Sunday, October 28, 2018
National one day Environmental Awareness Seminar at Tiruchirappalli Ponnampatti Town Panchayat on 28.10.2018 Tiruchirappalli District Collector K.Rajamani, BDU Register Dr. Gopinath and Scope Subburaman participated . District welfare Fund Committee Life Member M.a.Aleem attended. EO Dr.Shaul Hameed organised the seminar
Friday, October 26, 2018
Death due to Pregabalin and Gabapentin. Aleem M A , Hakkim A M BMJ 2018;363:k4364 .
BMJ
News
Pregabalin and gabapentin become controlled drugs to cut deaths from misuse
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4364 (Published 16 October 2018)
Cite this as: BMJ 2018;363:k4364
Rapid response
Re: Pregabalin and gabapentin become controlled drugs to cut deaths from misuse
Death due to Pregabalin and Gabapentin.
In India, pregabalin and gabapentin are increasingly being used illicitly. Both drugs can depress the central nervous system, which may result in sedation and cause breathing difficulties.
In patients who are already taking substances that depress the central nervous system such as alcohol, opioids, and the benzodiazepine group of drugs, pregabalin and gabapentin may cause overdose side effects and toxicities.
To reduce the number of tragic deaths due to pregabalin and gabapentin, strict guidelines should be adopted for these drug prescriptions.
These drugs should not be allowed to be advertised to promote business on television and in non-medical magazines in all countries.
So it is ideal for reclassification of these drugs as class C controlled substances all over the world, including in India.
Competing interests: No competing interests
26 October 2018
M.A. Aleem
Emeritus Professor of Neurology* Visiting neurology consultant** Neurologist***
A.M.Hakkim
The Tamilnadu Dr.M.G.R Medical University* Dhanalakshmi Srinivasan Medical College Hospital** ABC Hospital***
Chennai 600032* Perambalur 621212** Trichy 620018*** Tamilnadu India
@drmaaleem
Thursday, October 25, 2018
World Stroke Day 2018 Article on Stroke In Trichy The Hindu Tamilnadu India on 25.10.2018
https://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/unchecked-hypertension-results-in-stroke/article25316715.ece
The Hindu Tiruchi 25.10.2018
TODAY'S PAPER NATIONAL TAMIL NADU
TAMIL NADU
‘Hypertension can lead to stroke’
SPECIAL CORRESPONDENT
OCTOBER 25, 2018 00:00 IST
UPDATED: OCTOBER 25, 2018 05:02 IST
The Health department in Tiruchi district has been sensitising patients over 30 years of age to the link between hypertension and stroke.
Patients being treated in primary health centres and other hospitals for non-communicable diseases such as hypertension and diabetes are being educated about the importance of prevention of hypertension to avoid stroke, Deputy Director of Health Services Subramani said.
Hypertension, when left uncontrolled, inevitably causes stroke, he explained.
The local medical fraternity has cautioned that hypertension gets detected only over a period of time since the symptoms are not obvious. Many private hospitals in the city are educating patients about the complications in connection with World Stroke Day on October 29.
For many, life after stroke will not be the same. But with the right care and support, leading a meaningful life will still be possible.
‘Support’ being the campaign theme for 2018, the hospitals are keen on raising awareness of key issues and needs of stroke survivors and caregivers in order to achieve the best possible quality of life after stroke.
Advances in modern medicine, medications, and medical technology notwisthanding, stroke diseases impose a substantial mortality and morbidity risk to individuals with increased economic burden to society, said M.A. Aleem, Emeritus Professor-Neurology, The Tamilnadu Dr.M.G.R. Medical University.
Situation in India
Developing countries such as India account for more than four-fifths of all strokes. The stroke incidence rate in India is much higher than in other developing countries with approximately 1.8 million Indians out of a population of 1.2 billion suffering from stroke every year, Dr. Aleem, who is also past president, Tamil Nadu Puducherry Association of Neurologists, added.
The disease, if left untreated, causes damage to 32,000 brain cells every second, Dr. Aleem explained, while emphasising on early detection against the backdrop of the reality that stroke is not limited to the elderly.
Evidence suggests that within days of stroke the injured brain has the ability for limited neuronal regeneration by angiogenesis and is coupled with neurogenesis. Most of the spontaneous stroke recovery occurs in the first 3-6 months after the acute neurological event.
In order to achieve greater proportion of recovery, a much higher intensity of therapy has to be considered . Greater intensity of stroke rehabilitation has been associated with improved outcomes. Most importantly, stroke patients need the best form of psychological and emotional support, he said.
World stroke Day 2018 Article in Trichy The Hindu 0n 25.10.2018
https://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/unchecked-hypertension-results-in-stroke/article25316715.ece
Tuesday, October 23, 2018
Our Indian Prime Minister Modi Awarded the 20 18 Seoul Peace Prize
கொரியாவின் 2018 சியோல் அமைதி விருதை பெறுகிறார் பிரதமர் மோடி.
அதற்கு அந்த விருது குழு கொடுத்திருக்கும் காரணங்கள்:
சர்வதேச ஒத்துழைப்பை மேம்படுத்தியது,
உலகளாவிய பொருளாதார வளர்ச்சியை உயர்த்தியது,
இந்தியாவின் பொருளாதார வளர்ச்சிக்கு உழைப்பது,
லஞ்ச ஒழிப்பு,
சமூக ஒருங்கிணைப்பு,
பணக்காரர்களுக்கும் ஏழைகளுக்குமிடையேயான பொருளாதார இடைவெளியை மோடினாமிக்ஸ் (Modinomics) மூலம் குறைத்தது,
டீமானடைசேஷன் மூலம் தூய பொருளாதாரம்,
பிராந்திய மற்றும் உலக அமைதிக்கான பங்களிப்பு (Modi Doctrine' and the 'Act East Policy.'),
- எதையெல்லாம் மோடி தவறாக செய்தார் என்று எதிர்க்கட்சிகள் குறைகூறினவோ, அதையெல்லாம் சரியாக செய்ததாக கூறி கொரியா விருது அளிக்கிறது பிரமருக்கு. இந்தியர்களுக்கு பெருமை! எதிரிகளுக்கு பர்னால்!
Prime Minister Modi Awarded the 20 18 Seoul Peace Prize
While awarding the 2018 Seoul Peace Prize, the Award Committee recognized Prime Minister Modi's contributions to the growth of the Indian and global economies, crediting 'Modinomics' for reducing social and economic disparity between the rich and the poor. The Committee lauded PM's initiatives to make the government cleaner through anti-corruption measures and demonetization. The Committee also credited Prime Minister for his contribution towards regional and global peace through a proactive foreign policy with countries around the world under the 'Modi Doctrine' and the 'Act East Policy.' Prime Minister Modi is the fourteenth recipient of this award
World Stroke Day 2018 OCTOBER 29 : Support for Life After Stroke #UpAgainAfterStroke -Prof.Dr.M.A.Aleem M.D.D.M (Neuro) TRICHY TAMILNADU INDIA
World Stroke Day 2018 : Support for Life After Stroke
-Prof.Dr.M.A.Aleem M.D.D.M (Neuro)
Emeritus Professor Neurology
The Tamilnadu Dr.M.G.R. Medical University
Past President
Tamilnadu Pondycherry Association of Neurologists
Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.
Fromer HOD and Professor of Neurology Senior Neurology civil surgeon KAPVGMC and
MGM Govt. Hospital
Consultant Neurologist
ABC Hospital
Trichy 620018
Tamilnadu
India
drmaaleem@hotmail.com
Phone 9443159940
Introduction
Around 80 million people living in the world today have experienced a stroke and over 50m survivors live with some form of permanent disability as a result. While for many, life after stroke won’t be quite the same, with the right care and support living a meaningful life is still possible. As millions of stroke survivors show us every day, it is possible to get Up Again After Stroke.
While the impact of stroke will be different for everyone. On World Stroke Day on 29th October 2018 we want to focus the world’s attention on what unites stroke survivors and caregivers, namely their resilience and capacity to build on the things that stroke can’t take away; their determination to keep going on the recovery journey.
In 2018, the theme of the campaign is ‘support’ and the focus of our campaign is raising awareness of key issues and needs of stroke survivors and caregivers, in order to achieve the best possible quality of life after stroke.
Despite advances in modern medicine, medications, and medical technology, stroke diseases impose a substantial mortality and morbidity risk to the individual with increased economic burden to the society. Globally, stroke is the second leading cause of death after ischemic heart disease, with approximately 6.7 million stroke deaths every year.
In India
Stroke is the second most common cause of death after coronary artery diseases globally. It is also the most prevalent cause of chronic adult disability. However, while stroke threatens humankind all across the globe, developing countries like India account for more than four-fifths of all strokes. The stroke incidence rate in India is much higher than in other developing countries with approximately 1.8 million Indians out of a population of 1.2 billion suffering from stroke every year.
Early detection is very crucial because in stroke, 32,000 brain cells are damaged every second the disease goes untreated.
Previous hospital-based data from India observed a high proportion of young stroke (first-ever stroke onset below 40 years of age), ranging between 15 and 30%.
Stroke is not limited to the elderly only.
In India, common risk factors for stroke such as hypertension, diabetes, smoking, and dyslipidemia are prevalent and insufficiently controlled due to low awareness levels of the disease. Another major challenge is that treatment for stroke is still evolving in India. Until recently, physicians have been using intravenous tPA, a clot-busting drug to open blocked blood vessels, as the first line of defense. Five global clinical trials have shown that the addition of stent retriever therapy to IV-tPA improves functional disability in patients and is now recommended as a first-line treatment for acute ischemic strokes.
Many people affected by stroke are unable to access treatment and rehabilitation due to lack of awareness. People generally tend to ignore the symptoms of stroke. However, early detection is very crucial because in stroke, 32,000 brain cells are damaged every second the disease goes untreated. But ignorance about stroke symptoms, poor infrastructure, and hesitancy about hospital admission even when infrastructure and access are available often leads to delay.
Stroke is treatable and its impact can be significantly reduced. The addition of stent retriever technology has reduced disability, improved neurological outcomes and increased the rate of return to functional independence in patients suffering stroke.
While stroke is a major public health concern worldwide, the burden on India has been increasing at an alarming rate over the past few decades. The startling statistics show that there is an urgency with which the phenomenon of stroke needs to be addressed in India for reducing the huge stroke burden that the country is facing. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized.
As the population rapidly ages, the burden of stroke is expected to increase significantly, posing challenges to limited healthcare resources.
There have been many advances in management of stroke. However, stroke is still one of the leading causes of disabilities and mortality worldwide with significant socioeconomic burden. This article summarizes the consequences of stroke in the elderly, predictors of stroke rehabilitation outcomes, role of rehabilitation in neuronal recovery, importance of stroke rehabilitation.
Stroke Consequences
The incidence of stroke increases with age, in both men and women with approximately 50% of all strokes occurring in people over age 75 and 30% over age 85 . Stroke is among the top leading causes of disability and reduced quality of life . Elderly patients are at higher risk of mortality, poorer functional outcomes, prolonged length of hospital stay, and institutionalization .
Mobility Problems
Motor impairment is the most common deficit after stroke, which either happens as a direct consequence of the lack of signal transmission from cerebral cortex or as a slowly accumulating process of the cerebral injuries or muscle atrophy due to learned disuse. The risk of falling and fall-related injuries were higher in stroke elders . Risk factors associated with increased fall risks in stroke survivors include poor general health, time from first stroke, psychiatric problems, urinary incontinence, pain, motor impairment, and a history of recurrent falls . Risk factors associated with fall-related injuries are female gender, poor general health, past injury from fall, psychiatric problems, urinary incontinence, impaired hearing, pain, motor impairment, and presence of multiple strokes . Motor function deficits, increased fall risks, and fall-related injuries can significantly affect the patients’ mobility, and their daily living activities which limit their participation in social events and other professional activities.
Higher Function Problems
Poststroke cognitive impairment is common and can affect up to one-third of stroke survivors . However, subtle cognitive impairment may not appear apparent, especially when the stroke survivor seems to have recovered functionally in other aspects . In most cases, these deficits are persistent and usually have progressively worsened . Poststroke cognitive impairment is also more common in those with recurrent strokes . It often coexists with other neuropsychological problems including language disorders, fatigue, depression, and apathy . The mechanisms of poststroke cognitive impairment could be either directly due to cerebral vascular injury or indirectly due to an associated asymptomatic Alzheimer pathology or white matter changes from small vessel disease . Factors independently associated with dementia in stroke survivors include atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes mellitus, and previous transient ischemic attack . The combined motor and cognitive impairments significantly increase risks of long term functional disability and increase healthcare cost as reflected by an increase in hospital readmission rates and mortality rates .
Urination and Defecation problems
Bladder and bowel dysfunction are common and cause significant distress to stroke survivors. Poststroke urinary incontinence or retention has been shown to affect about 30% of stroke survivors . Urinary incontinence is an important marker of stroke severity and has been linked with functional dependency, increased risk of institutionalization, and mortality . Risk factors for poststroke urinary retention include cognitive impairment, diabetes mellitus, aphasia, poor functional status on admission, and urinary tract infection . Common gastrointestinal symptoms after stroke include dysphagia, heartburn, abdominal pain, fecal incontinence, bleeding gastrointestinal tract, and constipation . Among these, constipation is the most common bowel dysfunction with the incidence ranging from 29% to 79% in stroke survivors and more prevalent in hemorrhagic stroke patients . Although fecal incontinence is less common with a prevalence of 11% at 1 year after stroke, it is associated with increased risk of nursing home admission and 1-year mortality rate .
Infection
Infection is a serious complication after a stroke despite optimal management. The reported prevalence of poststroke infection ranges from 5% to 65%, depending on the study population, study design, and the definition of infection . Mortality rate is higher in stroke patients with any type of infection, particularly higher in patients with pneumonia and patients with urinary tract infection . Among the survivors, stroke-associated infection is also an independent risk factor for poor outcome at discharge and at 1 year . The association between poststroke infection and poor outcome is likely related to a delay in rehabilitation due to prolonged hospital stay and immobilization as well as general frailty . More importantly, evidence from experimental studies suggests that infection also promotes antigen presentation and autoimmunity against the brain which worsens the outcome .
After Stroke
Following a stroke, patients may have impaired mobility which predisposes them to pressure sores and deep vein thrombosis (DVT). Pressure ulcer results from an imbalance between external mechanical forces acting on skin and soft tissue and the internal susceptibility of skin and its underlying soft tissue to injury. Pressure ulcer is associated with increased poststroke mortality in both genders and patients aged 60 years or older . Stroke patients also have an increased risk of developing deep DVT and pulmonary embolism due to immobility and raised prothrombotic activity . The major risk factors of poststroke DVT include advanced age, male gender, congestive heart failure, malignancy, and fluid and electrolyte disorders .
Pain
Pain is a frequent but often neglected complication of stroke . It can happen immediately, weeks, or months after a stroke event and can span a spectrum from irritating headache to debilitating limb pain secondary to complex regional pain syndrome, spasticity or joint subluxation, and /or contractures . Pain, together with depression and fatigue, is associated with increased risk of cognitive impairment, functional dependence, and reduced quality of life in stroke survivors . Reported risk factors for the development of poststroke pain include female gender, older age at stroke onset, history of alcohol use and depression, anatomical location of stroke and presence of clinical features such as spasticity, reduced upper extremity movement, and sensory deficits .
Stroke Rehabilitation
Due to the medical complications after stroke, many patients are markedly functionally disabled when they are discharged from acute care. Functional recovery is based on the restitution of brain tissue and on the relearning of and compensation for lost functions . Therefore, understanding and identification of predictors of good rehabilitation outcomes in addition to institution of early rehabilitation are essential in the recovery phase after an acute stroke event.
Age has been well established as a strong predictor of functional outcome and discharge destination in stroke patients in multiple studies across the world in both young and elderly stroke survivors . A large community-based cohort study in Denmark reported more than 58% of the very elderly (85 years old and above) were discharged to nursing homes or died during hospital stay poststroke .
Cognitive impairment which occurs either as a prestroke condition or a poststroke is often significantly correlated with reduced functional gains and poor rehabilitation outcomes in elderly patients.
The cognitive impairment (preexisting or new) together with age was the most important predictor of institutionalization 3 years after stroke . Pre stroke dementia has been shown to increase risk of 6-month and delayed poststroke mortality . However, elderly stroke patients with cognitive impairments could still benefit from rehabilitation.
Hence, cognitive impairment should be screened for and has to be taken into consideration when rehabilitation goals are formulated and rehabilitation program ought to be individualized according to the stroke survivor’s learning ability .
Activities of Daily Living (ADL)
dependency on admission, significantly predicts functional dependency outcome in stroke survivors . Elderly stroke patients with poorer preadmission functional status also have longer length of stay and are less likely discharged to an independent or assisted living situation .
Aphasia arising from stroke was associated with worse outcomes in both the acute and chronic stroke periods with poorer functional recovery and increased length of rehabilitation and mortality risk .
Urinary incontinence is predictive of poor stroke outcome . Mortality at 6 months has been shown to increase in stroke patients with initial urinary incontinence . 64% of incontinent poststroke patients were discharged to nursing homes compared to 18% for continent poststroke patients . The link between urinary incontinence and poor outcomes could be related to incontinence associated with severe hemiparesis, larger stroke lesions, stroke lesion location, and a disruption of the neuromicturition pathways .
Rehabilitation process after Stroke
Rehabilitation aims to enhance and augment natural mechanisms of recovery. At the time of ischemic injury, immediate mechanisms of repair are initiated, which include resolution of poststroke edema, vicriation of function, and reversal of diaschisis. Vicariation refers to neighboring tissues taking over a function lost by the stroke-affected tissue . Diaschisis is based on the mechanism of reduction in metabolism and blood flow of intact brain regions which are distant away from the ischemic core but are still functionally and structurally connected with the ischemic core. It is thought that at least some of the improvement observed after a stroke could be due to the reversal of diaschisis .Such processes lead to “unmasking” of latent networks which can be as rapid as several hours within ischemic injury .
Evidence suggests that, within days of stroke, the injured brain has the ability for limited neuronal regeneration by angiogenesis and is coupled with neurogenesis. The ability to self-repair has been shown to happen in aged brains . The repair processes are initially intense and then slow down. Most of the spontaneous stroke recovery occurs in the first 3-6 months after the acute neurological event . Generally, patients make 70% of their recovery in the first 3 months after a stroke . Despite variations in therapy, such observations of proportional recovery have remained consistent which means that a minimum amount of spontaneous activity and therapy is enough for proportional recovery to happen . An exception to this proportional recovery rule includes damage to the corticospinal tract which results in poorer recovery from impairment .
In order to achieve a greater proportion of recovery, a much higher intensity of therapy has to be considered . Greater intensity of stroke rehabilitation has been associated with improved outcomes . Skill learning and active participation help to promote plasticity and network activation in stroke recovery . Motor retraining not only enables somatotopic reorganization to happen in perilesional areas and in distant areas connected to the infarct site but also negate the inhibitory effects of myelin associated proteins and ephrins which suppress axonal sprouting . An “enriched environment” in addition to motor retraining has been shown to facilitate motor recovery and neural plasticity in animal studies due to the numerous associated cellular and molecular effects . Rehabilitation facilities are ideal enriched environments as they are often situated in stimulating and specialized centers managed by a multidisciplinary team of medical professionals.
Specialized stroke rehabilitation units have been shown to improve functional outcomes, decrease mortality and reduce length of hosp stay in moderate to severe stroke patients . Combining an enriched environment with skill retraining, stroke rehabilitation units are made up of a multidisciplinary team of medical professionals who offer realistic goal setting and engage in multimodal disability and impairment assessment, medical management, and functional training.
The rehabilitation team addresses the many challenges stroke patients could face such as sensorimotor and balance impairments, dysphagia, cognitive-communication impairments, mood disorders, visual and hearing impairments, and hemispatial neglect. Regular multidisciplinary meetings are conducted to discuss the rehabilitation goals, rehabilitation intervention, functional improvement, discharge planning, and arrangement of outpatient rehabilitation. These structured meetings have been shown to improve functional outcomes . Such collaborative teamwork involves communication among the team members, working towards a common goal and accepting responsibility as a group for the final outcome of the patients . Recommended realistic goals are also planned together with the patients and their caregivers to prepare them for a smooth transition to outpatient rehabilitation and discharge destination with the eventual aim to achieve maximum independence as possible .
The hours of therapy vary across different inpatient rehabilitation settings. Generally, most guidelines advocate minimum 45 minutes of each relevant therapy for at least 5 days a week .I Immediate rehabilitation can improves functional outcomes, independence, and mortality compared to a subacute rehabilitation, given the interprofessional team of providers, advanced treatment strategies, and the requirement that patients participate in therapy at least three hours daily . Patient’s ability to tolerate such level of intensity has to be taken into account when considered for an acute intensive inpatient rehabilitation placement. When the stroke patient is admitted to inpatient rehabilitation, the rehabilitation team would assee patient and determine an individualized rehabilitation program of suitable intensity and duration to suit the needs for favorable stroke recovery .
It is generally recommended to commence stroke rehabilitation as soon as patients are medically stable, to maximize their functional gains and to take advantage of the period of early stroke recovery . However, caution and individualized clinical judgement are indicated especially in older patients and patients with intracerebral hemorrhage .
Very early, more frequent, and increased dose of mobilization intervention reduced the odds of a favorable outcome at 3 months after stroke when compared with usual care .
Earlier access to rehabilitation seems to favor better functional outcomes, shorten length of hospital stay, and increase likelihood of discharge to home .
Due to residual functional disability and associated medical complications, poststroke elderly survivors and their caregivers often experience significant physical, mental, and social challenges adischarged home. In most cases, caregivers are usually poorly understood and ill-prepared for their roles and responsibilities they must face at home As elderly stroke survivors require substantial care demands at home, their caregivers often feel overwhelmed and exhausted, which eventually lead to depression and deterioration of physical health .
Conclusion
The following support as being most important to recovery sfter Stroke
Be provided with hope for the best possible recovery I can make now and into the future
Receive psychological and emotional support in a form that best meets my needs
Be included in all aspects of society regardless of any disability I may have
Receive support (financial or otherwise) to ensure I am cared for in the longer term
Be supported to return to work and/or other activities I may choose to participate in after my stroke
Get access to formal and informal advocacy to assist me with access to the services I need
Be connected to other stroke survivors and caregivers so I may gain and provide support in my recovery from stroke
In conclusion, stroke in elderly patients poses a major public health concern, due to its strong association with multiple medical complications, poorer functional outcomes, and substantial healthcare cost. For stroke survivors and their families, a good and comprehensive rehabilitation program is the key to recovery and to enable them to reach their highest level of independence as possible. The success of a stroke rehabilitation unit depends on the effective utilization of its resources and seamless coordination between different healthcare professionals as well as the ongoing support from the caregivers and other community services. Provision of evidence-based and culturally relevant stroke rehabilitation will help to effectively manage limited local healthcare resources and improve quality of life in our aging population.
Tuesday, October 16, 2018
World Stroke Day 2018 OCTOBER 29 : Support for Life After Stroke #UpAgainAfterStroke -Prof.Dr.M.A.Aleem M.D.D.M (Neuro) TRICHY TAMILNADU INDIA
World Stroke Day 2018 : Support for Life After Stroke
-Prof.Dr.M.A.Aleem M.D.D.M (Neuro)
Emeritus Professor Neurology
The Tamilnadu Dr.M.G.R. Medical University
Past President
Tamilnadu Pondycherry Association of Neurologists
Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.
Fromer HOD and Professor of Neurology Senior Neurology civil surgeon KAPVGMC and
MGM Govt. Hospital
Consultant Neurologist
ABC Hospital
Trichy 620018
Tamilnadu
India
drmaaleem@hotmail.com
Phone 9443159940
Introduction
Around 80 million people living in the world today have experienced a stroke and over 50m survivors live with some form of permanent disability as a result. While for many, life after stroke won’t be quite the same, with the right care and support living a meaningful life is still possible. As millions of stroke survivors show us every day, it is possible to get Up Again After Stroke.
While the impact of stroke will be different for everyone. On World Stroke Day on 29th October 2018 we want to focus the world’s attention on what unites stroke survivors and caregivers, namely their resilience and capacity to build on the things that stroke can’t take away; their determination to keep going on the recovery journey.
In 2018, the theme of the campaign is ‘support’ and the focus of our campaign is raising awareness of key issues and needs of stroke survivors and caregivers, in order to achieve the best possible quality of life after stroke.
Despite advances in modern medicine, medications, and medical technology, stroke diseases impose a substantial mortality and morbidity risk to the individual with increased economic burden to the society. Globally, stroke is the second leading cause of death after ischemic heart disease, with approximately 6.7 million stroke deaths every year.
In India
Stroke is the second most common cause of death after coronary artery diseases globally. It is also the most prevalent cause of chronic adult disability. However, while stroke threatens humankind all across the globe, developing countries like India account for more than four-fifths of all strokes. The stroke incidence rate in India is much higher than in other developing countries with approximately 1.8 million Indians out of a population of 1.2 billion suffering from stroke every year.
Early detection is very crucial because in stroke, 32,000 brain cells are damaged every second the disease goes untreated.
Previous hospital-based data from India observed a high proportion of young stroke (first-ever stroke onset below 40 years of age), ranging between 15 and 30%.
Stroke is not limited to the elderly only.
In India, common risk factors for stroke such as hypertension, diabetes, smoking, and dyslipidemia are prevalent and insufficiently controlled due to low awareness levels of the disease. Another major challenge is that treatment for stroke is still evolving in India. Until recently, physicians have been using intravenous tPA, a clot-busting drug to open blocked blood vessels, as the first line of defense. Five global clinical trials have shown that the addition of stent retriever therapy to IV-tPA improves functional disability in patients and is now recommended as a first-line treatment for acute ischemic strokes.
Many people affected by stroke are unable to access treatment and rehabilitation due to lack of awareness. People generally tend to ignore the symptoms of stroke. However, early detection is very crucial because in stroke, 32,000 brain cells are damaged every second the disease goes untreated. But ignorance about stroke symptoms, poor infrastructure, and hesitancy about hospital admission even when infrastructure and access are available often leads to delay.
Stroke is treatable and its impact can be significantly reduced. The addition of stent retriever technology has reduced disability, improved neurological outcomes and increased the rate of return to functional independence in patients suffering stroke.
While stroke is a major public health concern worldwide, the burden on India has been increasing at an alarming rate over the past few decades. The startling statistics show that there is an urgency with which the phenomenon of stroke needs to be addressed in India for reducing the huge stroke burden that the country is facing. Without more effective public education of all demographic groups, the full potential of acute prevention will not be realized.
As the population rapidly ages, the burden of stroke is expected to increase significantly, posing challenges to limited healthcare resources.
There have been many advances in management of stroke. However, stroke is still one of the leading causes of disabilities and mortality worldwide with significant socioeconomic burden. This article summarizes the consequences of stroke in the elderly, predictors of stroke rehabilitation outcomes, role of rehabilitation in neuronal recovery, importance of stroke rehabilitation.
Stroke Consequences
The incidence of stroke increases with age, in both men and women with approximately 50% of all strokes occurring in people over age 75 and 30% over age 85 . Stroke is among the top leading causes of disability and reduced quality of life . Elderly patients are at higher risk of mortality, poorer functional outcomes, prolonged length of hospital stay, and institutionalization .
Mobility Problems
Motor impairment is the most common deficit after stroke, which either happens as a direct consequence of the lack of signal transmission from cerebral cortex or as a slowly accumulating process of the cerebral injuries or muscle atrophy due to learned disuse. The risk of falling and fall-related injuries were higher in stroke elders . Risk factors associated with increased fall risks in stroke survivors include poor general health, time from first stroke, psychiatric problems, urinary incontinence, pain, motor impairment, and a history of recurrent falls . Risk factors associated with fall-related injuries are female gender, poor general health, past injury from fall, psychiatric problems, urinary incontinence, impaired hearing, pain, motor impairment, and presence of multiple strokes . Motor function deficits, increased fall risks, and fall-related injuries can significantly affect the patients’ mobility, and their daily living activities which limit their participation in social events and other professional activities.
Higher Function Problems
Poststroke cognitive impairment is common and can affect up to one-third of stroke survivors . However, subtle cognitive impairment may not appear apparent, especially when the stroke survivor seems to have recovered functionally in other aspects . In most cases, these deficits are persistent and usually have progressively worsened . Poststroke cognitive impairment is also more common in those with recurrent strokes . It often coexists with other neuropsychological problems including language disorders, fatigue, depression, and apathy . The mechanisms of poststroke cognitive impairment could be either directly due to cerebral vascular injury or indirectly due to an associated asymptomatic Alzheimer pathology or white matter changes from small vessel disease . Factors independently associated with dementia in stroke survivors include atrial fibrillation, previous stroke, myocardial infarction, hypertension, diabetes mellitus, and previous transient ischemic attack . The combined motor and cognitive impairments significantly increase risks of long term functional disability and increase healthcare cost as reflected by an increase in hospital readmission rates and mortality rates .
Urination and Defecation problems
Bladder and bowel dysfunction are common and cause significant distress to stroke survivors. Poststroke urinary incontinence or retention has been shown to affect about 30% of stroke survivors . Urinary incontinence is an important marker of stroke severity and has been linked with functional dependency, increased risk of institutionalization, and mortality . Risk factors for poststroke urinary retention include cognitive impairment, diabetes mellitus, aphasia, poor functional status on admission, and urinary tract infection . Common gastrointestinal symptoms after stroke include dysphagia, heartburn, abdominal pain, fecal incontinence, bleeding gastrointestinal tract, and constipation . Among these, constipation is the most common bowel dysfunction with the incidence ranging from 29% to 79% in stroke survivors and more prevalent in hemorrhagic stroke patients . Although fecal incontinence is less common with a prevalence of 11% at 1 year after stroke, it is associated with increased risk of nursing home admission and 1-year mortality rate .
Infection
Infection is a serious complication after a stroke despite optimal management. The reported prevalence of poststroke infection ranges from 5% to 65%, depending on the study population, study design, and the definition of infection . Mortality rate is higher in stroke patients with any type of infection, particularly higher in patients with pneumonia and patients with urinary tract infection . Among the survivors, stroke-associated infection is also an independent risk factor for poor outcome at discharge and at 1 year . The association between poststroke infection and poor outcome is likely related to a delay in rehabilitation due to prolonged hospital stay and immobilization as well as general frailty . More importantly, evidence from experimental studies suggests that infection also promotes antigen presentation and autoimmunity against the brain which worsens the outcome .
After Stroke
Following a stroke, patients may have impaired mobility which predisposes them to pressure sores and deep vein thrombosis (DVT). Pressure ulcer results from an imbalance between external mechanical forces acting on skin and soft tissue and the internal susceptibility of skin and its underlying soft tissue to injury. Pressure ulcer is associated with increased poststroke mortality in both genders and patients aged 60 years or older . Stroke patients also have an increased risk of developing deep DVT and pulmonary embolism due to immobility and raised prothrombotic activity . The major risk factors of poststroke DVT include advanced age, male gender, congestive heart failure, malignancy, and fluid and electrolyte disorders .
Pain
Pain is a frequent but often neglected complication of stroke . It can happen immediately, weeks, or months after a stroke event and can span a spectrum from irritating headache to debilitating limb pain secondary to complex regional pain syndrome, spasticity or joint subluxation, and /or contractures . Pain, together with depression and fatigue, is associated with increased risk of cognitive impairment, functional dependence, and reduced quality of life in stroke survivors . Reported risk factors for the development of poststroke pain include female gender, older age at stroke onset, history of alcohol use and depression, anatomical location of stroke and presence of clinical features such as spasticity, reduced upper extremity movement, and sensory deficits .
Stroke Rehabilitation
Due to the medical complications after stroke, many patients are markedly functionally disabled when they are discharged from acute care. Functional recovery is based on the restitution of brain tissue and on the relearning of and compensation for lost functions . Therefore, understanding and identification of predictors of good rehabilitation outcomes in addition to institution of early rehabilitation are essential in the recovery phase after an acute stroke event.
Age has been well established as a strong predictor of functional outcome and discharge destination in stroke patients in multiple studies across the world in both young and elderly stroke survivors . A large community-based cohort study in Denmark reported more than 58% of the very elderly (85 years old and above) were discharged to nursing homes or died during hospital stay poststroke .
Cognitive impairment which occurs either as a prestroke condition or a poststroke is often significantly correlated with reduced functional gains and poor rehabilitation outcomes in elderly patients.
The cognitive impairment (preexisting or new) together with age was the most important predictor of institutionalization 3 years after stroke . Pre stroke dementia has been shown to increase risk of 6-month and delayed poststroke mortality . However, elderly stroke patients with cognitive impairments could still benefit from rehabilitation.
Hence, cognitive impairment should be screened for and has to be taken into consideration when rehabilitation goals are formulated and rehabilitation program ought to be individualized according to the stroke survivor’s learning ability .
Activities of Daily Living (ADL)
dependency on admission, significantly predicts functional dependency outcome in stroke survivors . Elderly stroke patients with poorer preadmission functional status also have longer length of stay and are less likely discharged to an independent or assisted living situation .
Aphasia arising from stroke was associated with worse outcomes in both the acute and chronic stroke periods with poorer functional recovery and increased length of rehabilitation and mortality risk .
Urinary incontinence is predictive of poor stroke outcome . Mortality at 6 months has been shown to increase in stroke patients with initial urinary incontinence . 64% of incontinent poststroke patients were discharged to nursing homes compared to 18% for continent poststroke patients . The link between urinary incontinence and poor outcomes could be related to incontinence associated with severe hemiparesis, larger stroke lesions, stroke lesion location, and a disruption of the neuromicturition pathways .
Rehabilitation process after Stroke
Rehabilitation aims to enhance and augment natural mechanisms of recovery. At the time of ischemic injury, immediate mechanisms of repair are initiated, which include resolution of poststroke edema, vicriation of function, and reversal of diaschisis. Vicariation refers to neighboring tissues taking over a function lost by the stroke-affected tissue . Diaschisis is based on the mechanism of reduction in metabolism and blood flow of intact brain regions which are distant away from the ischemic core but are still functionally and structurally connected with the ischemic core. It is thought that at least some of the improvement observed after a stroke could be due to the reversal of diaschisis .Such processes lead to “unmasking” of latent networks which can be as rapid as several hours within ischemic injury .
Evidence suggests that, within days of stroke, the injured brain has the ability for limited neuronal regeneration by angiogenesis and is coupled with neurogenesis. The ability to self-repair has been shown to happen in aged brains . The repair processes are initially intense and then slow down. Most of the spontaneous stroke recovery occurs in the first 3-6 months after the acute neurological event . Generally, patients make 70% of their recovery in the first 3 months after a stroke . Despite variations in therapy, such observations of proportional recovery have remained consistent which means that a minimum amount of spontaneous activity and therapy is enough for proportional recovery to happen . An exception to this proportional recovery rule includes damage to the corticospinal tract which results in poorer recovery from impairment .
In order to achieve a greater proportion of recovery, a much higher intensity of therapy has to be considered . Greater intensity of stroke rehabilitation has been associated with improved outcomes . Skill learning and active participation help to promote plasticity and network activation in stroke recovery . Motor retraining not only enables somatotopic reorganization to happen in perilesional areas and in distant areas connected to the infarct site but also negate the inhibitory effects of myelin associated proteins and ephrins which suppress axonal sprouting . An “enriched environment” in addition to motor retraining has been shown to facilitate motor recovery and neural plasticity in animal studies due to the numerous associated cellular and molecular effects . Rehabilitation facilities are ideal enriched environments as they are often situated in stimulating and specialized centers managed by a multidisciplinary team of medical professionals.
Specialized stroke rehabilitation units have been shown to improve functional outcomes, decrease mortality and reduce length of hosp stay in moderate to severe stroke patients . Combining an enriched environment with skill retraining, stroke rehabilitation units are made up of a multidisciplinary team of medical professionals who offer realistic goal setting and engage in multimodal disability and impairment assessment, medical management, and functional training.
The rehabilitation team addresses the many challenges stroke patients could face such as sensorimotor and balance impairments, dysphagia, cognitive-communication impairments, mood disorders, visual and hearing impairments, and hemispatial neglect. Regular multidisciplinary meetings are conducted to discuss the rehabilitation goals, rehabilitation intervention, functional improvement, discharge planning, and arrangement of outpatient rehabilitation. These structured meetings have been shown to improve functional outcomes . Such collaborative teamwork involves communication among the team members, working towards a common goal and accepting responsibility as a group for the final outcome of the patients . Recommended realistic goals are also planned together with the patients and their caregivers to prepare them for a smooth transition to outpatient rehabilitation and discharge destination with the eventual aim to achieve maximum independence as possible .
The hours of therapy vary across different inpatient rehabilitation settings. Generally, most guidelines advocate minimum 45 minutes of each relevant therapy for at least 5 days a week .I Immediate rehabilitation can improves functional outcomes, independence, and mortality compared to a subacute rehabilitation, given the interprofessional team of providers, advanced treatment strategies, and the requirement that patients participate in therapy at least three hours daily . Patient’s ability to tolerate such level of intensity has to be taken into account when considered for an acute intensive inpatient rehabilitation placement. When the stroke patient is admitted to inpatient rehabilitation, the rehabilitation team would assee patient and determine an individualized rehabilitation program of suitable intensity and duration to suit the needs for favorable stroke recovery .
It is generally recommended to commence stroke rehabilitation as soon as patients are medically stable, to maximize their functional gains and to take advantage of the period of early stroke recovery . However, caution and individualized clinical judgement are indicated especially in older patients and patients with intracerebral hemorrhage .
Very early, more frequent, and increased dose of mobilization intervention reduced the odds of a favorable outcome at 3 months after stroke when compared with usual care .
Earlier access to rehabilitation seems to favor better functional outcomes, shorten length of hospital stay, and increase likelihood of discharge to home .
Due to residual functional disability and associated medical complications, poststroke elderly survivors and their caregivers often experience significant physical, mental, and social challenges adischarged home. In most cases, caregivers are usually poorly understood and ill-prepared for their roles and responsibilities they must face at home As elderly stroke survivors require substantial care demands at home, their caregivers often feel overwhelmed and exhausted, which eventually lead to depression and deterioration of physical health .
Conclusion
The following support as being most important to recovery sfter Stroke
Be provided with hope for the best possible recovery I can make now and into the future
Receive psychological and emotional support in a form that best meets my needs
Be included in all aspects of society regardless of any disability I may have
Receive support (financial or otherwise) to ensure I am cared for in the longer term
Be supported to return to work and/or other activities I may choose to participate in after my stroke
Get access to formal and informal advocacy to assist me with access to the services I need
Be connected to other stroke survivors and caregivers so I may gain and provide support in my recovery from stroke
In conclusion, stroke in elderly patients poses a major public health concern, due to its strong association with multiple medical complications, poorer functional outcomes, and substantial healthcare cost. For stroke survivors and their families, a good and comprehensive rehabilitation program is the key to recovery and to enable them to reach their highest level of independence as possible. The success of a stroke rehabilitation unit depends on the effective utilization of its resources and seamless coordination between different healthcare professionals as well as the ongoing support from the caregivers and other community services. Provision of evidence-based and culturally relevant stroke rehabilitation will help to effectively manage limited local healthcare resources and improve quality of life in our aging population.
Monday, October 15, 2018
Replay From International Headache Society (IHS) for M.A.Aleem Neurologist India request to Proclaim World Headache Day
14.10.2018
REPLAY From
Stefan Evers
Secretary
International Headache Society (IH
Dear Colleague,
Thank you very much for this initiative. IHS has been debating the implementation of a World Headache Day for some time now. We have a small group working on this. However, it is difficult to get all stakeholders under one umbrella. We hope to make a step forward next year.
Best wishes,
Stefan Evers
ALEEM schrieb am 2018-10-13:
Sunday, October 14, 2018
Saturday, October 13, 2018
World Thrombosis Day 2018 October 13th -M.A.Aleem India
Thrombosis Day is 13 October 2018, but thrombosis is a condition that causes 1 in 4 people to die around the world every year.
Together, we can Keep Life Flowing and build a community of engagement.
Friday, October 12, 2018
Wednesday, October 10, 2018
Award for neurologist
https://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/Award-for-neurologist/article15218969.ece/amp/
Tuesday, October 9, 2018
Monday, October 8, 2018
Sunday, October 7, 2018
Saturday, October 6, 2018
Health Tips for Rainy Days - Dr.M.A.Aleem Trichy Tamilnadu India
Health Tips for Rainy Days
Dr.M.A.Aleem M.D.D.M (Neuro)
Emeritus Professor
The Tamilnadu Dr.M.G.R. Medical University
Past President
Tamilnadu Pondycherry Association of Neurologists
Former Vice-Principal
KAPV Govt. Medical College and MGM Govt. Hospital.
Fromer HOD and Professor of Neurology Senior Neurology civil surgeon KAPVGMC and
MGM Govt. Hospital
Consultant Neurologist
ABC Hospital
Trichy 620018
Tamilnadu
India
drmaaleem@hotmail.com
Phone 9443159940
The India Meteorological Department has said that a heavy to very heavy rainfall in Tamilnadu for the next 5 days. There are also chances of extremely heavy rainfall (above 24.4 cm)
In rainy days staying healthy requires self care .
The rain and water lying around makes it easy for mosquitoes to breed and increases the risk of mosquito transmitted infections, such as malaria and dengue fever and encephalitis. Viral infections such as hepatitis are also common in addition to bacterial diseases such as typhoid cholera and diarrhoea. The high humidity can also contribute to numerous skin diseases and fungal infections.
Chronic skin conditions such as eczema, acne and psoriasis tend to worsen during the monsoon season. The climate is also ideal for fungus to thrive.
Health Tips for Rainy season days
If you’re fond of street food, the rainy season isn’t the time to indulge. Pollution of water and raw vegetables is very common during these days. You can easily fall ill from contaminants.
Apply a strong insect repellent to keep mosquitoes away and prevent getting bitten.
Where possible, try to avoid walking through dirty water.
Besides leptospirosis, it can lead to numerous fungal infections of the feet and nails.
Also avoid walking where water is lying on the road, as traffic will drive by and spray it all over you.
Dry your feet whenever they get wet. Don't continue to wear wet socks or wet shoes.
Keep your skin clean by bathing twice a day. The humidity can cause a buildup of sweat and dirt, along with other toxins, on the surface of the skin.
Avoid colds and coughs by keeping your body warm and dry.
Don’t enter air conditioned rooms with wet hair and damp clothes.
Avoid wearing tight clothing or clothing made out of synthetic fabric.
Stick to pure cotton or linen.
Use anti-fungal talc to prevent accumulation of sweat and moisture in skin folds.
If you suffer from asthma or diabetes, avoid staying anywhere with damp walls. It promotes the growth of fungus and can be especially harmful.
Drink lots of warming herbal teas, especially those with antibacterial properties.
Take Vitamin C to boost your immune system and help fight off infections.
Children's skin is particularly vulnerable during the monsoon season. Impetigo is a contagious skin infection that causes red sores that can break open, ooze fluid, and develop a crust. The sores usually appear around the mount and nose. Scabies, from mites, is also common during the monsoon and produces itchy skin.
Do's and Don'ts in Rainy Days
Enjoying rain is not a grave matter if you are taking some on-time precautionary measures as sometimes a little carelessness will lead to serious consequences. Let’s learn some Do’s and Don’ts to follow during the monsoon season.
The Hygiene and Food
Don’t: Don’t eat or drink outside food and water. Your immune system is at a risk in rainy season. The ailments that can catch you in this season are cough and cold, fevers, diarrhea, jaundice and typhoid. Most of these diseases are either food borne or water borne therefore the take care of hygiene .Drink boiled or authentically filtered water and avoid eating any street side food.
Do’s: It’s time to munch some Pakoras with imli sauce or gulp fresh lemonade with home -made French fries .Ask your mom to make monsoon dishes at home and for some time forget those weight loss regimens. Avoid too cold eatables and never consume food and water that’s or have been left uncovered.
Bathing in the Rain Shower:
Don’t: Never get wet in unhygienic premises or open fields where you are surrounded by pollutants .Remember, chicken gunya, Dengue and other contagious pathogens are just behind you in this season therefore enjoy rain at a neat and clean location.
Do’s: Enjoy the pouring rain standing right in your balcony or at roof top area .Feel every drop of rain and Thanks God for his immense blessings.
Clothing:
Don’t: Wear heavy or voluminous trousers. Avoid delicate fabrics for example chiffon or silk, don’t wear light colored dresses.
Do’s: wear lightweight and quick dry fabric preferably of a dark shade. During wet and windy season skinny trousers or leggings serves the best. They remain in their shape during a chilling gust of wind. Their fabric dries quickly, not letting you soaked for a longer period. Black is good as it will hide the signs of muddy debris.
Lightning Time:
Don’t: Lightning can hit 60 miles away from the nearest rainfall therefore never stand in open areas, like porches, balconies, swimming pools and sport arenas.
Do’s: At the time of lightning locate yourself under a sturdy building or hard-topped vehicles.
Skin Care:
Don’t: Don’t forget to hydrate or moisturize your skin. Monsoons can dehydrate dry skin as well as produce extra hydration on oily skin producing acne n therefore treat your skin according to the type.
Do’s: use a good cleanser to remove oil and dirt without disturbing the natural moisture. A high proportion of sunrays penetrate clouds therefore it is recommended to apply sunscreen, even though we are not directly exposed to the sun rays. A water-based sun block should be applied half an hour before going out.
Foot Care:
Don’ts: Don’t wear heavy shoes that enclose your feet and avoid dirty water to reach your feet to get saved from fungal infections.
Do’s: Try to wear light and open sandals as they will help your feet to get dried quickly.
Driving:
Don’ts: Don’t drive recklessly or compete or the speed.
Do’s: Drive slowly and put the pressure on brakes slowly. Try to avoid puddles or if you have to encounter them move slowly and carefully. Maintain a good distance from the vehicle in front of you to avoid accidents .Use headlights, fog lights and emergency lights and keep your wipers working .Motorcyclist should avoid to ride in heavy rains for emergencies they must wear helmets and check the treads of tyres, because less treads can cause skidding.
The most important precaution is to get away from any wiring or area where electric wires are present or exposed.
Friday, October 5, 2018
Thursday, October 4, 2018
Hospitals blamed for improper disposal of biomedical wastes Times of India On 5.10.2018 Trichy
Hospitals blamed for improper disposal of biomedical wastes
Times of India On 5.10.2018 Trichy
CITY
Balajee C R | TNN |
GET THE APP
Hospitals blamed for improper disposal of biomedical wastes
Oct 5, 2018, 00:42 IST
Cleared/435 Words
Trichy: Several private hospitals and clinics in the city are not been following due procedure in disposing of biomedical waste, consumer rights activists have claimed. Corroborating their claims, district collector K Rajamani said that he had been getting several complaints regarding improper disposal of medical wastes by some hospitals. However, doctors have denied the claims.
According to experts, generally, biomedical wastes constitute almost 85% non-infectious waste, 10% infectious, and the remaining 5% hazardous or radioactive. Some of them are biodegradable, while some aren’t. Doctors warned that improper disposal of biomedical wastes could lead to breakout of several diseases.
Last week, the Tamil Nadu Consumer Federation filed a complaint with collector Rajamani about the improper way of disposing biomedical waste by hospitals during the quarterly consumer meeting. “We’ve been receiving several complaints that most of the hospitals and clinics in the city have been disposing biomedical waste along with the domestic garbage and some times even at Uyyakondan canal,” consumer rights activist and president of the federation, M Sekaran said.
Rajamani said that he had been receiving such complaints from others as well. “I wouldn’t say that improper biomedical disposal has been happening at an alarming rate, but a handful of hospitals have been engaging in that. It’s an hazardous practice. Among those, a few of the hospitals are from within the city and few are on the outskirts,” he said.
The collector added that surveillance and probe would be held at hospitals in the city and if they were found to be not engaging in proper way of disposing the clinical waste, strict action would be taken against them.
The standard procedure followed in Trichy district is that biomedical wastes -- based on the categories -- are segregated and dumped into four different coloured (yellow, blue, red and white) bins. An agency, Medicare Enviro Systems, collects these wastes from the hospitals on a daily basis and does incineration at its incinerator at Sengipatti. Around 200 hospitals are said to have tied up with Medicare Enviro Systems, which receives around 500kg to 600kg of medical waste from Trichy district on a daily basis.
However, doctors in the city denied the allegations and said that Trichy is one of the top cities when it comes to adhering to proper disposal of biomedical waste. “Trichy is a pioneer in terms of how biomedical wastes should be disposed of in the right way,” former president of Indian Medical Association, Trichy, M S Ashraf said.
A representative from Medicare Enviro Systems though said that only 20% to 30% of hospitals did the segregation procedure efficiently by dumping the wastes as per the colour codes.
Vox pop:
Dr M A Aleem, neurologist
All of the doctors know how hazardous radioactive and chemical wastes from a hospital are – so all hospitals should pay extra emphasis for proper disposal of biomedical waste.
N Ravichandran,
corporation commissioner
So far, I’ve not heard of complaints about improper disposal of biomedical wastes by hospitals and clinics within the city. If there’s a specific complaint, I would immediately call for an inspection
Graphic points
Categories of biomedical wastes segregation under
colour codes
Yellow: human anatomical waste, animal anatomical waste, soiled waste, expired or discarded medicines, chemical waste, micro and other clinical lab waste and chemical liquid waste
Red: Contaminated waste (recyclable) like catheters, urine bags, syringes without needles etc.
White: Waste sharps including metals
Blue: Glassware
Improper way of disposing biomedical waste could lead to breakout of following diseases
(according to doctors)
1. Hepatitis
2. Dengue
3. AIDS
4. Cholera
5. Typhoid
6. Encephalitis
7. Soft tissue infections
8. Malaria
Wednesday, October 3, 2018
http://www.cockroachcreations.com/%e0%ae%ae%e0%ae%95%e0%ae%be%e0%ae%a4%e0%af%8d%e0%ae%ae%e0%ae%be%e0%ae%b5%e0%ae%bf%e0%ae%a9%e0%af%8d-%e0%ae%8e%e0%ae%b5%e0%ae%b0%e0%af%86%e0%ae%b8%e0%af%8d%e0%ae%9f%e0%af%8d-%e0%ae%9a%e0%ae%bf%e0%ae%95/
மகாத்மாவின் எவரெஸ்ட் சிகரம் என்று அழைப்போம் பிரதமருக்கு திருச்சி நரம்பியல் நிபுணர் வேண்டுகோள்
டாக்டர் எம்.ஜி.ஆர்., மருத்துவ பல்கலைக்கழகத்தில் பணியாற்றிய நரம்பியல் பேராசிரியரும், தமிழகம், பாண்டிச்சேரி நரம்பியல் நிபுணர்கள் அசோசியேசன் முன்னாள் தலைவரும், திருச்சியில் உள்ள கி.ஆ.பெ.விஸ்வநாதம் மருத்துவக் கல்லுாரி மற்றும் மகாத்மா காந்தி மருத்துவமனை முன்னாள் துணை முதல்வருமாக இருந்தவர் நரம்பியல் நிபுணர் எம்.ஏ.அலீம்.
தற்போது, நாட்டுக்கு சுதந்திரம் பெற்றுத் தந்த மகாத்மா காந்தியின் 150வது பிறந்த தினத்தை கொண்டாடியுள்ளோம். அவரை போற்றும் வகையிலும், 150 பிறந்த தினத்தை கொண்டாடும் வகையிலும், இமய மலையின் உயர்ந்த சிகரமான எவரெஸ்ட் சிகரத்தை, மகாத்மாமாவின் எவரெஸ்ட் சிகரம் என்று அழைக்க வேண்டும். இதற்கு பிரதமர் நரேந்திர மோடி, நடவடிக்கை எடுக்க வேண்டும், என்று நரம்பியல் நிபுணர் எம்.ஏ.அலீம் வேண்டுகோள் விடுத்துள்ளார்.
Tuesday, October 2, 2018
Monday, October 1, 2018
Subscribe to:
Posts (Atom)