Knowledge dissemination activity by INTAS Pharmaceuticals Ltd.

1. Knowledge dissemination activity by INTAS Pharmaceuticals Ltd.

2. What is a stroke? • Stroke happens when the blood supply to part of the brain is cut off. • Without blood, brain cells can be damaged or die. • This damage can have different effects depending on where it happens in the brain. • It can affect people’s body, mobility and speech, as well as how they think and feel.

3. Stroke – Some facts • Stroke is the leading cause of disability and the second leading cause of death globally. • Stroke can happen to anyone at any age. Stroke affects everyone: survivors, family and friends, workplaces and communities. 17M - Strokes 6M - deaths 5M - Permanently Disabled • Stroke is preventable • World Stroke #Up Again After Stroke: Support for Life After Stroke.

4. Six Key Facts about Stroke

5. Six Key Facts about Stroke

6. Six Key Facts about Stroke

7. Stroke Symptoms

8. Stroke Is Preventable • Did you know that 90% of strokes are linked to 10 avoidable risks? • If you have diabetes, heart problems or history of stroke/TIA talk to your doctor about stroke risk and preventive treatments.

9. Know The Risks • CONTROL HIGH BLOOD PRESSURE • Hypertension is linked to almost half of all strokes. • Knowing and controlling your blood pressure with • lifestyle change, or medication will reduce your • risk of stroke. • DO MODERATE EXERCISE 5 TIMES A WEEK • Over a third of all strokes happen to people who don’t take regular exercise. • Moderate exercise five times a week will reduce your risk of stroke.

10. Know The Risks REDUCE YOUR CHOLESTEROL • More than 1 in 4 strokes are linked to high levels of ‘bad’ (LDL) cholesterol. • Eating low saturated, non-hydrogenated fats instead of saturated fats will reduce your stroke risk. • If you can’t maintain a healthy cholesterol level with diet alone, talk to your doctor about treatments that could help. EAT A HEALTHY, BALANCED DIET • Almost a quarter of strokes are linked to poor diet, in particular low consumption of fruit and vegetables. • Eating five or more portions of fruit and vegetables will reduce your risk of stroke.

11. Know The Risks STOP SMOKING AND AVOID SECOND-HAND EXPOSURE • More than 1 in 10 strokes are linked to smoking. • Stopping smoking will reduce your risk of stroke. • Getting help to quit increases your chances of success MAINTAIN A HEALTHY BMI OR WAIST TO HIP RATIO • Almost 1 in 5 strokes are linked to obesity. • A good way to know if you need to lose weight is to divide your waist measurement by your hip measurement. • If the number is over 0.9 (man) and 0.85 (woman) your weight is putting you at higher risk of stroke and you would benefit from losing weight

12. Know The Risks IDENTIFY AND TREAT ATRIAL FIBRILLATION • An irregular heartbeat or other heart condition is linked to 9% of strokes. • Talk to your doctor about possible treatments to reduce your risk. REDUCE ALCOHOL INTAKE • Over 1 million strokes each year are linked to excessive alcohol consumption. • Reducing our alcohol intake to two units of alcohol a day for men and one for women will help to reduce your stroke risk.

13. Know The Risks DIABETES • As well as sharing many of the same risk factors, diabetes increases the risk of stroke. • Reducing your risk of diabetes will reduce your risk of stroke. • If you have diabetes, talk to your doctor about treatments to reduce your risk of stroke.

14. What can you do to prevent stroke? INDIVIDUALS • Find out more about your individual stroke risk using a clinically approved stroke risk assessment tool. • Get your blood pressure checked. • Talk to a healthcare practitioner about steps you can take to reduce your risk prevent stroke. • Take steps to implement positive lifestyle changes and reduce your exposure to air pollution. • Get support. • Talk to family and friends about your reasons for preventing stroke and identify ways you can help each other make positive lifestyle changes.

15. What can you do to prevent stroke? HEALTH PRACTITIONERS • Understand how medical conditions and behaviours impact on patient stroke risks. • A third of strokes happen to patients with a history of stroke/TIA. Ensure patients with a history of stroke, or cardiovascular conditions are offered preventive treatment. • Take steps to control hypertension and atrial fibrillation in your patients. • Offer blood pressure and pulse checks to your patients and communities. • Provide information and support to patients and communities and help them take steps that would reduce their lifetime risk of stroke.

16. 6 key facts about stroke treatment 1. Early recognition makes a big difference. • Knowing the signs of stroke and getting treatment quickly saves lives and improves recovery. • If you think someone may have had a stroke, do this FAST check: • Face ­– Is one side drooping? • Arms – Raise both arms. Is one side weak? • Speech – Is the person able to speak? Are words jumbled or slurred? • Time – Act quickly and seek emergency medical attention immediately.

17. 6 key facts about stroke treatment 2. Around 1 in 10 more people make an excellent recovery when cared for in a specialized stroke unit. • All patients with stroke (ischaemic or haemorrhagic) should be admitted to a specialized stroke unit, which involves a designated ward with a specialized team.

18. 6 key facts about stroke treatment 3. Clot-busting drugs (tPA or thrombolysis) increase the chance of a good outcome by 30%. • Clot-busting drugs break up blood clots. • This treatment can be administered up to 4.5 hours of symptom onset in many patients with ischaemic stroke. • The earlier it is given, the greater the effect.

19. 6 key facts about stroke treatment 4. Clot retrieval treatment increases the chance of a good outcome by more than 50%. • Clot retrieval treatment (mechanical thrombectomy) involves removing a blood clot and can improve survival rates and reduce disability for many people with ischaemic stroke caused by large artery blockage.

20. 6 key facts about stroke treatment 5. Rehabilitation is a critical step in the treatment process. • Rehabilitation starts in the hospital as soon as possible following a stroke. • It can improve function and help the survivor regain as much independence as possible over time.

21. 6 key facts about stroke treatment 6. One in four survivors will have another stroke. Treatments that prevent another stroke include drugs to lower blood pressure and cholesterol, antiplatelet therapies, anticoagulation for atrial fibrillation, surgery or stenting for selected patients with severe carotid artery narrowing.

22. Disorders After Stroke PAIN • Paralyzed shoulder muscles are not able to help tendons keep the upper end of the arm in the shoulder joint. • As a result the arm drops from the joint which is very painful and can prevent rehabilitation of the hand and arm.

23. Disorders After Stroke DEPRESSION • Depression after stroke, as after any severe illness, is very common, often goes without diagnosis, reduces the patient's capacity for rehabilitation, and impairs his/her quality of life. • Furthermore this affects not only stroke survivors but also their spouses or next-of-kin who take care of the patients. • For many of the patients, their spouses and their children, this burden is long-standing

24. Disorders After Stroke COGNITIVE DECLINE • Stroke can lead to cognitive decline, and it is even more common after a recurrent stroke • This is also the case after recurrent subclinical strokes which are often not diagnosed due to missing classical symptoms of stroke • Yet, they cause more and more damage and reduce the mental capacity of patients

25. Disorders After Stroke SPASTICITY • Spasticity is like a "wicked charley horse." Brain injury from stroke sometimes causes paralyzed muscles to involuntarily contract (shorten or flex) after trying to move a limb. • Spasticity in the arm can cause a tight fist, bent elbow and arm pressed against the chest. • This can seriously interfere with a stroke survivor's ability to perform daily activities such as dressing. • Spasticity in the leg may cause a stiff knee, pointed foot and curling toes.

26. #UpAgainAfterStroke: Support for Life After Stroke • Be provided with hope for the best possible recovery I can make now and into the future • Receive psychological and emotional support in a form that best meets my needs • Be included in all aspects of society regardless of any disability I may have

27. #UpAgainAfterStroke: Support for Life After Stroke • Receive support (financial or otherwise) to ensure I am cared for in the longer term • Be supported to return to work and/or other activities I may choose to participate in after my stroke • Get access to formal and informal advocacy to assist me with access to the services I need • Be connected to other stroke survivors and caregivers so I may gain and provide support in my recovery from stroke

37. Prepared & Edited by: Dr. Meera Kacha Editorial Board : Dr. Alok Chaturvedi, Dr. Parag Bhattacharya, Dr. Kishore Sonkusare, Dr. Pragna Patel, Dr. Nilanj Dave Disclaimer: The matter published herein has been developed and validated by in house medical writers. Although great care has been taken in compiling and checking the information, the authors from Intas Pharmaceuticals Limited, Ahmedabad, shall not be responsible or in anyway, liable for any errors, omissions or inaccuracies in this publication whether arising from negligence or otherwise however, or for any consequences arising there from. This Information has been brought to you by