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Dr K K Aggarwal

The vast majority of diabetic patients who develop diabetic retinopathy (eye involvement) have no symptoms until the very late stages (by which time it may be too late for effective treatment). Because the rate of progression may be rapid, therapy can be beneficial for both symptom amelioration as well as reduction in the rate of disease progression, it is important to screen patients with diabetes regularly for the development of retinal disease. The eyes carry important early clues to heart disease, signaling damage to tiny blood vessels long before symptoms start to show elsewhere. Diabetic people with retinopathy are more likely to die of heart disease over the next 12 years than those without it. As per a study from the University of Sydney and the University of Melbourne in Australia and the National University of Singapore, people with retinopathy are nearly twice as likely to die of heart disease as people without it.

People with these changes in the eyes may be getting a first warning that damage is occurring in their arteries, and work to lower cholesterol and blood pressure. Patients with retinopathy have a greater risk of incident cardiovascular disease (CVD) events, including heart attack, stroke, revascularization, and CVD death, compared with those without retinopathy.

Switching to late nights and late mornings on the weekend is associated with cardiometabolic risk. Termed “social jetlag”, it is associated with poorer lipid profiles, worse glycemic control, and increased adiposity in healthy adults, as per a report published in Journal of Clinical Endocrinology & Metabolism. These metabolic changes can contribute to the development of obesity, diabetes and cardiovascular disease.

A total of 111 study participants had a social jetlag of more than 60 minutes. Compared to the other study participants, these individuals had:

  • Higher mean triglycerides: 107 mg/dL versus 91 mg/dL (P=0.009)
  • Lower mean HDL-cholesterol: 54 mg/dL versus 57 mg/dL (P=0.014)
  • Higher mean fasting insulin levels: 13.5 µU/mL versus 12 µU/mL (P=0.03)
  • More insulin resistance as measured by homeostatic model assessment: 4.0 versus 3.7 (P=0.028)
  • Greater mean waist circumference: 94 cm versus 89 cm (P=0.001)
  • Higher mean BMI: 28 versus 26 (P=0.004).

It has been shown that regulating sleep times can help treat insomnia, and this emerging evidence, along with others, suggests that perhaps doing so will have benefits in treatment and prevention of other diseases.

Flu in children

By Dr K K Aggarwal
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  • The classical features of uncomplicated flu in children include abrupt onset of fever, headache, muscle pain and malaise affected by manifestations of respiratory tract illness – sore throat, cough and nasal discharge.
  • All the above features may not be present in children.
  • Flu sometimes may last for more than a week in children.
  • Ear discharge, development into asthma and pneumonia are common complications in children.
  • Complicated pneumonia may be severe and rapidly fatal, especially if the bacterium is Staph.
  • During winter, a diagnosis of flu should be considered in all children with fever; children with fever and acute onset of respiratory illness; children with fever and exhilaration of underlying chest condition; children with pneumonia and children with fever of more than 100, with severe cough or sore throat.
  • Fever is present in over 95% of cases, often more than 39°C.
  • Cough is present in over 77% patients.
  • Nasal discharge is present in more than 78% patients.
  • Headache is present in more than 26% patients.
  • Muscle pain is present in more than 71 % patients.
  • Incubation period is 1-4 days with high transmissibility.
  • The treatment is often symptomatic.
  • Cough hygiene should be practiced.

Some tips to prevent type 2 diabetes

By Dr K K Aggarwal
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  • Exercise more Exercise has various benefits including preventing weight gain, controlling blood sugar levels, and other conditions. A minimum of 30 minutes of physical activity every day is very beneficial.
  • Eat healthy A diet rich in whole grain, fruits, and vegetables is very good for the body. Fibrous food will ensure that you feel fuller for a longer period and prevent any cravings. Avoid processed and refined food as much as possible.
  • Limit your alcohol intake and quit smoking Too much alcohol leads to weight gain and can increase your blood pressure and triglyceride levels. Men should limit drinks to two per day and women to one per day. Smokers are twice as likely to develop diabetes as non-smokers and therefore, it is a good idea to quit this habit.
  • Understand your risk factors Doing so can help you in taking preventive measures at the earliest and avoid complications.

Smoking makes you 5 years older

By Dr K K Aggarwal
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  • Men have a greater chance of dying than women, and smoking increases any adult’s risk of death just as if five years were suddenly added to their age.
  • For men who have never smoked, heart disease presents their greatest risk for death at any age, exceeding the odds of dying from lung, colon and prostate cancer combined.
  • Male smokers face a lung cancer risk that is greater than the odds of heart disease taking their lives after age 60, and is tenfold higher than the chance of dying from prostate and colon cancer combined.
  • The chances of dying from heart disease and breast cancer are similar for nonsmoking women until age 60, when heart disease becomes a greater risk.
  • For female smokers, dying from lung cancer or heart disease is more likely than dying from breast cancer after age 40.

Tips to prevent pneumonia

By Dr K K Aggarwal
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  • Get vaccinated with the flu and pneumococcal vaccines
  • Practice respiratory and cough hygiene to protect yourself against respiratory infections that may lead to pneumonia.
  • Respiratory hygiene: Keep a distance of minimum 3-6 ft, from a person who is coughing, sneezing or singing to prevent cross infection, specifically, from flu. Most respiratory particles are more than 5 microns in size (except tuberculosis droplet nuclei) and do not travel a distance of more than 3 ft.
  • Cough hygiene: Cough on your sleeves or tissue paper (and discard it immediately) and not in hands and handkerchief. Wash hands with soap and water after coughing or sneezing or use an alcohol-based hand rub
  • Dont smoke as it can damage the natural defense of the lungs against respiratory infections.
  • Keep the immune system strong by getting enough sleep, exercising regularly, and eating a healthy diet.

Some tips to keep obesity under check

By Dr K K Aggarwal
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  • Skip carbohydrates once in a week.
  • Combine a sweet food with bitter food (for instance choose to cook aloo methi over aloo matar).
  • Consume bitter green items in foods such as karela, methi, palak, bhindi, etc.
  • Do not eat trans fats.
  • Do not consume more than 80 ml of soft drink in a day.
  • Do not consume sweets with more than 30% sugar.
  • Avoid maida, rice, and white sugar.
  • Walk, walk and walk…

Follow a healthy diet for a healthy heart

By Dr K K Aggarwal
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  • Diet should be low in sodium and no person should consume more than 6 gm of sodium chloride in a day.
  • Consumption of trans fats, which is found in hydrogenated oils or vanaspati ghee, should be minimal as they are bad for the heart and reduce the good HDL cholesterol and increase the bad LDL cholesterol.
  • A person should avoid eating out as much as possible since the food in most restaurants and hotels has high amounts of trans fats and is generally bad for the heart
  • Refined carbohydrates like white bread, white flour, white rice and refined sweetened cereals and white sugar should be avoided and replaced with options like whole grain flour, healthy green cereals and oat meal.
  • Any sweet item containing more than 10% sugar should be limited. On an average the sugar content in soft drinks is 10%, Indian sweets contain 30-50% sugar.

Some facts on Malaria

By Dr K K Aggarwal
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  • Malaria is transmitted by the bite of a female anopheles mosquito.
  • The mosquito bite occurs mainly between dusk and dawn.
  • Malaria can also be transmitted through blood transfusion, or via sharing of contaminated needles.
  • Bed nets are good against malaria as the major malarial vectors bite during the night.
  • The behavior of the mosquitoes may differ. Some may prefer to rest indoors and feed indoors in the night. Some may prefer to rest and feed outdoors earlier in the day.
  • Preventive therapy of malaria can be instituted during pregnancy in high risk areas.
  • The malarial mosquito feeds every third day compared to the dengue mosquito, which feeds three times in a day.
  • Unlike the malaria mosquito, the dengue mosquito bites during the day.
  • Malarial fever presents with chills, especially during afternoon.
  • Spraying of the indoor residential walls and ceiling is effective against mosquitoes.
  • DDT is widely used as indoor residential spraying.
  • DDT should not be applied more than once or twice in a year on the walls.
  • Mosquito contact with DDT surface would generally save from lethal exposure outside the house.
  • Public must know that spray may require rearrangement of the furniture. Walls may become streaked with chemical treatment and residual odor from DDT.
  • The other alternative is malathion spray.

Don’t start if you do not drink; if you cannot stop, limit your intake

By Dr K K Aggarwal
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  • The definition of a standard drink differs in countries: US = 14-15 gm alcohol equivalent to 12 oz beer, 5 oz wine and 1.5 oz 80 proof liquor; UK 8 gm alcohol, Japan 19.75 gm alcohol and India 10 gm alcohol.
  • A standard drink usually means a US drink.
  • Alcohol contents: Beer 5%; Malt liquor 7%; Table wine 12%; Fortified wine (sherry, port) 17%; Cordial liquor (aperitif) 24%; Brandy (single jigger) 40% and 80 proof gin, Vodka, whisky 40%.
  • 10 ml of alcohol (hard liquor) = 0.8 gm of alcohol; 1 oz = 30 ml; 12 oz of beer = 360 ml of beer (360×5% = 18 ml of alcohol = 14.4 gm of alcohol); 18 oz of beer = 8 to 9 oz of malt liquor = 5 oz of table wine = 3-4 oz of 45 wine = 2-3 oz of cordial liquor = 1.5 oz of brandy = 1.5 oz hard liquor.
  • Binge drinking means 4 or more drinks at one time (women) or 5 or more at one time (men).
  • Heavy drinking means more than 7 drinks per week or 3 drinks per occasion (women) or more than 14 drinks per week or 4 drinks per occasion (men).
  • Moderate drinking means less than 2 drinks per day (women) and less than 3 drinks per day (men) and for people aged more than 65, less than two drinks per day.
  • Safe limits: No level of alcohol compensation can be 100% safe for some people.
  • Contraindications: Pregnancy, present or strong family history of alcoholism, previous paralysis because of brain hemorrhage, liver disease, pancreas disease, running potentially dangerous equipment or machinery.
  • Limit alcohol in acute gastritis, esophagitis, strong family history of breast cancer and pre-cancerous GI lesions.
  • Ideal dose of alcohol = 6 gm per day.
  • 10-15gm of ethanol is found in one glass of wine, one can or bottle of beer or one mixed drink.
  • One should not take more than two drinks (men) and one drink daily (women).
  • Men under the age of 45 may experience more harm than benefit from alcohol consumption.
  • Alcohol benefits for the heart are only in 45+ people.

Nine modifiable risk factors for heart attack

By Dr K K Aggarwal
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The majority of known risk factors for heart attack are modifiable by specific preventive measures.

The nine potentially modifiable factors include smoking, dyslipidemia, hypertension, diabetes, abdominal obesity, psychosocial factors, regular alcohol consumption, daily consumption of fruits and vegetables and regular physical activity. These account for over 90 percent of the population attributable risk of a first heart attack.

In addition, aspirin is recommended for primary prevention of heart disease for men and women whose 10-year risk of a first heart attack event is 6 percent or greater.

Smoking cessation reduces the risk of both heart attack and stroke. One year after quitting, the risk of heart attack and death from heart disease is reduced by one-half, and after several years begins to approach that of nonsmokers.

A number of observational studies have shown a strong inverse relationship between leisure time activity and decreased risks of CVD. Walking 80 minutes in a day and whenever possible with a speed of 80 steps per minute are the current recommendations.

Do not heat leafy vegetables twice

By Dr K K Aggarwal
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Nitrates in foods such as spinach, beet root and lettuce stimulate the production of nitric oxide in the body. Nitric oxide relaxes blood vessels. Ingested nitrate is reduced by oral, commensal, bacteria to nitrite, which can further be reduced to nitric oxide.

Vegetables are a major source of dietary nitrate. Green leafy and root vegetables, such as spinach and carrots, provide more than 85% of dietary nitrate. Foods in which nitrite are present are bacon, fermented sausage, hot dogs, bologna, salami, corned beef, ham and other products such as smoked or cured meat, fish and poultry. The conversion of dietary nitrate to nitrite has antimicrobial benefits in the mouth and stomach. Some epidemiological studies show a reduced rate of gastric and intestinal cancer in groups with a high vegetable-based nitrate intake.

Nitrate is totally harmless; however, it can be converted to nitrite and some portion of nitrite to nitrosamines, some of which are known to be carcinogenic. Heating increases the conversion rate. The longer the heat treatment, the more nitrosamines will be formed. Hence, the recommendation not to heat leafy vegetables twice.

Adding lemon juice to vegetables will reduce the formation of nitrosamines. It contains vitamin C, which also reacts with nitrite, thereby preventing the nitrosamine formation.

WHO Five Keys to Safer Food

By Dr K K Aggarwal
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Key 1: Keep clean

  • Wash your hands before handling food and often during food preparation.
  • Wash your hands after going to the toilet.
  • Wash and sanitize all surfaces and equipment used for food preparation.
  • Protect kitchen areas and food from insects, pests and other animals.

Key 2: Separate raw and cooked food

  • Separate raw meat, poultry and seafood from other foods.
  • Use separate equipment and utensils such as knives and cutting boards for handling raw foods.
  • Store food in containers to avoid contact between raw and prepared foods.

Key 3: Cook thoroughly

  • Cook food thoroughly, especially meat, poultry, eggs and seafood.
  • Bring foods like soups and stews to boiling to make sure that they have reached 70°C. For meat and poultry, make sure that juices are clear, not pink. Ideally, use a thermometer.
  • Reheat cooked food thoroughly.

Key 4: Keep food at safe temperatures

  • Do not leave cooked food at room temperature for more than 2 hours.
  • Refrigerate promptly all cooked and perishable food (preferably below 5°C).
  • Keep cooked food piping hot (more than 60°C) prior to serving.
  • Do not store food too long even in the refrigerator.
  • Do not thaw frozen food at room temperature.

Key 5: Use safe water and raw materials

  • Use safe water or treat it to make it safe.
  • Select fresh and wholesome foods.
  • Choose foods processed for safety, such as pasteurized milk.
  • Wash fruits and vegetables, especially if eaten raw.
  • Do not use food beyond its expiry date.

(Source: The Five Keys to Safer Food Manual World Health Organization, 2006)

A slight move is all that matters

By Dr K K Aggarwal
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Middle-aged women who move around more in their daily life have lower levels of intra-abdominal fat, a risk factor for heart disease. A minor modification in daily routine – reducing the time watching TV or increasing the walk time to work – can make a difference in the long-term health.

Visceral fat is a hot topic because of metabolic syndrome, which predisposes people to diseases.

Intra-abdominal fat, or the fat that wraps around the organs in the abdomen and chest, tends to accumulate at midlife and can contribute to developing diabetes, hypertension and heart disease. The fat around the organs is known to be more related to heart disease and diabetes. A woman does not need to appear outwardly heavy to have a potentially troublesome extra “tire” around her organs.

Exercise for long has been known to reduce the amount of intra-abdominal fat.

Fog vs Smog

By Dr K K Aggarwal
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Whenever the humidity is high, air movement is less and temperature is low, fog is the automatic result. It occurs when water droplets are suspended in the air.

Smog, on the other hand, is the combination of smoke and fog. When the level of pollutants is high in the atmosphere, the pollutant particles get mixed into the fog, thereby reducing the visibility further. The result is called smog. The smoke includes toxic emissions from vehicle pollutants, open burning of crops or industrial pollutants.

Fog and smog are more common during wet or early winter. Wet winter is characterized by fall in temperature along with high humidity, whereas, dry or late winter is characterized by absence of fog, smog and presence of chilly airy winds.

Exposure to smog has known adverse health effects. Acute ill-effects may include redness of eyes, coughing or throat irritation, difficulty in breathing. Smog can trigger acute asthma attacks; it may even trigger a heart attack, stroke, arrhythmia. Children, elderly, patients with diabetes, heart and lung diseases are especially vulnerable to the adverse effects of smog and should take special precautions to protect themselves.

  • Patients with asthma and chronic bronchitis should get the dose of their medicine increased during smog days.
  • Avoid exertion or activities like running, jogging in conditions of smog.
  • Avoid walking during smog hours.
  • Avoid going out as much as possible.
  • Drive slowly during smog hours.
  • Heart patients should stop their early morning walk during smog hours.
  • Remember to get flu and pneumonia vaccination.