Monday, August 25, 2014

Bharat Ratna To Former Chief Minister Annadurai and Muthuramalinga Thever


Well before DMK demand I have made a plea on 3.11.2012 to honor Anna and MuthuRamalinga Thaver with Bharat Ratna posthumously based on their service to people. This request was in my blogger in November 2012



Bharat Ratna To Former Chief Minister Annadurai


Well before DMK demand I have made a plea on 3.11.2012 to honor Anna and MuthuRamalinga Thaver with Bharat Ratna posthumously based on their service to people. This request was in my blogger in November 2012



National Epilepsy Programme-J Assoc Phyicians india 2014:62:766-767

CURRENT ISSUE • JAPI AUGUST 2014 • VOL. 62




Correspondences

National Epilepsy Programme

MA Aleem*

*Professor of Neurology, KAPV Government Medical College, MGM Government Hospital, ABC Hospital Trichy-620018, Tamil Nadu

Sir,

I have read the supplement on epilepsy with great interest.1 In India more than 70% of the population living in rural area. Because of this and lack of awareness due to illiteracy the treatment gap for epilepsy is more in Indian population so it is better to have a National Epilepsy Programme “and the same can be implemented in the primary health care level as other National health programme in India.

Reference

1. Khadilkar SV. Epilepesy – an update. JAPI 2013;61:5(Suppl-8).

 

Saturday, August 23, 2014

Mild Infection and Stroke in Children


Minor Infections May Increase Stroke Risk in Children


According to the recent analysis, the risk is highest during the 3 days following a doctor's visit for an infection in a children, after which it rapidly diminishes. This suggests that an infection has an acute and powerful effect on stroke risk that is very transient in children.


Minor Infections



The rate of infection before the stroke or index date was greater for cases than controls in each of 3 time periods: within 3 days, 4 to 7 days, and 8 to 30 days in children. After adjustment for these periods, sex, immunologic, hematologic, and cardiac disease, and head and neck trauma in the preceding month, a diagnosis of infection 3 days before a stroke conferred a 12-fold increased risk for arterial ischemic stroke .

The risk rapidly diminished after those 3 days, with no increased risk for stroke beyond 1 week.

The cause may be the infection-related activation of the coagulation cascade rather than arterial injury. Circulating inflammatory factors increase the risk for blood clots and possibly cause inflammation of the lining of the heart or blood vessels leading to the brain.

It also might have something to do with exposure to cold remedies containing vasoactive ingredients or mechanical forces leading to cervical arterial dissection. "If your blood vessels are inflamed and you have some sort of minor trauma like coughing or sneezing or play wrestling or diving into a pool, the vessels are just a bit more prone to injury.

The important message is that infection can be a trigger in children who are otherwise predisposed to stroke. "In some case, they are otherwise predisposed in ways we understand, like children who have congenital heart disease or sickle cell disease, but in other cases, they're predisposed in ways we don't understand," although genetics could play a role.



Overall, about 15% of children with stroke will go on to have a recurrence but in those with abnormalities of blood vessels to the brain, the recurrence rate of over 50%.

Vaccinations may be an avenue toward avoiding stroke. In a large international prospective study of infection in childhood stroke, some results of which were presented earlier this year. Vaccinations are protective against childhood stroke. They also found that herpes infections are quite common in children with stroke, which is important because these infections can be treated with, for example, the antiviral acyclovir.

"This is one more reason that vaccination programs and good hygiene are so important in preventing infection in children.

And although aspirin, a mild blood thinner, has been linked to Reye's syndrome,.May be aspirin isn't such a bad idea in kids with an infection, adding that this idea is "certainly preliminary."

But also important is for parents — and physicians — to recognize that stroke really does happen to children.

Friday, August 22, 2014

No Part Time Medical courses-- BMJ⁠ 2014;349:g4897

Views & Reviews

Personal View

If doctors can train part time, why not medical students?

BMJ⁠ 2014⁠; 349⁠ doi: http://dx.doi.org/10.1136/bmj.g4897 (Published 11 August 2014)⁠

Cite this as: BMJ⁠ 2014;349:g4897


Rapid Responses


No Part Time Medical courses

In recent days everybody learns everything through the Internet, including medicine. But knowing medicine without patients and adequate training is very difficult. Part time medical courses and training at all levels can only produce money making medical men with inadequate medical knowledge. So Part Time medical courses or training should not be encouraged at any level in any country.

Competing interests: No competing interests

21 August 2014

M A Aleem

Neurologist

KApv Govt Medical college. MGM Govt Hospital. ABC Hospital

Trichy 620018 Tamilnadu India

No Part Time Medical courses

Views & Reviews

Personal View

If doctors can train part time, why not medical students?

BMJ⁠ 2014⁠; 349⁠ doi: http://dx.doi.org/10.1136/bmj.g4897 (Published 11 August 2014)⁠

Cite this as: BMJ⁠ 2014;349:g4897

Rapid Responses


Views & Reviews

Personal View

If doctors can train part time, why not medical students?

BMJ⁠ 2014⁠; 349⁠ doi: http://dx.doi.org/10.1136/bmj.g4897 (Published 11 August 2014)⁠

Cite this as: BMJ⁠ 2014;349:g4897

Rapid Responses


No Part Time Medical courses

In recent days everybody learns everything through the Internet, including medicine. But knowing medicine without patients and adequate training is very difficult. Part time medical courses and training at all levels can only produce money making medical men with inadequate medical knowledge. So Part Time medical courses or training should not be encouraged at any level in any country.

Competing interests: No competing interests

21 August 2014

M A Aleem

Neurologist

KApv Govt Medical college. MGM Govt Hospital. ABC Hospital

Trichy 620018 Tamilnadu India

Friday, August 15, 2014

Allow experimental drugs free of cost in Ebola virus diseases BMJ⁠ 2014;349:g4997


Feature

Infectious Diseases

Ebola: an opportunity for a clinical trial?

BMJ⁠ 2014⁠; 349⁠ doi: http://dx.doi.org/10.1136/bmj.g4997 (Published 06 August 2014)⁠

Cite this as: BMJ⁠ 2014;349:g4997



Allow experimental drugs free of cost in Ebola virus diseases

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death. But if patients or their family members are willing to have the experimental drugs as treatment for Ebola virus infection we can allow the new and experimental medications FREE of cost.

Competing interests: No competing interests

15 August 2014

M A Aleem

Neurologist

Kapv Govt medical college MGM Govt hospital ABC hospital

Trichy 620018 Tamilnadu India

Wednesday, August 13, 2014

International Left handers Day 13 August 2014

International Left handers Day

August 13 is designated International Lefthanders Day by Lefthanders International. It was first observed on the 13th of August, 1976. As the name suggests, it is meant to promote awareness of the inconveniences facing left-handers in a predominantly right-handed world. It celebrates their uniqueness and differences, who are from seven to ten percent of the world's population. Thousands of left-handed people in today's society have to adapt to use right handed tools and objects.

There’s also a more serious side to the day, which spreads awareness about the special needs of left-handed kids. Also, left-handers are far more likely to develop schizophrenia than right-handers, for reasons not well understood.


While it had been observed on Aug. 13 of each year by many left handers since 1976, Left-handers Day was declared by the Left-Hander's Day Club on August 13, 1996. It was made to annually celebrate certain people's sinistrality and raise awareness of the advantages and disadvantages of being left-handed.



Mothers who give birth over the age of 40 are 128 percent more likely to have a child with left-handedness than a woman who has a baby in her 20s.

Lefties have been traced back to the caveman days. Archaeologists believe that some cave paintings were created by a left- handed artist.

There are phrases in English, which suggest left-handedness is negative. A “left-handed complement” is an insult. A “left-handed marriage” is not at all a marriage but an adulterous sexual relationship.

Lefties are more likely to be geniuses. 

Throughout history, being left-handed was seen as various things, like: a bad habit, rebellion, criminality, the mark of the devil, a sign of neurosis, or even a trait marking creativity and musical ability.
Left-handedness runs in the family, the British royal family namely. The Queen Mother, Queen Elizabeth II, Prince Charles, and Prince William are or were all lefties.

Lefties are more likely to loathe spiral notebooks. 

Here are some other famous lefties: President Barak Obama, Oprah, Angelina Jolie, Julia Roberts, Justin Bieber, Sarah Jessica Parker, Bruce Willis, Scarlett Johansson, Jon Stewart, Lady Gaga and Tina Fey. 

It’s not sure what makes a person become a lefty. Some scientists say it could be more testosterone in utero; others say it could be the hand babies prefer to have in their mouths.

The Boston Strangler, Jack the Ripper and Osama Bin Laden were all lefties.

Among Eskimos, every lefty is a potential sorcerer.

Some researchers believe lefties are better at handling stimuli, which means they’re naturally better at video games.

Some scholars say lefties are the last unorganized minority in society because they don’t have a collective power or real sense of common identity.

In Scotland, if a person is a unlucky it is said he or she was “baptized by a left-handed priest.”

Lefties tend to be more susceptible to negative emotions like depression and anger because they engage in the right side of their brains more aggressively.

Some scholars say lefties generally die nine years earlier than righties.

Nearly 30 million people in the U.S. are left-handed.

There are many artistic representations that show Satan as being left-handed.




Left-handers have been the subject of curiosity, stigma and even fear over the centuries. Researchers now, however, are recognizing the scientific importance of understanding why people use one hand or the other to write, eat or toss a ball.

Handedness, as the dominance of one hand over the other is called, provides a window into the way our brains are wired, experts say. And it may help shed light on disorders related to brain development, like dyslexia, schizophrenia and attention deficit hyperactivity disorder, or ADHD, which are more common in left-handed people.

Modern lefty lore says left-handers are smarter, more creative and have an advantage over righties. But is it true? WSJ's Christina Tsuei looks into the science of lefties.

Other recent research suggests that mixed-handedness—using different hands for daily tasks and not having a dominant one—may be even more strongly linked than left-handedness to ADHD and possibly other conditions.

About 10% of people are left-handed, according to expert estimates. Another 1% of the population is mixed-handed. What causes people not to favor their right hand is only partly due to genetics—even identical twins, who have 100% of the same genes, don't always share handedness.

More important, researchers say, are environmental factors—especially stress—in the womb. Babies born to older mothers or at a lower birth weight are more likely to be lefties, for example. And mothers who were exposed to unusually high levels of stress during pregnancy are more likely to give birth to a left-handed child. A review of research, published in 2009 in the journal Neuropsychologia, estimated that about 25% of the variability in handedness is due to genetics.

On average there is no significant difference in IQ between righties and lefties, studies show, belying popular perceptions. There is some evidence that lefties are better at divergent thinking, or starting from existing knowledge to develop new concepts, which is considered an element of creativity. And left-handed people have salaries that on average are about 10% lower than righties, according to recent research performed at Harvard University that analyzed large income data bases, although findings of some earlier studies were mixed.
Left-handed people make up about 10% of the population, while 1% of the population appear not to be dominant with either hand, known as mixed-handed.

Being left-handed is only partially genetic.

For reasons not clearly understood, handedness depends mainly on how a baby's brain develops while in the womb.

On average there is no difference in intelligence between right-and left-handed people. But lefties do better on an element of creativity known as divergent thinking.

  ⁠

Six of the last 12 U.S. presidents, including Barack Obama and George H. W. Bush, have been lefties.



Left-handed people earn on average 10% lower salaries than righties, according to a recent study. Findings of some earlier studies on income have been mixed.

Despite popular misperceptions, lefties aren't more accident prone than right-handed people and don't tend to die at a younger age.

Left-handedness has been linked to increased risk of certain neurodevelopmental disorders like schizophrenia and ADHD. Mixed-handedness is even more strongly associated with ADHD.

Most people's brains have a dominant side. More symmetrical brains of mixed-handed people may explain the link to some neural disorders.


Left-handedness appears to be associated with a greater risk for a number of psychiatric and developmental disorders. While lefties make up about 10% of the overall population, about 20% of people with schizophrenia are lefties, for example. Links between left-handedness and dyslexia, ADHD and some mood disorders have also been reported in research studies.

The reasons for this aren't clear. Scientists speculate it could be related to a concept known as brain lateralization. The brain has two halves. Each performs primarily separate, specialized functions, such as language processing, which mainly takes place in the left hemisphere. There is lots of communication between the hemispheres.

Typically in right-handers, the brain's left side is dominant. But this tendency doesn't hold up with lefties, as scientists previously believed. Some 70% of lefties rely on the left hemisphere for their language centers, a key brain function, says Metten Somers, a psychiatrist and researcher who studies brain lateralization at Utrecht University Medical Center in the Netherlands. This doesn't appear to present problems, scientists say.

The other 30% of lefties appear to exhibit either a right-dominant or distributed pattern, Dr. Somers says. They may be more prone to impaired learning or functioning, and at greater risk for brain disorders, he says.

Hemisphere dominance is typical and more efficient. Symmetry, in which neither side is dominant, is believed linked to disorders, researchers say. People with schizophrenia, for instance, exhibit more symmetrical activation of their brain hemispheres than those without the disorder, studies show.

In a 2008 study, Alina Rodriguez, a psychology professor at Mid Sweden University in Östersund who studies handedness, brain development and ADHD, found that left- or mixed-handedness in children was linked to a greater risk of difficulty with language as well as ADHD symptoms. In another study published last year in Pediatrics, involving nearly 8,000 Finnish children, Dr. Rodriguez found that mixed-handedness rather than left-handedness was linked to ADHD symptoms.

And knowing that a child was mixed-handed and had ADHD symptoms at age 8 helped predict much more accurately than just knowing they had symptoms at that age whether the child would continue to have symptoms at age 16. (What happens when people are forced to switch from writing with their dominant hand to the other isn't well known, experts say.)


One reason that not more is known about lefties is that many studies of how the brain works prohibit left-handers from participating because their brain wiring is known to be different, says Robin Nusslock, a psychology professor at Northwestern University in Evanston, Ill., who uses neuroimaging to study mood disorders.

Research that suggests that there is a link between favoring the left hand and an increased risk of bipolar disorder and ADHD, among other conditions. Emily Nelson has details on Lunch Break.

A potential pathway between prenatal stress and brain wiring could be cortisol, the body's main stress hormone, which can interfere with brain development, says Carsten Obel, a professor at the public-health department at Aarhus University in Denmark who has conducted research on the prenatal environment and risk of disease. Cortisol is able to pass over the placenta barrier to influence the baby.

Lefties have an advantage in sports such as tennis, fencing and baseball, when up against a righthanded competitor, but not in noninteractive sports such as gymnastics. Agence France Presse/Getty Images

Several studies show that stressful life events, such as the death of a loved one or job loss, during pregnancy increase the risk of having non-right-handed children. In one study of 834 Danish mothers and their 3-year-old children, Dr. Obel and his colleagues found that mothers who reported multiple stressful events during their third trimester of pregnancy and experienced distress were more than three times as likely to have a mixed-handed child, 17% compared with 5%, according to the 2003 paper published in Developmental Medicine & Child Neurology.

Another large study followed 1,700 Swedish mothers and children until the kids were 5 years old. It found that mothers with depressive symptoms or who underwent stressful life events while pregnant were more likely to have left- or mixed-handed children. The work was published by Dr. Rodriguez and her colleagues in 2008 in the Journal of Child Psychology and Psychiatry.

Experts suggest that left- and mixed-handedness could be used as a risk factor for possible psychiatric or developmental conditions, along with behavioral difficulties, such as having a hard time in school. The presence of such risk factors could prompt early evaluation for those conditions, they say.



The Health Risks of Being Left-Handed

Lefties Face Chance Of ADHD, Other Disorders; Brain Wiring Holds Clues


Left-handers have been the subject of curiosity, stigma and even fear over the centuries. Researchers now, however, are recognizing the scientific importance of understanding why people use one hand or the other to write, eat or toss a ball.

Handedness, as the dominance of one hand over the other is called, provides a window into the way our brains are wired, experts say. And it may help shed light on disorders related to brain development, like dyslexia, schizophrenia and attention deficit hyperactivity disorder, or ADHD, which are more common in left-handed people.

Modern lefty lore says left-handers are smarter, more creative and have an advantage over righties. But is it true? WSJ's Christina Tsuei looks into the science of lefties.

Other recent research suggests that mixed-handedness—using different hands for daily tasks and not having a dominant one—may be even more strongly linked than left-handedness to ADHD and possibly other conditions.

About 10% of people are left-handed, according to expert estimates. Another 1% of the population is mixed-handed. What causes people not to favor their right hand is only partly due to genetics—even identical twins, who have 100% of the same genes, don't always share handedness.

More important, researchers say, are environmental factors—especially stress—in the womb. Babies born to older mothers or at a lower birth weight are more likely to be lefties, for example. And mothers who were exposed to unusually high levels of stress during pregnancy are more likely to give birth to a left-handed child. A review of research, published in 2009 in the journal Neuropsychologia, estimated that about 25% of the variability in handedness is due to genetics.

On average there is no significant difference in IQ between righties and lefties, studies show, belying popular perceptions. There is some evidence that lefties are better at divergent thinking, or starting from existing knowledge to develop new concepts, which is considered an element of creativity. And left-handed people have salaries that on average are about 10% lower than righties, according to recent research performed at Harvard University that analyzed large income data bases, although findings of some earlier studies were mixed.



One reason that not more is known about lefties is that many studies of how the brain works prohibit left-handers from participating because their brain wiring is known to be different, says Robin Nusslock, a psychology professor at Northwestern University in Evanston, Ill., who uses neuroimaging to study mood disorders.

Research that suggests that there is a link between favoring the left hand and an increased risk of bipolar disorder and ADHD, among other conditions. Emily Nelson has details on Lunch Break.


A potential pathway between prenatal stress and brain wiring could be cortisol, the body's main stress hormone, which can interfere with brain development, says Carsten Obel, a professor at the public-health department at Aarhus University in Denmark who has conducted research on the prenatal environment and risk of disease. Cortisol is able to pass over the placenta barrier to influence the baby.

Lefties have an advantage in sports such as tennis, fencing and baseball, when up against a righthanded competitor, but not in noninteractive sports such as gymnastics. Agence France Presse/Getty Images

Several studies show that stressful life events, such as the death of a loved one or job loss, during pregnancy increase the risk of having non-right-handed children. In one study of 834 Danish mothers and their 3-year-old children, Dr. Obel and his colleagues found that mothers who reported multiple stressful events during their third trimester of pregnancy and experienced distress were more than three times as likely to have a mixed-handed child, 17% compared with 5%, according to the 2003 paper published in Developmental Medicine & Child Neurology.




Why Are Some People Left-Handed?

Being a righty or a lefty could be linked to variations in a network of genes that influence right or left asymmetries in the body and brain





President Barack Obama is left-handed, as well as at least six former presidents.

For the left-handed people of the world, life isn’t easy. Throughout much of history, massive stigmas attached to left-handedness meant they were singled out as everything from unclean to witches. In Medieval times, writing with your left-hand was a surefire way to be accused of being possessed by the devil; after all, the devil himself was thought to be a lefty. The world has gotten progressively more accepting of left-handed folk, but there are still some undeniable bummers associated with a left-handed proclivity: desks and spiral notebooks pose a constant battle, scissors are all but impossible to use and–according to some studies–life-expectancy might be lower than for right-handed people.

What makes humanity’s bias against lefties all the more unfair is that left-handed people are born that way. In fact, scientists have speculated for years that a single gene could control a left-right preference in humans. Unfortunately, they just couldn’t pinpoint exactly where the gene might lie.

Now, in a paper published today in PLOS Genetics a group of researchers have identified a network of genes that relate to handedness in humans. What’s more, they’ve linked this preference to the development of asymmetry in the body and the brain.

In previous studies, the researchers observed that patients with dyslexia exhibited a correlation between the gene PCSK6 and handedness. Because every gene has two copies (known as alleles), every gene has two chances for mutation; what the researches found was that dyslexic patients with more variance in PCSK6–meaning that one or both of their PSCK6 alleles had mutated–were more likely to be right-handed.

The research team found this especially interesting, because they knew that PCSK6 was a gene directly associated with the development of left-right asymmetry in the body. They weren’t sure why this would present itself only in dyslexic patients, as dyslexia and handedness are not related. So the team expanded the study to include more than 2,600 people who don’t have dyslexia.

The study found that PCSK6 didn’t work alone in affecting handedness in the general population. Other genes, also responsible for creating left-right asymmetry in the body, were strongly associated with handedness. Like PCSK6, the effect that these genes have on handedness depends on how many mutations the alleles undergo. Each gene has the potential for mutation–the more mutations a person has in any one direction (toward right handedness or left handedness) the more likely they are to use that hand as their dominant hand, or so the researchers speculate.

The hypothesis is a logical response to a key question: If handedness is genetic and if right-handedness is such a dominant trait, why hasn’t left-handedness been forced out of the genetic pool? In reality, the research suggests that handedness could be more subtle than simple “dominant” or “recessive” traits–a whole host of genes might play significant roles.

What’s especially exciting is that these genes all relate to the development of left-right asymmetry in the body and brain, creating a strong case for correlation between the development of this symmetry and the development of handedness. Disrupting any of these genes could lead to serious physical asymmetry, like situs inversus, a condition where the body’s organs are reversed (heart on the right side of the body, for example). In mice, the disruption of PCSK6 resulted in serious abnormal positioning of organs in their bodies.

If physical asymmetry is related to handedness, then people with situs inversus should favor one hand more often than what you’d find in the general population. Studies show that this isn’t the case–individuals with this condition mirror the general population’s split in handedness–leading the researchers to postulate that while these genes certainly influence handedness, there might be other mechanisms in the body that compensate for handedness in the event of major physiological asymmetries.

Other animals, such as polar bears or chimpanzees, also have handedness–chimpanzees have been known to prefer one hand to the other when using tools or looking for food, but the split within a population hangs around 50/50. Humans are the only species that show a truly distinct bias toward one hand or the other: a 90/10 right/left split throughout the population.

One predominant hypothesis for this bias relates to another distinct human trait: language ability. Language ability is split between the different hemispheres of the brain, much like handedness, which suggests that handedness became compartmentalized along with language ability, For most, the parts of the brain that govern language are are present in the left-side of the brain–these people tend to be right-handed. The few that have language skills focused in the right side of the brain tend to be left-handed.

However, William Brandler, a PhD student at Oxford University and the paper’s lead author, isn’t convinced that this theory holds much stock, as correlations between language and handedness in research aren’t well established. Brandler is more interested in learning how the permutations and combinations of genetic mutations play into humans’ likelihood to be right-handed. “Through understanding the genetics of handedness, we might be able to understand how it evolved,” he says. “Once we have the full picture of all the genes involved, and how they interact with other genes, we might be able to understand how and why there is such a bias.”

And he’s confident that even if environmental factors (like the continued hatred of lefties by two-thirds of the world) place pressure on handedness, any baseline bias still boils down to genetics. “People think it’s just an environmental thing, but you’ve got to think, why is there that initial bias in the first place, and why do you see that bias across all societies? Why aren’t there societies where you see a bias to the left?” Brandler asks. “There is a genetic component to handedness, hundreds of different genetic variants, and each one might push you one way or the other, and it’s the type of variance, along with the environment you’re in and the pressures acting on you, which affect your handedness.”

But until a larger population can be tested–hundreds of thousands, by Brandler’s estimates–a full genetic map of what controls handedness and why our population isn’t evenly split between righties and lefties can’t be determined. “It’s going to take a bit of time before these materialize—but it will happen,” Brandler says. “There’s been a whole revolution in genetics such that, in a few years time, we’re really going to start to understand the genetic basis of complex traits.”

Tuesday, August 12, 2014

No Ebola Virus Disease in TamilNadu India


Ebola virus disease


Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever, is a severe, often fatal illness in humans.

EVD outbreaks have a case fatality rate of up to 90%.

EVD outbreaks occur primarily in remote villages in Central and West Africa, near tropical rainforests.

The virus is transmitted to people from wild animals and spreads in the human population through human-to-human transmission.

Fruit bats of the Pteropodidae family are considered to be the natural host of the Ebola virus.

Severely ill patients require intensive supportive care. No licensed specific treatment or vaccine is available for use in people or animals.

Ebola first appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. The latter was in a village situated near the Ebola River, from which the disease takes its name.

Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species:

Bundibugyo ebolavirus (BDBV)

Zaire ebolavirus (EBOV)

Reston ebolavirus (RESTV)

Sudan ebolavirus (SUDV)

Taï Forest ebolavirus (TAFV).

BDBV, EBOV, and SUDV have been associated with large EVD outbreaks in Africa, whereas RESTV and TAFV have not. The RESTV species, found in Philippines and the People’s Republic of China, can infect humans, but no illness or death in humans from this species has been reported to date.

Transmission

Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.

Ebola then spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. Burial ceremonies in which mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola. Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness.

Health-care workers have frequently been infected while treating patients with suspected or confirmed EVD. This has occurred through close contact with patients when infection control precautions are not strictly practiced.

Among workers in contact with monkeys or pigs infected with Reston ebolavirus, several infections have been documented in people who were clinically asymptomatic. Thus, RESTV appears less capable of causing disease in humans than other Ebola species.

However, the only available evidence available comes from healthy adult males. It would be premature to extrapolate the health effects of the virus to all population groups, such as immuno-compromised persons, persons with underlying medical conditions, pregnant women and children. More studies of RESTV are needed before definitive conclusions can be drawn about the pathogenicity and virulence of this virus in humans.

Signs and symptoms

EVD is a severe acute viral illness often characterized by the sudden onset of fever, intense weakness, muscle pain, headache and sore throat. This is followed by vomiting, diarrhoea, rash, impaired kidney and liver function, and in some cases, both internal and external bleeding. Laboratory findings include low white blood cell and platelet counts and elevated liver enzymes.

People are infectious as long as their blood and secretions contain the virus. Ebola virus was isolated from semen 61 days after onset of illness in a man who was infected in a laboratory.

The incubation period, that is, the time interval from infection with the virus to onset of symptoms, is 2 to 21 days.

Diagnosis

Other diseases that should be ruled out before a diagnosis of EVD can be made include: malaria, typhoid fever, shigellosis, cholera, leptospirosis, plague, rickettsiosis, relapsing fever, meningitis, hepatitis and other viral haemorrhagic fevers.

Ebola virus infections can be diagnosed definitively in a laboratory through several types of tests:

antibody-capture enzyme-linked immunosorbent assay (ELISA)

antigen detection tests

serum neutralization test

reverse transcriptase polymerase chain reaction (RT-PCR) assay

electron microscopy

virus isolation by cell culture.

Samples from patients are an extreme biohazard risk; testing should be conducted under maximum biological containment conditions.

Vaccine and treatment

No licensed vaccine for EVD is available. Several vaccines are being tested, but none are available for clinical use.

Severely ill patients require intensive supportive care. Patients are frequently dehydrated and require oral rehydration with solutions containing electrolytes or intravenous fluids.

No specific treatment is available. New drug therapies are being evaluated.

New drug ? New Vaccine ?

Two American missionary workers infected with Ebola were given an experimental drug called ZMapp which seems to have saved their lives.The drug, developed by a San Diego firm, had never been tried before on humans, but it showed promise in small experiments on monkeys.

But rolling out an untested drug during a massive outbreak would also be very difficult, according to MSF. Experimental drugs are typically not mass-produced, and tracking the success of such a drug if used would require extra medical staff where resources are already scarce. ZMapp’s maker says it has very few doses ready for patient use.

There are other experimental drugs out there.Tekmira, a Vancouver-based company that has a $140 million contract with the U.S. Department of Defense to develop an Ebola drug, began Phase 1 trials with its drug in January. But the FDA recently halted the trial, asking for more information.

At least one potential Ebola vaccine has been tested in healthy human volunteers, according to Thomas Geisbert, a leading researcher at the University of Texas Medical Branch. And last week, the NIH announced that a safety trial of another Ebola vaccine will start as early as September.

And in March, the U.S. National Institute of Health awarded a five-year, $28 million grant to establish a collaboration between researchers from 15 institutions who were working to fight Ebola.

“A whole menu of antibodies have been identified as potentially therapeutic, and researchers are eager to figure out which combinations are most effective and why,” a news release about the grant said.


Natural host of Ebola virus

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are considered possible natural hosts for Ebola virus. As a result, the geographic distribution of Ebolaviruses may overlap with the range of the fruit bats.

Ebola virus in animals

Although non-human primates have been a source of infection for humans, they are not thought to be the reservoir but rather an accidental host like human beings. Since 1994, Ebola outbreaks from the EBOV and TAFV species have been observed in chimpanzees and gorillas.

RESTV has caused severe EVD outbreaks in macaque monkeys (Macaca fascicularis) farmed in Philippines and detected in monkeys imported into the USA in 1989, 1990 and 1996, and in monkeys imported to Italy from Philippines in 1992.

Since 2008, RESTV viruses have been detected during several outbreaks of a deadly disease in pigs in People’s Republic of China and Philippines. Asymptomatic infection in pigs has been reported and experimental inoculations have shown that RESTV cannot cause disease in pigs.

Prevention and control

Controlling Reston ebolavirus in domestic animals

No animal vaccine against RESTV is available. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) should be effective in inactivating the virus.

If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

As RESTV outbreaks in pigs and monkeys have preceded human infections, the establishment of an active animal health surveillance system to detect new cases is essential in providing early warning for veterinary and human public health authorities.

Reducing the risk of Ebola infection in people

In the absence of effective treatment and a human vaccine, raising awareness of the risk factors for Ebola infection and the protective measures individuals can take is the only way to reduce human infection and death.

In Africa, during EVD outbreaks, educational public health messages for risk reduction should focus on several factors:

Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

Reducing the risk of human-to-human transmission in the community arising from direct or close contact with infected patients, particularly with their bodily fluids. Close physical contact with Ebola patients should be avoided. Gloves and appropriate personal protective equipment should be worn when taking care of ill patients at home. Regular hand washing is required after visiting patients in hospital, as well as after taking care of patients at home.

Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.

Pig farms in Africa can play a role in the amplification of infection because of the presence of fruit bats on these farms. Appropriate biosecurity measures should be in place to limit transmission. For RESTV, educational public health messages should focus on reducing the risk of pig-to-human transmission as a result of unsafe animal husbandry and slaughtering practices, and unsafe consumption of fresh blood, raw milk or animal tissue. Gloves and other appropriate protective clothing should be worn when handling sick animals or their tissues and when slaughtering animals. In regions where RESTV has been reported in pigs, all animal products (blood, meat and milk) should be thoroughly cooked before eating.

Controlling infection in health-care settings

Human-to-human transmission of the Ebola virus is primarily associated with direct or indirect contact with blood and body fluids. Transmission to health-care workers has been reported when appropriate infection control measures have not been observed.

It is not always possible to identify patients with EBV early because initial symptoms may be non-specific. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices at all times. These include basic hand hygiene, respiratory hygiene, the use of personal protective equipment (according to the risk of splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health-care workers caring for patients with suspected or confirmed Ebola virus should apply, in addition to standard precautions, other infection control measures to avoid any exposure to the patient’s blood and body fluids and direct unprotected contact with the possibly contaminated environment. When in close contact (within 1 metre) of patients with EBV, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

Laboratory workers are also at risk. Samples taken from suspected human and animal Ebola cases for diagnosis should be handled by trained staff and processed in suitably equipped laboratories.


Situation in India

Health Minister Harsh Vardhan Monday said "there is no Ebola Virus Disease (EVD) in India", adding the country has mechanism for prompt treatment and subsequent monitoring.

"There is no EVD in India," he said in a statement.

He added: "There is no reason for getting worried over the odd case of a visitor to the country arriving in an indisposed condition. We have all the mechanisms in place for prompt treatment and subsequent monitoring."

His statement came in the aftermath of a traveller from Nigeria having symptoms of upper respiratory tract infection at the IGI Airport Saturday.

The traveller was taken to the Ram Manohar Lohia Hospital here where he tested negative for EVD.

Vardhan ordered another review meeting Monday between officers of the ministries of health, home, external affairs, civil aviation and the National Disaster Management Authority besides representatives of World Health Organisation.


In Tamilnadu

Health Minister C. Vijayabaskar on Monday said in the Assembly that the government had created awareness on dealing with Ebola in hospitals across the State as early as April.

During the debate on the demand for grants for his department, he said it was because of the stringent monitoring measures put in by the government, a person returning to Chennai from Africa on Saturday was properly screened for the viral infection.

That person did not show any symptoms of Ebola and was later discharged.

Reiterating that there was no need for panic, he said awareness about Ebola among medical professionals in government hospitals was created.

Alert Airport

Alert should be given to all International airport in India to watch and screen passengers with fever and red
rashes who traveled through or from African countries.

Monday, August 11, 2014


National Epilepsy Programme

MA Aleem*

*Professor of Neurology, KAPV Government Medical College, MGM Government Hospital, ABC Hospital Trichy-620018, Tamil Nadu

Sir,

I have read the supplement on epilepsy with great interest.1 In India more than 70% of the population living in rural area. Because of this and lack of awareness due to illiteracy the treatment gap for epilepsy is more in Indian population so it is better to have a National Epilepsy Programme “and the same can be implemented in the primary health care level as other National health programme in India.

Reference

1. Khadilkar SV. Epilepesy – an update. JAPI 2013;61:5(Suppl-8)

Tuesday, August 5, 2014

World Breastfeeding Week 1-7 August 2014 -BREASTFEEDING: A Winning Goal - For Life!

World Breastfeeding Week


1–7 August 2014

World Breastfeeding Week(WBW) is celebrated every year from 1 to 7 August in more than 170 countries to encourage breastfeeding and improve the health of babies around the world.


Breastfeeding is the best way to provide infants with the nutrients they need. WHO recommends exclusive breastfeeding starting within one hour after birth until a baby is six months old. Nutritious complementary foods should then be added while continuing to breastfeed for up to two years or beyond.


The theme for WBW 2014: BREASTFEEDING: A Winning Goal - For Life!

This year' s theme asserts the importance of increasing and sustaining the protection, promotion and support of breastfeeding - in the Millennium Development Goals (MDGs) countdown, and beyond. We call on all celebrants of WBW to Protect, Promote and Support Breastfeeding: it is a vital Life-Saving Goal!


WBW 2014 Objectives :

In 1990 eight global goals, the Millennium Development Goals (MDGs), were set by governments and the United Nations to fight poverty and promote healthy and sustainable development in a comprehensive way by 2015. There are regular "countdowns" to gauge progress in achieving the goals. This year's WBW theme responds to the latest countdown by asserting the importance of increasing and sustaining the protection, promotion and support of breastfeeding in the post 2015 agenda, and engaging as many groups, and people of various ages as possible.

Wherever you are, progress can be made and sustained. For this to happen you need to be prepared, set goals and targets, join forces and ACT!

Protect, Promote and Support breastfeeding: it is a vital, life-saving goal!




The Millennium Development Goals (MDGs) are meant to be achieved by 2015 - next year! Although much progress has taken place, there is still a lot of "unfinished business". Here are some examples: Poverty has gone down, but 1 in 8 people still go to bed hungry. Undernutrition affects about a quarter of all children globally. Overweight, the other form of malnutrition is becoming more common too. In the last 2 decades, child mortality has decreased by about 40%, but still almost 7 million children under five die each year, mainly from preventable diseases. As the overall rate of under-five mortality has declined, the proportion of neonatal deaths (during the first month of life) comprises an increasing proportion of all child deaths. Globally, maternal mortality has declined from 400 per 100,000 live births in 1990 to 210 in 2010, but fewer than half of women deliver in baby-friendly maternities. By protecting, promoting and supporting breastfeeding, YOU can contribute to each of the MDGs in a substantial way. Exclusive breastfeeding and adequate complementary feeding are key interventions for improving child survival, potentially saving about 20% of children under five. Let's review how the UN's Scientific Committee on Nutrition illustrated how breastfeeding is linked to each of the Millennium Development Goals.


Promoting proper feeding for infants and young children


Initiation of breastfeeding within the first hour of life

Malnutrition is responsible, directly or indirectly for about one third of deaths among children under five. Well above two thirds of these deaths, often associated with inappropriate feeding practices, occur during the first year of life.

Nutrition and nurturing during the first years of life are both crucial for life-long health and well-being. In infancy, no gift is more precious than breastfeeding; yet barely one in three infants is exclusively breastfed during the first six months of life.


The World Health Organization recommends that infants start breastfeeding within one hour of life, are exclusively breastfed for six months, with timely introduction of adequate, safe and properly fed complementary foods while continuing breastfeeding for up to two years of age or beyond.

Promoting sound feeding practices is one of the main programme areas that the Department of Nutrition for Health and Development focuses on. Activities include the production of sound, evidence-based technical information, development of guidelines and counselling courses, provision of guidance for the protection, promotion and support of infant and young child feeding at policy, health service and community levels, production of appropriate indicators and maintenance of a Global Data Bank on Infant and Young Child Feeding.


Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.

Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.

Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.


How breastfeeding benefits you and your Baby


Breastfeeding protects your baby from a long list of illnesses

Breastfeeding can protect your baby from developing allergies

Breastfeeding may boost your child's intelligence

Breastfeeding may protect your child from obesity

Breastfeeding may lower your baby's risk of SIDS

Breastfeeding can reduce your stress level and your risk of postpartum depression

Breastfeeding may reduce your risk of some types of cancer



Breast milk is best for your baby, and the benefits of breastfeeding extend well beyond basic nutrition. In addition to containing all the vitamins and nutrients your baby needs in the first six months of life, breast milk is packed with disease-fighting substances that protect your baby from illness.

That's one reason the American Academy of Pediatrics recommends exclusive breastfeeding for the first six months (although any amount of breastfeeding is beneficial). And scientific studies have shown that breastfeeding is good for your health, too.

Here's a look at some of the most important benefits breastfeeding offers you and your baby.

Breastfeeding protects your baby from a long list of illnesses

Numerous studies from around the world have shown that stomach viruses, lower respiratory illnesses, ear infections, and meningitis occur less often in breastfed babies and are less severe when they do happen. Exclusive breastfeeding (meaning no solid food, formula, or water) for at least six months seems to offer the most protection.

One large study by the National Institute of Environmental Health Sciences showed that children who are breastfed have a 20 percent lower risk of dying between the ages of 28 days and 1 year than children who weren't breastfed, with longer breastfeeding associated with lower risk.



10 tips for breastfeeding success

 

Watch a lactation consultant help a new mom learn how to breastfeed her baby.

The main immune factor at work here is a substance called secretory immunoglobulin A (IgA) that's present in large amounts in colostrum, the first milk your body produces for your baby. (Secretory IgA is present in lower concentrations in mature breast milk.) The substance guards against invading germs by forming a protective layer on the mucous membranes in your baby's intestines, nose, and throat.

Your breast milk is specifically tailored to your baby. Your body responds to pathogens (virus and bacteria) that are in your body and makes secretory IgA that's specific to those pathogens, creating protection for your baby based on whatever you're exposed to.

Breastfeeding's protection against illness lasts beyond your baby's breastfeeding stage, too. Studies have shown that breastfeeding can reduce a child's risk of developing certain childhood cancers. Scientists don't know exactly how breast milk reduces the risk, but they think antibodies in breast milk may give a baby's immune system a boost.

Breastfeeding may also help children avoid a host of diseases that strike later in life, such as type 1 and type 2 diabetes, high cholesterol, and inflammatory bowel disease. In fact, preemies given breast milk as babies are less likely to have high blood pressure by the time they're teenagers.

For babies who aren't breastfed, researchers have documented a link between lack of breastfeeding and later development of Crohn's disease and ulcerative colitis.

Breastfeeding can protect your baby from developing allergies

Babies who are fed a formula based on cow's milk or soy tend to have more allergic reactions than breastfed babies.

Scientists think that immune factors such as secretory IgA (only available in breast milk) help prevent allergic reactions to food by providing a layer of protection to a baby's intestinal tract. Without this protection, inflammation can develop and the wall of the intestine can become "leaky." This allows undigested proteins to cross the gut where they can cause an allergic reaction and other health problems.

Babies who are fed formula rather than breast milk don't get this layer of protection, so they're more vulnerable to inflammation, allergies, and other eventual health issues.

Breastfeeding may boost your child's intelligence

Various researchers have found a connection between breastfeeding and cognitive development. In a study of more than 17,000 infants followed from birth to 6 1/2 years, researchers concluded from IQ scores and other intelligence tests that prolonged and exclusive breastfeeding significantly improves cognitive development.

Another study of almost 4,000 children showed that babies who were breastfed had significantly higher scores on a vocabulary test at 5 years of age than children who were not breastfed. And the scores were higher the longer they had been nursed.

Preterm infants with extremely low birth weight who received breast milk shortly after birth improved their mental development scores at 18 months when compared with preterm infants who weren't given breast milk. In a later study, researchers found that the higher scores held at 30 months, and that the babies who received breast milk were also less likely to be hospitalized again because of respiratory infections.

Experts say that the emotional bonding that takes place during breastfeeding probably contributes to some of the brainpower benefits, but that the fatty acids in breast milk may play the biggest role.

Breastfeeding may protect your child from obesity

The American Academy of Pediatrics recommends breastfeeding as a way to help reduce your child's risk of becoming overweight or obese. An analysis of 17 studies published in the American Journal of Epidemiology shows that breastfeeding reduces a child's risk of becoming overweight as a teen or adult. The strongest effect is in children who were exclusively breastfed, and the longer the baby was breastfed the stronger the link.

Experts think that breastfeeding may affect later weight gain for several reasons:

Breastfed babies are better at eating until their hunger is satisfied, leading to healthier eating patterns as they grow.

Breast milk contains less insulin than formula. (Insulin stimulates the creation of fat.)

Breastfed babies have more leptin in their system, a hormone that researchers believe plays a role in regulating appetite and fat.

Compared with breastfed babies, formula-fed infants gain weight more rapidly in the first weeks of life. This rapid weight gain is associated with later obesity.

Breastfeeding may lower your baby's risk of SIDS

A large German study published in 2009 found that breastfeeding – either exclusively or partially – is associated with a lower risk of sudden infant death syndrome (SIDS). The researchers concluded that exclusive breastfeeding at 1 month of age cut the risk of SIDS in half.

The U.S. Centers for Disease Control and Prevention (CDC) recommends breastfeeding for as long as possible to reduce the risk of SIDS

How breastfeeding benefits you and your baby



Breastfeeding can reduce your stress level and your risk of postpartum depression

The National Institutes of Health reviewed more than 9,000 study abstracts and concluded that women who didn't breastfeed or who stopped breastfeeding early on had a higher risk of postpartum depression.

Many women report feeling relaxed while breastfeeding. That's because nursing triggers the release of the hormone oxytocin. Numerous studies in animals and humans have found that oxytocin promotes nurturing and relaxation. (Oxytocin released while nursing also helps your uterus contract after birth, resulting in less postpartum bleeding.)

One study found that women who had high amounts of oxytocin in their system (50 percent of breastfeeding moms as opposed to 8 percent of bottle-feeding moms) had lower blood pressure after being asked to talk about a stressful personal problem.

By the way, if you're being treated for depression, you can still breastfeed your baby. Your healthcare practitioner can help you identify safe ways to treat your depression while nursing.

Breastfeeding may reduce your risk of some types of cancer

Numerous studies have found that the longer women breastfeed, the more they're protected against breast and ovarian cancer. For breast cancer, nursing for at least a year appears to have the most protective effect.

It's not entirely clear how breastfeeding helps, but it may have to do with the structural changes in breast tissue caused by breastfeeding and the fact that lactation suppresses the amount of estrogen your body produces. Researchers think the effect on ovarian cancer may be related to estrogen suppression as well.


Studies are finding new benefits of breastfeeding all the time. The May 2010 issue of Pediatrics, for example, published a study showing that babies who are breastfed are less likely to have fevers after their immunizations than babies who are formula fed.


Sunday, August 3, 2014

Midlife Alcohol Abuse Increases Late Life Memory Loss

Midlife Alcohol Abuse Linked to Severe Memory Impairment


Problem drinking in middle age appears to significantly increase the risk for severe memory loss in later life, new research shows.



Investigators at the University of Exeter Medical School in the United Kingdom found that middle-aged adults with alcohol use disorders (AUDs) had more than double the risk of developing severe memory impairment almost 20 years later.


This finding ― that middle-aged people with a history of problem drinking more than double their chances of memory impairment when they are older ― suggests that this is a public health issue that needs to be addressed; that more research is required to investigate the potential harms associated with alcohol consumption throughout life.

Saturday, August 2, 2014

Vaccine For Parkinson's Disease

Parkinson's Vaccine Looks Promising


The first vaccine being developed for Parkinson's disease (PD) is showing early promise.


A phase 1 pilot trial of subcutaneous injections of PD01A, carried out at a single center in Vienna, Austria, shows that the vaccine was well tolerated and safe, that it induced an immune response, and that the immune response appeared to be improving function.



The vaccine targets alpha-synuclein, a protein that is highly expressed in the brain and that tends to aggregate in patients with PD. It is thought that this process either interferes with normal alpha-synuclein function or is itself toxic to cells. PD01A is designed to stimulate the body to produce antibodies that bind to and clear excess alpha-synuclein.




Because the vaccine is intended to prevent PD, it is important to identify the disease as early as possible.



"The most convincing" piece of evidence from the study is that immune responders show a clinically better response than immunological non-responders.


Friday, August 1, 2014

Re: Vaccinate boys as well as girls against HPV: it works, and it may be cost effective: BMJ⁠ 2014;349:g4834

Vaccinate boys as well as girls against HPV: it works, and it may be cost effective

BMJ⁠ 2014⁠; 349⁠ doi: http://dx.doi.org/10.1136/bmj.g4834 (Published 29 July 2014)⁠

Cite this as: BMJ⁠ 2014;349:g4834

Rapid responses

Re: Vaccinate boys as well as girls against HPV: it works, and it may be cost effective

Vaccinate Transgender Too

To prevent HPV infection and its acute and late complications not only male and female but also transgendar should also be vaccinated against HPV infection. it gives protection against many curable and not curable complications of HPV infection

Competing interests: No competing interests

31 July 2014

M A ALEEM

Neurologist

Kapv Govt Medical College MGM Govt Hospital

ABC Hospital Trichy 620018 Tamilnadu India