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By Dr Vipul Gupta
Pediatric strokes even though rare, is one of the leading causes of significant morbidity and mortality. In comparison to stroke occurring in adults, children present differently with unique risk factors that often optimizes the outcomes. As the risk factors for pediatric stroke vary from that in adults, the cases are often diagnosed at later stages, or remain misdiagnosed.
According to the data reported in various International journals, mortality rate of children suffering from stroke under the age of 15 years is around 25% and the remaining will have a recurrence or will have persistent neurological disorders, difficulty in learning or seizures. Unlike adults where the risk factors are predominated by diabetes, hypertension and atherosclerosis, pediatric risk factors are more diverse and larger in number.
However the instances of pediatric stroke are under reported and may be more than we realize. This is attributed to the fact that the symptoms mimic other diseases that lead to misdiagnosis and hence delay in its treatment. With recent advancements in the field of neurointervention, the survival rates of pediatric stroke (also suffering from congenital heart ailments, sickle cell disease or other blood disorders) has doubled due to improved intervention and awareness.
What is pediatric stroke?
Stroke is caused by the occlusion or rupture of arteries and veins in the brain and can be ischemic or hemorrhagic or both. Ischemic strokes are more commonly caused due to arterial blockage, but can also happen with venous blockage. When the blockage leads to rupturing of the blood vessels causing bleeding it is termed as hemorrhagic stroke. Ischemic stroke in adults accounts for 85% of all strokes whereas only 50% are attributed in the case of pediatric stroke.
Children are also vulnerable to a mini stroke (Transient Ischemic attacks – TIA) when the blood supply to the brain is interrupted for a very short time. Usually the symptoms subside immediately after TIA, but the chances for a stroke to occur within the next 24 hours doubles.
What are the symptoms?
As stroke can happen at any age, from infancy to adulthood, the age determines the appropriate treatment option for the neurointerventionist. It is thus often misdiagnosed due to the fact that the effects of stroke or its symptoms are not noticeable.
Strokes are first detected when the problems arise with their learning and development. Most noticeably there may be problems with movements in only one side of the body. Seizures are the most common symptom in infants upto 28 days old and in children upto 18 years may experience weakness or paralysis on one side of the body, facial drooping, speech problems and headaches. These symptoms are most commonly associated with ischemic strokes. Symptoms for hemorrhagic strokes include vomiting, seizures and occasional headaches.
The effect of stroke depends on the area of occurrence of stroke in the brain and the amount of damaged caused. People having larger strokes can be permanently paralyzed on one side of their body or lose their ability to speak. But some having small strokes may only have temporary problems like weakness of an arm or leg. With timely intervention most of the cases are recoverable completely.
Who is at more risk?
The risk factors and reasons for pediatric stroke are distinct and varied including malformations in the blood vessels and other congenital abnormalities.
Ischemic stroke is the leading cause pediatric stroke and the risk factors include –
1. Congenital heart ailments - Heart disorders cause up to 25 per cent of ischemic strokes in children. They can be a result of congenital heart disease, an abnormality present since birth or acquired heart disease. Stroke is not usually the first sign of heart disease. Often heart disease has been diagnosed before the child has a stroke.
2. Congenital Blood Disorders – also known as prothrombotic disorders, the condition causes the blood to thicken and clot faster. Sickle cell Disease (SCD) is another inherited condition that affects the development of RBC and changes its shape from round to sickle. Though rare, it can also cause bleeding in the brain blood vessels. Other conditions include leukemia, Anemia, and autoimmune disorders.
3. Arterial Malformation – stroke can occur due to irregular formation of arteries in the brain. Being congenital, children born with this condition often go undetected until the symptoms of stroke are persistent. Such kids need regular monitoring for recurrent strokes.
Hemorrhagic strokes attributes to 50% of the cases of pediatric stroke and the main reason is Arterio-Venous Malformation (AVM). It is a rare malformation of the arteries and veins where the high pressure blood pumped from the heart to the brain directly move to the veins that passes blood at relatively low pressure. This change in pressure causes rupturing of the vessels thereby causing bleeding.
How is it treated?
The treatment for hemorrhagic stroke focuses on stabilizing the child by controlling the blood pressure, body temperature and prevents shortness of breath before treating the hemorrhage. The surgical options include microsurgery to clip the aneurysm or remove the abnormal vessels.
The treatment for ischemic stroke works on to reduce the damage to the brain and prevent another stroke. Doctors prescribe blood thinner and also monitor reflexes, eye movements, speech skills, swallowing and other body functions. Also how the child is processing to and reacting to light, pictures, sound and touch.
Dr Vipul Gupta is the Director, Neurointervention, Agrim Institute for Neuro Sciences, Artemis Hospital
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Dr. Pradeep Muley
Cancer seems to have a way of deeply invading the lives of those stricken by the disease. And very often the treatment isn't much friendlier to patients. But some recent advances in cancer treatment are helping, including some minimally invasive and non surgical procedures, especially in case of Liver tumours.
While surgery to remove a liver tumor offers the best chance for a cure, surgery is not an option for more than two-thirds of patients with primary liver cancer which is said to be the fifth most common cancer and the third most common cause of cancer-related death worldwide. Approximately, seventy percent of patients with liver cancer cannot opt for surgery for many reasons, like, the tumours could be too large to be removed or they could be too close to major blood vessels or other organs. And many a times, patients may have many small tumors in the liver, thus making surgery too risky or impractical.
Also liver surgery is a complex procedure because many of the major blood vessels leading to and from the heart pass behind or through the organ. In addition, the liver can tear easily and will bleed profusely if injured.
When liver tumors are small in size and number and have not spread to nearby blood vessels – and no cirrhosis or other liver conditions are present – patients may also be eligible for a liver transplant. But again, not many patients are in condition to go through a liver transplant surgery.
In such circumstances, interventional radiologists may perform minimally invasive surgeries like embolization or thermal ablation, etc, depending on the patient's case history. These minimally invasive therapies use imaging techniques such as CT, ultrasound, or MRI to guide the delivery of treatments directly to tumor sites.
In a typical Embolization surgery, the interventional radiologists inject chemotherapy drugs through a thin tube into the major vessel that delivers blood to the liver. The drug is mixed with a substance that not just blocks the artery for cutting off blood flow to the tumor but also restricts most of the chemotherapy drug from reaching out to other parts of the body. Thus, it is trapped near the tumor only.
This type of treatment often keeps the tumor away from getting the oxygen and nutrients it needs to grow, and therefore, healthy tissue is protected. The blockage may be temporary or permanent, depending on the kind of drug that is used to block the blood vessel. The liver still receives blood from a vein that brings blood from the stomach and intestine to keep the healthy tissue alive. Embolization can be repeated to treat recurrences that may develop later.
If required, radiologists may use this procedure to send radioactive particles to tumors that are too large to be treated with surgery which is called radioembolisation. It's a therapy used to treat both primary and metastatic live tumors. This is primarily a palliative, which means it relieves patients' of symptoms and is not a curative treatment. It elicits fewer side effects if compared with standard cancer treatments.
Another alternative way is to send particles into the tumor to release chemotherapy directly inside it for days or weeks. This is usually done with the help of X-rays, that guides surgeon/ radiologist directly to the tumor.
Another technique involves destroying tumor by heat or cold. This technique is often meant for people with three or fewer tumors. There are several types of thermal ablation, including radiofrequency ablation, which uses radio waves to superheat the tumor, and cryoablation, which freezes the tumor. Other types of thermal ablation use lasers, microwaves, and focused ultrasound waves to kill tumor cells. The selection of heat or cold depends on the size, location, and shape of your tumor.
Another non surgical way to treat liver Tumor is through minimally invasive laparoscopic or robotic surgery. In this procedure, a thin, lighted tube with a camera on its tip is inserted through a tiny incision in the abdomen to remove tumors or, in selected cases, part of the liver.
Medical professionals are evaluating the effectiveness of these minimally invasive approaches and their potential to reduce complications that can often arise with traditional, open surgery. For instance, having minimally invasive surgery can significantly reduce recovery time compared with traditional surgery.
Also these treatments benefit patients not just by extending their lives but also improves their quality of life, which is of utmost importance in cancer patients.
*Dr. Pradeep Muley is the Head Interventional Radiologist at Fortis Hospital, Vasant Kunj
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- Denis Giles
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1. SOF is inviting School Students to Develop Competitive Spirit through National Cyber Olympiad.
Students, who want to learn the competitive spirit and fight amongst each other in a healthy way, are invited in the National Cyber Olympiad. The Olympiad’s aim is to make the approach towards IT, Science and other subjects in classrooms more interactive, practical and innovative. Also, motivating students to take part in the national, international competition, programmes and events.
Last date to submit the application form is November 20, 2018. In order to be eligible for this Olympiad, candidates need to fulfil the mandated requirements:
Eligibility
Students of standard 1st to 12th are eligible to ally for this Olympiad also it is a single level exam.
Scholarship Reward
The awards will be given at different levels:
1. International Level
• 1st rank holder will be awarded with an amount of INR 50,000 and a gold medal.
• 2nd rank holder will be awarded with an amount of INR 25,000 and a silver medal.
• 3rd rank holder will be awarded with an amount of INR 10,000 and a bronze medal.
• Each winner will also be awarded with an outstanding performance certificate.
2. Zonal Level
• 1st rank holder will be awarded with an amount of INR 5000 and a gold medal.
• 2nd rank holder will be awarded with an amount of INR 2500 and a silver medal.
• 3rd rank holder will be awarded with an amount of INR 1000 and a bronze medal.
• 4th to 10th rank holder will be awarded with INR 1000 worth gifts, medal and certificate of distinction.
• 11th to 25th rank holder will be awarded with medal and certificate of distinction.
• 26th + rank holders will be awarded with participation certificate.
3. At School Level
• The top three rank holders will be given a gold, silver and bronze medal, respectively, along with the Student Performance Report (SPR).
• Each student will be awarded a participation certificate.
How to Apply
Students are requested to register through their respected schools.
About
The National Cyber Olympiad is an initiative by Science Olympiad Foundation which was established by the leading academicians, scientists and media personalities with the motive of promoting science, mathematics, computer education, English, General Knowledge and professional courses.
Click Here to Know More
http://www.b4s.in/AC/SNC6
https://www.buddy4study.com/scholarship/sof-national-cyber-olympiad-nco-2018-19
Courtesy: www.buddy4study.com / Call: 08448709545, 08527484563
2. Opportunity for Rising Leaders to Work with Leading Institution with TJ India-Youth Fellowship Program 2019
Telangana Jagruthi, a non-governmental organisation (NGO) is offering a two-week programme for budding leaders, who have made their contribution towards Sustainable Development Goals (SDGs), to work with leading institution and learn diplomacy, development, policy and education, and whet their communication, innovation, problem solving and management skills.
Last date to submit the application form is November 20, 2018. In order to be eligible for this fellowship, candidates need to fulfil the mandated requirements:
Eligibility
• Young entrepreneur, who are running a start-up, NGO, initiative, campaign that leads to sustainable development goal.
• Upcoming leaders with demonstrated leadership skills and passion towards bringing positive changes in the world.
• Leaders, who are about to achieve success or have not received large-scale public attention, are eligible to apply.
Scholarship Reward
• Opportunity to get face to face with leading Indian Government, non-profit and business sectors leaders.
• On ground experience in ones choice of project of Telangana Jagruthi as a volunteer and consultant.
• Opportunity to attend two day Telangana Jagruthi International Youth Leadership Conference 2019, to present ones ideas and experiences in front of global leaders.
How to Apply
Interested candidates can send their essay and essential documents via email to This email address is being protected from spambots. You need JavaScript enabled to view it., with subject line as ‘TJIYLC - 2019 Fellow_First Name_Last Name_Application'
Other Important Details
Applying candidate needs to submit the below- mentioned documents:
1. Applicant's photograph and bio
2. Applicant's updates CV which highlights his or her skills and achievements
3. A Statement of Purpose (SOP) in words not more than 600 which must include applicant's motivation and expectations for the Youth Fellowship Program and also the following factors:
• A project, organisation, or an initiative that the applicant has led or started
• Applicant's vision and motivation about the same
• How this project, initiative, organisation contributes towards a sustainable development goal
4. An essay in 250 to 500 words on a Telangana Jagruthi program, project of the applicant's choice describing how he, she would like to contribute towards the project in the second week of his, her immersion program and, or what he or she expects to learn from the experience. Telangana Jagruthi programs and projects can be accessed at http://telanganajagruthi.org/
Click Here to Know More
http://www.b4s.in/AC/TIF7
https://www.buddy4study.com/scholarship/tj-india-youth-fellowship-program-2019
Courtesy: www.buddy4study.com / Call: 08448709545, 08527484563
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- Denis Giles
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In America, there are many who ask Trump, where’s the Wall he promised he would build. A wall that would keep outsiders out. And in India, there are many who ask about the Temple. Where is the Temple, that was supposed to be built?
Where is The Wall and The Temple? Why have they not been built, the people cry.
“Hey people! Are you so blind, that you cannot see?”
“What?” cry the people who have asked for wall and temple.
“That the Wall has been built, and the Temple too!”
“Where?” ask the people, surprise on their faces, “Where has the wall and the temple been built?”
“In your minds!”
“Walls have been built in what were once the United People of America, dividing, the white man from the rest, and the country from the rest of the world!”
“And the temple? Where has it been built?”
“Again, in your minds! Dividing the people who worship in temples and the people who don’t!”
“Yes!” cry the people, a hush entering their voices “We do see the Wall and we do see the Temple, built in our minds!”
And then from the Wall and the Temple do I hear a cry, “We are not meant to separate! We are meant to protect! We are not meant to divide, we are meant to unite!”
“I,” says the Wall with humility, “Protect, those that stay within, against those that attack my people in the world outside. I am not meant to divide, but to stand, shoulder to shoulder with each brick that makes me up, and safeguard, those who live within! How, ever, was I made a wall that divides?”
“And I,” says the Temple, “Am built to bring peace in the minds of men. To show that war and murder are not the ways for man to impose his feelings on another. How, ever, did I become a temple that divides?”
In silence the people stare, and then cast down their eyes. “It is we who have allowed those bricks to be built to divide,” they say, “It is we who opened our minds to division and destruction!”
“Then open your minds again!” cries the Wall.
“Open your hearts!” cries the Temple.
“Let peace and quiet be restored in you!” cry the Wall and the Temple, “Let nobody plant thoughts about us that are not the truth! We are meant to protect and pacify. Not divide and destroy!”
Yes dear people, pull down brick by brick, false walls and temples built by those who want to separate and sever, and build instead Walls and Temples that Safeguard and Still the minds and hearts of men..!
Which is what walls and temples are for, isn’t it?
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By Dr. Pradeep Mulley
Peripheral artery disease is a common circulatory problem in which narrowed arteries reduce blood flow to the limbs. The legs don't receive enough blood flow to keep up with demand of day to day walking. This causes symptoms, most notably leg pain when walking called claudication which disappears after a few minutes of rest but again pain starts when person starts walking.
What causes PAD?
Atherosclerosis - a condition where fatty deposits (plaques) build up in the artery walls, thereby narrowing the lumen and reducing blood flow. Less commonly, the cause of peripheral artery disease may be blood vessel inflammation, injury to the limb, unusual anatomy of ligaments or muscles pressing on the artery, or radiation exposure. Other factor that raises the risk of PAD include -
· Smoking · Diabetes · Obesity (a body mass index over 30) · High blood pressure · High cholesterol · A family history of peripheral artery disease, heart disease or stroke · High levels of homocysteine, a protein component that helps build and maintain tissue.
People who smoke or have diabetes have the greatest risk of developing peripheral artery disease.
What are the associated complications?
· Critical limb ischemia - This condition begin as open sores that don't heal, an injury, or an infection of the foot or leg that progress and cause tissue death (gangrene), sometimes requiring amputation of the affected limb.
· Stroke and heart attack - The atherosclerosis that causes the signs and symptoms of peripheral artery disease can also build up in arteries supplying blood to the heart and brain.
What are the symptoms?
· Claudication - Painful cramping in hip, thigh or calf muscles after certain activities, such as walking or climbing stairs.
· Leg numbness or weakness, Sores on toes, feet or legs that won't heal
· Coldness in lower leg or foot, especially when compared with the other side
· A change in the color of legs
· Hair loss or slower hair growth on feet and legs
· Slower growth of toenails and Shiny skin on legs
· No pulse or a weak pulse in legs or feet
· Erectile dysfunction in men
If peripheral artery disease progresses, pain may occur even at rest or when lying down (ischemic rest pain). It may be intense enough to disrupt the sleep.
Early diagnosis is the key to treatment
Physical exam – the doctor examines for a weak or absent pulse below a narrowed area of your artery, whooshing sounds (bruits) over your arteries that can be heard with a stethoscope, evidence of poor wound healing in the area where your blood flow is restricted, and decreased blood pressure in your affected limb. The following tests may be done to intervene the condition -
· Ankle-brachial index (ABI) - It compares the blood pressure in your ankle with the blood pressure in your arm.
· Ultrasound - Doppler ultrasound evaluates the blood flow through the blood vessels and identifies blocked or narrowed arteries.
· Angiography - By injecting a dye (contrast material) into the blood vessels, the doctor can view blood flow through the arteries as it happens, using imaging techniques, such as X-ray imaging or magnetic resonance angiography (MRA) or computerized tomography angiography (CTA).
Catheter angiography is a more invasive procedure that involves guiding a catheter through an artery in groin to the affected area and injecting the dye. Although minimally invasive, this type of angiography gives best visualization and allows for simultaneous diagnosis and treatment — finding the narrowed area of a blood vessel and then widening it with a dilating procedure or administering medication to improve blood flow.
How is it treated?
· Medication – medicines are provided to prevent blood clot and improve the blood flow. With the use of vasodilators, the aim is to reduce the blood pressure (under 130/80 mm Hg), lower cholesterol levels (<100 mg/dL) and control pain and other symptoms.
· Thrombolytic Therapy – In case the blood clot is blocking an artery the doctor may inject a clot dissolving drug into the affected artery to break it up.
· Angioplasty – this method is most commonly performed in cases of short segment block. In this procedure, a small (catheter) is threaded through a blood vessel to the affected artery where, a small balloon on the tip of the catheter is inflated to reopen the artery and flatten the blockage into the artery wall, while at the same time stretching the artery open to increase blood flow. Then a stent is inserted in the artery to help keep it open.
· Bypass surgery – This is done in case of long segment of blocked or narrowed artery. A graft bypass is created using a vessel from another part of the body or a blood vessel made of synthetic fabric.
* Dr. Pradeep Mulley is the Head Interventional Radiologist at Fortis Hospital, Vasant Kunj