Dr. M .A. Aleem become member of prestigious American Acedemy Neurology

Dr. M .A. Aleem become prestigious member of American Acedemy Neurology

The quality of life is good in patients with knee replacement. ALEEM.M.A. HAKKIM.A.M.BMJ 2017;356:j1131

BMJ

Research

Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1131 (Published 28 March 2017)

Cite this as: BMJ 2017;356:j1131

Rapid response

Re: Impact of total knee replacement practice: cost effectiveness analysis of data from the Osteoarthritis Initiative

The quality of life is good in patients with knee replacement.

Patients with knee replacement are free from pain. They may also have improved gait. Their day today activities of daily living also show improvement.

Most knee replacement implants are made from non-ferromagnetic materials and, therefore, tend to be acceptable for patients undergoing MRI examinations.

Competing interests: No competing interests

30 March 2017

M A Aleem

Neurologist

A M Hakkim

ABC Hospital

Annamalainagar Trichy 620018 Tamilnadu India

@drmaaleem

Epilepsy is still a reason for prohibiting or annulling marriages in India

Epilepsy is still a reason for prohibiting or annulling marriages in India

Epilepsy is a chronic noncommunicable disorder of the brain that affects people of all ages.
Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.
Nearly 80% of the people with epilepsy live in low- and middle-income countries.
People with epilepsy respond to treatment approximately 70% of the time.
About three fourths of people with epilepsy living in low- and middle- income countries do not get the treatment they need.
In many parts of the world, people with epilepsy and their families suffer from stigma and discrimination.
Epilepsy is a chronic disorder of the brain that affects people worldwide. It is characterized by recurrent seizures, which are brief episodes of involuntary movement that may involve a part of the body (partial) or the entire body (generalized), and are sometimes accompanied by loss of consciousness and control of bowel or bladder function.
Seizure episodes are a result of excessive electrical discharges in a group of brain cells. Different parts of the brain can be the site of such discharges. Seizures can vary from the briefest lapses of attention or muscle jerks to severe and prolonged convulsions. Seizures can also vary in frequency, from less than 1 per year to several per day.
One seizure does not signify epilepsy (up to 10% of people worldwide have one seizure during their lifetime). Epilepsy is defined as having 2 or more unprovoked seizures. Epilepsy is one of the world’s oldest recognized conditions, with written records dating back to 4000 BC. Fear, misunderstanding, discrimination and social stigma have surrounded epilepsy for centuries. This stigma continues in many countries today and can impact on the quality of life for people with the disorder and their families.
Signs and symptoms
Characteristics of seizures vary and depend on where in the brain the disturbance first starts, and how far it spreads. Temporary symptoms occur, such as loss of awareness or consciousness, and disturbances of movement, sensation (including vision, hearing and taste), mood, or other cognitive functions.
People with seizures tend to have more physical problems (such as fractures and bruising from injuries related to seizures), as well as higher rates of psychological conditions, including anxiety and depression. Similarly, the risk of premature death in people with epilepsy is up to 3 times higher than the general population, with the highest rates found in low- and middle-income countries and rural versus urban areas.
A great proportion of the causes of death related to epilepsy in low- and middle-income countries are potentially preventable, such as falls, drowning, burns and prolonged seizures.
Rates of disease
Approximately 50 million people currently live with epilepsy worldwide. The estimated proportion of the general population with active epilepsy (i.e. continuing seizures or with the need for treatment) at a given time is between 4 and 10 per 1000 people. However, some studies in low- and middle-income countries suggest that the proportion is much higher, between 7 and 14 per 1000 people.
Globally, an estimated 2.4 million people are diagnosed with epilepsy each year. In high-income countries, annual new cases are between 30 and 50 per 100 000 people in the general population. In low- and middle-income countries, this figure can be up to two times higher.
This is likely due to the increased risk of endemic conditions such as malaria or neurocysticercosis; the higher incidence of road traffic injuries; birth-related injuries; and variations in medical infrastructure, availability of preventative health programmes and accessible care. Close to 80% of people with epilepsy live in low- and middle-income countries.
Causes
Epilepsy is not contagious. The most common type of epilepsy, which affects 6 out of 10 people with the disorder, is called idiopathic epilepsy and has no identifiable cause.
Epilepsy with a known cause is called secondary epilepsy, or symptomatic epilepsy. The causes of secondary (or symptomatic) epilepsy could be:
brain damage from prenatal or perinatal injuries (e.g. a loss of oxygen or trauma during birth, low birth weight),
congenital abnormalities or genetic conditions with associated brain malformations,
a severe head injury,
a stroke that restricts the amount of oxygen to the brain,
an infection of the brain such as meningitis, encephalitis, neurocysticercosis,
certain genetic syndromes,
a brain tumor.
Treatment
Epilepsy can be treated easily and affordably with inexpensive daily medication that costs as little as US$ 5 per year. Recent studies in both low- and middle-income countries have shown that up to 70% of children and adults with epilepsy can be successfully treated (i.e. their seizures completely controlled) with anti-epileptic drugs (AEDs). Furthermore, after 2 to 5 years of successful treatment and being seizure-free, drugs can be withdrawn in about 70% of children and 60% of adults without subsequent relapse.
In low- and middle-income countries, about three fourths of people with epilepsy may not receive the treatment they need. This is called the “treatment gap”.
In many low- and middle-income countries, there is low availability of AEDs. A recent study found the average availability of generic antiepileptic medicines in the public sector of low- and middle-income countries to be less than 50%. This may act as a barrier to accessing treatment.
It is possible to diagnose and treat most people with epilepsy at the primary health- care level without the use of sophisticated equipment.
WHO demonstration projects have indicated that training primary health-care providers to diagnose and treat epilepsy can effectively reduce the epilepsy treatment gap. However, the lack of trained health-care providers can act as a barrier to treatment for people with epilepsy.
Surgical therapy might be beneficial to patients who respond poorly to drug treatments.
Prevention
Idiopathic epilepsy is not preventable. However, preventive measures can be applied to the known causes of secondary epilepsy.
Preventing head injury is the most effective way to prevent post-traumatic epilepsy.
Adequate perinatal care can reduce new cases of epilepsy caused by birth injury.
The use of drugs and other methods to lower the body temperature of a feverish child can reduce the chance of febrile seizures.
Central nervous system infections are common causes of epilepsy in tropical areas, where many low- and middle-income countries are concentrated.
Elimination of parasites in these environments and education on how to avoid infections can be effective ways to reduce epilepsy worldwide, for example those cases due to neurocysticercosis.
Social and economic impacts
Epilepsy accounts for 0.6%, of the global burden of disease, a time-based measure that combines years of life lost due to premature mortality and time lived in less than full health. Epilepsy has significant economic implications in terms of health care needs, premature death and lost work productivity.
An Indian study conducted in 1998 calculated that the cost per patient of epilepsy treatment was as high as 88.2% of the country’s per capita Gross National Product (GNP), and epilepsy-related costs, which included medical costs, travel, and lost work time, exceeded $2.6 billion/year (2013 USD).(1)
Although the social effects vary from country to country, the discrimination and social stigma that surround epilepsy worldwide are often more difficult to overcome than the seizures themselves. People living with epilepsy can be targets of prejudice. The stigma of the disorder can discourage people from seeking treatment for symptoms, so as to avoid becoming identified with the disorder.
Human rights
People with epilepsy can experience reduced access to health and life insurance, a withholding of the opportunity to obtain a driving license, and barriers to enter particular occupations, among other limitations. In many countries legislation reflects centuries of misunderstanding about epilepsy. For example:
In both China and India, epilepsy is commonly viewed as a reason for prohibiting or annulling marriages.
In the United Kingdom, laws which permitted the annulment of a marriage on the grounds of epilepsy were not amended until 1971.
In the United States of America, until the 1970s, it was legal to deny people with seizures access to restaurants, theatres, recreational centres and other public buildings.
Legislation based on internationally accepted human rights standards can prevent discrimination and rights violations, improve access to health-care services, and raise the quality of life for people with epilepsy.

Epilepsy is a major public health concern. As an initiative established in 1997, WHO, the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) are carrying out a global campaign – “Out of the Shadows” – to provide better information and raise awareness about epilepsy and strengthen public and private efforts to improve care and reduce the disorder's impact.
This, as well as other WHO projects on epilepsy, have shown that there are simple, cost-effective ways to treat epilepsy in resource-poor settings, thereby significantly reducing treatment gaps. For example, a project carried out in China resulted in treatment gap reductions of 13% over 1 year and significant improvements in access to care for people with epilepsy.
Projects which aim to reduce the treatment gap and morbidity of people with epilepsy, to train and educate health professionals, to dispel stigma, to identify potential prevention strategies, and to develop models integrating epilepsy control into local health systems are ongoing in many countries.
In particular, the WHO Programme on Reducing the Epilepsy Treatment Gap and the Mental Health Gap Action Programme (mhGAP) currently seek to achieve these goals in Ghana, Mozambique, Myanmar and Viet Nam. These projects combine several innovative strategies. They focus on expanding the skills of primary care and non-specialist health professionals at the community level to diagnose, treat and follow up people with epilepsy. It will mobilize the community to better support people with epilepsy and their families. 

NEUROPSYCHIATIC ADVERSE EFFECTS OF "PARTY DRUGS" .Aleem M A. Hakkim A M. BMJ 2017;356:j1195

BMJ

Analysis

To prohibit or regulate psychoactive substances: has New Zealand got the right approach?

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j1195 (Published 17 March 2017)

Cite this as: BMJ 2017;356:j1195

Rapid response

Re: To prohibit or regulate psychoactive substances: has New Zealand got the right approach?

NEUROPSYCHIATIC ADVERSE EFFECTS OF "PARTY DRUGS"

There are many old and new psychoactive substances used as party drugs in recent days. They are used as single agent or along with many substances with or without alcohol.
Today consumption of these agents must be suspected in the differential diagnosis of psychiatric, neurological, cardiovascular, or metabolic disturbances of unknown origin in a young patients.

Users of psychoactive substances gets euphoria, increased drive, loquacity, a subjective need to move and act, lightening of mood, diminished hostility, clear thinking, sexual stimulation, and heightened perception of music . These agents are used orally intranasally, rectally, or intravenously . Substances in this group may induce a strong desire for further doses.

The adverse effects of these psychoactive substances are neurological psychiatric metabolic cardiovascular cutaneous gastrointestinal and pulmonary.

The neurological effects of psychoactive drugs are headache
mydriasis light-headedness
paresthesia
seizures dystonic movements tremor
amnesia dysgeusia
cerebral edema motor automatisms muscle spasm nystagmus
parkinsonism and stroke. The muscular effects are elevated CK level
rhabdomyolysis and
compartment syndrome.
Some time fever , bruxism
diaphoresis
hyperthermia
urinary disturbances and
unpleasant body odor can also occurs.

The psychiatric manifestations of psychoactive agents are agitation aggression hallucinations confusion anxiety
insomnia catatonia
anhedonia anorexia
depression increased libido injurious behavior panic attacks
self-injurious behavior
suicidality and psychosis

Competing interests: No competing interests

24 March 2017

M A Aleem

Neurologist

A M Hakkim

ABC Hospital

Annamalainagar Trichy 620018 Tamilnadu India

@drmaaleem

Dr.M. A.Aleem Neurologist Participated and Addressed as Chief Guest at SENSORS' 17 Valedictory Ceremony organised by NIT Trichy on 12.3.2017

Dr.M. A.Aleem Neurologist Participated and Addressed as Chief Guest at SENSORS' 17 Valedictory Ceremony organised by the Department of Instrumentation and Control Engineering at National Institute of Technology- NIT Trichirappalli on 12.3.2017. Dr A Ramakalyan ICE Dept and V Moovithakkumar publicity Head  honoured Dr Aleem.

Air Pollution in Children . Aleem M A. Hakkim A M. Cite this as: BMJ 2017;356:j667

BMJ

Research

Particulate air pollution and mortality in 38 of China’s largest cities: time series analysis

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j667 (Published 14 March 2017)

Cite this as: BMJ 2017;356:j667

Rapid response

Re: Particulate air pollution and mortality in 38 of China’s largest cities: time series analysis

Air Pollution in Children

Children face much higher health risks from air pollution than adults. Children breathe twice as quickly, taking in more air in relation to their body weight, while their brains and immune systems are still developing and vulnerable. Tiny particulate matter in polluted air can cause lung cancer, strokes and heart disease over the long term, as well as triggering symptoms such as stroke and heart attacks that kill more rapidly.

About 600,000 children younger than 5 across the world are dying every year from air pollution-related diseases. Millions more are suffer from respiratory diseases that diminish their resilience and affect their physical and cognitive development.

Counting 2 billion children breathing unhealthy air—out of a total 2.26 billion world population of children—means the vast majority are being exposed to levels of pollution considered by the world Health Organisation to be unsafe.

About a third of the 2 billion children in the world who are breathing toxic air live in northern India and neighboring countries, risking serious health effects including damage to their lungs, brains and other organs.

Out of that 2 billion breathing toxic air, about 620 million of them are in South Asia—mostly in northern India. Another 520 million children are breathing toxic air in Africa, and 450 million are in East Asia, mainly China.

The WHO categorised air pollution as the sixth biggest cause of deaths in India, triggering an alarm with studies showing breathing ailments were on the rise in Indian cities.

Competing interests: No competing interests

17 March 2017

M A Aleem

Neurologist

A M Hakkim

ABC Hospital

Annamalainagar, Trichy 620018, Tamilnadu.India.

@drmaaleem