SUICIDE – YOUNG AT RISK IN INDIA FOR World Suicide Prevention Day 10/09/2012

World Suicide Prevention Day 10/09/2012

SUICIDE – YOUNG AT RISK IN INDIA

Dr.M. A.ALEEM.M.D.D.M.,(Neuro)

Consultant Neurologist and Epileptologist.

Trained at Institution of neurology Queen’s Square London.

Professor of Neurology KAPV Government Medical college.

MGM Government Hospital Trichy -620017. Tamilnad,India.

 Introduction:

                          On average, almost 3000 people commit suicide daily. For every person who completes a suicide, 20 or more may attempt to end their lives. At the global level, awarness needs to be raised that suicide is a major preventable cause of premature death.Every year World Suicide Prevention Day on 10 September is adopted to promotes worldwide commitment and action to prevent Suicides September 10^th, 2012 marks the 10^th anniversary of the world Suicide Prevention Day: ten years of research, ten yars of prevention, ten years of education and dissemination of information.The theme of world Suicide Prevention Day this year 2012 is “Suicide Prevention across the Globe: Strengthening Protective Factors and Instilling Hope”

 The Magnitude of the problem:

                        Suicidal behaviour has become a major public health problem across the world. It is a complex phenomenon that usually occurs along a continuum, progressing from suicidal thoughts, to planning, to attempting suicide, and finally dying by suicide, which represents the final tragic outcome of a morbid process. Approximately one million people worldwide die by suicide each year. This corresponds to one death by suicide every 40 seconds.  Suicide attempts and suicidal ideation are far more common; for example, the number of suicide attempts may be up to 20 times the number of deaths by suicide. It is estimated that about 5% of persons attempt suicide at least once in their life and that the lifetime prevalence of suicidal ideation in the general population is between 10 and 14%. Suicide is one of the leading causes of death in the world and over the last years rates have increased by 60% in some countries. In addition, suicide statistics may not always be accurate. Many suicides are hidden among other causes of death, such as single car, single driver road traffic accidents, unwitnessed drownings and other undetermined deaths. In addition, suicide is estimated to be under-reported for multiple reasons including stigma, religious concerns and social attitudes. The psychological and social impact of suicide of the family and community is enormous.                                                                                                                                                                                                               Statistics:

<!--[if !supportLists]-->§  <!--[endif]-->Every year, almost one million people die from suicida;a ”global” mortality rate of 16 per 100,000, or one death every 40 seconds.

<!--[if !supportLists]-->§  <!--[endif]-->In the last 45 years suicide rates have increased by 60% worldwide. . Suicide is among the three leading causes of death among those aged 15-44 years in some countries, and the second leading cause of death in the 10-24 years age group;these figures do not include . suicide attempts which are up to 20 times more frequent than completed suicide.

<!--[if !supportLists]-->§  <!--[endif]-->Suicide worldwide is estimated to represent 1.8% of the total global burden of disease in 1998 and 2.4% in countries with market and former socialist economies in 2020.

<!--[if !supportLists]-->§  <!--[endif]--> Although traditionally suicide rates have been highest among the male elderly, rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of countries, in both developed and developing countries.

<!--[if !supportLists]-->§  <!--[endif]-->Mental disorders (particularly depression and alcohol use disorders) are a major risk factor for suicide in Europe and North America; however, in Asian countries impulsiveness plays an important role. Suicide is complex with psychological, social, biological, cultural and environment factors involved.

Problems in India:

                        Suicide in India is slightly above world rate. Of the half million people reported to die of suicide worldwide every year, 20% are Indians, for 17% of world population. In the last two decades, the suicide rate has increased from 7.9 to 10.3 per 100,000 with very high rates in some southern regions. In a study published in The Lancet in June 2012, the estimated number of suicides in India in 2010 was about 187,000, making the cause of 3 percent of death that  year. A large proportion of adult suicide deaths were found to occur between the ages of 15 years and 29 years, especially in women. Suicide attempters are ten times the suicide completers. In India age standardized are suicide death rate per 100,000 people at all age 18.6for boys and 12.7 for girls and women. Suicide become the second leading cause of death among the young in India.                                                                                                                                                                                          

                        The WHO reports about 1 million suicides a year, which would be a rate of about 14 per 100,000 in a global population of 7 billion. Suicide may soon be leading cause of death in india. In our country among men, 40 per cent of suicides were among people age 15-29. For women, it was nearly 60 per cent.

                        The rapid changes on society that have come with globlalization, the breakdown of the families. Suicide become the second-leading cause of death among the young in India. “The young face very high competition and pressure from families to succeed. Many parents think their child should come first in the class. Of course, that can’t happen,” may also lead to suicide . When youths start to despair, they often don’t think to seek help, or shun the idea because “they think psychiatry is only for crazy people,” So most of them landed in suicide. The risk of completing a suicide was 43% higher in men, who finished secondary or higher education, in comparison to those who had not completed primary education. Among women, the risk increased to 90%.

                             Four o f India’s southern states Tamil nadu, Andhra Pradesh, Karnataka and kerala  that together constitute  22% of the country’s population recorded 42% of suicide deaths in men and 40% of self-inflicted fatalities in women in 2010.Maharashtra and West Bengal together accounted for an additional 15% of suicide deaths. Delhi recorded the lowest suicide rate in the country. In absolute numbers, the most suicide deaths in individuals, aged 15 years or older, were in AP (28,000), Tamil Nadu (24,000) and Maharashtra (19,000). Of the total deaths by suicide in individuals aged 15 years or older, about 40% suicide deaths in men and about 56% in women occurred in individuals aged 15-29 years. Suicides deaths occurred at younger ages in women (average age 25 years) than in men (average age 34 years). Educated persons were at greater risk of completing a suicide.

                                                About half of suicide deaths (49% among men, and 44% among women) were due to poisoning(36.6%), mainly ingesting of pesticides. Hanging was the second(32.1%) most common cause for men and women, while burns(7.9%) accounted for about one-sixth of suicides by women.

                        

Age differences:

                            Suicidal behaviour can occur at any age. The frequency of  suicidal behaviour escalates steeply from childhood through middle to late adolescence and into adulthood. Suicide ranks as the second cause of death worldwide among 15-19 year olds, with at least 100,000 adolescents dying by suicide every year. Suicide rates are high among middle-aged and older adults and highest among those aged 75 and older. Elderly people are likely to have higher suicidal intent and use more lethal methods than younger people, and they are less likely to survive the physical consequences of an attempt.

Gender Differences:

                        On average, there are about three male suicides for every female suicide. This is more or less consistent across different age groups and in almost every country in the world. Conversely, rates of suicide attempts tend to be 2-3 time higher in women than in men, although the gender gap has narrowed in recent years. The disparity in suicide rates has been partly explained by the use of more lethal means and the experience of more aggression and higher intent to die, when suicidal, in men than women.There was a 64% correlation between domestic violence of women and suicidal ideation.

 Who is at risk of Suicide?  

(i) People with a history of suicide attempts of self harm:

                           A history of previous suicide attempt(s) of self harm is the strongest predictor of future death by suicide, corresponding to a 30-40 times higher suicide rate than the general population. The first days and weeks following psychiatric hospitalization represent the most critical period of suicide risk for patients. This finding highlights the need to attend carefully to continuity of care for psychiatric patients.

(ii) People with a psychiatric disorder and/or substance-related disorder:

                            It has beendocumented that approximately half of the people who seriously consider taking their lives have been diagnosed with a mental disorder during their life, and that up to 90% of people who die by suicide have dt least one psychiatric diagnosis. Among all dianoses, depressive disorders are most commonly associated with suicidal behaviour, followed by substance-related disorders, schizophrenia and personality disorders. Alcohol and drug abuse and dependence have been identified as important risk factors for suicidal thoughts and behaviours. Current substance use, even in the absence of abuse or debendence, is a significant rick factor for unplanned suicide attempts among those with suicidal thoughts. Comorbidity,namely the presence of two or more psychiatric disorders or a psychiatric disorder and a substance use disorder, significantly increases the risk of suicide.

  (iii)Those who experience stressful life events:

                              Stressful life events often act as precipitants of suicide attempts or suicide by those with a diminished capacity to cope with them. Impulsive attempts may follow stressful life events, including family and interpersonal conflicts, relationship breakdowns, other interpersonal difficulties, the presence of legal/disciplinary problems, and financial and job difficulties. Periods of economic crisis and unemployment are associated with greater social vulnerability and often an increase in deaths by suicide.Bereavement, consistently described as one of life’s most stressful events, has been shown to elevate the risk of suicide and suicidal behaviour in vulnerable people, particularly if the death is by suicide. The rick of suicide is aiso greater among patients with severe physical illnesses, such as cancer or HIV infection – in face, increased suicide rick has been found to be associated with a large number of medical conditions, ranging from asthma to traumatic brain injury. The experience of persistent stress also may explain the elevated risk of suicide in some occupations, such as physicians, military personnel and police officers, as well among people in prison. Moreover distal stressors, e.g. childhood trauma, have consistently been linked to an increased risk of suicidal behaviour in adult life.

(iv) Young at risk in India                                   

                        Young Indians are more likely to commit suicide than previously thought, especially those living in weathier and more educated regions, according to recent India’s rapid development is driving many youths to despair. Opportunities that have come with two decades of economic boom and open markets have also brought more job anxiety, higher expectations and more pressure to achieve, mental health.

                        Suicide rates are highest in the 15-29 age group, peaking in southern regions that are considered richer and more developed with better education, social welfare and health care. That puts the young at high risk-a new phenomenon experts said has happened recently as more middle-class youths strive to meet achievement expectations, and new technologies like cell phones and social networking sites help break down traditional family units once relied on for support. Few likely reasons for the rise in suicide among young people beyond the increased pressure that has come with new economic opportunity and social fragmentation.  The higher rates may come from “the greater likelihood of disaponintments when aspirations that define success and happiness are distorted or unmet by the reality faced by young people in a rapidly changing society are also a few likely factors to commit suicide by young in India.

Strengthening Protective Factors and Instilling Hope

(i) Protective factors:

                          Despite the wide experience of the above-cited rick factors in populations, the fact that completed suicide is a relatively rare event indicates that there are a range of protective factors that act to mitigate the effects of exposure to risk factors. Among psychological factors, resilience (the ability to cope with adverse life events and adjust to them), a sense of personal self-worth and self-confidence, effective coping and problem-solving skills, and adaptive help-seeking behaviour are ofter considered to be protective against the development of suicidal behaviours. Social and cultural factors such as religious and social integration, social connectedness and maintenance of good relationships with friends, colleagues and neighbours, access to support from relevant others and ready access to health care are associated with a reduced risk of suicide and reduced repetition of attempted suicide. In addition, a healthy lifestyle, with maintenance of good diet and sleep habits, regular physical activity, abstinence from smoking and illicit drug use, is also associated with a reduced risk of suicidal behaviour.

                          In Tamilnadu adolencent health programme and Chief Minister.Jayalalitha’s computer schme to school students are very much helpful to prevent suicide among  students. Along with the easy  school education, better exam results in tamilnadu are also helpful to prevent suicide in students.

(ii)Respect of Self Esteem:

                        World Health Organization states that “Worldwide, suicide is among the top five causes of mortality in the 15-to 19-years age group and in many countries it makes first or second as a cause of death among both boys and girls in this age group”. And recommends “strengthening student’s self-esteem” to protect children and adolescents against mental distress and dependency, and enables them to cope adequately with difficult and stressful life situations. And “prevention bullying and violence at school” that specific skills should be available in the education system to prevent bullying and violence in and around the school promises in order create a safe environment free of intolerance. And as well “to de-stigmatize mental illness”.

Treatment:

                        There are various treatment modalities to reduce the risk of suicide by addressing the underlying conditions causing suicidal ideation, including, depending on case history, medical pharmacological and psychotherapeutic talk therapies.

                        The conservative estimate is that 10% of individuals with psychiatric disorders may have an undiagnosed medical condition causing their symptoms, upwards of 50% may have an undiagnosed medical condition which if not causing is exacerbating their psychiatric symptoms. Illegal drugs and prescribed medications may also produce psychiatric symptoms. Effective diagnosis and if necessary medical testing which mau include neuroimaging to diagnose and treat result of psychiatric symptoms, most often including depression, which are present in up to 90-95% of cases.

                        Recent research has shown that Lithium has been effective with lowering the risk of suicide in those with bipolar disorder to the same levels as the general population. Lithium has also proven effective in lowering the suicide risk in those with unipolar depression as well.   

                        There are multiple evidence-based psychotherapeutic talk therapies available to reduce suicidal ideation suth as dialectical behaviour therapy (DBT) for which multiple studies have reported varying degrees of clinical effectiveness in reducing suicidality. Benefits include a reduction in self-harm behaviours and suicidal ideations. Cognitive Behavior Therapy for suicide prevention (CBT-SP) is a form of DBT adapted for adolescents at high risk for repeated suicide attempts

Suicide prevention is possible:           

                        Suicide is a multi-determined phenomenon that occurs against a background of complex interacting biological, social, psychological and environmental rick and protective factors. Despite the complexity of this phenomenon, suicide can be prevented.

(i)Primary prevention:

                        Primary prevention of suicide requires broad modifications of social, economic and biological conditions to prevent members of a population from becoming suicidal. Primary prevention involves population-based interventions, rather than focusing on the individual at risk. Primary preventive interventions include restricting access to lethal methods, promoting physical health and positive mental health, promoting a responsible representation of suicide in social and other media, seeking to reduce stigmatization of mental illness and suicide and encouraging help-seeking behaviour through public awarness and education campaigns.

(ii)Secondary prevention:

                        Secondary prevention is aimed at minimising suicide risk in high-risk populations. In this sense, early identification of suicidal individuals, accurate diagnosis and effective treatment of mental health problems, especially mood disorders and substance-related disorders are crucial. More than half of the patients who die by suicide have seen their primary care physician within the month before their death. Therefore, improving primary care physicians’ recognition of psychiatric symptoms and disorders, suicide risk evaluation, treatment interventions and referral skills are key components of suicide prevention. Similarly, providing educational programs for “gatekeepers” (people who regularly come into contact with individuals or families in distress, such as clergy, first responders, pharmacists, teachers and police) can improve recognition of the risk of suicide and self-harm and facilitate referral of vulnerable people to appropriate assessment and treatment facilities.

(iii)Tertiary prevention:

                        Finally, tertiary prevention is aimed at preventing relapses of suicidal behaviour after a suicide attempt. This also involves the critical work of postvention __ the care, support and treatment of those impacted by suicide.

Suicide prevention in India:

                        In our country A three pronged attack to combat suicide are (1) reducing social isolation, (2) prevent social disintegration,and (3) treating mental disorders. Additionally a set of state led policies an being enforced to decrease the high suicide rate among farmors. Counselling program for school and college students along with their parents and teachers are also helpful to prevent suicide among students.                                                                                                                                        Suicides can be prevented through interventions like banning the most toxic pesticides and teaching rural communities on safe storage of pesticides. India should also start mental health promotion for toung people through schools and colleges and introduce crisis counseling services and services for treatment of depression and alcohol addiction.” In India current concern about suicides has focused on agricultural workers, over three in four suicide death in India occur in other occupational group( including those who are unemployed and homemakers).                                                                                                                                                                         Most suicide death occurred in rural areas –the age standardized death rates were about two times higher in rural than in urban areas. A reduced risk of suicide versus other causes of death in women who were widowed, divorced or separated, compared with married women and men. So marriage at appropriate age and time can also helpful to prevent suicide in reporductive age group.                                                                

                                                                                                        

 Dr.M. A.ALEEM.M.D.D.M.,(Neuro)                                                                           Consultant Neurologist and Epileptologist.                                                 Trained at Institution of neurology Queen’s Square London.                                                    Professor of Neurology KAPV Government Medical college.                                                     MGM Government Hospital Trichy -620017. Tamilnad,India.

                                                   

To Much Meat/Mutton Increases Stroke Risk

To much red meat intake such as Lamp, Beef, Pork and veal intake in a single serving as fresh, processed, and total red meat consumption in a day increases the risk for brain attack. one serving is equaled approximately 50grams of processed meat and one serving of fresh red meat and total red meat equaled to 100 to 120 grams. The risk of getting stroke with red meat is 11%to 15%. Red and possessed meat intake has also been associated with stomach and other cancers heart attack, type two diabetes, high blood pressure, heart failure and premature death. Its not just the fat content of the red meat that contributes to stroke but it may also be the heme iron in the red meat and the nitrates and nitrites found in the processed meat by increasing the blood pressure add the risk for getting stroke. Health message is to reduce the consumption of red meat especially processed meats and replace them with other other protein rich food such as poultry and fish and legumes. Its also good to adopt Islamic way of killing Lamps cows poultry and other allowed animals to eat. Islamic type of cutting animals may be useful to led out blood completely from the animals there by the heme iron one of the cause that increases the risk of stroke in the animal meat is very much reduced.

The Hindu : FEATURES / EDITORIAL FEATURES : Peace and tranquillity prevails

The Hindu : FEATURES / EDITORIAL FEATURES : Peace and tranquillity prevails

Apple prevent stroke

Intake of white fruits such as apple pears and vegetables is associated with lower risk of brain attack. Among four groups of fruits and vegetables such as green orange/yellow red /purple and white there is 9% reduction in stroke for each 25g per day increase in white fruits and vegetables intake with apple and pears. so an apple a day keeps stroke away.

HEALTH EFFECTS OF RAMADAN FASTING

HEALTH EFFECTS OF RAMADAN FASTING Dr.M.A.Aleem.MD.DM{Neuro} Professor of Neurology K.Apv Govt Medical collage&MGM Govt Hospital Trichy

This year the islamic month of Ramadan will start on July 20^th. Muslim all ove the world will start this month with fasting from dawn to dusk daily for 30 days as ordained in Quran.

Spiritual Aspect of Fasting:

“O you who believe fasting is prescribed to you as it was prescribed to those before you so that you can learn Taqwa”(Quran 2:183)

The Arabic word Taqwa is translated in many ways including God consciousness, God fearing, piety, and self restraing. Thus we are asked to fast daily for one Month from dawn to dusk and avoid food, water, sex and vulgar talk during that period.

But why do we need to fast? It is our experience that temptations and ways of the world tend to spoil our purity and austerity. Thus we indulge in food all of the time, snacking and nibbling the whole day, heading to obesity. We drink too much coffee, or tea, or carbonated drinks. Some sexaholics can not stay away from sex unless they do it at least once or more aday. When we argue, we leave our decency aside and resort to vulgar talk and even physical fighting.

Now when one is fasting, he or she cannot do all of that. When he looks at the mouth watering food, he cannot even taste it and he has to give up snacking and nibbling as well as smoking cigarettes if he dose. No constant coffee, tea, or coke drinking either. Sexual passions have to be curtailed and when he is provoked to fight, he says “I am fasting that Icannot respond to your provocation”. To achieve God consciousness or God nearness, a better, word, we are advised to do additional prayer and read the Quran.

Medical benefits of Fasting:

Medical benefits of Ramadan muslims do not fast because of medical benefits which are of a secondary nature. Fasting has been used by patients for weight management, to rest the digestive tract and for lowering lipids. There are many adverse effects of total fasting as well as of crash diets. Islamic fasting is different from such diet plans because in Ramadan fasting, there is no malnutrition or inadequate calorie intake. The calorie intake of Muslims during Ramadan is at or slightly below the nutritional requirement guidelines. In addition, the fasting in Ramadan is voluntarily taken and is not a prescribed imposition from the physician.

Ramadan is a month of self-regulation and self training, with the hope that this training will last beyond the end of Ramadan. If the lessons learned during Ramadan, whether in terms of dietary intake or righteousness, are carried on after Ramadan, there effects will be long lasting. Moreover, the type of food taken during Ramadan does not have any selective criteria of crash diets such as those which are protein only or fruit only type diets. Everything that is permissible is taken in moderate quantities.

The difference between Ramadan and total fasting is the timing of the food; during Ramadan, we basically miss lunch and take an early breakfast and do not eat until dusk. Abstinence from water for 8 to 10 hours is not necessarily bad for health and in fact, it causes concentration of all fluids within the body, producing slight dehydration. The body has its own water conservation mechanism; in fact, it has been shown that slight dehydration and water conservation, at least in plant life, improve their longevity.

Physiological effect of Fasting:

The physiological effect of fasting includes lowering of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recoommendation for the treatment of mild to moderate, stable, non-insulin diabetes, obesity, and essential hypertension. In 1994 the first international Congress on “Health and Ramadan”, held in casablanca, entered 50 extensive studies on the medical ethics of fasting. While improvement in many medical conditions was noted; however, in no way did fasting worsen any patients’ health or their baseline medical condition. On the other hand, patients who are suffering from sever diseases, whether type I diabetes or coronary artery disease, kidney stones, etc., are exempt from fasting and should not be allowed to fast.

Psychological effects of Fasting:

There are psychological effects of fasting as well. There is a peace and tranquility for those who fast during the month of Ramadan. Personal hostility is at a minimum, and the crime rate decreases. Muslims take advice from the prophet who said, “If one slanders you or aggresses against you, say I am fasting.” This psychological improvement could be related to better stabilization of blood glucose during fasting as hypoglycemia after eating, aggravates behavior changes. There is a beneficial effect of extra prayer at night. This not only helps with better utilization of food but also helps in energy output. There are 10 extra calories output for each unit of the prayer. Again, we do not do prayers for exercise, but a mild movement of the joints with extra calorie utilization is a better form of exercise. Similarly, recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory.

One of the odd nights in the last 10 days of Ramadan is called the night of power when angels descend down, and take the prayer of worship to God for acceptance.

Fasting is a special act of worship which is only between humans and God since no one else knows for sure if this person is actually fasting. Thus God says in hadith qudsi that “Fasting is for Me and I only will reward it”. In another hadith, the Prophet Mohammed (peace be upon him) has said “If one does not give up falsehoods in words and actions, God has no need of him giving up food and drink”.

Health issues of Fasting:

Special issues that may arise in consultation during Ramadan include providing advice on appropriate diet and on medical compliance among the muslim population.In this article,I Provide a personal perspective of why muslim fast and, as a muslim doctor, what advice I consider may be appropriate for fasting customers both healthy and those on medication, such as diabetic patients

The observance of fasting during Ramadan constitutes one of the five pillars of Islam. The experience of fasting is intended to teach muslims self-discipline and self-restraint, and understand a little of the plight of the less privileged (e.g., the hungry, the thirsty and the poor). Furthermore, Ramadan fasting is not just about disciplining the body to refrain from eating and drinking from predawn until sunset but is also about exerting control over the mind. This involves restraining anger, doing good deeds, exercising personal discipline, and preparing oneself to serve as a good Muslim and a good person. Ramadan is a month of peace and love in which individuals are encouraged to bury dufferences, to forget and forgive and to renew both human and spiritual relationships. Therefore, it contributes to the overall principle of making the individual more humane, more considerate and generally a more responsible member of society not just the individual. It does this, in part, by setting a standard for behaviour not only in this month but during the rest of the year and, indeed, every year muslim’s life. These principal tenets of Ramadan are important wheb considering our intentions and subsequent actions during this spiritual month, including those pertaining to the health of the individual. Fasting during Ramadan is prescribed for every healthy, adult Muslim whereas the weak, the sick, children, travellers and menstruating women are among those exempt. Muslims observing the fast are required to abstain not only from eating food and drinking water but also from consuming oral medicines and injecting intravenous nutritional fluids. However, not all Muslims who are ill seek this exemption and insist on fasting in any case. Fasting by Muslims during illness can cause problems if not supervised by health professionals. However, health problems during Ramadan can develop in otherwise healthy individuals and such patients could benefit from receiving advice on their diet.

Advice on diet for Fasting:

During this year where Ramadan falls in the mansoon season, and we do not have the very long days of the summer heat to contend with, most health problems are likely to arise from inappropriate diet or as a consequence of over-eating and Insufficient sleep.

There is no need to consume excess food at iftar (the food eaten in the period immediately after sunset to break fast), dinner, or sahur (the light meal generally eaten about half an hour to one hour before dawn). The reasons for this are two-fold. First, and most importantly, such a lifestyle contradicts the principle aims and spirit of Ramadan. Over-eating can be seen as a reflection of weak discipline and irresponsibility. Secondly, the body has regulatory mechanisms that reduce the metabolic rate and ensure efficient utilisation of body fat. Furthermore, most people assume a more sedentary lifestyle while fasting. The net result is that a balanced diet, that consists of less than the normal amount of food intake, is sufficient to keep a person healthy and active during the month of Ramadan.

To remain healthy during Ramadan, one should consume food from the major food groups: bread and cereal, milk and dairy products, fish, meat and poultry, beans, vegetables and furits. (Vegetarians and vegans should amend this list as appropriate.) Intake of fruits after a meal is strongly suggested. Diet in Ramadan should not differ much from the normal diet and should be as simiple as possible. The diet should be such that normal weight is maintained, neither losing nor gaining. However, if one is overweight, Ramadan is an ideal time to try to normalise one’s weight.

In view of the long hours of fasting, the so-called “complex carbohydrates”or slow digesting foods should be consumed at sahur so that the food lasts longer (about eight hours) resulting in less hunger during the day. These complex carbohydrates are found in foods that contain grains and seeds like barley, wheat, oats, millet, semolina, beans, lentils, wholemeal flour and unpolished rice.

In contrast, refined carbohydrates or fast-digesting food last for only three to four hours and may be better taken at iftar to restore blood glucose levels rapidly. Fast-burning foods include those that contain sugar and white flour. Dates are an excellent source of sugar, fibre, carbohydrates, potassium and magnesium and have been recommended since the days of the prophet Mohammed asa good way of breaking the fast.

Fried foods, very spicy foods and foods containing too much sugar, such as sweets, can cause health problems and should be limited during Ramadan. They cause indigestion, heart-burn and weight problems. Fasting can often increase gastric acidity levels causing a burning feeling, a heaviness in the stomach, and a sour mouth. This can be overcome by eating foods rich in fibre such as whole wheat bread, vegetables, hummus, beans, and fruits. These foods trigger muscular action, churning and mixing food, breaking it into small particles, and thus help reduce the build up acid in the stomach. Drinking of sufficient water and juicies between iftar and sleep to avoid dehydration, and for detoxification of the digestive system, should be encouraged in fasting individuals. However, the intake of large amounts of caffeine-containing beverages should be avoided, especially at sahur. For example, drinking too much tea will increase urine output and inevitably cause the loss of valuable mineral salts.

Fruits such as bananas are a good source of potassium, magnesium and carbohydrates. However, bananas can cause constipation and their intake has to be balanced with adequate fibre intake.

It is recommended that everyone engage in some kind of light exercise, such as stretching or walking. Overweight people should increase the amount of exercise and reduce the amount of food intake to help reduce weight.

It is also important to follow good time management procedures for Ibada (prayer and other religious activities), sleep, studies, work, and physical activities of exercise. A good balance in the amount of time attributed for each activity will lead to a healthier body and mind in Ramadan.

Advice for the sick who fast during Ramadan Fasting :

Ramadan fasting is obligatory for the healthy adult but, when fasting might significantly affect the health of the fasting individual or when one is genuinely sick, Islam exempts him or her from fasting. “God intends every facility for you, he does not want to put you into difficulties” (koren 2:185). From an Islamic point of view, this exemption represents more than a simple permission not to fast. The prophet said: “God likes his permission to be fulfilled, as he likes his will to be executed.” Another saying suggests that “a gift that God gives you, you have to accept”. In the light of these sayings, many believe that any Muslim who is sick, or whose sickness would adversely affect his well-being during the fasting period, should either not fast or at least break his fast accordingley. An additional argument often used is that if the fasting by a sick Muslim would jeopardise his health further, then this ultimately will neither benefit himself nor his role in society (Ummah) and he should be discouraged from observing the fast.

However, a significant number of patients, for whatever reasons, do decide to observe the fast. It is these patients who need to seek the opinion of health professionals on an individual basis.

Those suffering from minor ailments do not really have any problems fasting.

Those suffering from acute conditions may need advice about altering their dosing regimen. Drug that are normally required to be taken frequently, such as antibiotics, can be problematic for fasting patients. However, the increasing formulation of short- acting drugs as sustained release preparations, have offered much needed assistance to fasting patients.

For example, patients suffering form acute upper respiratory infections, such as a severe sore throat, may still be able to fast. Such a patient might be prescribed antibiotics that have to be taken three or four times a day and would not be able to fast. However, in order to facilitate fasting, the patient could be given a long-acting antibiotic, such as co-trimoxazole, which only needs to be taken 12- hourly, or azithromycin, which only needs to be taken once daily. This can be done only when the infecting organisms are susceptible to the alternative antibiotics, and needs to be discussed with the patient’s doctor.

Alternative routes of drug administration can help fasting patiens. Some patiens suffering from mild forms of angina pectoris could benefit from taking glyceryl trinitrate as a patch rather than sublingual tablets. The drug would enter the blood stream through the skin, and not orally (which would break the fast).

Again, this may only be possible in specific patients and needs to be discussed with the patient’s doctor. Doctoris should be willing to advise patients and practitioners on the availability of alternative dosage forms for medication during Ramadan.

There is a school of thought among medical practitioners that those patients who have mild to moderate high blood pressure and are also overweight should be encouraged to fast as this physician to adjust their medication. For example, the dose of diuretics should be reduced to avoid dehydration, and sustained release formulations can be given once a day before the predawn meal.

An increasing area where practitioners are likely to advise patients on fasting is in those suffering from diabetes mellitus. Many muslim, especially of Asian descent, have an increased risk of suffering from some from of diabetes.

The International Journal of Ramadan Fasting Research has suggested the following guidelines for health professionals treating Muslim patients with diabetes: “Diadetic patients who are controlled by diet alone can fast and hopefully,with weight reduction, their diabetes may even be improved.

Diabetics who are taking oral hypoglycaemic agents along with the dietary control should exercise extreme caution if they decide to fast. These patients should consult their medical doctor for dose adjustment. If they develop low blood sugar symptoms in the daytime, they should end the fast immediately.” In addition, diabetic patients taking insulin, should consult their doctor to see if their dose can be adjusted to allow fasting during Ramadan. In all cases of fasting with diabetes, blood sugar levels should be closely monitored, especially before and after meals.

General Recommendations for Ramadan fasting:

Do’s

• Maintain calorie intake to roughly what you take when not fasting. Ramadan is not for losing weight, unless you are overweight and. want to lose weight. Maintain the same level of activities (calorie expenditure) as when you were not fasting

• Eat slow burning foods, esp. At Suhur time. Complex carbohydrates are slow burning foods;e.g. wheat, bran, oat, beans, lentils, whole wheat flour, etc. Haleem is a good healthy slow burning meal!

• Eat high fiber foods, like whole wheat, oats, beans, lentils, vegetables (green beans, peas, spinach, and beetroot), fruits like figs, purnes, etc.

• Eat balanced meal, e.g. vegetables, fruit, meat (chicken, beef, and fish), bread, cereal, dairy products.

• Drink plenty of water and fluids. (water is preferable)

Do not

• Do not eat fast burning foods. Refined carbohydrates are fast burning foods, e.g. White flour bread, refined sugar, etc
• Do not eat fried and fatty foods. These cause heartburn and weight gain.

Do not (continued)

• Do not over-eat, especially at suhur time
• Tea: Do not drink excessive amount of tea, especially at suhur time. It contains theophylline, which is a mild diuretic (causes urination) and may exacerbate fasting related dehydration, and may contribute to salt and electrolyte deprivation. (coffee does not contain theophylline.) It is not healthy to drink tea for breaking the Fast.

Special Considerations:

Diabetes.

Non-insulin requiring diabetes mellitus (NIDDM) is aiso called adult onset diabetes. If it diet controlled or requires oral medication, then fasting may be done with precaution, after consulting your doctor. It may require reducing the dose of diabetic medication, and strict adherence to anti-diabetic diet, including eating complex carbohydrates (slow burning foods.) If you require insulin shots, then it may be too risky to observe Fasting.

Constipation.

Causes: Dehydration may exacerbate constipation, leading to piles or anal fissure which is very painful cracking lesion in anal area. Remedies: Drink plenty of water and fluids, high fiber containing fooda & vegetable. Using a stool softener pill (over the counter), psyllium (metamucil, etc.) powder, prune juice, etc. As a preventive measure might be helpful

Indigestion, Bloating.

Causes: Overeating, fried and fatty foods, eggs, cabbage, carbonated, drinks, like colas. Remedies. Avoid the above foods.

Lethargy, Feeling weak & Lightheaded.

Causes: Insufficient fluid and salt intake, or excessive fluid and

Electrolyte loss. Remedies: Increase water and fluid intake. Avoid

Excessive sweating and keep cool.

Hypoglycemia.

Low blood sugar. May cause feeling of weakness, especially in the

afternoon. Remedies: Eat Suhur. Eat slow digesting foods (complex

carbohydrates.) Avoid fast burning refined foods (white flour freads,

refined sugar containing foods)

Headache, nevousness, irritability.

Causes: This may be due to caffeine or nicotine withdrawal in those people who are dependent on these substances. Remedies: One to two errkd prior to starting the Fasts, gradually reduce the intake of tea, coffee, and

Cigarettes. Several carbonated drinks have added

Caffeine. Read the lable and what you are drinking!

Muscle Cramps.

Causes: Inadequate intake of calcium, magnesium and potassium

Remedies Eat foods rich in minerals, like vegetables,

Fruits, dairy products, dates,meat products.

Peptic Ulcer, Hiatal hernia, Gastritis, High Blood pressure, Kidney stones.

Consult tour doctor if you intend to Fast in Ramadan, if you suffer

From any of these.

Neurologica 2012

Neurologica 2012 is held at Hua kin from 14 to 17th July. Topics are very useful. I participated on floor discussion on status epilepticus topic presented by prof Shorovn.

WORLD HEPATITIS DAY 2012.

Every year WHO announces July 28th as world hepatitis day since 2007 to create awareness on hepatitis. Hepatitis viruses A B C D and E can cause acute and chronic infections of the liver and involve other organs. These viruses are a global health risk with around 240 million people being chronically infected with hepatitis B and around 150 million people being chronically infected with hepatitis C. This year theme for world hepatitis day is IT'S CLOSER THAN YOU THINK. Hepatitis doesn't discriminate against age race or gender.It can affect any one any where. Know it Confront it and get tested. To over come the hepatitis B infections in Tamilnadu our CM Jayalalitha has introduced Pentavalent vaccines along with hepatitis B vaccine for all children in Tamilnadu.