Second leading cause of death and paralysis in Sri Lanka:

Strokes

by Nilma DOLE

Neurologists in Sri Lanka have a vital role to play when it comes to treating a patient’s nervous system and illnesses pertaining to it. “There are several neurological disorders that are prevalent in society today but the most common condition are strokes which is the second leading cause of death and paralysis in Sri Lanka,” said President of the College of Neurologists, Dr. Sunethra Senanayake. While there is a National Stroke Association and Stroke Units to be implemented island-wide, the trend of strokes affecting people continues.

“In simple terms, a stroke occurs when blood flow to a part of the brain is stopped when a blood vessel in the brain is blocked or bursts open. If the blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen causing brain cells can die, causing permanent damage and even death,” said the doctor.

According to the doctor, there are two major types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke occurs when a blood vessel that supplies blood to the brain is blocked by a blood clot forming in an artery that is already very narrow called a thrombus. A clot at another blood vessel is called an embolism.

A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have problems in the blood vessels of the brain that make this more likely. The flow of blood that occurs after the blood vessel ruptures damages brain cells.

“Several cases of stroke affect the breadwinner of the family and not only does it hamper a person’s ability to work but a family member should nurse the patient round-the-clock,” said the doctor.

She said that there is mental depression on part of the patient and the family but strokes can be prevented if the trigger factors are carefully assessed and controlled.

“An elderly person having diabetes, hypertension, high blood pressure, obesity and a certain degree of stress are prone to have strokes especially if they don’t check themselves regularly,” she said. Moreover, a person with a family history of strokes and risk factors connected to strokes is also susceptible to developing strokes.

“Elderly people usually have a high risk so they should go for medical checkups frequently, controlling diseases such as diabetes, obesity, high cholesterol, smoking and hypertension should be done. It is a little price to pay for something deadly later,” she said. “As a neurologist, we can promptly identify a stroke through a CT scan which can assess the person’s condition,” she said.

From the time of diagnosis to treatment, a neurologist can identify the gravity of the stroke and prescribe treatment and medication to curb the stroke.

Dr. Senanayake said, “Disability affects 75% of stroke survivors enough to decrease their employability but a considerable number of stroke victims generally manage to recover partially and can manage to do their work independently.”

However, it doesn’t mean that all stroke victims can’t be cured. “Provided the right treatment is given and the correct physiotherapy is done, strokes can be cured depending on how well the patient responds to it,” she said.

While the most important illness in Sri Lanka for a neurologist are strokes, there are young people who get strokes. “If young people get it, such strokes can be easily cured with the right medication,” said Dr. Senanayake.

In addition, the neurologist’s role pertaining to nervous disorders also encompasses epileptic disorders and headaches.

There are many causes of epilepsy commonly seen in children and adolescents. Birth traumas, meningitis, brain tumors and genetic disorders can trigger epilepsy.

“When it comes to epilepsy, careful observations and studies should be done on the patients and we work together with the paediatricians to monitor and evaluate epileptic conditions especially in children,” said the doctor. Moreover, the conditions pertaining to headaches revolve around migranes, continuous headaches and headaches that occur on a daily basis.

According to the doctor, common primary headaches are tension type headaches. Headaches can be due to secondary causes such as tumors, infections and hemorrhage in the brain.

“We carefully determine what sort of condition the patient has and offer the right treatment and what they need to do in order to stop the headaches with the right advice,” said Dr.Senanayake.

A neurologist is a physician who specialises in neurology, and is trained to investigate, or diagnose and treat neurological disorders.

Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research. Overall, the role of the Neurologists isn’t easy and it is important that we realise that neurology is an important medical specialisation.

For more advice on how a neurologist can help you, attend the Sunday Observer sponsored Medicare 2011 National Healthcare exhibition to obtain a better understanding of aspects pertaining to health and neurology.

MRI technique may predict, prevent strokes

Researchers at the University of Utah’s Comprehensive Arrhythmia and Research Management (CARMA) Center have found that delayed-enhancement magnetic resonance imaging (DE-MRI) holds promise for predicting the risks of strokes, the third leading cause of death in the U.S. Their latest study on a novel application of this technology appears in the Feb. 15 issue of the Journal of the American College of Cardiology.

The study included 387 patients who were treated for atrial fibrillation (AF) at either the University of Utah (Salt Lake City) or Clinical Center Coburg (Coburg, Germany). AF is a little known heart rhythm disorder that affects more than 3.5 million Americans and causes more than 66,000 deaths a year. Individuals with AF are two to seven times more likely to suffer a stroke than the general population.

The purpose of the study was to determine if there was an association between an AF patient’s heart damage (for example, left atrial [LA] fibrosis), which was detected using DE-MRI, and commonly used markers for the risk of stroke, specifically the CHADS2 index. Although further prospective studies are needed, the preliminary results indicate that DE-MRI-based detection of LA fibrosis is independently associated with prior history of strokes. The findings also provide preliminary evidence that the physiological features of the LA could be used, in addition to clinical features, when identifying stroke risk in patients.

“We believe this method can be a valuable tool for clinicians to use in conjunction with the CHADS2 index for risk analysis and decisions about anticoagulation medications when treating AF patients,” said Nassir Marrouche, M.D., associate professor of cardiology and executive director of the CARMA Center and Director, Cardiac Electrophysiology Laboratories, for the University of Utah’s Division of Cardiology.

“Potentially, this will lead to improvement in current risk stratification schemes and enhance our understanding of the risks of thromboembolic (stroke) events in AF patients. We also hope this will lead to the development of effective strategies for stroke prevention.”

Although the anticoagulant warfarin is highly effective in preventing strokes, the drug also is associated with life-threatening hemorrhaging and requires intensive dosage monitoring. Risk stratification schemes have been developed to tailor anticoagulation therapy to the patients’ risk, and the CHADS2 index is the most accepted risk stratification model. Yet while this index is a valuable tool for predicting cerebrovascular events in high-risk patients, clinicians rely more heavily on clinical judgment when predicting thromboembolic risk in moderate-risk patients, a substantial portion of the AF population. The identification of novel, independent risk factors by DE-MRI may supplement existing tools to help guide clinician judgment in better allocating anticoagulation therapeutic strategies, especially with moderate risk AF patients.

The study concluded that LA fibrosis as determined through the use of DE-MRI is “associated with an increased risk of thromboembolism in AF patients. Clinician use of both a CHADS2 index and a quantified measure of atrial fibrosis has the potential to provide a more rigorous risk assessment and improve future risk stratification schemes.”

The University of Utah CARMA Center is conducting innovative research on the use of MRIs to treat atrial fibrillation. In 2009, it opened the first integrated electrophysiology (EP)-MRI research and clinical laboratory in North America. This year, it has begun a worldwide patient evaluation program at 16 international medical centers to investigate the use of delayed enhancement MRI to stage the progression of the disease. The CARMA Center also has developed the Utah AF Staging System, which enables early detection and “personalized” treatment and management for each atrial fibrillation patient.

Source: University of Utah Health Sciences

Guilty conscience can damage your immune system

by Cherry Norton

Feeling guilty about indulging in life’s pleasures can damage your health - so if you want to stay in peak condition you should adopt a more hedonistic approach, psychologists said in a recent report.

Research presented at the British Psychological Society’s annual conference in Winchester showed that those who feel guilty about eating, drinking, smoking or watching television suffered from a poorer immune system, making them more vulnerable to colds and flu.

The findings also suggested that women felt more guilty about their indulgences and were more likely to fall ill than men. Dr Geoff Lowe, a chartered psychologist from the University of Hull, who conducted the research said that people would be healthier if they relaxed and enjoyed “sins” - as long as they are not harmful to them.

“We ought to focus more on the positive things in life. If we enjoy simple pleasures that are not harmful to us we should not feel guilty about them. We should maximise the pleasure,” he said. “We should take a bit of time to smell the flowers.”

The findings showed that people who ate chocolate or watched daytime television soap operas felt more guilt than pleasure after the event. However having sex scored more than four times higher on pleasure than guilt.

“If you anticipate having guilty feelings about something you are less likely to do it. Guilty feelings are helpful in moderating harmful behaviour but we also need a positive boost of regular pleasures in order to reinforce the right kind of behaviour,” he said.

Dr Lowe and Dr John Greenman, an immunologist from Hull University, asked 30 people to list their pleasurable activities and rate them for guilt and pleasure.

Samples of their saliva were taken and tested for levels of immunoglobulin A. High levels of this substance are associated with a healthy immune system.

The participants rated their pleasures and the guilt associated with them from one to 10.

Overall people enjoyed drinking and eating, giving them a score of seven or eight on the pleasure scale, more than they felt guilty about them, scoring five or six, but the guilt of eating chocolate, rating eight, outweighed the pleasure, for which it scored seven. Men felt significantly less guilty about drinking alcohol than women.

Going shopping was only slightly more pleasurable than guilt-inducing, scoring eight out of 10 on the pleasure scale as against seven for guilt.

- The Independent

Cholesterol levels and vitamins in large eggs

According to new nutrition data from the United States Department of Agriculture’s Agricultural Research Service (USDA-ARS), eggs are lower in cholesterol than previously thought. The USDA-ARS recently reviewed the nutrient composition of standard large eggs, and results show the average amount of cholesterol in one large egg is 185 mg, 14 percent lower than previously recorded. The analysis also revealed that large eggs now contain 41 IU of vitamin D, an increase of 64 percent.

“We collected a random sample of regular large shell eggs from 12 locations across the country to analyze the nutrient content of eggs,” says Dr. Jacob Exler, Nutritionist with the Agricultural Research Service’s Nutrient Data Laboratory. “This testing procedure was last completed with eggs in 2002, and while most nutrients remained similar to those values, cholesterol decreased by 14 percent and vitamin D increased by 64 percent from 2002 values.”

The collected eggs were sent to a laboratory at Virginia Tech University to be prepared for nutrient analysis at certified nutrient analysis laboratories. The samples were randomly paired for the testing procedure, and the analysis laboratories tested samples to determine composition of a variety of nutrients including protein, fat, vitamins and minerals. Accuracy and precision were monitored using quality control samples.

According to Dr. Exler, this procedure is standard for the National Food and Nutrient Analysis Program (NFNAP), the program responsible for analyzing the nutrient composition of a wide variety of foods and making nutrition information publicly available. This information is available on the nutrient data lab website at www.ars.usda.gov/nutrientdata. The new nutrient information will also be updated on nutrition labels to reflect these changes wherever eggs are sold, from egg cartons in supermarkets to school and restaurant menus.

Cracking egg myths

Over the years, people have unnecessarily shied away from eggs - despite their taste, value, convenience and nutrition - for fear of dietary cholesterol. However, more than 40 years of research have demonstrated that healthy adults can enjoy eggs without significantly impacting their risk of heart disease.

“My research focuses on ways to optimize diet quality, and I have long suspected that eliminating eggs from the diet generally has the opposite effect. In our own studies of egg intake, we have seen no harmful effects, even in people with high blood cholesterol,” says Dr. David Katz, Director of the Yale University Prevention Research Center. Enjoying an egg a day can fall within current cholesterol guidelines, particularly if individuals opt for low-cholesterol foods throughout the day. The 2010 Dietary Guidelines for Americans suggest that eating one whole egg per day does not result in increased blood cholesterol levels and recommend that individuals consume, on average, less than 300 mg of cholesterol per day. A single large egg contains 185 mg cholesterol. Some researchers believe the natural decrease in the cholesterol level of eggs could be related to the improvements farmers have made to the hens’ feed. Hens are fed a high-quality, nutritionally balanced diet of feed made up mostly of corn, soyabean meal, vitamins and minerals. Poultry nutrition specialists analyze the feed to ensure that the natural nutrients hens need to stay healthy are included in their diets. Nutrition researchers at Iowa State University are compiling a report to outline potential reasons for the natural decrease in cholesterol in eggs.

Nutrient-rich eggs

Eggs now contain 41 IU of vitamin D, which is an increase of 64 percent from 2002. Eggs are one of the few foods that are a naturally good source of vitamin D, meaning that one egg provides at least 10 percent of the Recommended Daily Allowance (RDA). Vitamin D plays an important role in calcium absorption, helping to form and maintain strong bones.

The amount of protein in one large egg - 6 grams of protein or 12 percent of the Recommended Daily Value - remains the same, and the protein in eggs is one of the highest quality proteins found in any food. Eggs are all-natural, and one egg has lots of vitamins and minerals all for 70 calories.

Source: Egg Media Hotline