‘Stroke patients should be rushed to hospital promptly’

By Nilma DOLE

Strokes have been a hot topic for the health sector for a long time but people are still not careful and hardly do medical checkups.

Most wait until the last minute to attend to their stroke problems and by that time, it’s too late. A massive problem why deaths occur in strokes is due to the lack of knowledge on how to deal with it and what to do when a loved one gets a stroke.

Consultant neurologist, consultant in Sports Medicine and Head of the Institute of Sports Medicine Dr. Githanjan Mendis told the Sunday Observer that strokes which cause paralysis, are sudden onset weaknesses or numbness of one side of the body with difficulty in speech due to a blood clot blocking a blood vessel in the brain giving rise to an infarct or bleeding into the brain by rupturing a blood vessel. The doctor said, “Usually when this happens on one side of the brain, the other side of the body is affected.”

“Strokes are crucial because this is the most disabling condition in the world.

Consultant neurologist, consultant in Sports Medicine and Head of the Institute of Sports Medicine Dr. Githanjan Mendis

“At any time in any hospital in the world, one out of ten beds are occupied by a stroke patient.” According to the doctor who is a professional in sports medicine, in cases of stroke patients, 20 to 30 percent can die in the first instance, out of the remaining, 60 to 70 percent return to normal. Another ten percent will end up with some disability and another 10 percent will end up in a wheelchair. Another 10 percent will be bed-ridden and will need assistance. Another 10 percent will be in a vegetative or paralysed state.

“The World Health Organisation of the UN (WHO) and the World Federation of Neurologists have declared this millennium as the ‘Millennium of the Brain’ and have informed all world governments including the government of Sri Lanka to take every step to prevent strokes,” he said.

Just like in the case of heart attacks that affect the heart, strokes are called brain attacks. The primary causes are hypertension and smoking. “In Sri Lanka, if a patient gets weakness of one side of the body a numbness or a sudden onset with difficulty in speech, the tendency is to keep the patient at home and watch for one or two days. This is an urgent situation therefore, as soon as the patient is identified as having a stroke, they should be rushed to hospital immediately,” said Dr. Mendis.

Usually, the big hospitals have CT scanners and the larger hospitals have MRI scanners. Therefore, the first thing when a patient arrives in hospital is to check their airway, pulse, breathing and cardiac and then checking it regularly to see if they are functioning well. Next is to do CT or MRI scan because management of the patient differs whether it is infarct or a haemorrhage (bleeding).

He said, “These patients may have to be in an intensive care unit setup depending on the severity of the stroke can be managed in a ward. The first step is to limit the process of evolution of the stroke, in other words to stop the stroke from progressing. Therefore, certain medicines are given for this and also to limit the size of the infarct and to reduce the pressure in the brain. Also control of hypertension, diabetes mellitus, cholesterol, haemoglobin levels by use of medication is mandatory. Then looking after the breathing, heart and skin by way of caring is also necessary.” Physiotherapy, speech therapy in the case of speech disability and occupational therapy will help a stroke patient get back to normal life.

Then medication to get the legs moving, treatment of chest infection treatment of urine infections and treatment of heart conditions are also necessary. The plan is to get the patient cured quickly and discharged as soon as possible.

“In the Sri Lankan scenario, medical leave can be given up to three months. If the patient is the breadwinner of the family, social care also should be given.” The doctor said that if a stroke patient has to return to work, ‘light duty’ should be given where about two to three hours of work is done. “As doctors, our responsibility is to ensure that stroke patients are not cornered in their work places and are treated as socially acceptable human beings.”

Secondary prevention of another stroke is also essential.

In this context, absolute control of hypertension, diabetes mellitus, smoking, thick blood are also very essential by way of medication and periodic review in a clinic at least once a month where all these checks can be done. Patients with obesity should be given a diet chart to reduce the weight according to the height. Alcohol should be forbidden and stroke patients should be encouraged to lead a stress-free life where they don’t work like a machine.

”Physical exercise is mandatory that even the WHO prescription for exercise is to do some kind of exercise at least three days a week where your pulse goes up at least by 20,” said the doctor. Evening exercise is preferable to morning exercise.

This exercise can be obtained by outdoor exercise.Brisk-walking, jogging, running and taking part in sports activities such as swimming, tennis, table-tennis, badminton, squash and in-door gymnasium workouts such as using the treadmill, the strider and the ergo bicycle.

If this prescription is followed, recurrence of a stroke in a patient who has had a stroke can be minimised. Dr. Mendis said, “In any patient with a stroke after some time due to the disability, depression can set it.

Therefore, psychotherapy and anti-depressant medication may have to be given. Strokes in the young is also seen more increasingly in the Asian countries.” Patients less than the age of 45 years seem to be getting strokes and the exact reason for this is not known but it can be hereditary.

The doctor said that in all stroke patients, most often the body gives a warning sign where sudden onset, weakness, numbness or paralysis takes over. Sometimes this can also be due to difficulty in vision, which lasts for minutes or less than 24 hours and completely gets back to normal.

These are called transient ischemic attack (TIAs).

“Sometimes, blood circulation can get reduced to the small brain resulting in vertigo or giddiness, unsteadiness, nausea and vomiting which is called vertebrobasilar insufficiency and this is like a mini-stroke,” he said.

Strokes can be prevented by conducting annual medical checkups for men and women over the age of 40 years.In more developed countries, these tests have become mandatory and doctors are only paid if at least one check-up is done annually. In Sri Lanka, people are encouraged to undergo medical checks at least once a year.

This can be done in government or private hospitals. Well-woman and well-man clinics can be used to do medical checkups.

Finally, the aim of the government of Sri Lanka is to reduce strokes as much as possible.So, save your life by knowing more about strokes and prevent them soon.

If you are stricken with a stroke, you should deal with it effectively and promptly for it is a matter of life and death.

Obesity linked with heart rhythm disorder

Obesity directly causes electrical abnormalities of the heart.

There is growing evidence that obesity changes the structure and size of the heart muscle and the way it works and contracts, as well as its electrical function.

The latter leads to atrial fibrillation, the most common heart rhythm disorder in the world, affecting 10% of people over 75 years of age.

Dr Hany Abed a cardialogist is working with the University of Adelaide’s Centre for Heart Rhythm Disorders and the Discipline of Medicine to ascertain how obesity affects the heart and whether losing weight can actually reduce the risk of developing atrial fibrillation.

“We already know that obesity causes an increase in blood pressure and puts strain on the heart. Current basic laboratory research using a sheep model also shows that obesity causes electrical abnormalities in the heart chamber,” Dr Abed says.

Hospital admissions due to atrial fibrillation have more than tripled in Australia over the past 15 years with older, overweight men at most risk. The condition is also linked directly to strokes and heart attacks.

“It is now more common to be admitted to hospital with atrial fibrillation than it is for heart failure,” Dr Abed says.

“The problem with atrial fibrillation is that it is usually picked up incidentally, in health check-ups, or when someone suffers dizzy spells, heart palpitations and chest pains. Unfortunately, often the first sign of this heart rhythm disorder is when someone has a stroke.”

Dr Abed says the health sector estimates that two thirds of the incidence of atrial fibrillation expected by 2020 will be solely due to obesity.

“Unless we tackle the obesity problem it will be like trying to rescue the deck chairs from the Titanic.”

He says while obesity is not restricted to an age group, those most at risk of atrial fibrillation the elderly are becoming fatter and therefore escalating their chances of developing the heart disorder.

“The costs to the health system and the community are enormous.

However, early results in our research show that atrial fibrillation can be reversed if people lose weight.”

Source: University of Adelaide

Is it possible to be fat and healthy?

A study out of York University has some refreshing news: Being fat may actually be good for you.

The study finds that obese people who are otherwise healthy live just as long as their slim counterparts, and are less likely to die of cardiovascular causes.

“Our findings challenge the idea that all obese individuals need to lose weight,” says lead author Jennifer Kuk, assistant professor in York’s School of Kinesiology & Health Science, Faculty of Health.

“Moreover, it’s possible that trying - and failing - to lose weight may be more detrimental than simply staying at an elevated body weight and engaging in a healthy lifestyle that includes physical activity and a balanced diet with plenty of fruits and vegetables,” she says.

Kuk’s team looked at 6,000 obese people over a 16-year span, comparing their mortality risk with that of lean individuals.

They found that obese individuals who had no (or only mild) physical, psychological or physiological impairments had a higher body weight in early adulthood, were happier with this higher body weight, and had attempted to lose weight less frequently during their lives. However, these individuals were also more likely to be physically active and consume a healthy diet.

Researchers used a newly-developed grading tool, the Edmonton Obesity Staging System (EOSS), which has been found to be more accurate than Body Mass Index (BMI) for identifying who should attempt to lose weight. Developed by University of Alberta researchers, it is modelled on staging systems that classify the extent and severity of other diseases such as cancer, mental illness and heart disease.

It offers five stages of obesity based on both traditional physical measurements such as BMI and waist-to-hip ratio, plus clinical measurements that reflect medical conditions often caused or aggravated by obesity (such as diabetes, hypertension and heart disease).

Courtesy: Edmonton Obesity Staging System,
York University

A faster, cheaper way to diagnose TB

Researchers have discovered a faster, cheaper method for the diagnosis of tuberculosis (TB). A major barrier in TB prevention, especially in developing countries, is that diagnosis is slow and costly.

The new method is also cheaper than the current fastest methods. This research has been published in the Society for Applied Microbiology’s Journal of Applied Microbiology.

The bacterium which causes TB is called Mycobacterium tuberculosis and diagnosis of this disease is often done by growing and examining the bacteria in a laboratory.

This process is slow and can take up to 57 days. Faster methods have been developed, but these tend to be very expensive and are, therefore often unavailable in developing countries. Dr Braissant and his colleagues used a microcalorimeter to detect the growth of Mycobacterium tuberculosis. This method proved to be faster than growing the bacteria in the lab and as fast as other more expensive methods (between 5.5 and 12.5 days).

Microcalorimeters, like the one used in this research, measure the heat given off during a chemical, physical or biological process, in this case when the bacteria grow. One third of the world’s population are infected with TB and in 2009 there were 1.7 million deaths from the disease. TB is spread through the air via sneezing, coughing and spitting and it is estimated that every untreated person infects between 10 and 15 people per year.

Sources: Wiley-Blackwell, AlphaGalileo Foundation

Caffeine may lower risk of skin cancer

There might be a time when instead of just drinking that morning cup of coffee you lather it on your skin as a way of preventing harmful sun damage or skin cancer.

A new Rutgers study strengthens the theory that caffeine guards against certain skin cancers at the molecular level by inhibiting a protein enzyme in the skin, known as ATR. Scientists believe that based on what they have learned studying mice, caffeine applied directly to the skin might help prevent damaging UV light from causing skin cancer.

Prior research indicated that mice that were fed caffeinated water and exposed to lamps that generated UVB radiation that damaged the DNA in their skin cells were able to kill off a greater percentage of their badly damaged cells and reduce the risk of cells becoming cancerous.

“Although it is known that coffee drinking is associated with a decreased risk of non-melanoma skin cancer, there now needs to be studies to determine whether topical caffeine inhibits sunlight-induced skin cancer,” said Allan Conney, director of the Susan Lehman Cullman Laboratory for Cancer Research.

In this study, instead of inhibiting ATR with caffeinated water, Rutgers researchers, in collaboration with researchers from the University of Washington, genetically modified and diminished ATR in one group of mice. The results: the genetically modified mice developed tumors more slowly than the unmodified mice, had 69 percent fewer tumors than regular mice and developed four times fewer invasive tumors.

The study also found, however, that when both groups of mice were exposed to chronic ultraviolet rays for an extended period of time, tumor development occurred in both the genetically modified and regular mice. What this seems to indicate, says Conney, is that inhibiting the ATR enzyme works best at the pre-cancerous stage before UV-induced skin cancers are fully developed.

According to the National Cancer Institute, sunlight-induced skin cancer is the most prevalent cancer in the United States with more than 1 million new cases each year. Although multiple human epidemiologic studies link caffeinated beverage intake with significant decreases in several different type of cancers, including skin cancer, just how and why coffee protects against the disease is unknown.

“Caffeine might become a weapon in prevention because it inhibits ATR and also acts ad as a sunscreen and directly absorbs damaging UV light,” said Conney.

Courtesy:Rutgers University