chennai UrbanPopulation Study. Diabetes Care 2000;23:1295–300.

8.Vijay Viswanathan, Sivagami M, Seena R, Snehalatha C,Ramachandran A. Amputation Prevention Initiative in SouthIndia: Positive impact of foot care education. Diabetes Care2005;28:1019–21.

HERBAL MEDICINES ARE NOT WITHOUT ADVERSE EFFECT

HERBAL MEDICINES ARE NOT WITHOUT ADVERSE EFFECT

* M.A.ALEEM -, Assistant Professor of Neurology
* KALAVATHY PONNERIVAN


Editorial: Herbal medicines put into context

* E Ernst

BMJ 2003;327:881-882 doi:10.1136/bmj.327.7420.881 (Published 16 October 2003)


Dept of Neuromedicine KAPV Medical College and AGM Govt hospital Tichy-6200017.TamilNadu India

EDITOR - The editorial by Ernst on herbal medicines put into context1 was heartening. Herbal medicines are the most widely used one in India. According to an all India Ethno-botanical survey conducted by Indian Ministry of Environment [1985-1990], the tribal communities alone have a
More...

EDITOR - The editorial by Ernst on herbal medicines put into context1 was heartening. Herbal medicines are the most widely used one in India. According to an all India Ethno-botanical survey conducted by Indian Ministry of Environment [1985-1990], the tribal communities alone have a knowledge of the use of over 9000 species of plants of which the single major use catagories is tratitional medicine for which over 7500 species are used. The general public has a more positive view about herbal medicine because they are precieved as being natural and safe. In India some area of Tamil Nadu and Kerala have reported over 2000 plants and other resources are used for health care at the house hold level.

Recently many reports have shown that the plant medicines can also have mild to severe adverse health effects. Aristolochia and kava kava are proved to have nephro and hepatotoxicity2. St.Jhon’s wort is proved to have the potential of interaction with various other medicines and which may led to serious adverse effects such as graft rejection and failure to suppress HIV3. Ginko biloba extract have a variety of adverse effects which include headache, diarrohea, vomiting, and hemorhage due to ginkgolids a component of this extract4. Other commenly used herbal medicines that are thought to affect blood clotting include garlic, ginger, ginseng extracts5.

In India many plant medicines used by the traditional healers are not safe. In one of my study about iatrogenic seizures a 26 years old female had treatment for bronchial asthma from a traditional healer with indigenous plant extract probably containing Xanthine alkaloids developed generalized tonic clonic seizures6.

So it is important to realise that the plant medicines contain biologically active ingradiants which may cause adverse effects or they may interact with other conventional drugs.

M.A.ALEEM. Assitant Professor of Neurology, Dept of Neuromedicine KAPV Govt Medical College and AGM. Hospital, Trichy 620017. TAMIL NADU, INDIA. E-Mail: drmaaleem@hotmail.com

KALAVATHY PONNERIVAN, Professor of Biochemistry & DEAN KAPV. Govt Medical College and AGM Hospital, Trichy 620017. TAMIL NADU, INDIA.

Competing Intersts: None declared.

1. Ernst E.Herbal medicines put into context. BMJ 2003;327:381-2.

2. Barnes J, Quality efficacy and safety of Complementary medicines; fashions, facts and future. Part II: effiecncy and safety Br. J clin pharmacol 2003; 55:331-40

3. Ioannides C pharmacokinetic interactions Between herbal remedies and medicinal drugs, Xenobiotica 2002; 32:451-78

4. koltai M, Hosford D, Guinot P et al. platelet activating factors [PAF]. A review of its effects anatagonists and possible future clinical implications (part 1) Drugs 1991;42:9-29

5. Ang Lee MK.Moss J.Yuan C.S. Herbal medicines and perioperative care JAMA 2001; 286:208-16

6. Aleem.M.A Iatrogenic seizures a clinical study from southern india. J Neurol Sci 2001; 187(suppl):s411;

இலவச பன்றிக்காய்ச்சல் தடுப்பு மருந்து திருச்சி அரசு மருத்துவமனையில் வழங்கல்

இலவச பன்றிக்காய்ச்சல் தடுப்பு மருந்து திருச்சி அரசு மருத்துவமனையில் வழங்கல்
பதிவு செய்த நாள் : நவம்பர் 07,2010,04:21 IST

திருச்சி: திருச்சி மாவட்ட அரசு மருத்துவமனையில் பன்றிக்காய்ச்சலுக்கான இலவச சொட்டு மருந்து வழங்குவதை தமிழக அமைச்சர் நேரு துவக்கிவைத்தார். தமிழகத்தில் பன்றிக்காய்ச்சல் பரவுவதை தடுக்க மாநில அரசின் சுகாதாரத்துறை பல்வேறு நடவடிக்கை மேற்கொண்டு வருகிறது. அதன்படி, மாநிலம் முழுவதும் அரசு மருத்துவமனைகளில் பணியாற்றும் டாக்டர்கள், பணியாளர்களுக்கு இலவசமாக பன்றிக்காய்ச்சல் தடுப்பு மருந்து போடப்பட்டது. பொதுமக்கள் சலுகை விலையில் பன்றிக்காய்ச்சல் தடுப்பு மருந்தை தனியாரிடம் வாங்கிக் கொள்ளலாம் என்று அரசால் அறிவிக்கப்பட்டது. இதற்கு கடும் எதிர்ப்பு கிளம்பியது. ஏழை, எளிய மக்களால் பணம் கொடுத்து பன்றிக்காய்ச்சல் தடுப்பூசி வாங்க முடியாது என்பதால், அரசே இலவமாக வழங்கவேண்டும் என்று அனைத்து தரப்பினரிடமிருந்து கோரிக்கை எழுந்தது.



"கலைஞர் காப்பீடு திட்ட அடையாள அட்டை வைத்திருக்கும் அனைவருக்கும் பன்றிக்காய்ச்சல் சொட்டு மருந்து அரசு மருத்துவமனைகளில் போடப்படும்' என்று தமிழக அரசு அறிவித்தது. அதன்படி, திருச்சி மாவட்ட அரசு மருத்துவமனையில் பன்றிக்காய்ச்சல் நோய்க்கான இலவச தடுப்பு சொட்டு மருந்து வழங்குவதுக்கான துவக்கவிழா நேற்று நடந்தது. இதில், போக்குவரத்துத்துறை அமைச்சர் நேரு, டி.ஆர்.ஓ., ராமன், மாநகராட்சி கமிஷனர் பால்சாமி, அரசு மருத்துவக்கல்லூரி டீன் கார்த்திகேயன், துணைமுதல்வர் டாக்டர் அலீம், கண்காணிப்பாளர் பன்னீர்செல்வம், எம்.எல்.ஏ., பெரியசாமி, துணைமேயர் அன்பழகன் உள்ளிட்ட பலர் பங்கேற்றனர். பன்றிக்காய்ச்சல் தடுப்பு சொட்டு மருந்து வழங்குவதை அமைச்சர் நேரு துவக்கிவைத்தார். திருச்சி மாவட்ட அரசு மருத்துவமனையில் நேற்று முதல் பன்றிக்காய்ச்சல் தடுப்பு சொட்டு மருந்து இலவமாக காலை 10 மணி முதல் மதியம் ஒரு மணி வரை வழங்கப்படும். சொட்டு மருந்து வேண்டுவோர் கலைஞர் காப்பீடு திட்ட அடையாள அட்டையுடன் வரவேண்டும். மூன்று வயதுக்கு மேற்பட்ட மற்றும் ஆஸ்துமா, கடும் காய்ச்சல், அலர்ஜி போன்றவை இல்லாதவர்கள் மட்டுமே பன்றிக்காய்ச்சல் தடுப்பு சொட்டு மருந்து போட்டுக் கொள்ளவேண்டும் என்று அறிவுத்தப்பட்டுள்ளது.

தினமலர்

Alien hand syndrome

Neurology India March 2004 Vol 52 Issue 1 109
CMYK 109
Case Report
Xiao-Ping Wang
Dr. Laboratory of Neuro-degenerative diseases, School of Life Science University of Science & Technology of China, Hefei, PR China. 230026.
E-mail: wangxp@mail.hf.ah.cn
Alien hand syndrome: Contradictive movement and disorder of
color discrimination
X. P. Wang,*,** C. B. Fan,*** J. N. Zhou*
*Laboratory of Neuro-degenerative diseases, College of Life Science, University of Science & technology of China, Hefei, PR China;
**Department of Psychology, University of Montreal, Qc. Canada; ***Department of Neurology, Lujiang County Hospital of TCM, Anhui, PR
China.
A senile Chinese female patient with alien hand syndrome
of vascular etiology is reported. This case exhibited contradictive
movement, left-lateral paresis and disorder of color
discrimination, which might be a new subtype of the alien
limb syndrome.
Key Words: Alien hand syndrome, Involuntary movement,
Cerebrovascular diseases, Disorder of color discrimination.
Introduction
Alien limb syndrome or alien limb phenomenon is summarized
as: the patient complains that an arm or leg has a ‘life of
its own’ and is almost always asymmetrical; on examination,
the limb may move and even grasp objects involuntarily; best
assessed by distracting the patient with some other task and
observing the limb; often seen in corticobasal degeneration
(CBD).1-3 It is related with a cluster of symptoms characterized
by the involuntary movement of a single upper limb in
conjunction with the experience of estrangement from or personification
of the movements of the limb itself. However, a
reliable, anatomically derived definition of the alien hand syndrome
has been elusive. A reason for this broadened acceptable
application has been the identification of theoretically
dissociable subtypes.4 We present a case of a specific variety
or subtype of the alien hand syndrome, and discuss its etiology
and possible anatomical reasoning.
Case Report
A 74-year-old right-handed woman suddenly developed left-sided
slight weakness, feeling as if the “left hand was controlled by a ghost”
and sighted a gray wall as having five-six colors on its surface. Nine
weeks after this attack, she became dysphagic and dysarthric. Left
hemi-inattention was also noted. Initial brain CT without contrast
showed probable infarct in the right temporal-parietal-occipital region
involving the cortex and adjacent white matter. Follow-up MRI
in a week post-onset showed chronic ischemic lesion in the right temporal-
parietal-occipital gray and white matter, but callosal involvement
was not seen. She complained often that her left arm “doesn’t
do what its supposed to do. It always is controlled by a ghost or god.”
The nature of the involuntary movement in the left arm was primarily
uncontrolled levitation with intermittent writhing of her fingers.
No exploratory or self-stimulating behavior (grasping skin, clothing)
was ever noted to occur, and she often restrained her left arm
with her right hand. She could not perform bimanual tasks. The
patient had no formal education, had no positive personal or family
history or any mental disorder. There was no history of alcohol or
drug abuse.
Neurological examination revealed that her tongue was turned towards
the left. There were no tremors. The tendon reflexes in all the
four limbs were exaggerated. The patient showed right-left disorientation
and did not exhibit grasp reflex or apraxic symptoms in either
upper limb. The revised Hasegawa’s dementia scale showed her score
as 9, indicating that her intelligence was below normal. The routine
serum biochemical tests were normal. Her spontaneous verbal production
was nearly normal in rate and frequency of utterances, but
she had mild dysarthria. She exhibited pronounced left visual neglect
on line bisection and target cancellation tasks. Proprioception
and kinaesthesia were both severely impaired bilaterally, worse in
the left than the right upper limb. Tactile sensory and proprioceptive
impairment prevented meaningful testing of the patient’s ability to
differentiate between her affected hand and the examiner’s hand
when held out of sight. Stereognosis and tactile object naming were
not possible with the left hand, and were impaired with the right.
After 12 weeks of rehabilitation and the preventive management
of cerebral vascular risks and a small dose of tiapride, the levitation
and complaints of avolitional movement had reduced considerably in
frequency, though visual neglect, slight lower limb weakness, and
hemianesthesia remained. Throughout, the patient seemed perplexed
rather than angered or depressed by her contradictive movement.
Discussion
The alien hand syndrome was originally used to describe
cases involving the anterior part of corpus callosal lesions (splitbrain
person) producing involuntary or contradictive move110
Neurology India March 2004 Vol 52 Issue 1
110 CMYK
ments and a concomitant inability to distinguish the affected
hand from an examiner’s hand when these were placed in the
patient’s unaffected hand.1 Some varieties or subtypes of the
alien hand syndrome have been reported, involving lesions of
the corpus callosum alone, the corpus callosum and the dominant
medial frontal cortex, and the temporal or/and parietal
cortical/sub-cortical areas, and rarely, non-dominant hemisphere
thalamic infarcts.5-7 The pathogenic chart of the alien
hand syndrome has often been found to contain CBD
mainly,3,5,8 it has also been reported in the acute cerebral vascular
diseases,4,9 herpes viral encephalitis(Avrahami-Heller),
Alzheimer’s disease, progressive supranuclear palsy,10
epilepsies11 and Creutzfeldt –Jacob’s disease,12 which have been
seen in Europe, North and South America, and Asia.
Given this patient’s involuntary movements and her verbal
expressions of perplexity and estrangement from the movements,
she clearly manifested the alien hand syndrome as
defined in recent studies. She did not, however, exhibit the
mutism, apathy, exploratory behavior, groping, compulsive
manipulation of objects and tools, or grasp reflex reported in
callosal-frontal cases.1 She likewise exhibited the intermanual
conflict seen in callosal cases and exhibited no signs of callosal
disconnection. Despite the right temporal-parietal-occipital
region abnormalities on MRI, this patient was similar
to the reported cases of the alien hand syndrome associated
with posterior lesions. Such cases have involved multiple loci
of cerebral dysfunction (e.g., cortical and subcortical) caused
by single or multiple infarcts, which perhaps independently,
produced the subjective and behavioral symptoms of the alien
hand syndrome. Two previously reported cases of the alien
hand syndrome involved non-dominant hemisphere thalamic
infarcts in conjunction with additional cortical, sensory impairment.
Cases of posterior alien hand syndrome arising from
corticobasal degeneration may be similarly multi-determinate.
What we should mention is the symptom of the disorder of
color discrimination—our patient sighted gray as five-six
colors, which suggested considerable injuries in her occipital
region and a possible new subtype of alien hand syndrome.
We speculate that our patient’s feelings of estrangement from
her non-dominant upper limb and its movements were produced
by body schema distortion and hemineglect secondary
to the non-dominant, the right temporal-parietal-occipital region
lobe infarct. The fine etiology of her involuntary movement,
however, is not as clear. Another possibility is of basal
ganglia dysfunction. That the involuntary movements are not
specifically associated with any particular, theoretically critical
neuropathology represents a fundamental difference between
posterior alien hand syndrome and the callosal and callosal-
frontal varieties. Remission of the alien hand syndrome
of this type may occur with improvement of either the involuntary
movements, alterations in the body schema, or both.
Our patient’s involuntary movements had largely resolved on
her discharge, whereas her alterations in body schema (visual
neglect, hemianesthesia, and proprioceptive impairment) remained.
It may be reasonable to expect that, given this context,
any future occurrence of sustained involuntary movements
could produce a recurrence of the alien hand syndrome,
or vice versa.
At present, there seem to be some broad clusters of behavioral
and subjective symptoms subsumed under the diagnosis “alien
hand syndrome”. This patient and other examples suggest
that the alien hand syndrome may not only be as closely
associated with focal, critical lesion sites as its callosal and
callosal-frontal counterparts, but also with the temporal-parietal-
occipital region as well as with the single temporal or
single parietal region in the dominant cerebral hemisphere.
Rather, it seems to be a disorder of involuntary movement in
the context of alterations in body schema sufficient to cause
feelings of estrangement from those movements. These symptoms
may occur independently of one another and may occur
from either single or multiple lesions. The alien hand syndrome,
compared to “frozen feet”, a kind of contradictive phenomenon
seen often in Parkinsonism, may also be a symptom
of movement disorder so attention should be drawn to basal
ganglia dysfunction.
References
1. Bakchine S, Slachevsky A, Tourbah A, Serres I, Abdelmounni H. Four “alien” hands
for two hands after a lesion in corpus callosum. Rev Neurol 1999;155:929-34.
2. Aleem MA. Paroxysmal alien hand syndrome. J Assoc Physic Ind 2000;48:1035-6.
3. Wang XP. Corticobasal degeneration. Chin J Pract Inter Med 2000;20:755-7.
4. Bundick T Jr Spinella M. Subjective experience, involuntary movement, and
posterior alien hand syndrome. J Neurol Neurosurg Psychiatr 2000;68:83-5.
5. Carrilho PE, Caramelli P, Cardoso F, Barbosa ER, Buchpiguel CA, Nitrini R.
Involuntary hand levitation associated with parietal damage: another alien hand
syndrome. Arq Neuropsiquiatr 2001;59:521-5.
6. Marti-Fabregas J, Kulisevsky J, Baro E, Mendoza G, Valencia C, Marti-Vilalta
JL. Alien hand sign after a right parietal infarction. Cerebrovasc Dis
2000;10:70-2.
7. Kischka U, Ettlin TM, Lichtenstern L, Riedo C. Alien hand syndrome of the
dominant hand and ideomotor apraxia of the nondominant hand. Eur Neurol
1996;36:39-42.
8. Kompoliti K, Goetz CG, Boeve BF, Maraganore DM, Ahlskog JE, Marsden
CD, et al. Clinical presentation and pharmacological therapy in corticobasal
degeneration. Arch Neurol 1998;55:957-61.
9. Ong Hai BG, Odderson IR. Involuntary masturbation as a manifestation of
stroke-related alien hand syndrome. J Phys Med Rehabil 2000;79:395-8.
10. Gunal DI, Agan K, Aktan S. A case of spontaneous arm levitation in progressive
supranuclear palsy. Neurol Sci 2000;21:405-6.
11. Frattalic M, Grafman J, Patronas N, Makhlouf F, Litvan I. Language distur -
bances in corticobasal degeneration. Neurology. 2000;54:990-2.
12. Colomer Rubio E, Sanchez R oy R, Pareja Martinez A, Perla C, Villarroya T,
Cerda Nicolas M et al. Alien hand syndrome in Creutzfeldt- Jakob disease.
Neurologia 2001;16:223-6.
Accepted on 01.10.2002.
Wang XP, et al: Alien limb syndrome

25,000 people to be administered with swine flu vaccine

25,000 people to be administered with swine flu vaccine
Special Correspondent



Rs. 15 crore sanctioned by the State government, including Rs. 22.95 lakh for Tiruchi district

— Photo: R.M.Rajarathinam.

Precautionary step: Transport Minister K.N. Nehru inaugurating the free swine flu vaccination programme at Annal Gandhi Memorial Government Hospital in Tiruchi .

TIRUCHI: Free swine-flue vaccination will be administered to 25,000 persons in the district at the Annal Gandhi Memorial Government Hospital, said A..Karthikeyan, Dean, K.A.P.Viswanatham Government Medical College.

Speaking to reporters on the sidelines of the inauguration of the swine flu vaccination programme here on Saturday, Dr.Karthikeyan said those who had enrolled for the ‘Dr. Kalaignar Health Insurance Scheme for Life-saving Treatments' scheme alone would be eligible for the free nasal vaccination. The district has been sanctioned 25,000 doses in the first phase. On completion of the administration to the eligible beneficiaries more doses would be supplied as and when needed, Dr. Karthikeyan added.

The vaccination would be administered at Room No. 35 of the Annal Gandhi Memorial Government Hospital here from 10 a.m. to 1 p.m. on all days, including Sundays.

Rs. 15 crore sanctioned

The State government had sanctioned Rs.15 crore for the vaccination programme, including Rs.22.95 lakh for Tiruchi district.

M.A..Aleem, vice-principal of the college, said that all precautions would be taken before administering the vaccines. It would not be administered to infants aged up to 36 months; persons with acute wheezing; pregnant women and lactating mothers.

K.N.Nehru, State Transport Minister, inaugurated the vaccination programme. T.T.Balsamy, Corporation Commissioner; M.Anbazhagan, Deputy Mayor and S.Pannerselvam, Medical Superintendent were among those who were present on the occasion.



The Hindu,Trichy
Online edition of India's National Newspaper
Sunday, Nov 07, 2010

Familial Parkinsonian pyramidal syndrome

Year : 2000 | Volume : 48 | Issue : 3 | Page : 297-8

Familial Parkinsonian pyramidal syndrome.

Rajendran P, Aleem MA, Chandrasekaran R, Raveendran S, Ramasubramanian D


Parkinsonian symptoms may be due to infections, secondary to impaired immunologic mechanisms, head trauma, stress, ageing, genetic mechanism, toxin exposure and other secondary causes like parathyroid abnormalities, hypothyrodism, brain tumour, Wilson's disease, normal pressure hydrocephalus, noncommunicating hydrocephalus, and syringo mesencephalia. Parkinson's disease occuring in the younger age group may be due to Huntington disease and juvenile paralysis agitans described by Ramsay Hunt in 1917. Familial incidence was reported by Golbe 1990. Two cases in the same family presented to us with parkinsonian pyramidal syndromes.
First case : Male aged 25 years, presented with history of progressive difficulty in walking, hypokinesia, slowness of speech and frequent falls. There was no history of exposure to toxin, infection, or drug intake. Examination revealed mask like face, infrequent blinking, tremors of hands, asymmetrical rigidity, with normal eye movements. There was no KF ring and fundus were normal. There was no cranial nerve palsies. There was evidence of bipyramidal signs with brisk reflexes and extensor plantars. Bladder and sensory system were normal. There were no abnormal movements or dystonia. Serum ceruloplasmin was normal. CT scan brain and MRI brain were normal.
Second patient : Female aged 15 years, sister of first case, presented with frequent falls, progressive difficulty in walking and hypokinesia for the past three years. There was no history of fever, jaundice, drug intake or exposure to toxin.
On examination she had all the features of Parkinson's disease. There was no KF ring. Patient had bilateral brisk reflexes and extensor plantars. Serum ceruloplasmin was normal. CT scan brain and MRI were also normal.
Familial PD is clinically indistinguishable from sporadic PD,[1] although a few pairs of monozygotic twins concordant for PD have been documented.[2]
Study in Finland found concordance for PD in 18 pairs of monozygotic siblings.[3] Common experience weighs against Mendelian inheritance as a common cause of idiopathic parkinsonism. However, cases of familial parkinsonism are regularly encountered,[4] leading to the suggestion that genetic factors may be responsible in some cases.[5] It has been noted in several surveys that about 15% of parkinsonian patients have an affected relative. However, a lifetime incidence rate of 2.5% would be sufficient to account for this number by chance alone. Duvoisin found equal prevalence of parkinsonism in the immediate family of patients as in the spouse's family.[6]
Another possible source of underestimation is a difference in age of onset. At the time of the study, not enough time may have elapsed for the symptoms to appear in the co-twin. In the few concordant twin pairs identified, age at onset differed by 6.5 to 10 years. Affected members of a kindred with apparent autosomal dominant parkinsonism ranged in age of onset from 22 to 61 years. The possibility that parkinsonism is caused by environmental factors acting on genetically susceptible individuals is attracting increasing attention.
Genetic factors may contribute to the pathogenesis of Parkinson's disease (PD) by several mechanisms, such as preventing normal development of dopaminergic neurons, delayed programming or accelerated cell death, interfering with normal protective mechanisms. Although heredity alone is probably not the major determinant of PD, genetic susceptibility may play an important role in some or most patients with PD.
These two siblings had features of PD with pyramidal signs. As both patients responded well to L Dopa therapy, and since by investigations and clinical history, no other cause for Parkinson's disease could be made out, these patients may come under the category of Parkinsonian Pyramidal Syndrome[7] occuring in families.


» References Top

1. Maraganore DM, Harding AE, Marsden CD : A clinical and genetic study of familial Parkinson's disease. Mov Disord 1991; 6 : 205-211. Back to cited text no. 1
2. Jankovic and Reaches A : Parkinson's disease in monozygotic twins. Ann Neurol1986; 19 : 405-408. Back to cited text no. 2
3. Martila RJ, Kaprio J, Kostenvuo MD et al : Parkinson's disease in a nation wide twin cohort. Neurology 1988; 38 : 1217-1219. Back to cited text no. 3
4. Golbe LI : The genetics of Parkinson's disease: a reconsideration. Neurology1990; 40 (suppl 3): 7-14. Back to cited text no. 4
5. Johnson WG : Genetic susceptibility to Parkinson's disease. Neurology1991; 41 (suppl 2) : 82-87. Back to cited text no. 5
6. Duvoisin RC : The cause of Parkinson's disease. In: Marsden CD and Fahns (eds), Movement Disorders. London: Butterworth Scientific 1982. Back to cited text no. 6
7. Joseph Jankovic MD : Current understanding of etiology and pathogenesis of Parkinson's Disease. American Academy of Neurology, Annual Courses 1995; 4 : 1271-1272. Back to cited text no. 7


Neurology India

Melanoma secondaries presenting as stroke.

Year : 1999 | Volume : 47 | Issue : 3 | Page : 246-7

Melanoma secondaries presenting as stroke.

Manivannan R, Aleem MA, Rajarathinam A, Rajendran P, Meikandan D, Chandrasekaran M, Raveendran S, Ramasubramanian D


Melanoma accounts for less than 2% of all cancers. Skin and eye are the most commonly affected organs. Melanocytes are derived from neural crest cells during embryonic development and get widely distributed along the cranio-spinal axis. Malignant melanomas most often present as secondary deposits arising from a primary lesion elsewhere in the body. In 1992, the International Agency for Research on Cancer, in a comprehensive review concluded `there was sufficient evidence in humans for the carcinogenicity of solar radiation, which can causes cutaneous melanoma'. Risk factors for childhood melanoma are include a gaint congenital melanocytic naevus, atypical (dysplastic) mole syndrome, xeroderma pigmentosum and immunodeficiency state.

A 26 year old male was admitted with acute onset of right hemiplegia without aphasia in March 1997 at Govt. Rajaji Hospital, Madurai. Patient was a known case of xeroderma pigmentosum since childhood. He developed gradually increasing nodular swelling over the left shoulder joint, and was diagnosed as cutaneous malignant melanoma on excision biopsy. He developed headache and vomiting, after one month, followed by sudden onset right hemiplegia with facial paresis but without aphasia. CT scan of brain showed a hypodense lesion in temporoparietal region with surrounding oedema. MRI showed a similar lesion over left temporo parietal region with surrounding oedema on T2W images [Figure 1]. The tumour was partially removed through left temporo parietal craniotomy. Histology confirmed it to be malignant melanoma. The patient was then subjected to chemotherapy and radiotherapy.

Melanoma is the third common metastasis to involve the brain after lung and breast carcinoma. Presentation is usually due to increased intra cranial pressure with headache being the primary symptoms in 45-50%, seizure in 15-22%, motor disturbance in 15% and a cerebral catastrophie in 24% of cases.[1],[2] The median interval between diagnosis of cutaneous disease and CNS involvement has variably been reported as 29 months to 42 months.[3],[4] Frontal and parietal lobes are affected most frequently. The lesions are commonly subcoritcal in location and require advanced technique of intra operative localisation. lntra cranial melanoma must be suspected if a patient with extensive pigmentation of skin or a giant pigmented naevus develops signs of an intra cranial lesion.


» References Top

1. Balasubramaniam V. Ramamurthi B : Melanoma of meninges. Neuorl India 1964; 12 : 15-17. Back to cited text no. 1
2. Bullard DE, Cox E8, Seiglar HF : Central nervous system metastasis in malignant melanoma. Neurosurgery 1981; 8 : 26-30. Back to cited text no. 2
3. Crisp DE, Thompson IA : Primary malignant melanomatosis of the meninges. Arch Neurol 1981; 38 : 528-529. Back to cited text no. 3
4. Deshpande DH, Dastur HM, Pandya SK: Primary melanoma of leptomeninges. Neurol India 1970; 12 : 15-17. Back to cited text no. 4



Neurology India

Humanitarian Doctor Award to Dr.M.A.Aleem by An Islamic foundation at Trichy

Humanitarian Doctor Award to Dr.M.A.Aleem by An Islamic foundation at Trichy

HEALTH EFFECTS OF FIREWORKS AND CRACKERS AND SAFETY TIPS OF BURSTING OF CRACKERS

HEALTH EFFECTS OF FIREWORKS AND CRACKERS AND

SAFETY TIPS OF BURSTING OF CRACKERS

Prof.Dr.M.A.Aleem, M.D.,D.M(Neuro)

HOD & Professor of Neurology

KAPV Govt. Medical College

Visiting consultant Neurologist at ABC Hospital

Trichy

INTRODUCTION

In India, Diwali is known as one of the most famous festivals. On the occasion of this festival, people burn crackers and sparkles to express their happiness. The burning of these fireworks leads to metal pollution in air. Metal concentrations in ambient air were observed to be very high as compared to background values on previous days. For some metals the concentrations were observed to be higher than reported at industrial sites.

Bursting crackers and zooming rockets in the sky may be a wonderful sight but hazardous to nature, animals and human beings. The loud noise of the crackers and a heavy shower of metals and chemicals from the explosions are worth keeping in mind.

Globally, the fireworks industry is estimated to be around Rs 10,000 crore. The Chinese share is around Rs 3,000 crore, whereas India's share is very minuscule. Indian units export just sparklers.

There are more than Rs 700-crore fireworks industry in Sivakasi that houses 85 per cent of the total fireworks production capacity in the country. The 30-sq km radius around the small town generates business worth Rs 3,000 crore from three industries - printing, fireworks and matches.

 The pyrotechnic units in this small town carries out production activities for 11 months and sells the fireworks for one month which in turn is used up by consumers in just one day (at least 90 per cent of the production).

Sivakasi Fireworks Industries produces around 135 varieties using around six chemicals (aluminium and magnesium powder; potassium, strontium, barium nitrates; potassium chlorate; red phosphorous; zinc oxide; sulphur) as inputs. But it is the aluminium powder that is largely consumed.

Classifications:

Fireworks and crackers could be classified into four categories - noise (crackers), motion (rockets), display (flowerpots) and varieties that combine all these three. Currently, the ratio of colour fireworks:noise crackers is 60:40 and this is expected to change to 80:20.In addition, we are confident that our crackers will meet the noise-level restriction of 125 decibel levels at 4-metre distance.

HARMFUL EFFECTS OF FIREWORKS AND CRACKERS

The fireworks and crackers has gone out of hand nowadays with firework and crackers becoming a health hazard to senior citizens, children, infants, adult  and asthmatics.

Health Effects due to crackers:

1. The level of suspended particles in the air increases alarmingly during Diwali, causing eye, throat and nose problems. Although most of us do not feel the immediate impact, these problems can later develop into serious health hazards.

2. Suspended particulate matter (SPM) exposure to the level of 100 ppm results in headache and reduced mental acuity. The effects are more pronounced in people with heart, lung or central nervous system diseases. Sulphur dioxide is readily soluble and dissolves in the larger airways of the respiratory system. This stimulates a contraction at 2 to 5 parts per million (ppm). At higher concentrations severe contraction restricts the breathing process.

3. Nitrogen dioxide is less soluble and so penetrates to the smaller airways and into the lungs. They destroy the linings of the respiratory surface, thereby reducing the intake of oxygen for the body. These cause respiratory allergies like asthma especially to the susceptible population.

4.Causes throat and chest congestion, and are likely to aggravate problems for those already suffering from coughs, colds and allergies.

5. High decibel level results in restlessness, anger, fidgetiness, impulsive behaviour and over-reaction to situations. Most crackers used have more than 80 dB noise that can cause temporary hearing loss.

6. Scientific data to suggests that noise pollution can cause leads to hearing loss, high blood pressure, heart attack and sleep disturbances. Normal decibel level for humans is 60 dB. An increase by 10 decibels means double the noise volume and intensity.

7. Children, pregnant women and those suffering from respiratory problems suffer the most due to excessive noise. It results in making them hyperactive or withdrawn.

8. Allergic bronchitis, acute exacerbation of bronchial asthma, chronic bronchitis, ephysema, COPD (chronic obstructive pulmonary diseases), allergic rhinitis, laryngitis, ssinusitis, pneumonia and common cold increase durinf this times.The number of his patients doubles during Diwali. The firework is one of the provoking factors for childhood bronchial asthma that there is threat of exposure even from the unburnt material. These particles are very small (1 to 5 microns in size) and contain metals along with carbon.

Chemicals used in crackers and their harmful effects :

•    Lead : Affects the central nervous system in humans. When heated it can emit highly toxic fumes.    Young children can suffer mental retardation and semi-permanent brain damage by exposure to lead.

•    Magnesium : Inhalation of magnesium dust and fumes can cause metal fume fever. Particles  embedded in the skin produce gaseous blebs and gas gangrene. Dangerous fire hazard in the form of dust or flakes when exposed to flames. Poisoning takes the form of progressive deterioration in the central nervous system.

•    Zinc : Pure zinc powder is non-toxic to humans by inhalation but difficulty arises from oxidation (burning), as it emits zinc fumes. It stimulates the sensation of vomiting.

•    Manganese : Toxicity caused by dust or fumes. The main symptoms of exposure are languor, sleepiness, weakness, emotional disturbances, spastic gait and paralysis.

•    Sodium : When heated in air, it emits toxic fumes of sodium oxide. Can cause dangerous fire hazard when exposed to heat and moisture.

•    Potassium : Dangerous fire hazard and explosion can occur.

•    Copper : Inhalation of copper dust and fume causes irritation in the respiratory tract. Absorption of excess copper results in "Wilson's disease" in which excess copper is deposited in the brain, skin, liver, pancreas and the myocardium (middle muscular layer in the heart).

•    Cadmium : Its absorption can damage the kidneys and can  cause anaemia. Cadmium causes

increased blood pressure and also a disease called "Itai-Itai", which makes bones brittle resulting in multiple fractures.

•    Phosphorous in the form of PO4 : Dangerous fire hazard when exposed to heat or chemical reaction. Poison by inhalation, ingestion, skin contact and subcutaneous routes. Ingestion affects the central nervous system. Toxic quantities have an acute effect on the liver and can cause severe eye damage.

•    Sulphur in the form of SO4 : It affects the upper respiratory tract and the bronchi. It may cause edema of the lungs or glottis, and can produce respiratory paralysis. Poison to humans by inhalation. An eye, skin and mucous membrane irritant and corrosive.

•    Nitrate : Highly inflammable and on decomposition they emit highly toxic fumes. The symptoms are dizziness, abdominal cramps, vomiting, bloody diarrhea, weakness, convulsions and collapse.

•    Nitrite : Large amounts taken by mouth may produce nausea, vomiting, cyanosis, collapse and coma. Repeated small doses can cause a fall in blood pressure, rapid pulse, headaches and visual disturbances. When heated, emit highly toxic fumes of NOx.

Noise Pollution caused by Fire Crackers:

Crackers that make a noise of more than 125 decibels at four metres distance from the point of bursting are banned by the law. Given here are the hazards posed by excessive noise pollution caused by crackers:

1.      Hearing loss, high blood pressure, heart attack and sleeping disturbances.

2. Sudden exposure to loud noise could cause temporary deafness or permanent relative        deafness.

Noise maths:

Is the noise contributed by two crackers going off at the same split second enormous? Fireworks industry officials say the total sound level increases by just 3 decibels. Which means 110 dB+110dB = 113dB.

If the noise difference between two crackers is more than 10 decibels, the lesser noise is not heard at all. That is, 110dB+99dB = 110dB.

Sound effects :

Normal decibel level for humans is 60 dB. An increase by 10 decibels means double the noise volume and intensity. High decibel level results in restlessness, anger, fidgetiness, impulsive behaviour and over-reaction to situations. Most crackers used have more than 80 dB noise that can cause temporary hearing loss. Noise pollution can cause hearing loss, high blood pressure, heart attack and sleep disturbances.

Environmental pollution effects :

(a)    The level of suspended particles in the air increases alarmingly during Diwali, causing eye, throat and nose problems.

(b)    Suspended particulate matter exposure to the level of 100 ppm results in headache and reduced mental acuity. The effects are more pronounced in people with heart, lung or central nervous system diseases.

(c)    Sulphur dioxide is readily soluble and dissolves in the larger airways of the respiratory system. At higher concentrations severe contraction restricts the breathing process.

(d)    Nitrogen dioxide is less soluble and so penetrates to the smaller airways and into the lungs, thereby reducing the intake of oxygen for the body. These cause respiratory allergies like asthma especially to the susceptible population. It causes throat and chest congestion, and are likely to aggravate problems for those already suffering from coughs, colds and allergies.

(e)    Allergic bronchitis, acute exacerbation of bronchial asthma, chronic bronchitis, ephysema, COPD (chronic obstructive pulmonary diseases), allergic rhinitis, larynigitis, sinusitis, pneumonia and common cold increase during this time. Firework is one of the provoking factors for childhood bronchial asthma.

Diwali which has now turned almost to a festival of firing crackers leads to many people getting, many people lose their eyes, some become deaf, animals like dogs and cows don't get place to hide and protect themselves. But still this process is going on. Even a small country like Nepal has banned the use of firecrackers. But, can't we?  A combination of will and public support to limit health and environmental hazards and at the same time maintain memorable traditions, is needed to restore Deepawali to its pristine flavour.

CONCLUSION

The conflict between competing interests in society - safety, health, and calm on the one hand, and tradition on the other hand, has evolved over time, and the health effects are receiving greater attention.

A simple restriction on the cracker size and its chemical content is a better way of noise control. The Department of Explosives has offered to the Supreme Court that it will experiment with various firecrackers and evolve prescriptions on the desired size and chemical content for each variety of firecrackers so that the noise level is retained below 125 decibel.

To ban fireworks is not a practical solution. What is needed is an eco-friendly product — a firework that can produce light and sound, but not cause any harm to the person or the environment. This is not an impossible demand to meet.

Some US-based companies have already started to produce eco-friendly fireworks. One US company Chemical and Engineering Newshas shifted to nitrogen based fuels instead of carbon-based ones to produce clean fireworks. In addition, these improved fireworks consume only one tenth of barium quantity for producing colours. This considerably cuts down the release of small particles, produces less smoke and makes the firework environment friendly.

To avoid health hazards due to fireworks and crackers to some extent, the following points are to be noted.

1.                  Noise production limit in decibels can be noted in packs.

2.                  Chemical composition can be listed in the packs.

3.                  Specific instruction to children, adult, pregnant women and patients with asthma are to be noted in the packs.

4.                  Fireworks and crackers not only produces health hazards in users but also in people those who are working in their production. So in fireworks and crackers factory child labour should not be allowed to work.

DO AND DON’T’S  IN FIREWORKS AND CRACKERS USAGE

Do’s while bursting crackers:

• Use fireworks only outdoor.
• Buy fireworks of authorized/reputed manufacturers only.
• Light only one firework at a time, by one person. Others should watch from a safe distance.
• Keep the fireworks to be used at a safer place.
• Organize a community display of fireworks rather than individuals handling crackers.
• Always use a long candle/'phooljhari' for igniting fire crackers and keep elbow joint straight to increase the distance between the body and the crackers.
• Keep two buckets of water handy. In the event of fire, extinguish flame by pouring water from the buckets. Every major fire is small when it starts.
• In case of burns, pour large quantity of water on the burnt area.
• In case of major burns, after extinguishing the fire, remove all smoldering clothes. Wrap the victim in a clean bedsheet.
• The patient should be taken to a burns specialist or a major hospital. Don't panicky.
• In case of eye burns, wash the eye with tap water for 10 minutes and take the victim to a hospital.

Don'ts while bursting crackers:

• Don't ignite fireworks while holding them.
• Don't bend over the fireworks being ignited.
• Don't ignite fireworks in any container.
• Don't approach immediately to the misfired fireworks.
• Don't tamper with misfired fireworks.
• Don't attempt to make fireworks at home.
• Don't allow small children to handle fireworks.
• Don't throw or point fireworks at other people.
• Don't carry fireworks in the pocket.
• Don't store firecrackers near burning candles and diyas.
• Don't light firecrackers in narrow by lanes; preferably use open areas and parks.
• Don't wear synthetic clothing; preferably wear thick cotton clothing.
• Don't wear loosely hanging clothes; secure all clothes properly.
• Don't apply any cream or ointment or oil on burnt area.
• Don't drive recklessly while taking a burn victim to the hospital; a delay of up to one hour is immaterial.

Diwali Safety Measures:

Fireworks are the important things in joyful Diwali or Deepavali. No one can imagine a Diwali without crackers. As crackers are important on Diwali, the safety measures are also important to make the festival safest and happiest. There is a list of Do’s and Don’ts which make your Diwali sparkling.

Store Crackers Safely:
Keep the crackers in a closed box, out of reach of children and animals. Keep them away from all the sources of heat.

Wear Cotton Clothes:
Don’t wear loose clothes which can catch fire easily. Long dresses are also unsafe. Wearing cotton clothes prevents you from fire.

Light one at a time:
Light one cracker at a time. Lighting more than one cracker at a time may confuse you and there is a possibility for an unfortunate incident.

Keep Children Away:
When you light the crackers, keep the children away. Make sure that when children light the crackers, even one adult is there with them.

Safegaurd Your Ears: Hearing the constant sound of crackers above 85 dB may harm your inner ear. Make sure that you give yourself a break every 15 minutes. Wear cotton swabs in your ears for safety.

In unavoidable cases wear noise control devices such as noise attenuators or noise cancelling headphones and mufflers to safegaurd yourself from hazardous sounds.

STRIKE - OUT STROKE CHALLENGE

Prof. Dr. M A. Aleem, M.D.D.M. (Neuro)

HOD & Professor of Neurology,

Dept. of Neurology,

KAPV Govt Medical College, AGM Govt. Hospital, Trichy – 620018, T.N. India.

Cell 94431 – 59940, 99442-41270.

Every six seconds, regardless of age or gender – someone somewhere will die from stroke.
This, however, is more than a public health statistic. These are people, who at one time, were someone’s sister, brother, wife, husband, daughter, son, partner, mother, father… friend. They did exist and were loved. Behind the numbers are real lives. The World Stroke Organization (WSO) is calling for urgent action to address the silent stroke epidemic by launching the “One in Six” campaign on World Stroke Day, 29 October.
The objective of the campaign is to put the fight against stroke front and center on the global health agenda. The “One in Six” theme was selected by leaders of the WSO to highlight the fact that in today’s world, one in six people worldwide will have a stroke in their lifetime. Everyone is at risk and the situation could worsen with complacency and inaction.
The “One in Six” campaign celebrates the fact that not only can stroke be prevented, but that stroke survivors can fully recover and regain their quality of life with the appropriate long-term care and support. The two-year campaign aims to reduce the burden of stroke by acting on six easy challenges:
1. Know your personal risk factors: high blood pressure, diabetes, and high blood cholesterol.
2. Be physically active and exercise regularly.
3. Avoid obesity by keeping to a healthy diet.
4. Limit alcohol consumption.
5. Avoid cigarette smoke. If you smoke, seek help to stop now.
6. Learn to recognize the warning signs of a stroke and how to take action.
Stroke is the second leading cause of death for people above the age of 60, and the fifth leading cause in people aged 15 to 59. Stroke also attacks children, including newborns.  Each year, nearly six million people die from stroke. In fact, stroke is responsible for more deaths every year than those attributed to AIDS, tuberculosis and malaria put together – three diseases which have set the benchmark for successful public health advocacy, capturing the attention of the world’s media and which consequently has provoked world leaders, governments and many sectors of civil society to act.
Stroke is indiscriminate and does not respect borders. Individual countries cannot address the challenges of stroke in isolation. World Stroke Day brings together advocacy groups, patient survivor support networks, volunteer stroke societies, public health authorities, physicians, nurses and others within the allied health professions including civil society at-large, for a collaborative approach to comprehensive stroke education, advocacy, prevention, treatment and long-term care and support for stroke survivors.

The facts behind “1 in 6” campaign

The theme of the 2010 campaign is "1 in 6". The reason behind this is to emphasize how widespread stroke is. Not many people are aware of this fact. One in six people in the world will suffer a stroke in their lifetime;

·        The lifetime risk of stroke is 1 in 5 for women, 1 in 6 for men:

• Every two seconds, someone in the world suffers a stroke
• Every six seconds, someone dies of a stroke
• Every six seconds, someone’s quality of life will forever be changed – they will permanently be physically disabled due to stroke

Facts and Figures 

Question:
Is it true that stroke is responsible for nearly six million deaths every year?

Answer:
Yes, it is. According to the World Health Organization and other leading stroke experts, stroke claims 5.8 million lives each year.
Question:
Is it true that stroke kills more people each year than AIDS, tuberculosis and malaria put together?
Answer: 
Yes, it is. (1) In 2008, AIDS-related deaths totaled 2.0 million (1.7 million – 2.4 million); (2) 1.8 million people died from TB in 2008, including 500,000 people with HIV; (3) there were 247 million cases of malaria in 2006, causing nearly one million deaths, mostly among African children.
According to the World Health Organization and other leading stroke experts, stroke claims 5.8 million lives each year.
Question:
Is it true that stroke also attacks children?
Answer:
Yes, it is.  Stroke also attacks children, including newborns. Visit WSO member organization websites below for more information:
Question:
Is it true that most strokes are not painful?
Answer:
Yes it is.  Most strokes are not painful. Eighty percent of strokes are caused by a blood clot in the brain and usually do not hurt, although some do. Stroke cuts off oxygen to a part of the brain.  Brain cells begin to die but this is usually not painful. Don’t ignore symptoms because they don’t hurt. Only 20% of strokes are caused by bleeding inside the brain, and this type of stroke is usually very painful. 
Question:
Is it true that on a global scale, stroke claims a life every six seconds?
Answer:
Yes, it is. Worldwide, it is estimated that six people die from a stroke every 60 seconds.
Question:
Is it true that every two seconds, someone, somewhere in the world is having a stroke?
Answer: 
Yes it is. There an estimated 30 incidences of stroke per 60 seconds worldwide. Majority are referred to as "silent" strokes. These are the most common type of strokes. The word "silent" is a misnomer. When subjects with "silent" infarcts are examined they have subtle neuropsychological and neurological deficits. An article from the Framingham Study suggests that 1 in 10 individuals, stroke free and living in the community, with a mean age of 62±9 years have a "silent" stroke. If ignored, little strokes could spell big trouble. One subclinical stroke is associated with increased chance of having others and of experiencing a clinical stroke and/or dementia. The combination of subclinical strokes and subclinical Alzheimer lesions may be a background for the association of stroke and dementia given that the lifetime risk of developing either or both is one in three.

Question:
Is it true that 80% of all people who have suffered from a stroke now live in low and mid-income countries?

Answer: 
Yes, it is. The burden of stroke now disproportionately affects individuals living in resource-poor countries. From 2000 to 2008, the overall stroke incidence rates in low to middle income countries, exceeded that of high-income countries, by 20%.
Question:
Is it true that the incidence of stroke is growing and that a disproportionate burden is unfolding in resource-constrained countries where awareness of prevention, care and support is lowest?
Answer:
Yes it is. Today, two-thirds of all individuals that have suffered from a stroke live in developing countries where health systems are already challenged to the limit.
Question:
Is it true that stroke is the second leading cause of death for people above the age of 60 years?
Answer:
Yes, it is. According to the World Health Organization (WHO), stroke is the leading cause of death for people above the age of 60 and the fifth leading cause in people aged 15-59. 
Question:
Is it true that most people do not recognize the first symptoms presented by stroke?
Answer:
Correct. Approximately 70% of patients do not correctly recognize their TIA or minor stroke, 30% delay seeking medical attention for >24 hours, regardless of age, sex, social class, or educational level, and approximately 30% of early recurrent strokes occur before seeking attention. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized.
Question:
Is it true that high blood pressure is the leading risk factor for stroke?
Answer:
Yes, it is. It is very important to find out if you are at risk for high blood pressure, diabetes or high blood cholesterol.
Question:
Is it true that stroke is a leading cause of disability worldwide?

Answer:
Yes, it is. Stroke is a leading cause of disability worldwide. 

Join the “One in Six” campaign.  Tell six other people to take this “strike-out stroke” challenge.

Stroke – Indian Scenario

India is silently witnessing a stroke epidemic Stroke is a Non-communicable disease of increasing socioeconomic importance in ageing populations. According to WHO, stroke was the second commonest cause of worldwide mortality in 1990 and, the third commonest cause of mortality in more developed countries; it was responsible for about 4·4 million deaths worldwide. In the recent estimates made in 1999, the number of deaths due to stroke reached 5·54 million worldwide, with two-thirds of these deaths occurring in less developed countries. Stroke is also a major cause of long-term disability and, has potentially enormous emotional and socioeconomic consequences for patients, their families, and health services. The case-fatality rate due to stroke is reported to vary varies from 11.7% to 32.4%.

In 2005, estimates indicated that 58 million people died, and in them chronic diseases accounted for 35 million deaths (60%). Cardiovascular diseases, predominantly heart disease and stroke, were the cause of death in 17·5 million individuals. After heart disease, Stroke is the second leading single cause of death, with 5·8 million fatal cases per year, 40% of which are in people younger than 70 years. About 15 million new acute stroke events arise every year, and about 55 million people have had a stroke at some time in the past, either with or without residual disability; two-thirds of these individuals live in low income and middle-income countries. Demographic changes, urbanization, and increased exposure to major stroke risk factors will fuel the stroke burden in the future. By 2025, four out of five stroke events will occur in people living in these regions.

The prevalence of stroke in India varies in different regions of the country and, ranges from 40 to 270 per 100 000 population. Approximately 12% of all strokes occur in the population <40 years of age. Major risk factors identified in India are hypertension (blood pressure >95 mm Hg diastolic), hyperglycemia, tobacco use, and low hemoglobin levels (<10 gm %). Stroke accounts for 2 percent of hospital registrations, 1.5 percent of medical registrations and 9 to 30 percent of neurological admissions in major hospitals. The National Commission on Macroeconomics and Health has projected that cases of stroke would increase from 1,081,480 in 2000 to 1,667,372 in 2015. The ICMR study on Burden of Disease (2005) has 1

estimated that there has been an increase in the number of stroke cases in India during the last one and a half decades by 17.5 %. Mortality due to strokes has increased by 7.8% from 1998 to 2004.

Prevention and Control of Cardiovascular diseases, Diabetes and Stroke in Tamil Nadu.

Tamil Nadu has incorporated this component into its recently launched state wide health systems project, which is supported by the World Bank. The need for multi component interventions, affecting several behaviors would be necessary for designing programs related to chronic diseases.

Stroke is a major public health problem. According to World Health Organization (WHO), stroke has caused about 5.54 million deaths worldwide in 1999 with two-thirds of these deaths occurring in less developed countries. Stroke is also the most common neurological condition causing long-term disability and has enormous emotional and socioeconomic consequences in patients, their families and health services. The latest available estimates from Indian Council of Medical Research (ICMR) indicate that in 2004 there were 930,985 cases of stroke in India with 639,455 deaths and 6.4 million disability adjusted life years (DALY) lost.

In India the incidence of stroke is likely to rise in the coming years due to:

1. increase in population
2. increase in life expectancy
3. rapid urbanization from migration of villagers to the cities
4. changing lifestyles involving sedentary habits, smoking, excess alcohol use, etc.
5. rising stress level in life

According to the estimates by the National Commission on Macroeconomics and Health, India, there will be 1.67 million stroke cases in India in 2015

Stroke – FAQs

What is a stroke?

A stroke occurs when a blood vessel (artery) that supplies blood to the brain bursts or is blocked by a blood clot. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours. As a result, the part of the body controlled by the damaged section of the brain cannot function properly.

If you have symptoms of a stroke, you need emergency care, just as though you are having a heart attack. If medical treatment begins soon after symptoms are noticed, fewer brain cells may be permanently damaged.

What causes a stroke?

• An ischemic stroke is caused by a reduction in blood flow to the brain. This can be caused by a blockage or narrowing in an artery that supplies blood to the brain or when the blood flow is reduced because of a heart or other condition.
• A hemorrhagic stroke develops when an artery in the brain leaks or bursts and causes bleeding inside the brain tissue or near the surface of the brain.

Before having a stroke, you may have one or more transient ischemic attacks (TIAs), which are warning signals that a stroke may soon occur. TIAs are often called mini-strokes because their symptoms are similar to those of a stroke. However, unlike stroke symptoms, TIA symptoms usually disappear within 10 to 20 minutes, although they may last up to 24 hours.

What are the symptoms?

Symptoms of a stroke begin suddenly and may include:

• Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.
• Vision problems in one or both eyes, such as double vision or loss of vision.
• Confusion, trouble speaking or understanding.
• Trouble walking, dizziness, loss of balance or coordination.
• Severe headache.

How is a stroke diagnosed?

Time is critical in diagnosing and treating a stroke. The first step will be a physical exam and tests of your brain function, followed by a type of X-ray called a CT scan of the brain to establish the type of stroke-ischemic or hemorrhagic. This distinction is critical because the medicine given for an ischemic stroke (tissue plasminogen activator, or t-PA) could be life-threatening if given to someone with a hemorrhagic stroke (bleeding in the brain). A prompt diagnosis is also crucial because t-PA should be given within 3 hours of when your symptoms began.

How is it treated?

Ischemic stroke: Doctors will first stabilize your condition and try to restore or improve blood flow to the brain. If less than 3 hours have passed since your symptoms began, tissue plasminogen activator (t-PA), a clot-dissolving medicine, may be given. Research shows that the medicine can improve recovery from a stroke, especially if given within 90 minutes of your first symptoms.1

Hemorrhagic stroke: Treatment for a hemorrhagic stroke is difficult. It includes monitoring and controlling bleeding and pressure in the brain and other efforts to stabilize vital signs, especially blood pressure.

After your initial emergency treatment, health professionals will focus on preventing complications such as pneumonia and future strokes. Your health professional will also involve you in a stroke rehabilitation program as soon as possible.

Can I prevent a stroke?

You can help prevent a stroke by eliminating risk factors.

You may lower your risk of stroke if you can control certain diseases or conditions. These include:

• High blood pressure (hypertension). High blood pressure is the second most important stroke risk factor after age.
• Diabetes. Having diabetes doubles your risk for stroke because of the circulation problems associated with the disease.2
• High cholesterol. High cholesterol can lead to hardening of your arteries (atherosclerosis). Hardening of the arteries can cause coronary artery disease and heart attack, which can damage the heart muscle and increase your risk of stroke.
• Other heart conditions, such as atrial fibrillation, endocarditis, heart valve conditions, or cardiomyopathy.

You also can make lifestyle changes that may help you lower your risk of stroke. These include:

• Quitting smoking. Daily cigarette smoking can increase the risk of stroke 2½ times.
• Becoming more active. Physical activity reduces the risk of stroke.
• Eating a nutritious diet. Having more fruits, vegetables, fish, and whole grains (for example, brown rice) in your diet may help lower your risk of stroke and other diseases.

Some risk factors, however, can't be changed. Risk factors that you cannot change include:

• Age. The risk for stroke increases with age. Most strokes occur in people older than 65.2
• Race. African Americans, Native Americans, and Alaskan Natives have a higher risk than people of other races.
• Gender. Stroke is more common in men than women. However, at older ages, more women than men have strokes. At all ages, more women than men die of stroke.
• Family history. The risk for stroke is greater if a parent, brother, or sister has had a stroke or transient ischemic attack (TIA).

Prior history of stroke or TIA. About 14% of people who have a stroke have another stroke within 1 year.

Prof. Dr. M A. Aleem, M.D.D.M. (Neuro)

HOD & Professor of Neurology

Dept. of Neurology