Dr K K Aggarwal

World Stroke Day: Common mistakes in managing strokes

1. Failure to diagnose intracerebral hemorrhage or subarachnoid hemorrhage in time.
2. Not ensuring airway protection and not assessing swallowing and preventing aspiration.
3. Not optimizing position of head end of the bed with respect to the risk of elevated intracranial pressure, aspiration, and the presence of comorbid cardiopulmonary disease. One should keep the head in neutral alignment with the body and elevating the head of the bed to 30 degrees. For patients in the acute phase of stroke who are not at risk for elevated intracranial pressure, aspiration, or worsening cardiopulmonary status, keep the head of bed flat (0 to 15 degree head-of-bed position).
4. Not obtaining emergent brain imaging (with CT or MRI) and other important laboratory studies, including cardiac monitoring during the first 24 hours after the onset of ischemic stroke.
5. Not checking serum glucose and correcting hyperglycemia or hypoglycemia.
6. Not starting insulin in time in patients who have serum glucose concentrations >180 mg/dL.
7. Not evaluating and treating the source of fever. In acute stroke one should maintain normothermia for at least the first several days.
8. Lowering blood pressure in patients with acute ischemic stroke who are not treated with thrombolytic therapy. In these patients one should treat high BP only if the hypertension is extreme (systolic BP >220 mmHg or diastolic BP >120 mmHg), or if the patient has another clear indication (active ischemic coronary disease, heart failure, aortic dissection, hypertensive encephalopathy, acute renal failure, or pre-eclampsia/eclampsia). When treatment is indicated, one should follow cautious lowering of blood pressure by approximately 15 % during the first 24 hours after stroke onset.
9. Not lowering blood pressure in patients with acute ischemic stroke who will receive thrombolytic therapy. Antihypertensive treatment is recommended so that systolic BP is ≤185 mmHg and diastolic BP is ≤110 mmHg.
10. In both intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), the approach to BP lowering must account for the potential benefits (e.g., reducing further bleeding) and risks (e.g., reducing cerebral perfusion).
11. Not considering thrombolytic therapy for patients with acute ischemic stroke.
12. Not starting antithrombotic therapy within 48 hours of stroke onset.
13. Not starting prophylaxis for deep venous thrombosis and pulmonary embolism.
14. Not continuing statins in patients receiving statin therapy prior to stroke onset.

Do not eat bitter bottle gourd (lauki)

1. Bottle gourd belongs to the cucumber or cucurbitaceae family. Lauki or bottle gourd (Lagenaria siceraria) fruit juice is advocated as a part of complementary and alternative medicine. If the bottle gourd juice becomes bitter it is considered toxic. The Indian Journal of Gastroenterology has reported 15 patients, who developed toxicity due to drinking bitter bottle gourd juice. Patients presented with abdominal pain, vomiting, blood in vomit, diarrhea and hypotension within 15 min to 6 hours after ingestion of the bottle gourd juice. (Indian J Gastroenterol 2011 Oct 11. Epub ahead of print)
2. First, slice a piece from bottle gourd, taste if it’s bitter. If it’s bitter, discard it immediately, as per ICMR.
3. Dr S K Sharma, Head, Dept. of Medicine at AIIMS: Lauki juice should not be mixed with any other juice.
4. Like other members of the gourd family, the bottle gourd contains the tetracyclic triterpenoid cucurbitacins compound, which is responsible for the bitter taste that can cause serious side-effects and even death.
5. Boiled and cooked bottle gourd has no risk.

Facts about tea, coffee and cola drinks

1. Caffeine is consumed in coffee, tea, soft drinks, and small amounts in chocolate.
2. It is the most widely used pharmacologically active substance in the world.
3. Caffeine can acutely raise blood pressure by 10 mmHg in patients who are infrequently exposed.
4. There is no effect on blood pressure in habitual coffee drinkers
5. It does not increase the risk of incident hypertension.
6. There is no evidence that caffeine in doses used in routine can provoke a spontaneous arrhythmia in individuals with or without a history of cardiac arrhythmia. There is no protective effect of caffeine abstinence also. In heart patients with coronary disease, the risk may be increased in individuals who are slow metabolizers of caffeine and drink two or more cups of coffee per day.
7. Ingestion of large quantities of caffeine is associated with arrhythmic and cardiovascular events, especially in patients with underlying cardiac disease.
8. Patients with a history of cardiac arrhythmia or at increased risk for cardiovascular events should moderate their caffeine intake from all sources.
9. Consumption of caffeinated beverages is associated with some short-term benefits like increased mental alertness and improved athletic performance.
10. Consumption of caffeinated beverages is associated with short term adverse effects including headache, anxiety, tremors, and insomnia.
11. In the long term, caffeine is also associated with generalized anxiety disorder, depression, and substance abuse disorders.
12. Long term benefits of caffeinated beverages are dose-dependent. Caffeine is associated with a reduced risk of Parkinson disease, Alzheimer disease, alcoholic cirrhosis, and gout.
13. Both caffeinated and decaffeinated coffee are associated with a lower risk of type 2 diabetes.
14. Several studies have linked coffee consumption with prevalence of various cancers.
15. The majority of studies show there may be a modest inverse relationship between coffee consumption and all-cause mortality.
16. Caffeine withdrawal is a well-documented clinical syndrome with headache being the most common symptom.

[Source Uptodate]