Stroke: What triggers it

Dr. Turin Chowdhury

Cause and mechanism of stroke: Stroke occurs when blood circulation to the brain is interrupted. Brain cells can then die from the lack of oxygen resulting from the decreased blood flow. The dying brain cells cause loss of body function control capacity of the brain. This creates a medical emergency. There are two common causes behind this disruption:
   * Blood clots obstructing blood vessels, and
   * Bleeding occurring in the brain.
   Blood clots obstructing blood vessel: The stroke caused by blood clots cause what are known as Ischemic strokes. The clots or gummed up fatty deposits in the artery wall can act as dams on the walls of the arteries, obstructing the natural flow of blood to the brain. Leading towards the brain cells become oxygen starved. Stroke is the end result. Two different types blood clot can be seen — Thrombus-This is a clot that forms over time and stays at the site of the blockage, rather than traveling elsewhere on the artery highway.
   Embolism-This is a traveling blood clot. It forms in one place, then gets carried along in the bloodstream until it wedges into a smaller vessel, blocking blood flow from that vessel
   Bleeding occurring in the brain: The stroke caused by the internal bleeding in the brain is known as hemorrhagic stroke. This happens when small blood vessels in the brain weaken and finally burst, damaging brain cells. Hypertension is the most common cause.
   Burden of stroke: Our brain is the control centre of the bodily functions. Stroke can affect a person in different ways. Generally the magnitude and variety of the effects depends on the type of stroke, the area of the brain involved and the extent of the brain injury. Brain injury from a stroke can affect the senses, motor activity, speech and the ability to understand. It can also influence ones behavioral and thought patterns, memory as well as control on emotions. Paralysis or weakness on one side of the body is common. A severe stroke attack can even lead to fatal outcome.
   Triggering of stroke: We can think of forest fire to understand the inter relation among the trigger factor and risk factors. Some factors sets up the stage of a forest fire or bush fire to take place. Such a presence of very dry weather, suitable dryness of the forest or bushes to catch and spread fire, very less or no rain during that time, absence of surface water in that area, etc. Presence of these things does not cause the forest fire or bush fire by them selves but they prepare the stage for the occurrence. Presence of these factors increases the chance of a forest or bush fire in comparison to the absence of these factors. Now in these given circumstances any uncontrolled camp fires, sudden shoot-up of the environmental temperature, human mistakes with combustion related activities in that place will initiate the forest fire or bush fire. These things will act as the triggering factor for the event. This situation can be compared with the stroke risk factors. The presence of these risk factors sets up the stage for the stroke event to happen. And the triggering factors will initiate the acute onset of the stroke event.
   
   What factors may act as triggers?
   These factors act as a supplementary factor on the existing risk factors. In general stroke episodes have higher chance of being triggered in a person having stroke risk factors already existing in him or her. The factor which influences this initiation of the event is considered as triggering factor. The mechanism of the triggers is not that clearly understood yet. The possible triggers for stroke are;
   Stress: Sudden overwhelming stress can trigger a stroke. Individual response to stress may be a contributing factor. Scientists have noted a relationship between disease risk and stress in a person’s life, their health behaviors and socioeconomic status. These factors may affect the established risk factors. For example, people under stress may over eat, start smoking or smoke more than their usual habit.
   Emotional out burst: Too much emotional out burst such as anger or fear can act as a trigger to stroke. These emotional eruptions contribute to the sudden raise of blood pressure which may kick off the stroke episode.
   Binge drinking: Spree drinking may act as a trigger of stroke in the background of deteriorating heart risk profile. This may act as leading to the abrupt raise in blood pressure, thus increasing the immediate risk of stroke attack.
   Caffeine: Research suggests coffee can trigger a stroke event in people who have very negative risk profile. It is already known that caffeine causes transient increases in blood pressure. But the relation of caffeine and stroke has not been yet established to fully.
   Temperature: Though still controversial, but some medical scientists points towards the sudden extreme conditions in terms to environmental temperatures as a stroke triggering factor. Though the main hypothesis behind this is the physical stress related response of the body to the changes in the environmental temperature.
   Pollution: Air pollution may raise risk of stroke. Researchers found that breathing polluted air may contribute to stroke. Air pollutants specially the tiny ones have been linked to stroke. Fine particles in air pollution may raise fatal stroke risk in people aged 65 and older during warm months.
   Infections: Infections can trigger stroke among the people who are already at risk. Researchers commented that heart attack and stroke risk rise people during the first few days following the diagnosis of influenza, pneumonia, bronchitis, and other respiratory tract infections.
   The lethal combination: risk factors and trigger
   It was thought in general that, when in a person there is previously existing risk factors present in terms of family history or in terms of life style; then the person is more susceptible towards the stroke in the presence of a triggering factor. Triggering factor is mainly a very acute and short time episode such as, sudden fluctuation in temperature, or a episode of high shooting blood pressure level, or a heavy drinking session, or even a out burst of high emotional episode. It can be described as the opening ceremony; everything is present, just we need some one to cut the string with scissors.
   
   Knowing the triggers and avoiding them
   It is quite important for us to learn and know the stroke triggering factors. This is very much true for those who have risk factors of stroke present among them. Knowing about triggering factors will equip us with the necessary knowledge in regards to avoiding the triggers of stroke. All people, especially with presence with any of the risk factors, should be educated about the possible triggers of stroke. This should be done both in community level as well as personal level. The doctors will educate their patients who visit them as high risk stroke patients. On the other hand information should be disseminated in the public media regarding the stroke triggers in order to spread knowledge and understanding among the general population. In addition to that the risk factor modification strategy and processes to avoid the triggers should be sought out by the patient and the consulting physician because in conjunction with avoiding the trigger, the controlling the risk is also very important for stroke prevention.

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A Cambodian orphanage

Rayyan Kamal

I’m surprised by Yale’s generosity sometimes. For example, the university’s undergraduate career services department paid for the Yalies interning in Singapore to go to Phnom Penh this past weekend and work at the Center for Children’s Happiness, an orphanage. Plane fares and hotel expenses were covered. Maybe Yale does more than bleed parents dry of their funds. Or maybe, as someone mused, our esteemed college is seeking to beautify its brochure.
   Cambodia’s capital reminded me of Dhaka in many ways, though it has far fewer people. I think both cities are at the same level on the path to development. Phnom Penh’s airport road and Dhaka’s airport road are virtually identical. The Cambodians we met were very friendly. Their inability to speak English (and our inability to speak Khmer) did not prove to be a significant barrier. I especially enjoyed riding on tuk tuk’s, Cambodia’s version of our baby taxis, except that the sides are not covered and the vehicles can carry about six people.
   The highlight of the trip was the reason we went there: to interact with the children, aged from three to eighteen, most of whom are orphans. Most of them had previously been working at Phnom Penh’s mammoth-sized garbage dump collecting and selling recyclables, which explains why the children were so well-behaved and genuinely happy. Ravenous for affection, they latched on to us the moment we arrived. It was a two-way street. They could sense our needs, sometimes even before we could. Bottled water for thirst, fanning with books/plates/whatever was around for heat, caps for the sun.
   It was a treat to see such caring children. They are hard-working too. Of the children I talked to, 90 per cent told me that their favorite pastime was studying. Now how many kids do you know who would say that? In fact, one of them studied so assiduously that he was awarded a scholarship to United World College in Singapore. From working in a garbage dump to attending one of the world’s finest high schools. That’s no small feat.
   Especially moving was the story of the orphanage’s founder, Mr. Mech Sokha, himself an orphan. He lost his parents during the Khmer Rouge genocide of 1975 to 1979. After the regime was overthrown, Sokha, denied a high school education, worked various jobs and studied to pay for night classes. During the early 90’s, he worked as a driver for a small Japanese NGO based in Phnom Penh. It was during this time that he met and befriended the affluent Ms. Osanai Mieko, whom he drove around while she was in Phnom Penh. She paid for him to study child development and NGO management in the Philippines. Later, when he returned to Phnom Penh, she provided the funds needed to realize Sokha’s dream, an orphanage for children living and working as garbage pickers on the Steung Meanchey landfill.
   The children adore Mr. Sokha. They compete with each other to give him the best gift: a drawing, a handmade bracelet, etc. And he seems to love them all equally. In fact, his two biological children have grown up in the orphanage as well.
   Rayyan Kamal is a sophomore at Yale University.

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Dr. Kaniz-e-Batul

The 20th of Jamadius Sani is a memorable day in the history of Islam; for, on this day was born the beloved daughter of the Prophet (PBUH) and the Lady of the Heaven Hazrat Fatematuz Zahra (R.). She was the ideal of the woman community and the pride of womanhood.
   Hazrat Fatematuz Zahra (R.) was born when women were not considered tne progeny of man. She was born at the end of the era of ignorance and darkness (Jahiliyah). Even due to her own birth as a woman, the dignity of her family among different ignorant and superstitious tribes was curbed. The great Prophet of Islam ensured the status of women and strengthened their hand even in the then society which was submerged in superstition and ignorance.
   One question that normally comes to the mind is why Hazrat Fatema is called the greatest woman of the world? There are many a woman of honour and dignity with high status in the history of Islam. They all acquired that status by dint of their respective qualities. These great women include: Hazrat Mariam, Hazrat Asiah, Ummul Mumineen Hazrat Khadizah and Hazrat Fatematuz Zahra (R.).
   In his book 'Maulana Abdul Awwal Jaunapuri' Professor Dr. Muhammad Abdullah refers to Maulana Abdul Awwal's book entitled, Al Muhakamatu Baina Fazilati Fatema Wa Ayesha says 'Hazrat Fatema (R.) told Hazrat Ayesha, I am superior to you for, I am a limb of the Prophet of Allah. Hazrat Ayesha answered: What you told concerns an issue related to this world. But, in the Hereafter, I will be there with the Prophet of Allah in honour of His status. So, please realise my status.
   On hearing this, Hazrat Fatema kept silent. Then Hazrat Ayesha stood up, kissed Fatema's head and said, 'How nice would it have been, had I been worth a piece of your hair!'
   The great status of Hazrat Fatematuz Zahra (R.) could be known from the traditions of the Prophet (PBUH). He said, 'Fatema is my limb.'
   Hazrat Muhammad (PBUH) is a man who attained completeness and Hazrat Fatema is his distinguished and dignified limb? Our Prophet Himself taught through his deed that he is a blessing for the world of creation and Fatema is a part of that blessing. Fatema is the ideal for the whole of the woman community; for, the Prophet developed her as an ideal to the choice of his own mind, keeping Fatema in close touch with himself.
   The Holy Quran says:
   'In the Prophet of Allah there is certainly for you a good exemplar' (Ahzab : 21)
   There are such regulations meant for woman which could be best taught realistically by a woman. The Prophet (PBUH) taught Fatema such best teachings so that she can, in turn realistically teach women.
   On the earth, life of a woman could be divided into three sections, Viz, woman as a daughter, woman as a wife and woman as a mother. Hazrat Fatematuz Zahra was a loving daughter of her father. She always used to carry out the instructions of her father. She was an ideal a mother and a wife as well as. It is her sacred lap where Imam Hossain was brought up. The holy Prophet said:
   'Hasan and Hossain are the leaders of the youth in heaven. When Hazrat Fatema was only 8 years old, her great mother Hazrat Khadija passed away. Following the demise of her mother, Hazrat Fatema assumed the charge of looking after the great Prophet (PBUH). There was similarity between her appearance and mood and that of her father. While in her father's house, Hazrat Fatema used to do all the household works.
   Very often, the great Prophet of God used to return home with dust spread all over his body or being wounded by the rain of stones thrown at him by the infidels. Hazrat Fatema used to clean and nipe the wounds and bandage them. History testifies to the fact that often the infidels would launch attacks on the Prophet (P.B.U.H) and Hazrat Fatema would try to protect the great Prophet (P.B.U.H) from their attacks. She had profound love for her father.
   
   Khatune Jannat
   The great Prophet (PBUH) greatly endeared and respected Hazrat Fatema, so much so that whenever she used to come to her father, at once the father used to stand in honour of his daughter and made room for her to seat beside him.
   Hazrat Fatematuz Zahra gained this status to the Prophet (PBUH) not only as a daughter, but for her personal piety (taqwa) and holiness.
   Today as soon as we open the newspaper, we come to know that women are being killed due to illegitimate dowry. This is due only to the fact that we do not properly follow the ideals of the Prophet and his daughter Hazrat Fatematuz Zahra.
   The Prophet (PBUH) gives as gifts to his daughter the following items : one date leaf prayer mat, one pillow, one animal Hyde as bed, clay pots, leather water pot and a grindstone to grind wheat. Receiving the gifts, Hazrat Ali and Fatema expressed their deep gratitude to Allah.
   The great Prophet, thus, set a conclusive example for his Ummah through the marriage of Hazrat Fatema. Let us follow the ideals of the great Prophet and his daughter and act accordingly. This, nonetheless, does not mean to go back in time for centuries and use the same items which are somehow abolished in some societies and communities. Rather, following the exemplary Muslim woman, i.e. Hazrat Zahra, means to be grateful to the basics of life (as dowry or whatsoever) so that love and sincerity play the crucial role in family life and peace of mind prevails among family members.
   The author is a professor, Department of Urdu, Dhaka University

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Fish and rice makes one Bengali

Saad Quasem

When I moved to Philadelphia from Bangladesh, I believed in eating whatever I could find and I was assured that nothing close to bhaat and daal would be available. However, I was wrong the local “Indian store” (which is present in most areas) is full of spices, vegetables, desi meat cuts, fish and other cooking mediums. I had only found access to the store about six months after I moved here.
   I had been just began to assimilate into savouring pasta, baked chicken, tuna sandwiches and other easy to prepare items for my meals, then I found access to the desi store, it took me minutes to start preparing Bengali cuisines and I was rather content with what I was doing. After living with desis of different sections of the Sub-Continent, it became even more apparent that their cooking styles wholly differ than what we are used to.
   Long after I have settled into cooking and barely miss home food, I came across an article of a fellow Bengali Chitrita Banerji published in The Daily Star. After reading her article “A Bengali Bounty” I felt as if she could speak my mind. For years I have faced the same crisis as no non-Bengali would understand my situation, Indian restaurant food would sicken me because of the nausea tic smell of curry powder. Even a reference to home food by Banerji to a westerner reminds them of curry powder and creamy sauces, whereas Bengali cuisine stands days apart.
   The most fascinating bit that touched my heart and soul is about fish. This excerpt will speak for itself. “Bengalis love fish. Mention Bengali food to anyone in India, and the first image it evokes is that of fish and rice. There was absolute, indissoluble agreement over the fact that no fish can rival the hilsa’s exquisite flavor or delectably tender flesh, not the large rui with its ceremonial and ritual status. To me, the hilsa is both a memory of joyful family meals and a symbol of loss.”
   Frozen Hilsa is available in the desi store, however. The taste of fresh Hilsa cannot rival any others whatsoever. My family is full of over-enthusiastic fish lovers and as Banerji says “There are more varieties of freshwater fish in Bengal than weeks in a year.” I would not be surprised if my grandmother had made me try all. Last year I was reading The Daily Star online, sitting in my apartment here and saw a picture of the largest fish in the zoological history of Bangladesh. I was not surprised as my cousin called me to say, that they had feasted upon that same fish and that her father had frozen a few important pieces for me to eat, upon arrival (which was no later than a few weeks actually).
   It brings great joy to me, that accounts synonymous of mine are being written and published. Now I am convinced that I have been enduring a commonly faced phenomenon. Along with the similarities of circumstances, I feel free to convince the desi store manager that it is not possible that he sells every single Bangladeshi item, as he definitely does not have more than a handful of fish varieties, whereas apparently there are more than the number of weeks in a year.

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