Study settles debate over head position following stroke

New Delhi, 22nd June 2017: Stroke or Brain Attack is the leading cause of death and disability in the world. A trial involving more than 11,000 patients has revealed sitting up or lying flat after a stroke makes no difference to their recovery.

The research led by The George Institute for Global Health set out to discover if the bed position of people with the most common form of stroke, (acute ischemic) reduced death or disability.

Some studies had indicated lying flat may improve recovery by increasing blood flow in the main arteries to the brain, but there were fears it also raised the risks of pneumonia.

The worldwide results published in the New England Journal of Medicine found the position of a patient’s head does not affect outcomes.

Lead investigator Professor Craig Anderson of The George Institute of Global Health, Sydney said: "Many stroke specialists believe that the way the body is positioned after stroke makes a difference to their patient’s recovery. But, there was really no conclusive evidence to back this up. We know the first 24 hours of care post-stroke is crucial to recovery, so it was vital to find out if sitting up or lying down flat could make any difference."

National lead Principal Investigator Professor Jeyaraj D Pandian, Honorary Professor, the George Institute for Global Health & Head of Neurology at Christian Medical College, Ludhiana stated that "Head position does not matter so much over and above good nursing care. It does not help with recovery, with mortality or how a patient feels. However, we also found there were no significant harms associated with either lying down flat or sitting up."

The study is the largest ever randomised nursing care trial and took place at 114 hospitals in nine countries (UK, Australia, China, Taiwan, India, Sri Lanka, Chile, Brazil, Colombia).Professor Pandian added, Patients were either assigned to lie flat with their face upwards or with their head raised to at least 30 degrees during the first 24 hours after being admitted to the hospital for a stroke. They were then assessed 90 days later. From India 499 patients were enrolled from 6 stroke centers (Christian Medical College, Ludhiana; PGIMER, Chandigarh; Dr. Ramesh Superspeciality Hospitals, Guntur; SCTIMST Trivandrum and Baby Memorial Hospital, Calicut).

Professor Anderson said the results were very reassuring to lower to middle income countries, where lying flat is more commonly practiced due to the lack of motorized beds.

"What we found is that patients found lying flat somewhat uncomfortable, but it certainly didn’t make their condition any worse. Our findings suggest a review of current clinical practice guidelines is warranted," Professor Pandian added. The majority of patients who took part in the study had mild to moderate severity strokes, with an average age of 68 years.

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Dealing with Ear Pain while Scuba Diving

Ear pain while scuba diving is a common problem encountered by almost every diver at some point; it is also called ear squeeze. The primary reason of this can be due to the difference in pressure between the ear and the outer environment. There can be many other causes and a person experiencing such sensation must see an ENT Specialist for a better diagnostic.

ENT Specialist Explain the Cause for Ear Pain While Scuba Diving

The pain occurs when the diver descends deeper underwater; it is because the water pressure on the tympanic membrane (ear drum) increases. The pain increases as the diver descend deeper as every 33 feet deeper under the water the atmospheric pressure changes by 1 atmosphere.

The eustachian tube plays a major in equalizing this pressure. Under normal circumstance, this tube opens and allows the pressure on the eardrum to balance with the water pressure outside in the sea. But if the eustachian tube does not open then due to the water pressure the eardrum is pushed inward causing inflaming and stretching of the ear canal and causing pain.

If the diver continues to descend deeper in the sea ignoring the pain, the eardrums may burst causing vomiting, nausea, and dizziness because the seawater rushes into the middle ear.

Some of the reasons why the Eustachian tube might not equalize can be attributed to things like smoking, extreme ear cleaning, allergies, respiratory infections, nasal polyps, and previous facial trauma.

Dealing with the Pain

It is essential that the diver immediately attends to the pain. The best way to treat or suspend the pain is to avoid diving for few days and consult a doctor. In the initial stage, oral decongestants and nasal spray might be administered to help with the eustachian tube and if an allergy persists then the physician may prescribe antihistamines.

Pain medication and ear drops may be advised to relieve the pain in the ear. If the eardrum is ruptured then an antibiotic might be required. Oral steroids may need to be administered if the patient is suffering from facial paralysis.

Few Tips for Easy Equalizing

Few precautionary measures can be practiced by the diver to avoid ear pain while diving and help the process of equalizing.

The diver can start the dive early and try to equalize the ear, it has been observed that chewing gum can help in the process. One must also observe a pop in the ears as it indicates that the eustachian tubes are opening.

It helps if you descend feet-first; it has been widely observed that if you descend feet-first, equalizing happens faster. Extend and look up to help your eustachian tubes open. ENT Specialists say that if you experience pain that means your tube haven’t opened and you need to stop.

Avoid the consumption of food that prompts the production of mucus; food like milk. Stay away from tobacco and alcohol as it irritates the mucus membranes and in turn increases the production of more mucus. Prevent water from going up the nose as it again increases the mucus production.

ENT Specialists Advice

This is a serious issue with diving and no diver should take it lightly. It can lead to serious damages to the nose, the ear and even the throat. It is also observed that some threat to the brain is also posed. The affected person should consult the doctor if they have experienced any of the symptoms or pain in the ear after or during diving. It is also advised that the diver takes a partner with them while going diving. 

Post Heart Attack Angioplasty

Also commonly known as balloon angioplasty this process is an endovascular procedure which is used to widen up the blocked or narrowed arteries of the heart and veins. A coronary angioplasty is performed with the help of a balloon-tipped catheter. This catheter is inserted in the wrist or the groin in order to enlarge the narrowing coronary artery.

In some other cases, the catheter contains a stainless steel mesh known as a stent, which is used to keep the blood vessel in an open position and has the ability to remain in that place even after the balloon has been deflated and removed.

Usually performed immediately after a heart attack, preferably within twenty-four hours, getting the procedure done at the right time considerably reduces your risk of having a successive heart attack.

It is important to understand the reason why cardiac arrests occur. The coronary artery gets blocked due to the plaque that gets left behind in the walls of the arteries of the heart. The blockage occurs because of large amounts of cholesterol intake, lack of physical exercise and unhealthy lifestyle choices such as excessive drinking or smoking.

Since heart failures and heart attacks are grave medical emergency, immediate action is the key to minimize the extent and amount of damage caused. Depending on the type of facilities available in the hospital, a procedure like this can cost anywhere between one to three lakhs in India.

Admittedly, it is a little heavy on the pocket, but it is highly recommended and very favorable in the long run to consult an experienced doctor as your muscles would be less likely to suffer any sort of damage if your doctor is able to restore the blood supply quickly.

There are benefits as well as risks involved with post heart attack angioplasty. A careful understanding of both will allow you to choose wisely and minimize the implicated risks.

Benefits:

Research suggests that a post heart attack angioplasty drastically reduces the risks of further heart attacks thus having the potential to save lives. It is possibly the most efficient method of getting the blood flowing quickly towards the heart. It is also very helpful in relieving chest pains caused by blockages and decreasing other related symptoms. In comparison to an open heart surgery, this procedure is definitely less complicated, requires lesser post-operation care, and allows its patients to recover more quickly.

Risks:

Every medical procedure comes with a certain amount of risk attached to it. This invasive procedure may cause you to react against the anesthetic or the dye being used. Other materials used in the process can also cause a side effect. Other types of risks that are hugely associated with the procedure are:

Clotting, bleeding or bruising at the point where the insertion is made.

People suffering from existing kidney problems may experience further kidney damages.

Damages may occur to the blood vessel, artery or the heart valve.

Although this procedure is associated with the risk of heart attack, the possibility is very low.

The important thing to remember is that an emergency procedure is not the complete cure for blocked arteries. In several cases, where a stent isn’t used, the coronary artery can become narrow again, known as restenosis.

Avoid opting for a seemingly pocket-friendly procedure, and go for the complete solution that’ll give you longer lasting results.

Life after Angioplasty:

One of the main reasons for heart failures or cardiac arrests is an unhealthy lifestyle. An improvement in diet and an appropriate amount of exercising guarantees a healthier lifestyle and a decreased chance of your coronary arteries being blocked. Consult your doctor before going in for exercises like cycling, jogging, and swimming as it substantially increases your heart rate. Alternatively, a cardiac rehabilitation program might be the best way to go. A complete and healthy change in your lifestyle (diet, food, and exercise) is the most recommended course of action to avoid any further complications.

Fortis Heart Failure Centre in Chennai performs Angioplasty for the cost of one and a half lakh rupees (1,50,000) along with a private ward and excluding the stent. Whereas, in Sarvana Heart Hospital Chennai, the procedure in a private ward can cost around one lakh and twenty thousand rupees (1,20,000). Rates and costs, of course, vary from ward to ward and hospital to hospital, but a general inference can be drawn from the above illustrations.