SLEEPING PILLS AND HEALTH HAZARDS

SLEEPING PILLS: Pills for Blissful Sleep or Early Deaths?

Sleeping pills (sedatives and hypnotics) are commonly used (and abused) by the general population. About 6-10% of adults use prescription sleeping pills. The usage of sleeping pills is higher among women and overweight people. Usage also increases with increasing age and in those with pain or depressive illness.

Insomnia (an inability to get normal sleep) is cited as the commonest reason to use sleeping pills. A normal adult requires 7-9 hours of sleep per night. Sleeping pills help increase the number of sleeping hours providing bliss to people with insomnia. But is this bliss coming at a cost? Are there any health hazards associated with sleeping pill usage? The current article is aimed at finding out the risks and hazards of sleeping pill usage.

Do sleeping pills lead to more deaths?

Several studies have shown that use of sleeping pills is associated with higher death rates. In a large study published in British medical Journal in 2012, more than 10,000 people who used sleeping pills were compared to about 24,000 people who did not use sleeping pills. They were followed up for 2.5 years. The hazard of death was three times more in people prescribed as little as 1-18 sleeping pill tablets per year. The hazard for death increased with higher number of prescriptions per year, and it was five times more for those using greater than 132 doses of sleeping pills per year. This increased risk of death was seen with older benzodiazepines (such as alprazolam, lorazepam, diazepam) as well as newer agents (such as zolpidem and eszopiclone). The comparison was done after accounting for smoking, obesity and other risk factors that could contribute to more deaths.

In another study from UK, about 35,000 patients who were prescribed sleeping pills were compared to about 70,000 people who were not prescribed sleeping pills (control group). They were followed up for a mean duration of 7.6 years and death rates were compared between the two groups. In the first year, twice as many deaths occurred in the “sleeping pills” group as compared to the “control” group. After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription.

Sleeping pills and cancer

In a large study, the risk of cancer increased by 35% in people who were prescribed sleeping pills, as compared to those without sleeping pills. This puts “use of sleeping pills” as risky as “smoking cigarettes” said, study leader Daniel F. Kripke.

Sleeping pills adversely affect work output

Sleeping pills cause drowsiness and hang over and affect the performance in work the next day too. Concentration is impaired and memory loss may be seen.

Sleeping pills and falls

Sleeping pill use is linked to falls in elderly, which is an important cause of fractures in them.

Sleeping pills increase the risk of road traffic accidents

Use of sleeping pills lead to increased road traffic accidents. This is because it hampers the attention and concentration ability.

Above hazards prove that sleeping pills are unhealthy and dangerous. Long-term use of sleeping pills has never been studied in people and should be discouraged. If sleeping pills are used at all, it should be for a short period of a few days and with extreme caution.

Dr Sudhir Kumar MD DM

Consultant Neurologist

Apollo Health City, Hyderabad
Email: drsudhirkumar@yahoo.com
Ph: 0091-40-23607777/60601066

UPDATE ON POLIO INFECTION AND VACCINATION

UPDATE ON POLIO INFECTION AND VACCINATION

1. Polio virus infection was a common cause of paralysis of legs and arms in many people across the world (including India) until the last decade.

2. As of January 2016, polio has been eliminated from all countries of the world except Pakistan and Afghanistan. The last case of Polio in India was seen in 2011.

3. There are 3 types of polioviruses called as types 1, 2 and 3. No polio infection has occurred due to type 2 poliovirus since 1999. The last case of Type3 virus-related polio was seen in 2012. So, at present, all polio infections are caused by type 1 poliovirus.

4. So, now, there is no need to use vaccine against all three types of viruses. The current oral polio vaccine (bivalent oral polio vaccine) gives protection against types 1 and 3 poliovirus types, and that is sufficient.

5. It is important to avoid using the older trivalent polio vaccine (which gave immunity against all three polio virus types), as older vaccine was responsible for rare complications called as vaccine associated paralytic polio (VAPP). In India, trivalent polio vaccine will be removed from April 2016, and only bivalent OPV would be available.

6. There are two types of polio vaccines- inactivated polio vaccine (IPV) and oral polio vaccine (OPV). As the name suggests, in IPV, the virus is in inactive state, and there is no risk of VAPP with this. So, in countries with no polio infection, it is better to use IPV. However, IPV does not prevent outbreaks of polio. So, in countries where polio infection is still present or there is a risk of epidemic, OPV is preferred.

7. In India, OPV is the vaccine of choice, given at birth, 6 weeks, 10 weeks and 14 weeks of age to children. IPV is optional and can be taken at 14 weeks of age along with third dose of DPT and OPV.

8. World Health Organization (WHO) has planned comprehensive strategies aiming eradication of polio to make the world free of polio by 2018. When this happens, polio would become the second infection to be eradicated (after small pox). The last case of small pox occurred in 1975 in Bangladesh.

DR SUDHIR KUMAR MD (INTERNAL MEDICINE) DM (NEUROLOGY)

SENIOR CONSULTANT NEUROLOGIST

Apollo Hospitals, Jubilee Hills, Hyderabad-500096

Phone- 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com
Online consultation:  http://bit.ly/Dr-Sudhir-kumar

MYTHS AND FACTS ABOUT SEX

Myths and Facts about Sex

Sex is among the commonest practices responsible for procreation and pleasure. It is almost universally practiced from the ancient times in humans. However, there are several myths and controversies surrounding it. Sex, being a taboo topic in our societies, is not openly discussed with elders and teachers. As a result, the myths propagate and the truth remains hidden. In this article, I would discuss the myths and facts about sex.

At what age can sex be started?

Several surveys indicate that teenagers are sexually active since around 15 years of age. However, it should be noted that the legal age for sex after consent is 18 years (in India). So, sex with a person below 18 (even after marriage) is illegal. This age limit may vary in different countries.

What is the normal/safe frequency of sex?

First of all, there is no “one” normal frequency of sex. It depends on a lot of factors, such as moods, daily schedules, location, presence of children or other family members, any physical illness, age of the person, any personal grief, and so on. So, if a couple is happy, it does not matter how often they are having sex. Generally, the fears are “are we having too much or too little sex?” Regarding too much sex, there is no need to worry as long as it is done within the legal framework, and does not jeopardies the daily work/schedule. The average frequency of sex (as per studies) is about once in 3-4 days in younger couples, and once in 6-7 days in older couples. Now, you should not start worrying if your frequency is below the above numbers. What matters is the happiness and satisfaction levels among couples and sex is just one of the many things contributing to satisfaction and contentment.

Is masturbation safe?

Masturbation refers to the self-stimulation of genitals (penis, clitoris or vagina) in order to achieve sexual arousal and pleasure, often leading to climax (orgasm). There are several myths among younger people about masturbation. They feel that it- is immoral, leads to weakness, leads to deformities of penis, or it decreases the chance of good sex after marriage. It should be noted that masturbation is a healthy habit and can be practiced throughout life, even after marriage. Most people (more than 90%) masturbate. With masturbation, there is no fear of pregnancy or sexually transmitted diseases (STDs). Masturbation is, however, wrong, if it inhibits sexual relationship with the partner, or if it is done in public, or if it interferes with daily responsibilities. The guilt associated with masturbation can also lead to problems.

Is oral or anal sex safe?

Health wise, anal or oral sex does not lead to any additional hazards, which are not seen with conventional sex. So, if a couple likes it, they can practice it. There is no risk of getting pregnant with anal or oral sex. The legal status, however, differs in different countries.

Is male-male or female-female sex (homosexuality) safe?

Sex between people of same sexes- homosexuality (in men) and lesbianism (in women) are medically safe. There is no risk of pregnancy, however, the risk of acquiring STDs is similar to that with conventional sex. Homosexuality just indicates a different sexual orientation of these people. Homosexuality, however, is still illegal in India and many other countries. In addition, it is a social stigma too.

Is sex with multiple partners safe?

Sex with multiple partners is a risky behavior and should be avoided. There is a high risk of contracting STDs. In addition, it can lead to instability in a person’s life. In a married person, it can lead to break-ups and divorce.

How long should a normal intercourse last?

The duration of normal intercourse ranges from 3 to 7 minutes. This is the time from entering the vagina upto the time of orgasm, and does not include the time of foreplay. Anything less than 1-2 minutes is considered too short and is labeled as premature ejaculation. Shorter duration intercourse (and premature ejaculation) may leave female partners less satisfied or unsatisfied.

What is the normal penis size?

The penis should be measured when erect, and the average length varies from 5.5 to 6.3 inches (14-16 cm). The penis is considered small only if it is less than 3 inches (7.6 cm) when erect. Anything more than 3 inches is enough to satisfy a woman. Women consider girth (or width) of penis more important than the length. When erect, the normal girth (or circumference) of penis is 12-13 cm (4.7 to 5.1 inches). However, there are many men who are anxious about the size of their penis, which explains the boom of devices and pills that claim penis enlargement effects. It should be noted that the size of penis when flaccid may vary and does not play a role in determining the penis size when erect. This means that men with relatively small penis when flaccid can have the same size when erect.

Is it normal to have a curved penis?

Penis when erect can point upwards or downwards, or slightly to left or right. All these are normal. However, if there is a significant bend in penis, it could point to a disease called as Peyronie’s disease. You should consult a Urologist for evaluation.

Is nocturnal emission abnormal?

Nocturnal emissions refer to ejaculation during sleep among men, often after an orgasm. In women, there is vaginal lubrication along with orgasm. These are normal phenomena and do not indicate any disease.

What is the normal frequency of orgasm?

Men reach orgasm more often than women. Men reach orgasms about 75% of times. There are multiple reasons for the differences between men and women. In addition to social and cultural reasons, it is also that orgasm is not the most important aspect of sex for women. With oral sex and foreplay added to intercourse, women and men orgasm rates are almost similar. Also, orgasm rates are higher in a committed relationship rather than during occasional/first flings. Women are able to attain "multiple" orgasms. Also, it is alright to "fake" an orgasm by a woman to make the overall sex experience better for the couple. 

I have tried to cover some of the most important facts and myths related to sex here. I am sure you may have additional queries, which can be posted here as comments or can be sent to my email.

Dr Sudhir Kumar MD DM

Senior Consultant Neurologist

Apollo Health City, Jubilee Hills,

Hyderabad, India-500096

Phone: 0091-40-23607777/60601066

Email: drsudhirkumar@yahoo.com

Online consultation:http://bit.ly/Dr-Sudhir-kumar

  

How Does Brain Differentiate Love from Lust?

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Health City, Jubilee Hills, Hyderabad.

Online consultation:http://bit.ly/Dr-Sudhir-kumar

IMPORTANT FACTS ABOUT ZIKA VIRUS INFECTION

IMPORTANT FACTS ABOUT ZIKA VIRUS

1. Zika virus is an infection, transmitted by mosquito bite.

2. Common symptoms include fever, skin rash, joint pains, headache and muscle pains.

3. This infection is common in Brazil, other South American countries, Mexico and Carribean islands. However, it is likely to spread to other countries soon. No cases have been identified in India yet. 

4. The mosquito that spreads Zika virus (Aedes) also spreads dengue and Chikun Gunya fever.

5. There is no vaccine to prevent Zika virus infection. So, the only method to prevent this infection is to prevent mosquito bites.

6. If Zika virus affects a pregnant woman, then, it may have adverse impact on the baby. This includes microcephaly (small brain size) and poor development of brain.

7. In rare cases, paralysis of arms and legs, due to Zika virus may occur (due to Guillain Barre syndrome).

8. An infected person can spread the zika virus infection to other, through mosquito bites. So, it is better to isolate them for a week.

9. The zika virus infection can be suspected based on the symptoms, and history of travel to affected areas within the past two weeks. The confirmation can be done by blood tests.

10. In addition to mosquito bites and mother-to-child transmission, Zika virus can also rarely spread via sexual intercourse and blood transfusion.

Dr Sudhir Kumar MD (Medicine), DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Hyderabad

Phone: 0091-40-23607777

Email: drsudhirkumar@yahoo.com

Online consultation:http://bit.ly/Dr-Sudhir-kumar

An INTERVIEW focussing on COMMON NEUROLOGICAL PROBLEMS (with special focus on WOMEN)

MIGRAINE- A COMPLEX HEADACHE

Migraine – A complex headache

What is migraine?

Migraine is a condition characterized by frequent episodes of headaches, associated with nausea or vomiting. Commonly, migraine headache is experienced on one side of the head around the temples and occasionally may shift from one side to the other. It arises from a combination of blood vessel enlargement and release of chemicals from nerves that are in close proximity to these blood vessels. During a migraine attack, the artery located just under the skin of the temple and outside the skull enlarges causing release of chemicals that cause an inflammation and further pain. This also triggers the sympathetic nervous system to react with feelings of nausea, vomiting and aversions to light, smell and sound.

Different types of Migraine:

In clinical practice, doctors see patients with two kinds of migraine viz migraine with aura and migraine without aura.

Migraine with aura: This is also known as classic migraine, and here the patients feel sensory symptoms (aura) 10-20 minutes prior to the attack. An aura is described as seeing hazy or flashing lines or blind spots in the centre of vision. Patients with classic migraine may also experience mental fuzziness and unclear speech. Almost 1 in 5 migraine sufferer experiences an aura.

Migraine without aura: This is the most common migraine and the patient in this case does not experience an aura although all other symptoms and factors for the attack are similar.

What triggers a migraine?

A migraine trigger is different for each migraineur and what acts as a trigger for one, may not start a headache in another. Some of the most common migraine triggers are –

• Changes in weather and especially summer heat
• Sensory disturbances such as strong smells, flashing or fluorescent lights, extreme and continuous loud noise

• Certain food items such as over fermented cheese, alcohol, red wine, nuts
• Stress and anxiety
• Sleep pattern disturbance
• Erratic meal timings and fasting 

What to do during a migraine episode?

For some patients it is difficult to differentiate between migraine and normal headache. Taking over-the-counter pain killers do not help relieve a migraine headache. If the headache is experienced on one side of the head along with nausea and vomiting, lasting 4 hours or more, then one needs to immediately consult a general physician. 

What are the treatment options available for migraine?

There are two levels of treatment options available for treating migraine.

Preventive treatment: Identifying and being aware of the triggers and trying to avoid them completely is one way to prevent migraine attacks. Maintaining a migraine diary and recording history helps tremendously to prevent a migraine attack.

Drugs for treating migraine: There are several classes of drugs that are used to treat a migraine headache. Although these are actually prescribed for other conditions such as depression, blood pressure, or allergy, experience shows that they can also halt a migraine headache.

What is the outcome in cases of Migraine?

Migraine attacks are at its peak in the age group of 25-55 years. Therefore as one grows older, the frequency of attacks gradually diminishes. For most patients, avoiding known triggers and following a therapeutic regimen works best to overcome migraine headache.

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

SUMMER HEAT AND NEUROLOGICAL PROBLEMS

Summer is here and temperatures are starting to rise. Summer has its share of fun, with lots of delicious mangoes and frequent trips to ice cream joints. However, it also brings with it, its share of problems. Here, I would discuss the neurological problems that may get worse with summer heat.

1. Migraine- Migraine is a condition characterized by frequent episodes of headaches, associated with nausea or vomiting. Headaches in migraine patients are triggered or exacerbated with a number of factors, heat being one of them. It is common to have severe headache with every outing in the scorching sun. So, it is better to avoid going out during the hottest parts of day- 12 noon to 3 pm. Also, one can use umbrella to avoid direct sunlight.

2. Multiple sclerosis (MS)- MS is a disease that affects central nervous system (brain, spinal cord and optic nerves). In this disease, there is damage to the myelin sheath, the covering of the nerves. The symptoms in MS patients get worse with increased heat, as after exposure to summer heat, hot water baths, strenuous exercises, etc. The symptoms noted are blurred vision, fatigue, weakness and cognitive dysfunction. So, patients with MS should avoid heat exposure.

3. Heat stroke- Heat stroke occurs if body temperature rises to abnormally high levels on exposure to heat for prolonged duration. Generally, our body tries to regulate temperature with sweating, increased thirst, etc when exposed to heat. However, these mechanisms may fail when exposed to high temperatures for prolonged periods. Symptoms of heat stroke include high temperature, headache, nausea, weakness, muscle cramps, confusion, and in severe cases, unconsciousness and coma may also occur.

4. Brain stroke- Exposure to heat can lead to dehydration, thereby, increasing the chances of a brain stroke. Brain stroke may lead to paralysis due to blockage of blood supply to a part of brain.

5. Epilepsy- Heat can be a trigger for seizures. Some people experience an increase in seizure frequency during summer months. In children below the age of six, febrile seizures are common, where they get seizures during an episode of high fever. Also in adults, high fever can trigger an episode of seizure. There is a special type of epilepsy, where the person gets a seizure after taking hot water bath; this type of epilepsy is referred to as “hot water epilepsy”.  The increase in seizure frequency may be due to loss of anti-epileptic medications through too much sweating or perspiration in hot weather.

Strategies to beat the summer heat:

• Stay indoors as much as possible, especially during the hotter parts of day,
• Use umbrella to avoid direct sunlight exposure,
• Stand in shade,
• Use AC or fan, when indoors,
• Drink plenty of water and juices to keep yourself well hydrated.

DR.  SUDHIR KUMAR MD (Medicine) DM (Neurology)

Senior Consultant Neurologist,

Apollo Hospitals, Hyderabad, India.

Email: drsudhirkumar@yahoo.com

Appointments: 0091-40-23607777/60601066