Risk Factors for Solitary Seizures

Risk Factors for Solitary Seizures DISCUSSION The aim of this study is to find out the underlying risk factors involved in recurrence of solitary seizure in patient with normal neuroimaging, in patients in whom treatment is not initiated. This will help to guide the patients who are at risk for recurrence. After the detailed history and clinical examination, laboratory and electroencephalogram and imaging, we analyzed the similarities and differences which will help in making conclusions from this study. Comparisons were done with other studies conducted related to this study. In present study total number of 110 cases from OPD (Medicine) and those admitted in wards, Command hospital, southern command, Pune with history of solitary seizure was taken after satisfying the inclusion criteria. In a study by Mussico24 in 2002, subjects less than 25years constituted 48% as compared to 50% in present study i.e 55 cases were < 25 years. Mean age at the time of seizure was 32 years in study of Von Donselaar23 in 2000 and 24.8 years in the study of Mussico24. The mean age at the time of seizure in our study is 29.62 years. The youngest patient was of 18 year and the oldest patient was 70 year old. Hopkins25 in 1998 conducted a study in which most frequent age range was 16-29 years. . This is similar to result of Von Donselaar23 (2000) concluded from his study of subjects who are 20 years or more, in which the most frequently affected age group is 30 years. Study regarding duration of new onset seizure showed that out of 60 cases, 38 cases (63.33%) had seizure for 10 Min. Mean duration of seizure was 5.11 min in our study as compared to 6.23 min in a study by Bernal B, Altman NR58 (2003). Maximum patient (30 cases; 60%) had seizure duration less than 5 min which is similar to the study done by Benbadis SR 59et al. (1995). Male to female ratio is 11:1 in present study. Annegers26 (1996) and Bora27(1995) found a slight preponderance of female cases in their study. Many authors(Von Donselaar23 2000, Mussico24 2002, Hopkins40 1998) report a mild to moderate preponderance of males in their studies. Imaging was done in all 110 cases. It was abnormal in 34 cases (31%) and normal in 76% cases. In patients with with abnormal neuroimaging, antiepileptic treatment was started and remaining cases were followed up for 12 months for recurrence. Bernal B, Altman NR58 (2003) found 37% CT head abnormality in patients presented with single seizure. Wallace60 (1974) conducted a study in which imaging revealed abnormality in 51 out of 132 subjects (38%). But reports in various study varies from 19% (Young34 et al 1982) to 51% (Rogel Ortiz50 F, 2006). CT was diagnostic in 34% case of generalized seizure shown in study by Scolloni Lanzurri G72 (1977) In present study, abnormal EEG was seen in 14 cases (12.73%) out of 110 cases. A Berg and D. Bettis et al98 (2000) found abnormal EEG in 42% of cases of singles seizure during post ictal period in their study. In study done by Van donselar 23(2000), EEG found epileptiform discharges in 29% subjects. In present study, all patient with abnormal EEG or imaging were started on antiepileptics and remaining patient with normal EEG/ imaging were not given antiepileptic treatment (60 cases) and followed up for 1 year for recurrence. Risk factors were studed in recurrence and non recurrence group. Various risk factors such as family history of seizures, childhood convulsion, past history/ evidence of tuberculosis, developmental delay, history of alcohol intake, head injury and sleep deprivation, abnormal neurological examination were studied and were compared with different studies. Family history was present in 3 cases (5%) out of total 60 cases which were followed up in our study, out of 3 cases(5%) with family history of seizure, 1 case has shown recurrence, while Shinnar S and Berg AT 41(1998) found positive family history in 5% of cases which is similar to our study. History of developmental delay was present in 2 cases (3.3%), and history of febrile convulsion were present in 4 cases (6.67%) among the untreated follow up group. Annegers26 (1996) and Bora27 (1996) have shown that neurologic deficit from birth was more common in association with seizure in males as compared to females in their studies. . 3 cases (5%) had history of Alcoholism. (Alc E 1997) shown that alcohol use has been to be a powerful risk factor for a first generalized tonic clonic seizure. Out of 60 cases which were followed, 24 cases had one or more of the above mentioned risk factor. Out of these 24, 4 cases recurred ( 17 %). While in patients without these risk factors i.e in 36 cases only 6 % cases (2 cases) recurred. Hence, presence of these risk factors increases the rate of recurrence in cases of single seizure. American College of Emergency Physician Policy (2004)38 also state that rate of recurrence is more in those patent who has one or more of these risk factors and should be treated with antiepileptic treatment irrespective of CT head and EEG. Out of total number of 6 recurrence, 1(16.7%) occurred within 7 days, 3 (50%) occurred within next 21 days of first seizure, 1 (16.7%) occurred within 1 to 3 months of first seizure. Hence, risk of recurrence decreased with passage of time. Scotoni49 et al (1999) and Das46 et al (2006) has also reported recurrence rate to be much higher in first three months. Rate of recurrence was 10 % in our study i.e. out of 60 patients with solitary unprovoked seizure with normal neurological examination and normal neuroimaging which were followed up for 12 months, 6 cases has shown recurrence, and almost all cases recurred in first 3 months. In previous studies done, rate of recurrence varied from 16% to 71 % (Treinman DM55, 1993), but follow up duration was different. In a study by D. Chadwick48 et al (Lancet 2006), recurrence rate was 21% in follow up of 1 year, most cases recurred within 3 months which is comparable to our study. Scotoni AE et al49 (1999) conducted the study rate of recurrence was 18%, duration of follow up was 6 months in this study. Out of 60 untreated cases 6 (10.0%) had recurrence in next 12 month. 3 cases in 18-25 age group (10.34%),1 cases in 26-35 age group (5.88%),1 case in 36-45 age group (12.50 %),0 case in 46-55 age group and 1 case in >55 age group(50.0%) had recurrence. In study by Mussico 24(2002) in which less than 16 years age group has double the recurrence risk of seizure as compared to 16-60 years age group. 6/ 60 cases had recurrence out of which 4 cases were male and 2 were female, total cases in male group were 55 and in female group were 5, hence recurrence rate was 7.3% in male and 40% in female. This sex difference in our study is due to cases were taken in military hospital, male population is more In study by D. Chadwick 18et al (2006), sex difference in recurrence and non recurrence group was not very significant. Study regarding duration of new onset seizure showed that out of 60 cases, 38 cases (63.33%) had seizure for 10 Min. The mean duration of seizure in recurrence group was 8.17 Â ± 4.44 min as compared to 4.7 Â ± 3.0 min in non recurrence group. Incidence of seizure recurrence is more in patients with longer duration of seizure. Duration of seizure at initial presentation was 10.1 + 5.2 min in the recurrence group and 6.5 + 4.1 min in the non recurrence group in a study by Das C.P.46 et al (2006). Martinovic and Jovic et al 51(2004) conducted a study in which the mean duration of seizure was 26.4 min in recurrence group and 4.6 min non recurrence group in a study. In one of 6 patients(16.6%) in recurrence group, family history of seizure was present compared to study conducted by Das46 et al (2006) and Hauser 43 (1998) repoted that sibling affected with epilepsy is a risk factor for recurrence of seizure in patients with solitary seizure. In our study, history of alcohol intake was present in 16.6% cases in recurrence group as compared to 3.70 % in non recurrence group which is same as those of alcohol and epilepsy study group (1997). Earnest and Feldman et al61 (1988) found similar results history of alcoholism in 12% of recurrent cases after single seizure.

Analysis of The Communist Manifesto Essay -- Karl Marx, marxism, Bourg

Karl Marx (1818-1883) was one of the most influential thinkers and writers of modern times. Although it was only until after his death when his doctrine became world know and was titled Marxism. Marx is best known for his publication, The Communist Manifesto that he wrote with Engels; it became a very influential for future ideologies. A German political philosopher and revolutionary, Karl Marx was widely known for his radical concepts of society. This paper give an analysis of â€Å"The Manifesto† which is a series of writings to advocate Marx ‘s theory of struggles between classes. I will be writing on The Communist Manifesto, published in 1848, which lays down his theories on socialism and Communism. The Manifesto has four sections. In the first section, it discusses Communism, and the theory of history and the relationship between Proletarians and Bourgeoisie. The second section explains the relationship between the Communists and the proletarians. The third sections addressed the flaws in other previous socialist literature. The final section discusses the relationship between the Communists and other The Communist Manifesto describes how as history society matured so did the history of class conflicts. Claiming that every society is essentially divided into the oppressors and the oppressed (126). Marx will explain in the past, societies were organized in more complex combinations and hierarchies, but modern society is being split into two ‘hostile camps’ (128). He saw he bourgeoisie as nothing more than millionaires who sought to profit with the Industrial Revolution and the begging of globalization. Doing so at the expense of the proletariats, which can be explained as the working or lower class. Today we can compare the b... ...in equality would be through socialist system. Abolishing private property that only adds to the bourgeoisie’s capital furthering their power. The working class is nothing more than human capital, â€Å"the means of production within a society both engenders and controls them, making them slaves to the production of goods†. He advocated that communism is the only alternative to escape this system. Thought is a product of matter and without; there would be no separate ideas. Equally comes from placing society† his or her according ability and to each according to their need†. Works Cited http://www.marxists.org/archive/marx/works/1852/germany/index.htmWritten: 1851-1852;†¨First Published: New York Tribune, 1851-1852, as book, 1896;†¨Edited: Eleanor Marx Aveling;†¨Transcribed: Sally Ryan 1999;†¨HTML Markup: Sally Ryan 1999;†¨ Proofed and corrected: Mark Harris 2010.

Stress Management Introduction

Stress is a stage produced by a change in the environment that is perceived as challenging, threatening or damaging to the person’s dynamic balance or equilibrium. It is a natural part of life but Hans Selye defines it as â€Å"the nonspecific response of the body to any demand made upon it. † That means good things (for example, a job promotion) to which we must adapt (termed eustress) and bad things (for example, the death of a loved one) to which we must adapt (termed distress). Other individuals explain stress as a person’s physical and psychological reaction to the demands in his or her life.Furthermore, Selye was really onto something. His research proved so interesting and important that he drew a large number of followers. One of these was A. T. W Simeons who related evolution to psychosomatic disease. He also stated that when our self- esteems to threatened, the brain prepares the body with the fight-or-flight response. People use the word â€Å"stressà ¢â‚¬  in various ways: as an external force that causes a person to become tense or upset, as the internal state of arousal, and as the physical response of the body to various demands.In other words, the body reacts to stressors – the things that upset or excite us – in the same way, whether they are positive or negative. In addition, it is further characterized as: (1) it is a product of unpleasant environment emanating from negative experience, (2) it is a person’s response to chaotic set of environment and (3) it is a gap between the requirements of a situation and the ability to meet such. Background of the study In 2008, Reynolds and Turner believed that stress is a multifaceted phenomenon that may even have beneficial effects in some cases.Other researchers have added to the work of Cannon, Selye, Simeons, and others to shed more light on the relationship of stress to body processes. With this understanding has come a better appreciation of which illness es and diseases are associated with stress and how to prevent these conditions from developing. Others also helped clarify the effects of stress. Stewart Wolf demonstrated its effects on digestive function; Lawrence Leshan studied its effects on the development of cancer; Meyer Friedman and Ray Rosenman identified relationship between stress and coronary heart diseases; and Wolf and Wolff studied stress and headaches.Others in fact have found ways of successfully treating people with stress-related illness. The ABC model which was formulated by Albert Ellis shows how distress is the result of our beliefs about events rather than of the events themselves. According to him, an activating event triggers people to form an irrational or negative belief about it, which in turn shapes the consequences and of the event. On the other hand, a stressor is any stimulus from internal or external environment which challenges the adaptation capabilities of an individual and places a strain upon th e person resulting to a stressful reaction or illness.It has a potential of triggering a fight-or-flight response. As far as anyone can tell, internal psychological stressors are rare or even absent in most animals but present in humans. This stressor for which our bodies were evolutionarily trained is a threat to our safety. We encounter many different types of stressor. Some are environmental (toxins, heat, cold), some psychological (threats to self-esteem, depression), others sociological (unemployment, death of loved one), and still others philosophical (use of time, purpose in life).Now that you know what a stressor is and what stress reactivity is, it is time to define stress itself. Defining stress becomes a problem, even for the experts. Still another view of stress conceptualizes it as the difference between pressure and adaptability. That is, stress = pressure – adaptability. For our purpose, we will operationally define stress as the combination of a stressor and s tress reactivity. Without both of these components, there is no stress. Dr. Hans Selye, one of the first people to study stress, divides people into 2 categories: racehorses and turtles.A racehorse loves to run and will die from exhaustion if it is corralled or confined in a small space. A turtle on the other hand will die from exhaustion if it is forced to run on a treadmill, moving too fast for its slow nature. We each have to find our own healthy stress level, somewhere between that of the racehorse and the turtle. The key in coping with stress is realizing that your perception and response to stressors are crucial. Changing the way you interpret the events or situations – a skill called â€Å"reframing† – can make all the difference.Physical reactions to stress are muscle tension, sweating, over alertness, dry mouth or throat, chest discomfort, sleep problems, fast and shallow breathing and butterflies in the stomach. Emotional reactions to stress are feelin g under pressure, feeling tense and unable to relax, increased tearfulness, feelings of conflict, feeling mentally drained, frustration of aggression, fears of social embarrassment, being constantly frightened, increasing irritability/ complaining, lacking inability to feel pleasure and the Feeling of mentally drained.Dealing with the effects of stress, you can minimize many of the physical effects of stress by utilizing these single self-help techniques. For headache, have a warm bath or lie down quietly for a few hours to relieve it. For palpitations, breathe deeply and slowly to encourage your heartbeat to return to normal. For loss of appetite, eat small portions of food that you find appetizing and take your time eating.For rapid breathing, try â€Å"Breathing to Relax technique† by breathing slowly and deeply through your nose and out to your mouth, expanding your abdomen as you breathe in. For sweating, loosen tight garments and shed any extra layers of clothing. For i ncreased urination, restrict your intake of fluid, especially tea and coffee, if you know you are going to be in a stressful situation and for reduce sex drive, explain to your partner that your loss of interest is temporary and not a rejection of him or her.To Manage stress one should (1) Get priorities right, (2) Exercise regularly, (3) Learn to delegate, (4) Make space for leisure time, (5) Try to develop a social network, (6) Have a proper breaks for meal, (7) Listen carefully to those around you, (8) Try to keep things in proportion, (9) Get to know yourself better and (10) Enjoy yourself, and your family and friends. Statement of the Problem 1. ) Why do people need to know the effects of stress to one’s health? 2. ) How does stress arise among people? 3. ) How can people deal with stress? 4. )How can stress be evaluated? 5. Why do college students more prone to stress than high school students? Objectives of the study This study aims: 1. ) To distinguish the different e ffects of stress to one’s health/being. 2. ) To explain how stress arise among people/ individual. 3. ) To discuss several ways on how people can deal with stress. 4. ) To evaluate stress levels. 5. ) To differentiate college and high school student’s stress probability. Significance of the Study 1. ) Students. It will help them particularly the higher students (the colleges) because they experience several problems, financially, love life, wrong time management and more.Stress has a relation to their academic performance. 2. ) Workers. They experience work blues because of their doubts about their job, their co workers and more. It may be helpful to them. 3. ) Family. It will be helpful to them for different problems like for bills, foods, clothes and other things needed in the family makes the parents or the bread winner stress. 4. ) Government and other institution’s people. Since they are responsible for the welfare of the people, they are prone to stress. D ifferent problems of the community were blamed to them, that’s why this is helpful to them.

Essay about Business Ethics - 1439 Words

What is ethics? Ethics can be defined as a set of principles used by an individual to govern his or her decisions in an effort to ensure fairness and equality. Business ethics, as defined by the Stanford Encyclopedia of Philosophy is the applied ethics discipline that addresses the moral features of commercial activity. The same source also gives a history of business ethics which states that the concept as an academic principle is relatively young-only about forty years old; but in general is as old as trade itself. In this paper, the following aspects of ethics will be discussed: Ethical issues faced in business; recent trends in business ethics; international considerations in business ethics; quantitative techniques and ethics.†¦show more content†¦As such, business people go to great lengths to protect the company’s ideas; even going so far as to require employees to sign confidentiality agreements. If an employee gives out confidential information, whethe r voluntarily or involuntarily, it has the potential to set the company back and cause them to lose money. According to Miranda Morley in her article titled ‘What Are the Major Ethical Issues Businesses Face?’ Other issues faced are employee behavior, employee work conditions and supplier/customer relations. If, for example, a supervisor discriminated against an employee because off race, religion or gender it would be deemed unethical. It may also be seen as unethical for an employee to spend company time doing personal activities. In respect to employee work conditions, it is unethical for employers to subject employees to unsafe work areas; to not compensate employees adequately for the work done; or to require an employee to do an unusually difficult task or work unusually long hours. With regard to supplier/customer relations, business owners must consider whether it is ethical to do business with a supplier that has unethical practices. For example a clothing store must decide if they will continue to do business with a supplier who utilizes child labor. Businesses must also ensure that they do not falsely advertise products or services or produce anything sub-standard for clients. Recent Trends in BusinessShow MoreRelatedBusiness Ethics : Ethics And Business943 Words   |  4 Pagesdiscussions in Business is Ethics. Some people believe that the decisions businesses make in interest of the business has no place in ethics and that they are essentially amoral. These businesses believe that their main objective is to simply make a profit and that it does not affect the success of the business. Whereas some businesses believe that they have to take ethics into consideration, in order for their business to be a success. Richard T. 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