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How stroke can be prevented
Knee locking needs early care
Brushing of teeth — some facts
Low socio-economic status raises risk of cancer death
Leukaemia drug may prove beneficial for stroke patients
Health Notes
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How stroke can be prevented
Strokes or cerebro-vascular accidents (CVA) are an important cause of death (third highest), afflicting approximately half a million people in developed countries. However, unlike cancer and heart disease, public knowledge of strokes is minimal. Most people know the risk factors that lead to heart disease such as high cholesterol and high blood pressure and diabetes. Stroke shares many of these risk factors — in fact, the two diseases coexist quite often and may have to be tackled at the same time. 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 figures present quite a stark picture. Every 45 seconds, someone in the United States has a stroke. Last year there were 7,50,000 full-fledged strokes in the US and half a million transient ischemic attacks (TIAs) or ministrokes. The ministrokes are more of a concern because they may at times be ignored by the patient, but they are the harbingers of a deadly stroke, and timely treatment provides dramatic relief. Ministrokes are often under-diagnosed. A US National Stroke Association study shows that 2.5 per cent 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 ministroke without realising it. Again though we do not have reliable data for the Indian population, we must learn from these grim figures. These findings clearly show that if the public knew how to spot the symptoms of stroke, specially ministrokes, and sought prompt medical treatment, thousands of lives could be saved and major disability could be avoided.
1. Sudden numbness or weakness of the face, arm or leg, especially on one side. 2. Sudden confusion, trouble in speaking or understanding. 3. Sudden trouble seeing in one or both eyes. 4. Sudden trouble walking, dizziness, loss of balance or coordination. 5. Sudden, severe headache with no known cause. The treatment is by a delicate but very simple and effective procedure called a carotid endarterectomy. Simply put, the doctor removes the block in the carotid artery and repairs it. It can be performed under local or general anaesthesia and takes less than half an hour to perform. During surgery while the artery is clamped to repair it, blood supply to the brain may be maintained by the use of a shunt, which temporarily bypasses the block. For the repair the surgeon may use a piece of vein from the patients own leg or a special biocompatible cloth (Dacron or PTFE - polytetra-flouroethylene). Special magnifying loops and very fine sutures, which are not readily visible to the naked eye, are used for the repair. The results are excellent as the risk of developing a major stroke is dramatically reduced. Roughly, out of a population of a million people, there are about 50-100 people who would benefit from carotid endarterectomy. A non-surgical procedure called carotid stenting can also be performed when indicated with good results. In spite of having excellent results with this surgery, it is still emphasised that a stroke is quite easily avoidable . You can greatly help yourself by simple ways of changing your lifestyle:
Nearly 80 per cent strokes can be prevented and the morbidity and mortality associated with this disease can be greatly reduced by lifestyle changes, control of the risk factors and surgery where indicated. The writer, Chairman, Cardiac Sciences , Sigma New Life Heart Institute, Ludhiana, is a former Senior Consultant, Escorts Heart Institute, New Delhi.
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Knee locking needs early care
Individuals who walk with a limp suffer from the instability of knee or knee locking. They should initiate treatment as early as possible as procrastination in such cases leads to knee arthritis, disability, etc. Limping due to the arthritis of the knee joint causes pain on the inner side of the knee. In order to avoid pain, such patients acquire a waddling gait leading to the bending of the lower leg bones vis-à-vis bowlegs. Instability or giving away of the knee is usually indicative of either ACL (anterior cruciate ligament) injury or weak thigh muscles. ACL restricts the anterior and the rotational movement of the tibia (the long bone of the lower leg). Weak muscles around the knee joint are unable to sustain the weight of the body, leading to a feeling of giving away. The decision to undergo arthroscopic repair of the ACL or conservative treatment becomes a major problem for such individuals. The reasons are as follows: a) Cost of surgery. b) Repaired ACL knees tend to remain unstable for prolonged periods of time, risking further damage to restored ACL. c) Surgical reconstruction does not strengthen the knee. It merely puts the ACL back into position within the knee. Lack of strength in the knee area makes an individual more prone to further injury. Locking of the knee from a bent position to straightening the leg is usually due to meniscus tear or the presence of loose bodies in the knee joint. Meniscus is a cushion in the knee which acts as a shock absorber and is usually torn with a sudden twisting injury (e.g. sudden changing direction, especially during a sporting situation). Meniscus tear is a common condition wherein a patient complains of recurrent knee pain with episodes of catching/ or locking of the knee joint. Treatment: Early treatment involves icing, wrapping with crepe bandage and elevation to reduce pain and swelling. l Analgesic and anti-inflammatory medicines have an important role to reduce pain and swelling during the acute stage. l Non-impact conditioning like walking/stationary cycling, swimming etc, is encouraged as soon as possible. l The main treatment is to improve the range of motion and strengthen the muscle controlling the knee joint to improve stability. People who do not rehabilitate properly are likely to hasten the degeneration of the knee joint. It is, therefore, mandatory to plan a rehabilitation programme to avoid the recurrence of knee pain. The rehabilitation programme must start at low intensity, increasing gradually to a high intensity level, and should be concluded when the patient is able to run. The writer is Director, Medical Services, Power Utilities,
Haryana.
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Brushing of teeth — some facts Major dental afflictions, caries and periodontal (gum) disease are infective in nature. Their nature is explicit from a simple experiment on a group of mice in which the bacteria were eliminated. This group did not develop dental caries despite taking diet conducive for its production. Later, a few mice having caries were introduced into this group of caries-free mice. The result was that the other mice contracted caries after some time. Similarly, if the caries -producing bacteria in the mother are labelled by scientific means for identification and tracking of their movement, these very bacteria are seen to be transferred by direct contact from the mothers’ mouth to her children’s. These can also pass through an indirect route by way of the sharing of spoons between mother, care-taker or any other person and the child. Dental diseases — both dental caries and gum disease — are caused by bacteria and their reaction with our food. Logically, if bacteria are eliminated, there will be no dental disease. In reality, if these bacteria are totally eradicated, the other opportunist infections -fungal infections - develop in the mouth. In order to control dental disease, the game-plan is to not totally eliminate-bacteria, but to reduce their number in the mouth to low levels so that these remain harmless. Bacteria are spread all over in the oral cavity. Primarily, there are three areas of large aggregations of these in the mouth : tooth surfaces; dorsal (top) surface of the tongue; and gingival sulcus. Gingival sulcus is a space of about 1 -2 mm running all around the tooth at the edge of the meeting place of the gum with the tooth. It may be noted that the gum at this place is not firmly attached with the tooth. Keeping the teeth clean by brushing, flossing and inter-dental brushing is the best way to remove bacteria from the above-mentioned three major locations and to keep their population under control. The method of brushing plays an important role in the efficient removal of bacteria. A combination of three methods of brushing is required to effectively clean all tooth surfaces. The uniting of 32 teeth with one another ends up creating many nooks and corners. Imagine how many different strokes are required for taking dust out from a single corner in a room. Likewise, a combination of the following three methods of tooth- brushing is essential to effectively clean teeth. The short, the horizontal-stroke method is one of the best methods. Here, the bristles of the brush are kept at 90° to the surfaces of the teeth and horizontal boot-polishing like movements, not long but short strokes, are made. All the teeth, from the outer to the inner side, are cleaned with minimum pressure. The second method is the circular movement of the tooth-brush. The bristles are kept in the same way as above. In this case small circular movements are made first in the clockwise direction followed by anti-clockwise direction. The third method consists of moving bristles from gum downwards for the upper teeth and the gum upwards for the lower teeth. The recommendation is to initially use the tooth brush without any paste. The above methods employed dislodge the bacteria from the tooth surfaces and also automatically from the gingival sulcus. As the mouth becomes filled with bacteria-containing spit, it is spat out. This procedure is continued for 5 -7 minutes. After this, tooth-paste is applied and brushing continued for another 1-2 minutes. Interdental brushing and flossing are used to clean the sides (proximal surfaces) of the teeth. The top surface of the tongue also harbours a large collection of bacteria. The anterior part of the tongue has more of aerobic bacteria, whereas the bacteria on the posterior part is anaerobic, i.e., those that can survive without the presence of oxygen. The tongue is cleaned also with brush by running it softly in to and fro — back to forward movements. It has been seen that if the tongue is cleaned regularly, the number of bacteria dramatically decreases and also the bacteria population on the posterior part of the tongue changes from anaerobic to aerobic. This method is expected to reduce the number of bacteria in the mouth to a considerably low level to be protective to oral health. The writer is Head, Dental Department, The Apollo Clinic,
Chandigarh. Email: chawlahs@gmail.com
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Low socio-economic status raises risk of cancer death
Washington: Cancer patients with low socio-economic status are at a greater risk of dying after cancer diagnosis, according to a new study. The research led by Tim Byers of the University of Colorado Denver found that cancer patients with low socio-economic status (SES) have more advanced cancers at diagnosis, receive less aggressive treatment, and have a higher risk of dying in the five years following cancer diagnosis. Byers and colleagues from seven states conducted the Breast, Colon and Prostate Cancer Data Quality and Patterns of Care (POC) Study, where they looked at the medical record sources for 13,598 cancer cases diagnosed in seven states in 1997, including 4,844 women with breast cancer, 4,332 men with prostate cancer, and 4,422 men and women with colorectal cancer. They also determined the socio-economic status of the neighbourhood of each patient by using the neighbourhood-specific income and education data from the 2000 U.S. census. They found that for all three types of cancers, individuals of low socio-economic status had more advanced stages of cancer and received less aggressive treatment. —
ANI
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Leukaemia drug may prove beneficial for stroke patients
London: A new study has found that a drug used to treat leukaemia may also prove beneficial for stroke patients — a finding that may have the potential to revolutionise the treatment of stroke. Researchers from the Ludwig Institute for Cancer Research (LICR) and the University of Michigan Medical School have found that leukaemia drug, imatinib (Gleevec(r)) when combined with drug tPA, used to treat stroke, effectively lowered the risk of tPA-associated bleeding in mice. The tPA drug treatment is limited use within the first three hours of the stroke onset. However, the new study showed that the new drug combo reduced the bleeding risk even when tPA was given as late as five hours. According to WHO, less than 3 per cent of patients with this type of stroke receive tPA because the narrow safety window has often passed by the time a stroke patient reaches a hospital and is diagnosed. —
ANI
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Health Notes Washington: A simple blood test, along with the screening of recent-onset symptoms linked to ovarian cancer, will now be able to improve the early detection of ovarian cancer by 20 per cent, according to new findings by researchers at Fred Hutchinson Cancer Research Center. Symptoms linked to ovarian cancer include abdominal or pelvic pain, difficulty eating or feeling full quickly and abdominal bloating. The researchers have found that when used alone, a simple four-question symptom-screening questionnaire and the CA125 ovarian-cancer blood test each detect about 60 per cent of women with early-stage ovarian cancer and 80 per cent of those with late-stage disease. — ANI
Leukaemia drug may prove beneficial for stroke patients
London: A new study has found that a drug used to treat leukaemia may also prove beneficial for stroke patients — a finding that may have the potential to revolutionise the treatment of stroke. Researchers from the Ludwig Institute for Cancer Research (LICR) and the University of Michigan Medical School have found that leukaemia drug, imatinib (Gleevec(r)) when combined with drug tPA, used to treat stroke, effectively lowered the risk of tPA-associated bleeding in mice. The tPA drug treatment is limited use within the first three hours of the stroke onset. However, the new study showed that the new drug combo reduced the bleeding risk even when tPA was given as late as five hours. —
ANI
Drug to reverse mental
retardation
Since 50 per cent of TSC patients also suffer from autism, the findings offer new hope for addressing learning disorders due to autism, according to researchers. Using a mouse model for TSC, the researchers tested rapamycin, a drug approved by the FDA to fight tissue rejection following organ transplants. —
ANI
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