Friday, October 20, 2017

Social media a cause for self harm . Aleem. M.A. BMJ 2017;359:j4351

BMJ

Research

Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j4351 (Published 18 October 2017)

Cite this as: BMJ 2017;359:j4351

Rapid responses

Re: Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care

Recently, social media have become an important cause of self harm and self inflicted injuries in children and adolescents.

Competing interests: No competing interests

20 October 2017

M.A. Aleem

Neurologist

ABC Hospital

Trichy 620018 Tamilnadu India

@drmaaleem

Tuesday, October 17, 2017

Dengue management in The Hindu Trichy on 18.10.2017

The Hindu Trichy on 18.10. 2017

Platelet deficiency is not the cause of death, say doctors

R. Krishnamoorthy
TIRUCHI,

OCTOBER 18, 2017 00 :00 IST

UPDATED: OCTOBER 18, 2017 04:33 IST

“Primary cause of death is capillary leakage”

Medical fraternity here have been reaching out to the public with the assurance that dengue patients can effectively be nursed back to health and that there was no need for undue anxiety.

The scenario of people running around in search of platelets for transfusion is all too common in the corridors of the hospitals. However, contrary to the perceptions, platelet deficiency is not the cause of death of people suffering from dengue.

The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure, M. A. Aleem, Neurologist, and former Vice-Principal of KAP Viswanatham Government Medical College, said.

According to International guidelines, if a patient’s platelet count is below 10,000, and there is spontaneous, active bleeding, platelet transfusion is required.

“Most people do not realize is that the first line of treatment for dengue is not platelet transfusion. It, in fact, does more harm than good if used in a patient whose counts are over 10,000,” he said.

Fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the patient passes adequate urine. This is all that is required to treat the patient.

Giving unnecessary platelet transfusion can make the patient more unwell, Dr. Aleem explained.

Common symptoms of dengue include high fever, running nose, a mild skin rash, cough, and pain behind the eyes and in the joints.

However, some people may develop a red and white patchy skin rash followed by loss of appetite, nausea, vomiting, etc. Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids.

Uninhabited plots require attention. Stagnation of water in such plots in the midst of weeds pose danger to the health of residents, according to R. Ganesan, a resident of Tiruvanaikoil

Though the civic body has been spraying pesticides at water stagnation points, the onus is as much on the public to prevent breeding of the aedes aegypti mosquitoes, doctors say.

According to Health Department officials, all hospitals have been apprised of the WHO protocols in providing care to dengue patients.

Dengue management

http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/platelet-deficiency-is-not-the-cause-of-death-say-doctors/article19880233.ece

Sir wish you your family a happy DIWALI- Dr Aleem neurologist abc hospital trichy

Thursday, October 12, 2017

நீயல்லால் தெய்வமில்லை

பாடியவர்: சீர்காழி கோவிந்தராஜன்
இயற்றியவர்: உளுந்தூர்ப் பேட்டை ஷண்முகம்

நீயல்லால் தெய்வமில்லை எனது
நெஞ்சே நீ வாழும் எல்லை முருகா
நீயல்லால் தெய்வமில்லை எனது
நெஞ்சே நீ வாழும் எல்லை முருகா
நீயல்லால் தெய்வமில்லை எனது
நெஞ்சே நீ வாழும் எல்லை முருகா
நீயல்லால் தெய்வமில்லை
முருகா முருகா முருகா
தாயாகி அன்புப் பாலூற்றி வளர்த்தாய்
தந்தையாய் நின்றே சிந்தை கவர்ந்தாய்
தாயாகி அன்புப் பாலூற்றி வளர்த்தாய்
தந்தையாய் நின்றே சிந்தை கவர்ந்தாய்
குருவாகி எனக்கு நல்லிசை தந்தாய் ஞான
குருவாகி எனக்கு நல்லிசை தந்தாய்
திருவே நீ என்றும் என் உள்ளம் நிறைந்தாய்
திருவே நீ என்றும் என் உள்ளம் நிறைந்தாய்
நாயேனை நாளும் நல்லவனாக்க
நாயேனை நாளும் நல்லவனாக்க
ஓயாமல் ஒழியாமல் உன்னருள் தந்தாய்
ஓயாமல் ஒழியாமல் உன்னருள் தந்தாய்
நீயல்லால் தெய்வமில்லை எனது
நெஞ்சே நீ வாழும் எல்லை முருகா
நெஞ்சே நீ வாழும் எல்லை

வாயாரப் பாடி மனமார நினைந்து
வணங்கிடலே என்தன் வாழ்நாளில் இன்பம்
வாயாரப் பாடி மனமார நினைந்து
வணங்கிடலே என்தன் வாழ்நாளில் இன்பம்
தூயா முருகா மாயோன் மருகா
தூயா முருகா மாயோன் மருகா
தொழுவதொன்றே இங்கு யான் பெற்ற இன்பம் உன்னைத்
தொழுவதொன்றே இங்கு யான் பெற்ற இன்பம்

நீயல்லால் தெய்வமில்லை எனது
நெஞ்சே நீ வாழும் எல்லை முருகா
நீயல்லால் தெய்வமில்லை
முருகா முருகா முருகா

Sunday, October 8, 2017

Health is Important Than Crackers


Health is Important Than Crackers

-Dr.M.A.Aleem

  Former Vice-Principal

  KAPV Govt. Medical College. 

 Trichy.

 Consultant Neurologist and             

 Epileptologist

 ABC Hospital

 Trichy Tamilnadu India


With the one of the grandest festival of India “The Diwali” at our doorsteps, we are also getting close to the noisy and polluting crackers. These fire crackers not only cause Air Pollution but also cause Noise Pollution. Crackers are injurious to senior citizens and children’s health.

Crackers not only are injurious to humans but also for other beings such as, animals and birds. Animals whose ears are more sensitive such as Dogs and Cats get afraid and often lose their hearing ability. These problems are also faced by us and these crackers often lead to temporary or permanent deafness.

Hence it is advised to you all to encourage a crackers free Diwali. So, here are some adverse effects of crackers on health.

Air Pollution

Air pollution takes the first position when it comes to the adverse effects of crackers on health. According to articles across the internet, air pollution goes up by 50% during Diwali in India. Air pollution leads to respiratory illnesses such as Asthma, Bronchitis and other Lung problems. Hence, it is advised to avoid crackers to avert the hazards of air pollution on our health.

Smog

Effects of crackers on healthThe pollution thus caused due to crackers also leads to Smog (Smoke + Fog). Smog is not only injurious to health but also causes problems during night driving as it obstructs our view. Smog can occur if there is no wind or rain within 2-3 days from such special occasion. Smog also leads to health problems such as skin burning and Lung Cancers. Hence, Smog is one of the most adverse effect(s) of crackers on health.

Global Warming

The Oxides and Dioxides of Sulphur and Nitrogen are released during the burning of crackers. These are very much harmful to human health and also to the environment around us. These gases are also known as the “Green House Gases” which not only aid in the rising temperatures across the globe but also in the depletion of Earth’s protective shield “The Ozone Layer” which might be hazardous to the living beings around us as they will be directly exposed to Sun’s harmful radiations. Hence Crackers cause Global warming and Global warming has adverse effects on our health.

Noise Pollution

Noise pollution is as dangerous as the Air pollution. Noise pollution is also one of the leading adverse effects of crackers on health. It not only affects the Human Beings but also the animals around us such as cats and dogs as they have Ears that are more sensitive than the Humans. Noise pollution caused by crackers might also lead to temporary or permanent deafness.

Injuries & Wounds

Crackers are not only injurious to health but can also cause injuries to the individuals, especially to the children. If crackers are not fired properly they might cause wounds on the parts of body which is exposed to them. In many cases, Children have lost their lives or have lost their eyesight by not litting the crackers properly. Hence, it is one of the most adverse effects of crackers.

Garbage Disposals

After Diwali the main problem that comes to our sight is the Garbage lying on the roads. This garbage is chemical hazardous garbage that is very difficult to dispose off as it might affect the people’s health who live near these disposal areas of the cities. another adverse Effects of crackers on health is that Many firecracker factories and industries in India dont impose security measures and make people work in factories without any safety measures. These chemicals get exposed to their skin, eyes, lungs and increase toxic levels in the body. Many studies have shown that continuous exposure to such hazardous chemicals can lead to impairment or even impotency leading to birth of unhealthy babies.

Additional Health hazards

Crackers are not only injurious to elderly citizens and children but also to the pregnant women. There have been many cases across the globe where the pollution has lead to Miscarriage in pregnant women. Hence pregnant women are advised not to leave their homes when the bursting of crackers is at its peak. Miscarriage is one of the most adverse effects of crackers on health. Other than this, many children are exploited and made to work in firecrackers factories. These children get exposed to harmful chemicals which hinders their growth or even increases toxic levels in their bodies.

Fire and loss of lives

During Diwali there are always headlines in the National Newspapers that some house/workshop has been a prey to fire due to crackers and many people lost their lives. Hence fire crackers not only injure us but can also kill us. Hence Fire is one of the most adverse effects of crackers on health and our lives too.

Harmful Effects of Crackers & Fireworks

simple sparklers have given way to elaborate fireworks that can light up the entire sky above your home. Unfortunately the fumes that these crackers produce are harmful to the the environment and us.

Copper: Causes irritation in the respiratory tract.

Cadmium: Reduces the oxygen carrying capacity of blood, leading to anaemia.

Lead: Lead in the body has a harmful effect on the nervous system.

Magnesium: Magnesium fumes cause a condition known as metal fume fever.

Zinc: Causes metal fume fever and also induces vomiting.

Sodium: Sodium is a highly reactive element and combines with moisture to cause burns.

i) The SPM (suspended particulate matter) levels rise to a large extent during Diwali. 
It can cause throat, nose & eye related problems which can later develop into adverse health hazards. 
It can lead to headaches & reduced mental acuity when it reaches the level of 100 ppm. 
It has much more severe effects in people with heart, respiratory or nervous system disorders. 
It can aggravate problem for people suffering from cold, allergies or coughs and can also cause congestion of throat & chest.

ii) Increase amount of noise has harmful effects on animals as well as humans. Standard decibel level for humans is 60 dB. 
Increase in the decibel level can lead to: 
Restlessness 
Temporary or Permanent Hearing Loss 
Fidgetiness 
High Blood Pressure 
Anger 
Heart Attack 
Sleep Disturbance 
Impulsiveness 
Can lead to withdrawal behaviour or hyperactivity in pregnant women, children & those suffering from respiratory problems.

iii) Fireworks can also cause health problems like:
Chronic bronchitis 
Common Cold 
Allergic Bronchitis 
Bronchial Asthma 
Sinusitis 
Chronic Obstructive Pulmonary Diseases (COPD) 
Ephysema 
Rhinitis 
Pneumonia 
Laryngitis

iv) It results in smog which can reduce visibility thereby leading to accidents as well as is toxic if inhaled. 
- It is said that one big firecracker like "1000 walas" and "hydrogen bombs" can produce up to 250 cc of smoke. 
- It can also cause water contamination and acid rains. 
- It results in air pollution that creates carcinogenic sulphur compounds and airborne arsenic effect.

v) Use of "rockets" near houses gives rise to many injuries each year. There is no law pertaining to the same.

vi) Harmful effects of fireworks displays: 
- Green light produced in fireworks displays comes from Barium that is radioactive and poisonous. 
- Blue colour produced from copper compounds comes from dioxins linked to cancer. 
- Different effects are produced by using different chemicals that are linked to a host of health and respiratory problems.

Therefore it’s a humble request to everyone to avoid crackers on Diwali or any other special occasion as its just equivalent to burning money. One can also celebrate it by having a get together with relatives and friends and sharing light and warm moments with them. Avoiding crackers will also protect your loved ones and will bring the family together during such occasions.

Effects of crackers on health are adverse and can lead to injuries or even loss of life. Celebrate this Diwali-2017 by meeting people, sharing sweets, having dinner together or playing social games doing so increases human bonding and makes everybody happy and keeps everybody out of danger.

Thursday, October 5, 2017

world cerebral palsy day 2017 October 6 - 'We will tell the world … I am here, we are here'.

World Cerebral Palsy Day: Friday 6 October 2017

-Dr.M.A.Aleem

Neurologist

ABC Hospital

Trichy

Tamilnadu

India

World Cerebral Palsy Day is celebrated every year on 6 Oct to raise awareness as well as to ensure that persons with cerebral palsy have access to their human rights and opportunities, just like everyone else.

What is cerebral palsy?

Cerebral palsy is the most common physical disability in childhood. It affects 17 million people globally, and 350 million family members and caregivers. It is caused by an injury to the developing brain which occurs before, during or soon after birth. For most cases, the cause is unknown. Cerebral palsy is a lifelong disability that affects movement and is often accompanied by speech, swallowing, cognitive, vision and hearing impairments.

Theme for World Cerebral Palsy Day 2017

The theme for world cerebral palsy day 2017 is - 'We will tell the world … I am here, we are here'. It is time to close the gap between the everyday circumstances and the real potential of people living with cerebral palsy. Too many people receive ineffective therapies, too many individuals and their families lack access to basic information and support, too little money is being spent on research, and far too many societies keep people with cerebral palsy out of sight, out of mind and out of options.

World Cerebral Palsy Day is a movement of people with cerebral palsy and their families, and the organisations that support them, in more than 60 countries. Our vision is to ensure that children and adults with cerebral palsy (CP) have the same rights, access and opportunities as anyone else in our society. It is only together, that we can make that happen.

World Cerebral Palsy (CP) Day is Friday 6 October in 2017. More than just an awareness day, it is an opportunity to: 1. Celebrate and express pride in the lives and achievements of those with CP and the people and the organisations that support them 2. Create a powerful voice for those with CP to change their world 3. Connect organisations across the globe so they are better equipped to meet the needs of those with CP 4. Create new solutions to everyday problems 5. Act as a catalyst for social change and education campaigns that create solutions to universal challenges 6. Produce tangible, actions and outcomes that measurably improve the lives of those with CP 7. Raise awareness of CP and the issues that affect people with CP at a local, national and international level to create more inclusive societies. The project is coordinated by the World Cerebral Palsy Initiative, a group of non-profit cerebral palsy organisations with a global vision to create real change for people living with CP.

About cerebral palsy
There are 17 million people across the world living with cerebral palsy (CP). Another 350 million people are closely connected to a child or adult with CP. It is the most common physical disability in childhood. CP is a permanent disability that affects movement. Its impact can range from a weakness in one hand, to almost a complete lack of voluntary movement. It is a complex disability: 1 in 4 children with CP cannot talk, 1 in 3 cannot walk, 1 in 2 have an intellectual disability, 1 in 4 have epilepsy.* CP is a lifelong disability and there is no known cure.

Wednesday, October 4, 2017

A Few Facts About Dengue Fever- Dr M A Aleem Former Vice Principal KAPV Govt Medical College Trichy

A Few Facts About Dengue Fever

Dr M A Aleem
Former Vice Principal
KAPV Govt Medical College
Trichy

Platelet deficiency is not the cause of death in people suffering from Dengue

According to  International guidelines, unless a patient’s platelet count is below 10,000, and there is spontaneous, active bleeding, no platelet transfusion is required. The outbreak of dengue in the City and Hospital beds are full and families are seen running around in search of platelets for transfusion. However what most people do not realize is that the first line of treatment for dengue is not platelet transfusion. It, in fact, does more harm than good if used in a patient whose counts are over 10,000.

The primary cause of death in patients suffering from dengue is capillary leakage, which causes blood deficiency in the intravascular compartment, leading to multi-organ failure. At the first instance of plasma leakage from the intravascular compartment to the extravascular compartment, fluid replacement amounting to 20 ml per kg body weight per hour must be administered. This must be continued till the difference between the upper and lower blood pressure is over 40 mmHg, or the patient passes adequate urine. This is all that is required to treat the patient. Giving unnecessary platelet transfusion can make the patient more unwell.

“While treating dengue patients, physicians should remember the ‘Formula of 20' i.e. rise in pulse by more than 20; fall of BP by more than 20; difference between lower and upper BP of less than 20 and presence of more than 20 hemorrhagic spots on the arm after a tourniquet test suggest a high-risk situation and the person needs immediate medical attention.”

Dengue fever is a painful mosquito-borne disease. It is caused by any one of four types of dengue virus, which is transmitted by the bite of an infected female Aedes aegypti mosquito. Common symptoms of dengue include high fever, runny nose, a mild skin rash, cough, and pain behind the eyes and in the joints. However, some people may develop a red and white patchy skin rash followed by loss of appetite, nausea, vomiting, etc. Patients suffering from dengue should seek medical advice, rest and drink plenty of fluids. Paracetamol can be taken to bring down fever and reduce joint pains. However, aspirin or ibuprofen should not be taken since they can increase the risk of bleeding.

The risk of complications is in less than 1% of dengue cases and, if warning signals are known to the public, all deaths from dengue can be avoided.
DENGUE NS1-Best test is NS1
Cannot be false +ve
Is + from day 1 to 7 ideally.
If on day 1 is -ve, repeat it next day.
Always ask for ELISA based NS1 tests as card tests are misleading.

Value of IgG & IgM dengue-
In a pt with reduced platelets and looking "sick" on day 3 or 4 of illness, a very high titre of IgG with borderline rise in IgM signifies secondary dengue. These pts are more prone to complications.
In primary dengue IgG becomes + at end of 7 days, while IgM is + after day 4.

Immature Platelet fraction/IPF
A very useful test in Dengue for pts with thrombocytopenia.
If IPF in such a pt is > 10%, despite a pl count of 20, 000 he is out of danger & platelets will rise in 24 hrs
If its 6%, repeat the same next day. Now if IPF has increased to 8% his platelets will certainly increase within 48 hrs.
If its less then 5%, then his bone marrow will not respond for 3-4 days & may be a likely candidate for pl transfusion.
Better to do an IPF even with borderline low platelet count.

A low Mean Platelet volume or MPV means platelets are functionally inefficient and such pts need more attention.

What is Dengue?    

Dengue is a fever due to virus spread to humans by Ade's mosquito bite (Day time biter - Morning  to Evening)

What are the symptoms of Dengue fever? 

Dengue presents as High grade fever 103, with Headach, rashes, bleeds, vomiting pain in the eyes, abdomen, joints and muscles as severe bodyache, ..

What are the danger signs requiring admission in hospital?  Patient may require hospitalization in case of Persistent vomiting / severe stomach pain, cold/red  palms&soles, drowsiness / refusal of feeds, bleeds/bruises/Malèna, No Urine output for more than 6hrs
All these Appears only when fever goes away from 5th day to next 48 Hrs,
This s *Critical Phase*of Dengue fever.
Needs close Monitoring when FEVER goes away...

When to do tests?
What tests are to be done?
First 3 days of fever please do CBC, Most important to watch is Platelets count, Packed cell volume(PCV) and NS1Dengue Antigen and Only after 5 days of fever Do Elisa DENGUE Serology test.

What is the treatment for Dengue fever?   

Treatment for Dengue fever is only supportive since antiviral drugs against Dengue virus isn't discovered yet,..
But taking care of Dehydration status & Close monitoring is mandatory,
So Monitor the fluid intake and urine output once in 2to4 hours.

The patient should take adequate fluids, W.H.O approved
liquid.ORS / RELYTE / ELECTRAL /  ORS Ready-mix.

How can Dengue be prevented?
AVOID MOSQUITO BITE as far as possible by applying repellent lotion /cream / spray /  band /sticker,...
Use mosquito net / bat / mosquito repellent gel tray / liquid / matt.
Covering water containers should be encouraged. 
*Keep your Environmental clean*

Nothing to panic since Dengue fever is like any other Viral fever with  mortality of 1%
Very less than
Pneumonia(most dangerous),MEASLES, Diarrhoea, Typhoid, Japanese encephalitis, Hib Brain fever, Hepatitis A,B
(All of those are Vaccine preventable)
So make sure that your kids receive vaccination for all of the above)

*DURING FEVER: Do's*
Close monitoring of hourly temperature, Vital signs BP, Pulse,  liquid intake&urine output are important especially when fever goes beyond 3 to 7days and if fever recurs within 30 days.

As a First aid Please do give tepid- sponging or set AC at 25°¢ in order to cool and bring down the body temperature,
Give Paracetamol as prescribed every 4 to 6th hourly also Nilavembu kudineer, and Plenty of Fluids, Fresh juices, Soups, Normal Food & ORS  till you consult the Doctor

Please give a spoon once in 5 minutes of W.H.O approved ORS  liquid.OR PEDIALYTE OR ELECTRAL OR ORS READY-MIX to prevent most important Dehydration,...

*To prevent Fever*:

AVOID MOSQUITO BITES,
DRINK BOILED& Cooled water adequately
Consume Home made favourite drinks, foods after washing the hands and plates in drinking water.

*DURING FEVER: Don'ts*
Avoid going to quacks,
Avoid injections in muscles during fever,
Avoid over the counter or self medications.
Single injection in the muscle won't cure any fever in fact injection will harm the muscle & nerve...

Avoid water storage without covering, prevent mosquito breeding to prevent Dengue fever,.
*Good Nutritional Status is the Shield to Combat   Complications of  Dengue*
*To Keep your Environment Clean&Friendly
Its each one of our Responsibility*
Thanks,
Take care.