|HEALTH TRIBUNE||Wednesday, May 28, 2003, Chandigarh, India|
a silent killer
— a silent killer
Stroke is a condition in which blood supply to a part of the brain is suddenly and seriously impaired resulting in injury to this vital organ. This may be due to (1) The clogging of a vessel — causing an ischemic stroke — accounting for 80% of all strokes, or (2) bleeding from a ruptured vessel, a haemorrhagic stroke.
Stroke is a leading cause of death in India after heart attack and cancer. Though we do not have a proper database, we can take a sobering lesson from the following American statistics: every 53 seconds someone in America has a stroke; someone dies of a stroke every 3.3 minutes; 600,000 Americans will have a stroke and 160,000 of them will die; about 4.4 million stroke survivors are alive today and stroke costs the US between $ 30 billion and $ 40 billion per year. Far worse than the mortality rate is its morbidity, as it leaves two out of three victims disabled for life. People think it is something which happens to the aged, and yet nearly a third of the patients are under 60 years of age.
Unlike cancer and heart disease, which are extensively publicised, public knowledge on strokes is negligible. Yet strokes are an important cause of death afflicting approximately half a million people in developed countries. Most people know the risk factors that lead to heart disease such as a high cholesterol level and high blood pressure and diabetes. Stroke shares many of these risk factors — in fact, the two diseases coexist quite often and such a patient is labelled a vasculopath. The modifiable risk factors are high blood pressure, cigarette smoking, diabetes mellitus, high blood cholesterol and lipids, physical inactivity, obesity, and the presence of heart disease.
The following grim figures were discussed at the 25th International Stroke Conference in New Orleans recently. In 1999 alone there were 750,000 full-fledged strokes in the US and half a million transient ischemic attacks (TIAs) or mini-strokes. The mini-strokes are more of a concern because they may at times be ignored by the patient. They are the harbingers of a deadly stroke and timely treatment affords dramatic relief.
The cause of a mini-stroke is generally temporary interruption of blood flow to the brain. The symptoms last from a few seconds to 24 hours. They do not themselves cause permanent neurological damage, but are precursors of a major stroke. They need a quick diagnosis and treatment as well as appropriate follow-up to prevent future injury.
Mini-strokes are often underdiagnosed. The National Stroke Association (USA) study showed that 2.5% of all adults aged 18 or older (about 4.9 million people) have experienced a confirmed TIA. An additional 1.2 million Americans over the age of 45 have most likely suffered a mini-stroke without realising it. Again though we do not have reliable data for the Indian population, we must learn from these sobering figures. These findings clearly show that if the public knew how to spot the symptoms of stroke, especially mini-strokes and sought prompt medical treatment, thousands of lives could be saved and major disability avoided.
The problem is that the symptoms of a mini-stroke may be subtle and temporary. The symptoms to watch out for are:
* Trouble seeing in one or both eyes.
* Numbness or weakness in the face, any arm or leg, especially on one side of the body.
* Difficulty in walking, dizziness, loss of balance or coordination.
* Confusion and difficulty in speaking or understanding.
* Severe headache with no known cause.
A TIA precedes a stroke in more than 20% cases. A TIA is actually a brief stroke that has virtually all the symptoms of a major one though it does not cause any permanent damage. But they are dramatic advance warnings that a full-fledged stroke may occur. A TIA patient is 16 times more likely to have a stroke than otherwise. If you have any of the above symptoms you must immediately see a doctor. People who ignore these symptoms in the hope that it will pass after a good night's sleep can land up in serious trouble in the form of a major stroke which could have been prevented. So, TIAs are extremely important stroke warning signs — don't ignore them! Treat them as a life-threatening emergency. Even if a full blown stroke is in progress, treatment by clot-busting drugs (if indicated) within three hours will greatly reduce the severity of the stroke.
One of the most important causes of a stroke or a mini-stroke is a blockage in the artery to the brain — the internal carotid artery. The block is of a cholesterol plaque or atheroma. The disease is called carotid artery stenosis and it affects the artery as it courses to the brain under the muscles of the neck. It can be easily diagnosed by a thorough examination and a simple test called a carotid doppler.
You can greatly help yourself by simple ways of changing your lifestyle:
* Quit smoking
* Reduce alcohol intake to no more than one drink a day (if at all)
* Increase your physical activity, perform regular aerobic exercise
* Control blood pressure by regular medication
* Control diabetes
Stroke is thus not an unavoidable certainty of life. It is not the "stroke" of luck. Nearly 80% strokes can be prevented and the morbidity and mortality associated with this killer disease can be greatly reduced by lifestyle changes, the control of risk factors and surgery where indicated.
A large number of working women entrust their children to the care of creches, run by different individuals or organisations. During the course of our practice we have come across a relatively high frequency of illnesses in these children.
Enquiries from the parents of such children revealed that the conditions prevailing in the creches are far from satisfactory.
We visited 17 creches in Chandigarh and found total disregard for the welfare of the children and an attitude of total neglect for basic health requirements in most cases.
The creches had children varying from a few months to 12 years of age. Fifteen-twenty children were handled together in a room of approximately 10 ft by 14 ft. The children laid on the floor with heads touching each other, and there was less than six inches of space between two children. Toys were available at a few centres. A room had been labelled a play-room at some centres, but it was locked and the key was reported to be in the possession of an absentee superviser.
Proper kitchen facilities like an oven or a chulha, an aquaguard and a functional refrigerator were found only at one centre. Half of the creches had refrigerators but children's food was not kept in these, so as not to contaminate the cold water supply of the attendants. Milk bottles for children were lying uncovered and flies had a field day. The attendants informed that only curd was allowed to be kept in the refrigerator.
The water offered to children came from overhead tanks as fresh water supply was uncertain. Nobody cared to know when the water-tanks had been last cleaned. Vessels in which water was stored were not kept covered. The facilities and the environment were poor, the staff caring for the little ones presented a dismal picture.
Though three workers, a superviser and two attendants, were sanctioned in a few creches, all three were present only in one. The ayas were totally unaware of the concept of hygiene and child care.
The attendants themselves presented a pathetic picture, with unkempt hair, claws of nails and dirty clothes which indicated that they were extremely busy. They did not undergo any medical examination, what to talk of chest X-ray to screen for tuberculosis and typhoid inoculation as they were handling food. No wonder then that diarrhoea is almost a monthly problem and the unfortunate ones get tuberculosis as well.
The standards for establishing creches around the world include an adequate staff-to-children ratio—for example, 1:3 for ages up to two years and 1:4 for two-three years and 1:8 for 3-5 years. One lavatory and a wash-basin for 10 children is desirable, and separate toilet facilities should be available. Clear space recommended per child, excluding fixtures, is at least 30 sq ft and no room regardless of size should hold more than 16 children. Proper facilities for happy change and feeding by separate staff are the minimum requirements. The kitchen should meet the safety standards for food and food-handlers.
The superviser in charge and all deputies should be qualified and trained in children care. The list can be exhaustive. It is hoped the health authorities will enforce the minimum standards for running creches around the country to ensure the safety of children.
The Indian Academy of Paediatrics, Chandigarh chapter, will be happy to cooperate.
Fish intake controls depression
Washington: Many women are afraid to add fish to their diet for the perceived effects of mercury and its impact on the brain development of the foetus. But a new study has revealed that omega-3, an essential fatty acid found in seafood, may help to lower the risk of depression during pregnancy.
The study by researchers at the American National Institute of Health and the University of Illinois-Chicago found that pregnant women who had a deficient intake of omega-3 acids had double the risk of depression than women with a normal to high intake, according to a report in HealthScout.
"During pregnancy, the baby gets omega-3 at the expense of the mother," explains study co-author Dr John Davis, a professor of psychiatry at the University of Illinois-Chicago who presented at the American Psychiatry Association’s annual meeting in San Francisco.
Using British data compiled from 14,541 women who were expected to deliver between 1991 and 1992, the researchers used a statistical model to analyse the association between omega-3 fatty acids and depression. Even after the researchers adjusted the data for confounding factors such as age, prior history of depression, education and substance abuse, the association remained strong.
Washington: A study conducted here has found that the eyes which have undergone LASIK (laser surgery) with a superior-hinged flap attached at the top of the cornea have more chances of loss of corneal sensation and presence of dry eye signs and symptoms, than in eyes that have received LASIK with a nasal-hinged flap attached on the side closest to the nose. The study is published in the May issue of Ophthalmology, the clinical journal of the American Academy of Ophthalmology, the Eye M.D. Association. ANI
London: Once the bartender knows what passive smoking is doing to him, he might change his opinion over banning cigarette smoking in public places.
Dublin- based researchers at Media Lab Europe are developing a device that allows people to monitor the damage of passive smoking. It’s a wearable gadget that takes readings of the amount of carbon monoxide and other particles given off by cigarette smoke, according to a report in BBC.
"It will allow people, especially those that work in smoky environments, to see how much damage passive smoking is doing them", said Jamie Rasmussen, a researcher at Media Lab Europe. ANI
‘Brain tangles’ hit memory
Washington: Researchers in the United States have taken a step further in finding out why memory deteriorates with age.
They revealed that memory loss might be linked to so-called "brain tangles". These occur when twisted fragments of proteins within nerve cells clog up the cells. Large numbers of these tangles are already known to cause Alzheimer’s disease, according to a report in BBC. ANI
New malaria vaccine
In a major step towards making an effective vaccine for malaria,
researchers have injected human volunteers with one scrap of DNA and
then another in a poxvirus, thus tricking their immune systems into
producing enough cells to attack the disease. ANI