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Biomedical subjects

P M Dalal

Publications and source records attributed to P M Dalal.

At least 19 recordsLinked to original sources
PubMed2002

Cerebrovascular disease in type 2 diabetes mellitus.

Incidence of CVD in diabetic men was reported to be twice as that of non-diabetics and almost three times greater in diabetic women in the Framingham Study. It is postulated that excessive glycation and oxidation, endothelial dysfunction and increased platelet aggregation may be responsible for endothelial proliferation and thickening of plasmatic membrane in small blood vessels ('lipohyalinosis') leading to lacunar infarction. Prothrombotic state may precipitate a stroke, however, platelet aggregability, elevated fibrinopeptide A (FPA) and D-dimer were not significantly related to stroke in diabetic mellitus (DM), whereas suppressed fibrinolytic activity was a common finding. Of many unknown factors in pathogenesis, the deficient insulin secretion, resistance to action of insulin at level of 'insulin receptors', changes in counter regulatory hormones (e.g. glucagon, pancreatic polypetides, growth hormone, catecholamines, etc.) and decrease in the hepatic sensitivity to insulin action in suppressing glucose output have received more attention. Hyperosmolar state can simulate stroke syndromes. Early recognition and treatment of risk factors such as hypertension or better glycemic control, correction of hyperlipidemia or obesity in diabetic population are important. In diabetic subjects already showing recurrent transient cerebral ischemic attacks (TIAs) or minor strokes, the benefit of antiplatelet agents or antithrombotic therapy in prevention of major strokes is well established. Ramipril has been found to be effective in reducing stroke risk by 33% in diabetic patinets in HOPE study.

Brain Ischemia↗
PubMed2001

Ischaemic strokes: management in first six hours.

Cerebrovascular disease (CVD) or stroke is one of the foremost causes of high morbidity and mortality for many nations of the world, posing a major socio-economic challenge in the occupational and neuro-rehabilitational programmes of the 'stroke-survivors'. For example, in USA alone it has been estimated that a sum of 3261 million dollars is spent as direct cost for treatment, in addition to 4104 million dollars as indirect costs, consequent on economic losses of 'stroke victims'. Thus, the new concept in stroke pathophysiology and strategies for stroke prevention have assumed global importance. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15% of urban population is hypertensive (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many other reasons such as patient's compliance in taking medicine and poor followup in clinical practice that may lead to failure in reducing stroke mortality. In subjects, who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin is well established in prevention of stroke. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight. Associated conditions like diabetes mellitus etc. should also be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base stations for these surveys, because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

Anticoagulants↗
PubMed1997

Strokes in the elderly: prevalence, risk factors & the strategies for prevention.

Current demographic trends suggest that the Indian population will survive through the peak years of occurrence of stroke (age 55-65 yr) and stroke-survivors in the elderly with varying degree of residual disability, will be a major medical problem. The available data from community surveys from different regions of India for 'hemiplegia' presumed to be of vascular origin indicate a crude prevalence rate in the range of 200 per 100,000 persons. Thus, the anticipated costs of rehabilitation of stroke-victims will pose enormous socio-economic burden on our meagre health-care resources, similar to what is now faced by industrialised nations in the West. Therefore, prevention of strokes at any age should be our main strategy in national health planning. Among all risk factors for strokes, hypertension is one of the most important and treatable factor. Community screening surveys, by well defined WHO protocol, have shown that nearly 15 per cent of the urban population is 'hypertensive' (160/95 mm Hg or more). Though high blood pressure has the highest attributable risk for stroke, there are many reasons such as patient's compliance in taking medicines and poor follow up in clinical practice that may lead to failure in reducing stroke mortality. In subjects who have transient ischaemic attacks (TIAs), regular use of antiplatelet agents like aspirin in prevention of stroke is well established. It is also mandatory to prohibit tobacco use and adjust dietary habits to control body weight, and associated conditions like diabetes mellitus etc., should be treated. It is advisable to initiate community screening surveys on well defined populations for early detection of hypertension and TIAs. Primary health care centres should be the base-stations for these surveys because data gathered from urban hospitals will not truly reflect the crude prevalence rates for the community to design practical prevention programmes.

Aged↗
PubMed1995

Use of calcium channel blockers in acute ischemic cerebrovascular disease.

Many studies have shown that increased intracellular concentration of calcium ions is an important factor influencing neuronal damage in acute ischemic cerebrovascular disease (ICVD) and administration of calcium-channel blockers during the "open therapeutic window" have beneficial cytoprotective effects. In a prospective ICVD study we administered dihydropyridine compound "nimodipine" (1.5 to 2.0 mg/kg/day) either orally or as continuous intravenous drip round the clock for the first three days followed by oral therapy along with standard treatment after the diagnosis of a stroke was confirmed by CT Scan. The "ICVD" control cases received best medical care (BMC). The degree of functional neuronal recovery (using modified Mathew's scale) was assessed after three weeks of therapy. Our study shows significant improvement in the quality of neurologic recovery though there was no change in mortality rate in both the groups.

Acute Disease↗
PubMed1989

Strokes in the young population in west-central India--some observations on changing trends in morbidity and mortality.

From two prospective stroke studies during the period 1963-1968 and 1978-1982 at Bombay, using identical methodologies, it is observed that there is a significant drop in case fatality rate (32-12%) thereby resulting in a higher survival (68-88%) but with residual disability. Thus, these changing trends have posed a major social challenge in occupational rehabilitation and in solving the needs for stroke survivors, particularly in the younger age-groups.

Adolescent↗