Saturday, February 18, 2017

Pharma Opiods Abuse In India. Aleem. M . A. Hakkim.A.M. BMJ 2017;356:j715



War on Drugs

US surgeon general: doctors have central role in solving opioid epidemic

BMJ 2017; 356 doi: (Published 15 February 2017)

Cite this as: BMJ 2017;356:j715

Rapid response

Re: US surgeon general: doctors have central role in solving opioid epidemic

Pharma Opiods Abuse In India

Pharmaceutical opioids are semi-synthetic medications that derive from the active opiate alkaloids found in the opium poppy. In various formulations, they are advised to relieve pain. They reduce the intensity of pain signals and are capable of producing positive, reinforcing effects in the user as heroin.

At a neurological level, pharmaceutical opioids work to supress the pain signals from the body, but the ensuing psychological effects—like euphoria and extreme relaxation—serve as the primary building blocks for the development of abuse and addiction. The summation of these effects prove intensely rewarding to those abusing them—eliciting persistent alterations in brain chemistry that may further compel an individual to use the drug, time and again.

Among pharma opioids are buprenorphine, pentazocine dextropropyxyphyne and cough syrups like Corex and Benadryl are used because of over the counter sales in developing and in underdeveloped countries.

Most of the times these agents are used as cocktails in various routes of admistrations with or without alcohol in India.

If a person begins using opioids for medical reasons, it is more likely that a dependency will develop first, potentially escalating into abuse behaviors. On the illicit market, abuse is generally the starting point for dependency. No matter how you cut it, opioid misuse is a dangerous habit with far-reaching consequences.

Competing interests: No competing interests

17 February 2017

M A Aleem


A M Hakkim

ABC Hospital.

Annamalainagar, Trichy 620018, Tamilnadu, India


Friday, February 17, 2017

At Dhanalakshmi Srinivasan Medical College & Hospital Siruvachur Perambalur , Cath Lab, Cardio Thoracic Unit and Super Speciality Wing was Inaugurated on 17.2.2017.

At Dhanalakshmi Srinivasan Medical College & Hospital Siruvachur Perambalur , Cath Lab, Cardio Thoracic Unit and Super Speciality Wing was Inaugurated  on 17.2.2017.

Shri K . Nanthakumar IAS District Collector Perambalur participated as the chief Guest .

Shri . A. Srinivasan Founder-Chairman of Dhanalakshmi Srinivasan Group of Institutions presided the function .

Monday, February 13, 2017

3rd International Epilepsy Day 13.2.2017

2017 Revised Classification of Seizures

The International League Against Epilepsy (ILAE) is the world's main scientific body devoted to the study of epilepsy, and it has recently revised its classification of seizures. The changes will help make diagnosing and classifying seizures more accurate and easier.
In this article, you’ll find the new general outline of basic seizure classification. An expanded view of seizure classification has also been developed and will be updated on in the coming weeks
People with epilepsy have recurring seizures that often occur spontaneously and without warning. The official definition of a seizure is "a transient occurrence of signs and/or symptoms due to an abnormal excessive or synchronous neuronal activity in the brain."
This means that during a seizure, large numbers of brain cells are activated abnormally at the same time. It is like an "electrical storm" in the brain.
The nature of the seizures depends on many factors, such as the person’s age, the sleep-wake cycle, prior injuries to the brain, genetic tendencies, medications, which circuits in the brain are involved, and many others.
Separating seizures into different types helps guide further testing, treatment, and prognosis or outlook. Using a common language for seizure classification also makes it easier to communicate among clinicians caring for people with epilepsy and doing research on epilepsy. The classification also provides common words for people with epilepsy and the general public to describe their seizures.
History of Seizure Classification
For decades, the most common words to describe seizures were grand mal and petit mal. Although the medical meaning of these terms was fairly precise, some people often used them loosely when referring to any big or little seizure.
For over 35 years, the terms partial and generalized seizures were used to describe types of seizures. This system divided seizures into partial (seizures starting in one area or side of the brain) and generalized (seizures starting in both sides of the brain at the same time).
Partial seizures were then defined by whether a person was aware or conscious during the seizure.
Simple partial seizures: Person is aware of what happens during the event.
Complex partial seizures: Person has some impaired awareness during the seizure. They may be confused, partially aware, or not aware of anything during a seizure.
The old classifications worked for many years but did not capture many types of seizures. This new version will hopefully be more complete.
The New Basic Classification
The basic classification is a simple version of the major categories of seizures. The new basic seizure classification is based on 3 key features.
Where seizures begin in the brain
Level of awareness during a seizure
Other features of seizures
Defining Where Seizures Begin
The first step is to separate seizures by how they begin in the brain. The type of seizure onset is important because it affects choice of seizure medication, possibilities for epilepsy surgery, outlook, and possible causes.
Focal seizures: Previously called partial seizures, these start in an area or network of cells on one side of the brain.
Generalized seizures: Previously called primary generalized, these engage or involve networks on both sides of the brain at the onset.
Unknown onset: If the onset of a seizure is not known, the seizure falls into the unknown onset category. Later on, the seizures type can be changed if the beginning of a person’s seizures becomes clear.
Focal to bilateral seizure: A seizure that starts in one side or part of the brain and spreads to both sides has been called a secondary generalized seizures. Now the term generalized refers only to the start of a seizure. The new term for secondary generalized seizure would be a focal to bilateral seizure.
Describing Awareness
Whether a person is aware during a seizure is of practical importance because it is one of the main factors affecting a person’s safety during a seizure. Awareness is used instead of consciousness, because it is simpler to evaluate.
Focal aware: If awareness remains intact, even if the person is unable to talk or respond during a seizure, the seizure would be called a focal aware seizure. This replaces the term simple partial.
Focal impaired awareness: If awareness is impaired or affected at any time during a seizure, even if a person has a vague idea of what happened, the seizure would be called focal impaired awareness. This replaces the term complex partial seizure.
Awareness unknown: Sometimes it’s not possible to know if a person is aware or not, for example if a person lives alone or has seizures only at night. In this situation, the awareness term may not be used or it would be described as awareness unknown.
Generalized seizures: These are all presumed to affect a person’s awareness or consciousness in some way. Thus no special terms are needed to describe awareness in generalized seizures.
ILAE 2017 classification of seizure types basic version
Describing Motor and Other Symptoms in Focal Seizures
Many other symptoms may occur during a seizure. In this basic system, seizure behaviors are separated into groups that involve movement.
Focal motor seizure: This means that some type of movement occurs during the event. For example twitching, jerking, or stiffening movements of a body part or automatisms (automatic movements such as licking lips, rubbing hands, walking, or running).
Focal non-motor seizure: This type of seizure has other symptoms that occur first, such as changes in sensation, emotions, thinking, or experiences.
It is also possible for a focal aware or impaired awareness seizure to be sub-classified as motor or non-motor onset.
Auras: The term aura to describe symptoms a person may feel in the beginning of a seizure is not in the new classification. Yet people may continue to use this term. It’s important to know that in most cases, these early symptoms may be the start of a seizure.
Describing Generalized Onset Seizures
Seizures that start in both sides of the brain, called generalized onset, can be motor or non-motor.
Generalized motor seizure: The generalized tonic-clonic seizure term is still used to describe seizures with stiffening (tonic) and jerking (clonic). This loosely corresponds to “grand mal.” Other forms of generalized motor seizures may happen. Many of these terms have not changed and a few new terms have been added. (see image below)
Generalized non-motor seizure: These are primarily absence seizures and the term corresponds to the old term “petit mal.” These seizures involve brief changes in awareness, staring, and some may have automatic or repeated movements like lipsmacking.
Describing Unknown Onset Seizures
When the beginning of a seizure is not known, this classification still gives a way to describe whether the features are motor or non-motor.
The New Expanded Classification
The expanded classification keeps the framework of the basic classification, but adds more seizure types as subheadings. In the following image, the types of features under motor and non-motor seizures are listed for all types: focal, generalized, and unknown onset.
ILAE 2017 classification of seizure types expanded version
General Comments
Classification of a seizure type is only part of the seizure description. The work to update the seizure classification has been done by a large group of dedicated people in epilepsy over a number of years. This new sysyem will move us forward, making it easier to describe seizures and using a common language to talk about them.
A few other points:
The new classification is designed to have some flexibility. Use of other descriptive terms or even free text is encouraged.
Most seizures can be classified by signs and symptoms that happen during a seizure. However, other information is useful when available, for example, phone videos, EEG, MRI, and other brain imaging, blood tests, or gene tests. For practical purposes, long descriptive terms are probably not useful for day-to-day life.
This new seizure classification does not change the definition of epilepsy or epilepsy syndromes. The ILAE also has produced a new classification of the epilepsies, which we look forward to learning more about. The epilepsy classification includes the whole clinical picture, with information on seizure types, causes, EEG pattern, brain imaging, genetics, and epilepsy syndromes, such as Lennox-Gastaut syndrome and juvenile myoclonic epilepsy.
While the ILAE 2017 seizure classification is exciting, changing terms can be confusing and can take a lot of work. The Epilepsy Foundation is committed to helping educate people about the changes, what it means for them, and how older terminology relates to this new system.
Information about seizure types on and in our print materials is being updated.
Online forums and other ways of reaching out to everyone affected by these changes are being explored.

Friday, February 10, 2017

Not for Misconceptions and against Medical Ethics . Aleem M A .BMJ 2017;356:j631 .



Welcome to BMJ Opinion.

BMJ 2017; 356 doi: (Published 07 February 2017)

Cite this as: BMJ 2017;356:j631

Rapid response

Not for Misconceptions and against Medical Ethics

BMJ Opinion is a required platform to express our views. But it should not become a platform to spread one's individual culture and misconceptions about medical facts, research and ethics

Competing interests: No competing interests

10 February 2017

M A Aleem


ABC Hospital

Annamalainagar . Trichy 620018. Tamilnadu. India.


Friday, February 3, 2017

Abortion is a Human Right . Aleem M A. Hakkim A M. BMJ 2017;356:j511


Views And Reviews

Personal View

The global gag rule and what to do about it

BMJ 2017; 356 doi: (Published 01 February 2017)

Cite this as: BMJ 2017;356:j511

Rapid response

Abortion is a Human Right

The United Nations Committee Affirms Abortion As A Human Right

Pope Francis has said that priests are to absolve women and health workers who procured an abortion or aided in one.

The right to safe abortion, to determine when and if to become a parent, and the right to healthy sexuality is an issue of both human rights and of social justice. Induced abortion is one of the most commonly performed medical interventions. Making abortion illegal does not reduce the number of abortions. Access to safe abortion and legalization of abortion can prevent unnecessary suffering and death of women.

In countries where abortion is legal and available, abortion is an extremely safe procedure. Making abortion illegal does not reduce the number of abortions: it simply reduces the safety of abortion. According to The World Health Organization (WHO), 20 million of the 42 million abortions performed every year are illegal and unsafe. In every country, it is young, rural and low-income women who bear the most suffering from unsafe abortion. These women are often already mothers, struggling to support the children they already have. With no safe options, women try to abort using sharp instruments or unsafe chemicals, or they seek help from people with no medical training. As a result, a woman dies of an unsafe abortion every 10 minutes (about 47 000 women every year).

Competing interests: No competing interests

03 February 2017

M A Aleem


A M Hakkim

ABC Hospital

Annamalainagar. Trichy 620018.Tamilnadu. India


Thursday, February 2, 2017

In Dt Next  chennai on 3.2.2017 on NEET

FRI, FEB 03, 2017

In Dt Next  chennai on 3.2.2017

Stakeholders divided on TN NEET law
Published: Feb 03,201705:15 AM

Though the state government has passed an Act on National Eligibility Cum Entrance Test (UG), (NEET) examinations providing a relaxation for candidates from Tamil Nadu, the move has only evoked mixed response from various sections.


Chennai: A majority supports the state’s move, fearing that the NEET will not augur well for those students who may benefit from the reservation and merit-based seat allocation by the state.

Neurologist and former vice-principal of K A P Viswanatham Government Medical College, Tiruchy M A Aleem said, “In Tamil Nadu, most of the students choose Tamil as their medium of instruction in schools. They are admitted into colleges on the basis of the marks they obtain in the board exam. These students will stand 80-90 per cent chance in getting admissions in private or government run colleges. But, when the NEET comes in, they will have to compete at the national level and their entry into medical colleges in the state will be reduced. Moreover, students from other states who come and study here may return to their natives. As a result, the health care service in TN will take a beating.”

Similarly, General Secretary of Doctors Association for Social Equality (DASE), G R Ravindranath said, “The quota of TN government in medical seats must be exempted from NEET. AIIMS and JIPMER must be brought under the ambit of NEET. The admissions must be done through a single window system and since the government is holding the exams, they must fix the fee to put an end to capitation fee. The government must bear the tuition fee of those students whose parents have an annual income of less than Rs 12 lakh. The association also opposed the exit test for doctors - NEXT.”

However, the teacher’s association is worried over the condition of students from rural areas as to how they would face the uniform national level examination. Tamil Nadu Teachers Association P K Illamaran said, “Students from state board syllabus, mainly from rural areas, cannot appear for a national level examination where the question paper is based on a CBSE syllabus. It does not mean that the students are not competent enough, but because of the vast difference in the syllabus.”  

Change India director A Narayanan said that the bill, which has many shortcomings, was tabled in a hurried manner. It could be struck down, when challenged in the Supreme Court. The claim is that the NEET would take away the seats of Tamil Nadu students. But, it should be noted that the seats were allocated on a quota basis. Many also allege that it would not bode well for rural students, even the current counselling system in the State was not giving a fair deal to them, he argued. Less than 1.5 per cent of students from government schools alone manage to get a medical seat in a government college which is a social injustice. “While this is the case, people claim NEET will bring in imbalance in admissions,” he said.